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Background: Economic dimension comprises important determinants of food choices, particularly income and prices. Aim: Identification of the influence of food prices and diet costs on the consumption of food groups considered protection and risk factors for cardiometabolic diseases. Methods: Food groups classification follows the proposal of "What we eat in America?" from the National Health and Nutrition Examination Survey (NHANES), adapted to Latin America. Data on food consumption from the Health Survey of Sao Paulo (2003, 2008, and 2015), representative at population level, was used. Log-linear regressions were estimated for food groups, controlling for endogeneity through augmented regression-test Results: Results showed increase in prices per calorie of whole grains and red meat from 2003-2015 and a decrease in prices per calorie of fruits, vegetables, beans, legumes, oilseeds and fish/seafood. Food groups had price elasticities between -0.01 and -1.6, i.e., decrease in consumption associated with increase in prices. Results showed statistically significant effects of substitution and complementarity, particularly substitution between sweetened beverages and fruits (2003, ß = 0.606; 2008: ß = 0.683; 2015, ß = 0.848), complementarity between nuts and seeds and whole grains (2003, ß = -0.646; 2008, ß = -0.647; 2015,ß = -0.901), and vegetables and processed meat (2003, ß = -1.379; 2015, ß = -1.685). Conclusion: Findings of the study represent relevant evidence for design strategies towards the adoption of healthier diets, particularly through subsidies to protection food groups, promoting lower prices and higher diet quality. The evidence may be useful for policymakers and researchers in fields of nutrition and health in diverse countries worldwide, especially due to absence of robust evidence in literature.

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Introdução: Ter uma alimentação adequada e saudável envolve diferentes aspectos, entre os quais o custo é um dos principais determinantes. Objetivo: Investigar os custos da alimentação em amostra representativa da população residente no município de São Paulo em 2003, 2008 e 2015. Métodos: Foram utilizados dados do estudo transversal, base populacional, ISA-Nutrição, com residentes no município de São Paulo. Dados socioeconômicos e estilo de vida foram coletados em visitas domiciliares e inquérito telefônico e, consumo alimentar, por dois recordatórios de 24 horas. Para avaliação da qualidade e classificação da dieta foram utilizados: Índice de Qualidade da Dieta Revisado - IQD-R, grupos de alimentos de proteção ou de risco para doenças cardiometabólicas baseados na classificação What we eat in América? (WEEIA), adaptada para América Latina e análise da aderência às recomendações da Organização Mundial da Saúde (OMS) quanto ao consumo de frutas, verduras e legumes, açúcar, sódio e gordura saturada. A estimativa de custos da alimentação foi baseada em preços dos alimentos das Pesquisas de Orçamento Familiar (POF) do Instituto Brasileiro de Geografia e Estatística (IBGE), sendo adotados critérios definidos de pareamento para linkage (ano de estudo, renda familiar per capita, perfil familiar), incluindo, aplicação de fatores de cocção e conversão, assim como uso de deflatores para comparação entre diferentes períodos. Elasticidades da demanda por alimentos foram analisadas utilizando-se regressão log-linear (endogeneidade/teste Durbin-Wu-Hausman). Associação entre custo e qualidade da dieta foi avaliada por meio de custo-efetividade/incremental. Resultados: De 2003 a 2015, houve aumento nos preços por caloria de cereais integrais e carne vermelha. Por outro lado, queda para frutas, verduras/legumes, feijão, leguminosas, oleaginosas/sementes e peixes/frutos do mar. Elasticidades-preço destes grupos de alimentos apresentaram coeficientes negativos, mostrando tendência de redução do consumo devido ao aumento dos preços. Cereais integrais mostraram complementaridade com oleaginosas e sementes, enquanto verduras/legumes, complementaridade com carnes processadas em 2003 e 2015, e oleaginosas/sementes em 2008 e 2015. Frutas e bebidas açucaradas apresentaram relação de substituição. Em 2015, dietas que apresentaram maior aderência às recomendações dietéticas (IQD-R - maiores pontuações) possuíam maior custo. No entanto, maior aderência às recomendações da Organização Mundial da Saúde (OMS) quanto ao consumo de frutas, verduras/legumes, sódio, açúcares e gordura saturada representou menor custo. Indivíduos que compraram alimentos em feiras livres tiveram menor custo da dieta e aqueles com renda inferior a um salário-mínimo comprometem quase totalidade do orçamento familiar com alimentação (99,49%). Verifica-se maior participação no custo da dieta, do grupo das carnes, independente da qualidade da dieta. Conclusões: O método linkage constituiu-se um recurso importante para avaliação do custo das dietas em estudos em que estas informações estão ausentes. Devido à alta elasticidade-preço no período avaliado (12 anos), consumidores do município de São Paulo responderam ao aumento dos preços com redução do consumo. Grandes mudanças nos preços relativos de bebidas açucaradas deveriam ser necessárias para reduzir seu consumo, com possibilidade de substituição às frutas. Impostos para carnes ou subsídios para legumes e verduras devem considerar potenciais efeitos cruzados. Por outro lado, subsídios, aos cereais integrais, beneficiaria o consumo de oleaginosas e sementes. Maior custo de dietas apresentou maior aderência às recomendações dietéticas e local de compra de alimentos (feiras livres) melhoria na qualidade nutricional da dieta com menor custo.

Introduction: Having an adequate and healthy diet involves different aspects, among which cost is one of the main determinants. Objective: To investigate the costs of food in a representative sample of the population living in São Paulo in samples from the years 2003, 2008 and 2015. Methods: We used data from the cross-sectional, population-based study, ISA-Nutrition, with residents in the municipality of São Paulo in 2003, 2008, and 2015. Socioeconomic and lifestyle data were collected in home visits and telephone survey and, food intake, by two 24-hour recall. To evaluate the quality and classification of diet, we used: the Brazilian Health Eating Index - Revised (BHEI-R); protection or risk groups for cardiometabolic diseases based on the "What we eat in America?" (WEEIA) classification, adapted for Latin America and analysis of adherence to World Health Organization (WHO) recommendations for fruit and vegetable consumption, sugar, sodium, and saturated fat. The estimation of food costs was based on food prices from the Household Budget Surveys (HBS) of the Brazilian Institute of Geography and Statistics (IBGE), adopting well-defined pairing criteria for linkage (year of study, per capita family income, family profile), including the application of cooking and conversion factors, as well as the use of deflators for comparison between different periods. Food demand elasticities were analyzed using log-linear regression (endogeneity/Durbin-Wu-Hausman test). Association between cost and diet quality was assessed using cost-effectiveness/incremental. Results: From 2003 to 2015, there was an increase in prices per calorie for whole grains and red meat. On the other hand, declines for fruits, vegetables/legumes, beans, legumes, oilseeds/seeds, and fish/seafood. The price elasticities of these food groups showed negative coefficients, showing a tendency of consumption to decrease due to price increases. Whole grains showed complementarity with oilseeds and seeds, while vegetables/legumes, complementarity with processed meats in 2003 and 2015, and oilseeds/seeds in 2008 and 2015. Fruits and sugar-sweetened beverages showed a substitution relationship. In 2015, diets that showed higher adherence to dietary recommendations (BHEI-R - higher scores) had higher cost. However, higher adherence to World Health Organization (WHO) recommendations for fruit, vegetable intake, sodium, sugars, and saturated fat represented lower cost. Individuals who bought food at street markets had lower dietary costs and those with incomes below one minimum wage spent almost the entire family budget on food (99.49%). There was a greater participation of the meat group in the cost of the diet, regardless of the quality of the diet. Conclusions: The linkage method can be an important resource for evaluating the cost of diets in studies where this information is absent. Due to the high price elasticity over the evaluated period (12 years), consumers in São Paulo responded to price increases by reducing consumption. Large changes in the relative prices of sugar-sweetened beverages would be necessary to reduce their consumption, with the possibility of substitution to fruit. Taxes for meat or subsidies for vegetables should consider potential cross effects. Subsidies, to whole grains, would benefit the consumption of oilseeds and seeds. Higher cost of diets showed greater adherence to dietary recommendations and location of food purchase (street markets) improved nutritional diet quality at lower cost.

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ABSTRACT Objective: To evaluate associations between snacking and energy, nutrients and food source, and to identify the contribution of snacking across age, sex, weight status and lifestyle behaviors among adolescents and young adults. Methods: A sub-sample was calculated from the population-based cross-sectional study 2015-Health Survey of São Paulo (ISA-Capital). The survey "ISA-Nutrição" used a sample of non-institutionalized individuals aged >15 years. For this study, only adolescents (12-18 years old; n=418) and young adults (19-29 years old; n=218) were included. Snacks were identified, and their contribution to energy, nutrients, and food sources were calculated. Descriptive statistics and logistic regressions were used. Results: Participants experienced an average of 2.9±0.6 snacking occasions per day. Young adults consumed more energy from morning and night snacks, and adolescents, from afternoon snacks. The top three food sources on snacking contributed to 30.5% of energy: cookies (11.8%), sugar sweetened beverages (9.4%), sweets and other desserts (9.3%). Although results were non-significant, being a female (Odds Ratio [OR] 0.93; 95% confidence interval [95%CI] 0.36-1.49), meeting the physical activity recommendations (OR 0.75; 95%CI 0.25-1.25), and scoring higher for the healthy eating index (OR 0.88; 95%C 0.24-1.52) were all factors related to increased intake of snacks. Alternatively, overweight individuals (OR -0.54; 95%CI -1.00 to -0.08) consumed less snacks. Conclusions: Improving the quality of snacks should be considered in behavior-change strategies.

RESUMO Objetivo: Avaliar associações entre lanches e consumo de energia, nutrientes e fontes alimentares e identificar seus contribuintes por idade, sexo, status de peso e comportamentos de estilo de vida entre adolescentes e jovens adultos. Métodos: Subamostra calculada a partir do estudo de base-populacional transversal Inquéritos de Saúde de São Paulo (ISA-Capital, 2015). O ISA-Nutrição utilizou amostra de indivíduos não-institucionalizados com idade >15 anos. Para este estudo, apenas adolescentes (12-18 anos; n=418) e jovens adultos (19-29 anos; n=218) foram incluídos. Os "lanches" foram definidos, bem como foram calculadas a contribuição de energia e nutrientes, e as fontes alimentares. Estatística descritiva e regressões logísticas foram utilizadas. Resultados: Em média foram realizados 2,9±0,6 lanches por dia pelos participantes. Jovens adultos consumiram mais energia nos lanches da manhã e noite, enquanto adolescentes, à tarde. As três principais fontes de alimentos nos lanches contribuíram em 30,5% para o total de energia: biscoitos (11,8%), bebidas açucaradas (9,4%), e doces e outras sobremesas (9,3%). Apesar de os resultados não serem significantes, ser do sexo feminino (Odds Ratio [OR] 0,93, intervalo de confiança de 95% [IC95%] 0,36-1,49), atingir as recomendações de atividade física (OR 0,75, IC95% 0,25-1,25), e ter alta pontuação no índice do total da qualidade dieta (OR 0,88, IC95% 0,24-1,52) resultou em aumento na ingestão de lanches. Alternativamente, ter sobrepeso (OR -0.54, IC95% -1.00 a -0.08) está relacionado a menores chances de consumir lanches. Conclusões: Estratégias para melhorar a qualidade dos lanches deveriam ser consideradas nas intervenções de mudança de comportamentos.

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OBJECTIVE: To evaluate the validity of self-reported body mass and height measurements in adolescents, adults and older adults according to sex, age, leisure-time physical activity level, nutritional status, and cardiometabolic risk factors. METHODS: The study included 856 subjects, aged 12 years or older, who participated in the São Paulo Health Survey (ISA-2015) and who had their body mass and height measured and self-reported. Based on the Body Mass Index (BMI), a classification of nutritional status was made according to standardized criteria for each phase of life. The validation of self-reported data was examined by the Intraclass Correlation Coefficient, Bland-Altman and paired T-Test. Linear regression models were used to estimate the calibration coefficients, and sensitivity and specificity tests were performed. RESULTS: Self-reported body mass and height values tend to be very similar to measured values, with a few exceptions. For the adolescents, an underestimation of height was noted, while for the older adults, an overestimation. There was a consistent underestimation of self-reported body mass among women, and an overestimation of BMI among men who practiced less than 150 minutes of physical activity per week during leisure time. The calibration process of self-reported measures made them more consistent with the values measured, increasing the sensitivity in the classification of nutritional status among women and the specificity among men. CONCLUSIONS: Self-reported measures of height, body mass and BMI provided valid and reliable measures, presenting a substantial improvement after calibration.

OBJETIVO: Avaliar a validade da massa corporal e da estatura autorreferidas em adolescentes, adultos e idosos segundo sexo, idade, nível de atividade física no lazer, estado nutricional e fatores de risco cardiometabólicos. MÉTODOS: Participaram do estudo 856 sujeitos, com 12 anos ou mais, que responderam ao Inquérito de Saúde de São Paulo (ISA-2015) e que possuíam a massa corporal e a estatura autorreferidas e aferidas. Com base no índice de massa corporal, realizou-se uma classificação do estado nutricional de acordo com critérios padronizados para cada fase da vida. A validade das medidas autorreferidas foi examinada usando o coeficiente de correlação intraclasse, Bland-Altman e o teste t pareado. Utilizaram-se regressões lineares para elaborar os coeficientes de calibração, e realizaram-se testes de sensibilidade e especificidade. RESULTADOS: Os principais resultados apontam que os valores de massa corporal e estatura autorreferidas tendem a ser bem similares aos aferidos, apesar de algumas exceções. Para os adolescentes, notou-se uma subestimação da estatura, ao passo que, para os idosos, houve superestimação. Com relação à massa corporal, houve consistente subestimação da medida autorreferida entre as mulheres. Entre os homens que praticavam menos de 150 minutos semanais de atividade física no lazer, notou-se superestimação do índice de massa corporal. O processo de calibração das medidas autorreferidas tornou-as mais concordantes com as medidas aferidas, aumentando a sensibilidade na classificação do estado nutricional entre as mulheres e a especificidade entre os homens. CONCLUSÕES: As medidas autorreferidas de estatura, massa corporal e índice de massa corporal forneceram medidas válidas e confiáveis, apresentando melhoras substanciais após a calibração.

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OBJECTIVE: To evaluate associations between snacking and energy, nutrients and food source, and to identify the contribution of snacking across age, sex, weight status and lifestyle behaviors among adolescents and young adults. METHODS: A sub-sample was calculated from the population-based cross-sectional study 2015-Health Survey of São Paulo (ISA-Capital). The survey "ISA-Nutrição" used a sample of non-institutionalized individuals aged >15 years. For this study, only adolescents (12-18 years old; n=418) and young adults (19-29 years old; n=218) were included. Snacks were identified, and their contribution to energy, nutrients, and food sources were calculated. Descriptive statistics and logistic regressions were used. RESULTS: Participants experienced an average of 2.9±0.6 snacking occasions per day. Young adults consumed more energy from morning and night snacks, and adolescents, from afternoon snacks. The top three food sources on snacking contributed to 30.5% of energy: cookies (11.8%), sugar sweetened beverages (9.4%), sweets and other desserts (9.3%). Although results were non-significant, being a female (Odds Ratio [OR] 0.93; 95% confidence interval [95%CI] 0.36-1.49), meeting the physical activity recommendations (OR 0.75; 95%CI 0.25-1.25), and scoring higher for the healthy eating index (OR 0.88; 95%C 0.24-1.52) were all factors related to increased intake of snacks. Alternatively, overweight individuals (OR -0.54; 95%CI -1.00 to -0.08) consumed less snacks. CONCLUSIONS: Improving the quality of snacks should be considered in behavior-change strategies.

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Este artigo tem como objetivo avaliar o estado nutricional em relação à presença de cáries dentárias em crianças de 4 a 6 anos de idade, do município de Cajamar, São Paulo. Trata-se de estudo transversal com crianças entre 4 a 6 anos (n=1642), acompanhadas pelo Programa Saúde na Escola (PSE) do Município de Cajamar, São Paulo. A classificação do estado nutricional foi baseada no Índice de Massa Corporal (IMC) e a avaliação das condições bucais, por meio do índice ceo-d e critério para Risco de Cárie. A análise do estado nutricional, faixa etária e sexo conforme o número de cáries, foi feita por meio dos testes Mann-Whitney U e Kruskal-Wallis (p<0,05). Observou-se maior prevalência de meninos entre 4 a 6 anos. Em todas as faixas etárias a prevalência de excesso de peso foi de aproximadamente 30% e eutrofia em torno de 70%. 65% (n=1068) das crianças não apresentavam risco de cárie (A) e 28,8% (n=475), alto risco (D, E e F). Das 1162 crianças sem cáries, 0,2% eram magras (n=2), 67,2% (n=781) eutróficas e 32,7% (n=380) possuíam excesso de peso. A frequência de 1 a 5 cáries maior entre meninas e de 6 ou mais cáries, entre meninos. Segundo estado nutricional, o número médio do número de cáries foi de 2,17 para magreza, 0,93 para eutrofia e 0,65 para excesso de peso (p<0,010). Conclui-se que houve diferença entre número cáries e estado nutricional, na qual crianças com déficit nutricional apresentavam maior número de cáries dentárias comparadas às eutróficas ou com excesso de peso, sugerindo-se a inclusão do estado nutricional na avaliação odontológica.

This article aims at evaluating the nutritional status in relation to the presence of dental caries in children aged 4 to 6 years in the city of Cajamar, in the state of São Paulo. It is a cross-sectional study with children aged 4 to 6 years (n=1642) accompanied by the School Health Program of the City of Cajamar, São Paulo. The nutritional status classification was based on the Body Mass Index (BMI) and the evaluation of oral conditions, through the ceo-d index, and criteria for risk for caries. The analysis of the nutritional status, age, and sex according to the number of caries was made through the Mann-Whitney U and Kruskal-Wallis tests (p<0.05). A higher prevalence was observed among boys aged 4 to 6 years. In all age groups, there was a prevalence of 30% of overweight children, and eutrophy of approximately 70%. A total of 65% (n=1068) of the children presented no risk of caries (A), whereas 28.8% (n=475) showed high risk (D, E, and F). Among the 1162 children with no caries, 0.2% were thin (n=2); 67.2% (n=781) eutrophic; and 32.7% (n=380) were overweight. Girls presented a higher frequency of 1 to 5 caries while boys presented frequency of having 6 or more caries. According to the nutritional status, the average number of caries was 2.17 for thin individuals; 0.93 for eutrophic individuals; and 0.65 for overweight individuals (p<0.010). It could be concluded that there was a difference between the number of caries and the nutritional status, in which children with nutritional deficit presented a higher number of dental caries when compared to eutrophic or overweight ones, suggesting the inclusion of the nutritional status in the dental evaluation.

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Community Health Agents (CHAs) are important collaborators in combating illnesses related to poor eating habits. The objective of this work was to verify the knowledge of the community health workers of Cajamar city about food and the main diseases related to bad eating habits. This is a cross-sectional study, conducted from August to September 2011, in Cajamar city, São Paulo by trained interviewers. 57 HCWs were interviewed who answered two questionnaires, the first to characterize them and the second to obtain data on basic knowledge about food and the main diseases related to poor eating habits. 96.5% of the CHA were female, had an average of 34 years, 88.1% had two children, predominance of complete high school (56.1%; n=32). They had the function of CHAs as the main source of income, receiving up to three minimum wages and exercising it for at least six months (52.6%). When the subject was food, 94.5% report that they are the first to address the issue. The main difficulties were that people did not follow the guidelines (43%) and lack of knowledge (40%). There was a good performance in the issues regarding chronic diseases (76.6% of hits) and risk groups (97%). In questions about food groups and food security, there was low performance (rate of hits of 55.2% and 55.3%, respectively). The qualification of CSAs is fundamental for the improvement of the work performed, being important the use of educational strategies that provide continuous learning. (AU)

Os Agentes Comunitários de Saúde (ACS) são importantes colaboradores no combate de doenças relacionadas aos maus hábitos alimentares. O objetivo deste trabalho foi verificar o conhecimento dos ACS do município de Cajamar sobre alimentação e as principais doenças relacionadas aos maus hábitos alimentares. Trata-se de um estudo transversal, realizado no período de agosto a setembro de 2011, no município de Cajamar, São Paulo por entrevistadores treinados. Foram entrevistados 57 ACS que responderam a dois questionários, o primeiro com intuito de caracterizá-los e o segundo para obter dados quanto aos conhecimentos básicos sobre alimentação e as principais doenças relacionadas aos maus hábitos alimentares. 96,5% dos ACS eram do sexo feminino, possuíam em média 34 anos, 88,1% possuíam dois filhos, predominância de ensino médio completo (56,1%; n=32). Possuíam a função de ACS como principal fonte de renda, recebendo até três salários mínimos e exercendo-a há pelo menos seis meses (52,6%). Quando o assunto foi alimentação, 94,5% relatam que são os primeiros a abordar o assunto. As principais dificuldades encontradas foram que as pessoas não seguem as orientações (43%) e a falta de conhecimentos (40%). Verificou-se bom desempenho nas questões que se referiam às doenças crônicas (76,6% de acertos) e grupos de risco (97%). Já nas questões sobre grupos alimentares e segurança alimentar, houve baixo desempenho (índice de acertos de 55,2% e 55,3%, respectivamente). A capacitação dos ACS mostra-se fundamental para o aprimoramento do trabalho desempenhado, sendo importante o uso de estratégias educativas que proporcionem aprendizado contínuo. (AU)

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OBJECTIVE: We investigated the associations between objectively assessed sedentary behavior (SB) and moderate-to-vigorous physical activity (MVPA) and body composition variables among a representative sample of Brazilian adults. METHODS: Using an accelerometer, SB and MVPA were monitored for at least 5 days in 524 participants (261 men; age, 18-65 years). Each minute epoch was classified as sedentary or spent in light, moderate, or vigorous physical activity (LPA, MPA, and VPA, respectively). The measured body composition variables included abdominal perimeter (AP) and neck circumference (NC). RESULTS: Men accumulated significantly more min/day of MPA (37.82 versus 27.28), VPA (1.10 versus 0.31), MVPA (39.02 versus 27.61), and steps/day (14,978 versus 13,443) than women (p<.001). In men, MPA, VPA, MVPA, and steps/day were negatively associated with AP (p<.05) independently of SB. Only VPA was significantly associated with NC (ß= 0.113; p=.002). In women, only SB was significantly associated with AP (ß= 0.003; p=.031). There were no significant associations between physical activity intensities and body composition in women. CONCLUSIONS: Our findings on the unequal association of physical activity with body composition variables between sexes can help inform future intervention strategies in Brasil.

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SUMMARY OBJECTIVE We investigated the associations between objectively assessed sedentary behavior (SB) and moderate-to-vigorous physical activity (MVPA) and body composition variables among a representative sample of Brazilian adults. METHODS Using an accelerometer, SB and MVPA were monitored for at least 5 days in 524 participants (261 men; age, 18-65 years). Each minute epoch was classified as sedentary or spent in light, moderate, or vigorous physical activity (LPA, MPA, and VPA, respectively). The measured body composition variables included abdominal perimeter (AP) and neck circumference (NC). RESULTS Men accumulated significantly more min/day of MPA (37.82 versus 27.28), VPA (1.10 versus 0.31), MVPA (39.02 versus 27.61), and steps/day (14,978 versus 13,443) than women (p<.001). In men, MPA, VPA, MVPA, and steps/day were negatively associated with AP (p<.05) independently of SB. Only VPA was significantly associated with NC (β= 0.113; p=.002). In women, only SB was significantly associated with AP (β= 0.003; p=.031). There were no significant associations between physical activity intensities and body composition in women. CONCLUSIONS Our findings on the unequal association of physical activity with body composition variables between sexes can help inform future intervention strategies in Brasil.

RESUMO OBJETIVO Investigar a associação do comportamento sedentário (CS) e da atividade física de moderada a vigorosa (AFMV), avaliados objetivamente, com variáveis de composição corporal em uma amostra de adultos brasileiros. MÉTODOS CS e AFMV foram monitorados por meio de acelerômetros no mínimo por cinco dias, em 524 participantes (231 homens; 18-65 anos). Cada período de epoch de um minuto foi classificado como sedentário, atividade física leve (AFL), moderada (AFM) ou vigorosa (AFV). As variáveis de composição corporal medidas foram: perímetro abdominal (PA) e circunferência do pescoço (CP). RESULTADOS Os homens acumularam significativamente (p<0,001) mais min/dia em AFM (37,82 versus 27,28), AFV (1,10 versus 0,31), AFMV (39,02 versus 27,61), e passos/dia (14.978 versus 13.443) do que as mulheres. Nos homens, AFM, AFV, AFMV e passos/dia associaram-se (p<0,05) negativamente com PA, independentemente do CS. Somente AFV associou-se significativamente (β= -0,113; p=0,002) com CP. Já nas mulheres, apenas CS associou-se significativamente com o PA (β= 0,003; p=0,031). Não houve associações significativas entre as intensidades de atividade física com a composição corporal nas mulheres. CONCLUSÕES Nossos achados sobre a associação desigual da atividade física com composição corporal entre os sexos aumentam a base de evidências e podem ajudar a informar futuras estratégias de intervenção no Brasil.

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OBJECTIVE: To investigate the association among social determinants, lifestyle variables and diet quality in São Paulo, Brazil. DESIGN: Cross-sectional study, 2015 Health Survey of São Paulo (Inquérito de Saúde de São Paulo (2015 ISA-Capital)) with Focus on Nutrition Study (2015 ISA-Nutrition). SETTING: Population-based study, with a representative sample of adults living in São Paulo, Brazil. PARTICIPANTS: Adults (aged 20-59 years, n 643) and older adults (aged ≥60 years, n 545). RESULTS: We observed differences in the Brazilian Healthy Eating Index-Revised (BHEI-R) by education, income, occupation, sex and race. Whole grains (0·63 points, 12·6 % of the maximum score), sodium (2·50 points, 25·0 %) and solid fat, alcohol and added sugars (9·28 points, 46·4 %) components had the lowest BHEI-R scores. Factors positively associated with diet quality included the presence of one disease or more (e.g. diabetes mellitus, hypertension, cancer, hypercholesterolaemia: ß = 0·636, P < 0·001), income (middle income: ß = 0·478, P < 0·001; high income: ß = 0·966, P < 0·001) and occupation (other: ß = 1·418, P < 0·001). Energy (ß = -0·001, P < 0·001), alcohol consumption (ß = -0·207, P = 0·027), education level (middle education: ß = -0·975, P < 0·001; high education: ß = -1·376, P < 0·001), races other than white (ß = -0·366, P < 0·001) and being unemployed (ß = -0·369, P < 0·046) were negatively associated with diet quality. CONCLUSIONS: Groups affected by socio-economic inequalities need better diet quality. Governmental actions should be implemented to reduce the consumption of energy-dense and sodium-rich foods, facilitate access and information on healthy eating, and conduct nutritional education.

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