Given evident multiple threats to food systems and supplies, food security, human health and welfare, the living and physical world and the biosphere, the years 2016-2025 are now designated by the UN as the Decade of Nutrition, in support of the UN Sustainable Development Goals. For these initiatives to succeed, it is necessary to know which foods contribute to health and well-being, and which are unhealthy. The present commentary outlines the NOVA system of food classification based on the nature, extent and purpose of food processing. Evidence that NOVA effectively addresses the quality of diets and their impact on all forms of malnutrition, and also the sustainability of food systems, has now accumulated in a number of countries, as shown here. A singular feature of NOVA is its identification of ultra-processed food and drink products. These are not modified foods, but formulations mostly of cheap industrial sources of dietary energy and nutrients plus additives, using a series of processes (hence 'ultra-processed'). All together, they are energy-dense, high in unhealthy types of fat, refined starches, free sugars and salt, and poor sources of protein, dietary fibre and micronutrients. Ultra-processed products are made to be hyper-palatable and attractive, with long shelf-life, and able to be consumed anywhere, any time. Their formulation, presentation and marketing often promote overconsumption. Studies based on NOVA show that ultra-processed products now dominate the food supplies of various high-income countries and are increasingly pervasive in lower-middle- and upper-middle-income countries. The evidence so far shows that displacement of minimally processed foods and freshly prepared dishes and meals by ultra-processed products is associated with unhealthy dietary nutrient profiles and several diet-related non-communicable diseases. Ultra-processed products are also troublesome from social, cultural, economic, political and environmental points of view. We conclude that the ever-increasing production and consumption of these products is a world crisis, to be confronted, checked and reversed as part of the work of the UN Sustainable Development Goals and its Decade of Nutrition.

The present commentary contains a clear and simple guide designed to identify ultra-processed foods. It responds to the growing interest in ultra-processed foods among policy makers, academic researchers, health professionals, journalists and consumers concerned to devise policies, investigate dietary patterns, advise people, prepare media coverage, and when buying food and checking labels in shops or at home. Ultra-processed foods are defined within the NOVA classification system, which groups foods according to the extent and purpose of industrial processing. Processes enabling the manufacture of ultra-processed foods include the fractioning of whole foods into substances, chemical modifications of these substances, assembly of unmodified and modified food substances, frequent use of cosmetic additives and sophisticated packaging. Processes and ingredients used to manufacture ultra-processed foods are designed to create highly profitable (low-cost ingredients, long shelf-life, emphatic branding), convenient (ready-to-consume), hyper-palatable products liable to displace all other NOVA food groups, notably unprocessed or minimally processed foods. A practical way to identify an ultra-processed product is to check to see if its list of ingredients contains at least one item characteristic of the NOVA ultra-processed food group, which is to say, either food substances never or rarely used in kitchens (such as high-fructose corn syrup, hydrogenated or interesterified oils, and hydrolysed proteins), or classes of additives designed to make the final product palatable or more appealing (such as flavours, flavour enhancers, colours, emulsifiers, emulsifying salts, sweeteners, thickeners, and anti-foaming, bulking, carbonating, foaming, gelling and glazing agents).

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Objective: To present and discuss the dietary guidelines issued by the Brazilian government in 2014. Design: The present paper describes the aims of the guidelines, their shaping principles and the approach used in the development of recommendations. The main recommendations are outlined, their significance for the cultural, socioeconomic and environmental aspects of sustainability is discussed, and their application to other countries is considered. Setting: Brazil in the twenty-first century.

Differential access to healthy foods has been hypothesized to contribute to health disparities, but evidence from low and middle-income countries is still scarce. This study examines whether the access of healthy foods varies across store types and neighborhoods of different socioeconomic statuses (SES) in a large Brazilian city. A cross-sectional study was conducted in 2010–2011 across 52 census tracts. Healthy food access was measured by a comprehensive in-store data collection, summarized into two indexes developed for retail food stores (HFSI) and restaurants (HMRI). Descriptive analyses and multilevel models were used to examine associations of store type and neighborhood SES with healthy food access. Fast food restaurants were more likely to be located in low SES neighborhoods whereas supermarkets and full service restaurants were more likely to be found in higher SES neighborhoods. Multilevel analyses showed that both store type and neighborhood SES were independently associated with in-store food measures. We found differences in the availability of healthy food stores and restaurants in Sao Paulo city favoring middle and high SES neighborhoods.

There is worldwide recognition that the burden of noncommunicable diseases (NCDs) and obesity-related health problems is rapidly increasing in low-and middle-income countries. Environmental determinants of obesity are likely to differ between countries, particularly in those undergoing rapid socioeconomic and nutrition transitions such as Brazil. This study aims to describe some built environment and local food environment variables and to explore their association with the overweight rate and diet and physical activity area-level aggregated indicators of adults living in the city of Sao Paulo, the largest city in Brazil. This formative study includes an ecological analysis of environmental factors associated with overweight across 31 submunicipalities of the city of Sao Paulo using statistical and spatial analyses. Average prevalence of overweight was 41.69% (95% confidence interval 38.74, 44.64), ranging from 27.14% to 60.75% across the submunicipalities. There was a wide geographical variation of both individual diet and physical activity, and indicators of food and built environments, favoring wealthier areas. After controlling for area socioeconomic status, there was a positive correlation between regular fruits and vegetables (FV) intake and density of FV specialized food markets (r=0.497; pG0.001), but no relationship between fastfood restaurant density and overweight prevalence was found. A negative association between overweight prevalence and density of parks and public sport facilities was seen (r=−0.527; pG0.05). Understanding the relationship between local neighborhood environments and increasing rates of poor diet, physical activity, and obesity is essential in countries undergoing rapid economic and urban development, such as Brazil, in order to provide insights for policies to reduce increasing rates of NCDs and food access and health inequalities.

Background: Brazil is currently debating the implementation of front-of-package labels. This study tested if Warning labels (WLs) improved consumer understanding, perceptions, and purchase intentions compared to Traffic-Light labels (TLLs) in 1607 Brazilian adults. Methods: In this online, randomized controlled experiment participants saw images of 10 products and answered questions twice—once in a no-label, control condition and then again in a randomly assigned label condition. The relative differences in responses between WLs and TLLs between control and label conditions were estimated using one-way ANOVAs or Chi-square tests. Results: Presenting WLs on products compared to TLLs helped participants: (i) improve their understanding of excess nutrient content (27.0% versus 8.2%, p < 0.001); (ii) improve their ability to identify the healthier product (24.6% versus 3.3%, p < 0.001); (iii) decrease perceptions of product healthfulness; and (iv) correctly identify healthier products (14.0% versus 6.9%, p < 0.001), relative to the control condition. With WLs, there was also an increase in the percentage of people: (v) expressing an intention to purchase the relatively healthier option (16.1% versus 9.8%, p < 0.001); and (vi) choosing not to buy either product (13.0% versus 2.9%, p < 0.001), relative to the control condition. The participants in the WL condition had significantly more favorable opinions of the labels compared to those in the TLL group. Conclusions: WLs would be more effective, compared to the TLL, at improving consumer food choices.

O artigo descreve a experiência do governo brasileiro na organização das ações de Alimentação e Nutrição ao que cabe à Atenção Básica. As ações são desenvolvidas por meio da Vigilância Alimentar e Nutricional, com o uso do Sistema de Vigilância Alimentar e Nutricional como principal ferramenta; Ações de Promoção à Saúde e da Alimentação Saudável, com a implementação do Guia Alimentar para a População Brasileira, da Estratégia Nacional para a Alimentação Complementar Saudável, do Programa Saúde na Escola e Ações de controle e prevenção da Obesidade, Doenças Crônicas e deficiências de micronutrientes, com foco na anemia ferropriva e hipovitaminose A. As ações de Alimentação e Nutrição na Atenção Básica foram fortalecidas com a inserção do nutricionista nas equipes dos Núcleos de Apoio à Saúde da Família - equipes multidisciplinares que garantem o matriciamento das ações de Alimentação e Nutrição às equipes de Atenção Básica. A intersetorialidade é uma das vertentes das ações de Alimentação e Nutrição na Atenção Básica, tanto com atendimento as famílias beneficiárias do Programa Bolsa Família como com a integração das ações dos diferentes setores (Saúde, Educação, Assistência Social e Trabalho) no território. Configura-se como desafio a consolidação, expansão e universalização das ações propostas para a atenção básica no Brasil.