ABSTRACT:

Objective:

To analyze the food consumption patterns of residents of Brumadinho, Minas Gerais, Brazil, according to sociodemographic characteristics, neighborhood and area of residence.

Methods:

Cross-sectional study with baseline data from the Brumadinho Health Project, conducted with 2,805 adult individuals. The healthy food consumption markers analyzed were: fruits and vegetables (FV), beans and fish; the unhealthy markers were: sweets and soda/artificial juices, whole-fat milk and red meat with visible fat or chicken with skin. Prevalence values and 95% confidence intervals were calculated for the total sample and according to sociodemographic characteristics, presence of commercial establishments with varieties of FV in the neighborhood and area of residence affected by the dam failure.

Results:

Among the healthy food consumption markers, the most common was beans (81.6%), and among the unhealthy ones, whole-fat milk (68.8%) and red meat with visible fat/chicken with skin (61.1%). Women were more prone to higher consumption of FV, while men, of beans and fish; the prevalence of these markers was higher among individuals with higher education degrees and higher incomes. Unhealthy eating markers were more prevalent among men, younger people, individuals with lower educational level and lower incomes, and residents in an area directly affected by the dam failure or in a mining region.

Conclusion:

Less than half of the participants were considered to follow regular or recommended consumption of healthy eating markers, except for beans. Individual characteristics and area of residence were associated with individuals’ food consumption patterns and should be taken into account in actions to promote adequate and healthy eating.

Keywords:
Disasters; Food consumption; Eating behavior; Eating habits; Descriptive epidemiology

INTRODUCTION

Adequate and healthy food behavior is essential for the promotion of health and well-being¹1 World Health Organization. Diet, nutrition and the prevention of chronic diseases. Report of a joint WHO/FAO expert consulation. Genebra: World Health Organization; 2003 [Internet]. [cited on Jun 12, 2022]. Available from: https://apps.who.int/iris/handle/10665/42665
https://apps.who.int/iris/handle/10665/4... and, in Brazil, it is a right guaranteed by the Federal Constitution²2 Brasil. Presidência da República. Casa Civil. Subchefia para Assuntos Jurídicos. Constituição da República Federativa do Brasil de 1988 [Internet]. 1988 [cited on Jun 12, 2022]. Available from: http://www.planalto.gov.br/ccivil_03/constituicao/constituicao.htm
http://www.planalto.gov.br/ccivil_03/con... . According to the Food Guide for the Brazilian Population, an adequate and healthy diet should be based on in natura or minimally processed foods, or preparations based on them, to the detriment of ultra-processed foods (UPF)³3 Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Guia alimentar para a população brasileira [Internet]. 2014 [cited on Jun 12, 2022]. Available from: https://bvsms.saude.gov.br/bvs/publicacoes/guia_alimentar_populacao_brasileira_2ed.pdf
https://bvsms.saude.gov.br/bvs/publicaco... .

However, studies on the trend of changes in the dietary pattern of Brazilians showed an increase in the consumption of UPF such as soft drinks, cookies and ready meals, and a reduction in the consumption of in-natura and minimally processed foods such as beans, roots and tubers, fruits and vegetables (FV)⁴4 Brasil. Instituto Brasileiro de Geografia e Estatística. Pesquisa nacional de saúde 2019: percepção do estado de saúde, estilos de vida, doenças crônicas e saúde bucal: Brasil e grandes regiões. Rio de Janeiro: IBGE; 2020 [Internet]. 2020 [cited on Jun 12, 2022]. Available from: https://biblioteca.ibge.gov.br/visualizacao/livros/liv101764.pdf
https://biblioteca.ibge.gov.br/visualiza... . These pattern changes seem to come from urbanization and industrialization processes, changes in the organization of families and in food systems, among other factors, affecting different population groups in different ways⁵5 Costa DVP, Lopes MS, Mendonça RD, Malta DC, Freitas PP, Lopes ACS. Diferenças no consumo alimentar nas áreas urbanas e rurais do Brasil: Pesquisa Nacional de Saúde. Ciênc Saúde Coletiva 2021; 26(suppl 2): 3805-13. https://doi.org/10.1590/1413-81232021269.2.26752019
https://doi.org/10.1590/1413-81232021269... .

Changes in dietary patterns can also be the result of disasters⁶6 Ma E, Ohira T, Nakano H, Maeda M, Yabe H, Sakai A, et al. Dietary pattern changes in Fukushima residents after the Great East Japan Earthquake: the Fukushima Health Management Survey 2011-2013. Public Health Nutr 2021; 24(8): 2195-204. https://doi.org/10.1017/S1368980020000300
https://doi.org/10.1017/S136898002000030... , as they may impact on the quality of food⁷7 Lourdes EB, Santana HC, Macedo LR, Silva Correia F, Cordeiro Pacheco T, Nascimento DP, et al. Changes in dietary and water use habits after the Doce River contamination with mining tailings. Food Sci Technol 2021; 42: e11021. https://doi.org/10.1590/fst.11021
https://doi.org/10.1590/fst.11021... and the on the population’s quality of life. Families can lose access to land—often the main source of food and income—and have their food choices affected⁸8 Rukundo PM, Iversen PO, Andreassen BA, Oshaug A, Kikafunda J, Rukooko B. Perceptions on the right to adequate food after a major landslide disaster: a cross-sectional survey of two districts in Uganda. BMC Int Health Hum Rights 2015; 15: 9. https://doi.org/10.1186/s12914-015-0047-x
https://doi.org/10.1186/s12914-015-0047-... despite remedial measures. Studies conducted with populations affected by disasters have reported a high level of food insecurity and little food diversity⁸8 Rukundo PM, Iversen PO, Andreassen BA, Oshaug A, Kikafunda J, Rukooko B. Perceptions on the right to adequate food after a major landslide disaster: a cross-sectional survey of two districts in Uganda. BMC Int Health Hum Rights 2015; 15: 9. https://doi.org/10.1186/s12914-015-0047-x
https://doi.org/10.1186/s12914-015-0047-... ,⁹9 Clay LA, Papas MA, Gill KB, Abramson DM. Factors associated with continued food insecurity among households recovering from Hurricane Katrina. Int J Environ Res Public Health 2018; 15(8): 1647. https://doi.org/10.3390/ijerph15081647
https://doi.org/10.3390/ijerph15081647... .

On January 25, 2019, a disaster occurred in Brumadinho, Minas Gerais, Brazil: the collapse of the tailings dam of the mine Córrego do Feijão, under the responsibility of mining company Vale S.A. The ore tailings reached nine census sectors, compromising the housing of part of the population, crops and animal husbandry¹⁰10 Barcellos C, Silva DX, Romão A, Froes C, Saldanha R, Gracie R, et al. Avaliação dos impactos sobre a saúde do desastre da mineração da Vale (Beumadinho, MG). Nota Técnica Fiocruz [Internet]. 2019 [cited on Jun 7, 2022]. Available from: https://www.epsjv.fiocruz.br/sites/default/files/files/relat%C3%B3rio_Brumadinho_impacto_sa%C3%BAde_01_fev_b.pdf
https://www.epsjv.fiocruz.br/sites/defau... , and caused at least 272 deaths¹¹11 Peixoto SV, Asmus CIRF. O desastre de Brumadinho e os possíveis impactos na saúde. Cienc Cult 2020; 72(2), 43-6. http://dx.doi.org/10.21800/2317-66602020000200012
http://dx.doi.org/10.21800/2317-66602020... ,¹²12 Peixoto SV, Firmo JOA, Fróes-Asmus CIR, Mambrini JVM, Freitas CM, Lima-Costa MF, et al. Projeto Saúde Brumadinho: aspectos metodológicos e perfil epidemiológico dos participantes da linha de base da coorte. Rev Bras Epidemiol 2022; (supl 2): E220002. https://doi.org/10.1590/1980-549720220002.supl.2.1
https://doi.org/10.1590/1980-54972022000... . In addition, the contamination of the Paraopeba River¹³13 Polignano MV, Lemos RS. Rompimento da barragem da Vale em Brumadinho: impactos socioambientais na bacia do rio Paraopeba. Cienc Cult 2020; 72(2): 37-43. http://dx.doi.org/10.21800/2317-66602020000200011
http://dx.doi.org/10.21800/2317-66602020... may have further harmed agricultural activities. All this impacted the population’s way of living and, possibly, their feeding patterns.

Despite the lack of previous data on the food consumption patterns of the population of Brumadinho, characterizing it after the disaster is important, especially when considering the need for actions to promote adequate and healthy feeding in the municipality. So, this article aimed to analyze the food consumption of individuals residing in Brumadinho, Minas Gerais, Brazil, according to their sociodemographic characteristics, neighborhood and areas of residence.

METHODS

Study Design and Location

This was a cross-sectional study carried out with baseline data from a longitudinal study called Brumadinho Health Project, conducted in Brumadinho, Minas Gerais, Brazil, with the objective of producing information about the health of the population to ensure the resolution of health care in the municipality¹²12 Peixoto SV, Firmo JOA, Fróes-Asmus CIR, Mambrini JVM, Freitas CM, Lima-Costa MF, et al. Projeto Saúde Brumadinho: aspectos metodológicos e perfil epidemiológico dos participantes da linha de base da coorte. Rev Bras Epidemiol 2022; (supl 2): E220002. https://doi.org/10.1590/1980-549720220002.supl.2.1
https://doi.org/10.1590/1980-54972022000... .

Brumadinho’s human development index (HDI) is 0.747 and its population was estimated, in 2021, in 41,208 inhabitants across an area of 639,434 km2¹⁴14 Brasil. Instituto Brasileiro de Geografia e Estatística. Cidades. Brumadinho [Internet]. 2022 [cited on Jun 7, 2022]. Available from: https://cidades.ibge.gov.br/brasil/mg/brumadinho/panorama
https://cidades.ibge.gov.br/brasil/mg/br... .

Study Population and Sample

The sample of the Brumadinho Health Project was designed to represent the population aged 12 years and over residing in the municipality in 2019, according to three different estimation domains:

1. Sample from other regions (individuals not directly affected by the dam failure and non-residents in mining areas);

2. Individuals directly affected by the dam failure (residents before or at the time of the survey in areas directly affected by the disaster or by the water from the Paraopeba River, contaminated by the mud); and

3. Individuals residing in mining areas¹²12 Peixoto SV, Firmo JOA, Fróes-Asmus CIR, Mambrini JVM, Freitas CM, Lima-Costa MF, et al. Projeto Saúde Brumadinho: aspectos metodológicos e perfil epidemiológico dos participantes da linha de base da coorte. Rev Bras Epidemiol 2022; (supl 2): E220002. https://doi.org/10.1590/1980-549720220002.supl.2.1
   https://doi.org/10.1590/1980-54972022000... .

The sampling plan considered the stratification of the population by census sector, as established by the Brazilian Institute of Geography and Statistics (IBGE) in 2019. A random sample of households was selected in the sectors belonging to the sample domain of other regions (domain 1), while all households in regions considered directly affected (domain 2) or exposed to mining activity (domain 3) that consented to participate were included.

For all estimation domains in each selected household, all residents aged 12 years or older were interviewed, which gave us 3,080 participants and a response rate of 86.4%. For this article, only adult individuals (18 years of age or older) were included, totaling 2,805 respondents.

More details about the research can be found in the project’s webpage (http://www.minas.fiocruz.br/saudebrumadinho/), in the article on its methodology¹²12 Peixoto SV, Firmo JOA, Fróes-Asmus CIR, Mambrini JVM, Freitas CM, Lima-Costa MF, et al. Projeto Saúde Brumadinho: aspectos metodológicos e perfil epidemiológico dos participantes da linha de base da coorte. Rev Bras Epidemiol 2022; (supl 2): E220002. https://doi.org/10.1590/1980-549720220002.supl.2.1
https://doi.org/10.1590/1980-54972022000... .

Data Collection Procedures

A questionnaire addressing sociodemographic data, perception of the neighborhood’s food setting and food consumption pattern was applied to participants at their households. All interviewers were trained and certified, and conducted the interviews between June and November 2021.

Variables Analyzed

The sociodemographic variables investigated were: sex (male and female), age range (18–24, 25–39, 40–59 and 60 and older), self-reported skin color (white, black, brown, yellow or indigenous), marital status (single, married/living together/stable union and divorced-separated/widowed), education (incomplete elementary school II or less, complete elementary school II, incomplete high school, complete high school, incomplete higher education, higher education or more) and monthly household income per capita (relation between monthly income of household members by the total number of household residents—categorized into tertiles).

The participants’ perception of the region’s food context was investigated by asking them to report the presence of commercial food establishments (markets, street markets or other points of sale) with a variety of fresh FV in the neighborhood. This question is part of a self-reported neighborhood scale, which was adapted and validated for the Brazilian population¹⁵15 Santos SM, Griep RH, Cardoso LO, Alves MGM, Fonseca MJM, Giatti L, et al. Adaptação transcultural e confiabilidade de medidas de características autorreferidas de vizinhança no ELSA-Brasil. Rev Saúde Pública 2013; 47(2): 122-30. https://doi.org/10.1590/S0034-8910.2013047003871
https://doi.org/10.1590/S0034-8910.20130... . The variable area of residence was analyzed based on three domains: other regions, region directly affected by the dam failure and mining region.

For the assessment of feeding patterns, healthy eating (FV, beans and fish) and unhealthy eating markers (sweets, soda/artificial juice, whole-fat milk and red meat with visible fat/chicken with skin) were investigated.

The analysis of food consumption patterns was performed according to the Surveillance System of Risk and Protection Factors for Chronic Non-Communicable Diseases by Telephone Survey (Vigitel)¹⁶16 Brasil. Ministério da Saúde. Informações de Saúde. Vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico. Vigitel. Notas técnicas [Internet]. 2022 [cited on Jun 7, 2022]. Available from: http://tabnet.datasus.gov.br/cgi/vigitel/vigteldescr.htm
http://tabnet.datasus.gov.br/cgi/vigitel... (Supplementary Table 1).

Statistical Analysis

For each food marker assessed, the prevalence values and respective 95% confidence intervals (95%CI) were estimated for the total population and per category of variables of interest.

Significant differences between prevalence values were tested by the χ² statistical test with Rao-Scott correction. In cases of significant differences between prevalence values of variables with three or more categories, two-by-two comparisons were made, and Bonferroni correction was applied.

Statistical analyses were performed using the Stata^® software, version 14.0 (StataCorp LLC, CollegeStation, TX), considering sample weighting and the effect of sample ­design.

Ethical Considerations

The Brumadinho Health Project was approved by the Research Ethics Committee (20814719.5.0000.5091), and all interviewees signed an informed consent form to participate in the study.

RESULTS

Of the participants, 57.1% were women, 36.2% were aged between 40 and 59 years old, 44.2% reported having brown skin color, 59.6% were married, 29.0% had completed high school, and 37.8% were in the first income tertile (37.8%). Most individuals had commercial establishments with a variety of fresh FV (57.9%) around their homes and lived in other regions of the city (95.5%) (Supplementary Table 2).

The prevalence of regular consumption of FV was 35.0% (95%CI 32.1–38.1), being higher among women (39.4%; 95%CI 35.9–43.0) and those aged 60 years or older (49.3%; 95%CI 43.1–55.5). Married individuals also had a higher prevalence (38.7%; 95%CI 34.9–42.8) compared to single individuals (25.9%; 95%CI 21.2–31.3); as well as those with higher education (66.1%; 95%CI 58.2–73.2) and higher income (48.3%; 95%CI 42.6–54.0) compared to the other categories (Table 1).

The recommended consumption of FV was reported by 21.1% of the participants (95%CI 18.4–24.0), being higher among: women (23.6%; 95%CI 20.1–27.5); individuals aged 60 years or older when compared to those aged 18–24 years (27.2%; 95%CI 21.5–33.7 vs. 13.1%; 95%CI 8.4–19.9); with higher education or more compared to those with complete elementary school II or less (higher education or more: 33.5%; 95%CI 24.7–43.7 vs. complete elementary school II: 16.1%; 95%CI 11, 4–22.1 and fundamental I complete or less 15.6%; 95%CI 12.5–19.3); and individuals in the highest income tertile when compared to those in the lowest tertile (27.5%; 95%CI 22.4–33.4 vs. 16.9%; 95%CI 12.9–21.8) (Table 1).

Most participants (81.6%; 95%CI 79.0–83.9) reported consuming beans regularly, although it was higher among: men (87.2%; 95%CI 84.1–89.8); individuals aged 25 years or older (25–39, 83.9%; 95%CI 79.3–87.6; 40–59, 83.8%; 95%CI 80.0–86.9; 60 and older, 82.4%; 95%CI 77.0–86.8) when compared to younger people (18–24, 68.2%; 95%CI 59.2–76.0); married and widowed (84.5%; 95%CI 81.0–87.4 and 89.4%; 95%CI 81.2–94.3, respectively) when compared to single (75.0%; 95%CI 69, 8–79.6); with complete high school education or less (complete elementary school or less: 87.9%; 95%CI 84.7–90.4; complete elementary school II: 83.6%; 95%CI 77.1–88.5 and high school education: 82.7%; 95%CI 78.5–86.3) when compared to those with higher education or more (64.8%; 95%CI 56.7–72.0); with intermediate income when compared to those with higher income (86.9%; 95%CI 82.4–90.4 vs. 77.7%; 95%CI 72.5–82.1); and whose surroundings did not have commercial establishments with fresh FV varieties (87.8%; 95%CI 84.7–90.4) (Table 1).

Regular consumption of fish was reported by 38.2% of respondents (95%CI 34.8–41.8), being higher among: men (41.5%; 95%CI 37.0–46.2); individuals aged 40-59 years when compared to those aged 18–24 years (42.4%; 95%CI 37.3–47.7 vs. 27.6%; 95%CI 20.2–36.3%); with complete higher education (higher education or more: 52.8%; 95%CI 42.1–63.2) when compared to those with complete elementary school or less and high school (32.9%; 95%CI 28.8–37.4 and 52.8%; 95%CI 42.1–63.2, respectively); higher income (50.8%; 95%CI 44.0–57.6); and who reported the presence of commercial establishments with fresh varieties of FV in their area (43.1%; 95%CI 38.6–47.7) (Table 1).

The prevalence of regular consumption of sweets was 17.7% (95%CI 15.5–20.1), being higher among individuals with complete high school and higher education (21.6%; 95%CI 17.7–26.1 and 23.4; 95%CI 16.5–31.9, respectively) when compared to those with complete elementary school I or less. The prevalence of regular consumption of soft drinks/artificial juices was 10.4% (95%CI 8.6–12.5), being higher among: men (13.5%; 95%CI 10.7–16.8); younger individuals (23.8%; 95%CI 17.1–32.2) when compared to those aged 40–59 years (9.1%; 95%CI 6.7–12.3) or 60 years and older (4.7%; 95%CI 3.0–7.4); individuals with self-reported skin color as black (18.8%; 95%CI 12.9–26.4) when compared to white individuals (7.4%; 95%CI 5.2–10.4); single individuals compared to married individuals (15.8%; 95%CI 12.1–20.3 vs. 8.7%; 95%CI 6.8–11.2); individuals with an intermediate level of education (complete elementary school II: 17.8%; 95%CI 12.2–24.5 and high school: 17.8%; 95%CI 12.2–24.5); and with lower income (15.6%; 95%CI 11.8–20.5) (Table 2).

The prevalence of consumption of whole-fat milk was 68.8% (95%CI 65.4–72.0), being higher among individuals with high school education or less (complete elementary school or less: 76.4%; 95%CI 71.6–80.7; complete elementary school II: 72.9%; 95%CI 66.1–78.7 and high school: 69.0%; 95%CI 63.5–74.0) when compared to those with higher education degrees or more (4.2%; 95%CI 2.0–8.6); belonging to the first and second income tertiles (71.4%; 95%CI 66.8–75.5 and 73.1%; 95%CI 66.8–78.6, respectively) compared to those in the highest tertile (61.7%; 95%CI 55.4–67.6); and who did not report presence of commercial establishments selling fresh FV varieties in the neighborhood (72.7%; 95%CI 68.2–76.8).

Consumption of red meat with visible fat/chicken with skin was reported by 61.1% (95%CI 58.0–64.2) of the participants, being higher among: men (69.3%; 95%CI 65.1– 73.3); individuals aged up to 59 years (18–24 years: 65.5%; 95%CI 56.8–73.2; 25–39: 67.2%; 95%CI 61.0–72.9 and 40–59: 65.1%; 95%CI 60.5–69.5) when compared to the elderly (50.4%; 95%CI 44.4–56.4); with complete high school or less (complete elementary school or less: 69.9%; 95%CI 65.1–74.3; complete elementary school II: 76.8%; 95%CI 70.3–82.3 and high school education: 60.0%; 95%CI 54.3–65.5) when compared to those with higher education degrees or more (34.3%; 95%CI 27.1–42.4); and belonging to the first income tertile (72.1%; 95%CI 67.4–76.4) compared to those in the second and third tertiles (61.3%; 95%CI 54.9–67.9 and 51.7%; 95%CI 45.4–57.9, respectively) (Table 2).

As for healthy and unhealthy food markers according to area of residence, the prevalence of regular and recommended consumption of FV was lower (25.9%; 95%CI 22.7–29.3; 15.2%; 95CI % 12.8–18.0, respectively) among individuals residing in the region directly affected by the tailings dam failure. This group was also linked to a higher prevalence of consumption of beans (86.7%; 95%CI 83.9–89.1) and sweets (24.2%; 95%CI 21.2–27.4) when compared with people living in other regions. There was also greater regular consumption of soft drinks/artificial juices (29.9%; 95%CI 25.4–34.9) and of red meat with excess fat/chicken with skin (79.2%; 95%CI 74.5–83.1), as well as lower consumption of whole-fat milk (59.4%; 95%CI 54.3–64.2) among individuals residing in mining regions (Table 3).

DISCUSSION

Less than half of the participants of the Brumadinho Health Project had regular or recommended consumption of healthy eating markers, except for beans, which was reported by most respondents. Among the unhealthy eating markers, the most frequent ones were related to fat consumption, such as whole-fat milk and red meat with visible fat/chicken with skin. Regarding the distribution of markers according to the variables analyzed, women reported higher consumption of FV (regular and recommended), and men, of beans and fish. Higher prevalence values of these markers were observed among individuals with higher education and higher income. In addition, individuals who had access to commercial establishments selling fresh FV varieties in their neighborhood reported higher consumption of beans and fish. On the other hand, unhealthy eating markers were more common among men, younger age groups, individuals with low education and low income, and residing in regions directly affected by the tailings dam failure and with mining activities.

The prevalence values of regular and recommended consumption of FV were similar to those observed in the Brazilian adult population—34.3% and 22.1%¹⁷17 Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Análise em Saúde e Vigilância de Doenças não Transmissíveis. Vigitel Brasil 2021: vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico: estimativas sobre frequência e distribuição sociodemográfica de fatores de risco e proteção para doenças crônicas nas capitais dos 26 estados brasileiros e no Distrito Federal em 2021. Brasília: Ministério da Saúde; 2021 [Internet]. 2021 [cited on Aug 12, 2022]. Available from: https://www.gov.br/saude/pt-br/centrais-de-conteudo/publicacoes/publicacoes-svs/vigitel/vigitel-brasil-2021-estimativas-sobre-frequencia-e-distribuicao-sociodemografica-de-fatores-de-risco-e-protecao-para-doencas-cronicas/view
https://www.gov.br/saude/pt-br/centrais-... , respectively. However, among Brazilians, consumption of beans (68.3%)¹⁸18 Santin F, Gabe KT, Levy RB, Jaime PC. Food consumption markers and associated factors in Brazil: distribution and evolution, Brazilian National Health Survey, 2013 and 2019. Cad Saúde Pública 2022; 38(Suppl 1): e00118821. https://doi.org/10.1590/0102-311X00118821
https://doi.org/10.1590/0102-311X0011882... was lower and consumption of fish (46.6%)¹⁸18 Santin F, Gabe KT, Levy RB, Jaime PC. Food consumption markers and associated factors in Brazil: distribution and evolution, Brazilian National Health Survey, 2013 and 2019. Cad Saúde Pública 2022; 38(Suppl 1): e00118821. https://doi.org/10.1590/0102-311X00118821
https://doi.org/10.1590/0102-311X0011882... was higher. Similarly, associations in the Brazilian population with sociodemographic characteristics similar to the ones assessed in this study were also identified, such as higher consumption of FV among women¹⁷17 Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Análise em Saúde e Vigilância de Doenças não Transmissíveis. Vigitel Brasil 2021: vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico: estimativas sobre frequência e distribuição sociodemográfica de fatores de risco e proteção para doenças crônicas nas capitais dos 26 estados brasileiros e no Distrito Federal em 2021. Brasília: Ministério da Saúde; 2021 [Internet]. 2021 [cited on Aug 12, 2022]. Available from: https://www.gov.br/saude/pt-br/centrais-de-conteudo/publicacoes/publicacoes-svs/vigitel/vigitel-brasil-2021-estimativas-sobre-frequencia-e-distribuicao-sociodemografica-de-fatores-de-risco-e-protecao-para-doencas-cronicas/view
https://www.gov.br/saude/pt-br/centrais-... ,¹⁹19 Jaime PC, Stopa SR, Oliveira TP, Vieira ML, Szwarcwald CL, Malta DC. Prevalência e distribuição sociodemográfica de marcadores de alimentação saudável, Pesquisa Nacional de Saúde, Brasil 2013. Epidemiol Serv Saúde 2015; 24(2): 267-76. https://doi.org/10.5123/S1679-49742015000200009
https://doi.org/10.5123/S1679-4974201500... ,²⁰20 Brasil. Instituto Brasileiro de Geografia e Estatística. Pesquisa de orçamentos familiares 2017-2018: análise do consumo alimentar pessoal no Brasil. Rio de Janeiro: IBGE; 2020 [Internet]. 2020 [cited on Jun 7, 2022]. Available from: https://biblioteca.ibge.gov.br/visualizacao/livros/liv101742.pdf
https://biblioteca.ibge.gov.br/visualiza... and married individuals²¹21 Canuto R, Fanton M, Lira PIC. Iniquidades sociais no consumo alimentar no Brasil: uma revisão crítica dos inquéritos nacionais. Ciênc Saúde Coletiva 2019; 24(9): 3193-212. https://doi.org/10.1590/1413-81232018249.26202017
https://doi.org/10.1590/1413-81232018249... , and higher consumption of beans among men¹⁷17 Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Análise em Saúde e Vigilância de Doenças não Transmissíveis. Vigitel Brasil 2021: vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico: estimativas sobre frequência e distribuição sociodemográfica de fatores de risco e proteção para doenças crônicas nas capitais dos 26 estados brasileiros e no Distrito Federal em 2021. Brasília: Ministério da Saúde; 2021 [Internet]. 2021 [cited on Aug 12, 2022]. Available from: https://www.gov.br/saude/pt-br/centrais-de-conteudo/publicacoes/publicacoes-svs/vigitel/vigitel-brasil-2021-estimativas-sobre-frequencia-e-distribuicao-sociodemografica-de-fatores-de-risco-e-protecao-para-doencas-cronicas/view
https://www.gov.br/saude/pt-br/centrais-... ,¹⁹19 Jaime PC, Stopa SR, Oliveira TP, Vieira ML, Szwarcwald CL, Malta DC. Prevalência e distribuição sociodemográfica de marcadores de alimentação saudável, Pesquisa Nacional de Saúde, Brasil 2013. Epidemiol Serv Saúde 2015; 24(2): 267-76. https://doi.org/10.5123/S1679-49742015000200009
https://doi.org/10.5123/S1679-4974201500... ,²¹21 Canuto R, Fanton M, Lira PIC. Iniquidades sociais no consumo alimentar no Brasil: uma revisão crítica dos inquéritos nacionais. Ciênc Saúde Coletiva 2019; 24(9): 3193-212. https://doi.org/10.1590/1413-81232018249.26202017
https://doi.org/10.1590/1413-81232018249... .

The prevalence of regular consumption of fish and FV was higher among individuals with high levels of education and higher income, possibly due to the form of access and prices of these foods, which are usually more expensive¹⁹19 Jaime PC, Stopa SR, Oliveira TP, Vieira ML, Szwarcwald CL, Malta DC. Prevalência e distribuição sociodemográfica de marcadores de alimentação saudável, Pesquisa Nacional de Saúde, Brasil 2013. Epidemiol Serv Saúde 2015; 24(2): 267-76. https://doi.org/10.5123/S1679-49742015000200009
https://doi.org/10.5123/S1679-4974201500... . On the other hand, consumption of beans was lower in these subgroups. Although beans are a traditional food for Brazilians, their consumption reduces progressively as the income range gets higher²²22 Rodrigues RM, Souza AM, Bezerra IN, Pereira RA, Yokoo EM, Sichieri R. Most consumed foods in Brazil: evolution between 2008-2009 and 2017-2018. Rev Saúde Pública 2021; 55(Supl 1): 4s. https://doi.org/10.11606/s1518-8787.2021055003406
https://doi.org/10.11606/s1518-8787.2021... and as individuals go through higher education²¹21 Canuto R, Fanton M, Lira PIC. Iniquidades sociais no consumo alimentar no Brasil: uma revisão crítica dos inquéritos nacionais. Ciênc Saúde Coletiva 2019; 24(9): 3193-212. https://doi.org/10.1590/1413-81232018249.26202017
https://doi.org/10.1590/1413-81232018249... ,²³23 Velásquez-Meléndez G, Mendes LL, Pessoa MC, Sardinha LMV, Yokota RTC, Bernal RTI, et al. Trends in frequency of consumption of beans assessed by means of a telephone survey in Brazilian state capitals between 2006 and 2009. Ciênc Saúde Coletiva 2012; 17(12): 3363-70. https://doi.org/10.1590/s1413-81232012001200021
https://doi.org/10.1590/s1413-8123201200... . These subgroups possibly experience earlier changes in eating habits, such as the reduction in consumption of home-made food that require more time to prepare, such as rice and beans²²22 Rodrigues RM, Souza AM, Bezerra IN, Pereira RA, Yokoo EM, Sichieri R. Most consumed foods in Brazil: evolution between 2008-2009 and 2017-2018. Rev Saúde Pública 2021; 55(Supl 1): 4s. https://doi.org/10.11606/s1518-8787.2021055003406
https://doi.org/10.11606/s1518-8787.2021... , and the increased consumption of ready-to-eat foods and the habit of having meals away from home²⁴24 Bezerra IN, Vasconcelos TM, Cavalcante JB, Yokoo EM, Pereira RA, Sichieri R. Evolution of out-of-home food consumption in Brazil in 2008-2009 and 2017-2018. Rev Saúde Pública 2021; 55(suppl 1): 6s. https://doi.org/10.11606/s1518-8787.2021055003221
https://doi.org/10.11606/s1518-8787.2021... .

The report of access to commercial establishments with a variety of fresh FV in the neighborhood was associated with higher consumption of beans and fish, as well as with lower intake of whole-fat milk. The food settings, defined as the physical, economic, political and sociocultural environment related to feeding, can influence the choices of food and beverages and, consequently, the nutritional status of individuals²⁵25 Egger G, Swinburn B. An “ecological” approach to the obesity pandemic. BMJ 1997; 315(7106): 477-80. https://doi.org/10.1136/bmj.315.7106.477
https://doi.org/10.1136/bmj.315.7106.477... . More specifically, food setting built, one of the dimensions of food setting, plays a fundamental role in the quality of diet, affecting the access to food, as well as food availability and suitability in a certain geographic area²⁶26 Gordon-Larsen P. Food availability/convenience and obesity. Adv Nutr 2014; 5(6): 809-17. https://doi.org/10.3945/an.114.007070
https://doi.org/10.3945/an.114.007070... .

Disasters like the one in Brumadinho can affect both the environment and food consumption patterns. The nature of food problems after disasters depends on the type, duration and size of the affected area²⁷27 Pan American Health Organization. Food and nutrition in disasters [Internet]. 2010 [cited on Jun 7, 2022]. Available from: https://www.paho.org/en/health-emergencies/food-and-nutrition-disasters
https://www.paho.org/en/health-emergenci... . Studies that evaluated the repercussions of disasters of different natures have indicated a worsening in eating habits among adult individuals immediately after the disaster; however, it is still unclear whether this association remains in the long term²⁸28 Nozue M, Ishikawa-Takata K, Sarukura N, Sako K, Tsuboyama-Kasaoka N. Stockpiles and food availability in feeding facilities after the Great East Japan Earthquake. Asia Pac J Clin Nutr 2014; 23(2): 321-30. https://doi.org/10.6133/apjcn.2014.23.2.14
https://doi.org/10.6133/apjcn.2014.23.2.... . In the present investigation, there was a lower consumption of FV (regular and recommended) among individuals residing in the region directly affected by the tailings dam failure. Research carried out in Governador Valadares, a city surrounded by river Rio Doce, which was polluted with mining tailings in a disaster similar to that of Brumadinho, reported a reduction or interruption in the consumption of FV and freshwater fish even 17 months after the disaster.

Most respondents reported that public water supply from the river Rio Doce could contaminate crops and preparation of food⁷7 Lourdes EB, Santana HC, Macedo LR, Silva Correia F, Cordeiro Pacheco T, Nascimento DP, et al. Changes in dietary and water use habits after the Doce River contamination with mining tailings. Food Sci Technol 2021; 42: e11021. https://doi.org/10.1590/fst.11021
https://doi.org/10.1590/fst.11021... , which could have possible long-term negative repercussions on eating habits and, consequently, on their health. In this sense, as the Brumadinho Health Project is a longitudinal study that aims to monitor dietary patterns of individuals affected by disasters, its contribution is to produce more evidence on the subject.

Regarding the consumption of foods that are markers of unhealthy eating, the prevalence of consumption of candy/sweets and whole-fat milk, similar to the Brazilian population, was 21.7 and 60.6%, respectively, as presented by the National Health Survey of 2013²⁹29 Claro RM, Santos MAS, Oliveira TP, Pereira CA, Szwarcwald CL, Malta DC. Consumo de alimentos não saudáveis relacionados a doenças crônicas não transmissíveis no Brasil: Pesquisa Nacional de Saúde, 2013. Epidemiol Serv Saúde 2015; 24(2): 257-65. https://doi.org/10.5123/S1679-49742015000200008
https://doi.org/10.5123/S1679-4974201500... . However, regular consumption of soft drinks/artificial juice was higher (20.4%)¹⁸18 Santin F, Gabe KT, Levy RB, Jaime PC. Food consumption markers and associated factors in Brazil: distribution and evolution, Brazilian National Health Survey, 2013 and 2019. Cad Saúde Pública 2022; 38(Suppl 1): e00118821. https://doi.org/10.1590/0102-311X00118821
https://doi.org/10.1590/0102-311X0011882... , while consumption of red meat with fat/chicken with skin was lower (37.2%)²⁹29 Claro RM, Santos MAS, Oliveira TP, Pereira CA, Szwarcwald CL, Malta DC. Consumo de alimentos não saudáveis relacionados a doenças crônicas não transmissíveis no Brasil: Pesquisa Nacional de Saúde, 2013. Epidemiol Serv Saúde 2015; 24(2): 257-65. https://doi.org/10.5123/S1679-49742015000200008
https://doi.org/10.5123/S1679-4974201500... . The higher consumption of fatty meats among residents of Brumadinho may be related to cultural aspects, since Minas Gerais is one of the Brazilian states that most consume fatty meat³⁰30 Malta DC, Moura L, Bernal RTI. Diferenciais dos fatores de risco de Doenças Crônicas não Transmissíveis na perspectiva de raça/cor. Ciênc Saúde Coletiva 2015; 20(3): 713-25. http://doi.org/10.1590/1413-81232015203.16182014
http://doi.org/10.1590/1413-81232015203.... . The prevalence of unhealthy eating markers was higher among males, individuals in younger age groups, with lower educational levels and lower income ranges, as observed in national studies¹⁸18 Santin F, Gabe KT, Levy RB, Jaime PC. Food consumption markers and associated factors in Brazil: distribution and evolution, Brazilian National Health Survey, 2013 and 2019. Cad Saúde Pública 2022; 38(Suppl 1): e00118821. https://doi.org/10.1590/0102-311X00118821
https://doi.org/10.1590/0102-311X0011882... ,²⁹29 Claro RM, Santos MAS, Oliveira TP, Pereira CA, Szwarcwald CL, Malta DC. Consumo de alimentos não saudáveis relacionados a doenças crônicas não transmissíveis no Brasil: Pesquisa Nacional de Saúde, 2013. Epidemiol Serv Saúde 2015; 24(2): 257-65. https://doi.org/10.5123/S1679-49742015000200008
https://doi.org/10.5123/S1679-4974201500... .

High prevalence of consumption of soft drinks/artificial juice, in turn, was found among individuals who declared themselves to be black and single when compared to those who reported having white skin color and being married, respectively. The few studies conducted so far on unhealthy eating markers corroborate these results, showing that risk markers were associated with being brown and/or black³⁰30 Malta DC, Moura L, Bernal RTI. Diferenciais dos fatores de risco de Doenças Crônicas não Transmissíveis na perspectiva de raça/cor. Ciênc Saúde Coletiva 2015; 20(3): 713-25. http://doi.org/10.1590/1413-81232015203.16182014
http://doi.org/10.1590/1413-81232015203.... ,³¹31 Lopes MS, Freitas PP, Silva CO, Mendonça RD, Campos SF, Malta DC, et al. Healthy lifestyle by race/skin color and educational level in Brazil. RSD 2021; 10(12): e577101220911. https://doi.org/10.33448/rsd-v10i12.20911
https://doi.org/10.33448/rsd-v10i12.2091... and being single²¹21 Canuto R, Fanton M, Lira PIC. Iniquidades sociais no consumo alimentar no Brasil: uma revisão crítica dos inquéritos nacionais. Ciênc Saúde Coletiva 2019; 24(9): 3193-212. https://doi.org/10.1590/1413-81232018249.26202017
https://doi.org/10.1590/1413-81232018249... .

Differences were also identified in the markers of unhealthy food consumption when it comes to individuals’ area of residence. Higher regular consumption of soft drinks/artificial juice and red meat with excess fat/chicken with skin was reported by residents of a mining region. We did not find studies in the literature that specifically evaluated food markers in population groups residing in mining regions in Brazil for comparison purposes. However, it is hypothesized that these results may derive from the profile of residents of this region, who are proportionately younger and with low educational level (data not shown). In any case, these findings show the need to better understand regional and local differences in food consumption patterns, as well as to implement actions to promote adequate and healthy eating habits according to the area of residence of individuals⁵5 Costa DVP, Lopes MS, Mendonça RD, Malta DC, Freitas PP, Lopes ACS. Diferenças no consumo alimentar nas áreas urbanas e rurais do Brasil: Pesquisa Nacional de Saúde. Ciênc Saúde Coletiva 2021; 26(suppl 2): 3805-13. https://doi.org/10.1590/1413-81232021269.2.26752019
https://doi.org/10.1590/1413-81232021269... .

Despite the relevant results, this study has limitations that must be considered. Measuring food consumption according to markers that assess the frequency of food consumption, and not through food frequency questionnaires and 24-hour food recalls—which are more accurate instruments that provide data on the amount of food ingested— is one of them³²32 Pereira RA, Sichieri R. Métodos de avaliação do consumo de alimentos. In: Kac G, Sichieri R, Gigante DP, orgs. Epidemiologia nutricional [online]. Rio de Janeiro: Editora FIOCRUZ/Atheneu; 2007. p. 181-200.. Consumption markers are simple and quick-to-apply instruments that make it possible to identify dietary inadequacies in large-population studies. Furthermore, they have been used in national surveys¹⁷17 Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Análise em Saúde e Vigilância de Doenças não Transmissíveis. Vigitel Brasil 2021: vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico: estimativas sobre frequência e distribuição sociodemográfica de fatores de risco e proteção para doenças crônicas nas capitais dos 26 estados brasileiros e no Distrito Federal em 2021. Brasília: Ministério da Saúde; 2021 [Internet]. 2021 [cited on Aug 12, 2022]. Available from: https://www.gov.br/saude/pt-br/centrais-de-conteudo/publicacoes/publicacoes-svs/vigitel/vigitel-brasil-2021-estimativas-sobre-frequencia-e-distribuicao-sociodemografica-de-fatores-de-risco-e-protecao-para-doencas-cronicas/view
https://www.gov.br/saude/pt-br/centrais-... ,¹⁹19 Jaime PC, Stopa SR, Oliveira TP, Vieira ML, Szwarcwald CL, Malta DC. Prevalência e distribuição sociodemográfica de marcadores de alimentação saudável, Pesquisa Nacional de Saúde, Brasil 2013. Epidemiol Serv Saúde 2015; 24(2): 267-76. https://doi.org/10.5123/S1679-49742015000200009
https://doi.org/10.5123/S1679-4974201500... and by the Food and Nutrition Surveillance System (Sisvan)³³33 Brasil. Sistema de Vigilância Alimentar e Nutricional. Sobre o SISVAN [Internet]. 2022 [cited on Aug 16, 2022]. Available from: https://sisaps.saude.gov.br/sisvan/
https://sisaps.saude.gov.br/sisvan/... to monitor food consumption of the Brazilian population with eyes to creating public policies and supporting decision-making on health care³⁴34 Brasil. Ministério da Saúde. Matriz para organização dos cuidados em alimentação e nutrição na atenção primária à saúde. Brasília: Ministério da Saúde; 2022 [Internet]. 2022 [cited on Aug 16, 2022]. Available from: http://189.28.128.100/dab/docs/portaldab/publicacoes/matriz_organizacao_cuidados_nutricao_aps.pdf
http://189.28.128.100/dab/docs/portaldab... .

Another limitation is the impossibility of evaluating other food markers that are relevant to the local population, as well as the lack of control of outcomes by potential confounding variables. Since the Brumadinho Health Project is a large longitudinal study, covering different blocks of variables, we had to limit the number of food markers analyzed. However, the markers investigated are those of greatest importance for the Brazilian population and most commonly evaluated in epidemiological studies. As for the control by confounding variables, this was a descriptive study that sought to understand the food consumption pattern of the population according to sociodemographic characteristics, neighborhood settings and area of residence, so that, later on, more robust hypotheses can be elaborated to investigate the multicausality of the outcomes of interest.

The potential of this work should be emphasized, including the fact that it is the first Brazilian population-based study to assess the food consumption pattern of a population affected by a major disaster. This study, therefore, provides important information to support actions that can promote adequate and healthy feeding in the municipal health services, aiming to guarantee health and the human right to adequate feeding. It is noteworthy, however, that these actions must be in line with the economic and social context of the population and respect and value the cultural dimensions of food so it can be feasible and sustainable, while promoting the population’s well-being.

ACKNOWLEDGEMENTS:

We would like to thank the participants of the project for their cooperation and participation.

REFERENCES

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