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Food and nutrition surveillance is fundamental to the formulation, implementation, monitoring, and evaluation of public policies on food and nutrition. The comparative analysis of the evolution of food and nutrition surveillance actions between countries makes it possible to learn about advances, challenges and innovations for the planning of interventions. This study aimed to describe and compare food and nutrition surveillance actions in Brazil and Portugal, countries with different geographical dimensions and socio-economic profiles, but with the common characteristic of having a universal healthcare system. We manually searched for documents describing food and nutrition surveillance actions and for potential data sources on the institutional websites of the Brazilian and Portuguese governments. The recommendations of the READ approach were used (59 documents were identified for Brazil and 29 for Portugal). In Brazil, food and nutrition surveillance actions are included in health policies and in the constraints of conditional cash transfer programs. The Brazilian Households Budget Surveys and health surveys are used simultaneously with the Brazilian National Food and Nutrition Surveillance System (SISVAN). In Portugal, food and nutrition surveillance actions are part of health policies, via the National Program and the Integrated Strategy for the Promotion of Healthy Eating. Among the data sources identified are the Portuguese Food Balance Sheet and household budget, health and food surveys, as well as initiatives to monitor the nutritional status of children and adolescents. In both countries, strategies need to be improved in terms of the regularity of data recording, the harmonization of food consumption indicators and the dissemination of information.

A vigilância alimentar e nutricional é fundamental para a formulação, a implementação, o monitoramento e a avaliação de políticas públicas de alimentação e nutrição. A análise comparativa da evolução das ações de vigilância alimentar e nutricional entre países permite o conhecimento de avanços, desafios e inovações para o planejamento de intervenções. O objetivo foi descrever e comparar as ações de vigilância alimentar e nutricional no Brasil e em Portugal, países com dimensões geográficas e perfis socioeconômicos distintos, mas com sistema de saúde universal em comum. Nós buscamos por documentos que descrevessem as ações de vigilância alimentar e nutricional e por potenciais fontes de dados de maneira manual em websites institucionais dos governos brasileiro e português. O estudo utilizou as recomendações da abordagem READ (59 documentos foram identificados para o Brasil e 29 para Portugal). No Brasil, as ações de vigilância alimentar e nutricional estão inseridas em políticas de saúde e nas condicionalidades dos programas de transferência condicionada de renda. As Pesquisas de Orçamentos Familiares e os inquéritos de saúde são utilizados simultaneamente no Sistema de Vigilância Alimentar e Nutricional (SISVAN). Em Portugal, as ações de vigilância alimentar e nutricional estão inseridas nas políticas de saúde, por meio do Programa Nacional e da Estratégia Integrada para a Promoção da Alimentação Saudável. Entre as fontes de dados identificadas estão a Balança Alimentar Portuguesa, os inquéritos de orçamentos familiares, de saúde e alimentares, além de iniciativas para o monitoramento do estado nutricional de crianças e adolescentes. Em ambos os países, as estratégias precisam ser aprimoradas em relação à regularidade do registro de dados, à harmonização dos indicadores do consumo alimentar e à disseminação das informações.

La vigilancia alimentaria y nutricional es fundamental para la formulación, implementación, monitoreo y evaluación de las políticas públicas de alimentación y nutrición. El análisis comparativo de la evolución de las acciones de vigilancia alimentaria y nutricional entre países permite el conocimiento de los avances, desafíos e innovaciones para la planificación de intervenciones. El objetivo fue describir y comparar las acciones de vigilancia alimentaria y nutricional en Brasil y en Portugal, países con diferentes dimensiones geográficas y perfiles socioeconómicos, pero con un sistema de salud universal en común. Buscamos documentos que describieran las acciones de vigilancia alimentaria y nutricional y posibles fuentes de datos manualmente en sitios web institucionales de los gobiernos de Brasil y Portugal. El estudio utilizó las recomendaciones del enfoque READ (se identificaron 59 documentos para Brasil y 29 para Portugal). En Brasil, las acciones de vigilancia alimentaria y nutricional están incluidas en políticas de salud y en las condicionalidades de los programas de transferencia condicionada de ingresos. Las Encuestas de Presupuestos Familiares y los estudios de salud se utilizan simultáneamente con el Sistema de Vigilancia Alimentaria y Nutricional (SISVAN). En Portugal, las acciones de vigilancia alimentaria y nutricional están incluidas en las políticas de salud, por medio del Programa Nacional y de la Estrategia Integrada para la Promoción de una Alimentación Saludable. Entre las fuentes de datos identificadas, se encuentran la Balanza Alimentaria Portuguesa, las encuestas de presupuestos familiares, de salud y alimentarias. Además de iniciativas para el monitoreo del estado nutricional de niños y adolescentes. En ambos países, es necesario mejorar las estrategias con relación a la regularidad del registro de datos, a la armonización de los indicadores de consumo de alimentos y a la difusión de la información.

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OBJECTIVE: To explore the internal structure and analyze evidence of measurement invariance of the Sisvan form of food intake markers of the Food and Nutrition Surveillance System (Sisvan) for children aged six to 23 months. METHODS: Sisvan microdata from 2015 to 2019 were used. After analyzing sample adequacy, exploratory factor analysis was carried out considering factor loadings (≥ 0.30 and < 0.85), communality (> 0.20), model fit indices - Tucker-Lewis index (TLI) > 0.90, and root mean square error of approximation (RMSEA) < 0.08. A critical analysis of the form items was performed to adjust the parameters. Measurement stability was investigated between age groups, macro-regions and longitudinally by multi-group confirmatory factor analysis in configural, metric, and scalar invariance models. Configural invariance was accepted if RMSEA < 0.08 and TLI and comparative fit index (CFI) > 0.90. Metric and scalar invariances were accepted if ΔRMSEA < 0.015 and ΔCFI < 0.01, compared to the previous model. RESULTS: After critical analysis, items were grouped (vegetables and leafy greens; meat or eggs and liver) and excluded (salty food; porridge with milk; rice, potatoes, yams, cassava, flour, or pasta). The exploratory model comprised three factors: healthy complementary feeding (fruit; vegetables; orange or dark green leafy vegetables or fruits; meat, offal, or egg; beans), ultra-processed (yogurt; hamburger and/or sausages; sweetened drinks; instant noodles, packet snacks, or salty cookies; sandwich cookies, sweets, or treats), and milk feeding (breast milk; other milk), with satisfactory factor loadings, communalities and fit (TLI: 0.918, RMSEA: 0.071). The reformulated instrument was stable in the invariance models tested. CONCLUSIONS: With the incorporation of the modifications to the Sisvan form, the food intake markers subsidize a more adequate interpretation of the feeding situation of children aged six to 23 months.

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BACKGROUND: Several strategies for identifying biologically implausible values in longitudinal anthropometric data have recently been proposed, but the suitability of these strategies for large population datasets needs to be better understood. This study evaluated the impact of removing population outliers and the additional value of identifying and removing longitudinal outliers on the trajectories of length/height and weight and on the prevalence of child growth indicators in a large longitudinal dataset of child growth data. METHODS: Length/height and weight measurements of children aged 0 to 59 months from the Brazilian Food and Nutrition Surveillance System were analyzed. Population outliers were identified using z-scores from the World Health Organization (WHO) growth charts. After identifying and removing population outliers, residuals from linear mixed-effects models were used to flag longitudinal outliers. The following cutoffs for residuals were tested to flag those: -3/+3, -4/+4, -5/+5, -6/+6. The selected child growth indicators included length/height-for-age z-scores and weight-for-age z-scores, classified according to the WHO charts. RESULTS: The dataset included 50,154,738 records from 10,775,496 children. Boys and girls had 5.74% and 5.31% of length/height and 5.19% and 4.74% of weight values flagged as population outliers, respectively. After removing those, the percentage of longitudinal outliers varied from 0.02% (<-6/>+6) to 1.47% (<-3/>+3) for length/height and from 0.07 to 1.44% for weight in boys. In girls, the percentage of longitudinal outliers varied from 0.01 to 1.50% for length/height and from 0.08 to 1.45% for weight. The initial removal of population outliers played the most substantial role in the growth trajectories as it was the first step in the cleaning process, while the additional removal of longitudinal outliers had lower influence on those, regardless of the cutoff adopted. The prevalence of the selected indicators were also affected by both population and longitudinal (to a lesser extent) outliers. CONCLUSIONS: Although both population and longitudinal outliers can detect biologically implausible values in child growth data, removing population outliers seemed more relevant in this large administrative dataset, especially in calculating summary statistics. However, both types of outliers need to be identified and removed for the proper evaluation of trajectories.

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ABSTRACT OBJECTIVE To explore the internal structure and analyze evidence of measurement invariance of the Sisvan form of food intake markers of the Food and Nutrition Surveillance System (Sisvan) for children aged six to 23 months. METHODS Sisvan microdata from 2015 to 2019 were used. After analyzing sample adequacy, exploratory factor analysis was carried out considering factor loadings (≥ 0.30 and < 0.85), communality (> 0.20), model fit indices - Tucker-Lewis index (TLI) > 0.90, and root mean square error of approximation (RMSEA) < 0.08. A critical analysis of the form items was performed to adjust the parameters. Measurement stability was investigated between age groups, macro-regions and longitudinally by multi-group confirmatory factor analysis in configural, metric, and scalar invariance models. Configural invariance was accepted if RMSEA < 0.08 and TLI and comparative fit index (CFI) > 0.90. Metric and scalar invariances were accepted if ΔRMSEA < 0.015 and ΔCFI < 0.01, compared to the previous model. RESULTS After critical analysis, items were grouped (vegetables and leafy greens; meat or eggs and liver) and excluded (salty food; porridge with milk; rice, potatoes, yams, cassava, flour, or pasta). The exploratory model comprised three factors: healthy complementary feeding (fruit; vegetables; orange or dark green leafy vegetables or fruits; meat, offal, or egg; beans), ultra-processed (yogurt; hamburger and/or sausages; sweetened drinks; instant noodles, packet snacks, or salty cookies; sandwich cookies, sweets, or treats), and milk feeding (breast milk; other milk), with satisfactory factor loadings, communalities and fit (TLI: 0.918, RMSEA: 0.071). The reformulated instrument was stable in the invariance models tested. CONCLUSIONS With the incorporation of the modifications to the Sisvan form, the food intake markers subsidize a more adequate interpretation of the feeding situation of children aged six to 23 months.

RESUMO OBJETIVOS Explorar a estrutura interna e analisar evidências de invariância de mensuração do formulário de marcadores do consumo alimentar do Sistema de Vigilância Alimentar e Nutricional (Sisvan) para crianças de seis a 23 meses. MÉTODOS Utilizaram-se microdados do Sisvan de 2015 a 2019. Após análise de adequação da amostra, realizou-se análise fatorial (AF) exploratória considerando valores de cargas fatoriais (≥ 0,30 e < 0,85), comunalidade (> 0,20) e índices de ajuste do modelo - índice de Tucker-Lewis (TLI) > 0,90 e raiz do erro quadrático médio de aproximação (RMSEA) < 0,08. Empreendeu-se uma análise crítica aos itens do formulário para adequação dos parâmetros. A estabilidade de mensuração foi investigada entre grupos etários, macrorregiões e longitudinalmente por AF confirmatória multigrupo em modelos de invariância configural, métrica e escalar. A invariância configural foi aceita se RMSEA < 0,08 e TLI e índice de ajuste comparativo (CFI) > 0,90. Invariâncias métrica e escalar foram aceitas se ΔRMSEA < 0,015 e ΔCFI < 0,01, comparando-se ao modelo anterior. RESULTADOS Após análise crítica, itens do formulário foram agrupados (legumes e verduras; carnes ou ovos e fígado) e excluídos (comida de sal; mingau com leite; arroz, batata, inhame, mandioca, farinha ou macarrão). O modelo exploratório compreendeu três fatores: alimentação complementar saudável (frutas; hortaliças; vegetal ou fruta alaranjados ou folhas verdes escuras; carnes, vísceras ou ovo; feijão), ultraprocessada (iogurte; hambúrguer e/ou embutidos; bebidas adoçadas; macarrão instantâneo, salgadinhos de pacote ou biscoitos salgados; biscoito recheado, doces ou guloseimas), e láctea (leite do peito; outro leite), com cargas fatoriais, comunalidades e ajuste satisfatórios (TLI: 0,918, RMSEA: 0,071). O instrumento reformulado foi estável nos modelos de invariância testados. CONCLUSÕES Com a incorporação das modificações ao formulário do Sisvan, os marcadores subsidiam uma interpretação mais adequada da situação alimentar de crianças de seis a 23 meses.

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The Brazilian Strategy for the Prevention and Care of Childhood Obesity (PROTEJA) aims to implement a set of actions to prevent obesity in Brazil. As such, this qualitative and descriptive documentary study presents the Strategy's stages of the operational design, general proposal, evaluation and monitoring conducted by the Brazilian Ministry of Health's technical coordination. After analyzing the epidemiological data on children and the existing policies aimed at obesity prevention, and reviewing the scientific literature and recommendations, PROTEJA was formulated and approved by the Brazilian Ministry of Health, and 1,320 municipalities committed to implementing 20 essential and 5 complementary actions, from 41, including some structural to improve environments. Coordinated by the Brazilian Ministry of Health in partnership with subnational governments and universities, the Strategy also relies on a local team for implementation support, as well as implementation and impact evaluations. Actions will be monitored annually, and the indicators will impact financial incentives. As a strong, evidence-based and innovative strategy aiming to promote healthy environments in cities, PROTEJA has the potential to open a path to childhood obesity reversal, as well as add to the implementation science and contribute to the development and improvement of public policies for obesity prevention; however, its implementation remains a challenge.

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OBJECTIVE: To evaluate the quality of anthropometric data of children recorded in the Food and Nutrition Surveillance System (SISVAN) from 2008 to 2017. METHOD: Descriptive study on the quality of anthropometric data of children under five years of age admitted in primary care services of the Unified Health System, from the individual databases of SISVAN. Data quality was annually assessed using the indicators: coverage, completeness, sex ratio, age distribution, weight and height digit preference, implausible z-score values, standard deviation, and normality of z-scores. RESULTS: In total, 73,745,023 records and 29,852,480 children were identified. Coverage increased from 17.7% in 2008 to 45.4% in 2017. Completeness of birth date, weight, and height corresponded to almost 100% in all years. The sex ratio was balanced and approximately similar to the expected ratio, ranging from 0.8 to 1. The age distribution revealed higher percentages of registrations from the ages of two to four years until mid-2015. A preference for terminal digits "zero" and "five" was identified among weight and height records. The percentages of implausible z-scores exceeded 1% for all anthropometric indices, with values decreasing from 2014 onwards. A high dispersion of z-scores, including standard deviations between 1.2 and 1.6, was identified mainly in the indices including height and in the records of children under two years of age and residents in the North, Northeast, and Midwest regions. The distribution of z-scores was symmetric for all indices and platykurtic for height/age and weight/age. CONCLUSIONS: The quality of SISVAN anthropometric data for children under five years of age has improved substantially between 2008 and 2017. Some indicators require attention, particularly for height measurements, whose quality was lower especially among groups more vulnerable to nutritional problems.

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OBJECTIVE: To describe the time trends and socio-economic inequalities in infant and young child feeding practices in accordance with the Brazilian deprivation index (BDI). DESIGN: This time-series study analysed the prevalence of multiple breast-feeding and complementary feeding indicators based on data from the Brazilian Food and Nutrition Surveillance System, 2008-2019. Prais-Winsten regression models were used to analyse time trends. Annual percent change (APC) and 95 % CI were calculated. SETTING: Primary health care services, Brazil. PARTICIPANTS: Totally, 911 735 Brazilian children under 2 years old. RESULTS: Breast-feeding and complementary feeding practices differed between the extreme BDI quintiles. Overall, the results were more favourable in the municipalities with less deprivation (Q1). Improvements in some complementary feeding indicators were observed over time and evidenced such disparities: minimum dietary diversity (Q1: Δ 47·8-52·2 %, APC + 1·44, P = 0·006), minimum acceptable diet (Q1: Δ 34·5-40·5 %, APC + 5·17, P = 0·004) and consumption of meat and/or eggs (Q1: Δ 59·7-80·3 %, APC + 6·26, P < 0·001; and Q5: Δ 65·7-70·7 %, APC + 2·20, P = 0·041). Stable trends in exclusive breast-feeding and decreasing trends in the consumption of sweetened drinks and ultra-processed foods were also observed regardless the level of the deprivation. CONCLUSIONS: Improvements in some complementary food indicators were observed over time. However, the improvements were not equally distributed among the BDI quintiles, with children from the municipalities with less deprivation benefiting the most.

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The aim of the present study was to estimate the population coverage of recording food intake markers in Brazil's Food and Nutrition Surveillance System (Sisvan) and mean annual percent change (APC) in coverage according to the system used for data entry (e-SUS APS and Sisvan Web). We conducted an ecological time series study of the period 2015-2019. The data were stratified into region and age group. APC in coverage was calculated using Prais-Winsten regression and the correlation between APC and HDI, GDP per capita and primary healthcare coverage was assessed using Spearman's correlation coefficient. Population coverage of recording food intake markers at national level was 0.92% in 2019. Mean APC in coverage throughout the period was 45.63%. The region and age group with the highest coverage rate were the Northeast (4.08%; APC=45.76%, p<0.01) and children aged 2-4 years (3.03%; APC=34.62%, p<0.01), respectively. There was an upward trend in data entry using e-SUS APS, to the detriment of Sisvan Web. There was a positive correlation between APC in coverage using e-SUS APS and HDI and GDP per capita in some age groups. Population coverage of recording Sisvan food intake markers remains low across the country. The e-SUS APS has the potential to be an important strategy for expanding food and nutrition surveillance.

O objetivo deste estudo foi estimar a cobertura populacional e a taxa de incremento anual (TIA) média, em âmbito nacional, do registro de marcadores do consumo alimentar do Sistema de Vigilância Alimentar e Nutricional (Sisvan), entre 2015 e 2019, considerando a entrada dos dados via Estratégia e-SUS APS e Sisvan Web. Trata-se de estudo ecológico de séries temporais, com estratificação por macrorregiões e faixas etárias. A TIA da cobertura foi calculada utilizando regressão de Prais-Winsten e a correlação com IDH, PIB per capita e cobertura da APS foi avaliada por teste de Spearman. A cobertura populacional do registro de marcadores de consumo alimentar no país foi de 0,92% em 2019, com TIA significante de 45,63% desde 2015. As maiores coberturas foram observadas na região Nordeste (4,08%; TIA=45,76%, p<0,01) e em crianças entre 2 e 4 anos (3,03%; TIA=34,62%, p<0,01). Houve tendência crescente para a entrada dos dados via e-SUS APS, em detrimento do Sisvan Web. A TIA da cobertura dos registros via e-SUS APS exibiu correlação positiva com IDH e PIB per capita em alguns recortes etários. A cobertura populacional do registro de marcadores de consumo alimentar do Sisvan ainda se mostra incipiente no país e o e-SUS APS parece ser uma estratégia relevante para sua expansão.

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Resumo O objetivo deste estudo foi estimar a cobertura populacional e a taxa de incremento anual (TIA) média, em âmbito nacional, do registro de marcadores do consumo alimentar do Sistema de Vigilância Alimentar e Nutricional (Sisvan), entre 2015 e 2019, considerando a entrada dos dados via Estratégia e-SUS APS e Sisvan Web. Trata-se de estudo ecológico de séries temporais, com estratificação por macrorregiões e faixas etárias. A TIA da cobertura foi calculada utilizando regressão de Prais-Winsten e a correlação com IDH, PIB per capita e cobertura da APS foi avaliada por teste de Spearman. A cobertura populacional do registro de marcadores de consumo alimentar no país foi de 0,92% em 2019, com TIA significante de 45,63% desde 2015. As maiores coberturas foram observadas na região Nordeste (4,08%; TIA=45,76%, p<0,01) e em crianças entre 2 e 4 anos (3,03%; TIA=34,62%, p<0,01). Houve tendência crescente para a entrada dos dados via e-SUS APS, em detrimento do Sisvan Web. A TIA da cobertura dos registros via e-SUS APS exibiu correlação positiva com IDH e PIB per capita em alguns recortes etários. A cobertura populacional do registro de marcadores de consumo alimentar do Sisvan ainda se mostra incipiente no país e o e-SUS APS parece ser uma estratégia relevante para sua expansão.

Abstract The aim of the present study was to estimate the population coverage of recording food intake markers in Brazil's Food and Nutrition Surveillance System (Sisvan) and mean annual percent change (APC) in coverage according to the system used for data entry (e-SUS APS and Sisvan Web). We conducted an ecological time series study of the period 2015-2019. The data were stratified into region and age group. APC in coverage was calculated using Prais-Winsten regression and the correlation between APC and HDI, GDP per capita and primary healthcare coverage was assessed using Spearman's correlation coefficient. Population coverage of recording food intake markers at national level was 0.92% in 2019. Mean APC in coverage throughout the period was 45.63%. The region and age group with the highest coverage rate were the Northeast (4.08%; APC=45.76%, p<0.01) and children aged 2-4 years (3.03%; APC=34.62%, p<0.01), respectively. There was an upward trend in data entry using e-SUS APS, to the detriment of Sisvan Web. There was a positive correlation between APC in coverage using e-SUS APS and HDI and GDP per capita in some age groups. Population coverage of recording Sisvan food intake markers remains low across the country. The e-SUS APS has the potential to be an important strategy for expanding food and nutrition surveillance.

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OBJECTIVE: To estimate the prevalence of vitamin A deficiency (VAD) in children and associated risk factors. DESIGN: Analysis of data from a cross-sectional multicentre study performed in the primary care units of the municipalities from January to June 2015. The children's legal guardians answered a socio-economic questionnaire, and the children's blood samples were obtained by venipuncture. Plasma retinol was determined by HPLC. Plasma retinol values of <0·70 µmol/l were considered VDA. Poisson multiple regression with robust variance was used. Values of P < 0·05 were considered significant. The data were analysed in the SPSS software, 21.0. SETTING: Forty-eight poorest municipalities in the South Region of Brazil. PARTICIPANTS: Children (n 1503) aged 12-59 months. RESULTS: The prevalence of VAD in the sample was 1·9 % (95 % CI (0·5, 6·8)). The following risk factors were associated with the outcome in the final explanatory model: family received Bolsa Familia program benefits (PR = 3·19; 95 % CI (1·69, 6·02)), child was not being breastfed (PR = 5·22; 95 % CI (1·68, 16·18)) and stunting (PR = 4·75; 95 % CI (2·10, 10·73)). CONCLUSIONS: VAD did not represent a public health problem for children living in socio-economically vulnerable municipalities in the South Region of Brazil, suggesting a new panorama of this nutritional deficiency even in regions of low socio-economic conditions in these three states. Thus, in view of the current nutritional transition scenario, it is necessary to continuously monitor and improve public policies related to vitamin A supplementation in the country.

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Resumo O presente estudo ecológico descritivo objetivou analisar o papel indutor de um incentivo financeiro federal repassado aos municípios brasileiros em 2020, em meio à pandemia de COVID-19, no aumento do número de atendimentos individuais para a condição de obesidade na atenção primária à saúde (APS). Utilizaram-se dados secundários, obtidos no Sistema de Informação em Saúde para a Atenção Básica e no Sistema de Vigilância Alimentar e Nutricional (SISVAN). Em 2021, 74,8% dos 5.504 municípios que receberam o incentivo financeiro apresentaram aumento no número de atendimentos individuais para a condição avaliada como obesidade na APS, em relação a 2020. O número de pessoas identificadas com obesidade e o número de atendimentos individuais para esta condição foram maiores em 2021 do que nos demais anos analisados (2017 a 2020). Na comparação de 2021 com 2020 (ano de recebimento do incentivo financeiro), observou-se que o percentual de aumento de atendimentos individuais foi superior ao percentual de aumento de pessoas com obesidade registradas no SISVAN (77,6% vs. 39,1%). Em conclusão, incentivos financeiros federais, canalizados para o fortalecimento do cuidado às pessoas com obesidade no âmbito da APS, figuram como importantes mecanismos de indução de ações em nível local.

Abstract This descriptive ecological study sought to analyze the inductive role of a federal financial incentive passed on to Brazilian municipalities in 2020, during the COVID-19 pandemic, in increasing the number of individual consultations for the condition of obesity in primary health care (PHC). Secondary data obtained from the Health Information System for Primary Care and from the Food and Nutrition Surveillance System (SISVAN) were used. In 2021, 74.8% of the 5,504 municipalities that received the financial incentive, showed an increase in the number of individual obesity consultations in PHC, compared to 2020. The number of people identified with obesity and the number of individual visits for this condition were higher in 2021 than in the other years analyzed (2017 to 2020). Comparing 2021 with 2020 (year of receipt of the financial incentive), it was observed that the percentage of increase in the number of individual consultations for the condition of obesity was higher than the increase in the number of people identified with obesity in the SISVAN (77.6 % vs. 39.1%). In conclusion, federal financial incentives for municipalities, channeled to enhance care for people with obesity within the scope of PHC, are important mechanisms for inducing actions at the local level.

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ABSTRACT OBJECTIVE To evaluate the quality of anthropometric data of children recorded in the Food and Nutrition Surveillance System (SISVAN) from 2008 to 2017. METHOD Descriptive study on the quality of anthropometric data of children under five years of age admitted in primary care services of the Unified Health System, from the individual databases of SISVAN. Data quality was annually assessed using the indicators: coverage, completeness, sex ratio, age distribution, weight and height digit preference, implausible z-score values, standard deviation, and normality of z-scores. RESULTS In total, 73,745,023 records and 29,852,480 children were identified. Coverage increased from 17.7% in 2008 to 45.4% in 2017. Completeness of birth date, weight, and height corresponded to almost 100% in all years. The sex ratio was balanced and approximately similar to the expected ratio, ranging from 0.8 to 1. The age distribution revealed higher percentages of registrations from the ages of two to four years until mid-2015. A preference for terminal digits "zero" and "five" was identified among weight and height records. The percentages of implausible z-scores exceeded 1% for all anthropometric indices, with values decreasing from 2014 onwards. A high dispersion of z-scores, including standard deviations between 1.2 and 1.6, was identified mainly in the indices including height and in the records of children under two years of age and residents in the North, Northeast, and Midwest regions. The distribution of z-scores was symmetric for all indices and platykurtic for height/age and weight/age. CONCLUSIONS The quality of SISVAN anthropometric data for children under five years of age has improved substantially between 2008 and 2017. Some indicators require attention, particularly for height measurements, whose quality was lower especially among groups more vulnerable to nutritional problems.

RESUMO OBJETIVOS Avaliar a qualidade dos dados antropométricos de crianças registradas no Sistema de Vigilância Alimentar e Nutricional (Sisvan) no período 2008-2017. MÉTODOS Estudo descritivo sobre a qualidade dos dados antropométricos de crianças menores de 5 anos atendidas nos serviços de atenção primária do Sistema Único de Saúde, a partir das bases de dados individuais do Sisvan. A qualidade dos dados foi avaliada anualmente por meio dos indicadores: cobertura, completude, razão entre sexos, distribuição da idade, preferência por dígitos de peso e estatura, valores de escore-z implausíveis, desvio-padrão e normalidade dos escores-z. RESULTADOS No total, 73.745.023 registros e 29.852.480 crianças foram identificados. A cobertura aumentou de 17,7% em 2008 para 45,4% em 2017. A completude da data de nascimento, peso e estatura correspondeu a quase 100% para todos os anos. A razão entre sexos foi equilibrada e aproximadamente similar a razão esperada, variando entre 0,8 e 1. A distribuição da idade revelou maiores percentuais de registros entre as idades de 2 a 4 anos até meados de 2015. Uma preferência pelos dígitos terminais "zero" e "cinco" foi identificada entre os registros de peso e estatura. As porcentagens de escores-z implausíveis excederam 1% para todos os índices antropométricos, com redução dos valores a partir de 2014. Uma alta dispersão dos escores-z, incluindo desvios-padrão entre 1,2 e 1,6, foi identificada principalmente nos índices incluindo estatura e nos registros de crianças menores de 2 anos e residentes das regiões Norte, Nordeste e Centro-Oeste. A distribuição dos escores-z foi simétrica para todos os índices e platicúrtica para estatura/idade e peso/idade. CONCLUSÕES A qualidade dos dados antropométricos do Sisvan para crianças menores de 5 anos melhorou substancialmente entre 2008 e 2017. Alguns indicadores requerem atenção, sobretudo para medidas de estatura, cuja qualidade foi principalmente inferior entre os grupos mais vulneráveis a agravos nutricionais.

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Abstract: The Brazilian Strategy for the Prevention and Care of Childhood Obesity (PROTEJA) aims to implement a set of actions to prevent obesity in Brazil. As such, this qualitative and descriptive documentary study presents the Strategy's stages of the operational design, general proposal, evaluation and monitoring conducted by the Brazilian Ministry of Health's technical coordination. After analyzing the epidemiological data on children and the existing policies aimed at obesity prevention, and reviewing the scientific literature and recommendations, PROTEJA was formulated and approved by the Brazilian Ministry of Health, and 1,320 municipalities committed to implementing 20 essential and 5 complementary actions, from 41, including some structural to improve environments. Coordinated by the Brazilian Ministry of Health in partnership with subnational governments and universities, the Strategy also relies on a local team for implementation support, as well as implementation and impact evaluations. Actions will be monitored annually, and the indicators will impact financial incentives. As a strong, evidence-based and innovative strategy aiming to promote healthy environments in cities, PROTEJA has the potential to open a path to childhood obesity reversal, as well as add to the implementation science and contribute to the development and improvement of public policies for obesity prevention; however, its implementation remains a challenge.

Resumo: A Estratégia de Prevenção e Atenção à Obesidade Infantil (PROTEJA) visa promover a implementação de um pacote de ações para prevenção da obesidade no Brasil. Este estudo apresenta as etapas de desenho operacional, proposta geral, avaliação e monitoramento do PROTEJA realizadas pela coordenação técnica do Ministério da Saúde. Trata-se de um estudo qualitativo baseado em análise descritiva documental. A formulação da estratégia envolveu análise de dados epidemiológicos de crianças brasileiras, análise de políticas existentes, e uma revisão da literatura científica e das recomendações O PROTEJA foi então formulado e aprovado pelo Ministério da Saúde e 1.320 municípios se comprometeram a implementar 20 ações essenciais e 5 complementares das 41 ações, incluindo algumas estruturais para melhoria dos ambientes. A estratégia é coordenada pelo Ministério da Saúde em parceria com governos subnacionais e universidades. Sua implementação conta com apoio de uma equipe em nível local, e prevê a avaliação da implementação e de impacto. As ações serão monitoradas anualmente, e os indicadores também implicarão nos incentivos financeiros. O PROTEJA é uma estratégia forte, baseada em evidências e inovadora que visa promover ambientes saudáveis nas cidades, mas sua implementação é desafiadora. Não obstante, apresenta um possível caminho para a reversão da obesidade infantil. Também pode agregar à ciência de implementação e contribuir para o desenvolvimento e aprimoramento de políticas públicas de prevenção da obesidade.

Resumen: La Estrategia Brasileña para la Prevención y Atención de la Obesidad Infantil (PROTEJA) tiene como objetivo promover la implementación de un conjunto de acciones para prevenir la obesidad en Brasil. Este estudio presenta las etapas del diseño operativo, la propuesta general, la evaluación y el seguimiento de PROTEJA realizadas por la coordinación técnica del Ministerio de Salud brasileño. Se trata de un estudio cualitativo basado en el análisis descriptivo de documentos. La formulación de la estrategia implicó el análisis de datos epidemiológicos de niños brasileños, el análisis de las políticas existentes y una revisión de la literatura científica y de las recomendaciones. PROTEJA fue entonces formulado y aprobado por el Ministerio de Salud, y 1.320 municipios se comprometieron a implementar 20 acciones esenciales y 5 complementarias de las 41 acciones, incluidas algunas estructurales para mejorar los entornos. La estrategia es coordinada por el Ministerio de Salud en colaboración con gobiernos subnacionales y universidades. Su implementación cuenta con el apoyo de un equipo a nivel local, y prevé una evaluación de la implementación y de impacto. Las acciones se monitorearán anualmente, y los indicadores también implicarán incentivos económicos. PROTEJA es una estrategia sólida, basada en evidencias e innovadora que busca promover entornos saludables en las ciudades, pero su implementación es un desafío. Sin embargo, presenta una posible vía para revertir la obesidad infantil. También puede agregar a la ciencia de implementación y contribuir al desarrollo y a la mejora de políticas públicas para prevenir la obesidad.

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RESUMO O objetivo do presente estudo foi mostrar a evolução do percentual de escolas aderidas ao Programa Saúde na Escola (PSE) que realizaram atividade coletiva sobre Promoção da Alimentação Adequada e Saudável (Paas) ao longo dos últimos cinco anos e verificar se há diferença desse indicador segundo adesão ao Programa Crescer Saudável (PCS). Trata-se de um estudo de delineamento ecológico, desenvolvido com dados cadastrados no Sistema de Informação em Saúde para a Atenção Básica (Sisab). Houve incremento na realização de ações coletivas sobre Paas durante o período de 2017 a 2019. Em 2020, houve redução das ações realizadas; e em 2021, houve incremento de ações realizadas em comparação com 2020. Os municípios que receberam recurso financeiro adicional por terem aderido ao PCS apresentaram os maiores percentuais de escolas que realizaram atividades coletivas sobre Paas. A realização das ações de Paas não ocorreu de forma homogênea segundo as macrorregiões brasileiras. Conclui-se que, nos últimos anos, houve o fortalecimento das ações de Paas no âmbito do PSE, com significativa redução dessa ação no contexto da pandemia da Covid-19. O recebimento do recurso adicional do PCS favoreceu o desenvolvimento das ações sobre Paas, o que reforça a importância do repasse financeiro regular.

ABSTRACT The study aims to show the evolution of the percentage of schools adhering to the School Health Program (PSE) that carried out a collective activity on the Promotion of Adequate and Healthy Eating (PAAS) over the last five years and verify if there is a difference in this indicator according to adhesion to the Healthy Growth Program (PCS). Ecological study, developed with data registered in the Health Information System for Primary Care (SISAB). The performance of collective actions on PAAS from 2017 to 2019 increased. In 2020, there was a reduction in the actions carried out; and in 2021 there was an increase in actions carried out compared to 2020. The municipalities that received additional funds from the PCS had the highest percentages of schools carrying out collective activities on PAAS. The implementation of PAAS actions did not occur homogeneously according to the Brazilian macro-regions. It is concluded that there has been a strengthening of PAAS actions within the scope of the PSE, with a significant reduction of this action in the context of the COVID-19 pandemic. Getting additional resources from the PCS favored the development of actions on PAAS, which reinforces the importance of regular financial transfers.

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Chronic non-communicable diseases correspond to the main cause of death in the world and have inadequate nutrition as one of its main modifiable risk factors, highlighting the excessive consumption of sodium and its association with cardiovascular diseases, mediated by blood pressure. This study evaluated the impact of different policy scenarios for reducing sodium consumption from processed and ultra-processed foods in the prevention of deaths due to cardiovascular outcomes in the adult population in Brazil. We used secondary data from public reports and databases of the Brazilian Unified National Health System (SUS) and population surveys. We analyzed the impacts, up to 2027, of three scenarios: maintenance of the current voluntary targets, and two mandatory scenarios, considering the lowest targets in the Americas and the lowest global targets. The Preventable Risk Integrated ModEl (PRIME) analyzed the deaths prevented or delayed from sodium consumption in such scenarios. In 2027, more than 72,000 deaths would be attributed to excess sodium; the voluntary goals would result in the prevention or postponement of up to 4,001 (95% uncertainty intervals - 95%UI: 1,611-6,563) deaths, while the mandatory scenarios would result in the prevention of 9,704 (95%UI: 3,955-15,665) and 15,561 (95%UI: 6,350-25,096) deaths from cardiovascular diseases, considering the lower regional and international targets, respectively. The findings suggest that the maintenance of voluntary targets has limited impact when compared to possible and more restrictive scenarios of reducing sodium content in processed and ultra-processed foods and reinforce the need to adopt measures with greater effectiveness in the country.

Doenças crônicas não transmissíveis correspondem à principal causa de morte no mundo e têm a alimentação inadequada como um de seus principais fatores de risco modificáveis, destacando-se o consumo excessivo de sódio e sua associação com doenças cardiovasculares, mediadas pela pressão arterial. Este estudo avaliou o impacto de diferentes cenários de políticas para a redução do consumo de sódio com base em alimentos processados e ultraprocessados na prevenção de mortes por desfechos cardiovasculares na população adulta no Brasil. Foram utilizados dados secundários, de relatórios e bases públicas do Sistema Único de Saúde e de inquéritos populacionais. Foram analisados os impactos, até 2027, de três cenários: manutenção das atuais metas voluntárias, e dois cenários mandatórios, considerando as menores metas nas Américas e as menores metas mundiais. Para a análise das mortes prevenidas ou adiadas com base no consumo de sódio em tais cenários foi utilizado o Preventable Risk Integrated ModEl (PRIME). Em 2027, mais de 72 mil mortes seriam atribuíveis ao excesso de sódio e as metas voluntárias resultariam na prevenção ou adiamento de até 4.001 (intervalos de 95% de incerteza - II95%: 1.611-6.563) mortes, e os cenários mandatórios resultariam na prevenção de 9.704 (II95%: 3.955-15.665) e 15.561 (II95%: 6.350-25.096) mortes por doenças cardiovasculares, considerando as menores metas regionais e internacionais, respectivamente. Os achados sugerem que a manutenção de metas voluntárias tem impacto limitado quando comparada a cenários possíveis e mais restritivos de redução do teor de sódio em alimentos processados e ultraprocessados, e reforçam a necessidade de adoção de medidas com maior efetividade no país.

Las enfermedades crónicas no transmisibles son la principal causa de muerte en el mundo y cuentan con la alimentación inadecuada, como uno de sus principales factores de riesgo modificables, destacándose el consumo excesivo de sodio y su asociación con enfermedades cardiovasculares, causadas por la presión arterial. Este estudio evaluó el impacto de diferentes escenarios de políticas para la reducción del consumo de sodio, en base a alimentos procesados y ultraprocesados, en la prevención de muertes por desenlaces cardiovasculares en la población adulta brasileña. Se utilizaron datos secundarios, de informes y bases públicas del Sistema Único de Salud y de encuestas poblacionales. Se analizaron impactos, hasta 2027, en tres escenarios: mantenimiento de las actuales metas voluntarias, y dos escenarios obligatorios, considerando metas menores en las Américas y las menores metas mundiales. Para el análisis de las muertes prevenidas o pospuestas, basándose en el consumo de sodio en tales escenarios, se utilizó el Preventable Risk Integrated ModEl (PRIME). En 2027, más de 72 mil muertes serían atribuibles al exceso de sodio y las metas voluntarias resultarían en la prevención o aplazamiento de hasta 4.001 (intervalos de 95% de incertidumbre - II95%: 1.611-6.563) muertes, y los escenarios obligatorios resultarían en la prevención de 9.704 (II95%: 3.955-15.665) y 15.561 (II95%: 6.350-25.096) muertes por enfermedades cardiovasculares, considerando las menores metas regionales e internacionales, respectivamente. Los resultados sugieren que el mantenimiento de metas voluntarias tiene un impacto limitado, cuando se compara con escenarios posibles y más restrictivos de reducción del contenido de sodio en alimentos procesados y ultraprocesados, y refuerzan la necesidad de adopción de medidas con una mayor efectividad en el país.

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This study aimed to systematize food and nutrition actions developed in primary health care (PHC) from 1999 to 2019, identifying advances in this period and current perspectives. This is a qualitative study that analyzed documents published between 1999 and 2020, available in scientific databases and in the gray literature. In addition, a quantitative analysis was conducted using information systems from the Brazilian Ministry of Health, such as the Food and Nutrition Surveillance System and the Health Information System for Primary Care, and microdata from the Program for Improving Access and Quality of Primary Health Care (PMAQ-AB). The actions and regulatory milestones identified were categorized as federal administration, food and nutrition surveillance, promotion of proper healthy food, nutritional care - multiple burdens of poor nutrition and training. The results showed food and nutrition actions followed the pace of the epidemiological scenario, considering the multiple burdens of poor nutrition. The first decade was more focused on handling issues involved in hunger, malnutrition and micronutrient deficiency and, in 2006, it started to emphasize prevention and care for people with obesity and other non-communicable chronic diseases and promote proper healthy food, developing actions in the period with a strong intersectoral character and understanding PHC as a priority field of action in the Brazilian Unified National Health System (SUS). The universalization of food and nutrition actions in PHC is still a current challenge.

O objetivo do estudo é sistematizar as ações de alimentação e nutrição desenvolvidas na atenção primária à saúde (APS), de 1999 a 2019, identificando os avanços no período e perspectivas atuais. É uma pesquisa qualitativa realizada baseando-se na análise de documentos publicados entre 1999 e 2020, disponíveis em bases de dados científicos e na literatura cinza. Adicionalmente, realizou-se análise quantitativa valendo-se de sistemas de informação do Ministério da Saúde, como o Sistema de Vigilância Alimentar e Nutricional e o Sistema de Informação em Saúde para a Atenção Básica e dos microdados do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB). As ações e marcos normativos identificados foram categorizados em gestão, vigilância alimentar e nutricional, promoção da alimentação adequada e saudável, atenção nutricional - múltipla carga de má nutrição e formação. Os resultados revelam que as ações de alimentação e nutrição acompanharam o cenário epidemiológico, considerando-se a múltipla carga da má nutrição, estando a primeira década mais direcionada ao enfrentamento da fome, da desnutrição e carências de micronutrientes e; a partir de 2006, passou a dar ênfase à prevenção e cuidado de pessoas com obesidade e outras doenças crônicas não transmissíveis, além da promoção da alimentação adequada e saudável, desenvolvendo, durante todo o período, ações com forte caráter intersetorial e compreendendo o lócus da APS como campo prioritário de atuação no Sistema Único de Saúde. A universalização das ações de alimentação e nutrição na APS, contudo, é ainda um desafio atual.

El objetivo del estudio es sistematizar las acciones de alimentación y nutrición desarrolladas en la atención primária a la salud (APS), de 1999 a 2019, identificando los avances durante este período y perspectivas actuales. Es una investigación cualitativa, realizada basándose en el análisis de documentos publicados entre 1999 y 2020, disponibles en bases de datos científicas y en literatura gris. Asimismo, se realizó un análisis cuantitativo, valiéndose de sistemas de información del Ministerio de Salud, como el Sistema de Vigilancia Alimentario y Nutricional y el Sistema de Información en Salud para la Atención Básica, así como de los microdatos procedentes del Programa Nacional de Mejoría de Acceso y Calidad de la Atención Básica (PAMQ-AB). Las acciones y marcos normativos identificados fueron categorizados en gestión, vigilancia alimentaria y nutricional, promoción de la alimentación adecuada y saludable, atención nutricional - múltiple carga de mala nutrición y formación. Los resultados revelan que las acciones de alimentación y nutrición acompañaron el escenario epidemiológico, considerándose la múltiple carga de la mala nutrición, estando la primera década más dirigida al combate del hambre, desnutrición y carencias de micronutrientes y, a partir de 2006, pasó a dar énfasis a la prevención y cuidado de personas con obesidad y otras enfermedades crónicas no transmisibles, además de la promoción de la alimentación adecuada y saludable, desarrollando, durante todo el período, acciones con un fuerte carácter intersectorial y comprendiendo el locus de la APS como campo prioritario de actuación en el Sistema Único de Salud. La universalización de las acciones de alimentación y nutrición en la APS constituye un desafío todavía actual.

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The association between lifestyle factors and mental health has been evaluated in isolation; however, there has been a lack of information about lifestyle patterns and Common Mental Disorders (CMD) in adolescents. Therefore, the present study aims to assess the association between sets of lifestyle patterns and the occurrence of CMD in Brazilian adolescents evaluated in a national school-based cross-sectional survey. The outcome variable considered was presence of CMD. Lifestyle patterns were identified from the Principal Component Analysis. Consumption of foods, water and alcoholic beverages, sleep, physical activity, and smoking were used to identify patterns as explanatory variables. Sociodemographic characteristics, administrative dependence of the school and, nutritional status, were considered adjustment factors in the regression model. A total of 70,427 adolescents were evaluated. The principal component analysis identified three lifestyle patterns: high consumption of ultra-processed foods and low consumption of unprocessed or minimally processed foods (pattern 1); high consumption of alcoholic beverages and tobacco in the last 30 days (pattern 2); and high consumption of water and high level of physical activity (pattern 3). In the adjusted model, in patterns 1 and 2, the third tertile presented greater chance of CMD (OR 1.68; CI 95% 1.51-1.87 and OR 1.38; CI 95% 1.19-1.60, respectively). In pattern 3, the second (OR 0.88; CI 95% 0.80-0.96) and the third (OR 0.80; CI 95% 0.72-0.88) tertiles presented lower chances of CMD among the adolescents evaluated. Therefore, we suggest that health-promoting practices aimed at adolescents include multiple behaviors, with the objective of ensuring physical, mental, and social well-being.

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OBJECTIVE: In Brazil, national estimates of childhood malnutrition have not been updated since 2006. The use of health information systems is an important complementary data source for analysing time trends on health and nutrition. This study aimed to examine temporal trends and socio-demographic inequalities in the prevalence of malnutrition in children attending primary health care services between 2009 and 2017. DESIGN: Time trends study based on data from Brazil's Food and Nutrition Surveillance System. Malnutrition prevalence (stunting, wasting, overweight and double burden) was annually estimated by socio-demographic variables. Prais-Winsten regression models were used to analyse time trends. Annual percent change (APC) and 95 % CI were calculated. SETTING: Primary health care services, Brazil. PARTICIPANTS: Children under 5 years old. RESULTS: In total, 15,239,753 children were included. An increase in the prevalence of overweight (APC = 3·4 %; P = 0·015) and a decline in the prevalence of wasting (-6·2 %; P = 0·002) were observed. The prevalence of stunting (-3·2 %, P = 0·359) and double burden (-1·4 %, P = 0·630) had discrete and non-significant reductions. Despite the significant reduction in the prevalence of undernutrition among children in the most vulnerable subgroups (black, conditional cash transfer's recipients and residents of poorest and less developed areas), high prevalence of stunting and wasting persist alongside a disproportionate increase in the prevalence of overweight in these groups. CONCLUSIONS: The observed pattern in stunting (high and persistent prevalence) and increase in overweight elucidate setbacks in advances already observed in previous periods and stresses the need for social and political strategies to address multiple forms of malnutrition.

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Few studies have investigated the simultaneous effect of individual and contextual factors on the occurrences of anemia. This study aims to evaluate the variability of children's hemoglobin levels from municipalities in social vulnerability and its association with factors of individual and municipal nature. This is a cross-sectional, multi-center study, with children data (12-59 months) collected from 48 municipalities of the Southern region of Brazil, that were included in the Brazil Without Poverty Plan. Individuals' data were collected using a structured questionnaire, and secondary and ecological data of children's municipalities were collected via national surveys and institutional websites. The outcome was defined as the hemoglobin level obtained by HemoCue. A multilevel analysis was performed using Generalized Linear Models for Location Scale and Shape using R, with a 5% significance level. A total of 1,501 children were evaluated. The mean hemoglobin level was 12.8g/dL (95%CI: 12.7-12.8), with significant variability between municipalities. Lower values of hemoglobin were observed in children who lived in municipalities with a higher urbanization rate and a lower number of Community Health Agents, in relation to the reference categories. At the individual level, lower hemoglobin values were identified for children under 24 months, not enrolled at daycares, who were beneficiaries of the conditional cash transfer program and diagnosed with underweight. The results shed light on important factors at the municipal and the individual levels that were associated to the hemoglobin levels of children living in municipalities in social vulnerability.

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In Brazil, the promotion, protection, and recovery of health are among the initiatives provided by the public and universal Unified Health System (SUS). The primary healthcare level (PHC), the preferred point of access to the system, plays the role of coordinating and ordinating health care services and actions in the network. In the context of PHC, feeding and nutrition efforts must be aligned with National Feeding and Nutrition Policy (PNAN) guidelines and may be supported by feeding and nutritional surveillance actions. Data from PHC information systems and population surveys show that excess weight affects more than half the adult population of Brazil, and that consumption of ultra-processed foods is on the rise. This scenario requires that health care teams be prepared to prioritize initiatives for users with chronic diseases, using risk stratification, stabilization of the disease, and enhancement of supported self-care with a focus on diet and physical activity. At the same time, considering the country's epidemiological profile, teams must carry out initiatives to fight undernutrition and prevent anemia and hypovitaminosis A to address the multiple burden of malnutrition. The present article describes the current scenario of feeding and nutrition initiatives implemented at the PHC level in Brazil via the SUS.

En Brasil, el Sistema Único de Salud (SUS), que es público y universal, ofrece medidas de promoción, protección y recuperación de la salud. La atención primaria de salud es la puerta preferida de acceso de la población al SUS, y su función es coordinar y ordenar las medidas y los servicios de salud disponibles en la red. En el ámbito de la atención primaria de salud, las medidas de alimentación y nutrición deben estar en consonancia con las directrices de la política nacional de alimentación y nutrición, y pueden potenciarse a partir de medidas de vigilancia alimentaria y nutricional. Los datos de los sistemas de información disponibles en todas las unidades básicas de salud y en encuestas poblacionales indican que más de la mitad de la población adulta en Brasil presenta exceso de peso y que ha aumentado el consumo de alimentos ultraprocesados. Esa situación exige que los equipos de salud se organicen con objeto de priorizar ciertas medidas para las personas con trastornos crónicos, según la estratificación del riesgo, la estabilización del trastorno y la potenciación del autocuidado apoyado, con enfoque en la alimentación y la actividad física. Al mismo tiempo, según el perfil epidemiológico, los equipos deben emprender actividades de lucha contra la desnutrición y de prevención de la anemia y de la carencia de vitamina A, teniendo en cuenta la múltiple carga de la malnutrición en el país. El objetivo del presente artículo es presentar el panorama actual de las medidas relativas a la alimentación y nutrición que se llevan a cabo en el ámbito de la atención primaria de salud en el SUS.