ABSTRACT OBJECTIVE To study the association between ultra-processed food consumption and carbon and water footprints of the Brazilian diet. METHODS Cross-sectional analysis on data collected in 2008–2009 on a probabilistic sample of the Brazilian population aged ≥ 10 years (n = 32,886). Individual food intake was assessed using two 24-hour food records, on non-consecutive days. The environmental impact of individual diets was calculated by multiplying the amount of each food by coefficients that quantify the atmospheric emissions of greenhouse gases in grams of carbon dioxide equivalent (carbon footprint) and freshwater use in liters (water footprint), both per gram or milliliter of food. The two coefficients consider the food life cycle ‘from farm to fork.’ Crude and adjusted linear regression models and tests for linear trends assessed the association between the ultra-processed food contribution to total energy intake (quintiles) and the diet carbon and water footprints. Potential confounders included age, sex, education, income, and region. Total energy intake was assessed as a potential mediation variable. RESULTS In the crude models, the dietary contribution of ultra-processed foods was linearly associated with the carbon and water footprints of the Brazilian diet. After adjustment for potential confounders, the association remained significant only regarding the diet water footprint, which increased by 10.1% between the lowest and highest quintile of the contribution of ultra-processed foods. Additional adjustment for total energy intake eliminated this association indicating that the dietary contribution of ultra-processed foods increases the diet water footprint by increasing energy intake. CONCLUSIONS The negative impact of ultra-processed foods on the diet water footprint, shown for the first time in this study, adds to the negative impacts of these foods, already demonstrated regarding dietary nutrient profiles and the risk for several chronic non-communicable diseases. This reinforces the recommendation to avoid ultra-processed foods made in the official Brazilian Dietary Guidelines and increasingly in dietary guidelines of other countries.

ABSTRACT OBJECTIVE To study the association between ultra-processed food consumption and carbon and water footprints of the Brazilian diet. METHODS Cross-sectional analysis on data collected in 2008–2009 on a probabilistic sample of the Brazilian population aged ≥ 10 years (n = 32,886). Individual food intake was assessed using two 24-hour food records, on non-consecutive days. The environmental impact of individual diets was calculated by multiplying the amount of each food by coefficients that quantify the atmospheric emissions of greenhouse gases in grams of carbon dioxide equivalent (carbon footprint) and freshwater use in liters (water footprint), both per gram or milliliter of food. The two coefficients consider the food life cycle ‘from farm to fork.’ Crude and adjusted linear regression models and tests for linear trends assessed the association between the ultra-processed food contribution to total energy intake (quintiles) and the diet carbon and water footprints. Potential confounders included age, sex, education, income, and region. Total energy intake was assessed as a potential mediation variable. RESULTS In the crude models, the dietary contribution of ultra-processed foods was linearly associated with the carbon and water footprints of the Brazilian diet. After adjustment for potential confounders, the association remained significant only regarding the diet water footprint, which increased by 10.1% between the lowest and highest quintile of the contribution of ultra-processed foods. Additional adjustment for total energy intake eliminated this association indicating that the dietary contribution of ultra-processed foods increases the diet water footprint by increasing energy intake. CONCLUSIONS The negative impact of ultra-processed foods on the diet water footprint, shown for the first time in this study, adds to the negative impacts of these foods, already demonstrated regarding dietary nutrient profiles and the risk for several chronic non-communicable diseases. This reinforces the recommendation to avoid ultra-processed foods made in the official Brazilian Dietary Guidelines and increasingly in dietary guidelines of other countries.

ABSTRACT OBJECTIVE To estimate beef consumption and its influence on carbon and water footprints, as well as to improve the nutritional quality of the Brazilian diet. METHODS The amount of beef and other foods consumed was evaluated by two 24-hour food records in a representative sample of the Brazilian population ≥ 10 years of age (n = 32,853) from 2008 to 2009. The environmental impact of the diet considered the coefficients of the carbon footprint (gCO2 and/kg) and the water footprint (liters/kg) of the foods, as well as their nutritional quality considering the nutrient composition of each food associated with the prevention of nutritional deficiencies or the increase/decrease in chronic disease risk. Linear and logistic regression models, crude and adjusted for sex, age, education, income, region, and area, were used to respectively study the association of fifths of the caloric contribution of beef with the environmental impacts of the diet and inadequate nutrient intake. RESULTS Carbon and water footprints and protein, iron, zinc, vitamin B12, saturated fat, and sodium contents were higher in the fraction of the diet composed of beef, whereas fiber and added sugar contents were higher in the fraction composed by the other foods. Dietary beef contribution was directly associated with the carbon and water footprints of the diet and the risk of saturated fat and sodium excess, besides fiber insufficiency, inversely associated with the risk of protein, iron, zinc, and vitamin B12 insufficiency. CONCLUSION Reducing beef consumption in Brazil would also reduce the carbon and water footprints of the diet, as well as the risk of chronic diseases related to food. Therefore, in order not to increase the risk of nutritional deficiencies, monitoring the increased intake of other foods rich in protein, iron, zinc, and vitamin B12 is suggested.

RESUMO OBJETIVO Estimar o consumo de carne bovina e a sua influência nas pegadas de carbono e na pegada hídrica, bem como mesurar a qualidade nutricional da dieta no Brasil. MÉTODOS A quantidade consumida de carne bovina e dos demais alimentos foi avaliada por dois registros alimentares de 24 horas em amostra representativa da população brasileira ≥ 10 anos de idade (n = 32.853) entre 2008 e 2009. O impacto ambiental da dieta considerou os coeficientes da pegada de carbono (gCO2e/kg) e da pegada hídrica (litros/kg) dos alimentos, bem como sua qualidade nutricional considerando a composição de cada alimento em nutrientes associados à prevenção de deficiências nutricionais ou ao aumento/diminuição do risco de doenças crônicas. Modelos de regressão linear e logística, brutos e ajustados para sexo, idade, escolaridade, renda, região e área, foram utilizados para estudar, respectivamente, a associação de quintos da contribuição calórica de carne bovina com os impactos ambientais da dieta e com a ingestão inadequada de nutrientes. RESULTADOS As pegadas de carbono e hídrica e os teores de proteína, ferro, zinco, vitamina B12, gordura saturada e sódio foram maiores na fração da dieta composta por carnes bovinas, enquanto o teor de fibra e de açúcar de adição foram maiores na fração composta pelos demais alimentos. A contribuição dietética de carne bovina mostrou-se associada diretamente com as pegadas de carbono e hídrica da dieta e com o risco de ingestão excessiva de gordura saturada e de sódio, além de ingestão insuficiente de fibra, associando-se inversamente com o risco de ingestão insuficiente de proteína, ferro, zinco e vitamina B12. CONCLUSÃO A redução no consumo de carne bovina no Brasil diminuiria as pegadas de carbono e hídrica da dieta, assim como o risco de doenças crônicas relacionadas à alimentação. Portanto, para não aumentar o risco de deficiências nutricionais, é sugerido o acompanhamento do aumento da ingestão de outros alimentos fontes de proteína, ferro, zinco e vitamina B12.

RESUMO OBJETIVO Estimar o consumo de carne bovina e a sua influência nas pegadas de carbono e na pegada hídrica, bem como mesurar a qualidade nutricional da dieta no Brasil. MÉTODOS A quantidade consumida de carne bovina e dos demais alimentos foi avaliada por dois registros alimentares de 24 horas em amostra representativa da população brasileira ≥ 10 anos de idade (n = 32.853) entre 2008 e 2009. O impacto ambiental da dieta considerou os coeficientes da pegada de carbono (gCO2e/kg) e da pegada hídrica (litros/kg) dos alimentos, bem como sua qualidade nutricional considerando a composição de cada alimento em nutrientes associados à prevenção de deficiências nutricionais ou ao aumento/diminuição do risco de doenças crônicas. Modelos de regressão linear e logística, brutos e ajustados para sexo, idade, escolaridade, renda, região e área, foram utilizados para estudar, respectivamente, a associação de quintos da contribuição calórica de carne bovina com os impactos ambientais da dieta e com a ingestão inadequada de nutrientes. RESULTADOS As pegadas de carbono e hídrica e os teores de proteína, ferro, zinco, vitamina B12, gordura saturada e sódio foram maiores na fração da dieta composta por carnes bovinas, enquanto o teor de fibra e de açúcar de adição foram maiores na fração composta pelos demais alimentos. A contribuição dietética de carne bovina mostrou-se associada diretamente com as pegadas de carbono e hídrica da dieta e com o risco de ingestão excessiva de gordura saturada e de sódio, além de ingestão insuficiente de fibra, associando-se inversamente com o risco de ingestão insuficiente de proteína, ferro, zinco e vitamina B12. CONCLUSÃO A redução no consumo de carne bovina no Brasil diminuiria as pegadas de carbono e hídrica da dieta, assim como o risco de doenças crônicas relacionadas à alimentação. Portanto, para não aumentar o risco de deficiências nutricionais, é sugerido o acompanhamento do aumento da ingestão de outros alimentos fontes de proteína, ferro, zinco e vitamina B12.

ABSTRACT OBJECTIVE To estimate beef consumption and its influence on carbon and water footprints, as well as to improve the nutritional quality of the Brazilian diet. METHODS The amount of beef and other foods consumed was evaluated by two 24-hour food records in a representative sample of the Brazilian population ≥ 10 years of age (n = 32,853) from 2008 to 2009. The environmental impact of the diet considered the coefficients of the carbon footprint (gCO2 and/kg) and the water footprint (liters/kg) of the foods, as well as their nutritional quality considering the nutrient composition of each food associated with the prevention of nutritional deficiencies or the increase/decrease in chronic disease risk. Linear and logistic regression models, crude and adjusted for sex, age, education, income, region, and area, were used to respectively study the association of fifths of the caloric contribution of beef with the environmental impacts of the diet and inadequate nutrient intake. RESULTS Carbon and water footprints and protein, iron, zinc, vitamin B12, saturated fat, and sodium contents were higher in the fraction of the diet composed of beef, whereas fiber and added sugar contents were higher in the fraction composed by the other foods. Dietary beef contribution was directly associated with the carbon and water footprints of the diet and the risk of saturated fat and sodium excess, besides fiber insufficiency, inversely associated with the risk of protein, iron, zinc, and vitamin B12 insufficiency. CONCLUSION Reducing beef consumption in Brazil would also reduce the carbon and water footprints of the diet, as well as the risk of chronic diseases related to food. Therefore, in order not to increase the risk of nutritional deficiencies, monitoring the increased intake of other foods rich in protein, iron, zinc, and vitamin B12 is suggested.

RESUMO OBJETIVO: Estimar a pegada de carbono da dieta brasileira e de estratos sociodemográficos dessa população. MÉTODOS: A pegada de carbono da dieta foi estimada com base nos dados de dois registros alimentares de 24 horas, obtidos em 2008 e 2009, de uma amostra probabilística da população brasileira com 10 ou mais anos de idade (n = 34.003) e em coeficientes de impacto ambiental de alimentos e preparações culinárias consumidos no Brasil (gCO2e/kg). Médias com intervalos de confiança de 95% do consumo alimentar (kcal/pessoa/dia) e da pegada de carbono da dieta (gCO2e/pessoa/dia e em gCO2e/2.000kcal) foram calculadas para o conjunto da população e para estratos segundo sexo, idade, renda, escolaridade, macrorregiões e Unidade Federativa. Modelos de regressão linear foram utilizados para identificar diferenças significativas (p < 0,05) na pegada de carbono da dieta de diferentes estratos sociodemográficos. RESULTADOS: A pegada média de carbono da dieta brasileira foi de 4.489gCO2e/pessoa/dia. Foi maior para o sexo masculino, para a faixa etária de 20 a 49 anos e para as regiões Norte e Centro-Oeste, e tendeu a aumentar com a renda e a escolaridade. O padrão de associação da pegada a variáveis sociodemográficas não se alterou substancialmente com o ajuste para diferenças na quantidade consumida de alimentos, exceto por uma redução no excesso relativo da pegada entre homens e pelo aumento no excesso relativo da pegada na região Centro-Oeste. CONCLUSÃO: A pegada de carbono da dieta brasileira excede em cerca de 30% a pegada da dieta humana que poderia atender, simultaneamente, os requisitos nutricionais de uma dieta saudável e a meta global de contenção do aumento da temperatura média do planeta. O padrão de associação dessa pegada às variáveis sociodemográficas pode auxiliar na identificação de alvos prioritários para ações públicas que visem a reduzir os impactos ambientais do consumo alimentar no Brasil.

ABSTRACT OBJECTIVE: To estimate the carbon footprint of the Brazilian diet and of sociodemographic strata of this population. METHODS: Carbon footprint of the diet was estimated based on data from two 24-hour diet records, obtained in 2008 and 2009, from a probabilistic sample of the Brazilian population aged 10 years and over (n = 34,003) and on environmental impact coefficients of food and culinary preparations consumed in Brazil (gCO2e/kg). Means with 95% confidence intervals of food consumption (kcal/person/day) and the carbon footprint of the diet (gCO2e/person/day and in gCO2e/2,000kcal) were calculated for the population as a whole and for strata according to sex, age, income, education, macro-regions and Federative Unit. Linear regression models were used to identify significant differences (p < 0.05) in the dietary carbon footprint of different sociodemographic strata. RESULTS: The average carbon footprint of the Brazilian diet was 4,489gCO2e/person/day. It was higher for males, for the age group from 20 to 49 years and for the North and Midwest regions, and tended to increase with income and education. The pattern of association of footprint with sociodemographic variables did not change substantially with adjustment for differences in the amount of food consumed, except for a reduction in the relative excess of the footprint among males and an increase in the relative excess of the footprint in the Midwest region. CONCLUSION: The carbon footprint of the Brazilian diet exceeds by about 30% the footprint of the human diet, which could simultaneously meet the nutritional requirements of a healthy diet and the global goal of containing the increase in the planet's average temperature. The pattern of association of this footprint with sociodemographic variables can help identify priority targets for public actions aimed at reducing the environmental impacts of food consumption in Brazil.

RESUMO OBJETIVO: Estimar a pegada de carbono da dieta brasileira e de estratos sociodemográficos dessa população. MÉTODOS: A pegada de carbono da dieta foi estimada com base nos dados de dois registros alimentares de 24 horas, obtidos em 2008 e 2009, de uma amostra probabilística da população brasileira com 10 ou mais anos de idade (n = 34.003) e em coeficientes de impacto ambiental de alimentos e preparações culinárias consumidos no Brasil (gCO2e/kg). Médias com intervalos de confiança de 95% do consumo alimentar (kcal/pessoa/dia) e da pegada de carbono da dieta (gCO2e/pessoa/dia e em gCO2e/2.000kcal) foram calculadas para o conjunto da população e para estratos segundo sexo, idade, renda, escolaridade, macrorregiões e Unidade Federativa. Modelos de regressão linear foram utilizados para identificar diferenças significativas (p < 0,05) na pegada de carbono da dieta de diferentes estratos sociodemográficos. RESULTADOS: A pegada média de carbono da dieta brasileira foi de 4.489gCO2e/pessoa/dia. Foi maior para o sexo masculino, para a faixa etária de 20 a 49 anos e para as regiões Norte e Centro-Oeste, e tendeu a aumentar com a renda e a escolaridade. O padrão de associação da pegada a variáveis sociodemográficas não se alterou substancialmente com o ajuste para diferenças na quantidade consumida de alimentos, exceto por uma redução no excesso relativo da pegada entre homens e pelo aumento no excesso relativo da pegada na região Centro-Oeste. CONCLUSÃO: A pegada de carbono da dieta brasileira excede em cerca de 30% a pegada da dieta humana que poderia atender, simultaneamente, os requisitos nutricionais de uma dieta saudável e a meta global de contenção do aumento da temperatura média do planeta. O padrão de associação dessa pegada às variáveis sociodemográficas pode auxiliar na identificação de alvos prioritários para ações públicas que visem a reduzir os impactos ambientais do consumo alimentar no Brasil.

ABSTRACT OBJECTIVE: To estimate the carbon footprint of the Brazilian diet and of sociodemographic strata of this population. METHODS: Carbon footprint of the diet was estimated based on data from two 24-hour diet records, obtained in 2008 and 2009, from a probabilistic sample of the Brazilian population aged 10 years and over (n = 34,003) and on environmental impact coefficients of food and culinary preparations consumed in Brazil (gCO2e/kg). Means with 95% confidence intervals of food consumption (kcal/person/day) and the carbon footprint of the diet (gCO2e/person/day and in gCO2e/2,000kcal) were calculated for the population as a whole and for strata according to sex, age, income, education, macro-regions and Federative Unit. Linear regression models were used to identify significant differences (p < 0.05) in the dietary carbon footprint of different sociodemographic strata. RESULTS: The average carbon footprint of the Brazilian diet was 4,489gCO2e/person/day. It was higher for males, for the age group from 20 to 49 years and for the North and Midwest regions, and tended to increase with income and education. The pattern of association of footprint with sociodemographic variables did not change substantially with adjustment for differences in the amount of food consumed, except for a reduction in the relative excess of the footprint among males and an increase in the relative excess of the footprint in the Midwest region. CONCLUSION: The carbon footprint of the Brazilian diet exceeds by about 30% the footprint of the human diet, which could simultaneously meet the nutritional requirements of a healthy diet and the global goal of containing the increase in the planet's average temperature. The pattern of association of this footprint with sociodemographic variables can help identify priority targets for public actions aimed at reducing the environmental impacts of food consumption in Brazil.

Resumo Fundamentos: Associação entre obesidade, terapia interdisciplinar e exercício físico intenso foi descrita para obesos. Contudo o estudo das atividades físicas representando as tarefas do dia a dia e o risco cardiovascular nas atividades do cotidiano torna-se necessário para verificar a ocorrência dessa associação. Objetivo: Investigar se um período de 18 semanas de terapia interdisciplinar é capaz de promover benefícios nos parâmetros cardiovasculares no repouso e durante o exercício físico em adultos obesos. Métodos: Amostra de 32 indivíduos de ambos os sexos com índice de massa corporal de 30 a 39,9 kg/m2 e idade entre 30 e 50 anos. Intervenção com terapia interdisciplinar (educação física, psicologia, nutrição e fisioterapia), duração de 18 semanas e mensuração de dados antropométricos de massa corporal, estatura, circunferências de cintura e quadril, avaliação de esforço máximo em ergômetro antes e após o período de terapia. Resultados: A terapia interdisciplinar diminuiu pressão arterial sistólica (PAS): 125,83 ± 9,86 (basal) vs 120,28 ± 16,82 (final), frequência cardíaca (FC): 74,75 ± 11,02 (basal) vs 72,77 ± 10,72 (final), e duplo-produto (DP) em repouso. Reduziu também durante o esforço submáximo PAS estágios 1: 143,44 ± 9,28 (basal) vs 131,56 ± 15,26; estágio 2: 152,23 ± 21,91 (basal) vs 141,56 ± 17,43 (final), PAD estágio 2: 89,89 ± 9,58 (basal) vs 83,13 ± 9,65 (final), FC estágio 1: 118,40 ± 12,90 (basal) vs 110,87 ± 7,66 (final); estágio 2: 137,09 ± 16,54 (basal) vs 130,37 ± 11,51 (final) e o DP referentes aos estágios iniciais. Conclusão: A terapia interdisciplinar reduziu a sobrecarga do sistema cardiovascular em repouso e no esforço submáximo em adultos obesos otimizando o repouso e atividades do cotidiano. (Int J Cardiovasc Sci. 2017;30(2):128-135)

Abstract Background: Association between obesity, interdisciplinary therapy and intense physical exercise was described for obese patients. However, the study of physical activities representing daily tasks and cardiovascular risk in everyday activities becomes necessary to verify the occurrence of this association. Objective: To investigate whether a period of 18 weeks of interdisciplinary therapy is capable of promoting benefits in cardiovascular parameters at rest and during exercise in obese adults. Methods: Sample of 32 individuals of both sexes with body mass index of 30 to 39.9 kg/m2 and age between 30 and 50 years. Intervention with interdisciplinary therapy (physical education, psychology, nutrition and physiotherapy), duration of 18 weeks and measurement of anthropometric data of body mass, height, waist and hip circumferences, maximum exercise ergometer evaluation before and after the therapy period. Results: Interdisciplinary therapy decreased systolic blood pressure (SBP): 125.83 ± 9.86 (baseline) vs 120.28 ± 16.82 (final), heart rate (HR): 74.75 ± 11.02 (baseline) ) Vs 72.77 ± 10.72 (final), and double-product (DP) at rest. Reduced also during the submaximal PAS stress stages 1: 143.44 ± 9.28 (baseline) vs 131.56 ± 15.26; Stage 2: 152.23 ± 21.91 (baseline) vs. 141.56 ± 17.43 (final), PAD stage 2: 89.89 ± 9.58 (baseline) vs 83.13 ± 9.65 (final) , FC stage 1: 118.40 ± 12.90 (baseline) vs 110.87 ± 7.66 (final); Stage 2: 137.09 ± 16.54 (baseline) vs 130.37 ± 11.51 (final) and the PD referring to the initial stages. Conclusion: Interdisciplinary therapy reduced the overload of the cardiovascular system at rest and submaximal effort in obese adults, optimizing rest and daily activities.