title: Food environment and fruit and vegetable intake in a urban population: a multilevel analysis.
abstract: BACKGROUND
  Environmental, social and individual factors influence eating patterns, which in turn affect the risk of many chronic diseases. This study aimed to estimate associations between environmental factors and the consumption of fruit and vegetables among adults in a Brazilian urban context.
  
  
  METHODS
  Data from the surveillance system for risk factors for chronic diseases (VIGITEL) of Brazilian Ministry of Health were used. A cross-sectional telephone survey (VIGITEL - 2008-2010) was carried out with 5826 adults in the urban area of Belo Horizonte. Individual variables were collected. The frequency of fruit and vegetables consumption was assessed from number of servings, weekly frequency and an intake score was calculated. Georeferenced variables were used to characterize the food environment. The density of healthy food outlets (stores specialized in selling fruit and vegetables), unhealthy food outlets (bars, snack bars and food trucks/trailers) and the neighborhood family income were investigated and associated with fruit and vegetables intake score. Weighted multilevel linear regression was used to evaluate the associations between the environment variables and the fruit and vegetables intake score.
  
  
  RESULTS
  Higher fruit and vegetables intake scores were observed in neighborhoods with higher density of healthy food outlets and higher income. Lower scores were observed in neighborhood with higher density of unhealthy food outlets. These associations were adjusted by individual variables such as gender, age, physical activity, sugar sweetened beverages consumption, education level and smoking.
  
  
  CONCLUSIONS
  The food environment might explain some of the socioeconomic disparities with respect to healthy food intake and health outcomes. Healthy food stores are less common in socially disadvantaged neighborhoods, and therefore, healthy foods such as fruits and vegetables are less available or are of a lower quality in lower income areas.
  
  
  CONCLUSIONS
  Food environment characteristics and neighborhood socioeconomic level had significant associations with fruit and vegetable intake score. These are initial findings that require further investigation within the middle income world populations and the role of the environment with respect to both healthy and unhealthy food acquisition and intake.
authors.affiliation: Departamento de Nutrição e Saúde, Universidade Federal de Viçosa, Viçosa, Minas Gerais, Brazil. milenecpessoa@gmail.com.
authors.forename: Milene Cristine
authors.initials: MC
authors.lastname: Pessoa
authors.affiliation: Departamento de Nutrição, Universidade Federal de Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil. larissalouresmendes@gmail.com.
authors.forename: Larissa Loures
authors.initials: LL
authors.lastname: Mendes
authors.affiliation: Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem, Universidade Federal de Minas Gerais, Av. Alfredo Balena, 190, Belo Horizonte, Minas Gerais, Brasil, 30130-100. criziansaar@gmail.com.
authors.forename: Crizian Saar
authors.initials: CS
authors.lastname: Gomes
authors.affiliation: Departamento de Ciências do Movimento Humano, Universidade Federal de São Paulo, Santos, São Paulo, Brazil. paula.andrea.martins@gmail.com.
authors.forename: Paula Andréa
authors.initials: PA
authors.lastname: Martins
authors.affiliation: Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem, Universidade Federal de Minas Gerais, Av. Alfredo Balena, 190, Belo Horizonte, Minas Gerais, Brasil, 30130-100. jguveme@gmail.com.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Velasquez-Melendez
mesh_terms: D000328:Adult; D001938:Brazil; D003132:Commerce / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D005638:Fruit; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D055361:Multilevel Analysis; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012931:Social Environment; D012959:Socioeconomic Factors; D014505:Urban Population / Q000706:statistics & numerical data*; D014675:Vegetables