Hypertensive subjects’ perceptions of the food system and health
DOI:
https://doi.org/10.12957/demetra.2026.85375Keywords:
Food System. Qualitative Research. Health Promotion. Social Determinants of Health.]Abstract
The hegemonic food system is associated with malnutrition and the increasing prevalence of chronic non-communicable diseases, such as hypertension. This study aims to describe the food system from the perspective of individuals diagnosed with hypertension. It is a qualitative study conducted in Primary Health Care in Ouro Preto, Minas Gerais, Brazil, through four workshops using the “talking map” technique, each lasting approximately 90 minutes. The data produced were systematized into reports and analyzed through thematic content analysis. Participants reported significant changes in the food system, highlighting the shift from food practices based on family cultivation and preparation to the consumption of ultra-processed foods. They associated these transformations with the loss of sensory quality in food, reduced dietary diversity, and the intensive use of chemical inputs, all of which have negative impacts on planetary health. In addition, they identified food prices as a determining factor in food choices and recognized farmers’ markets as spaces whichpromote access to healthy foods. In conclusion, participants perceived the hegemonic food system as a health risk factor and acknowledged the need for changes to promote adequate and healthy eating practices.
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References
1. High Level Panel of Experts on Food Security and Nutrition of the Committee on World Food Security (HLPE). Nutrition and food systems: a report by the High-Level Panel of Experts on Food Security and Nutrition of the Committee on World Food Security. Rome: FAO; 2017.
2. Seferidi P, Scrinis G, Huybrechts I, Woods J, Vineis P, Millett C. The neglected environmental impacts of ultra-processed foods. Lancet Planet Health 2020;4:e437-e438. https://doi.org/10.1016/S2542-5196(20)30177-7
3. Porto MF, Soares WL. Modelo de desenvolvimento, agrotóxicos e saúde: um panorama da realidade agrícola brasileira e propostas para uma agenda de pesquisa inovadora. Dossiê Temático: Trabalho, Saúde e Meio Ambiente na Agricultura: Interações, Impactos e Desafios à Segurança e Saúde do Trabalhador. Rev Bras Saúde Ocup 2012;37(125):17-50. https://doi.org/10.1590/S0303-76572012000100004.
4. Monteiro CA, Moubarac JC, Cannon G, Ng SW, Popkin B. Ultra-processed products are becoming dominant in the global food system. Obes Rev 2013;14(Suppl. 2):21-8. https://doi.org/10.1111/obr.12107
5. Food and Agriculture Organization of the United Nations (FAO), International Fund for Agricultural Development, UNICEF, World Food Programme, WHO. The state of food security and nutrition in the world 2017: building climate resilience for food security and nutrition. Rome: Food and Agriculture Organization of the United Nations, 2017.
6. Swinburn BA, Kraak VI, Allender S, Atkins VJ, Baker PI, Bogard JR, Brinsden H, et al. The Global Syndemic of Obesity, Undernutrition, and Climate Change: The Lancet Commission report. Lancet 2019; 393(10173):791-846. https://doi.org/10.1016/S0140-6736(18)32822-8
7. High Level Panel of Experts on Food Security and Nutrition (HLPE). Investing in smallholder agriculture for food security: a report by the High-Level Panel of Experts on Food Security and Nutrition. Rome: FAO; 2013.
8. Peres J, Matioli V, Swinburn B. A sindemia global e a classificação NOVA. Cad. Saúde Pública 2021;37 Sup 1:e00312520. https://doi.org/10.1590/0102-311X00312520
9. Organização Mundial da Saúde (OMS). Declaração de Alma-Ata: primeira conferência internacional sobre cuidados primários de saúde. Genebra: OMS; 1978.
10. Organização Mundial da Saúde (OMS). Carta de Ottawa para a promoção da saúde: primeira conferência internacional sobre promoção da saúde. Genebra: OMS; 1986.
11. Nascimento BR, Brant LCC, Yadgir S, Oliveira GMM, Roth G, Glenn SD, et al. Trends in prevalence, mortality, and morbidity associated with high systolic blood pressure in Brazil from 1990 to 2017: estimates from the “Global Burden of Disease 2017” (GBD 2017) study. Popul Health Metrics 2020;18(Supl. 1):17. https://doi.org/10.1186/s12963-020-00218-z
12. Machado AD, Marchioni DM, Carvalho AM. A insustentabilidade dos sistemas alimentares atuais deve ser integrada no entendimento da COVID-19 como uma sindemia. Cad. Saude Publica 2021;37(12):e00253221. https://doi.org/10.1590/0102-311X00253221
13. Ramos JFC, Miranda L, Peixoto MVM, Marques MR, Mendes LC, Pereira EHP. Participative research and comprehensive child healthcare promotion strategies in the Brazilian National Health System (SUS). Interface (Botucatu) 2018;22(67):1077-89. https://doi.org/10.1590/1807-57622017.0280
14. Canesqui AM. Pesquisas qualitativas em nutrição e alimentação. Rev. Nutr 2009;22(1):125-139. https://doi.org/10.1590/S1415-52732009000100012
15. Instituto Brasileiro de Geografia e Estatística (IBGE). Ouro Preto. [Internet] [acessado 2023 mar 24]. Disponível em: https://cidades.ibge.gov.br/brasil/mg/ouro-preto/panorama.
16. Minayo MCS. O desafio do conhecimento: pesquisa qualitativa em saúde. 14ª ed. São Paulo: Hucitec; 2014.
17. Basch CE. Focus group interview: an underutilized research technique for improving theory and practice in health education. Health EducQ 1987;14(4):411-48. https://doi.org/10.1177/109019818701400404
18. Toledo RF, Giatti LL. Challenges to participation in action research. Health Promot Int. 2015;30(1):162-173. https://doi.org/10.1093/heapro/dau079
19. Matuk T, Toledo RF. O uso de técnicas de pesquisa participativa frente à complexidade do sistema agroalimentar. In: Toledo RF, Rosa TEC, Keinert TM, Cortizo CT, organizadores. Pesquisa participativa em saúde: vertentes e veredas. Temas de Saúde Coletiva. São Paulo: Instituto de Saúde; 2018. p. 471-482.
20. Bardin L. Análise de Conteúdo. Lisboa: Edições 70; 1970.
21. Silveira VNC, dos Santos AM, França AKTC. Determinants of the consumption of ultra-processed foods in the Brazilian population. British JournalofNutrition 2024;132(8):1104-1109. https://doi.org/10.1017/S0007114524001429
22. Kim H, Hu EA, Rebholz CM. Ultra-processed food intake and mortality in the USA: results from the Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994). Public Health Nutr 2019;22(10):1777-1785. https://doi.org/10.1017/S1368980018003890
23. Mendonça RD, Lopes AC, Pimenta AM, Gea A, Martinez-Gonzalez MA, Bes-Rastrollo M. Ultra-Processed Food Consumption and the Incidence of Hypertension in a Mediterranean Cohort: The Seguimiento Universidad de Navarra Project. Am J Hypertens 2017;30(4):358-366. https://doi.org/10.1093/ajh/hpw137
24. Proença, RPC. Alimentação e globalização: algumas reflexões. Cienc. Cult 2010;62(4):43-47.
25. Marijn Stok F, Renner B, Allan J, Boeing H, Ensenauer R, Issanchou S, et al. Dietary Behavior: An Interdisciplinary Conceptual Analysis and Taxonomy. Front Psychol 2018;20(9):1689. https://doi.org/10.3389/fpsyg.2018.01689
26. Garcia RWD. Reflexos da globalização na cultura alimentar: considerações sobre as mudanças na alimentação urbana. Rev Nutr 2003;16(4):483-492.https://doi.org/10.1590/S1415-52732003000400011
27. Martins APB, Levy RB, Claro RM, Moubarac JC, Monteiro CA. Participação crescente de produtos ultraprocessados na dieta brasileira (1987-2009). Rev Saude Publ 2013;47:656-665. https://doi.org/10.1590/S0034-8910.2013047004968
28. Serafim P, Borges CA, Cabral-Miranda W, Jaime PC. Ultra-Processed Food Availability and Sociodemographic Associated Factors in a Brazilian Municipality. Frontiers in Nutrition 2022;9:e858089. https://doi.org/10.3389/fnut.2022.858089
29. Instituto Brasileiro de Geografia e Estatística, Diretoria de Pesquisas, Coordenação de Trabalho e Rendimento. Pesquisa de Orçamentos Familiares 2017-2018: análise do consumo alimentar pessoal no Brasil. Rio de Janeiro: IBGE; 2020.
30. Louzada MLC, Cruz GL, Silva KAAN, Grassi AGF, Andrade GC, Rauber F, Levy RB, Monteiro CA. Consumo de alimentos ultraprocessados no Brasil: distribuição e evolução temporal 2008–2018. Rev Saude Publica 2023;57,1-13. https://doi.org/10.11606/s1518-8787.2023057004744
31. Popkin BM, Ng SW. The nutrition transition to a stage of high obesity and noncommunicable disease prevalence dominated by ultra-processed foods is not inevitable. Obes Rev 2022;23(1):e13366. https://doi.org/10.1111/obr.13366
32. Baker P, Machado P, Santos T, Sievert K, Backholer K, Hadjikakou M, et al. Ultra-processed foods and the nutrition transition: Global, regional and national trends, food systems transformations and political economy drivers. Obes Rev 2020;21(12):1-22, 2020. https://doi.org/10.1111/obr.13126
33. Meller FO, Schäfer AA, Santos LP, Quadra MR, Miranda VIA. Double Burden of Malnutrition and Inequalities in the Nutritional Status of Adults: A Population-Based Study in Brazil, 2019. Int J Public Health 2021;66:609179. https://doi.org/10.3389/ijph.2021.609179
34. Jobim PFC, Nunes LN, Giugliani R, Cruz IBM. Existe uma associação entre mortalidade por câncer e uso de agrotóxicos? Uma contribuição ao debate. Cienc Saude Colet 2010;15(1):277-288. https://doi.org/10.1590/S1413-81232010000100033
35. Lopes CVA, Albuquerque GSC. Agrotóxicos e seus impactos na saúde humana e ambiental: uma revisão sistemática. Saúde debate 2018;42(117):518-528. https://doi.org/10.1590/0103-1104201811714
36. Silva GP, Zanella R. A contribuição da polifeira do agricultor (UFSM – Santa Maria) com a Segurança Alimentar e Nutricional. In: Preiss PV, Schneider S, Coelho-de-Souza G, organizadores. Contribuição Brasileira à Segurança Alimentar e Nutricional Sustentável. Porto Alegre; 2020. p. 227-241.
37. de Arruda ASF, Mascarenhas GM de A, de Oliveira WH. A agricultura familiar como alternativa: em busca de segurança alimentar e nutricional. [Internet]. [citado 4 de agosto de 2025];25(2). Disponível em: https://www.e-publicacoes.uerj.br/intersecoes/article/view/57362
38. Fardet A, Rock E. Ultra-Processed Foods and Food System Sustainability: What are the Links? Sustainability 2020;12(15), 6280. https://doi.org/10.3390/su12156280
39. GarzilloJMF, Machado PP, Leite FHM, Steele EM, Poli VFS, Louzada MLC, Levy RB, Monteiro CA. Carbon footprint of the Brazilian diet. Rev Saude Publ 2021;55(90):1-10. https://doi.org/10.11606/s1518-8787.2021055003614
40. Geyer Roland, JambeckJR, Law KL. Production, use, andfate of all plastics ever made. Science Advances 2017;3(7):e1700782. https://doi.org/10.1126/sciadv.1700782.
41. Verghese K, Lewis H, Lockrey S, Williams H. Packaging’s Role in Minimizing Food Loss and Waste Across the Supply Chain. Packag Technol Sci 2015;28(7):603-620. https://doi.org/10.1002/pts.2127
42. European Commission. A European Strategy for Plastics in a Circular Economy. Brussels, Belgium: European Commission; 2018.
43. Barboza LGA, Vethaak AD, LavoranteBRBO, Lundebye A-K, Guilhermino L. Marine microplastic debris: An emerging issue for food security, food safety and human health. Mar Pollut Bull 2018;133:336–348. https://doi.org/10.1016/j.marpolbul.2018.05.047
44. Kumar Rakesh, VermaA, ShoneA, Sinha R, SinhaS; JhaPK, et al. Impacts of Plastic Pollution on Ecosystem Services, Sustainable Development Goals, and Need to Focus on Circular Economy and Policy Interventions. Sustainability 2021;13(17):9963. https://doi.org/10.3390/su13179963.
45. Yates J, Kadiyala S, Deeney M, Carriedo A, Gillespie S, Heindel JJ, et al. A toxic relationship: ultra‑processed foods & plastics. Globalization and Health 2024;20(1):74,24. https://doi.org/10.1186/s12992-024-01078-0.
46. Anderson E, Wei R, Liu B, Plummer R, Kelahan H, Tamez M, et al. Improving Healthy Food Choices in Low-Income Settings in the United States Using Behavioral Economic-Based Adaptations to Choice Architecture. Front Nutr 2021;6(8):734991. https://doi.org/10.3389/fnut.2021.734991
47. Costa BVL, Menezes MC, Oliveira CDL, Mingoti SA, Jaime PC, CaiaffaWT, Lopes ACS. Does access to healthy food vary according to socioeconomic status and to food store type? Anecologic study. BMC Public Health 2019;19:775. https://doi.org/10.1186/s12889-019-6975-y
48. Atanasova P, Kusuma D, Pineda E, Frost G, Sassi F, Miraldo M. The impact of the consumer and neighbourhood food environment on dietary intake and obesity-related outcomes: A systematic review of causal impact studies. SocSci Med 2022;299:114879. https://doi.org/10.1016/j.socscimed.2022.114879
49. Iizaka S, Koitabashi E, Negishi T, Kawamura A, Iizuka Y. Distance from the nearest grocery stores and frequency of store-specific shopping are associated with dietary intake frequency among the community-dwelling independent elderly population. Nutr Health 2020;26(3):197-207. https://doi.org/10.1177/0260106020923806
50. Siegrist M, Hartmann C. Impact of sustainability perception on consumption of organic meat and meat substitutes. Appetite 2019;132:196-202. https://doi.org/10.1016/j.appet.2018.09.016
51. Dupuits C, Mooney E, McCloat A. Consumer Knowledge and Willingness Pertaining to the Adoption of a Sustainable Diet: A Scoping Review. Nutrients 2024;10;16(24):4254. https://doi.org/10.3390/nu16244254
52. Triches RM. Repensando o mercado da alimentação escolar: novas institucionalidades para o meio rural. In: Grisa C, Schneider S, organizadores. Políticas públicas de desenvolvimento rural no Brasil. Porto Alegre: UFRGS; 2015. p. 16-200.
53. Scarabelot M, Schneider S. As cadeias agroalimentares curtas e desenvolvimento local - um estudo de caso no município de Nova Veneza/SC. Faz Cienc Fran Beltrão 2012;14(19):101-30.
54. Maluf, RSJ. Segurança alimentar e nutricional. Petrópolis: Vozes; 2007.
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Copyright (c) 2026 Anabele Pires Santos, Berenice Romão Ferreira, Mariana Carvalho de Menezes, Larissa Loures Mendes, Renata Adrielle Lima Vieira, Júlia Cristina Cardoso Carraro; Raquel de Deus Mendonça
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