RESEARCH Research and Professional Briefs Dietary Quality and Associated Factors among Adults Living in the State of São Paulo, Brazil REGINA MARA FISBERG, PhD; JULIANA MASAMI MORIMOTO, MSc; BETZABETH SLATER, PhD; MARILISA BERTI DE AZEVEDO BARROS, PhD; LUANA CARANDINA, PhD; MOISÉS GOLDBAUM, PhD; MARIA DO ROSÁRIO DIAS DE OLIVEIRA LATORRE, PhD; CHESTER LUIZ GALVÃO CÉSAR, PhD ABSTRACT This study sought to analyze dietary quality and associ- ated factors among adults living in regions of the State of São Paulo, Brazil. It was a cross-sectional population- based study of a sample of 3,454 adults ages 20 years and over who were included in the Household Health Survey. Dietary intake was measured by means of the 24-hour recall method, and dietary quality was assessed by means of the Healthy Eating Index (HEI), adapted to local real- ities. Probabilistic samples were obtained via multistage cluster samples from four regions in the State of São Paulo. Linear regression analyses were performed to evaluate the relationships between the HEI and the de- mographic, socioeconomic, and lifestyle variables. Among the individuals assessed, 5% had a good diet, 74% a diet that needed some degree of improvement, and 21% a poor diet. The means for HEI components were lowest for vegetables, fruits, and dairy products. The highest HEI scores were obtained by individuals who were nonsmok- ers, practiced physical activity, were retired, lived in houses or apartments, and had adequate living condi- tions surrounding them. In the multiple regression anal- ysis, the variables of numbers of consumer durable goods, schooling of the head of the family, energy intake, and age had a positive association with the HEI. However, the association was inverse for the variables of smoking and body mass index. Higher dietary quality is associated with higher income, higher schooling level, better nutri- tional status, and being a nonsmoker. Knowledge of these factors is important for implementing programs for pre- ventive nutrition or intervention. J Am Diet Assoc. 2006;106:2067-2072. D iet is an important factor in disease prevention and health promotion. The two main causes of death in Brazil, cardiovascular disease (31.5%) and cancer (15.3%) (1), are associated with dietary intake. The ef- fects of increasing globalization and urbanization over the last few decades have influenced dietary patterns and lifestyles among different population groups throughout the world. Patterns that are far from what is recom- mended are frequently observed. The so-called Western diet prevails, characterized by high levels of fat, satu- rated fat, and sodium, with low levels of calcium and fiber. These types of food have been strongly associated with increasing rates of obesity and increases in the in- cidence of noncommunicable diseases (2,3). The data from the most recent survey of family budgets by the Brazilian Institute for Geography and Statistics (4) showed that there has been a declining trend in the consumption of complex carbohydrates (1974-1975, 61.66%; 2002-2003, 55.90%) and increasing consumption of saturated fatty acids (1974-1975, 7.44%; 2002-2003, 8.05%) and total fat (1974-1975, 26.77%; 2002-2003, 30.52%). The same survey showed that 44% of the popu- lation over 18 years old was overweight and that 8.9% of men and 13.1% of women in the whole of Brazil and 10.3% of men and 13.9% of women in the State of São Paulo were obese. Knowledge of eating patterns enables the formulation of public policies directed toward health promotion, main- tenance, or recovery. Thus, the development of tools that allow the assessment of dietary quality has gained de- served prominence in research conducted by health and nutrition professionals. Studies using indices that mea- sure dietary quality and summarize the main character- istics of healthful eating habits enable evaluation of pos- sible associations between diet and demographic, socioeconomic, and lifestyle factors. They may thus be able to identify vulnerable segments of the population. Reports in the literature have shown that individuals R. M. Fisberg is associate professor, Department of Nu- trition, Faculty of Public Health, University of São Paulo, Brazil. J. M. Morimoto is assistant lecturer, School of Biological and Health Sciences, Methodist University, Sao Bernardo do Campo, Brazil. B. Slater is lecturer, Department of Nutrition, Faculty of Public Health, University of São Paulo, Brazil. M. Berti de Azevedo Barros is lecturer, Department of Preventive Medicine, University of Campinas, Brazil. L. Carandina and M. Goldbaum are lecturers, Department of Preven- tive Medicine, University of the State of São Paulo, Botucatu, Brazil. M. do Rosário Dias de Oliveira La- torre and C. Luiz Galvão César are full professors, De- partment of Epidemiology, Faculty of Public Health, University of São Paulo, Brazil. Address correspondence to: Regina Mara Fisberg, PhD, University of São Paulo, Faculty of Public Health, Department of Nutrition, Av. Dr. Arnaldo, 715. São Paulo, Brazil, 01246-904. E-mail: rfisberg@usp.br Copyright © 2006 by the American Dietetic Association. 0002-8223/06/10612-0006$32.00/0 doi: 10.1016/j.jada.2006.09.010 © 2006 by the American Dietetic Association Journal of the AMERICAN DIETETIC ASSOCIATION 2067