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Mello, A.V. (Diet quality and relationship with social determinants of health in residents of São Paulo city (2003 and 2015)). 2018. Dissertation Faculdade de Saúde Pública da Universidade de São Paulo, São Paulo, 2018. Portuguese. Introduction Diet quality is influenced by socioeconomic inequalities. However, there is lack of evidence regarding the level of inequalities in diet quality, and whilst there are wide-ranging efforts to promote healthier diets, issues regarding the dimensions of equity in health are neglected. Therefore, it is essential to understand these issues for development and appropriate implementation of specific interventions in public health. Objective To evaluate diet quality of residents in São Paulo city of 2003, 2008 and 2015 and its association with SDH. Methods Data from the ISA-Nutrition cross-sectional study of 2003, 2008 and 2015 were used, with a probabilistic sample of adolescents, adults and older adults residents in São Paulo city. Socioeconomic and lifestyle data were collected through a semi-structured questionnaire and food consumption, through 24hour dietary recalls. The diet quality was assessed based on the Revised Brazilian Healthy Eating Index (BHEI-R). The descriptive variables were compared using a 95% confidence interval. Differences between BHEI-R means, and its components were compared across age group, year of study and structural SDH. The association of inequalities and SDH with diet quality was based on multiple linear regression models and on the concentration index (CI), which allowed the identification of income-related inequality in diet quality among individuals with different socioeconomic levels. Results We observed that the BHEI-R scores gradually improved over 12-years, with older adults showing the greatest improvement. The increase in overall population score was observed for total fruits, whole fruits, whole grains, oils and sodium. The main contributor to socioeconomic inequality in diet quality in 2003 was ethnic group, and in 2008 and 2015, it was per capita household income; age was a persistent factor of inequality in diet quality over the years. Concentration indices indicated that individuals with lower income had higher scores on BHEI-R in 2003; however, there was a shift in favor of higher income individuals in 2008 and 2015. In 2015, there were differences among BHEI-R components for education, income, occupation, sex and ethnic group, and the components whole grains, sodium and calories from solid fat, alcoholic beverage and added sugar are among the furthest from the index reference values. Factors positively associated with diet quality of residents in São Paulo city in 2015 were number of diseases, income and "other" category of occupation. Factors negatively associated were energy, alcohol consumption, education, ethnicity nonwhite and being unemployed. These factors explain the diet quality in 54%. Conclusions The observed inequalities are useful to subsidize public policies and specific actions for different levels of education, income, occupation, sex, ethnic group and age groups, as well as to encourage actions aimed at a healthy lifestyle. Descriptors: Food Consumption; Health Eating Index; Inequality in Health; Income Social Determinants, Social Inequality.

Qualidade da dieta e relação com determinantes sociais da saúde em residentes do município de São Paulo (2003 e 2015)