Nutritionists in the Brazilian Unified Health System: a perspective on their role in Primary Health CareABSTRACT
To examine the trajectory of nutritionists’ practice in Primary Health Care within the Brazilian Unified Health System. We conducted a narrative review, integrating scientific articles since the establishment of Unified Health System in 1988. The search was performed in the following databases: Scientific Electronic Library Online, National Library of Medicine, Latin American and Caribbean Health Sciences Literature, Scopus, and Web of Science. The material was organized into three thematic axes: historical overview of integration, professional training, and workforce sizing. Sixty-five studies published between 2002 and 2025 were analyzed. The role of nutritionists was limited during the first decade of Unified Health System implementation, expanding significantly with the establishment of the Family Health Support Centers. The 1999 and 2012 editions of the National Food and Nutrition Policy positioned nutritionists as key players in the development of interdisciplinary care strategies. We observed some efforts to align the training of nutritionists and continuing health education with Unified Health System care models and the health needs of the population. Successful training experiences were identified in university-service integration, despite curricular gaps in Collective Health. The insufficient number of nutritionists and working conditions hinder the implementation of actions in Primary Health Care. The work of nutritionists in Primary Health Care has advanced with improved public policies, including the interdisciplinary dimension. However, challenges remain regarding training, integration, and daily practices, which limit the strengthening of food and nutrition practices in the Unified Health System.
Keywords
Comprehensive health care; Healthcare models; Nutritionists; Nutrition policy; Primary health care; Unified Health System
RESUMO
Analisar a trajetória da atuação de nutricionistas na Atenção Primária à Saúde no Sistema Único de Saúde. Realizou-se revisão narrativa integrando artigos científicos a partir da constituição do Sistema Único de Saúde, em 1988, nas bases de dados: Scientific Electronic Library Online, National Library of Medicine, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Scopus e Web of Science. Organizou-se o material em três eixos: panorama histórico da inserção; formação; dimensionamento da força de trabalho. Analisaram-se 65 estudos publicados entre 2002 e 2025. Na primeira década de implementação do Sistema Único de Saúde, a atuação de nutricionistas foi limitada, expandindo-se com a inserção nos Núcleos de Apoio à Saúde da Família. As edições 1999 e 2012 da Política Nacional de Alimentação e Nutrição engendraram o protagonismo desses profissionais na construção de estratégias interdisciplinares de cuidado. Há esforços para alinhar a formação e a educação permanente de nutricionistas aos modelos de atenção do Sistema Único de Saúde e às necessidades de saúde das populações. Evidenciaram-se experiências formativas exitosas na integração universidade-serviços, apesar de lacunas curriculares em Saúde Coletiva. O insuficiente quantitativo de nutricionistas e a precariedade das condições de trabalho, relacionados ao subfinanciamento do Sistema Único de Saúde, restringem a efetivação das ações na Atenção Primária à Saúde. A atuação de nutricionistas na Atenção Primária à Saúde avançou, com o aprimoramento das políticas públicas, incluindo a dimensão interdisciplinar do trabalho. Entretanto, persistem desafios relativos à formação, à inserção e ao cotidiano de trabalho, que restringem o fortalecimento das práticas de alimentação e nutrição no Sistema Único de Saúde.
Palavras-chave
Assistência Integral à Saúde; Modelos de Assistência à Saúde; Nutricionistas; Política nutricional; Atenção Primária à Saúde; Sistema Único de Saúde
INTRODUCTION
Primary Health Care (PHC) is guided by the principles of Sistema Único de Saúde (SUS, Unified Health System) and constitutes the care model responsible for operationalizing universality, equity, and integrality, presupposing the right to health. Regarding food and nutrition issues, the Política Nacional de Alimentação e Nutrição (PNAN, National Food and Nutrition Policy) represents the key locus for implementing these principles. Since its first edition in 1999, the PNAN and its subsequent unfoldings have guided Food and Nutrition (F&N) actions within the SUS, according to the health needs of populations in their respective territories. Aligned with the guiding principles of healthcare work, Nutritional Care (NC) is legitimized in this setting through the Multiprofessional teams (eMulti). In this context, nutritionists play a strategic role in the management and qualification of NC, which encompasses the provision of food and nutrition-related health care, including surveillance, promotion, protection, treatment, recovery, prevention, and control of health and nutritional conditions, especially emphasizing the promotion of adequate and healthy eating for the entire population. These actions are embedded within interdisciplinary and intersectoral practices to address the complexity involved in the health-disease-care process and ensure effectiveness within the Redes de Atenção à Saúde (RAS, Health Care Networks), considering the adversities imposed by the socioeconomic and political vulnerabilities of the contemporary Brazilian context [1-12].
The available scientific literature on the role of nutritionists in PHC recognizes the importance of these professionals in ensuring comprehensive health care. However, as far as is currently known, publications of a descriptive or documentary nature predominate, based on local experiences and focused on professionals’ perceptions of their own work [8,13-15]. Given the undeniable validity of these contributions, this study aims to move towards a systematization of the scattered evidence concerning the practices of nutritionists at this care level. Considering the 85 years of these professionals’ work in Brazil, this article aims to analyze their incorporation and trajectory within PHC, based on a literature review, highlighting historical milestones, advances, challenges, and perspectives for strengthening formative and professional practices within the RAS.
METHODS
This study consists of a narrative review of the scientific literature designed to answer the following guiding question: How is the role of nutritionists in PHC within the SUS characterized?
Based on this question, keywords were defined for the bibliographic search in the following databases: Scientific Electronic Library Online (SciELO.br), National Library of Medicine (PubMed), Latin American and Caribbean Literature in Health Sciences (Lilacs), Scopus, and Web of Science.
The following search terms were used: “nutritionist” AND “primary health care” OR “basic health care” OR “Brazilian unified health system” OR “delivery of health care” OR “health care” OR “integrality in health” OR “comprehensive health care” OR “nutritional care” OR “health of indigenous populations” OR “quilombola communities” OR “food and nutrition actions” OR “technical area of food and nutrition” OR “food and nutritional surveillance” OR “health promotion”.
We employed the Rayyan software to consolidate search results and screen records. Two authors independently and blindly performed duplicate removal and screening based on title and abstract review. Inclusion criteria comprised original articles, reviews, essays, and scientific notes published in indexed scientific journals in Portuguese, English, or Spanish. Exclusion criteria included duplicate articles, documents without full text, and texts with no reference to the role of the nutritionist in PHC or lacking description or analysis of the period from the creation of the SUS until 2025.
After the initial screening of the scientific literature and the preliminary analysis of eligible articles, the full texts of selected studies were read and discussed among the authors to establish thematic axes for data extraction. These documents were systematized by authorship, year, objectives, methodological approach, main results, and study location. Axis 1 addressed the trajectory of nutritionists’ incorporation and practice in PHC since the creation of the SUS (1988), with temporal landmarks based on the two editions of the PNAN (1999 and 2012). Axis 2 analyzed the educational dimension of nutritionists within the SUS, including the academic training and permanent health education in PHC. Axis 3 examined the sizing of the health workforce, emphasizing the number of nutritionists in PHC. The discussion across these three axes was guided by official documents and by major national [4,5,16-19] and international [20,21] agendas in the field of Food and Nutrition in Collective Health [22,23]. This process enabled the development of an analytical model of nutritionists’ professional practices in PHC.
RESULTS
Figure 1 presents an analytical model interrelating the thematic axes and the main findings from the literature on the work of nutritionists in PHC. At the center of the model are the dimensions of professional incorporation and training, connected to three domains: (1) structuring references and frameworks for professional practice (including public policies, educational guidelines, and national and international agendas); (2) challenges; and (3) perspectives for the implementation of NC and the strengthening of F&N actions within PHC.
Analytical model of nutritionists’ professional practices in Primary Health Care (PHC) within the Brazilian Unified Health System (SUS), based on a literature review. Brazil, 2025.
A total of 140 references were identified, 45 of which were excluded due to duplication and 30 for not meeting the eligibility criteria, resulting in 65 articles selected for this review. In Chart 1, the articles published between 2002 and 2025 are listed chronologically, organized by the three thematic axes that emerged from the search process.
Role of Nutritionists in Primary Health Care, according to thematic axes resulting from a narrative review of the scientific literature: (1) Historical panorama of incorporation; (2) Training; (3) Workforce sizing. Brazil, 2025.
In Axis 1, 17 studies were identified addressing the historical trajectory of professional incorporation, predominantly literature reviews, essays, and debate articles [1-3,9,24-36]. The trajectory of nutritionists’ inclusion in PHC reveals progress associated with the development of the SUS and the consolidation of the field of Food and Nutrition in Collective Health. The participation of these professionals was limited in the first decade of the SUS, expanding significantly with the establishment of the Núcleos de Apoio à Saúde da Família (NASF, Family Health Support Centers) in the first decade of the 2000s. In both editions of the PNAN (1999 and 2012), the leading role of nutritionists in interdisciplinary practices focused on nutritional care was strengthened.
Axis 2 encompassed 33 studies related to the training of nutritionists for the SUS, using different methodological approaches [1,9,10,13,28,31-58]. The findings highlight the need to ensure professional training and continuing education processes aligned with the SUS care models, in order to meet the specific needs of population groups and territories. In this context, both educational gaps and successful experiences in linking teaching and health services were identified.
Most of the analyzed studies were concentrated in Axis 3, which focused on workforce sizing (n=55) [1,3,6-10,24-36,38,39,42,43,45,46,48,50,53-55,57,59-80]. The evidence points to an insufficient number of nutritionists in PHC and substandard working conditions across several contexts, factors that limit the implementation of F&N actions within the SUS.
DISCUSSION
Axis 1: Historical overview of the incorporation of nutritionists in PHC
It is assumed that the field of knowledge and practices in Food and Nutrition in Collective Health requires an interdisciplinary perspective. Its origin dates back to the 1970s, within the context of the health movement and the struggle for the human right to adequate food. Emerging from the intersection between Collective Health and F&N, it integrates the psychosocial, cultural, economic, and environmental dimensions related to food and nutrition, with biological, epidemiological, planning, and management aspects of actions, as well as attention to the social determinants of health and nutrition in the territories where population groups live and interact [11,12,22,23].
With the reframing of the field of Food and Nutrition in Brazilian Collective Health, within the broader context of the Brazilian Health Reform that culminated in the establishment of the SUS (1988–1990) [22], possibilities for the training and practice of nutritionists in the Health sector expanded, notably in PHC. This expansion, however, had limited expression on the PHC Network in the initial years, given the negligible number of practicing nutritionists [14,30] and the predominance of curative actions to the detriment of health promotion practices [59,60].
Despite the limited technical participation of nutritionists in the delivery of health care during the first decade of SUS implementation [24], a gradual increase was observed in their inclusion within planning, management, and social control bodies across the three governmental spheres [26]. Noteworthy is the availability of nutritionists working in the Coordenação Geral de Alimentação e Nutrição (CGAN, General Coordination of Food and Nutrition) since its origin in 1998. The same occurred at the state level, within the State Food and Nutrition Coordinations, and at the municipal level, as representatives of the category in the collegiate social control instances in SUS management [14,15,24].
In the dynamic of reorganizing the care model in PHC, in 1994, with the establishment of the Family Health Program, the nutritionist professional was not included in the minimum multiprofessional team, despite their formative and technical-scientific relevance for integrating family health teams [59], and contrary to the advocacy of professional entities [15]. With the Estratégia Saúde da Família (ESF, Family Health Strategy), between 1991 and 1994, the process of expanding health actions to the territories was initiated, and, starting with the NASF, in 2008, the nutritionist professional was integrated into the teams. The expansion and diversification of the NASF teams, in 2011, guided by the demands of municipalities and territories, contributed to the growing number of nutritionists and, consequently, the population’s access to F&N actions in PHC [25].
Advances were observed in the first edition of the PNAN (Brazil, 1999), with relevance to F&N actions in implementing SUS guidelines. Of note is the technical-scientific leadership of nutritionists in developing a F&N agenda within the health sector, committed to promoting adequate and healthy eating, Food and Nutrition Security (FNS), and the human right to adequate food [3]. From then on, the work of these professionals and other PHC practitioners began to involve care strategies extending beyond health services, in dialogue and coordination with other sectors, including civil society [8].
By establishing PHC as the coordinator of the RAS and health care, in the second edition of the PNAN (2012), the organization of NC emerges as the first guideline [3]. Thus, nutritionists assumed a relevant role in supporting other professionals in conducting F&N actions and managing integrated activities related to food and nutritional care. Furthermore, with the revision of the PNAN and its repositioning towards the cooperation and articulation in FNS, new challenges were incorporated into intersectoral collaborations in the PHC for the effectiveness of its nine guidelines, requiring the leading role of nutritionists [2,3,5,9,55]. Grounded on consultation with a panel of experts, Bortolini et al. [36] identified that funding guarantees, the availability of nutritionists, and training are cross-cutting themes in the recommendations for strengthening the PNAN guidelines.
Regarding the institutional framework that guides the practice of nutritionists and other professionals in PHC, the PNAN is integrated with the Política Nacional de Atenção Básica (PNAB, National Primary Health Care Policy, editions of 2006, 2011, and 2017) and the Política Nacional de Promoção da Saúde (PNPS, National Health Promotion Policy, 2006 and 2014), which recognize the centrality of food and nutrition issues in the health agenda. Concerning the defense of FNS, the Política Nacional de Segurança Alimentar e Nutricional (PNSAN, National Food and Nutrition Security Policy, 2010) and the Planos Nacionais de Segurança Alimentar e Nutricional (Plansan, National Food and Nutrition Security Plans 2012–2025, 2016–2019, 2024–2027) necessarily permeate the PNAN, which requires intersectoral coordination [2]. We should also mention political-institutional frameworks such as the Marco de Referência de Educação Alimentar e Nutricional para as Políticas Públicas (Food and Nutrition Education Framework for Public Policies, 2012) [81], the second edition of the Guia Alimentar para a População Brasileira (Dietary Guidelines for the Brazilian Population, 2014) [82], and the Guia Alimentar para Crianças Brasileiras menores de 2 anos (Dietary Guidelines for Brazilian Children Under Two Years of Age, 2019) [83], which are part of the PNAN spectrum.
Under these circumstances, planning and management mechanisms for teamwork began to guide the practice in PHC, establishing matrix support for the ESF reference teams [30,84]. The methodology for interdisciplinary health work management [84] modulated knowledge and competencies required for adequate matrix support of actions in PHC in general, and in NC in particular [68]. By integrating interdisciplinary teams, the nutritionist professional added specific skills to teamwork, bringing a technical-pedagogical repertoire to support care for individuals, families, and communities in their territories [25,27,42,46,68].
Local studies, primarily conducted in the Brazilian Southeast, confirm the strategic role of nutritionists across different care lines, such as pregnant and postpartum women [63,76], older adults [70], children [67,74], and adults [8,64]. This role was decisive in defining nutritional care protocols for the maternal and child population, with increased coverage of iron and vitamin A supplementation in municipalities in the Northeast [29,48]. Likewise, nutritionists are fundamental in coordinating Food and Nutrition Education programs [43,50,69,72,75] and Food and Nutrition Surveillance [34], underscoring their importance for effective, comprehensive health care in PHC.
However, barriers hinder professional practice in PHC and the implementation of F&N actions. The substandard working conditions, including employment arrangements that lead to turnover, low remuneration, and labor overload, stands out among these limitations. Additionally, the continuous demand for professional qualification and infrastructure issues, such as inadequate facilities, lack of equipment, supplies, and transportation for house calls, also emerge. Studies indicate that this set of reasons constrains the consolidation of qualified professional practices in the daily routine of health services [34,43,71,73,75,76].
Notably, the growing incorporation and recognition of nutritionists in NC [6,7,9,27,31,33] were adversely affected by the reforms to the PNAB (2017) and by changes in federal PHC financing, both implemented during the neoliberal agendas of the Michel Temer (2016-2018) and Jair Bolsonaro (2019-2022) administrations. In the new PHC financing model, the federal funding for the maintenance of the Núcleos Ampliados de Saúde da Família e Atenção Básica (NASF-AB, Expanded Family Health and Primary Care Centers) was withdrawn, and targets and resource allocation were modified to become performance-based [85]. This resulted in weakened employment relationships, with adverse effects on the performance of PHC professionals, including nutritionists [85]. In this regard, evidence on the impacts of the transition from NASF-AB teams to eMulti on local management and on the RAS appears to be lacking.
We should highlight that the dismantling of public policies began in 2016 with the implementation of fiscal austerity measures, resulting in significant budget cuts that affected social protection policies [86,87]. This backdrop, therefore, predates the Coronavirus Disease 2019 (COVID-19) pandemic, with consequences for health and FNS policies, as well as for the work processes of nutritionists in PHC [57,80], which persists to the present day [85,88].
Axis 2: Training Nutritionists for the SUS
The training of nutritionists, as Higher Education health professionals, aligns with SUS doctrinal principles, which implies a commitment to comprehensive health care in the defense of the right to health and food [52]. Collective Health is a specific field of practice for nutritionists and integrates the central axis for the ethical-humanistic and critical-reflexive training of professionals engaged in addressing the country’s socioeconomic, environmental, cultural, and food-related realities [13,45,52 55,89].
The Lei de Diretrizes e Bases da Educação (LBD, Law of Guidelines and Bases of Education), the Sistema Nacional de Avaliação da Educação Superior (Sinaes, National Higher Education Evaluation System), and the Diretrizes Curriculares Nacionais (DCN, National Curriculum Guidelines) constitute the legal framework for developing the political-pedagogical projects of undergraduate Nutrition programs, which guide the construction of curricula oriented toward developing professional competencies and skills [18,19]. The DCN for Undergraduate Nutrition Programs guide the training of nutritionists grounded in SUS doctrinal principles, namely, integrality in health, universality, and social participation [55,89].
Established in 2001, the DCN advanced regarding the then-current national minimum curriculum, which was predominantly theoretical, anchored in the biomedical model, and characterized by fragmented and technicist curricular organization [18]. These guidelines introduced innovations by fostering student leadership in the teaching-learning process and outlining a professional profile based on generalist training, with an expanded range of competencies and fields of practice [89]. Recently revised, the 2025 DCN emphasize the mobilization of cognitive, procedural, and attitudinal resources to build competencies that overcome persistent challenges and meet new demands in the SUS scenario, with an emphasis on practical experiences [19].
The competencies of nutritionists in PHC should encompass dimensions related to the care model, meaning they must include competencies in health care, humanistic and sociocultural abilities, communication, and technical and methodological skills [55]. The Matriz de Ações de Alimentação e Nutrição na Atenção Básica de Saúde (Matrix of Food and Nutrition Actions in PHC, 2009) and, more recently, the Matriz para Organização dos Cuidados em Alimentação e Nutrição na Atenção Primária à Saúde (Matrix for the Organization of Food and Nutrition Care in PHC, 2022) are fundamental instruments for guiding training processes and professional practices. A review study highlighted the contribution of the first matrix as a reference for interdisciplinary work aimed at achieving comprehensive health care [40].
Despite this trajectory, gaps in nutritionists’ curricula to meet health needs were revealed, particularly in ESF territories [35,39,45,56]. This situation signals the scarce improvements in undergraduate Nutrition curricula nationwide [37,45,52]. In an analysis of nutritionist training in Brazil, Recine et al. [37] identified that most programs dedicated a maximum of 30% of the workload to curricular units in Public Health, such as Nutritional Assessment, Food and Nutrition Education, Public Health Nutrition, and Epidemiology, of which approximately 82% were mandatory. By analyzing the syllabi from the political-pedagogical project of an undergraduate Nutrition course, Alves and Martinez [45] noted the absence of essential competencies for work in the SUS (such as leadership, continuing education, and communication), along with a poorly articulated distribution of other relevant content for practice settings.
Despite recognition of the centrality of Public Health in academic training [49], a biologicist and fragmented perspective of nutritionists’ practice in PHC predominates [34,70]. This reinforces the need for greater theoretical-practical integration and stronger university-service articulation to enhance the development of competencies and skills capable of meeting the practical demands of vulnerable territories [39,49,56].
In this context, inductive strategies aimed at restructuring interdisciplinary training within the SUS stand out, such as Programa de Educação pelo Trabalho para Saúde (PET-Saúde, Education through Work for Health Program) and Programa Nacional de Reorientação da Formação Profissional em Saúde (Pró-Saúde, National Program for the Reorientation of Professional Training in Health), implemented to promote teaching-service integration through intersectoral collaboration between Education and Health [58]. These pedagogical strategies, aligned with the “training SUS” proposal, have contributed to the early incorporation of undergraduates into the RAS, in public and private Higher Education institutions. However, barriers related to faculty work persist, such as difficulties in articulating different areas of knowledge, work overload, professional devaluation, and insufficient continuing education activities [52]. Added to this are obstacles in interactions with professionals and service managers, which compromise the planning and sustainability of teaching-learning processes in the training of nutritionists for the SUS [52]. Analyzing curriculum changes guided by PET-Saúde in Rio de Janeiro, Brinco et al. [58] recognized the need for investments to sustain these initiatives, including the qualification of preceptors and faculty and the political-institutional support of universities.
From this perspective, theoretical-practical articulations that integrate teaching, research, and extension activities are noteworthy, as they promote professional training in Food and Nutrition in Collective Health capable of overcoming the biomedical, fragmented, and prescriptive model of health care [13,49]. Training experiences reveal potential in health work, promoting integrated approaches that affect nutritionist training and interdisciplinary actions in PHC [41,45,47].
Based on a proposal for shared training between Nutrition students and those from other health fields, Frutuoso et al. [47] identified tensions between common/interdisciplinary approaches and technical/specific aspects of Nutrition, such as nutritional diagnosis and dietary counseling. Nutritionists’ specific practices should be critically analyzed, as interdisciplinary actions enable the development of shared technologies and strategies that are more innovative and effective. In the same public university, Medeiros et al. [41] reported a successful experience with an interdisciplinary curricular internship in Social Nutrition and Psychology, highlighting the potential of joint supervision and the joint construction of knowledge, practices, and bonds with services.
Furthermore, multiprofessional residency programs in the SUS are strategic for workforce development within the RAS, as they qualify newly graduated professionals and service preceptors in light of the complexity of practice settings [45]. In this regard, continuing education is a key mechanism for improving practices in care, management, and social participation in the daily work routine [38,43,58]. In large Brazilian municipalities, predominantly in the Southeast and Northeast regions, continuing education activities in F&N within the ESF more frequently occurred at the local level, involving planning and group-based educational activities [43]. These initiatives were fostered by partnerships and the availability of service infrastructure. However, barriers such as scheduling constraints and insufficient managerial staff hindered the full development of these work fronts [43].
Axis 3: Workforce sizing and the number of nutritionists in PHC
In this area, Resolution N°380/2005 of the Conselho Federal de Nutrição (CFN, Federal Council of Nutrition) was an advance in the field of Food and Nutrition in Collective Health, by establishing numerical parameters for the inclusion of nutritionists in different areas, based on the number of professionals per number of inhabitants. This is grounded in the principle of comprehensive health care, defining Collective Health as an area of practice within institutional policies and programs, PHC, and health surveillance. Specifically regarding professional responsibilities, further detail was provided with the repeal of CFN Resolution N°380/2005 and the incorporation of CFN Resolution N°600/2018, when the numerical parameters were guided by the legal framework of the NASF [55].
As previously mentioned, the early decades following the creation of SUS were marked by the incipient incorporation of nutritionists in PHC [24,60]. Between 2008 and 2013, with the implementation of the NASF, the number of nutritionists significantly increased across all Brazilian regions [30,33,65], making them the third most prevalent professional group, after psychologists and physical therapists [30]. Despite this growth, the number of nutritionists remained below the recommendations of professional regulatory bodies and the health needs of population groups in the various Brazilian territories [48,53,60-62,66,77,78].
A study conducted in 65 municipalities in the state of São Paulo found that only 19% of the 220 basic health units employed nutritionists [53]. In the 2010s, authors pointed to the low incorporation of nutritionists in PHC in metropolitan regions of the state of São Paulo [53,60,77], with evidence from the municipalities of São Paulo [61] and Santos [66]. Notably, most studies on workforce planning for nutritionists in PHC were conducted in the Brazilian Southeast [53,60,61,66,77], with fewer studies in the Northeast [29, 67] and Midwest [78].
The insufficient number of nutritionists in PHC was commonly associated with precarious infrastructure and work processes in different settings, resulting in an overload of responsibilities for these professionals [61,66]. As a result, individual-based activities predominated, to the detriment of health promotion and protection actions [53,60,61,63 66,67,70]. These weaknesses hindered the fulfillment of work demands and the qualified delivery of F&N actions [54,61,63,66,79], compromising both health care and training processes within SUS [53].
On the other hand, the availability of nutritionists in PHC management and technical teams is associated with higher quality in the development of actions, in terms of structure, work processes, and user evaluation [29,67,73,78]. According to studies conducted in municipalities in the state of Paraíba, the level of implementation of F&N actions was higher in locations with greater workforce availability in PHC, and that included nutritionists in their ESF teams [67,74,90]. In municipalities of the state of Mato Grosso do Sul, from the perspective of managers, the incorporation of nutritionists into teams was related to greater involvement of these professionals in decision-making processes within the F&N technical area, with streamlined specific funding, including resource allocation, goal-setting, and development of materials [78].
Workforce sizing in PHC, emphasizing the adequacy of the number of nutritionists, interdisciplinary work, and qualification for F&N actions, aligns with Brazil’s commitments to the global strategies for the United Nations Decade of Action on Nutrition (2016-2025) [20,32]. Therefore, inducing and ensuring the availability of nutritionists in PHC stands as an essential recommendation for strengthening the PNAN and consolidating food and nutrition care in SUS [36].
In this context, we should situate the Sustainable Development Goals (SDGs) of the 2030 Agenda regarding the role of nutritionists in PHC, highlighting: SDG 2 (zero hunger and sustainable agriculture); SDG 3 (good health and well-being); SDG 10 (reduced inequalities); SDG 12 (responsible consumption and production); SDG 13 (climate action); and SDG 17 (partnerships for the goals). Regarding the workforce indicators in the SUS to achieve SDG 3, only the number of medical and nursing professionals is considered, without including nutritionists [21]. Therefore, to ensure effective F&N actions in PHC and achieve the SDGs, we should reflect on the position of nutritionists within teams and on their contribution to training processes and workforce sizing.
This study has limitations due to the narrative nature of the literature review, which was addressed through methodological rigor by making explicit the inclusion and exclusion criteria for the materials and the consistency of database selection. Conversely, the originality of this study provides an analytical overview of the nutritionists’ practices in PHC, which may support the improvement of policies and strategies within SUS. Other limitations include the lack of a more in-depth chronological analysis of the period from SUS implementation until 2002, the starting point of the included studies, and the impossibility of a broader regional analysis due to the scarce studies in some regions of the country (namely, North and South). Nevertheless, the findings identified literature gaps. They fostered new reflections on the role of these professionals, advancing the field of Food and Nutrition in Collective Health and the development of F&N actions in PHC.
CONCLUSION
This review analyzed the role of nutritionists in PHC, focusing on their professional incorporation, trajectory, and contributions to Nutritional Care, from the establishment of the SUS to the challenges faced more recently (2025). The findings revealed a complex formative and professional landscape, shaped by distinct competing interests related to the very trajectory of the SUS, within political changes and budgetary constraints. The two PNAN editions (1999 and 2012) and their implementation mechanisms were fundamental in consolidating the field of F&N within the Health sector, reaffirming the centrality of PHC as the organizer of care and strengthening the professional scope of nutritionists in Nutritional Care. Additionally, the inclusion of nutritionists in the NASF teams (2008) expanded the workforce and promoted integrality in health, interdisciplinarity, and intersectoral collaboration. However, to date, there is no knowledge regarding the effects of the implementation of eMulti in 2023 on the practices of nutritionists in PHC.
The availability of nutritionists in the planning and management of actions in PHC has driven advances in Nutritional Care, such as the implementation of policies and care lines, and the development of educational and surveillance initiatives. However, obstacles persist regarding the number of professionals, the necessary improvement in working conditions, and qualifications for F&N actions, issues associated with SUS underfunding. These challenges indicate that significant progress is still required to ensure greater incorporation, professional development, and recognition of nutritionists within the SUS.
Finally, we underscore the importance of conducting macro- and micro-political actions that converge with SUS doctrinal principles and the health needs in the territories where populations accessing PHC facilities live and work, in order to ensure more effective performance by nutritionists and other professionals. Only then will it be possible to align this theme with the global agenda, from the perspective of sustainability and the defense of health and adequate food as fundamental rights.
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How to cite this article:
Medeiros MAT, Vedovato GM, Neves JA, Mata MM. Nutritionists in the Brazilian Unified Health System: a perspective on their role in Primary Health Care. Rev Nutr. 2026;39:e15431. https://doi.org/10.1590/1678-9865202639e15431en
Data Availability
The research data are available in the body of the document.
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Editor
Francisco de Assis Guedes de Vasconcelos
