Nutrition and Brazil’s unified health system: intersectoral integration, professional practice, and structural challenges

Brazil’s Unified Health System (SUS) is a public health model grounded in universality, equity, and integrality. Within this framework, food and nutrition are strategic components for promoting health and reducing inequalities. However, the literature lacks comprehensive analyses of how nutrition is operationalized within SUS and its intersectoral policies. This narrative review aims to investigate how food and nutrition actions are integrated into SUS, identifying institutional frameworks, implementation barriers, and professional practice dynamics. It seeks to answer: How does SUS articulate with food and nutrition policies in Brazil, and what are the challenges and opportunities for strengthening this interface? This review examined Brazilian legislation, national policies, institutional programs, and key scientific literature. Thirty-eight sources published between 1988 and 2024 were selected based on their thematic relevance, national scope, and analytical depth. The results reveal three dominant themes: 1- Institutional advances in policy articulation; 2- Persistent structural barriers such as fragmentation and biomedical dominance; 3- Evolving role of nutrition professionals in primary care. Despite robust normative frameworks like the National Food and Nutrition Policy (PNAN) and National Policy for Food and Nutrition Security (PNSAN), implementation remains uneven. The COVID-19 pandemic intensified vulnerabilities, demanding new competencies and digital strategies. Strengthening the SUS-nutrition interface requires interdisciplinary training, political commitment, and participatory governance. Food must be recognized as both a human right and a cultural practice to build a democratic and sustainable health system.