Factors associated with the consumption of ultra-processed food by Brazilian adolescents: National Survey of School Health, 2015

Silva, Janiquelli Barbosa; Elias, Bianca Caroline; Warkentin, Sarah; Mais, Laís Amaral; Konstantyner, Tulio

doi:10.1590/1984-0462/2022/40/2020362

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Brasil

Revista Paulista de Pediatria

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Original Article • Rev. paul. pediatr. 40 • 2022 • https://doi.org/10.1590/1984-0462/2022/40/2020362 copy

Factors associated with the consumption of ultra-processed food by Brazilian adolescents: National Survey of School Health, 2015

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To identify the prevalence and factors associated with the consumption of ultra-processed foods by Brazilian adolescents.

Methods:

The sample was representative of adolescents and participants in the cross-sectional population-based study National Survey of School Health, 2015 edition (PeNSE-2015). A self-administered questionnaire was used for data collection. The variable weekly consumption of ultra-processed foods was considered, and consumption more than seven times a week was considered excessive. Descriptive and inferential analyses of demographic, socioeconomic, behavioral and environmental characteristics potentially associated with the outcome were performed. Poisson's multiple regression model was adjusted to control for confounding factors.

Results:

The prevalence of excessive consumption of ultra-processed foods among 16,324 adolescents in Brazil was 75.4%. Nine factors independently associated with this outcome were identified: age under 15 years (RR 1.08; p<0.001), daily sitting time greater than four hours (RR 1.13; p<0.001), eating while watching TV or studying more than four days a week (RR 1.09; p<0.001), daily TV time greater than three hours (RR 1.08; p<0.001), breakfast frequency less than four days a week (RR 1,03; p=0.001), having a cell phone (RR 1.12; p<0.001), absent maternal education (RR 0.88; p<0.001), being enrolled in a private school (RR 1.05; p=0.002) located in the urban area (RR 1.13; p=0.002).

Conclusions:

The results express the multifactorial characteristic of excessive consumption of ultra-processed foods and suggest the need for the development and implementation of health policies to guide the consumption of these foods and the importance of adopting healthy behaviors for this population group in both school and home environments.

Keywords:
Adolescent; Food consumption; Industrialized foods; Health surveys

			n	%	95%CI
Socioeconomic and demographic characteristics
	Administrative dependency of the school	Private	16,556	25.6	(13.7–42.7)
	Administrative dependency of the school	Public	16,556	74.4	(57.3–86.3)
	School location	Urban	16,556	95.3	(91.2–97.5)
	School location	Rural	16,556	4.7	(2.5–8.8)
	Full-time school shift	No	16,513	95.4	(94.1–96.4)
	Full-time school shift	Yes	16,513	4.6	(3.7–5.9)
	Sex	Female	16,556	48.1	(46.9–49.4)
	Sex	Male	16,556	51.9	(50.7–53.2)
	Skin color	White	16,533	40.1	(35.0–45.5)
	Skin color	Other^* * black, yellow, brown and indigenous;	16,533	59.9	(54.5–65.1)
	Age	≥15 years	16,556	48.4	(38.1–58.8)
	Age	<15 years	16,556	51.6	(41.2–61.9)
	Having a cell phone	Yes	16,538	88.0	(85.2–90.4)
	Having a cell phone	No	16,538	12.0	(9.6–14.8)
	Living with mother	No	16,545	11.5	(10.1–13.2)
	Living with mother	Yes	16,545	88.5	(86.8–89.9)
	Living with both parents	No	16,537	41.6	(39.3–44.0)
	Living with both parents	Yes	16,537	58.4	(56–60.7)
	Number of people in household	≤4	16,541	62.7	(59.5–65.9)
	Number of people in household	≥5	16,541	37.3	(34.1–40.5)
	Mother's schooling	Did not study	16,522	4.3	(3.3–5.6)
	Mother's schooling	Studied^ elementary school, high school, higher education: complete or incomplete;	16,522	95.7	(94.4–96.7)
Eating behavior
	Attitude towards own's weight	None	16,390	36.2	(34.5–37.9)
	Attitude towards own's weight	Some^* ***** reported attempt to maintain, lose or gain weight; MPF: fresh and minimally processed foods; BHU: basic health unit.	16,390	63.8	(62.1–65.5)
	Frequency of breakfast	≤4 days	16,544	35.3	(33.0–37.7)
	Frequency of breakfast	>4 days	16,544	64.7	(62.3–67.0)
	Frequency of eating meals with father, mother or guardian	≤4 days	16,531	29.3	(26.9–31.7)
	Frequency of eating meals with father, mother or guardian	>4 days	16,531	70.7	(68.3–73.1)
	Frequency of eating meals while watching TV or studying	>4 days	16,541	43.8	(41.3–46.3)
	Frequency of eating meals while watching TV or studying	≤4 days	16,541	56.2	(53.7–58.7)
	Frequency of meals offered by the school	<3 days	16,551	76.6	(72.3–80.4)
	Frequency of meals offered by the school	≥3 days	16,551	23.4	(19.6–27.7)
	Presence of snack bar at school	Yes	16,556	57.0	(47.6–66.0)
	Presence of snack bar at school	No	16,556	43.0	(34.0–52.5)
	Frequency of consumption of MPF	≤4 days	16,480	70.2	(68.2–72.1)
	Frequency of consumption of MPF	>4 days	16,480	29.8	(27.9–31.8)
Use of public health service
	Care at BHU in the last 12 months	Yes	16,328	49.8	(47.2–52.5)
	Care at BHU in the last 12 months	No	16,328	50.2	(47.5–52.8)
Sedentary behaviors
	Daily TV time	More than 3 hours	16,506	39.1	(36.3–42.0)
	Daily TV time	Up to 3 hours	16,506	60.9	(58.0–63.7)
	Daily sitting time	More than 4 hours	16,472	38.8	(36.9–40.7)
	Daily sitting time	Up to 4 hours	16,472	61.2	(59.3–63.1)

		Categories	Excessive consumption of UPF	PR (95%CI)	p-value
Socioeconomic and demographic characteristics
	Administrative dependency of the school	Private	78.8	1.06 (1.01–1.11)	0.011
	Administrative dependency of the school	Public	74.2	1.06 (1.01–1.11)	0.011
	School location	Urban	76.2	1.28 (1.18–1.40)	0.000
	School location	Rural	58.9	1.28 (1.18–1.40)	0.000
	Full-time school shift	No	75.7	1.08 (1.02–1.15)	0.008
	Full-time school shift	Yes	69.4	1.08 (1.02–1.15)	0.008
	Sex	Female	75.8	1.01 (1.00–1.03)	0.121
	Sex	Male	75.0	1.01 (1.00–1.03)	0.121
	Skin color	White	77.2	1.04 (1.01–1.08)	0.022
	Skin color	Other^* * black, yellow, brown and indigenous;	74.2	1.04 (1.01–1.08)	0.022
	Age	≥15 years	78.2	1.08 (1.05–1.11)	0.000
	Age	<15 years	72.7	1.08 (1.05–1.11)	0.000
	Having a cell phone Living with mother	Yes	76.9	1.19 (1.15–1.24)	0.000
		No	64.5
		Yes	75.0
	Living with both parents	No	76.4	1.03 (1.00–1.05)	0.033
	Living with both parents	Yes	74.7	1.03 (1.00–1.05)	0.033
	Number of people in household	≤4	76.0	1.02 (1.00–1.05)	0.039
	Number of people in household	≥5	74.4	1.02 (1.00–1.05)	0.039
	Mother's schooling	Did not study	62.7	0.83 (0.78–0.89)	0.000
	Mother's schooling	Studied^ elementary school, high school, higher education: complete or incomplete;	76.0	0.83 (0.78–0.89)	0.000
Eating behavior
	Attitude towards own's weight	None	77.1	1.02 (1.00–1.05)	0.022
	Attitude towards own's weight	Some^* ***** reported attempt to maintain, lose or gain weight; UPF: ultra-processed foods; PR: prevalence ratio. MPF: fresh and minimally processed foods.	74.4	1.02 (1.00–1.05)	0.022
	Frequency of breakfast	≤4 days	78.5	1.07 (1.04–1.09)	0.000
	Frequency of breakfast	>4 days	73.7	1.07 (1.04–1.09)	0.000
	Frequency of eating meals with father, mother or guardian	≤4 days	77.9	1.05 (1.02–1.08)	0.000
	Frequency of eating meals with father, mother or guardian	>4 days	74.4	1.05 (1.02–1.08)	0.000
	Frequency of eating meals while watching TV or studying	>4 days	80.6	1.13 (1.11–1.16)	0.000
	Frequency of eating meals while watching TV or studying	≤4 days	71.3	1.13 (1.11–1.16)	0.000
	Frequency of meals offered by the school	<3 days	76.0	1.04 (1.01–1.08)	0.010
	Frequency of meals offered by the school	≥3 days	73.4	1.04 (1.01–1.08)	0.010
	Presence of snack bar at school	Yes	76.9	1.05 (1.02–1.09)	0.004
	Presence of snack bar at school	No	73.4	1.05 (1.02–1.09)	0.004
Sedentary behaviors
	Frequency of consumption of MPF	More than 3 hours	81.2	1.14 (1.12–1.17)	0.000
	Frequency of consumption of MPF	Up to 3 hours	71.7	1.14 (1.12–1.17)	0.000
	Use of public health service	More than 4 hours	84.0	1.21 (1.18–1.24)	0.000
	Use of public health service	Up to 4 hours	70.0	1.21 (1.18–1.24)	0.000

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[1] *Corresponding author. E-mail: janiquelli.bs@outlook.com (J. Silva).