Is breakfast consumption among Brazilian schoolchildren associated with an ultra-processed food dietary pattern?

Temporal trend of food consumption markers, breakfast consumption and association with overweight/obesity in schoolchildren aged 7 to 10 years between 2007 and 2019

Obesity has a multifactorial origin. Among the behavioural risk factors, excessive consumption of unhealthy foods, skipping breakfast and reduced physical activity stand out. The main objective of this article was to identify trends in dietary habits and their association with overweight/obesity over a 12-year period in schoolchildren aged 7 to 10 years in Florianópolis, southern Brazil. A cross-sectional panel analysis study, using anthropometric, sociodemographic, physical activity and food consumption data of schoolchildren aged 7 to 10 years, collected in three waves of the Study of Prevalence of Obesity in Children and Adolescents (EPOCA), carried out during the years 2007, 2012/2013 and 2018/2019, was performed. To analyse the trend in dietary variables over the years, the 95% CIs were compared with the non-overlap of intervals indicating statistical significance. Multiple logistic regression analysis was performed to test the association of weight status with dietary markers. The prevalence of overweight/obesity was 34.4%, 37.2% and 34.2% in 2007, 2012/2013 and 2018/2019, respectively, and there were no statistically significant differences among waves. There was a progressive and significant reduction in the consumption of soft drinks and sweets and in eating breakfast by schoolchildren, from 2007 to 2019. Breakfast consumption was inversely associated with the chance of overweight/obesity (OR 0.74, 95% CI 0.59-0.93), and female students were less likely to have overweight/obesity when compared to boys (OR 0.70, 95% CI 0.61-0.81). The reduction in the consumption of soft drinks and sweets over the years might be caused by efforts in public policies that intended to reduce the consumption of unhealthy foods among schoolchildren. The progressive and significant reduction in having breakfast should be better elucidated in future studies, to minimise the potential impact of this practice on schoolchildren's bodyweight.

Consumption of ultra-processed foods and low dietary diversity are associated with sedentary and unhealthy eating behaviors: A nationwide study with Brazilian Schoolchildren

BACKGROUND

Consumption of ultra-processed foods and low dietary diversity are risk factors for chronic diseases.

AIM

To evaluate the association between food consumption and sedentary and unhealthy eating behaviors of Brazilian schoolchildren between 6 and 11 years old.

METHODS

Cross-sectional study. A prevalence sample was calculated considering the number of children enrolled in elementary school. This sample was distributed proportionally to Brazil's macro-regions and the type of school (public or private). The questionnaire was developed in Google Forms and disseminated through the snowball technique. The questionnaire was filled in by the children's parents, with information about the child's identification and health. Afterward, the child completed a questionnaire by her/himself. We used the previously validated Illustrated Questionnaire on Food Consumption for Brazilian Schoolchildren and the Illustrated Questionnaire on Eating and Sedentary Behaviors. Food consumption was analyzed using the NOVA score and the dietary diversity score. Poisson's regression with robust variance was performed (p<0.05).

RESULTS

The study included 2,021 dyads. Of these, 27.6% of children reported eating five or more ultra-processed foods and 39.0% four or fewer natural or staple foods the previous day. Using screens, proxy of sedentary behavior (Prevalence Ratio-PR = 1.8, Confidence Interval-CI95%1.2-2.8) and eating at irregular hours (PR = 1.6, CI95%1.2-2.2) were risk factors for high consumption of ultra-processed foods and low dietary diversity in schoolchildren. In addition, eating the three main meals on the previous day (PR = 0.6, CI95%0.4-0.8) was identified as protective factors against the consumption of ultra-processed foods and in favor of dietary diversity among schoolchildren.

CONCLUSION

Sedentary and unhealthy eating behaviors were associated with the consumption of ultra-processed foods and low dietary diversity in Brazilian schoolchildren.