Fazer refeições com os pais está associado à maior qualidade da alimentação de adolescentes brasileiros

Regular Family Meals Associated with Nutritional Status, Food Consumption, and Sedentary and Eating Behaviors of Brazilian Schoolchildren and Their Caregivers

The influence of family meals on nutrition and health for families has been understudied, especially in low- and middle-income countries. We aimed to analyze associations between regular family meals and body mass index (BMI), food consumption, eating, and sedentary behaviors among Brazilian schoolchildren and their caregivers. A cross-sectional study was conducted with 1887 Brazilian schoolchildren aged 6-11 years and their caregivers. Caregivers provided sociodemographic data, their child's weight and height, and the frequency of family meals. Schoolchildren provided data on gender and silhouette scale. Both provided their food consumption, eating, and sedentary behavior data. Associations between regular family meals and BMI, ultra-processed food consumption, and dietary diversity were assessed through multivariate logistic regression models. Correlations of regular family meals with eating and sedentary behaviors were assessed using Pearson chi-square. Regular family meals were frequent (86.6%), and they were associated with less unhealthy BMI in caregivers (AOR: 0.74; 95%CI: 0.5-0.9), as well as higher dietary diversity in caregivers (AOR: 1.66; 95%CI: 1.0-2.7) and in schoolchildren (AOR: 1.78; 95%CI: 1.4-2.3). The coexistence of high dietary diversity and both low ultra-processed food consumption (AOR: 1.45; 95%CI: 1.0-2.1) and healthy BMI (AOR: 1.41; 95%CI: 1.0-1.9) in children was associated with regular family meals. Regular family meals were correlated with healthy eating behaviors in child-caregiver dyads (p < 0.002) and with sedentary behavior in caregivers (p = 0.019). Our findings underscore regular family meals as a protective factor against malnutrition among Brazilian families.

Healthy dietary patterns linked to Brazilian adolescents' school meal adherence

OBJECTIVE

This study aimed to verify the association between adherence to school meals provided by the National School Feeding Program and dietary patterns in adolescents from Brazilian public schools.

METHODS

Data from the 2019 National School Health Survey were used, with a nationally representative sample of Brazilian school adolescents (n=53,477; 13-17 years old). Food consumption of healthy and unhealthy food markers was obtained from a food consumption questionnaire. Regular consumption was considered ≥5 times/week. Latent class analysis was used to identify dietary patterns whose association with adherence to school meals was evaluated by multinomial logistic regression models, with adjustment for sociodemographic and eating behavior variables.

RESULTS

Three dietary patterns were identified: "unhealthy" - higher consumption of soft drinks and sweets (9.2% of adolescents); "healthy" - higher consumption of beans, vegetables, and fruits (27.1%); and "monotonous" - higher consumption of beans (63.7%). High adherence to school meals (every day) and unsatisfactory adherence (1-4 times/week) were positively associated with the healthy pattern even after adjustment for possible potential confounders (OR 1.37, 95%CI 1.23-1.52; OR 1.20, 95%CI 1.10-1.30, respectively).

CONCLUSION

The results showed that the consumption of school meals offered by the National School Feeding Program can contribute to healthy eating habits among Brazilian adolescents.

Diet quality and snack preferences of Turkish adolescents in private and public schools

Introduction

Socioeconomic level is one of the important factors determining diet quality. Snack preferences are affected by socioeconomic level. The objective of this research was to determine the effect of socioeconomic levels on diet quality and snack preferences among adolescents from different socioeconomic backgrounds.

Methods

The study involved 118 adolescents aged between 10-18 years residing in Istanbul. A questionnaire prepared by the researchers was used to obtain information on the adolescents' dietary habits, consumption of main meals and snacks, habits, and food consumption records. The participants' food consumption was assessed using the retrospective 24-hour recall method, and diet quality was evaluated using the calculated nutrient adequacy ratio (NAR) and mean adequacy ratio (MAR).

Results

The mean age of the adolescents was 16.42±0.89 years. The number of snacks consumed in private schools was found to be higher than in public schools (p < 0.05). The NAR score for vitamin C consumption was significantly higher in private schools compared to public schools (p < 0.05). Although the MAR scores of adolescents in private schools were higher than those in public schools, this difference was not statistically significant. The majority of adolescents in private schools regularly consumed fresh fruit (67.2%), milk (60.3%), yogurt (60.3%), and nuts (56.9%) as snacks. In contrast, 45% of adolescents in public schools regularly consumed pastries (p < 0.05).

Discussion

It was observed that adolescents studying in public schools had a lower tendency to prefer healthy foods for snacks compared to those in private schools. Socioeconomic level was identified as an important factor influencing eating habits during adolescence. Considering that the level of income is significantly different between the adolescents studying at private and public schools, the higher consumption of snacks by the adolescents studying at private school may be associated with higher income.

Association between Consumption of Ultra-Processed Foods and Sociodemographic Characteristics in Brazilian Adolescents

BACKGROUND

The consumption of ultra-processed foods is associated with several negative health outcomes. Studies on adolescents have shown that this population has a high consumption of these foods, especially in high-income countries. However, there are no studies on the types of ultra-processed foods consumed. The present study evaluated secondary data from a representative sample of the National School Health Survey, the consumption of ultra-processed foods by 159,245 Brazilian adolescents.

METHODS

Data were collected via a self-administered questionnaire using a mobile device. A Poisson regression model was used to assess the prevalence of ultra-processed food consumption and its correlation with sociodemographic characteristics.

RESULTS

The consumption of ultra-processed foods was significant among Brazilian adolescents, and almost half of the participants reported consumption the day before. We observed that sociodemographic characteristics such as school type, race/skin color, region, municipality type, age, living with mother, living with father, and maternal education level were associated with greater or lesser consumption of ultra-processed foods. Adolescents who study in private schools, are female, white, and live in non-capital cities consume more ultra-processed foods.

CONCLUSIONS

Access to in natura and minimally processed foods must be on the agenda of governments and encouraged by food and nutrition education to guarantee the right to adequate and healthy food.

Eating contexts and their associations with socio-demographic factors in Brazilian adolescents (EVA-JF Study)

OBJECTIVE

To describe the eating contexts and estimate their associations with socio-demographic factors in a sample of Brazilian adolescents.

DESIGN

Cross-sectional study. We used an exploratory questionnaire about eating contexts (encompassing regularity of meals, places where they occur and if they take place with attention and in company), which was submitted to cluster analysis. Subsequently, three clusters were identified: cluster 1, 'appropriate eating contexts at breakfast, lunch and dinner'; cluster 2, 'inappropriate eating context at breakfast' and cluster 3, 'inappropriate eating context at dinner'. Multinomial logistic regression models were performed, without and with adjustments, using cluster 1 as reference.

SETTING

Twenty-nine public schools of Juiz de Fora, MG, Southeast Brazil.

PARTICIPANTS

Adolescents, 14-19-year-olds (n 835).

RESULTS

We observed relevant prevalence of adolescents omitting breakfast (52·9 %) and dinner (39·3 %), and who had the habit of eating sitting/lying on the couch/bed or standing/walking, and in front of screens. Breakfast usually occurred unaccompanied (70·8 %); around half (47·5 %) and little over a third (36·1 %) of the sample also would usually have lunch and dinner unaccompanied, respectively. Furthermore, through multivariate analysis, we found associations of eating contexts clusters with female sex (more likely in clusters 2 and 3), age range 14-15-year-olds (less likely in cluster 2) and higher mother's schooling (more likely in cluster 3).

CONCLUSIONS

We verified an alarming prevalence of adolescents with eating contexts unaligned with healthy eating recommendations. Additionally, inappropriate eating contexts at breakfast and/or at dinner were associated with socio-demographic factors (sex, age range and mother's schooling).

Increased Consumption of Ultra-Processed Food Is Associated with Poor Mental Health in a Nationally Representative Sample of Adolescent Students in Brazil

The objective of this study was to analyze the association between ultra-processed food (UPF) consumption and mental health symptoms in a nationally representative sample of the Brazilian adolescent student population. Cross-sectional analyses with data from the National School-Based Health Survey (PeNSE 2019) were performed. Self-reported information was obtained for the frequency of five mental health symptoms in the last month and the consumption of thirteen UPFs in the last 24 h. Generalized linear models adjusting for the main confounders were performed for each sex. Of the 94,767 adolescent students (52.4% girls) included, 8.1% of the boys and 27.2% of the girls reported "almost always" or "always" having at least four of the five mental health symptoms. In the fully adjusted models, compared to the boys who consumed ≤3 UPF, those consuming ≥6 UPF reported more frequent symptoms of poor mental health (ß-coefficient = 0.27 [0.03, 0.51]; p-for-trend = 0.005). A similar association was observed in girls (ß-coefficient = 0.31 [0.13, 0.50]; p-for-trend = 0.001). In conclusion, in this large sample of adolescent students from an entire country, the higher the consumption of UPF was, the higher the frequency of reported symptoms of poor mental health. These findings remained significant regardless of sociodemographic and lifestyle factors, self-perceived body image, and bullying victimization.

Adolescents' Nutrition: The Role of Health Literacy, Family and Socio-Demographic Variables

Adolescent obesity rates are increasing on an epidemic level and food intake is one of the most important causes of this condition. From an ecological perspective, food intake is, in turn, influenced by many factors that need to be considered. This study aims to evaluate the associations between socio-demographic factors (gender, family origin, socio-economic status, parent's education level), which consist of social stratifiers, health literacy and family context, as independent variables, and food intake (consumption of fruits, vegetables, soft drinks and sweets and breakfast frequency) and outcomes (Body Mass Index category), as dependent variables. Data were retrieved from 2145 students (13 and 15 years old) from the Lombardy region (Italy) who participated in the 2018 edition of Health Behaviour in School-Aged Children (HBSC). Six multiple binary logistic regression models were used in this study. Fruit, vegetable and soft drinks consumption models were related to all three-factor levels. Breakfast consumption frequency was associated with socio-demographic variables. BMI category was associated with socio-demographic and family variables. The results confirmed the existence of social inequalities, the importance of health literacy in predicting healthy behaviours and the relevance of the family context. The study confirms the importance of the ecological approach to understanding food intake and overweight/obesity status in adolescents.

Skipping breakfast associated with socioeconomic and lifestyle factors in Brazilian adolescents

The aim is to estimate the prevalence and evaluate the association of socioeconomic and lifestyle factors with skipping breakfast among Brazilian adolescent students. A cross-sectional study carried out with adolescent ninth-graders from Brazilian public and private schools participating in the 2015 National School Health Survey. The prevalence of skipping breakfast (less than five days/week) and its respective 95% confidence intervals were estimated and stratified by gender according to demographic, socioeconomic, and lifestyle factors, self-perceived body image, and attitudes towards weight. A three-block hierarchical Poisson regression, considering the complex sample design. The prevalence of skipping breakfast was 35.6%, higher among girls than boys. In both genders, skipping breakfast was positively associated with the highest socioeconomic level, morning school shift, paid work, regular consumption of alcoholic beverages, living only with the mother, the father or neither, the irregular consumption of school food and meals with parents, considering oneself too fat/fat and trying to lose weight. In general, skipping breakfast was associated with socioeconomic factors and lifestyle behaviors harmful to health among adolescent students.

Social determinants of health associated with the experience of hunger among Brazilian adolescents

The aim of this study was to identify social determinants of health associated with the experience of hunger among school-age adolescents in Brazil. We conducted a cross-sectional study with a sample of 16,526 adolescents using data from the 2015 National School-based Student Health Survey. Experience of hunger was determined based on the answer to the question "In the last 30 days, how often have you been hungry because there wasn't enough food at home?" The social determinants of health were analyzed using Poisson regression with robust variance. The prevalence of the experience of hunger was 22.8% (95%CI: 21.9-23.7). The experience of hunger was directly associated with being male (PR = 1.12; 95%CI: 1.07-1.16); not being overweight (PR = 1.08; 95%CI: 1.04-1.13 ); irregular consumption of beans (PR = 1.20; 95%CI: 1.13-1.26), vegetables (PR=1.16; 95%CI: 1.09-1.22) and fruit (PR = 1.19; 95%CI: 1.13-1.24); body dissatisfaction (PR = 1.26; 95%CI: 1.18-1.35); and not regularly eating lunch or dinner with parents or guardians (PR = 1.41; 95%CI: 1.32-1.52). An inverse association was found between the experience of hunger and maternal education level and living in the Mid-West, Southeast and South. The findings show that the experience of hunger among Brazilian adolescents coexists with risky eating behaviors, body dissatisfaction, and social inequality.

School Food Environment in Urban Zambia: A Qualitative Analysis of Drivers of Adolescent Food Choices and Their Policy Implications

Identifying context specific points for reforming policy to promote healthier food environments and consumer behavior in critical life stages like adolescence is crucial in addressing the double burden of malnutrition. Using a qualitative study design, we conducted 20 focus group discussions with grade 10 pupils from ten secondary schools in Lusaka. Turner’s framework which conceptualizes the food environment into two domains—the external domain (availability, pricing, vendor and product properties, and marketing and regulation of food) and the internal domain (accessibility, affordability, convenience, and desirability of food)—was used to guide thematic data analysis and results interpretation. Adolescents stated their food choices are largely based on personal preference linked to the need for social acceptability among peers. Adolescents felt their food choice is limited to ‘cheap junk foods’ which are affordable and readily available at school. Healthy foods like fruits were said to be inaccessible and unaffordable by the majority of adolescents. Some adolescents stated they were attracted to certain foods by adverts they see on TV and social media. School food environments in urban Lusaka do not support healthy food choices. Policy reforms are required to increase access to affordable healthy food options in schools, and to curb the indiscriminate marketing of unhealthy foods to adolescents.

Social determinants of health associated with the experience of hunger among Brazilian adolescents

Abstract The aim of this study was to identify social determinants of health associated with the experience of hunger among school-age adolescents in Brazil. We conducted a cross-sectional study with a sample of 16,526 adolescents using data from the 2015 National School-based Student Health Survey. Experience of hunger was determined based on the answer to the question “In the last 30 days, how often have you been hungry because there wasn’t enough food at home?” The social determinants of health were analyzed using Poisson regression with robust variance. The prevalence of the experience of hunger was 22.8% (95%CI: 21.9-23.7). The experience of hunger was directly associated with being male (PR = 1.12; 95%CI: 1.07-1.16); not being overweight (PR = 1.08; 95%CI: 1.04-1.13 ); irregular consumption of beans (PR = 1.20; 95%CI: 1.13-1.26), vegetables (PR=1.16; 95%CI: 1.09-1.22) and fruit (PR = 1.19; 95%CI: 1.13-1.24); body dissatisfaction (PR = 1.26; 95%CI: 1.18-1.35); and not regularly eating lunch or dinner with parents or guardians (PR = 1.41; 95%CI: 1.32-1.52). An inverse association was found between the experience of hunger and maternal education level and living in the Mid-West, Southeast and South. The findings show that the experience of hunger among Brazilian adolescents coexists with risky eating behaviors, body dissatisfaction, and social inequality.

Factors associated with non-frequent breakfast consumption in adolescents (EVA-JF Study)

ABSTRACT Objective To estimate the association of infrequent breakfast consumption with socioeconomic, behavioral, and individual factors in a sample of Brazilian adolescents from public schools. Methods Cross-sectional study with adolescents aged from 14 to 19 from public schools in Juiz de Fora, state of Minas Gerais. The frequency of consumption of breakfast, snacks, soft drinks, industrialized drinks, the usual food consumption, body mass index, body fat percentage, and waist circumference were evaluated. Other socioeconomic, behavioral, and individual data were obtained through questionnaires. Logistic regression analysis and hierarchical selection of variables were used to verify the associated factors. Results The sample consisted of 805 adolescents; 53.4% reported infrequent breakfast consumption. Through hierarchical logistic regression analysis, it was evidenced that the house occupancy status (OR: 0.618; 95%CI: 0.4410.865; p=0.005) was the distal factor associated with infrequent breakfast consumption; the intermediate factors were the consumption of industrialized beverages (OR: 0.658; 95%CI: 0.486-0.890; p=0.007) and percentage of energy from processed foods (OR: 0.935; 95%CI: 0.907-0.964; p<0.001); and the proximal factors were the male gender (OR: 0.696; 95%CI: 0.520-0.932; p=0.0015) and being nonwhite (OR: 1.529; 95%CI: 1.131-2.069; p=0.006). Conclusion Male adolescents who lived in owned houses, with occasional consumption of industrialized beverages and a higher percentage of energy derived from processed foods, had lower chances of infrequent breakfast consumption, while non-white adolescents had higher chances.

Methodological Aspects of Diet Quality Indicators in Childhood: A Mapping Review

Diet quality indicators (DQIns) are tools that aim to assess an individual's overall diet quality. Previous reviews focused mainly on health-related outcomes but did not provide detailed information about components, assessment variables, or important methodological issues for the development and application of DQIns in the pediatric age. The current mapping review aims to provide comprehensive guidance regarding DQIns developed through a priori methodology in children aged ≤14 y that have been applied worldwide. A mapping review was conducted, whereby 1665 original articles describing the development, modifications, and updates of DQIns, published up to June 26, 2020, in English and Spanish, were retrieved. A total of 139 articles were identified and classified into 13 subgroups. There were 10 overall DQIns: Healthy Eating Indexes (n = 25), Dietary Diversity Scores (n = 20), Diet Quality Indexes (n = 16), Food Variety Scores (n = 11), Healthy and Unhealthy Scores (n = 11), Feeding and Eating Indexes (n = 10), Diet Quality Scores (n = 5), Nutritional Adequacy and Micronutrients Indexes (n = 5), Dietary Guidelines Indexes (n = 5), and Other Healthy Diet Indexes (n = 13). Three additional subgroups of dietary and lifestyle indicators found were Mediterranean Diet Indexes (n = 10), Diet-Lifestyle Indexes (n = 5), and Breakfast Quality Indexes (n = 3). This compilation of DQIns will help researchers select the most appropriate tool for future epidemiological studies by considering a careful selection of information about the assessment components, scoring methods, and key methodological issues. The main limitations of this review are that, due to its nature, a risk-of-bias assessment was not performed and the article screening was completed in 2 databases (PubMed/MEDLINE and Scopus). More research is needed to identify health-related outcomes associated with DQIns in the pediatric population, using clearer and more standardized methodological criteria.

Percentage of energy contribution according to the degree of industrial food processing and associated factors in adolescents (EVA-JF study, Brazil)

OBJECTIVE

To evaluate energetic contribution according to the degree of industrial food processing and its association with sociodemographic, anthropometric, biochemical, clinical and behavioural characteristics in adolescents.

DESIGN

Cross-sectional study (Adolescent Lifestyle Study). Food consumption was assessed using 24-h dietary recalls, with foods classified by degree of industrial progressing. The usual diet was estimated using the Multiple Source Method. In a linear regression model, the energy percentage (E %) was associated with sociodemographic, anthropometric, biochemical, clinical and behavioural characteristics, after adjustment for sex and age.

SETTING

Juiz de Fora, Brazil.

PARTICIPANTS

Eight hundred and four adolescents, of both sexes, 14-19 years of age, enrolled in public schools.

RESULTS

The E % of unprocessed or minimally processed foods corresponded to 43·1 %, processed foods to 11·0 % and the ultraprocessed foods to 45·9 %. E % of unprocessed foods was associated with socio-economic stratum (adjusted β = -0·093; P = 0·032), neck circumference (adjusted β = 0·017; P = 0·049), screen time (adjusted β = -0·247; P = 0·036) and HDL-cholesterol (adjusted β = -0·156; P = 0·003). E % of ultraprocessed foods was associated with socio-economic stratum (adjusted β = 0·118; P = 0·011), screen time (adjusted β = 0·375; P = 0·003), BMI (adjusted β = -0·029; P = 0·025), neck circumference (adjusted β = -0·017; P = 0·028) and HDL-cholesterol (adjusted β = 0·150; P = 0·002).

CONCLUSIONS

There was a high E % of ultraprocessed foods in the diet of the adolescents. Actions are needed to raise the awareness of adopting healthy eating habits.

Eating context and ultraprocessed food consumption among UK adolescents

We aimed to evaluate the association between eating context patterns and ultraprocessed food consumption at two main meal occasions in a representative sample of UK adolescents. Data were acquired from 4-d food records of adolescents aged 11-18 years, who participated in the 2014-2016 UK National Diet and Nutrition Survey (n 542). The eating context was assessed considering the location of the meal (lunch and dinner) occasion, the individuals present, whether the television was on and if the food was consumed at a table. Ultraprocessed foods were identified using the NOVA classification. Exploratory factor analysis was used to identify eating context patterns for lunch and dinner. Linear regression models adjusted for the covariates were utilised to test the association between eating context patterns and the proportion of total daily energy intake derived from ultraprocessed foods. Their contribution was about 67 % to energy intake. Three patterns were retained for lunch ('At school with friends', 'TV during family meal' and 'Out-of-home (no school)'), and three patterns were retained for dinner ('Watching TV alone in the bedroom', 'TV during family meal' and 'Out-of-home with friends'). At lunch, there was no significant association between any of the three patterns and ultraprocessed food consumption. At dinner, the patterns 'Watching TV alone in the bedroom' (coefficient: 4·95; 95 % CI 1·87, 8·03) and 'Out-of-home with friends' (coefficient: 3·13; 95 % CI 0·21, 6·14) were associated with higher consumption of ultraprocessed food. Our findings suggest a potential relationship between the immediate eating context and ultraprocessed food consumption by UK adolescents.

Family meal frequency and its association with food consumption and nutritional status in adolescents: A systematic review

This systematic review evaluated the association between frequency of family meals (FFM) and nutritional status (NS) and/or food consumption (FC) in adolescents. The protocol was registered with PROSPERO (CRD42017062180) and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. No publication date, language, or meal type restrictions were imposed. Only full-text original articles were included; qualitative studies were excluded. Studies were identified by searching 5 electronic databases (PubMed, Web of Science, Scopus, BVS Brazil, and Adolec) and gray literature (Google Scholar) and by scanning reference lists of included articles. Risk of bias was assessed using the Newcastle-Ottawa scale for cohort and cross-sectional studies. Initial search yielded 2001 results and 47 articles were included. An updated literature search added 3 articles. Of the 50 studies included, 25 studied the association between FFM and NS, 32 investigated the association between FFM and FC, being that seven studies analyzed both outcomes. Thirty-four were cross-sectional studies, 12 were longitudinal studies, and 4 studies analyzed both cross-sectional and longitudinal data. Thirty-five studies were rated as having good quality, whereas 19 were of fair quality. Sample size ranged from 140 to 102 072 participants. Most investigations evaluated the frequency of breakfast, lunch, and/or dinner/supper/evening meals over a 1-week period. Seventeen studies identified a positive relationship between high FFM and better NS, and 26 found a positive association between high FFM and better FC. In conclusion, this review showed an association between FFM and healthy dietary patterns, such as increased consumption of fruits and vegetables. Further research is needed to understand the association between FFM and NS, since some studies showed a protective role of family meals against obesity in this age group, whereas other studies identified no significant association between these variables.

[Association between sharing meals with parents or guardians and obesity in Brazilian adolescents]

The study aimed to analyze the association between sharing lunch or supper with parents/guardians and obesity in Brazilian adolescents participating in the Study of Cardiovascular Risk Factors in Adolescents (ERICA in Portuguese). This was a cross-sectional, school-based study with adolescents 12 to 17 years of age. Obesity was classified by body mass index based on World Health Organization criteria, according to age and sex. The association between obesity and sharing lunch and supper with parents/guardians (never, sometimes, almost every day, and every day) was analyzed according to crude and sex- and age-adjusted prevalence ratios. A total of 71,740 adolescents were assessed. Of these, 48% and 60% of girls and 56% and 65% of boys, respectively, shared lunch and supper every day or nearly every day. Boys who shared lunch and supper with their parents/guardians nearly every day and every day showed lower prevalence of obesity. Stratified by age bracket, only younger boys that ate lunch with their parents/guardians sometimes (PR = 0.64; 95%CI: 0.46-0.89), nearly every day (PR = 0.50; 95%CI: 0.37-0.69), and every day (PR = 0.65; 95%CI: 0.49-0.85) and supper with their parents/guardians every day (PR = 0.61; 95%CI: 0.43-0.87) showed lower prevalence of obesity. The findings highlight the importance of promoting healthy eating behaviors in the family setting as part of strategies to prevent obesity in adolescents.