Ambiente alimentar de escolas públicas e privadas brasileiras: associação com o consumo de alimentos ultraprocessados e evolução temporal a partir da Pesquisa Nacional de Saúde do Escolar (PeNSE)

Abstract

The school food environment can impact students' diets either negatively or positively, depending on the foods available in these locations. In this context, it becomes relevant to understand the evolution of the school food environment and how this environment, influences students' eating practices. This study aimed to evaluate the food environment in Brazilian schools, its association with the consumption of ultra-processed foods among students, and it is temporal evolution. For this purpose, data from the National School Health Survey (PeNSE) were used. The research resulted in two manuscripts presented below: Article 1: Association between the school food environment and the consumption of ultra-processed foods, using data from PeNSE 2019. The food environment was assessed using the indicator "availability of foods and beverages in the school food environment," and food consumption was based on the reported consumption of 13 ultra-processed foods on the previous day, which resulted in a score, with high consumption considered when the score ≥ 5. Multilevel Logistic Regression models stratified by school administrative dependence and adjusted for sociodemographic variables were used to evaluate the association between the food environment and the consumption of ultra-processed foods. Adolescents reported an average consumption of 4.34 ultra-processed items (95% CI: 4.30-4.38), with no difference between those in public and private schools. Regarding food availability, a better score was observed in public schools (11.23; 95% CI: 11.00-11.49) compared to private schools (10.43; 95% CI: 10.21-10.65). Students from public (OR: 0.93; 95% CI 0.90; 0.96) and private schools (OR: 0.94; 95% CI 0.90; 0.98) enrolled in schools that are in the highest quartile for the food and beverage availability score (≥score 14) showed lower odds of high consumption of ultra-processed foods. Article 2: Temporal assessment of the school food environment, using data from PeNSE 2012, 2015, and 2019. The food environment was also assessed using the indicator "availability of foods and beverages in the school food environment," calculated by considering, both separately and jointly, the school canteens and alternative points of sale of foods around schools. Temporal trends in the prevalence of key variables and in food environment scores were evaluated through comparisons of confidence intervals across survey years, with the year of data collection considered as the exposure. Across all evaluated years, a consistently high prevalence of ultra-processed food sales was identified in both school canteens and alternative points of sale in the surrounding school environments. Public schools exhibited the highest mean scores across all editions of the study, with the exception of private schools in the Southeast region in 2019. Variations in the food and beverage availability score were identified throughout the period under analysis. The subscore related to school canteens demonstrated more favorable changes, particularly between 2015 and 2019. In contrast, the subscore for alternative food outlets declined during the same period.. These findings suggest that a healthier school food environment is associated with reduced consumption of ultra-processed foods among Brazilian adolescents. Moreover, the observed deterioration especially in alternative sales points over time underscores the urgent need for the implementation of more effective strategies aimed at improving these environments.