Avaliação do ambiente alimentar no entorno das escolas: revisão sistemática e abordagem ecológica

Abstract

Introduction: The food environment has different elements that define the patterns of food consumption and its determinants, including the types of retail food environments and access. Around schools, the presence of retail food establishments can be a potentiating or protective factor for overweight in students, depending on access to these place as well as types of foods available therein. Objective: To evaluate the food environment around public and private schools in Belo Horizonte-MG and to systematically review the relationship between the food environment around schools and obesity in children and adolescents. Methods: In order to meet the first objective, an ecological study was carried out, which had as its unit of analysis public and private schools (n = 1436) and food selling establishments (n = 12551) in Belo Horizonte - MG, considering the different income levels from the neighborhood of the schools. . The distribution of establishments (mixed, healthy and unhealthy) in the 250 meters buffer around schools was evaluated, stratified according to type of education (provision of early childhood education and elementary and secondary schools), administrative dependence (public and private) and the average income of the school census tract (in tertiles). The bivariate Ripley K function was used to test the significance of cluster agglomerations around schools. For the second objective, a systematic review was conducted, the search for the articles was carried out by two independent researchers and included studies of the MEDLINE, EMBASE and SCOPUS databases published until May 2019 and conducted according to the guidelines of Meta-analyzes of Observational Studies in Epidemiology (MOOSE), following the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. Results: In the ecological study, it was found that buffers do not reach schools revealed that 93.04%, 84.19%, 59.61% participate in at least one establishment, unhealthy and healthy, respectively. Private schools, which teach elementary and high school, located in regions of less vulnerability, with greater quantity and agglomeration of retail food environment. In assessing the per capita income of the school, gradually reduce the percentage of mixed and unhealthy food sales, regardless of administrative dependency. When reviewing systematically, 31 studies that show the relationship between the food environments around of schools with overweight in children and adolescents. Fourteen studies verified a direct association between proximity and density of retail food establishment (mainly fast-food restaurants, convenience stores and grocery stores) around schools and overweight in children and adolescents. However, three studies were not associated and four were inversely associated. Conclusion: The children and teenagers are more exposed to unhealthy food environments. There is a need to implement public policies that promote the improvement of the food environment, by encouraging the establishment of healthy establishments near schools.