Consumo de bebidas açucaradas: associação com as características do ambiente alimentar escolar e padrões de comportamento em saúde

Abstract

Background: Sugar-sweetened beverages refer to any non-alcoholic liquid sweetened with various forms of added sugars. The excessive sugar-sweetened beverages consumption by adolescents has been associated with overweight and obesity, chronic non-communicable diseases, and mental disorders. These beverages are widely available in the residential and school environment and are considered important determinants in the predisposition to unhealthy food choices. In Brazil, studies evaluating the relationship between sugar-sweetened beverages availability in the school environment and their consumption among adolescents are still rare. Studies on sugar-sweetened beverages consumption patterns can help in the management of chronic non-communicable diseases and other diseases. However, there are no studies that evaluate the relationship between behaviors and sugar-sweetened beverages consumption. Objective: To evaluate the association of behavior in health patterns and the school food environment with sugar-sweetened beverages consumption among Brazilian adolescents. Methods: Cross-sectional study that analyzed data from the Cardiovascular Risk Study on Adolescents conducted in 2013 and 2014 with 71,553 adolescents aged 12-17 years attending public and private schools in Brazilian cities with over 100,000 inhabitants. In Article 1, the analysis of the main components was performed to identify patterns of behavior in health, and the multivariate model of logistic regression ordinal was performed to evaluate the association between behavior in health patterns and the snacks purchase in the school cafeteria with sugar-sweetened beverages consumption. Sugar-sweetened beverages consumption tertile was used as a dependent variable in Article 1. In Article 2, linear regression models were estimated using generalized estimation equations stratified by school type, with sugar-sweetened beverages consumption in ml as the dependent variable. The school food environment was the main effect and was evaluated by the number of drinkers, the sale of soft drinks, the presence of soft drink advertisements, and the presence of a street vendor selling this type of beverage. The analyses were performed using the Stata software version 14.0, using the svy command because it is a complex sample, with a significance level of 0.05. Results: Article 1: Three health behavior patterns were identified. Pattern 1 is characterized by higher consumption of natural and minimally processed food, higher water consumption, and greater physical activity; pattern 2 is characterized by more days of alcoholic beverages and smoking; pattern 3 is characterized by higher consumption of ultra-processed food and longer screen time. Belonging to health behavior patterns 2 and 3, and regularly buying snacks in the school cafeteria increased the chances of consuming sugar-sweetened beverages, while belonging to health behavior pattern 1 decreased the chance of consuming these beverages. Article 2: Belonging to public schools that sold soft drinks or owned street vendors that sold soft drinks, and belonging to private schools that sold soft drinks increase sugar-sweetened beverages consumption in adolescents. Conclusion: The adoption of health behavior patterns and the school food environment are associated with sugar-sweetened beverages consumption. Therefore, unhealthy health behaviors patterns and a school food environment with higher availability of ultra-processed beverages may be associated with increased sugar-sweetened beverages consumption. These results indicate the importance of adopting regulatory measures to reduce sugar-sweetened beverages consumption, such as the taxation of these beverages or the prohibition of sales in and around schools. Also, it highlights the importance of adopting healthy habits, which may indirectly stimulate the adoption of other habits beneficial to health.