Tendência temporal no consumo alimentar tradicional de feijão no país e sua relação com o estado nutricional da população adulta brasileira

Abstract

Introduction: In Brazil, beans represent a symbol of a traditional diet. However, there is a tendency to weaken and replace traditional food cultures by a modern, global and unhealthy diet, with harmful effects over health. Objective: To identify temporal trends in the traditional consumption of beans in the country, and to analyze its association with the nutritional status of the Brazilian adult population. Methods: This thesis was developed into two scientific articles, based on data from the Surveillance System of Risk and Protection Factors for Chronic Diseases by Telephone Survey (Vigitel). The article 1 comprised a time series analysis in a probabilistic sample of 572,675 adults, whose objective was to identify the temporal trend of traditional food consumption of beans in the adult population of the capitals of the Brazilian states and the Federal District, between the years 2007 and 2017, and estimate its prevalence projection up to the year 2030. Three indicators of weekly consumption of beans were created and estimated for each year of the study: regular consumption (≥ 5 days/week), non-regular consumption (1 to 4 days/week) and non-consumption (0 days/week) of beans. Prais-Winsten regression was used in linear spline models in two analyzed periods: 2007-2011 and 2012-2017, along with the completed period (2007-2017). Future prevalence projections were calculated based on its tendency from 2012 to 2017. The manuscript 2 comprised a cross-sectional in a probabilistic sample of 563,094 adults, whose objective was to analyze the association between traditional consumption of beans with weight gain and nutritional status (overweight and obesity indicators) in the Brazilian adult population of capitals of the States and the Federal District, between 2009 and 2019. Four indicators of the weekly bean consumption were created and estimated: non-consumption (0 days/week); low consumption (1 to 2 days/week), moderate consumption (3 to 4 days/week); and regular consumption (5 to 7 days/week) of beans. The associations between frequency of weekly bean consumption (0 to 7 days/week) and bean consumption indicators (both as independent variables) with the outcomes of weight gain (BMI) and the nutritional status (overweight and obesity) were investigated by multiple linear regression and logistic regression models, respectively. All models were adjusted for sociodemographic variables (age, educational level, survey year, sex, race/skin color), lifestyle variables (smoking, leisure-time physical activity, abusive alcohol consumption; television viewing habit (≥ 3 hours/day); and dietary variables (regular consumption (≥ 5 days/week) of sugar-sweetened beverages, fruits, and vegetables; and in natura and ultraprocessed food scores (data available only in the 2019 survey)). Values were presented as regression coefficients (β) and Odds Ratio, with their respective confidence intervals. Three sensitivity analyzes were performed using: 1. A subsample of 2019 survey, in which the models were adjusted for two novel dietary variables: in natura and ultraprocessed food scores; 2. A subsample of 25% from original sample (2009-2019); 3. Stratification by two periods of analyses (2009-2013; and 2014-2019). Results: The article 1 identified a downward trend in the prevalence of regular/traditional consumption of beans in recent years (2012-2017) in both sexes, all age groups and in individuals with low and medium schooling (0 to 11 years of study). Regular consumption of beans (≥ 5 days/week) held the highest prevalence in both halves of the analyzed period. Estimated projections indicated that an inversion will likely occur in the year 2025, whereas non-regular consumption will become the most frequent in the population (48.2%). In women, this inversion was predicted for 2022 and, for men, in 2029. The manuscript 2 identified that regular/traditional consumption of beans (≥ 5 days/week) was inversely associated to BMI (β: -0,41 kg/m² (IC 95%: -0,49; -0,34, P ≤ 0,002)), with a protective effect over overweight (OR: 0,86 (IC 95%: 0,84; 0,89, P ≤ 0,002)) and obesity (OR: 0,85 (IC 95%: 0,82; 0,89, P ≤ 0,002)). Non-consumption (0 days/week) and low-consumption of beans (1-2 days/week) presented positive associations with BMI, and were risk factors in the chance to develop overweight and obesity. All sensitivity analyzes corroborated the findings of the main investigation. Conclusions: The downward trend in the traditional bean food consumption reveals its nutritional fragility. Estimated prevalence projection indicated that, by 2025, regular consumption of beans will cease to be the predominant habit in the country. Regularity in the weekly bean consumption was the differential element towards a direct or an inverse association with the outcomes, highlighting the role of food choices on dietary patterns and, consequently, on health.