Associação do ambiente alimentar de varejo com a depressão em adultos de Belo Horizonte-MG: um recorte do projeto CUME

Abstract

Introduction: Depression is a leading cause of global disability and is associated with unhealthy dietary patterns. Transformations in retail food environments (RFE) have led to an increased availability of ultra-processed foods, while the presence of establishments offering unprocessed/minimally processed foods remains limited, especially in urban areas. This context may negatively influence mental health; however, the relationship between RFE and depression is still underexplored. Objective: This study evaluated the association between RFE and depression in adults from Belo Horizonte-MG, Brazil. Methods: This is a cross-sectional study involving 2,577 public higher education graduates residing in Belo Horizonte, sourced from the Cohort of Universities of Minas Gerais (CUME). Sociodemographic, behavioral, and health variables were collected from self-reported baseline questionnaires of the CUME. RFE variables were analyzed through the count, proportion, density, and density ratio of food-selling establishments in census tracts of the municipality, which were categorized as: (a) unprocessed/minimally processed; (b) mixed; and (c) ultra-processed, according to the CAISAN methodology. Information on private locations for physical activity and the Health Vulnerability Index (HVI) was also used. Logistic regression analyses using Generalized Estimating Equations (GEE) were conducted, with bootstrap resampling adjustment (1,000 repetitions) to ensure the robustness of estimates. The estimated effects in odds ratios (OR) with confidence intervals (CI95%) were calculated using STATA statistical software (version Stata/MP 14.2). Results: A higher proportion of unprocessed and/or minimally processed establishments (OR 0.20; CI95% 0.10–0.73) and the density ratio of unprocessed/ultra-processed (OR 0.52; CI95% 0.28–0.97) were inversely associated with depression. Among establishments with a predominance of ultra-processed foods, delivery-type establishments (OR 1.11, CI95% 1.01–1.22) and candy stores (OR 1.14, CI95% 1.00–1.30) were associated with higher odds of depression. Bakeries, commercial establishments with a mixed food pattern, also showed increased odds of depression (OR 1.12, CI95% 1.01–1.24). Conclusion: The RFE has characteristics that can have both protective and risk roles on depression, depending on the predominance of establishments selling unprocessed or ultra-processed foods. The results highlight the importance of public policies that promote access to unprocessed foods and mitigate the presence of ultra-processed foods in urban environments. Future research is recommended to consider longitudinal studies with other population segments, particularly with heterogeneous geographic and socioeconomic profiles, to deepen the understanding of the relationship between food environments and mental health.