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Objective: To analyse the dietary intake of Brazilian adolescents and investigate its association with sociodemographic factors as well as health-risk and healthprotective behaviours. Design: Cross-sectional study. Setting: The study was based on data supplied by the National Survey of Schoolchildren's Health (2012) on sociodemographic factors, dietary intake and health-risk and health-protective behaviours of schoolchildren in Brazil. A nutritional scale was elaborated combining markers of healthy and unhealthy diets. Poisson regression analysis was applied to investigate the association between the sociodemographic factors and regular intake (≥5 times/week) of selected foods; linear regression analysis was applied to investigate the association of sociodemographic and behavioural factors with nutritional scale score. Subjects: A total of 109 104 adolescents attending the ninth year of education at 2842 schools in Brazil. Results: Fewer than 30 % of the adolescents consumed raw or cooked vegetables on a regular basis, whereas more than one-third reported regular intake of sweets, soft drinks and sweet biscuits. Adolescents from the southern area and the oldest ones were those most exposed to inadequate dietary intake. The nutritional scale average score was higher in the students attending public school and exhibited a positive correlation with protective behaviours, such as being physically active, having meals with parents and eating breakfast, and a negative correlation with risk behaviours such as eating while studying or watching television and having smoked, drunk alcohol or used other drugs in the previous 30 d. Conclusions:The results indicate an association between undesirable nutritional habits and other risk behaviours among Brazilian adolescents. Keywords Adolescent health School Food consumption Eating behaviour Risk factorsAlthough chronic non-communicable diseases (NCD) are a matter of great public health concern worldwide, they affect developing countries more significantly (1) . In Brazil, NCD cause approximately 70 % of deaths and the prevalence of their main risk factors has shown an unfavourable tendency. These facts make it necessary to implement surveillance programmes to form the basis of timely and strategic interventions (2) . Inadequate dietary habits stand out among the risk factors common to NCD as a whole. Surveys on the types of food available in Brazilian households conducted in the past three decades have shown a steady increase of ultraprocessed foods and a significant reduction of natural or minimally processed foods and cooking ingredients in all socio-economic classes and geographical regions (3,4) . That tendency is a serious cause for concern because some features intrinsic to ultra-processed foods (high energy density, free sugar, sodium, total fat and saturated fat; low protein and fibre) are associated with excessive weight gain and increased risk for NCD (5)(6)(7) . Although changes in dietary habits are required in all age ranges, adolescence should be a focus ...

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BackgroundPhysical activity in adolescents is associated with short- and long-term health benefits. Physical activity can occur in various domains and is influenced by a complex network of factors. The aims of this study are 1) to describe the physical activity of Brazilian adolescents in physical education classes, during leisure time, and during active commuting and 2) to investigate the socio-demographic and behavioral factors associated with physical activity.MethodsThe representative sample included 109,104 Brazilian students in the final year of elementary school from 2,842 schools. The weekly frequency and duration of physical activity were assessed. A variety of socio-demographic and behavioral factors were studied. A multiple Poisson regression analysis was used to test for associations between physical activity and the socio-demographic and behavioral variables.ResultsMost of the students (97.0%) engaged in physical activity in at least one of the domains studied, especially physical education at school (81.7%) and leisure time physical activity (67.5%). However, only 29% of the adolescents reached the recommended level of physical activity. Among the adolescents who reached the minimum recommended time for physical activity, the various domains contributed the following proportions to total physical activity: leisure time physical activity (PR 12.5; 95% CI 11.17-13.97), active commuting (PR 1.63; 95% CI 1.59-1.67), and physical education at school (PR 1.36; 95% CI 1.29-1.44). The weekly frequency of all activities was greater among boys than among girls. Moreover, nearly two-thirds (61.8%) of students spent more than two hours per day engaging in sedentary behaviors; the prevalence of sedentary behaviors was similar between boys and girls (59.0 and 64.5%, respectively).Total level of physical activity, leisure time physical activity, and active commuting were associated with higher nutritional scores.ConclusionsPhysical activity is important in any health promotion program. Therefore, it is necessary to invest in policies and interagency initiatives that promote all domains and to ensure that the general population helps determine the scope and design of such policies.

Considering the increased contribution of foods consumed outside home and their potential impact on diet, this study aims to identify eating out patterns and their association with nutritional dietary quality in Brazil. We used the Individual Food Intake Survey 2008–2009, conducted with 34,003 individuals aged 10 and up. We used factor analysis by principal component to identify out-of-home eating patterns and linear regression to explore the association between patterns scores and dietary quality. We identified three food patterns. The “Traditional meal” pattern carried more rice, beans, meat, roots and tubers, pasta, vegetables and eggs. The “typical Brazilian breakfast/tea” pattern carried more fresh bread, margarine, milk, cheese and butter. The “Ultra-processed food” pattern carried more ready-to-eat meals and soft drinks. The “traditional meal” pattern was positively associated with calories from proteins, fiber, iron, potassium and sodium densities, whereas “typical Brazilian breakfast/tea” and “ultra-processed food” patterns were positively associated with energy density, the percentage of calories from lipids or carbohydrates, trans fat and free sugar. Out-of-home eating may have a negative impact on nutritional dietary quality when based on ultra-processed food. However, it is possible to maintain a healthy out-of-home diet with adherence to traditional Brazilian cuisine.

Objective:To describe out-of-home consumption according to the purpose and extent of industrial processing and also evaluate the association between eating out and ultra-processed food consumption, taking account of variance within and between individuals.Design:Cross-sectional study.Setting:Brazil.Participants:The study was based on the Individual Food Intake of the Brazilian Household Budget Survey, carried out with 34 003 individuals aged 10 years or more, between May 2008 and May 2009. All food items were classified according to food processing level. The habit of eating out was evaluated through the frequency of days each individual reported eating out, described according to sociodemographic characteristics. The contribution of food energy per group and subgroup was estimated according to the frequency of eating out. In addition, multilevel modelling was employed to evaluate the association between eating out and ultra-processed food consumption.Results:In Brazil, culinary preparations accounted for most of the energy eaten out. However, it was possible to observe a higher contribution of ultra-processed foods, especially sugary beverages and ready-to-eat meals, as the frequency of out-of-home consumption increased. Compared with food consumption exclusively at home, eating out increased the consumption of ultra-processed foods by 0·41 percentage points within and between individuals.Conclusion:In Brazil, the same individual and different individuals had greater consumption of ultra-processed foods when they ate out of home compared with when they ate at home. So, it is necessary to implement public policies which discourage the out-of-home consumption of ultra-processed foods and that provide affordable and accessible less-processed food options.

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Objectives: The aim of this study was to analyse the clustering of multiple health-related behaviours among adolescents and describe which sociodemographic characteristics are associated with these patterns.Design: Cross-sectional study. Setting: Brazilian schools assessed by the National Survey of School Health (PeNSE, 2012).Participants: 104 109 Brazilian ninth-grade students from public and private schools (response rate=82.7%). Methods: Exploratory and confirmatory factoranalyses were performed to identify behaviour clustering and linear regression models were used to identify socio-demographic characteristics associated with each one of these behaviour patterns.Results: We identified a good fit model with three behaviour patterns. The first was labelled 'problembehaviour' and included aggressive behaviour, alcohol consumption, smoking, drug use and unsafe sex; the second was labelled 'health-compromising diet and sedentary behaviours' and included unhealthy food indicators and sedentary behaviour; and the third was labelled 'health-promoting diet and physical activity' and included healthy food indicators and physical activity. No differences in behaviour patterns were found between genders. The problembehaviour pattern was associated with male gender, older age, more developed region (socially and economically) and public schools (compared with private). The 'health-compromising diet and sedentary behaviours' pattern was associated with female gender, older age, mothers with higher education level and more developed region. The 'health-promoting diet and physical activity' pattern was associated with male gender and mothers with higher education level.Conclusions: Three health-related behaviour patterns were found among Brazilian adolescents. Interventions to decrease those negative patterns should take into account how these behaviours cluster together and the individuals most at risk.