Clustering of unhealthy food habits and its association with socioeconomic factors among Brazilian workers

BENEDET, Jucemar; DEL DUCA, Giovani Firpo; SILVEIRA, Pablo Magno da; COUTINHO, Andrée Philippe Pimentel; OLIVEIRA, Elusa Santina Antunes de; NAHAS, Markus Vinicius

doi:10.1590/1678-98652017000600011

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ORIGINAL ARTICLES • Rev Nutr 30 (6) • Nov-Dec 2017 • https://doi.org/10.1590/1678-98652017000600011 copy

Clustering of unhealthy food habits and its association with socioeconomic factors among Brazilian workers

Agrupamento de hábitos alimentares não saudáveis e sua associação com fatores socioeconômicos entre trabalhadores brasileiros

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

Investigate the clustering of four unhealthy food habits (low intake of fruits, low intake of vegetables, high intake of candy, and high intake of fried snacks), and to identify the association between the number of these clustered habits and sociodemographic variables.

Methods

This was a cross-sectional representative study of industrial workers from 24 Federative Units in Brazil conducted between 2006 and 2008. The low weekly intake of fruits and vegetables (<5 days/week) and high weekly intake of candy and fried snacks (≥5 days/weeks) were evaluated using a validated questionnaire. Simultaneity was analyzed with stratification by sex, calculating the Observed (O) and Expected (E) prevalence and the O/E ratio for each of the 16 possible food intake combinations.

Results

Among the 47,477 workers studied, in both men and women, the simultaneous presence of high weekly intake of candy and fried snacks(O/E=3.58; 95%CI=3.12–4.10 and O/E=2.17; 95%CI=1.76–2.62) and of the four unhealthy food habits (O/E=2.32; 95%CI=2.01–2.66 and O/E=4.02; 95%CI=3.44–4.65) exceeded the expected percentages if these foods were consumed separately. When compared to subjects without or with only one unhealthy food habit, the combination of the four negative dietary behaviors was more frequent among women, workers with a lower education level, and those living without a partner.

Conclusion

Unhealthy food habits tend to cluster together in both sexes, suggesting a strong interaction, particularly for the four unhealthy food habits together, especially among women, less educated workers and without a partner.

Keywords
Epidemiological studies; Feeding behavior; Occupational Health

Variables	Men (n=33,161)		Women (n=14,316)		p ^b b p-value resulting from Chi-square tests or tests of linear trend.
Variables	n	%	n	%
Age (years)					<0.001
≤29	14,965	45.3	6,836	47.9
30-39	10,085	30.5	4,554	31.1
40-49	5,678	17.2	2,265	15.9
≥50	2,298	7.0	640	4.2
Current marital status					<0.001
With a partner	20,117	60.8	6,547	45.8
Without a partner	12,952	39.2	7,742	54.2
Education (years)					<0.001
≤7	7,274	22.0	1,695	11.9
8	5,666	17.1	1,759	12.3
9-11	16,372	49.5	7,801	54.6
≥12	3,782	11.4	3,021	21.2
Monthly household income (US$)^a a Variable with the largest number of missing data for men (n=343; 1.0%) and women (n=153; 1.1 %);					<0.001
≤280.00	10,810	32.9	4,259	30.1
281.00-700.00	13,821	42.1	5,630	39.8
701.00-1,400.00	5,337	16.3	2,879	20.3
≥1,401.00	2,850	8.7	1,395	9.8
Food habit
Low intake of fruits and juices	19,999	60.6	8,004	56.2	<0.001
Low intake of vegetables	16,559	50.2	6,045	42.4	<0.001
High intake of fried snacks	2,424	7.4	921	6.5	0.003
High intake of candy	4,095	12.4	2,886	20.3	<0.001

N° of food habits	Food habits				Men (n=32,878)				Women (n=14,192)
N° of food habits	Low intake of fruit	Low intake of vegetables	High intake of fried snacks	High intakeof candy	n	% Observed	% Expected	O/E (95%CI)	n	% Observed	% Expected	O/E (95 % Cl)
0	^○ ○ Absence of food habits.	^○ ○ Absence of food habits.	^○ ○ Absence of food habits.	^○ ○ Absence of food habits.	6,976	21.2	16.1	1.30 (1.27; 1.33)	3,489	24.6	19.0	1.28(1.24; 1.32)
1	^● ● Presence unhealthy food habits;	^○ ○ Absence of food habits.	^○ ○ Absence of food habits.	^○ ○ Absence of food habits.	6,308	19.2	24.5	0.78(0.76; 0.79)	2,779	19.6	24.1	0.80 (0.77; 0.83)
1	^○ ○ Absence of food habits.	^● ● Presence unhealthy food habits;	^○ ○ Absence of food habits.	^○ ○ Absence of food habits.	3,242	9.9	16.1	0.61 (0.59; 0,63)	1,242	8.8	13.9	0.62 (0.59; 0.66)
1	^○ ○ Absence of food habits.	^○ ○ Absence of food habits.	^● ● Presence unhealthy food habits;	^○ ○ Absence of food habits.	432	1.3	1.3	1.02 (0.93; 1,1 2)	107	0.7	1.3	0.57 (0.47; 0.69)
1	^○ ○ Absence of food habits.	^○ ○ Absence of food habits.	^○ ○ Absence of food habits.	^● ● Presence unhealthy food habits;	1,167	3.6	2.3	1.55 (1.46; 1.64)	853	6.0	4.8	1.24(1.16; 1.33)
2	^● ● Presence unhealthy food habits;	^● ● Presence unhealthy food habits;	^○ ○ Absence of food habits.	^○ ○ Absence of food habits.	10,518	32.0	24.5	1.30 (1.27; 1.32)	3,317	23.4	17.6	1.31 (1.27; 1.36)
2	^● ● Presence unhealthy food habits;	^○ ○ Absence of food habits.	^● ● Presence unhealthy food habits;	^○ ○ Absence of food habits.	331	1.0	1.9	0.52 (0.46; 0.57)	124	0.9	1.7	0.52 (0.43; 0.62)
2	^● ● Presence unhealthy food habits;	^○ ○ Absence of food habits.	^○ ○ Absence of food habits.	^● ● Presence unhealthy food habits;	836	2.5	3.5	0.73 (0.68; 0.78)	643	4.5	6.1	0.74 (0.68; 0.80)
2	^○ ○ Absence of food habits.	^● ● Presence unhealthy food habits;	^● ● Presence unhealthy food habits;	^○ ○ Absence of food habits.	297	0.9	1.3	0.71 (0.63; 0.79)	65	0.5	1.0	0.47 (0.37; 0.61)
2	^○ ○ Absence of food habits.	^● ● Presence unhealthy food habits;	^○ ○ Absence of food habits.	^● ● Presence unhealthy food habits;	502	1.5	2.3	0.67 (0.61; 0.73)	299	2.1	3.5	0.59 (0.53; 0.67)
2	^○ ○ Absence of food habits.	^○ ○ Absence of food habits.	^● ● Presence unhealthy food habits;	^● ● Presence unhealthy food habits;	213	0.6	0.2	3.58(3.12; 4.10)	102	0.7	0.3	2.17 (1.76; 2.62)
3	^● ● Presence unhealthy food habits;	^● ● Presence unhealthy food habits;	^● ● Presence unhealthy food habits;	^○ ○ Absence of food habits.	688	2.1	1.9	1.08(1.00; 1.16)	191	1.4	1.2	1.10(0.95; 1.27)
3	^● ● Presence unhealthy food habits;	^● ● Presence unhealthy food habits;	^○ ○ Absence of food habits.	^● ● Presence unhealthy food habits;	916	2.8	3.5	0.80 (0.75; 0.85)	653	4.6	4.5	1.02 (0.95; 1.11)
3	^● ● Presence unhealthy food habits;	^○ ○ Absence of food habits.	^● ● Presence unhealthy food habits;	^● ● Presence unhealthy food habits;	121	0.4	0.3	1.34(1.11; 1.60)	86	0.6	0.4	1.43 (1.15; 1.77)
3	^○ ○ Absence of food habits.	^● ● Presence unhealthy food habits;	^● ● Presence unhealthy food habits;	^● ● Presence unhealthy food habits;	122	0.4	0.2	2.06(1.71; 2.46)	66	0.5	0.2	1.91 (1.48; 2.43)
4	^● ● Presence unhealthy food habits;	^● ● Presence unhealthy food habits;	^● ● Presence unhealthy food habits;	^● ● Presence unhealthy food habits;	209	0.6	0.3	2.32 (2.01; 2.66)	176	1.2	0.3	4.02 (3.44; 4.65)

Variable	2 versus 0 or 1				3 versus 0 or 1				4 versus 0 or 1
	Crude analysis		Adjusted analysis		Crude analysis		Adjusted analysis		Crude analysis		Adjusted analysis
	OR (95 %CI)	P	OR (95%CI)	P	OR (95%CI)	P	OR (95%CI)	P	OR (95 %CI)	P	OR (95 %CI)	P
Gender		<0.001		<0.001		0.001		0.072		<0.001		<0.001
Men	1.00		1.00		1.00		1.00		1.00		1.00
Women	0.77 (0.73; 0.80)		0.75 (0.72; 0.78)		1.15(1.06; 1.25)		1.08 (0.99; 1.17)		1.80 (1.47; 2.20)		1.62 (1.32; 1.99)
Age (years)		<0.001*		<0.001		<0.001*		<0.001		<0.001*		<0.001
≤29	1.00		1.00		1.00		1.00		1.00		1.00
30-39	0.81 (0.77; 0.84)		0.82 (0.78; 0.86)		0.57 (0.52; 0.63)		0.62 (0.57; 0.69)		0.35 (0.27; 0.45)		0.43 (0.33; 0.56)
40-49	0.67 (0.63; 0.71)		0.68 (0.64; 072)		0.40 (0.36; 0.46)		0.45 (0.39; 0.51)		0.21 (0.14; 0.32)		0.27 (0.18; 0.41)
≥50	0.54(0.50; 0.59)		0.54 (0.49; 0.59)		0.26 (0.21; 0.33)		0.29(0.23; 0.36)		0.14(0.07; 0.30)		0.19(0.09; 0.41)
Marital status		<0.001*		0.013		<0.001*		<0.001		<0.001*		<0.001
With a partner	1.00		1.00		1.00		1.00		1.00		1.00
Without a partner	1.13 (1.09; 1.18)		1.05(1.01; 1.10)		1.66 (1.53; 1.79)		1.32 (1.22; 1.43)		2.94(2.37; 3.65)		2.02 (1.61; 2.53)
Educational level (years)		<0.001*		<0.001		0.781		0.498		0.136		0.701
≤7	1.00		1.00		1.00		1.00		1.00		1.00
8	0.98(0.91; 1.04)		0.94(0.88; 1.00)		1.05 (0.92; 1.21)		0.91 (0.79; 1.04)		1.39 (0.95; 2.05)		1.11 (0.74; 1.66)
9-11	0.85 (0.81; 0.90)		0.87 (0.82; 0.92)		1.14(1.03; 1.27)		0.94 (0.84; 1.06)		1.65 (1.21; 2.25)		1.08 (0.76; 1.53)
≥12	0.67 (0.63; 0.72)		0.88 (0.81; 0.96)		0.93 (0.81; 1.07)		0.94(0.79; 1.11)		1.11 (0.74; 1.66)		0.86 (0.54; 1.36)
Family income (quartiie)	<0.001*		<0.001		<0.001*		<0.001		<0.005		0.159
≤280	1.00		1.00		1.00		1.00		1.00		1.00
281-700	0.83 (0.79; 0.86)		0.88 (0.84; 0.92)		0.84(0.77; 0.92)		0.90 (0.82. 0.99)		0.83 (0.66; 1.05)		0.94(0.73; 1.19)
701-1400	0.61 (0.58; 0.65)		0.69 (0.65; 0.74)		0.66 (0.59; 0.74)		0.75 (0.66; 0.85)		0.84(0.63; 1.12)		1.01 (0.74; 1.39)
≥1401	0.53 (0.49; 0.57)		0.62 (0.57; 0.68)		0.62 (0.53; 0.72)		0.74 (0.62; 0.88)		0.46 (0.30. 0.73)		0.65 (0.40; 1.07)

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[1] Note:

[TFN01] ^a
Variable with the largest number of missing data for men (n=343; 1.0%) and women (n=153; 1.1 %);

[TFN02] ^b
p-value resulting from Chi-square tests or tests of linear trend.