Social inequalities in the food consumption profile of the Brazilian population: National Health Survey, 2013

Medina, Lhais de Paula Barbosa; Barros, Marilisa Berti de Azevedo; Sousa, Neuciani Ferreira da Silva; Bastos, Tássia Fraga; Lima, Margareth Guimarães; Szwarcwald, Celia Landmann

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Revista Brasileira de Epidemiologia

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ORIGINAL ARTICLE • Rev. bras. epidemiol. 22 (Suppl 02) • 2019 • https://doi.org/10.1590/1980-549720190011.supl.2 copy

Social inequalities in the food consumption profile of the Brazilian population: National Health Survey, 2013

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT:

Introduction:

High income concentration prevails in Brazil and socioeconomic status influences living and health conditions, including dietary quality.

Objective:

To measure the magnitude of social inequalities in the food quality profile of the Brazilian population.

Method:

We analyzed data from 60,202 adults who participated in the 2013 National Health Survey. The prevalence of indicators of food quality was estimated according to gender, ethnicity, income, schooling, and health insurance. We calculated prevalence ratios using multiple Poisson regression.

Results:

Healthy food consumption was more prevalent among females, white people, and individuals with higher socioeconomic status. However, we also found a higher prevalence of some foods considered unhealthy, such as sweets, sandwiches, snacks, and pizzas, among the most favored social segments, in women, and white people, expressing the concomitance of healthy and unhealthy eating habits. The comparison between the consumption of skim and low-fat milk according to income (prevalence ratio - PR = 4.48) presented the most significant difference.

Conclusion:

In addition to the expressive social inequality identified in the Brazilian food profile, mixed patterns were detected, including healthy and unhealthy foods. These results point out the need for monitoring and promoting healthy eating habits, taking into account the social inequalities and contradictions concerning food intake.

Keywords:
Food consumption; Health Status Disparities; Diet, food, and nutrition

	Prevalence (%)			Prevalence ratio (PR)^a
	Total	Male (n=25,920)	Female (n=34,282)	PR^b (95%CI)
≥ 5x per week^c
Raw V	46.5	42.2	50.3	1.18 (1.14 - 1.22)
Cooked V	32.1	27.7	35.7	1.27 (1.21 - 1.32)
Fruits	41.4	34.9	47.1	1.33 (1.28 - 1.38)
Fresh juice	25.2	24.5	25.8	1.05 (1.00 - 1.10)
Beans	71.8	76.7	67.5	0.87 (0.86 - 0.89)
≥ 1x per week^c
Fish	54.5	55.3	53.9	0.97 (0.94 - 0.99)
Option for foods with less fat
Skim or low-fat milk	17.0	13.4	20.0	1.44 (1.33 - 1.55)
Skinless chicken	76.1	69.0	82.3	1.18 (1.16 - 1.21)
Red meat without visible fat	69.5	60.3	77.9	1.28 (1.26 - 1.31)
≤ 2x per week^c
Red meat	28.2	22.7	33.0	1.43 (1.36 - 1.50)
Sugary drinks	37.3	42.5	32.7	1.15 (1.13 - 1.18)
Sweet foods	38.1	38.1	38.2	0.99 (0.96 - 1.01)
Sandwiches, snacks, or pizzas	13.6	12.7	14.3	0.98 (0.96 - 0.99)

	Prevalence (%)		Prevalence ratio (PR)^a
	Black and multiracial (n=35,143)	White (n=24,106)	PR^b (95%CI)
≥ 5x per week^c
Raw V	38.9	54.5	1.18 (1.14 - 1.22)
Cooked V	28.7	35.2	1.08 (1.03 - 1.13)
Fruits	36.5	46.5	1.16 (1.12 - 1.20)
Fresh juice	25.9	24.3	1.13 (1.07 - 1.19)
Beans	76.0	67.7	0.87 (0.86 - 0.89)
≥ 1x per week^c
Fish	55.8	52.7	1.06 (1.02 - 1.09)
Option for foods with less fat
Skim or low-fat milk	12.8	21.1	1.52 (1.40 - 1.66)
Skinless chicken	76.6	75.5	1.04 (1.02 - 1.07)
Red meat without visible fat	67.8	71.2	1.06 (1.04 - 1.09)
≤ 2x per week^c
Red meat	29.5	26.7	0.96 (0.91 - 1.01)
Sugary drinks	37.2	37.5	1.00 (0.98 - 1.03)
Sweet foods	34.3	42.3	0.90 (0.88 - 0.92)
Sandwiches, snacks, or pizzas	10.6	16.8	0.95 (0.93 - 0.96)

	Prevalence ratio (PR)^a
	PR^b (95%CI)	PR^b (95%CI)	PR^b (95%CI)	PR^b (95%CI)
	(2/1)	(3/1)	(4/1)	(5/1)
≥ 5x per week^c
Raw V	1.27 (1.16 - 1.38)	1.49 (1.36 - 1.63)	1.71 (1.57 - 1.87)	2.11 (1.93 - 2.31)
Cooked V	1.18 (1.06 - 1.31)	1.30 (1.17 - 1.45)	1.46 (1.32 - 1.61)	1.95 (1.76 - 2.15)
Fruits	1.28 (1.18 - 1.40)	1.55 (1.42 - 1.69)	1.88 (1.72 - 2.04)	2.34 (2.15 - 2.56)
Fresh juice	1.27 (1.16 - 1.40)	1.47 (1.33 - 1.63)	1.67 (1.52 - 1.84)	2.42 (2.17 - 2.69)
Beans	1.02 (0.99 - 1.06)	1.00 (0.97 - 1.04)	0.90 (0.87 - 0.94)	0.65 (0.62 - 0.69)
≥ 1x per week^c
Fish	0.96 (0.92 - 1.01)	0.96 (0.91 - 1.02)	1.10 (1.05 - 1.16)	1.43 (1.35 - 1.51)
Option for foods with less fat
Skim or low-fat milk	1.08 (0.88 - 1.31)	1.26 (1.04 - 1.53)	2.11 (1.76 - 2.55)	4.48 (3.70 - 5.43)
Skinless chicken	1.01 (0.98 - 1.04)	1.03 (1.00 - 1.07)	1.13 (1.09 - 1.16)	1.22 (1.18 - 1.27)
Red meat without visible fat	1.04 (1.00 - 1.08)	1.04 (1.00 - 1.09)	1.13 (1.08 - 1.18)	1.29 (1.24 - 1.35)
≤ 2x per week^c
Red meat	0.76 (0.71 - 0.81)	0.70 (0.65 - 0.75)	0.63 (0.59 - 0.68)	0.73 (0.66 - 0.80)
Sugary drinks	0.92 (0.88 - 0.96)	0.88 (0.84 - 0.92)	0.92 (0.89 - 0.96)	1.01 (0.96 - 1.06)
Sweet foods	0.93 (0.90 - 0.96)	0.86 (0.82 - 0.89)	0.83 (0.80 - 0.86)	0.80 (0.76 - 0.85)
Sandwiches, snacks, or pizzas	0.98 (0.96 - 0.99)	0.94 (0.92 - 0.96)	0.90 (0.88 - 0.92)	0.86 (0.83 - 0.88)

	Prevalence ratio (PR)^a
	PR^b (95%CI)	PR^b (95%CI)	PR^b (95%CI)	PR^b (95%CI)
	(2/1)	(3/1)	(4/1)	(5/1)
≥ 5x per week^c
Raw V	1.34 (1.25 - 1.43)	1.45 (1.35 - 1.57)	1.71 (1.59 - 1.83)	1.94 (1.81 - 2.08)
Cooked V	1.37 (1.26 - 1.50)	1.48 (1.33 - 1.64)	1.71 (1.56 - 1.88)	2.01 (1.83 - 2.21)
Fruits	1.35 (1.26 - 1.44)	1.62 (1.50 - 1.75)	1.85 (1.72 - 1.98)	2.12 (1.96 - 2.28)
Fresh juice	1.28 (1.17 - 1.40)	1.37 (1.24 - 1.53)	1.64 (1.49 - 1.79)	2.03 (1.83 - 2.25)
Beans	0.96 (0.93 - 0.98)	0.91 (0.89 - 0.94)	0.85 (0.83 - 0.88)	0.67 (0.64 - 0.70)
≥ 1x per week^c
Fish	1.07 (1.02 - 1.13)	1.18 (1.12 - 1.25)	1.27 (1.21 - 1.34)	1.52 (1.43 - 1.61)
Option for foods with less fat
Skim or low-fat milk	1.25 (1.09 - 1.44)	1.47 (1.24 - 1.74)	2.13 (1.84 - 2.46)	4.12 (3.59 - 4.72)
Skinless chicken	1.04 (1.01 - 1.08)	1.13 (1.08 - 1.17)	1.19 (1.15 - 1.24)	1.25 (1.20 - 1.30)
Red meat without visible fat	1.00 (0.97 - 1.04)	1.04 (0.99 - 1.08)	1.14 (1.10 - 1.19)	1.23 (1.18 - 1.28)
≤ 2x per week^c
Red meat	0.95 (0.89 - 1.02)	0.92 (0.84 - 1.00)	0.84 (0.77 - 0.91)	0.89 (0.82 - 0.98)
Sugary drinks	1.00 (0.97 - 1.04)	0.97 (0.94 - 1.01)	1.00 (0.96 - 1.03)	1.10 (1.05 - 1.14)
Sweet foods	0.97 (0.94 - 0.99)	0.90 (0.86 - 0.94)	0.86 (0.83 - 0.90)	0.79 (0.75 - 0.83)
Sandwiches, snacks, or pizzas	0.99 (0.98 - 1.01)	0.96 (0.93 - 0.98)	0.92 (0.90 - 0.94)	0.88 (0.86 - 0.91)

	Prevalence (%)		Prevalence ratio (PR)^a
	Without insurance (n=43,834)	With insurance (n=16,368)	PR^b (95%CI)
≥ 5x per week^c
Raw V	40.9	59.5	1.30 (1.26 - 1.34)
Cooked V	28.0	41.1	1.32 (1.26 - 1.38)
Fruits	36.2	53.3	1.41 (1.36 - 1.45)
Fresh juice	23.4	29.5	1.44 (1.37 - 1.51)
Beans	74.7	65.3	0.85 (0.83 - 0.87)
≥ 1x per week^c
Fish	52.3	59.6	1.23 (1.19 - 1.27)
Option for foods with less fat
Skim or low-fat milk	11.8	28.1	2.29 (2.12 - 2.47)
Skinless chicken	74.0	80.6	1.13 (1.11 - 1.15)
Red meat without visible fat	66.6	76.0	1.15 (1.13 - 1.17)
≤ 2x per week^c
Red meat	29.1	25.9	0.91 (0.87 - 0.96)
Sugary drinks	38.1	35.5	1.06 (1.03 - 1.08)
Sweet foods	35.5	44.2	0.88 (0.86 - 0.91)
Sandwiches, snacks, or pizzas	11.7	17.9	0.94 (0.92 - 0.95)

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[1] Corresponding author: Lhais de Paula Barbosa Medina. Rua Tessália Vieira de Camargo, 126, Cidade Universitária Zeferino Vaz, CEP: 13083-887, Campinas, SP, Brazil. Email: lhaisdepaula@gmail.com