Food sales in Brazilian schools and consumption of ultra-processed food among adolescents: the Study of Cardiovascular Risks in Adolescents (ERICA) 2013–2014

Inadequate eating habits in adolescence are an important risk factor for obesity and other chronic non-communicable diseases in adulthood. The school environment can have a relevant impact on adolescent behaviour, since many habits acquired in this phase affect the individual throughout life, with visible effects on health. In this study, we aimed to evaluate the association between food sales at Brazilian schools and ultra-processed food consumption among adolescents. The Study of Cardiovascular Risk Factors in Adolescents (ERICA) was a nationwide, school-based survey conducted from 2013 to 2014, including public and private schools in 121 Brazilian cities. Dietary intake was assessed via a 24-h recall, and foods were divided according to the Nova classification based on the degree of processing. Unadjusted and adjusted linear regression models were used to assess the association between exposure to school food sales and intake of ultra-processed food. The prevalence of exposure to food sales was 55·2 %, and the mean diet share of ultra-processed foods was 34·5 %. Exposure to food sales in schools was associated with higher consumption of ultra-processed food (<i>β</i> = 0·11; <i>P</i> = 0·002). The results were similar when the analyses were stratified according to sex, usual intake of school meals and public school attendance (<i>β</i> = 0·11; <i>P</i> = 0·002). The association between exposure to food sales in schools and higher consumption of ultra-processed food suggests that school sales can influence adolescents' food choices.