School food environment and dietary patterns among brazilian adolescents: a cross-sectional study

Abstract

Introduction: adolescents’ dietary intake and food choices are shaped by multiple factors, particularly the environments in which food is obtained and consumed. As schools are a major component of the adolescent food environment, understanding how the school physical environment influences eating patterns is essential, given the growing adoption of unhealthy lifestyles. Objective: to evaluate the relationship between Brazilian adolescents’ dietary patterns and the school physical food environment using PeNSE 2019 data. Methods: this cross-sectional study analyzed data from 159,245 students participating in the 2019 Brazilian National School Health Survey (PeNSE). Dietary patterns were identified using Principal Component Analysis (PCA), and their associations with the school physical environment were evaluated using Poisson regression with robust variance. Results: healthy and unhealthy eating patterns were identified in the study population. School meal provision (PR: 1.016; 95%CI: 1.006–1.025) and the presence of school gardens (PR: 1.012; 95%CI: 1.004–1.020) were associated with the healthy eating pattern, whereas ultra-processed food advertising (PR: 1.012; 95%CI: 1.003–1.020) and the presence of snack bars (PR: 1.026; 95%CI: 1.015–1.038) were associated with the unhealthy eating pattern.   Conclusion: the findings highlight that protective and risk factors coexist within the same school environment and may simultaneously influence adolescents’ food choices. They reinforce the importance of strengthening school feeding policies, advancing national regulations for school food environments, and supporting future research to generate evidence for the development and refinement of healthier school food policies.