From the PCA it was possible to verify two components, the first related to a healthy food consumption pattern by the regular consumption of fruits, vegetables, and beans and the second to a mixed pattern, since it cannot be considered a healthy feeding behavior just not to regularly consume sweets, soft drinks, and food from snack bars. Regarding the associated factors, the adolescents most likely to belong to the third tertile of component 1, i.e., those who regularly consumed fruits, vegetables, and beans, lived in the Midwest and Southeast regions, their mothers had higher education, and they had healthier daily habits. Adolescents who belonged to the third tertile of component 2, on the other hand, were positively associated with being male, aged 16 and 17, studying in public schools, not consuming alcoholic beverages, and not being sedentary.
In this study, the consumption of healthy foods was present mainly among adolescents with better socioeconomic conditions. Fruits and vegetables are essential for a healthy food consumption pattern and act as protective factors for NCDs16 and beans are a cultural food present in Brazilian meals and an important marker of healthy eating in the country17. However, the consumption of these foods is influenced by socioeconomic factors such as family income and purchase price18,19. One study found an increase in the share of fruits and vegetables in total food purchases, when there was a decrease in price or an increase in family income18, which was also influenced by a higher level of maternal schooling, possibly due to knowledge and better accessibility to healthy food options20. In Brazil, according to the National Health Survey, the recommended consumption of fruits and vegetables was also higher in the Southeast and Midwest regions and among those with white skin color and complete higher education21.
These data show the disparities between feeding behaviors and socioeconomic levels, which reflects the need for policies aimed at improving living conditions and access to healthy food. There is still a need for progress in market regulation strategies that provide opportunities for the production and distribution of fruits and vegetables, in establishing policies to tackle the determinants of food insecurity, in reducing food prices, in strengthening income transfer programs, in addition to macroeconomic policies that are consistent with the generation of employment and income and that are synergistic with social policies, so that we can move towards overcoming poverty.
It is noteworthy that the consumption of these foods was also positively associated with adolescents who ate breakfast, lunch, or dinner with their parents, did not eat meals with other activities, and who ate school meals. Studies show that the habit of eating breakfast and having meals with parents or guardians favors the adoption of healthier food consumption patterns, being protective factors against overweight and obesity22–24. Parental support and control are important in shaping adolescents’ feeding behaviors and raising awareness of healthier choices, which will also have an impact on their continuity during adult life.
Exposure to screens is considered a sedentary behavior and causes distractions that interfere with physiological signals of hunger and satiety, leading to inappropriate food choices such as the consumption of ultra-processed foods and contributing to overweight in early stages of life25,26. One study showed that most adolescents reported consuming snacks in front of screens sometimes, and approximately 40.0% almost always or always adopted this practice27.
With regard to school meals, the Brazilian National School Feeding Program ensures the provision of adequate and healthy food, ensuring food and nutritional security, along with health education actions for public school students, which encourages the formation of healthy feeding behaviors28,29. For this reason, adolescents who eat school meals were more likely to consume fruits, vegetables, and beans. This highlights the importance of maintaining and investing in health promotion programs, as they positively impact on quality of life and improve students’ feeding behaviors.
The second component of this study was formed by a mixed pattern, i.e., adolescents who did not regularly consume sweets, soft drinks, and food from snack bars, and was also associated with socioeconomic factors such as gender, age, and administrative dependency of the school. A study based on the 2015 PeNSE found that adolescents with a higher socioeconomic status had a higher consumption of ultra-processed foods20, because unlike high-income countries, where these foods are cheaper and easily accessible, in Brazil they are still more expensive, especially in local shops compared to supermarkets30. Food choices are complex processes and price is considered a primary determinant of food demand, so the lower consumption of food in more vulnerable groups does not occur uniformly, as consumption is restricted to various types of food, both healthy and unhealthy.
For both components, there was an association with healthy lifestyle habits, such as not consuming alcoholic beverages and not presenting sedentary behavior. Health behaviors tend to occur simultaneously, due to the synergistic relationship31. More active individuals are motivated to eat healthier32,33. On the other hand, the coexistence of health risk factors is also a reality among adolescents22,34,35. Therefore, understanding and monitoring lifestyle habits in adolescence is essential for developing health promotion actions aimed at multiple health behaviors and consequently reducing the burden of disease in adult life.
Some limitations of this study need to be considered: memory bias and the self-administered questionnaire, which can lead to incorrect interpretations of the questions by the students and underestimates or overestimates of the indicators studied. However, PeNSE was based on the main international surveys, such as the Global School-Based Student Health Survey, the Health Behaviour in School-Aged Children, and the Youth Risk Behavior Surveillance System, which have validated the questionnaire, with satisfactory results in the reproducibility and validity analyses. There is also the fact that the research investigates students regularly enrolled and attending school in Brazil, excluding adolescents who do not have this educational link and who may be more vulnerable. Nevertheless, PeNSE also covers schools located in indigenous areas and in places with remote access, expanding the sample of the 2019 edition, which made it possible to disaggregate it by major regions, Federative Units, and capital municipalities. In addition, the 2019 PeNSE questionnaire removed several questions referring to the regular consumption of healthy and unhealthy foods in the last seven days, which made it impossible to choose other dependent variables, but it was possible to select those considered by the literature to be markers of a healthy and protective diet for NCDs.
This study advances in identifying the food consumption patterns of Brazilian adolescents and in identifying the sociodemographic variables associated with food consumption, and is the first nationally representative study carried out using data from the last edition of PeNSE.