Desigualdades sociais no consumo alimentar de brasileiros

Abstract

Introduction: Brazil is a country marked by deep inequalities. However, the way educational, gender and race/skin color inequalities interact and act on food consumption remains uncertain. Objectives: 1) To analyze the trend of social (educational) inequality in food consumption among Brazilians from 2008 to 2019, and 2) to analyze the inequality in the consumption of natural/minimally processed and ultra-processed foods by Brazilians with a sex and race/color intersection, in 2019. Methods: We used cross-sectional data from the Telephone Surveillance System (VIGITEL) of individuals ≥18 years old living in Brazilian capitals and the Federal District and assessed the inequality (0-3, 4-8, 9-11 and ≥12 years of study) in food consumption according to sex and race/skin color (White and Black/Brown). Article 1: Time series 2008-2019 with 621,689 individuals. Food consumption was evaluated through 1) Consumption of ≥5 portions of fruits and vegetables in ≥5 days/week; 2) Consumption of beans in ≥5 days/week and 3) Consumption of soft drinks or artificial juices in ≥5 days/week. Inequality was assessed by the slope index of inequality (SII) and concentration index (CIX). Positive values of SII and CIX indicate a higher prevalence among more educated citizens and negative among less-educated. Article 2: We included data from 2019 with 52,443 individuals. We assessed the daily consumption of natural/minimally processed and ultra-processed foods, and considered it high when reported consumption of ≥5 different foods from each food group, the day before the interview. Inequality was assessed by the SII and relative index of inequality (RII). Values of RII> 1.0 indicate higher food consumption among the most educated. Results: Article 1: Fruits and vegetable consumption was more prevalent among the more educated, while beans were mostly consumed by the less educated. The highest absolute inequality was found for beans (SII2019 -25.9). The consumption of soft drinks or artificial juices decreased in all education levels. In 12 years, the absolute inequality increased for fruit and vegetable consumption (SII2008 12.8 to SII2019 16.2), remained for beans (SII2008 -23.1 to SII2019 -25.9), and reduced for soft drinks or artificial juices (SII2008 8.7 to SII2019 0.4). Relative inequality was low and constant. Article 2: The consumption of natural/minimally processed and ultra-processed foods was more frequent at the highest level of education and intermediate education (9-11 years), respectively. The absolute educational inequality for natural/minimally processed foods was greater among White women (SII 21.8; 95%CI 15.3-28.4) and Black/Brown men (SII 19.3; 95%CI 12.5-26.1). In the consumption of ultra-processed, Black/Brown men (SII 7.3; 95%CI 0.5-14.0) and Black/Brown women (SII 5.6; 95%CI 1.0-10.2) showed greater educational inequality absolute than White men (SII -3.3; 95%CI -10.9-4.3; P=0.04). Conclusions: From 2008 to 2019, inequalities in the consumption of soft drinks or artificial juices reduced, although there was a troublesome increase in the social gap for the recommended consumption of fruits and vegetables. In 2019, educational inequalities impacted the consumption of natural/minimally processed foods more than ultra-processed, and inequalities were greater between Black/Brown men and women than White men for the consumption of ultra-processed foods.