Utilization of food outlets and intake of minimally processed and ultra-processed foods among 7 to 14-year-old schoolchildren. A cross-sectional study.

BACKGROUND Access to food retailers is an environmental determinant that influences what people consume. This study aimed to test the association between the use of food outlets and schoolchildren's intake of minimally processed and ultra-processed foods. DESIGN AND SETTING This was a cross-sectional study conducted in public and private schools in Florianópolis, state of Santa Catarina, southern Brazil, from September 2012 to June 2013. METHODS The sample consisted of randomly selected clusters of schoolchildren aged 7 to 14 years, who were attending 30 schools. Parents or guardians provided socioeconomic and demographic data and answered questions about use of food outlets. Dietary intake was surveyed using a dietary recall questionnaire based on the previous day's intake. The foods or food groups were classified according to the level of processing. Negative binomial regression was used for data analysis. RESULTS We included 2,195 schoolchildren in the study. We found that buying foods from snack bars or fast-food outlets was associated with the intake frequency of ultra-processed foods among 11-14 years old in an adjusted model (incidence rate ratio, IRR: 1.11; 95% confidence interval, CI: 1.01;1.23). Use of butchers was associated with the intake frequency of unprocessed/minimally processed foods among children 11-14 years old in the crude model (IRR: 1.11; 95% CI: 1.01;1.22) and in the adjusted model (IRR: 1.11; 95% CI: 1.06;1.17). CONCLUSIONS Use of butchers was associated with higher intake of unprocessed/minimally processed foods while use of snack bars or fast-food outlets may have a negative impact on schoolchildren's dietary habits.