Characteristics of the school food environment associated with hypertension and obesity in Brazilian adolescents: a multilevel analysis of the Study of Cardiovascular Risks in Adolescents (ERICA)

Objective: To characterize the food environment in schools that participated in the Study of Cardiovascular Risks in Adolescents (ERICA) and to identify individual and contextual factors associated with hypertension and obesity. Design: National school-based survey. Setting: Blood pressure, weight and height were measured, and characteristics of the schools were obtained in interviews with the principals. For each outcome, multilevel models of mixed effects were applied by logistic regression. Participants: School-going adolescents aged 12-17 years. Results: A total of 73 399 adolescents were evaluated. The prevalence of hypertension was 9 center dot 6 (95 % CI 9 center dot 0, 10 center dot 3) % and that of obesity was 8 center dot 4 (95 % CI 7 center dot 9, 8 center dot 9) %. Approximately 50 % of the adolescents were able to purchase food at school and in its immediate vicinity and 82 % had access to no-charge meals through Brazil's National School Feeding Program. In the adjusted analysis, hypertension was associated (OR; 95 % CI) with the consumption of meals prepared on the school premises (0 center dot 79; 0 center dot 69, 0 center dot 92), the sale of food in the school's immediate vicinity (0 center dot 67; 0 center dot 48, 0 center dot 95) and the purchase of food in the school cafeteria (1 center dot 29; 1 center dot 11, 1 center dot 49). It was observed that there were lower odds of obesity among students who were offered meals prepared on the school premises (0 center dot 68; 0 center dot 54, 0 center dot 87). Conclusions: High frequency of sales of ultra-processed foods in schools was identified. Contextual and individual characteristics in the school food environment were associated with hypertension and obesity, pointing to the need for regulation and supervision of these spaces.