Abstract:

The objective was to investigate how often Brazilian adolescents eat meals with their parents and verify the association between this habit and quality of the diet. Data were from the Brazilian National Survey of School Health (PeNSE-2015). The sample consisted of adolescents enrolled in the ninth grade in public and private schools, ranging in age from 11 to 19 years. The target exposure was eating meals with parents (0-4 and ≥ 5 days/week) and the outcomes were frequent consumption (≥ 5 days/week) of healthy and unhealthy dietary markers. Healthy diet scores (range 0-21) and unhealthy diet scores (range 0-35) were based on total days that the adolescent reported consuming each of the dietary markers. Poisson and linear regression models were used, adjusted by sociodemographic variables. Frequent sharing of meals with parents (≥ 5 days/week) was seen in 74% (95%CI: 73.4-74.7) of the adolescents. Those reporting this habit showed higher likelihood of frequent consumption of beans (PR = 1.22; 95%CI: 1.19-1.26), fruits (PR = 1.34; 95%CI: 1.28-1.39), and vegetables (PR = 1.39; 95%CI: 1.34-1.44), and lower likelihood of frequent consumption of sweets (PR = 0.91; 95%CI: 0.88-0.94), ultra-processed salty foods (PR = 0.91; 95%CI: 0.87-0.94), and fried salty snacks (PR = 0.85; 95%CI: 0.80-0.90). Eating meals with parents was positively associated with healthy diet scores and inversely associated with unhealthy diet scores . Eating meals with parents is a common habit in Brazilian adolescents and is associated with better quality of diet.

Keywords:
Meals; Family; Food Consumption; Adolescent

Introduction

Obesity is a public health problem that affects children and adolescents at high rates worldwide ¹1. GBD 2015 Obesity Collaborators; Afshin A, Forouzanfar MH, Reitsma MB, Sur P, Estep K, et al. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med 2017; 377:13-27.^,22. GBD 2013 Obesity Collaboration; Marie Ng, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional and national prevalence of overweight and obesity in children and adults 1980-2013: a systematic analysis. Lancet 2014; 384:766-81.. In Brazil, prevalence of obesity in this age group is 14% ³3. Aiello AM, Marques de Mello L, Souza Nunes M, Soares da Silva A, Nunes A. Prevalence of obesity in children and adolescents in brazil: a meta analysis of cross-sectional studies. Curr Pediatr Rev 2015; 11:36-42.. Data from a national survey in 2014 showed that one out of four Brazilian adolescents had excess weight and 8.4% were already obese ⁴4. Bloch KV, Klein CH, Szklo M, Kuschnir MCC, Abreu GA, Barufaldi LA, et al. ERICA: Prevalences of hypertension and obesity in Brazilian adolescents. Rev Saúde Pública 2016; 50 Suppl 1:9s.. Meanwhile, adolescents’ dietary habits have been characterized by high consumption of ultra-processed foods, high in fats, sugars, and sodium, and low consumption of fruits and vegetables ⁵5. Souza AM, Pereira R, Yokoo EM, Levy RB, Sichieri R. Alimentos mais consumidos no Brasil: Inquérito Nacional de Alimentação 2008-2009. Rev Saúde Pública 2013; 47 Suppl 1:190s-9s.^,66. Souza AM, Barufaldi LA, Abreu GA, Giannini DT, Oliveira CL, Santos MM, et al. ERICA: Intake of macro and micronutrients of Brazilian adolescents. Rev Saúde Pública 2016; 50 Suppl 1:5s.^,77. Andrade SC, Previdelli AN, Cesar CLG, Marchioni DML, Fisberg RM. Trends in diet quality among adolescents, adults and older adults: a population-based study. Prev Med Rep 2016; 4:391-6.. Factors contributing to this scenario include the familiar environment, which plays an important role in the development of eating habits in children and adolescents ⁸8. Savage JS, Fisher JO, Birch LL. Parental influence on eating behavior: conception to adolescence. J Law Med Ethics 2007; 35:22-34.^,99. Fulkerson JA, Larson N, Horning M, Neumark-Sztainer D. A review of associations between family or shared meal frequency and dietary and weight status outcomes across the lifespan. J Nutr Educ Behav 2014; 46:2-19.^,1010. Patrick H, Nicklas TA. A review of family and social determinants of children's eating patterns and diet quality. J Am Coll Nutr 2005; 24:83-92..

Studies have suggested that sharing meals with the family may serve as a protective factor against problems related to health conditions in childhood and adolescence ¹¹11. Nicklas TA, Baranowski T, Baranowski JC, Cullen K, Rittenberry L, Olvera N. Family and child-care provider influences on preschool children's fruit, juice, and vegetable consumption. Nutr Rev 2001; 59:224-35.^,1212. Coall DA, Hertwig R. Grandparental investment: past, present, and future. Behav Brain Sci 2010; 33:1-19.. Sharing meals also has great potential as a learning environment, where parents can demonstrate healthy eating habits and children can learn about foods and their preparation and eating behaviors and attitudes ¹³13. Reid M, Worsley A, Mavondo F. The obesogenic household: factors influencing dietary gatekeeper satisfaction with family diet. Psychol Mark 2015; 32:544-57..

A meta-analysis published in 2018 including 57 studies showed that family meals were associated with healthy diet and low body mass index in children and adolescents ¹⁴14. Dallacker M, Hertwig R, Mata J. The frequency of family meals and nutritional health in children: a meta-analysis. Obes Rev 2018; 19:638-53.. Still, these studies were conducted in high-income countries, the vast majority in the USA, followed by European countries. Studies assessing the family environment and its association with dietary patterns are still rare in Brazil. The existing scientific studies address anthropological aspects of sharing meals and the impacts of globalization on changes in eating practices ¹⁵15. Romanelli G. O significado da alimentação na família: uma visão antropológica. Medicina (Ribeirão Preto) 2006; 39:333-9.^,1616. Garcia RWD. Reflexos da globalização na cultura alimentar: considerações sobre as mudanças na alimentação urbana. Rev Nutr 2003; 16:483-92., or only report the prevalence of this practice and its association with some of the population’s sociodemographic characteristics ¹⁷17. Barufaldi LA, Abreu GA, Oliveira JS, Santos DF, Fujimori E, Vasconselos SML, et al. ERICA: prevalência de comportamentos alimentares saudáveis em adolescentes brasileiros. Rev Saúde Pública 2016; 50 Suppl 1:6s.. The current study thus aimed to investigate how often Brazilian adolescents eat meals with their parents and verify the association between this habit and quality of diet.

Methods

Study population, sampling, and data collection

We analyzed data from the third edition of the Brazilian National Survey of School Health (PeNSE), conducted in 2015 by the Brazilian Institute of Geography and Statistics (IBGE) in partnership with the Brazilian Ministries of Health and Education. PeNSE is a cross-sectional survey with a representative sample of Brazilian ninth-grade students (n = 102,072) 11 to 19 years of age and enrolled in public and private schools (n = 3,040 schools).

Schools were selected according to the number of classes and type of administration (public versus private). In each school in the sample, ninth-grade classes were selected randomly and with equal probabilities between classes existing in 2015, as follows: one class in each school that reported having up to two ninth-grade classes, and two classes in each school with three or more ninth-grade classes. All the students in the selected classes were invited to participate in the study.

Students answered a self-applied smartphone questionnaire with questions of sociodemographic characteristics, family and school context, and dietary practices. Further details on the sampling process can be assessed by the PeNSE publication ¹⁸18. Instituto Brasileiro de Geografia e Estatística. Pesquisa Nacional de Saúde do Escolar: 2015. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 2016..

Study variables

The habit of sharing meals (lunch or dinner) with the family was assessed with the following question: “Do you usually eat lunch or dinner with your mother, father, or guardian?”, with the following answers: “Yes, every day”; “Yes, 5-6 days a week”; “Yes, 3-4 days a week”; “Yes, 1-2 days a week”; “Rarely”; or “No”. The study adopted the term “parents” for “mother, father, or guardian”, and eating meals with parents was categorized as 0-4 and ≥ 5 days per week, with the latter defined as frequent consumption.

Diet quality was assessed with the following question: “In the last 7 days, on how many days did you eat ...?”, for each of the markers of healthy diet (beans, fruits, vegetables) and unhealthy diet (candy, hamburger, ham, baloney, salami, sausage, hotdog, instant noodles, packaged salty foods, crackers, fried salty snacks, sodas, and fast food). The term “ultra-processed salty foods” was used for the group that included processed meats (hamburger, ham, baloney, salami, sausage, hotdog), packaged snacks, instant noodles, and crackers. Consumption of markers of healthy and unhealthy diet was categorized as frequent (≥ 5 days a week) and not frequent (0-4 days a week). Next, two scores were created for the continuous analysis. Healthy diet score was based on the sum of days of the week that the adolescent reported consuming each of the three healthy markers, and could vary from zero (did not consume any of these foods on any day) to 21 (consumed all of the foods on all 7 days). The unhealthy diet score was created in the same way, but adding the frequency of consumption of the five unhealthy markers, ranging from zero to 35. The higher the score, the higher the consumption of these dietary markers. The scores were created to allow consolidating healthy and unhealthy indicators, and not only each single variable.

The sociodemographic variables were: sex; age bracket (≤ 13 years, 14, 15, ≥ 16 years); maternal schooling (incomplete elementary, complete elementary, complete secondary; complete university); school administration (public versus private); race/color (white, black, brown, Asian-descendent, indigenous); geographic region of school and student’s residence (North, Northeast, Southeast, South, Central); municipality of residence (state capital and non-capital); family arrangement (lives with mother and father, only with mother, only with father, or with neither); and household assets and services score. The assets and services score was based on the following reported items: landline, mobile phone, computer, internet access, car, and housemaid services three or more days a week. Each item was assigned a weight, the equivalent to the inverse frequency of possession of assets or presence of services in the total sample. The sum of the weights produced the score for each individual, later divided into tertiles ¹⁹19. Levy RB, Castro IRR, Cardoso LO, Tavares LF, Sardinha LMV, Gomes FS, et al. Consumo e comportamento alimentar entre adolescentes brasileiros: Pesquisa Nacional de Saúde do Escolar (PeNSE), 2009. Ciênc Saúde Colet 2010; 15 Suppl 2:3085-97..

Ethical aspects

The PeNSE 2015 survey was approved by the National Committee for Research Ethics of the National Health Council (CNS), under case review n. 1.006.467 of March 30, 2015. Students and schools were advised as to guaranteed data confidentiality and anonymity.

Data analysis

We calculated the prevalence rates and confidence intervals for frequent consumption of the dietary markers, as well as frequent consumption of meals with parents, according to the socioeconomic variables.

Multiple imputation by chained equations was performed for the variable maternal schooling, which showed 26.9% of losses. Sociodemographic and dietary variables were used as predictive variables in the imputation because they were part of subsequent analytical models ²⁰20. Sterne JAC, White IR, Carlin JB, Spratt M, Royston P, Kenward MG, et al. Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls. BMJ 2009; 338:b2393.. The other variables showed losses less than 0.3%.

The association between eating meals with parents and frequent consumption of each healthy and unhealthy dietary marker was assessed as prevalence ratio (PR), obtained by Poisson regression models. The association between eating meals with parents and healthy and unhealthy diet scores was assessed with linear regression models. Covariables with p < 0.20 in the univariate models with the outcome were used for adjustment in the multiple models.

All the analyses used Stata 14.1 (https://www.stata.com), considering the sample’s complexity and setting statistical significance at p < 0.05.

Results

Tables 1 and 2 show frequent consumption of markers of healthy and unhealthy diet according to the sociodemographic characteristics of Brazilian adolescents. More than half (52.8%; 95%CI: 51.8-53.8) showed frequent consumption of beans, and about one-third ate fruits (32.7%; 95%CI: 32.1-33.4) and vegetables (37.7%; 95%CI: 37.0-38.4) at least 5 days a week. As for unhealthy dietary markers, 41.6% (95%CI: 41.0-42.3) of the adolescents reported frequent consumption of sweets, 31.3% (95%CI: 30.7-32.0) of ultra-processed salty foods, 13.7% (95%CI: 13.2-14.2) of fried salty snacks, 26.7% (95%CI: 26.0-27.3) of sodas, and 5.2% (95%CI: 4.9-5.4) of fast food. Frequent consumption of beans was higher in public school students, in black, brown, or indigenous students compared to whites, and in those not living in state capitals, and was inversely associated with the household assets/services score and maternal schooling. Consumption of fruits and vegetables showed a direct association with the assets/services score and maternal schooling. Frequent consumption of vegetables was higher in private school students and white students compared to black, brown, and indigenous (Table 1). Frequent consumption of all unhealthy dietary markers was higher in students reporting higher maternal schooling and in the higher tertiles of household assets/services. Frequent consumption of ultra-processed salty foods, which included processed meats, packaged salty snacks, and crackers was also higher in private school students (Table 2).

Approximately 74% (95%CI: 73.4-74.7) of the adolescents reported eating meals with parents at least 5 days a week, a habit that was more frequent in boys, younger adolescents, children of mothers with less schooling, public school students, and those not living in state capitals (Table 3).

Table 4 shows the association between frequency of eating meals with parents and frequent consumption of healthy and unhealthy dietary markers. Eating meals with parents at least 5 days a week was positively associated with frequent consumption of beans (PR = 1.22; 95%CI: 1.19-1.26), fruits (PR = 1.34; 95%CI: 1.28-1.39), and vegetables (PR = 1.34; 95%CI; 1.28-1.39) and negatively associated with frequent consumption of sweets (PR = 0.91; 95%CI: 0.88-0.94), ultra-processed salty foods (PR = 0.91; 95%CI: 0.87-0.94), and fried salty snacks (PR = 0.85; 95%CI: 0.80-0.90). There was no significant association for consumption of sodas and fast food (p > 0.05).

The analysis of consolidated indicators via dietary scores showed that eating meals with parents was positively associated with the healthy diet score (β = 1.86; p < 0.001) and inversely associated with the unhealthy diet score (β = -0.62; p < 0.001) (Figure 1).

Discussion

This study aimed to assess the association between eating meals with parents as a family environment characteristic and quality of diet in Brazilian adolescents. The results showed that eating meals with parents was associated with better diet quality in adolescents, specifically more frequent consumption of beans, fruits, and vegetables, and less frequent consumption of sweets, ultra-processed salty foods, and fried salty snacks. Sharing meals frequently with parents was positively associated with healthy diet score and inversely with unhealthy diet score.

Eating meals with parents was a frequent habit in Brazilian adolescents, more than 70% of whom reported sharing meals with them at least 5 days of week. This was similar to another Brazilian study that found 68% of adolescents always or almost always eating meals with parents ¹⁷17. Barufaldi LA, Abreu GA, Oliveira JS, Santos DF, Fujimori E, Vasconselos SML, et al. ERICA: prevalência de comportamentos alimentares saudáveis em adolescentes brasileiros. Rev Saúde Pública 2016; 50 Suppl 1:6s.. In our study, this habit was more frequent in boys, younger adolescents, public school students, and those living with the mother and father.

More than half of the adolescents ate beans frequently, but fewer than one-third reported frequent consumption of other healthy dietary markers (fruits and vegetables). Meanwhile, unhealthy markers stood out, with more than 30% of adolescents reporting frequent consumption of sweets and ultra-processed salty foods. These results are consistent with previous studies showing that Brazilian adolescents’ diet is still marked by consumption of traditional foods like beans, but that these foods are being replaced by ultra-processed products like sweets, cookies, sodas, and fast food ⁶6. Souza AM, Barufaldi LA, Abreu GA, Giannini DT, Oliveira CL, Santos MM, et al. ERICA: Intake of macro and micronutrients of Brazilian adolescents. Rev Saúde Pública 2016; 50 Suppl 1:5s.^,77. Andrade SC, Previdelli AN, Cesar CLG, Marchioni DML, Fisberg RM. Trends in diet quality among adolescents, adults and older adults: a population-based study. Prev Med Rep 2016; 4:391-6.^,1919. Levy RB, Castro IRR, Cardoso LO, Tavares LF, Sardinha LMV, Gomes FS, et al. Consumo e comportamento alimentar entre adolescentes brasileiros: Pesquisa Nacional de Saúde do Escolar (PeNSE), 2009. Ciênc Saúde Colet 2010; 15 Suppl 2:3085-97.^,2121. Azeredo CM, Rezende LFM, Canella DS, Moreira RC, Castro IRR, Luiz OC, et al. Dietary intake of Brazilian adolescents. Public Health Nutr 2015; 18:1215-24.. A recent study also using data from the PeNSE 2015 survey showed that although the amounts consumed daily were not evaluated, it is worrisome that four out of ten Brazilian adolescents already reported consuming ultra-processed foods on a daily basis ²²22. Costa CS, Flores TR, Wendt A, Neves RG, Assunção MCF, Santos IS. Comportamento sedentário e consumo de alimentos ultraprocessados entre adolescentes brasileiros: Pesquisa Nacional de Saúde do Escolar (PeNSE), 2015. Cad Saúde Pública 2018; 34:e00021017..

Socioeconomic differences in the consumption of healthy and unhealthy dietary markers in Brazilian adolescents were found in a previous study by Azeredo et al. using data from PeNSE 2012 ²¹21. Azeredo CM, Rezende LFM, Canella DS, Moreira RC, Castro IRR, Luiz OC, et al. Dietary intake of Brazilian adolescents. Public Health Nutr 2015; 18:1215-24., in which the relations were similar to the more recent study. We found that older adolescents shared meals less frequently with their parents, corroborating a previous study by Barufaldi et al. ¹⁷17. Barufaldi LA, Abreu GA, Oliveira JS, Santos DF, Fujimori E, Vasconselos SML, et al. ERICA: prevalência de comportamentos alimentares saudáveis em adolescentes brasileiros. Rev Saúde Pública 2016; 50 Suppl 1:6s., and consumed more fried snacks, fast food, and sodas. A possible explanation is that as they grow older, adolescents gain greater independence and autonomy to purchase and consume their own meals without their parents’ presence ²³23. Scaglioni S, Cosmi V, Ciappolino V, Parazzini F, Brambilla P, Agostoni C. Factors influencing children's eating behaviours. Nutrients 2018; 10:706.. The relationship between frequency of eating with parents and indicators of social vulnerability such as maternal schooling, household assets/services, and race/color is not clear. Although such characteristics favor consumption of meals with parents, they are also associated with less frequent consumption of fruits and vegetables, showing that other factors such as prices and availability of these foods in regions with lower socioeconomic status may influence the consumption of healthy foods in this population group ²⁴24. Duran AC, Roux AVD, Latorre MR, Jaime PC. Neighborhood socioeconomic characteristics and differences in the availability of healthy food stores and restaurants in São Paulo, Brazil. Health Place 2013; 23:39-47.^,2525. Claro RM, Maia EG, Costa BVL, Diniz DP. Preço dos alimentos no Brasil: prefira preparações culinárias a alimentos ultraprocessados. Cad Saúde Pública 2016; 32:e00104715..

The association in our study between eating meals with the family and better quality of diet in adolescents is corroborated by other studies, conducted in high-income countries ²⁶26. Fink SK, Racine EF, Mueffelmann RE, Dean MN, Herman-Smith R. Family meals and diet quality among children and adolescents in North Carolina. J Nutr Educ Behav 2014; 46:418-22.^,2727. Larson N, MacLehose R, Fulkerson JA, Berge JM, Story M, Neumark-Sztainer D. Eating breakfast and dinner together as a family: associations with sociodemographic characteristics and implications for diet quality and weight status. J Acad Nutr Diet 2013; 113:1601-9.^,2828. Neumark-Sztainer D, Larson NI, Fulkerson JA, Eisenberg ME, Story M. Family meals and adolescents: What have we learned from Project EAT (Eating Among Teens). Public Health Nutr 2010; 13:1113-21.^,2929. Fulkerson JA, Neumark-Sztainer D, Hannan PJ, Story M. Family meal frequency and weight status among adolescents: Cross-sectional and 5-year longitudinal associations. Obesity (Silver Spring) 2008; 16:2529-34.^,3030. Utter J, Scragg R, Schaaf D, Mhurchu CN. Relationships between frequency of family meals, BMI and nutritional aspects of the home food environment among New Zealand adolescents. Int J Behav Nutr Phys Act 2008; 5:50.^,3131. Rasmussen M, Krølner R, Klepp KI, Lytle L, Brug J, Bere E, et al. Determinants of fruit and vegetable consumption among children and adolescents: a review of the literature. Part I: quantitative studies. Int J Behav Nutr Phys Act 2006; 3:22.. American adolescents that eat meals with parents tend to consume more fruits and vegetables ²⁶26. Fink SK, Racine EF, Mueffelmann RE, Dean MN, Herman-Smith R. Family meals and diet quality among children and adolescents in North Carolina. J Nutr Educ Behav 2014; 46:418-22.^,2727. Larson N, MacLehose R, Fulkerson JA, Berge JM, Story M, Neumark-Sztainer D. Eating breakfast and dinner together as a family: associations with sociodemographic characteristics and implications for diet quality and weight status. J Acad Nutr Diet 2013; 113:1601-9.^,2828. Neumark-Sztainer D, Larson NI, Fulkerson JA, Eisenberg ME, Story M. Family meals and adolescents: What have we learned from Project EAT (Eating Among Teens). Public Health Nutr 2010; 13:1113-21.. In New Zealand, adolescents that share meals with the family perceive more support from parents for a healthy diet, have limits on the time they spend watching television, and are more prone to having fruits and vegetables available at home every day ³⁰30. Utter J, Scragg R, Schaaf D, Mhurchu CN. Relationships between frequency of family meals, BMI and nutritional aspects of the home food environment among New Zealand adolescents. Int J Behav Nutr Phys Act 2008; 5:50.. A systematic literature review identified household availability of fruits and vegetables, frequent family meals, and parental support for a healthy diet as potential determinants of consumption of fruits and vegetables by children and adolescents ³¹31. Rasmussen M, Krølner R, Klepp KI, Lytle L, Brug J, Bere E, et al. Determinants of fruit and vegetable consumption among children and adolescents: a review of the literature. Part I: quantitative studies. Int J Behav Nutr Phys Act 2006; 3:22.. These findings underline parents’ crucial role in children’s eating patterns through their eating behaviors, attitudes, and styles ¹⁰10. Patrick H, Nicklas TA. A review of family and social determinants of children's eating patterns and diet quality. J Am Coll Nutr 2005; 24:83-92..

The experiences of shared meals can also have positive long-term effects. Data from a population-based cohort in Minnesota, USA, showed that regular meals with the family were associated with healthier eating patterns both in adolescence and later in adulthood ³²32. Neumark-Sztainer D, Hannan PJ, Story M, Croll J, Perry C. Family meal patterns: associations with sociodemographic characteristics and improved dietary intake among adolescents. J Am Diet Assoc 2003; 103:317-22.^,3333. Larson NI, Neumark-Sztainer D, Hannan PJ, Story M. Family meals during adolescence are associated with higher diet quality and healthful meal patterns during young adulthood. J Am Diet Assoc 2007; 107:1502-10.. Recent analyses in this same cohort, followed for 15 years, showed that family eating practices were carried over to the next generation ³⁴34. Watts A, Berge JM, Loth K, Larson N, Neumark-Sztainer D. The transmission of family food and mealtime practices from adolescence to adulthood: longitudinal findings from project EAT-IV. J Nutr Educ Behav 2018; 50:141-7.. The results evidenced that adolescents’ family environment can shape their eating practices in adulthood.

Meals with the family promote not only improved diet quality ²⁶26. Fink SK, Racine EF, Mueffelmann RE, Dean MN, Herman-Smith R. Family meals and diet quality among children and adolescents in North Carolina. J Nutr Educ Behav 2014; 46:418-22.^,2727. Larson N, MacLehose R, Fulkerson JA, Berge JM, Story M, Neumark-Sztainer D. Eating breakfast and dinner together as a family: associations with sociodemographic characteristics and implications for diet quality and weight status. J Acad Nutr Diet 2013; 113:1601-9. and lower levels of excess weight in adolescents ²⁹29. Fulkerson JA, Neumark-Sztainer D, Hannan PJ, Story M. Family meal frequency and weight status among adolescents: Cross-sectional and 5-year longitudinal associations. Obesity (Silver Spring) 2008; 16:2529-34.^,3030. Utter J, Scragg R, Schaaf D, Mhurchu CN. Relationships between frequency of family meals, BMI and nutritional aspects of the home food environment among New Zealand adolescents. Int J Behav Nutr Phys Act 2008; 5:50., but also provide an opportunity for dietary education (improvement of culinary skills and healthy habits, for example) ³⁵35. Pyper E, Harrington D, Manson H. The impact of different types of parental support behaviours on child physical activity, healthy eating, and screen time: a cross-sectional study. BMC Public Health 2016; 16:568. and social living, promoting commensality ³⁶36. Departamento de Atenção Básica, Secretaria de Atenção à Saúde, Ministério da Saúde. Guia alimentar para a população brasileira. 2ª Ed. Brasília: Ministério da Saúde; 2014. and psychological well-being ²⁸28. Neumark-Sztainer D, Larson NI, Fulkerson JA, Eisenberg ME, Story M. Family meals and adolescents: What have we learned from Project EAT (Eating Among Teens). Public Health Nutr 2010; 13:1113-21.. Thus, sharing meals with family represents a key sociocultural element in health promotion for adolescents ²³23. Scaglioni S, Cosmi V, Ciappolino V, Parazzini F, Brambilla P, Agostoni C. Factors influencing children's eating behaviours. Nutrients 2018; 10:706.. Due to the potential short- and long-term impact of parents’ dietary practices on their children, it is important to invest in family interventions aimed at encouraging shared healthy meals, a practice recommended by the Food Guide for the Brazilian Population ³⁶36. Departamento de Atenção Básica, Secretaria de Atenção à Saúde, Ministério da Saúde. Guia alimentar para a população brasileira. 2ª Ed. Brasília: Ministério da Saúde; 2014..

Some limitations and weaknesses in the study merit discussion. This was the first population-based study to analyze the relationship between eating meals with parents and diet quality in Brazilian adolescents. Another strength is the use of the database from PeNSE 2015, a nationwide school-based survey including data on students from rural towns and state capitals and the Federal District. The survey’s high response rate (82.2%) and high school coverage in this age bracket (97% from 6 to 14 years and 88% from 15 to 19 years) contributed to the study’s external validity ³⁷37. Instituto Brasileiro de Geografia e Estatística. Pesquisa Nacional por Amostra de Domicílios. v. 33. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 2013.. The study also assessed both regular consumption of single foods and healthy and unhealthy diet scores, and found consistency in the associations. The limitations feature the fact that the questionnaire used by PeNSE 2015 did not allow a more detailed quantitative analysis of the adolescents’ diet, since it included a limited number of foods and did not consider the size of portions or whether the food was consumed more than once a day, but rather the number of days the student ate a given food in the previous week. In addition, the absence of data on the parents’ diet prevented analyzing the association between quality of the adolescents’ and parents’ diet. Finally, residual unmeasured confounding or mediating factors may at least partially explain the associations. Nevertheless, the results were consistent for frequent consumption and for the diet scores. In addition, the cross-sectional design limits the capacity to acess causal associations between eating meals with parents and adolescents’ diet quality.

Conclusions

Our results showed that eating meals with parents is associated with more consumption of healthy foods and less consumption of unhealthy foods, thus suggesting that this habit reflects improved diet quality in Brazilian adolescents. Therefore, interventions focused on the promotion of healthy eating environments should address barriers to sharing meals in the family, besides acknowledging the role of this practice as an instrument for promoting healthy diet.

Acknowledgments

This study was financial supported by Brazilian National Research Council (CNPq, process #444794/2014-0), which is linked to process #426094/2018-2. B. G. Martins had an Undergraduate Research Mentorship scholarship from CNPq (grant #112083/2016-1). F. Rauber is beneficiary of a Post-Doctoral program scholarship from São Paulo State Research Foundation (FAPESP, grant # 2016/14302-7). C. Z. Ricardo is beneficiary of a Master’s program scholarship from FAPESP (grant #2014/26711-3). P. P. Machado is a beneficiary of a Doctoral scholarship (FAPESP, grant #2016/13168-5).

References

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History