ABSTRACT

Objective:

To assess the regular consumption of soft drinks among Brazilian adolescents according to sociodemographic characteristics, eating habits, and lifestyle.

Methods:

This is a cross-sectional study using data from 118,497 adolescents from the 2019 National Survey of School Health (PeNSE), a population survey periodically carried out in Brazil. The prevalence of regular soft drinks consumption was estimated and, using Poisson regression analysis, the association of this consumption with variables related to eating habits and lifestyle (physical and sedentary activities, use of cigarette and alcohol) was verified.

Results:

The frequency of regular soft drinks consumption was 17.2% (95%CI 16.6–17.8%). Multiple logistic regression analysis showed an association between regular soft drinks consumption and: living in the Southeast and Midwest regions (PR=1.49 and PR=1.50), boys (PR=1.22), eating meals while using a screen on five or more days a week (PR=1.20), eating breakfast less than five days a week (PR=1.14), consuming sweets five or more days a week (PR=2.16), and consuming fast food three or more times a week (PR=2.28). Spending more than three hours a day in sedentary activities (PR=1.18) and cigarette use (PR=1.22) and binge drinking (PR=1.21) were also statistically and significantly associated with regular soft drinks consumption.

Conclusion:

Adolescents’ regular consumption of soft drinks is associated with the region of residence, sex, and unhealthy eating and lifestyle habits. Interventions to promote the reduction of regular soft drinks consumption among Brazilian adolescents should consider innovative strategies that include comprehensive public policies appropriate to the profile of adolescents.

Keywords:
Health surveys; Adolescent behavior; Carbonated beverages; Adolescent; Health risk behaviors

INTRODUCTION

Adolescent health is a recurring topic in national¹1 Braga RAM, Bezerra IN, Nogueira MDA, Souza AM, Martins GS, Almondes KGS, et al. Cardiometabolic risk assessment: a school-based study in Brazilian adolescent. Nutr Metab Cardiovasc Dis 2024; 34(4): 1069-79. https://doi.org/10.1016/j.numecd.2023.12.016
https://doi.org/10.1016/j.numecd.2023.12... ,²2 Malta DC, Morais EAH, Silva AG, Souza JB, Gomes CS, Santos FM, et al. Mudanças no uso do tabaco entre adolescentes brasileiros e fatores associados: Pesquisa Nacional de Saúde do Escolar. Ciênc Saúde Coletiva 2024; 29(9): e08252023. https://doi.org/10.1590/1413-81232024299.08252023
https://doi.org/10.1590/1413-81232024299... and international³3 Jones P, Yala JA, Knight KN, Song JM, Adkins SML, Battaglia-Hoffman G, et al. Unifying public health surveillance: a scoping review of global use of the youth risk behavior survey. J Adolesc Health 2024; 75(3): 383-91. https://doi.org/10.1016/j.jadohealth.2024.03.001
https://doi.org/10.1016/j.jadohealth.202... ,⁴4 Hashemi-Aghdam MR, Shafiee G, Ebrahimi M, Ejtahed HS, Yaseri M, Motlagh ME, et al. Trend of passive smoking and associated factors in Iranian children and adolescents: the CASPIAN studies. BMC Public Health 2022; 22(1): 603. https://doi.org/10.1186/s12889-022-13045-8
https://doi.org/10.1186/s12889-022-13045... population surveys. In this context, studies on excessive weight gain in this age group, which results in overweight or obesity among adolescents, stand out. These are conditions that can persist into adulthood, with consequences in the short, medium, and long term⁵5 Hu H, Song J, MacGregor GA, He FJ. Consumption of soft drinks and overweight and obesity among adolescents in 107 countries and regions. JAMA Netw Open 2023; 6(7): e2325158. https://doi.org/10.1001/jamanetworkopen.2023.25158
https://doi.org/10.1001/jamanetworkopen.... ,⁶6 Mahumud RA, Sahle BW, Owusu-Addo E, Chen W, Morton RL, Renzaho AMN. Association of dietary intake, physical activity, and sedentary behaviours with overweight and obesity among 282,213 adolescents in 89 low and middle income to high-income countries. Int J Obes (Lond) 2021; 45(11): 2404-18. https://doi.org/10.1038/s41366-021-00908-0
https://doi.org/10.1038/s41366-021-00908... , such as the development of noncommunicable diseases and injuries (NCDIs) and psychosocial impacts⁷7 Santana CCA, Hill JO, Azevedo LB, Gunnarsdottir T, Prado WL. The association between obesity and academic performance in youth: a systematic review. Obes Rev 2017; 18(10): 1191-9. https://doi.org/10.1111/obr.12582
https://doi.org/10.1111/obr.12582... ,⁸8 Pereira DBS, Santos IKS, Pastorello CCV, Mazzeti CMS, Pereira MHQ, Pereira MLAS, et al. Risk assessment of obesity-related noncommunicable diseases through body mass index trajectories in adulthood: NHANES 2007–2018. Am J Hum Biol 2024; 36(4): e24000. https://doi.org/10.1002/ajhb.24000
https://doi.org/10.1002/ajhb.24000... .

In addition to overweight and obesity, other risk factors associated with adult NCDIs include sociodemographic characteristics, eating habits, and lifestyle⁹9 Budreviciute A, Damiati S, Sabir DK, Onder K, Schuller-Goetzburg P, Plakys G, et al. Management and prevention strategies for non-communicable diseases (NCDs) and their risk factors. Front Public Health 2020; 8: 574111. https://doi.org/10.3389/fpubh.2020.574111
https://doi.org/10.3389/fpubh.2020.57411... . Considering that adolescence is a period in which habits are established and often maintained in adulthood, the consolidation of healthy eating habits and lifestyles at this stage is essential for the prevention of overweight/obesity and, consequently, of NCDIs¹⁰10 Damascena NF, Costa PRF, Queiroz VAO, Santana MLP, Pinto EJ, Pitangueira JCD, et al. Variação temporal da ocorrência do excesso de peso e da obesidade abdominal em adolescentes da cidade de Salvador, Bahia, Brasil. Ciênc Saúde Coletiva 2022; 27(8): 3203-13. https://doi.org/10.1590/1413-81232022278.22882021
https://doi.org/10.1590/1413-81232022278... ,¹¹11 Kankaanpää A, Tolvanen A, Heikkinen A, Kaprio J, Ollikainen M, Sillanpää E. The role of adolescent lifestyle habits in biological aging: a prospective twin study. Elife 2022; 11: e80729. https://doi.org/10.7554/eLife.80729
https://doi.org/10.7554/eLife.80729... .

Among unhealthy eating habits, soft drinks consumption has been investigated in both adolescents and adults due to the increasing consumption and association with NCDIs¹²12 Schneider S, Schilling L, Osenbrügge N. Determinants of soft drink consumption among children and adolescents in developed countries – a systematic review. Cent Eur J Public Health 2021; 29(4): 290-300. https://doi.org/10.21101/cejph.a6755
https://doi.org/10.21101/cejph.a6755...

13 Pacheco LS, Tobias DK, Li Y, Bhupathiraju SN, Willett WC, Ludwig DS, et al. Sugar-sweetened or artificially-sweetened beverage consumption, physical activity, and risk of cardiovascular disease in adults: a prospective cohort study. Am J Clin Nutr 2024; 119(3): 669-81. https://doi.org/10.1016/j.ajcnut.2024.01.001
https://doi.org/10.1016/j.ajcnut.2024.01... -¹⁴14 Malik VS, Hu FB. The role of sugar-sweetened beverages in the global epidemics of obesity and chronic diseases. Nat Rev Endocrinol 2022; 18(4): 205-18. https://doi.org/10.1038/s41574-021-00627-6
https://doi.org/10.1038/s41574-021-00627... . It is also known that excessive consumption of sweetened beverages contributes to the development of obesity, type 2 diabetes, cardiovascular diseases, and other metabolic conditions¹⁵15 Malik VS, Hu FB. Sugar-sweetened beverages and cardiometabolic health: an update of the evidence. Nutrients 2019; 11(8): 1840. https://doi.org/10.3390/nu11081840
https://doi.org/10.3390/nu11081840... ,¹⁶16 Chaves OC, Velasquez-Melendez G, Costa DAS, Caiaffa WT. Consumo de refrigerantes e índice de massa corporal em adolescentes brasileiros: Pesquisa Nacional de Saúde do Escolar. Rev Bras Epidemiol 2018; 21(suppl 1): E180010. https://doi.org/10.1590/1980-549720180010.supl.1
https://doi.org/10.1590/1980-54972018001... .

The identification of characteristics and habits of adolescents in relation to the consumption of soft drinks can contribute to establishing prevention actions more directed to specific groups¹⁶16 Chaves OC, Velasquez-Melendez G, Costa DAS, Caiaffa WT. Consumo de refrigerantes e índice de massa corporal em adolescentes brasileiros: Pesquisa Nacional de Saúde do Escolar. Rev Bras Epidemiol 2018; 21(suppl 1): E180010. https://doi.org/10.1590/1980-549720180010.supl.1
https://doi.org/10.1590/1980-54972018001... ,¹⁷17 Beal T, Morris SS, Tumilowicz A. Global patterns of adolescent fruit, vegetable, carbonated soft drink, and fast-food consumption: a meta-analysis of global school-based student health surveys. Food Nutr Bull 2019; 40(4): 444-59. https://doi.org/10.1177/0379572119848287
https://doi.org/10.1177/0379572119848287... . Thus, the objective of this study was to outline the profile of Brazilian adolescents in relation to soft drinks consumption and to verify possible associations of regular soft drinks consumption with sociodemographic characteristics, eating habits, and lifestyle.

METHODS

Study design and population

This is a cross-sectional study in which microdata of the 2019 National Survey of School Health (Pesquisa Nacional de Saúde do Escolar – PeNSE) were analyzed. This school-based survey with national representativeness was carried out in 2009, 2012, 2015, and the most recent edition in 2019. The research consists of an electronic questionnaire self-administered by adolescents enrolled and regularly attending the seventh to ninth grades of Elementary School and the tenth to twelfth grades of High School (morning, afternoon, and evening shifts) from public and private schools. In the 2019 edition, data were collected from 4,253 schools in 1,288 municipalities and questionnaires from 160,721 students, totaling 159,245 valid questionnaires (in which the adolescent registered that he/she would like to participate in the research, in addition to informing sex and age, in classes that reached minimum requirements for achievement)¹⁸18 Instituto Brasileiro de Geografia e Estatísticas. Pesquisa Nacional de Saúde do Escolar (PeNSE): 2019. Rio de Janeiro: IBGE; 2021.. In the present study, adolescents aged 13 to 17 years were included and those with missing data on the variables of interest were excluded. The flowchart of the exclusions made until obtaining the studied sample is described in Figure 1.

The 2019 edition of PeNSE was approved by the National Commission of Ethics in Research (Comissão Nacional de Ética em Pesquisa – Conep) of the National Health Council (Conselho Nacional de Saúde – CNS), under opinion No. 3.249.268, of April 8, 2019.

Definition of the analyzed variables

The dependent variable under study was soft drink consumption, assessed through the question: "In the last seven days, in how many of them did you have soft drinks?". Responses were categorized into: sporadic consumption, defined as consumption in less than five days in the last week, and regular consumption, defined as consumption in five or more days in the last week¹⁹19 Leal MABF, Lima CEB, Mascarenhas MDM, Rodrigues MTP, Paiva SSC, Sousa CRO, et al. Associação entre fatores sociodemográficos e comportamentos de risco à saúde cardiovascular de adolescentes brasileiros com 13 a 17 anos: dados da Pesquisa Nacional de Saúde do Escolar 2015. Epidemiol Serv Saúde 2019; 28(3): e2018315. https://doi.org/10.5123/S1679-49742019000300008
https://doi.org/10.5123/S1679-4974201900... . The independent variables analyzed included sociodemographic characteristics, eating habits, and lifestyle.

The sociodemographic variables selected were region of residence (Northeast; North; Southeast; South; Midwest), sex (girls; boys), age group (13 to 15 years; 16 to 17 years), skin color or race (brown; white; Black; Asian; Indigenous), level of education (elementary school; high school), and type of school (public; private).

Questions about eating habits included: having meals accompanied by an adult, having meals while using a screen (TV, computer, or cell phone), and eating breakfast. Habit ("Do you usually…") and frequency (times a week) were considered. These variables were categorized into regular consumption, if consumed five or more days a week, or sporadic consumption, if consumed less than five days a week. Also regarding eating habits, questions were asked about the consumption in the last seven days of: beans, vegetables, sweets (exemplified in the question as: candies, confectionery, chocolates, gums, bonbons, lollipops, and others), fresh fruits or fruit salad. Regular consumption of these foods was defined as five or more days in the last seven days, or sporadic consumption, if it occurred less than five days in the last week¹⁸18 Instituto Brasileiro de Geografia e Estatísticas. Pesquisa Nacional de Saúde do Escolar (PeNSE): 2019. Rio de Janeiro: IBGE; 2021.,²⁰20 Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Orientações para avaliação de marcadores de consumo alimentar na atenção básica. Brasília: Ministério da Saúde; 2015.. Frequent fast food consumption was considered as three or more days, defined through the question: "In the last seven days, in how many of them did you eat in diners, hot dog stands, pizzerias, fast-food restaurants, etc.?". Less than three days was defined as sporadic consumption for this variable²¹21 Ellwood P, Asher MI, García-Marcos L, Williams H, Keil U, Robertson C, et al. Do fast foods cause asthma, rhinoconjunctivitis and eczema? Global findings from the International Study of Asthma and Allergies in Childhood (ISAAC) phase three. Thorax 2013; 68(4): 351-60. https://doi.org/10.1136/thoraxjnl-2012-202285
https://doi.org/10.1136/thoraxjnl-2012-2... .

Regarding lifestyle, the variables of physical and sedentary activities, use of cigarette and alcohol were evaluated. Physical activity was measured by total time in the last week, including time spent commuting, physical education classes, and leisure time. This total time was categorized as less than recommended (less than 300 minutes per week) or recommended (greater than or equal to 300 minutes per week)²²22 Hallal PC, Knuth AG, Cruz DKA, Mendes MI, Malta DC. Prática de atividade física em adolescentes brasileiros. Ciênc Saúde Coletiva 2010; 15(suppl 2): 3035-42. https://doi.org/10.1590/S1413-81232010000800008
https://doi.org/10.1590/S1413-8123201000... . The daily time of sedentary activities (watching television, playing video games, using a cell phone or computer, and other sitting activities), without considering Saturday and Sunday and time spent sitting at school, was inquired regarding habit ("How many hours a day do you usually…?") and dichotomized as more than three hours or three hours or less per day²³23 Soares CAM, Leão OAA, Freitas MP, Hallal PC, Wagner MB. Tendência temporal de atividade física em adolescentes brasileiros: análise da Pesquisa Nacional de Saúde do Escolar de 2009 a 2019. Cad Saúde Pública 2023; 39(10): e00063423. https://doi.org/10.1590/0102-311xpt063423
https://doi.org/10.1590/0102-311xpt06342... . Cigarette use was dichotomized into ‘yes’ for those who answered that they had smoked one or more cigarettes in the last 30 days and ‘no’ otherwise²⁴24 Instituto Nacional de Câncer José Alencar Gomes da Silva. A situação do tabagismo no Brasil : dados dos inquéritos do Sistema Internacional de Vigilância, da Organização Mundial da Saúde, realizados no Brasil, entre 2002 e 2009. Rio de Janeiro: INCA; 2011.. For the use of alcohol, no cutoff points were identified for the consumption of adolescents; therefore, the criteria for defining binge drinking (heavy episodic drinking) of the World Health Organization for adults was considered, categorizing the answers into ‘yes’ if the adolescent reported that he/she had four or more drinks on at least one occasion or ‘no’ if he/she had less than four drinks in the last 30 days²⁵25 Andrade AG. Álcool e a saúde dos brasileiros: panorama 2019. São Paulo: Centro de Informações sobre Saúde e Álcool; 2019.. The pieces of information on all analyzed variables were self-reported.

Statistical analyses

Descriptive analyses were performed for all variables included in the study. Weighted prevalence and 95% confidence intervals (95%CI) were calculated for categorical variables. For comparisons between each exposure variable and the regular consumption of soft drinks, the Rao-Scott χ² test was used, which considers the sample design of the study. A Poisson regression model was developed to verify possible associations between regular soft drinks consumption and independent variables. In the final model, only the variables that were statistically significant in the bivariate analysis were included. The analyses were carried out in SAS on Demand for Academics, version 3.81, considering the complex research sample design. A value of p<0.05 was considered statistically significant.

RESULTS

The frequency of regular soft drinks consumption among adolescents was 17.3% (95%CI 16.7–18.0%). According to the bivariate analyses, there was an association between the prevalence of regular soft drinks consumption and the adolescent's region of residence, sex, and skin color/race. We observed a higher prevalence in boys (18.2%) when compared to girls (16.5%) (Table 1).

In the unadjusted analysis of the variables of eating habits, a higher prevalence of regular consumption of soft drinks was observed among adolescents who eat meals while using screens (20.4%), those who have breakfast sporadically (20.2%), those who consume sweets (30.0%) regularly, and among adolescents who frequently consume fast food (39.2%) (Table 2).

Regarding lifestyle, adolescents who reported more than three hours of sedentary activities per day had a higher prevalence of regular soft drinks consumption (20.5%). Cigarette and alcohol use were also associated with a higher prevalence of regular soft drinks consumption, with frequencies of 28.2 and 27.7%, respectively (Table 3).

In the multivariate analysis, there was a greater chance of regular consumption of soft drinks in adolescents living in the North (prevalence ratio — PR=1.13; 95%CI 1.04–1.23), Southeast (PR=1.49; 95%CI 1.40–1.60), South (PR=1.31; 95%CI 1.20–1.41), and Midwest (PR=1.50; 95%CI 1.41–1.59) when compared to Northeast residents. In addition, the regular consumption of soft drinks was more frequent among boys (PR= 1.22; 95%CI 1.16–1.29). As for eating habits, adolescents who reported having meals while using a screen had a greater chance of regular soft drinks consumption (PR=1.20; 95%CI 1.13–1.27). Likewise, those who reported eating breakfast sporadically (PR=1.14; 95%CI 1.08–1.21) and consuming sweets regularly (PR=2.16; 95%CI 2.03–2.29) also showed a greater chance of regular soft drinks consumption. Adolescents who reported consuming fast food frequently had 2.28 times the chance of having regular consumption of soft drinks when compared to those who consumed fast food sporadically (PR=2.28; 95%CI 2.16–2.41). Regular soft drinks consumption was 18% higher among adolescents with sedentary activities for more than three hours a day (PR=1.18; 95%CI 1.12–1.25). In addition, the regular consumption of soft drinks was more than 20% higher among those who reported using cigarettes (PR=1.22; 95%CI 1.11–1.33) and binge drinking (PR=1.21; 95%CI 1.12–1.30) (Table 4).

DISCUSSION

Our results point to the profile of regular soft drinks consumption among Brazilian adolescents, with regional variations, by skin color/race, and higher in boys. Regarding eating habits, the regular consumption of soft drinks was associated with eating meals while using screens, not having breakfast on five or more days of the week, and the frequent consumption of sweets and fast food. Lifestyles with prolonged time in sedentary activities, cigarette use, and binge drinking were also associated with regular soft drinks consumption.

The prevalence of regular soft drinks consumption observed in our study was much lower than the value of 42.8% (95%CI 32.4–50.7%) estimated in a global meta-analysis, which considered daily consumption¹⁷17 Beal T, Morris SS, Tumilowicz A. Global patterns of adolescent fruit, vegetable, carbonated soft drink, and fast-food consumption: a meta-analysis of global school-based student health surveys. Food Nutr Bull 2019; 40(4): 444-59. https://doi.org/10.1177/0379572119848287
https://doi.org/10.1177/0379572119848287... . However, when comparing our data on adolescents with data from other national surveys, we noticed a slightly higher prevalence. According to data from the 2017–2018 Consumer Expenditure Survey (Pesquisa Nacional de Orçamentos Familiares – POF), there is a prevalence of 15.4%²⁶26 Instituto Brasileiro de Geografia e Estatísticas. Pesquisa de orçamentos familiares: 2017-2018: análise do consumo alimentar pessoal no Brasil. Rio de Janeiro: IBGE; 2020. in the total population, and authors of a study with data from the Surveillance System of Risk and Protective Factors for Noncommunicable Chronic Diseases by Telephone Survey (Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico – VIGITEL) identified a significant reduction in the frequency of regular consumption of soft drinks or synthetic juices by the population of state capitals and the Federal District, from 26.4% in 2008 to 15.0% in 2019²⁷27 Crepaldi BVC, Okada LM, Rauber F, Levy RB, Azeredo CM. Social inequality in food consumption between 2008 and 2019 in Brazil. Public Health Nutr 2022; 25(2): 214-24. https://doi.org/10.1017/S1368980021002950
https://doi.org/10.1017/S136898002100295... .

The regional variations found in our study point to a higher prevalence of regular consumption of soft drinks in adolescents living in the Southeast and Midwest regions, followed by the South and lower prevalence values in the North and Northeast. These prevalence values differ from the POF 2017–2018 results, in which the South region stands out with the highest regular consumption of soft drinks²⁶26 Instituto Brasileiro de Geografia e Estatísticas. Pesquisa de orçamentos familiares: 2017-2018: análise do consumo alimentar pessoal no Brasil. Rio de Janeiro: IBGE; 2020.. The higher prevalence of regular soft drinks consumption found for boys was also observed in other studies¹²12 Schneider S, Schilling L, Osenbrügge N. Determinants of soft drink consumption among children and adolescents in developed countries – a systematic review. Cent Eur J Public Health 2021; 29(4): 290-300. https://doi.org/10.21101/cejph.a6755
https://doi.org/10.21101/cejph.a6755... ,¹⁶16 Chaves OC, Velasquez-Melendez G, Costa DAS, Caiaffa WT. Consumo de refrigerantes e índice de massa corporal em adolescentes brasileiros: Pesquisa Nacional de Saúde do Escolar. Rev Bras Epidemiol 2018; 21(suppl 1): E180010. https://doi.org/10.1590/1980-549720180010.supl.1
https://doi.org/10.1590/1980-54972018001... .

In our study, a relevant finding was the positive association between regular consumption of soft drinks and eating habits markers of unhealthy diet, quite common in adolescents, such as having meals while using screens, skipping breakfast, and the consumption of sweets and fast food.

Excessive screen time is often studied in adolescents²⁸28 Maia EG, Silva LES, Santos MAS, Barufaldi LA, Silva SU, Claro RM. Padrões alimentares, características sociodemográficas e comportamentais entre adolescentes brasileiros. Rev Bras Epidemiol 2018; 21(suppl 1): E180009. https://doi.org/10.1590/1980-549720180009.supl.1
https://doi.org/10.1590/1980-54972018000... ,²⁹29 Jensen ML, Carpentier FRD, Corvalán C, Popkin BM, Evenson KR, Adair L, et al. Television viewing and using screens while eating: associations with dietary intake in children and adolescents. Appetite 2022; 168: 105670. https://doi.org/10.1016/j.appet.2021.105670
https://doi.org/10.1016/j.appet.2021.105... , and eating meals while using screens can lead to loss of perception of food, interfering with physiological signs of hunger and satiety²⁹29 Jensen ML, Carpentier FRD, Corvalán C, Popkin BM, Evenson KR, Adair L, et al. Television viewing and using screens while eating: associations with dietary intake in children and adolescents. Appetite 2022; 168: 105670. https://doi.org/10.1016/j.appet.2021.105670
https://doi.org/10.1016/j.appet.2021.105... ,³⁰30 Oliveira JS, Barufaldi LA, Abreu GA, Leal VS, Brunken GS, Vasconcelos SML, et al. ERICA: use of screens and consumption of meals and snacks by Brazilian adolescents. Rev Saude Publica 2016; 50(Suppl 1): 7s. https://doi.org/10.1590/s01518-8787.2016050006680
https://doi.org/10.1590/s01518-8787.2016... . According to data from the Study of Cardiovascular Risks in Adolescents (Estudo de Riscos Cardiovasculares em Adolescentes – ERICA), approximately 60.0% of adolescents ate meals almost always or always in front of the television, a habit that was associated with the regular consumption of soft drinks in our study³⁰30 Oliveira JS, Barufaldi LA, Abreu GA, Leal VS, Brunken GS, Vasconcelos SML, et al. ERICA: use of screens and consumption of meals and snacks by Brazilian adolescents. Rev Saude Publica 2016; 50(Suppl 1): 7s. https://doi.org/10.1590/s01518-8787.2016050006680
https://doi.org/10.1590/s01518-8787.2016... . Authors of a research conducted in Chile showed that more than 85% of adolescents used screens during meals, consuming 42.3% of daily calories while watching TV. However, there were no significant differences in the nutrient profile between having meals with and without using screens, but higher weekly screen time was associated with a less healthy diet, which included higher consumption of sweetened beverages among Chilean adolescents²⁹29 Jensen ML, Carpentier FRD, Corvalán C, Popkin BM, Evenson KR, Adair L, et al. Television viewing and using screens while eating: associations with dietary intake in children and adolescents. Appetite 2022; 168: 105670. https://doi.org/10.1016/j.appet.2021.105670
https://doi.org/10.1016/j.appet.2021.105... .

In a study on adolescents from the state of Espírito Santo, Brazil, sedentary behavior was associated with inadequate eating habits and poorer diet quality³¹31 Fontes PAS, Siqueira JH, Martins HX, Oliosa PR, Zaniqueli D, Mill JG, et al. Comportamento sedentário, hábitos alimentares e risco cardiometabólico em crianças e adolescentes fisicamente ativos. Arq Bras Cardiol 2023; 120(2): e20220357. https://doi.org/10.36660/abc.20220357
https://doi.org/10.36660/abc.20220357... . It is known that inadequate eating habits associated with sedentary lifestyle in childhood can trigger the onset of cardiometabolic diseases in the future³¹31 Fontes PAS, Siqueira JH, Martins HX, Oliosa PR, Zaniqueli D, Mill JG, et al. Comportamento sedentário, hábitos alimentares e risco cardiometabólico em crianças e adolescentes fisicamente ativos. Arq Bras Cardiol 2023; 120(2): e20220357. https://doi.org/10.36660/abc.20220357
https://doi.org/10.36660/abc.20220357... ,³²32 Hobbs M, Pearson N, Foster PJ, Biddle SJH. Sedentary behaviour and diet across the lifespan: an updated systematic review. Br J Sports Med 2015; 49(18): 1179-88. https://doi.org/10.1136/bjsports-2014-093754
https://doi.org/10.1136/bjsports-2014-09... .

Alcohol use in adolescence tends to occur together with other health risk behaviors such as smoking³³33 Coutinho ESF, França-Santos D, Magliano ES, Bloch KV, Barufaldi LA, Cunha CF, et al. ERICA: patterns of alcohol consumption in Brazilian adolescents. Rev Saude Publica 2016; 50(Suppl 1): 8s. https://doi.org/10.1590/s01518-8787.2016050006684
https://doi.org/10.1590/s01518-8787.2016... . When analyzing the data obtained in this study, we found an association between alcohol and tobacco use and regular soft drink consumption by adolescents. Authors of a longitudinal study with adolescents conducted in Finland observed that alcohol use in adolescence increases the risk of smoking in adulthood³⁴34 Paavola M, Vartiainen E, Haukkala A. Smoking, alcohol use, and physical activity: A 13-year longitudinal study ranging from adolescence into adulthood. J Adolesc Health 2004; 35(3): 238-44. https://doi.org/10.1016/j.jadohealth.2003.12.004
https://doi.org/10.1016/j.jadohealth.200... . In Brazil, researchers of the ERICA study found that 21% of the interviewed adolescents had consumed alcohol in the 30 days prior to the interview³³33 Coutinho ESF, França-Santos D, Magliano ES, Bloch KV, Barufaldi LA, Cunha CF, et al. ERICA: patterns of alcohol consumption in Brazilian adolescents. Rev Saude Publica 2016; 50(Suppl 1): 8s. https://doi.org/10.1590/s01518-8787.2016050006684
https://doi.org/10.1590/s01518-8787.2016... . Alcohol consumption by this population is worrisome due to the greater tendency to impulsivity in this age group, the impairment of brain development in childhood and adolescence caused by alcohol, and risk behaviors in the adolescent age group that may last into adulthood, influencing the development of other habits³⁵35 Zappe JG, Alves CF, Dell’Aglio DD. Comportamentos de risco na adolescência: Revisão sistemática de estudos empíricos. Psicologia em Revista 2018; 24(1): 79-100. https://doi.org/10.5752/P.1678-9563.2018v24n1p79-100
https://doi.org/10.5752/P.1678-9563.2018... .

Among the limitations of the present study, it should be noted that the obtained data were based on the adolescents’ reports, which may lead to information bias. Nonetheless, we emphasize that population surveys carried out in several countries also adopt this methodology to collect data in large samples³3 Jones P, Yala JA, Knight KN, Song JM, Adkins SML, Battaglia-Hoffman G, et al. Unifying public health surveillance: a scoping review of global use of the youth risk behavior survey. J Adolesc Health 2024; 75(3): 383-91. https://doi.org/10.1016/j.jadohealth.2024.03.001
https://doi.org/10.1016/j.jadohealth.202... ,⁴4 Hashemi-Aghdam MR, Shafiee G, Ebrahimi M, Ejtahed HS, Yaseri M, Motlagh ME, et al. Trend of passive smoking and associated factors in Iranian children and adolescents: the CASPIAN studies. BMC Public Health 2022; 22(1): 603. https://doi.org/10.1186/s12889-022-13045-8
https://doi.org/10.1186/s12889-022-13045... ,³⁰30 Oliveira JS, Barufaldi LA, Abreu GA, Leal VS, Brunken GS, Vasconcelos SML, et al. ERICA: use of screens and consumption of meals and snacks by Brazilian adolescents. Rev Saude Publica 2016; 50(Suppl 1): 7s. https://doi.org/10.1590/s01518-8787.2016050006680
https://doi.org/10.1590/s01518-8787.2016... . Furthermore, we could not estimate the number of soft drinks consumed by the participants of the 2019 PeNSE due to the lack of information; however, the option for the variable of regular consumption of soft drinks proved to be adequate, as we analyzed adolescents’ habits.

Reducing the consumption of ultra-processed foods, including soft drinks, is one of the recommendations of the Dietary Guidelines for the Brazilian Population, given that they are associated with excessive calorie consumption and increased risk of obesity³⁶36 Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Guia alimentar para a população brasileira. Brasília: Ministério da Saúde; 2014.. With our data, we emphasize the need for specific interventions, recognizing the profile of adolescents to promote healthier eating and lifestyle habits. These interventions should consider an integrated approach, acting not only in reducing the consumption of soft drinks, but also in factors associated with this regular consumption — such as the consumption of sweets and fast food. The National School Feeding Program (Programa Nacional de Alimentação Escolar – PNAE) serves public, philanthropic schools, and community entities in this sense, promoting healthy eating habits and developing initiatives on food and nutrition education³⁷37 Brasil. Ministério da Educação. Fundo Nacional de Desenvolvimento da Educação. Programa Nacional de Alimentação Escolar 2024 [Internet]. 2024 [cited on Sept. 12, 2024]. Available at: https://www.gov.br/fnde/pt-br/acesso-a-informacao/acoes-e-programas/programas/pnae
https://www.gov.br/fnde/pt-br/acesso-a-i... .

The incentive to have meals without using screens, to have breakfast daily, to reduce the time of sedentary activities, and to avoid the use of cigarette and alcohol requires, in addition to public policies, an awareness of these aspects by the family. These measures are paramount to protect the health of adolescents and reduce the burden of diseases related to the regular consumption of soft drinks.

ACKNOWLEDGEMENTS

The authors would like to thank the National Council for Scientific and Technological Development (CNPq).

REFERENCES

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