Inequalities in the community food environment around Brazilian households with children under 5 years from a national survey in Brazil

Abstract

This study characterizes the community food environment around households in Brazil with children < 5 years of age and analyzes its association with socioeconomic and demographic stratifiers. Data from 12,524 households from the Brazilian National Survey on Child Nutrition (ENANI-2019) were used. The community food environment was assessed through the perception of mothers or caregivers using three indicators: fruit and vegetable score (FV-S), ultra-processed foods score (UPF-S), and community food environment healthiness score (CFEH-S), all ranging from 0–10 points, categorized as low (worse), medium, and high (better). Unadjusted and adjusted multinomial logistic regression analyses were conducted to determine the independent associations between macro-region, household location, race/skin color, level of education of the mother or caregiver, and basic sanitation, and FV-S, UPF-S, and CFEH-S. The frequency of low and high categories was 21.8% and 64.1% for FV-S, 74.3% and 7.7% for UPF-S, and 34.1% and 9.8% for CFEH-S. Adjusted regressions showed that the North macro-region had the worst scenario for FV-S and CFEH-S. For UPF-S, the Northeast and South regions had the worst scenarios. Despite worse FV-S, rural households had better UPF-S and CFEH-S. Households with 0 or 1 basic sanitation service (sewage system, potable water, or garbage collection) had worse FV-S scores; those with 1 service had the worst CFEH-S scenario. We found that macro-region, place of residence, and access to sanitation services are associated with the healthiness of the community food environment around households with children < 5 years in Brazil.