Nutritional transition in Brazil has led to significant changes in the population's dietary patterns over the past decades, characterized by an increase in the consumption of ultra-processed foods, high levels of sugars, fats, and sodium, and a reduction in the intake of natural or minimally processed foods.1 The Brazilian nutritional transition has been marked by a decline in malnutrition and a rise in overweight and obesity rates.2

The change in the dietary profile of the population has not only occurred in adults but also among adolescents. A study with data from the 2019 National Survey of School Health (PeNSE) showed that the consumption of ultra-processed foods was 97.3 % and there was a reduction in the consumption of fresh fruits and vegetables from 2015 to 2019.3 In 2022, over 4.4 million adolescents aged 10 to 19 were monitored through the Ministry of Health's Food and Nutrition Surveillance System. Of these, nearly 1.4 million were diagnosed with overweight, obesity, or severe obesity.4

This scenario is worrisome because unhealthy dietary patterns can lead to both nutritional deficiencies and also excesses, which may affect the growth process inherent in puberty and contribute to the increase in Food and Nutritional Insecurity, overweight and obesity, and the development of non-communicable diseases (NCDs).2,5

Adolescence represents a critical period for the establishment of dietary habits that may persist into adulthood and significantly impact health. In this context, identifying the dietary patterns of Brazilian adolescents is essential, as it enables a deeper understanding of the eating behaviors within this age group and helps to identify the factors associated with these habits. Food consumption is influenced by multiple determinants, including food availability and access, as well as individual, family, social, school, contextual, and health-related factors.6 Furthermore, it provides a more integrated and comprehensive view of dietary behavior compared to those that assess food consumption in isolation, offering stronger evidence to support food and nutrition surveillance actions and to inform public health policies aimed at promoting access to healthy foods for the entire population, particularly the most vulnerable groups.7

This study aimed to identify the dietary patterns of Brazilian adolescents and to verify their associated factors.

Considering the values adopted, the first and second components were extracted, which showed a variance of 46 %. The first component was characterized by regular consumption of healthy foods (fruits, vegetables, and beans). The second component was characterized by a mixed pattern (non-regular consumption of sweet treats, soft drinks, and fast food). The analysis achieved a satisfactory KMO (Supplementary Material 2).

The characteristics of adolescents belonging to pattern 1 are described in Tables 1 and 2 provides a detailed description of the characteristics of adolescents associated with pattern 2.

The final multivariate model for Pattern 1, is outlined in Table 3. The more likely of regularly consume fruits, vegetables, and beans were entre adolescents residing in all regions, particularly the Central-West (OR = 2.21; 95% CI: 1.95–2.51), with higher maternal schooling (OR = 1.48; 95% CI: 1.36–1.60), who did not consume alcoholic beverages (OR = 1.09; 95% CI: 1.01–1.17), who practiced physical activity (OR = 1.88; 95% CI: 1.77–2.00), were not sedentary (OR = 1.20; 95% CI: 1.13–1.28), who ate breakfast (OR = 1.64; 95% CI: 1.54–1.74), had lunch or dinner with their parents (OR = 1.55; 95% CI: 1.45–1.66), did not eat with other activities (OR = 1.31; 95% CI: 1.22–1.41), and ate school meals (OR = 1.08; 95% CI: 1.01–1.16).

Table 4 presents the multivariate model for Pattern 2. The likelihood of non-regular consumption of sweets, soft drinks, and fast food was higher among male adolescents (OR = 1.32; 95% CI: 1.25–1.39), aged 16 and 17 (OR = 1.16; 95% CI: 1.08–1.23), from public schools (OR = 1.24; 95% CI: 1.17–1.31), who did not consume alcoholic beverages (OR = 1.28 95 %CI: 1.21–1.36), who were not sedentary (OR = 1.21 95% CI: 1.14–1.29).

From the PCA it was possible to verify two patterns, the first related to a healthy food consumption pattern by the regular consumption of fruits, vegetables, and beans and the second to a mixed pattern since it cannot be considered a healthy dietary pattern just not to regularly consume sweet treats, soft drinks, and fast-food.

Fruits, vegetables, and greens are essential for a healthy dietary pattern and act as protective factors against NCDs).9 Beans, a culturally significant food in Brazilian meals, serve as an important indicator of healthy eating in the country.10 However, the consumption of these foods is determined by various factors in different contexts and can be influenced by socioeconomic and demographic characteristics.11 Brazil has a vast territorial extent, and differences in climate, culture, and economic activities are reflected in the diverse dietary habits of its population, as well as in the supply, availability, and access to these foods. The Southeast region accounts for the majority of the volume of fruits and vegetables traded, while the North has the lowest percentage, which affects the price and accessibility for the end consumer. Individuals living in economically disadvantaged regions have lower consumption of healthy foods, a consequence of the distribution, availability, and prices of these foods, as well as lower income to purchase them.12

In this context, parental education levels are factors that influence the type of dietary patterns adolescents adopt,7 as individuals with higher education levels tend to have better income and employment, which facilitates the consumption of healthier foods. Higher education also possibly leads to greater knowledge about nutrition and dietary recommendations for food choices, as well as better access to healthy food options.13

These data show the disparities between dietary patterns and socioeconomic levels, which reflects the need for intersectoral public policies that encompass everything from food production to consumption. There is still a need for progress in market regulation strategies that provide opportunities for the production and distribution of fruits and vegetables, in establishing policies to tackle the determinants of food insecurity, reducing food prices, and in strengthening income transfer programs and policies to strengthen familiar agriculture.

Not consuming alcoholic beverages, physical activity practice, and avoiding a sedentary lifestyle are also protective factors against NCDs, as they can reduce the risk of cardiovascular diseases, diabetes, and various types of cancer, in addition to helping with weight control and improving the quality of life and mental health.14 For both patterns, there was an association with healthy lifestyle habits. Health behaviors tend to occur simultaneously, due to the synergistic relationship. More active individuals are motivated to eat healthier.15,16 On the other hand, the coexistence of health risk factors is also a reality among adolescents.17,18 Therefore, understanding and monitoring lifestyle habits in adolescence is essential for developing health promotion actions aimed at multiple health behaviors and consequently reducing the burden of disease in adult life.

Breakfast is often described as the most important meal of the day. The nutritional quality and regularity of breakfast consumption are associated with better physical, mental, and academic performance, as well as better engagement in physical activity, quality of life, and overall health.19 Children and adolescents who regularly eat breakfast have a higher intake of several nutrients, especially vitamins and minerals, compared to those who skip breakfast.20 However, despite these benefits, the prevalence of children and adolescents skipping breakfast is increasing, particularly among those with lower socioeconomic status.20 The habit of skipping breakfast is also associated with higher consumption of ultra-processed foods and other obesogenic behaviors.17 Promoting the habit of eating breakfast among young people can be facilitated by political and educational measures.

Eating meals with parents or guardians provides benefits for adolescents, such as promoting healthy eating habits, increasing the consumption of fruits, vegetables, whole grains, and beans, and reducing the intake of ultra-processed foods. Additionally, it contributes to improved psychosocial well-being and academic performance, while providing emotional support, more dialogue, and greater contact between parents or guardians and adolescents.17,21–23 These benefits may be related to greater parental control over meal routines, which allows them to monitor food intake and influence healthy food choices, as well as promote regular mealtimes.21–23 However, it is important to consider that there are differences in family environment characteristics and meals, such as the diversity, quality, and quantity of food consumed, family interpersonal relationships, meal planning, eating while watching TV, parental education, family income, and parent's employment status, all of which also influence dietary patterns and lifestyle.21,23

Exposure to screens is considered a sedentary behavior and causes distractions that interfere with physiological signals of hunger and satiety, leading to inappropriate food choices such as the consumption of ultra-processed foods and contributing to overweight in the early stages of life. One study showed that most adolescents reported consuming snacks in front of screens sometimes, and approximately 40.0 % almost always or always adopted this practice.24

Regarding school meals, the Brazilian National School Feeding Program ensures the provision of adequate and healthy food, ensuring food and nutritional security, along with health education actions for public school students, which encourages the formation of healthy dietary pattern.25 The program aims to foster healthy eating habits through food and nutrition education initiatives and by offering free meals that meet all the nutritional needs of public school students. The menus are planned based on fresh, minimally processed foods, with a ban on sugary foods and restrictions on ultra-processed items high in sodium or saturated fats.25 For this reason, adolescents who eat school meals are more likely to consume fruits, vegetables, and beans. This highlights the importance of maintaining and investing in health promotion programs, as they positively impact quality of life and improve students’ dietary patterns.

In this regard, adolescents attending public schools were more likely to exhibit non-regular consumption of sweet treats, soft drinks, and fast food. This may be related to the school meals program, which promotes healthy eating as mentioned earlier, but also to economic factors that influence the purchase of these foods. Generally, low- or middle-income families are more likely to enroll their children in public schools, while higher-income families tend to opt for private schools.26 A study based on the PeNSE found that adolescents with a higher socioeconomic status had a higher consumption of ultra-processed foods,13 because unlike high-income countries, where these foods are cheaper and easily accessible, in Brazil they are still more expensive, especially in local shops compared to supermarkets.27

Regarding eating habits by gender, national studies show differences in behavior when comparing boys and girls. Male adolescents exhibited more frequent consumption of soft drinks,3 higher average intake of energy and sodium,28 and greater consumption of fruits, vegetables, and beans.3 In contrast, girls consumed more snacks in front of screens24 and sweet treats.3 The consumption of ultra-processed foods and fresh fruits or fruit salads was similar between the genders.3 These differences may be influenced by various factors, such as social and cultural pressures, concerns about physical appearance, and the dietary patterns of their families and social environment.

Adolescents' eating habits vary significantly according to age group. The transition from childhood to adolescence brings physiological changes and increased influence from the social environment, leading to shifts in dietary patterns.29 Younger adolescents tend to have diets more guided by their parents, while older adolescents are influenced by external factors, such as friends and social media, and experience greater independence in decision-making. Additionally, exposure to stressful situations and social pressures in late adolescence can lead to an increase in the consumption of unhealthy foods and lifestyles.7,18,29 The results of this study showed that older adolescents are more likely to avoid unhealthy foods; however, this does not imply that they do not consume such foods. Therefore, it is essential to further explore the factors influencing eating behavior throughout adolescence, including the transition to adulthood, in order to assess changes in diet and the influence of family, school, work, and social environments.

As a limitation of the study, it should be considered that the 2019 PeNSE questionnaire omitted several questions regarding the regular consumption of healthy and unhealthy foods over the past seven days, which limited the selection of additional dependent variables. However, it was possible to select those considered by the literature as markers of a healthy and protective diet against NCDs.

This study identified two primary dietary patterns. The first, is classified as a healthy pattern due to the consumption of fruit, vegetables, and beans. The second, a mixed pattern, was evidenced by the irregular consumption of sweet treats, soft drinks, and fast foods. Both patterns were associated with socioeconomic variables and healthy lifestyle habits. To monitoring the health behavior of adolescents remains crucial to supporting public surveillance, strengthening social and school-based policies, reducing inequalities, and improving access to healthy food and health promotion services among adolescents.

Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG). Programa de Apoio à Fixação de Jovens Doutores no Brasil (Processo: BPD-00893–22).