Degree of food processing of household acquisition patterns in a Brazilian urban area is related to food buying preferences and perceived food environment

Highlights

• We analyzed the association between consumer behaviors and food acquisition patterns.

• Buying fresh produce at supermarket is related to lower ultra-processed purchase.

• Walking and use of fresh produce market are related to minimally-processed purchase.

• The use of taxi to buy food is associated with ultra-processed pattern.

• Perceived access to fresh produce influences household food acquisition patterns.

Abstract

Objective: This cross-sectional study examined the association between local food environment and consumers' acquisition of ultra-processed food. Methods: Households were randomly selected from 36 census tracts in Santos City, Brazil. Mothers, of varying economic status, who had children ages 10 or younger (n = 538) were interviewed concerning: their household food acquisition of 31 groups of food and beverages, perceptions of local food environment, food sources destinations, means of transportation used, and socioeconomic status. Food acquisition patterns were classified based on the degree of industrial food processing. Logistic regression models were fitted to assess the association between consumer behaviors and acquisition patterns. Results: The large variety of fresh produce available in supermarkets was significantly related to lower odds of ultra-processed food purchases. After adjusting for sociodemographic characteristics, higher odds for minimally-processed food acquisition were associated with: frequent use of specialized markets to purchase fruits and vegetables (OR 1.89, 95% CI 1.01–2.34), the habit of walking to buy food (OR 1.58, 95% CI 1.08–2.30), and perceived availability of fresh produce in participants' neighborhood (OR 1.58, 95% CI 1.08–2.30). Acquisition of ultra-processed food was positively associated with the use of taxis as principal means of transportation to food sources (OR 2.35, 95% CI 1.08–5.13), and negatively associated with perceived availability of a variety of fruits and vegetables in the neighborhood (OR 0.57, 95% CI 0.37–0.88). Conclusion: The results suggest that interventions aiming to promote acquisition of less processed food in settings similar to Santos, may be most effective if they focus on increasing the number of specialized fresh food markets in local neighborhood areas, improve residents' awareness of these markets' availability, and provide appropriate transportation.

Introduction

Obesity and diet-related chronic diseases have emerged as global challenges of the 21th century, fueled by rapid and intense urbanization, and subsequent changes in food environments and food choices (Huang et al, 2009, Larson, Story, 2009, Ludwig, 2011, Townshend, Lake, 2009). Globalization, free trade, economic growth and urbanization are macro-level factors that increased utilization of new food production technologies, and influenced the types of foods available in neighborhoods worldwide (Monteiro et al, 2011, Monteiro et al, 2013, Pérez-Cueto et al, 2010, Townshend, Lake, 2009).

Although the availability of healthy foods is a significant influence on food choice (Hawkes, 2009, Larson, Story, 2009, Murakami et al, 2009, Walker et al, 2012), the consumer decisions are also motivated by other factors, including: perceived barriers to obtaining healthy food (such as distance to food sources), quality of food sold, prices, and store attributes such as store size, food safety, cleanliness, customer service, and brands sold (Blitstein et al, 2012, Gittelsohn, Sharma, 2009, Krukowski et al, 2012, Larson, Story, 2009, Macdonald et al, 2011, Morland, Evenson, 2009, Thornton et al, 2012, Walker et al, 2012). These factors may interact with community characteristics such as the socioeconomic status (SES) of its residents, and racial and ethnic composition (D'Angelo et al, 2011, Dennisuk et al, 2011, Jaime et al, 2011, Macdonald et al, 2007).

Food processing is theorized to be a shaping force in the global food system. It dominates the food supply of both developed and developing countries, and influences the availability of food products in local stores (Macdonald et al, 2007, Monteiro et al, 2011). Ultra-processed foods are very palatable, flavorful, satisfying, inexpensive and ready-to-eat products that tend to have a long shelf-life (Davis et al, 2011, Monteiro et al, 2011). Accordingly, ultra-processed foods are hypothesized to be the major dietary driver of obesity and non-communicable diet-related chronic diseases, due to use of ingredients such as hydrogenated oils, fats, flours, starches, sugar, additives, and industrial processing methods such as frying, smoking, and canning (Davis et al, 2011, Ludwig, 2011, Monteiro et al, 2011, Monteiro et al, 2013, Moubarac et al, 2013).

In developed countries, many studies have examined the influence of the food environments and food purchases on dietary and health outcomes (Caspi et al, 2012, D'Angelo et al, 2011, Glanz, 2009, Glanz et al, 2012, Hawkes, 2009, Krukowski et al, 2012, Larson, Story, 2009, Macdonald et al, 2011, Morland, Evenson, 2009, Murakami et al, 2009, Pérez-Cueto et al, 2010, Walker et al, 2012). Little is known about the food environment and food acquisition patterns in Brazil (Duran et al, 2013, Jaime et al, 2011, Martins et al, 2013, Velásquez-Melendez et al, 2013). Therefore, we investigated the association between participants' food-related behaviors, perceptions about the local food environment, food acquisition patterns, degree of food processing, and characteristics of food sources in urban areas of varying socioeconomic status, in Santos City, Brazil.