Changes in the healthiness of private school canteens in three Brazilian cities with different regulatory contexts

Abstract

In Brazil, there is no federal law regulating the school food environment against the commercialization of unhealthy foods, only municipal and state initiatives. This study describes the changes in the healthiness of school canteens in three Brazilian cities with different regulatory contexts. A repeated cross-sectional study was conducted in 2022 and 2023, with probabilistic samples of private schools in Recife, Niterói, and Porto Alegre. The Healthiness Index (HI) was calculated, scoring positively for the availability of fresh, minimally processed, and processed foods, and negatively for the presence of ultra-processed foods. Differences between years and cities were assessed using statistical tests, and the relative change in HI was analyzed using negative binomial regression. In 2022 and 2023, a total of 240 and 203 canteens were assessed, respectively. In 2022, the HI in Porto Alegre was higher than in Recife (70 vs. 54, p<0.00) and Niterói (44, p<0.00). In 2023, the healthiness of Recife’s canteens worsened (50, p<0.00). Compared to Recife, the HI increased by 24% in Niterói (RT = 1.24; 95%CI: 1.17-1.32), possibly due to a law prohibiting the sale and advertising of ultra-processed foods in schools. Porto Alegre, which has had specific legislation since 2018, maintained a more favorable scenario, but the HI decreased by 6% (RT = 0.94; 95%CI: 0.90-0.97). Despite this, Porto Alegre’s HI remained higher than in Recife (vs. 50, p<0.00) and Niterói (vs. 46, p<0.00). The establishment of national regulations on food sales in schools, alongside actions to promote the transition to healthy canteens and foster sustained policy adherence, would be beneficial.