Household food diversity and nutritional status among adults in Brazil

BACKGROUND: The aims of this study were to evaluate whether a diversity of healthy foods in a household would decrease the availability of unhealthy foods and to evaluate the association between a healthy dietary diversity score (DDS) and nutritional status among adults. METHODS: Data from the 2002-2003 Brazilian Household Budget Survey were used. This nationwide survey used a two-stage sampling technique: households were selected after selection of primary sample units (PSUs). Analyses were based on 3,393 PSUs, evaluating 659,816 records of food items purchased by 35,237 households. The DDS was based on the healthy food groups according to Brazilian food guidelines. Per capita acquisition of sugar, sweets, sugar-sweetened beverages and crackers, cookies and cakes (unhealthy food groups) in PSUs was also calculated. Individual weight and height were measured at household. Multivariate linear regression models estimated the association of underweight and overweight and obesity (excess weight) with the PSUs' DDS. RESULTS: Greater acquisition of unhealthy food groups was associated with higher DDS. A high PSU's DDS was negatively associated with underweight (β = -0.38; p-value = 0.04) and positively associated with excess weight (β = 0.98; p-value = 0.05) after adjustment for availability of unhealthy food groups and socioeconomic variables. CONCLUSIONS: Our data indicate that there was no replacement of unhealthy food groups by healthy food groups, therefore a healthy diet message for obesity prevention should be combined with a message focused on eating less.