Influence of socioeconomic factors on the adoption of dietary patterns among women using the Brazilian Unified Health System (SUS)

Authors

DOI:

https://doi.org/10.21527/2176-7114.2026.51.16741

Keywords:

Dietary patterns; Women; Socioeconomic factors, Factor analysis.

Abstract

This study aimed to identify the predominant dietary patterns among adult women using the Brazilian Unified Health System (SUS) in João Pessoa, Paraíba, Brazil, and to estimate the effects of different factors on adherence to these patterns. This cross-sectional study included 268 women aged 18–59 years recruited from 10 Family Health Units. Face-to-face interviews were conducted to characterize the study population, assess nutritional status, and evaluate dietary intake using 24-hour dietary recalls. Dietary patterns were identified through exploratory factor analysis using principal component extraction. Factors with eigenvalues greater than 1 were retained, followed by varimax rotation. Adherence to the dietary patterns was assessed using tests for comparison of means, including Student’s t-test and analysis of variance (ANOVA). The effect of each independent variable was evaluated using multiple logistic regression models, with each dichotomized factor considered as the dependent variable. Four dietary patterns were identified, designated as “Unhealthy,” “Mixed 1,” “Mixed 2,” and “Traditional,” accounting for 36% of the total variance. Pregnancy was associated with greater adherence to both the “Unhealthy” pattern (OR: 7.62; 95% CI: 3.59–16.19) and the “Traditional” pattern (OR: 6.00; 95% CI: 2.82–12.78). Being older than 35 years was associated with the “Traditional” pattern (OR: 2.10; 95% CI: 1.06–4.18), whereas lower educational attainment was associated with the “Unhealthy” pattern (OR: 3.10; 95% CI: 1.18–8.12). Low income was also associated with this pattern but lost statistical significance in the multivariable model. Unhealthy food choices among women of lower socioeconomic status should be considered when developing health strategies aimed at promoting nutrition education and access to healthy foods. Older women showed greater adherence to the traditional dietary pattern, suggesting that the worsening in diet quality may be a relatively recent phenomenon.

References

1. Pingali P, Sunder N. Transitioning Toward Nutrition-Sensitive Food Systems in Developing Countries. Annual Review of Resource Economics. Annual Reviews; 2017;9(Volume 9, 2017):439–459.

2. Popkin BM, Corvalan C, Grummer-Strawn LM. Dynamics of the Double Burden of Malnutrition and the Changing Nutrition Reality. Lancet. 2020;395(10217):65–74. PMCID: PMC7179702

3. Cunha GJG da, Patu LJG, Ferreira JC de S, Freitas FMN de O. Fatores determinantes no perfil nutricional e consumo alimentar de gestantes atendidas pelo sistema único de saúde / Determining factors in the nutritional profile and food consumption of pregnant women care by the single health system. Brazilian Journal of Health Review. 2022 May 18;5(3):9764–9779.

4. Zuccolotto DCC, Crivellenti LC, Franco LJ, Sarotelli DS, Zuccolotto DCC, Crivellenti LC, Franco LJ, Sarotelli DS. Padrões alimentares de gestantes, excesso de peso materno e diabetes gestacional. Revista de Saúde Pública [Internet]. 2019 [cited 2019 Sep 27];53. Available from: http://www.scielo.br/scielo.php?script=sci_abstract&pid=S0034-89102019000100247&lng=pt&nrm=iso&tlng=pt

5. Food and Agriculture Organization of the United Nations. Dietary assessment: a resource guide to method selection and application in low resource settings. Rome: FAO; 2018.

6. Cheng W, Li L, Long Z, Ma X, Chen F, Ma L, Zhang S, Lin J. Association between Dietary Patterns and the Risk of Hyperemesis Gravidarum. Nutrients. 2023 Jul 25;15(15):3300. PMCID: PMC10420833

7. Newby PK, Tucker KL. Empirically derived eating patterns using factor or cluster analysis: a review. Nutr Rev. 2004 May;62(5):177–203. PMID: 15212319

8. Pinto MLM, Queiroz MP, Santos ABMV dos, Silva N da R, Pereira MTL, Campos R da S. Gestação na adolescência: padrões alimentares e correlação com seu perfil socioeconômico. Research, Society and Development. 2020 May 5;9(7):e169973976–e169973976.

9. Lee A, Patay D, Herron LM, Parnell Harrison E, Lewis M. Affordability of current, and healthy, more equitable, sustainable diets by area of socioeconomic disadvantage and remoteness in Queensland: insights into food choice. International Journal for Equity in Health. 2021 Jun 30;20(1):153.

10. REDE PENSSAN. Insegurança alimentar e desigualdades de raça/cor da pele e gênero - II VIGISAN: Suplemento II / Rede Brasileira de Pesquisa em Soberania e Segurança Alimentar [Internet]. 2023 [cited 2024 Sep 23]. Available from: https://olheparaafome.com.br/

11. Andrade MLS de S, Canuto R, Oliveira JS, Bacalhau SPOS, Tavares FCLP, Lira PIC de, Leal VS. Padrões alimentares de mulheres em idade reprodutiva: realidade na Zona da Mata nordestina. DEMETRA: Alimentação, Nutrição & Saúde. 2020 May 28;15(0):43552.

12. Caetano L da C, Garcez A, Bairros F de S, Costa JSD da, Olinto MTA. Associação entre capital social e padrões alimentares em mulheres do Sul do Brasil. Ciênc saúde coletiva. ABRASCO - Associação Brasileira de Saúde Coletiva; 2023 Jul 7;28:1915–1926.

13. Pinheiro M de M, Oliveira JS, Leal VS, Lira PIC de, Souza NP de, Campos F de AC e S. Prevalência do excesso de peso e fatores associados em mulheres em idade reprodutiva no Nordeste do Brasil. Rev Nutr. Pontifícia Universidade Católica de Campinas; 2016;29:679–689.

14. Zhang M, You S, Yi S, Zhang S, Xiao Y. Vulnerability of Poverty Between Male and Female-Headed Households in China. J Fam Econ Iss [Internet]. 2024 [cited 2024 Jul 27]; Available from: https://doi.org/10.1007/s10834-024-09969-5

15. Viana MACBM, Alverga CCF, Freire FLPN, Cruz RFA, Lima RLFC, Vianna RPT. Avaliação do impacto da insegurança alimentar na saúde de mulheres gestantes e não gestantes: aspectos metodológicos de uma coorte no município de João Pessoa, Paraíba. Segur Aliment Nutr. 2024;31:e024018.

16. Silva JF, Rodrigues MJ, Silva MR. UTILIZAÇÃO DO KOBOTOOLBOX PARA CARACTERIZAÇÃO DAS UNIDADES DE SAÚDE DA REDE MUNICIPAL DE JATAÍ-GO, 2019. Hygeia - Revista Brasileira de Geografia Médica e da Saúde. 2022;120–135.

17. World Health Organization. WHO guidelines on physical activity and sedentary behaviour [Internet]. Geneva: WHO; 2020 [cited 2026 May 25]. Available from: WHO guidelines on physical activity and sedentary behaviour

18. Fisberg RM, Marchioni DML, Previdelli AN, Carvalho AM de, Mendes A, Timm A de S, Gorgulho BM, Verly Junior E, Steluti J, Brunacio KH, Piovezan LG, Castro MA de, Bigio RS, Selem SS de C, Baltar VT. Manual de avaliação do consumo alimentar em estudos populacionais: a experiência do inquérito de saúde em São Paulo (ISA). 2012 [cited 2024 Oct 1]; Available from: https://repositorio.usp.br/item/002316691

19. Verly E, Castro MA, Fisberg RM, Marchioni DML. Precision of usual food intake estimates according to the percentage of individuals with a second dietary measurement. J Acad Nutr Diet. 2012;112(7):1015–1020. PMID: 22889632

20. Galante AP. Desenvolvimento e validação de um método computadorizado para avaliação do consumo alimentar, preenchido por indivíduos adultos utilizando a Web [Internet] [text]. Universidade de São Paulo; 2007 [cited 2023 Jul 10]. Available from: http://www.teses.usp.br/teses/disponiveis/89/89131/tde-11032013-155020/

21. Harttig U, Haubrock J, Knüppel S, Boeing H, EFCOVAL Consortium. The MSM program: web-based statistics package for estimating usual dietary intake using the Multiple Source Method. Eur J Clin Nutr. 2011 Jul;65 Suppl 1:S87-91. PMID: 21731011

22. Hair JF, Black WC, Babin BJ, Anderson RE, Tatham RL. Análise multivariada de dados - 6ed. Bookman Editora; 2009.

23. Fonseca MJ, Faerstein E, Chor D, Lopes CS. Validade de peso e estatura informados e índice de massa corporal: estudo Pró-Saúde. Rev Saude Publica. 2004;38(3):392-8.

24. Brito RCS, Oliveira AGRC. Validação de medidas autorreferidas para estado nutricional: estudo a partir da PNS 2019. Rev Saude Publica. 2024;58:28.

25. WHO. Obesity : preventing and managing the global epidemic : report of a WHO consultation [Internet]. 2000 [cited 2019 Mar 27]. Available from: https://apps.who.int/iris/handle/10665/42330

26. Harris J, Chisanga B, Drimie S, Kennedy G. Nutrition transition in Zambia: Changing food supply, food prices, household consumption, diet and nutrition outcomes. Food Sec. 2019;11(2):371–387.

27. Marshall NE, Abrams B, Barbour LA, Catalano P, Christian P, Friedman JE, Hay WW, Hernandez TL, Krebs NF, Oken E, Purnell JQ, Roberts JM, Soltani H, Wallace J, Thornburg KL. The importance of nutrition in pregnancy and lactation: lifelong consequences. Am J Obstet Gynecol. 2022;226(5):607–632. PMCID: PMC9182711

28. Hassani Zadeh S, Boffetta P, Hosseinzadeh M. Dietary patterns and risk of gestational diabetes mellitus: A systematic review and meta-analysis of cohort studies. Clinical Nutrition ESPEN. 2020;36:1–9.

29. Oliveira PG, de Sousa JM, Assunção DGF, de Araujo EKS, Bezerra DS, Dametto JF dos S, Ribeiro KD da S. Impacts of Consumption of Ultra-Processed Foods on the Maternal-Child Health: A Systematic Review. Front Nutr. 2022;9:821657. PMCID: PMC9136982

30. Paula WO, Patriota ESO, Gonçalves VSS, Pizato N. Maternal Consumption of Ultra-Processed Foods-Rich Diet and Perinatal Outcomes: A Systematic Review and Meta-Analysis. Nutrients. 2022;14(15):3242. PMCID: PMC9370797

31. Schrubbe V, Silva DLF, Almeida CCB, Taconeli CA, Elias VCM, Macedo M de S, Franceschini S do CC, Crispim SP. Ultra-processed food consumption during pregnancy and newborn weight. Rev Bras Saude Mater Infant. Instituto de Medicina Integral Prof. Fernando Figueira; 2024;24:e20230189.

32. Silva DCG da, Ferreira FG, Pereira DLM, Magalhães ELG de, Longo GZ. Degree of food processing and its relationship with overweight and body adiposity in Brazilian adults. Rev Nutr. Pontifícia Universidade Católica de Campinas; 2021;34:e200135.

33. Lins APM, Sichieri R, Coutinho WF, Ramos EG, Peixoto MVM, Fonseca VM. Alimentação saudável, escolaridade e excesso de peso entre mulheres de baixa renda. Ciênc saúde coletiva. ABRASCO - Associação Brasileira de Saúde Coletiva; 2013 Feb;18: 357–366.

34. Silva BO da, Gaia JA, Wanderley TM, Ramos RW de O, Matias JG, Azevedo M de LSG. nível de escolaridade como fator de vulnerabilidade social e sua influência no excesso de peso de mulheres em Alagoas, 2018. SEMPESq - Semana de Pesquisa da Unit - Alagoas [Internet]. 2019 [cited 2023 Aug 14]; (7). Available from: https://eventos.set.edu.br/al_sempesq/article/view/12195

35. Islam DMR. Education and Food Consumption Patterns: Quasi-Experimental Evidence from Indonesia. SSRN Journal [Internet]. 2021 [cited 2023 Aug 14]; Available from: https://www.ssrn.com/abstract=3925151

36. Araújo ES, Da Mota Santana J, Monteiro Brito S, Barbosa Dos Santos D. Consumo alimentar de gestantes atendidas em Unidades de Saúde. Mundo da Saúde. 2016;40(1):28–37.

37. Pires IG, Gonçalves DR. Consumo alimentar e ganho de peso de gestantes assistidas em unidades básicas de saúde / Food consumption and weight gain of pregnant women assisted in public health units. Brazilian Journal of Health Review. 2021 Jan 7;4(1):128–146.

38. Wasem S, Nicoletto BB. Comportamento alimentar e insatisfação da imagem corporal em mulheres da Serra Gaúcha. RBONE Rev Bras Obes Nutr Emagrecimento. 2024;18(117):1176-83.

39. Raj S. Influences of the Nutrition Transition on Chronic Disease. In: Noland D, Drisko JA, Wagner L, editors. Integrative and Functional Medical Nutrition Therapy: Principles and Practices [Internet]. Cham: Springer International Publishing; 2020 [cited 2024 Aug 7]. p. 17–29. Available from: https://doi.org/10.1007/978-3-030-30730-1_2

40. Cacau LT, Sampaio HA de C, Carioca AAF, Adriano LS, Pinheiro LGP, Azevedo CV, Mendes AL de RF, Rocha DC, Bezerra IN. Padrões alimentares e fatores associados em mulheres residentes de um munícipio do Nordeste do Brasil. Saúde (Santa Maria) [Internet]. 2021 Apr 22 [cited 2022 Jul 23]; Available from: https://periodicos.ufsm.br/revistasaude/article/view/64012

41. Graciliano NG, Silveira JAC da, Oliveira ACM de. Consumo de alimentos ultraprocessados reduz a qualidade global da dieta de gestantes. Cad Saúde Pública. Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz; 2021 Mar 12;37:e00030120.

42. Souza EB de. Transição nutricional no Brasil: análise dos principais fatores. Cadernos UniFOA. 2010;5(13):49–53.

43. Silveira EA, Martins BB, Abreu LRS de, Cardoso CK de S. Baixo consumo de frutas, verduras e legumes: fatores associados em idosos em capital no Centro-Oeste do Brasil. Ciênc saúde coletiva. ABRASCO - Associação Brasileira de Saúde Coletiva; 2015 Dec;20:3689–3699.

44. WHO. Increasing fruit and vegetable consumption to reduce the risk of noncommunicable diseases [Internet]. 2023 [cited 2024 Aug 27]. Available from: https://www.who.int/tools/elena/interventions/fruit-vegetables-ncds

45. Covitel. Covitel - Inquérito Telefônico de Fatores de Risco para Doenças Crônicas não Transmissíveis em Tempos de Pandemia [Internet]. Vital Strategies. 2022 [cited 2023 Aug 12]. Available from: https://www.vitalstrategies.org/resources/covitel-inquerito-telefonico-de-fatores-de-risco-para-doencas-cronicas-nao-transmissiveis-em-tempos-de-pandemia/

46. McKenzie BL, Santos JA, Geldsetzer P, Davies J, Manne-Goehler J, Gurung MS, Sturua L, Gathecha G, Aryal KK, Tsabedze L, Andall-Brereton G, Bärnighausen T, Atun R, Vollmer S, Woodward M, Jaacks LM, Webster J. Evaluation of sex differences in dietary behaviours and their relationship with cardiovascular risk factors: a cross-sectional study of nationally representative surveys in seven low- and middle-income countries. Nutrition Journal. 2020;19(1):3.

47. Nyanchoka MA, van Stuijvenberg ME, Tambe AB, Zuma MK, Mbhenyane XG. Fruit and Vegetable Consumption Patterns and Risk of Chronic Diseases of Lifestyle among University Students in Kenya. Int J Environ Res Public Health. 2022;19(12):6965. PMCID: PMC9222637

48. Carandang RR, Shafiee Hanjani L, Worsley A, Lim R, Moran LJ, Teede HJ, et al. Perceived stress and depressive symptoms are associated with emotional eating but not nutritional intake during pregnancy: a prospective cohort study. J Midwifery Womens Health. 2024;69(1):64-70.

Published

2026-10-21

Issue

Section

ORIGINAL ARTICLE

How to Cite

Influence of socioeconomic factors on the adoption of dietary patterns among women using the Brazilian Unified Health System (SUS). (2026). Revista Contexto & Saúde, 26(51), e16741. https://doi.org/10.21527/2176-7114.2026.51.16741