Association Between Food Environment Characteristics and Overweight and Anemia in Socially Vulnerable Children Living in Favelas

Background: The food environment plays a significant role in determining children’s nutritional status, especially in socially vulnerable settings, where the high availability of ultra-processed beverages can contribute to both overweight and nutritional deficiencies, such as anemia. Thus, this study aimed to assess the association between the availability of fruits, vegetables, and ultra-processed beverages in the food environment and the occurrence of overweight and anemia in children living in socially vulnerable areas. Methods: This is a cross-sectional study with an ecological component, conducted between 2020 and 2021, involving 665 children residing in 40 favelas and urban communities in Maceió, Alagoas, Brazil. Socioeconomic, anthropometric, and hematological data were collected, along with a characterization of the food environment in 624 establishments using the AUDITNOVA tool, focusing on the availability of fruits, vegetables, and ultra-processed beverages. The outcomes investigated were overweight (BMI-for-age z-score > +2) and anemia (hemoglobin < 11 g/dL). Multilevel models were used to assess the associations between the food environment and the outcomes of interest. Results: The prevalence of overweight was 19.7%, while anemia affected 50.4% of the children assessed. Greater availability of fruits and vegetables was associated with a lower chance of being overweight (OR: 0.82; 95% CI: 0.79–0.98). In contrast, high availability of ultra-processed beverages was associated with a higher chance of being overweight (OR: 1.35; 95% CI: 1.07–1.84) and anemia (OR: 1.53; 95% CI: 1.04–2.29). Conclusion: Food environments characterized by widespread availability of ultra-processed beverages were associated with a higher prevalence of overweight and anemia among children. In comparison, greater availability of fresh or minimally processed foods was associated with a lower prevalence of overweight. These findings highlight the importance of public policies that promote healthier food environments in socially vulnerable areas.