Smoking and consumption of ultra-processed foods - a combination of risky choices: A cross-sectional study using Vigitel 2018 data.

Background: Smoking and unhealthy diet are important risk factors for cardiovascular and metabolic diseases, contributing to public health crises.

Objective: To evaluate the consumption of natural/minimally processed and ultra-processed foods by Brazilian adults (18-59 years old) according to smoking status.

Design and setting: Cross-sectional study of a representative population sample from 26 state capitals and the Federal District (Brazil-2018).

Methods: Data were obtained from Vigitel-Surveillance System for Risk and Protection Factors for Chronic Diseases by Telephone Survey. Participants were categorized as smokers, ex-smokers, and never smokers. Multinomial logistic regression was used for analyses.

Results: Of the 30,800 adults evaluated, 9.4% (95%CI: 8.7-10.2) were smokers and 16.5% (95%CI: 15.8-17.3) were ex-smokers. Smokers were less likely to consume fruit and natural juice, and more likely to consume soda or artificial juice (≥ 5 days/week) than ex-smokers and never smokers. Regarding the daily frequency of consumption, smokers were observed to be less likely to eat fruit more than 1 time/day and more likely to drink ≥ 3 cups/cans of soda/day. Compared to never smokers, smokers had a 42% higher chance of consuming ≥ 3 glasses of natural juice/day. On the day before the interview, fruit, milk, tubers, squash, and okra consumption were lower among smokers than non-smokers. Smokers were more likely to report consuming soft drinks, fruit juice, sauces, ready-made dishes, margarine, and sausages.

Conclusion: Smokers had lower fruit consumption, and higher consumption of natural juices and ultra-processed foods. We highlight the need for strategies that encourage healthy eating and smoking cessation.