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

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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.