The objective of this study was to use ERICA data from adolescents from Brazilian public schools to investigate the role of school feeding in insulin resistance markers. Public school students (12-17 years old) with available biochemical examinations were selected. Adolescents answered a self-administered questionnaire, and contextual characteristics were obtained through interviews with principals. A multilevel mixed-effects generalized linear model was performed at the contextual and individual levels with each insulin resistance marker (fasting insulin, HOMA-IR, and blood glucose levels). A total of 27,990 adolescents were evaluated (50.2% female). The prevalence of (1) altered insulin was 12.2% (95% CI; 11.1, 13.5), (2) high HOMA-IR was 24.7% (95% CI; 22.8, 26.7), and (3) high blood glucose was 4.6% (95% CI; 3.8, 5.4). School feeding was positively associated with an insulin resistance marker, decreasing by 0.135 units of HOMA-IR (95% CI; -0.19, -0.08), 0.469 μU/L of insulin levels (95% CI; -0.66, -0.28), and 0.634 mg/dL of blood glucose (95% CI; -0.87, -0.39). In turn, buying food increased blood glucose by 0.455 mg/dL (95% CI; 0.16, 0.75). School feeding was positively associated with insulin resistance variables, demonstrating the potential of planned meals in the school environment to serve as a health promoter for the adolescent population.
Keywords: adolescent; adolescent health; insulin resistance; multilevel analysis; school feeding; school food environment.