Revista Adolescência e Saúde

Revista Oficial do Núcleo de Estudos da Saúde do Adolescente / UERJ

NESA Publicação oficial
ISSN: 2177-5281 (Online)

Vol. 13 nº 4 - Oct/Dec - 2016

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Páginas 7 a 14


Consumption of ultra-processed food and food coloring agents by adolescents from a public school

Consumo de alimentos ultraprocesados y colorantes alimenticios por adolescentes de una escuela pública

Consumo de alimentos ultraprocessados e corantes alimentares por adolescentes de uma escola pública

Autores: Cristhiane Maria Bazílio de Omena Messias1; Havena Mariana dos Santos Souza2; Ingrid Rafaella Mauricio Silva Reis3

1. PhD in Chemistry and Biotechnology, Alagoas Federal University (UFAL). Maceió, Alagoas State, Brazil. Adjunct Professor 1F, Nutrition Course and Teacher Training and Interdisciplinary Practices Graduate Studies Program (PPGFPPI), Pernambuco University (UPE). Petrolina, Pernambuco State, Brazil
2. Bachelor's Degree in Nutrition, Pernambuco University (UPE). Petrolina, Pernambuco State, Brazil
3. Bachelor's Degree in Nutrition, Pernambuco University (UPE). Petrolina, Pernambuco State, Brazil

Cristhiane Maria Bazílio de Omena Messias
Universidade de Pernambuco (UPE), Campus Petrolina, Curso de Nutrição
BR 203 KM2 S/N. Campus Universitário, Vila Eduardo
Petrolina, PE, Brasil. CEP: 56328 - 903
crisbomena@hotmail.com; cristhiane.omena@upe.br

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Keywords: Adolescent, food consumption, industrialized foods, food coloring agents.
Palabra Clave: Adolescente, consumo de alimentos, alimentos industrializados, colorantes de alimentos.
Descritores: Adolescente, consumo de alimentos, alimentos industrializados, corantes de alimentos.

Abstract:
OBJECTIVE: The purpose of this study was to evaluate the consumption of ultra-processed foods and food coloring agents by adolescents from a public school.
METHODS: This is a cross-sectional study conducted with students enrolled in 2013 with 10-17 year old, of both genders (n = 526) from a public school in Petrolina-PE, The research instrument used to assess dietary intake was the 24-hour dietary recall. From this recall, the consumption of ultra-processed food and of food coloring agents was presented by sex. Data were described using descriptive statistics.
RESULTS: it was observed that all adolescents had high intake of foods rich in fats, sugars, sodium and dyes. Among the foods high in sodium, the most cited by both sexes were sausages (1117.3 mg on average) and pizzas (736.7 to 762 mg). The one rich in sugars were chocolate powder (77.39g), stuffed cookies (40.62g) and finally, those rich in saturated and trans fats were margarine (16.7 / 25.8 g) and sausages (9.25 / 0.55g). As for the natural colorants, the most often cited by both sexes were Urucum (80.98%), Caramel IV (77.94%), and the artificial colorants: Red Bordeaux (49.24%), Red 40 / Allura (30.42%). CONCLUSION: The high consumption of ultra-processed food is related to the possible development of chronic diseases as well as adverse reactions to the exposure of food coloring agents, which generally include toxic metabolism reactions (allergies) and carcinogenicity, the latter being a long-term consequence.

Resumen:
OBJETIVO: Este trabajo tuvo como objetivo verificar el consumo de alimentos ultraprocesados y colorantes de alimentos por adolescentes de una escuela pública.
MÉTODOS: Se trata de un estudio transversal realizado con alumnos matriculados en el año 2013 en la franja etaria de 10-17 años de edad, de ambos sexos (n=526) de una escuela pública en Petrolina-PE. El instrumento de pesquisa utilizado para la evaluación del consumo alimenticio fue el Recordatorio 24 horas. A partir del recordatorio, se presentó el consumo de alimentos ultraprocesados y colorantes de alimentos por sexo. Los datos fueron descritos utilizando estadística descriptiva.
RESULTADOS: Al verificar el consumo alimenticio de los adolescentes, se observó que todos presentaron una ingestión significativa de alimentos ricos en grasas, azúcares, sodio y colorantes de alimentos. De entre los alimentos ricos en sodio más citados por ambos sexos están los embutidos (1.117,3mg en promedio), pizzas (736,7-762 mg). Ya los ricos en azúcares fueron el chocolate en polvo (77,39g), bizcochos rellenos (40,62g), y finalmente, los ricos en grasas saturadas y trans fueron margarinas (16,7/25,8g), embutidos (9,25/0,55g). En relación a los colorantes del tipo natural más citados por ambos sexos se destacan el Urucú (80,98%) y Caramelo IV (77,94%), en cuanto a los artificiales: Rojo Bordeaux (49,24%), Rojo 40/allura (30,42%).
CONCLUSIÓN: El consumo alto de alimentos ultraprocesados está relacionado con el posible desarrollo de enfermedades crónicas no transmisibles, así como reacciones adversas en relación a exposición a los colorantes de alimentos que incluyen, en general, reacciones tóxicas en el metabolismo (alergias) y carcinogenicidad, siendo esta última una consecuencia a largo plazo.

Resumo:
OBJETIVO: Este trabalho teve como objetivo verificar o consumo de alimentos ultraprocessados e corantes de alimentos por adolescentes de uma escola pública.
MÉTODOS: Trata-se de um estudo transversal realizado com alunos matriculados no ano de 2013 na faixa etária de 10-17 anos de idade, de ambos os sexos (n=526) de uma escola pública em Petrolina-PE. O instrumento de pesquisa utilizado para a avaliação do consumo alimentar foi o Recordatório 24 horas. A partir do recordatório, apresentou-se o consumo de alimentos ultraprocessados e corantes de alimentos por sexo. Os dados foram descritos utilizando estatística descritiva.
RESULTADOS: Ao verificar o consumo alimentar dos adolescentes, observou-se que todos apresentaram uma ingestão significativa de alimentos ricos em gorduras, açúcares, sódio e corantes de alimentos. Dentre os alimentos ricos em sódio mais citados por ambos os sexos estão os embutidos (1.117,3mg em média), pizzas (736,7-762 mg). Já os ricos em açúcares foram o achocolatado em pó (77,39g), biscoitos recheados (40,62g), e por fim, os ricos em gorduras saturadas e trans foram margarinas (16,7/25,8g), embutidos (9,25/0,55g). Quanto aos corantes do tipo natural mais citados por ambos os sexos destacam-se o Urucum (80,98%) e Caramelo IV (77,94%), quanto aos artificiais: Vermelho Bordeaux (49,24%), Vermelho 40/allura (30,42%).
CONCLUSÃO: O consumo elevado de alimentos ultraprocessados está relacionado com o possível desenvolvimento de doenças crônicas não transmissíveis, bem como, reações adversas quanto a exposição aos corantes de alimentos que incluem, em geral, reações tóxicas no metabolismo (alergias) e carcinogenicidade, sendo esta última uma consequência a longo prazo.

INTRODUCTION

During adolescence, eating habits commonly include excessive consumption of soda pop, refined sugars, and sugary drinks with high calorie counts, rich in salt, saturated fat, and chemical additives, together with fast food snacks, all contributing to overweight, with a greater likelihood of developing Non-Communicable Chronic Diseases (NCCD) such as diabetes and obesity, among others. In parallel to these poor eating habits eating habits, low intakes of fruit, vegetables and dairy products are also noted1.

Industrialization and urbanization drive changes in eating patterns, boosting consumption of ultra-processed foods, due to their hyper-palatability resulting from chemical additives, especially coloring agents that make foods more appealing to the eye, with notable influence on choices2.

Food coloring agents constitute a class of food additives that may be classified as natural or artificial/synthetic, intended to add, intensify or standardize food product coloring agents, offering the same characteristics of the natural product3.

It is worthwhile stressing that from the nutritional standpoint, the use of these substances is unnecessary, as their function is merely to add color to foods, used only to enhance appearance. Studies have been demonstrating the occurrence of adverse reactions, such as toxic reactions in the metabolism that trigger allergies, together with behavioral alterations and carcinogenicity, with these effects appearing over the short and / or long terms3,4.

Noteworthy among the artificial coloring agents allowed in Brazil under current legislation and Resolutions Nº 382 to 388 promulgated on August 9, 1999 by the Public Health Regulator (ANVISA), are sunset yellow (E-110), tartrazine yellow (E-102), amaranth (E-123), erythrosine red (E-127), azorubine (E-122), patent blue V (E-131), red 40 (E-129), ponceau 4R (E-124), indigotine blue (E-132), brilliant blue (E-133) and fast green (E-143). Natural colorants include: curcumin, cochineal, chlorophyll, beetroot red, carotenoids and caramel (I - IV)3.

Eating habits play a key role in health, development and growth, particularly during phases with heavier nutrient demands, such as childhood and adolescence. Recent studies suggest that eating patterns during childhood and adolescence may step up the likelihood of developing Non-Communicable Chronic Diseases during adulthood5,6.

Faced by this evidence, this study intends to examine the consumption of ultra-processed foods and coloring agents in food items eaten by adolescents enrolled at a government school, due to the possible consequences that might arise from high consumption of these agents.


MATERIALS AND METHODS

STUDY DESIGN


This cross-sectional study was conducted between August 2013 and June 2015 at a government school in Petrolina, Pernambuco State. The sample consisted of boys and girls enrolled at this school in 2013, between 10 and 17 years old (n = 526), with 350 girls (66.54%) and 176 boys (33.46%).

This study is a sub-project of the Energy, Macro-Nutrient and Micro-Nutrient Consumption among Adolescents at the Professor Vande de Souza Ferreira laboratory school in Petrolina, Pernambuco State, approved by the Ethics Committee at the Pernambuco University under CAAE Nº 10290612.1.0000.5207 in February, 2013.

The inclusion criteria were: pupils must be enrolled at the government school where the project was being conducted; between 10 and 17 years old; and have permission to participate in this study through handing in Deeds of Informed Consent signed by their parents or guardians. The exclusion criteria were turning 18 years old in 2013 and unwillingness to participate in the project.

Data Collection

Initially, all participants were provided with information on the survey, after which their parents or guardians received the Deeds of Informed Consent. Once they were signed and returned, the adolescents then moved on to the assessment of their food intake.

The research tool used to assess their food intake was the 24-hour food journal (R24h - Recordatório 24 horas), used to define and quantify all foods and beverages ingested during the period prior to the interview, which could be the 24 preceding hours, or, more commonly, the previous day 7.

The Food Journal was completed in two separate interviews (a typical day: Monday through Friday; and an atypical day: Saturday, Sunday and holidays) scheduled about two weeks apart, in order to establish the average consumption of each pupil, assessing the total amount of foods and nutrients ingested, thus allowing their regular diets to be assessed8.

In order to help the respondents estimate the amounts of food consumed, audiovisual resources were used, such as: photographs, replicas and illustrations (photo album - UNICAMP/UFG).

Data Analysis

Through these food journals, the consumption of ultra-processed foods and coloring agents was assessed among adolescents at a government school in Petrolina, Pernambuco State, as a benchmark, Executive Board Resolution RDC Nº 24 promulgated on June 15, 2010 was used to classify foods high in salt, sugars and fats, in addition to the current Resolution Nº 44 issued by the National Food Standards and Commission (CNNPA) in 1977, which classifies and lists the coloring agents permitted in Brazil9,10.

The following programs were used for the statistical treatment of the data: Excel (Version 2013) and Graph Pad Prism, Version 6.01 (Graph Pad Inc., San Diego, CA, USA. A descriptive statistical analysis was conducted (mean, standard deviation and percentages).


RESULTS

When analyzing the food intake of these adolescents, it was noted that they all reported ample consumption of foods high in fats, sugars and salt, stressing that this was generally more common among girls than boys (Table 2).






In order to classify foods by their salt, sugar and / or fat content, Executive Board Resolution RDC Nº 24 promulgated on June 15, 2010 was used as a parameter (Table 1). The high-salt foods mentioned most commonly by both boys and girls are: processed meats (1,117.30 mg on average), pizzas (736,7-762 mg), ready-to-eat lasagnas (502 mg) and hamburgers (472.53 mg). High-sugar items include chocolate milk (77.39 g), sandwich cookies (40,62 g), breakfast cereals (38,02 g) and soda pop (10-12 g).

Food items with high saturated / trans fat contents included: margarine (16.7/25.8 g), processed meats (9.25/0.55g) and sandwich cookies (6.2/4.21 g), with all nutrient quantities presented by 100g of food.

Girls consumed more high-salt food items such as: processed meats (94.86%), baked and fried finger snacks (46.28%) and pizzas (19.42%), while boys consumed larger amounts of sugary items such as: sandwich cookies (23.86%), breakfast cereals (9.65%) and soda pop (60.79%).

It was noted that both boys and girls presented high intakes of ultra-processed foods and consequently natural and artificial coloring agents.

Noteworthy among the natural coloring agents mentioned most frequently by boys and girls are: beta-carotene (44.11%), cochineal carmine (51.71%), turmeric /curcumin (56.27%), caramel IV (77.94%), urucum (80.98%) with tartrazine (24.14%), indigotine blue (27.95%), sunset yellow (29.47%), allura red 40 (30.42%) and Bordeaux red (49.24%) being more common among boys.

The foods items contributing most to consumption of the coloring agents mentioned above are soda pop (n=272), hard candies and lollipops (n=52), ice-creams/popsicles (n=71), cheeses (n=252), corn chips (n=70), artificial juices (n=131) and ramen noodles (n=40) (Table 3).




DISCUSSION

Families and schools are the places where children and adolescents observe, acquire and absorb lifestyles, including their eating habits. This is why it is necessary to assess food intake among adolescents at both locations11.

In Brazilian schools, canteens allow adolescents to select the foods they will consume, tailored to their purchasing power, preferences and habits, making it increasingly difficult for them to pick healthier meals12. This is because these establishments offer foods that are nutrient-poor but high in fats, sugars and salts, with flavors that appeal to youngsters and hamper the adoption of healthier habits.

This is perhaps one of the reasons for the poor quality of school snacks found in this study, packed with industrialized items that are high in salts, sugars and fats, in addition to food coloring agents used to brighten their colors12,13.

An epidemiological study analyzing snack consumption among schoolchildren found high and frequent consumption of sweets, fried foods, artificial juices and packaged chips and crisps, together with foods high in sugars, fats and salts. Moreover, soda pop consumption was also high, replacing fresh juices and dairy beverages. These habits characterizing inadequate food intake was also noted in the workplace14.

Another possible explanation for poor eating habits among adolescents consists of frequent meals away from home, skipping meals and replacing home-cooked meals by industrialized options that are fast and / or easy to prepare, especially fast food, with excessive amounts of sugar, salt and saturated / trans fats with high energy density and food coloring agents 15.

Diets that are high in fat, particularly saturated fat and cholesterol, salt and sugar, while poor in complex carbohydrates, vitamins and minerals, together with sedentary lifestyles, are driving the upsurge in diet-related diseases such as obesity, diabetes, cardiovascular problems, high blood pressure, osteoporosis and cancer. This is a matter of much concern for diets during childhood and adolescence, which are important phases for healthy growth and development16.

With regard to the consumption of ultra-processed foods with added food coloring agents in Brazil, local legislation regulating their use is laxer than the laws in many other countries, such as USA, Austria and Norway, with rising concern over the consumption of foods containing these items in their composition, due to their negative effects on the human body17.

Laboratory studies have been showing that artificial food coloring agents consumed in excessive amounts over the longer term may have adverse effects ranging from a simple rash to asthma, immunological reactions and even cancer18. Stressing that these are the possible consequences of overconsumption of foods containing these substances or if the amounts in the food exceeds the Acceptable Daily Intake (ADI) drawn up by the Joint FAO/WHO Expert Committee on Food Additives (JECFA) 19.

The natural coloring agent most widely used by Brazilian industry (accounting for around 90% of natural coloring agents used in Brazil and 70% worldwide) is urucum, which was mentioned most frequently and consumed to the greatest extent by boys and girls20. Also identified in adolescent diets, tartrazine is one of the most controversial artificial coloring agents, known to cause a range of food allergies and banned in many countries, although still used in Brazil, not only in foods, but also medications19.

These findings underscore the need for significant changes in adolescent eating patterns, in parallel to ongoing education and nutrition at schools, in addition to reaching out to their families.


CONCLUSION

In order to achieve health levels that ensure proper development and well-being, it is important to introduce education strategies that underscore the importance of cutting back on the consumption of ultra-processed foods that are high in fats, sugars, salts and coloring agents, particularly the artificial type. Through this approach, healthier food intake and better-balanced diets would be encouraged, thus helping avoid the possible development of food-related diseases during adulthood, or even during adolescence.


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