Revista Oficial do Núcleo de Estudos da Saúde do Adolescente / UERJ
NESA Publicação oficial
ISSN: 2177-5281 (Online)
|Original Article|| Imprimir
Páginas 33 a 41
Autores: Elaine Alves Souza1; Jordana Araújo Borba2; Janaína Maiana Abreu Barbosa3; Glauco Frazão Flexa Ribeiro4 Maylla Luanna Barbosa Martins5
1. Graduate, Nutrition Course, Tocantins Federal University (UFT). Palmas, Tocantins State, Brazil
Maylla Luanna Barbosa Martins
How to cite this article
Keywords: Food consumption, food habits, adolescent.
The World Health Organization (WHO) defines adolescence as the age bracket between 10 and 19 years old, constituting a time of transition between childhood and adulthood and characterized by sweeping body changes triggered by puberty and emotional, mental and social development spurts 1,2.
During this stage of life, food consumption has many implications for individual growth and development, while also helping shape eating habits whose consequences may extend into adult life. In today´s world, teen diets tend towards high calorie contents, rich in fats, sugars and salt, while lacking fruit, vegetables and greens (FVG), which is a nutritional characteristic of this transition process 3,4.
Inadequate consumption of fruit, vegetables and greens (FVG) by the population studied may result in the appearance of non-communicable diseases (NCD) and other ailments, stunted growth, poor resistance, greater susceptibility to infections and weaker learning capabilities, possibly due to insufficient supplies of vitamins and minerals in these foods5.
According to Toral et al.6, most adolescents are well informed about healthy diets, underscoring the importance of criteria such as an even balance, moderation, variety of foods, fractioned intake and the roles played by nutrients. However, this group encounters many difficulties in its attempts to achieve a healthy diet, including adequate FVG consumption. These factors are subject to influences from families, friends, the media and social pressures, dislike of the taste of some foods rated as healthy, greed, temptations offered by unhealthy foods, social and economic factors, poverty, excessive consumption of processed products, the practicality of unhealthy meals and others1,4.
Rich in vitamins, minerals, fibers and bio-active compounds, a wide variety of FVG must be eaten regularly, in order to protect against mineral and vitamin deficiencies, avoiding nutritional shortfalls and helping prevent NCD. Furthermore, the fibers in FVG also curb appetites and increase feelings of fullness, with lower total cholesterol (TC synthesis) and low-density lipo-protein fractions (LDL), in addition to slowing carbohydrate absorption after meals7,5,8.
In view of the importance of FVG consumption by adolescents and the lack of studies exploring this topic among adolescents living in Maranhão State, it was decided to conduct this study in order to analyze their FVG intake by the frequency with which they are consumed, providing guidance for strategies that encourage consumption of these foods.
This study is part of a population-based study examining Mother and Child Health Status in Maranhão State. The focus of this paper is an analysis of fruit, vegetables and greens consumption by adolescents between 10 and 19 years old. This descriptive survey adopts a quantitative approach.
The sample was calculated on the basis of overweight, based on diagnosis of overweight and obesity among adolescents in Maranhão State which reached 10.5% (IBGE, 2006)9, according to the Family Budgets Survey (POF). The respondents thus consisted of 1,399 adolescents, ascertaining that the size of this study is sufficient to assess the nutrition indicators for adolescents in Maranhão State with a 3% error margin and a 95% confidence interval, a design effect of 2 and a significance level of 5%, with 3% estimate accuracy.
The multi-stage sampling process was based on clusters, in three stages. Initially, the municipalities were selected through a random draw; next, the census sectors were selected within each municipality; and finally, the starting point in each sector was selected through a random draw, on which basis specific numbers of homes were visited. The sampling process began with the preparation of a comprehensive listing of municipalities in Maranhão State and their respective populations, based on the Demographic Census drawn up by the Brazilian Institute for Geography and Statistics (IBGE, 2006)10.
In all, thirty clusters were drawn at random (in order to obtain a normal distribution) through systematic sampling with size-proportional probabilities, meaning that municipalities with larger populations were more likely to be selected or be drawn twice or more, in order to ensure that the sample reflected the population distribution of this State.
The data were collected between July 2007 and January 2008, obtained through the Food Consumption Frequency Questionnaire (FCFQ). The initial list of foods was taken from the FCFQ validated by Sichieri (1998)11, then adapted to the specific regional characteristics of Maranhão State, tailored to the eating habits and culture of the target population. In order to draw up a list of foods, two 24-hour food journals were completed on different days by 150 people living in a neighborhood whose social and economic status is heterogeneous. The journals were analyzed by nutrient intake and energy consumption. Foods contributing most to the diet of the study population in nutritional terms were included in the FCFQ list, using the method developed by Block et al.12.
Food portions were defined as small, medium and large, with the percent (P) calculation for each food rating P50 as a medium portion of a specific food, corresponding to the medium portion in the FCFQ, with the other portion sizes equivalent to P25 (small) and P75 (large). The portions were based on ordinary home measurements, taking the mean as a benchmark. Additionally, FVG consumption frequency was classified under Never, Daily, Weekly and Monthly. The final questionnaire listed 92 food items and was validated, with correlation coefficients ranging from 0.40 to 0.70. The FCFQ explored food consumption during the previous twelve months, in order to encompass seasonal fruits and vegetables.
The fruits listed in the questionnaire were: banana, orange, tangerine, apple, watermelon, mango, Surinam cherry (acerola), avocado and starfruit, together with regional fruits: bacuri, cupuaçu, juçara, buriti and pequi. The vegetables and greens were: lettuce, tomato, purslane, hibiscus, West Indian gherkin, okra, onion, pumpkin, carrot and kale.
The information was processed and analyzed through the Stata 10.0 software. After processing and analyzing the data, frequencies and percentages were generated for fruit, vegetables and greens consumption by frequency of intake, divided into Never, Daily, Weekly and Monthly. Daily consumption was also divided into Low, Adequate and High, following the recommendations in the Brazilian Food Pyramid drawn up by Philippi et al.13, ranking daily consumption as Low at less than three portions of fruits and four portions of vegetables and greens; Adequate, at three to five portions of fruits and four to five portions of vegetables and greens; and High at five or more portions of fruit, vegetables and greens.
This study was approved on October 20, 2006 by the Research Ethics Committee at the Maranhão State University Hospital through Protocol Nº 33104-747/2006, with the research activities complying with the provisions set forth in Resolution Nº 196 issued by the National Health Council on October 10, 1996, and its supplementary directives.
This project ascertained that 33.38% of the 1,399 adolescents were girls, with 66.62% boys. In terms of their domiciles, 48.04% lived in rural zones and 51.96% in urban areas. The family incomes of most (42.46%) of the respondents were up to one minimum wage (Table 1).
Regarding the participation of fruit in the diets of adolescents in Maranhão State, the highest daily consumption at once or more was posted for bananas (15.87%) and oranges/tangerines (13.87%). Together with apples and pineapples, they posted the highest weekly consumption levels. Regional fruits were less widely consumed, with the following appearing more frequently in the Never Eat category: pequi (92.99%), bacuri/cupuaçu (92.92%), starfruit (91.71%) and buriti (91.57%) (Table 2).
With regard to daily vegetables and greens consumption, onions were noteworthy (36.45%), tomatoes (35.96%) and parsley and spring onions (cheiro verde) (29.58%); kale (90.20%), purslane/hibiscus (69.55%) and okra/West Indian gherkin (67.19%) posted the highest percentages in the Never Eat category, as reported by these adolescents (Table 3).
In terms of rating FVG consumption as Low, Adequate and High, 84.27% reported low fruit intake and 71.98% ate insufficient amounts of vegetables and greens. Adequate and high fruit consumption was found among 15.73% of the respondents, reaching 28.02% for vegetables and greens (Table 4).
This study noted inadequate FVG intake among adolescents in Maranhão State. These findings are similar to those of Gambardela et al.14 and Silva et al.15, which also found insufficient consumption of these foods, including higher consumption of greens than fruits.
These results are also aligned with a survey conducted by Toral et al.4 of 234 adolescent schoolchildren in São Paulo, of whom 82.1% and 77.8% reported low consumption of fruit and vegetables/greens, respectively, compared to the recommendations in the Brazilian Food Pyramid13. Similar findings may also be noted in the study by Mendes and Catão3, conducted with adolescents in the town of Formiga, Minas Gerais State, with most of these youngsters reporting low intakes of these foods (79.1% for fruits and 75.6% for vegetables and greens).
A study conducted in Teixeira de Freitas, Bahia State, with 354 adolescents enrolled in municipal government schools, showed that fruit, vegetables and greens were not part of their habitual diets16. Inadequate consumption was also found by Castañola et al.17 among adolescents in the Buenos Aires Metropolitan Region, noting that 68% of this population did not eat any FVG at all.
The fruits most widely consumption by these adolescents were those best known to the population in general: bananas, oranges/tangerines and apples; similar findings were noted in the study by Costa et. al.18 These fruits are not viewed as regional in Maranhão State, as they are grown in different parts of Brazil and also sold elsewhere. For vegetables and greens, the work of Costa et al.18 found that onions and tomatoes are the most widely consumed, with only parsley and spring onions (cheiro verde) not rating high in this study, as this is a regional food item found more in Northeast Brazil.
The least-consumed FVG are those grown locally. This may be explained through a variety of factors, including the fact that regional food items are viewed as unimportant, as local communities are unaware of the importance of appreciating their own culture and the advantages of eating foods with higher nutritional values that are specific to this region, which offers optimum conditions for growing them. Other reasons may be cultural universalization, with marketing efforts and products shipped from major agricultural hubs in South and Southeast Brazil, resulting in eating habits becoming increasingly more similar in different parts of Brazil, leading to a loss of cultural identity when a specific community ceases to eat regional foods. Another factor is the harvest and inter-harvest periods characteristic of this food group, although this FCFQ encompassed the entire previous year, in order to make provision for seasonal factors.
We know that healthy eating habits must primarily focus on redeeming regional diets based on the consumption of food grown locally, culturally respected and with high nutritional value, such as FVG7. The Brazilian climate ensures that a wide variety of these foods is easily available, offering benefits to the population such as a whole, in addition to low growing costs with no heavy financial investments required. Knowledge, appreciation, production and consumption of regional foods boost community pride and self-sufficiency, pumping up local economies and enhancing the quality of life19.
It was noted that widely-consumed vegetables and greens reached higher percentages than fruit intakes, which may be associated with the presence of these foods in daily meals, often used as condiments. Fruit was expected to outstrip greens, particularly as an easy snack eaten raw, while greens require preparation14.
Flavor and taste rank among the most important reasons for inadequate FVG consumption, mainly because of low energy density and limited protein and fat contents, which make food tastier. This may also reflect cultural influences, as well as comments from relatives and friends5.
It is stressed that younger generations are more likely to experience a globalization process that encompasses food, where the use of marketing techniques highlighting processed products and fast foods can be identified, encouraging adolescents to prefer foods rated as unhealthy and replacing healthier options such as FVG8.
As sources of micronutrients, fibers and other benefits such as bio-active compounds, FVG consumption is important; low consumption heightens the risk of developing NCDs, meaning that these items should be eaten in adequate portions every day in the meals of the entire population.
There is a clear need to heighten awareness among the population in Maranhão State of the importance of eating more of these foods, encouraging their production and sale through educational strategies and other incentives implemented through government and community actions that offer easier access and greater availability for these foods.
The data obtained in this study indicate unfavorable local eating habits. This situation could be reversed if the population studied were to consume FVG grown regionally or even locally, often in back yards where they are easily accessed, tasting better and providing more nutrients and flavor, without using pesticides that may be harmful to human beings and the soil, thus offering stronger guarantees of adequate nutrition and food security.
A strategy for influencing the consumption of regional FVG would be to provide guidelines on the correct storage of these foods by the population, through drying, freezing and lyophilization, in addition to compotes and conserves, allowing them to be eaten throughout the year, not only when harvested.
It is thus necessary to draw up nutrition and dietary education strategies, with the government playing an important role in encouraging this consumption through implementing policies and programs, in addition to deploying and disseminating the materials provided by the Ministry of Health that highlight the importance of regional foods and encourage their consumption, in order to enhance health with a better quality of life.
It is suggested that further research projects be conducted in order to discover the reason behind the low FVG intakes among adolescents in Maranhão State.
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