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

Original Article Imprimir 

Páginas 33 a 41


Consumption of fruit and vegetables by adolescents from Maranhão State

Consumo de frutas, legumbres y verduras por adolescentes del Estado do Maranhão

Consumo de frutas, legumes e verduras por adolescentes do Estado do Maranhão

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
2. Graduate, Nutrition Course, Tocantins Federal University (UFT). Palmas, Tocantins State, Brazil
3. Master's Degree in Collective Health, Maranhão Federal University (UFMA). São Luís, Maranhão State, Brazil.Bachelor's Degree in Nutrition, pela Faculdade Santa Terezinha (CEST). Professor, Nutrition Course, Faculdade Santa Terezinha (CEST). São Luís, Maranhão State, Brazil
4. Bachelor's Degree in Medicine, Tocantins Federal University (UFT). Palmas, Tocantins State, Brazil
5. Doctoral student in Collective Health. Master`s Degree in Collective Health, Maranhão Federal University (UFMA). São Luís, Maranhão State, Brazil. Professor, Tocantins Federal University (UFT). Palmas, Tocantins State, Brazil

Maylla Luanna Barbosa Martins
Avenida NS 15, 109 Norte, Plano Diretor Norte
Palmas, TO, Brasil. CEP: 77001-090
maylla@uft.edu.br

PDF Portuguese      


Scielo

Medline


How to cite this article

Keywords: Food consumption, food habits, adolescent.
Palabra Clave: Consumo de alimentos, hábitos alimenticios, adolescente.
Descritores: Consumo de alimentos, hábitos alimentares, adolescente.

Abstract:
OBJECTIVE: Analyze the consumption of fruits and vegetables by adolescents from the state of Maranhão.
METHODS: A population-based study was conducted in 28 municipalities of Maranhão, defined by a cluster sampling process performed in three steps. A total of 1399 adolescents were interviewed with aged between 10 to 19 years old. Data collection was conducted from July 2007 to January 2008, and the Food Consumption Frequency Questionnaire was used for validated regional specificities.
RESULTS: Was found an insufficient consumption of fruits (84.27%) and vegetables (71.98%) by the adolescents surveyed. It was observed that the most consumed fruit daily were banana and orange/tanja, that together with apple and pineapple had higher weekly frequency consumption. In terms of the daily consumption of vegetables, onion, tomato and parsley stood out, but also the weekly consumption of pumpkin and carrot. Pequi, bacuri, cupuaçu, carambola, buriti, cabbage, joão-gome/vinagreira and okra/maxixe, which are regional fruits and vegetables had lower frequencies of consumption, which ranged from 67.19% to 92.99% for those who never consume.
CONCLUSION: The data obtained in this study indicate unfavorable situation for the local food habits. It is necessary the elaboration of education strategies in order to encourage individuals to consume higher portions of fruits and vegetables, prioritizing regional food and culture, for a better health and quality of life.

Resumen:
OBJETIVO: Analizar el consumo de frutas, legumbres y verduras de adolescentes del Estado de Maranhão.
MÉTODOS: Estudio de base poblacional realizado en 28 municipios de Maranhão definidos por medio del proceso de muestra por conglomerados, realizado en tres etapas. Fueron entrevistados 1399 adolescentes de 10 a 19 años. La recolección de datos fue realizada en los meses de julio de 2007 a enero de 2008, siendo utilizado el Cuestionario de Frecuencia de Consumo Alimenticio para obtención de los datos, validado para especificaciones regionales.
RESULTADOS: Fue constatado consumo insuficiente de frutas (84,27%) y de legumbres/verduras (71,98%) por los adolescentes investigados. Se observó que las frutas más consumidas diariamente fueron banana y naranja/tangerina, que juntas con manzana y piña lograron frecuencias mayores de consumo semanal. Con relación al consumo de legumbres/verduras se destacaron diariamente cebolla, tomate y perejil, pero también el consumo semanalmente la zapallo y zanahoria. El pequi, bacuri, cupuaçu, chirimoya, buriti, couve, João-gome/vinagreira y quiabo/maxixe que son frutas y legumbres/verduras regionales, lograron bajas frecuencias de consumo que variaron entre 67,19% a 92,99%, para los que nunca consumen.
CONCLUSIÓN: Los datos obtenidos en el presente estudio indican una situación desfavorable para el hábito alimenticio local. Se hace necesario entonces la elaboración de estrategias de educación alimenticia y nutricional que incentiven a los individuos al mayor consumo de frutas, legumbres y verduras, dando prioridad a los alimentos regionales y su cultura, a fin de proporcionar salud y calidad de vida.

Resumo:
OBJETIVO: Analisar o consumo de frutas, legumes e verduras de adolescentes do Estado do Maranhão.
MÉTODOS: Estudo de base populacional realizado em 28 municípios do Maranhão definidos por meio do processo de amostragem por conglomerados, realizado em três etapas. Foram entrevistados 1399 adolescentes de 10 a 19 anos. A coleta de dados foi realizada nos meses de julho de 2007 a janeiro de 2008, sendo utilizado o Questionário de Frequência de Consumo Alimentar para obtenção dos dados, validado para especificidades regionais.
RESULTADOS: Foi constatado consumo insuficiente de frutas (84,27%) e de legumes/verduras (71,98%) pelos adolescentes pesquisados. Observou-se que as frutas mais consumidas diariamente foram banana e laranja/tanja, que juntas com maçã e abacaxi obtiveram frequências maiores de consumo semanal. Em relação ao consumo de legumes/verduras destacaram-se diariamente cebola, tomate e cheiro verde, mas também o consumo semanalmente a abóbora e cenoura. O pequi, bacuri, cupuaçu, carambola, buriti, couve, joão-gome/vinagreira e quiabo/maxixe que são frutas e legumes/verduras regionais, obtiveram baixas frequências de consumo que variaram entre 67,19% a 92,99% para os que nunca consomem.
CONCLUSÃO: Os dados obtidos no presente estudo indicam uma situação desfavorável para o hábito alimentar local. Se faz necessário é a elaboração de estratégias de educação alimentar e nutricional que incentivem os indivíduos ao maior consumo de frutas, legumes e verduras, priorizando os alimentos regionais e sua cultura, a fim de proporcionar saúde e qualidade de vida.

INTRODUCTION

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.


METHODS

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.


RESULTS

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).




DISCUSSION

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.


CONCLUSION

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.


REFERENCES

1. Eisenstein E, Coelho KSC, Coelho SC, Coelho MASC. Nutrição na adolescência. J. pediatr. (Rio J.). 2000; 76 (Supl.3): S263-74.

2. World Health Organization (WHO). Physical status: the use and interpretation of anthropometry. WHO technical report series. Geneva: World Health Organization. 1995. 463 p.

3. Mendes KL, Catão LP. Avaliação do consumo de frutas, verduras e legumes por adolescentes de Formiga - MG e sua relação com fatores socioeconômicos. Alim Nutr, Araraquara 2010; 21(2): 291-296.

4. Toral N, Slater B, Cintra I de P.; Fisberg M. Comportamento alimentar de adolescentes em relação ao consumo de frutas e verduras. Rev Nutr, Campinas, 2006; 19(3): 331-340.

5. Ferreira A, Chiara VL, Kuschnir MCC. Alimentação saudável na adolescência: consumo de frutas e hortaliças entre adolescentes brasileiros. Rev Adolescência & Saúde, Rio de Janeiro, 2007; 4(2): 48-52.

6. Toral N, Conti MA, Slater B. A alimentação saudável na ótica dos adolescentes: percepções e barreiras à sua implementação e características esperadas em materiais educativos. Cad Saúde Pública, Rio de Janeiro, 2009, 25(11): 2386-2394.

7. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Guia alimentar para a população brasileira: promovendo a alimentação saudável. Secretaria de Atenção à Saúde. Brasília, DF, 2008. 210 p.

8. World Health Organization.Diet, nutrition and the prevention of chronic diseases. Report of a joint.WHO/FAO expert consultation.Geneva; 2003.160 p.

9. Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa de Orçamentos Familiares 2002-2003. Antropometria e análise do estado nutricional de crianças e adolescentes no Brasil. 2006. 140 p.

10. Instituto Brasileiro de Geografia e Estatística (IBGE). Síntese de indicadores sociais. Orçamento e Gestão. 2006. 317 p.

11. Sichieri R. Avaliação do consumo alimentar e do consumo de energia. In: Sichieri R. (Org.). Epidemiologia da Obesidade, Rio de Janeiro: Eduerj, 1998; p. 65-88.

12. Block G, et al. A data-based approach to diet questionnaire design and testing. Am. J. Epidemiol. 1986; 12(3): 453-69.

13. Philippi ST, Latterza AR, Cruz ATR, Ribeiro LC. Pirâmide alimentar adaptada: guia para escolha dos alimentos. Rev Nutr, Campinas, 1999; 12(1): 65-80.

14. Gambardella AMT, Frutuoso MFP, Franch C. Prática alimentar de adolescentes. Rev Nutr, Campinas, 1999; 12(1): 5-19.

15. Silva ARV, Damasceno MMC, Marinho NBP, Almeida LS, Araújo MFM, Almeida PC, Almeida IS. Hábitos alimentares de adolescentes de escolas públicas de Fortaleza, CE, Brasil. Rev Bras Enferm, Brasília, 2009; 62(1): 18-24.

16. Santos JS, Costa COM, Sobrinho CLN, Silva MCM, Souza KEP, Melo BO. Perfil antropométrico e consumo alimentar de adolescentes de Teixeira de Freitas, Bahia. Rev Nutr, Campinas, 2005; 18(5): 623-632.

17. Castañola DJ, Magariños M, Ortiz S. Patrón de ingesta de vegetales y frutas en adolescentes enel área metropolitana de Buenos Aires. Arch Argent Pediatr 2004; 102(4): 265-270.

18. Costa MCD, Júnior LC, Matsuo T. Hábito alimentar de escolares adolescentes de um município do oeste do Paraná. Rev Nutr, Campinas, 2007; 20(5): 461-471.

19. Brasil. Ministério da Saúde. Secretaria de Políticas de Saúde. Coordenação-Geral da Política de Alimentação e Nutrição. Alimentos regionais brasileiros. 1. ed. - Brasília: 2002. 140 p.
adolescencia adolescencia adolescencia
GN1 © 2004-2017 Revista Adolescência e Saúde. Fone: (21) 2868-8456 / 2868-8457
Núcleo de Estudos da Saúde do Adolescente - NESA - UERJ
E-mail: secretaria@adolescenciaesaude.com