Revista Oficial do Núcleo de Estudos da Saúde do Adolescente / UERJ
NESA Publicação oficial
ISSN: 2177-5281 (Online)
|Original Article|| Imprimir
Páginas 73 a 80
Autores: Analú Biazus da Silva1; Márcia Keller Alves2; Fernanda Bissigo Pereira3
1. Bachelor's Degree in Nutrition, Nossa Senhora de Fátima College. Caxias do Sul, Rio Grande do Sul State, Brazil
Márcia Keller Alves
How to cite this article
Keywords: Students, nutritional status, adolescent nutrition.
According to the World Health Organization (WHO), adolescence is the period between 10 and 19 years of age1, with rapid growth and development during which nutritional status indicates healthy living conditions². In early adolescence, biological changes and personality alterations take place in parallel, taking on new shapes. Self-image also changes, as adolescents start to feel that their body image fails to match up to their ideals³. A healthy diet should form a part of basic education, in order to reduce problems during adulthood caused by poor diet. Thus, in addition to family and the media, schools play an important role in the development of eating habits among children, with massive influence on individual health, growth and development.
Dietary intake standards during childhood and adolescence may pave the way for obesity and cardiovascular diseases during adulthood4. Changes in family eating habits, including greater consumption of fast foods, pre-prepared meals and carbonated soft drinks have been introduced during the past thirty years5.
It is known that overweight is multifactorial in origin among adolescents, with genetic and environmental factors involves, including lifestyles. Genetics contribute some 25% to 30% of factors associated with obesity, while social and economic factors are normally associated negatively with health and nutrition events6. Data from the latest Family Budgets Survey (POF)7 show that the overweight and obesity rates in Brazil reached 21.5% and 5.8 % respectively among adolescents. In the South, overweight rose from 20.3% to 24.6% among adolescent boys, and from 17.7% to 21% for teenage girls7,8.
The nutritional status of adolescents is a matter of much interest, as obesity in this age bracket has been associated with the early appearance of high blood pressure, dyslipidemias, more Type 2 diabetes and emotional disorders, in addition to adverse effects on posture and gait9.
Schools are an appropriate place to introduce public policies promoting health, while monitoring the appearance of eating disorders must always be part of classroom activities, as nutrient shortfalls may result in a series of cognitive and motor difficulties10. Consequently, the objective of this study was to identify nutritional status, food consumption and classroom performance among pupils at a state school in Flores da Cunha, Rio Grande do Sul State.
This descriptive cross-sectional study was conducted at a state school in Flores da Cunha, Rio Grande do Sul State, with 650 secondary school pupils between 14 and 17 years of age invited to participate. However, after a detailed explanation of its objectives, risks and benefits, only 100 pupils returned Deeds of Informed Consent signed by their parents or guardians, and were included in this study. This was the size of the final sample used in this research project. The data were collected during August 2013. This study was approved by the Research Ethics Committee of the Virvi Ramos Cultural and Scientific Association, compliant with Opinion Nº 10172513.0.000.5523.
Anthropometric data were collected at the school, in a room set aside for this purpose. The respondents were weighed on a portable electronic WISO® brand scale, with a capacity of up to 180 kg, wearing the least possible amount of clothing and without shoes. Their height was measured on a SANNY® brand stadiometer with a height of 2.06 meters, with markings every 0.1 cm. Their height was measured standing erect and barefoot, with their feet together and parallel, with hips, shoulders and the back of the head touching the stadiometer, with their arms loose along their bodies. They were asked to remain erect while being measured, without hunching or stretching, looking straight ahead.
Based on the weight and height measurements, the Body Mass Index (BMI) was calculated, with nutritional status classified through the indices established by the WHO (2007)11 for adolescents.
Waist circumference was measured with the pupils standing erect, using a SIGVARIS® non-stretch tape measure that was placed around each pupil at the mid-point between the iliac crest and the rib cage. Readings were taken when breathing out. Waist circumference measurements were used to classify the risk of cardiovascular disease through the waist/height ratio (WHR)12, adopting a figure of >0.50 cm for both genders.
Food intake quality was investigated through the Fonseca food frequency questionnaire13, as this is a practical tool that is easy to apply, listing foods that are regularly eaten in this State (such as jerky) and enjoyed by adolescents (such as soda pop). Questions also addressed items related to diet and health assessments.
Classroom performance was evaluated through pupil records, supplied by the school administration. They were analyzed for the three years prior to the study, checking whether the participants passed or failed each year.
The data were analyzed through the Statistical Package for the Social Sciences (SPSS software) version 19.0, with a statistical significance level of 5% (p<0.05). The categorical variables were described through absolute and relative frequencies. Associations among the categorical variables were assessed through Pearson´s chi-squared test.
The characteristics of the study participants are presented in Table 1, with most being female (74%), in the first year of secondary school (68%), not working at the time of the survey (68%) and with a pass rate of 96% during the past three years.
When asked about the presence of pathologies, including hypercholesterolemia, blood pressure alterations, diabetes mellitus and anemia, 84% of the adolescents responded negatively. Moreover, 53% stated that they had no relatives with these pathologies. In terms of nutritional status, 75% of these adolescents were eutrophic, and 82% were not at risk for cardiovascular diseases.
Table 2 shows the weekly frequency of food group consumption by gender. It may be noted that 42.3% of the boys eat salted meat less than once a week, 46.2% eat eggs and 42.3% eat fried foods between one and three times a week. Among the girls, it was noted that 78.4% do not eat butter and 46.2% do not usually eat pork. In terms of industrialized products, processed meats, beef and soda pop, the referred consumption was 1 to 3 times a week by girls in the following proportion, respectively: 48.6%, 45.9%, 59.4% and 41.9%. It was also noted that the girls consumed sugar as a sweetener, hard candies and greens four times a week or more, in larger proportions than boys.
There was a significant gender-related difference for processed products consumption, with girls eating more processed products than boys (p <0.019) (Table 2). Also noteworthy is the choice of foods eaten more by these adolescents: fast foods (73% cheeseburgers, 57% pizzas and 47% hotdogs); fruits and vegetables (69% apples, 66% bananas, 62% oranges, 80% lettuce, 54% tomatoes and 33% carrots); dairy products and processed meats (83% milk, 80% cheese, 71% yoghurt, 74% ham, 46% wieners and 45% salami).
The findings for the anthropometric variables (nutritional status and WHR) presented no significant differences (p=0.425 and p=0.554, respectively) compared to the fail rates among these adolescents.
The descriptive findings of this study indicate a prevalence of teenage girls in the first year of secondary school with excellent classroom performance during the past three years. In this study, it was noted that most of these adolescents did not work, meaning that they were not engaged in any remunerated activities. The fact that most of them did not work might be related to their ages between 13 and 14 years old, when registered remunerated work is not permitted.
At the moment, youngsters under 18 years old are able to learn a skill and also earn extra income in a healthy and legal manner through the Young Apprentice Program run by the government. This Program complies with all the rules ensuring that work does not adversely affect the development or classroom performance of these youngsters. This Program offers technical courses that can train and build up the capacities of these youngsters from an early age, ensuring that they respond to market demands and ensuring easier entry into the job market14. Some companies have Worker Meal Programs (PAT), that assign high priority to low income workers. It is thus believed that they could offer healthier and better-balanced meals to these youngsters, as professional nutritionists plan all meals under this Program15.
The absence of pathologies among most of these adolescents is predictable, as they are more prevalent at older ages. This does not exclude the need for eating projects that encourage a healthy diet among schoolchildren, helping ensure that they avoid over consumption of foods high in carbohydrates, fats and salt, as poor diet may lead to the appearance of pathologies at young ages. They also reported the absence of these pathologies in their families, which is a good health indicator, as some of these diseases are hereditary.
In terms of nutritional status measured through the BMI (Kg/m), the findings of this study corroborate those of Garcia et al.16, where 78.4% of these researched adolescents were also in the eutrophic range. The prevalence of eutrophic measurements at this age is favorable, helping avoid diseases such as diabetes mellitus, high blood pressure, cardiovascular diseases, cancer and also bullying, which are duly associated with thin or obese stereotypes. As they live in the mountainous Serra Gaúcha range of Southern Brazil, the prevalence of eutrophia is also positive, as the cold climate and dishes typical of this region, often Italian (pizza, pasta, trucker´s rice with jerky, assorted cheeses and sweets such as ambrosia and sago with cream, among others) might well foster obesity.
In terms of the Waist / Height Ratio (WHR), 82% of the assessed adolescents presented no risk of developing cardiovascular diseases. These findings may well be related to the consumption of products with excessive amounts of fat, sugar and salt, in addition to empty calories that offer no benefits to adolescent bodies, and may even result in fat building up in the abdominal region. Weekly food consumption showed that girls eat more processed products (48.6%), together with sweet treats in general such as hard candies and sweets (48.6%). Similar findings were found in the studies by Costa et al.17 (59.5%) and Malta et al.18 (50.9%), where girls ate sugar, bonbons, hard candies and sweets more frequently.
Although most of the adolescents in this research project are eutrophic (75%), the figures for overweight (21%) and obesity (4%) underscore the need for dietary guidance. Mendonça et al.19 list the main dietetic factors driving the upsurge in overweight / obesity among Brazilians as: eating away from home, easier access to fast food and the expansion of industrialized / processed foods. It may be noted that these factors are harmful and may also appear at early ages, such as during adolescence, as seen in the study, particularly for adolescents and processed food consumption.
In a study of adolescent boys and girls, Neutzling et al.5 mention that processed food consumption frequency (such as fries and chips) no more than once a week was more frequent among boys, contrasting with the findings of this study.
A high intake frequency was noted for fruit and vegetables, eaten four times a week or more. These data are positive due to the fact that the consumption of these foods help prevent diseases while avoiding overweight and obesity. Corroborating these findings, in the study by Costa et al.17, the foods consumed most frequently by adolescents each week were lettuce, tomatoes, carrots, oranges, bananas and apples. Fruit and vegetable consumption is underscored by the WHO as a factor for preventing chronic diseases during adult life20.
The findings of this study may serve as a basis to support healthier eating habits during the teen years, while lessening the appearance of pathologies at younger ages. Schools may contribute through promoting activities that encourage nutrition education and healthy eating by implementing projects encouraging the consumption of regional foods, instead of their processed counterparts, ensuring autonomy for these youngsters in their dietary choices.
This study leads to the conclusion that most of these schoolchildren were eutrophic, at no risk for cardiovascular diseases due to their Waist / Height Ratios; teenage girls consumed more processed products, and repeating a year is not associated with overweight and obesity among adolescents.
1. World Health Organization. Physical status: use and interpretation of anthropometry. Report of the WHO Expert Committee WHO Technical Report Series, 854. Geneva: WHO; 1995.
2. Rodrigues AM, Fisberg M, Cintra IP. Avaliação do estado nutricional, prevalência de sintomas de anorexia nervosa e bulimia nervosa e percepção corporal de modelos adolescentes brasileiras. Nutrição Brasil 2005; 4(4): 182 -187.
3. Branco LM, Cintra IP, Fiberg M. Adolescente gordo ou magro: realidade ou fantasia? Nutrição Brasil 2006; 5 (4): 189-194.
4. Andrade RG, Pereira RA, Sichieri R. Consumo alimentar de adolescentes com e sem sobrepeso do município do Rio de Janeiro. Cad Saúde Pública 2003; 32(3): 111-119.
5. Neutzling MB, Assunção MCF, Malcon MC, Hallal PC, Menezes AMB. Hábitos alimentares de escolares adolescentes de Pelotas, Brasil. Rev Nutr 2010; 23(3): 379-388.
6. Fagundes ALN, Ribeiro DC, Naspitz L, Garbelini LEB, Vieira JKP, Da Silva AP, et al. Prevalência de sobrepeso e obesidade em escolares da região de Palheiros do município de São Paulo. Rev Paul Pediatr 2008; 26(3): 212-7.
7. Brasil. POF - Pesquisa De Orçamentos Familiares 2002 - 2003. IBGE. Available at: http://www.ibge.gov.br/home/estatistica/populacao/condicaodevida/pof/2002/pof2002.pdf
8. Brasil. POF - Pesquisa De Orçamentos Familiares 2008 - 2009. IBGE. Available at: http://www.ibge.gov.br/home/presidencia/noticias/imprensa/ppts/0000000108.pdf.
9. Enes CC, Slater B. Obesidade na adolescência e seus principais fatores determinantes. Rev Bras Epidemiol 2010; 13(1): 163-71.
10. Machado EHS, Leone C, Szarfarc SC. Deficiência de ferro e desenvolvimento cognitivo. Rev Bras Cresc e Desenv Hum 2011; 21(2): 368-373.
11. World Health Organization. Curvas de Crescimento: 5 a 19 anos. 2007. Available at: http://www.who.int/growthref/en/.
12. Pereira PF, Serrano HMS, Carvalho GQ, Lamounier JÁ, Peluzio MCG, Franceschini SCC, et al. Circunferência da cintura e relação cintura/estatura: úteis para identificar risco metabólico em adolescentes do sexo feminino? Rev Paul Pediatr 2011; 29(3): 372-7.
13. Fonseca MJM, Chor D, Valente JG. Hábitos alimentares entre funcionários de banco estatal: padrão de consumo alimentar. Cad Saúde Pública 1999; 15 (1): 29-40.
14. Brasil. Centro de Integração Empresa Escola. CIEE/RS. Available at: https://www.cieers.org.br/internet2/site.do?m=doPaginaPrincipal
15. Conselho Federal de Nutricionistas (CFN). [accessed on: April 6, 2014]. Available at: http://www.cfn.org.br/eficiente/sites/cfn/pt-br/site.php?secao=perguntasfrequentes&pub=1437.
16. Garcia GCB, Gambardella AMD, Frutoso MFP. Estado nutricional e consumo alimentar de adolescentes de um Centro de Juventude da cidade de São Paulo. Rev Nutr 2003; 16(1): 41-50.
17. Costa MCD, Júnior LC, Matsuo T. Hábito alimentar de escolares adolescentes de um município do oeste do Paraná. Rev Nutr 2007; 20(5):461-471.
18. Malta DC, Sardinha LMV, Mendes I, Barreto SM, Giatti L, Castro IRR, et al. Prevalência de fatores de risco e proteção de doenças crônicas não transmissíveis em adolescentes: resultados da Pesquisa Nacional de Saúde do Escolar (PeNSE), Brasil, 2009. Ciência & Saúde Coletiva 2010; 15(2): 3009-3019.
19. Mendonça CP, Dos Anjos LA. Dietary and physical activity factors as determinants of the increase in overweigh/obesity in Brazil. Cad Saude Publica 2004; 20(3): 698-709.
20. World Health Organization (WHO). Obesity: Preventing And Managing The Global Epidemic. Report of a WHO Consultation. WHO Technical Report Series. 2004; 894 (5).