Revista Oficial do Núcleo de Estudos da Saúde do Adolescente / UERJ
NESA Publicação oficial
ISSN: 2177-5281 (Online)
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Páginas 81 a 88
Autores: Cristhiane Maria Bazílio de Omena Messias1; Marianne Louise Marinho Mendes2; Carla Nunes Santos3; Emerson Iago Garcia e Silva4; Wekeanne Cardoso Martim5
1. Bachelor's Degree in Nutrition and PhD in Science, Alagoas Federal University (UFAL). Maceió, Alagoas State, Brazil. Adjunct Professor, Undergraduate Course in Nutrition and Tenured Lecturer, Graduate Studies Program Stricto Sensu For Teacher Training and Interdisciplinary Practices (PPGFPPI), Pernambuco University (UPE) - Campus Petrolina. Petrolina, Pernambuco State, Brazil
Cristhiane Maria Bazílio de Omena Messias
How to cite this article
Keywords: Adolescent, food consumption, fruit, vegetables.
Adolescence is a developmental stage leading to the culmination of the bio-psycho-social maturation process of human beings. According to the World Health Organization (WHO), adolescence lasts from 10 to 19 years of age. Under the Children's and Adolescents' Statute (ECA), it begins at 12 and ends at 18 years of age. During this period, sweeping physical changes occur, with the nutritional status of these adolescents being of fundamental importance for their development1, characterized by massive somatic, psychological and social transformations2.
Adolescents are a vulnerable group in terms of diet, due to their rising nutritional needs, eating patterns, lifestyles and susceptibility to surrounding influences3. It is worthwhile stressing that nutritional status influences morbidity and mortality risks, through the development and growth of these adolescents4.
Encouraging fruit and vegetable consumption is a worldwide priority, in order to enhance population health5. Eating a variety of fruit, vegetables and greens ensures adequate intakes of most micro-nutrients, fibers and a range of nutritionally essential elements. Moreover, eating more fruit, vegetables and greens may help ease out foods with greater concentrations of saturated fats, sugar and salt6.
The Eating Guide for the Brazilian Population defines greens as the edible portion of a plant, including leaves, flowers, buds or stems, while vegetables are the edible parts consisting of fruit, seeds or underground growth. Fruit is the flesh around the seeds, sweetish, juicy and with a characteristic aroma7.
Almost all fruit and vegetables are excellent sources of vitamins, mineral salts and antioxidants, such as vitamin C, phenolic compounds and carotenoid pigments8. In addition to providing important components for basic physical functions, they are also sources of bio-active compounds directly associated with disease prevention9.
Fruit and vegetables are important elements in a healthy diet, and their consumption in adequate quantities may lower the risks of cardiovascular diseases and some types of cancer. Estimates indicate that inadequate fruit and vegetable consumption ranks among the top ten risk factors for the total global burden of disease. Adequate intake consists of consuming at least five portions (400 g) of fruit and vegetables a day 10.
The eating patterns characteristic of adolescents include excessive consumption of carbonated soft drinks, sugars and junk foods, with low fruit and vegetable intake, tightly restricted diets or food fads, as well as skipping breakfast. These dietary imbalances pave the way for nutritional distortions, in addition to insufficient absorption of micronutrients11.
According to the Eating Guide for the Brazilian Population (2008), stepping up fruit, vegetables and greens consumption may be rated as the most important challenge for a sound diet, as scientific evidence highlighting the health-related benefits of these foods is undeniable, and also because the average consumption of vegetables, greens and fruit is low, despite their abundance in Brazil7.
Based on previous reports, this study assesses fruit, vegetables and greens consumption by lower and middle class adolescents at a government school in Petrolina, Pernambuco State.
This cross-sectional study was conducted between August 2013 and July 2014, at the Professor Vande de Souza Ferreira Laboratory School in Petrolina, Pernambuco State. The sample consisted of 77 boys and 133 girls between 15 and 17 years old (n = 210), enrolled at this school in 2013. Initially, the research project was explained, after which parents or guardians received Deeds of Informed Consent. This study is a sub-project of the Energy, Macronutrient and Micronutrient Consumption by Adolescents at the Professor Vande de Souza Ferreira Laboratory School, Petrolina, Pernambuco State Project approved by the Ethics Committee, Pernambuco University, Opinion Nº: 200.105, in February 2013.
Initially, the adolescents were provided with explanations of the research project, after which they or their parents / guardians handed back the signed Deeds of Informed Consent, and the pupils moved on to the food intake assessment stage.
The research tool used for this assessment was the 24-Hour Journal (J24) that defines and quantifies all foods and beverages ingested during the period prior to the interview, which may be the preceding 24 hours or more commonly, the previous day12.
The J24 technique was used on two separate occasions (a typical day - Monday to Friday, and an atypical day - Saturday, Sunday and holidays), with an interval of around two weeks, in order to establish the mean consumption of each youngster, assessing total nutrient and food intake, thus allowing estimates of their normal diets13. The information was supplied by the pupils, being advised and assisted while completing the 24-hour journal, which included all meals taken each day, including breakfast, morning snack, lunch, afternoon snack, dinner and bedtime snack; meal times, types of preparation and quantities, using kitchen measurements and volumes.
In order to help respondents estimate the amounts of food eaten, audiovisual resources were used, such as: photographs, replicas and figures (photo album; UNICAMP/UFG).
Based on the completed questionnaires, the mean individual consumption of fruit, vegetables and greens was calculated for these youngsters. The information obtained was transformed into average portions, analyzed in terms of their adequacy for the fruit, greens and vegetables food groups, using the recommendation issued by the World Health Organization (WHO 2003), under the 5 A Day program, which suggests consuming at least five portions of fruit, greens and vegetables every day (preferably divided into three portions of vegetables and greens and two portions of fruit).
The Excel (Version 2013) and Graph Pad Prism (Graph Pad Inc., San Diego, CA, USA, Version 6.01) programs were used for the statistical treatment of the data. Initially, a descriptive statistical analysis was conducted (mean, standard deviation and percentages). In order to assess links between gender and fruit, greens and vegetables intake, an inferential analysis was conducted through the Student t test with 0.05 significance.
The qualitative consumption assessment of fruit showed that 79.6% of the respondents ate fruit, with 46.2% and 24.8% vegetables and greens respectively. These findings took into consideration only daily consumption frequency, regardless of gender, age or amounts ingested.
When stratifying the population by gender, it was noted that 60 boys (77.9%) ate fruit, while 106 girls (80.4%) reported some intake. When analyzing vegetables and greens consumption, it was noted that 33 (44.1%) of the boys and 64 (48.1%) of the girls ate vegetables; 18 (23.4%) of the boys and 34 (25.6%) of the girls reported that they ate greens.
Table 1 shows the mean fruit, greens and vegetables intake by gender and age bracket, with boys and girls both reporting inadequate vegetable consumption, regardless of age. No significant gender-related differences were noted in terms of the consumption of fruit (p = 0.38), greens (p = 0.06) and vegetables (p = 0.08). It was noted that the respondents fail to comply with the recommendations in the Eating Guide for the Brazilian Population, which suggests daily consumption of three portions of vegetables and greens and three portions of fruit. Neither did they comply with the recommendation issued by the WHO, eating less than a full portion of fruit, vegetables and greens a day.
When stratified by gender (Table 2), the ratio between food consumption measured by portions of fruit, vegetables and greens showed that boys and girls reported very inadequate fruit intake, failing to reach the recommended level of three portions a day. It is also noted that adequate fruit consumption (≥ 3 Portions) was uncommon for both genders. However, boys presented a higher percentage of not eating fruit, compared to girls. In terms of vegetables and greens, low consumption was found for both genders, failing to reach a single portion under the current recommendations, although 3% of the girls did consume the recommended three portions a day.
The types of fruit, greens and vegetables intake reported by boys and girls are shown in Table 3. This indicates that the most common types of ingestion were raw, juices, soups and salads, and consequently were the most easily accepted by this segment of the population.
In terms of fruit consumption types, raw juice consumption was highest, with lower figures for sweets, smoothies and roasted / baked goods. Studies indicate that juice consumption by adolescents is on the rise, replacing raw fruit. In terms of vegetables and greens consumption, it was noted that raw salads and soups were the most common.
According to the Eating Guide for the Brazilian Population, daily consumption of three portions of fruit and two portions of vegetables and greens is recommended. This Guide also stresses the importance of eating these foods every day, as they are high in vitamins and minerals, enhancing health and lowering the risk of diseases, including non-communicable chronic diseases (diabetes, heart diseases and some types of cancer), while also helping prevent and control obesity7.
According to the Ministry of Agriculture, Brazil is the world´s third-largest fruit producer, with 12.35% of total output in 2005, channeled mainly to domestic markets, with only small amounts sold internationally. At the moment, Brazil accounts for around 2% of global fruit exports7.
Through its irrigation hubs, the Northeast is the main region producing and exporting fresh tropical fruit in Brazil. The São Francisco Valley has become notable at the domestic and international levels for producing top grade fruit and vegetables. Mangos, grapes, melons, bananas and onions, among others, are currently the main crops, expanding widely14. The main fruit production hub in this region is the Petrolina/Juazeiro irrigated perimeter, which is a powerhouse for the local economy, generating jobs and incomes, as well as supplying fresh fruit vegetables for regular consumption.
Although the Petrolina/Juazeiro hub is one of the main fresh fruit production centers in Northeast Brazil, the findings indicate that fruit, vegetables and greens, are not sought frequently or significantly, underscoring the fact that low intakes of these foods is not a supply-side problem, but is rather a matter of demand, which is insufficient or almost non-existent.
Several local and international studies indicate inadequate or insufficient consumption of fruit, vegetables and greens. Particularly outstanding among them is the study conducted with private and government school pupils in Santa Catarina State, noting that 26.6% of the respondents did not eat fruit and vegetables even once a day15.
A study conducted by Leal et al. (2010), in order to assess food intake and meal patterns among adolescents at a government school on Ilha Bela, São Paulo State, using the food pyramid as a comparative tool, also detected low fruit, greens and vegetables intake, finding that this food group was at the top of the pyramid, while the sweets and fats group formed its base3.
A study assessing prevalence and factors associated with fruit, greens and vegetables intake among adolescents at government schools in Caruaru, Pernambuco State, noted that 10% of these adolescents stated that they did not eat fruit and 30.7% did not eat vegetables and greens. The prevalence of daily fruit consumption reached 32.9%, with 29% for vegetables and greens. Only 6.5% of these adolescents ate all these foods every day 16.
According to Monticelli et al. (2013)17 in a study conducted at two municipal schools in Curitiba, Paraná State, inadequate fruit, greens and vegetables intake was also found, noting that 71% of the sample assessed reported inadequate consumption.
A study conducted by Castañola et al. (2004) in order to explore the food intake of adolescents in the Buenos Aires Metropolitan Region in Argentina found that 68% of these adolescents ate no vegetable portions at all during the day18.
In a study exploring health-hazardous behavior among adolescents on the triple frontier between Brazil, Argentina and Paraguay, Legnani (2006) noted that 67% of these youngsters reported inadequate intake, in terms of their fruit consumption habits. The highest proportion (72.1%) was found among Argentine teens, with the lowest among Paraguayans (60.1%); it was noted that most adolescents in the Triple Frontier region failed to reach the minimum daily consumption levels for fruit (77.3%) and vegetables (79.7%). Among Brazilian adolescents, higher proportions of youngsters were found who failed to meet the minimum recommendations for fruit (80.6%) and vegetables (84.8%)19.
In our study, the values noted for adolescents showed quantitative intakes of fruit at 79.6%, with vegetables and greens at 46.2% and 24.8% respectively, lower than the figures found by Legnani for Argentina and Uruguay, and higher compared to the Brazilian data.
In order to assess the fruit, vegetables and greens intake of university students enrolled in the undergraduate Nutrition course at the Triangulo Mineiro Federal University (UFTM), Cansian et al. (2012) found that 25.2% of them never or rarely ate these food types 20. This study assessed the percentage of university students consuming 1.1 to 2 portions of fruit and 0 to 1 portion of vegetables, finding figures of 22.31% and 38.66% respectively. The number of university students eating these food types either sporadically or rarely was high (25.2%).
Inadequate consumption of fruit and vegetables portions was also noted in a study by Toral et al. (2006)21 that assessed eating behaviors among adolescents in terms of fruit and vegetable consumption, noting that these pupils ingested less than one portion a day 21. Similar data were found in a study conducted in Formiga, Minas Gerais State, in order to assess fruit, greens and vegetables intake by adolescents and links to social and economic factors, which showed that the mean consumption of fruit portions reached 1.74, while vegetables and greens intake varied from 0.06 to eight portions a day 22. These figures are close to the results of this study, once more corroborating inadequate consumption of fruit, greens and vegetables by teenagers.
In terms of types of ingestion, a study conducted at a private school in Piauí State showed excessive intakes (80%) of juices, with raw consumption far less frequent. Leafy greens were eaten less than fruit (52.04%), with data similar to those found in this project2.
This low fruit and vegetable intake may be due to many reasons. According to Ferreira & Veloso (2007), poor palatability of these foods has been indicated as one of the causes, as they lack the high protein, fat and energy density levels that make foods tastier. Another cause could be changes in the daily lives of adolescents and their environments that foster shifts in behavior, altering their acceptance of foods23.
Based on these reports, it is necessary to reassess the school and non-school context in terms of fruit, greens and vegetables intake by adolescents. The current situation is appalling, and may be modified or improved through nutritional education steps and underpinned by political and social support, as failure to eat fruit, greens and vegetables will be reflected in future social, political and nutritional problems.
Regardless of age, teen boys and girls eat very little fruit, greens and vegetables. Their lack of appetite for these foods is a matter of concern, as plant-based foods offer protection, in addition to being excellent sources of nutrients that are essential for their development. Influencing the growth, development and health of these youngsters, eating habits are of vital importance, as they contribute to healthy lifestyles and help prevent future pathologies. Consequently, this situation underscores the urgent need for educational steps encouraging healthy eating habits.
Financial support: Introduction to Science grant from the National Council for Scientific and Technological Development (CNPq).
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