Revista Adolescência e Saúde

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

NESA Publicação oficial
ISSN: 2177-5281 (Online)

Vol. 16 nº 2 - Apr/Jun - 2019

Original Article Imprimir 

Páginas 56 a 63


Consumption of ultra-processed foods by adolescents

Consumo de alimentos ultraprocesados por los adolescentes

Consumo de alimentos ultraprocessados por adolescentes

Autores: Julieny da Cruz Santos1; Deise Mainara Almeida de Carvalho2; Lucinéia de Pinho3

1. Graduation course of Nutrition. Health College of Ibituruna - FASI. Montes Claros, MG, Brazil
2. Graduation course of Nutrition. Health College of Ibituruna - FASI. Montes Claros, MG, Brazil
3. Doctorate in Health Sciences. Professor of the Nutrition course. Health College of Ibituruna - FASI. Montes Claros, MG, Brazil

Correspondência:
Julieny da Cruz Santos
Faculdade de Saúde Ibituruna (FASI) - Curso de Nutriçao
Av. Profa. Aida Mainartina Paraiso, no 99 - Ibituruna
Montes Claros - MG, Brasil. CEP: 39408-007
(dacruzjulieny@gmail.com)

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Keywords: Adolescent; Food consumption; Industrialized Foods.
Palabra Clave: Adolescente; Alimentos Industrializados; Consumo de Alimentos.
Descritores: Adolescente; Alimentos Industrializados; Consumo de Alimentos.

Abstract:
OBJECTIVE: Evaluate the consumption of ultra-processed foods (UPF) by adolescents of the municipal school network of Montes Claros - MG.
MATERIALS AND METHODS: This is a cross-sectional study, carried out in 2017, with adolescents enrolled in grades 6 through 9, with a mean age of 13.00 ± 1.34 years. Two questionnaires were used: i) a structured and self-administered questionnaire containing the demographic variables (gender, age group and school series) and ii) the Food Frequency Questionnaire (QFA), used to evaluate the frequency of daily consumption of Ultra-processed Foods.
RESULTS: It was observed that the soft drinks, sausages and snacks in packages were consumed daily by 11.2%, 12.5% and 33.7%, respectively. Almost half of the students (44.2%) had not consumed snacks in packages in the week prior to the study. There were high proportions of the consumption of ultra-processed foods (61.2%), among them, the most consumed were sweets, followed by soft drinks, sausages and packaged snacks (48.0%, 23.5%, 19.0% and 13.07%, respectively). Regular consumption of packaged snacks and snacks were significantly associated with sex, being more prevalent in females (P <0.001). The prevalence of regular UPF consumption was also higher among females (p = 0.002). Regarding regular consumption according to age group, higher prevalences were observed in adolescents aged 13-14 years (p = 0.041).
CONCLUSION: This study evidenced high prevalence of ultra-processed foods among adolescents. Thus, it is necessary to raise the awareness adolescents about the consequences of excessive consumption these foods, through actions to promote healthy eating in school environment.

Resumen:
OBJETIVO: Evaluar el consumo de Alimentos Ultraprocesados (AUP) por adolescentes de la red municipal de enseñanza de Montes Claros - MG.
MATERIALES Y MÉTODOS: Se trata de un estudio transversal, realizado en 2017, con adolescentes matriculados del 6° al 9° año, con edad media de 13,00 ±1,34 años. Fueron utilizados dos tipos de cuestionarios: i) un cuestionario estructurado y auto-aplicable conteniendo las variables demográficas (sexo, franja etaria y serie escolar), y ii) el Cuestionario de Frecuencia Alimenticia (QFA) utilizado para evaluar la frecuencia del consumo diario de Alimentos Ultraprocesados.
RESULTADOS: Se observó que los alimentos embutidos, bebidas y golosinas fueron consumidos diariamente por 11,2%, 12,5% y 33,7%, respectivamente. Casi la mitad de los alumnos (44,2%) no habían consumido salados de paquete en la semana anterior al estudio. Fueron encontradas altas proporciones del consumo de alimentos ultraprocesados (61,2%), de entre estos, los más consumidos fueron golosinas, seguido por bebidas, embutidos y salados de paquete (48,0%, 23,5%, 19,0% y 13,07%, respectivamente). El consumo regular de golosinas y salados de paquete fueron asociados significativamente al sexo, siendo más prevalente en el femenino (P<0,001). La prevalencia del consumo regular de AUP también fue mayor entre el sexo femenino (p=0,002). En relación al consumo regular según la franja etaria, mayores prevalencias fueron observadas en adolescentes con edad entre 13-14 años (p=0,041).
CONCLUSION: Este estudio deja en evidencia altas prevalencias de consumo de alimentos ultraprocesados entre adolescentes. Siendo así, es necesaria la concientización de los adolescentes sobre las consecuencias del consumo excesivo de esos alimentos a través de acciones de promoción de alimentación saludable en el ambiente escolar.

Resumo:
OBJETIVO: Avaliar o consumo de Alimentos UltraProcessados (AUP) por adolescentes da rede municipal de ensino de Montes Claros - MG.
MATERIAIS E MÉTODOS: Trata-se de um estudo transversal, realizado em 2017, com adolescentes matriculados do 6º ao 9º ano, com idade média de 13,00 ±1,34 anos. Foram utilizados dois tipos de questionários: i) um questionário estruturado e autoaplicável contendo as variáveis demográficas (sexo, faixa etária e série escolar), e ii) o Questionário de Frequência Alimentar (QFA) utilizado para avaliar a frequência do consumo diário de Alimentos Ultraprocessados.
RESULTADOS: Observou-se que os alimentos embutidos, refrigerantes e guloseimas foram consumidos diariamente por 11,2%,12,5% e 33,7%, respectivamente. Quase metade dos alunos (44,2%) nao haviam consumido salgados de pacote na semana anterior ao estudo. Foram encontradas altas proporçoes do consumo de alimentos ultraprocessados (61,2%), dentre estes, os mais consumidos foram guloseimas, seguido por refrigerantes, embutidos e salgadinhos de pacote (48,0%, 23,5%, 19,0% e 13,07%, respectivamente). O consumo regular de guloseimas e salgadinhos de pacote foram associados significativamente ao sexo, sendo mais prevalente no feminino (P<0,001). A prevalência do consumo regular de AUP também foi maior entre o sexo feminino (p=0,002). Em relaçao ao consumo regular segundo a faixa etária, maiores prevalências foram observadas em adolescentes com idade entre 13-14 anos (p=0,041).
CONCLUSAO: Este estudo evidenciou altas prevalências do consumo de alimentos ultraprocessados entre adolescentes. Sendo assim, é necessário a conscientizaçao dos adolescentes sobre as consequências do consumo excessivo desses alimentos, através de açoes de promoçao da alimentaçao saudável no ambiente escolar.

INTRODUCTION

The social and economic transformations since the emergence of globalization and industrialization resulted in changes in food consumption. In Brazil, the concern was primarily focused on energy deficiency and nutritional deficiency, but in recent years has focused on overweight, obesity and consequently on chronic non communicable diseases (NCDs)1. Ingestion of fresh or minimally processed foods has fast foods, soft drinks, sweets and snacks rich in sugars, fats and preservatives became part of the population's diet2.

According to the World Health Organization - WHO (1995), adolescence marks the transition from childhood to adulthood, ranging from 10 to 19 years3. It is a period characterized by intense physical modifications of puberty, cognitive and psychosocial transformations and ends with the insertion in adult society4. It is during this period that eating habits are consolidated, where changes in food consumption occur due to physiological changes and the influence that the social environment has on adolescents5.

Among young people, inappropriate eating habits are characterized by excessive consumption of sugars, fats, preservatives and sodium from ultra-processed products, associated with low consumption of fruits and vegetables, favoring weight gain and the onset of diseases6. Teenagers are also more susceptible to the influence of the media that imposes thinness as beauty standards, resulting in negative food consumption. For to stay within the standards, they omit important meals such as breakfast or dinner, resulting in low energy and nutrient consumption7. Therefore, they represent a group of nutritional vulnerability, since they have their high energy needs, and their eating habits, lifestyle and environmental factors make them more susceptible to NCD8.

Socioeconomic factors such as parental education and family income are related to adolescents' food consumption. Those with better economic conditions have more access to foods with low nutritional value and high caloric density, while in low-income families the consumption and quantity of these foods is higher9.

Inadequate diet is one of the most relevant risk markers associated with the current epidemic of non-communicable chronic diseases, which constitute the main reason for mortality in Brazil10.

According to the complexity of the socioeconomic and cultural factors of adolescents' eating habits, it is necessary to expand the public policy actions that can intervene in the determinants of these factors. In this perspective, in order to know the consumption profile of adolescents and to subsidize actions to be implemented and/or reformulated as a measure of health promotion of this population group, this study aimed to evaluate the consumption of ultra-processed foods among 6th to 9th grade adolescents of the public school system of Montes Claros - MG.


MATERIALS AND METHODS

This study is part of the research project entitled "Health at School". This is a quantitative, descriptive and cross-sectional study, conducted with adolescents of both sexes, enrolled in the last four grades of elementary school in public schools in Montes Claros - MG. Montes Claros is a medium-sized city, located north of the state of Minas Gerais, Brazil, and represents the main urban center of the region. According to the Brazilian Institute of Geography and Statistics (IBGE) of 2018, the estimated population for the year 2017 was around 402,027 inhabitants. Montes Claros has 33 municipal public schools in the urban area for elementary school II, with approximately 4,231 students enrolled in 2017.

To calculate the sample, the following parameters were considered: event prevalence of 50%, confidence level of 95% and standard error of 5%. Correction for the design effect was adopted (Deff = 2.0) and a 20% increase was also established to compensate for the possible absence of responses and losses. The participation of at least 750 adolescents was estimated.

The inclusion criteria for adolescents were those who were regularly enrolled in the 6th to 9th grades of elementary school, and the signing of the informed consent form, showing the consent of the students and their parents/guardians for the students to participate in the research. Students who were not present at the time of data collection, pregnant women and those with debilitating chronic diseases such as chronic anemia, heart failure, severe asthma, patients with genetic syndromes and hypothyroidism, or those with chronic corticosteroids were excluded from the study.

Before starting the research, a pilot study was conducted with adolescents of both genders in order to improve the instruments and methodological procedures. Data collection was conducted in 2017 within schools during the class day. A team of trained health academics aligned with the methodology performed the procedure. Initially, the adolescents were informed about the study and verbally asked about their consent to participate in the research. Those who agreed to participate were given a "consent form" to be completed by their parents or guardians and a "consent form" to be completed by the student himself.

One of the instruments used in this study was a self-administered structured questionnaire containing demographic variables: gender, age and grade. In addition to a Food Frequency Questionnaire (FFQ), used to assess the frequency of daily consumption of at least one group of Ultra-Processed Foods (UPA), the variable was investigated based on the question: "In the last 7 days, how many days did you eat...?" For each of the following foods/food groups: treats, sodas, sausages (hamburger, sausage, bologna, salami, ham, nuggets or sausage), and packet chips. Daily intake of at least one group of UPA was determined by the affirmative response to consumption of at least one of the groups on all seven days of the investigated week.

Firstly, the frequencies of food intake of ultra-processed foods in the last week were calculated. Then, the prevalence rates of regular consumption were obtained, as well as their respective 95% confidence intervals (95% CI). The chi-square test was used to evaluate possible differences between exposure categories. For all analyzes, a significance level of 5% was considered.

Statistical treatment of the collected information was performed using the Statistical Package for the Social Sciences (SPSS), version 20.0. For sample characterization, descriptive statistical analysis of frequencies (n) simple and percentage (%) were used. This research met the ethical precepts established by Resolution no. 466/2012 and was approved by the Ethics Committee on Research with Human Beings of the State University of Montes Claros (CEP), under protocol number 1.908.982.


RESULTS

The study included 1475 adolescents with an average age of 13.00 ± 1.34 years, 50.1% (n = 739) female and 49.9% (n = 736) male. Most respondents were enrolled in 7th grade (Table 1).




Table 2 shows the distribution of weekly frequency of ultra-processed food consumption among the evaluated adolescents. Cold cuts and soft drinks were consumed weekly by 77% of the students, where 33.7% and 12.5% consumed daily sweets and soft drinks, respectively. It was also noted that almost half of the students (44.2%) had not eaten salty snacks in the week prior to the study.




Figure 1 reveals that high proportions of ultra-processed food consumption were found among adolescents in the seven days prior to the study (61.2%). Among these, the most consumed were goodies, followed by soft drinks, sausages and snack foods (48%, 23.5%, 19% and 13%, respectively).


Figure 1. Percentages of frequency of consumption of ultra-processed foods by adolescents in municipal schools in Montes Claros-MG, 2017.



Table 3 presents the frequency analysis of regular consumption of ultra-processed foods according to gender and age group. Regular consumption of treats and snack foods was significantly associated with gender, being more prevalent in females (P <0.001). The prevalence of regular UPA consumption was also higher among females (p=0.002). Regarding regular consumption according to age group, higher prevalence was observed in adolescents aged 13-14 years (p=0.041).




DISCUSSION

Adolescence promotes greater autonomy over making their own decisions about eating behavior, and may negatively influence lifestyle. Social life becomes more important, interfering with the formation of eating habits and, therefore, in this phase, behavioral changes tend to occur11. Such modifications are related to the high intake of processed products and decreased consumption of fresh foods. Currently, there is the accelerated increase of these changes in food behavior in underdeveloped countries, which undergo economic, social and technological changes, resulting in greater purchasing power, which facilitates access to ultra-processed foods12,2.

Studies by Monteiro et al. in 19 countries, 26.4% of the participants' total dietary energy came from processed foods. In Portugal and Italy the average household availability of ultra-processed foods was 10.2% and 13.4%, respectively; in Germany 46.2% and the United Kingdom presented index of 50.4%. This same study revealed an association in the availability of ultra-processed foods and obesity among adults13. In Brazil, in a study by Louzada et al., Individuals with high consumption of ultra-processed foods had significantly higher body mass index and were more likely to develop obesity when compared to individuals with low consumption14.

The present study revealed high consumption of at least one food from the AUP group. Costa et al. investigated regular intake of four groups of salty UPA among adolescents. Daily intake of at least one group of UPA was reported by almost 40% of the students, and the highest percentage was observed among females (51.3%)15. Another study conducted with adults from Pelotas by Gigante et al. showed that the intake of ultra-processed foods contributed more than 50% of the total calories consumed by participants, with a higher prevalence among females16.

The pattern of eating sweets was marked by a high consumption, characterizing it as an unhealthy factor of food. Correa et al. identified a similar eating pattern among adolescents, with 41.3% consumption of treats on five days or more a week, where cookies and sodas were consumed by 35.1% and 33.2% of the participants, respectively17. Inadequate eating habits Among adolescents, it may be related to the frequency with which they eat meals away from home, omit meals or replace them with easily accessible industrialized preparations such as fast food5.

Messias et al. evaluated the consumption of ultra-processed foods by public school students, and found high levels of products with high sugar and sodium content. Among the high-sodium processed foods most cited by both sexes are sausages and pizza (1,117.3 mg on average and 736,7762 mg, respectively). Those with high sugar content are chocolate powder and cookies filled with 77.39g and 40.62g, respectively18. Inadequate diets and physical inactivity are associated with the emergence of diseases such as obesity, diabetes, cardiovascular disease, hypertension and cancer. This is an alarming factor considering that adolescence is an important phase of growth and development16.

Although similarities with the dietary pattern reported by other authors are found, the comparison of the present study with the others should be carefully done due to the differences in the characteristics of the studied population and the instruments used to evaluate the dietary pattern. This study has limitations arising from the dietary record such as underestimation of food intake and/or modification of habitual consumption in the days preceding the research.

The present study contributes to other findings in the literature and its results reflect the need to monitor ultra-processed food consumption, and reinforce the need for food and nutrition-oriented public policy actions that emphasize the reduction in UPA consumption.


CONCLUSION

This study showed high prevalence of regular consumption of ultra-processed foods among adolescents enrolled in Montes Claros public school. Among the ultra-processed foods analyzed stand out the treats with the highest weekly consumption. The highest prevalence of regular UAP consumption was found among female adolescents aged 13-14 years. Considering this scenario, it is necessary to make adolescents aware of the consequences of excessive consumption of ultra-processed foods, through actions to promote healthy eating in the school environment. Such strategies are essential to prevent unhealthy food intake from continuing into adulthood and, consequently, to chronic non communicable diseases.


NOTE

Source of funding: Voluntary Scientific Initiation Program (ICV) of the State University of Montes Claros (Unimontes), Institutional Program of Scientific Initiation Scholarships for Medical Education - PIBIC/EM, National Council for Scientific and Technological Development (CNPq). Scientific Initiation Program with Scholarship (PROIC BOLSA) from Health College of Ibituruna (FASI).


REFERENCES

1. Santos GG, Farias GO, Guimaraes ACA, Correia PMS, Marinho A. Obesidade e adolescencia: uma análise dos estudos. Revista brasileira de atividade física e saúde. 2016; 20(02): 57-71.

2. Eicher-Miller HAE, Fulgoni VL, Keast DR. Processed food contributions to energy and nutrient intake differ among us children by race/ethnicity. Nutrients. 2015; (7): 10076-10088

3. World Health Organization. Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. Geneva: WHO. 1995.

4. Barreto AC, Andrade MIS, Lima VLM, Diniz AS. Escores de peso corporal e consumo alimentar em adolescentes do nordeste do Brasil. Revista Paulista de Pediatria. 2015; (33): 318-325.

5. D'avila GL, Silva DAS, Vasconcelos FAG. Associaçao entre consumo alimentar, atividade física, fatores socioeconômicos e percentual de gordura corporal em escolares.Ciência & Saúde Coletiva. 2016; (2): 1071-1081.

6. Silva DAS, Silva RJS. Associaçao entre prática de atividade física e consumo de fruta, verdura e legumes em adolescentes do nordeste do brasil. Rev paul pediatr. 2015; 33(02): 167-172.

7. Makinen MM et al. Desenvolvimento da autoimagem e seus componentes durante um ano de acompanhamento em adolescentes com excesso e peso normal. Criança e Adolescente. Psiquiatria e saúde mental. 2015; 9(5).

8. Tavares LF, Castro IRR, Levy RB, Cardoso LO, Claro RM. Padroes alimentares de adolescentes brasileiros: resultados da pesquisa nacional de saúde do escolar (Pense). Caderno de Saúde Pública. 2014; 30(12):1-13.

9. D'avila HF, Kirsten VR. Consumo energético proveniente de alimentos ultraprocessados por adolescentes. Rev Paul Pediatr. 2017; 35(1):54-60

10. Faria ER, Faria FR, Pinto CA, Franceschini SCC, Peluzio MCG, Priore SE. Consumo alimentar e síndrome metabólica em adolescentes do sexo feminino. Revista da associaçao brasileira de nutriçao. 2014; 6(1):21-28.

11. Silva JG, Teixeira MLO, Ferreira MA. Alimentaçao na adolescência e as relaçoes com a saúde do adolescente. Texto Contexto Enferm; 2014; 23(4): 1095-103.

12. Vieiro VSF, Farias JM. Açoes educativas para a sensibilizaçao de um estilo de vida mais saudável em adolescentes. J. Phys. Educ. 2017; (28):1-9.

13. Monteiro CA, Moubarac JC, Levy RB, Canella DS, Louzada MLDC, Cannon G.. Household availability of ultra-processed foods and obesity in nineteen European countries. Public Health Nutr. 2018; 21(1):18-26.

14. Louzada MLC , Baraldi LG , Steele EM, Martins APB, Canella DS, Moubarac JC,  Levy RB, Canhao G, Afshin A, Imamura F, Mozaffarian D, Monteiro CA. Consumo de alimentos ultraprocessados e obesidade em adolescentes e adultos brasileiros. Prev Med. 2015;( 81):9-15.

15. Costa CS, Flores TR, Wendt A, Neves RG, Santos MCFA. Sedentary behavior and consumption of ultra-processed foods by Brazilian adolescents: Brazilian National School Health Survey (PeNSE) 2015. Caderno de Saúde Pública. 2018; (34).

16. Bielemann RM, Motta JVS, Minten  GC, Horta BL, Gigante DP. Consumo de alimentos ultraprocessados e impacto na dieta de adultos jovens. Rev Saúde Pública 2015;(49):28.

17. Correa RS, Vencato PH, Rockett FC, Bosa VL. Padroes alimentares de escolares: existem diferenças entre crianças e adolescentes. Ciência & Saúde Coletiva. 2015; (22): 553-562.

18. Messias CMBO, Souza HMSS, Reis IRMS. Consumo de alimentos ultraprocessados e corantes alimentares por adolescentes de uma escola pública. Adolesc. Saude. 2016;13(4): 4-7.
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