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 82 a 92


Changes in the consumption of ultra-processed foods over a decade among brazilian students

Cambios en el consumo de alimentos ultraprocesados durante una década entre estudiantes brasileños

Mudanças no consumo de alimentos ultraprocessados durante uma década entre estudantes brasileiros

Autores: Jaqueline Aragoni da Silva1; Kelly Samara Silva2; Giovani Firpo Del Duca3; Jucemar Benedet4; Monica Costa Silva5; Pablo Magno da Silveira6; Markus Vinicius Nahas7

1. Doctoring and Master in Physical Education by the Federal University of Santa Catarina (UFSC). Florianópolis, SC, Brazil
2. Master and Doctorate in Physical Education by the Federal University of Santa Catarina (UFSC). Teacher by the Federal University of Santa Catarina (UFSC). Florianópolis, SC, Brazil
3. Doctorate in Physical Education by the Federal University of Santa Catarina (UFSC). Master in Epidemiology by the Federal University of Pelotas (UFPel). Pelotas, RS, Brazil. Teacher by the Federal University of Santa Catarina (UFSC). Florianópolis, SC, Brazil
4. Doctorate in Physical Education by the Federal University of Santa Catarina (UFSC). Master in Nutrition by the Federal University of Santa Catarina (UFSC). Teacher by the Federal University of Santa Catarina (UFSC). Florianópolis, SC, Brazil
5. Master in Physical Education by the Federal University of Santa Catarina (UFSC). Florianópolis, SC, Brazil
6. Doctoring in Physical Education by the Federal University of Santa Catarina (UFSC). Florianópolis, SC, Brazil
7. Doctorate in Physical Education by the University of Southern California (USC). Consultant in the area of promotion for heathy life styles. Florianópolis, SC, Brazil

Correspondência:
Jaqueline Aragoni da Silva
Universidade Federal de Santa Catarina, Departamento de Educaçao Física
Rua Engenheiro Agronômico Andrei Cristian Ferreira, s/nº - Trindade
Florianópolis - SC, Brasil. CEP: 88040-900
(jaqueline.aragoni@outlook.com)

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Keywords: Diet; Nutrition; Foods; Adolescents; Health; Epidemiology.
Palabra Clave: Dieta; Nutrición; Alimentos; Adolescentes; Salud; Epidemiología.
Descritores: Dieta; Nutriçao; Alimentos; Adolescentes; Saúde; Epidemiologia.

Abstract:
OBJECTIVE: Analize the changes in the consumption of ultraprocessed foods over a decade among students from the Southern Brazil. We hipothesize that there would be changes on the prevalence of sweet, soda and snacks consumption over a decade.
METHODS: It was a secondary analyzes of the Project "Lifestyle and risk behavior of students from Santa Catarina, Brazil" (COMPAC). Two school-based surveys were conducted in 2001 (n=5,028) and 2011 (n=6,529). A validate questionarie was applied to collect informations about frequence of consumption (never: non consumers; weekly consumers:1-6 days; daily consumers: 7 days) of soda, sweets and snacks. Logistic regression was applied to verify the association between year (2001 vs 2011) and consumption of ultraprocessed foods, according to sex, age and housing area. A representative sample of the students (15-19 years) enrolled in public schools from Santa Catarina, Brazil.
RESULTS: Regarding the results, it was verified a reduction in the prevalence of daily consumers of soda (from 19.7 to 10.0%), sweets (from 34.3% to 8.0%) and snacks (from 17.9% to 3.9%). In other hand, there was an increase in the prevalence of weekly consumers of these ultra-processed foods. Furthermore, the changes varied according to sex, age and housing area.
CONCLUSION: It was possible to conclude that even though there was a decrease in the prevalence of daily consumers of soda, sweets and snacks, further actions are required since it was observed an increase in the prevalence of weekly consumers of those ultra-processed foods.

Resumen:
OBJETIVO: Analizar las mudanzas de consumo de alimentos ultraprocesados a lo largo de una década entre estudiantes del sur de Brasil. Nosotros presentamos la hipótesis de que habría mudanzas en la prevalencia de consumo de dulces, bebidas y salados a lo largo de una década.
MÉTODOS: Este consistió en un análisis secundario del Proyecto "Estilo de vida y comportamiento de riesgo de estudiantes de Santa Catarina, Brasil" (COMPAC). Fueron realizadas dos investigaciones de base escolar en 2001 (n = 5,028) y 2011 (n = 6,529). Un cuestionario validado fue utilizado para recolectar informaciones sobre la frecuencia de consumo (nunca: no consumidores; consumidores semanales: 1-6 días; consumidores diarios: 7 días) de bebidas, dulces y salados. La regresión logística fue aplicada para verificar la asociación entre el año (2001 vs. 2011) y el consumo de alimentos ultraprocesados, de acuerdo con sexo, edad y área de residencia. La muestra fue representativa de los alumnos (15-19 años) matriculados en escuelas públicas de Santa Catarina, Brasil.
RESULTADOS: En relación a los resultados, se verificó una reducción en la prevalencia de consumidores diarios de bebidas (de 19,7 a 10,0%), dulces (de 34,3% para 8,0%) y salados (de 17,9% para 3,9%). Por otro lado, hubo un aumento en la prevalencia de consumidores semanales de esos alimentos ultraprocesados. Además de eso, las mudanzas variaron al analizar por sexo, edad y área de residencia.
CONCLUSION: Fue posible concluir que, a pesar de una disminución de la prevalencia de consumidores diarios de bebidas, dulces y salados, son necesarias más acciones pues se observó un aumento en la prevalencia de consumidores semanales de esos alimentos ultraprocesados.

Resumo:
OBJETIVO: Analisar as mudanças de consumo de alimentos ultraprocessados ao longo de uma década entre estudantes do sul do Brasil. Nós levantamos a hipótese de que haveria mudanças na prevalência de consumo de doces, refrigerantes e salgadinhos ao longo de uma década.
MÉTODOS: Este consistiu em uma análise secundária do Projeto "Estilo de vida e comportamento de risco de estudantes de Santa Catarina, Brasil" (COMPAC). Foram realizados dois inquéritos de base escolar em 2001 (n = 5,028) e 2011 (n = 6,529). Um questionário validado foi utilizado para coletar informaçoes sobre a frequência de consumo (nunca: nao consumidores; consumidores semanais: 1-6 dias; consumidores diários: 7 dias) de refrigerantes, doces e salgadinhos. A regressao logística foi aplicada para verificar a associaçao entre o ano (2001 vs. 2011) e o consumo de alimentos ultraprocessados, de acordo com sexo, idade e área de moradia. A amostra foi representativa dos alunos (15-19 anos) matriculados em escolas públicas de Santa Catarina, Brasil.
RESULTADOS: Em relaçao aos resultados, verificou-se uma reduçao na prevalência de consumidores diários de refrigerante (de 19,7 a 10,0%), doces (de 34,3% para 8,0%) e salgadinhos (de 17,9% para 3,9%). Por outro lado, houve um aumento na prevalência de consumidores semanais desses alimentos ultraprocessados. Além disso, as mudanças variaram quando analisadas por sexo, idade e área de moradia.
CONCLUSAO: Foi possível concluir que, apesar de uma diminuiçao da prevalência de consumidores diários de refrigerante, doces e salgadinhos, sao necessárias mais açoes pois observou-se um aumento na prevalência de consumidores semanais desses alimentos ultraprocessados.

INTRODUCTION

Ultra-processed foods are industrial formulations made largely of substances extracted from foods (oils, fats, sugar, starch, proteins), derived from food constituents (hydrogenated fats, modified starch) or synthesized in the laboratory based on organic materials such as petroleum. and charcoal (dyes, flavorings, flavor enhancers and various types of additives used to provide products with attractive sensory properties)1. Increasing production and consumption of processed and ultra-processed foods is a major cause of the current worldwide pandemic of obesity and non-communicable diseases and injuries2.

The participation of ultra-processed foods in the Brazilian diet is still much lower than that found in developed countries or even in other developing countries, where fast food culture already predominates over traditional food culture3. In Brazil, the diet is composed of several influences and is currently strongly characterized by a combination of a so-called "traditional" diet (based on rice with beans) and ultra-processed foods, varying according to age groups4. Among adolescents, there is a diet with higher consumption of ultra-processed foods and lower consumption of beans, salads and vegetables in general, which characterizes this age group as having the worst diet profile among Brazilians4.

The growing interest of young individuals for ultra-processed foods has alerted government agencies about the need to recommend and monitor eating habits, as it is known that diet is one of the main determinants of energy balance and is directly related to the development of obesity5-7. The World Health Organization (WHO) recommends reducing the consumption of high energy and sodium foods, saturated fats, trans fats and refined and nutrient poor carbohydrates1. And in Brazil, the new food guide for the Brazilian population warns of the type of processing to which foods are submitted before their acquisition, preparation and consumption2.

Several observational studies have sought to investigate the trend of food consumption. International studies have observed an increase in the consumption of snacks, snacks, fast foods and soft drinks8-11. In Brazil, the Family Budget Survey (POF) has verified at each stage of the research, a significant increase in the consumption of ultra-processed products. Another study of adolescents from public schools evaluated changes in the beverage consumption profile and found a reduction in milk consumption and an increase in the consumption of processed beverages12.

Despite this evidence, there are few studies that specifically examine the consumption of soda, sweets and snacks, especially focusing on changes in their consumption. Thus, the aim of the study was to evaluate changes in the consumption of these foods among adolescents in southern Brazil from 2001 to 2011. Our hypothesis is that there may be changes in the prevalence of soda, candy and snack foods consumption over a decade.


METHODS

This is a cross-sectional study, originated from a larger research entitled "Lifestyle and Risk Behaviors of Young Santa Catarina (COMPAC)", conducted in 2001 and 2011, with high school students aged 15-19 years, enrolled in state public schools of Santa Catarina, Brazil. Participants received a letter of informed consent, or their guardian if they were under the age of 18, and could only participate in the research with the permission of their guardians. This study was approved by the Research Ethics Committee of the Federal University of Santa Catarina, under processes no. 064/2000 and 1029/2010.

According to the 2000 and 2010 school census, a total of 205,543 and 205,572 young people enrolled in public schools were indicated, respectively, and these data were used to calculate the sample size. The following statistical parameters were also used to estimate sample size: unknown prevalence, estimated at 50%, due to numerous existing variables; 95% confidence interval, with a maximum error of two percentage points, resulting in a minimum sample of 2,373 students. The sample was by cluster, and the total value was multiplied by two, totaling a sample of 4,746 students of which 25% were added in case of loss or refusal during the collection. Thus, the final sample size was where 5,932 participants. The sampling calculation was the same for both surveys.

The sampling strata consider the six geographical regions and their Regional Education Councils (26 in total). The sampling procedures were divided into two steps. In the first stage, schools were stratified by size (large: ≥ 500 students; averages: 200 to 499 students; and small: <200 students). In the second stage the classes were selected according to the study period and school year. In 2001, 216 schools were selected by systematic sampling, with refusal of five, totaling 211 schools. And in 2011, 90 schools were selected. All students from the chosen classes that were present in the classroom were selected. More information can be obtained in previous publication13.

The study variables were derived from questionnaires used in the 2001 and 2011 survey, which were based on other international questionnaires for the adolescent population13. The present study used questions related to eating habits, gender, area of residence and age. Table 1 contains more details about study variables.




Initially, descriptive analyzes of all variables were performed. The prevalences and the respective confidence intervals (95% CI) were calculated, as well as the delta percentage to verify the difference in prevalence between the years. Multinomial logistic regression was used to analyze the odds ratios of adolescents consuming sweets, snacks and sodas in the 2011 survey compared with 2001. The analysis were stratified and adjusted for gender, age group and area of residence. Stata 13.0 statistical software (Stata Corp., College Station, USA) was used.




RESULTS

In 2001, most students were female (59.6%), aged between 17 and 19 years (53.0%) and urban residents (82.4%). In 2011, this prevalence continued, with most students being female (57.8%), aged 15 to 16 years (60.7%) and urban residents (80.4%). Figure 1 provides information on trends in eating habits over a decade among adolescents in Santa Catarina. From 2001 to 2011 there was a reduction in daily consumers of soft drinks (from 19.7% to 10%), sweets (from 34.3% to 8%) and snack foods (from 17.9% to 3.9%). On the other hand, the proportion of weekly consumers increased for all outcomes analyzed during this period.


Figure 1. Changes over a decade in the consumption of soft drinks, sweets and snacks in students of public high schools in Santa Catarina, Brazil.



Regarding changes in soft drink consumption from 2001 to 2011 (Table 1), the prevalence of daily consumers decreased by 50% for each subgroup. In the 2011 survey, boys (OR: 0.57; 95% CI: 0.43; 0.76) in both age groups (OR: 15-17 years: 0.57; 95% CI: 0.42; 0 , 78 and OR: 18-19 years: 0.70; 95% CI: 0.52; 0.92) and residents in urban areas (OR: 0.60; 95% CI: 0.47; 0.76) were less likely to drink soda every day than adolescents with the same characteristics as the 2001 survey. The prevalence of weekly soda consumers increased from 2001 to 2011 across all subgroups.

Regarding the consumption of sweets, the prevalence of daily consumption decreased in all subgroups studied between 2001 and 2011 (Table 2). The proportion of this decrease ranged from - 75.5% (urban area) to - 80.6% (rural area). Adolescents from all subgroups in 2011 were less likely to be daily candy consumers than those in 2001, and probability values ranged from 0.15 (95% CI: 0.10; 0.20) to 0.24 (95% CI). %: 0.19; 0.32). The prevalence of weekly candy consumers increased from 2001 to 2011 only among older adolescents (OR: 1.42; 95% CI: 1.09; 1.84).




The prevalence of daily snack consumption decreased in all subgroups, between 2001 and 2011, this reduction ranged from - 77.2% (urban area) to - 82.9% (rural urban). In 2011, adolescents from all subgroups were less likely to eat snacks every day compared to 2001, and odds ranged from 0.17 (95% CI: 0.09; 0.30) to 0.29 (95% CI). : 0.21; 0.38). Weekly consumers increased from 2001 to 2011 in all subgroups except those in the rural area (Table 3).




DISCUSSION

Our results suggest that there has been a decrease in the daily proportion of these foods consumed over a decade, with differences between the subgroups. These findings are relevant, considering the need for more actions focused on food consumption among adolescents, as already highlighted by other authors14. Monitoring eating habits trends is essential for planning future intervention programs and for formulating and evaluating national policies and nutrition guides15.

This study identified a decrease in daily consumption of soft drinks, sweets and snacks among Brazilian adolescents over a decade, corroborating data from the Health Behavior in School-Aged Children (HBSC) survey. This survey was conducted in the United States and several European countries, focusing on the behavior of children and adolescents. In their findings, the authors found a decrease from 2001/2002 to 2009/2010 in the proportion of daily candy and soft drink consumers in the United States10, Finland, Norway, and Sweden14-16, and the Czech Republic17.

The authors hypothesize that these changes are the result of the success of current public policies in their countries10 at both individual and population levels14. Examples of these initiatives include attempts to raise awareness about healthy eating habits and control sales of unhealthy food and beverages in the school environment17. In Santa Catarina, the law (State Law No. 12,061 of December 2001) was implemented stipulating that beverage and food services in schools should meet the nutritional quality criteria in order to preserve adolescent health. Thus, sweets, sodas and snacks were banned from school canteens. In addition, in 2004, the Ministry of Health launched a plan to promote healthy nutritional behavior by the school community, called the "Ten Steps to Promoting Healthy Diet in Schools"18. These initiatives may have contributed to the changes observed in this study.

Although there was a decrease in the proportion of daily consumers, it was possible to observe an increase in weekly consumers of sweets (42.1%), soft drinks (16.1%) and snacks (23.4%). The National Food Guide recommends avoiding these dietary indicators as they are ultra-processed products and thus are associated with high caloric intake and tend to replace healthy foods which increase the risk of heart disease, diabetes and different types of cancer2. In this context, more approaches to reduce the consumption of these foods are needed. In addition to public policies focusing on the school community, broader actions should be delineated with an emphasis on family and school environments7.

In addition, actions should be directed to subgroups, as trends differ according to gender, age and region of residence. Further investigation is needed to understand why some groups improve their diet while others do not. For example, it is important to understand why there was a high odds ratio in 2011 (vs 2001) of being a weekly consumer of candy in older but not younger teens, as well as being a weekly consumer of soda in urban but not for rural areas. These findings may help to detect what really works or does not work for each group of adolescents. These questions are of great relevance and have been highlighted by other authors14,19,20.

This study provides information on consumption trends of different dietary indicators from a representative sample of adolescents from public schools in Santa Catarina. Moreover, these trends were analyzed according to sociodemographic characteristics in order to clarify some disparities that could be considered and prioritized in future actions for high risk groups. Despite these strengths, it is also necessary to consider the limitations of the present study, such as the fact that the questionnaire allows to verify only the frequency and not the total consumption of each of the dietary indicators. Thus, it was not possible to infer conclusions about the changes between 2001 and 2011 in relation to the total consumption of these foods. Finally, while the study design allows trends to be identified over a decade, more collections made between these years could allow for more detailed trend analysis.


CONCLUSIONS

Daily consumption of sweets, soft drinks and snacks decreased among adolescents from Santa Catarina from 2001 to 2011. These results are encouraging, but more action is needed as the proportion of weekly consumers has increased, which means that a considerable proportion of teenagers still consume ultra-processed foods a few days a week. In addition, healthy eating initiatives should consider the characteristics of adolescents, such as gender, age and area of residence, as trends appear to differ according to these subgroups.


IMPLICATIONS FOR SCHOOL HEALTH

Actions to reduce the consumption of soft drinks, sweets and snacks are needed to further reduce the consumption of ultra-processed foods. Thus, targeted initiatives should consider the characteristics of adolescents such as gender, age and area of residence.


THANKS

This work was supported by the Higher Education Personnel Improvement Coordination - Brazil (CAPES) - Financing Code 001. The authors also thank the National Council for Scientific and Technological Development (CNPq).


REFERENCES

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2. World Health Organization. Diet, nutrition and the prevention of chronic diseases.  Report of the joint WHO/FAO expert consultation Genebra. 2003.

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