FREQUENCY OF HEALTHY EATING HABITS AMONG STUDENTS OF A PUBLIC UNIVERSITY IN NORTHEASTERN BRAZIL
Frequência de hábitos alimentares saudáveis entre estudantes de uma universidade pública do Nordeste do Brasil
Frecuencia de hábitos alimentarios saludables de estudiantes de una universidad pública del Noreste de Brasil
Abstract:
Objective:
The aim of this study was to measure the frequency of healthy eating habits among students of a public university in Northeastern Brazil. Methods: This is a cross-sectional population-based study. The sample was randomly composed of 933 undergraduate students of both genders aged 18-35 years. The frequency of healthy eating habits was assessed based on the adherence to the 10 Steps to Healthy Eating proposed by Brazil’s Ministry of Health. The frequency of each step was measured through questions compiled from previous publications. Results: The steps to the healthy eating with the lowest frequencies of adherence were related to the practice of adding salt to prepared foods (18.6%, n=185) and to the consumption of fruits and vegetables (28.3%, n=281) and foods rich in fat (21.5%, n=213) and sugar (48.9%, n=486). However, there was an adequate consumption of beans (83.8%, n=832) and a prevalence of normal nutritional status of 69.6% (n=691) among the students. None of the interviewees followed all the steps to the healthy eating. The average adherence rate was at least 6 steps. Men and women presented different habits and food preferences. Conclusion: The university students presented a low frequency of healthy eating habits due to the high intake of food high in fat and sugar and mainly the low consumption of fruits and vegetables and the practice of adding salt to prepared foods. This may, in turn, predispose them to increased risks of morbidity and mortality from noncommunicable diseases.
Keywords:
Students, Food Habits, Nutritional Status, Guideline Adherence, Health Promotion.
Resumo:
Objetivo: O objetivo deste estudo foi medir a frequência de hábitos alimentares saudáveis entre estudantes de uma universidade pública do Nordeste do Brasil. Métodos: Este é um estudo transversal de base populacional. A amostra foi aleatoriamente composta por 993 graduandos, ambos os sexos e idade entre 18 e 35 anos. A frequência de hábitos alimentares saudáveis foi avaliada a partir da adesão aos 10 Passos para a Alimentação Saudável propostos pelo Ministério da Saúde do Brasil. A frequência de cada passo foi coletada por meio de perguntas compiladas a partir de publicações prévias. Resultados: Os passos da alimentação saudável, que tiveram as menores frequências de adesão, estiveram relacionados à prática de adicionar sal aos alimentos prontos (18,6%, n=185) e ao consumo de frutas e hortaliças (28,3%, n=281) e de alimentos gordurosos (21,5%, n=213) e ricos em açúcar (48,9%, n=486). No entanto, observou-se um adequado consumo de feijão (83,8%, n=832) e a prevalência de estado nutricional eutrófico de 69,6% (n=691) entre os estudantes. Nenhum dos indivíduos entrevistados aderiu a todos os passos da alimentação saudável. A taxa média de adesão foi de, pelo menos, 6 passos. Homens e mulheres apresentaram hábitos e preferências alimentares distintos. Conclusão: Os estudantes universitários apresentaram baixa frequência de hábitos alimentares saudáveis devido à alta ingestão de alimentos ricos em gordura e açúcar e devido, principalmente, ao baixo consumo de frutas e vegetais e a prática de adição de sal aos alimentos já preparados. Isto pode, por sua vez, predispô-los a um maior risco de morbidade e mortalidade por doenças não transmissíveis.
Palavras-chave:
Estudantes, Hábitos Alimentares, Estado Nutricional, Fidelidade a Diretrizes, Promoção da Saúde.
Resumen:
Objetivo: El objetivo del estudio fue medir la frecuencia de hábitos alimentarios saludables entre estudiantes de una universidad pública del noreste de Brasil. Métodos: Estudio transversal de base poblacional. La muestra fue randomizada y consistió de 933 estudiantes de graduación, de ambos los sexos y edades entre 18 y 35 años. La frecuencia de hábitos alimentarios saludables fue valorada a partir de la adhesión de 10 pasos para la Alimentación Saludable propuesta por el Ministerio de la Salud de Brasil. Se recogió la frecuencia de cada paso a través de cuestiones elaboradas de publicaciones anteriores. Resultados: Los pasos de la alimentación saludable los cuales tuvieron las más bajas frecuencias de adhesión estuvieron relacionadas con las practicas de la adición de sal en las comidas preparadas (18,6%, n=185) y al consumo de frutas y vegetales (28,3%, n=281) y de las comidas llenas de grasa (21,5%, n=213) y azúcar (48,9%, n=486). Sin embargo, un adecuado consumo de frijoles (83,8%, n=832) y la prevalencia del estado nutricional normal del 69,6% (n=691) fueron observados entre los estudiantes. Ninguno de los individuos entrevistados siguió los pasos de la alimentación saludable. La tasa media de adhesión fue de al menos 6 pasos. Hombres y mujeres han demostrado hábitos distintos y preferencias de comidas. Conclusión: Los estudiantes universitarios presentaron baja frecuencia de hábitos alimentarios saludables debido a la elevada ingesta de comidas con elevado nivel de grasa y azúcar y, principalmente, al bajo consumo de frutas y vegetables y la práctica de adicción de sal en las comidas preparadas. Eso puede contribuir a la predisposición de riesgos elevados de morbidad y mortalidad por enfermedades no comunicables.
Palabras clave:
Estudiantes, Hábitos Alimenticios, Estado Nutricional, Adhesión a Directriz, Promoción de la Salud.
INTRODUCTION
Among the behaviors that characterize the lifestyle of a population, eating habits have received global attention(1-3). The formation of eating habits is influenced by a number of physiological, psychological, sociocultural and economic factors(4). The typical situations of adolescence and early adulthood, such as the intense biological changes and psychosocial instability, along with the changes arising from becoming a university student could turn these individuals into a vulnerable group with health implications(5).
Undesirable eating practices, physical inactivity, stress, alcohol consumption, and smoking can interfere in the social and physical formation, as well as in the nutritional status and biological vulnerability of young
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people(5-7). Some studies have assessed eating habits among university students(8-10) and observed, in most of the cases, a low prevalence of healthy eating habits, high intake of foods high in fat and/or sugar, and low intake of fruits and vegetables.
Studies on eating behavior in the university environment(8,11) revealed the factors that influence the adoption of unhealthy eating habits among students. Some of these factors are: experience in student housing, meal skipping, eating away from home, snacking and fast-food consumption. Poor eating habits would still be influenced by new behaviors and social relations, which suggest evidences of eating compulsion in some students who, due to anxiety, may turn the diet into an “escape from reality” for the situations of physical and mental stress(5). These practices may contribute to the prevalence of overweight and obesity, which have assumed alarming proportions worldwide(6,12-14).
Brazil, as most developing countries, has defined strategies for the control of noncommunicable diseases (NCDs), such as the promotion of healthy eating habits(15). One of the actions adopted by the Ministry of Health was the development of 10 Steps to Healthy Eating (Chart 1) as part of the National Plan for the Promotion of Healthy Eating(16), based on the Global Strategy on Diet, Physical Activity and Health by the World Health Organization(17,18).
The adoption of healthy eating habits is associated with the prevention of NCDs and health promotion(17). University students represent a young adult population for whom the adoption of a healthy lifestyle is extremely important(6,7,19). In turn, knowing the nutritional status of different population groups is an essential step in promoting healthy lifestyles since it allows the planning of nutritional education programs, as well as guidance and proper management of public policies for health promotion(19). Therefore, the aim of this study was to measure the frequency of healthy eating habits among students of a Northeastern public university from Brazil.
METHODS
This is a cross-sectional population-based study. The sample was randomly selected and consisted of 993 university students enrolled in the first half of 2011 in the Federal University of Sergipe of both genders aged from 18 to 35 years. Volunteers were recruited in classrooms and hallways of the campus. For the initial screening of the volunteers, self-report of any noncommunicable diseases and physiological conditions such as pregnancy and lactation were considered exclusion criteria.
The sample was calculated taking into account a prevalence rate of 12% of healthy eating habits observed in a previous study(20), a sampling error of 2.3%, significance level of 1% and a population size of 12.241. Thus, a minimum sample of 873 individuals was obtained. Considering a 10% additional for possible losses and refusals, the sample size was determined to bef 993 individuals.
In order to characterize the population, descriptive information were collected: gender, age, academic major, year of study, and school shift (morning and/or afternoon). Questions compiled from a study about the 10 Steps to Healthy Eating proposed by the Ministry of Health(15) were used in the data collection. Chart 1 shows the 10 steps. These questions were applied in a pretest involving 50 individuals in order to perform the necessary adjustments, train the interviewers and thus avoid collecting biased data. All interviewers attended an initial training session before the pretest. During the collection, meetings were held in order to clarify doubts and strengthen the guidance on data collection.
The frequency of food consumption was assessed through students’ reports regarding their eating habits in the previous year. The response options were distributed into: less than once/week, once/week, twice or three times/week, four to six times/week and daily. The foods assessed were: fruits and vegetables (step 1), beans (step 2), fatty foods (step 3), high-sugar foods (step 6), soft drinks and alcoholic beverages (step 7).
The other steps related to eating habits and lifestyle were collected through direct questions: “Do you usually add more salt to food served in your plate?” (step 4), “How many meals do you usually have each day?” (step 5); “Do you eat too fast? Do you finish your meals before the others?” (step 8); and “Do you exercise regularly? Do you accumulate 30 minutes of physical activity/day or 150 minutes/week?” (step 10).
Anthropometric data (self-reported weight and height) were used to calculate the Body Mass Index (BMI) and classify the nutritional status (step 9) following the criteria adopted by the World Health Organization(21). A previous study conducted with a population of adults validates weight and height self-reports(22).
The processing and analysis of the results were performed using the SPSS for Windows, version 20.0. Absolute and relative frequencies of the descriptive variables and of the adherence to the 10 Steps to Healthy Eating were calculated. Continuous variables such as age and BMI were categorized and eating habits were classified as adequate or inadequate according to the steps to healthy eating. Thus, Pearson chi-squared test was used to check for association between the descriptive variables and the adherence/adequacy to the steps to healthy eating. A significance level of 5% was adopted.
In accordance with the principles of the declaration of Helsinki, all volunteers were informed about the study protocol and signed the consent form. The research project was approved by the Research Ethics Committee of the Federal University of Sergipe and by the National Health Council (Opinion No. 0064.0.107.000-11).
RESULTS
Table I shows the characteristics of the population. Among the students included in the sample, more than half were freshmen (55.2%, n=548) and had a mean age of 20.23 ± 2.79 years. Most students were enrolled in exact sciences courses (43.2%, n=429), lived in the capital city and surrounding cities (80.0%, n=782) and were at normal weight according to the BMI (70.7%, n=691).
The frequency of adherence to the 10 Steps to Healthy Eating (Chart I) is presented in Table II. Less than 30% of the students (28.3%, n=281) met the minimum recommendation of daily consumption of fruits and vegetables established by the Ministry of Health (step 1). On the other hand, the consumption of beans (step 2) presented high adequacy among most of the students (83.8%, n=832), especially among men (p<0.001). The adherence to step 1 was associated with a greater number of meals (Table III).
The findings related to foods high in sugar (step 6) revealed that less than half of the students (48.9%, n=486) meet the recommendation of up to twice a week. The adequate consumption of fatty foods (step 3) was also not a priority on the part of most students (21.5%, n=213). Gender was directly associated with the adherence to these steps. While the consumption of foods high in sugar was adequate among men (p<0.001), the consumption of fatty foods was more adequate among women (p=0.015). Still, step 6 was associated with an increase in age (Table III).
The step with the lowest rate (18.6%, n=185) was the one related to adding salt to already prepared meals, which is represented by the habit of taking the salt shaker to the table (step 4). The highest adequacy (98.1%, n=974), on the other hand, corresponded to the consumption of alcohol and soft drinks (step 7). Men presented a greater adequacy to the step 7 (p=0.012).
The recommendations of the Ministry of Health to have three daily meals and a snack (step 5) and eat slowly (step 8) were respectively reported by 64.2% (n=638) and 50.4% (n=500) of the respondents. The findings related to these steps were associated with nutritional status, age, and gender (Table III).
A significant portion of the population (69.6%, n=691) was normal according to the nutritional status (step 9). However, less than half (42.3%, n=420) reported exercising at least 30 minutes per day (step 10). Gender was directly associated with the following steps: predominance of normal weight among women (p=0.01) and regular physical activity among men (p<0.001). Still, step 10 was associated with the increase in body weight (Table III).
No significant associations were found regarding the adherence to the 10 steps when comparing each field of study. It is important to highlight that none of the interviewees followed all the steps to healthy eating, but there was an average of at least 6 steps.