Monotony in the consumption of fruits and vegetables and food environment characteristics

Mendonça, Raquel de Deus; Lopes, Mariana Souza; Freitas, Patrícia Pinheiro; Campos, Suellen Fabiane; Menezes, Mariana Carvalho de; Lopes, Aline Cristine Souza

doi:10.11606/S1518-8787.2019053000705

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • Rev. Saúde Pública 53 • 2019 • https://doi.org/10.11606/S1518-8787.2019053000705 copy

Monotony in the consumption of fruits and vegetables and food environment characteristics

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To analyze the quantity and diversity in the consumption fruits and vegetables, as well as its relationship with the consumer’s purchase characteristics and food environment.

METHODS

Baseline study stemming from a controlled and randomized community trial investigating a sample representative of Primary Health Care services (Health Academy Program) of Belo Horizonte, state of Minas Gerais. The intake of fruits and vegetables was analyzed in servings/day, whereas diversity was assessed by the Food Frequency Questionnaire. Users were also questioned on the frequency, purchase location and availability of these foods at their households. To assess the consumer’s food environment, commercial establishments within a 1.6 km radius around the program unit sampled were audited.

RESULTS

3,414 adults and older adults (88.1% women) were investigated, as well as 336 commercial establishments, in 18 units of the Health Academy Program. The average consumption of fruits and vegetables was adequate [5.4 (SD = 2.1) servings/day] but monotonous, with average daily intake of two different types. In the establishments audited, a good diversity (77.7% and 85.0%) and variety (74.5% and 81.4%) of fruits and vegetables was observed, although with lower quality of vegetables (60.4%). After adjusting for sociodemographic variables, we identified that knowledge on food crops (p = 0.006), increased monthly availability of fruits at households (p < 0.001), and greater variety of fruits (p = 0.03) and quality of vegetables (p = 0.05) in commercial establishments could improve the quantitative intake of fruits and vegetables, whereas a greater variety of fruits (p = 0.008) would increase consumption diversity.

CONCLUSIONS

The intake of fruits and vegetables was quantitatively adequate but monotonous, being influences by the consumer environment. Such results highlight the need for improving educational actions in health services and programs, in addition to acting on the consumer environment, aiming to promote and maintain the adequate and diversified consumption, as recommended by Brazilian guidelines for proper and healthy eating.

Food Intake; Vegetables; Fruit; Diet Surveys; Food and Nutrition Education

Variable	Total	Quintile of total consumption of fruits and vegetables					p*

		Q1	Q2	Q3	Q4	Q5
Fruits and vegetables (servings/day)	5.4 (2.1)	3.0 (0.6)	4.3 (0.3)	5.2 (0.2)	6.2 (0.3)	8.5 (1.9)	< 0.001
Age (years)	56.7 (11.7)	54.7 (12.6)	56.2 (11.8)	56.8 (11.3)	57.7 (11.3)	58.6 (11.1)	< 0.001
Sex (%)							0.001
Female	88.1	89.5	90.1	88.0	86.9	84.5
Male	11.9	10.5	9.9	11.0	13.1	15.5
Years of study	7.2 (4.1)	7.1 (4.2)	7.1 (4.0)	7.5 (4.1)	7.2 (4.0)	7.3 (4.2)	0.39
Marital status (%)							0.71
Common-law marriage	61.6	60.8	62.9	62.5	61.0	61.0
Divorced	8.3	8.2	8.3	7.9	7.8	9.2
Single	14.1	15.9	13.6	13.1	13.9	13.7
Widowed	16.0	15.1	15.2	16.5	17.3	16.1
Occupation (%)							0.02
Housewife	28.7	31.1	27.8	29.3	29.6	25.5
Retiree	36.7	30.4	33.9	36.3	40.4	43.8
Unemployed	2.0	2.9	1.9	2.1	1.8	1.2
Employee	32.6	35.6	36.4	32.4	28.3	29.5
Economic class (%)							0.83
A/B	29.5	28.7	30.0	30.1	29.7	29.2
C	55.0	53.3	55.6	57.3	56.0	53.1
D/E	15.5	18.0	14.4	12.6	14.3	17.7
PAS time (months)	19.8 (15.3)	18.8 (15.1)	19.5 (14.7)	20.0 (15.7)	20.5 (15.7)	20.4 (15.3)	0.21
BMI (kg/m²)	27.9 (4.8)	27.6 (4.8)	27.6 (4.8)	28.2 (4.7)	27.9 (5.0)	28.0 (5.1)	0.06
Smoking habit (%)	5.7	6.1	4.3	7.2	5.2	5.6	0.99
Chronic diseases (%)
Diabetes	16.9	12.5	13.9	18.3	19.9	21.0	< 0.001
Arterial hypertension	53.2	47.8	51.8	54.4	57.1	55.9	< 0.001
Dyslipidemia	44.1	41.2	42.5	46.1	46.5	44.8	0.62
Health perception (%)							0.48
Very good/good	71.7	71.4	73.4	70.7	73.7	69.6
Regular/Poor/Very poor	28.3	28.6	26.6	29.3	26.3	30.4
Practice of physical exercises (minutes/week)	209.6 (79.9)	201.9 (63.4)	206.8 (71.7)	208.6 (86.9)	218.3 (89.8)	213.0 (84.8)	0.004
Daily diversity (types)
Fruits	1.5 (1.4)	0.8 (1.0)	1.2 (1.3)	1.6 (1.4)	1.7 (1.4)	1.9 (1.5)	< 0.001
Vegetables	0.9 (1.4)	0.7 (1.2)	0.8 (1.3)	0.9 (1.4)	0.9 (1.2)	1.1 (1.6)	< 0.001
Fruits and vegetables	2.3 (2.1)	1.6 (1.7)	2.1 (2.0)	2.6 (2.3)	2.6 (2.2)	3.1 (2.4)	< 0.001

Variable	Total	Quintile of total consumption of fruits and vegetables					p*

		1	2	3	4	5
Knowledge on harvests (%)	75.0	70.8	71.7	78.7	76.4	77.9	< 0.001
Establishment where fruits and vegetables are bought (%)
Supermarkets	40.5	41.6	39.4	39.7	41.3	40.4	0.91
Subsidized Grocery Store	40.8	38.6	39.1	43.5	39.2	43.7	0.07
Private Grocery Store	80.5	82.0	80.9	80.0	81.1	78.5	0.14
Free Trade Fairs	81.2	80.0	82.1	82.4	80.6	81.0	0.89
Municipal Market	23.7	25.5	23.0	23.5	25.3	21.4	0.23
Vegetable garden or donation	22.8	22.1	22.9	21.2	24.7	23.5	0.37
Fruit acquisition frequency (%)							< 0.001
3 times or more/week	8.6	6.5	8.4	8.4	8.8	11.3
1–2 times/week	77.9	73.8	79.0	76.6	80.7	79.7
3 times or less/month	13.5	19.7	12.6	15.0	10.5	9.0
Vegetables acquisition frequency (%)							< 0.001
3 times or more/week	12.9	10.6	12.3	11.9	12.9	16.8
1 to 2 times/week	76.1	73.1	76.9	76.9	77.9	76.0
3 times or less/month	11.0	16.3	10.8	11.2	9.2	7.2
Monthly Availability (days)
Fruits	27.1 (6.6)	25.5 (8.3)	27.1 (6.5)	27.2 (6.3)	28.2 (5.3)	27.9 (5.8)	< 0.001
Vegetables	28.1 (5.5)	27.4 (6.7)	27.9 (5.7)	28.1 (5.6)	29.0 (4.0)	28.6 (5.0)	< 0.001

Region	PAS unit	Adequacy (%)

		Variety of fruits	Variety of vegetables	Fruit diversity	Vegetables diversity	Fruit quality	Vegetables quality
1	1	70.0	70.0	70.0	80.0	85.7	87.5
	2	90.0	90.0	90.0	90.0	100.0	77.8
2	3	77.1	79.2	77.1	72.2	94.1	90.9
	4	83.3	83.3	91.7	75.0	90.0	100.0
3	5	63.6	81.8	75.8	93.9	54.1	38.7
	6	68.7	80.6	80.6	93.5	65.2	37.9
4	7	70.6	88.2	76.5	88.5	54.5	33.3
	8	43.7	62.5	50.0	88.2	73.3	42.8
5	9	83.3	83.3	83.3	68.5	73.3	56.2
	10	70.0	70.0	70.0	83.3	57.1	25.0
6	11	81.8	63.6	81.8	70.0	71.4	50.0
	12	77.8	55.6	77.8	81.8	60.0	62.5
7	13	88.2	100.0	88.2	77.8	80.0	70.6
	14	81.2	95.4	90.9	100.0	78.9	77.2
8	15	70.0	90.0	70.0	95.4	50.0	22.2
	16	71.4	73.3	80.0	90.0	81.2	33.3
9	17	87.1	80.6	87.1	80.0	96.0	82.1
	18	87.7	81.2	87.5	87.5	84.6	73.3

Total		75.4	80.6	79.8	84.2	75.5	60.4

Explanatory variables	B	Standard error	95%CI	p
Model with the outcome variable fruit and vegetables intake (servings)

Individual variables – level 1
Knowledge on harvests^a	0.27	0.09	0.08–0.46	0.006
Buys fruits 3 times or more/week	0.58	0.18	0.22–0.94	0.002
Buys fruits 1 to 2 times/week	0.33	0.13	0.07–0.58	0.012
Monthly Availability of Fruit (days)	0.03	0.01	0.02–0.05	< 0.001
Adjustment variables
Age (years)	0.02	0.00	0.01–0.02	< 0.001
Sex	0.52	0.13	0.27–0.77	< 0.001
Years of study	0.01	0.01	–0.01–0.03	0.56
Environment variables – level 2
Variety of fruits	1.07	0.48	0.13–2.01	0.03
Vegetables quality^b	1.59	0.83	–0.03–3.21	0.05
Random effect
Variance between groups (τ00)	0.14	0.06	0.06–0.33	-
Intra-group variance (σ²)	2.02	0.03	1.96–2.07	-

Model with the outcome variable diversity in the consumption of fruits and vegetables

Individual variables – level 1
Adjustment variables
Age (years)	0.00	0.00	–0.01–0.01	0.58
Sex	0.05	0.12	–0.20–0.30	0.70
Years of study	0.00	0.01	–0.02–0.02	0.79
Environment variables – level 2
Fruit diversity	0.27	0.10	0.07–0.46	0.008
Vegetables quality^b	0.32	020	0.07–0.70	0.11
Random effect
Variance between groups (τ00)	0.31	0.08	0.19–0.53	-
Intra-group variance (σ²)	2.02	0.03	1.97–2.08	-

Faculdade de Saúde Pública da Universidade de São Paulo Avenida Dr. Arnaldo, 715, 01246-904 São Paulo SP Brazil, Tel./Fax: +55 11 3061-7985 - São Paulo - SP - Brazil
E-mail: revsp@usp.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Correspondence: Raquel de Deus Mendonça Departamento de Nutrição – UFMG Av. Professor Alfredo Balena, 190 Sala 102, Santa Efigênia 30130-100 Belo Horizonte, MG, Brasil E-mail: raqueldmendonca@gmail.com