ABSTRACT
Ultra-Processed Foods are packaged formulation resulting from several sequences of industrial processes, they are manufactured entirely from substance derived from foods and several additives used to imitate sensory properties of foods or to disguise unpalatable aspects of the final product. The diets of adolescents are of public health concern due to evidence risk for type 2 diabetes, metabolic syndrome and Cardio Vascular Disease (CVD). This study was carried out to assess the consumption of Ultra-Processed Food, dietary pattern and anthropometric status among adolescents (10-19) in Igbo Etiti Local Government Area, Enugu State. 440 adolescents were selected using a simple random sampling technique balloting without replacement from the 10 schools out of all the schools in the Local Government Area. A validated questionnaire was used to obtain information on adolescents’ data, socio-economic characteristic, Anthropometric measurements of the adolescents were taken to compare with WHO reference standard. Data obtained were subjected to statistical analysis using Statistical Package for Social Sciences (SPSS) version 22.0. The results showed that less than half (41.1%) of the respondents were of male gender while more than half (58.9%) of the respondents constituted female gender; About 42.0% of the respondents were within the age range of 10-15years while 58.0% were within 16-19years. The result also showed that more than half (50.7%) of the respondents have their education level in the Junior Classes while 49.3% of the respondents were in Senior classes. The result also showed that only (10.4%) of the respondents are of 1-6 household size while less than half (31.4%) are from 7-9 household size but majority (58.2%) of the respondents have household size above 10. The findings of the study shows that majority of the respondents rarely consume Ultra Processed Food which can be linked to their nutritional status because more than half of them had a normal body mass index and few of them were overweight and none of them were obese.
TABLE OF CONTENTS
Cover page
Title Page i
Certification ii
Dedication iii
Acknowledgements iv
Table of Contents v
List of Tables viii
Abstract ix
CHAPTER 1: INTRODUCTION
1.1 Background of the Study 1
1.2 Statement of the Problem 4
1.3 Objective of the Study 5
1.4 Significance of the Study 6
CHAPTER 2: REVIEW OF LITERATURE
2.1 Overview of Adolescents 7
2.2 Adolescents eating habits 8
2.3 Adolescents food choice 10
2.3.1 Food choice influence 10
2.4 Nova food classification system 14
2.4.1 Unprocessed or minimally processed food 15
2.4.2 Processed culinary ingredients 16
2.4.3 Processed food 17
2.4.4 Ultra-processed food products 18
2.5 Identifying ultra-processed food 19
2.6 Consumption of ultra-processed food and body fat during adolescence 21
2.7 Problems associated with processed and ultra-processed food products 22
2.8 Impact of ultra-processed food products on nutrition, health, and well-being 25
2.8.1 Ultra-processed foods and the risk of non-communicable disease 27
2.9 Dietary pattern 28
2.9.1 24-hour dietary recall 28
2.9.2 Food frequency questionnaire (FFQ) 29
2.10 Anthropometry 31
2.10.1 Weight 32
2.10.2 Height 32
2.10.3 Body mass index 33
2.10.4 Waist circumference 34
2.10.5 Hip circumference 34
2.10.6 Waist-hip-ratio 35
CHAPTER 3: MATERIALS AND METHODS
3.1 Design of the Study 36
3.2 Area of the Study 36
3.3 Population for the Study 37
3.4 Sample and Sampling Techniques 37
3.4.1 Sampling size determination 37
3.4.2 Sampling procedure 38
3.5 Preliminary activities 39
3.5.1 Preliminary visits 39
3.5.2 Training of research assistants 39
3.5.3 Informed consent 39
3.5.4 Ethical approval 40
3.6 Data collection 40
3.6.1 Questionnaire design 40
3.6.2 Questionnaire administration 41
3.6.3 Anthropometry 41
3.6.4 Weight measurement 41
3.7 Data analysis 42
3.8 Statistical analysis 44
CHAPTER 4: RESULTS AND DISCUSSION
4.1 Background information and socio-economic characteristics of the Respondents 45
4.2 Background information and socio-economic characteristics of parents
of the Respondents 48
4.3 Consumption pattern of ultra-processed food of the respondents 51
4.4a Anthropometric status of the respondents 56
4.4b Anthropometric status of the respondents by gender (Sex) 56
4.5 Relationship between the consumption ultra-processed food and anthropometric
Status of the respondents 59
CHAPTER 5: SUMMARY, RECOMMENDATIONS AND CONCLUSION
5.1 Conclusion 64
5.2 Recommendation 64
References 66
Appendices 78
LIST OF TABLES
4.1 Socio-demographic characteristics of the respondents 47
4.2 Socio-demographic characteristics of parents of the respondents 50
4.3 Consumption pattern of ultra-processed food of the respondents 54
4.4a Anthropometric status of the respondents 56
4.4b Anthropometric status of the respondents by gender (Sex) 58
4.5 Relationship between the consumption level of the respondents and their anthropometric status 61
CHAPTER ONE
INTRODUCTION
1.1 BACKGROUND OF THE STUDY
The diets of adolescents are of public health concern due to evidence relating to poor znutrition in childhood to subsequent obesity and elevated risks for type 2 diabetes, metabolic syndrome and Cardio Vascular Diseases (CVD) (Canete et al., 2008), all of which are increasing in prevalence (World Health Organization, 2004). Exacerbating this scenario, some dietary patterns such as snacking, usually on energy-dense food meal skipping, particularly breakfast, or irregular meal wide use of fast food and low consumption of fruits and vegetables appear quite common among adolescents (Cavadini et al., 2009).
Processed foods are foods that have been altered to add substances that substantially change their nature or use while ultra-processed food and drink products are packaged formulations resulting from several sequences of industrial processes (hence ultra-processed). They are manufactured mostly or entirely from substances derived from foods and several additives used to imitate sensory properties of foods or to disguise unpalatable aspects of the final product. They typically contain little or no intact foods, and are ready to drink, eat or heat up (Martínez et al., 2016; Monteiro et al., 2018). These products (particularly ultra-processed products) are more energy-dense and have more fat, sugar and sodium than fresh or minimally processed foods and culinary ingredients (such as oils, sugar, and salt) (Moubarac et al., 2013). Moreover, the sale and consumption of ultra-processed products is rapidly increasing throughout the world (Monteiro et al., 2013).
The relationship between consumption of specific ultra-processed foods such as soft drinks and diet-related chronic non-communicable diseases is well documented (Micha et al., 2015). Cross-sectional studies have also shown an association between ultra-processed food intake and outcomes such as obesity and metabolic syndrome (Louzada et al., 2015). Increased risks of obesity, hypertension and dyslipidaemia among higher consumers of ultra-processed foods have also been reported by cohort studies (Mendonça et al., 2016). Indeed, studies have shown ultra-processed foods are the major dietary contributors of added sugars with the mean added sugars content almost tripling between the first and last quintiles of ultra-processed food consumption (Martínez et al., 2017). An increase in dietary contribution of ultra-processed foods has also been associated with both a decrease in protein, fibre, vitamins A, C, D and E, zinc, potassium, phosphorus, magnesium and calcium densities, and with an increase of carbohydrate, added sugar and saturated fat contents (Martínez et al., 2017).
Adolescence is a period between the ages of 10 and 19 years, characterized by many physiological changes and formation of lifelong eating habits (WHO, 2004). Eating habits acquired during infancy, childhood and adolescence, whether healthy or not, are likely to be maintained throughout life (Movassagh et al., 2017). Dietary components, such as food products rich in cholesterol, saturated fatty acids (Kuipers et al., 2011), trans fatty acids (Ganguly and Pierce, 2012) and sodium (ODonnell et al., 2013), can have deleterious effects if consumed in inadequate amounts and intervals. Increased intake of processed and ultra-processed foods and drinks by adolescents are major contributors to obesity (Mistry and Puthussery, 2015).
The increase in obesity in this population has occurred in parallel with changes in the global food system, which currently makes available a wide variety of ready-to-eat foods and beverages, known as ultra-processed foods (Souza et al., 2016). While processing ensures improvement of food availability, digestibility, short-term safety, transportability, and storage life (Ludwig, 2011), Ultra Processed Foods (UPF) are often energy-dense and poor in micronutrients; thus, they may have a potential deleterious role on health. In addition, their high palatability, which is associated with their convenience and aggressive advertising, are factors that have stimulated their consumption (Bielemann et al., 2015).
The high palatability, availability and the aggressive marketing of these products challenge their conscious consumption and make them preferred substitutes for adolescents (Moodie et al., 2013). Another exacerbating factor is that the introduction of these products has been occurring very early in childrens diets, even before 12 months of age (Longo-Silva et al., 2015). Processed and ultra-processed foods, especially energy-dense foods high in sugar, fat and salt, is gradually displacing home-prepared meals and the consumption of fresh fruit and vegetables in typical diets in Enugu State. Thus, this study will be carried out to assess the consumption of processed and ultra-processed food products and dietary pattern of adolescents in Igbo-Etiti L.G.A in Enugu State.
1.2 STATEMENT OF PROBLEM
The epidemiological and nutritional scenario in recent decades has proven dynamic, resulting from global changes in lifestyles and dietary habits (Schmidt et al., 2011). Urbanization and industrialization have contributed to changes in eating patterns (Popkin, 2006). With the food transition, the dietary profile of adolescents has been characterized by high energy density, while high-fiber and nutritionally balanced foods have been replaced by heavily-processed high-fat and high-sugar products (Martins et al., 2013).
The food choices of adolescents in Igbo-Etiti, Enugu State are not consistent with the dietary guidelines and food intake tends to be low in fruit, vegetables, and calcium-rich foods and high in fat (Story et al., 2012). Hilsen et al. (2010) reported that a large number of adolescents consume unhealthy food items at school.
The sale and consumption of ultra-processed products is rapidly increasing throughout the world especially in Enugu State. According to the NOVA classification proposed by Monteiro et al. (2018), Ultra-Processed Foods (UPF) differ from less processed foods in that they fail to maintain their basic identity, undergoing various processing stages and techniques and including substances used exclusively in industries. Ultra-Processed Foods are nutritionally unbalanced and heavily consumed in high- and low-income countries, but their consumption is also growing rapidly in medium-income countries like Nigeria (Monteiro et al., 2013). Examples of these products include cream-filled cookies, “packaged” salty snacks, sodas, and “instant” noodles, among others. The low nutritional quality of these foods has a negative impact on individuals health, and the consumption of Ultra Processed Foods has been related to metabolic syndrome and obesity in adolescents which has presented a growing prevalence over the last three decades. Adolescence is an important phase for health promotion and the prevention of risk factors, since eating habits are acquired during this phase, as well as in childhood, and tend to persist throughout life (WHO, 2003). Given the above, the aim of this study was to assess the consumption of processed and ultra-processed food products and dietary pattern of adolescents in Igbo-Etiti L.G.A in Enugu State.
1.3 OBJECTIVES OF THE STUDY
1.3.1 General Objective of the Study
The general objective of the study is to assess the consumption of processed and ultra-processed food products and dietary pattern of adolescents (10-19 years) in Igbo-Etiti L.G.A in Enugu State.
1.3.2. Specific Objective of the Study
The specific objectives of this study are to:
i. assess the socio-economic characteristics of the respondents
ii. ascertain the consumption of ultra-processed foods of the adolescents
iii. assess the anthropometric status of the respondents using body mass index.
iv. determine the relationship between respondents consumption of processed and ultra-processed foods, and their anthropometric status.
1.4 SIGNIFICANCE OF THE STUDY
Findings from this study will provide information on the food and dietary habits of adolescents. It will also provide information on the intake of processed and ultra-processed foods among adolescents. Also, it will be of interest and useful to health practitioners, nurses, doctors, nutritionists and educationist by providing them with the information on the relationship between consumption of processed and ultra-processed foods, dietary pattern and anthropometric status of adolescents. This study will help to identify the lapses and provide strategies in improving food habits among adolescents. The study would also be useful to nutritionists, corporate and professional bodies by providing sufficient information which would serve as a medium or basis for further researches to be carried out in the near future.
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