ABSTRACT
Dietary pattern is the general profile of food and nutrient consumption which is characterized on the basis of the usual eating habits. Ultra-processed food products are made from processed substances extracted or refined from whole foods which includes, hydrogenated oils and fats, flours and starches, variants of sugar, and cheap parts or remnants of animal foods; with little or no whole foods. This study assessed the consumption of ultra-processed foods, dietary pattern and anthropometric status of adults 18-45 years in Aba South Local Government Area, Abia State Nigeria. The study adopted a cross-sectional research design whereby 443 respondents were randomly selected for the study. Data was collected from the respondents with the use of a well-structured and validated questionnaire and it was analyzed with the use of Statistical package for social science (SPSS) for windows version 23.0. The findings of the result was presented in frequency and percentage. The result showed that more than half (61.2%) of the respondents were of the age range 18-25 years, 33.8% were of 26-41 years and only 5.0% were of 42-45 years. The result showed that less than half (44.7%) of the respondents were males and more than half (55.3%) were females. The result showed that majority (86.2%) were Christians, whereas 8.4% and 5.4% practiced Tradition and Islam respectively. The result showed that majority (83.5%) had the household size between 1-6 persons, while 13.8% had 7-9% persons and 2.7% had 10 persons and above. The result showed that more than half (64.8%) of the respondents were Igbos, 8.8% were Hausa and 26.9% were Yorubas and other religions. The result showed that 17.6% of the respondents had no formal education, while 35.7% attended primary-secondary school and very many (46.6%) had tertiary education. The result showed that majority (77.0%) of the respondents earned below N 60,000 per month, while 9.7% earned between N 61,000-N 90,000 and 13.3% earned from N 91,000 and above. The result showed that 6.1% of the respondents worked as civil/public servant, 7.7% were farmers, 50.3% were students, whereas 13.5% were artisans and 2.5% were unemployed. The result showed that vast majority (86.9%) of the respondents consumed ultra-processed food and only few (13.1%) do not. The result showed that 28.2% of the respondents consumed soft drinks, 25.3 consumed packaged bread and 13.3% consumed pizza and chocolate bars. The result showed that majority (70.4%) of the respondents’ skipped meals and 29.6% never skipped meals. The result showed that 40.7% skipped breakfast, 37.2% skipped lunch, whereas 11.9% skipped dinner and 2.7% skipped breakfast and lunch. The result showed that vast majority (90.1%) of the respondents consumed snacks and only very little (9.9%) do not take snacks. The result showed that 25.3% of the respondents consumed soft drinks daily, 40.6% consumed it once a week and 12.4% consumed it 2-3 times a week. The result showed that 24.4% consumed doughnuts daily, 27.3% consumed it once a week and 21.1% consumed it 2-3 times a week. The result showed that 12.4% consumed flavored yoghurt daily, 20.1% consumed it 2-3 times a week and more than half (52.8%) never consumed it. The result showed that 2.7% consumed Shawarma daily, 9.3% consumed it once a week and majority (67.7%) never consumed it. The result showed that 7.9% consumed beer daily, 19.2% consumed it once a week and 27.8% consumed it 2-3 times a week. The result showed that the nutritional status of the respondents were very poor following the findings by anthropometric measurement, 26.4% were overweight, 6.8% were obese whereas 33.4% had underweight as well as normal body mass index (BMI). The findings proved lack of nutritional knowledge and awareness as regards consumption of ultra-processed foods and its influence on nutritional status. Again, the findings indicated poor dietary pattern and voracious consumption of unhealthy and non-nutritious foods. Therefore there should be an urgent intervention by nutritionist, dietitians and other health related professions in addressing the pandemics.
TABLE
OF CONTENTS
TITLE PAGE
i
CERTIFICATION
ii
DEDICATION
iii
ACKNOWLEDGMENT
iv
TABLE OF CONTENTS
v
LIST OF TABLES
viii
ABSTRACT
ix
CHAPTER 1
INTRODUCTION
1
1.1 Statement of problem
3
1.2 Objectives
4
1.3 Significance of study
5
CHAPTER 2
LITERATURE REVIEW
2.1 Ultra-processed foods
7
2.1.1 NOVA food classification system
11
2.1.2 Identification of ultra-processed
foods
18
2.2 Changes in eating patterns
19
2.3 Dietary patterns
22
2.4 Anthropometry 24
2.5 Nutritional Status
25
CHAPTER
3
MATERIALS AND METHODS
3.1 Study design
27
3.2 Area of study
27
3.3 Study population
27
3.4 Sampling and sampling techniques
28
3.4.1 Sample size calculation
28
3.4.2 Sampling procedure
28
3.5 Preliminary activities
29
3.5.1 Preliminary visit
29
3.5.2 Training of research assistants
29
3.5.3 Informed consent
29
3.5.4 Ethical approval 29
3.6 Data collection
30
3.6.1 Questionnaire administration 30
3.6.2 Socio-demographic data
30
3.6.3 Dietary history data
30
3.6.4 Consumption of processed and ultra-processed
foods and drinks 31
3.6.5 Socio-economic data
31
3.6.6 Anthropometric measurements
31
3.7 Data analysis
31
3.8 Statistical analysis
31
CHAPTER
4
RESULT AND DISCUSSION
32
4.1
The
Socio-Economic/Demographic Characteristics of The Respondents 38
4.2
Dietary Pattern and
Consumption of Ultra-Processed Food Products of the
Respondents. 42
4.3
Effect of Noodles Consumption, Soft
Drinks, Packed Bread Consumption
And Cake Consumption on the Body Mass Index of
the Respondents 46
4.4 Effect of Canned Fish Consumption on the
Body Mass Index
of
The Respondents Studied 50
4.5
Frequency of Consumption
of Ultra-Processed Foods of the Respondents 55
4.6 Anthropometric Characteristics of the
Respondents 56
4.7 Anthropometric Characteristics of the
Respondents by Sex 58
CHAPTER
5
CONCLUSION AND RECOMMNDATION 61
5.1 Conclusion 61
5.2 Recommendations 62
References
LIST
OF TABLES
Table
4.1: Background information and
socio-economic/demographic
characteristics
of the respondents 41
Table
4.2: Dietary pattern and
consumption of ultra-processed food products
of
the respondents 45
Table
4.3: Effect of instant noodles
consumption, soft drinks, packed bread
consumption
and cake consumption on the body mass index of the
respondents
studied 49
Table
4.4: Effect of canned fish
consumption on the body mass index of the
respondents studied 51
Table
4.5 Frequency of consumption of ultra-processed
foods by the respondents 52
Table
4.6: Anthropometrics
characteristics of the respondents 55
Table
4.7: Anthropometric characteristics
of the respondents by sex 60
CHAPTER
1
INTRODUCTION
BACKGROUND OF THE STUDY
The increasing westernization, urbanization
and mechanization occurring in most countries around the world is associated
with changes in the diet towards one of high fat, high energy-dense foods and a
sedentary lifestyle (WHO, 2010). This shift is also associated with the current
rapid changes in adult obesity. Even in many low income countries, obesity is
now rapidly increasing, and often coexists in the same population with chronic
undernutrition (WHO, 2010). Dietary pattern is
the general profile of food and nutrient consumption which is characterized on
the basis of the usual eating habits (Canete et al., 2017). The analysis of dietary patterns gives a more
comprehensive impression of the food consumption habits within a population. It
may be better at predicting the risk of diseases than the analysis of isolated nutrients
or foods because the joint effect of various nutrients involved would be better
identified (Canete et al., 2017).
Diets in adults have public health implications due to evidence relating to
poor nutrition in childhood to subsequent obesity and elevated risks for type 2
diabetes, metabolic syndrome, and cardiovascular diseases (Canete et al., 2017). Ultra-processed
foods already make up more than half of the total dietary energy consumed in
high-income countries such as the USA, Canada, and the UK, and between one-fifth
and one-third of total dietary energy in middle-income countries such as
Brazil, Mexico and Chile (Baraldi, 2018; Moubarac et al., 2017; Rauber et al., 2018).
Ultra-processed
products are made from processed substances extracted or refined from whole
foods which includes oils, hydrogenated oils and fats, flours and starches,
variants of sugar, and cheap parts or remnants of animal foods; with little or
no whole foods. They are ready-to-consume, and are entirely or mostly made from
industrial ingredients and additives, and are extremely profitable (Moodie,
2013). Some of these processed products include burgers, frozen
pasta, pizza and pasta dishes, nuggets and sticks, crisps, biscuits,
confectionery, cereal bars, carbonated and other sugared drinks, and various
snack products of which the majority is made, advertised, and sold by large or
transnational corporations and are very durable, palatable, and ready to
consume (Moodie, 2013). The observed high prevalence
of obesity and nutrition related diseases highlights the need to focus on
nutritional interventions and dietary pattern of all individuals especially
adults in most of the developing countries (Ebrahim, 2012).
Cross-sectional studies have also shown an
association between ultra-processed food intake and outcomes such as obesity
and non-communicable diseases in many adults. Increased risks of obesity,
hypertension and dyslipidemia among higher consumers of ultra-processed foods
have also been reported by cohort studies (Flegal et al., 2010). Ultra-processed foods are typically energy
dense and have a high glycaemic index (Ebrahim, 2012). They are low in dietary
fibre, micronutrients, and Phytochemicals and are high in unhealthy types of
dietary fat, free sugars, and sodium (Ebrahim, 2012). Ultra-processed products
are harmless; when consumed in small amounts and with other healthy sources of
calories. However, intense palatability (achieved by high content fat, sugar,
salt, and cosmetic and other additives), sophisticated and aggressive marketing
strategies (such as reduced price for super-size servings), have led to an
increase in the consumption of ultra-processed products and displacement of
fresh or minimally processed foods very likely (Ebrahim, 2012).
These
factors also make ultra-processed products liable to harm endogenous satiety
mechanisms and so promote energy, overconsumption and thus obesity.
The
average growth in sales of these products amounts to about 1% per year in high-income
countries and up to 10% per year in middle-income countries (Monteiro et al., 2013). Population based studies
conducted in several countries, most of them using national dietary intake
surveys have shown that ultra-processed foods are typically high energy-dense
products, high in sugar, unhealthy fats and salt, and low in dietary fiber,
protein, vitamins and minerals (Moubarac et
al., 2017; Rauber et al., 2018; Louzada et al., 2018). Unhealthy dietary habits characterized by the consumption of fast foods,
drinking of sugar sweetened beverages, low fruits and vegetables intakes
contributes to the increasing trend of overweight and obesity. Snacking and
fast food consumption have being identified as a contributory factor to the
development of adult overweight and obesity in Nigeria (Olumakaiye et al.,
2010). Poor diet
(high consumption of sugar, salt, saturated fat, etc.) and unhealthy lifestyle
(smoking, alcohol consumption and physical inactivity) have been identified as
major risk factors of cardiovascular disease and other non-communicable diseases
(NCDs) (Olumakaiye et al., 2010). Many adolescents
who encounter numerous health risks along the path to adulthood, many of which
affect quality of life and life expectancy. Studies have shown that youths are
particularly vulnerable to poor eating habits and are said to be in the habit
of eating “junks” (Papadaki and Scott, 2012). These poor eating habits may
likely arise from lack of knowledge of the cumulative effects of their eating
habits. In Nigeria, where there is an increase in fast food centers in its
urban cities, it is a major concern (Ajala, 2016).
1.1 Statement of the problem
In Nigeria today, there have been an
increase in the mortality and morbidity rate of both the affluent and the poor
or marginalized people as a result of diet related non-communicable chronic
diseases such as hypertension, diabetics, dyslipidemia, cancer and other
cardiovascular diseases which are as a result of ultra-processed foods. This
problem is not only restricted to adult but also to the adolescents, children
and infants among all age brackets. Ultra-processed
foods are of major challenge in the economic and socio-economic status of the
nation as it afflicts every home; especially the low- and middle-income states,
which have little or no resources for survival. Ultra-processed foods have now
taken over our indigenous and natural products as individuals now look for the
already made products which tend to save time and relieve stress and at the
same time, feed the human system with intolerable disease and deadly illnesses.
Although, ultra-processed foods and drinks are now foods that everybody enjoys
to eat rather than eating natural and nutrient dense foods which provides
adequate nutrients and maintains a proper health status, there is a need to
look at this pattern of eating in our regional communities and surroundings, as
the level of sedentary lifestyle; like the western countries have become the
pattern for both the old and young, especially the adults and those of the
middle age groups. However, in Nigeria, because of economic development, people
both in rural and urban settings have begun to shift from consumption of
traditional foods towards the consumption of processed and refined foods. Poor
diet (high consumption of sugar, salt, saturated fat, etc.) and unhealthy
lifestyle (smoking, alcohol consumption and physical inactivity) have been
identified as major risk factors of cardiovascular disease and other
non-communicable diseases (NCDs) such as overweight, obesity and chronic
diseases, including diabetes, hypertension and dyslipidemia (Larsen et al., 2012). Poor diet is reported to
contribute up to 87% of high blood pressure cases in sub-Saharan Africa
(Olatunbosun et al., 2000). In 2001 chronic diseases, which
include cardiovascular diseases, cancers, diabetes and obesity, contributed 59%
of the 56.5million reported deaths in the world and 46% of the global burden of
disease (WHO, 2003). Data from Nigerian studies suggest that NCDs have
overtaken communicable diseases as leading causes of morbidity and mortality
due to poor dietary lifestyle (Sani et al.,
2010; Oladipo et al., 2010). It has
been estimated that by 2020 more than 60% of the total burden of chronic
diseases in the world will occur in Asia and Africa (WHO, 2003). Several
surveys carried out globally assessing individual food intake, household food
expenses, or supermarket sales have suggested that ultra-processed food
products contribute to between 25% and 50% of total daily energy intake
(Moubarac et al., 2015; Poti et al., 2015; Slimani et al., 2009). Nutrition-related health
problems such as overweight and obesity in adults are increasingly significant
causes of disability and premature death both in developed and developing
countries including Nigeria (WHO, 2015). The identification of food consumption
pattern and dietary intake and its influence on anthropometric status of adults
is an important strategy for promoting healthy nutritional status and reducing
the disability associated with excess weight gain.
1.2
Objectives of the study:
1.2.1 General objectives of the study
The general objective of the study is
to determine the consumption of ultra-processed foods, dietary pattern and
anthropometric status of adults in Aba South Local Government Area, Abia State Nigeria.
1.2.2 Specific
objectives of the study
The specific
objectives of this study are to:
i.
determine the socio-economic/demographic
characteristics of the respondents
ii.
assess
the dietary pattern and consumption of ultra-processed foods of adults using
food frequency questionnaires
iii.
determine the anthropometric status of the
respondents
1.3
Significance of the study
The study will be significant in the
area of assessing the general knowledge of adults in Aba South local government
of Abia State on the consumption of ultra-processed foods and drinks, to
evaluate the dietary pattern and nutritional status of adults in Aba South local
government area. This study will be of immense benefits to organizations like
World Health Organization (WHO), Food and agricultural organization (FAO) in
creating awareness about the relationship between the consumption of
ultra-processed foods and drinks and the health challenges that are associated
with them. The nutritional status and dietary pattern of people will change
when they are properly informed about the risk and severity of consuming such
foods in abnormal ways. The study will also acquaint nutritionist, dietitians
and food policy makers to advocate effect of consuming such foods in
moderations. This discovery will aid in various ways which include:
1. Nutritionist and
Dietitians: This research work will aid in
creating awareness about the consumption of ultra-processed foods and drinks
and its health implications.
2. Health workers:
This study will help to promote the consumption of traditional foods in Aba
South local government area and its environs. It will also help health workers
towards achieving optimal health in the society.
3. Government: This
study will aid the government in implementing policies that will ensure good
health for her citizens. It will aid the government to enact programs that will
educate her citizens on the benefits of consuming traditional foods instead of
ultra-processed foods.
4. Researchers:
This study will be a guide for further research on ultra-processed foods and
drinks. It will also aid in improvement of other previous studies and as
reference materials.
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