Ultra-processed foods (UPFs) high in fats, sugar and salt (HFSS) are industrially formulated food products manufactured largely by the Big Food companies. Ultra-processed foods are formulated and packaged in such a way to make them intensely palatable, have a long shelf stability and eliminate the need for culinary preparations. Examples of UPFs are carbonated and other sugar sweetened beverages (SSBs) such as potato chips, cookies, biscuits, sweets, nuggets, instant noodles, energy drinks, frozen desserts, ice-cream, infant formula, sweetened breakfast cereals and fruit drinks. The consumption of ultra-processed foods (UPFs) and sugar-sweetened beverages is increasing rapidly, replacing use of traditional or indigenous, culturally acceptable freshly cooked food. The potential cause of the pandemic of overweight, obesity and rapid rise of related chronic diseases such as stroke, high blood pressure and coronary heart diseases especially in under developed countries is the corresponding increase in the production, processing and consumption of readily available ‘fast’ or ‘convenience’ ready-to-eat or ready-to-heat processed food and beverage products. The consumption of ultra-processed foods and drinks, and dietary pattern of adults was found out to be one of the causes of overweight and obesity in adults which in turn affects the BMI giving rise to the development of non-communicable diseases like hypertension, diabetes, dyslipidaemia and cancer among higher consumers of ultra-processed foods. This study was designed to assess the consumption of ultra-processed foods, dietary pattern and anthropometric status of adults aged (20-49 years) in Ikwuano Local Government Area, Abia State. The study is a cross sectional survey. A total of 440 adults were randomly selected for this study. A well structured and validated questionnaire was used to collect information on the socio-economic and demographic characteristics, the consumption of ultra-processed foods, the dietary pattern and the anthropometric status of the respondents. The questionnaire was coded and entered into computer using the statistical package for social sciences (SPSS) version 24.0. The data were analyzed using descriptive statistics. More than half of the respondents studied were (67.0%) males and (33.0%) females. Majority of the adults studied were between the age of 26 and 32 years (62.3%). The study showed that men more commonly consumed ultra-processed foods compared to women. About more than half of the respondents (53.0%) who had overweight consumed soft drinks daily. About more than half of the respondents (60.7%) whose body mass index were normal consumed cake. Chi-square analysis was used to assess the relationship between the consumption of processed and ultra-processed food, dietary pattern and the anthropometric status of the respondents. The chi-square analysis showed that there was a significant association between consumption of cake and BMI of the respondents (p=0.000). This implies that consumption of cake have an effect on the body mass index of the respondents. The study indicated that men mostly consume ultra-processed foods than women. This study showed that there was high rate of obesity amongst male adults than female adults which implies that there was a significant relationship between obesity, dietary patterns and consumption of ultra-processed foods and drinks. The problem was found to be more prevalent among males than females. Nutrition education should focus on enlightening the community on the need of consuming hand-made dishes made from fresh indigenous foods as well as encourage and support healthy food preparation. Statutory regulatory bodies need to regulate unhealthy products such as the food additives, colour and preservatives used in producing ultra-processed products which has been found to be problematic.
TABLE OF CONTENTS
TITLE PAGE i CERTIFICATION ii DEDICATION iii ACKNOWLEDGEMENT iv
TABLE OF CONTENT v LIST OF TABLES viii
Background of the study 1
1.1 Statement of the problem 4
1.2 Objectives of the study 6
1.2.1 General objective of the study 6
1.2.2 Specific objectives of the study 6
1.3 Significance of the study 7
2.1 Food consumption, dietary pattern and lifestyle 9
2.1.1 Ultra-processed foods and drinks 9
2.1.2 The nature of ultra-processed foods 11
2.2 NOVA food classification and it’s food groups 13
2.2.1 Unprocessed and minimally processed foods 14
2.2.2 Processed culinary ingredients 15
2.2.3 Processed foods 16
2.2.4 Ultra-processed foods 17
2.3 Identifying ultra-processed 19
2.3.1 Ultra-processed food intake and nutrient-based dietary patterns 21
2.4 Ultra processed foods and its associated risk factor 22
2.4.1 Ultra-processed foods and obesity 22
2.4.2 Ultra processed foods and cardiovascular diseases 22
2.4.3 Ultra-processed foods and cancer 24
2.4.4 Ultra-processed food and food allergy 26
2.5 Dietary pattern 27
2.6 Nutritional status 27
MATERIALS AND METHODS
3.1 Study design 29
3.2 Area of study 29
3.3 Population of the study 29
3.4 Sampling and sampling techniques 30
3.4.1 Sample size determination 30
3.4.2 Sampling procedure 31
3.5 Preliminary activities 31
3.5.1 Preliminary visits 31
3.5.2 Training of research assistants 31
3.5.3 Informed consent 32
3.5.4 Ethical clearance 32
3.6 Data collection 32
3.6.1. Questionnaire design 33
3.6.2 Questionnaire administration 33
3.6.3 Interview 33
3.6.4 Anthropometric measurements 33
3.6.5 Dietary assessment 34
3.7 Data analysis 34
3.8 Statistical analysis 35
RESULTS AND DISCUSSION
4.1 Socio-economic and demographic characteristics of the respondents 36
4.2 Consumption pattern of ultra processed food and drinks of the respondents 39
4.3 Anthropometric status of the respondents 43
4.4 Anthropometric status of the respondents by sex 44
4.5 Relationship between ultra-processed foods consumption and the body mass index of the respondents studied. 45
CONCLUSION AND RECOMMENDATION
5.1 Conclusion 46
5.2 Recommendation 47
LIST OF TABLES
Table 4.1: Socio-economic and demographic characteristics of the respondents 38
Table 4.2: Consumption pattern of ultra processed food and drinks of the respondents 42
Table 4.3: Anthropometric status of the respondents 43
Table 4.4: Anthropometric status of the respondents by sex 44
Table 4.5: Relationship between ultra-processed foods consumption and the body mass index of the respondents studied 45
BACKGROUND OF THE STUDY
The dietary patterns of the world population have been on transition due to the high consumption of ready-to-eat foods which have increased levels of fat and sugar, and lower intake of unprocessed foods, such as fruits, vegetables, tubers, and cereals (oat meals) (Monteiro et al., 2011). The potential cause of the pandemic of overweight, obesity and rapid rise of related chronic diseases especially in under developed countries is the corresponding increase in the production, processing and consumption of readily available ‘fast’ or ‘convenience’ ready-to-eat or ready-to-heat processed food and beverage products (WHO, 2003). Recent research shows that consumption of various products such as cookies (biscuits), baked products, sweets and desserts, sugar-sweetened drinks or products, processed meats, and French fries and chips (chips and crisps) is associated with weight gain in adults (Mozaffarian et al., 2011).
Curiously, the fact that the products are heat processed is mostly elided or understated or even overlooked or ignored. Furthermore, food processing as such is not identified in food classifications, such as Canada’s Food Guide (Health Canada, 2011). Additionally, food processing is rarely addressed in dietary assessments: methods including the 24 hour recall and Food Frequency Questionnaire are usually not adequate or enough to collect sufficient data that would allow the distinction of foods based on processing method.
Ultra-processed foods are defined within the NOVA classification system, which groups foods according to the extent and purpose of industrial processing. NOVA is a food classification system developed by researchers at the university of Sao Paulo Brazil (Monteiro et al., 2010). Processes enabling the manufacture of ultra-processed foods include the fractioning of whole foods into substances, chemical modifications of these substances, assembly of unmodified and modified food substances, frequent use of cosmetic additives and sophisticated packaging. Processes and ingredients used to manufacture ultra-processed foods are designed to create highly profitable (low-cost ingredients, long shelf-life, emphatic branding), convenient (ready-to-consume), hyper-palatable products liable to displace all other NOVA food groups, notably unprocessed or minimally processed food products (Canno et al., 2016). A practical way to identify an ultra-processed product is to check to see if its list of ingredients contains at least one item characteristic of the NOVA ultra-processed food group, which is to say, either food substances never or rarely used in kitchens (such as high-fructose corn syrup, hydrogenated or interesterified oils, and hydrolysed proteins), or classes of additives designed to make the final product palatable or more appealing (such as flavours, flavour enhancers, colours, emulsifiers, emulsifying salts, sweeteners, thickeners, and antifoaming, bulking, carbonating, foaming, preservatives, gelling and glazing agents) (Monteiro et al., 2016). Ultra-processed foods already make up more than half of the total dietary energy consumed in high-income countries and between one-fifth and one-third of total dietary energy in middle-income countries. 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 fibre, protein, vitamins and minerals (Chediel et al., 2010). Cross-sectional and longitudinal studies have shown that increases in the dietary share of ultra-processed foods result in deterioration of the nutritional quality of the overall diet and increased obesity, hypertension, coronary and cerebrovascular diseases, dyslipidaemia, metabolic syndrome, gastrointestinal disorders, and total and breast cancer. Avoidance of ultra-processed foods is the ‘golden rule’ of national dietary guidelines issued recently in Latin American countries (Collins et al., 2019).
Ultra-processed fast foods and soft drinks are the main business of transnational and big national catering chains, whose outlets are also often open until late at night, and whose products are designed to be consumed also in the street, while working or driving, or watching television. Over-consumption is also pushed by lightly regulated or often practically unregulated advertising that identifies fast and convenience food, soft drinks and other ultra-processed products as a necessary and integral part of the good life, and even, when the products are ‘fortified’ with micronutrients, as essential to the growth, health and well-being (Allemandi, 2018) . General, animal foods are good sources of various amino acids, vitamins and minerals, but contain little or no dietary fibre. Quite often they are energy-dense and high in unhealthy types of fat. Plant foods are usually low in energy density and good sources of dietary fibre. Many are high in various micronutrients and bioactive compounds, and some are good sources of amino acids. This is why the human species has evolved as omnivorous. This explains why a great variety of traditional and long established food systems have been developed that have in common, the combination of plant foods with complementary nutrient profiles, such as grains (cereals) with legumes (pulses), or roots with tubers and legumes, or grains with vegetables, and usually with modest amounts of animal foods.
1.1 STATEMENT OF THE PROBLEM
Due to the sudden increase of obesity and overweight and other non communicable diseases (NCDs), the consumption of ultra-processed foods and drinks, and dietary pattern of adults was found out to be one of the causes of overweight and obesity in adults which in turn affects the BMI giving rise to the development of non-communicable diseases like hypertension, diabetes, dyslipidaemia and cancer among higher consumers of ultra-processed foods. The consumption of ultra-processed foods (UPFs) and sugar-sweetened beverages is increasing rapidly, replacing use of traditional or indigenous, culturally acceptable freshly cooked food (Moodie et al., 2013). These Ultra-processed products are characteristically formulated from ‘refined’ and ‘purified’ ingredients freed from the fibrous watery matrix of their original raw materials. They are formulated to be sensually appealing, hyper-palatable, and habit-forming, by the use of sophisticated mixtures of cosmetic and other additives, and state of the craft packaging and marketing. The leading branded ultra-processed foods and drinks are manufactured by transnational companies creating substrates for their products at rock-bottom or even subsidised process (Baker and Friel, 2016). They penetrate new markets in lower-income countries, with massive marketing and advertising budgets, and may undercut local industries, drive them out of business, or take them over. Rauber (2018) reported that high consumption of Ultra-processed foods correlated with lower intake of protein, fibre, and potassium and a higher intake of carbohydrates, free sugars, total fats, saturated fats, and sodium, thereby increasing the risk of diet-related non communicable diseases, cardiovascular diseases and some cancers. The world health organization (WHO) and the World Cancer Research Fund state that sugary drinks, energy dense snacks and 'fast food', all of which are ultra-processed, are key drivers of obesity, diabetes, cardiovascular diseases and certain cancers. In the last decades, ultra-processed products have usually become relatively or even absolutely cheaper to manufacture, and sometimes – not always – relatively cheaper to buy. They are often manufactured in increasingly supersized packages and portions at discounted prices with no loss to the manufacturer (Mallarino et al., 2013). The packaging may cost more than the contents. Ultra-processed snacks and soft drinks are available in ‘convenience’ stores and other outlets often open late or even 24/7, and vended in machines placed in streets, gas stations, hospitals, schools and many other locations. Ultra-processed fast foods and soft drinks are the main business of transnational and big national catering chains, whose outlets are also often open until late at night, and whose products are designed to be consumed also in the street, while working or driving, or watching television. Over-consumption is also pushed by lightly regulated or often practically unregulated advertising that identifies fast and convenience food, soft drinks and other ultra-processed products as a necessary and integral part of the good life, and even, when the products are ‘fortified’ with micronutrients, as essential to the growth, health and well-being (Allemandi, 2018). A feature of the promotion of ultra-processed products in low-income countries, is incitement to over-consumption much more blatant than any now commonly found in other high-income countries where obesity is understood by all to be a crisis. Another feature is the direct marketing of branded products to impoverished communities (Monteiro et al., 2010). These products are made in such a way that the consumers cannot easily resist them with the saying “ Take one, taste and you will surrender!. It would be strange if, in the volume now manufactured and consumed, they were not a leading cause of the current pandemic of overweight and obesity. Importantly, there was a significant positive association between the availability and consumption of ultra-processed foods and the prevalence of adult obesity at national level (Monteiro et al., 2018). Most people crave and consume more of these ready to eat or convenient foods not necessarily because they want them but because they see these ultra-processed foods are the fastest and easiest food to prepare or consume. Others also consume them just to save time while few other take them as meal to meet up their daily dietary requirement. Additionally, due to the increase of fast. food centres, convenience food store, shops in Ikwuano L.G.A of Abia State, Nigeria. There is a major concern as this is a major contributor to the consumption of ultra-processed products among adults. Although the consequencies of such decisions is unknown to them. Hence, the purpose of this study. These has predominantly giving rise to non-communucable diseases like hypertension, high blood pressure, diabetes and stroke amongst adults.
1.2 OBJECTIVES OF THE STUDY
General Objective of the study
The general objective of the study was to investigate the consumption of ultra-processed foods and dietary pattern of adults aged (20-49 years) in Ikwuano Local Government Area, Abia State.
Specific Objectives of the study
The specific Objectives of this study were;
1. To determine the socio-economic and demographic characteristics of the respondents.
2. To ascertain the consumption of ultra-processed food and dietary pattern of the respondents.
3. To assess the anthropometric status of the respondents.
4. To determine the relationship between ultra-processed food consumption and the body mass index of the respondents.
1.3 SIGNIFICANCE OF THE STUDY
The findings of this study will enlighten the public on the importance of attaining good nutritional standard within the household and also the health consequences associated with increased consumption of ultra-processed foods and beverages thereby limiting the prevalence of some ailments such as non communicable diseases, cardiovascular diseases and some cancers (De Vogli et al., 2014). This study will help policy makers and regulatory bodies in implementing laws that will guide the production, distribution and consumption of some of the products listed as ultra-processed products. Also consumers will be empowered to always make the right choices in food selection thereby improving the well being of households as well as the community. With the recognition of role of Ultra-processed foods in causing Non-communicable diseases, this study will enlighten the individual on the need to create a selective efforts to regulate the marketing of Ultra-processed and as well reducing their consumption (Foodie et al.,2013). However, more needs to be done to effectively reduce their consumption. A comprehensive documentation of national efforts and evaluation of their impact may be a first step. More importantly, a global marketing code should be adopted, based on which national legal instruments may be enacted. Such a Code should provide recommendations for prohibiting Ultra-processed food advertising and promotion, particularly to children; prohibiting sponsorship of research, sports and academic activities by Ultra-processed food manufacturers, and developing a system for monitoring and implementation of the code. The code should also prohibit participation of Ultra-processed food manufacturers in national and international policymaking and programme implementation. This study will also be useful for health practitioners, policy makers, researchers and educationists by providing them with relevant information regarding production and consumption of ultra-processed foods. Correspondingly, production and accessibility of wholesome foods need to be increased and improved by adopting specific policies, and regulatory actions designated to make healthy choices the easy choices backed by education programs. It is hoped that if the result of this research is really implemented by the households both at community, wards ,districts and state levels, it will further help to correct many bad practices associated with production and consumption of ultra-processed foods and drinks thereby encouraging many to feed adequately.
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