Dietary practices of quota and non-quota students at a Brazilian public university

Patrícia Maria Périco Perez Inês Rugani Ribeiro de Castro Amanda da Silva Franco Daniel Henrique Bandoni Daisy Blumenberg Wolkoff About the authors

Resumo

As práticas alimentares de universitários foram descritas e examinadas segundo forma de ingresso na universidade (cotistas e não cotistas). Foi realizado um estudo seccional com 1336 graduandos de uma universidade pública utilizando questionário autopreenchido e identificado abarcando os hábitos de realizar desjejum e de substituir o almoço e/ou o jantar por lanche e o consumo regular de alimentos marcadores de alimentação saudável e não saudável. A análise da associação entre forma de ingresso e práticas alimentares foi feita por meio de modelos de regressão logística uni e multivariada. Foram observadas proporções expressivas de: não realização do desjejum, substituição do jantar por lanche, baixo consumo de frutas, hortaliças e feijão e consumo frequente de bebidas açucaradas, guloseimas e biscoitos e/ou salgadinhos “de pacote”. Entre cotistas, foi mais frequente o consumo de feijão, de biscoitos e/ou salgadinhos “de pacote” e de biscoitos doces e menos frequentes a substituição de jantar por lanche e o consumo de hortaliças e de frutas. Cotistas e não cotistas apresentaram práticas alimentares com algumas semelhanças e desfavoráveis para a saúde. As diferenças observadas entre os dois grupos foram, em sua maioria, na direção de um quadro mais desfavorável para os cotistas, exceto para feijão.

Consumo de alimentos; Hábitos alimentares; Estudantes; Política social

Abstract

Abstract Dietary practices of college students were described and examined according to the means by which they were admitted to the university (quota and non-quota students). A cross-sectional study was conducted with undergraduates (n = 1336) at a public university using a self-administered and identified questionnaire that inquired about their habits of eating breakfast and substituting lunch and/or dinner with snacks as well as the regular consumption (≥ 5 times a week) of markers for healthy and unhealthy eating. Analysis of the association between means of admission to the university and dietary practices was done using univariate and multivariate logistic regression models. It was observed that significant proportions of the students did not eat breakfast; substituted dinner with snacks; had low fruit, vegetable and bean consumption; and frequently consumed sugary beverages, sweets, cookies and packaged salty snacks. The quota students were found to more frequently consume beans, cookies and packaged salty snacks and less frequently substitute dinner with snacks and consume vegetables and fruits. Quota and non-quota students had some similarities in their dietary practices that were unhealthy. The differences observed between the two groups were largely more unfavorable for the quota students, with the exception of bean consumption.

Food consumption; Dietary habits; Students; Public policy

Introduction

The promotion of healthy dietary practices is currently a priority on the public policy agenda for health, food and nutrition in Brazil11. Brasil. Ministério da Saúde (MS). Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Política Nacional de Alimentação e Nutrição. 3ª ed. Brasília: MS; 2012. Série B. Textos Básicos de Saúde.. The dietary practices of young adults (on which this study focuses) are influenced by the environment in which they are placed, as occurs with other population groups22. Van Der Horst K, Oenema A, Ferreira I, Wendel-Vos W, Giskes K, Van Lenthe F, Brug J. A systematic review of environmental correlates of obesity-related dietary behaviors in youth. Health Educ Res 2007; 22(2):203-226.. Promoting these practices in organizational settings is an action highlighted in the National Food and Nutrition Policy11. Brasil. Ministério da Saúde (MS). Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Política Nacional de Alimentação e Nutrição. 3ª ed. Brasília: MS; 2012. Série B. Textos Básicos de Saúde., the National Health Promotion Policy33. Brasil. Ministério da Saúde (MS). Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Política Nacional de Promoção da Saúde. 3 ed.. Brasília: MS; 2010. Série B. Textos Básicos de Saúde., affirmative action policies44. Sousa LP, Portes EA. As propostas de políticas/ações afirmativas das universidades públicas e as políticas/ações de permanência nos ordenamentos legais. Rev Bras Estud Pedagog 2011; 92(232):516-541., and the National Food and Nutrition Security System55. Brasil. Presidência da República. Casa Civil. Lei nº 11.346, de 15 de setembro de 2006. Cria o Sistema Nacional de Segurança Alimentar e Nutricional - SISAN com vistas em assegurar o direito humano à alimentação adequada. Brasília: Diário Oficial da União 2006; 18 set., in accordance with policies proposed by the World Health Organization, which point to school, community and work settings as important places that are strategic to promoting healthy eating66. World Health Organization (WHO). Diet, nutrition and the prevention of chronic diseases. Geneva: WHO; 2003..

The university setting merits particular attention, as many dietary habits that students acquire there continue into adult life, representing a unique opportunity to promote healthy eating77. Haberman S, Luffey D. Weighing in college students’ diet and exercise behaviors. J Am Coll Health 1998; 46(4):189-191.. For many students, attending a university represents the first occasion in which they need to take responsibility for their own housing, food and time and financial management. An inability to handle such tasks may result in skipping meals and eating snacks, thus leading to the nutritional inadequacy of the food consumed88. Duarte FM, Almeida SDS, Martins KA. Alimentação fora do domicílio de universitários de alguns cursos da área da saúde de uma instituição privada. O Mundo da Saúde 2013; 37(3):288-298.. Studies focusing on university students are still scarce. However, various studies have suggested that such students exhibit inappropriate dietary patterns88. Duarte FM, Almeida SDS, Martins KA. Alimentação fora do domicílio de universitários de alguns cursos da área da saúde de uma instituição privada. O Mundo da Saúde 2013; 37(3):288-298.

9. Vieira VCR, Priore SE, Ribeiro SMR, Franceschini SCC, Almeida LP. Perfil socioeconômico, nutricional e de saúde de adolescentes recém-ingressos em uma universidade pública brasileira. Rev Nutr 2002; 15(3):273-282.

10. Papadaki A, Hondros G, Scott JA, Kapsokefalou M. Eating habits of University students living at, or away from home in Greece. Appetite 2007; 49(1):169-176.
-1111. Marcondelli P, Costa THM, Schmitz BAS. Nível de atividade física e hábitos alimentares de universitários do 3º ao 5º semestres da área da saúde. Rev Nutr 2008; 21(1):39-47..

In Brazil in recent years, the university setting has become even more strategic as a place to promote healthy eating and food and nutritional security44. Sousa LP, Portes EA. As propostas de políticas/ações afirmativas das universidades públicas e as políticas/ações de permanência nos ordenamentos legais. Rev Bras Estud Pedagog 2011; 92(232):516-541., as affirmative action measures have been implemented that provide university access to individuals who have historically been excluded1212. Santos JT. Ações afirmativas e educação superior nas universidades brasileiras: um balanço crítico da produção. Rev Bras Estud Pedagog 2012; 93(234):401-422.. This has been achieved through systems that prioritize admission according to various criteria: economic (income), racial (black people), schooling (having studied in public schools) and others. The most well-known practice is the system in which university spaces are reversed via quotas. Studies have shown that these policies have been successful in enabling admission to universities but that they have been less effective in ensuring that the students will remain in the institutions until graduatoin44. Sousa LP, Portes EA. As propostas de políticas/ações afirmativas das universidades públicas e as políticas/ações de permanência nos ordenamentos legais. Rev Bras Estud Pedagog 2011; 92(232):516-541.,1212. Santos JT. Ações afirmativas e educação superior nas universidades brasileiras: um balanço crítico da produção. Rev Bras Estud Pedagog 2012; 93(234):401-422.. An effective policy to ensure that students admitted through the quota system remain enrolled presupposes a guarantee of access to permanence scholarships, meals (in a university restaurant), student housing, books and media in general, among other resources1212. Santos JT. Ações afirmativas e educação superior nas universidades brasileiras: um balanço crítico da produção. Rev Bras Estud Pedagog 2012; 93(234):401-422..

In 2003, the State University of Rio de Janeiro – SURJ (the location of the present study) implemented a quota system for admissions via entrance exam. It was the first Brazilian public university to adopt this affirmative action measure. In 2011 (the year the present study was conducted), measures were developed to promote the permanence of quota students at the university, including the provision of books and the offering of permanence scholarships. Food provision measures such as opening a university restaurant were not considered.

Until the time of the present study, no study had been published about the dietary practices of the groups affected by this affirmative action measure in Brazil that could support measures aimed at ensuring food and nutritional security as an element of an effective permanence policy. The present study aimed to describe the dietary practices of SURJ students and examine them according the means by which they were admitted to the university (through quotas or otherwise) with the objective of identifying whether or not there were differences in relation to these practices.

Methods

Study design and population

This is a cross-sectional study aimed at the environment of students who enrolled in the first semester of 2011 in 31 undergraduate disciplines among the 24 academic units located on the central SURJ campus and who took classes in the second period of the day at the time of data collection. These students were selected due to the fact that their academic activities were concentrated on campus at the beginning of their college studies. In addition, they were already accustomed to life at SURJ since they had experienced the university setting for at least six months and thus had adapted their dietary routines to this new stage in their lives.

Data collection

Data were collected on 36 days between August and October 2011. This was preceded by meetings with a representative of the office of the SURJ Vice-Chancellor for Undergraduate Studies and the directors of the academic departments in order to inform them about the proposed study and the procedures to be conducted for its realization.

The lists of the students enrolled in the academic departments as well as the class days, times and locations for each major included in the study were accessed through the university’s Undergraduate Academic System and with the assistance of the department coordinators.

At the beginning of each class, trained researchers gave self-applied questionnaires to the students who had agreed to participate and had signed the Free and Clear Consent Form. The students took between 10 and 15 minutes to complete the questionnaire. The classes were visited an average of 5.3 times in different departments and at different times in order to include as many students as possible.

Questionnaire

The data collection instrument was a self-administered questionnaire that was developed based on the instruments used in surveillance systems for risk factors directed at the youth of other countries1313. Kann L, Kinchen SA, Williams BI, Ross JG, Lowry R, Grunbaum JA, Lloyd J. Youth Risk Behavior Surveillance - United States. MMWR 1999; 49(5):1-96.,1414. Freedman DS, Khan LK, Dietz WH, Srinivasan SR, Berenson GS. Relationship of childhood obesity to coronary heart disease risk factors in adulthood: The Bogalusa Heart Study. Pediatrics 2001; 108(3):712-718., Brazilian adolescents1515. Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa Nacional de Saúde Escolar- 2009. Rio de Janeiro: IBGE; 2009., and Brazilian adults1616. Brasil. Ministério da Saúde (MS). Secretaria de Vigilância em Saúde Secretaria de Gestão Estratégica e Participativa. Vigitel Brasil 2010. Vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico. Brasília: MS; 2011. Série G. Estatística e Informação em Saúde. It had previously been tested with nutrition students who were enrolled in the university in the second semester of 2010 (n = 21). Terms and/or words that were not clearly understood by the students were revised (e.g. the definitions of lunch, dinner and sweets). The final version of the questionnaire was comprised of 39 questions that inquired about the identification and characterization of the student and his/her dietary practices, including dietary routine and consumption of certain foods (including food groups or preparations) in the seven days preceding the data collection. The question’s structure was: “In the last seven days, on how many days did you eat (type of food)?” The response options were: “It did not eat (type of food) in the last seven days”, “On one day in the last seven days”, “On two days in the last seven days”, “On three days in the last seven days”, “On four days in the last seven days”,

“On five days in the last seven days”, “On six days in the last seven days” and “Every day in the last seven days”.

The dietary routines considered were: 1) eating each of the three meals and 2) substituting lunch and/or dinner with a snack. Eating each of the three meals was included as a study topic based on the Food Guide for the Brazilian Population in effect at the time, which recommended eating three meals per day, interspersed with small snacks1717. Brasil. Ministério da Educação, Ministério da Saúde (MS). Gabinete do Ministro. Guia alimentar para a população brasileira: promovendo a alimentação saudável. Brasília: MS; 2005. Série A. Normas e Manuais Técnicos.. Furthermore, there is evidence that eating breakfast frequently is associated with a lower risk for overweight and obesity1818. Levin KA, Kirby J. Irregular breakfast consumption in adolescence and the family environment: Underlying causes by family structure. Appetite 2012; 59(1):63-70. and an improvement in scholastic performance1919. Nicklas TA, Morales M, Linares A, Yang SJ, Baranowski T, De Moor C, Berenson G. Children’s meal patterns have changed over a 21-year period: the Bogalusa heart study. J Am Diet Assoc 2004; 104(5):753-761.. The practice of substituting lunch and/or dinner with a snack was also examined because this practice has been shown to be associated with overweight and obesity1010. Papadaki A, Hondros G, Scott JA, Kapsokefalou M. Eating habits of University students living at, or away from home in Greece. Appetite 2007; 49(1):169-176.,2020. Brunt AR, Rhee YS. Obesity and lifestyle in U.S. college students related to living arrangements. Appetite 2008; 51(3):615-621.. The foods selected were those considered to be markers for healthy eating (HEM) and unhealthy eating (UHEM). This selection was based on nutritional recommendations for a healthy diet as well as evidence that suggests an association between these variables and risk factors for chronic disease66. World Health Organization (WHO). Diet, nutrition and the prevention of chronic diseases. Geneva: WHO; 2003.,2121. Malik VS, Schulze MB, Hu FB. Intake of sugar-sweetened beverages and weight gain: a systematic review. Am J Clin Nutr 2006; 84(2):274-288.,2222. Dauchet L, Amouyel P, Hercberg S, Dallongeville J. Fruit and vegetable consumption and risk of coronary heart disease: a meta-analysis of cohort studies. J Nutr 2006; 136(10):2588-2593..

Study variables and indicators

The following socio-demographic variables were studied: means of admission to the university (with or without a reserved space, in which two categories were adopted: quota students and non-quota students, assuming that the quota students had a lower socio-economic level in light of the criteria set for the space reservation policy previously described); sex; age (categorized as ≤ 18; 19; 20 - 22; > 22 years old a posteriori, according to the age distribution observed for the group of students studied); domestic arrangement in regard to the sharing of housing (living alone, with family, with friend(s) or with partner); mother’s schooling (none, did not complete elementary school, completed elementary school, did not complete high school, completed high school, did not complete college and completed college); and the presence of the following possessions and services: landline telephone, computer, home internet access and having a bathroom in the home. These possessions and services were selected due to their greater discriminatory power in relation to others (e.g. refrigerator, television and stove) as evidenced in the the 2009 National School Health Study database, which serves as a basis for the risk factor and health protection monitoring system for adolescents and includes students in the last year of elementary school.

Dietary routines were measured by weekly frequency and the following occurrences were ascertained for the previous seven days: eating each of the recommended meals (breakfast, morning snack, lunch, afternoon snack and dinner) and substituting lunch and/or dinner with a snack. Lunch and dinner were considered to be meals that contained rice with beans and/or meat with salad and/or cooked vegetables; soup; and pasta, among others, excluding sandwiches. The habit of eating breakfast five or more days a week was adopted as a healthy eating marker (HEM) while the habit of substituting lunch and/or dinner with a snack was adopted as an unhealthy eating marker (UHEM).

In regard to food consumption, 13 foods, food groups and preparations were analyzed for the seven days preceding the study inside and/or outside the academic environment: beans; vegetables in general (excluding roots and tubers); raw vegetables; cooked vegetables; fruits in their natural form; French fries and/or fried snacks; hamburger and/or sausage; packaged salty snacks; crackers; cookies; sweets (candy, chocolate, gum, lollipops, etc.); soft drinks; and sugary drinks,, excluding drinks containing milk or yogurt and including soft drinks, juices, mate tea, natural guaraná, other teas, coffee, flavored waters, sports drinks and soy-based drinks. The first five foods were considered to be healthy eating markers (HEM) while the last eight foods were considered to be unhealthy eating markers (UHEM).

Based on the weekly frequency that each of the foods, food groups and/or selected preparations was consumed, two types of indicators were created: (1) percentage distribution of weekly frequency of consumption of each food and (2) proportion of the students who consumed each food more regularly (on at least five of the seven days preceding the data collection) and less regularly (on between zero and four of the preceding seven days)2323. Castro IRR, Cardoso LO, Engstrom EM, Levy RB, Monteiro CA. Vigilância de fatores de risco para doenças não transmissíveis entre adolescentes: a experiência da cidade do Rio de Janeiro, Brasil. Cad Saude Publica 2008, 24(10):2279-2288.. Similar indicators were developed for the dietary routines.

Data Analysis

The students’ socio-economic conditions were characterized according to their means of admission to the university. The frequencies of food consumption and of the variables about the students’ dietary routines were estimated for the total population and according to the means of university admission. The statistical significance of the differences between the quota students and the non-quota students in regard to their socio-demographic characteristics was assessed using the chi-square test. The critical level for identifying significant differences was 0.05.

Analysis of the association between means of university admission (independent variable) and each of the regular dietary practices ((≥ 5 days in the week) (dependent variable) was done using univariate and multivariate logistical regression models (the latter considered student sex and age group as co-variables), which generated gross and adjusted odds ratios and their respective 95% confidence intervals.

Data entry was done by independent typists and was double-verified using Microsoft Excel® 2007. Data analysis was performed with the support of the Statistical Package for the Social Sciences (SPSS) v. 21.0.

Ethical aspects

The present study was approved by the Ethics Commission of the office of the SURJ Vice-Chancellor for Post-Graduate Studies and Research under Opinion No. 037/2011. Students who participated in the study agreed to do so and signed a Free and Clear Consent Form.

Results

Of the 1508 students who enrolled in the first semester of 2011 (according to official SURJ data), 1336 (88.6%) were studied. Reasons for non-participation in the study were an inability to locate a student (n = 138) and refusal to participate (n = 34). Of all the individuals studied, 38.8% were quota students and 61.2% were non-quota students. Their socio-demographic characteristics are presented in Table 1. Most of them were female (56.4%); lived with their families (88%); had a landline telephone, computer and internet access at home (more than 90%); had a mother who had at least completed high school (71.7%); and around half (50.6%) were aged 19 or less and had at least two bathrooms at home (50.3%).

With the exception of domestic arrangement in regard to the sharing of housing, the two studied groups differed in regard to all of the socio-demographic variables studied. The group of quota students had a greater proportion of females and a lesser proportion of individuals whose mothers had completed high school (56.9% of the quota students vs. 81.1% of the non-quota students), who had the possessions and services studied and who had at least two bathrooms at home. In addition, a greater proportion of the quota students were 20 years of age or older (Table 1). The mean age of this group was 21.61 (SD = 5.04) while the mean age of the non-quota students was 21.47 (SD = 6.00) – i.e. there was no significant statistical difference between the two groups.

Regarding the students’ dietary routines, it can be observed that about half of them (52.2%) ate breakfast every day, a majority (66.5%) regularly ate lunch and a little more than one-third (37.1%) ate dinner daily. It was also found that the practice of having an afternoon snack was more common than having a morning snack and that substituting dinner with a snack was more common than substituting lunch with a snack (Table 2).

In terms of food consumption, a lower daily consumption frequency was observed for the HEM foods (beans, vegetables and fruits). It merits highlighting the proportion of students who reported not eating any of these foods or eating them on only one or two days of the week (20.3%, 28.5% e 51.1%, respectively). On the other hand, the daily consumption of sugary drinks (46.2%), sweets (24.9%), and packaged salty snacks (17.9%) was found to be common (Table 2).

Eating breakfast, substituting lunch with a snack and substituting dinner with a snack on at least five days of the week were recorded for 67.3%, 4.8% and 24.3% of the students, respectively. No statistically significant differences were observed between the quota and non-quota students in the univariate regression models. These results held up after adjustment, with the exception of substituting dinner with a snack, which was less common among the quota students (Table 3).The frequency of regularly eating (≥ 5 days/week) the HEM foods varied from 20.8% (cooked vegetables) to 55.7% (beans). The consumption frequency for the UHEM foods varied from 14.5% (French fries and/or fried snacks) to 63.2% (sugary drinks). A greater proportion of the quota students regularly ate beans and packaged salty snacks while a greater proportion of the non-quota students regularly ate raw vegetables, fruit and sugary drinks (showing statistically significant differences) (Table 4). These results held up after adjusting for confounding factors, except for sugary drinks and cookies.

Discussion

The following unhealthy practices were observed in significant proportions of the young adults studied: not eating breakfast; substituting dinner for a snack; low consumption of fruit, vegetables and beans; and frequent consumption of sugary drinks, sweets and packaged salty snacks. Quota students and non-quota students presented generally similar dietary practices. However, when differences did exist, they usually tended to be less favorable for the quota students. Although this group ate beans more frequently and substituted dinner with a snack less frequently, it was observed that they ate fruit and vegetables less frequently and ate packaged salty snacks and cookies more frequently.

The comparison of our findings for the group of individuals studied with those of other studies is limited due to differences in the socio-demographic characteristics of the groups studied, the questionnaire and the construction of the dietary and socio-economic indicators used. Even so, certain results merit highlighting. In general, our findings agree with those of the 2008-2009 Family Budget Survey2424. Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa de Orçamentos Familiares 2008-2009 - Avaliação nutricional da disponibilidade domiciliar de alimentos no Brasil. Rio de Janeiro: IBGE; 2010., which showed that the traditional Brazilian diet has been largely displaced by a diet rich in ultra-processed ready-to-consume products2525. Monteiro CA, Levy RB, Claro RM, Castro IRR, Cannon G. A new classification of foods based on the extent and purpose of their processing. Cad Saude Publica 2010;26(11):2039-2049.,2626. Brasil. Ministério da Saúde (MS). Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Guia alimentar para a população brasileira. 2ª ed. Brasília: MS; 2014. in all population age groups and at different socio-economic levels.

Studies conducted with university students in relation to HEM foods have shown that the insufficient consumption of fruit and vegetables has also been recorded in various settings both in Brazil and in other countries88. Duarte FM, Almeida SDS, Martins KA. Alimentação fora do domicílio de universitários de alguns cursos da área da saúde de uma instituição privada. O Mundo da Saúde 2013; 37(3):288-298.,99. Vieira VCR, Priore SE, Ribeiro SMR, Franceschini SCC, Almeida LP. Perfil socioeconômico, nutricional e de saúde de adolescentes recém-ingressos em uma universidade pública brasileira. Rev Nutr 2002; 15(3):273-282.,1111. Marcondelli P, Costa THM, Schmitz BAS. Nível de atividade física e hábitos alimentares de universitários do 3º ao 5º semestres da área da saúde. Rev Nutr 2008; 21(1):39-47.,2727. Feitosa EPS, Dantas CAO, Andrade-Wartha ERS, Marcellini PS, Mendes-Netto RS. Hábitos alimentares de estudantes de uma universidade pública no nordeste, Brasil. Rev Alim Nutr 2010; 21(2):225-230.,2828. Ramalho AA, Dalamaria T, Souza OF. Consumo regular de frutas e hortaliças por estudantes universitários em Rio Branco, Acre, Brasil: prevalência e fatores associados. Cad Saude Publica 2012; 28(7):1405-1413. Only one study (conducted in the Brazilian state of Sergipe)2727. Feitosa EPS, Dantas CAO, Andrade-Wartha ERS, Marcellini PS, Mendes-Netto RS. Hábitos alimentares de estudantes de uma universidade pública no nordeste, Brasil. Rev Alim Nutr 2010; 21(2):225-230. analyzed the frequency of bean consumption among university students. Its results show that a greater proportion of students in Sergipe regularly consume this food compared with university students in Rio de Janeiro.

In regard to UHEM foods, our findings agree with other studies conducted with university students that report a high level of consumption for sweets/soft drinks88. Duarte FM, Almeida SDS, Martins KA. Alimentação fora do domicílio de universitários de alguns cursos da área da saúde de uma instituição privada. O Mundo da Saúde 2013; 37(3):288-298.

9. Vieira VCR, Priore SE, Ribeiro SMR, Franceschini SCC, Almeida LP. Perfil socioeconômico, nutricional e de saúde de adolescentes recém-ingressos em uma universidade pública brasileira. Rev Nutr 2002; 15(3):273-282.

10. Papadaki A, Hondros G, Scott JA, Kapsokefalou M. Eating habits of University students living at, or away from home in Greece. Appetite 2007; 49(1):169-176.
-1111. Marcondelli P, Costa THM, Schmitz BAS. Nível de atividade física e hábitos alimentares de universitários do 3º ao 5º semestres da área da saúde. Rev Nutr 2008; 21(1):39-47.,2727. Feitosa EPS, Dantas CAO, Andrade-Wartha ERS, Marcellini PS, Mendes-Netto RS. Hábitos alimentares de estudantes de uma universidade pública no nordeste, Brasil. Rev Alim Nutr 2010; 21(2):225-230., cookies and other ultra-processed foods1010. Papadaki A, Hondros G, Scott JA, Kapsokefalou M. Eating habits of University students living at, or away from home in Greece. Appetite 2007; 49(1):169-176..

The finding that about one-third (32.7%) of the individuals studied did not regularly eat breakfast was similar to those of other studies with university students conducted in Viçosa, MG and Campinas, SP, Brazil, between 1998 and 200499. Vieira VCR, Priore SE, Ribeiro SMR, Franceschini SCC, Almeida LP. Perfil socioeconômico, nutricional e de saúde de adolescentes recém-ingressos em uma universidade pública brasileira. Rev Nutr 2002; 15(3):273-282.,2929. Alves HJ, Boog MCF. Comportamento alimentar em moradia estudantil: um espaço para promoção da saúde. Rev Saude Publica 2007; 41(2):197-204.. The finding that a significant portion of the group studied substituted dinner with a snack agrees with the findings of a study conducted with university students in the state of Minas Gerais, in which 49% of the students preferred to have a snack instead of eating dinner, even when this meal was offered to them at the university restaurant at a subsidized price99. Vieira VCR, Priore SE, Ribeiro SMR, Franceschini SCC, Almeida LP. Perfil socioeconômico, nutricional e de saúde de adolescentes recém-ingressos em uma universidade pública brasileira. Rev Nutr 2002; 15(3):273-282..

Studies have shown that the university environment and routine can make it difficult to have a healthy diet due to various factors (e.g. tight scheduling of activities, behavioral changes, inappropriate time management and economic difficulties). These conditions lead to students opting for quick snacks to the detriment of healthy preparations, having meals at irregular times and skipping meals88. Duarte FM, Almeida SDS, Martins KA. Alimentação fora do domicílio de universitários de alguns cursos da área da saúde de uma instituição privada. O Mundo da Saúde 2013; 37(3):288-298.,2626. Brasil. Ministério da Saúde (MS). Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Guia alimentar para a população brasileira. 2ª ed. Brasília: MS; 2014.,2929. Alves HJ, Boog MCF. Comportamento alimentar em moradia estudantil: um espaço para promoção da saúde. Rev Saude Publica 2007; 41(2):197-204.,3030. Fabián C, Pagán I, Rios JL, Betancourt J, Cruz SY, González AM, Palacios C, González MJ, Rivera-Soto WT. Dietary patterns and their association with sociodemographic characteristics and perceived academic stress of college students in Puerto Rico. PR Health Sci J 2013; 32(1):36-43..

Our findings also agree with those of Vigitel – a surveillance system of risk factors for and protection against chronic diseases aimed at adults in the Brazilian federal and state capitals1616. Brasil. Ministério da Saúde (MS). Secretaria de Vigilância em Saúde Secretaria de Gestão Estratégica e Participativa. Vigitel Brasil 2010. Vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico. Brasília: MS; 2011. Série G. Estatística e Informação em Saúde. To enhance the comparability of Vigitel’s results with ours, we have extracted information from its 2010 database (available at: http://tabnet.datasus.gov.br/cgi/dh.exe?vigitel/vigitel10.def) about the regular consumption of four of the seven foods/ food groups examined in our study [beans, fruits, vegetables and sugary drinks (soft drinks and artificial juices)] for young adults aged 18-24 and for young adults aged 18-24 with twelve or more years of schooling in Brazil as a whole and in the areas available on the system [region (in this case, the Southeast) and city (in this case, Rio de Janeiro)].

In general, the proportion of students who regularly consumed beans and vegetables was smaller than that of young adults aged 18-24 both in the Brazilian capitals and in the two areas examined. This difference may be partially explained by the fact that the two groups do not necessarily have the same age distribution. In our study, for example, close to half of the students were under 20 years of age and may have had dietary practices that are more similar to those of adolescents than of young adults. The results of various national and international studies conducted with adolescents have conclusively shown that the dietary practices adopted by these young adults are characterized by diets rich in fat, sugar and sodium and a low consumption of fruit, vegetables, milk and dairy products compared to older adults3131. Leal GVS, Philippi ST, Matsudo SMM, Toassa EC. Consumo alimentar e padrão de refeições de adolescentes, São Paulo, Brasil. Rev Bras Epidemiol 2010; 13(3):457-467.

32. Hoppu U, Lehtisalo J, Tapanainen H, Pietinen P. Dietary habits and nutrient intake of Finnish adolescents. Public Health Nutr 2010; 13(6):965-972.
-3333. Veiga GV, Costa RS, Araújo MC, Souza AM, Bezerra IN, Barbosa FS, Sichieri R, Pereira RA. Inadequação do consumo de nutrientes entre adolescentes brasileiros. Rev Saude Publica 2013; 47(Supl. 1):212S-221S..

Also in regard to the dietary profile of the set of individuals studied, a deepening of the discussion about the consumption of sugary drinks (including soft drinks) is merited. The high frequency (63.2%) of sugary drink consumption found is in accordance with the findings of other national and international studies, which indicate that the majority of young adults consume excessive amounts of these products3434. Popkin BM. Patterns of beverage use across the lifecycle. Physiol Behav 2010; 100(1):4-9.,3535. Feferbaum R, Abreu LC, Leone C. Fluid intake patterns: an epidemiological study among children and adolescents in Brazil. BMC Public Health 2012; 12:1-7..

Furthermore, it is noteworthy that our study found the regular consumption of sugary drinks to be nearly twice as frequent as that of soft drinks. These findings corroborate evidence that soft drink consumption is being displaced by the consumption of other sugary drinks of low nutritional value3434. Popkin BM. Patterns of beverage use across the lifecycle. Physiol Behav 2010; 100(1):4-9.,3636. Sichieri R, Trotte AP, de Souza RA, Veiga GV. School randomized trial on prevention of excessive weight gain by discouraging students from drinking sodas. Public Health Nutr 2009; 12(2):197-202..

An examination of the results presented here according to the students’ means of admission leads us to reflect on the relationship between socio-economic level and dietary practices. Notwithstanding the methodological differences between our study and others, we observe convergent results with studies conducted with youth and adults. Similarly to our study, other studies have shown that individuals (adolescents and/or adults) at higher socio-economic levels generally consume more fruits55. Brasil. Presidência da República. Casa Civil. Lei nº 11.346, de 15 de setembro de 2006. Cria o Sistema Nacional de Segurança Alimentar e Nutricional - SISAN com vistas em assegurar o direito humano à alimentação adequada. Brasília: Diário Oficial da União 2006; 18 set.,2828. Ramalho AA, Dalamaria T, Souza OF. Consumo regular de frutas e hortaliças por estudantes universitários em Rio Branco, Acre, Brasil: prevalência e fatores associados. Cad Saude Publica 2012; 28(7):1405-1413,3737. Souza AM, Pereira RA, Yokoo EM, Levy RB, Sichieri R. Alimentos mais consumidos no Brasil: Inquérito Nacional de Alimentação 2008-2009. Rev Saude Publica 2013; 47(Supl. 1):190S-199S.,3838. Delva J, Johnston LD, O’Malley PM. The Epidemiology of overweight and related lifestyle behaviors racial/ethnic and Socioeconomic Status differences among American Youth. Am J Prev Med 2007; 33(Supl. 4):S178-S186., vegetables1515. Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa Nacional de Saúde Escolar- 2009. Rio de Janeiro: IBGE; 2009.,2828. Ramalho AA, Dalamaria T, Souza OF. Consumo regular de frutas e hortaliças por estudantes universitários em Rio Branco, Acre, Brasil: prevalência e fatores associados. Cad Saude Publica 2012; 28(7):1405-1413,3737. Souza AM, Pereira RA, Yokoo EM, Levy RB, Sichieri R. Alimentos mais consumidos no Brasil: Inquérito Nacional de Alimentação 2008-2009. Rev Saude Publica 2013; 47(Supl. 1):190S-199S.,3838. Delva J, Johnston LD, O’Malley PM. The Epidemiology of overweight and related lifestyle behaviors racial/ethnic and Socioeconomic Status differences among American Youth. Am J Prev Med 2007; 33(Supl. 4):S178-S186. and—to a lesser extent--beans1515. Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa Nacional de Saúde Escolar- 2009. Rio de Janeiro: IBGE; 2009.,3737. Souza AM, Pereira RA, Yokoo EM, Levy RB, Sichieri R. Alimentos mais consumidos no Brasil: Inquérito Nacional de Alimentação 2008-2009. Rev Saude Publica 2013; 47(Supl. 1):190S-199S. compared to those of lower socio-economic levels. On the other hand, we found controversial results in regard to the consumption of sweets. While our findings showed similar consumption patterns between the two groups, we identified a study that showed more frequent consumption among adolescents of higher socio-economic levels3939. Nunes MMA, Figueiroa JN, Alves JGB. Excesso de peso, atividade física e hábitos alimentares entre adolescentes de diferentes classes econômicas em Campina Grande (PB). Rev Ass Med Bras 2007; 53(2):130-134. and another study that indicated a more frequent consumption among those of lower socio-economic levels1515. Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa Nacional de Saúde Escolar- 2009. Rio de Janeiro: IBGE; 2009.. Furthermore, while we observed that the practice of eating breakfast was similar between the two groups, other studies have observed a direct association between socio-economic level and this practice among adolescents and adults1515. Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa Nacional de Saúde Escolar- 2009. Rio de Janeiro: IBGE; 2009.,3838. Delva J, Johnston LD, O’Malley PM. The Epidemiology of overweight and related lifestyle behaviors racial/ethnic and Socioeconomic Status differences among American Youth. Am J Prev Med 2007; 33(Supl. 4):S178-S186..

Another aspect that merits comment is the fact that our study found soft drink and sugary drink consumption to be similar between quota students and non-quota students while other studies have found a higher consumption of these products among individuals of higher socio-economic status1515. Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa Nacional de Saúde Escolar- 2009. Rio de Janeiro: IBGE; 2009.,3737. Souza AM, Pereira RA, Yokoo EM, Levy RB, Sichieri R. Alimentos mais consumidos no Brasil: Inquérito Nacional de Alimentação 2008-2009. Rev Saude Publica 2013; 47(Supl. 1):190S-199S.,3939. Nunes MMA, Figueiroa JN, Alves JGB. Excesso de peso, atividade física e hábitos alimentares entre adolescentes de diferentes classes econômicas em Campina Grande (PB). Rev Ass Med Bras 2007; 53(2):130-134.. In addition, we observed an inverse association between the regular consumption of cookies and socio-economic level while other studies have found a direct association between the two1515. Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa Nacional de Saúde Escolar- 2009. Rio de Janeiro: IBGE; 2009.,3838. Delva J, Johnston LD, O’Malley PM. The Epidemiology of overweight and related lifestyle behaviors racial/ethnic and Socioeconomic Status differences among American Youth. Am J Prev Med 2007; 33(Supl. 4):S178-S186..

In summary, our results converge with those of other studies in regard to the association between socio-economic level and the consumption of fruits and vegetables (direct) and of beans (inverse). This finding demonstrates the complexity of the relationship between socio-economic level and dietary practices as well as the influence that different life contexts and phases can exert on them. It also points to the importance of understanding how this association plays out in different realities.

With regard to this study’s methodological aspects, it is worth mentioning the limitations and choice potentiality of a closed questionnaire covering specific foods to characterize the dietary practices of the studied group. On one hand, it is a fact that such a questionnaire doesn’t cover the entire dietary scope of the studied group. On the other hand, similar questionnaires that have focused on the consumption of healthy and unhealthy eating marker foods on the seven days preceding data collection have demonstrated great discriminatory power in characterizing dietary practices among adults1616. Brasil. Ministério da Saúde (MS). Secretaria de Vigilância em Saúde Secretaria de Gestão Estratégica e Participativa. Vigitel Brasil 2010. Vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico. Brasília: MS; 2011. Série G. Estatística e Informação em Saúde as well as dietary practices and patterns among adolescents4040. Levy RB, Castro IRR, Cardoso LO, Tavares LF, Sardinha LMV, Gomes FS, Costa AWN. Consumo e comportamento alimentar entre adolescentes brasileiros: Pesquisa Nacional de Saúde do Escolar (PeNSE), 2009. Cien Saude Colet 2010; 15(2):3085-3097.,4141. Tavares LF, Castro IRR, Levy RB, Cardoso LO, Claro RM. Padrões alimentares de adolescentes brasileiros: resultados da Pesquisa Nacional de Saúde do Escolar (PeNSE). Cad Saude Publica 2014; 30(12):2679-2690.. Instruments structured as described above have been recently validated among adults4242. Monteiro CA, Moura EC, Jaime PC, Claro RM. Validade de indicadores do consumo de alimentos e bebidas obtidos por inquérito telefônico. Rev Saude Publica 2008; 42(4):582-589. and adolescents4343. Tavares LF, Castro IRR, Levy RB, Cardoso LO, Passos MD, Brito FSB. Validade relativa de indicadores de práticas alimentares da Pesquisa Nacional de Saúde do Escolar entre adolescentes do Rio de Janeiro, Brasil. Cad Saude Publica 2014; 30(5):1029-1041.. In addition, the application of these questionnaires has operational advantages in the context of the study presented here—i.e. the use of a self-administered questionnaire together with a large number of individuals in a short period of time.

A positive aspect of this study is that it covered a significant proportion (88.6%) of the group to be studied. Another favorable aspect is that the proportionality between the quota students and the non-quota students in the study (38.8% vs. 61.2%) is similar to that of the entire university student body (35.7% vs. 64,3%)4444. DataUERJ 2012. Anuário estatístico - base de dados 2011. Núcleo de Informação e Estudos de Conjuntura- NIESC. [acessado 2011 ago 9]. [cerca de 356p.]. Disponível em: http://www2.datauerj.uerj.br/pdf/DATAUERJ_2012.pdf.
http://www2.datauerj.uerj.br/pdf/DATAUER...
, which suggests that there was no selective loss.

Nevertheless, it is worth commenting on the fact that this study was limited to the students attending courses offered at the university’s central campus. Although this campus accounts for 75.0% of all students enrolled in the university, the present study did not consider those students who attend other campuses that are located in cities with different characteristics from those of Rio de Janeiro. These cities generally have a lower quality of life, as measured by the Municipal Human Development Index (MHDI), such as in the case of the cities of Duque de Caixas and São Gonçalo (which have MHDI scores of 0.711 and 0.739, respectively, compared with 0.799 for Rio de Janeiro)4545. Programa das Nações Unidas para o Desenvolvimento (PINUD). Atlas do desenvolvimento humano no Brasil. [acessado 2014 set 17]. [cerca de 5p.]. Disponível em http://www.pnud.org.br/IDH/Default.aspx?indiceAccordion=1&li=li_AtlasMunicipios.
http://www.pnud.org.br/IDH/Default.aspx?...
, or are located in more outlying areas of the metropolitan region, as is the case for the cities of Nova Friburgo and Resende. Therefore, one cannot rule out the possibility that the students at these campuses have different dietary practices from those of the group studied.

It was observed that the dietary practices of the quota and non-quota students had some similarities and were generally unhealthy and that the differences between the two groups generally tended to be more unfavorable for the quota students who, as described above, had a lower socio-economic level compared with the non-quota students. These findings point to the need for implementing measures to promote healthy eating and food and nutritional security for this population group. From this perspective, it is worth noting that, following the completion of this study, SURJ opened a university restaurant that offers meals at subsidized prices for all students and even lower prices for quota students. A study is currently being conducted to assess the impact of this restaurant’s existence on the diets of students according to their means of admission to the university.

Acknowledgements

We would like to thank the Nutrition Institute of the State University of Rio de Janeiro (SURJ) for its logistical support for our field work, as well as the undergraduate students in the SURJ Nutrition Department who served as volunteer researchers for the field work.

References

  • 1
    Brasil. Ministério da Saúde (MS). Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Política Nacional de Alimentação e Nutrição 3ª ed. Brasília: MS; 2012. Série B. Textos Básicos de Saúde.
  • 2
    Van Der Horst K, Oenema A, Ferreira I, Wendel-Vos W, Giskes K, Van Lenthe F, Brug J. A systematic review of environmental correlates of obesity-related dietary behaviors in youth. Health Educ Res 2007; 22(2):203-226.
  • 3
    Brasil. Ministério da Saúde (MS). Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Política Nacional de Promoção da Saúde 3 ed.. Brasília: MS; 2010. Série B. Textos Básicos de Saúde.
  • 4
    Sousa LP, Portes EA. As propostas de políticas/ações afirmativas das universidades públicas e as políticas/ações de permanência nos ordenamentos legais. Rev Bras Estud Pedagog 2011; 92(232):516-541.
  • 5
    Brasil. Presidência da República. Casa Civil. Lei nº 11.346, de 15 de setembro de 2006. Cria o Sistema Nacional de Segurança Alimentar e Nutricional - SISAN com vistas em assegurar o direito humano à alimentação adequada. Brasília: Diário Oficial da União 2006; 18 set.
  • 6
    World Health Organization (WHO). Diet, nutrition and the prevention of chronic diseases Geneva: WHO; 2003.
  • 7
    Haberman S, Luffey D. Weighing in college students’ diet and exercise behaviors. J Am Coll Health 1998; 46(4):189-191.
  • 8
    Duarte FM, Almeida SDS, Martins KA. Alimentação fora do domicílio de universitários de alguns cursos da área da saúde de uma instituição privada. O Mundo da Saúde 2013; 37(3):288-298.
  • 9
    Vieira VCR, Priore SE, Ribeiro SMR, Franceschini SCC, Almeida LP. Perfil socioeconômico, nutricional e de saúde de adolescentes recém-ingressos em uma universidade pública brasileira. Rev Nutr 2002; 15(3):273-282.
  • 10
    Papadaki A, Hondros G, Scott JA, Kapsokefalou M. Eating habits of University students living at, or away from home in Greece. Appetite 2007; 49(1):169-176.
  • 11
    Marcondelli P, Costa THM, Schmitz BAS. Nível de atividade física e hábitos alimentares de universitários do 3º ao 5º semestres da área da saúde. Rev Nutr 2008; 21(1):39-47.
  • 12
    Santos JT. Ações afirmativas e educação superior nas universidades brasileiras: um balanço crítico da produção. Rev Bras Estud Pedagog 2012; 93(234):401-422.
  • 13
    Kann L, Kinchen SA, Williams BI, Ross JG, Lowry R, Grunbaum JA, Lloyd J. Youth Risk Behavior Surveillance - United States. MMWR 1999; 49(5):1-96.
  • 14
    Freedman DS, Khan LK, Dietz WH, Srinivasan SR, Berenson GS. Relationship of childhood obesity to coronary heart disease risk factors in adulthood: The Bogalusa Heart Study. Pediatrics 2001; 108(3):712-718.
  • 15
    Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa Nacional de Saúde Escolar- 2009 Rio de Janeiro: IBGE; 2009.
  • 16
    Brasil. Ministério da Saúde (MS). Secretaria de Vigilância em Saúde Secretaria de Gestão Estratégica e Participativa. Vigitel Brasil 2010. Vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico. Brasília: MS; 2011. Série G. Estatística e Informação em Saúde
  • 17
    Brasil. Ministério da Educação, Ministério da Saúde (MS). Gabinete do Ministro. Guia alimentar para a população brasileira: promovendo a alimentação saudável Brasília: MS; 2005. Série A. Normas e Manuais Técnicos.
  • 18
    Levin KA, Kirby J. Irregular breakfast consumption in adolescence and the family environment: Underlying causes by family structure. Appetite 2012; 59(1):63-70.
  • 19
    Nicklas TA, Morales M, Linares A, Yang SJ, Baranowski T, De Moor C, Berenson G. Children’s meal patterns have changed over a 21-year period: the Bogalusa heart study. J Am Diet Assoc 2004; 104(5):753-761.
  • 20
    Brunt AR, Rhee YS. Obesity and lifestyle in U.S. college students related to living arrangements. Appetite 2008; 51(3):615-621.
  • 21
    Malik VS, Schulze MB, Hu FB. Intake of sugar-sweetened beverages and weight gain: a systematic review. Am J Clin Nutr 2006; 84(2):274-288.
  • 22
    Dauchet L, Amouyel P, Hercberg S, Dallongeville J. Fruit and vegetable consumption and risk of coronary heart disease: a meta-analysis of cohort studies. J Nutr 2006; 136(10):2588-2593.
  • 23
    Castro IRR, Cardoso LO, Engstrom EM, Levy RB, Monteiro CA. Vigilância de fatores de risco para doenças não transmissíveis entre adolescentes: a experiência da cidade do Rio de Janeiro, Brasil. Cad Saude Publica 2008, 24(10):2279-2288.
  • 24
    Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa de Orçamentos Familiares 2008-2009 - Avaliação nutricional da disponibilidade domiciliar de alimentos no Brasil Rio de Janeiro: IBGE; 2010.
  • 25
    Monteiro CA, Levy RB, Claro RM, Castro IRR, Cannon G. A new classification of foods based on the extent and purpose of their processing. Cad Saude Publica 2010;26(11):2039-2049.
  • 26
    Brasil. Ministério da Saúde (MS). Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Guia alimentar para a população brasileira 2ª ed. Brasília: MS; 2014.
  • 27
    Feitosa EPS, Dantas CAO, Andrade-Wartha ERS, Marcellini PS, Mendes-Netto RS. Hábitos alimentares de estudantes de uma universidade pública no nordeste, Brasil. Rev Alim Nutr 2010; 21(2):225-230.
  • 28
    Ramalho AA, Dalamaria T, Souza OF. Consumo regular de frutas e hortaliças por estudantes universitários em Rio Branco, Acre, Brasil: prevalência e fatores associados. Cad Saude Publica 2012; 28(7):1405-1413
  • 29
    Alves HJ, Boog MCF. Comportamento alimentar em moradia estudantil: um espaço para promoção da saúde. Rev Saude Publica 2007; 41(2):197-204.
  • 30
    Fabián C, Pagán I, Rios JL, Betancourt J, Cruz SY, González AM, Palacios C, González MJ, Rivera-Soto WT. Dietary patterns and their association with sociodemographic characteristics and perceived academic stress of college students in Puerto Rico. PR Health Sci J 2013; 32(1):36-43.
  • 31
    Leal GVS, Philippi ST, Matsudo SMM, Toassa EC. Consumo alimentar e padrão de refeições de adolescentes, São Paulo, Brasil. Rev Bras Epidemiol 2010; 13(3):457-467.
  • 32
    Hoppu U, Lehtisalo J, Tapanainen H, Pietinen P. Dietary habits and nutrient intake of Finnish adolescents. Public Health Nutr 2010; 13(6):965-972.
  • 33
    Veiga GV, Costa RS, Araújo MC, Souza AM, Bezerra IN, Barbosa FS, Sichieri R, Pereira RA. Inadequação do consumo de nutrientes entre adolescentes brasileiros. Rev Saude Publica 2013; 47(Supl. 1):212S-221S.
  • 34
    Popkin BM. Patterns of beverage use across the lifecycle. Physiol Behav 2010; 100(1):4-9.
  • 35
    Feferbaum R, Abreu LC, Leone C. Fluid intake patterns: an epidemiological study among children and adolescents in Brazil. BMC Public Health 2012; 12:1-7.
  • 36
    Sichieri R, Trotte AP, de Souza RA, Veiga GV. School randomized trial on prevention of excessive weight gain by discouraging students from drinking sodas. Public Health Nutr 2009; 12(2):197-202.
  • 37
    Souza AM, Pereira RA, Yokoo EM, Levy RB, Sichieri R. Alimentos mais consumidos no Brasil: Inquérito Nacional de Alimentação 2008-2009. Rev Saude Publica 2013; 47(Supl. 1):190S-199S.
  • 38
    Delva J, Johnston LD, O’Malley PM. The Epidemiology of overweight and related lifestyle behaviors racial/ethnic and Socioeconomic Status differences among American Youth. Am J Prev Med 2007; 33(Supl. 4):S178-S186.
  • 39
    Nunes MMA, Figueiroa JN, Alves JGB. Excesso de peso, atividade física e hábitos alimentares entre adolescentes de diferentes classes econômicas em Campina Grande (PB). Rev Ass Med Bras 2007; 53(2):130-134.
  • 40
    Levy RB, Castro IRR, Cardoso LO, Tavares LF, Sardinha LMV, Gomes FS, Costa AWN. Consumo e comportamento alimentar entre adolescentes brasileiros: Pesquisa Nacional de Saúde do Escolar (PeNSE), 2009. Cien Saude Colet 2010; 15(2):3085-3097.
  • 41
    Tavares LF, Castro IRR, Levy RB, Cardoso LO, Claro RM. Padrões alimentares de adolescentes brasileiros: resultados da Pesquisa Nacional de Saúde do Escolar (PeNSE). Cad Saude Publica 2014; 30(12):2679-2690.
  • 42
    Monteiro CA, Moura EC, Jaime PC, Claro RM. Validade de indicadores do consumo de alimentos e bebidas obtidos por inquérito telefônico. Rev Saude Publica 2008; 42(4):582-589.
  • 43
    Tavares LF, Castro IRR, Levy RB, Cardoso LO, Passos MD, Brito FSB. Validade relativa de indicadores de práticas alimentares da Pesquisa Nacional de Saúde do Escolar entre adolescentes do Rio de Janeiro, Brasil. Cad Saude Publica 2014; 30(5):1029-1041.
  • 44
    DataUERJ 2012. Anuário estatístico - base de dados 2011. Núcleo de Informação e Estudos de Conjuntura- NIESC. [acessado 2011 ago 9]. [cerca de 356p.]. Disponível em: http://www2.datauerj.uerj.br/pdf/DATAUERJ_2012.pdf
    » http://www2.datauerj.uerj.br/pdf/DATAUERJ_2012.pdf
  • 45
    Programa das Nações Unidas para o Desenvolvimento (PINUD). Atlas do desenvolvimento humano no Brasil. [acessado 2014 set 17]. [cerca de 5p.]. Disponível em http://www.pnud.org.br/IDH/Default.aspx?indiceAccordion=1&li=li_AtlasMunicipios
    » http://www.pnud.org.br/IDH/Default.aspx?indiceAccordion=1&li=li_AtlasMunicipios

Publication Dates

  • Publication in this collection
    Feb 2016

History

  • Received
    03 Mar 2015
  • Reviewed
    16 June 2015
  • Accepted
    18 June 2015
ABRASCO - Associação Brasileira de Saúde Coletiva Av. Brasil, 4036 - sala 700 Manguinhos, 21040-361 Rio de Janeiro RJ - Brazil, Tel.: +55 21 3882-9153 / 3882-9151 - Rio de Janeiro - RJ - Brazil
E-mail: cienciasaudecoletiva@fiocruz.br