O. Bogomolets National Medical University, Kyiv, Ukraine
SUMMARY. Vegetables and fruit make up 50 % of the recommended in Ukraine healthy daily diet. Sufficient consumption of their various kinds provides us with all required for the human body nutrients. A great variety of these food kinds in Ukraine offers the possibility of wide choice according to the taste and financial preferences of all population groups, including students’youth.
Insufficient consumption or complete deficiency of some vegetables or fruit in the students’ diet disregards intake of all essential nutrients: vitamins, food fibers and low glycemic index carbohydrates in particular.
Aim: evaluation of fruit and vegetables daily consumption, including the preserved ones, in order to correct the students’youth diet.
Materials and methods: using the questionnaire [7] authors collected the data and evaluated the results on the medical students’diet. Participation in the survey was voluntary, with the previous consent of the respondents. The sample contains 858 respondents, 570 females and 288 males, aged from 18 to 25, representing the 2nd, 4th and 6th study years’students of the O. Bogomolets National medical university. The sample was randomly selected.
Results: the article represents the results of comparative evaluation of the real vegetable - fruit daily consumption, including preserved food, regarding the recommended data. The authors estimated daily consumption of the following vegetables and fruit: potatoes, cabbage, beets, carrots, apples, pears and citrus fruit. The following scale was used for evaluation of the consumption of potatoes: “I don’t consume potatoes”, “I consume less than 100 g daily”, “I consume 100-250 g daily”; cabbage, beets and carrots: “I don’t consume them”, “I consume less than 200 g daily”, “I consume 200-300 g daily”, “I consume more than 300 g daily”; apples, pears and citrus fruit: “I don’t consume them”, “I consume less than 200 g daily”, “I consume 200-400 g daily”, “I consume more than 400 g daily”.
The consumption of preserved vegetables and fruit was evaluated by the scale: “I don’t consume them”, “I consume not more than 100 g daily”, “I consume 100-200 g daily”.
The authors established that half of all respondents consume traditional for the Ukrainians vegetables (cabbage, carrots and beets) according to the dietary recommendations, no dependence on the gender or study course revealed. One fifth of the male respondents and one tenth of female ones don’t consume cabbage and carrots, no dependence on the study year established; one third don’t consume the beets. Half of the surveyed consume not more than 100 g of potatoes, with no dependence on gender and study year. A third of the respondents consume daily 100-250 g of potatoes, a tenth of them don’t consume potatoes at all.
Half of the surveyed daily consume apples (200 g), one third of the respondents consume more than 200 g, no dependence on the gender and study course established; one tenth of male and one twentieth of female respondents don’t consume apples at all. A third of the respondents daily consume citrus fruit in quantity which doesn’t exceed 200 g and another third don’t consume them. One fifth of respondents consume pears (not more than 200 g). About half of the surveyed males and females don’t consume pears.
At the same time, more than half of the respondents consume preserved vegetables and fruit, with no dependence on the gender and study year. One fifth of male and more than one fifth of female respondents daily consume 100-200 g of preserved products.
Conclusions. The results evidence that 50 % of students’diets don’t correspond to the national nutritional recommendations according to the products daily intake and variety of the consumed products. 10 % of respondents don’t consume vegetables and fruit, no dependence on the gender and study year established. More than 50 % of the respondents consume home-made preserved vegetables and fruit. Daily evaluation of vegetable and fruit consumption reveals insufficient consumption of the products, which represents a risk factor of vitamin and microelement deficiency, polynutrient deficiency and, consequently, alimentary-dependent diseases of students’ youth.
The obtained data require for individual correction of essential nutrients in the students’ dietary ratios.
Key Words: questionnaire, ratio, daily consumption, vegetables, fruit, alimentary diseases, correction, students’ youth.
INTRODUCTION
Daily requirements in essential nutrients and energy can only be met if the person’s diet contains sufficient amounts of foods from all of the categories of “healthy foods” [1, 2, 3]. Such products of plant origin include vegetables, fruits and berries. The products of this group have different qualitative and quantitative contents of useful nutrients; this is why their variety in the daily diet provides for a balanced intake of all of the necessary nutrients. In Ukraine, half of the recommended basket of healthy eating must include daily vegetables, fruits and berries [1,2,3].
As advised by the leading specialists in Ukraine, the recommended target level of consumption of vegetables and fruits is over 300 g per each product category [2, 3, 4, 5, 6], namely: 4–5 servings of vegetables (75 g each) and 2 servings of fruits (150 g each) [2, 3, 4, 5, 6]. The following are examples of one serving of vegetables: 75 g of cooked green or orange vegetables, 75 g of cooked dry or canned legumes and lentils, 75 g of starchy vegetables (0.5 of a mid-sized potato), 75 g of green leafy vegetables, 75 g of tomatoes or a mid-sized tomato [2]. Examples of one serving of fruit include: 150 g of or one medium-sized fruit (e.g., apple, pear, banana, orange), 150 g of or two small-sized fruits (e.g., apricot, plum, kiwi), 150 g of compote or canned fruit, 30 g of dried fruit [2]. Potatoes are not a part of the recommended daily quantity of vegetables and should not be used as a significant replacement [2].
An acceptable alternative to fresh vegetables and fruits in winter season includes frozen, dried and canned fruits and vegetables, which are but insignificantly inferior to fresh ones in terms of nutritive value [2].
Due to their parapharmacological properties, vegetables and fruits are widely recommended for use in rational, therapeutic, prophylactic and dietetic nutrition [6,8-16].
Availability and sufficient quantities of these products in the diets of students is beneficial, since they increase host resistance to adverse factors and substantially enhance performance in the winter period.
Objective of the study: hygienic assessment of mean daily consumption of vegetables and fruits (including canned ones) in order to rectify the dietary intakes of student youth.
Materials and methods of the study
Study design: transverse (cross-sectional) blind study. The survey was performed with the prior informed consent of respondents. Time of survey: cut-offs on December 2016/January 2017. This is the time when manifestations of alimentary deficits are the most evident. The questionnaire survey was conducted by the persons trained in polling techniques.
Inclusion criterion: 2nd year, 4th year or 6-year medical students.
Exclusion criteria: students on temporary or long-term therapeutic or prophylactic diets, students with alternative/non-traditional dietary habits (vegetarians/vegans, adherents of raw food diet, etc.), subjects with sub-compensated/compensated chronic disease, pregnant women (in 2nd and 3d trimester).
The following methods were used in the study: questionnaire survey method and the statistical method (Ukraine-licensed Medstatistika software).
The results of the study. The study has used a questionnaire form [7] developed by the specialists at the Department of Hygiene and Ecology No. 4 of Bogomolets National Medical University. This questionnaire form has been peer-reviewed by the leading researchers in the field of hygiene of nutrition, dietology and public health. The survey enrolled 858 respondents, all of them were 2nd, 4th and 6th-year medical students. The polling was performed with prior informed consent of respondents. The survey population was formed randomly. The age of the participants was 18 to 25 years; there were 570 females and 288 males. Gender- and study year-specific distribution of respondents was as follows: 213 second-year females and 126 second-year males, 192 fourth-year females and 89 fourth-year males, 165 sixth-year females and 73 sixth-year males.
The object of the study included dietary patterns of medical students. The author has analysed mean daily consumption of foods of plant origin, i.e. vegetables and fruits, including canned vegetables and fruits.
During the analysis of consumption of vegetables and fruits, the author assessed mean daily use of potatoes, cabbage, red beets, carrots, apples, pears and citrus fruits, as well as canned vegetables, fruits and berries.
Mean daily consumption of potatoes was analysed using the following scale: no consumption, up to 100 g, 100–250 g, over 250 g (according to options in the questionnaire form). No potato consumption was reported by 7.1 %, 4.5 %, and 13.7 % of male respondents of years 2, 4 and 6, respectively and by 14.5 %, 13.05 % and 7.3 % of female respondents of years 2, 4, 6, respectively. Daily potato use of up to 100 g was reported by 40.5 %, 39.3 % and 41.0 % of male students and by 55.0 %, 42.2 % and 41.2 % of female students of respective aforementioned years. Daily potato use at 100–250 g was reported by 35.0 %, 30.4 % and 27.5 % of male respondents, and by 27.7 %, 28.15 % and 38.8 % of female respondents of years 2, 4 and 6, respectively. Eating more than 250 g of potatoes daily was reported by 17.4 %, 25.8 % and 17.8 % of male respondents, and by 2.8 %, 16.6 % and 12.7 % of female respondents of years 2, 4 and 6, respectively. The data on the mean daily consumption of potatoes by medical students are given in Fig. 1.
Fig. 1. Mean daily consumption of potatoes by medical students
Mean daily consumption of cabbage, red beets and carrots was analysed using the following scale: no consumption, up to 200 g, 200–350 g, over 300 g (according to options in the questionnaire form).
No cabbage consumption was reported by 22.2 %, 20.2 % and 13.7 % of male respondents of years 2, 4 and 6, respectively and by 12.7 %, 11.45 % and 12.1 % of female respondents of years 2, 4, 6, respectively. Consumption of up to 200 g was reported by 45.2 %, 47.2 % and 45.2 % of male students, and by 48.8 %, 47.9 % and 44.9 % of female students of years 2, 4 and 6, respectively. Consumption at 200–300 g was reported by 26.2 %, 24.7 % and 34.25 % of male respondents, and by 29.1 %, 22.4 % and 32.1 % of female respondents of years 2, 4 and 6, respectively. More than 300 g of cabbage in the daily diet was reported by 6.4 %, 7.9 % and 6.85 % of male respondents, and by 9.4 %, 18.25 % and 10.9 % female respondents of years 2, 4 and 6, respectively. The data on the mean daily consumption of cabbage by medical students are given in Fig. 2.
Fig. 2. Mean daily consumption of cabbage by medical students
No red beets were reported in the diets of 44.4 %, 33.7 % and 39.7 % of male students of years 2, 4 and 6, respectively, and of 28.5 %, 31.8 % and 23.6 % of female students of years 2, 4, 6, respectively. Up to 200 g was reported by 33.35 %, 30.35 % and 32.9 % of male respondents, and by 36.2 %, 37.5 % and 46.7 % of female subjects of years 2, 4 and 6, respectively. Daily consumption of 200–300 g was reported by 17.45 %, 24.7 % and 26.0 % of male respondents, and by 26.8 %, 25.0 % and 20.6 % of female subjects of years 2, 4 and 6, respectively. More than 300 g red beets daily in the diet were reported by 4.8 %, 11.25 % and 1.4 % males, and by 8.5 %, 5.7 % and 9.1 % of female students of years 2, 4 and 6, respectively. The data on the mean daily consumption of red beets by medical students are given in Fig. 3.
Fig. 3. Mean daily consumption of red beets by medical students
No consumption of carrots was reported by 30.1 %, 16.9 % and 20.5 % of male respondents (of years 2, 4 and 6, respectively) and by 15.0 %, 16.15 % and 21.2 % of female respondents (of years 2, 4 and 6, respectively). Up to 200 g was reported by 40.5 %, 43.8 % and 42.5 % of male respondents and by 49.8 %, 50.55 % and 40.0 % female students of years 2, 4 and 6, respectively. Daily carrot consumption of 200–300 g was reported by 23.8 %, 28.1 % and 31.5 % of males, and by 26.3 %, 22.4 % and 28.5 % of females of years 2, 4 and 6, respectively. Over 300 g of carrot in the daily diet was reported by 5.6 %, 11.2 % and 5.5 % of male respondents and by 8.9 %, 10.9 % and 10.3 % of female respondents of years 2, 4 and 6, respectively. The data on the mean daily consumption of carrots by medical students are given in Fig. 4.
Fig. 4. Mean daily consumption of carrots by medical students
Mean daily consumption of fruits by the students of years 2, 4 and 6 was analyzed using the following categories: no consumption, up to 200 g, 200–400 g and over 400 g (according to options in the questionnaire form). As reported in the survey, 15.1 %, 4.5 % and 13.7 % of male respondents and 5.6 %, 4.7 % and 10.9 % of female subjects did not eat apples. Consumption of up to 200 g was reported by 42.85 %, 49.5 % and 42.5 % of male respondents and by 43.7 %, 52.6 % and 45.5 % of female respondents, respectively. Consumption at 200–400 g was reported by 33.3 %, 31.4 % and 34.2 % of male respondents and by 38.0 %; 31.8 % and 33.3 % of female respondents. Over 400 g was reported by 8.75 %, 14.6 % and 9.6 % of male respondents and by 12.7 %, 10.9 % and 10.3 % of female respondents of years 2, 4 and 6, respectively. The data on the mean daily consumption of apples by medical students are given in Fig. 5.
Fig. 5. Mean daily consumption of apples by medical students
No pears were part of the diet in 56.3 %, 46.05 % and 54.75 % of male respondents, and in 39.9 %, 72.4 % and 57.6 % of female respondents of years 2, 4 and 6, respectively. Inclusion of up to 200 g to the diet was reported by 19.85 %, 25.8 % and 22.0 % males and 27.2 %, 10.9 % and 18.2 % of females. Consumption of 200–400 g was reported in 16.7 %, 16.9 % and 20.5 % of male respondents, and by 24.0 %, 14.6 % and 14.5 % female respondents of years 2, 4 and 6, respectively. Over 400 g was reported by 7.15 %, 11.25 % and 2.75 % of male respondents and by 8.9 %, 2.1 % and 9.7 % of female respondents of years 2, 4 and 6, respectively. The data on the mean daily consumption of pears by medical students are given in Fig. 6.
Fig. 6. Mean daily consumption of pears by medical students
No citrus fruits were reported in the rations of 35.7 %, 28.1 % and 34.2 % of male respondents of years 2, 4 and 6, respectively, and by 11.3 %, 28.65 % and 26.7 % female respondents of the same years. Up to 200 g were consumed by 29.35 %, 34.8 % and 28.8 % males and by 36.2 %, 41.15 % and 35.7 % females of respective years of study. Inclusion of 200–400 g to the diet was reported by 26.2 %, 23.6 % and 31.5 % of male respondents and by 36.2 %, 25.0 % and 27.9 % female respondents of years 2, 4 and 6, respectively. Over 400 g were reported by 8.75 %, 13.5 % and 5.5 % of male respondents, and by 16.3 %, 5.2 % and 9.7 % of female respondents of years 2, 4 and 6, respectively. The data on the mean daily consumption of citrus fruits by medical students are given in Fig. 7.
Fig. 7. Mean daily consumption of citrus fruits by medical students
Mean daily consumption of canned vegetables and fruits was analysed using the following scale: no consumption, up to 100 g, 100–200 g, (according to options in the questionnaire form). These products were not used by 24.6 %, 15.7 % and 16.4 % of males and by 24.4 %, 22.4 % and 20.0 % females of years 2, 4 and 6, respectively. Up to 100 g was reported in the diets of 64.3 %, 65.2 % and 64.4 % of male respondents and 55.4 %, 53.1 % and 55.75 % female respondents of years 2, 4 and 6, respectively. From 100 g to 200 g was present in the diets of 11.1 %, 19.1 % and 19.2 % of males and 20.2 %, 24.5 % and 24.25 % females of years 2, 4 and 6, respectively. Mean daily consumption of canned vegetables and fruits by medical students are given in Table 1.
Table 1
Mean daily consumption of canned vegetables and fruits by medical students
Results: Sufficient and recommendation-compliant daily amounts of traditional vegetables in Ukrainian diet (cabbage, carrots, red beets) were consumed by half of the respondents regardless of their gender and year of study. No use of cabbage and carrots was reported by 1/5 of male respondents and 1/10 of female respondents (regardless of the year of study); no use of red beets was reported by a third of respondents. Regardless of their gender and year of study, half of the respondents ate up to 100 g of potatoes per day and one third ate 100–250 g per day. A smaller fraction, 1/10 of respondents, did not eat potatoes at all.
Half of the respondents consumed 200 g of apples and one third consumed >200 g of apples as part of their diets; 1/10 of male respondents and 1/20 of female respondents reported they did not eat apples at all. A third of respondents ate citrus fruits up to 200 g daily. A third of the respondents did not consume citrus fruits. Up to 1/5 of respondents had pears in their diet (up to 200 g). Half of the male respondents and a third of female respondents did not have pears at all in their diets.
At the same time, more than half of respondents (regardless of their gender and year of study) had homemade canned fruits and vegetables in their diets; 1/5 of male respondents and more than 1/5 of female respondents consumed 100–200 g of canned products daily.
Conclusion
It was found that dietary patterns in 50 % of students failed to meet national dietary guidelines for the consumption of vegetables and fruits, in terms of both varieties and mean daily consumption. As many as 10 % of respondents consumed no vegetables and fruits (regardless of their gender and year of study). As a probable substitute, 50 % of respondents included homemade canned vegetables and fruits in their diets. Evaluation of mean daily servings of vegetables and fruits yields a conclusion that they are inadequate, which may lead to vitamin deficiencies, mineral deficiencies and polynutrient deficiencies, as well as lack of fundamental nutrients, ultimately resulting in alimentary-dependent disease in young people. This situation requires case-based adjustment of daily student rations to ensure appropriate levels of critical and essential nutrients.
REFERENCES
1. The Law of Ukraine “On approval of Normal Levels of Physiological Needs of Population of Ukraine in Principal Nutrients and Energy”: as of 03 September 2017 / Ministry of Health of Ukraine. – Official Publ. – Kyiv: Ministry of Justice of Ukraine, 2017.
2. Piven N. Recommendations on healthy nutrition of adults / Nataliya Piven // The Practicing Physician. – 2018. – No. 1. – P. 39–46.
3. Grygorenko А. Guidelines for general practitioners of family medicine on counselling patients about the basic principles of healthy eating / A. Grygorenko. // Guidelines according to MoH Order 16 dated 14 January 2013. – 2013. – 30 pgs.
4. Omelchuk S. T. GENERAL NUTRITION Study Guide / S. T. Omelchuk, O. V. Kuzminska. – Kyiv, 2016. – P. 65–68.
5. Hygiene of nutrition with the fundamentals of nutrition science / [T. I. Anistratenko, T. M. Bilko, O. V. Blagodarova et al. – Kyiv: Medicine, 2007. – P. 327 – 372.
6. Shvets O. V. The significance of sufficient and balanced diet in the prevention of the most dangerous of modern disease / O. V. Shvets. // Nutrition and Health. – 2010. – No. 1. – P. 9–14.
7. Yeltsova L. B. Rationale for the ways to improve the questionnaire survey method to assess actual nutrition of the population / L. B. Ieltsova, S. T. Omelchuk // Medical Perspectives. – 2017. – No. 3.– P. 104–112.
8. Crowe K. M. Deconstructing a fruit serving: comparing the antioxidant density of select whole fruit and 100 % fruit juices / K. M. Crowe, E. Murray // J Acad Nutr Diet. – 2013. – No. 113. – P. 1354–8.
9. Gerhauser C. Cancer chemopreventive potential of apples, apple juice, and apple components / Gerhauser // Planta Med.. – 2008. – №74. – С. 1608–24.
10. Influence of apple polyphenols on inflammatory gene expression. / M. Jung, S. Triebel, T. Anke et al // Mol Nurs Food Res.. – 2009. – №53. – С. 1263–80.
11. Comparative study on the effects of apple peel polyphenols and apple fresh polyphenols on cardiovascular risk factors in mice / J. Tian, X. Wu, M. Zhang et al. // Clin Exp Hypertens. – 2018. – №40. – С. 65–72.
12. The effects of acute wild blueberry supplementation on the cognition of 7-10-year-old schoolchildren / K. L. Barfoot, G. May, D. J. Lamport et al. // European Journal of Nutrition. – 2018. – С. 1–10.
13. Tomatoes protect against development of UV-induced keratinocyte carcinoma via metabolomic alterations / J. L. Cooperstone, K. L. Tober, K. M. Riedl et al. // Scientific Reports. – 2017.
14. Xu X. Tomato consumption and prostate cancer risk: a systematic review and meta-analysis / X. Xu, J. Li, X. Wang // Scientific Reports. – 2016. – №6.
15. H.Chen Association between dietary carrot intake and breast cancer: A meta-analysis. /F. Shao, F. Zhang, Q. Miao // Medicine (Baltimore). – 2018. – №97. – С. e12164.
16. Hufnagl K. Does a carrot a day keep the allergy away? / K. Hufnagl, E. Jensen-Jarolim // Immunol Lett. – 2018.
Надійшла до редакції 5.04.2018 р.