Effects of a Nutritional Intervention Using Pictorial Representations for Promoting Knowledge and Practices of Healthy Eating Among Brazilian Adolescents

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2019 Mar 12

PMID 30856205

Citations 8

Authors

Lais Gomes Fonseca

Maria Natacha Toral Bertolin

Muriel Bauermann Gubert

Eduardo Freitas da Silva

Affiliations

Soon will be listed here.

Abstract

This study aimed to evaluate the effect of a nutritional intervention involving a problem-raising approach and the use of pictorial representations on the promotion of knowledge and practices of healthy eating among adolescents. This randomized study included 461 adolescents from public schools in Brasilia, Federal District, Brazil (intervention group: 273 students from four schools; control group: 188 students from three schools). Mean age was 14.8±1.0, and 52.9% were boys. The intervention consisted of three meetings with interactive activities about principles of healthy eating, food classification, importance of reading labels and analyzing food advertising critically, and representations of healthy and unhealthy meals and their sugar, salt, and fat content. Pictorial materials consisted of food drawings, food models, and a food packaging model. Controls were not exposed to any activity. Dietary knowledge, consumption, and behaviors were the variables of interest. The intervention group showed a higher mean score of correct answers to questions about dietary knowledge than the control group (p = 0.0006), with higher odds of correctly answering questions about in natura (OR: 3.7; 95% CI: 1.9-6.6), minimally processed (OR: 3.6; 95% CI: 1.9-6.4), processed (OR: 2.2; 95% CI: 1.1-4.3), and ultra-processed foods (OR: 3.5; 95% CI: 1.8-6.6) and composition of ultra-processed foods (OR: 2.4; 95% CI: 1.3-4.4). Participants in the intervention group were also 2.5 times more likely to correctly answer questions about the importance of the dietary environment (95% CI: 1.1-5.5) and caution with food advertising (95% CI: 1.2-5.3) than controls. Increased weekly consumption of vegetables (p = 0.0077; OR: 2.4; 95% CI: 1.26-4.51) and reduced consumption of soft drinks (p = 0.0212; OR: 0.36; 95% CI: 0.15-0.86) were observed in the intervention group compared to the control group. The proposed intervention increased adolescents' knowledge and improved some of their dietary habits. Educational activities using a problem-raising approach and pictorial representations of food appear to be effective in promoting healthy eating practices among adolescents.

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References

Reicks M, Banna J, Cluskey M, Gunther C, Hongu N, Richards R . Influence of Parenting Practices on Eating Behaviors of Early Adolescents during Independent Eating Occasions: Implications for Obesity Prevention. Nutrients. 2015; 7(10):8783-801. PMC: 4632451. DOI: 10.3390/nu7105431. View

Pearson N, Griffiths P, Biddle S, Johnston J, McGeorge S, Haycraft E . Clustering and correlates of screen-time and eating behaviours among young adolescents. BMC Public Health. 2017; 17(1):533. PMC: 5452360. DOI: 10.1186/s12889-017-4441-2. View

Toral N, Slater B . Intervention based exclusively on stage-matched printed educational materials regarding healthy eating does not result in changes to adolescents' dietary behavior. ScientificWorldJournal. 2012; 2012:174640. PMC: 3322369. DOI: 10.1100/2012/174640. View

Louzada M, Bortoletto Martins A, Canella D, Baraldi L, Levy R, Claro R . Ultra-processed foods and the nutritional dietary profile in Brazil. Rev Saude Publica. 2015; 49:38. PMC: 4544452. DOI: 10.1590/S0034-8910.2015049006132. View

Somsri P, Satheannoppakao W, Tipayamongkholgul M, Vatanasomboon P, Kasemsup R . A Cosmetic Content-Based Nutrition Education Program Improves Fruit and Vegetable Consumption Among Grade 11 Thai Students. J Nutr Educ Behav. 2016; 48(3):190-8.e1. DOI: 10.1016/j.jneb.2015.11.002. View

Blass E, Anderson D, Kirkorian H, Pempek T, Price I, Koleini M . On the road to obesity: Television viewing increases intake of high-density foods. Physiol Behav. 2006; 88(4-5):597-604. DOI: 10.1016/j.physbeh.2006.05.035. View

Hollands G, Prestwich A, Marteau T . Using aversive images to enhance healthy food choices and implicit attitudes: An experimental test of evaluative conditioning. Health Psychol. 2011; 30(2):195-203. DOI: 10.1037/a0022261. View

Ho M, Garnett S, Baur L, Burrows T, Stewart L, Neve M . Impact of dietary and exercise interventions on weight change and metabolic outcomes in obese children and adolescents: a systematic review and meta-analysis of randomized trials. JAMA Pediatr. 2013; 167(8):759-68. DOI: 10.1001/jamapediatrics.2013.1453. View

Higgs S, Donohoe J . Focusing on food during lunch enhances lunch memory and decreases later snack intake. Appetite. 2011; 57(1):202-6. DOI: 10.1016/j.appet.2011.04.016. View

10.

Tavares L, de Castro I, Levy R, Cardoso L, Passos M, Brito F . [Relative validity of dietary indicators from the Brazilian National School-Based Health Survey among adolescents in Rio de Janeiro, Brazil]. Cad Saude Publica. 2014; 30(5):1029-41. DOI: 10.1590/0102-311x00000413. View

11.

Xavier I, Hardman C, Andrade M, Barros M . Frequency of consumption of fruits, vegetables and soft drinks: a comparative study among adolescents in urban and rural areas. Rev Bras Epidemiol. 2014; 17(2):371-80. DOI: 10.1590/1809-4503201400020007eng. View

12.

Houts P, Shankar S, Klassen A, Robinson E . Use of pictures to facilitate nutrition education for low-income African American women. J Nutr Educ Behav. 2006; 38(5):317-8. DOI: 10.1016/j.jneb.2006.06.002. View

13.

Monteiro C, Moubarac J, Cannon G, Ng S, Popkin B . Ultra-processed products are becoming dominant in the global food system. Obes Rev. 2013; 14 Suppl 2:21-8. DOI: 10.1111/obr.12107. View

14.

Wilkinson K, Light J . Preliminary investigation of visual attention to human figures in photographs: potential considerations for the design of aided AAC visual scene displays. J Speech Lang Hear Res. 2011; 54(6):1644-57. PMC: 3462357. DOI: 10.1044/1092-4388(2011/10-0098). View

15.

Monteiro C, Levy R, Claro R, de Castro I, Cannon G . Increasing consumption of ultra-processed foods and likely impact on human health: evidence from Brazil. Public Health Nutr. 2011; 14(1):5-13. DOI: 10.1017/S1368980010003241. View

16.

Chagas C, Barros Pontes E Silva T, Reffatti L, Botelho R, Toral N . Rango Cards, a digital game designed to promote a healthy diet: a randomized study protocol. BMC Public Health. 2018; 18(1):910. PMC: 6056995. DOI: 10.1186/s12889-018-5848-0. View

17.

Souza A, Barufaldi L, Abreu G, Giannini D, Oliveira C, Santos M . ERICA: intake of macro and micronutrients of Brazilian adolescents. Rev Saude Publica. 2016; 50 Suppl 1:5s. PMC: 4767036. DOI: 10.1590/S01518-8787.2016050006698. View

18.

Kelly M, Barker M . Why is changing health-related behaviour so difficult?. Public Health. 2016; 136:109-16. PMC: 4931896. DOI: 10.1016/j.puhe.2016.03.030. View

19.

da Silva K, Fiaccone R, Couto R, de Cassia Ribeiro-Silva R . EVALUATION OF THE EFFECTS OF A PROGRAMME PROMOTING ADEQUATE AND HEALTHY EATING ON ADOLESCENT HEALTH MARKERS: AN INTERVENTIONAL STUDY. Nutr Hosp. 2015; 32(4):1582-90. DOI: 10.3305/nh.2015.32.4.9512. View

20.

Ramos F, Santos L, Reis A . [Food and nutrition education in school: a literature review]. Cad Saude Publica. 2013; 29(11):2147-61. DOI: 10.1590/0102-311x00170112. View