Effects of a nutritional intervention using pictorial representations for promoting knowledge and practices of healthy eating among Brazilian adolescents

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.

The Color Nutrition Information Paradox: Effects of Suggested Sugar Content on Food Cue Reactivity in Healthy Young Women

“…It has already been demonstrated that nutritional knowledge is able to influence FCR [8]. A number of studies has found a positive correlation between nutritional knowledge and healthy dietary habits [9][10][11][12][13][14]. The knowledge transfer about the sugar content of food seems to be a promising starting point for such interventions because large proportions of calories are consumed in the form of sugar [15].…”

Efeitos do serious game Nutrigame - seu guia alimentar no conhecimento alimentar de adolescentes: um estudo piloto qualitativo de avaliação formativa

“…O reconhecimento mais contundente das categorias 1 e 4 da classificação NOVA, respectivamente, in natura e minimamente processados e ultraprocessados e o uso de termos populares, em especial, "alimento industrializado" associado a "alimento não saudável" também já foi observado tanto em estudos com adolescentes como com adultos [5,21,22].…”

“…As recomendações atuais, baseadas na extensão e propósito do processamento em detrimento do perfil de calorias e nutrientes, adota a regra de ouro: prefira os alimentos in natura e minimamente processados e preparações culinárias a base destes alimentos e evite os alimentos ultraprocessados [2]. No entanto, evidências apontam conhecimento insuficiente dos adolescentes sobre o sistema NOVA [4][5][6]. Adicionalmente, crianças e adolescentes com obesidade apresentam cinco vezes mais chance de continuarem com obesidade na vida adulta quando comparados a crianças e adolescentes eutróficos [7].…”

“…Deste modo, intervenções nesta fase da vida são importantes para prevenir e atenuar a epidemia da obesidade. A literatura demonstra que adolescentes que recebem alguma intervenção de educação alimentar e nutricional apresentam maior chance de aprender os conceitos sobre o processamento de alimentos, sobre a importância do ambiente alimentar adequado e como analisar as informações da publicidade de alimentos [5].…”

Tailored smartphone intervention to promote healthy eating among Brazilian adolescents: a randomised controlled trial protocol

“…In addition, when calculating the minimum sample, an estimated loss of 31.8% was added between preintervention and postintervention. 29 Thus, the minimum sample was 390 individuals: 38 in the CG, 38 in the GG and 314 in the TG.…”