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Food purchasing sites. Repercussions for healthy eating
Appetite 70 (2013) 99–103
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Appetite journal homepage: www.elsevier.com/locate/appet
Research report
Food purchasing sites. Repercussions for healthy eating Janaína Calu Costa a, Rafael M. Claro b,⇑, Ana Paula B. Martins b, Renata B. Levy b,c a
Department of Nutrition, School of Public Health, Universidade de São Paulo., Av. Dr. Arnaldo, 715, Sao Paulo, SP 01246-904, Brazil Nutrition and Health Epidemiological Research Center, School of Public Health, Universidade de São Paulo., Av. Dr. Arnaldo, 715, Sao Paulo, SP 01246-904, Brazil c Department of Preventive Medicine, School of Medicine, Universidade de São Paulo., Av. Dr. Arnaldo, 455, Cerqueira César, CEP 01246903, Sao Paulo, SP, Brazil b
a r t i c l e
i n f o
Article history: Received 17 September 2012 Received in revised form 25 June 2013 Accepted 28 June 2013 Available online 5 July 2013 Keywords: Food purchase Food supply Retail Supermarket Grocery shopping Food storage
a b s t r a c t Changes in the food system are associated with the increase in consumption of foods with low nutritional value in recent decades. Data on food purchasing for household consumption, collected from the Instituto Brasileiro de Geografia e Estatística (IBGE – Brazilian Institute of Geography and Statistics) Household Budget Survey (HBS) in 2002–3, were used to describe the contribution of food purchasing sites (FPS) to the diet of Brazilian families. All the 241 distinct FPS mentioned in the HBS were grouped into ten categories, according to the nature of the products available. Food acquisitions were organized into seven groups. Supermarkets and hypermarkets accounted for 49% of the acquisitions and were the main source of six out of the seven food groups. Street markets and greengroceries stood out in the acquisitions of fruits and vegetables, accounting for 39% of this market. The large contribution of supermarkets and hypermarkets to the diet shows the need for healthy eating promotion policies aiming at these locations. Street markets and greengroceries represent important allies for healthy eating. Ó 2013 Elsevier Ltd. All rights reserved.
Introduction Important changes have occurred in the dietary habits of the Brazilian population in recent decades, especially with regard to the decrease in the consumption of traditional food items in the diet, such as rice, beans and cassava flour, and the increase in the consumption of ultra-processed products, such as sodas, sausages and cookies (IBGE, 2010; Levy, Claro, Mondini, Sichieri, & Monteiro, 2012; Monteiro, Levy, Claro, Castro, & Cannon, 2011). Evidence associates the increase in the consumption of ultra-processed products with excessive weight gain and the increase in the incidence of chronic diseases such as diabetes, hypertension, cardiovascular diseases and certain types of cancer (WHO, 2004). In Brazil, the consumption of ultra-processed food products accounts for almost a quarter of total food consumption (Levy et al., 2012; Monteiro et al., 2011) and almost half of the adult population is already overweight (IBGE, 2010). Dietary behavior is determined by a complex combination of biological, socio-cultural, economic and technological factors (European Food Information Council., 2005). Thus, it is believed that changes in food production and distribution methods, which have occurred in the last decades, are important determinants of current food choices. Among these changes stands out the rising share of supermarkets and hypermarkets in the food market, in parallel with a reduction in the participation of more traditional ⇑ Corresponding author. E-mail address: [email protected] (R.M. Claro). 0195-6663/$ - see front matter Ó 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.appet.2013.06.094
and smaller establishments, such as greengroceries, street markets and small grocery stores (Reardon & Berdegué, 2002), which were the only locations available for the purchasing of foods during most of the 20th century (Reardon, Henson, & Gulati, 2009). The rise of supermarkets, especially those organized in large chains in countries such as the United States, Canada and parts of Europe, began in the mid-1920s. Their growth occurred slowly until they became responsible for approximately 80% of the food retail business in 2009 (Reardon et al., 2009). In contrast, in Brazil, where the first supermarket was established decades later in the 1950s (Knoke, 1963; Belik, 2004), the growth of this sector has occurred in a faster and more intense way since the 1990s, achieving levels similar to those observed in developed countries in only two decades. The difference in the speed of growth of this sector between developed and developing countries is very similar to the speed of occurrence of the process of nutritional and epidemiological transition in these regions (Popkin, 2001). The food policy agenda is greatly affected by the food market dynamics, as this influences all supply structure levels (Timmer, 2008) and is able, among other things, to regulate the food market chain, especially agricultural production (Ghezán, 2002; Shepherd, 2005; Traill, 2006; Timmer, 2008; Buckley, Cowan, & McCarthy, 2007). In spite of this, the relationship between food market structure and the adoption of healthy food practices has hardly been studied, especially in developing countries such as Brazil, where the food market and diet have changed quickly and intensely in the past decades. The present study aimed to estimate the contribution of food purchase sites to the diet consumed in Brazilian
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households taking in account the nature, purpose and intensity of processing of food acquisitions. Methods Sampling and data collection The data used in the present study originated from the Household Budget Survey (HBS), conducted by the Instituto Brasileiro de Geografia e Estatística (IBGE – Brazilian Institute of Geography and Statistics) between July 2002 and June 2003 in a probabilistic sample of 48,470 Brazilian households. The 2002–3 HBS employed a complex cluster sampling procedure, with the selection of census tracts in the first stage and of households within these tracts in the second stage. Selection of census tracts was preceded by the analysis of the 215,790 tracts from the 2000 Demographic Census to obtain strata of households with high geographic and socioeconomic homogeneity. For this end were considered the location of the tract (Region, State, state capital/metropolitan area/non-capital, urban/rural) and the range of variation in socioeconomic status among the tract’s households (mean years of schooling of heads of household, according to the 1996 population count) of each geographic site. Finally, 443 strata of households were formed, all geographically and socioeconomically homogeneous. The number of tracts selected from within each stratum was proportional to the total number of households in that stratum, with a minimum of two tracts selected per stratum. Next, households were selected within each tract by random sampling without replacement. Interviews within each selected stratum were distributed uniformly across the four quarters of the study so as to reproduce the seasonal variation in income, prices, and purchasing of food and other products. The main information from the 2002–3 HBS analyzed in this study includes the records of purchases of foods and beverages for household consumption made on seven consecutive days. These records, noted down in a booklet by the household residents themselves (or with help from an IBGE interviewer when necessary), include detailed information about the cost (in Brazilian currency), the amount acquired (in kilograms or liters) and the site of the acquisition. Only a general description of the acquisition site was recorded (i.e. supermarket or street market) based on a list of expected most frequent sites. Sites not present in this list were initially recorded as ‘‘other sites’’ followed from a brief description from the respondent (standardized by IBGE after data collection). The mean number of food acquisition reported by each household was 13.3. The short reference period used to record household food expenditures does not allow for the identification of the usual food purchase patterns of each household. In this analysis, the cluster of households corresponding to the set of households visited within each of the 443 strata in the sample was used as study unit. The mean number of households studied in each unit of study (sampling stratum) was 109.6 (varying between nine and 804). Construction of variables Food groups The records of purchase of a certain food in a certain unit of study were added (approximately 1300 distinct types of foods were reported in the 2002–3 HBS). Whenever necessary, the inedible fraction was excluded, according to the corresponding correction factors (IBGE, 1978). The total amount purchased of each item was converted into energy (kcal) with the use of the Aquinut software (Univerisdade de São Paulo, n.d.), mainly built from the TACO (Brazilian Food Composition Table) (Unicamp, 2004) database. In
the case of foods not found in this table, the official USDA national nutrient database, version 23 (USDA, 2009), was used. The records of food purchases were divided into seven groups, based on the classification constructed according to the nature, extent and purpose of food processing proposed by Monteiro, Levy, Claro, Castro, and Cannon (2010). Fresh or minimally processed foods were gathered into three groups: (i) grains (rice, beans and similar products), roots and tubers (and derivates); (ii) meats, milk, eggs and fish (including seafood and crustaceans); and (iii) fruits and vegetables; the remaining cooking ingredients were gathered in two groups: (iv) sugars; (v) oils and fats; and (vi) ultraprocessed products were gathered in a single group: bread, biscuits (sweet and salty), candies, cheeses, sausages (including processed meats), mayonnaise-based sauces and broths, sodas (including sweetened beverages) and instant meals and manufactured food mixtures. The remaining foods (such as nuts and seeds, seasonings and infusions) and alcoholic beverages were grouped in a single complementary group (vii). Food purchase sites (FPS) The 241 distinct food purchase sites (FPS) mentioned in the HBS to obtain foods and beverages for household consumption were grouped according to their physical structure, nature of the main products commercialized and specific commercialization characteristics. A total of ten groups were established: super/hypermarkets; small markets/grocery stores; bakeries; street markets/ greengroceries; butcher shops/meatpacking businesses; street vendors; bars/cafeterias/restaurants; home production; food supply centers; and others (Fig. 1). Data analysis The mean amount of each food group acquired for household consumption was expressed in kcal per capita per day (kcal/pc/ day), dividing the sum of calories of each category by the total number of individuals in the stratum and by the number of record days. The relative contribution of FPS to household food consumption was described by the percentage of the total caloric value acquired in each of the FPS categories. Next, the contribution of each FPS category to the total of each of the seven food groups acquired was also identified. The analytical procedures of this study were performed with the Stata software, version 11, taking into consideration the 2002–3 HBS sample design. Results The daily energy availability was 1811 kcal per capita, of which 33.0% corresponded to the staple food group (grains such as rice and beans, roots and tubers), followed by ultra-processed products (such as sodas and biscuits) with 23.8% (Table 1). While the group of sugars and that of oils and fats accounted for nearly one fifth of the total caloric value, fruits and vegetables corresponded to a little more than 2%. Super/hypermarkets accounted for almost half of the total number of calories acquired (49.0%), followed by small markets/grocery stores (16.5%) and street markets and greengroceries (7.3%) (Table 2). Thus, super/hypermarkets accounted for most of the acquisition of six out of the seven food groups analyzed when compared to other sites, with a contribution to the total caloric value acquired ranging from 37.3% in the case of ultra-processed products to more than 60% in the case of sugars and oils and fats. The only exception was the group of fruits and vegetables, in which
J.C. Costa et al. / Appetite 70 (2013) 99–103
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Fig. 1. Categorization of food distribution equipment according to physical structure, nature of the main products available and specific marketing characteristics.
street markets (and the remaining locations specialized in the distribution of fruits of vegetables) accounted for 39.2% of the total number of calories acquired (Table 3). Small markets/grocery stores were the second most important FPS category for five out of the seven food groups, except for the groups of fruits and vegetables and ultra-processed products. The latter group stood out when compared to the other groups as its purchase pattern was well distributed among the several FPS categories. In addition, super/hypermarkets, bakeries, small markets/grocery stores and butcher shops/meatpacking businesses had an important contribution to the acquisition of ultra-processed products of 21.4%, 12.6% and 9.2%, respectively (Table 3). Discussion The detailed record of all food purchases made by a representative sample of the entire country, obtained by the 2002–3 HBS, allowed researchers to estimate the contribution of the different food purchase sites to the diet consumed by Brazilian families. Super/hypermarkets contributed significantly to the current food
Table 1 Contribution of food groups to the total energy available in the Brazilian householdsa. Brazil, 2002–3 HBS/IBGE.
Rice, beans, roots and tubers Ultra-processed products Oils and fats Sugars Meats, milk, fish and eggs Fruits and vegetables Alcoholic beverages and others Total
Mean (kcal/pc/ day)
(95%CI)
%
597.3 430.6 250.9 214.7 184.0 42.1 91.8 1811.5
(559.5–635.1) (408.5–452.7) (234.9–267.0) (199.4–230.1) (176.5–191.4) (39.6–44.6) (77.2–106.4)
33.0 23.8 13.9 11.9 10.2 2.3 5.1 100.0
Obs: 1 kcal = 4.19 kJ. a This information relates only to household food availability. Food consumed away from home was not considered (for more information see methods section).
purchase pattern, accounting for one in every two calories purchased in Brazilian households. These locations were the main source of acquisition of six out of the seven food groups analyzed. Grocery stores and small markets also showed significant contribution to Brazilian food purchases, accounting for 16.5% of the household availability of calories. Street markets (and other locations specialized in the distribution of fruits and vegetables) stood out due to their important role in the acquisition of fruits and vegetables consumed in Brazilian households. Until the time when this study was completed, researchers were unaware of other studies aimed at identifying the contribution of FPS to the population diet using national data. Several studies (Asfaw, 2007; Block & Kouba, 2006; Brunner, van der Horst, & Siegrist, 2010; Buckley et al., 2007; Emond, Madanat, & Ayala, 2005; Kaufman, 2005; Krukowski, McSweenwey, Sparks, & West, 2012; Morland, 2006) have paid attention to the assessment of access to food purchase sites and the characteristics of these locations, such as healthy eating promotion aspects, especially in developed countries. The way that FPS were recorded in the 2002–3 HBS does not enable results similar to these studies to be obtained (no Site name or location was recorded). However, our results allow researchers to observe household food availability in Brazil, using an unexplored perspective and emphasizing important information for the development of public policies aimed at the improvement of the Brazilian population’s diet. The most relevant aspect of these findings is the great concentration of food purchases in super/hypermarkets. While this scenario might have contributed to the improvement of food safety in the country (increasing the economic and physical access to food (Zenk et al., 2005), on the other hand, it also has negative aspects. Its known that market concentration offers a hazard to fair trade and can influence demand, in this specific case by promoting the sales of unhealthy ultra-processed products (due to a higher profit margin). Despite this market appeal, these products are dangerous to human health due to a high sodium, free sugar and fat content (Monteiro et al., 2011).
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Table 2 Mean caloric value acquired and contribution of food purchase sites (FPS) to household food availabilitya. Brazil, HBS/IBGE 2002–3.
Super/hypermarkets Small markets/grocery stores Street markets/greengroceries Food supply centers Bakeries Home production Street vendors Butcher shops/meatpacking businesses Bars/cafeterias/restaurants Others
Mean (kcal/pc/day)
(95%CI)
%
887.0 299.5 131.6 124.3 116.1 86.3 64.7 51.4 16.2 34.4 1811.5
(814.3–659.7) (257.9–341.1) (109.2–153.9) (103.1–145.5) (106.9–125.4) (54.2–118.4) (55.6–73.9) (47.1–55.6) (14.0–18.4) (27.8–41.0)
49.0 16.5 7.3 6.9 6.4 4.8 3.6 2.8 0.9 1.9 100.0
Obs: 1 kcal = 4.19 kJ. a This information relates only to household food availability. Food consumed away from home was not considered (for more information see methods section).
Table 3 Contribution of each food purchase location to the total caloric value of each food group available in the Brazilian householdsa. Brazil, 2002–3 HBS/IBGE.
Super/hypermarkets Small markets/grocery stores Bakeries Street markets/ greengroceries Butcher shops/ meatpacking businesses Street vendors Bars/cafeterias/ restaurants Home production Food supply centers Others Total a
Rice, beans, roots and tubers
Ultra-processed products
Oils and fats
Sugars
Meats, milk, fish and eggs
Fruits and vegetables
Alcoholic beverages and others
%
(95%CI)
%
(95%CI)
%
%
%
%
%
56.5 17
(52.7–60.4) (14.9–19.2)
37.3 12.6
(34.4–40.1) 62.6 (11.0–14.1) 18.4
(59.2–66.0) 61.4 (15.8–21.0) 20.1
(57.8–64.9) 38.5 (17.5–22.8) 11.2
(35.2–41.8) 30.5 (9.9–12.4) 7.6
(26.7–34.3) 45.0 (6.6–8.6) 20.6
(41.4–48.7) (16.4–24.8)
0.5 8.7
(0.3–0.7) (7.1–10.3)
21.4 4.9
(20.1–22.8) 1.6 (4.0–5.8) 5.9
(1.4–1.9) (4.6–7.2)
1.1 6.7
(0.8–1.4) (5.3–8.1)
8.0 6.4
(6.8–9.1) (5.3–7.5)
0.3 39.2
(0.2–0.4) 1.4 (35.7–42.7) 9.8
(0.9–1.9) (7.9–11.7)
0.1
(0.0–0.2)
9.2
(8.3–10.1)
0.2
(0.1–0.4)
0.0
(0.0–0.0)
9.4
(8.2–10.6)
0.2
(0.1–0.3)
0.3
(0.0–0.7)
3.1 0.2
(2.6–3.6) (0.1–0.3)
3.0 2.6
(2.6–3.4) (2.2–2.9)
1.8 0.2
(1.2–2.3) (0.1–0.3)
1.4 0.1
(1.0–1.9) (0.1–0.2)
8.4 0.6
(7.2–9.6) (0.3–0.8)
7.7 0.5
(6.9–8.5) (0.1–0.8)
4.1 2.3
(3.2–5.1) (1.8–2.8)
3.4 8.6 1.9 100.0
(2.3–4.5) (6.9–10.2) (1.3–2.4)
2.4 (1.5–3.2) 5.6 (4.7–6.5) 1.0 (0.7–1.3) 100.0
3.7 7.1 5.6 100.0
(2.5–4.8) (5.5–8.8) (3.9–7.3)
(95%CI)
1.0 (0.4–1.5) 7.4 (6.1–8.8) 0.9 (0.5–1.2) 100.0
(95%CI)
0.1 (0.0–0.2) 8.3 (6.5–10.1) 0.7 (0.4–1.1) 100.0
(95%CI)
8.2 (6.2–10.3) 6.2 (5.1–7.3) 3.2 (2.7–3.8) 100.0
(95%CI)
6.3 (4.5–8.1) 6.2 (5.1–7.3) 1.6 (1.0–2.1) 100.0
(95%CI)
This information relates only to household food availability. Food consumed away from home was not considered (for more information see methods section).
The role of small markets/grocery stores in the Brazilian diet was also highlighted. These locations provide a variety of foods, similar to that of super/hypermarkets, and the geographical proximity to consumers is their greatest appeal, promoting a higher frequency of food purchases (Bawa, 1999). In terms of the nutritional quality of food purchases in these sites, studies that have assessed the acquisition of healthy items in different establishments did not find a significant difference between purchases made in smaller ´ Angelo, Suratestablishments and those made in supermarkets (D kar, Song, & Stauffer, 2011). The relevance of street markets and greengroceries stood out in this study. Although these FPS accounted for less than 10% of the total calories acquired, their great contribution to the purchase of fruits and vegetables (more than 30% of the total amount acquired) must be seen as extremely positive. They are characterized by great dynamism between the distribution and point of sale, which may justify the choice of these locations to purchase fresh foods (Reardon et al., 2009). Some limitations in the analysis of the results of the present study should be taken into consideration. First, data from this study deal with household food availability, not intake itself. The fraction not consumed is unknown and out-of-home consumption is not analyzed. Although food waste is unknown, it is believed to mainly affect fresh or minimally processed foods (such as meats, milk, fruits and vegetables). This would imply an overestimation of the contribution of locations specialized in the distribution of such products to the dietary pattern of the Brazilian population,
although without changing the meaning of the findings of this study. Additionally, in Brazil, foods and beverages purchased for household consumption accounted for more than three quarters (76%) of the total spending on food (IBGE, 2004). The short reference period (one week) to collect data on food purchases made per household in the 2002–3 HBS could equally be an important limitation in this study. Aiming to minimize this limitation, researchers adopted households clusters as unit of study, which were homogeneous with regard to geographic location and socioeconomic characteristics and contained households studied throughout a period of one year.
Conclusions The results of the present study emphasize the hypothesis that the changes occurring in the Brazilian food distribution sector, especially the concentration of food purchases in super/hypermarkets, are associated with the consumption of unhealthy ultra-processed products. This situation shows the need for healthy eating promotion policies aimed at these locations, particularly with regard to the guarantee of access to healthy foods, such as fruits and vegetables and lean meat. Additionally, the great contribution of street markets and greengroceries to the acquisition of fruits and vegetables is a logical reason for these locations to be the aim of specific healthy eating promotion actions as well.
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The application of this methodology to other Household Budget Surveys (there are data available from the 1986–87, 1995–96 and 2008–09 HBSs) will enable the understanding of the actual speed of food distribution changes in the country and the way they are affecting the food consumption of Brazilian families. References Asfaw, A. (2007). Supermarket purchase and the dietary patterns of households in Guatemala. Discussion Paper 696, Washington: International Food Policy Research Institute. Bawa, K. (1999). A model of household grocery shopping behavior. Marketing Letters, 10(2), 149–160. Belik, W. (2004). Supermercados e Produtores. Limites, Possibilidades e Desafios. Anais XII Congresso da Sociedade Brasileira De Economia e Sociologia Rural, Cuiabá. Block, D., & Kouba, J. (2006). A comparison of the availability and affordability of a market basket in two communities in the Chicago area. Public Health Nutrition, 9(7), 837–845. Brunner, T. A., van der Horst, K., & Siegrist, M. (2010). Convenience food products. Drivers for consumption. Appetite, 55, 498–506. Buckley, M., Cowan, C., & McCarthy, M. (2007). The convenience food market in Great Britain. Convenience food lifestyle (CFL) segments. Appetite, 49, 600–617. D´Angelo, H., Suratkar, S., Song, H., & Stauffer, E. (2011). Access to food source and food source use are associated with healthy and unhealthy food-purchasing behaviors among low-income African–American adults in Baltimore City. Public Health Nutrition, 14(9), 1632–1639. Emond, J. A., Madanat, H. N., & Ayala, G. X. (2005). Do Latino and non-Latino grocery stores differ in the availability and affordability of healthy food items in a lowincome, metropolitan region? Public Health Nutrition, 15(2), 360–369. European Food Information Council. (2005). The determinants of food choice. EUFIC, Review n°8/2005. Ghezán, G. (2002). Impact of supermarkets and FPSt-food chains on horticulture supply chains in Argentina. Development Policy Review, 20(4), 389–408. Instituto Brasileiro de Geografia e Estatística. Pesquisa de Orçamentos Familiares 2002–2003. Análise da disponibilidade domiciliar de alimentos e do estado nutricional no Brasil. Rio de Janeiro: IBGE. Instituto Brasileiro de Geografia e Estatística. Pesquisa de Orçamentos Familiares 2008–2009. Análise da disponibilidade domiciliar de alimentos e do estado nutricional no Brasil. Rio de Janeiro: IBGE. Instituto Brasileiro de Geografia e Estatística. Estudo Nacional da Despesa Familiar – ENDEF 1974/75. Rio de Janeiro: IBGE. Kaufman, P. (2005). Rural poor have less access to supermarkets, large grocery stores. Rural Development Perspectives, 13(3), 19–26.
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Contents lists available at SciVerse ScienceDirect
Appetite journal homepage: www.elsevier.com/locate/appet
Research report
Food purchasing sites. Repercussions for healthy eating Janaína Calu Costa a, Rafael M. Claro b,⇑, Ana Paula B. Martins b, Renata B. Levy b,c a
Department of Nutrition, School of Public Health, Universidade de São Paulo., Av. Dr. Arnaldo, 715, Sao Paulo, SP 01246-904, Brazil Nutrition and Health Epidemiological Research Center, School of Public Health, Universidade de São Paulo., Av. Dr. Arnaldo, 715, Sao Paulo, SP 01246-904, Brazil c Department of Preventive Medicine, School of Medicine, Universidade de São Paulo., Av. Dr. Arnaldo, 455, Cerqueira César, CEP 01246903, Sao Paulo, SP, Brazil b
a r t i c l e
i n f o
Article history: Received 17 September 2012 Received in revised form 25 June 2013 Accepted 28 June 2013 Available online 5 July 2013 Keywords: Food purchase Food supply Retail Supermarket Grocery shopping Food storage
a b s t r a c t Changes in the food system are associated with the increase in consumption of foods with low nutritional value in recent decades. Data on food purchasing for household consumption, collected from the Instituto Brasileiro de Geografia e Estatística (IBGE – Brazilian Institute of Geography and Statistics) Household Budget Survey (HBS) in 2002–3, were used to describe the contribution of food purchasing sites (FPS) to the diet of Brazilian families. All the 241 distinct FPS mentioned in the HBS were grouped into ten categories, according to the nature of the products available. Food acquisitions were organized into seven groups. Supermarkets and hypermarkets accounted for 49% of the acquisitions and were the main source of six out of the seven food groups. Street markets and greengroceries stood out in the acquisitions of fruits and vegetables, accounting for 39% of this market. The large contribution of supermarkets and hypermarkets to the diet shows the need for healthy eating promotion policies aiming at these locations. Street markets and greengroceries represent important allies for healthy eating. Ó 2013 Elsevier Ltd. All rights reserved.
Introduction Important changes have occurred in the dietary habits of the Brazilian population in recent decades, especially with regard to the decrease in the consumption of traditional food items in the diet, such as rice, beans and cassava flour, and the increase in the consumption of ultra-processed products, such as sodas, sausages and cookies (IBGE, 2010; Levy, Claro, Mondini, Sichieri, & Monteiro, 2012; Monteiro, Levy, Claro, Castro, & Cannon, 2011). Evidence associates the increase in the consumption of ultra-processed products with excessive weight gain and the increase in the incidence of chronic diseases such as diabetes, hypertension, cardiovascular diseases and certain types of cancer (WHO, 2004). In Brazil, the consumption of ultra-processed food products accounts for almost a quarter of total food consumption (Levy et al., 2012; Monteiro et al., 2011) and almost half of the adult population is already overweight (IBGE, 2010). Dietary behavior is determined by a complex combination of biological, socio-cultural, economic and technological factors (European Food Information Council., 2005). Thus, it is believed that changes in food production and distribution methods, which have occurred in the last decades, are important determinants of current food choices. Among these changes stands out the rising share of supermarkets and hypermarkets in the food market, in parallel with a reduction in the participation of more traditional ⇑ Corresponding author. E-mail address: [email protected] (R.M. Claro). 0195-6663/$ - see front matter Ó 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.appet.2013.06.094
and smaller establishments, such as greengroceries, street markets and small grocery stores (Reardon & Berdegué, 2002), which were the only locations available for the purchasing of foods during most of the 20th century (Reardon, Henson, & Gulati, 2009). The rise of supermarkets, especially those organized in large chains in countries such as the United States, Canada and parts of Europe, began in the mid-1920s. Their growth occurred slowly until they became responsible for approximately 80% of the food retail business in 2009 (Reardon et al., 2009). In contrast, in Brazil, where the first supermarket was established decades later in the 1950s (Knoke, 1963; Belik, 2004), the growth of this sector has occurred in a faster and more intense way since the 1990s, achieving levels similar to those observed in developed countries in only two decades. The difference in the speed of growth of this sector between developed and developing countries is very similar to the speed of occurrence of the process of nutritional and epidemiological transition in these regions (Popkin, 2001). The food policy agenda is greatly affected by the food market dynamics, as this influences all supply structure levels (Timmer, 2008) and is able, among other things, to regulate the food market chain, especially agricultural production (Ghezán, 2002; Shepherd, 2005; Traill, 2006; Timmer, 2008; Buckley, Cowan, & McCarthy, 2007). In spite of this, the relationship between food market structure and the adoption of healthy food practices has hardly been studied, especially in developing countries such as Brazil, where the food market and diet have changed quickly and intensely in the past decades. The present study aimed to estimate the contribution of food purchase sites to the diet consumed in Brazilian
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households taking in account the nature, purpose and intensity of processing of food acquisitions. Methods Sampling and data collection The data used in the present study originated from the Household Budget Survey (HBS), conducted by the Instituto Brasileiro de Geografia e Estatística (IBGE – Brazilian Institute of Geography and Statistics) between July 2002 and June 2003 in a probabilistic sample of 48,470 Brazilian households. The 2002–3 HBS employed a complex cluster sampling procedure, with the selection of census tracts in the first stage and of households within these tracts in the second stage. Selection of census tracts was preceded by the analysis of the 215,790 tracts from the 2000 Demographic Census to obtain strata of households with high geographic and socioeconomic homogeneity. For this end were considered the location of the tract (Region, State, state capital/metropolitan area/non-capital, urban/rural) and the range of variation in socioeconomic status among the tract’s households (mean years of schooling of heads of household, according to the 1996 population count) of each geographic site. Finally, 443 strata of households were formed, all geographically and socioeconomically homogeneous. The number of tracts selected from within each stratum was proportional to the total number of households in that stratum, with a minimum of two tracts selected per stratum. Next, households were selected within each tract by random sampling without replacement. Interviews within each selected stratum were distributed uniformly across the four quarters of the study so as to reproduce the seasonal variation in income, prices, and purchasing of food and other products. The main information from the 2002–3 HBS analyzed in this study includes the records of purchases of foods and beverages for household consumption made on seven consecutive days. These records, noted down in a booklet by the household residents themselves (or with help from an IBGE interviewer when necessary), include detailed information about the cost (in Brazilian currency), the amount acquired (in kilograms or liters) and the site of the acquisition. Only a general description of the acquisition site was recorded (i.e. supermarket or street market) based on a list of expected most frequent sites. Sites not present in this list were initially recorded as ‘‘other sites’’ followed from a brief description from the respondent (standardized by IBGE after data collection). The mean number of food acquisition reported by each household was 13.3. The short reference period used to record household food expenditures does not allow for the identification of the usual food purchase patterns of each household. In this analysis, the cluster of households corresponding to the set of households visited within each of the 443 strata in the sample was used as study unit. The mean number of households studied in each unit of study (sampling stratum) was 109.6 (varying between nine and 804). Construction of variables Food groups The records of purchase of a certain food in a certain unit of study were added (approximately 1300 distinct types of foods were reported in the 2002–3 HBS). Whenever necessary, the inedible fraction was excluded, according to the corresponding correction factors (IBGE, 1978). The total amount purchased of each item was converted into energy (kcal) with the use of the Aquinut software (Univerisdade de São Paulo, n.d.), mainly built from the TACO (Brazilian Food Composition Table) (Unicamp, 2004) database. In
the case of foods not found in this table, the official USDA national nutrient database, version 23 (USDA, 2009), was used. The records of food purchases were divided into seven groups, based on the classification constructed according to the nature, extent and purpose of food processing proposed by Monteiro, Levy, Claro, Castro, and Cannon (2010). Fresh or minimally processed foods were gathered into three groups: (i) grains (rice, beans and similar products), roots and tubers (and derivates); (ii) meats, milk, eggs and fish (including seafood and crustaceans); and (iii) fruits and vegetables; the remaining cooking ingredients were gathered in two groups: (iv) sugars; (v) oils and fats; and (vi) ultraprocessed products were gathered in a single group: bread, biscuits (sweet and salty), candies, cheeses, sausages (including processed meats), mayonnaise-based sauces and broths, sodas (including sweetened beverages) and instant meals and manufactured food mixtures. The remaining foods (such as nuts and seeds, seasonings and infusions) and alcoholic beverages were grouped in a single complementary group (vii). Food purchase sites (FPS) The 241 distinct food purchase sites (FPS) mentioned in the HBS to obtain foods and beverages for household consumption were grouped according to their physical structure, nature of the main products commercialized and specific commercialization characteristics. A total of ten groups were established: super/hypermarkets; small markets/grocery stores; bakeries; street markets/ greengroceries; butcher shops/meatpacking businesses; street vendors; bars/cafeterias/restaurants; home production; food supply centers; and others (Fig. 1). Data analysis The mean amount of each food group acquired for household consumption was expressed in kcal per capita per day (kcal/pc/ day), dividing the sum of calories of each category by the total number of individuals in the stratum and by the number of record days. The relative contribution of FPS to household food consumption was described by the percentage of the total caloric value acquired in each of the FPS categories. Next, the contribution of each FPS category to the total of each of the seven food groups acquired was also identified. The analytical procedures of this study were performed with the Stata software, version 11, taking into consideration the 2002–3 HBS sample design. Results The daily energy availability was 1811 kcal per capita, of which 33.0% corresponded to the staple food group (grains such as rice and beans, roots and tubers), followed by ultra-processed products (such as sodas and biscuits) with 23.8% (Table 1). While the group of sugars and that of oils and fats accounted for nearly one fifth of the total caloric value, fruits and vegetables corresponded to a little more than 2%. Super/hypermarkets accounted for almost half of the total number of calories acquired (49.0%), followed by small markets/grocery stores (16.5%) and street markets and greengroceries (7.3%) (Table 2). Thus, super/hypermarkets accounted for most of the acquisition of six out of the seven food groups analyzed when compared to other sites, with a contribution to the total caloric value acquired ranging from 37.3% in the case of ultra-processed products to more than 60% in the case of sugars and oils and fats. The only exception was the group of fruits and vegetables, in which
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Fig. 1. Categorization of food distribution equipment according to physical structure, nature of the main products available and specific marketing characteristics.
street markets (and the remaining locations specialized in the distribution of fruits of vegetables) accounted for 39.2% of the total number of calories acquired (Table 3). Small markets/grocery stores were the second most important FPS category for five out of the seven food groups, except for the groups of fruits and vegetables and ultra-processed products. The latter group stood out when compared to the other groups as its purchase pattern was well distributed among the several FPS categories. In addition, super/hypermarkets, bakeries, small markets/grocery stores and butcher shops/meatpacking businesses had an important contribution to the acquisition of ultra-processed products of 21.4%, 12.6% and 9.2%, respectively (Table 3). Discussion The detailed record of all food purchases made by a representative sample of the entire country, obtained by the 2002–3 HBS, allowed researchers to estimate the contribution of the different food purchase sites to the diet consumed by Brazilian families. Super/hypermarkets contributed significantly to the current food
Table 1 Contribution of food groups to the total energy available in the Brazilian householdsa. Brazil, 2002–3 HBS/IBGE.
Rice, beans, roots and tubers Ultra-processed products Oils and fats Sugars Meats, milk, fish and eggs Fruits and vegetables Alcoholic beverages and others Total
Mean (kcal/pc/ day)
(95%CI)
%
597.3 430.6 250.9 214.7 184.0 42.1 91.8 1811.5
(559.5–635.1) (408.5–452.7) (234.9–267.0) (199.4–230.1) (176.5–191.4) (39.6–44.6) (77.2–106.4)
33.0 23.8 13.9 11.9 10.2 2.3 5.1 100.0
Obs: 1 kcal = 4.19 kJ. a This information relates only to household food availability. Food consumed away from home was not considered (for more information see methods section).
purchase pattern, accounting for one in every two calories purchased in Brazilian households. These locations were the main source of acquisition of six out of the seven food groups analyzed. Grocery stores and small markets also showed significant contribution to Brazilian food purchases, accounting for 16.5% of the household availability of calories. Street markets (and other locations specialized in the distribution of fruits and vegetables) stood out due to their important role in the acquisition of fruits and vegetables consumed in Brazilian households. Until the time when this study was completed, researchers were unaware of other studies aimed at identifying the contribution of FPS to the population diet using national data. Several studies (Asfaw, 2007; Block & Kouba, 2006; Brunner, van der Horst, & Siegrist, 2010; Buckley et al., 2007; Emond, Madanat, & Ayala, 2005; Kaufman, 2005; Krukowski, McSweenwey, Sparks, & West, 2012; Morland, 2006) have paid attention to the assessment of access to food purchase sites and the characteristics of these locations, such as healthy eating promotion aspects, especially in developed countries. The way that FPS were recorded in the 2002–3 HBS does not enable results similar to these studies to be obtained (no Site name or location was recorded). However, our results allow researchers to observe household food availability in Brazil, using an unexplored perspective and emphasizing important information for the development of public policies aimed at the improvement of the Brazilian population’s diet. The most relevant aspect of these findings is the great concentration of food purchases in super/hypermarkets. While this scenario might have contributed to the improvement of food safety in the country (increasing the economic and physical access to food (Zenk et al., 2005), on the other hand, it also has negative aspects. Its known that market concentration offers a hazard to fair trade and can influence demand, in this specific case by promoting the sales of unhealthy ultra-processed products (due to a higher profit margin). Despite this market appeal, these products are dangerous to human health due to a high sodium, free sugar and fat content (Monteiro et al., 2011).
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Table 2 Mean caloric value acquired and contribution of food purchase sites (FPS) to household food availabilitya. Brazil, HBS/IBGE 2002–3.
Super/hypermarkets Small markets/grocery stores Street markets/greengroceries Food supply centers Bakeries Home production Street vendors Butcher shops/meatpacking businesses Bars/cafeterias/restaurants Others
Mean (kcal/pc/day)
(95%CI)
%
887.0 299.5 131.6 124.3 116.1 86.3 64.7 51.4 16.2 34.4 1811.5
(814.3–659.7) (257.9–341.1) (109.2–153.9) (103.1–145.5) (106.9–125.4) (54.2–118.4) (55.6–73.9) (47.1–55.6) (14.0–18.4) (27.8–41.0)
49.0 16.5 7.3 6.9 6.4 4.8 3.6 2.8 0.9 1.9 100.0
Obs: 1 kcal = 4.19 kJ. a This information relates only to household food availability. Food consumed away from home was not considered (for more information see methods section).
Table 3 Contribution of each food purchase location to the total caloric value of each food group available in the Brazilian householdsa. Brazil, 2002–3 HBS/IBGE.
Super/hypermarkets Small markets/grocery stores Bakeries Street markets/ greengroceries Butcher shops/ meatpacking businesses Street vendors Bars/cafeterias/ restaurants Home production Food supply centers Others Total a
Rice, beans, roots and tubers
Ultra-processed products
Oils and fats
Sugars
Meats, milk, fish and eggs
Fruits and vegetables
Alcoholic beverages and others
%
(95%CI)
%
(95%CI)
%
%
%
%
%
56.5 17
(52.7–60.4) (14.9–19.2)
37.3 12.6
(34.4–40.1) 62.6 (11.0–14.1) 18.4
(59.2–66.0) 61.4 (15.8–21.0) 20.1
(57.8–64.9) 38.5 (17.5–22.8) 11.2
(35.2–41.8) 30.5 (9.9–12.4) 7.6
(26.7–34.3) 45.0 (6.6–8.6) 20.6
(41.4–48.7) (16.4–24.8)
0.5 8.7
(0.3–0.7) (7.1–10.3)
21.4 4.9
(20.1–22.8) 1.6 (4.0–5.8) 5.9
(1.4–1.9) (4.6–7.2)
1.1 6.7
(0.8–1.4) (5.3–8.1)
8.0 6.4
(6.8–9.1) (5.3–7.5)
0.3 39.2
(0.2–0.4) 1.4 (35.7–42.7) 9.8
(0.9–1.9) (7.9–11.7)
0.1
(0.0–0.2)
9.2
(8.3–10.1)
0.2
(0.1–0.4)
0.0
(0.0–0.0)
9.4
(8.2–10.6)
0.2
(0.1–0.3)
0.3
(0.0–0.7)
3.1 0.2
(2.6–3.6) (0.1–0.3)
3.0 2.6
(2.6–3.4) (2.2–2.9)
1.8 0.2
(1.2–2.3) (0.1–0.3)
1.4 0.1
(1.0–1.9) (0.1–0.2)
8.4 0.6
(7.2–9.6) (0.3–0.8)
7.7 0.5
(6.9–8.5) (0.1–0.8)
4.1 2.3
(3.2–5.1) (1.8–2.8)
3.4 8.6 1.9 100.0
(2.3–4.5) (6.9–10.2) (1.3–2.4)
2.4 (1.5–3.2) 5.6 (4.7–6.5) 1.0 (0.7–1.3) 100.0
3.7 7.1 5.6 100.0
(2.5–4.8) (5.5–8.8) (3.9–7.3)
(95%CI)
1.0 (0.4–1.5) 7.4 (6.1–8.8) 0.9 (0.5–1.2) 100.0
(95%CI)
0.1 (0.0–0.2) 8.3 (6.5–10.1) 0.7 (0.4–1.1) 100.0
(95%CI)
8.2 (6.2–10.3) 6.2 (5.1–7.3) 3.2 (2.7–3.8) 100.0
(95%CI)
6.3 (4.5–8.1) 6.2 (5.1–7.3) 1.6 (1.0–2.1) 100.0
(95%CI)
This information relates only to household food availability. Food consumed away from home was not considered (for more information see methods section).
The role of small markets/grocery stores in the Brazilian diet was also highlighted. These locations provide a variety of foods, similar to that of super/hypermarkets, and the geographical proximity to consumers is their greatest appeal, promoting a higher frequency of food purchases (Bawa, 1999). In terms of the nutritional quality of food purchases in these sites, studies that have assessed the acquisition of healthy items in different establishments did not find a significant difference between purchases made in smaller ´ Angelo, Suratestablishments and those made in supermarkets (D kar, Song, & Stauffer, 2011). The relevance of street markets and greengroceries stood out in this study. Although these FPS accounted for less than 10% of the total calories acquired, their great contribution to the purchase of fruits and vegetables (more than 30% of the total amount acquired) must be seen as extremely positive. They are characterized by great dynamism between the distribution and point of sale, which may justify the choice of these locations to purchase fresh foods (Reardon et al., 2009). Some limitations in the analysis of the results of the present study should be taken into consideration. First, data from this study deal with household food availability, not intake itself. The fraction not consumed is unknown and out-of-home consumption is not analyzed. Although food waste is unknown, it is believed to mainly affect fresh or minimally processed foods (such as meats, milk, fruits and vegetables). This would imply an overestimation of the contribution of locations specialized in the distribution of such products to the dietary pattern of the Brazilian population,
although without changing the meaning of the findings of this study. Additionally, in Brazil, foods and beverages purchased for household consumption accounted for more than three quarters (76%) of the total spending on food (IBGE, 2004). The short reference period (one week) to collect data on food purchases made per household in the 2002–3 HBS could equally be an important limitation in this study. Aiming to minimize this limitation, researchers adopted households clusters as unit of study, which were homogeneous with regard to geographic location and socioeconomic characteristics and contained households studied throughout a period of one year.
Conclusions The results of the present study emphasize the hypothesis that the changes occurring in the Brazilian food distribution sector, especially the concentration of food purchases in super/hypermarkets, are associated with the consumption of unhealthy ultra-processed products. This situation shows the need for healthy eating promotion policies aimed at these locations, particularly with regard to the guarantee of access to healthy foods, such as fruits and vegetables and lean meat. Additionally, the great contribution of street markets and greengroceries to the acquisition of fruits and vegetables is a logical reason for these locations to be the aim of specific healthy eating promotion actions as well.
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