Abstract
ObjectiveTo compare two Nutrition and Health Surveys in Taiwan (NAHSITs) 15–18 years apart to evaluate secular changes in ultra-processed food (UPF) consumption and expenditure among Taiwanese adolescents aged 16–18 years and the influences of such changes on dietary quality.DesignThis cross-sectional study was based on two representative surveys (NAHSIT 1993–1996, n = 788; NAHSIT 2011, n = 1,274) of senior high school students. Dietary information and food expenditure were based on 24-h dietary recall. All food items were classified into original foods, processed culinary ingredients, processed foods, and UPFs based on NOVA criteria. Dietary quality was categorized as poor or good based on the mean of the Youth Healthy Eating Index–Taiwan Revised.ResultsCompared to 1993–1996, adolescents consumed less energy from original foods (55 vs. 39%) but more from processed foods (12 vs. 18%) and UPFs (21 vs. 25%) in 2011, with no apparent gender differences. Those who consumed more UPFs had the lowest proportions of protein energy intake in both surveys (13.7 and 13.1%). Those who consumed more UPFs had higher levels of saturated fat and lower levels of monounsaturated and polyunsaturated fat, dietary fiber, and micronutrient intakes. The participants who consumed more UPFs and fewer original foods exhibited poorer dietary quality. Boys and girls exhibited equal UPF expenditure in both surveys despite an increase in UPF energy consumption. The adjusted odds ratios (95% confidence interval) were 1.33 (1.16–1.52) and 1.36 (1.10–1.69) for the risk of poor dietary quality with 10% increases in UPF energy intake and expenditure, respectively, in 2011.ConclusionsUPF energy consumption among Taiwanese adolescents increased between 1993–1996 and 2011. Observed trends in expenditure suggest that lower UPF costs influenced food choices during this period. Increasing UPF intake and expenditure was associated with poor dietary quality.
Highlights
MethodsStudy population The NAHSITs are an established policy instrument of the Center for Survey Research, Academia Sinica, on behalf of the Department of Health, Taiwan, since 1993
We found that the consumption of ultra-processed food (UPF) among Taiwanese senior high school students increased, leading to a reduction in dietary quality between 1993–1996 and 2011
Changing dietary patterns The current study provides a unique description of changes in the consumption of industrially processed foods among Taiwanese adolescents from 1993–1996 to 2011
Summary
Study population The NAHSITs are an established policy instrument of the Center for Survey Research, Academia Sinica, on behalf of the Department of Health, Taiwan, since 1993. They survey representative samples of the free-living population. In the 1993–1996 household-based survey, there were five mutually exclusive strata (Northern 1, Northern 2, Central, Southern, and Eastern strata) and three extra strata for specific population groups (Hakka areas, Penghu Islands, and mountainous areas). The 2011 survey comprised five mutually exclusive strata (Northern 1, Northern 2, Central, Southern, and Eastern strata), and from each of these strata four senior high schools were randomly selected; in turn, 60 students were randomly selected from each high school. All participants had face-to-face interviews to provide sociodemographics and health examinations for anthropometry and fasting blood collection
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