Deficient Intakes of Energy and Macronutrients in Pakistani Female Students Assessed by Composite Samples Method
Muhammad Muzaffar A.K. Khattak
The main purpose of the study was to compare the energy and macronutrients intakes by composite sample method. Duplicate food samples for seven days i.e., breakfast, lunch and dinner and whatever else ate during the week were analyzed for macronutrients consumption. Twenty female students were registered from the female hostel of the NWFP, Agricultural University Peshawar Pakistan. Age, weight, height and skin folds of the students were recorded on the day of the registration. From the anthropometry Basal Metabolic Index (BMI) was determined. The composite food samples were analyzed for protein, carbohydrates and fats. The energy values were determined by multiplying the daily eaten protein, carbohydrates and fats with 4, 4 and 9, respectively. The mean values of energy and macronutrients intakes were compared with the norms as appropriate. The energy and protein intakes were lower by -29.34% and protein intake was higher by 42.65% compared with American Dietetic Association (ADA). Similarly, compared to the WHO/FAO values the energy was lower -30.57 and protein was higher by 43.29, respectively. The energy contribution was higher from protein by 151% and lower from carbohydrates and fats by -28.35 and 23.43%, respectively. This study suggests that students are having deficient or imbalance energy intakes from macronutrients and are at the risk of malnutrition.
Nutritional status rather improved nutritional status plays an important role
in the well being of an individual or a community (ies). Nutritional status
is assessed in different ways but the most frequent used methods are anthropometric,
bio-chemical, 24 h dietary-recall intakes and others as well. All these methods
can be applied to individuals assessment, community (ies) assessment, or surveys
conducted for the nutritional status (Jelliffe, 1996;
McMahan and Bistrain, 1991). It has been observed that
the university students are at the risk of specific nutrients deficiencies,
the energy requirements are mainly met through dietary fat intakes. Furthermore,
students in hostel develop faulty food habits (Khattak et
al., 2002; Chiplonkar et al., 1993; Wyka
and Zechałko-Czajkowska, 2007; Skibniewska et
al., 2007). These faulty foods habits have been explained to be associated
with low nutrients densities of foods consumption (Skibniewska
et al., 2007). This may result in higher or lower intakes of nutrients
and it has been shown that the university students in particular male
have higher energy and protein intake (Statalic et al.,
2007). A similar trend was observed in the students both in male and female
in the NWFP, Agricultural University, Peshawar, Pakistan when assessed for energy
and macronutrients intakes through food frequency questionnaires (Khattak
et al., 2002). Therefore, this study was designed with an effort
to confirm whether or not it is lower among the female students of the NWFP,
Agricultural University, Peshawar, Pakistan by composite food sample method.
MATERIALS AND METHODS
Twenty female students were registered from the female hostel of the NWFP,
Agricultural University, Peshawar, Pakistan for the assessment of energy and
macronutrients (protein, carbohydrate and fats) intakes by composite food samples
method. The age, weight and height of the students were recorded on the day
of the registration. Also, the skin fold thicknesses of the students were recorded
on the day of the registration. The students were asked to collect duplicate
foods samples for a week i.e., breakfast, lunch and dinner and whatever else
ate during the day. The seven days foods samples were bulked and composite samples
were prepared. From the body weight and heights of the students the BMI was
determined according to the formula; weight (kg)/height (m)2. The
skin-folds were assessed by using the adipometer and the percent body fats of
the students were assessed from the body fat measurement chart for women provided
in the manual of the adipometer (ACCU-Measure Fitness 2000.LLC P.O. Box 441
Englewood, Co 80155-4411). The collected duplicate food samples were blended
with the help of common kitchen food blender on the next day of the last collection.
The samples were analyzed for the macronutrients namely protein, carbohydrates
and fats by the method of AOAC (1980) and consequently
the energy was calculated. The energy values of the composites samples were
determined by multiplying the daily eaten protein, carbohydrates and fats with
4, 4 and 9, respectively (Williams, 1999; Goplan
et al., 1981). The anthropometric and dietary intakes were compared
with the international norms namely American Dietetic Association (ADA), World
Health Organization and Food and Agriculture Organization (WHO, 1985, 1990,
1995; FAO/WHO, 1985, 2001). Based
on ADA, the reference energy of the students was determined by multiplying the
mean body weights (kg) by 40 kcal day-1 which was 56.5x40 = 2260
kcal day-1. The reference protein of the students was determined
by multiplying the mean body weights (kg) by 0.8 g kg-1 body weight
day-1 which was 56.5x0.8 = 45.0 g day-1 (ADA). According
to the WHO/FAO, the reference energy and protein requirements of the students
were determined from the reference values for Asian population for the given
weight 56.5 kg. The protein energy requirement was 2300 kcal day-1
and 45.0 g day-1, respectively (WHO, 1990,
1995; FAO/WHO, 1985, 2001). Similarly,
based on the HWCNR, the energy contribution of macronutrients was determined
and the reference values of protein, carbohydrates and fats were taken as 15,
55 and 30 g day-1, respectively. The means were compared for the
various parameters with the aforementioned norms as appropriate. Descriptive
statistics was performed for various comparisons using a statistical package
MINITAB (release 8.2) Inc. State. Drive. USA.
||Anthropometry measurements of the students
||Comparison of energy and macronutrients intakes of the students
with the norms
The anthropometry measurements of the students indicated that the height, body weight, skin fold thickness, body fat and Basal Metabolic Index (BMI) were lower than the WHO reference values by -4.91, -2.59, -19.17, -16.20 and -4.38%, respectively (Table 1). Similarly, when the energy intake was compared with the norms i.e., American Dietetic Association and World Health Organization the energy consumption was lower by -29 and 30, respectively (Table 2). Protein intake was higher than the recommended reference of ADA and WHO by 43.28 and 42.28%, respectively. Based on the Health Welfare Canada Nutrition Recommendation, when the percent contribution to the total energy was determined from protein, carbohydrate and fats it was found to be 37.65, 39.41 and 22.97% (g/100 g), respectively. The percent increase/decrease over the references intake for protein, carbohydrate and fats was +151.02, -28.35 and -23.43%, respectively (Table 2).
Students in the universities have been assessed for energy and nutrients intakes
in various universities in different countries around the world. The studies
conducted so far report imbalance intake of energy, macronutrients and micronutrients.
The present study and the earlier study conducted on the students in this campus
who were assessed for the adequacy of energy and macronutrients are comparable
in term of trends of higher or lower intakes. The indices for height, body weight,
skin fold, body fat, BMI, energy intake were all lower in this study whereas
the only food matrix among the macronutrient was protein which was higher than
the norms in either case compared to the norms. The same have been reported
in other studies where lower anthropometry was observed in particular lower
BMI in the female students as indicated in the Table 1 (Sanlier
and Unusan, 2007; Peterson et al., 2007; Oliveras
LoÂ´pez et al., 2006). The present study provide useful information
and of course confirm the earlier study results performed on the energy and
macronutrients intakes through Food Frequency Questionnaires (FFQ) and it was
found that the female students had lower energy intake compared to the ADA reference
intake (ADA). The energy intakes among the Pakistani female students both assessed
by FFQS previously by Khattak et al. (2002) and
through composite food sample method presently were lower than the references
intakes. The important point here is the comparison of the intakes of energy
assed by both the methods showed reduced consumption of energy. Similar, reduced
consumption for energy was observed in the Brazilian study conducted on the
university students (Martins Bion et al., 2008).
In the Brazilian study the decrease in the energy consumption was 21%. In Pakistani
students (present study) the consumption of energy was lower by 29.34%. The
reduction in energy consumption in the Brazilian student was not at the expense
of lower macronutrients (protein, carbohydrates and fats) since the students
consumed within the reference amount but the only thing they say is about the
dietary fiber; perhaps the author took into account the fermentation energy.
In the Pakistani female students, the reduction in the energy consumption was
mainly at the expense of lower intake of dietary carbohydrates and fat which
were lower than the recommended/permissible limits. In a study conducted by
Statalic et al. (2007) on the Croatian students
has shown that the average energy intake was increased by 130% of the dietary
reference intake which is much higher in comparison to our study. In the Croatian
students 64.3% of the students had protein intakes more than double of the dietary
reference intake. Similarly, the Pakistani female students had higher consumption
of protein and the increase over the reference was 150% which is more than double
of the recommended level (Table 2). The observed increase
in protein takes and reduced energy consumption compared to the norms both in
this study and the earlier one (Khattak et al., 2002)
is due to lower intake of carbohydrate and fat. Therefore, there has been an
imbalance of macronutrients intakes among the students and similar imbalance
of macronutrient is exhibited in the form of increased protein and reduced energy.
Furthermore, when macronutrients are imbalance then presumably the micronutrients
are imbalanced too. This has been shown in particular in female students (Statalic
et al., 2007). The imbalance of macronutrients is evident well when
the percent contribution of the macronutrients to the total energy was determined.
The decrease over the references contribution to the energy intake for carbohydrate
and fats per se need to be explored among these students.
In conclusion, this study suggests that students are having deficient or imbalance energy intakes from macronutrients and are at the risk of malnutrition.
Authors would like to acknowledge the students of the NWFP, Agricultural University, Peshawar-Pakistan who volunteered to this study.
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