Bread has been produced in Anatolia for about eight thousand years and is a food item consumed commonly all over the world1-3. The first produced bread was obtained by mixing the roasted or ground cereal grains with water and baking the dough. While in the hunter-gatherer societies, lived in the Palaeolithic age, the diet was based on protein and fat, the consumption of cereal and bread increased in the Neolithic age and cereal-based products became the most important food items for humans4. Having high nutritional value, being cheap, the ease of obtaining the materials used in production, having a neutral taste and aroma and being consumed with many foods make bread the most basic food item5.
The type and amount of the consumed bread varies with the changes in the health indicators and socioeconomic and cultural conditions of societies. It is known that there are so many types of bread that can not be counted in the world and some societies are known with their own specific bread types6. Bread is also the most valuable product related to wheat in Turkey and has an important place in Turkish cuisine7.
It is clear that, bread has an important place in human nutrition because of being a good source of energy and nutrient8. It is specified that more than half of the people living around the world provide more than half of daily dietary energy intake from bread. In addition, in many Western European countries, daily bread consumption provides half of the daily dietary carbohydrate, one-third of the daily dietary protein, more than half of the B group vitamins and more than 75% of the vitamin E intakes6.
The increasing awareness of consumers and interest in different types of bread in recent years has led to increased consumption of high fiber bread types9. There are many positive health effects of dietary fiber such as decreased postprandial glucose level, total and LDL cholesterol levels and prevention of colon cancer10. For this reason, nutrition and nutrient guidelines published in official institutions in many countries focus on whole grains as the most basic food item of a healthy and balanced diet11.
Bread consumption levels of individuals living in Turkey were evaluated previously with local and national studies1,7,12-14. However, there is limited data on the contribution of bread consumption to daily dietary energy and nutrient intake. So, this study aimed to evaluate bread consumption of well-educated individuals, who are staff of a university in Turkey and contribution of bread consumption to daily dietary energy and nutrient intake.
MATERIALS AND METHODS
Study area and population: All academic and administrative units in Karamanoğlu Mehmetbey University were visited between March and July 2018 and all staff members were informed about the study. A total of 334 staff members (229 academic staff members and 105 civil servants) who agreed to participate the study with a written affirmation, were included in the study.
Data collection: Within the scope of the study, a questionnaire including bread consumption habits and general information about preference of bread was applied and data were collected by face to face interview. In addition, bread consumption levels and bread types in 24 h dietary recall were recorded. The ‘Food and Meal Photo Catalog’15, a photographic atlas including Turkish foods and meals, was used to determine the types and quantities of consumed bread.
Evaluation of energy and nutrients intakes from bread consumption: Energy and nutrient intake from bread consumption were analysed by a food analysis software, Nutrition Information System (BEBIS)16. For evaluation of percentage of adequate intake of nutrient from bread consumption, adequate intake levels for carbohydrate, fiber and minerals in Turkey Nutrition Guideline 201517 was took into account.
Statistical analysis: Statistical analysis was performed using IBM SPSS version 20.0 software (IBM Corp. Armonk, NY, US). Levene’s and Kolmogorov-Smirnov tests were used for homogenity and normality. Binomial and one sample chi-square tests were used for evaluating the statistical difference between expected and observed values. For evaluation of qualitative and quantitative data, Pearson chi-square and Student's t tests were used respectively. Statistically significance was accepted at the level of 0.05.
Ethical approval: For the study, ethics committee approval numbered 02-2018/08 was obtained from Karamanoğlu Mehmetbey University Non-Interventional Clinical Research Ethics Committee.
The mean age of the participants in the study was 34.6±6.87 years (35.8±7.57 years for men and 32.4±4.73 years for women). The percentages of males, married participants and academic staff members were 63.5, 71.3 and 68.6% respectively.
There were statistically significant differences between expected and observed values in terms of gender, marital status, personal status and income level (p<0.05) (Table 1).
The percentage of white bread consumers was 50.0%. This rate was 58.0% for men and 36.1% for women. Participants stated that they consumed whole grain bread with the percentage of 28.7% (18.9% for men and 45.9% for women). Also, the academic staff members consumed white bread types more than the civil servants (53.3% for academic staff members and 42.9% for civil servants); on the other hand the civil servants consumed traditional bread types more than academic staff members (10.5% for academic staff and 23.8% for civil servants) (p<0.05). Men specified that their bread preference reason was ‘habit’ with the percentage of 51.9%; and women stated that they prefered bread firstly for ‘health’ with the percentage of 45.1%. It was determined that the breakfast was the most bread-consumed meal. Also, 28.8% of men stated that they preferred packed bread and this rate was 54.1% in women (p<0.05). There were no statistical significant differences between the academic staff members and civil servants in terms of the factors affecting the choice of bread, the most bread-consumed meal, bread purchase place and packed bread consumption (p>0.05) (Table 2).
Most of the participants, consumed white bread, declared their satisfaction level with bread consumption as moderate (33.5%) and good (33.5%). The good satisfaction rates were 44.9 and 41.7% in individuals who consumed traditional bread types and who consumed whole grain bread respectively. Also, 36.4% of the individuals consuming wholemeal bread expressed that they were not satisfied with the bread they consumed (Table 3).
The mean amount of bread consumptions were 147.3±83.98 g for men and 86.5±47.92 g for women respectively and there was a statistically significant difference between genders in terms of bread consumption (p<0.05). In addition, daily dietary intake of energy, carbohydrate, fiber, thiamine, vitamin B6, folate and sodium from bread consumption in men significantly higher than those in women (p<0.05). There were no statistically significant differences between academic staff members and civil servants in terms of bread consumption amounts and daily dietary intake from bread consumption (p>0.05) (Table 4).
For evaluation of adequacy levels of nutrients from daily bread consumption of individuals ‘adequate intakes (AI) in Turkey Nutrition Guideline 2015’ were took into account. Carbohydrate intake from bread consumption provides averagely 54.7% of adequate intake of daily dietary carbohydrate in men. This averagely rate was 31.6% in women and the difference in genders was statistically significant (p<0.05). Further, bread consumption provided adequate nutrient intake (AI) in men significantly higher than those in women (p<0.05) (Table 5).
Bread consumption is indispensable for Turkish society and consuming nutrient-rich bread types is important in terms of providing adequate nutrient intake. There was no significant difference in terms of bread consumption habits in general between academic staff members and civil servants. On the other hand, there were significant differences in terms of bread type preference, bread consumption habits and bread consumption amounts between genders (p<0.05).
It was determined that the most consumed bread type was white loaf bread with the percentage of 50.0% in the present sample. Also, whole grain bread, traditional bread types such as lavash, yufka and leavened bread and wholemeal bread were commonly consumed with the percentages of 28.7, 14.7 and 6.6% respectively.
|| Some characteristics of bread consumption according to gender and staff status
|*Pearson chi square test
||Satisfaction levels according to the general consumed bread types
|*Pearson chi square test
||Bread consumption amount and nutrient intakes from bread consumption with 24 hour dietary recall according to the gender and staff status
|*Student’s t test
||The providing rates of adequate intake (AI; reported in Turkey Nutrition Guideline 2015) from bread consumption
|*Student’s t test
In two studies conducted in Turkey, it was reported that the most common bread type consumed was white bread12,13. In a national survey conducted in Sweden, it was found that the most consumed bread types were whole grain bread and white bread with the percentages of 37 and 36% respectively18. These results show that bread is one of the most important elements of Turkish diet. Moreover, it is striking that the preference rates of white bread in the local studies on bread consumption of the Turkish society are quite high compared to this study1,7,12-14. So, it is thought that education is an important factor affecting bread consumption.
While 58.0% of men primarily prefered white loaf bread, 45.1% of women stated that they primarily consumed whole grain bread (p<0.05). Similarly, Aksoylu et al.8 reported that women consumed non-refined bread types significantly higher than men. The results show that women are more sensitive than men to healthy bread consumption.
Breakfast takes attention as a meal most bread-consumed with 53.9%. In the study conducted by Aksoylu et al.8, 48.3% of the participants stated that they mostly consumed bread at the breakfast. So, it is thought that because of consuming cereal meals such as rice, pasta, bulgur pilaf and Turkish ravioli, bread consumption was less in the lunch and dinner.
Homemade bread consumption in rural areas is replaced by fabricated bread consumption in urban areas. As expected, the majority of participants (53.0%) declared that they bought bread from supermarkets where is easy to access. In a study conducted in Saudi Arabia, it was reported that the most preferred places to purchase bread were bakeries, groceries and supermarkets with the percentages of 35.9, 16.0 and 12.4% respectively19. From these results, it can be concluded that the places close to the home were preferred to purchase bread.
In the present study the mean daily bread consumption amounts were 147.3±83.98 g for men and 86.5±47.92 g for women respectively. According to the Turkey Nutrition and Health Survey 201014 results, in urban areas the mean bread consumption amounts for men were 237.63 g in the 19-30 age group, 236.61 g in the 31-50 age group and 205.65 g in the 51-64 age group respectively. For women, these rates were 142.83 g in the 19-30 age group, 143.15 g in the 31-50 age group and 140.18 g in the 51-64 age group respectively. In the study conducted in Sweden18 and in the National Diet and Nutrition Survey20 conducted in United Kingdom, the mean bread consumption amounts were quietly lower in comparison with this study. These results reveals the fact that bread is one of the basic food in Turkish diet. However, the fact that the bread consumption amounts of the participants are lower than the data of Turkey Nutrition and Health Survey 2010 suggests that the education level is important for bread consumption awareness.
In the National Diet and Nutrition Survey21 in UK, it has been reported that 1% of adequate intake of folate was provided from bread consumption in adult men and this rate was 3% in adult women. It has also been reported that 20% of daily dietary carbohydrate intake was provided from bread consumption. In this study, averagely 17.0 and 10.0% of adequate intake of folate was provided from bread consumption in men and women respectively. In addition, 46.4% of adequate intake of carbohydrate was provided from bread consumption. In the previous National Diet and Nutrition Survey22 in UK, it was reported that 14% of adequate intake of thiamine and about one in five of adequate intake of dietary fiber provided from bread consumption. On the other hand, in this study 19.2% of adequate intake of thiamine and 22.9% of adequate intake of dietary fiber were provided from bread consumption. All these results show that bread is the main carbohydrate source in Turkish diet. Bread type is quite important in terms of adequate intake of nutrients such as B vitamins and dietary fiber.
Dietary fiber is an important component of the mediterranean diet and is an effective nutrient in the prevention of many diseases such as diabetes, hipercolesterolemia and colon cancer23. In the present study, the mean dietary fiber intakes from bread consumption were 6.6±4.11 g for men and 4.2±3.10 g for women. In another study conducted in the Netherlands, these mean amounts were 11.9 and 9.9 g for men and women respectively24. In the light of these data it is considered that the consumption of whole grains instead of refined grains may have a significant effect on providing dietary fiber intake.
It is concluded that one of the determinants of bread consumption habits is education level. However, dietary carbohydrate intake is a matter of debate nowadays and more detailed awareness of people about healthy carbohydrate sources is considerable for food safety. It is not realistic that removing entirely the bread, the most basic components of the Turkish diet, from diet. In healthy nutrition, the type of bread is also important as much as amount of bread. Bread types produced from non-refined grain flours are important source for dietary fiber and B vitamins.
It is believed that government-sponsored activities such as education about healthy bread consumption in public open spaces, public spots posted on national and local media and addressing the subject in school curriculum able to change people’s bread consumption habits significantly.
This study discovers the contribution of bread consumption to daily dietary energy and nutrient intake in university staff that can be beneficial for evaluation of the place of bread in diet of Turkish well-educated individuals. The study will help authorities to determine the policies about healthy eating and healthy bread consumption in Turkish society. Also the study will help the researcher to uncover the critical areas of causes of unhealthy bread consumption that many researchers were not able to explore. Thus a new theory related to the parameters that can effect bread consumption may be arrived at.