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DOI: 10.1590/1413-81232021268.09592020
ARTICLE
Contribution of different foods according to the Nova
classification to dietary fiber intake in adolescents
Abstract The aims of the present study were to
evaluate dietary fiber intake and associated fac-
tors in adolescents, identify food sources of the
nutrient, and determine associations between
indicators of dietary patterns (energy/macronu-
trients/micronutrients) and dietary fiber intake.
A population-based cross-sectional study was
conducted involving 24-hour recall data. The
NOVA classification was used to determine the
contribution of foods to dietary fiber intake. Refe-
rence values from the World Health Organization
(≥12.5 g) and the US Institute of Medicine (14
g) per 1,000 kcal were used to assess intake. The
mean intake of dietary fiber/1,000 kcal/day was
6.4 g (1.5 g of soluble fiber and 4.9 g of insoluble
fiber) among the 891 adolescents. Fiber intake was
low, especially among those who ate fruits, vege-
tables, and beans less, those who consumed soft
drinks and processed meats more, and those who
did not eat breakfast every day. Unprocessed/mi-
nimally processed foods provided 68.8%, 53.7%,
and 72.1% of total, soluble, and insoluble fiber,
respectively, whereas ultra-processed products
provided 24.8%, 37.9%, and 21.0% respectively.
Fiber intake was inversely associated with energy
intake, fat, free sugar, and animal protein in the
diet. The insufficient fiber intake underscores the
need for actions that promote healthy nutrition on
the individual and family levels.
Key words Dietary Fiber, Adolescents, Health
Surveys
Rafaela de Campos Felippe Meira (https://orcid.org/0000-0002-8075-0447) 1
Caroline Dario Capitani (https://orcid.org/0000-0002-3466-6148) 2
Antonio de Azevedo Barros Filho (https://orcid.org/0000-0001-6239-1121) 1
Marilisa Berti de Azevedo Barros (https://orcid.org/0000-0003-3974-195X) 3
Daniela de Assumpção (https://orcid.org/0000-0003-1813-996X) 1
1 Departamento de
Pediatria, Faculdade
de Ciências Médicas,
Universidade Estadual de
Campinas (UNICAMP). R.
Tessália Vieira de Camargo
126, Cidade Universitária.
13083-887 Campinas SP
Brasil. danideassumpcao@
gmail.com
2 Faculdade de Ciências
Aplicadas, UNICAMP.
Campinas SP Brasil.
3 Departamento de Saúde
Coletiva, Faculdade
de Ciências Médicas,
UNICAMP. Campinas SP
Brasil.
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Meira RCF et al.
Introduction
Studies report that greater dietary fiber intake di-
minishes the risk of colon cancer1, cardiovascular
disease2,3, and death due to heart disease and all-
cause cancer4. A study analyzing data from three
American prospective cohorts found an associa-
tion between carbohydrate quality and the risk of
type 2 diabetes, as diets with a high glycemic load
and a lower quantity of cereal fibers increased
the risk of the disease by around 50%5. A study
involving European adolescents found an inverse
relation between soluble dietary fiber intake and
blood glucose levels6. The US National Health
and Nutrition Examination Survey (2001-2012)
identified a smaller waist circumference and low-
er body mass index in children and adolescents
(six to 18 years of age) who ingested whole grains
more7.
Despite the health benefits, dietary fiber in-
take is far from the recommended values. Accord-
ing to the 2008-2009 Brazilian Family Budget
Survey, the availability of dietary fiber in Brazil-
ian homes was 12.3 g/day, whereas fiber intake
recommended by the World Health Organization
and adopted by the Brazilian Health Ministry is
a minimum of 25.0 g/day8. In a study conducted
in the United States, daily fiber intake was 17.0
g among adults (≥19 years) and adequate intake
ranged from 21 to 38 g/day in this population9. In
a study conducted in Australia, mean fiber intake
was 23.8 g/day and only 28.2% of adults (≥19
years) achieved the recommended daily intake
of 30 g for men and 25 g for women10. Among
adolescents, mean fiber intakes is reported to
be around 20 g for Brazilians11, Europeans6, and
Australians10. Moreover, mean fiber intake is re-
ported to be only 13 g among American children/
adolescents9.
There is no universal definition of dietary
fiber. However, one of the most widely used is
that proposed by Codex Alimentarius, which de-
fines the nutrient as carbohydrate polymers with
ten or more monomer units that are not hydro-
lysable by endogenous enzymes of the small in-
testine in humans12,13. Codex considers fiber to be
carbohydrates naturally found in foods as well as
isolated or extracted from the food matrix and
synthesized by industrial processes that present
scientifically proven health benefits12.
Dietary fiber is subdivided based on solubil-
ity in water, viscosity, and fermentation14-16. Vis-
cous, soluble fibers form a gel when in contact
with water, which influences the consistency of
the chyme, prolongs the digestion and absorp-
tion of nutrients, and reduces the appetite as well
as the absorption of cholesterol and glucose. The
fermentation (complete or partial) of fiber pro-
duces short-chain fatty acids, which furnish en-
ergy for the mucosa of the colon and play a role
in the maintenance of the integrity of the intes-
tinal barrier as well as the regulation of the im-
mune system. Insoluble fibers exert a laxative ef-
fect and increase both fecal volume and intestinal
transit time14-16. As the characteristics of dietary
fiber coincide in foods, one’s diet should contain
a variety of fruit, leafy vegetables, tubers, beans,
and whole grains.
The most recent edition of the Dietary Guide
for the Brazilian Population recommends that
foods in natura and minimally processed foods,
such as fruit, vegetables, roots, tubers, legumes,
and seeds, be predominant in the diet of individ-
uals17. This recommendation is fundamental in
the contemporary challenge of promoting ade-
quate dietary fiber intake.
Considering the importance of dietary fiber,
the need to evaluate fiber intake and identify
source foods in the diet, as well as the scarcity of
population-based studies analyzing this nutrient,
the aims of the present study were to evaluate di-
etary fiber intake and associated factors in ado-
lescents, identify dietary sources of this nutrient,
and determine associations between indicators
of dietary practices (energy, micronutrients, and
macronutrients) and fiber intake.
Methods
This study involved the use of data from two
population-based cross-sectional studies involv-
ing community-dwelling residents of urban areas
of the city of Campinas in the state of São Paulo,
Brazil. The population of the studies comprised
three age domains: adolescents (10 to 19 years),
adults (20 to 59 years), and older people (60 years
or older).
The aim of the 2014-15 Campinas Health
Survey was to investigate demographic/socio-
economic characteristics and multiple health di-
mensions, such as morbidities, the use of health-
care services, preventive practices, lifestyle, and
the use of medications. For such, a questionnaire
organized in 12 thematic blocks was adminis-
tered by trained interviewers with the aid of an
electronic device (tablet).
The sample for the 2014-15 Campinas Health
Survey was selected using a two-stage, probabilis-
tic, cluster sampling process. In the first stage, 70
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census sectors were randomly selected with prob-
ability proportional to size (given by the number
of homes counted during the 2010 census). The
sectors were ordered based on the mean income
of the heads of households. Next, 14 census sec-
tors were selected from each of the five adminis-
trative districts of the city18.
A minimum sample size was selected for each
age domain (1,000 adolescents, 1,400 adults, and
1,000 older people). The sample sizes were es-
tablished considering maximum variability for
the frequency of the events studied (p=0.50), a
95% confidence level (z=1,96), a sampling error
of three to four percentages points for adults and
four to five percentage points for adolescents and
older people, and a design effect of 218.
The second stage consisted of the definition
of the number of households necessary to reach
the minimum sample size for each age domain.
Thus, 3,119 households were selected for inter-
views with adolescents, 1,029 were selected for in-
terviews with adults, and 3,161 were selected for
interviews with older people, assuming non-re-
sponse rates of 27%, 22%, and 20%, respectively.
In each household, interviews were held with all
residents in the age domain for which the house-
hold was selected18.
The present study also involved an analysis
of data from the 2014-15 Campinas Food Intake
and Nutritional Status Survey (Campinas Nutri-
tion Survey), which was developed with the same
sample as the 2014-15 Campinas Health Survey.
After participation in the health survey, the in-
terviewers returned to the homes of the same
individuals to answer a nutrition questionnaire
composed of a 24-hour Recall (24hR), Food Fre-
quency Questionnaire, and questions addressing
body perception, weight loss practices, self-rat-
ed diet quality, frequency of meal consumption,
etc. The data collection process was standardized
through training exercises, supervision of the
field team, and the creation of support material
(interviewer’s manual, protocol for the adminis-
tration of the 24hR, and a photographic manual).
The interviews were initiated with the 24hR,
for which the following statement was made:
“Please, tell me what you ate and drank yesterday
from the moment you woke up until the time you
went to sleep”19. The Multiple Pass Method was
used to stimulate the respondent’s memory and
obtain more precise estimates of food intake20.
This method consists of an interview structured
in five steps: Quick List (spontaneous report of all
foods and beverages ingested the previous day),
Forgotten Foods (checking for frequently forgot-
ten foods), Time and Eating Occasion (records of
the time, name, and place of the consumption of
meals), Detail Cycle (detailing of each item, such
as preparation method, composition of meals,
type, and respective quantities), and Final Probe
(general review)20.
The foods and culinary preparations were re-
corded in household units or measures. Trained
nutritionists reviewed the 24hRs to identify and
correct possible errors and subsequently quan-
tified the household measures of the foods into
units of weight and volume using household
measure tables21,22, food labels, and consumer
services. The food intake data were entered into
the Nutrition Data System for Research (NDS-R,
version 2015, Nutrition Coordinating Center,
University of Minnesota) by the team of nutri-
tionists. Typical culinary preparations not found
in the database of the program were evaluated
based on standard recipes21-23. These prepara-
tions were stored in the User Recipe module and
were available for use when needed.
The fieldwork was conducted on different
days of the week, including Saturdays and Sun-
days, and the interviews lasted an average of 30
minutes (CI95%: 28.6 to 31.3). The questionnaire
of the Campinas Nutrition Survey was entered
into a mask developed with the use of the EpiDa-
ta program, version 3.1 (EpiData Assoc., Odense,
Denmark). After entering the dietary data of the
NDS-R and the data from the questionnaire in
the EpiData program, a consistency analysis was
performed to correct any typographical errors.
Variables used in the study
The variable of interest was total, soluble, and
insoluble dietary fiber intake (g/day) obtained
from the 24hR. The quantities of total dietary
fiber and the fractions (soluble and insoluble)
were expressed as energy density (g/1000 kcal/
day). Reference values from the WHO (≥12.5
g/1,000 kcal) and the US Institute of Medicine
(IOM) (14 g/1,000 kcal) were used to evaluate
dietary fiber intake.
The following were the independent variables:
Demographic and socioeconomic characteris-
tics: sex (male and female), age group (10 to 14
and 15 to 19 years), self-reported race/skin col-
or (white and non-white), schooling of head of
household (0 to 4, 5 to 8, 9 to 11 and ≥12 years
of study), and family income per capita using the
Brazilian monthly minimum wage (BMMW) as
reference (< 0.5, ≥0.5 to <1.0, ≥1.0 to <1.5 and
≥1.5 times the BMMW).
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Food intake, checking of food labels, self-rat-
ed diet quality, and body mass index (BMI): fre-
quency of weekly consumption of fruit, raw and
cooked vegetables, beans, and milk (≥five and
<five times)24, soft drinks and processed meats
(≤two and >two times)24, weekly frequency of
having breakfast (seven and <seven times)24,25,
and practice of checking food labels (no and yes/
sometimes)26. Self-rated diet quality was obtained
based on the answer to the following question
“What do you consider the quality of your diet
to be?” (categorized as very good/good, fair, and
poor/very poor). The BMI [weight (kg)/height²
(m)] was calculated using reported weight and
measured height, as reported height has lower
validity than reported weight in adolescents27.
Nutritional status was classified according to
BMI for age as underweight/ideal (≤85th percen-
tile) and overweight/obesity (>85th percentile)28.
Food processing category: the 500 food items
reported on the 24hRs were coded using the
NOVA classification, which considers the ex-
tent and purpose of the industrial processing of
foods29. The food items were then united into
four groups: 1) in natura or minimally processed,
legumes, fruit, leafy vegetables, tubers, milk,
meat, eggs, grains (rice, oats, wheat, corn, cassa-
va [whole and flours]), seeds, etc.; 2) processed,
French roll, cheese, fruit in syrup, pickled vegeta-
bles/legumes; 3) ultra-processed, sweetened bev-
erages, cookies/crackers, sandwich bread, mar-
garine, processed meats, chocolate milk, instant
pasta, candies, snacks, chips; 4) culinary ingredi-
ents, butter, salt, sugar, and vegetable oil29. The
contribution of the groups and respective foods
to total fiber was expressed as energy density and
percentage.
Indicators of eating practices: energy, carbohy-
drates, total protein, proteins of a vegetable and
animal origin, total fat, saturated fat, trans fat,
added sugar, cholesterol, sodium, and potassium.
The indicators were derived from the 24hRs and
were selected based on the WHO nutrient intake
guidelines30,31.
Data analysis
Mean and standard deviation (SD) values
were calculated for the density of total, soluble,
and insoluble fiber (g/1,000 kcal/day) according
to the categories of the independent variables.
Generalized linear regression models adjusted by
sex were also created to estimate mean dietary fi-
ber intake (total and soluble/insoluble fractions).
Variables with a p-value <0.20 in the bivariate
analysis were incorporated into each model and
those with a p-value <0.05 after the adjustments
remained in the models. Graphic techniques and
the Akaike Information Criterion (AIC) revealed
that gamma distribution best fit the fiber intake
data. The contribution of the food groups and re-
spective foods was then calculated in relation to
total and fractional fiber content. Linear regres-
sion analysis was employed to determine the as-
sociation between indicators of eating practices
and fiber intake (categories in quartiles) and the
general significance of the model was determined
using the F test. The level of significance on the
statistical tests was set to 5%. All analyses were
performed with the aid of the svy module of the
Stata program (version 15.0), which considers
weights and sampling design.
Ethical considerations
The Campinas Health Survey and Campinas
Nutrition Survey received approval from the Hu-
man Research Ethics Committee of Universidade
Estadual de Campinas (UNICAMP) as well as
the National Research Ethics Committee (CEP/
CONEP system). The present study also received
approval from the UNICAMP Human Research
Ethics Committee.
Results
Among the 1,023 adolescents interviewed during
the Campinas Health Survey, 109 did not partic-
ipate in the Campinas Nutrition Survey (10.7%
refusal/loss rate). Among the 914 interviews, 866
(94.7%) were held with the adolescents them-
selves and 48 (5.3%) were held with parents or
guardians (mothers constituted the majority of
such cases [67.7%]).
Regarding the 24hR, 11 individuals declined
to answer (adolescents or parents/guardians)
and another twelve 24hRs were excluded for an
implausible total energy value (<600 kcal [n=10]
or >6000 kcal). Therefore, the present study in-
volved information from 891 adolescents. Mean
age was 14.6 years (CI95%: 14.4 to 14.8).
The sample had slightly higher proportions
of boys (52.0%), adolescents 15 to 19 years of
age (52.7%), and self-declared white individ-
uals (55.5%). A total of 19.7% of the heads of
households had up to four years of schooling
and 26.1% of the families received less than half
the BMMW per capita. A low frequency of fruit
consumption (<five times/week) was reported
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by 61.9% of the adolescents. A low frequency of
the consumption of beans (<five times/week)
was reported by 28.3% and a high frequency of
soft drink consumption (>two times/week) was
reported by 50.7%. A total of 63.7% of the sam-
ple had breakfast every day and 31.4% had the
practice of reading food labels (Tables 1 and 2).
Mean total fiber intake was 12.6 g (CI95%:
12.2 to 13.2), mean soluble fiber intake was 3.0
g (CI95%: 2.8 to 3.2), and mean insoluble fiber
intake was 9.6 g (CI95%: 9.2 to 10.0). Regard-
ing sex, mean daily total, soluble, and insolu-
ble fiber intake was respectively 11.7 g (CI95%:
11.2 to 12.3), 2.9 g (CI95%: 2.7 to 3.0), and 8.8
g (CI95%: 8.4 to 9.3) among the girls and 13.5 g
(CI95%: 12.9 to 14.2), 3.1 g (CI95%: 2.9 to 3.3),
and 10.4 g (CI95%: 9.8 to 10.9) among the boys
(data not presented in tables).
Daily dietary fiber intake was estimated at 6.4
g/1,000 kcal in the overall sample, corresponding
to 1.5 g/1,000 kcal of the soluble fraction and 4.9
g/1,000 kcal of the insoluble fraction. Girls had
a higher total dietary fiber intake than boys. Sol-
uble dietary fiber intake was higher among girls
and adolescents in the higher strata with regards
to schooling of the head of the household (≥12
years in comparison to ≤four years of study) and
family income per capita (≥1.5 times the BMMW
compared to <0.5 times the BMMW) (Table 1).
Dietary fiber intake was lower among adoles-
cents who consumed fruits, raw and cooked veg-
etables, and beans less than five times per week
and consumed soft drinks and processed meats
more than twice per week. Individuals who did
not eat breakfast every day and those who did not
have the practice of checking food labels had low-
er mean dietary fiber intake. Total and insoluble
dietary fiber intakes were lower among adoles-
cents who rated the quality of their diet as poor/
very poor compared to those who rated their diet
quality as very good/good (Table 2).
Table 3 displays the results of the generalized
linear regression models for total, soluble, and
insoluble dietary fiber intake. Adolescents who
consumed fruits, raw vegetables, and beans at a
lower weekly frequency, those who consumed
soft drinks and processed meats with a great-
er weekly frequency, and those who did not eat
breakfast every day had lower mean total dietary
fiber intake. Mean soluble fiber intake was higher
Table 1. Mean density of total. soluble. and insoluble dietary fiber according to sociodemographic variables among
adolescents 10 to 19 years of age. 2014-2015 Campinas Nutrition Survey.
Variables n (%) Total fiber SD Soluble SD Insoluble SD
g/1000 kcal g/1000 kcal g/1000 kcal
Sex
Male 463 (52.1) 6.2a±2.4 1.4a±0.9 4.8 ±2.1
Female 428 (47.9) 6.6b±3.9 1.6b±1.4 5.0 ±3.1
Total 891 6.4 ±2.7 1.5 ±0.9 4.9 ±2.4
Age group (in years)
10 to 14 422 (47.4) 6.4 ±2.5 1.5 ±0.8 4.8 ±2.0
15 to 19 469 (52.6) 6.5 ±3.5 1.5 ±1.1 4.8 ±2.8
Race/skin color
White 487 (55.5) 6.4 ±2.9 1.6 ±1.1 4.8 ±2.4
Non-white 400 (44.5) 6.4 ±3.4 1.5 ±1.4 4.9 ±2.6
Schooling of head of family (in years)
0 to 4 177 (19.6) 6.2 ±2.5 1.4a±1.1 4.8 ±2.0
5 to 8 292 (33.6) 6.5 ±4.1 1.6a.b ±1.5 5.0 ±3.0
9 to 11 257 (28.9) 6.1 ±3.5 1.5a.b ±1.6 4.7 ±2.7
12 or more 150 (17.8) 6.7 ±4.9 1.8b±1.6 4.9 ±3.8
Family income per capita (minimum wage)*
<0.5 234 (26.1) 6.4 ±2.6 1.4a±1.1 5.0 ±2.4
≥0.5 to <1.0 302 (33.0) 6.5 ±4.2 1.5a.b ±1.4 5.0 ±3.6
≥1.0 to <1.5 190 (21.3) 6.1 ±3.3 1.5a.b ±1.4 4.6 ±2.7
≥1.5 165 (19.6) 6.6 ±4.6 1.7b±1.5 4.9 ±3.7
n: number of adolescents in unweighted sample; %: Percentage in weighted sample; SD: standard deviation; *BMMW: Brazilian
monthly minimum wage; a.b: different letters indicate statistically significant differences.
Source: Food Consumption and Nutritional Status Survey of the city of Campinas. Brazil (2014-2015 Campinas Nutrition Survey).
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Meira RCF et al.
among girls and adolescents whose heads of the
household had more schooling and was lower
among those who consumed fruits, raw vegeta-
bles, and beans at a lower weekly frequency, those
who consumed soft drinks at a greater weekly
frequency, and those who did not eat breakfast
every day. Lower insoluble dietary fiber intake
was associated with the consumption of fruits,
raw vegetables, and beans less than five times per
week, processed meats more than twice per week,
and breakfast less than seven days per week.
Foods in natura and minimally processed
foods provided 68.0% of total dietary fiber, pro-
cessed foods provided 7.2%, and ultra-processed
Table 2. Mean density of total, soluble, and insoluble dietary fiber according to food consumption, checking food
labels, self-rated diet quality, and body mass index among adolescents 10 to 19 years of age. 2014-2015 Campinas
Nutrition Survey.
Variables n (%) Total fiber SD Soluble SD Insoluble SD
g/1.000 kcal g/1.000 kcal g/1.000 kcal
Consumption of fruit
≥5 times per week 330 (38.0) 7.1a±3.2 1.7a±1.1 5.4a±2.5
<5 times per week 561 (62.0) 6.0b±4.7 1.4b±1.6 4.5b±3.5
Consumption of raw vegetables
≥5 times per week 246 (28.3) 7.1a±3.1 1.7a±1.1 5.4a±2.6
<5 times per week 645 (71.7) 6.1b±5.3 1.5b±2.0 4.7b±4.3
Consumption of cooked
vegetables
≥5 times per week 99 (11.2) 7.4a±4.1 1.8a±1.6 5.5a±3.0
<5 times per week 792 (88.8) 6.2b±11.8 1.4b±4.5 4.7b±8.4
Consumption of milk
≥5 times per week 469 (52.9) 6.5 ±2.6 1.5 ±1.1 4.9 ±2.2
<5 times per week 422 (47.1) 6.3 ±3.3 1.5 ±1.4 4.7 ±2.5
Consumption of beans
≥5 times per week 641 (71.7) 6.6a±2.3 1.5a±1.0 5.1a±2.3
<5 times per week 250 (28.3) 6.0b±3.6 1.7b±1.4 4.2b±2.7
Consumption of soft drinks
≤2 times per week 441 (49.4) 6.7a±2.7 1.6a±1.0 5.1a±2.3
>2 times per week 450 (50.6) 6.0b±3.4 1.4b±1.3 4.6b±2.7
Consumption of processed
meats
≤2 times per week 495 (55.4) 6.6a±3.1 1.6 ±1.1 5.0a±2.4
>2 times per week 396 (44.6) 6.2b±3.6 1.5 ±1.4 4.7b±2.8
Breakfast (frequency)
7 times per week 569 (63.8) 6.7a±2.6 1.6a±0.9 5.0a±2.1
<7 times per week 322 (36.2) 5.9b±3.4 1.4b±1.1 4.5b±2.7
Checking of food labels
No 613 (68.7) 6.2a±2.5 1.5a±1.0 4.7a±2.2
Yes/sometimes 278 (31.3) 6.8b±3.7 1.7b±1.3 5.1b±2.8
Self-rated diet quality
Very good/good 509 (57.3) 6.5a±2.7 1.5 ±1.1 5.0a±2.3
Fair 311 (34.6) 6.4a.b ±2.6 1.5 ±1.0 4.9a.b ±2.1
Poor/very poor 71 (8.1) 5.6b±3.2 1.6 ±1.5 4.0b±2.1
Body mass index (kg/m²)
Underweight/ideal 543 (66.5) 6.4 ±2.7 1.6 ±0.9 4.8 ±2.1
Overweight/obesity 275 (33.5) 6.5 ±2.8 1.6 ±1.2 4.9 ±2.3
n: number of adolescents in unweighted sample; %: percentage in weighted sample; SD: standard deviation; a,b: different letters
indicate statistically significant differences.
Source: Food Consumption and Nutritional Status Survey of the city of Campinas, Brazil (2014-2015 Campinas Nutrition Survey).
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foods provided 24.8%. In the in natura group,
beans, grains, fruit, roots, and tubers were the
main sources of dietary fiber and beans contrib-
uted the most insoluble fiber. Among processed
foods, French rolls contributed the most fiber.
Among ultra-processed foods, cookies/crackers,
sandwich bread, and chocolate milk contributed
the most fiber. Approximately 38.0% of soluble
fiber came from ultra-processed foods (Table 4).
An increase in dietary fiber intake was associ-
ated with a reduction in energy content, animal
protein, total fat, saturated fat, cholesterol, and
added sugar. The increase in dietary fiber intake
was also associated with an increase in carbohy-
drates, vegetable protein, and potassium (Table
5).
Discussion
In the present study, mean dietary fiber intake
adjusted for energy was 6.4 g/1,000 kcal/day. The
total was 12.7 g (13.5 g among boys and 11.7 g
among girls). These values are below the intake
Table 3. Generalized linear regression models of variables associated with total, soluble, and insoluble dietary fiber
density (g/1000 kcal). 2014-2015 Campinas Nutrition Survey.
Variables Model 1 - Total dietary fiber*
Estimate p-value
Intercepto 7.9
Sex (female)/(male) 0.36 0.064
Fruit (<5 days/week)/(≥5) -0.78 <0.001
Raw vegetables (<5 days/week)/(≥5) -0.60 0.001
Beans (<5 days/week)/(≥5) -0.55 0.007
Soft drinks (>2 days/week)/(≤2) -0.32 0.037
Processed meats (>2 days/week)/(≤2) -0.40 0.014
Breakfast (<7 days/week)/(7) -0.60 0.001
Variables Model 2 - Soluble dietary fiber**
Estimate p-value
Intercept 1.7
Sex (female)/(male) 0.14 0.035
Fruit (<5 days/week)/(≥5) 0.26 0.036
Raw vegetables (<5 days/week)/(≥5) -0.14 0.024
Beans (<5 days/week)/(≥5) -0.17 0.010
Soft drinks (>2 days/week)/(≤2) 0.27 0.002
Processed meats (>2 days/week)/(≤2) -0.16 0.013
Breakfast (<7 days/week)/(7) -0.23 <0.001
Variables Model 3 - Insoluble dietary fiber***
Estimate p-value
Intercept 6.1
Sex (female)/(male) 0.22 0.143
Fruit (<5 days/week)/(≥5) -0.66 <0.001
Raw vegetables (<5 days/week)/(≥5) -0.47 0.004
Beans (<5 days/week)/(≥5) -0.82 <0.001
Soft drinks (>2 days/week)/(≤2) -0.36 0.008
Processed meats (>2 days/week)/(≤2) -0.44 0.004
*Variables incorporated into model 1: sex, weekly consumption of fruit, beans, raw and cooked vegetables, soft drinks, and processed
meats, self-rated diet quality, practice of checking food labels, and weekly consumption of breakfast; **Variables incorporated into
model 2: sex, race/skin color, schooling of head of household, family income, weekly consumption of fruit, beans, raw and cooked
vegetables, and soft drinks, practice of checking food labels, and weekly consumption of breakfast; ***Variables incorporated into
model 3: sex, weekly consumption of fruit, beans, raw and cooked vegetables, milk, soft drinks, and processed meats, self-rated diet
quality, practice of checking food labels, and weekly consumption of breakfast.
Source: Food Consumption and Nutritional Status Survey of the city of Campinas, Brazil (2014-2015 Campinas Nutrition Survey).
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Table 4. Density and contribution of food groups/items in relation to total, soluble, and insoluble dietary fiber (in
grams). 2014-2015 Campinas Nutrition Survey.
Food groups Density (g/1000 kcal/day) Contribution (%)
TDF SDF IDF TDF SDF IDF
In natura/minimally processed 4.2 0.8 3.4 68.0 53.7 72.1
Beans 1.7 0.1 1.6 28.2 4.7 35.1
Grains 0.7 0.2 0.5 10.8 15.5 9.5
Fruit 0.6 0.2 0.4 9.1 15.1 7.4
Roots and tubers 0.4 0.2 0.2 7.1 13.6 5.2
Rice 0.4 0.0 0.4 6.3 0.2 8.1
Vegetables 0.4 0.1 0.3 5.9 4.6 6.3
Processed 0.4 0.1 0.3 7.2 8.4 6.9
French roll 0.4 0.1 0.3 6.5 7.6 6.2
Ultra-processed 1.5 0.5 1.0 24.8 37.9 21.0
Cookies/crackers 0.3 0.1 0.2 5.2 8.8 4.2
Sandwich bread 0.3 0.1 0.2 4.5 8.1 3.5
Chocolate milk 0.2 0.0 0.2 3.5 3.3 3.6
Processed sauces 0.2 0.1 0.1 2.9 3.7 2.8
Sweets 0.2 0.1 0.1 2.8 4.2 2.3
Salty snacks 0.1 0.0 0.1 2.2 2.5 2.1
Instant pasta 0.1 0.0 0.1 1.4 1.8 1.3
TDF: total dietary fiber; SDF: soluble dietary fiber; IDF: insoluble dietary fiber.
Source: Food Consumption and Nutritional Status Survey of the city of Campinas, Brazil (2014-2015 Campinas Nutrition Survey).
Table 5. Mean energy and nutrient intake according to density of dietary fiber in quartiles among adolescents 10
to 19 years of age. 2014-2015 Campinas Nutrition Survey.
Variables Total mean Density of dietary fiber (g/1000 kcal) in quartiles p-value*
1 2 3 4
Energy (kcal/day) 2034.0 2164.8 2142.2 1978.8 1849.5 <0.001
% of energy from:
Carbohydrates 50.6 46.5 49.6 51.8 54.8 <0.001
Total protein 15.8 16.6 15.7 15.5 15.4 0.083
Plant protein 5.4 4.0 5.2 5.9 6.6 <0.001
Animal protein 10.4 12.6 10.6 9.6 8.8 <0.001
Total fat 33.6 36.6 34.6 32.7 30.4 <0.001
Saturated fat 10.8 12.4 11.4 10.3 9.2 <0.001
Trans fat 1.2 1.4 1.2 1.2 1.1 0.064
Free sugar 11.8 15.0 12.3 10.2 9.4 <0.001
Cholesterol (mg) 239.2 311.2 244.8 212.4 187.7 <0.001
Sodium (g) 3.5 3.5 3.7 3.4 3.3 0.072
Potassium (mg) 1968.8 1724.0 1953.5 1996.5 2203.1 <0.001
Dietary fiber ranges (g/1000 kcal) in each quartile: 1 (0.46 to ≤4.78); 2 (>4.78 to ≤6.20); 3 (>6.20 to ≤7.64); 4 (>7.64 to 22.58); *F
test: used to determine significance of linear regression model.
Source: Food Consumption and Nutritional Status Survey of the city of Campinas, Brazil (2014-2015 Campinas Nutrition Survey).
recommended by the WHO (≥25 g/day or 12,5
g/1,000 kcal)30 and the IOM (38 g/day for boys
and 26 g for girls or 14 g/1,000 kcal/day)32.
Dietary fiber intake in the present study was
lower than that described for adolescents in Eu-
rope (20.3 g and 8.4 g/1,000 kcal/day)6, the Unit-
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ed States (13.2 g/day)9, and Australia (19.8 g/day
for children/adolescents nine to 13 years of age
and 18.8 g/day for adolescents 14 to 18 years of
age)10. It was also lower than that estimated for
Brazilian adolescents in a previous study (20.4
and 18.8 g for boys and girls 10 to 13 years of age,
respectively; 23.4 and 18.5 g for body and girls 14
to 18 years of age, respectively)11.
Dietary patterns in the Brazilian population
have undergone intense transformations in re-
cent decades, with a reduction in the consump-
tion of traditional foods, such as rice, beans, and
cassava, and an increase in the consumption of
highly processed foods, such as cookies/crackers,
ice creams, and fast food33,34. Besides the scarcity
of fiber and other nutrients, these products have
characteristics that stimulate excessive consump-
tion, such as high palatability, broad advertising,
and accessibility to all social strata17. Data from
the 2008-2009 Brazilian Family Budget Survey
showed that 69.5% and 21.5% of total energy
intake came from food in natura and ultra-pro-
cessed products35. These figures were respective-
ly 28.6% and 50.7% in the United Kingdom in
200836.
During food processing, dietary fiber is add-
ed to food products due to its technological role,
such as water and fat retention capacity, thick-
ening, texture modification, flavor modification,
gel formation, the control of the crystallization of
sugar, etc37. For instance, inulin is a soluble fiber
used to replace fat in baked goods, dairy prod-
ucts, sauces, and creamy spreads37. In the Unit-
ed States, a diversity of synthetic non-digestible
carbohydrates (polydextrose, short-chain fruc-
tooligosaccharides, and galactooligosaccharides)
and isolates (alginate and fiber from the cell wall
of plants) are used in commercial products and
have been defined as dietary fiber by the US Food
and Drug Administration38. However, one should
bear in mind that, regardless of the presence of
these types of fiber, ultra-processed products are
not healthy.
Girls had greater total and soluble dietary
fiber intake than boys in the bivariate analysis
and had greater soluble fiber intake in the final
model. Among the participants of the cross-sec-
tional Healthy Lifestyle in Europe by Nutrition
in Adolescence (HELENA-CCS) study, dietary fi-
ber intake was higher among girls than boys (8.9
g/1,000 kcal versus 7.8 g/1,000 kcal; p<0,001) and
compliance with the IOM recommended intake
was also higher among girls than boys (11.4%
versus 2.1%)6. In Australia, no significant dif-
ferences between the sexes were found regard-
ing the proportion of adolescents who achieved
the reference values established for the popula-
tion of the country10. In a study involving Bra-
zilian adolescents, the prevalence of inadequate
dietary fiber intake (≤12.5 g/1,000 kcal) was
higher among girls, reaching as high as 86.0%
in the group aged 14 to 18 years11. The results
of national surveys reveal that unhealthy eating
patterns are more common among female ado-
lescents than males24,39. Maia et al.24 found that
an unhealthy eating pattern characterized by the
consumption of sweets, fried foods, instant pasta,
chips, crackers, and processed meats was associ-
ated with inadequate behaviors, such as the habit
of not eating breakfast, not having meals with
one’s parents, and eating at fast food restaurants.
Therefore, the finding in the present study may
be due to the greater consumption of unhealthy
foods among girls.
The consumption of soluble fiber was higher
in homes in which the head of the household had
a higher level of schooling compared to those with
up to only four years of schooling. A study con-
ducted in Australia found that dietary fiber intake
was higher in the segment with a higher income,
as 51.1% of the richest individuals achieved the
recommended intake of this nutrient compared
to 33.3% of the poorest individuals10. In a previ-
ous study, a higher consumption of fruit and veg-
etables was found among Brazilian adolescents
whose mothers had a complete university/college
education compared to those whose mothers had
an incomplete primary school education40. The
fast growth in the participation of ready-to-eat
or nearly ready-to-eat food products and the re-
duction in the consumption of foods in natura is
a phenomenon that touches all social segments
of the population34. Data from the 2008-2009
Brazilian Family Budget Survey revealed a 7.5%
reduction in the caloric contribution of foods in
natura and an 19.3% increase in the participa-
tion of ready-to-eat products in the population
classified in the first and last income quintiles34.
Lower dietary fiber intake was found among
adolescents who consumed fruit, raw vegeta-
bles, and beans less and consumed soft drinks
and processed meat more during the week.
Plant-based foods have different quantities of
dietary fiber. The main sources are grains (pref-
erably whole), tubers, legumes, vegetables, and
fruit14-16. Pectin is a fermentable, viscous, soluble
fiber found in fruit, legumes, oats, potato, and
the white portion of orange peel. Cellulose is a
non-fermentable soluble fiber found in grains,
vegetables, fruit peels, nuts, and seeds14-16. Data
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Meira RCF et al.
from the 2008-2009 Brazilian Family Budget
Survey demonstrate that the consumption of ul-
tra-processed products negatively affects dietary
quality, as the fiber contents is three times lower
in the portion of the diet composed of ultra-pro-
cessed produced compared to foods in natura35.
Lower total, soluble, and insoluble dietary fi-
ber intake was also found among individuals who
did not eat breakfast every day. The results of the
2013-2014 Estudo de Riscos Cardiovasculares em
Adolescentes de 12-17 anos (ERICA [Study of
Cardiovascular Risk in Adolescents 12 to 17 years
of age]) indicate that 21.9% of the participants
never ate breakfast (25.8% of the girls and 18.2%
of the boys)41. In a study conducted in the city of
São Paulo, 38.0% did not eat breakfast, whereas
the contribution of this meal to total dietary fiber
among adolescents was nearly 20.0% (4.0 g for
boys and 3.4 g for girls)42. In the United King-
dom, children and adolescents (four to 18 years
of age) who ate breakfast every day had a greater
intake of dietary fiber, calcium, iron, and folate.42
Breakfast is one of the three main meals of the
day17 and makes an important contribution to
dietary fiber intake through the consumption of
fruit, bread, and whole grains.
In the bivariate analysis, an association was
found between self-rated diet quality as poor/
very poor and low fiber intake and an associa-
tion was found between the practice of checking
food labels and greater fiber intake. These find-
ings reveal the importance of eating habits and
healthy behaviors to promoting the consump-
tion of foods that are sources of fiber. A previ-
ous study found a poor overall diet quality, lower
consumption of whole grains and fruit, and a
higher consumption of solid fats and added sug-
ar among adolescents who considered the quality
of their diet to be poor/very poor44.
In the city of Campinas, 31.2% (CI95%: 26.8
to 35.9) of the adolescents had the practice of
checking food labels and mainly looked at the ex-
piration date (82.1%), calories (19.7%), and fat
content (10.7%), whereas only 1.0% checked the
dietary fiber content. Therefore, the association
between fiber intake and label reading does not
reflect a concern on the part of these adolescents
regarding the content of this nutrient, but rather
a concern for other characteristics of food.
In the present study, foods in natura and min-
imally processed foods provided 68.0% of total
dietary fiber, 53.7% of the soluble fraction, and
72.1% of the insoluble fraction. Among Brazil-
ians aged ten years or older, the foods that most
contributed dietary fiber were beans (36.9%),
rice (9.8%), bread (9.3%), vegetables (7.8%),
fruit (7.7%), and cassava flour (5.5%)8. Among
European adolescents, the foods that most pro-
vided fiber were bread (20.8%, 24.4%, and 18.4%
of total, soluble, and insoluble fiber, respective-
ly), grains, roots, and tubers (17.5%, 20.1%, and
17.9%), sweets/salty snack foods (16.7%, 11.5%,
and 19.1%), fruit (13.9%, 13.1%, and 14.0%),
and vegetables (9.8%, 9.3%, and 10.0%)6. Ul-
tra-processed products provided nearly 25.0%
of the total fiber in the diet of the adolescents of
Campinas. This results merits reflection, as the
contribution of these products to fiber intake
equals that of its energy contribution, meaning
that an increase in the consumption of ultra-pro-
cessed products would tend to lead to a reduction
in dietary fiber intake35. Ultra-processed foods
are nutritionally unbalanced and, according to
the recommendations of the Food Guide for the
Brazilian Population, should be avoided17.
The increase in fiber intake was inversely
associated with energy content, animal protein,
total fat, saturated fat, cholesterol, and free sug-
ar in the diet. Dietary fiber is naturally found
in plant-based foods, which are good sources of
nutrients and generally have a lower energy den-
sity in comparison to foods of an animal origin.
Indeed, the current national recommendation is
for predominantly plant-based foods in natura
to be the basis of one’s diet17. A study conducted
with American adults (≥19 years) found that an
increase in fiber intake contributed significantly
to the increase in the diet quality score45, show-
ing that this nutrient is an important marker of
the quality of one’s diet, as found in the present
investigation.
Among the limitations of this study, the use
of a single 24hR does not represent the habitual
food intake of adolescents due to the variability
in the diet19. However, the 24hR is considered ad-
equate for estimating the average intake of foods
and nutrients when administered in a popula-
tion-based study on different days of the week
and months of the year.
Another limitation regards the use of self-rat-
ed diet quality, which is a construct that has been
explored little in the literature. In 2017, Ro-
drigues et al.46 investigated the applicability of
the question “In your opinion, what is the quality
of your diet?” to evaluate diet quality in adoles-
cents and found 28% sensitivity and 79% speci-
ficity in detecting diets of good and poor nutri-
tional quality, respectively. The authors pointed
out the limitation in the use of this question for
adolescents, as products such as cookies/crackers,
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Ciência & Saúde Coletiva, 26(8):3147-3160, 2021
sweets, sweetened beverages, and fast food were
not perceived as being part of a diet of poor qual-
ity46. In the present study, lower fiber intake was
found among the adolescents who rated their
diet as being poor, which is in line with a result
found in a study that reports an inverse relation
between the consumption of ultra-processed
foods and dietary fiber intake35.
This study offers information on total dietary
fiber intake as well as the soluble and insoluble
fractions and describes food sources of this nu-
trient according to the NOVA classification in a
representative sample of adolescents from the
city of Campinas, Brazil. The results reveal in-
sufficient fiber intake in all subgroups analyzed.
Foods in natura/minimally processed foods pro-
vided nearly 70% of the total fiber content of the
diet. Moreover, the consumption of energy, fat,
free sugar, and animal protein diminished with
the increase in fiber intake.
These findings underscore the importance
of the recommendation for foods in natura and
minimally processed foods17 to constitute the ba-
sis of one’s diet. The findings can also contribute
to the planning of actions that promote healthy
eating on both the individual and family levels.
Collaborations
RCF Meira participated in the proposal of the
article, literature review, and writing of the
manuscript. CD Capitani, AA Barros Filho, and
MBA Barros performed a critical review of the
intellectual content and statistical analyses. D As-
sumpção guided the proposal of the article, per-
formed the data analysis, and contributed to the
writing of the manuscript. All authors approved
the final version of the manuscript.
3158
Meira RCF et al.
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Article submitted 13/05/2019
Approved 19/05/2020
Final version submitted 21/05/2020
Chief Editors: Romeu Gomes, Antônio Augusto Moura da
Silva
This is an Open Access article distributed under the terms of the Creative Commons Attribution License
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