Nutritional and food insecurity of construction workers

Abstract

BACKGROUND: Construction workers have intensive contact with their workplace and are possibly susceptible to Nutritional and Food Insecurity.

OBJECTIVE: This paper assessed the Food Security status, diet and anthropometric measures of workers in the Construction Industry living in the city of João Pessoa, PB.

METHODS: This cross-sectional study included 59 workers housed at construction sites. The workers were given the Brazilian Scale for Measuring Food Insecurity and Nutrition, had anthropometric measures taken and completed the Diet Quality Index, comparing their eating at the construction site and at home. Statistical analyses described the mean, standard deviation, frequency and Pearson correlations.

RESULTS: Food Insecurity was reported by 71.2% of the workers, and 69.5% were overweight. The mean values of the Healthy Eating Index suggested that the workers’ diets were in need of modification. There were statistically significant inverse associations among the Healthy Eating Index and Body Mass Index, waist circumference, percentage of total fat and cholesterol.

CONCLUSIONS: Values obtained using the Scale showed Food Insecurity coupled with high excess weight and dietary inadequacies, revealing that these workers are at risk for health problems.

Keywords

Construction industry food security nutritional assessment food consumption

1 Introduction

1.1 Nutrition and Food Security (NFS) as a public policy

Food and nutrition are indispensable elements of health promotion and protection, aiding human growth and development and promoting good citizenship and quality of life. Brazilian law considers food and nutrition a social right [1 –5]. In this way, the Brazilian State is co-responsible for ensuring Food Security (FS) for the achievement of the Human Right to Food (HRFN).

1.2 Food security and construction workers

From this perspective, construction workers are embedded in a context where they need FS to be ensured. Reports conducted by the Department of Statistics and Socioeconomic Studies in Brazil (DIEESE–Acronym in Portuguese) between 2009 and 2013 described the following profile of workersin the construction industry: mostly blacks and browns, have lower average incomes than other professional groups, low education level, and precarious working conditions [6 –8].

Within this discussion, we should also consider workers who are housed at the construction sites. Farmers that work and live at the construction sites during the week return less often to their hometowns. These workers have greater contact with the workplace and are possibly subject to different feeding situations and hence greater food insecurity in relation to other workers not housed at the job site.

In 2003, the process of validation of an instrument to measure the FS in the Brazilian population began, creating the Brazilian Food Insecurity Scale (EBIA–Acronym in Portuguese). After its release, research on the subject became possible, especially the National Sample Survey of Households (PNAD–Acronym in Portuguese), which made the first diagnosis of FS in 2004 and later, in 2009 and 2013, obtained comparative data of the phenomenon within the Brazilian population [9].

Even with the use of EBIA, the implementation of Work Food Program in Brazil (PAT–Acronym in Portuguese) for the past 40 years and several studies on occupational health, there are still few studies that consider the FS situation of workers to be a subject of research. Thus, this article assesses Food Security status, diet and anthropometric measures of workers in the Construction Industry living in the city of João Pessoa, PB.

2 Methods

2.1 Characterization of the study

The study was originally conducted with 112 workers in the Construction industry who were housed at the construction sites. They were part of a program called Programa Escola Zé Peã o (PEZP), which is an initiative of the Federal University of Paraíba (UFPB), in partnership with the Union of Workers of the Construction Industry and Furniture of João Pessoa (SINTRICON/JP–Acronym in Portuguese).

2.2 Inclusion/exclusion criteria

Only workers with at least three months of housing at the construction site were included in the study. Individuals affected by mental or metabolic disease were excluded.

In addition to the criteria described above, to develop this research, it was necessary to consider the existence of intense seasonal employment in the workforce, causing layoffs or relocation of construction sites. A study conducted by DIEESE in six Brazilian capitals in 2011 found the high turnover rate in construction industry, with young people up to 24 years of age among the most affected workers due to the growth in the number of dismissals in this age group in recent years. Thus, turnover is one of the characteristics of this industry, which causes uncertainty about the operator’s length of time in the workplace. Given this process and in an attempt to establish methodological rigor, only the data from the 59 workers who participated in all stages of research were analyzed.

2.3 Data collection

The data were collected as part of the Nutrition Education and Health Project, which is attached to PEZP. The program focuses on literacy for workers.

Data collection occurred at the construction site of the 11 members of PEZP. Three stages of data collection, each separated by at least three months, took place at each site between January and December,2013. In the first stage, anthropometric data were collected (weight, height, waist circumference and triceps skinfold, biceps, subscapular and suprailiac). In the second stage, 24-hour dietary recalls (R24hs) were conducted, one referring to food provided at the construction site and the other referring to the food provided at home on the weekend. In the last stage, the R24hs were conducted again using the same procedure (food eaten at home and at the work site), and the workers completed a socioeconomic questionnaire documenting their age, race, education, job position and average pay at work. Additionally, the questionnaire included the EBIA scale in the adult module, which referred to their FS situation athome.

Body Mass Index (BMI), defined as the individual’s body mass divided by the square of their height, was calculated from the weight and height data. Waist circumference (WC) was also measured. For the classification of BMI and WC, the values proposed by WHO [10] were used. All measurements were obtained from the mean of three recordings performed by the same technician.

To estimate percentage of body fat (% BF), we first obtained the body density (BD) by the following equation: BD = (A–B) log ∑×4-folds. Where A and B are coefficients according to age and gender. After calculating the density, it was possible to determine the percentage of fat using the following equation: % BF = [(4.95 ÷ BD) –4.50]×100. The equations and values were reported by Cuppari [11].

Nutrients and energy from the dietary recalls were quantified with the aid of Avanutri^® software, version 4.0. The ingredients of meals were determined and classified according to the food guide pyramid. The Health Eating Index (HEI) of the workers was then calculated, using the method proposed by Kennedy et al. [12] and adapted by Fisberg et al. [13].

Six components of the HEI were represented by food groups (cereals, breads, tubers and roots; vegetables; fruits; milk and dairy; meat and eggs; and legumes), three components were represented by nutrients (total fat, cholesterol and sodium), and the last component was represented by diet variety. Based on the recalls, the food was converted to portions according to their caloric value and the group to which they belonged, in consonance with the food guide for the Brazilian population and the adapted food pyramid by Philippi et al. [14].

Each component was evaluated and assigned a score from zero to ten, with intermediate values calculated proportionately. According to Fisberg et al. [13], the recommended maximum score for each item was as follows: cereals (5–9 servings), vegetables(4-5 servings), fruits (3–5 servings), legumes (1 serving) milk and dairy products (3 servings), meat and eggs (1-2 servings), total fat (30–45% of total caloric value of the diet), cholesterol (300 to 450 mg / day), sodium (2400 to 4800 mg / day) and range (3 to 8 different food / day). It is worth mentioning that the same food consumed more than once, regardless of the form of preparation (fried, baked, etc.), was counted only once.

The scores for each component were added together at the end to generate the final score of each HEI R24hs. The total score was divided into three categories according to Bowman et al. [15]: a score less than 51 points indicated an inadequate diet; a score between 51 and 80 points suggested that diet modification might be necessary; and a score above 81 points indicated a healthy diet. One hundred eighty-four R24hs were analyzed for preparation of HEI, with mean values obtained for meals eaten at the jobsite and at home.

Along with the questionnaire, the workers answered the EBIA in an attempt to distinguish the FS at home from the conditions of FS experienced by workers at the construction sites. The participants responded to the adult EBIA module, which contained eight questions. Every question had two answer choices: “Yes” and “No”. The questions referred to the period of three months prior to the day of the interview. The households were classified according to their condition of food security into four categories: FS, mild Food Insecurity, moderate Food Insecurity and severe Food Insecurity. The score for each household corresponded to the number of affirmative answers to the questions ofEBIA.

2.4 Data analysis

Descriptive statistics were calculated, such as the mean, standard deviation, and frequencies of EBIA scores, as well as socioeconomic data, anthropometric data, body composition and HEI scores. Mean values of each component of the diet were also described, and the Pearson correlation coefficient between HEI and EBIA, BMI, WC, and dietary variables (energy, percentage of total fat and saturated fat, cholesterol) were calculated. Statistical analyses were performed using the Statistical Package for Social Sciences (SPSS) version 20.0. When necessary, the HEI results were calculated separately to compare food consumption at home and at thejobsite.

2.5 Ethical aspects

This research was submitted to The Research Ethics Committee from the Center of Health Sciences of the Federal University of Paraíba (CEP/CCS/UFPB) and approved under the protocol # 259 106. All workers involved were informed about the aims and objectives of the research and signed the consent form that was requested, in accordance with Resolution # 466/2012 of the National Health Council [16].

3 Results

3.1 Individual characteristics

All study participants were male and were 39.2 years old on average. Most of them were browns (69.5%), with incomplete primary education (67.8%), working as auxiliary bricklayers (47.5%) and earning an average of R $ 956.8.

3.2 Levels of food insecurity and nutritional status

The data in Table 1 reveal that 27.1% of the workers reported Food Security, 71.2% endorsed mild Food Insecurity and 1.7% endorsed moderate Food Insecurity. Regarding the nutritional aspects, 55.9% were overweight, 11.9% had class I obesity, 1.7% had class III obesity and 30.5% were at a normal weight. The waist circumference (WC) measurement showed that 61.0% did not have metabolic risk, as opposed to 39.0% who had metabolic risk. The average value of % BF was 21.5%, demonstrating that they were above the average amount of fat that is recommended for men.

3.3 The Healthy Eating Index (HEI)

Table 2 presents the number of servings, recommendations and the HEI classification of 236 diet recalls, which represents total number of recalls collected over the stages of the study, separated by jobsite versus home. Both at the construction site and at home, the average servings of legumes, meats and eggs were above the recommended range. On the other hand, consumption of vegetables, fruits, milk and dairy products, total fat and sodium was below the recommended range. Only cholesterol remained normal. Legume consumption doubled at home compared to the construction site. The HEI evaluation showed that the diets needed modifications for 94.9% of the workers at the construction site and 76.3% at home. Only 3.4% of workers had a healthy diet at the construction site.

Table 3 summarizes the scores of the components of the HEI. The mean values of the following component scores showed the highest score values (greater than eight points) for food at the construction site and at home: cereal, legumes, meats and eggs, total fat, sodium and dietary variety. The scores of the following groups had the worst values (less than five points) in HEI at the construction site: vegetables, fruits and milk and dairy. The cholesterol, vegetable, and dairy components had lower recorded values at home than at the construction site. The diet at the construction site received a score of zero on milk and dairy for 75% of the workers, and for 97.8% of them, the score for the meat and eggs group was ten. None of the workers received scores of zero in the component of diet variety.

The average HEI assigned to the studied population was 70.1 for the construction site and 68.8 at home. The average amount of energy did not differ between the different categories of the diet. However, the values for the total fat, saturated fat and cholesterol levels increased as the scores of the diet at the construction site decreased. At home, only the percentage of total fat and cholesterol increased as the HEI scores worsened (Table 4).

The correlation coefficients between the HEI scores and BMI, WC, percentage of total fat and cholesterol revealed statistically significant inverse associations (p < 0.05) (Table 5).

4 Discussion

4.1 Scenario of food insecurity

Brazil has been expanding the concept of and the national agenda on FS. Beginning as a political and participatory process involving various segments of society, it was later conceived as a state policy, incorporating a nutritional aspect, in addition to other dimensions such as health, culture, environmental, social and economic. Gradually, the understanding of FS surpassed ideas about national security and food shortages to reflect the State’s obligation to its citizens [17].

After validation of the EBIA in Brazil, FS was measured in several studies. The levels of food insecurity and nutrition observed in this study were higher than the data found in the PNAD (2013), which showed 22.6% and 36.5% of households with some degree of food insecurity in the country and in the state where the study occurred, respectively [18]. Similarly, Salles-Costa et al. [19] in a population-based survey conducted in Rio de Janeiro showed a Food Insecurity prevalence of 53.8% [19].

This investigation showed a high prevalence of mild food insecurity. This finding could be understood as uncertainty about personal or family ability to obtain the necessary food for the near future; that is, the concern that food may run out before more food can be produced or bought. In addition, Food Insecurity might be associated with inadequate quality of food resulting from strategies aimed to increase the quantity of the food [20–21]. That framework may be due to the difficulties faced by workers to obtain adequate food, which is directly influenced by the relationship between workforce and employers.

In contrast to the data presented in this study, a population-based study conducted by McIntyre,Bartoo and Emery [22] on the level of food security in the Canadian labor force between 2007 and 2008 showed that only 5.2% of Construction workers had food insecurity [22].

4.2 Overweight in construction workers

Nutritional assessment, according to the BMI of the study participants, showed that more than half were overweight. This statistic is higher than that demonstrated by Fernandes and Vaz [23], who performed analysis of BMI for Construction workers from a São Paulo company, using records of Occupational Medicine Service, and found that 33.1% were overweight and 6.5% were obese [23]. These data were supported when presented with WC values and % BF, showing a metabolic and cardiovascular risk scenario in the labor force.

The increasing consumption of low-cost foods with high caloric density and eating disorders generated by anxiety and uncertainty related to involuntary food restriction may be some of the causes of overweight [24]. A diet rich in cereals and meat but low in fruits and vegetables provided at construction sites and households may also have contributed to the excess weight observed.

4.3 Food consumption

In the study, the lower was the HEI values, the higher were BMI, WC, total fat and cholesterol. A study conducted by Tande, Magel and Strand [25] on the relationship between abdominal obesity and HEI in adult Americans revealed that with every 10 point increase in the HEI, the odds of obesity among men rose by 14.5%, and for each extra point assigned to the fruit component, the risk of obesity decreased 2.6% [25]. Thus, poor nutrition can cause the appearance or worsening of metabolic disease.

The analysis of the mean of the HEI scores by classification of categories with dietary aspects reinforced the hypotheses about factors that may contribute to weight gain and disease. The results were similar to those found by Fisberg et al. [13] in a study of adaptation and application of HEI, where it was noticed that when the scores of the diet decreased, there was an increase in total and saturated fat and cholesterol [26]. For example, workers with worse HEI scores had higher amounts of lipids in their diet, and their BMI and WC results were likely to constitute a nutritional and health risk.

The mean of the HEI scores from the household and the construction site were similar to the values found by Loureiro et al. [27] and Morimoto et al. [28], which were 75.2 and 60.4, respectively [27–28]. Despite the fact that the HEI scores did not show a significant difference in the article in question, the number of workers that required a diet change was far higher at the construction site than at home. That allowed us to infer that there are bigger problems with the food supplied at construction sites.

Overall, the number of portions of vegetables, fruits, milk and dairy products, total fat and sodium were lower than recommended. Assessing dietary intakes of beneficiaries of the Bolsa Família Program 1in a state capital in Brazil, Lima et al. [29] revealed low intake of fruits, vegetables and dairy products in the general population. It is worth noting that the present study showed high consumption of legumes, demonstrated by the high prevalence of ten scores and the maximum number of the portion assigned to the group. This may be due to the Brazilian habit of consuming beans daily in several meals throughout the day.

5 Conclusions

Even with the support of legislation and intense agenda of actions related to ensuring the NFS, from the perspective of human rights, the results revealed a scenario of Nutritional and Food Insecurity experienced by the workers surveyed. The current situation reflects the denial of human rights and respect as a citizen harms human dignity and is associated with various health problems.

The overall analysis of food through the HEI demonstrated inadequacies, such that most of the components of the diet were in disagreement with the proposed recommendations and the intake of certain food groups was lacking for some workers. Moreover, almost all the workers at the construction site had a diet that needed improvement. Those findings demand changes in the general food supply but higher attention to that provided in worksites.

The high prevalence of overweight associated with WC and percentage of body fat, unsettled the researchers because of the contradiction between this situation and the intense load of work required for this type of job activity. Even noticing changes in the work process in the construction sites and feeding patterns of the general population, it is necessary to boost studies designed to address the causes of overweight among workers.

It is noteworthy that in the literature, few studies have focused on the NFS conditions of construction workers. Others studies in the field of nutritional assessment are needed to add to knowledge of culture and eating habits. Additionally, nutritional and dietary interventions are needed to acquire a greater understanding of these subjects.

Conflict of interest

None to declare.

Collaborators

All authors participated in the conceptualization of the manuscript. Brasil and Araujo participated of all stages of this research. Vianna participated in the conceptualization and review of the manuscript.

Footnotes

Acknowledgments

The authors thank Maria Paula de Paiva, Gilderlania Danta, Jacianne da Silva Alves for the support in data collection process.

1

The program intends to transfer provisions to families that are considered to be in extreme poverty. The criteria used for payment is the number of kids and pregnant women in the family and whether the children are at school

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