Background: Research on changing dietary practices is rare in lower and middle income countries, and understanding the impact of global economic processes on population health and nutrition is important, especially of rural communities. We analyzed the diet of 22 families in Brasília Legal, a riverside community in the Tapajós River region of the Brazilian Amazon, using nonparametric tests to compare dietary surveys taken in 1999 and 2010. Results: Data from the two surveys show that food obtained through commercial supply chains became more frequent in household diets, corresponding to significant increases in daily consumption of food items rich in energy, protein, and sugar. At the same time, there was a decline in traditional Amazonian food intake. Conclusions: Comparing these results with household socio-economic characteristics and drawing on open-ended interviews, we consider the multiple influences that economic development processes may have had on local diets. The introduction of new income sources and employment opportunities, infrastructural and transportation expansion, as well as environmental change appear to have influenced the observed dietary shifts. Such shifts are likely to have important implications for the nutritional status of communities in the Amazon, highlighting concerning trade-offs between current development trajectories and human health. Public policies and health education programs must urgently consider the interactions between sustainable development priorities in order to address emerging health risks in this rapidly changing region.
Antecedentes: Pesquisas sobre mudanças nas práticas alimentares são raras nos países de renda média e baixa, mas são necessárias no intuito de compreender o impacto dos processos econômicos globais na saúde e nutrição das populações, especialmente em comunidades rurais. Utilizando-se inquéritos alimentares, analisou-se o consumo alimentar de 22 famílias em Brasília Legal, uma comunidade ribeirinha da região do rio Tapajós na Amazônia brasileira, usando-se testes não paramétricos para comparar dados de inquéritos alimentares realizados em 1999 e 2010. Resultados: Os dados dos dois inquéritos mostram que os alimentos obtidos por meio da cadeia comercial de suprimentos se tornaram mais frequentes nos perfis de consumo doméstico, levando a aumentos significativos no consumo diário de alimentos ricos em energia, proteína e açúcar. Ao mesmo tempo, houve um declínio na ingestão de alimentos tradicionais da Amazônia. Conclusões: Comparando-se esses resultados com as características socioeconômicas das famílias e baseando-se em entrevistas abertas, consideram-se as múltiplas influências que os processos de desenvolvimento econômico podem ter tido nos perfis de consumo alimentar local. A introdução de novas fontes de renda e oportunidades de emprego, a expansão de infraestruturas e do transporte, bem como as mudanças ambientais parecem ter influenciado as mudanças alimentares observadas. É provável que essas mudanças tenham implicações importantes para o estado nutricional das comunidades na Amazônia, destacando-se possíveis impactos preocupantes das atuais trajetórias de desenvolvimento sobre a saúde humana. As políticas públicas e os programas de educação em saúde devem considerar urgentemente as interações entre as diversas prioridades de desenvolvimento sustentável, a fim de enfrentar os riscos emergentes à saúde nessa região em rápida transformação.
Keywords: Traditional diet; Amazon; Nutrition transition; Community; Rural development; Alimentação tradicional; Amazônia; transição alimentar; comunidade; desenvolvimento rural
Human history has been marked by food and nutritional changes, influenced by a range of environmental, economic, geographic and social factors. Over the last three centuries, dietary habits and nutritional status changed rapidly in North America and Europe, notably after World War II [[
In Latin America, traditional diets based on foods that are rich in fibers, complex carbohydrates, trace elements, and phytochemical compounds have been replaced by diets that are characterized by refined sugars, animal products, and highly processed foods [[
In Brazil, the seminal book Geografia da Fome (Geography of Hunger) was the first to consolidate and systematize national information on food and nutrition [[
In the Brazilian Amazon, dietary practices are strongly influenced by the regional biogeography, indigenous traditions, and the presence of European colonists and African descendants [[
In Brasília Legal, a rural riverside community in the lower Tapajós River region in western Pará state, a dietary survey was conducted in 1999 as part of a larger interdisciplinary research project [[
In this paper, we conducted a follow-up dietary survey with the same families evaluated by Passos et al. [[
This study was conducted in the community of Brasília Legal, located in the municipality of Aveiro (Fig. 1). The village was established in 1836 as a center of resistance and trading post during the Cabanagem social movement [[
Graph: Fig. 1 Tapajos River region and location of the community Brasília Legal
In 1999, there were 110 households in Brasília Legal. The total population was 557 people, with 249 identifying as female and 308 as male [[
Longitudinal data was collected with 22 families in Brasília Legal in 1999 and again with the same families in 2010. Four of the families who participated in the 1999 study were unavailable for follow-up due to illness, death or work. The 1999 study was carried out for a year [[
For both years, we conducted dietary surveys to document daily food consumption (including solids and/or liquids) using the "Food Diary" method [[
In addition to the food consumption data, socio-demographic characteristics of participating household heads were recorded, including their age, education level, and birthplace (origin). Household living conditions and livelihood strategies were also documented (income sources, primary occupation). To qualitatively understand the observed changes in diet, semi-structured interviews were also carried out with all participants. Open-ended, thematic questions were oriented towards perceptions of food and nutrition, household dietary history, including transitions in the consumption of foods produced by the household and purchased products. Broader changes in local socio-economic conditions, such as employment, access to electricity, transportation, and their effect on diet were also discussed with participants. When necessary, primary interview data about local trajectories of change were corroborated with our knowledge and experience of the region, participant observation, or verified by regional experts.
All participants signed an informed consent form and no compensation was provided. This research is in accordance with the guidelines established by the Ethics Committee on Human Research of the Faculty of Health Sciences at the University of Brasília as well as the National Commission on Ethics in Human Research (authorization number 095/08).
To analyze changes in household food intake and socioeconomic characteristics in Brasília Legal from 1999 and 2010, data were analyzed using the statistical program Statview v.5 (SAS Institute, 1998). We compared changes in sociodemographic data among the 22 families between 1999 and 2010 using McNemar's test for paired nominal data. Recorded food intake profiles were compared using the Wilcoxon nonparametric test for paired samples, adopting p < 0.05 level of significance.
Table 1 outlines the key sociodemographic characteristics of the 22 families who participated in the food surveys conducted in 1999 and 2010. All participants are from the northern region of Brazil and were born in the state of Pará. Although most informants had at least some level of formal schooling at the time of interview, the level of education was higher among women.
Socio-demographic characteristics of household heads participating in the 2010 food intake survey
Characteristics Women* ( Proportion of participants (%) Men ( Proportion of participants (%) 31–40 years 2 9.1 0 0 41–50 years 8 36.4 6 31.6 51–60 years 5 22.7 6 31.6 60+ years 7 31.8 5 26.3 No Information 0 0 2 10.5 No formal education 0 0 2 10.5 Basic education (1 to 4 years) 5 22.7 8 42.1 Primary school (5 to 8 years) 11 50 6 31.6 Secondary school (9 to 11 years) 6 27.3 2 10.5 No information 0 0 1 5.3
* In 2010, three of the households were women-led (i.e., there was no male household head)
Table 2 compares the livelihood strategies and living conditions of participating families in 1999 and 2010, demonstrating that there were important changes in household assets and infrastructure over a decade. In 1999, few families had access to electricity through household generators. In September 2010, the federal government installed electrical lines, equalizing the supply of electricity to all families in the community. The primary occupation of household heads has evolved over time. Several household heads transitioned to retirement, highlighting the effect of household aging on livelihood strategies. Similarly, fewer respondents reported fishing and farming activities as their primary occupation in 2010 compared to 1999.
Economic strategies and living conditions of the 22 households that participated in both the 1999 and 2010 food intake surveys. The bold type/asterisk (*) indicates that there is a significant difference between the 2 years
Characteristics 1999 2010 Total (%) Total (%) Brick house 10 45.5 15 68.2 0.065 Wooden house 12 54.5 7 31.8 0.065 Television 19 86.4 21 95.5 0.24 parabolic antenna 18 81.8 21 95.5 0.12 Radio 13 59.1 21 95.5 Well drinking water 22 100.0 22 100.0 NS Electricity 4 18.2 22 100.0 internal bathroom 12 54.5 15 68.2 0.19 Social assistance (Bolsa Familia) 0 0.0 8 36.4 Fishers assistance (Bolsa Pesca) 0 0.0 6 27.3 Pension 1 4.5 10 45.5 Public servant 9 40.9 9 40.9 0.342 Formal employment 1 4.5 4 18.2 0.186 Small business 5 22.7 8 36.4 0.225
* In 1999, two of the households were women-led (i.e., there was no male household head) and in 2010 this increased to three households, which is associated to the death or emigration of men # one-tailed McNemar's test p-value to test whether socio-economic conditions of the 22 households have improved between 1999 and 2010
Overall, household income sources changed over time, with significant increases in the number of families benefiting from public assistance. In the 2000s, poverty alleviation and rural development programs were introduced in Brazil, offering new income sources to households. At the time of the follow-up survey in 2010, about half of the participating households were receiving social benefits from the Bolsa Pesca (assistance for rural fishers to sustain their practices) or from Bolsa Familia (a conditional cash transfer program that provides a monthly salary to families with school-aged to subsidize household income). Likewise, more than a third of the participating households began receiving benefits from the public pension plan, which provides a monthly salary to qualifying rural workers over a certain age.
A comparison of food intake in 1999 and 2010 shows a significant increase in the consumption of cereal items, such as rice, pasta, cake and corn (p < 0.05 for each, Table 3). While no difference in fish consumption was documented, there was a considerable increase in the consumption of beef and frozen (commercially farmed) chicken. When all purchased meats were grouped together, the increase in consumption of this protein source is significant (p < 0.0001). On the other hand, intake of local free-range chicken and game meat significantly decreased (p = 0.0159, 0.0066 respectively).
Daily food consumption in 1999 and 2010 of participating families, expressed as the total number of days a food item was consumed out of the 15 days that were surveyed
Food category 1999 (mean ± SD) 2010 (mean ± SD) Trend Wilcoxon Test ( Rice 12.4 ± 3.6 14.7 ± 0.7 Bread 12.7 ± 0.6 12.0 ± 2.5 0.4441 Pasta 1.8 ± 2.5 4.3 ± 4.0 Cookies/crackers 1.9 ± 2.9 2.0 ± 1.8 0.6791 Cake 0.4 ± 0.7 1.7 ± 2.2 Corn 0.5 ± 1.3 1.7 ± 2.0 Carnivorous fish 4.6 ± 3.1 3.5 ± 3.6 0.1730 Omnivorous fish 4.4 ± 2.8 6.1 ± 2.9 0.0853 Herbivorous fish 4.5 ± 3.2 4.4 ± 2.2 0.8789 Beef 4.0 ± 2.4 8.7 ± 3.4 Local free-range chicken 1.0 ± 1.3 0.2 ± 0.5 Frozen farmed chicken 0.4 ± 0.8 2.8 ± 2.6 Game meat 4.5 ± 2.6 2.6 ± 2.5 Purchased meatsb 4.4 ± 2.4 9.5 ± 3.1 Eggs 2.7 ± 2.1 5.5 ± 3.3 Milk 8.0 ± 5.1 13.4 ± 1.7 Butter 12.0 ± 3.9 13.8 ± 2.0 0.0883 Total 12.2 ± 2.8 12.7 ± 2.9 0.8871 Tomato 11.4 ± 3.6 11.0 ± 4.1 0.7510 Bean 4.2 ± 3.5 8.2 ± 4.2 Collard greens 0.6 ± 1.5 2.9 ± 3.9 Pepper 1.6 ± 3.0 1.3 ± 2.1 0.8613 Cabbage 0.04 ± 0.2 2.0 ± 2.8 Cassava flour 14.7 ± 0.6 14.4 ± 0.7 0.3139 Cassava 0.0 ± 0.0 1.3 ± 3.8 Potato 0.5 ± 1.2 3.0 ± 3.6 Parsley 7.4 ± 5.6 11.1 ± 3.6 Onion 13.3 ± 2.3 13.3 ± 2.0 0.8617 Garlic 2.1 ± 4.3 9.4 ± 3.4 Paprika 0.3 ± 1.3 10.2 ± 3.2 Total 8.9 ± 3.8 11.3 ± 3.9 0.0582 Banana 5.5 ± 4.0 9.2 ± 3.9 0.04 ± 0.2 0.0 ± 0.0 0.3287 Orange 0.5 ± 1.0 3.5 ± 3.6 Guava 1.2 ± 2.3 0.6 ± 1.8 0.1834 Mango 1.8 ± 3.3 0.1 ± 0.6 1.4 ± 2.8 0.4 ± 0.9 0.1330 Watermelon 0.1 ± 0.3 1.8 ± 2.0 Avocado 0.5 ± 1.1 0.4 ± 1.0 0.9492 Pineapple 0.04 ± 0.2 0.5 ± 0.9 Apple 0.3 ± 0.8 0.7 ± 1.0 0.1823 Papaya 0.4 ± 1.3 1.0 ± 1.9 0.2049 Acerola 0.7 ± 1.2 0.04 ± 0.2 Cashew 2.2 ± 3.2 1.4 ± 2.1 0.2243 Grape 0.1 ± 0.6 0.3 ± 0.9 0.4652 Coconut 0.3 ± 0.6 0.1 ± 0.3 0.1159 Coffee 14.3 ± 1.1 13.5 ± 1.9 0.1261 Natural fruit juice 0.7 ± 2.4 2.1 ± 2.8 Processed juice 0.04 ± 0.2 2.7 ± 2.7 Soft drinks 0.1 ± 0.3 1.6 ± 2.1
Bold p-values indicate that there is a statistically significant difference in consumption between the 2 years (p < 0.05)
Overall, families consumed more fruits and vegetables in 2010 than in 1999, especially beans, collard greens and cabbage (p = 0.0009, 0.0395, 0.0010 respectively). Among the tubers and roots documented, only intake of cassava and potatoes increased (p = 0.0180, 0.0056 respectively). While there is no statistical difference for fruit consumption between survey years when they are grouped together, the analysis of individual fruits does highlight important changes. Specifically, the consumption of bananas, oranges, watermelon and pineapple increased significantly (p < 0.05 for each). On the other hand, daily intake of mangos and acerola, two fruits locally harvested, decreased (p = 0.0323, 0.0251 respectively). The main streets of the community are lined with large mango trees, however, in 2010 the trees were pruned to their shaft to facilitate the installation of electrical lines. As such, mangos were scarce in the community in the year of the follow-up survey. Coffee was the most consumed beverage in both years and there was no significant change overtime. In 2010, there was an increase in the consumption of natural juice (p = 0.0281), processed juices (p = 0.0006) as well as soft drinks (p = 0.0046).
In addition to the categories in Table 3, the 2010 survey documented consumption of packaged, canned, and cured foods, including bologna, pepperoni, mayonnaise, sour cream, ketchup, canned tuna, sardines and meats, chili sauce, premade seasoning, Sazom® seasoning, condensed milk, tomato paste, instant noodles, vinegar, baking powder, Neston® instant cereal drink, corn starch, corn-based snack products, artificial sweeteners, soybean oil, salt, sugar, tapioca flour, and pizza. These items highlight the diversity of processed foods that were consumed by members of this riverside community in 2010. The daily recorded rate of intake for these foods was, on average, low in surveys and in some cases, there were no records of these foods in 1999. As such, a comparative analysis of these items was not undertaken.
Since the introduction of processed items into diets, participating families reported lower consumption of certain foods, many of local origin. When asked about their historical dietary practices, participants uniformly stated that the following foods were more common when they were children but are now scarce in the region: coconut oil/milk, lard, corn oil, babaçu nuts/oil, forest fruits, game meat, local free-range chicken, fresh milk. Participants also indicated that some fish species became less abundant in 2010.
When asked about foods that are being consumed more frequently since childhood, participants reported increases in frozen farmed chicken, purchased meats, beef, non-Amazonian fruits (i.e., apples, grapes and pears), powdered milk, canned meat, premade seasoning, soy oil, pasta, cookies/crackers and soft drinks.
Participants consistently noted that the causes of these dietary changes are rooted in the introduction of new income sources, such as the Bolsa Familia, and new employment opportunities on growing, nearby industrial farms or in the lumber industry. They also mentioned improved transportation, greater food access, and the availability of credit plans to purchase foods. Participants also attributed transitions in consumption to land use changes, notably agricultural encroachment on forested areas that decreases the local availability of game meat, as well as overfishing of some species with high commercial values on regional markets.
When informants were asked about the desirability of these dietary changes, 90.1% of families said that the food situation in the community had improved, owing to their increased access to new food items. Only two families felt that the food situation had deteriorated over time, citing the lack of locally produced foods as the cause. In 2010, most participants considered buying food easier than subsistence agriculture and extractivist activities (hunting, fishing and forest gathering), and they valued the higher availability and access to new foods. Nonetheless, many were also aware that environmental degradation has impacted their diets.
Over a ten-year period, food from commercial supply chains became more frequent in household diets in the rural community of Brasilia Legal. Daily consumption of packaged, processed items and foods rich in energy, protein, and sugar significantly increased. At the same time, family meals included fewer traditional, locally harvested foods. These observations parallel trends across Brazil and Latin America of increasing supermarketization and nutrition transitions ongoing since the 1980s [[
During the study period, the Brazilian Amazon became increasingly integrated into the national and global economies. Publicly-funded development and agrarian programs promoted land-use transitions for small-scale farmers as well as private-sector agribusiness and extractivist industries [[
Between the time of the first survey in 1999 and 2010, improvements in transportation and mobility changed food access in Brasília Legal. The paving of the highway BR-163 (Fig. 1) and more regular river transport options have, on the one hand, allowed urban supermarkets to be supplied with more diverse products, while simultaneously providing rural households with access to cities to purchase food items directly. A similar phenomenon has been observed in the Peruvian Amazon, with the paving the Interoceanic Highway, which was associated with a Westernization of the diet in the rural region of Madre de Dios [[
New income sources and employment opportunities that increase household purchasing power are likely to have contributed to the observed changes in diet. With higher per-capita revenue, families are able to buy more varieties of food and consume more food overall [[
Household access to electricity in Brasília Legal over the study period could also explain the significant rise in frozen, industrially farmed meat consumption. While families without electricity must consume foods almost immediately, electricity allows items to be stored for later consumption. In 1999, Brasília Legal was not connected to the public power grid, but when the logging company opened in 2004, several families benefited from the generators offered by the enterprise. It wasn't until September 2010, however, that power lines were installed through the public program Luz para Todos (Light for All), supplying electricity to all families in the community. This study was carried out just after installation, so it is expected that equalized access to electricity will further accentuate food shifts in the community.
The decline of traditional Amazonian foods in family meals may be in part attributed to changing livelihoods and lifestyles as well as deforestation, which has impacted the availability of wild game, fruits and nuts. In Brasília Legal, the land area dedicated to cattle ranching doubled between 2001 and 2009, while the forest area dropped from nearly 80% to under 60% coverage [[
At the time of the second survey, fewer farmers in the community were producing grain and tuber food staples; however, a significant increase in rice and cassava consumption was documented. Supermarkets sell commercial grains, often produced in southern Brazil, at prices that far outcompete local producers, further promoting the shift away from local production and reinforcing a dependence on purchased items in communities. With the added pressures of climate change on land and water resources, smallholders face additional challenges for producing local crops and harvesting traditional foods.
Overfishing, declining water quality and pollution linked to soil erosion and frequent passage of boats, can also affect the availability of aquatic species and, consequently, local fishing yields. Although another study reported a decrease in fish consumption in the same community between 2000 and 2006 [[
The increasing consumption of processed foods, often with low nutritional values, suggests that Brasília Legal is experiencing a nutrition transition [[
An additional health concern is the increase in dietary caloric intake, as more food is being consumed overall and more processed sugars were introduced into diets [[
This study has a number of strengths which are worth underlining. The study reports the data collected in the same families surveyed in 1999 and 2010, providing an opportunity for paired-comparisons to document the changes which occurred within household diets over this period. The team has decades of experience working with this community, which made it possible to create a food diary adapted to the local diet. The mixed-methods approach, by which participant interviews are combined with quantitative data from food diaries, provides an opportunity to develop an in-depth understanding of changes and their underlying drivers. This study also has certain limitations, the main one being that the food diary methodology we used did not collect information about the origin of the specific food items reported being consumed (i.e., produced/harvested by the family or the community, bought at a local business, or bought at an urban supermarket). Another limitation is related to the fact that data was collected at the household level and not the individual level. Food consumption patterns are known to differ according to age and gender [[
Over a period of 10 years, there were significant shifts in household diet in the riverside community of Brasília Legal in the Brazilian Amazon. In addition to higher overall consumption of meat, dairy, and cereals, intake of novel food items increased such as sugar-sweetened processed beverages, non-Amazonian fruit varieties, and frozen, farmed meats that are purchased in supermarkets and often imported from elsewhere in Brazil and South America. At the same time, traditional Amazonian foods became less present in diets, including forest fruits and game meats that are associated with local harvesting practices.
Regional development processes driven by planned government programs and private sector involvement appear to be underlying these dietary shifts. Infrastructural improvements saw the construction of roads, enhanced river transportation, and installation of electrical lines, allowing households to gain access to and store supermarket-bought foods. New employment opportunities and subsidized income programs boosted household wealth and power to purchase such products. At the same time, deforestation and expansion of pasturelands have impacted the availability of forest-derived foods around the community, probably contributing to decreased intake of traditional Amazonian dietary components.
While these dietary changes suggest a nutritional transition, given the lack of biometric data, we cannot conclusively diagnose nutritional status. Furthermore, in the Amazon, there is little data with which to compare our results, raising the need for continuous monitoring of community population health by means of longitudinal studies to complement clinical and epidemiological studies. Nonetheless, this novel study provides empirical confirmation that there have been significant shifts in diet, which may present risks to human health.
Our study also highlights potential trade-offs between development programs and population health. Fostering access to affordable energy, alleviating poverty through direct income subsidies, and promoting agrarian development through land-use change seems to be, at the moment, at odds with the maintenance of traditional, healthy dietary habits. Important work has been done to identify food policy areas that need to be addressed to deal with nutrition transition and supermarketization in Latin America, especially in the context of urbanization [[
Financial support was provided by the Teasdale-Corti Foundation and the International Development Research Center (IDRC) (Grant # 103460–049).
This work was carried out as part of the Poor Land Use, Poor Health (PLUPH) project with support from the Global Health Research Initiative (GHRI), a collaborative research funding partnership of the Canadian Institutes of Health Research, the Canadian International Development Agency, Health Canada, the International Development Research Centre, and the Public Health Agency of Canada. We are grateful to the communities of Brasília Legal (Western Para, Brazil) for their hospitality, participation and collaboration with fieldwork and to Leandra Fatorelli for support on this research. This manuscript is in loving memory of Dr. Robert Davidson, who dedicated his career to community-based research in the Tapajos River region.
JSO contributed to manuscript writing and supported data analysis and interpretation, DPA contributed to the research concept, conducted field work, data analysis and supported writing, CJSP conducted field work, data analysis and contributed to research concept, MF contributed to the research concept and revision of manuscripts, DM contributed to research concept, RD contributed to field work, ML contributed to research concept and manuscript reviewing, CAR contributed to research concept, FM contributed to writing, field work, and data analyses. The author(s) read and approved the final manuscript.
The datasets analyzed during the current study are available from the corresponding author on reasonable request.
All participants signed an informed consent form and no compensation was provided. This research is in accordance with the guidelines established by the Ethics Committee on Human Research of the Faculty of Health Sciences at the University of Brasília as well as the National Commission on Ethics in Human Research (authorization number 095/08).
Written informed consent was obtained from all participants for publication of field data and socio-demographic details of individuals. The consent form is held by the authors/by the authors' institution and is available for review by the Editor-in-Chief.
The authors declare that they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
By Jordan Sky Oestreicher; Deusilene Pereira do Amaral; Carlos José Sousa Passos; Myriam Fillion; Donna Mergler; Robert Davidson; Marc Lucotte; Christina A. Romaña and Frédéric Mertens
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