Sumy State University, Sumy, Ukraine
Abstract. The analysis of nutrition of the population of Ukraine for the period from 1990 to 2017 is presented, as well as the nutritional composition of the minimal set of food products (food consumer basket) for persons belonging to the main social and demographic groups has been characterised. Study of nutrition of the population was based on the method of balance calculations. The peculiarities of nutrition of the population of Ukraine, as well as positive and negative trends of changes in nutrition were determined.
Key words: Ukraine, nutrition of population, alimentary-dependent condition, food consumer basket, food products, alimentary substances.
Introduction. Nutrition, based on the biological laws of nature, is an important factor in maintaining individual and population health. Violation of the fundamental principles of nutrition inevitably leads to diseases, disability, decreased life expectancy and even fatal outcomes. According to the WHO European Regional Bureau, about 80 % of all diseases are somehow related to nutrition, and for 41 % of them, nutrition is a leading risk factor [10]. Among these diseases are circulatory diseases and neoplasms, which are extremely common in Ukraine. According to official statistics, every 23rd resident of the country suffers from circulatory diseases, and every 46th Ukrainian is on a dispensary registry due to oncological conditions.
Diseases associated with alimentary risk factors cause significant economic losses to the state. For example, annual economic losses only due to temporary incapacity, disability and premature death from circulatory diseases in Ukraine exceed UAH 2 billion [6]. In Germany, the value of additional annual economic costs that only relate to the diagnostics, treatment and rehabilitation of patients with alimentary-dependent conditions, is 30 % of the total cost for healthcare system, in the USA, this figure is USD 137 billion [3], in the UK — tens of millions of pounds sterling [12]. In these conditions, the interest in studying the nutrition of the population of Ukraine seems quite natural.
Study objective was to analyse the nutritional peculiarities of the population of Ukraine during the period from 1990 to 2017 and the nutritional composition of the food consumer basket of Ukrainians, to establish the degree of compliance of the level and nature of nutrition with the physiological needs over time for 27 years, to find out the peculiarities of nutrition of the population of Ukraine in modern conditions.
Materials and methods. Nutrition of the population was studied using the balance method, which is to study the intake of food products on average per capita over time over the years. Data on the intake of food and alimentary substances were obtained from the statistical yearbooks of the State Statistics Committee of Ukraine “Balance and intake of food products by the population of Ukraine” during 1990–2016. The daily food intake and consumption of nutrients with food were calculated on a daily basis.
The composition of the food consumer basket of the Ukrainian population was studied according to Decree of the Cabinet of Ministers of Ukraine as of October 11, 2016 No. 780 “On approval of the sets of food products, sets of non-food products and sets of services for major social and demographic groups of population”. The daily food consumer basket was calculated per person, and using standard tables of the chemical composition of food products — their nutritional composition was calculated.
The data obtained during the study were compared with scientifically justified physiological standards of nutrition adopted by the WHO, national consumption standards and European Directives in the field of healthy nutrition (Table 1).
Table 1. Rate of daily intake of food products.
1) Threshold values set in the Law of Ukraine “On Food Security of Ukraine” approved by the Verkhovna Rada of Ukraine at the end of 2011, however rejected under the initiative of the President of Ukraine on July 05, 2012. Rejection of the Law is justified by the range of reasons, including incomplete clearness of the composition of products that should be included in the consumer basket.
2) As per food package set by Decree of the Cabinet of Ministers of Ukraine as of April 14, 2000 No. 656.
3) As per food package set by Decree of the Cabinet of Ministers of Ukraine as of October 11, 2016 No. 780.
4) World Health Organization (2000) CINDI Dietary Guide. World Health Organization, Geneva, Switzerland. http:// www.euro.who.int/document/e70041.pdf (accessed August 2013).
5) Also considering sugar containing in confectionery.
6) Parameter, we have been calculated considering WHO guides
The correspondence of the food and nutritional composition of the food consumer basket with the physiological needs of a person was determined. Differences in the nutrition of the population of Ukraine and other countries were established by their comparison with the best demographic parameters. Information on food intake in other countries during 2000–2013 was obtained from the official website of the Food and Agriculture Organization of the UNO (FAO) [11]. To determine the intake of omega-6 and omega-3 polyunsaturated fatty acids (hereinafter referred to as omega-6 and omega-3 PUFA), information on the content of these nutrients in food products from the e-guide of the US Department of Agriculture was used [14]. To determine the levels of consumption of trans-fats by the population of Ukraine, data from the official website of the State Statistics of Ukraine on the consumption of margarines, spreads, confectionery products were used, and data on the content of trans-fats in these products were obtained from the open electronic resource of the Scientific and Research Centre for Independent Consumer Expert Evaluations “TEST” [7].
Results and discussion. In the 90s of the previous century, the average daily diet of Ukrainians was significantly higher in the content of energy and plastic products compared with nowadays. An average Ukrainian daily consumed about 730 g of cereals and potatoes, 200 g of meat and fish, more than 1 litre of milk and dairy products (as milk), 1 egg and 30 g of vegetable oil. The daily intake of vegetables and fruit (regular value products) amounted to 410 g/daily in those years, which slightly exceeded the minimal threshold of this parameter recommended by WHO, and, at the same time, it was significantly higher than in most European countries. For example, the average intake of vegetables and fruit in Germany, Denmark, the Netherlands, Czech Republic, UK in this period was less than 300 g per day [1]. The energy value of the averaged diet of Ukrainians at the end of the 20th century was 3,597 kcal per day that corresponded to the energy needs of the 4th class of labour (hard labour) according to the modern classification. However, social and economic transformations that arose in subsequent years, first of all, the unprecedented pace of urbanization, economic crises and military conflicts have led to a change in the way of life of Ukrainians, deterioration of their material condition and the availability of certain types of food. This significantly influenced the quantitative and qualitative characteristics of the population. As of 2016, intake of meat has decreased by 25 %, bread and cereal products — by 24 %, milk — by 44 %, sugar — by 28.5 %, while the intake of vegetables has increased by 28 % (Table 2).
At the background of quantitative changes in the Ukrainian food basket by almost a quarter (by 855 kcal), the caloric value of the daily diet reduced, now it is at the level of the energy needs of the population of the 2nd class of labour — 2,742 kcal/daily. The minimal value of this parameter was registered in 2000 — 2,661 kcal/daily. Data on caloric intake obtained using the balance method, fully correspond to the results of another domestic study of nutrition of the population, conducted using the questionnaire method [4].
Table 2. Changes in food product intake over time during 1990–2016, in g of edible portion.
It should be noted that the European average daily value of a diet is much higher — it is 3,301.6 kcal/daily, however the decrease in the caloric value of the daily diet in Ukraine does not seem to be critical to us, as it happened in parallel with changes in the structure of economic employment of the population: during 1990–2016, the number of workers engaged in heavy labour (in industry, agriculture and building) decreased from 60.2 % to 36.8 % [2].
As a result of changes in the product set, the nutritional composition of the diet also changed. The number of proteins in it decreased by 20 % — from 105 g per day in 1990 to 84 g per day in 2016, however their energy quota of daily caloric value of food throughout the period varied within 11.2 % to 12.6 % and did not exceed the known optimal values for a balanced diet (Table 3). However, a more detailed analysis has shown that during 1995–2005, Ukrainians suffered from deficiencies in animal proteins — sources of essential amino acids and easily digestible iron.
Table 3. Characteristics of nutrient composition of average daily diet in Ukrainians during 1990–2016.
1), 2) As per own studies
For better information perceiving, parameters deviating from reference and recommended values are in bold in this and further tables
This could not help but affect the health of the country’s population - it was during these years that there was a sharp deterioration in population health and the growth of a number of diseases, in particular cardiovascular, neurological, oncological, for which nutrition is a significant risk factor. It is known, for example, that the lack of animal protein in nutrition and, as a result, some essential amino acids, namely methionine, tryptophan and valine, can adversely affect the biosynthesis of haemoglobin and lead to the development of hypoxic states and related disorders of the functioning of the nervous and cardiovascular systems [5]. It has also been shown that deficiency of proteins in the diet leads to an increase in the absorption of xenobiotics and weakens body immunobiological reactivity.
Some positive changes occurred in the intake of fat by the population. At the end of the 20th century, their energy share in Ukrainian food was too high — it was almost 38 % of the number of calories consumed per day. This was due to the high content of saturated fats of animal origin in food. The decline in livestock production in the period of the economic crisis in the country has led to a significant reduction in the intake of pork, beef and milk by the population, and the amount of fats in the daily diet has decreased by more than one third — from 146.1 g to 92 g per day, and their share in a daily caloric value has reached almost optimal values. Since 2000, the contribution of saturated fats to the daily caloric value of the diet has decreased to 8.16–10.8 %, upon the recommended value — up to 10 %. At the same time, the energy share of polyunsaturated fats has always been high — it was within 10.5–14.6 % of the daily calorie intake, upon the recommended value of this parameter from 6 to 10 %.
Polyunsaturated fats are not synthesised in the human body and therefore should come from food. In their structure, omega-6 and omega-3 fatty acids (hereinafter omega-6 PUFA and omega-3 PUFA) are presented. It is known that they are not interchangeable, differ in function and metabolism, and often have opposite physiological effects, and therefore their balance in the body is extremely important. There is an evidence [16] that the evolution of mankind took place in conditions that ensure consumption of these fatty acids in a ratio of 1:1. However, the agricultural revolution of the 19th–20th centuries and the development of agribusiness led to a change in the proportion of omega-6 and omega-3 PUFA in food, with the tendency towards a decrease of the latter 1:1. Currently, in the majority of western diets, the ratio of these fatty acids is 15:1–20:1 [17, 18]. The study of the structure of polyunsaturated fatty acids in the diet of Ukrainians revealed even more significant imbalance of these nutrients — the ratio of omega-6 to omega-3 PUFA over the last 27 years ranged from 77:1 to 91:1 with some increase starting in 2000 (Table 4). Meanwhile, the scientifically justified value of this parameter is only 1:1–5:1. It is believed that its increase can initiate the pathogenesis of many chronic diseases, including cardiovascular, oncological, inflammatory and autoimmune [16, 8]. The main reason for the significant imbalance of omega-6 and omega-3 PUFA in Ukrainian diet is a significant shortage of dietary sources of omega-3 PUFA — the daily rate of intake of these fatty acids is 2–3 g/daily, however, their actual intake according to our study, is at least 4.5–5-fold lower. Plant sources of omega-3 PUFA intake — soybean, rape, linseed, olive and rapeseed oil — are not very popular in Ukraine. The main source of consumption of these fatty acids in our country is fatty sea fish, primarily herring and mackerel, however their consumption in our country over the last three decades was too small — only 2.5–10 g/daily on average per 1 person, this is much less than in the countries with better population health parameters: 8–10-fold lower than in the EU countries, and 18-fold lower than in Japan.
Table 4. Intake of ω-6 and ω-3 PUFA and their ratio in a nutrition of the population of Ukraine over time during 1990–2015.
The dangerous component of alimentary fats is trans-isomers of fatty acids or so-called trans-fats. High levels of cardiovascular mortality are associated with their dietary abundance. A small amount of trans-fats are always present in natural food products of animal origin — milk and meat, where they are formed as a result of the functioning of bacteria of the multi-chamber stomach of ruminants. Trans fatty acids are well preserved in meat and dairy products, however their natural amount, as a rule, does not exceed 5–8 %. Industrial trans-fats that are formed during hydrogenation (margarine production) and deodorisation of vegetable oils, as well as the food products containing them, first of all, confectionery products, are of a food hazard. However, the content of trans fats in Ukraine is not standardised in all products, the ratio is included only in standards for margarine and spreads, they should contain no more than 8 % trans-fats. According to the Scientific and Research Centre for Independent Consumer Expert Evaluation “TEST”, the average content of trans-fats in margarine was 6.56 ± 0.89 g/100 g, meanwhile, in confectionery, it was much higher — 28.4 ± 5.09 g/100 g.
Our analysis showed that in 2012–2017, Ukrainians consumed an average of 11.5–13.3 g/daily of margarine and 12.0–47.5 g/daily of confectionery products, rates of the daily intake of trans-fats only in composition of these products were 14.1–3.4 g per person and their energy share in total caloric value of diet was in the range of 4.4–1.9 % (Table 5). It should be noted that these data are far from complete because of the lack of information on the trans-fats intake of other foods (cheese, butter, mayonnaise, etc.). In this regard, the actual levels of trans-fat consumption are much higher.
Table 5. The rate of intake of trans-fats by the population of Ukraine during 2012–2017 per 1 person.
Interestingly that since 2015 in Ukraine, there has been a tendency toward the reduction of the population’s demand for confectionery, which is more likely to have a positive impact on public health, as it promotes a reduction in the consumption of not only trans-fats but also simple carbohydrates. However, this favourable trend is countered by the active aspirations of economists and producers to fill the domestic confectionery market, which, in their opinion, is far from its saturation [1].
It should be noted that due to the worldwide accumulation of data on the negative effects of trans-fats on human health, the WHO initially recommended restricting the consumption of partially hydrogenated fats and oils that are sources of trans-fats up to 1 % of energy values of a diet, and in 2009, called on countries to complete elimination of industrial sources of trans-fats from nutrition [13]. In January 2004, Denmark became the first country in the world to legislate the content of artificial trans-fats in foods. State measures of this country managed to virtually eliminate the content of artificial trans-fats in food, as a result, in the next three years, circulatory mortality decreased by 14.5 per 100 thousand population [15], and in 2012, this parameter was over 31 %.
Regarding carbohydrates, their amount in a daily diet of Ukrainians for three decades has decreased by only 15 % — from 439 g/daily in 1990 to 372 g/daily in 2015, however, significant changes have affected the ways and sources of their entry into the body. In 1990, cereals and potatoes were the main products supplying carbohydrates to the body, their daily consumption by the population of Ukraine was 372 g/daily and 358 g/daily, respectively. Consumption of other sources of carbohydrates — fruits and vegetables — was at the level of 280 g/daily and 130 g/daily, respectively. The amount of sugar in the daily diet was very significant and reached 140 g/daily. In 2015, the situation has changed: intake of grain products decreased by 25 %, sugar — by 35 %, and the number of vegetables in the diet, on the contrary, increased by 60 %. Such changes, on the one hand, led to an increase in the consumption of simple carbohydrates and fibre, as well as potassium, ascorbic acid and beta-carotene, which are contained in large amounts in vegetables, and, on the other hand, led to a decrease in the intake of starch, tocopherol, thiamine, nicotinic acid with food, which are presented in higher amounts in cereal products. The daily intake of fruits for almost 27 years did not change, and now it accounts for 136 g against 130 g in 1990, but these levels are much lower than optimal quantities: According to WHO recommendations for daily energy consumption over 2,800 kcal, daily intake of at least 400 g of fruits is optimal, in the case of lower energy consumption, at the level of 2,200–2,800 kcal, the optimum amount of fruits consumption is 300 g/daily.
Particular attention should be paid to intake of added sugar (granulated sugar), which is a source of “empty” calories: its daily intake for almost three decades has decreased from 140 g to 91 g, and the energy quota in the total caloric value of the diet has decreased from 15 % to 13.6 %. However, even such amount of its consumption should be considered too high. Due to the fact that added sugar is considered an important risk factor for the development of many diseases, including obesity, caries, diabetes, the WHO recommends daily intake in amounts not exceeding 5–10 % of daily energy consumption [9], which taking into account the average energy consumption of Ukrainians is about 34–67 g/daily. It should be noted that according to the FAO, the consumption of added sugar in Ukraine is much higher than in developed countries: 70 % higher than in Japan, 25 % — than in Italy and Norway, 13 % higher than in France and Germany.
Certain changes are observed in the consumption of vitamins and minerals by the Ukrainian population. Due to reduced intake of milk and meat, calcium content in Ukrainian diet decreased from 1,362 g/daily in 1990 to 901 g in 2016, and iron content — from 25 g/daily in 1990 to 20.1 g/daily in 2015, but these levels do not exceed scientifically-based daily needs. Reduced intake of retinol, thiamine, riboflavin, niacin by the population due to the reduction in the intake of beef and cereal products is also not critical (Table 6).
Table 6. Intake of mineral substances and vitamins in Ukraine over time during 1990–2016, g/daily.
1) World Health Organization (2000) CINDI Dietary Guide. World Health Organization, Geneva, Switzerland. http:// www.euro.who.int/document/e70041.pdf (accessed August 2013).
2) Scientific Committee of Food,1993
One of the mechanisms for regulating nutrition policy in Ukraine is the development of a minimal set of food products (food consumer basket) for persons belonging to the main social and demographic groups. This minimal set of food products, in accordance with current legislation, should ensure normal body functioning and maintenance of the population health. The volume of the set of products determines the volume of the subsistence minimum of the resident, and therefore is a health forming factor that becomes of particular importance in current conditions of serious deterioration of population health. The food consumer basket is approved by the Cabinet of Ministers of Ukraine and reviewed every 5 years. As shown by the results of the study of the nutritional composition of the minimal set of products of Ukrainians (Table 7), its caloric value is 2,724 kcal/daily, and the ratio of proteins, fats and carbohydrates in it, in general, corresponds to well-known principles of rational nutrition.
Table 7. Nutritional characteristics of minimal daily set of food products in Ukrainians (food consumer basket).
The food consumer basket contains almost enough animal (full-rate) proteins — 48 % from the total proteins. The ratio of omega-6 PUFA to omega-3 PUFA in the minimal daily set of products is traditionally high — 59:1. The amount of trans-fats is at least 10.46 g/daily, and their contribution to the total caloric value of the basket products is 3.6 %. The relative share of simple carbohydrates is 43 % (149 g/daily) of the total carbohydrates in the set of products that is 2-fold higher than the optimal rate of intake. At least 60 % (89 g/daily) of simple carbohydrates in the composition of set of products of consumer basket includes refined carbohydrates of confectionery products (at least 23 g — hidden carbohydrates) and granulated sugar (66 g), which exceeds the scientifically justified level of intake of added sugar almost by 33 %. The food consumer basket contains 301 g/daily of vegetables (except for potatoes) and 164 g/daily of fruits and berries — in the amount of 465 g/daily. This is higher than the minimum threshold set by the WHO (400 g/daily, however, less than the optimal daily amount in a diet under its caloric value.
Attention is drawn to the fact that the nutritional composition of the food consumer basket is characterised by the same peculiarities as for the average daily diet of actual nutrition. It seems that this is due to the fact that the composition of the consumer basket is based on the population demand for food, and not on the basis of a scientifically justified set of products.
Conclusion. Changes in the nutrition of the population of Ukraine over time during 1990–2017 has both positive and negative features. Favourable trends are the decrease in the intake of fats to their optimal levels in comparison with 1990, including saturated ones, as well as an increase in animal proteins in the diet to their optimal levels in comparison with 1995–2005. Negative nutrition parameters are too high levels of intake of added sugar and trans-fats, a significant imbalance of omega-6 and omega-3 PUFA, as well as a deficit in fruits intake.
The nutritive composition of the food consumer basket approved by the Cabinet of Ministers of Ukraine generally retains the peculiarities that we have established in the analysis of actual nutrition suggesting the absence of a scientifically justified policy for state regulation in the field of healthy nutrition in Ukraine.
Further studies will be aimed at establishing the most effective nutrition change scenarios to improve population health.
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