INTRODUCTION

Fruits and vegetables are an indispensable component of a healthy diet as they provide the main micronutrients, dietary fiber and other essential compounds; there is evidence that daily consumption of fruits and vegetables in adequate amounts is associated with reduced risk of developing various diseases. On the other hand, an increase in fruits and vegetables in the diet contributes to displacing foods rich in saturated fats, trans fats, sugars, or sodia.^1-3

Fruits and vegetables are important sources of vitamins, minerals and carbohydrates, although concentrations of these compounds vary according to the fruit or vegetable consumed. They are also a source of fiber, which includes lignin and non-starchy polysaccharides, as well as active ingredients with antioxidant activity to which are attributed an anti-aging effect and an important role in the prevention of non-communicable diseases (NCDS). Another benefit is the feeling of fullness, which leads to a reduction in total calorie intake and a reduction in the likelihood of developing overweight and obesity.^4-7

Nowadays, fruit and vegetable consumption varies from region to region (depending on the population analyzed) with an estimated 100 g/ day in low-income countries and approximately 450 g/ day in Western Europe. Insufficient intake of fruits and vegetables is responsible for about a fifth of gastrointestinal neoplasms, a third of ischemic heart disease, and a tenth of cerebrovascular disease. In this way, up to 1.7 million people could be saved each year if there were sufficient consumption of fruits and vegetables.¹

Because of their role in preventing NCDS, The World Health Organization and the Food and Agriculture Organization of the United Nations (FAO) launched in 2003 an initiative known as the "global strategy on diet, physical activity and health" which they hoped to promote consumption by increasing fruit and vegetable production.⁶. The main thrust of the initiative was to promote the consumption of at least five servings of these foods per day by the population through the strategy known as "five fruits and vegetables per day."^1,8

University education, while providing professional skills, can lead to changes in students' lifestyles that could affect their diet and nutritional status, which in turn would have repercussions on academic performance. Such modifications may occur due to the demand and competitiveness of university careers, which cause students to devote much time to them, neglecting certain healthy lifestyles that, if not the object of intervention, could remain beyond university life, affecting their risk of developing diseases in the future.^9-12

In the case of the students' diet, one of the aspects that can be affected is the consumption of fruits and vegetables, which according to some studies could reach proportions lower than those reported in the general population. This is more relevant in the case of students of professional careers in health sciences who during their professional practice should promote healthy eating as well as other lifestyles oriented towards disease prevention.^6,10,11

The National University Hermilio Valdizán (UNHEVAL) is a peruvian university located in the city of Huanuco, which is located in the central zone of the Andes at an altitude of 1894 masl. In 2018, the university had 14 faculties and 19 professional careers, the career of human medicine had 376 enrolled students.

This research aims to determine the prevalence and factors associated with low consumption of fruits and vegetables in students of the first and sixth year of the career of human medicine at UNHEVAL during July 2018.

MATERIAL AND METHODS

Descriptive cross-sectional study. The population consisted of all students from the first to the sixth year of studies of the professional career of human medicine of UNHEVAL who were enrolled and studying in July 2018, excluding those who had booked registration, had withdrawn or did not agree to participate voluntarily in the study. No sampling was performed, we worked with the entire population of students of the professional career in human medicine who met the selection criteria for being small and accessible.

Data collection was based on the application of a self-administered questionnaire to students, which provided information on sociodemographic variables, fruit and vegetable consumption variables and possible factors variables associated with the consumption of these:

- Sociodemographic components: age, sex, year of study. - Consumption of fruits and vegetables: consumption of at least 5 portions daily, average number of fruits and vegetables consumed daily. - Factors associated with low consumption of fruits and vegetables: desire to have enough money to buy them, lack of availability of fruits and vegetables on campus, insufficient time to purchase fruits and vegetables, exposure to media messages recommending the consumption of fruits and vegetables.

The questionnaire was applied at the end of a class scheduled after coordination with the delegates of the year of study and course verifying the correct completion of the items prior to receipt. A second date was scheduled for the application of the instrument in order to capture the students who were not present in the first application of the questionnaire. The questionnaire was validated through expert judgment, obtaining the agreement index and undergoing a pilot test to verify the behavior of the instrument in the field as well as the comprehensibility of the items by the students.

With the data collected from each student, we obtained the prevalence of low consumption of fruits and vegetables in the students as well as the factors associated with low consumption.

Data processing was performed using the statistical program SPSS version 23.0 for Windows. Descriptive statistics were performed based on obtaining frequencies, percentages, measures of central tendency (mean, median) and dispersion (standard deviation). For the bivariate analysis we used Pearson's chi-square test and for the multivariate analysis we used a binary logistic regression model obtaining the odds ratio or adjusted odds ratio (ORAJ). Calculations were performed with a 95% confidence level.

The project was approved by the Ethics Committee of the University Research Directorate of UNHEVAL (Resolution N° 0200-2018-UNHEVAL-FM-D). The confidentiality of the information obtained was ensured and ethical principles were respected in accordance with the Declaration of Helsinki. Prior to the application of the questionnaire, each participant signed an informed consent form.

RESULTS

Of a total of 373 students enrolled who agreed to participate in the research, two students in the third year of studies did not complete the questionnaire so that 371 students were available for analysis.

Of the 371 students participating in the research, 52.6% were women and 47.4% were men; In addition, the highest frequency of students was in the third year of studies (28.6%). The average age was 23.8 ± 4.3 years (median 24 years), ranging from 16 to 46 years of age. The general characteristics of the students are shown intable 1.

The main reasons for not consuming fruits and vegetables by the students were the fact that it is rare to get them in college cafeterias (78.7%), insufficient time for selection, purchase and preparation (73.6%) and living with one of the parents who are responsible for feeding the student (55.3%). This is shown intable 3.

Bivariate analysis was performed with Pearson's chi square test and found that insufficient time for the selection, purchase and preparation of fruits and vegetables as well as living with one of the parents were significantly associated with low consumption of fruits and vegetables. Age less than or equal to 20 years, sex, considering that the price of fruits and vegetables is high, studying in the first three years of the professional career, considering that it is rare to get fruits and/or vegetables in college cafeterias and exposure to messages in the media that recommend consuming fruits and vegetables were not significantly associated with low consumption of fruits and vegetables. This is shown intable 4.

Variables that obtained a p≤0.10 were entered into a logistic regression model for multivariate analysis and found that the only factor associated with low fruit and vegetable intake was insufficient time for selection, purchase, and preparation of fruits and vegetables; While, living with one of the parents who are responsible for feeding the student was a protective factor for the low consumption of fruits and vegetables (see table 5).

DISCUSSION

This research shows that a high frequency of the students of the professional career of Human Medicine at UNHEVAL have low consumption of fruits and vegetables; In addition, the only factor associated with low consumption was insufficient time for selection, purchase and preparation of fruits and vegetables; While, living with one of the parents of the student is a protective factor because they are responsible for feeding the student.

Regarding the prevalence of low fruit and vegetable intake, it was observed that overall, six out of ten students had this risk factor; However, the prevalence found is lower than that reported by the National Institute of Statistics and Informatics¹³in the Demographic and Family Health Survey (ENDES 2017) for the general population of Peru aged 15 years or more, where the low consumption of fruits and vegetables reached 89.1%. This indicates that it is possible that the curriculum contents of the medical career have a positive effect on the consumption of a fraction of students, particularly contents oriented towards nutrition and prevention of NCDS. Contrary to expectations, there was no trend in consumption according to years of study.

When assessing the factors associated with low consumption of fruits and vegetables, multivariate analysis identified insufficient time for selection, purchase and preparation of fruits and vegetables as the only factor, this has been linked in other publications to the academic load of the course, represented by class hours and study hours^14-17. This is in line with what was found by Olivares¹⁵in a study conducted with students from the University of Chile, who identified lack of time as the second main barrier to adequate fruit and vegetable consumption. Unlike the students of the University of Chile, the lack of time for the selection, purchase and preparation of fruits and vegetables in the students of National University Hermilio Valdizán was significantly higher (63.0% versus 33.4%), which could be explained by the high demand of the medical career in comparison with the other professional careers that comprised the sample of the Olivares study, which included non-medical health careers. As well as careers in social sciences and exact sciences

The only protective factor identified by this research was the fact that the student lived with one of his parents because they were responsible for feeding. This would be explained by what has been established by some publications that consider that the family would influence the way students eat, being positive the teaching given by their parents, favoring a healthy diet by acquiring foods with these characteristics^17-19. This is in line with what was reported by Papadaki and col.¹⁸who found in a sample of university students in Greece that students living outside the home had developed more unfavorable eating habits than those living in the family home with one of their parents, indicating that moving away from the family home and taking responsibility for preparing and purchasing food affected the eating habits of students.

The study carried out with students of the UNHEVAL has identified the factors associated with low consumption of fruits and vegetables in students, which is the first step in the design of an educational intervention specifically aimed at students that allows the improvement of food by students as well as intervention on unhealthy lifestyles. Such an intervention should consider promoting the sale of fruits and vegetables by university food suppliers which would have a positive effect on NCD prevention and habits of future health professionals. While it is true that the results obtained can be extrapolated from the statistical point of view only to students of the faculty of human medicine of UNHEVAL, it is possible that the reality of the students is similar in other universities so the results obtained could contribute with other universities to the design of future preventive interventions.

A limitation of the present research is that it did not address differences in fruit and vegetable intake according to students' socioeconomic status, unlike other researchs²⁰. However, it is possible that this has not significantly affected the results obtained due to the fact that the perception of the price of fruits and vegetables by the students was considered within the factors under study, which in turn would influence their consumption

Another limitation is the number of students participating in the study. Thus, the estimate of prevalence according to years of study is in some cases affected by the low number of students which is reflected in the confidence intervals of the estimates which are extended for students in the fifth and sixth year. This is not the case for the overall estimate for students in the first to sixth year where the number of students does not significantly affect the low consumption estimate. It should be taken into account that the research considered almost all enrolled students so there was no significant loss of students and that these are the limitations of working with preformed groups.

CONCLUSION

The prevalence of low consumption of fruits and vegetables in students of the professional career of human medicine of the National University Hermilio Valdizán was 60.1%. Insufficient time for selection, purchase and preparation of fruits and vegetables is a factor associated with low consumption; while, living with one of the parents is a protective factor.