Edited by: Gioconda San-Blas, Academia de Ciencias Físicas, Matemáticas y Naturales de Venezuela (ACFIMAN)/Instituto Venezolano de Investigaciones Científicas, Venezuela
Reviewed by: Annemie Geeraerd, KU Leuven, Belgium; Andrew Robert Gray, University of Otago, New Zealand
This article was submitted to Agro-Food Safety, a section of the journal Frontiers in Sustainable Food Systems
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
Venezuela is currently in a difficult social, political, and economic situation that has exposed people to many factors, including socioeconomic disadvantages, food insecurity, and lack of access to healthy and nutritious foods. These factors are associated with low dietary diversity, especially for economically dependent university students. In this study, we aimed to identify the associations between socioeconomic status, food security, and dietary diversity among sociology students at the Central University of Venezuela (UCV). This cross-sectional study was conducted between June and November 2016 on a simple random sample of 270 students. Indicators were calculated using data collected by the Mendez-Castellano socioeconomic questionnaire, the Community Childhood Hunger Identification Projects Scale of Food Security adapted and validated for Venezuelans (Cronbach's alpha = 0.898), and the validated dietary diversity scale for individuals. The rate response was 100%. It was observed that most of the sample is located between the socioeconomic status of the rich and middle class (82.6%), presents some degree of food insecurity (85.9%), and maintains a diet with low dietary diversity (54.8%). Our main finding is that the socioeconomic status in the households of those students is not associated with either their food security level or their dietary diversity, but these constructs are related in a significant statistical way. In particular, the odds of a student household having a diverse diet instead of a monotonous diet are 3.92 (95% CI: 2.91; 4.93) times greater for those in food security instead of moderate/severe food insecurity. It is concluded that these students have a multifactorial critical food situation, in which the food right is violated, which could affect their permanence and academic performance.
Food security (FS) is a construct defined by the Food and Agriculture Organization of the United Nations as “the situation when all people, at all times, have physical, social and economic access to sufficient, safe and nutritious food that meets their dietary needs and food preference for an active and healthy life” (FAO,
In light of the last 8-year events in Venezuela such as massive protests, unemployment, poverty, low wages, hunger, and malnutrition (Doocy et al.,
In this food crisis, the need for food competes with other necessities such as health services, transportation, housing, etc. (Tapia et al.,
A food-insecure household often decreases the quality and quantity of food, which directly affects nutrient adequacy (Lorenzana and Mercado,
DD has been identified as a key predictable element of high-quality diets in terms of nutrient adequacy globally, and it probably reflects the economic accessibility of different food items (Wanyama et al.,
DD is positively linked with FS and socioeconomic status, and it is much easier and cheaper to use than traditional food security measures (FAO,
For university students, food choice and food consumption are determined by taste, health, and economic reasons (Ukegbu et al.,
While the association between sociodemographic factors and dietary practices has been established in different settings (Hoddinott and Yohannes,
This is a cross-sectional study among a representative sample of university students at the Sociology School of the Central University of Venezuela. It was decided to use only one school because of certain difficulties and logistics due to the students' protests around the country and limited financial resources for research at the university. The study took place in the first academic semester of the year 2016 when there was a total of 905 students registered from the first semester until the tenth semester of sociology. Because we have no information on the proportion of university students in food insecurity or low DD, we initially assumed that 50% of the households have these conditions to estimate the sample size. Considering this assumption, a 95% confidence level, and a 5% margin of error to estimate the proportion of students in food insecurity and/or low DD, the required minimum sample size was 270 students (with finite population correction). Students were randomly selected from a sample frame of student IDs. In total, 270 students answered the interview-based questionnaires, so the response rate was 100%. The data collection was performed from September 19, 2016 to November 25, 2016.
All students gave written consent to participate. The study was conducted according to the Declaration of Helsinki guidelines and ethical guidelines for research and approved by the Institutional Ethical Committed under the number 1204-16 protocol. Data were collected by trained enumerators in face-to-face interviews, using a pre-established questionnaire. The survey consisted of four modules: 1—items regarding students' identification, 2—a socioeconomic status section, 3—a food security module, and 4—a dietary diversity section. Each part is described below.
The construct socioeconomic status (SES) was measured by using the Mendez-Castellano and Mendez (
Household food security, in the last 6 months, was determined using the Community Childhood Hunger Identification Projects Scale of Food Security adapted and validated for Venezuelans by Lorenzana and Sanjur (
The scale has 12 questions related to worry about lack of food, insufficient quality and quantity meals, and going to sleep hungry, both in adults and children of the household. For each item, the respondent may select a frequency of the experience (never, rarely, sometimes, or always). The maximum score possible is 36, which would represent the highest level of food insecurity. Therefore, if a household has zero points, it indicates food security; if it has between 1 and 12 points, there is low insecurity; from 13 to 24 points, it has moderate insecurity; and, based on this score, the home is considered severely insecure if it gets more than 24 points. We denote the numerical indicator of FS by FS# and the categorized version by FS4.
DD was measured using a single 24-h recall of the student, using only unquantified data. A licensed nutritionist and dietitian administered the qualitative 24-h recall. All recalls reported 54 food types that were categorized into nine different standardized food groups: (1) cereal-based and tubers; (2) dark green leafy vegetables; (3) vitamin A-rich fruits and vegetables; (4) other fruits and vegetables; (5) organ meat; (6) fleshy meat and fish; (7); eggs; (8) legumes, nuts, and seeds; and (9) milk and dairy products, according to FAO's guidelines (FAO,
The nine food groups were dichotomized. A score of one (1) was given to each food group consumed and zero (0) when certain that no foods in that group were eaten in a single day. Dietary diversity score was calculated, for each person, by the summation of the number of times different food items under each food group was eaten on a day. There are no established cutoff points in terms of the number of food groups to indicate adequate or inadequate dietary diversity. However, we establish three categories, considering that the maximum is a score of 9. The student had low DD if three or fewer groups were eaten on the addressed day, four and five food groups as medium DD, and six or more food groups indicated high DD. The numerical indicator of DD is denoted by DD# and the categorized version of the variable by DD3.
The approach we used was descriptive and exploratory. Instead of assuming the existence of a possible causal relationship between the constructs considered (SES, FS, and DD), we aimed to find a possible multivariate interdependency among them in the particular context of a sample of Venezuelan university students.
Descriptive characteristics of the categorical versions of SES, FS, and DD were assessed by percentage distribution to highlight the important differences across all household characteristics. We also summarized the joint distribution of counts of the categorical versions in a three-way contingency table.
To establish how the categorized version of three variables SES#, FS#, and DD# are related, we performed an analysis using log-linear modeling to determine the significant associations between variables (Agresti,
We can see that the natural log of the ijk cell count is explained by the main effects of variables
which says that the ijk cell count is explained by the three main effects of variables
Since we did not assume any directional associations among the variables, we did not assign the role of explained or explicative variables to the categorized version of SES#, FS#, and DD#. We fitted the eight possible log-linear reduced versions of the model with all main effects and interaction terms necessary to produce a good fit for the three-way table of counts. To select the model that best fits the data, we used three criteria: (1) acceptance of the null hypothesis that the model explains as well as the saturated model of the table's counts using a likelihood ratio goodness-of-fit chi-squares test, (2) parsimony, and (3) the smallest value of the Bayesian information criterion (BIC). The same model was obtained using conditional tests of log-linear models embedded in hierarchical chains. We did all statistical analyses using the SPSS® software (version 21.0). Results were considered significant at the 0.05 level.
The mean (±SD) age of the participants was 21.6 ± 3.2 years, and 66.3% were female.
Socioeconomic characteristics of students' households in Caracas, 2016.
Sex | Female | 179 | 66.3 |
Male | 91 | 33.7 | |
Occupation of the head of the family | University profession | 109 | 40.4 |
Higher technical profession | 52 | 19.3 | |
Employees without profession | 72 | 26.7 | |
Specialized workers | 30 | 11.1 | |
Unskilled | 7 | 2.6 | |
Mother's educational level | University and workers above | 129 | 47.8 |
Complete secondary education | 83 | 30.7 | |
Incomplete secondary education | 47 | 17.4 | |
Complete primary education | 11 | 4.1 | |
Income source | Fortune | 1 | 0.4 |
Freelance fees | 57 | 21.1 | |
Monthly salary | 176 | 65.2 | |
Weekly salary | 33 | 12.2 | |
Donations | 3 | 1.1 | |
Accommodation conditions | Luxury home | 7 | 2.6 |
Housing in optimal conditions | 118 | 43.7 | |
Housing in good condition | 133 | 49.3 | |
Housing with some deficiencies | 12 | 4.4 | |
Strata | I | 20 | 7.4 |
II | 122 | 45.2 | |
III | 101 | 37.4 | |
IV | 27 | 10 | |
Levels | Secure | 38 | 14.1 |
Low insecurity | 200 | 74.1 | |
Moderate insecurity | 29 | 10.7 | |
Severe insecurity | 3 | 1.1 | |
Levels | High | 4 | 1.5 |
Middle | 118 | 43.7 | |
Low | 148 | 54.8 |
About 22.2% of students come from outside Caracas, 18.9% do not live with their family, and only 7% were heads of the family. Most households have three or four members (54.4%), followed by 32.3% with five or more members.
Of sociology students, 85.9% were categorized as food insecure. The mean (±SD) DD# score was 3.5 ± 0.9, and 54.8% of students had low DD (
As shown in
Frequency of occurrence on indicators of the Venezuelan Food Security Scale of student's households in Caracas, 2016.
Lack of money at home to buy food | 88 (32.6) | 137 (50.7) | 36 (13.3) | 9 (3.3) |
The number of meals for an adult decreases due to a lack of money to buy food | 135 (50.0) | 103 (38.1) | 27 (10) | 5 (1.9) |
The number of usual meals at home decreases due to lack of money to buy food | 112 (41.5) | 123 (45.6) | 25 (9.3) | 10 (3.7) |
Some adults eat less at the main meal because food is not enough for everyone | 124 (45.9) | 103 (38.1) | 35 (13.0) | 8 (3.0) |
Some members of the household eat less than they want due to lack of money in the household | 92 (34.1) | 117 (43.3) | 42 (15.6) | 19 (7.0) |
Less essential food for children is bought because the money is not enough | 220 (81.5) | 20 (7.4) | 22 (8.1) | 8 (3.0) |
A child goes to bed hungry because they can't afford food | 259 (95.9) | 9 (3.3) | 2 (0.7) | 0 (0.0) |
Decreases the number of meals per child due to lack of money to buy food | 250 (92.6) | 19 (7.0) | 0 (0.0) | 1 (0.4) |
Some children eat less at the main meal because the foods are not enough for everyone | 246 (91.1) | 21 (7.8) | 3 (1.1) | 0 (0.0) |
A child complains of hunger due to a lack of food at home | 247 (91.5) | 14 (5.2) | 6 (2.2) | 3 (1.1) |
An adult goes to bed hungry because they can't afford food | 167 (61.9) | 75 (27.8) | 21 (7.8) | 7 (2.6) |
An adult complains of hunger due to a lack of food at home | 130 (48.1) | 85 (31.5) | 40 (14.8) | 15 (5.6) |
The proportion of consumed foods groups in the past 24 h in sociology students of Caracas, 2016.
Distribution of dietary diversity score (DDS) among sociology students of Caracas, 2016.
Cross classification of FS3, DD2, and SES4.
Strata I | High–middle | 4 | 3 | 1 | 8 |
Low | 4 | 8 | 0 | 12 | |
Strata II | High–middle | 12 | 41 | 5 | 58 |
Low | 5 | 49 | 10 | 64 | |
Strata III | High–middle | 5 | 36 | 3 | 44 |
Low | 4 | 44 | 9 | 57 | |
Strata IV | High–middle | 2 | 10 | 0 | 12 |
Low | 2 | 9 | 4 | 15 | |
Total | 38 | 200 | 32 | 270 |
The relationship between SES4, FS3, and DD2 was analyzed by obtaining the best log-linear model, which fits the three-way contingency table as shown in
Log-linear models adjusted to explain the relationship structure among SES4, FS3, and DD2.
1 | [SES4] [FS3] [DD2] | 17 | 27.53 | 0.051 | 0.00 | −13.81 |
2 | [SES4] [FS3•DD2] | 15 | 19.99 | 0.172 | 0.27 | −16.47 |
3 | [FS3] [SES4•DD2] | 14 | 26.92 | 0.020 | 0.02 | −7.12 |
4 | [DD2] [SES4•FS3] | 11 | 16.27 | 0.131 | 0.41 | −10.48 |
5 | [SES4•DD2] [FS3•DD2] | 12 | 19.39 | 0.079 | 0.30 | −9.78 |
6 | [SES4•FS3] [FS3•DD2] | 9 | 8.74 | 0.462 | 0.68 | −13.14 |
7 | [SES4•FS3] [SES4•DD2] | 8 | 15.66 | 0.047 | 0.43 | −3.79 |
8 | [SES4•FS3][SES4•DD2][FS3•DD2] | 6 | 7.47 | 0.279 | 0.73 | −7.12 |
Furthermore, the model selected has the smallest value of BIC (Bayesian information criterion). Also, it has fewer terms and can be easily interpretable.
According to
Student's distribution between FS3 and DD2 categories.
Food security (FS3) | Secure | 23 | 15 | 38 | |
% | 60.5 | 39.5 | 100 | ||
Low insecurity | 90 | 110 | 200 | ||
% | 45.0 | 55.0 | 100 | ||
Moderate–severe insecurity | 9 | 23 | 32 | ||
% | 28.1 | 71.9 | 100 | ||
Total | 122 | 148 | 270 | ||
% | 100 | 100 | 100 |
Similarly, the odds of a student having a diverse diet instead of a monotone diet is 3.92 (95% CI: 2.91; 4.93) times greater for those who are in food security instead of moderate/severe food insecurity. Furthermore, the odds of a student household being in low security instead of moderate/severe insecurity when the household has a diverse diet are 2.09 (95% CI: 1.27; 2.91) times greater for those who have a diverse diet than for those who have a monotonous diet.
The present study was designed to examine associations among socioeconomic status, household food security, and dietary diversity among a sample of university students in Caracas, Venezuela. Most of the sociology students of the UCV were strata II and III in the categorized version of SES, in some categories of food insecurity and low DD. Notably, we found an association between FS3 and DD2. These findings may help us understand the complex interaction among these factors in university students. It represents a start for other important questions related to the consequences of these conditions over academic performance.
This study supports evidence from other observations about SES in Venezuelan university students. Ledezma et al. (
Instability in acquiring food necessary for daily consumption is reflected in 85.9% of students' households with food insecurity. In Venezuela, there are very few studies that evaluated the food insecurity status among university students. Hernández et al. (
The DD construct is hardly evaluated in Venezuela. We did not find studies about DD in Venezuelan university students. In this study, the DD was low. The mean DD# for all households is 3.5 foods, which suggests that on average, every household consumed almost four different food groups (out of nine) the day before the survey. This confirms the theory of a monotonous diet in the country (Landaeta-Jiménez et al.,
In this observational study, a log-linear modeling analysis was used. This technique has the advantage of assessing all high-order interactions and, in doing so, rule out a result known as Simpson's paradox by which, for example, conclusions from two-dimensional marginal tables can be contradicted by the three-dimensional information (Christensen,
The fitted model indicates that SES4 is independent of FS3 and DD2 in a statistically significant way. In contrast, a recent study conducted by Wanyama et al. (
Besides, we found that FS3 is related to DD2. A result which is in line with some studies that proposed that dietary diversity score is a proxy measure of food security and
A possible explanation for the joint independence of SES4 with FS3 and DD2 might be the harmonization of the diet due to the low income and food scarcity that affects Venezuela (Landaeta-Jiménez et al.,
These data must be interpreted with caution because the association does not mean causation. Being limited to the sociology students of only one public university, these findings are based on a small sample of participants and can neither be extrapolated to all the UCV students nor the population of university students of Venezuela. We use a single 24-h recall period that does not indicate a student's habitual diet. The selected FS instrument asks several questions about children, which could affect the household FS measurement in the 20% of students living away from home, especially those from outside the region. The study data analysis uses qualitative variables, which may differ from a quantitative approach, e.g., through standard regression models or structural equation modeling. We have not had the opportunity to adjust for sex, age, living arrangements, or other potential confounder variables. Future research should include how each gender influences some of these items. Additionally, it was not possible to assess the biochemistry and nutritional anthropometric status; therefore, despite its exploratory nature, this study offers some insight into the food and dietary indicators among some university students.
The study concludes that there is an association between food security and dietary diversity among a sample of sociology students at the Central University of Venezuela. Whereas, the socioeconomic status in households of those students was not associated with their food security level or dietary diversity. Most of them are in food insecurity with a low dietary diversity, which could affect their nutritional status, academic performance, and permanence in the university.
Ensuring appropriate systems, services, and support for university students at UCV should be a priority for the educational systems, especially in this crisis context. Reactivation of the university dining at UVC should be considered a priority strategy to improve food security and dietary diversity.
Further studies are required to fully understand the multifactorial food situation of Venezuelan university students. Other types of nutritional assessment indicators could be included such as dimension and composition anthropometric indicators along with blood concentration of iron, retinol, and folate.
The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.
The studies involving human participants were reviewed and approved by the Ethics Review Committee of the Central University of Venezuela. The patients/participants provided their written informed consent to participate in this study.
All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
The authors thank Daniela Gonzalez and Irina Rodríguez for helping in data collection.
The Supplementary Material for this article can be found online at: