Abstract

Food insecurity occurs when the right to food in adequate quality and quantity on a regular basis is disrespected. This study aimed to identify food and nutrition insecurity (FNI) and its possible association with socioeconomic and dietary variables in rural settlements of Sergipe. We verified food insecurity through the Brazilian of Food Insecurity Scale and associations via odds ratio multivariate regression analysis. We evaluated 179 families from four rural settlements in the state of Sergipe. An FNI prevalence of 88.8% was identified (48.6% light insecurity, 25.1% moderate and 15.1% severe). An adjusted statistical association was found between FNI and variables family income per capita (ORa = 3.11, p = 0.008) and food variety (ORa = 2.73, p = 0.004). Families showed high prevalence of food and nutritional insecurity, determined by low income and low variety of food in this population. It is essential to implement more effective and comprehensive public policies that actually ensure food security, also aiming at nutrition education and greater food production opportunities.

Rural settlements; Food security; Socioeconomic factors

Introduction

According to Law 11.346/2006, Food and Nutrition Security (FNS) includes the realization of the universal right to regular and permanent access to quality food in sufficient quantity, without compromising access to other essential needs, based on health-promoting food practices that respect cultural diversity and are environmentally, culturally, economically and socially sustainable¹1. Brasil. Lei nº. 11.346 de 15 de setembro de 2006. Lei Orgânica de Segurança Alimentar e Nutricional. Diário Oficial da União 2006; 18 set..

Food insecurity measured according to the Brazilian Food Security Scale (EBIA) ranges from the lightest level, where there is concern about the uncertainty of access to food, to the most serious level, characterized by hunger. The UN estimated that, in 2013, 867 million people worldwide were chronically undernourished and 70% of people living in Food and Nutrition Insecurity (FNI) were from rural areas²2. Food and Agriculture Organization of the United Nations (FAO). Statistical Yearbook. Rome: FAO; 2013..

In Brazil, despite the reduction when compared to 2004, 22.6% of households are in some level of food insecurity, which represents 52 million people. The rural area shows prevalence of food insecurity higher than the urban area, and the Northeast has the highest percentages of food insecurity in Brazil, as well as the highest percentage of families in moderate or severe food insecurity in the Brazilian rural area³3. Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa Nacional por Amostra de Domicílios: segurança alimentar 2013. Rio de Janeiro: IBGE; 2014..

An important part of the rural population is in the settlements, since it represents almost 1 million of Brazilian families. In addition, it promotes an increased food supply and a decreased rural exodus. The Northeast accounts for about 30% of these families, but with only 11.2% of the hectares allocated to settlements in Brazil⁴4. Instituo Nacional de Colonização e Reforma Agrária (INCRA). [online]. Brasília; 2014. [acessado 2014 dez 27]. Disponível em: http://painel.incra.gov.br/sistemas/index.php
http://painel.incra.gov.br/sistemas/inde... .

In Sergipe, most of the settlements are located in low-fertility soils, dry climate and low infrastructure and are far from economically active areas⁵5. Lopes ESA. Da colonização dirigida na Amazônia à reforma agrária no nordeste: (origem, trajetórias e perspectivas de colonos e assentados). São Cristóvão: Editora UFS; 2013.. Although agrarian reform is a project of national relevance with a high-level commitment in its implementation, land appropriation is no guarantee of food security⁶6. Cócaro, H, Cócaro ES, Reis RM, Calegario CLL. Condições de (in)segurança alimentar em um assentamento rural do estado do Mato Grosso. Cadernos de Agroecologia 2011; Fortaleza. p. 1-6.

7. Busato MA, Gallina LS, Dreyer DC, de Quadros JC, Lavratti E, Teo CRPA. Segurança alimentar e nutricional e as condições do ambiente em assentamento rural de Santa Catarina. Alim. Nutr. 2011; 22(4):555-559^-88. Obana K, Pereira APA, Cesário AC, Vieira VCR. Prevalência e gradientes da insegurança alimentar em um assentamento de reforma agrária localizado no sul do estado de Minas Gerais. Cadernos de Agroecologia 2010; Porto de Galinhas..

Studies have shown the relationship of FNI with lower family income, low schooling, greater number of household residents, inadequate basic sanitation, lack of employment relationship and higher prevalence among rural families⁹9. Morais DC, Dutra LV, Franceschini SDCC, Priore SE. Insegurança alimentar e indicadores antropométricos, dietéticos e sociais em estudos brasileiros: uma revisão sistemática. Cien Saude Colet 2014; 19(5):1475-1488.. As for food intake, besides the quantitative restriction identified by the Brazilian Food Insecurity Scale (EBIA), FNI has also been associated with a lower dietary quality, with lower consumption of protein-rich foods (belonging to the group of legumes, milk and derivatives, meat and eggs) and regulators (fruits and vegetables), as well as greater lack of meals and glycidic uptake⁹9. Morais DC, Dutra LV, Franceschini SDCC, Priore SE. Insegurança alimentar e indicadores antropométricos, dietéticos e sociais em estudos brasileiros: uma revisão sistemática. Cien Saude Colet 2014; 19(5):1475-1488..

The importance of a healthy and adequate diet for the promotion of health and the prevention of diseases by both nutrients’ deficit and excess is known¹⁰10. Brasil. Ministério da Saúde (MS). Secretaria de Atenção à Saúde. Guia alimentar para a população brasileira: promovendo a alimentação saudável. Brasília: MS; 2008..

Considering the eradication of hunger as a goal of the millennium²2. Food and Agriculture Organization of the United Nations (FAO). Statistical Yearbook. Rome: FAO; 2013., the vulnerability of rural settlements and the importance of the topic for the formulation of more effective public policies, this study aimed to evaluate the association between food insecurity and dietary and socioeconomic variables of families in rural settlements in Sergipe.

Methodology

This cross-sectional analytical study was part of the research project “Participatory Experimentation and Agroecology in Rural Settlements of Sergipe” under the coordination of EMBRAPA Coastal Tablelands in partnership with the Federal University of Sergipe. Socioeconomic, anthropometric, dietary and food insecurity data were collected between May 2011 and 2013.

The study population consisted of 179 families, out of 184 families, belonging to four settlements located in Sergipe regions, such as the São Sebastião (ARSS, Pirambu, Eastern Sergipe), the José Gomes da Silva (ARJGS, Lagarto, Central-South Sergipe), the Novo Marimbondo (ARNM, Tobias Barreto, Central-South Sergipe) and the José Felix de Sá (ARJFS, Aquidabã, Mid-hinterland of Sergipe). According to the National Institute for Colonization and Agrarian Reform (INCRA), 170 families benefited from agrarian plots in these four settlements, however, during collection, we noted that some children of the beneficiaries formed families and built residences within the parents’ plot, which justifies a larger number of participants in the survey¹¹11. Instituo Nacional de Colonização e Reforma Agrária (INCRA). [online]. Brasília, Distrito Federal; 2015. [acessado 2015 jan 12]. Disponível em: http://www.incra.gov.br/images/reforma_agraria/projetos_e_programas/relacao_beneficiarios/sr23_se.pdf
http://www.incra.gov.br/images/reforma_a... .

Properly trained personnel carried out data collection, thus, it was necessary for researchers to remain in the settlements for a few weeks due to the difficult access and distance of locations.

Families were visited in their homes and, after signing the Informed Consent Form, the head of the family, he/she who contributed with the highest income, answered a previously structured socioeconomic questionnaire and the 24-hour reminder. In addition, a method adapted and validated for the Brazilian urban and rural population used by the Brazilian Institute of Geography and Statistics (IBGE) for National Household Sample Survey (PNAD) was also applied.

This method consists of 15 questions with a yes/no answer on food restriction due to economic constraints in the last three months. The following cutoff points according to affirmative answers were considered for families with members under 18 years of age: 1-5 light insecurity (LI), 6-10 moderate insecurity (MI) and 10-15 severe insecurity (SI). For families without children under 18 years of age, affirmative answers cutoff points were: 1-3 LI, 4-5 MI, 6-8 SI, and no affirmative response was considered as food security for both cases¹²12. Santos LPD, Costa MGD, Santos JVD, Lindemann IL, Gigante DP. Comparação entre duas escalas de segurança alimentar. Cien Saude Colet 2014; 19(1):279-286.. Food security or insecurity situation was adopted as a dependent variable. Anthropometric measurements were also performed on all family members, totaling 706 people.

The socioeconomic variables investigated refer to schooling, profession, age, gender and monthly income of residents of each household, as well as participation in some type of Government Cash Transfer Program (CTP). The criterion adopted in this paper for the definition of poverty and extreme poverty lines uses cut-off points designated by the World Bank, where US$ 1.00 per day per person is the extreme poverty line and US$ 2.00 per day per person is the poverty line¹³13. The World Bank. World Development Report. Oxford: Oxford University Press; 1990., calculated from the total family income, including CTP amounts.

For greater reliability, the 24-hour reminder was applied with the help of a photo album with portions of various foods of varying size made from several other albums¹⁴14. Lopez RPS, Botelho RBA. Álbum fotográfico de porções alimentares. São Paulo: Metha; 2008.

15. Sales RL, Costa NMB, Silva MMS. Avaliando o consumo alimentar por fotos. [CD-ROM]. Viçosa: UFV; 2004.

16. Vitolo MR. Nutrição: da gestação ao envelhecimento. Rio de Janeiro: Ed Rúbio; 2008.^-1717. Zabotto CB, Vianna RPT. Registro fotográfico para inquéritos dietéticos: Utensílios e Porções. Goiânia: UFG; 1996..

Nutrient intake and food groups were estimated using the Nutrition Data System for Research software (NDSR, Version 2011, Minneapolis, University of Minnesota), a computerized diets analysis program. The nutrient content data of the software were compared to the Food Composition Table (TACO), and when less than 80% or in excess of 120% were corrected according to the value found in the reference table¹⁸18. Núcleo de Estudos e Pesquisas em Alimentação – NEPA. Tabela Brasileira de Composição de Alimentos. 2° ed. Campinas: Unicamp; 2006.. The evaluation was based on the Dietary Reference Intake¹⁹19. Padovani RA, Amaya-Fárfan J, Colugnati FAB, Domene SMA. Dietary reference intakes: aplicabilidade das tabelas em estudos nutricionais. Revista de Nutrição 2006; 19(6):741-760. and according to the Brazilian Food Guide¹⁰10. Brasil. Ministério da Saúde (MS). Secretaria de Atenção à Saúde. Guia alimentar para a população brasileira: promovendo a alimentação saudável. Brasília: MS; 2008..

A varied diet is one consisting of at least five food groups, excluding oils and fats and sweets and sugars groups.

As for anthropometric measures, BMI was calculated for adults and elderly and BMI/age for children and adolescents, identifying the nutritional status. Diagnosis was based on WHO recommendations²⁰20. World Health Organization (WHO). Obesity: Preventing and managing the global epidemic. Report of a WHO consultationonobesity. Geneve: WHO; 1998..

Tools used were Lider electronic scale, P-150M model, with capacity of 150 kg, with 100g scale; Alturexata portable stent with bilateral scale of 35 to 213 cm and 0.1cm resolution; Sanny Medical measuring tape in flat steel with 0.5cm width and 0.1cm precision and; Lange® adipometer developed by Cambridge Scientific Industries, USA.

Statistical analysis was performed with IBM SPSS Statistics 16.0 software. Descriptive analyzes were performed to characterize population, Pearson’s chi-square test and gross and odds ratio-adjusted prevalence ratios, which were applied to investigate the association between independent (socioeconomic, dietary and anthropometric) variables with prevalence of food insecurity. Associations with p < 0.20 were selected for the adjusted multivariate regression model, with a statistical significance of p < 0.05 and CI of 95%.

For better statistical adjustment, dependent variables were classified into two groups: 1) Food and Nutrition Security and Light Food Insecurity (FNS – LFI) and 2) Moderate and Severe Food Insecurity (MSFI). Research was approved by the Ethics Committee for Research with human beings, Federal University of Sergipe.

Results

In these settlements, lands are mainly geared to agriculture, while only a small part is destined to cattle raising. Its main common crops are maize, beans and manioc. These foods are generally used for subsistence, but are also marketed at street markets when they exceed production. Regarding cultivation, vegetable gardens are set in some houses, aiming the local commerce. The use of agrochemicals is common practice, and these are bought by the farmers themselves in agricultural houses, not always with the correct technical recommendation.

They have incomplete infrastructure, with electric power, but not all have piped water, solid waste disposal and sewage treatment. Settlements lack operational schools or health centers, therefore, it is necessary to move to neighboring communities. Settlements leisure activities are mainly to go to bars, football games, local festivities and religious mass.

Sociodemographic characterization of the four settlements in Sergipe (Tables 1 and 2) analyzed from 179 families showed that, of the heads of households, 73.2% were male, 40.2% were overweight, 71.5% were farmers and 67.4% % had four or fewer people residing in the household. It is important to highlight that two heads of families were not submitted to anthropometry evaluation due to their absence in the settlements on collection days. Thus, the nutritional status sample was reduced to 177 individuals. The most common family composition was a couple with children (62.6%). It is important to note that no head of household had access to higher education and 78.2% had incomplete elementary education. In addition, 19% of households were classified below the poverty line (extreme poverty).

While none of the settlements studied have schools, when compared to schooling between heads and children of the family, children have higher schooling, with 1.9% of illiteracy, 11% of incomplete secondary education and 0.6 % attending higher education, corroborating results from other studies²¹21. Souza-Esquerdo VF, Bergamasco SMPP, de Oliveira, JTA, Oliveira ES. Segurança alimentar e nutricional e qualidade de vida em assentamentos rurais. Segurança Alimentar e Nutricional 2013; 20(1):13-23..

The prevalence of food insecure families was 88.8%, of which 48.6% with LFI, that is, with uncertainty regarding access to food in the future, 25.1% with MFI, indicating a qualitative and quantitative food restriction for adults, and 15.1% with SFI, meaning a quantitative restriction even for children, with possible hunger episodes²²22. Segall-Corrêa AM, Pérez-Escamilla R, Maranha LK, Sampaio MFA, Yuyama L, Alencar F, Vianna RPT, Vieira ACF, Coitinho D, Schmitz BS, Leão MM, Gubert M. Acompanhamento e avaliação da segurança alimentar de famílias brasileiras: validação de metodologia e de instrumento de coleta de informação. Campinas: Universidade Estadual de Campinas, Organização Pan-Americana da Saúde, Ministério de Saúde; 2003. (Relatório Técnico).. Cronbach’s alpha reached 0.91, which is excellent, showing that questions were answered according to the theoretical expectation of the very scale, in increasing order of seriousness of food insecurity.

Associations between variables are described in Table 3. A statistical association was found between Food and Nutrition Insecurity (FNI) and variables per capita family income, meat and eggs group intake, interval between meals and varied diet.

There were no associations with significant differences between food insecurity and energy intake, schooling, protein intake (g/kg) and with regard to the number of household residents. There were also no associations between being a beneficiary or not of a Cash Transfer Program (CTP) and gender of the head of the family and FNI.

In Table 4, we can observe the odds ratio and the 95% confidence interval of FNI determinants in the final model of the adjusted regression. Variables that remained related to food insecurity were unvaried diet and per capita income “extreme poverty” that were, respectively, 2.7 and 3.11 times more likely to be in MSFI. Categories interval between meals and protein intake remained in the model for better adjustment of variables.

Discussion

The main findings of this study include the identification of high FNI rates (88.8%) in rural settlements in Sergipe and the relationship of this situation associated with low income and low food variety. When compared to data published by PNAD (2014), the prevalence of FNI found in this study was more than triple the average found in Brazil (22.6%) and considerably higher than the prevalence found in the Northeast (38.1%), . The moderate and severe food insecurity in this study is 40.2%, much higher than the rural areas of the Northeast (20.1%) and Brazil (7.8%)³3. Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa Nacional por Amostra de Domicílios: segurança alimentar 2013. Rio de Janeiro: IBGE; 2014.. With regard to other settlements in different regions of the country, whose percentage of MSFI ranges from 0 to 22%, we note that the prevalence presented in this study is a matter of much greater concern⁶6. Cócaro, H, Cócaro ES, Reis RM, Calegario CLL. Condições de (in)segurança alimentar em um assentamento rural do estado do Mato Grosso. Cadernos de Agroecologia 2011; Fortaleza. p. 1-6.^,77. Busato MA, Gallina LS, Dreyer DC, de Quadros JC, Lavratti E, Teo CRPA. Segurança alimentar e nutricional e as condições do ambiente em assentamento rural de Santa Catarina. Alim. Nutr. 2011; 22(4):555-559^,88. Obana K, Pereira APA, Cesário AC, Vieira VCR. Prevalência e gradientes da insegurança alimentar em um assentamento de reforma agrária localizado no sul do estado de Minas Gerais. Cadernos de Agroecologia 2010; Porto de Galinhas.^,2121. Souza-Esquerdo VF, Bergamasco SMPP, de Oliveira, JTA, Oliveira ES. Segurança alimentar e nutricional e qualidade de vida em assentamentos rurais. Segurança Alimentar e Nutricional 2013; 20(1):13-23.^,2323. Veiga LS, Cócaro H, Cócaro ES, Costa RN, Jesus EL, Oliveira MLS. Relações entre (in)segurança alimentar e as condições sociais em um assentamento rural do estado de Minas Gerais. In: VIII Congresso Brasileiro de Agroecologia; 2013; Porto Alegre. p. 1-5.. The low food production during the collection period may have probably exacerbated these percentages, especially due to water scarcity caused by frequent droughts in the studied region, considering that, in 2013, the worst drought in the last 30 years left 1,228 municipalities in the northeast region in a state of emergency²⁴24. Brasil. Instituo Nacional de Pesquisas Espaciais. INPE [online]. São José dos Campos, São Paulo; 2015. [acessado 2015 maio 31]. Disponível em: http://www.inpe.br/noticias/namidia/img/clip20032013_08.pdf
http://www.inpe.br/noticias/namidia/img/... .

The FAO Statistical Yearbook (2013) reported that, between 2010 and 2012, 19.1% of the world’s population suffered from deprived access to food, with a higher percentage in low-income countries and a higher concentration in Africa (28.9%) than in developing countries (22.5%). When viewed in more detail, it is possible to identify that North Africa has a much lower percentage (5.8%) than sub-Saharan Africa (33.3%). Countries with the worst rates are Burundi (81.4%), Cameroon (77.8%), Eritrea (75.4%), Somalia (74.3%), which are close to the percentage found in this study, and Zambia (56.3%), all of these Africans, in addition to Haiti (53.2%), located in Central America²2. Food and Agriculture Organization of the United Nations (FAO). Statistical Yearbook. Rome: FAO; 2013..

The lack of association between FNI, energy intake and body composition variables may reflect the nutritional transition, demonstrating that FNI is not necessarily characterized by malnutrition anymore. Some studies have already identified a relation between food insecurity and overweight, since it has increased in the economically disadvantaged classes, probably due to the acquisition of foods with low nutritional value and high caloric density at lower prices⁹9. Morais DC, Dutra LV, Franceschini SDCC, Priore SE. Insegurança alimentar e indicadores antropométricos, dietéticos e sociais em estudos brasileiros: uma revisão sistemática. Cien Saude Colet 2014; 19(5):1475-1488.^,2525. Souza BFDNJ, Marín-León L. Food insecurity among the elderly: cross-sectional study with soup kitchen users. Revista de Nutrição 2013; 26(6):679-691.^,2626. Monteiro F, Schmidt ST, da Costa IB, Almeida CCB, Silva Matuda N. Bolsa Família: insegurança alimentar e nutricional de crianças menores de cinco anos. Cien Saude Colet 2014; 19(5):1347-1357..

In contrast to other studies⁹9. Morais DC, Dutra LV, Franceschini SDCC, Priore SE. Insegurança alimentar e indicadores antropométricos, dietéticos e sociais em estudos brasileiros: uma revisão sistemática. Cien Saude Colet 2014; 19(5):1475-1488.^,2727. Bittencourt LS, Santos SMCD, Pinto EDJ, Aliaga MA, Ribeiro-Silva RC. Factors Associated with Food Insecurity in Households of Public School Students of Salvador City, Bahia, Brazil. J Health Popul Nutr 2013; 31(4):471-479.

28. Godoy KC, Sávio KEO, Akutsu RDC, Gubert MB, Botelho RBA. Perfil e situação de insegurança alimentar dos usuários dos Restaurantes Populares no Brasil. Cad Saude Publica 2014; 30(6):1239-1249.

29. Aquino, JDS, Sequeira-de-Andrade LAS, Silva PEBAD, Silva APD, Vieira CRDS, Lira PICD. Food insecurity and socioeconomic, food and nutrition profile of schoolchildren living in urban and rural areas of Picos, Piauí. Revista de Nutrição 2014; 27(4):395-404.^-3030. Lopes TS, Sichieri R, Salles-Costa R, Veiga GV, Pereira RA. Family Food Insecurity and Nutritional Risk in Adolescents from a Low-Income Area of Rio De Janeiro, Brazil. J Biosoc Sci 2013; 45(05):661-674., schooling showed no association with FNI, probably because this population is very homogeneous regarding low schooling, a result also found in other settled populations⁷7. Busato MA, Gallina LS, Dreyer DC, de Quadros JC, Lavratti E, Teo CRPA. Segurança alimentar e nutricional e as condições do ambiente em assentamento rural de Santa Catarina. Alim. Nutr. 2011; 22(4):555-559^,2121. Souza-Esquerdo VF, Bergamasco SMPP, de Oliveira, JTA, Oliveira ES. Segurança alimentar e nutricional e qualidade de vida em assentamentos rurais. Segurança Alimentar e Nutricional 2013; 20(1):13-23.^,3131. Fietz VR, Salay E, Watanabe EAMT. Condições socioeconômicas, demográficas e estado nutricional de adultos e idosos moradores em assentamento rural em Mato Grosso do Sul, MS. Rev Segurança Alimentar e Nutricional 2010; 17(1):73-82.. Low schooling contributes to people generally not getting well paid work opportunities outside the settlements, not promoting increased income and decreased food insecurity. At the same time, there is hope for improvement, since an increasing number of children and adolescents are achieving higher levels of schooling, which may reflect improvements in relation to the current situation.

The lack of association between FNI and gender of the head of the family goes against other studies that found the greatest vulnerability to FNI when family head was female²⁷27. Bittencourt LS, Santos SMCD, Pinto EDJ, Aliaga MA, Ribeiro-Silva RC. Factors Associated with Food Insecurity in Households of Public School Students of Salvador City, Bahia, Brazil. J Health Popul Nutr 2013; 31(4):471-479.^,3030. Lopes TS, Sichieri R, Salles-Costa R, Veiga GV, Pereira RA. Family Food Insecurity and Nutritional Risk in Adolescents from a Low-Income Area of Rio De Janeiro, Brazil. J Biosoc Sci 2013; 45(05):661-674.. In this study, the prevalence of the same profession (farmers) with similar conditions to produce food and the low prevalence of female heads of household with child and without spouse influenced this result. However, it should be noted that, in general, when women are recognized as the receiving beneficiaries of funds from cash transfer programs, families are strengthened, as there is an acknowledgment that funds will be obtained for their benefit. In addition, they prioritize the diet of children and when food is insufficient, as in the case of this study, there is a need to support women even more so that they can feed themselves and ensure family sustenance. However, it is perceived that, even with several public policies stimulating women empowerment, this is still far from the truth in many rural areas.

It is known that low family income is one of the main determinants of FNI.⁹9. Morais DC, Dutra LV, Franceschini SDCC, Priore SE. Insegurança alimentar e indicadores antropométricos, dietéticos e sociais em estudos brasileiros: uma revisão sistemática. Cien Saude Colet 2014; 19(5):1475-1488.^,2727. Bittencourt LS, Santos SMCD, Pinto EDJ, Aliaga MA, Ribeiro-Silva RC. Factors Associated with Food Insecurity in Households of Public School Students of Salvador City, Bahia, Brazil. J Health Popul Nutr 2013; 31(4):471-479.

28. Godoy KC, Sávio KEO, Akutsu RDC, Gubert MB, Botelho RBA. Perfil e situação de insegurança alimentar dos usuários dos Restaurantes Populares no Brasil. Cad Saude Publica 2014; 30(6):1239-1249.

29. Aquino, JDS, Sequeira-de-Andrade LAS, Silva PEBAD, Silva APD, Vieira CRDS, Lira PICD. Food insecurity and socioeconomic, food and nutrition profile of schoolchildren living in urban and rural areas of Picos, Piauí. Revista de Nutrição 2014; 27(4):395-404.^-3030. Lopes TS, Sichieri R, Salles-Costa R, Veiga GV, Pereira RA. Family Food Insecurity and Nutritional Risk in Adolescents from a Low-Income Area of Rio De Janeiro, Brazil. J Biosoc Sci 2013; 45(05):661-674.^,3232. Anschau FR, Matsuo T, Segall-Corrêa AM. Insegurança alimentar entre beneficiários de programas de transferência de renda. Rev. Nutr 2012; 25(2):177-189.^,3333. Figuero A, Pedraza D. Segurança alimentar em famílias com crianças matriculadas em creches públicas do estado da Paraíba, Brasil. Revista de Nutrição 2013; 26(5):517-527. In this population, the average monthly income was R$ 651.00 (US$192,69) , a figure slightly lower than the minimum wage in force in 2013, which was R$ 678.00 (US$ 200,59). Some 83.2% of the families received some type of government CTP. Of these, 73.7% received the Bolsa Família (Family Grant) Program (PBF). It is important to highlight the role of this program toward improving family income and its effectiveness in reducing FNI³⁴34. Instituto de pesquisa econômica aplicada (IPEA). Programa bolsa família: uma década de inclusão e cidadania. Brasília: IPEA; 2013.. Possibly, without the presence of CTPs, the situation of food insecurity would have been even worse, since some families declared that this was the only source of fixed income.

Nevertheless, while increased income decreases the possibilities of FNI due to increased purchasing power and that most of the income has been shown to be geared to the purchase of food³⁵35. Instituto Brasileiro de Análises Sociais e econômicas (IBASE). Repercussões do Programa Bolsa Família na Segurança Alimentar e Nutricional das famílias beneficiadas. Rio de Janeiro: IBASE; 2008., several studies indicate that improved income does not necessarily imply better diet quality²⁶26. Monteiro F, Schmidt ST, da Costa IB, Almeida CCB, Silva Matuda N. Bolsa Família: insegurança alimentar e nutricional de crianças menores de cinco anos. Cien Saude Colet 2014; 19(5):1347-1357.^,3535. Instituto Brasileiro de Análises Sociais e econômicas (IBASE). Repercussões do Programa Bolsa Família na Segurança Alimentar e Nutricional das famílias beneficiadas. Rio de Janeiro: IBASE; 2008.

36. Lima FEL, Fisberg RM, Uchimura, KY, Pitcheth T. Programa Bolsa-Família: qualidade da dieta de população adulta do município de Curitiba, PR. Rev Bras Epidemiol 2013; 16(1):58-67.

37. Cabral MJ, Vieira KA, Sawaya AL, Florêncio TMMT. Perfil socioeconômico, nutricional e de ingestão alimentar de beneficiários do Programa Bolsa Família. Estudos avançados 2013; 27(78):71-87.^-3838. Cotta RMM, Machado JC. Programa Bolsa Família e segurança alimentar e nutricional no Brasil: revisão crítica da literatura. Rev Panam Salud Publica 2013; 33(1):54-60. and nutritional status³⁹39. Wolf MR, Barros Filho ADA. Estado nutricional dos beneficiários do Programa Bolsa Família no Brasil – uma revisão sistemática. Cien Saude Colet 2014; 19(5):1331-1338.. A study by the Brazilian Institute of Social and Economic Analyses (IBASE) which identified the repercussions of the PBF on the food security of beneficiary families found an increased purchase of sugars, cookies and other industrialized products, as well as a preference for food purchases that children enjoy most³⁵35. Instituto Brasileiro de Análises Sociais e econômicas (IBASE). Repercussões do Programa Bolsa Família na Segurança Alimentar e Nutricional das famílias beneficiadas. Rio de Janeiro: IBASE; 2008.. Another study carried out with the PBF beneficiary population in the city of Curitiba found a monotonous diet and low consumption of fruits, vegetables and dairy products, a result similar to this study³⁶36. Lima FEL, Fisberg RM, Uchimura, KY, Pitcheth T. Programa Bolsa-Família: qualidade da dieta de população adulta do município de Curitiba, PR. Rev Bras Epidemiol 2013; 16(1):58-67..

In this study, it was observed that, among the food groups with intake below the recommended minimum, fruits (89.4%), vegetables (90.5%) and milk and derivatives (93.9%) stand out. These data reflect a high percentage of inadequacy for several nutrients such as fiber (90%), vitamin A (77.1%), C (73.7%) and E (96%), as well as minerals such as calcium (86%), magnesium (90%) and potassium (91.6%) (data not shown). It is important to note that adequate intake of these nutrients can reduce the risk of cardiovascular disease, improve plasma cholesterol levels and increase the efficiency of the immune system¹⁶16. Vitolo MR. Nutrição: da gestação ao envelhecimento. Rio de Janeiro: Ed Rúbio; 2008..

The most consumed food groups were meat, legumes, oils and fats (considered by the high frequency of foods prepared by frying and consumption of margarine cited by 29.05% of the population), as well as the group of sweets (represented mainly by white sugar, 91.6%, frequently used in the preparation of coffee) and the group of cereals, pasta, roots and tubers, where the most cited foods were couscous (67.03%), manioc flour (59.7%), white rice (79.3%) and white bread (56.98%).

It is important to mention that the food produced in the agrarian lots was basically corn, beans and manioc, in addition to a small production of vegetables and fruits. However, preference is given to trade in free markets. Associating these factors, we can understand the low intake of fruits, vegetables and milk and dairy products in this population. Possibly, the inadequate consumption of nutrients by the head of the family is due to the unavailability of all the food groups at home, suggesting that a similar consumption by other members of the family.

These results are similar to those of the Family Budget Survey (POF) in the years 2002-03 and 2008-09, which identified a declining consumption of fruits and vegetables, becoming insufficient, and excess calories from sugar and saturated fat in the diet of Brazilians, as well as a greater consumption of rice, beans, legumes, roots and tubers in rural areas and manioc flour in the Northeast. The consumption of milk, fruits, vegetables and meats has been shown to increase with income, unlike beans, tubers and roots⁴⁰40. Levy-Costa RB, Sichieri R, Pontes NDS, Monteiro CA. Disponibilidade domiciliar de alimentos no Brasil: distribuição e evolução (1974-2003). Rev Saude Publica 2005; 39(4):530-540.^,4141. Levy RB, Claro RM, Mondini L, Sichieri R, Monteiro CA. Distribuição regional e socioeconômica da disponibilidade domiciliar de alimentos no Brasil em 2008-2009. Rev Saude Publica 2012; 46(1):6-15.. A high inadequacy for vitamins A, C, E, calcium and magnesium was also identified for age group from 19 to 59 years, regardless of the household being urban or rural⁴²42. Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa de Orçamentos Familiares 2008-09. Rio de Janeiro: IBGE; 2010..

In this study, we understand that having a varied diet implies the ingestion of five food groups of the six main ones (fruits, vegetables, legumes, cereals, meats and milk and derivatives). This invariably requires not only a satisfactory family income of individuals, but also the existence of good eating habits, valuing food diversity, issues that are not always directly correlated.

The study has an important limitation regarding the period of data collection in view of the drought that occurred in the region. Such situation may have contributed to the diet and planting of the families and, consequently, to the perception of food insecurity. Another possible limitation was the use of EBIA, a psychometric scale that verifies the perception of food insecurity and possibly its food safety classification does not contemplate the definition of FNS of Law 11.366/2006. However, this is a method adapted to the Brazilian urban and rural population, with simple application and analysis, characterizing families at different levels of FNI. In addition to the easy understanding by the respondent and low cost, it is more frequently used in studies, including in national surveys, which allows greater reliability in the comparison of results. It should be noted, however, that this study reports a household survey conducted in four agrarian reform settlements located in three different regions of the state. It is possible that data shown represent the reality of other settlements in the region. In addition, it is unheard of to identify low dietary variety as a risk factor for food insecurity in rural settlement populations.

This result raises the importance of strengthening cash transfer public policies, such as the PBF, and that encourage the small farmer from more vulnerable families, such as the food purchase program (PAA). In addition, it is essential that they be associated with health education in the countryside, greater promotion of agroecological production, valuing of regional foods and their local marketing. It is believed that, given the results found, these could be key strategies to improve the food insecurity landscape of this population. Further studies with this population are also proposed to designate other possible food insecurity determinants and thus provide a better formulation of public policies.

Final considerations

The families studied showed high prevalence of food and nutritional insecurity, determined by low family income and low food variety. The population of this study evidenced great social vulnerability, even with a large portion receiving government cash transfers, predominantly the Bolsa Família Program. We also observed a monotonous diet based on rice, manioc flour, couscous, white bread, beans, meats and coffee. Consequently, also insufficient food, since much of the population cannot achieve even the minimum recommendation for important food groups such as milk and dairy products, fruits and vegetables. Although land tenure dignifies a previously forgotten population, these people still experience hardships in terms of access to education, basic sanitation, health and technical assistance services. In addition, food habits of this population may favor the prevalence and/or occurrence of NCDs, especially those related to food. Therefore, more effective comprehensive public policies that actually ensure food security are also required, aiming at food education and more possibilities to produce food. Thus, in the future, one can avoid the emergence of diseases and important psychological traumas arising from food insecurity.

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