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Occupational Medicine Advance Access originally published online on October 16, 2006
Occupational Medicine 2006 56(8):575-577; doi:10.1093/occmed/kql103
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© The Author 2006. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Short Reports

Protein-energy supplements to preserve nutritional status of sugar cane cutters

Paula Chiarello1, Paulo Scatena Sobrinho2, Marta Neves Campanelli Marçal Vieira3 and Rosa Wanda Diez Garcia3

1 Av Bandeirantes, 3900 Monte Alegre, Ribeirão Preto, São Paulo 14049-190, Brazil
2 Usina da Pedra, Serrana, São Paulo, Brazil
3 Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil

Correspondence to: Paula Chiarello, Av Bandeirantes, 3900 Monte Alegre, Ribeirão Preto, São Paulo 14049-190, Brazil. Tel: +55 16 36023098; fax: +55 16 36023098; e-mail: paulagc{at}fmrp.usp.br


   Abstract
Top
 Abstract
Introduction
 Methods
 Results
 Discussion
 Conflicts of interest
 References
 
Background Sugar cane cutters in south-eastern Brazil are temporarily hired for the harvest period of 8 months. They often have minimal benefits and may not receive adequate nutrition.

Aims To evaluate alterations in weight and body composition of sugar cane cutters during harvest with the use of protein-energy and electrolyte supplements.

Methods Three products were used daily: a milk drink, a seasoned manioc meal mixture and an electrolyte replacement fluid, adding ~398 kcal and 28.5 g of protein/day.

Results There were small, but significant, reductions in body mass index and percentage body fat with maintenance of lean mass. There was a significant improvement in hydration status, serum albumin and cholesterol. There were no medical absences related to dehydration.

Conclusions Even though alterations in body mass and biochemistry were small, the significance of the findings suggests these supplements may have a useful role to play in reducing lean mass losses and maintaining nutritional and hydration status of these workers.

Keywords      Nutritional status; sugar cane cutters; supplements


   Introduction
Top
 Abstract
 Introduction
Methods
 Results
 Discussion
 Conflicts of interest
 References
 
In the south-east region of Brazil, sugar cane cutters are responsible for the manual collection of sugar cane during the harvest period (8 months). Their living and working conditions are often inadequate with poor-quality drinking water, diet, housing and sanitation [1,2]. The cutters are usually migrants from other regions and are remunerated according to their production under a temporary work contract that exempts the employer from observing labour rights, which would include, for example, provision of food. These workers are popularly known as ‘bóias-frias’ (cold lunch eaters) due to their habit of carrying their own food (‘bóia’) in kettles or buckets to their place of work, where they take their meals.

There are few scientific publications, especially recent ones, reporting qualitative and quantitative data about meals consumed at the workplace or the nutritional requirements and nutritional status of this group of workers. It is known that energy expenditure during the sugar cane harvest period may greatly exceed the energy supply offered by the available diet, a fact that may impair the maintenance of body stores and tissues, contributing to a state of marginal malnutrition in these individuals [3,4,5].

Production in the sugar–alcohol sector has been growing significantly over the last two decades, with a worker cutting 12 tons of sugar cane per day, 50% more than his average production in the 1980s. During the year 2005, the occurrence of nine deaths among workers in this region attracted the attention of the United Nations to determine whether work exhaustion contributed to these deaths.

The objective of the present study was to assess alterations in body mass and composition, and other parameters of nutritional state, in sugar cane cutters with the use of food and hydroelectrolytic complements.


   Methods
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 Abstract
 Introduction
 Methods
Results
 Discussion
 Conflicts of interest
 References
 
Eighteen temporary workers hired by Usina da Pedra, located in the municipality of Serrana, São Paulo, Brazil, were enrolled, at random, in the study, with 15 of them completing the study. Two workers severed their contract with the company during the study period and a third one had to leave due to a personal accident. The group consisted of 13 men and 2 women aged 22–41 years followed during the harvest period of 2003. After information about the study, all agreed and signed a written authorization to be evaluated throughout the harvest period, by means of anthropometric measurements and the collection of two fasting blood samples. As we did not use a control group, ethical clearance was not sought.

The first sample was collected as part of the routine tests required for admission to the company and was used for some additional analyses regarding the biochemical evaluation of nutritional status. Besides nutritional status, work attendance and complaints of pain and cramps were evaluated at the beginning and at the end of this period, through March–October 2003.

Three different dietary supplement products were offered free of charge to all workers throughout the harvest. The products were available in individual plastic containers which were collected by the company after use.

Firstly, powder for a milk drink which was to be consumed was diluted in 250 ml of water (hot or cold) in a thermos bottle and ingested by the workers at the beginning of the working day (5.00 a.m.). The drink provided 20 g of total protein, 32% of which consisted of high biological value protein from powdered whole milk and powdered milk whey. Secondly, manioc flour mixture as a 30-g portion added to the food brought from home at lunchtime and consumed close to 10.00 a.m. Thirdly, powder for oral rehydration consisting of mineral salts, vitamin C and carbohydrates was also diluted in 250 ml of cold water and ingested close to 13.00 p.m.

The sum of the energy supply of the rehydration drink (80 kcal), the milk drink (198 kcal) and the manioc flour mixture (120 kcal) corresponded to ~398 additional calories and 28.5 g of protein (22.5% of animal origin) per working day. Table 1 presents the general nutritional information for the products.


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  		Table 1 Principal nutritional composition of the three complements

 
On the day of blood sample collection, weight and height were measured as well as waist and arm circumferences. The analyses of body composition were carried out using a model 310 Byodinamics bioimpedance instrument, that allows the determination of free fat mass (lean mass) and fat mass in subjects without significant fluid and electrolyte abnormalities, when using specific bioelectrical impedance analysis (BIA) equations and established procedures [6]. Biochemical tests included total serum cholesterol, HDL cholesterol and serum albumin and ferritin.

Differences between the means and standard deviations of the parameters evaluated were analysed by the non-parametric Wilcoxon test, with the level of significance set at P < 0.05.


   Results
Top
 Abstract
 Introduction
 Methods
 Results
Discussion
 Conflicts of interest
 References
 
All supplements were well-accepted during the 8 months period between first and final assessment. Used and empty packages were collected and counted to confirm the distribution to all workers and to prevent littering. Total body water, measured by bioimpedance, was greater than at the beginning of the study (+5.7%). There were no missed days off work with medical certificates related to fluid–electrolyte losses or muscle problems.

Table 2 presents the initial and final values for the anthropometric and biochemical data analysed. There was a small, but significant, weight loss (–2.4%) after the harvest period, with body mass index also significantly reduced, although not sufficiently to alter nutritional status. A significant loss of body fat mass (–15.3%) was observed as determined by bioimpedance, and a significant decrease in arm and waist circumference was also recorded. Lean mass, estimated by the difference between non-fat mass and body water, did not show significant changes.


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  		Table 2 Average values (± standard error) of anthropometric, body composition and biochemical measurements taken before and after the use of complements for 8 months

 
Regarding the biochemical analyses, a positive and significant 12% oscillation was observed in mean serum albumin values, with a small increase in total cholesterol and maintenance of HDL cholesterol. No significant difference was observed in serum ferritin levels.


   Discussion
Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
Conflicts of interest
 References
 
This simple pilot project suggests that nutritional supplements may have a role to play in maintaining nutritional status and preventing dehydration, in sugar cane cutters during the harvest period. There was an improvement in hydration status demonstrated by better work attendance and diminished complaints of pain and cramps during this harvest. The water–electrolyte supplement could be effective in preventing or recovering the electrolyte loss commonly occurring under these conditions and which is responsible for the majority of medical attendances.

For ethical reasons, we did not use a control group of workers but even without a control group it can be assumed that there was maintenance of nutritional status regarding protein and a small loss of body fat. This was possibly provoked by inadequate energy ingestion in relation to the expenditure imposed by the working activity. While the nutritional quality of lunch brought from home was not evaluated, it is likely that the energy value and protein quality are below that required by this group for this activity.

In South Africa, the working day of sugar cane cutters appears to be similar and also occurs under adverse conditions, provoking health problems affecting in particular the eyes, the respiratory apparatus and the musculoskeletal system, with the frequent occurrence of fainting and collapse on sunny days [7]. The monitoring of a group of 12 sugar cane cutters revealed a working day of 7.5 h, with a mean production of 9 tons of cut cane per day, an estimated energy expenditure of 11 695 kJ (2785 kcal) and an energy ingestion of ~5179 kJ (1233 kcal) during work. Despite the ingestion of 6l of fluid, these workers lost, on average, 3% of their body weight after each working day [5].

In Brazil, the living and working conditions and the health problems of sugar cane cutters are not much different from the conditions mentioned above [8]. Angeleli et al. [3] analysed the traditional diet of 14 sugar cane cutters in this same region and observed that, on average, breakfast plus lunch provided 900–1200 kcal, completed by a supper that added 800–1000 kcal, for a total daily energy supply of ~1700–2200 kcal. The offer of more nutritionally adequate lunches for 3 months added 355 kcal and 20 g of protein per day, improving nutritional status (a weight gain of 2.1 kg) and working capacity (ergometric treadmill test).

Extrapolating from the African and the Brazilian studies and with production of up to 12 tonnes of cut sugar cane per day, our workers are likely to have slightly negative energy balance throughout the harvest period, explaining the loss of fat mass. The additional energy (400 kcal) and protein (28 g) would have minimized this loss and contributed to the preservation of lean mass and protein status.

The weight loss evidenced in the African study certainly reflects fluid loss throughout the working day. Electrolyte replacement, together with increased water intake seems to have been efficient in preventing dehydration cases, with no complaints of pain and cramps sufficient to prevent work which commonly occurs otherwise at harvest time. The use of an energy drink (350 additional kcal) also distributed to sugar cane cutters in Guatemala, for almost 23 months, appeared to maintain energy balance without an adverse effect on productivity [9].

We intend to further evaluate the nutritional content of the meals brought to the field and the energy expenditure of this type of working day in order to establish the nutritional significance of these supplements. The expectation is that the labour laws for this sector will undergo transformations aimed at improving the living and working conditions, insuring additional benefits and rights for these workers. While this situation is not established, the use of this type of supplement may help preserve the health and nutritional status of this group.


   Conflicts of interest
Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
 Conflicts of interest
References
 
None declared


   References
Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
 Conflicts of interest
 References
 

  1. Alessi NP and Navarro VL. (1997) Health and work in rural areas: sugar cane plantation workers in Ribeirao Preto, Sao Paulo, Brazil. Cad Saúde Pública 13:(Suppl. 2), 111–121.

  2. Scopinho RA, Eidi F, Vian CEF, Silva PRC. (1999) New technologies and workers' health: mechanization of sugar cane harvesting. Cad Saúde Pública 15:147–161.[Medline]

  3. Angeleli WA, Vichi FL, Vannucchi H, Desai ID, Dutra de Oliveira JE. (1983) Dietary supplementation and improvement in physical work performance of agricultural migrant workers of southern Brazil. Arch Latinoam Nutr 33:158–169.[Web of Science][Medline]

  4. Vannucchi H, Duarte RM, Dutra de Oliveira JE. (1983) Studies on the protein requirement of Brazilian rural workers ("boias frias") given a rice and bean diet. Int J Vitam Nutr Res 53:338–344.[Web of Science][Medline]

  5. Lambert MI, Cheevers EJ, Coopoo Y. (1994) Relationship between energy expenditure and productivity of sugar cane cutters and stackers. Occup Med (Lond) 44:190–194.

  6. Kyle UG, Bosaeus I, De Lorenzo AD, et al. (2004) Bioelectrical impedance analysis—part I: review of principles and methods. Clin Nutr 23:1226–1243.[CrossRef][Web of Science][Medline]

  7. Robins TG, Salie F, Gwagwa T. (1998) Occupational hazards, living conditions, and physical assault of sugar cane workers in KwaZulu-Natal, South Africa. S Afr Med J 88:1117–1127.[Web of Science][Medline]

  8. Arbex MA, Bohm GM, Saldiva PH, Conceicao GM, Pope AC, Braga AL. (2000) Assessment of the effects of sugar cane plantation burning on daily counts of inhalation therapy. J Air Waste Manag Assoc 50:1745–1749.[Web of Science][Medline]

  9. Immink MD, Blake CC, Viteri FE, Flores R, Torun B. (1986) Energy supplementation and productivity of Guatemalan sugar-cane cutters: a longitudinal approach. Arch Latinoam Nutr 36:247–259.[Web of Science][Medline]


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This Article
Right arrow Abstract Freely available
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