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Objective: To examine the micronutrient status of disadvantaged pre-schoolers from Northeast Brazil, following the introduction of pro-poor policies, by assessing the prevalence of anaemia and micronutrient deficiencies and the role of sociodemographic factors, genetic Hb disorders and parasitic infections. Design: In a cross-sectional study, data on sociodemographic status, health, growth, genetic Hb disorders, parasites and nutrient supply from day-care meals were obtained. Fasting blood samples were collected and analysed for Hb, serum ferritin, transferrin receptor, folate, vitamin B 12 , retinol, Zn and Se. Setting: Seven philanthropic day-care centres serving urban slums in Salvador, Northeast Brazil. Subjects: Pre-schoolers aged 3-6 years from disadvantaged households. Results: Of the 376 sampled children, 94 % were of black or mixed race; 33 % and 29 % had at least one genetic Hb disorder and intestinal parasite, respectively. Stunting and underweight were #5 %; 14 % were overweight. Day-care centres supplied micronutrient-dense meals and snacks each weekday. Less than 10 % of pre-schoolers had anaemia and micronutrient deficiencies. Predictors (P , 0?05) of Hb were a 3?7 thalassaemia, Se and retinol (but not ferritin). Micronutrient predictors (P , 0?05) were: elevated a 1 -glycoprotein for ferritin, Hb AS and BMI Z-score .1 for transferrin receptor, Zn and elevated a 1 -glycoprotein for retinol, sex and helminths for Se, helminths for vitamin B 12 , and Giardia intestinalis infection for serum folate. Conclusions: Impaired growth, anaemia and micronutrient deficiencies were uncommon among these disadvantaged pre-schoolers attending day care. A range of interventions including provision of micronutrient-dense, fortified day-care meals, deworming and vitamin A supplementation likely contributed to improved micronutrient status, suggesting expanded coverage of these programmes.

BackgroundEarlier we reported on growth and adiposity in a cross-sectional study of disadvantaged Brazilian preschoolers. Here we extend the work on these children, using structural equation modelling (SEM) to gather information on the complex relationships between the variables influencing height and adiposity. We hope this information will help improve the design and effectiveness of future interventions for preschoolers.MethodsIn 376 preschoolers aged 3–6 years attending seven philanthropic daycares in Salvador, we used SEM to examine direct and indirect relationships among biological (sex, ethnicity, birth order, maternal height and weight), socio-economic, micronutrient (haemoglobin, serum selenium and zinc), and environmental (helminths, de-worming) variables on height and adiposity, as reflected by Z-scores for height-for-age (HAZ) and body mass index (BMIZ).ResultsOf the children, 11 % had HAZ < −1, 15 % had WHZ < −1, and 14 % had BMIZ > 1. Of their mothers, 8 % had short stature, and 50 % were overweight or obese. Based on standardized regression coefficients, significant direct effects (p < 0.05) for HAZ were maternal height (0.39), being white (−0.07), having helminth infection (−0.09), and serum zinc (−0.11). For BMIZ, significant direct effects were maternal weight (0.21), extremely low SES (−0.15), and haemoglobin (0.14). Indirect (p < 0.05) effects for HAZ were sex (being male) (−0.02), helminth infection (−0.01), de-worming treatment (0.01), and serum selenium (−0.02), and for BMIZ were extremely low SES (−0.001), helminth infection (−0.004), and serum selenium (0.02).ConclusionsOf the multiple factors influencing preschoolers’ growth, helminth infection was a modifiable risk factor directly and indirectly affecting HAZ and BMIZ, respectively. Hence the WHO de-worming recommendation should include preschoolers living in at-risk environments as well as school-aged children.

Brazil has implemented pro‐poor social policies but whether they have improved growth, health, and micronutrient status of disadvantaged daycare children in Salvador is unknown. In a cross‐sectional survey we collected data from 376 disadvantaged preschoolers aged 3–6 y in 7 daycares in Salvador on socioeconomic status, growth, daycare meals, parasites, and biomarkers. Prevalence of underweight, wasting, and stunting was low (<10%); 13% had BMIZ‐scores >1SD. Children from very poor households (HHs) had lower somatic growth compared to poor HHs (p<0.01). Nutrient supply from daycare meals was enhanced by Fe and folate fortification and was adequate, despite low energy density (0.79 kcal/g), except for Ca, vitamin A, and B1. 29% were infected with >1 parasite which negatively impacted on retinol, B12, and Se biomarkers (p<0.05), but not on growth. Deworming and vitamin A supplements protected against helminths and Giardia. Anemia, Zn, Se, folate, vitamin A, and B12 deficiencies were low (<10%). In conclusion, some pro‐poor policies were associated with improved health and nutritional status, including provision of fortified daycare meals, deworming, and vitamin A supplementation. Program coverage should be expanded and improvements made to reduce deficits in nutrient supply of meals and parasitic infections. Funded by Interstate Batteries (USA), Human Nutrition and University of Otago Research Fund.

Growth of preschool children from poor urban households of NE Brazil can be affected by multiple factors through complex pathways. Structural equation modelling examined the direct and indirect inter‐relationships between socio‐demographic, biological, environmental, and nutritional factors on z‐scores for height‐for‐age (HAZ) and body‐mass‐index (BMIZ) in a cross‐sectional study of 264 disadvantaged preschoolers aged 3‐6 years in 7 philanthropic daycares in Salvador. Statistically significant (p<0.05) direct effects, as shown by standardized regression coefficients, for i) HAZ were maternal height (0.38), being white (‐0.10), of high birth order (‐0.16), and having a helminth infection (‐0.08); and for ii) BMIZ were maternal weight (0.21), haemoglobin (0.14), and extremely low SES (‐0.19). Significant (p<0.05) indirect effects for i) HAZ were sex (‐0.02) and serum Se (‐0.02); and for ii) BMIZ was having a helminth infection (‐0.003). One of the most complex indirect pathways influencing both stature and ponderal growth involved helminths, which acted on serum Se and then serum Zn. In conclusion, multiple factors influence linear growth and body mass indices of these preschoolers, of which treatment of helminth infections with deworming is a modifiable risk factor with the potential to enhance somatic growth. Grant Funding Source: Funded by University of Otago Research Fund and Nutrition Department PBRF fund