Association Between Interpersonal Violence With Inadequate Nutritional Status Among Brazilian Adolescents

Abstract

Research focusing on the relationship between interpersonal violence and nutritional status in adolescence is scarce and has distinct results. The objective of this study is to investigate the association of family physical and sexual violence with inadequate nutritional status in Brazilian adolescents. We used data from the 2015 Brazilian National Survey of School Health. This study includes 11.850 students, older than 13 years, attending from sixth to ninth grade of elementary school and from the 1st to the 3rd year of high school. The exposures were family physical violence and rape. The outcome was nutritional status, assessed through body mass index. The association between exposures and outcome were investigated using a multinomial logistic regression model. These analyses were adjusted for demographic, socioeconomic, and family variables. The prevalence of family physical violence victimization was approximately 14% among adolescents for both sexes. The prevalence of rape was 4.6% and 5.7% among male and female adolescents, respectively. Family physical violence was not associated with being underweight, overweight, or obese, in either crude or adjusted models for both sexes. Sexual violence was inversely associated with being underweight only for male adolescents (OR: 0.21, CI 95%: 0.06–0.75). In female adolescents, sexual violence was associated with overweight/obesity (OR: 1.64, CI 95%:1.15–2.33). In this study, rape, but not family physical violence victimization, was associated with nutritional status in adolescents of both sexes. Nonetheless, this association was different between boys and girls. Rape was inversely associated with being underweight in male adolescents, whereas, in female adolescents, it was associated with excess body weight.

Childhood and adolescent nutrition outcomes among girls exposed to gender-based violence: A rapid evidence assessment of quantitative research

“…In the articles we reviewed, exposure to sexual abuse in school aged girls was associated with elevated BMI in late childhood, peri-puberty (ages 6–11), and late adolescence into early adulthood. Importantly, we noted that in Martin and Martin, (2010) [ 64 ], Peckins et al, (2019) [ 57 ], Elsenburg et al, (2022) [ 71 ], and Souza Marques et al, (2022) [ 66 ], such relationships were only noted among girls, thereby suggesting the importance of conducting a sex-stratified analysis. Other studies have also examined the nutritional impact of adverse childhood life events, including one systematic review focused on the relationship between ACEs more generally and childhood obesity among both boys and girls, which highlighted that sexual abuse appears to have a greater effect on childhood obesity than other ACEs and particularly among girls [ 43 ].…”

“…The following forms of GBV were measured: child marriage [ 61 , 68 ], sexual assault and rape [ 63 , 65 , 66 ], CSA perpetrated by parents/caregivers [ 41 , 56 – 59 , 62 , 64 , 67 , 69 – 71 ], and dating violence/IPV [ 60 ] ( Table 6 ). Some studies did not use validated survey instruments to measure GBV [ 63 , 65 – 67 , 70 , 71 ], and in some cases relied on a single question to assess girls’ GBV exposure [ 63 , 66 , 67 ]. Clark et al, (2014) [ 60 ] employed the Conflict and Tactics Scale, which is a widely used and validated instrument.…”

“…In addition, other nutrition indicators that were assessed included height for age, weight for height, height for younger children, leg length, waist circumference, fat mass index, android fat percentage, mid-upper arm circumference (MUAC), and anemia among the older children and adolescents. Height and weight were assessed using either anthropometric measurements [ 41 , 56 – 61 , 64 , 66 , 67 , 69 – 71 ] or self-reported height and weight (which may be affected by recall error or bias based on context dependent body ideals) [ 63 , 69 , 72 ]. Either weight for height or BMI were calculated as appropriate according to participants’ ages and operationalized for analysis using different methods [ 73 , 74 ].…”

“…Exposure to CSA and adolescent exposure to intimate partner/dating violence was further positively associated with elevated BMI. Marques et al (2021) examined the relationship between exposure to rape and overweight/obesity among female adolescents over 13 years in Brazil, concluding that rape was positively and significantly associated with overweight and obesity among girls [ 66 ]. Veldwijk et al, (2012) [ 63 ] analyzed the relationship between sexual assault perpetrated by adults or peers and the presence of underweight, overweight, and obesity among adolescents between 13 and 16 years in the Netherlands.…”

“…The only significant association found indicated that exposure to sexual abuse lowered the odds of being underweight. Using cross-sectional data from Brazil, Souza Marques et al, (2022) reported that for adolescent girls (attending school), forced sexual intercourse was positively related to overweight/obesity versus normal BMI and for adolescent males, forced sexual intercourse increased the odds of underweight versus normal BMI [ 66 ]. The only null result came from Anderson et al’s (2015) [ 75 ] study; these results stemmed from a simple bivariate analysis between forced sex and overweight.…”