Shifts towards overweight and double burden of malnutrition among socio-economically vulnerable children: a longitudinal ecological analysis of Brazilian municipalities

Silva, Natanael de Jesus; Silva, Rita de Cássia Ribeiro; Rasella, Davide; Alves, Flávia Jôse Oliveira; Campello, Tereza; Fiaccone, Rosemeire Leovigildo; Barreto, Maurício Lima

doi:10.1017/s1368980020004735

Cited by 13 publications

(15 citation statements)

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“…While the prevalence of DBM was found to be stable over the studied period, it reached just over 5 % in children aged 2 years or younger. Although this phenomenon has been well-documented in households and communities throughout the stages of life (37) , very little is known with respect to individuals, especially young children. The underlying basis of DBM is not yet fully understood, but some studies have suggested it is particularly related to inadequate nutrition during the period following conception, resulting in restricted intrauterine growth-which might entail delayed linear growth-and subsequent exposure to 'obesogenic environments' (38,39) .…”

Section: Discussionmentioning

confidence: 99%

Time trends and social inequalities in child malnutrition: nationwide estimates from Brazil’s food and nutrition surveillance system, 2009–2017

Silva

Felisbino-Mendes

et al. 2021

Public Health Nutr.

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Objective: In Brazil, national estimates of childhood malnutrition have not been updated since 2006. The use of health information systems is an important complementary data source for analysing time trends on health and nutrition. This study aimed to examine temporal trends and sociodemographic inequalities in the prevalence of malnutrition in children attending primary health care services between 2009 and 2017. Design: Time trends study based on data from Brazil’s Food and Nutrition Surveillance System. Malnutrition prevalence (stunting, wasting, overweight, and double burden) was annually estimated by sociodemographic variables. Prais-Winsten regression models were used to analyse time trends. Annual percent change (APC) and 95% confidence intervals (95%CI) were calculated. Setting: Primary health care services, Brazil. Participants: Children under five years old. Results: In total, 15,239,753 children were included. An increase in the prevalence of overweight (APC=3.4%; p=0.015) and a decline in the prevalence of wasting (-6.2%; p=0.002) were observed. The prevalence of stunting (-3.2%, p=0.359) and double burden (-1.4%, p=0.630) had discrete and non-significant reductions. Despite the significant reduction in the prevalence of undernutrition among children in the most vulnerable subgroups (black, conditional cash transfer’s recipients, and residents of poorest and less developed areas), high prevalence of stunting and wasting persist alongside a disproportionate increase in the prevalence of overweight in these groups. Conclusions: The observed pattern in stunting (high and persistent prevalence) and increase in overweight elucidates setbacks in advances already observed in previous periods and stress the need for social and political strategies to address multiple forms of malnutrition.

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Section: Discussionmentioning

confidence: 99%

Time trends and social inequalities in child malnutrition: nationwide estimates from Brazil’s food and nutrition surveillance system, 2009–2017

Silva

Felisbino-Mendes

et al. 2021

Public Health Nutr.

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“…This study used the IQDAG [14], developed in Brazil, a upper-middle-income country with similar public health issues regarding maternal and child health as South Africa [11][12][13]. Overall, one in ve participants in the current study had poor dietary quality, while only 2.4% achieved a "good quality" diet.…”

Section: Discussionmentioning

confidence: 95%

“…The nine-component Diet Quality Index Adapted for Pregnant Women (IQDAG) was developed in 2018 in Brazil. Like South Africa, Brazil is an upper LMIC experiencing nutrition transition, a triple burden of malnutrition, and a high prevalence of adverse maternal and birth outcomes [11][12][13]. The IQDAG comprises three food groups: legumes, vegetables and fresh fruit; ve nutrients and components vital to pregnancy: iron, folate, calcium, bre and omega-3 (alpha-linolenic acid); and ultra-processed foods as a moderator component [14].…”

Section: Introductionmentioning

confidence: 99%

Cross sectional analysis of dietary quality among pregnant women in central South Africa: The NuEMI study

Berg

Jordaan

Robb

et al. 2022

Preprint

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Background: During pregnancy, poor dietary quality is linked to maternal complications and poor birth outcomes, but no dietary quality index for pregnancy has been developed using African data. This study aimed to determine the diet quality of South African pregnant women by applying the Diet Quality Index Adapted for Pregnant Women (IQDAG), developed in Brazil, to data collected in the NuEMI (Nutritional status of Expectant Mothers and their newborn Infants) study.Methods: The NuEMI study applied a descriptive study design to collect data from 681 pregnant women visiting an antenatal clinic at a regional hospital in Mangaung, central South Africa. The IQDAG was applied to dietary data collected with a quantitative food frequency questionnaire during structured interviews. Energy and nutrient intakes were quantified with the South African Medical Research Council Food Composition Database. The Women’s Dietary Diversity Score (WDDS) was applied to 24h-recall data obtained during the interviews. Associations of IQDAG scores, nutrient intakes, sociodemographic variables, WDDS and birth anthropometry were explored by contingency tables.Results: Participants had a median age of 31.9 years (IQR: 26.8‒36.7) and a median pregnancy stage of 32.0 weeks (IQR: 26.0‒36.0). The median total dietary quality score (61/100; IQR:53‒68) indicated that most of these women had a suboptimal diet. Only 2.5% had a good dietary quality, reaching at least 80% of the maximum IQDAG score that represents the minimum pregnancy recommendations. The median intakes for none of the nine components of the IQDAQ met the recommendations. Fruit, vegetables, legume, dietary calcium and omega-3 intakes were particularly low, while the intake of ultra-processed foods was above optimal. Most participants consumed only half of the recommended amounts of iron and folate from their diets. IQDAG scores were significantly (p<0.0001) associated with the dietary intakes of most nutrients, even after correction for energy intakes, and with dietary diversity (p<0.0001) and length-for-age z scores at birth (p=0.01).Conclusions: Pregnant women In a South African public health setting had poor to suboptimum dietary quality. Improving the dietary quality of pregnant women in low to middle-income countries would reduce the high financial and human cost of poor birth outcomes and maternal complications. The results also emphasise the importance of prenatal micronutrient supplementation.

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“…Thus, within our model we could determine the joint effect of stunting in children when having an overweight mother, but also the effect of only child stunting. Literature regarding this topic is scarce, especially in Latin America, where most of the manuscripts are focused on cross-sectional analyses reporting changes in the DBM over time 17,[24][25][26] . A cross-sectional study in Peru evaluated data from children under-5 years of age and their mothers, using information from the Demographic Health Surveys from 1996 to 2016, and reported that during this period there was an important increase in the proportion of children with and without undernutrition that have an overweight or obese mother 17 .…”

Section: Comparison With Previous Studiesmentioning

confidence: 99%

Double burden of malnutrition as a risk factor for overweight and obesity

2022

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OBJECTIVE To assess the longitudinal effect of double burden of malnutrition (DBM) on the risk of developing child and adolescent overweight or obesity. METHODS Analysis of the Peruvian Young Lives Study, younger cohort: baseline (2002) and 4 follow-ups (2006–2007, 2009–2010, 2013–2014, and 2016–2017). Outcomes were the incidence of overweight and obesity as defined by the World Health Organization standards. The exposure comprised a variable with 4 categories: non-stunted child with a non-overweight mother (reference group), non-stunted child with an overweight mother, stunted child with a non-overweight mother, and stunted child with an overweight mother (i.e., DBM). Poisson regression models were built to assess the association of interest, and relative risks (RR) and 95%CI were reported. RESULTS Data from 2,034 children; 50.0% were girls and the mean age was 12.0 (3.6) months at baseline. Non-stunted children with an overweight mother had greater risk (RR = 1.64; 95%CI: 1.35–1.99) of developing overweight, compared with the risk for stunted children with a non-overweight mother (RR = 1.38; 95%CI: 1.10–1.72), and for those with DBM (RR = 1.28; 95%CI: 1.02–1.61). When compared with the reference group, obesity risk was greater among non-stunted children with an overweight mother (RR = 2.33; 95%CI: 1.68–3.22), greater among stunted children with a non-overweight mother (RR = 2.59; 95%CI: 1.75–3.84), and greater among those with DBM (RR = 2.14; 95%CI: 1.39–3.28). CONCLUSIONS DBM is a risk factor for childhood overweight and obesity in Peru. Dual-duty policies tackling both undernutrition in children and overweight in mothers are needed to reduce DBM and its future effects in Peru.

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Shifts towards overweight and double burden of malnutrition among socio-economically vulnerable children: a longitudinal ecological analysis of Brazilian municipalities

Cited by 13 publications

References 30 publications

Time trends and social inequalities in child malnutrition: nationwide estimates from Brazil’s food and nutrition surveillance system, 2009–2017

Time trends and social inequalities in child malnutrition: nationwide estimates from Brazil’s food and nutrition surveillance system, 2009–2017

Cross sectional analysis of dietary quality among pregnant women in central South Africa: The NuEMI study

Double burden of malnutrition as a risk factor for overweight and obesity

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