Infant nutrition and growth: trends and inequalities in four population-based birth cohorts in Pelotas, Brazil, 1982-2015

Analysis of the global burden of disease study highlights the global, regional, and national trends of idiopathic epilepsy epidemiology from 1990 to 2019

Epilepsy is a profound disorder, accounting for roughly 1% of the global disease burden. It can result in premature death and significant disability. To comprehensively understand the current dynamics and trends of idiopathic epilepsy, a deep insight into its epidemiological attributes is vital. We evaluated the incidence, prevalence, mortality, and disability-adjusted life years associated with idiopathic epilepsy from 1990 to 2019 using data and methodologies from the Global Burden of Disease Study. In 2019, there were approximately 2,898,222 individuals diagnosed with idiopathic epilepsy. Intriguingly, from 1990 to 2019, the age-standardized incidence rate of idiopathic epilepsy was consistently lower in women compared to men. Over these three decades, global mortality connected to idiopathic epilepsy increased by 13.95%. However, within the same period, age-standardized death rates for idiopathic epilepsy decreased from 1.94 per 100,000 population to 1.46 per 100,000 population. Predictions indicate an increase in the incidence of idiopathic epilepsy across all age brackets through 2035, especially among the elderly aged 80 and above. Mortality rates are projected to climb for those aged 80 and above while remaining relatively unchanged in other age demographics. Idiopathic epilepsy continues to be a significant contributor to both disability and death. The findings of our study underscore the critical importance of incorporating idiopathic epilepsy management into modern healthcare frameworks. Such strategic inclusion can enhance public awareness of relevant risk factors and the range of available therapeutic interventions.

Wealth inequalities in nutritional status among the tribal under-5 children in India: A temporal trend analysis using NFHS data of Jharkhand and Odisha states - 2006-21

Background

Undernutrition remains a major public health concern in India, especially among children belonging to the Scheduled Tribes (ST). In this study, we analyse wealth inequalities in nutritional outcomes within ST communities in two tribal-dominated states of India, namely, Odisha and Jharkhand. The study also compares the trends in nutrition outcomes between ST and Non-ST children in these states.

Methods

We have conducted a trend analysis of the prevalence and inequalities in the nutritional indicators among ST children under age five using unit-level data of the National Family Health Survey (NFHS) [NFHS-3(2005-06),4 (2015-16) and 5(2019-2021)]. Wealth-related inequalities were analysed using the Slope Index of Inequality (SII), which measures absolute inequality, and the relative Concentration Index (CIX), which measures relative inequality. We have also analysed the correlation between Antenatal Care (ANC) visits and nutritional indicators using the Pearson Correlation test.

Results

The trend analysis shows that the prevalence of undernutrition remains higher among ST children in India as compared to Non-ST children between NFHS-3 (2005-06) and NFHS-5 (2019-2020) in Jharkhand and Odisha. The SII and CIX values show that statistically significant inequalities in stunting and underweight exist among children belonging to various wealth quintiles within the ST category in both states. Wasting is found to be significantly prevalent across all wealth quintiles. Also, we found a negative association between ANC visits and all three nutritional indicators.

Interpretation

Our study highlights the importance of monitoring both the absolute and relative wealth inequalities in nutritional outcomes. This is due to the fact that while inequalities across groups may reduce, the prevalence of poor nutritional outcomes may increase among certain groups. Such observations, therefore, will enable policymakers to focus further on those groups and devise appropriate interventions.

Predictive models of newborn body composition: a systematic review

OBJECTIVE

To analyze the prediction models of fat-free mass and fat mass of neonates who had air displacement plethysmography as a reference test.

DATA SOURCE

A systematic review of studies identified in the PubMed, Virtual Health Library (BVS), SciELO, and ScienceDirect databases was carried out. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist was used for inclusion of studies, the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD) report was used to select only predictive models studies, and the Prediction Model Risk of Bias Assessment Tool (PROBAST) was used to assess the risk of bias in the models.

DATA SYNTHESIS

This study is registered in PROSPERO with identification CRD42020175048. Five hundred and three studies were found during the searches, and only four papers (six models) were eligible. Most studies (three) used the sum of different skinfolds to predict neonatal body fat and all presented weight as the variable with the highest contribution to predicting neonatal body composition. Two models that used skinfolds showed high coefficients of determination and explained, significantly, 81% of the body fat measured by air displacement plethysmography, while the models using bioimpedance did not find a significant correlation between the impedance index and the fat-free mass.

CONCLUSIONS

The few studies found on this topic had numerous methodological differences. However, the subscapular skinfold was a strong predictor of neonatal body fat in three studies. It is noteworthy that such model validation studies should be carried out in the future, allowing them to be subsequently applied to the population. The development of these models with low-cost tools will contribute to better nutritional monitoring of children and could prevent complications in adulthood.

Evolution of infant feeding practices in children from 9 to 24 months, considering complementary feeding indicators and food processing: Results from the Brazilian cohort of the MAL‐ED study

Infant feeding practices impact children's nutritional and health status, influencing growth and development. This study aimed to analyse the evolution of infant feeding practices from 9 to 24 months of age, considering infant and young child feeding (IYCF) indicators and food processing. The infant feeding practices in children from the Brazilian site of the MAL‐ED study were evaluated at 9 (n = 193), 15 (n = 182) and 24 months (n = 164) using 24‐h dietary recalls. IYCF indicators were evaluated, and the extent of food processing was evaluated, using the NOVA classification. Breastfeeding declined significantly over time, from 77.6% at 9 months to 45.1% at 24 months. Although dietary diversity did not significantly change during the study period (80.5% at 24 months), the minimum acceptable diet significantly increased from 67.9% to 76.1% at 24 months (p < 0.0005). All the studied children consumed sweetened beverages from 9 months. Unhealthy food consumption and zero vegetable or fruit consumption significantly increased over time (p < 0.0005). Unprocessed food consumption decreased from 9 to 24 months of age (p < 0.0005), while ultra‐processed food consumption increased (p < 0.0005) during the study period. Logistic regressions showed that, at 9 months, breastfed children presented a lower risk for ultra‐processed food consumption (odds ratio [OR] = 0.31; 95% confidence interval [CI] = 0.13–0.77); and children reaching the minimum acceptable diet presented more risk for ultra‐processed food consumption (OR = 2.31; 95% CI = 1.01–5.27). In conclusion, data showed a reduction in the quality of infant feeding practices over the first 2 years of life, with a decrease in breastfeeding and an increase in the consumption of unhealthy and ultra‐processed foods.

Data showed a reduction in the quality of infant feeding practices over the first 2 years of life.

Breastfeeding decreased over the studied period. There was an increase in the consumption of ultra‐processed and unhealthy foods, which occurred concomitantly to the increase of no consumption of fruits/vegetables.

Breastfeeding was an important protective factor against a greater consumption of ultra‐processed food.

National nutrition policy should consider promoting breastfeeding and increasing fresh and minimally processed food consumption in children under 2 years.

[Inequalities in risk behaviors for chronic noncommunicable diseases: Vigitel, 2019]

This study analyzes the economic, racial, and geographic inequalities in risk behaviors for chronic non-communicable diseases of Brazilian adults. This is a cross-sectional study conducted with data from the 2019 Vigitel (Risk and Protective Factors Surveillance System for Chronic Noncomunicable Diseases Through Telephone Interview). The analyzed risk behaviors were smoking, alcohol abuse, physical inactivity, overweight, regular consumption of soft drinks or artificial juice drinks, and non-regular consumption of fruits, legumes, and vegetables. Inequalities in risk behaviors were assessed considering Brazilian's schooling level and their dwelling region, via the slope index of inequality (SII). Equiplots graphs were also built to better illustrate the inequalities. Stata svy command was used for all analyses due to the complexity of the sampling process. In total, 52,395 patients were evaluated. Significant inequalities in risk behaviors for chronic non-communicable diseases were observed: most risk behaviors were concentrated in those with low schooling. Smoking and soft drinks consumption were more observed in the Southern region of Brazil. Public policies are necessary to reduce the inequalities found, allowing for improvement in health indicators of the Brazilian population.

Evaluating the effect of Bolsa Familia, Brazil's conditional cash transfer programme, on maternal and child health: A study protocol

BACKGROUND

Conditional Cash Transfer Programs have been developed in Latin America in response to poverty and marked social inequalities on the continent. In Brazil, the Bolsa Familia Program (BFP) was implemented to alleviate poverty and improve living conditions, health, and education for socioeconomically vulnerable populations. However, the effect of this intervention on maternal and child health is not well understood.

METHODS

We will evaluate the effect of BFP on maternal and child outcomes: 1. Birth weight; 2. Preterm birth; 3. Maternal mortality; and 4. Child growth. Dynamic retrospective cohort data from the 100 Million Brazilian Cohort (2001 to 2015) will be linked to three different databases: Live Birth Information System (2004 to 2015); Mortality Information System (2011 to 2015); and Food and Nutritional Surveillance System (2008 to 2017). The definition of exposure to the BFP varies according to the outcome studied. Those who never received the benefit until the outcome or until the end of the follow-up will be defined as not exposed. The effects of BFP on maternal and child outcomes will be estimated by a combination of propensity score-based methods and weighted logistic regressions. The analyses will be further stratified to reflect changes in the benefit entitlement before and after 2012.

DISCUSSION

Harnessing a large linked administrative cohort allows us to assess the effect of the BFP on maternal and child health, while considering a wide range of explanatory and confounding variables.

Consumption of Added Sugar among Chinese Toddlers and Its Association with Picky Eating and Daily Screen Time

Objectives: This study aimed to examine the relationship between daily screen time, picky eating, and consumption frequency of sugared foods and sugar-sweetened beverages (SSBs). Methods: The research data came from the Young Investigation (YI) study conducted in 10 cities in China. This study used sociodemographic information, feeding behavior, picky eating reported by parents, and the consumption frequency of sugared foods and SSBs of 879 toddlers aged 1−3 years. The relationship between daily screen time and picky eating behavior was assessed using logistic regression. The zero-inflated negative binomial (ZINB) model was used to fit the consumption frequencies of sugared foods and SSBs. Results: In all, 13.1% (n = 115) of toddlers did not have sugared foods 1 month before the survey, while 73.3% (n = 644) of toddlers did not have SSBs 1 month before the survey. The consumption rate of sugared foods was relatively higher than SSBs (χ2 = 661.25, p < 0.001). After adjusting for social demographic information, no relationship was found between daily screen time and picky eating (OR = 1.437; 95% CI: 0.990,2.092). The ZINB model showed that, among children who ate sugared foods, children who were picky eaters ate them more often (IRR = 1.133; 95% CI: 1.095,1.172), but no association was found between picky eating and the chance of avoiding sugared foods (OR = 0.949; 95% CI: 0.613,1.471). Children who were picky eaters were less likely not to drink SSBs (OR = 0.664; 95% CI: 0.478,0.921). However, among children who consumed SSBs, picky eaters drank them less frequently (IRR = 0.599; 95% CI: 0.552,0.650). Children with a screen time of no less than 1 h/d ate sugared foods more frequently (IRR = 1.383; 95% CI: 1.164,1.644), and they were less likely to avoid sugared foods (OR = 0.223; 95% CI: 0.085,0.587). The longer the screen time per day was, the less likely children did not have SSBs (<1 h/d: OR = 0.272; 95% CI: 0.130, 0.569; ≥1 h/d: OR = 0.136; 95% CI: 0.057, 0.328). Conclusions: The consumption rate of sugared foods was higher than that of SSBs. Picky eating and daily screen time were related to the consumption frequency of added sugar among Chinese toddlers aged 1−3 years. Picky eaters consumed sugared foods more frequently and were more likely to drink SSBs. Children whose daily screen time reached 1 h/d were more likely to eat sugared foods and drink SSBs.

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

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 socio-demographic 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 socio-demographic variables. Prais-Winsten regression models were used to analyse time trends. Annual percent change (APC) and 95 % CI were calculated.

SETTING

Primary health care services, Brazil.

PARTICIPANTS

Children under 5 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 elucidate setbacks in advances already observed in previous periods and stresses the need for social and political strategies to address multiple forms of malnutrition.

Regional and socioeconomic disparities in cardiovascular disease in Canada during 2005-2016: evidence from repeated nationwide cross-sectional surveys

Introduction

The objective of this study is to examine the temporal trends and patterns of regional and socioeconomic disparities in cardiovascular disease (CVD) in Canada during 2005–2016.

Methods

A total of 670 000 adults aged ≥20 years who participated in the Canadian Community Health Surveys between 2005 and 2016 were enrolled for this study. CVD referred to heart disease and stroke in this study. Equivalised household income was used as a proxy of socioeconomic status. Absolute and relative socioeconomic inequalities were measured by slope index of inequality (SII) and relative index of inequality (RII), respectively.

Results

In 2015/2016, the overall age-adjusted and sex-adjusted prevalence of heart disease and stroke was 4.80% (95% CI 4.61% to 4.98%) and 1.25% (95% CI 1.13% to 1.36%), respectively. Trend analyses suggested a significant decline in the age-adjusted and sex-adjusted prevalence of heart disease (P for trend <0.001) and a non-significant decline in the age-adjusted and sex-adjusted prevalence of stroke (P for trend=0.058) from 2005 to 2016. Nevertheless, the total number of adults suffering from heart disease and stroke increased by 8.9% and 20.2% over the study period, respectively. Moreover, the age-adjusted and sex-adjusted prevalence of heart disease and stroke varied widely across all health regions, and both of them tended be higher among those with lower income. The SII and RII indicated that there were persistent absolute and relative socioeconomic inequalities in heart disease and stroke across all surveys (eg, SII for heart disease in both sexes, 2005: 0.04 (95% CI 0.03 to 0.04); 2015/2016: 0.03 (95% CI, 0.02 to 0.04); RII for heart disease in both sexes, 2005: 1.99 (95% CI 1.75 to 2.27); 2015/2016: 1.77 (95% CI 1.52 to 2.08).

Conclusion

Geographical and socioeconomic disparities should be taken into account during the further efforts to strengthen preventive measures and optimise healthcare resources for heart disease and stroke in Canada.

Early onset of overweight among children from low-income families: The role of exclusive breastfeeding and maternal intake of ultra-processed food

CONTEXT

There is an increasing prevalence of overweight during early childhood in the most impoverished areas in Brazil, although there is a lack of evidence regarding its onset.

OBJECTIVES

To investigate the incidence and risk factors associated with overweight among low-income children during their first year of life.

METHODS

We analysed data from a prospective birth cohort study conducted in Brazil, which followed-up children at birth, 3rd, 6th and 12th months (n = 196). The overweight incidence (zBMI/A > 2SD) was analysed using the Kaplan-Meier survival estimator and its associated factors by the Coxs regression model. Missing data were addressed with multiple imputations and results on the final adjusted model were calculated by pooling the estimates generated for each imputed dataset.

RESULTS

The overweight incidence was 17 events/100 children-year, and most cases occurred before the 6th month. The final model showed that children exclusively breastfed up to 30 days (vs. >30 days; HR 2.68; 95%CI 1.11-6.49) and whose mothers consumed ultra-processed foods more than 4 times/day (vs. ≤4 times/day; HR 3.02; 95%CI 1.28-7.13) presented a higher risk of developing overweight.

CONCLUSION

The overweight incidence was high in this impoverished population. Shorter exclusive breastfeeding duration and an unhealthy household food environment provided a short-term risk increase.

Trends and Regional Variation in Prevalence of Cardiovascular Risk Factors and Association With Socioeconomic Status in Canada, 2005-2016

IMPORTANCE

Cardiovascular disease remains the second leading cause of death in Canada. Monitoring and tracking the trends and disparities in major cardiovascular risk factors could provide benchmarks for future cardiovascular health strategies.

OBJECTIVE

To investigate the temporal trends, regional variations, and socioeconomic disparities in major cardiovascular risk factors in Canada from 2005 to 2016.

DESIGN, SETTING, AND PARTICIPANTS

This repeated cross-sectional survey study included adults aged 20 years and older from 6 Canadian Community Health Survey cycles between 2005 and 2016. Cardiovascular risk factors included hypertension, diabetes, obesity, and current smoking. Socioeconomic status was measured using equivalized household income. Data analysis was performed from September 2019 to April 2020.

EXPOSURES

A total of 112 health regions and socioeconomic status.

MAIN OUTCOMES AND MEASURES

Age- and sex-adjusted prevalence of hypertension, diabetes, obesity, and current smoking by year; health regions; and socioeconomic status. Absolute numbers were rounded to base 100 for confidentiality purposes, and percentages were based on weighted numbers. Slope index of inequality (SII) and relative index of inequality (RII) were calculated to assess absolute and relative socioeconomic inequalities, respectively.

RESULTS

A total of 670 000 respondents (329 000 [49.1%] men; 341 000 [50.9%] women) aged 20 years and older from 6 survey cycles were enrolled for this study. The largest age group was those aged 40 to 59 years (eg, 2005 cycle: 40.2% [95% CI, 39.9%-40.6%]). In the 2015/2016 cycle, the overall age- and sex-adjusted prevalence rates of hypertension, diabetes, obesity, and current smoking were 20.7% (95% CI, 20.4%-21.1%), 7.2% (95% CI, 7.0%-7.5%), 20.1% (95% CI, 19.7%-20.6%), and 17.8% (95% CI, 17.4%-18.2%), respectively. From 2005 to 2016, there was a significant increase in the prevalence of hypertension, diabetes, and obesity (eg, prevalence of diabetes in both sexes, 2005: 5.8% [95% CI, 5.6%-6.0%]; 2015/2016: 7.2% [95% CI, 7.0%-7.5%]; P < .001) but a significant decrease in the prevalence of current smoking (both sexes, 2005: 22.1% [95% CI, 21.7%-22.5%]; 2015/2016: 17.8% [95% CI, 17.4%-18.2%]; P < .001). The prevalence of all the risk factors varied widely across health regions (eg, obesity, Vancouver Health Service Delivery Area: 6.7% [95% CI, 4.5%-9.0%]; Miramichi Area: 36.8% [95% CI, 27.3%-46.3%]). In addition to obesity among men, all risk factors tended to be more common among those with lower income (eg, prevalence of hypertension in both sexes, 2015/2016, lowest income group: 23.2% [95% CI, 22.4%-24.0%]; highest income group: 18.4% [95% CI, 17.7%-19.1%]). The SII and RII indicated consistent absolute and relative socioeconomic inequalities in hypertension, diabetes, and current smoking over time (eg, RII for hypertension in both sexes, 2005: 1.25; 95% CI, 1.18-1.33; 2015/2016: 1.34; 95% CI, 1.26-1.43). However, the phenomenon of absolute and relative socioeconomic inequalities in obesity was only observed among women (eg, RII for 2015/2016 for obesity in women; 1.74 (95% CI, 1.56-1.93); men: 1.09; 95% CI, 0.99-1.21).

CONCLUSIONS AND RELEVANCE

During the study period, the prevalence of hypertension, diabetes, and obesity significantly increased, while the prevalence of current smoking significantly decreased. Geographic and socioeconomic gaps should be considered and addressed in future interventions and policies targeted at reducing these cardiovascular risk factors in Canada.

A randomized controlled trial testing the efficacy of a Nurse Home Visiting Program for Pregnant Adolescents

To test the efficacy of a nurse home visiting program (HVP) on child development, maternal and environmental outcomes in the first years of life. We conducted a randomized controlled trial to test the efficacy of Primeiros Laços, a nurse HVP for adolescent mothers living in a poor urban area of São Paulo, Brazil. Eighty adolescent mothers were included and randomized to receive either Primeiros Laços (intervention group, n = 40) or healthcare as usual (control group, n = 40). Primeiros Laços is a home visiting intervention delivered by trained nurses that starts during the first 16 weeks of pregnancy and continues to the child's age of 24 months. Participants were assessed by blind interviewers at 8-16 weeks of pregnancy (baseline), 30 weeks of pregnancy, and 3, 6, 12, and 24 months of child's age. We assessed oscillatory power in the mid-range alpha frequency via electroencephalography when the children were aged 6 months. Child development was measured by the Bayley Scales of Infant Development Third Edition (BSID-III). Weight and length were measured by trained professionals and anthropometric indexes were calculated. The home environment and maternal interaction with the child was measured by the Home Observation and Measurement of the Environment. Generalized estimating equation models were used to examine intervention effects on the trajectories of outcomes. Standardized effect sizes (Cohen's d) were calculated using marginal means from endpoint assessments of all outcomes. The trial was registered at clinicaltrial.gov: NCT02807818. Our analyses showed significant positive effects of the intervention on child expressive language development (coefficient = 0.89, 95% CI [0.18, 1.61], p = 0.014), maternal emotional/verbal responsivity (coefficient = 0.97, 95% CI [0.37, 1.58], p = 0.002), and opportunities for variety in daily stimulation (coefficient = 0.37, 95% CI [0.09, 0.66], p = 0.009). Standardized effect sizes of the intervention were small to moderate. Primeiros Laços is a promising intervention to promote child development and to improve the home environment of low-income adolescent mothers. However, considering the limitations of our study, future studies should be conducted to assess Primeiros Laços potential to benefit this population.Clinical Trial Registration: The study was registered at clinicaltrial.gov (Registration date: 21/06/2016 and Registration number: NCT02807818).

Toxic stress, health and nutrition among Brazilian children in shelters

Background

Living in a shelter is an adverse experience that generates toxic stress. This situation can cause the dysregulation of the hypothalamic-pituitary-adrenal axis and exert a negative impact on health.The aim of the present study was to determine the association between toxic stress and social, clinical and nutritional characteristics in children at welfare institutions in a city of northeastern of Brazil.

Methods

An analytical, cross-sectional study was conducted with male and female children up to 60 months of age who live in shelters. Hair cortisol was used for the assessment of stress (immunoassay). The anthropometric data collected were height for age, body mass index for age, arm circumference for age, and head circumference for age (expressed in z-scores). We also evaluated food intake using markers proposed by the Brazilian Dietary and Nutritional Vigilance Surveillance System as well as the occurrence of dental caries and anemia.

Results

Sixty-three children one to 60 months of age participated in the present study. Asthma was the most frequent disease (11.1%). The prevalence of short stature, anemia and dental caries in the sample was 22.2, 22.2 and 9.4%, respectively. Cortisol levels ranged from 0.93 pg/mg to 391.29 pg/mg (median: 6.17 pg/mg). Higher cortisol levels were found in children with illnesses (p = 0.012) and those who had been hospitalized after being admitted to the institutions (p = 0.001).

Conclusions

The majority of children had unhealthy eating behavior. The cortisol concentrations found in the present study were suggestive of dysregulation of the hypothalamic-pituitary-adrenal axis. Hypercortisolism was associated with illness and hospitalization.

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

OBJECTIVE

To investigate the shifts and factors associated with different scenarios resulting from the prevalence of child stunting and overweight in Brazilian municipalities.

DESIGN

This is an ecological study using municipality-level panel data of stunting and overweight prevalence and socio-economic characteristics from 2008 to 2014. The municipalities were classified according to the WHO-UNICEF prevalence thresholds for stunting and overweight and were categorised into four nutritional scenarios: no burden (prevalence of stunting < 20 % and overweight < 10 %), stunting burden (prevalence of stunting ≥ 20 % and overweight < 10 %), overweight burden (prevalence of stunting < 20 % and overweight ≥ 10 %) and double burden (prevalence of stunting ≥ 20 % and overweight ≥ 10 %).

SETTING

Totally, 4443 Brazilian municipalities.

PARTICIPANTS

Aggregated data of children under 5 years old enrolled in the Brazil's conditional cash transfer programme (Bolsa Família).

RESULTS

A mean reduction from 14·2 % to 12·7 % in the prevalence of stunting and an increase from 17·2 % to 18·4 % in the prevalence of overweight were observed. The predominant scenarios were overweight burden and double burden. The odds of both scenarios increased with higher gross domestic product (GDP) per capita and decreased with higher unemployment rates. Stunting and double burden decreased with higher expected years of schooling, and stunting burden increased with household crowding.

CONCLUSION

Our findings indicate an advanced nutrition transition stage in Brazil, associated mainly with municipal GDP per capita growth, which has contributed to increasing the burden of overweight alone or coexisting with stunting (double burden) among children in the most socio-economically vulnerable strata of the population.

Ethnic inequalities in child stunting and feeding practices: results from surveys in thirteen countries from Latin America

Background

Although the prevalence of child stunting is falling in Latin America, socioeconomic inequalities persist. However, there is limited evidence on ethnic disparities. We aimed to describe ethnic inequalities of stunting and feeding practices in thirteen Latin American countries using recent nationally representative surveys.

Methods

We analyzed national surveys carried out since 2006. Based on self-reported ethnicity, skin color or language, children were classified into three categories: indigenous/ afrodescendant/reference group (European or mixed ancestry). Stunting was defined as height (length)-for-age < − 2 standard deviations relative to WHO standards. Family wealth was assessed through household asset indices. We compared mean length/height-for-age and prevalence of stunting among the three ethnic groups.

Results

Thirteen surveys had information on indigenous and seven on afrodescendants. In all countries, the average length/height-for-age was significantly lower for indigenous, and in eleven countries there were significant differences in the prevalence of stunting: the pooled crude stunting prevalence ratio between indigenous and the reference group was 1.97 (95% CI 1.89; 2.05); after adjustment for wealth and place of residence, prevalence remained higher among indigenous (PR = 1.34, 95% CI 1.28; 1.39) in eight countries. Indigenous aged 6–23 months were more likely to be breastfed, but with poor complementary feeding, particularly in terms of dietary diversity. Afrodescendants showed few differences in height, and in two countries tended to be taller compared to the reference group.

Conclusions

In all Latin American countries studied, indigenous tended to be shorter and afrodescendants presented few differences with relation to the reference group. In order to reach the SDG’s challenge of leaving no one behind, indigenous need to be prioritized.

Lifetime overweight and adult asthma: 1978/1979 Ribeirão Preto Birth Cohort, São Paulo, Brazil

Studies focusing on obesity and asthma frequently consider the weight at a given time; thus, modeling pathways through lifetime overweight may contribute to elucidate temporal aspects in this relationship. This study modeled the pathways in the association of lifetime overweight with asthma in adult life, using data from the 1978/1979 Birth Cohort, Ribeirão Preto, São Paulo, Brazil (n = 2,063) at birth (baseline), school age (9/11 years) and adult age (23/25 years). A theoretical model was proposed to explore the effects of lifetime overweight on asthma in adult life analyzed by structural equation modeling. Parental obesity (SC - standardized coefficenttotal = 0.211, p < 0.001; SCdirect = 0.115, p = 0.007) and overweight at school age (SCtotal = 0.565, p < 0.0001; SCdirect = 0.565, p < 0.0001) were associated with overweight in adult life. Parental obesity (SCdirect = 0.105, p = 0.047) and nutritional status at birth (SCtotal = -0.124, p = 0.009; SCdirect = -0.131, p = 0.007) were associated with asthma in adult life. A higher "current adult socieconomic situation" was inversely associated to overweight (SCdirect = -0.171, p = 0.020) and to asthma in adult life (SCtotal = -0.179, p = 0.041; SCdirect = -0.182, p = 0.039). Parental obesity showed a transgenerational effect in weight, triggering to childhood and adulthood overweight. Parallel to underweight at birth, parental obesity was also a risk to asthma in adult life. While, the socioeconomic status in adult life protected from both, overweight and asthma.

Trends and inequalities in maternal and child health in a Brazilian city: methodology and sociodemographic description of four population-based birth cohort studies, 1982-2015

Background

Few low-middle-income countries have data from comparable birth cohort studies spanning over time. We report on the methods used by the Pelotas cohorts (1982, 1993, 2004 and 2015) and describe time trends in sociodemographic characteristics of the participant families.

Methods

During the four study years, all maternity hospitals in the city were visited daily, and all urban women giving birth were enrolled. Data on socioeconomic and demographic characteristics were collected using standardized questionnaires, including data on maternal and paternal skin colour, age and schooling, maternal marital status, family income and household characteristics. The analyses included comparisons of time trends and of socioeconomic and ethnic group inequalities.

Results

Despite a near 50% increase in the city’s population between 1982 and 2015, the total number of births declined from 6011 to 4387. The proportion of mothers aged ≥35 years increased from 9.9% to 14.8%, and average maternal schooling from 6.5 [standard deviation (SD) 4.2] to 10.1 (SD 4.0) years. Treated water was available in 95.3% of households in 1982 and 99.3% in 2015. Three-quarters of the families had a refrigerator in 1982, compared with 98.3% in 2015. Absolute income-related inequalities in maternal schooling, household crowding, household appliances and access to treated water were markedly reduced between 1982 and 2015. Maternal skin colour was associated with inequalities in age at childbearing and schooling, as well as with household characteristics.

Conclusions

During the 33-year period, there were positive changes in social and environmental determinants of health, including income, education, fertility and characteristics of the home environment. Socioeconomic inequality was also reduced.

Hospital admissions in the first year of life: inequalities over three decades in a southern Brazilian city

BACKGROUND

Hospital admissions in infancy are declining in several countries. We describe admissions to neonatal intensive care units (NICU) and other hospitalizations over a 33-year period in the Brazilian city of Pelotas.

METHODS

We analysed data from four population-based birth cohorts launched in 1982, 1993, 2004 and 2015, each including all hospital births in the calendar year. NICU and other hospital admissions during infancy were reported by the mothers in the perinatal interview and at the 12-month visit, respectively. We describe these outcomes by sex of the child, family income and maternal skin colour.

RESULTS

In 1982, NICUs did not exist in the city; admissions into NICUs increased from 2.7% of all newborns in 1993 to 6.7% in 2015, and admission rates were similar in all income groups. Hospitalizations during the first year of life fell by 29%, from 23.7% in 1982 to 16.8% in 2015, and diarrhoea admissions fell by 95.2%. Pneumonia admissions fell by 46.3% from 1993 to 2015 (no data available for 1982). Admissions due to perinatal causes increased during the period. In the poorest income quintile, total admissions fell by 33% (from 35.7% to 23.9%), but in the richest quintile these remained stable at around 10%, leading to a reduction in inequalities. Over the whole period, children born to women with black or brown skin were 30% more likely to be admitted than those of white-skinned mothers.

CONCLUSIONS

Whereas NICU admissions increased, total admissions in the first year of life declined by nearly one-third. Socioeconomic disparities were reduced, but important gaps remain.

Early determinants of linear growth and weight attained in the first year of life in a malaria endemic region

We investigated linear growth and weight attained among 772 children at 10–15 months of age in the first population-based birth cohort in the Brazilian Amazon. Sociodemographic, maternal and birth characteristics were collected in interviews soon after birth at baseline. Anthropometric evaluation was conducted at 10–15 months. Multiple linear regression models were fitted for length-for-age (LAZ) and body mass index (BMI)-for-age Z scores (BAZ), considering a hierarchical conceptual framework with determinants at distal, intermediate and proximal levels, with adjustment for the child’s sex and age. Mean LAZ and BAZ were 0.31 (SD: 1.13) and 0.35 (SD: 1.06), respectively. Overall, 2.2% of children were stunted and 6.6% overweight. Among socioeconomic factors, household wealth index was positively associated with LAZ (p for trend = 0.01), while children whose families received assistance from the Bolsa Família conditional cash transfer program were 0.16 Z score thinner (95% CI: -0.31, -0.00). Maternal height and BMI were positively associated with both LAZ and BAZ at 10–15 months of age (p for trend <0.001). Child’s size at birth was positively related with LAZ (p<0.001 for both birth weight and length). BAZ was 0.34 (95% CI: 0.24, 0.44) higher, but 0.11 lower (95% CI: -0.21, -0.02), for each increase in 1 Z score of birth weight and length, respectively. Children with at least one reported malaria episode within the first year of life were 0.58 (95% CI: -1.05, -0.11) Z score shorter. Socioeconomic and intergenerational factors were consistently associated with LAZ and BAZ at 10–15 months of age. The occurrence of malaria was detrimental to linear growth. In a malaria endemic region, reduction of inequalities and disease burden over the first 1,000 days of life is essential for taking advantage of a critical window of opportunity that can redirect child growth trajectories toward better health and nutrition conditions in the long term.

Maternal anthropometry: trends and inequalities in four population-based birth cohorts in Pelotas, Brazil, 1982-2015

BACKGROUND

Pre-pregnancy nutritional status and weight gain during pregnancy have short- and long-term consequences for the health of women and children. This study was aimed at evaluating maternal height,- and overweight or obesity at the beginning of the pregnancy and gestational weight gain, according to socioeconomic status and maternal skin colour of mothers in Pelotas, a southern Brazilian city, in 1982, 1993, 2004 and 2015.

METHODS

In 1982, 1993, 2004 and 2015, the maternity hospitals in Pelotas were visited daily, all deliveries were identified and mothers who lived in the urban area of the city were interviewed. Maternal weight at the beginning of the pregnancy was self-reported by the mother or obtained from the antenatal card. Maternal height was collected from the maternity records or measured by the research team. Overweight or obesity was defined by a body mass index ≥25 kg/m2. Gestational weight gain was evaluated according to the Institute of Medicine guidelines.

RESULTS

In the four cohorts, we evaluated 19 931 women. From 1982 to 2015, the prevalence of overweight or obesity at the beginning of the pregnancy increased from 22.1% to 47.0% and height increased by an average of 5.2 cm, whereas gestational weight gain did not change. Socioeconomic status was positively associated with maternal height, and the difference between the poorest and the wealthiest decreased. Overweight or obesity was lower among those mothers in the extreme categories of family income.

CONCLUSIONS

Over the 33-year span, mothers were taller at the beginning of the pregnancy, but the prevalence of overweight or obesity more than doubled.