Stunting and overweight among children in Northeast Brazil: prevalence, trends (1992-2005-2015) and associated risk factors from repeated cross-sectional surveys

Association of parental level of education and child factors on length-for-age indicator among socially vulnerable children aged 6-24 months from a Brazilian state using structural equation modelling

This cross-sectional study employs structural equation modelling (sEM) to explore both direct and indirect effects of parental level of education and child individual factors on the length-for-age outcomes in children aged 6-24 months assisted by the Bolsa Família Program in the State of Alagoas. A total of 1448 children were analysed by the sEM technique. A negative standardised direct effect (sDE) of the children's younger age (sDE: -0·06; P = 0·017), the use of bottle feeding (sDE: -0·11; P < 0·001) and lack of a minimum acceptable diet (sDE: -0·09; P < 0·001) on the length-for-age indicator was found. Being female (SDE: 0·08; P = 0·001), a higher birth weight (SDE: 0·33; P < 0·001), being ever breastfed (sdE: 0·07; P = 0·004) and a higher level of parental education (SDE: 0·09; P < 0·001) showed a positive SDE effect on the child's length-for-age. The model also demonstrated a negative standardised indirect effect (SIE) of the sweet beverage consumption (SIE: -0·08; P = 0·003) and a positive effect of being ever breastfed (SIE: 0·06; P = 0·017) on the child's length-for-age through parental level of education as a mediator. This research underscores the crucial role of proper feeding practices and provides valuable insights for the development of targeted interventions, policies and programmes to improve nutritional well-being and promote adequate linear growth and development among young children facing similar challenges.

Early introduction of ultra-processed foods is associated with overweight and anaemia in socially vulnerable Brazilian children

This study aimed to evaluate the early introduction of ultra-processed foods (UPF) and identify its association with overweight and anaemia in Brazilian children living in a situation of social vulnerability. A population-based cross-sectional study was conducted in a Brazilian capital. Children aged 12-59 months were included. The presence of overweight and anaemia was evaluated, as well as the introduction of twelve different UPF in children's first year of life. Association analysis was performed using Poisson regression, with robust estimates of variances. A total of 561 children were studied; 85·5 % had consumed at least one UPF evaluated in the first year of life; 19·1 % were overweight and 52·0 % were anaemic. Adjusted multivariate analyses identified that the early introduction of soft drinks (Prevalence Ratio (PR) = 1·18, 95 % CI (1·02, 1·38)), packaged snacks (PR = 1·17, 95 % CI (1·05, 1·30)) and powdered soft drinks (PR = 1·36, 95 % CI (1·16, 1·60)) increased the likelihood of children being overweight, and the early introduction of chocolate drink (PR = 1·25, 95 % CI (1·02, 1·53)) increased the likelihood of them being anaemic, when comparing children who consumed these UPF before reaching 1 year of age with those who consumed these foods at 12 months of age or older. From the results found, one can see the existing relationship between the early introduction of UPF with overweight and anaemia, being necessary to intensify public health policies to combat malnutrition, focusing on the promotion of proper and healthy eating, especially during the phase of food introduction, focusing on the population living in socially vulnerable situations.

Ethnoracial disparities in childhood growth trajectories in Brazil: a longitudinal nationwide study of four million children

BACKGROUND

The literature contains scarce data on inequalities in growth trajectories among children born to mothers of diverse ethnoracial background in the first 5 years of life.

OBJECTIVE

We aimed to investigate child growth according to maternal ethnoracial group using a nationwide Brazilian database.

METHODS

A population-based retrospective cohort study employed linked data from the CIDACS Birth Cohort and the Brazilian Food and Nutrition Surveillance System (SISVAN). Children born at term, aged 5 years or younger who presented two or more measurements of length/height (cm) and weight (kg) were followed up between 2008 and 2017. Prevalence of stunting, underweight, wasting, and thinness were estimated. Nonlinear mixed effect models were used to estimate childhood growth trajectories, among different maternal ethnoracial groups (White, Asian descent, Black, Pardo, and Indigenous), using the raw measures of weight (kg) and height (cm) and the length/height-for-age (L/HAZ) and weight-for-age z-scores (WAZ). The analyses were also adjusted for mother's age, educational level, and marital status.

RESULTS

A total of 4,090,271 children were included in the study. Children of Indigenous mothers exhibited higher rates of stunting (26.74%) and underweight (5.90%). Wasting and thinness were more prevalent among children of Pardo, Asian, Black, and Indigenous mothers than those of White mothers. Regarding children's weight (kg) and length/height (cm), those of Indigenous, Pardo, Black, and Asian descent mothers were on average shorter and weighted less than White ones. Regarding WAZ and L/HAZ growth trajectories, a sharp decline in average z-scores was evidenced in the first weeks of life, followed by a period of recovery. Over time, z-scores for most of the subgroups analyzed trended below zero. Children of mother in greater social vulnerability showed less favorable growth.

CONCLUSION

We observed racial disparities in nutritional status and childhood growth trajectories, with children of Indigenous mothers presenting less favorable outcomes compared to their White counterparts. The strengthening of policies aimed at protecting Indigenous children should be urgently undertaken to address systematic ethnoracial health inequalities.

[Temporal trend in the prevalence of malnutrition in children under five assisted by the Brazilian Income Transfer Program (2008-2019)]

This study aimed to analyze the temporal trend of malnutrition in children aged under five years assisted by the Brazilian Income Transfer Program from 2008 to 2019, by exploring regional inequalities and seeking to determine the impact of the economic and political crises aggravated in 2014, and the government's adherence to fiscal austerity policies on the trend. The analyses were performed using aggregated data from infants (0-23 months) and preschoolers (24-59 months), extracted from the Brazilian Food and Nutritional Surveillance System (SISVAN) assisted by the Brazilian Income Transfer Program (n = 34,272,024). Trends were analyzed using generalized linear models with age-specific mixed effects (negative binomial distribution and log linkage function). The regional inequalities were analyzed based on the grouping of Federative Units according to the Social Vulnerability Index (SVI) and the influence of crises and austerity policies on the prevalence of malnutrition by the interaction between "year" and "crisis" (2008-2013 vs. 2014-2019). There was a reduction in the prevalence of child malnutrition until mid-2013, when the trends became stationary for preschoolers and upward for infants. There was also a higher risk of malnutrition in Federative Units with medium- and high-social vulnerability, when compared to those with low-social vulnerability. The inflection points in the trends corroborate the hypothesis that the political and economic crises, and the governmental responses to these crises, negatively impacted the nutritional status of children in poverty and extreme poverty in Brazil.

Stunting disparities and its associated factors among preschool children of employed and unemployed mothers in Gondar City: a comparative community-based cross-sectional study

Introduction

A stunted child refers to a child who is too short for his/her age, which is the most common cause of morbidity and mortality in children under five in developing countries. Stunting in preschool children is caused by a multitude of socioeconomic and child-related factors, including the employment status of women. This study aimed to compare the prevalence and factors associated with stunting of preschool children among employed and unemployed mothers in Gondar city, Northwest Ethiopia, in 2021.

Methods

From 30 February to 30 March 2021, a community-based comparative cross-sectional study was conducted among 770 preschool children of employed and unemployed mothers in Gondar city. A structured questionnaire-based interview with anthropometric measurements was used to collect data. A multi-stage sampling technique was used. Data were entered into EPI Info version 7.22 and transferred to Stata version 14 for further analysis. To identify factors associated with stunting, a binary logistic regression analysis was used. The presence of an association was declared based on a p-value of <0.05 and confidence intervals.

Results

A total of 770 preschool children participated in the study. The overall prevalence of stunting among preschool children was 39.7% (95% CI: 36.3-43.2). The prevalence was higher among preschool children of employed mothers (42.6%) (95% CI: 37.6-47.5) than among unemployed mothers (36.7%) (95% CI: 32.0-41.7). Maternal age [AOR = 2.8, 95% CI: 1.26-6.34] and wealth status [AOR = 0.32, 95% CI: 0.18-0.57] were significantly associated with stunting among unemployed mothers, while family size [AOR = 7.19, 95% CI: 2.95-17.5], number of children under the age of five [AOR = 1.92, 95% CI: 1.12-3.29], and having a home servant [AOR = 0.126, 95% CI: 0.06-0.26] were associated with stunting of preschool children among employed mothers.

Conclusion

Stunting is more common in preschool children of employed mothers than in those of unemployed mothers. As a result, interventions such as raising awareness among employed mothers to devote time and care to their children, as well as concerned bodies assisting women with preschool or under-five children, is required. The nutrition intervention should focus on encouraging dietary diversity to combat the existing nutrition-associated stunting in children. Similarly, further research on the difference between employed and unemployed mothers' child stunting status as well as an investigation of extra variables such as the number of hours worked by an employed mother is also recommended to upcoming researchers.

Is It Important to Increase Physical Activity Among University Students During the Second-Wave COVID-19 Pandemic in Asian Countries? A Cross-Sectional Study of the Knowledge, Attitudes, and Practices in Asian Countries

Background

Difficulties in exercising have occurred for the entire world’s population during this COVID-19 pandemic, especially in the second wave at the end of 2021. Most worrying is the lack of physical activity in young adults, as lack of exercise will increase the risk of noncommunicable diseases in the future. The youth such as university student can be agents of change, to increase physical activity, from sedentary to sport life. This study aimed to determine the relationship between knowledge, attitudes, and actions of university students and the correlation between the related variables.

Methods

This study is a cross-sectional observational study involving 458 Asian university students based on Asian and African nationalities. This research was conducted from December 2021 to January 2022, during the second wave of the COVID-19 pandemic in Asia. The variables studied were the knowledge, attitudes, and actions of university students with regard to sports, and the statistical test used was the Chi-squared test.

Results

The results showed that the research subjects were mainly from Indonesia and India (95.8%), there were more women than men (69.9% vs 30.1%), the most common age range was 18–20 years (61.4%), and 45.4% had a normal body mass index. In total, 48.3% had high knowledge, 93.4% had a positive attitude, and 34.7% had good practice. There was a significant relationship between knowledge and attitude (p=0.002) but not with action.

Conclusion

This study found that good knowledge was associated with a good attitude, but due to the COVID-19 pandemic with activity restrictions on university students, there was no relationship with action.

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Uncovering the Research Gaps to Alleviate the Negative Impacts of Climate Change on Food Security: A Review

Climatic variability has been acquiring an extensive consideration due to its widespread ability to impact food production and livelihoods. Climate change has the potential to intersperse global approaches in alleviating hunger and undernutrition. It is hypothesized that climate shifts bring substantial negative impacts on food production systems, thereby intimidating food security. Vast developments have been made addressing the global climate change, undernourishment, and hunger for the last few decades, partly due to the increase in food productivity through augmented agricultural managements. However, the growing population has increased the demand for food, putting pressure on food systems. Moreover, the potential climate change impacts are still unclear more obviously at the regional scales. Climate change is expected to boost food insecurity challenges in areas already vulnerable to climate change. Human-induced climate change is expected to impact food quality, quantity, and potentiality to dispense it equitably. Global capabilities to ascertain the food security and nutritional reasonableness facing expeditious shifts in biophysical conditions are likely to be the main factors determining the level of global disease incidence. It can be apprehended that all food security components (mainly food access and utilization) likely be under indirect effect via pledged impacts on ménage, incomes, and damages to health. The corroboration supports the dire need for huge focused investments in mitigation and adaptation measures to have sustainable, climate-smart, eco-friendly, and climate stress resilient food production systems. In this paper, we discussed the foremost pathways of how climate change impacts our food production systems as well as the social, and economic factors that in the mastery of unbiased food distribution. Likewise, we analyze the research gaps and biases about climate change and food security. Climate change is often responsible for food insecurity issues, not focusing on the fact that food production systems have magnified the climate change process. Provided the critical threats to food security, the focus needs to be shifted to an implementation oriented-agenda to potentially cope with current challenges. Therefore, this review seeks to have a more unprejudiced view and thus interpret the fusion association between climate change and food security by imperatively scrutinizing all factors.

Consumption of Ultra-Processed Foods in Brazilian Children: An Analysis of Regional Trends

PURPOSE

Childhood obesity has become a concern for the Brazilian Unified Health System, which has recently started to investigate children's eating habits in basic health units. This study examined the trends and ultra-processed foods (UPF) consumption in Brazilian children.

DESIGN AND METHODS

This repeated cross-sectional study included 492,630 children (2-9 years old), from different Brazilian regions, in the years 2015 and 2019. The children's food consumption was assessed by nurses using a nationally standardized instrument. Information was provided by the Food and Nutrition Surveillance System Brazilian.

RESULTS

The UPF consumption in Brazilian children is generally high and was higher among children in the South and Midwest regions. The consumption of sweetened beverages was more prevalent among all the UPF assessed and continues to increase among children in the Northeast region. Declining trends in UPF consumption were observed in children from all regions, except for the Northeast region, whose trends increased in almost all evaluated foods.

PRACTICE IMPLICATIONS

Nurses, especially, have a primary role in guiding the reduction of UPF consumption, as they are the first health professionals to have access to this information. Increasing trends in UPF consumption can be mitigated by the inclusion of nutritionists in basic health units. Brazilian children need to be assisted by public policies that promote food education.

Increasing Mothers’ Knowledge of Infant and Young Child Feeding through Booklets in Banggai Regency, Central Sulawesi Province, Indonesia

Background: Stunting is caused in part by feeding behavior in infants and young children. Knowledge is the most important factor in shaping one's attitude and behavior, particularly when it comes to infants and young children feeding. This study aims to find out how the mothers’ knowledge of infant and child feeding could be increased through booklets in Banggai Regency, Central Sulawesi Province, Indonesia. Method: This study is a quasi-experimental non-randomized study with pre and post-test only control design. Study was conducted in Jayabakti Village, Banggai Regency. Sample consisted of 40 mothers of children under five collected with purposive sampling method from October to December 2020. At the local Integrated Health Service Post, booklets were distributed once a month as part of the study intervention. Over the duration of the three-month study period, booklets were distributed three times. The used booklets were the modified version of the WHO-developed Infant and Young Child Feeding Counseling: An Integrated Course. The mean difference was used to compare the results of the pre- and post-tests on knowledge of infant and young child feeding. The hypothesis test was applied with a 95% confidence level of 0.05. Result: The respondents with ages ranging between 15 and 20 were 42.5%. Mothers graduated from senior high schools were 45%. Mothers that had three children were 55.0%. Family income was 586,000 rupiahs in average. After the booklets distribution for three months, there was an increase in the mothers’ knowledge regarding infant and young child feeding. The older the mother's age, the better her knowledge (p=0,015). Factors of children's age and mother's education did not have a significant effect. Conclusion: Mothers knowledge regarding infant and young child feeding at Banggai Regency Central of Sulawesi is generally good. After using the booklets, their knowledge has increased. With time, the mother's knowledge expands. Formal education has no significant effect on infants and young children nutrition knowledge

[Trend in the prevalence of anemia in children from maroon communities according to two population-based surveys in Alagoas State, Brazil (2008-2018)]

The study aimed to assess trends in the prevalence of anemia in children from quilombos (maroon communities) in Alagoas State, Brazil. This was a descriptive study comparing the results of two household surveys (2008; n = 950 and 2018; n = 426), involving a sample of children from 6 to 59 months of age. Anemia was diagnosed as hemoglobin < 110g/L (HemoCue). Prevalence rates between the two surveys were described by percentage and by prevalence ratio (PR) and 95% confidence interval (95%CI), calculated by Poisson regression. Prevalence rates for anemia in 2008 and 2018 were 53% (95%CI: 49.8-56.1) and 38% (95%CI: 33.4-42.6), respectively, or a decrease of 28.3% (RP = 0.72; 95%CI: 0.63-0.82). Children 6 to 24 months of age had higher anemia rates than those 25 to 59 months of age, both in 2008 (72% vs. 44%) and in 2018 (54.8% vs. 28.3%). There was a reduction in prevalence in both age brackets (23.9% and 35.7%, respectively). This sharper decline in older children meant that younger children had nearly double the prevalence rate compared to older children (PR = 1.94; 95%CI: 1.53-2.46). In conclusion, there was a major decline in prevalence of anemia during the period studied, but anemia persisted as a relevant public health problem, especially in children 6 to 24 months of age. The children in the sample are exposed to harsh social vulnerabilities, evidencing that health promotion for this population requires more than actions in the public health sphere itself. Healthcare workers and administrators should be alert to the data presented here, aimed at implementation of measures to confront the social and health iniquities that contribute to greater vulnerability in this ethnic-racial group.