Insegurança alimentar em domicílios com adolescentes da Amazônia Legal Brasileira: prevalência e fatores associados

Changes in prevalence of overweight in adolescents living in areas highly vulnerable to food insecurity

This study ascertained changes, over 5 years, in the prevalence of overweight in adolescents and associations with socio-demographic variables and food insecurity. Two cross-sectional population-based studies were conducted with 511 (2005) and 314 (2010) adolescents resident in Campos Elíseos (Duque de Caxias-RJ). Overweight was evaluated by sex and age specific cut-off points of BMI (weight/height²). The prevalence of food insecurity was investigated using the Brazilian Food Insecurity Scale. Logistic regression was used to determine the association between changes in overweight over time and sex, age, skin colour, and food insecurity. Overweight was found to increase significantly, between 2005 and 2010, in boys who were younger (from 20.1% to 49.5%), black or brown (22.2% to 37.3%), those with per capita income of up to half a minimum wage (13.6% to 32.5%) and those experiencing moderate or severe food insecurity (9.2% to 36.3%). It was concluded that overweight increased significantly in adolescents living in an area of food insecurity, and that younger, black or brown, lower-income adolescents, and those living with moderate and severe food insecurity, were more exposed to that increase.

Use Database to Evaluate the Prevalence of Hunger Among Adolescents in Brazil

Food insecurity and malnutrition have become serious problems in many countries. In recent years, Brazil has experienced an increase in the prevalence of food insecurity and hunger. However, there is limited information on the status of these issues, and food security assessments are only performed as household measures. Therefore, the use of available databases is essential to expand information and support decision-making in the fight against food insecurity. This study aimed to evaluate the relationship between reports of hunger among adolescents and their sociodemographic characteristics. We used data from the 2015 National School Health Survey. The main variable of interest was obtained from responses to the following question: “Over the past 30 days, how often have you gone hungry because you did not have enough food at home?”. The responses were separately gathered from those who reported going hungry and those who did not. Socioeconomic characteristics were evaluated simultaneously. For statistical analysis, a Pearson chi-square test and multiple analyses were performed using Poisson regression models. A total of 101,888 adolescents were evaluated. The variable used to measure hunger was associated with maternal education, internet access, and fruit intake. The results showed a positive association between adolescents who reported going hungry and women, black and indigenous adolescent students living in households with more than five people, adolescents not living with their father, and adolescents planning to work or not knowing what they will do after completing the ninth grade. The results demonstrate that it is possible to use secondary data with a single question to assess, monitor, and provide insights into how food security impacts the sociodemographic groups differently.

Prevalence of overweight and obesity among Brazilian adolescents over time: a systematic review and meta-analysis

OBJECTIVE

To estimate the burden of excess weight in Brazilian adolescents.

DESIGN

Systematic review with meta-analysis.

SETTING

We searched the literature in four databases (MEDLINE/PubMed, EMBASE, SciELO and LILACS). Studies were included if they had cross-sectional or cohort design and enrolled Brazilian adolescents. Studies based on self-reported measures were excluded. Random effect models were used to calculate prevalence estimates and their 95 % CI.

PARTICIPANTS

Brazilian adolescents (10 to 19 years old).

RESULTS

One hundred and fifty-one studies were included. Trend analyses showed a significant increase in the prevalence of excess weight in the last decades: 8·2 % (95 % CI 7·7, 8·7) until year 2000, 18·9 (95 % CI 14·7, 23·2) from 2000 to 2009, and 25·1 % (95 % CI 23·4, 26·8) in 2010 and after. A similar temporal pattern was observed in the prevalence of overweight and obesity separately. In sensitivity analyses, lower prevalence of excess weight was found in older adolescents and those defined using International Obesity Task Force cut-off points. The Southeast and South regions had the highest prevalence of excess weight, overweight and obesity. No significant difference in prevalence by sex was found, except for studies before the year 2000.

CONCLUSIONS

The prevalence of overweight and obesity in Brazilian adolescents is high and continues to rise. Public policies on an individual level and targeting modifications in the obesogenic environment are necessary.

[Acceptance of school food by Brazilian adolescents: individual and school context determinants]

The scope of this study was to evaluate the acceptance of school food by Brazilian adolescents, taking individual and school context determinants into consideration. A total of 10,262 adolescents in public schools of the 2015 Brazilian National Survey of School Health (PeNSE 2015) were assessed. Multilevel regression was used to estimate the effect of variables of the individual context and the school environment on low acceptance of school food by adolescents. The prevalence of low acceptance (consumption of school meals ≤ 2 days/week) was 64.2% in this group. The explanatory model showed less acceptance of this practice among female adolescents (PR=1.09; CI: 1.03-1.14), among those aged 15 years or older (PR=1.08; CI: 1.02-1.14), those who regularly consumed soft drinks (PR=1.09; CI: 1.03-1.15), those who did not regularly have lunch and dinner with parents and guardians (PR=1.08; CI: 1.02-1.14), and those who lived in households with less than 4 people (PR=1.07; CI: 1.02-1.13). Concerning the school environment, studying in schools with more than 1,000 students (PR=1.22; CI: 1.12-1.33) and the presence of a cafeteria (PR=1.15; CI: 1.08-1.22) led to low acceptance. The results revealed the importance of the school context in determining the consumption of school meals by adolescents.

Da fome à palatabilidade estéril: ‘espessando’ ou ‘diluindo’ o Direito Humano à Alimentação Adequada no Brasil?

RESUMO No cenário contemporâneo, a tríade ‘alimento-mercadoria-doença’ se ‘espessa’ e se ‘dilui’ em virtude dos rearranjos das crises econômicas globais e suas expressões locais na dinâmica política-econômica-social capitalista. Reproduzindo-se em suas diferentes faces: a da escassez – fome, desnutrição, carências nutricionais; e a dos problemas advindos do excesso de consumo de alimentos altamente industrializados – sobrepeso, obesidade e doenças crônicas não transmissíveis. No Brasil, a alimentação enquanto um direito social encontra-se em disputa, como todos os outros direitos, em virtude da crise econômica global e sua expressão em nível local. Este ensaio visa a oferecer uma reflexão sobre os contornos que o Direito Humano à Alimentação Adequada (DHAA) vem apresentando no Brasil na história recente. Para tanto, optou-se por oferecer uma análise crítica sobre esses contornos. O artigo se estrutura em três partes: a primeira destaca as desenvolturas do tema a partir da agenda da segurança alimentar e nutricional global e local; a segunda explicita o percurso da construção histórica mais recente no cenário nacional e os desafios atuais mediante ao cenário de desmontes dos direitos sociais; e a terceira lança alguns questionamentos para a tomada de consciência sobre as posições e as ações assumidas pelos agentes sociais envolvidos.

Factors associated with food security in households in the urban area of the state of Tocantins, Northern Brazil

OBJECTIVE

To evaluate the factors associated with food insecurity in families living in the urban area of Tocantins/Brazil.

METHODS

This is a population-based cross-sectional study conducted in the urban area of 22 municipalities in the 8 microregions of the state. A semi-structured questionnaire was applied to the head of household to obtain socioeconomic and demographic data, and the Brazilian Food Insecurity Scale (EBIA) was used to assess food insecurity at home. The anthropometric assessment of the residents was made by measuring weight, height/length and waist circumference. Multinomial logistic regression was performed to assess the association of food insecurity with individual/household variables, and Pearson's chi-square test was used to compare whether there was a difference in the prevalence of food insecurity between microregions and between families with and without individuals under 18 years.

RESULTS

A total of 596 households were evaluated, of which 63.4% were in a food insecurity situation. The final model of the multivariate analysis showed that low head-of-household schooling, low per capita income, receiving social assistance benefits and lack of clean drinking water in the household were associated with food insecurity (p < 0.05).

CONCLUSIONS

The findings of this study reveal the high prevalence of food insecurity in the families studied and their associated factors, showing the need for local actions and public policies to improve health conditions, education and income of the population, and consequently, improve the scenario of food and nutritional insecurity in the state.

[Evaluation indicators of Food and Nutritional Insecurity and associated factors: systematic review]

The scope of this paper was to systematically investigate the indicators used in the evaluation of food and nutritional insecurity and associated factors in Brazilian studies. After selection in the databases using search terms and reverse search, 89 articles were included. The majority of the articles evaluated food and nutritional insecurity according to the indicator of perception, using the Brazilian Scale of Food Insecurity (83.1%), the American Scale (5.62%) and isolated questions (2.25%). The other articles evaluated the presence of malnutrition among children (1.12%), expenditure on food (1.12%), adult-equivalent dietary intake (1.12%), protocols (2.25%), and prediction models (2.25%). Food and nutritional insecurity (measured by the different indicators) was associated with socioeconomic and demographic factors, health and lifestyle conditions, food consumption and nutritional status, based on families, specific age groups, beneficiaries of government programs, among others, as sample units. The majority of the studies merely evaluated the food dimension of the insecurity, thereby increasing the difficulty in evaluating this complex situation.

Food Insecurity during Pregnancy in a Maternal-Infant Cohort in Brazilian Western Amazon

The aim of this study was to determine the prevalence and analyze the factors associated with food insecurity during gestation in a maternal-infant cohort in Brazilian Western Amazon. A population-based cross-sectional study was conducted with parturients from a maternal-infant cohort in Rio Branco, located in the Western Brazilian Amazon. The dependent variable food insecurity (FI) was obtained through the Brazilian Scale of Food Insecurity, and associated factors were identified through multiple logistic regression. The prevalence of FI in pregnancy was of 34.8%. Regarding severity, the prevalence of mild food insecurity was 24.6%, moderate food insecurity was 4.8%, and severe food insecurity was 5.4%. The factors directly associated with FI were the presence of open sewage in the peridomestic environment; belonging to the lower economic classes; being an income transfer program beneficiary, while the factors inversely associated with FI were schooling equal to or greater than 8 years; having a partner; primigestation; and regular consumption of fruits and vegetables during pregnancy. These findings reinforce the need for the ratification of actions aimed at the domestic economy in the income transfer programs and the development of actions of food and nutritional education in the gestational period.

Relationship between social indicators and food insecurity: a systematic review

ABSTRACT: Introduction: The relationships between the social indicators (SIs) that determine food insecurity (FI) have not been described yet. This systematic review aims to identify which SIs are associated with FI in Brazilian households and how these relationships are explained. Methods: The research protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO - CRD42018106527). Three independent researchers performed the search in the Latin American and Caribbean Health Sciences Literature (LILACS) and National Library of Medicine (PubMed) databases (June/2018). The study included articles that used the Brazilian Household Food Insecurity Measurement Scale (Escala Brasileira de Insegurança Alimentar - EBIA) to assess FI and that evaluated the association between SIs and FI. Results: We included 18 articles in this review. The Kappa concordance index between the researchers was 0.72 (95%CI 0.42 - 1.00). Most articles were cross-sectional and used multivariate regression for the statistical analysis. At least one income-related SI had a significant association with FI, and, in most studies, they presented the highest values of association measures. We organized the authors’ explanation about the relationships between SIs and FI in a conceptual model. The study identified three possible justifications for the association between SIs and FI: direct relationship, relationship mediated by income, or relationship mediated by another SI and income. Conclusion: Income assumed a central role in the mediation between several SIs and FI. However, the analysis methods of the studies did not allow us to investigate this mediation. Therefore, improving data analysis to isolate and understand the effect of SIs on FI is still necessary.

Evidence of the validity of the Food and Nutritional Security Scale for adolescents (ESANa)

This study aimed to develop a valid and reliable scale for assessing food and nutritional insecurity, specifically in adolescents. The initial version of the scale consisted of two subscales: perception of food insecurity and perception of nutritional security. The items were submitted to content analysis (n = 4) by a group of food and nutrition security experts, and semantic analysis (n = 20) by a group of adolescents conveniently sampled from the target population. After adjustments, the final version of the scale was applied to adolescent students (n = 425) aged 12 to 18 years (m = 14.32±0.96; CV = 6.7%). A two-factor model was the most appropriate after performing exploratory factor analysis. The subscales showed modest values of the alpha coefficient (0.69 and 0.60, respectively). Daily consumption of fruits, vegetables and soft drinks was significantly associated with higher scores in the food and nutrition security perception scale. Therefore, it is recommended to combine food access-based items with other aspects related to attitudes and behaviors towards healthy eating in order to achieve a more accurate picture of adolescent's needs and better guide public policies.

Food and nutritional insecurity in Brazil and its correlation with vulnerability markers

This study aimed to analyze space-time distribution of the prevalence of food and nutritional insecurity (FNI) in the Brazilian Federative Units and their correlation with vulnerability markers. This is an ecological study, with data from the National Household Sample Survey (2004, 2009 and 2013) and Atlas Brazil (2010). A time analysis of the spatial distribution of FNI prevalence was performed. Moran's Index was used in bivariate spatial analysis. The prevalence of FNI have decreased along the years studied and showed a negative and moderate spatial correlation with the Human Development Index; a positive and moderate correlation with the percentage of the extremely poor, child mortality, social vulnerability index, human capital social vulnerability index; and positive and strong correlation with income and work social vulnerability index. We can conclude that there was a lower prevalence of FNI in the analyzed years and that the Brazilian territory showed two distinct patterns: territories with higher FNI prevalence and worse conditions as regards income, work and child health in the North and Northeast; and territories with lower FNI prevalence and lower vulnerability in the Midwest, Southeast and South.

Suitability of the eight-item version of the Brazilian Household Food Insecurity Measurement Scale to identify risk groups: evidence from a nationwide representative sample

Objective

The Brazilian Household Food Insecurity Measurement Scale (EBIA) has eight general/adult items applied in all households and six additional items exclusively asked in households with children and/or adolescents (HHCA). Continuing an investigation programme on the adequacy of model-based cut-off points for EBIA, the present study aims to: (i) explore the capacity of properly stratifying HHCA according to food insecurity (FI) severity level by applying only the eight ‘generic’ items; and (ii) compare it against the fourteen-item scale.

Design

Latent class factor analysis (LCFA) models were applied to the answers to the eight general/adult items to identify latent groups corresponding to FI levels and optimal group-separating cut-off points. Analyses involved a thorough classification agreement evaluation and were performed at the national level and by macro-regions.

Setting

Data derived from the cross-sectional Brazilian National Household Sample Survey of 2013.

Participants

A nationally representative sample of 116 543 households.

Results

In all households and investigated domains, LCFA detected four distinct household food (in)security groups (food security and three levels of severity of FI) and the same set of cut-off points (1/2, 4/5 and 6/7). Misclassification in the aggregate data was 0·66 % in adult-only households and 1·06 % in HHCA. Comparison of the scale reduced to eight items with the ‘original’ fourteen-item scale demonstrated consistency in the classification. In HHCA, the agreement between both classifications was 96·2 %.

Conclusions

Results indicate the eight ‘generic’ items in HHCA can be reliably used when it is not possible to apply the fourteen-item scale.

[Food insecurity in rural communities in Northeast Brazil: does belonging to a slave-descendent community make a difference?]

This study aimed to measure the prevalence of food insecurity in a rural area of Northeast Brazil and investigate this outcome according to residence in quilombola communities (descendants of African slaves) versus non-quilombola communities. This was a cross-sectional study in 21 rural communities, 9 of which quilombolas, in 2014, using the Brazilian Food Insecurity Scale (EBIA). Prevalence rates and prevalence ratios were estimated for food insecurity, and Poisson multiple regression analysis with robust variance was performed. Food insecurity was found in 52.1% of the families: 64.9% in quilombola communities and 42% in the others. Food insecurity was associated with belonging to a quilombola community (PR = 1.25), lower economic status (PR = 1.89; 2.98, and 3.22 for status C2, D, and E, respectively), beneficiaries of Bolsa Família program (PR = 1.52), and four or more household members (PR = 1.20). Food insecurity prevalence was high in the entire population, but it was even higher in quilombola communities, even though they belonged to the same coverage area. The results emphasize this population's vulnerability.

Insegurança alimentar no Brasil segundo diferentes cenários sociodemográficos

Resumo O objetivo deste artigo é apontar a prevalência de insegurança alimentar, assim como fatores associados, em diferentes cenários sociodemográficos no Brasil. Realizou-se revisão sistemática com metanálise de artigos publicados de 2004 a 2013 sobre Segurança Alimentar e Nutricional a partir da busca em bases de dados. Calculou-se a média ponderada da prevalência de insegurança alimentar e as Razões de Chances considerando a categorização dos artigos segundo a origem de suas amostras. A média ponderada da prevalência de insegurança alimentar para escolas/creches, serviços de saúde/beneficiários do Programa Bolsa Família e populações em iniquidades sociais foi, respectivamente, de 61,8%, 76,6% e 87,2%, com maiores Razões de Chances em relação aos estudos de base populacional e aos resultados da PNAD. A renda familiar, a quantidade de indivíduos no domicílio e o tipo de moradia foram as principais variáveis que apresentaram relação inversa significante com a insegurança alimentar. Os resultados evidenciam a determinação social da insegurança alimentar no Brasil.

A Model-Based Approach to Identify Classes and Respective Cutoffs of the Brazilian Household Food Insecurity Measurement Scale

BACKGROUND

The Brazilian Household Food Insecurity Measurement Scale (EBIA) is the main tool for assessing household food insecurity (FI) in Brazil, assisting in monitoring and improving national public policies to promote food security. Based on the sum of item scores, households have been classified into 4 levels of FI, with the use of cutoffs arising from expert discussions informed by psychometric analyses and policy considerations.

OBJECTIVES

This study aimed to identify homogeneous latent groups corresponding to levels of FI, examine whether such subgroups could be defined from discriminant cutoffs applied to the overall EBIA raw score, and compare these cutoffs against those currently used.

METHODS

A cross-sectional population-based study with a representative sample of 1105 households from a low-income metropolitan area of Rio de Janeiro was conducted. Latent class factor analysis (LCFA) models were applied to the answers to EBIA's items to identify homogeneous groups, obtaining the number of latent classes for FI measured by the scale. Based on this and a thorough classification agreement evaluation, optimal cutoffs for discriminating between different severity levels of FI were ascertained. Model-based grouping and the official EBIA classification cutoffs were also contrasted.

RESULTS

LCFA identified 4 homogeneous groups with a very high degree of class separation (entropy = 0.906), endorsing the classification of EBIA as a 4-level measure of FI. Two sets of cutoffs were identified to separate such groups according to household type: 1/2, 5/6, and 10/11 in households with children and adolescents (score range: 0-14); and 1/2, 3/4, and 5/6 in adult-only households (score range: 0-7).

CONCLUSION

Although roughly classifying EBIA as in previous studies, the current approach suggests that, in terms of raw score, households endorsing only one item of the scale would be better classified by being placed in the same stratum as those remaining negative on all items.

Household food insecurity and child health

Food insecurity, the lack of consistent access to sufficient quality and quantity of food, affects an estimated 800 million people around the world. Although household food insecurity is generally associated with poor child nutrition and health in the USA, we know less about household food insecurity and child health in developing countries. Particularly lacking is research assessing how associations between household food insecurity and children's health outcomes may differ by child age and among children beyond age 5 years in low-income settings. We use data from a population-based sample of households with children ages 3-11 years (N = 431) in León, Nicaragua to consider how household food insecurity is associated with three measures of child health: illness, anaemia and low height-for-age. Our results provide new evidence that even mild household food insecurity is detrimental to children's health; and that child age conditions the associations between household food insecurity and child health. We find that food insecurity is especially harmful to health during early childhood, but continues to have significant associations with health into middle childhood (up to ages 7-8 years). We discuss the potential implications of these results for future child health research and policies in low-income countries. © 2016 John Wiley & Sons Ltd.

(In)segurança alimentar entre famílias com crianças menores de cinco anos residentes em área de vulnerabilidade social de Campina Grande, Paraíba

OBJETIVO: Avaliar a situação de (in)segurança alimentar de famílias com crianças menores de cinco anos residentes em área de vulnerabilidade social e sua associação com características biológicas, com a situação de saúde das crianças e com o contexto socioeconômico familiar. MÉTODOS: Estudo transversal, envolvendo 76 famílias com crianças menores de cinco anos e com algum membro ex-catador de materiais recicláveis do lixão desativado de Campina Grande, Paraíba. A segurança alimentar foi avaliada pela Escala Brasileira de Insegurança Alimentar. Foi estudada a associação da situação da insegurança alimentar com características das crianças e socioeconômicas por meio de análise múltipla de determinação. RESULTADOS: A prevalência de insegurança alimentar caracterizou 96,1% das famílias, predominando as formas moderada (34,2%) e grave (32,4%). As famílias em cujo núcleo havia crianças que tiveram perda de peso nos últimos 15 dias e aquelas com destino de lixo não coletado apresentaram maiores chances de insegurança alimen-tar moderada e insegurança alimentar grave, de 9,49 vezes (IC95%=1,95-46,26) e 6,71 vezes (IC95%=1,34-33,59), respectivamente. CONCLUSÃO: A alta vulnerabilidade dessa população reflete-se em condições de insegurança alimentar associadas à condição social e de saúde que precisam ser equacionadas a fim de se garantir o direito humano à alimentação adequada.