Natanael de Jesus Silva1,2, Rita de Cássia Ribeiro-Silva2,3, Davide Rasella1,2, Flávia Jôse Oliveira Alves1,2, Tereza Campello2,4,5, Rosemeire Leovigildo Fiaccone2,6, Maurício Lima Barreto1,2. 1. Institute of Collective Health, Federal University of Bahia, Salvador, BA, Brazil. 2. Center for Data Integration and Knowledge for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Sl 315. Rua Mundo, 121. Trobogy, Salvador, BA41745-715, Brazil. 3. School of Nutrition, Federal University of Bahia, Salvador, BA, Brazil. 4. Fiocruz School of Government, Oswaldo Cruz Foundation, Brasília, DF, Brazil. 5. University of Nottingham, Nottingham, UK. 6. Institute of Mathematics and Statistics, Federal University of Bahia, Salvador, BA, Brazil.
Abstract
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.
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.
Authors: Andrew L Thorne-Lyman; Natalie Valpiani; Kai Sun; Richard D Semba; Christine L Klotz; Klaus Kraemer; Nasima Akhter; Saskia de Pee; Regina Moench-Pfanner; Mayang Sari; Martin W Bloem Journal: J Nutr Date: 2009-11-18 Impact factor: 4.798