Sex differences in the relationship between food insecurity and weight status in Brazil.

Obesity and undernutrition are manifestations of malnutrition that affect many people worldwide. A lack of access to food may explain the association of food insecurity (FI) with both undernutrition and obesity, but there are other factors that are specifically related to obesity. Studies have also found that FI is related to both overweight and obesity among women but not among men. The present study aimed to evaluate the association between FI and weight status among adults from a nationally representative sample of Brazil and to consider the impacts of sex. Data from the 2017/2018 Household Budget Survey (n=28,112), a national cross-sectional study, were analyzed using the Brazilian Household FI Scale (EBIA) and body mass index (BMI; measured in kg/m2) by individual self-reported weight and height. Associations were estimated by odds ratios (ORs) with 95% confidence intervals (CIs) considering a multinomial logistic regression model. Women with severe FI were more than twice (OR=2.36) as likely to be underweight and had a higher frequency of obesity (OR=1.39). Among men, severe FI status was a protective factor for overweight (OR=0.58) and obesity (OR=0.61). In conclusion, FI was a risk factor for underweight and obesity among women but not among men.

Inadequacy of gestational weight gain during high-risk pregnancies is not associated with household food insecurity.

BACKGROUND: Inadequate gestational weight gain (GWG) is associated with adverse outcomes in maternal and child health and can be enhanced by social inequalities, such as lower education and household food insecurity (HFI). Women are more vulnerable to HFI, which has been associated with negative health effects for pregnant women during the prenatal and puerperal periods, particularly in regard to the aggravation of pregnancy risks. This study investigated the association between sociodemographic characteristics and HFI with respect to adequacy of total GWG among women with high-risk pregnancies. METHODS: This was a prospective cohort study that evaluated the total GWG of 169 pregnant women. The women were seen at a public university hospital in the metropolitan region of Rio de Janeiro (Brazil). Their sociodemographic and gestational characteristics and the Brazilian Scale of Domestic Food Insecurity were investigated. To estimate the total GWG, the difference between the patient weight at the last prenatal visit and the initial patient weight was verified, with both collected from the medical records of the pregnant women. The classification of the total GWG considered the recommendations of the Institute of Medicine (IOM) (2009). A multinomial logistic regression model assessed the risk (odds ratio; OR) and confidence intervals (CI 95%)) of insufficient and excessive GWG with exposure to HFI and other covariates (p value <0.05). RESULTS: Insufficient and excessive GWG were observed in 27.8% and 47.9% of the pregnant women, respectively. More than half of the women (74.6%) had a high education level. Exposure to mild HFI occurred in 44.2% of the women. After adjustment, the HFI was not associated with insufficient or excessive GWG. The educational level of women was the only variable significantly associated with a lower risk of GWG insufficiency (OR: 0.10; 95% CI: 0.01-0.89). CONCLUSIONS: In this population, higher maternal education was a protective factor against insufficient GWG. We highlight the importance of additional health support and counseling for women in the most vulnerable social conditions, considering the importance of access to information for reducing health risks.

Governmental programmes associated with food insecurity among communities of descendants of enslaved blacks in Brazil.

OBJECTIVE: To assess the access to government programmes and their association with food insecurity (FI) in families from quilombolas communities in Brazil. DESIGN: An analysis of secondary data from the 2011 Quilombolas Census was performed in Brazilian territories. The Brazilian Household Food Insecurity Measurement Scale (Escala Brasileira de Insegurança Alimentar, EBIA) was used to assess the household FI status. The relationships of governmental programmes with the levels of FI were estimated using logistic regression models. SETTING: Greater national survey census of food and nutritional security of the recognised Quilombolas Brazilian territories. PARTICIPANTS: Totally, 8743 quilombolas families. RESULTS: The prevalence of household FI was 86·1 % (moderate/severe FI: 55·9 %, 95 % CI 54·8, 56·9). After adjustment for socio-demographic variables, access to rural development programmes (Food Acquisition Program: OR: 0·6, 95 % CI 0·4, 0·8, P-value < 0·01) and health programmes (Center for Family Health Support: OR: 0·5, 95 % CI 0·5, 0·7, P-value < 0·001) is inversely and significantly associated with moderate/severe FI. The Brazilian conditional cash transfer programme (Bolsa Família) was associated with quilombolas families with moderate/severe levels of FI (OR: 3·3, 95 % CI 2·8, 4·0, P-value < 0·001). CONCLUSIONS: The prevalence of FI was high among quilombolas families. Despite reduced participation in governmental programmes, rural development, agriculture and conditional cash transfer programmes are fundamental to the autonomy of quilombolas communities. In spite of the low participation, when families are able to access these programmes, the study revealed the importance of these initiatives in reducing the likelihood of severe levels of FI.

Household food insecurity associated with gestacional and neonatal outcomes: a systematic review.

BACKGROUND: Food insecurity (FI) occurs when people lack secure access to sufficient amounts of safe and nutritious food. FI has been associated with negative effects on human health, including during the prenatal and neonatal periods. The objective of this study is to evaluate the consequences of FI for pregnant women's and newborns' health. METHODS: A literature search was performed with three independent researchers based on the PRISMA guidelines; the search covered the period of November 2008 to July 2019 and was conducted in the following databases: the US National Library of Medicine at the National Institutes of Health (PubMed), Latin American and Caribbean Health Sciences (LILACS), Cochrane Library, Web of Science, Embase, Scopus and OpenGrey. The terms and descriptors were defined by consulting the Medical Subject Headings (MeSH) and Health Sciences Descriptors (DeCS) platforms and mainly included "food security", "food insecurity", "pregnancy" and "newborn". The studies were selected through a title and abstract review and then a reading of the full text. The quality of the studies and the risk of bias were analysed based on the criteria defined in the "Joanna Briggs Institute Reviewers' Manual" and by Guyatt and colleagues for interventional studies. The population, study design, FI measurement instruments, FI proportions, outcomes, confounders and results were extracted from the 37 studies that were selected according to the eligibility and quality criteria. RESULTS: FI ​​proportions ranged from 5.2 to 87%. Most studies were conducted with African populations (42.2%) and applied globally used scales to assess FI (56.7%); 27% of the studies adapted scales. There were wide variations in the instruments used to estimate FI. The main outcomes related to FI included stress, anxiety and depression during pregnancy, followed by dietary quality and dietary diversity. Associations of FI with birth defects, neonatal mortality and the early introduction of animal milk to the infant's diet were also observed. CONCLUSIONS: It is necessary to pay attention to the diversity of FI measurement instruments before FI results are compared. FI can be a risk factor for depression and stress during pregnancy, as well as for neonatal mortality, newborn health problems and breastfeeding interruption. TRIAL REGISTRATION: This systematic review was registered on PROSPERO (CRD42018109478).

Effects of family income and conditional cash transfers on household food insecurity: evidence from a longitudinal study in Northeast Brazil.

OBJECTIVE: Food insecurity (FI) is a challenge to policy makers worldwide, who need to understand which polices and programmes are effective at overcoming FI. The present study aimed to examine the impact of family income and conditional cash transfers on changes in household FI status in a highly vulnerable municipality in Northeast Brazil. DESIGN: A population-based longitudinal cohort study among families in a municipality in the semi-arid area in Northeast Brazil (2011 and 2014). FI was estimated with the Brazilian Household Food Insecurity Measurement Scale (EBIA). The effects of family income and cash transfer on changes in FI were estimated using logistic regression models and the population-attributable risk fraction. SETTING: Households in Cuité, Paraíba, Brazil. PARTICIPANTS: Household respondents interviewed in 2011 (n 358) and 2014 (n 326). RESULTS: There was a reduction in FI prevalence of 17·5 % across time; 24·5 % of families who were food insecure in 2011 became food secure in 2014. After adjustment, families that did not experience an increase in their total household income or a reduction in the cash transfer amount were at increased risk of persistent FI across time. If the cash transfer programme had not been in place, about 10 % of the families that switched from food insecure to food secure across time would have remained in FI instead. CONCLUSIONS: The decrease of FI occurred in an area of extreme climatic and social vulnerability. These changes were more related to the cash transfer than the increase in family income over time.

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.

Modeling Optimal Cutoffs for the Brazilian Household Food Insecurity Measurement Scale in a Nationwide Representative Sample.

Background: This is the second part of a model-based approach to examine the suitability of the current cutoffs applied to the raw score of the Brazilian Household Food Insecurity Measurement Scale [Escala Brasileira de Insegurança Alimentar (EBIA)]. The approach allows identification of homogeneous groups who correspond to severity levels of food insecurity (FI) and, by extension, discriminant cutoffs able to accurately distinguish these groups.Objective: This study aims to examine whether the model-based approach for identifying optimal cutoffs first implemented in a local sample is replicated in a countrywide representative sample.Methods: Data were derived from the Brazilian National Household Sample Survey of 2013 (n = 116,543 households). Latent class factor analysis (LCFA) models from 2 to 5 classes were applied to the scale's items to identify the number of underlying FI latent classes. Next, identification of optimal cutoffs on the overall raw score was ascertained from these identified classes. Analyses were conducted in the aggregate data and by macroregions. Finally, model-based classifications (latent classes and groupings identified thereafter) were contrasted to the traditionally used classification.Results: LCFA identified 4 homogeneous groups with a very high degree of class separation (entropy = 0.934-0.975). The following cutoffs were identified in the aggregate data: between 1 and 2 (1/2), 5 and 6 (5/6), and 10 and 11 (10/11) in households with children and/or adolescents <18 y of age (score range: 0-14), and 1/2, between 4 and 5 (4/5), and between 6 and 7 (6/7) in adult-only households (range: 0-8). With minor variations, the same cutoffs were also identified in the macroregions. Although our findings confirm, in general, the classification currently used, the limit of 1/2 (compared with 0/1) for separating the milder from the baseline category emerged consistently in all analyses.Conclusions: Nationwide findings corroborate previous local evidence that households with an overall score of 1 are more akin to those scoring negative on all items. These results may contribute to guide experts' and policymakers' decisions on the most appropriate EBIA cutoffs.

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.

Low fruit consumption and omission of daily meals as risk factors for increased blood pressure in adults.

A population-based cross-sectional survey with cluster sampling design and with inverse sampling was conducted in 2010, in a sample of 1590 adults (19-60 years old) exposed to a high prevalence of food insecurity, in the municipality of Duque de Caxias, metropolitan region of Rio de Janeiro, Brazil. The objective of the study was to evaluate the association of socio-demographic factors, the consumption of fruits and vegetables and the number of meals with increased blood pressure (BP). A hierarchical model that considered variables related to the basic, intermediate and immediate determinants of increased BP was adopted. By using Poisson's regression, univariate models were tested to obtain the prevalence ratio (PR) and its respective 95 % CI. After fitting the model, age (age group 50-59 years) (PR 1·62; 95 % CI 1·09, 2·41), low consumption of fruits in a week (PR 1·37; 95 % CI 1·07, 1·74), fewer meals per day (PR 1·72; 95 % CI 1·21, 2·43) and overweight (PR 1·78; 95 % CI 1·31, 2·20) remained significantly associated with increased BP. Therefore, the results found here reinforce the importance of encouraging and developing strategies that ensure access to healthy foods to minimise increased BP in similar populations.

Intimate partner violence, common mental disorders and household food insecurity: an analysis using path analysis.

OBJECTIVE: To investigate the direct and indirect associations between psychological and physical intimate partner violence and the occurrence of common mental disorders (CMD) and how they relate to the occurrence of household food insecurity (HFI). DESIGN: This was a population-based cross-sectional study. Intimate partner violence was assessed using the Brazilian version of the Revised Conflict Tactics Scale (CTS2) and HFI was assessed using the Brazilian Food Insecurity Scale. The propositional analytical model was based on a review of the literature and was tested using path analysis. SETTING: Duque de Caxias, Greater Rio de Janeiro, Brazil (April-December 2010). SUBJECTS: Women (n 849) who had been in a relationship in the 12 months preceding the interview. RESULTS: Both psychological and physical violence were found to be major risk factors of HFI. Psychological violence was associated with HFI indirectly via physical violence and CMD, and directly by an unidentified path. The effects of physical violence seemed to be manifested exclusively through CMD. Most of the variables in the propositional model related to socio-economic position, demographic characteristics, degree of women's social support and partner alcohol misuse were retained in the 'final' model, indicating that these factors contribute significantly to the increased likelihood of HFI. CONCLUSIONS: The results reinforce the importance of considering domestic violence and other psychosocial aspects of family life when implementing interventions designed to reduce/eradicate HFI.

Inverse association between social support and household food insecurity in a metropolitan area of Rio de Janeiro, Brazil.

OBJECTIVE: To verify the association between perceived social support and household food insecurity (HFI). DESIGN: A cross-sectional survey. SETTING: A population-based study with a representative sample of households from a metropolitan area of Rio de Janeiro, Brazil, conducted in 2010. HFI was estimated with the Brazilian Food Insecurity Scale (EBIA). Social support was assessed using the adapted and validated Brazilian version of the Medical Outcomes Study Social Support Survey. Multinomial logistic regression was used to evaluate the association between social support and HFI, adjusting for potential confounders. SUBJECTS: Adults (n 1022) aged 19-60 years old (27% men, 73% women) who were responsible for feeding the household. RESULTS: Individuals with high scores of social support were less likely to experience moderate HFI (OR=0·96; 95% CI 0·94, 0·99) and severe HFI (OR=0·96; 95% CI 0·94, 0·98). CONCLUSIONS: These findings indicate that social support may contribute to reducing HFI in populations vulnerable to poverty. Strategies to increase social relationships should be encouraged in this group to enhance their perceived social support.

Household food insecurity: a systematic review of the measuring instruments used in epidemiological studies.

OBJECTIVE: To conduct a systematic review aimed at identifying and characterizing the experience-based household food security scales and to synthesize their psychometric properties. DESIGN: Search in the MEDLINE, LILACS and SciELO databases, using the descriptors ('food insecurity' OR 'food security') AND ('questionnaires' OR 'scales' OR 'validity' OR 'reliability'). There was no limitation on the period of publication. All articles had their titles and abstracts analysed by two reviewers. The studies of interest were read in their entirety and the relevant information extracted using a standard form. RESULTS: The initial bibliographic search identified 299 articles. Of these, the 159 that seemed to meet the criteria for inclusion were read fully. After consultation of the bibliographic references of these articles, twenty articles and five documents were added, as they satisfied the previously determined criteria for inclusion. Twenty-four different instruments were identified; all were brief and of easy application. The majority were devised in the USA. Forty-seven references reported results of psychometric studies. The instruments that presented the highest number of psychometric studies were the Core Food Security Measurement/Household Food Security Survey Module (CFSM/HFSSM) and the Self-Perceived Household Food Security Scale. CONCLUSIONS: There are a number of structured scales available in the literature for characterization of household food insecurity. However, despite some psychometric studies already existing about the majority of the instruments, it is observed that, except for the studies of the CFSM/HFSSM, these are still restricted to appraisal of a few aspects of reliability and validity.

Relationship of socio-economic factors and parental eating habits with children's food intake in a population-based study in a metropolitan area of Brazil.

OBJECTIVE: To evaluate the association of sociodemographic factors and parental food consumption with children's food intake. DESIGN: A cross-sectional survey. SETTING: A population-based study with a representative sample in a metropolitan region of Rio de Janeiro, Brazil. Parents' socio-economic variables, age and education level and children's age were obtained by face-to-face interviews. The parental food intake was assessed using an FFQ and the children's food intake was assessed using two 24 h recalls. SUBJECTS: Children (n 366) aged 6-30 months and their parents. RESULTS: The hierarchical regression analysis indicated that parents' age was positively associated with the intake of vegetables among children (ß = 0·73, 95% CI 0·11, 1·34), while parents' educational level was positively associated with the intake of fats (ß = 3·52, 95% CI 0·04, 7·01) and negatively associated with the intake of beans (ß = -13·98, 95% CI -27·94, -0·03). The age of the children was positively associated with the intakes of meats and eggs (ß = 2·88, 95% CI 1·55, 4·22), sugars (ß = 5·08, 95% CI 1·85, 8·30) and coffee (ß = 1·77, 95% CI 0·71, 2·84), and negatively associated with the intake of vegetables (ß = -2·12, 95% CI -3·20, -1·05). The influence of parental food intake was observed for the food groups of breads, cereals and tubers (ß = 0·06, 95% CI 0·003, 0·12), beans (ß = 0·11, 95% CI -0·003, 0·22) and fruits (ß = 0·10, 95% CI 0·03, 0·16). Unfavourable socio-economic variables were associated with intakes of breads, cereals and tubers, vegetables, fruits, meats, sugars and coffee by children. CONCLUSIONS: Parental food intake is associated with children's intake of cereals, beans and fruits independent of socio-economic status.

Family food insecurity and nutritional risk in adolescents from a low-income area of Rio de Janeiro, Brazil.

The study objective was to analyse the association between food insecurity and the weight and height status of adolescents from a low-income area in the metropolitan region of Rio de Janeiro, Brazil. The population-based cross-sectional survey included 523 adolescents aged 12-18 years, selected by a three-stage cluster sample. Dietary intake was ascertained with a food frequency questionnaire and family food insecurity was assessed with a validated questionnaire. The analysis estimated weighted means of energy and nutrient intakes by families' socioeconomic characteristics and the association between dietary intake with overweight and stunting. The prevalence of mild family food insecurity was 36%, and 24% of the families reported moderate or severe food insecurity. Overweight prevalence was 24%, and the prevalence of stunting was 9%, with no significant differences between sex or age groups. Family food insecurity was associated with unfavourable socioeconomic characteristics, but there was no association between socioeconomic characteristics (including family food insecurity) and overweight or stunting. Moderate or severe family food insecurity was inversely associated with intake of protein and calcium. In addition, stunting was associated with low calcium and iron intake. The co-existence of family food insecurity with overweight and stunting implies a high nutritional risk for adolescents from poor areas of Rio de Janeiro. Nevertheless, the observed absence of a statistical association between family food insecurity and weight status attests to the complexity of this issue.

Regional and social inequalities in food insecurity in Brazil, 2013-2018.

This study aims to analyze the association between social indicators and the worsening of food insecurity in 2013 and 2018 in different regions of Brazil. Data from the Brazilian National Household Sample Survey (2013) and Brazilian Household Budgets Survey (2018) were analyzed, considering nationally representative samples of 110,750 and 57,920 households, respectively. Food insecurity was assessed using the Brazilian Food Insecurity Scale by estimating the percentage changes in food insecurity levels between 2013 and 2018, according to sociodemographic variables. The association between social indicators and food insecurity disaggregated by region was estimated using multinomial logistic regression models. Although North and Northeast regions had higher proportions of food insecurity, the Southeast and Central-West regions had the highest increase in food insecurity in the same periods. Income was the indicator with the highest association with food insecurity both in 2013 and 2018. We also observed the association between the presence of three or more residents aged under 18 in a household and a higher risk of food insecurity in North and South regions. Food insecurity increased unevenly among regions during the Brazilian economic crisis, which reinforced regional inequality. Moreover, food insecurity was greater among households with worse social and economic living conditions, contributing to social inequality in the country. Thus, strengthening public policies to promote food security and nutrition according to regional social inequities is necessary.

Food insecurity in households with persons with disabilities in a situation of extreme vulnerability in Brazil: a secondary cross-sectional analysis.

Background: Inequities in access to education, work and health care are striking among persons with disabilities, making this population more vulnerable to poverty, lack of access to basic services and violation of rights such as access to food. Household food insecurity (HFI), marked by precarious income, has increased among persons with disabilities. In Brazil, the Continuous Cash Benefit (In Portuguese, Benefício de Prestação Continuada - BPC) is the guarantee of a minimum wage for persons with disabilities as a measure to promote social security and access to income in a situation of extreme poverty. Thus, the objective of this study was to assess HFI among persons with disabilities in extreme poverty in Brazil. Methods: A cross-sectional study with national representation was carried out with data from the 2017/2018 Family Budget Survey, with moderate and severe food insecurity as the dependent variable, and the situation of food insecurity measured using the Brazilian Food Insecurity Scale. Prevalence and odds ratio estimates were generated with 99% confidence intervals. Findings: Approximately 25% of households experienced HFI, with a higher prevalence in the North Region (41%), receiving up to 1 income quintile (36.6%), with a female (26.2%) and black person (31%) as a reference. The analysis model found that region, per capita household income, and social benefits received in the household were statistically significant factors. Interpretation: The BPC proved to be an important source of household income for persons with disabilities living in extreme poverty in Brazil: in almost three-quarters of the households, it was the only social benefit received, and, for most of them, it represented more than half of the total household income. Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

[Gender and skin color/race intersections in food insecurity across Brazilian households]. / Interseções de gênero e raça/cor em insegurança alimentar nos domicílios das diferentes regiões do Brasil.

Food insecurity is distributed unequally throughout Brazilian regions. This study aims to investigate the intersections of gender and skin color/race in the cases of food insecurity in households across Brazil. Microdata from the 2018 Brazilian Household Budgets Survey (POF) were used, with a sample of 57,920 households. Food insecurity levels were compared to profiles created from the intersection of gender (man and woman) and skin color/race: white man, white woman, mixed-race man, mixed-race woman, black man, and black woman. Prevalence ratios (PR) were estimated using Poisson regression models to investigate the association of profiles with moderate/severe food insecurity, separated by macroregion. The North had the worst proportions of all food insecurity levels (57%), followed by Northeast (50.4%). The North, Northeast, and Central-West macroregions had prevalence of moderate/severe food insecurity up to five times higher among households headed by women compared to those headed by men (p < 0.001). Moderate/severe food insecurity was associated to households headed by black women in all macroregions of Brazil, but prevalence ratios in Southeast were higher compared to other regions for mixed-race women (PR = 1.16; 95%CI: 1.13-1.20), while the PR was higher in South for black women (PR = 1.17; 95%CI: 1.13-1.21). Outcomes suggest that the intersectional food insecurity data in Brazil - focused on gender, skin color/race and macroregion of residence - should be considered for policies aimed at reducing hunger and related issues.

A insegurança alimentar e seus determinantes se distribuem de forma desigual entre as macrorregiões brasileiras. O objetivo deste estudo foi investigar as intersecções de gênero e raça/cor da pessoa de referência na ocorrência de insegurança alimentar em domicílios nas diferentes regiões do Brasil. Foram utilizados os microdados da Pesquisa de Orçamentos Familiares (POF) de 2018, com amostra de 57.920 domicílios. Os níveis de insegurança alimentar foram considerados com análises em relação aos perfis criados a partir da intersecção do gênero (homem e mulher) e raça/cor: homem branco, mulher branca, homem pardo, mulher parda, homem preto e mulher preta. Razões de prevalência (RP) foram estimadas por meio de modelos de regressão de Poisson para investigar a associação dos perfis com a insegurança alimentar moderada/grave, estratificados por macrorregião. O Norte apresentou as piores proporções de todos os níveis de insegurança alimentar (57%), seguido do Nordeste (50,4%). As regiões Norte, Nordeste e Centro-oeste apresentaram prevalência de insegurança alimentar moderada/grave até 5 vezes maior entre domicílios chefiados por mulheres comparados aos chefiados por homens (p < 0,001). A insegurança alimentar moderada/grave esteve mais associada aos domicílios chefiados pelas mulheres negras em todas as macrorregiões do Brasil, porém, no Sudeste, a RP foi mais elevada, quando comparada às demais regiões, para a mulher parda (RP = 1,16; IC95%: 1,13-1,20), enquanto na Região Sul a RP foi maior para a mulher preta (RP = 1,17; IC95%: 1,13-1,21). Os achados sugerem que o debate interseccional sobre os dados de insegurança alimentar no Brasil, considerando o gênero, a raça/cor da pele e a região de residência, deve ser somado ao tema das políticas voltadas para redução da insegurança alimentar e das iniquidades relacionadas.

La inseguridad alimentaria y sus determinantes está distribuida desigualmente por las macrorregiones de Brasil. El objetivo de este estudio fue investigar las intersecciones de género y raza/color de piel de la persona de referencia en la ocurrencia de inseguridad alimentaria en hogares de diferentes regiones brasileñas. Se utilizaron microdatos de la Encuesta de Presupuestos Familiares (POF) de 2018 de una muestra de 57.920 hogares. Se consideraron los niveles de inseguridad alimentaria con relación a los perfiles creados desde la intersección de género (hombre y mujer) y raza/color de piel: hombre blanco, mujer blanca, hombre pardo, mujer parda, hombre negro y mujer negra. Las razones de prevalencia (RP) se estimaron por modelos de regresión de Poisson para evaluar la asociación de los perfiles con inseguridad alimentaria moderada/grave, estratificados por macrorregión. La Región Norte tuvo las peores proporciones en todos los niveles de inseguridad alimentaria (57%), seguida del Nordeste (50,4%). Las regiones Norte, Nordeste y Centro-oeste mostraron prevalencias moderada/grave de inseguridad alimentaria hasta 5 veces mayores entre los hogares con mujeres como jefas del hogar en comparación con los hogares liderados por hombres (p < 0,001). La inseguridad alimentaria moderada/grave se asoció más en los hogares donde las mujeres negras eran las jefas del hogar en todas las macrorregiones de Brasil, sin embargo, en el Sudeste la RP fue mayor en comparación con las demás regiones para las mujeres pardas (RP = 1,16; IC95%: 1,13-1,20), mientras que en la Región Sur la RP fue mayor para las mujeres negras (RP = 1,17; IC95%: 1,13-1,21). Los hallazgos sugieren que el debate interseccional sobre los datos de inseguridad alimentaria en Brasil, considerando el género, la raza/color de piel y la región de residencia, debe agregarse al tema de las políticas destinadas a reducir la inseguridad alimentaria y sus inequidades asociadas.

Gender, skin color, and household composition explain inequities in household food insecurity in Brazil.

It is well known that female-headed households (FHHs) are more likely to experience food insecurity (FI) than male-headed households (MHHs), however there is a dearth of evidence on how gender intersects with other social determinants of FI. Thus, this paper investigated changes in the prevalence of household FI in Brazil from 2004 to 2018 by the intersection of gender, race/skin color and marital status of the household reference person. Data from three cross-sectional nationally representative surveys that assessed the status of FI using the Brazilian Household Food Insecurity Measurement Scale were analyzed (N2004 = 107,731; N2013 = 115,108, N2018 = 57,204). Multinomial logistic regression models were used to examine the relationship between profiles of gender, race/skin color, marital status of the head of the household with household FI stratified by the presence of children <5 years of age. Over time, FHHs had a higher prevalence of mild and moderate/severe FI than did households headed by men. Food security prevalence increased from 2004 to 2013 and decreased between 2013 and 2018 for households headed by men and women. In 2018, households headed by black/brown single mothers with children < 5 years of age were at the highest FI risk. The probability of reporting moderate/severe FI in these households were 4.17 times higher (95% CI [2.96-5.90]) than for households headed by married white men. The presence of children in the household was associated with a higher probability of moderate/severe FI, especially for households headed by black/brown individuals regardless of the reference person's gender. The results suggest that gender inequities combined with darker skin color and the presence of children at home potentiate the risk of moderate/severe FI. Policy makers need to consider the principles of intersectionality when investing in codesigning, implementing, evaluating, and scaling up evidence-based programs to reduce FI.

Access to governmental programs/benefits and food insecurity in urban and rural areas of Northeast Brazil. / Acesso aos benefícios e programas governamentais e insegurança alimentar nas áreas rurais e urbanas do Nordeste brasileiro.

This paper analyzes food insecurity (FI) in urban and rural areas of the Northeast region of Brazil associated with certain social determinants and access to governmental benefits/programs. Data about FI from the National Household Budget Survey (2017-2018) were analyzed, including socio-economic variables and access to government benefits/programs of supplemental income (Bolsa Família, Ongoing transfer benefits, Food voucher and Food basket). Multinomial logistic regression models were performed to assess the relationship between FI and access to government programs/benefits. Half of the families in the Northeast were classified as being subject to FI, the prevalence and severity being higher in rural households. The composition of the family, with at least one retired individual, significantly reduced the probability of being FI at all levels of severity. Access to the Food basket (in cash) benefit and Bolsa Família was associated with being a factor of protection against severe FI in rural areas, while in urban areas the food voucher benefit was the main factor of protection. Income transfer programs and access to social benefits contribute to combatting FI, highlighting the importance of maintaining and scaling-up these initiatives for vulnerable populations.

O trabalho analisa a insegurança alimentar (IA) nas áreas urbana e rural da região Nordeste do Brasil e sua associação com fatores sociais e o acesso a benefícios/programas governamentais. Foram avaliados dados sobre IA da Pesquisa de Orçamentos Familiares (2017-2018), considerando variáveis socioeconômicas e o acesso a benefícios/programas governamentais de transferência de renda (Bolsa Família, Benefício de Prestação Continuada, Cartão Alimentação e Cesta de Alimentos). Modelos de regressão logística multinomial tendo IA como desfecho foram utilizados para avaliar a relação com os programas governamentais. Metade das famílias se encontrava em IA, sendo maior a prevalência e gravidade nos domicílios rurais. A composição da família por ao menos um indivíduo aposentado reduziu significativamente a probabilidade de ocorrência dos níveis mais severos da IA. O acesso à Cesta de Alimentos (em dinheiro) e ao Bolsa Família associou-se como fator de proteção para a IA grave na área rural; na área urbana, o benefício Cartão Alimentação foi o principal fator de proteção. Programas de transferência de renda e o acesso a benefícios sociais contribuíram para o enfrentamento da IA, destacando a relevância da manutenção e ampliação dessas iniciativas para populações vulnerabilizadas.

Changes in meal frequency among adolescents living in a socially vulnerable area of the Rio de Janeiro metropolitan region, Brazil. / Mudanças na frequência do consumo de refeições em adolescentes residentes em área de vulnerabilidade social da região metropolitana do Rio de Janeiro, Brasil.

This study described changes in meal frequency over a 5-year period among adolescents living in the Rio de Janeiro metropolitan region. The data used were from two cross-sectional, population-based studies conducted by home visits. In 2005 the final sample was 1089 households with 511 adolescents (aged 12 to 18 years) and in 2010, 1121 households with 314 adolescents. Meal frequency was obtained through self-administered questionnaire and the adolescents were assessed for appropriate weight by BMI cut-off points, by sex and age group. Increasingly, traditional daily lunch was replaced by snacks (from 3.7% to 13.7%) and traditional dinner was eaten (62.9% to 72.0%). Overweight adolescents ate breakfast less often than those not overweight (in 2005, 68.3% and 79.3%, p=0.02 and, in 2010, 59.5% and 77.4%, p=0.03). Traditional daily lunch was increasingly replaced by snacks and consumption of traditional dinner increased over the 5-year period. Also, eating breakfast every day was associated with BMI classification at both study times: those who were overweight consumed breakfast less frequently.

O objetivo deste estudo foi descrever as mudanças na frequência do consumo de refeições de adolescentes residentes na região metropolitana do Rio de Janeiro, em período de 5 anos. Utilizaram-se dados de dois estudos transversais, de base populacional, que foram realizados por meio de visitas domiciliares. Em 2005, a amostra final foi de 1089 domicílios com 511 adolescentes (de 12 a 18 anos), e em 2010 de 1121 domicílios com 314 adolescentes. A frequência do consumo de refeições foi obtida por meio de questionário autopreenchido e a avaliação da adequação de peso dos adolescentes foi realizada com base nos pontos de corte do IMC por sexo e faixa etária. Houve aumento da substituição diária do almoço tradicional por lanche (3,7% para 13,7%) e no consumo do jantar tradicional (62,9% para 72,0%). Os adolescentes com sobrepeso consumiram o desjejum com menor frequência do que aqueles sem sobrepeso (2005: 68,3% vs 79,3% p=0,02, 2010: 59,5% vs 77,4% p=0,03). Conclui-se que houve aumento da substituição diária do almoço tradicional por lanche e no consumo do jantar tradicional no período de 5 anos. Ademais, a prática do desjejum diário se associou com a classificação de IMC nos dois momentos do estudo, de modo que aqueles com sobrepeso consomem o desjejum com menor frequência.