FACTORS ASSOCIATED WITH INADEQUATE MILK CONSUMPTION AMONG ADOLESCENTS: NATIONAL SCHOOL HEALTH SURVEY - PENSE 2012.

OBJECTIVE: To identify the prevalence and factors associated with inadequate milk consumption among adolescents. METHODS: This was a cross-sectional study based on secondary data from the National School Health Survey (2012), a Brazilian survey carried out using a self-administered questionnaire in a representative sample of 9th-grade students from public and private schools. The frequency of milk intake and its association with socio-demographic characteristics, food consumption and physical activity were estimated. A descriptive and inferential analysis of factors associated with inadequate milk consumption (no consumption at least one of the seven days of the week) was performed. A multiple logistic model was adjusted to control confounders. RESULTS: The sample included 108,828 adolescents and inadequate milk consumption ocurred in 58.9%. The final model included nine variables independently associated with inadequate milk intake: breakfast frequency less than 4 days per week (odds ratio [OR]=2.40; p<0.001), unprocessed or minimally processed foods intake less than 5 days per week (OR=1.93; p<0.001), living in the northeast region (OR=1.39; p<0.001), less maternal schooling (OR=1.35; p<0.001), physical inactivity (OR=1.33; p<0.001), attending public school (OR=1.26; p<0.001), not being white (OR=1.14; p<0.001), being older than 14 years old (OR=1.13; p<0.001) and having a habit of eating meals while watching TV or studying (OR=1.04; p=0.036). CONCLUSIONS: Inadequate milk consumption is prevalent among Brazilian adolescents. The identification of associated factors suggests the need to develop nutritional guidance strategies for the prevention of diseases that result from low calcium intake.

Factors associated with inadequate milk consumption among adolescents: national school health survey - pense 2012 / Fatores associados ao consumo inadequado de leite em adolescentes: pesquisa nacional de saúde do escolar - pense 2012

ABSTRACT Objective: To identify the prevalence and factors associated with inadequate milk consumption among adolescents. Methods: This was a cross-sectional study based on secondary data from the National School Health Survey (2012), a Brazilian survey carried out using a self-administered questionnaire in a representative sample of 9th-grade students from public and private schools. The frequency of milk intake and its association with socio-demographic characteristics, food consumption and physical activity were estimated. A descriptive and inferential analysis of factors associated with inadequate milk consumption (no consumption at least one of the seven days of the week) was performed. A multiple logistic model was adjusted to control confounders. Results: The sample included 108,828 adolescents and inadequate milk consumption ocurred in 58.9%. The final model included nine variables independently associated with inadequate milk intake: breakfast frequency less than 4 days per week (odds ratio [OR]=2.40; p<0.001), unprocessed or minimally processed foods intake less than 5 days per week (OR=1.93; p<0.001), living in the northeast region (OR=1.39; p<0.001), less maternal schooling (OR=1.35; p<0.001), physical inactivity (OR=1.33; p<0.001), attending public school (OR=1.26; p<0.001), not being white (OR=1.14; p<0.001), being older than 14 years old (OR=1.13; p<0.001) and having a habit of eating meals while watching TV or studying (OR=1.04; p=0.036). Conclusions: Inadequate milk consumption is prevalent among Brazilian adolescents. The identification of associated factors suggests the need to develop nutritional guidance strategies for the prevention of diseases that result from low calcium intake.

RESUMO Objetivo: Identificar a prevalência e os fatores associados ao consumo inadequado de leite em adolescentes. Métodos: Estudo transversal com base em dados secundários da Pesquisa Nacional de Saúde do Escolar (PeNSE; 2012), inquérito brasileiro realizado por meio de questionário autoaplicável em amostra representativa de alunos do nono ano do ensino fundamental de escolas públicas e privadas. Estimou-se a frequência da ingestão de leite e sua associação com características sociodemográficas, consumo alimentar e prática de atividade física. Foi realizada análise descritiva e inferencial dos fatores associados ao consumo inadequado de leite (ausência em pelo menos um dos sete dias da semana). Um modelo logístico múltiplo foi ajustado para controle das variáveis de confusão. Resultados: A amostra incluiu 108.828 adolescentes e o consumo inadequado de leite foi de 58,9%. O modelo final incluiu 9 variáveis independentemente associadas à ingestão inadequada de leite: frequência de desjejum inferior a 4 dias semanais (odds ratio [OR]=2,40; p<0,001), consumo de alimentos in natura e minimamente processados inferior a 5 dias semanais (OR=1,93; p<0,001), residir na Região Nordeste (OR=1,39; p<0,001), menor escolaridade materna (OR=1,35; p<0,001), inatividade física (OR=1,33; p<0,001), frequentar escola pública (OR=1,26; p<0,001), não ser da raça branca (OR=1,14; p<0,001), ter idade superior a 14 anos (OR=1,13; p<0,001) e possuir o hábito de realizar as refeições assistindo à TV ou estudando (OR=1,04; p=0,036). Conclusões: O consumo inadequado de leite é frequente entre adolescentes brasileiros. A identificação de fatores associados sugere a necessidade do desenvolvimento de estratégias de orientação nutricional para a prevenção de doenças resultantes da baixa ingestão de cálcio.

Assessment of dietary intake in an inner-city African American population and development of a quantitative food frequency questionnaire to highlight foods and nutrients for a nutritional invention.

PRIMARY OBJECTIVE: To characterize the diets of low-income inner-city African Americans to develop a population-specific quantitative food frequency questionnaire (QFFQ) that will be used to highlight foods and nutrients for a nutritional intervention program aimed at reducing the risk of chronic disease and to evaluate the program. METHODS AND PROCEDURES: A cross-sectional survey conducted in inner-city Baltimore, Maryland, USA. Twenty-four-hour dietary recalls were collected in 91 low-income African Americans aged between 18 and 74 years. MAIN OUTCOMES AND RESULTS: The average daily energy intake was approximately 2,165 kcal for women and 2,509 kcal for men. The percentages of energy from fat were approximately 34% and 33% for women and men, respectively. Sodas were the main contributor to energy and sugar intake. A 113-item QFFQ was developed. CONCLUSIONS: The results highlighted specific foods and nutrients that would be targeted in the nutritional intervention. The QFFQ developed is culturally appropriate and specific for low-income African Americans in inner-city Baltimore.

Influence of socio-economic and lifestyle factors on overweight and nutrition-related diseases among Tunisian migrants versus non-migrant Tunisians and French.

BACKGROUND: Migrant studies in France revealed that Mediterranean migrant men have lower mortality and morbidity than local-born populations for non-communicable diseases (NCDs). We studied overweight and NCDs among Tunisian migrants compared to the population of the host country and to the population of their country of origin. We also studied the potential influence of socio-economic and lifestyle factors on differential health status. METHODS: A retrospective cohort study was conducted to compare Tunisian migrant men with two non-migrant male groups: local-born French and Tunisians living in Tunisia, using frequency matching. We performed quota sampling (n = 147) based on age and place of residence. We used embedded logistic regression models to test socio-economic and lifestyle factors as potential mediators for the effect of migration on overweight, hypertension and reported morbidity (hypercholesterolemia, type-2 diabetes, cardiovascular diseases (CVD)). RESULTS: Migrants were less overweight than French (OR = 0.53 [0.33-0.84]) and had less diabetes and CVD than Tunisians (0.18 [0.06-0.54] and 0.25 [0.07-0.88]). Prevalence of hypertension (grade-1 and -2) and prevalence of hypercholesterolemia were significantly lower among migrants than among French (respectively 0.06 [0.03-0.14]; 0.04 [0.01-0.15]; 0.11 [0.04-0.34]) and Tunisians (respectively OR = 0.07 [0.03-0.18]; OR = 0.06 [0.02-0.20]; OR = 0.23 [0.08-0.63]). The effect of migration on overweight was mediated by alcohol consumption. Healthcare utilisation, smoking and physical activity were mediators for the effect of migration on diabetes. The effect of migration on CVD was mediated by healthcare utilisation and energy intake. No obvious mediating effect was found for hypertension and hypercholesterolemia. CONCLUSION: Our study clearly shows that lifestyle (smoking) and cultural background (alcohol) are involved in the observed protective effect of migration.

Ethnic disparities in nutrition-related mortality in New Zealand: 1997-2011.

AIMS: To estimate the mortality due to non-optimal levels of systolic blood pressure, total blood cholesterol, body mass index (BMI), and vegetable and fruit intake amongst Maori and non-Maori in New Zealand in 1997. In addition, to estimate the ethnic-specific burden of disease that could potentially be avoided in 2011 if exposure to these risk factors were reduced. METHODS: The study uses comparative risk assessment methodology, a systematic approach to estimating both attributable and avoidable burden of disease developed by the World Health Organization. RESULTS: About 47% of deaths among Maori and 39% of deaths among non-Maori were estimated to be due to the selected risk factors. Age-standardised mortality rates for attributable ischaemic heart disease burden were consistently higher in Maori for individual risk factors. Age standardised mortality attributable to BMI was relatively higher for Maori, especially diabetes mortality. Estimates of avoidable mortality suggest that the health gains for Maori would be relatively greater than for non-Maori across all risk factors, but particularly with improvements in BMI. CONCLUSIONS: Non-optimal levels of systolic blood pressure, cholesterol, BMI, and to a lesser extent vegetable and fruit intake are major modifiable causes of death in New Zealand. Small changes in risk factor levels could have a major impact on population health within a decade, with relatively greater health gains for Maori.

Does race matter? Children's height in Brazil and South Africa.

I examine racial differences in child stunting in mid-1990s South Africa and Brazil, two multiracial societies with different histories of legal support for racial discrimination. Using data from nationally representative household samples linked to community-level measures, the analysis shows that racial inequality in the distribution of socioeconomic resources across households and communities explains much of the racial difference in stunting in both countries. Even after these factors are controlled, however, the results indicate that in South Africa, nonwhite children are still at greater risk of growth faltering than are white children. The nature of socioeconomic and racial differences in children's growth is examined, and major determinants are discussed. These findings suggest that although state-sanctioned racism may help to explain the greater racial inequality in stunting in South Africa than in Brazil, the eradication of a disadvantage for nonwhites will depend on changes in the same fundamental socioeconomic inequalities that characterize both nations.

Women's social power, child nutrition and poverty in Mali.

While the macro-level association between poverty and child malnutrition is well-established, the concept of 'poverty' and its operationalization in terms of measures of socioeconomic status shed little or no light on the mechanisms through which malnutrition is created and/or prevented. This paper investigates a woman's social power, one such mechanism that may mediate the impact of poverty on childhood nutrition. This micro-level factor is examined using survey data on 402 children 5 years of age and younger and their 261 Fulbe mothers in rural Mali. A conceptual model of social power is developed and used to test the hypothesis that a mother's social power can predict her child's nutritional status.

Variations in nutritional risk among black and white women who receive home-delivered meals.

The maintenance of good nutritional status is a cornerstone of health, function, and quality of life. To assess indicators and correlates of high levels of nutritional risk, sociodemographic, functional status, and nutritional data were collected from a diverse sample of 729 older women. Results from ordered logit analysis indicated that being Black, having an income < or = 125% of the federal poverty level, living alone, and being in the younger-old age group (ages 60 to 74 years) were associated with moderately high and very high levels of nutritional risk. An examination of individual and multiple nutritional risk indicators suggested a heightened vulnerability of Black women to inadequate dietary intake, even net of income and other influential variables. With demographic projections of an increasingly numerous and diverse older population who may face health and nutritional challenges, researchers must strengthen efforts to assist policymakers and service providers to properly target nutrition services.

[Child health and nutrition in a Teréna indigenous community, Mato Grosso do Sul, Brazil]. / Nutrição e saúde infantil em uma comunidade indígena Teréna, Mato Grosso do Sul, Brasil.

This paper describes the health and nutritional situation of South American Indian children from a Teréna community, characterizing their nutritional status, food consumption, and socioeconomic and environmental conditions. The sample included 100 children, ranging from 0 to 59 months of age and living in Aldeia Córrego do Meio, Mato Grosso do Sul. Prevailing nutritional deficits were: 8.0% for the weight-for-age index, 16.0% for height-for-age, and 5.0% for weight-for-height. The growth deficit rate was higher than that of the Brazilian population as a whole, probably reflecting the precarious socioeconomic, environmental, and health conditions in this Teréna community. Analysis of the average nutrient sufficiency in the infant diet showed that nutritional recommendations for the different groups were not complied with. New studies, characterized as transdisciplinary and longitudinal, are necessary to better understand this process.

Nutritional assessment of two famine prone Ethiopian communities.

STUDY OBJECTIVES: To compare two ethnically distinct Ethiopian populations (Oromo Arsi in Elka in the Rift Valley and Anyuak in Punjido in Gambella) for two widely used anthropometric indices of protein-energy malnutrition: body mass index < 18.5 and arm muscle circumference < 80% of the median of the US NHANES reference data. DESIGN: Anthropometric measurements were made in two cross sectional community surveys. SETTING: The Elka village in the central Rift Valley and the Punjido village in western Ethiopia. PARTICIPANTS: 1170 and 560 people from all age groups in Elka and Punjido, respectively. MAIN RESULTS: Estimates of the prevalence of malnutrition in each group differed considerably when defined from the body mass index, but were quite similar when the arm muscle circumference was used. Data for children indicated that the boys and girls in one group (Punjido) were taller but had about the same weights for age as those in the other group (Elka), suggesting that the low body mass indices among the Punjido might have a genetic basis. CONCLUSIONS: Body mass index systematically overestimates the prevalence of malnutrition among the Anyuaks in Punjido. Local reference data from a well nourished Anyuak sample or from an ethnically related population is needed to evaluate appropriately malnutrition using the body mass index. This study shows that care must be taken when assessing different ethnic groups using existing international anthropometric references.

Which way kaikai blo umi? Food and nutrition in the Torres Strait.

The people of the Torres Strait suffer a disproportionate level of diet-related disease, especially diabetes. The Torres Strait Health Strategy identified the difficulty in obtaining healthy food, particularly fruit and vegetables, as a major problem for people living in the Torres Strait. This study examined traditional plant food supply systems and current local production of fruit and vegetables. The supply system of fruit and vegetables from mainland Australia was also examined. Traditional garden food production was seen to continue (mainly to provide food for ceremonial occasions), but had declined because of easy access to store foods, changes in the physical, social and economic environment, limited access to land and water, and quarantine restrictions on movement of garden produce. Supplies of fruit and vegetables from the Australian mainland were infrequent and the prolonged transit time meant that produce was often in poor condition on arrival and prone to continued rapid deterioration due to limited store-level storage facilities. Demand for fresh produce exceeded supply.

Socio-economic causes and cultural explanations of childhood malnutrition among the Chagga of Tanzania.

This study provides an in-depth analysis of the complexity of factors involved in selective child survival among the Chagga people of Mt Kilimanjaro, Tanzania. Carried out during the first of a series of post-independence economic crises, the study analyzes the impact of fluctuations in world economy, ecological stresses, demographic pressures, and class formation in creating conditions of poverty and lessening the ability of many Chagga to provide adequate care for their children. Qualitative and quantitative information are given from a follow-up study of families whose children were placed in a nutrition rehabilitation program during the drought of 1972-73. Four cases from that study further demonstrate the impact of macroeconomic forces on individuals and provide material for analyzing a complex pattern of cultural beliefs which made up part of the Chagga people's explanations for child malnutrition.

Ethnic group differences in nutritional status of young children from low-income areas of an urban county.

A nutrition assessment survey was undertaken among 566 preschool children from randomly selected low income households located within an urban county. The purpose of the survey was to determine the prevalence of selected nutrition problems and to identify relationships among ethnic and economic variables and nutritional status. Underweight was identified in 1.8%, overweight in 15.4%, and short stature in 13.1% of children. Southeast Asian children had a higher prevalence of short stature than the other ethnic groups. Low hemoglobin values were identified in 4.3%, low hematocrit in 6.9%, and elevated erythrocyte protoporphyrin in 6.0% of children. The prevalence of elevated EP was significantly higher among Southeast Asian children than non-Southeast Asians and likely was due to iron deficiency. Results of the survey suggest that Southeast Asian children constitute the group at highest nutritional risk in the low income areas surveyed.