The cost of improving nutritional outcomes through food-assisted maternal and child health and nutrition programmes in Burundi and Guatemala.

Evidence on the cost-effectiveness of multisectoral maternal and child health and nutrition programmes is scarce. We conducted a prospective costing study of two food-assisted maternal and child health and nutrition programmes targeted to pregnant women and children during the first 1,000 days (pregnancy to 2 years). Each was paired with a cluster-randomized controlled trial to evaluate impact and compare the optimal quantity and composition of food rations (Guatemala, five treatment arms) and their optimal timing and duration (Burundi, three treatment arms). We calculated the total and per beneficiary cost, conducted cost consequence analyses, and estimated the cost savings from extending the programme for 2 years. In Guatemala, the programme model with the lowest cost per percentage point reduction in stunting provided the full-size family ration with an individual ration of corn-soy blend or micronutrient powder. Reducing family ration size lowered costs but failed to reduce stunting. In Burundi, providing food assistance for the full 1,000 days led to the lowest cost per percentage point reduction in stunting. Reducing the duration of ration eligibility reduced per beneficiary costs but was less effective. A 2-year extension could have saved 11% per beneficiary in Guatemala and 18% in Burundi. We found that investments in multisectoral nutrition programmes do not scale linearly. Programmes providing smaller rations or rations for shorter durations, although less expensive per beneficiary, may not provide the necessary dose to improve (biological) outcomes. Lastly, delivering effective programmes for longer periods can generate cost savings by dispersing start-up costs and lengthening peak operating capacity.

Conditional Cash Transfers in the Amazon: From the Nutrition Transition to Complex Dietary Behavior Change.

Nutrition transition theory describes a progressive substitution of local staples for industrialized processed foods in local diets, a process documented diversely across world regions, and increasingly observed in rural areas of the global south. Here we examine the role of conditional cash transfer programs, in particular the emblematic Brazilian Bolsa Família (BFP), in driving nutritional transition in rural areas of the Amazon. Based on ethnographic research with both participating and nonparticipating women in the Amanã Sustainable Development Reserve (SDR), our analysis integrates Food Frequency Questionnaires (FFQ), seasonal 24-hour food intake recalls, and stable isotope ratios in fingernails to examine dietary behavioral change. Contrary to dietary changes observed elsewhere in the Amazon, participation in the BFP is not associated with a significant substitution of local staples for industrialized processed foods in Amanã. While an increase in the consumption of some industrialized foods was observed, it has been selective and it has not changed the structure of diets. Factors such as social and cultural value of local staples, resident's involvement with the SDR, their relationship with lake and upland forest and agricultural environments, and limited market access have buffered the expansion of industrialized processed foods as observed elsewhere.

Do nutrition and cash-based interventions and policies aimed at reducing stunting have an impact on economic development of low-and-middle-income countries? A systematic review.

BACKGROUND: Childhood stunting is the most common manifestation of chronic malnutrition. A growing body of literature indicates that stunting can have negative repercussions on physical and cognitive development. There are increasing concerns that low- and middle-income countries (LMICs) are particularly susceptible to adverse consequences of stunting on economic development. The aim of this review is to synthesize current evidence on interventions and policies that have had success in reducing stunting and explore the impact of successes on economic indicators. METHODS: This review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles were searched through MEDLINE via PubMed and Ovid, Cochrane Library, Web of Science and ProQuest. Only articles that addressed the effects of nutrition and cash-based interventions and/or policies on stunting and reported effects on childhood mortality and/or human capital indicators were included. Two reviewers independently abstracted data and assessed quality. RESULTS: Seventeen studies from Africa (47%), South America (41%), and South Asia (12%) met the eligibility criteria: 8 cohort studies, 4 case studies, 4 Randomized Control Trials (RCTs) and 1 quasi-trial. Three types of interventions/policies were evaluated: multisectoral policies, nutritional supplementations and cash-based interventions (CCT). Overall, 76% of the included studies were successful in reducing stunting and 65% of interventions/policies reported successes on stunting reductions and economic successes. Five of the 11 successful studies reported on nutritional supplementation, 4 reported on multisectoral policies, and 2 reported on CCT interventions. Average Annual Rate of Reduction (AARR) was calculated to assess the impact of multisectoral policies on childhood mortality. AARR for under 5 mortality ranged from 5.2 to 6.2% and all countries aligned with the global target of 4.4% AARR. Quality assessment yielded positive results, with the biggest concerns being attrition bias for cohort studies, blinding for trials and generalizability of results for case studies. CONCLUSIONS: Evidence suggests that investment in fighting chronic malnutrition through multisectoral policies, multi-year nutritional supplementation (protein or multiple micronutrient supplementation) and possibly CCTs can have a long-term impact on economic development of LMICs. More evidence is needed to inform practices in non-represented regions while prioritizing standardization of economic indicators in the literature.

Recommendations From SNAP Participants to Improve Wages and End Stigma.

We present views of the Supplemental Nutrition Assistance Program (SNAP) from the perspective of participants. We are SNAP participants and academic researchers who have worked together for 11 years to understand, explain, and address food insecurity.SNAP is ensnared in much larger problems in US society related to the stigmatization of people who are poor and a lack of appreciation for the value and skills of their work. We encourage the public health community to think beyond SNAP, focus more assertively on wages and work supports, and replace our means-tested safety net with a new system of universal income that promotes equity, inclusion, and health for all.Although we offer recommendations to improve SNAP, the goal of most SNAP recipients has always been to move beyond the need for this program. The public health community can take the lead in finding more egalitarian, dignified, and effective ways to address poverty and food insecurity.

Food Aid for Nutrition: Narrative Review of Major Research Topics Presented at a Scientific Symposium Held October 21, 2017, at the 21st International Congress of Nutrition in Buenos Aires, Argentina.

BACKGROUND: Food aid is a valuable tool for meeting global nutrition goals, particularly for vulnerable populations of children and reproductive-aged women. On October 21, 2017, the Food Aid Quality Review Project hosted a scientific symposium at the 21st International Congress on Nutrition in Buenos Aires, Argentina, to take stock of what the global community has learned about selected topics in the research literature on food aid used to address malnutrition. OBJECTIVE: This article presents the discussion that took place during the symposium, which was guided by presentations by 6 experts from the field of nutrition, food aid, and humanitarian response. CONCLUSION: The recent upsurge in research on food aid has advanced the collective knowledge of what food aid products and programs work for addressing nutrition, but there is much more to learn. Presentations in this symposium called for further inquiry on (1) different and novel food aid formulations, (2) the cost-effectiveness of products and programs, and (3) market-based approaches to food assistance. Continuing to expand the evidence base on these topics is critical to improving global nutrition programs.

Household food insecurity in black-slaves descendant communities in Brazil: has the legacy of slavery truly ended?

OBJECTIVE: To identify the factors associated with food insecurity among Quilombolas communities in Brazil. DESIGN: An analysis of secondary data assessed in the 2011 Quilombolas Census was performed. The Brazilian Food Insecurity Measurement Scale (Escala Brasileira de Insegurança Alimentar, EBIA) was used to assess household food security status. Sociodemographic conditions and access to social programmes and benefits were also evaluated. SETTING: National survey census from recognized Quilombolas Brazilian territories. SUBJECTS: Quilombolas households (n 8846). RESULTS: About half (47·8 %) of the Quilombolas lived in severely food-insecure households, with the North and Northeast regions facing the most critical situation. Households located in North Brazil, whose head of the family had less than 4 years of education, with a monthly per capita income below $US 44, without adequate sanitation and without adequate water supply had the greatest chance of experiencing moderate or severe food insecurity. Households that had access to a water supply programme for dry regions (Programa Cisternas) and an agricultural harvest subsidy programme (Programa Garantia Safra) had less chance of experiencing moderate and severe food insecurity. Households that did not have access to health care (Programa Saúde da Família) had greater chance of suffering from moderate or severe food insecurity. CONCLUSIONS: Interventions are urgently needed to strengthen and promote public policies aimed to improve living conditions and food security in Quilombolas communities.

Perspectives on the SUN Movement: Waterlow lecture delivered at the International Congress of Nutrition in Granada, 16 September 2013.

The Waterlow lecture was named to commemorate Professor John Waterlow, an eminent figure in nutrition during the last half of the 20th century. David Nabarro worked with Professor Waterlow for a period of his career and was invited to deliver the Waterlow lecture during the International Congress of Nutrition in Granada on 16 September 2013.

[Socio-demographic and nutritional characteristics of Brazilian children under 2 years of age who were beneficiaries of conditional cash transfer programs in 2006]. / Características sociodemográficas e nutricionais de crianças brasileiras menores de 2 anos beneficiárias de programas de transferência condicionada de renda em 2006.

The conditional cash transfer programs (PTCR) seek to combat poverty and hunger and to ensure food security. Children under the age of two of beneficiary families are more vulnerable to environmental conditions. This study seeks to describe this population according to socio-economic, demographic and nutritional variables. Secondary data from the National Survey on Demography and Health of Women and Children (PNDS-2006) were used. Data were described using mean and standard deviations. Associations were described using the chi-square test with confidence intervals of 95%. Of the 1735 children, 29.4% were PCTR beneficiaries with average family income of R$430.20 and average benefits of R$75. Among those living in the Northeast or in the rural area of the country, one in every three received benefits. Among those experiencing severe food insecurity, 52.3% were PTCR beneficiaries. Children from socio-economic classes D and E and whose mothers had less than four years education were associated with PTCR. Among the nutritional disorders of child beneficiaries, overweight for age prevailed. Of those who ceased exclusive breastfeeding in less than two months, 31.2% were beneficiaries. The need for preventive nutritional education was identified in order to optimize the use of benefits.

[Food security, income, and the Bolsa Família program: a cohort study of municipalities in Paraíba State, Brazil, 2005-2011]. / Segurança alimentar, renda e Programa Bolsa Família: estudo de coorte em municípios do interior da Paraíba, Brasil, 2005-2011.

This study aims to evaluate the impact of the conditional cash transfer program known as Bolsa Família in overcoming food insecurity. A cohort study was conducted in 2005 and 2011 in a sample of families in São José dos Ramos and Nova Floresta, Paraíba State, Brazil. In 2005, 609 households were interviewed, and in 2011 we located and re-interviewed 406 families. There had been an increase in food security and mild food insecurity and an improvement in socioeconomic indicators. A significant association was observed between higher income and improved food security. The program showed a positive impact by increasing income and providing improved levels of food security and mild food insecurity. Other socioeconomic variables may be contributing to this improvement. The fight against food insecurity and malnutrition thus requires additional policies and programs that act on other determinants.

Características sociodemográficas e nutricionais de crianças brasileiras menores de 2 anos beneficiárias de programas de transferência condicionada de renda em 2006 / Socio-demographic and nutritional characteristics of Brazilian children under 2 years of age who were beneficiaries of conditional cash transfer programs in 2006

Programas de transferência condicionada de renda (PTCR) visam o combate à pobreza e à fome e a garantia da segurança alimentar. Crianças menores de 2 anos de famílias beneficiárias são mais vulneráveis às condições ambientais. Este estudo objetiva caracterizar esta população segundo variáveis socioeconômicas, demográficas e nutricionais. Utilizaram-se dados secundários da Pesquisa Nacional de Demografia e Saúde da Crian ça e da Mulher (PNDS-2006). Descreveram-se os dados em média e desvios-padrão. Para as associações utilizou-se o teste qui-quadrado e intervalos de confiança de 95%. Das 1735 crianças 29,4% eram beneficiárias de PTCR com renda média familiar de R$430,20 e valor médio dos benefícios de R$75. Dentre as que residiam no Nordeste ou na região rural do país, uma em cada três recebiam PTCR. Entre as que viviam em insegurança alimentar grave, 52,3% pertenciam a PTCR. Classes econômicas D e E e baixa escolaridade materna associaram-se a PTCR. Entre os desvios nutricionais das crianças beneficiárias, prevaleceu o peso elevado para idade. Das que interromperam o aleitamento materno exclusivo antes dos dois meses, 31,2% eram de PTCR. Identifica-se a necessidade de educação nutricional preventiva a fim de otimizar a utilização do benefício.

The conditional cash transfer programs (PTCR) seek to combat poverty and hunger and to ensure food security. Children under the age of two of beneficiary families are more vulnerable to environmental conditions. This study seeks to describe this population according to socio-economic, demographic and nutritional variables. Secondary data from the National Survey on Demography and Health of Women and Children (PNDS-2006) were used. Data were described using mean and standard deviations. Associations were described using the chi-square test with confidence intervals of 95%. Of the 1735 children, 29.4% were PCTR beneficiaries with average family income of R$430.20 and average benefits of R$75. Among those living in the Northeast or in the rural area of the country, one in every three received benefits. Among those experiencing severe food insecurity, 52.3% were PTCR beneficiaries. Children from socio-economic classes D and E and whose mothers had less than four years education were associated with PTCR. Among the nutritional disorders of child beneficiaries, overweight for age prevailed. Of those who ceased exclusive breastfeeding in less than two months, 31.2% were beneficiaries. The need for preventive nutritional education was identified in order to optimize the use of benefits.

Seguranca alimentar, renda e Programa Bolsa Familia: estudo de coorte em municipios do interior da Paraiba, Brasil, 2005-2011 / Food security, income, and the Bolsa Família program: a cohort study of municipalities in Paraíba State, Brazil, 2005-2011 / La seguridad alimentaria, los ingresos y Programa Bolsa Familia: estudio de cohorte de municipios en Paraiba, Brasil, 2005-2011

Este trabalho tem por objetivo avaliar o impacto do Programa Bolsa Família na superação da Insegurança Alimentar. Realizou-se um estudo de coorte em 2005 e 2011, em amostra de famílias residentes em São José dos Ramos e Nova Floresta, Paraíba, Brasil. Em 2005 foram avaliados 609 domicílios e em 2011 foram encontradas e entrevistadas 406 famílias. Houve aumento da segurança alimentar/insegurança alimentar leve e melhoria nos indicadores socioeconômicos. Percebeu-se uma relação significativa entre a elevação da renda e a melhoria dos níveis de Insegurança Alimentar. O programa impacta positivamente no aumento da renda, propiciando melhorias dos níveis de segurança alimentar/insegurança alimentar leve. Percebeu-se que outras variáveis socioeconômicas podem estar contribuindo na melhoria deste perfil. Diante disso, no combate à insegurança alimentar e nutricional, são necessárias outras políticas e programas que ajam nos demais determinantes.

This study aims to evaluate the impact of the conditional cash transfer program known as Bolsa Família in overcoming food insecurity. A cohort study was conducted in 2005 and 2011 in a sample of families in São José dos Ramos and Nova Floresta, Paraíba State, Brazil. In 2005, 609 households were interviewed, and in 2011 we located and re-interviewed 406 families. There had been an increase in food security and mild food insecurity and an improvement in socioeconomic indicators. A significant association was observed between higher income and improved food security. The program showed a positive impact by increasing income and providing improved levels of food security and mild food insecurity. Other socioeconomic variables may be contributing to this improvement. The fight against food insecurity and malnutrition thus requires additional policies and programs that act on other determinants.

Este estudio tiene como objetivo evaluar el impacto del Programa Bolsa Familia para superar la inseguridad alimentaria. Se realizó un estudio de cohorte en el año 2005 y 2011 en una muestra de familias que viven en São José dos Ramos y el Nova Floresta, Paraíba, Brasil. En 2005 se evaluaron 609 hogares y 2011 no se han encontrado y entrevistado a 406 familias. Hubo un aumento de seguridad alimentaria/inseguridad alimentaria. Así como una ligera mejora de los indicadores socioeconómicos. Se observó una relación significativa entre el aumento de los ingresos y la mejora de los niveles de inseguridad alimentaria. El programa tiene un impacto positivo en el aumento de los ingresos, proporcionar mejores niveles de seguridad alimentaria/inseguridad alimentaria. Se percibió que otras variables socioeconómicas pueden estar contribuyendo a la mejora de este perfil. Por lo tanto, en la lucha contra la inseguridad alimentaria y la nutrición, las políticas y los programas adicionales que actúan son determinantes.

Transferencia de renda no Brasil e desfechos nutricionais: revisao sistematica / Transferencia de renta en Brasil y consecuencias nutricionales / Cash transfer in Brazil and nutritional outcomes: a systematic review

OBJETIVO : Analisar a influência de programas de transferência condicionada de renda sobre desfechos relacionados à alimentação e nutrição de famílias beneficiadas no Brasil. MÉTODOS : Foi realizada revisão sistemática da literatura com estudos de avaliação originais feitos no Brasil, incluindo ensaios clínicos e estudos observacionais. Foram consultadas as bases de dados PubMed, Scopus, Web of Science e LILACS, incluindo estudos publicados desde 1990. Analisaram-se os estudos segundo programa avaliado, participantes, delineamento da pesquisa, local de realização, principais conclusões, fatores de confundimento e limitações metodológicas. Os estudos foram classificados de acordo com o desfecho (estado nutricional, consumo alimentar e segurança alimentar e nutricional) e tipo de inferência para a associação com programas de transferência condicionada de renda (adequação, plausibilidade ou probabilidade). RESULTADOS : Foram encontrados 1.412 documentos não duplicados. Quinze preencheram os critérios de elegibilidade e 12 destes avaliaram o Programa Bolsa Família. Cinco estudos de plausibilidade e dois estudos de adequação apontam uma influência positiva dos programas de transferência de renda no estado nutricional das crianças beneficiárias. A influência desses programas sobre o consumo alimentar foi analisada em um estudo de adequação de base populacional e três pesquisas transversais de plausibilidade em municípios diferentes. Todas indicaram maior consumo de alimentos entre os beneficiários. As três análises transversais de plausibilidade sugerem influência positiva desses programas na segurança alimentar e nutricional dos beneficiários. As principais limitações metodológicas apontadas ...

OBJETIVO : Analizar la influencia de programas de transferencia condicionada a la renta sobre consecuencias en la alimentación y nutrición de familias beneficiadas en Brasil. MÉTODOS : Se realizó revisión sistemática de la literatura con estudios de evaluación originales efectuados en Brasil, incluyendo ensayos clínicos y estudios de observación. Se consultaron las bases de datos PubMed, Scopus, Web of Science y Lilacs incluyendo estudios publicados desde 1990. Se analizaron los estudios según programa evaluado, participantes, delineamiento del estudio, lugar de realización, principales conclusiones, factores de confusión y limitaciones metodológicas. Los estudios fueron clasificados de acuerdo a la consecuencia (estado nutricional, consumo alimentario y seguridad alimentaria y nutricional) y tipo de inferencia para la asociación con programas de transferencia condicionada de renta (adecuación, plausibilidad o probabilidad). RESULTADOS : Se encontraron 1.412 documentos no duplicados. Quince cumplieron con los criterios de selección y 12 de estos evaluaron el Programa Beca Familia. Cinco estudios de plausibilidad y dos estudios de adecuación señalan influencia positiva de los programas de transferencia de renta en el estado nutricional de los niños beneficiarios. La influencia de estos programas sobre el consumo alimentario fue analizada en un estudio de adecuación de base poblacional y tres investigaciones transversales de plausibilidad en municipios diferentes. Todas indicaron mayor consumo de alimentos entre los beneficiarios. Los tres análisis transversales de plausibilidad sugieren influencia positiva de estos programas en la seguridad alimentaria y nutricional de los beneficiarios. Las principales limitaciones metodológicas señaladas fueron corte transversal y dificultades de la colecta de datos, pequeño tamaño ...

OBJECTIVE : To analyze the influence of conditional cash transfer programs on diet and nutrition outcomes among beneficiary families in Brazil. METHODS : A systematic review of literature was carried out with original evaluation studies conducted in Brazil, including all types of clinical trials and observational studies. The search was conducted in PubMed, Scopus, Web of Science and LILACS databases for papers published since 1990. The studies were analyzed according to the program evaluated, participants, study design, location, principal conclusions, confounding factors and methodological limitations. They were classified according to outcomes (nutritional status, dietary intake and food security) and level of evidence for the association with conditional cash transfer programs (adequacy or plausibility). RESULTS : We found 1,412 non-duplicated papers. Fifteen met the eligibility criteria and twelve evaluated the Bolsa Família program. Five plausibility studies and two adequacy analyses indicated a positive influence of conditional cash transfer programs on nutritional status of the beneficiary children. The conditional cash transfer programs influence on dietary intake was analyzed in one population-based adequacy study and three cross-sectionals plausibility researches in different municipalities. All of them indicated that beneficiaries had higher food intake than non-beneficiaries. The three cross-sectional plausibility analyses suggest a positive influence of conditional cash transfer programs on the food security of the beneficiaries. The main methodological limitations found were using cross-sectional analysis and difficulties in data collection, small sample sizes and limitations of the instruments used. CONCLUSIONS : The few studies found indicated a positive association between Brazilian conditional cash transfer programs and improvements in the recipients’ diet and nutrition. Greater efforts to widen and ...

The impact of public expenditure on undernourishment distribution in Mexico.

The status of undernourishment in children under the age of five in Mexico is open to debate. Linked to poverty, underweight and stunting, the rates of undernourishment are reported to be diminishing, although poverty remains an incessant problem. This study was done to determine whether there is an association between public expenditure and underweight and stunting distribution in Mexico based on data from the 2006 health and population census and from macroeconomic, social, and demographic variables. We used principal component analysis to reduce the number of variables and analyze their behavior. Multiple regressions showed that underweight and stunting are significantly associated with the marginalization index, support from the Sistema Nacional para el Desarrollo Integral de la Familia (DIF) supplies and breakfast program, the gross domestic product per capita, and expenditure from the Opportunities program. Further, public expenditure aimed to combat undernourishment is inadequately oriented to address the needs of the poor.

[The Bolsa Família cash transfer program and food and nutrition security in Brazil: a critical review of the literature]. / Programa Bolsa Família e segurança alimentar e nutricional no Brasil: revisão crítica da literatura.

OBJECTIVE: To critically review studies evaluating the impact of Bolsa Família (PBF), a federal cash transfer program, for food and nutrition security in Brazil. METHODS: The Cochrane Library, LILACS, Medline and SciELO databases were searched, as well as public organization websites. All studies based on primary data were selected. The following were excluded: studies using secondary data, review articles, studies that did now allow the establishment of associations between PBF and food and nutrition security, as well as studies evaluating food security strictly in sanitary terms. RESULTS: Ten studies were included. Of these, five concluded that PBF had a positive impact on the food and nutrition security of participating families. Three studies observed an increase in the consumption of foods with higher calorie content and less nutritional value. This change in dietary habits is a risk factor for the development of overweight, obesity, and noncommunicable chronic diseases. CONCLUSIONS: The guarantee of food and nutrition security requires programs that focus on both malnutrition and overweight and obesity. Cash transfer programs such as the PBF can contribute more effectively to the nutritional well-being of participants if they are combined with other types of interventions, such as actions to promote healthy eating.

Programa Bolsa Família e segurança alimentar e nutricional no Brasil: revisão crítica da literatura / The Bolsa Família cash transfer program and food and nutrition security in Brazil: a critical review of the literature

OBJETIVO: Revisar criticamente os estudos que avaliaram os impactos do Programa Bolsa Família (PBF) na promoção da segurança alimentar e nutricional no Brasil. MÉTODOS: Foram consultadas as bases de dados Biblioteca Cochrane, LILACS, Medline e SciELO, bem como os portais de organizações públicas. Foram selecionados os estudos que utilizaram dados primários e excluídos estudos baseados em dados secundários, artigos de revisão, estudos que não permitiram estabelecer uma associação entre PBF e segurança alimentar e nutricional, bem como os estudos que avaliaram a segurança do alimento no que se refere apenas à qualidade sanitária. RESULTADOS Foram selecionados 10 estudos, dos quais cinco concluíram que o PBF teve um impacto positivo na segurança alimentar e nutricional das famílias beneficiárias. Entretanto, três estudos constataram um aumento do consumo de alimentos de maior densidade calórica e baixo valor nutritivo. Essa mudança no hábito alimentar é um fator de risco para o desenvolvimento do sobrepeso, obesidade e das doenças crônicas não transmissíveis. CONCLUSÕES: A garantia de segurança alimentar e nutricional exige programas que contemplem tanto o combate à desnutrição quanto ao sobrepeso e à obesidade. Programas de distribuição de renda, como o PBF, podem contribuir mais efetivamente para o bem-estar nutricional dos beneficiários quando combinados com outros tipos de intervenções, como ações de promoção de alimentação saudável.

OBJECTIVE: To critically review studies evaluating the impact of Bolsa Família (PBF), a federal cash transfer program, for food and nutrition security in Brazil. METHODS: The Cochrane Library, LILACS, Medline and SciELO databases were searched, as well as public organization websites. All studies based on primary data were selected. The following were excluded: studies using secondary data, review articles, studies that did now allow the establishment of associations between PBF and food and nutrition security, as well as studies evaluating food security strictly in sanitary terms. RESULTS: Ten studies were included. Of these, five concluded that PBF had a positive impact on the food and nutrition security of participating families. Three studies observed an increase in the consumption of foods with higher calorie content and less nutritional value. This change in dietary habits is a risk factor for the development of overweight, obesity, and noncommunicable chronic diseases. CONCLUSIONS: The guarantee of food and nutrition security requires programs that focus on both malnutrition and overweight and obesity. Cash transfer programs such as the PBF can contribute more effectively to the nutritional well-being of participants if they are combined with other types of interventions, such as actions to promote healthy eating.

[Cash transfer in Brazil and nutritional outcomes: a systematic review]. / Transferência de renda no Brasil e desfechos nutricionais: revisão sistemática.

OBJECTIVE: To analyze the influence of conditional cash transfer programs on diet and nutrition outcomes among beneficiary families in Brazil. METHODS: A systematic review of literature was carried out with original evaluation studies conducted in Brazil, including all types of clinical trials and observational studies. The search was conducted in PubMed, Scopus, Web of Science and LILACS databases for papers published since 1990. The studies were analyzed according to the program evaluated, participants, study design, location, principal conclusions, confounding factors and methodological limitations. They were classified according to outcomes (nutritional status, dietary intake and food security) and level of evidence for the association with conditional cash transfer programs (adequacy or plausibility). RESULTS: We found 1,412 non-duplicated papers. Fifteen met the eligibility criteria and twelve evaluated the Bolsa Família program. Five plausibility studies and two adequacy analyses indicated a positive influence of conditional cash transfer programs on nutritional status of the beneficiary children. The conditional cash transfer programs influence on dietary intake was analyzed in one population-based adequacy study and three cross-sectionals plausibility researches in different municipalities. All of them indicated that beneficiaries had higher food intake than non-beneficiaries. The three cross-sectional plausibility analyses suggest a positive influence of conditional cash transfer programs on the food security of the beneficiaries. The main methodological limitations found were using cross-sectional analysis and difficulties in data collection, small sample sizes and limitations of the instruments used. CONCLUSIONS: The few studies found indicated a positive association between Brazilian conditional cash transfer programs and improvements in the recipients' diet and nutrition. Greater efforts to widen and qualify evaluations are needed in order to assess more comprehensively the impact of conditional cash transfer programs in Brazil.