Influence of domestic violence on the association between malnutrition and low cognitive development.

OBJECTIVES: To investigate the size and direction of the association between malnutrition and low cognitive performance and to evaluate the effect of domestic violence on this association. METHODS: This cross-sectional study enrolled students of both sexes, aged 7 to 14 years old, attending public elementary schools. The Raven's Progressive Matrices Test was used to measure cognitive development, the Revised Conflict Tactics Scales (CTS2), to measure domestic violence, and the body mass index (BMI) for age and sex, to define anthropometric indices. Socioeconomic data and information about food intake were also collected. Malnutrition was defined as BMI < 3rd percentile. Cognitive deficit was defined when the results of Raven's test were ≤ 25th percentile. Family violence was defined as a positive answer in at least one item about severe physical violence in the last 12 months. The size of the associations of interest was expressed as prevalence ratio (PR) and 95% confidence interval (95%CI). RESULTS: Below-average intellectual development was found for 63.3% of the participants. Malnutrition was identified in 9.5%. Malnutrition had a negative effect on cognitive performance (adjusted prevalence ratio [aPR] = 1.60, 95% CI = 1.01 - 2.52; p = 0.042) when adjusted for the association between exposure to domestic violence and age. CONCLUSION: The association between malnutrition and below-average intellectual development found in this study was affected by domestic violence, which must be taken into account when addressing the problem.

Influência da violência familiar na associação entre desnutrição e baixo desenvolvimento cognitivo / Influence of domestic violence on the association between malnutrition and low cognitive development

OBJETIVO: Verificar a direção e a magnitude da associação entre desnutrição e baixo desempenho cognitivo. Além disso, avaliar a influência da violência familiar nessa relação. MÉTODOS: Trata-se de um estudo transversal em que participaram estudantes, de ambos os sexos, com idade entre 7 e 14 anos, provenientes da rede pública do ensino fundamental. O teste das matrizes progressivas de Raven foi utilizado para mensurar desenvolvimento cognitivo; as escalas táticas de conflito revisadas, para mensurar a violência familiar; e o índice de massa corporal, para diagnóstico do estado nutricional. Foram ainda obtidas informações socioeconômicas e aquelas referentes ao consumo alimentar. A desnutrição foi classificada com base no índice de massa corporal < percentil 3; o baixo nível cognitivo, nos resultados do Raven < percentil 25. Considerou-se caso de violência familiar uma resposta positiva a qualquer um dos atos de violência física grave durante os últimos 12 meses. A magnitude das associações de interesses foi expressa em razão de prevalência e respectivos intervalos de confiança de 95%. RESULTADOS: Identificou-se que 63,3% dos participantes encontravam-se com desenvolvimento intelectual abaixo da média. A desnutrição foi identificada em 9,5%. Os dados revelaram a influencia negativa da desnutrição sobre o baixo desempenho cognitivo (razão de prevalência ajustada= 1,60; intervalo de confiança de 95% = 1,01-2,52; p = 0,042), associação observada quando ajustada pela exposição a violência doméstica e idade. CONCLUSÃO: Constatou-se associação entre desnutrição e desenvolvimento intelectual abaixo da média, a qual é influenciada pela violência familiar, o que deve ser levado em consideração na abordagem do problema.

OBJECTIVE: To investigate the size and direction of the association between malnutrition and low cognitive performance and to evaluate the effect of domestic violence on this association. METHODS: This cross-sectional study enrolled students of both sexes, aged 7 to 14 years old, attending public elementary schools. The Raven's Progressive Matrices Test was used to measure cognitive development, the Revised Conflict Tactics Scales (CTS2), to measure domestic violence, and the body mass index (BMI) for age and sex, to define anthropometric indices. Socioeconomic data and information about food intake were also collected. Malnutrition was defined as BMI < 3rd percentile. Cognitive deficit was defined when the results of Raven's test were < 25th percentile. Family violence was defined as a positive answer in at least one item about severe physical violence in the last 12 months. The size of the associations of interest was expressed as prevalence ratio (PR) and 95% confidence interval (95%CI). RESULTS: Below-average intellectual development was found for 63.3% of the participants. Malnutrition was identified in 9.5%. Malnutrition had a negative effect on cognitive performance (adjusted prevalence ratio [:aPR]:=1.60, 95% CI = 1.01 - 2.52; p = 0.042) when adjusted for the association between exposure to domestic violence and age. CONCLUSION: The association between malnutrition and below-average intellectual development found in this study was affected by domestic violence, which must be taken into account when addressing the problem.

Parental violence and the occurrence of severe and acute malnutrition in childhood.

Evidence from developed countries has linked family violence with severe acute malnutrition (SAM), yet no similar studies have been conducted in developing countries where the risk of SAM is higher. To redress this gap, the objective of this study was to explore the role of intimate partner violence (IPV) among caregivers as an independent risk factor for SAM. A hospital-based case-control (n = 172 : 345) study was carried out in six paediatric hospitals of Rio de Janeiro (1995-99). Cases comprised children (1-24 months) admitted with SAM (weight-for-height z-score < -2 SD). Controls were children of the same age admitted for non-traumatic surgery. Couple violence was gauged through the Conflict Tactics Scales from two perspectives: (a) two ordinal variables characterising the intensity of verbal and physical aggression based on scores, and (b) a four-level variable representing a pattern of increasing violence seriousness. Unconditional logistic regression analysis was performed to control for confounding factors. Parents of SAM cases had higher Conflict Tactics scores than parents of controls, indicating more severe partner violence. The adjusted odds ratio for the comparison of the highest to the lowest scores (10 vs. 0) was 4.15 (95% confidence interval 1.55, 11.15). Using the four-level variable for violence seriousness, a threefold SAM risk was found for children with parents reporting severe physical abuse, but not for those with parents reporting verbal aggression or more minor physical assaults. In addition to traditionally studied risk factors, the findings suggest that family violence may also play an important role in SAM among children. Moreover, these findings indicate that the risk for SAM is not associated with all types of IPV, but that children exposed to severe and recurrent events are more likely to be admitted for SAM. For the prevention or early detection of SAM, this result points to a specific population group requiring rigorous public health targeting, especially in terms of accurate detection of both SAM and IPV, as well as appropriate handling and follow-up of violent families.