Recent changes in growth trajectories: a population-based cohort study of over 5 million Brazilian children born between 2001 and 2014.

Background: There is limited evidence on recent trends in childhood growth trajectories in Low-/middle-income countries. We investigated how age-trajectories for height and Body Mass Index (BMI) have changed among Brazilian children born in two different time periods after 2000. Methods: We used a population-based cohort (part of the "Cohort of 100-Million Brazilians") created by the linkage of three Brazilian administrative databases: the Cadastro Único of the Federal Government, the National System of Live Births and the National Nutritional and Food Surveillance System. We included longitudinal data on 5,750,214 children who were 3 to <10 years of age and born between 2001 and 2014 (20,209,133 observations). We applied fractional polynomial models with random-effects to estimate mean height and BMI trajectories for children. Findings: Compared to children born in 2001-2007, the cohort born in 2008-2014 were on average taller, by a z-score of 0.15 in boys and 0.12 in girls. Their height trajectories shifted upwards, by approximately 1 cm in both sexes. Levels of BMI increased little, by a z-score of 0.06 (boys) and 0.04 (girls). Mean BMI trajectories also changed little. However, the prevalence of overweight/obesity increased between cohorts, e.g., from 26.8% to 30% in boys and 23.9%-26.6% in girls aged between 5 and <10 years. Interpretation: An increase of 1 cm in mean height of Brazilian children during a short period indicates the improvement in maternal and child health, especially those from low-income families due to the new health and welfare policies in Brazil. Although mean BMI changed little, the prevalence of child overweight/obesity slightly increased and remained high. Funding: This work was supported by National Council for Scientific and Technological Development - CNPq; Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES; National Institute for Health Research (NIHR) Great Ormond Street Hospital Biomedical Research Centre; Society for the Study of Human Biology; Fundação de Amparo à Pesquisa do Estado de Minas Gerais - FAPEMIG; Departamento de Ciência e Tecnologia da Secretaria de Ciência, Tecnologia, Inovação e Complexo da Saúde do Ministério da Saúde - Decit/SECTICS/MS. The study also used resources from the Centre for Data and Knowledge Integration for Health (CIDACS), which receives funding from the Bill & Melinda Gates Foundation, the Wellcome Trust, the Health Surveillance Secretariat of the Ministry of Health and the Secretariat of Science and Technology of the State of Bahia (SECTI-BA).

Food and nutrition insecurity: a marker of vulnerability to asthma symptoms.

OBJECTIVE: To evaluate the association between food and nutrition insecurity and asthma in children from Latin America. DESIGN: Cross-sectional study. SETTING: São Francisco do Conde, Bahia, north-eastern Brazil. SUBJECTS: The study included 1307 children aged 6-12 years from public elementary schools. Asthma symptoms were collected using a questionnaire that was translated and adapted from the International Study of Asthma and Allergies in Childhood, phase III. The diagnosis of asthma was determined based on reports of wheezing in the previous 12 months. The Brazilian Food Insecurity Scale was used to identify food insecurity. We also obtained demographic, socio-economic and anthropometric information for each participant. We used multivariate logistic regression analyses to assess the associations of interest. RESULTS: Of the children surveyed, 10·4% had a history of wheezing and 64·5% had some degree of food and nutrition insecurity. We found a positive dose-response relationship and statistically significant associations of asthma with moderate (OR = 1·71, 95% CI 1·01, 2·89) and severe (OR = 2·51, 95% CI 1·28, 4·93) food and nutrition insecurity. CONCLUSIONS: The results show that moderate and severe food and nutrition insecurity are markers of vulnerability to wheezing. It is important to note that the results of studies in this field have potential implications for social policies that promote food security. Further studies to identify the mechanisms involved in the relationship between food and nutrition insecurity and asthma are needed.

Factors associated with food insecurity in households of public school students of Salvador City, Bahia, Brazil.

This cross-sectional study was conducted to find out the factors associated with food insecurity (FI) in households of the students aged 6-12 years in public schools of Salvador city, Bahia, Brazil. The study included 1,101 households. Food and nutritional insecurity was measured using the Brazilian Food Insecurity Scale (BFIS). Data on socioeconomic and demographic characteristics as well as environmental and housing conditions were collected during the interviews conducted with the reference persons. Multivariate polytomous logistic regression was used in assessing factors associated with food insecurity. We detected prevalence of food insecurity in 71.3% of the households. Severe and moderate forms of FI were diagnosed in 37.1% of the households and were associated with: (i) female gender of the reference person in the households (OR 2.21, 95% CI 1.47-3.31); (ii) a monthly per-capita income below one-fourth of the minimum wage (US$ 191.73) (OR 2.63, 95% CI 1.68-4.08); (iii) number of residents per bedroom below 3 persons (OR 1.91, 95% CI 1.23-2.96); and (iv) inadequate housing conditions (OR 1.84, 95% CI 1.12-4.49). Socioeconomic inequalities determine the factors associated with FI of households in Salvador, Bahia. Identifying vulnerabilities is necessary to support public policies in reducing food insecurity in the country. The results of the present study may be used in re-evaluating strategies that may limit the inequalities in school environment.