Food Insecurity and the Negative Impact on Brazilian Children's Health-Why Does Food Security Matter for Our Future Prosperity? Brazilian National Survey (PNDS 2006/07).

BACKGROUND: Food insecurity (FI) refers to limited or uncertain access to food resulting from financial constraints. Numerous studies have shown association between FI and adverse health outcomes among adults and children around the world, but in Brazil, such information is scarce, especially if referring to nationally representative information. OBJECTIVE: To test for an independent association between FI and health outcomes. METHODS: Most recent Brazilian Demographic and Health Survey using nationally representative complex probability sampling. Participants were 3923 children <5 years of age, each representing a household. Data from the validated Brazilian Food Insecurity Scale were dichotomized as food secure (food security/mild FI) or food insecure (moderate FI/severe FI). Poisson regression was used to test for associations between FI and various health indicators. RESULTS: Models adjusted for socioeconomic and demographic variables showed that children hospitalized for pneumonia or diarrhea were 30% more prevalent in FI households (adjusted prevalence ratio [aPR]: 1.3; 1.1-1.6). Underweight children were 40% more prevalent in FI households (aPR: 1.4; 1.1-1.7). Children who didn't eat meat and fruits and vegetables every day were 20% and 70% more prevalent in FI households (aPR: 1.2; 1.1-1.4 and aPR: 1.7; 1.3-2.3), respectively. CONCLUSION: Children who grow up in food-insecure households have been shown to have worse health conditions than those in food-secure households. Consequently, their human capital accumulation and work-life productivity are likely to be reduced in the future, leading them into adulthood less capable of generating sufficient income, resulting in a cycle of intergenerational poverty and FI.

Effect of an Educational Program on Schoolchildren's Energy Expenditure during Physical Education Classes / Efeito de um programa de educação no gasto energético de escolares durante as aulas de educação física

OBJECTIVE: Physical activity is a means of prevention of noncommunicable diseases. The level of physical activity of children is decreasing in Brazil, and this can increase the risks of diseases associated with sedentary lifestyles and obesity. METHOD: This is a school-based randomized controlled trial which evaluated the impact of an educational intervention on children's physical activity level, energy expenditure, and teacher's behavior during physical education classes at public schools in São Paulo. The studied population comprised children attending the 1st and the 2nd grades of eight schools (three exposed and five unexposed to teacher training on a course in nutrition and physical activity). Outcomes were measured by direct observation, recorded by a VHS camera during physical education classes; data from 78 physical education classes were analyzed by the System for Observing Fitness Instruction Time - SOFIT. RESULTS: After intervention, results showed highly significant increases in children's physical activity level (walking, p < 0.001; vigorous activities (p < 0.001), and a decrease in the standing category (p < 0.001). It also showed a nonsignificant increase in mean energy expenditure of children (70.6% = 27.6Kcal), but the interaction's effect of group and time (intervention) was highly significant (32.4Kcal; 95%CI 24.7 - 40.1, p < 0.001) indicating the intervention effectiveness in increasing the energy expenditure of children during Physical Education classes. It also showed an increase in length of physical education classes (26.2 to 32.1 minutes (p = 0.01). CONCLUSION: There was a change in teachers' behavior with a positive impact on children's physical activity level and energy expenditure after the educational intervention.

OBJETIVO: A prática de atividade física é uma forma de prevenção de doenças não transmissíveis. O nível de atividade física das crianças tem diminuído no Brasil, fato que pode contribuir para o aumento do risco de doenças associadas com o sedentarismo e a obesidade. MÉTODO: Este é um ensaio educacional randomizado controlado que avaliou o impacto de uma intervenção educacional para professores no nível de atividade física e no gasto energético das crianças, e no comportamento do professor durante as aulas de educação física em escolas públicas de São Paulo. A população estudada compreendeu crianças de 1ᵃ e 2ᵃ series de oito escolas (três expostas e cinco não-expostas ao treinamento de professores em nutrição e atividade física). Os resultados foram medidos por observação direta e gravados por uma câmera VHS durante as aulas de educação física. Dados de 78 aulas de educação física foram analisados segundo o System for Observing Fitness Instruction Time - SOFIT. RESULTADOS: Após intervenção, os resultados mostraram aumentos significantes no nível de atividade física das crianças (caminhada, p < 0.001; atividades vigorosas (p < 0.001), e diminuição na categoria na qual a criança permanecia em pé (p < 0.001)). No entanto, os resultados mostraram um aumento não-significante na média do gasto energético pelas crianças (70.6% = 27.6Kcal), porém a interação do grupo e do tempo (intervenção) foi altamente significante (32.4Kcal; 95% CI 24.7; 40.1, p < 0.0001) indicando a efetividade da intervenção em aumentar o gasto energético das crianças durante a aulade educação física. Os resultados mostraram também um aumento na duração da aula de educação física (26.2 para 32.1 minutos (p = 0.01). CONCLUSÃO: Houve diferença no comportamento dos professores com um impacto positivo no nível de atividade física e no gasto energético das crianças após a intervenção educacional.

Fatores associados ao consumo de bebidas açucaradas entre pré-escolares brasileiros: inquérito nacional de 2006 / Factors associated with the consumption of soft drinks among Brazilian preschool children: national survey of 2006

Resumo O crescente consumo de bebidas açucaradas como os refrigerantes ou sucos artificiais está associado à prevalência de obesidade no Brasil e no mundo. Este estudo se propõe a conhecer a frequência de consumo destas bebidas entre crianças brasileiras de 24 a 59 meses e investigar associações com variáveis demográficas, socioeconômicas e nutricionais. Utilizando dados da Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher − 2006, o padrão alimentar foi obtido com o questionário de frequência de alimentos e bebidas nos sete dias anteriores à data da entrevista e a antropometria usou medidas de peso e de estatura das crianças. Entre os pré-escolares, 37,3% consumiram refrigerantes e sucos artificiais 4 dias ou mais por semana. Os fatores que apresentaram associação estatisticamente significante com consumo frequente de BA foram residir em regiões de maior desenvolvimento econômico do país, em áreas urbanas, pertencer ao estrato de maior poder aquisitivo, mães que assistiam TV regularmente e excesso de peso da criança, estavam associados ao consumo de refrigerantes e sucos artificiais em 4 ou mais dias por semana. Novos estudos são necessários para a compreensão da real contribuição das bebidas açucaradas na epidemia de obesidade infantil.

Abstract The rising consumption of sweetened beverages such as soft drinks or artificial juices is associated with the prevalence of obesity in Brazil and around the world. This study seeks to verify the frequency of consumption of these beverages among Brazilian children aged 24-59 months and to investigate the association of soft drinks with demographic, socioeconomic and nutritional variables. Using data from the National Survey on Demography and Health of Women and Children − 2006, the eating habits were obtained using the food and drink frequency questionnaire for the seven days preceding the interview, and anthropometry recorded the weight and height of children. Among preschoolers, 37.3% consumed soft drinks and artificial juices 4 or more days per week. The factors significantly associated with frequent consumption of soft drinks were living in regions of higher economic development of the country, in urban areas, belonging to the higher income bracket, with mothers watching TV regularly and excess weight of the child, were associated with consumption of soft drinks and artificial juices 4 or more days per week. Further studies are needed to understand the effective contribution of soft drinks on the epidemic of childhood obesity.

[Factors associated with the consumption of soft drinks among Brazilian preschool children: national survey of 2006]. / Fatores associados ao consumo de bebidas açucaradas entre pré-escolares brasileiros: inquérito nacional de 2006.

The rising consumption of sweetened beverages such as soft drinks or artificial juices is associated with the prevalence of obesity in Brazil and around the world. This study seeks to verify the frequency of consumption of these beverages among Brazilian children aged 24-59 months and to investigate the association of soft drinks with demographic, socioeconomic and nutritional variables. Using data from the National Survey on Demography and Health of Women and Children - 2006, the eating habits were obtained using the food and drink frequency questionnaire for the seven days preceding the interview, and anthropometry recorded the weight and height of children. Among preschoolers, 37.3% consumed soft drinks and artificial juices 4 or more days per week. The factors significantly associated with frequent consumption of soft drinks were living in regions of higher economic development of the country, in urban areas, belonging to the higher income bracket, with mothers watching TV regularly and excess weight of the child, were associated with consumption of soft drinks and artificial juices 4 or more days per week. Further studies are needed to understand the effective contribution of soft drinks on the epidemic of childhood obesity.

Association between socioeconomic and biological factors and infant weight gain: Brazilian Demographic and Health Survey - PNDS-2006/07 / Associação entre fatores socioeconômicos e biológicos e o ganho de peso de lactentes: Pesquisa Nacional de Demografia e Saúde (PNDS) de 2006/07

OBJECTIVE: To examine the associations between socioeconomic and biological factors and infant weight gain. METHODS: All infants (0-23 months of age) with available birth and postnatal weight data (n = 1763) were selected from the last nationally representative survey with complex probability sampling conducted in Brazil (2006/07). The outcome variable was conditional weight gain (CWG), which represents how much an individual has deviated from his/her expected weight gain, given the birth weight. Associations were estimated using simple and hierarchical multiple linear regression, considering the survey sampling design, and presented in standard deviations of CWG with their respective 95% of confidence intervals. Hierarchical models were designed considering the UNICEF Conceptual Framework for Malnutrition (basic, underlying and immediate causes). RESULTS: The poorest Brazilian regions (-0.14 [-0.25; -0.04]) and rural areas (-0.14 [-0.26;-0.02]) were inversely associated with CWG in the basic causes model. However, this association disappeared after adjusting for maternal and household characteristics. In the final hierarchical model, lower economic status (-0.09 [-0.15; -0.03]), human capital outcomes (maternal education < 4th grade (-0.14[-0.29; 0.01]), higher maternal height (0.02[0.01; 0.03])), and fever in the past 2 weeks (-0.13[-0.26; -0.01]) were associated with postnatal weight gain. CONCLUSION: The results showed that poverty and lower human capital are still key factors associated with poor postnatal weight gain. The approach used in these analyses was sensitive to characterize inequalities among different socioeconomic contexts and to identify factors associated with CWG in different levels of determination. .

OBJETIVO: Examinar as associações entre fatores socioeconômicos e biológicos e o ganho de peso de lactentes. MÉTODOS: Foram selecionados todos os lactentes (0-23 meses de idade) com dados de peso ao nascer e pós-natal avaliados na última pesquisa com representatividade nacional realizada no Brasil (2006/07) por amostragem probabilística complexa. A variável de resultado foi o Evolução Ponderal Condicional (CWG), que representa quanto um indivíduo desviou de seu ganho de peso esperado, considerando o peso ao nascer. As associações foram estimadas utilizando regressão linear simples e múltipla hierárquica, considerando o plano amostal da pesquisa e apresentadas em desvios padrão do CWG com seus respectivos intervalos de confiança de 95%. Os modelos hierárquicos foram estruturados considerando o Modelo Conceitual de Desnutrição da UNICEF (causas básicas, inerentes e imediatas). RESULTADOS: As regiões brasileiras mais pobres (-0,14 [-0,25; -0,04]) e a área rural (-0,14 [-0,26; -0,02]) foram inversamente associadas ao CWG no modelo de causas básicas. Contudo, essa associação desapareceu após o ajuste pelas características maternas e do ambiente familiar. No modelo hierárquico final, a baixa condição econômica (-0,09 [-0,15; -0,03]), as variáveis de capital humano (escolaridade materna < 5° ano (-0,14 [-0,29; 0,01])), maior estatura materna (0,02 [0,01; 0,03])) e febre nas duas semanas anteriores à pesquisa (-0,13 [-0,26; -0,01]) foram inversamente associadas ao ganho de peso pós-natal. CONCLUSÃO: Os resultados mostraram que a pobreza e baixo capital humano ainda são fatores fundamentais associados ao ganho de peso pós-natal abaixo de esperado. A abordagem utilizada em nossas análises foi sensível ao caracterizar desigualdades entre diferentes contextos socioeconômicos e ao identificar fatores associados ao CWG em diferentes níveis de determinação. .

Association between socioeconomic and biological factors and infant weight gain: Brazilian Demographic and Health Survey--PNDS-2006/07.

OBJECTIVE: To examine the associations between socioeconomic and biological factors and infant weight gain. METHODS: All infants (0-23 months of age) with available birth and postnatal weight data (n = 1763) were selected from the last nationally representative survey with complex probability sampling conducted in Brazil (2006/07). The outcome variable was conditional weight gain (CWG), which represents how much an individual has deviated from his/her expected weight gain, given the birth weight. Associations were estimated using simple and hierarchical multiple linear regression, considering the survey sampling design, and presented in standard deviations of CWG with their respective 95% of confidence intervals. Hierarchical models were designed considering the UNICEF Conceptual Framework for Malnutrition (basic, underlying and immediate causes). RESULTS: The poorest Brazilian regions (-0.14 [-0.25; -0.04]) and rural areas (-0.14 [-0.26;-0.02]) were inversely associated with CWG in the basic causes model. However, this association disappeared after adjusting for maternal and household characteristics. In the final hierarchical model, lower economic status (-0.09 [-0.15; -0.03]), human capital outcomes (maternal education < 4th grade (-0.14[-0.29; 0.01]), higher maternal height (0.02[0.01; 0.03])), and fever in the past 2 weeks (-0.13[-0.26; -0.01]) were associated with postnatal weight gain. CONCLUSION: The results showed that poverty and lower human capital are still key factors associated with poor postnatal weight gain. The approach used in these analyses was sensitive to characterize inequalities among different socioeconomic contexts and to identify factors associated with CWG in different levels of determination.

[Food insecurity in Brazilian families with children under five years of age]. / Insegurança alimentar em domicílios brasileiros com crianças menores de cinco anos.

This article analyzes food insecurity and hunger in Brazilian families with children under five years of age. This was a nationally representative cross-sectional study using data from the National Demographic and Health Survey on Women and Children (PNDS-2006), in which the outcome variable was moderate to severe food insecurity, measured by the Brazilian Food Insecurity Scale (EBIA). Prevalence estimates and prevalence ratios were generated with 95% confidence intervals. The results showed a high prevalence of moderate to severe food insecurity, concentrated in the North and Northeast regions (30.7%), in economic classes D and E (34%), and in beneficiaries of conditional cash transfer programs (36.5%). Multivariate analysis showed that the socioeconomic relative risks (beneficiaries of conditional cash transfers), regional relative risks (North and Northeast regions), and economic relative risks (classes D and E) were 1.8, 2.0 and 2.4, respectively. Aggregation of the three risks showed 48% of families with moderate to severe food insecurity, meaning that adults and children were going hungry during the three months preceding the survey.

Insegurança alimentar em domicílios brasileiros com crianças menores de cinco anos / Food insecurity in Brazilian families with children under five years of age / Inseguridad alimentaria en los hogares brasileños con niños menores de cinco años

Este artigo se propõe a estudar o processo de insegurança alimentar e fome em domicílios brasileiros com crianças menores de cinco anos. É um estudo transversal com representatividade nacional executado com dados da Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher (PNDS-2006) tendo como variável dependente a insegurança alimentar moderada e grave (IAM+G), medida através da Escala Brasileira de Insegurança Alimentar (EBIA). Foram geradas estimativas de prevalência e razão de prevalência com intervalos de 95% de confiança. Os resultados apontam para alta prevalência de IAM+G concentrada nas regiões Norte e Nordeste (30,7%), nas classes econômicas D e E (34%) e em beneficiários de Programas de Transferência de Renda (PTR; 36,5%). O modelo de análise multivariada constatou que os riscos sociais (beneficiário de PTR), regionais (Norte e Nordeste) e econômicos (classes D e E) eram de 1,8, 2,0 e 2,4, respectivamente. Agregando-se os três riscos observou-se que 48% dos domicílios encontravam-se em IAM+G, ou seja, crianças e adultos passaram fome nos três meses anteriores ao inquérito.

This article analyzes food insecurity and hunger in Brazilian families with children under five years of age. This was a nationally representative cross-sectional study using data from the National Demographic and Health Survey on Women and Children (PNDS-2006), in which the outcome variable was moderate to severe food insecurity, measured by the Brazilian Food Insecurity Scale (EBIA). Prevalence estimates and prevalence ratios were generated with 95% confidence intervals. The results showed a high prevalence of moderate to severe food insecurity, concentrated in the North and Northeast regions (30.7%), in economic classes D and E (34%), and in beneficiaries of conditional cash transfer programs (36.5%). Multivariate analysis showed that the socioeconomic relative risks (beneficiaries of conditional cash transfers), regional relative risks (North and Northeast regions), and economic relative risks (classes D and E) were 1.8, 2.0 and 2.4, respectively. Aggregation of the three risks showed 48% of families with moderate to severe food insecurity, meaning that adults and children were going hungry during the three months preceding the survey.

Se plantea estudiar el proceso de inseguridad alimentaria y el hambre en los hogares brasileños con niños menores de cinco años. Se trata de un estudio transversal a nivel nacional, realizado con datos de la Encuesta Nacional de Demografía y Salud de la Mujer y la Infancia (PNDS 2006), siendo la variable dependiente la inseguridad alimentaria moderada y grave (IAM+G), medidas mediante la Escala Brasileña de Inseguridad Alimentaria (EBIA). Se generaron estimaciones de prevalencia y razón de prevalencia con intervalos de 95% de confianza. Los resultados muestran una alta prevalencia de IAM+G en el Norte y Nordeste (30,7%), en las clases económicas D y E (34%), y entre los beneficiarios de los programas de transferencias de renta (36,5%). El modelo de análisis multivariado descubrió que los riesgos sociales (beneficiario de programas de transferencias de renta), regionales (Norte y Nordeste) y económicos (clases D y E) fueron de 1,8, 2,0 y 2,4, respectivamente. Mediante la agregación de los tres riesgos se encontró el 48% de los hogares en IAM+G, o sea, adultos y niños tuvieron hambre durante los tres meses anteriores a la encuesta.

[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.

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.