Time trends and social inequalities in child malnutrition: nationwide estimates from Brazil's food and nutrition surveillance system, 2009-2017

Objective In Brazil, national estimates of childhood malnutrition have not been updated since 2006. The use of health information systems is an important complementary data source for analysing time trends on health and nutrition. This study aimed to examine temporal trends and socio-demographic inequalities in the prevalence of malnutrition in children attending primary health care services between 2009 and 2017. Design Time trends study based on data from Brazil's Food and Nutrition Surveillance System. Malnutrition prevalence (stunting, wasting, overweight and double burden) was annually estimated by socio-demographic variables. Prais-Winsten regression models were used to analyse time trends. Annual percent change (APC) and 95 % CI were calculated. Setting Primary health care services, Brazil. Participants Children under 5 years old. Results In total, 15,239,753 children were included. An increase in the prevalence of overweight (APC = 3·4 %; P = 0·015) and a decline in the prevalence of wasting (-6·2 %; P = 0·002) were observed. The prevalence of stunting (-3·2 %, P = 0·359) and double burden (-1·4 %, P = 0·630) had discrete and non-significant reductions. Despite the significant reduction in the prevalence of undernutrition among children in the most vulnerable subgroups (black, conditional cash transfer's recipients and residents of poorest and less developed areas), high prevalence of stunting and wasting persist alongside a disproportionate increase in the prevalence of overweight in these groups. Conclusions The observed pattern in stunting (high and persistent prevalence) and increase in overweight elucidate setbacks in advances already observed in previous periods and stresses the need for social and political strategies to address multiple forms of malnutrition

Combined association of obesity and other cardiometabolic diseases with severe COVID-19 outcomes: a nationwide cross-sectional study of 21 773 Brazilian adult and elderly inpatients.

OBJECTIVES: To investigate the combined association of obesity, diabetes mellitus (DM) and cardiovascular disease (CVD) with severe COVID-19 outcomes in adult and elderly inpatients. DESIGN: Cross-sectional study based on registry data from Brazil's influenza surveillance system. SETTING: Public and private hospitals across Brazil. PARTICIPANTS: Eligible population included 21 942 inpatients aged ≥20 years with positive reverse transcription-PCR test for SARS-CoV-2 until 9 June 2020. MAIN OUTCOME MEASURES: Severe COVID-19 outcomes were non-invasive and invasive mechanical ventilation use, intensive care unit (ICU) admission and death. Multivariate analyses were conducted separately for adults (20-59 years) and elders (≥60 years) to test the combined association of obesity (without and with DM and/or CVD) and degrees of obesity with each outcome. RESULTS: A sample of 8848 adults and 12 925 elders were included. Among adults, obesity with DM and/or CVD showed higher prevalence of invasive (prevalence ratio 3.76, 95% CI 2.82 to 5.01) and non-invasive mechanical ventilation use (2.06, 1.58 to 2.69), ICU admission (1.60, 1.40 to 1.83) and death (1.79, 1.45 to 2.21) compared with the group without obesity, DM and CVD. In elders, obesity alone (without DM and CVD) had the highest prevalence of ICU admission (1.40, 1.07 to 1.82) and death (1.67, 1.00 to 2.80). In both age groups, obesity alone and combined with DM and/or CVD showed higher prevalence in all outcomes than DM and/or CVD. A dose-response association was observed between obesity and death in adults: class I 1.32 (1.05 to 1.66), class II 1.41 (1.06 to 1.87) and class III 1.77 (1.35 to 2.33). CONCLUSIONS: The combined association of obesity, diabetes and/or CVD with severe COVID-19 outcomes may be stronger in adults than in elders. Obesity alone and combined with DM and/or CVD had more impact on the risk of COVID-19 severity than DM and/or CVD in both age groups. The study also supports an independent relationship of obesity with severe outcomes, including a dose-response association between degrees of obesity and death in adults

Metodos estatisticos para analise de dados categorizados com estruturas complexas

Orientador: Eliana Heiser de Freitas MarquesDissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Matematica, Estatistica e computação CientificaResumo: Dados categorizados com estruturas complexas, resultantes de esquemas amostrais envolvendo conglomerados ou resultantes de respostas repetidas com as observações ocorrendo de forma agregada, têm sido freqüente na literatura e têm gerado preocupações por parte dos pesquisadores, no que diz respeito aos métodos de estimação dos parâmetros de interesse. A realização deste trabalho tem por finalidade apresentar duas propostas avançadas: a metodologia da razão de médias provenientes de amostras complexas e as equações de estimação generalizadas para respostas correlacionadas, como novas alternativas para análise de dados não triviais. A motivação deste trabalho foi estudar essas novas ferramentas e no que diz respeito às aplicações, dar uma contribuição aos pesquisadores da área de saúdeAbstract: Categorical data with complex structures as a result of cluster sampling designs or repeated outcomes with observations occuring in some aggregated form, has been appearing recently in literature generating research and publications directed to methods of estimation of parameters, considering the possible correlation among the grouped observations. The purpose of dissertation is to present two advanced methodologies: a weighted regression method for analysis of multivariate categorical outcomes from cluster samples based on ratio means and the generalized estimating equations (GEE), extensions and diagnostics as new alternatives to analyse these non-standard data structures. The motivation for this study with respect to application was to contribute with new tools for research in the area of public healthMestradoMestre em Estatístic

Factores asociados con el índice de masa corporal en niños brasileños: modelo de ecuaciones

BARRETO, Mauricio Lima. “Documento produzido em parceria ou por autor vinculado à Fiocruz, mas não consta à informação no documento”.Submitted by Ana Maria Fiscina Sampaio ([email protected]) on 2018-03-01T17:59:07Z No. of bitstreams: 1 Horta TG Factors associated with body mass index....pdf: 742644 bytes, checksum: 05075a7dd732ecbbfd1f044193361b65 (MD5)Approved for entry into archive by Ana Maria Fiscina Sampaio ([email protected]) on 2018-03-01T18:14:24Z (GMT) No. of bitstreams: 1 Horta TG Factors associated with body mass index....pdf: 742644 bytes, checksum: 05075a7dd732ecbbfd1f044193361b65 (MD5)Made available in DSpace on 2018-03-01T18:14:24Z (GMT). No. of bitstreams: 1 Horta TG Factors associated with body mass index....pdf: 742644 bytes, checksum: 05075a7dd732ecbbfd1f044193361b65 (MD5) Previous issue date: 2017Federal University of Bahia, Brazil. FAPESB - Fundação de Amparo à Pesquisa do Estado da Bahia.Federal University of Minas Gerais. School of Nursing. Department Maternal Infant and Public Health. Belo Horizonte, MG, BrazilFederal University of Bahia. Nutrition School. Nutrition Science Department. Salvador, BA, BrasilFederal University of Bahia. Institute of Mathematics. Department of Statistics. Salvador, BA, Brazil / Federal University of Bahia. Institute of Public Health. Salvador, BA, BrazilFederal University of Bahia. Institute of Public Health. Salvador, BA, BrazilFederal University of Minas Gerais. School of Nursing. Department Maternal Infant and Public Health. Belo Horizonte, MG, Brazilprevalencia en las poblaciones de los países desarrollados y en desarrollo. Objetivo: el objetivo de este estudio fue estimar la asociación entre las condiciones socioeconómicas, el consumo y el exceso de peso corporal en los niños. Métodos: estudio transversal de una muestra probabilística representativa de la población brasileira que incluyó 3.676 niños provenientes de la última Encuesta Nacional de Demografía y Salud. El índice de masa corporal (IMC) de los niños fue la variable desenlace. El nivel socioeconómico, IMC materno, inseguridad a la hora de alimentarles y el consumo de alimentos obesogénicos fueron consideradas variables independientes. Las ecuaciones estructurales fueron usadas como método de análisis. Resultados: las condiciones socioeconómicas infl uyeron directamente el IMC de los niños (β = 0,102; p = 0,02), mediado por la ingesta de alimentos obesogénicos (β = 0,018; p = 0,04). Se observó asociación directa entre el IMC de la madre y del niño (β = 0,169; p < 0,001) y entre el consumo de alimentos obesogénicos y el IMC del niño (β = 0,114; p < 0,001). Conclusiones: la condición socioeconómica favorable, el IMC materno y la ingesta de alimentos obesogénicos pueden potencialmente contribuir para el aumento del IMC del niño.Overweight and obesity in children is an important global problem. Its prevalence is increasing in developed and developing countries. Objective: The aim of this study was to evaluate the association between socioeconomic conditions, maternal body mass index (BMI), food security, and intake of obesogenic foods on excess body weight in children. Methods: A cross-sectional study was conducted, using the data of 3,676 children from the latest National Demographic and Health Survey in Brazil. The children’s BMI was the study outcome. Socioeconomic condition, maternal BMI, food security, and intake of obesogenic foods were use as predictors. structural equation models were used for analysis. Results: Socioeconomic conditions directly infl uenced the children’s BMI (β = 0.102; p = 0.02), mediated by intake of obesogenic foods (β = 0.018; p = 0.04). A direct association was observed between maternal and child BMIs (β = 0.169; p < 0.001) and intake of obesogenic foods and child BMI (β = 0.114; p < 0.001). Conclusions: Favorable socioeconomic conditions, increased maternal BMI, and intake of obesogenic foods contributed to increased child BMI

Factors associated with nutritional outcomes in the mother-child dyad: a population-based cross-sectional study

"Documento produzido em parceria ou por autor vinculado à Fiocruz, mas não consta à informação no documento".Submitted by Ana Maria Fiscina Sampaio ([email protected]) on 2017-04-06T17:14:48Z No. of bitstreams: 1 Gea-Horta T Factors_associated_with_nutritional_outcomes....pdf: 252445 bytes, checksum: b550cd092b6a70ce69385120a0ccec39 (MD5)Approved for entry into archive by Ana Maria Fiscina Sampaio ([email protected]) on 2017-04-06T17:27:23Z (GMT) No. of bitstreams: 1 Gea-Horta T Factors_associated_with_nutritional_outcomes....pdf: 252445 bytes, checksum: b550cd092b6a70ce69385120a0ccec39 (MD5)Made available in DSpace on 2017-04-06T17:27:23Z (GMT). No. of bitstreams: 1 Gea-Horta T Factors_associated_with_nutritional_outcomes....pdf: 252445 bytes, checksum: b550cd092b6a70ce69385120a0ccec39 (MD5) Previous issue date: 2016Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil and would also like to thank the Brazilian National Council of Research and Technology (CNPq) for a scholarship that supported a fellowship at the Federal University of Bahia, BrazilFederal University of Minas Gerais. Department of Maternal Infant and Public Health. School of Nursing. BeloHorizonte, MG, BrasilFederal University of Bahia. Nutrition School. Nutrition Science Department. Salvador, BA, BrasilFederal University of Bahia. Institute of Mathematics. Salvador, BA, BrasilFederal University of Bahia. Institute of Public Health. Salvador, BA, BrasilFederal University of Minas Gerais. Department of Maternal Infant and Public Health. School of Nursing. BeloHorizonte, MG, BrasilTo estimate factors associated with double burden of nutritional outcomes in the mother-child dyad at the household level (child stunting and/or maternal overweight). Design: Cross-sectional study using the Brazilian Demographic and Health Survey. Nutritional outcomes were: mother with normal weight and child with normal height; overweight mother and child with normal height; mother with normal weight and short-stature child; and overweight mother and child with short stature (double burden). The child was classified as short when height-for-age Z-score was <−2 and the mother as overweight when BMI was ≥25·00 kg/m2. Socio-economic status, environment, social vulnerability, maternal characteristics and the child’s food intake were the exposure factors. The hierarchical approach for multinomial logistic regression modelling was used to assess the associations. Setting: National Demographic and Health Survey of Children and Women conducted in Brazil, 2006–2007. Subjects: Mother–child dyads (n 3676). Results: After adjustments, lower maternal educational level (OR=3·53; 95% CI 1·33, 9·33) and inadequate household (non-masonry house; OR=2·54; 95% CI 1·39, 4·66) were associated with the double burden of malnutrition. Mother’s short stature (OR=3·41; 95% CI 1·76, 6·61), child’s vegetable intake on less than or equal to 4 d/week (OR=2·21; 95% CI 1·03, 4·75) and inadequate household (non-masonry house; OR=2·29; 95% CI 1·36, 3·87) were associated with child’s short stature. The lack of breast-feeding (OR=2·00; 95% CI 1·07, 3·72) was associated with maternal overweight. Conclusions: The present findings contribute to establishing strategies promoting health and healthy diets, by considering the growth deficit and overweight/obesity concomitantly

Associação entre padrões alimentares e índice de massa corporal em amostra de crianças e adolescentes do Nordeste brasileiro

Barreto, Maurício Lima. “Documento produzido em parceria ou por autor vinculado à Fiocruz, mas não consta à informação no documento”.Submitted by Ana Maria Fiscina Sampaio ([email protected]) on 2018-04-04T13:51:55Z No. of bitstreams: 1 Santos NH Association between eating patterns and....pdf: 148504 bytes, checksum: c07dde46cefeae3701423b1ae15d71f9 (MD5)Approved for entry into archive by Ana Maria Fiscina Sampaio ([email protected]) on 2018-04-04T13:59:34Z (GMT) No. of bitstreams: 1 Santos NH Association between eating patterns and....pdf: 148504 bytes, checksum: c07dde46cefeae3701423b1ae15d71f9 (MD5)Made available in DSpace on 2018-04-04T13:59:34Z (GMT). No. of bitstreams: 1 Santos NH Association between eating patterns and....pdf: 148504 bytes, checksum: c07dde46cefeae3701423b1ae15d71f9 (MD5) Previous issue date: 2014FAPESB (Project n. 7638/2009).Universidade Federal da Bahia. Escola de Nutrição. Salvador, BA, BrasilUniversidade Federal da Bahia. Instituto de Matemática. Salvador, BA, BrasilUniversidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, BrasilUniversidade Federal da Bahia. Escola de Nutrição. Salvador, BA, BrasilUniversidade Federal da Bahia. Escola de Nutrição. Salvador, BA, BrasilO objetivo deste estudo foi identificar a associação entre padrões alimentares e índice de massa corporal (IMC) em crianças e adolescentes. Estudo transversal realizado em amostra de 1.247 estudantes entre 6 a 12 anos, de ambos os sexos, matriculados na rede pública de ensino de São Francisco do Conde, Bahia, Brasil. Para avaliar o estado nutricional foi utilizado o IMC. Informações de frequência de consumo alimentar, além das demográficas e socioeconômicas foram obtidas para cada participante. Os padrões alimentares foram obtidos a partir de análise fatorial. A prevalência de excesso ponderal foi de 17,3% (10,2% de sobrepeso e 7,1% de obesidade). Foram encontrados dois padrões alimentares: padrão “obesogênico” e “prudente”. O primeiro, caracterizado pelo consumo de doces, pratos típicos brasileiros, pastelarias, fast food, óleos, leite, cereais, bolos e molhos, esteve positivamente associado ao aumento do IMC (ßi = 0,244; p = 0,018). Os resultados apontaram associação do padrão obesogênico com aumento do IMC.The aim of this study was to assess the relationship between eating patterns and body mass index (BMI) in children and adolescents. This is a cross-sectional study of 1,247 male and female students, aged between 6 and 12, from public elementary schools in São Francisco do Conde, Bahia State, Brasil. BMI was used to analyze the children’s nutritional status. Food consumption frequencies, in addition to demographic and socioeconomic information, were collected for each participant. Dietary patterns were identified through a factor analysis. The prevalence of overweight and obesity was 17.3% (10.2% overweight and 7.1% obese). Two eating patterns, “obesogenic” and “prudent”, were identified. The former is characterized by sweets and sugars, typical Brazilian dishes, pastries, fast food, oils, milk, cereals, cakes, and sauces, and was positively associated with increased BMI (ßi = 0.244; p = 0.018). An “obesogenic” dietary pattern was associated with increased BMI.El objetivo de este estudio fue identificar la asociación entre patrones dietéticos e índice de masa corporal (IMC) en niños y adolescentes. Se trata de un estudio transversal, realizado en muestra de 1.247 estudiantes entre 6 a 12 años de edad, de ambos los sexos, inscritos en la red pública de enseñanza de São Francisco do Conde, Bahía, Brasil. Para evaluar el estado nutricional se utilizó el IMC. La información sobre la frecuencia de consumo alimentario, además de la demográfica y socioeconómica, se consiguió con cada participante. Los patrones dietéticos fueron obtenidos a partir del análisis factorial. La prevalencia de exceso ponderal fue de 17,3% [10,2% de sobrepeso y 7,1% de obesidad]. Fueron encontrados dos patrones dietéticos: “obesogénico” y “prudente”. El primero, caracterizado por el consumo de azúcares, platos típicos brasileños, pastelerías, fast food, aceites, leche, cereales, pasteles y salsas estuvo asociado al aumento del IMC (ßi = 0,244; p = 0,018). Los resultados apuntaron asociación del patrón dietético “obesogénico” y aumento del IMC

Association between eating patterns and body mass index in a sample of children and adolescents in Northeastern Brazil

The aim of this study was to assess the relationship between eating patterns and body mass index (BMI) in children and adolescents. This is a cross-sectional study of 1,247 male and female students, aged between 6 and 12, from public elementary schools in São Francisco do Conde, Bahia State, Brasil. BMI was used to analyze the children’s nutritional status. Food consumption frequencies, in addition to demographic and socioeconomic information, were collected for each participant. Dietary patterns were identified through a factor analysis. The prevalence of overweight and obesity was 17.3% (10.2% overweight and 7.1% obese). Two eating patterns, “obesogenic” and “prudent”, were identified. The former is characterized by sweets and sugars, typical Brazilian dishes, pastries, fast food, oils, milk, cereals, cakes, and sauces, and was positively associated with increased BMI (ßi = 0.244; p = 0.018). An “obesogenic” dietary pattern was associated with increased BMI