Factors associated with anemia and vitamin A deficiency in Brazilian children under 5 years old: Brazilian National Survey on Child Nutrition (ENANI-2019) Translated title: Fatores associados à anemia e deficiência de vitamina A em crianças brasileiras menores de cinco anos: Estudo Nacional de Alimentação e Nutrição Infantil (ENANI-2019) Translated title: Factores asociados con la anemia y la deficiencia de vitamina A en niños brasileños menores de cinco años: Estudio Nacional de Alimentación y Nutrición Infantil (ENANI-2019)

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Abstract:

Factors associated with anemia and vitamin A deficiency were investigated in 7,716 children 6-59 months of age studied in the Brazilian National Survey on Child Nutrition (ENANI-2019). We adopted a hierarchical approach based on a United Nations Children’s Fund (UNICEF) theoretical model with three levels, stratifying by age (6-23; 24-59 months). Prevalence ratio (PR) and 95% confidence interval (95%CI) were estimated. Enabling determinants: a higher prevalence of anemia was observed in children 6-23 months whose mothers had ≤ 7 years of schooling (PR = 1.92; 95%CI: 1.10; 3.34), < 20 years old (PR = 2.47; 95%CI: 1.34; 4.56) or 20-30 years old (PR = 1.95; 95%CI: 1.11; 3.44), mixed-race (PR = 1.57; 95%CI: 1.06; 2.23); and in children 24-59 months in the North Region (PR = 3.11; 95%CI: 1.58; 6.13). A higher prevalence for vitamin A deficiency was observed in children 6-23 months from Central-West (PR = 2.32; 95%CI: 1.33; 4.05), and in children 24-59 months living in the North (PR = 1.96; 95%CI: 1.16; 3.30), South (PR = 3.07; 95%CI: 1.89; 5.01), and Central-West (PR = 1.91; 95%CI: 1.12; 3.25) and whose mothers were 20-34 years (PR = 1.62; 95%CI: 1.11; 2.35). Underlying determinants: the presence of more than one child < 5 years old in the household was associated with a higher prevalence of anemia (PR = 1.61; 95%CI: 1.15; 2.25) and vitamin A deficiency (PR = 1.82; 95%CI: 1.09; 3.05) in children 6-23 months. Immediate determinants: consumption of 1-2 groups of ultra-processed foods in children 24-59 months (PR = 0.44; 95%CI: 0.25; 0.81) and lack of breastfeeding in the day before in children 6-23 months (PR = 0.56; 95%CI: 0.36; 0.95) were associated with lower prevalence of anemia and vitamin A deficiency. Public policies focused on geographically and socially vulnerable groups are needed to promote equity.

Resumo:

Fatores associados a anemia e deficiência de vitamina A foram investigados em 7.716 crianças de 6-59 meses de idade parte da Estudo Nacional de Alimentação e Nutrição Infantil (ENANI-2019). Adotamos uma abordagem hierárquica baseada em um modelo teórico do Fundo das Nações Unidas para a Infância (UNICEF) com três níveis estratificados por idade (6-23; 24-59 meses). Foram estimadas razões de prevalência (RP) e intervalos de 95% de confiança (IC95%). Determinantes habilitadores: observamos maior prevalência de anemia em crianças de 6-23 meses de idade cujas mães tinham ≤ 7 anos de escolaridade (RP = 1,92; IC95%: 1,10; 3,34), < 20 anos de idade (RP = 2,47; IC95%: 1,34; 4,56) ou 20-30 anos de idade (RP = 1,95; IC95%: 1,11; 3,44), cor parda (RP = 1,57; IC95%: 1,06; 2,23); e em crianças de 24-59 meses de idade na Região Norte (RP = 3,11; IC95%: 1,58; 6,13). Encontramos maior prevalência de deficiência de vitamina A em crianças de 6-23 meses de idade no Centro-oeste (RP = 2,32; IC95%: 1,33; 4,05) e em crianças de 24-59 meses de idade residentes nas regiões Norte (RP = 1,96; IC95%: 1,16; 3,30), Sul (RP = 3,07; IC95%: 1,89; 5,01) e Centro-oeste (RP = 1,91; IC95%: 1,12; 3,25) cujas mães tinham entre 20-34 anos de idade (RP = 1,62; IC95%: 1,11; 2,35). Determinantes subjacentes: a presença de mais de uma criança < 5 anos de idade no domicílio se associou a maior prevalência de anemia (RP = 1,61; IC95%: 1,15; 2,25) e deficiência de vitamina A (RP = 1,82; IC95%: 1,09; 3,05) em crianças de 6-23 meses de idade. Determinantes imediatos: o consumo de 1-2 grupos de alimentos ultraprocessados em crianças de 24-59 meses de idade (RP = 0,44; IC95%: 0,25; 0,81) e o não aleitamento materno no dia anterior em crianças de 6-23 meses de idade (RP = 0,56; IC95%: 0,36; 0,95) foram associados com a menor prevalência de anemia e deficiência de vitamina A. Políticas públicas focadas em grupos geográfica e socialmente vulneráveis são necessárias para promover equidade.

Resumen:

Los factores asociados con la anemia y la deficiencia de vitamina A se investigaron en 7.716 niños de 6-59 meses de edad que formaban parte del Estudio Nacional de Alimentación y Nutrición Infantil (ENANI-2019). Adoptamos un enfoque jerárquico basado en un modelo teórico del Fondo de las Naciones Unidas para la Infancia (UNICEF) con tres niveles estratificados por edad (6-23; 24-59 meses). Se estimaron las razones de prevalencia (RP) y el intervalo de 95% de confianza (IC95%). Factores determinantes: observamos una mayor prevalencia de anemia en los niños de 6-23 meses de edad cuyas madres tenían ≤ 7 años de escolaridad (RP = 1,92; IC95%: 1,10; 3,34), < 20 años de edad (RP = 2,47; IC95%: 1,34; 4,56) o de 20-30 años de edad (RP = 1,95; IC95%: 1,11; 3,44), color pardo (RP = 1,57; IC95%: 1,06; 2,23); y en niños de 24-59 meses edad en la Región Norte (RP = 3,11; IC95%: 1,58; 6,13). Encontramos una mayor prevalencia de deficiencia de vitamina A en los niños de 6-23 meses de edad en el Centro-oeste (RP = 2,32; IC95%: 1,33; 4,05) y en los niños de 24-59 meses de edad que residen en las regiones Norte (RP = 1,96; IC95%: 1,16; 3,30), Sur (RP = 3,07; IC95%: 1,89; 5,01) y Centro-oeste (RP = 1,91; IC95%: 1,12; 3,25) cuyas madres tenían entre 20-34 años de edad (RP = 1,62; IC95%: 1,11; 2,35). Determinantes subyacentes: la presencia de más de un niño < 5 años de edad en el hogar se asoció a la mayor prevalencia de anemia (RP = 1,61; IC95%: 1,15; 2,25) y deficiencia de vitamina A (RP = 1,82; IC95%: 1,09; 3,05) en niños de 6-23 meses de edad. Determinantes inmediatos: el consumo de 1-2 grupos de alimentos ultraprocesados en niños de 24-59 meses de edad (RP = 0,44; IC95%: 0,25; 0,81) y no consumo de leche materno el día anterior en niños de 6-23 meses de edad (RP = 0,56; IC95%: 0,36; 0,95) se asociaron con una menor prevalencia de anemia y deficiencia de vitamina A. Las políticas públicas enfocadas en los grupos geográfica y socialmente vulnerables son necesarias para promover la equidad.

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Most cited references 52

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Ultra-processed foods: what they are and how to identify them

Carlos A. Monteiro, Geoffrey Cannon, Renata B. Levy … (2019)

The present commentary contains a clear and simple guide designed to identify ultra-processed foods. It responds to the growing interest in ultra-processed foods among policy makers, academic researchers, health professionals, journalists and consumers concerned to devise policies, investigate dietary patterns, advise people, prepare media coverage, and when buying food and checking labels in shops or at home. Ultra-processed foods are defined within the NOVA classification system, which groups foods according to the extent and purpose of industrial processing. Processes enabling the manufacture of ultra-processed foods include the fractioning of whole foods into substances, chemical modifications of these substances, assembly of unmodified and modified food substances, frequent use of cosmetic additives and sophisticated packaging. Processes and ingredients used to manufacture ultra-processed foods are designed to create highly profitable (low-cost ingredients, long shelf-life, emphatic branding), convenient (ready-to-consume), hyper-palatable products liable to displace all other NOVA food groups, notably unprocessed or minimally processed foods. A practical way to identify an ultra-processed product is to check to see if its list of ingredients contains at least one item characteristic of the NOVA ultra-processed food group, which is to say, either food substances never or rarely used in kitchens (such as high-fructose corn syrup, hydrogenated or interesterified oils, and hydrolysed proteins), or classes of additives designed to make the final product palatable or more appealing (such as flavours, flavour enhancers, colours, emulsifiers, emulsifying salts, sweeteners, thickeners, and anti-foaming, bulking, carbonating, foaming, gelling and glazing agents).

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Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995–2011: a systematic analysis of population-representative data

Gretchen Stevens, Mariel Finucane, Luz María De-Regil … (2013)

Summary Background Low haemoglobin concentrations and anaemia are important risk factors for the health and development of women and children. We estimated trends in the distributions of haemoglobin concentration and in the prevalence of anaemia and severe anaemia in young children and pregnant and non-pregnant women between 1995 and 2011. Methods We obtained data about haemoglobin and anaemia for children aged 6–59 months and women of childbearing age (15–49 years) from 257 population-representative data sources from 107 countries worldwide. We used health, nutrition, and household surveys; summary statistics from WHO's Vitamin and Mineral Nutrition Information System; and summary statistics reported by other national and international agencies. We used a Bayesian hierarchical mixture model to estimate haemoglobin distributions and systematically addressed missing data, non-linear time trends, and representativeness of data sources. We quantified the uncertainty of our estimates. Findings Global mean haemoglobin improved slightly between 1995 and 2011, from 125 g/L (95% credibility interval 123–126) to 126 g/L (124–128) in non-pregnant women, from 112 g/L (111–113) to 114 g/L (112–116) in pregnant women, and from 109 g/L (107–111) to 111 g/L (110–113) in children. Anaemia prevalence decreased from 33% (29–37) to 29% (24–35) in non-pregnant women, from 43% (39–47) to 38% (34–43) in pregnant women, and from 47% (43–51) to 43% (38–47) in children. These prevalences translated to 496 million (409–595 million) non-pregnant women, 32 million (28–36 million) pregnant women, and 273 million (242–304 million) children with anaemia in 2011. In 2011, concentrations of mean haemoglobin were lowest and anaemia prevalence was highest in south Asia and central and west Africa. Interpretation Children's and women's haemoglobin statuses improved in some regions where concentrations had been low in the 1990s, leading to a modest global increase in mean haemoglobin and a reduction in anaemia prevalence. Further improvements are needed in some regions, particularly south Asia and central and west Africa, to improve the health of women and children and achieve global targets for reducing anaemia. Funding Bill & Melinda Gates Foundation, Grand Challenges Canada, and the UK Medical Research Council.

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Trends and mortality effects of vitamin A deficiency in children in 138 low-income and middle-income countries between 1991 and 2013: a pooled analysis of population-based surveys.

Gretchen Stevens, James Bennett, Quentin Hennocq … (2015)

Vitamin A deficiency is a risk factor for blindness and for mortality from measles and diarrhoea in children aged 6-59 months. We aimed to estimate trends in the prevalence of vitamin A deficiency between 1991 and 2013 and its mortality burden in low-income and middle-income countries.

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Author and article information

Contributors

Inês Rugani Ribeiro de Castro:

ORCID: http://orcid.org/0000-0002-7479-4400

Role: contributed to the study conception and designRole: the article’s writing and reviewRole: approved the final version

Paula Normando:

ORCID: http://orcid.org/0000-0002-6443-7733

Role: contributed to the study conception and designRole: the article’s writing and reviewRole: approved the final version

Dayana Rodrigues Farias:

ORCID: http://orcid.org/0000-0003-0278-8375

Role: contributed to the study conception and designRole: the article’s writing and reviewRole: approved the final version

Talita Lelis Berti:

ORCID: http://orcid.org/0000-0003-1160-3512

Role: contributed to the data processing and analysisRole: article writing, and reviewRole: approved the final version

Raquel Machado Schincaglia:

ORCID: http://orcid.org/0000-0002-8450-6775

Role: contributed to the data processing and analysisRole: article writing, and reviewRole: approved the final version

Pedro Gomes Andrade:

ORCID: http://orcid.org/0000-0002-3964-6787

Role: contributed to the data processing and analysisRole: article writing, and reviewRole: approved the final version

Neilane Bertoni:

ORCID: http://orcid.org/0000-0002-2539-9965

Role: contributed to the data processing and analysisRole: article writing, and reviewRole: approved the final version

Elisa Maria de Aquino Lacerda:

ORCID: http://orcid.org/0000-0002-1830-4278