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      Nutrition transition in Brazilian children under 5 years old from 2006 to 2019 Translated title: Transição nutricional em crianças brasileiras menores de 5 anos de idade entre 2006 e 2019 Translated title: Transición nutricional en niños brasileños menores de 5 años de edad entre 2006 y 2019

      research-article
      1 , 2 , 3 , 4 , 3 , 5 , 3 , 3 , 3 , 6 , 3 , 3 , 7 , 3
      Cadernos de Saúde Pública
      Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz
      Growth Disorders, Overweight, Anemia, Vitamin A Deficiency, Breastfeeding, Transtornos do Crescimento, Sobrepeso, Anemia, Deficiência de Vitamina A, Aleitamento Materno, Trantornos del Crecimiento, Sobrepeso, Anemia, Deficiencia de Vitamina A, Lactancia Materna

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          Abstract:

          This manuscript aims to report the nutrition transition in Brazilian children under 5 years old from 2006 to 2019. Microdata from the Brazilian National Survey on Demography and Health of Women and Children (PNDS 2006) and the Brazilian National Survey on Child Nutrition (ENANI-2019) were analyzed. The indicators considered were: micronutrient status (anemia and vitamin A deficiency), anthropometric status (stunting and excessive weight), and breastfeeding practice (exclusive breastfeeding among children < 6 months and continued breastfeeding among children 12-23 months). We also analyzed minimum dietary diversity (MDD), consumption of ultra-processed foods, consumption of meat or eggs, and not consuming fruits or vegetables in children 6-59 months of age only for ENANI-2019. Equiplot charts were generated according to geographic region, maternal schooling level, and maternal race/skin color. From 2006 to 2019, the prevalence rates of anemia and vitamin A deficiency decreased from 20.5% to 10.1% and 17.2% to 6%, respectively. The prevalence of stunting remained at 7%, and excessive weight rates increased from 6% to 10.1%. The prevalence of exclusive breastfeeding among children < 6 months increased from 38.6% to 45.8%, and of continued breastfeeding among children 12-23 months from 34.6% to 43.6%. In 2019, 61.5% of children achieved the MDD, 88.8% consumed ultra-processed foods, 83.1% consumed meat or egg, and 25.7% did not consume fruits or vegetables the day before the survey. Trends of decreased micronutrient deficiencies, increased breastfeeding, and excessive weight rates, as well as reductions in disparities related to geographic region, maternal schooling level, and maternal race/skin color, were observed for most of the indicators.

          Resumo:

          Buscamos reportar a transição nutricional em crianças brasileiras menores de 5 anos de idade entre 2006 e 2019. Foram analisados microdados da Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher (PNDS 2006) e do Estudo Nacional de Alimentação e Nutrição Infantil (ENANI-2019). Foram considerados os seguintes indicadores: status de micronutrientes (anemia e deficiência de vitamina A), estado nutricional antropométrico (excesso de peso e baixa estatura) e a prática de aleitamento materno (aleitamento materno exclusivo entre crianças < 6 meses e aleitamento materno continuado entre crianças de 12-23 meses). Analisamos a diversidade alimentar mínima (DAM), o consumo de alimentos ultraprocessados, de carne ou ovos e o não consumo de frutas ou hortaliças apenas para o ENANI-2019 em crianças de 6-59 meses de idade. Equiplots foram gerados de acordo com a região geográfica, escolaridade e raça/cor da pele maternas. Entre 2006 e 2019, as prevalências de anemia e deficiência de vitamina A diminuíram de 20,5% para 10,1% e de 17,2% para 6%, respectivamente. A prevalência de déficit de estatura manteve-se em 7% e a de excesso de peso aumentou de 6% para 10,1%. A prevalência de aleitamento materno exclusivo entre crianças < 6 meses aumentou de 38,6% para 45,8% e a de aleitamento materno continuado entre crianças de 12-23 meses aumentou de 34,6% para 43,6%. Em 2019, 61,5% das crianças atingiram a DAM, 88,8% consumiram alimentos ultraprocessados, 83,1% consumiram carne ou ovos e 25,7% não consumiram frutas ou hortaliças no dia anterior à pesquisa. Observamos tendências de diminuição das deficiências de micronutrientes, aumento do aleitamento materno e excesso de peso e reduções em disparidades regional, de escolaridade e de raça/cor da pele maternas para a maioria dos indicadores.

          Resumen:

          Buscamos informar sobre la transición nutricional en niños brasileños menores de 5 años entre 2006 y 2019. Se analizaron microdatos de la Encuesta Nacional de Demografía y Salud del Niño y de la Mujer (PNDS 2006) y del Encuesta Nacional de Alimentación Nutrición Infantil (ENANI-2019). Se consideraron los siguientes indicadores: estado de micronutrientes (anemia y deficiencia de vitamina A), estado nuricional antropométrico (sobrepeso y baja estatura) y la práctica de la lactancia materna (lactancia materna exclusiva en niños < 6 meses y lactancia materna continua entre niños de 12-23 meses) como indicadores. Analizamos la diversidad dietética mínima (DDM), el consumo de alimentos ultraprocesados, carne o huevos, y el no consumo de frutas o verduras solo para ENANI-2019 en niños de 6-59 meses de edad. Se generaron equiplots en función de la región geográfica, la educación y raza/color de la piel de la madre. Entre 2006 y 2019, las prevalencias de anemia y deficiencia de vitamina A disminuyeron del 20,5% al 10,1% y del 17,2% al 6%, respectivamente. La prevalencia del déficit de estatura se mantuvo en el 7 % y la de sobrepeso aumentó del 6% al 10,1%. La prevalencia de lactancia materna exclusiva en niños < 6 aumentó del 38,6% al 45,8% y la de lactancia materna continua entre niños de 12-23 meses aumentó del 34,6% al 43,6%. En 2019, el 61,5% de los niños alcanzaron DDM, el 88,8% consumieron alimentos utraprocesados, el 83,1% consumieron carne o huevos y el 25,7% no consumieron frutas o verduras el día anterior a la encuesta. Observamos tendencias de disminución de las deficiencias de micronutrientes, un aumento de la lactancia materna y sobrepeso y reducciones en las disparidades regionales, de escolaridad y de raza/color de la piel de la madre para la mayoría de los indicadores.

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          Most cited references70

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          Dynamics of the double burden of malnutrition and the changing nutrition reality

          The double burden of malnutrition (DBM), defined as the simultaneous manifestation of both undernutrition and overweight and obesity, affects most low-income and middle-income countries (LMICs). This Series paper describes the dynamics of the DBM in LMICs and how it differs by socioeconomic level. This Series paper shows that the DBM has increased in the poorest LMICs, mainly due to overweight and obesity increases. Indonesia is the largest country with a severe DBM, but many other Asian and sub-Saharan African countries also face this problem. We also discuss that overweight increases are mainly due to very rapid changes in the food system, particularly the availability of cheap ultra-processed food and beverages in LMICs, and major reductions in physical activity at work, transportation, home, and even leisure due to introductions of activity-saving technologies. Understanding that the lowest income LMICs face severe levels of the DBM and that the major direct cause is rapid increases in overweight allows identifying selected crucial drivers and possible options for addressing the DBM at all levels.
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            Global prevalence and trends of overweight and obesity among preschool children.

            Childhood obesity is associated with serious health problems and the risk of premature illness and death later in life. Monitoring related trends is important. The objective was to quantify the worldwide prevalence and trends of overweight and obesity among preschool children on the basis of the new World Health Organization standards. A total of 450 nationally representative cross-sectional surveys from 144 countries were analyzed. Overweight and obesity were defined as the proportion of preschool children with values >2 SDs and >3 SDs, respectively, from the World Health Organization growth standard median. Being "at risk of overweight" was defined as the proportion with values >1 SD and ≤2 SDs, respectively. Linear mixed-effects modeling was used to estimate the rates and numbers of affected children. In 2010, 43 million children (35 million in developing countries) were estimated to be overweight and obese; 92 million were at risk of overweight. The worldwide prevalence of childhood overweight and obesity increased from 4.2% (95% CI: 3.2%, 5.2%) in 1990 to 6.7% (95% CI: 5.6%, 7.7%) in 2010. This trend is expected to reach 9.1% (95% CI: 7.3%, 10.9%), or ≈60 million, in 2020. The estimated prevalence of childhood overweight and obesity in Africa in 2010 was 8.5% (95% CI: 7.4%, 9.5%) and is expected to reach 12.7% (95% CI: 10.6%, 14.8%) in 2020. The prevalence is lower in Asia than in Africa (4.9% in 2010), but the number of affected children (18 million) is higher in Asia. Childhood overweight and obesity have increased dramatically since 1990. These findings confirm the need for effective interventions starting as early as infancy to reverse anticipated trends.
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              Double-duty actions: seizing programme and policy opportunities to address malnutrition in all its forms

              Actions to address different forms of malnutrition are typically managed by separate communities, policies, programmes, governance structures, and funding streams. By contrast, double-duty actions, which aim to simultaneously tackle both undernutrition and problems of overweight, obesity, and diet-related non-communicable diseases (DR-NCDs) have been proposed as a way to effectively address malnutrition in all its forms in a more holisitic way. This Series paper identifies ten double-duty actions that have strong potential to reduce the risk of both undernutrition, obesity, and DR-NCDs. It does so by summarising evidence on common drivers of different forms of malnutrition; documenting examples of unintended harm caused by some undernutrition-focused programmes on obesity and DR-NCDs; and highlighting examples of double-duty actions to tackle multiple forms of malnutrition. We find that undernutrition, obesity, and DR-NCDs are intrinsically linked through early-life nutrition, diet diversity, food environments, and socioeconomic factors. Some evidence shows that programmes focused on undernutrition have raised risks of poor quality diets, obesity, and DR-NCDs, especially in countries undergoing a rapid nutrition transition. This Series paper builds on this evidence to develop a framework to guide the design of double-duty approaches and strategies, and defines the first steps needed to deliver them. With a clear package of double-duty actions now identified, there is an urgent need to move forward with double-duty actions to address malnutrition in all its forms.
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                Author and article information

                Contributors
                Role: contributed to the study conception and designRole: writing and reviewRole: approved the final version of the article
                Role: contributed to the study conception and designRole: writing and reviewRole: approved the final version of the article
                Role: contributed to the study conception and designRole: writing and reviewRole: approved the final version of the article
                Role: contributed to the study conception and designRole: writing and reviewRole: approved the final version of the article
                Role: contributed to the study conception and designRole: writing and reviewRole: approved the final version of the article
                Role: contributed to the study conception and designRole: writing and reviewRole: approved the final version of the article
                Role: contributed to the study conception and designRole: writing and reviewRole: approved the final version of the article
                Role: contributed to the study conception and designRole: writing and reviewRole: approved the final version of the article
                Role: contributed to the study conception and designRole: writing and reviewRole: approved the final version of the article and performed the data processing and analysis
                Role: contributed to the study conception and designRole: writing and reviewRole: approved the final version of the article and performed the data processing and analysis
                Role: contributed to the study conception and designRole: writing and reviewRole: approved the final version of the article
                Role: contributed to the study conception and designRole: writing and reviewRole: approved the final version of the article
                Role: contributed to the study conception and designRole: writing and reviewRole: approved the final version of the article
                Role: contributed to the study conception and designRole: writing and reviewRole: approved the final version of the article
                Journal
                Cad Saude Publica
                Cad Saude Publica
                csp
                Cadernos de Saúde Pública
                Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz
                0102-311X
                1678-4464
                23 October 2023
                2023
                : 39
                : Suppl 2
                : e00216622
                Affiliations
                [1 ] Instituto de Nutrição, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil.
                [2 ] Departamento de Nutrição Social, Universidade Federal Fluminense, Niterói, Brasil.
                [3 ] Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil.
                [4 ] Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
                [5 ] Instituto de Estudos em Saúde e Biológicas, Universidade Federal do Sul e Sudeste do Pará, Belém, Brasil.
                [6 ] Divisão de Pesquisa Populacional, Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro, Brasil.
                [7 ] Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil.
                Author notes
                [Correspondence ] G. Kac Departamento de Nutrição Social e Aplicada, Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro. Av. Carlos Chagas Filho 373, Centro de Ciências da Saúde, Bloco J, 2° andar, sala 29, Rio de Janeiro, RJ 21941-902, Brasil. gilberto.kac@ 123456gmail.com

                Additional information: ORCID: Inês Rugani Ribeiro de Castro (0000-0002-7479-4400); Luiz Antonio dos Anjos (0000-0002-5257-6912); Elisa Maria de Aquino Lacerda (0000-0002-1830-4278); Cristiano Siqueira Boccolini (0000-0002-4804-5641); Dayana Rodrigues Farias (0000-0003-0278-8375); Nadya Helena Alves-Santos (0000-0002-0098-6047); Paula Normando (0000-0002-6443-7733); Maiara Brusco de Freitas (0000-0003-1737-8918); Pedro Gomes Andrade (0000-0002-3964-6787); Neilane Bertoni (0000-0002-2539-9965); Raquel Machado Schincaglia (0000-0002-8450-6775); Talita Lelis Berti (0000-0003-1160-3512); Letícia B. Vertulli Carneiro (0000-0003-0832-2293); Gilberto Kac (0000-0001-8603-9077).

                Author information
                http://orcid.org/0000-0002-7479-4400
                http://orcid.org/0000-0002-5257-6912
                http://orcid.org/0000-0002-1830-4278
                http://orcid.org/0000-0002-4804-5641
                http://orcid.org/0000-0003-0278-8375
                http://orcid.org/0000-0002-0098-6047
                http://orcid.org/0000-0002-6443-7733
                http://orcid.org/0000-0003-1737-8918
                http://orcid.org/0000-0002-3964-6787
                http://orcid.org/0000-0002-2539-9965
                http://orcid.org/0000-0002-8450-6775
                http://orcid.org/0000-0003-1160-3512
                http://orcid.org/0000-0003-0832-2293
                http://orcid.org/0000-0001-8603-9077
                Article
                00401
                10.1590/0102-311XEN216622
                10599229
                37878871
                401823bf-9f69-438f-a643-d5fc9fc15f7d

                This is an open-access article distributed under the terms of the Creative Commons Attribution License

                History
                : 14 November 2022
                : 20 April 2023
                : 19 May 2023
                Page count
                Figures: 3, Tables: 2, Equations: 0, References: 64
                Categories
                Debate

                growth disorders,overweight,anemia,vitamin a deficiency,breastfeeding,transtornos do crescimento,sobrepeso,deficiência de vitamina a,aleitamento materno,trantornos del crecimiento,deficiencia de vitamina a,lactancia materna

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