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To investigate the prevalence and socio-economic inequalities in breast milk, breast milk substitutes (BMS) and other non-human milk consumption, by children under 2 years in low- and middle-income countries (LMIC).
We analysed the prevalence of continued breast-feeding at 1 and 2 years and frequency of formula and other non-human milk consumption by age in months. Indicators were estimated through 24-h dietary recall. Absolute and relative wealth indicators were used to describe within- and between-country socio-economic inequalities.
Nationally representative surveys from 2010 onwards from eighty-six LMIC.
394 977 children aged under 2 years.
Breast-feeding declined sharply as children became older in all LMIC, especially in upper-middle-income countries. BMS consumption peaked at 6 months of age in low/lower-middle-income countries and at around 12 months in upper-middle-income countries. Irrespective of country, BMS consumption was higher in children from wealthier families, and breast-feeding in children from poorer families. Multilevel linear regression analysis showed that BMS consumption was positively associated with absolute income, and breast-feeding negatively associated. Findings for other non-human milk consumption were less straightforward. Unmeasured factors at country level explained a substantial proportion of overall variability in BMS consumption and breast-feeding.
Breast-feeding falls sharply as children become older, especially in wealthier families in upper-middle-income countries; this same group also consumes more BMS at any age. Country-level factors play an important role in explaining BMS consumption by all family wealth groups, suggesting that BMS marketing at national level might be partly responsible for the observed differences.
Much is known about national trends in child undernutrition, but there is little information on how socio-economic inequalities are evolving over time. We aimed to assess socio-economic inequalities in stunting prevalence over time.
We selected nationally representative surveys carried out since the mid-1990s for which information was available on asset indices and on child anthropometry. We identified twenty-five countries that had at least two surveys over an interval of 10 years or more, totalling eighty-seven surveys. Stunting prevalence was calculated according to wealth quintiles. Absolute and relative inequalities were calculated and time trends were obtained by regression.
Nationally representative household surveys from twenty-five low- and middle-income countries.
Children <5 years of age.
National prevalence declined significantly in twenty-two of the twenty-five countries. In eighteen out of twenty-five countries, relative reductions were higher among the rich than among the poor. Overall, there was no indication that inequalities improved. Striking examples are Nepal, with a 17·0 percentage points decline in stunting per decade, but where inequalities increased sharply; and Brazil, where stunting fell by 6·7 percentage points and inequalities were all but eliminated.
Global progress in reducing stunting has not been accompanied by improved equity, but countries varied markedly in how successful they were in reducing prevalence among the poorest children. It is important to document how some countries were able to reduce inequalities, so that these lessons can be used to foster global progress, particularly in light of the increased importance of within-country inequalities in the post-2015 agenda.
To investigate the association of family income at birth with BMI among young adults who have been followed since birth.
A birth cohort study.
In 1982, all children born in Pelotas, southern Brazil, were included in a perinatal survey and visited at ages 1, 2, 4, 15, 18–19 and 23 years.
Cohort members (n 4297) were traced and interviewed in 2004–2005. In all follow-ups, participants were weighed and measured, and BMI and prevalence of obesity were calculated for each age. Family income was obtained in minimum wages in 1982 and as a continuous variable, in reais, in later follow-ups. Skin colour was self-reported in 2004–2005.
Mean BMI and prevalence of obesity differed between males and females. In males, a direct relationship was found throughout life and among females this relationship was modified by age. During childhood, BMI was higher among girls from higher income groups and this association was inversed at age 23 years. At this same age, mean BMI among black women was 1·3 kg/m2 higher than among white women, even after adjustment for current family income.
The findings show in men that the relationship between income and BMI is similar to that seen in less developed areas, whereas among adult women the relationship is similar to that observed in developed countries. In addition to the effect of socio-economic status, skin colour also has an influence on the BMI of adult women.
To verify the impact of flour fortification on anaemia in Brazilian children. The survey also investigated the role of Fe deficiency as a cause of anaemia and estimated the bioavailability of the Fe in the children's diet. This local study was complemented by a nationwide survey of the types of Fe compounds added to flour.
Series of population-based surveys conducted in 2004 (baseline study), 2005, 2006 and 2008.
Pelotas, Rio Grande do Sul, Brazil.
Children under 6 years of age residing in the urban area of the city of Pelotas, Southern Brazil (n 507 in 2004; n 960 in 2005; n 893 in 2006; n 799 in 2008). In 2008, a sub-sample of children (n 114) provided venous blood samples to measure body Fe reserve parameters (ferritin and transferrin saturation).
We found no impact of fortification, with an increase in anaemia prevalence among children under 24 months of age. Hb levels decreased by 0·9 g/dl in this age group between 2004 and 2008 (10·9 g/dl to 10·0 g/dl; P < 0·001). Roughly 50 % of cases of anaemia were estimated to be due to Fe deficiency. Half of the mills surveyed used reduced Fe to fortify wheat flour. Total Fe intake from all foodstuffs was adequate for 88·6 % of the children, but its bioavailability was only 5 %.
The low bioavailability of the Fe compounds added to flours, combined with the poor quality of children's diets, account for the lack of impact of mandatory fortification.
To identify dietary patterns among young adults and the relationships with socio-economic, demographic and lifestyle characteristics.
Population-based, cross-sectional analysis of a cohort study. Food intake was assessed by a frequency questionnaire, and dietary patterns were identified using principal components analysis.
A total of 4202 men and women aged 23 years, who participated in the 1982 Pelotas Birth Cohort Study.
Five dietary patterns were identified: common Brazilian, processed food, vegetable/fruit, dairy/dessert and tubers/pasta. Subjects who had low own or maternal educational levels, low social position or who were always poor throughout life had high adherence to the common Brazilian dietary pattern. In contrast, the processed food pattern was more likely to be followed by those belonging to middle and high social position and who were never poor. Men and smokers showed high adherence to the processed food and common Brazilian dietary patterns. Vegetable/fruit pattern was more likely to be followed by women and subjects engaged in physical activity. Women also showed high adherence to the dairy/dessert pattern.
Our study among young Brazilian adults has identified distinct dietary patterns that are clearly influenced by socio-economic and lifestyle characteristics, which have important policy implications in a country with marked social and economic inequalities.
Obesity is an increasingly prevalent nutritional disorder throughout the world. In particular, abdominal obesity is associated with cardiovascular and metabolic risk. The present study aimed to evaluate the effects of skin colour and life-course socio-economic indicators on waist circumference (WC), hip circumference (HC) and waist:hip ratio (WHR) in young adults.
Population-based birth cohort study. Individuals born in 1982 in Pelotas (southern Brazil) were visited on a number of occasions from birth to age 23–24 years. A sample of the cohort was sought in 2006 and 972 individuals were located. The analysis was restricted to individuals with complete data available (442 males, 414 females).
In men, family income at birth and in 2004–5 were positively associated with WC and HC, but not with WHR. Regardless of current income, men born to wealthier families had larger WC and HC as adults. Skin colour was not associated with any of the outcomes. In women, early poverty was associated with smaller HC, and current poverty with larger WC. Poverty at any age thus led to higher WHR. Black women had larger WC and HC than white women, but there were no differences in WHR. All the associations were partially mediated by education and behavioural variables.
The effects of early socio-economic position on WC and HC persist even after adjustment for adult socio-economic position, highlighting the importance of interventions during the first years of life.
Census data were used to investigate the influences of socioeconomic and environmental variables on child mortality rates in southern Brazil. By multivariate logistic regression analysis the effects of correlated factors were distinguished, after adjustment for maternal age and parity. Low family income and, to a lesser degree, low employment status of the head of the family were associated with high child mortality levels. Place of residence, education of the mother and of the head of the family, availability of piped water in the home, access to a toilet and type of housing were all associated with childhood mortality variation, even after allowing for the effects of income and employment. The contributions of the source of the water supply and type of sanitation facilities, however, were less clear and tended to become unimportant after controlling for the socioeconomic variables. There was also no apparent advantage in being covered by government health insurance.
The evidence for an association between poor nutrition in early life and subsequent obesity is inconclusive. In the present study, we investigated the associations between stunting, wasting and underweight at 2 and 4 years of age, and body composition in adolescence in male subjects studied since birth. The 1982 Pelotas Birth Cohort Study included all children born in maternity hospitals and living in the urban area of the city of Pelotas, Southern Brazil. All males born in 1982 were legally required to enlist in the army between January and April 2000. We were thus able to track 2250 subjects in 2000 (78·9 % of the original cohort). Anthropometric measurements were collected in 1984 and 1986, and body composition was assessed in 2000. In the present analysis, we used as predictors the nutritional indices height-for-age, weight-for-height and weight-for-age presented in six categories. Outcomes included fat, lean and body mass indices and fat:lean mass ratio, derived from anthropometric and bioimpedance measurements. ANOVA and linear regression were used in the analyses to adjust for confounding. All predictors were positively associated with fat and body mass indices. Height-for-age Z score at age 2 or 4 years was not associated with lean mass index, but all other predictors were associated. Fat:lean mass ratio was associated only with weight-for-height Z score. Our results suggest that undernutrition is not a risk factor for overweight and obesity in our population and may partially protect against fatness in adolescence.
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