Frequency of nutritional disorders and their risk factors among children attending 13 nurseries in São Paulo, Brazil
a cross-sectional study
Keywords:
Risk factors, Child day care centers, Nutritional status, Infant, Health promotionAbstract
CONTEXT AND OBJECTIVE: Nutritional disorders are associated with health problems earlier in life. The objective here was to estimate the frequency of nutritional disorders and their risk factors among children. DESIGN AND SETTING: Cross-sectional study in nurseries at 13 day-care centers in São Paulo, Brazil. METHODS: The mothers of 482 children were interviewed, with anthropometry on these children. Chil-dren whose anthropometric indices for weight and height were greater than two standard deviations were considered to have nutritional disorders. RESULTS: Children in families with lower per capita income (odds ratio [OR]: 2.25; 95% confidence interval, CI: 1.08-4.67) and who presented neonatal risk (OR 8.08; 95% CI: 2.29-28.74), had incomplete vaccinations (OR 3.44; 95% CI: 1.15-10.31) or were male (OR 3.73; 95% CI: 1.63-8.56) were more likely to be malnourished. Children in families with lower per capita income were also less likely to be overnourished (OR 0.40; 95% CI: 0.19-0.88). Children who were exclusively breastfed for less than two months (OR 2.95; 95% CI: 1.35-6.44) or who were male (OR 2.18; 95% CI: 1.02-4.65) were also at greater risk of being overnourished. Children who presented neonatal risk (OR 3.41; 95% CI: 1.04-11.23), had incomplete vaccinations (OR 3.18; 95% CI: 1.30-7.76), or were male (OR 2.76; 95% CI: 1.56-4.90) were more likely to have a nutritional disorder. CONCLUSIONS: Nutritional disorders remain present in children attending nurseries in São Paulo. Actions should focus on boys, children who were exclusively breastfed for less than two months and those without up-to-date vaccinations.
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References
de Onis M, Blössner M, Borghi E. Global prevalence and trends of overweight and obesity among preschool children. Am J Clin Nutr. 2010;92(5):1257-64.
Best C, Neufingerl N, van Geel L, van den Briel T, Osendarp S. The nutritional status of school-aged children: why should we care? Food Nutr Bull. 2010;31(3):400-17.
World Health Organization. Nutrition Landscape Information System (NLIS) country profile indicators: interpretation guide. Geneva: World Health Organization; 2010.
Wachs TD. Multiple influences on children’s nutritional deficiencies: a systems perspective. Physiol Behav. 2008;94(1):48-60.
Lee YS. Consequences of childhood obesity. Ann Acad Med Singapore. 2009;38(1):75-7.
World Health Organization. WHO Child Growth Standards: methods and development. Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age. Geneva: World Health Organization; 2006.
World Health Organization. WHO Statistical Information System (WHOSIS). World Health Statistics 2010. Geneva: World Health Organization; 2010.
Monteiro CA, Conde WL. Tendência secular da desnutrição e da obesidade na infância na cidade de São Paulo (1974-1996) [Secular trends in malnutrition and obesity among children in the city of São Paulo, Brazil (1974-1996).] Rev Saude Publica. 2000; 34(6 Suppl):52-61.
Gigante DP, Victora CG, Araújo CL, Barros FC. Tendências no perfil nutricional das crianças nascidas em 1993 em Pelotas, Rio Grande do Sul, Brasil: análises longitudinais [Trends in the nutritional profile of children born in 1993 in Pelotas, Rio Grande do Sul, Brazil: longitudinal analyses]. Cad Saude Publica. 2003;19 Suppl:S141-7.
Hawkes C. Uneven dietary development: linking the policies and processes of globalization with the nutrition transition, obesity and diet-related chronic diseases. Global Health. 2006;2:4.
Pan American Health Organization. World Health Organization. Health in the Americas. Washington: Pan American Health Organization; 2007.
Han JC, Lawlor DA, Kimm SYS. Childhood Obesity. Lancet. 2010;375(9727):1737-48.
Instituto Nacional de Estudos e Pesquisas Educacionais Anísio Teixeira. Censo Escolar da Educação Básica, 2011 – resumo técnico. Brasília: Instituto Nacional de Estudos e Pesquisas Educacionais Anísio Teixeira; 2012. Available from: http://download.inep.gov.br/educacao_ basica/censo_escolar/resumos_tecnicos/resumo_tecnico_censo_ educacao_basica_2011.pdf. Accessed in 2014 (Nov 18).
Taddei JA, Oliveira MN, Konstantyner T. Impacto do Treinamento de Educadores de Creches Públicas/Filantrópicas nas Práticas Higiênico-Dietéticas e na Saúde/Nutrição dos Lactentes. Project FAPESP no. 2006/02597-0. São Paulo: Unifesp. Available from: http:// www.bv.fapesp.br/pt/auxilios/21977/impacto-do-treinamento-de-educadoras-de-creches-publicasfilantropicas-nas-praticas-higienico-dieteti/. Accessed in 2014 (Dec 4).
Gregg M. Field epidemiology. 3rd ed. Oxford: Oxford University Press; 2008.
Rosenblit J, Abreu CR, Szterling LN, et al. Evaluation of three methods for hemoglobin measurement in a blood donor setting. Sao Paulo Med J. 1999;117(3):108-12.
Kirkwood BR, Sterne JAC. Chi-squared tests for 232 and larger contingency tables. In: Kirkwood BR, Sterne JAC, eds. Essential medical statistics. 2nd ed. Malden: Blackwell Science; 2003. p. 165-76.
Kleinbaum DG, Kupper LL, Nizam A, Muller KE. Applied regression analysis and other multivariable methods. 4th ed. Duxbury: Brooks/Cole; 2008.
Vitolo MR, Gama CM, Bortolini GA, Campagnolo PD, Drachler Mde L. Some risk factors associated with overweight, stunting and wasting among children under 5 years old. J Pediatr (Rio J). 2008;84(3):251-7.
Wang Y, Monteiro C, Popkin BM. Trends of obesity and underweight in older children and adolescents in the United States, Brazil, China, and Russia. Am J Clin Nutr. 2002;75(6):971-7.
Griffiths P, Matthews Z, Hinde A. Gender, family, and the nutritional status of children in three culturally contrasting states of India. Soc Sci Med. 2002;55(5):775-90.
Sakisaka K, Wakai S, Kuroiwa C, et al. Nutritional status and associated factors in children aged 0-23 months in Granada, Nicaragua. Public Health. 2006;120(5):400-11.
Rosas LG, Guendelman S, Harley K, et al. Factors associated with overweight and obesity among children of Mexican descent: results of a binational study. J Immigr Minor Health. 2011;13(1):169-80.
Pande R. Selective gender differences in childhood nutrition and immunization in rural India: the role of siblings. Demography. 2003;40(3):395-418.
Bloss E, Wainaina F, Bailey RC. Prevalence and predictors of underweight, stunting, and wasting among children aged 5 and under in western Kenya. J Trop Pediatr. 2004;50(5):260-70.
Zhou L, He G, Zhang J, et al. Risk factors of obesity in preschool children in an urban area in China. Eur J Pediatr. 2011;170(11):1401-6.
Owen CG, Martin RM, Whincup PH, Smith GD, Cook DG. Effect of infant feeding on the risk of obesity across the life course: a quantitative review of published evidence. Pediatrics. 2005;115(5):1367-77.
Wiedmeier JE, Joss-Moore LA, Lane RH, Neu J. Early postnatal nutrition and programming of the preterm neonate. Nutr Rev. 2011;69(2):76-82.
Gupta RS, Shuman S, Taveras EM, Kulldorff M, Finkelstein JA. Opportunities for health promotion education in child care. Pediatrics. 2005;116(4):e499-505.
