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Norde MM, Bromage S, Marchioni DML, Vasques AC, Deitchler M, Arsenaut J, de Carvalho AM, Velloso L, Willett W, Giovannucci E, Geloneze B. The global diet quality score as an indicator of adequate nutrient intake and dietary quality - a nation-wide representative study. Nutr J 2024; 23:42. [PMID: 38627669 PMCID: PMC11022474 DOI: 10.1186/s12937-024-00949-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 04/10/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND The Global Diet Quality Score (GDQS) was developed to be a simple, timely and cost-effective tool to track, simultaneously, nutritional deficiency and non-communicable disease risks from diet in diverse settings. The objective was to investigate the performance of GDQS as an indicator of adequate nutrient intake and dietary quality in a national-representative sample of the Brazilian population. METHODS Nationally-representative data from 44,744 men and non-pregnant and non-lactating women aging ≥ 10 years, from the Brazilian National Dietary Survey were used. Dietary data were collected through two 24-h recalls (24HR). The GDQS was calculated and compared to a proxy indicator of nutrient adequate intake (the Minimum Dietary Diversity for Women-MDD-W) and to an indicator of high-risk diet for non-communicable diseases (caloric contribution from ultra-processed foods-UPF). To estimate the odds for overall nutrient inadequacy across MDD-W and GDQS quintiles, a multiple logistic regression was applied, and the two metrics' performances were compared using Wald's post-test. RESULTS The mean GDQS for Brazilians was 14.5 (0-49 possible range), and only 1% of the population had a low-risk diet (GDQS ≥ 23). The GDQS mean was higher in women, elderly individuals and in higher-income households. An inverse correlation was found between the GDQS and UPF (rho (95% CI) = -0.20(-0.21;-0.19)). The odds for nutrient inadequacy were lower as quintiles of GDQS and MDD-W were higher (p-trend < 0.001), and MDD-W had a slightly better performance than GDQS (p-diff < 0.001). Having a low-risk GDQS (≥ 23) lowered the odds for nutrient inadequacy by 74% (95% CI:63%-81%). CONCLUSION The GDQS is a good indicator of overall nutrient adequacy, and correlates well with UPF in a nationally representative sample of Brazil. Future studies must investigate the relationship between the GDQS and clinical endpoints, strengthening the recommendation to use this metric to surveillance dietary risks.
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Affiliation(s)
- Marina M Norde
- Obesity and Comorbidities Research Center, University of Campinas, Campinas, SP, Brazil.
| | - Sabri Bromage
- Institute of Nutrition, Mahidol University, Phuttamonton, Thailand
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Dirce M L Marchioni
- Department of Nutrition, School of Public Health of the University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Ana Carolina Vasques
- Obesity and Comorbidities Research Center, University of Campinas, Campinas, SP, Brazil
- School of Applied Sciences, University of Campinas, Limeira, SP, Brazil
| | - Megan Deitchler
- Intake-Center for Dietary Assessment, FHI 360, Washington, DC, USA
| | - Joanne Arsenaut
- Intake-Center for Dietary Assessment, FHI 360, Washington, DC, USA
| | - Aline M de Carvalho
- Department of Nutrition, School of Public Health of the University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Lício Velloso
- Obesity and Comorbidities Research Center, University of Campinas, Campinas, SP, Brazil
| | - Walter Willett
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Edward Giovannucci
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Bruno Geloneze
- Obesity and Comorbidities Research Center, University of Campinas, Campinas, SP, Brazil
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Silva NDJ, Silva JFDME, Carrilho TRB, Pinto EDJ, de Andrade RDCS, Silva SA, Pedroso J, Spaniol AM, Bortolini GA, Fagundes A, Nilson EAF, Fiaccone RL, Kac G, Barreto ML, Ribeiro-Silva RDC. Quality of child anthropometric data from SISVAN, Brazil, 2008-2017. Rev Saude Publica 2023; 57:62. [PMID: 37878848 PMCID: PMC10519688 DOI: 10.11606/s1518-8787.2023057004655] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 12/19/2022] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVE To evaluate the quality of anthropometric data of children recorded in the Food and Nutrition Surveillance System (SISVAN) from 2008 to 2017. METHOD Descriptive study on the quality of anthropometric data of children under five years of age admitted in primary care services of the Unified Health System, from the individual databases of SISVAN. Data quality was annually assessed using the indicators: coverage, completeness, sex ratio, age distribution, weight and height digit preference, implausible z-score values, standard deviation, and normality of z-scores. RESULTS In total, 73,745,023 records and 29,852,480 children were identified. Coverage increased from 17.7% in 2008 to 45.4% in 2017. Completeness of birth date, weight, and height corresponded to almost 100% in all years. The sex ratio was balanced and approximately similar to the expected ratio, ranging from 0.8 to 1. The age distribution revealed higher percentages of registrations from the ages of two to four years until mid-2015. A preference for terminal digits "zero" and "five" was identified among weight and height records. The percentages of implausible z-scores exceeded 1% for all anthropometric indices, with values decreasing from 2014 onwards. A high dispersion of z-scores, including standard deviations between 1.2 and 1.6, was identified mainly in the indices including height and in the records of children under two years of age and residents in the North, Northeast, and Midwest regions. The distribution of z-scores was symmetric for all indices and platykurtic for height/age and weight/age. CONCLUSIONS The quality of SISVAN anthropometric data for children under five years of age has improved substantially between 2008 and 2017. Some indicators require attention, particularly for height measurements, whose quality was lower especially among groups more vulnerable to nutritional problems.
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Affiliation(s)
- Natanael de Jesus Silva
- Fundação Oswaldo CruzInstituto Gonçalo MonizCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasil Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil.
- Universitat de BarcelonaInstituto de Salud Global de BarcelonaBarcelonaEspaña Universitat de Barcelona. Instituto de Salud Global de Barcelona. Barcelona, España.
| | - Juliana Freitas de Mello e Silva
- Fundação Oswaldo CruzInstituto Gonçalo MonizCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasil Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil.
| | - Thaís Rangel Bousquet Carrilho
- Universidade Federal do Rio de JaneiroInstituto de Nutrição Josué de CastroObservatório de Epidemiologia NutricionalRio de JaneiroRJBrasil Universidade Federal do Rio de Janeiro. Instituto de Nutrição Josué de Castro. Observatório de Epidemiologia Nutricional. Rio de Janeiro, RJ, Brasil.
| | - Elizabete de Jesus Pinto
- Fundação Oswaldo CruzInstituto Gonçalo MonizCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasil Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil.
- Universidade Federal do Recôncavo da BahiaSanto Antônio de JesusBABrasil Universidade Federal do Recôncavo da Bahia. Santo Antônio de Jesus, BA, Brasil.
| | - Rafaella da Costa Santin de Andrade
- Ministério da SaúdeCoordenação-Geral de Alimentação e NutriçãoBrasíliaDFBrasil Ministério da Saúde. Coordenação-Geral de Alimentação e Nutrição. Brasília, DF, Brasil.
| | - Sara Araújo Silva
- Ministério da SaúdeCoordenação-Geral de Alimentação e NutriçãoBrasíliaDFBrasil Ministério da Saúde. Coordenação-Geral de Alimentação e Nutrição. Brasília, DF, Brasil.
| | - Jéssica Pedroso
- Ministério da SaúdeCoordenação-Geral de Alimentação e NutriçãoBrasíliaDFBrasil Ministério da Saúde. Coordenação-Geral de Alimentação e Nutrição. Brasília, DF, Brasil.
| | - Ana Maria Spaniol
- Ministério da SaúdeCoordenação-Geral de Alimentação e NutriçãoBrasíliaDFBrasil Ministério da Saúde. Coordenação-Geral de Alimentação e Nutrição. Brasília, DF, Brasil.
| | - Gisele Ane Bortolini
- Ministério da SaúdeCoordenação-Geral de Alimentação e NutriçãoBrasíliaDFBrasil Ministério da Saúde. Coordenação-Geral de Alimentação e Nutrição. Brasília, DF, Brasil.
| | - Andhressa Fagundes
- Universidade Federal de SergipeDepartamento de NutriçãoSão CristóvãSEBrasil Universidade Federal de Sergipe. Departamento de Nutrição. São Cristóvão, SE, Brasil.
| | - Eduardo Augusto Fernandes Nilson
- Ministério da SaúdeCoordenação-Geral de Alimentação e NutriçãoBrasíliaDFBrasil Ministério da Saúde. Coordenação-Geral de Alimentação e Nutrição. Brasília, DF, Brasil.
| | - Rosemeire Leovigildo Fiaccone
- Fundação Oswaldo CruzInstituto Gonçalo MonizCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasil Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil.
- Universidade Federal da BahiaInstituto de Matemática e EstatísticaSalvadorBABrasil Universidade Federal da Bahia. Instituto de Matemática e Estatística. Salvador, BA, Brasil.
| | - Gilberto Kac
- Universidade Federal do Rio de JaneiroInstituto de Nutrição Josué de CastroObservatório de Epidemiologia NutricionalRio de JaneiroRJBrasil Universidade Federal do Rio de Janeiro. Instituto de Nutrição Josué de Castro. Observatório de Epidemiologia Nutricional. Rio de Janeiro, RJ, Brasil.
| | - Maurício Lima Barreto
- Fundação Oswaldo CruzInstituto Gonçalo MonizCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasil Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil.
- Universidade Federal da BahiaInstituto de Saúde ColetivaSalvadorBABrasil Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil.
| | - Rita de Cássia Ribeiro-Silva
- Fundação Oswaldo CruzInstituto Gonçalo MonizCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasil Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil.
- Universidade Federal da BahiaEscola de NutriçãoSalvadorBABrasil Universidade Federal da Bahia. Escola de Nutrição. Salvador, BA, Brasil.
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Bernabé-Ortiz A, Quinteros-Reyes C, Carrillo-Larco RM. Double burden of malnutrition as a risk factor for overweight and obesity. Rev Saude Publica 2022; 56:93. [PMID: 36383806 PMCID: PMC9635849 DOI: 10.11606/s1518-8787.2022056004205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 01/28/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To assess the longitudinal effect of double burden of malnutrition (DBM) on the risk of developing child and adolescent overweight or obesity. METHODS Analysis of the Peruvian Young Lives Study, younger cohort: baseline (2002) and 4 follow-ups (2006-2007, 2009-2010, 2013-2014, and 2016-2017). Outcomes were the incidence of overweight and obesity as defined by the World Health Organization standards. The exposure comprised a variable with 4 categories: non-stunted child with a non-overweight mother (reference group), non-stunted child with an overweight mother, stunted child with a non-overweight mother, and stunted child with an overweight mother (i.e., DBM). Poisson regression models were built to assess the association of interest, and relative risks (RR) and 95%CI were reported. RESULTS Data from 2,034 children; 50.0% were girls and the mean age was 12.0 (3.6) months at baseline. Non-stunted children with an overweight mother had greater risk (RR = 1.64; 95%CI: 1.35-1.99) of developing overweight, compared with the risk for stunted children with a non-overweight mother (RR = 1.38; 95%CI: 1.10-1.72), and for those with DBM (RR = 1.28; 95%CI: 1.02-1.61). When compared with the reference group, obesity risk was greater among non-stunted children with an overweight mother (RR = 2.33; 95%CI: 1.68-3.22), greater among stunted children with a non-overweight mother (RR = 2.59; 95%CI: 1.75-3.84), and greater among those with DBM (RR = 2.14; 95%CI: 1.39-3.28). CONCLUSIONS DBM is a risk factor for childhood overweight and obesity in Peru. Dual-duty policies tackling both undernutrition in children and overweight in mothers are needed to reduce DBM and its future effects in Peru.
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Affiliation(s)
- Antonio Bernabé-Ortiz
- Universidad Peruana Cayetano HerediaCenter of Excellence in Chronic DiseasesLimaPeru Universidad Peruana Cayetano Heredia. Center of Excellence in Chronic Diseases. Lima, Peru,Universidad Científica del SurLimaPeru Universidad Científica del Sur. Lima, Peru
| | - Carmen Quinteros-Reyes
- Universidad Peruana Cayetano HerediaCenter of Excellence in Chronic DiseasesLimaPeru Universidad Peruana Cayetano Heredia. Center of Excellence in Chronic Diseases. Lima, Peru
| | - Rodrigo M. Carrillo-Larco
- Universidad Peruana Cayetano HerediaCenter of Excellence in Chronic DiseasesLimaPeru Universidad Peruana Cayetano Heredia. Center of Excellence in Chronic Diseases. Lima, Peru,Imperial College LondonSchool of Public HealthDepartment of Epidemiology and BiostatisticsLondonUK Imperial College London. School of Public Health. Department of Epidemiology and Biostatistics. London, UK
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Falcão IR, Ribeiro-Silva RDC, Alves FJO, Ortelan N, Silva NJ, Fiaccone RL, de Almeida MF, Pescarini JM, Lisboa CS, Júnior EPP, Paixao ES, Ferreira AJF, Teixeira CSS, Rocha ADS, Katikireddi SV, Ali MS, Dundas R, Leyland A, Rodrigues LC, Ichihara MY, Barreto ML. Evaluating the effect of Bolsa Familia, Brazil's conditional cash transfer programme, on maternal and child health: A study protocol. PLoS One 2022; 17:e0268500. [PMID: 35604890 PMCID: PMC9126365 DOI: 10.1371/journal.pone.0268500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/01/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Conditional Cash Transfer Programs have been developed in Latin America in response to poverty and marked social inequalities on the continent. In Brazil, the Bolsa Familia Program (BFP) was implemented to alleviate poverty and improve living conditions, health, and education for socioeconomically vulnerable populations. However, the effect of this intervention on maternal and child health is not well understood. METHODS We will evaluate the effect of BFP on maternal and child outcomes: 1. Birth weight; 2. Preterm birth; 3. Maternal mortality; and 4. Child growth. Dynamic retrospective cohort data from the 100 Million Brazilian Cohort (2001 to 2015) will be linked to three different databases: Live Birth Information System (2004 to 2015); Mortality Information System (2011 to 2015); and Food and Nutritional Surveillance System (2008 to 2017). The definition of exposure to the BFP varies according to the outcome studied. Those who never received the benefit until the outcome or until the end of the follow-up will be defined as not exposed. The effects of BFP on maternal and child outcomes will be estimated by a combination of propensity score-based methods and weighted logistic regressions. The analyses will be further stratified to reflect changes in the benefit entitlement before and after 2012. DISCUSSION Harnessing a large linked administrative cohort allows us to assess the effect of the BFP on maternal and child health, while considering a wide range of explanatory and confounding variables.
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Affiliation(s)
- Ila Rocha Falcão
- School of Nutrition, Federal University of Bahia, Salvador, Brazil
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Rita de Cássia Ribeiro-Silva
- School of Nutrition, Federal University of Bahia, Salvador, Brazil
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Flávia Jôse Oliveira Alves
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| | - Naiá Ortelan
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Natanael J. Silva
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Rosemeire L. Fiaccone
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Department of Statistics, Federal University of Bahia, Salvador, Brazil
| | | | - Júlia M. Pescarini
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Cinthia Soares Lisboa
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Feira de Santana State University, Feira de Santana, Brazil
| | - Elzo Pereira Pinto Júnior
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Enny S. Paixao
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Andrea J. F. Ferreira
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| | - Camila Silveira Silva Teixeira
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| | - Aline dos Santos Rocha
- School of Nutrition, Federal University of Bahia, Salvador, Brazil
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | | | - M. Sanni Ali
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ruth Dundas
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland
| | - Alastair Leyland
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland
| | - Laura C. Rodrigues
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Maria Yury Ichihara
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| | - Mauricio L. Barreto
- Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
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Ribeiro-Silva RDC, Silva NDJ, Felisbino-Mendes MS, Falcão IR, de Andrade RDCS, Silva SA, Nilson EAF, Spaniol AM, Fiaccone RL, Paixão E, Ichihara MYT, Velasquez-Melendez G, Barreto ML. Time trends and social inequalities in child malnutrition: nationwide estimates from Brazil's food and nutrition surveillance system, 2009-2017. Public Health Nutr 2021; 25:1-11. [PMID: 34915949 PMCID: PMC9991727 DOI: 10.1017/s1368980021004882] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 11/11/2021] [Accepted: 12/14/2021] [Indexed: 12/27/2022]
Abstract
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.
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Affiliation(s)
- Rita de Cássia Ribeiro-Silva
- School of Nutrition, Federal University of Bahia, Av. Araújo Pinho, nº 32, Canela, CEP 40.110-150, Salvador, BA, Brazil
- Center for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, BA, Brazil
| | - Natanael de Jesus Silva
- Center for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, BA, Brazil
| | - Mariana Santos Felisbino-Mendes
- Department of Maternal and Child Nursing and Public Health, Nursing School, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Ila Rocha Falcão
- Center for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, BA, Brazil
| | | | - Sara Araújo Silva
- General-Coordination Office for Food and Nutrition Policy, Ministry of Health, Brasília, DF, Brazil
| | | | - Ana Maria Spaniol
- General-Coordination Office for Food and Nutrition Policy, Ministry of Health, Brasília, DF, Brazil
| | - Rosemeire Leovigildo Fiaccone
- Center for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, BA, Brazil
- Institute of Mathematics and Statistics, Federal University of Bahia, Salvador, BA, Brazil
| | - Enny Paixão
- Center for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, BA, Brazil
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Gustavo Velasquez-Melendez
- Department of Maternal and Child Nursing and Public Health, Nursing School, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Maurício Lima Barreto
- Center for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, BA, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, BA, Brazil
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The Association between a Novel Baby-Friendly Hospital Program and Equitable Support for Breastfeeding in Vietnam. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136706. [PMID: 34206374 PMCID: PMC8296950 DOI: 10.3390/ijerph18136706] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 06/14/2021] [Accepted: 06/16/2021] [Indexed: 11/16/2022]
Abstract
Background: Rates of early initiation of breastfeeding are low in Southeast Asia, despite evidence that increased initiation of early breastfeeding would lead to better long-term infant and child health and decrease inequities in long-term health and well-being. In response, a novel performance-based, baby-friendly hospital program designates hospitals that adhere to evidence-based early essential newborn care (EENC) and breastfeeding interventions as Centers of Excellence for Breastfeeding (COE). This study examined whether hospital participation in the program was associated with better breastfeeding outcomes. Methods: Hospitals (n = 28) were invited into the program in December 2018. Hospitals developed an improvement plan for promoting a breastfeeding-friendly environment and meeting the standards of the COE accreditation process and were enrolled on a rolling basis over the course of a year. Post-partum surveys were conducted with parents (n = 9585) from January 2019 through April 2020 to assess their breastfeeding and post-partum experience. Segmented regression models were used to assess how breastfeeding outcomes evolved before and after hospital enrollment in the COE program. Results: Enrollment was associated with a 6 percentage-point (95% CI: 3, 9) increase in the level of early initiation of breastfeeding, which continued to increase in the post-enrollment period, and a 5 percentage-point (95% CI: 2, 9) increase in the level of exclusive breastfeeding during hospital stay. We did not observe evidence that enrollment was immediately associated with receipt of lactation counseling or exclusive breastfeeding at survey time. Conclusion: The prevalence of early and exclusive breastfeeding increased after enrollment in the COE program, suggesting that the program has the potential to improve breastfeeding initiation rates and longer-term child health and well-being. Further research should be conducted to examine whether the program has an impact on the overall duration of breastfeeding.
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