Exoplanetas Alysson Bruno Barbosa Moreira [email protected].
Carlos A. Monteiro ([email protected]) São Paulo University, Brazil
description
Transcript of Carlos A. Monteiro ([email protected]) São Paulo University, Brazil
Monteiro et al., Public Health Nutrition, Feb 2002
The IUNS Bellagio meeting on the nutrition transition in the developing countries.
THE RELATIVE BURDEN OF DISEASE DUE TO UNDER- AND TO OVER-NUTRITION:
EVIDENCE FROM BRAZIL
Carlos A. Monteiro ([email protected])
São Paulo University, Brazil
Monteiro et al., Public Health Nutrition, Feb 2002
THE BURDEN OF DISEASE DUE TO UNDER- AND TO OVER-NUTRITION IN
THE DEVELOPING COUNTRIES
• What is the present situation?
• What has been the pace of change? Is over-nutrition replacing (or adding to) under-nutrition?
• Are young children, old children, and adults similarly affected?
• Are distinct social classes equally affected?
Monteiro et al., Public Health Nutrition, Feb 2002
THE BURDEN OF NUTRITIONAL DISEASES:COMPONENTS AND DEFINITIONS
• The under-nutrition burden: nutritional imbalances caused by insufficient consumption and/or excessive expenditure of energy and nutrients.
• The over-nutrition burden: nutritional imbalances caused by excessive consumption and/or insufficient expenditure of energy and nutrients.
Monteiro et al., Public Health Nutrition, Feb 2002
THE BURDEN OF NUTRITIONAL DISEASES:HOW TO MEASURE IT?
Diseases Direct indicators
Indirect indicators
Energy imbalances
(under or over)
Anthropometry Diet and physical activity evaluation
Energy-related nutrient imbalances
(under or over)
Biochemical and clinical tests
Diet evaluation
Anthropometry
Nonenergy-related nutrient imbalances
(under or over)
Biochemical and clinical tests
Diet evaluation
Monteiro et al., Public Health Nutrition, Feb 2002
BRAZIL
• Repeated national anthropometric surveys in the 70’s, 80’s , and 90’s.
• Great historical development contrasts between the poor northern regions and the rich southern regions.
• Great income disparities between and within the regions.
Monteiro et al., Public Health Nutrition, Feb 2002
BRAZIL
Monteiro et al., Public Health Nutrition, Feb 2002
SOUTHEASTUS$ 4,490
NORTHEASTUS$ 1,635
GDP PER CAPITA (BRAZIL, 1994)
NORTHUS$ 2,299
CENTERWESTUS$ 3,650
SOUTHUS$ 3,983
Monteiro et al., Public Health Nutrition, Feb 2002
What is the relative burden of disease due to under- and to
over-nutrition?
- in the (less developed) northeastern Brazil
- in the (more developed) southeastern Brazil
Monteiro et al., Public Health Nutrition, Feb 2002
INDICATORS EMPLOYED TO ASSESS UNDER- AND OVER-NUTRITION
• In young children (1-4 y)height-for-age < -2 z; weight-for-height > + 2 z; international growth reference
• In old child/adolescents (10-17 y)BMI < 5th centile; BMI > 95th centile; the 1989 survey as the reference distribution
• In adults (20 y and +)BMI < 18.5 kg/m2; BMI 30.0 kg/m2
Monteiro et al., Public Health Nutrition, Feb 2002
THE RELATIVE BURDEN OF UNDER- AND OVER-NUTRITION
Northeastern and southeastern of Brazil 1996/7
19
5,94,8 5,3
4,22,7
4,6
8,5
5,2
12,9
10,4
5,9
0
10
20
youngchild
old child adult youngchild
old child adult
%
UNDER OVER
SOUTHEASTNORTHEAST
Monteiro et al., Public Health Nutrition, Feb 2002
Is over-nutrition replacing or adding to under-nutrition?
Monteiro et al., Public Health Nutrition, Feb 2002
TRENDS IN THE RELATIVE BURDEN OF UNDER- AND OVER-NUTRITION Brazilian young children: 1975-1996
47,1
1922,7
84,82,9 1,5 2,7 3,7 4,5 5,2
29,9
0
10
20
30
40
50
1975 1989 1996 1975 1989 1996
%
UNDER OVER
NORTHEASTERN BRAZIL SOUTHEASTERN BRAZIL
Monteiro et al., Public Health Nutrition, Feb 2002
TRENDS IN THE RELATIVE BURDEN OF UNDER- AND OVER-NUTRITION
Brazilian old child/adolescents: 1975-1997
8,9
5,9
8,2
3,9
5,3
1
2,5
4,6
2,5
7,3
12,9
4,9
0
5
10
15
1975 1989 1997 1975 1989 1997
%
UNDER OVER
NORTHEASTERN BRAZIL SOUTHEASTERN BRAZIL
Monteiro et al., Public Health Nutrition, Feb 2002
TRENDS IN THE RELATIVE BURDEN OF UNDER- AND OVER-NUTRITION
Brazilian adults: 1975-1997
12
5,9
9,8
5,14,2
2,7
5,1
8,5
5,4
9,910,4
7,4
0
5
10
15
1975 1989 1997 1975 1989 1997
%
UNDER OVER
NORTHEASTERN BRAZIL SOUTHEASTERN BRAZIL
Monteiro et al., Public Health Nutrition, Feb 2002
Are distinct social classes equally affected by the nutrition transition?
Monteiro et al., Public Health Nutrition, Feb 2002
Is the under-nutrition gap between poor and rich being
eliminated ?
Income groups: the 25% poorest and the 25% richest families in each region.
Monteiro et al., Public Health Nutrition, Feb 2002
TRENDS IN UNDER-NUTRITION GAPS lower income vs. upper income
young children
60,8
28,8
39,9
17,3
7,2
26,2
8,6
2,46
2,4 3
42,4
0
20
40
60
80
1975 1989 1997 1975 1989 1997
%
25% POOREST 25% RICHEST
NORTHEASTERN BRAZIL SOUTHEASTERN BRAZIL
Monteiro et al., Public Health Nutrition, Feb 2002
Is the over-nutrition gap between rich and poor being reduced (or
even reversed) ?
Income groups: the 25% poorest and the 25% richest families in each region.
Monteiro et al., Public Health Nutrition, Feb 2002
TRENDS IN OVER-NUTRITION GAPS lower income vs. upper income
adult men
0,7
1,8 1,6
2,93,8
2,5
5,1
8,4
5,4
8,2
10,2
0,8
0
4
8
12
1975 1989 1997 1975 1989 1997
%
25% POOREST 25% RICHEST
NORTHEASTERN BRAZIL SOUTHEASTERN BRAZIL
Monteiro et al., Public Health Nutrition, Feb 2002
TRENDS IN OVER-NUTRITION GAPS lower income vs. upper income
adult women
3,1
7,76,1
11,2
14,1
6,7
9,8
14,5
7,9
14,4
8,9
5,2
0
5
10
15
20
1975 1989 1997 1975 1989 1997
%
25% POOREST 25% RICHEST
NORTHEASTERN BRAZIL SOUTHEASTERN BRAZIL
Monteiro et al., Public Health Nutrition, Feb 2002
Is the net effect of the nutrition transition positive or negative to
the poor?
Income groups: the 25% poorest and the 25% richest families in each region.
Monteiro et al., Public Health Nutrition, Feb 2002
TRENDS IN UNDER- + OVER-NUTRITION lower income vs. upper income
young children
63,2
30,1
42,8
19,4
11,2
29,5
11,4 9,312,8 13,7 11,6
43,6
0
20
40
60
80
1975 1989 1997 1975 1989 1997
%
25% POOREST 25% RICHEST
NORTHEASTERN BRAZIL SOUTHEASTERN BRAZIL
Monteiro et al., Public Health Nutrition, Feb 2002
TRENDS IN UNDER- + OVER-NUTRITION lower income vs. upper income
adult women
20,7
17,3
2017,6
23
19,1
15,9
20,1
14,7
18,7
12
16,4
0
10
20
30
1975 1989 1997 1975 1989 1997
%
25% POOREST 25% RICHEST
NORTHEASTERN BRAZIL SOUTHEASTERN BRAZIL
Monteiro et al., Public Health Nutrition, Feb 2002
BMI DISTRIBUTION lower income vs. upper income southeastern adult women, 1997
0
0,1
0,2
0,3
0,4
0,5
-3,5 -2,5 -1,5 -0,5 0,5 1,5 2,5 3,5
BMI Z-SCORE
Lower income Higher income
Monteiro et al., Public Health Nutrition, Feb 2002
DIET AND PHYSICAL ACTIVITY PATTERNS IN LOWER AND UPPER INCOME GROUPS
Monteiro et al., Public Health Nutrition, Feb 2002
DIETARY PATTERNS BY INCOMEBrazil metropolitan households, 1996
24,1
7,5
25,4
7,7
27,6
9,1
29,9
10,4
0
10
20
30
ENERGY FROM TOTAL FAT
ENERGY FROMSATURATED FAT
%
25% POOREST 25% 25% 25% RICHEST
Monteiro et al., Public Health Nutrition, Feb 2002
DIETARY PATTERNS BY INCOMEBrazil metropolitan households, 1996
13,9
2,3
14,3
2,4
12,7
3,5
9,8
5,2
0
5
10
15
ENERGY FROM SUGAR ENERGY FROM FRUITSAND VEGETABLES
%
25% POOREST 25% 25% 25% RICHEST
Monteiro et al., Public Health Nutrition, Feb 2002
ANY LEISURE-TIME PHYSICAL ACTIVITY BY INCOME, BRAZIL, 1997
8,3
1,3
12,7
6,5
21,5
7,2
31,5
18
0
10
20
30
40
MEN WOMEN
%
25% POOREST 25% 25% 25% RICHEST
Monteiro et al., Public Health Nutrition, Feb 2002
SMOKERS BY INCOME BRAZIL, 1989
52,9
33,8
49,4
28,8
44,1
27,1
38,6
24,4
0
20
40
60
MEN WOMEN
%
25% POOREST 25% 25% 25% RICHEST
Monteiro et al., Public Health Nutrition, Feb 2002
PREVALENCE OF OBESITY IN WOMEN BY SOCIOECONOMIC STATUS
29,3
21,1
36,8
14,1
25,8
43,4
0
20
40
60
Chile 1988 Curaçao 1994
% B
MI
> 3
0 kg
/m2
LOW MIDDLE HIGH
Sources: Berrios 1990; Grol 1997.
Monteiro et al., Public Health Nutrition, Feb 2002
PREVALENCE OF OBESITY IN WOMEN BY SCHOOLING LEVEL (1987-1996)
1,5
8,2
13,8
15,8
9,5
13,1
10,4 10
5,4
7,1
0
5
10
15
20
Haiti Guatemala Peru Rep. Dom. Mexico
% B
MI
> 3
0 kg
/m2
LOW HIGH
Source: Martorell et al. 2000