carlos a. monteiro ([email protected]) são paulo university, brazil
DESCRIPTION
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. - PowerPoint PPT PresentationTRANSCRIPT
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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
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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?
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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.
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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
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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.
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Monteiro et al., Public Health Nutrition, Feb 2002
BRAZIL
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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
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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
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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
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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
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Monteiro et al., Public Health Nutrition, Feb 2002
Is over-nutrition replacing or adding to under-nutrition?
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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
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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
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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
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Monteiro et al., Public Health Nutrition, Feb 2002
Are distinct social classes equally affected by the nutrition transition?
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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.
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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
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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.
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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
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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
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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.
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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
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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
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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
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Monteiro et al., Public Health Nutrition, Feb 2002
DIET AND PHYSICAL ACTIVITY PATTERNS IN LOWER AND UPPER INCOME GROUPS
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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
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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
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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
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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
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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.
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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