Trends of height-for-age Z-scores according to age among Brazilian children under 5 years old from 2006 to 2019  <span class="so-article-trans-title" dir="auto"> Translated title: Tendências dos escores Z de estatura por idade entre crianças brasileiras menores de cinco anos de 2006 a 2019 </span> <span class="so-article-trans-title" dir="auto"> Translated title: Tendencias de las puntuaciones Z de la talla por edad entre los niños brasileños menores de cinco años de 2006 a 2019 </span>

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Abstract

This study compared the distribution of stunting and height-for-age (HAZ) Z-scores among age groups in data from the Brazilian National Survey on Demography and Health of Women and Children (PNDS 2006) and the Brazilian National Survey on Child Nutrition (ENANI-2019). The final sample comprised 4,408 and 14,553 children < 59 months of age in the PNDS 2006 and ENANI-2019, respectively. Children with HAZ scores < -2 according to the World Health Organization (WHO) growth standard were classified as stunted. Prevalence, 95% confidence intervals (95%CI), means, and standard deviations were estimated for Brazil and according to age. The distribution of HAZ scores at each age (in months) was estimated using the svysmooth function of the R survey package. Analyses considered the complex sampling design of the studies. Statistical differences were determined by analyzing the 95%CI of the overlap of point estimates. From 2006 to 2019, the prevalence of stunting for children < 12 months of age increased from 4.7% to 9%. As expected, the smoothed curves showed a higher mean HAZ score for children < 24 months of age in 2006 than in 2019 with no overlap of 95%CI among children aged 6-12 months. For children ≥ 24 months of age, we observed a higher mean HAZ score in 2019. Although the prevalence of stunting among children < 59 months of age was similar between 2006 and 2019, mean HAZ scores among children ≥ 24 months of age increased, whereas the mean HAZ score among children < 24 months of age decreased. Considering the deterioration in living conditions and the potential impact of the COVID-19 pandemic, we expect a greater prevalence of stunting in Brazil in the near future.

Translated abstract

Este estudo comparou a distribuição dos escores Z de estatura (ZAI) e déficit de estatura por faixas etárias nos dados da Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher (PNDS 2006) e da Pesquisa Nacional de Nutrição Infantil (ENANI-2019). Nossa amostra final foi composta por 4.408 e 14.553 crianças < 59 meses de idade da PNDS 2006 e ENANI-2019, respectivamente. Crianças com escores HAZ < -2 de acordo com o padrão de crescimento da Organização Mundial da Saúde (OMS) foram classificadas como tendo déficit de estatura. Prevalências, intervalos de 95% de confiança (IC95%), médias e desvios padrão foram estimados para o Brasil e de acordo com a idade. A distribuição dos HAZ em cada idade (em meses) foi estimada usando a função svysmooth do pacote R. Nossas análises consideraram o desenho amostral complexo dos estudos. Diferenças estatísticas foram determinadas pela análise da sobreposição pontual dos IC95%. Entre 2006 e 2019, a prevalência de déficit de estatura para crianças < 12 meses de idade aumentou de 4,7% para 9%. Como esperado, as curvas suavizadas revelaram um HAZ médio maior para crianças < 24 meses de idade em 2006 do que em 2019, sem sobreposição de IC95% entre crianças de 6-12 meses. Para crianças ≥ 24 meses de idade, observamos um HAZ médio maior em 2019. Embora a prevalência de déficit de estatura entre crianças < 59 meses de idade tenha sido semelhante entre 2006 e 2019, observamos um aumento no HAZ médio entre crianças ≥ 24 meses de idade e uma diminuição no HAZ médio entre crianças < 24 meses de idade. Considerando a deterioração das condições de vida e o potencial impacto da pandemia de COVID-19, espera-se uma maior prevalência de déficit de estatura no Brasil no futuro próximo.

Translated abstract

Este estudio comparó la distribución de las puntuaciones Z de talla (ZTE) y el déficit de estatura por grupos de edad en los datos de la Encuesta Nacional de Demografía y Salud del Niño y de la Mujer (PNDS 2006) y la Encuesta Nacional de Nutrición Infantil (ENANI-2019). Nuestra muestra final consistió en 4.408 y 14.553 niños < 59 meses de edad de PNDS 2006 y ENANI-2019, respectivamente. Los niños con puntuaciones HAZ < -2 según el patrón de crecimiento de la Organización Mundial de la Salud (OMS) se clasificaron como con déficit de talla para edad. Las prevalencias, los intervalos de 95% de confianza (IC95 %), las medias y las desviaciones estándar se estimaron para Brasil y según la edad. La distribución de HAZ para cada edad (en meses) se estimó utilizando la función svysmooth del paquete R. Nuestros análisis tuvieron en cuenta el complejo diseño de muestra de los estudios. Las diferencias estadísticas se determinaron mediante el análisis de la superposición puntual de los IC95 %. Entre 2006 y 2019, la prevalencia del déficit de talla para edad en niños < 12 meses de edad aumentó del 4,7 % al 9%. Como se esperaba, las curvas suavizadas revelaron un HAZ promedio mayor para los niños < 24 meses de edad en 2006 que en 2019, sin una superposición del IC95 % entre los niños de 6-12 meses. Para los niños ≥ 24 meses de edad, observamos un HAZ promedio mayor en 2019. Aunque la prevalencia del déficit de talla para edad entre los niños < 59 meses de edad fue similar entre 2006 y 2019, observamos un aumento en el HAZ promedio entre los niños ≥ 24 meses de edad y una disminución en el HAZ promedio entre los niños < 24 meses de edad. Teniendo en cuenta el deterioro de las condiciones de vida y el impacto potencial de la pandemia de COVID-19, se espera una mayor prevalencia de déficit de talla para edad en Brasil en un futuro cercano.

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Childhood stunting: a global perspective

Mercedes de Onis, Francesco Branca (2016)

Abstract Childhood stunting is the best overall indicator of children's well‐being and an accurate reflection of social inequalities. Stunting is the most prevalent form of child malnutrition with an estimated 161 million children worldwide in 2013 falling below −2 SD from the length‐for‐age/height‐for‐age World Health Organization Child Growth Standards median. Many more millions suffer from some degree of growth faltering as the entire length‐for‐age/height‐for‐age z‐score distribution is shifted to the left indicating that all children, and not only those falling below a specific cutoff, are affected. Despite global consensus on how to define and measure it, stunting often goes unrecognized in communities where short stature is the norm as linear growth is not routinely assessed in primary health care settings and it is difficult to visually recognize it. Growth faltering often begins in utero and continues for at least the first 2 years of post‐natal life. Linear growth failure serves as a marker of multiple pathological disorders associated with increased morbidity and mortality, loss of physical growth potential, reduced neurodevelopmental and cognitive function and an elevated risk of chronic disease in adulthood. The severe irreversible physical and neurocognitive damage that accompanies stunted growth poses a major threat to human development. Increased awareness of stunting's magnitude and devastating consequences has resulted in its being identified as a major global health priority and the focus of international attention at the highest levels with global targets set for 2025 and beyond. The challenge is to prevent linear growth failure while keeping child overweight and obesity at bay.

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Impacts of COVID-19 on childhood malnutrition and nutrition-related mortality

Derek D. Headey, Rebecca Heidkamp, Saskia Osendarp … (2020)

The unprecedented global social and economic crisis triggered by the COVID-19 pandemic poses grave risks to the nutritional status and survival of young children in low-income and middle-income countries (LMICs). Of particular concern is an expected increase in child malnutrition, including wasting, due to steep declines in household incomes, changes in the availability and affordability of nutritious foods, and interruptions to health, nutrition, and social protection services. 1 One in ten deaths among children younger than 5 years in LMICs is attributable to severe wasting because wasted children are at increased risk of mortality from infectious diseases. 2 Before the COVID-19 pandemic, an estimated 47 million children younger than 5 years were moderately or severely wasted, most living in sub-Saharan Africa and south Asia. 3 The economic, food, and health systems disruptions resulting from the COVID-19 pandemic are expected to continue to exacerbate all forms of malnutrition. Estimates from the International Food Policy Research Institute suggest that because of the pandemic an additional 140 million people will be thrown into living in extreme poverty on less than US$1·90 per day in 2020. 4 According to the World Food Programme, the number of people in LMICs facing acute food insecurity will nearly double to 265 million by the end of 2020. 5 Sharp declines are expected in access to child health and nutrition services, similar to those seen during the 2014–16 outbreak of Ebola virus disease in sub-Saharan Africa. 6 Early in the COVID-19 pandemic, UNICEF estimated a 30% overall reduction in essential nutrition services coverage, reaching 75–100% in lockdown contexts, including in fragile countries where there are humanitarian crises. 7 The accompanying call to action on child malnutrition and COVID-19 from leaders of four UN agencies 8 in The Lancet is an important first step for the international community. Alongside these efforts, the Standing Together for Nutrition consortium, a multidisciplinary consortium of nutrition, economics, food, and health systems researchers, is working to estimate the scale and reach of nutrition challenges related to COVID-19. These efforts link three approaches to model the combined economic and health systems impacts from COVID-19 on malnutrition and mortality: MIRAGRODEP's macroeconomic projections of impacts on per capita gross national income (GNI); 4 microeconomic estimates of how predicted GNI shocks impact child wasting using data on 1·26 million children from 177 Demographic Health Surveys (DHS) conducted in 52 LMICs between 1990–2018; 9 and the Lives Saved Tool (LiST), which links country-specific health services disruptions and predicted increases in wasting to child mortality. 10 What do our initial analyses and estimates suggest? First, the MIRAGRODEP projections suggest that even fairly short lockdown measures, combined with severe mobility disruptions and comparatively moderate food systems disruptions, result in most LMICs having an estimated average 7·9% (SD 2·4%) decrease in GNI per capita relative to pre-COVID-19 projections. 4 Second, the microeconomic model projections indicate that decreases in GNI per capita are associated with large increases in child wasting. 9 Our own analyses, based on these estimates applied to 118 LMICs, suggest there could be a 14·3% increase in the prevalence of moderate or severe wasting among children younger than 5 years due to COVID-19-related predicted country-specific losses in GNI per capita. We estimate this would translate to an additional estimated 6·7 million children with wasting in 2020 compared with projections for 2020 without COVID-19; an estimated 57·6% of these children are in south Asia and an estimated 21·8% in sub-Saharan Africa. © 2020 Reuters/Jorge Cabrera 2020 Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. Third, when the projected increase in wasting in each country is combined with a projected year average of 25% reduction in coverage of nutrition and health services, we estimate there would be 128 605 (ranging from 111 193 to 178 510 for best and worst case scenarios) additional deaths in children younger than 5 years during 2020, with an estimated 52% of these deaths in sub-Saharan Africa. The range reflects coverage scenarios, as previously described by Roberton and colleagues, 10 using a low of 15% and high of 50% disruption in vitamin A supplementation, treatment of severe wasting, promotion of improved young child feeding, and provision of micronutrient supplements to pregnant women. Our projections emphasise the crucial need for the actions to protect child nutrition that are urged by the UN leaders in the accompanying Comment. 8 These actions require rapid mobilisation of domestic and donor resources at a time when most national economies are reeling from COVID-19-related losses. In 2017, the Word Bank estimated that $7 billion per year over 10 years is needed to reach the global Sustainable Development Goal nutrition targets. 11 These estimates need to be revised upwards to overcome COVID-19-related setbacks. The COVID-19 pandemic is expected to increase the risk of all forms of malnutrition. The wasting-focused estimates we present here are likely to be conservative, given that the duration of this crisis is unknown, and its full impacts on food, health, and social protection systems are yet to be realised. The disruption of other health services during lockdowns will further compromise maternal and child health and mortality, 10 and with the deepening of economic and food systems crises, other forms of malnutrition, including child stunting, micronutrient malnutrition, and maternal nutrition, are expected to increase. 1 Without adequate action, the profound impact of the COVID-19 pandemic on early life nutrition could have intergenerational consequences for child growth and development and life-long impacts on education, chronic disease risks, and overall human capital formation. 12 Forthcoming analyses by this consortium will examine a range of diet and nutrition outcomes in women and young children and provide consensus advice on multisectoral actions and resources needed to recover and support optimal nutrition now and into the future.

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Postnatal growth standards for preterm infants: the Preterm Postnatal Follow-up Study of the INTERGROWTH-21(st) Project.

Jose Villar, Francesca Giuliani, Zulfiqar Bhutta … (2015)

Charts of size at birth are used to assess the postnatal growth of preterm babies on the assumption that extrauterine growth should mimic that in the uterus.

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Author and article information

Contributors

Inês Rugani Ribeiro de Castro:

ORCID: http://orcid.org/0000-0002-7479-4400

Role: contributed to the study design, writing, and reviewRole: approved the final version

Dayana Rodrigues Farias:

ORCID: http://orcid.org/0000-0003-0278-8375

Role: contributed to the study design, writing, and reviewRole: approved the final version

Talita Lelis Berti:

ORCID: http://orcid.org/0000-0003-1160-3512

Role: contributed to the data processing and analysis, writing and reviewRole: approved the final version

Pedro Gomes Andrade:

ORCID: http://orcid.org/0000-0002-3964-6787

Role: contributed to the data processing and analysis, writing and reviewRole: approved the final version

Luiz Antonio dos Anjos:

ORCID: http://orcid.org/0000-0002-5257-6912

Role: contributed to the study design, writing, and reviewRole: approved the final version

Nadya Helena Alves-Santos:

ORCID: http://orcid.org/0000-0002-0098-6047

Role: contributed to the study design, writing, and reviewRole: approved the final version

Elisa Maria de Aquino Lacerda:

ORCID: http://orcid.org/0000-0002-1830-4278

Role: contributed to the study design, writing, and reviewRole: approved the final version

Maiara Brusco de Freitas:

ORCID: http://orcid.org/0000-0003-1737-8918

Role: contributed to the study design, writing, and reviewRole: approved the final version

Gilberto Kac:

ORCID: http://orcid.org/0000-0001-8603-9077

Role: contributed to the study design, writing, and reviewRole: approved the final version

Journal

Journal ID (nlm-ta): Cad Saude Publica

Journal ID (iso-abbrev): Cad Saude Publica

Journal ID (publisher-id): csp

Title: Cadernos de Saúde Pública

Publisher: Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz

ISSN (Print): 0102-311X

ISSN (Electronic): 1678-4464

Publication date (Electronic, pub): 28 August 2023

Publication date (Electronic, collection): 2023

Volume: 39

Issue: Suppl 2

Electronic Location Identifier: e00087222

Affiliations

[1 ] Instituto de Nutrição, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil.

[2 ] Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil.

[3 ] Departamento de Nutrição Social, Universidade Federal Fluminense, Niterói, Brasil.

[4 ] Instituto de Estudos em Saúde e Biológicas, Universidade Federal do Sul e Sudeste do Pará, Marabá, Brasil.

Author notes

[Correspondence ] G. Kac Departamento de Nutrição Social e Aplicada, Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro. Av. Carlos Chagas Filho 373, Centro de Ciências da Saúde, Bloco J, 2º andar, sala 29, Rio de Janeiro, RJ 21941-902, Brasil. gilberto.kac@ 123456gmail.com

Additional information: ORCID: Inês Rugani Ribeiro de Castro (0000-0002-7479-4400); Dayana Rodrigues Farias (0000-0003-0278-8375); Talita Lelis Berti (0000-0003-1160-3512); Pedro Gomes Andrade (0000-0002-3964-6787); Luiz Antonio dos Anjos (0000-0002-5257-6912); Nadya Helena Alves-Santos (0000-0002-0098-6047); Elisa Maria de Aquino Lacerda (0000-0002-1830-4278); Maiara Brusco de Freitas (0000-0003-1737-8918); Gilberto Kac (0000-0001-8603-9077).

5 Other members of the Brazilian Consortium on Child Nutritional: Cristiano Siqueira Boccolini, Letícia B. Vertulli Carneiro, Paula Normando, Raquel Machado Schincaglia.