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Abstract
BackgroundSocioeconomic inequalities in child nutrition may change rapidly over time, particularly in populations undergoing the nutrition transition. Yet, the few available studies are repeated cross-sectional surveys. By studying three prospective birth cohorts in the same city over a period of more than two decades, we describe secular trends in overweight and stunting at different ages, according to socioeconomic position.MethodsPopulation-based birth cohort studies were launched in the city of Pelotas (Brazil) in 1982, 1993 and 2004, with follow-up visits at twelve, 24 and 48 months. Children were weighed and measured at every visit. Z-scores of length/height-for-age and body mass index-for-age were calculated using the WHO Child Growth Standards. The slope and relative indices of inequality, based on family income quintiles, were estimated for each follow-up visit.ResultsBetween the 1982 and 2004 cohorts, stunting among four-year-olds declined (from 10.9% to 3.6%), while overweight increased (from 7.6% to 12.3%). In every visit, stunting prevalence was inversely related to income. Both absolute and relative inequalities declined over time; among four-year-olds stunting dropped from 26.0% in the 1982 cohort to 6.7% in the 2004 cohort in the poorest group, while in the richest group stunting prevalence dropped from 2.7% in 1982 to 1.1% in the 2004 cohort study. The secular trend towards increased overweight was evident for four-year-olds, in almost all socioeconomic groups, but not among one and two-year-olds. Among four-year old children, overweight prevalence increased in all income quintiles, by 130% in the middle-income group, 64% in the poorest and 41% in the richest group.ConclusionsThe decline in stunting is remarkable, but the increase in overweight among four-year olds – particularly among the poorest and the middle-income groups– requires concerted efforts to prevent the long term consequences of child overweight.
Highlights
Socioeconomic inequalities in child nutrition may change rapidly over time, in populations undergoing the nutrition transition
The secular trend towards increased overweight prevalence was evident for four-year-olds, in all socioeconomic groups (Table 3), but there were no clear trends for children aged one and two years
The secular trend towards increased overweight was evident for four-year-olds in almost all socioeconomic groups, but there were no clear trends for children aged one or two years
Summary
Socioeconomic inequalities in child nutrition may change rapidly over time, in populations undergoing the nutrition transition. By studying three prospective birth cohorts in the same city over a period of more than two decades, we describe secular trends in overweight and stunting at different ages, according to socioeconomic position. The double burden of malnutrition in populations undergoing economic development includes both undernutrition and overweight [1]. Linear growth retardation or stunting is a measure of long-term undernutrition, which is generally caused by a combination of poor nutrition, infectious diseases and suboptimal child care [2,3]. Stunting in childhood has been shown to negatively affect human capital in the short and long-term, including lower intellectual performance, reduced work capacity and poor reproductive performance [4,5]. In the last decades stunting prevalence declined in most developing countries; trend analyses based on 80 countries showed that prevalence of stunting dropped from 40% in 1990 to 29% in 2008 in the developing world [7]
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