Caracterização socioeconômica, alimentar e nutricional de crianças assistidas pelo Programa Bolsa Família no estado de Alagoas
Data
2024-07-09
Autores
Normande, Marília Moura e Mendes 
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivo: Esta tese teve como objetivo caracterizar as condições socioeconômicas e nutricionais que influenciam o padrão alimentar (PA), o estado nutricional e a prática do aleitamento materno continuado em crianças de 6 a 24 meses assistidas pelo Programa Bolsa Família (PBF), em municípios do estado de Alagoas, Brasil. Métodos: Trata-se de estudo transversal com crianças de 6 a 24 meses, assistidas pelo PBF e residentes em 6 municípios do estado de Alagoas. Os dados socioeconômicos foram obtidos através de formulário padronizado, enquanto a avaliação da insegurança alimentar utilizou a Escala Brasileira de Insegurança Alimentar. A avaliação antropométrica incluiu a medida de comprimento. O consumo alimentar foi analisado com um questionário baseado nos indicadores das práticas alimentares para crianças menores de dois anos, com foco nas 24 horas anteriores à entrevista. Para avaliar os PA, foi realizada análise de componentes principais, seguida de regressão linear multinível para verificar associação entre as características socioeconômicas e os PA encontrados. As associações das características das crianças com a prática do aleitamento materno continuado foram realizadas através de regressão de Poisson com estimativa robusta da variância. Além disso, foi utilizada a Modelagem de Equações Estruturais para explorar os efeitos da escolaridade dos pais e das características da criança no índice comprimento-para-idade. Resultados: Os resultados estão apresentados na forma de três artigos originais. O primeiro artigo avaliou 1604 crianças assistidas pelo PBF e encontrou 4 PA. PA1 composto por alimentos tradicionais da dieta brasileira, PA2 formado majoritariamente por alimentos ultraprocessados, PA3 por leite com açúcar de adição e PA4 por alimentos in natura e minimamente processados. A maior idade e escolaridade dos responsáveis foram negativamente associadas com o PA2 (β= −0,008; (IC95% −0,017; −0,000); β= −0,037; (IC95% −0,056; −0,018), respectivamente). A insegurança alimentar foi negativamente associada ao PA4 (β= −0,204; (IC95% −0,331; −0,078)), enquanto a maior idade e escolaridade dos responsáveis apresentaram associação positiva (β= 0·011; IC95% (0,003; 0,019); β= 0,043; (IC95% 0,025; 0,061), respectivamente). O segundo artigo também avaliou 1604 crianças assistidas pelo PBF e encontrou que a maior prevalência do aleitamento materno continuado estava associada a menor renda per capita (RP: 0,92; IC95%: 0,90–0,99) e idade do responsável (<19 anos: RP: 0,96, IC95%: 0,94–0,98; 19–35 anos: RP: 0,97, IC95%: 0,90–0,98), a não escolaridade do responsável (RP: 0,91; IC95%: 0,90–0,98), insegurança alimentar grave (RP: 0,98; IC95%: 0,94– 0,99), e ao consumo de alimentos processados (RP: 0,92; IC95%: 0,91–0,98) e ultraprocessados (RP: 0,95; IC95%: 0,92–0,98). O terceiro artigo avaliou 1448 crianças assistidas pelo PBF e observou efeito direto negativo da menor idade da criança (-0.06; p=0,017), uso de mamadeira (-0,11; p<0,001) e não ter uma dieta minimamente aceitável (-0.09; p<0.001) no índice de comprimento-para-idade. Ser menina (0,08; p=0,001), o maior peso ao nascer (0,33; p<0,001), ter sido amamentada (0,07; p=0,004) e o maior nível de escolaridade dos pais (0,09; p<0,001) apresentaram efeito direto positivo no índice de comprimento-para-idade. Também foi encontrado efeito indireto negativo do consumo de bebidas açucaradas (-0,08; p=0,003) e indireto positivo de ter sido amamentada (0,06; p=0,017) no índice de comprimento-para-idade mediados pelo nível de escolaridade dos pais. Conclusões: Esses achados sugerem a associação adversa das baixas condições socioeconômicas na prática do aleitamento materno continuado e na formação dos PA no início da vida. Além disso, enfatizam a importância das práticas alimentares adequadas, assim como um maior nível de escolaridade dos responsáveis, para o correto crescimento linear. Isso demonstra que o PBF, isoladamente, não é capaz de assegurar adequado crescimento e desenvolvimento das crianças assistidas, sendo essencial fortalecer políticas públicas para controlar o consumo excessivo de alimentos ultraprocessados e dos substitutos do leite materno, como também a promoção de ambientes alimentares mais saudáveis.
Objective: This thesis aimed to characterize the socioeconomic and nutritional conditions that influence the dietary pattern (DP), nutritional status, and continued breastfeeding practice in children aged 6 to 24 months assisted by the Bolsa Família Program (PBF) in municipalities of the state of Alagoas, Brazil. Methods: This is a cross-sectional study with children aged 6 to 24 months, assisted by the PBF and residing in 6 municipalities in the state of Alagoas. Socioeconomic data were obtained through a standardized form, while the assessment of food insecurity used the Brazilian Food Insecurity Scale. Anthropometric assessment included length measurement. Dietary intake was analyzed using a questionnaire based on the indicators to assess infant and young child feeding practices, focusing on the 24 hours prior to the interview. To assess dietary patterns (DP), principal component analysis was performed, followed by multilevel linear regression to examine the association between socioeconomic characteristics and the identified DPs. Associations of child characteristics with continued breastfeeding practice were conducted using Poisson regression with robust variance estimation. Additionally, Structural Equation Modeling was used to explore the effects of parental education and child characteristics on length-for-age indicator. Results: The results are presented in the form of three original articles. The first article evaluated 1604 children assisted by the PBF and found 4 DP. DP1 consisted of traditional Brazilian food, DP2 was predominantly composed of ultra-processed foods, DP3 of milk with added sugar, and DP4 of fresh and minimally processed foods. Older age and higher education level of caregivers were negatively associated with DP2 (β= -0.008; (95% CI -0.017; -0.000); β= -0.037; (95% CI -0.056; -0.018), respectively). Food insecurity was negatively associated with DP4 (β= -0.204; (95% CI -0.331; -0.078)), while older age and higher education level of caregivers showed a positive association (β= 0.011; 95% CI (0.003; 0.019); β= 0.043; (95% CI 0.025; 0.061), respectively). The second article also assessed 1604 children assisted by the PBF and found that the prevalence of continued breastfeeding was associated with lower per capita income (PR: 0.92; 95% CI: 0.90–0.99) and age of the caregiver (<19 years: PR: 0.96, 95% CI: 0.94–0.98; 19–35 years: PR: 0.97, 95% CI: 0.90–0.98), caregiver's lack of education (PR: 0.91; 95% CI: 0.90–0.98), severe food insecurity (PR: 0.98; 95% CI: 0.94– 0.99), and consumption of processed (PR: 0.92; 95% CI: 0.91–0.98) and ultra-processed foods (PR: 0.95; 95% CI: 0.92–0.98). The third article evaluated 1448 children assisted by the PBF and observed a direct negative effect of younger age of the child (-0.06; p=0.017), bottle feeding (-0.11; p<0.001), and not having a minimally acceptable diet (-0.09; p<0.001) on length-for-age. Being female (0.08; p=0.001), higher birth weight (0.33; p<0.001), having been breastfed (0.07; p=0.004), and higher parental education level (0.09; p<0.001) showed a direct positive effect on length-for-age. A negative indirect effect of sugary beverage consumption (-0.08; p=0.003) and a positive indirect effect of having been breastfed (0.06; p=0.017) on length-for-age mediated by parental education level were also found. Conclusions: These findings suggest the adverse association of low socioeconomic conditions on the practice of continued breastfeeding and the formation of DP in early life. Additionally, they emphasize the importance of adequate dietary practices, as well as higher levels of caregiver education, for proper linear growth. This demonstrates that the PBF alone is not capable of ensuring the adequate growth and development of the assisted children, highlighting the need to strengthen public policies to control the excessive consumption of ultra-processed foods and breast milk substitutes, while promoting healthier food environments.
Objective: This thesis aimed to characterize the socioeconomic and nutritional conditions that influence the dietary pattern (DP), nutritional status, and continued breastfeeding practice in children aged 6 to 24 months assisted by the Bolsa Família Program (PBF) in municipalities of the state of Alagoas, Brazil. Methods: This is a cross-sectional study with children aged 6 to 24 months, assisted by the PBF and residing in 6 municipalities in the state of Alagoas. Socioeconomic data were obtained through a standardized form, while the assessment of food insecurity used the Brazilian Food Insecurity Scale. Anthropometric assessment included length measurement. Dietary intake was analyzed using a questionnaire based on the indicators to assess infant and young child feeding practices, focusing on the 24 hours prior to the interview. To assess dietary patterns (DP), principal component analysis was performed, followed by multilevel linear regression to examine the association between socioeconomic characteristics and the identified DPs. Associations of child characteristics with continued breastfeeding practice were conducted using Poisson regression with robust variance estimation. Additionally, Structural Equation Modeling was used to explore the effects of parental education and child characteristics on length-for-age indicator. Results: The results are presented in the form of three original articles. The first article evaluated 1604 children assisted by the PBF and found 4 DP. DP1 consisted of traditional Brazilian food, DP2 was predominantly composed of ultra-processed foods, DP3 of milk with added sugar, and DP4 of fresh and minimally processed foods. Older age and higher education level of caregivers were negatively associated with DP2 (β= -0.008; (95% CI -0.017; -0.000); β= -0.037; (95% CI -0.056; -0.018), respectively). Food insecurity was negatively associated with DP4 (β= -0.204; (95% CI -0.331; -0.078)), while older age and higher education level of caregivers showed a positive association (β= 0.011; 95% CI (0.003; 0.019); β= 0.043; (95% CI 0.025; 0.061), respectively). The second article also assessed 1604 children assisted by the PBF and found that the prevalence of continued breastfeeding was associated with lower per capita income (PR: 0.92; 95% CI: 0.90–0.99) and age of the caregiver (<19 years: PR: 0.96, 95% CI: 0.94–0.98; 19–35 years: PR: 0.97, 95% CI: 0.90–0.98), caregiver's lack of education (PR: 0.91; 95% CI: 0.90–0.98), severe food insecurity (PR: 0.98; 95% CI: 0.94– 0.99), and consumption of processed (PR: 0.92; 95% CI: 0.91–0.98) and ultra-processed foods (PR: 0.95; 95% CI: 0.92–0.98). The third article evaluated 1448 children assisted by the PBF and observed a direct negative effect of younger age of the child (-0.06; p=0.017), bottle feeding (-0.11; p<0.001), and not having a minimally acceptable diet (-0.09; p<0.001) on length-for-age. Being female (0.08; p=0.001), higher birth weight (0.33; p<0.001), having been breastfed (0.07; p=0.004), and higher parental education level (0.09; p<0.001) showed a direct positive effect on length-for-age. A negative indirect effect of sugary beverage consumption (-0.08; p=0.003) and a positive indirect effect of having been breastfed (0.06; p=0.017) on length-for-age mediated by parental education level were also found. Conclusions: These findings suggest the adverse association of low socioeconomic conditions on the practice of continued breastfeeding and the formation of DP in early life. Additionally, they emphasize the importance of adequate dietary practices, as well as higher levels of caregiver education, for proper linear growth. This demonstrates that the PBF alone is not capable of ensuring the adequate growth and development of the assisted children, highlighting the need to strengthen public policies to control the excessive consumption of ultra-processed foods and breast milk substitutes, while promoting healthier food environments.
Descrição
Citação
NORMANDE, Marília Moura e Mendes. Caracterização socioeconômica, alimentar e nutricional de crianças assistidas pelo Programa Bolsa Família no estado de Alagoas. 2024. 120 f. Tese (Doutorado em Nutrição) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP). São Paulo, 2024.