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Carlos A. Monteiro (carlosam@usp.br) São Paulo University, Brazil

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 (carlosam@usp.br) São Paulo University, Brazil.

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Carlos A. Monteiro (carlosam@usp.br) São Paulo University, Brazil

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  1. 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 (carlosam@usp.br) São Paulo University, Brazil

  2. 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?

  3. 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.

  4. THE BURDEN OF NUTRITIONAL DISEASES:HOW TO MEASURE IT?

  5. 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.

  6. BRAZIL

  7. GDP PER CAPITA (BRAZIL, 1994) NORTH US$ 2,299 NORTHEAST US$ 1,635 CENTERWEST US$ 3,650 SOUTHEAST US$ 4,490 SOUTH US$ 3,983

  8. 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

  9. 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

  10. THE RELATIVE BURDEN OF UNDER- AND OVER-NUTRITIONNortheastern and southeastern of Brazil 1996/7

  11. Is over-nutrition replacing or adding to under-nutrition?

  12. TRENDS IN THE RELATIVE BURDEN OF UNDER- AND OVER-NUTRITION Brazilian young children: 1975-1996

  13. TRENDS IN THE RELATIVE BURDEN OF UNDER- AND OVER-NUTRITIONBrazilian old child/adolescents: 1975-1997

  14. TRENDS IN THE RELATIVE BURDEN OF UNDER- AND OVER-NUTRITIONBrazilian adults: 1975-1997

  15. Are distinct social classes equally affected by the nutrition transition?

  16. Is the under-nutrition gap between poor and rich being eliminated ? Income groups: the 25% poorest and the 25% richest families in each region.

  17. TRENDS IN UNDER-NUTRITION GAPSlower income vs. upper income young children

  18. 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.

  19. TRENDS IN OVER-NUTRITION GAPSlower income vs. upper income adult men

  20. TRENDS IN OVER-NUTRITION GAPSlower income vs. upper income adult women

  21. 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.

  22. TRENDS IN UNDER- + OVER-NUTRITION lower income vs. upper income young children

  23. TRENDS IN UNDER- + OVER-NUTRITION lower income vs. upper income adult women

  24. BMI DISTRIBUTION lower income vs. upper income southeastern adult women, 1997

  25. DIET AND PHYSICAL ACTIVITY PATTERNS IN LOWER AND UPPER INCOME GROUPS

  26. DIETARY PATTERNS BY INCOMEBrazil metropolitan households, 1996

  27. DIETARY PATTERNS BY INCOMEBrazil metropolitan households, 1996

  28. ANY LEISURE-TIME PHYSICAL ACTIVITY BY INCOME, BRAZIL, 1997

  29. SMOKERS BY INCOME BRAZIL, 1989

  30. PREVALENCE OF OBESITY IN WOMEN BY SOCIOECONOMIC STATUS Sources: Berrios 1990; Grol 1997.

  31. PREVALENCE OF OBESITY IN WOMEN BY SCHOOLING LEVEL (1987-1996)

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