Estado nutricional de crianças menores de 5 anos de idade atendidas na Estratégia Saúde da Família

Abstract

Introduction: Despite Brazil's progress in addressing malnutrition, the country's nutritional picture shows wide regional and social inequalities, as well as the persistence of nutritional deficiencies that coexist with the accelerated increase in overweight. These circumstances may undermine advances related to sustainable development goals, given the importance of nutrition for them. Children under five years of age attending at the Family Health Strategy and/or beneficiaries of the Programa Bolsa Família represent a vulnerability group with potential for malnutrition. Objectives: To evaluate factors associated with nutritional status in children under 5 years of age attending at the Family Health Strategy. Methods: This is a cross-sectional study conducted with children aged 0-59 months living in municipalities in the state of Paraíba, users of Family Health Strategy. The study comprised two different research scenarios, with samples of 413 and 474 children, respectively. Variables related to socio demographic, social support and maternal and child care were investigated. Height-for-age (H/A) and Body Mass Index-for-age (BMI/A) Z-scores were calculated using WHO Anthro software v.3, 2009, considering as reference the population of the Multicentre Growth Reference Study. Children with Z-scores <-2 for H/A were classified as stunting. Children with Z-scores > 2 for BMI/A were classified as overweight/obese. In scenario 1, the analysis of canonical correlation was used to evaluate the relationship between the set of observed variables of mothers and children. In order to explain stunting and overweight/obesity of children in the scenario 2, all variables were inserted in Decision Tree Models using the CHAID algorithm. Results: In scenario 1, 39 (9.4%) of children were diagnosed stunting and 68 (16.5%) were overweight/obese. In the first canonical function, a strong correlation was observed between H/A (-0.95) of the children with the mother's height (-0.49), birth weight (- 0.47), gestational age (-0.34) and socioeconomic level (-0.30). The second canonical function shows that the age of the child (-0.66), the BMI of the mother (-0.43), the benefit of the Programa Bolsa Família (-0.42) and social support (-0.30) were correlated with BMI/A (- 0.76). In scenario 2, the prevalence of stunting and overweight/obesity in children was 7.9% and 12.8%, respectively, which were related to maternal nutritional status. The stunting also had as relevant exposures the age of the child less than 2 years and moderate/severe food and nutritional insecurity. For overweight/obesity, not being a beneficiary of the Programa Bolsa Família and the worst socioeconomic situation were also factors associated with the outcome. Conclusions: The prevalence of stunting and overweight/obesity observed in the present study and its determinants (characteristics of the child at birth, maternal nutritional status and social environment) provide a basis for the orientation of preventive measures aimed at improving the nutritional status of from the earliest stages of life.