RESUMO
Multiple forms of malnutrition coexist in infants and young children (IYC) in Peru. The World Health Organization has proposed double-duty actions (DDAs) to simultaneously address undernutrition and overweight/obesity. We assessed current implementation of- and priority for- government-level actions to tackle multiple forms of malnutrition in IYC in Peru. Mapping of current policy activity was undertaken against 47 indicators of good practice for five DDAs (exclusive breastfeeding, complementary feeding, food marketing, maternal nutrition, preschool nutrition; assessed by 27 indicators) and for the enabling policy environment, i.e., 'infrastructure support' (health in all policies, platforms for interactions, financing, monitoring, governance, leadership; assessed by 20 indicators). Interviews with 16 national experts explored views on the level of and barriers to implementation of DDAs and infrastructure support, as well as their prioritisation based on likely impact and feasibility. The level of implementation of actions was categorised into two groups (agenda setting/formulation vs. implementation/evaluation). Mean scores were generated for prioritisation of DDAs and infrastructure support. Deductive qualitative analysis was undertaken to identify barriers that influence policy implementation. Only 5/27 DDA indicators were reported as fully implemented by all national experts (international code that regulates the marketing of breastmilk substitutes, iron supplementation for IYC, micronutrient powders in IYC, iron/folic acid supplementation in pregnant women, paid maternity leave). Only 1/20 infrastructure support indicator (access to nutrition information) was rated as fully implemented by all experts. Barriers to implementing DDAs and infrastructure support included: legal feasibility or lack of regulations, inadequate monitoring/evaluation to ensure enforcement, commercial influences on policymakers, insufficient resources, shifting public health priorities with the COVID-19 pandemic and political instability. The experts prioritised 12 indicators across all five DDAs and eight infrastructure support indicators. Experts highlighted the need to improve implementation of all DDAs and identified ways to strengthen the enabling policy environment.
Assuntos
Desnutrição , Humanos , Peru/epidemiologia , Lactente , Pré-Escolar , Desnutrição/epidemiologia , Desnutrição/prevenção & controle , Feminino , COVID-19/epidemiologia , COVID-19/prevenção & controle , Prioridades em Saúde , MasculinoRESUMO
Multiple forms of malnutrition coexist in Peru, especially in peri-urban areas and poor households. We investigated the magnitude of, and the contribution of, dietary and socio-demographic factors to the double burden of malnutrition (DBM) at maternal (i.e., maternal overweight/obesity with anaemia) and dyad (i.e., maternal overweight/obesity with child anaemia) levels. A cross-sectional survey was conducted among low-income mother-child (6-23 months) dyads (n = 244) from peri-urban communities in Peru. Dietary clusters and the minimum dietary diversity score (MDD) were generated for mothers and infants, respectively. A composite indicator using the maternal dietary clusters and the MDD was created to relate to dyad level DBM. Two dietary clusters were found: (i) the 'high variety (i.e., animal-source foods, fruit and vegetables), high sugary foods/beverages' (cluster 1) and (ii) the 'high potato, low fruit and vegetables, low red meat' (cluster 2). DBM prevalence among mothers and dyads was 19.9% and 36.3%, respectively. Logistic regression analyses revealed that the only socio-demographic factor positively associated with maternal DBM was maternal age (aOR/5 years: 1.35 [1.07, 1.71]). Mothers belonging to diet cluster 1 were less likely to experience the DBM (aOR = 0.52 [0.26, 1.03]), although CIs straddled the null. Socio-demographic factors positively associated with dyad level DBM included maternal age (aOR/5 years: 1.41 [1.15, 1.73]), and having ≥ two children under 5 years (aOR = 2.44 [1.23, 4.84]). Diet was not associated with dyad-level DBM. Double-duty actions that tackle the DBM are needed given that one-third of dyads and a fifth of mothers had concurrent overweight/obesity and anaemia.
Assuntos
Anemia , Desnutrição , Obesidade Materna , Feminino , Humanos , Mães , Estudos Transversais , Sobrepeso/epidemiologia , Peru/epidemiologia , Fatores Socioeconômicos , Desnutrição/epidemiologia , Obesidade/epidemiologia , Anemia/epidemiologia , PrevalênciaRESUMO
The COVID-19 pandemic may impact diet and nutrition through increased household food insecurity, lack of access to health services, and poorer quality diets. The primary aim of this study is to assess the impact of the pandemic on dietary outcomes of mothers and their infants and young children (IYC) in low-income urban areas of Peru. We conducted a panel study, with one survey prepandemic (n = 244) and one survey 9 months after the onset of COVID-19 (n = 254). We assessed breastfeeding and complementary feeding indicators and maternal dietary diversity in both surveys. During COVID-19, we assessed household food insecurity experience and economic impacts of the pandemic on livelihoods; receipt of financial or food assistance, and uptake of health services. Almost all respondents (98.0%) reported adverse economic impacts due to the pandemic and 46.9% of households were at risk of moderate or severe household food insecurity. The proportion of households receiving government food assistance nearly doubled between the two surveys (36.5%-59.5%). Dietary indicators, however, did not worsen in mothers or IYC. Positive changes included an increase in exclusive breastfeeding <6 months (24.2%-39.0%, p < 0.008) and a decrease in sweet food consumption by IYC (33.1%-18.1%, p = 0.001) and mothers (34.0%-14.6%, p < 0.001). The prevalence of sugar-sweetened beverage consumption remained high in both mothers (97%) and IYC (78%). In sum, we found dietary indicators had not significantly worsened 9 months into the COVID-19 pandemic. However, several indicators remain suboptimal and should be targeted in future interventions.
Assuntos
COVID-19 , Mães , COVID-19/epidemiologia , Criança , Pré-Escolar , Dieta , Feminino , Insegurança Alimentar , Abastecimento de Alimentos , Humanos , Lactente , Pandemias , Peru/epidemiologia , Inquéritos e QuestionáriosRESUMO
PURPOSE: Despite the urgency regarding increasing rates of obesity and chronic diseases in the Caribbean, few studies described the nutrition transition. We aimed to provide such information by identifying dietary patterns in the French West Indies and their characteristics. METHODS: This cross-sectional analysis included 1144 Guadeloupeans and Martinicans from a multistage sampling survey conducted on a representative sample. Dietary patterns were identified using principal component analysis followed by a clustering procedure, and described using multivariable regression models. RESULTS: Four patterns were identified: (i) a "prudent" pattern characterized by high intakes of fruits, vegetables, legumes, seafood and yogurts, low intakes of fatty and sweet products, and a high Diet Quality Index-International (DQI-I); (ii) a "traditional" pattern characterized by high intakes of fruits, vegetables, tubers and fish, low intakes of red and processed meat, snacks, fast foods, and sweetened beverages, with a high DQI-I, mostly shaped by women and older persons; (iii) a "convenient" pattern characterized by high intakes of sweetened beverages, snacks, and fast foods, with the lowest DQI-I, principally shaped by young participants; (iv) a "transitioning" pattern characterized by high consumptions of bread, processed meat, sauces, alcoholic and sweetened beverages, but also high intakes of tubers, legumes, and fish, mainly shaped by men, middle aged, of whom 35% had metabolic syndrome. CONCLUSION: The co-existing dietary patterns in the French West Indies, marked by a generational contrast, seem to reflect different steps in dietary change as described in the literature, suggesting an ongoing nutrition transition.
Assuntos
Dieta , Estado Nutricional , Idoso , Idoso de 80 Anos ou mais , Região do Caribe , Estudos Transversais , Comportamento Alimentar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índias OcidentaisRESUMO
BACKGROUND: Obesity and metabolic diseases represent a major health burden in the Caribbean, particularly since a large part of the population is disadvantaged. However, socioeconomic inequalities in chronic diseases are poorly explored in this region. We investigated the association between socioeconomic position and metabolic syndrome (MetS) prevalence and explored the contribution of diet quality to explain this association, among adults in the French West Indies. METHODS: This cross-sectional analysis included 1144 subjects (≥16 y) from a multistage sampling survey conducted in 2013-2014 on a representative sample of the Guadeloupean and Martinican population. MetS prevalence was assessed using the Joint Interim Statement. Dietary intakes were estimated from 24 h-dietary recalls, and diet quality was assessed through the Diet Quality Index-International (DQI-I). Associations between socioeconomic indicators (education, employment, social assistance benefits) and MetS prevalence, and the potential contribution of diet quality in this association were assessed using multivariable logistic regression models, adjusted for sociodemographic characteristics. RESULTS: MetS prevalence adjusted for age and sex was 21 and 30% among Guadeloupean and Martinican, respectively. Compared to high-educated participants, low-educated subjects were more likely to be at risk of MetS (OR = 2.4; 95%CI = [1.3-4.4], respectively), as were recipients of social assistance benefits compared to non-recipients (OR = 2.0; 95%CI = [1.0-4.0]). The DQI-I explained 10.5% of the overall variation in MetS due to education. CONCLUSIONS: Socioeconomic inequalities in MetS prevalence, reflected by education and social assistance benefits, were found. However, diet quality contributed only to socioeconomic inequalities due to education underlining that education may impact health through the ability to generate overall dietary behavior, long-term beneficial. Our work identified subgroups with higher risk of MetS, which is needed when implementing public health measures, particularly in this Caribbean population with of high poverty rates. Further prospective studies are needed to improve our understanding of the mechanisms of social inequalities in MetS in a high poverty rates context.