Mondini L, Monteiro C. Relevância epidemiológica da desnutrição e da obesidade em distintas classes sociais: métodos de estudo e aplicaçâo a população brasileira. [Epidemiological significance of malnutrition and obesity within different social classes: methods of study and application to the Brazilian population.] Revista Brasileira de Epidemiolog í a [Brazilian Journal of Epidemiology] 1998 April; 1(1): 28-39.

Objectives: To obtain malnutrition and obesity prevalence data for children and adults by socioeconomic strata, utilizing comparable criteria.

Methodology: Authors reanalyzed data from the Brazilian National Health and Nutrition Survey of 1989, concerning men and women (18-64 years old) and children (6-35 months old). National prevalence data were estimated by family income categories. Malnutrition was defined taking into account body mass index (BMI) values below the 5th percentile. BMI values greater than the 95th percentile defined obesity. In both extremes the authors used World Health Organization standard references (weight/age and weight/height as determined by the for children and BMI determinations for adults).

Results: Malnutrition occurs 1.5 times more frequently than obesity among children; the reverse pattern in adults the ratio. The most frequent nutritional problem is adult obesity (15%), especially for women (20%). The results broken down by socioeconomic strata show that in families below the poverty line, child malnutrition remains high (21%), while adult female obesity begins to occur commonly (13%). In poor families with incomes above the poverty line, female obesity (20%) exceeds child malnutrition (15%), while child and adult male obesity reach epidemiologically important rates (> 6%). In families whose incomes are not sufficient to cover basic needs (below the poverty line), obesity in children and adult women is, respectively, 2 and 3 times more frequent than malnutrition. In families with a higher family income, the risk of obesity clearly predominates over malnutrition for children and adults.

Conclusions: The study demonstrates that child malnutrition is relatively controlled, even among those sectors of modest income. On the other hand, obesity reaches alarming levels, among lower income groups, and particularly for adult women. These findings establish the need to review conventional models of causality, in order to redefine strategies for dealing with nutrition. The determinants that must be considered are: access to health services, quality of child care, education and information, and cultural and behavioral patterns.

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