Transição Nutricional, Pobreza e Globalização: risco de sobrepeso em pré-escolares no estado de Pernambuco, Brasil.

Overweight in childhood is emerging as a global-scale epidemic. Following the global trend, overweight is on the rise among the whole Brazilian population. Globalization, through its impact on markets (production, advertisement campaigns and food availability and accessibility), is accelerating the nutritional transition process that has been going on in the last decades. In order to plan effective public health policies, a full understanding of the scale, trends and risk factors of these processes is required. Objectives: To establish the prevalence of, and the factors associated to, the “risk of overweight” (defined by WHO as: Body Mass Index/Age ≥ 1 and Z-score < 2) in pre-school children in the State of Pernambuco, Brazil. Methods: Cross-sectional study based on data from the 3rd Statal Research on Health and Nutrition (III Pesquisa Estadual de Saúde e Nutrição), collected in 2006. The analysis included variables related to the mother, the child, the socio-economic conditions and the health care services. After determining the prevalence ratio for each variable through a univariate analysis, the conditions that resulted in a p value < 0,20 were analysed through Poisson regression. After adjusting for the confounding factors, only the variables with p value ≤ 0,05 were considered. Results: The prevalence of “risk of overweight” was 21,6%, significantly over the estimates made by the World Health Organization for developing countries for the year 2010 (13,6%). No significant differences were found between rural and urban areas as well as between socio-economic groups. Only three variables showed an independent effect: presence of only one child with less than 5 years in the household, mother‘s BMI ≥ 30kg/m2 and no breastfeeding. Conclusions: The absence of differences between geographic areas, housing, socio-economic condition and biological characteristics of the children reveal that overweight in less than five-year olds tends to a homogeneous distribution, meaning that these children are exposed to an “obesogenic” environment. Since the processes that contribute to create this environment act from a global to a regional level, any solid strategy to tackle them must begin from its complexity, operating from a macroscopic level to a local one. Financing: public funding from the University of Bologna, Italy.