Fatores associados ao crescimento linear e ao peso atingido no primeiro ano de vida em Cruzeiro do Sul, Acre

• Ano de defesa: 2019
• Autor(a) principal: Paghi Dal Bom, Juliana [UNIFESP]
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP); Brasil
• Palavras-chave em Português: Children; linear growth; attained weight; nutritional status; malnutrition; Brazilian Amazon; low- and middle-income regions; Crianças; crescimento linear; peso atingido; estado nutricional; má nutrição; Amazônia Brasileira; regiões de baixa e média renda; Saúde Coletiva
• Link de acesso: http://repositorio.unifesp.br/handle/11600/50936

Objective: To investigate the associated factors with linear growth and weight attained in the first year of life in the municipality of Cruzeiro do Sul, Acre. Methods: The present study is part of the MINA Study, a population-based birth cohort whose baseline data collection occurred between July 1, 2015 and June 30, 2016, from all hospital admissions for delivery of residents in the municipality, with assessment of sociodemographic and health history information. At 10-15 months, follow-up interviews were conducted to collect data on maternal and infant characteristics, as well as perform an anthropometric evaluation. Outcomes of interest were length for age and body mass index (BMI) for age Z-scores according to the World Health Organization growth standards. From a hierarchical conceptual model with determinants at distal, intermediate and proximal levels and adjustment for the child’s age and sex, multiple linear regression models were fitted for length for age and BMI for age Z-scores, as well as multiple logistic regression models for overweight (BMI for age Z-score >2.0). Results: A total of 772 babies were followed-up at 10-15 months, 52.2% female. At baseline, 39% of participants were beneficiaries of the Bolsa Família Program, 30% reported up to 9 years of schooling, and 31% of the mothers did not attend the minimum recommended number of 6 prenatal appointments. At 26 (SD: 6.6) years of age, mean maternal height was 157.5 cm (SD: 6.0) and 45% were overweight. At birth, mean weight and length for gestational age Zscores were 0.19 (SD: 0.99) and 0.11 (SD: 1.05). During the first year, 2.7% of the children were affected by malaria. Regarding nutritional status, 2.0% of girls and 2.4% of boys were stunted while 6.7% of girls and 6.0% of boys were overweight, with no differences between the sexes. In multiple models for the length for age Z-score, a positive ossociation with wealth index quintiles and maternal height (p for trend <0.01) was observed. An increase of 1 Z-score of birth weight and length for gestational age corresponded to a mean length for age 0.17 (95% CI: 0.07; 0.27) and 0.15 (95% CI: 0.05; 0.25) Z-score higher in the first year. Children with malaria in the first year had a linear growth -0.58 (95% CI: -1.05, -0.11) Z-score lower in comparison with those unaffected. In adjusted analyzes for BMI for age Z-score, there was an inverse relationship with receipt of the Bolsa Família Program (-0.16 Z-score, 95% CI -0.31; -0.00) and maternal age (-0.25 Z-score, 95% CI -0.49, -0.02 for infants born to mothers aged ≥30 years). There was a positive association with maternal BMI and birth weight Z-score (p for trend <0.01). In multiple models for overweight, there was a positive association with wealth index quintiles (p for trend <0.01). An increase of 1 Z-score of birth weight resulted in a 37% greater chance of being overweight in the first year (95% CI 1.03, 1.81). Conclusions: Positive associations of socioeconomic context, intergenerational influences and birth size with linear growth and weight attained in the first year of life were confirmed. In addition, there was a relevant and consistently negative impact of the occurrence of malaria on linear growth of infants. Strategies involving potentially modifiable factors associated with nutritional status at 10-15 months may be particularly relevant from the perspective of a critical window of opportunity up to one thousand days of life.