Tiago Feitosa da Silva

Malnutrition and overweight are significant public health challenges, especially in low- and middle-income countries. In the Amazon, high rates of malnutrition and the alarming rise of obesity highlight persistent regional inequalities. Therefore, the aim of this study was to analyze spatial distributions and temporal trends of malnutrition among children under five, adults, and elderly individuals in primary healthcare services across municipalities in the Legal Amazon from 2013 to 2023. Methods: This ecological study used data from the Food and Nutritional Surveillance System (SISVAN). The analysis included the prevalences of underweight, overweight, and obesity, stratified by year, sex, and federative unit. Spatial distributions were analyzed using QGIS version 3.22, and temporal trends were assessed with Joinpoint version 4.6 and expressed as annual percentage changes (APCs) and 95% confidence intervals (95% CIs). Results: Between 2013 and 2023, SISVAN monitored 10,451,758 children under five years, 30,831,720 adults, and 4,456,650 elderly individuals in the Legal Amazon. Stunting in children under five years decreased from 20.45% to 15.30%, with a significant downward trend (APC: −2.7; 95% CI: −3.7; −1.6). Childhood overweight exhibited a general downward trend but with notable fluctuations. Overweight in adults increased from 48.85% to 64.64%, and obesity from 17.10% to 28.49%, both showing significant upward trends. For the elderly, underweight decreased from 17.47% to 13.04%, with a downward trend until 2018, while overweight increased from 42.35% to 48.22%, with a significant upward trend until 2017. Conclusions: Despite progress in reducing childhood underweight, its prevalence in the Legal Amazon remains high compared to national averages. Significant regional disparities and rising overweight rates among adults and elderly individuals indicate a need for targeted public health strategies to address these nutritional issues.

The aim of this study was to analyze the trend of severe obesity in the capitals of the Brazilian states and the Federal District, from 2006 to 2021. For this purpose, a time-series, population-based, observational study was designed using data from the VIGITEL Survey. The dependent variable of this study was the prevalence of severe obesity, which was defined as a body mass index ≥ 40 kg/m². Time series analysis was conducted using Joinpoint Regression Analysis Software v.4.9.1.0. In this study, a normal distribution was assumed, and the average annual percentage change (AAPC) and 95% confidence intervals (95% CIs) were presented. In total, 778,445 individuals participated in the study (38.2% were male and 61.8% were female). The prevalence of severe obesity has increased from 1.1% in 2006 to 1.9% in 2021. The average annual percentage change indicates an upward trend for the period (AAPC: 4.7; 95% CI: 3.8; 5.7). When stratifying the trend of severe obesity by sex, a significant upward trend was observed for females (AAPC: 4.3; 95% CI: 1.9; 6.8). There was a significant upward trend for all age groups, skin colors, and education levels. However, the older age groups and those with less education had lower AAPC.

Undergraduates may face challenges to assure food security, related to economic and mental distress, especially during the COVID-19 pandemic. This study aimed to assess food insecurity and its associated factors in undergraduates during the COVID-19 pandemic. An online cross-sectional study was conducted from August 2020 to February 2021 with 4775 undergraduates from all Brazilian regions. The questionnaire contained socio-economic variables, the validated Brazilian food insecurity scale, and the ESQUADA scale to assess diet quality. The median age of the students was 22.0 years, and 48.0% reported income decreasing with the pandemic. Food insecurity was present in 38.6% of the students, 4.5% with severe food insecurity and 7.7% moderate. Logistic regressions showed students with brown and black skin color/race presented the highest OR for food insecurity; both income and weight increase or reduction during the pandemic was also associated with a higher OR for food insecurity, and better diet quality was associated with decreased OR for food insecurity. Our study showed a considerable presence of food insecurity in undergraduates. Policy for this population must be directed to the most vulnerable: those with brown and black skin color/race, who changed income during the pandemic, and those presented with difficulties maintaining weight and with poor diet quality.