Nutrition transition and double burden of undernutrition and excess of weight in Brazil

Background: Brazil, a unique Latin American country recognized as 1 of the 8 major economies of the world, is experiencing a significant deterioration in health equality in the past decade, despite its universal and free-of-charge health service that is governed by its national constitution.

Objective: The objective was to describe the double burden at the national, household, and individual levels as well as its major trends across all demographic strata in the past 40 y.

Design: The data were collected from 6 Brazilian national surveys conducted in 1974-1975, 1989, 1996, 2002-2003, 2006, and 2008-2009. Anthropometric indicators were estimated for all age groups and anemia indicators for children aged <5 y and women aged >15 y according to WHO recommendations. The annual increment rate was calculated for all indicators to assess the different time points among surveys.

Results: In 2008-2009, 1 of every 7 citizens was obese. From 1974-1975 to 2008-2009, the annual obesity increment rate for men was 4.7% each year and was 2.5% each year for women. A large decrease in undernutrition in adults was observed from 1974-1975 to 1989. In children <5 y of age, no increase in the prevalence of overweight across the analyzed periods was observed, whereas a major decrease in the prevalence of undernutrition was detected from 1996 to 2006-2007. The prevalence of the obese mother-underweight child pair was low. No association between anemia and any other child anthropometric indicator was detected. Prevalence trends of adult obesity stratified by quintiles of per capita household income showed different trajectories for men and women across the surveys. In the last period, the poorest and richest adults showed positive incremental rates of obesity.

Conclusions: In Brazil, the current prevalence of excess weight is at least 3-fold higher than that of undernutrition. The lowest prevalence rate in the last period analyzed was observed in children <5 y of age. Inclusive social policies have succeeded in reducing poverty and in identifying new challenges related to obesity control or reduction.