The nutritional status of disadvantaged preschool children attending daycares in Salvador, Northeast Brazil: a cross-sectional study

In the poor Northeast region of Brazil, grave concerns exist regarding the prevalence of anaemia and vitamin A deficiency, and the increasing risk of overweight among preschool children. Brazil has introduced pro-poor social policies, such as preschool daycare programmes, yet comprehensive studies of the growth, health, and micronutrient status of disadvantaged daycare children in NE Brazil are lacking. We conducted a cross-sectional study of 376 disadvantaged preschoolers aged three to six years in seven philanthropic daycares in Salvador, NE Brazil and assessed their growth and biomarkers of morbidity and micronutrient status; explored potential predisposing factors to parasitic infections, micronutrient deficiencies, and poor iron status; and examined multiple factors associated with their somatic growth by a structural equation model (SEM). Our results showed nearly half of the households were classified as having extremely low SES and the remainder low SES. The prevalence of underweight, wasting, and stunting in the preschoolers was low ( 1SD. The energy density of the daycare meals was low (0.79 kcal/g), yet the nutrient supply was enhanced by iron and folic acid fortification and was adequate, except for calcium, vitamin A, and thiamine. Nearly 30% were infected with >1 parasite, with boys and children from extremely low SES having more than twice the risk of helminth infections (p<0.05). Helminths negatively impacted on selenium and vitamin B-12 biomarkers (p<0.05), whereas Giardia intestinalis was positively associated with serum folate (p<0.05). Deworming treatment and vitamin A supplements were inversely associated with helminths and Giardia, respectively. Anaemia and zinc, selenium, folate, vitamin A, and B-12 deficiencies were low ( 1 g/L). More than 30% had a genetic haemoglobin disorder. A significant inverse association was found between haemoglobin and α3.7 thalassemia (p 1SD (p<0.05). Based on the SEM, the significant positive direct effect on HAZ-scores was maternal height (p<0.001), and the major negative associations were being male, white, of high birth order, and having a helminth infection. Similarly, the main positive predictor of BMIZ-scores was maternal weight (p<0.001), whereas extremely low SES and being male were the significant negative direct effects on BMIZ-scores (p