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Open Access Highly Accessed Research article

Nutritional status of children under 5 years of age in the Brazilian Western Amazon before and after the Interoceanic highway paving: a population-based study

Alanderson A Ramalho1, Saulo AS Mantovani1, Breno M Delfino1, Thasciany M Pereira1, Antonio C Martins1, Humberto Oliart-Guzmán1, Athos M Brãna1, Fernando LCC Branco1, Rhanderson G Campos1, Andréia S Guimarães1, Thiago S Araújo1, Cristieli SM Oliveira1, Cláudia T Codeço2, Pascoal T Muniz1 and Mônica da Silva-Nunes1*

Author Affiliations

1 Centro de Ciências da Saúde e do Desporto, Universidade Federal do Acre. Campus Universitário, BR 364, Km 04, Bairro Distrito Industrial, Rio Branco, AC, Brazil

2 Scientific Computing Program, Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, RJ, Brazil

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BMC Public Health 2013, 13:1098  doi:10.1186/1471-2458-13-1098

Published: 28 November 2013



The aim of this study was to analyse the prevalence of undernutrition, overweight and associated factors, before and after the implementation of the Interoceanic Highway.


A population-based cross-sectional study on children under 5 years of age was conducted in the municipality of Assis Brasil, AC, Brazil, in 2003 and 2010. Prevalence of undernutrition was observed by using height-for-age Z-scores (HAZ) and adopting a cut-off point equal to or lower than a -2 Z-score. Overweight prevalence was defined by a cut-off point equal to or greater than a +2 Z-score of the WHZ index. Z-scores were calculated relative to WHO 2006 reference data. Semi-structured questionnaires were applied to the children’s guardians, investigating family socio-economic and demographic characteristics, morbidities, access to services and child care. Associated factors were identified by hierarchical multiple logistic regression analysis.


The prevalence of low HAZ (undernutrition) was 7.0% in 2003 and 12.2% in 2010. The prevalence of high WHZ (overweight) was 1.0% and 6.6% for 2003 and 2010, respectively. It was not possible to adjust the multiple model for the year 2003. The factors associated with low HAZ in 2010 were: wealth index, the situation of living with biological parents, maternal height and presence of open sewage, whereas the factors associated with a high WHZ in the same year were: child’s age, mother’s time of residence in the location, mother’s body mass index.


Overweight increase within this undernutrition scenario reveals that the process of nutritional transition began in this Amazonian city only in the last decade, and therefore, it is delayed when compared to overweight in other parts of Brazil. Such nutritional transition in Assis Brasil may have been facilitated by the construction of the Interoceanic Highway.