Food Insecurity, Anemia and Vitamin A Deficiency in Brazilian Children Aged between 6 and 59 Months of Age: Brazilian National Survey on Child Nutrition (ENANI-2019)

Background: Anemia and vitamin A deficiency (VAD) can be related to poverty and food insecurity (FI), which can increase risk of stunting and delayed child development. Objectives: This study aims to assess the association between FI and the occurrence of anemia and VAD in Brazilian children aged 6-59 months. Methods: Data from 6020 children from the Brazilian National Survey on Child Nutrition (2019) were used. FI was assessed using the Brazilian Food Insecurity Scale, classifying households into food security (FS) and FI levels. The outcomes were anemia [hemoglobin <10.5 g/dL (6-23 months) and hemoglobin <11 g/dL (24-59 months)] and VAD (retinol corrected by C-reactive protein <0.7 mu mol/L). FI frequencies, anemia, and VAD prevalences were calculated according to FI levels, 95% confidence intervals (CIs), and P-trend. The adjusted prevalence ratio (PR) was estimated using quasi-Poisson regression. Results: The prevalence of mild, moderate, and severe FI was 37.7% (95% CI: 32.0%, 43.4%), 6.2% (95% CI: 4.8%, 7.6%), and 4.2% (95% CI: 3.1%, 5.3%), respectively. The prevalence of anemia was 7.1% (95% CI: 5.9%, 8.3%), and VAD was 3.0% (95% CI: 2.5%, 3.6%). A significant linear trend (P-trend < 0.001) was observed in the prevalence of anemia according to the degree of FI: severe (15.5%; 95% CI: 8.1%, 22.9%), moderate (10.0%; 95% CI: 5.4%, 14.6%), mild (6.6%; 95% CI: 4.9%, 8.3%), and FS (6.4%; 95% CI: 4.7%, 8.1%). Children living in households with severe FI had an 82% higher prevalence of anemia (PR: 1.82; 95% CI: 1.40, 4.17) than those living in FS. A significant linear trend (P-trend <0.001) was observed in the prevalence of VAD according to the degree of FI: severe (3.3%; 95% CI: 0.0%, 6.7%), moderate (5.8%; 95% CI: 2.3%, 9.2%), FI (2.8%; 95% CI: 1.9%, 3.7%), and FS (2.9%; 95% CI: 2.1%, 3.7%). No association was observed between FI and VAD. Conclusions: Severe FI was associated with anemia among Brazilian children aged 6-59 months.