1. Monteiro et al., Public Health Nutrition, Feb 2002 The IUNS Bellagio meeting on the nutrition transition in the developing countries. THE RELATIVE BURDEN OF DISEASE DUE TO UNDER- AND TO OVER-NUTRITION: EVIDENCE FROM BRAZIL Carlos A. Monteiro (carlosam@usp.br) São Paulo University, Brazil

2. Monteiro et al., Public Health Nutrition, Feb 2002 THE BURDEN OF DISEASE DUE TO UNDER- AND TO OVER-NUTRITION IN THE DEVELOPING COUNTRIES What is the present situation? What has been the pace of change? Is over- nutrition replacing (or adding to) under- nutrition? Are young children, old children, and adults similarly affected? Are distinct social classes equally affected?

3. Monteiro et al., Public Health Nutrition, Feb 2002 THE BURDEN OF NUTRITIONAL DISEASES: COMPONENTS AND DEFINITIONS The under-nutrition burden: nutritional imbalances caused by insufficient consumption and/or excessive expenditure of energy and nutrients. The over-nutrition burden: nutritional imbalances caused by excessive consumption and/or insufficient expenditure of energy and nutrients.

4. Monteiro et al., Public Health Nutrition, Feb 2002 THE BURDEN OF NUTRITIONAL DISEASES: HOW TO MEASURE IT? DiseasesDirect indicators Indirect indicators Energy imbalances (under or over) AnthropometryDiet and physical activity evaluation Energy-related nutrient imbalances (under or over) Biochemical and clinical tests Diet evaluation Anthropometry Nonenergy-related nutrient imbalances (under or over) Biochemical and clinical tests Diet evaluation

5. Monteiro et al., Public Health Nutrition, Feb 2002 BRAZIL Repeated national anthropometric surveys in the 70’s, 80’s, and 90’s. Great historical development contrasts between the poor northern regions and the rich southern regions. Great income disparities between and within the regions.

6. Monteiro et al., Public Health Nutrition, Feb 2002 BRAZIL

7. Monteiro et al., Public Health Nutrition, Feb 2002 SOUTHEAST US$ 4,490 NORTHEAST US$ 1,635 GDP PER CAPITA (BRAZIL, 1994) NORTH US$ 2,299 CENTERWEST US$ 3,650 SOUTH US$ 3,983

8. Monteiro et al., Public Health Nutrition, Feb 2002 What is the relative burden of disease due to under- and to over-nutrition? - in the (less developed) northeastern Brazil - in the (more developed) southeastern Brazil

9. Monteiro et al., Public Health Nutrition, Feb 2002 INDICATORS EMPLOYED TO ASSESS UNDER- AND OVER-NUTRITION In young children (1-4 y) height-for-age + 2 z; international growth reference In old child/adolescents (10-17 y) BMI 95 th centile; the 1989 survey as the reference distribution In adults (20 y and +) BMI < 18.5 kg/m 2 ; BMI  30.0 kg/m 2

10. Monteiro et al., Public Health Nutrition, Feb 2002 THE RELATIVE BURDEN OF UNDER- AND OVER-NUTRITION Northeastern and southeastern of Brazil 1996/7

11. Monteiro et al., Public Health Nutrition, Feb 2002 Is over-nutrition replacing or adding to under-nutrition?

12. Monteiro et al., Public Health Nutrition, Feb 2002 TRENDS IN THE RELATIVE BURDEN OF UNDER- AND OVER-NUTRITION Brazilian young children: 1975-1996

13. Monteiro et al., Public Health Nutrition, Feb 2002 TRENDS IN THE RELATIVE BURDEN OF UNDER- AND OVER-NUTRITION Brazilian old child/adolescents: 1975-1997

14. Monteiro et al., Public Health Nutrition, Feb 2002 TRENDS IN THE RELATIVE BURDEN OF UNDER- AND OVER-NUTRITION Brazilian adults: 1975-1997

15. Monteiro et al., Public Health Nutrition, Feb 2002 Are distinct social classes equally affected by the nutrition transition?

16. Monteiro et al., Public Health Nutrition, Feb 2002 Is the under-nutrition gap between poor and rich being eliminated ? Income groups: the 25% poorest and the 25% richest families in each region.

17. Monteiro et al., Public Health Nutrition, Feb 2002 TRENDS IN UNDER-NUTRITION GAPS lower income vs. upper income young children

18. Monteiro et al., Public Health Nutrition, Feb 2002 Is the over-nutrition gap between rich and poor being reduced (or even reversed) ? Income groups: the 25% poorest and the 25% richest families in each region.

19. Monteiro et al., Public Health Nutrition, Feb 2002 TRENDS IN OVER-NUTRITION GAPS lower income vs. upper income adult men

20. Monteiro et al., Public Health Nutrition, Feb 2002 TRENDS IN OVER-NUTRITION GAPS lower income vs. upper income adult women

21. Monteiro et al., Public Health Nutrition, Feb 2002 Is the net effect of the nutrition transition positive or negative to the poor? Income groups: the 25% poorest and the 25% richest families in each region.

22. Monteiro et al., Public Health Nutrition, Feb 2002 TRENDS IN UNDER- + OVER-NUTRITION lower income vs. upper income young children

23. Monteiro et al., Public Health Nutrition, Feb 2002 TRENDS IN UNDER- + OVER-NUTRITION lower income vs. upper income adult women

24. Monteiro et al., Public Health Nutrition, Feb 2002 BMI DISTRIBUTION lower income vs. upper income southeastern adult women, 1997

25. Monteiro et al., Public Health Nutrition, Feb 2002 DIET AND PHYSICAL ACTIVITY PATTERNS IN LOWER AND UPPER INCOME GROUPS

26. Monteiro et al., Public Health Nutrition, Feb 2002 DIETARY PATTERNS BY INCOME Brazil metropolitan households, 1996

27. Monteiro et al., Public Health Nutrition, Feb 2002 DIETARY PATTERNS BY INCOME Brazil metropolitan households, 1996

28. Monteiro et al., Public Health Nutrition, Feb 2002 ANY LEISURE-TIME PHYSICAL ACTIVITY BY INCOME, BRAZIL, 1997

29. Monteiro et al., Public Health Nutrition, Feb 2002 SMOKERS BY INCOME BRAZIL, 1989

30. Monteiro et al., Public Health Nutrition, Feb 2002 PREVALENCE OF OBESITY IN WOMEN BY SOCIOECONOMIC STATUS Sources: Berrios 1990; Grol 1997.

31. Monteiro et al., Public Health Nutrition, Feb 2002 PREVALENCE OF OBESITY IN WOMEN BY SCHOOLING LEVEL (1987-1996)