FAO Nutrition Country Profile Brazil (2000)

Nutrition Country Profiles BRAZIL - October, 2000 FAO Rome
FAO - NUTRITION COUNTRY PROFILES
BRAZIL
FOOD AND AGRICULTURE ORGANIZATION OF

THE
UNITED
NATIONS
FOOD AND AGRICULTURE ORGANIZATION

OF THE UNITED NATIONS
Nutrition Country Profiles - BRAZIL
Note for the reader
The objective of the Nutrition Country Profiles (NCP) is to

provide concise analytical summaries describing the food and
nutrition situation in individual countries with background statistics on
food-related factors. The profiles present consistent and comparable
statistics in a standard format. This pre-defined format combines a set
of graphics, tables and maps each supported by a short explanatory
text. Information regarding the agricultural production, demography
and socio-economic level of the country are also presented.
In general, data presented in the NCP are derived from national
sources as well as from international databases (FAO, WHO...).
Technical notes giving detailed information on the definition
and use of the indicators provided in the profile can be obtained from
ESNA upon request. An information note describing the objectives of
the NCP is also available.
Useful suggestions or observations to improve the quality of this
product are welcome.
For more information please contact:
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Nutrition Country Profile of Brazil

prepared by: Maria Antonia M. Galeazzi for the Food and Agriculture Organization
the United Nations in collaboration with Rosanne Marchesich (FAO-ESNA).
The designations employed and the presentation of material in this publication do not imply the expression of any opinion whatsoever on
the part of the Food and Agriculture Organization of the United Nations concerning the legal status of any country, territory, city or area or
of its authorities, or concerning the delimitation of its frontiers .
FAO, 2000
Table of contents
SUMMARY------------------------------------------------------------------------------------------------------- 3
TABLE 1: GENERAL STATISTICS OF BRAZIL ----------------------------------------------------- 4
I. OVERVIEW --------------------------------------------------------------------------------------------------- 5
1.
2.
3.
4.
5.
Geography ....................................................................................................................... 5
Population........................................................................................................................ 5
Level of development: poverty, education and health.................................................. 6
Agricultural production, land use and food security..................................................... 7
Economy .......................................................................................................................... 8
II. THE FOOD AND NUTRITION SITUATION ---------------------------------------------------------- 9

1. Trends in energy requirements and energy supplies .................................................. 9
2. Trends in food supplies ................................................................................................10
3. Food consumption ........................................................................................................13
4. Infant feeding practices..................................................................................................15
5. Anthropometric data ......................................................................................................16
6. Micronutrient deficiencies .............................................................................................21
REFERENCES ---------------------------------------------------------------------------------------------- 25
MAPS are presented after the <REFERENCES>
- General map of Brazil.
- Map 1: Population density by state in 1996.
- Map 2: Prevalence of poverty by state in 1990 (hunger map)
- Map 3: Prevalence of underweight in children under five years of age by state from 1989 to 1992.
- Map 4: Prevalence of stunting among children under five years of age by state from 1989 to
1992.
- Map 5: Prevalence of chronic energy deficiency among women of fertile age by Macro-Region in
1996.
Graphs, tables and maps can be visualised by clicking on the words in bold and underline,
only in the Full profile pdf file.
SUMMARY
The diversification of food patterns in Brazil is strongly related to differences in access to food and food
habit. Except for the Amazon region and the arid northeast area of Serto, no large differences in terms of agroecological characteristics or agricultural production throughout the country exist. This implies that the main food
items, which provide most of the dietary energy supply, are similar from one region to another.
The national prevalence of underweight among children under five years in 1996 was of 6%, which showed
an important decrease compared to the 18% in 1975 and the 7% in 1989.The prevalence was higher in rural areas
with 9% of underweight compared to urban areas where there were only 5 % of underweight children. In 1992, among
the nine states composing the northeast region, Maranho and Piau had the highest prevalence of underweight
among children under five years (MOH, 1996; UNICEF, 1995) (Map 3).
Among the northeast states, Maranho and Piau showed the highest prevalences of stunting which
corresponded to a high and medium prevalence in these states (Map 4). Wasting was not a public health problem
in Brazil: 5% in 1975, 2% in 1989 and 1996 (MOH, 1996; Monteiro, 1991; Monteiro, 1992).
Information concerning the prevalence of overweight showed a decrease from 8% in 1975 to 5% in 1996
(MOH, 1996; Monteiro et al., 1992). The improvement observed in the nutritional status of children under five years
of age, between 1975 and 1989, can partly be explained by the important economic growth, the decrease of
absolute poverty, as well as the improvement of health services, education and infrastructures.
The prevalence of chronic energy deficiency (BMI<18.5 k g/m) among women between the ages of 15-49
was of 6%, which is close to the normal value of 5% (BEMFAM, 1997). Differences between urban and rural areas
and among regions decreased from 1975 to 1996.The highest prevalence was found in Rio de Janeiro (9%) and rural
area (8%), especially northeast rural (9%). However, the prevalence of CED is still considered to be low (MOH,
1996; Monteiro et al., 1992; UNICEF, 1995).
Among adults, the prevalence of CED is decreasing and the prevalence of overweight and obesity is
increasing (Map 5) (BEMFAM, 1997).
A 1994-95 national study showed a national Total Goitre Rate (TGR) prevalence of 4% among school
children (6 to 14 years). The most prevalent areas were detected in the states of Mato Grosso do Sul and Roraima
(20%). A prevalence of TGR was found at the municipal level, allowing the identification of endemic area. Since
1983 the Ministry of Health has closely monitored the mandatory iodization of table salt by the industry and
compliance is now almost universal. In 1996, measurement s carried out by the DHS on salt iodizat ion indicat ed that
more than 95% of household salt was iodized (UNICEF, 1998) (Table 5 ).
Vitamin A deficiency (VAD) is public health problem in some areas of the country. In the north region, a
study was carried out in 1998 among children under five years from the city of Belm (state of Par). The results
found a 12% prevalence of VAD. In the same year, in the southeast region, a study was carried out in health units
located in the poor areas of the city of Rio de Janeiro. The prevalence of VAD on the basis of the serum retinol level
varied from 14% in pregnant women to 56% in new-borns (Teixeria, 1998).
In the northeast region, the 1998 analysis of children under five years found that 48% of the children were
anaemic (Hb<11g/dL), the prevalence being higher in rural (56%) than in urban areas (41%).In 1992, In the same
year, 12% of pregnant women from So Paulo were anaemic (Guerra, 1992; INAN/MS IMI -DN/UFP SES/PE, 1998)
(Table 5).
TABLE 1: GENERAL STATISTICS OF BRAZIL

Last updated: 16/06/00
Indicator ()
Year
Unit
Indicator ()
1995
1995
ha per person
ha per person
1996-98
1996-98
1996-98
1996-98
thousands
thousands
thousands
millions
156396
30670
27673
868
1998
1998
1998
1998
1998
1998
1995-2000
1995-2000
2030
1995
1995
thousands
% of total pop.
% of total pop.
% of total pop.
% of total pop.
% of total pop.
% of total pop.
% of rural pop.
thousands
% of total pop.
pop. per km2
165850
11.6
24.7
56.2
7.5
19.9
1.9
-6.2
236100
19.4
18.6
A. Land in use for agriculture

1.
2.
Agricultural land
Arable and permanent crop land
Year
Unit
1996-98
kcal/caput/day
G. Average Food Supply

1.539
0.411
1.
Dietary Energy Supply (DES)
2960
B. Livestock
1.
2.
3.
4.
Cattle
Sheep & goats
Pigs
Chickens
Percentage of DES by major food groups

7.9%
2.8%
Cereals (excl. beer)
C. Population
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Total population
0-5 years
6-17 years
18-59 years
>= 60 years
Rural population
Annual population growth rate, Total
Annual population growth rate, Rural
Projected total population in 2030
Agricultural population
Population density
GNP per capita, Atlas Method
Human Development Index rating (new)
Incidence of poverty, Total
Incidence of poverty, Rural
Life expectancy at birth (both sexes)
Under-five mortality rate
current US$
min[0] - max[1]
% of population
% of population
years
per 1,000 live births
1996-98
1996-98
1996-98
% of total imports
% of total exports
% of cereals imports
E. Food Trade
1. Food Imports (US $)
2. Food Exports (US $)
3. Cereal Food Aid (100 t)
Sweeteners
Fruits & Vegetables
1.6%
Vegetable oils
Animal Fats
10.9%
Meat & offals

4.8%
Fish & seafood

Milk & Eggs
4.8%
6.0%
1997
1997
1990
1990
1998
1998
Starchy roots
Pulses, nuts, oilcrops
D. Level of Development
1.
2.
3.
4.
5.
6.
30.7%
11.0%
Other
19.0%
4790
0.739
17
33
% Energy from:
66.9 2. Protein
42 3. Fat
4. Proteins
7.8 5. Vegetable products
15.8 6. Animal products
0.0
Note: Value not indicated if below 1%
1996-98
1996-98
% of total energy
% of total energy
10.6
24.9
1996-98
1996-98
1996-98
g/caput/day
% of total proteins
% of total proteins
76.7
48.6
51.4
1995-97
1995-97
millions
% of total pop.
16.2
10.0
H. Food Inadequacy
F. Indices of Food Production
1. Food Production Index
2. Food Production Index Per Capita
1996-98
1996-98
1989-91=100
1989-91=100
1. Total population "undernourished"

131.0 2. % population "undernourished"
... no data available
118.3
used
see References for data sources
BRAZIL
I. OVERVIEW
1. Geography
The Federal Republic of Brazil is located in the centre of South America and is bordered by
Argentina, Uruguay, Paraguay, Bolivia, Peru, Colombia, Venezuela, Guyana, Suriname, French
Guyana and the Atlantic Ocean. Its land area is of 8 511 965 km, with land boundaries adding up
to 14 691 km and its coastline stretching to 7408 km. Brazil occupies 48% of the South American
continent.
Brazil consists of 5 regions: north, northeast, centerwest, southeast and centersouth; 26
states; a Federal District in the centerwest, where the capital Brasilia is located. There are 5507
municipalities whose political, fiscal and administrative autonomy is enshrined in the Brazilian
Constitution of 1988. The number of municipalities in a state varies widely, ranging from 15 in the
state of Roraima to 853 in Minas Gerais.
Much of the country consists of hilly uplands, plateau and low mountains, with the Upper
Amazon Basin being the largest plain. Three major rivers drain the Highlands, the largest being the
Amazon. Four main kinds of vegetation are found in Brazil: tropical rain forests in the Amazon Basin
and along the Atlantic coast; semi-deciduous forests from the south part of the state of Natal until
Porto Alegre; scrubby thorn woodlands in the northeast and woodland savannah in the interior.
The climate is mainly tropical but presents important differences between regions. The north
region is mainly humid with dry seasons, due to the high concentration of water from the Amazonas
forest and rivers. The northeast region, which has few perennial rivers, is considered to be the hottest
and driest part of the country with recurring drought. The climate in the southeast and centersouth
region is mainly sub-tropical with low temperatures at high altitude. The centerwest has mainly
tropical rains.
2. Population
In 1998, the Brazilian population was estimated to have almost 166 million inhabitants (UN, 1999)
(Table 1). With an estimate total growth rate of 1.9%, from 1995-2000, the expected total
population for 2030 is projected to reach 236 million (UN, 1998). The growth rate decreased from
2.7% in 1990-1995 to 1.9% in 1995-2000 (UN, 1999). The rural population decreased due to two
main migration periods. The first took place from 1950 to 1970 and was directed towards the
southeast and important metropolitan areas, while the second occurred from 1970 to 1990, mainly
due to the modernisation of agriculture. Consequently, the overall rural population fell from 50% in
1965 to 20% in 1998. The rural growth rate from 1995 to 2000 was of -6.2%, and the rural
population is expected to drop to 11% by 2030 (UN. 1999) (Table 1 and Table 2). The outcome
will be a demographic explosion in developed areas and in the main cities.
The populations of the municipalities vary widely. Half of them have fewer than 10 000
inhabitants and account for only 9% of the Brazilian population, while 28 municipalities (under 1%)
have more than 500 000 inhabitants, which account for 27% of the population. In 1997, 79% of the
population lived in urban areas (ranging from 89% in the southeastern to 74% in the northeast)
(PAHO/WHO, 1999). The north represents 45% of the countries total area and includes 7% of the
total population. At the state level, the lowest demographic densities are in the north and centerwest
regions (with the exception of the Federal District). The highest density is in the southeast, and in
particular in Rio de Janeiro and So Paulo. The north and northeast regions respectively host 58%
and 61% of the rural area-living people. The most uninhabited areas of the north are occupied by
small population groups living on wood cutting, mining extraction and indigenous reserves (IBGE
DPE/DEPIS, 1997) (Map 1).
The population distribution by age in 1998 indicates that 36% of the population was under
17 years old, 56% was between 18-59 years and 8% was above 60 years. Life expectancy at birth
was 66.9 years for both sexes, from 19952000 (UN, 1999) (Table 1). However, there are
differences at the subnational level. Life expectancy in the northeast and south regions was 58 and 65
years respectively. The fertility rate in 1999 was 2.2 (UNICEF, 2000).
The official language of Brazil is Portuguese. Data from the National Household Survey
(PNAD) in 1996 indicated that 55% of the total population was white, 6% black, 38% mulatto, the
others representing less than 1%).
3. Level of development: poverty, education and health
The Gross National Product (Atlas method) in 1997 was of US$ 4790. In 1990, the national
percentage of the population living below the poverty line was of 17%. The rural prevalence was of
33% and the urban prevalence was of 13% (WB, 2001).
In 1996, 7% of the population was unemployed. Unemployment was found to be highest in
the centerwest region (8%) (IBGE/PNAD,1996). In the northeast and rural areas the prevalence of
poverty was the highest (39%). Poverty in the more industrialised areas (chiefly in the southeastern
region) is described as increasingly urban or metropolitan (Rocha, 1996). Based on income
distribution, 20% of the Brazilian population with the highest income held 63% of the wealth and the
poorest 20%, held only 3% of the wealth (PAHO/WHO,1999).
The adult literacy rate from 19951999 was of 86% for males and of 85% for females
(UNICEF, 2000). Regional differences exist: 88% in the north, 61% in the northeast, 87% in the
centerwest and 91% in the south and southeast. High illiteracy rates were also found among those
over 65 years: 40% of men and 48% of women. The average number of study years is 4.5 among
men and 4.6 among women (UNICEF, 2000). In 1997, the Human Development Index (HDI) of
Brazil was of 0.739 (UNDP, 1999).
From 1995-1999 all males and 96% of the females were enrolled in primary school. The
attendance rate was of 93% for males and of 94% for females. Only 75% of the children completed
grade five (UNICEF, 2000).
The under five mortality rate decreased from 177 deaths per 1000 live births in 1960 to 42
deaths per 1000 live births in 1998 (UNICEF, 2000) The decrease was greater in urban areas than
in rural areas (INEI, 1996). Infant mortality rate decreased from 115 deaths per 1000 live births in
1960 to 34 deaths per 1000 live births in 1999 (UNICEF, 2000). In particular, from 1990 to 1995
the decline in the infant mortality rate was greater in urban areas, which increased the gap between
rural and urban areas. In 1996, the northeast region had the highest prevalence of infant and under
five mortality rates. The south region had the lowest prevalence for both rates (INEI, 1996).
Eighty three percent of the national population had improved drinking water in 1999
however there were large urban and rural differences with 89% in urban and only 58% in rural areas.
For the same year, seventy two percent of the total population had adequate sanitation facilities with
81% in urban areas and only 32% in rural areas (UNICEF, 2000).
One hundred percent of routine EPI (expanded programme on immunization) vaccines were
financed by the government in 1997-1999. Children under one year who were fully immunized
against tuberculosis (TB) diphtheria (DPT), polio and measles were 99%, 94%, 96% and 96%,
respectively (UNICEF, 2000).
Chronic diseases are slowly replacing infectious and parasitic diseases as the principal cause
of mortality. The maternal mortality rate in 1999 was 160 per 100 000 live births (UNICEF, 2000).
Maternal mortality, although difficult to estimate, is decreasing as a result of improved access and
quality to health services and programmes. Pregnant women immunized against tetanus represented
20% of all pregnant women, from 1997-1999 (UNICEF, 2000). Overall, national access to health
services has increased since the late 1980s: an increase in prenatal care coverage from 74% to 85%
of expectant mothers, and of deliveries in health establishments from 80% to 91% (PAHO/WHO,
1999). However, the northeast and north regions, especially rural areas, lack available health
infrastructures.
4. Agricultural production, land use and food security
In 1996, the agricultural sector generated 10% of GDP (PAHO/WHO, 1999). Brazil is the worlds
largest sugar producer accounting for about 13% of world production. Large alcohol stocks, and
increases in domestic sugar consumption due to demographic and economic growth, and expanding
sugar exports are boosting sugar production.
Brazilian agriculture has maintained an average annual growth rate of about 5% during the
last 40 years. In 1999, Brazil was one of the three largest producers of soybean (30 904 232 t),
maize (32 178 276 t), cacao (205 899 t), oranges (22 772 180 t), sugarcane (333 314 400 t),
cassava (20 932 514 t), banana (55 591 720 t), cashew nuts (124 773 t), pepper (34 581 t), beef
(6 182 400 t), chicken (4 905 200 t) and castor seed (25 623 t). The country is among the ten
largest producers of pork (1 751 600 t), eggs (1 524 500 t), honey (18 200 t), peanuts (1760 t),
rice (11 778 807 t) and milk (22 636 000 t) (FAOSTAT, 1999). About 80% of crop and livestock
production is concentrated in the central and southern zones: So Paulo, Mato Grosso do Sul,
Sergipe, Rio de Janeiro, Minas Gerais, Bahia, Rio Grande do Sul and Gois. In addition, new
agricultural borders, towards the north and centerwest, have increased the annual production of grain
(cereals and pulses) over the last 10 years (1989-1999) by 9%. Rice and bean production have
remained constant in the last 10 years, however, soy and corn production have increased by 22%
and 8% respectively (EIU, 2000).
Brazil's 1999/2000 soybean crop production is being threatened by prolonged dryness. The
southern states of Mato Grosso do Dul, Parana and Rio Grande do Sul are lagging behind in
soybean production due to the ongoing drought. Vegetation conditions during 1999 were worse than
in 1997 and 1998 in the states of Mato Grosso do Sul, Parana, and Rio Grande do Sul, which
jointly produce about 51% of Brazil's soybeans (USDA/FAS, 1999).
Land use in Brazil can be broken down into the following categories: arable land (5%),
permanent crops (1%), permanent pastures (22%), forests and woodland (58%) and other (14%).
The countrys fishing potential, despite its vast coastline, has not been fully utilised (EIU, 2000). In
1995, 1.539 ha per person was agricultural land and 0.411 ha per person was arable and permanent
crop land (FAOSTAT, 1999).
Despite increased agricultural production, food insecurity is still a problem in Brazil. The
main underlying causes are economic access to food, especially in urban areas and were land is
insufficient. The problem of food insecurity is party due to the rural crisis and migration to cities as a
result of the farm modernisation programme which led to an increase in the basic food prices. In
addition, lack of infrastructure in certain areas, led to an increase in transportation and
communication costs, resulting in high market prices. Efforts to stabilize the food supply, and include
small farmers in the market, are still needed. The acceleration of the agrarian reform and the
formulation of a new food supply policy are priority, together with actions to decrease unemployment
and decrease income distribution inequalities (EIU, 2000).
In 1990, the Map of Hunger (Map 2) (Peliano, 1993) showed that 32 million people in
Brazil were food insecure, which corresponds to 22% of the population. This group had an annual
income of about US$170, which is insufficient to buy a food basket. Those who suffer from food
insecurity are equally distributed between urban (metropolitan and non-metropolitan) and rural areas.
However, non-metropolitan areas are more affected than metropolitan areas, 11.2 and 4.4 million
respectively. The northeast and north regions, with the lowest GDP in 1995, present the worst
social indicator of Brazil.
The northeast region concentrates the highest number of indigenous people (17.2 million) and
the highest number of food insecure (10 million). Rural poverty is usually associated with a less
developed infrastructure and poor access to health services. At the state level, Bahia and Minas
Gerais present the highest number of food insecure. They are followed by the states Cear of So
Paulo, Pernambuco, Paran and Rio de Janeiro (Peliano, 1993).
5. Economy
The Real Plan, implemented in July 1994, resulted in hyperinflation since the plan exposed
imbalances in public finances. From 1995-1999 the public sector was not able to generate a
primary surplus. This resulted in a proposal to cut public spending, particularly wages and pensions.
Brazil faced a currency crisis that had an impact in early 1999, but a swift policy response
allowed the economy to recover more quickly than anticipated, with a growth for 1999 at almost
1%. In Brazil, high domestic interest rates in the second half of 1998 added to the government debt
and, alongside lower tax revenues in the wake of the economic slowdown.
The Brazilian exchange rate devaluated after massive losses of reserves. Brazils devaluation,
uncertainties in the run-up to elections, and a tighter U.S. monetary policy spread the economic
downturn in 1999. The Brazilian devaluation worsened the external environment for many countries
in the region. Prices of key commodities exported by Brazil (coffee, soybeans, and sugar) fell
sharply in the first half of the year at the same time that Brazilian import demand collapsed,
significantly reducing export revenues in a number of countries. However, the expected economic
outcome for Brazil is likely to be much better than envisioned and should keep the decline in the
regions GDP to about -0.6%. (World Bank, 2000).
II. THE FOOD AND NUTRITION SITUATION
1. Trends in energy requirements and energy supplies

Per caput energy requirements1 increased from 1965 to 1997 but are expected to decrease by
2030. At the national level, trends in food requirements reflect the changes in population structure
and in particular in the age, sex and urban-rural distribution of the population. The growth in per
caput requirements is expected to drop because urbanisation is increasing. The percentage of people
living in urban centres has increased by more than half from 1965 and 1997, and the total population
almost doubled in the same time period. The per caput dietary energy supply (DES) has followed
population growth and the trends in energy requirements, increasing from 2330 kcal/day in 1965 to
2960 kcal/day in 1997, exceeding per caput energy requirements (Table 2) (FAOSTAT, 1999).
Table 2: Total population, urbanisation, energy requirements and dietary energy supplies
(DES) per person and per day in 1965, 1997 and 2030
Year
1965
1997
2030
84351
161533
225161
Percentage urban (%)
50.4
79.0
88.9
Per caput energy requirements (kcal/day)
2096
2328
Per caput DES (kcal/day) *
2330
2960
2167
__
Total population (thousands)
*Three-year average calculated for 1964-66 and 1996-98 (Source: FAOSTAT)
The share of fat in total DES has increased from 16% to 25% in the period 1964-1998
while the percentage of carbohydrates decreased from 74% to 65% during the same period. The
share of protein in total DES remained the same at 11% during the 32 year period (FAOSTAT,
1999) (Figure 1).
Per caput energy requirements are calculated on the basis of the sex and age distribution of the population, using
references for body size, physical activity levels (higher among the rural population, lower among the urban), energy needs for
pregnancy and lactation. The method of calculation is derived from James & Schofield (1990). The requirements are exp ressed
per average person of the country. Thus requirements are low in young and/or urbanized populations and higher in older or
rural populations.
10
Figure 1: Share of protein, fat and carbohydrate in Dietary Energy Supply Trends from
1964-66 to 1996-98
3000
DES kcal/caput/day
2500
2000
21.6
25.0
24.9
15.7
10.6
16.4
10.3
18.8
21.0
9.8
9.6
9.8
9.8
73.7
73.3
71.5
69.4
68.6
65.2
64.5
1964-66
1969-71
1974-76
1979-81
1984-86
1989-91
1996-98
10.6
1500
1000
500
0
Brazil
Carbohydrates
Protein
Fat
Source: FAOSTAT
2. Trends in food supplies

Quantity - Many food groups presented an increase in quantity during the period of 196466 to
199698, in particular fruits and vegetables and milk and eggs, which reached 145 kg/caput/year
and 125 kg/caput/year respectively and represent the major food items in Brazil. The supply of
cereals also increased slightly over the entire time period but peaked from 19791986. Cereals are
now the third major food item. Starchy roots which was the major food group item from 19641971
(123 kg/caput/year) but continually decreased and in 1996-1998, it was the fifth major food item
(69 kg/caput/year). This contributes to the overall observed decrease in DES of carbohydrates.
Meat and offal, sweeteners and other food groups also increased gradually during the 32 year time
period.
Food groups with the lowest availability are pulses, nuts and oilcrops, fish and seafood,
vegetable oils and animal fats. Fish and seafood, vegetable oils and animal fats have remained fairly
constant over the 32 time period, whilst the pulses, nuts and oilcrops group decreased from 31
kcal/caput/year to 22 kg/caput/year for the same time period (Figure 2).
11
Figure 2: Supplies of major food groups (in kg/caput/year)

Trends from 1964-66 to 1996-98
150
125
Starchy roots
Sweeteners
kg/caput/year
100

Fruits & Vegetables
75
Vegetable oils
Animal Fats
50
Meat & offals
Fish & seafood
25
Milk & Eggs

Other
0
1964-66
1969-71
1974-76
1979-81
1984-86
1989-91
1996-98
Energy Through out the entire period, cereals and sweeteners have been the two main
food groups as a share of DES, although the first tends to decrease and the second to increase.
Cereals have been the main source of energy in Brazil from 196466 to 19961998 from 36% to
31%, respectively (mainly rice). This is followed by sweeteners (mainly sugar) (16% to 19%), meat
and offals (5% to 11%), vegetable oils (4% to 11%) and milk and eggs (6% to 8%). The DES of
fruits and vegetables and fish and seafood remained constant at 5% and under 1%, respectively, for
the entire time period (Figure 3).
Sugar consumption is increasing in Brazil due to population growth as well as to greater
consumption of sugar-containing products such as soft drinks, ice cream and candy, which have
been stimulated by the Real Plan.
The percent of energy from animal products increased from 13% to 21% and the percent of
protein from animal products also increased from 32% to 51%, which can be attributed to the
increase in meat and offal consumption. However, the percentage of fat from animal products
remained constant at 50%. The percentage of energy from vegetable products decreased from 87%
to 79% which can be attributed to the decrease consumption of cereals and starchy roots (11% to
5%) and pulses, nuts and oilcrops (12% to 6%). The percentage of protein from vegetable products
decreased from 69% to 49% and the percentage of fat from vegetable products remained constant
at 50% (FAOSTAT, 1999).
12
Figure 3: Share of major food groups in Dietary Energy Supply

3000
2500

Starchy roots
2000
Sweeteners
kcal/caput/day

Fruits & Vegetables
Vegetable oils
1500
Animal Fats
Meat & offals
Fish & seafood
Milk & Eggs
Other
1000
500
0
1964-66
Brazil
1969-71
1974-76
1979-81
1984-86
1989-91
1996-98
Source: FAOSTAT
Major food imports and exports: Contribution of food import expressed as a percent of
DES increased from 11% in 196466 to 21% in 199698. This growth is mainly due to the increase
of imported food, in particular cereals (wheat and barley for processing), as a consequence of the
open market. In 199698 the import of cereals accounted for 9 616 448 t/year. Until 1979, cereals
(mainly wheat) represented total import contribution, however, after 1979, oils crops and eventually
vegetable oils and milk and products contributed to the total DES of imports (FAOSTAT, 1999)
(Figure 4).
Figure 4: Major food imports as a percentage of Dietary Energy Supply
25
% of DES
20
15
Oilcrops
Vegetable Oils
10
Milk & products
0
Brazil
1964-66
1969-71
1974-76
1979-81
1984-86
1989-91
1996-98
Source: FAOSTAT
13
Brazil is the worlds largest sugar exporter, accounting for about 13% of world production
and 19% of exports (EIU, 2000). Since 1989-91 sugar exports have more than tripled from 4% to
14% of total DES in 199698 or 7 004 892 t/year. There is concern that the financial crisis in
eastern Asian markets will reduce some of the Brazilian sugar export potential (FAS, 1998) in the
future.
In 19961998 vegetable oils (mainly soybean oil) and oil crops represented 7% of total
DES for both groups. Fruits (mainly oranges) represented 4% of total DES or 15 346 080 t/year.
Up until 1976, Brazil exported some cereals but since 1979 it has represented less than 1% of the
total DES. The export of meat and offals has increased since 19641966 but still only represented
1% of total DES in 19961998 (FAOSTAT, 1999) (Figure 5).
Figure 5: Major food exports as a percentage of Dietary Energy Supply
40
30
% of DES

Sweeteners
20
Oilcrops
Fruit (excl. wine)
Vegetable oils
10
0
Brazil
1964-66
1969-71
1974-76
1979-81
1984-86
1989-91
1996-98
Source: FAOSTAT
3. Food consumption
The diversification of food patterns in Brazil are strongly related to differences in access to
food and food habits. In fact, except for the Amazon region and the arid northeast area of Serto, no
large differences in terms of agro-ecological characteristics or agricultural production throughout the
country exist. This implies that the main food items, which provide most of the DES, are similar from
one region to another. However, the remote areas listed above consume and produce mostly local
traditional foods.
Differences among socio-economic groups are highlighted in the national food consumption
study carried out from 197475 as part of the National Survey of Domestic Expenses (ENDEF).
This survey was carried out on 55 000 households countrywide and included a seven day weighted
food intake. The results indicated that the basic food items for meals were beans, cassava and rice.
Cassava was found to be characteristic of the poorest 14% of the population; mainly in rural areas
and urban northeast. Rice, on the other hand was the most common food item among affluent
populations in the urban and rural areas. Consumption of other food items such as meat, milk, wheat
products and fish, were strongly influenced by food habits and food access. In the north and
centrewest fish was consumed more often than in other areas (ENDEF, 1975).
In 1974/75, the average energy intake was found to be 1900 kcal/caput/day in the north and
northeast and 2400 kcal/caput/day in the south, southeast and centrewest. Protein intake varied from
14
59 g in the southeast to 72 g in the south. Beans were the main source of protein among low income
households (ENDEF, 1975).
In the last ten years, fast urbanisation and industrialisation; have contributed to changes in the
food habits. In 1987 food consumption data were made available from the Household Expenditure
Survey (POF). Results could not be compared to the 1975 survey because of the different
methodologies used. One limitation of this study is that the fluctuation in food prices over the 15 year
time period may have decreased the accuracy of the food consumption data for this study (IBGE,
1987)
The main findings are that cereals were the principal source of energy intake (17-24% of
total DES), followed very closely by sweeteners (13-19% of total DES) and oils/fats (15-21% of
total DES). Also, a generally low energy intake was observed, varying from 1616 kcal/caput/day in
Goinia to 1754 kcal/caput/day in Curitiba (IBGE, 1987).
In 1996 the Ministry of Health supported a Household Food Consumption survey which
included the cities of Braslia, Goinia, Ouro Preto, Campinas and Rio de Janeiro, and in 1997
included Curitiba and Belem. The survey used a methodology, which combined frequency monthly
records of food consumption and food expenses. The results, when compared to the 1987 surveys,
showed an increase in protein and energy intake. The share of total energy intake of cereals,
sweeteners and oils/fats decreased while meat and offals, chicken and eggs and milk increased their
share of total energy intake. As a percent of total DES, cereals still occupied the first place (1518%), except in Rio de Janeiro and Ouro Preto where oils/fats (12%) and sweeteners (18%)
exceeded cereals. The consumption of fish was highest in the regions closest to sea shore or to rivers
such as Belem in the north (13.3 kg/caput/year) and Rio de Janeiro (11.4 kg/caput/year) close to the
Atlantic sea (Table 3) (Galeazzi et al., 1998).
15
Table 3: Food consumption surveys

Source
Year of survey Location
Sample
Number Sex
Age
households
(years)
Average food intake
Major Food Groups (kg/caput/year)
Galeazzi et al. 1998 Rio de Janeiro

MOH, 1996
Cereals
Roots/
Tubers
Pulses
Fruits/
Vegetables
Oils/Fats
Meat
Fish
Milk products Sweeteners
Chicken &
Eggs
Other
...
M/F
All
66.5
31.6
20.1
253.9
14.6
29.7
11.4
75.5
40.2
31.67
78.7
Campinas
...
M/F
All
75.0
22.0
12.3
172.4
12.7
38.8
4.7
88.7
36.1
27.63
94.7
Ouro Preta
...
M/F
All
77.3
21.5
18.9
109.5
13.3
29.7
1.6
55.3
40.1
21.68
60.5
Goiania
...
M/F
All
67.9
18.4
15.2
241.2
21.3
37.2
2.4
79.1
30.9
24.82
58.6
Curitiba
...
M/F
All
51.9
12.9
13.2
86.1
12.6
11.8
2.6
9.8
35.7
10.24
30.0
Belem
...
M/F
All
58.7
38.8
13.8
145.0
10.3
48.5
13.3
10.4
31.6
29.19
38.7
Brasila
...
M/F
All
71.9
20.9
12.9
169.6
17.1
37.8
3.5
74.0
37.6
34.11
55.5
Nutrient Intake (person/day)

MOH, 1996
Energy
(kcal)
% Protein
% Fat
Protein
(g)
% from
Animal
products
Fat
(g)
% from
Animal
products
...
M/F
All
2589
15
26
90
57
69
35
Campinas
...
M/F
All
2279
14
28
82
59
72
42
Ouro Preta
...
M/F
All
2384
12
27
67
54
65
38
Goiania
...
M/F
All
2354
13
30
79
56
80
35
Curitiba
...
M/F
All
2174
14
26
39
33
43
13
Belem
...
M/F
All
2228
14
24
80
59
61
31
Brasila
...
M/F
All
2267
13
42
76
56
106
52
Share of major food groups in total energy intake (% kcal)
...
M/F
All
24.3
Roots/
Tubers
4.0
7.7
Fruits/
Vegetables
11.1
Campinas
...
M/F
All
28.4
2.5
4.8
7.8
12.9
8.0
10.0
16.0
4.41
Ouro Preta
...
M/F
All
4.4
31.7
2.6
5.7
5.1
14.3
7.1
7.9
19.4
3.61
Goiania
...
M/F
2.4
All
26.5
2.7
5.8
12.5
17.1
7.7
8.2
13.2
3.82
Curitiba
...
2.3
M/F
All
31.7
2.8
6.4
5.6
18.7
3.9
2.7
24.1
1.67
Belem
2.0
...
M/F
All
23.0
13.0
5.5
14.0
9.9
10.3
4.1
15.0
2.22
Brasila
1.7
...
M/F
All
29.1
3.1
5.1
7.1
15.5
8.6
8.8
17.1
20.8
2.1
Cereals
MOH, 1996
Pulses
Oils/Fats
Meat
Fish
12.8
5.2
8.6
16.9
Chicken &
Eggs
4.83
Milk products Sweeteners
Other
3.3
Note: ... Data not available
4. Infant feeding practices

Ninety three percent of the children are breast-fed in Brazil. Among them, 71% are breastfed during their first day of life. The average duration of breast-feeding is 7 months; however duration
varies in different geographical locations. In Rio de Janeiro, the north and the centerwest, the
average length of breast-feeding is 10 months, while in the centereast it is 4.4 months. The education
level of the mother was not identified as a strong determinant of the differences observed in
breastfeeding duration.
Sixty percent of infants under one month were being breast-feed exclusively and it dropped
to 34% for infants two to three months old and to 20% for infants from four to six months. A positive
correlation was found between the duration of exclusive and increased socio-economic status. The
longest duration of exclusive breast-feeding is in urban areas and in the south region. Mothers with a
higher education level exclusively breast-fed for longer than mothers who were less educated. Still,
the duration of exclusive breast-feeding among infants is short when compared to the WHO
recommendations of six months.
Among infants under three months of age, complementary feeding consists mainly of liquids.
Solid foods are introduced around 4 months. Roots and tubers are introduced to 19% of infants
16
between the age of four and six months. Infants who were not breastfed receive infant formula.
These infants receive solid food and animal proteins within the first four months of life. Cereals are
consumed by 17% of bottle fed infants; which is twice as much as breast-fed infants (UNICEF,
1994).
5. Anthropometric data
Anthropometry of children
The nutritional status of children under five years is commonly assessed using three indices: weightfor-height which reflects acute growth disturbances, height-for-age which reflects long-term growth
faltering and weight-for-age which is a composite indicator of both long and short term effects.
Weights and heights of children are compared with the reference standards (NCHS/CDC/WHO)
and the prevalence of anthropometric deficits is usually expressed as the percentage of children
below a specific cut-off point such as minus 2 standard deviations (SD) from the median value of the
international reference data (WHO, 1983).
The sources of anthropometric data used to describe the nutritional status of the population
are the following:
The ENDEF (Estudo Nacional da Despesa Familiar) is a nationwide nutritional survey that
was carried out in 1975. It was based on a national probability sample of 36 969 children under five
years selected from urban and rural districts from five geographical regions of the country: north,
northeast, south, centerwest, southeast. The rural area of both the north and centerwest regions,
which in 1980 represented 2% and 3% of the total population respectively, were not included in the
sample (Monteiro et al., 1992).
The PNSN (Pesquisa Nacional sobre Sade e Nutrio) is a survey on health and nutrition
which was conducted in 1989 on a 7314 children under five years selected within the five previously
mentioned geographical regions of the country, excluding the rural area of the north (Monteiro et al.,
1991).
In 1996, DHS (Demographic and Health Survey) carried out a survey on 3 815 children
under five years. The study included both urban and rural areas (excluding rural areas in the north)
of seven predefined macro-regions (north, northeast, south, centerwest, centereast and the states of
Rio de Janeiro and So Paulo (MOH, 1996).
The national prevalence of underweight among children under five years in 1996 was 6%,
showing a decrease compared to 18% in 1975 and 7% in 1989. In 1996, males (6%) are more
affected than females (5%). The highest prevalence was in rural areas (9%) (MOH, 1996; Monteiro
et al., 1991; 1992).
In 1992, among the nine states composing the northeast region, Maranho and Piau had the
highest prevalence of underweight among children under five years (UNICEF, 1995) (Map 3).
According to the information available on child anthropometry an important improvement
occurred between 1975 and 1996 in the nutritional status of children under five at national, regional
and state level. The prevalence of stunting decreased from 32% in 1975 to 15% in 1989. However,
in 1996, stunting was still the main nutrition problem affecting children under five years, with a
prevalence of 11% at the national level and 19% in the rural area (MOH, 1996; Monteiro et al.,
1991; 1992) (Table 4a).
17
Still, in 1996, important differences existed between regions, the highest prevalence of
stunting was in the northeast (18%) and the lowest prevalence of stunting was in the south (5%). Rio
de Janeiro had an even lower prevalence of 3%. (MOH, 1996) (Table 4a).
Among the northeast states in 1992, Maranho and Piau showed the highest prevalences of
stunting which corresponded to a high and medium prevalence in these states (UNICEF, 1995)
(Map 4).
The differences in income level between regions influence the differences in the level of
stunting both directly and indirectly. Nevertheless, it appear that for the same income level, regional
disparities in childrens nutritional status persist indicating that factors other than income play an
important role in determining regional disparities. These factors relate to education and health.
18
Looking at the situation in the rural and urban area of each region the highest prevalence of
stunting in 1996 was in the rural northeast (25%). However no data are available for the rural area of
the north. The 1975 data shows that the rural populations both in the northeast and the centersouth
have a much higher prevalence of stunting than in the urban areas of these regions.
In Brazil, the national prevalence of wasting was 5% in 1975 and 2% in 1989 and 1996. At
the regional level the prevalence was very low in 1996; 1% in the northeast and less than 1% in the
centersouth (MOH, 1996). The prevalence increased slightly for children under 6 months and 6-11
months; 3% and 4%, respectively (BEMFAM, 1997). However, Rio de Janeiro showed a wasting
prevalence of 5% (MOH, 1996; Monteiro et al., 1991; 1992) (Table 4a).
Information concerning the prevalence of overweight showed a decrease from 8% in 1975
to 5% in 1989 and 1996. The prevalence of overweight for both sexes in 1975 was slightly higher
for males than females (8% and 7%, respectively). In 1996 the prevalence of overweight was 5% for
both genders. In 1975 rural areas showed a slightly higher prevalence of overweight than urban areas
(8% and 7%, respectively) however, in 1996 the prevalence of overweight was 5% for both areas
(MOH, 1996; Monteiro et al., 1992) (Table 4a).
The improvement observed in the nutritional status of children under five between 1975 and
1996 can partly be explained by the important economic growth, the decrease of absolute poverty,
as well as the improvement in health services, education and infrastructures, which characterised the
1970-1988 period. In less developed regions improvements were less significant because of limited
access to these regions.
No studies were carried out in Brazil to determine adolescent (10 to 19 years old)
anthropometry.
19
Table 4a: Anthropometric data on children

Source/
Year of survey
MOH, 1996
DHS, 1996
Monteiro, 1991
PNSN, 1989
Monteiro, 1992
ENDEF, 1975
Location
Size
Sample
Sex Age
(years)
Percentage of Malnutrition
Underweight
% W/A
Stunting
% H/A
Wasting
% W/H
Overweight
% W/H
3,815
1,926
1,890
2,903
912
M/F
M
F
M/F
M/F
<5
<5
<5
<5
<5
< -2SD*
5.7
5.9
5.4
4.6
9.2
< -2SD*
10.5
11.5
9.4
7.8
19.0
< -2SD*
2.3
2.3
2.4
2.3
2.6
> +2SD*
4.9
4.7
5.1
5.0
4.7
Centereast
478
Centerwest
260
Northeast
1329
Northwest
212
Rio de Janeiro 315
So Paulo
718
South
503
M/F
M/F
M/F
M/F
M/F
M/F
M/F
<5
<5
<5
<5
<5
<5
<5
5.5
3.0
8.3
7.7
3.8
4.7
2.0
5.3
8.2
17.9
16.2
2.9
6.3
5.1
2.5
2.9
2.8
1.2
4.8
1.4
0.9
5.6
2.7
4.5
4.5
6.7
5.5
4.7
National
National
National
7314
3717
3597
M/F
M
F
<5
<5
<5
7.0
6.8
7.2
15.4
16.3
14.5
2.0
2.4
1.7
5.4
4.9
5.9
North
Northeast
Centersouth
1458
1000
2080
M/F
M/F
M/F
<5
<5
<5
10.6
12.8
2.3
23.0
27.3
8.7
3.1
2.4
1.4
5.2
2.5
8.2
National
National
National
Urban
Rural
National
National
National
Urban
Rural
36,969 M/F
18,758 M
18,211 F
25,208 M/F
11,767 M/F
<
<
<
<
<
5
5
5
5
5
18.4
18.7
18.2
14.6
22.8
32.0
32.5
31.6
25.9
39.2
5.0
4.9
5.1
4.9
5.2
7.6
7.8
7.4
7.7
7.4
Centerwest
North
Northeast
South
Southeast
3,137
3018
13260
5746
11801
<
<
<
<
<
5
5
5
5
5
13.3
24.5
27.0
11.7
13.4
25.5
38.9
45.6
25.1
22.0
3.9
6.4
5.5
3.6
5.2
6.8
5.4
7.6
8.0
7.5
M/F
M/F
M/F
M/F
M/F
Source: available at http://www.who.int/nutgrowthdb/

Note: Each index is expressed in terms of the number of standard deviations (SD) units from the median of the
NCHS/CDC/WHO international reference population.* Includes children who are below -3 SD.
20
Anthropometry of adults
The nutritional status of adults was assessed using the body mass index (BMI) calculated as weight
(kg) over height squared (m2). For classifying individuals according to their nutritional status, cut-off
levels of BMI have been proposed. Adults with a BMI under 18.5 kg/m2 are considered to suffer
from chronic energy deficiency (CED). A BMI of more than 25 kg/m2 but under 29.9 kg/m2
indicates overweight and over 30 kg/m2 indicates obesity.
In 1996, the prevalence of CED among women between the ages of 15 to 49 years was
6%. A decrease in the prevalence of CED was observed in the northeast and centersouth region. In
1996, the highest prevalences of CED were found in the rural areas (8%), especially the northeast
rural area (9%). Rio de Janeiro also had a prevalence of 9% (Map 5) (BEMFAM, 1997).
While CED decreased, overweight and obesity in this population group increased. The
prevalence of overweight at the national level increased from 19% in 1975 to 27% in 1989, while
obesity increased from 7% to 12% during the same period. Although not presented in Table 4b, it
appears than women are more affected by overweight and obesity than men (Sichieri et al, 1996). In
1989 urban area had a higher prevalence of both overweight and obesity than rural area
(BEMFAM, 1997).
In 1996, the mean BMI shows a trend towards overweight and obesity since values are
concentrated in the upper limit of the recommended range (24.0 kg/m at the national level). A
difference was observed between regions, with the lowest mean BMI found in the northeast (23.4
kg/m) and the highest in the more developed regions of the south (24.8 kg/m) and So Paulo (24.8
kg/m) (BEMFAM, 1997). However, in 1996, the prevalence of both overweight and obesity were
higher in rural areas than in urban areas. Overweight and obesity are considered to be a public health
problem in Brazil.
21
Table 4b: Anthropometric data on adults

Body Mass Index
2
(kg/m )
mean
SD median
Chronic Energy
Deficiency
% BMI
< 18.5
Overweight
% BMI
Obesity
% BMI
25.0-29.9
>30.0
BEMFAM, 1997 National
2951
15-49
24.0
...
...
6.3
DHS, 1996
Urban
2325
15-49
24.1
...
...
5.8
18.8
6.9
Rural
626
15-49
23.6
...
...
7.8
20.4
7.9
Northeast
927
15-49
23.4
...
...
7.7
15.4
4.8
Northeast urban
...
15-49
...
...
...
6.3
...
...
Northeast rural
...
15-49
...
...
...
8.8
...
...
Centersouth
...
15-49
24.8
...
...
5.8
...
...
Centersouth urban ...
15-49
...
...
...
5.8
...
...
Centersouth rural
...
15-49
...
...
...
6.1
...
...
Rio de Janeiro
258
15-49
23.9
...
...
8.8
...
...
So Paulo
588
15-49
24.8
...
...
6.4
...
...
17168
9325
6565
F
F
F
>18
>18
>18
...
...
...
...
...
...
5.8
4.8
8.6
26.6
27.9
21.6
11.8
12.6
8.8
Northeast
...
Northeast urban 1850
Northeast rural
1937
Centersouth
...
Centersouth urban1742
Centersouth rural 1823
F
F
F
F
F
F
>18
>18
>18
>18
>18
>18
...
...
...
...
...
...
...
...
...
...
...
...
...
...
8.4
5.2
12.2
4.7
4.6
5.1
25.4
17.1
...
...
...
8.9
4.3
...
14.3
...
...
BEMFAM, 1997
ENDEF, 1975 National
65169
Urban
...
Rural
...
Northeast
...
Northeast urban
...
Northeast rural
...
Centersouth
...
Centersouth urban ...
Centersouth rural ...
F
F
F
F
F
F
F
F
F
>18
>18
>18
>18
>18
>18
>18
>18
>18
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
9.7
...
...
11.8
10.8
13.3
7.8
7.1
9.6
BEMFAM, 1997
PNSN, 1989
National
Urban
Rural
...
...
18.8
...
...
...
...
...
...
...
6.9
...
...
...
...
...
...
...
...
Notes: ... Data not available
6. Micronutrient deficiencies
Iodine Deficiency Disorders (IDD):
Iodine deficiency disorders (IDD) include the clinical and sub-clinical manifestations of iodine
deficiency. Iodine deficiency in pregnant women may cause irreversible brain damage in the
developing foetus, whereas in infants and young children it may cause psychomotor retardation and
intellectual impairment. Total goitre rate (TGR) is the proportion of the population with a prevalence
of goitre for all grades combining both palpable and visible goitre.
Iodine deficiency was assessed in 1975 through a national survey conducted on 421 756
children from 7 to 14 years of age. The results indicated a national prevalence of TGR of 14% (not
in Table). At the state level, the highest prevalences were in Bahia, Minas Gerais, Maranho and
Rondonia and prevalences varied from 25% to 33%. These corresponded to moderate to severe
prevalences of IDD in Brazil at the different state levels (WHO, 1982). Later, in 1984, school
children from the states of Goias, Par, Maranho, Minas Gerais and Bahia were found to have a
prevalence of TGR that was greater than 30%.
In 1994/95 a national survey was carried out among school children from 6 to 14 years from
428 municipalities. The results showed a national TGR prevalence of 4%. The most prevalent levels
were detected in the States of Mato Grosso do Sul and Roraima (20% for both).
22
Since 1983 the Ministry of Health has closely monitored the mandatory iodization of table
salt. In 1996, measurements carried out by the DHS on salt iodization found that more than 95% of
household salt was iodized. The smallest values (90-92%) were found in the rural area and in the
north region (UNICEF, 1998).
Iron Deficiency anaemia (IDA):
The consequences of iron deficiency anaemia (IDA) include reduced physical work capacity and
productivity, impaired cognitive functions and brain metabolism and reduced immuno-competence.
The causes of IDA include low dietary intake in relation to the recommended dietary allowances
(RDA), poor bio-availability of iron in the diet, malaria and a high prevalence of parasitic infestations.
In 1998, 590 children under five years from the state of Pernambuco were studied using a
heamoglobin cut off point of under 11 g/dL. A 48% prevalence of IDA was found and the
prevalence was higher in the rural areas (56%) than in the urban areas (41%) (INAN/MS - IMIP DN/UFPE - SES/PE, 1998).
In 1992, in the state of So Paulo (southeast), 2992 children from 6 to 24 months of age
were examined using a haemoglobin cut-off point of 11 g/dL. The results, considered representative
for the state, indicated a 59% prevalence of IDA (Torres de Almeida, 1992). In the same year, 363
pregnant women were screened by the health department of the district of Butantan (So Paulo City)
and a 12% prevalence of IDA was determined using a haemoglobin cut-off point of 11 g/dL (Guerra
et al., 1992). There is no information available on the actions carried out to control iron deficiency in
Brazil (Table 5).
Vitamin A Deficiency (VAD):
Vitamin A is an essential micronutrient required for normal health and survival. It is involved in
several critical functions in the body including vision, immune system, reproduction, growth and
development. Children under five years are most susceptible to VAD. The consequences of VAD
are tragic: they include night blindness, irreversible blindness, growth retardation and increased
susceptibility to infections. Pregnant women are also prone to VAD and their children are likely to
become deficient.
Several studies on VAD have been carried out during the last 20 years. They are all locally
based surveys, which mainly concern states and cities and/or particular area or population groups.
In the northeast region VAD was reported in several studies in the past decades. Among
them, the most significant are described below and were carried out in the states of Paraiba, Bahia ,
Pernambuco, Cear and Rio Grande do Norte.
In the state of Paraba, an epidemiological survey was conducted in 1981/82 on 5561
children under 12 years from six localities representative of the three different ecological regions of
the state (Santos et al, 1983). Clinical signs of VAD were found only in the semiarid region (Serto).
Prevalence of Bitot spot (X1B) was 0.6% and the prevalence of corneal scars (X3) was 0.1%, both
being above the critical level and confirming VAD to be a public health problem in Serto (WHO,
1995). School children (five to under twelve years) had a higher prevalence of Bitot spots (0.9%)
and night blindness (XN) (1.8%) than children under five years (0.3% and 0.2%, respectively).
When comparing the harvest seasons results with the interharvest season results, the study shows
seasonal variation, with a higher prevalence of xerophthalmia during the interharvest period and most
prominent in the Serto area compared to the other areas studied (Table 5)
23
These data were confirmed in a successive study carried out in the same state among
children under six years. Moreover, this survey demonstrated that severe xerophthalmia occurred
mainly among very young children, even among infant below six months of age living in the Coastal
region. Mild xerophthalmia affected mostly older children from the semi-arid area of Serto. In the
first case, breast-feeding practices may have played an important role in the development of VAD,
since in the area, 21% of children were never breast-fed and infants were often weaned during the
second month of life. In the second case, VAD could be explained mainly by irregularity in crop
production and the low availability of fruits and green leafy vegetables (DAns et al, 1987; 1988).
A similar study was undertaken in 1989 among 563 children under five years in the urban
area (7 small towns) of the semi-arid zone of the state of Bahia. No clinical sign of deficiency were
registered but more than 5% of serum retinol levels where below the cut-off point of under
0.70mol/L. Therefore VAD was classified as a public health problem in the seven localities
investigated (WHO, 1982). A 24 hours food consumption survey carried out at the same time
revealing that only 8% of children had an adequate intake of vitamin A; 66% received under half of
the recommended daily intake (Santos et al, 1996).
In the same year, levels of serum retinol were measured in 2619 children from 2 to 6 years
of age from a representative sample of the city of Recife (state of Pernambuco) and the prevalence
of VAD was 34% (Santos et al, 1996).
In 1986, 6291 children under five years from 3 towns of the semi-arid area of the state of
Rio Grande do Norte were screened for clinical signs of VAD. The prevalence of Bitots spot was
found to be 0.6% confirming that VAD in this particular area is a public health problem (Mariath et
al., 1989) (Table 5).
In the same year, in the southeast region, a study was carried out in health units located in the
poor areas of the city of Rio de Janeiro. The prevalence of VAD on the basis of the serum retinol
levels under 0.70g/L varied from 14% in pregnant women to 56% in new-borns.
In the north region, a study was carried out in 1998 among children under five years from the
city of Belm (state of Par). The results found a 12% prevalence of VAD. In the same year, in the
southeast region, a study was carried out in health units located in the poor areas of the city of Rio de
Janeiro. The prevalence of VAD on the basis of the serum retinol level varied from 14% in pregnant
women to 56% in new-borns (Teixeria, 1998).
24
Table 5: Surveys on micronutrient deficiencies

Source/
Deficiency
Location
Year of survey
Size
Sex
Sample
Age
%
Years
Iron
Torres de Almeida, 1992
1992
Hb < 11 g/dL
State of So Paulo
2992
M/F
0.5 - 2
59.0
Hb < 11 g/dL
So Paulo city (2)
363
pregnant women
12.0
Guerra et al., 1992

1992
INAN/MS - IMIP - DN/UFPE
SES/PE, 1998
State of Pernambuco
Hb < 11 g/dL
Total
590
M/F
<5
48.0
"
"
Urban
Rural
249
251
M/F
M/F
<5
<5
41.0
56.0
4991
Vitamin A
Santos et al, 1983
1981/1982
Mariath et al. 1989

1986
Note: ... Data not available
State of Paraba
XN
Serto (Semi-arid area)
M/F
<12
0.20
X1B
(Harvest season)
M/F
<12
0.60
X2
"
M/F
<12
0.02
X3
"
M/F
<12
0.10
XN
"
M/F
<5
0.20
X1B
"
2802
M/F
<5
0.30
X2
X3
"
"
M/F
M/F
<5
<5
0.00
0.10
XN
"
M/F
5 - <12
1.80
X1B
X2
"
"
2189
M/F
M/F
5 - <12
5 - <12
0.90
0.05
X3
"
M/F
5 - <12
0.09
XN
Serto (Semi-arid)
M/F
<12
0.00
X1B
(Interharvest period)
570
M/F
<12
1.90
X2
"
M/F
<12
0.00
X3
"
M/F
<12
0.18
X1B
State of Rio Grande do Norte

(Semi-arid area) (1)
M/F
<5
0.60
6291
25
REFERENCES
BEMFAM. 1997. Sade da Mulher e da Criana, in : Pesquisa Nacional Sobre Demografia e
Sade-PNDS 1996. Rio de Janeiro.
DAns, C., Dricot, J., Diniz, A.S., Mariath, J.G.R. & Santos, L.M.P. 1988. Geographic
distribution of xerophthalmia in the state of Paraiba, northeast Brazil. Ecology of Food
and Nutrition 1988; 22: 131-138.
D'Ans, C., Dricot, J.M. & Mariath, J.G. 1987. Vitamin A periodic dosing in the state of
Paraiba, Northeast Brasil. Xeroph Club Bull 1987;35:3-4.
EIU (Economist Intelligence Unit). 2000. Brazil Country Profile, 2000. Website at:
http://db.eiu.com/report_dl.asp?mode=pdf&valname=CP9BRA
ENDEF. 1975. Estudo Nacional de Despesad Familiares-1975 Instituto Brasiuleiro de
Geografica e estadstica (IBGE).Brazil.
FAOSTAT. 1999. FAO web page. Statistics database. FAO, Rome.
FAS ( Federation of American Scientists ). 1998. Brazilian Sugar Production and Exports
Set Records ( http://www.fas.usda.gov/htp2/sugar/1998/98-05/may98cover.html )
Galeazzi. M.A. M. & Falchoni, P. Jnr. 1998. Inqurito de Consumo Alimentar da rea
Metropolitana de Braslia- Relatrio Tcnico-Secretaria de Sade de Braslia.
Guerra, E.M. 1992. Prvalencia de deficincia de ferro em gestante de primera consulta em
centros de sade de rea metropolitana- Ver. Sade pblica 26(2):88-95.
IBGE (Instituto Brasileiro de Geografia e Estatstica). 1987. Pesquisa de Oramentos Familiares
(POF). Brazil.
IBGE DPE/DEPIS. 1997. Projees Populacionais: Brasil e Grandes Regies. Brazil.
IBGE/PNAD. 1996. Pesquisa Nacional por Amostra de Domiclios. Brazil.
INAN/MS IMIP DN/UFPE SES/PE. 1998. - Sade, nutrio, alimentao e condies
socioeconmicas no Estado de Pernambuco. Brazil.
INEI. 1996. Encuesta Demogrfica y de Salud Familiar 1996 (ENDES). Brazil.
James, W.P.T. & Schofield, E,C. 1990. Human Energy Requirements. A manual for planners
and nutritionists. FAO & Oxford Medical Publications. New York.
26
Lira, P.I.C., Cartagena, H.A., & Mello, R. 1985. Estado nutricional de crianas menores de
seis anos, segundo posse da terra, em areas rurais do estado de Pernambuco, nordeste
do Brasil. Arch Latinoam Nutr 1985; 35(2):247-57.
Mariath, J.G.R. et al., 1989. Vitamin A activity of buriti (Mauritia vinifera Mart) and its
effectiveness in the treatment and prevention of xerophthalmia. Am J Clin Nutr
1989;49;849-853.
MOH ( Ministry of Health ). 1996. Pesquisa nacional sobre demografia e sade 1996
(relatorio preliminar ). Demographic and health surveys. Rio de Janeiro, Brasil.
Monteiro, C.A. 1987. Estudos das condies de sade das crianas do Municpo de So
Paulo (1984/85). V. Anemia. Rev. Sade pbl., 21 (3): 255-60.
Monteiro, C.A., Benicio M.H. & Gouveia, N.C. 1991. Growth and nutrition status of t he
Brazilian children: findings from the 1989 National Health and Nutrition Survey.
Country Studies on Nutrition Anthropometry NUT/ANTREF/1/91. World Health
Organization. Geneva, Switzerland.
Monteiro, C.A., Benicio, M.H., Iunes R., Gouveia, N.C. Taddei, J.A. & Cardosos, M.A.
1992. Nutrition status of Brazilian children: trends from 1975 to 1989. Bulletin of the
World Health Organization 1992:70:657-666.
PAHO/WHO. 1999. Health Systems and Services Profile for Brazil, Washington DC, USA.
Peliano, M.T.M. 1993. O Mapa da Fome: Subsdios Formulao de uma Poltica de
Segurana Alimentar. Rio de Janeiro: IPEA, March, 1993 (Documento de Poltica, 14).
Rocha, S. 1996. Poverty Studies in Brazil, Review. IPEA (Instituto de Pesquisa Econmica
Aplicada ) Rio de Janeiro.
Santos, L.M., Assis, M.O. & Martins, M.C. 1996. Nutritional status of pre-school
children in the semi-arid region of Bahia (Brasil): II Vitamin A deficiency. Rev. Sade
Pblica, 30 (1): 67-74.
Santos, L.M.P., Dricot, J.M., Ascuitti, L.S. & D'Ans C. 1983. Xerophthalmia in the state of
Paraiba, northeast of Brazil: clinical findings. Am. J. Clin. Nutr. 38, 139-144.
Sichieri, R., Mathias, T. & Moura, A.S. 1996. Stunting, high weight-for-height, anemia and
dietary intake among Brazilian students from a rural community. Nutrition Research,
Vol. 16. No. 2, pp. 201-209.
Texeiea, D.E.T.A. 1998. Determinaco dos nveis sricos de retinol e ferro em criancas menores
de 5 anos na cidade de Belm. Universidade Federal do Par, Belm. Mimeo.
27
Torres M.A.de Almeida. 1992. Anaemia Carencial Ferropriva No Estado de So Paulo :

Situao Actual e Formas de Interveno- Secretaria do Estado da Sade So Paulo,
Brasil.
UN. 1998. World Urbanisation Prospects. 1996 Revision. United Nations Population Division.
New York.
UN. 1999. World Urbanisation Prospects Database 1950-2050. The 1998 Revision. United
Nations Population Division. New York.
UNDP (United Nations Development Programme). 1999. Human Development Report.
Oxford University Press. New York.
UNICEF. 1994. Diagnstico de sade materno infantil no estado de sergipe. Governo de
SERGIPE. Brazil.
UNICEF. 1995. Sade e Nutrico das Criancas Nordestinas. Pesquisas estaduais 1987-1992.
Brazil.
UNICEF. 1998. A Infncia Brasilera nos Anos 90. Braslia Brasil.
UNICEF. 2000. The state of the worlds children 2000. United Nations Childrens Fund.
Oxford University Press. New York.
USDA/FAS. 1999
WHO. 1982. Joint WHO/UNICEF/USAID/HKI/IVACG meeting. Control of vitamin A
deficiency and xerophthalmia. Jakarta, 1980. Report. Geneva, 1982. (WHO
Technical Report Series, 672).
WHO. 1983. Measuring change in nutritional status. Geneva, Switzerland
World Bank. 2000. The World Development Indicators 1999 CD-ROM. Win*STARS System
Version 4.0. World Bank, Washington, D.C.
World Bank. 2001. The World Development Indicators 2000 CD-ROM. Win*STARS System
Version 5.0. World Bank, Washington, D.C.
28
References of data presented in Table 1, unless otherwise stated:

Source:
Indicator:
FAOSTAT. 1999
A.1-2, B, C.10-11, E.1-3, F, G
UN. 1998/1999 rev.
C.1-9, D.5
World Bank. 1999.
D.1,
WB. 2001.
D.3-4
UNDP. 1997.
D.2
UNICEF. 2000.
D.6
SOFI. 1999.
29
NCP of BRAZIL
MAPS
- General map of Brazil.

- Map 1: Population density by state in 1996.
- Map 2: Prevalence of poverty by state in 1990 (hunger map).
- Map 3: Prevalence of underweight among children under five years of age by state in
1989-1992.
- Map 4: Prevalence of stunting among children less than five years of age by state in
1989-1992.
- Map 5: Prevalence of chronic energy deficiency among women of fertile age by MacroRegion in 1996.
General Map of Brazil
Boa Vista
Macapa
Belem
Manaus
#Fortaleza
#Teresina
Rio Branco
#Natal
#Joao Pessoa
#Recife
# Porto Velho
#Maceio
#Aracaju
Palmas
#Salvador
V&
Brasilia
# Cuiaba
#
#Goiania
Belo Horizonte
# Campo Grande
Main Rivers
Main Cities
# Vitoria
#
Rio de Janeiro
Sao Paulo
Curitiba
State
V&
# Florianopolis
Capital
Porto Alegre
N
W
E
S
Scale 1:28 000 000 (approx.)
FAO-GIS (SDRN)/ESNA, March 1998
Geographic Projection (Lat/Long)
The designations employed and the presentation of the material in the maps do not imply the expression
of any opinion whatsoever on the part of FAO concerning the legal or constitutional status of any country,
territory or sea area, or concerning the delimitation of frontiers.
Brazil
Map 1: Population density by State in 1996

Source: IBGE DPE/DEPIS, 1997
RORAIMA
AMAPA
AMAZONAS
PARA
CEARA
MARANHAO
RIO GRANDE DO NORTE
PARAIBA
PIAUI
PERNAMBUCO
ACRE
ALAGOAS
TOCANTINS
RONDONIA
SERGIPE
BAHIA
MATO GROSSO
GOIAS
V
&
MINAS GERAIS
Population / Km
MATO GROSSO DO SUL
ESPIRITO SANTO
0 - 9,9
SAO PAULO
10,0 - 49,9
RIO DE JANEIRO
50,0 - 99,9
100,0 - 199,9
>= 200,0
V
&
PARANA
SANTA CATARINA
Capital
RIO GRANDE DO SUL
N
W
E
S
Scale 1:28 000 000 (approx.)
Brazil
Map 2: Prevalence of poverty by state in 1990 (Hunger map)

Source: Peliano, 1993 (IPEA)
RORAIMA
87.293
AMAPA
105.320
MARANHAO
AMAZONAS
CEARA
PARA
5.127.772
6.427.695
2.573.571
1.419.603
RIO GRANDE DO NORTE
PARAIBA
2.312.310
3.236.088
PIAUI
PERNAMBUCO 7.181.242
2.633.200
ACRE
ALAGOAS
208.921
TOCANTINS
RONDONIA
2.418.107
SERGIPE
BAHIA
1.401.811
546.943
11.525.866
MATO GROSSO
1.718.408
GOIAS
4.900.216
V
&
MINAS GERAIS
15.606.971
MATO GROSSO DO SUL
% of food insecure
ESPIRITO SANTO
1.752.919
population
2.504.154
SAO PAULO
32.432.027
0 - 1.9
RIO DE JANEIRO
13.929.217
2.0 - 4.9
PARANA
5.0 - 9.9
9.096.924
10.0 - 14.9
SANTA CATARINA
No data available
4.437.013
V
&
RIO GRANDE DO SUL

9.020.119
Distrito Federal
N
W
Note: The State of Tocantins was still in 1990 part of the State of Goias.
E
S
Scale 1:28 000 000 (approx.)
Brazil
Map 3: Prevalence of underweight among children

less than 5 years by state in 1989-1992
Source: UNICEF, 1995
RORAIMA
AMAPA
AMAZONAS
PARA
CEARA
MARANHAO
RIO GRANDE DO NORTE
PARAIBA
PIAUI
PERNAMBUCO
ACRE
ALAGOAS
TOCANTINS
RONDONIA
SERGIPE
BAHIA
MATO GROSSO
GOIAS
V
&
MINAS GERAIS
MATO GROSSO DO SUL
ESPIRITO SANTO
SAO PAULO
% weight for age < -2 SD
RIO DE JANEIRO
< 5.0
5.0 - 9.9
PARANA
10.0 - 14.9
15.0 - 19.9
SANTA CATARINA
No data available
V
&
RIO GRANDE DO SUL
Capital
N
W
E
S
Scale 1:28 000 000 (approx.)
Brazil
Map 4: Prevalence of stunting among children

less than 5 years by state in 1989-1992
Source: UNICEF, 1995
RORAIMA
AMAPA
AMAZONAS
PARA
CEARA
MARANHAO
RIO GRANDE DO NORTE
PARAIBA
PIAUI
PERNAMBUCO
ACRE
ALAGOAS
TOCANTINS
RONDONIA
SERGIPE
BAHIA
MATO GROSSO
GOIAS
V
&
MINAS GERAIS
MATO GROSSO DO SUL
ESPIRITO SANTO
SAO PAULO
% height for age < -2 SD
RIO DE JANEIRO
< 5.0
5.0 - 9.9
PARANA
10.0 - 19.9
20.0 - 29.9
SANTA CATARINA
30.0 - 39.9
No data available
RIO GRANDE DO SUL
V
&
Capital
N
Note: State of CEARA
( 0-36 months )
E
S
Scale 1:28 000 000 (approx.)
Brazil
Map 5: Prevalence of chronic energy deficiency among women

of fertile age (*) by Macro-Region in 1996
Source: Bemfam, 1997
NORTE
NORDESTE
CENTRO-OESTE
V
&
CENTRO-LESTE
SAO PAULO
% BMI < 18.5 (kg/m)
RIO DE JANEIRO
2.5 - 4.9
5.0 - 6.9
7.0 - 9.9
No data available
V
&
SUL
Capital
N
(*) - mothers (15-49 years)
E
S
Scale 1:28 000 000 (approx.)
Brazil

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Nutrition Country Profiles BRAZIL - October, 2000 FAO Rome

FAO - NUTRITION COUNTRY PROFILES

FOOD AND AGRICULTURE ORGANIZATION OF

FOOD AND AGRICULTURE ORGANIZATION

Nutrition Country Profiles - BRAZIL

Note for the reader

The objective of the Nutrition Country Profiles (NCP) is to

Nutrition Country Profile of Brazil

Nutrition Country Profiles - BRAZIL

II. THE FOOD AND NUTRITION SITUATION ---------------------------------------------------------- 9

Nutrition Country Profiles - BRAZIL

TABLE 1: GENERAL STATISTICS OF BRAZIL

A. Land in use for agriculture

G. Average Food Supply

Dietary Energy Supply (DES)

Percentage of DES by major food groups

Meat & offals

Fish & seafood

Note: Value not indicated if below 1%

1. Total population "undernourished"

see References for data sources

Nutrition Country Profiles - BRAZIL

Nutrition Country Profiles - BRAZIL

Nutrition Country Profiles - BRAZIL

Nutrition Country Profiles - BRAZIL

Nutrition Country Profiles - BRAZIL

II. THE FOOD AND NUTRITION SITUATION

1. Trends in energy requirements and energy supplies

Percentage urban (%)

Per caput energy requirements (kcal/day)

Per caput DES (kcal/day) *

Total population (thousands)

*Three-year average calculated for 1964-66 and 1996-98 (Source: FAOSTAT)

Nutrition Country Profiles - BRAZIL

2. Trends in food supplies

Nutrition Country Profiles - BRAZIL

Figure 2: Supplies of major food groups (in kg/caput/year)

Cereals (excl. beer)

Pulses, nuts, oilcrops

Milk & Eggs

Nutrition Country Profiles - BRAZIL

Figure 3: Share of major food groups in Dietary Energy Supply

Cereals (excl. beer)

Pulses, nuts, oilcrops

Milk & products

Nutrition Country Profiles - BRAZIL

Cereals (excl. beer)

Nutrition Country Profiles - BRAZIL

Nutrition Country Profiles - BRAZIL

Table 3: Food consumption surveys

Average food intake

Major Food Groups (kg/caput/year)

Galeazzi et al. 1998 Rio de Janeiro

Milk products Sweeteners

Nutrient Intake (person/day)

Galeazzi et al. 1998 Rio de Janeiro

Share of major food groups in total energy intake (% kcal)

Milk products Sweeteners

Note: ... Data not available

4. Infant feeding practices

Nutrition Country Profiles - BRAZIL

Nutrition Country Profiles - BRAZIL

Nutrition Country Profiles - BRAZIL

Nutrition Country Profiles - BRAZIL