The nutrition transition in amazonia: rapid economic change and its impact on growth and development in Ribeirinhos.

The goal of this longitudinal study was to assess the impact of economic change and increased market integration on subsistence strategies, living conditions, growth, and nutritional status of Ribeirinhos living in the rural Amazon, Brazil. Data on weight, height, skinfolds, and circumferences, as well as data on economic strategies and living conditions were collected from 469 individuals in 2002 and 429 in 2009. Of these, 204 individuals were measured on both occasions. Independent and paired t-tests were used to identify changes in nutritional status over time in the larger sample and smaller, longitudinal subsample, respectively. Multiple linear regressions were used to examine the relationship between changes in economic/living conditions and nutritional status in the longitudinal subsample. Results indicate modest improvements in linear growth (HAZ) and among male children the observed increase was related to enrollment in the Brazilian conditional cash transfer program, Bolsa Família (P = 0.03). In terms of short-term measures of nutritional status, we found a significant increase in ZTSF and a reduction in ZUMA in most age/sex groups. Among subadults, there was a negative relationship between ZUMA and access to electricity (P = 0.01) and positive relationship between ZUMA and the sale of the açaí fruit (P = 0.04). Significant changes in weight and BMI (P < 0.01) were found among adult females and both were negatively related to household cash income (P = 0.02 and P = 0.03, respectively). Despite significant changes in economic strategies and lifestyle, changes in nutritional status were modest which may be explained by increased food insecurity documented during this early stage of transition.