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Risk factors for overweight among Brazilian adolescents of low-income families: a case–control study

Published online by Cambridge University Press:  02 January 2007

Daniela Silveira
Affiliation:
Discipline of Nutrition & Metabolism, Department of Pediatrics, Federal University of São Paulo, Rua Loefgreen 1647, 04040-032São Paulo, SP, Brazil
José Augusto De Aguiar Carrazedo Taddei*
Affiliation:
Discipline of Nutrition & Metabolism, Department of Pediatrics, Federal University of São Paulo, Rua Loefgreen 1647, 04040-032São Paulo, SP, Brazil
Maria Arlete Meil Schimith Escrivão
Affiliation:
Discipline of Nutrition & Metabolism, Department of Pediatrics, Federal University of São Paulo, Rua Loefgreen 1647, 04040-032São Paulo, SP, Brazil
Fernanda Luisa Ceragioli Oliveira
Affiliation:
Discipline of Nutrition & Metabolism, Department of Pediatrics, Federal University of São Paulo, Rua Loefgreen 1647, 04040-032São Paulo, SP, Brazil
Fabio Ancona-Lopez
Affiliation:
Discipline of Nutrition & Metabolism, Department of Pediatrics, Federal University of São Paulo, Rua Loefgreen 1647, 04040-032São Paulo, SP, Brazil
*
*Corresponding author: Email [email protected] or [email protected]
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Abstract

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Objective

To study risk factors for overweight among Brazilian adolescents of low-income families.

Design

Case–control study of obese and non-obese adolescents.

Setting

Anthropometric survey including 1420 students (aged 14–19 years) attending a public high school in São Paulo, Brazil.

Methods

Selection of 83 overweight (body mass index (BMI) >85th percentile) and 89 non-overweight (BMI >5th percentile and <85th percentile) subjects, frequency-matched by age, gender, pubertal development and socio-economic status. Among the nutritional, familial and behavioural data available, five covariates (parents' obesity, adolescents' past obesity, to have a best friend, dietary restriction and habit of napping) were included in the fitted hierarchical conditional logistic regression models.

Measurements

Parents or guardians and adolescents were weighed, measured and answered a pre-tested questionnaire applied by trained nutritionists and paediatricians.

Results

The prevalence of overweight was 15.2%. As previous risks, obese parents and obesity during infancy presented odds ratios (OR) and 95% confidence intervals (CI) of 2.23 (1.15–4.35) and 3.60 (1.47–8.80), respectively. As concurrent factors, the habit of napping, to have a best friend and reported dietary restriction presented OR (95% CI) of 3.43 (1.32–8.92), 5.15 (1.76–15.07) and 7.26 (2.95–17.88), respectively. Dietary patterns, frequency of obesogenic foods and other physical activity indicators presented no statistical significance.

Conclusion

In case–control studies, OR may overestimate the true risks. Parents' obesity and previous childhood obesity were identified as risk factors; therefore these factors should be the target for preventive programmes and policies in order to prevent the burden of obesity in the near future.

Type
Research Article
Copyright
Copyright © The Authors 2006

References

1World Health Organization (WHO). Obesity: Preventing and Managing the Global Epidemic. Report of a WHO Consultation on Obesity. Geneva: WHO, 1998.Google Scholar
2Stettler, N. Comment: The global epidemic of childhood obesity: is there a role for the paediatrician?. Obesity Reviews 2004; 5(Suppl. 1): 13.Google Scholar
3National Center for Health Statistics. Overweight children and adolescents 6–19 years of age, according to sex, age, race, and Hispanic origin: United States, selected years 1963–65 through 1999–2000 [database]. Available at http://www.cdc.gov/nchs/data/hus/tables/2002/02hus071.pdf. Accessed 13 August 2004.Google Scholar
4Abrantes, MM, Lamounier, JA, Colosimo, EA. [Overweight and obesity prevalence in Northeast and Southeast regions of Brazil]. Revista da Associação Médica Brasileira 2003; 49(2): 162–6.Google Scholar
5Ribeiro, IC, Taddei, JAAC, Colugnati, F. Obesity among children attending elementary public schools in São Paulo, Brazil: a case–control study. Public Health Nutrition 2003; 6(7): 659–63.CrossRefGoogle Scholar
6Monteiro, PO, Victora, CG, Barros, FC, Monteiro, LM. Birth size, early childhood growth, and adolescent obesity in a Brazilian birth cohort. International Journal of Obesity and Related Metabolic Disorders 2003; 27(10): 1274–82.Google Scholar
7Wabitsch, M. Overweight and obesity in European children and adolescents: causes and consequences, treatment and prevention. An introduction. European Journal of Pediatrics 2000; 159(Suppl. 1): S5S7.Google Scholar
8Sobal, J, Stunkard, AJ. Socioeconomic status and obesity: a review of the literature. Psychological Bulletin 1989; 105(2): 260–75.Google Scholar
9Crespo, CJ, Ainsworth, BE, Keteyian, SJ, Heath, GW, Smit, E. Prevalence of physical inactivity and its relation to social class in US adults: results from the Third National Health and Nutrition Examination Survey, 1988–1994. Medicine and Science in Sports and Exercise 1999; 31(12): 1821–7.CrossRefGoogle ScholarPubMed
10Baghurst, KI, Record, SJ, Baghurst, PA, Syrette, JA, Crawford, D, Worsley, A. Sociodemographic determinants in Australia of the intake of food and nutrients implicated in cancer aetiology. Medical Journal of Australia 1990; 153(8): 444–52.CrossRefGoogle ScholarPubMed
11Jeffery, RW, French, SA. Socioeconomic status and weight control practices among 20- to 45-year-old women. American Journal of Public Health 1996; 86(7): 1005–10.Google Scholar
12Drewnowski, A, Specter, SE. Poverty and obesity: the role of energy density and energy costs. American Journal of Clinical Nutrition 2004; 79(1): 616.CrossRefGoogle ScholarPubMed
13McArthur, L, Pena, M, Holbert, D. Effects of socioeconomic status on the obesity knowledge of adolescents from six Latin American cities. International Journal of Obesity and Related Metabolic Disorders 2001; 25(8): 1262–8.Google Scholar
14Drewnowski, A, Popkin, BM. The nutrition transition: new trends in the global diet. Nutrition Reviews 1997; 55(2) 3143.CrossRefGoogle ScholarPubMed
15Monteiro, CA, D'A Benicio, MH, Conde, WL, Popkin, BM. Shifting obesity trends in Brazil. European Journal of Clinical Nutrition 2000; 54(4): 342–6.CrossRefGoogle ScholarPubMed
16da Veiga, GV, da Cunha, AS, Sichieri, R. Trends in overweight among adolescents living in the poorest and richest regions of Brazil. American Journal of Public Health 2004; 94(9): 1544–8.CrossRefGoogle ScholarPubMed
17Parsons, TJ, Power, C, Logan, S, Summerbell, CD. Childhood predictors of adult obesity: a systematic review. International Journal of Obesity and Related Metabolic Disorders 1999; 23(Suppl. 8): s1107.Google ScholarPubMed
18World Health Organization (WHO). Diet, Nutrition and the Prevention of Chronic Diseases. Technical Report Series No. 916 Geneva: WHO, 2003.Google Scholar
19Gortmaker, SL, Must, A, Perrin, JM, Sobol, AM, Dietz, WH. Social and economic consequences of overweight in adolescence and young adulthood. New England Journal of Medicine 1993; 329(14): 1008–12.Google Scholar
20DiPietro, L, Mossberg, HO, Stunkard, AJ. A 40-year history of overweight children in Stockholm: life-time overweight, morbidity, and mortality. International Journal of Obesity and Related Metabolic Disorders 1994; 18(9): 585–90.Google ScholarPubMed
21Must, A, Jacques, PF, Dallal, GE, Bajema, CJ, Dietz, WH. Long-term morbidity and mortality of overweight adolescents. A follow-up of the Harvard Growth Study of 1922 to 1935. New England Journal of Medicine 1992; 327(19): 1350–5.CrossRefGoogle ScholarPubMed
22Serdula, MK, Ivery, D, Coates, RJ, Freedman, DS, Williamson, DF, Byers, T. Do obese children become obese adults? A review of the literature. Preventive Medicine 1993; 22(2): 167–77.Google Scholar
23Power, C, Lake, JK, Cole, TJ. Measurement and long-term health risks of child and adolescent fatness. International Journal of Obesity and Related Metabolic Disorders 1997; 21(7): 507–26.CrossRefGoogle ScholarPubMed
24Power, C, Lake, JK, Cole, TJ. Body mass index and height from childhood to adulthood in the 1958 British born cohort. American Journal of Clinical Nutrition 1997; 66(5): 1094–101.Google Scholar
25Whitaker, RC, Wright, JA, Pepe, MS, Seidel, KD, Dietz, WH. Predicting obesity in young adulthood from childhood and parental obesity. New England Journal of Medicine 1997; 337(13): 869–73.CrossRefGoogle ScholarPubMed
26World Health Organization. Facts related to chronic diseases [online]. Available at http://www.who.int/dietphysicalactivity/publications/facts/chronic/en/. Accessed 16 August 2004.Google Scholar
27 Laval University. Economic cost of obesity [database]. Available at http://www.obesity.chair.ulaval.ca/IOTF.htm#Economic%20Cost. Accessed 21 May 2004.Google Scholar
28Kottke, TE, Wu, LA, Hoffman, RS. Economic and psychological implications of the obesity epidemic. Mayo Clinic Proceedings 2003; 78(1): 92–4.CrossRefGoogle ScholarPubMed
29Lobstein, T, Baur, L, Uauy, R. Obesity in children and young people: a crisis in public health. Obesity Reviews 2004; 5(Suppl. 1): 4104.CrossRefGoogle Scholar
30Must, A, Dallal, GE, Dietz, WH. Reference data for obesity: 85th and 95th percentiles of body mass index (wt/ht2) and triceps skinfold thickness. American Journal of Clinical Nutrition 1991; 53(4): 839–46.CrossRefGoogle ScholarPubMed
31Dean, AG, Dean, JA, Coulombier, D, Drendel, KA, Smith, DC, Burton, AH, et al. Epi-Info, Version 6.0: A Word Processing, Database, and Statistics Program for Epidemiology on Microcomputers. Atlanta, GA: Centers for Disease Control and Prevention, 1994.Google Scholar
32Stata Corporation. Stata Statistical Software, Release 7.0 [computer program]. College Station, TX: Stata Corporation, 2001.Google Scholar
33Victora, CG, Huttly, SR, Fuchs, SC, Olinto, MT. The role of conceptual frameworks in epidemiological analysis: a hierarchical approach. International Journal of Epidemiology 1997; 26(1): 224–7.CrossRefGoogle ScholarPubMed
34Mickey, RM, Greenlands, S. The impact of confounder selection criteria on effect estimation. American Journal of Epidemiology 1989; 129(1): 125–37.CrossRefGoogle ScholarPubMed
35Gama, CM. Consumo alimentar e estado nutricional de adolescentes matriculados em escolas da rede particular e estadual do bairro de Vila Mariana, São Paulo. Thesis, Universidade Federal de São Paulo, São Paulo, Brazil, 1999.Google Scholar
36von Der Heyde, R. Fatores de risco de doença arterial coronariana em adolescentes da rede de ensino de Curitiba, Paraná, e em seus familiars. Thesis, Universidade Federal de São Paulo, São Paulo, Brazil, 2001.Google Scholar
37Giuliano, ICB. Perfil lipídico em crianças e adolescentes da rede escolar de Florianópolis. Thesis, Universidade Federal de Santa Catarina, Florianópolis, Brazil, 2003.Google Scholar
38Neutzling, MB, Taddei, JA, Gigante, DP. Risk factors of obesity among Brazilian adolescents: a case–control study. Public Health Nutrition 2003; 6(7): 743–9.Google Scholar
39Stettler, N, Tershakovec, AM, Zemel, BS, Leonard, MB, Boston, RC, Katz, SH, et al. Early risk factors for increased adiposity: a cohort study of African American subjects followed from birth to young adulthood. American Journal of Clinical Nutrition 2000; 72(2): 378–83.Google Scholar
40Eriksson, J, Forsén, T, Osmond, C, Barker, D. Obesity from cradle to grave. International Journal of Obesity and Related Metabolic Disorders 2003; 27(6): 722–7.Google Scholar
41Hediger, ML, Overpeck, MD, Kuczmarski, RJ, Ruan, WJ. Association between infant breastfeeding and overweight in young children. Journal of the American Medical Association 2001; 285(19): 2453–60.Google Scholar
42Centers for Disease Control and Prevention, National Center for Health Statistics. Third National Health and Nutritional Examination Survey (NHANES III) [database]. Available at http://www.cdc.gov/nchs/products/elec_prods/subject/nhanes3.htm. Accessed 13 August 2004.Google Scholar
43von Kries, R, Koletzko, B, Sauerwald, T, von Mutius, E, Barnert, D, Grunert, V, et al. Breast feeding and obesity: cross sectional study. British Medical Journal 1999; 319(7203): 147–50.Google Scholar
44Birch, LL, Fisher, JO. Development of eating behaviors among children and adolescents. Pediatrics 1998; 101(3 Pt 2): 539–49.Google Scholar
45Lucas, A, Boyes, S, Bloom, SR, Aynsley-Green, A. Metabolic and endocrine responses to a milk feed in six-day-old term infants: differences between breast and cow's milk formula feeding. Acta Paediatrica Scandinavica 1981; 70(2): 195200.CrossRefGoogle ScholarPubMed
46Lopez-Alarcon, M, Garza, C, Habicht, JP, Martinez, L, Pegueros, V, Villalpando, S. Breastfeeding attenuates reductions in energy intake induced by a mild immunologic stimulus represented by DPTH immunization: possible roles of interleukin-1β, tumor necrosis factor-α and leptin. Journal of Nutrition 2002; 132(6): 1293–8.Google Scholar
47Magarey, AM, Daniels, LA, Boulton, TJ, Cockington, RA. Predicting obesity in early adulthood from childhood and parental obesity. International Journal of Obesity and Related Metabolic Disorders 2003; 27(4): 505–13.CrossRefGoogle ScholarPubMed
48Lluch, A, Herbeth, B, Mejean, L, Siest, G. Dietary intakes, eating style and overweight in the Stanislas Family Study. International Journal of Obesity and Related Metabolic Disorders 2000; 24(11): 1493–9.CrossRefGoogle ScholarPubMed
49Willett, WC. Nutritional Epidemiology. New York: Oxford University Press, 1998.CrossRefGoogle Scholar
50United Nations. Some options for improving nutrition in the 1990s. SCN News 1991; (Suppl. 7) [serial on the Internet]. Available at http://www.unsystem.org/scn/archives/scnnews07supplement/index.htm. Accessed 13 August 2004.Google Scholar
51Troiano, RP, Briefel, RR, Carroll, MD, Bialostosky, K. Energy and fat intakes of children and adolescents in the United States: data from the National Health and Nutrition Examination Surveys. American Journal of Clinical Nutrition 2000; 72(Suppl. 5): 1343S–53S.CrossRefGoogle ScholarPubMed
52Magarey, AM, Daniels, LA, Boulton, TJ. Prevalence of overweight and obesity in Australian children and adolescents: reassessment of 1985 and 1995 data against new standard international definitions. Medical Journal of Australia 2001; 174(11): 561–4.CrossRefGoogle ScholarPubMed
53Prentice, AM, Jebb, SA. Obesity in Britain: gluttony or sloth?. British Medical Journal 1995; 311(7002): 437–9.CrossRefGoogle ScholarPubMed
54Dollman, J, Olds, T, Norton, K, Stuart, D. The evolution of fitness and fatness in 10–11 year old Australian children: changes in distributional characteristics between 1985 and 1997. Pediatric Exercise Science 1999; 11: 108–21.Google Scholar
55Luke, A, Philpott, J, Brett, K, Cruz, L, Lun, V, Prasad, N, et al. . Physical inactivity in children and adolescents: CASM AdHoc Committee on Children's Fitness. Clinical Journal of Sport Medicine 2004; 14(5): 261–6.Google Scholar
56Torun, B. Physical activity patterns in Central America. In: Peña, M, Bacallao, J, eds. Obesity and Poverty: A New Public Health Challenge. PAHO Scientific Publication No. 576. Washington, DC: Pan American Health Organization, 2000; 3343.Google Scholar
57Barboza, ERC. Adolescência feminina e obesidade: estudo comparativo de aspectos biopsicossociais entre obesas e eutróficas, moradoras da região sul da cidade de São Paulo. Thesis, Faculdade de Medicina de Santo Amaro, São Paulo, Brazil, 2003.Google Scholar
58Falkner, NH, Neumark-Sztainer, D, Story, M, Jeffery, RW, Beuhring, T, Resnick, MD. Social, educational, and psychological correlates of weight status in adolescents. Obesity Research 2001; 9(1): 3242.Google Scholar
59Strauss, RS. Childhood obesity and self-esteem. Pediatrics 2000; 105(1): e15.Google Scholar