Prevalence of abdominal obesity in adolescents: association between sociodemographic factors and lifestyle

Castro, João Antônio Chula; Nunes, Heloyse Elaine Gimenes; Silva, Diego Augusto Santos

doi:10.1016/j.rppede.2016.01.007

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ORIGINAL ARTICLES • Rev. paul. pediatr. 34 (3) • Jul-Sep 2016 • https://doi.org/10.1016/j.rppede.2016.01.007 copy

Prevalence of abdominal obesity in adolescents: association between sociodemographic factors and lifestyle

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To estimate the prevalence of abdominal obesity and verify the association with sociodemographic factors (gender, school shift, ethnicity, age, maternal education and economic status) and lifestyle (alcohol consumption, sleep, soft drink consumption, level of physical activity and sedentary behavior) in adolescents in Southern Brazil.

Methods:

This was a cross-sectional epidemiological study of 930 adolescents (490 girls) aged 14–19 years, living in the city of São José, SC, Brazil. A self-administered questionnaire was used to collect sociodemographic and lifestyle data. Abdominal obesity was measured through the waist circumference and analyzed according to gender and age. Descriptive statistics (absolute and relative frequency, mean and standard deviation) and binary logistic regression, expressed as Odds Ratios (OR) and 95% confidence interval (95%CI) were employed, with p<0.05 being considered statistically significant; the SPSS 17.0 software was used for the statistical analyses.

Results:

The prevalence of abdominal obesity was 10.6% for the total sample (10.5% male, 10.8% female). Adolescents that watched television daily for two or more hours (OR=2.11, 95%CI 1.08–4.13) had a higher chance of having abdominal obesity and adolescents whose mothers had fewer than eight years of schooling (OR=0.56; 95%CI from 0.35 to 0.91) had a lower chance of having abdominal obesity.

Conclusions:

Approximately one in 10 adolescents had abdominal obesity; the associated factors were maternal schooling (≥8 years) and television screen time (≥2h/day).

KEYWORDS
Waist circumference; Lifestyle; Anthropometry; Epidemiology; Adolescent health; Public health

Type	Variables	Instrument/Question	Categorization
Dependent	Waist circumference	Anthropometric tape	Cutoff points
			Female:	Male:
			14 years≥77	14 years≥79
			15 years≥78.3	15 years≥81.1
			16 years≥79.1	16 years≥83.1
			17 years≥79.8	17 years≥84.9
			18 years≥80.1	18 years≥86.7
			19 years≥80.1	19 years≥88.4
			<Cutoff point=Normal
			Cutoff points=Abdominal obesity³3 Taylor RW, Jones IE, Williams SM, Goulding A. Evaluation of waist circumference, waist-to-hip ratio, and the conicity index as screening tools for high trunk fat mass, as measured by dual-energy X-ray absorptiometry, in children aged 3-19 y. Am J Clin Nutr. 2000;72:490-495.

Independents	Sex	What is your sex?	Female/Male
	Skin color	The Brazilian census uses the words white, brown, black, yellow and indigenous to classify the color or race of people. If you had to answer this question, how would you rate yourself about your color or ethnicity?	White
	Skin color		Black/Brown/Yellow/Indigenous¹⁵15 World Health Organization [homepage on the Internet]. Handbook on health inequality monitoring with a special focus on low-and middle-income countries. Available from: http://www.who.int/gho/health_equity/handbook/en/ http://www.who.int/gho/health_equity/handbook/en/ [cited 28.07.15]. http://www.who.int/gho/health_equity/han...
	Age	How old are you?	14-16 years
	Age	How old are you?	17-19 years[30]
	Maternal education	What is the level of education completed by your mother?	<8 years
	Maternal education	What is the level of education completed by your mother?	≥8 years¹⁶16 United Nations [homepage on the Internet]. Human development report 2014. Sustaining human progress: reducing vulnerabilities and building resilience 2014. Available from: http://www.uy.undp.org/content/dam/undp/library/corporate/HDR/2014HDR/HDR-2014-English.pdf http://www.uy.undp.org/content/dam/undp/library/corporate/HDR/2014HDR/HDR-2014-English.pdf [cited 28.07.15]. http://www.uy.undp.org/content/dam/undp/...
	Economic level	What is the monthly income of your family (the current minimum wage is R$724)?¹⁷17 Associação das Empresas de Pesquisa [homepage on the Internet]. Critério de Classificação Econômica Brasil 2014. Available from: http://www.abep.org/codigos-e-guias-da-abep http://www.abep.org/codigos-e-guias-da-abep [cited 28.07.15]. http://www.abep.org/codigos-e-guias-da-a...	A/B=High
	Economic level		C/D/E=Low⁹9 Glaner MF, Pelegrini A, Cordoba CO, Pozzobon ME. Associação entre insatisfação com a imagem corporal e indicadores antropométricos em adolescentes. Rev Bras Educ Fis Esporte. 2013;27:129-136.
	School shift	What is your school shift?	Morning/Afternoon/Full day=Day
	School shift	What is your school shift?	Evening=Evening
	Physical activity	During a typical week, on how many days you practice moderate to vigorous physical activity (physical activity during leisure time, at work, and going to school)?¹⁸18 Guedes DP, Lopes CC. Validação da versão brasileira do youth risk behavior survey. Rev Saude Publica. 2010;44:840-850.	<5 days=Insufficiently active
	Physical activity		≥5 days=Active¹⁹19 Tremblay MS, Leblanc AG, Janssen I, Kho ME, Hicks A, Murumets K, et al. Canadian sedentary behaviour guidelines for children and youth. Appl Physiol Nutr Metab. 2011;36:5-71.
	Alcohol consumption	During the last 30 days, on how many days did you drink five or more alcoholic beverages in a single occasion?¹⁸18 Guedes DP, Lopes CC. Validação da versão brasileira do youth risk behavior survey. Rev Saude Publica. 2010;44:840-850.	No day=No
	Alcohol consumption		≥1 day=Yes²⁹29 National Health and Medical Research Council. Australian guidelines to reduce health risks from drinking alcohol. Available from: http://www.nhmrc.gov.au/ http://www.nhmrc.gov.au/ [cited 28.07.2015]. http://www.nhmrc.gov.au/...
	Soft drink consumption	During the last 7 days, how many times did you drink a bottle, can or glass of soda such as Coca-Cola, Fanta, Sprite, Pepsi and Pureza? (Do not consider diet and light soft drinks)¹⁸18 Guedes DP, Lopes CC. Validação da versão brasileira do youth risk behavior survey. Rev Saude Publica. 2010;44:840-850.	I did not drink soft drinks in the last 7 days=No
	Soft drink consumption		Other options=Yes¹²12 Gómez-Martínez S, Martínez-Gómez D, Perez de Heredia F, Romeo J, Cuenca-Garcia M, Martin-Matillas M, et al. Eating habits and total and abdominal fat in Spanish adolescents: influence of physical activity. J Aadolesc Health. 2012;50:403-409.
	Sleep	Do you sleep well and feel rested?²⁰20 Rodriguez Anez CR, Reis RS, Petroski EL. Brazilian version of a lifestyle questionnaire: translation and validation for young adults. Arq Bras Cardiol. 2008;91:92-98.	Almost never/Rarely/Sometimes=No
	Sleep		With relative frequency/Almost always=Yes²⁰20 Rodriguez Anez CR, Reis RS, Petroski EL. Brazilian version of a lifestyle questionnaire: translation and validation for young adults. Arq Bras Cardiol. 2008;91:92-98.
	TV Time	How many hours per day do you watch TV on school days (Monday to Friday)?	<2h/≥2h¹⁹19 Tremblay MS, Leblanc AG, Janssen I, Kho ME, Hicks A, Murumets K, et al. Canadian sedentary behaviour guidelines for children and youth. Appl Physiol Nutr Metab. 2011;36:5-71.
	TV Time	How many hours per day do you watch TV on weekends (Saturday and Sunday)?
	Computer time	How many hours per day do you use the computer on school days (Monday to Friday)?	<2h/≥2h¹⁹19 Tremblay MS, Leblanc AG, Janssen I, Kho ME, Hicks A, Murumets K, et al. Canadian sedentary behaviour guidelines for children and youth. Appl Physiol Nutr Metab. 2011;36:5-71.
	Computer time	How many hours per day do you use computer on weekends (Saturday and Sunday)?
	Video game time	How many hours per day you play video games on school days (Monday to Friday)?	<2h/≥2h¹⁹19 Tremblay MS, Leblanc AG, Janssen I, Kho ME, Hicks A, Murumets K, et al. Canadian sedentary behaviour guidelines for children and youth. Appl Physiol Nutr Metab. 2011;36:5-71.
	Video game time	How many hours per day you play video games on weekends (Saturday and Sunday)?
	Total screen time	Total	<4hours/≥4hours²¹21 De Moraes AC, Fernandes CAM, Elias RGM, Makashima ATA, Reichert FF, Falcão MC. Prevalência de inatividade física e fatores associados em adolescentes. Rev Assoc Med Bras. 2009;55:523-528.^,²²22 Da Silva KS, Nahas MV, Peres KG, Lopes Ada S. Factors associated with physical activity, sedentary behavior, and participation in physical education among high school students in Santa Catarina State, Brazil. Cad Saude Publica. 2009;25:2187-2200.
	Travel to school	How do you usually travel to school?	Walking/biking=Active
	Travel to school	How do you usually travel to school?	Car or motorcycle/bus=Passive²²22 Da Silva KS, Nahas MV, Peres KG, Lopes Ada S. Factors associated with physical activity, sedentary behavior, and participation in physical education among high school students in Santa Catarina State, Brazil. Cad Saude Publica. 2009;25:2187-2200.

Variables	Sample	Waist circumference	p-value	Abdominal obesity	p-value
	n (%)	M±SD		n (%)
Total	930	71.5±8.0		99 (10.6)
Sex
Male	440 (47.3)	73.8±7.7		46 (10.5)
Female	490 (52.7)	69.4±7.6	<0.01^a a p≤0.05; Mann-Whitney U test for independent samples.	53 (10.8)	0.85

Skin color
White	574 (62.7)	71.0±7.7		56 (9.8)
Black/brown/yellow/red	342 (37.3)	72.0±8.3	0.09	41 (12.0)	0.28

Age (years)
14-16	539 (58.0)	70.6±7.7		54 (10.0)
17-19	391 (42.0)	72.7±8.2	<0.01^a a p≤0.05; Mann-Whitney U test for independent samples.	45 (11.5)	0.46

Maternal education
<8 years	518 (56.4)	71.3±8.0		49 (9.5)
≥8 years	400 (43.6)	71.7±8.0	0.38	50 (12.5)	0.14

Economic level
High	537 (68.2)	71.5±7.7		51 (9.5)
Low	250 (31.8)	71.2±8.6	0.32	31 (12.4)	0.21

School shift
Day	644 (69.8)	70.8±7.9		66 (10.2)
Evening	278 (30.2)	72.9±8.0	<0.01^a a p≤0.05; Mann-Whitney U test for independent samples.	33 (11.9)	0.46

Variables	Sample	Waist circumference	p-value	Abdominal obesity	p-value
	n (%)	M±SD		n (%)
Total	930	71.5±8.0		99 (10.6)
Physical activity
Insufficiently active	832 (92.1)	71.5±8.1		94 (11.3)
Active	71 (7.9)	72.0±6.7	0.30	5 (7.0)	0.27

Alcohol consumption
Não	610 (66.1)	70.9±7.9		61 (10.0)
Sim	313 (33.9)	72.4±8.1	0.01^a a p≤0.05; Mann-Whitney U test for independent samples.	38 (12.1)	0.32

Soft drink consumption
Não	143 (15.9)	72.2±8.7		21 (14.7)
Sim	754 (84.1)	71.3±7.9	0.45	78 (10.3)	0.12

Sleep (sleep well)
Não	559 (61.4)	71.3±8.0		58 (10.4)
Sim	351 (38.6)	71.7±7.9	0.62	39 (11.1)	0.72

TV time
<2h	192 (21.4)	71.6±7.3		15 (7.8)
≥2h	705 (78.6)	71.4±8.3	0.23	84 (11.9)	0.08

Computer time
<2h	281 (31.3)	71.6±8.7		36 (12.8)
≥2h	616 (68.7)	71.4±7.8	0.83	63 (10.2)	0.29

Video game time
<2h	646 (72.0)	71±7.9		72 (11.1)
≥2h	251 (28.0)	72.6±8.3	0.01^a a p≤0.05; Mann-Whitney U test for independent samples.	27 (10.8)	0.85

Total screen time
<4h	115 (12.8)	70.7±7.9		13 (10.3)
≥4h	782 (87.2)	71.6±8.1	0.41	86 (11.0)	0.86

Travel to school
Active	448 (49.9)	71.2±7.8		43 (9.6)
Passive	449 (50.1)	71.7±8.3	0.58	56 (12.5)	0.17

	Crude analysis		Adjusted analysis^a a Adjusted analysis for all independent variables.
	OR (CI)	p-value	OR (CI)	p-value
Sex ^b b Distal level to outcome variables.		0.70		0.71
Male	1		1
Female	0.90 (0.53-1.53)		1.08 (0.70-1.65)

Skin color ^b b Distal level to outcome variables.		0.10		0.28
White	1		1
Black/brown/yellow/red	1.50 (0.92-2.45)		1.26 (0.82-1.93)

Age (years) ^b b Distal level to outcome variables.		0.44		0.49
14-16	0.82 (0.50-1.35)		0.86 (0.56-1.31)
17-19	1		1

Maternal education ^c c Intermediate level variables.		0.04^d d p≤0.05.		0.02^d d p≤0.05.
<8 years	0.59 (0.35-0.98)		0.56 (0.35-0.91)
≥8 years	1		1

Economic level ^c c Intermediate level variables.		0.06		0.07
High	1		1
Low	1.65 (0.97-2.78)		0.64 (0.39-1.06)

Shift ^c c Intermediate level variables.		0.45		0.49
Day	1		1
Evening	1.22 (0.72-2.07)		1.18 (0.72-1.93)

Physical activity ^e e Proximal level to outcome variables.		0.66		0.71
Insufficiently active	1.24 (0.46-3.35)		1.19 (0.45-3.15)
Active	1		1

Alcohol consumption ^e e Proximal level to outcome variables.		0.56		0.37
No	1		1
Yes	1.16 (0.69-1.93)		1.24 (0.76-2.03)

Soft drink consumption ^e e Proximal level to outcome variables.		0.08		0.11
No	1		1
Yes	0.57 (0.30-1.07)		0.62 (0.34-1.12)

Sleep (sleep well) ^e e Proximal level to outcome variables.		0.34		0.46
No	0.78 (0.47-1.29)		0.83 (0.51-1.35)
Yes	1		1

TV time ^e e Proximal level to outcome variables.		0.10		0.02^d d p≤0.05.
<2h	1		1
≥2h	1.82 (0.88-3.73)		2.11 (1.08-4.13)

Computer time ^e e Proximal level to outcome variables.		0.09		0.09
<2h	1		1
≥2h	0.61 (0.35-1.08)		0.66 (0.40-1.07)

Video game time ^e e Proximal level to outcome variables.		0.57		0.78
<2h	1		1
≥2h	0.84 (0.46-1.52)		0.92 (0.53-1.60)

Total screen time ^e e Proximal level to outcome variables.		0.44		0.54
<4h	1		1
≥4h	1.40 (0.59-3.36)		1.29 (0.55-3.01)

Travel to school ^e e Proximal level to outcome variables.		0.06		0.09
Active	1		1
Passive	1.60 (0.97-2.65)		1.51 (0.93-2.44)

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[1] * Corresponding author. E-mail:diegoaugustoss@yahoo.com.br (D.A. Silva).