Secular trends and factors associated with overweight among Brazilian preschool children: PNSN-1989, PNDS-1996, and 2006/07

Silveira, Jonas Augusto C.; Colugnati, Fernando Antônio B.; Cocetti, Monize; Taddei, José Augusto A.C.

doi:10.1016/j.jped.2013.09.003

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Original articles • J. Pediatr. (Rio J.) 90 (02) • May-Jun 2014 • https://doi.org/10.1016/j.jped.2013.09.003 copy

Secular trends and factors associated with overweight among Brazilian preschool children: PNSN-1989, PNDS-1996, and 2006/07^☆ ☆ Please cite this article as: Silveira JA, Colugnati FA, Cocetti M, Taddei JA. Secular trends and factors associated with overweight among Brazilian preschool children: PNSN-1989, PNDS-1996, and 2006/07. J Pediatr (Rio J). 2014;90:258-66.

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE:

to describe the secular trends in overweight among preschool children in the years 1989, 1996, and 2006, and to identify risk factors associated with this condition in 2006.

METHODS:

anthropometric data from three surveys (1989, 1996, and 2006) with a representative sample of the population were analyzed. Overweight was defined as the weight-for-height Z-score. The multivariable models of overweight association with risk factors were generated by Poisson regression, and the estimates were shown as prevalence ratios with their respective 95% confidence intervals (PR [95% CI]).

RESULTS:

throughout the 17-year period studied, the relative prevalence of overweight in preschoolers increased by 160% in Brazil, representing an increase of 9.4% per year. Based on data from the National Survey on Demography and Health of Women and Children - 2006/07, four multivariable models were created (macro-environmental, maternal, individual, and final model) assuming hierarchy among the risk factors. In the final model, only the following remained associated with overweight: regions South/Southeast (1.55 [1.17 to 2.06]), middle-class (1.35 [1.02 to 1.77]), maternal obesity (1.66 [1.22 to 2.27]), birth weight > 3.9 kg (1.87 [1.31 to 2.67]), and being an only child or having only one sibling (1.81 [1.31 to 2.49]).

CONCLUSION:

the prevalence of overweight among preschool children in Brazil has increased dramatically over the past 17 years, and it was higher in the 1996-2006 period. Future strategies for prevention and control of overweight in public health should focus or intensify actions in communities that are characterized by the presence of the risks identified in the present study.

Preschooler; Overweight; Obesity; Epidemiological surveys; Nutritional epidemiology; Brazil

Characteristics	n ^a	µ or P ^b	95% CI	Characteristics	n	µ or P ^b	95% CI
Age (months)	2,908	41.5	40.9; 42.1	Region (%)	2,908
3 years (%)	975	33.6	30.8; 36.5	S and SE	1,166	54.9	50.7; 59.1
4 years (%)	980	33.8	31.0; 36.8	N, NE and MW	1,742	45.1	40.9; 49.3
5 years (%)	953	32.6	30.1; 35.1	Area of residency (%)	2,908
Gender (%)	2,908			Urban	1,869	79.9	75.6; 83.7
Males	1,493	52.2	49.0; 55.3	Rural	1,039	20.1	16.3; 24.4
Females	1,415	47.8	44.7; 51.0	Economic class (%)	2,908
Birth weight (kg)	2,774	3.25	3.22; 3.28	A1 - B2, D and E	1,789	60.6	57.1; 63.9
WHZ ^c	2,635	0.61	0.55; 0.66	C1 - C2	1,119	39.4	36.1; 42.9
WAZ ^c	2,687	0.08	0.02; 0.14	Maternal age ^e (%)	2,908
HAZ ^c	2,652	-0.42	-0.50; -0.34	< 21 years	720	26.6	23.7; 29.8
Nutritional status ^d (%)	2,635			≥ 21 years	2,188	73.3	70.2; 76.3
Underweight (<-2SD)	17	0.6	0.3; 1.3	Maternal obesity (%)	2,874
Normal weight (±2SD)	2,406	91.6	89.8; 93.2	≤ 30 kg/m²	2,415	84.3	81.7; 86.6
Overweight (>+2SD)	212	7.8	6.3; 9.5	> 30 kg/m²	459	15.7	13.4; 18.3
Number of siblings (%)	2,908			Maternal education (%)	2,887
Up to 1 sibling	1,774	70.6	67.3; 73.8	< 7 years	1,311	37.5	34.1; 41.1
> 1 sibling	1,134	29.4	26.2; 32.7	≥ 7 years	1,576	62.5	58.9; 65.9
Number of TV sets (%)	2,908			Exclusive BF (%)	2,779
≤ 1 TV set	2,245	72.4	68.2; 76.2	≤ 150 days	1,841	63.7	60.4; 66.8
> 1 TV set	663	27.6	23.7; 31.8	> 150 days	938	36.3	33.2; 39.6
FFQ soft drinks or artificial juice (%)	2,874			FFQ soft drinks or artificial juice and fried foods (%)	2,851
< four days/weeks	1,876	62.8	58.9; 66.6	< four days/week	2,653	91.3	88.9; 93.1
≥ four days/week	998	37.2	33.4; 41.1	≥ four days/week	198	8.7	6.9; 11.1
FFQ fried foods (%)	2,856
< four days/week	2,496	86.4	83.7; 88.7
≥ four days/week	360	13.6	11.3; 16.3

Variables	References	n/t ^a	Overweight ^b		Bivariate analysis
			P (%)	95% CI	PR	95% CI	p
Macro-environmental
Region	S and SE	111/1,041	8.9	6.7; 11.8	1.68	1.29; 2.19	0.000
	N, NE, and MW	101/1,594	6.4	4.9; 8.5	1
Area of residency	Urban	144/1,689	8.2	6.5; 10.2	1.19	0.88; 1.59	0.252
	Rural	68/946	6.3	4.1; 9.4	1
Socioeconomic class	C1 and C2	102/1,013	8.7	6.6; 11.4	1.48	1.13; 1.95	0.004
	A1 - B2, D and E	110/1,622	7.2	5.3; 9.6	1

Maternal
Maternal age (at birth)	< 21 years	46/659	6.4	3.9; 10.3	0.83	0.61; 1.13	0.233
	≥ 21 years	166/1,976	8.3	6.6; 10.4	1
Maternal education	≥ seven years	133/1,415	8.8	6.8; 11.4	1.45	1.10; 1.89	0.008
	< seven years	78/1,200	6.2	4.5; 8.5	1
Maternal obesity	BMI > 30 kg/m²	53/364	10.9	7.1; 16.4	1.78	1.32; 2.40	0.000
	BMI ≤ 30 kg/m²	157/2,045	7.1	5.6; 9.0	1

Individual
Gender	Male	112/1,329	6.8	5.1; 9.1	1.10	0.85; 1.43	0.471
	Female	100/1,306	8.8	6.6; 11.5	1
Birth weight	≥ 3.9 kg	30/209	14.2	8.5; 22.8	1.64	1.15; 2.34	0.007
	< 3.9 kg	175/2,111	7.2	5.7; 8.9	1
Number of siblings	Up to one sibling	155/1,595	8.5	6.7; 10.7	1.77	1.30; 2.41	0.000
	More than one sibling	57/1,040	6.1	3.9; 9.3	1
Number of TV sets	> one TV set	62/589	8.4	5.6; 12.5	1.44	1.07; 1.93	0.017
	≤ one TV set	150/2,046	7.5	5.9; 9.6	1
Exclusive BF	< 150 days	145/1,683	8.1	6.2; 10.4	1.30	0.95; 1.77	0.095
	≥ 150 days	56/845	6.9	4.7; 9.9	1
FFQ soft drinks or artificial juice	≥ four days/week	94/911	9.1	6.5; 12.6	1.49	1.14; 1.94	0.003
	< four days/week	118/1,704	7.1	5.5; 9.1	1
FFQ fried foods	≥ four days/week	35/328	10.1	6.0; 16.4	1.40	0.99; 1.97	0.053
	< four days/week	173/2,269	7.4	5.9; 9.2	1
FFQ soft drinks and fried foods	≥ four days/week	22/176	10.8	5.4; 20.3	1.62	1.06; 2.48	0.025
	< four days/week	186/2,417	7.2	6.1; 9.3	1

Variables	References	Model 1			Model 2			Model 3 ^a			Model 4 ^a
		PR	95% CI	p	PR	95% CI	p	PR	95% CI	p	PR	95% CI	p
Macro-environmental
Region	S and SE	1.63	1.25; 2.12	0.000							1.55	1.17; 2.06	0.002
Socioeconomic class	C1 and C2	1.42	1.08; 1.86	0.012							1.35	1.02; 1.77	0.034

Maternal
Maternal education	≥ SEVEN years				1.50	1.15; 1.97	0.003
Maternal obesity	BMI > 30 kg/m²				1.87	1.39; 2.52	0.000				1.66	1.22; 2.27	0.001

Individual
Birth weight	≥ 3.9 kg							1.91	1.35; 2.72	0.000	1.87	1.31; 2.67	0.001
Number of siblings	Up to ONE sibling							1.85	1.35; 2.55	0.000	1.81	1.31; 2.49	0.000
FFQ soft drinks and artificial juice	≥ four days/week							1.36	1.03; 1.79	0.030

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