Acessibilidade / Reportar erro

Prevalence and factors associated with excess body weight in adolescents

Abstract

Objective

Analyze the prevalence of excess body weight in adolescents and associated factors.

Methods

Cross-sectional study involving 635 adolescents, male and female, between 10 and 16 years of age, in state-owned public schools. A multidisciplinary team collected the data in the second semester of 2016. Data on demographics, family history, pubertal development and behavioral habits were collected. The adolescents were classified by their nutritional status. Bivariate analysis and Poisson hierarchical multiple regression were applied, which revealed the association and the prevalence ratio between excess body weight and the other variables.

Results

The prevalence of excess weight was 32.8% of the adolescents, associated with a family history of dyslipidemia (p=0.003; PR=1.474; 95%CI=1.139-1.907) and alcohol consumption (p=0.044; PR=1.430; 95%CI= 1.009-2.028). The remaining variables in this research were not associated with excess body weight.

Conclusion

High prevalence rates of excess body weight were found among the adolescents, associated with a family history of dyslipidemia and alcohol consumption.

Overweight; Obesity; Adolescent; Risk factors; Prevalence

Resumo

Objetivo

Analisar a prevalência de excesso de peso corporal em adolescentes e fatores associados.

Métodos

Estudo transversal conduzido com 635 adolescentes de ambos os sexos, com idade entre 10 e 16 anos, em escolas públicas estaduais. A coleta de dados foi realizada no segundo semestre de 2016 por uma equipe multidisciplinar. Coletou-se dados demográficos, da história familiar, desenvolvimento púbere e hábitos comportamentais. Foi feita a classificação dos adolescentes, conforme o estado nutricional. Utilizou-se a análise bivariada e a regressão múltipla hierarquizada de Poisson, o que possibilitou verificar a associação do excesso de peso corporal com as demais variáveis, bem como a razão de prevalência entre elas.

Resultados

A prevalência de excesso de peso foi de 32,8% dos adolescentes, associada a história familiar de dislipidemia (p=0,003; RP=1,474; IC95%= 1,139-1,907) e a ingestão de álcool (p=0,044; RP=1,430; IC95%= 1,009-2,028). As demais variáveis neste estudo não foram associadas ao EPC.

Conclusão

Verificou-se altas prevalências de excesso de peso corporal entres os adolescentes, associadas à história familiar de dislipidemia e ingestão de álcool.

Sobrepeso; Obesidade; Adolescente; Fatores de risco; Prevalência

Resumen

Objetivo

analizar la prevalencia del exceso de peso corporal en adolescentes y factores asociados.

Métodos

estudio transversal realizado con 635 adolescentes de ambos sexos, entre 10 y 16 años de edad, en escuelas públicas provinciales/departamentales. La recolección de datos fue realizada en el segundo semestre de 2016 por un equipo multidisciplinario. Se recolectaron datos demográficos, antecedentes familiares, desarrollo de la pubertad y hábitos de comportamiento. Los adolescentes fueron clasificados según su estado nutricional. Se utilizó el análisis bivariado y la regresión múltiple jerárquica de Poisson, lo que posibilitó verificar la asociación del exceso de peso corporal con las demás variables, así como el motivo de prevalencia.

Resultados

se observó la prevalencia del exceso de peso en el 32,8% de los adolescentes, asociada a los antecedentes familiares de dislipidemia (p=0,003; RP=1,474; IC95%= 1,139-1,907) y a la ingesta de alcohol (p=0,044; RP=1,430; IC95%= 1,009-2,028). Las demás variables de este estudio no fueron asociadas al EPC.

Conclusión

se verificó una alta prevalencia de exceso de peso corporal entre los adolescentes, relacionada con antecedentes familiares de dislipidemia e ingesta de alcohol.

Sobrepeso; Obesidad; Adolescente; Factores de riesgo; Prevalencia

Introduction

Obesity is characterized by the atypical and excessive accumulation of body fat, damaging people’s health and quality of life as it is related to higher early morbidity and mortality.11. World Health Organization (WHO). Obesity and overweight [Internet]. Genève:WHO; 2017. [cited 2017 Aug 02]. Available from: http://www.who.int/mediacentre/factsheets/fs311/en/.
http://www.who.int/mediacentre/factsheet...
It is currently a relevant global public health concern and, amidst this scenario, the prevalence of excess body weight (EBW) in children and adolescents is also increasing, entailing health risks.22. Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384:766–81.

In view of this reality, we found that adolescents with EBW are more prone to systemic arterial hypertension (SAH), dyslipidemias, metabolic syndrome, diabetes (DM), depression, low self-esteem, low academic performance and low quality of life. Likewise, these adolescents may become overweight adults with increased chances of morbidity and mortality due to cardiovascular diseases (CVD) and some types of cancer.33. Reilly JJ, Kelly J. Long-term impact of overweight and obesity in childhood and adolescence on morbidity and premature mortality in adulthood: systematic review. Int J Obes (Lond). 2011;35(7):891-8.

In the United States, 17% of young people were obese in 2011-2014. The prevalence of obesity among children (6-11 years) amounted to 17.5% and among adolescents (12-19 years) 20.5%.44. Ogden CL, Carroll MD, Fryar CD, Flegal KM. Prevalence of obesity among adults and youth: United States, 2011-2014. NCHS Data Brief. 2015;(219):1-8. In Sri Lanka, the prevalence of overweight among adolescents was 11.0% and obesity 2.4%; in India, 19.0% of overweight and, in Pakistan, 11.0% of obesity.55. Jayawardena R, Ranasinghe P, Wijayabandara M, Hills AP, Misra A. Nutrition Transition and Obesity Among Teenagers and Young Adults in South Asia. Curr Diabetes Rev. 2017;13(5):444–51 In Brazil, approximately 23.7% of adolescents suffered from EBW, and 8.3% of male and 3% of female adolescents were obese.66. Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa de orçamentos familiares 2008-2009 [Internet]. Rio de Janeiro: IBGE: 2010. [citado 2017 Ago 2]. Disponível em: https://biblioteca.ibge.gov.br/visualizacao/livros/liv50063.pdf . Portuguese.
https://biblioteca.ibge.gov.br/visualiza...
In the Brazilian Southeast, in a recent systematic review of overweight and obesity rates in children and adolescents in the Brazilian macro-regions, the prevalence was 41.3%, lower only than in the South (43.8%).77. Guimarães Junior MS, Fraga AS, Araújo TB, Tenório MC. [Cardiovascular risk factor: obesity between children and adolescents in the brazilian macroregions]. Rev Bras Obes Nutr Emagrec. 2018;12(69):132-42. Portuguese.

The EBW is notorious for its multifactorial etiology, and seems to be more strongly associated with behavioral than biological factors,88. Wadden TA, Brownell KD, Foster GD. Obesity: Responding to the global epidemic. J Consult Clin Psychol. 2002;70(3):510-25. suggesting lifestyle as a determinant factor of health status,88. Wadden TA, Brownell KD, Foster GD. Obesity: Responding to the global epidemic. J Consult Clin Psychol. 2002;70(3):510-25.,99. Janssen I, Katzmarzyk PT, Boyce WF. Comparison of overweight and obesity prevalence in school-aged youth from 34 countries and their relationship with physical activity and dietary patterns. Obes Rev. 2005; 6(2):123-32. as well as the family, social and school environments.1010. Reilly JJ. Descriptive epidemiology and health consequences of childhood obesity. Best Pract Res Clin Endocrinol Metab. 2005; 19(3):327-41. Considering that children and adolescents between the ages of 7 and 14 should be in a school environment,1111. United Nations Children’s Fundation (UNICEF). [Situation of children and adolescents in Brazil]. [Internet]. UNICEF; 2015 [cited 2018 Jun 29]. Available from: https://www.unicef.org/brazil/educacao.
https://www.unicef.org/brazil/educacao...
a considerable part of their time is spent in school, which makes it an attractive place to investigate EBW. In view of the above, this study aims to analyze the prevalence of EBW in adolescents and associated factors.

Methods

This cross-sectional study was carried out with adolescents, male and female (10 and 16 years old), enrolled in basic (5th to 9th grade) and secondary education (1st and 2nd year) in the city of Montes Claros, Minas Gerais, Brazil. The city has a total of 77,833 students enrolled in basic and secondary education.1212. Prefeitura de Montes Claros. Montes Claros. Educação [Internet]. Montes Claros; 2013 [citado 2018 Jun 5]. Disponível em: http://www.montesclaros.mg.gov.br/cidade/aspectosgerais/educacao.htm.
http://www.montesclaros.mg.gov.br/cidade...
The sample size aimed to reach an estimate of population parameters with a prevalence of 0.50, and consequently, a larger sample size. A confidence level of 95% was adopted, with a 5% significance level 5%. The corrections for finite populations and for the design effect were executed, with design effect equal to 1.5. A 10% increase was also established to minimize possible losses and refusals. A sample of 634 adolescents was estimated.

A two-stage cluster sampling process was adopted. In the first stage, five schools were selected to represent the four regions of the city (North, South, East and West), by sampling proportional to the size. The eligibility criteria of the schools were: (i) state-owned public, (ii) basic and secondary school level, (iii) not currently participating in any physical or health activity intervention. In the second stage, adolescents were drawn in all classes of the selected schools, based on the attendance list, by simple random sampling. Teens who were absent during the draw were replaced by others who preceded or followed them on the school attendance list and who agreed to participate in the survey.

Adolescents who reported important significant inflammatory and infectious kidney disease, liver and hematological disease, using drugs that affect the metabolic and hemodynamic profile, pregnant adolescents and those who did not attend for data collection were excluded from the study. According to the established criteria, the final sample consisted of 635 adolescents with proportionality for sex and age and representative of the population, net of losses.

The directors of the selected schools received information about the study and agreed to participate in the research. Parents and / or guardians and adolescents signed consent and informed consent forms, respectively, to participate in the survey. A multidisciplinary team collected the data at the schools in the second half of 2016.

The team was trained and calibrated. The results were submitted to the kappa coefficient, showing satisfactory levels of intra and inter-rater agreement (Kappa ≥ 0.60), beyond chance.

The weight of the adolescents was measured using portable digital scales with capacity of 150kg, precision of 0.1kg (Body complete model, with 8 electrodes and interface model BF 100 - Beurer). To measure height, we used a portable stadiometer with a folding measuring rod and support tripod, measuring capacity from 115cm to 210cm, tolerance: +/- 2mm at 210cm, and resolution in millimeters (Sanny professional model). Height (cm) and weight (kg) measures were used to calculate BMI (weight (kg) / height (m22. Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384:766–81.). In order to classify the adolescents in terms of EBW, WHO parameters (score Z≥1) for age and sex were used.1313. World Health Organization (WHO). Global Database on Child Growth and Malnutrition: growth reference data for 5–19 years. [Internet]. Genève: WHO; 2007. [cited 2018 Aug 8]. Available from: http://www.who.int/growthref/en/.
http://www.who.int/growthref/en/...

To evaluate the metabolic parameters for total cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL) and triglycerides (TG), the adolescents fasted for 12 hours, after which specialized technicians of a reference laboratory took peripheral venous blood samples. The biochemical tests were performed using the Labtest® Labmax Laben® automatic analyzer. The enzyme kit - Trinder was used to measure the levels of CT, TG and HDL. LDL was calculated using the Friedewald equation: LDL = total cholesterol - (HDL + triglyceride/5), and enzymatic colorimetric method. The cut-off points used to evaluate the serum levels of these components followed recommendations in the current literature:1414. Faludi AA, Izar MC, Saraiva JF, Chacra AP, Bianco HT, Afiune Neto A, et al. [Update of the Brazilian directive on dyslipidemias and prevention of atherosclerosis – 2017]. Arq Bras Cardiol. 2017; 109(2 Suppl.1):1-76. Portuguese.,1515. Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents; National Heart, Lung, and Blood Institute. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report. Pediatrics. 2011; 128(Suppl 5):S213-56. for individuals 0-19 years old - CT: desirable <170mg/dL; borderline 170-199mg/dL; high> 200mg/dL; LDL: desirable <110mg/dL; borderline 110-129mg/dL; high> 130mg/dL; HDL: desirable> 45mg/dL; borderline 40-45mg/dL; TG: desirable <90mg/dL; borderline 90-129mg/dL; high> 150mg/dL. In this study, the parameters of CT, LDL and TG were categorized as desirable and undesirable (borderline and high) and HDL as desirable and undesirable (borderline).

A previously tested questionnaire was applied to collect information among the adolescents, containing self-reported questions about:

  • Demographics: sex (male/ female) and age (10 to 13 years / 14 to 16 years);

  • Family history: obesity and dyslipidemia (yes / no);

  • Pubertal development: sexual maturation assessed through the following questions (a) Have you already got your first period?; (b) Has your voice already deepened? (yes / no);

  • Behavioral habits: alcohol consumption (yes / no); food consumption assessed by means of questions adapted from the Ministry of Health “Food test”:1616. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Guia alimentar: como ter uma alimentação saudável [Internet]. Brasília (DF): Ministério da Saúde; s.d. [citado 2018 Apr 15]. Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/guia_alimentar_alimentacao_saudavel.pdf
    http://bvsms.saude.gov.br/bvs/publicacoe...
    “Consumption of sweets (sweets of any kind, filled cakes with icing and sweet cookies, soft drinks and processed juices) more than twice per week (yes / no); consumption of ultra-processed foods (fried foods, fried snacks or crisps, salted meats, hamburgers, hams and sausages) more than twice per week (yes / no); physical exercise assessed by means of the International Physical Activity Questionnaire (IPAQ) short version, classified as sedentary, insufficiently active A, insufficiently active B, active, highly active, ranked in this study as sedentary (sedentary, insufficiently active A, insufficiently active B) and active (active, highly active).

The dependent research variable was EBW and the independent variables were organized as follows:

  1. Demographic characteristics: sex, age;

  2. Family history: obesity and dyslipidemia;

  3. Pubertal development: sexual maturation;

  4. Lipid profile: CT, LDL, HDL, TG;

  5. Behavioral habits: alcohol consumption, food consumption and physical exercise.

Based on the organization of the variables into levels, the following hierarchical model was raised for this study (Figure 1).

Figure 1
Hierarchized model of determinants of excess body weight in adolescents

The descriptive analysis of the independent variables was carried out using simple and relative frequencies. Then, the bivariate analyses were performed between the outcome variable (EBW) and each independent variable (demographic characteristics, family history, pubertal development, behavioral habits, lipid profile), adopting the Poisson hierarchical multiple regression model with robust variance. The crude prevalence ratios (PR) were estimated with their respective 95% confidence intervals. Variables that presented descriptive level (p-value) of up to 20% were selected for multiple analysis. In this analysis, the hierarchical Poisson regression model was used. For this model, the scheme presented in Figure 1 was composed of blocks of variables at the distal (demographic variables and family history), intermediate (pubertal development) and proximal (behavioral habits and lipid profile) levels. The design effect was corrected.

The distal-level blocks were the first to be included in the model, remaining as an adjustment factors for the intermediate and proximal determinants. Subsequently, the variables of the intermediate level were included, remaining as adjustment factor for the variables of the proximal level. Finally, the variables of the proximal level were included. At all levels, only those variables with a descriptive level of p <0.05 remained in the model, after adjusting for the variables of the previous levels. Adjusted prevalence ratios (PR) with their respective 95% confidence intervals were estimated. The statistical program used in the analyses was the Statistical Package for the Social Sciences (SPSS version 20.0). This study received approval from the research ethics committee of the State University of Montes Claros under number 1.503.680.

Results

In total, 635 adolescents participated in the study, the majority being female (60.9%), with a mean age of 13.8 (SD = ± 1.7) years. A family history of obesity and dyslipidemia was reported by 33.8% and 15.3% of respondents, respectively. Among the adolescents, 74.3% reported sexual maturation. As for the lipid profile, 50.9% presented undesirable CT. Regarding behavioral habits, 72.0% confirmed the consumption of sweets and 85.3% of ultra-processed foods (Table 1). The prevalence of EBW among adolescents was 32.8%.

Table 1
Descriptive and bivariate analysis between excess body weight and demographic characteristics, family history, pubertal development, lipid profile, behavioral habits of adolescents between 10 and 16 years of age from state-owned public schools in Montes Claros, Minas Gerais, Brazil, 2016 (N = 635).

In the bivariate analysis of demographic characteristics, there was a statistical association at 20% of EBW for the variables: sex (p = 0.065), family history of obesity (p = 0.163) and dyslipidemia (p = 0.002). The following characteristic of pubertal development was statistically associated with the outcome variable: sexual maturation (p = 0.074). Regarding the lipid profile, LDL (p = 0.050) and HDL (p = 0.050) parameters were associated with the outcome. Regarding the variables related to behavioral habits, the association between EBW and alcohol consumption remained significant (p = 0.030) (Table 1).

When the effect of the independent variables was analyzed using Poisson hierarchical multiple regression over EBW, the association with a family history of dyslipidemia (p=0.003; PR=1.474; 95%CI=1.139-1.907) and alcohol consumption (p=0.044; PR=1.430; 95%CI=1.009-2.028).

Discussion

As verified, 32.8% of the adolescents presented excess body weight, associated with a family history of dyslipidemia and alcohol intake. The other variables in this study were not associated to EBW.

In the United States, higher prevalence rates of EBW were found in the United States in the states of Arkansas (37.5%), Mississippi (44.5%) and Georgia (37.3%),1717. Singh GK, Kogan MD, Van Dyck PC. Changes in state-specific childhood obesity and overweight prevalence in the United States from 2003 to 2007. Arch Pediatr Adolesc Med. 2010;164(7):598-607. as well as in China, 33.2%.1818. Ying-Xiu Z, Shu-Rong W. Secular trends in body mass index and the prevalence of overweight and obesity among children and adolescents in Shandong, China, from 1985 to 2010. J Public Health (Oxf). 2012;34(1):131-7. This prevalence rate corresponded to 27% in Australia,1919. Olds TS, Tomkinson GR, Ferrar KE, Maher CA. Trends in the prevalence of childhood overweight and obesity in Australia between 1985 and 2008. Int J Obes (Lond). 2010;34(1):57-66. 14 to 28% in Europe,2020. Currie C, Zanotti C, Morgan A, Currie D, Looze Md, Roberts C, et al. Social determinants of health and well-being among young people. Health Behaviour in School-aged Children (HBSC) study: international report from the 2009/2010 survey. Copenhagen: WHO Library Cataloguing in Publication Data; 2012. and 18.9% of overweight and 8.6% of obesity in Syria for populations of adolescents.2121. Nasreddine L, Mehio-Sibai A, Mrayati M, Adra N, Hwalla N. Adolescent obesity in Syria: prevalence and associated factors. Child Care Health Dev. 2010;36(3):404–13.

In Brazil, it was observed that excess weight rates among adolescents have increased uninterruptedly in the last 34 years. Among adolescent males, the presence of overweight increased from 3.7% (1974-75) to 21.7% (2008-09); in female adolescents, from 7.6% to 19.4% in the same age group. The same was observed for obesity, from 0,4% to 5,9% in the male adolescents and from 0,7% to 4,0% in the female adolescents when comparing the same periods.66. Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa de orçamentos familiares 2008-2009 [Internet]. Rio de Janeiro: IBGE: 2010. [citado 2017 Ago 2]. Disponível em: https://biblioteca.ibge.gov.br/visualizacao/livros/liv50063.pdf . Portuguese.
https://biblioteca.ibge.gov.br/visualiza...
In another study also carried out with adolescents from municipal schools in the city of Montes Claros, it was observed that 18.5% of the surveyed individuals presented EBW.2222. Pinho L, Flávio EF, Santos SHS, Botelho AC, Caldeira AP. Excess weight and food consumption of adolescents in public schools in northern Minas Gerais state, Brazil. Ciênc Saúde Coletiva. 2012;19(1):67-74. Research found 29.5% of EBW in Rio Branco-AC,2323. Silva Júnior LM, Santos AP, Souza OF, Farias ES. Prevalence of excess weight and associated factors in adolescents of private schools of an Amazonic urban area, Brazil. Rev Paul Pediatr. 201;(2):217-22. 27.6% in Porto Alegre-RS,2424. Schommer VA, Barbiero SM, Cesa CC, Oliveira R, Silva AD, Pellanda LC. Excess Weight, Anthropometric Variables and Blood Pressure in Schoolchildren aged 10 to 18 years. Arq Bras Cardiol. 2013 ;102(4):312-8. 21.2% in Goiânia-GO,2525. Carneiro CS, Peixoto MR, Mendonça KL, Póvoa TI, Nascente FM, Jardim TS, et al. Overweight and associated factors in adolescents from a brazilian capital. Rev Bras Epidemiol. 2017;20(2):260-73. 20.8% in João Pessoa-PB.2626. Instituto Nacional de Estudos e Pesquisas Anísio Teixeira (INEP). Censo escolar 2010. Visão geral dos principais resultados [Internet]. Brasília (DF): INEP; 2010. [citado 2017 Dez 13]. Disponível em: http://download.inep.gov.br/download/censo/2010/apresentacao_divulgacao_censo_2010.pdf
http://download.inep.gov.br/download/cen...
Given the multifactorial genesis of obesity, in that not only genetic factors, but also environmental and behavioral variables seem to influence its onset, the variable observed prevalence between different regions can probably be justified.2727. Pinto RP, Nunes AA, Mello LM. Analysis of factors associated with excess weight in school children. Rev Paul Pediatr. 2016;34(4):460–8.

In this study, the association of sex with EBW was not observed. In the literature, however, it is reported that the increase in EBW in female adolescents may be due to the fact that they are close to puberty2828. Biro FM, Khoury P, Morrison JA. Influence of obesity on timing of puberty. Int J Androl. 2006;29(1):272-7. and accumulate a much higher percentage of fat and less lean mass than male adolescents.2929. Pietrobelli A, Boner AL, Tato L. Adipose tissue and metabolic effects: New insight into measurements. Int J Obes. 2005;29 (2 Suppl 2):S97–100

The presence of a family history of dyslipidemia in this study was significantly associated with EBW. Particularities of the domestic environment have been referred to as being relevant in the etiology of chronic diseases, as they may influence healthy or unhealthy lifestyles.3030. World Health Organization (WHO). The challenge of obesity in the WHO European Region and the strategies for response. Copenhagen: WHO; 2007. Full independence is still a future expectation for most adolescents and the guidance received from the parents tends to influence the way they perceive themselves.3131. Krug I, Villarejo C, Jimenez-Murcia S, Perpina C, Vilarrasa N, Granero R, et al. Eating-related Environmental Factors in underweight eating disorders and obesity: Are there common vulnerabilities during childhood and early adolescence? Eur Eat Disord Rev. 2013;21:202–8

According to the literature, the sole fact that adolescents suffer from EBW favors the adverse lipid profile.3232. Wattigney WA, Harsha DW, Srinivasan SR, Webber LS, Berenson GS. Increasing impact of obesity on serum lipids and lipoproteins in young adults: The Bogalusa Heart Study. Arch Intern Med. 199;151(10):2017-22. If they present family members with a family history of hypercholesterolemia and / or premature coronary artery disease (men <55 years or women <65 years) and the adolescents suffer, among others, from SAH, DM, smoking, obesity or atherosclerotic disease, they become candidates for the screening for familial hypercholesterolemia as a preventive measure for atherosclerosis.1616. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Guia alimentar: como ter uma alimentação saudável [Internet]. Brasília (DF): Ministério da Saúde; s.d. [citado 2018 Apr 15]. Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/guia_alimentar_alimentacao_saudavel.pdf
http://bvsms.saude.gov.br/bvs/publicacoe...
Thus, paying attention to the lipid profile of adolescents and their relatives becomes justifiable. There are few studies that evaluate these conditions together though.

The lipid profile of the adolescents was not associated with EBW in this research. A study with adolescents from Paraná did not find a significant association either between the lipid parameters of adolescents classified as overweight.3333. Honorato AS, Bando E, Uchimura TT, Junior MM. Anthropometric, lipids and blood glucose profiles in adolescents of a philanthropic institution in the northwest Paraná. J Bras Patol Med Lab. 2010;46(1):7-15.

An association between physical activity and EBW was expected, which was not confirmed in this study. Research conducted with Portuguese students found that overweight and obese students are relatively un-active. Body weight is related to physical fitness rates, so that overweight and obese individuals are more likely to be unfit.3434. Figueiredo C, Santos D, Souza M, Seabra A, Maia J. Obesidade e sobrepeso em adolescentes: relação com atividade física, aptidão física, maturação biológica e “status” socioeconômico. Rev Bras Educ Fis Esporte. 2011;25(2): 225-35. In this study, the IPAQ short version was used to evaluate the physical activity. Authors argue that this instrument still needs adjustments for the sake of application to younger adolescents in order to improve the validity indicators.3535. Guedes DP, Lopes CC, Guedes JE. Reprodutibilidade e validade do Questionário Internacional de Atividade Física em adolescentes. Rev Bras Med Esporte. 2005;11(2):151-8. Nevertheless, IPAQ has the advantage of being widely used in studies, which permits the comparability of the data.

Alcohol consumption was associated with EBW among the adolescents surveyed. The most common age among adolescents to test alcohol is around the age of 12.3636. Gearhardt AN, Corbin WR. Body mass index and alcohol consumption: family history of alcoholism as a moderator. Psychol Addict Behav. 2009;23(2):216-25. In this period of life, alcohol consumption tends to increase due to the intensification of group activities. Considering the physiological peculiarities of adolescence and the fact that these youngsters are in school, any amount of alcohol intake, however small, will constitute a threat to the adolescents’ balance and good health.3838. Fonseca SC, Mourão-Carvalhal MI, Coelho EM. [Changes of food habits in school-aged children and adolescents]. EDUSER: revista de educação. 2017;9(1):42-52. Portuguese. Alcoholic beverages are highly caloric and can interfere with appetite and weight gain.

The food consumption of sweets and ultra-processed foods was not associated with EBW. The eating habits of adolescents, high in fat, sugar and sodium and low in vitamins and minerals, may contribute to the increase of chronic noncommunicable diseases such as overweight and obesity.11. World Health Organization (WHO). Obesity and overweight [Internet]. Genève:WHO; 2017. [cited 2017 Aug 02]. Available from: http://www.who.int/mediacentre/factsheets/fs311/en/.
http://www.who.int/mediacentre/factsheet...
,2222. Pinho L, Flávio EF, Santos SHS, Botelho AC, Caldeira AP. Excess weight and food consumption of adolescents in public schools in northern Minas Gerais state, Brazil. Ciênc Saúde Coletiva. 2012;19(1):67-74. The diverging results may be due to the measuring of food consumption data.

The different methodologies and classifications of variables related to family history, pubertal development, lipid profile and behavioral habits may have influenced the comparison of the results.

This study should be interpreted in the light of some limitations. The sample was obtained with schoolchildren from the public network, so the results should be viewed with caution for the purpose of extrapolation to other groups of adolescents in different contexts, although in the same region. The data for the variable sexual maturation were obtained without physical evaluation of the adolescents; the information about alcohol consumption and eating habits was based on self-report, which may have generated bias due to inaccurate information, embarrassment, and memory. It should be noted, however, that this study used a representative sample of the population, obtained in a probabilistic way.

Actions to prevent EBW and associated factors are desirable. In this sense, nursing plays an important role because they are close to the health service users, including adolescents, and can implement actions involving this clientele for the purpose of prevention of weight control and alcohol intake and screening for family history of dyslipidemias.

The nurse can engage in individual or collective educational activities on behavioral habits in adolescence in Primary Health Care (PHC). Nursing consultations with adolescents in PHC should be prioritized and should consider the sociocultural, behavioral and family context in the prevention and control of excess weight.

Conclusion

These findings alert to the high prevalence rates of EBW among adolescents in the state-owned public education network in Montes Claros, associated with the family antecedents of dyslipidemia and alcohol consumption.

Referências

  • 1
    World Health Organization (WHO). Obesity and overweight [Internet]. Genève:WHO; 2017. [cited 2017 Aug 02]. Available from: http://www.who.int/mediacentre/factsheets/fs311/en/
    » http://www.who.int/mediacentre/factsheets/fs311/en/
  • 2
    Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384:766–81.
  • 3
    Reilly JJ, Kelly J. Long-term impact of overweight and obesity in childhood and adolescence on morbidity and premature mortality in adulthood: systematic review. Int J Obes (Lond). 2011;35(7):891-8.
  • 4
    Ogden CL, Carroll MD, Fryar CD, Flegal KM. Prevalence of obesity among adults and youth: United States, 2011-2014. NCHS Data Brief. 2015;(219):1-8.
  • 5
    Jayawardena R, Ranasinghe P, Wijayabandara M, Hills AP, Misra A. Nutrition Transition and Obesity Among Teenagers and Young Adults in South Asia. Curr Diabetes Rev. 2017;13(5):444–51
  • 6
    Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa de orçamentos familiares 2008-2009 [Internet]. Rio de Janeiro: IBGE: 2010. [citado 2017 Ago 2]. Disponível em: https://biblioteca.ibge.gov.br/visualizacao/livros/liv50063.pdf . Portuguese.
    » https://biblioteca.ibge.gov.br/visualizacao/livros/liv50063.pdf
  • 7
    Guimarães Junior MS, Fraga AS, Araújo TB, Tenório MC. [Cardiovascular risk factor: obesity between children and adolescents in the brazilian macroregions]. Rev Bras Obes Nutr Emagrec. 2018;12(69):132-42. Portuguese.
  • 8
    Wadden TA, Brownell KD, Foster GD. Obesity: Responding to the global epidemic. J Consult Clin Psychol. 2002;70(3):510-25.
  • 9
    Janssen I, Katzmarzyk PT, Boyce WF. Comparison of overweight and obesity prevalence in school-aged youth from 34 countries and their relationship with physical activity and dietary patterns. Obes Rev. 2005; 6(2):123-32.
  • 10
    Reilly JJ. Descriptive epidemiology and health consequences of childhood obesity. Best Pract Res Clin Endocrinol Metab. 2005; 19(3):327-41.
  • 11
    United Nations Children’s Fundation (UNICEF). [Situation of children and adolescents in Brazil]. [Internet]. UNICEF; 2015 [cited 2018 Jun 29]. Available from: https://www.unicef.org/brazil/educacao
    » https://www.unicef.org/brazil/educacao
  • 12
    Prefeitura de Montes Claros. Montes Claros. Educação [Internet]. Montes Claros; 2013 [citado 2018 Jun 5]. Disponível em: http://www.montesclaros.mg.gov.br/cidade/aspectosgerais/educacao.htm
    » http://www.montesclaros.mg.gov.br/cidade/aspectosgerais/educacao.htm
  • 13
    World Health Organization (WHO). Global Database on Child Growth and Malnutrition: growth reference data for 5–19 years. [Internet]. Genève: WHO; 2007. [cited 2018 Aug 8]. Available from: http://www.who.int/growthref/en/
    » http://www.who.int/growthref/en/
  • 14
    Faludi AA, Izar MC, Saraiva JF, Chacra AP, Bianco HT, Afiune Neto A, et al. [Update of the Brazilian directive on dyslipidemias and prevention of atherosclerosis – 2017]. Arq Bras Cardiol. 2017; 109(2 Suppl.1):1-76. Portuguese.
  • 15
    Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents; National Heart, Lung, and Blood Institute. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report. Pediatrics. 2011; 128(Suppl 5):S213-56.
  • 16
    Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Guia alimentar: como ter uma alimentação saudável [Internet]. Brasília (DF): Ministério da Saúde; s.d. [citado 2018 Apr 15]. Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/guia_alimentar_alimentacao_saudavel.pdf
    » http://bvsms.saude.gov.br/bvs/publicacoes/guia_alimentar_alimentacao_saudavel.pdf
  • 17
    Singh GK, Kogan MD, Van Dyck PC. Changes in state-specific childhood obesity and overweight prevalence in the United States from 2003 to 2007. Arch Pediatr Adolesc Med. 2010;164(7):598-607.
  • 18
    Ying-Xiu Z, Shu-Rong W. Secular trends in body mass index and the prevalence of overweight and obesity among children and adolescents in Shandong, China, from 1985 to 2010. J Public Health (Oxf). 2012;34(1):131-7.
  • 19
    Olds TS, Tomkinson GR, Ferrar KE, Maher CA. Trends in the prevalence of childhood overweight and obesity in Australia between 1985 and 2008. Int J Obes (Lond). 2010;34(1):57-66.
  • 20
    Currie C, Zanotti C, Morgan A, Currie D, Looze Md, Roberts C, et al. Social determinants of health and well-being among young people. Health Behaviour in School-aged Children (HBSC) study: international report from the 2009/2010 survey. Copenhagen: WHO Library Cataloguing in Publication Data; 2012.
  • 21
    Nasreddine L, Mehio-Sibai A, Mrayati M, Adra N, Hwalla N. Adolescent obesity in Syria: prevalence and associated factors. Child Care Health Dev. 2010;36(3):404–13.
  • 22
    Pinho L, Flávio EF, Santos SHS, Botelho AC, Caldeira AP. Excess weight and food consumption of adolescents in public schools in northern Minas Gerais state, Brazil. Ciênc Saúde Coletiva. 2012;19(1):67-74.
  • 23
    Silva Júnior LM, Santos AP, Souza OF, Farias ES. Prevalence of excess weight and associated factors in adolescents of private schools of an Amazonic urban area, Brazil. Rev Paul Pediatr. 201;(2):217-22.
  • 24
    Schommer VA, Barbiero SM, Cesa CC, Oliveira R, Silva AD, Pellanda LC. Excess Weight, Anthropometric Variables and Blood Pressure in Schoolchildren aged 10 to 18 years. Arq Bras Cardiol. 2013 ;102(4):312-8.
  • 25
    Carneiro CS, Peixoto MR, Mendonça KL, Póvoa TI, Nascente FM, Jardim TS, et al. Overweight and associated factors in adolescents from a brazilian capital. Rev Bras Epidemiol. 2017;20(2):260-73.
  • 26
    Instituto Nacional de Estudos e Pesquisas Anísio Teixeira (INEP). Censo escolar 2010. Visão geral dos principais resultados [Internet]. Brasília (DF): INEP; 2010. [citado 2017 Dez 13]. Disponível em: http://download.inep.gov.br/download/censo/2010/apresentacao_divulgacao_censo_2010.pdf
    » http://download.inep.gov.br/download/censo/2010/apresentacao_divulgacao_censo_2010.pdf
  • 27
    Pinto RP, Nunes AA, Mello LM. Analysis of factors associated with excess weight in school children. Rev Paul Pediatr. 2016;34(4):460–8.
  • 28
    Biro FM, Khoury P, Morrison JA. Influence of obesity on timing of puberty. Int J Androl. 2006;29(1):272-7.
  • 29
    Pietrobelli A, Boner AL, Tato L. Adipose tissue and metabolic effects: New insight into measurements. Int J Obes. 2005;29 (2 Suppl 2):S97–100
  • 30
    World Health Organization (WHO). The challenge of obesity in the WHO European Region and the strategies for response. Copenhagen: WHO; 2007.
  • 31
    Krug I, Villarejo C, Jimenez-Murcia S, Perpina C, Vilarrasa N, Granero R, et al. Eating-related Environmental Factors in underweight eating disorders and obesity: Are there common vulnerabilities during childhood and early adolescence? Eur Eat Disord Rev. 2013;21:202–8
  • 32
    Wattigney WA, Harsha DW, Srinivasan SR, Webber LS, Berenson GS. Increasing impact of obesity on serum lipids and lipoproteins in young adults: The Bogalusa Heart Study. Arch Intern Med. 199;151(10):2017-22.
  • 33
    Honorato AS, Bando E, Uchimura TT, Junior MM. Anthropometric, lipids and blood glucose profiles in adolescents of a philanthropic institution in the northwest Paraná. J Bras Patol Med Lab. 2010;46(1):7-15.
  • 34
    Figueiredo C, Santos D, Souza M, Seabra A, Maia J. Obesidade e sobrepeso em adolescentes: relação com atividade física, aptidão física, maturação biológica e “status” socioeconômico. Rev Bras Educ Fis Esporte. 2011;25(2): 225-35.
  • 35
    Guedes DP, Lopes CC, Guedes JE. Reprodutibilidade e validade do Questionário Internacional de Atividade Física em adolescentes. Rev Bras Med Esporte. 2005;11(2):151-8.
  • 36
    Gearhardt AN, Corbin WR. Body mass index and alcohol consumption: family history of alcoholism as a moderator. Psychol Addict Behav. 2009;23(2):216-25.
  • 37
    Pires CG, Mussi FC, Souza RC, Silva DO, Santos CA. Consumo de bebidas alcóolicas entre estudantes de enfermagem. Acta Paul Enferm. 2015;28(4):301-307.
  • 38
    Fonseca SC, Mourão-Carvalhal MI, Coelho EM. [Changes of food habits in school-aged children and adolescents]. EDUSER: revista de educação. 2017;9(1):42-52. Portuguese.

Publication Dates

  • Publication in this collection
    10 Oct 2019
  • Date of issue
    Sep-Oct 2019

History

  • Received
    10 Sept 2018
  • Accepted
    4 June 2019
Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
E-mail: actapaulista@unifesp.br