Prevalence of weight excess in Brazilian children and adolescents: a systematic review

Prevalência de excesso de peso em crianças e adolescentes brasileiros: uma revisão sistemática

Abstract

The prevalence of obesity is rapidly increasing worldwide, no mattering age groups and socioeconomic status. In Brazil, it is still unclear the prevalence of obesity in children and adolescents, since most Brazilian studies have only verified regional prevalence of obesity. Therefore, the aim of the present study was to analyze the scientific production regarding the prevalence of weight excess in Brazilian children and adolescents. A search in the relevant electronic databases Medline/Pubmed, Web of Science, Lilacs, Scielo and BVS was performed. After analyzing 61 studies, the overall prevalence was 25.5%. When sample was stratified weight excess degree, a prevalence of 17% and 11.6% for overweight and obesity were observed, respectively. Analyzing differences by sex, boys presented higher prevalence of overall weight excess (e.g., 26.4% vs 23.5%), overweight (17% vs 16%) and obesity (11.9% vs 9.1%) than girls. With respect to Brazilian regions and its differences, individuals from southern presented the highest prevalence of overall weight excess (33.2%) and overweight (20.1%). The southeastern region showed the highest prevalence of obesity (18.2%). The results obtained in the current study indicate that Brazil presents a scenario of crescent increasing on the prevalence of weight excess. These results are in accordance with studies from other countries, and reinforce the increase of the overall weight excess prevalence in Brazilian children and adolescents, highlighting the increasing of obesity rates, since it is a more concerning condition than overweight. Therefore, preventive measures to reduce weight excess increase, as well as treatment programs aiming to tackle obesity in childhood should be public health system top priority.

Key words
Adolescents; Brazil; Children; Obesity

Resumo

A prevalência da obesidade tem aumentado em todo o mundo em todas as faixas etárias e níveis socioeconômicos. No Brasil, ainda é incerto a prevalência de obesidade em crianças e adolescentes devido a maioria dos estudos serem de características regionais.Portanto,o propósito do presente estudo foi analisar a produção científica referente à prevalência de excesso de peso em crianças e adolescentes brasileiros. Realizou-se uma busca nas bases de dados MEDLINE/PubMed, WEB of Science, LILACS, Scielo e BVS.Foram analisados 61 estudos, sendo identificado 17% de sobrepeso e 11,6% de obesidade.As prevalências de excesso de peso (26,4% vs 23,5%), sobrepeso (17% vs 16%) e obesidade (11,9% vs 9,1%) foram maiores entre os meninos comparados as meninas, respectivamente. As crianças e os adolescentes da Região Sul apresentaram maior prevalência de excesso de peso (33,2%) e sobrepeso (20,1%), e as do Sudeste maior prevalência de obesidade (18,2%). Nossa análise indicou que o Brasil apresenta um quadro de prevalência crescente de excesso de peso, similar ao de outros países.Os resultados reforçam o aumento da prevalência de excesso de peso em crianças e adolescentes no Brasil, especialmente pelo aumento da obesidade, que é considerada uma condição mais grave que o sobrepeso. Portanto, medidas preventivas para diminuir esta tendência de aumento do excesso de peso, bem como programas de tratamento da obesidade na infância e adolescência deve ser prioridade do Sistema único de Saúde (SUS).

Palavras-chave
Adolescentes; Brasil; Crianças; Obesidade

INTRODUCTION

During the last decades, obesity has become a global epidemic that affects practically all ages and socioeconomic groups¹, being considered the most concerning public health issue. Nowadays, there is about 2.8 million deaths every year in consequence of weight excess¹. The projections for 2025 indicate that the global prevalence of obesity will reach 18% in men and 21% in women, in which severe obese will trespass 6% and 9% in men and women, respectively².

Children and adolescents are increasingly more exposed to factors that lead to weight gain^3,4. Early obese children with 3 to 4 years old present from 15% to 25% more odds to become obese adults, and this odds goes to 50% after 6 years of age⁴. In youth, obesity reflects an direct influence on postural changes, depression, anxiety, and psychological dysfunctions^3,4.

In Brazil, childhood overweight and obesity are major public health issues that affect all ages and regions but with distinct intensity, mostly due to the socioeconomic differences among regions and individuals⁵. Hence, national coverage studies are essential to monitor children and adolescents health⁶.

However, evidence about nutritional status of Brazilian children and adolescents are not properly updatep^7-9. The management of an updated national monitoring panel about children and adolescents nutritional status is seem as essential to organize future prevention and treatment plans aiming to tackle obesity^10,11. Thus, the aim of the present study was to verify the scientific production regarding the prevalence of weight excess (e.g., overweight and obesity) in Brazilian children and adolescents.

Methodological Procedures

Search strategy

The present systematic review was conducted strictly following the guidance from the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA)¹². Potential studies were searched in five electronic databases: 1) Medical Literature Analysis and Retrieval System Online (MEDLINE), through PubMed; 2) Web of Knowledge (Web of Science); 3) Latin American and Caribbean Literature in Health Sciences (LILACS); 4) Scientific Electronic Library Online (Scielo); 5) Virtual Health Library (VHL). Articles published between June 1, 2014-March 31, 2018 were considered for eligibility. The following terms were used in studies search: ‘Prevalence’, ‘frequency’, ‘obesity’, ‘obese’, ‘overweight’, ‘children’, ‘adolescent’, ‘youth’, ‘Brazil’, ‘Brazilian’. Searches were conducted independently by two authors (CFS and JMR), aiming to duplicate search and match results. In case of divergence, a third author (TLCS) was consulted to establish consensus.

Study selection

Only observational studies were included (e.g., cross-sectional and longitudinal). As inclusion criteria studies had to be performed with Brazilian children or adolescents (e.g., individuals until 19 years old), published from June 2014 to March 2018, who presented the prevalence of overweight and/or obesity. Studies in English and Portuguese were considered eligible for inclusion.

A manual search from the reference lists of the accepted articles was posteriorly performed. Only full reported studies were considered for eligibility (e.g., short communications, editorials or comments were excluded). Potential articles were organized, assessed and further selected with the aid of the software EndNote X7^®.

Data extraction

Relevant information from included articles was extracted independently by four reviewers (CFS, JMR, TLCS and FBL) in an electronic spreadsheet. Data was organized in eight domains: author and year of publication, sample, sex, age, prevalence of overweight, criterion used to classify BMI, Brazilian region, administrative e dependence.

Quality assessment of selected studies

To verify the methodological quality of selected articles, the National Institutes of Health’s Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was applied in each accepted study individually¹³ (Supplementary table 1 and 2).

RESULTS

Search on the aforementioned electronic databases, 2,729 potential articles were retrieved for further analysis. After exclusion of duplicate records and reading of titles and abstracts, 71 studies were selected to be fully examined. Of those, 61 studies met the eligibility criteria and were included to compose the current systematic review (Figure 1).

Figure 1
Flow chart of the systematic review.

All selected studies had a cross-sectional design, and two of them were baseline data from cohort studies^14,15.

Beyond prevalence of obesity, studies approached different themes (e.g., weight excess and its behavior determinants (30.2%), weight associated risk factors (30.2%), nutritional status (12.7%), use of other anthropometric measures (6.2%), sociodemographic factors (4.7%), dental problems (3.2%), weight excess measured by different BMI cut-off points (3.2%), breastfeeding (3.2%), BMI and body image (1.6%), genetics (1.6%), quality of life, anxiety and socioeconomic factors (1.6%) and action plans aiming to tackle obesity (1.6%).

The overall total sample of selected studies was 197.763 individuals, in which 47.3% were from female sex. Nevertheless, 11.4% of studies did not present data stratified by sex. Regarding age group, 53.5% of studies had children as sample, 14.8% were developed with adolescents, and 32.8% with both children and adolescents. Studies characteristics of included studies are minutely described in table 1.

Table 1
Characteristics of the prevalence studies of overweight and obesity in Brazilian children and adolescents.

Study	N	% Of Male Sex	Age		Overweight (%)			Obesity (%)			Excess of Weight (%)			BMI Class. Crit.	Region	Adm. Dep.
			INF	SUP	T	M	F	T	M	F	T	M	F
Pozzaet al.4	6.829	49.7	0.5	15	17.5	16.8	18.2	12.9	14.4	11.4	30.4	31.2	29.6	WHO	Southeastern	School
Santos et al.21	501	50.5	7	10	15.2	12.6	17.7	8.8	9.9	7.7	24	22.5	25.4	COLE	Northeastern	School
Almeida et al.22	62	53	9	10	15.5	21	10	10	6	14	25.5	27	24	WHO	Southeastern	School
Anjos et al.23	20.113	50.3	3	17	17.6	17.6	17.5	12.4	14.7	10.1	30.0	32.3	27.6	WHO	Allgroups	School
Anzolinet al.24	229	100	10	15	25.8	-	-	-	-	-	-	-	-	WHO	Southeastern	Project
Araújo et al.15	548	52	2	5	4.2	4	4	-	-	-	4.2	4	4	WHO	Northeastern	School
Carneiro et al.25	1.169	46.9	12	18	14.1	-	-	7.1	-	-	21.2	26.3	16.8	WHO	Midwest	School
Ferrari et al.17	328	49.1	9	11	23.8	-	-	28	-	-	51.8	50.3	53.4	WHO	Southeastern	School
Gonsalezet al.26	1.531	44.9	7	10	28.5	-	-	14.1	-	-	42.6	-	-	WHO	Southern	School
Lira et al.10	20.755	-	0.5	5	9.7	-	-	9.3	-	-	19	-	-	WHO	Northeastern	School
Melo et al.27	249	44.2	14	19	-	-	-	-	-	-	24.1	-	-	WHO	Northeastern	School
Neves et al.28	346	48	8	8	19.9	-	-	20.8	-	-	40.7	-	-	WHO	Southern	School
Pedrazaet al.29	1.081	49.9	5	10	12.3	-	-	9.2	-	-	21.5	-	-	WHO	Northeastern	School
Ripkaet al.30	374	100	12	17	20.3	-	-	5.6	-	-	25.9	-	-	WHO	Southern	School
Santos et al.31	820	51.2	9	18	19.2	-	-	7.8	-	-	27	-	-	CDC	Northeastern	School
Silva et al.5	1.132	46	14	19	33.4	17.7	16.3	12.7	5.2	7.5	46.1	22.9	23.8	WHO	Southern	School
Almeida et al.6	511	46.8	7	9	13.9	-	-	24.6	-	-	38.5	-	-	WHO	Southeastern	School
Araujoet al.19	313	44.3	8	10	21.7	17.8	24.7	17.5	16.1	14.9	39.2	33.9	39.6	WHO	Southeastern	School
Barbosa Filho et al.32	2.035	49.9	6	11	-	-	-	-	-	-	9.4	11.4	7.5	WHO	Southern	School
Bloch et al.33	73.399	44.6	12	17	17.1	16.6	17.6	8.4	9.2	7.6	25.5	25.8	25.2	WHO	Allregions	School
Bruscatoet al.34	2.150	48	6	18	-	-	-	-	-	-	21	-	-	WHO	Southern	School
Cavalcantiet al.35	559	41	15	19	11.8	-	-	6.8	-	-	18.6	-	-	CDC	Northeastern	School
Farias Júnior et al.36	2.776	42.1	14	18	13.1	-	-	-	-	-	13.1	18.4	9.2	COLE	Northeastern	School
Ferrari et al.18	328	48.5	9	11	23.8	17.2	30.8	28	33.1	22.6	51.8	50.3	53.4	WHO	Southeastern	School
Grillo et al.3	400	55	6	10	13	14	11.7	10	12.2	7.3	23	26.2	19	WHO	Southern	School
Marques et al.37	645	44.4	13	19	18.3	-	-	2.8	-	-	21.1	-	-	WHO	Southern	School
Reuteret al.16	406	50	7	17	-	-	-	-	-	-	57.4	-	-	WHO	Southern	School
Silva et al.38	2.180	51.05	7	10	9.8	11.2	8.4	11.1	7.4	14.8	20.9	18.6	23.2	WHO	Southern	School
Silva et al.39	232	61.2	4	5	16.4	-	-	0.9	-	-	17.3	16.2	18.9	WHO	Southeastern	School
Alves Junior et al.20	1.132	44	14	19	37.3	-	-	17.2	8.1	29.2	54.5	-	-	WIL-LIAMS	Southern	School
Bertuolet al.40	65	-	2	5	24.62	-	-	13.85	-	-	38.47	-	-	WHO	Southern	School
Bispo et al.41	1.030	52.5	11	17	13.8	-	-	8.1	-	-	21.9	-	-	WHO	Southeastern	School
Caldeiraet al.42	219	52.5	4	5	-	-	-	-	-	-	9.6	-	-	WHO	Southeastern	School
D'Avilaet al.43	962	41.1	11	14	18.3	-	-	11.6	-	-	29.9	34.1	28.8	WHO	Southern	School
Dutraet al.44	616	51.3	0	8	-	-	-	-	-	37.5	-	-	37.5	WHO	Southern	Hospital
Eneset al.45	476	45.4	11.1	0.81	-	-	-	-	-	-	36.1	36.1	36.2	WHO	Southeastern	School
Fernandes et al.46	91	54.9	1	10	-	-	-	-	-	-	8.9	87.5	12.5	WHO	Southeastern	Hospital
Ferrari et al.47	441	49	9	11	23.1	-	-	22.2	-	-	45.3	-	-	WHO	Southeastern	School
Ferreira et al.48	1.338	52.2	9	11	-	-	-	13.4	-	-	-	-	-	WHO	Northeastern	School
Miranda et al.49	200	45.5	8	10	14.5	13.2	15.6	19	20.9	17.4	33.5	34.1	33	CDC	Southeastern	School
Monteiroet al.50	1.088	47.7	13	19	10.5	-	-	-	-	-	10.5	9.5	11.4	WHO	Northeastern	School
Motteret al.51	2.506	46.8	7	14	20.6	-	-	12.6	-	-	33.2	-	-	WHO	Southern	School
Nascimento-Ferreiraet al.52	1.014	45.2	14	19	13.1	-	-	3.8	-	-	16.9	-	-	WHO	Northeastern	School
Passos et al.53	335	49.7	6	10	26	28	24	24.7	15	5	50.7	43	29	WHO	Southern	School
Ramos et al.54	1.640	-	0	5	-	-	-	-	-	-	19.1	-	-	WHO	Northeastern	School
Roman et al.55	2.759	0	9	17	-	-	8.8	-	-	6.7	-	-	15.5	WHO	Southern	School
Rosiniet al.56	1.011	47.6	6	14	21.1	-	-	13.2	-	-	34.3	-	-	WHO	Southern	School
Silvaet al.57	19.289	51	5	10	15	16.1	14.8	11	11.9	9.1	26	28	23.9	WHO	Midwest	Datasus
Sparrenbergeret al.58	204	50	2	10	-	-	-	-	-	-	34	-	-	WHO	Southern	BHU
Vicenziet al.11	782	52.9	6	7	-	-	-	-	-	-	38.1	-	-	WHO	Southern	School
Barbosa Filho et al.59	2.035	49.9	7	10	19.4	-	-	6	-	-	25.4	-	-	WHO	Southern	School
Fariaet al.60	92	47.8	10	17	-	-	-	51.1	52.3	50	51.1	-	-	WHO	Southeastern	School
Garcez et al.61	158	50.1	12	19	11	-	-	2.4	-	-	13.4	-	-	WHO	Southeastern	Residence
Martins et al.62	590	46.6	7	14	8.7	-	-	13.3	-	-	22	13.5	13.7	WHO	Northeastern	School
Mendonça et al.63	1.168	47.1	12	18	22.4	-	-	14.7	-	-	37.1	28.4	17.1	WHO	Midwest	School
Marthendalet al.64	130	51.5	14	18	16.1	22.3	9.2	5.4	7.5	3.2	21.5	29.8	12.4	WHO	Southern	School
Mülleret al.65	6.397	50.2	0	5	-	-	-	-	-	-	12	12.8	10.5	WHO	Allregions	Residence
Oppitzet al.66	1.663	50.4	0	5	6.4	-	-	1.7	-	-	8.1	31.5	28.9	WHO	Northeastern	School
Pinho et al.67	535	32	11	17	-	-	-	-	-	-	18.5	16.4	19.5	WHO	Southeastern	School
Rosaneliet al.68	4.609	47	6	11	16.9	17.8	16	7.6	8.6	6.6	24.5	26.4	22.6	WHO	Southern	School
Souza et al.69	1.187	48.6	6	14	-	-	-	-	-	-	24.4	24.8	24.1	WHO	Sudeste	School

• Note. N: sample number; M: Male; T: Total; F: Female; BMI: Body mass index; WHO: World Health Organization; CDC: Centers for Disease Control and Prevention; DATASUS: Department of the Brazilian single health system; BHU: basic health Unit.

The mean of overall weight excess prevalence of selected studies was 25.5%, in which a prevalence of 17% and 11.6% were verified for overweight and obesity, respectively. Overall weight excess prevalence ranged between 4.2%¹⁵ and 57.4%¹⁶. Obesity prevalence varied between 0.9%⁵ and 28%^17,18, and overweight prevalence ranged between 4.2%¹⁹ and 37.3%²⁰.

Considering analysis by sex, the prevalence of overall weight excess, overweight and obesity were 26.4%, 17% and 11.9% for boys, respectively. The prevalence of weight excess, overweight and obesity in girls were 23.5%, 16% and 9.1%, respectively.

Regarding the studies coverage, included studies were performed in all five Brazilian regions (e.g., Northern, Northeastern, Midwest, Southern and Southern). Only three studies (4.9%) had a national coverage. Studies were mostly developed in Southern region (36.1%). However, other regions have also contributed significantly (e.g., Southeastern (29.5%), Northeastern (23%), Midwest (4.9%) and Northern (1.6%). Studies were largely carried out in scholar environment (e.g., 89.1% of studies were conducted in schools).

Weight excess prevalence stratified by regions are presented in table 2. Regarding the prevalence of overweight, southern region showed the highest percentage (20.1%), followed by northern (19.2%), southeastern (17%), Midwest (15%) and northeastern (11.5%). However, the highest proportion of obese individuals were found in southeastern region (18.2%), being followed by southern (12.1%), Midwest (11%), northern (7.8%), and northeastern (9%).

Figure 2
Mean prevalence of weight excess in Brazilian children and adolescents stratified by sex and demographic region the period from 2014 to 2018.

Comparing previously published studies that analyzed prevalence of overall weight excess, overweight and obesity in Brazilian youth^7-9, we could observe a massive increase of obesity in Brazilian children and adolescents of about 150% (e.g., from 4.8% to 11.6%) during the last 28 years. Overweight presented an increase of 11% (e.g., from 15.2% to 17%) while overall weight excess increased 60% (from 16% to 25.4%) (Figure 3).

Figure 3
Growth of overall weight excess, overweight and obesity in Brazilian children and adolescents from 1990 to 2018.

DISCUSSION

The aim of the present systematic review was to verify the scientific production covering the period from 2014 to 2018 regarding the prevalence of weight excess in Brazilian children and adolescents. The overall prevalence in Brazilian children and adolescents was 25.5%, being 17% overweight and 11.6% obesity. Boys presented higher prevalence of overweight and obesity when compared to girls. The southern region presented the highest prevalence of overall weight excess (33.2%) and overweight (20.1%), while the southeastern region showed the highest prevalence of obesity (18.2%).

The prevalence of overweight and obesity in children and adolescents has increased over the last three decades. According to Ng et al.⁷⁰, from 1980 to 2013, the prevalence of overweight and obesity increase from 16.9% to 23.8% in boys and from 16.2% to 22.6% in girls in developed countries and from 8.1% to 12.9% in boys and from 8.4% to 13.4% in girls in developing countries. This means that the prevalence of overweight and obesity increased about 40% and 60% in developed and developing countries, respectively.

According to national data⁷¹, the prevalence of overweight and obesity in children raised from 10.9% to 34.8% in boys, and from 11.9% to 32.2% in girls and in adolescents raised from 3.7% to 21.7% in boys, and from 7.6% to 19.4% in girls from 1974 to 2009 in Brazil. The present review has verified a prevalence of overweight and obesity in Brazilian children and adolescents of 25.5%, according to studies published between 2014 and 2018.It represents that a quarter of the young population of Brazil is struggling with weight excess.

Interestingly, when the prevalence of overweight and obesity found in the present review was compared with previous reviews^7-9, we have found that the prevalence of overweight increased by 60% between 1990 and 2018. However, when analyzed only the prevalence of obesity, we noticed that the prevalence increased more than 150% in Brazilian children and adolescents.

Although overweight is a concern of health authorities, obesity is a more serious condition and requires urgent action, given its association with other comorbidities and early mortality⁷². According to the present review, more than 11% of Brazilian children and adolescents are obese. Its means that at least 1 in 10 young people are obese in Brazil. These results are in line with a recent publication by NCD Risk Factor Collaboration study⁷³ that has shown a dramatic increase in obesity, especially in low-income countries.

Regarding the stratification of the analysis according to sex, the prevalence of overweight and obesity was higher in boys than girls. Some studies have shown boys likely to be obese than girls^{3,21,23,49,53,57,60,64,68}. These differences can be attributed to the different lifestyles adopted by them, in which boys has spending much time in a sedentary behavior, such as watching television and play videogames, as well as access to unhealthy foods⁷⁴.

When analyzing the prevalence of overweight by Brazilian regions, we found a higher prevalence in the South (33%) and lower prevalence in Northeast (19%) of Brazil. On the other hand, when observing obesity prevalence alone, the southeastern region was the one with the highest prevalence of obesity. It might be explained by the cultural and economic background differences among Brazilian regions⁴.

However, it is important to highlight the paucity of studies developed in the Northern region of Brazil. Only one study³¹ developed in one city of the Northern region with a total sample size of 820 scholars from both sexes was selected for inclusion in the present systematic review. This might affect the prevalence of overweight reached in this region, in which was ranked the second higher among all Brazilian regions (19.2%). Probably, the findings from this study cannot be expanded to the whole Brazilian Northern region. Therefore, more studies about the prevalence of weight excess on the Brazilian Northern region are required in order to better elucidate this phenomenon in this region. According to the newest Brazilian national survey, the weight excess and obesity prevalence in Northern were 26.6% and 11.4%, respectively⁷¹.

The present systematic review has some limitations that need to be mentioned. Only data provided by this review do not allow us to establish an average for each nutritional status category. The limited number of databases adopted for the development of the current systematic review, the poor and regular methodological quality of some studies, as well as the lack of other data source searching and the coverage period of the review might be considered as biases. Altogether, differences found in prevalence may be associated to sample heterogeneity and study-addressed themes. Only few studies primarily aimed to investigate the nutritional status of children and/or adolescents. Yet, we aimed to settle all found prevalence, as well as the stratification by sex and country region, addressing the establishment of a potential association with the means found in previously published studies.

CONCLUSION

Summarily, the present systematic review showed that more than 25% of total children and adolescents’ population presented weight excess. Of those, 11.6% were severely affected for obesity, in which its prevalence more than double over the last 30 years. The highest prevalence was identified in boys from Southern and Southeastern of Brazil.

Thus, due to the alarming increase of obesity over the last decade e by the weight excess-related comorbidities in both childhood and adulthood, a follow-up with greater precision of these tendencies, as well as preventive and treatment action plans should be assumed as high priority in Brazilian health policies.

Funding

• This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. This study was funded by the authors.

Conflict of interest statement

• The authors have no conflict of interests to declare.

SUPPLEMENTARY FILE

Supplementary file 1
Quality assessment of the included studies.

Criteria

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01. Was the research question or objective in this paper clearly stated?

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02. Was the study population clearly specified and defined?

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03. Was the participation rate of eligible persons at least 50%?

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04. Were all the subjects selected or recruited from the same or similar populations (including the same time period)? Were inclusion and exclusion criteria for being in the study pre-specified and applied uniformly to all participants?

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05. Was a sample size justification, power description, or variance and effect estimates provided?

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06. For the analyses in this paper, were the exposure(s) of interest measured prior to the outcome(s) being measured?

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07. Was the timeframe sufficient so that one could reasonably expect to see an association between exposure and outcome if it existed?

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08. For exposures that can vary in amount or level, did the study examine different levels of the exposure as related to the outcome (e.g. categories of exposure, or exposure measured as continuous variable)?

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09. Were the exposure measures (independent variables) clearly defined, valid, reliable, and implemented consistently across all study participants?

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Y

Y

N

N

N

Y

Y

N

Y

Y

Y

Y

N

Y

Y

Y

Y

N

Y

Y

N

10. Was the exposure(s) assessed more than once over time?

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

11. Were the outcome measures (dependent variables) clearly defined, valid, reliable, and implemented consistently across all study participants?

Y

Y

Y

N

Y

Y

Y

Y

Y

N

N

Y

N

Y

Y

Y

N

Y

Y

N

Y

Y

Y

Y

N

Y

N

Y

12. Were the outcome assessors blinded to the exposure status of participants?

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

13. Was loss to follow-up after baseline 20% or less?

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

14. Were key potential confounding variables measured and adjusted statistically for their impact on the relationship between exposure(s) and outcome(s)?

N

Y

N

N

Y

Y

Y

N

Y

Y

N

Y

Y

Y

N

N

Y

N

N

N

Y

Y

N

N

N

N

N

N

Total Score

9

9

4

4

9

9

8

8

9

8

4

8

9

6

7

7

8

8

8

4

8

10

8

8

4

7

8

6

• Y: yes; N: no; NA: not applicable; NR: not reported.

Supplementary file 2
Quality assessment of the included studies.

Criteria	29	30	31	32	33	34	35	36	37	38	39	40	41	42	43	44	45	46	47	48	49	50	51	52	53	54	55	56	57	58	59	60	61
	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y
	N	Y	Y	Y	Y	Y	N	Y	Y	Y	Y	Y	Y	Y	Y	Y	N	Y	Y	Y	Y	Y	Y	Y	Y	N	N	Y	Y	Y	Y	Y	N
	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	N	N	Y	Y	Y	Y	Y
	Y	N	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	N	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	N	Y	Y	Y
	N	Y	Y	Y	N	Y	Y	N	Y	Y	N	Y	Y	N	N	N	Y	Y	N	N	Y	N	N	Y	Y	N	N	Y	N	N	N	N	N
	Y	N	Y	Y	Y	Y	Y	N	Y	Y	N	N	Y	Y	Y	Y	Y	Y	N	Y	Y	Y	Y	Y	Y	Y	Y	N	Y	Y	Y	Y	Y
	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
	N	N	Y	N	Y	Y	Y	Y	N	Y	N	Y	Y	Y	N	Y	Y	Y	Y	Y	N	Y	Y	Y	N	N	N	Y	Y	N	Y	N	Y
	Y	N	Y	N	Y	Y	Y	N	Y	N	N	Y	Y	N	Y	Y	N	Y	N	Y	Y	N	Y	Y	N	N	N	N	N	N	Y	Y	N
	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
	Y	N	Y	Y	Y	N	Y	N	Y	Y	N	Y	Y	N	N	Y	Y	Y	Y	Y	Y	N	Y	Y	Y	N	Y	N	N	Y	Y	Y	Y
	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
	N	N	N	Y	Y	N	Y	Y	Y	Y	N	N	Y	N	N	Y	Y	N	N	Y	N	N	Y	Y	Y	N	Y	N	N	Y	Y	Y	N
T.Score	6	4	9	8	9	8	9	6	9	9	4	8	9	6	6	9	8	9	6	9	8	6	9	10	8	4	5	5	6	6	9	8	6

• Y: yes; N: no; NA: not applicable; NR: not reported.

REFERENCES

• ¹
  World Health Organization/WHO. About obesity. World Obesity Federation. 2016; Availlable from: http://www.worldobesity.org/resources/aboutobesity [2018apr 18].
  » http://www.worldobesity.org/resources/aboutobesity
• ²
  NCD Risk Factor Collaboration/NCD-RisC. Trends in adult body-mass index in200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19.2 million participants. Lancet 2016; 387(10026):1377-96.
• ³
  Grillo LP, Conceição ML, de Matos CH, de Lacerda LLV. Estado nutricional e práticas de educação nutricional em escolares. Mundo Saúde 2016;40(2):230-8.
• ⁴
  Pozza FS, Nucci LB, Enes CC. Identifying Overweight and Obesity in Brazilian Schoolchildren. J Public Health Manag Pract 2018;24(3):204-10.
• ⁵
  Silva DAS, Martins PC, Gonçalves ECDA,. Comparison of three criteria for overweight and obesity classification among adolescents from southern Brazil. Motriz: J Phys Ed 2017;23(4):e1017118.
• ⁶
  Almeida PCD, da Silva JP, Carreiro Pinasco G, Cruz Hegner C, Cabrini Mattos D, Oliveira Potratz, et al. Perfil lipídico em escolares de Vitória-Brasil. J Hum Growth Dev 2016; 26(1): 61-6.
• ⁷
  Tassitano RM, Cecília M, Tenório M. Revisão sistemática sobre obesidade em adolescentes brasileiros Systematic review on obesity in Brazilian adolescents. Rev Bras Cineantropom Desempenho Hum 2009;1(4):449-56.
• ⁸
  Hobold E. Prevalência de sobrepeso e obesidade de crianças e adolescentes no Brasil : uma revisão sistemática. Arq Ciênc Saúde UNIPAR 2014;18(3):189-97.
• ⁹
  Aiello AM, Marques de Mello L, Souza Nunes M, Soares da Silva A, Nunes A. Prevalence of obesity in children and adolescents in brazil: a meta-analysis of cross-sectional studies. Curr Pediatr Rev 2015;11(1):36-42.
• ¹⁰
  Lira MCS, De Menezes RCE, Longo-Silva G, Oliveira MAA, Oliveira JS, CostaEC, et al.. Estado nutricional de crianças segundo critérios do SISVAN em municípios do estado de Alagoas. Mundo Saúde 2017;41(1):68-76.
• ¹¹
  Vicenzi K, Henn RL, Weber AP, Backes V, Paniz VMV, Donatti T, et al. Food insecurity and overweight in first grade students in the municipal school system in SãoLeopoldo, Rio Grande do Sul State, Brazil. Cad Saúde Publica 2015;31(5):1084-94.
• ¹²
  Moher D, Liberati A, Tetzlaff J, Altman DG, Prisma Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Medicine 2009;6(7):1000097.
• ¹³
  National Institutes of Health/NIH. Quality assessment tool for observationalcohort and cross-sectional studies. Bethesda: National Institutes of Health, Department of Health and Human Services. 2014; Avaliable from: http://www.nhlbi.nih.gov/health-pro/guidelines/in-develop/cardiovascular-risk-reduction/tools/cohort [2018apr 18].
  » http://www.nhlbi.nih.gov/health-pro/guidelines/in-develop/cardiovascular-risk-reduction/tools/cohort
• ¹⁴
  Fernandes MTB, Danti GV, Garcia DML, Ferraro AA. Excess body weight in children may increase the length of hospital stay. Clinics 2015;70(2): 87-90.
• ¹⁵
  Araujo AMD, Brandão SAD M, Araújo MADM, Frota KDMG, Moreira-AraujoRSDR. Overweight and obesity in preschoolers: Prevalence and relation to food consumption. Rev Assoc Med Bras 2017;63(2):124-33.
• ¹⁶
  Reuter CP, Burgos MS, Bernhard JC, Tornquist D, Klinger EI, Borges TS, et al. Association between overweight and obesity in schoolchildren with rs9939609 polymorphism (FTO) and family history for obesity. J Pediatr 2016;92(5):493-8.
• ¹⁷
  Ferrari GLM, Matsudo V, Katzmarzyk PT, Fisberg M. Prevalence and factors associated with body mass index in children aged 9-11 years. J Pediatr 2017;93(6):601-9.
• ¹⁸
  Ferrari GLDM, Matsudo V, Barreira TV, Tudor-Locke C, Katzmarzyk PT, Fisberg M. Correlates of moderate-to-vigorous physical activity in Brazilian children. J Phys Act Health 2016;13(10):1132-45.
• ¹⁹
  Araujo DS, Marquezin MCS, Barbosa TS, Fonseca FLA, Fegadolli C, Castelo PM. Assessment of quality of life, anxiety, socio‐economic factors and cariesexperience in Brazilian children with overweight and obesity. Int J Dent Hyg 2016;15(4):e156-62.
• ²⁰
  Alves Junior CAS, Gonçalves ECA, Silva DAS. Obesity in adolescents in SouthernBrazil: association with sociodemographic factors, lifestyle and maturational stage. Rev Bras Cineantropom Desempenho Hum 2016;18(5):557-66.
• ²¹
  Santos FK, Moura dos Santos MA, Almeida MB, Nobre IG, Nobre GG, Ferreira e Silva WT, et al. Biological and behavioral correlates of body weight status amongrural Northeast Brazilian schoolchildren. Am J Hum Biol 2018; 30(3):e23096.
• ²²
  Almeida IO, Navarro F. Caracterização do estado nutricional, atividade física e alimentação de escolares entre 9 e 10 anos da rede pública de ensino de Coimbra-MG. Rev Bras Nutri Esport 2017;11(63):327-38.
• ²³
  Anjos LAD, Silveira WDBD. Estado nutricional dos alunos da Rede Nacional de Ensino de Educação Infantil e Fundamental do Serviço Social do Comércio (Sesc), Brasil, 2012. Cien Saude Colet 2017; 22(5):1725-34.
• ²⁴
  Anzolin CC, Silva DAS, Zanuto EF, Cayres SU, Codogno JS, Junior PC, et al. Accuracy of different cutoff points of body mass index to identify overweight according to body fat values estimated by DEXA. J Pediatr 2017;93(1):58-63.
• ²⁵
  Carneiro CDS, Peixoto MDRG, Mendonça KL, Póvoa TIR, Nascente FMN, Jardim TDSV, et al. Overweight and associated factors in adolescents from abrazilian capital. Rev Bras Epidemiol 2017;20(2):260-73.
• ²⁶
  Gonsalez PS, Retondario A, Bricarello LP, González-Chica DA, Silva DAS, Vasconcelos FDAGD. Exclusive breastfeeding, complementary feeding andassociation with body fat excess among schoolchildren in Florianópolis, Santa Catarina, Brazil. Rev Bras Saúde Mater Infant 2017;17(1):115-25.
• ²⁷
  Melo ISV, Costa CACB, dos Santos JVL, dos Santos AF, Florêncio TMDMT, Bueno NB,. Consumption of minimally processed food is inversely associatedwith excess weight in adolescents living in an underdeveloped city. PloS One2017;12(11): e0188401.
• ²⁸
  Neves JCDJ, Souza AKVD, Fujisawa DS. Controle postural e atividade física em crianças eutróficas, com sobrepeso e obesas. Rev Bras Med Esport 2017; 23(3):241-5.
• ²⁹
  Pedraza DF, Silva FA, Melo NLSD, Araujo EMN, Sousa CPDC. Estado nutricional e hábitos alimentares de escolares de Campina Grande, Paraíba, Brasil. Cien Saude Colet 2017;22(2):469-77.
• ³⁰
  Ripka WL, Ulbricht L, Gewehr PM. Body composition and prediction equations using skinfold thickness for body fat percentage in Southern Brazilian adolescents. PloS One 2017;12(9):e0184854.
• ³¹
  Santos JP, dos Santos Farias E,. Fatores associados ao excesso de peso: estudo de baseescolar ao norte do Brasil. Rev Bras Obes Nutri Emagrecimento 2017;11(64):240-9.
• ³²
  Barbosa Filho VC, Campos WD, Fagundes RR, Lopes ADS, Souza EAD. Presença isolada e combinada de indicadores antropométricos elevados emcrianças: prevalência e fatores sociodemográficos associados. Cien Saude Colet 2016;21(1):213-24.
• ³³
  Bloch KV, Klein CH, Szklo M, Kuschnir MCC, Abreu GA, Barufaldi LA, et al. ERICA: prevalências de hipertensão arterial e obesidade em adolescentes brasileiros. Rev Saúde Pública 2016;50(1):9s.
• ³⁴
  NM, Pitrez Filho MS, Romor Vargas LT, Hauschild JÁ, Baldisserotto M, Sanseverino R, et al. A prevalência de obesidade na infância e adolescência é maior em escolas públicas no sul do Brasil. Nutr Clin Diet Hospitaria 2016;36(4):59-64.
• ³⁵
  Cavalcanti AL, Ramos IA, Cardoso AM, Fernandes LHF, Aragão AS, Santos FG, et al. Association between Periodontal Condition and Nutritional Status of Brazilian Adolescents: A Population-based Study. Iran J Public Health 2016;45(12):1586.
• ³⁶
  Farias Júnior JCD, Mendonça G. Temporal trend in overweight among adolescentsin northeastern Brazil. Arch Endocrinol Metab 2016;60(1):21-28.
• ³⁷
  Marques AC, Schlosser KC, de Freitas Couto S,d’Almeida KSM. Consumo de alimentos ricos em sódio e alteração dos níveis pressóricos em adolescentes de Itaqui/RS. Rev Assoc Med Rio Grande do Sul 2016;60(2):97-103.
• ³⁸
  Silva KEDS, Pelegrini A, Pinto ADA, Ronque ERV, Cyrino ES. Nutritional status of school cchildren aged 7-10 years enrolled in public and private schools of Cascavel, Paraná, Brazil. Rev Nutr 2016;29(5):699-708.
• ³⁹
  Silva KC, Nobre LN, Vicente SEDCF, Moreira LL, do Carmo Lessa A, Lamounier JA. Influência do índice glicêmico e carga glicêmica da dieta sobre o risco de sobrepeso e adiposidade na infância. Rev Paul Pediatr 2016; 34(3):293-300.
• ⁴⁰
  Bertuol CD, Navarro AC. Consumo Alimentar e prevalência de obesidade/emagrecimento em pré-escolares de uma escola infantil pública. Rev Bras Obes Nutri Emagrecimento 2015;9(52):127-34.
• ⁴¹
  Bispo S, Correia MITD, Proietti FA, Xavier CC, Caiaffa WT. Nutritional status of urban adolescents: individual, household and neighborhood factors based on datafrom The BH Health Study. Cad Saúde Publica 2015;31(1):232-45.
• ⁴²
  Caldeira KMS, Souza JMP, Souza SB. Overweight and its relationship withduration of breast feeding in preschoolers. J Hum Growth Development 2015; 25(1):89-96.
• ⁴³
  D’Avila GL, Müller RL, Gonsalez PS, Vasconcelos FDAGD. The association between nutritional status of the mother and the frequency and location of and company during meals and overweight/obesity among adolescents in the city of Florianópolis, Brazil. Rev Bras Saúde Mater Infant 2015;15(3):289-99.
• ⁴⁴
  Dutra GF, Kaufmann CC, Pretto AD, Albernaz EP. Television viewing habits and their influence on physical activity and childhood overweight. J Pediatr 2015; 91(4):346-51.
• ⁴⁵
  Enes CC, Slater B. Dietary intake of adolescents compared with the Brazilian Food Guide and their differences according to anthropometric data and physical activity. Rev Bras Epidemiol 2015;18(4):798-808.
• ⁴⁶
  Fernandes MTB, Danti GV, Garcia DML, Ferraro AA. Excess body weight in children may increase the length of hospital stay. Clinics 2015;70(2):87-90.
• ⁴⁷
  Ferrari GL, Araújo TL, Oliveira LC, Matsudo V, Fisberg M. Association betweenelectronic equipment in the bedroom and sedentary lifestyle, physical activity, and bodymassindex of children. J Pediatr 2015;91(6):574-82.
• ⁴⁸
  Ferreira HS, Lúcio GMA, Assunção ML, Silva BCV, Oliveira JS, Florêncio TMM et al. High blood pressure among students in public and private schools in Maceio, Brazil. PloS One 2015;10(11):0142982.
• ⁴⁹
  Miranda JMQ, Palmeira MV, Polito LFT, Brandão MRF, Bocalini DS, Junior AJF, et al. Prevalência de sobrepeso e obesidade infantil em instituições de ensino; públicas vs. privadas. Rev Bras Med Esporte 2015;21(2):104-107.
• ⁵⁰
  Monteiro AR, Dumith SC, Gonçalves TS, Cesar JA. Overweight among young people in a city in the Brazilian semiarid region: a population-based study.Cien Saude Colet 2016;21(4):1157-1164.
• ⁵¹
  Motter AF, Vasconcelos FA, Correa EN, Andrade DF. Pontos de venda de alimentos e associação com sobrepeso/obesidade em escolares de Florianopolis, SantaCatarina, Brasil. Cad Saúde Pública 2015;31(3):620-32.
• ⁵²
  Nascimento Ferreira MV, De Moraes AC, Carvalho HB, Moreno LA, Gomes Carneiro AL, Dos Reis VM, et al. Prevalence of cardiovascular risk factors, the association with socioeconomic variables in adolescents from low-income region. Nutr Hosp 2015;31(1):217-24.
• ⁵³
  Passos DR, Gigante DP, Maciel FV, Matijasevich A. Comportamento alimentar infantil: comparação entre crianças sem e com excesso de peso em uma escola do município de Pelotas, RS. Rev Paul Pediatr 2015;33(1):42-9.
• ⁵⁴
  Ramos CV, Dumith SC, César JA. Prevalence and factors associated with stuntingand excess weight in children aged 0‐5 years from the Brazilian semi-arid region. J Pediatr 2015;91(2):175-82.
• ⁵⁵
  Roman EP, Ribeiro RR, Guerra-Junior G, Barros-Filho AA,. Comparação do estado nutricional de meninas de acordo com diferentes referências para índice de massa corporal. Rev Bras Saúde Mater Infant 2015;15(1):121-9.
• ⁵⁶
  Rosini N, Moura SAO, Rosini RD, Machado MJ, da Silva EL. Síndrome Metabólica e Importância das Variáveis Associadas em Crianças e Adolescentes de Guabiruba-SC, Brasil. Arq Bras Cardiol 2015;105(1):37-44.
• ⁵⁷
  Silva DAS, Nunes HEG. Prevalência de baixo peso, sobrepeso e obesidade em crianças pobres do Mato Grosso do Sul. Rev Bras Epidemiol 2015;18(2):466-75.
• ⁵⁸
  Sparrenberger K, Friedrich RR, Schiffner MD, Schuch I, Wagner MB. Ultraprocessed food consumption in children from a Basic Health Unit. J Pediatr2015;91(6):535-42.
• ⁵⁹
  Barbosa Filho VC, da Silva Lopes A, Fagundes RR, de Campos W. Índices antropométricos em escolares de um município no Sul do Brasil: análise descritiva utilizando o método LMS1. Rev Paul Pediatr 2014;32(4):333-41.
• ⁶⁰
  Faria AG, Ribeiro MAG, Marson FAL, Schivinski CIS, Severino SD, Ribeiro JD, et al. Effect of exercise test on pulmonary function of obese adolescents. J Pediatr 2014;90(2):242-9.
• ⁶¹
  Garcez MR, Pereira JL, Fontanelli MM, Marchioni DML, Fisberg RM. Prevalência de dislipidemia segundo estado nutricional em amostra representativa de São Paulo. Arq Bras Cardiol 2014;103(6):476-84.
• ⁶²
  Martins VM, Sousa RV, Rocha ES, Leite RB, Gomes MC, Granville-Garcia AF. Assessment of the association between overweight/obesity and traumatic dental injury among Brazilian schoolchildren. Acta Odont Latinoam 2014;27(1):26-32.
• ⁶³
  Mendonça KL, Sousa AL, Carneiro CS, Nascente FM, Póvoa TI, Souza WK, et al. Does nutritional status interfere with adolescents’ body image perception? Eat Behav 2014;15(3):509-12.
• ⁶⁴
  Marthendal AT, Shimizu S, Azevedo LCD. Transtornos alimentares e sua relação com o estado nutricional em adolescentes de uma escola particular de Santa CatarinaBrasil. Arq Catarinense Med 2014;43(3):17-25.
• ⁶⁵
  Müller RDM, Tomasi E, Facchini LA, Piccini RX, Silveira DSD, Siqueira FV, et al. Prevalence of overweight and associated factors in under-five-year-old children in urban population in Brazil. Rev Bras Epidemiol 2014;17(2):285-96.
• ⁶⁶
  Oppitz IN, Cesar JÁ, Neumann NA. Excesso de peso entre menores de cinco anosem municípios do semiárido. Rev Bras Epidemiol 2014;17(4):860-72.
• ⁶⁷
  Pinho L, Botelho ACDC, Caldeira AP. Fatores associados ao excesso de peso em adolescentes de escolas públicas no norte de Minas Gerais. Rev Paul Pediatr 2014;32(2):237-43.
• ⁶⁸
  Rosaneli CF, Baena CP, Auler F, Nakashima ATA, Netto-Oliveira ER, Oliveira AB, et al. Aumento da pressão arterial e obesidade na infância: uma avaliação transversal de 4.609 escolares. Arq Bras Cardiol 2014;103(3):238-44.
• ⁶⁹
  Souza MCC, Tibúrcio JD, Bicalho MF, Rennó MS, Dutra JS, Campos LG, et al. Fatores associados à obesidade e sobrepeso em escolares. Texto Contexto Enferm 2014;23(3):712-9.
• ⁷⁰
  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(9945):766-81.
• ⁷¹
  Instituto Brasileiro de Geografia e Estatística/IBGE. Pesquisa. Familiares 20082009: Antropometria e estado nutricional de crianças, adolescentes e adultos no Brasil. 2010; Available from: https://biblioteca.ibge.gov.br/visualizacao/livros/liv50063.pdf [2018 apr 03].
  » https://biblioteca.ibge.gov.br/visualizacao/livros/liv50063.pdf
• ⁷²
  Global Burden of Metabolic Risk Factors for Chronic Diseases Collaboration. Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: a comparative risk assessment. Lancet Diabetes Endocrinol 2014;2(8):634-47.
• ⁷³
  NCD Risk Factor Collaboration/NCD-RisC. Worldwide trends in blood pressurefrom 1975 to 2015: a pooled analysis of 1479 population-based measurement studieswith 19∙1 million participants. Lancet 2017;389(10064):37-55.
• ⁷⁴
  Chung EK, Romney MC. Social Determinants of Childhood Obesity: Beyond Individual Choices. Curr Pediatr Rev 2012;8(3):237-52.

Publication Dates

• Publication in this collection
  Jul-Aug 2018

History

• Received
  22 Apr 2017
• Accepted
  12 July 2018