Relationship between short stature and obesity in Brazil: a multilevel analysis

Abstract

To ascertain the association of BMI and obesity with short stature, a cross-sectional telephone survey was conducted in 2006, using a multilevel approach, adjusting for individual-and city-level measures of socio-economic status. The study probabilistic sample consisted of 54 369 adults (. 18 years) living in households with access to telephone lines in each urban area of the twenty-six Brazilian state capitals and federal district. Odds of being currently obese and obese at age 20 years were compared between short stature individuals (5th percentile) and those with normal stature. After controlling for individual-and city-level sociodemographic characteristics and behaviours, high BMI was strongly associated with short stature individuals (P¼ 0·001). Among short stature women the adjusted OR of being obese was 3·0 (95 % CI 2·2, 4·2) compared with those with stature greater than the 5th percentile. Among men this adjusted OR was 2·0 (95 % CI 1·5, 2·6). When comparisons were made for BMI at age 20 years the OR were even larger (6 for men and 8 for women). Despite the growing body of evidence that environmental factors such as poor food choices and physical inactivity are the main determinants of the worldwide obesity epidemic, the greater difference in BMI and prevalence of obesity in the Brazilian capitals was explained mainly by individual factors. We found a strong association between obesity and short stature after adjustment for diet, physical activity, and many environmental factors. Intra-and inter-generational consequences of undernutrition are an alternative explanation for the regional disparities in obesity in Brazil. Short stature: Obesity: BMI: Telephone interviewsUndernutrition early in life has been associated with adulthood obesity in some (1 -4) , but not all, studies (5 -7) . According to Prentice (8) whether malnutrition in childhood predisposes to later obesity is difficult to analyse owing to the lack of prospective cohorts in developing countries.Cross-sectional studies in Brazil have shown that short adult stature, a marker for early undernutrition, is a risk factor for obesity among women, but not men, even after adjusting for contemporary differences in socio-economic status (3,9) . In addition, associations among women have only been observed in studies conducted in the developed regions of the country, suggesting that a minimum of food availability or the kind of food availability present in developed urban centres would be required for the expression of a possible metabolic programming at an early age (10) . In a recent study, a more accurate marker of early undernutrition -the ratio of height to sitting height -was also associated with a high percentage of fat and obesity in a survey of Brazilian women (11) .A possible physiological mechanism to explain these associations is low energy expenditure among women exposed to energy restriction during development, as shown for Brazilian adolescents with stunting (12,13) . A complementary rather than alternative hypothesis in explaining the...

<b>Nutritional status of children under five years living in area of social vulnerability of Campina Grande, Paraíba State

“…Both maternal weight and stature may influence the linear growth potential and weight gain of the children. These circumstances have been explained by the sharing of genetic, socioeconomic and environmental characteristics (Addo et al, 2013;Araújo et al, 2010;Felisbino-Mendes et al, 2014;Figueroa Pedraza et al, 2013;Sichieri et al, 2010;Symonds et al, 2013). Current analysis revealed a strong association between birth weight and the anthropometric nutritional status of children, with similar results in previous studies, such as studies based on municipal or state population data (Jesus, Castelão, Vieira, Gomes, & Vieira, 2014;Figueiroa et al, 2012;Rissin et al, 2011) and in populations marked by social inequity Lang et al, 2011;Silveira et al, 2010).…”

“…In spite of evidence in determining the nutritional status of children by environmental factors, affecting malnutrition and overweight rates (Araújo et al, 2010;Figueiroa, Alves, Lira, & Batista Filho, 2012;Lima et al, 2010;Monteiro et al, 2009;Rissin et al, 2011;Sichieri, Barbosa & Moura, 2010;Felisbino-Mendes, Villamor, & VelasquezMelendez,, 2014), individual factors may demonstrate strong association, especially when adjusted for environmental conditions and lifestyles with these outcomes (Araújo et al, 2010;FelisbinoMendes et al, 2014;Sichieri et al, 2010). Overweight and stunting are nutritional extremes that may coexist in families in developing countries.…”

Prevalence of overweihgt, obesity, abdominal-obesity and short stature of adult population of Rosario, Argentina

“…Short stature was associated with overweight and abdominal obesity in women but not in men, several studies have shown that short adult stature, a marker for early undernutrition, is a risk factor for obesity among women, but not men (58)(59)(60)(61)(62)(63)(64).…”

BMI, body fat and waist-to-height ratio of stunted v. non-stunted Indian children: a case–control study

“…Much of the evidence to support the relationship between stunting and obesity emerges from some cross-sectional studies that point towards a possible risk of overweight/ obesity among stunted children (7)(8)(9)(10)(11) and adolescents (12)(13)(14) . Some studies have also shown that stunted children and adolescents have higher total body fat percentage (BF%) and central adiposity (14)(15)(16)(17)(18) .…”