Associations of changes in BMI and body fat percentage with demographic and socioeconomic factors: the ELANA middle school cohort.

BACKGROUND AND OBJECTIVES: Adolescent weight and fat gain is determined by multiple factors. This study examined the association between changes in body fat indicators, excessive weight and fat gain, and sociodemographic factors among Brazilian adolescents over a 4-year period. METHODS: Body mass index (BMI) and body fat percentage (BFP) of 809 middle school students (mean age: 11.8 ± 1.15 years) were evaluated annually, from 2010 to 2013. Linear mixed effects models were used to assess the trajectories of BMI and BFP in both boys and girls according to the type of school attended (public or private) and skin colour. General estimating equations logistic regression analyses were performed to investigate associations between sociodemographic variables and the development of overweight or high BFP. RESULTS: Girls from private schools (p = 0.003) and white boys (p = 0.041) experienced bigger increases in BMI, as compared to girls from public schools and black/brown boys, respectively. White boys also had an increased chance of presenting excessive weight (OR = 3.28; CI 95%: 1.13-9.52) and BFP (OR = 3.32; CI 95%: 1.38-8.01) gain than black/brown boys. Conversely, white girls were less likely to present excessive body fat gain when compared to black/brown girls (OR = 0.42; CI 95%: 0.18-0.96). CONCLUSIONS: Adolescents who experienced better socioeconomic conditions, especially boys, were more likely to have greater increases in body fat indicators. Our findings contribute to the better understanding of BMI trajectories and body composition changes during puberty, as well as demonstrates the relationship between socioeconomic variables and adiposity indicators among adolescents in middle-income countries.

Clustering of multiple energy balance related behaviors is associated with body fat composition indicators in adolescents: Results from the HELENA and ELANA studies.

The objective of this study was to identify clustering patterns of four energy balance-related behaviors (EBRB): television (TV) watching, moderate and vigorous physical activity (MVPA), consumption of fruits and vegetables (F&V), and consumption of sugar-sweetened beverages (SSB), among European and Brazilian adolescents. EBRB associations with different body fat composition indicators were then evaluated. Participants included adolescents from eight European countries in the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescents) study (n = 2,057, 53.8% female; age: 12.5-17.5 years) and from the metropolitan region of Rio de Janeiro/Brazil in the ELANA study (the Adolescent Nutritional Assessment Longitudinal Study) (n = 968, 53.2% female; age: 13.5-19 years). EBRB data allowed for sex- and study-specific clusters. Associations were estimated by ANOVA and odds ratios. Five clustering patterns were identified. Four similar clusters were identified for each sex and study. Among boys, different cluster identified was characterized by high F&V consumption in the HELENA study and high TV watching and high MVPA time in the ELANA study. Among girls, the different clusters identified was characterized by high F&V consumption in both studies and, additionally, high SSB consumption in the ELANA study. Regression analysis showed that clusters characterized by high SSB consumption in European boys; high TV watching, and high TV watching plus high MVPA in Brazilian boys; and high MVPA, and high SSB and F&V consumption in Brazilian girls, were positively associated with different body fat composition indicators. Common clusters were observed in adolescents from Europe and Brazil, however, no cluster was identified as being completely healthy or unhealthy. Each cluster seems to impact on body composition indicators, depending on the group. Public health actions should aim to promote adequate practices of EBRB.

Sociodemographic characteristics determine dietary pattern adherence during pregnancy.

OBJECTIVE: Sociodemographic factors may affect adherence to specific dietary patterns during pregnancy. The present study aimed to identify dietary patterns during pregnancy and associated factors among Brazilian pregnant women. DESIGN: A cross-sectional analysis. Dietary intake was evaluated with a semi-quantitative FFQ during the first postpartum week; the time frame included the second and third gestational trimesters. Principal component analysis was used to identify dietary patterns during pregnancy. Sociodemographic data were obtained using a structured questionnaire. Multiple linear regressions were applied to test the associations between the sociodemographic factors and dietary patterns. SETTING: Mesquita, Rio de Janeiro, Brazil, 2011. SUBJECTS: Postpartum women (n 327) who were 18-45 years of age and Mesquita residents. RESULTS: Three different dietary patterns were identified: 'healthy' (mainly comprising legumes, vegetables and fruits), 'mixed' (mainly comprising candy, butter and margarine, and snacks) and 'traditional' (mainly comprising beans and rice). Women with a higher monthly per capita family income (ß=0·0006; 95% CI 0·0001, 0·001; P=0·011) and women of older age (ß=0·021; 95% CI -0·001, 0·042; P=0·058) were more likely to adhere to the 'healthy' dietary pattern. Women with higher parity were less likely to adhere to the 'healthy' pattern (ß=-0·097; 95% CI -0·184, -0·009; P=0·030) and were more likely to adhere to the 'traditional' pattern (ß=0·098; 95% CI 0·021, 0·175; P=0·012). Although not statistically significant, older women were less likely to adhere to the 'mixed' (ß=-0·017; 95% CI -0·037, 0·003; P=0·075) and 'traditional' (ß=-0·018; 95% CI -0·037, 0·001; P=0·061) dietary patterns. CONCLUSIONS: Monthly per capita family income, parity and maternal age were factors associated with adherence to a healthy diet during pregnancy.

Cross-sectional associations between body mass index, waist circumference, and multimorbidity: Pró-Saúde study.

Background: This study aimed (1) To investigate the association between the Body Mass Index (BMI) and waist circumference (WC) with multimorbidity (MM), and (2) To identify patterns of MM and investigate the relationship between BMI and WC with specific combinations of MM (patterns of MM). Methods: A cross-sectional study was conducted with 2,698 participants of the fourth phase of the Brazilian Longitudinal Study of Adult Health (Pró-Saúde Study). MM was defined by the presence of two or more morbidities. MM patterns were identified by exploratory factor analysis based on tetrachoric correlations. Logistic regression models were used to assess associations (odds ratios (OR) with the respective confidence intervals (CI)). Results: Of the total number of participants, 39.5% were overweight and 30.0% were obese; 89.0% (n = 1,468) of women and 77.0% (n = 952) of men were abdominally obese. Indeed, 60.7% (n = 1,635) was identified with MM. For the category four or more morbidities, OR values of 5.98 (95% CI 4.84-7.13) and 7.48 (95% CI 6.14-8.18) were found for each point of increase in BMI, and 6.74 (95% CI 5.48-7.99) and 8.48 (95% CI 7.64-9.29) for each additional centimeter in the WC, for female and male, respectively. Five patterns of MM were identified: respiratory, osteoarticular, cardiometabolic, gastric, and thyroid diseases (56.4% of the total variance). Positive associations were found between BMI and patterns of cardiometabolic, osteoarticular, thyroid and gastric diseases (higher OR of 1.09 [95% CI 1.04-1.14]) and less pronounced between WC and patterns of cardiometabolic and osteoarticular (higher OR of 1.04 [95% CI 1.03-1.04]). Conclusions: The results showed that an increase of both BMI and WC was associated with a higher number of morbidities and with patterns of cardiometabolic and osteoarticular diseases.

Design of a school randomized trial for nudging students towards healthy diet and physical activity to prevent obesity: PAAPAS Nudge study protocol.

OBJECTIVE: To evaluate the effectiveness of nudge activities at school on the students' body mass index (BMI). DESIGN: School-based factorial randomized community trial. SETTING: Eighteen public schools in the municipality of Duque de Caxias, metropolitan area of Rio de Janeiro, Brazil. PARTICIPANTS AND INTERVENTION: The 18 schools will be randomized into 4 group arms: group 1-control (without any activity); group 2-will receive educational activities in the classroom; group 3-will receive changes in the school environment (nudge strategies); group 4-will receive educational activities and changes in the school environment. Activities will occur during the 2018 school-year. MAIN OUTCOME MEASURE(S): The primary (BMI) and secondary (body fat percentage) outcomes will be assessed at baseline and after the study using a portable electronic scale with a segmental body composition monitor. The height will be measured by a portable stadiometer. ANALYSIS: Statistical analyses for each outcome will be conducted through linear mixed models that took into account the missing data and cluster effect of the schools.