[Quality of anthropometric data of children under 5 years in the Brazilian National Food and Nutrition Surveillance System, 2008-2020]. / Qualidade de dados antropométricos de crianças menores de 5 anos no Sistema de Vigilância Alimentar e Nutricional, 2008-2020.

The planning, monitoring, and evaluation of food and nutrition actions depend on reliable estimates based on adequate anthropometric data. The study aimed to analyze the quality of anthropometric data of children aged under 5 years in the Brazilian National Food and Nutrition Surveillance System (SISVAN) from 2008 to 2020. The sample comprised 23,453,620 children aged under 5 years. Initially, we evaluated the distribution of missing values and values outside the spectrum of the instrument, and calculated the digit preference index for weight and height. The nutritional indexes height for age (HAZ), weight for age (WAZ), and body mass index for age (BAZ) were calculated according to the World Health Organization 2006 child growth standards. Then, we identified the biologically implausible values (BIV) and calculated the standard deviation (SD) of the nutritional indexes. For each municipality, we calculated the mean and SD of HAZ and WAZ; and plotted the SD values as a function of the mean. In all Federative Units, the digit preference index reached a minimum value of 80 for height and 20 for weight. For the three nutritional indexes, there was a reduction in the frequency of BIV in the 2008-2020 period. Even after the exclusion of BIV, we identified high variability for the three nutritional indexes. The indicators evaluated showed low quality of measurement, especially in the North and Northeast regions. Our results indicate insufficient quality of anthropometric data in children aged under 5 years, and reinforce the need to invest in actions to improve the collection and recording of anthropometric information.

O planejamento, o monitoramento e a avaliação das ações de alimentação e nutrição dependem de estimativas confiáveis realizadas a partir de dados antropométricos de qualidade adequada. O objetivo deste estudo foi analisar a qualidade de dados antropométricos de crianças menores de 5 anos no Sistema de Vigilância Alimentar e Nutricional (SISVAN) no período de 2008 a 2020. A amostra compreendeu 23.453.620 crianças menores de 5 anos. Inicialmente, avaliamos a distribuição de valores faltantes e de valores fora do espectro do equipamento e calculamos o índice de preferência de dígito para peso e altura. Os índices nutricionais altura para idade (A-I), peso para idade (P-I) e índice de massa corporal para idade (IMC-I) foram calculados com a utilização do padrão de crescimento da Organização Mundial da Saúde, de 2006. Em seguida, sinalizamos os valores biologicamente implausíveis (VBI) e calculamos o desvio padrão (DP) dos índices nutricionais. Para cada município, calculamos a média e o DP de A-I e P-I e plotamos os valores de DP em função da média. Em todas as Unidades Federativas, o índice de preferência de dígito alcançou valor mínimo de 80 para altura e 20 para peso. Para os três índices nutricionais, houve redução da frequência de VBI no período de 2008 a 2020. Mesmo após a exclusão dos VBI, identificamos elevada variabilidade para os três índices nutricionais. Os indicadores avaliados demonstraram baixa qualidade da mensuração principalmente nas regiões Norte e Nordeste. Nossos resultados indicam qualidade insuficiente dos dados antropométricos em crianças menores de 5 anos e reforçam a necessidade de investimento em ações para o aprimoramento da coleta e do registro das informações antropométricas.

La planificación, monitoreo y evaluación de acciones de alimentación y nutrición dependen de estimaciones confiables realizadas a partir de datos antropométricos de calidad adecuada. El objetivo del estudio fue analizar la calidad de datos antropométricos de niños menores de 5 años en el Sistema de Vigilancia Alimentaria y Nutricional (SISVAN) entre los años 2008 y 2020. La muestra se compuso de 23.453.620 niños menores de 5 años. Al principio, evaluamos la distribución de valores faltantes y de valores fueras del espectro del equipo, y calculamos el índice de preferencia de dígito para peso y altura. Los índices nutricionales altura para edad (A-E), peso para edad (P-E) e índice de masa corporal para edad (IMC-E) se calcularon utilizando el patrón de crecimiento de la Organización Mundial de la Salud de 2006. Luego, indicamos los valores biológicamente inverosímiles (VBI) y calculamos la desviación estándar (DE) de los índices nutricionales. Para cada municipio, calculamos la media y la DE de A-E y P-E; y representamos los valores de DE en función de la media. En todas las Unidades Federativas, el índice de preferencia de dígito alcanzó el valor mínimo de 80 para altura y 20 para peso. Para los tres índices nutricionales, hubo una disminución de la frecuencia de VBI entre los años de 2008 y 2020. Incluso tras excluir los VBI, identificamos una alta variabilidad para los tres índices nutricionales. Los indicadores evaluados demostraron una baja calidad de medición, sobre todo en las regiones Norte y Nordeste. Nuestros resultados indican una calidad insuficiente de datos antropométricos en niños menores de 5 años y fortalecen la necesidad de inversión en acciones para mejorar la recolección y registro de las informaciones antropométricas.

Comparison of international height and BMI-for-age growth references and their correlation with adiposity in Brazilian schoolchildren.

This study verified the diagnostic accuracy of the nutritional status classified by the international height and BMI references of the World Health Organization (WHO) (WHO/2007), International Obesity Task Force (IOTF/2012) and MULT (2023). The data pool was composed by 22 737 subjects aged five to 16 years from the Santos and Porto Alegre surveys. A correlation matrix between the z-scores of the BMI references and the skinfold measurements was calculated through the Pearson correlation coefficient (r), and the subject's nutritional status was classified according to the international growth references. The accuracy for diagnosing obesity was performed separately by sex and using the 95th percentile of the triceps and subscapular skinfold sum, while Lin's concordance coefficient, Bland-Altman method and the Cohen's Kappa coefficient (Kappa) were used to verify the concordance and reliability among the BMI references. The correlation matrix showed a high positive correlation among the BMI z-scores (r ≥ 0·99) and among the skinfold measurements (r ≥ 0·86). The prevalence of stunting was higher when applying the MULT reference (3·4 %) compared with the WHO reference (2·3 %). The Bland-Altman plots showed the lowest critical difference (CD) between the height references of WHO and MULT (CD = 0·22). Among the BMI references, the WHO obesity percentile presented lower performance than MULT for boys, presenting a lower +LR value (WHO = 6·99/MULT 18 years = 10·99; 19 years = 8·99; 20 years = 8·09) for the same -LR values (0·04). Therefore, MULT reference holds promise as a valuable tool for diagnosing childhood obesity, particularly when considering sex differences. This enhances its suitability for assessing the nutritional status of Brazilian schoolchildren.

Association of dietary patterns and body phenotypes in Brazilian adolescents / Associação entre padrões alimentares e fenótipos corporais em adolescentes brasileiros

Abstract Objectives: to investigate the association between dietary patterns, physical activity, and body phenotypes in adolescents. Methods: this school-based cross-sectional study involved 1,022 adolescents aged ten to 19 years. Dietary patterns and body phenotypes were defined using a principal component analysis. Body phenotype was defined using anthropometry, body composition, biochemistry, sexual maturation, and dietary patterns from 19 food groups, using a food frequency questionnaire. The association between the dietary patterns and body phenotypes was assessed using a linear regression model. Results: five body phenotypes (BP1adiposity, BP2puberty, BP3biochemical, BP4muscular, BP5lipids_biochemical) and five dietary patterns (DP1ultraprocessed_foods, DP2fresh_foods, DP3bread_rice_beans, DP4culinary_preparations, DP5cakes_rice_beans) were identified. There were higher BP_adiposity scores for obese adolescents, but energy expenditure was similar for obese and non-obese adolescents. Physical activity was positively associated with BMI, BP_adiposity, and BP_puberty. We observed a negative association between DP_ultraprocessed_foods and BMI, and a positive association between DP_fresh_food. DP_fresh_foods was positively associated with BP_adiposity; DP_ultraprocessed_foods and DP_culinary_preparations were negatively associated with this phenotype. BP_biochemical was negatively associated with DP_fresh_foods. Conclusion: we identified a negative association between a dietary pattern composed mainly of ultra-processed foods, fresh foods, and BP_adiposity. These associations need to be better explored, especially in adolescents, as both dietary patterns and phenotypes were defined using multivariate analysis.

Resumo Objetivos: investigar associação entre padrão alimentar (PA), atividade física (AF) e fenótipos corporais (FC) em adolescentes. Métodos: estudo transversal de base escolar com 1.022 adolescentes de dez a 19 anos. Padrão alimentar e fenótipo corporal foram definidos por meio da análise de componentes principais. O fenótipo corporal foi definido usando antropometria, composição corporal, bioquímica e maturação sexual, e padrão alimentar a partir de 19 grupos de alimentos de um questionário de frequência alimentar. A associação entre padrão alimentar e fenótipo corporal foi avaliada por modelo de regressão linear. Resultados: foram identificados cinco fenótipos corporais (FC1adiposidade, FC2puberdade, FC3bioquímico, FC4muscular, FC5lipídios_bioquímico) e cinco padrões alimentares (PA1alimentos_ultraprocessados, PA2alimentos_frescos, PA3pão_arroz_feijão, PA4preparações_culinárias, PA5bolos_arroz_feijão). Há maiores escores de FC_adiposidade para adolescentes com obesidade, mas o gasto energético foi semelhante para adolescentes com e sem diagnóstico de obesidade. Atividade física associou-se positivamente com IMC, FC_adiposidade e FC_puberdade. Observamos associação negativa entre PA_ultraprocessados e IMC, e positiva entre PA_alimentos_frescos. PA_alimentos_frescos associou-se positivamente com FC_adiposidade; PA_ultraprocessados e PA_preparações_culinárias se associaram negativamente a este fenótipo. FC_bioquímico associou-se negativamente com PA_alimentos_frescos. Conclusão: identificamos associação negativa entre padrão alimentar composto principalmente por alimentos ultraprocessados e alimentos in natura e FC_adiposidade. Essas associações devem ser exploradas com o mesmo público em estudos futuros, principalmente em adolescentes, pois tanto o padrão alimentar quanto o fenótipo foram definidos por meio de análise multivariada.

Qualidade de dados antropométricos de crianças menores de 5 anos no Sistema de Vigilância Alimentar e Nutricional, 2008-2020 / Quality of anthropometric data of children under 5 years in the Brazilian National Food and Nutrition Surveillance System, 2008-2020 / Calidad de datos antropométricos de niños menores de 5 años en el Sistema de Vigilancia Alimentaria y Nutricional, 2008-2020

O planejamento, o monitoramento e a avaliação das ações de alimentação e nutrição dependem de estimativas confiáveis realizadas a partir de dados antropométricos de qualidade adequada. O objetivo deste estudo foi analisar a qualidade de dados antropométricos de crianças menores de 5 anos no Sistema de Vigilância Alimentar e Nutricional (SISVAN) no período de 2008 a 2020. A amostra compreendeu 23.453.620 crianças menores de 5 anos. Inicialmente, avaliamos a distribuição de valores faltantes e de valores fora do espectro do equipamento e calculamos o índice de preferência de dígito para peso e altura. Os índices nutricionais altura para idade (A-I), peso para idade (P-I) e índice de massa corporal para idade (IMC-I) foram calculados com a utilização do padrão de crescimento da Organização Mundial da Saúde, de 2006. Em seguida, sinalizamos os valores biologicamente implausíveis (VBI) e calculamos o desvio padrão (DP) dos índices nutricionais. Para cada município, calculamos a média e o DP de A-I e P-I e plotamos os valores de DP em função da média. Em todas as Unidades Federativas, o índice de preferência de dígito alcançou valor mínimo de 80 para altura e 20 para peso. Para os três índices nutricionais, houve redução da frequência de VBI no período de 2008 a 2020. Mesmo após a exclusão dos VBI, identificamos elevada variabilidade para os três índices nutricionais. Os indicadores avaliados demonstraram baixa qualidade da mensuração principalmente nas regiões Norte e Nordeste. Nossos resultados indicam qualidade insuficiente dos dados antropométricos em crianças menores de 5 anos e reforçam a necessidade de investimento em ações para o aprimoramento da coleta e do registro das informações antropométricas.

The planning, monitoring, and evaluation of food and nutrition actions depend on reliable estimates based on adequate anthropometric data. The study aimed to analyze the quality of anthropometric data of children aged under 5 years in the Brazilian National Food and Nutrition Surveillance System (SISVAN) from 2008 to 2020. The sample comprised 23,453,620 children aged under 5 years. Initially, we evaluated the distribution of missing values and values outside the spectrum of the instrument, and calculated the digit preference index for weight and height. The nutritional indexes height for age (HAZ), weight for age (WAZ), and body mass index for age (BAZ) were calculated according to the World Health Organization 2006 child growth standards. Then, we identified the biologically implausible values (BIV) and calculated the standard deviation (SD) of the nutritional indexes. For each municipality, we calculated the mean and SD of HAZ and WAZ; and plotted the SD values as a function of the mean. In all Federative Units, the digit preference index reached a minimum value of 80 for height and 20 for weight. For the three nutritional indexes, there was a reduction in the frequency of BIV in the 2008-2020 period. Even after the exclusion of BIV, we identified high variability for the three nutritional indexes. The indicators evaluated showed low quality of measurement, especially in the North and Northeast regions. Our results indicate insufficient quality of anthropometric data in children aged under 5 years, and reinforce the need to invest in actions to improve the collection and recording of anthropometric information.

La planificación, monitoreo y evaluación de acciones de alimentación y nutrición dependen de estimaciones confiables realizadas a partir de datos antropométricos de calidad adecuada. El objetivo del estudio fue analizar la calidad de datos antropométricos de niños menores de 5 años en el Sistema de Vigilancia Alimentaria y Nutricional (SISVAN) entre los años 2008 y 2020. La muestra se compuso de 23.453.620 niños menores de 5 años. Al principio, evaluamos la distribución de valores faltantes y de valores fueras del espectro del equipo, y calculamos el índice de preferencia de dígito para peso y altura. Los índices nutricionales altura para edad (A-E), peso para edad (P-E) e índice de masa corporal para edad (IMC-E) se calcularon utilizando el patrón de crecimiento de la Organización Mundial de la Salud de 2006. Luego, indicamos los valores biológicamente inverosímiles (VBI) y calculamos la desviación estándar (DE) de los índices nutricionales. Para cada municipio, calculamos la media y la DE de A-E y P-E; y representamos los valores de DE en función de la media. En todas las Unidades Federativas, el índice de preferencia de dígito alcanzó el valor mínimo de 80 para altura y 20 para peso. Para los tres índices nutricionales, hubo una disminución de la frecuencia de VBI entre los años de 2008 y 2020. Incluso tras excluir los VBI, identificamos una alta variabilidad para los tres índices nutricionales. Los indicadores evaluados demostraron una baja calidad de medición, sobre todo en las regiones Norte y Nordeste. Nuestros resultados indican una calidad insuficiente de datos antropométricos en niños menores de 5 años y fortalecen la necesidad de inversión en acciones para mejorar la recolección y registro de las informaciones antropométricas.

Infant feeding practices in three Latin American countries in three decades: what demographic, health, and economic factors are relevant?

Introduction: Studies in Latin America have focused either on analyzing factors associated with exclusive breastfeeding (EBF) or infant formula (IF). Purpose: Analyze the association between economic, sociodemographic, and health factors with EBF, mixed milk feeding (MixMF), and exclusive use of IF in three Latin American and Caribbean countries in the 1990s, 2000s, and 2010s. Methods: Cross-sectional time-series study using data from Demographic and Health Surveys between the 1990s and 2010s in Colombia (1995-2010), Haiti (1994-2017), and Peru (1996-2012) accounting for a sample of 12,775 infants under 6 months. Hierarchical logistic multilevel regression models were used to estimate the adjusted association between infant feeding outcomes (EBF, MixMF, exclusive use of IF) and contextual level DHS survey decade (1990s, 2000s and 2010s) and economic factors (Gross Domestic Product by purchasing power parity, female wage and salaried workers, labor force participation rate female) as well as individual level sociodemographic (maternal age, maternal education, number of children in the household, wealth index, mother living with a partner, area of residence, mother working outside of home), and health factors (breastfed in the first hour, C-section). Results: Factors associated with EBF cessation were c-section (OR: 0.76; 95%CI: 0.64, 0.92), mothers working outside of the home (OR: 0.79; 95%CI: 0.69, 0.90), families in the highest income quintile (OR: 0.64; 95%CI: 0.49, 0.84), and female wage and salaried workers (OR: 0.92; 95%CI: 0.91, 0.94). MixMF was associated with women with higher education (OR: 1.54; 95%CI: 1.21, 1.97), mother working outside of the home (OR: 1.26; 95%CI: 1.10, 1.43), c-section (OR: 1.37; 95%CI: 1.15, 1.62), families in the highest income quintiles (OR: 2.77; 2.10, 3.65). and female wage and salaried workers (OR: 1.08;95% CI: 1.05, 1.09). Exclusive use of IF was associated with a mother working outside of the home (OR: 2.09; 95%CI: 1.41, 3.08), c-section (OR: 1.65; 95%CI: 1.09, 2.51), families in the highest income quintiles (OR: 12.08; 95% CI: 4.26, 34.28), the 2010s (OR: 3.81; 95%CI: 1.86, 7.79), and female wage and salaried workers (OR: 1.12; 95%CI: 1.07, 1.16). Discussion/Conclusion: Factors related to women empowerment and gender equality jeopardized EBF and favored the exclusive use of IF in Latin America. Therefore, workplace interventions to promote, protect, and support breastfeeding practices are key to reducing exclusive use of IF.

Frequency of anthropometric implausible values estimated from different methodologies: a systematic review and meta-analysis.

CONTEXT: Poor anthropometric data quality affect the prevalence of malnutrition and could harm public policy planning. OBJECTIVE: This systematic review and meta-analysis was designed to identify different methods to evaluate and clean anthropometric data, and to calculate the frequency of implausible values for weight and height obtained from these methodologies. DATA SOURCES: Studies about anthropometric data quality and/or anthropometric data cleaning were searched for in the MEDLINE, LILACS, SciELO, Embase, Scopus, Web of Science, and Google Scholar databases in October 2020 and updated in January 2023. In addition, references of included studies were searched for the identification of potentially eligible studies. DATA EXTRACTION: Paired researchers selected studies, extracted data, and critically appraised the selected publications. DATA ANALYSIS: Meta-analysis of the frequency of implausible values and 95% confidence interval (CI) was estimated. Heterogeneity (I2) and publication bias were examined by meta-regression and funnel plot, respectively. RESULTS: In the qualitative synthesis, 123 reports from 104 studies were included, and in the quantitative synthesis, 23 studies of weight and 14 studies of height were included. The study reports were published between 1980 and 2022. The frequency of implausible values for weight was 0.55% (95%CI, 0.29-0.91) and for height was 1.20% (95%CI, 0.44-2.33). Heterogeneity was not affected by the methodological quality score of the studies and publication bias was discarded. CONCLUSIONS: Height had twice the frequency of implausible values compared with weight. Using a set of indicators of quality to evaluate anthropometric data is better than using indicators singly. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no. CRD42020208977.

[Duration of remote work and a positive diagnosis of COVID-19: an analysis of PNAD COVID19 data]. / Duração do trabalho remoto e diagnóstico positivo de COVID-19: análises dos dados da PNAD COVID19.

The scope of this work was to assess the association between the duration of remote work and a positive diagnosis of COVID-19 among individuals employed in Brazil. Data from the PNAD COVID19 (2020) survey were consulted. The variables in the work situation described included: absence from work due to physical distancing, work segment (work sector and formality: formal or informal private, military, statutory civil servant, CLT public sector, informal public sector, employer, self-employed/unpaid worker) and duration of remote work (no remote work for 1-2 months, 3-4 months, 5-7 months, respectively). The association between duration of remote work (exposure) and positive diagnosis for COVID-19 (outcome) was estimated by Cox regression, with adjustment for sociodemographic variables and work segment. The positive diagnosis of COVID-19 increased from 2.1% to 4.8% between July and November, and the frequency of remote work decreased from 11.6% to 9.5% between May and November. The risk of a positive diagnosis of COVID-19 was lower for people working remotely for 3-4 months, (HR=0.79; CI95%=0.67;0.92) and 5-7 months (HR=0.57; CI95%=0.48;0.67) compared to those who did not work remotely. There was a slight decrease in the percentage of remote work employees, and a longer duration reduced the risk of a positive diagnosis for COVID-19.

Nosso objetivo foi analisar a associação entre a duração do trabalho remoto e o diagnóstico positivo da COVID-19 entre pessoas ocupadas no Brasil. Foram utilizados dados da PNAD COVID19 (2020). As variáveis sobre a situação do trabalho descritas foram: afastamento do trabalho em função do distanciamento físico, segmento de trabalho (setor de trabalho e formalidade: privado formal/informal, militar, servidor público estatutário, setor público CLT/informal, empregador, conta-própria/trabalhador não remunerado) e duração do trabalho remoto (sem trabalho remoto, 1-2 meses, 3-4 meses, 5-7 meses). Associação entre duração do trabalho remoto (exposição) e diagnóstico positivo para COVID-19 (desfecho) foi estimada por regressão de Cox, com ajuste para variáveis sociodemográficas e segmento de trabalho. O diagnóstico positivo da COVID-19 aumentou de 2,1% para 4,8% entre julho e novembro, e a frequência de trabalho remoto reduziu de 11,6% para 9,5% entre maio e novembro. O risco de diagnóstico positivo da COVID-19 foi menor para pessoas que trabalharam remotamente por 3-4 meses (RR=0,79; IC95%=0,67;0,92) e 5 meses (RR=0,57; IC95%=0,48;0,67) comparadas àquelas que não trabalharam remotamente. Houve discreta redução do percentual de trabalhadores em trabalho remoto e sua maior extensão reduziu o risco de diagnóstico positivo para COVID-19.

Duração do trabalho remoto e diagnóstico positivo de COVID-19: análises dos dados da PNAD COVID19 / Duration of remote work and a positive diagnosis of COVID-19: an analysis of PNAD COVID19 data

Resumo Nosso objetivo foi analisar a associação entre a duração do trabalho remoto e o diagnóstico positivo da COVID-19 entre pessoas ocupadas no Brasil. Foram utilizados dados da PNAD COVID19 (2020). As variáveis sobre a situação do trabalho descritas foram: afastamento do trabalho em função do distanciamento físico, segmento de trabalho (setor de trabalho e formalidade: privado formal/informal, militar, servidor público estatutário, setor público CLT/informal, empregador, conta-própria/trabalhador não remunerado) e duração do trabalho remoto (sem trabalho remoto, 1-2 meses, 3-4 meses, 5-7 meses). Associação entre duração do trabalho remoto (exposição) e diagnóstico positivo para COVID-19 (desfecho) foi estimada por regressão de Cox, com ajuste para variáveis sociodemográficas e segmento de trabalho. O diagnóstico positivo da COVID-19 aumentou de 2,1% para 4,8% entre julho e novembro, e a frequência de trabalho remoto reduziu de 11,6% para 9,5% entre maio e novembro. O risco de diagnóstico positivo da COVID-19 foi menor para pessoas que trabalharam remotamente por 3-4 meses (RR=0,79; IC95%=0,67;0,92) e 5 meses (RR=0,57; IC95%=0,48;0,67) comparadas àquelas que não trabalharam remotamente. Houve discreta redução do percentual de trabalhadores em trabalho remoto e sua maior extensão reduziu o risco de diagnóstico positivo para COVID-19.

Abstract The scope of this work was to assess the association between the duration of remote work and a positive diagnosis of COVID-19 among individuals employed in Brazil. Data from the PNAD COVID19 (2020) survey were consulted. The variables in the work situation described included: absence from work due to physical distancing, work segment (work sector and formality: formal or informal private, military, statutory civil servant, CLT public sector, informal public sector, employer, self-employed/unpaid worker) and duration of remote work (no remote work for 1-2 months, 3-4 months, 5-7 months, respectively). The association between duration of remote work (exposure) and positive diagnosis for COVID-19 (outcome) was estimated by Cox regression, with adjustment for sociodemographic variables and work segment. The positive diagnosis of COVID-19 increased from 2.1% to 4.8% between July and November, and the frequency of remote work decreased from 11.6% to 9.5% between May and November. The risk of a positive diagnosis of COVID-19 was lower for people working remotely for 3-4 months, (HR=0.79; CI95%=0.67;0.92) and 5-7 months (HR=0.57; CI95%=0.48;0.67) compared to those who did not work remotely. There was a slight decrease in the percentage of remote work employees, and a longer duration reduced the risk of a positive diagnosis for COVID-19.

MULT: A new BMI reference to assess nutritional status of multi-ethnic children and adolescents.

OBJECTIVES: To develop a new Body Mass Index (BMI) reference (MULT) based on longitudinal data of multi-ethnic populations and to compare it to international BMI references. METHODS: The MULT BMI reference was constructed through the LMS method and the Generalized Additive Models for Location Scale and Shape (GAMLSS), with 81 310 observations of 17 505 subjects aged 0-22 years old, from the United Kingdom, Ethiopia, Peru, India, Vietnam, Brazil, and Portugal. Outlier values were removed based on weight z-scores (population level) and based on BMI z-scores using the linear mixed effects model (individual level). The MULT M, S and L curves were compared to the ones of the World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), International Obesity Task Force (IOTF), and Dutch Growth Study (DUTCH). The MULT BMI percentile cutoffs for overweight and obesity were calculated using the adult BMI values of 25 and 30 kg/m2 at 17, 18, 19, and 20 years old. RESULTS: MULT presented the lowest mean BMI values for the ages 102-240 months for boys and 114-220 months for girls. MULT S values were similar to the WHO and IOTF for children under 60 months of age and the highest during puberty, while the L curve showed to be more symmetric than the other BMI references. CONCLUSION: The MULT BMI reference was constructed based on recent data of populations from 10 countries, being a good option to assess the nutritional status of multi-ethnic populations.

Overweight and obesity in adulthood, sociodemographic factors, lifestyle, and the early burden of noncommunicable diseases among Americans: NHANES 2007-2018.

OBJECTIVES: To evaluate the association between nutritional status in early adulthood and the burden of noncommunicable diseases (NCDs); To evaluate the influence of sociodemographic factors and lifestyle on the outcomes of BMI kg/m2 ≤24.9, ≥25.0, and ≥30.0; to estimate the population attributable fraction (PAF) to BMI elevated at 25 years old in the burden of NCDs in American adults. METHODS: We used data from 15 721 American adults participating in the National Health and Nutrition Examination Survey from 2007 to 2018. The Hazard Ratio (HR), Incidence Rate Ratio (IRR), and 95% confidence intervals (CI) were estimated in the proportional risk regression models of Cox (entire population) and Poisson (restricted to non-patients), respectively. The proportionality of the risk between the burden of NCDs and BMI at 25 years old was drawn by the Kaplan-Meier curve, and the PAF was calculated. All analyses were adjusted taking into account the sample weights. RESULTS: Health disparities (sex, age, race/ethnicity, education, poverty index, and education level), and lifestyle (physical activity, smoking, and alcohol consumption) influenced the current nutritional status. Cumulative survival in overweight and obese groups decreased considerably over time (p < .0001). Being overweight and obese in adulthood may increase the risk of early NCDs (HR: 1.68, 95% CI: 1.54-1.84 and HR: 2.87, 95% CI: 2.56-3.21, respectively). About 22.72% (95% CI: 19.99-25.36, p < .001) of the burden NCDs could have been avoided if overweight at age 25 had been prevented. CONCLUSIONS: Monitoring weight change from young adulthood can provide a sensitive and useful clinical measure for early detection of adverse trends in NCDs risk.

MULT: New height references and their efficiency in multi-ethnic populations.

OBJECTIVES: To develop new height references (MULT) based on longitudinal data of multi-ethnic populations and to compare them to the height references from the Dutch Growth Study, from the Centers for Disease Control and Prevention (CDC) and from the World Health Organization (WHO). METHODS: The MUL height references were developed through the LMS method and the Generalized Additive Models for Location Scale and Shape. They were constructed based on 2611 subjects (15 292 measurements) from the advantaged quintile of the Young Lives (Younger Cohort), Millennium Cohort Study, Adolescent Nutritional Assessment Longitudinal Study, and Epidemiological Health Investigation of Teenagers in Porto studies. The M, S curves were described to compare the growth trajectory of the MULT, DUTCH, CDC and WHO height references. For the population comparative analysis, we used the total sample of the studies (91 063 observations, 17 641 subjects). The Lin's concordance correlation coefficient (CCC) and Cohen's kappa coefficient (K) were used to verify the agreement between MULT, WHO and CDC height references. RESULTS: The MULT height references showed taller boys for the periods of 61-174 months and 196-240 months and taller girls for 61-147 and 181-240 months, when compared to CDC and WHO height references. There was an almost perfect agreement between WHO and MULT height references (CCC >0.99) for the subjects aged 2 to 5 years. CONCLUSIONS: MULT height references presented a taller population and a high agreement with WHO growth charts, especially for children under 5 years, indicating that it could be useful to assess nutritional status of multi-ethnic populations.

Relação entre maturação sexual e indicadores antropométricos e pressóricos em adolescentes / Relationship between sexual maturation and anthropometric and blood pressure indicators in teenagers

Resumo Objetivou-se investigar a relação entre a maturação sexual com indicadores antropométricos e pressóricos de adolescentes. Estudo transversal de base populacional, realizado entre 2018 e 2020, com 345 adolescentes de 10 a 19 anos. Coletou-se variáveis sociodemográficas e antropométricas, pressão arterial e maturação sexual. A análise dos dados foi feita por meio da Análise de Componentes Principais, que gerou três componentes e, posteriormente, testou-se a correlação entre a maturação sexual e os componentes gerados. A maioria dos adolescentes eram do sexo feminino (53%), normotensos (66,1%) e com peso normal (73%). Houve correlação positiva entre o desenvolvimento das mamas com o componente 1 e o componente 2, e correlação negativa entre mamas e o componente 3. Nos meninos, o desenvolvimento dos genitais e pelos pubianos estiveram positivamente correlacionados com o componente 2 e inversamente correlacionados com o componente 3. Conclui-se que existe relação entre a maturação sexual e os indicadores antropométricos e pressóricos, sendo variáveis representativas de risco cardiovascular em adolescentes, mesmo que não em sua totalidade.

Abstract This study aimed to investigate the relationship between sexual maturation and anthropometric and blood pressure indicators in teenagers. This was a population-based cross-sectional study, conducted with 345 teenagers, aged 10 to 19 years, between 2018 and 2020. In this study, data referent to sociodemographic and anthropometric variables, blood pressure, and sexual maturation were collected. The data analysis was performed by applying the Principle Component Analysis (PCA), which generated three components and then tested the correlation between sexual maturation and the generated components. Most of the teenagers were female (53%), normotensive (66.1%), and with a normal weight (73%). A positive correlation was found between breast development and component 1 and component 2, as well as a negative correlation between the breasts and component 3. In the boys, the development of genitals and pubic hair was positively correlated with component 2 and inversely correlated with component 3. It could therefore be concluded that there is a relationship between sexual maturation and the anthropometric and blood pressure indicators, which proved to be representative variables for cardiovascular risk in teenagers, even if not in their entirety.

Relationship between sexual maturation and anthropometric and blood pressure indicators in teenagers. / Relação entre maturação sexual e indicadores antropométricos e pressóricos em adolescentes.

This study aimed to investigate the relationship between sexual maturation and anthropometric and blood pressure indicators in teenagers. This was a population-based cross-sectional study, conducted with 345 teenagers, aged 10 to 19 years, between 2018 and 2020. In this study, data referent to sociodemographic and anthropometric variables, blood pressure, and sexual maturation were collected. The data analysis was performed by applying the Principle Component Analysis (PCA), which generated three components and then tested the correlation between sexual maturation and the generated components. Most of the teenagers were female (53%), normotensive (66.1%), and with a normal weight (73%). A positive correlation was found between breast development and component 1 and component 2, as well as a negative correlation between the breasts and component 3. In the boys, the development of genitals and pubic hair was positively correlated with component 2 and inversely correlated with component 3. It could therefore be concluded that there is a relationship between sexual maturation and the anthropometric and blood pressure indicators, which proved to be representative variables for cardiovascular risk in teenagers, even if not in their entirety.

Objetivou-se investigar a relação entre a maturação sexual com indicadores antropométricos e pressóricos de adolescentes. Estudo transversal de base populacional, realizado entre 2018 e 2020, com 345 adolescentes de 10 a 19 anos. Coletou-se variáveis sociodemográficas e antropométricas, pressão arterial e maturação sexual. A análise dos dados foi feita por meio da Análise de Componentes Principais, que gerou três componentes e, posteriormente, testou-se a correlação entre a maturação sexual e os componentes gerados. A maioria dos adolescentes eram do sexo feminino (53%), normotensos (66,1%) e com peso normal (73%). Houve correlação positiva entre o desenvolvimento das mamas com o componente 1 e o componente 2, e correlação negativa entre mamas e o componente 3. Nos meninos, o desenvolvimento dos genitais e pelos pubianos estiveram positivamente correlacionados com o componente 2 e inversamente correlacionados com o componente 3. Conclui-se que existe relação entre a maturação sexual e os indicadores antropométricos e pressóricos, sendo variáveis representativas de risco cardiovascular em adolescentes, mesmo que não em sua totalidade.

Undernutrition and obesity trends in Brazilian adults from 1975 to 2019 and its associated factors.

Nutritional status has evolved in a dual trend worldwide: underweight has become a minor or local issue while overweight or obesity has risen to play a major role in the global burden of disease. In 2014, Brazil was ranked as the third country with the highest absolute number of obese men. Our aim was to estimate trends of underweight and obesity among Brazilian adults using a comprehensive set of surveys from 1974 to 2019. The data used in the study originate from subjects aged ≥ 18 in six Brazilian national surveys, presented in chronological order: Brazilian National Survey on Household Expenses (ENDEF 1974-1975); Brazilian National Survey on Health and Nutrition (PNSN 1989); Brazilian Household Budget Survey (POF 2002-2003, 2008-2009); and Brazilian National Health Survey (PNS 2013 and 2019). All six surveys were designed to sample household complexes that were representative of the Brazilian population. Body mass index was calculated (kg/m2). The nutritional status of individuals was classified following the standards. We have modeled obesity trend according to income and education strata. The trajectories of underweight and obesity over time in Brazil draw the classical "X" of nutrition transition. From 1975 to 2019 underweight has decreased from 9.1% to 2.5% among men and 12.2% to 3.4% among women. On the other hand, obesity trajectories have scaled up from 3% to 22% among men and from 9% to 30% among women. The increase in obesity rate is directly and negatively proportional to income quintiles. Sociodemographic (income and education) improvement is associated with an increase in obesity. All public policies intending to stop the obesity spread in Brazil have been ineffective or too small to be effective.

Evolution of breastfeeding indicators and early introduction of foods in Latin American and Caribbean countries in the decades of 1990, 2000 and 2010.

BACKGROUND: Early introduction of liquid/solid food before 6 months of age is one of the major barriers to exclusive breastfeeding. Our objective was to analyze the evolution of infant feeding practices for infants under 6 months of age in Latin American and Caribbean countries in the decades of 1990, 2000 and 2010. METHOD: Cross-sectional time series study with data from Demographic and Health Surveys carried out between 1990 and 2017 in six Latin America and Caribbean countries: Bolivia (1994 to 2008), Colombia (1995 to 2010), Dominican Republic (1996 to 2013), Guatemala (1995 to 2015), Haiti (1994/1995 to 2016/2017), Peru (1996 to 2018). Pooled sample comprised of 22,545 infants under the age of 6 months. Surveys were grouped in three decades: 1990s for surveys from 1990 to 1999, 2000s for surveys from 2000 to 2009, and 2010s for surveys from 2010 to 2017. Exclusive breastfeeding (EBF), predominant breastfeeding (PBF), mixed breastfeeding (mixed BF), supplemented breastfeeding (supplemented BF) and non-breastfeeding (non-BF), and individual foods (water, liquids, milk, infant formula, semi-solid/solid) were analyzed. Prevalence of breastfeeding and food indicators were calculated in pooled sample, according to the infant monthly age groups, decade of survey and residence area(rural/urban). RESULTS: Between 1990s and 2010s, there was an increase in the exclusive breastfeeding prevalence (1990s = 38.1%, 2010s = 46.6%) and a reduction in the PBF prevalence (1990s = 51.7%, 2010 s = 43.1%). There was a decrease in the liquids (1990s = 40.7%, 2010s = 15.8%) and milk prevalence (1990s = 20.4%, 2010s = 8.3%) and an increase in water (1990s = 32.3%, 2010s = 37.6%), and infant formula (1990s = 16.6%, 2010s = 25.5%) prevalence. All breastfeeding indicators, except exclusive breastfeeding, progressively increased according to the monthly age group in three decades, and EBF prevalence sharply decreased from 2 to 3 months of age in all decades. Exclusive breastfeeding prevalence was higher in rural area in the three decades (1990s rural = 43.8%, 1990s urban = 32.4%, 2010s rural = 51.1%, 2010s urban = 42.4%) and infant formula prevalence was higher in urban area (1990s rural = 8.6%, 1990s urban = 24.6%, 2010s rural = 15.9%, 2010s urban = 34.1%). CONCLUSIONS: In the last three decades, in all age groups, there was an increase in exclusive breastfeeding prevalence, as well as a significant reduction in liquids and milk. In the rural area, EBF prevalence remains higher than in urban. Increased water and infant formula feeding are the main barriers to achieving the Global Nutrition Target 2025 for exclusive breastfeeding.

Accuracy of international growth charts to assess nutritional status in children and adolescents: a systematic review.

OBJECTIVE: To verify, through a systematic review, the accuracy of nutritional assessment in children and adolescents using the length/height-for-age and BMI-for-age growth charts of the Centers for Disease Control and Prevention (CDC) (2000), the World Health Organization (WHO) (2006/2007) and the International Obesity Task Force (IOTF) (2012). DATA SOURCE: We selected articles from the databases Medical Literature Analysis and Retrieval System Online (MEDLINE), through PubMed, National Library of Medicine and The National Institutes of Health (NIH), Scientific Electronic Library Online (SciELO) and Virtual Health Library (VHL). The following descriptors were used for the search: "Child", "Adolescent", "Nutritional Assessment", "Growth Chart", "Ethnic Groups", "Stature by age", "Body Mass Index", "Comparison", "CDC", "WHO", and "IOTF". The selected articles were assessed for quality through the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies of the NIH. DATA SYNTHESIS: Thirty-three studies published between 2007 and 2020 were selected and, of these, 20 presented good quality, 12 presented fair quality and one presented poor quality. For children under five years old, the WHO length/height-for-age growth charts were shown appropriate for children from Argentina, South Africa, Brazil, Gabon, Qatar, Pakistan and the United States. For those five years old and older, the WHO BMI-for-age growth charts were accurate for the Brazilian and Canadian populations, while the IOTF growth charts were accurate for the European populations. CONCLUSIONS: There are difficulties in obtaining international growth charts for children from 5 years old and older that go along with a long period of growth, and which include genetic, cultural and socioeconomic differences of multiethnic populations who have already overcome the secular trend in height.

Overweight and Risk of Noncommunicable Diseases in Adulthood: An Analysis of NHANES IV 2015-2016.

BACKGROUND: Worldwide, overweight is one of the main risk factors for Noncommunicable Diseases (NCDs). In this scenario, Body Mass Index (BMI) is the main tool to assess nutritional status of the adult population. AIM: To analyze the association between overweight and the risk of developing type 2 diabetes Mellitus (T2DM) and/or high blood pressure (HBP) during adulthood. SUBJECTS AND METHODS: We used data of subjects aged between 30-64 years old from the United States National Survey of Health and Nutrition Examination (2015-2016). We calculated the risk of developing T2DM and/or HBP in adulthood using a Log-Binomial Regression model. We included sampling weights in our analysis and we adjusted it for confounding factors. RESULTS: We evaluated a total of 2,666 individuals. Overweight affected around 38% of the sample when they were 25 years old and around 70% during the interview. We found 4 factors (overweight, smoking, sedentary lifestyle, and age) that were positively associated with the development of T2DM and/or HBP. Long-term overweight more than doubles the risk of developing these diseases [RR = 2.44; 95%CI: 1.92-3.09]. CONCLUSION: The incidence of T2DM and/or HBP were positively associated with the overweight in adulthood. These results suggest that the prevention of overweight could decrease NCDs prevalence into adulthood.

Undernutrition and obesity trends in Brazilian adults from 1975 to 2019 and its associated factors / Tendências de subnutrição e obesidade em adultos brasileiros entre 1975 e 2019 e fatores associados / Tendencias de desnutrición y obesidad en adultos brasileños desde 1975 a 2019 y sus factores asociados

Nutritional status has evolved in a dual trend worldwide: underweight has become a minor or local issue while overweight or obesity has risen to play a major role in the global burden of disease. In 2014, Brazil was ranked as the third country with the highest absolute number of obese men. Our aim was to estimate trends of underweight and obesity among Brazilian adults using a comprehensive set of surveys from 1974 to 2019. The data used in the study originate from subjects aged ≥ 18 in six Brazilian national surveys, presented in chronological order: Brazilian National Survey on Household Expenses (ENDEF 1974-1975); Brazilian National Survey on Health and Nutrition (PNSN 1989); Brazilian Household Budget Survey (POF 2002-2003, 2008-2009); and Brazilian National Health Survey (PNS 2013 and 2019). All six surveys were designed to sample household complexes that were representative of the Brazilian population. Body mass index was calculated (kg/m2). The nutritional status of individuals was classified following the standards. We have modeled obesity trend according to income and education strata. The trajectories of underweight and obesity over time in Brazil draw the classical "X" of nutrition transition. From 1975 to 2019 underweight has decreased from 9.1% to 2.5% among men and 12.2% to 3.4% among women. On the other hand, obesity trajectories have scaled up from 3% to 22% among men and from 9% to 30% among women. The increase in obesity rate is directly and negatively proportional to income quintiles. Sociodemographic (income and education) improvement is associated with an increase in obesity. All public policies intending to stop the obesity spread in Brazil have been ineffective or too small to be effective.

O estado nutricional tem evoluído em duas direções no mundo: o baixo peso se tornou uma questão menor ou local, enquanto o sobrepeso ou obesidade passou a ter papel preponderante na carga global de doença. Em 2014, o Brasil ocupou terceiro lugar no mundo em número absoluto de homens obesos. O estudo teve como objetivo estimar as tendências nas taxas de baixo peso e obesidade entre adultos brasileiros, tendo como base um conjunto abrangente de inquéritos entre 1974 e 2019. Os dados utilizados no estudo se referem a indivíduos com 18 anos ou mais em seis pesquisas nacionais, apresentadas em ordem cronológica: Estudo Nacional de Despesa Familiar (ENDEF 1974-1975); Pesquisa Nacional sobre Saúde e Nutrição (PNSN 1989); Pesquisa de Orçamentos Familiares (POF 2002-2003, 2008-2009) e Pesquisa Nacional de Saúde (PNS 2013 e 2019). Todos os 6 inquéritos foram desenhados para obter amostras de complexos de domicílios que fossem representativas da população brasileira. O ídice de massa corporal foi calculado (kg/m2). O estado nutricional dos indivíduos foi classificado de acordo com as normas da Organização Mundial da Saúde. Modelamos a tendência da obesidade de acordo com as faixas de renda e escolaridade. As trajetórias de baixo peso e obesidade no Brasil ao longo do tempo mostram a forma clássica em "X" da transição nutricional. Entre 1975 e 2019, a taxa de baixo peso diminuiu de 9,1% para 2,5% entre homens e de 12,2% para 3,4% entre mulheres. Inversamente, as trajetórias da obesidade aumentaram de 3% para 22% entre homens e de 9% para 30% entre mulheres. O incremento na obesidade está relacionado diretamente e de maneira negativamente proporcional aos quintis de renda. A melhoria sociodemográfica (de renda e escolaridade) está associada ao aumento da obesidade. Todas as políticas públicas para interromper a expansão da obesidade no Brasil têm sido ineficazes, ou pequenas demais para ser eficazes.

El estatus nutricional ha evolucionado en una doble tendencia alrededor del mundo: el bajo peso se ha convertido en un problema menor o local, mientras que el sobrepeso o la obesidad ha aumentado desempeñando un papel importante en la carga global de la enfermedad. En 2014, Brasil se situó como el tercer país con la mayor carga absoluta de hombres obesos. Nuestro objetivo fue estimar las tendencias de bajo peso y obesidad entre brasileños adultos, utilizando un conjunto completo de encuestas desde 1974 a 2019. Los datos usados en el estudio procedieron de individuos con ≥18 años en 6 encuestas nacionales brasileñas, presentadas en orden cronológico: Estudio Nacional sobre Gasto Familiar (ENDEF 1974-1975); Encuesta Nacional de Salud y Nutrición (PNSN 1989); Encuestas sobre Presupuesto Familiar (POF 2002-2003, 2008-2009); y Encuesta Nacional de Salud (PNS 2013 y 2019). Las 6 encuestas se diseñaron para las muestras complejas de hogares que eran representativas de la población brasileña. Se calculó el indice de masa corporal (kg/m2). El estatus nutricional de los individuos se clasificó siguiendo los estándares de la Organización Mundial de la Salud. Hemos modelado la tendencia a la obesidad según el nivel de ingresos y educación. Las trayectorias de bajo peso y obesidad a lo largo del tiempo en Brasil dibujaron la clásica "X" de transición nutricional. Desde 1975 a 2019, ha decrecido el bajo peso de 9,1% a 2,5% entre hombres y de 12,2% a 3,4% entre mujeres. Las trayectorias de obesidad, en cambio, escalan desde el 3% al 22% entre hombres, y desde el 9% al 30% entre mujeres. El incremento en la tasa de obesidad es directamente y negativamente proporcional a los quintiles de ingresos. La mejora sociodemográfica (ingresos y educación) está asociada con un incremento en la obesidad. Todas las políticas públicas puestas en práctica para intentar detener la propagación de la obesidad en Brasil han sido inefectivas o demasiado pequeñas para ser efectivas.

Sampling plan and methodological aspects: a household healthcare survey in Piauí.

OBJECTIVE: To describe the methodological aspects of the Piauí home healthcare survey (ISAD-PI) and assess the relation between sampling plan, precision, and design effects, assuming that population health surveys are relevant instruments for health monitoring. METHODS: ISAD-PI was a population-based cross-sectional study that analyzed the living conditions and health status of the population residing in urban areas in the municipalities of Teresina and Picos, in Piauí. Sampling was carried out by conglomerates in two stages: Primary Sampling Units and households. To calculate the sample size, we considered the stratification of the population in both cities, according to the age of the individuals. We evaluated the "non-response" rate (NRR) and estimated the proportions according to sex and age, as well as the prevalence of social determinants of health in order to assess the compliance of the sampling plan. Analyses related to the precision according to the coefficient of proportion variation of the standard error (Cv-pˆ) and the design effect (deff). Cv-pˆ less than 20% and deff less than 1.5 were considered adequate. The total NRR of households was 38.2% in Teresina and 38.3% in Picos. We carried out twenty-four proportion estimates in relation to age and sex and 48 prevalence of social and health determinants estimates, totaling 72 estimates. Among them, 71 had Cv-pˆ less than 20% and 61 had deff less than or equal to 1.5. CONCLUSION: Data generated from the ISAD-PI may contribute to the assessment of health and morbidity conditions in the population. Furthermore, methodological aspects employed in this research may serve as a basis for studies carried out in other cities in Brazil.

[BMI variation, dietary patterns and physical activity among adults aged 21-44 years]. / Variação de IMC, padrões alimentares e atividade física entre adultos de 21 a 44 anos.

The scope of this article is to describe the association between BMI variation, eating patterns and physical activity among adults between 21 and 44 years of age from 2007 to 2012. It is a cross-sectional study using the VIGITEL database. Eating patterns were identified with Principal Components Analysis for the period from 2007 to 2012. Components with eigenvalues >1.0 were retained and factor loadings greater than |0.3| were highlighted. For each individual, a score was calculated per pattern. The Body Mass Index (ΔBMI) difference variable was then created. Linear regression with ΔBMI outcome and Poisson regression with obesity outcomes were conducted. Four eating patterns were retained: Prudent, Transition, Western and Traditional. After multivariate adjustment, ΔBMI was inversely associated with the habit of leisure-time physical activity. Obesity revealed a positive association with the Western pattern, watching television ≥3 hours a day and physical inactivity. Obesity was inversely associated with the Prudent pattern, the Traditional pattern, the practice of leisure-time physical activity and the habit of physical activity at work. Eating patterns based on unprocessed and minimally processed foods and practice of physical activity are protective factors against obesity.

O objetivo deste artigo é descrever a associação entre variação de IMC, padrões alimentares e atividade física entre adultos de 21 a 44 anos no período de 2007 a 2012. Estudo transversal com a base de dados do VIGITEL. Padrões alimentares foram identificados com Análise de Principais Componentes para o período de 2007 a 2012. Componentes com autovalores >1,0 foram retidos e cargas fatoriais superiores a |0,3| foram destacadas. Para cada indivíduo, um escore foi calculado por padrão. Em seguida foi criada variável de diferença do Índice de Massa Corporal (ΔIMC). Regressão linear com desfecho ΔIMC e regressão de Poisson com desfecho obesidade foram conduzidas. Quatro padrões alimentares foram retidos: Prudente, Transição, Ocidental e Tradicional. Após ajuste multivariável, ΔIMC mostrou-se inversamente associada à prática de atividade física no lazer. Obesidade apresentou associação positiva com padrão Ocidental, assistir à televisão ≥3 horas por dia e inatividade física. Obesidade mostrou-se inversamente associada com padrão Prudente, padrão Tradicional, prática de atividade física no lazer e prática de atividade física no trabalho. Padrões alimentares baseados em alimentos in natura e minimamente processados e prática de atividade física constituem fatores de proteção para a obesidade.