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Journal of Human Growth and Development

Print version ISSN 0104-1282On-line version ISSN 2175-3598

J. Hum. Growth Dev. vol.29 no.2 São Paulo May/Aug. 2019 



Prevalence and factors associated with obesity in children under five years old in Rio Branco - Acre



Delcio Damasceno da SilvaI; Marcos Venicius Malveira de LimaII; Pascoal Torres MunizIII; Marlon Negreiros de HolandaIV; Ozianndeny Ferreira CâmaraIV; Adilson MonteiroIV; Rubens WajnsztejnIV

IUniversidade Federal do Acre, Campus Floresta, Cruzeiro do Sul, Acre, Brasil
IISecretaria de Estado de Saúde do Acre, Rio Branco, Acre, Brasil
IIIUniversidade Federal do Acre, Rio Branco, Acre, Brasil
IVLaboratório de Delineamento de Estudos e Escrita Científica. Centro Universitário Saúde ABC, Santo André, SP, Brasil





INTRODUCTION: The nutritional status of children is considered an important instrument in measuring the health conditions and quality of life of a population. The increasing prevalence of obesity in children is a significant public health problem as it is an important risk factor for obesity in adulthood
OBJECTIVE: To evaluate the prevaslence and factors associated with childhood obesity in the city of Rio Branco - Acre
METHOD: A database analysis was carried out from the Risk Factors and Morbidity Survey for Noncommunicable Diseases in the Municipality of Rio Branco / Health and Nutrition for Adults and Children in 2008.This cross-sectional study examined 687 children aged 0 to 60 months in urban and rural areas. Statistical analysis considered expansion and sample design. The prevalence of childhood obesity according to the anthropometric indices P / I (weight for age), P / E (weight for height) and BMI / I (Body Mass Index) were respectively 6.85% (95% CI = 5.30). - 8.80), 6.66% (95% CI = 3.22 - 13.27) and 6.61% (95% CI = 3.25 - 12.98
RESULTS: The final model showed a higher prevalence of obesity in the BMI / I index under the following conditions: home in the urban area (PR = 6.81; 95% CI = 1.27 - 36.38), electric lighting without meter (PR = 2.10; 95% CI = 1.22 - 3.59), mother's height greater than 163cm (PR = 2.24; 95% CI = 1.12 - 4.47) and maternal obesity (RP = 2.37 95% CI = 1.19 - 4.72
CONCLUSION: The prevalence of obesity in the BMI / I index was high and is related to socioeconomic factors and specific maternal characteristics. It is necessary to promote actions that lead to the formation of a healthy lifestyle even in childhood

Keywords: childhood obesity, anthropometry, nutritional epidemiology.



Authors summary

Why was this study done?

The prevalence of obesity in children is a public health problem, the study was made because it is known that there is an association of overweight with the child's quality of life, so there is a need to investigate obesity focusing on this group to be create health promotion strategies.

What did the researchers do and find?

The researchers aimed to evaluate the prevalence of obesity among children under 5 years old through a population-based cross-sectional study in Rio Branco, Acre, Brazil and found that the prevalence of obesity is related to socioeconomic factors. and well-defined maternal characteristics such as: Urban domicile, type of electric light with meter, maternal height greater than or equal to 163cm and maternal obesity.

What do these findings mean?

The findings mean that there is a need for social intervention for the prevention of childhood obesity, starting with the promotion of a healthier lifestyle through the development of public policies, focusing on food orientation programs to address the challenges in preventing childhood obesity.



Obesity is a disease determined by the accumulation of energy, in the form of triglycerides, in adipose tissue distributed throughout the body and can cause health damage, facilitating the development or aggravation of associated diseases1. Obesity is treated as a worldwide epidemic, and its prevalence in children and adolescents has been increasing in the last three decades in developed and developing countries, causing a negative impact on public health2,3.

In children and adolescents, obesity is associated with risk factors for cardiovascular, respiratory and metabolic diseases, as well as contributing to low self-esteem and social discrimination. Thus, affecting school and social performance, leading to long-term psychological consequences, that also lead to emotional complications4-6. The growing increase in obesity in children and adolescents is important, since obesity, especially in adolescence, is a predictive factor for obesity in adulthood3,7.

In the pathogenesis of obesity, studies address behavioral and environmental aspects, as well as evaluate genetic and metabolic aspects. No environmental component, studies have shown that parents play an important role in choosing a child's food choices - especially in the first two years of life - and are also crucial in building self-esteem and self-image8,9.

With regard to the genetic factor, studies with adopted children showed that they had body mass index (BMI) related to their biological parents and not to the adoptive ones. This indicates that although the environment plays an important role in determining obesity, genetic influence is also crucial for its development10. The growing obesity situation in developing countries is critical and influences not only the economically disadvantaged individual, but also the disadvantaged groups11.

Therefore, the conceptual model of childhood obesity is still completely misunderstood. The results of targeted studies point to the coincidence of social, environmental, family and individual factors in determining overweight and obesity12. Anthropometric relationships between mothers and children, in addition to the biological component of genotypes, express the conditions between the generations that grew up in different times in different micro and macro environments13.

In 2014, the World Health Organization estimated that there were approximately 43 million overweight children up to 5 years of age in the world14. According to IBGE data, between 2008 and 2009, about 52% of boys and 34% of girls from five to nine years old were overweight or obese in Brazil15. Considering that the association of overweight is linked to reduced quality of life in children, several studies have been conducted to investigate obesity in this group aiming at the creation of health promotion strategies16. Thus, the objective of this study was to evaluate the prevalence of obesity among children under five years old in Rio Branco, Acre, Brazil.



This is a population-based cross-sectional study17, which is part of the research "Health and Nutrition in Children and Adults in the Municipality of Rio Branco, Acre (2008)" conducted by the Federal University of Acre in partnership with the Secretariat of Health Surveillance of the Ministry of Health, State Department of Health of Acre and Municipal Health Department of Rio Branco. The study population consisted of children under five years of age living in Rio Branco.

The sampling was obtained by conglomerates in two stages of selection, the first stage being the selection of census tracts and the second stage the selection of households within each sector, where the parents/guardians of children under five were interviewed, configuring a representative sample of the geographically distributed population in the city of Rio Branco.

In the first stage of selection, the primary sampling unit was the division of the municipality of Rio Branco into 250 census sectors, prepared by the Brazilian Institute of Geography and Statistics (IBGE; for the Census. Demographic survey of the year 2000, from which the 35 census sectors previously used by the National Household Sample Survey (PNAD) in 2006 were selected. In the second stage of selection, 25 households from each sector were drawn, totaling 875 households. In order to supply probable losses and refusals, 15% more households were selected, increasing the sample to 977 households, thus totaling 701 individuals for the initial sample, of these 98% (n = 687) were evaluated, 2% (n = 14) were losses due to non-consent of the parent or guardian in the child's participation in the research.

The data collection instrument used was an individual questionnaire elaborated based on the questionnaires applied in the Survey of Risk Factors and Protection against Chronic Diseases by Telephone Survey (VIGITEL Brazil 2006)18 and in the Household Survey on Risk Behaviors and Morbidity Diseases and Noncommunicable Disorders: Brazil, 15 Capitals and Federal District, 2002-200319. The questionnaire consists of thematic modules, with closed, semi-open and open questions, including the following restrictions: (1) socio-demographic and economic, with data on gender, age, marital status, income, education, occupation, among others; (2) health service usage and coverage assessment; (3) assessment of individual health status, with data on morbidity, lifestyle, tobacco and alcohol consumption, physical activity, among others; and (4) assessment of nutritional status, with data on anthropometry and eating habits.

Age was calculated based on physical exam collection data and birth data after the removal of birth records or equivalent documents. The weight was used with the aid of the microelectronic scale (Tanita bf 572 body fat, capacity of 130 kg with variation of 100g) evaluated by INMETRO with accepted and reproduced tolerance as children without shoes and clothes.

Height was measured horizontally in children under two years of age with an anthropometer made of natural wood measuring 1.30m and upright and using a stadiometer accurate to 1mm in children over two years. The answers regarding socioeconomic, family and child health data were answered, preferably, by the child's mother and in the absence of the child, by the responsible adult. Data were collected from November 2007 to October 2008, through an interview conducted by a team of research assistants trained for the application of the instrument and physical evaluation.

To evaluate obesity used as curves of the World Health Organization21. Obese children were used as children with anthropometric indices greater than +2 standard deviations (SD) for the P/I (weight by age), P/A (weight by height/length) and BMI/I (Body Mass Index by age). The indexes above -5DP and + 5DP were removed. As they were used when the disability of weight and height in three attempts on different days and times, and occurred when the guardian did not authorize the child's participation in the research.

The Epi Info 6.022 program (Centers for Disease Control and Prevention, Atlanta, United States) was used for database creation and double data entry was performed. Anthropometric indices were taken from the WHO Antro23 program (Department of Nutrition, World Health Organization, Geneva, Switzerland).

The analyses were performed using the Stata24 10.023 statistical package (Stata Corp. College Station, United States), in the survey module, where the specifications included the calculated sample weights for each household, the geographical strata, and the primary sampling unit, thus having the corrected data considering the effect of the sample design for the calculation of point estimates and confidence intervals. The prevalence of obesity for the P/I, P/A and BMI/I indexes was removed.

To evaluate the obesity risk association, the BMI/I index was chosen. Thus, prevalence ratios with 95% CI were calculated using Poisson regression. The final multivariate model adopted an association between obesity without BMI/I index and the socioeconomic-environmental conditions studied with a significance level of p <0.05. Data analysis was performed in stages. Firstly, a bivariate analysis between underprivileged obesity (BMI/I) was performed and as selected variables select no study, with an analysis of the risk of misuse due to brutality. As independent variables were performed so that a treatment period was treated as a reference, and as the risk of stratum excess was used in relation to this reference parameter.

To identify the factors associated with undoing and defining variable control, a multivariate block model was created and selected as candidates for the model as covariates with significance below 20% (p <0.20), and remained, without the final model, as variables with statistical significance after adjustment.

In compliance with the requirements required by Resolution no. 510/16 of the National Health Council, the project was examined and approved by the Research Ethics Committee of the Federal University of Acre (Protocol No. 23107.01150/2007-22). Written consent was requested by the parent or guardian of the child, and information was secured or confidential by means of the Informed Consent of Children (ICF-I).



The distribution by sex disassembled that 49.80% (n = 342) were male, in the distribution by age group, children aged 25 to 36 months represent 21.80% (n = 150), being the largest population in the sample, the smallest population was in the age group of 49 to 60 months but representing 17.50% (n = 120). Considering the place of domicile 93% (n = 639) of the children lived in the urban area of Rio Branco.

Table 1 presents the prevalence of obesity according to the anthropometric indices of the study population. It was observed that the highest prevalence was in the P/I index = 6.85% (95% CI = 5.30-8.80), in relation to gender, the male gender presented the highest prevalence in all studied indexes and the highest in the P/A ratio = 8.40% (95% CI = 3.53-18.71). As for the place of domicile, the urban area had the highest prevalence in the P/A and BMI/I indexes, with the highest in the P/A index = 10.91% (95% CI = 8.55-3.81). The highest prevalence of obesity in rural areas was found in the P/I ratio = 6.95% (95% CI = 4.74-10.07).

Regarding the age group, the highest prevalence were always found in the age group from 0 to 12 months, being the highest in the P/I index = 22.99 (95% CI = 14.42-34.95%), in the age 13 to 24 months the highest prevalence of obesity was 10.41% (95% CI = 5.04-20.26) in the BMI/I index; for the age group 25 to 36 months the highest prevalence was found in the P/I index = 6.23% (95% CI = 2.42-15.09), in the age groups from 37 to 48 months and 49 to 60 months the highest prevalences were found in the P/A and BMI/I indexes.

Table 2 presents the prevalence of obesity according to the BMI / I index for the general characteristics of the child, family and home. Males had a prevalence of obesity BMI / I = 7.66%, when compared to females we had a prevalence ratio of 1.39 (95% CI = 0.62-3.10).

Regarding self-reported mother color, the highest prevalence was found in the group of children with yellow and white mothers, respectively, 8.69% and 7.44%. Regarding the color of the child's self-reported father, the group of children with the black father had the lowest prevalence (1.86%), when compared to the group of the white father, we have a prevalence ratio of 3.58. (95% CI = 1.04-12.36) and, when compared to children with dark-haired fathers, we have a prevalence rate of 8.52 (95% CI = 1.83 - 39.74). The group of children in which the mother completed high school has a prevalence of 8.98% of obesity. Regarding family income, children living in households with income below 1000 reais (Brazilian coin) had a prevalence of 6.05% (Table 2).

In relation to the place of domicile, the urban area has a prevalence of obesity of 10.81%, compared to the group of children living in the countryside, a prevalence ratio of 8.12 (95% CI = 1.07) is obtained. -61.36). Regarding household characteristics, the highest prevalence of obesity according to BMI/I index was for the type of wall to be brickwork (10.08%), the floor was not wood (9.91%) and the presence of toilet (9.81%), but the condition of having electric lighting with meter had a prevalence of 11.59%, when compared to the group of children living at home with lighting meter we have a prevalence ratio of 2.22 (CI95 % = 1.27-3.88) (Table 2).

Regarding maternal care, pregnancy and participation, the highest prevalence of obesity was found in the group of children in which the mother is prenatal (6.76%), and who are oriented about breastfeeding (6.83%). When children who smoke before and during pregnancy have a prevalence of obesity of 5.54%, and those who have or suffer from alcohol before and during pregnancy result in pregnancy 6.95%. The group of children in which the mother underwent a cesarean section had a prevalence of obesity of 7.96%. Regarding the characteristics of children, those with birth weight greater than 2,500g had a prevalence of 7.23% and those with birth length less than or equal to 45cm had a prevalence of 11.25%. According to maternal characteristics, children with a height of 163cm or more presented a prevalence of obesity of 12.36%, when compared to the group with a height of less than 163cm, we obtained a prevalence ratio of 2.41 (95% CI = 1.26-4.62). Maternal obesity, according to body mass index, increasing the prevalence of obesity, according to the BMI/I index, in children by 134%. Regarding maternal age, the group of children with mothers aged 21 - 30 years had the highest prevalence of obesity of 7.52%. (Table 3).

Table 4 presents the prevalence of obesity according to the morbidities reported by the mother or guardian on the day of the interview. In the illnesses that occurred in the last 15 days, the highest prevalence of obesity for the BMI / I index was found in the groups without diarrhea (6.90%), without blood in the stool (6.66%), who had vomiting. (8.22%) and had no loss of appetite (7.59%). Children with wheezing in the last 12 months have a prevalence of obesity of 5.39%.

Table 5 shows the result of the final Poisson regression model for the prevalence of childhood obesity for the BMI / I index. In the adjusted model, the variables tested as factors associated with obesity, which remained significant were: the place of domicile in the urban area with PR = 6.81 (95% CI = 1.27-36.38), type of electric lighting with meter, RP = 2.10 (95% CI = 1.22-3.59), mother's height greater than or equal to 163cm with PR = 2.24 (95% CI = 1.12-4.47) and Body Mass Index of Mother classified as obesity PR = 2.37 (95% CI = 1.19-4.72).



The characterization of obesity in children does not yet show consensus in the literature, and the variety of methods applied and the different cutoff values employed make it difficult to compare the results obtained with other studies. Thus, the present discussion is based in person on the survey of studies that used BMI by age to determine obesity25.

The results reveal a high prevalence of obesity for children under five years old in the city of Rio Branco, which demonstrates the seriousness of the situation and reveals the need to include childhood obesity as a serious public health problem.

To compare our results, few studies were found or what are the same methods used for the age group and the determination of the indices used (BMI/I). Namely, Bueno and Fisberg26, in a representative study on children in public daycare centers in the city of São Paulo, found a prevalence of obesity in 2-4 year-olds of 4.6% and 2.4% for females and male, respectively. Silva et al.27 in a cross-sectional convenience sample study conducted at the Childcare Ambulatory Hospital of the Clinical Hospital of the Federal University of Pernambuco (UFPE) found a prevalence of obesity in preschoolers of 13.8 %.

Many studies have been found using school-age children, for example, in 2000, Giugliano and Carneiro28, in a study involving 452 schoolchildren in Brasilia aged 6 to 10 years found a prevalence of 5.3% for obesity. Soar et al.29 studying 419 children between seven and nine years old in a public school in Florianópolis - SC, found a prevalence of 6.7% for obesity. Trocon et al.9, in a cross-sectional study using a sample of schoolchildren, aged 6 to 14 years, in a public school (n = 107) in the city of Campinas and a sample from the Pediatric Outpatient Clinic. HC - Unicamp (n = 109) found a prevalence of obesity, respectively, of 20.2% and 11.2%. Abrantes et al.30 using data from the IBGE Survey on Living Standards in 2,683 children aged 2 to 10 years, a prevalence of 7.0% were observed.

Regarding the gender of the child, Martin and Ferris31 suggest that females may be a risk factor for childhood obesity since girls have more fat than boys. However, in our study, the prevalence of obesity in males was higher regardless of the anthropometric index used and a similar result was reported by Soar et al.29; Costa et al.32; Siqueira and Monteiro33.

Regarding the place of domicile, the high prevalence of obesity found in the urban area can be explained by the socioeconomic pattern of families, confirmed by the variable electric lighting with meter present in the household that remained in the final model. families in the city to high-carbohydrate foods, and decreased intake of animal and vegetable protein34.

According to the 2002-200325 Household Budget Survey, the average food availability in the urban area was 1700 kcal per person, while in the rural area it was 2400 kcal, despite the contradiction, this is explained by the higher frequency of food consumption outside household and genetic needs lower than the rural environment. The food culture of rural families in the northern region of Brazil, similar to that of the Northeast Region, is characterized by subsistence agriculture with limitations for high-fat foods, resulting in the high prevalence of food insecurity36.

In this study, the association between maternal height greater than or equal to 163cm and childhood obesity was detected; however, it was not possible to find studies relating only mother's height to the presence of obesity. However, the positive correlation between the nutritional status of parents and children is known, as they share genetic information regarding socioeconomic and environmental conditions, as pointed out by Sichiere et al.37,38.

A significant association was found between the prevalence of childhood obesity and the mother's nutritional status. Being a child of an obese mother, according to BMI, added in 137% the prevalence of obesity in the adjusted model, thus demonstrating the familial character of obesity3. However, we did not find a statistically significant association between the prevalence of obesity in the sample in relation to maternal education and family income, factors associated with childhood obesity reported by several studies in the literature. This can be explained by the epidemiological transition and demonstrates that the prevalence of obesity may be developing in all socioeconomic extracts.

One of the limitations of our study is related to the cross-sectional design that, although useful for the diagnosis of child health, does not allow us to evaluate the temporal sequence between exposure and outcome of interest. Cross-sectional studies may present difficulty in interpreting the outcome studied and the variables analyzed since there is the possibility of reverse chance bias, which occurs when apparent exposure is a consequence of the outcome, as reported by other studies39-43. Based on the results presented, it is suggested that measures to control and prevent health risks associated with childhood obesity are necessary, taking as an incentive action for a healthy lifestyle.

Thus, health diagnoses derived from a population-based study are fundamental to the planning of interventions aimed at changing the scenario of inequalities between regions of the country. The results show that the prevalence of obesity in children under five years old in the city of Rio Branco is linked to socioeconomic factors and well-defined maternal characteristics such as: place of residence in the urban area, type of electric lighting with meter, height of the mother larger and equal to 163cm and maternal obesity. Therefore, intervention is needed so that the most important current challenge is the prevention of childhood obesity through the promotion of a healthy lifestyle and the promotion of public policies aimed at food orientation programs. Promotion and prevention actions should begin in childhood, taking into account the influence of parents on the formation of eating habits and a healthy lifestyle.


D. D. Silva participated in the data analysis and final writing of the article. M. V. M. Lima guided and revised the data analysis. P. T. Muniz, A. Monteiro, M N Netherlands, The House, and R Wajnsztejn collaborated in the writing and critical revision of the article.



This research was funded by CNPQ (Case 136011 / 2008-0). The feasibility of the article is due to the Acre - Health Project in the Western Amazon (multi-institutional agreement process no. 007/2015 SESACRE-UFAC-FMABC).



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Manuscript received: November 2018
Manuscript accepted: March 2019
Version of record online: October 2019

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