Article | Published:

Epidemiology and Population Health

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

International Journal of Obesity (2018) | Download Citation


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.


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.


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).


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.

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.


  1. 1.

    World Health Organization. Growing up unequal: gender and socioeconomic differences in young people’s health and well-being. In: Inchley J, Currie D, Young T, Samdal O, Torsheim T, Augustson L, et al., editors. Health Behaviour in School-aged Children (HBSC) study: International report from the 2013/2014 survey. Copenhagen: WHO Regional Office for Europe; 2016. p. 292.

  2. 2.

    Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384:766–81.

  3. 3.

    Miqueleiz E, Lostao L, Regidor E. Stabilisation of the trend in prevalence of childhood overweight and obesity in Spain: 2001–11. Eur J Public Health. 2016;26:960–3.

  4. 4.

    Keß A, Spielau U, Beger C, Gausche R, Vogel M, Lipek T, et al. Further stabilization and even decrease in the prevalence rates of overweight and obesity in German children and adolescents from 2005 to 2015: a cross-sectional and trend analysis. Public Health Nutr. 2017; 20: 3075–83.

  5. 5.

    Instituto Brasileiro de Geografia e Estatística - IBGE. Pesquisa de Orçamentos Familiares 2008-2009: Antropometria e Estado Nutricional de Crianças, Adolescentes e Adultos no Brasil. Rio de Janeiro: Ministério do Planejamento, Orçamento e Gestão; 2010, 130 pages.

  6. 6.

    Instituto Brasileiro de Geografia e Estatística - IBGE. Pesquisa Nacional de Saúde do Escolar (PeNSE): 2015.  Rio de Janeiro: Ministério do Planejamento, Orçamento e Gestão; 2016, 132 pages.

  7. 7.

    Zhao M, Bovet P, Ma C, Xi B. Performance of different adiposity measures for predicting cardiovascular risk in adolescents. Sci Rep. 2017;7:43686.

  8. 8.

    Bjerregaard LG, Jensen BW, Ängquist L, Osler M, Sørensen TIA, Baker JL. Change in overweight from childhood to early adulthood and risk of type 2 diabetes. N Engl J Med. 2018;378:1302–12.

  9. 9.

    Llewellyn A, Simmonds M, Owen CG, Woolacott N. Childhood obesity as a predictor of morbidity in adulthood: a systematic review and meta-analysis. Obes Rev. 2016;17:56–67.

  10. 10.

    Bambra CL, Hillier FC, Cairns J-M, Kasim A, Moore HJ, Summerbell CD. How effective are interventions at reducing socioeconomic inequalities in obesity among children and adults? Two systematic reviews. Public Heal Res. 2015;3:1–446.

  11. 11.

    Chung A, Backholer K, Wong E, Palermo C, Keating C, Peeters A. Trends in child and adolescent obesity prevalence in economically advanced countries according to socioeconomic position: a systematic review. Obes Rev. 2015;17:276–95.

  12. 12.

    Dinsa GD, Goryakin Y, Fumagalli E, Suhrcke M. Obesity and socioeconomic status in developing countries: a systematic review. Obes Rev. 2012;13:1067–79.

  13. 13.

    Lima NP, Horta BL, Motta JVDS, Valença MS, Oliveira V, Santos TV Dos, et al. [Evolution of overweight and obesity into adulthood, Pelotas, Rio Grande do Sul State, Brazil, 1982-2012]. Cad saúde pública. 2015; 31: 2017–25.

  14. 14.

    Loomba-Albrecht LA, Styne DM. Effect of puberty on body composition. Curr Opin Endocrinol Diabetes Obes. 2009;16:10–15.

  15. 15.

    Fitzmaurice GM, Laird NM, Ware JH. Longitudinal and clustered data. In: Fitzmaurice GM, Laird NM, Ware JH, editors. Applied Longitudinal Analysis. Hoboken, New Jersey: John Wiley and Sons; 2011, p. 1–18.

  16. 16.

    González DA, Nazmi A, Victora CG. Growth from birth to adulthood and abdominal obesity in a Brazilian birth cohort. Int J Obes (Lond). 2010;34:195–202.

  17. 17.

    Victora CG, Sibbritt D, Horta BL, Lima RC, ScD TC, Wells J. Weight gain in childhood and body composition at 18 years of age in Brazilian males. Acta Paediatr. 2007;96:296–300.

  18. 18.

    Fonseca FL, Brandão AA, Pozzan R, Campana ÉMG, Luiz Pizzi O, Magalhães MEC, et al. Excesso de peso e o risco cardiovascular em jovens seguidos por 17 anos: estudo do Rio de Janeiro. Arq Bras Cardiol. 2010;94:207–15.

  19. 19.

    Muraro AP, Gonçalves-Silva RMV, Ferreira MG, Sichieri R. Effects of social mobility from childhood to adolescence on BMI. Public Health Nutr. 2016;19:814–21.

  20. 20.

    Moreira NF, Sichieri R, Reichenheim ME, Oliveira ASDDe, Da Veiga GV. The associations of BMI trajectory and excessive weight gain with demographic and socio-economic factors: the Adolescent Nutritional Assessment Longitudinal Study cohort. Br J Nutr. 2015;114:2032–8.

  21. 21.

    Twisk JWR. Applied Longitudinal Data Analysis for Epidemiology. Cambridge: Cambridge University Press; 2003.

  22. 22.

    Lohman TG, Martorell R. Anthropometric standardization reference manual. Human Kinetics Books: Champaign, IL; 1988.

  23. 23.

    Habicht J-P. Estandarizacion de metodos epidemiológicos cuantitativos sobre el terreno. Bol Sanit PAnam. 1974;75:375–84.

  24. 24.

    Pederson D, Gore C. Error en la medición antropométrica. In: Norton K, Olds T, editors. Antropometrica. Argentina: Biosystem Servicio Educativo; 2000, p. 61–70.

  25. 25.

    Houtkooper LB, Going SB, Lohman TG, Roche AF, Van Loan M. Bioelectrical impedance estimation of fat-free body mass in children and youth: a cross-validation study. J Appl Physiol. 1992;72:366–73.

  26. 26.

    ​Instituto Brasileiro de Geografia e Estatística - IBGE. Síntese de indicadores sociais: uma análise das condições de vida da população brasileira - 2010. Rio de Janeiro: Ministério do Planejamento, Orçamento e Gestão; 2010, 317 pages.

  27. 27.

    Saito MI. Maturação sexual: auto avaliação do adolescente. Pediatr (São Paulo). 1984;6:111–5.

  28. 28.

    Tanner JM. Growth at adolescence. 2nd ed. Oxford: Blackwell Scientific publication; 1962.

  29. 29.

    Bagni UV, Luiz RR, Veiga GV da. Overweight is associated with low hemoglobin levels in adolescent girls. Obes Res Clin Pract. 2013;7:e218–9.

  30. 30.

    de Onis M. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ. 2007;85:660–7.

  31. 31.

    Williams DP, Going SB, Lohman TG, Harsha DW, Srinivasan SR, Webber LS, et al. Body fatness and risk for elevated blood pressure, total cholesterol, and serum lipoprotein ratios in children and adolescents. Am J Public Heal. 1992;82:358–63.

  32. 32.

    Spyrides MHC, Struchiner CJ, Barbosa MTS, Kac G. Análise de dados com medidas repetidas. In: Kac G, Sichieri R, Gigante DP, editors. Epidemiologia Nutricional. Rio de Janeiro: Fiocruz e Atheneu; 2007, p. 245–60.

  33. 33.

    Adair LS, Fall CH, Osmond C, Stein AD, Martorell R, Ramirez-Zea M, et al. Associations of linear growth and relative weight gain during early life with adult health and human capital in countries of low and middle income: findings from five birth cohort studies. Lancet. 2013;382:525–34.

  34. 34.

    Lourenço BH, Villamor E, Augusto RA, Cardoso MA. Influence of early life factors on body mass index trajectory during childhood: a population-based longitudinal analysis in the Western Brazilian Amazon. Matern Child Nutr. 2015;11:240–52.

  35. 35.

    Lane SP, Bluestone C, Burke CT. Trajectories of BMI from early childhood through early adolescence: SES and psychosocial predictors. Br J Health Psychol. 2013;18:66–82.

  36. 36.

    Shin SH, Miller DP. A longitudinal examination of childhood maltreatment and adolescent obesity: results from the National Longitudinal Study of Adolescent Health (AddHealth) Study. Child Abus Negl. 2012;36:84–94.

  37. 37.

    Krueger PM, Reither EN. Mind the gap: Race/ethnic and socioeconomic disparities in obesity. Curr Diab Rep. 2015;15:95.

  38. 38.

    Wardle J, Brodersen NH, Cole TJ, Jarvis MJ, Boniface DR. Development of adiposity in adolescence: five year longitudinal study of an ethnically and socioeconomically diverse sample of young people in Britain. BMJ. 2006;332:1130–5.

  39. 39.

    Mehio-Sibai A, Feinleib M, Sibai TA, Armenian HK. A positive or a negative confounding variable? a simple teaching aid for clinicians and students. Ann Epidemiol. 2005;15:421–3.

  40. 40.

    Ministério da Educação-Brasil, Instituto Nacional de Estudos e Pesquisas Educacionais Anísio Teixeira. Indicadores Educacionais. (accessed 18 Jan 2018).

Download references


This study was funded by the National Council for Scientific and Technological Development (grant 47667/2011-9), the Research Support Foundation of the State of Rio de Janeiro (grants E26/ 110•847/2009, E26/110•626/2011 and E-26/110.774/2013) and Coordination for the Improvement of Higher Education Personnel (grant 23038.007702/2011-5).


The Adolescent Nutritional Assessment Longitudinal Study (ELANA) was funded by the National Council for Scientific and Technological Development (grant 47667/2011-9), the Research Support Foundation of the State of Rio de Janeiro (grants E26/ 110.847/2009, E26/110.626/2011 and E-26/110.774/2013) and Coordination for the Improvement of Higher Education Personnel (grant 23038.007702/2011-5).

Author information


  1. Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, 21941-901, Brazil

    • Milena Miranda de Moraes
    •  & Gloria Valeria da Veiga
  2. Faculty of Health Sciences, Federal University of Grande Dourados, Dourados, 79804-970, Brazil

    • Naiara Ferraz Moreira
  3. Department of Social Nutrition, Nutrition Institute, State University of Rio de Janeiro, Rio de Janeiro, 20550-900, Brazil

    • Alessandra Silva Dias de Oliveira
  4. Department of Epidemiology, Institute of Social Medicine, State University of Rio de Janeiro, Rio de Janeiro, 20550-900, Brazil

    • Diana Barbosa Cunha
    •  & Rosely Sichieri


  1. Search for Milena Miranda de Moraes in:

  2. Search for Naiara Ferraz Moreira in:

  3. Search for Alessandra Silva Dias de Oliveira in:

  4. Search for Diana Barbosa Cunha in:

  5. Search for Rosely Sichieri in:

  6. Search for Gloria Valeria da Veiga in:

Conflict of interest

The authors declare that they have no conflict of interest.

Corresponding author

Correspondence to Milena Miranda de Moraes.

Supplementary information

About this article

Publication history