Brief Communication | Published:


Time trends in prevalence and incidence rates of childhood overweight and obesity in Portugal: Generation XXI birth cohort

International Journal of Obesity (2018) | Download Citation


Childhood obesity estimates are steadily increasing worldwide. There is strong evidence that overweight children before puberty maintain this nutritional status for life. This study aimed to estimate the prevalence and incidence rates of overweight and obesity among children recruited as part of the Generation XXI birth cohort. Of the 8036 included children, 5497, 5397 and 4956 of them had follow-up measurements at 4, 7 and 10 years of age, respectively. The chi-square test, Student’s t-test, and survival curves were estimated according to sex. The prevalence of overweight remained stable at 4 and 7 years of age (22.0% and 22.1%, respectively) and slightly increased at age 10 (26.1%). Conversely, obesity prevalence increased with age (from 10.6 to 16.8%). Overweight was more prevalent in girls at all follow-ups, whilst obesity was similar between sexes at ages 4 and 7 (p= 0.050 and p = 0.218, respectively) but was more prevalent in boys at age 10 (p = 0.017). The incidence of obesity between 4 and 7 years of age was 11.4/1000 person-years, decreasing to 3.2/1000 person-years between 7 and 10 years of age. Our results reveal a high prevalence/incidence of obesity mainly among 4 and 7-year-old children, heightening the need for interventions at early ages to effectively curb childhood obesity in Portugal.

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Additional information

Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.


  1. 1.

    Han JC, Lawlor DA, Kimm SYS. Childhood obesity. Lancet. 2010;375:1737–48.

  2. 2.

    Campbell MK. Biological, environmental, and social influences on childhood obesity. Pediatr Res. 2016;79:205–11.

  3. 3.

    de Onis M, Blossner M, Borghi E. Prevalence and trends of stunting among pre-school children, 1990–2020. Public Health Nutr. 2012;15:142–8.

  4. 4.

    Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, 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.

  5. 5.

    World Health Organization.

  6. 6.

    Franks PW, Hanson RL, Knowler WC, Sievers ML, Bennett PH, Looker HC. Childhood obesity, other cardiovascular risk factors, and premature death. N Engl J Med. 2010;362:485–93.

  7. 7.

    Friedemann C, Heneghan C, Mahtani K, Thompson M, Perera R, Ward AM. Cardiovascular disease risk in healthy children and its association with body mass index: systematic review and meta-analysis. BMJ . 2012;345:e4759.

  8. 8.

    World Health Organization. Consideration of the evidence on childhood obesity for the Commission on Ending Childhood Obesity: report of the ad hoc working group on science and evidence for ending childhood obesity. Geneva, Switzerland: World Health Organization. 2016. ISBN 978-92-4-156533-2 (NLM classification: WD 210).

  9. 9.

    Rito AI, Graça P. Childhood Obesity Surveillance Initiative: COSI Portugal 2013. Lisboa: Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA, IP); 2015.

  10. 10.

    Wijnhoven TM, van Raaij JM, Spinelli A, Starc G, Hassapidou M, Spiroski I, et al. WHO European Childhood Obesity Surveillance Initiative: body mass index and level of overweight among 6–9-year-old children from school year 2007/2008 to school year 2009/2010. BMC Public Health. 2014;14:806.

  11. 11.

    Larsen PS, Kamper-Jorgensen M, Adamson A, Barros H, Bonde JP, Brescianini S, et al. Pregnancy and birth cohort resources in europe: a large opportunity for aetiological child health research. Paediatr Perinat Epidemiol. 2013;27:393–414.

  12. 12.

    de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ. 2007;85:660–7.

  13. 13.

    World Medical Association. World medical association declaration of helsinki: Ethical principles for medical research involving human subjects. JAMA. 2013;310:2191–4.

  14. 14.

    Turnbull BW. The empirical distribution function with arbitrarily grouped, censored and truncated data. J R Stat Soc, Ser B (Methodol). 1976;38:290–5.

  15. 15.

    R Development Core Team. R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; 2008.

  16. 16.

    Rito AI, Paixão E, Carvalho MA, Ramos C. Childhood Obesity Surveillance Initiative: COSI Portugal 2010; 2012.

  17. 17.

    Munthali RJ, Kagura J, Lombard Z, Norris SA. Early life growth predictors of childhood adiposity trajectories and future risk for obesity: birth to twenty cohort. Child Obes. 2017;13:384–91.

  18. 18.

    Padez C, Fernandes T, Mourao I, Moreira P, Rosado V. Prevalence of overweight and obesity in 7-9-year-old Portuguese children: trends in body mass index from 1970–2002. Am J Hum Biol. 2004;16:670–8.

Download references


Generation XXI was funded by Programa Operacional de Saúde – Saúde XXI, Quadro Comunitário de Apoio III and Administração Regional de Saúde Norte (Regional Department of Ministry of Health). This study was funded by FEDER through the Operational Programme Competitiveness and Internationalization and national funding from the Foundation for Science and Technology – FCT (Portuguese Ministry of Science, Technology, and Higher Education) (POCI-01-0145-FEDER-016837) under the project “PathMOB: Risco cardiometabólico na infância: desde o início da vida ao fim da infância” (Ref. FCT PTDC/DTP-EPI/3306/2014) and by the Unidade de Investigação em Epidemiologia - Instituto de Saúde Pública da Universidade do Porto (EPIUnit) (POCI-01-0145-FEDER-006862; Ref. UID/DTP/04750/2013), and the Calouste Gulbenkian Foundation. Ana Cristina Santos holds an FCT Investigator contract IF/01060/2015. This study is also a result of the project DOCnet (NORTE-01-0145-FEDER-000003), supported by Norte Portugal Regional Operational Programme (NORTE 2020), under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund (ERDF). The authors gratefully acknowledge the families enrolled in Generation XXI for their kindness, all members of the research team for their enthusiasm and perseverance and the participating hospitals and their staff for their help and support.

Author information


  1. EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal

    • Ana Isabel Freitas
    • , Carla Moreira
    •  & Ana Cristina Santos
  2. Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal

    • Ana Cristina Santos


  1. Search for Ana Isabel Freitas in:

  2. Search for Carla Moreira in:

  3. Search for Ana Cristina Santos in:

Conflict of interest

The authors declare that they have no conflict of interest.

Corresponding author

Correspondence to Ana Cristina Santos.

About this article

Publication history