Prevalence of Overweight and Obesity in Children and Adolescents Attended at Primary Health Care Units in Ilhéus, Bahia

Prevalence of Overweight and Obesity in Children and Adolescents Attended at Primary Health Care Units in Ilhéus, Bahia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prevalence of Overweight and Obesity in Children and Adolescents Attended at Primary Health Care Units in Ilhéus, Bahia Ednara dos Santos Azevedo, Maria Eduarda Freire dos Santos, Ângelo Daniel Azevedo Jácome da Silva, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6480537/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Obesity is characterized by excessive accumulation of body fat, causing harm to health and involving biological, environmental, behavioral and genetic factors, with 1.9 billion people suffering from obesity worldwide, 25% of Brazilian adults and 23.8% of residents of Bahia. In children and adolescents, the prevalence of obesity has increased significantly, reaching around 10-15% of the pediatric population in Brazil and worldwide, resulting in increased risks of chronic metabolic diseases and neuropsychological disorders, even at an early age. This study aimed to determine the prevalence of overweight and obesity among pediatric users of Primary Health Care Units in a municipality in southern Bahia. Anthropometric measurements were analyzed in a cross-sectional study of 775 children and adolescents aged 5 to 19 years, in addition to the evaluation of variables such as type of delivery, breastfeeding, age at menarche, screen time and physical activity, in addition to family history, collected by questionnaire. 59% of the participants were girls and 41% were boys, with a mean age of 10.1 years. The prevalence of excess weight was 27.8%, with 16.2% overweight and 11.6% obese, according to the WHO BMI Z-score. The highest prevalence of overweight was observed among 9-year-old children, and of obesity among 10-year-old children, with no significant difference between the sexes. The result reflects global trend and reinforces the necessity for public policies to control and prevent this condition and its comorbidities. Pediatrics Endocrinology & Metabolism Childhood obesity. Prevalence of overweight Body mass index overweight Children Adolescents Figures Figure 1 Introduction Obesity is characterized by excessive fat accumulation, influenced by biological, environmental, behavioral, and genetic factors ( 1 ). In Brazil, 34% of children and adolescents were overweight or obese in 2020, with projections of an increase to 50% in the coming decades, following past trends ( 2 , 3 ). The reduction in infectious diseases has been accompanied by an increase in cardiovascular diseases and cancer, emphasizing excess weight as a risk factor for health problems ( 4 ). In this context, Ilhéus, the city studied in this work, is located on the southern coast of Bahia, with a Human Development Index (HDI) of 0.69, below the Brazilian average (0.754) ( 5 ). According to data from the latest census, this municipality has a population of 178,000, including 49,058 inhabitants aged 5 to 19 years ( 5 ). Global changes in nutritional profiles are influenced by social, economic, climatic, and dietary factors, as well as behaviors such as physical inactivity, excessive screen time, and reduced sleep ( 6 , 7 ). These fators have led to a general increase in overweight and obesity, including children and adolescents ( 6 ). From a pathophysiological perspective, obesity results from an imbalance between food intake and reduced energy expenditure, influenced by individual and environmental factors ( 1 ). Key etiologies include hormonal factors, adipose tissue, genetic and external factors, with childhood obesity being multifactorial and, in most cases, of exogenous origin ( 7 , 8 ). Neonatal factors, such as excessive or insufficient gestational weight gain during gestation may influence the risk of childhood obesity, potentially promoting compensatory adiposity programming and a thrifty phenotype, respectively, increasing the risk of postnatal obesity ( 9 ). Exclusive and on-demand breastfeeding at an appropriate time reduces the risk of obesity by regulating hunger and satiety mechanisms ( 10 , 11 ). The WHO recommends that children and adolescents aged 5 to 17 engage in at least 60 minutes of moderate to vigorous intensity physical activity per day, primarily aerobic, to improve cardiorespiratory fitness and metabolic health ( 12 ). Considering the multifactorial causes of obesity and recognizing the importance of interdisciplinary programs can help prevent or reduce negative impacts on the daily lives of overweight children and adolescents ( 8 ). Thus, anthropometric assessment studies of children and adolescents in the Primary Health Care Units of Ilhéus, Bahia, help identify groups in need of intervention, support analysis of causal and risk factors and guide control strategies. These data also enable monitoring of local overweight prevalence and allow for comparisons with other regions. Primary obesity prevention is essential for public health, with the goal of fostering healthier adults through nutritional monitoring and preventive strategies beginning as early as pregnancy. This study, therefore, assessed the prevalence of overweight and obesity among children and adolescents aged 5 to 19 years in the Primary Health Care Units of Ilhéus. Materials and Method This cross-sectional prevalence study involved children and adolescents aged 5 to 19 years who were seen at urban Primary Health Care Units (UBS) in Ilhéus, Bahia, between January 2023 and February 2024. Participants with conditions that could influence obesity, such as endogenous causes, antipsychotic medication use, Autism Spectrum Disorder (ASD), or other neurological, psychiatric, or physical/mental disabilities, were excluded. Initially, 850 samples were obtained, with 775 participants selected after data validation and consent through an Informed Consent Form (ICF) or Assent Form (AF). Demographic and health information was collected, including variables such as birth weight, type of delivery, breastfeeding duration (in months), sex, age at menarche for girls, self-reported parental weight, screen time in hours (categorized as less or more than 4 hours per day), and physical activity hours (categorized as less or more than 4 hours per week). Following the questionnaire, an anthropometric assessment was performed according to the World Health Organization (WHO) anthropometry guidelines, including measures of weight, height, and waist circumference, as well as the calculation of Body Mass Index (BMI) using the standard formula [BMI (kg/m²) = body weight (kg)/height²(m²)]. To define the nutritional status of children and adolescents, the WHO 2007 reference was used, with cut-off points according to the table below: Table 1 Table 1 Weight-for-age Z-score cutoff points Value found in the child Nutritional Diagnosis < Percentil 0,1 < Score Z – 3 Severe thinness ≥ Percentil 0,1 e < Percentil 3 ≥ Score Z – 3 e < Score – 2 Thinness ≥ Percentil 3 e < Percentil 85 ≥ Score Z – 2 e < Score + 1 Eutrophy ≥ Percentil 85 e < Percentil 97 ≥ Score Z + 1 e Percentil 99,9 > Score Z + 3 Severe obesity Fonte: WHO (2007) Each participant was classified into a numerical nutritional category according to the BMI-for-age Z-score curve: severe thinness ( 1 ), thinness ( 2 ), normal weight ( 3 ), overweight ( 4 ), obesity ( 5 ), or severe obesity ( 6 ). The waist-to-height ratio (WHtR) was calculated, with values ≤ 0.5 considered appropriate and values > 0.5 indicating a risk of central adiposity. Prevalence of overweight (overweight and obesity) was analyzed by sex and age, and variables such as type of delivery, birth weight, breastfeeding duration, age at menarche, parental weight, daily screen time, and weekly physical activity were correlated. Data were processed in Excel 2016 and presented as mean ± standard deviation for continuous variables and as frequencies for categorical variables. Normality was tested using the Shapiro-Wilk test. Associations were evaluated using the Kruskal-Wallis test for all nutritional categories, Mann-Whitney for specific comparisons (normal weight and obese), and Chi-Square (χ²) for categorical variables, with significance at p < 0.05. Correlations between nutritional status and variables were analyzed using Spearman's coefficient with the Jamovi software, version 2.3 (2022). This study was approved by the Ethics Committee of the State University of Santa Cruz (Ilhéus, Bahia, Brazil) (CAAE: 61010822.6.0000.5526, approval 5.757.412). Results Of the 775 children and adolescents aged 5 to 19 years, 321 (41%) were male and 454 (59%) were female. The overall prevalence of excess weight was 27.8%, with 16.2% classified as overweight and 11.6% as obese, with no statistically significant difference between sexes (29% among girls, 27% among boys, p = 0.206). Table 2 shows the epidemiological data of the pediatric population using the services of Primary Health Care Units in Ilhéus-Bahia, specifying age range and categorical attributes: sex, type of delivery, breastfeeding, physical activity practice and duration, screen time, and central adiposity risk as a cardiovascular risk parameter. Table 2 Table 2 Description in absolute and relative frequencies of the study characteristics in relation to the total sample of child and adolescent users of the Basic Health Units of Ilhéus-Bahia in the period from January 2023 to February 2024. Feature Category N % Sex Female 454 59,00 Male 321 41,00 Type of delivery Natural 445 58,00 Caesarean 325 42,00 Breastfeeding Yes 723 94,00 No 46 6,00 Physical activity Yes 475 61,00 No 298 39,00 Regularity of physical activity 4h a /s b 169 24,00 Use of screens 4h a /d c 481 62,00 Risk of adiposity With 120 16,00 Withou 648 84,00 a: hours; b: weeks; c: day; d: circumference; e: stature. Analysis of continuous variables recorded an average breastfeeding duration of 19.84 months (equivalent to 1.65 years), an average age at menarche of 11.56 years, and a mean waist-to-height ratio (WHtR) below central adiposity risk level (p < 0.45). The categorization of nutritional status showed that most participants were of normal weight (65.98%). Additionally, 6.72% were below the adequate nutritional level, while 27.78% were above it. Among participants with excess weight, 16.17% were classified as overweight, 7.31% as obese, and 4.23% as severely obese. Children and adolescents with excess weight had a higher average birth weight (3.24 kg) compared to other groups (normal weight: 3.16 kg; underweight: 2.97 kg, p = 0.004, Fig. 1 ). The WHtR variable confirmed the risk of adiposity in participants with excess weight compared to other groups, with a mean of 0.51 versus 0.43 (normal weight) and 0.41 (underweight, p < 0.001). Participants with excess weight also had a higher average maternal weight (77.9 kg) than those in the normal weight group (69.80 kg) or underweight group (59.59 kg, p < 0.001). Breastfeeding duration and paternal weight showed no statistically significant differences. In comparing normal weight and obese nutritional statuses, obese participants had a higher average birth weight (3.34 kg) than normal-weight participants (3.16 kg, p = 0.004). The WHtR for obese participants was 0.54, indicating cardiovascular risk, while normal-weight participants had a ratio of 0.43 (p < 0.001). Additionally, obese participants had a higher average maternal weight average (79.55 kg) compared to those with normal weight (69.80 kg, p < 0.001). There were no significant differences in breastfeeding duration, age at menarche, or paternal weight among the groups. In Table 2 , comparisons of study participant characteristics by anthropometric category (normal weight and obesity) showed that children and adolescents with obesity had a higher frequency of cesarean delivery (19%) compared to natural birth (12%). Conversely, normal-weight participants had a lower frequency of cesarean delivery (81%) compared to natural births (88%), with p = 0.012. Regarding screen time, the group with excess weight had a higher frequency of screen time (> 4 hours per day) (31%) compared to those with less than 4 hours per day (23%), while the normal-weight group had the highest percentage of participants using screens for less than 4 hours per day (71%). However, this difference was not statistically significant (p = 0.058). The WHtR variable (cardiovascular risk) also showed a statistically significant difference when comparing frequencies: there was a higher cardiovascular risk frequency (WHtR) of 86% in the obese group compared to 4% without risk in this same group, versus normal-weight participants (14% with risk / 96% without risk, p < 0.001, Table 3 ). Table 3 Table 3 Comparative analysis between the categories of nutritional status eutrophy and obesity, and independent variables of child and adolescent users of the Basic Health Units of Ilhéus-Bahia in the period from January 2023 to February 2024. Features Categorias (n) Nutritional status (%) p * Eutrofia Obesidade Sex Female (349) 86 14 0,413 Male (249) 84 16 DT a Cesarian (252) 81 19 0,012* Natural (343) 88 12 B b Yes (40) 86 14 0,319 No (555) 80 20 PA c Yes (237) 86 14 0,436 No (361) 84 16 TIME PA (h d ) 4h (129) 87 13 Screen time (h) 4h (83) 83 17 RA e Yes (76) 14 86 < 0,001* No (517) 96 4 * Statistically different in relation to the other groups (eutrophy and low weight) (P < 0.05). a: type of delivery; b: breastfeeding; c: physical activity; d: time; e: risk of adiposity. Chi Square Test. Weak positive correlations were observed between nutritional status and birth weight, as well as between maternal and paternal reported weights. In other words, higher nutritional status correlated with higher birth weights (R: 0.12), maternal reported weight (R: 0.27), and paternal reported weight (R: 0.14). Discussion The findings of this study indicate a prevalence of excess weight in 27.8% of participants, with 16.2% classified as overweight and 11.6% as obese. These rates are close to the national prevalence of 32% for the same age range in 2020. However, the prevalence varies in other national and international studies ( 4 , 3 , 6 ). For example, in 2003, a study in Feira de Santana-BA found an overweight and obesity prevalence of 9.3% and 4.4%, respectively, among 699 students from public and private schools ( 13 ). In 2007, a study in Vitória-ES found a prevalence of excess weight of 23.3% among children aged 7 to 10 years ( 14 ). Additionally, a 2020 review on childhood obesity in Brazil highlighted that over three decades, the prevalence has risen from 8–12% among children under 10 years ( 3 ), emphasizing the need for effective intervention to combat this condition. The variability in nutritional data across Brazil is influenced by differing anthropometric methodologies, as well as cultural and regional factors, and the multifactorial etiology of obesity. Even so, childhood obesity tends to grow at an annual rate of 1.8%, with projections indicating that 50% of the population will be overweight by 2035 ( 2 ). In the current study, excess weight was slightly higher among girls (29%) than boys (27%), though this difference was not statistically significant. This finding aligns with the study in Feira de Santana-BA ( 13 ). However, a 2021 systematic review found a higher prevalence of excess weight among boys and in more developed regions of Brazil ( 3 ). Furthermore, a 2017 report on the nutritional status in Latin America pointed out that economic, cultural, and demographic shifts have affected populations unevenly, leading to a coexistence of malnutrition with overweight and obesity ( 15 ). For instance, a 2012 study in Mexico showed a 43.9% prevalence of excess weight, while Ecuador reported 26% excess weight and 19.1% malnutrition ( 15 ). The present study also found a significant association between excess weight and the type of delivery. Children and adolescents with excess weight had a higher cesarean delivery rate, while normal-weight participants had more natural births, with a statistically significant difference (p < 0.001). The relationship between cesarean delivery and obesity is controversial since many studies are based on BMI in children, which has limitations in pediatrics. However, evidence suggests that delivery type may influence the incidence of overweight and obesity in adulthood ( 16 , 17 ). For example, a Canadian study found that children born by cesarean delivery are 2.59 times more likely to be overweight than those born naturally, potentially influenced by maternal factors that contribute to the need for a cesarean ( 18 ). Most participants in the study (94%) reported breastfeeding for at least 6 months, with an average duration of 19 months, in line with WHO guidelines recommending exclusive breastfeeding for the first 6 months and continued breastfeeding up to 2 years of age ( 19 ). Normal-weight participants had a higher frequency and longer duration of breastfeeding compared to those with excess weight, including obese participants, though this difference was not statistically significant. A multinational study with 4,740 children found that breastfeeding acts as a protective factor against childhood obesity ( 11 ). Despite the high breastfeeding rate in this study, the duration of breastfeeding was assessed through self-reports, which may affect data accuracy. The study also found that 39% of participants were classified as sedentary, and 76% reported engaging in less than 4 hours of physical activity (PA) per week. Among those with excess weight, half (28%) also did not meet the recommended 4 hours of weekly PA. These data suggest that weekly PA levels are below the WHO recommendations, which suggest at least 60 minutes of exercise daily for children and adolescents ( 12 ). A 2019 multinational study showed that low PA levels and high sedentary behavior are associated with a higher likelihood of obesity in children. Conducted in an urban environment with available green spaces, this study highlights the importance of policies that encourage regular physical activity. A 2021 study also found that overweight/obesity status in children is associated with two or more hours of daily screen time, particularly with devices other than television ( 21 ). In the current study, 31% of participants with excess weight reported using screens for more than 4 hours daily, compared to 23% who reported less screen time, though this difference was not statistically significant (p = 0.058). The association between childhood obesity and screen time is attributed to sedentary behaviors that impact physical activity and dietary quality. A study in Saudi Arabia found that children with normal BMI used electronic devices for an average of 147.61 minutes, while those with higher BMI used devices for 204.5 minutes, a statistically significant difference (p < 0.05) ( 22 ). The risk of adiposity, measured by the waist-to-height ratio (WHtR), was significantly higher in participants with excess weight, with a mean WHtR of 0.51, compared to 0.43 in normal-weight participants and 0.41 in underweight participants (p < 0.001). Cardiovascular risk was observed in 86% of obese participants, whereas only 14% of normal-weight participants exhibited this risk (p < 0.001). These results are higher than those observed in an Australian study, which found an abdominal obesity prevalence of 13–14% ( 23 ), indicating a strong correlation between abdominal adiposity risk and the results of the present study. Obese participants had a mean birth weight of 3.34 kg, significantly higher than the 3.16 kg mean in the normal-weight group (p = 0.004). This suggests that a higher birth weight may increase the chances of future obesity. A study with 1,521 Sicilian children showed that a birth weight ≥ 4 kg (OR 1.83; p < 0.05) is a risk factor for childhood obesity ( 25 ). Thus, both maternal undernutrition and obesity are associated with an elevated risk of obesity for the child, highlighting the importance of maternal nutritional status in the intrauterine environment and its consequences for the offspring's health. The study revealed that the mothers of obese children and adolescents had significantly higher average weights than the mothers of normal-weight participants (p < 0.001). This suggests that maternal weight may be a risk factor for developing overweight/obesity in this sample. A study in Sicilian schools also found that having an overweight/obese mother is a risk factor for childhood obesity. In contrast, paternal weight did not show a statistically significant difference, although studies indicate that obesity in both parents considerably increases the risk of obesity in children ( 25 ). Understanding how parental behaviors, especially those of mothers, affect the environment in which children and adolescents are raised, including parental styles and influences on nutritional status, is essential ( 26 ). Limitations The study sample consisted solely of users of urban public health units, potentially reflecting conditions of lower-income groups relying on public health services. Nevertheless, the study included a large number of children, making it one of the most comprehensive analyses of the prevalence of overweight and obesity among public health unit users in Ilhéus, Bahia. Conclusion The prevalence of excess weight in the pediatric population served by Primary Health Care Units in Ilhéus, Bahia, was 27.8%, with 16.2% classified as overweight and 11.6% obese, with no significant sex differences. Participants with excess weight and obesity showed higher birth weights, and their mothers had higher average weights compared to the mothers of normal-weight participants. Although participants with excess weight and obesity reported more screen time, this difference was not statistically significant. This study provides valuable insights into the nutritional status of the youth population served by Primary Health Care Units, offering a foundation for future research on the nutritional conditions of children and adolescents in Ilhéus, Bahia. References KANSRA, A. 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BMC public health , v. 18, n. 1, 2018. DEARDORFF, J. et al. Childhood overweight and obesity and pubertal onset among Mexican-American boys and girls in the CHAMACOS longitudinal study. American journal of epidemiology , v. 191, n. 1, p. 7–16, 2022. PARRINO et al. The Role of Adipokines in the Obesity-Inflammation Relationship: Focus on Chemerin. Advances in Clinical Chemistry , 74, 171–219. 2016. CHEN, Y. et al. Positive parenting improves multiple aspects of health and well-being in young adulthood. Nature human behavior , v. 3, n. 7, p. 684–691, 2019. Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6480537","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":444925123,"identity":"b9a51ded-315b-4ddb-85d9-5cf210c2d85d","order_by":0,"name":"Ednara dos Santos Azevedo","email":"","orcid":"https://orcid.org/0009-0009-9798-7799","institution":"Universidade Estadual de Santa Cruz","correspondingAuthor":false,"prefix":"","firstName":"Ednara","middleName":"dos Santos","lastName":"Azevedo","suffix":""},{"id":444925124,"identity":"b969dd9d-16b6-4564-a6d8-f7c08d2ae740","order_by":1,"name":"Maria Eduarda Freire dos Santos","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/ElEQVRIie3Pv0oDQRDH8Z8MrM3GtAf+ewJhw0EQkjexuW12q1SCXHGEs1kbwVYQ9BUMvsAeC1etpk2pTSqLs7tGMQELEfaMncV+m2nmAzNALPZPswCtp0AOHOzQn4gHUrYJwXcizW+7RxePL7bNR/Lqxs0ai6k223zwjGJ8EiJDr0V16bW8flKniYWbGOKpQK0mZYhYBdszTpaei90GdkWYSrZKFybzJar3DyfvPE/b9WGMmG47yULB9Uon7z0frg6jjBHV6CZLuL1apzPPzo6tcAND5JKs65e5orfXYrR/6+lhYfPpYb9fnTdNMQ6SH4mvmW22HovFYrFAn7z0W1u281CsAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0009-0007-6125-0731","institution":"Universidade Estadual de Santa Cruz","correspondingAuthor":true,"prefix":"","firstName":"Maria","middleName":"Eduarda Freire dos","lastName":"Santos","suffix":""},{"id":444925125,"identity":"7f751a72-bb89-4949-9ab4-b92191395feb","order_by":2,"name":"Ângelo Daniel Azevedo Jácome da Silva","email":"","orcid":"https://orcid.org/0009-0009-1349-9342","institution":"Universidade Salvador","correspondingAuthor":false,"prefix":"","firstName":"Ângelo","middleName":"Daniel Azevedo Jácome da","lastName":"Silva","suffix":""},{"id":444925126,"identity":"14d68c51-0c1a-428f-a311-dbb616a41c37","order_by":3,"name":"Eduardo Rodrigues Alves Junior","email":"","orcid":"https://orcid.org/0000-0002-4785-0008","institution":"BiomedStat Professional Consulting and Development","correspondingAuthor":false,"prefix":"","firstName":"Eduardo","middleName":"Rodrigues Alves","lastName":"Junior","suffix":""},{"id":444925127,"identity":"86e9f79e-894f-4886-82d3-68e7a7b46866","order_by":4,"name":"Carlos Alberto Menezes","email":"","orcid":"https://orcid.org/0000-0003-2306-6494","institution":"Universidade Estadual de Santa Cruz","correspondingAuthor":false,"prefix":"","firstName":"Carlos","middleName":"Alberto","lastName":"Menezes","suffix":""}],"badges":[],"createdAt":"2025-04-18 16:58:26","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-6480537/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6480537/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":81174859,"identity":"c47c25ee-a616-40ba-a1d2-06c5ae825d58","added_by":"auto","created_at":"2025-04-23 06:07:30","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":76745,"visible":true,"origin":"","legend":"\u003cp\u003eAverage birth weight and relationship with nutritional category\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6480537/v1/86ab4754b4a2010c3875bd55.png"},{"id":81176493,"identity":"962e0228-83ff-4c6e-bb55-932d4db36217","added_by":"auto","created_at":"2025-04-23 06:23:59","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":925131,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6480537/v1/bc79a538-ca57-440a-8ca9-dc025268f7f1.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003ePrevalence of Overweight and Obesity in Children and Adolescents Attended at Primary Health Care Units in Ilhéus, Bahia\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eObesity is characterized by excessive fat accumulation, influenced by biological, environmental, behavioral, and genetic factors (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). In Brazil, 34% of children and adolescents were overweight or obese in 2020, with projections of an increase to 50% in the coming decades, following past trends (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). The reduction in infectious diseases has been accompanied by an increase in cardiovascular diseases and cancer, emphasizing excess weight as a risk factor for health problems (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn this context, Ilh\u0026eacute;us, the city studied in this work, is located on the southern coast of Bahia, with a Human Development Index (HDI) of 0.69, below the Brazilian average (0.754) (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). According to data from the latest census, this municipality has a population of 178,000, including 49,058 inhabitants aged 5 to 19 years (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGlobal changes in nutritional profiles are influenced by social, economic, climatic, and dietary factors, as well as behaviors such as physical inactivity, excessive screen time, and reduced sleep (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). These fators have led to a general increase in overweight and obesity, including children and adolescents (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFrom a pathophysiological perspective, obesity results from an imbalance between food intake and reduced energy expenditure, influenced by individual and environmental factors (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Key etiologies include hormonal factors, adipose tissue, genetic and external factors, with childhood obesity being multifactorial and, in most cases, of exogenous origin (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eNeonatal factors, such as excessive or insufficient gestational weight gain during gestation may influence the risk of childhood obesity, potentially promoting compensatory adiposity programming and a thrifty phenotype, respectively, increasing the risk of postnatal obesity (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Exclusive and on-demand breastfeeding at an appropriate time reduces the risk of obesity by regulating hunger and satiety mechanisms (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe WHO recommends that children and adolescents aged 5 to 17 engage in at least 60 minutes of moderate to vigorous intensity physical activity per day, primarily aerobic, to improve cardiorespiratory fitness and metabolic health (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Considering the multifactorial causes of obesity and recognizing the importance of interdisciplinary programs can help prevent or reduce negative impacts on the daily lives of overweight children and adolescents (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThus, anthropometric assessment studies of children and adolescents in the Primary Health Care Units of Ilh\u0026eacute;us, Bahia, help identify groups in need of intervention, support analysis of causal and risk factors and guide control strategies. These data also enable monitoring of local overweight prevalence and allow for comparisons with other regions. Primary obesity prevention is essential for public health, with the goal of fostering healthier adults through nutritional monitoring and preventive strategies beginning as early as pregnancy. This study, therefore, assessed the prevalence of overweight and obesity among children and adolescents aged 5 to 19 years in the Primary Health Care Units of Ilh\u0026eacute;us.\u003c/p\u003e"},{"header":"Materials and Method","content":"\u003cp\u003e This cross-sectional prevalence study involved children and adolescents aged 5 to 19 years who were seen at urban Primary Health Care Units (UBS) in Ilh\u0026eacute;us, Bahia, between January 2023 and February 2024. Participants with conditions that could influence obesity, such as endogenous causes, antipsychotic medication use, Autism Spectrum Disorder (ASD), or other neurological, psychiatric, or physical/mental disabilities, were excluded.\u003c/p\u003e \u003cp\u003e Initially, 850 samples were obtained, with 775 participants selected after data validation and consent through an Informed Consent Form (ICF) or Assent Form (AF). Demographic and health information was collected, including variables such as birth weight, type of delivery, breastfeeding duration (in months), sex, age at menarche for girls, self-reported parental weight, screen time in hours (categorized as less or more than 4 hours per day), and physical activity hours (categorized as less or more than 4 hours per week). Following the questionnaire, an anthropometric assessment was performed according to the World Health Organization (WHO) anthropometry guidelines, including measures of weight, height, and waist circumference, as well as the calculation of Body Mass Index (BMI) using the standard formula [BMI (kg/m\u0026sup2;)\u0026thinsp;=\u0026thinsp;body weight (kg)/height\u0026sup2;(m\u0026sup2;)].\u003c/p\u003e \u003cp\u003eTo define the nutritional status of children and adolescents, the WHO 2007 reference was used, with cut-off points according to the table below:\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eWeight-for-age Z-score cutoff points\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eValue found in the child\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNutritional Diagnosis\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt; Percentil 0,1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt; Score Z \u0026ndash; 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSevere thinness\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge; Percentil 0,1 e\u0026thinsp;\u0026lt;\u0026thinsp;Percentil 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge; Score Z \u0026ndash; 3 e\u0026thinsp;\u0026lt;\u0026thinsp;Score \u0026ndash; 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThinness\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge; Percentil 3 e\u0026thinsp;\u0026lt;\u0026thinsp;Percentil 85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge; Score Z \u0026ndash; 2 e\u0026thinsp;\u0026lt;\u0026thinsp;Score\u0026thinsp;+\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEutrophy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge; Percentil 85 e\u0026thinsp;\u0026lt;\u0026thinsp;Percentil 97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge; Score Z\u0026thinsp;+\u0026thinsp;1 e\u0026thinsp;\u0026lt;\u0026thinsp;Score z\u0026thinsp;+\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOverweight\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge; Percentil 97 e\u0026thinsp;\u0026le;\u0026thinsp;Percentil 99,9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge; Score Z\u0026thinsp;+\u0026thinsp;2 e\u0026thinsp;\u0026le;\u0026thinsp;Score\u0026thinsp;+\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eObesity\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt; Percentil 99,9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt; Score Z\u0026thinsp;+\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSevere obesity\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eFonte: WHO (2007)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eEach participant was classified into a numerical nutritional category according to the BMI-for-age Z-score curve: severe thinness (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e), thinness (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), normal weight (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e), overweight (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), obesity (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), or severe obesity (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). The waist-to-height ratio (WHtR) was calculated, with values\u0026thinsp;\u0026le;\u0026thinsp;0.5 considered appropriate and values\u0026thinsp;\u0026gt;\u0026thinsp;0.5 indicating a risk of central adiposity.\u003c/p\u003e \u003cp\u003ePrevalence of overweight (overweight and obesity) was analyzed by sex and age, and variables such as type of delivery, birth weight, breastfeeding duration, age at menarche, parental weight, daily screen time, and weekly physical activity were correlated.\u003c/p\u003e \u003cp\u003eData were processed in Excel 2016 and presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation for continuous variables and as frequencies for categorical variables. Normality was tested using the Shapiro-Wilk test. Associations were evaluated using the Kruskal-Wallis test for all nutritional categories, Mann-Whitney for specific comparisons (normal weight and obese), and Chi-Square (χ\u0026sup2;) for categorical variables, with significance at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Correlations between nutritional status and variables were analyzed using Spearman's coefficient with the Jamovi software, version 2.3 (2022).\u003c/p\u003e \u003cp\u003e This study was approved by the Ethics Committee of the State University of Santa Cruz (Ilh\u0026eacute;us, Bahia, Brazil) (CAAE: 61010822.6.0000.5526, approval 5.757.412).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eOf the 775 children and adolescents aged 5 to 19 years, 321 (41%) were male and 454 (59%) were female. The overall prevalence of excess weight was 27.8%, with 16.2% classified as overweight and 11.6% as obese, with no statistically significant difference between sexes (29% among girls, 27% among boys, p\u0026thinsp;=\u0026thinsp;0.206).\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the epidemiological data of the pediatric population using the services of Primary Health Care Units in Ilh\u0026eacute;us-Bahia, specifying age range and categorical attributes: sex, type of delivery, breastfeeding, physical activity practice and duration, screen time, and central adiposity risk as a cardiovascular risk parameter.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescription in absolute and relative frequencies of the study characteristics in relation to the total sample of child and adolescent users of the Basic Health Units of Ilh\u0026eacute;us-Bahia in the period from January 2023 to February 2024.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFeature\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e454\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e59,00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e321\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e41,00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eType of delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eNatural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e445\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e58,00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eCaesarean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e42,00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBreastfeeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e723\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e94,00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e6,00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePhysical activity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e475\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e61,00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e298\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e39,00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRegularity of physical activity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;4h\u003csup\u003ea\u003c/sup\u003e/s\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e549\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e76,00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;4h\u003csup\u003ea\u003c/sup\u003e/s\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e24,00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eUse of screens\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;4h\u003csup\u003ea\u003c/sup\u003e/d\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e292\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e38,00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;4h\u003csup\u003ea\u003c/sup\u003e/d\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e481\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e62,00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRisk of adiposity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eWith\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e16,00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eWithou\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e648\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e84,00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ea: hours; b: weeks; c: day; d: circumference; e: stature.\u003c/p\u003e \u003cp\u003eAnalysis of continuous variables recorded an average breastfeeding duration of 19.84 months (equivalent to 1.65 years), an average age at menarche of 11.56 years, and a mean waist-to-height ratio (WHtR) below central adiposity risk level (p\u0026thinsp;\u0026lt;\u0026thinsp;0.45).\u003c/p\u003e \u003cp\u003eThe categorization of nutritional status showed that most participants were of normal weight (65.98%). Additionally, 6.72% were below the adequate nutritional level, while 27.78% were above it. Among participants with excess weight, 16.17% were classified as overweight, 7.31% as obese, and 4.23% as severely obese. Children and adolescents with excess weight had a higher average birth weight (3.24 kg) compared to other groups (normal weight: 3.16 kg; underweight: 2.97 kg, p\u0026thinsp;=\u0026thinsp;0.004, Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe WHtR variable confirmed the risk of adiposity in participants with excess weight compared to other groups, with a mean of 0.51 versus 0.43 (normal weight) and 0.41 (underweight, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Participants with excess weight also had a higher average maternal weight (77.9 kg) than those in the normal weight group (69.80 kg) or underweight group (59.59 kg, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Breastfeeding duration and paternal weight showed no statistically significant differences.\u003c/p\u003e \u003cp\u003eIn comparing normal weight and obese nutritional statuses, obese participants had a higher average birth weight (3.34 kg) than normal-weight participants (3.16 kg, p\u0026thinsp;=\u0026thinsp;0.004). The WHtR for obese participants was 0.54, indicating cardiovascular risk, while normal-weight participants had a ratio of 0.43 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Additionally, obese participants had a higher average maternal weight average (79.55 kg) compared to those with normal weight (69.80 kg, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). There were no significant differences in breastfeeding duration, age at menarche, or paternal weight among the groups.\u003c/p\u003e \u003cp\u003eIn Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, comparisons of study participant characteristics by anthropometric category (normal weight and obesity) showed that children and adolescents with obesity had a higher frequency of cesarean delivery (19%) compared to natural birth (12%). Conversely, normal-weight participants had a lower frequency of cesarean delivery (81%) compared to natural births (88%), with p\u0026thinsp;=\u0026thinsp;0.012. Regarding screen time, the group with excess weight had a higher frequency of screen time (\u0026gt;\u0026thinsp;4 hours per day) (31%) compared to those with less than 4 hours per day (23%), while the normal-weight group had the highest percentage of participants using screens for less than 4 hours per day (71%). However, this difference was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.058).\u003c/p\u003e \u003cp\u003eThe WHtR variable (cardiovascular risk) also showed a statistically significant difference when comparing frequencies: there was a higher cardiovascular risk frequency (WHtR) of 86% in the obese group compared to 4% without risk in this same group, versus normal-weight participants (14% with risk / 96% without risk, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparative analysis between the categories of nutritional status eutrophy and obesity, and independent variables of child and adolescent users of the Basic Health Units of Ilh\u0026eacute;us-Bahia in the period from January 2023 to February 2024.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e \u003cp\u003eFeatures\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategorias\u003c/p\u003e \u003cp\u003e(n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003eNutritional status (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e*\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEutrofia\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eObesidade\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFemale (349)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0,413\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMale (249)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eDT\u003c/b\u003e\u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eCesarian (252)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e0,012*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eNatural (343)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eB\u003c/b\u003e\u003csup\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eYes (40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0,319\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eNo (555)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003ePA\u003c/b\u003e\u003csup\u003e\u003cb\u003ec\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eYes (237)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0,436\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eNo (361)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eTIME PA (h\u003c/b\u003e\u003csup\u003e\u003cb\u003ed\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;4h (428)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0,352\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;4h (129)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eScreen time (h)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;4h (233)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0,059\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;4h (83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eRA\u003c/b\u003e\u003csup\u003e\u003cb\u003ee\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eYes (76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0,001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eNo (517)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e* Statistically different in relation to the other groups (eutrophy and low weight) (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). a: type of delivery; b: breastfeeding; c: physical activity; d: time; e: risk of adiposity. Chi Square Test.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWeak positive correlations were observed between nutritional status and birth weight, as well as between maternal and paternal reported weights. In other words, higher nutritional status correlated with higher birth weights (R: 0.12), maternal reported weight (R: 0.27), and paternal reported weight (R: 0.14).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings of this study indicate a prevalence of excess weight in 27.8% of participants, with 16.2% classified as overweight and 11.6% as obese. These rates are close to the national prevalence of 32% for the same age range in 2020. However, the prevalence varies in other national and international studies (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). For example, in 2003, a study in Feira de Santana-BA found an overweight and obesity prevalence of 9.3% and 4.4%, respectively, among 699 students from public and private schools (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). In 2007, a study in Vit\u0026oacute;ria-ES found a prevalence of excess weight of 23.3% among children aged 7 to 10 years (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Additionally, a 2020 review on childhood obesity in Brazil highlighted that over three decades, the prevalence has risen from 8\u0026ndash;12% among children under 10 years (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e), emphasizing the need for effective intervention to combat this condition.\u003c/p\u003e \u003cp\u003eThe variability in nutritional data across Brazil is influenced by differing anthropometric methodologies, as well as cultural and regional factors, and the multifactorial etiology of obesity. Even so, childhood obesity tends to grow at an annual rate of 1.8%, with projections indicating that 50% of the population will be overweight by 2035 (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn the current study, excess weight was slightly higher among girls (29%) than boys (27%), though this difference was not statistically significant. This finding aligns with the study in Feira de Santana-BA (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). However, a 2021 systematic review found a higher prevalence of excess weight among boys and in more developed regions of Brazil (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Furthermore, a 2017 report on the nutritional status in Latin America pointed out that economic, cultural, and demographic shifts have affected populations unevenly, leading to a coexistence of malnutrition with overweight and obesity (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). For instance, a 2012 study in Mexico showed a 43.9% prevalence of excess weight, while Ecuador reported 26% excess weight and 19.1% malnutrition (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe present study also found a significant association between excess weight and the type of delivery. Children and adolescents with excess weight had a higher cesarean delivery rate, while normal-weight participants had more natural births, with a statistically significant difference (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The relationship between cesarean delivery and obesity is controversial since many studies are based on BMI in children, which has limitations in pediatrics. However, evidence suggests that delivery type may influence the incidence of overweight and obesity in adulthood (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). For example, a Canadian study found that children born by cesarean delivery are 2.59 times more likely to be overweight than those born naturally, potentially influenced by maternal factors that contribute to the need for a cesarean (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMost participants in the study (94%) reported breastfeeding for at least 6 months, with an average duration of 19 months, in line with WHO guidelines recommending exclusive breastfeeding for the first 6 months and continued breastfeeding up to 2 years of age (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Normal-weight participants had a higher frequency and longer duration of breastfeeding compared to those with excess weight, including obese participants, though this difference was not statistically significant. A multinational study with 4,740 children found that breastfeeding acts as a protective factor against childhood obesity (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Despite the high breastfeeding rate in this study, the duration of breastfeeding was assessed through self-reports, which may affect data accuracy.\u003c/p\u003e \u003cp\u003eThe study also found that 39% of participants were classified as sedentary, and 76% reported engaging in less than 4 hours of physical activity (PA) per week. Among those with excess weight, half (28%) also did not meet the recommended 4 hours of weekly PA. These data suggest that weekly PA levels are below the WHO recommendations, which suggest at least 60 minutes of exercise daily for children and adolescents (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). A 2019 multinational study showed that low PA levels and high sedentary behavior are associated with a higher likelihood of obesity in children. Conducted in an urban environment with available green spaces, this study highlights the importance of policies that encourage regular physical activity.\u003c/p\u003e \u003cp\u003eA 2021 study also found that overweight/obesity status in children is associated with two or more hours of daily screen time, particularly with devices other than television (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). In the current study, 31% of participants with excess weight reported using screens for more than 4 hours daily, compared to 23% who reported less screen time, though this difference was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.058). The association between childhood obesity and screen time is attributed to sedentary behaviors that impact physical activity and dietary quality. A study in Saudi Arabia found that children with normal BMI used electronic devices for an average of 147.61 minutes, while those with higher BMI used devices for 204.5 minutes, a statistically significant difference (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe risk of adiposity, measured by the waist-to-height ratio (WHtR), was significantly higher in participants with excess weight, with a mean WHtR of 0.51, compared to 0.43 in normal-weight participants and 0.41 in underweight participants (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Cardiovascular risk was observed in 86% of obese participants, whereas only 14% of normal-weight participants exhibited this risk (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). These results are higher than those observed in an Australian study, which found an abdominal obesity prevalence of 13\u0026ndash;14% (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e), indicating a strong correlation between abdominal adiposity risk and the results of the present study.\u003c/p\u003e \u003cp\u003eObese participants had a mean birth weight of 3.34 kg, significantly higher than the 3.16 kg mean in the normal-weight group (p\u0026thinsp;=\u0026thinsp;0.004). This suggests that a higher birth weight may increase the chances of future obesity. A study with 1,521 Sicilian children showed that a birth weight\u0026thinsp;\u0026ge;\u0026thinsp;4 kg (OR 1.83; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) is a risk factor for childhood obesity (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Thus, both maternal undernutrition and obesity are associated with an elevated risk of obesity for the child, highlighting the importance of maternal nutritional status in the intrauterine environment and its consequences for the offspring's health.\u003c/p\u003e \u003cp\u003eThe study revealed that the mothers of obese children and adolescents had significantly higher average weights than the mothers of normal-weight participants (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This suggests that maternal weight may be a risk factor for developing overweight/obesity in this sample. A study in Sicilian schools also found that having an overweight/obese mother is a risk factor for childhood obesity. In contrast, paternal weight did not show a statistically significant difference, although studies indicate that obesity in both parents considerably increases the risk of obesity in children (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Understanding how parental behaviors, especially those of mothers, affect the environment in which children and adolescents are raised, including parental styles and influences on nutritional status, is essential (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e"},{"header":"Limitations","content":"\u003cp\u003eThe study sample consisted solely of users of urban public health units, potentially reflecting conditions of lower-income groups relying on public health services. Nevertheless, the study included a large number of children, making it one of the most comprehensive analyses of the prevalence of overweight and obesity among public health unit users in Ilh\u0026eacute;us, Bahia.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe prevalence of excess weight in the pediatric population served by Primary Health Care Units in Ilh\u0026eacute;us, Bahia, was 27.8%, with 16.2% classified as overweight and 11.6% obese, with no significant sex differences. Participants with excess weight and obesity showed higher birth weights, and their mothers had higher average weights compared to the mothers of normal-weight participants. Although participants with excess weight and obesity reported more screen time, this difference was not statistically significant. This study provides valuable insights into the nutritional status of the youth population served by Primary Health Care Units, offering a foundation for future research on the nutritional conditions of children and adolescents in Ilh\u0026eacute;us, Bahia.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKANSRA, A. R.; LAKKUNARAJAH, S.; JAY, M. S. Childhood and adolescent obesity: A review.\u003cstrong\u003eFrontiers in\u003cem\u003e Pediatrics\u003c/em\u003e\u003c/strong\u003e, n. 8, p. 581-461. 2021.\u003c/li\u003e\n\u003cli\u003eWOF, \u003cstrong\u003eWorld Obesity Atlas 2024\u003c/strong\u003e, dispon\u0026iacute;vel em: [WOF-Obesity-Atlas-V7.pdf (worldobesity.org)].\u003c/li\u003e\n\u003cli\u003eFERREIRA, C. 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Prevalence of overweight, Body mass index, overweight, Children, Adolescents","lastPublishedDoi":"10.21203/rs.3.rs-6480537/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6480537/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eObesity is characterized by excessive accumulation of body fat, causing harm to health and involving biological, environmental, behavioral and genetic factors, with 1.9 billion people suffering from obesity worldwide, 25% of Brazilian adults and 23.8% of residents of Bahia. In children and adolescents, the prevalence of obesity has increased significantly, reaching around 10-15% of the pediatric population in Brazil and worldwide, resulting in increased risks of chronic metabolic diseases and neuropsychological disorders, even at an early age. This study aimed to determine the prevalence of overweight and obesity among pediatric users of Primary Health Care Units in a municipality in southern Bahia. Anthropometric measurements were analyzed in a cross-sectional study of 775 children and adolescents aged 5 to 19 years, in addition to the evaluation of variables such as type of delivery, breastfeeding, age at menarche, screen time and physical activity, in addition to family history, collected by questionnaire. 59% of the participants were girls and 41% were boys, with a mean age of 10.1 years. The prevalence of excess weight was 27.8%, with 16.2% overweight and 11.6% obese, according to the WHO BMI Z-score. The highest prevalence of overweight was observed among 9-year-old children, and of obesity among 10-year-old children, with no significant difference between the sexes. The result reflects global trend and reinforces the necessity for public policies to control and prevent this condition and its comorbidities.\u003c/p\u003e","manuscriptTitle":"Prevalence of Overweight and Obesity in Children and Adolescents Attended at Primary Health Care Units in Ilhéus, Bahia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-23 06:07:26","doi":"10.21203/rs.3.rs-6480537/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8a6a7aa9-d1b1-4575-a459-49490d84fa5f","owner":[],"postedDate":"April 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":47497884,"name":"Pediatrics"},{"id":47497885,"name":"Endocrinology \u0026 Metabolism"}],"tags":[],"updatedAt":"2025-04-23T06:07:26+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-23 06:07:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6480537","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6480537","identity":"rs-6480537","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}