integrative review article obesity in the rural area

Lagares EB Resende KA Romano MCC Obesity in the rural area relationship

EnglishPortuguese

J Nurs UFPE online Recife 13(3)796-810 Mar 2019 796

ISSN 1981-8963 ISSN 1981-8963 httpsdoiorg1052051981-8963-v13i03a238117p796-810-2019

OBESITY IN THE RURAL AREA RELATIONSHIP WITH MATERNAL ELEMENTS OBESIDADE INFANTIL NA ZONA RURAL RELACcedilAtildeO COM ELEMENTOS MATERNOS

OBESIDAD INFANTIL EN LA ZONA RURAL RELACIOacuteN CON ELEMENTOS MATERNOS Erika Barbosa Lagares1 Karolyne Arauacutejo Resende2 Maacutercia Christina Caetano Romano3

ABSTRACT

Objective to evaluate the association and similarity between nutritional status and dietary intake of children and their mothers in rural areas Method this is a bibliographic descriptive study type integrative carried out using the PECO strategy in the LILACS MEDLINE and COCHRANE databases with articles published between 2007 and 2016 Results 16 articles were included It was noticed that there is great variability of the instruments and references used for the evaluation of nutritional status and eating habits in the evaluated manuscripts The comparison between the maternal BMI and the BMI of the child was carried out in ten studies and all found a positive relation In eight studies food consumption between mother and child was evaluated and compared and all found significant relationships It is noteworthy that most of the articles are international with only two in Brazil In addition most of them were carried out in an urban area with only one investigation covering urban and rural areas Conclusion it is revealed that the results of this review do not show that nutritional status and maternal eating habits can determine the overweight of rural children Descriptors Child Obesity Nutritional status Food behavior Mother-child relationships Maternal nutrition

RESUMO

Objetivo avaliar a associaccedilatildeo e a similaridade entre o estado nutricional e a ingestatildeo dieteacutetica de crianccedilas e suas matildees na zona rural Meacutetodo trata-se de um estudo bibliograacutefico descritivo tipo revisatildeo integrativa realizado por meio da estrateacutegia PECO nas bases de dados LILACS MEDLINE e COCHRANE com artigos publicados entre 2007 e 2016 Resultados incluiacuteram-se 16 artigos Percebeu-se que haacute grande variabilidade dos instrumentos e referecircncias utilizados para a avaliaccedilatildeo do estado nutricional e dos haacutebitos alimentares nos manuscritos avaliados Realizou-se em dez estudos a comparaccedilatildeo entre o IMC materno e o IMC da crianccedila e todos encontraram relaccedilatildeo positiva Avaliou-se e comparou-se em oito estudos o consumo alimentar entre matildee e filho e todos encontraram relaccedilotildees significativas Destaca-se que a maioria dos artigos eacute internacional sendo apenas dois realizados no Brasil Realizou-se aleacutem disso a maior parte deles em zona urbana sendo que apenas uma investigaccedilatildeo abrangeu aacutereas urbana e rural Conclusatildeo revela-se que os resultados desta revisatildeo natildeo permitem evidenciar que o estado nutricional e os haacutebitos alimentares maternos podem determinar o excesso de peso de crianccedilas da zona rural Descritores Crianccedila Obesidade Estado nutricional Comportamento alimentar Relaccedilotildees matildee-filho Nutriccedilatildeo materna

RESUMEN

Objetivo evaluar la asociacioacuten y la similitud entre el estado nutricional y la ingestioacuten dieteacutetica de nintildeos y sus madres en la zona rural Meacutetodo se trata de un estudio bibliograacutefico descriptivo tipo revisioacuten integrativa realizado por medio de la estrategia PECO en las bases de datos LILACS MEDLINE y COCHRANE con artiacuteculos publicados entre 2007 y 2016 Resultados se incluyeron 16 artiacuteculos Se percibioacute que hay gran variabilidad de los instrumentos y referencias utilizados para la evaluacioacuten del estado nutricional y de los haacutebitos alimenticios en los manuscritos evaluados Se realizoacute en diez estudios la comparacioacuten entre el IMC materno y el IMC del nintildeo y todos encontraron relacioacuten positiva Se evaluoacute y se comparoacute en ocho estudios el consumo alimentario entre madre e hijo y todos encontraron relaciones significativas Se destaca que la mayoriacutea de los artiacuteculos son internacionales siendo apenas dos realizados en Brasil Se realizoacute ademaacutes la mayor parte de ellos en zona urbana siendo que soacutelo una investigacioacuten abarcoacute aacutereas urbanas y rurales Conclusioacuten se revela que los resultados de esta revisioacuten no permiten evidenciar que el estado nutricional y los haacutebitos alimenticios maternos pueden determinar el exceso de peso de los nintildeos de la zona rural Descriptores Nintildeo Obesidad Estado nutricional Conducta Alimentaria Relaciones Madre-Hijo Nutricioacuten Materna

1Nutritionist Federal University of Satildeo Joatildeo del-Rei UFSJ Divinoacutepolis (MG) Brazil Email erikablagaresyahoocombr ORCID iD

httpsorcidorg0000-0003-4459-0754 2Nurse Federal University of Satildeo Joatildeo del-Rei UFSJ Divinoacutepolis (MG) Brazil Email

karolyneresendegmailcom ORCID iD httpsorcidorg0000-0003-3363-6761 3PhD Federal University of Satildeo Joatildeo del-Rei UFSJ

Divinoacutepolis (MG) Brazil Email marciachristinacsgmailcom ORCID iD httpsorcidorg0000-0002-1819-4689

INTEGRATIVE REVIEW ARTICLE


EnglishPortuguese



It is known that obesity is a multifactorial

disease characterized by an excessive increase

of body fat having a detrimental effect on

the health of the individual with a significant

loss in quantity and quality of life1 It is

noticed that some cases of obesity are of

endogenous origin associated with hormonal

genetic or syndromic disorders such as

hypothyroidism Cushings syndrome growth

hormone deficiency defective leptin

signaling mutations at the melanocortin 4

receptor and the Prader-Willi and Bardet-

Biedl syndromes however most cases are of

exogenous origin due to the positive energy

balance2

Childhood obesity is a serious public health

problem of contemporary times It is

estimated by the World Health Organization

that 41 million children under five and more

than 340 million children and adolescents

aged five to 19 years were overweight or

obese in 2016 3 Recent research by the

Centers for Disease Control and Prevention

(CDC) conducted in the United States showed

that 121 of children between two and five

years of age and 180 between six and

eleven were obese4 It is inferred that in

Brazil according to the Family Budget Survey

(FBS) (2008-2009) one in three children aged

five to nine years were overweight with

514 of the boys and 438 of the girls 5

and of Brazilian children aged five to ten

years accompanied by SISVAN 284 are

overweight6

It is believed that overweight or obese

children who remain in this condition

throughout development tend to become

adults with neurometabolic and endocrine

complications as well as predisposition to the

metabolic syndrome cardiovascular diseases

such as dyslipidemia hyperinsulinemia

increased blood pressure and autonomic

dysfunction17-8 These children are often

presented with socialization difficulties and

they face suffering due to the stigmatization

of obesity reflecting in low self-esteem and

behavioral disorder characterizing bullying9

In addition to the genetic factor it

contributes to weight gain and body fat

which also predispose the environmental

factors to obesity and among them the

sedentary lifestyle and inadequate eating

habits 10-1 such as excessive exposure to

ultraprocessed foods and with low nutritional

value

Children of different socioeconomic levels

and places of housing have been reached

today either in urban or rural areas12 It is

observed that although in the countryside

the familys work practices involve planting

and the harvest favoring physical exercise

and access to in natura food an increase in

the consumption of processed products and

sedentary practices among children and their

families13-5

It is also believed that children acquire

their eating habits and lifestyle in the family

especially with the mother thus maternal

nutritional status and eating habits may

constitute risk factors for childhood obesity

In fact investigations have been carried out in

urban areas in order to verify this relationship

showing that maternal overweight and their

habits of life can be associated with higher

levels of BMI of the children16-7

One can certainly contribute to this

increase in the prevalence of overweight

among children also in rural settings18-9 and

considering the implications of obesity on

childrens health it is pertinent to deepen the

knowledge about the subject and seek

evidence about this causal relationship In this

research we sought to answer the question

Can nutritional status and maternal eating

habits determine the overweight of rural

children

Through the findings of this study a better

understanding of factors that may affect the

dietary intake patterns and the nutritional

status of the children will be possible and may

produce useful information for the

development of effective intervention

programs to promote healthy eating in

childhood especially in the family

environment

bull To evaluate the association and similarity

between nutritional status and dietary intake

of children and their mothers in rural areas

An integrative literature review was carried

out consisting of a scientific investigation

with the objective of gathering critically

evaluating and conducting a synthesis of the

results of several primary studies generating

evidence An integrative literature review was

carried out consisting of a scientific

investigation with the objective of gathering

critically evaluating and conducting a

synthesis of the results of several primary

studies generating evidence20 The research

question was defined through the strategy

PECO on research and search for evidence

(People - children from five to ten years old -

Exposure - nutritional status and eating habits

INTRODUCTION

METHOD

OBJECTIVE


EnglishPortuguese



of the mother - Comparison - yes no relation

- Outcomes - excess weight and inadequate

eating habits of the child) PECO on research

and search for evidence (People - children

from five to ten years old - Exposure -

nutritional status and eating habits of the

mother - Comparison - yes no relation -

Outcomes - excess weight and inadequate

eating habits of the child)

The research was carried out in the

electronic databases MEDLINE (Medical

Literature Analysis and Retrieval System

Online) LILACS (Latin American and

Caribbean Health Sciences Literature) and

Cochrane Central (Register of Controlled

Trials) merging the following terms from the

list of Descriptors in Health Sciences (DeCs)

and Medical Subject Headings (MeSH) in

English child obesity nutritional status

feeding behavior mother-child relationship

maternal nutrition and in English child

obesity nutritional status feeding behavior

mother-child relations maternal nutrition

The following inclusion criteria were

considered all types of studies published in

the last ten years published between January

2007 and December 2016 with a population

between five and ten years of age The

chronological period for the inclusion of the

studies in order to investigate the most up-to-

date data on the subject was defined The age

group is justified because it is a phase with an

accelerated ascendancy of excess weight in

addition this group has peculiar

characteristics in the pattern of growth and

diagnostic criteria5 The data was collected

from March to November 2017 The studies

were selected by two reviewers

independently The studies were at first

tested by the reading of titles and abstracts

and in the event of disagreement between

them it was decided in plenary for the

moment to read the whole article and then it

was defined on the inclusion of the

manuscript The PRISMA (Preferred Reporting

Items for Systematic Reviews and Meta-

Analyzes) protocol 21 was followed for the

identification selection eligibility and

inclusion of studies

In the next phase the selected studies

were read in full and simultaneously a

standardized and structured instrument was

used to collect data from each article in

order to systematize the relevant information

as well as to classify the level of scientific

evidence according to the categorization of

the Agency for Healthcare Research and

Quality (AHRQ)22

A total of 29 articles were selected for

reading in full After reading 13 articles were

excluded because they did not respond to the

research question or because the age group

was in disagreement with that defined in the

inclusion criteria (Figure 1)


EnglishPortuguese



Figure 1 Flowchart of databases Divinoacutepolis (MG) Brazil 201721

Included in this review were 16 articles

that answered the question of the study of

which 12 are of cross-sectional design three

cohort and one systematic review It should

be emphasized that there is great variability

of the instruments and references used to

evaluate the nutritional status and eating

habits in the evaluated manuscripts It was

also found that the type of analysis of the

relationship between study variables is

heterogeneous (Figure 2)

Study (Author year)

Study population

Drawing

Location

Anthropometric measurements

Instruments to evaluate eating habits

Variables compared between mother and child

Scientific Evidence

Francis et al 200723

197 five-year-old girls and their parents

Longitudinal

Pennsylvania United States of America

Percentile of BMI Age (children) BMI (parents) at baseline

Food disinhibition subscale (country)

Maternal BMI and BMI Child Positive relationship when father and mother were overweight (p lt001) and when only the mother was overweight (p lt005))

Level 3

- Loacutepez Alvarenga et al 200724

552 children between eight and 12 years of age (406 with

Cross-sectional

Mexico

Means and Standard Deviation of BMI weight and height (children and

Questionnaire containing 43 questions about parents habits 34 about

Maternal food preference and childs food preference

Level 4

RESULTS

Records identified through searches in the MEDLINE database (n= 218)

Records after deleting duplicate studies (n=464)

Excluded studies

(n=435)

Studies selected for reading in full (n=

464)

Complete studies assessed for eligibility (n= 29)

Full studies excluded (n= 13)

IDEN

TIF

ICA

TIO

N

ELIG

IBIL

ITY

SELEC

TIO

N

INC

LU

SIO

N

Studies included in quantitative

synthesis (n= 16)

Records identified through searches in the LILACS database (n= 166)

Records identified through searches in the COCHRANE database (n= 203)


EnglishPortuguese



participation of both parents and 146 with participation only of the father or the mother)

parents) childrens habits and 31 questions related to food frequency

positive association for diet refrigerant (rm= 097 rf = 086) frutas (rm=

077 rf= 082) verduras (rm= 092 rf= 094) pescados (rm= 076 rf= 078)

Zeller et al 200725

78 obese and 71 non-obese children and adolescents ages eight to 16 and their parents

Cross-sectional

USA

BMI Z score age (child) BMI (parents)

Did not evaluate eating habits

Maternal BMI and Child BMI positive relation (OR 28 p lt00001)

Level 4

Mazur et al 200826

2182 girls and 2066 boys with a mean age of 104 and 105 years respectively

Cross-sectional

Poland



BMI maternal and BMI child positive relation for girls (OR 1428 p lt0001) and boys (OR 1675 p lt00001)

Level 4

Beydoun e

Wang 200927

1370 boys 1322 girls (from two to 18 years old) 1061 fathers and 1230 mothers

Cross-sectional

USA

Means and Standard Deviation of BMI (children and parents)

Two 24-hour food reminders

Maternal food intake and infant food intake positive correlation for total intake of cholesterol calcium and dairy products fruits and vegetables (p lt005)

Level 4

Rosenkranz et al 201028

76 girls from nine to 13 years old and their mothers

Cross-sectional

USA

Percentile and Z score of BMI age (child) BMI (parents)

Questionnaire on the consumption of fruit vegetables and sugary drinks

BMI maternal and BMI child positive relation if considered the connectivity (p lt005)

Maternal food intake and dietary intake of the child direct relationship between fruit consumption (p lt001) vegetable intake (p =

Level 4


EnglishPortuguese



001)

Wang et al 201129

24 studies with children adolescents and their parents

Systematic review

USA

Did not evaluate anthropometric data

24-hour food recall Food Frequency Questionnaire (FFQ)

Food consumption of parents (does not evaluate mother and father individually) and food consumption of the child moderate or weak association (mean correlation of approximately 02)

Level 1

Bernardo et al 201230

1223 children seven to ten years old and their parents

Cross-sectional

Florianoacutepolis- SC Brazil


Previous Day Food Questionnaire (QUADA) version 3

Maternal BMI and child BMI positive relation (OR 158 p = 0001)

Level 4

Laster et al 201331

177 children two to five years old and their mothers

Cross-sectional

North Carolina United States

Percentile of BMI age (child) BMI (parents)


Maternal food intake and infant food intake positive correlation between the quality of the diet of the mother and child (r = 044 p lt00001)

Level 4

Park et al 201532

1350 six-year-olds and their mothers

Cross-sectional

USA

BMI Z score age (child) BMI (mother)

Four adapted questions from the Child Feeding Questionnaire

Maternal food pattern and infant food consumption significant relation (p lt005)

Level 4

Robinson et al 201433

66 families with children aged eight to 12 years

Cross-sectional

Hunter e Forster (New South Wales Australia)


Australian Eating Survey (AES)- adults

Australian Child and Adolescent Eating Survey (ACAES)-Children

Maternal food intake and infant food intake positive correlation for the intake of plant variety (p lt001) and meat intake (p lt0001)

Level 4

Tschann et al 201534

322 Mexican-American children ages eight to ten and their parents

Longitudinal (cohort two years)

California United States of America

Ratio of Waist Height percentile of BMI age (child) BMI (parents) at baseline

Parental Feeding Practices (PFP) Questionaire

BMI maternal and child BMI positive relation (p lt0001)

Level 3

Faith 302 girls Longitu USA BMI Z Not Maternal Leve


EnglishPortuguese



et al 201335

and 316 boys mean ages of 522 and 523 months respectively and their parents

dinal (cohort

ten years)

score age (child) BMI (mother)

reported (Food issues administered in 1986)

BMI and Child BMI Positive relationship (OR ranged from 248 to 863 and from 227 to 403 for boys)

l 3

Mendes et al 201536

60 children six to ten years old

Cross-sectional

Itauacutena- MG Brazil

BMI Age Percentile

Semiquantitative food frequency questionnaire (SQFFQ)

BMI maternal and child BMI positive relation (p = 0004)

Level 4

Miranda-Riacuteos et al 201537

174 schoolchildren aged five to 12 years and their mothers

Cross-sectional

Arandas Jalisco Mexico


24-hour reminder

Maternal BMI and Child BMI Positive Relationship [OR 155 p = 0003]

Maternal food consumption and infant food consumption Positive association in energy consumption (p = 004) (p lt0001 and p = 0005 respectively) and carbohydrate intake by daughters (p = 0004)

Level 4

Parrino et al 201638

2025 children (1001 women and 1024 men) aged nine to 14 years

Cross-sectional

Catania-Province of Enna (Urban and rural areas) - Sicily

BMI Z Age (child) Waist Height Ratio BMI (parents)


Maternal BMI and child BMI positive relation (r = 025 p lt00001)

Level 4

Figure 2 Description of study articles according to selected variables published in the period from

2007 to 2016 BMI Body Mass Index MG Minas Gerais OR Odds Ratio SC Santa Catarina

In all the studies included in this review

except for the systematic review study BMI as

an anthropometric indicator of the nutritional

status of children and their mothers and as a

child evaluation parameter the studies used

BMI Age in Z score 25-6303337 percentile2331-

236 Z score and percentile2835 Z score and

waist height ratio3438 mean and standard

deviation of BMI2427 It is reported that two

articles did not classify BMI as children2427

other two34-5 did not refer to the criteria used

five investigations 23252831-2 adopted the

criteria proposed by the Centers for Disease

Control and Prevention (CDC) in 200039 three

other studies263338 used the proposal of the

International Obesity Task Force (IOTF) of

2000 and 200240-1 and the last three

studies3036-7 used the criteria of the World

Health Organization (WHO) in 2006 and

200742-3

Among these studies ten of them

compared the maternal BMI with the BMI of

the child and all found a positive relation (p

lt00523 OR 28 [CI95 18-435] plt

0000125 OR 1428 [CI 95 1031-1979] plt

0001 OR 1675 [CI951178-2382] plt

00001 for girls and boys respectively26 plt

00528 PR 158 [CI 95 126-198]30 r= 036

plt 000134 OR varied 248-863 e 227-403

[CI 95] for girls and boys respectively35 OR

225 [CI95 25-2032]36 OR 155 [CI 95

18-132]37 OR 233 [CI95 180ndash301]38)

The prevalence of overweight in the

majority of the original studies was evaluated


EnglishPortuguese



varying from 116 to 84 among mothers and

from 216 to 51 among the children It is

mentioned that three studies did not present

the prevalence of overweight obesity of the

children evaluated242733 In one the mean Z

score for BMI age was 042 plusmn 119 for girls

and 073 plusmn 118 for boys33 It was shown in

two other studies that the average BMI was

202 plusmn 01 27 and another 192 plusmn 41 for public

school children and 191 plusmn 32 for private

school children24 Data on the dietary intake of

children in eleven studies were evaluated 23-

427-3336-7 but only eight of them evaluated

parental feeding and compared the

consumption of mother-infant dyads2831-2 and

also father-son2427293337

The questionnaires used to collect data

between the studies were differed It is

noticed that some authors30 used QUADA

version 3 which consists of an illustrated

questionnaire referring to the food

consumption of the previous day in a

qualitative way others32 used four questions

extracted from the Infant Feeding

Questionnaire and focused on maternal

behavior regarding the childs diet and two

questions regarding the frequency with which

the child had ingested non-alcoholic sugary

drinks in the last month Some authors have

used validated semiquantitative food

frequency questionnaires (FFQs) Australian

Eating Survey (AES) for adults and Australian

Child and Adolescent Eating Survey (ACAES)

for children3336 others used the 24-hour food

recall 272931 as well as some authors who

used a structured questionnaire with

questions about the eating habits of children

and parents24 another group of authors used a

questionnaire on the consumption of fruit

vegetables and sugary drinks 28 and the

studies included in the review29 used FFQs and

or 24-hour food recall

t is exposed from the studies found in this

review that only two 2837 simultaneously

evaluated the relationship of BMI between

mother and child contemplating data on the

food consumption of both in urban

environment A total of 76 girls aged nine to

13 years and their mothers were evaluated

The higher the connectivity score in the

relationship between mother and daughter

the greater the similarity between their BMI

(p lt005)28 there was a significant similarity

in the consumption of fruits and vegetables by

children and their mothers (p = 001 and p

lt001 respectively) The childs eating habit

was also directly associated with this habit (p

lt0001) but there was no similarity relation

between the intake of sugary beverages by

the children and their mothers (pgt 005) In a

study of 172 Mexican children aged five to 12

years and their mothers it was found that

obese mothers had a significantly higher

proportion of obese children compared to

normal or overweight mothers [OR 155 (IC 95

18-132) p = 0003]37 However the state of

overweight and maternal obesity in a single

group was compared to the overweight and

obesity status of the children but no

statistical association was found The risk of

excessive energy consumption by their

daughters (p = 004) increased by 11 times the

mothers excessive energy consumption The

maternal lipid intake was associated with the

lipid intake of their sons and daughters (p

lt0001 and p = 0005 respectively) and the

mothers carbohydrate intake was associated

with their daughters consumption (p = 0004)

Increased sugar consumption by mothers

increased the risk of excessive sugar

consumption in their sons and daughters by

four to five times

In a study carried out in Brazil specifically

in a city in the center-west of Minas Gerais

the factors associated with infant BMI in 60

children between six and ten years old were

measured and the mothers obesity was found

as an independent variable associated with

excess (p = 0004) Of the children whose

mothers were obese 714 were overweight

versus 151 of those whose mothers were not

obese In this study the average daily intake

of breads (p = 003) and the lowest average

daily intake of yogurt (p = 0007) were

statistically significant with statistically

significant associations with the highest BMI of

the child The average daily intake of chip

snacks (p = 008) was also directly associated

with the highest infant BMI and the highest

average daily intake of ice creams (p = 009)

was indirectly associated with higher child

BMI without statistical significance Other

variables such as fathers obesity birth

weight breastfeeding and number of children

were evaluated however they were not

associated with the BMI of the child36

A follow-up study of 197 girls five years of

age was performed at the baseline until the

age of 13 and the prevalence of overweight

of the girls over time was evaluated It should

be noted that BMI change patterns were

higher than expected for normal growth

among daughters of overweight parents

compared with girls whose parents were not

overweight [mean weight gain 408 plusmn 133 kg

291 plusmn 62 kg respectively) p lt0001] It was

observed that girls from families in which only

mothers were overweight showed a faster rate

of increase in BMI over time compared to


EnglishPortuguese



those in which neither parent was overweight

(p lt005)

25 characteristics of parents associated

with obesity in children and adolescents were

examined in a study to better understand the

obesogenic family environment It was found

that mothers and fathers of obese youngsters

had significantly higher BMIs compared to

mothers and fathers of overweight children

[(Mothers 352 plusmn 96 kg m2 vs 276 plusmn 69 kg

m2 Parents 333 plusmn 84 kg m 2 vs 282 plusmn

47 kg m 2 of youngsters with and without

overweight respectively) p lt0001] Maternal

obesity increased by 28 times the chance of

the child being obese until [p lt00001 95 CI

180-435] and as expected the

socioeconomic level did not differ significantly

among the participants since it is a

convenience sample whose sociodemographic

characteristics of families tend to be similar

In one study 26 risk factors for the

development of obesity in children in the

south-eastern region of Poland were assessed

It was found that maternal obesity was highly

associated with the presence of obesity in

children with a differential impact between

the sexes [OR 1428 (95 CI 1031-1979) p

lt0001] in girls and [OR 1675 (95 CI 1178-

2382) p lt00001) in boys Childrens obesity

was also significantly associated with paternal

obesity (p lt0001) however this relation is

higher with the mother It was found that

family income parental education level and

maternal occupation were not associated with

the presence of obesity in children and the

lower number of children living in the same

household was significantly associated with

childhood obesity (p lt005)

The early risk factors for obesity related to

the parents of 2025 Sicilian children aged nine

to 14 years living in urban and rural areas

were estimated38 Obese mothers had a

significantly higher prevalence of obese

children (329 vs 96 in normal weight

mothers p lt0005) The BMI of both fathers

and mothers was significantly correlated with

the BMI-z score (r = 027 and r = 025

respectively p lt00001) waist circumference

(r = 025 (r = 027 and p = 023 respectively

p lt00001) also adjusted for age and sex (p

lt005) There was also a significant

relationship between the level of parental

schooling and the childs weight status It was

inferred that when the mother or father had a

low level of schooling the prevalence of

childhood obesity was significantly higher than

when the parents had a high educational level

(p lt005) in addition overweight and obese

children had a significantly higher prevalence

of high birth weight (PN ge 4 kg) compared to

lean or normal-weight children (61 vs 31

p lt005) It was found that the prevalence of

high birth weight was significantly higher

among overweight and obese females (80 vs

37 p lt005) but no significant differences

were found between areas urban and rural

areas for BMI z scores for BMI and waist-to-

height ratio however children living in urban

areas had a significantly higher WC (748 plusmn

114 vs 733 plusmn 119 lt005) than children in

rural areas

A total of 1223 schoolchildren aged seven

to ten years 492 boys and 508 girls were

found and a significant relationship was

found between the nutritional status of the

children and the nutritional status of their

mothers30 It was observed that the

prevalence of overweight or obesity was 158

times higher among children of mothers who

were overweight (p = 0001) with no

significant difference between genders

revealing that approximately 849 of the

children had habits healthy diet but in this

investigation there was no significant

association between family income and

overweight

In a longitudinal study35 302 girls and 316

boys mean age of 45 years at baseline were

observed during a ten-year follow-up

Measurements of anthropometric

measurements were made at five moments

during the study and maternal obesity was a

predictor of the increase in overweight

obesity in girls (OR ranged from 248 to 863

p lt00001) and (OR ranged from 227 to 403

p lt00006) in boys at all time points

In another longitudinal study 34 32-year-old

Mexican American children aged eight to ten

years were followed for two years of follow-up

regarding the influence of parental feeding

practices on the childs weight and positive

correlation between BMI waist height ratio

of children and parental BMI both maternal

BMI and paternal BMI (p lt0001) The

socioeconomic level of the families was

associated with lower BMI and lower waist-to-

height ratio (r = -012 p lt005)

The influence of maternal food preferences

on childrens food preferences was

measured24 This study was carried out in a

public school and a private school comparing

therefore two groups from different social

strata It was observed that the mothers of

the public school students had a higher BMI

when compared to the mothers of the private

school (p lt00001) The preferences of the

children were more strongly associated with

maternal food preferences compared to the

paternal preferences for the following foods

vegetables (rmom = 092 rdad = 058 rchild =


EnglishPortuguese



094) fruits (rmom = 077 rdad = 047 rchild =

082) diet refrigerant (rmom = 097 rdad = 060

rchild = 086) and fish (rmom = 076 rdad = 063

rchild = 078) The results showed that mothers

influenced their childrens food preferences by

30 and this association was stronger for

students in public schools both parents

influenced their children in regular

consumption of common refrigerant (rmom =

084 rdad= 081 rchild = 098)

The association between ingestion and

dietary pattern between parents and children

in a representative sample of the United

States was studied27 and it was found that the

adjusted correlations were significantly

stronger between mother-child dyads than

between parent-child dyads and when

comparing food intake among children and

their mothers a correlation was observed

between cholesterol intake (rson=047

rdaughter=031 plt 005) calcium and dairy

products (rson=030 rdaughter=030 plt 005)

fruits and vegetables (rson=031 rdaughter=037

plt 005) It is generally suggested from the

findings of this study that the similarity in

dietary intake between parents and children is

relatively weak (correlations ranged from 020

to 033 for total energy intake and diet) It

was increased in parents who ate healthy food

three times the likelihood of children also

having a healthy diet and the age of the child

significantly modified this relationship which

was higher for children aged between two and

ten years [OR 405 (95 CI 245-668) p

lt005] compared to those over the age of 10

[OR 155 (95 CI 101-2 36) p lt005] When

the socioeconomic level was considered it

was only an interaction for the consumption of

diet soda with a significant correlation

between parents and children of better social

class (r = 031 p lt005)

The quality of the diet of preschool

children and their mothers with overweight

was determined in a study 31 assessing the

correlation between the quality of the

maternal diet and the childs diet The

maternal-infant scores of the diet quality

index were correlated with each other (r =

044 p lt00001) and more than half of the

children met the recommendations of total

grains milk and oils however only 6 of the

children met the recommendation of total

vegetables compared to 18 of the mothers

Children and mothers were significantly

different in the percentage of adequacy to

recommendations for fruits vegetables

whole grains milk and meat and beans It

should be noted that the quality of the infant

diet was better among those children with

longer breastfeeding children of white

mothers married and non-smokers however

BMI-Z score and BMI category were not

associated with quality of the childs diet

The comparison between the dietary intake

of the children and their respective parents

was found 33 and there were moderate

positive correlations between the father-child

dyads in relation to the percentages of energy

intake from fats saturated fats and

carbohydrates (r = 040-046 P lt005) while

the mother-infant dyads presented moderate

to moderate positive correlations for all

percentages of intake such as plant variety (r

= 040 p lt001) meat intake (r = 046 p

lt0001) except for carbohydrates (r = 027 p

lt005) besides strong correlations for the

general quality of the diet (r = 050 - 059)

The influence of maternal dietary practices

on the ingestion of non-alcoholic sugary drinks

in a sample of 1350 six-year-old children was

evaluated and 23 of children were found to

be overweight and consume these beverages

once a day and that regardless of the

nutritional status of the child children of

mothers who limited their consumption of

sweets and unhealthy foods were significantly

less likely to consume non-alcoholic

sweetened beverages (p lt005)32

In a systematic review with meta-analysis

29 the similarity in food intake of children and

their parents was found 24 studies published

in the period from 1980 to 2011 were

identified of which 15 were included in the

meta-regression analysis Significantly the

results of the studies were varied and

generally speaking weak to moderate

correlations were suggested for nutrient

intake between parents and children with a

mean correlation coefficient of 020 (95 CI

013- 028) and 021 (95 CI 018-024) for

total fat and energy respectively It is further

noted by the authors that associations for

these dietary items have become weaker over

the years It should be noted that food

frequency questionnaires (FFQs) produced a

lower correlation than the 24-hour records or

reminders and the better methodological

quality of the studies showed a stronger

correlation in fat intake It is emphasized that

the majority of the studies that composed this

review was based on small non-representative

samples and about half of them were carried

out in the United States being scarce the

work done in underdeveloped countries

It is understood that the results of this

research do not show that nutritional status

and maternal eating habits can determine the

overweight of rural children It is added that

DISCUSSION


EnglishPortuguese



although the sample of the study population

varies between 60 and 4248 children totaling

13858 participants only one study was

carried out with rural children showing the

lack of research on the subject with the

mentioned public

The prevalence of overweight and

childhood obesity found in the studies in this

review varied between 216 and 51 It is

reported that a systematic review study 44

worldwide identified a substantial increase in

childhood obesity with 238 of boys and

226 of girls in developed countries being

overweight or obese In developing countries

prevalence of overweight and obesity

increased from 81 to 129 in 2013 for boys

and from 84 to 134 in girls

The methodology for collecting the

anthropometric data was used to calculate

the BMI between the studies The weight and

height measures of the children were obtained

by a majority of them (n = 13) through an

evaluation carried out by a trained

researcher In one of the selected studies

these measures were measured by the

respective mothers However it was noticed

that the anthropometric measurements of the

mothers were self-reported in more than half

of the studies (n = 9) Self-reported measures

may include outdated data errors lack of

knowledge or underreporting of overweight45

It was verified that the instruments used

for the evaluation of food consumption were

heterogeneous which makes it difficult to

compare the results found It is noteworthy

that only three studies evaluated the

consumption of non-alcoholic sugary drinks It

is relevant to evaluate this aspect in the

dietary pattern since studies have discussed

the possible association between the

consumption of sugary drinks and the BMI It

was pointed out in the literature review that 46 the overall index of non-alcoholic sugary

beverages consumption is high in the child and

adolescent population and that additional

studies especially follow-up studies should

be implemented to elucidate its effect on BMI

and health in general

It was verified that the majority of the

articles of this revision is international being

only two realized in Brazil In addition most

urban area surveys were carried out with only

one study covering urban and rural areas and

did not find significant differences in the

prevalence of overweight between the two

areas demonstrating that the nutritional

transition also affects children As a result

the hypothesis is that rural inhabitants have

more access to healthy foods such as fruits

and vegetables as well as having adequate

physical space for planting and growing

gardens and leisure activities in the air free

so they would be less likely to become

obese47 It is necessary in this sense to carry

out further investigations with this public for

a better understanding about the prevalence

of obesity and associated factors in children

residing in this area

The relationship in BMI and the dietary

pattern between mother and child in this

review was observed especially in urban

children These findings may support genetic

causation but environmental and family

components should be considered since

parents and the family environment are the

primary influences of life habits that children

tend to follow It is understood that family

practices such as food consumption absence

of physical activity hours in front of the

television or computer are examples that

directly influence the choices and

conditioning of the individual in relation to

habits of life48

Among the studies analyzed in this review

nine of them evaluated the socioeconomic

status of the participants and from these

one found a significant association between

the higher socioeconomic level and the lower

child BMI34 Evidence suggests that

socioeconomic status is an important element

associated with obesity although the existing

literature is not consensual There was a

direct association between higher family

income and obesity in schoolchildren 12

justifying that greater access to consumer

goods stimulates sedentariness such as

excessive use of the computer In addition

due to the higher purchasing power access to

an inadequate nutritional standard such as

the use of sugary drinks delicacies and

industrialized foods of high energy value49

t was found that more than half of the

studies 75 (n = 12) are of the transverse

type characterized as level 4 of scientific

evidence 19 (n = 3) are descriptive cohort

studies characterized as level 3 of evidence

and 6 (n = 1) are of systematic review

characterized as level 1 of evidence however

because they are not randomized controlled

clinical trials we can not extract causal

inferences34

It was found with regard to the

representativeness of the samples that 438

(n = 7) of the selected studies had sampling

for convenience It becomes impracticable to

state that the data from the studies analyzed

with non-randomized sampling represent a

population and representative and random

samples are essential from the point of view

of internal and external validity to ensure that


EnglishPortuguese



the information collected is extended to the

population50

The lack of studies evaluating the

relationship between nutritional status and

food consumption among children from five to

ten years old and their mothers especially in

rural environments shows that only two of

the articles evaluated in this review presented

it clearly It is known that the family directly

influences the health promotion practices or

the illness of its members since it plays a

fundamental role in the formation of values

beliefs knowledge and habits of life51

Therefore it is necessary in relation to

the factors associated with overweight in

children of longitudinal rural surveys that

assess the highest possible volume of variables

of the mother and child such as the

consumption of sugary drinks non-alcoholic

socioeconomic status BMI level of physical

activity favoring the analysis of the

determinants of this phenomenon of global

magnitude

It is concluded that the results of this

review do not show that nutritional status and

maternal eating habits can determine the

overweight of rural children considering that

in this research only one study was conducted

in rural areas and nevertheless it is an

international study that did not compare

maternal and child food consumption It is

therefore recommended to implement more

studies in the rural area mainly in Brazil on

this subject

Foundation for Research Support in Minas

Gerais - FAPEMIG Federal University of Satildeo

Joatildeo del-Rei (UFSJ)

1 World Health Organization Global

strategy on diet physical activity and health

childhood over weight and obesity [Internet]

Geneva WHO 2016 [cited 2017 Dec 04]

Available from

httpwwwwhointdietphysicalactivitychil

dhooden

2 Mason K Page L Balikcioglu PG Screening

for Hormonal Monogenic and Syndromic

Disorders in Obese Infants and Children

Pediatric Ann 2015 Sept 43(9)e218-24 Doi

httpsdoiorg10392800904481-20140825-

08

3 World Health Organization Obesity and

Overweight [Internet] Geneva WHO 2018

[cited 2018 Mar 20] Available from

httpwwwwhointmediacentrefactsheets

fs311en

4 Ogden CL Carroll MD Kit BK Flegal KM

Prevalence of obesity and trends in body mass

index among US children and adolescents

1999-2010 JAMA 2012 Feb 307(5) 483-90

Doi httpdoi101001jama201240

5 Ministeacuterio do Planejamento Orccedilamento e

Gestatildeo (BR) Instituto Brasileiro de Geografia

e Estatiacutestica Pesquisa de orccedilamento familiar

2008-2009 anaacutelise do consumo alimentar

pessoal no Brasil [Internet] Rio de Janeiro

IBGE 2011 [cited 2017 dec 04] Available

from

httpsbibliotecaibgegovbrvisualizacaoli

vrosliv50063pdf

6 Ministeacuterio da Sauacutede (BR) Sistema de

Vigilacircncia Alimentar e Nutricional Relatoacuterios

de Acesso Puacuteblico [Internet] Brasiacutelia

Ministeacuterio da Sauacutede 2018 [cited 2017 Dec 05]

Available from

httpdabsistemassaudegovbrsistemassis

vanrelatorios_publicosrelatoriosphp

7 Avery CL Holliday KM Chakladar S Engeda

JC Hardy ST Reis JP et al Disparities in

Early Transitions to Obesity in Contemporary

Multi-Ethnic US Populations PloS One 2016

June 11(6) e0158025 Doi

httpsdoiorg101371journalpone015802

5

8 Nobre RS Guimaratildees MR Batista AMO

Sousa AF Lima LHO Silva ARV

Anthropometric indicators that predict

metabolic syndrome among adolescents

Texto contexto-enferm 2018 Mar

27(1)e5270016 Doi

httpdxdoiorg1015900104-

070720180005270016

9 Victorino SVZ Soares LG Marcon SS

Higarashi IH Living with childhood obesity

the experience of children enrolled in a

multidisciplinary monitoring program Rev

Rene 2014 NovDec 15(6)980-9 Doi

10152532175-67832014000600011

10 Parikka S Maumlki P Levaumllahti E Lehtinen-

Jacks S Martelin T Laatikainen T

Associations between parental BMI

socioeconomic factors family structure and

overweight in Finnish children a path model

approach BMC Public Health 2015

Mar15271 Doi httpdoi 101186s12889-

015-1548-1

11 Saunders TJ Chaput JP Tremblay MS

Sedentary behaviour as an emerging risk

factor for cardiometabolic diseases in children

and youth Can J Diabetes 2014 Feb

38(1)53-61 Doi http doi

101016jjcjd201308266

CONCLUSION

REFERENCES

AKNOWLEDGEMENTS


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Frequency of obesity and related risk factors

among school children and adolescents in a

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study Sao Paulo Med J 2015 MarApr

133(2)125-30 Doi httpdoi 1015901516-

318020148960412

15 Bubolz CTR Madruga SW Rombaldi AJ

Azevedo MA Gonzales NG Food intake

according to the type of food consumed in

schools in a rural area in southern Brazil

Ciecircnc Sauacutede Coletiva 2016 Sept Doi


8123201823815902016

16 Menella JA Ontogeny of taste

preferences basic biology and implications for

health Am J Clin Nutr 2014 Mar 99704S-

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17 Santos DRL Lira PIC Silva GAP Excess

weight in preschool children the role of food

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Barbian CD Welser L et al Social and

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19 Barbosa Filho VC Campos W Fagundes

RR Lopes AS Souza EA Isolated and

combined presence of elevated

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prevalence and sociodemographic correlates

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20 Souza MT Silva MD Carvalho R

Integrative review what is it How to do it

Einstein 2010 JanMar 8(1)102-6 Doi

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21 Moher D Liberati A Tetzlaff J Altman

DG PRISMA Group Preferred reporting items

for systematic reviews and meta-Analyses the

PRISMA statement PLoS Med 2009 July

216(7)e1000097 Doi httpdoi

101371journalpmed1000097

22 Agency for Health Care Research and

Quality Quality improvement and monitoring

at your fingertips [Internet] Rockville AHRQ


httpwwwqualityindicatorsahrqgov

23 Francis LA Ventura AK Marini M Birch

LL Parent overweight predicts daughtersrsquo

increase in BMI and disinhibited overeating

from 5 to 13 years Obesity (Silver Spring)

2007 June 15(6) 1544-53 Doi

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24 Loacutepez-Alvarenga JC Vaacutezquez-Velaacutezquez

V Bolado-Garciacutea VE Gonzaacutelez-Barranco J

Castantildeeda-Loacutepez J Robles L et al Influencia

de los padres sobre las preferencias

alimentarias en nintildeos de dos escuelas

primarias con diferente estrato econoacutemico

Estudio ESFUERSO Gac Meacuted Meacutex [Internet]

2007 Sept [cited 2017 Dec 05] 143 (6)463-9

Available from

httpwwwmedigraphiccomcgi-

binnewresumencgiIDARTICULO=15262

25 Zeller MH Reiter-Purtill J Modi AC

Gutzwiller J Vannatta K Davies H Controlled

study of critical parent and family factors in

the obesigenic environment Obesity (Silver

Spring) 2007 Jan 15(1)126-36 Doi


26 Mazur A Klimek K Telega G Hejda G

Wdowiak L Malecka-Tendera E Risk factors

for obesity development in school children

from South-eastern Poland Ann Agric Environ

Med 2008 Jan 15(2)281-5 PMID19061264

27 Beydoun MA Wang Y Parentndashchild dietary

intake resemblance in the United States

evidence from a large representative survey

Soc Sci Med 2009 June 68(12)2137-44 Doi

httpdoi101016jsocscimed200903029

28 Rosenkranz RR Bauer A Dzewaltowski

DA Mother-daughter resemblance in BMI and

obesity-related behaviors Int J Adolesc Med

Health 2010 OctDec 22(4)477-89 PMID

21404879

29 Wang Y Beydoun M Li J Liu Y Moreno

LA Do children and their parents eat a similar

diet Resemblance in child and parental

dietary intake-systematic review and

metaanalysis J Epidemiol Community Health

2011 Feb 65(2)177-89 Doi

httpdoi101136jech2009095901

30 Bernardo CO Pudla KJ Longo GZ

Vasconcelos FA Factors associated with

nutritional status of 7-10 year-old


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schoolchildren sociodemographic variables

dietary and parental nutritional status Rev

Bras Epidemiol 2012 Sept 15(3)651-61

PMID 23090311

31 Laster LER Lovelady CA West DG

Wiltheiss GA Brouwer RJN Stroo M et al

Diet Quality of Overweight and Obese Mothers

and Their Preschool Children J Acad Nutr

Diet 2013 Nov113(11) 1476-83 Doi

httpdoi101016jjand201305018

32 Park S Li R Birch L Mothersrsquo Child-

Feeding Practices Are Associated with

Childrenrsquos Sugar-Sweetened Beverage Intake

J Nutr 2015 Apr 145(4)806-12 Available

from httpdoi 103945jn114207233

33 Robinson LN Rollo ME Watson J Burrows

TL Collins CE Relationships between dietary

intakes of children and their parents a cross-

sectional secondary analysis of families

participating in the Family Diet Quality Study

J Hum Nutr Diet 2014 Oct 28 (5)443-51 Doi

http doi 101111jhn12261

34 Tschann JM Martinez SM Penilla C

Gregorich SE Pasch LA Groat CL et al

Parental feeding practices and child weight

status in Mexican American families a

longitudinal analysis Int J Behav Nutr Phys

Act 2015 May 1266 Available from

http101186s12966-015-0224-2

35 Faith MS Heo M Kral TVE Sherry B

Compliant eating of maternally prompted food

predicts increased body mass index z-score

gain in girls results from a population-based

sample Child Obes 2013 Oct 9(5)427-36

Doi 101089chi20120098

36 Mendes RC Tavares CG Figueredo GFD

Silva RL Diniz KGD Gonccedilalves R Anastaacutecio

LR Factors associated with overweight and

body mass index in three schools of Itauacutena-

MG Rev Med Minas Gerais 2015 JanMar

25(1) 30-6 Doi

httpwwwdxdoiorg1059352238-

318220150007

37 Miranda-Riacuteos LL Vaacutesquez-Garibay EM

Romero-Velarde E Nuntildeo-Cosiacuteo ME Campos-

Barrera LR Energy consumption the

distribution of macronutrients and BMI in

mothers and their Mexican schoolchildren

Nutr Hosp 2015 Dec 32(6)2622-32 Doi

httpdoi 103305nh20153269542

38 Parrino C Vinciguerra F La Spina N

Romeo L Tumminia RB Squatrito S et al

Influence of early‑life and parental factors on

childhood overweight and obesity J

Endocrinol Invest 2016 Nov 39(11)1315-21

Doi 101007s40618-016-0501-1

39 Kuczmarski RJ Ogden CL Guo SS

Grummer-Strawn LM Flegal KM Mei Z et al

2000 CDC growth charts for the United States

Methods and development National Center

for Health Statistics Vital Health Stat

[Internet] 2002 [cited 2015 Jan 15] 11(246)

1-189 [cited 2018 Mar 26] Available from

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sr11_246pdf

40 Cole TJ Bellizzi MC Flegal KM Dietz WH

Establishing a standard definition for child

overweight and obesity worldwide

international survey BMJ 2000 May

320(7244)1240-3 PMID 10797032

41 Cole TJ Flegal KM Nicholls D Jackson

AA Body mass index cut offs to define

thinness in children and adolescents

international survey BMJ 2007 July

335(7612)194-7 Doi

101136bmj3923839944455

42 World Health Organization Child Growth

Standards Lenghheght-for-age weight-for-

age weight-for-height and body mass index-

for-age methods and development [Internet]

Geneva WHO 2006 [cited 2018 Mar 26]

Available from

httpwwwwhointchildgrowthstandardst

echnical_reporten

43 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

Sept 85(9)660-7 PMID 18026621

44 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

Aug 384(9945)766-81 Doi

httpsdoiorg101016S0140-

6736(14)60460-8

45 Agnolo CMD Gravena AAF Lopes TCR

Rocha-Brischiliari SC Carvalho MDB Pelloso

SM et al Overweight and associated factors

population study in Southern Brazil Rev Bras

Pesq Sauacutede [Internet] 2014 JulySept [cited

2018 Mar 05] 16(3) 38-47 Available from

httpswwwresearchgatenetpublication2

81973361

46 Cafeacute ACC Lopes CAO Novais RLR Bila

WC Silva DK Romano MCC Lamounier JA

Intake of sugar-sweetened beverages milk

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Pediatr 2018 JanMar 36(1)91-9 Doi


0462201836100010

47 Baggio A Marques F Mendes KG Infanto-

juvenil obesity in urban and rural areas a

systematic review Rev Bras Nutr Clin

[Internet] 2014 Jan [cited 2018 Feb 20]


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29(1)76-80 Available from

httpwwwbraspencombrhomewp-

contentuploads20161213-Obesidade-

infantojuvenilpdf

48 Mariz LS Enders BC Santos VEP Tourinho

FSV Vieira CENK Causes of infantile-juvenile

obesity reflexions based on the theory

Hannah Arendt Texto contexto-enferm 2015

JulySept 24(3) 891-7 Doi


07072015002660014

49 Villa JKD Santos TSS Ribeiro AQ Silva

AR SantrsquoAna LFR Pessoa MC Dietary patterns

of children and socioeconomical behavioral

and maternal determinants Rev Paul Pediatr

2015 June 33(3)302-9 Doi

httpdxdoiorg101016jrpped2015050

01

50 Vieira S Introduccedilatildeo agrave bioestatiacutestica 5th

ed Rio de Janeiro Elsevier 2011

51 Almeida LM Campos KFC Randow R

Guerra VA Estrateacutegias e desafios da gestatildeo da

Atenccedilatildeo Primaacuteria agrave Sauacutede no controle e

prevenccedilatildeo da obesidade Rev Gestatildeo Sauacutede

2017 Jan 8(1)114-39 Doi

httpdxdoiorg1018673gsv8i123924

Submission 20180909 Accepted 20190131 Publishing 20190301

Corresponding Address

Erika Barbosa Lagares Rua Joatildeo Severino Azevedo 2191 Bairro Sagrada Famiacutelia

CEP 35500-461 minus Divinoacutepolis (MG) Brazil


EnglishPortuguese



It is known that obesity is a multifactorial

disease characterized by an excessive increase

of body fat having a detrimental effect on

the health of the individual with a significant

loss in quantity and quality of life1 It is

noticed that some cases of obesity are of

endogenous origin associated with hormonal

genetic or syndromic disorders such as

hypothyroidism Cushings syndrome growth

hormone deficiency defective leptin

signaling mutations at the melanocortin 4

receptor and the Prader-Willi and Bardet-

Biedl syndromes however most cases are of

exogenous origin due to the positive energy

balance2

Childhood obesity is a serious public health

problem of contemporary times It is

estimated by the World Health Organization

that 41 million children under five and more

than 340 million children and adolescents

aged five to 19 years were overweight or

obese in 2016 3 Recent research by the

Centers for Disease Control and Prevention

(CDC) conducted in the United States showed

that 121 of children between two and five

years of age and 180 between six and

eleven were obese4 It is inferred that in

Brazil according to the Family Budget Survey

(FBS) (2008-2009) one in three children aged

five to nine years were overweight with

514 of the boys and 438 of the girls 5

and of Brazilian children aged five to ten

years accompanied by SISVAN 284 are

overweight6

It is believed that overweight or obese

children who remain in this condition

throughout development tend to become

adults with neurometabolic and endocrine

complications as well as predisposition to the

metabolic syndrome cardiovascular diseases

such as dyslipidemia hyperinsulinemia

increased blood pressure and autonomic

dysfunction17-8 These children are often

presented with socialization difficulties and

they face suffering due to the stigmatization

of obesity reflecting in low self-esteem and

behavioral disorder characterizing bullying9

In addition to the genetic factor it

contributes to weight gain and body fat

which also predispose the environmental

factors to obesity and among them the

sedentary lifestyle and inadequate eating

habits 10-1 such as excessive exposure to

ultraprocessed foods and with low nutritional

value

Children of different socioeconomic levels

and places of housing have been reached

today either in urban or rural areas12 It is

observed that although in the countryside

the familys work practices involve planting

and the harvest favoring physical exercise

and access to in natura food an increase in

the consumption of processed products and

sedentary practices among children and their

families13-5

It is also believed that children acquire

their eating habits and lifestyle in the family

especially with the mother thus maternal

nutritional status and eating habits may

constitute risk factors for childhood obesity

In fact investigations have been carried out in

urban areas in order to verify this relationship

showing that maternal overweight and their

habits of life can be associated with higher

levels of BMI of the children16-7

One can certainly contribute to this

increase in the prevalence of overweight

among children also in rural settings18-9 and

considering the implications of obesity on

childrens health it is pertinent to deepen the

knowledge about the subject and seek

evidence about this causal relationship In this

research we sought to answer the question

Can nutritional status and maternal eating

habits determine the overweight of rural

children

Through the findings of this study a better

understanding of factors that may affect the

dietary intake patterns and the nutritional

status of the children will be possible and may

produce useful information for the

development of effective intervention

programs to promote healthy eating in

childhood especially in the family

environment

bull To evaluate the association and similarity

between nutritional status and dietary intake

of children and their mothers in rural areas

An integrative literature review was carried

out consisting of a scientific investigation

with the objective of gathering critically

evaluating and conducting a synthesis of the

results of several primary studies generating

evidence An integrative literature review was

carried out consisting of a scientific

investigation with the objective of gathering

critically evaluating and conducting a

synthesis of the results of several primary

studies generating evidence20 The research

question was defined through the strategy

PECO on research and search for evidence

(People - children from five to ten years old -

Exposure - nutritional status and eating habits

INTRODUCTION

METHOD

OBJECTIVE


EnglishPortuguese




























































Quality (AHRQ)22








EnglishPortuguese















Study (Author year)

Study population

Drawing

Location




Scientific Evidence



Longitudinal





Level 3



Cross-sectional

Mexico




Level 4

RESULTS



Excluded studies

(n=435)


464)



IDEN

TIF

ICA

TIO

N

ELIG

IBIL

ITY

SELEC

TIO

N

INC

LU

SIO

N


synthesis (n= 16)




EnglishPortuguese







Zeller et al 200725


Cross-sectional

USA




Level 4

Mazur et al 200826


Cross-sectional

Poland




Level 4

Beydoun e

Wang 200927


Cross-sectional

USA




Level 4



Cross-sectional

USA





Level 4


EnglishPortuguese



001)

Wang et al 201129


Systematic review

USA




Level 1



Cross-sectional





Level 4

Laster et al 201331


Cross-sectional





Level 4

Park et al 201532


Cross-sectional

USA




Level 4



Cross-sectional






Level 4








Level 3



EnglishPortuguese



et al 201335


dinal (cohort

ten years)




l 3

Mendes et al 201536


Cross-sectional


BMI Age Percentile



Level 4



Cross-sectional



24-hour reminder



Level 4



Cross-sectional





Level 4






















200742-3




lt00523 OR 28 [CI95 18-435] plt

0000125 OR 1428 [CI 95 1031-1979] plt

0001 OR 1675 [CI951178-2382] plt


00528 PR 158 [CI 95 126-198]30 r= 036

plt 000134 OR varied 248-863 e 227-403


225 [CI95 25-2032]36 OR 155 [CI 95

18-132]37 OR 233 [CI95 180ndash301]38)




EnglishPortuguese




















































































four to five times







































EnglishPortuguese




(p lt005)

























the sexes [OR 1428 (95 CI 1031-1979) p












































rural areas















overweight




































EnglishPortuguese












084 rdad= 081 rchild = 098)
























ten years [OR 405 (95 CI 245-668) p


[OR 155 (95 CI 101-2 36) p lt005] When





class (r = 031 p lt005)



























































013- 028) and 021 (95 CI 018-024) for



















DISCUSSION


EnglishPortuguese








mentioned public












































































habits of life48




























inferences34











EnglishPortuguese




population50





















magnitude











this subject








Available from


dhooden





httpsdoiorg10392800904481-20140825-

08





fs311en




1999-2010 JAMA 2012 Feb 307(5) 483-90








from


vrosliv50063pdf





Available from







June 11(6) e0158025 Doi


5






27(1)e5270016 Doi


070720180005270016






10152532175-67832014000600011








015-1548-1






101016jjcjd201308266

CONCLUSION

REFERENCES

AKNOWLEDGEMENTS


EnglishPortuguese









07072014001740013






869220172306150424






133(2)125-30 Doi httpdoi 1015901516-

318020148960412







8123201823815902016




11S Doi





30(1)45-56 Doi


98652017000100005






10(1)75-82 Doi


18702017v10n1p75-82








8123201521100262015





45082010rw1134
















2007 June 15(6) 1544-53 Doi









2007 Sept [cited 2017 Dec 05] 143 (6)463-9

Available from







Spring) 2007 Jan 15(1)126-36 Doi






Med 2008 Jan 15(2)281-5 PMID19061264










21404879






2011 Feb 65(2)177-89 Doi






EnglishPortuguese






PMID 23090311





Diet 2013 Nov113(11) 1476-83 Doi




















http101186s12966-015-0224-2






Doi 101089chi20120098






25(1) 30-6 Doi


318220150007







httpdoi 103305nh20153269542






Doi 101007s40618-016-0501-1









sr11_246pdf





320(7244)1240-3 PMID 10797032





335(7612)194-7 Doi

101136bmj3923839944455






Available from


echnical_reporten





Sept 85(9)660-7 PMID 18026621







Aug 384(9945)766-81 Doi


6736(14)60460-8








81973361








0462201836100010






EnglishPortuguese






infantojuvenilpdf







07072015002660014





2015 June 33(3)302-9 Doi


01







2017 Jan 8(1)114-39 Doi







EnglishPortuguese




























































Quality (AHRQ)22








EnglishPortuguese















Study (Author year)

Study population

Drawing

Location




Scientific Evidence



Longitudinal





Level 3



Cross-sectional

Mexico




Level 4

RESULTS



Excluded studies

(n=435)


464)



IDEN

TIF

ICA

TIO

N

ELIG

IBIL

ITY

SELEC

TIO

N

INC

LU

SIO

N


synthesis (n= 16)




EnglishPortuguese







Zeller et al 200725


Cross-sectional

USA




Level 4

Mazur et al 200826


Cross-sectional

Poland




Level 4

Beydoun e

Wang 200927


Cross-sectional

USA




Level 4



Cross-sectional

USA





Level 4


EnglishPortuguese



001)

Wang et al 201129


Systematic review

USA




Level 1



Cross-sectional





Level 4

Laster et al 201331


Cross-sectional





Level 4

Park et al 201532


Cross-sectional

USA




Level 4



Cross-sectional






Level 4








Level 3



EnglishPortuguese



et al 201335


dinal (cohort

ten years)




l 3

Mendes et al 201536


Cross-sectional


BMI Age Percentile



Level 4



Cross-sectional



24-hour reminder



Level 4



Cross-sectional





Level 4






















200742-3




lt00523 OR 28 [CI95 18-435] plt

0000125 OR 1428 [CI 95 1031-1979] plt

0001 OR 1675 [CI951178-2382] plt


00528 PR 158 [CI 95 126-198]30 r= 036

plt 000134 OR varied 248-863 e 227-403


225 [CI95 25-2032]36 OR 155 [CI 95

18-132]37 OR 233 [CI95 180ndash301]38)




EnglishPortuguese




















































































four to five times







































EnglishPortuguese




(p lt005)

























the sexes [OR 1428 (95 CI 1031-1979) p












































rural areas















overweight




































EnglishPortuguese












084 rdad= 081 rchild = 098)
























ten years [OR 405 (95 CI 245-668) p


[OR 155 (95 CI 101-2 36) p lt005] When





class (r = 031 p lt005)



























































013- 028) and 021 (95 CI 018-024) for



















DISCUSSION


EnglishPortuguese








mentioned public












































































habits of life48




























inferences34











EnglishPortuguese




population50





















magnitude











this subject








Available from


dhooden





httpsdoiorg10392800904481-20140825-

08





fs311en




1999-2010 JAMA 2012 Feb 307(5) 483-90








from


vrosliv50063pdf





Available from







June 11(6) e0158025 Doi


5






27(1)e5270016 Doi


070720180005270016






10152532175-67832014000600011








015-1548-1






101016jjcjd201308266

CONCLUSION

REFERENCES

AKNOWLEDGEMENTS


EnglishPortuguese









07072014001740013






869220172306150424






133(2)125-30 Doi httpdoi 1015901516-

318020148960412







8123201823815902016




11S Doi





30(1)45-56 Doi


98652017000100005






10(1)75-82 Doi


18702017v10n1p75-82








8123201521100262015





45082010rw1134
















2007 June 15(6) 1544-53 Doi









2007 Sept [cited 2017 Dec 05] 143 (6)463-9

Available from







Spring) 2007 Jan 15(1)126-36 Doi






Med 2008 Jan 15(2)281-5 PMID19061264










21404879






2011 Feb 65(2)177-89 Doi






EnglishPortuguese






PMID 23090311





Diet 2013 Nov113(11) 1476-83 Doi




















http101186s12966-015-0224-2






Doi 101089chi20120098






25(1) 30-6 Doi


318220150007







httpdoi 103305nh20153269542






Doi 101007s40618-016-0501-1









sr11_246pdf





320(7244)1240-3 PMID 10797032





335(7612)194-7 Doi

101136bmj3923839944455






Available from


echnical_reporten





Sept 85(9)660-7 PMID 18026621







Aug 384(9945)766-81 Doi


6736(14)60460-8








81973361








0462201836100010






EnglishPortuguese






infantojuvenilpdf







07072015002660014





2015 June 33(3)302-9 Doi


01







2017 Jan 8(1)114-39 Doi







EnglishPortuguese















Study (Author year)

Study population

Drawing

Location




Scientific Evidence



Longitudinal





Level 3



Cross-sectional

Mexico




Level 4

RESULTS



Excluded studies

(n=435)


464)



IDEN

TIF

ICA

TIO

N

ELIG

IBIL

ITY

SELEC

TIO

N

INC

LU

SIO

N


synthesis (n= 16)




EnglishPortuguese







Zeller et al 200725


Cross-sectional

USA




Level 4

Mazur et al 200826


Cross-sectional

Poland




Level 4

Beydoun e

Wang 200927


Cross-sectional

USA




Level 4



Cross-sectional

USA





Level 4


EnglishPortuguese



001)

Wang et al 201129


Systematic review

USA




Level 1



Cross-sectional





Level 4

Laster et al 201331


Cross-sectional





Level 4

Park et al 201532


Cross-sectional

USA




Level 4



Cross-sectional






Level 4








Level 3



EnglishPortuguese



et al 201335


dinal (cohort

ten years)




l 3

Mendes et al 201536


Cross-sectional


BMI Age Percentile



Level 4



Cross-sectional



24-hour reminder



Level 4



Cross-sectional





Level 4






















200742-3




lt00523 OR 28 [CI95 18-435] plt

0000125 OR 1428 [CI 95 1031-1979] plt

0001 OR 1675 [CI951178-2382] plt


00528 PR 158 [CI 95 126-198]30 r= 036

plt 000134 OR varied 248-863 e 227-403


225 [CI95 25-2032]36 OR 155 [CI 95

18-132]37 OR 233 [CI95 180ndash301]38)




EnglishPortuguese




















































































four to five times







































EnglishPortuguese




(p lt005)

























the sexes [OR 1428 (95 CI 1031-1979) p












































rural areas















overweight




































EnglishPortuguese












084 rdad= 081 rchild = 098)
























ten years [OR 405 (95 CI 245-668) p


[OR 155 (95 CI 101-2 36) p lt005] When





class (r = 031 p lt005)



























































013- 028) and 021 (95 CI 018-024) for



















DISCUSSION


EnglishPortuguese








mentioned public












































































habits of life48




























inferences34











EnglishPortuguese




population50





















magnitude











this subject








Available from


dhooden





httpsdoiorg10392800904481-20140825-

08





fs311en




1999-2010 JAMA 2012 Feb 307(5) 483-90








from


vrosliv50063pdf





Available from







June 11(6) e0158025 Doi


5






27(1)e5270016 Doi


070720180005270016






10152532175-67832014000600011








015-1548-1






101016jjcjd201308266

CONCLUSION

REFERENCES

AKNOWLEDGEMENTS


EnglishPortuguese









07072014001740013






869220172306150424






133(2)125-30 Doi httpdoi 1015901516-

318020148960412







8123201823815902016




11S Doi





30(1)45-56 Doi


98652017000100005






10(1)75-82 Doi


18702017v10n1p75-82








8123201521100262015





45082010rw1134
















2007 June 15(6) 1544-53 Doi









2007 Sept [cited 2017 Dec 05] 143 (6)463-9

Available from







Spring) 2007 Jan 15(1)126-36 Doi






Med 2008 Jan 15(2)281-5 PMID19061264










21404879






2011 Feb 65(2)177-89 Doi






EnglishPortuguese






PMID 23090311





Diet 2013 Nov113(11) 1476-83 Doi




















http101186s12966-015-0224-2






Doi 101089chi20120098






25(1) 30-6 Doi


318220150007







httpdoi 103305nh20153269542






Doi 101007s40618-016-0501-1









sr11_246pdf





320(7244)1240-3 PMID 10797032





335(7612)194-7 Doi

101136bmj3923839944455






Available from


echnical_reporten





Sept 85(9)660-7 PMID 18026621







Aug 384(9945)766-81 Doi


6736(14)60460-8








81973361








0462201836100010






EnglishPortuguese






infantojuvenilpdf







07072015002660014





2015 June 33(3)302-9 Doi


01







2017 Jan 8(1)114-39 Doi







EnglishPortuguese







Zeller et al 200725


Cross-sectional

USA




Level 4

Mazur et al 200826


Cross-sectional

Poland




Level 4

Beydoun e

Wang 200927


Cross-sectional

USA




Level 4



Cross-sectional

USA





Level 4


EnglishPortuguese



001)

Wang et al 201129


Systematic review

USA




Level 1



Cross-sectional





Level 4

Laster et al 201331


Cross-sectional





Level 4

Park et al 201532


Cross-sectional

USA




Level 4



Cross-sectional






Level 4








Level 3



EnglishPortuguese



et al 201335


dinal (cohort

ten years)




l 3

Mendes et al 201536


Cross-sectional


BMI Age Percentile



Level 4



Cross-sectional



24-hour reminder



Level 4



Cross-sectional





Level 4






















200742-3




lt00523 OR 28 [CI95 18-435] plt

0000125 OR 1428 [CI 95 1031-1979] plt

0001 OR 1675 [CI951178-2382] plt


00528 PR 158 [CI 95 126-198]30 r= 036

plt 000134 OR varied 248-863 e 227-403


225 [CI95 25-2032]36 OR 155 [CI 95

18-132]37 OR 233 [CI95 180ndash301]38)




EnglishPortuguese




















































































four to five times







































EnglishPortuguese




(p lt005)

























the sexes [OR 1428 (95 CI 1031-1979) p












































rural areas















overweight




































EnglishPortuguese












084 rdad= 081 rchild = 098)
























ten years [OR 405 (95 CI 245-668) p


[OR 155 (95 CI 101-2 36) p lt005] When





class (r = 031 p lt005)



























































013- 028) and 021 (95 CI 018-024) for



















DISCUSSION


EnglishPortuguese








mentioned public












































































habits of life48




























inferences34











EnglishPortuguese




population50





















magnitude











this subject








Available from


dhooden





httpsdoiorg10392800904481-20140825-

08





fs311en




1999-2010 JAMA 2012 Feb 307(5) 483-90








from


vrosliv50063pdf





Available from







June 11(6) e0158025 Doi


5






27(1)e5270016 Doi


070720180005270016






10152532175-67832014000600011








015-1548-1






101016jjcjd201308266

CONCLUSION

REFERENCES

AKNOWLEDGEMENTS


EnglishPortuguese









07072014001740013






869220172306150424






133(2)125-30 Doi httpdoi 1015901516-

318020148960412







8123201823815902016




11S Doi





30(1)45-56 Doi


98652017000100005






10(1)75-82 Doi


18702017v10n1p75-82








8123201521100262015





45082010rw1134
















2007 June 15(6) 1544-53 Doi









2007 Sept [cited 2017 Dec 05] 143 (6)463-9

Available from







Spring) 2007 Jan 15(1)126-36 Doi






Med 2008 Jan 15(2)281-5 PMID19061264










21404879






2011 Feb 65(2)177-89 Doi






EnglishPortuguese






PMID 23090311





Diet 2013 Nov113(11) 1476-83 Doi




















http101186s12966-015-0224-2






Doi 101089chi20120098






25(1) 30-6 Doi


318220150007







httpdoi 103305nh20153269542






Doi 101007s40618-016-0501-1









sr11_246pdf





320(7244)1240-3 PMID 10797032





335(7612)194-7 Doi

101136bmj3923839944455






Available from


echnical_reporten





Sept 85(9)660-7 PMID 18026621







Aug 384(9945)766-81 Doi


6736(14)60460-8








81973361








0462201836100010






EnglishPortuguese






infantojuvenilpdf







07072015002660014





2015 June 33(3)302-9 Doi


01







2017 Jan 8(1)114-39 Doi







EnglishPortuguese



001)

Wang et al 201129


Systematic review

USA




Level 1



Cross-sectional





Level 4

Laster et al 201331


Cross-sectional





Level 4

Park et al 201532


Cross-sectional

USA




Level 4



Cross-sectional






Level 4








Level 3



EnglishPortuguese



et al 201335


dinal (cohort

ten years)




l 3

Mendes et al 201536


Cross-sectional


BMI Age Percentile



Level 4



Cross-sectional



24-hour reminder



Level 4



Cross-sectional





Level 4






















200742-3




lt00523 OR 28 [CI95 18-435] plt

0000125 OR 1428 [CI 95 1031-1979] plt

0001 OR 1675 [CI951178-2382] plt


00528 PR 158 [CI 95 126-198]30 r= 036

plt 000134 OR varied 248-863 e 227-403


225 [CI95 25-2032]36 OR 155 [CI 95

18-132]37 OR 233 [CI95 180ndash301]38)




EnglishPortuguese




















































































four to five times







































EnglishPortuguese




(p lt005)

























the sexes [OR 1428 (95 CI 1031-1979) p












































rural areas















overweight




































EnglishPortuguese












084 rdad= 081 rchild = 098)
























ten years [OR 405 (95 CI 245-668) p


[OR 155 (95 CI 101-2 36) p lt005] When





class (r = 031 p lt005)



























































013- 028) and 021 (95 CI 018-024) for



















DISCUSSION


EnglishPortuguese








mentioned public












































































habits of life48




























inferences34











EnglishPortuguese




population50





















magnitude











this subject








Available from


dhooden





httpsdoiorg10392800904481-20140825-

08





fs311en




1999-2010 JAMA 2012 Feb 307(5) 483-90








from


vrosliv50063pdf





Available from







June 11(6) e0158025 Doi


5






27(1)e5270016 Doi


070720180005270016






10152532175-67832014000600011








015-1548-1






101016jjcjd201308266

CONCLUSION

REFERENCES

AKNOWLEDGEMENTS


EnglishPortuguese









07072014001740013






869220172306150424






133(2)125-30 Doi httpdoi 1015901516-

318020148960412







8123201823815902016




11S Doi





30(1)45-56 Doi


98652017000100005






10(1)75-82 Doi


18702017v10n1p75-82








8123201521100262015





45082010rw1134
















2007 June 15(6) 1544-53 Doi









2007 Sept [cited 2017 Dec 05] 143 (6)463-9

Available from







Spring) 2007 Jan 15(1)126-36 Doi






Med 2008 Jan 15(2)281-5 PMID19061264










21404879






2011 Feb 65(2)177-89 Doi






EnglishPortuguese






PMID 23090311





Diet 2013 Nov113(11) 1476-83 Doi




















http101186s12966-015-0224-2






Doi 101089chi20120098






25(1) 30-6 Doi


318220150007







httpdoi 103305nh20153269542






Doi 101007s40618-016-0501-1









sr11_246pdf





320(7244)1240-3 PMID 10797032





335(7612)194-7 Doi

101136bmj3923839944455






Available from


echnical_reporten





Sept 85(9)660-7 PMID 18026621







Aug 384(9945)766-81 Doi


6736(14)60460-8








81973361








0462201836100010






EnglishPortuguese






infantojuvenilpdf







07072015002660014





2015 June 33(3)302-9 Doi


01







2017 Jan 8(1)114-39 Doi







EnglishPortuguese



et al 201335


dinal (cohort

ten years)




l 3

Mendes et al 201536


Cross-sectional


BMI Age Percentile



Level 4



Cross-sectional



24-hour reminder



Level 4



Cross-sectional





Level 4






















200742-3




lt00523 OR 28 [CI95 18-435] plt

0000125 OR 1428 [CI 95 1031-1979] plt

0001 OR 1675 [CI951178-2382] plt


00528 PR 158 [CI 95 126-198]30 r= 036

plt 000134 OR varied 248-863 e 227-403


225 [CI95 25-2032]36 OR 155 [CI 95

18-132]37 OR 233 [CI95 180ndash301]38)




EnglishPortuguese




















































































four to five times







































EnglishPortuguese




(p lt005)

























the sexes [OR 1428 (95 CI 1031-1979) p












































rural areas















overweight




































EnglishPortuguese












084 rdad= 081 rchild = 098)
























ten years [OR 405 (95 CI 245-668) p


[OR 155 (95 CI 101-2 36) p lt005] When





class (r = 031 p lt005)



























































013- 028) and 021 (95 CI 018-024) for



















DISCUSSION


EnglishPortuguese








mentioned public












































































habits of life48




























inferences34











EnglishPortuguese




population50





















magnitude











this subject








Available from


dhooden





httpsdoiorg10392800904481-20140825-

08





fs311en




1999-2010 JAMA 2012 Feb 307(5) 483-90








from


vrosliv50063pdf





Available from







June 11(6) e0158025 Doi


5






27(1)e5270016 Doi


070720180005270016






10152532175-67832014000600011








015-1548-1






101016jjcjd201308266

CONCLUSION

REFERENCES

AKNOWLEDGEMENTS


EnglishPortuguese









07072014001740013






869220172306150424






133(2)125-30 Doi httpdoi 1015901516-

318020148960412







8123201823815902016




11S Doi





30(1)45-56 Doi


98652017000100005






10(1)75-82 Doi


18702017v10n1p75-82








8123201521100262015





45082010rw1134
















2007 June 15(6) 1544-53 Doi









2007 Sept [cited 2017 Dec 05] 143 (6)463-9

Available from







Spring) 2007 Jan 15(1)126-36 Doi






Med 2008 Jan 15(2)281-5 PMID19061264










21404879






2011 Feb 65(2)177-89 Doi






EnglishPortuguese






PMID 23090311





Diet 2013 Nov113(11) 1476-83 Doi




















http101186s12966-015-0224-2






Doi 101089chi20120098






25(1) 30-6 Doi


318220150007







httpdoi 103305nh20153269542






Doi 101007s40618-016-0501-1









sr11_246pdf





320(7244)1240-3 PMID 10797032





335(7612)194-7 Doi

101136bmj3923839944455






Available from


echnical_reporten





Sept 85(9)660-7 PMID 18026621







Aug 384(9945)766-81 Doi


6736(14)60460-8








81973361








0462201836100010






EnglishPortuguese






infantojuvenilpdf







07072015002660014





2015 June 33(3)302-9 Doi


01







2017 Jan 8(1)114-39 Doi







EnglishPortuguese




















































































four to five times







































EnglishPortuguese




(p lt005)

























the sexes [OR 1428 (95 CI 1031-1979) p












































rural areas















overweight




































EnglishPortuguese












084 rdad= 081 rchild = 098)
























ten years [OR 405 (95 CI 245-668) p


[OR 155 (95 CI 101-2 36) p lt005] When





class (r = 031 p lt005)



























































013- 028) and 021 (95 CI 018-024) for



















DISCUSSION


EnglishPortuguese








mentioned public












































































habits of life48




























inferences34











EnglishPortuguese




population50





















magnitude











this subject








Available from


dhooden





httpsdoiorg10392800904481-20140825-

08





fs311en




1999-2010 JAMA 2012 Feb 307(5) 483-90








from


vrosliv50063pdf





Available from







June 11(6) e0158025 Doi


5






27(1)e5270016 Doi


070720180005270016






10152532175-67832014000600011








015-1548-1






101016jjcjd201308266

CONCLUSION

REFERENCES

AKNOWLEDGEMENTS


EnglishPortuguese









07072014001740013






869220172306150424






133(2)125-30 Doi httpdoi 1015901516-

318020148960412







8123201823815902016




11S Doi





30(1)45-56 Doi


98652017000100005






10(1)75-82 Doi


18702017v10n1p75-82








8123201521100262015





45082010rw1134
















2007 June 15(6) 1544-53 Doi









2007 Sept [cited 2017 Dec 05] 143 (6)463-9

Available from







Spring) 2007 Jan 15(1)126-36 Doi






Med 2008 Jan 15(2)281-5 PMID19061264










21404879






2011 Feb 65(2)177-89 Doi






EnglishPortuguese






PMID 23090311





Diet 2013 Nov113(11) 1476-83 Doi




















http101186s12966-015-0224-2






Doi 101089chi20120098






25(1) 30-6 Doi


318220150007







httpdoi 103305nh20153269542






Doi 101007s40618-016-0501-1









sr11_246pdf





320(7244)1240-3 PMID 10797032





335(7612)194-7 Doi

101136bmj3923839944455






Available from


echnical_reporten





Sept 85(9)660-7 PMID 18026621







Aug 384(9945)766-81 Doi


6736(14)60460-8








81973361








0462201836100010






EnglishPortuguese






infantojuvenilpdf







07072015002660014





2015 June 33(3)302-9 Doi


01







2017 Jan 8(1)114-39 Doi







EnglishPortuguese




(p lt005)

























the sexes [OR 1428 (95 CI 1031-1979) p












































rural areas















overweight




































EnglishPortuguese












084 rdad= 081 rchild = 098)
























ten years [OR 405 (95 CI 245-668) p


[OR 155 (95 CI 101-2 36) p lt005] When





class (r = 031 p lt005)



























































013- 028) and 021 (95 CI 018-024) for



















DISCUSSION


EnglishPortuguese








mentioned public












































































habits of life48




























inferences34











EnglishPortuguese




population50





















magnitude











this subject








Available from


dhooden





httpsdoiorg10392800904481-20140825-

08





fs311en




1999-2010 JAMA 2012 Feb 307(5) 483-90








from


vrosliv50063pdf





Available from







June 11(6) e0158025 Doi


5






27(1)e5270016 Doi


070720180005270016






10152532175-67832014000600011








015-1548-1






101016jjcjd201308266

CONCLUSION

REFERENCES

AKNOWLEDGEMENTS


EnglishPortuguese









07072014001740013






869220172306150424






133(2)125-30 Doi httpdoi 1015901516-

318020148960412







8123201823815902016




11S Doi





30(1)45-56 Doi


98652017000100005






10(1)75-82 Doi


18702017v10n1p75-82








8123201521100262015





45082010rw1134
















2007 June 15(6) 1544-53 Doi









2007 Sept [cited 2017 Dec 05] 143 (6)463-9

Available from







Spring) 2007 Jan 15(1)126-36 Doi






Med 2008 Jan 15(2)281-5 PMID19061264










21404879






2011 Feb 65(2)177-89 Doi






EnglishPortuguese






PMID 23090311





Diet 2013 Nov113(11) 1476-83 Doi




















http101186s12966-015-0224-2






Doi 101089chi20120098






25(1) 30-6 Doi


318220150007







httpdoi 103305nh20153269542






Doi 101007s40618-016-0501-1









sr11_246pdf





320(7244)1240-3 PMID 10797032





335(7612)194-7 Doi

101136bmj3923839944455






Available from


echnical_reporten





Sept 85(9)660-7 PMID 18026621







Aug 384(9945)766-81 Doi


6736(14)60460-8








81973361








0462201836100010






EnglishPortuguese






infantojuvenilpdf







07072015002660014





2015 June 33(3)302-9 Doi


01







2017 Jan 8(1)114-39 Doi







EnglishPortuguese












084 rdad= 081 rchild = 098)
























ten years [OR 405 (95 CI 245-668) p


[OR 155 (95 CI 101-2 36) p lt005] When





class (r = 031 p lt005)



























































013- 028) and 021 (95 CI 018-024) for



















DISCUSSION


EnglishPortuguese








mentioned public












































































habits of life48




























inferences34











EnglishPortuguese




population50





















magnitude











this subject








Available from


dhooden





httpsdoiorg10392800904481-20140825-

08





fs311en




1999-2010 JAMA 2012 Feb 307(5) 483-90








from


vrosliv50063pdf





Available from







June 11(6) e0158025 Doi


5






27(1)e5270016 Doi


070720180005270016






10152532175-67832014000600011








015-1548-1






101016jjcjd201308266

CONCLUSION

REFERENCES

AKNOWLEDGEMENTS


EnglishPortuguese









07072014001740013






869220172306150424






133(2)125-30 Doi httpdoi 1015901516-

318020148960412







8123201823815902016




11S Doi





30(1)45-56 Doi


98652017000100005






10(1)75-82 Doi


18702017v10n1p75-82








8123201521100262015





45082010rw1134
















2007 June 15(6) 1544-53 Doi









2007 Sept [cited 2017 Dec 05] 143 (6)463-9

Available from







Spring) 2007 Jan 15(1)126-36 Doi






Med 2008 Jan 15(2)281-5 PMID19061264










21404879






2011 Feb 65(2)177-89 Doi






EnglishPortuguese






PMID 23090311





Diet 2013 Nov113(11) 1476-83 Doi




















http101186s12966-015-0224-2






Doi 101089chi20120098






25(1) 30-6 Doi


318220150007







httpdoi 103305nh20153269542






Doi 101007s40618-016-0501-1









sr11_246pdf





320(7244)1240-3 PMID 10797032





335(7612)194-7 Doi

101136bmj3923839944455






Available from


echnical_reporten





Sept 85(9)660-7 PMID 18026621







Aug 384(9945)766-81 Doi


6736(14)60460-8








81973361








0462201836100010






EnglishPortuguese






infantojuvenilpdf







07072015002660014





2015 June 33(3)302-9 Doi


01







2017 Jan 8(1)114-39 Doi







EnglishPortuguese








mentioned public












































































habits of life48




























inferences34











EnglishPortuguese




population50





















magnitude











this subject








Available from


dhooden





httpsdoiorg10392800904481-20140825-

08





fs311en




1999-2010 JAMA 2012 Feb 307(5) 483-90








from


vrosliv50063pdf





Available from







June 11(6) e0158025 Doi


5






27(1)e5270016 Doi


070720180005270016






10152532175-67832014000600011








015-1548-1






101016jjcjd201308266

CONCLUSION

REFERENCES

AKNOWLEDGEMENTS


EnglishPortuguese









07072014001740013






869220172306150424






133(2)125-30 Doi httpdoi 1015901516-

318020148960412







8123201823815902016




11S Doi





30(1)45-56 Doi


98652017000100005






10(1)75-82 Doi


18702017v10n1p75-82








8123201521100262015





45082010rw1134
















2007 June 15(6) 1544-53 Doi









2007 Sept [cited 2017 Dec 05] 143 (6)463-9

Available from







Spring) 2007 Jan 15(1)126-36 Doi






Med 2008 Jan 15(2)281-5 PMID19061264










21404879






2011 Feb 65(2)177-89 Doi






EnglishPortuguese






PMID 23090311





Diet 2013 Nov113(11) 1476-83 Doi




















http101186s12966-015-0224-2






Doi 101089chi20120098






25(1) 30-6 Doi


318220150007







httpdoi 103305nh20153269542






Doi 101007s40618-016-0501-1









sr11_246pdf





320(7244)1240-3 PMID 10797032





335(7612)194-7 Doi

101136bmj3923839944455






Available from


echnical_reporten





Sept 85(9)660-7 PMID 18026621







Aug 384(9945)766-81 Doi


6736(14)60460-8








81973361








0462201836100010






EnglishPortuguese






infantojuvenilpdf







07072015002660014





2015 June 33(3)302-9 Doi


01







2017 Jan 8(1)114-39 Doi







EnglishPortuguese




population50





















magnitude











this subject








Available from


dhooden





httpsdoiorg10392800904481-20140825-

08





fs311en




1999-2010 JAMA 2012 Feb 307(5) 483-90








from


vrosliv50063pdf





Available from







June 11(6) e0158025 Doi


5






27(1)e5270016 Doi


070720180005270016






10152532175-67832014000600011








015-1548-1






101016jjcjd201308266

CONCLUSION

REFERENCES

AKNOWLEDGEMENTS


EnglishPortuguese









07072014001740013






869220172306150424






133(2)125-30 Doi httpdoi 1015901516-

318020148960412







8123201823815902016




11S Doi





30(1)45-56 Doi


98652017000100005






10(1)75-82 Doi


18702017v10n1p75-82








8123201521100262015





45082010rw1134
















2007 June 15(6) 1544-53 Doi









2007 Sept [cited 2017 Dec 05] 143 (6)463-9

Available from







Spring) 2007 Jan 15(1)126-36 Doi






Med 2008 Jan 15(2)281-5 PMID19061264










21404879






2011 Feb 65(2)177-89 Doi






EnglishPortuguese






PMID 23090311





Diet 2013 Nov113(11) 1476-83 Doi




















http101186s12966-015-0224-2






Doi 101089chi20120098






25(1) 30-6 Doi


318220150007







httpdoi 103305nh20153269542






Doi 101007s40618-016-0501-1









sr11_246pdf





320(7244)1240-3 PMID 10797032





335(7612)194-7 Doi

101136bmj3923839944455






Available from


echnical_reporten





Sept 85(9)660-7 PMID 18026621







Aug 384(9945)766-81 Doi


6736(14)60460-8








81973361








0462201836100010






EnglishPortuguese






infantojuvenilpdf







07072015002660014





2015 June 33(3)302-9 Doi


01







2017 Jan 8(1)114-39 Doi







EnglishPortuguese









07072014001740013






869220172306150424






133(2)125-30 Doi httpdoi 1015901516-

318020148960412







8123201823815902016




11S Doi





30(1)45-56 Doi


98652017000100005






10(1)75-82 Doi


18702017v10n1p75-82








8123201521100262015





45082010rw1134
















2007 June 15(6) 1544-53 Doi









2007 Sept [cited 2017 Dec 05] 143 (6)463-9

Available from







Spring) 2007 Jan 15(1)126-36 Doi






Med 2008 Jan 15(2)281-5 PMID19061264










21404879






2011 Feb 65(2)177-89 Doi






EnglishPortuguese






PMID 23090311





Diet 2013 Nov113(11) 1476-83 Doi




















http101186s12966-015-0224-2






Doi 101089chi20120098






25(1) 30-6 Doi


318220150007







httpdoi 103305nh20153269542






Doi 101007s40618-016-0501-1









sr11_246pdf





320(7244)1240-3 PMID 10797032





335(7612)194-7 Doi

101136bmj3923839944455






Available from


echnical_reporten





Sept 85(9)660-7 PMID 18026621







Aug 384(9945)766-81 Doi


6736(14)60460-8








81973361








0462201836100010






EnglishPortuguese






infantojuvenilpdf







07072015002660014





2015 June 33(3)302-9 Doi


01







2017 Jan 8(1)114-39 Doi







EnglishPortuguese






PMID 23090311





Diet 2013 Nov113(11) 1476-83 Doi




















http101186s12966-015-0224-2






Doi 101089chi20120098






25(1) 30-6 Doi


318220150007







httpdoi 103305nh20153269542






Doi 101007s40618-016-0501-1









sr11_246pdf





320(7244)1240-3 PMID 10797032





335(7612)194-7 Doi

101136bmj3923839944455






Available from


echnical_reporten





Sept 85(9)660-7 PMID 18026621







Aug 384(9945)766-81 Doi


6736(14)60460-8








81973361








0462201836100010






EnglishPortuguese






infantojuvenilpdf







07072015002660014





2015 June 33(3)302-9 Doi


01







2017 Jan 8(1)114-39 Doi







EnglishPortuguese






infantojuvenilpdf







07072015002660014





2015 June 33(3)302-9 Doi


01







2017 Jan 8(1)114-39 Doi






integrative review article obesity in the rural area

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