Abstract

The article seeks to investigate the association between overweight in adolescents and the nutritional state of the parents and identify possible determinants. The search was carried out in the Pubmed, Lilacs, Scielo databases and Virtual Health Library (BVS), were searched regarding the period from 2004 to 2014. The descriptors were: “Adolescent”, “Risk factors”, “Obesity”, “Parents” and “Overweight”. Of the 366 articles, only 07 met al.l the eligibility criteria. Higher prevalence of overweight in adolescents was noted in studies conducted in Brazil and Greece, while the prevalence of obesity was higher in studies conducted in United States. Higher overweight prevalence in male adolescents was verified. All studies showed that the presence of overweight or obesity in the father or the mother increases the risk of adolescents developing overweight, and this risk is even greater when both parents are obese. The strong association between overweight in adolescents and nutritional status of the parents found in the selected studies is related to many factors, thus the presence of a risk factor, such as genetic predisposition, can be ameliorated by a protective factor, such as healthy eating habits.

Adolescent; Risk factors; Obesity; Parents and Overweight

Introduction

Adolescence represents a period of the life cycle that is marked by intense biological and psychosocial changes. Obesity among adolescents is a major public health problem that has been on the rise in recent years¹1. Tassitano R, Tenório M, Hallal P. Systematic review on obesity in Brazilian adolescents. Brazilian Journal of Kinanthropometry and Human Performance 2009; 11(4):449-456..

Behavioral changes that have occurred in recent decades, including reduced levels of physical activity and increases in the consumption of high calorie foods, have driven an epidemiological transition, characterized by a drop in the prevalence of infectious diseases and an increase in the prevalence of chronic non-communicable diseases, among them obesity, which is currently at pandemic levels²2. Popkin BM. Nutritional patterns and transitions. Population and Development. Nutr Rev 1993; 19(1):138-157..

A global study using systematic analysis showed the prevalence of overweight in children and adolescents in developing countries to be 12.9% in boys and 13.4% in girls³3. Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, Mullany EC, Biryukov S, Abbafati C, Abera SF, Abraham JP, Abu-Rmeileh NM, Achoki T, AlBuhairan FS, Alemu ZA, Alfonso R, Ali MK, Ali R, Guzman NA, Ammar W, Anwari P, Banerjee A, Barquera S, Basu S, Bennett DA, Bhutta Z, Blore J, Cabral N, Nonato IC, Chang JC, Chowdhury R, Courville KJ, Criqui MH, Cundiff DK, Dabhadkar KC, Dandona L, Davis A, Dayama A, Dharmaratne SD, Ding EL, Durrani AM, Esteghamati A, Farzadfar F, Fay DF, Feigin VL, Flaxman A, Forouzanfar MH, Goto A, Green MA, Gupta R, Hafezi-Nejad N, Hankey GJ, Harewood HC, Havmoeller R, Hay S, Hernandez L, Husseini A, Idrisov BT, Ikeda N, Islami F, Jahangir E, Jassal SK, Jee SH, Jeffreys M, Jonas JB, Kabagambe EK, Khalifa SE, Kengne AP, Khader YS, Khang YH, Kim D, Kimokoti RW, Kinge JM, Kokubo Y, Kosen S, Kwan G, Lai T, Leinsalu M, Li Y, Liang X, Liu S, Logroscino G, Lotufo PA, Lu Y, Ma J, Mainoo NK, Mensah GA, Merriman TR, Mokdad AH, Moschandreas J, Naghavi M, Naheed A, Nand D, Narayan KM, Nelson EL, Neuhouser ML, Nisar MI, Ohkubo T, Oti SO, Pedroza A, Prabhakaran D, Roy N, Sampson U, Seo H, Sepanlou SG, Shibuya K, Shiri R, Shiue I, Singh GM, Singh JA, Skirbekk V, Stapelberg NJ, Sturua L, Sykes BL, Tobias M, Tran BX, Trasande L, Toyoshima H, van de Vijver S, Vasankari TJ, Veerman JL, Velasquez-Melendez G, Vlassov VV, Vollset SE, Vos T, Wang C, Wang X, Weiderpass E, Werdecker A, Wright JL, Yang YC, Yatsuya H, Yoon J, Yoon SJ, Zhao Y, Zhou M, Zhu S, Lopez AD, Murray CJ, Gakidou E. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384(9945):766-781.. While in developed countries, the figures are even higher with 23.8% of boys and 22.6% of girls with overweight or obesity³3. Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, Mullany EC, Biryukov S, Abbafati C, Abera SF, Abraham JP, Abu-Rmeileh NM, Achoki T, AlBuhairan FS, Alemu ZA, Alfonso R, Ali MK, Ali R, Guzman NA, Ammar W, Anwari P, Banerjee A, Barquera S, Basu S, Bennett DA, Bhutta Z, Blore J, Cabral N, Nonato IC, Chang JC, Chowdhury R, Courville KJ, Criqui MH, Cundiff DK, Dabhadkar KC, Dandona L, Davis A, Dayama A, Dharmaratne SD, Ding EL, Durrani AM, Esteghamati A, Farzadfar F, Fay DF, Feigin VL, Flaxman A, Forouzanfar MH, Goto A, Green MA, Gupta R, Hafezi-Nejad N, Hankey GJ, Harewood HC, Havmoeller R, Hay S, Hernandez L, Husseini A, Idrisov BT, Ikeda N, Islami F, Jahangir E, Jassal SK, Jee SH, Jeffreys M, Jonas JB, Kabagambe EK, Khalifa SE, Kengne AP, Khader YS, Khang YH, Kim D, Kimokoti RW, Kinge JM, Kokubo Y, Kosen S, Kwan G, Lai T, Leinsalu M, Li Y, Liang X, Liu S, Logroscino G, Lotufo PA, Lu Y, Ma J, Mainoo NK, Mensah GA, Merriman TR, Mokdad AH, Moschandreas J, Naghavi M, Naheed A, Nand D, Narayan KM, Nelson EL, Neuhouser ML, Nisar MI, Ohkubo T, Oti SO, Pedroza A, Prabhakaran D, Roy N, Sampson U, Seo H, Sepanlou SG, Shibuya K, Shiri R, Shiue I, Singh GM, Singh JA, Skirbekk V, Stapelberg NJ, Sturua L, Sykes BL, Tobias M, Tran BX, Trasande L, Toyoshima H, van de Vijver S, Vasankari TJ, Veerman JL, Velasquez-Melendez G, Vlassov VV, Vollset SE, Vos T, Wang C, Wang X, Weiderpass E, Werdecker A, Wright JL, Yang YC, Yatsuya H, Yoon J, Yoon SJ, Zhao Y, Zhou M, Zhu S, Lopez AD, Murray CJ, Gakidou E. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384(9945):766-781.. In Brazil, data from the Study of Household Budgets (POF – Pesquisa de Orçamentos Familiares) from 2008-2009 showed the prevalence of overweight in adolescents to be 21.7% for males and 19.4% for females, numbers that are worrying given the serious problems that are associated with excess adiposity⁴4. Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa de orçamentos familiares 2008-2009: antropometria e análise do estado nutricional de crianças e adolescentes no Brasil. Rio de Janeiro: IBGE; 2010..

The early development of obesity, in infancy or adolescence, is a strong predictor of the persistence of this infirmity in adult life and a risk factor for the development of other chronic non-communicable diseases such as cardiovascular disease, dyslipidemia, arterial hypertension, type 2 diabetes and some types of neoplasms⁵5. Terres NG, Pinheiro RT, Horta BL, Pinheiro KAT, Horta LL. Prevalência e fatores associados ao sobrepeso e à obesidades em adolescentes. Rev Saude Publica 2006; 40(4):627-633..

There are a number of factors associated with the development of overweight in adolescence, among them: parental factors; inappropriate eating habits; physical inactivity; screen time; relationships with peers; socioeconomic levels; the social context in which the individual is brought up; maternal schooling and parents’ nutritional status⁶6. Vasconcellos MB, Anjos LA, Vasconcellos MTL. Estado nutricional e tempo de tela de escolares da Rede Pública de Ensino Fundamental de Niterói, Rio de Janeiro, Brasil. Cad Saude Publica 2013; 29(4):713-722.^,77. Frutuoso MFP, Bovi TG, Gambardella AMD. Adiposidade em adolescentes e obesidade materna. Rev. Nutr. 2011; 24(1):5-15..

Studies have shown a strong association between parents’ overweight and adiposity in adolescents. This association also involves genetic factors, since children of obese parents have a considerably greater risk of becoming obese and of adopting inadequate behaviors such as poor dietary habits that are passed down through generations⁷7. Frutuoso MFP, Bovi TG, Gambardella AMD. Adiposidade em adolescentes e obesidade materna. Rev. Nutr. 2011; 24(1):5-15.

8. Bernardo CO, Vasconcelos FA. Association of parents’ nutritional status, and sociodemographic and dietary factors with overweight/obesity in schoolchildren 7 to 14 years old. Cad Saude Publica 2012; 28(2):291-304.^-99. Pontes LM, Amorim RJ, Lira PIC. Prevalência e fatores associados ao excesso de peso em adolescentes da rede pública de ensino de João Pessoa, Paraíba. Rev AMRIGS 2013; 57(2):105-111.. Thus, this study seeks to verify the association between overweight among adolescents and the nutritional status of their parents, in order to identify possible determining factors.

Methods

This study involves a systematic review of the literature based on the following question that uses the PECO strategy¹⁰10. Brasil. Ministério da Saúde (MS). Secretaria de Ciência, Tecnologia e Insumos Estratégicos. Departamento de Ciência e Tecnologia. Diretrizes metodológicas: Elaboração de Revisão Sistemática e Metanálise de estudos observacionais comparativos sobre fatores de risco e prognóstico. Brasília: MS; 2014.: “What is the association between overweight in adolescents and the parents’ nutritional status, when compared with children of eutrophic individuals?”. The revision was based on the PRISMA directive: Preferred Reporting Items for Systematic Reviews¹¹11. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M Devereaux PJ, Kleijnen J, Moher D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009; 339:b2700..

The bibliographic review was carried out between November 2014 and January 2015, using the following databases: Publisher Medline (Pubmed), Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs), Scientific Electronic Library Online (Scielo) and Biblioteca Virtual de Saúde (BVS). For the search strategy the following key terms were combined using the Boolean operators OR and AND: “Overweight”, “obesity”, “risk factors”, “adolescent” and “parents”. For the search on Pubmed, the key terms were identified using Medical Subject Headings (Mesh), published by the U.S. National Library of Medicine (http://www.nlm.nih.gov/mesh/), and the following search terms were used: (((“overweight”[MeSH Terms] OR “obesity” [MeSH Terms]) AND “risk factors”[MeSH Terms]) AND “adolescent”[MeSH Terms]) AND “parents”[MeSH Terms]. For the searches carried out on Lilacs, Scielo and BVS, the terms were drawn from the key terms at ‘Descritores em Ciência da Saúde’ (DeCS), available at the ‘Biblioteca Virtual em Saúde’ portal (http://decs.bvs.br), and the following search terms were used, respectively: obesity [subject key term] and adolescent [subject key term] and parents [subject key term], (overweight) OR (obesity) AND (risk factors) AND (adolescent) AND (parents) and (tw:(overweight)) OR (tw:(obesity)) AND (tw:(risk factors)) AND ((tw:(adolescent)) AND (tw:(parents)).

The inclusion criteria that were used were: original studies involving humans, with a representative and random sample selection, in which the nutritional status of adolescents was evaluated in line with the curves proposed by the World Health Organization (WHO)¹²12. De Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ 2007; 85(9):660-667. or by the Centers for Disease Control and Prevention (CDC)¹³13. Kuczmarski RJ, Ogden CL, Grummer-Strawn LM, Flegal KM, Guo SS, Wei R, Mei Z, Curtin LR, Roche AF, Johnson CL. CDC growth charts: United States. Adv Data 2000; (314):1-27. or the International Obesity Task Force (IOTF)¹⁴14. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 2000; 320(7244):1240-1243. and the nutritional status of the parents was measured using Body Mass Index (BMI)¹⁵15. World Health Organization (WHO). Physical status: the use and interpretation of anthropometry. Geneva: WHO; 1995. Technical Report Series, 854.; with an association between excess weight in adolescents and overweight/obesity in parents, using multivariate statistical analysis; written in Portuguese, English or Spanish and published in the last ten years (between January 2004 and December 2014).

The selection of articles was carried out by two researchers working independently, and involved three stages: reading of the title, reading of the abstract and reading of the complete article. After reading the title and abstract, the full text was read in order to identify those which fulfilled the inclusion criteria, as per the pre-established protocol.

The kappa agreement index was calculated and was found to be 0.85, which points to a high level of agreement between the researchers¹⁶16. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1997; 33(1):159-174.. Any disagreements were resolved by consensus between the two readers. Once the articles had been selected, the data was extracted, following the protocol that had been defined in advance by the authors, then put into a table in Microsoft Office Excel 2007.

The articles were evaluated for quality using the STROBE check-list, translated by Malta et al.¹⁷17. Malta M, Cardoso LO, Bastos FI, Magnanini MM, Silva CM. STROBE initiative: guidelines on reporting observational studies. Rev Saude Publica 2010; 44(3):559-565, containing 22 items relating to the essential points that should be described in observational studies. Each item was given a score from 0 to 1 point, and any article that scored 50% (11 points) of the overall points was considered to be of good quality.

Results

366 articles were initially identified, including 154 on Pubmed, 8 on Lilacs, 2 on Scielo and 202 on BVS. Of the articles found on BVS, only 10 were not indexed in the other databases, so 192 were excluded from the original number. The titles and abstracts were evaluated, resulting in the exclusion of 137 articles that did not meet the criteria established previously. After reading through the remaining 37 articles, seven were found to meet the eligibility criteria and were selected by both researchers (Figure 1).

The main characteristics of each of the seven studies are shown in Chart 1, in decreasing order of the score they obtained using an analysis of methodological quality. The average score obtained using the STROBE protocol was 17, with a maximum of 19.3⁸8. Bernardo CO, Vasconcelos FA. Association of parents’ nutritional status, and sociodemographic and dietary factors with overweight/obesity in schoolchildren 7 to 14 years old. Cad Saude Publica 2012; 28(2):291-304.^,1818. Veltsista A, Kanaka C, Gika A, Lekea V, Roma E, Bakoula C. Tracking of Overweight and Obesity in Greek Youth. Obes Facts 2010; 3(3):166-172. and a minimum of 15¹⁹19. Birbilis M, Moschonis G, Mougios V, Manios Y, Healthy Growth Study’ group. Obesity in adolescence is associated with perinatal risk factors, parental BMI and sociodemographic characteristics. Eur J Clin Nutr 2013; 67(1):115-121. (Chart 1).

The majority of the studies were carried out in the United States²¹21. Kowaleski-Jones L, Brown BB, Fan JX, Smith KR, Zick CD. Are You What Your Mother Weighs? Evaluating the Impact of Maternal Weight Trajectories on Youth Overweight. Matern Child Health J 2010; 14(5):680-686.^,2222. Liu Y, Chen H, Liang L, Wang Y. Parent-Child Resemblance in Weight Status and Its Correlates in the United States. PLoS ONE 2013; 8(6):e65361., Greece¹⁸18. Veltsista A, Kanaka C, Gika A, Lekea V, Roma E, Bakoula C. Tracking of Overweight and Obesity in Greek Youth. Obes Facts 2010; 3(3):166-172.^,1919. Birbilis M, Moschonis G, Mougios V, Manios Y, Healthy Growth Study’ group. Obesity in adolescence is associated with perinatal risk factors, parental BMI and sociodemographic characteristics. Eur J Clin Nutr 2013; 67(1):115-121. and Brazil⁸8. Bernardo CO, Vasconcelos FA. Association of parents’ nutritional status, and sociodemographic and dietary factors with overweight/obesity in schoolchildren 7 to 14 years old. Cad Saude Publica 2012; 28(2):291-304.^,2323. Marins VMR, Almeida RMVR, Pereira RA, Barros MBA. The relationship between parental nutritional status and overweight children/adolescents in Rio de Janeiro, Brazil. Public Health 2004; 118(1):43-49. and all were published in the period between 2004 and 2013⁸8. Bernardo CO, Vasconcelos FA. Association of parents’ nutritional status, and sociodemographic and dietary factors with overweight/obesity in schoolchildren 7 to 14 years old. Cad Saude Publica 2012; 28(2):291-304.^,1818. Veltsista A, Kanaka C, Gika A, Lekea V, Roma E, Bakoula C. Tracking of Overweight and Obesity in Greek Youth. Obes Facts 2010; 3(3):166-172.^,1919. Birbilis M, Moschonis G, Mougios V, Manios Y, Healthy Growth Study’ group. Obesity in adolescence is associated with perinatal risk factors, parental BMI and sociodemographic characteristics. Eur J Clin Nutr 2013; 67(1):115-121.^,2121. Kowaleski-Jones L, Brown BB, Fan JX, Smith KR, Zick CD. Are You What Your Mother Weighs? Evaluating the Impact of Maternal Weight Trajectories on Youth Overweight. Matern Child Health J 2010; 14(5):680-686.

22. Liu Y, Chen H, Liang L, Wang Y. Parent-Child Resemblance in Weight Status and Its Correlates in the United States. PLoS ONE 2013; 8(6):e65361.

23. Marins VMR, Almeida RMVR, Pereira RA, Barros MBA. The relationship between parental nutritional status and overweight children/adolescents in Rio de Janeiro, Brazil. Public Health 2004; 118(1):43-49.^-2424. Maddah M, Nikooyeh B. Obesity among Iranian Adolescent Girls: Location of Residence and Parental Obesity. J Health Popul Nutr 2010; 28(1):61-66.. The sample sizes ranged from 914²³23. Marins VMR, Almeida RMVR, Pereira RA, Barros MBA. The relationship between parental nutritional status and overweight children/adolescents in Rio de Janeiro, Brazil. Public Health 2004; 118(1):43-49. to 9571²²22. Liu Y, Chen H, Liang L, Wang Y. Parent-Child Resemblance in Weight Status and Its Correlates in the United States. PLoS ONE 2013; 8(6):e65361. individuals and, of the studies selected, two are prospective cohort studies¹⁸18. Veltsista A, Kanaka C, Gika A, Lekea V, Roma E, Bakoula C. Tracking of Overweight and Obesity in Greek Youth. Obes Facts 2010; 3(3):166-172.^,2121. Kowaleski-Jones L, Brown BB, Fan JX, Smith KR, Zick CD. Are You What Your Mother Weighs? Evaluating the Impact of Maternal Weight Trajectories on Youth Overweight. Matern Child Health J 2010; 14(5):680-686., while all the others are cross-sectional studies⁸8. Bernardo CO, Vasconcelos FA. Association of parents’ nutritional status, and sociodemographic and dietary factors with overweight/obesity in schoolchildren 7 to 14 years old. Cad Saude Publica 2012; 28(2):291-304.^,1919. Birbilis M, Moschonis G, Mougios V, Manios Y, Healthy Growth Study’ group. Obesity in adolescence is associated with perinatal risk factors, parental BMI and sociodemographic characteristics. Eur J Clin Nutr 2013; 67(1):115-121.^,2222. Liu Y, Chen H, Liang L, Wang Y. Parent-Child Resemblance in Weight Status and Its Correlates in the United States. PLoS ONE 2013; 8(6):e65361.

23. Marins VMR, Almeida RMVR, Pereira RA, Barros MBA. The relationship between parental nutritional status and overweight children/adolescents in Rio de Janeiro, Brazil. Public Health 2004; 118(1):43-49.^-2424. Maddah M, Nikooyeh B. Obesity among Iranian Adolescent Girls: Location of Residence and Parental Obesity. J Health Popul Nutr 2010; 28(1):61-66.. The studies included members of both sexes in similar proportions, with the exception of one which was carried out in Iran and involved only female adolescents (Chart 1)²⁵25. Kumanyika SK. Minisymposium on obesity: overview and some strategic considerations. Annu Rev Public Health 2001; 22:293-308..

The objectives and statistical analyses of the selected studies are presented in Chart 2. The multivariate analysis that was most commonly used to check for an association between nutritional status of adolescents and their parents and to calculate the risk of this event was logistical regression¹⁸18. Veltsista A, Kanaka C, Gika A, Lekea V, Roma E, Bakoula C. Tracking of Overweight and Obesity in Greek Youth. Obes Facts 2010; 3(3):166-172.^,2222. Liu Y, Chen H, Liang L, Wang Y. Parent-Child Resemblance in Weight Status and Its Correlates in the United States. PLoS ONE 2013; 8(6):e65361.

23. Marins VMR, Almeida RMVR, Pereira RA, Barros MBA. The relationship between parental nutritional status and overweight children/adolescents in Rio de Janeiro, Brazil. Public Health 2004; 118(1):43-49.^-2424. Maddah M, Nikooyeh B. Obesity among Iranian Adolescent Girls: Location of Residence and Parental Obesity. J Health Popul Nutr 2010; 28(1):61-66.. The dependent variable in the studies was overweight and/or obesity in adolescents, and the independent variable was excess adiposity in parents. In addition, other independent variables were analyzed such as: family income, level of schooling of parents, diet, the practice of physical activity, sedentary lifestyle, location of residence, among other socioeconomic and demographic variables (Chart 2).

Chart 3 shows the principle results and methodological limitations of the selected studies. The prevalence of obesity and overweight varied according to the geographic region in which the study was developed. A greater prevalence of overweight was found in the studies carried out in Brazil⁸8. Bernardo CO, Vasconcelos FA. Association of parents’ nutritional status, and sociodemographic and dietary factors with overweight/obesity in schoolchildren 7 to 14 years old. Cad Saude Publica 2012; 28(2):291-304.^,2323. Marins VMR, Almeida RMVR, Pereira RA, Barros MBA. The relationship between parental nutritional status and overweight children/adolescents in Rio de Janeiro, Brazil. Public Health 2004; 118(1):43-49. and in Greece¹⁸18. Veltsista A, Kanaka C, Gika A, Lekea V, Roma E, Bakoula C. Tracking of Overweight and Obesity in Greek Youth. Obes Facts 2010; 3(3):166-172.^,1919. Birbilis M, Moschonis G, Mougios V, Manios Y, Healthy Growth Study’ group. Obesity in adolescence is associated with perinatal risk factors, parental BMI and sociodemographic characteristics. Eur J Clin Nutr 2013; 67(1):115-121., while the research carried out in the United States found the prevalence of obesity to be greater²¹21. Kowaleski-Jones L, Brown BB, Fan JX, Smith KR, Zick CD. Are You What Your Mother Weighs? Evaluating the Impact of Maternal Weight Trajectories on Youth Overweight. Matern Child Health J 2010; 14(5):680-686.^,2323. Marins VMR, Almeida RMVR, Pereira RA, Barros MBA. The relationship between parental nutritional status and overweight children/adolescents in Rio de Janeiro, Brazil. Public Health 2004; 118(1):43-49.. The lowest prevalence of obesity was found in a prospective cohort in Greece¹⁸18. Veltsista A, Kanaka C, Gika A, Lekea V, Roma E, Bakoula C. Tracking of Overweight and Obesity in Greek Youth. Obes Facts 2010; 3(3):166-172.. With regard to frequency by sex, there were found to be greater prevalence of overweight in male adolescents (Chart 3)⁸8. Bernardo CO, Vasconcelos FA. Association of parents’ nutritional status, and sociodemographic and dietary factors with overweight/obesity in schoolchildren 7 to 14 years old. Cad Saude Publica 2012; 28(2):291-304.^,1818. Veltsista A, Kanaka C, Gika A, Lekea V, Roma E, Bakoula C. Tracking of Overweight and Obesity in Greek Youth. Obes Facts 2010; 3(3):166-172.^,1919. Birbilis M, Moschonis G, Mougios V, Manios Y, Healthy Growth Study’ group. Obesity in adolescence is associated with perinatal risk factors, parental BMI and sociodemographic characteristics. Eur J Clin Nutr 2013; 67(1):115-121.^,2121. Kowaleski-Jones L, Brown BB, Fan JX, Smith KR, Zick CD. Are You What Your Mother Weighs? Evaluating the Impact of Maternal Weight Trajectories on Youth Overweight. Matern Child Health J 2010; 14(5):680-686.

22. Liu Y, Chen H, Liang L, Wang Y. Parent-Child Resemblance in Weight Status and Its Correlates in the United States. PLoS ONE 2013; 8(6):e65361.^-2323. Marins VMR, Almeida RMVR, Pereira RA, Barros MBA. The relationship between parental nutritional status and overweight children/adolescents in Rio de Janeiro, Brazil. Public Health 2004; 118(1):43-49..

Perinatal, behavioral, biological and socioeconomic factors were significantly associated with a greater risk of excess weight in adolescents and these include: excess of pre-gestational weight; smoking during pregnancy; rapid weight gain during childhood⁸8. Bernardo CO, Vasconcelos FA. Association of parents’ nutritional status, and sociodemographic and dietary factors with overweight/obesity in schoolchildren 7 to 14 years old. Cad Saude Publica 2012; 28(2):291-304.; skipping meals²⁴24. Maddah M, Nikooyeh B. Obesity among Iranian Adolescent Girls: Location of Residence and Parental Obesity. J Health Popul Nutr 2010; 28(1):61-66.; male sex⁸8. Bernardo CO, Vasconcelos FA. Association of parents’ nutritional status, and sociodemographic and dietary factors with overweight/obesity in schoolchildren 7 to 14 years old. Cad Saude Publica 2012; 28(2):291-304.^,1818. Veltsista A, Kanaka C, Gika A, Lekea V, Roma E, Bakoula C. Tracking of Overweight and Obesity in Greek Youth. Obes Facts 2010; 3(3):166-172.^,1919. Birbilis M, Moschonis G, Mougios V, Manios Y, Healthy Growth Study’ group. Obesity in adolescence is associated with perinatal risk factors, parental BMI and sociodemographic characteristics. Eur J Clin Nutr 2013; 67(1):115-121.^,2121. Kowaleski-Jones L, Brown BB, Fan JX, Smith KR, Zick CD. Are You What Your Mother Weighs? Evaluating the Impact of Maternal Weight Trajectories on Youth Overweight. Matern Child Health J 2010; 14(5):680-686.

22. Liu Y, Chen H, Liang L, Wang Y. Parent-Child Resemblance in Weight Status and Its Correlates in the United States. PLoS ONE 2013; 8(6):e65361.^-2323. Marins VMR, Almeida RMVR, Pereira RA, Barros MBA. The relationship between parental nutritional status and overweight children/adolescents in Rio de Janeiro, Brazil. Public Health 2004; 118(1):43-49.; overweight in parents⁸8. Bernardo CO, Vasconcelos FA. Association of parents’ nutritional status, and sociodemographic and dietary factors with overweight/obesity in schoolchildren 7 to 14 years old. Cad Saude Publica 2012; 28(2):291-304.^,1818. Veltsista A, Kanaka C, Gika A, Lekea V, Roma E, Bakoula C. Tracking of Overweight and Obesity in Greek Youth. Obes Facts 2010; 3(3):166-172.^,1919. Birbilis M, Moschonis G, Mougios V, Manios Y, Healthy Growth Study’ group. Obesity in adolescence is associated with perinatal risk factors, parental BMI and sociodemographic characteristics. Eur J Clin Nutr 2013; 67(1):115-121.^,2121. Kowaleski-Jones L, Brown BB, Fan JX, Smith KR, Zick CD. Are You What Your Mother Weighs? Evaluating the Impact of Maternal Weight Trajectories on Youth Overweight. Matern Child Health J 2010; 14(5):680-686.

22. Liu Y, Chen H, Liang L, Wang Y. Parent-Child Resemblance in Weight Status and Its Correlates in the United States. PLoS ONE 2013; 8(6):e65361.

23. Marins VMR, Almeida RMVR, Pereira RA, Barros MBA. The relationship between parental nutritional status and overweight children/adolescents in Rio de Janeiro, Brazil. Public Health 2004; 118(1):43-49.^-2424. Maddah M, Nikooyeh B. Obesity among Iranian Adolescent Girls: Location of Residence and Parental Obesity. J Health Popul Nutr 2010; 28(1):61-66.; black parents²¹21. Kowaleski-Jones L, Brown BB, Fan JX, Smith KR, Zick CD. Are You What Your Mother Weighs? Evaluating the Impact of Maternal Weight Trajectories on Youth Overweight. Matern Child Health J 2010; 14(5):680-686.; living in low income areas²⁴24. Maddah M, Nikooyeh B. Obesity among Iranian Adolescent Girls: Location of Residence and Parental Obesity. J Health Popul Nutr 2010; 28(1):61-66.; low level of schooling of parnets⁸8. Bernardo CO, Vasconcelos FA. Association of parents’ nutritional status, and sociodemographic and dietary factors with overweight/obesity in schoolchildren 7 to 14 years old. Cad Saude Publica 2012; 28(2):291-304.^,2121. Kowaleski-Jones L, Brown BB, Fan JX, Smith KR, Zick CD. Are You What Your Mother Weighs? Evaluating the Impact of Maternal Weight Trajectories on Youth Overweight. Matern Child Health J 2010; 14(5):680-686.^,2323. Marins VMR, Almeida RMVR, Pereira RA, Barros MBA. The relationship between parental nutritional status and overweight children/adolescents in Rio de Janeiro, Brazil. Public Health 2004; 118(1):43-49.; and lower family income²¹21. Kowaleski-Jones L, Brown BB, Fan JX, Smith KR, Zick CD. Are You What Your Mother Weighs? Evaluating the Impact of Maternal Weight Trajectories on Youth Overweight. Matern Child Health J 2010; 14(5):680-686.^,2222. Liu Y, Chen H, Liang L, Wang Y. Parent-Child Resemblance in Weight Status and Its Correlates in the United States. PLoS ONE 2013; 8(6):e65361..

All the studies showed that the presence of overweight or obesity in the father or mother increases the risk of adolescents developing excess adiposity⁸8. Bernardo CO, Vasconcelos FA. Association of parents’ nutritional status, and sociodemographic and dietary factors with overweight/obesity in schoolchildren 7 to 14 years old. Cad Saude Publica 2012; 28(2):291-304.^,1818. Veltsista A, Kanaka C, Gika A, Lekea V, Roma E, Bakoula C. Tracking of Overweight and Obesity in Greek Youth. Obes Facts 2010; 3(3):166-172.^,1919. Birbilis M, Moschonis G, Mougios V, Manios Y, Healthy Growth Study’ group. Obesity in adolescence is associated with perinatal risk factors, parental BMI and sociodemographic characteristics. Eur J Clin Nutr 2013; 67(1):115-121.^,2121. Kowaleski-Jones L, Brown BB, Fan JX, Smith KR, Zick CD. Are You What Your Mother Weighs? Evaluating the Impact of Maternal Weight Trajectories on Youth Overweight. Matern Child Health J 2010; 14(5):680-686.

22. Liu Y, Chen H, Liang L, Wang Y. Parent-Child Resemblance in Weight Status and Its Correlates in the United States. PLoS ONE 2013; 8(6):e65361.

23. Marins VMR, Almeida RMVR, Pereira RA, Barros MBA. The relationship between parental nutritional status and overweight children/adolescents in Rio de Janeiro, Brazil. Public Health 2004; 118(1):43-49.^-2424. Maddah M, Nikooyeh B. Obesity among Iranian Adolescent Girls: Location of Residence and Parental Obesity. J Health Popul Nutr 2010; 28(1):61-66. and that this risk is still greater when both parents are overweight⁸8. Bernardo CO, Vasconcelos FA. Association of parents’ nutritional status, and sociodemographic and dietary factors with overweight/obesity in schoolchildren 7 to 14 years old. Cad Saude Publica 2012; 28(2):291-304.^,1818. Veltsista A, Kanaka C, Gika A, Lekea V, Roma E, Bakoula C. Tracking of Overweight and Obesity in Greek Youth. Obes Facts 2010; 3(3):166-172.^,2222. Liu Y, Chen H, Liang L, Wang Y. Parent-Child Resemblance in Weight Status and Its Correlates in the United States. PLoS ONE 2013; 8(6):e65361.. In the prospective cohort study carried out in Greece, the adolescents were found to have a five-fold greater risk of being obese when both parents were obese, when compared with children of eutrophic parents (Chart 3)¹⁸18. Veltsista A, Kanaka C, Gika A, Lekea V, Roma E, Bakoula C. Tracking of Overweight and Obesity in Greek Youth. Obes Facts 2010; 3(3):166-172..

The main methodological limitations of the studies cited were: use of self-referred anthropometric data⁸8. Bernardo CO, Vasconcelos FA. Association of parents’ nutritional status, and sociodemographic and dietary factors with overweight/obesity in schoolchildren 7 to 14 years old. Cad Saude Publica 2012; 28(2):291-304.^,1818. Veltsista A, Kanaka C, Gika A, Lekea V, Roma E, Bakoula C. Tracking of Overweight and Obesity in Greek Youth. Obes Facts 2010; 3(3):166-172.^,1919. Birbilis M, Moschonis G, Mougios V, Manios Y, Healthy Growth Study’ group. Obesity in adolescence is associated with perinatal risk factors, parental BMI and sociodemographic characteristics. Eur J Clin Nutr 2013; 67(1):115-121.^,2121. Kowaleski-Jones L, Brown BB, Fan JX, Smith KR, Zick CD. Are You What Your Mother Weighs? Evaluating the Impact of Maternal Weight Trajectories on Youth Overweight. Matern Child Health J 2010; 14(5):680-686.^,2222. Liu Y, Chen H, Liang L, Wang Y. Parent-Child Resemblance in Weight Status and Its Correlates in the United States. PLoS ONE 2013; 8(6):e65361.^,2424. Maddah M, Nikooyeh B. Obesity among Iranian Adolescent Girls: Location of Residence and Parental Obesity. J Health Popul Nutr 2010; 28(1):61-66. and the inability to establish a causality relationship (Chart 3)⁸8. Bernardo CO, Vasconcelos FA. Association of parents’ nutritional status, and sociodemographic and dietary factors with overweight/obesity in schoolchildren 7 to 14 years old. Cad Saude Publica 2012; 28(2):291-304.^,1919. Birbilis M, Moschonis G, Mougios V, Manios Y, Healthy Growth Study’ group. Obesity in adolescence is associated with perinatal risk factors, parental BMI and sociodemographic characteristics. Eur J Clin Nutr 2013; 67(1):115-121..

Discussion

Obesity is a chronic disease with multifaceted causes that is characterized by an excess of adiposity on the body, that has a negative impact on health²⁶26. World Health Organization (WHO). Obesity: preventing and managing the global epidemic: report of a WHO Consultation. Geneva: WHO; 2000. WHO Technical Report Series 894.. It is linked to biological, genetic and environmental factors, and is caused by a positive energy balance, whereby the individual ingests more energy than he or she expends through organic processes²⁵25. Kumanyika SK. Minisymposium on obesity: overview and some strategic considerations. Annu Rev Public Health 2001; 22:293-308.. It is a risk factor for the development of Chronic Non-Communicable Diseases (CNCDs), including cardiovascular disease which is the principle cause of mortality globally. In Brazil, approximately 30% of deaths are attributed to heart-related illness²⁷27. Brasil. Ministério da Saúde (MS). Secretaria Executiva. Datasus. Informações de saúde. Estatísticas vitais. [acessado 2015 abr 24]. Disponível em: www2.datasus.gov.br/DATASUS/index.php?area=0205
www2.datasus.gov.br/DATASUS/index.php?ar... .

The high prevalence of overweight found in the studies of Brazilian adolescents may be related to the nutritional transition which the country’s population has passed through. According to Gaino et al.²⁸28. Gaino NM, Amancio RD, Oetterer M, Silva MV. Disponibilidade domiciliar de alimentos industrializados no Brasil. Higiene Alimentar 2012; 26(206/207):55-63., in the last 30 years, there has been a significant increase in the consumption of industrialized foods, with increases of: 317.6% in the consumption of prepared food products; 584.6% in the consumption of guarana flavored fizzy drinks; and 966.6% of yoghurts. These increases are cause for concern since they are associated with a concomitant increase in the incidence of obesity in the Brazilian population.

In the Greek studies¹⁸18. Veltsista A, Kanaka C, Gika A, Lekea V, Roma E, Bakoula C. Tracking of Overweight and Obesity in Greek Youth. Obes Facts 2010; 3(3):166-172.^,1919. Birbilis M, Moschonis G, Mougios V, Manios Y, Healthy Growth Study’ group. Obesity in adolescence is associated with perinatal risk factors, parental BMI and sociodemographic characteristics. Eur J Clin Nutr 2013; 67(1):115-121., elevated levels of overweight were found that can also be attributed to changes in dietary habits and in the practice of physical activity, arising from socioeconomic changes that have occurred in recent decades¹⁹19. Birbilis M, Moschonis G, Mougios V, Manios Y, Healthy Growth Study’ group. Obesity in adolescence is associated with perinatal risk factors, parental BMI and sociodemographic characteristics. Eur J Clin Nutr 2013; 67(1):115-121..

Among the articles chosen for the present systematic revision, the greatest prevalence of obesity was among American adolescents. Liu et al.²²22. Liu Y, Chen H, Liang L, Wang Y. Parent-Child Resemblance in Weight Status and Its Correlates in the United States. PLoS ONE 2013; 8(6):e65361. and Kowaleski-Jones et al.²¹21. Kowaleski-Jones L, Brown BB, Fan JX, Smith KR, Zick CD. Are You What Your Mother Weighs? Evaluating the Impact of Maternal Weight Trajectories on Youth Overweight. Matern Child Health J 2010; 14(5):680-686. carried out studies of adolescents in the United States and observed that socioeconomic variables demonstrated the greatest association with excess weight in adolescents, since those with greater family income and lower levels of maternal schooling had a greater prevalence of overweight and obesity. According to Frederick et al.²⁹29. Frederick CB, Snellman K, Putnam RD. Increasing socioeconomic disparities in adolescent obesity. PNAS 2014; 111(4):1338-1342., the prevalence of obesity in American adolescents has, in recent years, decreased amongst the population with the highest socioeconomic levels while it has gradually increased among those in the lowest income bracket. This may be related to low levels of physical activity, due to a lack of spaces that might allow for the practice of physical exercise near to their homes, and also to food errors, since healthy foods such as fruits and vegetables are more costly than fast food and may not be available to purchase near to where adolescents live.

In this revision, male adolescents showed greater prevalence of overweight, when compared with their female counterparts. This finding is consistent with those from other studies in the literature. In the National Survey of School Health (Pesquisa Nacional de Saúde do Escolar - PeNSe), which was carried out in schools in Brazilian state capital cities, a greater prevalence of overweight was found among boys (24%) in the 11 to 19 age range, when compared with girls (22.1%) of the same age³⁰30. Araújo C, Toral N, Silva ACF, Velásquez-Melendez G, Dias AJR. Estado nutricional dos adolescentes e sua relação com variáveis sociodemográficas: Pesquisa Nacional de Saúde do Escolar (PeNSE), 2009. Cien Saude Colet 2010; 15(2):3077-3084.. Similar results were reported in a longitudinal study of American children and adolescents, among whom the prevalence of obesity was 23.5% among boys and 17.8% among girls in the 8^th year of school and with an average age of 14.1 years³¹31. Cunningham SA, Kramer MR, Narayan KMV. Incidence of Childhood Obesity in the United States. N Engl J Med 2014; 370(5):403-411.. One of the factors that may explain the greater frequency of overweight among boys is that adolescent girls tend to monitor their weight more and are more aware of their body images and therefore of their weights. In this way, although both sexes face similar environmental risk factors, boys show a greater tendency towards overweight and obesity.

In the studies selected, perinatal factors such as excess weight during pregnancy, maternal smoking and accelerated growth during childhood increased the risk of adolescents displaying overweight or obesity. In a literature review, Godfrey et al.³²32. Godfrey KM, Gluckman PD, Hanson MA. Developmental origins of metabolic disease: life course and intergenerational perspectives. Trends Endocrinol Metabol 2010; 21(4):p199-205. (2010), confirmed that children of obese mothers, independently of their birthweight, showed a greater probability of having excess weight and consequently a greater risk of developing CNCDs. Skipping meals was related to overweight/obesity among adolescents. Terres et al.⁵5. Terres NG, Pinheiro RT, Horta BL, Pinheiro KAT, Horta LL. Prevalência e fatores associados ao sobrepeso e à obesidades em adolescentes. Rev Saude Publica 2006; 40(4):627-633. carried out a cross-sectional, population-based study of adolescents in Pelotas, Rio Grande do Sul state and reported similar findings since adolescents who reported skipping meals were found to have a 2.54% greater risk of being obese. Lower levels of schooling among parents, lower income and living in low-income areas were positively associated with excess weight in adolescents. These variables are inter-related, since low levels of paternal and maternal schooling reduce the chance of finding well paid jobs, leading to lower family incomes which can influence where people live.

Among the several factors that are related to overweight and obesity in adolescence in this systematic revision, parents’ nutritional status was found to have a strong influence⁷7. Frutuoso MFP, Bovi TG, Gambardella AMD. Adiposidade em adolescentes e obesidade materna. Rev. Nutr. 2011; 24(1):5-15.^,3333. Ramos AMPP, Barros Filho AA. Prevalência da obesidade em adolescentes de Bragança Paulista e sua relação com a obesidade dos pais. Arq Bras Endocrinol Metab 2003; 47(6):663-668.. Power et al.’s³⁴34. Power C, Pouliou T, Li L, Cooper R, Hyppönen E. Parental and offspring adiposity associations: Insights from the 1958 British birth cohort. Ann Hum Biol 2011; 38(4):390-399. longitudinal study of Britons born in 1958 showed an inter-generational transmission of adiposity. In this birth cohort study, an association was found between high BMI of parents and children across three generations.

The significant association between overweight in adolescents and overweight or obesity in their parents, when compared with the children of eutrophic parents, can be explained, at least in part, by behavioral factors. A 2012 study carried out by Morton et al.³⁵35. Morton KL, Wilson AH, Perlmutter LS, Beauchamp MR. Family leadership styles and adolescent dietary and physical activity behaviors: a cross-sectional study. Int J Behav Nutr Phys Act 2012; 9(1):48. showed that families that have transformational behaviors had health food consumption levels and greater levels of physical activity among adolescents. The level of physical activity of adolescents appears to be directly related to the practice of physical activity by their parents, as confirmed by Cheng et al.³⁶36. Cheng LA, Mendonça G, Farias Júnior JC. Physical activity in adolescents: analysis of the social influence of parents and friends. J Pediatr 2014; 90(1):35-41. in a study of adolescents aged between 14 and 19 in Brazil, indicating that having parents who are sedentary can be a determining factor leading to intra-family overweight.

The food habits of previous generations are also related to children’s nutritional status. Alia et al.³⁷37. Alia KA, Wilson DK, St. George SM, Schneider E, Kitzman-Ulrich H. Effects of Parenting Style and Parent-Related Weight and Diet on Adolescent Weight Status. J Pediatr Psychol 2013; 38(3):321-329. found that the consumption of fruits and vegetables by parents was related to lower weight among adolescent children, showing that one of the strategies for reducing the prevalence of excess weight in individuals in this age range would be to reeducate parents and children about food habits.

Genetic factors have a significant impact on the nutritional status of parents and children, however more research is required on the relevant mechanisms involved. A study carried out in Japan found evidence that points to paternal transition of obesity induced by a diet rich in fats, which can be passed through genomes and is related to the genes Peg3 and Igf2³⁸38. Morita S, Horii T, Kimura M, Arai Y, Kamei Y, Ogawa Y, et al.. Paternal Allele Influences High Fat Diet-Induced Obesity. PLoS ONE 2014; 9(1):e85477..

The conclusion that can thus be drawn is that the significant association between overweight in adolescents and parents’ nutritional status, reported in the selected studies, is related to several factors. In this way, the presence of a risk factor such as genetic predisposition for example, can be counter-weighted by a protective factor such as health food habits.

Regarding methodological shortcomings of the selected articles, the majority of studies refer to the use of self-reported data on weight and height, however anthropometric measures show high levels of agreement with standard measures³⁹39. Neto GAM, Polito MD, Lira VA. Fidedignidade entre peso e estatura reportados e medidos e a influência do histórico de atividade física em indivíduos que procuram a prática supervisionada de exercícios. Rev Bras Med Esporte 2005; 11(2):141-145. Studies such as the Surveillance of Chronic Illnesses by Telephone Interview (VIGITEL - Vigilância de Doenças crônicas por Inquérito Telefônico)⁴⁰40. Brasil. Ministério da Saúde (MS). Secretaria de Vigilância em Saúde (Vigitel). Brasil 2006: vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico. Brasília: MS; 2007., have used self-reported weight and height data, which simplifies the work and reduces costs. Another limitation was that it was not possible to establish a causal relationship, however this is inherent to cross-sectional studies.

To summarize, the studies shows that adolescents whose parents were overweight have a greater risk of being overweight or obese when compared with eutrophic peers. This risk is greater when both parents are obese. The percentage contribution of environmental and genetic factors in this associated is not defined in the literature, although it is known that both have a role to play. The selected studies show that several factors in addition to parents’ weight are related to overweight/obesity in adolescence, with the most important being lower family income, lower level of mother’s schooling and male sex.

This findings point to the need for public policies focused on the prevention and/or treatment of overweight/obesity in adolescence. These policies need to consider biological and socioeconomic differences and must also target parents if they are to be most effective.

In addition, studies are needed that evaluate in isolation each risk factor involved in developing overweight in adolescence given that there is a tendency for this nutritional disorder to continue to adulthood.

References

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