Association between socioeconomic and nutritional factors and height of Brazilian adolescents: results from the <i>Study of Cardiovascular Risk in Adolescents</i>

Cheuiche, Amanda Veiga; Cureau, Felipe Vogt; Madalosso, Mariana Migliavacca; Telo, Gabriela Heiden; Schaan, Beatriz D.

doi:10.1590/0102-311XEN277321

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ARTICLE • Cad. Saúde Pública 38 (7) • 2022 • https://doi.org/10.1590/0102-311XEN277321 copy

Association between socioeconomic and nutritional factors and height of Brazilian adolescents: results from the Study of Cardiovascular Risk in Adolescents

Associação entre fatores socioeconômicos e nutricionais e altura de adolescentes brasileiros: resultados do Estudo de Riscos Cardiovasculares em Adolescentes

Asociación entre los factores socioeconómicos y nutricionales y la estatura de los adolescentes brasileños: resultados del Estudio de Riesgo Cardiovascular en Adolescentes

Authorship SCIMAGO INSTITUTIONS RANKINGS

This study aims to describe the mean height of adolescents from the five regions of Brazil and to evaluate socioeconomic and nutritional factors associated with normal growth. This is a cross-sectional study conducted in the Brazilian urban and rural areas with students aged 12 to 17 years (n = 71,553). Anthropometry, socioeconomic variables, physical activity, and diet were evaluated. Height-for-age z-scores were calculated and multiple linear regression models were used to investigate the association of exposure variables with height (outcome) by sex and age (12-13, 14-15, and 16-17 years). We observed a lower mean height in adolescents from the North Region and in individuals with low socioeconomic status. At 17 years of age, the closest to the final height in this sample, mean heights for girls and boys were 160.9 ± 0.1cm and 173.7 ± 0.3cm, respectively. In multiple linear regression analysis, physical activity (girls β = 0.119, 95%CI: 0.035; 0.202; boys β = 0.092, 95%CI: 0.012; 0.172) and high level of maternal education (girls β = 0.103, 95%CI: 0.001; 0.204; boys β = 0.39, 95%CI: 0.245; 0.534) were positively associated with height-for-age z-score in 16- to 17-year-old boys and girls. Other factors positively associated with height-for-age z-score in older students include higher protein consumption (β = 0.022, 95%CI: 0.010; 0.035) and obesity (β = 0.217, 95%CI: 0.084; 0.350) for boys, and low weight (β = 0.205, 95%CI: 0.028, 0.382) for girls. We observed differences in the mean height among adolescents from the five Brazilian regions. Normal growth, especially among older adolescents, was associated with high maternal education, practice of physical activity, protein consumption, and body mass index (BMI) categories.

Keywords:
Body Height; Anthropometry; Adolescent; Socioeconomic Factors

	Brazil (n = 71,553)
	Girls (55.5%)	Boys (45.5%)
	%	%
Age (years)
12	11.2	11.2
13	16.3	16.8
14	18.1	18.3
15	18.7	19.6
16	20.3	19.3
17	15.5	14.8
Ethnicity
White	39.5	40.5
Black	6.8	9.9
Mixed-race	51.2	46.6
Others	2.6	3.0
Socioeconomic status (terciles)
First	39.1	31.0
Second	32.9	32.5
Third (richest)	28.0	36.5
Maternal education (years)
0-3	10.8	9.0
4-8	26.8	26.5
9-12	35.7	32.8
> 12	26.8	31.7
School area
Urban	96.3	96.0
Rural	3.7	4.0
School type
Public	83.3	82.0
Private	16.7	18.0
Physical activity
Inactive	65.0	42.0
Active	35.0	58.0
Diet quality index [mean (SE)]	14.9 (0.1)	19.0 (0.1)
Tanner
Stage 1	0.5	0.7
Stage 2	4.7	7.2
Stage 3	22.1	14.8
Stage 4	37.0	43.8
Stage 5	35.6	33.5
Age at menarche (years) [mean (SE)]	11.7 (0.1)	NI

Age (years)	Girls			Boys
Age (years)	Coefficient	95%CI	p-value	Coefficient	95%CI	p-value
12-13
BMI *
Normal weight (reference)
Underweight	-0.139	-0.377; 0.098	0.250	-0.573	-0.747; -0.399	< 0.001
Overweight	0.117	0.019; 0.216	0.020	0.391	0.194; 0.589	< 0.001
Obesity	0.435	0.291; 0.580	< 0.001	0.712	0.564; 0.859	< 0.001
Protein consumption ^,*	0.016	-0.002; 0.034	0.091	0.015	-0.001; 0.032	0.067
Physical activity (> 60 min/day) *	-0.015	-0.109; 0.080	0.762	-0.040	-0.144; 0.064	0.454
Black/Mixed-race ***	-0.034	-0.140; 0.072	0.524	0.048	-0.080; 0.176	0.463
Private school ^#	-0.025	-0.144; 0.093	0.675	0.326	0.213; 0.439	< 0.001
Maternal education (years) ^##
< 4 (reference)
4-8	-0.026	-0.201; 0.149	0.774	0.147	-0.076; 0.370	0.197
9-12	0.021	-0.169; 0.210	0.830	0.231	0.021; 0.442	0.031
> 12	0.097	-0.105; 0.299	0.348	0.259	0.032; 0.485	0.025
14-15
BMI *
Normal weight (reference)
Underweight	-0.032	-0.170; 0.105	0.643	-0.466	-0.643; -0.289	< 0.001
Overweight	0.096	0.017; 0.176	0.018	0.292	0.147; 0.438	< 0.001
Obesity	0.353	0.171; 0.535	< 0.001	0.398	0.279; 0.517	< 0.001
Protein consumption ^,*	0.002	-0.011; 0.016	0.735	0.011	-0.007; 0.028	0.228
Physical activity (> 60 min/day) *	0.035	-0.022; 0.093	0.223	-0.034	-0.140; 0.072	0.527
Black/Mixed-race ***	-0.064	-0.163; 0.035	0.203	-0.001	-0.080; 0.078	0.975
Private school ^#	0.071	-0.036; 0.178	0.191	0.125	0.019; 0.231	0.020
Maternal education (years) ^##
< 4 (reference)
4-8	0.072	-0.105; 0.249	0.427	0.133	-0.003; 0.269	0.055
9-12	0.135	0.021; 0.249	0.020	0.161	0.024; 0.298	0.022
> 12	0.158	0.025; 0.291	0.020	0.217	0.049; 0.384	0.011
16-17
BMI *
Normal weight (reference)
Underweight	0.205	0.028; 0.382	0.023	-0.075	-0.299; 0.149	0.511
Overweight	-0.097	-0.191; -0.003	0.043	0.066	-0.072; 0.205	0.349
Obesity	0.064	-0.199; 0.326	0.634	0.217	0.084; 0.350	0.001
Protein consumption ^,*	0.001	-0.015; 0.015	0.993	0.022	0.010; 0.035	< 0.001
Physical activity (> 60 min/day) *	0.119	0.035; 0.202	0.006	0.092	0.012; 0.172	0.024
Black/Mixed-race ***	0.073	-0.001; 0.148	0.053	0.009	-0.097; 0.115	0.870
Private school ^#	0.081	-0.007; 0.168	0.073	0.096	-0.023; 0.214	0.114
Maternal education (years) ^##
< 4 (reference)
4-8	0.082	-0.042; 0.205	0.195	0.249	0.114; 0.384	< 0.001
9-12	0.103	0.001; 0.204	0.047	0.312	0.183; 0.440	< 0.001
> 12	0.072	-0.063; 0.206	0.294	0.390	0.245; 0.534	< 0.001

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[1] Correspondence
B. D. Schaan Serviço de Endocrinologia, Hospital das Clínicas de Porto Alegre. Rua Ramiro Barcelos 2350, prédio 12, 4º andar, Porto Alegre, RS 90035-003, Brasil. bschaan@hcpa.edu.br