Overweight and abdominal fat in adult population of Teresina, PI

Abstracts

OBJECTIVE: To determine prevalence of overweight and abdominal fat in adult population in the urban area of Teresina-PI. METHODS: Cross-sectional study with probabilistic sample by conglomerates. The study evaluated 464 adults, 20 to 59 years of age living in the urban area of Teresina-PI. Nutritional status was classified by the body mass index (BMI) and abdominal fat accumulation was estimated according to waist circumference. The significance level was set at 5% (p<0.05). RESULTS: Prevalence of overweight and obesity according to nutritional status based on BMI was, respectively, 30.0% and 7.7%. There was an increase in the proportion of overweight and obesity among men with progressively higher family income. Highest rates of obesity were found among individuals 50 to 59 years of age with stable marriages and nonsmokers. No association was found between individual or family income and presence of abdominal fat in the population. CONCLUSION: Prevalence of overweight in the study population follows the Brazilian trend. Proportions of overweight and obesity were higher among men and increased with age. Women and married persons showed a greater tendency for abdominal obesity.

Overweight; obesity; body mass index; waist circunference

OBJETIVO: Determinar a prevalência de excesso de peso e adiposidade abdominal em adultos residentes na zona urbana da cidade de Teresina-PI. MÉTODOS: Estudo transversal com amostra probabilística por conglomerados. Foram avaliados 464 adultos, entre 20 e 59 anos, residentes na zona urbana do município de Teresina-PI. O estado nutricional foi classificado com base no Índice de Massa Corporal (IMC), e o acúmulo de gordura abdominal foi estimado pela medida da circunferência da cintura. O nível de significância foi estabelecido em 5% (p<0,05). RESULTADOS: As prevalências de sobrepeso e obesidade segundo IMC foram, respectivamente, de 30% e 7,7%. Houve aumento na proporção de sobrepeso e obesidade entre os homens com o aumento da renda familiar. Maiores proporções de obesidade abdominal foram encontradas entre os indivíduos na faixa etária de 50 a 59 anos, com relação conjugal estável e não fumantes. Não houve associação entre a renda individual ou familiar com a presença de obesidade abdominal na população. CONCLUSÃO: A prevalência de excesso de peso na população do estudo segue tendência nacional. As proporções de sobrepeso e de obesidade foram maiores entre os homens e aumentaram com a idade. Mulheres e indivíduos com união conjugal estável mostraram maior tendência à obesidade abdominal.

Sobrepeso; obesidade; índice de massa corporal; circunferência da cintura

ORIGINAL ARTICLE

Overweight and abdominal in adult population of Teresina, PI

Lorena Guimarães Martins Holanda^I; Maria do Carmo de Carvalho e Martins^II; Manoel Dias de Souza Filho^III; Cecília Maria Resende Gonçalves de Carvalho^IV; Regina Célia de Assis^V; Lívia Maria Moura Leal^VI; Lorena Patrícia Leal Mesquita^VI; Emanuella Machado Costa^VI

^IM.D. from Universidade Federal do Piauí - UFPI, Teresina, PI, Brazil

^IIPhD in Biological Sciences; Professor of the Post-graduation Program on Food and Nutrition, UFPI; Professor of the Department of Biophysics and Professor of Faculdade NOVAFAPI, Teresina, PI, Brazil

^IIIM. Sc. in Sciences and Health; Professor of UFPI - Campus Ministro Reis Veloso, Parnaíba, PI, Brazil

^IVPhD in Nutrition Science from Universidade Estadual de Campinas; Professor of the Post-Graduation Programme, Food and Nutrition Department, of UFPI, Teresina, PI, Brazil

^VPhD in Biochemistry from Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo - USP; Professor of the Department of Biochemistry and Pharmacology of UFPI, Teresina, PI, Brazil

^VIM. D. from UFPI, Teresina, PI, Brazil

^{Corresponding author}

ABSTRACT

OBJECTIVE: To determine the prevalence of overweight and abdominal fat in the adult population in the urban area of Teresina, PI, Brazil.

METHODS: This is a cross-sectional study with probability sampling by conglomerates. The study evaluated 464 adults, 20 to 59 years of age, living in the urban area of Teresina, PI, Brazil. Nutritional status was classified according to body mass index (BMI), and abdominal fat accumulation was estimated according to waist circumference. The significance level was set at 5% (p < 0.05).

RESULTS: The prevalence of overweight and obesity according to nutritional status, based on BMI, was 30.0% and 7.7%, respectively. An increase in the proportion of overweight and obesity among men with progressively higher family income was observed. Higher rates of obesity were found among individuals 50 to 59 years of age with stable relationships and nonsmokers. An association between individual or family income and presence of abdominal fat was not observed in the population.

CONCLUSION: The prevalence of overweight in the study population follows the national trend. Proportions of overweight and obesity were higher among men and increased with age. Women and married individuals showed a greater tendency for abdominal obesity.

Keywords: Overweight; obesity; body mass index; waist-hip ratio.

Introduction

Obesity is a chronic disease and a known risk factor for several debilitating diseases, with a high social cost, such as type 2 diabetes, hypertension, strokes, cardiopathies, dyslipidemias, and some types of cancer¹.

The pattern of fat distribution can reveal some predisposition of an individual for developing complications, and it is widely known that central adiposity is associated to metabolic imbalances and cardiovascular risk². Thus, it has been demonstrated that abdominal obesity can increase in up to 10 times the risk for developing type 2 diabetes, besides also being a risk factor for hypertension in adults with ages between 20 and 45 years³.

The prevalence of overweight and obesity is universally increasing, achieving, according to estimates of the Pesquisa de Orçamentos Familiares (POF), approximately 40% and 12.7%, respectively, of the adult Brazilian population in 2002-2003⁴. The increased prevalence of overweight, both in developing and developed countries, is associated with a high incidence of a number of clinical and surgical pathologies⁵.

Anthropometry is the method used more often in obesity diagnosis, since it is cheaper, non-invasive, universally applicable, and has good acceptance by the population⁶. Body mass index (BMI) and waist circumference are among the most used anthropometric indicators. At a populational level, waist circumference is more practical and easy to use in large scale studies, as well as in health promotion actions, allowing the identification of levels of intervention in the population⁷.

The objective of the present study was to identify the prevalence of overweight and abdominal fat in adults in the urban area of Teresina, PI, Brazil.

Methods

This is a transversal, domiciliary-based study with probability sampling by conglomerates. Calculation of the sample size was based on POF, which estimated a 40% prevalence of overweight in the Brazilian adult population⁴. Confidence level of 95% and margin of error of 3% was established. The sample population was distributed in five strata, according to zoning provided by Census⁸, and redistributed in clusters corresponding to neighborhoods in each zone of Teresina, PI.

Parameters investigated were divided in two blocks. The first one included socio-demographic parameters, such as age, gender, marriage status, religion, race, number of persons residing in that house, schooling, and familial and individual income. The second block included anthropometric parameters, such as weight, height, body mass index (BMI), and waist circumference (WC).

Height and weight measurements were performed with the subject barefoot and wearing light clothes. Height was calibrated to the nearest 0.5 cm with a tape measure fixed vertically on a wall in order to make a 90 degree angle with the floor. Weight was measured using a portable scale, previously calibrated to the proximal 0.1 kg. Waist circumference was obtained by using a non-elastic tape measure with 0.5 cm scale, placed without applying pressure, in a horizontal plane, in the smaller circumference between the inferior border of the last rib and the iliac crest⁹.

Global nutritional state was classified according to body mass index (BMI), based on cutting points proposed by the WHO¹⁰. Normal weight was defined as BMI > 18.5 and < 25 kg/m²; overweight, BMI > 25 and < 30 kg/m²; and obesity as BMI > 30 kg/m². The expression overweight was used to define individuals with excess weight or obesity, i.e., individuals with BMI > 25 kg/m².

Weight circumference (WC) was used to identify the pattern of fat distribution, which, besides being associated with abdominal fat mass (subcutaneous and intra-abdominal), is considered as an indicator risk of cardiometabolic diseases¹¹. Waist circumference was classified, according to cut-off points suggested by the WHO¹⁰, as increased when equal or greater than 80 cm for females; equal or greater than 94 cm for males; and very increased when equal or greater than 88 cm for females and equal and greater than 102 cm for males.

This study was approved by the Ethics on Research Committee of Universidade Federal do Piauí. The study was conducted in compliance with the recommendations of Resolution 196/96 of the National Health Council on studies involving humans¹² and the Declaration of Helsinki¹³. All individuals enrolled signed an informed consent after explanations on the objectives and possible benefits and risks of the study.

Data were processed in the BioEstat 5.0¹⁴ and EpiInfo 6.04b¹⁵ programs. The level of significance was established at 5% (p < 0.05), and Analysis of Variance (ANOVA), Tukey post-hoc test, and Chi-square test were used for statistical analysis.

Results

Four hundred and sixty-four individuals, ages 20 to 59 years, with a mean age of 35.82 years, mostly females (64.6%), participated in this study. When evaluating the distribution of the study population regarding their nutritional state, we observed that 30% and 7.7% of adults were overweight or obese, respectively. Regarding gender, the proportion of overweight individuals, i.e., BMI greater than 25 kg/m², was 35.4% in females, and 42% in males (Table 1).

Table 2 shows the distribution of overweight and obesity prevalence of, based on BMI by socioeconomic characteristics of the population according to gender. Among individuals with stable relationships, 44.8% (p = 0.014) of females were overweight, while 54.8% of males were overweight (p = 0.0008). An association between individual income and prevalence of overweight and obesity was not observed in males and females, but an increased proportion of overweight and obesity was observed among males with increased familial income (p = 0.02).

We also observed that, among females aged 50 to 59 years, the proportion of overweight and obesity was 70.5% (p = 0.0001), while the proportion of overweight and obesity in males in the same age group was 50%. In the 40 to 49 age group, the proportion of males with overweight and obesity was 59.1% (p = 0.027) (Table 2).

It was also observed that 57.4% of the females physically active were obese or overweight (p = 0.0006), but the same did not apply to males (p = 0.57). Among women with higher education, approximately 24% had a BMI above 25 kg/m², although this proportion was higher in women who did not have the same degree of schooling (41.6%) (p = 0.02). Among males, a positive relationship between schooling and BMI was not observed (p = 0.71) (Table 2).

Regarding the results in Table 2, it was observed among female smokers a proportion of overweight and obesity of 24.1% (p = 0.0008), and this proportion among female non-smokers was 61.7%. Regarding male non-smokers, approximately 60% had a BMI above 25 kg/m², while among male smokers, the proportion was 36.4% (p = 0.04). As for family history of obesity, an association with overweight and obesity was not observed (p > 0.05)(Table 2).

Table 3 shows the distribution of abdominal obesity prevalence in both genders in the study population. Higher proportion of abdominal obesity in the age group of 50 to 59 years, stable relationship, and non-smokers (p < 0.05) was observed. Additionally, an association between individual or family income and abdominal obesity was not observed (p > 0.05).

Analysis of results in Table 3 shows that 61.3% of females who are physically active (p = 0.0002) and 43.6% of females who did not finish college (p = 0.01) had abdominal obesity. Besides, among males, an association between a family history of obesity and presence of abdominal obesity was observed (p = 0.04), but this relationship was not present in females (p = 0.62).

Discussion

WHO¹⁶ considers overweight and obesity, which affect all age groups, the main public health problems in the world. In the present study, the prevalence of overweight (30%) and obesity (7.7%) observed are similar to the national pattern⁴.

POF results regarding males revealed a prevalence of overweight and obesity of 41% and 8.9%, respectively. Among females, 40% are overweight and 13.1%, obese⁴. Analyzing the proportion of overweight and obesity between genders, we observed that approximately 28% of females and 33.5% of males were overweight, while a little over 7% of females and 8.5% of males were obese. These results were lower than those of Gigante et al.¹⁷ in a study on the prevalence of overweight and obesity and associated factors in Brazil, in which 39% of females and 47% of males were overweight and, in both genders, 11% were obese.

We observed that the proportion of overweight and obesity increase with age, and this characteristic is greater in females. These results are in agreement with the POF data of 2002-2003, in which obesity with age partially reproduces the pattern of overweight, which tends to increase more slowly and steadily with age in women (20 to 64 years) and more quickly in men (20 to 54 years)⁴.

Francischi et al.³ justified weight gain with aging due to factors such as reduction in basal metabolism due to loss of muscle mass, reduction of physical activities, and increase in food consumption.

When stratification by income is investigated, an increase in overweight and obesity prevalence with increased income was observed in males, which was also reported by Abrantes et al.¹⁸ On the other hand, Monteiro et al.¹⁹ observed greater prevalence of overweight and obesity in low income families.

In the present study, the prevalence of overweight and obesity, both identified by BMI and WC, was greater among those individuals in stable relationships, without difference between genders. The influence of marital status on nutritional status is not clear, since in some studies, such as that of Sarturi et al.²⁰, a positive relationship between those variables was not observed. On the other hand, in other studies, such as that by Rosmond and Björntorp, who demonstrated using waist/hip relationship that married women had a higher risk of obesity²¹.

Physical activities were associated with greater prevalence of overweight and obesity in females, but this association was not observed in males. This finding can be probably explained by the fact that many people start physical activities because they are overweight. These individuals would benefit from physical activities, since physically active individuals have better insulin sensitivity, glucose tolerance, and lipid metabolism, as well as lower morbidity and mortality than those with a sedentary lifestyle²².

An inverse relationship between overweight and schooling was observed in females, similar to the results of the study by Gigante et al.¹⁷; however, schooling was not associated with overweight in males.

Accumulation of abdominal fat is a more serious risk factor for cardiovascular diseases risk and changes in glucose-insulin homeostasis than generalized obsesity²³. A positive association between increased waist circumference and higher blood pressure levels has been demonstrated²⁴. In the present study, the presence of abdominal obesity evaluated by waist circumference was related to gender and age, corroborating the observations of Martins et al.²⁵ who observed an increased prevalence of abdominal obesity with age and in females. Unlike the study of Veras et al.²⁶, with college students, which did not observe a relationship between abdominal obesity and gender.

A strong concordance between the classification of obesity according to BMI and WC in females was observed. This was also observed by Velásquez-Meléndez et al.²³ who reported a concordance greater than 80% between overweight and obesity, determined by BMI and WC in women.

Regarding physical activities, the present study diverges from others, since a greater prevalence of abdominal obesity among physically active patients was observed, while other studies indicate a relationship between obesity and a sedentary lifestyle²⁷. As mentioned, this result is probably due to the fact that physically active individuals usually had weight problems.

In the present study, smoking was associated with obesity, as defined by BMI and WC, and greater prevalence of obesity was observed among non-smokers. Other studies also have reported higher prevalence of obesity among non-smokers and former smokers. However, these data should be carefully analyzed, since there is no conclusive evidence of direct association between smoking, easy weight loss and weight maintenance in stable condition, or the large effect of quitting on weight gain²⁸. On the other hand, even if smoking had a proven effect on weight gain, it would be much smaller than the benefits associated with healthier lifestyle habits, and cessation of smoking is among them².

Conclusion

The prevalence of overweight and obesity in the urban population of Teresina, PI, Brazil, follows the same trend of the Brazilian population, being a target group for health actions to control non-transmissible diseases and complications. The proportion of overweight and obesity was greater in males and increased with age, especially among females. Females showed a greater tendency for abdominal obesity, as well as individuals in stable relationships.

References

1. Field AE, Coakley EH, Must A, Spadano JL, Laird N, Dietz WH, et al. Impact of overweight on the risk of developing common chronic disease during a 10-year period. Arch Int Med. 2001; 161:1581-6.

2. Sousa RMRP, Sobral DP, Paz SMRS, Martins MCC. Prevalência de sobrepeso e obesidade entre funcionários plantonistas de unidades de saúde de Teresina-PI. Rev Nutr. 2007; 20:473-82.

3. Francischi RPP, Pereira LO, Freitas CS, Klopfer ML, Santos RC, Vieira P, et al. Obesidade: atualização sobre sua etiologia, morbidade e tratamento. Rev Nutr. 2000; 13:17-29.

4. Brasil. Ministério do Planejamento, Orçamento e Gestão. Instituto Brasileiro de Geografia e Estatística. Pesquisa de orçamento familiar 2002-2003. Análise da disponibilidade domiciliar de alimentos e do estado nutricional no Brasil. Rio de Janeiro: IBGE; 2004 p. 40-76.

5. Mancini MC, Carra MK. Dificuldade diagnóstica em pacientes obesos: parte I. [citado 5 nov 2010]. Rev Abeso. 2001; 3(3). Disponível em: http://www.abeso.org.br.

6. Organização Mundial da Saúde. Physical status: the use and interpretation of anthropometry. Geneva; WHO; 1995.

7. Olinto MTA, Nácul LC, Dias-da-Costa JS, Gigante DP, Menezes AM. B, Macedo S. Níveis de intervenção para obesidade abdominal: prevalência e fatores associados. Cad Saúde Pública. 2006; 22:1207-15.

8. Instituto Brasileiro de Geografia e Estatística. Censo Demográfico 2000. Características da população e dos domicílios. Rio de Janeiro: IBGE; 2001.

9. Centro Colaborador em Alimentação e Nutrição da Região Centro-Oeste/MS/UFJ. Antropometria. Manual de técnicas e procedimentos. Vigilância nutricional. 2ª ed. Goiânia; 2003.

10. Organização Mundial da Saúde. Division of Noncommunicable Diseases. Programme of Nutrition Family and Reproductive Health. Obesity: preventing and managing the global epidemic: report of a WHO consultation on obesity. Geneva; WHO; 1998.

11. Klein S, Allison DB, Heymsfield SB, Kelley DE, Leibel RL, Nonas C, et al. Waist circumference and cardiometabolic risk. Diabetes Care 2007; 30:1647-52.

12. Brasil. Ministério da Saúde. Conselho Nacional de Saúde. Comissão Nacional de Ética em Pesquisa. Resolução 196/96 sobre pesquisa envolvendo seres humanos. Brasília (DF); 1996.

13. World Medical Association. Declaration of Helsinki. Ethical principles for medical research involving human subjects. 59^th WMA General Assebly, Seoul; 2008.

14. Ayres M, Ayres JRM, Ayres DL, Santos AAS. Bioestat 5.0. Sociedade Civil Mamirauá. Pará; 2007.

15. Dean AG, Dean JA, Coulombier D, Brendel KA, Smith DC, Burton HA, et al. Epi Info, version 6.04: a word processing database and statistics program for a epidemiology on microcomputers. Atlanta: Centers for Disease Control and Prevention; 1996.

16. Organização Mundial de Saúde. Obesity: preventing and managing the global epidemic. Geneva; WHO; 2000.

17. Gigante DP, Moura EC, Sardinha LMV. Prevalência de excesso de peso e obesidade e fatores associados, Brasil, 2006. Rev Saúde Pública. 2009; 43:83-9.

18. Abrantes MM, Lamounier JA, Colosimo EA. Prevalência de sobrepeso e obesidade nas regiões Nordeste e Sudeste do Brasil. Rev Assoc Med Bras. 2003; 49:162-6.

19. Monteiro CA, Mondini L, Souza ALM, Popkin BM. Da desnutrição para a obesidade: a transição nutricional no Brasil. In: Monteiro CA. Velhos e novos males da saúde no Brasil: a evolução do país e de suas doenças. 2ª ed. São Paulo: Hucitec, Nupens-USP; 2000, p. 247-55.

20. Sarturi JB, Neves J, Peres KG. Obesity in adults people: a population based study in a small town in South of Brazil, 2005. Ciênc Saúde Coletiva. 2010; 15:105-13.

21. Rosmond R, Björntorp P. Psychosocial and socioeconomic factors in women and their relationship to obesity and regional body fat distribution. Int J Obes Relat Metab Disord. 1999; 23:138-45.

22. Blair SN. Evidence for success of exercise in weight loss and control. Ann Intern Med. 1993; 119:702-6.

23. Velásquez-Meléndez G, Kac G, Valente JG, Tavares R, Silva CQ, Garcia ES. Evaluation of waist circumference to predict general obesity and arterial hypertension in women in Greater Metropolitan Belo Horizonte, Brazil. Cad Saúde Pública. 2002; 18:765-71.

24. Martins MCC, Ricarte IF, Rocha CHL, Maia RB, Silva VB, Veras AB, et al. Pressão arterial, excesso de peso e nível de atividade física em estudantes de universidade pública. Arq Bras Cardiol. 2010; 95:192-9.

25. Martins IS, Marinho SP. O potencial diagnóstico dos indicadores da obesidade centralizada. Rev. Saúde Pública. 2003; 37:760-7.

26. Veras AB, Sousa LG, Assis RC, Souza Filho MD, Martins MCC. Level of Physical Activity and Nutritional Status of Students at a Public University in Brazil. The FIEP Bulletin. 2009; 79:648-52.

27. Björntorp P. Body fat distribution, insulin resistence, and metabolic disease. Nutrition 1997; 13:795-03.

28. Gruber J, Frakes M. Does falling smoking lead to rising obesity? J Health Econ. 2006; 25:183-97.

Submitted on: 07/24/2010

Approved on: 09/30/2010

Conflict of interest: None.

Received from Universidade Federal do Piauí - UFPI, Teresina, PI

References

• 1. Field AE, Coakley EH, Must A, Spadano JL, Laird N, Dietz WH, et al. Impact of overweight on the risk of developing common chronic disease during a 10-year period. Arch Int Med. 2001; 161:1581-6.
• 2. Sousa RMRP, Sobral DP, Paz SMRS, Martins MCC. Prevalência de sobrepeso e obesidade entre funcionários plantonistas de unidades de saúde de Teresina-PI. Rev Nutr. 2007; 20:473-82.
• 3. Francischi RPP, Pereira LO, Freitas CS, Klopfer ML, Santos RC, Vieira P, et al. Obesidade: atualização sobre sua etiologia, morbidade e tratamento. Rev Nutr. 2000; 13:17-29.
• 5. Mancini MC, Carra MK. Dificuldade diagnóstica em pacientes obesos: parte I. [citado 5 nov 2010]. Rev Abeso. 2001; 3(3). Disponível em: http://www.abeso.org.br
• 6. Organização Mundial da Saúde. Physical status: the use and interpretation of anthropometry. Geneva; WHO; 1995.
• 7. Olinto MTA, Nácul LC, Dias-da-Costa JS, Gigante DP, Menezes AM. B, Macedo S. Níveis de intervenção para obesidade abdominal: prevalência e fatores associados. Cad Saúde Pública. 2006; 22:1207-15.
• ⁸ Instituto Brasileiro de Geografia e Estatística. Censo Demográfico 2000. Características da população e dos domicílios. Rio de Janeiro: IBGE; 2001.
• ⁹ Centro Colaborador em Alimentação e Nutrição da Região Centro-Oeste/MS/UFJ. Antropometria. Manual de técnicas e procedimentos. Vigilância nutricional. 2ª ed. Goiânia; 2003.
• 10. Organização Mundial da Saúde. Division of Noncommunicable Diseases. Programme of Nutrition Family and Reproductive Health. Obesity: preventing and managing the global epidemic: report of a WHO consultation on obesity. Geneva; WHO; 1998.
• 11. Klein S, Allison DB, Heymsfield SB, Kelley DE, Leibel RL, Nonas C, et al. Waist circumference and cardiometabolic risk. Diabetes Care 2007; 30:1647-52.
• 12. Brasil. Ministério da Saúde. Conselho Nacional de Saúde. Comissão Nacional de Ética em Pesquisa. Resolução 196/96 sobre pesquisa envolvendo seres humanos. Brasília (DF); 1996.
• ¹³ World Medical Association. Declaration of Helsinki. Ethical principles for medical research involving human subjects. 59^th WMA General Assebly, Seoul; 2008.
• 14. Ayres M, Ayres JRM, Ayres DL, Santos AAS. Bioestat 5.0. Sociedade Civil Mamirauá. Pará; 2007.
• 15. Dean AG, Dean JA, Coulombier D, Brendel KA, Smith DC, Burton HA, et al. Epi Info, version 6.04: a word processing database and statistics program for a epidemiology on microcomputers. Atlanta: Centers for Disease Control and Prevention; 1996.
• 16. Organização Mundial de Saúde. Obesity: preventing and managing the global epidemic. Geneva; WHO; 2000.
• 17. Gigante DP, Moura EC, Sardinha LMV. Prevalência de excesso de peso e obesidade e fatores associados, Brasil, 2006. Rev Saúde Pública. 2009; 43:83-9.
• 18. Abrantes MM, Lamounier JA, Colosimo EA. Prevalência de sobrepeso e obesidade nas regiões Nordeste e Sudeste do Brasil. Rev Assoc Med Bras. 2003; 49:162-6.
• 19. Monteiro CA, Mondini L, Souza ALM, Popkin BM. Da desnutrição para a obesidade: a transição nutricional no Brasil. In: Monteiro CA. Velhos e novos males da saúde no Brasil: a evolução do país e de suas doenças. 2Ş ed. São Paulo: Hucitec, Nupens-USP; 2000, p. 247-55.
• 20. Sarturi JB, Neves J, Peres KG. Obesity in adults people: a population based study in a small town in South of Brazil, 2005. Ciênc Saúde Coletiva. 2010; 15:105-13.
• 21. Rosmond R, Björntorp P. Psychosocial and socioeconomic factors in women and their relationship to obesity and regional body fat distribution. Int J Obes Relat Metab Disord. 1999; 23:138-45.
• 22. Blair SN. Evidence for success of exercise in weight loss and control. Ann Intern Med. 1993; 119:702-6.
• 23. Velásquez-Meléndez G, Kac G, Valente JG, Tavares R, Silva CQ, Garcia ES. Evaluation of waist circumference to predict general obesity and arterial hypertension in women in Greater Metropolitan Belo Horizonte, Brazil. Cad Saúde Pública. 2002; 18:765-71.
• 24. Martins MCC, Ricarte IF, Rocha CHL, Maia RB, Silva VB, Veras AB, et al. Pressão arterial, excesso de peso e nível de atividade física em estudantes de universidade pública. Arq Bras Cardiol. 2010; 95:192-9.
• 25. Martins IS, Marinho SP. O potencial diagnóstico dos indicadores da obesidade centralizada. Rev. Saúde Pública. 2003; 37:760-7.
• 26. Veras AB, Sousa LG, Assis RC, Souza Filho MD, Martins MCC. Level of Physical Activity and Nutritional Status of Students at a Public University in Brazil. The FIEP Bulletin. 2009; 79:648-52.
• 27. Björntorp P. Body fat distribution, insulin resistence, and metabolic disease. Nutrition 1997; 13:795-03.
• 28. Gruber J, Frakes M. Does falling smoking lead to rising obesity? J Health Econ. 2006; 25:183-97.

Publication Dates

• Publication in this collection
  25 Feb 2011
• Date of issue
  Feb 2011

History

• Received
  24 July 2010
• Accepted
  30 Sept 2010