Temporal trends in birthweight and its association with overweight/obesity in schoolchildren from a Brazilian city: a cross-sectional panel study (2002–2019)

Rossi, Camila Elizandra; Barboza, Bernardo Paz; Hinnig, Patrícia de Fragas; Vasconcelos, Francisco de Assis Guedes de

doi:10.1590/1516-3180.2025.3474.24042026

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Original Article • Sao Paulo Med. J. 144 (4) • 2026 • https://doi.org/10.1590/1516-3180.2025.3474.24042026 linkcopy

Temporal trends in birthweight and its association with overweight/obesity in schoolchildren from a Brazilian city: a cross-sectional panel study (2002–2019)

SCIMAGO INSTITUTIONS RANKINGS

BACKGROUND: Long-term metabolic complications in childhood are associated with birthweight.

OBJECTIVES: This study aimed to examine trends in the prevalence of low and high birthweight over a 16-year period and to investigate the association between birthweight and overweight/obesity among schoolchildren aged 7 to 10 years.

DESIGN AND SETTING: The analyses included four school-based cross-sectional surveys conducted in Florianópolis.

METHODS: The probabilistic panels were conducted in 2002, 2007, 2012–2013, and 2018–2019. Multiple logistic regression models were used to assess the associations between low and high birthweight and childhood overweight/obesity. Adjusted models included biological, socioeconomic, survey-period, and dietary-intake variables.

RESULTS: Over the 16-year period, low birthweight showed a progressive and statistically significant increase, rising by 58.3% from 2002 to 2018–2019. In contrast, the prevalence of high birthweight was 9.1% in 2002 and declined significantly over the ten-year period from 2002 to 2012–2013, decreasing by 40.7%. In the adjusted model, high birthweight was significantly associated with overweight/obesity across all study waves (OR = 1.63; 95% CI = 1.32–2).

CONCLUSION: A statistically significant upward trend in the prevalence of low birthweight was observed among schoolchildren in Florianópolis from 2002 to 2018–2019. Despite a reduction in high birthweight over time, high birthweight remained directly associated with overweight/obesity, independently of food intake and other confounding factors.

KEYWORDS (MeSH terms):
Infant; Low Birth Weight; High Birth Weight Infant; Child; Nutritional Status; Cross-Sectional Surveys

AUTHOR’S KEYWORDS:
Birth weight; Overweight; Obesity; Associated Factors; Cross-Sectional Panels; Temporal Trend

Parameters	2002	2007	2012–2013	2018–2019
Population of 7–10-year-old schoolchildren in the municipality	28.395	25.619	19.172	27.110
Total number of elementary schools in the municipality	122	87	85	82
Total number of schools included in the survey†	16	17	30	30
Prevalence of overweight/obesity (%)	10	10	38	39
Sampling error (%)	2	2	3.5 (two-tailed) with a 95% CI	3.5 (two-tailed) with a 95% CI
Design effect	2	1.3	1.8	1.8
Additional (losses/refusals)	–	10%	10%	10%
Expected final sample	–	1.210	1.440	1.430
Total number of invited students	3.313	1.350	2.234	3.098
Total number of students investigated	2.936	1.232	1.423	922
Participation rate	88.6%	91.2%	63.7%	29.8%

Food and beverage		Survey year
Item or food group		2002	2007	2012–2013	2018–2019
Dairy products	Milk/cheese	■	■	■
	Milk		■	■	■
	Cheese		■	■	■
	Coffee with milk		■	■	■
	Yogurt	■	■	■	■
Fruits and vegetables	Fruits	■	■	■	■
	Green leaves	■	■	■	■
	Legumes				■
	Vegetable soup		■	■	■
	Fresh juice	■	■	■	■
Fast food and processed meat	Hamburger/pizza	■	■	■
	French fries	■	■	■	■
	Sausages				■
	Fried snacks/hamburger/pizza/hot dogs				■
In natura animal protein	Beef/chicken	■	■	■	■
	Fish	■
	Fish/seafood		■	■	■
	Eggs	■			■
Major sources of carbohydrates	Cheese bread				■
	Pasta/bread/crackers	■	■	■
	Pasta				■
	Bread				■
	Breakfast cereal				■
	Rice	■	■	■	■
	Beans	■	■	■	■
	Manioc flour				■
	Corn/potato/mashed potato				■
	Cake without icing				■
Sweets	Cake with icing				■
	Candies	■	■	■	■
	Stuffed biscuits				■
	Chocolate				■
	Ice cream				■
Sugary drinks	Sodas/soft drinks	■	■	■	■
Sugary drinks	Chocolate milk	■	■	■	■
Highly processed food	Packaged chips-type snacks		■	■	■
Highly processed food	Instant pasta		■	■	■
	Water				■
Total		16	21	21	34

Characteristic		2002 (n = 2.243)			2007 (n = 1.177)			2012–2013 (n = 1.446)			2018/ 2019 (n = 828)			Final dataset (n = 5.694)
Characteristic		n	%/mean	95% CIa	n	%/mean	95% CIa	n	%/mean	95% CIa	n	%/mean	95% CIa	n	%/mean	95% CIa
Sex
	Male	1.094	48.8	46.7–50.8	572	48.6	45.7–51.4	680	47	44.5–49.6	366	44.2	40.9–47.6	2712	47.6	46.3–48.9
	Female	1.149	51.2	49.2–53.3	605	51.4	48.5–54.3	766	53	50.4–55.5	462	55.8	52.4–59.2	2982	52.4	51.1–53.7
School type
	Public	1.406	62.7	60.7–64.7	902	76.6 *	74.1–79	930	64.3	61.8–66.7	498	60.1	56.8–63.4	3736	65.6	64.4–66.8
	Private	837	37.3	35.3–39.3	275	23.4 *	21–25.9	516	35.7	33.3–38.2	330	39.9	36.6–43.2	1958	34.4	33.2–35.6
Birthweight (g)		2.243	3.313,3	3.229,2–3,397,5	1.177	3.300,4	3.211,7–3.389,2	1446	3.220,7	3.178,1–3.263,2	828	3.197,2	3.232,1–3.262,3	5694	3.264,8	3.250,2–3.279,3
Birthweightc
	LBW	134	6 *	5.1–7	97	8.2	6.8–10	141	9.7 *	8.3–11.4	79	9.5 *	7.7–11.7	451	7.9	7.2–8.6
	IBW	417	18.6	17–20.3	226	19.2	17.1–21.1	309	21.4	19.4–23.6	168	20.3	17.7–23.2	1120	19.7	18.6–20.7
	ABW	1.488	66.3	64.4–68.3	772	65.6	62.8–68.3	918	63.5	61–65.9	526	63.5	60.2–66.7	3704	65	63.8–66.3
	HBW	204	9.1 *	8–10.4	82	7	5.6–8.6	78	5.4 *	4.3–6.7	55	6.6	5.1–8.6	419	7.4	6.7–8
Weight statusd
	Without OW/OB	1.534	68.4	66.4–70.3	782	66.4	63.7–69.1	916	63.7	61.2–66.2	539	65.1	61.8–68.3	3707	66.3	65–67.5
	With OW/OB	709	31.6	29.7–33.6	395	33.6	30.9–36.3	521	36.3	33.8–38.8	289	34.9	31.7–38.2	1886	33.7	32.5–35

Variables		Overweight/obesitya
Variables		OR	95% CI	p value
Birthweight
	Adequate birthweight	Ref
	Low birthweight	0.8	0.64–1	0.053
	Insufficient birthweight	0.72	0.61–0.83	< 0.001
	High birthweight	1.62	1.32–2	< 0.001
Sex
	Male	Ref
	Female	0.73	0.65–0.82	< 0.001
Type of school
	Public	Ref
	Private	1.15	1.02–1.3	0.021
Fruit intake
	No	Ref
	Yes	0.93	0.82–1.04	0.238
Legumes or vegetables intake
	No	Ref
	Yes	0.93	0.83–1.05	0.305
Soft drinks intake
	No	Ref
	Yes	0.96	0.85–1.09	0.573
Sweets intake
	No	Ref
	Yes	0.8	0.71–0.91	< 0.001
Survey year
	2002	Ref
	2007	1.08	0.93–1.27	0.285
	2012–2013	1.22	1.05–1.42	0.008
	2018–2019	1.05	0.87–1.28	0.548

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[TFN1] ^†
School units were drawn based on geographic region, type of administration (public and private), and number of students.