High temporal, geographic, and income variation in body mass index among adults in Brazil

Effects of socioeconomic status on the obesity knowledge of adolescents from six Latin American cities

OBJECTIVE

To examine the effects of socioeconomic status (SES) on the obesity knowledge of adolescents in six Latin American cities.

DESIGN

Data were collected using an anonymous, self-administered questionnaire consisting of demographic questions and a 25-item multiple-choice obesity knowledge test. Test items were clustered under five topics: the fat and calorie content of foods and beverages; weight loss methods; energy expenditure; food preparation methods; and the relationship between obesity and health.

SUBJECTS

A total of 1272 ninth grade students from higher and lower SES families were recruited at schools in Buenos Aires, Argentina (n=195); Guatemala City, Guatemala (n=212); Havana, Cuba (n=213); Lima, Peru (n=218); Panama City, Panama (n=195); and Santiago, Chile (n=239).

RESULTS

Mean test scores reflected a low level of obesity knowledge among adolescents from higher and lower SES groups in all six cities. Nevertheless, a trend for higher scores emerged in favor of adolescents from wealthier families. This income effect persisted after controlling for gender and weight status. The weakest knowledge areas among youth from the higher SES groups were food preparation methods and the relationship between obesity and health while those for adolescents from the lower SES groups were the fat and calorie content of foods and beverages and the relationship between obesity and health. Classroom instruction about obesity was generally more available to students from the higher SES groups. The majority of adolescents from both SES groups were interested in learning more about weight loss methods, energy expenditure, and the fat and calorie content of foods and beverages. The topic of least interest was the relationship between obesity and health.

CONCLUSION

These preliminary findings suggest a need for more obesity education programs for adolescents, especially for those living in poverty.

[Physical activity in a probabilistic sample in the city of Rio de Janeiro]

This study evaluated physical activity in a probabilistic sample of 4,331 individuals 12 years of age and older residing in the city of Rio de Janeiro, who participated in a household survey in 1996. Occupation and leisure activity were grouped according to categories of energy expenditure. The study also evaluated number of hours watching TV, using the computer, or playing video-games. Only 3.6% of males and 0.3% of females reported heavy occupational work. A full 59.8% of males and 77.8% of females reported never performing recreational physical activity, and there was an increase in this prevalence with age, especially for men. Women's leisure activities involved less energy expenditure and had a lower median duration than those of men. Mean daily TV/video/computer time was greater for women than for men. The greater the level of schooling, the higher the frequency of physical activity for both sexes. Analyzed jointly, these data show the low energy expenditure through physical activity by the population of the city of Rio de Janeiro. Women, the middle-aged, the elderly, and low-income individuals were at greatest risk of not performing recreational physical activity.

Nutrition transition in Latin America: the case of Chile

The nutritional situation of Latin America is changing rapidly from one characterized by underweight and stunting to one where chronic diseases such as cancer, cardiovascular disease, and type 2 diabetes are increasingly prevalent. In Chile, under-nutrition has virtually disappeared, but rising obesity rates and risk factors for chronic diseases indicate the need to modify existing programs and emphasize prevention of diet-related chronic diseases.

[Changes in nutritional status of pregnant women assisted at the basic health network, Santo Andre, Brazil]

Nutritional conditions in the pre-gestacional period and during pregnancy were evaluated in 372 pregnant women based on the body mass index and Rosso's Graph. Approximately half (51%) the pregnant women presented normal pre-gestacional weight; however, 17.7% were underweight and 31.3% overweight. In the third trimester, 18.8% were underweight and 28.2% overweight. The weight at birth increased as nutritional conditions during pregnancy improved. These results show the importance of appropriate anthropometric control in order to prevent a bad neonatal prognosis and reaffirms the importance of such activity during the whole routine of pre-natal control.

[Prevalence of risk factors for cardiovascular disease in the Guaraní-Mbyá population of the State of Rio de Janeiro]

Social change has been involved in the unequal distribution patterns of chronic diseases in several populations. Among Indian communities experiencing life pattern changes, international studies have reported increased prevalence of hypertension and other cardiovascular risk factors. Such increased prevalence was ascertained in a survey conducted in 1999 in selected Guaraní-Mbyá communities (Sapukai, Paraty-Mirim, and Araponga) in the State of Rio de Janeiro, Brazil. A population census was carried out and interviews and clinical and biochemical evaluations were conducted with 80 men and 71 women. Observed prevalence of selected risk factors in the overall sample, including men and women, was as follows for the three communities: hypertension (4.8%, 2.6%, 7.4%); overweight (26.7%, 19.5%, 34.8%); total cholesterol levels (2.8%, 2.7%, 2.9%), and increased triglyceride levels (12.6%, 9.5%, 15.9%). All prevalence rates were higher among women and at older ages. The results suggest that the Guaraní communities have a moderate risk of chronic diseases and that measures to reduce these risk factors should be adopted.

Obesity trends in Latin America: transiting from under- to overweight

Latin America is undergoing a rapid demographic and nutritional transition. A recent WHO/PAHO survey on obesity in the region revealed an increasing trend in obesity as countries emerge from poverty, especially in urban areas. In contrast, in middle income countries, obesity tends to decline as income increases; this is especially so in women. Dietary changes and increasing inactivity are considered the crucial contributory factors that explain this rise. The end result is a progressive rise in overweight and obesity, especially in low income groups who improve their income and buy high fat/high carbohydrate energy-dense foods. Intake of these foods increases to the detriment of grains, fruits and vegetables. Most aboriginal populations of the Americas have changed their diet and physical activity patterns to fit an industrialized country model. They now derive most of their diet from Western foods and live sedentary and physically inactive lives. Under these circumstances they develop high rates of obesity, insulin resistance and type 2 diabetes. Supplementary feeding programs are common in the region; the number of beneficiaries significantly exceeds the malnourished. Weight-for-age definition of undernutrition without assessment of length will overestimate the dimension of malnutrition and neglect the identification of stunted overweight children. Providing food to low income stunted populations may be beneficial for some, although it may be detrimental for others, inducing obesity especially in urban areas. Defining the right combination of foods/nutrients, education and lifestyle interventions that are required to optimize nutrition and health is a present imperative.

Obesidade na adolescência: fator de risco para complicações clínico-metabólicas

Sessenta e seis adolescentes, sendo 38 obesos (25F/13M) e 28 não obesos (23F/5M), pareados pelo sexo, idade, cor; nível de escolaridade e estágio de maturação sexual, foram submetidos a um inquérito clínico-demográfico e à avaliação clínico-laboratorial. A relação cintura-quadril foi maior no grupo dos obesos do que nos não obesos (0,86±0,08 vs. 0,74±0,04; p< 0,01), assim como as medidas de pressão arterial sistólica e diastólica (120,2±12,1 vs. 105,4±9,1mmHg; p<0,01 e 74,3±7,7 vs. 65,5±9,4mmHg; p<0,01, respectivamente). A lesão dermatológica acanthosis nigricans predominou no grupo dos obesos (n= 24, 63,2%). Os obesos apresentaram valores de HDL-colesterol inferiores aos dos não obesos (36,5±10,5 vs. 43,0±9,2mg/dl, respectivamente; p< 0,05). Os níveis de triglicerídeos e ácido úrico foram maiores no grupo dos obesos se comparado aos não obesos (124,6±80,0 vs. 74,2±31,4mg/dl, respectivamente; p< 0,01 e 5,8±1,4 vs. 4,5±1,0mg/dl, respectivamente; p< 0,01). Não houve diferença nos valores de colesterol, LDL colesterol e na glicemia basal entre os dois grupos. Os adolescentes obesos procuraram tratamento na maioria das vezes movidos por uma preocupação com a saúde (n= 15, 39,5%). Um número significativo desses adolescentes já havia feito uso de medicamentos visando a perda ponderal no passado. Concluímos que a obesidade na adolescência pode estar relacionada a um perfil clínico-metabólico desfavorável, caracterizado por níveis mais elevados de pressão arterial sistólica e diastólica, triglicerídeos, ácido úrico, e mais reduzidos de HDL-colesterol; e ainda pela presença de acanthosis nigricans.

Influence of parental height and sociodemographic factors on adolescent height in Brazil

OBJECTIVE

To analyze the influence of parental stature and environmental factors on the stature of adolescents from a national survey sample.

METHODS

A nationwide survey was carried out in 1989 among a stratified, two-stage, probability cluster sample of 14,455 Brazilian households to provide estimates of anthropometric deficits for urban and rural populations from the five regions of the country. Stature was measured for 5681 boys and girls age 14-18 years, 78.9% of their fathers, and 93.8% of their mothers. Associations between explanatory variables and adolescent height in centimeters were assessed by fitting multiple linear models to the data.

RESULTS

The predicted effects of parental stature and environmental conditions together sum to a total of 17 cm when comparing a boy born to parents with stature below the median and living in the underdeveloped rural Northeast region (1.56 m) with one born to parents with stature above the median and living in the partially industrialized urban South region (1.73 m). For girls, this estimated difference was 12 cm. For boys, the overall influence of parents' stature was 10 cm (R(2)= 0.40) and the sociodemographic factors had an overall influence of 7 cm (R(2) = 0.29). For girls, these values were 7 cm (R(2)= 0.35) for the parental influence and 5 cm (R(2) = 0.11) for the sociodemographic factors.

CONCLUSIONS

Mother's stature had the same influence on adolescent's stature as father's stature. Independent of parental stature, environmental factors have a strong influence on adolescent stature, particularly among boys.

Prevalence of pre-obesity and obesity in urban adult Mexicans in comparison with other large surveys

OBJECTIVE

1. To estimate the prevalence of pre-obesity and obesity in a 1992 to 1993 national survey of the Mexican urban adult population. 2. To compare our findings with other national surveys and with data for Mexican Americans.

RESEARCH METHODS AND PROCEDURES

The national representative sample of the Mexican urban adult population included 8462 women and 5929 men aged 20 to 69 years from 417 towns of >2500 people. Body mass index (BMI), calculated from measured weight and height, was classified using the World Health Organization categories of underweight (BMI < 18.5 kg/m2), normal weight (BMI 18.5 to 24.9 kg/m2), pre-obesity (PreOB = BMI 25 to 29.9 kg/m2) and obesity (OB = BMI 30+ kg/m2). Estimates for Mexican Americans were calculated from U.S. survey data.

RESULTS

Overall, 38% of the Mexican urban adult population were classified as pre-obese and 21% as obese. Men had a higher prevalence of pre-obesity than women did at all ages, but women had higher values of obesity. Both pre-obesity and obesity increased with age up to the age range brackets of 40 to 49 or 50 to 59 years for both men and women. Both pre-obesity and obesity prevalence estimates were remarkably similar to data for Mexican Americans from 1982 through 1984. Comparison with other large surveys showed that countries differed more in the prevalence of obesity than of pre-obesity, leading to differences in the PreOB/OB ratio, and that countries also differed in the gender ratio (female/male) for both pre-obesity and obesity.

DISCUSSION

Pre-obesity and obesity were high in our population and increased with age. Our approach of characterizing large surveys by PreOB/OB and gender ratios appeared promising.

The obesity epidemic in children and adults: current evidence and research issues

PURPOSE

The term "epidemic" of obesity implies that obesity is a characteristic of populations, not only of individuals. The purpose of this paper is to review evidence on obesity in populations and to identify future research issues.

METHODS

To examine recent increases in the population prevalence of overweight or obesity, a literature search was undertaken.

RESULTS

Trends in overweight or obesity among adults showed considerable variability internationally. Some countries, including Canada, Finland (men), New Zealand, the United Kingdom, the United States, and Western Samoa showed large increases in prevalence (>5 percentage points), whereas several other countries showed smaller or no increases. Overweight is also increasing among children and adolescents, at least in some countries. It is not clear what the expected prevalence of overweight or obesity might be in the current environment, and these findings may be most usefully viewed as shifts in the distribution of a population characteristic. The reasons for these shifts are not clear. The health implications of these shifts are also not clear, in part because trends in cardiovascular risk factors do not always parallel trends in obesity. Of the classic epidemiologic triad of host, agent, and environment, the environment has often received the least attention.

CONCLUSIONS

The economic, social, and cultural factors that influence the distribution of body mass index in a population are not well understood. Future research needs include continued monitoring of trends in obesity and in related health conditions and observational studies to examine the causes of these trends. Public health research should aim at defining realistic goals and strategies to improve health in an environment conducive to high levels of overweight and obesity.

Reliability of self-reported weight and height among state bank employees

INTRODUCTION

Self-reported weight and height were compared with direct measurements in order to evaluate the agreement between the two sources.

METHODS

Data were obtained from a cross-sectional study on health status from a probabilistic sample of 1,183 employees of a bank, in Rio de Janeiro State, Brazil. Direct measurements were made of 322 employees. Differences between the two sources were evaluated using mean differences, limits of agreement and intraclass correlation coefficient (ICC).

RESULTS AND CONCLUSION

Men and women tended to underestimate their weight while differences between self-reported and measured height were insignificant. Body mass index (BMI) mean differences were smaller than those observed for weight. ICC was over 0.98 for weight and 0.95 for BMI, expressing close agreement. Combining a graphical method with ICC may be useful in pilot studies to detect populational groups capable of providing reliable information on weight and height, thus minimizing resources needed for field work.

[Anthropometric profile of employees from a government bank in the state of Rio de Janeiro, Brazil. 1 Body mass index and sociodemographic factors]

This study first describes the anthropometric profile of employees at Banco do Brasil and then compares these results to those of the Brazilian National Health and Nutritional Survey, PNSN/1989, for the Southeastern region of the country. It is a cross-sectional study with a sample comprising 647 bank clerks. Weight and height informed by respondents were used to compute the body mass index (BMI). Among bank clerks, 8.8% were underweight, 27.8% were overweight and 6.4% were obese. Overweight increased with age and was about 3 times greater in men than in women. Among social and demographic variables, sex, age, and schooling best explained BMI variance. For men, proportion of overweight was higher in bank clerks than in the PNSN population, while for women, PNSN showed higher frequencies of overweight as compared to female bank clerks. High prevalence of overweight in the general population, as well as in specific groups like bank clerks, highlights the urgent need for definition and development of prevention and control policies capable of impacting risk factors and ultimately leading to a decrease in social cost due to mortality from chronic diseases.

Relação entre o consumo alimentar e atividade física com índice de massa corporal em funcionários universitários

Nas últimas duas décadas observou-se um importante aumento da prevalência de obesidade no Brasil, contudo não existem dados populacionais atualizados sobre ingestão de alimentos e atividades físicas, que seriam em última instância os fatores que poderiam explicar este aumento de obesidade. Estudou-se a associação entre o consumo de calorias e gordura e a prática de atividades físicas com o índice de massa corporal, em um estudo transversal com 91 funcionários universitários. O consumo alimentar foi avaliado por um questionário semi-quantitativo de freqüência de consumo de alimentos e por quatro recordatórios de 24 horas. Peso e altura foram medidos e calculou-se o índice de massa corporal por meio da relação peso/altura em kg/m². As atividades físicas desenvolvidas no trabalho, no lazer e no deslocamento para o trabalho e/ou escola no mês que antecedeu a pesquisa foram investigadas através de questionário. Estimou-se o gasto energético associado às atividades físicas, através de equações propostas pela Organização Mundial da Saúde. Em análise linear multivariada associaram-se positivamente ao índice de massa corporal a idade (p=0,02), pertencer ao grupo de funcionários de nível médio e de apoio, comparados aos professores (p=0,004) e ser do sexo feminino (p=0,04). Ainda, nesta análise, um aumento de 500 calorias no gasto energético estimado equivaleu a uma redução de aproximadamente 2kg no peso de um indivíduo com 1,60m (p=0,008). Para os dois métodos usados para avaliação de consumo, a ingestão de calorias e de gordura associaram-se, significativamente, com o índice de massa corporal (p< 0,05), porém esta associação foi modificada pelo sexo, sendo negativa para as mulheres e fracamente positiva para os homens. Este estudo mostrou que o sexo feminino, nível socioeconômico e o gasto energético são preditivos de obesidade e sugere que mulheres obesas subestimam seu consumo alimentar.

[Factors associated with obesity among adolescents]

INTRODUCTION

Obesity during adolescence is considered a strong predictor of adult obesity. The present study assessed the overweight/obesity prevalence and associated factors in middle class adolescents of a school in the city of Niteroi, Rio de Janeiro, Brazil, and evaluated the correlation between body mass index with anthropometric measures of fatness.

METHOD

The analysis covered 391 students aged from 15 to 17 years. Adolescents had their weight, height, skinfold thickness and upper arm circumference measured at school. A food frequency questionnaire (list of 79 items) and a questionnaire including food habits, parents anthropometric characteristics, physical activity and other factors associated with obesity were filled out by the adolescents at school.

RESULTS

The proportion of overweight individuals among boys (Body Mass Index (BMI) greater than the 90th percentile of the Brazilian population) was 23.9%, whereas the prevalence among girls was 7.2%. The fact of being on a slimming diet was a relevant factor for the prediction of BMI and was 7 times more frequent among girls than among boys. Among boys, being on a diet, absence of breakfast, and family body appearance were positively associated with BMI. Among girls these variables were also significantly associated, whereas age at menarche was negatively associated with BMI. Hours of watching TV/video/video-game was associated with BMI only among boys. The correlation coefficient between BMI and measures of fatness varied from 0.7 to 0.9 for boys, and from 0.8 to 0.90 for girls.

CONCLUSIONS

BMI appears to be a good indicator of obesity among adolescents and showed that girls demonstrated an exaggerated preoccupation with body image and stereotyped slim body patterns.

Trends in Body Mass Index in Developing Countries

The purpose of this study was to examine the extent to which adult body mass index (BMI) has changed in developing countries over the past several decades. The analysis is based on a compilation and analysis of mean BMI in 1,432 published samples from developing countries measured between 1957 and 1994. A hierarchical multiple-regression model is applied to these data, controlling for country and study as random covariates and modelling age, sex, socio-economic status, and year as fixed effects. The results reveal a statistically significant increase in mean BMI between 1957 and 1994 in all major regions of the developing world. The size of the increase was 1.4 kg/m2 over the 37-year period, with a 95% confidence interval of 0.4 to 2.4 kg/m2. Mean BMI appears to have increased in all major regions of the developing world, although the size of the increase varies across regions. Using assumptions about the statistical distribution of BMI within populations and cut-off points recommended by the World Health Organization, the analysis suggests that the increase in mean BMI may have resulted in a slight decrease in the prevalence of underweight (BMI<18.5 kg/m2) but is unlikely to have produced an increase in obesity (BMI>30 kg/m2) in most regions. By contrast, the use of lower cut-off points to define obesity, as is done in many individual studies, would suggest that obesity has increased in developing countries. These results highlight the importance of using standardized definitions for underweight and obesity among adults, the need to assess and consider the prevalence of both conditions simultaneously during planning and policy development, and the need to identify policy instruments appropriate to the nutritional profile within a country.

Obesity in Latin American women and children

National surveys conducted since 1982 were used to assess maternal and child obesity in Latin American and Caribbean countries and in U. S. residents of Mexican descent. Obesity in women, a body mass index (BMI) >/=30 kg/m2, was 3% in Haiti, 8-10% in eight Latin American countries and 29% in Mexican Americans. Median BMI for Latin American women were near or above the 50th percentile of the general U.S. population; values exceeded the 75th percentile in the case of Mexican Americans. The prevalence of overweight (>1 SD above mean weight-for-height) in children 1-5 y of age ranged from 6% in Haiti to 24% in Peru among 13 countries. Overweight occurred in 24% of Mexican-American children. Prevalences of overweight in children and of obesity in women were greater in urban areas and in households of higher socioeconomic status. Overweight in children increased with higher maternal education; however, in some countries, obesity in women decreased with higher education. No general pattern of change over time was observed in eight countries in overweight in children. Obesity in women increased in the three countries with such data and in Mexican-American women and children. There was a tendency for greater national incomes to be associated with greater obesity levels in women and with lower levels of stunting in children. Levels of obesity in the region indicate a public health concern, particularly among women, considering that studies have identified mortality and morbidity risks associated with obesity in adults.

Factors affecting nutrition behavior among middle-class adolescents in urban area of Northern region of Brazil

INTRODUCTION

Brazil has been called a nation in nutrition transitional because of recent increases in the prevalence of obesity and related chronic diseases. With overweight conditions already prevalent among middle-income populations, there exists a need to identify factors that influence nutrition behavior within this group.

OBJECTIVE

To address this subject, a research study was implemented among middle-class adolescents attending a large private secondary school in Manaus, Amazonas, Brazil. The study determined the availability and accessibility of snack foods as well as subjects' attitudes and preferences towards, and the influence of family and friends on healthy (high-nutrient density) snack choices.

METHODS

The 4-stage process included: (a) a nutrition expert focus group discussion that reported local nutrition problems in general and factors related to adolescent nutrition, (b) an adolescent pilot survey (n = 63) that solicited information about snacking preferences and habits as well as resources for nutrition information and snack money: (c) a survey of various area food market sources to determine the availability and accessibility of high nutrient density snacks; and (d) a follow-up adolescent survey (n = 55) that measured snack food preferences and perceptions about their cost and availability.

RESULTS

Results included the finding that, although affordable high nutrient density snacks were available, preferences for low nutrient density snacks prevailed. The adolescents were reportedly more likely to be influenced by and obtain nutrition information from family members than friends.

CONCLUSION

From study results it is apparent that a focus on food availability will not automatically result in proper nutritional practices among adolescents. This fact and the parental influence detected are evidence of a need to involve adolescents and their parents in nutrition education campaigns to improve adolescent snack food choices.

[Prevalence and risk factors of obesity in adults]

INTRODUCTION

A population-based cross-sectional study was conducted in Pelotas, Southern Brazil, with the objective of determining the prevalence of obesity and identify associated, variables as this condition increased markedly in the country between 1974 and 1989.

MATERIAL AND METHODS

One thousand and thirty-five adults between 20 and 69 years of age were studied. Obesity was defined as a Body Mass Index--BMI--equal to or over 30 Kg/square meter). The multivariate analyses took into account the hierarchical model of the variables associated with obesity for both men and women.

RESULTS

The prevalence for the overall population was of 21% (CI 18-23). It was higher among women--25% (CI 22-29) than for men--15% (CI 12-18). Socioeconomic status was positively associated with obesity among men, whereas the opposite situation was reported for women, with those belonging to the poorest social strata presenting increased BMI. Reported obesity in their parents was associated with increased BMI in the subjects, and this association remained statistically significant even after compensating for the effect of possible confounding variables. Self-reported diabetes and arterial hypertension doubled the risk of obesity, whereas non-smoking was associated with obesity only among women. Variables which were not associated with obesity after adjusting for confounders were alcohol consumption, marital status and parity. Women having more daily meals were less prone to obesity, even after controlling for confounders, and this association was not quite significant for men (p = 0.07).

CONCLUSIONS

The prevalence of obesity was higher among women, and important differences in risk factors were noticed when the population was considered by sex.

Growth and body mass index of Brazilians ages 9 through 17 years

Obesity during adolescence is considered a strong predictor of adult obesity, and obesity and overweight have been increasing among Brazilian adults. To gauge the relative frequency of overweight among adolescents in Brazil, we compared the distributions of body mass index (kg/m2) and stature in national population based samples of the U.S. and Brazil. U.S. adolescents were on average about 10 cm taller than Brazilians, although growth spurts occurred at the same age for both populations. Brazilian adolescents were leaner than their U.S. counterparts. This difference was reduced among girls in the postpubertal period. At age 17 years, U.S. boys were about 10 kg heavier than Brazilian boys, but the difference among girls was only 2 kg. In families above the poverty level in the more developed South region, body mass index distribution for boys was closer to that of the U.S., and older girls tended to have higher body mass index than U.S. girls. Within Brazil, body mass index varied by ethnicity with Mulattos, but not Blacks, of both sexes having lower body mass index than Whites of the same age. Urban adolescents had higher body mass index than those living in rural areas. In general, the patterns seen among Brazilian adults were found among children. Among girls, in particular, overweight has become an identifiable problem during adolescence.

The nutrition transition in low-income countries: an emerging crisis

Scientists have long recognized the importance of the demographics and epidemiologic transitions in higher income countries. Only recently has it become understood that similar sets of broadly based changes are occurring in lower income countries. What has not been recognized is that concurrent changes in nutrition are also occurring, with equally important implications for resource allocation in many low-income countries. Several major changes seem to be emerging, leading to a marked shift in the structure of diet and the distribution of body composition in many regions of the world: a rapid reduction in fertility and aging of the population, rapid urbanization, the epidemiologic transition, and economic changes affecting populations in different and uneven ways. These changes vary significantly over time. In general, we find that problems of under- and overnutrition often coexist, reflecting the trend in which an increasing proportion of people consume the types of diets associated with a number of chronic diseases. This is occurring more rapidly than previously seen in higher income countries, or even in Japan and Korea. Examples from Thailand, China, and Brazil provide evidence of the changes and trends in dietary intake, physical activity, and body composition patterns.