Influence of Socioeconomic Status on the Prevalence of Stunted Growth and Obesity in Prepubertal Indonesian Children

Prevalence of Childhood Short Stature, Underweight, Overweight, and Obesity Among Primary School Children

Background This study, the first of its kind in Morocco, was conducted to compare the prevalence of growth disorders among children enrolled in public, private, urban, and rural schools in Oujda-Angad Province. Methods A cross-sectional observational study was conducted among primary schools in Oujda-Angad Province from November 2017 to April 2018, with a stratified random cluster sampling of public, private, urban, and rural primary schools. Results A representative sample of 1582 students aged from five to 15 years old was selected. The sample included 779 females (49.2%) and 803 males (50.8%), with an average age of 9.3 ± 1.96 years. The average weight of the students was 29.3 ± 9.6 kg (range: 12-130 kg), the average height was 133.7 ± 12.16 cm (range: 104.5-175.5 cm), and the mean body mass index (BMI) was 16.05 ± 3.31 kg/m² (range: 8.33-76.9 kg/m²). Overall, short stature (SS) and underweight were significantly more prevalent in the public and rural schools, while obesity was highest in the urban private schools that ranked as the schools with the highest socioeconomic status (SES) students (p < 0.01). Female students were more likely to be overweight and obese, while male students were more likely to be underweight. Conclusion Our study provides an estimate of the prevalence of excess weight, underweight, and short stature in a primary school population. Our results reflect the importance of the problem, the need to monitor the nutritional status at both the individual and the community level, and the need to put in place preventive, diagnostic, and early management strategies before the problem worsens.

The double burden of malnutrition and dietary patterns in rural Central Java, Indonesia

Background

Indonesia is undergoing a nutrition transition (NT) comprised of rising rates of overweight/obesity and consumption of high fat food/snacks but is still struck by undernutrition, causing a double burden of malnutrition. Little research pertains to the double burden of malnutrition and its associations with diet in rural Indonesia using primary village level data.

Methods

We conducted a 24-hour food recall and food frequency questionnaire and assessed anthropometric status of rural villagers from four villages in Central Java, Indonesia. Exploratory principal component analysis was used to identify dietary patterns and multi-level modeling was performed to identify variables associated with dietary pattern indicative of the NT.

Findings

1,521 participants were included in analysis. Double burden of malnutrition was prevalent whereby 32.3% of children were stunted, 68.8% of women 35–49 years-old were overweight, and 39% of homes were classified as double burden. The NT was evident in a dietary pattern associated with soft drink, snacks, and animal products. There was small but significant correlation between undernutrition and stunting status among children (r = −0.139, p < 0.01). The NT was associated with young age (B = 1.696, 95% CI = 1.508–1.885) but not with overweight (B = −0.099, 95% CI = −0.184–−0.013).

Interpretation

Our findings suggest that whilst the typical pattern of the double burden of malnutrition (stunted child/overweight adult) exists in rural Central Java, dietary patterns indicative of the NT are predominant among children, not adults. Overweight among adults may not be necessarily due to a diet indicative of the NT, and nutrition interventions in rural Central Java should focus on educating parents of young children about the health-risks of a diet associated with a NT.

Funding

Funding was obtained from the UBS-Optimus Foundation and the National Health and Medical Research Council.

Decomposition of socioeconomic inequality in growth disorders to its determinants in pediatric population: the CASPIAN IV study

Purpose

The current study aims to evaluate socioeconomic inequality in growth disorders and its determinants in Iranian children and adolescents.

Methods

In this nationwide cross-sectional survey, 14,880 students aged 6-18 years were selected through multistage cluster sampling method from urban and rural areas of 30 provinces of Iran in 2011. Socioeconomic status (SES) was calculated using principle component analysis. Socioeconomic inequality in growth disorders (including; underweight, excess weight, overweight, general obesity, abdominal obesity, and short stature) was assessed using concentration index (C) and slope index of inequality (SII). The Oaxaca Blinder decomposition method was used to determine determinants of this inequality.

Results

Totally, 13,486 students participated in this study (participation rate: 90.6%), comprising 50.8% boys and 75.6% urban inhabitants. Their mean age was 12.47 ± 3.36 years with no significant gender difference. The prevalence of excess weight, overweight, and general and abdominal obesity increased linearly as SES increased, and the prevalence of underweight and short stature decreased linearly as SES increased. The C index for underweight and short stature was negative, which suggests that inequality was in favor of high SES groups, and regarding overweight, excess weight, general and abdominal obesity, the index was positive, indicating that inequality was in favor of in low SES groups.

Conclusion

Our findings show a considerable inequality in prevalence of growth disorders in Iranian children and adolescents. These findings provide practical information for health policies and programs.

Household socioeconomic status in relation to childhood general and central obesity in Farrokhshahr, Iran

BACKGROUND

Although the association between socioeconomic status (SES) and general/central obesity has extensively been examined, limited data are available in this regard among children. The aim of this study was to examine the association between household SES and obesity among children.

METHODS

This cross-sectional study was done in Farrokhshahr, Iran, among primary school children aged 6-12 years in 2009. SES was examined using participants' and their parents' oral responses to a pretested questionnaire. In the current study, participants were classified based on tertiles of SES score to low, medium, and high SES categories. General as well as central obesity was defined based on age- and sex-specific national cut-off points.

RESULTS

Comparing individuals in the highest versus lowest tertile of SES, there was no significant difference in mean waist circumference (WC), but those in the middle tertile of SES had greater means of body mass index (BMI) than those in the lowest tertile after controlling for potential confounders (16.19 ± 0.27 vs. 15.27 ± 0.27 kg/m2, P = 0.002). We observed a greater chance of general obesity for those in the highest tertile of SES compared with those in the lowest tertile [odds ratio (OR): 4.00, 95% confidence interval (CI): 1.53-10.59, Ptrend = 0.004]. No significant association was seen between SES and central obesity, either before or after controlling for potential confounders.

CONCLUSION

We found that children in the highest SES class had a greater chance of general obesity than those in the lowest SES class. There was no significant association between SES and central obesity.

Childhood stunting in Thailand: when prolonged breastfeeding interacts with household poverty

BACKGROUND

Childhood stunting, defined as the height-for-age standardized score lower than minus two, is one of the key indicators for assessing well-being and health of a child; and can be used for monitoring child health inequalities. Thailand has been successful in improving health and providing financial protection for its population. A better understanding of the determinants of stunting will help fill both knowledge and policy gaps which promote children's health and well-being. This study assesses the factors contributing to stunting among Thai children aged less than five years.

METHODS

This study obtained data from the Multiple Indicator Cluster Survey Round 4 (MICS4), conducted in Thailand in 2012. Data analysis consisted of three steps. First, descriptive statistics provided an overview of data. Second, a Chi-square test determined the association between each covariate and stunting. Finally, multivariable logistic regression assessed the likelihood of stunting from all independent variables. Interaction effects between breastfeeding and household economy were added in the multivariable logistic regression.

RESULTS

In the analysis without interaction effects, while the perceived size of children at birth as 'small' were positively associated with stunting, children in the well-off households were less likely to experience stunting. The analysis of the interactions between 'duration of breastfeeding' and 'household's economic level' found that the odds of stunting in children who were breastfed longer than 12 months in the poorest household quintile were 1.8 fold (95% Confidence interval: 1.3-2.6) higher than the odds found in mothers from the same poorest quintiles, but without prolonged breastfeeding. However prolonged breastfeeding in most well-off households (those between the second quintile and the fifth wealth quintile) did not show a tendency towards stunting.

CONCLUSIONS

Childhood stunting was significantly associated with several factors. Prolonged breastfeeding beyond 12 months when interacting with poor economic status of a household potentiated stunting. Children living in the least well-off households were more prone to stunting than others. We recommend that the MICS survey questionnaire be amended to capture details on quantity, quality and practices of supplementary feeding. Multi-sectoral nutrition policies targeting poor households are required to address stunting challenges.

Relationships Among Perceived and Actual Motor Skill Competence and Physical Activity in Indonesian Preschoolers

This study examined the feasibility of recruiting and collecting data of Indonesian preschooler’s fundamental motor skill (FMS) competence, perceived motor competence, and physical activity in school. A secondary purpose was to explore the relationship among perceived motor competence, FMS competence, school day physical activity behaviors, playground physical activity behaviors, and sex of Indonesian preschoolers from urban and rural environments. Preschoolers (N = 66; n = 35 rural, n = 31 urban) were evaluated on the Pictorial Scale of Perceived Movement Skill Competence (PMSC), Perceived Physical Competence subscale (PPC). FMS competence was evaluated using the Test of Gross Motor Development-3. Three-day accelerometry at school yielded percent of school day and percent of playground time spent in moderate-to-vigorous physical activity (MVPA) and sedentary behaviors. Children spent 80% of the school day in sedentary behavior and 7% in MVPA. There were sex differences (p < .05) in ball skills favoring boys, and location differences on sedentary playground behaviors (p < .05) with rural children being more sedentary. Children felt “pretty good” about their motor skills (3.29–3.46) on the PPC and PMSC. Regression analyses revealed that location and locomotor skills predicted 13.8% of playground sedentary behaviors; PPC and locomotor skills explained 13.3% of MVPA on the playground; and ball skills predicted 7.7% of PPC. These findings emphasize the need for early motor skill and physical activity interventions and highlight the importance of perceived motor competence.

A review of child stunting determinants in Indonesia

Child stunting reduction is the first of 6 goals in the Global Nutrition Targets for 2025 and a key indicator in the second Sustainable Development Goal of Zero Hunger. The prevalence of child stunting in Indonesia has remained high over the past decade, and at the national level is approximately 37%. It is unclear whether current approaches to reduce child stunting align with the scientific evidence in Indonesia. We use the World Health Organization conceptual framework on child stunting to review the available literature and identify what has been studied and can be concluded about the determinants of child stunting in Indonesia and where data gaps remain. Consistent evidence suggests nonexclusive breastfeeding for the first 6 months, low household socio-economic status, premature birth, short birth length, and low maternal height and education are particularly important child stunting determinants in Indonesia. Children from households with both unimproved latrines and untreated drinking water are also at increased risk. Community and societal factors-particularly, poor access to health care and living in rural areas-have been repeatedly associated with child stunting. Published studies are lacking on how education; society and culture; agriculture and food systems; and water, sanitation, and the environment contribute to child stunting. This comprehensive synthesis of the available evidence on child stunting determinants in Indonesia outlines who are the most vulnerable to stunting, which interventions have been most successful, and what new research is needed to fill knowledge gaps.

Overweight and obesity in Indonesia: prevalence and risk factors-a literature review

OBJECTIVES

Overweight/obesity is a problem faced by both high- and low- and middle-income countries. This review aimed to report published data on the prevalence of overweight and obesity in Indonesian children, adolescents, and adults, along with the associated risk factors.

STUDY DESIGN

Literature review.

METHODS

We conducted a literature search for articles published in English (through Medline via OvidSP, Scopus, Global Health via OvidSP and Web of Science electronic databases) and Indonesian languages (several websites, direct contact with Indonesian public health researchers, practitioners and Ministry of Health staff) from earliest to March 2016. We screened the results and ensured the quality of included studies with Loney's tools for critically appraising prevalence or incidence studies.

RESULTS

We included 17 papers on the topic which were available in full text and passed the critical appraisal process. The prevalence of overweight/obesity has increased over the past two decades in Indonesian children, adolescents and adults. Prevalence rates are higher in boys than girls among children, but higher in females in the adolescent and adult age groups. The prevalence of overweight/obesity is also higher in those living in urban areas and with higher income or education.

CONCLUSIONS

Overweight/obesity is a serious public health problem in Indonesia with a continuing increase in its prevalence. Interventions at the household level and beyond are needed to successfully lower the prevalence of overweight/obesity in the country.

The current prevalence and regional disparities in general and central obesity among children and adolescents in Shandong, China

BACKGROUND

Childhood obesity has increased dramatically during the past decades, both in developing and developed countries. The present study examined the prevalence and regional disparities in general and central obesity among children and adolescents in Shandong, China.

METHODS

A total of 30,459 students (15,249 boys and 15,210 girls) aged 7-18years participated in the study. Height, weight and waist circumference (WC) of all subjects were measured, body mass index (BMI) and waist-to-height ratio (WHtR) were calculated. The BMI cutoff points recommended by the International Obesity Task Force (IOTF) were used to define general obesity. Central obesity was defined as WHtR≥0.5. Both BMI and WHtR were used to define three types of obesity as follows: general obesity only, central obesity only and combined obesity.

RESULTS

The overall prevalences of general obesity only, central obesity only and combined obesity were 10.99, 8.47 and 8.70% for boys and 9.47, 5.12 and 3.19% for girls, respectively. The sum of the prevalence of the three types of obesity was 28.16% for boys and 17.78% for girls, boys had higher prevalence of obesity than girls (P<0.01). Substantial urban-rural and regional disparities exist in childhood obesity, children and adolescents from urban, coastal and high socioeconomic status (SES) districts showed a higher prevalence of obesity than their counterparts from rural, inland and low SES districts (P<0.01).

CONCLUSION

The widespread prevalence of obesity in children and adolescents has become an important public health concern. Results from this study also suggested that the additional measurement of WC (WHtR) is better than BMI alone to identify obese individuals, distinguishing the types of obesity and examining the prevalence of various types of obesity is useful in practice.

Prevalence of Overweight and Obesity among Children and Adolescents in Shandong, China: Urban-Rural Disparity

BACKGROUND

The pattern of urban-rural disparity in childhood obesity varies across countries. The present study examined the change trend of urban-rural disparity in childhood overweight and obesity from 1985 to 2014 in Shandong, China.

METHODS

Data for this study were obtained from four cross-sectional surveys of school children carried out in 1985, 1995, 2005 and 2014 in Shandong Province, China. In this study, 39 943 students aged 7-18 years were included (14 458 in 1985, 7198 in 1995, 8568 in 2005 and 9719 in 2014). Height and weight of all subjects were measured; body mass index (BMI) was calculated from their height and weight. The BMI cutoff points recommended by the International Obesity Task Force were used to define overweight and obesity.

RESULTS

The prevalence of overweight and obesity was increasing continuously both in urban and rural areas over the past 29 years (1985-2014). The prevalence of combined overweight and obesity was significantly higher in urban than in rural children and adolescents in 1985, 1995 and 2005 (p < 0.01). However, a rapid increase in the prevalence of combined overweight and obesity was observed in rural areas after 2005; as a result, the urban-rural disparity was getting narrower, and no significant urban-rural disparity was observed in 2014 (p > 0.05).

CONCLUSION

The change trend of urban-rural disparity should be concerned in the future; policies and interventions focused on childhood overweight and obesity should pay attention to rural areas.

Stunting coexisting with overweight in 2·0-4·9-year-old Indonesian children: prevalence, trends and associated risk factors from repeated cross-sectional surveys

Objective

The persistence of undernutrition, along with overweight and obesity, constitute the double burden of malnutrition. The present study aimed to: (i) describe the prevalence and trends of concurrent stunting and overweight in Indonesian children; (ii) identify potentially associated risk factors; and (iii) determine whether stunted children are at greater risk of overweight compared with those of healthy height.

Design

A secondary data analysis of children aged 2·0–4·9 years in four cross-sectional studies of the Indonesian Family Life Survey. Children’s height and BMI Z-scores were calculated based on the WHO Child Growth Standards (2006). We defined ‘concurrent stunting and overweight’ as height-for-age Z-score <−2 and BMI Z-score >+1. Multivariate generalised linear latent and mixed models were used to determine associated risk factors.

Setting

Thirteen out of twenty-seven provinces in Indonesia.

Subjects

Children (n 4101) from four waves of the Indonesian Family Life Survey (1993–2007).

Results

There were inconsistent trends in the prevalence of concurrent stunting and overweight from waves 1 to 4. Children were more likely to be stunted and overweight when they were in the youngest age group (2·0–2·9 years), were weaned after the age of 6 months, had short-statured mothers or lived in rural areas. Stunted children were significantly more likely to be overweight than healthy-height children (OR>1) but did not differ significantly different across each wave (OR=1·34–2·01).

Conclusions

Concurrent stunting and overweight occurs in Indonesian children aged 2·0–4·9 years. Current policies and programmes need to be tailored for the management of this phenomenon.

Prevalence of Growth Disorders in a Nationally Representative Sample of Iranian Adolescents According to Socioeconomic Status: The CASPIAN-III Study

BACKGROUND

This study aims to assess the prevalence of growth disorders among a nationally representative sample of Iranian adolescents according to the socioeconomic status (SES) of their living area.

METHODS

This nationwide cross-sectional survey was conducted among a representative sample of 5624 adolescents aged 10-18 years. They were selected by multistage cluster sampling from 27 provinces of Iran. Subnational classification of the country was based on geography and social class of each region. Analysis of variance and Chi-square tests were used to compare the prevalence of growth disorders according to sex and SES of the living regions.

RESULTS

The mean and standard deviation for body mass index was 19.42 (4.09) kg/m(2), with a significant trend from the Southeast region with lowest SES to the Central part with highest SES (p(trend) < 0.001). The prevalence of obesity, combined overweight and obesity, as well as abdominal adiposity increased with a significant trend from low to high SES (all p(trend) < 0.001, except for girls' height, p(trend) = 0.003). The opposite direction was documented for the prevalence of underweight and short stature, with the highest frequencies in the Southeast (lowest SES) and the lowest in Central part (highest SES).

CONCLUSION

Excess weight was more prevalent in high SES regions, whereas underweight and short stature were more prevalent in low SES regions. These findings underscore the necessity of implementing evidence-based health promotion programs and preventive strategies according to SES.

Weight disorders and anthropometric indices according to socioeconomic status of living place in Iranian children and adolescents: The CASPIAN-IV study

BACKGROUND

Excess weight in children and adolescents is a multi-factorial phenomenon and associated with earlier risk of obesity-related diseases. This study aims to assess the prevalence of weight disorders and the mean values of anthropometric indices according to regional, socioeconomic, and urban-rural variations among Iranian children and adolescents.

MATERIALS AND METHODS

This nationwide study was performed in 2011-2012 among a representative multi-stage cluster sample of 14,880 Iranian students aged 6-8 years. The World Health Organization (WHO) reference curves were used to define weight disorders. Abdominal obesity was defined as the waist-to-height ratio (WHtR) of more than 0.5. Iran was classified into four regions according to the socioeconomic status (SES).

RESULTS

The mean (95% confidence interval) of body mass index (BMI), waist circumference (WC), and hip circumference (HC) was 18.8 (18.7, 18.9) kg/m(2), 67.0 (66.7, 67.3) cm, and 80.8 (80.3, 81.2) cm, respectively. The prevalence of underweight was 12.2%. A total of 9.7%, 11.9%, and 19.1% of students overweight, obese, and abdominally obese, respectively. The highest mean of BMI, WC, wrist circumference, HC, and WHtR were related to the second high SES (North-northeast) area (19.2 [18.8, 19.5], 68.3 [67.3, 69.4], 14.8 [14.7, 15.0], 82.6 [81.1, 84.0], and 0.464 [0.460, 0.468]). In contrast, the lowest SES (Southeast) region had the lowest mean of these anthropometric indices (17.6 [17.1, 18.2], 63.2 [61.7, 64.8], 14.5 [14.2, 14.8], 76.9 [74.9, 79.0], and 0.439 [0.434, 0.444]).

CONCLUSION

We found considerable differences in the prevalence of anthropometric measures throughout the country by SES of the region. Health policy making and implementing health strategies should consider SES of regions.

Urban environments and obesity in southeast Asia: a systematic review, meta-analysis and meta-regression

Many environmental factors contribute to the rise in prevalence of obesity in populations but one key driver is urbanization. Countries in Southeast (SE) Asia have undergone rapid changes in urbanization in recent decades. The aim of this study is to provide a systematic review of studies exploring the relationship between living in an urban or rural environment (urbanicity) and obesity in Southeast Asia. In particular, the review will investigate whether the associations are uniform across countries and ages, and by sex. The literature search was conducted up to June 2014 using five databases: EMBASE, PubMed, GlobalHealth, DigitalJournal and Open Grey. Forty-five articles representing eight of the eleven countries in SE Asia were included in the review. The review found a consistent positive association between urbanicity and obesity in countries of Southeast Asia, in all age groups and both genders. Regional differences between the associations are partly explained by gross national income (GNI). In countries with lower GNI per capita, the association between urbanicity and obesity was greater. Such findings have implications for policy makers. They imply that population level interventions need to be country or region specific, tailored to suit the current stage of economic development. In addition, less developed countries might be more vulnerable to the negative health impact of urbanization than more developed countries.

Prevalence and regional distribution of childhood overweight and obesity in Shandong Province, China

BACKGROUND

The rising prevalence of childhood obesity was observed in China. This study assessed the prevalence and district distribution of childhood obesity in Shandong Province, China.

METHODS

A cross-sectional study was conducted in the province. A total of 42 275 students (21 222 boys and 21 053 girls) aged 7-18 years from 16 districts participated in this study. Height and body weight of all subjects were measured, and the body mass index (BMI) was calculated. The prevalence of overweight and obesity was obtained according to the International Obesity Task Force (IOTF) cut-offs.

RESULTS

In 2010, the prevalence rates of combined overweight and obesity reached 26.86% in urban boys, 18.32% in rural boys, 14.36% in urban girls, and 11.31% in rural girls, respectively. An increasing trend was observed in the prevalence of overweight and obesity from the low socioeconomic status (SES) group to the moderate and high SES groups. The prevalence rates of combined overweight and obesity in the three SES groups were 18.46%, 21.08% and 27.31% in boys and 10.43%, 12.42% and 15.18% in girls, respectively.

CONCLUSIONS

There is a high level of overweight and obesity among children and adolescents in Shandong Province, China. The distribution of childhood obesity is positively associated with the regional SES.

Prevalence of Overweight, Obesity, and Thinness among Urban School-Aged Children and Adolescents in Southern Nigeria

Background

Overweight and obesity are public health problems all over the world because of their devastating social, economic, and health consequences, and they coexist with undernutrition in developing countries. Yet, there are few data on the magnitude of these problems in Nigeria.

Objective

To assess the prevalence of overweight, obesity, and thinness among urban school-aged children and adolescents.

Methods

A cross-sectional study of 1,599 children and adolescents 5 to 18 years of age was conducted. The subjects were randomly selected from schools in four urban towns (Lagos, Port Harcourt, Nsukka, and Aba) in southern Nigeria. A validated and pretested questionnaire was used to collect information on the background of the children and adolescents and their parents' socioeconomic status. Weight and height measurements were taken, and body mass indexes were calculated. Overweight, obesity, and thinness were defined according to the International Obesity Task Force cutoff points for children and adolescents 2 to 18 years of age. The data were analyzed by descriptive statistics, cross tabulations, and chi-squared tests.

Results

The prevalence rates of overweight, obesity, and thinness were 11.4%, 2.8%, and 13.0%, respectively. More females (3.7%) than males (1.8%) were obese ( p < .05). The prevalence of overweight was higher among adolescents 10 to 18 years of age (13%) than among children 5 to 9 years of age (9.4%) (p < .001) and was highest (23.1%) at age 15 years. Thinness was significantly more prevalent among children (19.0%) than adolescents (8.3%) ( p < .001) and was highest (28.6%) at age 7 years. Age- and sex-related increases and decreases were observed in the prevalence of overweight, obesity, and thinness. The rates of overweight, obesity, and thinness were affected by location and income levels.

Conclusions

The prevalence rates of overweight and obesity are increasing among urban Nigerian children and adolescents and are of equal magnitude to the prevalence of undernutrition.

Regional, socioeconomic and urban-rural disparities in child and adolescent obesity in China: a multilevel analysis

AIM

To study socio-demographic patterns of obesity in Chinese children and adolescents.

METHODS

Data came from the 2005 cycle of the Chinese National Survey on Student's Constitution and Health. In all, 231,326 subjects aged 7-18 years, distributed across 622 schools and 30 provinces, were analysed. Multilevel modelling was used to estimate variations at individual, school area and province levels.

RESULTS

The prevalence of obesity varied enormously across different areas. Young people living in high socioeconomic and urban areas had higher body mass index (BMI) and higher odds of overweight and obesity than those living in lower socioeconomic and rural areas. Subjects living in provinces with a higher standard of living, as indicated by less perinatal mortality, lower Engel coefficient, and higher personal expenditure on health had higher BMI and higher odds of overweight and obesity than those living in less affluent provinces. An interaction between gender and urbanicity revealed that boys in urban areas were especially prone to obesity.

CONCLUSION

In contrast to most present-day high income countries, obesity among young people in China is associated with affluence and urban residence. Intervention and strategy for obesity prevention should be targeting high socioeconomic families in urban areas, perhaps with particular focus on boys.

Are birth weight and maternal smoking during pregnancy associated with malnutrition and excess weight among school age children?

In the late 1980's child malnutrition was still prevalent in Brazil, and child obesity was beginning to rise in the richest regions of the country. To assess the extent of the nutritional transition during the period and the influence of birth weight and maternal smoking on the nutritional condition of schoolchildren, we estimated the prevalence of excess weight and malnutrition in a cohort of Brazilian schoolchildren from 1987 to 1989. We calculated the body mass index (BMI) of 8- to 10-year-old schoolchildren born in Ribeirão Preto in 1978/79. We considered children with a BMI <5th percentile (P5) to be malnourished, children with P5 > or = BMI<P85 to be thin and normal, and children with BMI > or = P85 to be overweight. We evaluated the association of these nutritional disorders with birth factors (infant weight, sex, preterm delivery, number of pregnancies, maternal smoking during pregnancy, marital status, and schooling) and type of school using nominal logistic regression. A total of 2797 schoolchildren were evaluated. There was a significant prevalence of malnutrition (9.5%) and excess weight already tended to increase (15.7%), while 6.4% of the children were obese. Excess weight was more prevalent among children attending private schools (odds ratio, OR = 2.27) and firstborn children (OR = 1.69). Maternal smoking during pregnancy protected against malnutrition (OR = 0.56), while children with lower birth weight were at higher risk for malnutrition (OR = 4.23). We conclude that a nutritional transition was under way while malnutrition was still present, but excess weight and related factors were already emerging.