title: Social inequalities in BMI trajectories: 8-year follow-up of the Pró-Saúde study in Rio de Janeiro, Brazil.
abstract: OBJECTIVE
  In a cohort of government employees in Rio de Janeiro, Brazil, we investigated prospectively, sex-specific associations between education and BMI trajectories and their potential effect modification by race.
  
  
  METHODS
  Of the 4030 participants in Phase 1 (1999), 3253 (81 %) participated in Phase 2 (2003) and 3058 (76 %) participated in Phase 3 (2006). Education was categorized as elementary, high school or college graduate. Study participants self-identified as White, Black or Pardo. BMI was calculated from measured weight and height. BMI trajectories were modelled using a generalized additive regression model with mixed effects (GAMM).
  
  
  METHODS
  The Pro-Saúde Study, a longitudinal investigation of social determinants of health.
  
  
  METHODS
  Women (n 1441) and men (n 1127) who participated in the three phases of data collection and had complete information for all study variables.
  
  
  RESULTS
  Women and men with less than high school, or only a high school education, gained approximately 1 kg/m(2) more than college graduates (women: 1·06 kg/m(2) (P<0·001) and 1·06 kg/m(2) (P<0·001), respectively; men: 1·04 kg/m(2) (P=0·013) and 1·01 kg/m(2) (P=0·277), respectively). For women only, race was independently associated with weight gain. Women identifying as Pardo or Black gained 1·03 kg/m(2) (P=0·01) and 1·02 kg/m(2) (P=0·10), respectively, more than Whites. No effect modification by race was observed for either men or women.
  
  
  CONCLUSIONS
  While both lower education and darker race were associated with greater weight gain, gender similarities and differences were observed in these associations. The relationship between weight gain and different indicators of social status are therefore complex and require careful consideration when addressing the obesity epidemic.
authors.affiliation: 1National School Public Health,Oswaldo Cruz Foundation,Rua Leopoldo Bulhões 1480,Room 813,Rio de Janeiro,RJ,CEP 21041-210,Brazil.
authors.forename: Dóra
authors.initials: D
authors.lastname: Chor
authors.affiliation: 2Centre of Statistics and Applications,University of Lisbon,Lisbon,Portugal.
authors.forename: Valeska
authors.initials: V
authors.lastname: Andreozzi
authors.affiliation: 1National School Public Health,Oswaldo Cruz Foundation,Rua Leopoldo Bulhões 1480,Room 813,Rio de Janeiro,RJ,CEP 21041-210,Brazil.
authors.forename: Maria J M
authors.initials: MJ
authors.lastname: Fonseca
authors.affiliation: 1National School Public Health,Oswaldo Cruz Foundation,Rua Leopoldo Bulhões 1480,Room 813,Rio de Janeiro,RJ,CEP 21041-210,Brazil.
authors.forename: Letícia O
authors.initials: LO
authors.lastname: Cardoso
authors.affiliation: 4Department of Epidemiology,Rollins School of Public Health,Emory University,Atlanta,GA,USA.
authors.forename: Sherman A
authors.initials: SA
authors.lastname: James
authors.affiliation: 5Institute of Social Medicine,Rio de Janeiro State University,Rio de Janeiro,Brazil.
authors.forename: Claudia S
authors.initials: CS
authors.lastname: Lopes
authors.affiliation: 5Institute of Social Medicine,Rio de Janeiro State University,Rio de Janeiro,Brazil.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Faerstein
mesh_terms: D000328:Adult; D015992:Body Mass Index; D001938:Brazil; D015331:Cohort Studies; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D006077:Government Agencies; D054624:Health Status Disparities; D019456:Health Transition; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status / Q000208:ethnology; D009765:Obesity / Q000191:economics / Q000453:epidemiology* / Q000208:ethnology; D050177:Overweight / Q000191:economics / Q000453:epidemiology* / Q000208:ethnology; D012737:Sex Factors; D012959:Socioeconomic Factors; D014504:Urban Health / Q000191:economics / Q000208:ethnology; D015430:Weight Gain / Q000208:ethnology
keywords: Cohort studies; Health status disparities; Race/ethnicity; Weight gain