Open Access
Original Article, Biomed Biopharm Res., 2022; 19(1):31-41
doi: 10.19277/bbr.19.1.278; pdf version [+]Portuguese html version [PT] 


Anthropometric evaluation of pre-school and school-age children from the European Macaronesian region

Nelson Tavares*, Tatiana Silva, Cíntia Ferreira-Pêgo

CBIOS – Universidade Lusófona’s Research Center for Biosciences & Health Technologies, Campo Grande 376, 1749-024 Lisboa, Portugal

*current affiliation: Natiris, Portugal

corresponding author: This email address is being protected from spambots. You need JavaScript enabled to view it.



The growing prevalence of childhood obesity has triggered an interest in the effects of excessive weight gain in childhood. The identification of overweight and obese children at an early stage and their referral to start a treatment designed to achieve and/or maintain a healthy weight comprise fundamental foundations in sustaining a healthy state. A cross-sectional analysis was conducted to assess the prevalence of normal weight, overweight, and obesity in preschool and school children in the archipelago of Madeira and Azores, and the Canary Islands. The sample included 3481 individuals (1,768 boys and 1,713 girls) aged 3 to 9 years. The prevalence of pre-obesity (20.90% vs. 16.50%) and obesity (14.10% vs. 13.00%) was higher in girls and the Odds Ratio of overweight and obesity was higher in girls and between 4 and 9 years. The boys from Madeira and the Azores and the girls from Madeira had a higher probability [1.30 (1.02-1.67)] of having a high Body Mass Index. The results expose the need for educational strategies and interventional measures that contribute to the control of childhood obesity.


Keywords: Anthropometric evaluation; Children; European Macaronesia; Obesity; Overweight

Received:31/12/2021; Accepted: 22/03/2022



Obesity is characterized as a multifactorial disease that has been described as having a dynamic phase (becoming obese) and a static phase (maintenance of a given level of obesity). Its cause has been traced to physiological and behavioral factors and not simply the result of excessive feeding. The treatment for obesity is extremely complex and is not fully resolving, focusing on physiological theories (focusing on genetics, metabolic rates, and fat cells), behavioral (focusing on physical activity and food intake) and restrictive (analysing the effects of (mental) cognitions on the physiological process of (bodily) feeding).

Childhood obesity has triggered an exponential increase in interest in the effects resulting from excessive weight gain in childhood, due to the progressive increase in its rate and the fact that the development of adipose cellularity in this period is determinant in the patterns of body composition of an adult individual (1), as well as a potential instigator of comorbidities such as type 2 diabetes mellitus, hypertension, nonalcoholic fatty liver, obstructive sleep apnea and dyslipidemias (2). In addition to these integral factors in health areas, obesity also carries unnecessary financial burdens and therefore its prevention is extremely relevant, as well as the identification of overweight and obese children at an early stage so that they can be referred to initiate treatment aiming to achieve and/or maintain a healthy weight (3).

Many studies carried out in several countries worldwide have shown a significant and growing number of overweight or obese children, such as Israel, which has increased its prevalence from 5.8% to 11.9%, and Malta, which has grown from 7.4% to 13.4% (4), revealing that childhood obesity has become a challenging problem.

In Portugal, approximately 31.6% of children aged 7 to 8 years presented as overweight (including obesity) (5). Some studies that investigated the prevalence of overweight and obesity in childhood and adolescence, including students from schools in the archipelagos of Madeira and the Azores (6–10), have found high levels of obesity (11). In Spain, specifically in the Canary Islands, 32.8% of individuals analyzed aged between 2 and 24 years are overweight, of whom 18% presented obesity (12), placing it as the autonomous community with one of the highest rates of childhood obesity in the entire Spanish territory (13,14). But few studies in Portugal and Spain assess the prevalence of overweight (including obesity) with preschool and school children and in this sense, considering all the pretexts mentioned above, the primary objective of the present analysis was the evaluation of anthropometric data of a sample of preschool and school children and subsequent assessment of the prevalence of normal weight, overweight and obesity in the region designated as European Macaronesia.


Materials and Methods

Design and study population

The present study consisted of a cross-sectional analysis to evaluate the prevalence of normal weight, overweight, and obesity in preschool and school children from European Macaronesia, namely the archipelagos of Madeira, Azores, and the Canary Islands. Participants aged between 3 and 9 years were randomly recruited from public schools in the municipality of Câmara de Lobos (Madeira Island) and the islands of São Miguel, Faial, and Terceira, all included in the Azores archipelago, and from private schools on the island of Gran Canaria. The inclusion criteria of the children involved the written consent of the parents (according to the Helsinki Declaration), not presenting apparent disease, and being present on the day scheduled for the visit. The evaluations took place during the school years 2016/2017 (in the Madeira archipelago) and 2018/2019 (in the Azores archipelago and the Canary Islands). The effective sample size of the present study was 3481 participants, and the sample was not representative of the general population either in terms of age, gender or region.

Anthropometric parameters assessment

Trained personnel measured weight using an electronic scale, recording the value to the nearest decigram (0.1 kg), and height using a calibrated stadiometer. Stature was assessed with the children standing upright, with their backs to the stadiometer and with their feet and knees together, their heads positioned so that the gaze remained horizontal, according to the Frankfurt plane (16). The value was recorded to the nearest millimeter (0.1 cm). All the participants wore lightweight clothing and no shoes during the measurements. Body Mass Index (BMI) was subsequently calculated from the measurements obtained in each child using the normalized formula [Weight (in kg)/ Height2 (in m)] (17). Normal weight, overweight, and obesity were classified using the international age and gender cut-off points according to those proposed by the International Obesity Task Force (IOTF) (15).

Statistical analysis

Data were presented either as means and standard deviation (SD) for continuous variables or numbers and percentages for dichotomous variables. We compared the distribution of the selected characteristics between groups using χ2 tests for categorical variables or Student’s t-tests or analysis of variance (ANOVA), as appropriate, for continuous variables. 

Logistical regression models were fitted to assess the associations between presenting a BMI corresponding to overweight and/or obesity cutoff (dependent variable) and gender (two categories), age (seven categories), or archipelago (three categories) as exposure. The models were adjusted for gender, age, and archipelago, except when any of these variables were the independent variable. All statistical tests were two-tailed and the significance level was set at p<0.05. All analyses were performed using the SPSS software version 26.0 (SPSS Inc, Chicago, IL, USA).


Results and Discussion

A total of 3481 individuals (1768 boys and 1713 girls) from the Azores, Madeira, and Canary Island took part in the present analysis with a mean age of 6.48 years (SD:1.96).

The general characteristics of the studied population according to gender are summarized in Table 1. No statistical differences were found regarding age, weight, and BMI in the studied population. However, height was significantly different between boys and girls, with girls being shorter.

Table 2 shows the anthropometric measurements for each age category assessed, split by gender. Boys were statistically taller than girls at age 5 (1.14 m vs. 1.12 m), 6 (1.20 m vs. 1.19 m), and 8 (1.32 m vs. 1.31 m). Additionally, boys aged 5 years old were statistically heavier than girls (21.86 kg vs. 20.84 kg) of the same age.

Female children were more overweight and obese than boys at all ages, except for overweight at age 9. Nevertheless, it should be noted that these relations were not statistically significant. However, when the analysis was performed considering the entire sample, not divided by age categories, it was found that girls were significantly more overweight (20.90% vs. 16.50%) and obese (14.10% vs. 13.00%) compared to boys (Table 3).

The odds ratio of presenting BMI corresponding to overweight and obesity according to IOTF children cutoff (Table 4) were significantly higher for girls and participants at age 4, 5, 6, 7, 8, and 9 years old in the full-adjusted model. When the comparison was performed according to gender, it was found that boys older than 6 years old and girls older than 5 years old presented a higher probability of being overweight and/or obese. In the same line of analysis, an odds ratio analyses was also conducted according to the archipelago of residence. Children from Azores and Madeira presented a higher risk of being overweight and/or obese, taking into consideration Canary Island as a reference. When the analysis was performed divided by gender, it was noted that boys from Madeira and Azores, and only girls from Madeira presented a higher probability [1.30 (1.02-1.67)] of presenting BMI over the recommendations.

These findings were consistent with previous reports (8,16,17) indicating that girls had a higher prevalence of overweight (including obesity) in early childhood. Regarding the prevalence of overweight and/or obesity as a function of the location of individuals, several studies have described that some of the highest levels of obesity in the world are found in island populations (18–22), as is the case in the Azores, Madeira and Canary Islands. These results can be explained by a number of factors, including low levels of physical activity and a decrease in consumption of traditional, fresh, local island foods, such as fish, meat, and fruits and vegetables, which have been replaced by a high energy density diet (22). However, to the best of our knowledge this publication is the first to describe this data and to evaluate exclusively anthropometric data in children aged between 3 and 9 years in the archipelagos of Madeira, Azores and Canary Islands. More studies are needed, however, to better understand the sociodemographic variables that could explain the results obtained. The present study was not focused or integrated with the evaluation of explanatory variables, therefore, future studies are necessary to clarify the behaviors that can trigger this condition. In this view, an inherent limitation to this study include the fact that lifestyle behaviors (eating habits, physical activity, and sedentary behaviors) of the children were not evaluated (23). Additionally, it was not possible to collect data in Cape Verde for their integration and processing in the current study. These results emphasize the importance of educational strategies and intervention measures at early ages that contribute to effective control of childhood obesity, reducing its rates (24,25).



The results obtained at the present work revealed a significantly higher prevalence of overweight and obesity in female participants of almost all ages analyzed and residents of the Azores and Madeira archipelago. These findings expose the need for better and new educational strategies, public health policies, and interventional measures at early ages in a way to contribute to effective control of childhood obesity worldwide.


Authors Contributions Statement

N.T. conceptualization and study design; N.T. experimental implementation and data collection; C.F.-P. data analysis; N.T., T.S., C.F.-P. drafting, editing, and reviewing; C.F.-P tables; N.T., C.F.-P. supervision and final writing.



Cíntia Ferreira Pêgo is funded by Foundation for Science and Technology (FCT) Scientific Employment Stimulus contract with the reference number CEEC/CBIOS/NUT/2018. This work is funded by national funds through FCT - Foundation for Science and Technology, I.P., under the UIDB/04567/2020 and UIDP/ 04567/2020 projects.



The authors would like to express thanks to all participants in the study.


Conflict of Interests

The authors declare there are no financial and/or personal relationships that could present a potential conflict of interests.



  1. Soares, L.D., Petroski, E.L. (2003) Prevalência, fatores etiológicos e tratamento da obesidade infantil. Revista brasileira de cineantropometria & desempenho humano, 5(1):63–74.
  2. Kumar, S., & Kelly, A. S. (2017). Review of Childhood Obesity: From Epidemiology, Etiology, and Comorbidities to Clinical Assessment and Treatment. Mayo Clinic proceedings92(2), 251–265.
  3. Güngör, N. K. (2014). Overweight and obesity in children and adolescents. Journal of clinical research in pediatric endocrinology6(3), 129–143.

4.. Nittari, G., Scuri, S., Petrelli, F., Pirillo, I., di Luca, N. M., & Grappasonni, I. (2019). Fighting obesity in children from European World Health Organization member states. Epidemiological data, medical-social aspects, and prevention programs. La Clinica terapeutica170(3), e223–e230. /

  1. Rito, I., Graça, P. Childhood Obesity Surveillance Initiative: relatório COSI Portugal 2013 [Internet]. 2015 [cited 2022 Feb 21] p. 36. Available from:
  2. Gouveia, É., Freitas, D., Maia, J., Beunen, G., Claessens, A., Marques, A., Thomis, M., Almeida, S., Lefevre, J. (2009). Prevalência de sobrepeso e de obesidade em crianças e adolescentes na Região Autónoma da Madeira, Portugal. Acta Pediátrica Portuguesa, 40(6), 245-251.
  3. Freitas, D., Beunen, G., Maia, J., Claessens, A., Thomis, M., Marques, A., Gouveia, E., & Lefevre, J. (2012). Tracking of fatness during childhood, adolescence and young adulthood: a 7-year follow-up study in Madeira Island, Portugal. Annals of human biology39(1), 59–67.
  4. Rito, A., Wijnhoven, T. M., Rutter, H., Carvalho, M. A., Paixão, E., Ramos, C., Claudio, D., Espanca, R., Sancho, T., Cerqueira, Z., Carvalho, R., Faria, C., Feliciano, E., & Breda, J. (2012). Prevalence of obesity among Portuguese children (6-8 years old) using three definition criteria: COSI Portugal, 2008. Pediatric obesity7(6), 413–422.
  5. Wijnhoven, T. M., van Raaij, J. M., Spinelli, A., Rito, A. I., Hovengen, R., Kunesova, M., Starc, G., Rutter, H., Sjöberg, A., Petrauskiene, A., O'Dwyer, U., Petrova, S., Farrugia Sant'angelo, V., Wauters, M., Yngve, A., Rubana, I. M., & Breda, J. (2013). WHO European Childhood Obesity Surveillance Initiative 2008: weight, height and body mass index in 6-9-year-old children. Pediatric obesity8(2), 79–97.
  6. Freitas, A. I., Moreira, C., & Santos, A. C. (2019). Time trends in prevalence and incidence rates of childhood overweight and obesity in Portugal: Generation XXI birth cohort. International journal of obesity (2005)43(2), 424–427.
  7. Ferreira-Pêgo, C., Carrapa, A., Gaipo, S., Parece, T., Marinho, R., Dias, T., Viveiros, F., Carvalho, R., César, R., Tavares, N. (2019) Anthropometric evaluation of pre-school and school age children from Azores archipelago, Portugal. Biomedical and Biopharmceutical Research,16(2): 165-175.
  8. Ferreira-Pêgo, C., Galván, E., Morales, S., Fábregas, J., Martín, Y., Tavares, N. (2019) Anthropometric evaluation of children aged between 3 and 9 years from Canary Island. Biomedical and Biopharmceutical Research,16(2):153–64.
  9. Pérez-Rodrigo, C., Aranceta Bartrina, J., Serra Majem, L., Moreno, B., & Delgado Rubio, A. (2006). Epidemiology of obesity in Spain. Dietary guidelines and strategies for prevention. International journal for vitamin and nutrition research. Internationale Zeitschrift fur Vitamin- und Ernahrungsforschung. Journal international de vitaminologie et de nutrition76(4), 163–171.
  10. Serra Majem, L., Ribas Barba, L., Aranceta Bartrina, J., Pérez Rodrigo, C., Saavedra Santana, P., & Peña Quintana, L. (2003). Obesidad infantil y juvenil en España. Resultados del Estudio enKid (1998-2000) [Childhood and adolescent obesity in Spain. Results of the enKid study (1998-2000)]. Medicina clinica121(19), 725–732.
  11. Cole, T. J., Bellizzi, M. C., Flegal, K. M., & Dietz, W. H. (2000). Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ (Clinical research ed.)320(7244), 1240–1243.
  12. Ng, M., Fleming, T., Robinson, M., Thomson, B., Graetz, N., Margono, C., Mullany, E. C., Biryukov, S., Abbafati, C., Abera, S. F., Abraham, J. P., Abu-Rmeileh, N. M., Achoki, T., AlBuhairan, F. S., Alemu, Z. A., Alfonso, R., Ali, M. K., Ali, R., Guzman, N. A., Ammar, W., … Gakidou, E. (2014). Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet (London, England)384(9945), 766–781.
  13. Rito, A. I., Paixão E., Carvalho M.A., Ramos, C. (2011) Childhood Obesity Surveillance Initiative: COSI Portugal 2008.
  14. Garza, J. R., Pérez, E. A., Prelip, M., McCarthy, W. J., Feldman, J. M., Canino, G., & Ortega, A. N. (2011). Occurrence and correlates of overweight and obesity among island Puerto Rican youth. Ethnicity & disease, 21(2), 163–169.
  15. Athanasopoulos, D. T., Garopoulou, A. I., & Dragoumanos, V. P. (2011). Childhood obesity and associated factors in a rural Greek island. Rural and remote health11(4), 1641.
  16. Schwiebbe, L., van Rest, J., Verhagen, E., Visser, R. W., Holthe, J. K., & Hirasing, R. A. (2011). Childhood obesity in the Caribbean. The West Indian medical journal60(4), 442–445.
  17. Grech, V., & Farrugia Sant'Angelo, V. (2009). Body mass index estimation in a school-entry aged cohort in Malta. International journal of pediatric obesity : IJPO : an official journal of the International Association for the Study of Obesity4(2), 126–128.
  18. Curtis M. (2004) The Obesity Epidemic in the Pacific Islands. Journal of Development and Social Transformation, 1:37–42. .
  19. Ferreira, M., Faria, V., Sousa, B., Tavares, N. (2019) Evaluation of the nutritional status in pre-school and school children, Madeira Island, Portugal. Biomedical and Biopharmceutical Research,16(1):8–18.
  20. Pereira, S. A., Seabra, A. T., Silva, R. G., Katzmarzyk, P. T., Beunen, G. P., & Maia, J. A. (2010). Prevalence of overweight, obesity and physical activity levels in children from Azores Islands. Annals of human biology37(5), 682–691.
  21. Penilla, C., Tschann, J. M., Sanchez-Vaznaugh, E. V., Flores, E., & Ozer, E. J. (2017). Obstacles to preventing obesity in children aged 2 to 5 years: Latino mothers' and fathers' experiences and perceptions of their urban environments. The international journal of behavioral nutrition and physical activity14(1), 148.
  22. Pérez-Rodrigo, C., Aranceta Bartrina, J., Serra Majem, L., Moreno, B., & Delgado Rubio, A. (2006). Epidemiology of obesity in Spain. Dietary guidelines and strategies for prevention. International journal for vitamin and nutrition research. Internationale Zeitschrift fur Vitamin- und Ernahrungsforschung. Journal international de vitaminologie et de nutrition76(4), 163–171.
  23. Madden, A. M., Tsikoura, T., & Stott, D. J. (2012). The estimation of body height from ulna length in healthy adults from different ethnic groups. Journal of human nutrition and dietetics : the official journal of the British Dietetic Association25(2), 121–128.