Research Square · Nov 3, 2026
Early-life undernutrition and adult obesity among Indigenous women in Brazil: a population-based study grounded in the DOHaD framework
By Santos ABF, de Amorim JF, Ferreira HdS
Background Early-life undernutrition may have lasting effects on growth and metabolism and may contribute to the development of obesity later in life. According to the Developmental Origins of Health and Disease (DOHaD) theory, nutritional and other environmental exposures during critical periods of development can shape long-term health and disease susceptibility. However, evidence on the relationship between early-life undernutrition and adult obesity among Indigenous populations remains limited. This study therefore investigated the association between early-life undernutrition and obesity among Indigenous women in Alagoas, Brazil, within the DOHaD framework. Methods Analytical, population-based cross-sectional study with a probabilistic sample (n = 813). The association between early-life undernutrition (exposure) and adult obesity (outcome) was examined using logistic regression, in an analytical approach analogous to a case–control design, with participants stratified according to current nutritional status (BMI < 30 or ≥ 30 kg/m²). Exposure was defined by an elevated Head Circumference-to-Height Index (HHI > 1.028), used as a marker of undernutrition during critical periods of growth, ensuring biological plausibility and temporal precedence of the investigated relationship. Results After adjustment, early-life undernutrition was associated with higher odds of adult obesity (OR = 2.46; 95% CI: 1.75–3.45). Additionally, participation in the labor market (OR = 1.42; 95% CI: 1.03–1.96) and living with a partner (OR = 2.12; 95% CI: 1.47–3.45) were independently associated with obesity. Conclusion The findings support the DOHaD theory, indicating that early-life undernutrition constitutes a risk factor for obesity—and consequently for its comorbidities—among Indigenous women. These results reinforce the importance of public policies and early interventions aimed at promoting food and nutritional security from childhood, focusing on preventing undernutrition and mitigating its long-term effects across the life course. Clinical trial number: not applicable.