Rapidly transitioning societies are experiencing dramatic increases in obesity and cardio-metabolic risk; however, few prospective studies from developing countries have quantified these increases or described their joint relationships.

We collected dietary, physical activity, demographic, anthropometric and cardio-metabolic risk factor data from 376 Guatemalan young adults in 1997–98 (aged 20–29 years) and in 2002–04 (aged 25–34 years).

In total, 42 % of men and 56 % of women experienced weight gain >5 kg in 5 years. Percent body fat (%BF) and waist circumference (WC) increased by 4·2 % points and 5·5 cm among men, and 3·2 % points and 3·4 cm among women, respectively. Five-year increases in both %BF and WC were associated with lower physical activity, urban residence and shorter height among men but not among women (test for heterogeneity P < 0·05 for residence and physical activity). Changes in %BF and WC and concomitant changes in cardio-metabolic risk factors were similar for men and women. In standardised regression, change in %BF was associated with changes in TAG (β=0·19; 95 % CI 0·08, 0·30), total:HDL cholesterol (β=0·22; 95 % CI 0·12, 0·33) and systolic (β=0·22; 95 % CI 0·12, 0·33) and diastolic (β=0·18; 95 % CI 0·08, 0·28) blood pressure, but not with glucose; associations were similar for WC.

Over 5 years this relatively young population of Guatemalan adults experienced rapid increases in multiple measures of adiposity, which were associated with adverse changes in lipid and blood pressure levels.