Atendimento ambulatorial versus programa de educação infantil : qual oferece mais mudança de hábito?

De acordo com um recente relatório da Organização Mundial de Saúde, a obesidade atingiu proporções epidêmicas em todo o mundo. Hoje a obesidade é muito comum e está começando a substituir a desnutrição e as doenças infecciosas. A obesidade está relacionada com doenças crônico-degenerativas e com sérias conseqüências psicológicas para o indivíduo. A obesidade é uma doença complexa e heterogênea, influenciada por diversos genes, no entanto, a combinação dos genes envolvidos no desenvolvimento de formas de obesidade ainda não foi definitivamente determinada (REILLY et al, 2002). A obesidade, ou o aumento da adiposidade, é geralmente atribuída a um desequilíbrio entre a energia ingerida (padrão alimentar) e a energia gasta (atividade física e metabolismo basal). Assim, o manejo da obesidade consiste em tornar esse balanço energético negativo, sendo o exercício considerado um dos aspectos principais, associado com mudanças alimentares e de estilo de vida saudáveis (ESCRIVÃO & LOPEZ, 1998). Dietas são, na maioria das vezes, transitórias. Então, a mudança de hábito alimentar e de atividade física são os aspectos principais, especialmente na criança, uma vez que a manutenção de peso irá proporcionar uma melhora dramática da composição corporal, já que o crescimento linear ainda existe. Mas, qualquer mudança de hábito necessita da colaboração da família (HILL et al, 1993). Assim, o presente estudo teve como objetivo principal comparar um programa de educação em obesidade infantil com o atendimento ambulatorial para manejo de obesidade infantil quanto a mudanças de hábitos alimentares e de atividade física e aquisição de conhecimentos em dieta saudável. Foi desenvolvido inicialmente um programa de educação em obesidade infantil e posteriormente comparado com o atendimento ambulatorial habitual. O presente estudo constou de um ensaio clínico randomizado entre crianças e adolescentes com idade entre 7 e 13 anos incompletos que tivessem IMC compatível para obesidade, de acordo com a idade e sexo, segundo classificação de COLE et al (2002). Os sujeitos foram aleatoriamente distribuídos em dois grupos. Cada grupo foi acompanhado por oito meses, sendo que o primeiro e o oitavo encontro serviram para responder questionários que avaliavam aspectos gerais, hábitos alimentares e de atividade física, conhecimentos gerais sobre dieta saudável e avaliação corporal. O grupo ambulatorial teve atendimento mensal com aferição de peso e orientações gerais quanto alimentação e atividade física. O grupo programa tinha encontro mensal, em grupo, seus participantes assistiam a uma aula expositiva e, posteriormente, eram divididos em grupos para atividades monitoradas, e os pais e/ou responsáveis ficavam discutindo suas dificuldades e como mudar hábitos. As 38 crianças inicialmente apresentavam algumas diferenças quanto a atividade física, mas após a intervenção elas se assemelharam, apresentando ambas tendência a desfechos favoráveis. O grupo programa passou a fazer mais atividade física e caminhar, e reduziu sedentarismo. O grupo programa foi mais efetivo em reduzir colesterol total. Houve também uma melhora do hábito alimentar do grupo programa, com menor consumo de massa + arroz, bebida láctea + leite, leite, salsicha + frios e sanduíche + bauru. Assim, conclui-se que as intervenções foram semelhantes e de sucesso, podendo-se aplicar mais o programa, que pode envolver menos profissionais, mais sujeitos e ser realizado em qualquer local, especialmente nas escolas, que são, na realidade, o local de mudança.

Excesso de peso em região do nordeste brasileiro: contraste entre escolares de rede pública e privada de ensino

The prevalence of obesity has been increased in the last three decades. It is already considered as epidemic by the World Health Organization and reaches around 300 million people worldwide. The weight gain in all ages is related to a sedentary way of life and hyper caloric food ingestion at the modern society. Obesity is a chronic disease and leads to high blood pressure, diabetes, cardiovascular diseases and cancer. The aim of this study was to evaluate the prevalence of weight excess among student in Natal schools and to analyze its association with age, gender, school category and geographic localization in city zones. This was a transversal study which enrolled 1927 children. 1084 of these were between 6 and 8 years-old (group 1) and 843 were 9 to 10 years-old (group 2). 895 of the total children studied in private schools and 1032 studied in public schools. 33,6% of the students had body mass index equal or above the 85th percentile and were considered as having weight excess. There was no statistical difference in this prevalence considering neither gender nor age. The weight excess prevalence in private schools was 54,5% and in public ones was 15,6% (p<0,01; OR=6,49). Weight excess was also more prevalent in the south and east city zones (41,3%) which have better quality of life index than in the north and west zones (28,4%) (p<0,01). In conclusion, the weight excess prevalence among students is found to be high in Natal and programs of intervention and prevention of obesity are necessary. The higher prevalence in private schools as in the wealthier city zones reflects the link between obesity and high socioeconomic level found in countries in developing. This was an interdisciplinary work with participation of epidemiology, child nutrition and pediatric endocrinology following the recommendations and principles of the Post graduation Program in Health Sciences of the Federal University of Rio Grande do Norte

High-fat diet associated with obesity induces impairment of mouse corpus cavernosum responses

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Bioelectric impedance overestimates the body fat in overweight and underestimates in Brazilian obese women: a comparation with Segal equation 1

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Risk factors for low birth weight in Botucatu city, SP state, Brazil: A study conducted in the public health system from 2004 to 2008

Background: Low birth weight (LBW), defined as birth weight less than 2500 g, has a complex etiology and may be a result of premature interruption of pregnancy or intrauterine growth restriction. The objective of this study was to provide information on determinants of LBW and contribute to the understanding of the problem in Brazil. Methods. A case-control study was conducted in Botucatu city, SP state, Brazil. The study population consisted of 2 groups with 860 newborns in each group as follows: low weight newborns (LWNB) and a control group (weight ≤ 2500 g). Secondary data from 2004 to 2008 were collected using the Live Birth Certificate (LBC) and records from medical charts of pregnant women in Basic Health Units (BHU) and in the Public University Hospital (UH). Variables were as follows: maternal socio-demographic characteristics, pregnancy and birth conditions including quality of prenatal care according to 3 criteria. They were based on parameters established by the Ministry of Health (MH), one of them, the modified Kessner Index. The multivariable analysis by logistic regression was used to evaluate the association between variables and LBW. Results: According to the analysis, the factors associated with LBW were as follows: prematurity (OR = 56.98, 95% CI 29.52-109.95), twin pregnancy (OR = 20.00, 95% CI 6.25-100.00), maternal smoking (OR = 2.12, 95% CI 1.33-3.45), maternal malnourishment (OR = 2.30, 95% CI 1.08-5.00), maternal obesity (OR = 2.30, 95% IC 1.18-4.48), weight gain during pregnancy less than 5 kg (OR = 2.63, 95% CI 1.35-5.00) and weight gain during pregnancy more than 15 kg (OR = 2.26, 95% CI 1.16-4.41). Adequacy of prenatal care visits adjusted to gestational age was less frequent in the LBW group than in the control group (68.7% vs. 80.5%, x 2 p < 0.001). According to the modified Kessner Index, 64.4% of prenatal visits in the LWNB group were adequate. Conclusion: LWNB are a quite heterogeneous group of infants concerning their determinants and prevention actions against LBW and the follow-up of these infants have also been very complex. Therefore, improvement in the quality of care provided should be given priority through concrete actions for prevention of LBW. © 2012 Fonseca et al; licensee BioMed Central Ltd.

Dietary, anthropometric, and biochemical determinants of uric acid in free-living adults

Background: High plasma uric acid (UA) is a prerequisite for gout and is also associated with the metabolic syndrome and its components and consequently risk factors for cardiovascular diseases. Hence, the management of UA serum concentrations would be essential for the treatment and/or prevention of human diseases and, to that end, it is necessary to know what the main factors that control the uricemia increase. The aim of this study was to evaluate the main factors associated with higher uricemia values analyzing diet, body composition and biochemical markers. Methods. 415 both gender individuals aged 21 to 82 years who participated in a lifestyle modification project were studied. Anthropometric evaluation consisted of weight and height measurements with later BMI estimation. Waist circumference was also measured. The muscle mass (Muscle Mass Index - MMI) and fat percentage were measured by bioimpedance. Dietary intake was estimated by 24-hour recalls with later quantification of the servings on the Brazilian food pyramid and the Healthy Eating Index. Uric acid, glucose, triglycerides (TG), total cholesterol, urea, creatinine, gamma-GT, albumin and calcium and HDL-c were quantified in serum by the dry-chemistry method. LDL-c was estimated by the Friedewald equation and ultrasensitive C-reactive protein (CRP) by the immunochemiluminiscence method. Statistical analysis was performed by the SAS software package, version 9.1. Linear regression (odds ratio) was performed with a 95% confidence interval (CI) in order to observe the odds ratio for presenting UA above the last quartile (♂UA > 6.5 mg/dL and ♀ UA > 5 mg/dL). The level of significance adopted was lower than 5%. Results: Individuals with BMI ≥ 25 kg/m§ssup§2§esup§ OR = 2.28(1.13-4.6) and lower MMI OR = 13.4 (5.21-34.56) showed greater chances of high UA levels even after all adjustments (gender, age, CRP, gamma-gt, LDL, creatinine, urea, albumin, HDL-c, TG, arterial hypertension and glucose). As regards biochemical markers, higher triglycerides OR = 2.76 (1.55-4.90), US-CRP OR = 2.77 (1.07-7.21) and urea OR = 2.53 (1.19-5.41) were associated with greater chances of high UA (adjusted for gender, age, BMI, waist circumference, MMI, glomerular filtration rate, and MS). No association was found between diet and UA. Conclusions: The main factors associated with UA increase were altered BMI (overweight and obesity), muscle hypotrophy (MMI), higher levels of urea, triglycerides, and CRP. No dietary components were found among uricemia predictors. © 2013 de Oliveira et al.; licensee BioMed Central Ltd.

Efeito da fibra dietética e do exercício físico resistido na doença hepática gordurosa

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Marcadores de risco para o Diabete Melito Infantil: um estudo de caso controle em crianças de zero a 10 anos

Pós-graduação em Ginecologia, Obstetrícia e Mastologia - FMB

Obesidade infantil: etiologia, consequências e formas de intervenção

Obesity is defined as excess body fat. It is considered today a serious public health problem and has reached high proportions in childhood and adolescence. Among factors highlight the lifestyle, poor diet and little physical activity for their development. Childhood obesity is not treated can become permanent in adulthood increases the risk of several diseases such as cardiovascular, metabolic and other disorders such as depression, low self-esteem among others. It's extreme need multidisciplinary intervention to prevent it, with guidelines on healthy eating habits and regular physical activity. Treatment is necessary in a multidisciplinary team of doctors, nutritionists, physical educators, psychologists and family that has a decisive weight in the treatment of obese children. The media could give more space for the disclosure of childhood obesity, so that the population is aware of this epidemic in a more serious understand its risks and health effects. This bibliographic study has character and aims to seek the causes of obesity, its consequences in adulthood and possible forms of intervention

Prevalência de hipertensão arterial em adolescentes escolares em Ibitinga: importância do histórico familiar

Hypertension (H) affects approximately 1,2 billion of people in the world. Among the main risk factors are weight excess, sedentary lifestyle, socio economic condition and family history of H. The main aim of this study was to assess the prevalence of hypertension in teenager scholars in Ibitinga, finding the role of family history of H and to correlates these results with nutritional condition, anthropometric variables and socio economic condition. This research analyzed 150 participants (50 teenager students and their parents) in public and private schools. All the volunteers had their weight (kg) and height (m) measured to calculate the body mass index (BMI). The students were classifieds from table of percentile of obesity (Centers for Disease Control and Prevention, CDC). The blood pressure (BP) was evaluated according to V Arterial Hypertension Brazilian Guidelines (VAHBG, 2006). The high values considered of BP were: ≥140x90 mmHg for adults and percentile >95 for teenagers. The socio economic condition was categorized from IBGE. Among the students, 36% had high BP and 20% borderline. The percentage of high BP were bigger in the public (44%) than private schools (28%), showing a negative correlation between socio economic condition and systolic BP (SBP, r=0.2857) and diastolic BP (DBP, r=0,0165). The prevalence of elevated BP was higher in the girls of public schools (47% vs 40% boys) and in the boys at the private schools (33% v s23%). Weight excess was present in 42% of children (12% obesity and 30% overweight). Again, public schools had prevalence of obesity (52% vs 3% in the private) which was not correlated with socio economic condition. Percentage of overweight and obesity were bigger in the girls of both public (54% vs 50% boys) and private (38% vs 25%) schools. Among the students with H, 67% were overweight. Elevated BP was found in 54% of the fathers and 32% of the mothers. With respect to nutritional condition, 56% of the...

O papel de enfermeiros na equipe multidisciplinar frente ao sobrepeso/obesidade em ambiente de trabalho

Overweight and obesity are pandemics and have been widely discussed in Public Health and Health at Work. Comorbidities such as metabolic syndrome, hypertension, diabetes mellitus type 2, orthopedic disorders and coronary diseases can induce to absenteeism, reduced work performance, disability and death. The aim of this review is to discuss the role of the nurse in control and prevention of these illnesses in the workplace. We concluded that occupational health nurses work should act proactively with a multidisciplinary team aimed at individual and collective monitoring of actions designed to control and prevent overweight and obesity. Furthermore, this professional should follow up the health of individual workers with a high body mass index in order to warn and prevent comorbidities related to these conditions.

Análise de dados sobre crianças com excesso de peso com auxílio de recursos computacionais

Pós-graduação em Desenvolvimento Humano e Tecnologias - IBRC

Fluid intake patterns: an epidemiological study among children and adolescents in Brazil

Background: Energy from liquids is one of the most important factors that could impact on the high prevalence of children and adolescents obesity around the world. There are few data on the liquid consumption in Brazil. The aim of this study is to evaluate the volume and quality of liquids consumed by Brazilian children and adolescents and to determine the proportion of their daily energy intake composed of liquids. Methods: A multicenter study was conducted in five Brazilian cities; the study included 831 participants between 3 and 17 years of age. A four-day dietary record specific to fluids was completed for each individual, and the volume of and Kcal from liquid intake were evaluated. The average number of Kcal in each beverage was determined based on label information, and the daily energy intake data from liquids were compared with the recommendations of the National Health Surveillance Agency (Agencia Nacional de Vigilancia Sanitaria-ANVISA), the Brazilian food regulation authority, according to each subject's age. Results: As the children aged, the volume of carbonated beverages that they consumed increased significantly, and their milk intake decreased significantly. For children between the ages of 3 and 10, milk and dairy products contributed the greatest daily number of Kcal from liquids. Sugar sweetened beverages which included carbonated beverages, nectars and artificial beverages, accounted for 37% and 45% of the total Kcal from liquid intake in the 3-to 6-year-old and 7- to 10-year-old groups, respectively. Among adolescents (participants 11- to 17-years old), most of the energy intake from liquids came from carbonated beverages, which accounted for an average of 207 kcal/day in this group (42% of their total energy intake from liquids). Health professionals should be attentive to the excessive consumption of sugar sweetened beverages in children and adolescents. The movement toward healthier dietary patterns at the individual and population levels may help to improve programs for preventing overweight and obesity in children and adolescents. Conclusion: From childhood to adolescence the daily volume of liquid ingested increased reaching a total of 2.0 liters on average. Of this volume, the daily volume of milk ingested decreased while the carbonated drinks, sweetened, nectars and artificial beverages increased significantly. The proportion of water remained constant in about 1/3 of the total volume. From 3 to 17 years of age the energy intake from carbonated beverages increased by about 20%. The carbonated drinks on average corresponded to a tenth of the daily requirements of energy of adolescents.

Influence of asthma definition on the asthma-obesity relationship

Background: Epidemiological studies suggest an association between obesity and asthma in adults and children. Asthma diagnosis criteria are different among studies. The aim of this study was to test the influence of asthma definition on the asthma-obesity relationship. Methods: In a cross-sectional analysis of 1922 men and women, subjects completed a translated questionnaire from the European Community Respiratory Health Survey and underwent spirometry and a bronchial challenge test. Weight, height and waist circumference were measured. Multiple logistic regression analysis was carried out to assess the association of variables related to obesity and asthma. Asthma was defined either by the presence of symptoms with bronchial hyperresponsiveness (BHR) or by a self-report of a physician-made diagnosis. The following variables were separately tested for associations with asthma: socioeconomic characteristics, schooling, physical activity, smoking status, anthropometry and spirometry. Results: No association was detected between asthma confirmed by BHR and obesity indicators, odds ratio (OR) = 1.08 (95% confidence interval: 0.69 - 1.68) for obesity assessed by body mass index >= 30 kg/m(2); OR = 1.02 (0.74 - 1.40) for obesity assessed by abnormal waist-to-height ratio; and, OR = 0.96 (0.69 - 1.33) for abnormal waist circumference. On the contrary, a previous diagnosis of asthma was associated with obesity, OR = 1.48 (1.01 - 2.16) for body mass index >= 30 kg/m(2); OR = 1.48 (1.13 - 1.93) for abnormal waist-to-height ratio; and, OR = 1.32 (1.00 - 1.75) for abnormal waist circumference. Female gender, schooling >= 12 years and smoking were associated with BHR-confirmed asthma. Physically inactive subjects were associated with a previous diagnosis of asthma. Conclusions: Our findings indicate that the relationship between asthma and obesity in epidemiological studies depends on the definition adopted. Certain components of asthma, for instance, symptoms may be more prone to the obesity influence than other ones, like bronchial hyperresponsiveness.

Maternal obesity in high-risk pregnancies and postpartum infectious complications

Objective: To analyze the association between maternal obesity and postnatal infectious complications in high-risk pregnancies. Methods: Prospective study from August 2009 through August 2010 with the following inclusion criteria: women up to the 5th postpartum day; age L 18 years; high-risk pregnancy; singleton pregnancy with live fetus at labor onset; delivery at the institution; maternal weight measured on day of delivery. The nutritional status in late pregnancy was assessed by the body mass index (BMI), with the application of the Atalah et al. curve. Patients were graded as underweight, adequate weight, overweight, or obese. Postpartum complications investigated during the hospital stay and 30 days post-discharge were: surgical wound infection and/or secretion, urinary infection, postpartum infection, fever, hospitalization, antibiotic use, and composite morbidity (at least one of the complications mentioned). Results: 374 puerperal women were included, graded according to the final BMI as: underweight (n = 54, 14.4%); adequate weight (n = 126, 33.7%); overweight (n = 105, 28.1%); and obese (n = 89, 23.8%). Maternal obesity was shown to have a significant association with the following postpartum complications: surgical wound infection (16.7%, p = 0.042), urinary infection (9.0%, p = 0.004), antibiotic use (12.3%, p < 0.001), and composite morbidity (25.6%, p = 0.016). By applying the logistic regression model, obesity in late pregnancy was found to be an independent variable regardless of the composite morbidity predicted (OR: 2.09; 95% CI: 1.15-3.80, p = 0.015). Conclusion: Maternal obesity during late pregnancy in high-risk patients is independently associated with postpartum infectious complications, which demonstrates the need for a closer follow-up of maternal weight gain in these pregnancies.