Síntomas músculo-esqueléticos durante el embarazo en una muestra de mujeres ecuatorianas

Introducción: Los manuales de obstetricia citan numerosos signos y síntomas músculo-esqueléticos pero los porcentajes de mujeres que los presentan no aparecen registrados. Y en los trabajos no se estudian todos ellos simultáneamente. Objetivo: describir el comportamiento de los síntomas músculo-esqueléticos durante el embarazo. Material y Métodos: 745 gestantes, entrevistadas entre las 8 y 12 semanas de gestación, entre las 18 y 22 y entre las 37 y 42, procedentes de centros de salud de Esmeraldas (Ecuador). Resultados: Un 31,8% tuvo lumbalgia en algún momento de la gestación y un 15,6% ciatalgia, la lumbalgia aparece en un 40% en el tercer trimestre mientras que la ciatalgia desciende con el curso de la gestación. El dolor púbico y el de miembros inferiores se presenta en un 42,7% y un 46,6% de todas las mujeres. No se han encontrado diferencias en función de la edad, paridad, talla, peso, estado nutricional, raza o actividad. Conclusiones: Las gestantes tienen dificultad para diferenciar los procesos dolorosos. Han sobreinformado la presencia de ciatalgia en detrimento de la lumbalgia. El dolor de miembros inferiores es el más frecuente. La sintomatología músculo-esquelética dificulta el desempeño de las actividades de la vida diaria a más de un 10% de las mujeres.

Malnutrición y desigualdades en la España del franquismo; el impacto del complemento alimenticio lácteo en el crecimiento de los escolares españoles (1954-1978)

A lo largo del siglo XX, la población española fue consolidando su proceso de transición nutricional y alimentaria. En la etapa pre-transicional, se produjo un renovado interés por las deficiencias que mostraba la alimentación de los niños y se apostó por la educación alimentaria-nutricional para superarlas. El objetivo del trabajo es analizar el estado nutricional, a través de la talla como parámetro antropométrico, que mostraba la población escolar del ámbito rural español, entre las décadas de 1950 y 1970, su evolución y las diferencias que existían entre regiones. Los resultados ponen de manifiesto que al inicio de la década de 1960 se apreciaban dos patrones: un primer grupo donde la estatura de los niños de la costa cantábrica, zona de Levante, Cataluña y Baleares, mostraba niveles similares a los de niños bien alimentados; y un segundo grupo donde las tallas eran inferiores, en el que se encontraban las regiones de Andalucía, Extremadura y Galicia. Entre 1954 y 1977, las tallas de los niños bien alimentados mostraron un incremento que fue especialmente intenso entre 1954 y la primera mitad de la década de 1960. En el caso de los niños y niñas que acudían a las escuelas nacionales del ámbito rural, también se produjo un significativo incremento en la talla, además de corregirse las diferencias regionales que existían al principio de los años sesenta. En todos aquellos avances habrían influido tanto el complemento alimenticio, como las actividades de educación alimentación y nutrición que se llevaron a cabo en el marco del Programa EDALNU.

¿Ha cambiado el patrón de consumo alimentario de la población española del año 2006 al 2011 en plena crisis económica?

Antecedentes/Objetivos: El consumo de alimentos es un indicador que mide calidad de la dieta y estado nutricional. El consumo está influido directamente por la estructura de precios relativos a los alimentos. El objetivo es determinar y comparar la calidad de la dieta de la población española entre los años 2006 y 2011, y su relación con las variables socioeconómicas. Métodos: Estudio trasversal utilizando los datos de la Encuesta Nacional de Salud (ENS) 2006 y 2011. La muestra de la ENS-06 está compuesta por 29.478 personas, mujeres 15.019; hombres 14.459, y la del 2011 por 20.884 personas, mujeres 10.696; hombres 10.188. Variables: sexo, edad, grupos de alimentos, frecuencia de consumo, clase social (clase I, II y III hacen referencia a trabajos no manuales, clase IV y V trabajos manuales) y nivel de estudios. Se calculó el Índice de Alimentación Saludable (IASE) a partir de los grupos de alimentos, frecuencia de consumo y recomendaciones dietéticas (SENC, 2004). El IASE clasifica la alimentación en: saludable, necesita cambios y poco saludable. Se calculó la tasa de variación entre los dos años y se realizó un contraste de proporciones. Se utilizó el programa Excel y el paquete estadístico SPSS 20.0. Resultados: La prevalencia de hombres con alimentación saludable ha aumentado 7,6% respecto al 2006 (p-valor = 0,001), mientras que las mujeres con alimentación poco saludable ha aumentado 3,7%. Las personas de 45-64 años con una alimentación poco saludable han aumentado un 42,9% respecto al 2006 (p-valor = 0,001). Sin embargo los jóvenes de 16-24 años con alimentación poco saludable han disminuido un 29,5% (p-valor < 0,001). La población sin estudios con una alimentación poco saludable ha aumentado un 76,5% (p-valor < 0,001). La población con trabajos no manuales (clase I), como directivos de empresas que se alimentan saludablemente ha aumentado 14,3% respecto al 2006 (p-valor = 0,001), y la población con trabajos manuales (clase IV) que se alimenta saludablemente ha disminuido un 9,9%. Conclusiones: Las personas con mejores trabajos no-manuales han mejorado su alimentación, mientras que la población con trabajos manuales con alimentación poco saludable también han aumentado. La crisis económica actual puede estar influyendo en los cambios observados en la calidad de la dieta de la población española.

La transición sanitaria en Colombia (1946-2001)

Introducción: A pesar de las múltiples críticas que ha suscitado el concepto de la transición sanitaria, en Colombia, que al parecer se encuentra inmersa en un modelo polarizado prolongado de la transición epidemiológica, no se ha establecido como estos cambios, han producido variaciones en el estado de salud de su población a lo largo del tiempo. Por esto, es necesario analizar la transición sanitaria desde 1946 al 2001 a través de la descripción de sus distintos componentes; describiendo y discutiendo las variaciones de las condiciones sanitarias que ha sufrido la población colombiana a lo largo de este periodo por la influencia de las condiciones socioeconómicas. Material y métodos: Se realizó un estudio longitudinal, analítico-descriptivo de la transición sanitaria en Colombia desde 1946 hasta el 2001, basado en datos secundarios de fuentes estadísticas de organismos colombianos y de otras fuentes como las procedentes de organismos internacionales. La limitación más evidente, fue la dificultad para encontrar los datos suficientes del periodo de estudio considerado, que nos permitiera realizar un análisis adecuado de una gran variedad de indicadores, que pudieron estar implicados. Resultados: Colombia ha experimentado una transición demográfica desde 1951 a 2001, dado por una reducción de las tasas de mortalidad, natalidad y fecundidad; además de un aumento de la urbanización de la población por una creciente migración rural-urbana; y donde los factores de violencia y pobreza fueron de gran influencia en esta transformación. Colombia también se encuentra dentro de un «modelo polarizado prolongado» de la transición epidemiológica, lo que supone también la existencia de una doble carga de enfermedad o superposición epidemiológica. Se evidencia un aumentó en la inversión en salud, en la cobertura del sistema de salud, y en la atención prenatal y del parto. Se observan inequidades urbano-rurales en el acceso a los servicios básicos, aunque se observan mejoras a nivel general en la situación nutricional y el nivel educativo de la población. La situación de pobreza se ha mantenido constante, aunque en las zonas rurales se observó un agravamiento de su situación. La violencia ha tenido dos picos de recrudecimiento, pero solo se pudo corroborar el ocurrido desde mediados de los ochenta, por el gran aumento de los homicidios en hombres. Conclusiones: - Colombia experimentó una transición demográfica durante la segunda mitad del siglo XX, influenciada por la violencia y la pobreza. - La ubicación de Colombia dentro de un «modelo polarizado prolongado» de la transición epidemiológica, revela una situación de doble carga de enfermedad o superposición epidemiológica. - Las reformas realizadas al sistema de salud, intentaron responder a los nuevos desafíos que imponían las transiciones demográfica y epidemiológica. Sin embargo, con los datos obtenidos, no es posible hacer una evaluación más detallada, de si la atención sanitaria respondió a la nueva dinámica epidemiológica. - Hay diferencias urbano-rurales y regionales en el acceso a servicios básicos y en el estado nutricional de la población. - Resulta paradójico el descenso observado en los indicadores de criminalidad en Colombia, a partir de la segunda mitad de la década de los ochenta; precisamente cuando se observa un gran incremento en la mortalidad por homicidios. - La pobreza como un aspecto clave dentro de la transición sanitaria en Colombia, muestra un panorama poco alentador, producto de un empeoramiento de la situación de pobreza de las zonas rurales y los pequeños centros urbanos.

Influencia de un plan de educación sanitaria en alimentación y nutrición para pacientes/familiares en dos unidades de hemodiálisis

Objetivos. Aumentar los conocimientos de los pacientes en hemodiálisis sobre su alimentación y nutrición para mejorar su estado nutricional.

Ingesta energética y de macronutrientes en mujeres atletas

Objetivo: determinar la ingesta de macronutrientes adecuada para mejorar el estado nutricional de las mujeres atletas y su rendimiento deportivo. Métodos: se realizó una búsqueda en cuatro bases de datos: EBSCO, Proquest, Pubmed y OvidSP, empleando las palabras clave “protein intake” AND “athletes” y “endurance athletes” AND “nutrition”. Criterios de selección: artículos originales sobre el consumo de proteínas en atletas femeninas (Entre 2009 y 2014), en revistas científicas indexadas. Resultados: se identificaron 722 artículos, de los cuales solo el 1,4% fueron considerados como incluidos. El 100% eran ensayos clínicos finalizados y publicados en el extranjero, el 50% en EE. UU. El 20% eran estudios exclusivos de mujeres atletas y el 80% incluían hombres y mujeres en la muestra. En el 70% de los estudios las mujeres atletas presentaron déficits energéticos; en la ingesta proteica, el 70% cumplieron con las recomendaciones dietéticas; la ingesta de hidratos de carbono fue inadecuada en el 90% de los ensayos clínicos y, en el 50%, las mujeres presentaban una sobreingesta de grasas. Conclusiones: existe una deficiencia de información acerca de la nutrición en mujeres atletas en Europa y a nivel internacional. Las atletas femeninas consumen energía y macronutrientes en menor proporción que los atletas masculinos. No existe consenso en el rango de proteínas recomendado y se encuentran discrepancias en el consumo en función del tipo de ejercicio físico que se realice. Se recomienda llevar a cabo un acuerdo entre instituciones científicas de prestigio sobre la ingesta energética y de macronutrientes en el deporte, especialmente en la mujer.

A abordagem médica de seguimento das crianças com síndrome do intestino curto

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Análise descritiva da função respiratória de adultos com fibrose quística

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Evolução da perceção parental da imagem corporal da criança : análise retrospetiva de dois estudos

Introdução: A obesidade é reconhecida pela OMS como um importante problema de saúde pública, que afeta adultos, crianças e adolescentes e que tem tomado proporções epidémicas em todo o mundo. Os estudos revelam que os pais, mas sobretudo as mães se mostram preocupadas e concordam com a adoção de hábitos alimentares saudáveis, no entanto a perceção que estas têm do estado nutricional dos filhos nem sempre é adequada e frequentemente a imagem corporal é distorcida, percebendo-se contudo que esta distorção tem vindo a diminuir. Foi neste âmbito que emergiu como objetivo geral deste estudo, explorar a evolução da perceção parental da imagem corporal da criança em dois estudos, estudo A (Graça Aparício) e estudo B (Graça Aparício, Madalena Cunha, João Duarte; Anabela Pereira, Jorge Bonito, Carlos Albuquerque), publicados respetivamente, em 2012 e 2013 e relacioná-la com o comportamento alimentar da criança do estudo B. Material e métodos: Este estudo de carácter retrospetivo e transversal, foi realizado com as crianças que participaram no estudo A e no estudo B, num total de 2216 crianças em idade pré-escolar, média idade= 4.51 anos (±0.97Dp), residentes as crianças do estudo A na região de Viseu e Dão e as do estudo B, nas regiões Viseu, Lamego, Vila Real, Évora e Leiria, tendo sido efetuada pelos autores originais, uma avaliação antropométrica e classificação nutricional das crianças com base no referencial NCHS (CDC, 2000). Para a recolha de dados os autores originais, utilizaram um Questionário de Caracterização Sociodemográfica das Crianças e dos Progenitores; o Questionário de Avaliação da Perceção Parental da Imagem Corporal da criança (Collins, 1991) e o Questionário de Caracterização do Comportamento Alimentar Infantil (CEBQ), traduzido e validado para a população portuguesa por Viana & Sinde (2008). Resultados: Comparativamente ao estudo A, no estudo B os pais revelaram-se significativamente mais preocupados com o estado nutricional dos seus filhos (p= 0,000). Ainda no estudo B uma maior percentagem de pais assinala as imagens representativas de pré-obesidade (27,5%) e obesidade (0,6%), comparativamente ao estudo A, onde se verifica o oposto; uma maior sinalização das crianças no grupo da normalidade e baixo-peso (56,3% e 20,4% respetivamente). Apurou-se uma diferença de médias significativa da perceção parental da imagem corporal da criança entre o estudo A e o estudo B, evidenciando a perceção dos pais, a uma maior aproximação com os valores mais elevados de IMC dos filhos, ou seja, os pais têm uma perceção menos distorcida da imagem corporal dos filhos, quando estes apresentam valores de IMC mais elevados. Relativamente ao comportamento alimentar, apesar dos comportamentos de “atração pela comida” se associarem a uma perceção parental de imagem corporal maior, e de alguns dos comportamentos de “evitamento da comida” se associarem a uma perceção parental de imagem corporal menor, a relação entre o comportamento alimentar e a perceção parental da imagem corporal criança não se revelou significativa. Conclusões: Os resultados indicam uma maior acurácia da perceção da imagem corporal dos pais ao real estado nutricional dos filhos, podendo este facto ser o primeiro passo para o seu reconhecimento do excesso de peso dos seus filhos e facilitar a adequação a um estilo de vida mais saudável entre as crianças em idade pré-escolar, e maior sensibilização da família para o controlo do excesso de peso na infância. Palavras-chave: Perceção parental, imagem corporal, Obesidade infantil.

Prevalência da síndrome metabólica e seus componentes nos estágios pubertários de escolares do sexo feminino norte-rio-grandenses

The diagnosis of nutritional status is extremely re levant in clinical practice and population assessment, due to the association betwe en body fat and metabolic alterations. The aim of this study is to analyze th e prevalence of metabolic syndrome (MS) and its components in the pubertal stages of f emale students in Rio Grande do Norte state, Brazil, in accordance with Internation al Diabetes Federation criteria. This is a cross-sectional study with 449 students aged betw een 8 and 19 years, stratified into pubertal stages systematized by Marshal and Tanner (1969), as follows: 27.6% prepubertal, 44.3% pubertal and 28.1% postpubertal, with mean ages of 9.4±1.27, 12.4±2.23 and 15.1±1.88 years, respectively. Preval ences were analyzed using distribution of frequencies and their respective 95 % confidence intervals, while the chi- square test and odds ratio were applied to analyze the associations between variables. The general prevalence of MS was 3.3% (CI: 2% - 5%) , without occurrences in the prepubertal stage, observing that it emerges from t he pubertal stage onwards with a prevalence of 2.5% (CI 95% 0.1% - 5%), 1% (CI 95% 0.4% - 2.3%) of cases with overweight and 1.5% (CI 95% -0.1% - 3.2%) with obes e individuals, while in the postpubertal stage the prevalence is 7.9% (CI 95% 3 .2% - 12.6%), 0.8% (CI 95% -0.8% - 2.3%) normal weight cases, 4% (CI 95% 0.6% - 7.4% ) overweight and 3.1% (CI 0.1% - 6.2%) obese individuals. There was an association (p<0.02) between pubertal stages and MS ( x 2 =5.2), with an OR of 3.3 (CI: 1.2 - 5), showing tha t postpubertal adolescents are more prone to SM than pubertals, while the OR i n obese individuals was 2.1 (CI: 2– 2.2) compared to the overweight. Body mass index (B MI) ( x 2 = 29.4; p<0.001) and age range ( x 2 = 13.1; p<0.001) showed a significant linear assoc iation with MS. Of the adolescents with MS, those aged ten years or younge r exhibited higher %G. The most prevalent components in all the stages were altered waist circumference (27.2% [CI 23% - 31%]) and low HDL cholesterol (39.6% [CI 35% – 44%]), which, coupled with hypertension, displayed significant differences in the postpubertal stage in relation to the other stages. The results show that MS emerges from the pubertal stage onwards in proportion to excess childhood body fat, a fact tha t calls for prevention strategies using an educational approach, reducing the large demand on the National Health System. Keywords: Metabolic syndrome, pubertal stages, risk factors.

Avaliação das condicionalidades em saúde do Programa Bolsa Família

The programs of conditional cash transfer are widespread in developing countries in Latin America with emphasis on Brazil as a new paradigm in social p olicies for poverty eradication . Consist of transferring monetary funds from the government directly to poor families by fulfilling the condition alities on education and health . In health, even wi th variations between countries , conditionality targeting public pregnant women and children with a view to improving health indic ators maternoinfantil as growth , infant mortality and prenatal care. The objectives of this study are to compare the transfer progr am conditional Brazilian income , the Family and similar programs in Latin A merica in relation to it s effects on growth in children , and to evaluate the effect of Bolsa Família in the prevalence of use of services ( conditionalities ) of prenatal care in Brazilian health services whose teams joined the Programa de Acesso e Melhoria da Qualidade da Atenção Básica (PMAQ - AB) . For the first objective a systematic review , we selec ted ten articles between 1007 ( one thousand and seven ) found in the databases Embase , PubMed, Scopus , Scielo and Lilacs databases was performed . Articles are ob servational epidemiological studies of transverse descriptive and analytical types of cohort and case - co ntrol. For the second objective, for it is a prevalence study , a statistical analysis using Poisson regression with robust variance was performed to i nvestigate how the prevalence of compliance with conditionalities on health was influenced b y various explanatory variables . Ratios , crude and adjusted prevalence , with their respective confidence i ntervals of 95 % were estimated . The family joined the sch olarship program was considered as the main expo sure variable . Confounding variables were: maternal age , race / color, paid employment , marital status and region of residence . In d ata analysis software R 3.0.1 (RDevelopment Core Team 2013 ) was used . Rega rding the comparison of the Bolsa Família with other programs in Latin America , the review found similar results regarding the positive effect of income transfer in the nutritional status o f beneficiary children programs , and these effects are more evident in children under two years old and belonging to familie s of lower socioeconomic status . For the prevalence of conditionalities entres different groups of users of the Bolsa Família and nonusers results showed no statistically significant difference betwe en respondents (with children under two years ) registered and not registered in PBF on issues relating to: me et at least six prenatal visits , meet and participate in health education activities . It follows from side to increase minimum income for families in extreme poverty showed positive impact on children's health in Brazil and Latin America. The o ther is not confirmed in Brazil , an increase in conditionality expressed in use of primary care by the user s of the Bolsa Família services.

Avaliação da suplementação de vitamina E sobre a concentração de alfa-tocoferol no leite materno em mulheres com partos prematuros

The term vitamin E refers to a group of eight molecular compounds which differ in structure and bioavailability, and the RRR-alpha-tocopherol more biologically active form. The composition of vitamin E in breast milk undergoes variations during lactation, colostrum and milk richer in this micronutrient compared to transitional and mature milk. Newborns, especially premature infants are more susceptible to vitamin E deficiency and to prevent the damage caused by this deficiency has been proposed supplementation of neonates with this micronutrient, however, there is no consensus to carry out this intervention. Thus, maternal supplementation with RRRalpha-tocopherol in the postpartum period can be a good alternative to try to raise the alpha-tocopherol levels in breast milk and therefore provide the premature newborn adequate amounts of vitamin E. This study to evaluate the effect of supplementation with 400 UI acetate RRR-alpha-tocopherol in women with premature births, on the concentration of alpha-tocopherol in breast milk colostrum, transitional and mature. The study included 89 healthy adult women were enrolled in the control group (n = 51) and supplemented group (n = 38). Blood samples were collected and milk colostrum soon after birth (0h milk) twenty-four hours, new rate of colostrum milk was collected (24h milk). The transitional and mature milk were collected in seven days (7d milk) and thirty days (30d milk) after delivery, respectively. Supplementation in the supplemented group was held after the collection of blood and 0h milk. The alpha-tocopherol analyzes were performed by high-performance liquid chromatography. Serum levels of alpha-tocopherol less than 516 μg/dL were considered indicative of nutritional deficiency. The average concentration of alphatocopherol in the serum of the control group mothers was 1159.8 ± 292.4 μg/dL and the supplemented group was 1128.3 ± 407.2 μg/dL (p = 0.281). All women had nutritional status in vitamin E suitable. In both groups, it was observed that the concentration of vitamin E in colostrum milk was higher compared to transitional and mature milk. In the supplemented group, the concentration of alpha-tocopherol in the milk increased 60 % after supplementation, from 1339.3 ± 414.2 μg/dL (0h milk) to 2234.7 ± 997.3 μg/dL (24h milk). While the control group values in colostrum 0h and colostrum 24h were similar (p = 0.681). In the control group the follow-on milk alphatocopherol value was 875.3 ± 292.4 μg/dL and in the group supplemented 1352.8 ± 542.3 μg/dL, an increase of 35% in the supplemented group compared to control (p <0.001). In mature milk alpha-tocopherol concentrations between the control group (426.6 ± 187.5 μg/dL) and supplemented (416.4 ± 214.2 μg/dL) were similar (p = 0.853). Only 24h milk supplemented group answered the nutritional requirement of alpha-tocopherol (4 mg/day) of the newborn. These results show that the transport of this micronutrient for milk occurs in a controlled and limited way. Thus, the native vitamin E supplementation increases the concentration of alpha-tocopherol in colostrum and milk and transition does not influence the concentration in mature milk. Only the increase in colostrum milk was sufficient to meet the nutritional requirement of premature newborns.

Avaliação da concentração de vitamina A materna e de neonatos prematuros e a termo

Vitamin A is an essential nutrient for many physiological processes such as growth and development, so that their adequate nutritional state is essential during pregnancy and lactation. Lactating women and children in breastfeeding are considered risk groups for vitamin A deficiency and some factors may increase the risk of vitamin A deficiency, such as prematurity. The aim of this work was to evaluate the vitamin A concentration in preterm and term lactating women and newborns by determination of retinol in maternal serum, umbilical cord serum and breast milk collected until 72 hours postpartum. 182 mothers were recruited and divided into preterm group (GPT; n = 118) and term group (GT, n = 64). In preterm group were also analyzed transition milk (7th-15th day; n = 68) and mature milk (30th-55th day; n = 46) samples. Retinol was analyzed by high-performance liquid chromatography (HPLC). Maternal retinol concentration in serum was 48.6 ± 12.3 µg/dL in GPT and 42.8 ± 16.3 µg/dL in the GT (p <0.01). Cord serum retinol was 20.4 ± 7.4 µg/dL in GPT and 23.2 ± 7.6 µg/dL in GT (p> 0.05). Among newborns, 43% of premature and 36% of term had low levels of serum retinol in umbilical cord (<20 µg/dL). In colostrum, the retinol in preterm and term groups had an average of 100.8 ± 49.0 µg/dL and 127.5 ± 65.1 µg/dL, respectively (p <0.05). The retinol average in preterm milk increased to 112.5 ± 49.7 µg/dL in transition phase and decreased to 57.2 ± 23.4 µg/dL in mature milk, differing significantly in all stages (p <0.05). When comparing with the recommendation of vitamin A intake (400 µg/day) GT colostrum reached the recommendation for infants, but in GPT the recommendation was not achieved at any stage. Mothers of premature infants had higher serum retinol than mothers at term; however, this was not reflected in serum retinol of umbilical cord, since premature had lower concentration of retinol. Such condition can be explained due to lower maternal physiological hemodilution and placental transfer of retinol to the fetus during preterm gestation. Comparison of retinol in colostrum showed lower concentrations in GPT; however the transition phase there was a significant increase of retinol content released by the mammary gland of preterm mothers. This situation highlights a specific physiological adaptation of prematurity, likely to more contribute to formation of hepatic reserves of retinol in premature infants.

A influência da perda de peso no perfil inflamatório de mulheres com síndrome dos ovários policísticos

The polycystic ovary syndrome (PCOS) is considered the most common endocrine disorder in reproductive age women, with a prevalence ranging from 15 to 20%. In addition to hormonal and reproductive changes, it is common in PCOS the presence of risk factors for developing cardiovascular disease (CVD) and diabetes mellitus, insulin resistance (IR), visceral obesity, chronic low-grade inflammation and dyslipidemia. Due to the high frequency of obesity associated with PCOS, weight loss is considered as the first-line treatment for the syndrome by improving metabolic and normalizes serum androgens, restoring reproductive function of these patients. Objectives: To evaluate the inflammatory markers and IR in women with PCOS and healthy ovulatory with different nutritional status and how these parameters are displayed after weight loss through caloric restriction in with Down syndrome. Methods: Tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6) and C-reactive protein (CRP) were assessed in serum samples from 40 women of childbearing age. The volunteers were divided into four groups: Group I (not eutrophic with PCOS, n = 12); Group II (not eutrophic without PCOS, n = 10), Group III (eutrophic with PCOS, n = 08) and Group IV (eutrophic without PCOS, n = 10). The categorization of groups was performed by body mass index (BMI), according to the World Health Organization (WHO) does not eutrophic, overweight and obesity (BMI> 25 kg / m²) and normal weight (BMI <24.9 kg / m²). IR was determined by HOMA-IR index. In the second phase of the study a controlled dietary intervention was performed and inflammatory parameters were evaluated in 21 overweight and obese women with PCOS, before and after weight loss. All patients received a low-calorie diet with reduction of 500 kcal / day of regular consumption with standard concentrations of macronutrients. Results: Phase 1: PCOS patients showed increased levels of CRP (p <0.01) and HOMAIR (p <0.01). When divided by BMI, both not eutrophic group with PCOS (I) as eutrophic with PCOS (III) showed increased levels of CRP (I = 2.35 ± 0,55mg / L and 2.63 ± III = 0,65mg / L; p <0.01) and HOMA-IR (I = 2.16 ± 2.54 and III = 1.07 ± 0.55; p <0.01). There were no differences in TNF-α and IL-6 between groups. Step 2: After the weight loss of 5% of the initial weight was reduced in all of the components of serum assessed inflammatory profile, PCR (154.75 ± 19:33) vs (78.06 ± 8.9) TNF α (10.89 ± 5.09) vs (6:39 ± 1:41) and IL6 (154.75 ± 19:33) vs (78.06 ± 08.09) (p <0:00) in association with improvement some hormonal parameters evaluated. Conclusion: PCOS contributed to the development of chronic inflammation and changes in glucose metabolism by increasing CRP, insulin and HOMA-IR, independent of nutritional status. The weight loss, caloric restriction has improved the inflammatory condition and hormonal status of the evaluated patients.

Avaliação da efetividade do Programa de Alimentação do Trabalhador

This study analyzed the Worker’s Healthy Eating Program in Rio Grande do Norte state (RN) to assess its possible impact on the nutritional status of the workers benefitted. To that end, we conducted a cross-sectional observational prospective study based on a multistage stratified random sample comparing 26 small and medium-sized companies from the Manufacturing Sector (textiles, food and beverages, and nonmetallic minerals) of RN, divided into two equal groups (WFP and Non WFP). Interviews were conducted at each company by trained interviewers from Tuesday to Saturday between September and December 2014. Data were collected on the company (characterization and information regarding the program’s desired results) and workers (personal and professional information, anthropometrics, health, lifestyle and food consumed the previous day). Population estimates were calculated for RN on the characteristics of workers and the study variables. The main variable was BMI. The secondary variables were waist circumference (WC), nutritional diagnosis, calorie intake, blood pressure, metabolic variables and lifestyle indicators. The statistical method used was hierarchical mixed effects linear regression for interval variables and hierarchical mixed effects logistic regression for binary variables. The variables measured in ordinal scales were analyzed by ordinal logistic regression adjusted for correlated variables, adopting robust standard errors. The results for interval variables are presented as point estimates and their 95% confidence intervals; and as odds-ratios and their 95% confidence intervals for binary variables. The Fisher’s exact and Student’s t-tests were used for simple comparisons between proportions and means, respectively. Differences were considered statistically significant at p<0.05. A total of 1069 workers were interviewed, of which 541 were from the WFP group and 528 from the Non WFP group. Subjects were predominantly males and average age was 34.5 years. Significant intergroup differences were observed for schooling level, income above 1 MW (minimum wage) and specific training for their position at the company. The results indicated a significant difference between the BMI of workers benefitted, which was on average 0.989 kg/m2 higher than the BMI of workers from the Non WFP group (p=0.002); and between the WC, with the waist circumference of WFP group workers an average of 1.528 cm larger (p<0.05). Higher prevalence of overweight and obesity (p<0.001) and cardiovascular risk (p=0.038) were recorded in the WFP group. Tests on the possible effect of the WFP on health (blood pressure and metabolic indicators) and lifestyle indicators (smoking, alcohol consumption and exercise) were not significant. With respect to worker’s diets, differences were significant for consumption of saturated fat (lunch and daily intake), salt (lunch, other meals and daily intake) and proteins (other meals and daily intake), with higher consumption of these nutrients in the WFP group. The study showed a possible positive impact of the WFP on nutritional status (BMI and WC) among the workers benefitted. No possible effects of the program were observed for the lifestyle indicators studied. Workers benefitted consumed less salt, saturated fat and protein. The relevance of the WFP is recognized for this portion of society and it is understood that, if the program can reach and impact those involved, the development of educational initiatives aimed at nutritional and food safety may also exert a positive influence.