Thesis (MNutr (Human Nutrition))--Stellenbosch University, 2008. / INTRODUCTION: The best known reference standards used to evaluate the growth and development of infants and children are the 1977 National Centre for Health Statistics (NCHS) - , the 2000 Centres for Disease Control and Prevention (CDC) - and the World Health Organization (WHO) (2006). The NCHS reference standards were used to analyse anthropometric data from the 1999 National Food Consumption Survey (NFCS). It was anticipated that using the 2000 CDC and the 2006 WHO reference standards may lead to differences in the previously estimated prevalences of stunting, wasting, underweight, risk of overweight, overweight and obesity in the study population. AIM: To compare the anthropometric status of children aged 12 - 60 months when using the 1977 NCHS -, the 2000 CDC -, and the 2006 WHO reference standards. METHODS: A secondary analysis of anthropometric data from the 1999 NFCS was conducted using different reference standards to compare anthropometric status in terms of the prevalences of stunting, wasting, underweight, risk of overweight, overweight and obesity. Relationships between anthropometric status and other variables such as breastfeeding, maternal education level and type of housing were explored. RESULTS: The prevalences of stunting, obesity and overweight were significantly higher and the prevalence of underweight and wasting were lower when using the 2006 WHO compared to the 1977 NCHS and the 2000 CDC reference standards. A significant relationship was found between weight-forheight and breastfeeding when using any one of the reference standards and between BMI-for-age and breastfeeding when using the 2006 WHO reference standard. A significant relationship was shown between maternal education level and height-for-age and weight-for-age when using any one of the three reference standards and a significant association was found between weight-for-height and BMI-for-age and the type of housing when using any of the three reference standards. CONCLUSIONS: The prevalences of stunting and obesity were higher when using the 2006 WHO reference standards compared to the 1977 NCHS and 2000 CDC reference standards. This may be due to the linear growth and rate of weight gain of breastfed infants differing from formula fed infants and the 2006 WHO reference made use of the exclusively and predominantly breastfed infant living under normal healthy conditions as the normative model which is a prescription of how children should not grow and .not an indication of how children are growing. In conclusion, the 2006 WHO reference standard must be the only reference standard used nationally and internationally when assessing the growth and nutritional status of infants and children.

Cette thèse propose une étude des cultures enfantines et des rapports intergénérationnels à partir de l’alimentation. Les pratiques alimentaires des enfants, leurs représentations ainsi que celles de leurs parents à leur égard sont envisagées comme un observatoire des relations entre enfants ainsi qu’entre les adultes et les plus jeunes. A partir d’une méthodologie qualitative, il s’agit de donner toute leur place aux discours des enfants (âgés de 4 à 12 ans) et de leurs parents, pour interroger la dynamique des rapports intra et intergénérationnels. Au carrefour de la sociologie de l’enfance et de l’alimentation, ce travail s’attache à analyser la construction des cultures enfantines et des appartenances à différents groupes d’âges ainsi qu’à observer les effets des normes sociales et des modèles éducatifs qui régulent les consommations enfantines. Les rapports de genre, les origines sociales et les lieux d’habitation sont autant de facteurs qui influencent ces logiques. De façon transversale, cette recherche est l’occasion d’interroger la place de l’enfant dans les sociétés contemporaines occidentales. / This PhD proposes to study children’s cultures and intergenerational relationships by observing foodconsumption. Children’s practices with food, their representations as well as those of their parents on their consumption of food are considered as an observatory of relationships between children and between adults and younger. Developing a qualitative methodology, it is given its rightful place to the children discourses (aged 4 to 12 years) and those of their parents to explore the dynamics of intra and intergenerational relationships. At the intersection of sociology of childhood and food, this work focuses on analyzing the construction of children’s cultures and of belongings to different age groups. It also questions the effects of social norms and educational patterns regulating children consumption of food. Gender relations, social origins and spaces of residence are important factors that influence these logics. Transversely, this research is an opportunity to examine the social place of the child in contemporary Western societies.

The thesis compares the carbon footprints generated by household food consumption in urban and rural areas of selected regions within the European Union, and deepens the knowledge of the impact contemporary society has on global climate change. Selected regions come from the Czech Republic, Germany, Hungary and the Netherlands. The first part summarises the findings of climate change and its impact on the environment, the concept of sustainable development, and the consumer behaviour of the Czech population in the food sector, with a focus on the possibility to influence carbon footprint production. The second part addresses the particular comparison of carbon footprints generated by household food consumption and evaluates the results. The conclusion from this part of the dissertation can be used as a guide to help reduce carbon footprints through food consumption.

RESULTADOS: Participaram do estudo 63 indivíduos (42,9% OI tipo I; 17,5 OI tipo III; 39,7 OI tipo IV). As características clínicas dos indivíduos estavam de acordo com a variabilidade fenotípica da doença. Todos os indivíduos com OI tipo III possuiam baixa estatura grave. Em relação estado nutricional, a maioria dos indivíduos foram classificados como eutróficos, entretanto somando sobrepeso e obesidade foi observado 37,0%, 44,6% e 32,0% para OI tipo I, III e IV, respectivamente. Os resultados das avaliações das dobras cutâneas mostraram-se concordantes à classificação do estado nutricional dos indivíduos, pois pacientes com dobras cutâneas classificadas acima do percentil 85 apresentaram estado nutricional de sobrepeso e obesidade. A gordura corporal calculada através do DEXA apresentou forte correlação (r=0, 803) com a gordura corporal calculada pelo somatório das dobras cutâneas. Em relação ao consumo alimentar a média do percentual de adequação de calorias apresentou diferença significativa entre os dois métodos (OMS ou Kcal/cm) (p=0, 002). Consumo de energia acima de 110% foi observado em 45,6% e 40,4% dos indivíduos para ambos os métodos. A OI tipo III apresentou uma média do percentual de adequação de calorias mais elevado que a OI tipo I e IV em ambos os métodos. Para a classificação da adequação do consumo alimentar de macronutrientes, 12,7% dos indivíduos apresentaram consumo abaixo do ponto de corte mínimo estabelecido para carboidrato, enquanto que 23,8% e 30,8% dos indivíduos apresentaram consumo alimentar acima do ponto de corte máximo para proteína e lipídio, respectivamente. Observamos uma associação entre o diagnóstico nutricional e os pontos de corte de consumo alimentar estabelecidos. A classificação consumo alimentar de cálcio abaixo do ponto de corte mínimo foi observado em 76,2% dos indivíduos, sendo 79,5% a média do percentual de adequação do consumo de cálcio, estando abaixo do ponto de corte mínimo. A média do consumo de cálcio ingerido foi de 770mg/dia. Foi observada uma correlação inversa (r= -0 527) entre a idade e a adequação no consumo de cálcio. CONCLUSÃO: Este estudo demonstra que a OI apresentam uma variabilidade clínica grande. A baixa estatura é uma característica marcante na OI, principalmente, em indivíduos com tipo III. Os indivíduos, em sua maioria, foram classificados como eutróficos, porém foi observada incidência de sobrepeso e obesidade nos pacientes. As dobras cutâneas mostraram- se concordantes com o diagnóstico nutricional dos indivíduos. O percentual de gordura corporal calculada pelo somatório das dobras cutâneas apresentou forte correlação com a percentual de gordura corporal calculado pelo DEXA. Em relação, ao consumo alimentar, indivíduos classificados com OI tipo III, apresentaram maior consumo de energia, do que os indivíduos com OI tipos I e IV. Para o consumo de macronutrientes, embora a maioria dos indivíduos apresentarem consumo adequado, alguns indivíduos apresentaram baixo consumo de carboidrato e alto consumo de proteína e lipídio. O baixo consumo de cálcio apresentou- se 76,2% da população estando abaixo do ponto de corte mínimo. Foi observada também uma correlação inversa entre idade e adequação no consumo de cálcio. Este estudo manifesta a necessidade de uma intervenção nutricional direcionada a estes pacientes uma vez que a adequação do estado nutricional e do consumo alimentar são fatores importantes para a saúde óssea. / BACKGROUND: Osteogenesis Imperfecta (OI) is an inherited disease that results in decreased bone mass and fragility leading to an increased susceptibility to fractures. OBJECTIVE: The aim of this study was to evaluate clinical, anthropometric, nutritional status and describe the profile of food intake in pediatric patients with OI. METHODS: We conducted a cross-sectional study of pediatric patients form 0-19 years of age of both gender attending the OI outpatient clinic of Hospital de Clínicas de Porto Alegre. All subjects underwent clinical evaluation, anthropometric measurements and nutritional assessment. Percentage of body fat was calculated using the sum of skinfolds (triceps and subscapular) and measured by Dual Energy X-Ray Absoptiometry (DEXA). Both measurements were correlated. Food intake was calculated using the food diary for three days and for calculation of calories two methods were used: reference table by age by WHO and the formula Kcal / cm. The values used to ensure adequate intake of macronutrients (carbohydrate, protein and lipid) were according to FAO/ WHO and the food intake of micronutrients (calcium) according to DRI, considering the Adequate Intake (AI) for age. It was established as suitable for food intake of calories and nutrients intake between the cutoffs of 90 to 110%. For data analysis SPSS V.18 was used. The tests for statistical analysis were One Way ANOVA, t-student, Kappa, Pearson correlation tests. We considered significant values p <0.05. RESULTS: The study enrolled 63 subjects (42.9% OI type I, 17.5% OI type III, 39.7% OI type IV). The clinical characteristics of individuals were in agreement with the phenotypic variability of the disease. All individuals with OI type III had been classified with severe short stature. The nutritional status of most individuals were classified as normal, however overweight or obesity were observed respectively in 37.0%, 44.6% and 32.0% for OI type I, III and IV, respectively. The results of evaluations of skinfolds were shown to be consistent with the classification of nutritional status of individuals, because patients with skinfolds above the 85th centile showed nutritional status of overweight and obesity. Body fat estimated by DEXA showed a strong correlation (r = 0.803) with body fat calculated from the sum of skinfolds. Regarding the profile of food consumption the average proportion of adequate calories showed significant difference between the two methods (WHO or Kcal/cm) (p = 0.002). Food consumption in excess of 110% was observed in 45.6% and 40.4% of subjects for both methods. The OI type III showed an average proportion of adequate calories higher than OI type I and IV in both methods. To classify the adequacy of dietary intake of macronutrients 12.7% of subjects had intake below the threshold cutoff for carbohydrate, whereas 23.8 and 30.8% of subjects had food intake above the cutoff limit for protein and lipid. We observed an association between nutritional status and the cutoff of food consumption set. Classification dietary intake of calcium below the minimum cutoff point was observed in 76.2% of subjects and the average intake of calcium was 770mg/dia. We observed an inverse correlation (r = -0.527) between age and calcium intake. CONCLUSION: This study demonstrates that the OI have a great clinical variability. Short stature is a hallmark in OI, especially in individuals with type III. Individuals, in most cases, were classified as normal, but it was found that the incidence of overweight and obesity in patients. The skinfolds were shown to be consistent with the diagnosis of nutritional subjects. skinfolds showed a strong correlation with body fat percentage calculated by DEXA. In relation to the food intake, individuals classified as OI type III, had higher energy consumption than individuals with OI type I and IV. For the consumption of macronutrients, although most people develop adequate intake, some individuals had low carbohydrate intake and high intake of protein and lipid. The low intake of calcium was 76.2% of the population being below the minimum cutoff. There was also an inverse correlation between age and fitness for consumption of calcium. This study shows the need for a nutritional intervention targeted to these patients since their nutritional status and dietary intake are important factors for bone health.

Objective: To investigate the prevalence of and factors associated with anemia in school children from Maceió, Brazil. Methods: Cross-sectional study using probability sampling of 1518 children (9.8 ± 0.5 years of age) attending public (n=931) and private (n=587) primary schools in the municipality. Semi-structured questionnaires were used to obtain socioeconomic, demographic, anthropomorphic, hemoglobin and dietary data. The measure of association used was prevalence ratio (PR) and respective CI95%, calculated by Poisson regression with robust variance adjustment, for the crude and adjusted analyses. Results: The prevalence of anemia was found to be higher amongst the public school children than the private school children (10.8% vs. 7.0%; PR=1.54; CI95%: 1.1; 2.2). At the public schools, the variables that remained significantly associated with anemia after the multivariate analysis were “consumption of fruits and fruit juices < 2 portions/day” (PR=2.19; CI95%: 1.18; 4.06) and “male” (PR=1.51; CI95%: 1.001; 2.30). At the private schools, these variables were “working mother” (PR=2.83; CI95%: 1.23; 6.52) and “monthly school fees < R$ 188.00” (PR=3.20; CI95%: 1.46; 7.03). Conclusion: Anemia amongst school-age children is a public health problem in the Brazilian city of Maceió. Even when it is classified as slight, it requires the attention of public policy managers, in view of the associated damage to health, cognitive development, school performance, and the quality of life of the individuals affected. / Fundação de Amparo a Pesquisa do Estado de Alagoas / Objetivo: Investigar a prevalência e os fatores associados à anemia em escolares de Maceió. Métodos: Estudo transversal com amostra probabilística de 1518 alunos (9,8 ± 0,5 anos), pertencentes às redes pública (n=931) ou privada (n=587) de ensino fundamental do município. Foram utilizados questionários semiestruturados para a obtenção de informações socioeconômicas, demográficas, antropométricas, hemoglobina e de consumo alimentar. Utilizou-se como medida de associação a razão de prevalência (RP) e respectivo IC95%, calculados por regressão de Poisson com ajuste robusto da variância, tanto na análise bruta como na ajustada. Resultados: A prevalência de anemia em crianças da rede pública foi superior à observada naquelas da rede privada (10,8% vs. 7,0%; RP=1,54; IC95%: 1,1; 2,2). As variáveis que entre alunos da rede pública se manteve significantemente associada à anemia após análise multivariável foram “consumo de frutas e sucos < 2 porções/dia” (RP=2,19; IC95%: 1,18; 4,06) e ser do “sexo masculino” (RP=1,51; IC95%: 1,001 a 2,03). Nas escolas privadas, foram “mãe trabalhar fora de casa” (RP=2,83; IC95%: 1,23; 6,52) e “mensalidade escolar < R$ 188,00” (RP=3,20; IC95%: 1,46; 7,02). Conclusão: A anemia em escolares de Maceió é um problema de saúde pública que, embora classificado como do tipo leve, requer atenção por parte dos gestores das políticas públicas, haja vista os danos causados à saúde, desenvolvimento cognitivo, aprendizagem e à qualidade de vida dos indivíduos afetados.

The Chronic Noncommunicable Diseases (NCDs), among them cardiovascular disease are present in the population in alarming numbers. Studies show the direct and indirect food intake with the development of these disorders. To do so, they become necessary research to assess the dietary patterns of the population, in order to support the formulation of actions and public health policies to control these diseases. This subject was the focus of this dissertation in order to explore what the main tools and methods that are being used in epidemiological research on the dietary pattern of the population and evaluate the dietary intake of patients seen in Ambulatory NCD Teaching Nutrition, University Hospital Federal University of Alagoas the literature review revealed that the most frequently used instruments for the assessment of food consumption remain the most traditional: food Frequency Questionnaire - FFQ and 24h recall - 24HR evaluated compared to the food groups, and adjustment to DRI's. As for consumer research with patients showed an adequate intake in respect to nutrients, micronutrients in relation to the consumption was only suitable for the vitamins A, B12, C and the mineral selenium compared to RDA and finally assessment performed by the method of RAS as the cutoff, revealed a high proportion of individuals with probability of inadequate intake for micronutrients, except iron and vitamin C. Given the above results, it is possible to realize that nutrition policy and nutrition education activities are necessary and which act continuously and impacting the population. / Conselho Nacional de Desenvolvimento Científico e Tecnológico / As Doenças Crônicas Não Transmissíveis (DCNT), dentre elas, as doenças cardiovasculares, estão presentes na população em números alarmantes. Estudos comprovam a relação direta e indireta do consumo alimentar com o desenvolvimento destas patologias. Para tanto, tornam-se necessárias pesquisas que avaliem o padrão alimentar da população, de forma a subsidiar a formulação de ações e políticas públicas de saúde no controle destas doenças. Esta temática foi o foco desta dissertação com o objetivo de explorar quais os principais instrumentos e métodos que estão sendo utilizados em pesquisas epidemiológicas sobre o padrão dietético da população e avaliar o consumo alimentar de portadores de DCNT atendidos em Ambulatório de Ensino de Nutrição do Hospital Universitário da Universidade Federal de Alagoas A revisão da literatura revelou que os instrumentos mais utilizados para a avaliação do consumo alimentar continuam sendo os mais tradicionais: Questionário de Frequência Alimentar – QFA e o Recordatório 24h – R24h avaliados comparação à grupos alimentares, e adequação à Ingestão Dietética de Referência (Dietary References Intakes – DRI’s). Já a pesquisa de consumo com os pacientes revelou uma ingestão adequada no que se refere a macronutrientes; em relação aos micronutrientes o consumo foi adequado apenas para as vitaminas A, B12, C e para o mineral selênio, quando comparado à ingestão dietética recomendada (Recommended Dietary Allowance / RDA) e por fim, a avaliação realizada através do método da EAR (Estimated Average Requirement/ Necessidade média estimada) como ponto de corte, revelou uma alta proporção de indivíduos com probabilidade de ingestão inadequada para os micronutrientes , à exceção do ferro e vitamina C. Diante dos resultados expostos, é possível perceber que políticas de nutrição e ações de educação nutricional se fazem necessárias e que atuem de maneira contínua e impactante na população.

Made available in DSpace on 2015-07-22T20:49:47Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-03-31 / Introdução: A alimentação nos primeiros anos de vida cumpre papel fundamental na manutenção da saúde e formação de hábitos alimentares saudáveis, trazendo consequências importantes a curto e longo prazo. Diversos fatores que caracterizam a sociedade contemporânea têm influenciado no aumento da rede de creches gratuitas nas médias e grandes cidades do país. Estas unidades funcionam por até 12 horas/dia, e de acordo com as diretrizes devem oferecer às crianças 100% das suas necessidades nutricionais diárias. Objetivo: Avaliar o consumo energético e a adequação da dieta de crianças frequentadoras de berçários de oito creches públicas e filantrópicas, no município de São Paulo, SP. Métodos: Estudo transversal descritivo, parte do Projeto Crecheficiente II, vinculado à Universidade Federal de São Paulo (UNIFESP). A coleta de dados ocorreu entre agosto e setembro de 2007, nos berçários de oito creches do município de São Paulo, totalizando 16 berçários, que atendem 236 crianças. O consumo alimentar foi avaliado pelo método de pesagem direta durante três dias não-consecutivos. O cálculo nutricional foi realizado utilizando-se o software Diet Win Profissional 2.0® e a adequação foi calculada para energia segundo a Necessidade Energética Estimada (Estimated Energy Requirement – EER, 2002), para proteína, ferro, vitaminas A e C, segundo a Necessidade Média Estimada (Estimated Average Requirement – EAR) do National Research Council (2002) e para cálcio segundo a Ingestão Adequada (Adequate Intake – AI, 1999). Os dados foram duplamente digitados, validados e analisados no programa Epi-Info 2000, versão 3.4.3. Resultados: A média do consumo alimentar nas creches estudadas demonstrou inadequação para os nutrientes analisados, havendo déficit de energia, ferro e cálcio e excesso de proteína, vitaminas A e C. A distribuição dos percentuais de adequação dos macronutrientes mostrou-se inadequada para lipídeos. Conclusões: Os resultados desse estudo permitiram concluir que não foram atendidas as recomendações nutricionais diárias de energia, ferro e cálcio, tendo excedido as recomendações de proteína, vitamina C e vitamina A, refletindo a necessidade de uma avaliação crítica do programa de alimentação de préescolares do município. / Objective: To evaluate the energy intake and diet adequacy among children enrolled at nurseries of public and not-for-profit daycare centers in São Paulo City. Methods: Cross-sectional study aiming at assessing food consumption using the straight weighing method during three non-consecutive days. Nutrition values were achieved using Professional DietWin software. Diet adequacy was calculated using the following parameters: Estimated Energy Requirement – EER for energy; Estimated Average Requirement – EAR for protein, iron, vitamins C and A; Adequate Intake – AI for calcium since there is no EAR for this nutrient. Data were doubled entered, validated and analyzed using Epi Info. Results: Food consumption mean for the eight daycare centers has demonstrated that nutrients analyzed were inadequate for energy with deficits of iron and calcium, and excess of proteins, vitamins A and C. Distribution of adequacy percentuals for macronutrients showed inadequacy for lipids. Conclusion: The results allow the conclusion that the daily nutrition reccomendations for energy, iron and calcium were not attended while for protein , vitamin C and vitamin A reccomendations were exceded which reflects the necessity of critical assessment of São Paulo preschool food program. / TEDE / BV UNIFESP: Teses e dissertações

Made available in DSpace on 2015-07-22T20:50:28Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-04-29. Added 1 bitstream(s) on 2015-08-11T03:25:54Z : No. of bitstreams: 1 Publico-11753.pdf: 726554 bytes, checksum: eeead891085aba4318385e6bb1c44fc3 (MD5) / Introdução: A síndrome metabólica (SM) é um transtorno complexo que associa fatores de risco cardiovasculares bem estabelecidos. A ingestão alimentar tem sido associada a SM, no entanto, o papel da dieta em sua gênese não é bem compreendido. Objetivo: Verificar a prevalência de SM e seus componentes relacionando-os à ingestão alimentar em Policiais Militares da região oeste do Paraná. Métodos: Foi analisada a circunferência da cintura, a pressão arterial, a glicemia em jejum, o triacilgliceróis, o HDL-colesterol e a ingestão alimentar de 280 Policiais Militares, do gênero masculino, de 21 a 50 anos, do oeste do Paraná. A SM e seus componentes seguiram os critérios do NCEP-ATPIII adaptados pela IDBSM. Utilizou-se de três recordatórios alimentar de 24h para análise da ingestão dos carboidratos, proteínas, gorduras, fibras, vitaminas A, C, E, D, B12, B9 e cálcio. Comparou-se a média da ingestão de nutrientes entre os policiais com e sem SM e seus componentes. Resultados: Encontraram-se 69 (24,6%) casos de SM. Dentre os componentes da SM, os mais prevalentes foram a hipertrigliceridemia, HDL-colesterol baixo e hipertensão arterial. Houve alta prevalência de inadequação dos micronutrientes analisados. Policiais com circunferência da cintura aumentada ingerem mais energia (p<0,001), carboidratos (p=0,02), fibras (p=0,04), proteínas (p=0,002) e gorduras totais (<0,01). Policiais com SM apresentaram maior ingestão energética (p=0,03). A ingestão média de vitamina D foi menor nos grupos: circunferência da cintura aumentada (p<0,05), hipertrigliceridemia (p<0,05), hipertensão arterial (p=0,04) e presença de SM (p<0,05). Conclusão: Os policiais militares apresentaram ingestão deficiente dos micronutrientes estudados. Apesar da limitação do corte transversal do presente estudo, os resultados sugerem que a SM nesta população pode estar relacionada com ingestão excessiva de energia e baixa ingestão de vitamina D. É necessária maior atenção ao estado de saúde e ingestão alimentar desta população avaliada, que é responsável pela segurança da população brasileira. / Introduction: The metabolic syndrome (MetSyn) is a complex disorder that is related to well-established cardiovascular risk factors. The food intake has been associated with MetSyn, however, the role of diet in its origin is not well understood. Objective: To investigate the prevalence of MetSyn and its components relating them to the food intake of the Military Police Officers in the Western region of Paraná. Methods: We analyzed the waist circumference, blood pressure, fasting glucose, triglycerides, high-density lipoprotein (HDL) cholesterol and dietary intake of 280 military police officers, male, 21 to 50 years in Western Paraná. MetSyn and its components were defined by NCEP-ATPIII adapted by IDBSM. We used three 24-hour food recalls for analysis of intake of carbohydrates, proteins, fats, fiber, vitamins A, C, E, D, B12, B9, and calcium. We compared the nutrient intake average between officers with and without MetSyn and its components. Results: We found 69 (24.6%) cases of MetSyn. Among the components of MetSyn, the most prevalent ones were hypertriglyceridemia, low HDL-cholesterol and hypertension. There was a high prevalence of inadequacy in the analyzed micronutrient. Police officers with increased waist circumference eat more energy (p <0.001), carbohydrate (p = 0.02), fibers (p = 0.04), protein (p = 0.002) and total fat (<0.01). Police officers with MetSyn showed higher energy intake (p = 0.03). The intake average of vitamin D was lower in the groups: increased waist circumference (p <0.05), hypertriglyceridemia (p <0.05), hypertension (p = 0.04) and presence of MetSyn (p <0, 05). Conclusion: The military police officers had a poor intake of micronutrients. Despite the limitations of this cross-sectional study, the results suggest that MetSyn in this population can be related to excessive intake of energy and low intake of vitamin D. More attention should be paid to the health conditions and dietary intake of this studied population, who is responsible for providing security service for the Brazilian people. / TEDE / BV UNIFESP: Teses e dissertações

Regular physical activity and a healthful diet are important influences on health. Nevertheless, few studies have focused on the influence of habitual physical activity on diet preferences. The aim of this cross-sectional study was to investigate the relationship between habitual physical activity and dietary intake, body composition, metabolic and hormonal variables and cardiovascular risk factors in postmenopausal women with no evidence of cardiovascular disease. One hundred and five women (mean age: 55.2±4.9 years) consulting for climacteric symptoms underwent anthropometric and hormonal assessment. Usual dietary intake was assessed with a food frequency questionnaire, and habitual physical activity with a digital pedometer. Participants were classified as physically inactive (5 999 steps daily) or physically active (≥ 6 000 steps daily). A negative correlation was observed between steps/day and percent body fat (r = - 0.470; P<0.001), waist circumference (r = - 0.356; P<0.001) and body mass index (r = - 0.286; P=0.003). Compared to the inactive group, active participants had lower diastolic blood pressure (P=0.012), ultrasensitive C-reactive protein (us-CRP) (P=0.011), fasting glucose (P=0.003), fasting insulin (P=0.019) and homeostasis model assessment index (P=0.017), and higher intake of protein, total fat, cholesterol, calcium, iron, zinc, selenium, meats, eggs, and whole-fat dairy foods. After adjustment for age and time since menopause, the risk for metabolic syndrome increased with physical inactivity, high blood pressure, us-CRP, and percent body fat. In conclusion, both habitual physical activity and dietary choices may have contributed towards a more favorable cardiovascular profile and lower risk of metabolic syndrome in postmenopausal women.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Esta tese é composta por dois artigos que buscaram avaliar a relação entre pressão arterial e consumo alimentar em adolescentes, no ensaio comunitário randomizado denominado PAPPAS (Pais, Alunos e Professores Pela Alimentação Saudável), conduzido com alunos do 5 ano de vinte escolas públicas do município de Duque de Caxias, Rio de Janeiro. Este ensaio teve como objetivo principal reduzir o ganho de peso excessivo dos adolescentes, por meio de intervenções que estimularam o consumo de frutas e feijão e desencorajaram o consumo de bebidas adoçadas e biscoitos. A pesquisa foi conduzida durante o ano letivo de 2010. A coleta de dados de consumo alimentar e medidas antropométricas ocorreu em três fases: (1) início do ano letivo, (2) metade do ano letivo e (3) fim do ano letivo. A pressão arterial foi mensurada nas fases 2 e 3. Nove sessões de educação nutricional foram realizadas. Pais/responsáveis e professores receberam informação e material de divulgação sobre os mesmos temas abordados em sala de aula. As análises estatísticas consideraram os dados faltantes e o efeito de conglomerado. No primeiro artigo é apresentado o efeito da intervenção na pressão arterial dos adolescentes. Os hábitos alimentares dos adolescentes são inadequados e redução do consumo de biscoitos e refrigerantes, bem como aumento do consumo de frutas, podem contribuir para redução da pressão arterial. Os achados nessa população de adolescentes com baixa prevalência de pressão arterial elevada sugerem que a qualidade da dieta pode contribuir para redução da pressão arterial, independente de possíveis modificações no IMC. Os resultados reforçam a importância da promoção de hábitos alimentares saudáveis para prevenir doenças cardiovasculares na vida adulta. No segundo artigo, em análise transversal, verificou-se a associação entre pressão arterial e consumo de refrigerante. O consumo de refrigerantes é comum entre adolescentes. Consumidores de refrigerante diet/light, seguido por consumidores de refrigerantes adoçados com açúcar, apresentaram pressão arterial mais alta indicando que a redução do consumo de refrigerantes é importante, bem como a prevenção da substituição de bebidas adoçadas com açúcar por bebidas diet/light. Os resultados sugerem que escolhas alimentares inadequadas podem estar associadas ao aumento da pressão arterial. / This thesis consists of two articles that evaluated the relationship between blood pressure and dietary intake in adolescents, as the secondary aim of the randomized community trial named PAPPAS (Parents, Students and Teachers Through Healthy Eating), conducted with students in the 5th grade of twenty public schools in the municipality of Duque de Caxias, Rio de Janeiro. The main aim of the study was to reduce excessive weight gain in adolescents using interventions encouraging the consumption of fruits and beans and discouraging the consumption of sweetened beverages and cookies. The project was conducted during the school year of 2010. Data about dietary intake and anthropometric measures were collected in three phases: (1) beginning of the school year, (2) middle of the school year and (3) end of the school year. Blood pressure was measured in phases 2 and 3. Nine sessions of intervention about nutritional education were performed. Parents/guardians and teachers received information and materials on the same topics covered in the classroom. Statistical analyses considered missing data and the cluster effect. In the first article, the effect of the intervention on blood pressure of students is presented. The dietary habits among adolescents are inadequate and reduction of cookies and soft drinks consumption, as well as increase of fruits consumption may reduce blood pressure. The findings in this population of adolescents with very low prevalence of hypertension, suggest that changes in the quality of diet may change BP independent of possible changes in BMI. These results highlight the importance of promoting healthy eating behaviors to prevent cardiovascular diseases later in life. In the second article, in a cross-sectional analysis, it was investigate the association between blood pressure and soft drink consumption. The consumption of soft drinks is common in Brazilian adolescents. Diet/light soft drinks consumers, followed by sugar-sweetened consumers, presented higher blood pressure indicating that reduction of soft drink frequency of consumption is important, as well as the prevention of substitution of sugar-sweetened beverages by diet/light beverages. The present results suggest that inadequate food choices and dietary habits among adolescents may be associated with higher blood pressure.