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Made available in DSpace on 2018-06-04T19:14:37Z (GMT). No. of bitstreams: 0 Previous issue date: 2017-03-31 / INTRODUÇÃO: O envelhecimento populacional está ocorrendo em todo o mundo, trazendo grandes desafios políticos, econômicos e sociais para o Setor Saúde. Neste contexto, inadequações nutricionais podem comprometer significativamente a saúde e a qualidade de vida dos idosos. OBJETIVO: Avaliar a inadequação de nutrientes em idosos e a associação dessa inadequação com fatores demográficos, doenças crônicas não transmissíveis e número de atividades de vida diárias comprometidas. MÉTODOS: Trata-se de um estudo transversal, aninhado a uma coorte de idosos do projeto EPIDOSO II. Foram incluídos no estudo 596 idosos que responderam ao recordatório de 24 horas. Foram criadas variáveis indicadoras (sim/não) de inadequação das variáveis nutricionais (energia, carboidratos, proteínas, lipídios, fibras, álcool, vitaminas A, B2, C, D, cálcio, ferro, zinco e sódio). Determinamos um critério de adequação ou inadequação nutricional, onde a soma de sete ou mais inadequações das variáveis nutricionais indicaria inadequação nutricional. Modelos de regressão logística foram utilizados para avaliar a associação entre inadequação nutricional e as variáveis independentes. RESULTADOS: Foram estudados indivíduos com idade ≥ a 60 anos, sendo 412 mulheres e 184 homens, com idade média de 72,3 anos (dp=7,4 anos), o IMC médio encontrado para essa população foi de 27,3 kg/m2 (dp=4,8), 59,1% dos indivíduos foram classificados como inadequação nutricional. A análise de regressão logística múltipla mostrou associação positiva entre inadequação nutricional e sexo masculino (OR=1,60; IC95% [1,11; 2,31]; p=0,011), idade em anos (o acréscimo de 1 ano de idade aumenta a chance em 1,036; p=0,003), estado conjugal separado (OR=2,12; IC95% [1,14; 3,92]; p=0,017) e ter número de atividades de vida diárias comprometidas (OR=1,55; IC95% [1,07; 2,24]; p=0,020). CONCLUSÃO: Inadequação nutricional relacionou-se com fatores demográficos e comprometimento funcional. Conhecer os fatores que se relacionam com inadequações nutricionais são de fundamental importância para o planejamento de políticas de saúde em nutrição. / INTRODUCTION: Population aging is occurring all over the world, bringing major political, economic and social challenges to the Health Sector. In this context, nutritional inadequacies can significantly compromise the health and quality of life of the elderly. OBJECTIVE: To evaluate the inadequacy of nutrients in the elderly and its association with demographic factors, chronic non communicable diseases and number of compromised daily life activities. METHODS: This is a cross-sectional study, nested with a cohort of elderly individuals from the EPIDOSO II project. The study included 596 elderly individuals who responded to the 24-hour recall. Nutritional variables (energy, carbohydrates, proteins, lipids, fibers, alcohol, vitamins A, B2, C, D, calcium, iron, zinc and sodium) were used as indicators of the inadequacy of nutritional variables. We determined a criterion of nutritional adequacy or inadequacy, where the sum of seven or more inadequacies of the nutritional variables points to nutritional inadequacy. Logistic regression models were used to evaluate the association between nutritional inadequacy and independent variables. RESULTS: Individuals aged ≥ 60 years, 412 women and 184 men, with a mean age of 72.3 years (sd=7.4), the mean BMI found was 27.3 kg/m2 (sd=4.8), 59.1% of individuals were classified as having nutritional inadequacy. Multiple logistic regression analysis showed a positive association between nutritional inadequacy and males (OR=1.60; 95%CI [1.11; 2.31]; p=0.011), age in years (an increase of 1 year of age increases the odds in 1.036; p=0.003), a separate marital status (OR= 2.12; 95%CI [1.14; 3.92]; p=0.017) and to have at least one compromised daily life activity (OR=1.55; 95%CI [1.07; 2.24]; p=0.020). CONCLUSION: Nutritional inadequacy was related to demographic factors and functional impairment. Knowing the factors that relate to nutritional inadequacies are of fundamental importance for the planning of health policies in nutrition. / BV UNIFESP: Teses e dissertações

Dans les pays occidentaux, la consommation de protéines animales, majoritaire, diminue depuis une décennie. Elle est, dans la majorité des cas, associée négativement à différents paramètres de durabilité, et les études modélisant des régimes durables ont montré que les différents paramètres n’étaient pas toujours compatibles. Des régimes améliorant largement différents paramètres de durabilité ont été modélisés, mais la prise en compte de l’acceptabilité culturelle est insuffisante et nécessite des approfondissements. L’objectif de cette thèse était de modéliser des trajectoires acceptables de réarrangement de la consommation de sources protéiques pour augmenter l’adéquation nutritionnelle et d’en évaluer les impacts sur la durabilité. L’étude des consommations de sources de protéines en France a permis de conclure que les apports en protéines sont adéquats pour l’ensemble de la population, mais qu’il existe différents profils de consommation protéique, caractérisés par des niveaux de sécurité nutritionnelle différents. Une étude réalisée en 2018 a permis d’établir que les niveaux de consommation de viande étaient prédits par les attitudes, les normes sociales, et l’auto-efficacité perçue vis-à-vis de la réduction de la consommation de viande. Pour les travaux de modélisation pas-à-pas de l’alimentation, il a été considéré acceptable pour un individu de consommer un nouvel aliment, si celui-ci était largement consommé par des individus au profil de consommation protéique similaire. Cette hypothèse a été validée par une enquête en 2018. Les travaux de modélisation ont permis d’identifier que certaines recommandations alimentaires étaient efficaces pour l’ensemble de la population, mais que d’autres étaient spécifiques à certains profils de consommation protéique, caractérisés par des profils nutritionnels et des répertoires alimentaires spécifiques. Enfin, des modèles ont permis d’identifier que viser systématiquement plus de protéines végétales lors des premières modifications diététiques permet, malgré une adéquation nutritionnelle légèrement plus faible, d’obtenir de meilleurs paramètres de durabilité. / In Western countries, the consumption of animal protein, which is the predominant protein source, has been decreasing over the last decade. This consumption has been negatively associated with different sustainability parameters in the majority of cases, and studies modelling sustainable diets have shown that the different parameters are not always compatible. Diets that significantly improve different sustainability parameters have been modelled, but the consideration of cultural acceptability is insufficient and requires further investigation. The objective of this thesis was to model acceptable trajectories of rearrangement of protein source consumption to increase nutritional adequacy and to evaluate its impacts on sustainability. The study of protein source consumption in France led to the conclusion that protein intake is adequate for the entire population, but that there are different profiles of protein intake characterized by different levels of nutritional security. A study conducted in 2018 found that meat consumption levels were predicted by attitudes, social norms, and perceived behavioral control related to the reduction of meat consumption. For the stepwise dietary modelling study, it was considered acceptable for an individual to consume a new food if it was widely consumed by individuals with a similar profile of protein intake. This hypothesis was validated by a survey conducted in 2018. The modelling work identified that some dietary recommendations were effective for the general population, but others were specific to certain profiles of protein intake characterized by specific nutritional profiles and food repertoires. Finally, models have identified that systematically targeting more plant proteins during the first dietary modifications allows, despite a slightly lower nutritional adequacy, to obtain better sustainability parameters.

Magister Public Health - MPH / Background: The World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) recommend exclusive breastfeeding for the first six months of life and introduction of nutritionally adequate and safe complementary foods after 6 months with continued breastfeeding to 2 years and beyond. A variety of foods in the diet is needed to ensure that the nutrient needs of breastfed and non-breastfed children are met. Price of food and affordability are the main barriers of accessing sufficient, safe and nutritious diets to meet dietary needs for an active and healthy life. Many low-income households cannot afford a healthy nutritionally adequate diet, because of the cost of nutrient-rich foods relative to income. Aim: The aim of the study was to determine whether cost of the diet is associated with dietary diversity, energy and nutrient density, and nutrient adequacy in breastfeeding and non-breastfeeding children aged 12 to 24 months. Objectives: For breastfed and non-breastfed children age 12 to 24 months, to determine: (i) dietary diversity, nutrient adequacy and cost of total dietary intake; (ii) dietary diversity, nutrient density, energy density and cost of the complementary diet; (iii) the association of cost of the diet with dietary diversity and nutrient adequacy; and (iv) the association of cost of the complementary diet with dietary diversity, nutrient density and energy density of the complementary Study design: The study is a descriptive study and used an existing dataset consisting of pooled previously collected 24-hour dietary recalls for children age 12 to 24 months from the two most recent independent studies (n=1064). The dataset included data on dietary energy and nutrients, mean adequacy ratio, nutrient adequacy ratios, micronutrient density per 100 kcal of the complementary diet and cost of food per 100g edible portion.

Magister Scientiae (Nutrition Management) - MSc(NM) / Micronutrient deficiencies are of public health concern in South Africa. These deficiencies affect pregnancy outcomes, growth, functional and cognitive development of children and, the health and productivity of women. As an intervention, the South African government implemented the National Food Fortification Programme (NFFP), which was mandated in 2003 and according to which, the staple foods consumed by most of the population e.g. maize meal and wheat flour (and thus bread) are fortified with a premix of thiamin, niacin, riboflavin, vitamin A, folate, vitamin B6, iron and zinc. There is limited data which looks at the contribution fortified staple food to the dietary intakes and measures of nutrient assessment among South African women of reproductive age (WRA).

Orientadores: Jaime Amaya-Farfan, Lucia Helena Simões da Costa Paiva / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Engenharia de Alimentos / Made available in DSpace on 2018-08-11T20:42:13Z (GMT). No. of bitstreams: 1 Cuneo_Florencia_D.pdf: 1042044 bytes, checksum: 191aa9c61592ed944d96d92c55608262 (MD5) Previous issue date: 2008 / Resumo: Objetivos: Avaliar em mulheres o potencial terapêutico do hidrolisado de colágeno, como suplemento alimentar, no tratamento da baixa densidade mineral óssea e as características nutricionais e dietéticas de mulheres na pós- menopausa. Métodos: Realizou-se um ensaio clínico do tipo duplo cego, aleatorizado, com mulheres na pós-menopausa, que apresentaram baixa densidade mineral óssea na coluna lombar diagnosticada por DEXA atendidas no Ambulatório de Menopausa do Centro de Atenção Integral à Saúde da Mulher da Universidade Estadual de Campinas. As mulheres recrutadas incluíram na alimentação hidrolisado de colágeno (10 g/dia) ou placebo por um período de 24 semanas. Foram determinados ao início do ensaio: cálcio, fósforo, fosfatase alcalina, creatinina plasmática, calciúria de 24 horas e o marcador de reabsorção óssea, telopeptídeo-carboxilo terminal plasmático do colágeno tipo I (CTX), e os marcadores de formação óssea, osteocalcina e fosfatase alcalina óssea no início, e após 12 e 24 semanas de tratamento. O consumo de energia e nutrientes essenciais foi estimado com Recordatório de 24h e Questionário de Freqüência Alimentar usando a Tabela Brasileira de Composição de Alimentos (TACO), como referência. Os dados foram analisados estatisticamente no programa SAS, através de análise de variância multivariada para medidas repetidas MANOVA e foram determinadas as correlações entre diferentes variáveis do estudo clínico (índice de correlação de Pearson), adotando-se o nível de significância estatística de 5%. Resultados: Um total de 71 mulheres com 57,3 ± 4,8 anos concluiu o estudo, 35 receberam placebo e 36 hidrolisado de colágeno. O índice de massa corporal das mulheres foi 27,4 ± 4,5 kg/m2. Encontrou-se 42% das mulheres estudadas com sobrepeso e 26% com obesidade. Com relação aos macronutrientes, 38% das mulheres consumiam lipídeos em excesso. O consumo diário de colesterol foi de 222 ± 98 mg, 22% das mulheres consumiu excessiva gordura saturada. De modo geral, a porcentagem de mulheres que apresentou inadequação no consumo de minerais e vitaminas. Em 94% das mulheres o consumo de cálcio (654±358 g/dia) foi inferior à ingestão adequada para a faixa etária. Não foram encontradas correlações entre a idade, variáveis dietéticas e ósseas estudadas e os marcadores do metabolismo ósseo. Os resultados dos marcadores, tanto de formação como de reabsorção óssea, não foram diferentes entre ambos os tratamentos. Das mulheres que sofriam de dores articulares ou ósseas um 34% relataram o desaparecimento da dor durante ou até a finalização do tratamento. Conclusões: Este estudo não mostrou nenhum efeito do HC sobre o metabolismo ósseo medido através de marcadores bioquímicos. O HC mostrou efeitos analgésicos para dores ósseo-articulares nas mulheres tratadas. A maioria das mulheres estava com excesso de peso relatou uma ingestão inadequada de cálcio / Abstract: Objectives: Evaluate the potential effect of hydrolyzed collagen, as a dietetic supplement, in the treatment of osteopenic postmenopausal women and to study of the anthropometric and food intake characteristics of the group. Methods: a randomized double-blind clinical assay with osteopenic postmenopausal women, was planned. The volunteers ingested 10 g/day of hydrolyzed collagen or a placebo for a period of 24 weeks. Calcium, phosphate, alkaline phosphatase, serum creatinine, 24h urinary calcium, the bone resorption marker carboxy-terminal collagen crosslinks (CTX) and the bone formation markers (osteocalcine and bone-specific alkaline phosphatase) were determined at the beginning and at 12 and 24 weeks of treatment. The intakes of nutrients and energy were estimated using the 24h record and a food frequency questionnaire using the Brazilian Food Composition Table (TACO) as reference. Results were analyzed using the SAS (MANOVA) and the Pearson¿s correlations were determined between variables, adopting 5% as a level of significance. Results: The sample was constituted of 35 placebo and 36 treated subjects (mean age 57.3 ± 4.8 years and BMI of 27,4 ± 4,5 kg/m2). Of those subjects belonging to the treated group that complained from articular or bone pains, 34% reported the cessation of the symptom by the end of the study. The analysis of variance revealed no significant effect of the dietary supplement on bone metabolism. No Pearson¿s correlations were found between the set of variables (age, nutrient intake, BMI, mineral density) and markers of bone metabolism, at either one of the times. Forty-two percent of the patients were overweight and 26% obese. Excess of lipids in the diet was observed in 38% of the women and 22% exceeded the recommendations for saturated fat. Cholesterol uptake was 222 ± 98 mg. The mean intake of calcium was 654 ± 358 g/day and 94% failed to reach the adequacy intake. Conclusions: Under the conditions of this intervention consumption of the hydrolyzed collagen did not produce any observable effects in bone metabolism as measured by currently accepted markers of bone resorption or formation. Most of the patients exhibited inadequacy in calcium intake as well as excessive body weight / Doutorado / Nutrição Experimental e Aplicada à Tecnologia de Alimentos / Doutor em Alimentos e Nutrição

La grossesse est une période de la vie d’une femme qui s’accompagne d’une augmentation des besoins nutritionnels dont la satisfaction est nécessaire à la bonne santé de la mère et de l’enfant à naître. Durant cette période, les femmes seraient plus enclines à l’adoption de pratiques alimentaires plus saines. L’objectif de ce travail de thèse était d’étudier ces différents aspects de la nutrition pendant la grossesse puis d’élaborer et d’évaluer une méthode de conseils alimentaires personnalisés et pas-à-pas afin d’améliorer l’adéquation nutritionnelle des femmes enceintes en France. Un indice de qualité nutritionnelle de l’alimentation existant : le PANDiet, a été adapté à la période de la grossesse en tenant compte des références nutritionnelles spécifiquement définies pour cette période. Il a été montré qu’en l’absence de modifications qualitatives du régime en début de grossesse, l’adéquation nutritionnelle ne pouvait pas être maintenue. Trois types de conseils alimentaires personnalisés ont alors été élaborés et se sont révélés efficaces pour améliorer la qualité nutritionnelle de l’alimentation. Cependant, plus les conseils étaient efficaces moins ils étaient acceptables par les femmes enceintes. Un compromis a donc été trouvé pour sélectionner les deux types de conseils les plus acceptables par les femmes enceintes tout en étant efficaces pour améliorer la qualité nutritionnelle de leur alimentation. Ces deux types de conseils alimentaires personnalisés, fondés respectivement sur des modifications des quantités consommées d’aliments et sur des substitutions au sein du même sous-groupe d’aliments, ont été proposés à des femmes enceintes françaises lors d’un essai randomisé contrôlé. Par ailleurs, des données qualitatives, ont permis d’identifier que ces dernières étaient à la recherche d’informations positives et crédibles concernant l’alimentation pour contribuer au bien-être de leur bébé mais aussi au leur. Durant l’essai randomisé contrôlé, l’approche proposant des recommandations alimentaires génériques associées aux conseils alimentaires personnalisés, générés pas-à-pas par notre algorithme, s’est révélée plus efficace pour améliorer la qualité nutritionnelle de l’alimentation de femmes enceintes qu’une approche proposant uniquement les recommandations génériques. Par ailleurs, selon l’étude qualitative menée auprès de participantes à l’essai randomisé contrôlé il apparaît que proposer des conseils alimentaires pendant la grossesse permet de résoudre la cacophonie informationnelle. / Pregnancy is a specific period in life characterized by an increase in nutrient needs that should be met for the health of both the mother and her baby. During this period, women would be keener on adopting healthier dietary practices. The objective of this thesis was to study these different aspects of nutrition during pregnancy and to design and evaluate a tailored, stepwise dietary advice method which aims to improve the nutrient adequacy of the diet of French pregnant women. The PANDiet score, a diet quality index, has been adapted to pregnancy by using the nutrient requirements established for this period. It has been shown that the absence of qualitative changes in a woman’s diet in the beginning of pregnancy prevented the maintenance of the nutrient adequacy. Three types of tailored dietary changes were then designed. They proved to be efficient in improving the nutrient adequacy of the diet. The more efficient the type of dietary changes was, the less acceptable it was by pregnant women. Thus, a trade-off has been considered to select the two types of dietary changes that were the most acceptable by pregnant women while showing efficiency in the improvement of the nutrient adequacy of their diet. These two types of tailored dietary changes, which respectively involved modifications of the amount consumed of foods and substitutions of foods within the same food subgroup, have been proposed to French pregnant women during a randomized controlled trial. Furthermore, qualitative data revealed that pregnant women sought for positive and trustworthy information about nutrition-related in order to contribute towards the well-being of both their baby and themselves. In the randomized controlled trial, the approach proposing tailored dietary advice, generated in a stepwise process, in addition to generic dietary guidelines proved to be more efficient in improving the nutrient adequacy of the diet of pregnant women than the approach using only generic dietary guidelines. Furthermore, according to semi-directive interviews led with some women included in the randomized controlled trial, it appeared that dietary counseling during pregnancy resulted in solving the confusion related to nutrition issues.