Submitted by SBI Biblioteca Digital (sbi.bibliotecadigital@puc-campinas.edu.br) on 2017-02-15T13:09:03Z No. of bitstreams: 1 FERNANDA SEYR POZZA.pdf: 3157840 bytes, checksum: 13e75c72246a5b3271c74c20cb5bf791 (MD5) / Made available in DSpace on 2017-02-15T13:09:03Z (GMT). No. of bitstreams: 1 FERNANDA SEYR POZZA.pdf: 3157840 bytes, checksum: 13e75c72246a5b3271c74c20cb5bf791 (MD5) Previous issue date: 2016-12-05 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / Background: For any intervention in a population, we need to understand its characteristics and needs. Monitoring of health in childhood and adolescence can be done by the Body Mass Index (BMI). In anthropometry, this index is used due to its low cost, ease of obtaining and other factors. The School Health Program (PSE) is a federal proposal for the improvement of the population quality of life by integrating health and education areas, to address vulnerabilities that affect the development of students from public schools. Early health monitoring can alert to prevent the progression of excess weight in adulthood, as in Brazil the nutrition transition is occurring as already occurred in developed countries. Objective: To evaluate the nutritional status of children and adolescents accompanied by the School Health Program in Itatiba-SP, in 2014. Methods: Cross-sectional study about the prevalence of nutritional status, with 6.829 schoolchildren aged 0-15 years who participated in the PSE. We made comparisons between gender, age and location. We elaborated specific BMI curves for this sample, which were compared to the WHO BMI reference curves. Results: In the sample, 50.3% were female. In children younger than 5 years, the prevalence of overweight was 37.9%, between ? 5 to <10 years it was 33.9%, and ? 10 years was 34.0%. In females, there was a higher prevalence of overweight (18.2%), whereas in males, obesity and severe obesity were more prevalent, 10.7% and 3.7%, respectively, compared to girls (9.5% and 1.9%) (p<0.001). For older children, preteens and teenagers, we found that girls of 11, 13 and 14 years old had higher mean BMI compared to boys of the same age (p <0.05). Regarding location, it was found that the region with the highest income showed higher prevalence of excess of weight. Considering the WHO BMI reference curves, the cutoff point from underweight to eutrophic, was similar to the standard BMI curve of our sample. However, at cutoff points between normal weight and overweight, the curve showed a higher standard. Conclusion: From our results, we found that simple anthropometric data (weight and height of students), could contribute to the assessment of nutritional status of schoolchildren, as well as providing health monitoring, and assisting in making public health decisions, also serving as comparison to other scientific studies. / Introdu??o: Para qualquer interven??o a um grupo populacional necessita-se compreender suas caracter?sticas e necessidades. O acompanhamento do estado nutricional na inf?ncia e na adolesc?ncia pode ser feito pelo ?ndice de Massa Corporal (IMC). Este ?ndice ? utilizado pelo baixo custo, simplicidade de realiza??o e outros fatores. O Programa Sa?de na Escola (PSE) ? uma proposta federal para a melhoria da qualidade de vida da popula??o brasileira ao integrar a educa??o ? sa?de, para enfrentar as vulnerabilidades que comprometem o desenvolvimento dos escolares da rede p?blica de ensino. O acompanhamento da sa?de precocemente alerta para evitar a progress?o do desvio nutricional na vida adulta, uma vez que no Brasil ocorre a transi??o nutricional. Objetivo: Avaliar o estado nutricional de crian?as e adolescentes acompanhados pelo PSE em Itatiba-SP em 2014. M?todo: Estudo transversal sobre preval?ncia dos Estados Nutricionais, com 6.829 escolares de 0 a 15 anos pertencentes ao PSE. Foram feitas compara??es entre g?nero, idade e localiza??o. Curvas de IMC espec?ficas dessa amostra foram comparadas com as curvas de refer?ncia da Organiza??o Mundial da Sa?de. Resultados: Na amostra, 50,3% eram do g?nero feminino. Nas crian?as menores que 5 anos, a preval?ncia de excesso de peso foi de 37,9%, entre ? 5 e < 10 anos foi de 33,9% e nos ? 10 anos foi de 34,0%. No g?nero feminino houve maior preval?ncia de sobrepeso (18,2%), ao passo que, no g?nero masculino, a obesidade e a obesidade grave estiveram mais presentes, 10,7% e 3,7%, respectivamente, se comparados ?s meninas (9,5% e 1,9%) (p<0,001). Para as crian?as mais velhas, pr?-adolescentes e adolescentes, encontramos que as meninas de 11, 13 e 14 anos apresentaram m?dia de IMC mais elevada se comparadas aos meninos de mesma idade (p<0,05). Em rela??o ? localiza??o, verificou-se que a regi?o com maior rendimento apresentou maior preval?ncia de excesso de peso. Considerando as curvas de refer?ncia da OMS, no ponto de corte de magreza para eutrofia, a curva padr?o da amostra estudada foi semelhante. No entanto, no ponto de corte entre eutrofia e sobrepeso, a curva apresentou um padr?o mais elevado. Conclus?o: A partir dos resultados pode-se verificar que dados de relativa simplicidade para aferi??o (peso e altura de escolares) contribuem na constata??o do estado nutricional, proporcionam o monitoramento da sa?de e auxiliam no subs?dio para tomadas de decis?es em sa?de p?blica ? comunidade, bem como servem como base de compara??o aos demais estudos cient?ficos.

Introdução O nível de atividade física (NAF) insuficiente e estado nutricional (EN) inadequado conferem risco de desenvolvimento de hipertensão arterial e diabete, bem como dificultam o controle destas doenças. Assim, infere-se que os custos despendidos pelo SUS com medicamentos, internações e consultas de hipertensos e diabéticos apresentem relação inversa com NAF, incluindo a prática de caminhada e EN. Entretanto, estudos epidemiológicos que descrevam estes custos e analisem essas associações na população idosa são inexistentes no Brasil, o que dificulta a fundamentação para a implementação de políticas publicas para a economia de recursos. Objetivo Descrever os custos com procedimentos de saúde de idosos hipertensos e diabéticos e verificar qual a sua associação com NAF e EN, segundo sexo e grupos etários. Métodos A amostra foi constituída por 806 idosos com autorreferência à hipertensão e/ou diabete ( 60 anos) residentes no município de São PauloSP, participantes das três coortes do Estudo Saúde, Bem-estar e Envelhecimento SABE - em 2010. A variável dependente custo total anual (em Reais), foi estimada com base nos dados autorreferidos sobre uso de medicamentos, uso dos serviços ambulatoriais e internações hospitalares, retroativos a um ano da coleta de dados. A variáveis explanatórias: i) NAF foi estimada a partir de entrevista utilizando o International Physical Activity Questionnaire (IPAQ, versão curta), classificando os idosos segundo duração da realização de atividades físicas moderada, em ativos ( 150 minutos/semana) e insuficientemente ativos (< 150 minutos/semana); ii) Prática de caminhada, categorizada segundo frequência semanal: a) 4 dias/ semana; b) 1 a 3 dias/semana; c) não caminha. iii) EN, identificado pelo índice de massa corporal (IMC), classificando os idosos em dois grupos: a) IMC < 28 kg/ m²; b) IMC 28 kg/ m² (excesso de peso); as variáveis de controle foram o sexo, grupos etários (a. 70 anos; b. 65 a 69 anos; c. 60 a 64 anos); estado civil (a. casado; b. outros) e, escolaridade (a. sem escolaridade; b. 1 ano). A descrição dos custos segundo as NAF e EN foi representada pelos valores de média e IC95 por cento , mediana e P25 P75, valores mínimos e máximos. Modelos de regressão logística múltipla foram empregados para analisar as associações entre variáveis dependentes e explanatórias. O nível de significância foi estabelecido em 5 por cento e todas as análises foram realizadas considerando amostras complexas, por meio do software Stata, 13.0. 9 Resultados: A média de custo total anual por pessoa foi de R$ 732,54 e a soma dos custos relativa a 12 meses para os 806 idosos foi de R$ 609.587,20, sempre superiores para idosos em excesso de peso, com NAF insuficiente e para idosos que não caminham. Idosos em excesso de peso apresentaram chance 50 por cento superior de estarem no grupo de maior custo total anual (OR 1.49, IC95 por cento 1.01 2.18) e mais de 70 por cento superior de maior custo com medicamentos (OR 1.71, IC95 por cento 1.18 2.47). A ausência de caminhada significou a chance superior para maiores custos anuais com medicamentos (OR 1.63, IC95 por cento 1.06 2.51) e custos totais (OR 1.82, IC95 por cento 1.17 2.81). Todas as análises ajustadas por sexo e idade. O NAF não se associou aos custos totais e custo com medicamentos (p>0.05). Conclusão: Os custos para o controle de HAS e DM em idosos são altos e se associam inversamente à prática de caminhada e ao estado nutricional, especialmente em relação ao custo com o uso de medicamentos antihipertensivos e hipoglicemiantes. / Background- The insufficient physical activity level (PAL) as well the inadequate nutritional status (NS) increases the risk of hypertension and the development of diabetes, and difficult the control of theses diaseases. Thus, we can infer that the costs spent by the public health system to the management of hypertension and diabetes in the population would shows an inverse relationship with physical activity level, including engagement in walking, and nutritional status. However, epidemiological studies describing these costs and analyzing these associations among elderly population are non-existent in Brazil, which makes difficult the implementation of public policies for the economy of resource. Aim - To describe the health care costs among hypertensive and diabetic elderly people and to analyze the associations with PAL and NS according to sex and age groups. Methods - The sample consisted of elderly people with self-reported hypertension and/or diabetes ( 60 years-old) living in São Paulo-SP, participants of the three cohorts SABE Study (Health, Wellbeing and Aging), in 2010. The dependent variable (total annual cost - in Reais, R$) was estimated based on self-reported use of medication, use of outpatient services and hospital admissions, retroactive to one year of data collection. The explanatory variables: i) PAL was estimated from interview using the International Physical Activity Questionnaire (IPAQ, short version), classifying the elderly accorind to the time performing in moderate physical activity ( 150 minutes / week) and insufficiently active (< 150 minutes / week). ii) Engagement in walking, categorized according to the weekly frequency: a) 4 days / week; b) 1 to 3 days / week; c) does not walk. a) BMI < 28 kg/m2; b) BMI 28 kg / m² (overweight); the control variables were sex and age groups: a) 70 years; b) 65-69 years; c) 60 to 64 years. The description of the costs according to the PAL and NS was represented by mean values and 95 per cent , median and P25 -P75, minimum and maximum values. Multiple logistic regression models were emplyed to analyze associations. The level of significance was set at 5 per cent and all analyzes were performed considering complex samples, using the Stata software, 10.0. Results - The average of total annual cost was R$ 732.54 and the sum of costs on 12 months was R$ 609,587.20, always higher for elderly with excess weight, insufficient PAL and the elderly who do not engage in walking. The group of elderly with excess weight showed a 50 per cent chance of 11 being in the highest annual total cost group (OR 1:49, 95 per cent 1:01 to 2:18) and 70 per cent higher for the costs with medicine use (OR 1.71, IC95 per cent 1.18 2.47). The absence of walking had higher chance for highest costs with medication (OR 1.63, 95 per cent CI 1:06 to 2:51) and total costs (OR 1.82, 95 per cent CI 1.17 - 2.81). All analyzes adjusted for sex and age. The PAL was not associated to the total costs and cost with medication. Conclusion- The costs related to the control of hypertension and diabetes in the elderly are high and were inversely associated to the engagement in walking and nutritional status, especially in relation to the costs with the use of antihypertensive and hypoglycemic medication.

Objetivo: Identificar os determinantes da desnutrição infantil, na Comuna de Bom Jesus, em Angola. Métodos: Estudo transversal de base populacional com 742 crianças menores de 5 anos, Bom Jesus, Angola, 2010. Foi aplicado um inquérito por entrevista para coleta das variáveis independentes, seguido da aferição do peso e estatura. A classificação nutricional seguiu critérios da Organização Mundial da Saúde (2006). Para identificar os fatores associados aos déficits de peso/idade (P/I), estatura/idade (E/I) e peso/estatura (P/E), foram calculadas razões de prevalência mediante regressão de Poisson com variância robusta, utilizando-se modelos de determinantes hierarquizados. Resultados/Conclusões: Bairro de moradia, idade da criança e sexo associaram-se aos déficits nutricionais. No nível distal, observou-se maior chance entre crianças de domicílios sem energia elétrica, que viviam com o pai e cujo pai tinha outra família, respectivamente, aos déficits de P/I, P/E e E/I. No nível intermediário, maior chance foi observada entre crianças cujo domicílio era abastecido com água de rio ou lago e os déficits de P/I (RP:2,01; IC95%1,01-4,02) e E/I (RP:1,67; IC95%1,04-2,69), assim como entre déficit de P/E e crianças cuja ordem de nascimento era a partir do terceiro. Neste nível, observou-se menor chance do déficit de P/E entre crianças cuja idade da mãe era entre 25 e 34 anos e déficit de P/I e aquelas com um irmão menor de 5 anos. No nível proximal, maior chance foi observada em crianças que apresentaram vômito, 15 dias anteriores à pesquisa, e os déficits de P/I (RP:2,01; IC95%1,33-3,30) e E/I (RP:1,53; IC95%1,04-2,69). Maior chance foi observada entre o déficit linear e a manifestação de diarreia com muco e sangue, à véspera do inquérito. Esses resultados justificam a elaboração de intervenções voltadas à adequada assistência pré-natal e puericultura e melhoria do acesso à água de qualidade. / Objective: To identify the determinants of childhood malnutrition in the community of Bom Jesus in Angola. Methods: Population based cross-sectional study of 742 children under 5 in Bom Jesus, Angola, 2010. Data on the independent variables were collected using an interview, and height and weight were measured. Nutritional status was classified according to World Health Organization (2006) criteria. Poisson regression with robust variance was used to calculate prevalence ratios in order to identify factors associated with weight/age (W/A), height/age (H/A) and weight/height (W/H) deficiencies, using hierarchical models of the determinants. Results/Conclusions: Neighborhood of residence and age and sex of the child were associated with nutritional deficiencies. On the distal level, there was association between not being connected to an electricity grid, the presence of the father in the household and having another family being, respectively, to W/A. W/H and H/A deficiencies. At the intermediate level, there was association between household water supply from the river or lake and W/A (PR:2.01; 95%CI 1.01-4.02) and H/A (PR:1.67; 95%CI 1.04-2.69) deficiencies, as well as between W/H deficit and children whose birth order was 3rd or later. At this level there was an inverse association between W/H and mother being aged between 25 and 34 and W/A deficiency and having one sibling aged under 5. At the proximal level, was observed association between children who had presented vomiting within the 15 days preceding the research and W/A (PR:2.01; 95%CI 1.33-3.30) and H/A (PR:1.53; 95%CI 1.04-2.69) deficiencies. Association was observed between linear deficiency and diarrhea containing blood or mucus on the day before the survey. These results justify the creation of interventions directed at adequate pre-natal care and childcare, improving and increasing access to clean water and sanitation.

O selênio é um elemento essencial à saúde humana, cuja distribuição heterogênea na natureza, favorece o aparecimento tanto da deficiência como da toxicidade. O objetivo deste estudo foi avaliar o estado nutricional relativo ao selênio de indivíduos idosos não institucionalizados antes e após a suplementação com castanha-do-brasil. Foram avaliados 40 indivíduos com idade &#8805; 60 anos, que satisfizeram os critérios de inclusão, ou seja, não eram usuários de suplementos vitamínicos-minerais e não apresentavam qualquer patologia que pudesse vir comprometer o estudo, como câncer, diabetes ou artrite reumatóide. Foram avaliados o consumo alimentar, os dados antropométricos e a concentração de selênio no sangue e unhas desta população antes e depois de uma suplementação de três meses com castanha-do-brasil. A avaliação do consumo alimentar foi feita através de registro alimentar por 3 dias e análise pelo software VirtualNutri. O selênio foi determinado por espectrometria de absorção atômica por geração de hidretos acoplados a cela de quartzo (HGQTAAS). Os resultados indicaram 38% e 0% de inadequação na ingestão de selênio em relação a EAR (Necessidade Média Estimada) antes e depois da suplementação respectivamente. A maioria do grupo apresentou antropometria normal. Verificou-se após a suplementação com castanha-do-brasil que o nível médio da concentração de selênio no plasma e eritrócito foi 49% e 229% maior respectivamente (p&#60;0,05). Nas unhas foi aceita a hipótese de que os valores antes e depois da suplementação foram estatisticamente iguais. / Selenium is an essential element to human health. Its irregular distribution in nature favors the emergence of both deficiency and toxicity, though. The goal of this research was to evaluate the selenium nutritional status in noninstitutionalized elders before and after the providing of brazil nut supplementation. We studied 40 individuals aged &#8805; 60 years-old who fulfilled the inclusion requirements, i.e., did not make use of vitaminic-mineral supplements and did not suffer from any pathologies able to interfere in the outcome of the study, such as cancer, diabetes or rheumatoid arthritis. We examined their diet, anthropometric data and selenium rates in blood and nails prior and subsequent to a three-month period of brazil nut supplementation. Diet evaluation was performed by taking alimentary notes during 3 days and by analyzing the data with VirtualNutri software. The ratio of selenium was measured using specthrometrics of atomic absorption by generation of hydrates Iinked to a quartz cell (HGQTAAS). Our results indicated 38% and 0% of inadequacy in selenium ingestion in reference to the EAR (Estimated Average Reference) before and after supplementation, respectively. Most of the group presented normal anthropometrical values. It was found that, following the administration of brazil nut, the average selenium rates in plasma and erythrocytes increased 49% and 229% respectively (p&#60;0,05). Concerning the nails, we accepted the hypothesis of statistically equal levels preceding and succeeding treatment.

Introdução. A prevalência da obesidade tem apresentado números cada vez mais elevados em populações mais jovens, inclusive entre as crianças de baixa idade de famílias de condição socioeconômica menos favorecida. Os determinantes deste desvio nutricional que têm sido estudados são diversos, abrangendo desde fatores genéticos até fatores ambientais. Dentre estes últimos, do ambiente que envolve a criança de baixa idade, é possível que a concepção materna acerca do excesso de peso na infância seja dos determinantes exógenos que contribuem para maior risco de desenvolver sobrepeso ou obesidade já na infância. Objetivo. Analisar as concepções maternas acerca do estado nutricional infantil verificando se as mesmas, caso sejam diferentes, podem ser fatores que contribuam para presença de sobrepeso ou obesidade em seus filhos menores de quatro anos de idade. Métodos. Estudo observacional, exploratório, transversal e quanti-qualitativo. Participaram mães de crianças em idade pré-escolar, matriculadas em creches públicas no ano de 2011. Foram entrevistadas mães de dois grupos: dezesseis mães de crianças com sobrepeso ou obesidade e quinze mães de crianças classificadas como eutróficos, segundoos pontos de corte para o índice de massa corporal recomendados pelo Ministério da Saúde, Brasil-2008. Foi utilizada a técninca de Análise de Conteúdo, com o auxílio do software Classification Hiérarchique Implicative et Cohésitive para analisar dados coletados por intermédio de entrevistas individuais semiestruturadas. Resultados. As concepções maternas acerca do excesso de peso de crianças e do estado nutricional de seus filhos se apresentam de forma diferente entre as mães de crianças pré-escolares obesas quando comparadas com as concepções das mães de crianças eutróficas. Sobre o estado nutricional infantil, mães de crianças com excesso de peso concebem que crianças magras estariam, provavelmente, mal alimentadas. Para as mães de crianças eutróficas os relatos salientam a influência familiar e genética como os principais determinantes do estado nutricional da criança. No entanto, para ambos os grupos de mães, a figura materna é concebida como tendo um papel fundamental na formação dos hábitos alimentares dos filhos, mas as mães das crianças obesas parecem não se apropriar desta concepção quando se trata de considerar os seus filhos. Conclusão. As concepções maternas acerca do estado nutricional das crianças são heterogêneas, o que inclui a apropriação das mesmas, podendo assim contribuir como um dos fatores implicados no desenvolvimento de excesso de peso e da obesidade dos seus filhos, já a partir da faixa etária pré-escolar. / Introduction: The prevalence of obesity has presented numbers each day higher in younger populations, including among young children from families with less favorable socioeconomic status. The determinants of this nutritional deviation that have been studied are diverse, ranging from genetics to environmental factors. Among the latter, the environmental surroundings of the young child, it is possible that the maternal conception, regarding overweight children, is the exogenous factor that contributes to increased risk of developing overweight or obesity in childhood. Objective: Analyze maternal conceptions regarding nutritional status to verify they are the same or if different, can they be factors that contribute to the presence of overweight or obesity in children under the age of four. Methods: This was an observational, exploratory, cross-sectional quantitative-qualitative study. Participants were mothers of children of preschool age, enrolled in public kindergartens in 2011. Mothers of two groups were interviewed: sixteen (16) mothers of overweight or obese children and fifteen (15) mothers of children classified as having normal weight, according to the cutoff points for BMI recommended by the Ministry of Health, Brazil-2008. Content Analysis was the technique utilized with the help of software Classification Hiérarchique Implicative et Cohésitive to analyze data collected through semi-structured interviews. Results: Maternal conceptions, regarding overweight children and nutritional status of their children, present themselves differently among mothers of preschool overweight /obese children when compared with the conceptions of mothers of normal weight children. With respect to child nutrition, mothers of overweight children perceive that thin children are most likely malnourished. For mothers of normal weight children, reports stress the family influence and genetics as the main determinants of a childs nutritional status. However, for both groups of mothers, the mother figure is perceived as having a key role in shaping the eating habits of children, but the mothers of overweight or obese children seem to not exercise this role when it comes to considering their children. Conclusion: Maternal conceptions about the nutritional status of children are heterogeneous, which includes ownership of them, and could contribute as one of the factors involved in the development of overweight and obesity of their children from pre-school ages on.

Une étude de la croissance et de l'alimentation de l'enfant en milieu urbain à Dakar (Sénégal) a été réalisée auprès de 1479 enfants de la naissance à l'âge de 36 mois et de leurs mères. Deux zones de niveau socio-économique contrasté dans le milieu urbain ont été sélectionnées : la zone de Médina, au centre de Dakar et la zone de Pikine, aux portes de Dakar. L'enquête s'articule autour du recueil de données anthropométriques chez les couples mère-enfant sélectionnés selon des critères objectifs de « bonne santé » et de la collecte d'un vaste ensemble de données environnementales (socioéconomiques, sociodémographiques, sanitaires et biologiques). L'approche quantitative de la croissance et de l'alimentation de l'enfant s'est effectuée par questionnaire auprès des mères sélectionnées. L'approche qualitative par focus group a permis d'apporter un éclairage plus fin des tendances observées dans l'enquête quantitative. Les données de l'enquête transversale sur la croissance de l'enfant ont été utilisées pour étudier les paramètres staturo-pondéraux des enfants, selon des variations imputables au genre, à l'âge de l'enfant ou à la zone de résidence. Peu de différences sont apparues dans la croissance entre Pikine et Médina. L'état nutritionnel des enfants (définis selon la norme de croissance OMS 2006) se dégrade néanmoins avec l'âge. La malnutrition s'exprime sous des signes différents selon la zone de résidence mais n'est pas plus fréquente dans la zone moins favorisée de Pikine. En revanche, les déterminants de la malnutrition sont communs aux deux zones enquêtées et laisse peu de place aux facteurs socio-économiques. / A population-based study about growth and feeding practices was conducted with a cluster sample of 1479 aged 0 to 36 months and their mother, in the urban area of Dakar (Senegal). In this urban area, two socioeconomic contrasted areas were selected : Medina zone, in the center of Dakar and Pikine zone, located at the city's doorstep. This study is organized around an anthropometric survey of healthy children and their mother and an extensive data collection (socioeconomic, socio-demographic, health and biological data). Questionnaires were addressed to the mothers and belong to the quantitative approach of growth and feeding practices among children. The aim of the qualitative approach by focus groups was to shed light on trends revealed by questionnaires analysis. Cross-sectional data extracted from a growth survey were used to determine the variation in the growth parameters due to sex, child's age or place of residence. Some minor differences could be observed between Pikine and Medina. Nutritional status (assessed by new WHO Growth Standards) decline as children are getting older. Among the two areas, malnutrition exists in different form but it's not area specific since the less-favoured area (Pikine) is not more affected by it. Nonetheless, there are common factors associated with malnutrition, which indicate the low economic impact. Birth-weight and maternal body mass index systematically belongs to the same and most explicative statistics models. The role of feeding practices (apprehended by food consumption) is not that important to explain malnutrition.

Introdução: As modificações econômicas, política e sociais ocorridas no Brasil, iniciadas com o movimento de redemocratização do país, favoreceram o investimento em políticas públicas com impacto marcante na nutrição infantil inclusive em municípios do interior da Amazônia. Esse movimento promoveu alterações importantes na estrutura epidemiológica da desnutrição, contudo, a modulação dessas transformações por fatores da paisagem Amazônica ainda é pouco investigada. Objetivo: Medir a prevalência da desnutrição, analisar sua evolução temporal, sua distribuição espacial, seus fatores associados e suas respectivas Frações de Impacto Potencial (PIF) em crianças pré-escolares da Amazônia. Metodologia: Os dados deste trabalho são oriundos de dois inquéritos de base populacional realizados nos anos de 2005 e 2012 com, respectivamente n=478 e n=836 crianças da zona urbana e rural de Jordão, Acre. A variável dependente do estudo foi o déficit de altura para idade (HAZ<-2). Foi analisada a evolução da prevalência de desnutrição e seus determinantes na área urbana e rural, além da obtenção de suas Frações de Impacto Potencial (FIP). Avaliou-se também a distribuição espacial das prevalências e das Odds Ratios (OR) do desfecho, além de testar a sua dependência espacial através de um modelo aditivo generalizado utilizando-se a rotina epigam do programa R. Também foram construídos modelos explicativos de fatores relacionados à desnutrição, para crianças com e sem ascendência indígena utilizando-se regressão de Poisson, com erro robusto. Resultados: As prevalências gerais de desnutrição foram de 35,8 por cento (ICI95 por cento : 31,5; 40,3) em 2005 e de 49,2 por cento (ICI95 por cento : 45,7; 52,6) para o ano de 2012. Identificou-se tendência temporal heterogênea nas prevalências do desfecho, com redução de 28,7 por cento na área urbana e incremento de 39,7 por cento na zona rural. O declínio foi atribuído à ampliação da cobertura da assistência pré-natal (porcentagem explicada: 18,8 por cento ), redução da pobreza (17,5 por cento ) e melhora das condições de nascimento (11,9 por cento ). Já o aumento ocorreu pela diminuição da produção de alimentos da agricultura familiar (12,1 por cento ), redução da altura materna (10,5 por cento ) e poder de compra das famílias (7,5 por cento ). Foram mapeadas áreas de elevado risco nutricional (OR=4 e OR=3; p<0,01), sobretudo em regiões localizadas à montante dos rios, próximas às suas cabeceiras, indicando a importância das condições de acesso e disponibilidade de alimentos na determinação da desnutrição. A modelagem espacial permitiu identificar covariáveis que interferem no crescimento linear infantil e conseguem explicar a dependência espacial em áreas de elevada OR de desnutrição. A escolaridade materna inferior a três anos de estudo (OR=3,2; IC95 por cento =2,4;4,3), residir em área rural (OR=9,8; IC95 por cento =7,4;13,0); consumo de álcool durante a gestação (OR=3,0; IC95 por cento =2,7;3,3) e pneumonia no último ano (OR=2,1; IC95 por cento =1,9;2,3) se destacam como fatores associados aos déficits de estatura nesta análise. Por sua vez, no estudo dos fatores associados à desnutrição entre crianças com e sem ascendência indígena, variáveis ligadas à incorporação de hábitos negativos da sociedade envolvente como o consumo de álcool durante a gestação, o uso de chupeta e a introdução de leite de vaca integral na dieta da criança se mostraram associadas ao desfecho no primeiro grupo, enquanto no segundo, variáveis ligadas à gestação tiveram maior poder explicativo. Conclusão: O estudo identificou cenários (urbano e rural) e segmentos populacionais (populações com e sem ascendência indígena) com prevalências de desnutrição heterogêneas e tendências temporais opostas. Barreiras geográficas, sociais e étnicas estão contribuindo para a manutenção da elevada prevalência de desnutrição nessa área, com estes achados auxiliando o entendimento das disparidades evidenciadas para a região Norte quando comparadas ao restante do país em relação ao cenário nutricional infantil / Background: The economic, political and social changes that took place in Brazil, which began with the country\'s redemocratization movement, favored investment in public policies with a significant impact on child nutrition, including in municipalities in the interior of the Amazon. This movement promoted important changes in the epidemiological structure of stunting; however the modulation of these transformations by factors of the Amazonian landscape is still little investigated. Objective: To measure the prevalence of malnutrition, to analyze its temporal evolution, its spatial distribution, its factors associated and its respective Potential Impact Fractions (FIP) in pre-school children in the Amazon. Methodology: Data from this study come from two population-based surveys conducted in 2005 and 2012 with, respectively, n = 478 and n = 836 children from urban and rural areas of Jordan, Acre. The study-dependent variable was the height-for-age deficit (HAZ <-2). It was analyzed the evolution of the prevalence of stunting and its determinants in the urban and rural area, in addition to obtaining its Potential Impact Fractions (PIF). The spatial distribution of prevalence and Odds Ratio (OR) of the outcome was also analyzed, as well as was tested the spatial dependence of ORs, through a generalized additive model using the R program\'s epigam routine. Factors associated to stunting, for children with and without indigenous ancestry, were identified using Poisson Regression, with robust variance. Results: The general prevalence of stunting was 35.8 per cent (CI95 per cent : 31.5; 40.3) in 2005 and 49.2 per cent (CI95 per cent : 45.7; 52.6) for the year 2012. A heterogeneous temporal trend was identified in the prevalence of stunting, with reduction of 28.7 per cent in the urban and an increase of 39.7 per cent in the rural areas, comparing the two surveys. In urban areas, this decline can be attributed to the increase in prenatal care coverage (explained percentage: 18.8 per cent ), poverty reduction (17.5 per cent ) and improved birth conditions (11.9 per cent ). In the rural area, the increase in the prevalence of stunting can be explained by the decrease in food production in family farming (12.1 per cent ), maternal height (10.5 per cent ) and household purchasing power (7.5 per cent ). The spatial analysis of the prevalence of stunting in this city allowed the identification of areas of high nutritional risk (OR = 4 and OR = 3; p <0.01), especially in regions located upstream of the river, indicating the importance of access and availability of food for the stunting determination. Spatial modeling allowed the identification of covariates that interfere with linear infant growth and explained spatial dependence in high OR areas of stunting. The maternal schooling under three years (OR = 3.2, 95 per cent CI = 2.4; 4.3), live in rural areas (OR = 9.8, 95 per cent CI = 7.4, 13.0), (OR = 3.0, 95 per cent CI = 2.7, 3.3) and pneumonia in the prior year (OR = 2.1, 95 per cent CI = 1.9) were factor associated to the height deficit. In turn, the study of the factors associated with stunting among children with and without indigenous ancestry showed important differences in these factors, with the first group presenting variables related to the incorporation of negative habits of the surrounding society such as the consumption of alcohol during pregnancy, the pacifier use and the introduction of whole cow\'s milk to the child\'s diet as important determinants of stunting, while in the second, variables related to gestation had greater weight. Conclusion: The study identified scenarios (urban and rural) and population segments (populations with and without indigenous ancestry) with a heterogeneous prevalence of stunting and opposite temporal trends. Geographical, social and ethnic barriers contribute to the maintenance of the high stunting prevalence in this area, with these findings facilitating the understanding of the disparities between the Brazilian North region compared to the rest of the country concerning to the child nutritional scenario

La fibromialgia es una enfermedad reumática, clasificada con el código OMS CIE-10- M79.7 (versión 2007), de carácter crónico que causa dolor muscular generalizado, rigidez, fatiga, alteraciones del sueño y trastornos cognitivos entre otros síntomas. La prevalencia en España está alrededor del 2.4%, aunque algunos estudios han situado esta cifra entorno al 4%, siendo las mujeres las que más la padecen, con gran diferencia respecto a los hombres. La fibromialgia, además, se presenta frecuentemente junto a otras patologías como el síndrome de fatiga crónica, la artritis reumatoide, el lupus eritematoso, el síndrome del colon irritable, la osteoartritis, e incluso la ansiedad y la depresión. Por todo ello, se trata de una enfermedad que afecta seriamente a la funcionalidad y a la calidad de vida de las personas que la padecen. La causa de esta enfermedad es desconocida y en la actualidad no existe ningún tratamiento farmacológico eficaz. El manejo integral del paciente, mediante un abordaje multidimensional, incluyendo actividad física, apoyo psicológico, terapia cognitivo-conductual y fármacos para paliar la sintomatología, es lo que ha demostrado ser más útil. La nutrición está siendo cada vez más investigada como un factor importante a tener en cuenta en el tratamiento de la fibromialgia. Hay algunos datos sobre los beneficios potenciales de los nutrientes antioxidantes, la importancia del control de peso, la posible presencia de intolerancias alimentarias, y del rol que pueden tener ciertas deficiencias o desequilibrios nutricionales. Sin embargo, el conocimiento no es todavía sólido y los mensajes dirigidos a los enfermos sobre la alimentación no es siempre rigurosa. Así, el objetivo del estudio ENCAVI ha sido valorar el estado nutricional y su relación con la calidad de vida y la capacidad funcional de pacientes. El estudio fue realizado con 103 pacientes, mujeres, de 53.74 ± 7.81 años como edad media y pertenecientes a diversas asociaciones de fibromialgia de Catalunya. Se tomaron medidas antropométricas y se administraron diversos cuestionarios a las pacientes sobre sus hábitos alimentarios, su calidad de vida y su estado de salud. Se constató, como en otros estudios que, en las pacientes, existe una elevada prevalencia de obesidad y sobrepeso, más que en la población en general. El exceso de peso afecta negativamente a algunos síntomas y a la calidad de vida de pacientes con FM, y por el contrario cómo la pérdida de peso resulta beneficiosa para estas personas. La capacidad funcional y la calidad de vida de pacientes con fibromialgia son peores cuando presentan de forma concomitante obesidad o sobrepeso. La masa muscular pareció relacionada positivamente con la calidad de vida de las pacientes. En estos pacientes la dieta suele ser desequilibrada y son frecuentes los cambios dietéticos y el uso de suplementos dietéticos y se ha observado que, en muchos de los casos, se realiza sin el consejo de ningún profesional de la salud y siguiendo indicaciones de fuentes de información no fiables o validadas. La conciencia alimentaria da lugar principalmente a dos perfiles de pacientes, el de aquéllas que cambiaron más sus hábitos dietéticos y utilizaban una mayor variedad de suplementos nutricionales, y el de aquéllas que no cambiaron su alimentación y eran nuevas usuarias de suplementos nutricionales, usando productos más específicos, como el magnesio y siguiendo en mayor proporción el consejo de algún profesional de la salud. El tratamiento más eficaz para estas personas es el abordaje multidisciplinar, tanto para mejorar la sintomatología como la calidad de vida, y además, se ha evidenciado que existe un problema de exceso de peso y de posibles desequilibrios alimentarios, es por todo recomendable que en la atención sanitaria se incluyan protocolos de orientación nutricional. / ENCAVI STUDY: QUALITY OF LIFE AND FUNCTIONALITY IN FIBROMYALGIA PATIENTS. Summary Author: Laura Isabel Arranz Iglesias Fibromyalgia (FM) is a chronic nonarticular pain syndrome with an unknown cause, probably with a multifactorial aetiology, and currently increasingly diagnosed. FM patients suffer from widespread musculoskeletal pain and stiffness, general fatigue, sleep disorders, cognitive impairment, and other symptoms which negatively affect their quality of life. The prevalence of fibromyalgia in Spain has been estimated to be around 2.4%. Related to management recent reviews show which interventions are more effective by reducing the symptoms of the disease, mainly pain but also fatigue and cognitive damage, revealing the fact that multidimensional approaches are the most appropriate for these patients. Some drugs, physical activity, relaxation techniques, and cognitive behaviour therapy are among the most useful tools used nowadays to treat FM. Nutrition has been pointed out as being a relevant factor to take into account in FM patients, due to different reasons: the potential benefits from antioxidant nutrients, either through vegetarian diets or nutritional supplements, to lower oxidative stress; the role of high body mass index in this disease; and the existence of some nutritional deficiencies or imbalances affecting the patients. The main purpose of this study was to describe the relationship among nutritional status, dietary habits, and quality of life and also functionality. A total of 103 women, with mean age 53.74 + 7.81, were recruited through different Spanish FM associations. Some anthropometric measures were taken and some questionnaires were fullfilled by them about dietary habits, quality of life and fibromyalgia impairment. Overweight and obesity are real health problems coexisting with FM disease. In our sample, mean value for Body Mass Index (BMI) was of 27.06 + 4.75, which is within the range of overweight reference values. In this group 68 of 103 patients were over the normal BMI values, meaning 66% of them. BMI is related to quality of life and functioning in these patients and also it is lean mass. Food awareness and attitudes towards diet were different among these FM patients. Nutritional supplement (NS) users changed their dietary habits more than those non-users. Among NS users, there were two different profiles, the first one, used to taking a wider range of NS through a self-care decision, followed professional recommendation in a lower degree, and used very few specific NS. And the second one, new NS users, used a narrower range of products. I would be necessary to give dietary advice to these patients to improve their diets and maintain a normal weight as well as good health.

Background: Children in South Africa are still affected by micronutrient deficiencies and children living in farm communities are especially vulnerable. African Leafy Vegetables (ALVs) are well endowed with micronutrients such as iron, zinc and vitamin A and might contribute to the nutritional status of children. However, these vegetables have been perceived as “poor people’s food” and over the years knowledge of and use of ALVs has decreased. Aim: This study assessed the potential contribution of ALVs to the nutritional status of children in a semi-rural farm community. Method: In this cross-sectional study, anthropometric indices, serum iron, zinc and retinol concentrations were determined in school children aged 5−13 years (n=155). Dietary intake of iron, zinc and vitamin A was evaluated by three 24-hour diet recalls of children (n=154). The iron, zinc and β-carotene content of selected ALVs was determined. Knowledge of and use of ALVs by primary caregivers was established using focus group discussions (FGDs). Descriptive statistics, independent t-tests, the Pearson Chi-Square Test and Mann-Whitney U Test were used. Anthropometric data were analysed using the World Health Organization Reference 2007 data. Dietary data were analysed using FoodFinder (version 3). Qualitative data from FGDs were translated, transcribed and color-coded to generate emerging themes. Results: Stunting (11%) was the most prevalent anthropometric indicator of malnutrition. This was supported by the low socio-economic status of households. Deficiency prevalence in iron (serum ferritin <15 μg/L; 15.5%) and vitamin A (serum retinol <20 μg/dL; 3.2%) was low. Zinc deficiency was the most prevalent (serum zinc <65 μg/dL; 74.8%) deficiency. Median dietary intake of iron, zinc and vitamin A was generally above the Estimated Average Requirement. ALVs were potentially good sources of iron, zinc and β-carotene and could contribute substantially to the Recommended Dietary Allowance for these nutrients in children, without taking into account inhibiting factors that might affect the bioavailability. Iron content of the ALVs studied ranged from 1.4−3.2 mg/100 g edible portion. Amaranthus cruentus was the best source of iron. Zinc content of the ALVs ranged from 0.7−1.4 mg/100g edible portions, with Cleome gynandra having the highest zinc composition. The β-carotene content of the ALVs ranged from 182−314 μg RAE/100 g edible portion, with both Amaranthus cruentus and Cleome gynandra being the best sources. Knowledge of ALVs and their use was indigenous and was transferred between generations. Caregivers had positive attitudes towards the use of ALVs. Conclusion: Although the prevalence of deficiencies was not severe (with exception of zinc deficiency), micronutrient deficiencies exist in the rural farm community studied. ALVs are potentially good sources of iron, zinc and β-carotene and might contribute to the nutritional status of school children. Knowledge of ALVs and the positive attitude and perceptions regarding their use by primary caregivers implied a potentially positive future response to interventions promoting consumption of ALVs in order to contribute to the alleviation of micronutrient deficiencies. / Thesis (MSc (Nutrition))--North-West University, Potchefstroom Campus, 2013.

Background: Children in South Africa are still affected by micronutrient deficiencies and children living in farm communities are especially vulnerable. African Leafy Vegetables (ALVs) are well endowed with micronutrients such as iron, zinc and vitamin A and might contribute to the nutritional status of children. However, these vegetables have been perceived as “poor people’s food” and over the years knowledge of and use of ALVs has decreased. Aim: This study assessed the potential contribution of ALVs to the nutritional status of children in a semi-rural farm community. Method: In this cross-sectional study, anthropometric indices, serum iron, zinc and retinol concentrations were determined in school children aged 5−13 years (n=155). Dietary intake of iron, zinc and vitamin A was evaluated by three 24-hour diet recalls of children (n=154). The iron, zinc and β-carotene content of selected ALVs was determined. Knowledge of and use of ALVs by primary caregivers was established using focus group discussions (FGDs). Descriptive statistics, independent t-tests, the Pearson Chi-Square Test and Mann-Whitney U Test were used. Anthropometric data were analysed using the World Health Organization Reference 2007 data. Dietary data were analysed using FoodFinder (version 3). Qualitative data from FGDs were translated, transcribed and color-coded to generate emerging themes. Results: Stunting (11%) was the most prevalent anthropometric indicator of malnutrition. This was supported by the low socio-economic status of households. Deficiency prevalence in iron (serum ferritin <15 μg/L; 15.5%) and vitamin A (serum retinol <20 μg/dL; 3.2%) was low. Zinc deficiency was the most prevalent (serum zinc <65 μg/dL; 74.8%) deficiency. Median dietary intake of iron, zinc and vitamin A was generally above the Estimated Average Requirement. ALVs were potentially good sources of iron, zinc and β-carotene and could contribute substantially to the Recommended Dietary Allowance for these nutrients in children, without taking into account inhibiting factors that might affect the bioavailability. Iron content of the ALVs studied ranged from 1.4−3.2 mg/100 g edible portion. Amaranthus cruentus was the best source of iron. Zinc content of the ALVs ranged from 0.7−1.4 mg/100g edible portions, with Cleome gynandra having the highest zinc composition. The β-carotene content of the ALVs ranged from 182−314 μg RAE/100 g edible portion, with both Amaranthus cruentus and Cleome gynandra being the best sources. Knowledge of ALVs and their use was indigenous and was transferred between generations. Caregivers had positive attitudes towards the use of ALVs. Conclusion: Although the prevalence of deficiencies was not severe (with exception of zinc deficiency), micronutrient deficiencies exist in the rural farm community studied. ALVs are potentially good sources of iron, zinc and β-carotene and might contribute to the nutritional status of school children. Knowledge of ALVs and the positive attitude and perceptions regarding their use by primary caregivers implied a potentially positive future response to interventions promoting consumption of ALVs in order to contribute to the alleviation of micronutrient deficiencies. / Thesis (MSc (Nutrition))--North-West University, Potchefstroom Campus, 2013.