Introdução: O aumento dos índices de obesidade infantil nas últimas décadas vem merecendo atenção crescente como problema de saúde pública, devido ao impacto que causa na vida das crianças pelas diversas alterações metabólicas e outras patologias, além de trazer consequências sociais, econômicas e psicológicas. Estudos visando a relação obesidade infantil e cognição tiveram início, no entanto, somente nos últimos anos. Objetivo: Investigar a linguagem escrita e as diferentes habilidades cognitivas envolvidas no seu processamento em crianças que foram diagnosticadas com obesidade desde a primeira infância. Material e Métodos: 41 crianças (média de idade: 9,6 anos) participaram desse estudo. Foram divididas em grupos conforme estado nutricional: G1 (n=14) crianças com diagnóstico atual de obesidade e histórico de sobrepeso/obesidade desde antes dos três anos e G2 (n=27) crianças eutróficas (pareadas segundo a idade e tipo de escola). Foram analisados dados do histórico médico e nível de atividade física e realizada a avaliação audiológica (pesquisas dos limiares entre 250Hz e 16000Hz) nos dois grupos. Em seguida foram submetidos à avaliação da leitura de palavras e pseudopalavras, a testes de aritmética, escrita sob ditado, consciência fonológica, nomeação automática rápida, memória de trabalho fonológica, memória de trabalho visuoespacial, atenção (teste por cancelamento) e flexibilidade cognitiva (teste de trilhas). Para a análise estatística utilizou-se o teste de Igualdade de Proporções, o teste Manny-Whitney e Manova Não-Paramétrica = 0,05. Resultados: Os grupos eram homogêneos na proporção de histórico de intercorrências pré e peri natais e histórico de convulsões/otites/anemia e apresentaram igualmente baixo nível de atividade física. Não foram observadas diferenças nos testes de desempenho escolar nas tarefas de leitura/escrita/aritmética, porém, os resultados do teste de avaliação do uso de rotas de leitura, indicou dificuldade de G1 em alternar as rotas fonológicas e lexicais demonstrando dificuldade em flexibilidade cognitiva. Essa dificuldade foi confirmada pelos resultados de desempenho do teste de trilhas e de atenção alternada, apesar de manterem bom desempenho em testes de atenção pura. Não foram encontradas diferenças entre os grupos nas tarefas de nomeação automática rápida e memória de trabalho visuoespacial. Quanto à memória de trabalho fonológica, o G1 apresentou melhor desempenho assim como em tarefas de consciência fonológica que mais se utilizam deste tipo de memória. A avaliação auditiva indicou limiares auditivos dentro do padrão de normalidade nos dois grupos, porém o G1 apresentou limiares auditivos significativamente mais elevados nas frequências mais graves (250hz a 4000hz). Conclusão: O presente estudo demonstrou que a condição de obesidade leva a alterações no desempenho cognitivo em crianças com efeitos positivos sobre a memória de trabalho fonológica e algumas tarefas de consciência fonológica, e efeitos negativos em outras como a flexibilidade cognitiva e atenção alternada que interferiram no processamento da linguagem escrita na habilidade para alternar rotas de leitura. O desempenho escolar em geral, dos grupos foi semelhante, já outros recursos cognitivos que auxiliam em sua aprendizagem podem ter sido requeridos. / Introduction: The rising of obesity rates in childhood has deserved attention as a healthy public problem due to the impact caused in the lives of children by various metabolic and other diseases, causing social, economic and psychological consequences. However, only in recent years the studies aiming the link between obesity in children and cognition has begun. Objective: Evaluate the different cognitive skills involved in the written language in children diagnosed with childhood obesity. Methods and Materials: 41 children (age average: 9,6 years old) participated of this study. The children were divided in groups according to nutritional status: G1 (n = 14) children diagnosed with obesity and with history of overweight / obese since three years or less, and G2 (n = 27) normal weight (matched by age and type of school). Audiological evaluation (thresholds between 250Hz and 16,000Hz) was performed in both groups after evaluation of medical historical data and level of physical activity. Tests involving reading words and pseudo words, arithmetic, writing under dictation, phonological awareness, rapid automatized naming, phonological working memory, visuospatial working memory, attention (cancellation test) and cognitive flexibility (trail making test) were performed . The Proportions Equality, Manny-Whitney and Manova Non-Parametric - = 0.05 tests were used for statistical analysis. Results: The groups were homogeneous considering the history prenatal and perinatal complications and history of seizures / ear infections / anemia besides the both groups presented low level of physical activity. There were no differences in school performance tests involving reading / writing / arithmetic. However, G1 presented difficulty to alternate the phonological and lexical routes in tests involving the use of reading routes, so indicating difficulties in cognitive flexibility. This difficulty was confirmed by the results obtained in trail making and alternating attention tests, even while maintaining a good performance in pure tests of attention. No differences were observed between groups in rapid automatized naming and visuospatial working memory tests. G1 presented the best performance in tasks involving phonological working memory. The thresholds of hearing were considered present in normal range for both groups in the hearing tests. However G1 presented thresholds of hearing higher in low frequencies (250hz a 4000hz). Conclusion: This study showed that childhood obesity can change cognitive performance in children. Positive effects on phonological working memory and in some phonological awareness tasks were observed. However, negative effects were observed in tasks involving cognitive flexibility and alternating attention which interfered in the processing of written language and in the ability to alternate reading routes. In general the school performance were similar in both groups, however other cognitive resources that assist in their learning may have been required.

Les programmes d'activité physique et les régimes alimentaires sont communément utilisés pour favoriser, en réduisant la balance énergétique, la perte de poids des patients en surpoids ou obèses. De tels programmes pâtissent d'une faible adhésion de la part des patients et d'un taux élevé d'abandons dû aux difficultés que rencontrent les individus à concilier exercice et restriction d'énergie. Il a été suggéré que l'exercice physique était un moyen potentiel pour réguler l'apport indirect d'énergie, ce qui pourrait s'avérer intéressant sur le plan du traitement de l'obésité.L'impact que l'exercice pouvait avoir sur la balance énergétique subséquente (apport et dépense énergétiques), ainsi que sur l'appétit, a été principalement étudié dans le cas d'adultes de faible corpulence, mais peu de données sont disponibles pour les populations d'individus obèses, et tout particulièrement pour les enfants qui souffrent d'obésité.Le but premier de ce travail était donc de déterminer si un exercice réalisé à un moment précis pouvait par la suite affecter la balance énergétique ainsi que l'appétit des adolescents obèses (Etude I). Par la suite, nous avons étudié l'importance que pouvait avoir l'intensité de l'exercice prescrit (intensité faible VS intensité élevée) sur les modifications de la balance énergétique et de l'exercice (Etude II). Les résultats démontrent qu'un exercice intensif (>70%VO2 max), exécuté en fin de matinée, favorise une balance énergétique réduite en diminuant principalement l'apport d'énergie. Cependant, les données restent contradictoires concernant l'apport de macronutriments après l'exercice, et il est nécessaire d'approfondir les recherches. En ce qui concerne les adaptations de la balance énergétique et de l'appétit après l'exercice, aucune différence n'avait été observée en fonction du sexe des individus. Les adaptations observées en termes d'apport énergétique n'étaient pas accompagnées de changements en termes de sensation de faim, ce qui laisse à penser que les adolescents obèses ne risquent pas de ressentir de la frustration.En 24h, la balance énergétique des adolescents obèses peut être réduite grâce à la fois à une dépense énergétique élevée et à un apport d'énergie réduit, quand un exercice intensif est réalisé en fin de matinée. Etant donné que de tels résultats découlent d'actes à caractère chroniques, il est nécessaire de les interroger, afin de savoir si l'exercice intensif peut s'avérer être un véritable outil permettant d'induire sur le long terme une réduction de la balance énergétique (en affectant à la fois la dépense et l'apport énergétique), et par la suite une perte de poids. / Physical activity programs and dietary restrictions are commonly used to favor weight-loss in overweight and obese patients, by reducing energy balance. Such programs suffer of a low adherence and high drop-out due to the difficulties met by patients to concomitantly support exercise and energy restriction. Physical exercise has been proposed as a potential indirect energy intake modulator, which could be interesting in terms of obesity treatment. The impact of exercise on subsequent energy balance (intake and expenditure) and appetite has been mainly questioned among lean adults but few data are available in obese populations, particularly pediatrics. The first aim of this work was then to determine whether or not an acute bout of exercise could affect subsequent energy balance and appetite in obese adolescents (STUDY I). Then the importance of the prescribed exercise intensity (Low vs High intensity) on those energy balance and appetite modifications has been investigated (STUDY II). The results demonstrate that an intensive exercise (>70%VO2max) realized by the end of the morning favors a reduced energy balance by mainly decreasing energy intake. The induced energy intake decrease was observed within minutes after the exercise (30 minutes, lunch time), with the onset being experienced about 7 hours after, during dinner time. Data remain however contradictive concerning the post exercise macronutrient intake, and further investigations are required. No gender difference was observed in terms of post exercise energy balance and appetite adaptations. The observed energy intake adaptations were not accompanied by appetite sensation modifications, suggesting that obese adolescents are not at risk for food frustration. Within 24-h, obese adolescents’ energy balance can be reduced thanks to both elevated energy expenditure and decreased energy intake when an intensive exercise is performed by the end of the morning. Such results need to be questioned as part of chronic interventions to know whether or not intensive exercise can provide a great tool to induced long term energy balance reduction (by dually affecting energy expenditure and intake) and then weight loss.

Childhood obesity has been an increasing problem in the United States, especially in rural areas. Effective prevention approaches are needed. This article describes the development, implementation, effectiveness, feasibility, and sustainability of a school-based obesity prevention pilot project, Winning with Wellness. The program was based on the coordinated school health model and included a community-based participatory research approach aimed at promoting healthy eating and physical activity in a rural Appalachian elementary school. Findings from this preliminary project revealed improvements in nutrition offerings and increased physical activity during the school day. In addition, the program was found to be acceptable to teachers, successfully implemented utilizing both existing and newly developed resources, and sustainable as evidenced in continued practice and expansion to other area schools.

INTRODUCTION: High prevalence rates of obesity, particularly among those residing in US rural areas, and associated physical and psychosocial health consequences, direct attention to the need for effective prevention programs. The current study describes an initial step in developing a school-based obesity prevention program in rural Appalachia, USA. The program, modeled on the Centers for Disease Control and Prevention Coordinated School Health (CSH) Program, includes a community-based participatory research approach to addressing the health needs specific to this region. METHODS: Focus groups with teachers, parents, and 4th grade students were used to understand perceptions and school policy related to nutrition, physical activity, and the role of the school in obesity prevention. RESULTS: Results revealed that these community stakeholders were concerned about the problem of child obesity and supported the idea of their school doing more to improve the diet and physical activity of its students. Specifically, all groups thought that foods and drinks consumed by students at school should be healthier and that they should have more opportunities for physical activity. However, they cited limitations of the school environment, academic pressures, and lack of parental support as potential barriers to making such changes. Parents were most concerned that their children were not getting enough to eat and they and the teachers were not in favor of BMI screening at the school. Parents were in favor of increasing physical activity during school and thought that parent volunteers should help students select foods in the cafeteria. Students cited examples of how diet and physical activity affect their health and school performance, and thought that they should have more physical education time and recess. CONCLUSIONS: The data collected in the current study contributed to the limited knowledge base regarding rural populations as well as identified strengths and potential barriers to assist with the development of a pilot program based on the CSH model, Winning with Wellness.

Health-related quality of life (HRQoL) is linked to health status in a variety of conditions. Less is known about the relation between quality of life and modifiable health behaviors, especially among medically underserved populations.ObjectiveThe purpose of the current study was to examine HRQoL as it relates to physical activity, sedentary behavior, and eating patterns in youth residing in Southern Appalachia.MethodsThe Pediatric Quality of Life Inventory and questions on physical activity and eating behaviors was completed by 152 sixth grade students in a regional sample of schools participating in the Winning with Wellness child obesity prevention project.ResultsThe current study found higher physical activity levels and lower levels of screen time to be associated with reports of more positive HRQoL.ConclusionsA more comprehensive understanding of factors surrounding health behavior may hold implications for obesity prevention/intervention programs.

Parent and child readiness to change have been identified as emerging areas informing pediatric obesity interventions. The purpose of this study was to increase understanding of child and parent readiness to change in obese youth by examining how these constructs are related to demographic variables, as well as to psychosocial functioning, in a sample of obese youth presenting for weight- management treatment. A secondary aim was to examine consistency between parent and child readiness to change. Two hundred twenty-eight 7- to 17-year-old children and their parents participated during the child’s initial assessment at a multidisciplinary weight-management clinic. Demographic variables included in analyses were child Body Mass Index, parent Body Mass Index, child age, child gender, child race, and family income. Children completed measures of quality of life, depression, social anxiety, internalizing and externalizing symptoms, and readiness to change. Parents completed assessments of children’s quality of life, children’s internalizing and externalizing symptoms, and parents’ own readiness to change. The child’s Body Mass Index was significantly related to both parent and child readiness to change. There was also a significant positive relation between child readiness to change and the child’s own report of social anxiety symptoms, as well as a curvilinear relation with internalizing symptoms, such as depression. In addition to the child’s Body Mass Index, parent readiness to change was positively related to the child’s age and was higher in African American parents than in European American parents. Race moderated the relation between parent readiness to change and health-related quality of life, internalizing symptoms, and externalizing problems. Parents and children were discordant in their ratings of readiness to change, with parents tending to report higher levels; the child’s Body Mass Index moderated the relation between parent and child report of readiness to change. Clinical implications and future directions are discussed.

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Agradecemos a compreensão. on 2016-04-19T13:50:29Z (GMT) / Submitted by Ana Carolina Viranda Pereira Lopes null (anacarolevc@hotmail.com) on 2016-04-27T01:37:31Z No. of bitstreams: 1 DISSERTAÇÃO ANA CAROLINA VIRANDA PEREIRA LOPES.pdf: 766765 bytes, checksum: f1e7da2b25a673b4ed66f4f2ed259b33 (MD5) / Approved for entry into archive by Felipe Augusto Arakaki (arakaki@reitoria.unesp.br) on 2016-04-28T16:12:05Z (GMT) No. of bitstreams: 1 lopes_acvp_me_bot.pdf: 766765 bytes, checksum: f1e7da2b25a673b4ed66f4f2ed259b33 (MD5) / Made available in DSpace on 2016-04-28T16:12:05Z (GMT). No. of bitstreams: 1 lopes_acvp_me_bot.pdf: 766765 bytes, checksum: f1e7da2b25a673b4ed66f4f2ed259b33 (MD5) Previous issue date: 2016-02-19 / A obesidade é definida como patologia crônica que se caracteriza pelo excesso de gordura corporal em relação à massa magra, sendo o sobrepeso definido como proporção relativa de peso maior que a desejável para a altura. A perspectiva brasileira é de que haja cerca de três milhões de crianças menores de 10 anos com excesso de peso, com 95% dos casos relacionados à má ingestão alimentar e 5% relacionados a fatores endógenos. O objetivo do presente estudo foi analisar a atenção à saúde nutricional de crianças de escolas públicas, em relação à alimentação, atividade física e estado de saúde, com vistas à proposição de aprimoramento de ações intersetoriais. O estudo foi do tipo epidemiológico, descritivo, transversal sobre hábitos de vida de crianças em idade escolar, no município de Bauru, situado na região centro-oeste do estado de São Paulo. Na caracterização do cenário escolar, o universo foi composto de 46 escolas de ensino fundamental, sendo 16 municipais e 30 estaduais, sendo que destas, participaram efetivamente do estudo 6 escolas municipais e 11 escolas estaduais. Os dados foram colhidos nas escolas por meio do envio de questionários aos responsáveis das crianças sorteadas para o estudo. Os professores representantes forneceram os dados referentes à conduta das escolas, por meio de questionário. Para caracterização da Alimentação Escolar, foi realizada uma visita ao setor responsável, e aplicação de um questionário à chefia da Seção de Alimentação de Unidades Escolares. Por fim, foi construído check-list para analisar o fornecimento de alimentos das cantinas particulares, existentes no interior das escolas públicas estaduais. Diante do observado pela presente pesquisa, verificou-se que não existe rotina de acompanhamento da saúde dos escolares na faixa etária estudada. O que se observa é a procura por atendimento em situações emergenciais. Considerando que o problema nutricional existe e passa despercebido, podendo se agravar com o passar da idade, existe a necessidade de estabelecer um fluxo de encaminhamento da criança com excesso de peso para atendimento e acompanhamento de saúde visando minimizar ou recuperar os riscos decorrentes desta condição nutricional. Produto: É sabido que o processo de mudança de hábito é extremamente complexo, e deve envolver toda a família da criança. Diante desta situação, dá-se a necessidade de ações intersetoriais, no intuito de atuar sobre os determinantes nutricionais e de saúde desta população. Apresenta-se assim, proposta de organização (na forma de um fluxograma) do cuidado nutricional dirigido a escolares, tendo como campo centralizador das ações as Unidades Básicas de Saúde e de Saúde da Família do município de Bauru. / Obesity is defined as a chronic disease that is characterized by an excess of body fat relative to lean body mass and overweight defined as the relative proportion of higher weight than desirable for the height. The Brazilian perspective is that there are about three million children under 10 years old are overweight, with 95% of cases related to poor food intake and 5% related to endogenous factors. The aim of this study was to analyze the attention to nutritional health of public school children in relation to diet, physical activity and health, with a view to enhancing proposition intersectoral action. The study was an epidemiological, descriptive, cross-over lifestyle habits of school children in the city of Bauru, located in the midwestern region of the state of São Paulo. In characterizing the school environment, the universe was composed of 46 elementary schools, 16 from the city and 30 state, and of these, actually participated in the study 6 from the city public schools and 11 state schools. Data were collected in schools by sending questionnaires to the heads of children randomly selected for the study. Representatives teachers provided data relating to the conduct of schools, through a questionnaire. To characterize the School Feeding, a visit to the responsible sector and application of a questionnaire to the head of the School Units Food section was performed. Finally, it was built checklist to analyze the supply of food from private canteens, existing within the public state schools. Before observed by this research, it was found that there is no health monitoring routine of school in the age group studied. What is observed is the demand for care in emergency situations. Whereas the nutritional problem and goes unnoticed and can worsen with increasing age, there is a need to establish a child forwarding flow overweight to care and health monitoring to minimize or recover the risks of this nutritional status. Product: It is known that the habit of switching process is extremely complex, and should involve all the child's family. In this situation gives the need for intersectoral action in order to act on the nutritional determinants and health of this population. It presents well, organization proposal (in the form of a flowchart) of nutritional care directed at school, with the centralizer field of action Basic Health Units and Family Health Units.

A obesidade e a cárie dentária são problemas de saúde pública, que atingem a população infantil. O objetivo deste estudo foi identificar a prevalência de cárie dentária e relacioná-la com a concentração da enzima anidrase carbônica VI, do íon cálcio, fluxo salivar e quantidade de biofilme dentário em crianças com sobrepeso/obesidade. Foram avaliadas 112 crianças de 4 a 6 anos de idade, de ambos os gêneros. A análise antropométrica foi realizada (percentil do IMC) e através dessa análise as crianças foram divididas em dois grupos: G1 sobrepesos/obesos (n=41) e G2 normais (n=71). Os exames bucais realizados para a cárie dentária foram os índices ceo-s e ICDAS II, quantidade de biofilme dentário pelo Índice de Placa de Turesky e volume de fluxo salivar estimulado. A concentração do íon Cálcio na saliva foi analisada pelo kit colorimétrico e da enzima Anidrase Carbônica VI pelo kit ELISA. Na sequência, as crianças de cada grupo foram divididas em 3 subgrupos: LC (livres de cárie), LI (com lesões iniciais) e C (com cárie). Os testes Wilcoxon, Mann-Whitney, teste t e correlação de Spearman foram aplicados (p<0,05). Não houve diferença significativa no ceo-s entre os grupos. Houve maior concentração média de cálcio salivar no G1 (G1=2847,96mM; G2=1230,90mM;p=0,001) e maior concentração da Anidrase Carbônica VI no G2 (G1=3455,18 pg/mL; G2=442428,9pg/mL;p=0,000). No G1 houve correlação negativa entre o ceo-s e íon Cálcio (r=-0,444;p=0,010). Já no G2, houve correlação negativa entre placa e a Anidrase Carbônica VI (r=-0,551;p=0,014). Pode-se concluir que o íon cálcio é fator protetor para cárie dentária em crianças. Já a anidrase carbônica VI parece não ser biomarcador para a cárie dentária. / Obesity and dental caries are public health problems that affect the child population. The aim of this study was to identify the prevalence of dental caries and relate it to the concentration of the enzyme carbonic anhydrase VI, calcium ion, salivary flow, and dental plaque in overweight/obesity children. The study was conducted on 112 children aged 4-6, of both genders. Anthropometric analysis was performed (BMI percentile) and by this analysis the children were divided into two groups: G1 - overweight/obese (n=41) and G2 - normal (n=71). The oral examinations performed for dental caries were the dmfs and ICDAS II indexes, measurement of the amount of dental plaque by the Turesky Board Index and volume of stimulated salivary flow. The concentration of calcium ion in saliva was measured by a colorimetric kit and the enzyme carbonic anhydrase VI by an ELISA kit. Then, children from each group were divided into three subgroups: CF (caries-free), IL (initial lesions) and D (decayed teeth). The Wilcoxon test, Mann-Whitney, t test and Spearman correlation (p<0.05) were applied. There was no significant difference in the dmfs between groups. There was higher concentration of salivary calcium in G1 (G1=2847.96mM; G2=1230.90mM; p=0.001), and higher concentration of carbonic anhydrase VI in G2 (G1 = 3455.18 pg/ml; G2 = 442428.9pg/ml; p = 0.000). In G1, there was negative correlation between dmfs and salivary calcium (r = -0.444; p = 0.010). In G2, there was negative correlation between dental plaque and carbonic anhydrase VI (r=-0.551; p=0.014). It can be concluded that the calcium ion is a protective factor for dental caries in children. The carbonic anhydrase VI does not seem to be a biomaker of dental caries.

Introdução: O aumento dos índices de obesidade infantil nas últimas décadas vem merecendo atenção crescente como problema de saúde pública, devido ao impacto que causa na vida das crianças pelas diversas alterações metabólicas e outras patologias, além de trazer consequências sociais, econômicas e psicológicas. Estudos visando a relação obesidade infantil e cognição tiveram início, no entanto, somente nos últimos anos. Objetivo: Investigar a linguagem escrita e as diferentes habilidades cognitivas envolvidas no seu processamento em crianças que foram diagnosticadas com obesidade desde a primeira infância. Material e Métodos: 41 crianças (média de idade: 9,6 anos) participaram desse estudo. Foram divididas em grupos conforme estado nutricional: G1 (n=14) crianças com diagnóstico atual de obesidade e histórico de sobrepeso/obesidade desde antes dos três anos e G2 (n=27) crianças eutróficas (pareadas segundo a idade e tipo de escola). Foram analisados dados do histórico médico e nível de atividade física e realizada a avaliação audiológica (pesquisas dos limiares entre 250Hz e 16000Hz) nos dois grupos. Em seguida foram submetidos à avaliação da leitura de palavras e pseudopalavras, a testes de aritmética, escrita sob ditado, consciência fonológica, nomeação automática rápida, memória de trabalho fonológica, memória de trabalho visuoespacial, atenção (teste por cancelamento) e flexibilidade cognitiva (teste de trilhas). Para a análise estatística utilizou-se o teste de Igualdade de Proporções, o teste Manny-Whitney e Manova Não-Paramétrica = 0,05. Resultados: Os grupos eram homogêneos na proporção de histórico de intercorrências pré e peri natais e histórico de convulsões/otites/anemia e apresentaram igualmente baixo nível de atividade física. Não foram observadas diferenças nos testes de desempenho escolar nas tarefas de leitura/escrita/aritmética, porém, os resultados do teste de avaliação do uso de rotas de leitura, indicou dificuldade de G1 em alternar as rotas fonológicas e lexicais demonstrando dificuldade em flexibilidade cognitiva. Essa dificuldade foi confirmada pelos resultados de desempenho do teste de trilhas e de atenção alternada, apesar de manterem bom desempenho em testes de atenção pura. Não foram encontradas diferenças entre os grupos nas tarefas de nomeação automática rápida e memória de trabalho visuoespacial. Quanto à memória de trabalho fonológica, o G1 apresentou melhor desempenho assim como em tarefas de consciência fonológica que mais se utilizam deste tipo de memória. A avaliação auditiva indicou limiares auditivos dentro do padrão de normalidade nos dois grupos, porém o G1 apresentou limiares auditivos significativamente mais elevados nas frequências mais graves (250hz a 4000hz). Conclusão: O presente estudo demonstrou que a condição de obesidade leva a alterações no desempenho cognitivo em crianças com efeitos positivos sobre a memória de trabalho fonológica e algumas tarefas de consciência fonológica, e efeitos negativos em outras como a flexibilidade cognitiva e atenção alternada que interferiram no processamento da linguagem escrita na habilidade para alternar rotas de leitura. O desempenho escolar em geral, dos grupos foi semelhante, já outros recursos cognitivos que auxiliam em sua aprendizagem podem ter sido requeridos. / Introduction: The rising of obesity rates in childhood has deserved attention as a healthy public problem due to the impact caused in the lives of children by various metabolic and other diseases, causing social, economic and psychological consequences. However, only in recent years the studies aiming the link between obesity in children and cognition has begun. Objective: Evaluate the different cognitive skills involved in the written language in children diagnosed with childhood obesity. Methods and Materials: 41 children (age average: 9,6 years old) participated of this study. The children were divided in groups according to nutritional status: G1 (n = 14) children diagnosed with obesity and with history of overweight / obese since three years or less, and G2 (n = 27) normal weight (matched by age and type of school). Audiological evaluation (thresholds between 250Hz and 16,000Hz) was performed in both groups after evaluation of medical historical data and level of physical activity. Tests involving reading words and pseudo words, arithmetic, writing under dictation, phonological awareness, rapid automatized naming, phonological working memory, visuospatial working memory, attention (cancellation test) and cognitive flexibility (trail making test) were performed . The Proportions Equality, Manny-Whitney and Manova Non-Parametric - = 0.05 tests were used for statistical analysis. Results: The groups were homogeneous considering the history prenatal and perinatal complications and history of seizures / ear infections / anemia besides the both groups presented low level of physical activity. There were no differences in school performance tests involving reading / writing / arithmetic. However, G1 presented difficulty to alternate the phonological and lexical routes in tests involving the use of reading routes, so indicating difficulties in cognitive flexibility. This difficulty was confirmed by the results obtained in trail making and alternating attention tests, even while maintaining a good performance in pure tests of attention. No differences were observed between groups in rapid automatized naming and visuospatial working memory tests. G1 presented the best performance in tasks involving phonological working memory. The thresholds of hearing were considered present in normal range for both groups in the hearing tests. However G1 presented thresholds of hearing higher in low frequencies (250hz a 4000hz). Conclusion: This study showed that childhood obesity can change cognitive performance in children. Positive effects on phonological working memory and in some phonological awareness tasks were observed. However, negative effects were observed in tasks involving cognitive flexibility and alternating attention which interfered in the processing of written language and in the ability to alternate reading routes. In general the school performance were similar in both groups, however other cognitive resources that assist in their learning may have been required.

Submitted by Juliana Lôbo Froio null (julianalf@marilia.unesp.br) on 2017-09-13T14:06:25Z No. of bitstreams: 1 DISSERTAÇÃO FINAL.pdf: 985415 bytes, checksum: 0b3264826b072fce716af20dcfe8031d (MD5) / Rejected by LUIZA DE MENEZES ROMANETTO (luizamenezes@reitoria.unesp.br), reason: Solicitamos que realize uma nova submissão seguindo a orientação abaixo: O arquivo submetido não contém o certificado de aprovação. A versão submetida por você é considerada a versão final da dissertação/tese, portanto não poderá ocorrer qualquer alteração em seu conteúdo após a aprovação. Corrija esta informação e realize uma nova submissão contendo o arquivo correto. Agradecemos a compreensão. on 2017-09-13T18:55:59Z (GMT) / Submitted by Juliana Lôbo Froio (fisioterapia@faip.edu.br) on 2017-09-28T19:22:56Z No. of bitstreams: 1 DISSERTAÇÃO FINAL.pdf: 1035253 bytes, checksum: 3a81f83de753dbc8f718a9f9bba356cb (MD5) / Approved for entry into archive by Monique Sasaki (sayumi_sasaki@hotmail.com) on 2017-09-29T17:50:06Z (GMT) No. of bitstreams: 1 froio_jl_me_rcla.pdf: 1058708 bytes, checksum: 123ae222ad78a3140087227f261dc8ee (MD5) / Made available in DSpace on 2017-09-29T17:50:06Z (GMT). No. of bitstreams: 1 froio_jl_me_rcla.pdf: 1058708 bytes, checksum: 123ae222ad78a3140087227f261dc8ee (MD5) Previous issue date: 2017-04-10 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Objetivo: investigar a influência da obesidade na modulação autonômica parassimpática e simpática da FC de crianças, nas condições de repouso e da MPA, e também as relações da obesidade com alterações no exame de sangue em jejum e índices antropométricos. Materiais e métodos: Foram estudados dois grupos, um de 23 crianças obesas (percentil do IMC igual ou maior que 97) e outro de 23 eutróficas (percentil igual ou menor que 85), confirmados pela avaliação antropométrica, cada grupo com 23 indivíduos. Exames laboratoriais de sangue foram classificados. A FC e os intervalos R-R (iR-R) instantâneos foram registrados em repouso com respiração espontânea, em decúbito dorsal por quinze minutos e analisados os índices temporais, espectrais e simbólicos. Após o tempo de coleta na postura anterior, o indivíduo ficou em pé ativamente e permaneceu assim por mais cinco minutos. A pressão arterial foi medida na postura decúbito dorsal e entre 90o e 120o segundos na postura em pé. Os ajustes da mudança postural ativa (MPA) foram analisados calculando-se a razão entre o maior valor do iR-R entre o 20º e o 40º batimento e o menor entre o 5º e o 20º batimentos obtidos na postura em pé (EWING, 1985) e a diferença entre os valores de pressão arterial sistólica (PAS) aferidos nas duas posturas. Resultados: Os principais achados nas análises de repouso referem-se ao fato de as medidas de obesidade global e abdominal estarem relacionadas negativamente com a bioquímica sanguínea e com os índices simbólicos de VFC. Já em relação à MPA, observou-se que a razão iR-R e a variação da PAS foram similares entre os grupos e não se correlacionam com as medidas antropométricas e bioquímicas, entretanto, podem estar associadas às diferenças nos mecanismos autonômicos. Considerações finais: Na condição de repouso, as crianças obesas apresentam menor complexidade na modulação da FC e essa alteração está relacionada tanto à obesidade global, quanto abdominal. Em relação aos ajustes à MPA, a magnitude das respostas da FC e da PAS dos obesos é similar aos eutróficos e não está associada significativamente com as medidas antropométricas e bioquímicas. Entretanto, as respostas da FC, na condição testada, sofrem efeitos da modulação parassimpática, apesar de explicar apenas parcialmente esses ajustes. E a variação da PAS correlaciona-se positivamente com a modulação parassimpática e negativamente com modulação simpática e o balanço simpatovagal. / Objective: to investigate the influence of obesity on the parasympathetic and sympathetic autonomic modulation of the HR of children, in the resting conditions and the MPA, as well as the relationships of obesity with changes in fasting blood test and anthropometric indices. Materials and methods: Two groups were studied, one of 23 obese children (BMI percentile equal to or greater than 97) and one of 23 eutrophic (percentile equal to or less than 85), confirmed by the anthropometric evaluation, each group with 23 individuals. Blood laboratory tests were classified. The HR and the instantaneous R-R (iR-R) intervals were recorded at rest with spontaneous breathing, in dorsal decubitus for fifteen minutes and the temporal, spectral and symbolic indices analyzed. After the collection time in the previous posture, the individual stood up actively and remained so for another five minutes. Blood pressure was measured in the dorsal decubitus position and between 90o and 120o seconds in standing posture. The adjustments of the active postural change (MPA) were analyzed by calculating the ratio between the highest value of the iR-R between the 20 th and 40 th beats and the lowest between the 5th and the 20th beats obtained in standing posture (EWING, 1985) And the difference between the values of systolic blood pressure (SBP) measured in both positions. Results: The main findings in the rest analyzes refer to the fact that the measures of global and abdominal obesity are negatively related to the blood biochemistry and to the symbolic indexes of HRV. Regarding MPA, it was observed that the iR-R ratio and the SBP variation were similar between the groups and did not correlate with the anthropometric and biochemical measures, however, they may be associated with the differences in the autonomic mechanisms. Conclusion: In the resting condition, obese children present a lower complexity in HR modulation and this alteration is related to both global and abdominal obesity. Regarding adjustments to MPA, the magnitude of the HR and SBP responses of obese individuals is similar to eutrophic and is not significantly associated with anthropometric and biochemical measures. However, the HR responses, under the condition tested, suffer effects of the parasympathetic modulation, although only partially explain these adjustments. And the variation of SBP correlates positively with the parasympathetic modulation and negatively with sympathetic modulation and the sympatovagal balance.