Objetivo: Sintetizar el efecto de la suplementación con ácidos grasos omega-3 sobre los componentes del Síndrome Metabólico (SM) en adultos con infección por el Virus de la Inmunodeficiencia Humana (VIH) en Tratamiento Antirretroviral de Gran Actividad (TARGA). Métodos: Llevamos a cabo una revisión sistemática y metaanálisis de ensayos clínicos aleatorizados. Definimos el SM según los criterios del ATP III basado en cinco componentes: triglicéridos, HDL, glucosa, circunferencia abdominal y presión arterial. Nuestra búsqueda primaria fue realizada en PubMed-MEDLINE, EMBASE, SCOPUS, Web of Science, CENTRAL, LILACS, SciELO hasta diciembre del 2019. Evaluamos el riesgo de sesgo con la herramienta Cochrane para ensayos clínicos. Estimamos el efecto conjunto mediante metaanálisis de efectos fijos y aleatorios en función a la heterogeneidad estadística. Calculamos diferencias de medias no estandarizadas (ΔMNE) y diferencia de medias estandarizadas (ΔME) con el estadístico d de Cohen (d-Cohen) para estimar el tamaño de efecto. Registramos el estudio en PROSPERO (CRD42019115749). Resultados: Encontramos un total de 13125 registros, a partir de los cuales incluimos 15 artículos en nuestro análisis: triglicéridos (15), HDL (5), glucosa (4), circunferencia abdominal (2) y presión arterial (1). Ocho artículos tuvieron alto riesgo de sesgo. Realizamos metaanálisis con nueve estudios para triglicéridos, observamos reducción significativa de los niveles [ΔMNE: -77,50 mg/dL (IC95% -117,72 a -37,28; I2: 27,2%)] con un efecto pequeño [Cohen-d: -0,43 (IC95% -0,62 a -0,25; I2:0,0%)]. Este efecto se acentúa cuando se acompaña de dieta y ejercicio [Cohen-d: -0,62 (IC95% -1,17 a -0,06; I2:0,0%)] o cuando se utiliza dosis mayores a 4 gr al día [Cohen-d: -0,58 (IC95% -0,93 a -0,23; I2:0,0%)]. No encontramos variación de acuerdo con los niveles basales de triglicéridos [Cohen-d: -0,43 (IC95% -0,62 a -0,25; I2:0,0%)]. Asimismo, efectuamos metaanálisis con cinco estudios para HDL, notamos que no hubo incremento significativo [ΔMNE:1,01 mg/dL (IC95% -1,35 a 3,37; I2: 0,0%)] con Cohen-d: 0,11 (IC95% -0,11 a 0,32; I2:0,0%). Al evaluar los otros componentes del SM detectamos alta heterogeneidad clínica y metodológica, por lo que no realizamos metaanálisis; no obstante, la totalidad de los estudios reportaron que no había efecto significativo de la suplementación sobre los niveles de glucosa sérica, circunferencia abdominal y presión arterial. Del mismo modo, no realizamos síntesis cuantitativa de los eventos adversos por la heterogeneidad y falta de reporte en los artículos individuales; sin embargo, la mayoría de los estudios informaron baja frecuencia de eventos adversos y sin diferencias con los producidos en los grupos de control. Conclusiones: En pacientes con infección por el VIH en TARGA la suplementación con ácidos grasos omega-3 reduce los niveles séricos de triglicéridos. No se observa efecto sobre los niveles séricos de HDL. La evidencia referente a los otros componentes del SM es escasa y apunta a que no habría efecto. Hubo baja frecuencia de eventos adversos fundamentalmente leves. / Objective: To synthesize the efficacy of omega-3 fatty acid supplementation on Metabolic Syndrome (MS) in adult with Human Immunodeficiency Virus (HIV) infection receiving Highly Active Antiretroviral Therapy (HAART). Methods: We carried out a systematic review and meta-analysis of randomized clinical trials. We used ATP III criteria to define MS based on five components: triglycerides, HDL, glucose, waist circumference and blood pressure. We performed a literature search in PubMed-Medline, Scopus, Web of Science, CENTRAL, LILACS, SciELO and EMBASE until December 2019. We assessed the risk of bias using the Cochrane tool for clinical trials. We calculated combined effect using random and fixed effects meta-analysis according the statistical heterogeneity. We calculated non-standardized means (ΔNSM) and standardized means (ΔSM) with Cohen’s d (Cohen-d) to estimate effect size. We registered this study in the International Prospective Register of Systematic Reviews (PROSPERO) (ID: CRD42019115749). Results: From 13,125 records, we included 15 in our analysis: triglycerides (15), HDL (5), glucose (4), waist circumference (2) and blood pressure (1). Eight studies had high risk of bias. We performed a quantitative synthesis with nine studies for triglycerides. We observed a significant reduction in serum levels [ΔNSM: 77,50 mg/dL (CI95% -117,72 to -37,28; I2: 27,2%)] with a small effect [Cohen-d: -0,43 (CI95% -0,62 to -0,25; I2:0,0%)]. This effect was higher when omega-3 supplementation included diet and exercise [Cohen-d: -0,62 (CI95% -1,17 to -0,06; I2:0,0%)] or when the doses was greater than 4 g per day [Cohen-d: -0,58 (CI95% -0,93 to -0,23; I2:0,0%)]. We did not find variation according to basal triglyceride levels [Cohen-d: -0,43 (CI95% -0,62 to -0,25; I2:0,0%)]. For HDL, we made a meta-analysis with five studies. No significant effect was found [ΔNSM: 1,01 mg/dL (CI95% -1,35 to 3,37; I2: 0,0%)] with Cohen-d: 0,11 (CI95% -0,11 to 0,32; I2:0,0%). We found high clinical and methodological heterogeneity when evaluating the other components of MS and therefore no meta-analysis was made. Nonetheless, all the studies indicated that there was no significant effect of supplementation on serum glucose, waist circumference and blood pressure levels. Likewise, we did not perform a quantitative synthesis of adverse events by heterogeneity and lack of reporting of these on individual articles. Nevertheless, most studies reported mild adverse events in some patients compared to the placebo control group. Conclusions: The supplementation of omega-3 fatty acid in adult patients with HIV in HAART reduces the serum triglyceride levels. Furthermore, the serum levels of HDL are not affected. The evidence regarding to the other components of MS is insufficient and suggests that there would be no effect. The adverse events found were mild. / Tesis

Background: Obesity and the accompanying increased morbidity and mortality risk is highly prevalent among older adults. As obese elderly might benefit from intentional weight reduction, it is necessary to determine associated and potentially modifiable factors on senior obesity. This cross-sectional study focuses on multi-morbid patients which make up the majority in primary care. It reports on the prevalence of senior obesity and its associations with lifestyle behaviors. Methods: A total of 3,189 non-demented, multi-morbid participants aged 65–85 years were recruited in primary care within the German MultiCare-study. Physical activity, smoking, alcohol consumption and quantity and quality of nutritional intake were classified as relevant lifestyle factors. Body Mass Index (BMI, general obesity) and waist circumference (WC, abdominal obesity) were used as outcome measures and regression analyses were conducted. Results: About one third of all patients were classified as obese according to BMI. The prevalence of abdominal obesity was 73.5%. Adjusted for socio-demographic variables and objective and subjective disease burden, participants with low physical activity had a 1.6 kg/m2 higher BMI as well as a higher WC (4.9 cm, p<0.001). Current smoking and high alcohol consumption were associated with a lower BMI and WC. In multivariate logistic regression, using elevated WC and BMI as categorical outcomes, the same pattern in lifestyle factors was observed. Only for WC, not current but former smoking was associated with a higher probability for elevated WC. Dietary intake in quantity and quality was not associated with BMI or WC in either model. Conclusions: Further research is needed to clarify if the huge prevalence discrepancy between BMI and WC also reflects a difference in obesity-related morbidity and mortality. Yet, age-specific thresholds for the BMI are needed likewise. Encouraging and promoting physical activity in older adults might a starting point for weight reduction efforts.

Introducción: El fenómeno de la migración es una de las problemáticas sociales con mayor impacto en el mundo y altera las dinámicas sociales, políticas y económicas de las sociedades a las que pertenecen los migrantes. En el Perú la migración desde las zonas rurales contribuye a la urbanización, esto puede aumentar las probabilidades de desarrollar obesidad central y por ende aumentar el riesgo a futuras complicaciones metabólicas. Objetivo: Evaluar la asociación entre la migración interna y la circunferencia de cintura en mujeres peruanas en edad fértil a nivel nacional en el 2018. Métodos: Realizamos un análisis secundario de datos de la ENDES del Perú 2018 (Peru DHS, 2018). En nuestro análisis se incluyó a mujeres de 15-49 años y se excluyó a las que reportaron estar embarazadas. Nuestra variable resultado fue circunferencia de cintura y nuestra variable de exposición la migración interna. Adicionalmente, estas variables fueron categorizadas según la Asociación Latinoamericana de diabetes (ALAD) como normal (CC <88 cm), obesidad central (CC de ≥ 88 cm) y la migración interna como flujo migratorio: urbano-urbano, urbano-rural, rural-rural, rural-urbano y urbano o rural no migrantes y tiempo desde migración (nunca migraron, <5, 5-9, ≥ 10 años). Utilizamos un modelo lineal generalizado (GLM) con familia poisson y función de enlace log para el cálculo de razones de prevalencia crudas y ajustadas. Resultados:. En cuanto al análisis multivariado se encontró que las mujeres no migrantes y que residen en zonas urbanas tienen 18% mayor probabilidad de tener obesidad central comparado a las mujeres que residen en zonas rurales (RP(a) 1.18 RP(c) 1.17, IC95% 1.07 – 1.30). Las mujeres que migran de rural a urbano, urbano a rural y urbano a urbano tienen 16% (IC 95%) mayor probabilidad de tener obesidad central comparado al rural no migrante. Conclusiones: Las mujeres que migraron de zonas rurales a urbanas, urbano a rural y urbano a urbano tienen mayor probabilidad de tener obesidad central comparado con el rural no migrante. Dentro del grupo de mujeres no migrantes, las mujeres urbanas tienen mayor probabilidad de tener obesidad central. / Introduction: Migration is a phenomenon that has major impact in the world, and it alters social, political, and economic dynamics. Migration from the rural side of Peru contributes to urbanization and can increase the chances of central obesity and therefore increase the risk of future metabolic complications. Objectives: To assess whether there is an association between internal migration and abdominal circumference in Peruvian women of childbearing age according to the Demographic and Family Health Survey of Peru in 2018. Methods: An analytical cross-sectional study was carried out using data from the 2018 Peru Demographic and Family Health Survey (Peru DHS, 2018). Women aged 15-49 years were included in this study and women who reported being pregnant were excluded. Our outcome variable was waist circumference, and our exposure variable was internal migration. Waist circumference (WC) was defined as central obesity using the Latino American Diabetes Association (ALAD) classification for central obesity with a WC > 88 cm. Internal migration was defined as migratory flow: urban-urban, urban-rural, rural-rural, rural-urban, and urban or rural non-migrants and time since migration (never migrated, <5, 5-9, ≥10 years). Generalized linear model (GLM) with poisson family and log link function was used to calculate raw and adjusted prevalence ratios. Results: In the multivariate analysis we found non-migrant women who reside in urban areas have an 18% greater probability of having central obesity compared to women who reside in rural areas (PR(a) 1.18 PR(c) 1.17, CI95 % 1.07 – 1.30). Women who migrate from rural to urban, urban to rural, and urban to urban have a 16% (95% CI) greater probability of having central obesity compared to rural non-migrants. Conclusions: This study showed that women who migrated from rural to urban, urban to rural and urban to urban have a higher probability of having central obesity, compared to rural non-migrants. / Tesis

No description available.

Background: Obesity has been associated with increased health care use, but it is unclear whether this is consistent across all measures of obesity. The objectives of this thesis were to compare obesity defined by four anthropometric measures, body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and percent body fat (%BF), and to estimate their associations with health care use among Canadian adults. Methods: A secondary data analysis was conducted from 30,097 individuals aged 45-85 years from the Canadian Longitudinal Study on Aging. Anthropometric measures were collected by trained research assistants and %BF, the reference standard, was measured using dual-energy x-ray absorptiometry. Obesity was defined as BMI≥30.0 kg/m2, WC≥88cm for females and ≥102cm for males, WHR≥0.85 for females and ≥0.90 for males, and %BF>35% for females and >25% for males. Approximately 18 months after baseline data collection, self-reported health care use in the past 12 months was collected, including any contact with a general practitioner, medical specialist, emergency department, and being a patient in a hospital overnight. Pearson correlation coefficients and sensitivity and specificity analyses were conducted to compare anthropometric measures to %BF. Relative risks and risk differences were calculated for measures of health care use, adjusted for sex, age, education, income, urban/rural, marital status, smoking status, and alcohol use. Secondary analyses were also stratified by sex and age. Results: The prevalence of obesity defined by BMI was 29%, by WC was 42%, by WHR was 62%, and by %BF was 73%. BMI and WC were highly correlated with %BF (r=0.75 and r=0.70, respectively) and WHR was weakly correlated with %BF (r=0.29). BMI and WC cut points demonstrated high specificity (>93%) and lower sensitivity (<58%) in predicting obesity defined by %BF. WHR cut points demonstrated high sensitivity (95%) and lower specificity (28%) in males, but lower sensitivity (44%) and high specificity (83%) in females in predicting %BF- defined obesity. There was an increased relative and absolute risk of health care use for all measures of obesity and all health care services. For example, WC-defined obesity was associated with increased relative risk (RR) of hospital overnight stay (RR: 1.40, 95% CI: 1.28- 1.54) and the risk difference (per 100) was 2.6 (95% CI:1.9-3.3). The risk of health care use was similar amongst females and males with obesity although relative risks and risk differences attenuated in the oldest adult group aged 75 and older compared to the youngest group aged 45- 54. Conclusion: The prevalence of obesity among Canadian adults varied substantially by anthropometric measure. BMI and WC have stronger correlations and concordance with %BF than does WHR, however all measures were positively associated with increased health care use. Further research should be conducted on obesity cut points to discern the best measure to predict health care use. / Thesis / Master of Public Health (MPH)

RESUMO Introdução- A prevalência de sobrepeso já ultrapassa 40% entre os adultos brasileiros. Isso justifica o monitoramento da obesidade entre crianças e adolescentes, concomitantemente com os déficits nutricionais que acometem as crianças de baixa renda, ainda que hoje se apresentem em patamares menores do que nas décadas anteriores. Objetivo- Descrever as prevalências e os fatores associados ao estado nutricional dos estudantes da 4ª à 9ª série do ensino fundamental de 3 regiões administrativas do município de Vitória. Método. Avaliouse o estado nutricional e o estágio de maturação sexual de 400 alunos de escolas públicas e privadas. Considerou-se em déficit de estatura os indivíduos com índice estatura/idade abaixo de -2 escores z do valor mediano da população de referência, em déficit de peso aqueles com Índice de Massa Corporal (IMC) abaixo do percentil 5 e com sobrepeso/obesidade o IMC ao percentil 85. Para o perímetro da cintura, adotou-se como referência o percentil 90 da população britânica. Resultados- Encontrou-se baixa prevalência de déficit de estatura (4,0%) e de déficit de peso (4,8%) e alta prevalência de sobrepeso/obesidade (21,3%) e de acúmulo de gordura na região da cintura (27,3%). No modelo de regressão linear geral múltipla, as variáveis associadas ao déficit de estatura foram: maturação sexual em estágio inicial (RP-14,84), faixa etária 14 anos (RP-5,08) e número de irmãos 2 (RP-4,52). Para déficit de peso: peso ao nascer 2500g (RP-0,23), IMC materno 25 (RP-0,19) e número de irmãos 2 (RP-2,76). Para sobrepeso/obesidade: maturação sexual em estágio inicial e intermediário (RP-2,19 e RP-2,13), IMC materno 25 (RP-2,04) e renda no nível mais alto (RP-1,78). Para acúmulo de gordura na região da cintura: IMC materno 25 (RP-1,75), renda no nível mais alto (RP- 1,88), faixa etária 14 anos (RP-0,50) e sedentarismo 28 horas/semana (RP-1,66). Conclusões- Ações de saúde pública são necessárias para o combate ao sobrepeso/obesidade e ao acúmulo de gordura na região da cintura, apresentando maior prevalência os indivíduos nos estágios iniciais e intermediários de maturação sexual, menores de 14 anos, de maior renda, cujas as mães apresentaram IMC 25 e sedentários. / Abstract Introduction: The overweight prevalence already exceeds 40% among Brazilian\'s adults. This justifies the monitoring of obesity among children and adolescents, as well as the nutritional deficits that affect children of low income, even though today it is present in levels lower than in previous decades. Objective: To describe the prevalence and the factors associated with the nutritional status of 4th to 9th grade Elementary to Middle School students in 3 administrative regions of the County of Vitória. Method: The nutritional status and sexual maturation stage of 400 private and public school individuals were evaluated. It was considered stunting those individuals with height-for-age below -2 Z-scores of median value for the reference population; wasting those with body mass index (BMI) below the percentile 5th and as overweight/obesity the BMI of percentile 85th. For waist circumference was adopted the percentile 90 of the British population. Results: There was a low prevalence of stunting (4.0%) and wasting (4.8%) and high prevalence of overweight/obesity (21.3%) and fat accumulation in the waist area (27.3%). In the multiple generalized linear model the variables associated with stunting were: initial stages of sexual maturation (PR-14.84), age >14 (PR-5.08), number of siblings >2 (PR-4.52). For wasting: birth weight > 2500g (PR- 0.23), maternal BMI >25 (PR-0.19), number of siblings >2 (PR-2.76). For overweight/obesity: initial and intermediate stages of sexual maturation (PR-2.19 and PR- 2.13), maternal BMI >25 (PR-1.75), high income level (PR-1.78). For fat accumulation in the waist area: maternal BMI >25 (PR-1.75), high income level (PR-1.87), age >14 (PR- 0.50), sedentary > 28 hours/week (PR-1.66). Conclusions: Public health action is needed to combat overweight/obesity and fat accumulation in the waist area, presenting higher prevalence the individuals in initial and intermediate sexual maturation stages, below age 14, higher income levels, whose mothers present BMI 25 and sedentary.

Intervenção nutricional educativa em pacientes submetidos à angioplastia transluminal coronária: ensaio clínico randomizado [Tese]. São Paulo: Faculdade de Medicina, Universidade de São Paulo; 2016. INTRODUÇÃO: Mudanças no estilo de vida são estimuladas na prevenção primária e secundária da doença arterial coronária. A educação para promoção de saúde requer uma atividade capaz de problematizar a realidade do indivíduo e capacitá-lo para escolhas conscientes. Considerando os aspectos pluridimensionais da alimentação e a dificuldade de mudanças no comportamento alimentar, o objetivo deste estudo foi analisar a efetividade de uma intervenção nutricional educativa em pacientes submetidos à angioplastia transluminal coronária (ATC) quanto à mortalidade e recorrência de eventos como infarto agudo do miocárdio (IAM), revascularização cirúrgica do miocárdio (RM) ou nova ATC em até um ano de acompanhamento. Os objetivos secundários incluíram consumo alimentar; medidas antropométricas e bioquímicas; estágios de mudança do comportamento alimentar e a ocorrência de eventos cardiovasculares em até quatro anos de seguimento, além de uma análise qualitativa dos fatores socioculturais e atitudinais que influenciaram as práticas alimentares dessa população. MÉTODOS: Foi realizado um ensaio clínico controlado, randomizado e pragmático, com duração de um ano, relativo aos cuidados clínico-nutricionais nos grupos controle e intervenção, sendo neste adicionadas oficinas educativas de nutrição com abordagem construtivista. O ensaio foi complementado com um estudo de coorte para observar eventos cardiovasculares em até quatro anos. Foram alocados 200 pacientes, sendo 101 no grupo intervenção. Ao final do primeiro ano e depois de quatro anos, foram calculadas a redução do risco absoluto e o risco relativo como medidas de incidência cumulativa, respectivamente. RESULTADOS: Ao final de um ano de seguimento, nos grupos intervenção e controle, respectivamente, houve cinco e sete óbitos (p = 0,53); cinco e seis IAM (p = 0,73); quatro e seis re-ATC (p = 0,50); e quatro e quatro RMs (p = 0,98). Após quatro anos, os RR entre os grupos de intervenção e controle foram 0,75 (IC95% 0,35-1,58) para óbito; 0,89 (IC95% 0,34-2,28) para IAM; 0,86 (IC95% 0,40-1,84) para re-ATC e 1,14 (IC95% 0,38-3,40) para RM. Quanto à ingestão alimentar, observou-se redução de gordura saturada (p=0,04) e aumento de fibras (p=0,03) e potássio (p=0,01) no grupo intervenção comparado ao controle. As medidas antropométricas e bioquímicas não apresentaram diferença entre os grupos. A análise estratificada mostrou um efeito protetor para a circunferência da cintura nos subgrupos de idosos [-2.6 cm (IC95% -4,7; -0.6)] e até quatro anos de estudo [-2.5 cm (IC95% -4,9; -0,1)], com interação entre eles (p=0,02). Quanto à mudança de comportamento, houve um aumento no número de indivíduos nos estágios de ação/manutenção de 2,2 vezes (IC95%1,0;5,2) no grupo intervenção, porém sem diferença entre os grupos. Foram identificados fatores socioculturais relacionados ao prazer, hábito, cultura e medo, bem como fatores atitudinais como mudanças declaradas, ambivalência e resistência que permearam as práticas alimentares independente do estágio de mudança, além do conhecimento adquirido, explícito ou ausente. CONCLUSÕES: A intervenção educativa pareceu vantajosa, embora a amostra não tenha sido suficiente para ser conclusiva quanto à ocorrência de eventos cardiovasculares. Houve redução de gordura saturada e aumento no consumo de fibras e potássio, porém sem melhora nas medidas antropométricas e bioquímicas, exceto um menor acúmulo de gordura abdominal em idosos e sujeitos com baixa escolaridade. Há de se fortalecer o debate dos aspectos culturais que constituem o espaço social alimentar e repensar a orientação valorizando as mudanças positivas e escolhas alimentares dentro de um contexto de padrão alimentar saudável / INTRODUCTION: Changes in lifestyle are encouraged in primary and secondary prevention of coronary artery disease. The education for health promotion requires an activity capable of problematizing the individual\'s reality and enabling him to make conscious choices. Considering the multidimensional aspects of feeding and the difficulty of changes in eating behavior, the objective of this study was to analyze the effectiveness of a nutrition education intervention program on mortality and recurrence of events as acute myocardial infarction (AMI), revascularization with re-percutaneous coronary intervention (re-PCI), or coronary artery bypass graft (CABG) surgery after one year of follow-up in patients who previously underwent elective PCI. The secondary objectives included food consumption, anthropometric and biochemical parameters, stages of dietary change, and recurrence of cardiovascular events after four years of follow-up, besides a qualitative analysis of the cultural and attitudinal factors that influenced the dietary practices of this population. METHODS: A controlled, randomized, and pragmatic clinical trial was performed during one-year, related to the clinical and nutritional care in the control and intervention groups, and nutrition education workshops that adopted a constructivist approach were additionally applied to the intervention group. The trial was complemented with a cohort study to observe cardiovascular events up to four years of follow-up. Two hundred patients were allocated, 101 in the intervention group. The absolute risk reduction and the risk ratio were calculated as measures of the cumulative incidence after one and four years, respectively. RESULTS: After one year of follow-up, in the intervention and control groups, respectively, there were five and seven deaths (p=0,53); five and six AMIs (p=0,73); four and six re-PCIs (p=0,50); and four and four CABGs (p=0,98). After four years, the risk ratios between intervention and control groups were 0,75 (95%CI 0,35-1,58) for death, 0.89 (95%CI 0,34-2,28) for AMI, 0,86 (95%CI 0,40-1,84) for re-PCI, and 1,14 (95%CI 0,38-3,40) for CABG. Regarding food consumption, a decrease in saturated fat (p = 0.04) and increase in fiber (p = 0.03) and potassium (p = 0.01) intakes were observed in the intervention group compared to the control group. Anthropometric and biochemical measurements did not show any difference between groups. The stratified analysis showed a protective effect for waist circumference in the elderly [-2.6 cm (95%CI-4,7; -0,6)] and individuals up to four years of study [-2.5 cm (95%CI -4,9 ;-0,1)] subgroups, with interaction between them (p = 0,02). Regarding the change in dietary behaviour, there was an increase in the number of individuals in the action/maintenance stages of 2.2 times (95%CI 1,0; 5,2) in the intervention group, but with no difference between the groups. Factors related to pleasure, habit, culture and fear were identified, as well as attitudinal factors such as stated changes, ambivalence and resistance that permeated eating practices regardless of the stage of change, as well as acquired, explicit or absent knowledge. CONCLUSION: The educational intervention seemed advantageous, although the sample was not enough to be conclusive about the occurrence of cardiovascular events. There was a reduction in saturated fat and an increase in fiber and potassium consumption, but there was no improvement in anthropometric and biochemical measurements, except for a lower accumulation of abdominal fat in the elderly and subjects with low schooling. There is a need to strengthen the debate on the cultural aspects that constitute the food social space and rethink the orientation by valuing positive changes and food choices within a healthy eating pattern

Submitted by Alison Vanceto (alison-vanceto@hotmail.com) on 2017-08-24T12:16:41Z No. of bitstreams: 1 DissROM.pdf: 1802563 bytes, checksum: 8a20822e115118f79c74001c251e9156 (MD5) / Approved for entry into archive by Ronildo Prado (ronisp@ufscar.br) on 2017-09-05T19:51:30Z (GMT) No. of bitstreams: 1 DissROM.pdf: 1802563 bytes, checksum: 8a20822e115118f79c74001c251e9156 (MD5) / Approved for entry into archive by Ronildo Prado (ronisp@ufscar.br) on 2017-09-05T19:51:38Z (GMT) No. of bitstreams: 1 DissROM.pdf: 1802563 bytes, checksum: 8a20822e115118f79c74001c251e9156 (MD5) / Made available in DSpace on 2017-09-05T19:57:23Z (GMT). No. of bitstreams: 1 DissROM.pdf: 1802563 bytes, checksum: 8a20822e115118f79c74001c251e9156 (MD5) Previous issue date: 2017-02-15 / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Objective: The aim of the present study was to investigate associations between abdominal obesity/dynapenia/dynapenic abdominal obesity and a single fall/recurrent falls as well as determine the effect size of such associations using two cutoff points for dynapenia. Methods: A cross-sectional study was conducted with 1.063 older adults pertaining to the third wave of the Saúde, Bem Estar e Envelhecimento (SABE – Health, Wellbeing and Ageing) study. Abdominal obesity was defined as a waist circumference of >102 cm for men and > 88 cm for women. The following were the cutoff points for dynapenia: grip strength < 30 kg for men and < 20 kg for women or < 26 kg for men and < 16 kg for women. Dynapenic abdominal obesity was defined by the combination of abdominal obesity and dynapenia. Regarding the outcome, the individuals were classified as non-fallers, single fallers or recurrent fallers. Socioeconomic, neuropsychiatric and environmental factors as well as living habits, polypharmacy, health status and functionality were the control variables in the multinomial regression models. Results: Adopting a cutoff point of 30/20, only one association was found: dynapenic abdominal obesity and a single fall (RRR = 2.37; 95% CI: 1.48-3.80). However, adopting a cutoff point of 26/16, dynapenic abdominal obesity (RRR = 1.93; 95% CI: 1.09-3.44), abdominal obesity (RRR = 1.65; 95% CI: 1.08-2.52) and dynapenia (RRR = 1.77; 95% CI: 1.01-3.13) were associated with a single fall, with a larger effect size of the association with dynapenic abdominal obesity than the other two conditions. Moreover, dynapenia defined using the 26/16 cutoff point was associated with recurrent falls (RRR = 2.39; 95% CI: 1.19-4.82). Conclusions: The cutoff point used to define dynapenia affects associations between abdominal obesity/dynapenia/dynapenic abdominal obesity and a single fall/recurring falls. A cutoff point of 26/16 is better for identifying such associations. / Objetivo: Investigar a associação de obesidade abdominal (OA), dinapenia e obesidade abdominal dinapênica (OA/D) com queda única e quedas recorrentes, assim como o tamanho do efeito de tais associações, adotando duas notas de cortes para dinapenia. Método: Estudo transversal com 1.063 idosos provenientes da terceira onda do Estudo SABE. OA foi definida como circunferência de cintura > 102 cm para homens e > 88 cm para mulheres. As notas de corte para dinapenia foram: força de preensão manual < 30 kg para homens e < 20 kg para mulheres ou < 26 kg para homens e < 16 kg para mulheres. OA/D foi definida pela associação de OA e dinapenia. Quanto ao desfecho, os idosos foram classificados como não caidores, caidores únicos ou recorrentes. Fatores socioeconômicos, neuropsiquiátricos, ambientais, hábitos de vida, polifarmácia, estado de saúde e funcionalidade foram variáveis de controle nos modelos de regressão multinomial. Resultados: Adotando a nota de corte 30/20, encontramos somente a associação entre OA/D e queda única (RRR = 2,37 IC 95% 1,48–3,80). Em contrapartida, adotando a nota de corte 26/16 tanto a OA/D (RRR = 1,93 IC 95% 1,09–3,44), quanto a OA (RRR = 1,65 IC 95% 1,08–2,52) e a dinapenia (RRR = 1,77 IC 95% 1,01–3,13) associaram-se à queda única, sendo o tamanho do efeito da associação maior com OA/D do que com as duas condições isoladas. Além disso, a dinapenia definida com o corte 26/16 associou-se com quedas recorrentes (RRR = 2,39 IC 95% 1,19–4,82). Conclusões: A nota de corte adotada para definir dinapenia modifica as associações de OA, dinapenia, OA/D com queda única e recorrente, sendo o corte 26/16 melhor para identificá-las. / FAPESP: 2015/18291-7

A morbidade e mortalidade por doenças cardiovasculares demonstram tendência geral de declínio, mas, em países em desenvolvimento como o Brasil a ocorrência destes eventos é crescente. A obesidade e principalmente a localização intraabdominal de gordura, relacionase com a ocorrência de doença crônica e diferentes tipos de dietas tem sido testados na busca pela efetiva redução da adiposidade. Fatores biológicos como a resistência à insulina pode interferir na resposta obtida com intervenções nutricionais. O objetivo deste estudo foi avaliar se a perda de peso e as mudanças ocorridas na composição corporal de mulheres saudáveis, eutróficas ou com sobrepeso, submetidas a um programa de prevenção de ganho de peso foram influenciadas pela resistência à insulina no inicio da intervenção. Tratase de um estudo observacional prospectivo. 203 mulheres foram alocadas randomicamente para dieta de baixo e alto índice glicêmico. Destas, 185, foram avaliadas quanto a presença de resistência a insulina na linha de base, 34,6 % foram classificadas como resistentes a insulina segundo o índice HOMAIR, no ponto de corte 2,71. As medidas antropométricas de localização de gordura, circunferência da cintura (CC) e relação cintura quadril (RCQ) associaramse com a resistência a insulina do inicio do estudo, sendo a RCQ a mais fortemente associada (razão de prevalência: 2,28; p=0,0005, enquanto que para CC o valor foi 1,53; p=0,04). A análise da modificação do peso e das medidas antropométricas de composição corporal ao longo dos 6 meses de acompanhamento não demonstrou diferença estatisticamente significante entre os grupos com e sem resistência a insulina. Em conclusão, embora a resistência à insulina tenha se correlacionado com a localização de gordura avaliada principalmente pela relação cintura quadril no inicio do estudo, ela não foi capaz de explicar mudanças na composição corporal e de peso em resposta a uma intervenção nutricional. / Morbidity and mortality caused by cardiovascular diseases show a general tendency to decline, but in developing countries, like Brazil, the occurrence of these events is increasing. Obesity and especially the location of intra-abdominal fat, is related to the occurrence of chronic disease and different types of diets have been tested in the search to effective reduction of adiposity. Biological factors such as insulin resistance can interfere with the response obtained with nutritional interventions. The aim of this study was to assess if the weight loss and the changes in the body composition of healthy women, normal weight or overweight, under a program for prevention of weight gain were influenced by the insulin resistance at the beginning of the intervention. This is a prospective observational study. 203 women have been randomly allocated to low and high glycemic index diets. Among these, 185 have been assessed for the presence of insulin resistance at baseline, 34.6% have been classified as insulin resistant according to the HOMA-IR, in the cut value of 2.71. The anthropometric measurements of fat location, waist circumference (WC) and waist hip ratio (WHR) associated with baseline insulin resistance, being the WHR the most strongly associated (prevalence ratio: 2.28, p = 0.0005, while for the WC the value was 1.53, p = 0.04). The analysis of weight modification and anthropometric measurements of body composition throughout the 6 months of follow-up, has not demonstrated statistical significant differences between the groups resistant and non resistant to insulin. In conclusion, although insulin resistance has been correlated to the location of fat mainly measured by waist hip ratio in the beginning of the study, it has not been able to explain changes in body composition and weight in response to a nutritional intervention.

A morbidade e mortalidade por doenças cardiovasculares demonstram tendência geral de declínio, mas, em países em desenvolvimento como o Brasil a ocorrência destes eventos é crescente. A obesidade e principalmente a localização intraabdominal de gordura, relacionase com a ocorrência de doença crônica e diferentes tipos de dietas tem sido testados na busca pela efetiva redução da adiposidade. Fatores biológicos como a resistência à insulina pode interferir na resposta obtida com intervenções nutricionais. O objetivo deste estudo foi avaliar se a perda de peso e as mudanças ocorridas na composição corporal de mulheres saudáveis, eutróficas ou com sobrepeso, submetidas a um programa de prevenção de ganho de peso foram influenciadas pela resistência à insulina no inicio da intervenção. Tratase de um estudo observacional prospectivo. 203 mulheres foram alocadas randomicamente para dieta de baixo e alto índice glicêmico. Destas, 185, foram avaliadas quanto a presença de resistência a insulina na linha de base, 34,6 % foram classificadas como resistentes a insulina segundo o índice HOMAIR, no ponto de corte 2,71. As medidas antropométricas de localização de gordura, circunferência da cintura (CC) e relação cintura quadril (RCQ) associaramse com a resistência a insulina do inicio do estudo, sendo a RCQ a mais fortemente associada (razão de prevalência: 2,28; p=0,0005, enquanto que para CC o valor foi 1,53; p=0,04). A análise da modificação do peso e das medidas antropométricas de composição corporal ao longo dos 6 meses de acompanhamento não demonstrou diferença estatisticamente significante entre os grupos com e sem resistência a insulina. Em conclusão, embora a resistência à insulina tenha se correlacionado com a localização de gordura avaliada principalmente pela relação cintura quadril no inicio do estudo, ela não foi capaz de explicar mudanças na composição corporal e de peso em resposta a uma intervenção nutricional. / Morbidity and mortality caused by cardiovascular diseases show a general tendency to decline, but in developing countries, like Brazil, the occurrence of these events is increasing. Obesity and especially the location of intra-abdominal fat, is related to the occurrence of chronic disease and different types of diets have been tested in the search to effective reduction of adiposity. Biological factors such as insulin resistance can interfere with the response obtained with nutritional interventions. The aim of this study was to assess if the weight loss and the changes in the body composition of healthy women, normal weight or overweight, under a program for prevention of weight gain were influenced by the insulin resistance at the beginning of the intervention. This is a prospective observational study. 203 women have been randomly allocated to low and high glycemic index diets. Among these, 185 have been assessed for the presence of insulin resistance at baseline, 34.6% have been classified as insulin resistant according to the HOMA-IR, in the cut value of 2.71. The anthropometric measurements of fat location, waist circumference (WC) and waist hip ratio (WHR) associated with baseline insulin resistance, being the WHR the most strongly associated (prevalence ratio: 2.28, p = 0.0005, while for the WC the value was 1.53, p = 0.04). The analysis of weight modification and anthropometric measurements of body composition throughout the 6 months of follow-up, has not demonstrated statistical significant differences between the groups resistant and non resistant to insulin. In conclusion, although insulin resistance has been correlated to the location of fat mainly measured by waist hip ratio in the beginning of the study, it has not been able to explain changes in body composition and weight in response to a nutritional intervention.