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)

Cardiovascular diseases are the leading cause of death in most industrialised countries and in developing countries the trend in cardiovascular-related deaths is increasing. World-wide, type 2 diabetes mellitus (T2DM) is an emerging cause of disability and premature death. Both these conditions are closely associated with the consumption of energy-dense foods and food products that are poor in nutrients, as well as with a sedentary lifestyle. Pharmacological and surgical interventions can improve the outcome and delay the progression of the disease, but in terms of population-level prevention there is no substitute for the adoption of a healthy lifestyle. SETTING The underlying studies were conducted in Västerbotten (the VIP study), and in Norrbotten and Västerbotten combined (the MONICA Project). Norrbotten andVästerbotten are the two northernmost counties in Sweden. Since the mid-1980sthe prevalence of cardiovascular disease has decreased and diabetes rates haveremained stable in this region, despite of an unbroken trend of increasing body weight. OBJECTIVE The aim of this thesis is to describe changes in reported dietary habits, estimatetheir relative importance as risk factors for diabetes and cardiovascular disease, and finally to identify lifestyle components as potential targets for intervention. RESULTS The first paper describes changes in self-reported food consumption between 1986 and 1999. During this period, the population in question switched from products with high saturated fatty acid content (e.g. milk containing 3% fat, butter) to foods containing less saturated fat (e.g. milk containing 1.5% fat, vegetable oil, low-fat margarine); pasta and rice were consumed more often, and potatoes were consumed less. Convenience foods (e.g. hamburgers, snacks, sweets) became more popular, whilst traditional dishes (e.g. potato dumplings, black pudding, blöta) decreased in popularity. Fruit and vegetable intake remained low. In paper two we study the effects of these changes in food intake on the risk of developing T2DM using body fat distribution as an early indicator. Increased consumption of convenience foods was associated with unfavourable changes (smaller hip circumference and larger waist circumference), whereas the increased consumption of vegetable oil and pasta was associated with low-risk fat distribution. In the third paper we report studies on the association between fat consumption and T2DM. We used the pattern of fatty acids in the membranes of red blood cells as a marker of fat intake. In addition to confirming earlier findings (markers of the intake of saturated fat are associated with increased risk of T2DM and markers of unsaturated fat are associated with reduced T2DM risk), we also identified associations between two markers of milk-derived saturated fat intake and enterolactone, a biomarker of dietary fibre intake, and the risk of developing myocardial infarction. Our results indicate that moderately high levels of enterolactone intake in men are associated with lower risk of experiencing myocardial infarction. Manuscript 5 ranks education level, physical activity, smoking status, and self-reported intake of dietary fibre and fatty acids according to their effects on body fat distribution. Increased levels of physical activity, a higher education level and a reduced intake of saturated fat from meat were ranked as the most strongly associated factors in both men and women. Increased intake of dietary fibre from grains in women, and increased intake of dietary fibre from fruits and vegetables in men, was also inversely associated with average waist circumference. CONCLUSION Both questionnaire-based and biological markers of the risk of developing diabetes or cardiovascular disease have been identified. Based on available population level measurements, reduced consumption of convenience foods, increased consumption of whole-grain products, fruits and vegetables, vegetable oil and pasta as well as increased physical activity are potential goals for interventions in northern Sweden.

Introdução: A poluição atmosférica é proveniente de complexas interações que envolvem emissões de poluentes atmosféricos e que sabidamente causam consequências negativas para a saúde humana. De acordo com alguns estudos, a exposição à poluição, durante a gestação, pode causar baixo peso ao nascimento e prematuridade. Contudo, não há ainda consenso sobre os períodos de maior susceptibilidade para a exposição à poluição, e quais seriam os seus efeitos nos desfechos do gestação e na determinação do sexo do recém-nascido (RN). Objetivos: Com a finalidade de investigar o impacto da poluição na gestação e, consequentemente, no RN, os objetivos deste projeto são avaliar a influência da exposição à poluição, antes da concepção, na determinação do sexo do RN, e, durante a gestação, nos desfechos do parto e na curva de crescimento da circunferência cefálica (CC) entre o terceiro trimestre e o parto. Métodos: Um estudo prospectivo com 371 gestantes, intitulado ProcriAR, foi realizado na cidade de São Paulo. Os poluentes dióxido de nitrogênio (NO2) e ozônio (O3) foram medidos durante cada trimestre da gestação por meio da utilização de amostradores passivos individuais (APIs). Simultaneamente, foi realizada a análise dos poluentes NO2 e material particulado com tamanho menor que 10 Micro m (MP10) medidos pela estação fixa de ar de Taboão da Serra da Companhia Ambiental do Estado de São Paulo (CETESB), localizada na zona oeste de São Paulo e a mais próxima da residência das gestantes do projeto. Os desfechos avaliados foram: idade gestacional, peso, comprimento e medida da CC do RN; sexo do RN e crescimento do polo cefálico entre o terceiro trimestre e o parto. Quando a variável desfecho era contínua, foi realizada análise linear multivariada, controle de idade gestacional, sexo do RN, idade materna no momento da concepção, índice de massa corporal (IMC), paridade, tabagismo, consumo de álcool, cor, nível de escolaridade completado, estado civil, índice de pulsatilidade (IP) da artéria umbilical no terceiro trimestre, e via de parto para a variável CC. Resultados: Não foram observadas associações entre a exposição ao NO2 e O3, avaliados em cada trimestre da gestação, e a idade gestacional, o peso, o comprimento, a CC ao nascer e o crescimento do polo cefálico fetal entre o terceiro trimestre e o parto. A exposição ao NO2 e MP10 no ano prévio à concepção influenciou na chance de ser do sexo feminino, ou seja, para cada aumento de 1 unidade do poluente do NO2, constatou-se um aumento de 10% na chance de ser do sexo feminino (Razão de chances (RC) = 1,100; intervalo de confiança (IC) de 95% = 1,040, 1,164; p = 0,001). Em relação ao MP10, para cada aumento de 1 unidade desse poluente, observou-se um aumento de 18 % na chance de ser do sexo feminino (RC = 1,176; IC de 95% = 1,054, 1,311; p = 0,004). Conclusão: Nossos resultados sugerem que, no ambiente de São Paulo, a exposição à poluição no ano prévio à concepção esteve associada à determinação do sexo do RN / Background: Ambient pollution may lead to adverse obstetric outcomes, such as premature birth and low birth weight. Objectives: To determine the influence of maternal air pollution exposure on sex ratio, on birth outcomes and on the growth curve of cephalic pole between the third trimester and the birth. Methods: ProcriAR, a prospective cohort study of 371 pregnant women, was conducted in the city of São Paulo. Nitrogen dioxide (NO2) and ozone (O3) were measured during each trimester using passive personal monitors. At the same time, NO2 and particulate matter lower than 10 Micro m (PM10) were measured by a fixed station. We evaluated the gestational age, birth weight, birth lenght, head circumference, newborn sex and the growth curve of cephalic pole between the third trimester and the birth. When the outcome variable was continuous, multivariate analysis was performed, controlling for gestational age, newborn sex, maternal age at conception, body mass index, parity, smoking, alcohol consumption, race, highest education level completed, marital status, umbilical artery pulsatility values at third trimester and type of delivery for the outcome head circumference. We used multiple logistic regression models to evaluate the association of being female based on a quantitative increase in pollutant concentration, controlling for maternal age at conception, parity and smoking. Results: Elevated exposure to pollutants NO2 and PM10 were associated with increased odds of being female. Each unit increase of NO2 exposure increased the odds of being female by 10% (odds ratio (OR) = 1,100, 95% confidence interval (CI) = 1,040, 1,164; p = 0,001) and each unit increase of PM10 increased by 18% (OR = 1,176, 95% CI 1,054, 1,311, p = 0,004). Conclusion: In São Paulo, maternal exposure to pollutants prior to conception was significantly associated with the odds of being female

Introdução: O nascimento de recém-nascidos pré-termo tardios (RNPT-T), geralmente tratados como \"quase termo\", vem aumentando nas últimas décadas. Vários fatores são atríbuídos à sua etiologia e contribuem para aumentar as taxas de morbimortalidade perinatal e infantil. Atualmente se dispõe de poucos estudos sobre esses recém-nascidos, especialmente sobre o seu crescimento. Objetivos: Analisar o crescimento de RNPT-T nos seis primeiros meses de idade corrigida. Métodos: Estudo observacional, analítico de uma coorte de 64 RNPT-T, coletados nos quatro maiores hospitais de Cuiabá, entre janeiro e setembro de 2013 e acompanhados até 6 meses de idade corrigida. Os dados foram coletados ao nascer, às 40 semanas, 3 e 6 meses de idade corrigida. Foram realizadas análises de correlação entre os parâmetros antropométricos perímetro braquial (PB) e prega cutânea tricipital (PCT) em função dos índices antropométricos PB/PC (perímetro cefálico), peso/comprimento (P/C) e Índice de Massa Corpórea (IMC) e realizada regressão linear múltipla. Resultados: Ao nascimento, 81,3% foram classificados como adequados para a idade gestacional, com a média de peso de 2343,80g ± 430,50. Todos os recém-nascidos apresentaram crescimento contínuo nos seis meses de idade corrigida para os valores de peso, comprimento e perímetro cefálico (PC). Já os valores médios de PCT, de PB/PC e de IMC não mostraram diferença aos 6 meses de idade corrigida. Todos os coeficientes de correlação (r) dos parâmetros PCT e PB em relação aos índices antropométricos apresentaram significância estatística, sendo os valores mais altos para PB versus PB/PC e P/C e menores para PB versus IMC. No modelo final da regressão linear múltipla da PCT, o PB/PC contribuiu significantemente para predizer o depósito de gordura ao nascimento, às 40 semanas e aos 3 meses de idade corrigida (33,8%%, 46,07% e 18,08% respectivamente); aos 6 meses o melhor preditor foi a razão P/C (10,45%). O melhor preditor para o PB foi o PB/PC, que permaneceu no modelo com valores de 73,71%% em todos os tempos avaliados. Conclusão: Os parâmetros peso, comprimento, perímetro cefálico e perímetro braquial e a relação P/C aumentaram nos quatro tempos de aferição, enquanto o PCT e as relações PB/PC e IMC não se modificaram do primeiro para o segundo trimestre e o PB/PC foi o melhor preditor do depósito de gordura subcutânea tricipital (PCT) e de massa gorda e muscular (PB) / Introduction: The birth of newborns late preterm (RNPT -T), usually treated as \"near term\", has been increasing in recent decades. Several factors are attributed to its etiology and contribute to increased rates of perinatal and infant morbidity and mortality. Currently there are few studies of these newborns, especially about their growth. Objectives: To analyze the growth pattern of late preterm infants from birth to six months of corrected age. Methods: This cohort study included 64 RNPT-T, in four major hospitals in Cuiabá, between January and September 2013 and followed until 6 months corrected age. Data were collected at birth, at 40 weeks, 3 and 6 months corrected age. Correlation analyzes between anthropometric parameters mid- arm circumference (MAC) and triceps skinfold (TS) on the basis of anthropometric indices MAC / HC (head circumference), weight / length (W / L) and body mass index (BMI) were performed multiple linear regression. Results: At birth, 81.3 % were classified as appropriate for gestational age, with the average weight of 2343.80 ± 430.50 g. All newborns had a continuous growth in the six months corrected age for the values of weight, length and head circumference (HC). The average value of TS values of MAC / HC and BMI showed no difference at 6 months of corrected age. All correlation coefficients (r) of the TS and MAC parameters in relation to anthropometric indices showed statistically significant, with the highest values for MAC versus MAC / HC and W / L and lower for MAC versus BMI. At the end of the TS model of multiple linear regression, the MAC / HC contributed significantly to predict the deposition of fat at birth, at 40 weeks and at 3 months\' corrected age (33.8 %, 46.07 % and 18.08 % respectively); at 6 months was the best predictor of the ratio W/ L (10.45%). The best predictor for the MAC was the MAC / HC, which remained in the model with values of 73.71 % at all evaluated times. Conclusion: The parameters weight, length, head circumference and arm - circumference and the ratio W / L increased in the four times of measurement, while the TS and MUAC / HC relations and BMI did not change from the first to the second quarter and MAC / HC was the best predictor of subcutaneous fat deposit triceps (TS) and fat and muscle (MAC) mass

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

Introdução: O nascimento de recém-nascidos pré-termo tardios (RNPT-T), geralmente tratados como \"quase termo\", vem aumentando nas últimas décadas. Vários fatores são atríbuídos à sua etiologia e contribuem para aumentar as taxas de morbimortalidade perinatal e infantil. Atualmente se dispõe de poucos estudos sobre esses recém-nascidos, especialmente sobre o seu crescimento. Objetivos: Analisar o crescimento de RNPT-T nos seis primeiros meses de idade corrigida. Métodos: Estudo observacional, analítico de uma coorte de 64 RNPT-T, coletados nos quatro maiores hospitais de Cuiabá, entre janeiro e setembro de 2013 e acompanhados até 6 meses de idade corrigida. Os dados foram coletados ao nascer, às 40 semanas, 3 e 6 meses de idade corrigida. Foram realizadas análises de correlação entre os parâmetros antropométricos perímetro braquial (PB) e prega cutânea tricipital (PCT) em função dos índices antropométricos PB/PC (perímetro cefálico), peso/comprimento (P/C) e Índice de Massa Corpórea (IMC) e realizada regressão linear múltipla. Resultados: Ao nascimento, 81,3% foram classificados como adequados para a idade gestacional, com a média de peso de 2343,80g ± 430,50. Todos os recém-nascidos apresentaram crescimento contínuo nos seis meses de idade corrigida para os valores de peso, comprimento e perímetro cefálico (PC). Já os valores médios de PCT, de PB/PC e de IMC não mostraram diferença aos 6 meses de idade corrigida. Todos os coeficientes de correlação (r) dos parâmetros PCT e PB em relação aos índices antropométricos apresentaram significância estatística, sendo os valores mais altos para PB versus PB/PC e P/C e menores para PB versus IMC. No modelo final da regressão linear múltipla da PCT, o PB/PC contribuiu significantemente para predizer o depósito de gordura ao nascimento, às 40 semanas e aos 3 meses de idade corrigida (33,8%%, 46,07% e 18,08% respectivamente); aos 6 meses o melhor preditor foi a razão P/C (10,45%). O melhor preditor para o PB foi o PB/PC, que permaneceu no modelo com valores de 73,71%% em todos os tempos avaliados. Conclusão: Os parâmetros peso, comprimento, perímetro cefálico e perímetro braquial e a relação P/C aumentaram nos quatro tempos de aferição, enquanto o PCT e as relações PB/PC e IMC não se modificaram do primeiro para o segundo trimestre e o PB/PC foi o melhor preditor do depósito de gordura subcutânea tricipital (PCT) e de massa gorda e muscular (PB) / Introduction: The birth of newborns late preterm (RNPT -T), usually treated as \"near term\", has been increasing in recent decades. Several factors are attributed to its etiology and contribute to increased rates of perinatal and infant morbidity and mortality. Currently there are few studies of these newborns, especially about their growth. Objectives: To analyze the growth pattern of late preterm infants from birth to six months of corrected age. Methods: This cohort study included 64 RNPT-T, in four major hospitals in Cuiabá, between January and September 2013 and followed until 6 months corrected age. Data were collected at birth, at 40 weeks, 3 and 6 months corrected age. Correlation analyzes between anthropometric parameters mid- arm circumference (MAC) and triceps skinfold (TS) on the basis of anthropometric indices MAC / HC (head circumference), weight / length (W / L) and body mass index (BMI) were performed multiple linear regression. Results: At birth, 81.3 % were classified as appropriate for gestational age, with the average weight of 2343.80 ± 430.50 g. All newborns had a continuous growth in the six months corrected age for the values of weight, length and head circumference (HC). The average value of TS values of MAC / HC and BMI showed no difference at 6 months of corrected age. All correlation coefficients (r) of the TS and MAC parameters in relation to anthropometric indices showed statistically significant, with the highest values for MAC versus MAC / HC and W / L and lower for MAC versus BMI. At the end of the TS model of multiple linear regression, the MAC / HC contributed significantly to predict the deposition of fat at birth, at 40 weeks and at 3 months\' corrected age (33.8 %, 46.07 % and 18.08 % respectively); at 6 months was the best predictor of the ratio W/ L (10.45%). The best predictor for the MAC was the MAC / HC, which remained in the model with values of 73.71 % at all evaluated times. Conclusion: The parameters weight, length, head circumference and arm - circumference and the ratio W / L increased in the four times of measurement, while the TS and MUAC / HC relations and BMI did not change from the first to the second quarter and MAC / HC was the best predictor of subcutaneous fat deposit triceps (TS) and fat and muscle (MAC) mass

O Diâmetro Abdominal Sagital (DAS) é uma medida antropométrica relacionada com a gordura visceral e empregada para avaliar a obesidade abdominal, uma variável associada à síndrome metabólica. Sua utilização é indicada na prática clínica para avaliação de risco cardiometabólico em adolescentes obesos. OBJETIVO: Verificar a concordância entre o DAS e a circunferência abdominal (CA) na avaliação da obesidade central e sua associação com os critérios da Síndrome Metabólica e HOMA-IR em adolescentes obesos. CASUÍSTICA E MÉTODOS: Estudo de corte transversal constituído por 83 adolescentes obesos entre 14 e 18 anos, (46 do sexo feminino e 37 do sexo masculino) matriculados no Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, nos ambulatórios das Unidades de Endocrinologia Pediátrica e de Adolescentes. Foram submetidos a avaliações antropométricas (IMC, Escore Z do IMC, percentual de gordura corporal, circunferência abdominal, diâmetro abdominal sagital), laboratoriais (HDL-c, triglicérides (TG), glicemia (GLIS) e insulina para o cálculo do HOMA-IR) e de pressão arterial sistólica (PAS) e diastólica (PAD), utilizadas para classificação dos critérios da SM. RESULTADOS: Todos os adolescentes apresentaram valores elevados de IMC (36,9±6,7 kg/m2), Z-IMC (+3,27±0,94) e 91,6% da casuística tiveram valores alterados no percentual de gordura corporal (41,4% para o grupo feminino e 36% para o grupo masculino), confirmando a obesidade grave do grupo. Considerando o percentil >=90 do Center for Disease Control and Prevention (CDC), no National Health and Nutrition Examination Survey (NHANES 2011-2014), 85,5% dos adolescentes apresentaram valores elevados de CA (117,7 ± 14,7) e 89,2% valores alterados no DAS (26,9±3,7). Quanto às variáveis laboratoriais, 32,5% dos pacientes apresentaram diminuição de HDL-c e níveis aumentados de: TG (10,8%); GLIS (3,6%); PAS (32,5%,); PAD (21,7%) e HOMA-IR (79,5%), considerando toda a amostra. De acordo com os critérios utilizados pelo International Diabetes Federation, 27,7% da casuística apresentou SM. O DAS demonstrou estar significantemente correlacionado com as variáveis PAS (r=0,489 p < 0,001), PAD(r=0,277 p 0,011) e HOMA-IR (r=0,462 p < 0,001) nos grupos geral, feminino, masculino, com e sem SM. A correlação encontrada entre as medidas do DAS e CA no grupo geral e feminino foi de r = 0,91 (p 0,000) e, no grupo masculino, de r = 0,93 (p 0,000). A concordância entre a CA e o DAS é significante (Kappa k = 0.511; p < 0,001). Nos grupos geral, feminino e masculino com SM, a concordância é mais expressiva (Kappa k = 1,00; p < 0,001.). Esses resultados mostram que os adolescentes apresentavam risco cardiometabólico aumentado e expressiva obesidade central, identificada pelo DAS e CA, apesar de 73,5% deles estarem medicados. O DAS oferece vantagem metodológica na sua mensuração. CONCLUSÕES: Nas condições deste estudo, conclui-se que: as medidas antropométricas CA e DAS se equivalem para o grupo de adolescentes avaliados na classificação da SM; O DAS é preditor de PAS, PAD e HOMA-IR e forte indicador de risco cardiometabólico em adolescentes obesos / The sagittal abdominal diameter (SAD) is an anthropometric measure related to visceral fat and used to evaluate abdominal obesity, a variable associated with the metabolic syndrome. Studies have suggested its employment in the clinical practice for estimating cardiometabolic risk of obese adolescents. OBJECTIVE: To verify the concordance between SAD and abdominal circumference in the assessment of central obesity and its association with the Metabolic Syndrome cluster and with HOMA-IR in obese adolescents. CASUISTICS AND METHODS: In a cross-sectional study, 83 obese adolescents between 14 and 18 years (46 females and 37males) with body mass index (BMI) of 36.9 ± 6.7 kg/m2, followed at the Pediatric Endocrinology Unit and at the Adolescent Unit of the Children\'s Institute, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo were submitted to anthropometric (BMI, BMI Z Score, body fat percentage, abdominal circumference, sagittal abdominal diameter), laboratory (HDL-c, triglycerides, glycemia and insulin for calculating HOMA-IR) and systolic and diastolic blood pressure assessments aimed for classification of metabolic syndrome. Previous consentment was given by all patients and their families. RESULTS: All adolescents presented elevated BMI and Z-BMI, and high body fat percentage was displayed by 91.6% of the patients (41.4% for the female group and 36% for the male group), confirming severe obesity. Considering the >= 90 percentile cut-off values as provided by the Anthropometric Reference Data for Children and Adults: United States 2011-2014 for abdominal circumference and SAD, 85.5% of the patients presented high abdominal circumference values (117.7±14.7) and 89.2% presented elevated values of SAD (26.9±3.7). With regard to laboratory variables, 32.5% of the patients displayed decreased HDL-c and increased values of: triglycerides (10.8%); glycemia (3.6%); systolic blood pressure (32.5%); diastolic blood pressure (21.7%) and HOMA-IR (79.5%). According to the criteria of the International Diabetes Federation (IDF), 27.7% of patients presented metabolic syndrome. SAD was significantly correlated with systolic (r=0.489 p < 0.001) and diastolic (r=0.277 p 0.011) blood pressures and HOMA-IR (r=0.462 p < 0.001) in the general, female and male groups, with and without metabolic syndrome. The correlation between SAD and abdominal circumference in the general and female groups was r = 0.91(p 0.000) and in the male group was r = 0.93 (p 0.000). The concordance between SAD and abdominal circumference was significant (Kappa coefficient k = 0.511; p < 0.001). In the general, male and female groups with metabolic syndrome, the concordance was more expressive (Kappa coefficient; k = 1.00 and p < 0.001). These results show that the adolescents presented increased cardiometabolic risk and significant central obesity identified by SAD and abdominal circumference although 73.5% of the studied patients were maintained under medication for clinical metabolic syndrome symptoms. SAD displayed methodological advantages concerning its measurement. CONCLUSIONS: Under the conditions of this study, it is concluded that: the anthropometric measurements of SAD and abdominal circumference are equivalent for metabolic syndrome classification of the studied adolescents; that SAD is a predictor of systolic and diastolic blood pressures and HOMA-IR and is a strong indicator of cardiometabolic risk in obese adolescents

O Diâmetro Abdominal Sagital (DAS) é uma medida antropométrica relacionada com a gordura visceral e empregada para avaliar a obesidade abdominal, uma variável associada à síndrome metabólica. Sua utilização é indicada na prática clínica para avaliação de risco cardiometabólico em adolescentes obesos. OBJETIVO: Verificar a concordância entre o DAS e a circunferência abdominal (CA) na avaliação da obesidade central e sua associação com os critérios da Síndrome Metabólica e HOMA-IR em adolescentes obesos. CASUÍSTICA E MÉTODOS: Estudo de corte transversal constituído por 83 adolescentes obesos entre 14 e 18 anos, (46 do sexo feminino e 37 do sexo masculino) matriculados no Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, nos ambulatórios das Unidades de Endocrinologia Pediátrica e de Adolescentes. Foram submetidos a avaliações antropométricas (IMC, Escore Z do IMC, percentual de gordura corporal, circunferência abdominal, diâmetro abdominal sagital), laboratoriais (HDL-c, triglicérides (TG), glicemia (GLIS) e insulina para o cálculo do HOMA-IR) e de pressão arterial sistólica (PAS) e diastólica (PAD), utilizadas para classificação dos critérios da SM. RESULTADOS: Todos os adolescentes apresentaram valores elevados de IMC (36,9±6,7 kg/m2), Z-IMC (+3,27±0,94) e 91,6% da casuística tiveram valores alterados no percentual de gordura corporal (41,4% para o grupo feminino e 36% para o grupo masculino), confirmando a obesidade grave do grupo. Considerando o percentil >=90 do Center for Disease Control and Prevention (CDC), no National Health and Nutrition Examination Survey (NHANES 2011-2014), 85,5% dos adolescentes apresentaram valores elevados de CA (117,7 ± 14,7) e 89,2% valores alterados no DAS (26,9±3,7). Quanto às variáveis laboratoriais, 32,5% dos pacientes apresentaram diminuição de HDL-c e níveis aumentados de: TG (10,8%); GLIS (3,6%); PAS (32,5%,); PAD (21,7%) e HOMA-IR (79,5%), considerando toda a amostra. De acordo com os critérios utilizados pelo International Diabetes Federation, 27,7% da casuística apresentou SM. O DAS demonstrou estar significantemente correlacionado com as variáveis PAS (r=0,489 p < 0,001), PAD(r=0,277 p 0,011) e HOMA-IR (r=0,462 p < 0,001) nos grupos geral, feminino, masculino, com e sem SM. A correlação encontrada entre as medidas do DAS e CA no grupo geral e feminino foi de r = 0,91 (p 0,000) e, no grupo masculino, de r = 0,93 (p 0,000). A concordância entre a CA e o DAS é significante (Kappa k = 0.511; p < 0,001). Nos grupos geral, feminino e masculino com SM, a concordância é mais expressiva (Kappa k = 1,00; p < 0,001.). Esses resultados mostram que os adolescentes apresentavam risco cardiometabólico aumentado e expressiva obesidade central, identificada pelo DAS e CA, apesar de 73,5% deles estarem medicados. O DAS oferece vantagem metodológica na sua mensuração. CONCLUSÕES: Nas condições deste estudo, conclui-se que: as medidas antropométricas CA e DAS se equivalem para o grupo de adolescentes avaliados na classificação da SM; O DAS é preditor de PAS, PAD e HOMA-IR e forte indicador de risco cardiometabólico em adolescentes obesos / The sagittal abdominal diameter (SAD) is an anthropometric measure related to visceral fat and used to evaluate abdominal obesity, a variable associated with the metabolic syndrome. Studies have suggested its employment in the clinical practice for estimating cardiometabolic risk of obese adolescents. OBJECTIVE: To verify the concordance between SAD and abdominal circumference in the assessment of central obesity and its association with the Metabolic Syndrome cluster and with HOMA-IR in obese adolescents. CASUISTICS AND METHODS: In a cross-sectional study, 83 obese adolescents between 14 and 18 years (46 females and 37males) with body mass index (BMI) of 36.9 ± 6.7 kg/m2, followed at the Pediatric Endocrinology Unit and at the Adolescent Unit of the Children\'s Institute, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo were submitted to anthropometric (BMI, BMI Z Score, body fat percentage, abdominal circumference, sagittal abdominal diameter), laboratory (HDL-c, triglycerides, glycemia and insulin for calculating HOMA-IR) and systolic and diastolic blood pressure assessments aimed for classification of metabolic syndrome. Previous consentment was given by all patients and their families. RESULTS: All adolescents presented elevated BMI and Z-BMI, and high body fat percentage was displayed by 91.6% of the patients (41.4% for the female group and 36% for the male group), confirming severe obesity. Considering the >= 90 percentile cut-off values as provided by the Anthropometric Reference Data for Children and Adults: United States 2011-2014 for abdominal circumference and SAD, 85.5% of the patients presented high abdominal circumference values (117.7±14.7) and 89.2% presented elevated values of SAD (26.9±3.7). With regard to laboratory variables, 32.5% of the patients displayed decreased HDL-c and increased values of: triglycerides (10.8%); glycemia (3.6%); systolic blood pressure (32.5%); diastolic blood pressure (21.7%) and HOMA-IR (79.5%). According to the criteria of the International Diabetes Federation (IDF), 27.7% of patients presented metabolic syndrome. SAD was significantly correlated with systolic (r=0.489 p < 0.001) and diastolic (r=0.277 p 0.011) blood pressures and HOMA-IR (r=0.462 p < 0.001) in the general, female and male groups, with and without metabolic syndrome. The correlation between SAD and abdominal circumference in the general and female groups was r = 0.91(p 0.000) and in the male group was r = 0.93 (p 0.000). The concordance between SAD and abdominal circumference was significant (Kappa coefficient k = 0.511; p < 0.001). In the general, male and female groups with metabolic syndrome, the concordance was more expressive (Kappa coefficient; k = 1.00 and p < 0.001). These results show that the adolescents presented increased cardiometabolic risk and significant central obesity identified by SAD and abdominal circumference although 73.5% of the studied patients were maintained under medication for clinical metabolic syndrome symptoms. SAD displayed methodological advantages concerning its measurement. CONCLUSIONS: Under the conditions of this study, it is concluded that: the anthropometric measurements of SAD and abdominal circumference are equivalent for metabolic syndrome classification of the studied adolescents; that SAD is a predictor of systolic and diastolic blood pressures and HOMA-IR and is a strong indicator of cardiometabolic risk in obese adolescents

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