Résumé : Problématique: Les comportements alimentaires à la petite enfance pourraient influencer le gain de poids. Alors que les enfants d’âge préscolaire passent beaucoup de temps dans des milieux de garde, peu d’études ne rapportent les liens entre leurs comportements alimentaires dans ces milieux et leur composition corporelle. De plus, les recherches dans ce domaine sont basées sur des données subjectives des parents. Les objectifs étaient donc de développer un outil de mesure objectif des comportements alimentaires et de l’utiliser afin d’examiner le lien entre ceux-ci en milieu de garde et la composition corporelle des enfants d’âge préscolaire. Méthodes : Cette étude transversale a été menée auprès de 309 enfants de 3 à 5 ans dans 24 milieux de garde. Le comportement alimentaire a été mesuré en effectuant l’évaluation des restes au repas du dîner. Les données de ces évaluations ont été utilisées pour développer un score représentant la réticence alimentaire et un représentant l’affinité. Des corrélations intra-classes ont été utilisées afin de déterminer la fidélité des nouvelles mesures. Des corrélations de Spearman ont été utilisées afin de comparer les nouvelles mesures aux comportements alimentaires rapportés par les parents. Des régressions linéaires multivariées ont été utilisées pour examiner la relation entre les scores de comportement alimentaire mesurées objectivement et le tour de taille et l’indice de masse corporelle (IMC) ajusté à l’âge des enfants. Résultats : La nouvelle mesure de réticence alimentaire a démontré une excellente fidélité inter-juge (ICC= 0,970 à 0,998, p<0.0001), intra-juge (ICC=0,975 à 0,998, p<0.0001) et une bonne fidélité test-retest (ICC=0,723, p<0.0001). Elle corrélait également avec une mesure subjective précédemment validée (rho= 0,534, p<0.0001). La nouvelle mesure d’affinité alimentaire n’était toutefois pas valide (rho= -0,182, p=0,2). Le score de réticence alimentaire était positivement associé à l’IMC ajusté à l’âge des enfants (bêta ajusté= 1,41, IC à 95%=0,15, 2,67), mais non avec leur tour de taille (bêta ajusté=0,60, IC à 95%= -0,86, 2,06). Conclusion : La nouvelle mesure de réticence alimentaire démontre une excellente fidélité et validité chez les enfants d’âge préscolaire en milieu de garde. Plus il y avait de la réticence alimentaire, plus l’IMC ajusté à l’âge abaisse. Les milieux de gardes pourraient donc être des milieux propices pour l’implantation d’interventions pour réduire la réticence alimentaire, et contrer l’insuffisance pondérale chez les jeunes affectés. / Abstract : Background: Eating behaviours could be associated with weight gain during early childhood. Although a majority of preschoolers spend most of their active day-time hours in daycare centres, associations between their eating behaviours at daycare and their body composition have been limitedly studied. Further, research on eating behaviours of children mainly relies on parent-reported measures. The objective of this study was to develop an objective measure of eating behaviours and to use it to assess the relationship between these behaviours and body mass index and waist circumference among preschoolers. Methods: This cross-sectional study was conducted among 309 children aged 3 to 5 in 24 daycare centres. Eating behaviours were measured through weighted digital plate waste analysis. Data from this evaluation was used to create a food reluctance score and a food affinity score. Intraclass correlations (ICC) were used to determine the reliability of the new measure. Spearman correlations were used to compare the new measures with parental report of eating behaviours. Multivariate linear regressions were used to examine the relationship between objectively measured food behaviours and children’s waist circumference and age-adjusted body mass index (BMI). Results: The new measure of food reluctance demonstrated excellent inter-rater reliability (ICC= 0.970 to 0.998, p<0.0001), intra-rater reliability (ICC=0.975 to 0.998, p<0.0001), and good test-retest reliability (ICC=0.723, p<0.0001). It also provided evidence of concurrent validity through correlation with a validated subjective measure (rho= 0.534, p<0.0001). The new measure of food affinity was however not valid (rho= -0.182, p=0.2). The food reluctance score was positively associated with children’s age-adjusted BMI (adjusted bêta; 95% CI= 1.41, 0.15, 2.67), but not with their waist circumference (0.60; -0.86, 2.06). Conclusion: The objective measure of food reluctance demonstrated evidence of reliability and validity. Greater demonstration of food reluctance at the daycare center was associated with a lower BMI. This suggests that daycare centers could represent promising settings for integrating strategies to counter food reluctance and counter inadequate weight gain among affected preschoolers.

Submitted by GABRIELA SILVA FERREIRA null (gsferreira4@gmail.com) on 2016-04-28T16:54:27Z No. of bitstreams: 1 Dissertação Final Gabriela Silva Ferreira.pdf: 2606301 bytes, checksum: 7b9aa44a7667048fbc03758c7f1c0259 (MD5) / Approved for entry into archive by Felipe Augusto Arakaki (arakaki@reitoria.unesp.br) on 2016-05-02T13:22:31Z (GMT) No. of bitstreams: 1 ferreira_gs_me_fran.pdf: 2606301 bytes, checksum: 7b9aa44a7667048fbc03758c7f1c0259 (MD5) / Made available in DSpace on 2016-05-02T13:22:31Z (GMT). No. of bitstreams: 1 ferreira_gs_me_fran.pdf: 2606301 bytes, checksum: 7b9aa44a7667048fbc03758c7f1c0259 (MD5) Previous issue date: 2016-03-04 / As políticas públicas de inclusão são um avanço para as pessoas com deficiência, visto que aquelas têm garantido seus direitos, seja na educação, na saúde ou em qualquer outro serviço público. Ao abordar a legislação educacional, além da legalidade conquistada e amparada por um quadro normativo e legal, devemos considerar que o direito à educação implica acesso, permanência e qualidade do ensino. Envolve também a conquista de um espaço educacional que, ao promover igualdade de oportunidades de desenvolvimento pleno das pessoas, faz da escola, além de ambiente para transmissão da cultura e socialização, um espaço para construção da identidade pessoal. Todavia, para que a Educação Inclusiva atinja seus objetivos, além da necessidade de contínua formação e especialização de todos os profissionais envolvidos no processo educativo, torna-se indispensável a efetivação de políticas públicas que proporcione uma educação de qualidade aos alunos com deficiência em todas as etapas da educação básica. Desta forma, a presente pesquisa teve como objetivo conhecer o processo de implementação de políticas públicas de inclusão na Educação Infantil, pois este conhecimento é fundamental para a proposição de ações futuras com vistas à qualidade da Educação Inclusiva. A pesquisa foi realizada por meio de estudo exploratório e descritivo, tendo como foco o atendimento em creches no município deFranca (no Estado de São Paulo), visando compreender se tais políticas estão sendo efetivamente executadas. A pesquisa empírica referenciada decorreu de uma abordagem quanti-qualitativa realizada em 25 creches inscritas na Secretaria de Educação da Prefeitura da cidade de Franca no início do ano de 2015. Todas possuíam em seu quadro crianças com algum tipo de deficiência. Os instrumentos metodológicos utilizados foram questionários, aplicados junto às coordenadoras das creches e entrevistas realizadas com professores das instituições em estudo e com a diretora da Divisão de Creches de Franca. Os dados da pesquisa consideraram que a chegada das crianças com deficiência à Educação Infantil é realidade e que a inclusão destas precisa ser assegurada com qualidade, o que implica em ambientes físicos adaptados, recursos pedagógicos adequados, proposta pedagógica com atendimento especializado complementar, capacitação dos profissionais e a necessidade de ser afirmada a implementação de uma política de Educação Inclusiva na Educação Infantil do município. / Inclusion public policies are a step forward for disabled people, since their rights — whether in education, health or any other public service — have been secured.When addressing the educational legislation, aside from the legality achieved and supported by a regulatory and legal framework, it must be considered that the right to education implies access, permanence, and quality of education.It also involves the achievement of an educational space that, by promoting equal opportunities for the full development of individuals, apart from being an environment for culture transmission and socialisation, turns the school into a space for personal identity formation. However, in order to inclusive education having its goals achieved, and in addition to the need for continuing education and training of all professionals involved in the educational process, it is essential that public policies providing quality education to disabled students in all stages of basic education are implemented.For that reason, the present paper aimed at assessing the process of implementing inclusion public policies in day care centres, forsuch knowledge is essential to propose future actions with a view to the quality of Inclusive Education.The survey was conducted through exploratory and descriptive study, focusing on the nursing in child care centresfrom Franca (in Sao Paulo state, Southeastern Brazil), and aiming at understanding whether such policies are being effectively implemented.The referenced empirical research arose from a quali-quantitative approach carried out in 25 child care centresregistered at the Department of Education of Franca’s City Hall at the beginning of 2015.All of them have some children with a disability in their care. The methodological instruments used were questionnaires applied tothe day care centres coordinators, interviews with the institutions’ teachers and the director of the Franca Child Care Centres Division.The research finds out that the access of disabled children to early child education is real, and that their inclusion needs to be ensured with quality, which implies adapted physical environments, appropriate teaching resources, pedagogic proposition with complementary specialized care, training of professionals, and the need to affirm the implementation of an Inclusive Education policy in Franca’s child education.