O objetivo deste estudo transversal foi a aplicação do enfoque de risco de acordo com a metodologia proposta pela Organização Mundial da Saúde em uma favela com alta mobilização social e organização comunitária, na zona leste do município de São Paulo. Foram identificadas familias (n=458) que possuiam crianças abaixo de cinco anos de idade (n=694), homogeneamente distribuidas entre sexo e faixa etária. A realização de entrevistas com as mães e tomada de medidas antropométricas das crianças permitiram identificar os fatores de risco e a desnutrição proteico-calórica (D.P.C.). A comunidade foi caracterizada em termos dos perfis do meio ambiente, da família, da mãe e da criança. A prevalência encontrada utilizando-se a classificação de Gomez, foi de 70,3 por cento eutróficos, 25,6 por cento desnutridos de I grau; 3,4 por cento desnutridos de II grau; e 0,6 por cento de III grau. Para o diagnóstico da desnutrição optou-se pelo padrão de referência NCHS, adotando-se o percentil 10 como nivel crítico e o indicador para peso/idade ( 19,7 por cento da população total). As 60 variáveis independentes identificadas foram analisadas considerando-se as categorias de \"risco\" e \"não risco\" para desnutrição. Foram selecionadas 17 variáveis estatisticamente associadas por meio do teste x2 (p<0.05) e Odds-Ratio. Os fatores de risco que compuseram a escala foram: água de torneira para beber, presença de chuveiro e de descarga na bacia, tamanho da família, número de cômodos na casa, presença de geladeira e de liquidificador, baixo peso ao nascer, morbidade e tipos de morbidade, diarréia, assistência médica, paridade, estado civil, suplementação alimentar, idade da mãe e pré-natal. Para alguns fatores de risco clássicos, como aleitamento materno, não ficou evidenciada a associação significante nesta comunidade de estudo. As variáveis da categoria risco que estatisticamente estavam associadas à desnutrição foram agrupadas e constituíram Escala de Risco, com faixas estatisticamente definidas, estabelecendo-se pontos de corte nas faixas, com base na validade por meio de modelo de regressão logística. Os achados demonstraram que esta escala é indicada pois foi desenvolvida baseada em dados reais da comunidade, com sensibilidade=85,606060 por cento e especificidade=31,760435 por cento . Concluiu-se que a referida escala pode ser usada pela comunidade e pelos serviços locais de saúde no combate conjunto a desnutrição. / The aim of this transversal study was to apply the nutritional approach, based on the World Health Organization risk approach methodology, on an slum in the east side of São Paulo city. From the slum, a highly organized community, were selected families (n=458) with children under five years old (n=694), with uniform sex and age distribution. The interviews with the mothers and the anthropometry measurements allowed the identification of the risk factors (independent variables) and the protein-energy malnutrition (dependent variable). The community was characterized in terms of environment, family/mother and children profiles. The adoption of Gomez-type nutrition classification presented prevalence of 70.3 per cent standard; 25.6 per cent first degree malnutrition; 3.4 per cent second degree malnutrition and 0.6 per cent third degree malnutrition. The malnutrition diagnosis used the NCHS - National Center for Health Statistics percentiles, adopting the 10th percentile as the critical level and the weight-for-age index (19.7 per cent of the total population). From the 60 independent variables analyzed as \"risk\" and \"no risk\" categories for the malnutrition, 17 were selected through the testing for significance -x2- p<0.05 as well as it was applied the Odds-Ratio to evaluate the strength of the association. The 17 risk factors that composed the risk scale were: drinking water; existing blender and refrigerator; shower and flush; family size; dwelling number of room; birth weight; morbidity and kinds of morbidity; diarrhoea; parity; marital status; medical assistance; nutritional supplementation; mother\'s age; and prenatal. Some classic risk factors, such as breast feeding, didn\' t present significance for the studied community. The risk scale was statistically defined in zones, establishing cut points based on the validity through multiple regression model. The findings showed that this scale is indicated because it was carried out based on actual community data, with sensibility = 85.606060 per cent and specifieity = 31.760435 per cent . In conel usion, is suggested the use of the scale in the community and by the local health services for joint action against the malnutrition.

O objetivo deste estudo transversal foi a aplicação do enfoque de risco de acordo com a metodologia proposta pela Organização Mundial da Saúde em uma favela com alta mobilização social e organização comunitária, na zona leste do município de São Paulo. Foram identificadas familias (n=458) que possuiam crianças abaixo de cinco anos de idade (n=694), homogeneamente distribuidas entre sexo e faixa etária. A realização de entrevistas com as mães e tomada de medidas antropométricas das crianças permitiram identificar os fatores de risco e a desnutrição proteico-calórica (D.P.C.). A comunidade foi caracterizada em termos dos perfis do meio ambiente, da família, da mãe e da criança. A prevalência encontrada utilizando-se a classificação de Gomez, foi de 70,3 por cento eutróficos, 25,6 por cento desnutridos de I grau; 3,4 por cento desnutridos de II grau; e 0,6 por cento de III grau. Para o diagnóstico da desnutrição optou-se pelo padrão de referência NCHS, adotando-se o percentil 10 como nivel crítico e o indicador para peso/idade ( 19,7 por cento da população total). As 60 variáveis independentes identificadas foram analisadas considerando-se as categorias de \"risco\" e \"não risco\" para desnutrição. Foram selecionadas 17 variáveis estatisticamente associadas por meio do teste x2 (p<0.05) e Odds-Ratio. Os fatores de risco que compuseram a escala foram: água de torneira para beber, presença de chuveiro e de descarga na bacia, tamanho da família, número de cômodos na casa, presença de geladeira e de liquidificador, baixo peso ao nascer, morbidade e tipos de morbidade, diarréia, assistência médica, paridade, estado civil, suplementação alimentar, idade da mãe e pré-natal. Para alguns fatores de risco clássicos, como aleitamento materno, não ficou evidenciada a associação significante nesta comunidade de estudo. As variáveis da categoria risco que estatisticamente estavam associadas à desnutrição foram agrupadas e constituíram Escala de Risco, com faixas estatisticamente definidas, estabelecendo-se pontos de corte nas faixas, com base na validade por meio de modelo de regressão logística. Os achados demonstraram que esta escala é indicada pois foi desenvolvida baseada em dados reais da comunidade, com sensibilidade=85,606060 por cento e especificidade=31,760435 por cento . Concluiu-se que a referida escala pode ser usada pela comunidade e pelos serviços locais de saúde no combate conjunto a desnutrição. / The aim of this transversal study was to apply the nutritional approach, based on the World Health Organization risk approach methodology, on an slum in the east side of São Paulo city. From the slum, a highly organized community, were selected families (n=458) with children under five years old (n=694), with uniform sex and age distribution. The interviews with the mothers and the anthropometry measurements allowed the identification of the risk factors (independent variables) and the protein-energy malnutrition (dependent variable). The community was characterized in terms of environment, family/mother and children profiles. The adoption of Gomez-type nutrition classification presented prevalence of 70.3 per cent standard; 25.6 per cent first degree malnutrition; 3.4 per cent second degree malnutrition and 0.6 per cent third degree malnutrition. The malnutrition diagnosis used the NCHS - National Center for Health Statistics percentiles, adopting the 10th percentile as the critical level and the weight-for-age index (19.7 per cent of the total population). From the 60 independent variables analyzed as \"risk\" and \"no risk\" categories for the malnutrition, 17 were selected through the testing for significance -x2- p<0.05 as well as it was applied the Odds-Ratio to evaluate the strength of the association. The 17 risk factors that composed the risk scale were: drinking water; existing blender and refrigerator; shower and flush; family size; dwelling number of room; birth weight; morbidity and kinds of morbidity; diarrhoea; parity; marital status; medical assistance; nutritional supplementation; mother\'s age; and prenatal. Some classic risk factors, such as breast feeding, didn\' t present significance for the studied community. The risk scale was statistically defined in zones, establishing cut points based on the validity through multiple regression model. The findings showed that this scale is indicated because it was carried out based on actual community data, with sensibility = 85.606060 per cent and specifieity = 31.760435 per cent . In conel usion, is suggested the use of the scale in the community and by the local health services for joint action against the malnutrition.

Indiana University-Purdue University Indianapolis (IUPUI) / Objective: Nutritional assessment and diagnosis of malnutrition in pediatric patients is dependent on anthropometric measurements. In macrocephalic children, current anthropometric measures may fail to correctly diagnose malnutrition. The purpose of this study is to determine if the measurement of mid-upper arm circumference (MUAC) in pediatric patients with macrocephaly better identifies children at nutritional risk as compared to weight-for-length (WFL) or body mass index (BMI). Methods: A cross-sectional pilot study of children aged 6-36 months with a head circumference 2 SD above the mean was performed. Visual assessment was used as the clinical “gold standard” for presence of malnutrition. MUAC was compared to the WFL or BMI for each child to determine which anthropometric measurement better identified presence of malnutrition. Statistics: Two-way contingency tables were used to summarize the relationships between each pair of assessments of whether a child is malnourished. Agreement between the methods was evaluated using kappa statistics and percent agreement. Analyses were performed using SAS version 9.4 ™ statistical software. Results: Twenty patients were included who met study criteria. The mean head circumference z-score was 2.6. The mean BMI/WFL z-score was 0.9, which would qualify the child as “nourished.” Of the 20 children included in the study, 20% (n=4) appeared visually malnourished on physical exam. BMI/WFL confirmed diagnosis of malnutrition in 75% (n=3) of children. MUAC confirmed diagnosis of malnutrition in 75% (n=3) of children. Diagnosis of malnutrition using BMI/WFL as compared to visual assessment had a non-significant p-value of 0.317. Diagnosis of malnutrition using MUAC as compared to visual assessment had a non-significant p-value of 0.317. With a p-value of >0.5, there is no statistically significant difference between BMI/WFL and MUAC in diagnosis of malnutrition. Conclusion: MUAC did not perform better than BMI/WFL at identifying malnutrition in pediatric macrocephalic patients.

A avaliação da situação nutricional de crianças na fase escolar é de suma importância para o diagnóstico de saúde e risco de doenças nessa faixa etária, uma vez que pode evitar morbidades no futuro. Nesse sentido, a presente pesquisa foi realizada com o objetivo de estimar a prevalência de alterações do estado nutricional de alunos do ensino fundamental (1.º e 2.º ciclos) em escolas públicas municipais da cidade de Pinhão – PR, com vista a contribuir para aumentar a cobertura dos sistemas de informação sobre a situação nutricional da população do município. Por cálculos estatísticos, foi definida a amostra em 400 alunos, para uma estimativa estatisticamente significativa. Esta foi estratificada, ou seja, 7 escolas foram investigadas com porcentagem proporcional ao número total de alunos de cada escola e os alunos de todas séries (1.ª a 4ª.) foram sorteados aleatoriamente e após essa seleção, foram pesados e medidos. O critério de exclusão foi: alunos fora da faixa etária definida, ou seja, inferior a 6 anos e superior a 10 anos de idade. Os métodos utilizados para avaliação do estado nutricional foram a medida de peso e estatura e dados relacionados à idade e sexo dos escolares. Posteriormente, foi realizada a classificação das crianças em eutróficas, em risco nutricional, baixo peso e com excesso de peso pelos percentis e escores Z de peso por estatura, peso por idade e estatura por idade. Foram avaliados 381 escolares regularmente matriculados no ensino fundamental, de 1.ª a 4.ª séries, da zona urbana do município de Pinhão – PR. Como resultados, o estudo demonstrou que a maior porcentagem de excesso de peso foi de 5,2% pelo critério de percentil e o de baixo peso foi de 3,9%, embora o risco nutricional em todas as avaliações foi alto (6,6 a 17,6%). A baixa altura para a idade ficou entre 9,2 e 10,2%. Como conclusão, o estudo evidencia o nanismo nutricional grave caracterizado pelas altas porcentagens de baixa altura para a idade encontradas como um dos fatores associados à subnutrição. Esses dados servem como subsídio para instrumentalizar ações com relação à situação nutricional da população do município, direcionando os serviços das secretarias de saúde e de educação a partirem para uma investigação ativa sobre a situação nutricional de sua população e não apenas dos usuários dos serviços públicos. Poderão também ser implementadas ações de promoção à saúde no ambiente escolar, utilizando-se da alimentação escolar, como medidas necessárias para melhorar este diagnóstico, bem como outras políticas públicas que favoreçam as famílias como cesta básica, bolsa escola e emprego, entre outras. / Evaluating the nutritional situation of school children is extremely important to diagnose health and disease risks in this age range, as it can avoid future morbidities. This study aimed to estimate the prevalence of nutritional alterations among basic education students (1st and 2nd cycle) at municipal public schools in Pinhão – PR, Brazil. The sample needed to obtain a statistically significant estimation was defined as 400 students. This group was stratified, that is, 7 schools were examined, using a percentage proportional to the total number of students at each school, and students from all levels (1st to 4th) were randomly selected, after which weight and height were determined. We chose age as the exclusion criteria, that is, students under 6 and over 10 years old were excluded. The nutritional state was evaluated by means of weight and stature measures and data related to age and gender. Next, we classified the children as eutrophic, at nutritional risk, low weight and overweight, in accordance with percentages and weight-for-length, weight-forage and length-for-age z-scores. We evaluated 381 students who were regularly enrolled in basic education (1st to 4th year) in the urban region of Pinhão – PR. The study demonstrated that, according to a percentile criterion, the highest level of overweight was 5.2%, against 3.9% for low weight, in spite of high nutritional risk scores in all evaluations (between 6.6 and 17.6%). Levels of low height for age ranged from 9.2 to 10.2%. In conclusion, the study discloses serious nutritional dwarfism, which is characterized by the high levels of low height for age we found, as one of the factors associated with undernutrition. These data provide support to take actions related to the municipal population’s nutritional situation, directing municipal health and education services to carry out an active research on the nutritional situation of the whole population instead of just public service users. School alimentation can be used to implement actions that promote health in school. These measures are needed to improve this diagnosis, as well as other public policies to help families, such as food packages, school benefits and employment, among others.

Abstract Nutritional status affects every aspect of a child?s health. Thorough nutritional assessment is hampered by the lack of a single comprehensive tool, which can cover all aspects of nutritional assessment. In three distinct studies, this thesis investigated the nutritional status of hospitalised children, children with coeliac disease and children with inflammatory bowel disease. Study 1 The objectives of this study were to assess prevalence of malnutrition and nutritional risk, and define demographic and anthropometric factors associated with nutritional risk among hospitalized children. In this cross sectional study, 157 hospitalised children were assessed for nutritional status using nutritional risk score (NRS) and anthropometric measurements. We found that 4.5%, 8.9%, 15.1% and 10.4% children were wasted, stunted, overweight and obese respectively. However, with the NRS, 47.8% of the children were at high nutritional risk. These children at high risk had lower weight for age (p=0.02), lower BMI percentiles for age (p=0.001) and longer hospitalization (p=0.001) than children at no risk. Study 2 The objectives of this study were to determine nutritional parameters in children with coeliac disease. Twenty-five children with coeliac disease and an equal number of age and gender matched controls were enrolled and anthropometric measurements, BIA and leptin levels were analysed in all. No significant differences were found between the children with coeliac disease and controls in these parameters. BMI percentile correlated with leptin levels in children with coeliac disease. Study 3 The objectives of this study were to determine anthropometric parameters and leptin levels in children with IBD and ascertain if BMI correlates with leptin levels in these children. Thirty children with IBD and 60 age and gender matched controls were enrolled. Anthropometric measurements and leptin levels were analysed and compared with controls. IBD children had significantly low weight for age (p=0.002), BMI percentiles (p=0.001) and leptin levels (p=0.009) compared to controls. There was a correlation between BMI and leptin levels in IBD children. In conclusion, this thesis has shown that one quarter of hospitalized children were overweight or obese, and further, that half of the hospitalised children were at high risk of nutritional deterioration and these children had longer hospital stay than children at no risk. Children with coeliac disease had similar anthropometric measurements, body compartments and leptin levels to controls. However, children with IBD had lower anthropometric measurements and leptin levels, indicating under-nutrition. Nutritional assessment should be a mandatory part of clinical management with nutritional status assessed by various tools including NRS, anthropometry, BIA and leptin levels.

Abstract Nutritional status affects every aspect of a child?s health. Thorough nutritional assessment is hampered by the lack of a single comprehensive tool, which can cover all aspects of nutritional assessment. In three distinct studies, this thesis investigated the nutritional status of hospitalised children, children with coeliac disease and children with inflammatory bowel disease. Study 1 The objectives of this study were to assess prevalence of malnutrition and nutritional risk, and define demographic and anthropometric factors associated with nutritional risk among hospitalized children. In this cross sectional study, 157 hospitalised children were assessed for nutritional status using nutritional risk score (NRS) and anthropometric measurements. We found that 4.5%, 8.9%, 15.1% and 10.4% children were wasted, stunted, overweight and obese respectively. However, with the NRS, 47.8% of the children were at high nutritional risk. These children at high risk had lower weight for age (p=0.02), lower BMI percentiles for age (p=0.001) and longer hospitalization (p=0.001) than children at no risk. Study 2 The objectives of this study were to determine nutritional parameters in children with coeliac disease. Twenty-five children with coeliac disease and an equal number of age and gender matched controls were enrolled and anthropometric measurements, BIA and leptin levels were analysed in all. No significant differences were found between the children with coeliac disease and controls in these parameters. BMI percentile correlated with leptin levels in children with coeliac disease. Study 3 The objectives of this study were to determine anthropometric parameters and leptin levels in children with IBD and ascertain if BMI correlates with leptin levels in these children. Thirty children with IBD and 60 age and gender matched controls were enrolled. Anthropometric measurements and leptin levels were analysed and compared with controls. IBD children had significantly low weight for age (p=0.002), BMI percentiles (p=0.001) and leptin levels (p=0.009) compared to controls. There was a correlation between BMI and leptin levels in IBD children. In conclusion, this thesis has shown that one quarter of hospitalized children were overweight or obese, and further, that half of the hospitalised children were at high risk of nutritional deterioration and these children had longer hospital stay than children at no risk. Children with coeliac disease had similar anthropometric measurements, body compartments and leptin levels to controls. However, children with IBD had lower anthropometric measurements and leptin levels, indicating under-nutrition. Nutritional assessment should be a mandatory part of clinical management with nutritional status assessed by various tools including NRS, anthropometry, BIA and leptin levels.

Abstract Nutritional status affects every aspect of a child?s health. Thorough nutritional assessment is hampered by the lack of a single comprehensive tool, which can cover all aspects of nutritional assessment. In three distinct studies, this thesis investigated the nutritional status of hospitalised children, children with coeliac disease and children with inflammatory bowel disease. Study 1 The objectives of this study were to assess prevalence of malnutrition and nutritional risk, and define demographic and anthropometric factors associated with nutritional risk among hospitalized children. In this cross sectional study, 157 hospitalised children were assessed for nutritional status using nutritional risk score (NRS) and anthropometric measurements. We found that 4.5%, 8.9%, 15.1% and 10.4% children were wasted, stunted, overweight and obese respectively. However, with the NRS, 47.8% of the children were at high nutritional risk. These children at high risk had lower weight for age (p=0.02), lower BMI percentiles for age (p=0.001) and longer hospitalization (p=0.001) than children at no risk. Study 2 The objectives of this study were to determine nutritional parameters in children with coeliac disease. Twenty-five children with coeliac disease and an equal number of age and gender matched controls were enrolled and anthropometric measurements, BIA and leptin levels were analysed in all. No significant differences were found between the children with coeliac disease and controls in these parameters. BMI percentile correlated with leptin levels in children with coeliac disease. Study 3 The objectives of this study were to determine anthropometric parameters and leptin levels in children with IBD and ascertain if BMI correlates with leptin levels in these children. Thirty children with IBD and 60 age and gender matched controls were enrolled. Anthropometric measurements and leptin levels were analysed and compared with controls. IBD children had significantly low weight for age (p=0.002), BMI percentiles (p=0.001) and leptin levels (p=0.009) compared to controls. There was a correlation between BMI and leptin levels in IBD children. In conclusion, this thesis has shown that one quarter of hospitalized children were overweight or obese, and further, that half of the hospitalised children were at high risk of nutritional deterioration and these children had longer hospital stay than children at no risk. Children with coeliac disease had similar anthropometric measurements, body compartments and leptin levels to controls. However, children with IBD had lower anthropometric measurements and leptin levels, indicating under-nutrition. Nutritional assessment should be a mandatory part of clinical management with nutritional status assessed by various tools including NRS, anthropometry, BIA and leptin levels.

Abstract Nutritional status affects every aspect of a child?s health. Thorough nutritional assessment is hampered by the lack of a single comprehensive tool, which can cover all aspects of nutritional assessment. In three distinct studies, this thesis investigated the nutritional status of hospitalised children, children with coeliac disease and children with inflammatory bowel disease. Study 1 The objectives of this study were to assess prevalence of malnutrition and nutritional risk, and define demographic and anthropometric factors associated with nutritional risk among hospitalized children. In this cross sectional study, 157 hospitalised children were assessed for nutritional status using nutritional risk score (NRS) and anthropometric measurements. We found that 4.5%, 8.9%, 15.1% and 10.4% children were wasted, stunted, overweight and obese respectively. However, with the NRS, 47.8% of the children were at high nutritional risk. These children at high risk had lower weight for age (p=0.02), lower BMI percentiles for age (p=0.001) and longer hospitalization (p=0.001) than children at no risk. Study 2 The objectives of this study were to determine nutritional parameters in children with coeliac disease. Twenty-five children with coeliac disease and an equal number of age and gender matched controls were enrolled and anthropometric measurements, BIA and leptin levels were analysed in all. No significant differences were found between the children with coeliac disease and controls in these parameters. BMI percentile correlated with leptin levels in children with coeliac disease. Study 3 The objectives of this study were to determine anthropometric parameters and leptin levels in children with IBD and ascertain if BMI correlates with leptin levels in these children. Thirty children with IBD and 60 age and gender matched controls were enrolled. Anthropometric measurements and leptin levels were analysed and compared with controls. IBD children had significantly low weight for age (p=0.002), BMI percentiles (p=0.001) and leptin levels (p=0.009) compared to controls. There was a correlation between BMI and leptin levels in IBD children. In conclusion, this thesis has shown that one quarter of hospitalized children were overweight or obese, and further, that half of the hospitalised children were at high risk of nutritional deterioration and these children had longer hospital stay than children at no risk. Children with coeliac disease had similar anthropometric measurements, body compartments and leptin levels to controls. However, children with IBD had lower anthropometric measurements and leptin levels, indicating under-nutrition. Nutritional assessment should be a mandatory part of clinical management with nutritional status assessed by various tools including NRS, anthropometry, BIA and leptin levels.

A avaliação da situação nutricional de crianças na fase escolar é de suma importância para o diagnóstico de saúde e risco de doenças nessa faixa etária, uma vez que pode evitar morbidades no futuro. Nesse sentido, a presente pesquisa foi realizada com o objetivo de estimar a prevalência de alterações do estado nutricional de alunos do ensino fundamental (1.º e 2.º ciclos) em escolas públicas municipais da cidade de Pinhão – PR, com vista a contribuir para aumentar a cobertura dos sistemas de informação sobre a situação nutricional da população do município. Por cálculos estatísticos, foi definida a amostra em 400 alunos, para uma estimativa estatisticamente significativa. Esta foi estratificada, ou seja, 7 escolas foram investigadas com porcentagem proporcional ao número total de alunos de cada escola e os alunos de todas séries (1.ª a 4ª.) foram sorteados aleatoriamente e após essa seleção, foram pesados e medidos. O critério de exclusão foi: alunos fora da faixa etária definida, ou seja, inferior a 6 anos e superior a 10 anos de idade. Os métodos utilizados para avaliação do estado nutricional foram a medida de peso e estatura e dados relacionados à idade e sexo dos escolares. Posteriormente, foi realizada a classificação das crianças em eutróficas, em risco nutricional, baixo peso e com excesso de peso pelos percentis e escores Z de peso por estatura, peso por idade e estatura por idade. Foram avaliados 381 escolares regularmente matriculados no ensino fundamental, de 1.ª a 4.ª séries, da zona urbana do município de Pinhão – PR. Como resultados, o estudo demonstrou que a maior porcentagem de excesso de peso foi de 5,2% pelo critério de percentil e o de baixo peso foi de 3,9%, embora o risco nutricional em todas as avaliações foi alto (6,6 a 17,6%). A baixa altura para a idade ficou entre 9,2 e 10,2%. Como conclusão, o estudo evidencia o nanismo nutricional grave caracterizado pelas altas porcentagens de baixa altura para a idade encontradas como um dos fatores associados à subnutrição. Esses dados servem como subsídio para instrumentalizar ações com relação à situação nutricional da população do município, direcionando os serviços das secretarias de saúde e de educação a partirem para uma investigação ativa sobre a situação nutricional de sua população e não apenas dos usuários dos serviços públicos. Poderão também ser implementadas ações de promoção à saúde no ambiente escolar, utilizando-se da alimentação escolar, como medidas necessárias para melhorar este diagnóstico, bem como outras políticas públicas que favoreçam as famílias como cesta básica, bolsa escola e emprego, entre outras. / Evaluating the nutritional situation of school children is extremely important to diagnose health and disease risks in this age range, as it can avoid future morbidities. This study aimed to estimate the prevalence of nutritional alterations among basic education students (1st and 2nd cycle) at municipal public schools in Pinhão – PR, Brazil. The sample needed to obtain a statistically significant estimation was defined as 400 students. This group was stratified, that is, 7 schools were examined, using a percentage proportional to the total number of students at each school, and students from all levels (1st to 4th) were randomly selected, after which weight and height were determined. We chose age as the exclusion criteria, that is, students under 6 and over 10 years old were excluded. The nutritional state was evaluated by means of weight and stature measures and data related to age and gender. Next, we classified the children as eutrophic, at nutritional risk, low weight and overweight, in accordance with percentages and weight-for-length, weight-forage and length-for-age z-scores. We evaluated 381 students who were regularly enrolled in basic education (1st to 4th year) in the urban region of Pinhão – PR. The study demonstrated that, according to a percentile criterion, the highest level of overweight was 5.2%, against 3.9% for low weight, in spite of high nutritional risk scores in all evaluations (between 6.6 and 17.6%). Levels of low height for age ranged from 9.2 to 10.2%. In conclusion, the study discloses serious nutritional dwarfism, which is characterized by the high levels of low height for age we found, as one of the factors associated with undernutrition. These data provide support to take actions related to the municipal population’s nutritional situation, directing municipal health and education services to carry out an active research on the nutritional situation of the whole population instead of just public service users. School alimentation can be used to implement actions that promote health in school. These measures are needed to improve this diagnosis, as well as other public policies to help families, such as food packages, school benefits and employment, among others.

Submitted by Aline Batista (alinehb.ufpel@gmail.com) on 2018-05-18T21:47:06Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_Paula_Piske.pdf: 961983 bytes, checksum: ae57fbc1bcc7c05e47d9a5a563096ccd (MD5) / Approved for entry into archive by Aline Batista (alinehb.ufpel@gmail.com) on 2018-05-18T22:43:34Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_Paula_Piske.pdf: 961983 bytes, checksum: ae57fbc1bcc7c05e47d9a5a563096ccd (MD5) / Approved for entry into archive by Aline Batista (alinehb.ufpel@gmail.com) on 2018-05-18T22:43:42Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_Paula_Piske.pdf: 961983 bytes, checksum: ae57fbc1bcc7c05e47d9a5a563096ccd (MD5) / Made available in DSpace on 2018-05-18T22:43:42Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_Paula_Piske.pdf: 961983 bytes, checksum: ae57fbc1bcc7c05e47d9a5a563096ccd (MD5) Previous issue date: 2018-01-18 / Sem bolsa / A doença grave ou crítica refere-se à amplitude de condições clínicas ou cirúrgicas que apresentam risco à vida e que, na maior parte das vezes, exigem internação em Unidade de Terapia Intensiva (UTI). Após uma agressão, ocorrem várias alterações metabólicas e hormonais com o objetivo de manutenção da homeostase do organismo. Esse quadro geralmente provoca, dentre outros efeitos, resistência à insulina e catabolismo proteico, colocando o paciente em risco nutricional significativo. Nutrition Risk Screening – 2002 (NRS -2002) e o Nutrition Risk in Critically ill (escore NUTRIC) são ferramentas de triagem nutricional indicadas pela ASPEN (2016) para avaliarem parâmetros de risco nutricional. O NUTRIC é a primeira ferramenta desenvolvida para avaliar pacientes de UTI. Entretanto, a triagem nutricional detecta apenas a presença de risco de desnutrição. A literatura sugere então, a utilização da Avaliação Subjetiva Global (ASG), ainda um método considerado padrão-ouro para realização desse tipo de avaliação no ambiente hospitalar. A partir disso, o presente estudo teve como objetivo comparar o poder prognóstico em pacientes críticos, a partir da observação do risco de morte após 28 dias da admissão na UTI, do NUTRIC e ASG de forma isolada e combinada. / Severe or critical illness refers to the range of life-threatening clinical or surgical conditions that most often require hospitalization in an Intensive Care Unit (ICU). After an aggression, several metabolic and hormonal changes occur in order to maintain the body's homeostasis. This condition usually causes, among other effects, insulin resistance and protein catabolism, placing the patient at significant nutritional risk. Nutrition Risk Screening - 2002 (NRS -2002) and Nutrition Risk in Critical Ill (NUTRIC score) are nutritional screening tools indicated by ASPEN (2016) to evaluate nutritional risk parameters, being the first tool developed to evaluate ICU patients. However, nutritional screening only detects the presence of risk of malnutrition. The literature suggests, therefore, the use of the Global Subjective Assessment (SGA), still in a gold standard method to perform this type of evaluation in the hospital environment. From this, the present study had as objective to compare the prognostic power in critically ill patients, from the observation of the risk of death after 28 days of admission to the ICU, of NUTRIC and ASG in an isolated and combined way