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Previous issue date: 2017-12-06 / Pontif?cia Universidade Cat?lica de Campinas ? PUC Campinas / Childhood obesity is a public health problem, with increasing prevalence worldwide. In addition to the associated genetic and environmental aspects, psychosocial and economic factors have been studied by influencing dietary choices and lifestyle. Among complications of childhood obesity, non-alcoholic fatty liver disease (NAFLD), is an important cause of liver disease in childhood, significantly increasing cardiovascular risk in this population. Currently, it is considered the hepatic manifestation of the metabolic syndrome. The NAFLD treatment aims primarily weight loss and an active lifestyle; depending, therefore, on adhesion to dietary guidance and proposed physical activities. In this context, the treatment motivation is essential. This study identified and analyzed biochemical, anthropometric, dietary, psychosocial and motivational variables and attitude for treatment, in overweight and obese children and adolescents, in their relationship with the NAFLD diagnosis. This is a prospective, transversal, descriptive and correlational study with 45 children and adolescents (5-17 years old), diagnosed with excess weight according to the World Health Organization criteria, attending the Child Obesity Clinic of an university hospital in a city of S?o Paulo State. The following tools were applied individually after the routine medical appointment: a) A Characterization Record of the Participants, with personal, family, anthropometric and dietary data and laboratory tests, including abdominal ultrasound; b) Psychosocial Assessment Tool 2.0 (PAT 2.0), for the evaluation of the family psychosocial risk; c) four questions about the motivation and attitudes about the dietetic treatment and physical activities. Statistical tests were applied: t-Student, Chi-Square and Fisher's exact test, with a significance level of 5%. Obesity was observed in 82,2% of the sample. There was a 33,3% prevalence of NAFLD, of which showed significantly higher triglyceride levels, higher severe obesity diagnosed by Body Mass Index (IBM/Age) Z-score, greater waist circumference and greater neck circumference. The dietary aspects of the NAFLD patients also showed higher carbohydrate intake compared to total caloric amount of the diet and lower total fat intake. In general, these children and adolescents reported ultra-processed foods and high energetic density food intake above the recommendation and dietary fiber source and low energy density foods intake below the recommendation. Families were at clinical level psychosocial risk (40,0%), especially in areas of child problems and family structure and resources. The families of the NAFLD patients also had significantly higher levels of psychosocial risk ("clinical"). The practice of physical activities and the motivation for the treatment were not different among the participants with and without NAFLD. Although 93,3% of the participants reported being motivated for treatment, 72,7% acknowledged doing "nothing" or "little" of what was proposed. These findings reaffirm the importance of understanding the family context and motivation and attitude for treatment as guiding elements for the multidisciplinary
team, when defining strategies and conducting the conventional treatment of childhood obesity and NAFLD. / A obesidade infantil ? um problema de sa?de p?blica, com preval?ncia crescente em todo o mundo. Al?m dos aspectos gen?ticos e ambientais associados, os fatores psicossociais e econ?micos t?m sido estudados por influenciar as op??es alimentares e o estilo de vida. Entre as complica??es da obesidade infantil, a esteatose hep?tica n?o alco?lica (EHNA) ? uma importante causa de doen?as hep?ticas na inf?ncia, aumentando significativamente o risco cardiovascular nessa popula??o. Atualmente, ? considerada a manifesta??o hep?tica da s?ndrome metab?lica. O tratamento da EHNA visa principalmente a perda de peso e um estilo de vida ativo; dependendo, portanto, da ades?o ?s orienta??es diet?ticas e ?s atividades f?sicas propostas. Nesse sentido, a motiva??o para o tratamento tem se mostrado fundamental. Este estudo identificou e analisou vari?veis bioqu?micas, antropom?tricas, diet?ticas, psicossociais e de motiva??o e atitude para o tratamento, em crian?as e adolescentes com sobrepeso e obesidade (SOB), em suas rela??es com o diagn?stico de EHNA. ? um estudo prospectivo, transversal, descritivo e correlacional, com 45 crian?as e adolescentes (5-17 anos), com diagn?stico de SOB pelos crit?rios da Organiza??o Mundial de Sa?de, sendo atendidos no Ambulat?rio de Obesidade Infantil de um hospital universit?rio de uma cidade do Estado de S?o Paulo. Foram aplicados individualmente, ap?s a consulta de rotina no ambulat?rio: a) uma Ficha de Caracteriza??o dos Participantes, com dados pessoais, familiares, antropom?tricos, diet?ticos e exames laboratoriais, incluindo o ultrassom abdominal; b) Psychosocial Assessment Tool 2.0 (PAT 2.0), para avalia??o do risco psicossocial familiar; c) quatro quest?es sobre a motiva??o e atitude em rela??o ao tratamento diet?tico e ?s atividades f?sicas. Foram aplicados os testes estat?sticos: t-Student, Qui-Quadrado e teste exato de Fisher, com n?vel de signific?ncia de 5%. Apresentaram obesidade 82,2% da amostra. Houve preval?ncia de 33,3% da amostra com EHNA, os quais apresentaram significativamente maiores n?veis de triglic?rides, maior gravidade da obesidade diagnosticada pelo Escore-Z do ?ndice de Massa Corporal (IMC/Idade), maior circunfer?ncia da cintura e maior circunfer?ncia do pesco?o. No aspecto diet?tico, os casos com EHNA apresentaram tamb?m maior ingest?o de carboidratos em rela??o ao valor cal?rico total da dieta e menor ingest?o de gorduras totais. No geral, essas crian?as e adolescentes relataram consumo acima da recomenda??o de alimentos ultraprocessados e de alta densidade energ?tica e consumo abaixo da recomenda??o de alimentos ricos em fibras e de baixa densidade energ?tica. As fam?lias estavam em risco psicossocial em n?vel cl?nico (40,0%), especialmente nas ?reas problemas da crian?a e estrutura familiar e recursos. As
fam?lias dos participantes com EHNA tamb?m apresentaram significativamente maior n?vel de risco psicossocial (?cl?nico?). A pr?tica de atividades f?sicas e a motiva??o para o tratamento n?o diferenciou os participantes com e sem EHNA. Embora 93,3% dos participantes tenham relatado estarem motivados para o tratamento, 72,7% reconheceram fazer ?nada? ou ?pouco? do que era proposto. Tais achados reafirmam a import?ncia da compreens?o do contexto familiar e da motiva??o e atitude para o tratamento como elementos norteadores para a equipe multidisciplinar, na defini??o de estrat?gias e condu??o do tratamento convencional da obesidade infantil e da EHNA.
| Identifer | oai:union.ndltd.org:IBICT/oai:tede.bibliotecadigital.puc-campinas.edu.br:tede/1014 |
| Date | 06 December 2017 |
| Creators | Gomes, Maria Camila Buarraj |
| Contributors | Enumo, S?nia Regina Fiorim, Hessel, Gabriel, Bernardi, J?lia Laura Delbue |
| Publisher | Pontif?cia Universidade Cat?lica de Campinas, Programa de P?s-Gradua??o em Ci?ncias da Sa?de, PUC-Campinas, Brasil, CCV ? Centro de Ci?ncias da Vida |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/masterThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da PUC_CAMPINAS, instname:Pontifícia Universidade Católica de Campinas, instacron:PUC_CAMP |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | 6411916762624721206, 500, 500, 600, -8538742193007695607, 6947100024386004490 |
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