Feeding therapy in a neurotypical child with feeding difficulties: A case report.

A feeding therapy developed in Brazil integrates aspects from diverse approaches and has increasingly been acknowledged as an adjunctive approach for addressing childhood feeding difficulties. In children, problems with eating are a common issue that affects their nutritional well-being, health, and overall quality of life, and can greatly hinder their social, emotional, and physical growth. In the realm of pediatrics, feeding therapy uses food and nutritional education, interactive games, and activities tailored to age groups and individualized treatment plans. The primary objective is to transform mealtime experiences and gradually foster children's acceptance of previously rejected foods. However, this treatment approach is new and recent in Brazil and lacks studies that explore and elucidate the topic. Therefore, this report aims to describe the follow-up and effects of feeding therapy in a 3-y and 8-mo-old neurotypical male patient with feeding difficulties who underwent feeding therapy conducted by a dietitian over a period of 19 wk. The feeding therapy consisted of 45-min sessions once a week in which food and nutrition education activities, games, and interactive activities, personalized according to the treatment plan, were carried out. The effects of feeding therapy were evaluated according to the patient's feeding progression throughout the sessions and their stepwise progress in the eating hierarchy. Based on our observations, the findings of this study suggest that feeding therapy practiced in Brazil can be a viable treatment approach for addressing feeding difficulties within this population. The feeding therapy originated in Brazil stands out from traditional nutritional care with its nurturing and compassionate approach that prioritizes respect for the child.

Prevalence of dyslipidemia, atherogenic and cardiovascular risk in overweight and obese adolescents.

OBJECTIVE: To analyze the lipid profile and cardiovascular risk of overweight and obese adolescents and correlate the findings with anthropometric measurements. METHODS: This is a cross-sectional study on overweight and obese adolescents of both sexes (aged 14 to 18 years old). The collected variables were sex, weight, height, age, total cholesterol, triglycerides, High-density lipoprotein (HDL) and low-density lipoprotein (LDL). The Atherogenic Index of Plasma and Castelli Risk Indices I and II were calculated. These indices were classified into cutoff points to stratify cardiovascular risk. The anthropometric profile was evaluated by Z score according to Body Mass Index for age. Significance level was considered as p≤0.05. RESULTS: A total of 146 adolescents participated in the study; the mean age was 16.4±1.1 years and most of them were girls (74.7%) and obese (52.7%). The prevalent dyslipidemias were high triglycerides (47.9%), LDL (26.7%), total cholesterol (37.7%), and low HDL (46.6%). Most adolescents presented increased atherogenic risk according to the Atherogenic Index of Plasma (55.5%); 15.1% presented high cardiovascular risk according to Castelli Risk Index I; and 13.7%, according to Castelli Risk Index II. Boys presented higher values of anthropometric measurements and Castelli Risk Indices I and II in relation to girls - who, conversely, presented higher values of HDL. There was a positive correlation of the Z score with Atherogenic Index of Plasma and a negative correlation with HDL. CONCLUSIONS: The adolescents of the study presented high prevalence of cardiovascular and atherogenic risk according to the evaluated indices. In addition, the increased cardiovascular risk was correlated with higher Body Mass Index.

Eating Competence among Brazilian College Students.

Eating competence (EC) is a biopsychosocial concept related to a healthier eating pattern. Studies have shown that weight gain and body shape and weight dissatisfaction are typical among college students, contributing to low self-esteem, risky eating behaviors, and a propensity to develop eating disorders. As eating habits are determinant factors for food choices that can be modified by eating behavior, this study aimed to evaluate EC in college students from Brazil, using the Brazilian version of the EC Satter Inventory (ecSI2.0™BR), and EC's association with health data. This cross-sectional study was conducted using an online survey spread using the snowball method. The self-report instrument was divided into three parts (socioeconomic and demographic data; health data; and ecSI2.0™BR). Recruitment took place through social networks, and 593 students from public and private universities from all five regions of Brazil participated in the survey. The EC average was 29.46 ± 8.67, and 46.2% of the sample were considered competent eaters. Total EC did not differ among gender and Brazilian region. Younger participants (up to 20 y/o) presented higher scores for total EC, contextual skills and food acceptance. The total EC and contextual skills of health sciences students did not differ from those of students in other areas, except for agricultural sciences in which students had lower total EC. Obese individuals and the participants who perceived themselves to be overweight had low scores for EC. This study confirmed the hypothesis that college students have low EC, causing worse health outcomes related to BMI, perceived body weight, and occurrence of hypertension and dyslipidemia.

Prevalence of dyslipidemia, atherogenic and cardiovascular risk in overweight and obese adolescents / Prevalência de dislipidemia, risco aterogênico e cardiovascular em adolescentes com sobrepeso e obesidade

Abstract Objective: To analyze the lipid profile and cardiovascular risk of overweight and obese adolescents and correlate the findings with anthropometric measurements. Methods: This is a cross-sectional study on overweight and obese adolescents of both sexes (aged 14 to 18 years old). The collected variables were sex, weight, height, age, total cholesterol, triglycerides, High-density lipoprotein (HDL) and low-density lipoprotein (LDL). The Atherogenic Index of Plasma and Castelli Risk Indices I and II were calculated. These indices were classified into cutoff points to stratify cardiovascular risk. The anthropometric profile was evaluated by Z score according to Body Mass Index for age. Significance level was considered as p≤0.05. Results: A total of 146 adolescents participated in the study; the mean age was 16.4±1.1 years and most of them were girls (74.7%) and obese (52.7%). The prevalent dyslipidemias were high triglycerides (47.9%), LDL (26.7%), total cholesterol (37.7%), and low HDL (46.6%). Most adolescents presented increased atherogenic risk according to the Atherogenic Index of Plasma (55.5%); 15.1% presented high cardiovascular risk according to Castelli Risk Index I; and 13.7%, according to Castelli Risk Index II. Boys presented higher values of anthropometric measurements and Castelli Risk Indices I and II in relation to girls — who, conversely, presented higher values of HDL. There was a positive correlation of the Z score with Atherogenic Index of Plasma and a negative correlation with HDL. Conclusions: The adolescents of the study presented high prevalence of cardiovascular and atherogenic risk according to the evaluated indices. In addition, the increased cardiovascular risk was correlated with higher Body Mass Index.

RESUMO Objetivo: Analisar o perfil lipídico e os índices de risco cardiovascular de adolescentes com sobrepeso e obesidade e correlacionar os achados com medidas antropométricas. Métodos: Estudo transversal com adolescentes com sobrepeso ou obesidade de ambos os sexos (14 a 18 anos). Foram coletadas as variáveis: sexo, peso, altura, idade, colesterol total, triglicerídeos, lipoproteína de alta densidade (HDL-c) e lipoproteína de baixa densidade (LDL-c). Calcularam-se o índice aterogênico plasmático e os índices de Castelli I e II. Eles foram classificados em pontos de corte para estratificar o risco cardiovascular. O perfil antropométrico foi avaliado por meio do escore Z com base no índice de massa corporal para a idade. Considerou-se o nível de significância p≤0,05. Resultados: Foram incluídos 146 adolescentes, com média de idade de 16,4±1,1 anos, a maioria do sexo feminino (74,7%) e obesa (52,7%). As dislipidemias prevalentes foram: triglicerídeos (47,9%), LDL-c (26,7%), colesterol total (37,7%) elevado e HDL-c baixo (46,6%). A maioria apresentou risco aterogênico aumentado pelo índice aterôgenico plasmático (55,5%); 15,1% apresentaram alto risco cardiovascular segundo o índice de Castelli I e 13,7%, segundo o índice de Castelli II. Os meninos apresentaram valores superiores de medidas antropométricas e índices de Castelli I e II em relação às meninas, que, por outro lado, apresentaram valores superiores de HDL-c. Houve correlação positiva do escore Z com o índice aterôgenico plasmático e negativa com HDL-c. Conclusões: Os adolescentes do estudo apresentaram alta prevalência de risco cardiovascular e aterogênico conforme os índices avaliados. Além disso, o risco cardiovascular aumentado foi correlacionado com maior índice de massa corporal.

Impacts of mindfulness-based interventions in people undergoing hemodialysis: a systematic review / Impactos de intervenções baseadas em mindfulness em pessoas submetidas a hemodiálise: uma revisão sistemática

Abstract Introduction: Chronic kidney disease (CKD) is a serious public health problem worldwide, leading to a series of physical and psychological comorbidities, in addition to costly treatments, lifestyle and dietary restrictions. There is evidence that mindfulness-based interventions (MBIs) offer complementary treatment for people with chronic illnesses, including CKD, with the aim of improving overall health, reducing side effects and treatment costs. This review aims to investigate the MBIs impact on people with CKD undergoing hemodialysis, and to identify the methodological quality of the current literature in order to support future studies. Methods: We ran searches in five databases (MEDLINE via PubMed, PsycINFO, Embase, Web of Science and Scopus) in July 2020. The papers were selected and evaluated by two reviewers independently, using predefined criteria, including the Cochrane Group's risk of bias tool and its recommendations (CRD42020192936). Results: Of the 175 studies found, 6 randomized controlled trials met the inclusion criteria, and ranged from 2014 to 2019. There were significant improvements in symptoms of anxiety, depression, self-efficacy, sleep quality, and quality of life (n=3) in the groups submitted to the intervention, in addition to physical measures such as blood pressure, heart rate and respiratory rate (n=1). Conclusions: MBIs can offer a promising and safe complementary therapy for people with CKD undergoing hemodialysis, acting on quality of life and physical aspects of the disease.

Resumo Introdução: A doença renal crônica (DRC) é reconhecida como um sério problema de saúde pública a nível mundial, levando a uma série de comorbidades físicas e psicológicas, além de tratamentos custosos e restrições no estilo de vida e alimentares. Há evidências de que as intervenções baseadas em mindfulness (IBMs) oferecem opções complementares ao tratamento de pessoas com doenças crônicas, incluindo DRC, com o objetivo de melhorar a saúde geral, reduzir os efeitos colaterais e custos do tratamento. Esta revisão objetiva investigar o impacto de IBMs em pessoas com DRC em hemodiálise, e identificar a qualidade metodológica da literatura atual a fim de auxiliar pesquisas futuras. Métodos: As pesquisas foram realizadas em cinco bases de dados (MEDLINE via PubMed, PsycINFO, Embase, Web of Science e Scopus), em julho de 2020. Os artigos foram selecionados e avaliados por dois revisores de forma independente, utilizando critérios predefinidos, incluindo a ferramenta de risco de viés do grupo Cochrane e suas recomendações (CRD42020192936). Resultados: Dos 175 estudos encontrados, 6 ensaios clínicos randomizados estavam de acordo com os critérios de inclusão, e variaram entre os anos de 2014 a 2019. Foram encontradas melhoras significativas para os sintomas de ansiedade, depressão, autoeficácia, qualidade de sono, e qualidade de vida (n=3) nos grupos que realizaram a intervenção, além de medidas físicas como pressão arterial, frequência cardíaca e taxa respiratória (n=1). Conclusões: As IBMs podem oferecer uma terapêutica complementar promissora e segura para pessoas com DRC em hemodiálise, atuando na qualidade de vida e em aspectos físicos da doença.

Intervenção interdisciplinar reduz o consumo de alimentos ultraprocessados em adolescentes com sobrepeso ou obesidade / Interdisciplinary intervention reduces the consumption of ultra-processed foods in adolescents with overweight or obesity

Este estudo objetivou avaliar o efeito da intervenção interdisciplinar com abordagem motivacional sobre o consumo de alimentos ultraprocessados em adolescentes com sobrepeso ou obesidade. O método utilizado foi um ensaio clínico randomizado no qual os participantes distribuíram-se em grupo controle (GC) e grupo intervenção (GI). A coleta de dados do consumo alimentar ocorreu mediante o recordatório de 24 horas, obtido no início e ao final das intervenções. Os alimentos consumidos foram categorizados nos quatro grupos da classificação alimentar NOVA conforme o grau de processamento a qual são submetidos. Participaram 42 adolescentes com média de idade de 16,5±1,3 anos, a maioria do gênero feminino (69%). No GI, a média de quilocalorias de alimentos ultraprocessados diminuiu 37,5% após a intervenção; em contrapartida, aumentou o consumo de alimentos processados em ambos os grupos. Concluiu-se que a intervenção interdisciplinar com abordagem motivacional foi eficaz na redução do consumo de alimentos ultraprocessados na população estudada.

The aim of this study was to evaluate the effect of interdisciplinary intervention with motivational approach on the consumption of ultra-processed foods in overweight or obese adolescents. The method used was a randomized clinical trial in which participants were allocated to control group (CG) and intervention group (IC). The data collection of food consumption occurred through the 24-hour food record, obtained at the beginning and end of interventions. The foods consumed were classified into the four NOVA groups according to the degree of processing which they are submitted. Forty-two adolescents with a mean age of 16.5±1.3 years, mostly female (69%), participated in the study. In IG, the average kcal of ultra-processed foods decreased by 37.5% after intervention. In contrast, there was an increase in the consumption of processed foods in both groups. It was concluded that the interdisciplinary intervention with a motivational approach was effective in reducing the consumption of ultra-processed foods in the studied population.

Impacts of mindfulness-based interventions in people undergoing hemodialysis: a systematic review.

INTRODUCTION: Chronic kidney disease (CKD) is a serious public health problem worldwide, leading to a series of physical and psychological comorbidities, in addition to costly treatments, lifestyle and dietary restrictions. There is evidence that mindfulness-based interventions (MBIs) offer complementary treatment for people with chronic illnesses, including CKD, with the aim of improving overall health, reducing side effects and treatment costs. This review aims to investigate the MBIs impact on people with CKD undergoing hemodialysis, and to identify the methodological quality of the current literature in order to support future studies. METHODS: We ran searches in five databases (MEDLINE via PubMed, PsycINFO, Embase, Web of Science and Scopus) in July 2020. The papers were selected and evaluated by two reviewers independently, using predefined criteria, including the Cochrane Group's risk of bias tool and its recommendations (CRD42020192936). RESULTS: Of the 175 studies found, 6 randomized controlled trials met the inclusion criteria, and ranged from 2014 to 2019. There were significant improvements in symptoms of anxiety, depression, self-efficacy, sleep quality, and quality of life (n=3) in the groups submitted to the intervention, in addition to physical measures such as blood pressure, heart rate and respiratory rate (n=1). CONCLUSIONS: MBIs can offer a promising and safe complementary therapy for people with CKD undergoing hemodialysis, acting on quality of life and physical aspects of the disease.

Autocuidado para hipertensos: desenvolvimento de um e-book como material educativo / Self-care to hipertensives: development of an e-book as an educative material

Objetivo: apresentar o desenvolvimento do material educativo intitulado "Auto-cuidado para Hipertensos: um guia para cuidar da sua saúde". Métodos: este material foi desenvolvido com base nas orientações para construção de materiais de orientação para o cuidado em saúde, teve como ponto de partida o estudo multicêntrico: "Efetividade de uma estratégia NUtricional para controle PRESSórico em pacientes com hipertensão arterial sistêmica usuários do Sistema Único de Saúde: estudo NUPRESS". Para a elaboração do material foi feito um levantamento bibliográfico. Em seguida, foi realizada a escrita dos temas abordados em forma de capítulos e, por último, foi montada a parte gráfica. Quando finalizado, o e-book foi enviado a 10 juízes que o avaliaram e validaram conforme a sua organização, estilo da escrita, aparência e apelo do material. Foram aceitas as sugestões dos juízes e realizadas as alterações. Resultados: os juízes (n=10), com média de idade de 43,7±17,6 anos e sendo 70% do sexo feminino, avaliaram em sua maioria, com concordância que o conteúdo do e-book possuía boa organização e aparência. Já os domínios de estilo de escrita e apelo foram os que apresentaram menor percentual de concordância entre os juízes, embora tenham obtido uma aprovação de 83,3% em cada dimensão. Conclusões: o e-book desenvolvido pode ser utilizado tanto por profissionais da saúde quanto por pessoas com hipertensão com o propósito de educação sobre a doença, saúde e autocuidado. O material tem linguagem objetiva e de fácil compreendimento, sem usar termos técnicos, além disso foram utilizados recursos gráficos para cativar e facilitar a leitura.

Aims: to present the development of the educational material entitled: "Autocuidado para Hipertensos: um guia para cuidar da sua saúde". Methods: this material was developed based on the guidelines for the construction of orientation materials for health care, taking as its starting point the multicenter study: "Effectiveness of a NUTRITION strategy for PRESSURE control in patients with systemic arterial hypertension users of the Unified Health System: NUPRESS study". For the elaboration of the material, a bibliographical surveywas made, then the themes were written in chapters, and finally, the graphic part was assembled. When finished, the e-book was sent to 10 judges who evaluated and validated it according to its organization, writing style, appearance, and appeal. The judges' suggestions were accepted, and the changes were made. Results: the judges (n=10), with a mean age of 43.7±17. 6 years and wich 70% were female, mostly agreed that the E-book content had good organization and appearance. The domains of writing style and appeal, on the other hand, presented the lowest percentage of agreement among the judges, although they obtained 83.3% approval in each dimension. Conclusions: the e-book developed can be used both by health professionals and people with hypertension for the purpose of education about the disease, health and self-care. The material has an objective and easy-to-understand language, without using technical terms, and graphic resources were used to captivate and facilitate reading.

The Effect of Different Interventions for Lifestyle Modifications on the Number of Diagnostic Criteria and Clinical Aspects of Metabolic Syndrome.

Background: Lifestyle intervention programs comprise the first-choice therapy to reduce the cardiovascular risk factors in metabolic syndrome (MetS). Our aim was to compare the effects of three lifestyle modification programs on the number of diagnostic criteria and clinical parameters of MetS. Methods: Twelve-week clinical trial, including 125 adults who presented at least three of the criteria defined by the revised NCEP ATP III (National Cholesterol Education Program Adult Panel III) for MetS. Individuals were randomized into three multidisciplinary intervention groups: Standard Intervention (SI), Group Intervention (GI) and Individual Intervention (II). Results: Seventy-one individuals, aged 34-59 years, concluded the study: SI: 20, GI: 25, and II: 26. The GI and II groups presented a significant decrease of body mass index, abdominal circumference, diastolic and systolic arterial pressure after intervention. The number of diagnostic criteria for MetS decreased significantly. Within the GI and II groups, 16.0% and 15.4% of the individuals, respectively, did not meet the criteria for the clinical condition studied at the end of the interventions. In the II group, the percentage of individuals with five criteria reduced 83.5%. In the GI group, the percentage of individuals with five criteria remained the same, but the number of individuals with four criteria presented a 50.0% reduction. Conclusions: Results reinforce that nonpharmacological strategies for changing lifestyle affect the reduction of cardiovascular risk factors existing in MetS. They are also able to remove the population from this clinical condition by decreasing the diagnostic criteria. II or GI lead to a successful treatment of MetS, especially when conducted by multidisciplinary team. Brazilian Registry of Clinical Trials-ReBEC number: RBR-9wz5fc.

Intervention Protocol Based on Transtheoretical Model of Behavior Change for Metabolic Syndrome / Protocolo de Intervenção Baseada no Modelo Transteórico de Mudança de Comportamento para Síndrome Metabólica

Abstract The present study is the translation and adaptation of an intervention based on the Transtheoretical Model of Change directed to patients at cardiovascular risk. The original 29-session manual was translated into Portuguese, extended to 36 sessions, and applied in a pilot study. The protocol was reduced to 12 sessions through the grouping based on the processes of change. The products of the present study were the processes in each behavior, the versatility of the protocol, the interdisciplinary work, the great cost-benefit, and the potential of effectiveness. Finally, the importance of consistent training in Motivational Interview, Transtheoretical Model and group management for proper use are highlighted, and the costs and benefits of protocols versus more flexible treatments are discussed.

Resumo Trata-se da tradução e adaptação de uma intervenção baseada no Modelo Transteórico de Mudança e direcionada para pacientes com risco cardiovascular. Inicialmente, o manual original com 29 sessões foi traduzido para a língua portuguesa, sendo ampliado para 36 sessões, e posteriormente aplicado em um estudo piloto. A partir de agrupamentos pelos processos de mudança, foi reduzido para 12 sessões. Evidencia-se como produtos deste trabalho o aprofundamento dos processos em cada comportamento, a versatilidade do protocolo, o trabalho interdisciplinar, o ótimo custo-benefício e o potencial de efetividade. Por fim, salienta-se a importância de um treinamento consistente em Entrevista Motivacional, Modelo Transteórico e manejo de grupos para sua utilização adequada, e discute-se os custos e os benefícios dos protocolos versus tratamentos mais flexíveis.

Fatores preditivos de desistência em um programa para adolescentes com sobrepeso ou obesidade: estudo MERC / Predictive factors of dropout from a program for overweight or obese adolescents: MERC study / Factores predictivos de desistimiento en un programa para adolescentes con sobrepeso u obesidad: estudio MERC

O objetivo deste estudo foi identificar fatores potenciais de impacto sobre a desistência em um ensaio clínico randomizado. Para participar das 12 semanas de intervenção, foram selecionados adolescentes com sobrepeso ou obesidade (IMC percentil ≥ 85), dos sexos masculino e feminino, com média de idade 16,44±1,09. Utilizou-se regressão logística binária para responder pelo desfecho de não conclusão. As regressões foram realizadas por blocos e as variáveis estudadas foram características demográficas e antropométricas, marcadores metabólicos, aspectos motivacionais, funcionamento psicológico e percepção das práticas alimentares parentais. Foi constatada uma taxa de desistência de 48,8%. A maior chance de desistência foi explicada no modelo final de regressão pela autoeficácia para mudança de estilo de vida (OR: 0,732; IC95%: 0,581-0,921; p=0,008), pelo suporte familiar (OR: 0,807; IC95%: 0,685-0,950; p=0,010), pela HbA1c (OR: 11,366; IC95%: 3,123-37,702; p=0,010) e por fatores relacionados às práticas alimentares parentais. Concluiu-se que a família e os aspectos relacionados à motivação para mudança podem ser determinantes de desistência em programas para perda de peso para adolescentes.

The number of overweight or obese adolescents has increased, but the rate of dropping out in programs for this population is high. The objective of this study was to identify potential factors of impact on dropping out in a randomized clinical trial. To take part in a 12-week intervention, overweight or obese adolescents (BMI percentile ≥ 85), males and females, with mean age 17.99±1.09 were selected. Binary logistic regression was used to account for the non-completion outcome. Regressions were performed by blocks and the variables studied were demographic and anthropometric traits, metabolic markers, motivational aspects, psychological functioning, and perception of parental food practices. The drop-out rate was 48.8%. The highest chance of withdrawal was explained in the final regression model by self-efficacy to change lifestyle (OR: 0.732; IC95%: 0.581-0.921; p=0.008), by family support (OR: 0.807; IC95%: 0.685-0.950; p=0.010), by HbA1c (OR: 11.366; IC95%: 3.123-37.702; p=0.010), and by factors associated with parental food practices. It was concluded that the family and aspects related to motivation for change can be determinants of dropping-out in weight-loss programs for teenagers.

El objetivo de este estudio fue identificar factores potenciales del impacto sobre la desistencia en un ensayo clínico aleatorizado. Se seleccionaron para participar en 12 semanas de intervención, adolescentes con sobrepeso u obesidad (IMC percentil ≥ 85), del sexo masculino y femenino con media de edad 16,44±1,09. Se utilizó regresión logística binaria para responder por el resultado de conclusión incompleta. Las regresiones fueron realizadas por bloques y las variables estudiadas fueron características demográficas y antropométricas, marcadores metabólicos, aspectos motivacionales, funcionamiento psicológico y percepción de las prácticas alimentarias parentales. La tasa de desistimiento fue de 48,8%. La mayor probabilidad de desistimiento fue explicada en el modelo final de regresión por auto-eficacia para el cambio de estilo de vida (OR: 0,732, IC95%: 0,581-0,921, p=0,008), por el soporte familiar (OR: 0,807, IC95%: 0,685-0,950; p=0,010), por la HbA1c (OR: 11,366, IC95%: 3,123-37,702; p=0,010) y por factores relacionados con las prácticas alimentarias parentales. Se concluyó que la familia y los aspectos relacionados con la motivación para el cambio pueden ser determinantes de la desistencia de programas para la pérdida de peso para los adolescentes.

Effect of an interdisciplinary intervention with motivational approach on exercise capacity in obese adolescents: a randomized controlled clinical trial.

Objective To evaluate the effect of an interdisciplinary intervention with a motivational approach on exercise capacity and usual physical activity levels in overweight and obese adolescents. Methods This is a randomized, controlled clinical trial with single blinding of subjects. Adolescents aged 15 to 18 years with overweight and obesity (body mass index ≥ 85 percentile) were included. The adolescents were randomized into two groups: interdisciplinary intervention or control - traditional approach aiming at lifestyle modifications. The initial evaluations were carried out, including the cardiopulmonary exercise test and the physical activity level measurement by using the International Physical Activity Questionnaire and a pedometer. The evaluations were performed in two moments: time zero (time of inclusion in the study) and after 3 months (end of intervention). There were 12 sessions with weekly meetings. Results A total of 37 participants were included, 19 in the Intervention Group. There were no significant differences in the baseline demographic, anthropometric and physical activity characteristics between groups, with mean age of 17.3±1.0 years in the Control Group, and 16.8±0.9 years in the Intervention Group (p=0.14). The motivational intervention did not cause significant differences (p>0.05) in the comparison of the variables of exercise capacity and usual physical activity (questionnaire and pedometer) between groups. Conclusion The intervention with a motivational approach did not alter exercise capacity and levels of usual physical activity in overweight and obese adolescents. Clinical Trial Registry: NCT02455973 and REBEC: RBR-234nb5.

Transtheoretical model for change in obese adolescents: MERC randomized clinical trial.

The randomized controlled trial evaluated the effectiveness of an intervention based on the Transtheoretical Model of Change on anthropometric, metabolic and motivational outcomes in obese adolescents. A total of 135 male and female adolescents were randomized to two groups: intervention group (n = 65) and control group (n = 70). The adolescents were evaluated 1 week before the interventions began and at the end of 12 weeks. There was no statistically significant difference between groups in the outcome variables. Intervention group reported magnitude of effect more expressive on body mass index percentile, waist circumference, waist-to-hip ratio, readiness to change diet and readiness to start exercise.

Effect of an interdisciplinary intervention with motivational approach on exercise capacity in obese adolescents: a randomized controlled clinical trial / Efeito de intervenção interdisciplinar com abordagem motivacional na capacidade de exercício em adolescentes obesos: ensaio clínico controlado randomizado

ABSTRACT Objective To evaluate the effect of an interdisciplinary intervention with a motivational approach on exercise capacity and usual physical activity levels in overweight and obese adolescents. Methods This is a randomized, controlled clinical trial with single blinding of subjects. Adolescents aged 15 to 18 years with overweight and obesity (body mass index ≥ 85 percentile) were included. The adolescents were randomized into two groups: interdisciplinary intervention or control − traditional approach aiming at lifestyle modifications. The initial evaluations were carried out, including the cardiopulmonary exercise test and the physical activity level measurement by using the International Physical Activity Questionnaire and a pedometer. The evaluations were performed in two moments: time zero (time of inclusion in the study) and after 3 months (end of intervention). There were 12 sessions with weekly meetings. Results A total of 37 participants were included, 19 in the Intervention Group. There were no significant differences in the baseline demographic, anthropometric and physical activity characteristics between groups, with mean age of 17.3±1.0 years in the Control Group, and 16.8±0.9 years in the Intervention Group (p=0.14). The motivational intervention did not cause significant differences (p>0.05) in the comparison of the variables of exercise capacity and usual physical activity (questionnaire and pedometer) between groups. Conclusion The intervention with a motivational approach did not alter exercise capacity and levels of usual physical activity in overweight and obese adolescents. Clinical Trial Registry: NCT02455973 and REBEC: RBR-234nb5.

RESUMO Objetivo Avaliar o efeito de uma intervenção interdisciplinar com abordagem motivacional na capacidade de exercício e no nível de atividade física habitual em adolescentes com sobrepeso e obesidade. Métodos Trata-se de ensaio clínico controlado, randomizado, com cegamento único dos indivíduos. Foram incluídos adolescentes com idade entre 15 e 18 anos, com sobrepeso e obesidade (índice de massa corporal ≥ percentil 85). Os adolescentes foram randomizados em dois grupos: intervenção interdisciplinar motivacional ou controle − abordagem tradicional, visando à modificação do estilo de vida. Foram realizadas as avaliações iniciais incluindo o teste de exercício cardiopulmonar e a aferição do nível de atividade física por meio do International Physical Activity Questionnaire e do pedômetro. As avaliações foram realizadas em dois momentos, no tempo zero (inclusão no estudo) e após 3 meses (término da intervenção). Foram realizadas 12 sessões com encontros semanais. Resultados Foram incluídos 37 participantes, sendo 19 no Grupo Intervenção. Não houve diferenças significativas nos dados basais de características demográficas, antropométricas e de atividade física entre os grupos, e a média de idade foi de 17,3±1,0 anos no Grupo Controle e 16,8±0,9 anos no Intervenção (p=0,14). A intervenção motivacional não provocou diferenças significativas (p>0,05) na comparação das variáveis de capacidade de exercício e atividade física habitual (questionário e pedômetro) entre os grupos. Conclusão A intervenção com abordagem motivacional não alterou a capacidade de exercício e os níveis de atividade física habitual em adolescentes com sobrepeso e obesidade. Clinical Trial Registry: NCT02455973 and REBEC: RBR-234nb5.

Comparação do consumo alimentar calculado a partir de duas tabelas de composição de alimentos / Comparing food intake calculated by two lists of food composition

O objetivo do presente trabalho foi comparar o consumo de energia, macronutrientes e micronutrientes calculado a partir de duas tabelas de composição dos alimentos: Tabela Brasileira de Composição de Alimentos (TACO) mais informações de rótulos de alimentos e United States Department of Agriculture Food Composition Databases (USDA). Trata-se de estudo transversal, com dados do consumo alimentar de participantes do estudo principal "Modificação do Estilo de Vida e Risco Cardiovascular". Os dados foram analisados por meio dos Testes de Kruskal Wallis, Post Hoc de Dunn, e Correlação de Pearson. Foram avaliados 59 Recordatórios de 24 horas e as medianas de 21 entre 29 nutrientes (72,4%) apresentaram diferença estatisticamente significativa (p<0,05) na comparação entre os resultados obtidos das tabelas avaliadas. Foram encontradas divergências significativas entre os valores nutricionais apresentados nas tabelas. Este fato alerta para o uso destes instrumentos e a sua influência nos resultados do cálculo do consumo alimentar e impacto na prescrição nutricional

Energy, macronutrient and micronutrient intakes are compared by two food composition lists: Brazilian Food Composition List and nutrition facts and the United States Department of Agriculture Food Composition Databases (USDA). Current transversal study comprised data on food intake of participants within the main research theme 'Changes in Life Style and Cardiovascular Risks'. Data were analyzed by Kruskal Wallis and Post-Hoc Dunn tests and by Pearson´s Co-relation test. Fifty-nine 24-h records were evaluated. Medians of 21 out of 29 nutrients (72.4%) showed statistically significant difference (p<0.05) when compared to results from evaluated tables. There was significant divergence between the nutrition rates in the lists. The above is a warning on the use of these tools and their influence on results in calculating food intake and impact in nutritional prescriptions

Acute Physical Effort Increases Sympathovagal Balance Responses to Autonomic Stimulation in Metabolic Syndrome.

BACKGROUND: There is little evidence of how metabolic syndrome (MS) affects sympathovagal balance responses to acute physical effort (APE) and autonomic stimulation (AS). This study aimed to evaluate the heart rate variability (HRV) responses to the combined APE and AS challenges. METHODS: Fourteen subjects (8 men; 49.15 ± 8.67 years) divided into two groups: 7 healthy volunteers [control group (CG)] and 7 patients with MS. Sympathovagal balance [low frequency (LF)/high frequency (HF) ratio] was accessed by HRV through the beat-to-beat heart rate (HR) electrocardiogram. Other variables analyzed were as follows: HR, RR-interval variance (VAR/ms2), LF and HF normalized units (un). The APE consisted of a 30-min walk at 65%-75% of the age-predicted maximal HR. The AS was achieved by changing from the supine to standing position (activity orthostatic position). RESULTS: At rest, all HRV variables differ with on MS, but after APE and AS LF (nu) and HF (nu) become similar to the CG. However, the LF/HF ratio responses to the AS were significantly different after APE, but only in the MS (CG rest: 367% ± 59% vs. recovery 495% ± 116%, P > 0.05; MS rest: 316% ± 88% vs. recovery: 665% ± 165%; P = 0.045). Comparing the difference between AS in rest and recovery (ΔAS = rest - recovery), the LF/HF ratio was notably higher in the MS group (CG: 94% ± 29% vs. MS: 415% ± 76%; P < 0.0001). CONCLUSIONS: The APE and AS induced by body posture changes activated a clear distinction in sympathovagal balance response in MS.

Melhora do estilo de vida reduz o índice de Castelli 1 em indivíduos com síndrome metabólica / Lifestyle improvement reduces Castelli 1 index in people with metabolic syndrome

Avaliar o efeito de diferentes intervenções para modificação do estilo de vida sobre o Índice de Castelli 1 em indivíduos com síndrome metabólica. Tratou-se de uma subanálise de um ensaio clínico randomizado. Foram incluídos no estudo indivíduos com diagnóstico de síndrome metabólica e idade entre 30 e 59 anos, que foram posteriormente randomizados em três diferentes grupos de intervenção. Foram realizadas avaliações antropométricas e bioquímicas no início do estudo e ao final dos três meses de intervenção. Participaram do estudo 59 indivíduos. Os modelos de intervenção realizados nos grupos intervenção individual e intervenção em grupo foram eficazes na redução significativa do índice de Castelli 1, com variância absoluta de -0,70 e -0,23, respectivamente. O modelo de intervenção padrão não demonstrou redução favorável. As intervenções que contemplaram acompanhamento multiprofissional produziram efeito benéfico na redução do índice de Castelli 1 em pacientes com síndrome metabólica.

The effect of different interventions for lifestyle modification on Castelli I Index in people with metabolic syndrome is evaluated. It is a sub-analysis of a randomized clinical assay. People with metabolic syndrome, aged between 30 and 59 years old, were included and later divided, at random, into three different intervention groups. Anthropometric and biochemical evaluations of 59 people were performed at the start and at the end of the three months of intervention. Intervention models undertaken in individual intervention groups and intervention in groups were efficient to significantly reduce Castelli 1 Index, with absolute variance of -0.70 and -0.23, respectively. Standard intervention model did not reveal favorable reduction. Interventions that underscored multiprofessional following up produced beneficent effect on the reduction of Castelli 1 Index in patients with metabolic syndrome.

MAXIMUM HEART RATE MEASURED VERSUS ESTIMATED BY DIFFERENT EQUATIONS DURING THE CARDIOPULMONARY EXERCISE TEST IN OBESE ADOLESCENTS. / FREQUÊNCIA CARDÍACA MÁXIMA MEDIDA VERSUS ESTIMADA POR DIFERENTES EQUAÇÕES DURANTE O TESTE DE EXERCÍCIO CARDIOPULMONAR EM ADOLESCENTES OBESOS.

OBJECTIVE: To compare the values of measured maximum heart rate (HRmax) and maximum heart rate estimated by different equations during the cardiopulmonary exercise test (CPET) in obese adolescents. METHODS: This is a cross-sectional study. Adolescents aged between 15 and 18 years old, with obesity (BMI Z-score>2.0) were included. Demographic and anthropometric data were collected, followed by CPET, recording HRmax. The highest heart rate reached at peak exercise was considered as HRmax. The comparison between measured and estimated HRmax values was performed using four previous equations. Descriptive statistics and the ANOVA test (Bonferroni post-test) were used. RESULTS: Fifty-nine obese adolescents were included, 44% of them male. The mean age was 16.8±1.2 years old and the BMI (Z-score) was 3.0±0.7. At peak exercise, the mean HRmax (bpm) was 190.0±9.2, the respiratory coefficient was 1.2±0.1, and the VO2max (mL/kg/min) was 26.9±4.5. When comparing the measured values of HRmax with those estimated by the different formulas, the equations "220-age", "208-0.7 x age" and "207-0.7 x age" were shown to overestimate (p<0.001) the measured HRmax results in obese adolescents. Only the "200-0.48 x age" equation presented similar results (p=0.103) with the values measured in the CPET. CONCLUSIONS: The findings of the present study demonstrate that the equation "200-0.48 x age" seems to be more adequate to estimate HRmax in obese adolescents.

OBJETIVO: Comparar os valores de frequência cardíaca máxima (FCmáx) medidos e estimados por diferentes equações durante o teste de exercício cardiopulmonar (TECP) em adolescentes obesos. MÉTODOS: Trata-se de um estudo transversal. Foram incluídos adolescentes, de idades entre 15 e 18 anos, com obesidade (escore-Z do índice de massa corpórea - IMC>2,0). Coletaram-se dados demográficos e antropométricos, seguidos da realização do TECP, pela qual foi registrada a FCmáx. O valor mais elevado de frequência cardíaca (FC) atingida no pico do exercício foi considerado como a FCmáx. A comparação entre os valores de FCmáx medidos e os estimados pelas equações foi realizada empregando-se quatro equações prévias. Utilizaram-se a estatística descritiva e o teste de ANOVA (pós-teste de Bonferroni). RESULTADOS: Foram incluídos 59 adolescentes obesos, sendo 44% do sexo masculino. A média de idade foi de 16,8±1,2 anos e a do IMC (escore-Z), de 3,0±0,7. No pico do exercício, a média de FCmáx (batimentos por minuto - bpm) foi de 190,0±9,2, o coeficiente de troca respiratória de 1,2±0,1 e o consumo máximo de oxigênio - VO2máx (mL/kg/min) - de 26,9±4,5. Ao comparar-se os valores medidos de FCmáx com os estimados pelas diferentes fórmulas, demonstrou-se que as equações "220-idade", "208-0,7 x idade" e a "207-0,7 x idade" superestimam (p<0,001) os resultados medidos de FCmáx em adolescentes obesos. Apenas a equação "200-0,48 x idade" apresentou resultados similares (p=0,103) com os valores mensurados no TECP. CONCLUSÕES: Os achados do presente estudo demonstram que a equação "200-0,48 x idade" parece ser mais adequada para estimar a FCmáx em adolescentes obesos.

Frequência cardíaca máxima medida versus estimada por diferentes equações durante o teste de exercício cardiopulmonar em adolescentes obesos / Maximum heart rate measured versus estimated by different equations during the cardiopulmonary exercise test in obese adolescents

RESUMO Objetivo: Comparar os valores de frequência cardíaca máxima (FCmáx) medidos e estimados por diferentes equações durante o teste de exercício cardiopulmonar (TECP) em adolescentes obesos. Métodos: Trata-se de um estudo transversal. Foram incluídos adolescentes, de idades entre 15 e 18 anos, com obesidade (escore-Z do índice de massa corpórea - IMC>2,0). Coletaram-se dados demográficos e antropométricos, seguidos da realização do TECP, pela qual foi registrada a FCmáx. O valor mais elevado de frequência cardíaca (FC) atingida no pico do exercício foi considerado como a FCmáx. A comparação entre os valores de FCmáx medidos e os estimados pelas equações foi realizada empregando-se quatro equações prévias. Utilizaram-se a estatística descritiva e o teste de ANOVA (pós-teste de Bonferroni). Resultados: Foram incluídos 59 adolescentes obesos, sendo 44% do sexo masculino. A média de idade foi de 16,8±1,2 anos e a do IMC (escore-Z), de 3,0±0,7. No pico do exercício, a média de FCmáx (batimentos por minuto - bpm) foi de 190,0±9,2, o coeficiente de troca respiratória de 1,2±0,1 e o consumo máximo de oxigênio - VO2máx (mL/kg/min) - de 26,9±4,5. Ao comparar-se os valores medidos de FCmáx com os estimados pelas diferentes fórmulas, demonstrou-se que as equações "220-idade", "208-0,7 x idade" e a "207-0,7 x idade" superestimam (p<0,001) os resultados medidos de FCmáx em adolescentes obesos. Apenas a equação "200-0,48 x idade" apresentou resultados similares (p=0,103) com os valores mensurados no TECP. Conclusões: Os achados do presente estudo demonstram que a equação "200-0,48 x idade" parece ser mais adequada para estimar a FCmáx em adolescentes obesos.

ABSTRACT Objective: To compare the values of measured maximum heart rate (HRmax) and maximum heart rate estimated by different equations during the cardiopulmonary exercise test (CPET) in obese adolescents. Methods: This is a cross-sectional study. Adolescents aged between 15 and 18 years old, with obesity (BMI Z-score>2.0) were included. Demographic and anthropometric data were collected, followed by CPET, recording HRmax. The highest heart rate reached at peak exercise was considered as HRmax. The comparison between measured and estimated HRmax values was performed using four previous equations. Descriptive statistics and the ANOVA test (Bonferroni post-test) were used. Results: Fifty-nine obese adolescents were included, 44% of them male. The mean age was 16.8±1.2 years old and the BMI (Z-score) was 3.0±0.7. At peak exercise, the mean HRmax (bpm) was 190.0±9.2, the respiratory coefficient was 1.2±0.1, and the VO2max (mL/kg/min) was 26.9±4.5. When comparing the measured values of HRmax with those estimated by the different formulas, the equations "220-age", "208-0.7 x age" and "207-0.7 x age" were shown to overestimate (p<0.001) the measured HRmax results in obese adolescents. Only the "200-0.48 x age" equation presented similar results (p=0.103) with the values measured in the CPET. Conclusions: The findings of the present study demonstrate that the equation "200-0.48 x age" seems to be more adequate to estimate HRmax in obese adolescents.

SALIVARY CORTISOL AND METABOLIC SYNDROME COMPONENT'S ASSOCIATION.

BACKGROUND: Actually the lifestyle exposes the population to several risk factors related to alimentary habits and less physical activity that contributes to chronic diseases appearance worldwide. AIM: To analyze the association between salivary cortisol and the components of metabolic syndrome. METHODS: This is a cross-sectional study. As part of it, 28 individuals aged 30-59 years presenting three or more of the following findings: CA: ≥88 cm for women and ≥102 cm for men; SBP>130 mmHg and DBP>85 mmHg; GL>100 mg/dl; TG>150 mg/dl; HDL<40 mg/dl for men and <50 mg/dl for women. Was performed analysis of salivary cortisol (by radioimmunoassay) from 25 salivary samples collected throughout the day, for evaluating changes in the circadian rhythm of this hormone (8AM, noon and 8PM). RESULTS: 28 evaluated individuals had a mean age of 51.9±7.5 years, mostly women (64.3%) and a mean of BMI 33.6±3.2 kg/m². The cortisol level from the 8AM averaged 18.7±4.8 ng/dlL. Individuals with FPG>110mg/dl, have significantly lower average levels of cortisol than ones with FPG <110 (12.8±5,2 vs. 17.3±4.2). Significant correlations were HOMA vs. WC (r=0,465; p˂0,005) and TG (r=0,473; p˂0,005), WC vs. FG (r=0,446; p˂0,005) and BMI (r=0,730; p˂0.0001); TG vs. HDL (r=0,441 p˂0,005) and FG (r=0,440; p˂0,005). CONCLUSION: Morning salivary cortisol in subjects with chronically elevated blood glucose can represent a downregulation of the hypothalamic-pituitary adrenal axis. This is an important finding not yet well investigated.