Variação da percepção do consumo de frutas em adolescentes: um ensaio comunitário controlado randomizado em Duque de Caxias - RJ / Variation in Adolescent Fruit Consumption Perception: a randomized controlled community trial in Duque de Caxias - RJ

Resumo Introdução A autoavaliação do consumo é um dos fatores determinantes para adoção de uma alimentação adequada e saudável. Objetivo Avaliar o efeito de uma intervenção nutricional na percepção do consumo de frutas em adolescentes. Método Trata-se de um ensaio comunitário randomizado controlado de base escolar. A intervenção consistiu em ações integradas de prevenção primária (nas escolas) e secundária (nos domicílios). Os participantes foram classificados em otimistas e não otimistas em relação à percepção do consumo de frutas combinando duas variáveis: frequência de consumo e autoavaliação da quantidade consumida. O efeito da intervenção foi testado por modelo de regressão logística com efeitos aleatórios. Resultados A frequência de otimistas na linha de base foi 19,1% e 18,5% nos grupos controle e intervenção, e 17,5% e 17,6% pós-intervenção, respectivamente (p=0,743 para interação grupo*tempo, e p=0,802 no modelo ajustado pela cor da pele). A prevalência de otimistas foi maior entre os meninos, entre aqueles que avaliaram sua alimentação como excelente/muito boa, com menor frequência de consumo de refrigerante e de biscoito, e entre aqueles que relataram realizar café da manhã ou almoço com os pais nunca ou quase nunca. Conclusão Não houve efeito da intervenção na mudança de percepção quanto ao consumo de frutas.

Abstract Background Self-perception about food consumption plays an important role in moving toward a healthy diet. Objective To assess the effect of a nutritional intervention on the perception of fruit consumption in adolescents. Method A community-based randomized trial was carried out. The intervention consisted of integrated actions of primary prevention (at school) and secondary prevention (at home), both encouraging the participants to adopt healthy eating habits through playful activities. The participants were classified as either "optimistic" or "non-optimistic" according to their reported fruit consumption and self-perception about the amount of fruit consumption. The intervention effect was tested using random-effects logistic regression. Results The frequency of optimistic individuals at baseline was 19.1% and 18.5% in the control and intervention groups, and 17.5% and 17.6% at the end of the study (p = 0,743 for the group*time interaction and 0,802 when adjusted for race). The prevalence of optimism was higher in males, in participants who considered their overall diet quality very good or excellent, among those with the lowest frequency of soda and cookie consumption, and in participants who rarely reported sharing mealtime with their parents. Conclusion The school-based intervention did not affect the change in perception regarding fruit intake.

Inequalities in food acquisition according to the social profiles of the head of households in Brazil / Desigualdades na aquisição de alimentos de acordo com a renda e os perfis sociais do chefe de família no Brasil

Abstract Brazil is characterized by strong social inequalities and differences in access to quality food and sufficient quantities of it, which represent a violation of the human right to adequate food. The aim was to assess food expenditures according to the social profiles of the head of the households. Data from the cross-sectional Brazilian Household Budget Survey (2017/2018) were used with a nationally representative sample of household survey participants (n=52,917). Poisson regression was used to estimate prevalence ratios (PR) to assess the association of different social profiles with the acquisition of food. The profile characterized by woman self-classified as white, with a higher education, which characteristics were positively and significantly associated with more acquisition of fruits (PR=1.22; CI95% 1.09-1.36) and vegetables and greens (PR=1.24; CI95% 1.09-1.41). Black women with low education levels showed a negative association with the consumption of soda (PR=0.53; CI95% 0.45-0.62), and prepared food (PR=0.52; CI95% 0.37-0.74). The results reveal great inequalities in the purchase of food between the social profiles of the heads of the family.

Resumo O Brasil é caracterizado por fortes desigualdades sociais e diferenças no acesso a alimentos de qualidade e em quantidade suficiente, o que representa uma violação do direito humano à alimentação adequada. O objetivo foi avaliar os gastos com alimentação de acordo com o perfil social do responsável pelo domicílio. Dados da Pesquisa de Orçamentos Familiares Brasileiros de corte transversal (2017/2018) foram usados com uma amostra nacionalmente representativa de participantes da pesquisa domiciliar (n=52.917). A regressão de Poisson foi utilizada para estimar razões de prevalência (RP) para avaliar a associação de diferentes perfis sociais com a aquisição de alimentos. O perfil caracterizado pela mulher auto classificada como branca, com maior escolaridade, cujas características estiveram positiva e significativamente associadas a maior aquisição de frutas (RP=1,22; IC95% 1,09-1,36), verduras e legumes (PR=1,24; IC95% 1,09-1,41) e queijo (RP=1,32; IC95% 1,09-1,59). Mulheres negras com baixa escolaridade apresentaram associação negativa com o consumo de refrigerantes (RP=0,53; IC95% 0,45-0,62) e alimentos preparados (RP=0,52; IC95% 0,37-0,74). Os resultados revelam grandes desigualdades na aquisição de alimentos entre os perfis sociais dos chefes de família.

Inequalities in food acquisition according to the social profiles of the head of households in Brazil.

Brazil is characterized by strong social inequalities and differences in access to quality food and sufficient quantities of it, which represent a violation of the human right to adequate food. The aim was to assess food expenditures according to the social profiles of the head of the households. Data from the cross-sectional Brazilian Household Budget Survey (2017/2018) were used with a nationally representative sample of household survey participants (n=52,917). Poisson regression was used to estimate prevalence ratios (PR) to assess the association of different social profiles with the acquisition of food. The profile characterized by woman self-classified as white, with a higher education, which characteristics were positively and significantly associated with more acquisition of fruits (PR=1.22; CI95% 1.09-1.36) and vegetables and greens (PR=1.24; CI95% 1.09-1.41). Black women with low education levels showed a negative association with the consumption of soda (PR=0.53; CI95% 0.45-0.62), and prepared food (PR=0.52; CI95% 0.37-0.74). The results reveal great inequalities in the purchase of food between the social profiles of the heads of the family.

Social inequalities among Brazilian older adults: a secondary cross-sectional analysis of a national survey / Desigualdades sociais entre idosos brasileiros: análise transversal de uma pesquisa nacional

Objective: This study aimed to evaluate sociodemographic and economic differences among Brazilian older adults according the region they live in. Methods: This cross-sectional, descriptive-analytical study included older adults aged ≥ 60 years, based on a secondary analysis of public data from a nationally representative survey called the Family Budget Survey. The data were disaggregated according to the 5 regions of the country and associated with sociodemographic and economic characteristics. Analyses of categorical and numerical variables and their associations were performed using multinomial logistic regression. Results: Among all participants in the Family Budget Survey, 26 199 (15%) were older adults. The southeast and south regions were found to had better living conditions and higher proportions of older adults. Regarding race, the southern region had the highest proportion of self-declared Whites, the southeastern region had the highest mean education level, and the northern and northeastern regions had the lowest levels of education and household income. Conclusions: The results suggest that the aging process is heterogeneous due to marked regional inequalities, which are related to social issues. Regional differences can be determinant in socioeconomic and demographic inequalities among the older population.

Objetivo: Este estudo teve como objetivo avaliar as diferenças sociodemográficas e econômicas entre idosos brasileiros de acordo com as macrorregiões. Metodologia: Estudo transversal, descritivo-analítico, realizado com indivíduos com ≥ 60 anos de idade, com base na análise secundária de dados públicos de um inquérito nacionalmente representativo denominado Pesquisa de Orçamentos Familiares. Os dados foram separados de acordo com as cinco regiões do País e foram associados a características sociodemográficas e econômicas. Realizaram-se análises de variáveis categóricas e numéricas e de suas associações por meio de regressão logística multinomial. Resultados: Entre todos os participantes da Pesquisa de Orçamentos Familiares, 26.199 (15%) eram idosos. Constatou-se que as regiões Sudeste e Sul apresentaram melhores condições de vida e maiores proporções de idosos. Em relação à raça/cor, a região Sul apresentou a maior proporção de autodeclarados brancos, a região Sudeste apresentou a maior média de escolaridade e as regiões Norte e Nordeste apresentaram os menores níveis de escolaridade e renda familiar. Conclusões: Os resultados sugerem que o processo de envelhecimento é heterogêneo em razão das acentuadas desigualdades regionais, que estão relacionadas a questões sociais. As diferenças regionais podem ser determinantes nas desigualdades socioeconômicas e demográficas entre a população idosa.

Effect of phytosterol capsule supplementation associated with the National Cholesterol Education Program Step 2 diet on low-density lipoprotein in children and adolescents with dyslipidemia: A double-blind crossover trial.

OBJECTIVE: To evaluate the effect of phytosterol capsule supplementation associated with the National Cholesterol Education Program (NCEP) Step 2 diet on LDL-C levels in children and adolescents with dyslipidemia. METHODS: This is a randomized, double-blind, crossover trial conducted with children and adolescents (n = 31; mean ± SD, age 9.0 ± 2.22 years, BMI zscore 1.65 ± 1.47 kg/m2) with dyslipidemia. After a run-in period, the participants were randomly allocated to control or intervention groups. The intervention group received capsules containing 1.5 g/day of phytosterols, and the control group received capsules containing 2 g/day of sunflower oil for 8 weeks. Patients in both groups were instructed to follow the NCEP Step 2 diet during the study. The primary outcome was LDL-C and secondary outcomes were total cholesterol (TC), HDL-C, triglyceride, insulin, blood pressure, and anthropometric measures. Intention-to-treat analyses were performed using the proc mixed procedure in SAS. RESULTS: The rate of change for LDL-C was not different between intervention and control groups (p=0.30). No significant reduction was also observed for TC (p=0.47), HDL-C (p=0.97), insulin (p=0.27), triglycerides (p=0.38), systolic blood pressure (p=0.11), and diastolic blood pressure (p=0.57) compared to control group. Although we observed a high adherence to the capsule intake (95.7% in phytosterol and 93.8% in the control group), the low adherence to the diet may have contributed to explaining the results. CONCLUSION: Daily phytosterol capsules supplementation associated with the NCEP Step 2 diet did not reduce LDL-cholesterol concentrations in children and adolescents with dyslipidemia.

Prevenção primária e secundária da obesidade: ensaio comunitário randomizado em escolares de Duque de Caxias, Rio de Janeiro / Primary and secundary prevention of obesity: a randomized community trial in schoolchildren from Duque de Caxias, Rio de Janeiro

A prevalência de obesidade entre crianças e adolescentes é alta no Brasil e no mundo, sendo considerado um grave problema de saúde pública. Escolas podem desempenhar um importante elo na prevenção da obesidade devido sua abrangência e seu papel formador de comportamentos. Contudo, as intervenções realizadas em diferentes países para prevenção da obesidade a nível escolar têm mostrado resultados contraditórios. Nessa Tese, são avaliados os dados de um ensaio de base escolar randomizado denominado PAAPPAS (Pais, Alunos, Agendes de Saúde e Professores Pela Alimentação Saudável), conduzido com alunos do 5º e 6º ano de dezoito escolas públicas do município de Duque de Caxias, Rio de Janeiro. O objetivo geral foi avaliar a eficácia da combinação da intervenção primária e secundária para redução do ganho excessivo de peso de adolescentes, por meio do estímulo à alimentação saudável e aumento da atividade física. O desfecho principal do estudo foi a redução do ganho de peso excessivo do grupo intervenção em relação ao grupo controle, por meio de intervenções que estimularam o consumo de alimentos saudáveis, atividade física e redução de sedentarismo durante o ano letivo de 2016. A coleta de medidas antropométricas e consumo alimentar ocorreram no início e no fim do ano letivo. A prevenção primária consistiu em seis sessões de educação nutricional e estímulo a realização de atividade física realizadas nas escolas e a secundária foi dirigida aos escolares com excesso de peso, sendo as orientações domiciliares realizadas por agentes comunitários de saúde, previa mente treinados. Para as análises longitudinais foram utilizados modelos lineares mistos através do procedimento PROC MIXED, que leva em consideração os dados faltantes e desbalanceados. As análises foram realizadas no software Statistical Analysis System (SAS). Foi realizada também análise segundo adesão ao protocolo nas atividades realizadas em classe e segundo a realização de visitas domiciliares pelos agentes de saúde. A variação média do índice de massa corporal não apresentou diferença entre os grupos controle e intervenção. Houve redução do percentual de gordura corporal menor no grupo experimental, comparado ao controle nos meninos. O grupo intervenção aumentou a atividade física em 12,5 minutos por semana em relação ao controle e ocorreu aumento no escore de frequência alimentar de alimentos saudáveis apenas entre as meninas (0,29; p = 0,04). O subgrupo com intervenção domiciliar e na escola também apresentou maior aumento de % de gordura corporal em relação ao grupo controle (0,89; p = 0,01). As mudanças comportamentais combinando a intervenção na escola e nos domicílios aumentaram a atividade física e os hábitos alimentares saudáveis, mas não promoveu redução do ganho de peso, sugerindo a possibilidade do seu aumento

The prevalence of obesity among children and adolescents is high in Brazil and in the world, being considered a serious public health problem. Schools can be an important link in preventing obesity due to its scope and its scope and its role in forming behaviors. However, interventions in different countries to prevent obesity at school level have shown contradictory results. In this Thesis, a randomized community trial called PAAPPAS (Parents, Students, Health Agents and Teachers for Healthy Eating), conducted with 5th and 6th grade students from eighteen public schools in Duque de Caxias, Rio de Janeiro. The objective was to evaluate the effectiveness of combining primary and secondary intervention to reduce excessive weight gain in adolescents by encouraging healthy eating and increasing physical activity. The main outcome of the study was to reduce excessive weight gain from the intervention group over the control group through interventions that stimulated healthy food consumption, physical activity and reduced physical inactivity during the 2016 school year. Anthropometric measurements and food consumption occured at the beginning and end of the school year. Primary prevention consisted of six sessions of nutrition education and physical activity carried out in schools and the secondary was directed to overweight students, with home-based guidance provided by community health agents. For longitudinal analyzes, mixed linear models were used through the PROC MIXED procedure, which takes into account missing and unbalanced data. The analyzes were performed using the Statistical Analysis System (SAS) software. An analysis was also performed according to adherence to the protocol in the activities in class and according to the performance of home visits by health agents. The mean variation in body mass index did not differ between the control and intervention groups. There was a reduction the percentage of lower body fat in the experiemental group, compared to the control in boys. The intervention group increased physical activity by 12.5 minutes per week compared to control and there was an increase in the food frequency score of health foods only among girls (0.29; p = 0.04). The subgroup with home and school intervention also showed a greater increase in %body fat compared to the control group (0.89; p = 0.01). Behavioral changes combining school and home intervention increased physical activity and healthy eating habits, but did not promote a reduction in weight gain, suggesting the possibility of their increase

Validity of basal metabolic rate prediction equations in elderly women living in an urban tropical city of Brazil.

OBJECTIVES: To measure basal metabolic rate (BMR) and to compare it with the values obtained from predictive equations in a sample of elderly (≥60 y) women. DESIGN: Cross-sectional study. PARTICIPANTS AND SETTING: Seventy-nine women living in Niterói, Rio de Janeiro, Brazil enrolled in physical activity programs open to the community. MEASUREMENTS: Anthropometric measures were obtained using standard procedures. Percent body fat (PBF) was assessed by DXA. BMR was measured (BMRm) by indirect calorimetry under standardized conditions and compared with BMR estimated by 14 predictive equations that included elderly individuals in their development. RESULTS: Mean (±SD) age, BMI and PBF were 69.7 ± 6.5 y, 27.2 ± 4.6 kg/m2 and 42.1 ± 5.9%. BMRm (4188.3 ± 707.2 kJ/day) was significantly lower than estimated BMR by all predictive equations, including the equation developed for the Niteroian adult population (4565.6 ± 607.9 kJ/day). This population-specific equation provided the largest number of results within ±10% of BMRm and the lowest overestimation (10.6 ± 15.4%), much lower than the results from the internationally recommended Schofield equation (27.2 ± 17.6%). Regression of calf circumference (CC), age and body mass on BMRm provided similar estimates in comparison to models with fat-free mass (FFM). CONCLUSIONS: All predictive equations provided biased, inaccurate estimates of BMR values in comparison to BMRm. Anthropometry and body composition explained only approximately 50% of the variability of BMRm. New equations should account for the variability of organ-metabolic rates and underlying undetected health conditions in older individuals living in tropical regions.

Design of a school randomized trial for nudging students towards healthy diet and physical activity to prevent obesity: PAAPAS Nudge study protocol.

OBJECTIVE: To evaluate the effectiveness of nudge activities at school on the students' body mass index (BMI). DESIGN: School-based factorial randomized community trial. SETTING: Eighteen public schools in the municipality of Duque de Caxias, metropolitan area of Rio de Janeiro, Brazil. PARTICIPANTS AND INTERVENTION: The 18 schools will be randomized into 4 group arms: group 1-control (without any activity); group 2-will receive educational activities in the classroom; group 3-will receive changes in the school environment (nudge strategies); group 4-will receive educational activities and changes in the school environment. Activities will occur during the 2018 school-year. MAIN OUTCOME MEASURE(S): The primary (BMI) and secondary (body fat percentage) outcomes will be assessed at baseline and after the study using a portable electronic scale with a segmental body composition monitor. The height will be measured by a portable stadiometer. ANALYSIS: Statistical analyses for each outcome will be conducted through linear mixed models that took into account the missing data and cluster effect of the schools.