Efetividade do aconselhamento nutricional em mulheres com excesso de peso atendidas na Atenção Primária à Saúde / Effectiveness of nutritional counseling for women with overweight in monitoring in Primary Health Care

RESUMO

Introducao: As altas taxas de doencas cronicas demandam por acoes alicercadas em mudancas nos modos de vida da populacao, sobretudo na Atencao Primaria a Saude (APS). Objetivo: Avaliar a efetividade do aconselhamento nutricional em mulheres com excesso de peso acompanhadas em Unidades Basicas de Saude (UBS). Metodos: Estudo de intervencao do tipo antes-e-depois, com mulheres com excesso de peso, . 20 anos, encaminhadas para acompanhamento nutricional em UBS dos Distritos Sanitarios Leste (UBS-L) e Barreiro (UBS-B) de Belo Horizonte-MG, durante 12 meses. Verificou-se a evolucao do estado nutricional pela aplicacao de anamnese no inicio e ao final do estudo, contendo dados sociodemograficos, economicos, de saude, habitos e consumo alimentar, e antropometria. A intervencao consistiu em aconselhamento nutricional individual, com intervalos de 30 a 50 dias. Foram realizados os testes t de Student pareado, Wilcoxon de postos sinalizados e McNemar e, regressao linear multipla para identificar variaveis da linha de base associadas aos desfechos delta percentual do peso, da circunferencia da cintura (CC) e do Indice de conicidade (Indice C) (p<0,05). Resultados: Foram avaliadas 48 mulheres (24 em cada UBS), a maioria adulta (62,5%-UBS-L; 79,2%-UBS-B). Apos 12 meses, na UBS-L houve incremento do consumo semanal de frutas (p=0,013), e numero de refeicoes (p=0,039); reducao do consumo de liquidos nas refeicoes (p=0,031); calorias (p=0,010), carboidratos (p=0,004), lipidios (p=0,014), acidos graxos monoinsaturados - AGM (p=0,004); Indice massa corporal . IMC (p=0,017), CC (p=0,019) e Razao cintura-altura - RCA (p=0,012). Na UBS-B constatou-se aumento da percepcao corporal como magra/normal (p=0,008), ingestao diaria de verduras (p=0,001) e legumes (p=0,039), numero de refeicoes (p=0,002), consumo de selenio (p=0,053) e vitamina C (p=0,015); e diminuicao da ingestao de sal (p=0,012), oleo (p=0,001), calorias (p=0,021), lipidios (p=0,001), acidos...

ABSTRACT

The high prevalence of chronic diseases demand interventions that encourage healthier lifestyles, specially in Primary Health Care (PHC). Objective: To evaluate the effectiveness of nutritional counseling for women with overweight in monitoring at PHC Units. Methods: Before-and-after intervention study, with overweight women, ≥20 years, that were referred to nutritional monitoring at PHC Units (PHCU) in the East District (PHCU-E) and Barreiro District (PHCU-B) of Belo Horizonte-MG, during 12 months. Was verified the evolution of nutritional status by applying anamnesis at the beginning and the end of intervention, aimed to assess sociodemographic and economic characteristics, health profile, habits and dietary intake, and anthropometry. The intervention consisted of individual nutritional counseling (intervals of 30-50 days). Descriptive analysis was performed and used statistical tests paired Student’s t, Wilcoxon and McNemar. Multiple linear regression was used to examine which baseline variables were associated with the outcomes: delta percentage of weight, Waist circumference (WC) and Conicity index - C Index (p<0.05). Results: Were evaluated 48 women (24 at each PHCU), most adults (PHCU-E 62.5%; PHCU-B 79.2%). After the intervention, at the PHCU-E there was an increase in consume of fruits (p=0.013), increase of the number of meals (p=0.039), reducing of the habit of consuming liquids at meals (p = 0.031), reducing of the consumption of calories (p=0.010), carbohydrates (p=0.004), fat (p=0.014), monounsaturated fatty acids - MUFA (p=0.004), and reducing in the body mass index-BMI (p=0.017), WC (p=0.019) and the waist to height ratio - WHtR (p=0.012). At PHCU-B, there was increased body perception as slim/normal (p=0.008), increase in the daily intake of leafy vegetables (p=0.001) and other vegetables (p=0.039), increase in the number of meals (p=0.002), increase in the consumption of selenium (p=0.053) and vitamin C (p=0.015)...