Intervenção nutricional com foco em mudança de comportamento em mulheres com excesso de peso e doença renal crônica na fase não dialítica
Data
2021-11-10
Autores
Pereira, Raíssa Antunes 
Orientadores
Cuppari, Lilian
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivo: Avaliar o efeito de uma intervenção nutricional com foco em mudança de comportamento e abordagem não-dieta em mulheres com excesso de peso e doença renal crônica (DRC) na fase não dialítica. Métodos: Trata-se de um ensaio clínico prospectivo não-controlado com mulheres no estadios 3a a 5 da DRC e com IMC ≥ 27 kg/m². A intervenção nutricional compreendeu 15 encontros (semanais ou quinzenais) em 4 grupos (com 4-7 participantes) abordando diferentes temáticas relacionadas aos aspectos da alimentação, incluindo o comer intuitivo, peso/imagem corporal, qualidade de vida, e DRC. As avaliações - que incluíram exames laboratoriais, parâmetros nutricionais e de composição corporal, questionários e instrumentos relacionados à qualidade de vida relacionada à saúde (Short Form Health Survey; SF-36), comer intuitivo (Intuitive Eating Scale 2; IES-2), comportamento de risco para transtornos alimentares e imagem corporal (escala de silhuetas brasileiras) foram realizadas antes e ao final da intervenção (duração de 3,5 meses a 6 meses). Foram conduzidos grupos focais no início e ao final da intervenção para avaliar percepções sobre alimentação saudável e aspectos da DRC, relacionamento com a comida e a vivência na intervenção. A gravação e transcrição dos grupos focais foram realizadas para posterior análise de conteúdo temática. As pacientes foram divididas entre comedoras mais e menos intuitivas na linha de base, utilizando o percentil 50 da IES-2 como ponto de corte. Resultados: Das 33 pacientes que iniciaram a intervenção [mediana e interquartil de idade=62,0 (58,0-68,0) anos; escolaridade= 9,0 (7,0-12,0) anos de estudo; IMC= 32,6 (30,2-39,3) kg/m²; taxa de filtração glomerular estimada= 28,0 (22,0-31,0) ml/min/1.73m²], 23 finalizaram com participação em quatro grupos diferentes. Os grupos não diferiram quanto às características sociodemográficas e clínicas das pacientes. Na linha de base (n=33), as pacientes comedoras mais intuitivas tinham maior idade e melhores escores de qualidade de vida relacionada à saúde. Após a intervenção (n=23), observou-se aumento no escore total da IES-2 e em três de suas subescalas; redução em comportamentos de risco para transtornos alimentares e redução da insatisfação com o tamanho corporal. Os parâmetros laboratoriais e nutricionais não mudaram após a intervenção. Da análise qualitativa dos grupos focais, emergiram quatro categorias no pré-intervenção (fatores influenciando no comer e viver; cultura da restrição; ambivalência ou estagnação no ser e estar; compreensão das limitações do ser) e quatro no pós-intervenção (valorização da abordagem; despertando a autoconfiança; sintonia com o ato de comer; descoberta de um ‘novo’ comer). Observou-se relatos na direção de um estilo de comer mais intuitivo, caracterizado também por melhor qualidade da alimentação, melhor respeito e apreciação corporal, além de melhor motivação para práticas de atividades físicas e para os cuidados e responsabilidades com o tratamento da DRC. Ainda, as pacientes revelaram-se surpresas com a abordagem, sentindo-se acolhidas e escutadas. Conclusões: A intervenção com abordagem comportamental em grupo teve efeitos positivos em vários aspectos do comportamento alimentar, especialmente no comer intuitivo, mas também em outros relacionados à ele, sendo uma possibilidade de estratégia promissora para melhorar a motivação e adesão às recomendações da DRC.
Objective: To evaluate the effect of a nutritional intervention focused on behavior change and with a non-diet approach in overweight women with non-dialysis dependent chronic kidney disease (CKD). Methods: This is an uncontrolled prospective clinical trial with women on stages 3a to 5 of the CKD and with body mass index ≥27 kg/m². The nutritional intervention comprised 15 meetings (weekly or biweekly) conducted in 4 groups (of 4-7 participants) addressing different themes related to aspects of eating, including intuitive eating, weight/body image, quality of life, and CKD. The assessments performed before and after the intervention, included laboratory tests, nutritional and body composition parameters, questionnaires, and instruments related to health-related quality of life (Short Form Health Survey; SF-36), intuitive eating (Intuitive Eating Scale 2; IES-2), behavior risk for eating disorders and body image (Brazilian silhouette scale). The intervention lasted 3.5 to 6 months. Focus groups were conducted before and after the intervention to assess perceptions about healthy eating and aspects of CKD, relationship with food and experience in the intervention. The speech recorded and transcribed was analyzed using a thematic content analysis. Patients were divided into more and less intuitive eaters at baseline, according to the 50th percentile of the IES-2 cut point. Results: Of the 33 patients who started the intervention [median and interquartile of: age=62.0 (58.0-68.0) years; education= 9.0 (7.0-12.0) years of study; BMI=32.6 (30.2-39.3) kg/m²; estimated glomerular filtration rate =28.0 (22.0-31.0) ml/min/1.73m²], 23 finished it in four different groups. Patients in each group did not differ in terms of sociodemographic and clinical characteristics. At baseline (n=33), the most intuitive eaters were older and had better health-related quality of life scores. After the intervention (n=23), there was an increase in total IES-2 score and in three out of four IES-2 subscales; reduction in behaviors risk for eating disorders and reduction in body size dissatisfaction. Laboratory and nutritional parameters did not change after the intervention. In the qualitative analysis, four categories emerged in the pre-intervention (factors influencing eating and living; culture of restrictive diet; ambivalence or stagnation of being; understanding of the limitations of human-being) and four in the post-intervention (appreciation of the approach; awakening self-confidence; attunement to the act of eating; discovery of a 'new' eating). There were reports towards a more intuitive eating style, also characterized by better food quality, better body respect and appreciation, in addition to better motivation for physical activity practices and for care and responsibilities with the treatment of CKD. Still, the patients were surprised by the approach, feeling welcomed and listened to. Conclusions: The non-diet group approach intervention had positive effects in many features of eating behavior, particularly on intuitive eating, and its related aspects. This approach has the potential to be a promising strategy to improve the motivation and the adherence of CKD patients to the dietary recommendations.
Objective: To evaluate the effect of a nutritional intervention focused on behavior change and with a non-diet approach in overweight women with non-dialysis dependent chronic kidney disease (CKD). Methods: This is an uncontrolled prospective clinical trial with women on stages 3a to 5 of the CKD and with body mass index ≥27 kg/m². The nutritional intervention comprised 15 meetings (weekly or biweekly) conducted in 4 groups (of 4-7 participants) addressing different themes related to aspects of eating, including intuitive eating, weight/body image, quality of life, and CKD. The assessments performed before and after the intervention, included laboratory tests, nutritional and body composition parameters, questionnaires, and instruments related to health-related quality of life (Short Form Health Survey; SF-36), intuitive eating (Intuitive Eating Scale 2; IES-2), behavior risk for eating disorders and body image (Brazilian silhouette scale). The intervention lasted 3.5 to 6 months. Focus groups were conducted before and after the intervention to assess perceptions about healthy eating and aspects of CKD, relationship with food and experience in the intervention. The speech recorded and transcribed was analyzed using a thematic content analysis. Patients were divided into more and less intuitive eaters at baseline, according to the 50th percentile of the IES-2 cut point. Results: Of the 33 patients who started the intervention [median and interquartile of: age=62.0 (58.0-68.0) years; education= 9.0 (7.0-12.0) years of study; BMI=32.6 (30.2-39.3) kg/m²; estimated glomerular filtration rate =28.0 (22.0-31.0) ml/min/1.73m²], 23 finished it in four different groups. Patients in each group did not differ in terms of sociodemographic and clinical characteristics. At baseline (n=33), the most intuitive eaters were older and had better health-related quality of life scores. After the intervention (n=23), there was an increase in total IES-2 score and in three out of four IES-2 subscales; reduction in behaviors risk for eating disorders and reduction in body size dissatisfaction. Laboratory and nutritional parameters did not change after the intervention. In the qualitative analysis, four categories emerged in the pre-intervention (factors influencing eating and living; culture of restrictive diet; ambivalence or stagnation of being; understanding of the limitations of human-being) and four in the post-intervention (appreciation of the approach; awakening self-confidence; attunement to the act of eating; discovery of a 'new' eating). There were reports towards a more intuitive eating style, also characterized by better food quality, better body respect and appreciation, in addition to better motivation for physical activity practices and for care and responsibilities with the treatment of CKD. Still, the patients were surprised by the approach, feeling welcomed and listened to. Conclusions: The non-diet group approach intervention had positive effects in many features of eating behavior, particularly on intuitive eating, and its related aspects. This approach has the potential to be a promising strategy to improve the motivation and the adherence of CKD patients to the dietary recommendations.
Descrição
Citação
PEREIRA, Raíssa Antunes. Intervenção nutricional com foco em mudança de comportamento em mulheres com excesso de peso e doença renal crônica na fase não dialítica. 2021. 226 f. Tese (Doutorado em Nutrição) - Escola Paulista de Medicina. Universidade Federal de São Paulo, São Paulo, 2021.