Efetividade de uma intervenção multicomponente de 16 meses sobre a melhora do estado nutricional e a mudança no consumo alimentar de escolares com excesso de peso
Data
2021-05-17
Autores
Almeida, Viviane Bellucci Pires de 
Orientadores
Domene, Semíramis Martins Álvares
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivo: Estudar o efeito de intervenção multicomponente de 16 meses sobre a melhora do estado nutricional e o consumo alimentar de escolares com excesso de peso. Métodos: Foram estudadas intervenções multicomponentes e ambientais em estudantes de baixa renda com excesso de peso em duas escolas públicas de São Paulo, cada uma com um conjunto de intervenções. Todos os escolares matriculados na 3ª a 5ª série (8 a 12 anos) participaram das atividades. Após 16 meses de intervenção, 216 alunos permaneceram no projeto. Ao início e ao final do período foram coletados dados relativos ao estadiamento puberal, à antropometria e exames bioquímicos; 124 escolares com excesso de peso (escore z de IMC / idade ≥1) (57%) responderam ao Questionário de Frequência Alimentar antes e após a intervenção, e destes, 120 estudantes responderam a escala para determinar ocorrência de vício alimentar, Yale Food Addiction Scale for Children. Modelos lineares de efeitos mistos foram usados para avaliar o impacto das intervenções sobre a evolução de cada desfecho ao longo do tempo. Resultados: O escore Z do IMC / Idade entre os alunos mostrou redução significativa de 0,23, independentemente da escola, sexo e idade (<0,001). Em relação à avaliação dos marcadores bioquímicos, não foi encontrada mudança após a intervenção, ao contrário da análise do consumo alimentar que mostrou diferenças significativas e entre as escolas após o tratamento. Entre os escolares, 33,4% apresentaram vício alimentar em pelo menos uma das duas avaliações. A ocorrência de vício alimentar influenciou a redução do peso (interação entre tempo e vício alimentar, β = 0,30, 95 % CI = 0,05 a 0,54), p = 0,016). A perda de peso foi observada apenas em indivíduos que não apresentavam vício alimentar (-0,3 no escore Z do IMC para idade, p<0,001); ao avaliar o efeito da intervenção e as mudanças nas variáveis dietéticas, foi possível verificar uma redução no consumo de bebidas lácteas açucaradas (-17 kcal, p = 0,04) apenas neste grupo. Conclusões: O esclarecimento da relevância do vício alimentar na infância pode ser um diferencial para a formulação de políticas nutricionais voltadas para essa fase da vida. A ocorrência de vício alimentar se associou com a manutenção do excesso de peso e com o consumo de alimentos ricos em açúcar, em especial bebidas lácteas. O controle do excesso de peso por meio de intervenções multicomponentes e ambientais com foco na prevenção e promoção da saúde pode melhorar os fatores relacionados à alimentação. A combinação de programas educacionais, práticas de atividade física e conscientização sobre o consumo de alimentos saudáveis, entre as famílias e no ambiente escolar, são os principais impulsionadores desse desfecho.
Objective: To study the effect of a 16-month multicomponent intervention on nutritional status and food consumption of children with excess weight. Methods: Multicomponent and environmental interventions were studied in low-income students with excess weight in two public schools in São Paulo, each with a set of interventions. All students enrolled in the 3rd to 5th grades (8 to 12 years old) participated in school activities. After 16 months of intervention, 216 students remained on the project and repeated the assessment of pubertal staging, anthropometry and biochemical tests; 124 children with excess weight (BMI/Age Z-score ≥1) (57%) answered the Food Frequency Questionnaire before and after the intervention, and of these, 120 students answered the Yale Food Addiction Scale for Children. Linear mixed-effect models were used to assess the impact of interventions on the evolution of each outcome over time. Results: BMI / Age Z score among students showed a significant reduction of 0.23 regardless of school, sex and age (<0.001). Regarding the assessment of biochemical markers, no significant change was found after the intervention, in contrast to the analysis of food consumption, which showed significant differences over time and between schools after treatment; 33.4% of the students had food addiction in at least one of the two assessments. The analysis to assess the effect of the intervention and the change in the BMI / Age Z score between the evaluations showed that the occurrence of food addiction influenced the weight reduction (interaction between time and food addiction, β = 0.30, 95% CI = 0.05 to 0.54), p = 0.016). Weight loss was observed only in individuals who did not have food addiction (-0.3, BMI / Age Z score, p<0.001). When evaluating the effect of the intervention and changes in dietary variables, it was possible to verify a reduction in the consumption of sugary milk drinks (-17 kcal, p = 0.04) only in this group. Conclusions: Clarifying the relevance of food addiction in childhood can be a differential for the formulation of nutritional policies aimed at this stage of life. Food addiction is associated with the maintenance of excess weight in schoolchildren undergoing nutritional intervention and the consumption of foods rich in sugar, especially sugary milk-based drinks. The control of excess weight through multicomponent and environmental interventions with a focus on prevention and health promotion can improve factors related to dietary intake. The combination of educational programs, physical activity practices and awareness about the consumption of healthy foods, among the families and the school environment, are the main drivers of this outcome.
Objective: To study the effect of a 16-month multicomponent intervention on nutritional status and food consumption of children with excess weight. Methods: Multicomponent and environmental interventions were studied in low-income students with excess weight in two public schools in São Paulo, each with a set of interventions. All students enrolled in the 3rd to 5th grades (8 to 12 years old) participated in school activities. After 16 months of intervention, 216 students remained on the project and repeated the assessment of pubertal staging, anthropometry and biochemical tests; 124 children with excess weight (BMI/Age Z-score ≥1) (57%) answered the Food Frequency Questionnaire before and after the intervention, and of these, 120 students answered the Yale Food Addiction Scale for Children. Linear mixed-effect models were used to assess the impact of interventions on the evolution of each outcome over time. Results: BMI / Age Z score among students showed a significant reduction of 0.23 regardless of school, sex and age (<0.001). Regarding the assessment of biochemical markers, no significant change was found after the intervention, in contrast to the analysis of food consumption, which showed significant differences over time and between schools after treatment; 33.4% of the students had food addiction in at least one of the two assessments. The analysis to assess the effect of the intervention and the change in the BMI / Age Z score between the evaluations showed that the occurrence of food addiction influenced the weight reduction (interaction between time and food addiction, β = 0.30, 95% CI = 0.05 to 0.54), p = 0.016). Weight loss was observed only in individuals who did not have food addiction (-0.3, BMI / Age Z score, p<0.001). When evaluating the effect of the intervention and changes in dietary variables, it was possible to verify a reduction in the consumption of sugary milk drinks (-17 kcal, p = 0.04) only in this group. Conclusions: Clarifying the relevance of food addiction in childhood can be a differential for the formulation of nutritional policies aimed at this stage of life. Food addiction is associated with the maintenance of excess weight in schoolchildren undergoing nutritional intervention and the consumption of foods rich in sugar, especially sugary milk-based drinks. The control of excess weight through multicomponent and environmental interventions with a focus on prevention and health promotion can improve factors related to dietary intake. The combination of educational programs, physical activity practices and awareness about the consumption of healthy foods, among the families and the school environment, are the main drivers of this outcome.
Descrição
Citação
ALMEIDA, Viviane Bellucci Pires de. Efetividade de uma intervenção multicomponente de 16 meses sobre a melhora do estado nutricional e a mudança no consumo alimentar de escolares com excesso de peso. São Paulo, 2021. 124 f. Tese (Doutorado em Nutrição) – Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2021.