Adherence to a nutritional counseling program for adults with excess weight and comorbidities

Objetivo: Investigar adesão a programa de aconselhamento nutricional em grupo para indivíduos com excesso de peso e comorbidades. Métodos: Estudo analítico de intervenção controlada e aberta. Oitenta adultos, de ambos os sexos, com índice de massa corporal entre 25 e 35kg/m², portadores de dois ou mais fatores de risco cardiovascular associados foram alocados aleatoriamente em dois grupos para acompanhamento por três meses. O grupo de intervenção com aconselhamento nutricional em grupo recebeu atendimento individual e participou de seis reuniões grupais para discussão sobre alimentação saudável e atividade física, com dinâmicas e método participativo. O grupo-controle, com atendimento padrão individual, foi assistido em três consultas ambulatoriais. Consideraram-se repercussões dietéticas antes e após a intervenção e assiduidade às reuniões como parâmetros de adesão ao tratamento. Resultados: Trinta e três participantes concluíram o estudo. Do total inicial, 45,8% e 40,7% do grupo de intervenção com aconselhamento nutricional em grupo e do grupo-controle com atendimento padrão individual, respectivamente, atingiram nível ótimo de assiduidade. Os fatores mais citados como barreiras à adesão ao tratamento foram fazer refeições fora de casa (46,7% - grupo-controle com atendimento padrão individual) e dificuldade em aplicar os conhecimentos na prática, principalmente em eventos sociais (33,3% - grupo de intervenção com aconselhamento nutricional em grupo). Verificou-se aumento significativo do percentual médio do uso de temperos naturais e do número de refeições ao dia nos dois grupos após a intervenção. Porém, não houve diminuição significativa do consumo energético intra ou entre os grupos. Conclusão: Apesar da abrangência do conteúdo e do emprego de um método participativo no grupo de intervenção, a adesão foi insuficiente para alterar significativamente os principais parâmetros dietéticos estudados. O aprofundamento da abordagem comportamental, continuada e ultiprofissional deve ser objeto de mais investigações. _______________________________________________________________________________________________________________ ABSTRACTObjective: The objective of this study was to verify adherence to a nutritional group counseling program for patients with excess weight and comorbidities. Methods: This was an analytical, open, controlled, intervention study. Eighty adults from both genders with a body mass index ranging from 25 to 35kg/m² with two or more associated cardiovascular risk factors were randomly allocated to two groups for a three-month follow-up. The intervention group with nutritional group counseling received personalized care and participated in six group meetings to discuss healthy eating and physical activity, with group dynamics and participatory method. The control group was given standard personalized care in three outpatient visits. The parameters of adherence to treatment were the dietary repercussions before and after the intervention and attendance to the meetings. Results: Thirty-three participants concluded the study. In all, 45.8% and 40.7% of intervention group and control group, respectively, had excellent attendance. The main barriers to adherence to treatment were the need of eating out (46.7% - control group) and the difficulty of putting their knowledge to use, especially in social occasions (33.3% - intervention group). There was a significant increase in the mean percentage use of natural seasonings and in the number of daily meals of both groups after the intervention. However, there was no significant decrease in energy intake within groups or between groups. Conclusion: Despite the breadth of the content and the use of a participatory method in the intervention group, adherence was not enough to change the main dietary parameters significantly

Metabolic syndrome in central Brazil : prevalence and correlates in the adult population

Background: The prevalence of metabolic syndrome (MetS) has increased in developing countries in recent decades. This syndrome, a clustering of metabolic abnormalities, has been correlated to various socioeconomic and behavioral variables. We investigated the prevalence and prevalence ratios (PR) of MetS and related factors in an adult population of the Federal District (FD) of Brazil, which is located in the central region of the country. Methods: A cross-sectional, population-based study conducted in 2007, with 2130 adults (aged 18 years or older) in the FD of Brazil. Metabolic syndrome was defined according to the recently harmonized criteria. The prevalence of MetS and PR were estimated for each sex according to the diagnostic components and the overall contribution of the selected correlates. Results: The overall prevalence of MetS was 32.0% (95%CI: 28.9–35.2), with no gender difference. The single component with the greatest contribution to the diagnosis of MetS was hypertension in men (PR 5.10, 95%CI: 3.17–8.22) and high waist circumference in women (PR 5.02, 95%CI: 3.77–6.69). The prevalence of MetS increased significantly and progressively with age and excess weight. In women, higher education was protective against MetS (PR 0.66, 95%CI: 0.49–0.89) compared to 8 or less years of education. There was no association between the prevalence of MetS and behavioral variables studied. Conclusions: This study provides comprehensive and alarming data about the prevalence of MetS among the adult population of Brazil’s FD. The results suggest that reducing education inequalities may be an important public policy goal to improve health outcomes, especially among women

Redução de fatores de risco em adultos com excesso de peso usuários da estratégia saúde da família no Distrito Federal

OBJETIVO: Avaliar os resultados de um programa multidisciplinar de promoção de hábitos saudáveis sobre parâmetros antropométricos e bioquímicos em usuários da Estratégia Saúde da Família do Distrito Federal. MÉTODOS: A amostra foi composta por 279 adultos de ambos os sexos com sobrepeso ou obesidade, alocados em dois grupos: intervenção e. O grupo intervenção (n=198) recebeu a assistência padrão da Estratégia Saúde da Família acrescida de atividades estruturadas de um programa multidisciplinar de promoção de hábitos saudáveis, o Programa Jogo de Cintura, incluindo intervenções nutricionais e de atividade física. O grupo controle (n=89) recebeu exclusivamente a assistência padrão da Estratégia Saúde da Família. A coleta dos dados ocorreu no início e após 4 e 8 meses de seguimento. Foram avaliados: índice de massa corporal, circunferência abdominal; glicemia em jejum e perfil lipídico. RESULTADOS: No grupo intervenção foram observadas reduções significativas da prevalência de obesidade (de 63,3% para 49,4%; p=0,027) e na média da circunferência abdominal (de 102,2 para 94,8cm; p<0,0001). Em ambos os grupos houve reduções no colesterol total, low-density liprotein e high-density liprotein cholesterol. CONCLUSÃO: O acompanhamento padrão da Estratégia Saúde da Família contribuiu para a redução de alguns fatores de risco em adultos com excesso de peso. Reduções nas medidas antropométricas foram maximizadas através de intervenções simples que estimulam modificações nos hábitos de vida. Esses resultados sugerem que o Programa Jogo de Cintura pode ser incorporado a outras equipes da Estratégia Saúde da Família, com o intuito de aperfeiçoar o controle da obesidade e a promoção da saúde. Questões sobre a adesão dos usuários ao programa devem ser futuramente investigadas.OBJECTIVE: To evaluate the results of a multidisciplinary program to promote healthy habits on anthropometric and biochemical parameters on participants of the Family Health Strategy of the Distrito Federal. METHODS: The sample consisted of 279 overweight and obese adults of both sexes divided into two groups: intervention (IG, n=198) and control group (CG, n=89). The IG received standard Family Health Strategy care plus a multidisciplinary health promoting program that included dietary interventions and physical activity, called Set Waist Program. The control group received only standard ESF care. Data were collected at baseline and after 4 and 8 months of follow up. Body mass index, waist circumference, fasting blood glucose and lipid profile were assessed. RESULTS: Prevalence of obesity (63.3% to 49.4%, p=0.027) and waist circumference (102.2cm to 94.8cm, p<0.0001) were significantly reduced in IG. Total cholesterol, LDL and HDL-cholesterol were reduced in both groups. CONCLUSION: Reductions in anthropometric measures were maximized through simple interventions that stimulated lifestyle changes. These results suggest that multidisciplinary initiatives such the Set Waist Program can be incorporated into other Family Health Strategy teams to optimize the control of obesity and health promotion. Participant compliance is an issue that deserves further investigation

Resting energy expenditure and protein balance in people with Epidermolysis Bullosa

Epidermolysis bullosa (EB) is a group of conditions characterized by severe fragility of the skin that causes recurring blistering. The recessive dystrophic subtype of EB (RDEB) has a strong impact on the nutritional status. We evaluated the resting energy expenditure (REE) and presence of protein catabolism in patients with RDEB. REE was assessed in 10 subjects (7 females; age range 4–33 years) by indirect calorimetry and using a predictive equation. Nitrogen balance was calculated by protein intake and 24 h urinary urea excretion estimations. An assessment of body surface area (BSA) with infected and non-infected skin lesions was applied to the nitrogen balance burn equation that was adapted to EB. The REE values predicted by the equation were consistently lower than the ones measured, except for two subjects. All subjects recorded high protein and energy intake, with protein intake being higher than 4 g protein/kg/day for five subjects. Even so, protein catabolism was observed in six subjects, three of whom had infected wounds. This study raises the hypothesis that the clinical and nutritional risks of people with RDEB are associated with an increased REE and negative nitrogen balance, which reinforces the importance of nutritional support

Nutritional aspects of children and adolescents with epidermolysis bullosa : literature review

Epidermolysis Bullosa is a genetic disorder that affects mainly the skin, however, all others systems are influenced. The nutritional care of children and adolescents with Epidermolysis Bullosa is a key treatment strategy, since the energy needs are increased due to the disease's metabolism, burdening the immune system and cicatrization process, symptoms caused by the disease hinder the intake and adequate absorption of nutrients, which may result in inadequate growth and development. Because this is a rare disease, there are few professionals who know the characteristics of both the clinical evolution and nutritional and dietary treatments. This literature review discusses the latest knowledge on energy and specific nutrient requirements to the dietary treatment and monitoring of children and adolescents with Epidermolysis Bullosa

Índices de avaliação da qualidade da dieta

Various indices and scores based on admittedly healthy dietary patterns or food guides for the general population, or aiming at the prevention of diet-related diseases have been developed to assess diet quality. The four indices preferred by most studies are: the Diet Quality Index; the Healthy Eating Index; the Mediterranean Diet Score; and the Overall Nutritional Quality Index. Other instruments based on these indices have been developed and the words 'adapted', 'revised', or 'new version I, II or III' added to their names. Even validated indices usually find only modest associations between diet and risk of disease or death, raising questions about their limitations and the complexity associated with measuring the causal relationship between diet and health parameters. The objective of this review is to describe the main instruments used for assessing diet quality, and the applications and limitations related to their use and interpretation.Para avaliação da qualidade da dieta, diferentes índices ou escores foram desenvolvidos, considerando padrões dietéticos reconhecidamente saudáveis ou baseando-se em guias alimentares para populações em geral ou para a prevenção de doenças. Dos vários índices, quatro deles servem de base para a maior parte dos estudos: Índice de Qualidade da Dieta, Índice de Alimentação Saudável, Escore da Dieta Mediterrânea e Índice Geral de Qualidade Nutricional. A partir desses modelos, alguns outros foram criados, com acréscimo do termo adaptado/revisado, ou em novas versões (I, II ou III) como referência do respectivo original. Esses índices, mesmo validados, apresentam associações geralmente modestas com o risco de mortalidade ou doenças, o que aponta suas limitações, bem como a complexidade de se medir a relação causal entre dieta e parâmetros de saúde. Esta revisão tem como objetivo descrever os principais instrumentos de avaliação da qualidade da dieta, assim como suas aplicações e limitações, relativas ao uso e interpretações

Common mental disorders prevalence in adolescents : a systematic review and meta-analyses

An increasing number of original studies suggest the relevance of assessing mental health; however, there has been a lack of knowledge about the magnitude of Common Mental Disorders (CMD) in adolescents worldwide. This study aimed to estimate the prevalence of CMD in adolescents, from the General Health Questionnaire (GHQ-12). Only studies composed by adolescents (10 to 19 years old) that evaluated the CMD prevalence according to the GHQ-12 were considered. The studies were searched in Medline, Embase, Scopus, Web of Science, Lilacs, Adolec, Google Scholar, PsycINFO and Proquest. In addition, the reference lists of relevant reports were screened to identify potentially eligible articles. Studies were selected by independent reviewers, who also extracted data and assessed risk of bias. Meta-analyses were performed to summarize the prevalence of CMD and estimate heterogeneity across studies. A total of 43 studies were included. Among studies that adopted the cut-off point of 3, the prevalence of CMD was 31.0% (CI 95% 28.0–34.0; I2 = 97.5%) and was more prevalent among girls. In studies that used the cut-off point of 4, the prevalence of CMD was 25.0% (CI 95% 19.0–32.0; I2 = 99.8%). Global prevalence of CMD in adolescents was 25.0% and 31.0%, using the GHQ cut-off point of 4 and 3, respectively. These results point to the need to include mental health as an important component of health in adolescence and to the need to include CMD screening as a first step in the prevention and control of mental disorders

ASSOCIAÇÃO ENTRE FORÇA MUSCULAR ISOCINÉTICA E FUNCIONALIDADE EM PACIENTES SUBMETIDOS À CIRURGIA BARIÁTRICA

ResumoObjetivo: verificar a relação entre força muscular e funcionalidade de pacientes pós bariátricos. Materiais e Métodos: participaram do estudo 22 voluntários submetidos ao by-pass gástrico em y de Roux, os quais foram recrutados no ambulatório do Hospital Universitário de Brasília; todos os participantes realizaram avaliação da força muscular por meio de um dinamômetro isocinético (Biodex system 3). Após a familiarização, o protocolo de avaliação consistiu de 2 séries de 4 repetições a 60º por segundo, sendo que o pico de torque foi considerado para as análises; o desempenho funcional foi avaliado por meio dos testes de levantar e sentar, timed up and go, e caminhada de 6 minutos; os dados foram apresentados por meio da estatística descritiva e o relacionamento entre as variáveis foi examinado por meio do coeficiente de correlação de Pearson; a significância estatística foi um valor de P &lt; 0.05. Resultado: um total de 22 voluntários, sendo 19 mulheres e 3 homens (idade média 38,36 ± 6,44), participaram do estudo, os quais foram submetidas a medidas de massa corporal total e estatura, bem como mensurações para avaliação do PT isocinético e funcionalidade; o tempo médio 3,92 anos, o PT relativo à massa corporal se relacionou positiva e significativamente com o desempenho no teste de caminhada de 6 minutos. Conclusão: a prática regular de atividade física parece estar associada a uma melhora na força muscular e na funcionalidade de pacientes pós bariátricos. AbstractObjective: to verify the relationship between muscular strength and functionality of post-bariatric patients. Materials and Methods: participated of study 22 volunteers underwent gastric by-pass in Roux-en Y, who were recruited at the outpatient clinic of the University hospital of Brasilia. All participants performed muscle strength assessment using an isokinetic dynamometer (Biodex system 3). After familiarization, the evaluation protocol consisted of 2 sets of 4 repetitions at 60º per second, with the peak torque being considered for the analyzes. Functional performance was assessed through sit-up, timed up and go, and 6-minute walk tests. Data were presented through descriptive statistics and the relationship between the variables was examined using the Pearson correlation coefficient. Statistical significance was P &lt;0.05. Results: A total of 22 volunteers, 19 women and 3 men (mean age 38.36 ± 6.44), participated in the study, who were submitted to measures of total body mass and height, as well as measurements for PT evaluation isokinetic and functionality. The mean time 3.92 years, PT relative to body mass was positively and significantly related to performance in the 6-minute walk test. Conclusion: Regular practice of physical activity seems to be associated with an improvement in muscle strength and function in post-bariatric patients. figshare DOI: 10.6084/m9.figshare.811124

Does probiotic consumption enhance wound healing? a systematic review

The use of probiotics is one of the emerging lines of treatment for wound healing. This systematic review aimed to summarize currently available evidence on the effect of oral or enteral probiotic therapy on skin or oral mucosal wound healing in humans. To verify the developments in this field and the level of available scientific evidence, we applied a broad search strategy with no restrictions on wound type, target population, probiotic strain, or intervention protocol used. This review included seven studies involving 348 individuals. Four studies reported positive outcomes for healing improvement after probiotic therapy, and none of the studies reported adverse effects or a marked increase in wound healing time. The positive or neutral results observed do not generate strong evidence regarding the effectiveness of probiotics for wound healing. However, they suggest a promising field for future clinical research where the probiotic strains used, type of wounds, and target population are controlled for

Effect of physical exercise on muscle strength in adults following bariatric surgery : a systematic review and meta-analysis of different muscle strength assessment tests

Individuals following bariatric surgery are considered at high risk for the development of sarcopenic obesity (excess fat mass, low muscle mass and low physical function), and exercise may play an important role in its prevention and treatment. We systematically reviewed 5 scientific databases (Embase, Medline, Scopus, SPORTDiscus, and Web of Science) and 2 grey literature databases (ProQuest and Google Scholar) for clinical trials that evaluated the effect of exercise on muscle strength in adults following bariatric surgery and conducted a separate meta-analysis for studies that used different muscle strength tests. Random-effect models, restricted maximum likelihood method and Hedges’ g were used. The review protocol was registered at the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42020152142). Fifteen studies were included (638 patients), none had a low risk of bias, and all were included in at least 1 of the 5 meta-analyses (repetition maximum [lower and upper limbs], sit-to-stand, dynamometer, and handgrip tests). Exercise interventions improved both upper (effect size, 0.71; 95% CI, 0.41–1.01; I 2 = 0%) and lower (effect size, 1.37; 95% CI, 0.84–1.91; I2 = 46.14) limb muscle strength, as measured by repetition maximum tests. Results were similar for the sit-to-stand (effect size, 0.60; 95% CI, 0.20–1.01; I2 = 68.89%) and dynamometer (effect size, 0.46; 95% CI, 0.06–0.87; I2 =31.03%), but not for the handgrip test (effect size, 0.11; 95% CI, -0.42–0.63; I2 = 73.27%). However, the certainty level of the meta-analyses was very low. Exercise with a resistance training component performed post bariatric surgery may improve muscle strength, which is related to sarcopenic obesity, functional capacity, and mortality risk, therefore should be included in the follow-up