Consumo alimentar de escolares do 2º ao 5º ano da rede pública de ensino de Florianópolis, SC: 2013 a 2015

Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Nutrição, Florianópolis, 2018.O objetivo deste estudo foi verificar a tendência e mudanças longitudinais no consumo alimentar de escolares do 2º ao 5º ano da rede pública de ensino de Florianópolis (SC) entre 2013 e 2015. Este é um estudo de delineamento do tipo painel (transversal repetido) e longitudinal. Foram utilizados dados de três levantamentos realizados em 2013 (n=1,934), 2014 (n=2,007) e 2015 (n=2,412). As medidas longitudinais foram extraídas de uma subamostra (n=522) de escolares monitorados nos anos de 2013 (estudo de base) e 2015 (estudo de seguimento). No estudo painel foram analisadas as tendências no consumo alimentar dos escolares. No estudo longitudinal, foram investigadas as mudanças no consumo alimentar e os fatores associados. Informações de consumo alimentar e atividade física foram obtidas com o questionário on-line do Consumo Alimentar e Atividade Física de Escolares (WebCAAFE). Os itens alimentares foram agrupados em sete grupos: laticínios; cereais; feijões; carnes e frutos do mar; frutas, verduras e legumes (FLV); doces e guloseimas; e lanches e alimentos ultraprocessados. Peso e altura foram aferidos nas escolas por pesquisadores treinados utilizando procedimentos padronizados. O teste Qui-quadrado de Pearson foi utilizado para analisar as diferenças da amostra durante os anos. Aplicou-se os testes Kruskal-Wallis e Kruskal-Wallis de tendência para análise das tendências entre 2013, 2014 e 2015 no estudo painel. A diferença da frequência média de consumo dos grupos alimentares nos estudos base e seguimento foi feita com os testes T pareado para dados paramétricos e Wilcoxon para dados não paramétricos. Regressão logística multinomial foi aplicada para verificar os fatores associados com as mudanças no consumo alimentar na amostra longitudinal. Verificou-se uma tendência de redução da média de frequência de consumo de cereais durante os três anos (2013: 3,52; 2014: 3,40; 2015: 3,39; p=0,025). Longitudinalmente, a média de frequência de consumo de carnes e frutos do mar (2013: 0,98 e 2015: 1,10; p=0,016) e doces e guloseimas (2013: 1,96 e 2015: 2,17; p=0,028) aumentou e a de lanches e alimentos ultraprocessados diminuiu (2013: 0,95 e 2015: 0,80; p=0,014). A idade esteve associada com a maior probabilidade de aumento de laticínios (RRR: 1,54 IC95%: 1,16 2,05). As meninas variaram mais o consumo de FLV e foram menos propensas a aumentar a frequência de doces e guloseimas (RRR: 0.55 IC95%: 0.34 0.90) e lanches e ultraprocessados (RRR: 0.56 IC95% 0.36 0.87). O maior tercil de renda do setor censitário relacionou-se com a menor probabilidade de reduzir consumo de doces e guloseimas (RRR: 0,51 IC95%: 0,27 0,96) e maior probabilidade de reduzir FLV (RRR: 1,81 IC95%: 1,04 3,14), enquanto o maior nível de atividade física apresentou maior probabilidade de redução de laticínios (2º Tercil: RRR: 1,75 IC95%: 1,05 2,89 e 3º Tercil: RRR: 3,38 IC95%: 1,90 5,99), doces e guloseimas (2º Tercil: RRR: 1,97 IC95%: 1,10 3,38) e lanches e ultraprocessados (3º Tercil: RRR: 1,82 - IC 95%: 1,05 3,15). Crianças que relataram o consumo referente a um dia de semana em 2013 e passaram a relatar sobre o final de semana em 2015 foram mais propensas a aumentar o consumo de doces e guloseimas (RRR: 2,12 IC95%: 1,14 3,93). O estudo painel demonstrou uma estabilidade no consumo da maioria dos grupos alimentares, no entanto, longitudinalmente, verificou-se mudanças em um período relativamente curto de dois anos.Abstract : The objective of this study was to verify the trends and longitudinal changes in food consumption among schoolchildren (2nd-5th grades) from public schools of Florianópolis (South of Brazil). This is a panel (time-series cross-sectional) and longitudinal study. Three cross-sectional surveys were carried in 2013 (n=1.934), 2014 (n=2.007) and 2015 (n=2.412). Longitudinal data were collected from a subsample (n=522) of schoolchildren monitored in 2013 (baseline study) and 2015 (follow-up study). In the panel study were analyzed the trends in food consumption. In the longitudinal study was investigated the changes of the food consumption and associated factors. Dietary intake and physical activity data were obtained using the validated questionnaire WebCAAFE. Food items were aggregated to seven food groups: dairy products; cereals; cooked beans; meat/fish/seafood; fruits/green leaves/vegetables; sweets; snacks and ultra-processed foods. Anthropometric measurements of weight and height were carried out by trained researchers in the schools using standard techniques. Pearson s chi-squared test was used to describe sample differences over the years. Kruskal-Wallis and Kruskal-Wallis trend were used to analyze trends among 2013, 2014 and 2015 in the panel study. Difference in the food groups mean intake frequency in the baseline and follow-up studies was done with Paired T-test for parametric data and Wilcoxon for non-parametric data. Multinomial logistic regression was applied to verify the factors associated with changes in dietary intake in the longitudinal sample. In the repeated cross-sectional observations, there was a reduction trend of cereals consumption frequency mean (2013: 3,52; 2014: 3,39 e 2015: 3,40; p=0,025). Longitudinally, the mean frequency of consumption of meat/fish/seafood (2013: 0,98 e 2015: 1,10; p=0,016) and sweets (2013: 1,96 e 2015: 2,17; p=0,028) increased and snacks and ultra-processed foods decreased (2013: 0,95 e 2015: 0,80; p=0,014). Age was associated with a higher probability of increased dairy products (RRR: 1,54 IC95%: 1,16 2,05). Girls varied more FLV consumption and were less likely to increase sweets (RRR: 0.55 IC95%: 0.34 0.90) and snacks and ultra-processed (RRR: 0.56 IC95% 0.36 0.87). The highest income tertile was related to a higher probability of consumption of sweets (RRR: 0,51 IC95%: 0,27 0,96) and a decrease in FLV (RRR: 1,81 IC95%: 1,04 3,14) while the higher level of physical activity was more likely to reduce dairy products (2nd tertile: RRR: 1,75 IC95%: 1,05 2,89 e 3rd tertile: RRR: 3,38 IC95%: 1,90 5,99), sweets (2nd tertile: RRR: 1,97 IC95%: 1,10 3,38) and snacks and ultra-processed (3rd tertile: RRR: 1,82 - IC 95%: 1,05 3,15). Children who reported consumption for a weekday in 2013 and reported on the weekend in 2015 were more likely to increase their consumption of sweets (RRR: 2,12 IC95%: 1,14 3,93). In conclusion, the panel study demonstrated a stability in the consumption of most of the food groups and longitudinally, there were changes in a relatively short period of two years

Associação entre padrões de estilo de vida e excesso de peso em crianças e adolescentes de 7 a 14 anos do município de Florianópolis (SC)

Tese (doutorado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Nutrição, Florianópolis, 2023.Fatores de estilo de vida, como consumo alimentar, atividade física, uso de telas e hábito sono, são importantes contribuintes para o excesso de peso (incluindo obesidade). Estes comportamentos podem se inter-relacionar e ter efeitos sinérgicos e cumulativos nesta condição. A abordagem de padrões de estilo de vida contribui para entender a influência combinada desses múltiplos comportamentos. Diante disso, métodos multivariados baseados em dados são úteis na identificação de padrões de estilo de vida. A presente tese buscou verificar a associação entre padrões de estilo de vida e excesso de peso em crianças e adolescentes de sete a 14 anos do município de Florianópolis (SC). O documento está dividido em três etapas: revisão sistemática, estudo metodológico e estudo observacional. Inicialmente realizou-se revisão sistemática da literatura para identificar a associação entre padrões de estilo de vida e excesso de peso em adolescentes. Em geral, os estudos revisados não encontraram associação significativas, mesmo quando os resultados foram estratificados por sexo. No entanto, ao analisar os resultados estratificados por risco de viés, identificou-se uma associação positiva entre padrão de estilo de vida predominantemente não saudável e padrões mistos com excesso de peso em estudos transversais com risco moderado de viés. O estudo metodológico buscou descrever os aspectos operacionais e características do Estudo da Prevalência da Obesidade de Crianças e Adolescentes de Florianópolis (EPOCA 2018/2019) conduzido em 30 escolas do município para monitorar a saúde da população de escolares do 2º ao 9º ano do ensino fundamental. O estudo observacional, por sua vez, utilizou dados do EPOCA 2018/2019. Os dados foram coletados por uma equipe previamente treinada através de protocolos padronizados. Consumo alimentar, atividade física e uso de tela foram avaliados por meio do questionário validado Web-CAAFE. Os dados de sono foram obtidos a partir de um questionário respondido pelos pais/responsáveis. A massa corporal e a estatura foram mensuradas e classificadas segundo Índice de Massa Corporal de acordo com os pontos de corte da Organização Mundial da Saúde. A análise fatorial exploratória com estimativa de componentes principais foi aplicada aos dados de consumo alimentar para determinar padrões alimentares. Escores de atividade física foram gerados com base nos valores equivalentes de metabólicos do compêndio de atividades físicas para jovens. Para as atividades de tela, a frequência diária (0 a 6) foi considerada. A duração do sono (noturno somado aos cochilos durante o dia) foi determinada através da média ponderada de horas de sono entre dias de semana e finais de semana. Análise de cluster em duas etapas (hierárquica e não hierárquica) foi realizada para identificar os padrões de estilo de vida. A regressão logística foi usada para explorar as associações entre os padrões de estilo de vida e excesso de peso. Os dados foram analisados no programa estatístico Stata, versão 13.0, considerando peso amostral utilizando comando ?svy? do software. Identificaram-se quatro padrões de estilo de vida nos escolares avaliados: (1) padrão considerado predominantemente saudável caracterizado por alto escore de atividade física, baixa frequência de atividades de tela, baixa duração do sono, alta adesão ao padrão alimentar de café da manhã tradicional brasileiro e baixa adesão ao padrão de ultraprocessados; (2) padrão considerado não saudável caracterizado por baixo escore de atividade física, alta frequência de atividades de tela, baixa duração do sono e alta adesão ao padrão de ultraprocessados; (3) padrão considerado misto caracterizado por baixo escore de atividade física, baixa frequência de atividades de tela, alta duração do sono, e maior adesão ao padrão alimentar misto e ao padrão alimentar tradicional brasileiro; (4) padrão considerado misto caracterizado por moderado a alto escore de atividade física, baixa frequência de atividades de tela, moderada a baixa duração do sono, maior adesão ao padrão alimentar tradicional brasileiro e ao padrão de frutas, vegetais e água. As crianças e os adolescentes do padrão de estilo de vida não saudável (padrão 2) tiveram 37% mais chance de apresentar excesso de peso em comparação com as crianças e adolescentes do padrão mais predominantemente saudável (OR=1,37 ? IC95%: 1,10-1,70). Os achados desta tese auxiliam no delineamento de novos estudos, no direcionamento de políticas públicas e fornecem subsídios para auxiliar no desenvolvimento de ações e intervenções multidisciplinares para a população.Abstract: Lifestyle factors, such as food intake, physical activity, screen use, and sleep habit, are important contributors to overweight (including obesity). These behaviors can interrelate and have synergistic and cumulative effects on this condition. The approach of lifestyle patterns contributes to understanding the combined influence of these multiple behaviors. Multivariate data-based methods are useful in identifying lifestyle patterns. This doctoral thesis sought to verify the association between lifestyle patterns and overweight in children and adolescents aged between seven and 14 years in the city of Florianópolis (SC). The document is divided into three stages: systematic review, methodological study, and observational study. Initially, a systematic review of the literature was carried out to identify the association between lifestyle patterns and overweight in adolescents. In general, the reviewed studies did not find significant associations, even when the results were stratified by gender. However, by analyzing the results stratified by risk of bias, a positive association between predominantly unhealthy and mixed lifestyle patterns with overweight was identified in cross-sectional studies with a moderate risk of bias. The methodological study sought to describe the operational aspects and characteristics of the Study of the Prevalence of Obesity in Children and Adolescents of Florianópolis (EPOCA 2018/2019) conducted in 30 schools in the city to monitor the health of the population of students from the 2nd to the 9th grade of elementary school. The observational study, in turn, used data from EPOCA 2018/2019. Data were collected by a previously trained team using standardized protocols. Food intake, physical activity, and screen use were evaluated through the validated Web-CAAFE questionnaire. Sleep data were obtained from a questionnaire answered by parents/guardians. Body mass and height were measured and classified according to body mass index by World Health Organization cut points. For the observational study, exploratory factor analysis with estimation of principal components was applied to food intake data to determine eating patterns. Physical activity scores were generated based on the equivalent values of metabolic (MET) of the physical activity compendium for young people. For screen activities, the daily frequency (0 to 6) was considered. The duration of sleep (at night added to naps during the day) was determined through the weighted average of sleep hours between weekdays and weekends. Two steps of cluster analysis (hierarchical and non - hierarchical) were performed to identify lifestyle patterns. Logistic regression was used to explore associations between lifestyle patterns and overweight. The data were analyzed in the Stata Statistical Program, version 13.0, considering sample weight using ?svy? command. Four lifestyle patterns were identified in the evaluated students: (1) predominantly healthy pattern, characterized by a high physical activity score, low frequency of screen activities, low sleep duration, high adherence to the traditional breakfast food pattern Brazilian, and low adherence to the ultra-processed standard; (2) the unhealthier pattern, characterized by low physical activity score, high frequency of screen activities, short sleep duration and high adherence to the ultra-processed pattern; (3) pattern considered mixed characterized by low physical activity score, low frequency of screen activities, high sleep duration, and greater adherence to the mixed dietary pattern and the traditional Brazilian dietary pattern; (4) pattern considered mixed characterized by moderate to high physical activity score, low frequency of screen activities, moderate to short sleep duration, greater adherence to the traditional Brazilian dietary pattern and the pattern of fruits, vegetables, and water. Children and adolescents from unhealthy lifestyle pattern (lifestyle pattern 2) had 37% more chance to overweight compared to children and adolescents from the most predominantly healthy pattern (OR = 1.37-CI95%: 1.10-1.70). The findings of this thesis help in the design of new studies, in the direction of public policies and provide subsidies to assist in the development of multidisciplinary actions and interventions for the population

Diagnóstico nutricional e elaboração de material didático para educação nutricional de escolares

The nutritional status and food intake of school-aged children from the municipal public school network of the city of Florianopolis, SC, were evaluated in order to draw up a plan of action organized in the form of educational materials for nutrition education at school. The nutritional status was assessed through the Body Mass Index (BMI) and food consumption through the online Questionnaire on Food Consumption and Physical Activity in School-Aged Children (webCAAFE). Between, march to november of 2014, 640 school-going children aged 7 to 10 years from nine municipal public schools were evaluated. A prevalence of 20% of overweight and 13% of obesity was observed, in addition to a high consumption of foods of low nutritional value. The teaching material was organized in a booklet covering eight different subjects, structured with supporting text for the teacher, an example of a collaborative class, supporting text for the student and playful educational activities. It is hoped that the booklet will contribute to the improvement of nutritional education actions and assist in the promotion of healthy eating habits since childhood.O estado nutricional e o consumo alimentar de escolares da rede pública municipal de Florianópolis, SC, foi avaliado com o objetivo de elaborar um plano de ação organizado na forma de material didático para a educação nutricional no ambiente escolar. O estado nutricional foi avaliado pelo índice de massa corporal e o consumo alimentar, através do Questionário do Consumo Alimentar e Atividade Física de Escolares (webCAAFE). Entre março e novembro de 2014, 640 escolares de 7 a 10 anos de nove escolas da rede pública foram avaliados, sendo observados 20% de sobrepeso, 13% de obesidade e elevado consumo de alimentos não saudáveis. O material didático organizado em uma cartilha abordou oito temáticas, estruturada com texto de apoio ao professor, exemplo de aula dialogada, texto de apoio ao aluno e atividades lúdicoeducativas. Espera-se que a cartilha contribua para o incremento das ações de educação nutricional e auxilie na promoção de hábitos alimentares saudáveis desde a infância.El estado nutricional y el consumo alimentar de niños en edad escolar de Florianópolis, SC, fue evaluada con el fin de elaborar un plan de acción organizada en forma de materiales educativos para la educación nutricional en la escuela. El estado nutricional se evaluó mediante el índice de masa corporal y la ingesta dietética por la encuesta de la ingesta de alimentos y la Actividad Física de la Escuela (webCAAFE). Entre marzo y noviembre de 2014, se evaluaron 640 alumnos de 7 a 10 años a partir de nueve escuelas públicas y se observaron 20% del exceso de peso, el 13% de la obesidad y el alto consumo de alimentos poco saludables. El material de instrucción organizada en un folleto dirigido ocho temática de texto, estructurado con apoyo del maestro, ejemplo de la clase dialógica, apoyo a los estudiantes texto y las actividades recreativas y educativas. Se espera que el folleto contribuirá al aumento de la educación sobre la nutrición y ayudar en la promoción de hábitos alimentarios saludables desde la infanci

How Brazilian Schoolchildren Identify, Classify, and Label Foods and Beverages—A Card Sorting Methodology

This study examined how Brazilian schoolchildren identified, classified, and labeled foods and beverages. Semi-structured interviews were conducted with 133 schoolchildren aged 7 to 10 years old from a public school located in southern Brazil in 2015. A set of cards with pictures of 32 food and beverage items from the web-based Food Intake and Physical Activity of Schoolchildren tool (Web-CAAFE) were used. Participants identified each item, formed groups for them based on similarity, and assigned labels for those groups. Student’s t-tests and analysis of variance (ANOVA) tests were used to verify the mean difference between the groups of items. K-means cluster analysis was applied to identify similar clusters. Schoolchildren made an average of 9.1 piles of foods and beverages that they thought were similar (±2.4) with 3.0 cards (±1.8) each. Five groups were identified: meats, snacks and pasta, sweets, milk and dairy products, and fruits and vegetables. The most frequently used nomenclature for labeling groups was taxonomic-professional (47.4%), followed by the specific food item name (16.4%), do not know/not sure (13.3%), and evaluative (health perception) (8.8%). The taxonomic-professional category could be applied to promote improvements in the identification process of food and beverage items by children in self-reported computerized dietary questionnaires

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care