Physical activity and nutrition education at the school environment aimed at preventing childhood obesity: evidence from systematic reviews

AbstractObjectiveTo organize the main findings and list the most frequent recommendations from systematic reviews of interventions developed at the school environment aimed at reducing overweight in children and adolescents.Data sourceSearches for systematic reviews available until December 31, 2014 were conducted in five electronic databases: Cochrane, PubMed, SciELO, SPORTDiscus, and Web of Science. Manual search for cross‐references were also performed.Summary of the findingsOf the initial 2,139 references, 33 systematic reviews adequately met the inclusion criteria and were included in the descriptive summary. In this set, interventions with periods of time greater than six months in duration (nine reviews), and parental involvement in the content and/or planned actions (six reviews) were identified as the most frequent and effective recommendations. Additionally, it was observed that boys respond more effectively to structural interventions, whereas girls respond to behavioral interventions. None of the included reviews was able to make inferences about the theoretical basis used in interventions as, apparently, those in charge of the interventions disregarded this component in their preparation.ConclusionsAlthough the summary identified evidence with important applications in terms of public health, there are still gaps to be filled in this field of knowledge, such as the effectiveness of different theoretical models, the identification of the best strategies in relation to gender and age of participants and, finally, the identification of moderating variables to maximize the benefits provided by the interventions.ResumoObjetivoOrganizar os principais achados e relacionar as recomendações mais frequentes das revisões sistemáticas de intervenções desenvolvidas no ambiente escolar com fins na redução do excesso de peso em crianças e adolescentes.Fonte dos dadosBuscas por revisões sistemáticas disponíveis até 31 de dezembro de 2014 foram feitas em cinco bases de dados eletrônicas: Cochrane, PubMed, SciELO, SPORTDiscus e Web of Science. Buscas manuais por referências cruzadas também foram desenvolvidas.Síntese dos dadosDas 2.139 referências iniciais, 33 revisões sistemáticas responderam adequadamente aos critérios de inclusão e compuseram a síntese descritiva. Nesse conjunto, identificaram‐se como recomendações mais frequentes e efetivas intervenções que têm períodos de tempo superior a seis meses de duração (nove revisões) e o envolvimento dos pais nos conteúdos e/ou ações previstas (seis revisões). Além disso, observou‐se que meninos respondem de forma mais efetivas às intervenções estruturais, enquanto as meninas às intervenções comportamentais. De modo consistente entre as revisões incluídas, nenhuma conseguiu fazer inferências sobre a base teórica usada nas intervenções, uma vez que, aparentemente, os responsáveis pelas intervenções desconsideraram esse componente em sua elaboração.ConclusõesEmbora a síntese tenha identificado evidências com aplicações importantes em termos de saúde coletiva, ainda existem lacunas a serem preenchidas nesse campo do conhecimento, tais como a efetividade de diferentes modelos teóricos, o reconhecimento das melhores estratégias em relação ao sexo e à idade dos participantes e, por fim, a identificação de variáveis moderadoras para potencializar os benefícios proporcionados pelas intervenções

Tendência secular e fatores associados ao excesso de peso entre pré-escolares brasileiros: PNSN-1989, PNDS-1996 e 2006/07

OBJECTIVE:to describe the secular trends in overweight among preschool children in the years 1989, 1996, and 2006, and to identify risk factors associated with this condition in 2006.METHODS:anthropometric data from three surveys (1989, 1996, and 2006) with a representative sample of the population were analyzed. Overweight was defined as the weight-for-height Z-score. The multivariable models of overweight association with risk factors were generated by Poisson regression, and the estimates were shown as prevalence ratios with their respective 95% confidence intervals (PR [95% CI]).RESULTS:throughout the 17-year period studied, the relative prevalence of overweight in preschoolers increased by 160% in Brazil, representing an increase of 9.4% per year. Based on data from the National Survey on Demography and Health of Women and Children - 2006/07, four multivariable models were created (macro-environmental, maternal, individual, and final model) assuming hierarchy among the risk factors. In the final model, only the following remained associated with overweight: regions South/Southeast (1.55 [1.17 to 2.06]), middle-class (1.35 [1.02 to 1.77]), maternal obesity (1.66 [1.22 to 2.27]), birth weight > 3.9 kg (1.87 [1.31 to 2.67]), and being an only child or having only one sibling (1.81 [1.31 to 2.49]).CONCLUSION:the prevalence of overweight among preschool children in Brazil has increased dramatically over the past 17 years, and it was higher in the 1996-2006 period. Future strategies for prevention and control of overweight in public health should focus or intensify actions in communities that are characterized by the presence of the risks identified in the present study.OBJETIVO:descrever a tendência secular do excesso de peso (EP) entre pré-escolares nos anos de 1989, 1996 e 2006 e identificar os fatores de risco associados a esta condição em 2006.MÉTODOS:análise dos dados de três inquéritos antropométricos (1989, 1996 e 2006) com a mostra representativa da população brasileira. O EP foi definido como o escore-Z de peso-para-altura > + 2. Os modelos multivariáveis de associação do EP com os fatores de risco foram gerados por meio da regressão de Poisson e as estimativas apresentadas como razão de prevalência com seus respectivos intervalos de confiança de 95% (RP [IC 95%]).RESULTADOS:no período de 17 anos estudado, a prevalência relativa do EP em pré-escolares aumentou em 160% no Brasil, representando incremento de 9,4% ao ano. A partir dos dados da Pesquisa Nacional de Demografia e Saúde da Mulher e da Criança-2006/07 criamos quatro modelos multivariáveis (macroambiental, materno, individual, modelo final) assumindo hierarquia entre os fatores de risco. No modelo final, permaneceram como fatores associados ao EP: as macrorregiões Sul/Sudeste (1,55 [1,17-2,06]), a classe média (1,35 [1,02-1,77]), a obesidade materna (1,66 [1,22-2,27]), o peso ao nascer > 3,9 kg (1,87 [1,31-2,67]) e ser filho único ou possuir um irmão (1,81 [1,31-2,49]).CONCLUSÃO:a prevalência de EP entre pré-escolares no Brasil aumentou drasticamente nos últimos 17 anos, sendo mais intenso no intervalo de 1996-2006. Futuras estratégias de prevenção e controle do EP em saúde pública devem considerar em seu escopo, ou intensificar suas ações, nas coletividades que se caracterizem pela presença dos riscos identificados neste trabalho.Universidade Federal de São Paulo (UNIFESP) Department of PediatricsUniversidade Federal de Juiz de Fora Division of NephrologyUNIFESP, Department of PediatricsSciEL

The effect of school-based physical activity interventions on body mass index: a meta-analysis of randomized trials

This study reviewed the effectiveness of school-based physical activity interventions aimed at reducing overweight, obesity and hypertension in children. We searched 14 databases and analyzed studies published between April 2009 and September 2012. Only randomized controlled trials performed at the school level that included elements of physical activity but did not include nutritional co-interventions were analyzed. Studies were assessed by two recommended tools (EPHPP and GRADE), and the standardized mean differences with 95% confidence intervals were collected for a random-effect meta-analysis. A total of 12 papers were included in the meta-analysis, and these were divided according to three outcomes: body mass index (11 trials, n  =  4,273, −0.02, 95% CI: −0.13 to 0.17, p  =  0.8); body weight (5 trials, n  =  1,330, −0.07, 95% CI: −0.18 to 0.04, p  =  0.2); and blood pressure (6 trials, n  =  1,549), including systolic (0.11, 95% CI: −0.10 to 0.31, p  =  0.3) and diastolic pressure (−0.00, 95% CI: −0.10 to 0.10, p  =  0.9). This meta-analysis of data from 11 randomized, school-based physical activity interventions suggests that, regardless of the potential benefits of physical activity in the school environment, the interventions did not have a statistically significant effect. However, it is difficult to generalize from these results because the duration, intensity and type of physical activity used in the interventions varied greatly.Cotas do Programa de Pos-Graduacao do Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq)Fundacao de Amparo a Pesquisa de Sao Paulo (FAPESP)Universidade de São Paulo Hospital das Clinicas Faculdade de MedicinaFederal University of São PauloFederal University of São Paulo Pediatrics Department, NutrologyUNIFESP, Pediatrics Department, Nutrology09/12438-5SciEL

The effect of school-based physical activity interventions on body mass index: a meta-analysis of randomized trials

This study reviewed the effectiveness of school-based physical activity interventions aimed at reducing overweight, obesity and hypertension in children. We searched 14 databases and analyzed studies published between April 2009 and September 2012. Only randomized controlled trials performed at the school level that included elements of physical activity but did not include nutritional co-interventions were analyzed. Studies were assessed by two recommended tools (EPHPP and GRADE), and the standardized mean differences with 95% confidence intervals were collected for a random-effect meta-analysis. A total of 12 papers were included in the meta-analysis, and these were divided according to three outcomes: body mass index (11 trials, n  =  4,273, −0.02, 95% CI: −0.13 to 0.17, p  =  0.8); body weight (5 trials, n  =  1,330, −0.07, 95% CI: −0.18 to 0.04, p  =  0.2); and blood pressure (6 trials, n  =  1,549), including systolic (0.11, 95% CI: −0.10 to 0.31, p  =  0.3) and diastolic pressure (−0.00, 95% CI: −0.10 to 0.10, p  =  0.9). This meta-analysis of data from 11 randomized, school-based physical activity interventions suggests that, regardless of the potential benefits of physical activity in the school environment, the interventions did not have a statistically significant effect. However, it is difficult to generalize from these results because the duration, intensity and type of physical activity used in the interventions varied greatly

Tendência temporal da prevalência de desnutrição em crianças menores de cinco anos assistidas pelo Programa Bolsa Família (2008-2019)

The objective of this study was to analyze the temporal trend of malnutrition in children under five years of age assisted by the Bolsa Família Program (PBF) between 2008 and 2019, exploring regional inequalities and seeking to determine the impact of the economic and political crises worsened in 2014 and of government adherence to fiscal austerity policies on the trend. Analyses were conducted using aggregate data from infants (0-23 months) and preschoolers (24-59 months) extracted from the Food and Nutrition Surveillance System (SISVAN) assisted by the PBF (n=34,272,024). Trends were analyzed using generalized linear models with age-specific mixed effects (negative binomial distribution and log-link function). Regional inequalities were analyzed by grouping the federative units according to the social vulnerability index (SVI) and the influence of crises and austerity policies on the prevalence of malnutrition by means of the interaction between "year" and "crisis" (2008-2013 vs. 2014-2019). There was a reduction in the prevalence of child malnutrition until mid-2013, when trends became stationary for preschoolers and upward for infants. Higher risk of malnutrition was also observed in states with medium and high social vulnerability compared to those with low social vulnerability. The turning point in the trends supports the hypothesis that the political and economic crises, and government responses to these crises, have negatively impacted the nutritional status of children in poverty and extreme poverty in Brazil.O objetivo deste estudo foi analisar a tendência temporal da desnutrição em crianças menores de cinco anos de idade assistidas pelo Programa Bolsa Família (PBF) entre 2008 e 2019, explorando desigualdades regionais e buscando determinar o impacto das crises econômica e política agravadas em 2014 e da adesão governamental às políticas de austeridade fiscal na tendência. As análises foram realizadas utilizando dados agregados de lactentes (0-23 meses) e pré-escolares (24-59 meses), extraídos do Sistema de Vigilância Alimentar e Nutricional (SISVAN) assistidas pelo PBF (n=34.272.024). As tendências foram analisadas por meio de modelos lineares generalizados com efeitos mistos específicos para as faixas etárias (distribuição binomial negativa e função de ligação log). As desigualdades regionais foram analisadas a partir do agrupamento das unidades federativas segundo o índice de vulnerabilidade social (IVS) e a influência das crises e das políticas de austeridade na prevalência de desnutrição por meio da interação entre “ano” e “crise” (2008-2013 vs. 2014-2019). Houve redução na prevalência de desnutrição infantil até meados de 2013, quando as tendências passaram a ser estacionárias para pré-escolares e ascendentes para lactentes. Observou-se também maior risco de desnutrição nos estados com média e alta vulnerabilidade social, quando comparadas àqueles com baixa vulnerabilidade social. O ponto de inflexão nas tendências corroboram a hipótese de que as crises política e econômica, e as respostas governamentais a estas crises, provocaram impacto negativo sobre o estado nutricional de crianças em situação de pobreza e extrema pobreza no Brasil

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Determinantes sociobiológicos de desvios nutricionais em pré-escolares - pesquisa nacional de demografia e saúde da criança e da mulher (PNDS) - 2006/07

Contexto: Inquéritos nacionais de saúde são importantes instrumentos para o reconhecimento das características sociais, demográficas e epidemiológicas da população, subsidiando o planejamento, a implementação e a avaliação de políticas públicas. As Pesquisas Nacionais de Demografia e Saúde da Criança e da Mulher (PNDS) de 1996 e 2006, conjuntamente com os inquéritos de 1974/75 (Estudo Nacional da Despesa Familiar - ENDEF) e 1989 (Pesquisa Nacional sobre Saúde e Nutrição - PNSN), vem cumprindo seu papel, permitindo comparações de seus dados ao longo do tempo em nível nacional e internacional dada à padronização dos métodos de amostragem e coleta de dados. Métodos: A presente tese analisou a tendência secular do excesso de peso (EP) entre pré-escolares (24-59 meses) por meio dos dados dos inquéritos nacionais de 1989, 1996 e 2006 e buscou analisar os fatores associados a essa condição no ano de 2006/07. Além disso, considerando o interesse da comunidade científica em relação ao ganho de peso e o consumo de bebidas açucaradas e o aleitamento materno exclusivo (AME) e os achados anteriores sobre o aumento da prevalência de EP, foi realizada análise testando o efeito destes fatores no ganho ponderal entre os pré-escolares, utilizando a variável "Evolução Ponderal Condicional" (EPC). Esta variável é o resíduo padronizado gerado por uma regressão linear específica para sexo, tendo o Z-score de peso-para-idade (ZP/I) no inquérito como variável de desfecho e o ZP/I ao nascer e a idade como variáveis independentes; portanto, a EPC representa o quanto a criança se desviou do ganho ponderal esperado considerando seus pares. Tal estratégia corrige importantes limitações da análise do ganho ponderal, tal como o efeito de regressão a média, a colinearidade de medidas antropométricas repetidas e as diferentes idades na data do inquérito. Resultados: Os resultados apontaram que a prevalência de EP entre pré-escolares aumentou drasticamente nos últimos 17 anos (160%), representando aumento relativo de 9,4% ao ano. Entre as macrorregiões brasileiras o incremento mais intenso ocorreu no intervalo de 96-06. Na análise de regressão de Poisson múltipla para os fatores associados ao EP, identificamos que as macrorregiões S e SE, a classe econômica média, crianças com mãe obesa ou que nasceram com peso ? 3,9 kg e ter um irmão ou ser filho único se apresentaram independentemente associados ao EP. No segundo trabalho, foi possível confirmar a hipótese de que o consumo excessivo de bebidas açucaradas e o AME apresentaram efeitos opostos em relação ao ganho ponderal, sendo que a EPC foi maior à medida que se aumenta o consumo de bebidas açucaradas. Conclusões: Futuras estratégias de prevenção e controle do EP em saúde pública devem considerar coletividades que se caracterizem pela presença destes riscos, uma vez que é crescente o número de evidências que apontam a extensão dos prejuízos causados no curso da vida. Além disso, sugere-se que a promoção de hábitos saudáveis de vida deve ser iniciada na mais tenra idade, conferindo a mesma atenção dedicada à promoção do aleitamento materno (exclusivo) entre as prioridades das Secretarias e Ministério da Saúde no Brasil. Do ponto de vista da prática clínica, a percepção destes riscos é simples e deve ser considerada como aspecto importante no cuidado integral da saúde da criança.Dados abertos - Sucupira - Teses e dissertações (2013 a 2016

Effects of nutrition education on recurrent coronary events after percutaneous coronary intervention: A randomized clinical trial

BACKGROUND: Changes in lifestyle include a healthy diet. However, due to different educational approaches, the effects of nutritional counselling are still not very encouraging and require further study. The objective of this study was to analyse the effectiveness of a nutrition education intervention program on mortality and recurrence of cardiovascular events evaluated after one and four years of follow-up. METHODS: A randomized clinical trial was performed at a public hospital in Brazil with 200 patients who had recently undergone elective percutaneous coronary intervention (PCI). In addition to the traditional care, the patients allocated to the intervention group attended nutrition education workshops that adopted a constructivist approach towards behavioural change for six months. Primary outcome was death, and secondary outcomes were acute myocardial infarction (AMI), revascularization with re-PCI, or coronary artery bypass graft (CABG) surgery. The magnitude of the first year effect was calculated by the absolute risk reduction, and the risk ratio was calculated as a measure of the cumulative incidence of events after four years. The critical p-value was assumed as 5%. RESULTS: After one year of follow-up, in the intervention and control groups, respectively, there were 5 and 7 deaths (p = 0.53); 5 and 6 AMIs (p = 0.73); 4 and 6 re-PCIs (p = 0.50); and 4 and 4 CABGs (p = 0.98). After four years, the risk ratios between intervention and control groups were 0.75 (95% CI 0.35–1.58) for death, 0.89 (95% CI 0.34–2.28) for AMI, 0.86 (95% CI 0.40–1.84) for re-PCI, and 1.14 (95% CI 0.38–3.40) for CABG. CONCLUSION: Although differences in events between the two groups were not significant, data suggest that the lower number of events observed in the intervention group is most notable with the longer follow-up. TRIAL REGISTRATION NUMBER: NCT01028066. Registered 8 December 2009, retrospectively registered