Impacto de intervenção em nível ambulatorial sobre o estado nutricional e outros indicadores de saúde entre crianças com excesso de peso

Abstract

Overweight reaches epidemic proportions among children and adolescents worldwide. The development of comorbidities is increasingly more frequent in overweight children, in addition to having a greater chance of chronic non-communicable diseases, premature death and disability in adult life. Its etiology is multi-factorial, requiring multi-component interventions, in order to improve healthy habits at various levels, including individual, family, school and community. Family based intervention studies for treating obesity have been shown to be effective. This study aimed to evaluate the impact of outpatient intervention on nutritional status and other health indicators of overweight children aged six to nine years. It is a randomized clinical trial with overweight children from six public schools. Schools were randomly allocated between intervention (GI, n = 4) and control (CG, n = 2) groups. Individuals in GC were given monthly nutrition consultation for five months. For GI, in addition to consultations, children received sachets containing 5 grams of chia seeds and flaxseed for daily consumption, and nine meetings were held during the same period, covering educational activities for caregivers and for children, in separate groups, and cooking workshops for all together. The educational activities themes included behavioral, nutritional education and physical activity issues. The biochemical evaluation was performed at the beginning and at the end of the study, and anthropometric at each consultation. The primary outcome was BMI, and the secondary outcomes were waist circumference (PC), Conicity Index (CI), abdominal perimeter (AP), HOMA-IR, total cholesterol, CRP, adiponectin, leptin and lipid hydroperoxides, among others (analyzed as continuous variables). Linear mixed effects models were used to assess the trajectories of the outcomes according to the gradient of participation in the study activities and according to the consumption levels of chia and linseed. The groups studied were similar at the study baseline. The trajectories of the biochemical and anthropometric outcomes did not present a statistically significant difference in the models produced. However, it was pointed out a tendency to improve the anthropometric outcomes, HOMA-IR, CRP and total cholesterol for the children who had more attendance to the activities. There was an inverse trend between lipid hydroperoxides and the gradient of participation in the study. Regarding the trajectories by consumption level of chia and linseed, for BMI and PA, there was a trend of improvement of the parameters as the consumption of chia and linseed increased. For PC, the only increasing curve was of the category "No consumption". HOMA-IR had upward trajectories for all categories, but suggesting lower slopes as consumption of chia and linseed increased. For lipid hydroperoxides and adiponectin the effect was the reverse, with better outcomes presented in the curve of those who had "No consumption". The intervention proved to be feasible to be implemented, but showed modest effects for anthropometric and biochemical outcomes