Nelson Nardo Junior

Validação interna do questionário de estágio de prontidão para mudança do comportamento alimentar e de atividade física

Objective: To translate into Portuguese the contents of the questionnaire for adaptation assessment of dietary and physical activity changes proposed by Sutton et al, to be used with adolescents; and to verify the internal consistency and reliability of this tool. Methods: The content validation was accomplished by a multidisciplinary group, which was consulted after the translation and back translation of the instrument in order to generate a coherent version, followed by the cultural adaptation performed using a Likert’s scale, from which adolescents assessed clarity and relevance of each statement. The reliability and internal consistency of the tool were assessed by a questionnaire applied to 32 obese adolescents of both genders from a multiprofessional program for obesity treatment. They had, on average, 13.5±1.59 years old and 86.1±18.8kg. The Cronbach’s alpha coefficient was used to assess the internal consistency, as well as Pearson, Spearman and intraclass correlation coefficients. Also the t-test was used to assess reliability. Results: The results of test and retests revealed the high reliability of the tool. Internal consistency showed good reliability rates for all areas, with all values higher than or near to 0.70. Conclusions: The questionnaire presented good internal consistency and reliability in obese adolescents. However, it

Impact of readiness to change behavior on the effects of a multidisciplinary intervention in obese Brazilian children and adolescents

The obesity epidemic is a global challenge that requires evidence-based intervention to slow the emergence of weight-related illness in children and adolescents. Thus, effective treatments are urgently needed. This study aimed to analyze whether there is relationship between the initial stage of readiness for behavior change (SRBC) and the results obtained through participation in a multidisciplinary program of obesity treatment (MPOT). The study included 113 overweight or obese children and adolescents who participated in an intervention for 16 weeks, in which the categorical variable was the SRBC. The dependent variables included: anthropometric measures of body composition, hemodynamic parameters (e.g., blood pressure values), and health-related physical fitness. Although stages 1 and 2 had greater improvements in flexibility than those in stage 5, and stage 1 had greater percentage changes in abdominal strength than those in stage 5, children and adolescents in the highest stage had greater percentage changes for anthropometric, hemodynamic and cardiorespiratory fitness, suggesting an impact of the stage of change on the effects of a MPOT. This study suggests that SRBC plays a role in obesity treatment in Brazilian children and adolescents and warrants consideration when enrolling patients to intervention.

Efeito do exercício físico aeróbio sobre o perfil lipídico de pacientes idosas, portadoras de Diabetes Mellitus tipo 2, atendidas em Unidade Básica de Saúde, Maringá, Estado do Paraná.

This study aims to evaluate the influence of a physical exercise program on the lipid profile in type 2 diabetic elderly women. The patients were...

Alterations in Metabolic Profile Occur in Normal-Weight and Obese Men during the Ramadan Fast Despite No Changes in Anthropometry

We examined the variations in eating behavior, appetite ratings, satiety efficiency, energy expenditure, anthropometric and metabolic profile markers prior to, during as well as 1 and 4 months after Ramadan in normal-weight and obese men. Anthropometric, energy expenditure (indirect calorimetry and accelerometry), metabolic (fasting blood sample), appetite (visual analogue scales), and eating behavior (Three-Factor Eating Questionnaire) measurements were performed in 10 normal-weight (age: 25.2 ± 4.7 years; BMI: 24.4 ± 1.9 kg/m2) and 10 obese (age: 27.0 ± 4.5 years; BMI: 34.8 ± 3.7 kg/m2) men. The satiety quotient (SQ) was calculated 180 minutes after breakfast consumption. All anthropometric variables, as well as resting and total energy expenditure, were greater in obese compared to normal-weight participants (P = 0.02–0.0001). Similarly, obese participants had greater triglycerides, insulin, and homeostatic model assessment-insulin resistance concentrations (P = 0.02–0.002). Greater apolipoprotein B, glucose, total cholesterol, and low-density lipoprotein concentrations were noted during Ramadan (P = 0.04–0.0001). Dietary restraint scores were also greater during Ramadan (P = 0.0001). No differences in anthropometry, other metabolic profile markers, energy expenditure, appetite ratings, and SQ were noted across sessions. Lastly, changes in anthropometric measurements correlated with delta metabolic profile markers, as well as changes in disinhibition eating behavior trait and dietary restraint scores. The Ramadan fast led to increases in certain metabolic profile markers despite no changes in appetite and anthropometry.

Physical, clinical, and psychosocial parameters of adolescents with different degrees of excess weight

OBJECTIVE: To compare body composition, hemodynamic parameters, health-related physical fitness, and health-related quality of life of adolescents with anthropometric diagnosis of overweight, obesity, and severe obesity. METHODS: 220 adolescents with excess body weight were enrolled. They were beginners in a intervention program that included patients based on age, availability, presence of excess body weight, place of residence, and agreement to participate in the study . This study collected anthropometric and hemodynamic variables, health-related physical fitness, and health-related quality of life of the adolescents. To compare the three groups according to nutritional status, parametric and non-parametric tests were applied. Significance level was set at p<0.05. RESULTS: There was no significant difference in resting heart rate, health-related physical fitness, relative body fat, absolute and relative lean mass, and health-related quality of life between overweight, obese, and severely obese adolescents (p>0.05). Body weight, body mass index, waist and hip circumference, and systolic blood pressure increased as degree of excess weightincreased (p<0.05). Dyastolic blood pressure of the severe obesity group was higher than the other groups (p<0.05). There was an association between the degree of excess weight and the prevalence of altered blood pressure (overweight: 12.1%; obesity: 28.1%; severe obesity: 45.5%; p<0.001). The results were similar when genders were analyzed separately. CONCLUSION: Results suggest that overweight adolescents presented similar results compared to obese and severely obese adolescents in most of the parameters analyzed.

Estágio de prontidão para mudança de comportamento de adolescentes interessados em ingressar no Programa Multiprofissional de Tratamento da Obesidade

OBJETIVO: Avaliar o estagio de prontidao para mudanca do comportamento (EPMC) alimentar e de atividade fisica de adolescentes e verificar a associacao entre as variaveis genero, faixa etaria e classificacao do indice de massa corporea (IMC) com o EPMC. METODOS: Foram avaliados 145 adolescentes entre dez e 18 anos interessados em ingressar no Programa Multiprofissional de Tratamento da Obesidade (PMTO). As avaliacoes incluiram, alem dos EPMC, parâmetros antropometricos. A analise estatistica envolveu a aplicacao do teste t de Student para amostras independentes e do teste de Mann-Whitney na comparacao entre os grupos. O teste do qui-quadrado de tendencia foi utilizado para verificar se houve ou nao associacao entre as variaveis do estudo, sendo significante p<0,05. RESULTADOS: Em relacao ao comportamento alimentar (quantidade e tamanho das porcoes), verificou-se associacao entre IMC e o EPMC. Tambem foi observado que os adolescentes mais velhos apresentaram EPMC mais avancado em relacao ao consumo de frutas e verduras. O mesmo se verificou em relacao a pratica habitual de atividade fisica. CONCLUSOES: Ha associacao entre IMC e o EPMC relacionado ao comportamento alimentar (quantidade e tamanho das porcoes), do mesmo modo que entre a idade e o EPMC relacionado ao consumo de frutas e vegetais e pratica habitual de atividade fisica. Recomenda-se a realizacao de estudos experimentais a fim de verificar se o EPMC tem poder preditivo em programas de intervencao destinados ao tratamento do excesso de peso

Tratamento multiprofissional da obesidade e sua cessação em adolescentes: efeitos no perfil hemodinâmico

To evaluate the effects of a Multiprofessional Program of Obesity Treatment (PMTO) and its cessation on hemodynamic profile in adolescents. We evaluated 19 excess of weight adolescents aged from 10 to 18 years. Anthropometric measures, resting blood pressure and resting heart rate were included in analysis. Adolescents completed 16 weeks of PMTO with a multiprofessional team focused on promote lifestyle changes in adolescents. The same adolescents returned to evaluation after eight weeks of activities cessation. After PMTO, we observed reducing in heart rate of girls without differences to cessation moment. Boys presented improvement in variables: abdominal circumference, BMI, relative body fat and lean mass after PMTO. After cessation period there was significant increase on body weight. Results evidences the positive impact of PMTO demonstrating different effects according to gender.

Prevalence of metabolically healthy obese phenotype and associated factors in South American overweight adolescents: a cross-sectional study

OBJECTIVE The aim of this study was to verify the prevalence of metabolically healthy obese (MHO) phenotype and associated factors in South American adolescents who are overweight. METHODS A cross-sectional study was carried out with 340 overweight adolescent boys and girls between 10 and 18 y of age. The participants were classified as MHO according to two definitions: absence of any metabolic syndrome component and absence of insulin resistance (IR). The MHO phenotype-associated factors analyzed were age, sex, nutritional status, waist circumference (WC), body composition, metabolic profile, and cardiorespiratory fitness. Multivariable logistic regression was used to determine predictors of MHO using odds ratios with 95% confidence intervals. RESULTS The prevalence of MHO in South American overweight adolescents was 49.4% and 55.9% according to MS and IR criteria, respectively. Sex and WC were predictors of the MHO phenotype, considering MS classification criterion. For the IR criterion, age, WC, and triacylglycerol levels were independent predictors of MHO in adolescents. Cardiorespiratory fitness did not predict MHO phenotype in any of the criteria used. CONCLUSIONS The prevalence of MHO in South American overweight adolescents was high and varied according to the definition used. Age, sex, WC, and triacylglycerolslevel were independent predictors of the MHO phenotype in this population.

Building a response criterion for pediatric multidisciplinary obesity intervention success based on combined benefits

To propose a response criterion for analyzing the intervention success by verifying patient outcomes after a multidisciplinary obesity treatment program in Brazilian children and adolescents. Obese children and adolescents (n = 103) completed a 16-week multidisciplinary intervention (IG) and were compared to the control group (CG) (n = 66). A cluster of parameters (e.g. total domain of HRQoL; BMI z-score; cardiorespiratory fitness; body mass; waist circumference; fat mass; lean mass) were measured pre and post-intervention, and the sum of the median percentage variation and the percentile 25 and 75 were used from IG and CG to determine the responsiveness to the program. We are proposing four ranges in which children and adolescents may be classified after the intervention: (1) CG percentile 50 values or lower are considered non-responsive to the intervention, (2) values greater than CG percentile 50 but lower than IG percentile 50 are considered slightly responsive, (3) values greater than IG percentile 50 but lower than IG percentile 75 were considered as moderately responsive, and (4) values greater than IG percentile 75 were considered very responsive.Conclusions: This criterion may serve as a complementary tool that can be employed to monitor the response to this model of multidisciplinary intervention.What is Known:• The effectiveness of multidisciplinary obesity interventions is usually determined by comparing changes in selected outcomes in the intervention versus versus control group.• There is no consensus about what should be assessed before and after the intervention program, which makes difficult to compare different programs and to determine their rate of responsiveness.What is New:• This study proposes a response criteria to pediatric obesity interventions following a similar model compared to ours based on key variables that presents low cost and high applicability in different settings.

Intervenção multiprofissional melhora a aptidão física relacionada à saúde de adolescentes com maior efeito sobre as meninas em comparação aos meninos

This study aimed to verify the differences between both boys and girls responses to a multidisciplinary program of obesity treatment on health-related physical fitness. One hundred and sixty three adolescents with excess body weight and aged 10 to 18 years took part in the present study. It was assessed anthropometric parameters, body composition, flexibility, abdominal strength/resistance and cardiorespiratory fitness before and after 16 weeks of a multiprofessional intervention. The multiprofessional intervention was developed by physical educators, nutritionist, psychologist, pediatrician and was focused on motivate eating and exercise changes which could promote positive changes on the parameters analyzed. The intervention was conducted three times per week in which theoretical intervention lasted one hour with physical educators, nutritionist and psychologist and another hour designated to practical interventions of the physical educators in which predominated resistance and aerobic exercise as well as basketball practice. After the intervention, both girls and boys presented significant improvements in BMI, waist and hip circumference, relative and absolute body fat, lean mass, flexibility, strength and resistance in abdominal and cardiorespiratory fitness; however the results were more expressive for girls on waist circumference, body fat (kg), VO2max and abdominal strength/resistance.