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Advisor(s)
Abstract(s)
Introdução: Atualmente tem-se verificado alterações ao estado nutricional nomeadamente com um aumento da prevalência de obesidade em todo o Mundo, tanto em adultos como em crianças. Em especial, a obesidade infantil é identificada como um problema de saúde pública de tendência crescente. Nas crianças portuguesas verifica-se a mesma realidade. No entanto, as causas para o aumento deste excesso ponderal em crianças ainda não estão totalmente esclarecidas. A idade pré-escolar reveste especial relevância na adoção de hábitos alimentares e de atividade física, pois estes tendem a manter-se durante a vida adulta. Neste sentido, os jardins-de-infância desempenham um importante papel, pois são os locais onde as crianças realizam uma parte significativa da sua alimentação. Por conseguinte, a alimentação praticada nos jardins-de-infância poderá ter um papel importante no desenvolvimento de um padrão alimentar mais saudável e menos “obesigénico”. Objetivos: Caracterizar e quantificar a energia das refeições do meio da manhã e meio da tarde; relacionar o valor energético consumido pelas crianças nestas refeições com o seu estado nutricional. Avaliar a influência do género e do meio de residência no consumo das refeições escolares. Métodos: A recolha dos dados antropométricos e alimentares das crianças deu-se entre Outubro de 2014 e Fevereiro de 2015. Como parâmetros antropométricos foram avaliados neste estudo, a estatura, o peso, os perímetros da cintura e do braço. Posteriormente, estes dados foram classificados de acordo com os percentis e calculado o Índice de Massa Corporal para cada criança com a respetiva classificação do estado nutricional, segundo os critérios da Organização Mundial de Saúde. Para a avaliação da ingestão alimentar das crianças no jardim-de-infância, procedeu-se à pesagem dos alimentos disponíveis e dos desperdícios através de uma balança digital. Para avaliar a ingestão alimentar das crianças fora das instalações do jardim-de-infância, foi entregue aos encarregados de educação um questionário para o preenchimento de um registo de ingestão alimentar de 3 dias (2 de semana e 1 de fim-de-semana). Foi realizado o cálculo das necessidades energéticas através da fórmula de Harris-Benedict, incluindo os dados de atividade física previamente recolhidos na aplicação do questionário. O tratamento estatístico das variáveis em estudo foi realizado através do programa SPSS versão 22. Resultados: Este estudo incluiu 153 crianças com idades entre os 3 e os 6 anos, apresentando uma mediana de 4,4 anos (3,0; 6,7). Relativamente à distribuição segundo o género, 53,6% eram rapazes. Verificou-se uma prevalência de excesso de peso/obesidade e obesidade de 12,4% e de 6,5% respetivamente, constataram-se valores superiores de excesso de peso e obesidade nos rapazes (7,8% e 3,9%), e nas crianças do meio urbano (8,5% e 4,6%). Relativamente à percentagem do valor energético ingerido nas refeições realizadas nos jardins-de-infância, os rapazes (66,8±15,8% vs. 52±11,4%; p = 0,000) e as crianças do meio rural (65±14,9% vs. 58,2±15,7%; p = 0,021) demostraram valores superiores. Em relação ao valor energético ingerido pelas crianças no total do dia (inclui as refeições ingeridas no jardim-de-infância e fora das instalações do mesmo), constatou-se que os rapazes e as raparigas ultrapassaram as suas necessidades energéticas em 36,1% e 7,9% respetivamente. Quanto à relação entre o valor energético consumido pelas crianças e a sua classificação do estado nutricional, não se verificou uma associação com significado estatístico. Considerando as refeições do meio da manhã e meio da tarde, verificou-se um consumo energético superior ao recomendado pela Direção Geral de Saúde em 6,2% e 10,5% respetivamente. No entanto, verificaram-se valores inferiores de consumo energético na refeição do almoço para rapazes e raparigas (-2,2% e -8,9% respetivamente) face às suas necessidades. Relativamente aos tipos de alimentos consumidos pelas crianças nas refeições do meio da manhã e meio da tarde, os mais consumidos foram os alimentos pertencentes ao grupo dos produtos lácteos. Quando analisamos os consumos dos diferentes alimentos nestas refeições verificamos diferenças entre os géneros apresentando os rapazes consumos superiores de alimentos do tipo farináceo (p=0,022) e dentro destes, de pão (p=0,009). Se considerarmos o consumo dos diferentes alimentos nas mesmas refeições mas diferenciando o meio de residência, verificamos no meio rural consumos superiores em produtos lácteos (p = 0,02), sumos (p = 0,001) e alimentos do tipo farináceo (p = 0,002). Quando analisados separadamente os alimentos do grupo dos farináceos, verificamos que as bolachas são os únicos que apresentam diferenças com significado estatístico (p = 0,000). Conclusão: Apesar de não existir uma relação entre o valor energético ingerido nos jardins-deinfância estudados e o estado nutricional das crianças, verificamos um consumo superior das crianças face às suas necessidades tanto nas refeições realizadas no jardim-de-infância, como no total das refeições realizadas ao longo do dia. Verificamos ainda, a existência de diferenças na seleção dos diferentes alimentos consumidos entre os géneros e meio de residência nas refeições do meio da manhã e meio da tarde.
ABSTRACT - Introduction: Currently there has been an increase in obesity prevalence worldwide, in both adults and children. In particular, childhood obesity is identified as a public health problem of a growing trend. In Portuguese children, there is the same reality. However, the causes of the increase in overweight children have not yet been fully clarified. The pre-school age has special relevance in adopting eating habits and physical activity which they will maintain throughout their lives. In this sense, the kindergarten plays an important role as they are the places where children spend a significant part of their diet. Therefore, the feeding practiced in the kindergartens may have an important role in the development of healthy eating behavior and less obesogenic Objectives: Characterize and quantify the energy of meals from mid-morning and mid-afternoon meals; relate the amount of energy consumed by children in these meals with their nutritional status. To assess the influence of gender and the environment where the child is in the consumption of school meals. Methods: The collection of anthropometric and dietary data of children took place between October 2014 and February 2015. The anthropometric parameters measured and evaluated in this study were the height, weight, waist circumference, and arm circumference. After this, the percentiles of each anthropometric parameters were identified and calculated the body mass index for each child with their classification of nutritional status, according to cutoffs of the World Health Organization. For the assessment of children´s dietary intake in kindergarten, the food consumed by the children was weighed and the waste, if there existed, was also weighed through a digital scale. To assess food intake of children out of the kindergarten, it was delivered to parents or guardians a questionnaire to fill a three days food intake registration (2 days of the week and 1 day of the weekend). It was calculated the energy requirements through the Harris-Benedict formula, including physical activity data previously collected in the questionnaire. Statistical analysis of the variables under study was performed using SPSS version 22. Results: They were included in this study 153 children aged between 3 and 6 years, with a median of 4,4 years (3,0; 6,7). According to gender, 53,6% were boys. There was a prevalence of overweight and obesity of 12,4% and 6,5% respectively, it was found in boys (7,8% overweight and 3,9% obese) and in children of the urban environment (8,5% overweight and 4,6% obesity) higher values for these two classifications. Regarding the percentage of the energy value ingested in food carried out in the kindergartens, the boys (66,8± 15,8% vs. 52 ± 11,4%; p = 0.000) and children in rural areas (65±14,9% vs. 58,2±15,7%; p = 0,021) demonstrated higher values. With regard to energy ingested by children all day (includes meals eaten in the kindergarten and out of the kindergarten), it was found that boys and girls exceeded their energy needs in 36,1% and 7,9% respectively. As for the relationship between the energy consumed by the children and their classification of nutritional status, there wasn't a relationship with statistical significance. Considering the mid-morning and mid-afternoon meals, it was found that children ate a higher energy value than recommended by the DGS of 6,2% and 10,5% respectively. However, there have been lower values of energy consumption in the lunch meal for boys and girls (-2.2% and -8.9% respectively) compared to their needs. On the types of food consumed by children in mid-morning and mid-afternoon meals, the most consumed were the food belonging to the group of dairy products. When we analyze the consumption of different foods in these meals we found gender differences showing the boys higher consumption of starchy foods (p = 0,022) and within these, bread (p = 0,009). If we consider the consumption of different foods in the same meal but differentiating the environment where the children are, we find among the rural areas a higher consumption of dairy products (p = 0,02), juices (p = 0,001) and starchy foods (p = 0,002). When analyzed separately the starchy food group, we found that cookies are the ones who have differences with statistical significance (p = 0,000). Conclusion: Although there isn´t a relationship between the energy consumed in the kindergartens studied and the children´s nutritional status, we found a higher intake of children meet their needs both in meals eaten in the kindergartens, as in total meals eaten throughout the day. We also verified the existence of differences in the selection of certain foods consumed between gender and residence in the mid-morning and mid-afternoon meals.
ABSTRACT - Introduction: Currently there has been an increase in obesity prevalence worldwide, in both adults and children. In particular, childhood obesity is identified as a public health problem of a growing trend. In Portuguese children, there is the same reality. However, the causes of the increase in overweight children have not yet been fully clarified. The pre-school age has special relevance in adopting eating habits and physical activity which they will maintain throughout their lives. In this sense, the kindergarten plays an important role as they are the places where children spend a significant part of their diet. Therefore, the feeding practiced in the kindergartens may have an important role in the development of healthy eating behavior and less obesogenic Objectives: Characterize and quantify the energy of meals from mid-morning and mid-afternoon meals; relate the amount of energy consumed by children in these meals with their nutritional status. To assess the influence of gender and the environment where the child is in the consumption of school meals. Methods: The collection of anthropometric and dietary data of children took place between October 2014 and February 2015. The anthropometric parameters measured and evaluated in this study were the height, weight, waist circumference, and arm circumference. After this, the percentiles of each anthropometric parameters were identified and calculated the body mass index for each child with their classification of nutritional status, according to cutoffs of the World Health Organization. For the assessment of children´s dietary intake in kindergarten, the food consumed by the children was weighed and the waste, if there existed, was also weighed through a digital scale. To assess food intake of children out of the kindergarten, it was delivered to parents or guardians a questionnaire to fill a three days food intake registration (2 days of the week and 1 day of the weekend). It was calculated the energy requirements through the Harris-Benedict formula, including physical activity data previously collected in the questionnaire. Statistical analysis of the variables under study was performed using SPSS version 22. Results: They were included in this study 153 children aged between 3 and 6 years, with a median of 4,4 years (3,0; 6,7). According to gender, 53,6% were boys. There was a prevalence of overweight and obesity of 12,4% and 6,5% respectively, it was found in boys (7,8% overweight and 3,9% obese) and in children of the urban environment (8,5% overweight and 4,6% obesity) higher values for these two classifications. Regarding the percentage of the energy value ingested in food carried out in the kindergartens, the boys (66,8± 15,8% vs. 52 ± 11,4%; p = 0.000) and children in rural areas (65±14,9% vs. 58,2±15,7%; p = 0,021) demonstrated higher values. With regard to energy ingested by children all day (includes meals eaten in the kindergarten and out of the kindergarten), it was found that boys and girls exceeded their energy needs in 36,1% and 7,9% respectively. As for the relationship between the energy consumed by the children and their classification of nutritional status, there wasn't a relationship with statistical significance. Considering the mid-morning and mid-afternoon meals, it was found that children ate a higher energy value than recommended by the DGS of 6,2% and 10,5% respectively. However, there have been lower values of energy consumption in the lunch meal for boys and girls (-2.2% and -8.9% respectively) compared to their needs. On the types of food consumed by children in mid-morning and mid-afternoon meals, the most consumed were the food belonging to the group of dairy products. When we analyze the consumption of different foods in these meals we found gender differences showing the boys higher consumption of starchy foods (p = 0,022) and within these, bread (p = 0,009). If we consider the consumption of different foods in the same meal but differentiating the environment where the children are, we find among the rural areas a higher consumption of dairy products (p = 0,02), juices (p = 0,001) and starchy foods (p = 0,002). When analyzed separately the starchy food group, we found that cookies are the ones who have differences with statistical significance (p = 0,000). Conclusion: Although there isn´t a relationship between the energy consumed in the kindergartens studied and the children´s nutritional status, we found a higher intake of children meet their needs both in meals eaten in the kindergartens, as in total meals eaten throughout the day. We also verified the existence of differences in the selection of certain foods consumed between gender and residence in the mid-morning and mid-afternoon meals.
Description
Mestrado em Nutrição Clínica
Keywords
Nutrição clínica Estado nutricional Criança Idade pré-escolar Jardim de infância Dieta alimentar Clinical nutrition Nutritional status Children Preschool age Kindergarten Diet
Citation
Santos TI. Ingestão de refeições em contexto pré-escolar e estado nutricional de crianças entre os 3 e os 6 anos [dissertation]. Lisboa: Escola Superior de Tecnologia da Saúde de Lisboa/Faculdade de Medicina da Universidade de Lisboa; 2015.
Publisher
Instituto Politécnico de Lisboa, Escola Superior de Tecnologia da Saúde de Lisboa