This cross-sectional study determined the influence of antiretroviral therapy (ART) on the lipid profile and insulin sensitivity of 119 perinatally HIV-infected Brazilian patients aged 6-19 years. Inadequate high-density lipoprotein cholesterol (HDL-c) concentrations were observed in 81.4% of patients. High concentrations of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c) and triglycerides (TG) were found in 33.9%, 9.7% and 35.6% of patients, respectively. There were statistically significant differences in mean concentrations of TC (P=0.004), HDL-c (P=0.015) and LDL-c (P=0.028) among children (<10 years), early adolescents (10-14 years) and late adolescents (15-19 years). Children presented the highest mean concentrations of TC and LDL-c, and patients in late adolescence presented the lowest concentrations of HDL-c. Insulin sensitivity, assessed by the Homeostasis Model Assessment (HOMA) index, was diagnosed in 16.7% of patients, with a statistically higher proportion (P=0.034) of insulin-resistant children (33.3%) compared with adolescents (12.5%). There was a statistically significant association between TG concentrations and use of ART regimens containing protease inhibitors (PI) (P=0.0003). Children presented a higher prevalence of insulin resistance and dyslipidaemia compared with adolescents, suggesting that ART, especially PIs, may lead to metabolic complications.

Objective: Although the benefits of highly active antiretroviral therapy (HAART) have been documented, it is thought to be associated to disturbances in nutritional status. These disturbances may occur early in life and are poorly understood. The present study aimed to investigate the relationship between anthropometric parameters and body composition of perinatally HIV-infected children and adolescents under HAART, according to use and non-use of protease inhibitors. Design: Cross-sectional study undertaken between August and December 2007. Demographic, socio-economic, clinical and anthropometric data were collected from the patients. The χ 2 test, Wilcoxon rank sum test (Mann-Whitney) and t test were used to compare the following variables between users and non-users of protease inhibitors: age, gender, per capita income, HAART exposure, antiretroviral therapy adopted in the last three years, CD4 count, viral load, pubertal stage, nutritional status (BMI-for-age, height-for-age, waist and neck circumferences, triceps skinfold thickness, body fat percentage, upper-arm fat area and upper-arm muscle area). Setting: An HIV/AIDS out-patient clinic, São Paulo, Brazil. Subjects: One hundred and fifteen patients (children and adolescents aged 6-19 years). Results: Protease inhibitors users had a higher prevalence of stunting (P = 0·03), lower BMI (P = 0·03) and lower percentage of body fat (P = 0·05) compared with non-users. There was no statistically significant difference between the HAART regimens and measurements of fat adiposity. Conclusions: The findings of the study suggest that children and adolescents under protease inhibitors are at higher risk of growth and development deviations, but not at risk of body fat redistribution.

Objective To describe the development and validation of a workshop protocol for the implementation of the Dietary Guidelines for the Brazilian Population in primary healthcare units. Methods This descriptive study was developed in the state of São Paulo, Brazil, and it involved 20-25 professionals in the experimentation phase and 12 experts in the content validity phase. The workshop protocol was developed according to three theoretical references: Dietary Guidelines, Interprofessional Collaborative Practice and Critical Reflexive Methodology. The protocol consisted of four 4-hour modules, 16 activities in 16 hours. The activities matrix was composed of three axes: (a) organizational strategies, (b) dietary guideline comprehension and (c) dietary guideline implementation. For the validity analysis, the expert panel assessed clarity, relevance and theoretical representativeness. Content validity index was calculated, and adequate activities scored >0.80. The proportion of experts who recognized the presence of the theoretical framework in the activities was calculated. Results All 16 proposed activities obtained a score greater than the established cut-off point, both for clarity and relevance. For theoretical representativeness analysis, the dietary guidelines reached higher scores on the (b) and (c) axes of the protocol and was less recognized on the (a) axis, whose highest score was for the Critical Reflexive Methodology. Interprofessional Collaborative Practice presented a higher score on the (c) axis and a lower one on the (b) axis. Conclusion The protocol was considered appropriate for its purpose and with potential application in the different scenarios of primary health care in Brazil.

The objective of this cross-sectional study was to assess the nutritional status of children and adolescents with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) receiving highly active antiretroviral therapy (HAART). One hundred and eighteen subjects aged 6-19 years attending an outpatient clinic in São Paulo city were involved in the study. The following anthropometric measurements were assessed: weight, height, waist circumference and triceps and subscapular skinfold thickness. One (0.9%) adolescent was diagnosed with abdominal obesity based on waist circumference measurement; three (2.5%) adolescents were obese based on subscapular skinfold thickness. According to the body mass index, the population studied was mainly eutrophic. The prevalence of fat redistribution, a characteristic of patients with HIV/AIDS under HAART, was low. We advise the development of further studies to assess the nutritional status of children and adolescents with HIV/AIDS using anthropometric measurements as well as computed tomography to detect fat redistribution.

Objective:To assess the nutritional and dietetic profile of freshman Nutrition undergraduate students, and its association with stages of changes (Transtheoretical Model) for fruit and vegetable intake.Methods:Demographic (age and gender), anthropometric (body mass index and waist circumference) and nutritional (pattern of fruit and vegetable intake) data were obtained. The Transtheoretical Model was used to identify the stages of change for fruit and vegetable intake. Food consumption was assessed with a questionnaire developed by the Ministry of Health. The significance level considered for all statistical tests was 0.05 (p<0.05).Results:From 433 eligible students, anthropometric measurements were taken from 219 (50.6%), and 299 (69%) underwent food intake evaluation. The sample included undergraduate students with a low frequency of adequate fruit and vegetables intake (29.8%), being the majority (64.9%) of them classified as at the preparation stage to increase the intake of these food groups. Prevalence of adequate fruit and vegetables intake was higher among students at the action/maintenance stages (83.3%) compared to those at the precontemplation/contemplation (18.3%) and at the preparation stages (32.0%). Students at the preparation stage presented the highest medians for body mass index (p=0.004) and waist circumference (p=0.039) compared to those at the precontemplation/contemplation stages. There was no association between fruit and vegetables intake and the presence of overweight or abdominal obesity (p=0.373).Conclusion:This instrument is effective to predict the food intake and, even among aware individuals and ready to change their food behavior, the prevalence of nutritional risk is high.

A todos os pacientes e seus responsáveis, por permitirem com que esse trabalho fosse concluído e por enriquecerem meus conhecimentos, ao permitirem que fossem avaliados.A todos os funcionários do Instituto da Criança, que de alguma maneira contribuíram para a coleta de dados. À minha mãe, Lourdes, cuja presença, apoio e afeto foram cruciais para enfrentar todas as dificuldades e ultrapassar as barreiras.Ao meu pai Donato e minha irmã Adriana pelo apoio e afeto em todos os momentos dessa jornada.As "mais do que amigas", Anna Maria Buehler e Amanda Aparecida Silva, por estarem sempre dispostas a oferecer uma palavra de conforto e incentivo. Para definição do histórico clínico e laboratorial, os prontuários foram analisados para obtenção da data do diagnóstico, esquema medicamentoso adotado nos últimos três anos e resultados de exames bioquímicos. Resultados -A avaliação da composição corporal por BIA foi capaz de identificar excesso de gordura corporal total em 30% das meninas e 26% dos meninos. Em contrapartida, 33,6% apresentaram sinais de depleção do tecido adiposo na região tricipital, sugerindo lipoatrofia. Em relação aos parâmetros bioquímicos, 16,7% dos pacientes foram diagnosticados com resistência à insulina, 35,6% com triglicérides elevados, 33,9% com colesterol total elevado, 9,7% com alterações nos níveis de LDL e 81,4% com concentrações reduzidas de HDL. As crianças consistiram no grupo com maior prevalência de dislipidemia e melhor estado imunológico, sugerindo maior vulnerabilidade aos antiretrovirais. Observou-se que os usuários dos esquemas terapêuticos alternativos e tríplices, ambos com inibidores de protease, apresentaram as maiores concentrações médias de triglicérides e, as menores de HDL-colesterol.

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Objetivos: Este estudo comparou o conhecimento e a percepção de autoeficácia e eficácia coletiva para aplicar o Guia Alimentar para a População Brasileira [Guia Alimentar] entre nutricionistas e demais profissionais de saúde da Atenção Básica. Métodos: Analisou-se o desempenho de 209 participantes em estudo de validação de constructo de duas escalas: GAB1 (conhecimento) e GAB2 (autoeficácia e eficácia coletiva). Geraram-se grupos segundo percentil (<75 e >75) e testaram-se as diferenças entre variáveis quantitativas/qualitativas e ser nutricionista. Razões de chance por modelos de regressão logística bivariada e múltipla foram calculadas para investigar as variáveis explicativas de cada constructo. Resultados: A média de conhecimento e autoeficácia dos nutricionistas foi estatisticamente superior a das outras profissões, observando-se associação entre ser nutricionista e elevado conhecimento e autoeficácia para aplicar o Guia Alimentar. Ser nutricionista e possuir elevada autoeficácia mostraram-se determinantes para elevado conhecimento sobre o Guia Alimentar. Ser nutricionista e possuir elevado conhecimento sobre o Guia Alimentar mostraram-se determinantes para elevada autoeficácia. A média de eficácia coletiva dos nutricionistas não foi estatisticamente diferente a das outras profissões. Nenhuma variável se mostrou explicativa para elevada eficácia coletiva. Discussão: Pelo nosso conhecimento, este estudo é o primeiro a avaliar o preparo de profissionais de saúde para implementar o Guia Alimentar, salientando a urgência de processos eficazes de capacitação profissional para consolidar o nutricionista como referência técnica para os demais profissionais. Conclusões: Ser nutricionista associou-se ao maior conhecimento e à maior autoeficácia para aplicar o Guia Alimentar, mas a eficácia coletiva não esteve associada à profissão.DOI: 10.12957/demetra.2019.39140