Efetividade de intervenções nutricionais e físicas em mulheres de serviço de promoção da saúde

Abstract

Introduction: Health promotion actions have been described as fundamental for improving the populations health, with emphasis interventions aiming towards healthy lifestyle practices, within the Brazilian National Healthcare System (SUS). Objective: To evaluate the effectiveness of interventions physical and nutritional on the dietaryand anthropometric profile of women using a Health Promotion Service of Belo Horizonte, Minas Gerais. Methods: This was an non-randomized controlled community trial among users 20 years of age at a SUS health promotion service the Municipal Health Department of Belo Horizonte so-called City Gyms. The control group (GIFI) was composed of women who practiced regular physical exercise and the intervention group (GIFIN), women who practiced physical exercise and participated in a nutritional intervention. The latter was stratified according to the intervention type: only individual (GIFINI), only collective (GIFINC) or both individual and collective (GIFINIC). The nutritional intervention consisted of dietary and nutritional education groups and/or individual counseling. The service users evolution was assessed through nutritional anamnesis applied on entry and after around 11 months of participation in the interventions. The instrument comprised sociodemographic and dietary habit questions, and included a food frequency questionnaire and a 24-hour recall. Descriptive analysis was performed, and followingtests were used: simple Student t, chi-square, Fisher exact and Mann-Whitney, for intergroups and McNemar, paired Student t, Wilcoxon and Kappa for intragroups (p < 0.05). Results: Assessments were made on 124 women (61 in GIFI and 63 in GIFIN) with similar sociodemographic and dietary habit characteristics. However, theparticipants in GIFIN had higher mean body mass index - BMI (27.8 ± 4.5 vs. 30.2 ± 6.2; p = 0.04), those in GIFINI (p = 0.02) and those in GIFINC, higher mean weight (p = 0.002), BMI (p < 0.001) and waist circumference (p = 0.001) when compared with those in GIFI. After the intervention, the participants in GIFI and GIFIN increased their number of daily means (p < 0.001). Those in GIFIN also reduced the habit of having meals while watching television (72.5% to 56.9%, p = 0.04) and their per capitaconsumption of oil [-6.0 ml (IQR: 14.5), p = 0.01] and sugar [-19.5 g (IQR: 42.5), p = 0.002]; increased their daily consumption of water [250.0 ml (IQR: 700.0), p = 0.003], fruits (58.1% to 79.0%, p = 0.004) and milk and derivatives (60.3% to 74.6%, p = 0.02). In analyzing GIFIN stratified according to nutritional intervention type, it was observed that the women in GIFINI and GIFINIC decreased their per capita oil consumption (p = 0.02 and p = 0.04) and GIFINIC increased their fruit consumption (p= 0.03); while those in GIFINC increased their daily water intake (p = 0.02] and reduced their sugar consumption (p = 0.04). Consequently, a weight reduction was observed the women in GIFIN (-1.3 ± 3.9 kg, p = 0.02), and a waist circumference reduction (p = 0.008) among participants in GIFINI. No significant changes in food consumption or anthropometry were noted in GIFI. Conclusion: The findings indicate that there is a need to combine nutritional interventions with regular practicing of physical exercises and to make such interventions viable within SUS routine services, as a strategy for encouraging healthier lifestyles