Efetividade do aconselhamento nutricional em mulheres com excesso de peso atendidas na Atenção Primária à Saúde

Abstract

Introduction: The high prevalence of chronic diseases demand interventions that encourage healthier lifestyles, specially in Primary Health Care (PHC). Objective: To evaluate the effectiveness of nutritional counseling for women with overweight in monitoring at PHC Units. Methods: Before-and-after intervention study, with overweight women, 20 years, that were referred to nutritional monitoring at PHC Units (PHCU) in the East District (PHCU-E) and Barreiro District (PHCU-B) of Belo Horizonte-MG, during 12 months. Was verified the evolution of nutritional status by applying anamnesis at the beginning and the end of intervention, aimed to assess sociodemographic and economic characteristics, health profile, habits and dietary intake, and anthropometry. The intervention consisted of individual nutritional counseling (intervals of 30-50 days). Descriptive analysis was performed and used statistical tests paired Students t, Wilcoxon and McNemar. Multiple linear regression was used to examine which baseline variables were associated with the outcomes: delta percentage of weight, Waist circumference (WC) and Conicity index - C Index (p<0.05). Results: Were evaluated 48 women (24 at each PHCU), most adults (PHCU-E: 62.5%; PHCU-B: 79.2%). After the intervention, at the PHCU-E there was an increase in consume of fruits (p=0.013), increase of the number of meals (p=0.039), reducing of the habit of consuming liquids at meals (p = 0.031), reducing of the consumption of calories (p=0.010), carbohydrates (p=0.004), fat (p=0.014), monounsaturated fatty acids - MUFA (p=0.004), and reducing in the body mass index-BMI (p=0.017), WC (p=0.019) and the waist to height ratio - WHtR (p=0.012). At PHCU-B, there was increased body perception as slim/normal (p=0.008), increase in the daily intake of leafy vegetables (p=0.001) and other vegetables (p=0.039), increase in the number of meals (p=0.002), increase in the consumption of selenium (p=0.053) and vitamin C (p=0.015). Also were found decrease in the daily intake of salt (p=0.012), oil (p=0.001), reducing of the consumption of calories (p=0.021), fat (p=0.001), saturated fatty acids (p=0.017), polyunsaturated fatty acids(p=0.001), MUFA (p=0.001), sodium (p=0.012), vitamin E (p=0.005), weight (p=0.007), BMI (p<0.001), WC (p<0.001), WHtR (p<0.001) and C index (p=0.001). Multivariate analysis indicated association of sociodemographic variables (occupation), health variables (sleep, hypercholesterolemia and perception of weight), food habits and consumption (breakfast, salt intake and liquid in the meals, and daily intake of leafy vegetables and milk), nutrient intake (calories, vitamins C and E; percentage of the total calories of protein source, inadequate intake of carbohydrates, lipids, cholesterol and selenium) and WHtR, with the response variables. Conclusion: There was an obvious improvement in the health and nutrition profile of users, showing the relevance of nutritional interventions in PHC for overweight women. Moreover, the identification of baseline factors associated with anthropometric evolution can contribute to more targeted actions, favoring its effectiveness.