Programa de intervención psicológica para el manejo de la obesidad infantil / Program of psychological intervention for the handling of the infantile obesity

RESUMEN Introducción: La obesidad es un problema de salud asociado a una morbilidad variada y cada vez en edades más tempranas de la vida. El documento actual tiene como objetivo exponer resultados de un estudio acerca de los hábitos asociados a la obesidad infantil, en la medida, además, en que se evalúan las relaciones afectivas compensatorias y las actitudes generadoras de alteraciones psicológicas en la familia, en función de la presentación de elementos del programa de intervención psicológica dirigido al manejo de la obesidad en un grupo de niños obesos que constituyeron parte de la muestra. Método: La muestra estuvo constituida por 13 niños obesos y 21 familiares remitidos de la consulta de Pediatría del Centro de Investigaciones Médico-Quirúrgicas. La elaboración del programa intervención psicológica se realizó en el primer semestre de 2019 y la experiencia derivada su aplicación se extiende hasta el momento actual. Resultados: Se realiza un análisis cualitativo, en el que se exponen los resultados a partir de la observación de la tendencia de las variables en el grupo. Se aplicaron la entrevista al niño y a la familia, el análisis psicográfico y las Siete figuras de Collins. Se examinan variables psicológicas. Discusión: Se constata la influencia de las variables analizadas en la obesidad infantil, teniendo en cuenta la correspondencia con los estudios de investigadores de Cuba y el mundo, lo cual redunda en la validez y actualidad de los resultados, para la implementación del programa con sesiones dirigidas a los niños y familiares.

ABSTRACT Introduction: Obesity is a health problem associated with varied morbidity and increasingly at earlier ages of life. The current document aims to present the results of a study about the habits associated with childhood obesity, to the extent, in addition, that the compensatory affective relationships and the attitudes that generate psychological alterations in the family are evaluated, depending on the presentation. of elements of the psychological intervention program aimed at managing obesity in a group of obese children who were part of the sample. Method: The sample consisted of 13 obese children and 21 relatives referred from the Pediatric consultation of the Medical-Surgical Research Center. The elaboration of the psychological intervention program was carried out in the first semester of 2019 and the derived experience of its application extends until the current moment. Results: A qualitative analysis is carried out, in which the results are presented from the observation of the trend of the variables in the group. The interview with the child and the family, the psychographic analysis and the Seven figures of Collins were applied. Psychological variables are examined. Discussion: The influence of the variables analyzed on childhood obesity is verified, taking into account the correspondence with the studies of researchers from Cuba and the world, which results in the validity and timeliness of the results, for the implementation of the program with Sessions for children and families.

Correlación del índice de masa corporal y de la circunferencia de cintura de las niñas y adolescentes con su ascendencia femenina hasta la tercera generación

RESUMEN Introducción: La intergeneracionalidad nutricional es reconocida como uno de los factores que influye en el aumento de la prevalencia de obesidad, principalmente a través de generaciones maternas. Poco se conoce sobre esta situación en nuestro país. Objetivo: evaluar la correlación del índice de masa corporal (IMC) y la circunferencia de cintura (CC) de niñas y adolescentes con su ascendencia femenina hasta la tercera generación durante los meses de julio a setiembre del 2019. Materiales y Métodos: Estudio analítico de corte transversal en 98 tríos (niñas y adolescentes, madres y abuelas maternas). Se recolectaron datos antropométricos de los tríos (peso, talla y CC). Se realizaron correlaciones entre: el IMC de la madre y la abuela con el puntaje Z del IMC/E de las niñas y adolescentes y la CC de la madre con las niñas y adolescentes. Se aplicó el coeficiente de correlación de Pearson. Investigación aprobada por Comité de Ética (Dictamen 460/19). Resultados: en promedio las niñas y adolescentes tuvieron 10,1±1,1 años, 0,8±1,6 DE puntaje Z IMC/Edad y 69,5±9,7 cm de CC; las madres tenían 37,4±6,8 años, 13 años de escolaridad, 28,8±7,3 kg/m2 de IMC y 92,1±13,4 cm de CC; y las abuelas 64,9±10,8 años, 7 años de escolaridad y 28,7±6,9 kg/m2 de IMC (Sobrepeso). La correlación del IMC de la madre con el puntaje Z de las niñas y adolescentes fue r: 0,2937 (p0,05). La correlación de CC entre madre-niña fue r: 0,264, (p<0,05). Conclusión: el IMC y la CC de las niñas y adolescentes se correlaciona con el IMC y CC de las madres, pero su potencia no es muy fuerte. Las hijas de madres obesas tienen mayor IMC medido por puntaje Z.

ABSTRACT Introduction: Nutritional intergenerationality is recognized as one of the factors that influences the increase in obesity prevalence, mainly through maternal generations. Little is known about this situation in our country. Objective: to evaluate the correlation of the body mass index (BMI) and the waist circumference (WC) of girls and adolescents compared to their female ancestry up to the third generation during the months of July to September 2019. Materials and methods: This was an analytical, cross-sectional study of 98 trios (girls and adolescents, maternal mothers and grandmothers). Anthropometric data of the trios (weight, height and WC) were collected. Correlations were made between: the BMI of the mother and the grandmother with the Z score of the BMI/E of the girls and adolescents and the WC of the mother with the girls and adolescents. Pearson's correlation coefficient was applied. The study was approved by the Ethics Committee (Approval # 460/19). Results: On average, the girls and adolescents were 10.1±1.1 years old, had a BMI/Age Z score of 0.8±1.6 SD and a WC of 69.5±9.7 cm; the mothers were 37.4±6.8 years old, had 13 years of schooling, BMI 28.8±7.3 kg/m2 and WC 92.1±13.4 cm; and the grandmothers 64.9±10.8 years, had 7 years of schooling and 28.7±6.9 kg/m2 BMI (Overweight). The correlation of the BMI of the mother with the Z score of the girls and adolescents was r: 0.2937 (p0.05). The WC correlation between mother and girl was r: 0.264, (p<0.05). Conclusion: The BMI and WC of girls and adolescents correlate with the BMI and WC of mothers, but its power is not very strong. The daughters of obese mothers have higher BMI measured by Z score.

Validation of the Family Health Behavior Scale for the Brazilian population

Abstract Objective: To validate the Family Health Behavior Scale (FHBS) for Brazilian families. Methods: The sample included 272 children aged 5 to 12 years old. Caregivers and their healthy answered the FHBS and questions about physical activity. In addition, anthropometric measurements of the children's weight and height were performed, as well as the bioimpedance exam. The scale was translated and the following validities were assessed: content (qualitative analysis and content validity index), construct (factor analysis) and concurrent validity (difference between domains and the total score with the categories of BMI, fat percentage and physical activity). Reliability (Cronbach's alpha, ceiling-floor effect, two-half test, intraclass correlation and Bland - Altman) was also assessed. Results: FHBS instrument performed well with regard to the psychometric properties in the Brazilian population. The content validity index was 0.987. Fit indices of the factor analysis were considered satisfactory, according to Bartlett's sphericity test (χ 2 = 1927, df = 351; p < 0.001) and the Kaiser-Meyer-Olkin index (KMO = 0.789). Concurrent validity, the differences between the mean of the domains and the total score between the categories of BMI (p = 0.011), percentage of fat (0.004) and physical activity (p < 0.001) were all significant. The reliability results were Cronbach's alpha internal consistency = 0.83, adequate ceiling-floor effect, 0.8105 (0.09 SD) two-half test, 0.626 intraclass correlation (95% CI: 0.406 to 0.777) and Bland - Altman -0.840 (-22.76 to 21.07). Conclusion: The FHBS adapted for the Brazilian population showed evidence of adequate psychometric performance.

Genetic polymorphisms and plasma concentrations of leptin (rs7799039) and adiponectin (rs17300539) are associated with obesity in children and adolescents / Polimorfismos genéticos e concentrações plasmáticas de leptina (rs7799039) e adiponectina (rs17300539) associados à obesidade em crianças e adolescentes

ABSTRACT Objective: The aim of this study was to compare the anthropometric, biochemical, and hormonal characteristics and the presence of genetic polymorphisms of leptin, adiponectin, and tumor necrosis factor alpha (TNF-α) between eutrophic and obese children and adolescents. Methods: This is a case-control study involving 104 children and adolescents. All subjects were assessed for anthropometric characteristics and clinical, laboratory, and genetic polymorphism parameters. The sample was selected from the pediatric endocrinology outpatient clinic specialized in the treatment of obesity in children and adolescents according to the Centers for Disease Control and Prevention (CDC) classification, and controls were selected from the same location in the general pediatric outpatient clinic. Results: As a result, the parameters, such as black color, obese parents, hypertensive parents, and early weaning, were found to be associated with obesity. Increased levels of insulin, triglyceride, total cholesterol, LDL cholesterol, CRP-U, AST, ALT, GGT, free T4, IGF-1, and uric acid and low levels of HDL cholesterol are found to be associated with a higher chance of obesity. The presence of AG/AA polymorphisms in the leptin is associated with a 290% (OR 3.9) higher chance of obesity, and for adiponectin genes, the chances are 740% (OR 8.4) higher. In these obese children and adolescents with AG/AA haplotypes, serum leptin levels were increased and adiponectin levels were decreased in eutrophic individuals, whereas serum TNF-α levels did not change. Conclusions: The AG/AA polymorphisms in the leptin and adiponectin genes alter the serum levels of these adipokines and predispose them to obesity, and many anthropometric, biochemical, and hormonal markers are altered, demonstrating early consequences for the health of these obese children and adolescents.

RESUMO Objetivo: Comparar as características antropométricas, bioquímicas, hormonais e a presença de polimorfismos genéticos de leptina, adiponectina e fator de necrose tumoral alfa (TNF-α) entre crianças e adolescentes eutróficos e obesos. Métodos: Trata-se de um estudo caso-controle conduzido com 104 crianças e adolescentes. Todos os indivíduos foram avaliados quanto às características antropométricas e parâmetros clínicos, laboratoriais e de polimorfismo genético. A amostra foi selecionada no ambulatório de endocrinologia pediátrica especializado no tratamento da obesidade em crianças e adolescentes de acordo com a classificação do Centers for Disease Control and Prevention (CDC), e os controles foram selecionados no mesmo local, porém no ambulatório de pediatria geral. Resultados: Alguns parâmetros foram associados à obesidade em nosso estudo: cor preta, pais obesos, pais hipertensos e desmame precoce. Níveis aumentados de insulina, triglicerídeos, colesterol total, colesterol LDL, PCR-U, AST, ALT, GGT, T4 Livre, IGF-1, ácido úrico e níveis baixos de colesterol HDL estão associados a uma chance maior de obesidade. A presença de polimorfismos AG/AA na leptina está associada a uma chance 290% (OR 3,9) maior de obesidade, enquanto para os genes da adiponectina as chances são 740% (OR 8,4) maiores. Nessas crianças e adolescentes obesos com haplótipos AG/AA, os níveis séricos de leptina aumentaram e os níveis de adiponectina diminuíram em relação aos eutróficos, já os níveis séricos de TNF-α não se alteraram. Conclusões: Concluiu-se que os polimorfismos AG/AA nos genes da leptina e adiponectina alteram os níveis séricos dessas adipocinas e predispõem à obesidade precoce, e muitos marcadores antropométricos, bioquímicos e hormonais ficam alterados, trazendo consequências para a saúde dessas crianças e adolescentes.

Childhood obesity: an ecological perspective

Abstract Objective: To describe the participation of the environment in the childhood obesity epidemic, since childhood obesity currently represents a great challenge, with high prevalence worldwide, including in Brazil. Data source: Survey of articles published in the last 10 years in PubMed, evaluating the interface between the environment and childhood obesity. Data synthesis: Recent studies show that the environment is very important in the etiopathogenesis of obesity and its comorbidities. Therefore, factors such as air pollution, exposure to chemical substances that interfere with the metabolism, excessive consumption of ultra-processed foods, changes in the intestinal microbiota, and sedentary lifestyle are associated with increased obesity, insulin resistance, type 2 diabetes, and changes in lipid metabolism. These factors have a greater impact on some stages of life, such as the first thousand days, as they affect the expression of genes that control the adipogenesis, energy expenditure, and the mechanisms for hunger/satiety control. Conclusions: Environmental aspects must be taken into account in the prevention and treatment of childhood obesity, both from the individual and the population point of view, with adequate and comprehensive public health policies.

Efetividade de uma estratégia para tratamento da obesidade infantil baseada no Guia Alimentar para a População Brasileira: um ensaio randomizado / Effectiveness of a strategy for the treatment of childhood obesity based on the Food Guide for the Brazilian Population: a randomized trial

O Guia Alimentar para a População Brasileira (GAPB) baseia suas recomendações na extensão e propósito do processamento ocorrido nos alimentos, e sugere que a redução do consumo de alimentos ultraprocessados (AUP) está relacionada a melhora na qualidade da alimentação e consequentemente perda de peso. Apesar de alguns estudos terem observado impacto importante na qualidade da dieta, não há evidências que a redução no consumo de AUP seja acompanhada por redução no consumo de energia total. O objetivo deste estudo é avaliar a efetividade de uma proposta de intervenção para tratamento da obesidade em crianças baseada no GAPB. Foi realizado um ensaio clínico randomizado com crianças entre 7 e 12 anos, encaminhados pelo Sistema Nacional de Regulação (SISREG) para atendimento ao ambulatório de nutrição do Hospital Universitário Pedro Ernesto (HUPE). Os participantes do Grupo controle (GC) e do Grupo Intervenção (GI) participaram de 6 atividades educativas padronizadas e contextualizadas com os 10 passos do GAPB. No GI, também foi prescrito um plano alimentar individualizado, com base nas recomendações nutricionais. Análise de intenção de tratar foi realizada para avaliar a taxa de variação do desfecho primário (índice de massa corporal (IMC)) e secundários (circunferência da cintura (CC) e peso), entre os GI e GC, com base em modelos de efeito mistos. Estas análises também foram aplicadas para medir o consumo alimentar, avaliado pela taxa de variação de gramas de AUP. Adicionalmente, os resultados do IMC foram comparados com curvas de crescimento, desenvolvidas pelo método LMS, que representa a evolução do IMC da população do estudo sem intervenção. Dos 101 participantes, 51 foram alocados no GI. Ao final do estudo, o IMC declinou no GI (Δ = -0,27 kg/m2) em relação ao GC (Δ = + 0,53 kg/m2), com diferença estatisticamente significativa entre os grupos (p=0.0002). Ao comparar o GC com a curva LMS, observou-se maior aumento do IMC no grupo LMS (Δ = + 1,02 kg/m2; p<0,0001). Para mudança de peso, o aumento foi maior no GC (Δ= +5,51), comparado ao GI (Δ= +3,7, p=<0,0001). E não houve diferença significativa na trajetória da CC entre os grupos. Ambos os grupos apresentaram um declínio no consumo de gramas de AUP até o quarto mês e um aumento gradual nos meses seguintes, sem diferença estatisticamente significativa (p=0,77). A combinação de uma abordagem qualitativa baseada nas recomendações do guia com o aconselhamento da restrição energética por meio do plano alimentar mostrou-se eficaz na redução da obesidade infantil. As atividades educativas tiveram impacto no consumo de AUP, porém, há uma dificuldade em manter em longos períodos mudanças comportamentais. Uma vez que o consumo destes alimentos pode prejudicar o tratamento da obesidade infantil, são necessárias estratégias que proporcionem a redução do consumo de AUP ao longo do tempo.

The Dietary Guidelines for the Brazilian Population (DGBP) rely its recommendation on the of extent and purpose that occurred in food and suggests that the reducing the consumption of ultra-processed foods (UPF) improves diet quality and consequent weight loss. Although some studies have observed an important impact on the quality of the diet, there is no evidence that the reduction in the consumption of UPF is accompanied by a reduction in total energy consumption. Thus, the goal of this study is to evaluate the effectiveness of an intervention proposal for the treatment of obesity in children based on the DGBP. A randomized clinical trial was carried out with children between 7 and 12 years old, referred by the National Regulatory System (SISREG) to the nutrition outpatient clinic of University Hospital Pedro Ernesto (HUPE) are evaluated. Participants in the Control Group (CG) and Intervention Group (IG) participated in 6 standardized educational activities contextualized with the 10 Steps of DGBP. In the IG, an individualized food plan was prescribed, based on nutritional recommendations. Intent-to-treat analysis were performed to assess the rate of change of primary (body mass index (BMI)) and secondary (waist circumference (WC) and weight) outcomes between IG and CG, based on mixed-effects models. These analyzes were also applied to measure food consumption, assessed by the rate of change of grams of AUP. Additionally, the BMI results were compared with growth curves, developed by the LMS method, which represents the BMI evolution of the study population without intervention. Of the 101 participants, 51 were allocated to the IG. At the end of the study, BMI declined in the IG (Δ = -0.27 kg/m2) in relation to the CG (Δ = + 0.53 kg/m2), with a statistically significant difference between the groups (p=0.0002). When comparing the GC with the LMS curve, a greater increase in BMI was observed in the LMS group (Δ = + 1.02 kg/m2; p<0.0001). For weight change, the increase was greater in the CG (Δ= +5.51), compared to the IG (Δ= +3.7, p=<0.0001). And there was no significant difference in the trajectory of WC between groups. Both groups showed a decline in grams of UPF until the fourth month and a gradual increase in the following months, with no statistically significant difference (p=0.77). The combination of a qualitative approach based on the DGBP with energy restriction advice through the food plan proved to be effective in reducing childhood obesity. Educational activities had an impact on UPF consumption, however, there is a difficulty in maintaining behavioral changes over long periods. Since the consumption of these foods can impair the treatment of childhood obesity, strategies are needed to reduce UPF consumption over time.

Prevalencia de Cistatina C elevada en pacientes con sobrepeso y obesidad en el noroeste de México

RESUMEN Introducción: en los últimos años se ha reportado un incremento en la prevalencia de obesidad infantil, siendo este un factor de riesgo para enfermedades crónico-degenerativas como la Enfermedad Renal Crónica; por ende, se requieren de biomarcadores endógenos para detectar las alteraciones en el filtrado glomerular, siendo la Cistatina C uno de ellos. Objetivo: Identificar la frecuencia de Cistatina C elevada en pacientes con sobrepeso y Obesidad del noroeste de México. Material y Métodos: se estudió un grupo de infantes de 6 a 12 años, a los cuales según antropometría se clasificó en normopeso, sobrepeso u obesidad. Se obtuvo la somatometria y los niveles de Cistatina C de cada uno de ellos para el cálculo del filtrado glomerular y clasificar la función renal y se buscó asociación entre estas dos condiciones mediante prueba de chi cuadrado. Resultados: de un grupo de 80 pacientes el 51.3% presentó sobrepeso/obesidad; de estos en el 46.3% se reportaron niveles altos de Cistatina C, de acuerdo con el rango de referencia propuesto por Filler 2003. La media para Tasa de Filtración Glomerular (TFG) en el grupo con sobrepeso/obesidad fue de 103.1 ml/min/1.73 m2, comparada con el grupo normopeso de 121.2 ml/min/1.73 m2. La frecuencia de niveles altos de Cistatina C en población con sobrepeso/obesidad fue de 62.9% comparado con un 26.6% en normopeso. Conclusiones: Los Niños de 6 a 12 años con exceso de peso presentan mayor frecuencia de nivel elevado de Cistatina C.

ABSTRACT Introduction: in recent years an increase has been reported in the prevalence of childhood obesity, which is a risk factor for chronic degenerative diseases such as Chronic Kidney Disease; therefore, endogenous biomarkers are needed to detect alterations in glomerular filtration, Cystatin C being one of them. Objective: To identify the frequency of elevated Cystatin C in overweight and obese patients in northwestern Mexico. Materials and Methods: a group of infants aged 6 to 12 years was studied, who according to anthropometry were classified as normal weight, overweight or obesity. Somatometry and Cystatin C levels were obtained from each of them to calculate glomerular filtration rate and classify renal function, and an association between these two conditions was sought using the chi-square test. Results: of a group of 80 patients, 51.3% were overweight / obese; Of these, 46.3% had high levels of Cystatin C, according to the reference range proposed by Filler 2003. The mean Glomerular Filtration Rate (GFR) in the overweight / obese group was 103.1 ml / min / 1.73 m2, compared to the normal weight group of 121.2 ml / min / 1.73 m2. The frequency of high levels of Cystatin C in the overweight / obese population was 62.9% compared to 26.6% in normal weight. Conclusions: Children from 6 to 12 years of age with excess weight have a higher frequency of high levels of Cystatin C.

Accuracy of neck circumference for diagnosing overweight in sixand seven-year-old children

Abstract Objective: To estimate the accuracy of neck circumference measurement as a method of diagnosing excess weight of six and seven-year-old children. Methods: 1026 six and seven-year-old children were included and anthropometric data were collected using cut-off points for the Body Mass Index (BMI) Z-score, in addition to the measurement of their neck circumference in centimeters. Pearson's correlation coefficient was used to assess the correlation between neck circumference and BMI. Sensitivity, specificity, positive and negative predictive values were calculated. The Receiver Operating Characteristic curve was used to measure the accuracy of neck circumference as a diagnostic method for excess weight. Results: A positive linear correlation value was observed between neck circumference and BMI 0.572 (p < 0.001). The accuracy value of the global ROC curve was 0.772 (p < 0.001). Sensitivity and specificity showed low values, but high positive predictive values were observed, especially between measures of 30 and 31 cm. Conclusion: Neck circumference showed accuracy of 77.2% as a diagnostic method for overweightness in six and seven-year-old children.

Impact of nutritional and physical activity interventions on the cognitive and academic achievement of schoolchildren

The objective of this review is to present the impact of nutritional education, physical activity and support network interventions on the nutritional status, cognitive and academic achievement of students under 18 years of age. According to the literature, multicomponent interventions that address diet, physical activity, and involve parents concluded to be more effective in combating obesity and enhancing academic achievement in young people. Therefore, the implementation of public policies that commit to intervene in a timely manner in the first stages of the life cycle, would have a considerably beneficial impact on health(AU)

El objetivo de esta revisión es dar a conocer el impacto de las intervenciones de educación nutricional, actividad física y redes de apoyo en el estado nutricional, rendimiento cognitivo y académico de estudiantes menores de 18 años. De acuerdo con la literatura, las intervenciones de carácter multicomponente que abordan alimentación, actividad física, e involucran a los padres concluyeron ser más efectivas para combatir la obesidad y potenciar el rendimiento académico en jóvenes. Por lo tanto, la implementación de políticas públicas que permitan intervenir de forma oportuna las primeras etapas del ciclo vital, tendrían un impacto considerablemente beneficioso para la salud(AU)

Distribución espacial de la obesidad y el riesgo cardiometabólico infantil en los departamentos Yerba Buena y Simoca de Tucumán, Argentina / Spatial distribution of obesity and childhood cardiometabolic risk in Tucumán, Argentina

Resumen En el escenario epidemiológico actual se destaca la participación de las enfermedades crónicas no transmisibles como causa de muerte. Entre ellas, la obesidad viene experimentando un rápido y constante crecimiento, hecho que le ha valido la denominación de pandemia. Su estudio desde una perspectiva territorial proporciona herramientas estratégicas para el conocimiento y gestión del territorio. El propósito de este trabajo fue caracterizar la distribución espacial de la obesidad y el riesgo cardiometabólico infantil en Tucumán (Argentina). Para ello, durante 2015, se efectuó un estudio exploratorio-descriptivo. Mediante un estudio antropométrico, se determinaron prevalencias de obesidad y riesgo cardiometabólico en escolares con edades comprendidas entre 8 y 12 años. Los datos primarios se agregaron a nivel de radios censales y se desarrollaron indicadores espaciales de obesidad y riesgo cardiometabólico para la elaboración de cartografía temática. El procesamiento estadístico se efectuó con SPSS 25, en el caso de los datos antropométricos y con QGIS 3.18 para el análisis espacial. A partir del estudio efectuado, los indicadores espaciales de obesidad y riesgo cardiometabólico detectaron particularidades en los contextos estudiados, ilustrando disparidades territoriales. Es posible concluir que la cartografía nutricional constituye un insumo susceptible de ser utilizado en el planeamiento territorial de la atención sanitaria. Desde una mirada prospectiva, la información nutricional georreferenciada podría llevar a recomendaciones específicas para el ordenamiento y la planificación territorial saludable.

Abstract In the current epidemiological scenario, the participation of chronic non-communicable diseases as the cause of death prevails. Among them, obesity is experiencing rapid and steady growth, a fact that has earned it the name of pandemic. Its study from a territorial perspective provides strategic tools for the knowledge and management of the territory. The purpose of this work was to characterize the spatial distribution of obesity and childhood cardiometabolic risk in Tucumán (Argentina). To this end, during 2015, an exploratory-descriptive study was carried out. Through an anthropometric study, prevalence of obesity and cardiometabolic risk were determined in schoolchildren aged between 8 and 12. Primary data were aggregated at census tracts level and spatial indicators of obesity and cardiometabolic risk were developed for the elaboration of thematic cartography. Statistical analysis was carried out with SPSS 25, in the case of anthropometric data, and QGIS 3.18 was applied for spatial analysis. The study showed that the spatialization of the obesity and cardiometabolic risk indicators detected particularities in the studied contexts, illustrating territorial disparities. So we can conclude that nutritional cartography constitutes an input that can be used in territorial planning of health care. From a prospective perspective, georeferenced nutritional information could lead to specific recommendations for healthy land management and planning.

Depresión materna como mediadora en el desarrollo de sobrepeso y obesidad infantil: una revisión integrativa / Maternal depression as a mediator in the development of childhood overweight and obesity: an integrative review

Introducción: la depresión materna interfiere en la crianza y la alimentación de los hijos a través de conductas de alimentación infantil. Objetivo: examinar cómo la depresión materna predispone al desarrollo de sobrepeso y obesidad infantil. Metodología: revisión integrativa empleando la metodología de Whittemore y Knafl, y la declaración PRISMA, en PubMed y CONRICyT, utilizando los descriptores "depression", "depressive symptoms","mothers" y "childhood obesity", e incluyendo artículos con metodología cuantitativa publicados entre 2013 y 2020 cuyos indicadores fueran peso y conductas en la población infantil. Resultados: en 22 artículos se identificaron vías conductuales, como conductas maternas de alimentación, estilos de alimentación, prácticas de alimentación infantil, inseguridad alimentaria y recurrencia de la depresión. Conclusión: seis vías conductuales poco aptas para la alimentación y el desarrollo se identificaron como mediadoras entre la depresión y el aumento de peso infantil.

Introduction: Maternal depression interferes with raising and feeding children through infant feeding behaviors. Objective: To examine how maternal depression predisposes to the development of childhood overweight and obesity. Methods: An integrative review with the Whittemore & Knafl methodology and the PRISMA background in PubMed and CONRICyT, using descriptors "depression","depressive symptomatology","mothers" and "childhood obesity". Articles with a quantitative methodology, from 2013 to 2020, with analysis of weight or behavior indicators in the child population were included. Results: In 22 articles, behavioral pathways were identified, such as: maternal eating behaviors, feeding styles, feeding practices, food insecurity and recurrence of depression. Conclusions: Six behavioral pathways unsuitable for eating and development were identified as mediators between depression and infant weight gain.

New reference parameters for body mass index in children aged six to ten years / Novos parâmetros de referência do índice de massa corpórea para crianças de seis a dez anos

ABSTRACT Objective: To determine new body mass index (BMI) reference values to classify the nutritional status of children aged six to ten years old from the city of Montes Claros (state of Minas Gerais), Southeast Brazil. Methods: The sample consisted of 3,863 individuals from both genders. Body mass and height were measured to determine the BMI. We adopted the Lambda, Mu, and Sigma (LMS) method to obtain the cut-off points. After that, each stratum curve was smoothed using quartic polynomials by gender. Average interpolation was used to determine the biannual distribution values. We calculated the 3rd, 85th, and 95th centiles to classify underweight, overweight, and obesity, respectively, according to gender and age. Results: After tabulating the LMS parameters at biannual intervals by gender, we plotted a graphic with seven centiles of BMI distribution and calculated the new BMI parameters for children aged 6-10 years old from the city of Montes Claros. The cut-off values for underweight, overweight, and obesity classification were, respectively, 17.5, 25 and 30 kg/m2. Conclusions: For the studied children, the use of traditional BMI references may result in the overestimation of underweight and underestimation of overweight and obesity. Studies should be carried out with periodic updates, respecting the characteristics of each location in order to use BMI reference values to classify the nutritional status of children and adolescents.

RESUMO Objetivo: Determinar novos valores de referência do índice de massa corporal (IMC) para a classificação do estado nutricional de crianças de seis a 10 anos da cidade de Montes Claros (MG) Brasil. Métodos: Foi utilizada uma amostra de 3.863 sujeitos de ambos os sexos, sendo mensurados massa corporal e estatura para a determinação do IMC. Para a obtenção dos pontos de corte utilizou-se o método Lambda, Sigma e Mu (LMS). Em seguida, as curvas de cada estrato foram suavizadas por polinômios de 4º grau por sexo, e, por interpolação das médias aritméticas, foram obtidos os valores semestrais da distribuição. Foram calculados os percentis 3%, 85% e 95% para a classificação de baixo peso, sobrepeso e obesidade, respectivamente, de acordo com sexo e idade. Resultados: Após a tabulação em intervalos semestrais dos valores dos parâmetros LMS por sexo, foi possível construir o gráfico com sete centis da distribuição do IMC, sendo apresentados os novos parâmetros do IMC para crianças de 6 a 10 anos de Montes Claros, equivalentes aos valores 17,5, 25 e 30 kg/m2 para baixo peso, sobrepeso e obesidade respectivamente. Conclusões: Em relação à população de Montes Claros, a utilização das tradicionais referências para o IMC pode resultar em uma superestimativa do baixo peso e subestimativa do sobrepeso e obesidade. O que se sugere é que, para o uso de valores de referência do IMC para classificar o estado nutricional de crianças e adolescentes, sejam realizados estudos com atualizações periódicas, respeitando as características de cada localidade.

Fruit and vegetable intake among overweight and obese school children: A cluster randomised control trial

@#Introduction: Adequate daily intake of fruits and vegetables is crucial for the prevention of chronic diseases. This study aimed to determine the effects of My Body is Fit and Fabulous at School (MyBFF@school) with nutrition education intervention (NEI) on the stages of change for fruit and vegetable intake among overweight and obese secondary school children based on the trans-theoretical model (TTM). Methods: This was a cluster randomised controlled trial involving 15 out of 415 eligible government secondary schools in central Peninsular Malaysia, which were randomly assigned into intervention (six schools; 579 school children) and control (nine schools; 462 school children). The intervention group was given NEI for 24 weeks, while the control group followed the existing school programme by the Ministry of Education. Results: There was no significant difference between the intervention and control groups for the stages of change, with majority at the maintenance stage after six months (intervention: 34.9%; control: 39.0%). The within group analysis showed a significant reduction after six months for those at the action stage (action and maintenance stage) from 68.0% to 60.4% in the intervention group and from 71.4% to 65.6% in the control group. However, there was a significant increase among those with adequate fruit and vegetable intake in the intervention group and no significant increase in the control group. Conclusion: MyBFF@school with NEI based on TTM provided acceptable changes in fruit and vegetable intake among overweight and obese secondary school children.

Comparação entre autoimagem e índice de massa corporal entre crianças residentes em favela do Rio de Janeiro, 2012 / Comparación entre la autoimagen y el índice de masa corporal entre los niños que viven en una favela en Rio de Janeiro, Brasil, 2012 / Comparison between self-image and body mass index among children living in a slum in Rio de Janeiro, Brazil, 2012

Objetivo: Analisar a concordância/discrepância entre autoimagem corporal e classificação do índice de massa corporal (IMC), segundo tipo de alimentação e influências do ambiente. Métodos: Análise transversal de 195 crianças pré-púberes (≥5 anos), atendidas na Atenção Primária à Saúde (APS), Manguinhos, Rio de Janeiro, Brasil. O IMC foi classificado conforme escore-z. Avaliou-se a autoimagem pela escala de silhuetas para crianças. Estimou-se a associação entre as covariáveis e subestimação/superestimação do IMC em relação à autoimagem, em modelo multinomial. Resultados: Crianças com sobrepeso subestimaram seu IMC, em comparação com a autoimagem, em maior proporção (58,6%) que aquelas com obesidade (22,0%) ou com eutrofia (49,0%). Essa dissociação correlacionou-se com a participação no programa de transferência de renda (RC=2,01 - IC95% 1,04;3,90) e com o consumo diário de alimentos açucarados (RC=3,88 - IC95% 1,05;14,39). Conclusão: A subestimação do IMC entre as crianças com excesso de peso deve ser considerada pela APS, visando aperfeiçoar as práticas de intervenção.

Objetivo: Verificar la correspondencia/divergencia entre autoimagen e índice de masa corporal (IMC), según variables relacionadas al tipo de alimentación e influencia del ambiente. Métodos: Análisis transversal de 195 niños prepúberes (≥5 anos), atendidos en la Atención Primaria de Salud (APS). Se utilizó la clasificación del IMC basada em la puntuación z de la Organización Mundial de la Salud. La autoimagen se evaluó según la escala de silueta validada para niños. Se estimó la asociación de covariables con el resultado de la subestimación/sobreestimación del estado nutricional en modelo multinomial. Resultados: Los niños con sobrepeso subestimaron su IMC, en comparación con la autoimagen, en una mayor proporción (58.6%) que los obesos (22.0%) y eutróficos (49.0%). Esta disociación de la representación se asoció con la participación en el programa de transferencia de renta (odds ratio [OR] = 2,01 - IC95% 1,04;3,90) y con el consumo diario de dulces (OR=3,88 - IC95% 1,05;14,39). Conclusión: La subestimación del IMC de los niños con sobrepeso debe tenerse en cuenta para la mejor intervención en las prácticas de atención primaria de salud.

Objective: To analyze agreement/discrepancy between body self-image and Body Mass Index (BMI), according to variables related to type of food and environment influence. Methods: This was a cross-sectional analysis of 195 prepubescent children (≥5 anos), attending a Primary Health Care service in Manguinhos, Rio de Janeiro. Z-scores were applied to classify BMI. Self-image was collected using the figure rating scale (silhouettes) validated for children. A multinomial model was used to estimate covariate association with the underestimated/overestimated BMI outcome in relation to self-image. Results: Overweight children underestimated their BMI, as compared with self-image, more often (58.6%) than obese children (22.0%) and children with adequate BMI (49.0%). This dissociation was correlated to participation in a cash transfer program (OR=2.01 - 95%CI 1.04;3.90) and daily consumption of sugar-sweetened foodstuffs (OR=3.88 - 95%CI 1.05;14.39). Conclusion Underestimation of BMI among overweight children should be taken into account by Primary Health Care services, in order to enhance intervention practices.

Panorama da obesidade em crianças brasileiras cadastradas no SISVAN: análise de uma década / Panorama of obesity in Brazilian children registered with SISVAN: Analysis of a decade

Objetivo: verificar a evolução da obesidade em crianças de zero a dez anos cadastradas no Sistema de Vigilância Alimentar e Nutricional no período de 2008 a 2018 em diferentes regiões do Brasil e em sua totalidade. Métodos: estudo de abordagem quantitativa do tipo ecológico, desenvolvido com dados secundários de domínio público e de livre acesso no meio eletrônico. Foram coletados percentuais e calculada média e intervalo de confiança do indicador Índice de Massa Corporal/idade em crianças de zero a dez anos, de ambos os sexos no período de 2008 a 2018 para os estratos regionais (regiões Centro-Oeste, Nordeste, Norte, Sudeste e Sul) e nacional (Brasil). Resultados: a obesidade apresentou valores maiores nas regiões Nordeste e Sul para a faixa etária de zero a cinco anos incompletos e de cinco a dez anos incompletos, respectivamente. Na sua totalidade, a Região Nordeste volta a ser destaque com maiores percentuais de obesidade e diferindo-se estatisticamente (p>0,0001) da Região Norte com valores menores. Conclusão: a análise do panorama apontou para o aumento da obesidade nas diferentes regiões do Brasil em crianças, fato que deve ser considerado importante na esfera pública para a formulação de políticas eficientes para essa população.

Aims: to verify the evolution of obesity in children from 0 to 10 years old registered in the Food and Nutrition Surveillance System from 2008 to 2018 in different regions of Brazil and in its entirety. Methods: quantitative ecological study, developed with secondary data of public domain and open access in the electronic medium. Percentages and mean and Confidence Interval of the BMI / age indicator were collected in children from zero to 10 years, of both sexes from 2008 to 2018 for the regional strata (Midwest, Northeast, north, southeast and south) and national (Brazil). Results: obesity showed higher values in the northeast and south for the age group from zero to five incomplete years and from five to ten incomplete years, respectively. In its entirety, the northeast region is again highlighted with higher percentages of obesity and statistically differing (p> 0.0001) from the northern region with lower values. Conclusion: that the panorama analysis pointed to the increase of obesity in different regions of Brazil in children, a fact that should be considered important in the public sphere for the formulation of efficient policies for this population.

Prácticas de alimentación infantil de cuidadores principales, conducta alimentaria y estado nutricional de preescolares en Chile / Child feeding practices of primary caregivers, eating behavior and nutritional status of preschoolers in Chile

Resumen Este estudio tuvo como objetivo conocer la relación entre estado nutricional, prácticas de alimentación del cuidador y conducta alimentaria en preescolares de una comuna del centro sur de Chile. La muestra estuvo compuesta por 249 preescolares y sus cuidadores principales. Se encontró una relación positiva entre índice de masa corporal (IMC) del niño y preocupación por el peso del niño (r = .51, p < .01), así como entre IMC del niño y alimentación restrictiva del cuidador (r = .20, p < .01). Se encontraron relaciones débiles aunque significativas entre estado nutricional (IMC y porcentaje de grasa corporal) y conducta alimentaria en niños. Análisis de correlaciones canónicas indicaron que las variables agrupadas de prácticas de alimentación infantil se relacionaron positivamente con el estado nutricional del niño (ρ3 = .54, < .001). Adicionalmente, se encontró que la preocupación por el peso del niño mediaba parcialmente la relación entre restricción alimentaria e IMC (IC 95% efecto indirecto "ab" [.02; .13]) y entre restricción y porcentaje de grasa corporal (IC 95% efecto indirecto "ab" [.06; .50]). Las actitudes y prácticas de alimentación infantil de los cuidadores principales, particularmente la preocupación por el peso del niño y la restricción en la alimentación juegan un rol crítico en la mantención y manejo de la obesidad en preescolares. Se exploran las implicancias prácticas de estos hallazgos.

Abstract The objective of this research was to determine the relationship between child nutritional status, feeding practices of the primary caregiver and the child eating behavior of preschoolers in a community in south-central Chile. The sample comprised 249 preschool children from three public and semi-public schools and their primary caregivers. A positive relationship was found between body mass index (BMI) and weight concern (r = .51, p < .01) and restrictive feeding practice (r = .20, p < .01). Significant but weak relationship existed between BMI, body fat percentage and child eating behavior. Canonical correlation analysis indicated that child feeding practices as a group were related to nutritional status of children. Additionally, weight concerns partially mediate the relationship between restrictive feeding and BMI (CI 95% indirect effect "ab" [.02; .13]) and body fat percentage (IC 95% efecto indirecto "ab" [.06; .50]). Child feeding practices of the primary caregivers, particularly weight concern and restrictive feeding play an important role in the management of the preschool children obesity.

Desarrollo e implementación de una propuesta educativa en el comedor escolar para la promoción de alimentación saludable en la escuela Cristóbal Colón en Santo Domingo de Heredia, Costa Rica / Development and implementation of a nutrition education approach using the school dining for promoting healthy eating in Cristóbal Colón school in Santo Domingo, Heredia, Costa Rica

RESUMEN Introducción: El sobrepeso y la obesidad infantil han alzado proporciones alarmantes a nivel mundial. El entorno escolar ha demostrado ser un espacio óptimo para la implementación de estrategias educativas con el fin de atacar esta problemática. El objetivo fue diseñar y aplicar una propuesta educativa para usar el comedor escolar como un espacio para la promoción de alimentación saludable. Metodología: Su población meta fueron los niños y las niñas de primero a sexto grado y el personal del centro educativo. Se desarrolló en cuatro etapas: diagnóstico, propuesta, implementación y evaluación. Se preguntó al estudiantado por preferencias y prácticas alimentarias, así como opiniones sobre el comedor; se realizaron grupos focales con el personal y se evaluó el comedor en infraestructura y servicio. La propuesta incluyó temas como desayuno en casa, autorregulación de tiempos de comida y consumo de frutas y vegetales. Se crearon mensajes educativos, se degustaron preparaciones nuevas y se redecoró el espacio del comedor durante un período de tres meses. Resultados: No se logró modificar preferencias alimentarias, ni el agrado por el comedor. Se vieron cambios en prácticas alimentarias. Disminuyó en un 12 % la cantidad de escolares que reportó almorzar doble, es decir en el comedor y en la casa, disminuyó 3 % quienes reportaron nunca desayunar y disminuyó un 4 % quienes reportaron traer merienda de la casa. Concusiones: El comedor escolar mostró el potencial de generar cambios en hábitos y conocimientos nutricionales de las niñas y los niños. Es necesario fomentar iniciativas educativas por períodos mayores de tiempo y con procesos de evaluación que valoren la adherencia de la población meta a hábitos y prácticas saludables a largo plazo.

ABSTRACT Introduction: Childhood obesity and overweight have reached alarming numbers world wise. The school environment has proven to be an optimal area to develop strategies against this situation. Methods: This project had the main objective of creating and implementing an educational approach to use the school canteen as a nutrition educational space. Its target population were the students from first to sixth grade and the school staff. It was developed in four phases: diagnosis, proposal, implementation and evaluation. A guided questionnaire was applied to students inquiring about food preferences and practices, and their opinions on the school canteen. In addition, there were focus groups with the staff and an evaluation of the consuming area in structure and service. The proposal included the importance of breakfast, self-regulation of meals and fruit and vegetable consumption. Education messages were created, tastings for new preparations were implemented and the redecoration of the dining area developed for a three-month period. Results: After the implementation, there were no changes in food preferences or opinion on the canteen. The main changes were found in students who reported eating double lunch, which decreased by 12%, the ones that said they never ate breakfast decreased 3% and the ones who bring snacks, decreased 4% Conclusion: the school canteen demonstrated to be useful to make changes in nutritional habits and knowledge of the students. However, it is necessary to encourage other nutritional education projects for longer periods and better long-term adherence evaluation of the healthy eating practices in the students.

Caracterización de la intervención educativa realizada por estudiantes de nutrición en escuelas públicas del cantón de La Unión para la prevención de la obesidad y la promoción de la salud / Characterization of the educational intervention carried out by nutrition students in public schools in the canton of La Unión for obesity prevention and health promotion

Resumen: Introducción: Frente al contexto de un 34 % de exceso de peso en la población escolarizada de Costa Rica, dentro del marco de trabajo del curso de la Escuela de Nutrición (ENu) de la Universidad de Costa Rica, llamado NU-2030 Módulo IV: Situación Alimentaria y Nutricional en el Ámbito Institucional II, los estudiantes de la ENu realizaron una intervención educativa para la prevención de la obesidad y la promoción de la salud, en nueve escuelas públicas del Circuito 06 del cantón La Unión. Metodología: Se analizaron los datos correspondientes a 12 proyectos de intervención, recolectados de agosto a noviembre del 2016 y documentados en 9 informes finales de curso. Los proyectos se dividieron en tres etapas. Fase diagnóstica: Se analizaron datos antropométricos y hábitos de estilo de vida en muestra de 1382 niños y niñas (N= 3802 preescolares y escolares inscritos), así como valoración de comidas ofrecidas en el entorno escolar. Fase de intervención: se trabajó con datos de 35 sesiones educativas efectuadas por estudiantes de la ENu para 1004 niñas y niños, 70 docentes, 12 colaboradoras del SAI, 4 personas de la administración y 7 padres y madres de familia. Los datos fueron recopilados en instrumentos diseñados en el curso para tal fin. Fase de evaluación: Se analizó la información de la evaluación formativa y sumativa. Resultados: Solo dos escuelas con prevalencia de exceso de peso inferior al promedio nacional y se reportaron para todas factores ampliamente mencionados por la literatura como favorecedores de un ambiente obesogénico (relacionados tanto con alimentación como con actividad física). El uso del juego con niños y niñas y sesiones constructivistas (aprender haciendo) con adultos fueron bien aceptadas en la implementación. No existen contrapartes profesionales nutricionistas en las instituciones. No fue posible observar cambios en hábitos alimentarios en ocho semanas de intervención. Conclusiones: Las intervenciones con apoyo docente y de la Dirección fueron más exitosas. El uso del juego para la educación nutricional de niños y niñas se considera una oportunidad. Ocho semanas de intervención permitieron cambios de conocimiento, no así de las prácticas. Preocupa el nulo involucramiento de los padres de familia.

Summary: Introduction: Against the context of 34% overweight in the school population of Costa Rica and within the framework of the course of the School of Nutrition (SNu) of the University of Costa Rica, called UN-2030 Module IV: Food and Nutritional Situation in the Institutional Environment II, SNu students carried out an educational intervention for the prevention of obesity and the promotion of health, in nine public schools in Circuit 06 of La Union Canton. Methodology: The data corresponding to 12 intervention projects, collected from August to November 2016 and documented in 9 final course reports, were analyzed. The projects were divided into three stages. Diagnostic phase: Anthropometric data and lifestyle habits were analyzed in a sample of 1382 children (N= 3802 preschoolers and school children enrolled), as well as assessment of meals offered in the school environment. Intervention phase: work was done with data from 35 educational sessions conducted by SNu students for 1004 children, 70 teachers, 12 SAI collaborators, four clerks and seven parents, collected in instruments designed in the course for that purpose. Evaluation phase: Formative and summative evaluation information was analyzed. Results: Only two schools with an overweight prevalence below the national average and were reported for all, factors widely mentioned in the literature as favoring an obesogenic environment (related to both food and physical activity). The use of play with children and constructivist sessions (learning by doing) with adults, were well accepted in the implementation. There are no professional nutritionist counterparts in the institutions. No change in eating habits could be observed in eight weeks of intervention. Conclusions: Interventions with teacher and management support were more successful. The use of play for the nutritional education of children is considered an opportunity. Eight weeks of intervention allowed changes in knowledge, but not in practices. The lack of parental involvement is a concern.

Asociación entre la distribución espacial de puntos de adquisición de alimentos y la prevalencia de obesidad infantil en el cantón La Unión, Costa Rica / Spatial distribution of food acquisition points and their association with the prevalence of childhood obesity in La Union County, Costa Rica

Resumen: Introducción: La obesidad infantil es un problema de salud pública en Costa Rica y su prevalencia ha mostrado un rápido crecimiento. El ambiente alimentario y de actividad física juega un rol crucial en el estilo de vida de los niños en edad escolar y sus familias. Este artículo trata de entender la relación entre la distribución espacial de los lugares de adquisición y venta de alimentos y la prevalencia de obesidad infantil en dos escuelas del cantón La Unión. Materiales y métodos: Se mapeó la ubicación de los lugares de venta de alimentos en los 8 distritos y si contaban con patentes, además, se evaluaron las distancias recorridas por escolares de los distritos de San Juan y Concepción para relacionarlas con el estado nutricional de 297 participantes. Resultados: Se identificaron 338 puntos de adquisición de los alimentos localizados principalmente en el distrito Tres Ríos en distancias muy cortas de los centros educativos. Del total de puntos, el 84.65 % no tiene patentes y estos están principalmente en Río Azul. Para los escolares del distrito de Concepción las distancias recorridas hacia la escuela disminuyen de forma significativa conforme aumenta el sobrepeso en los escolares. Conclusiones: Existe un crecimiento importante de los lugares de venta y distribución de alimentos que se encuentran a distancias no mayores a los 250 metros de los centros educativos, lo cual aumenta la probabilidad de acceder a los alimentos que allí se expenden. Conforme aumenta el exceso de peso en los escolares, estos reportan menores distancias recorridas hacia la escuela, lo cual agrega un riesgo mayor en esta población asociado a la reducida actividad física.

Abstract: Introduction: Childhood obesity is a public health problem in Costa Rica and its prevalence has shown rapid growth. The food and physical activity environment plays a crucial role in the lifestyle of school-age children and their families. This article tries to understand how the spatial distribution of places of purchase and sale of food can influence the prevalence of childhood obesity in two schools in the canton of La Unión. Materials and methods: A mapping of the location of food sales places in the 8 districts, the presence of patents in them and the distances traveled by schoolchildren from the districts of San Juan and Concepción and their relationship with the nutritional status of 297 school children. Results: 338 food acquisition points located mainly in the Tres Ríos district were identified in very short distances from the educational centers. For the students of Concepción District, the distances traveled to school decrease significantly as the overweight in schoolchildren increases. Conclusions: There is a significant growth in the places of sale and distribution of food that are located at distances no greater than 250 meters from educational centers, which increases the probability of accessing the food that is sold there. As excess weight increases in schoolchildren, they report shorter distances traveled to school, which adds a greater risk in this population which adds a greater risk in this population associated with reduced physical activity

Efectividad del modelo Póngale vida para la prevención de la obesidad infantil en escolares del cantón de La Unión, Costa Rica / Effectiveness of the Póngale Vida Model for the prevention of childhood obesity in schoolchildren, La Union County, Costa Rica

Resumen: Introducción: En Costa Rica, la prevalencia de obesidad infantil ha tenido un aumento considerable en los últimos años, por lo que es una prioridad para la salud pública. El objetivo del análisis es evaluar la efectividad del modelo Póngale Vida mediante las variables antropométricas, bioquímicas, preferencias alimentarias y de actividad física de las personas escolares. El modelo Póngale Vida busca promover estilos de vida saludables y prevenir la obesidad infantil en escolares de escuelas primarias públicas. Las estrategias se basan en el modelo ecológico e incluyen educación alimentaria y actividad física en diferentes escenarios (aula, la escuela, la familia y la comunidad) que podrían influenciar el comportamiento de las personas escolares. Metodología: En el 2009, se evaluaron 482 escolares, divididos en una escuela intervenida (N=255) y una escuela control (N=173), sin embargo, la muestra final fue de 287 escolares (n=255 y n=173 respectivamente). Se les evaluó el IMC, pliegue tricipital, perfil lipídico y se aplicó una entrevista al inicio y final de un periodo de 7 meses. Resultados: Hubo una disminución en la escuela intervenida en la media del puntaje Z del IMC/edad (Inicial= 0.54, Final= 0.48) contrario a la escuela control, la cual aumentó (Inicial=0.70, Final=0.85), pese a que la disminución en la primera no fue significativa, la diferencia en la medición final entre la escuela intervenida y control sí fue significativa (P=0.008). En los indicadores bioquímicos, todos muestran niños y niñas, en ambas escuelas, con valores considerados altos que merecen seguimiento posterior. Conclusión: La intervención permite modificar tendencias, por lo cual la escuela sigue siendo un escenario adecuado para la prevención de obesidad infantil, en este caso, Póngale Vida representa una opción para contribuir a cambios de corto y mediano plazo.

Abstract: Introduction: The prevalence of childhood obesity in Costa Rica has been growing in the last decade. This problem is now a public health priority. The objective of the analysis is to evaluate the effectiveness of the Pongale Vida Model, through the anthropometric and biochemical variables, food and physical activities preferences, of children. The Póngale Vida Model look for promote healthy lifestyles and prevent childhood obesity in school children from public schools. These strategies are based on an ecological model which includes nutrition education and physical activity in the scenarios that are considered may influence behaviors in children such as the classroom, school, family and community. Methodology: In 2009, initially 482 children, were evaluated, divided in one intervened school (n=255) and one control school (n=173), and a final sample of 287 schoolchildren (n=255 and n=173 respectively), were evaluated for BMI, triceps skinfold and lipid profile, as well as one interview was administered at baseline and after a 7 month period. Results: There was a decrease in the intervened school in the mean Z score of BMI/age (Initial=0.54, Final=0.48) contrary to the control school, which increased (Initial=0.70, Final=0.85), despite the decrease in the first it was not significant, the difference in the final measurement between the operated and control school was significant (P=0.008). The biochemical indicators showed high values in both schools which suggest the need of further follow up. Conclusion: The intervention allows to modify trends, for which the school environment continues to be a suitable scenario for the prevention of childhood obesity, Pongale Vida represents an option to contribute to changes in the short and medium term.