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N
utrition
assessment
– H
ome
-
based
nutritional
therapy
R
ev
A
ssoc
M
ed
B
ras
2016; 62(8):711-717
713
physical activity per day. All of the studies showed an im-
provement in the intake of fruits and vegetables.
6
(
A
)
When assessing 9 year-old girls with a BMI < p85
th
who received a diet high in calcium for 104 weeks as an
intervention, a total increase in energy consumption was
found, with no significant difference in fat mass or weight,
or the time spent practicing physical activity.
6
(
A
)
A study involving 878 participants aged 11 to 15 years,
with dietary intervention and physical activity through
computer-assisted assessment, monthly emails, telephone
counseling and family participation found no significant
difference in BMI and physical activity after 52 weeks of
intervention, and there was no result in relation to calo-
rie, fruit, and vegetable intake.
6
(
A
)
In order to evaluate the effects of dietary supplemen-
tation and home education on the physical and intel-
lectual development of children at risk of malnutrition,
authors selected households containing a pregnant wom-
an and one or more children under 5 years of age, at least
half of whom were below 85% of the weight-for-age ac-
cording to Colombian standards. The population was
divided into six groups: 1) those who only received med-
ical care, 2) those who participated in the home-based
education program, 3) those who received supplementa-
tion from the beginning of the study until the child was
6 months old, 4) those who began supplementation when
the child was 6 months old with monitoring until they
turned 3 years old, 5) those who received supplement
from the beginning of the study until the child turned 3
years old, and 6) those who received supplement from the
beginning of the study until the child turned 3 years old
and participated in the home-based education program.
Primary school teachers taught the mothers practical
techniques to improve the psychosocial stimulation of
their baby. Each residence was visited twice a week from
the beginning of the study until the child completed 36
months of age. Supplementation was undertaken in ac-
cordance with the energy and protein deficiency of each
family, based on the local daily recommendation. Bread
enriched with protein (daily supply of 1,664 kcal and 60
g protein), skimmed milk (daily supply of 1,460 kcal and
148 g protein), and cooking oil (1,198 kcal daily supply
and 0 g of protein) were provided for 1 year, with 623
calories and 30 g protein distributed to each family mem-
ber. Pregnant women and those breastfeeding received
an additional 233 kcal and 8.4 g of protein per day. Con-
sumption was assessed by 24-hour dietary recall, using
five indicators: daily energy consumption, daily protein
consumption, calories per food group, animal protein
percentage, and starch density (total percentage of calories
derived from cereals, starchy roots or tubers, and starchy
fruits). Supplementation considerably increased protein
consumption, exceeding the recommended daily levels,
while the group without supplementation remained
relatively unchanged and was significantly below the
level reached by the supplemented groups. The energy
consumption was less pronounced, but there was still a
difference between the groups (p<0.01), and the calorie
consumption for the groups without supplementation
tended to decrease over time. At the start of the study,
caloric consumption comprised 15% fat, 9% protein, and
76% carbohydrates. In the supplemented groups, the
source of calories remained unchanged, the fat source fell
(12%) and the protein source increased (13%).
7
(
B
)
Malnourished children aged 10 to 60 months living
in Malawi who were brought to a nutritional rehabilitation
unit were included in a research project if they were stable
in relation to weight-to-height, had mild edema (< 0.5 cm),
or both, and a good appetite [if the child consumed food
when offered and observing the child consume a test dose
of 30 g of ready-to-use therapeutic food (RUTF)]. The
children were divided into a standard treatment group
and another receiving RUTF at home. Weight, height, and
mean arm circumference (MAC) were measured every 2
weeks, and the children continued to be fed at the hospi-
tal or receive additional supplement at home with cereals
and vegetables. RUTF was produced by a local cooperative
composed of an energy dense fat paste (25% peanut butter,
28% sugar, 30% whole milk, 15% vegetable oil, and 1.4%
imported vitamins and minerals) packaged in plastic
bottles containing 260 g. Each bottle was recommended
for daily consumption by each malnourished child, with
175 calories, 5.3 g protein and the micronutrient content
reaching the WHO’s daily recommendation. After hospi-
tal discharge, the children undergoing standard treatment
received a corn (80%) and soy (20%) supplement mixed
with flour (enriched with vitamins and minerals), which
was meant to be consumed seven times a day. Children in
the RUTF group were more likely to attain a weight/height
score > -2, with increasing weight (4 week rate = 3.5±3.7
kg
vs.
2.0±6.9 kg), height (8 week rate = 0.19±0.59 mm/day
vs.
0.12±0.29 mm/day), and mean upper arm circumference
(4 week rate = 0.32±0.41 mm/day
vs.
0.23±0.33 mm/day)
in a better way than the standard treatment group. They
were also less likely to relapse or die, or to develop fever
(in the first 2 weeks: 68%
vs.
53%), diarrhea (in the first 2
weeks: 79%
vs.
72%) or cough (in the first 2 weeks: 82%
vs.
70%), all of which is significant data.
8,9
(
B
)