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OBJECTIVE: This study aimed to compare the effects of two lifestyle intervention programs for type 2 diabetes mellitus (T2DM) prevention - traditional or interdisciplinary psychoeducation-based intervention - in daily habits and cardiometabolic risk factors and investigate the role of the psychoeducational approach for the retention of individuals in the program. SUBJECTS AND METHODS: Between 2008 and 2010, in a public health service, 183 pre-diabetic individuals were allocated to two 18-month interventions involving diet and physical activity. Physical activity, diet, quality of life (QOL) and depression and biochemical measurements were obtained. Linear mixed-effect models were used to assess the effect of the interventions. A student t test was used to compare dropouts versus non-dropouts. RESULTS: Improvements in energy intake and physical activity were greater in the interdisciplinary than the traditional intervention. A decrease in fat mass and blood pressure was more pronounced with interdisciplinary intervention. Dropouts from the traditional intervention only had higher BMI and lower fiber intake and QOL than non-dropouts. CONCLUSION: The interdisciplinary psychoeducation-based intervention revealed useful for reducing cardiometabolic risk and retaining individuals with worse health profiles. This approach represents a feasible strategy for motivating high-risk individuals to adopt a long-term healthy lifestyle.

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ABSTRACT Objective This study aimed to compare the effects of two lifestyle intervention programs for type 2 diabetes mellitus (T2DM) prevention – traditional or interdisciplinary psychoeducation-based intervention – in daily habits and cardiometabolic risk factors and investigate the role of the psychoeducational approach for the retention of individuals in the program. Subjects and methods Between 2008 and 2010, in a public health service, 183 pre-diabetic individuals were allocated to two 18-month interventions involving diet and physical activity. Physical activity, diet, quality of life (QOL) and depression and biochemical measurements were obtained. Linear mixed-effect models were used to assess the effect of the interventions. A student t test was used to compare dropouts versus non-dropouts. Results Improvements in energy intake and physical activity were greater in the interdisciplinary than the traditional intervention. A decrease in fat mass and blood pressure was more pronounced with interdisciplinary intervention. Dropouts from the traditional intervention only had higher BMI and lower fiber intake and QOL than non-dropouts. Conclusion The interdisciplinary psychoeducation-based intervention revealed useful for reducing cardiometabolic risk and retaining individuals with worse health profiles. This approach represents a feasible strategy for motivating high-risk individuals to adopt a long-term healthy lifestyle.

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INTRODUCTION: Non-communicable chronic diseases (NCCDs) represent a burden for public health. Alongside the established cardiometabolic risk factors such as high blood pressure and disorders of glucose and lipid metabolism, living habits and nutritional status at different stages of life are seen as contributors to this scenario. Gut microbiota composition and subclinical inflammation have been pointed out as underlying mechanisms of NCCDs. Studies involving health professionals have brought relevant contributions to the knowledge about risk factors. Technological advances facilitate data collection and analysis for big samples. A web-based survey addressed to collect data from a cohort study, which is able to identify NCCDs risk factors, is highly desirable. The objective of the Brazilian Nutritionists' Health Study (NutriHS) is to gather online information on early life events, daily habits, emergent cardiometabolic risk factors and health outcomes of a specific subset of the Brazilian population. METHODS AND ANALYSIS: NutriHS, developed at the School of Public Health-University of Sao Paulo, Brazil, is a research initiative that enrols undergraduates of nutrition courses from Brazilian universities and graduated volunteers. A web-based self-administered system was designed to collect health-related data. After fulfilling online questionnaires (socioeconomic, early life events and lifestyle data), participants are invited to a clinical visit for physical examination and laboratory procedures (blood sampling, faeces collection and body composition). At a 3-year interval, they will be invited to repeat similar procedures. ETHICS AND DISSEMINATION: The NutriHS research protocol was approved by the Institutional Ethics Committee and is providing promising data which contribute to the understanding of pathophysiological links between early life events, body composition, gut microbiota, and inflammatory and metabolic risk profile. The combination of a friendly tool with the innovative purposes of NutriHS offers a remarkable resource for testing hypotheses about mechanisms of nutrition-related diseases and further planning of preventive programmes in public health.

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Introdução: Nicho interessante de pesquisa sobre o papel de hábitos de vida na saúde são os nutricionistas e estudantes de nutrição. Nesse sentido, surge o Nutritionists Health Study (NutriHS) na FSP-USP. Estudos desta natureza geram quantidade apreciável de informação, sendo desejável o uso de tecnologia para facilitar a obtenção e processamento de dados. Objetivos: O conjunto dos objetivos desta tese, que vão desde a criação de sistema web até sua aplicação no NutriHS, foram: 1) analisar softwares internacionalmente disponíveis, voltados à coleta e análise de dados sobre nutrição e alimentação; 2) desenvolver e implementar o sistema web, o e-NutriHS; 3) elaborar a documentação do sistema web; 4) proceder a validação os dados coletados pelo e-NutriHS; 5) comparar hábitos de vida (dieta e atividade física), medidas antropométricas e perfil bioquímico de estudantes de Nutrição e nutricionistas. Métodos: Realizou-se busca sistemática de estudos que utilizavam sistemas informatizados baseados na web. No desenvolvimento do e-NutriHS empregaram-se linguagens de programação livres: para o banco de dados utilizou-se MySQL 5.0 server via phpMyAdmin, localhost via UNIX socket e para a camada de apresentação Jquery 1.8, PHP 5.6, CSS e HTML 5. A documentação incluiu fluxogramas, arquitetura, código fonte e abordagem IBM Rational Unified Process, permitindo o desenvolvimento guiado por casos de uso, atendendo às recomendações do Instituto Nacional de Propriedade Industrial. Implementou-se a coleta de dados do NutriHS sobre hábitos de vida, eventos precoces da vida, saúde e clínico-laboratoriais, de estudantes de Nutrição em diferentes períodos do curso (1ª metade e 2ª metade) e graduados, por meio eletrônico e presencial. Bland-Altman e Kappa foram usadas para análises de concordância entre dados referidos e aferidos. Subgrupos de participantes foram comparados quanto a diversas variáveis (incluindo índice de dieta saudável) por ANOVA. Resultados: A busca das ferramentas de coleta eletrônica de dados de nutrição resultou em 10 estudos. A documentação do e-NutriHS incluiu detalhamento de fluxogramas, arquitetura, código fonte e casos de uso, atendendo às recomendações para registro de software. 723 indivíduos completaram dados autorreferidos no sistema e 228 realizaram antropometria, medidas de pressão arterial, composição corporal e coleta de materiais biológicos. Detectaram-se fortes correlações entre os valores antropométricos relatados e aferidos. A comparação de subgrupos mostrou tendência a menor consumo de energia, colesterol e carne vermelha e maior consumo de frutas & verduras nos grupos com maior duração da exposição a conhecimentos em nutrição. Os graduados apresentaram melhor escore de componentes do índice de dieta saudável e melhores índices lipídicos. Tais índices associaram-se ao consumo de frutas & verduras e inversamente ao de grãos refinados. Discussão: Instrumentos disponíveis na literatura apontam o meio eletrônico como de utilidade para condução de pesquisa em epidemiologia nutricional. O e-NutriHS atendeu adequadamente aos propósitos, motivando encaminhar seu registro de software. Com ferramenta eletrônica amigável, o NutriHS destacou-se como importante iniciativa de pesquisa em nutrição. Sugeriu que aquisição de conhecimento e habilidades traz benefícios clínicos que poderão, no longo prazo, reduzir o risco cardiometabólico. Conclui-se que o desenvolvimento do e-NutriHS proporcionou rápida implementação do NutriHS, gerando dados de alta qualidade e baixo custo. Abrem-se perspectivas de testar hipóteses sobre mecanismos de doenças e intervenções na sua fase longitudinal que poderão ser úteis para a saúde pública

Introduction: An interesting field of research on the role of lifestyle on health involves undergraduates and graduates of Nutrition Colleges. In this sense, emerges the Nutritionists\' Health Study (NutriHS) in the FSP-USP. This kind of study generates appreciable amount of information requiring technology to facilitate the data collection and processing. Objectives: The objectives for the development of this thesis began by programing a computerized system to its application in NutriHS. They were: 1) to analyze internationally available softwares addressed to the collection and analysis of data on nutrition; 2) to develop and implement the web system, e-NutriHS; 3) to develop the web system documentation; 4) to validate the data collected by NutriHS system; 5) to compare lifestyle habits (diet and physical activity), anthropometric measurements and biochemical profile of Nutrition undergraduates and nutritionists. Methods: A systematic search of epidemiological studies using web-based systems was performed. For the development of the e-NutriHS system free programming languages were employed: MySQL 5.0 for database server via phpMyAdmin, localhost via UNIX socket; and jQuery 1.8, PHP 5.6, CSS and HTML 5 for the users layer. Its documentation included detailed flowcharts, architecture, source code and the IBM Rational Unified Process approach, according to the National Institute of Industrial Property recommendations. Electronic data collection of the NutriHS participants on lifestyle, early life events, health and clinical laboratory from the undergraduates at different stages of course (1st half and 2nd half) and graduated, as well as face-to-face data collection, were implemented. Bland-Altman and Kappa were used for correlation analysis between reported and measured data. Subgroups of participants were compared according to a number of variables (including healthy eating index) by ANOVA. Results: Ten studies were selected in the search of webbased instruments. The e-NutriHS documentation included flowcharts, architecture, source code and use cases, taking into account the recommendations for software registration. 723 subjects completed self-reported data and 228 had measurements of anthropometry, blood pressure, body composition and collection of biological materials taken. Strong correlations were detected between reported and measured anthropometric values. In subgroups comparisons, a trend to lower energy and cholesterol red meat and higher fruits and vegetables intakes were found in groups with longer exposure to nutrition knowledge. The graduated group had better scores of some components the health eating index and better lipid indices. Lipid indices were associated with the intake fruits & vegetables and inversely with refined grains. Discussion: The systematic review indicates that web-based instruments are useful for conducting research in nutritional epidemiology. The e-NutriHS met its purposes appropriately, which led to referral to the software registration. The NutriHS has represented a major initiative research in nutrition. This suggested that acquisition of knowledge and skills reflects in clinical benefits that could reduce long term cardiometabolic risk. We conclude that the e-NutriHS development accelerate the NutriHS implementation, generating high-quality low-cost data. Perspectives of testing hypotheses about the mechanisms of nutrition-related diseases and interventions in the longitudinal phase are opened with potential use in public health

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