BDTD - Biblioteca Digital de Teses e Dissertações
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Master Thesis Relações entre o perfil antioxidante da dieta e parâmetros clínicos em indivíduos com esclerose lateral amiotrófica(Universidade Federal do Rio Grande do Norte, 2025-09-25) Felipe, Maria Luisa do Nascimento; Pedrosa, Lúcia de Fátima Campos; Lais, Lúcia Leite; https://orcid.org/0000-0002-8061-7048; https://orcid.org/0009-0001-7118-8747; Bezerra, Danielle Soares; Venske, Débora Kurrle Rieger; https://orcid.org/0000-0002-8726-8899Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease with a significant impact on the nutritional and functional status of individuals. Diet plays a central role in modulating inflammation, oxidative stress, and the clinical progression of the disease. Although dietary parameters such as the Dietary Antioxidant Quality Score (DAQS), the Dietary Total Antioxidant Capacity (DTAC), and the NOVA classification are used to assess diet quality, studies exploring their relationship with clinical outcomes in individuals with ALS remain scarce. This study aimed to evaluate the relationship between the dietary parameters DAQS and DTAC and clinical variables in individuals with ALS. A descriptive cross-sectional study was conducted with 68 individuals followed at the multidisciplinary ALS outpatient clinic of the Onofre Lopes University Hospital – HUOL (UFRN). The sample was characterized according to demographic, clinical, and nutritional characteristics. ALS progression and severity were assessed using the revised ALS Functional Rating Scale (ALSFRS-R). Nutritional status was determined by Body Mass Index [BMI (kg/m²)], categorized as underweight, normal weight, and overweight. Dietary intake was assessed using two nonconsecutive 24-hour dietary recalls (24HRs). Energy and micronutrient intake were analyzed using the Virtual Nutri Plus® software. The DAQS was calculated based on the intake of vitamin A, vitamin C, vitamin E, zinc, and selenium, and categorized as “low/medium” or “high.” The DTAC, expressed in mmol/1000 kcal/day, was estimated using literature data based on the Ferric Reducing Antioxidant Power (FRAP) method, and classified as “high” or “low” according to the median value. DTAC data were also described as the percentage contribution of each NOVA food classification group (unprocessed and minimally processed foods, processed culinary ingredients, processed foods, and ultra-processed foods) to the total DTAC. All collected variables underwent descriptive analysis. Variables with normal distribution were analyzed using the independent t-test, while non-normally distributed variables were analyzed using the non-parametric Mann–Whitney test. These tests were used to compare DAQS (high vs. low/medium) and DTAC (high vs. low) groups to demographic and clinical characteristics. Effect sizes were calculated for all statistical tests. Analyses were performed using R software, version 4.5.0, with a significance level of 5% (α = 0.05). Participants differed significantly by sex, with males presenting higher ALSFRS-R scores (p = 0.013), energy intake (kcal/day, p < 0.001), vitamin C intake (mg/day, p = 0.004), and zinc intake (mg/day, p = 0.018). The majority of DTAC (79.8%) originated from Group 1 foods according to the NOVA classification. Participants with a high DAQS had a shorter symptom duration in months (p = 0.023) and higher ALSFRS-R scores (p = 0.047) compared to those with low/medium DAQS. Higher BMI values were observed in the high DTAC group, differing significantly from the low DTAC group (p = 0.039). In conclusion, both DAQS and DTAC were associated with relevant clinical indicators in individuals with ALS, including nutritional status, functional capacity, and disease progression. The predominance of unprocessed and minimally processed foods as the main sources of dietary antioxidants highlights the importance of diet quality in the nutritional management of ALS.Master Thesis Validação do NCP-QUEST: instrumento para auditoria do Processo de Cuidado em Nutrição no Brasil(Universidade Federal do Rio Grande do Norte, 2025-03-26) Dourado, Laura Carvalheira; Vale, Sancha Helena de Lima; Lais, Lucia Leite; https://orcid.org/0000-0002-8061-7048; https://orcid.org/0000-0002-0972-1678; http://lattes.cnpq.br/2196322222299346; Bezerra, Ingrid Wilza Leal; Rabito, Estela Iraci; https://orcid.org/0000-0002-3857-9746Validation of NCP-Quest: Instrument for auditing the Nutrition Care Process in Brazil. The Nutrition Care Process (NCP) is a systematic and standardized care management model that consists of four steps to address nutritional problems and provide effective, high-quality care to individuals. To document nutrition care, a standardized language is used for each step, known as the Nutrition Care Process Terminology (NCPT). To assess the implementation of the NCP/NCPT, audit instruments are employed, with the NCP-Quest being the most up-to-date and validated tool in the United States. In 2020, in Brazil, the "Consórcio para Pesquisa e Implementação do PCN no Brasil" was established, marking the beginning of an effort to implement the NCP/NCPT in the country. Thus, the objective of this study was to validate the NCP-Quest for Brazilian Portuguese. This is a methodological study, divided into two phases: (1) Validation of the translated content and (2) Assessment of the instrument's reliability. The validity of the translated content was analyzed using the Content Validity Index (CVI), both for individual items (I-CVI) and for the overall instrument (S-CVI). The instrument's reliability was assessed using α-Krippendorff’s, the percentage of agreement among raters, and the intraclass correlation coefficient (ICC) for each item, NCP section, all items combined, and the total score. The I-CVI ranged from 0.80 to 1.00, and the SCVI was 0.988 in the first round and 0.992 in the second round of translated content validation. Inter-rater reliability for the total score showed an ICC of 0.964 (95% CI = 0.850 – 0.992) for average measures and 0.930 (95% CI = 0.739 – 0.983) for single measures, demonstrating excellent agreement. α-Krippendorff’s was 0.66, indicating sufficient agreement. When evaluating individual items, some showed a negative α-Krippendorff’s, indicating a higher level of disagreement than expected by chance, which may be related to different interpretations and the subjectivity of certain instrument items. Despite these variations in specific items, the overall results indicate that the NCP-Quest is a valid and reliable instrument for audits, making it suitable for application in the Brazilian context.Master Thesis Alimentação de trabalhadores de serviços comerciais de alimentação sob a ótica da saudabilidade e sustentabilidade(Universidade Federal do Rio Grande do Norte, 2025-08-04) Marinho, Thais de Gois Santos; Rolim, Priscilla Moura; https://orcid.org/0000-0002-3847-5744; http://lattes.cnpq.br/9630151999290632; Cunha, Diogo Thimoteo da; https://orcid.org/0000-0001-5928-9265; http://lattes.cnpq.br/4807107491488119; Seabra, Larissa Mont'Alverne Jucá; https://orcid.org/0000-0002-1878-4283; http://lattes.cnpq.br/1066492425111929Food services play a fundamental role in promoting food and nutrition security (FNS) and in reducing environmental impacts. This study evaluated menus from five commercial restaurants in Natal, Brazil, considering social, health, and environmental dimensions. In the social dimension, a sociodemographic questionnaire and the Brazilian Food Insecurity Scale (EBIA) were applied to 261 workers (67.9% men; mean age 32 years; 53.5% with completed high school). Among them, 70.2% were responsible for food purchasing and 70.6% for domestic meal preparation. Food insecurity affected 53.3% of workers and was associated with income (p=0.001), education (p=0.023), family composition (p=0.020), and municipality of residence (p=0.028). In the health dimension, the nutritional status of 438 workers was assessed, with 68.3% presenting overweight or obesity; obesity prevalence was 30.5% among men and 42.7% among women. Across 111 menus analyzed, caloric density was within the recommended range, but with high lipid and sodium content, reduced carbohydrates, and adequate protein. In the environmental dimension, 54.1% of foods were supplied locally, 43.2% from within the state, and 2.7% from other regions of Brazil. Menu composition included 59.8% fresh or minimally processed foods, 9.3% processed, 16.5% ultra-processed, and 24.7% culinary ingredients. Beef showed the highest environmental impact, followed by poultry, eggs, and pork, with weekly averages of carbon footprint 2.3 kgCO2, water footprint 1.94 L, and ecological footprint 12.5 kg/m². Data triangulation, inspired by mixed-methods approaches with interpretation grids, was also adopted by crossing three axes: (i) macronutrients × obesity; (ii) caloric-nutritional adequacy × obesity × food insecurity; and (iii) proteins × carbon footprint × water footprint, in order to integrate results, minimize bias, and enhance complementarity of findings. Triangulation analysis showed that although menus had relatively similar macronutrient composition, obesity outcomes differed across restaurants, indicating a stronger influence of social and contextual determinants. Furthermore, caloric-nutritional adequacy and food insecurity alone did not explain these variations, reinforcing the need for integrated approaches. From an environmental perspective, higher carbon and water footprints were associated with menus containing more animal protein, with relevant differences depending on the type of protein offered. The findings reveal a concerning scenario: food service workers, including those employed in renowned restaurants, face food insecurity, highlighting social vulnerabilities and invisibility in protection policies. Ensuring dignity requires better working and dietary conditions. While menus met caloric requirements, the excess of lipids and sodium increases the risk of chronic diseases such as obesity. In addition, beef consumption showed the greatest environmental impact, underscoring the urgency of rethinking food practices and policies to promote health, social equity, and sustainability.Master Thesis Estado nutricional de vitaminas lipossolúveis e cobalamina na Síndrome da Quilomicronemia Familiar (SQF): um estudo caso controle(Universidade Federal do Rio Grande do Norte, 2025-06-23) Batista, Leonam da Silva Pereira; Reis, Bruna Zavarize; Lima, Josivan Gomes de; http://lattes.cnpq.br/6456654111946909; https://orcid.org/0000-0001-8726-8699; http://lattes.cnpq.br/0683344477426879; https://orcid.org/0000-0002-4829-4648; http://lattes.cnpq.br/6869633707023330; Duarte, Graziela Biude Silva; Rodrigues, Karla Danielly da Silva RibeiroFamilial Chylomicronemia Syndrome (FCS) is a rare autosomal recessive genetic disorder primarily caused by mutations in the lipoprotein lipase (LPL) gene or genes related to its function, resulting in severe hypertriglyceridemia. FCS management requires rigorous nutritional therapy with severe lipid restriction (less than 20 g per day) that can directly impact the intake and absorption of fat-soluble vitamins and cobalamin. This study aimed to evaluate the nutritional status of fat-soluble vitamins and cobalamin in individuals with FCS compared to healthy individuals. A case-control study matched by sex, age, and BMI category (1:1) was conducted, including 11 FCS patients matched with their respective controls (n=11), with participants recruited from Onofre Lopes University Hospital (HUOL) and the Federal University of Rio Grande do Norte (UFRN). Individuals with FCS were grouped according to genotypic alteration, being classified as heterozygotes or homozygotes. Data on lifestyle, health, physical examination, gastrointestinal symptoms, anthropometric assessment, and dietary intake were collected. Blood samples were obtained for biochemical analysis of the following vitamins: serum retinol, serum phylloquinone, serum alpha-tocopherol, 25-hydroxyvitamin D, and serum cobalamin. Data were analyzed using SPSS Statistics v.26.0 software, adopting a 95% significance level (p < 0.05). Effect size was calculated using Cohen's d, Cliff's Delta, Eta squared, and Epsilon squared. A large effect size was observed for retinol, with the heterozygote group showing higher levels compared to the homozygote and control groups. There was also a large effect size for alpha-tocopherol, where heterozygote and homozygote groups presented higher levels than the control group, the latter showing possible insufficiency of this vitamin according to the adopted cutoff points. Additionally, an inversely proportional correlation was identified between vitamin D and triglyceride, total cholesterol, and VLDL levels, as well as a directly proportional correlation between cobalamin and serum retinol. Regarding food consumption, it was verified that individuals with FCS had lipid intake above the recommended nutritional guidance of 20g/day. Thus, individuals with FCS presented significantly elevated concentrations of alpha-tocopherol and serum retinol compared to controls, with heterozygotes showing even higher retinol levels. Dietary lipid consumption exceeded nutritional recommendations by more than twice, suggesting an inadequate dietary pattern that may contribute to the syndrome's metabolic alterations.Master Thesis Avaliação do cumprimento de requisitos sanitários, físico-químicos e de bem-estar animal em frigoríficos de origem de carnes e produtos cárneos fornecidos a Institutos Federais de Educação(Universidade Federal do Rio Grande do Norte, 2025-03-26) Lima, Cleantho Guilherme Galvão de; Seabra, Larissa Mont'Alverne Jucá; Bezerra, Ingrid Wilza Leal; http://lattes.cnpq.br/0148928535788097; https://orcid.org/0000-0002-1878-4283; http://lattes.cnpq.br/1066492425111929; https://orcid.org/0000-0003-1364-3470; http://lattes.cnpq.br/3125064060535239; Rolim, Priscilla Moura; Gomes, Sávio MarcelinoEnsuring sustainable consumption and production patterns is a global goal of the Sustainable Development Goals (SDGs), including the promotion of sustainable public procurement. In Brazil, food procurement by public institutions represents a significant portion of government purchases, making it essential to evaluate the potential environmental, social, and economic impacts these purchases may have. Therefore, understanding the origin and production process of the food acquired by public institutions is crucial for promoting responsible consumption and production. The objective of this study is to understand the origin of Meats and Meat Products (MMP) purchased by Federal Institutes of Education in Rio Grande do Norte (IFRN) and evaluate the compliance with hygienic-sanitary, physicochemical, and animal welfare requirements of slaughterhouses supplying MMP to the IFRN. A case study was conducted, using procurement data of MMP purchased through bidding processes by the IFRN from 2019 to 2022. The violations committed by the slaughterhouses supplying the MMP were identified through a database provided by the Ministry of Agriculture, Livestock, and Supply (MAPA). Data from 9 bidding minutes were obtained, totaling 11 different types of MMP from 19 slaughterhouses, with 11 largescale and 8 medium-scale. No small-scale slaughterhouses were observed in the evaluated bidding processes. Among the MMP provided, fresh poultry meat had the highest purchase volume, with approximately 26 tons, followed by canned fish and fresh beef, with 18.6 and 13.3 tons respectively. A total of 577 violations committed by the source slaughterhouses were identified during the evaluated period, with 62% being hygienic-sanitary violations, 8% physicochemical, and 30% animal welfare violations. The data from this study show that 58% of the slaughterhouses where the MMP purchased by IFRN originated from during the evaluated period had some type of violation. It is concluded that the MMP supplied to the federal institutes mostly comes from large-scale slaughterhouses and that the main violations committed by the slaughterhouses were hygienic-sanitary violations. However, a considerable percentage of violations related to animal welfare were also observed. Promoting fairer public procurement requires the commitment of the managers involved, with the determination of criteria in the bidding notices that allow for greater supplier diversification and prevent the participation of companies that fail to comply with not only sanitary requirements but also animal welfare requirements.Master Thesis Avaliação e previsões de sobrevivência do PROtocol for Nutritional Risk in Oncology (PRONTO)(Universidade Federal do Rio Grande do Norte, 2025-03-24) Silva, Danna Calina Nogueira e; Fayh, Ana Paula Trussardi; https://orcid.org/0000-0002-9130-9630; http://lattes.cnpq.br/0049770583345803; https://orcid.org/0000-0003-2890-0636; http://lattes.cnpq.br/7954301432227005; Verde, Sara Maria Moreira Lima; Lima, Severina Carla Vieira CunhaCancer is a complex disease characterized by the irregular growth of malignant cells and represents the second leading cause of death in the world. It causes metabolic changes that often result in nutritional deficits, including malnutrition. Approximately 20% of cancer patients die from malnutrition and associated complications, not from the disease itself. Therefore, early identification of nutritional risk favors earlier and more assertive interventions, the continuous monitoring of which contributes to risk reduction. The aim of this study was to evaluate the discriminatory and mortality prediction performance of the PROtocol for Nutritional Risk in Oncology (PRONTO) instrument in outpatients and hospitalized cancer patients. The study is a secondary analysis of a cohort with prospective data collection, which evaluated cancer patients in a hospital setting at the Onofre Lopes University Hospital - HUOL, of both sexes, aged over 20 years. Sociodemographic and anthropometric data were collected (weight and height to calculate body mass index - BMI). Nutritional risk was assessed using the shortened version of the Subjective Global Assessment Produced by the Patient (ASG-PPP), applied up to 48 hours after hospitalization, while PRONTO was assessed using retrospective data. Patients were followed up to assess immortality outcomes at 6 and 12 months. To verify the concurrent validity of PRONTO for assessing nutritional risk, accuracy metrics were calculated and Cox regression analysis was conducted to verify the association between the outcomes of interest and the presence of nutritional risk in order to test its predictive validity. A total of 390 patients were evaluated. They were elderly (45.6%), female (53.6%), with solid tumors (89%) and advanced stages of the disease (42.3%). Approximately half of the sample underwent chemotherapy treatment only (39.5%). The frequency of nutritional risk was higher using the PRONTO tool when compared to the ASGPPP (84.4% vs 76.4%, respectively). The classification of nutritional risk according to PRONTO showed moderate accuracy in identifying patients at nutritional risk (AUC 0.76, 95% CI 0.68 - 0.79), high sensitivity (95.3%) and positive predictive value (86.3%) obtained, low specificity (51.1%) and low negative predictive value (77.7%). The risk status identified by PRONTO was an independent and satisfactory predictor of mortality at 6 and 12 months (adjusted HR 2.96; 95% CI 1.05 to 8.32, adjusted HR 2.88; 95% CI 1.20 to 6.63). The study presents an initial assessment of the applicability of the PRONTO protocol, highlighting its potential as a tool for rapid identification of nutritional risk and prognosis in cancer patients. In clinical settings where formal nutritional screening is not available, PRONTO may represent an efficient and easy-to-implement approach, facilitating the early identification of patients at risk and enabling timely nutritional interventions in clinical practice.