Chronic diseases such as osteoporosis, type 2 diabetes, and cardiovascular disease are diseases of long duration, slow progression, and are by far the leading cause of death worldwide. A growing body of evidence links adverse exposures in early development with an increased risk of chronic diseases in adult life. The studies presented in this dissertation sought to exploit this phenomenon to determine the extent to which gestational and lactational exposure to a high fat diet predisposes the offspring to certain diseases in later life and if the eating habits of adult offspring would be able to mitigate or exacerbate these conditions.  In the study presented in Chapter III, dams fed an atherogenic high fat diet prior to conception and throughout gestation and lactation experienced excess hepatic lipid accumulation and poor birth outcome as characterized by smaller litter sizes and higher post-delivery mortality. In the offspring, gestational and lactational exposure to such a diet resulted in growth restriction and skeletal aberrations indicative of osteoporosis, despite being fed a standard rodent diet post-weaning. We propose that dietary-induced hyperlipidemia, along with pregnancy-associated factors, resulted in fatty liver and subsequently reduced litter sizes and increased early mortality, and that the skeletal aberrations seen in the mature offspring represent dietary-induced inhibition of osteogenesis in favor of adipogenesis. In the study presented in Chapter IV, early exposure to a high fat diet resulted in central obesity, elevated lipid levels, hyperglycemia, and additional markers used in the diagnosis of the metabolic syndrome. Altering the diets of the mature offspring demonstrated that the eating habits of adulthood have the potential to mitigate or exacerbate certain metabolic parameters established earlier in life. Mechanisms contributing to the observed metabolic aberrations could include developmental plasticity and mismatch, catch-up growth, and altered programming of the appetite regulatory network. Collectively, this research suggests that early exposure to a fat-rich diet can lead to metabolic and skeletal aberrations in the adult offspring and adds support to the developmental origins of health and disease hypothesis by finding that adverse nutritional exposures in early life can play a role in the chronic diseases of adulthood. / Ph. D.

Insulin sensitivity decreases during pregnancy, presumably an adaptation ensuring sufficient glucose supply to feto-placental tissues. Feeds high in non-structural carbohydrates are also linked to diminished insulin sensitivity in horses. Because the equine fetus is highly glucose reliant, maternal glucose and insulin dynamics during pregnancy may have implications for optimal fetal development in horses. Mismanagement of maternal nutrition during gestation could predispose the offspring to metabolic disorders (e.g. insulin resistance) later in life. In horses, insulin resistance is associated with increased risk for development of laminitis. These studies measured insulin sensitivity and glucose dynamics in pregnant and non-pregnant mares fed high sugar and starch (SS) or high fat and fiber (FF) feeds, as well as neonatal foals born from pregnant mares fed SS and FF feed. Insulin modified frequently sampled intravenous glucose tolerance tests (FSIGT) were applied to pregnant Thoroughbred mares (n = 22) at 28 ± 3 wks (Period 1) and 47 wks (Period 2) gestation, as well as non-pregnant mares (n=10) measured simultaneously. Following the first FSIGT mares were fed SS or FF feed for the remainder of the study. After 11 wks adaptation to feeding, a subset of mares were evaluated with hourly blood samples for 24 h to assess glycemic and insulinemic response to three times daily feeding while on pasture. Neonatal foal FSIGTs (n=20) were conducted at 5 ± 1 d of age. The minimal model of glucose and insulin dynamics was used to determine insulin sensitivity (SI), glucose effectiveness (Sg), acute insulin response to glucose (AIRg) and disposition index (DI). Pregnant mares during Period 1 exhibited lowered SI, Sg and elevated AIRg relative to non-pregnant mares. Pregnant mares demonstrated greater glycemic and insulinemic responses to feeding of both SS and FF meals than non-pregnant mares consuming the same feeds. Also, SS feed elicited greater glycemic and insulinemic areas under the curve following feeding than FF feed in pregnant mares. These data support that pregnancy in mares in associated with lowered SI by 28 wks gestation and that altered SI, Sg and AIRg are associated with different responses to consuming SS and FF feeds. Foals exhibited high basal glucose, basal insulin, SI and Sg relative to mature horses, indicating a large capacity for glucose uptake with or without insulin. Basal glucose concentrations were higher and basal insulin concentrations tended to be higher in SS than FF foals (P = 0.016 and P = 0.071, respectively). Glucose and insulin dynamics in late gestation mares and neonatal foals exemplify the adaptive nature of energy metabolism in horses. Furthermore, dietary energy composition affects glucose and insulin responses to feeding in late gestation mares, which in turn was associated with different basal blood concentrations of these variables in the resulting neonatal foals. / Master of Science

Grounded at the intersection of rhetorics of health and medicine (RHM), technical and professional communication (TPC), and transnational institutional communication, my study aimed to explore the transnational issues of negotiation and power and (mis)articulations within the realm of global maternal nutrition (MN) communication design. Specifically, I sought to demystify the behind-the-scenes interactions and negotiations among funders (in this case, USAID headquarters), contractors (global health designers for a project called "Advancing Nutrition"), and local partners (Global South program implementers). To achieve this goal, I conducted a rhetorical analysis of twenty-eight publicly available Advancing Nutrition MN artifacts, including program guides, worksheets, toolkits, and multimedia discourses. Additionally, I performed fifteen episodic narrative interviews with key informants from the Advancing Nutrition team, USAID, and local implementing agencies in India, Kyrgyz Republic, and Ghana. Through the theoretical lenses of power as assemblage and articulation, my findings suggested a continual flux of (re)articulation tension within global MN communication design. This tension stemmed from power assemblages—a confluence of historical-political-ideological forces at the production site in the Global North and the rigid socio-cultural framework at the implementation site in the Global South—in transnational content creation spaces. This tension manifested in maternal-child nutrition indicators, temporally bound MN program design, community narratives in local implementation sites, and an emphasis on normative views of women's nutrition. Despite the power differentials among funders, contractors, and implementers, global health designers employed tactical technical communication approaches, including coalitional actions and reconstructive moves, to empower women and mothers in the Global South. Thus I conclude that technical and health communication scholars can help global institutional actors create socially-inclusive communication design and foster intentional community-engaged interventions by both attuning themselves to and exposing globalized power structures in the context of public health document creation. / Doctor of Philosophy / Situated at the crossroads of health and medical rhetoric, technical and professional communication, and cross-border institutional interaction, my research set out to delve into the complexities of negotiation, power dynamics, and communication challenges in the global arena of maternal nutrition. Specifically, I aimed to shed light on the behind-the-scenes dealings and discussions among key players such as funders (like USAID headquarters), contractors (working on projects such as "Advancing Nutrition"), and local partners (implementing programs in the Global South). To accomplish this, I conducted a detailed analysis of twenty-eight publicly available materials related to the Advancing Nutrition initiative, including program guides, worksheets, toolkits, and multimedia presentations. Additionally, I conducted fifteen interviews with individuals from the Advancing Nutrition team, USAID, and local agencies in India, Kyrgyz Republic, and Ghana. Using the theoretical frameworks of power dynamics and articulation, my findings revealed a continual tension in how maternal nutrition communication is (re)shaped and understood on a global scale. This tension arises from a blend of historical, political, and ideological forces influencing content creation in the Global North, juxtaposed with the socio-cultural realities at the implementation sites in the Global South. It is evident in various aspects such as maternal-child nutrition metrics, the design of time-sensitive nutrition programs, local community narratives, and the portrayal of women's nutrition. Despite the inherent power imbalances among funders, contractors, and implementers, those involved in global health initiatives employed strategic communication methods, including collaborative efforts and reconstructive strategies, to empower women and mothers in the Global South. As a result, I argue that scholars in technical and health communication have a vital role to play in fostering inclusive communication design and facilitating community-focused interventions by both understanding and exposing global power dynamics in the realm of public health document creation.

Objetivo: Descrever a prevalência do Aleitamento Materno (AM) e do Aleitamento Materno Exclusivo (AME) no quarto mês de vida e avaliar a sua associação com variáveis sócio-demográficas, comportamentais, nutricionais da mãe e variáveis do parto, nos Postos de saúde da cidade de Porto Alegre, RS, Brasil. Método: Os participantes foram 370 pares mãe-filho usuários de Unidades Básicas de Saúde (UBS) de Porto Alegre, Rio Grande do Sul. As gestantes foram arroladas consecutivamente em sala de espera e foram acompanhadas até o quarto mês de vida da criança mediante contato telefônico no pós-parto imediato, e entrevista agendada na Unidade Básica de Saúde (UBS) no quarto mês pós-parto. Regressão de Poisson com variância robusta foi utilizada para estimar a associação entre o AM e os diferentes fatores, como também para verificar a associação entre o AME e fatores sociodemográficos, comportamentais e nutricionais. A Fração atribuível na população foi utilizada para avaliar a contribuição dos fatores associados modificáveis. Resultados: 92,6% das crianças iniciaram a amamentação e no quarto mês pós-parto 79,2 % ainda mamava no peito, sendo que 16% delas estavam em AME. Os alimentos mais precocemente introduzidos na dieta foram, a água, o leite de vaca e as fórmulas, já presentes na dieta de alguns bebês no primeiro mês de vida. Após análise multivariável, a escolaridade materna (RP = 1,64; IC 95%: 1,11 - 2,40) inferior a cinco anos, o fumo materno (RP = 1,56; IC95%: 1,09 - 2,22), o uso de bico (RP = 9,38; IC 95%: 3,90 - 22,59) e o baixo peso ao nascer (RP = 1,58; IC 95%: 1,00 - 2,48) se mostraram associados a uma menor prevalência de AM. Com relação ao AME, o uso de bico (RP = 1,14; IC 95%: 1,03 - 1,25), o trabalho materno (RP = 1,12; IC95%:1,03 - 1,21), o ganho de peso gestacional (RP = 1,09; IC 95%: 1,00 - 1,12) e a idade materna inferior a 19 anos (RP = 1,17 IC 95%: 1,03 - 1,25) estão associados com a introdução precoce de outros alimentos na dieta da criança. A ansiedade e depressão materna não se mostraram significativamente associadas ao AM nem ao AME. Conclusões: As prevalências do AM e do AME no quarto mês de vida ainda encontram-se baixas. Mesmo tendo um percentual elevado de crianças que iniciaram o AM, no quarto mês pós-parto somente 79,2 % delas continuava amamentando e, destas, apenas 16% estavam em AME. Os principais motivos de desmame referidos pelas mães foram o medo que a criança ficasse com fome e a falta de produção de leite. No quarto mês de vida, todos os tipos de alimentos já tinham sido ingeridos por algumas crianças pertencentes ao estudo. / Objective: To report the incidence of breastfeeding and exclusive breastfeeding at 4 months postpartum and to identify associated factors. Methods: Participants where 370 mother-infant pairs who were recruited consecutively from 10 different health care units from Porto Alegre, Rio Grande do Sul, Brazil, and were followed up by phone and interview until the 4 months postpartum. Data collected included sociodemographic, behavioral and nutritional factors related to breastfeeding and exclusive breastfeeding. Poisson regression was used to identify the factors related to a less prevalence of breastfeeding and exclusive breastfeeding. Results: 92, 6% of the children initiated breastfeeding, and at 4 months of age, 79,2% still breastfeeding. Water, milk and formulas were the firsts products being introduced to the children´s diet, and being consumed at the first month of live by 20, 9%, 8,7% and 17,2% of the population, respectively. Breastfeeding was independently, negatively associated with less than 5 years of maternal schooling (RP = 1,64; 95% CI: 1,11 - 2,40), pacifier use (RP= 9,38; 95% CI: 3,90 – 22,59), maternal smoking (RP = 1,56; 95% CI: 1,09 – 2,22) and low birth weight (RP = 1,58; 95% CI: 1,00 - 2,48). Exclusive breastfeeding was independently associated with pacifier use (RP = 1,14; 95%CI: 1,03 - 1,25), mother being working or studying (RP = 1,12; 95% CI:1,03 - 1,21), gestational weight gain (RP = 1,09; 95% CI: 1,00 - 1,12) and maternal age under 19 years (RP = 1,17; 95% CI: 1,03 – 1,25). Conclusions: Breastfeeding and exclusive breastfeeding rates still low. Even having an elevated percent of breastfeeding initiation, at 4 months postpartum only 79,2% stilled breastfeeding and the exclusive breastfeeding rate was only 16%. The principal reasons for not breastfeeding at 4 months post-partum was being afraid the child was hungry and not producing breast milk. At 4 months of age, many children were already eating all kind of food.

Exposure of the fetus to adverse conditions in utero may result in developmental adaptations that alter metabolism and postnatal growth of the offspring. This thesis investigated the effects of dam size and nutrition during pregnancy on growth, metabolic function and lactational and productive performance of the female offspring to two years of age. Four-hundred and fifty heavy (60.8 kg ± 0.18) and 450 light (42.5 kg ± 0.17) dams were randomly allocated to ad libitum or maintenance nutritional regimens from days 21 - 140 of pregnancy, under pastoral grazing conditions. From one week prior to lambing, all dams were fed ad libitum until weaning. After weaning, female progeny were managed and fed under pastoral conditions as one group. Maternal nutrition during pregnancy affected lamb growth to weaning, however, after weaning lamb growth was affected by dam size. Dam size had no effect on glucose metabolism, adrenal function or fat metabolism in 16-month-old female twin offspring. Dam nutrition during pregnancy had a minor effect on glucose metabolism and no effect on adrenal function or lipolysis, however, it did possibly affect gluconeogenesis and/or glycogenolysis, with increased glucose production in ewes born to maintenance-fed dams. Ewes born to dams fed maintenance showed greater milk production, lactose percentage, lactose and crude protein yield. Ewes born to heavy dams showed greater milk production and lactose yield. Dam size had no effect on reproductive performance of the female offspring. Being born to a larger dam showed no advantages over being born to smaller dams, for number of lambs born and weight of lambs at birth and weaning. ‘Grand’dam maintenance nutrition increased lamb birth and weaning weight and lamb growth rates of the ‘grand’offspring. Ewes born to maintenance-fed dams could have an advantage over ewes born to ad libitum-fed dams in physiological stressful situations in life as their liver may be able to supply more glucose to support their growing conceptus and milk production to increase the chances of survival of their offspring. These results indicate that it is possible to programme the offspring by feeding their dams differently during pregnancy under grazing conditions. With a better understanding of how offspring can be programmed through different maternal nutritional regimens, it may be possible to significantly increase the production potential of the New Zealand ewe population.

Objetivo: Descrever a prevalência do Aleitamento Materno (AM) e do Aleitamento Materno Exclusivo (AME) no quarto mês de vida e avaliar a sua associação com variáveis sócio-demográficas, comportamentais, nutricionais da mãe e variáveis do parto, nos Postos de saúde da cidade de Porto Alegre, RS, Brasil. Método: Os participantes foram 370 pares mãe-filho usuários de Unidades Básicas de Saúde (UBS) de Porto Alegre, Rio Grande do Sul. As gestantes foram arroladas consecutivamente em sala de espera e foram acompanhadas até o quarto mês de vida da criança mediante contato telefônico no pós-parto imediato, e entrevista agendada na Unidade Básica de Saúde (UBS) no quarto mês pós-parto. Regressão de Poisson com variância robusta foi utilizada para estimar a associação entre o AM e os diferentes fatores, como também para verificar a associação entre o AME e fatores sociodemográficos, comportamentais e nutricionais. A Fração atribuível na população foi utilizada para avaliar a contribuição dos fatores associados modificáveis. Resultados: 92,6% das crianças iniciaram a amamentação e no quarto mês pós-parto 79,2 % ainda mamava no peito, sendo que 16% delas estavam em AME. Os alimentos mais precocemente introduzidos na dieta foram, a água, o leite de vaca e as fórmulas, já presentes na dieta de alguns bebês no primeiro mês de vida. Após análise multivariável, a escolaridade materna (RP = 1,64; IC 95%: 1,11 - 2,40) inferior a cinco anos, o fumo materno (RP = 1,56; IC95%: 1,09 - 2,22), o uso de bico (RP = 9,38; IC 95%: 3,90 - 22,59) e o baixo peso ao nascer (RP = 1,58; IC 95%: 1,00 - 2,48) se mostraram associados a uma menor prevalência de AM. Com relação ao AME, o uso de bico (RP = 1,14; IC 95%: 1,03 - 1,25), o trabalho materno (RP = 1,12; IC95%:1,03 - 1,21), o ganho de peso gestacional (RP = 1,09; IC 95%: 1,00 - 1,12) e a idade materna inferior a 19 anos (RP = 1,17 IC 95%: 1,03 - 1,25) estão associados com a introdução precoce de outros alimentos na dieta da criança. A ansiedade e depressão materna não se mostraram significativamente associadas ao AM nem ao AME. Conclusões: As prevalências do AM e do AME no quarto mês de vida ainda encontram-se baixas. Mesmo tendo um percentual elevado de crianças que iniciaram o AM, no quarto mês pós-parto somente 79,2 % delas continuava amamentando e, destas, apenas 16% estavam em AME. Os principais motivos de desmame referidos pelas mães foram o medo que a criança ficasse com fome e a falta de produção de leite. No quarto mês de vida, todos os tipos de alimentos já tinham sido ingeridos por algumas crianças pertencentes ao estudo. / Objective: To report the incidence of breastfeeding and exclusive breastfeeding at 4 months postpartum and to identify associated factors. Methods: Participants where 370 mother-infant pairs who were recruited consecutively from 10 different health care units from Porto Alegre, Rio Grande do Sul, Brazil, and were followed up by phone and interview until the 4 months postpartum. Data collected included sociodemographic, behavioral and nutritional factors related to breastfeeding and exclusive breastfeeding. Poisson regression was used to identify the factors related to a less prevalence of breastfeeding and exclusive breastfeeding. Results: 92, 6% of the children initiated breastfeeding, and at 4 months of age, 79,2% still breastfeeding. Water, milk and formulas were the firsts products being introduced to the children´s diet, and being consumed at the first month of live by 20, 9%, 8,7% and 17,2% of the population, respectively. Breastfeeding was independently, negatively associated with less than 5 years of maternal schooling (RP = 1,64; 95% CI: 1,11 - 2,40), pacifier use (RP= 9,38; 95% CI: 3,90 – 22,59), maternal smoking (RP = 1,56; 95% CI: 1,09 – 2,22) and low birth weight (RP = 1,58; 95% CI: 1,00 - 2,48). Exclusive breastfeeding was independently associated with pacifier use (RP = 1,14; 95%CI: 1,03 - 1,25), mother being working or studying (RP = 1,12; 95% CI:1,03 - 1,21), gestational weight gain (RP = 1,09; 95% CI: 1,00 - 1,12) and maternal age under 19 years (RP = 1,17; 95% CI: 1,03 – 1,25). Conclusions: Breastfeeding and exclusive breastfeeding rates still low. Even having an elevated percent of breastfeeding initiation, at 4 months postpartum only 79,2% stilled breastfeeding and the exclusive breastfeeding rate was only 16%. The principal reasons for not breastfeeding at 4 months post-partum was being afraid the child was hungry and not producing breast milk. At 4 months of age, many children were already eating all kind of food.

Submitted by Jos? Henrique Henrique (jose.neves@ufvjm.edu.br) on 2017-04-19T19:30:59Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) ronilson_ferreira_freitas.pdf: 5087070 bytes, checksum: a5bcb636f9ce2c039312753f72cda782 (MD5) / Approved for entry into archive by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2017-04-20T16:50:48Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) ronilson_ferreira_freitas.pdf: 5087070 bytes, checksum: a5bcb636f9ce2c039312753f72cda782 (MD5) / Made available in DSpace on 2017-04-20T16:50:48Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) ronilson_ferreira_freitas.pdf: 5087070 bytes, checksum: a5bcb636f9ce2c039312753f72cda782 (MD5) Previous issue date: 2016 / O objetivo deste estudo foi avaliar e relacionar a qualidade da dieta materna e a composi??o do leite humano em ?cidos graxos no primeiro trimestre de lacta??o. Trata-se de um estudo epidemiol?gico observacional, transversal que foi desenvolvido no per?odo de agosto de 2014 ? dezembro de 2015. A amostra constituiu-se de 106 nutrizes residentes na zona urbana da cidade de Diamantina, Minas Gerais, Brasil. Os instrumentos de coleta dos dados foram question?rio semiestruturado para caracteriza??o da amostra e o recordat?rio de ingest?o habitual. A qualidade da dieta foi avaliada por meio do ?ndice de Alimenta??o Saud?vel validado para a popula??o brasileira (IAS). Amostras de leite materno maduro foram obtidas de 106 nutrizes, a partir da 5? semana p?s-parto, por meio de ordenha manual. A extra??o da gordura do leite foi realizada atrav?s do m?todo de Bligh-Dyer, e metiladas com met?xido de s?dio 0,25 mol/l em metanol dietil ? ?ter. O perfil de ?cidos graxos do leite foi determinado por um Cromat?grafo a G?s equipado com detector por ioniza??o de chamas. Para as an?lises deste estudo, foram estimadas as porcentagens m?dias e desvios padr?o, as medianas e intervalos interquart?licos. Utilizou-se o teste de Kolmogorov-Sminorv para testar a normalidade dos dados. Foi realizado teste de Correla??o de Pearson e de Spearman, para verificar associa??o entre as vari?veis. Posteriormente foi realizada a an?lise de regress?o linear m?ltipla e an?lise de regress?o multivariada. A pontua??o m?dia do IAS total de 64,36?10,68 e os alimentos do grupo das frutas total, fruta inteira, cereal total, cereal integral e leite e derivados, foram os componentes do IAS das nutrizes com menores pontua??es, e com maior frequ?ncia de nota m?nima. Foi poss?vel observar um baixo consumo de frutas totais, frutas inteiras, cereais totais, cereais integrais e leite e derivados. Dentre os ?cidos graxos saturados, foram observados valores mais elevados para os ?cidos graxos palm?tico (C16:0), este?rico (C18:0), mir?stico (C14:0) e l?urico (C12:0), respectivamente. Entre os ?cidos graxos mono-insaturados, verificou-se maior contribui??o dos ?cidos graxos oleico (C18:1) e palmitoleico (C16:1), respectivamente. O total de ?cidos graxos essenciais (linoleico e ?- linol?nico) foi de 14,94%.Foi poss?vel observar uma rela??o inversa entre o consumo de frutas totais com o perfil de ?cidos graxos poli-insaturados, e uma rela??o direta entre o consumo de frutas totais e cereais totais com os ?cidos mono-insaturados e saturados, o que sugere que a qualidade da dieta reflete na composi??o de ?cidos graxos do leite materno. / Disserta??o (Mestrado Profissional) ? Programa de P?s-Gradua??o em Sa?de, Sociedade e Ambiente, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 2016. / The aim of this study was to evaluate and relate the quality of maternal diet and the composition of human milk fatty acids in the first quarter of lactation. This is an observational epidemiological study, cross that was carried out from August 2014 to December 2015. The sample consisted of 106 nursing mothers living in the urban area of the city of Diamantina, Minas Gerais, Brazil. Collection instruments data were semi-structured questionnaire to characterize the sample and usual intake recall. The quality of the diet was assessed by the Healthy Eating Index validated for the Brazilian population (IAS). Mature human milk samples were obtained from lactating 106, from the 5th week after birth, by manual milking. The extraction of milk fat was performed using the Bligh-Dyer method and methylated with sodium methoxide 0.25 moles/l in methanol diethyl - ether. The profile of fatty acids of milk was determined by a gas chromatograph equipped with a flame ionization detector. For the analysis of this study, the estimated mean and standard deviation percentages, medians and interquartile ranges. We used the Kolmogorov-Sminorv test to test the normality of the data. It was performed Pearson correlation test and Spearman to verify associations between variables. Later it was performed the analysis of multiple linear regression and multivariate regression analysis. The average score of all IAS 64.36?10.68 and the food group of all fruits, whole fruit, whole grain, whole grain and dairy products, were the components of the IAS of nursing mothers with lower scores, and more frequency minimum score. It was observed a low intake of total fruits, whole fruits, total grains, whole grains and dairy products. Among the saturated fatty acids, higher values were observed for palmitic fatty acid (C16: 0), stearic (C18: 0), myristic (C14: 0) and lauric (C12: 0), respectively. Among the mono-unsaturated fatty acids there was a higher contribution from the fatty acids oleic (C18: 1) and palmitoleic (C16: 1), respectively. The total essential fatty acids (linoleic and linolenic ?-) was 14.94%. It was observed an inverse relationship between the intake of total fruit with the profile of polyunsaturated fatty acids, and a direct relation between the consumption of total fruit and total cereal with the monounsaturated and saturated acids, which suggests that the quality diet reflects the fatty acid composition of breast milk.

Introdução: O ganho de peso gestacional é um indicador de saúde materno-fetal, estando associado com duração da gestação, tipo de parto, peso do bebê ao nascer e retenção de peso materno pós-parto, cujos determinantes podem ser o estado nutricional prégestacional, o consumo alimentar e os fatores sociais. Objetivos: Descrever o ganho de peso total de gestantes atendidas em unidades básicas de saúde e sua associação com o estado nutricional pré-gestacional, com fatores sóciodemográficos e relacionados à gestação. Delineamento: Estudo de coorte prospectivo de gestantes arroladas consecutivamente entre a 16a e 36a semanas e seguidas até o parto. Cenário: Serviços de pré-natal na rede básica de saúde em duas cidades do Rio Grande do Sul, Brasil. Método: Na linha de base, foram realizadas entrevistas padronizadas incluindo questionários de freqüência alimentar, de características sócio-demográficas e de dados clínicos das gestantes. O seguimento ocorreu até o pós-parto imediato, sendo coletado o peso da gestante registrado em cada consulta de pré-natal. O ganho de peso foi classificado em “adequado”, “insuficiente” e “excessivo” conforme recomendação do Institute of Medicine (1990). Regressão logística polinomial foi utilizada para estimar a associação entre categorias de ganho de peso e estado nutricional pré-gestacional e fatores sóciodemográficos e gestacionais. Resultados: As incidências de ganho de peso insuficiente e excessivo das 667 gestantes amostradas foram de 29,1% e 42,7%, respectivamente. As gestantes com sobrepeso e obesidade pré-gestacional apresentaram maior ganho ponderal excessivo (OR: 3,43 IC 95%: 1,72 – 6,84 & OR: 10,78 IC 95%: 4,15 – 27,97) em relação às que iniciaram eutróficas e que ganharam peso dentro das recomendações. Dentre aquelas que iniciaram a gravidez com obesidade, apenas 5,2% obtiveram ganho adequado de peso. Das gestantes que iniciaram a gravidez com baixo peso, 40,2% tiveram ganho ponderal insuficiente. Conclusões: A incidência de ganho ponderal excessivo é elevada. Embora o ganho insuficiente de peso persista como um problema de saúde pública, o ganho excessivo está se configurando como um problema que precisa de atenção imediata nos serviços de prénatal. / Background: Pregnancy weight gain is an index of maternal and fetal health, being associated to number of weeks at delivery, mode of delivery, newborn weight at delivery, and maternal weight retention after-birth. Pre-pregnancy nutritional status, food intake, and social factors are its determinants. Objective: Describe pregnant women weight gain in primary care services and its association to pre-pregnancy nutritional status and other pregnancy related factors. Design: Longitudinal cohort of pregnant women enrolled at 16-36 weeks of gestation and followed up until delivery. Setting: Prenatal care in primary attention services in two cities in Rio Grande do Sul, Brazil. Method: At baseline, socio-demographic and food frequency questionnaires were applied. Clinical features were also evaluated. Maternal weight was collected at each prenatal care visit, and follow up was held until early puerperium. According to Institute of Medicine (1990), weight gain was classified as “adequate”, “insufficient” or “excessive”. Polinomial logistic regression was used to measure association among weight gain categories and prepregnancy nutritional status and socio-demographic and pregnancy features. Results: 667 women compose sample, and insufficient and excessive weight gain incidences were 29.1%, and 42.7%, respectively. Women classified as overweight and obese before pregnancy had a significant excessive weight gain in pregnancy (OR: 3.43 CI 95%: 1.72 – 6.84 & OR: 10.78 CI 95%: 4.15 – 27.97) comparing to normal-weighted women that gained adequate weight during pregnancy. Only 5.2% of women who began pregnancy as obese had a normal weight gain. Among those classified as underweight at pregnancy beginning, 40.2% gained less weight than recommended during pregnancy. Conclusions: Excessive weight gain incidence is high. Although insufficient weight gain is still a public health problem, excessive gain is becoming a problem that needs immediate attention in prenatal care.

Objetivo: Descrever a prevalência do Aleitamento Materno (AM) e do Aleitamento Materno Exclusivo (AME) no quarto mês de vida e avaliar a sua associação com variáveis sócio-demográficas, comportamentais, nutricionais da mãe e variáveis do parto, nos Postos de saúde da cidade de Porto Alegre, RS, Brasil. Método: Os participantes foram 370 pares mãe-filho usuários de Unidades Básicas de Saúde (UBS) de Porto Alegre, Rio Grande do Sul. As gestantes foram arroladas consecutivamente em sala de espera e foram acompanhadas até o quarto mês de vida da criança mediante contato telefônico no pós-parto imediato, e entrevista agendada na Unidade Básica de Saúde (UBS) no quarto mês pós-parto. Regressão de Poisson com variância robusta foi utilizada para estimar a associação entre o AM e os diferentes fatores, como também para verificar a associação entre o AME e fatores sociodemográficos, comportamentais e nutricionais. A Fração atribuível na população foi utilizada para avaliar a contribuição dos fatores associados modificáveis. Resultados: 92,6% das crianças iniciaram a amamentação e no quarto mês pós-parto 79,2 % ainda mamava no peito, sendo que 16% delas estavam em AME. Os alimentos mais precocemente introduzidos na dieta foram, a água, o leite de vaca e as fórmulas, já presentes na dieta de alguns bebês no primeiro mês de vida. Após análise multivariável, a escolaridade materna (RP = 1,64; IC 95%: 1,11 - 2,40) inferior a cinco anos, o fumo materno (RP = 1,56; IC95%: 1,09 - 2,22), o uso de bico (RP = 9,38; IC 95%: 3,90 - 22,59) e o baixo peso ao nascer (RP = 1,58; IC 95%: 1,00 - 2,48) se mostraram associados a uma menor prevalência de AM. Com relação ao AME, o uso de bico (RP = 1,14; IC 95%: 1,03 - 1,25), o trabalho materno (RP = 1,12; IC95%:1,03 - 1,21), o ganho de peso gestacional (RP = 1,09; IC 95%: 1,00 - 1,12) e a idade materna inferior a 19 anos (RP = 1,17 IC 95%: 1,03 - 1,25) estão associados com a introdução precoce de outros alimentos na dieta da criança. A ansiedade e depressão materna não se mostraram significativamente associadas ao AM nem ao AME. Conclusões: As prevalências do AM e do AME no quarto mês de vida ainda encontram-se baixas. Mesmo tendo um percentual elevado de crianças que iniciaram o AM, no quarto mês pós-parto somente 79,2 % delas continuava amamentando e, destas, apenas 16% estavam em AME. Os principais motivos de desmame referidos pelas mães foram o medo que a criança ficasse com fome e a falta de produção de leite. No quarto mês de vida, todos os tipos de alimentos já tinham sido ingeridos por algumas crianças pertencentes ao estudo. / Objective: To report the incidence of breastfeeding and exclusive breastfeeding at 4 months postpartum and to identify associated factors. Methods: Participants where 370 mother-infant pairs who were recruited consecutively from 10 different health care units from Porto Alegre, Rio Grande do Sul, Brazil, and were followed up by phone and interview until the 4 months postpartum. Data collected included sociodemographic, behavioral and nutritional factors related to breastfeeding and exclusive breastfeeding. Poisson regression was used to identify the factors related to a less prevalence of breastfeeding and exclusive breastfeeding. Results: 92, 6% of the children initiated breastfeeding, and at 4 months of age, 79,2% still breastfeeding. Water, milk and formulas were the firsts products being introduced to the children´s diet, and being consumed at the first month of live by 20, 9%, 8,7% and 17,2% of the population, respectively. Breastfeeding was independently, negatively associated with less than 5 years of maternal schooling (RP = 1,64; 95% CI: 1,11 - 2,40), pacifier use (RP= 9,38; 95% CI: 3,90 – 22,59), maternal smoking (RP = 1,56; 95% CI: 1,09 – 2,22) and low birth weight (RP = 1,58; 95% CI: 1,00 - 2,48). Exclusive breastfeeding was independently associated with pacifier use (RP = 1,14; 95%CI: 1,03 - 1,25), mother being working or studying (RP = 1,12; 95% CI:1,03 - 1,21), gestational weight gain (RP = 1,09; 95% CI: 1,00 - 1,12) and maternal age under 19 years (RP = 1,17; 95% CI: 1,03 – 1,25). Conclusions: Breastfeeding and exclusive breastfeeding rates still low. Even having an elevated percent of breastfeeding initiation, at 4 months postpartum only 79,2% stilled breastfeeding and the exclusive breastfeeding rate was only 16%. The principal reasons for not breastfeeding at 4 months post-partum was being afraid the child was hungry and not producing breast milk. At 4 months of age, many children were already eating all kind of food.

Introdução: O ganho de peso gestacional é um indicador de saúde materno-fetal, estando associado com duração da gestação, tipo de parto, peso do bebê ao nascer e retenção de peso materno pós-parto, cujos determinantes podem ser o estado nutricional prégestacional, o consumo alimentar e os fatores sociais. Objetivos: Descrever o ganho de peso total de gestantes atendidas em unidades básicas de saúde e sua associação com o estado nutricional pré-gestacional, com fatores sóciodemográficos e relacionados à gestação. Delineamento: Estudo de coorte prospectivo de gestantes arroladas consecutivamente entre a 16a e 36a semanas e seguidas até o parto. Cenário: Serviços de pré-natal na rede básica de saúde em duas cidades do Rio Grande do Sul, Brasil. Método: Na linha de base, foram realizadas entrevistas padronizadas incluindo questionários de freqüência alimentar, de características sócio-demográficas e de dados clínicos das gestantes. O seguimento ocorreu até o pós-parto imediato, sendo coletado o peso da gestante registrado em cada consulta de pré-natal. O ganho de peso foi classificado em “adequado”, “insuficiente” e “excessivo” conforme recomendação do Institute of Medicine (1990). Regressão logística polinomial foi utilizada para estimar a associação entre categorias de ganho de peso e estado nutricional pré-gestacional e fatores sóciodemográficos e gestacionais. Resultados: As incidências de ganho de peso insuficiente e excessivo das 667 gestantes amostradas foram de 29,1% e 42,7%, respectivamente. As gestantes com sobrepeso e obesidade pré-gestacional apresentaram maior ganho ponderal excessivo (OR: 3,43 IC 95%: 1,72 – 6,84 & OR: 10,78 IC 95%: 4,15 – 27,97) em relação às que iniciaram eutróficas e que ganharam peso dentro das recomendações. Dentre aquelas que iniciaram a gravidez com obesidade, apenas 5,2% obtiveram ganho adequado de peso. Das gestantes que iniciaram a gravidez com baixo peso, 40,2% tiveram ganho ponderal insuficiente. Conclusões: A incidência de ganho ponderal excessivo é elevada. Embora o ganho insuficiente de peso persista como um problema de saúde pública, o ganho excessivo está se configurando como um problema que precisa de atenção imediata nos serviços de prénatal. / Background: Pregnancy weight gain is an index of maternal and fetal health, being associated to number of weeks at delivery, mode of delivery, newborn weight at delivery, and maternal weight retention after-birth. Pre-pregnancy nutritional status, food intake, and social factors are its determinants. Objective: Describe pregnant women weight gain in primary care services and its association to pre-pregnancy nutritional status and other pregnancy related factors. Design: Longitudinal cohort of pregnant women enrolled at 16-36 weeks of gestation and followed up until delivery. Setting: Prenatal care in primary attention services in two cities in Rio Grande do Sul, Brazil. Method: At baseline, socio-demographic and food frequency questionnaires were applied. Clinical features were also evaluated. Maternal weight was collected at each prenatal care visit, and follow up was held until early puerperium. According to Institute of Medicine (1990), weight gain was classified as “adequate”, “insufficient” or “excessive”. Polinomial logistic regression was used to measure association among weight gain categories and prepregnancy nutritional status and socio-demographic and pregnancy features. Results: 667 women compose sample, and insufficient and excessive weight gain incidences were 29.1%, and 42.7%, respectively. Women classified as overweight and obese before pregnancy had a significant excessive weight gain in pregnancy (OR: 3.43 CI 95%: 1.72 – 6.84 & OR: 10.78 CI 95%: 4.15 – 27.97) comparing to normal-weighted women that gained adequate weight during pregnancy. Only 5.2% of women who began pregnancy as obese had a normal weight gain. Among those classified as underweight at pregnancy beginning, 40.2% gained less weight than recommended during pregnancy. Conclusions: Excessive weight gain incidence is high. Although insufficient weight gain is still a public health problem, excessive gain is becoming a problem that needs immediate attention in prenatal care.