Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2017-02-10T16:42:15Z No. of bitstreams: 1 CristianeSantosSanzioGurgel_TESE.pdf: 4190612 bytes, checksum: 773e7fec68bad460acc07eb6d8f76c81 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-02-10T21:19:07Z (GMT) No. of bitstreams: 1 CristianeSantosSanzioGurgel_TESE.pdf: 4190612 bytes, checksum: 773e7fec68bad460acc07eb6d8f76c81 (MD5) / Made available in DSpace on 2017-02-10T21:19:07Z (GMT). No. of bitstreams: 1 CristianeSantosSanzioGurgel_TESE.pdf: 4190612 bytes, checksum: 773e7fec68bad460acc07eb6d8f76c81 (MD5) Previous issue date: 2016-06-28 / Este estudo objetivou avaliar o estado de vitamina A de pu?rperas atendidas durante o parto na cidade de Natal/RN. Foram recrutadas no estudo 793 mulheres, 60.1% (n=485) da rede p?blica e 39.0% (n=310) a rede privada. Amostras de soro (n=619) e leite colostro (n=656) foram coletadas em ambiente hospitalar, ap?s jejum noturno. O leite maduro (n=154) foi coletado trinta dias ap?s o parto, em visita domiciliar. Os indicadores bioqu?micos (retinol no soro e leite materno) foram avaliados por local de moradia (capital vs interior) e por rede de atendimento em sa?de (p?blico vs privado). O consumo de vitamina A foi avaliado referente ao ?ltimo trimestre gestacional. Para avaliar as diferentes formas de suplementa??o materna com vitamina A e suas associa??es com os indicadores bioqu?micos (soro e leite materno) formaram-se subgrupos baseados nas suplementa??es que ocorreram durante a gesta??o: GC, F1, F2, F3 e no p?s-parto: GM. O retinol das amostras foi quantificado por cromatografia l?quida de alta efici?ncia (CLAE). Para o total de mulheres, a concentra??o m?dia de retinol s?rico foi de 41.8 ? 12.9?g/dL e a preval?ncia da DVA foi de 5.3% (n= 33) com retinol (<20 ?g/dL), com diferen?a significativa entre o retinol s?rico das mulheres provenientes da capital e do interior (p<0,01). Em Natal, as preval?ncias de defici?ncia encontradas nas regi?es norte, sul, leste e oeste foram respectivamente: 4.3% (n=6), 5.6% (n=7), 2.9% (n=3) e 11.9% (n=8). A m?dia de retinol no colostro no grupo total foi de 95,3+ 53.7?g/dL, entretanto 27.3% (n=179) apresentaram valores inadequados (<60 ?g/dL). Os valores m?dios estimados de retinol fornecido aos rec?m-nascidos atrav?s do colostro, n?o atingiram a recomenda??o m?nima de 400?g/RAE/dia da AI (Adequate Intake) para rec?m-nascidos, considerando a ingest?o de 396mL/dia. Houve diferen?a significativa entre o retinol no colostro das mulheres da capital e aquelas provenientes do interior (p<0.01). Ambos os grupos n?o forneceram a AI de vitamina A para o rec?m-nascido e tamb?m o mesmo foi observado com as lactantes das regi?es norte e oeste da cidade de Natal. No leite maduro, nenhum dos grupos de mulheres das diferentes regi?es atingiu a recomenda??o, considerando a ingest?o de 780mL/dia pelos rec?m-nascidos. Ao avaliar as pu?rperas separadamente por rede de atendimento em sa?de (p?blico vs privado) foi encontrada diferen?a significativa entre o retinol s?rico e retinol no colostro (p<0.0001), mas n?o houve diferen?a para o leite maduro (p>0.05). Na estimativa do fornecimento de retinol atrav?s do colostro e leite maduro, as mulheres da rede p?blica n?o forneceram vitamina A dentro da recomenda??o m?nima para o rec?m-nascido (AI=400?g/RAE/dia), ao contr?rio das mulheres da rede privada, que forneceram. O consumo diet?tico m?dio total de vitamina A das parturientes foi de 987.1 + 674.4 ?gRAE/dia, sendo 872.2 + 639.2 ?gRAE/dia na da rede p?blica e 1169.2 + 695.2 ?gRAE/dia na rede privada, com diferen?a altamente significativa (p<0,00001). Na avalia??o individual, 38.4% (n=100) e 17.3% (n=28) das mulheres das redes p?blica e privada tinham ingest?o abaixo da ideal. Ao se estudar as diferentes formas de suplementa??o com vitamina A, n?o foram encontrados casos de DVA nos grupos suplementados com F1, F2 e F3. Ao se analisar o efeito da suplementa??o sobre o retinol do colostro, o grupo F2 (betacaroteno) apresentou mais casos de inadequa??o (40%). Os grupos F2 e GM n?o forneceram a quantidade de retinol m?nima recomendada pela AI aos rec?m-nascidos. No retinol do leite maduro n?o houve diferen?a entre os grupos GC, F1, F2, F3 e GM e com percentuais de inadequa??o mais baixos no GM (14.3%) e os grupos GC e F2 n?o forneceram a quantidade de retinol m?nima recomendada pela AI para os rec?m-nascidos. Concluiu-se que a preval?ncia de DVA entre as pu?rperas atendidas em Natal foi considerada um problema "leve" de sa?de p?blica na popula??o em geral. Os grupos de alto risco neste estudo viviam em cidades do interior, eram atendidos na rede p?blica de sa?de e n?o tomavam vitamina A, como o suplemento regular durante a gesta??o. / This study aimed to evaluate the vitamin A status of women who delivered in Natal/RN. A total of 795 women were enrolled in the study. Serum (n=619) and colostrum (n=656) samples were collected in the hospital after an overnight fast. Mature milk samples (n=15) were collected at the women?s house thirty days after delivery. Biochemical indicators were evaluated according to home location (capital city vs. country towns) and type of health care system (public vs. private). Vitamin A intake was assessed using a food-frequency questionnaire (FFQ) corresponding to the last trimester of pregnancy. In order to evaluate the different forms of maternal supplementation with vitamin A and their associations with biochemical markers (maternal serum and breast milk), subgroups were formed based on the type of supplementation that occurred during pregnancy: GC, F1, F2, F3 and postpartum: GM. Retinol concentrations in the biological samples were quantified by high performance liquid chromatography (HPLC). For the total sample, the mean serum retinol concentration was 41.8 ?12.9?g/dL and the prevalence of VAD was 5.3% (n=33) of women presenting retinol concentrations (<20 ?g/dL), evidencing a significant difference in serum retinol concentrations between women from the capital city and from the countryside (p <0.01). In Natal, the prevalence of disability found in the north, south, east and west were, respectively, 4.3% (n= 6), 5.6% (n= 7), 2.9% (n= 3) and 11.9% (n= 8). The overall mean retinol concentration in colostrum was 95.3 ? 53.7?g/dL; however, 27.3% (n=179) of women presented inadequate values (<60 ?g/dL). The average estimated amounts of retinol provided to newborns through colostrum did not meet the minimum recommendation of 400 ?g/RAE/day of AI (Adequate Intake) for newborns in both groups, considering the intake of 396mL/day. It was found a significant difference in colostrum retinol concentrations between women from the capital city and from the countryside (p<0.01). In Natal, colostrum milk of women from the northern and western regions did not meet the AI. For mature milk, none of the groups from the different regions met the recommendation, considering the intake of 780mL/day. Evaluating the sample separately by childbirth care system (public vs. private), it was found a significant difference in serum and colostrum retinol concentrations between the groups (p <0.0001); there was no difference for the mature milk (p>0.05). Estimating the retinol supply through colostrum and mature milk, women attending the public health system did not provide the minimum vitamin A amount recommended for newborns (AI= 400?g/RAE/day), unlike women's private network, which provided. The average total dietary vitamin A intake of pregnant women was 987.1 ? 674.4 ?gRAE/day, was 872.2 + 639.2 ?gRAE/day for women attending the public health system and 1169.2 + 695.2 ?gRAE/day for those attending the private system, evidencing a highly significant difference (p<0.001). Individually assessing the participants, 38.4% (n=100) e 17.3% (n=28) of women in the public and private systems had vitamin A intakes below the ideal. There was no difference in serum retinol concentrations between the CG, F1, F2, F3 and MG groups (p<0.05), although only the supplemented groups F1, F2 and F3 had no cases of VAD. Regarding colostrum retinol levels, the F2 group (beta-carotene) presented the highest number of inadequate cases (40%). The F2 and MG groups did not provide the minimum amount of retinol recommended by AI for newborns. Regarding retinol concentrations in mature milk, there was no difference between the CG, F1, F2, F3 and MG groups, and the MG group presented the lowest percentage of inadequacy (14.3%), while the CG and F2 groups did not provide the minimum amount of retinol recommended by the AI for infants. It was concluded that the prevalence of VAD among mothers who delivered in Natal was considered a ?mild? public health problem in the overall population. High-risk groups in this study lived in towns, were attended in the public health system and did not take vitamin A as regular supplement during pregnancy.

Made available in DSpace on 2014-12-17T14:03:42Z (GMT). No. of bitstreams: 1 FernandaBSR_DISSERT.pdf: 1261202 bytes, checksum: 37b0751e1ff652078acf0329a1653ef1 (MD5) Previous issue date: 2013-06-27 / Universidade Federal do Rio Grande do Norte / Micronutrient deficiencies affect individuals mainly in developing countries, where vitamin A deficiency is a public health problem worldwide more worrying, especially in groups with increased physiological needs such as children and women of reproductive age. Vitamin A is supplied to the body through diet and has an important role in the visual process, cell differentiation, maintenance of epithelial tissue, reproductive and resistance to infection. The literature has demonstrated the relationship between vitamin A and diabetes, including gestational, leading to a risk to both mother and child. Gestational diabetes is any decrease in glucose tolerance of variable magnitude diagnosed each the first time during pregnancy, and may or may not persist after delivery. Insulin resistance during pregnancy is associated with placental hormones, as well as excess fat. Studies have shown that retinol transport protein produced in adipose tissue in high concentrations, this would be associated with resistance by interfering with insulin signaling. Therefore, this study aimed to evaluate the concentration of retinol in serum and colostrum from healthy and diabetic mothers in the immediate postpartum period. One hundred and nine parturient women were recruited, representing seventy-three healthy and thirty-six diabetic. Retinol was extracted and subsequently analyzed by High Performance Liquid Chromatography. Among the results highlights the mothers with gestational diabetes were older than mothers healthy, had more children and a higher prevalence of cases of cesarean section. Fetal macrosomia was present in 1.4% of healthy parturient women and in 22.2% of diabetic mothers. The maternal serum retinol showed an average of 39.7 ? 12.5 mg/dL for healthy parturients 35.12 ? 15 mg/dL for diabetic and showed no statistical difference. It was observed that in the group of diabetic had 17% vitamin A deficiency, whereas in the healthy group, only 4% of the women were deficentes. Colostrum, the concentration of retinol in healthy was 131.3 ? 56.2 mg/dL and 125.3 ? 41.9 mg/dL in diabetic did not differ statistically. This concentration of retinol found in colostrum provides approximately 656.5 mg/day for infants born to healthy mothers and 626.5 mg/day for infants of diabetic mothers, based on a daily consumption of 500 mL of breast milk and need Vitamin A 400 mg/day, thus reaching the requirement of the infant. The diabetic mothers showed significant risk factors and complications related to gestational diabetes. Although no 11 difference was found in serum retinol concentration and colostrum among women with and without gestational diabetes, the individual analysis shows that parturients women with diabetes are 4.9 times more likely to develop vitamin A deficiency than healthy parturients. However, the supply of vitamin A to the newborn was not committed in the presence of gestational diabetes / As car?ncias de micronutrientes afetam indiv?duos principalmente nos pa?ses em desenvolvimento, em que a hipovitaminose A ? um dos problemas de sa?de p?blica mais preocupante mundialmente, principalmente nos grupos com necessidades fisiol?gicas aumentadas como crian?as e mulheres em idade reprodutiva. A vitamina A ? fornecida ao organismo por meio da dieta e possui papel essencial no processo visual, diferencia??o celular, manuten??o do tecido epitelial, reprodu??o e resist?ncia ?s infec??es. A literatura tem demonstrado rela??o entre a vitamina A e diabetes, inclusive a gestacional, levando a um risco para bin?mio m?e-filho. A diabetes gestacional ? qualquer diminui??o da toler?ncia ? glicose de magnitude vari?vel diagnosticada pela primeira vez na gesta??o, podendo ou n?o persistir ap?s o parto. A resist?ncia ? insulina na gesta??o est? associada aos horm?nios placent?rios, bem como ao excesso de tecido adiposo. Estudos t?m demonstrado que a prote?na transportadora de retinol produzida no tecido adiposo, em altas concentra??es, estaria associada a esta resist?ncia por interferir na sinaliza??o da insulina. Com isso, este trabalho objetivou avaliar a concentra??o de retinol no soro e colostro de parturientes diab?ticas e saud?veis no p?s-parto imediato. Cento e nove parturientes foram recrutadas, correspondendo a setenta e tr?s saud?veis e trinta e seis diab?ticas. O retinol foi extra?do e posteriormente analisado por Cromatografia L?quida de Alta Efici?ncia. Dentre os resultados destaca-se que as parturientes com diabetes gestacional tinham idade superior a das parturientes saud?veis, possu?am mais filhos e maior preval?ncia de casos de cesarianas. A macrossomia estava presente em 1,4% das parturientes saud?veis e em 22,2% das parturientes diab?ticas. O retinol do soro materno apresentou uma m?dia de 39,7 ? 12,5 &#956;g/dL para parturientes saud?veis e 35,12 ? 15 &#956;g/dL para diab?ticas e n?o apresentaram diferen?a estat?stica. Foi observado que no grupo de diab?ticas 17% tinham hipovitaminose A, enquanto que no grupo saud?vel, apenas 4% das mulheres estavam deficientes. No colostro, a concentra??o de retinol nas saud?veis foi de 131,3 ? 56,2 &#956;g/dL e nas diab?ticas 125,3 ? 41,9 &#956;g/dL, n?o diferindo estatisticamente. Esta concentra??o de retinol encontrada no colostro fornece aproximadamente 656,5&#956;g/dia para os rec?m-nascidos de m?es saud?veis e 626,5 &#956;g/dia para os rec?m-nascidos de diab?ticas, com base em um consumo di?rio de 500 mL de leite materno e necessidade nutricional de vitamina A de 400 &#956;g/dia, 9 atingindo assim, o requerimento do lactente. As parturientes diab?ticas apresentaram importantes fatores de risco e complica??es relacionadas ? diabetes gestacional. Apesar de n?o ter sido encontrada diferen?a na concentra??o de retinol s?rico e do colostro entre as mulheres com e sem diabetes gestacional, a an?lise individual demonstra que as parturientes diab?ticas est?o 4,9 vezes mais prop?cias a desenvolver hipovitaminose A do que as parturientes saud?veis. Contudo, o fornecimento de vitamina A para o rec?m-nascido n?o foi comprometido na presen?a da diabetes gestacional