Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2016-04-26T19:16:12Z No. of bitstreams: 1 EvellynCamaraGrilo_DISSERT.pdf: 1083379 bytes, checksum: 5c4378ae79f8da0ab5335caca60a8c5d (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2016-04-28T21:55:39Z (GMT) No. of bitstreams: 1 EvellynCamaraGrilo_DISSERT.pdf: 1083379 bytes, checksum: 5c4378ae79f8da0ab5335caca60a8c5d (MD5) / Made available in DSpace on 2016-04-28T21:55:39Z (GMT). No. of bitstreams: 1 EvellynCamaraGrilo_DISSERT.pdf: 1083379 bytes, checksum: 5c4378ae79f8da0ab5335caca60a8c5d (MD5) Previous issue date: 2015-07-14 / As vitaminas A e E s?o nutrientes que possuem natureza lipof?lica e atuam em v?rios processos biol?gicos importantes, como a imunidade, reprodu??o, crescimento e desenvolvimento. Estas vitaminas s?o essenciais na fase inicial da vida e devem ser transferidas adequadamente da m?e para o filho durante a gesta??o e a lacta??o. A suplementa??o materna com vitamina A ? uma das estrat?gias de controle de sua defici?ncia no grupo materno-infantil, entretanto, estudos com animais evidenciaram que a suplementa??o com altas doses de vitamina A reduziu os n?veis de alfa-tocoferol (vitamina E) no soro e no leite. Assim, o objetivo deste trabalho foi avaliar a influ?ncia da suplementa??o materna com vitamina A sobre a concentra??o de retinol e alfa-tocoferol nos leites colostro e maduro de lactantes. Pu?rperas a termo e saud?veis foram aleatoriamente distribu?das nos grupos controle (n = 44) e suplementado (n = 44). Amostras de sangue e leite colostro foram coletadas no p?s-parto imediato e uma amostra de leite maduro foi coletada ap?s 30 dias. O grupo suplementado recebeu uma suplementa??o com palmitato de retinila (200.000 UI), imediatamente ap?s a primeira coleta de colostro. O retinol e o alfa-tocoferol das amostras biol?gicas foram analisados por Cromatografia L?quida de Alta Efici?ncia (CLAE). Valores s?ricos abaixo de 20 ?g/dL para a vitamina A e 516 ?g/dL para a vitamina E foram indicativos de defici?ncia. As concentra??es de retinol e alfa-tocoferol no soro das lactantes foram 46,4 ? 15,9 ?g/ dL e 1.023,6 ? 380,4 ?g/ dL, respectivamente, sendo consideradas adequadas. No grupo suplementado, verificou-se um aumento significativo dos n?veis de retinol no leite colostro, 24 horas ap?s interven??o (p<0,001), entretanto, n?o foi observada diferen?a estat?stica entre a concentra??o de retinol no leite maduro dos grupos avaliados (p>0,05). Al?m disso, ap?s a suplementa??o materna com vitamina A, houve uma redu??o significativa na concentra??o de alfa-tocoferol no leite colostro (p<0,05), que correspondeu a um decl?nio de 16,4% dos n?veis de vitamina E. Por outro lado, a administra??o do suplemento n?o influenciou os n?veis de alfa-tocoferol no leite maduro (p>0,05). Diante disso, conclui-se que a suplementa??o materna com altas doses de vitamina A aumentou os n?veis desse micronutriente no leite colostro, por?m, reduziu a biodisponibilidade do alfa-tocoferol, o que pode trazer preju?zos ? sa?de do neonato, que possui reservas limitadas de vitamina E ao nascimento. / Vitamins A and E are lipophilic nutrients that act in many important biological processes, such as immunity, reproduction, growth, and development. These vitamins are essential during the initial phase of life and should be properly transferred from mother to child during pregnancy and lactation. Maternal supplementation with vitamin A is one of the strategies for controlling its deficiency in the mother-child dyad, but studies with animals showed that supplementation with high doses of vitamin A reduces the levels of alpha-tocopherol (vitamin E) in the mother?s serum and milk. Hence, the objective of this study was to assess the influence of maternal supplementation with vitamin A on the concentration of retinol and alpha-tocopherol in colostrum and mature milk. Healthy puerperal women with term deliveries were randomly distributed into a control group (n=44) and a supplemented group (n=44). Blood and colostrum samples were collected immediately after delivery, and mature blood samples were collected 30 days later. The supplemented group received 200,000 IU of retinyl palmitate immediately after the first colostrum collection. The retinol and alpha-tocopherol levels in the biological samples were determined by high-performance liquid chromatography (HPLC). Serum vitamin A levels below 20 ?g/dL and serum vitamin E levels below 516 ?g/dL indicated deficiency. The retinol and alpha-tocopherol levels in the maternal serum were considered adequate at 46.4 ? 15.9 ?g/ dL and 1,023.6 ? 380.4 ?g/ dL, respectively. The colostrum retinol levels of the supplemented group increased significantly 24 hours after the intervention (p<0.001). However, the retinol levels in the mature milk of both groups did not differ (p>0.05). Moreover, after maternal supplementation with vitamin A, colostrum alpha-tocopherol level decreased by 16.4%, a significant reduction (p<0.05). However, vitamin A supplementation did not affect the alpha-tocopherol level of mature milk (p>0.05). In conclusion, maternal supplementation with high doses of vitamin A increased the colostrum level of this nutrient but reduced the bioavailability of alpha-tocopherol, which may harm the newborn?s health since newborns have limited vitamin E reserves.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2016-03-10T20:24:53Z No. of bitstreams: 1 JeaneFrancoPires_DISSERT.pdf: 1066232 bytes, checksum: d9e738b192a2350bed992f266b418f52 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2016-03-17T00:02:56Z (GMT) No. of bitstreams: 1 JeaneFrancoPires_DISSERT.pdf: 1066232 bytes, checksum: d9e738b192a2350bed992f266b418f52 (MD5) / Made available in DSpace on 2016-03-17T00:02:56Z (GMT). No. of bitstreams: 1 JeaneFrancoPires_DISSERT.pdf: 1066232 bytes, checksum: d9e738b192a2350bed992f266b418f52 (MD5) Previous issue date: 2015-05-05 / O termo vitamina E refere-se a um grupo de oito compostos moleculares que diferem em estrutura e biodisponibilidade, sendo o RRR-alfa-tocoferol a forma mais ativa biologicamente. A composi??o de vitamina E no leite materno sofre varia??es ao longo da lacta??o, sendo o leite colostro mais rico neste micronutriente quando comparado ao leite de transi??o e maduro. Os rec?m-nascidos, especialmente os prematuros s?o mais suscept?veis a defici?ncia de vitamina E e para prevenir os danos causados por esta defici?ncia tem sido proposta a suplementa??o do neonato com este micronutriente, por?m, n?o existe consenso para realiza??o desta interven??o. Assim, a suplementa??o materna com RRR-alfa-tocoferol no p?s-parto pode ser uma boa alternativa para tentar elevar os n?veis de alfa-tocoferol no leite materno e, consequentemente, fornecer ao rec?m-nascido prematuro quantidades adequadas de vitamina E. Este estudo objetivou avaliar o efeito da suplementa??o com 400 UI de acetato de RRR-alfa-tocoferol em mulheres com partos prematuros, sobre a concentra??o de alfa-tocoferol no leite materno colostro, transi??o e maduro. Participaram do estudo 89 pu?rperas adultas saud?veis, que foram distribu?das no grupo controle (n = 51) e grupo suplementado (n = 38). Foram coletadas amostras de sangue e leite colostro logo ap?s o parto (leite 0h), vinte e quatro horas ap?s, nova al?quota de leite colostro foi coletado (leite 24h). O leite de transi??o e maduro foram coletados em sete dias (leite 7d) e trinta dias (leite 30d) ap?s o parto, respectivamente. A suplementa??o no grupo suplementado foi realizada ap?s a coleta de sangue e leite 0h. As an?lises de alfa-tocoferol foram realizadas por cromatografia l?quida de alta efici?ncia. Valores s?ricos de alfa-tocoferol menores que 516 ?g/dL foram considerados indicativos de defici?ncia nutricional. A concentra??o m?dia de alfa-tocoferol no soro das parturientes do grupo controle foi 1159,8 ? 292,4 ?g/dL e do grupo suplementado foi 1128,3 ? 407,2 ?g/dL (p = 0,281). Todas as pu?rperas apresentaram estado nutricional em vitamina E adequado. Em ambos os grupos, foi poss?vel observar que a concentra??o de vitamina E no leite colostro foi maior em rela??o ao leite de transi??o e maduro. No grupo suplementado, a concentra??o de alfa-tocoferol no leite 24h aumentou em 60% ap?s a suplementa??o, passando de 1339,3 ? 414,2 ?g/dL (leite 0h) para 2234,7 ? 997,3 ?g/dL (leite 24h). Enquanto que o grupo controle os valores no colostro 0h e colostro 24h foram semelhantes (p = 0,681). No leite de transi??o do grupo controle o valor de alfa-tocoferol foi 875,3 ? 292,4 ?g/dL e no grupo suplementado 1352,8 ? 542,3 ?g/dL, com aumento de 35% no grupo suplementado em rela??o ao controle (p < 0,001). No leite maduro as concentra??es de alfa-tocoferol entre o grupo controle (426,6 ? 187,5 ?g/dL) e suplementado (416,4 ? 214,2 ?g/dL) foram semelhantes (p = 0,853). Apenas o leite 24h do grupo suplementado atendeu o requerimento nutricional de alfa-tocoferol (4 mg/dia) do rec?m-nascido. Tais resultados evidenciam que o transporte deste micronutriente para o leite ocorre de maneira controlada e limitada. Dessa forma, a suplementa??o materna com vitamina E eleva a concentra??o de alfa-tocoferol no leite colostro e de transi??o e n?o influencia a concentra??o no leite maduro. Apenas o aumento no leite colostro foi suficiente para atingir o requerimento nutricional do rec?m-nascido prematuro. / The term vitamin E refers to a group of eight molecular compounds which differ in structure and bioavailability, and the RRR-alpha-tocopherol more biologically active form. The composition of vitamin E in breast milk undergoes variations during lactation, colostrum and milk richer in this micronutrient compared to transitional and mature milk. Newborns, especially premature infants are more susceptible to vitamin E deficiency and to prevent the damage caused by this deficiency has been proposed supplementation of neonates with this micronutrient, however, there is no consensus to carry out this intervention. Thus, maternal supplementation with RRRalpha-tocopherol in the postpartum period can be a good alternative to try to raise the alpha-tocopherol levels in breast milk and therefore provide the premature newborn adequate amounts of vitamin E. This study to evaluate the effect of supplementation with 400 UI acetate RRR-alpha-tocopherol in women with premature births, on the concentration of alpha-tocopherol in breast milk colostrum, transitional and mature. The study included 89 healthy adult women were enrolled in the control group (n = 51) and supplemented group (n = 38). Blood samples were collected and milk colostrum soon after birth (0h milk) twenty-four hours, new rate of colostrum milk was collected (24h milk). The transitional and mature milk were collected in seven days (7d milk) and thirty days (30d milk) after delivery, respectively. Supplementation in the supplemented group was held after the collection of blood and 0h milk. The alpha-tocopherol analyzes were performed by high-performance liquid chromatography. Serum levels of alpha-tocopherol less than 516 ?g/dL were considered indicative of nutritional deficiency. The average concentration of alphatocopherol in the serum of the control group mothers was 1159.8 ? 292.4 ?g/dL and the supplemented group was 1128.3 ? 407.2 ?g/dL (p = 0.281). All women had nutritional status in vitamin E suitable. In both groups, it was observed that the concentration of vitamin E in colostrum milk was higher compared to transitional and mature milk. In the supplemented group, the concentration of alpha-tocopherol in the milk increased 60 % after supplementation, from 1339.3 ? 414.2 ?g/dL (0h milk) to 2234.7 ? 997.3 ?g/dL (24h milk). While the control group values in colostrum 0h and colostrum 24h were similar (p = 0.681). In the control group the follow-on milk alphatocopherol value was 875.3 ? 292.4 ?g/dL and in the group supplemented 1352.8 ? 542.3 ?g/dL, an increase of 35% in the supplemented group compared to control (p <0.001). In mature milk alpha-tocopherol concentrations between the control group (426.6 ? 187.5 ?g/dL) and supplemented (416.4 ? 214.2 ?g/dL) were similar (p = 0.853). Only 24h milk supplemented group answered the nutritional requirement of alpha-tocopherol (4 mg/day) of the newborn. These results show that the transport of this micronutrient for milk occurs in a controlled and limited way. Thus, the native vitamin E supplementation increases the concentration of alpha-tocopherol in colostrum and milk and transition does not influence the concentration in mature milk. Only the increase in colostrum milk was sufficient to meet the nutritional requirement of premature newborns.

Made available in DSpace on 2014-12-17T14:03:29Z (GMT). No. of bitstreams: 1 DanielleSB.pdf: 977139 bytes, checksum: 8435c2a5e1927080b529352e7ed8ae63 (MD5) Previous issue date: 2008-07-03 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / Vitamin A deficiency (VAD) is a serious public health problem in developing countries, and as a therapeutic and prophylactic measure retinil palmitate is being supplemented. Nevertheless its efficacy has been questioned. The objective of the study was to evaluate the supplementation of two retinil palmitate megadosis on the serum retinol levels of post partum healthy mothers from Dr. Jos? Pedro Bezerra (Hospital Santa Catarina) hospital, Natal - RN. The enrolled women (n=199) were randomly distributed into three studied groups and supplemented with retinil palmitate immediately after delivery with a single 200,000 IU dose (group S1), two 200,000 IU dose (group S2) with 24h difference between the doses, or no supplementation (group C). Among women selected, 143 remained until the end of the study. The influence of vitamin A dietary intake was evaluated during pregnancy and after 30 days of delivery. The average intake of the population was reasonable, but a high prevalence of inadequate intake was found. Retinol in colostrums and mature milk was determined by high performance liquid chromatography (HPLC). The retinol average in colostrums and mature milk in the supplemented and control groups were adequate according to the reference values. In colostrums, women from groups C, S1 and S2 presented retinol averages by milk volume of 94.8 ? 40.2 ?g/dL, 92.2 ? 50.0 ?g/dL and 91.8 ? 53.7 ?g/dL, respectively. No difference was found between these averages (p=0.965), this was also seen when the values where expressed as ?g/g of fat (p=0.905). After 30 days of delivery, retinol per milk volume differed between the control group (36.6 ? 17.5 ?g/dL) and groups supplemented with 200,000 IU (51.0 ? 28.8 ?g/dL) or 400,000 IU (55.2 ? 31.6 ?g/dL) of retinil palmitate (p<0,05). Nevertheless, when S1 and S2 groups where compared, no significant difference was found (p=0.97). Considering retinol/g of fat, the means were 12.7 ? 6.7 ?g/g, 15.6 ? 8.3 ?g/g and 17.2 ? 8.9 ?g/g for groups C, S1 and S2, respectively, with significant difference between groups S2 and C (p=0,01). Subclinical VAD prevalence showed a serious public health problem in the study population (32% in colostrums and 31.5% in mature milk). When analyzing the groups separately, the group which received two doses (200,000 IU + 200,000 IU) presented the lowest VAD prevalence (20.7%). Retinil palmitate supplementations of 200,000 IU and 400,000 IU (divided in two doses) in the immediate post partum showed no significant difference. Nevertheless, the 400,000 IU (divided in two doses) supplementation showed a reduction in VAD / A defici?ncia de vitamina A (DVA) ? um grave problema de sa?de p?blica nos pa?ses em desenvolvimento e por este motivo tem-se implementado a suplementa??o com retinil palmitato como medida terap?utica e profil?tica. Entretanto, a sua efic?cia tem sido questionada. O estudo objetivou avaliar o efeito da suplementa??o materna de duas megadoses de retinil palmitato (200.000 UI cada uma) no p?s-parto, sobre os n?veis de retinol no leite materno de lactantes saud?veis do hospital Dr. Jos? Pedro Bezerra (Hospital Santa Catarina), Natal - RN. As mulheres recrutadas (n=199) foram distribu?das aleatoriamente em tr?s grupos de estudo e suplementadas com retinil palmitato no p?s-parto imediato com dose ?nica de 200.000 UI (grupo S1), dose dupla de 200.000 UI espa?adas de 24h (grupo S2) ou n?o receberam suplementa??o (grupo C). Dentre as mulheres originalmente selecionadas, 143 permaneceram at? o fim do experimento. Foi verificada a influ?ncia do consumo alimentar de vitamina A durante a gesta??o e ap?s 30 dias do parto. O consumo m?dio da popula??o foi satisfat?rio, por?m ainda foi encontrada uma expressiva preval?ncia de consumo inadequado. O retinol no leite colostro e no leite maduro de 30 dias foi determinado por Cromatografia L?quida de Alta Efici?ncia (CLAE). As m?dias de retinol nos leites colostro e maduro dos grupos suplementados e controle, apresentaram-se adequadas em rela??o aos valores de refer?ncia. No leite colostro, as mulheres dos grupos C, S1 e S2 apresentaram m?dias de retinol por volume de leite de 94,8 ? 40,2 ?g/dL; 92,2 ? 50,0 ?g/dL e 91,8 ? 53,7 ?g/dL, respectivamente, n?o sendo encontrada diferen?a entre estas (p=0,965), o que tamb?m ocorreu quando expresso em ?g/g gordura (p=0,905). No p?s-parto de 30 dias, o retinol por volume de leite diferiu entre o grupo controle (36,6 ? 17,5 ?g/dL) e os grupos suplementados com 200.000 UI (51,0 ? 28,8 ?g/dL) ou 400.000 UI (55,2 ? 31,6 ?g/dL) de retinil palmitato (p<0,05). Por?m, quando S1 e S2 foram comparados entre si, n?o foi encontrada diferen?a significativa (p=0,97). Considerando-se o retinol/g de gordura, as m?dias foram 12,7 ? 6,7 ?g/g; 15,6 ? 8,3 ?g/g e 17,2 ? 8,9 ?g/g para os grupos C, S1 e S2, respectivamente, havendo diferen?a significativa entre S2 e C (p=0,01). A preval?ncia de defici?ncia subcl?nica de Vitamina A revelou um grave problema de sa?de p?blica (32% no leite colostro e 31,5% no leite maduro) na popula??o. Analisando-se os grupos separadamente, aquele que recebeu dose dupla (200.000 UI + 200.000 UI) apresentou o menor percentual de DVA (20,7%). As suplementa??es de 200.000 UI e 400.000 UI de retinil palmitato (dividida em duas doses) no p?s-parto imediato, n?o mostraram diferen?a significativa. Entretanto, considerando o ?ltimo tratamento, foi observada uma diminui??o da preval?ncia de DVA