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Syftet med denna studie var att undersöka familjers upplevelser av att minimera intaget av socker/snabba kolhydrater. Detta genomfördes med kvalitativa ostrukturerade intervjuer där föräldrarna i familjen fritt fick berätta utifrån olika teman. Dessa teman täckte områden som anledning, tillvägagångssätt, reaktioner, svårigheter, beteenden och eventuella hälsovinster relaterade till kostomläggningen. Utöver dessa familjer valdes tre bloggar ut inom området lågkolhydratkost. Dessa följdes och analyserades som komplement till intervjuerna. Resultaten tolkades utifrån socialkonstruktivistiskt synsätt och teorin om symbolisk interaktionism. De mest framträdande resultaten var att samtliga som ingått i studien har upplevt förbättringar i sin hälsa, i de flesta fall förbättrades även barnens kognitiva förmåga. Vidare upplevde de att traditionen med sötsaker som både belöning och tröst, är djupt rotad vilket innebar att kostomläggningen inte var så enkel att genomföra utan att få höra epitet som "fanatisk" och "extrem". Ingen av intervjupersonerna uppger att de kan tänka sig att återgå till kolhydratrik kost. / The aim of this study was to examine families' experiences of minimizing the intake of sugar/highcarbs. This has been studied with a qualitative unstructured method with the parents in three families from different free to tell based themes. These themes covered areas like reason, procedures, reactions, problems, behaviors and potential health benefits related to their dietary change. In addition to these families, three blogs were selected in the field of low carbohydrate diets. These were followed and analyzed as a supplement to the interviews. The results were interpreted on the basis of social constructivist approach and the theory of symbolic interactionism. The most prominent findings was that all who entered the study have experienced improvements in their health, in most cases also improved children's cognitive ability . Furthermore , they felt that the tradition of sweets as both reward and comfort, made their dietary change implement difficult without hearing the epithet as " fanatical " and " extreme" . None of the interviewees stated that they would be willing to return to the high-carbohydrate diet.

Title from first page of PDF document. Includes bibliographical references (p. 46-55).

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / O presente estudo tem como tema central o ganho de peso e o consumo alimentar no período reprodutivo. A tese está dividida em três partes: i) revisão da literatura científica sobre os fatores de risco para o ganho de peso excessivo na gestação e para a sua retenção no pós-parto; ii) análise quantitativa e qualitativa do consumo alimentar (energia, nutrientes e alimentos) do período gestacional para o pós-parto; e iii) avaliação prospectiva da associação entre a dieta hiperproteica (&#8805; 1.2 g/kg) e a variação de peso pós-gestacional. A revisão da literatura apontou como principais determinantes da variação de peso no pós-parto os seguintes fatores: ganho de peso gestacional, peso pré-gestacional, dieta, atividade física, lactação, idade, escolaridade, renda, paridade e raça. As partes ii e iii correspondem a dois artigos, sendo que a população do estudo empregada nas duas análises foi baseada em uma coorte de mulheres no pós-parto atendidas no Centro Municipal de Saúde (CMS) Marcolino Candau, localizado no Município do Rio de Janeiro. Dentre as 709 mulheres convidadas para participar da pesquisa, 479 ingressaram na coorte. As mulheres foram recrutadas através dos serviços de pré-natal e na rotina pediátrica de imunização do BCG, oferecidos pelo CMS, e imediatamente após o parto, na maternidade central de referência. A coleta de dados ocorreu entre maio de 1999 e abril de 2001, sendo 15 meses de recrutamento e 9 meses de seguimento. As mulheres foram entrevistadas aos 15 dias, 2, 6 e 9 meses do pós-parto. Foram consideradas elegíveis para as duas analises as mulheres com idade entre 18 e 45 anos de idade, entrevistadas até 30 dias do pós-parto, sem doenças crônicas pré-existentes, com gravidez de 35 ou mais semanas gestacionais e sem gestação gemelar. O estudo sobre a composição da dieta do período gestacional para o pós-parto contou com 276 mulheres que responderam aos dois questionários de freqüência de consumo alimentar (QFCA) aplicados aos 15 dias e aos 6 meses do seguimento. Os resultados mostraram que as mulheres consumiram dietas mais energéticas na gravidez e aquelas que mais restringiram o consumo de energia no pós-parto, apresentaram um incremento na densidade de proteínas da dieta. As análises das medidas repetidos do peso foram realizadas para avaliar o efeito da dieta hiperproteica (&#8805; 1.2 g/kg) sobre a variação de peso no pós-parto, para as quais haviam dados de uma amostra de 430 mulheres. Os resultados mostraram que as mulheres com dieta hiperproteica perderam mais peso do que as mulheres com dieta normo ou hipoproteica (< 1.2 g/kg) (226 g/mês versus 123 g/mês). As duas analises indicam que um pequeno incremento no consumo de proteínas promove maior perda de peso. Estudos longitudinais futuros devem incluir avaliação relativa a segurança das dietas hiperproteicas no pós-parto. / The central focus of the present study is the body weight change and food intake of women during the reproductive cycle. The study constitutes the final work in the authors Doctorate degree. It was divided in three parts: i) revision of the scientific literature regarding the main determinants in the development of maternal obesity; ii) longitudinal comparability of quantity and quality of the mothers diet (energy, nutrients and food intake) during pregnancy and postpartum; and iii) prospective evaluation of the effects of a high-protein (HP) diet (&#8805; 1.2 g/kg) versus a low-protein (LP) diet (< 1.2 g/kg) on body weight loss (BWL) during postpartum. Study population was constituted of a cohort of postpartum women, who underwent four follow-up evaluations (at 0.5, 2, 6, and 9 months) following delivery. These data were obtained from May 1999 to April 2001 (15 months recruitment and 9 mo. of follow up) at a primary healthy service Marcolino Candau Municipal Health Center in Rio de Janeiro City, Brazil. Participants were recruited: 1) during routine prenatal care at the Municipal Health Center; 2) at the time of routine Bacillus Calmette-Guérin immunization of the newborn at the same health center; and 3) at the main maternity hospital in the study area, one to three days following delivery. Among 709 women that were invited to participate in the research, 479 accepted. Eligibility criteria for enrollment in the cohort were: age between 15 to 45 years, less than 30 days following the delivery on the date of the first interview (approximately at 0.5 mo), absence of chronic diseases, no history of actual twin birth, gestational age at delivery &#8805; 35 weeks, and household address within the area of the local health center. Women aged < 18 years (n = 47) were excluded from the analyses. All study protocols met the guidelines of the Research Ethics Committee, and were approved by the Center for Collective Health Studies of the Federal University of Rio de Janeiro (NESC/UFRJ). The first part of the study, namely the revision of scientific literature, indicated the main risk factors for body weight change during postpartum: gestational weight gain, pre-pregnancy weight, diet, physical activity, breastfeeding, age, schooling, income, parity, and race. The second part of the study was aimed at accessing the dietary composition of women during pregnancy and postpartum., For that end, a semi-quantitative food frequency questionnaire (FFQ) which had been previously validated (Sichieri & Everhart, 1998) was applied during interview with the participants in their first visit to the health center (at the second or third trimester of pregnancy), and at six months following delivery. Two hundred and seventy-six women took part in both interview stages. Results showed that women in their gestational period have a higher intake of energy in their diet, and that women who restrained their energy intake the most presented a higher protein density in their diet during postpartum. Prospective analysis to evaluate the effects of a HP diet on BWL considered 430 participants at the first interview. Results showed that women with a HP diet lost more weight over time than women with a LP diet (226 g/month versus 123 g/month).

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / O presente estudo tem como tema central o ganho de peso e o consumo alimentar no período reprodutivo. A tese está dividida em três partes: i) revisão da literatura científica sobre os fatores de risco para o ganho de peso excessivo na gestação e para a sua retenção no pós-parto; ii) análise quantitativa e qualitativa do consumo alimentar (energia, nutrientes e alimentos) do período gestacional para o pós-parto; e iii) avaliação prospectiva da associação entre a dieta hiperproteica (&#8805; 1.2 g/kg) e a variação de peso pós-gestacional. A revisão da literatura apontou como principais determinantes da variação de peso no pós-parto os seguintes fatores: ganho de peso gestacional, peso pré-gestacional, dieta, atividade física, lactação, idade, escolaridade, renda, paridade e raça. As partes ii e iii correspondem a dois artigos, sendo que a população do estudo empregada nas duas análises foi baseada em uma coorte de mulheres no pós-parto atendidas no Centro Municipal de Saúde (CMS) Marcolino Candau, localizado no Município do Rio de Janeiro. Dentre as 709 mulheres convidadas para participar da pesquisa, 479 ingressaram na coorte. As mulheres foram recrutadas através dos serviços de pré-natal e na rotina pediátrica de imunização do BCG, oferecidos pelo CMS, e imediatamente após o parto, na maternidade central de referência. A coleta de dados ocorreu entre maio de 1999 e abril de 2001, sendo 15 meses de recrutamento e 9 meses de seguimento. As mulheres foram entrevistadas aos 15 dias, 2, 6 e 9 meses do pós-parto. Foram consideradas elegíveis para as duas analises as mulheres com idade entre 18 e 45 anos de idade, entrevistadas até 30 dias do pós-parto, sem doenças crônicas pré-existentes, com gravidez de 35 ou mais semanas gestacionais e sem gestação gemelar. O estudo sobre a composição da dieta do período gestacional para o pós-parto contou com 276 mulheres que responderam aos dois questionários de freqüência de consumo alimentar (QFCA) aplicados aos 15 dias e aos 6 meses do seguimento. Os resultados mostraram que as mulheres consumiram dietas mais energéticas na gravidez e aquelas que mais restringiram o consumo de energia no pós-parto, apresentaram um incremento na densidade de proteínas da dieta. As análises das medidas repetidos do peso foram realizadas para avaliar o efeito da dieta hiperproteica (&#8805; 1.2 g/kg) sobre a variação de peso no pós-parto, para as quais haviam dados de uma amostra de 430 mulheres. Os resultados mostraram que as mulheres com dieta hiperproteica perderam mais peso do que as mulheres com dieta normo ou hipoproteica (< 1.2 g/kg) (226 g/mês versus 123 g/mês). As duas analises indicam que um pequeno incremento no consumo de proteínas promove maior perda de peso. Estudos longitudinais futuros devem incluir avaliação relativa a segurança das dietas hiperproteicas no pós-parto. / The central focus of the present study is the body weight change and food intake of women during the reproductive cycle. The study constitutes the final work in the authors Doctorate degree. It was divided in three parts: i) revision of the scientific literature regarding the main determinants in the development of maternal obesity; ii) longitudinal comparability of quantity and quality of the mothers diet (energy, nutrients and food intake) during pregnancy and postpartum; and iii) prospective evaluation of the effects of a high-protein (HP) diet (&#8805; 1.2 g/kg) versus a low-protein (LP) diet (< 1.2 g/kg) on body weight loss (BWL) during postpartum. Study population was constituted of a cohort of postpartum women, who underwent four follow-up evaluations (at 0.5, 2, 6, and 9 months) following delivery. These data were obtained from May 1999 to April 2001 (15 months recruitment and 9 mo. of follow up) at a primary healthy service Marcolino Candau Municipal Health Center in Rio de Janeiro City, Brazil. Participants were recruited: 1) during routine prenatal care at the Municipal Health Center; 2) at the time of routine Bacillus Calmette-Guérin immunization of the newborn at the same health center; and 3) at the main maternity hospital in the study area, one to three days following delivery. Among 709 women that were invited to participate in the research, 479 accepted. Eligibility criteria for enrollment in the cohort were: age between 15 to 45 years, less than 30 days following the delivery on the date of the first interview (approximately at 0.5 mo), absence of chronic diseases, no history of actual twin birth, gestational age at delivery &#8805; 35 weeks, and household address within the area of the local health center. Women aged < 18 years (n = 47) were excluded from the analyses. All study protocols met the guidelines of the Research Ethics Committee, and were approved by the Center for Collective Health Studies of the Federal University of Rio de Janeiro (NESC/UFRJ). The first part of the study, namely the revision of scientific literature, indicated the main risk factors for body weight change during postpartum: gestational weight gain, pre-pregnancy weight, diet, physical activity, breastfeeding, age, schooling, income, parity, and race. The second part of the study was aimed at accessing the dietary composition of women during pregnancy and postpartum., For that end, a semi-quantitative food frequency questionnaire (FFQ) which had been previously validated (Sichieri & Everhart, 1998) was applied during interview with the participants in their first visit to the health center (at the second or third trimester of pregnancy), and at six months following delivery. Two hundred and seventy-six women took part in both interview stages. Results showed that women in their gestational period have a higher intake of energy in their diet, and that women who restrained their energy intake the most presented a higher protein density in their diet during postpartum. Prospective analysis to evaluate the effects of a HP diet on BWL considered 430 participants at the first interview. Results showed that women with a HP diet lost more weight over time than women with a LP diet (226 g/month versus 123 g/month).