O estudo das funções extra-esqueléticas da vitamina D vem ampliando-se nos últimos anos. Na gestação, a preocupação com os níveis de vitamina D maternos ocorre pela necessidade desta vitamina para a formação do esqueleto fetal e pela associação da hipovitaminose D com desfechos adversos materno-fetais. Para o recém-nascido (RN), as complicações incluem o baixo peso ao nascer, o comprometimento do crescimento longitudinal e as infecções respiratórias. Para a gestante, a deficiência de vitamina D vem sendo associada à alteração na homeostase glicêmica e ao aumento da incidência de diabetes gestacional (DG) , à pré-eclâmpsia e à vaginose bacteriana. Entretanto, a evidência científica atual ainda é controversa e não há definição estabelecida sobre o real benefício da suplementação da vitamina D na gestação. O diabetes gestacional, por sua vez, também está associado a desfechos adversos para a gestante e para a prole. Para o feto, há aumento da incidência de prematuridade, macrossomia, distócia de ombro e hipoglicemia neonatal; enquanto para a mãe, há associação com aumento da taxa de cesariana, pré-eclâmpsia e diabetes pós-gestacional. Desta forma, os desfechos adversos da hipovitaminose D e do DG presentes de forma simultânea na gestação podem ser aditivos. Este artigo propõe-se à revisão das repercussões da deficiência da vitamina D e do DG na gestação, para a mãe e para o RN, e discute a potencial repercussão da associação de ambas situações já que a hipovitaminose D pode estar relacionada com aumento da ocorrência de DG. / Extra-skeletal functions of vitamin D have been studied in the last years. During pregnancy, the concern with vitamin D levels is justified by its importance for the fetal skeleton development and by the association of hypovitaminosis D with adverse maternal and fetal outcomes. For the newborn, adverse outcomes include low birth weight, impaired longitudinal growth and respiratory infections. For the women, vitamin D deficiency has been associated with glucose homeostasis impairment and increased incidence of gestational diabetes (GD), preeclampsia and bacterial vaginosis. However, the available scientific data is still controversial and the real benefit of vitamin D supplementation during pregnancy is not defined. Hyperglycemia during pregnancy is also associated with increased rates of perinatal adverse outcomes. For the fetus and the newborn, GD is associated with an increased incidence of prematurity, macrosomia, shoulder dystocia and neonatal hypoglycemia; for the mother, there are increased rates of cesarean delivery, preeclampsia and type 2 diabetes. Therefore, adverse outcomes of hypovitaminosis D and GD present simultaneously during pregnancy could be additive. This manuscript aims to review the impact of vitamin D deficiency and of GD for the women and the newborn, and to discuss the potential association between these two clinical situations since hypovitaminosis D may increase the risk for GD.

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No. of bitstreams: 2 Dissertação - Lina Monteiro de Castro Lobo - 2013.pdf: 714186 bytes, checksum: 5d5c6b250a7a628a15bcfb47e33f1a3b (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2013-05-16 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / Introduction: Vitamin A deficiency can increase susceptibility to infection and reduce growth rate, besides it is an important cause of blindness in childhood. Infants and preschools are the most vulnerable groups to this deficiency. Objective: To evaluate the factors related to serum retinol in infants aged from six to 24 months who were attended at municipal daycare centers (CMEIs) in the city of Goiânia - Goiás State, Brasil. Methods: A cross-sectional study, undertaken between 2005 and 2006 in CMEIs located in Goiânia. A socioeconomic and demographic survey was performed as well as blood samples were drawn from 193 infants to analysis of complete blood count (CBC), serum retinol, ferritin and C-reactive protein (CRP). Retinol was determined by High Performance Liquid Chromatography (HPLC) being considered deficient retinol levels under 0,7 μmol/L. Data were analyzed by the softwares Stata/SE 12.0 and Statistical Package for the Social Sciences 18.0 (SPSS). T student test, Pearson’s or Spearman’s correlation and multiple linear regression were performed. Results: The mean serum of retinol level was of 1,00 ± 0,38 μmol/L and the prevalence of vitamin A deficiency was of 21,8%. The average levels of retinol did not differ significantly between gender, age, type of water consumed, prenatal assistance, breastfeeding (predominant or current), presence or absence of anemia and ferritin levels. There was no correlation between the mother’s schooling, birth weight and number of infants younger than five years of age with serum retinol. There was association between vitamin A deficiency and inflammation (p=0,04). For each CRP unit that increased there was a reduction of 0,133 e 0,115 mg/dL in serum retinol levels, according to two models of multiple linear regression, keeping other variables constant. Conclusion: Vitamin A deficiency in infants who were attended at a municipal daycare centers in Goiânia is high and the factor related to this deficiency was the inflammatory state of the child which is represented by the CRP serum levels, adjusted by sanitary sewage, habitation location and ferritin level. / Introdução: A deficiência de vitamina A pode aumentar a susceptibilidade à infecção e redução do crescimento, além de ser importante causa de cegueira na infância. Os grupos mais vulneráveis para esta deficiência são os lactentes e pré-escolares. Objetivo: avaliar os fatores relacionados ao retinol sérico em crianças de seis a 24 meses de idade que frequentavam Centros Municipais de Educação Infantil (CMEIs) no município de Goiânia-Goiás, Brasil. Métodos: Estudo transversal, realizado entre 2005 e 2006 em CMEIs da cidade de Goiânia. Realizou-se inquérito socioeconômico e demográfico e coleta de sangue de 193 crianças para análise do hemograma, retinol sérico, ferritina e proteína C-reativa (PCR). O retinol sérico foi determinado por Cromatografia Líquida de Alta Performance (HPLC) considerando como deficiência os níveis de retinol <0,7 μmol/L. Analisou-se os dados nos programas Stata/SE 12.0 e Statistical Package for the Social Sciences 18.0 (SPSS). Utilizou-se o teste t de Student, correlação de Pearson ou Spearman e regressão linear múltipla. Resultados: A média de retinol sérico foi de 1,00 ± 0,38 μmol/L e prevalência de deficiência de vitamina A de 21,8%. Os níveis médios de retinol sérico não apresentaram diferença estatística entre os sexos, idade da criança, tipo de água consumida, assistência pré-natal, aleitamento materno (predominante ou atual), presença ou não de anemia e níveis de ferritina. Não houve correlação entre escolaridade da mãe, peso ao nascer e número de crianças menor que cinco anos com o retinol sérico. Verificou-se associação entre deficiência de vitamina A e inflamação (p=0,04). Para cada unidade de aumento do PCR houve redução de 0,133 e 0,115 mg/dL nos níveis de retinol sérico, segundo dois modelos de regressão linear múltipla, mantendo as outras variáveis constantes. Conclusão: a deficiência de vitamina A nas crianças frequentadoras de CMEIs em Goiânia é alta e o fator relacionado à esta deficiência foi o estado inflamatório da criança representado pelos níveis séricos de PCR, ajustado pelo esgotamento sanitário, local de moradia e nível de ferritina.

A transcobalamina II (TCII) é a única proteína que leva a cobalamina (Cbl) para dentro das células. A TCII ligada a Cbl é denominada Holo-TC. Polimorfismos no gene TC2 podem alterar tanto a função como a concentração de Holo-TC. Os objetivos deste estudo foram avaliar se o parâmetro Holo-TC é um bom marcador de deficiência de Cbl; avaliar o efeito dos polimorfismos TC2 P259R, I23V e Q234R nos marcadores da deficiência da Cbl; verificar os fatores de predição para os valores de tHcy, SAM/SAH, MMA e Holo-TC nas gestantes e seus recém- nascidos. A Holo-TC não foi bom marcador para discriminar as gestantes com e sem deficiência de Cbl, diferente do encontrado no grupo de recém nascidos. Os genótipos matemos para os polimorfismos TC2 P259R e I23V não foram associados com as alterações nos valores matemos de tHcy, MMA e Holo-TC. Os neonatos portadores dos genótipos PR+RR apresentaram menores valores da razão SAM/SAH e maiores de MMA. Os neonatos com genótipos 23V+23VV apresentaram menores valores de SAM e maiores valores de tHcy. A combinação dos genótipos IV+VV/PR+RR no grupo de gestantes foi associada a menores valores de SAM. Já os neonatos com a mesma combinação de genótipos apresentaram menores valores de SAM e da razão SAM/SAH. O folato sérico foi o melhor fator de predição para a variação da tHcy materna, e a Cbl para os valores de Holo-TC, e finalmente a creatinina e a Cbl foram os fatores de predição para os valores de MMA. A Cbl e o folato foram os preditores para a tHcy neonatal quando foi utilizado apenas as variáveis independentes maternas no modelo de regressão linear múltipla. No entanto, quando as variáveis independentes foram as neonatais, Cbl, folato sérico e SAM/SAH neonatais foram as selecionadas para explicar os valores de tHcy neonatal. Para os modelos neonatais de MMA, a Cbl materna foi a única selecionada quando o modelo foi feito com variáveis independentes maternas. E noutro modelo da MMA neonatal, a Cbl e o genótipo PR + RR neonatal explicaram a variabilidade do MMA neonatal. Para a razão SAM/SAH neonatal, foram o folato sérico e o genótipo RR maternos as variáveis selecionadas quando só foram colocadas as variáveis independentes maternas no modelo. E finalmente, a tHcy e genótipos PR + RR foram as variáveis neonatais selecionadas no modelo de regressão linear múltipla para a razão SAM/SAH neonatal. Podemos concluir que os genótipos para os polimorfismos TC2 P259R e I23V não estão associados a variabilidade dos valores matemos dos metabólitos, no entanto, no recém nascido esta associação foi evidenciada. / Transcobalamin II (TCII) is the only protein that can take cobalamin (Cbl) into cells. When TCII is bound to the Cbl it is called Holo-TC. Polymorphisms inTC2 gene can alter both the function and the concentration of Holo-TC. The objective of this study was to evaluate whether the parameter Holo-TC is a good Cbl deficiency marker; to evaluate the effect of the polymorphisms TC2 P259R, I23V and Q234R in the Cbl deficiency markers; to verify the prediction factors for the values of tHcy, SAM/S~ MMA and Holo-TC in pregnant women and their neonates. Holo-TC has proved not be a good marker for discriminating pregnant women with Cbl deficiency from those without Cbl deficiency, unlike what was seen in the neonatal group. Maternal genotypes for polymorphisms TC2 P259R and I23 V were not related with the alterations ofmaternal values of tHcy, MMA and Holo-TC. The neonates presenting genotypes PR+RR showed lower SAM/SAH ratio values and higher MMA values. The neonates with genotypes 23V+23VV presented lower SAM values and higher tHcy values. The combination of genotypes IV+VV/PR+RR in the group of pregnant women was related with lower SAM values. On the other hand, the neonates presenting the same combination of genotypes presented lower SAM values and SAM/SAH ratio values. Se rum folate was the best predictor for the variation of the maternal tHcy, and Cbl for the Holo-TC values. The creatinine and the Cbl were the predictors for the values of MMA. Cbl and folate were the predictors for the neonatal tHcy when only the maternal independent variables were used in the multiple linear regression model. However, when the neonatal independent variables were used, Cbl, serum folate and SAM/SAH of neonates were selected to explain the neonatal tHcy values. For the neonatal models of MMA, only the maternal Cbl was selected for the model with maternal independent variables. In another neonatal MMA model, Cbl and neonatal PR + RR genotype explained the variability of the neonatal MMA. For the neonatal SAM/SAH ratio, serum folate and maternal RR genotype were the variables selected when only the maternal independent variables were used in the model. Finally, tHcy and genotypes PR + RR were the neonatal variables selected in the multiple linear regression model for the neonatal SAM/SAH ratio. We have concluded that the genotypes for the polymorphisms TC2 P25 9R and I23 V are not related to the variability of the maternal values of the metabolites; however, this relation is clear when evaluating the values observed in their newborn babies.

Introdução - Exposições adversas relacionadas ao estado nutricional na gestação têm sido associadas a desfechos desfavoráveis para a saúde materno-infantil. Nesse contexto, a deficiência de vitamina A (VA) é uma das carências nutricionais mais relevantes para a saúde dessa parcela da população, especialmente nos países em desenvolvimento. Objetivos - a) investigar preditores da concentração de retinol sérico no início do terceiro trimestre de gestação (Artigo 1), b) investigar a associação entre estado nutricional de VA durante a gestação e anemia materna no parto e peso ao nascer (Artigo 2) e c) investigar a prevalência e fatores associados com a cegueira noturna gestacional (XN) e anemia materna no parto (Artigo 3) em Cruzeiro do Sul, Acre, Amazônia Ocidental Brasileira. Métodos - Trata-se de estudo de coorte de nascimentos (MINA-Brasil: Saúde e Nutrição Materno-Infantil no Acre), a partir do recrutamento de gestantes do município. Entre fevereiro/2015 e maio/2016, gestantes inscritas no prénatal da área urbana foram rastreadas (n = 587) e dois inquéritos realizados: 1ª avaliação com 16-20 semanas de gravidez e a 2ª avaliação com 27-30 semanas de gestação. Informações sobre condições sociodemográficas, ambientais, histórico de saúde e estilo de vida, medidas antropométricas, coleta de sangue em jejum e exame de ultrassonografia foram obtidas pela equipe de pesquisa. Posteriormente, entre julho/2015 e junho/2016, foi realizado registro diário das internações para parto na única maternidade do município com coleta de informações sobre desfechos de interesse para o presente estudo. Modelos de regressão múltiplos de Poisson e lineares foram utilizados nas análises estatísticas, ao nível de significância P<0,05. Resultados - No Artigo 1 (n = 422), a presença de fumante no domicílio foi inversamente associado às concentrações de retinol sérico na gravidez (&#946;: -0,087; IC 95%: -0,166, -0,009); por outro lado, a sazonalidade (inverno amazônico - &#946;: 0,134; IC 95%: 0,063, 0,206), o consumo semanal de frutos amazônicos (ricos em carotenoides - &#946;: 0,087; IC 95%: 0,012, 0,162) e a concentração de retinol entre 16-20 semanas de gestação (&#946;: 0,045; IC 95%: 0,016, 0,074) foram positivamente associados à concentração de retinol sérico no início do terceiro trimestre gestacional. No Artigo 2 (n = 488), independente do momento avaliado na gestação, a deficiência de VA foi associada ao risco para anemia materna (RP: 1,39; IC 95%: 1,05, 1,84) e inversamente associada com as concentrações de hemoglobina materna no parto (&#946;: -3,34; IC 95%: -6,48, -0,20), após ajuste para covariáveis. No mesmo sentido, associação inversa também foi observada para o peso ao nascer (&#946;: -0,10; IC 95%: -0,20, -0,00), contudo, perdendo a significância estatística após ajuste para concentrações de ferritina plasmática. No Artigo 3 (n = 1.525), altas prevalências de cegueira noturna gestacional (11,54%) e anemia materna no parto (39,38%) foram encontradas nesta população. Os fatores associados à cegueira noturna foram o número de pessoas no domicílio (cinco ou mais- RP: 2,06; IC 95%: 1,24, 3,41), fumo na gestação (RP: 1,78; IC 95%: 1,15, 2,78) e ter realizado menos de seis consultas de pré-natal (RP: 1,61; IC 95%: 1,08, 2,40). Os fatores associados à anemia materna foram: ser adolescente (< 19 anos - RP: 1,18; IC 95%: 1,01, 1,38), malária na gestação (RP: 1,22; IC 95%: 1,01, 1,49), não ter usado suplementos na gestação (RP: 1,27; IC 95%: 1,01, 1,62) e o número de consultas de pré-natal (< 6 consultas - RP: 1,40; IC 95%: 1,15, 1,70) Conclusão - Em município da Amazônia Ocidental Brasileira, a carência de VA associou-se ao risco para anemia no parto e foi inversamente associada à hemoglobina materna e o peso ao nascer do bebê. Estratégias e ações para promoção da alimentação saudável e nutrição da mulher no pré-natal precisam ser reavaliadas visando redução dos efeitos adversos da carência de VA para o binômio mãe-filho. / Introduction - Adverse exposures related to antenatal nutrition care have been associated with poor maternal and child outcomes. In this sense, vitamin A (VA) deficiency is a relevant public health issue for this vulnerable population, especially in developing countries. Objectives - a) to investigate the predictors of serum retinol at the beginning of the third trimester of pregnancy (Article 1), b) to investigate associations between the VA status during pregnancy with the occurrence of maternal anemia and birth weight (Article 2), and c) to investigate the prevalence, as well as the associated factors with gestational night blindness and maternal anemia (Article 3) in Cruzeiro do Sul, Acre State, Western Brazilian Amazon. Methods - Prospective birth cohort study (MINA-Brazil: Maternal and Child Health and Nutrition in Acre State), starting with recruitment of pregnant women. Between February/2015 and May/2016, pregnant women registered in antenatal clinics in the urban area of Cruzeiro do Sul were screened (n = 587) and two follow-up surveys were performed: the 1st one between 16 to 20 weeks of pregnancy and the 2nd one between 27 to 30 weeks of pregnancy. Socioeconomic, environmental, health history and lifestyle, anthropometric measures, blood samples, and ultrasounds data were gathered by the research team. Subsequently, between July/2015 and June/2016, daily visits to the municipal maternity hospital were performed in order to register all births and the outcomes of interest for this study. Multiple Poisson and linear regression models were used for statistical analysis, at P<0.05. Results - In the Article 1 (n = 422), having a smoker in the household was inversely associated with serum retinol in pregnancy (&#946;: -0.087; 95% CI: -0.166, - 0.009); on the other hand, the seasonality (Amazonian winter - &#946;: 0.134; 95% CI: 0.063, 0.206), the weekly consumption of Amazonian carotenoid-rich fruits (&#946;: 0.087; 95% CI: 0.012, 0.162), and serum retinol in the first assessment (&#946;: 0.045; 95% CI: 0.016, 0.074) were positively associated with serum retinol at the beginning of the third trimester of pregnancy. In the Article 2 (n = 488), regardless the period assessed, VA deficiency was associated with the risk for maternal anemia (PR: 1.39; 95% CI: 1.05, 1.84), as well as it was inversely associated with maternal serum hemoglobin (&#946;: -3.34; 95% CI: -6.48, - 0.20), after adjustment for covariates. Similarly, inverse association was observed for the birth weight (&#946;: -0.10; 95% CI: -0.20, -0.00), even though it was no longer associated after adjustment for plasma ferritin. In the Article 3 (n = 1,525), high prevalence rate of gestational night blindness (11.5%) and maternal anemia (39.4%) were observed. Associated factors with gestational night blindness were the number of people in the household (five or more- PR: 2.06; 95% CI: 1.24, 3.41), smoking during pregnancy (PR: 1.78; 95% CI: 1.15, 2.78), and the completeness of less than six antenatal care visits (PR: 1.61; 95% CI: 1.08, 2.40). Associated factors with maternal anemia were being teenage (< 19 years - PR: 1.18; 95% CI: 1.01, 1.38), gestational malaria (PR: 1.22; 95% CI: 1.01, 1.49), did not use any supplementation during pregnancy (PR: 1.27; 95% CI: 1.01, 1.62), and the number of antenatal care visits (< 6 visits - PR: 1.40; 95% CI: 1.15, 1.70). Conclusion - In a city in the Western Brazilian Amazon, the VA deficiency was associated with the risk for maternal anemia and was inversely associated with maternal serum hemoglobin and the birth weight. The current strategies and interventions targeting antenatal nutrition care must be reviewed in order to reduce the adverse effects for mother-child binomial caused by VA deficiency.

No mundo as deficiências de ferro e de vitamina A atingem números alarmantes, afetando tanto a população com nível sócio-econômico mais baixo quanto aqueles mais favorecidos. O presente trabalho teve por objetivos avaliar a disponibilidade de ferro na presença do b-caroteno em combinações de alimentos fontes de ferro (espinafre, feijão e ovo) e de b-caroteno (cenoura, abóbora e couve), de custo relativamente baixo, as quais originaram nove misturas, assim denominadas: M1= ovo e abóbora; M2= espinafre e abóbora; M3= espinafre e couve; M4= ovo e couve; M5= espinafre e cenoura; M6= ovo e cenoura; M7= feijão e cenoura; M8= feijão e abóbora e M9= feijão e couve. As misturas, após cocção foram analisadas quanto à composição centesimal, teor de ácido oxálico, ácido fítico, taninos, minerais, diálise de ferro “in vitro” e determinação do teor de b-caroteno. Os dados foram analisados estatisticamente (Tukey 5%), pelo programa SAS. As misturas M1, M4 e M6 apresentaram o menor teor de fibra, com 1,32, 1,35 e 1,54 g/100g e os maiores resultados para proteína, 6,80, 7,13 e 6,59 g/100g respectivamente, como também para extrato etéreo 4,77, 4,79 e 5,73 g/100g. O teor de ácido oxálico variou de 0,14 a 0,27%, sendo que as misturas com espinafre apresentaram os maiores resultados; o teor de ácido fítico variou de 0,00 a 1,03 mg/g, sendo que as maiores concentrações predominaram nas amostras com feijão; o teor de taninos variou de 0,01 a 0,14 apresentando maiores teores, nas misturas com espinafre.O b-caroteno apresentou teores variando de 4,62 a 26,10 mg/100g. Quanto aos minerais observou-se variações de 0,19 a 1,00 g/Kg para fósforo; 0,82 a 1,37 g/Kg para potássio; 0,17 a 0,92 g/Kg para cálcio; 0,03 a 0,18 g/Kg para magnésio; 0,19 a 0,93g/Kg para enxofre; 0,00 a 0,65 mg/Kg para o cobre; 6,87 a 14,99 mg/Kg para o ferro; 0,00 a 13,08 mg/Kg para manganês e 2,88 a 7,16 mg/Kg para o zinco. A diálise de ferro apresentou variações de 3,39 a 31,11% , sendo que o melhor resultado apresentou-se na M6. Pode-se concluir que a fibra atuou como fator limitante na absorção do ferro. E, misturas com ovo, principalmente a M6, aumentaram a disponibilidade do ferro, sendo que, a proteína e o extrato etéreo atuaram de forma mais significativa no aumento da absorção, quando comparados ao b-caroteno. / In the world, iron deficiency and vitamin A deficiency reach alarming numbers, affecting population with level economic-social lower as well as people in better positions. This research aims to estimate the iron availability in the presence of b-carotene in food mixtures iron’s sources (spinach, bean and egg) and b-carotene’s sources (carrot, pumpkin and cabbage), with low prices, that have resulted nine mixtures, denominated: M1= egg and pumpkin; M2= spinach and pumpkin; M3= spinach and cabbage; M4= egg and cabbage; M5= spinach and carrot; M6= egg and carrot; M7= bean and carrot; M8= bean and pumpkin and M9= bean and cabbage. In this food mixtures, after cooking, were studied proximate composition, levels of oxalic acid, phytic acid, tannin, minerals, in vitro dialyzability of iron and levels of b-carotene. The statistical analysis was determinate (Tukey 5%) by SAS System. The food mixtures M1, M4, M6 showed low levels of dietetic fiber, 1,32, 1,35, 1,54 g/100g and the bigger results to protein 6,80, 7,13, 6,59 g/100g and to crude fat 4,77, 4,79, 5,73 g/100g, respectively. The oxalic acid ranges to 0,14 from 0,27%, with bigger results in food mixtures with spinach; phytic acid ranges to 0,00 from 1,03 mg/g, with high levels in bean’s samples; the tannin ranges to 0,01 from 0,14 with high levels in spinach’s samples. b-carotene showed levels ranges to 4,62 from 26,10 mg/100g. With regard to minerals, it’s ranges to 0,19 from 1,00 g/Kg in phosphorus; to 0,82 from 1,37 g/Kg in potassium; to 0,17 from 0,92 g/Kg in calcium; to 0,03 from 0,18 g/Kg in magnesium; to 0,19 from 0,93g/Kg in sulfur; to 0,00 from 0,65 mg/Kg in cupper; to 6,87 from 14,99 mg/Kg in iron; 0,00 a 13,08 mg/Kg in manganese and to 2,88 from 7,16 mg/Kg in zinc. In vitro dialyzability of iron ranges to 3,39 from 31,11%, and the best result was M6. It’s concluded that dietetic fiber was an inhibitor in the iron’s absorption. And, food mixtures with egg, mainly M6 (egg and carrot), increased iron availability and that crude protein and crude fat were more significant in absorption’s increase than b-carotene.

This study aims to analyze the effect of an improvised user-generated health awareness campaign which was based on a personal narrative and first-hand experience with the B12 deficiency symptoms in babies and toddlers. The campaign was conducted in 2015 with a follow-up video in 2016 and shared through social media outlets, informing about the topic and empowering individuals to take responsibility for their own or their child’s health by providing information that could serve as a guideline for early diagnosis and intervention and by presenting an outlook of how people with similar issues manage the condition.The impact of the campaign is being qualitatively and quantitatively accessed by interviews with medical professionals and respectively survey data from a national survey and statistics from the YouTube console. In consideration has been taken the trust the respondents have in the medical service and the usual access to health information both online and offline The quantitative data were collected using a national online survey in which 1185 individuals took part. It aimed to additionally identify the general public attitude towards medical service in and the awareness about the vitamin B12. Four people participated in the interviews, divided into two groups - parents of children, who had symptoms similar to those, shown in the videos; and health practitioners who have seen the videos and comment on its qualities as a self-diagnosing material as well as the effect that attention to the issue created on their medical practices. The results confirmed that the personal narrative of a campaign could help to create identification and thus be more persuasive and with further increased sharing potential of the message through social media. The concrete campaign reached cumulatively over 167.000 people through YouTube, which is around 2.4% of the population of Bulgaria and possibly creating a lasting impact on the public attitude towards vitamin/mineral and other deficiencies. We found out that social media and YouTube could serve as an impactful medium for disseminating health-related information online when accurate and persuasive information is being used. When addressing a wide audience with little or no prior knowledge of the subject the personal narrative or testimonial could create more impact than a neutral fact-providing material.

Vitamin D deficiency is common in individuals diagnosed with HIV and is known for its detrimental health effects. Its recognition as a potent immune-modulator with possible immune health implications in HIV disease progression was the main impetus for this study. The association between Vitamin D and CD4 count falls short of being consistent and is too weak to allow conclusions. Similarly, the literature is inconsistent with regard to the impact of Vitamin D supplementation on CD4. This observational, retrospective chart review study aimed to explore the relationship between Vitamin D deficiency and CD4 count/percent, and to evaluate whether changes in Vitamin D levels after supplementation corresponds with significant changes in CD4 count/percent in a cohort of African American, HIV-infected men who attended an HIV clinic in southeast Michigan (N = 70). The conceptual framework was based on the role of Vitamin D in regulating the immune responses through Vitamin D nuclear receptors on the CD4 cells. It postulated that an increase in Vitamin D level might enhance immune function, promote cellular anti-inflammatory state, and decelerate CD4 destruction. Data analysis included descriptive statistics, bivariate correlation, logistic and linear regression, t test, repeated measures ANOVA, and ANCOVA. Findings of the study did not support the hypotheses of significant correlation between Vitamin D and CD4 count (p = 0.458) and percent (p = 0.776), or of any impact of supplementation on CD4 count (p = 0.216) and percent (p = 0.918). Social change implications include providing health professionals, researchers, and policymakers with knowledge to tailor health promotion interventions aiming to reduce Vitamin D deficiency in favor of improving the overall health of HIV patients, especially high-risk groups such as African American HIV-infected patients.

No / With pressures on time and resources available to those undertaking research in paleopathology, poorly preserved archaeological human remains can often receive limited attention or be completely excluded from the analysis of archaeological sites. Although incomplete skeletons often yield minimal demographic information and can complicate the diagnosis of some pathological conditions, this is not universal. Significant information can be obtained even in partial remains on metabolic bone diseases (where, by definition, the whole skeleton is involved), and for conditions such as osteoarthritis and fractures which can be diagnosed in isolation. We present an example of an incomplete skeleton that provided valuable new information on pathological changes associated with osteomalacia, a condition that has been little studied to date in paleopathology. This skeleton also contributes to our understanding of the factors surrounding the classification of fractures, and provides new insight into the full range of circumstances in which eburnation can develop. This example demonstrates the value of including partial and poorly preserved skeletons in paleopathological analysis and the extent of information that can be obtained.

Un ensemble des données cohérentes de la littérature plaide en faveur d'une relation entre une baisse d'activité de la voie de signalisation de la vitamine A, des altérations de la plasticité synaptique et des déficits mnésiques spécifiques associés au vieillissement. Une diminution de l'activité de cette voie de signalisation est également évoquée dans les processus neurodégénératifs caractéristiques de la maladie d'Alzheimer. Dans ce contexte, les objectifs de ce travail étaient de mieux comprendre les conséquences neuro-anatomiques et fonctionnelles d'une baisse d'activité de la voie de signalisation de la vitamine A. Notre approche expérimentale a mis en œuvre 2 modèles animaux, un modèle de carence vitaminique A qui induit spécifiquement une baisse d'activité de sa voie de signalisation et un modèle d'hypothyroïdie dont il a été montré qu'il induit aussi une hypoactivité de la voie de signalisation de la vitamine A. La démarche expérimentale conduite chez les rats carencés en vitamine A comporte deux volets : (i) un volet mettant en œuvre l’imagerie et la spectroscopie RMN, (ii) un volet moléculaire consacrée à l’étude de l’expression de gènes cibles des rétinoïdes impliqués dans le processus amyloïdogène. Les mesures ont été réalisées, d'une part, chez des animaux soumis à un régime dépourvu en vitamine A pendant 10 semaines et d'autre part, chez des animaux soumis à ce même régime pendant une durée de 13 ou 14 semaines. Une partie des animaux carencés a été traitée par de l'AR. Les résultats montrent que dès 10 semaines de carence, les animaux présentent une altération du métabolisme et de son action cellulaire de la vitamine A qui se traduit par (i) une diminution significative du taux de vitamine A sérique, (ii) une diminution du taux d'ARNm codant pour les récepteurs RAR, dans le cerveau entier, le striatum, l'hippocampe et de manière moins prononcée le cortex des animaux. Après 10 semaines de régime dépourvu en vitamine A, des modifications métaboliques ont été mises en évidence essentiellement dans le cortex. Elles se traduisent par une hausse du (i) NAA/Cr, marqueur de la densité neuronale corrigée par une administration d'AR, et (ii) du GSH/Cr, indicateur du potentiel antioxydant cellulaire dans cette structure. Au plan anatomique, un ralentissement de la croissance cérébrale a été observé dés la 7ème semaine de régime. Une diminution du volume hippocampique et une augmentation des espaces ventriculaires ont été observées à partir de 11 semaines de carence. Au plan moléculaire, aucune modification de l'expression du gène codant pour APP, ou du rapport APP770-751/APP695, considéré comme un indicateur précoce de la MA n'a été observée après 10 semaines de carence. Après 14 semaines de régime dépourvu en vitamine A, de profondes modifications métaboliques sont observées dans les trois structures à savoir le cortex, l’hippocampe et le striatum. Au plan moléculaire, les principaux résultats suggèrent un basculement du processus biochimique de dégradation de la protéine APP en faveur de la voie amyloïdogénique dans le cortex, et par voie de conséquence en faveur de la formation du peptide Aß. Cependant, aucune modification du taux protéique des peptides Aß n'a été mise en évidence dans le cortex et l'hippocampe des rats carencés. Le modèle d'hypothyroïdie que nous avons mis en oeuvre entraine bien une hypoactivité de la voie de signalisation de la T3, observée dans l'hippocampe des animaux et une diminution du taux d'ARNm codant pour RARß observée dans le cortex des rats hypothyroïdiens. Au plan moléculaire, l'augmentation du rapport APP770-751/APP695 a été observée chez les rats rendus hypothyroïdiens par rapport aux rats témoins. Comme chez les rats carencés en vitamine A, les indicateurs de la voie physiologique ne sont que très faiblement affectés chez les rats rendus hypothyroïdiens. / Some data reveal that retinoid hyposignalling, presumably resulting from decreased bioavailability of retinoid ligands naturally, was shown to result in aging-related synaptic plasticity and long term potentiation (LTP) alterations as well as in aging-related decline of cognitive function. Moreover, genetic, metabolic and dietary evidence has been provided for a defective retinoid metabolism in Alzheimer disease (AD). Thus, key steps of the amyloid production process are under the control of proteins whose expression is positively regulated by RA in vitro. In this context, the aims of this work were to better understand neuro-anatomical and functionnal consequences of retinoid signaling brain hypoactivity. Our experimental method uses two animal models: a Vitamin A deficiency model which induce especially an hypoactivity of retinoid pathway, and an hypothyroid model which was also characterized by an hypoactivity of retinoid pathway. In the fisrt model, two main approch were used : (i) an NMR imaging and spectroscopy approach, (ii) a molecular approach to study expression of retinoid target genes implicated in amyloidogenic process. NMR results showed that VAD induces severe anatomic and metabolic disorders in particular a slowing of brain growth, hippocampus atrophy, and a decrease of NAA/Cr, marker of neuronal density which was observed in cortex, hippocampus and striatum. Molecular results reveal a vitamin A deficiency-related dysregulation of the amyloid pathway in the cortex of rats, which is known to be the first brain area altered by AD development. In this area, 14 weeks of deprived diet induces physiological dysregulation in the modulation of RA target genes leading to an increased amount of ADAM10, BACE and PS1, with some modifications in amyloidogenic pathway but without increased amount of Aß peptides. In hypothyroid model, molecular results suggests that adult onset-hypothyroidism may induce the amyloidogenic pathway of APP processing by increasing activity of ß and ?secretases and levels of amyloid peptides mainly in hippocampus. Together these data argue for the idea that hypoactivity of retinoid signalling which occurs naturally with aging could be a factor participating in accelerating aging and that hypothyroidism that become more prevalent with advancing age, could increase, via a hyposignaling of T3 pathway, the vulnerability of amyloidogenic pathway of APP processing as well as of other clinical symptoms of AD.

Il est maintenant bien établi que la vitamine A et son métabolite actif l’aciderétinoïque (AR), joueraient un rôle important dans les fonctions cognitives du cerveau adulte. La diminution de l’activité de la voie de signalisation des rétinoïdes et l’augmentation de celle des glucocorticoïdes (GC), se manifestent de manière concomitante au cours du vieillissementet participeraient aux altérations de plasticité et à l’étiologie du déclin cognitif lié à l’âge. De plus, certaines données ont mis en évidence des effets antagonistes de la voie des rétinoïdessur celle des glucocorticoïdes.L'objectif de ce travail visait donc à mieux comprendre les interactions entre ces deux voies de signalisation et leur impact sur les processus de plasticité cérébrale et les fonctions mnésiques chez le rongeur. L'approche expérimentale a consisté à étudier les effets d'une supplémentation nutritionnelle en vitamine A ou d'un traitement par l’AR sur le niveau corticostérone plasmatique et hippocampique, sur les mécanismes impliqués dans la biodisponibilité de la corticostérone, sur les processus de plasticité cérébrale (neurogenèse et plasticité synaptique) et sur la mémoire hippocampo-dépendante dans un modèle nutritionnel de carence en vitamine A mais également au cours du vieillissement.Nous avons montré qu’une carence en vitamine A entraînait une hyperactivation de la voie des glucocorticoïdes se traduisant par une hypersécrétion de corticostérone au niveau périphérique et hippocampique qui pourrait être liée à une diminution de capacité de liaison de la CBG mais également à une hyperactivation de la 11β-HSD1 au niveau hippocampique.D’autre part, une supplémentation nutritionnelle en vitamine A chez les rats carencés normalise les effets délétères observés sur la voie des glucocorticoïdes et supprime les altérations de neurogenèse hippocampique ainsi que les déficits de mémoire hippocampodépendante.De plus, un traitement par l’AR permettrait de moduler positivement la voie de signalisation des rétinoïdes chez la souris d’âge intermédiaire afin de diminuer l’amplitude de libération de corticostérone intrahippocampique, s’opposant ainsi aux effets délétères d’un excès de glucocorticoïdes sur les processus neurobiologiques et cognitifs au cours du vieillissement.Ce travail contribue à la démonstration d'une modulation de la biodisponibilité des glucocorticoïdes par le statut en vitamine A observée au cours d'une carence en vitamine A et du vieillissement. Il offre de nouvelles perspectives dans le développement d'une prévention du déclin cognitif lié à l'âge axée sur les facteurs nutritionnels tels que la vitamine A. / It is now established that vitamin A and its active metabolite, retinoic acid (RA), are required for cognitive functions in the adult hood. The hyposignaling of retinoic acid and the hyperactivity of the glucocorticoid (GC) pathway appear concomitantly during aging and both would contribute to the deterioration of hippocampal plasticity and functions. Moreover, recent data have evidenced counteracting effects of retinoids on the GC signaling pathway.The goal of the present study has been to shed more light on the interactions between both signaling pathways and their consequences on cerebral plasticity and memory processes.We have investigated them not only in a well-established nutritional model of vitamin A deficiency but also during aging. Indeed, our experimental approach has consisted inmanipulating the status in vitamin A (deficiency and/or supplementation or RA treatment) inrodents to better understand its impact on plasma and intrahippocampal corticosterone levelsand the mechanisms involved in corticosterone bioavailability. Hippocampus-dependentmemory and plasticity (adult neurogenesis and synaptic plasticity-related gene expression)have also been assessed.We have shown a hyperactivity of the glucocorticoid pathway in vitamin A-deficientrats, leading to elevated peripheral and hippocampal corticosterone levels. This is probably due to a decrease in CBG binding capacity and to the hyperactivity of the hippocampal 11β-HSD1. Furthermore, a vitamin A supplementation normalizes glucocorticoid activity and hippocampal neurogenesis levels and corrects memory deficits.Besides, in middle-aged mice, a RA treatment is able to positively modulate the retinoidsignaling pathway inducing a decreased hypersecretion of intrahippocampal corticosterone. It thus counteracts the deleterious effects of an excess of glucocorticoids on neurobiological and memory processes.Altogether, these results contribute to the demonstration that in vitamin A deficiency and during aging, the status in vitamin A modulates GC activity. This work proposes new preventive perspectives based on nutritional factors such as vitamin A in order to delay agerelated cognitive decline.