Introdução: A obesidade é um dos grandes problemas de Saúde Pública e atinge níveis epidêmicos em grande parte do mundo. A maioria dos indivíduos com excesso de peso são mulheres, no Brasil o tamanho desta população também é expressivo, as em idade fértil são as que apresentam maior risco para o desenvolvimento da obesidade, o que está associado ao ganho de peso excessivo durante a gestação e a retenção de peso após o nascimento. O excesso de peso materno está relacionado a desfechos negativos para saúde materno-infantil. Objetivo: Analisar o peso gestacional e desfechos perinatais em mulheres da região sudeste do Brasil. Método: estudo transversal, com a utilização de dados provenientes de uma coorte nacional, com base hospitalar denominada: Nascer no Brasil: Inquérito Nacional sobre Parto e Nascimento, inquérito realizado no período de 2011 e 2012.Partindo da amostra inicial total do Sudeste composta por 10.154 mulheres entrevistadas e considerando os fatores de inclusão e exclusão para esta pesquisa, chegou-se a uma amostra de 3.405 binômios (mãe /recém-nascido).As variáveis estudadas foram ganho de peso, idade materna, peso pré-gestacional, Índice de Massa Corporal inicial e final, idade gestacional, tipo de parto e peso ao nascer. Análise foi realizada através das medidas de tendência central. Foi utilizado teste de Mann-Whitney para dados de distribuição normal e coeficiente de Pearson para variáveis contínuas. Foram considerados como significante os resultados com um p a 0,05. Resultados: A maioria das participantes apresentou faixa etária entre 21 e 30 anos, os nascimentos ocorreram entre a 38ª e 39ª semana gestacional, e seus recém-nascidos tiveram peso mediano de 3.219 g. Grande parte das pesquisadas (61,04 por cento ) iniciaram a gestação com um estado nutricional considerado adequado e 31,51 por cento apresentavam excesso de peso anterior à gestação. O ganho de peso excessivo ocorreu em todas as categorias de IMC pré-gestacional representando 49,6 por cento da população total estudada. O peso anterior à gestação apresentou elevada correlação com ganho de peso total ao final da gestação. Também foi observada influência do ganho de peso na gestação com a via de parto, idade gestacional e peso do bebê ao nascer. Conclusão: A maioria da população iniciou a gestação com estado nutricional adequado, porém, houve ganho de peso excessivo considerável em todas as categorias de IMC, este influenciou na via de parto onde a maioria aconteceu por operação cesariana e no peso ao nascer. O estado nutricional inicial influencia fortemente o estado nutricional ao final da gestação. Por isto, é importante que os programas de intervenção atuem em todas as etapas deste período, inclusive na conscientização da importância de um peso adequado anterior a concepção. Além de promover ações que auxiliem nos cuidados quanto ao ganho de peso na gestação. / Introduction: Obesity is one of the biggest public health problem and reaches epidemic levels in many parts around the World. Most of the people who are overweight are women, in Brazil the size of this population is also expressive, the child-bearing age are at greatest risk to the obesity development, which is associated with excessive weight gain during pregnancy and weight retention after the birth. The maternal overweight is related to negative outcomes for maternal and child health. Objetive: To analyse gestational weight and perinatal outcomes in women of southeastern Brazil. Method: cross-sectional study using data from a national cohort with known hospital database: \"Nascer no Brasil: Inquérito Nacional sobre parto e nascimento survey conducted in 2011 and 2012. Start with initial sample of 10,154 southeastern women interviewed and considering the inclusion and exclusion factors for this research, come up with a sample of 3,405 binomials (mother /newborn). The studied variables were weight gain, maternal age, before pregnancy weight, initial and final body mass index, gestational age, mode of delivery and birth weight. Analysis was carried out through measures of central tendency. It used the Mann-Whitney test for normal distributed data and Pearson coefficient for continuous variables. They were considered as significant results for p 0.05. Results: Most participants had aged between 21 and 30 years old, the births occurred between the 38th and 39th week of gestation, and their newborns had average weight of 3,219 g. Most of the surveyed (61.04 per cent ) started pregnancy with adequate nutritional status and 31.51 per cent had excess weight prior to pregnancy. Excessive weight gain occurred in all prepregnancy BMI categories representing 49.6 per cent of the total studied population. The weight before pregnancy showed high correlation with total weight gain at the end of pregnancy. It was also observed influence of weight gain during pregnancy related to the mode of delivery, gestational age and weight of the baby at birth. Conclusion: Most of the population started pregnancy with adequate nutritional status, however, there was considerable excessive weight gain in all BMI categories, that influenced the type of delivery where most happened by cesarean and the birth weight. The initial nutritional status strongly influences the end of nutritional status in the pregnancy. Therefore, it is important that intervention programs operate in every stage of this period, including the awareness of the importance of a healthy weight before conception. In addition to promoting actions that help us care for weight gain during pregnancy.

A pecuária de corte no Brasil evoluiu muito em produtividade e qualidade do produto final, determinantes para a manutenção da atividade. A pesquisa no setor pecuário visa incrementar o lucro ao pecuarista, auxiliar na melhora das carcaças para o frigorífico e garantir carne de qualidade ao consumidor. A raça Nelore, amplamente difundida pelo país, sofre com o manejo nutricional deficiente, que prejudica o desempenho produtivo. O grão de milho é muito utilizado como fonte energética para os bovinos e estudos buscam melhorar o aproveitamento do amido do grão, como o fornecimento de grãos processados como milho úmido. Outra fonte energética para a suplementação de bovinos seria a gordura protegida da degradação ruminal. Neste experimento objetivou-se ampliar o conhecimento dos efeitos de alimentos energéticos (dietas contendo grão de milho seco ou úmido com ou sem gordura protegida da degradação ruminal) sobre a digestibilidade total, composição corporal e da carne de novilhos da raça Nelore. Não houve efeito dos tratamentos sobre os coeficientes de digestibilidade ou para a porcentagem de nutrientes digestíveis totais. Os tratamentos também não alteraram a composição corporal e as exigências líquidas de energia e proteína para ganho de peso. A inclusão de gordura à dieta reduziu a porcentagem de água e elevou o extrato etéreo da carne. Quanto ao perfil de ácidos graxos, o milho úmido aumentou os poliinsaturados, e a inclusão da gordura os ômega 6. Os cortes cárneos diferiram tanto na composição química quanto no perfil de ácidos graxos. / The beef cattle in Brazil have been a great development on productivity and quality of end product. These are decisive for the maintenance of the activity. Researchs about cattle look for to increase the profit to the farmer, improve the quality of carcasses for slaughtered and to guarantee quality meat to consumer. Nelore breed, the mostly cattle of Brazilian herd, suffers with deficient nutricional handling that reduce the performance of animals.The corn grain is very used as energy source for catlle and researchs look for to improve the digestibility of starch of grain, as the supply of processed grains as high moisture corn grain. Another energy source for feed cattle is ruminal protected fat. In this study looks for increased the knowledge of effects of energetic foods (diets containing dry or high moisture corn grain with or without ruminal protected fat) on total digestibility, body composition and meat composition of Nellore breed steers. There was no effect of diets on digestibility coefficients or The percentage total digestible nutrients. Diets didn't also change the body composition and net requirements of energy and protein for weight gain. The addition of fat reduced the percentage of water and increased ether extract in the meat. About the fatty acids profile, high moisture corn grain increased polyunsaturated, and fat increased omega 6. Meat cuts differed in chemical composition and fatty acids profile.

Introdução e objetivos – A finalidade prioritária no tratamento do diabetes mellitus gestacional (DMG) é alcançar níveis de glicemia materna tão próximos da normalidade quanto possível, a fim de reduzir os efeitos adversos associados à hiperglicemia na gestação. A auto verificação da glicemia capilar (perfil glicêmico) é o método mais usado para a monitorização do controle metabólico na gestação complicada por diabetes. Nosso objetivo foi analisar as associações entre os perfis glicêmicos maternos com os principais desfechos da gestação numa população de mulheres com DMG acompanhadas em ambulatório de pré-natal especializado em hospital universitário no sul do Brasil, Hospital de Clínicas de Porto Alegre (HCPA). Desenho e metodotologia – conduzimos um estudo de coorte prospectiva de gestantes referidas da rede de atenção primária de saúde pública para tratamento do DMG no HCPA, acompanhadas do diagnóstico ao parto. Pesquisamos associações entre os resultados dos perfis glicêmicos com o peso de nascimento e com o risco de recém-nascidos grandes para idade gestacional e de desfechos adversos perinatais. Resultados – acompanhamos 440 mulheres com DMG. A média do índice de massa corporal (IMC) foi 33.3kg/m2. 351 bebês (79.8%) mostraram peso adequado à idade gestacional no nascimento. As médias de glicemia nos perfis pré e pósprandiais aumentaram com o avanço na categoria de peso nascimento. Três ou mais perfis glicêmicos anormais foram o fator de risco mais robusto para o nascimento de bebês grandes (OR 3.15 1.51-6.55) e para o desenvolvimento de desfechos adversos perinatais (OR 2.28 1.59-3.29). O ganho de peso materno durante o tratamento associou-se ao risco de recém-nascido grande para idade gestacional, assim como o IMC pré-gestacional, esse último também fator de risco independente para eventos perinatais adversos. Conclusão – perfis glicêmicos anormais em mais de 2 ocasiões foram o fator de risco mais relacionado ao nascimento de um bebê grande para a idade gestacional e para o desenvolvimento de complicações neonatais. Efeito benéfico do tratamento do DMG, guiado pelos perfis glicêmicos, foi a maioria de recém-nascidos com peso adequado à idade gestacional nessa coorte, apesar da incidência de desfechos perinatais adversos não ter sido diferente entre as categorias de peso fetal de nascimento. / Background and objective – a priority target in the treatment of gestational diabetes mellitus (GDM) is attaining maternal glucose levels as close as possible to euglycemia, in order to decrease the adverse outcomes linked to hyperglycemia. Self-performed capillary glucose (glycemic profile) is the most widely used method for metabolic monitoring in pregnancy complicated by diabetes. We intended to analyze the associations of maternal glycemic profile to main pregnancy outcomes in a population of GDM women treated in a specialized prenatal clinic at a university hospital in South Brazil, Hospital de Clínicas de Porto Alegre (HCPA). Research design and methodology – we conducted a prospective cohort study of pregnant women, referred from public primary health care for treatment of GDM at HCPA, between 2008 and 2015. We searched associations of glycemic profiles to birth weight, large for gestational age newborn and adverse neonatal outcomes. Results – we followed 440 GDM women from diagnosis to delivery. Mean prepregnancy body mass index (BMI) was 33.3kg/m2; 351 babies (79.8%) had appropriate birth weight for gestational age. Mean glucose in pre-prandial and postprandial profiles increased with raising birth weight category. Three or more abnormal glycemic profiles showed the strongest association to a large baby (OR 3.15 1.51-6.55) and to a composite of adverse neonatal outcomes (OR 2.28 1.59- 3.29). Gestational weight gain in the course of treatment was associated to large babies, as pre-pregnancy BMI, the latter also an independent risk factor for adverse neonatal outcome. Conclusion – abnormal maternal glycemic profiles in more than two occasions were the stronger risk factor for delivering a large baby and for developing neonatal complications. A beneficial effect of GDM treatment, guided by glycemic profiles, was that most of our newborns had birth weight appropriate for gestational age, although incidence of adverse neonatal outcomes had been no different across birth weight categories.

Introdução: A obesidade é um dos grandes problemas de Saúde Pública e atinge níveis epidêmicos em grande parte do mundo. A maioria dos indivíduos com excesso de peso são mulheres, no Brasil o tamanho desta população também é expressivo, as em idade fértil são as que apresentam maior risco para o desenvolvimento da obesidade, o que está associado ao ganho de peso excessivo durante a gestação e a retenção de peso após o nascimento. O excesso de peso materno está relacionado a desfechos negativos para saúde materno-infantil. Objetivo: Analisar o peso gestacional e desfechos perinatais em mulheres da região sudeste do Brasil. Método: estudo transversal, com a utilização de dados provenientes de uma coorte nacional, com base hospitalar denominada: Nascer no Brasil: Inquérito Nacional sobre Parto e Nascimento, inquérito realizado no período de 2011 e 2012.Partindo da amostra inicial total do Sudeste composta por 10.154 mulheres entrevistadas e considerando os fatores de inclusão e exclusão para esta pesquisa, chegou-se a uma amostra de 3.405 binômios (mãe /recém-nascido).As variáveis estudadas foram ganho de peso, idade materna, peso pré-gestacional, Índice de Massa Corporal inicial e final, idade gestacional, tipo de parto e peso ao nascer. Análise foi realizada através das medidas de tendência central. Foi utilizado teste de Mann-Whitney para dados de distribuição normal e coeficiente de Pearson para variáveis contínuas. Foram considerados como significante os resultados com um p a 0,05. Resultados: A maioria das participantes apresentou faixa etária entre 21 e 30 anos, os nascimentos ocorreram entre a 38ª e 39ª semana gestacional, e seus recém-nascidos tiveram peso mediano de 3.219 g. Grande parte das pesquisadas (61,04 por cento ) iniciaram a gestação com um estado nutricional considerado adequado e 31,51 por cento apresentavam excesso de peso anterior à gestação. O ganho de peso excessivo ocorreu em todas as categorias de IMC pré-gestacional representando 49,6 por cento da população total estudada. O peso anterior à gestação apresentou elevada correlação com ganho de peso total ao final da gestação. Também foi observada influência do ganho de peso na gestação com a via de parto, idade gestacional e peso do bebê ao nascer. Conclusão: A maioria da população iniciou a gestação com estado nutricional adequado, porém, houve ganho de peso excessivo considerável em todas as categorias de IMC, este influenciou na via de parto onde a maioria aconteceu por operação cesariana e no peso ao nascer. O estado nutricional inicial influencia fortemente o estado nutricional ao final da gestação. Por isto, é importante que os programas de intervenção atuem em todas as etapas deste período, inclusive na conscientização da importância de um peso adequado anterior a concepção. Além de promover ações que auxiliem nos cuidados quanto ao ganho de peso na gestação. / Introduction: Obesity is one of the biggest public health problem and reaches epidemic levels in many parts around the World. Most of the people who are overweight are women, in Brazil the size of this population is also expressive, the child-bearing age are at greatest risk to the obesity development, which is associated with excessive weight gain during pregnancy and weight retention after the birth. The maternal overweight is related to negative outcomes for maternal and child health. Objetive: To analyse gestational weight and perinatal outcomes in women of southeastern Brazil. Method: cross-sectional study using data from a national cohort with known hospital database: \"Nascer no Brasil: Inquérito Nacional sobre parto e nascimento survey conducted in 2011 and 2012. Start with initial sample of 10,154 southeastern women interviewed and considering the inclusion and exclusion factors for this research, come up with a sample of 3,405 binomials (mother /newborn). The studied variables were weight gain, maternal age, before pregnancy weight, initial and final body mass index, gestational age, mode of delivery and birth weight. Analysis was carried out through measures of central tendency. It used the Mann-Whitney test for normal distributed data and Pearson coefficient for continuous variables. They were considered as significant results for p 0.05. Results: Most participants had aged between 21 and 30 years old, the births occurred between the 38th and 39th week of gestation, and their newborns had average weight of 3,219 g. Most of the surveyed (61.04 per cent ) started pregnancy with adequate nutritional status and 31.51 per cent had excess weight prior to pregnancy. Excessive weight gain occurred in all prepregnancy BMI categories representing 49.6 per cent of the total studied population. The weight before pregnancy showed high correlation with total weight gain at the end of pregnancy. It was also observed influence of weight gain during pregnancy related to the mode of delivery, gestational age and weight of the baby at birth. Conclusion: Most of the population started pregnancy with adequate nutritional status, however, there was considerable excessive weight gain in all BMI categories, that influenced the type of delivery where most happened by cesarean and the birth weight. The initial nutritional status strongly influences the end of nutritional status in the pregnancy. Therefore, it is important that intervention programs operate in every stage of this period, including the awareness of the importance of a healthy weight before conception. In addition to promoting actions that help us care for weight gain during pregnancy.

O objetivo do experimento foi avaliar o desempenho e a qualidade da carcaça de novilhos superprecoces submetidos a alturas de manejo de pastos de aveia preta e azevém anual (10, 20, 30 e 40 cm) e uma testemunha sem pastejo, bem como avaliar os efeitos dessas alturas de manejo sobre o estabelecimento e o rendimento da cultura de soja subseqüente. O experimento foi realizado na Fazenda do Espinilho, município de Tupanciretã, entre julho de 2004 e maio de 2005. Animais jovens com idade média de dez meses e peso inicial de 190 kg foram distribuídos num delineamento experimental de blocos ao acaso, com três repetições. As ofertas diárias de forragem para os tratamentos 10, 20, 30 e 40 cm foram, respectivamente, 8,8, 14,7, 29,0 e 48,9 kg de matéria seca/100 kg de peso vivo (PV). O ganho de peso por hectare foi superior nos tratamentos com menor altura de manejo, em decorrência da maior carga animal empregada, sendo 529,7, 489,5, 320,9 e 201,6 kg de PV/ha, para os respectivos tratamentos. O ganho médio diário e peso ao abate apresentaram resposta quadrática (P<0,05) conforme o incremento na altura do pasto. A deposição de gordura apresentou média de 3,8 mm e o rendimento médio de carcaça fria foi de 53,3% (P<0,05). As alturas reais do pasto ficaram próximas daquelas pretendidas, havendo um aumento linear da massa de forragem com o aumento das alturas de manejo do pasto. A taxa de acúmulo não foi afetada pelos tratamentos. A taxa de lotação apresentou resposta linear decrescente com o aumento da altura do pasto. A massa de forragem remanescente aumentou na medida em que houve incremento na altura de manejo do pasto. Foi observada diferença entre os tratamentos para palhada residual e estande inicial de plantas de soja, porém, essas diferenças não afetaram o rendimento de grãos da cultura. Concluiu-se que novilhos superprecoces atingem peso de abate e grau de acabamento adequados quando terminados em pastagem de inverno e suplementados no terço final do ciclo de pastejo. O melhor ganho médio diário foi obtido em altura entre 25 a 30 cm e a maior produção por área em 10 cm de altura. A utilização de pastos durante o inverno não prejudica o rendimento de grãos na cultura de soja subseqüente, possibilitando aumento da renda do produtor pela oportunidade de gerar receitas durante a entressafra da soja. / This trial aimed to evaluate the performance and carcass quality of “superprecoce” steers grazing oat and annual ryegrass pastures managed at 10, 20, 30 and 40 cm with a no grazing reference, as well as sward height management effects on soybean establishment and grain yield. The experiment was carried at Fazenda do Espinilho, Tupanciretã municipality, from July 2004 until May 2005. Young animals with 10 months on average and initial live weight of 190 kg were distributed in a randomized block design with three replicates. The daily herbage allowances were 8.8, 14.7, 29.0 and 48.9 kg of dry matter/100kg of live weight, respectively treatments. The live weight gain per hectare was superior in treatments with lower management heights, due to the greater stocking rate employed, being 529.7, 489.5, 320.9 and 201.6 kg of LW, respectively for the treatments 10, 20, 30 and 40cm height. The average daily gain and slaughter weight increased with pasture height being fitted by a quadratic model (P<0.05). The fat deposition and the medium dressing of cold carcass averaged 3.8mm and 53.3%, respectively (P<0.05). The actual sward heights were very similar to those previously intended. There was a linear increase in herbage mass with the increase of sward height. The pasture accumulation rate was not influenced by treatments. The stocking rate showed a decreased linear response with increasing sward height. Post grazing herbage mass increased with increasing sward height. Treatments had effect on initial soybean stand, but not in soybean yield. It was concluded that “superprecoce” steers can reache slaughter weight and adequately finishing degree when finished in winter cultivated pasture supplemented in final third of the grazing cycle. Better individual animal performance is obtained when pasture height ranges from 25 to 30 cm and animal production per hectare when the pasture was managed at 10 cm height. Results suggest grazing animals do not damage succeeding soybean crop, allowing farmers profitability enhancement during soybean intercropping.

This dissertation is a collection of three separate essays on the health of women and children. In the first essay, I along with my co-authors, analyzed the impact of two large, national-level health policies (the Janani Suraksha Yojana (JSY) and the National Rural Health Mission (NRHM)) on maternal health outcomes (proportion of institutional deliveries) in India. We used data from the India Human Development Survey (IHDS) and found that the JSY and the NRHM had a greater impact on institutional deliveries in high-focus states. We also found that the conditions of the public health facilities, did not change after the implementation of the JSY and the NRHM. Finally, we found that adequacy of health facilities was not associated with the likelihood of mothers in high-focus states having an institutional delivery. In the second essay, I examined whether a key social determinant of health in South Asia- gender inequality, is associated with physical health outcomes among Indian women. I found that the gender inequality expressed as the gendered household practice of seclusion was negatively associated with body weight of Indian women. Further, I found that participation in all household decisions by women of the household was generally not associated with body weight outcomes. The association between gendered household practices and women’s body weight outcomes was generally similar among rural and urban Indian women. In the final essay, I examined whether perinatal food environments (FE), maternal gestational weight gain (GWG) and early childhood weight (ECW) outcomes are associated. I used data on mother-children dyads from the Early Childhood Longitudinal Study – Birth cohort (ECLS-B), Area Resource Files (ARF) and Current Business Practices (CBP). I found that maternal GWG was associated with ECW outcomes. I also found that measures of food environment were associated with ECW outcomes. Specifically, I found that having an additional full-service restaurant per one thousand population in the maternal perinatal county of residence was associated with lower Body Mass Index (BMI) among children at age two years. Finally, I found that GWG did not mediate the association between food environment and ECW outcomes.

Background: Oruro is a mining city in the Bolivian highlands. Most of its citizens are exposed to polymetalic cocktails. This study aims to determine whether the neuropsychological development of one year-old children can be associated with 1) polymetalic exposures and/or 2) growth patterns. Methods: The thesis builds from data collected by the ToxBol multidisciplinary project. The health task was centred on the follow-up of a birth-cohort that set to evaluate child development. Children were examined at 11 and 12 months of age using the Bayley Scale of Infant Development (BSID). Results: 1) Analyses revealed no high concentrations of metals in the blood of pregnant women. 2) No neuropsychological anomalies were observed in association with metal concentrations or growth patterns. 3) A positive association was observed between low lead values in blood and the neuropsychological development of children. 4) During the first 6 months of life, growth rate was negatively associated with weight at birth and positively associated with the BMI at 12 months of age. Conclusion: Although heavy metallic pollution was demonstrated by environmental studies, unexpected low levels of exposure were registered from pregnant women. Neither the level of exposure to metals nor the growth patterns appear to have an impact on child neuropsychological development. We argue that the positive effect that was observed in association to lead might be caused by factors such as diet. / Antecedentes: Oruro es una ciudad minera del altiplano boliviano. Muchos de sus habitantes están expuestos a un cóctel polimetálico. El objetivo principal es el de determinar si existe una asociación entre desarrollo neuropsicológico de los niños de un año y 1) la exposición polimetálica y/o 2) los patrones de crecimiento. Métodos: Esta tesis está basada en los datos recogidos del Proyecto multidisciplinario ToxBol. Se realizó el seguimiento de una cohorte de niños para evaluar su desarrollo. Para evaluar el desarrollo neuropsicológico de los niños se utilizaron las escalas de Bayley de desarrollo infantil (BSID). Resultados: 1) No se observaron altas concentraciones de metales en sangre de las mujeres embarazadas. 2) No se observaron anormalidades neuropsicológicas en relación con concentraciones de metales o patrones de crecimiento. 3) Se observó una asociación positiva entre exposiciones bajas de plomo y el desarrollo neuropsicológico del niño al año de vida. 4) La velocidad de crecimiento, desde el nacimiento hasta los 6 meses, se asoció negativamente con el peso al nacer y positivamente con el BMI a los 12 meses. Conclusión: A diferencia de lo demostrado en otros estudios epidemiológicos, se observó una inesperada baja exposición. No se observó una relación entre el grado de exposición a metales- o los patrones de crecimiento -y el desarrollo neuropsicológico del niño. El efecto positivo del plomo creemos que se debe a otros factores como la dieta. / Antecedents: Oruro es una ciutat minera del altiplà Bolivià. La població es troba es contacte amb fonts de contaminación polimetàlica. L’objectiu principal es el de determinar si existeix una associació entre el desenvolupament neuropsicològic dels nens d’un any i 1) la exposició polimetálica i/o 2) patrons de creixement. Mètodes: Esta tesi està basada en dades del Projecte multidisciplinari ToxBol. La tasca de salut es va centrar en el seguiment del desenvolupament d’una cohort de nens. El desenvolupament neuropsicològic infantil es va avaluar amb les escales de Baley de Desenvolupament infantil (BSID). Resultats: 1) No es van observar concentracions altes de metalls en sang de les dones embarassades. 2) No es va observar anormalitats neuropsicològiques en realció amb les concentracions de metalls o patrons de creixement. 3) Es va observar una associació positiva entre concentracions baixes de plom en sang i el desenvolupament neuropsicològic dels nens d’un any. 4) La velocitat de creixement, des del naixement fins els 6 mesos, es va associar negativament amb el pes al néixer i positivament amb el BMI als 12 mesos. Conclusió: A diferencia del que esperàvem, es van registrar baixes concentracions de metalls a les dones embarassades. Tampoc s’observa una relació entre el grau d’exposició a metalls, o patrons de creixement, i el desenvolupament neuropsicològic del nens. El efecte positiu que observem del plom, pensem que es deu a altres factors com la dieta.

Le cancer du sein (CS) est la deuxième cause de décès liés au cancer parmi les femmes dans la plupart des pays industrialisés. Les personnes qui ont le CS peuvent ne pas hériter des mutations causant le cancer de leurs parents. Ainsi, certaines cellules subissent des mutations qui mènent au cancer. Dans le cas de cancer héréditaire, les cellules tumorales contiennent généralement des mutations qui ne sont pas trouvées ailleurs dans l'organisme, mais peuvent maintenir des mutations qui vont répartir dans toutes les cellules. La genèse du CS est le résultat des mutations de gènes qui assurent la régulation de la prolifération cellulaire et la réparation de l’ADN. Deux gènes semblent particulièrement concernés par les mutations. Les gènes ‘Breast Cancer 1’ (BRCA1) et ‘Breast Cancer 2’ (BRCA2), sont impliqués dans la prédisposition génétique de CS. On estime que 5-10% des cas de cancer du sein sont attribuables à une prédisposition génétique. La plupart de ces cancers sont liés à une anomalie du gène BRCA1 ou BRCA2. Plusieurs études ont été menées chez les femmes atteintes de CS sporadique et quelques études se sont concentrées sur celles qui sont porteuses de mutations de BRCA. Alors, notre recherche a été entreprise afin de vérifier l’hypothèse d’une association entre le CS, le mode vie et les habitudes alimentaires chez les Canadiennes-françaises non porteuses des 6 mutations de BRCA les plus fréquentes parmi cette population. Nous avons mené une étude cas-témoins dans cette population. Quelque 280 femmes atteintes du cancer du sein et non-porteuses de mutations de BRCA, ont été recrutées en tant que cas. Les témoins étaient recrutés parmi les membres de la famille des cas (n=15) ou à partir d'autres familles atteintes de CS (n=265). Les participantes étaient de tous âges, recrutées à partir d’une étude de cohorte qui est actuellement en cours, menée par une équipe de chercheurs au Centre Hospitalier Universitaire de Montréal (CHUM) Hôtel-Dieu à Montréal. Les apports alimentaires ont été recueillis par un questionnaire de fréquence semi-quantitatif validé et administré par une nutritionniste, qui portait sur la période avant les deux ans précédant le premier diagnostic de CS pour les cas et la période avant les deux ans précédant l’entrevue téléphonique pour les témoins. Un questionnaire de base était administré par l’infirmière de recherche aux participantes afin de colliger des renseignements sociodémographiques et sur les facteurs de risque du CS. Une association positive et significative a été détectée entre l’âge (plus de 50 ans) auquel les sujets avaient atteint leur Indice de Masse Corporel (IMC) le plus élevé et le CS rapport de cotes (OR) =2,83; intervalle de confiance à 95% (IC95%) (2,34-2,91). De plus, une association positive a été détectée entre un gain de poids de >34 lbs comparativement à un gain de poids de ≤15 lbs, dès l’âge de 20 ans OR=1,68; IC95% (1,10-2,58). Un gain de poids de >24 lbs comparativement à un gain de poids de ≤9 lbs, dès l’âge de 30 ans a aussi montré une augmentation de risque de CS OR=1,96; IC95% (1,46-3,06). Une association positive a aussi été détecté entre, un gain de poids de >12 lbs comparativement à un gain de poids de ≤1 lb, dès l’âge de 40 ans OR=1,91; IC95% (1,53-2,66). Concernant le tabagisme, nous avons observé une association positive et significative reliée à la consommation de plus de 9 paquets-années OR = 1,59; IC95% (1,57-2,87). Il fut suggéré que l’activité physique modéré confère une protection contre le CS: une pratique de > 24,8 (‘metabolic equivalent’) MET-hrs par semaine par rapport à ≤10,7 MET-hrs par semaine, diminue le risque du CS de 52% OR = 0,48 ; IC95% (0,31-0,74). L’activité physique totale (entre 16,2 et 33,2 MET-hrs par semaine), a aussi montré une réduction de risque de CS de 43% OR = 0,57 ; IC95% (0,37-0,87). Toutefois, il n'y avait aucune association entre une activité physique vigoureuse et le risque de CS. L’analyse portant sur les macro- et micro-nutriments et les groupes alimentaires a montré qu’un apport en énergie totale de plus de 2057 Kcal par jour augmentait le risque de CS de 2,5 fois OR = 2,54; IC95% (1,67-3,84). En ce qui concerne la consommation de café, les participantes qui buvaient plus de 8 tasses de café par jour avaient un risque de CS augmenté de 40% OR = 1,40; IC95% (1,09-2,24). Les sujets ayant une consommation dépassant 9 g d’alcool (éthanol) par jour avaient également un risque élevé de 55% OR = 1,55; IC95% (1,02-2,37). De plus, une association positive et significative a été détectée entre le CS et la consommation de plus de deux bouteilles de bière par semaine OR = 1,34; IC95% (1,28-2,11), 10 onces de vin par semaine OR = 1,16; IC95% (1,08-2,58) ou 6 onces de spiritueux par semaine OR = 1,09; IC95% (1,02-2,08), respectivement. En résumé, les résultats de cette recherche supportent l’hypothèse selon laquelle le mode de vie et les habitudes alimentaires jouent un rôle important dans l’étiologie de CS chez les Canadiennes-françaises non porteuses de mutations de BRCA. Les résultats nous permettent de constater que le gain de poids et le tabagisme sont liés à des risques élevés de CS, tandis que l'activité physique modérée aide à réduire ce risque. De plus, nos résultats suggèrent qu’un apport énergétique total relativement élevé et une consommation élevée de café et d'alcool peuvent accroître le risque de ce cancer. Ce travail a permis de mettre l’accent sur une nouvelle direction de recherche, jusqu'à présent non investiguée. Les résultats de ce travail de recherche pourraient contribuer à recueillir de nouvelles informations et des conseils pouvant influencer et aider la population à modifier son mode de vie et ses habitudes alimentaires afin de diminuer le risque de cancer du sein. / Breast cancer (BC) is the second leading cause of cancer-related deaths among women in most industrialised countries. Individuals who have breast cancer may not inherit cancer-causing mutations from their parents. Instead, certain cells undergo mutations that lead to cancer. In the case of hereditary cancer, tumor cells usually contain mutations not found elsewhere in the body, but also harbor a critical mutation shared by all cells. Autosomal dominant alterations in 2 genes, ‘Breast cancer 1’ (BRCA1) and ‘Breast cancer 2’ (BRCA2), are likely to account for familial cases of early-onset BC. It is estimated that 5-10% of breast cancers are due to a genetic predisposition. Most of these cancers are linked to an abnormality in the gene BRCA1 or BRCA2. Several studies have been conducted in women with sporadic BC but few studies have focused on those who carry BRCA mutations. Our research was undertaken to test the hypothesis of an association between the BC, lifestyle and eating habits among French-Canadian women who were non carriers of 6 frequently-occurring BRCA mutations. We conducted a case-control study in a French-Canadian population. Some 280 women with breast cancer and who were non-gene carriers of mutated BRCA gene were recruited as cases. Control subjects were women from families with breast cancer (n=265), except for 15 (5.4%) who came from the same families as cases. Participants of all ages were recruited from an on-going cohort studied by researchers at Centre Hospitalier Universitaire de Montreal (CHUM) Hôtel-Dieu in Montreal. A validated semi-quantitative food frequency questionnaire was administered by a nutritionist on telephone to ascertain dietary intake covering the period prior to 2 years before the initial diagnosis of BC among cases and the period prior to 2 years before the telephone interview for the controls. A core questionnaire was administered by the research team’s nurse to gather information on socio-demographic and lifestyle risk factors. BC risk was increased among subjects who reached their maximum body mass index (BMI) at an older age (more than 50 years) (OR=2.83; 95% CI: 2.34-2.91). In addition, a direct and significant association was noted between weight gain of >34 lbs compared to weight gain of ≤15 lbs, since age 20 (OR=1.68; 95% CI: 1.10-2.58). Moreover, a weight gain of >24 lbs compared to ≤9 lbs, showed an increased risk of BC since age 30 (OR=1.96; 95% CI: 1.46-3.06) and an increased BC risk was also observed with a weight gain of >12 lbs compared to ≤1 lb, since age 40 (OR=1.91; 95% CI: 1.53-2.66). Women who smoked more than 9 pack-years of cigarettes had a higher risk (59%) of BC (OR=1.59; 95% CI: 1.57-2.87). Subjects who engaged in >24.8 metabolic equivalent (MET)-hours per week compared to ≤10.7 MET-hours per week, of moderate physical activity had a 52% decreased risk of BC (OR=0.48; 95% CI: 0.31-0.74). Moreover, total physical activity between 16.2 and 33.2 MET-hours per week showed a 43% lower risk of BC (OR=0.57 95% CI: 0.37-0.87). However, there was no association between vigorous physical activity and BC risk. Energy intakes greater than 2,057 Kcal per day were significantly and positively related to BC risk (OR=2.54; 95%CI: 1.67-3.84). Women who consumed more than 8 cups of coffee per day had a 40% increased risk of BC: OR=1.40 (95%CI: 1.09-2.24). Subjects who consumed more than 9 g of alcohol (ethanol) per day had a heightened risk (55%) of BC: OR=1.55 (95%CI: 1.02-2.37). In addition, a positive and significant association was noted between the consumption of beer, wine and spirits and BC risk. The ORs were 1.34 (95%CI: 1.28-2.11) for >2 bottles of beer per week, OR=1.16 (95%CI: 1.08-2.58) for >10 oz of wine per week and OR=1.09 (95%CI: 1.02-2.08) for >6 oz of spirits per week, respectively. In summary, we found that weight history did affect breast cancer risk. Moreover, smoking appeared to raise the risk, whereas moderate physical activity had a protective effect. Our findings also indicate that relatively high total energy intake and high coffee and alcohol consumption may increase the risk of breast cancer. This work has highlighted an as-yet-untested research focus addressing relationships between lifestyle and dietary habits and BC among non-carriers of BRCA mutations. The report provides advice and guidance on what can be done to influence and change the lifestyle choices as well as dietary habits to help people to reduce their risk of breast cancer.

Insufficient sleep may be associated with obesity via increased energy intake and/or decreased energy expenditure. The present study therefore aimed to investigate effects of sleep restriction on energy balance in healthy young adults. Participants (14 men, 13 women) aged 35.3 ± 1.0 y with 23.6 ± 0.2 kg/m2 BMI completed a randomized, crossover study exposed to short and habitual sleep with 4 wk washout. Controlled diets were provided during the first 4 d, followed by 2 d of ad libitum eating. Ad libitum energy intake, energy expenditure and physical activity level were determined as well as energy balance and body weight. Results showed that ad libitum energy intake (p = 0.031), as well as total fat (p = 0.018) increased after short compared with habitual sleep, but physical activity level, energy expenditure, energy balance, and body weight remained unaffected by sleep duration. In conclusion, sleep deprivation elevates energy intake, which may lead to positive energy balance over time and increase the risk of weight gain and/or obesity.

Malgré le rôle important joué par les comportements alimentaires durant la grossesse, et de leurs implications pour la santé de la mère et de l’enfant à naître, plusieurs études soulignent que les besoins d’informations des femmes enceintes à faible revenu ou issues de minorités ethniques n’ont pas été comblés. Le comportement de recherche d’informations de femmes enceintes immigrantes maghrébines à faible revenu sera donc abordé via le modèle d’Engel, Kollat et Blackwell. L’objectif général est l’exploration de ce comportement de recherche d’informations en lien avec des thématiques associées à leur alimentation au cours de la grossesse. La thèse propose quatre questions spécifiques de recherche visant l’exploration des facteurs d’ordre individuel et d’environnement susceptibles d’influencer une recherche active d’informations, des sources auprès desquelles des informations sont recherchées, et de la nature de l’information recueillie. Un total de 28 femmes enceintes volontaires (14 primigestes et 14 secondigestes) ont été recrutées via le Dispensaire diététique de Montréal entre les mois d’août 2010 et 2011. Des entrevues semi-structurées de 60 à 90 minutes ont été réalisées par l’étudiante au doctorat. Les données ont été soumises à une analyse de contenu via le logiciel NVivo. Des facteurs d’ordre individuel susceptibles d’influencer le comportement de recherche active d’informations furent identifiés: perspective idéologique à l’égard de la grossesse, présence de malaises de grossesse, perception du caractère contradictoire des informations reçues, perceptions liées au caractère adéquat de l’information reçue, perceptions liées au caractère suffisant de l’information détenue, variation du poids corporel, valorisation du bien-être du bébé, attitudes à l’égard de la supplémentation prénatale, valorisation d’une saine alimentation et motivation à apprendre. Des facteurs d’environnement susceptibles d’influencer le comportement de recherche active d’informations ont été identifiés: culture (habitudes alimentaires, croyances alimentaires, croyances religieuses, perte de repères culturels traditionnels quant aux soins de santé et conseils offerts durant la grossesse) et interactions avec les membres de l’environnement social. Des sources d’informations significatives en lien avec la nutrition prénatale se sont avérées être pour les primigestes: diététiste, mère, amies, mari et Internet. Pour les secondigestes, ces sources d’informations étaient: diététiste, médecin, amies et mari. Une source d’informations professionnelle significative concernant la supplémentation prénatale et le gain de poids durant la grossesse, tant pour les primigestes que secondigestes, s’est révélée être la diététiste. Peu de femmes ont rapporté avoir reçu des professionnels de l’information à propos de la salubrité alimentaire et des risques de gagner trop de poids. Les résultats soulèvent une réflexion à l’égard de l’implication des professionnels en période prénatale et quant à la révision de leurs approches de counseling nutritionnel. Les résultats amènent également à réfléchir quant à l’amélioration des activités ayant pour objectif de répondre aux besoins d’informations des femmes enceintes immigrantes maghrébines à faible revenu en lien avec des thématiques liées à l’alimentation durant la grossesse. Pour terminer, il serait utile que de futures recherches s’attardent à mieux comprendre le comportement de recherche d’informations en lien avec des thématiques associées à l’alimentation de femmes enceintes de différents horizons culturels ou de celle de l’enfant à venir. / Despite the important role played by healthy behaviours during pregnancy, and their health implications for both mother and baby, several studies have highlighted that health information needs of low-income and ethnic minority pregnant women have not been met. Thus, the information-seeking behaviour of low-income pregnant Maghrebian women has been studied in this thesis by using the Engel, Kollat and Blackwell (EKB) model. The main objective of this thesis’s research is to explore information-seeking behaviours regarding nutrition-related topics during pregnancy in order to determine whether decisional processes regarding information-seeking behaviour differ among primigravid and secundigravid women. This thesis proposes four specific research questions aiming at the exploration of individual and environmental factors likely to influence the active information-seeking behaviour, the type of information and the sources from which such information is collected. Data has been collected among 28 low-income voluntary women (14 primigravid and 14 secundigravid) mainly referred by the Montreal Diet Dispensary between August 2010 and 2011. Semi-structured interviews lasting 60 to 90 minutes were conducted by the doctoral student. Data were analyzed using content analysis with NVivo software. On one hand, individual factors likely to influence the active information-seeking behaviour have been found to be: the ideological examination of pregnancy, presence of pregnancy discomforts, perception of conflicting information from providers, perceived adequacy of received nutrition information, perceived sufficiency of information, body weight changes, recognition of the baby’s well-being, attitudes toward prenatal supplementation, importance given to healthy eating, and motivation to learn. On the other hand, environmental factors likely to influence the active information-seeking behaviour have been identified to be: culture (eating habits, food beliefs, religious beliefs, loss of cultural markers regarding health care and counseling during pregnancy) and interactions with individuals from the social environment. Significant information sources consulted by primigravid women for topics regarding prenatal nutrition were as follows: the registered dietitian, mother, friends, husband, and Internet. For secundigravid women, significant information sources were as follows: the dietitian, doctor, friends and husband. A significant professional information source, both for primigravid and secundigravid women, about prenatal vitamin and mineral supplementation and pregnancy weight gain was the registered dietitian. Internet was a significant public information source from which primigravid women got information regarding prenatal nutrition-related topics. Few women reported having received, during their follow-up examinations, professional information related to food safety issues and risks of gaining too much weight during pregnancy. Overall, results presented in this thesis highlight the importance of improving communicating strategies in order to better address the information needs of low-income pregnant Maghrebian women. Results raise a number of questions with regards to improving the participation of professionals to prenatal education and their nutritional counseling. Moreover, results from this thesis suggest means to improve activity planning to better address the nutrition-related information needs of pregnant Maghrebian women during pregnancy. It would be useful for researchers to get involved in studies aimed at a better understanding of the information-seeking behaviour of expectant mothers from different cultural backgrounds regarding nutrition-related topics during pregnancy as well as the baby’s nutrition.