Gisele Souza

Micronutrientes na gestação e lactação

Vitamina A, ferro e zinco sao micronutrientes essenciais ao pleno funcionamento do organismo humano. Durante o periodo gestacional, seus requerimentos encontram-se aumentados devido ao intenso crescimento e proliferacao celular e, durante a lactacao, o leite materno constitui a mais importante fonte destes nutrientes para o recem-nascido e lactente. O atendimento as necessidades nutricionais do grupo materno-infantil, considerado como grupo de risco, para o desenvolvimento de carencias nutricionais, deve ser uma preocupacao dos profissionais de saude, e a prevencao e o diagnostico precoce da deficiencia de micronutrientes reveste-se de extrema importância. Este trabalho objetiva revisar informacoes disponiveis na literatura acerca do papel da vitamina A, do ferro e do zinco na gestacao e lactacao, enfatizando os agravos a saude decorrentes de sua deficiencia e o papel da suplementacao no combate ao estado carencial desses micronutrientes. Foram pesquisadas as bases de dados MEDLINE e LILACS, utilizando os decritores: vitamin A, iron, zinc, deficiency, pregnancy, lactation, newborn, anemia e micronutrient, no periodo 1966 a 2004. Sugerem-se medidas que concorram para a modificacao das praticas alimentares e da qualidade da dieta como estrategia de combate a deficiencia de micronutrientes e incluidas no elenco de acoes universais da atencao pre-natal. Tais acoes podem produzir beneficios para a saude materno-infantil e contribuir para a reducao dos niveis de morbi-mortalidade no binomio mae-filho.

Vitamin A concentration in human milk and its relationship with liver reserve formation and compliance with the recommended daily intake of vitamin A in pre-term and term infants in exclusive breastfeeding

PurposeTo evaluate vitamin A concentration in mature breast milk of nursing mothers aiming to meet the daily needs and the formation of liver reserve in pre-term (PT) and term infants (T) in comparison with the recommended intake for this nutrient in this group.MethodsWe analyzed the retinol concentration in the milk of 120 nursing mothers (40 of PT infants and 80 of T infants) by collecting 10xa0mL of mature breast milk, held by a hand spray of one of the breasts 2xa0h after the last feeding in the morning. The cutoff points adopted for identification of vitamin A deficiency (VAD) and the liver reserve were <1.05 and >2.3xa0μmol/L, respectively.ResultsThe concentrations of retinol in the human milk of T infants were superior to concentrations in the milk of PT infants (1.87xa0+xa00.81xa0>xa01.38xa0+xa00.67xa0μmol/L, pxa0<xa00.0001). They were higher in T compared to PT (352.64xa0+xa0152.72xa0>xa0217.65xa0+xa0105.65xa0μg, pxa0<xa00.0001), but both were below the recommendation. VAD was 20.0xa0% (T) and 27.5xa0% (PT). Only 40.0xa0% (T) and 22.5xa0% (PT) of the mothers had retinol concentrations in milk above 2.3xa0mmol/L.ConclusionThe milk of the nursing mothers studied did not have enough retinol to meet the daily needs and to form liver reserve in both groups, especially in PT newborns. This finding reinforces the idea that supplementation with massive doses of vitamin A in the immediate postpartum period can be used as a protective device of the infant against VAD.

Serum retinol and β-carotene levels and risk factors for cardiovascular disease in morbid obesity.

OBJECTIVEnto evaluate retinol and β-carotene serum levels and their relationship with risk factors for cardiovascular disease in individuals with morbid obesity, resident in Rio de Janeiro.nnnMETHODOLOGYnblood serum concentrations of retinol and β-carotene of 189 morbidly obese individuals were assessed. The metabolic syndrome was identified according to the criteria of the National Cholesterol Education Program (NCEP) and World Health Organization (WHO). Lipid profile, insulin resistance, basal insulin, glycemia, blood pressure, and anthropometry and their correlation with retinol and β-carotene serum levels were evaluated.nnnRESULTSnmetabolic syndrome diagnosis was observed in 49.0% of the sample. Within this percentage the levels of β-carotene were significantly lower when body mass index increased. Serum retinol didnt show this behavior. Serum retinol inadequacy in patients with metabolic syndrome (61.3%), according to WHO criterion, was higher (15.8%) than when the whole sample was considered (12.7%). When metabolic syndrome was diagnosed by NCEP criterion, β-carotene inadequacy was higher (42.8%) when compared to the total sample (37.5%). There was a significant difference between average β-carotene values of patients with and without metabolic syndrome (p=0.048) according to the classification of the NCEP. Lower values were found in patients with metabolic syndrome.nnnCONCLUSIONnconsidering the vitamin A contribution in antioxidant protection, especially when risk factors for cardiovascular disease are present, it is suggested that great attention be given to morbidly obese. This could aid in prevention and treatment of cardiovascular disease, which affects a significant part of the population.

Concentração de vitamina A no leite humano maduro

Objective: To quantify vitamin A levels in mature milk of 196 nursing women who were treated at the Maternity School of Rio de Janeiro and to evaluate its correlation with sociodemographic variables and degree of nutrition knowledge. Methods: To quantify retinol concentrations, 10 mL of mature milk were collected by manual expression of one breast, 2 hours after the last feed, in the morning period. Values below 1.05 µmol/L and 2.3 µmol/L were considered inadequate to meet satisfactory intake and to constitute vitamin A liver reserve, respectively. The following variables were also assessed: sex, age, familiar income, maternal education, basic sanitation conditions, number of people in the household, maternal age, prenatal care, and degree of nutrition knowledge. Results: Among the 196 lactating mothers analyzed, the average vitamin A concentration observed in mature milk was 1.76±0.85 µmol/L and prevalence of vitamin A deficiency was observed in 20.5% mothers. There was no significant difference between vitamin A levels in maternal milk and the variables socioeconomic status and nutrition knowledge. Only 38.9% of lactating women presented enough vitamin A concentrations in milk for the infants’ liver reserves (2.3 µmol/L). Conclusion: These findings reveal high prevalence of inadequate vitamin A nutritional status of mothers and infants, consistent with the national prevalence reported in women of childbearing age and Brazilian children, and that the intervention measures to fight this shortage should be extended to all pregnant and postpartum women, regardless of sociodemographic conditions and degree of nutrition knowledge, in order to improve the health of mother and child.

Vitamin A concentration in mature human milk

OBJECTIVEnTo quantify vitamin A levels in mature milk of 196 nursing women who were treated at the Maternity School of Rio de Janeiro and to evaluate its correlation with sociodemographic variables and degree of nutrition knowledge.nnnMETHODSnTo quantify retinol concentrations, 10 mL of mature milk were collected by manual expression of one breast, 2 hours after the last feed, in the morning period. Values below 1.05 µmol/L and 2.3 µmol/L were considered inadequate to meet satisfactory intake and to constitute vitamin A liver reserve, respectively. The following variables were also assessed: sex, age, familiar income, maternal education, basic sanitation conditions, number of people in the household, maternal age, prenatal care, and degree of nutrition knowledge.nnnRESULTSnAmong the 196 lactating mothers analyzed, the average vitamin A concentration observed in mature milk was 1.76±0.85 µmol/L and prevalence of vitamin A deficiency was observed in 20.5% mothers. There was no significant difference between vitamin A levels in maternal milk and the variables socioeconomic status and nutrition knowledge. Only 38.9% of lactating women presented enough vitamin A concentrations in milk for the infants liver reserves (2.3 µmol/L).nnnCONCLUSIONSnThese findings reveal high prevalence of inadequate vitamin A nutritional status of mothers and infants, consistent with the national prevalence reported in women of childbearing age and Brazilian children, and that the intervention measures to fight this shortage should be extended to all pregnant and postpartum women, regardless of sociodemographic conditions and degree of nutrition knowledge, in order to improve the health of mother and child.

Effect of vitamin A supplementation on clinical evolution in patients undergoing coronary artery bypass grafting, according to serum levels of zinc

Vitamin A and zinc are powerful antioxidants with synergy between them, thus protecting the organism against oxidative stress during the pre and postoperative periods. Our aim was to investigate the evolution clinical in patients undergoing coronary artery bypass grafting while receiving vitamin A supplements according to their zinc nutritional status. They were randomly divided into two groups (2:1): Control group (G1 = 60); and Supplemented group (G2 = 30) and subdivided according to the nutritional status of zinc. Serum concentrations of retinol, β-carotene, zinc and levels of malondialdehyde were measured prior to (T0) and on the 21st day (T1) following surgery. After surgery, was found a significant difference between G1 and G2 when comparing retinol (G1 = 38.7 ± 17.1 μg/dL and G2 = 62.1 ± 20.3 μg/dL; p < 0.001) and β-carotene (G1 = 12.3 ± 5.7 μg/dL and G2 = 53.5 ± 20.9 μg/dL; p < 0.001) in the patients with adequate concentrations of zinc. Analyzing the evolution clinical, operative mortality was 8.33% in G1 and 3.33% in G2. Hospitalization time significantly smaller in the G2 was found in the patients who had adequate concentrations of zinc (p = 0.001), as well as time in the intensive care unit both in those with adequate and inadequate levels of zinc (p = 0.047; p = 0.039). Such results may indicate that vitamin A supplementation may have a positive impact in combating the oxidative stress to which these patients are exposed above all in patients with adequate levels of zinc.

Vitamin A liver store: a case–control study

The present study aims to assess the vitamin A liver store in individuals who died of several causes and to compare them with those who died of violent causes. A case–control study was performed with 60 individuals, where 30 died of violent causes (control) and 30 of other causes (cardiovascular diseases, infections, other chronic degenerative diseases, several causes). According to the cause of death, the mean retinol from liver stores was 281.5±63.50 mg/g for individuals who died of violent causes—a significantly higher amount (P<0.05) than those observed in the other group (105.4±87.54 mg/g by cardiovascular diseases, 88.1±78.03 mg/g by infections, 162.4±119.19 mg/g by other chronic degenerative diseases and 205.5±126.63 mg/g by several causes). The highest prevalence of low vitamin A was observed in individuals who died of infections and cardiovascular diseases, which emphasizes the role of vitamin A in these pathological processes.

Vitamin A nutritional status in patients with coronary artery disease and its correlation with the severity of the disease

INTRODUCTIONnthe purpose of this study was to assess the vitamin A (VA) nutritional status of patients with coronary artery disease (CAD) andxa0its correlation with the severity of the disease, taking into consideration zinc concentration and oxidative stress.nnnMETHODSnthe patients were preoperative inpatients awaiting myocardial revascularization surgery. The serum concentrations of retinol, β-carotene,xa0zinc, malondialdehyde (MDA) and C-reactive protein (CRP) were quantified. CAD severity was assessed by cineangiography, observing thexa0parameters of severity, extent and occlusion. An echocardiogram was performed to assess the ejection fraction.nnnRESULTSnninety individuals were studied (64.5 ± 9.6 years). Zinc did not correlate with retinol (r = -0.009/p = 0.40), β-carotene (r = -0.06/p =xa00.73) or MDA (r = 0.03/p = 0.70), but zinc deficiency was more frequent amongst the patients with high MDA (quartiles 50 and 75). CRP wasxa0found to be associated with retinol (x2 = 3.95/p = 0.04). The individuals with retinol deficiency had more severe CAD, and β-carotene diminishedxa0as the extent score rose, although this was not statistically significant (p = 0.12). The degree of severity was associated to extent (x2 = 67.9)/(pxa0< 0.001), occlusion (x2 = 34.5/p < 0.001) and CRP (x2 = 5.9/p = 0.05), while extent was associated with MDA (x2 = 42.1)/(p < 0.001). Therexa0was a positive correlation between the ejection fraction and β-carotene (r = 0.42/p = 0.02).nnnCONCLUSIONnfindings from this study indicate that chronic inflammation resulting from atherosclerosis is related to disease severity and consequentxa0influence on nutritional status of VA.

Vitamin A supplementation according to zinc status on oxidative stress levels in cardiac surgery patients

INTRODUCTIONnit is widely reported that oxidative stress increases in patients undergoing cardiovascular surgery and causes negative outcomes, such as reduced immunological responses and postoperative complications. In this context, vitamin A and zinc serves an important function in the immunological system because it plays a role in fighting oxidative stress.nnnOBJECTIVESnto evaluate the effect of vitamin A supplementation on oxidative stress levels in cardiac surgery patients based on zinc nutritional status.nnnMETHODSna control group (G1) and a vitamin A intervention group (G2- 5,000 IU of vitamin A daily) were subdivided based on their zinc nutritional status. The patients serum concentrations of retinol, β-carotene, zinc and malondialdehyde were assessed before surgery (T0), on the 3rd (T1) and 21st postoperative day (T2).nnnRESULTSnin the individuals with adequate zinc concentrations, the retinol concentrations were significantly higher in G2 than in G1 at T1 and T2. In G2, the β-carotene concentrations were significantly higher in individuals with adequate zinc concentrations compared to those who had inadequate concentrations at T1 (p = 0.024) and T2 (p = 0.043). After surgery, malondialdehyde levels were significantly higher in individuals who had inadequate zinc concentrations, compared to those who had adequate zinc concentrations. Analyzing the clinical evolution, operative mortality, hospitalization time and length of stay in Intensive Care Unit (ICU) were lower in G2.nnnCONCLUSIONnvitamin A has contributed to the reduction of oxidative stress, particularly in patients with adequate zinc concentrations and, this way, may help decrease the risk of postoperative complications.