Fatores associados à capacidade antioxidante total da dieta de gestantes brasileiras

Detalhes bibliográficos
Autor(a) principal: CARVALHO, Roberta Rejane Santos de
Data de Publicação: 2023
Tipo de documento: Dissertação
Idioma: por
Título da fonte: Biblioteca Digital de Teses e Dissertações da UFMA
Texto Completo: https://tedebc.ufma.br/jspui/handle/tede/tede/4745
Resumo: Introduction: Pregnancy is considered a phase of oxidative stress, in which the demands for nutrients with antioxidant properties are increased. The total antioxidant capacity of the diet (TACd) is an instrument that evaluates the consumption of antioxidants present in the diet. Objective: The present study aimed to analyze the association of socioeconomic, regional, trimester and nutritional status factors with the CATd of Brazilian pregnant women participating in the “Multicentric Study on Iodine Deficiency (EMDI-BRASIL)”, carried out in eleven centers and distributed in nine states and the Federal District. Methods: This is a cross- sectional study with 2232 pregnant women, aged 18 years or older, in the first, second or third trimester of pregnancy, assisted by teams from Basic Health Units in eleven cities in Brazil, namely Aracaju, Belo Horizonte, Brasília, Macaé, Palmas, Pinhais, Ribeirão Preto, Rondonópolis, São Luís, Viçosa and Vitória, who reported not having thyroid disease (hypothyroidism, hyperthyroidism, Hashimoto's disease and neoplasms) or surgery on the thyroid gland. A semi-structured questionnaire was used to assess socioeconomic, demographic and health data and a 24-hour recall (R24h) was used to assess dietary intake. The total antioxidant capacity of the diet was obtained through the consumption of foods and beverages reported in the R24h and with the aid of tables that used the “ferric reducing-antioxidant power” (FRAP) method to calculate the amount of antioxidants in each food. Associations between sociodemographic factors and total dietary antioxidant capacity were analyzed using logistic regression. Results: The median CATd of pregnant women was 5.32 mmol/day. Pregnant women aged 20 to 34 years (OR:1.86; CI 95%; 1.26-2.76), 35 years or older (OR:3.68; CI 95%; 2.21-6.14) and who were in the second trimester of pregnancy (OR:1.50; CI 95%; 1.11-2.01) were more likely to be in the highest CATd tertile. While pregnant women with higher education (OR: 0.67; CI 95%; 0.48-0.92) were 67% less likely to be in the highest CATd tertile. Conclusion: The present study demonstrated that there are differences in the consumption of antioxidants in different cities in Brazil and that associated factors such as age, education and the gestational trimester can impact the intake of foods rich in antioxidants. We encourage the creation of public policies focused on these more vulnerable groups and alert health professionals about the need to reinforce the importance of a diet rich in antioxidants during prenatal care.
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spelling CARVALHO, Carolina Abreu dehttp://lattes.cnpq.br/0369417229006032CARVALHO, Carolina Abreu dehttp://lattes.cnpq.br/0369417229006032ROCHA, Daniela da Silvahttp://lattes.cnpq.br/2784611146553696FRANÇA, Ana Karina Teixeira da Cunhahttp://lattes.cnpq.br/8389486900285691http://lattes.cnpq.br/0220199843773331CARVALHO, Roberta Rejane Santos de2023-06-05T12:43:43Z2023-04-04CARVALHO, Roberta Rejane Santos de. Fatores associados à capacidade antioxidante total da dieta de gestantes brasileiras. 2023. 112 f. Dissertação (Programa de Pós-Graduação em Saúde Coletiva/CCBS) - Universidade Federal do Maranhão, São Luís, 2023.https://tedebc.ufma.br/jspui/handle/tede/tede/4745Introduction: Pregnancy is considered a phase of oxidative stress, in which the demands for nutrients with antioxidant properties are increased. The total antioxidant capacity of the diet (TACd) is an instrument that evaluates the consumption of antioxidants present in the diet. Objective: The present study aimed to analyze the association of socioeconomic, regional, trimester and nutritional status factors with the CATd of Brazilian pregnant women participating in the “Multicentric Study on Iodine Deficiency (EMDI-BRASIL)”, carried out in eleven centers and distributed in nine states and the Federal District. Methods: This is a cross- sectional study with 2232 pregnant women, aged 18 years or older, in the first, second or third trimester of pregnancy, assisted by teams from Basic Health Units in eleven cities in Brazil, namely Aracaju, Belo Horizonte, Brasília, Macaé, Palmas, Pinhais, Ribeirão Preto, Rondonópolis, São Luís, Viçosa and Vitória, who reported not having thyroid disease (hypothyroidism, hyperthyroidism, Hashimoto's disease and neoplasms) or surgery on the thyroid gland. A semi-structured questionnaire was used to assess socioeconomic, demographic and health data and a 24-hour recall (R24h) was used to assess dietary intake. The total antioxidant capacity of the diet was obtained through the consumption of foods and beverages reported in the R24h and with the aid of tables that used the “ferric reducing-antioxidant power” (FRAP) method to calculate the amount of antioxidants in each food. Associations between sociodemographic factors and total dietary antioxidant capacity were analyzed using logistic regression. Results: The median CATd of pregnant women was 5.32 mmol/day. Pregnant women aged 20 to 34 years (OR:1.86; CI 95%; 1.26-2.76), 35 years or older (OR:3.68; CI 95%; 2.21-6.14) and who were in the second trimester of pregnancy (OR:1.50; CI 95%; 1.11-2.01) were more likely to be in the highest CATd tertile. While pregnant women with higher education (OR: 0.67; CI 95%; 0.48-0.92) were 67% less likely to be in the highest CATd tertile. Conclusion: The present study demonstrated that there are differences in the consumption of antioxidants in different cities in Brazil and that associated factors such as age, education and the gestational trimester can impact the intake of foods rich in antioxidants. We encourage the creation of public policies focused on these more vulnerable groups and alert health professionals about the need to reinforce the importance of a diet rich in antioxidants during prenatal care.Introdução: A gestação é considerada uma fase de estresse oxidativo, na qual as demandas de nutrientes com propriedades antioxidantes estão aumentadas. A capacidade antioxidante total da dieta (CATd) é um instrumento que avalia o consumo de antioxidantes presentes na dieta. Objetivo: O presente estudo teve como objetivo analisar a associação de fatores socioeconômicos, regionais, trimestre e estado nutricional com a CATd de gestantes brasileiras participantes do “Estudo Multicêntrico sobre Deficiência de Iodo (EMDI-BRASIL) “, realizado em onze centros e distribuídos em nove estados e o Distrito Federal. Métodos: Trata-se de um estudo transversal com 2232 gestante, com 18 anos ou mais, do primeiro, segundo ou terceiro trimestres de gestação, atendidas pelas equipes das Unidades Básicas de Saúde de onze cidades do Brasil, a saber Aracaju, Belo Horizonte, Brasília, Macaé, Palmas, Pinhais, Ribeirão Preto, Rondonópolis, São Luís, Viçosa e Vitória, que relataram não possuir doença tireoidiana (hipotireoidismo, hipertireoidismo, Doença de Hashimoto e neoplasias) ou cirurgia na glândula tireoide. Foi realizado um questionário semiestruturado para avaliação dos dados socioeconômicos, demográficos e de saúde e o recordatório de 24h (R24h) para avaliação do consumo alimentar. A capacidade antioxidante total da dieta foi obtida através do consumo de alimentos e bebidas relatadas no R24h e com auxílio de tabelas que usaram o método “ferric reducing-antioxidant power” (FRAP) para calcular a quantidade de antioxidantes em cada alimento. As associações entre fatores sociodemográficos e capacidade antioxidante total da dieta foram analisadas por meio de regressão logística. Resultados: A mediana de CATd das gestantes foi de 5,32 mmol/dia. As gestantes com 20 a 34 anos (OR:1,86; IC 95%; 1,26-2,76), 35 anos ou mais (OR:3,68; IC 95%; 2,21-6,14) e que estavam no segundo trimestre de gestação (OR:1,50; IC 95%; 1,11-2,01) tiveram mais chances de estarem no maior tercil de CATd. Enquanto as gestantes com maior escolaridade (OR: 0,67; IC 95%; 0,48-0,92) tinham 67% menor chance de estarem no maior tercil de CATd. Conclusão: O presente estudo demonstrou que há diferenças no consumo de antioxidantes em diferentes cidades do Brasil e que fatores associados como, idade, escolaridade e o trimestre gestacional podem impactar na ingestão de alimentos ricos em antioxidantes. Encorajamos a elaboração de políticas públicas focadas nesses grupos mais vulneráveis e alertamos os profissionais de saúde sobre a necessidade de reforçar a importância de uma alimentação rica em antioxidantes durante o pré-natal.Submitted by Jonathan Sousa de Almeida (jonathan.sousa@ufma.br) on 2023-06-05T12:43:43Z No. of bitstreams: 1 ROBERTAREJANESANTOSDECARVALHO.pdf: 3421654 bytes, checksum: 0555516650b71fcc72f156b0b054d8b0 (MD5)Made available in DSpace on 2023-06-05T12:43:43Z (GMT). No. of bitstreams: 1 ROBERTAREJANESANTOSDECARVALHO.pdf: 3421654 bytes, checksum: 0555516650b71fcc72f156b0b054d8b0 (MD5) Previous issue date: 2023-04-04CNPqapplication/pdfporUniversidade Federal do MaranhãoPROGRAMA DE PÓS-GRADUAÇÃO EM SAÚDE COLETIVA/CCBSUFMABrasilDEPARTAMENTO DE MEDICINA III/CCBSantioxidantes;gestação;estresse oxidativo;consumo alimentar;fatores sociodemográficos.antioxidants;gestation;oxidative stress;food consumption;sociodemographic factors.ObstetríciaCiências da SaúdeFatores associados à capacidade antioxidante total da dieta de gestantes brasileirasFactors associated with total antioxidant capacity in the diet of Brazilian pregnant womeninfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/openAccessreponame:Biblioteca Digital de Teses e Dissertações da UFMAinstname:Universidade Federal do Maranhão (UFMA)instacron:UFMAORIGINALROBERTAREJANESANTOSDECARVALHO.pdfROBERTAREJANESANTOSDECARVALHO.pdfapplication/pdf3421654http://tedebc.ufma.br:8080/bitstream/tede/4745/2/ROBERTAREJANESANTOSDECARVALHO.pdf0555516650b71fcc72f156b0b054d8b0MD52LICENSElicense.txtlicense.txttext/plain; charset=utf-82255http://tedebc.ufma.br:8080/bitstream/tede/4745/1/license.txt97eeade1fce43278e63fe063657f8083MD51tede/47452023-06-05 09:43:43.185oai:tede2: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Biblioteca Digital de Teses e Dissertaçõeshttps://tedebc.ufma.br/jspui/PUBhttp://tedebc.ufma.br:8080/oai/requestrepositorio@ufma.br||repositorio@ufma.bropendoar:21312023-06-05T12:43:43Biblioteca Digital de Teses e Dissertações da UFMA - Universidade Federal do Maranhão (UFMA)false
dc.title.por.fl_str_mv Fatores associados à capacidade antioxidante total da dieta de gestantes brasileiras
dc.title.alternative.eng.fl_str_mv Factors associated with total antioxidant capacity in the diet of Brazilian pregnant women
title Fatores associados à capacidade antioxidante total da dieta de gestantes brasileiras
spellingShingle Fatores associados à capacidade antioxidante total da dieta de gestantes brasileiras
CARVALHO, Roberta Rejane Santos de
antioxidantes;
gestação;
estresse oxidativo;
consumo alimentar;
fatores sociodemográficos.
antioxidants;
gestation;
oxidative stress;
food consumption;
sociodemographic factors.
Obstetrícia
Ciências da Saúde
title_short Fatores associados à capacidade antioxidante total da dieta de gestantes brasileiras
title_full Fatores associados à capacidade antioxidante total da dieta de gestantes brasileiras
title_fullStr Fatores associados à capacidade antioxidante total da dieta de gestantes brasileiras
title_full_unstemmed Fatores associados à capacidade antioxidante total da dieta de gestantes brasileiras
title_sort Fatores associados à capacidade antioxidante total da dieta de gestantes brasileiras
author CARVALHO, Roberta Rejane Santos de
author_facet CARVALHO, Roberta Rejane Santos de
author_role author
dc.contributor.advisor1.fl_str_mv CARVALHO, Carolina Abreu de
dc.contributor.advisor1Lattes.fl_str_mv http://lattes.cnpq.br/0369417229006032
dc.contributor.referee1.fl_str_mv CARVALHO, Carolina Abreu de
dc.contributor.referee1Lattes.fl_str_mv http://lattes.cnpq.br/0369417229006032
dc.contributor.referee2.fl_str_mv ROCHA, Daniela da Silva
dc.contributor.referee2Lattes.fl_str_mv http://lattes.cnpq.br/2784611146553696
dc.contributor.referee3.fl_str_mv FRANÇA, Ana Karina Teixeira da Cunha
dc.contributor.referee3Lattes.fl_str_mv http://lattes.cnpq.br/8389486900285691
dc.contributor.authorLattes.fl_str_mv http://lattes.cnpq.br/0220199843773331
dc.contributor.author.fl_str_mv CARVALHO, Roberta Rejane Santos de
contributor_str_mv CARVALHO, Carolina Abreu de
CARVALHO, Carolina Abreu de
ROCHA, Daniela da Silva
FRANÇA, Ana Karina Teixeira da Cunha
dc.subject.por.fl_str_mv antioxidantes;
gestação;
estresse oxidativo;
consumo alimentar;
fatores sociodemográficos.
topic antioxidantes;
gestação;
estresse oxidativo;
consumo alimentar;
fatores sociodemográficos.
antioxidants;
gestation;
oxidative stress;
food consumption;
sociodemographic factors.
Obstetrícia
Ciências da Saúde
dc.subject.eng.fl_str_mv antioxidants;
gestation;
oxidative stress;
food consumption;
sociodemographic factors.
dc.subject.cnpq.fl_str_mv Obstetrícia
Ciências da Saúde
description Introduction: Pregnancy is considered a phase of oxidative stress, in which the demands for nutrients with antioxidant properties are increased. The total antioxidant capacity of the diet (TACd) is an instrument that evaluates the consumption of antioxidants present in the diet. Objective: The present study aimed to analyze the association of socioeconomic, regional, trimester and nutritional status factors with the CATd of Brazilian pregnant women participating in the “Multicentric Study on Iodine Deficiency (EMDI-BRASIL)”, carried out in eleven centers and distributed in nine states and the Federal District. Methods: This is a cross- sectional study with 2232 pregnant women, aged 18 years or older, in the first, second or third trimester of pregnancy, assisted by teams from Basic Health Units in eleven cities in Brazil, namely Aracaju, Belo Horizonte, Brasília, Macaé, Palmas, Pinhais, Ribeirão Preto, Rondonópolis, São Luís, Viçosa and Vitória, who reported not having thyroid disease (hypothyroidism, hyperthyroidism, Hashimoto's disease and neoplasms) or surgery on the thyroid gland. A semi-structured questionnaire was used to assess socioeconomic, demographic and health data and a 24-hour recall (R24h) was used to assess dietary intake. The total antioxidant capacity of the diet was obtained through the consumption of foods and beverages reported in the R24h and with the aid of tables that used the “ferric reducing-antioxidant power” (FRAP) method to calculate the amount of antioxidants in each food. Associations between sociodemographic factors and total dietary antioxidant capacity were analyzed using logistic regression. Results: The median CATd of pregnant women was 5.32 mmol/day. Pregnant women aged 20 to 34 years (OR:1.86; CI 95%; 1.26-2.76), 35 years or older (OR:3.68; CI 95%; 2.21-6.14) and who were in the second trimester of pregnancy (OR:1.50; CI 95%; 1.11-2.01) were more likely to be in the highest CATd tertile. While pregnant women with higher education (OR: 0.67; CI 95%; 0.48-0.92) were 67% less likely to be in the highest CATd tertile. Conclusion: The present study demonstrated that there are differences in the consumption of antioxidants in different cities in Brazil and that associated factors such as age, education and the gestational trimester can impact the intake of foods rich in antioxidants. We encourage the creation of public policies focused on these more vulnerable groups and alert health professionals about the need to reinforce the importance of a diet rich in antioxidants during prenatal care.
publishDate 2023
dc.date.accessioned.fl_str_mv 2023-06-05T12:43:43Z
dc.date.issued.fl_str_mv 2023-04-04
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/masterThesis
format masterThesis
status_str publishedVersion
dc.identifier.citation.fl_str_mv CARVALHO, Roberta Rejane Santos de. Fatores associados à capacidade antioxidante total da dieta de gestantes brasileiras. 2023. 112 f. Dissertação (Programa de Pós-Graduação em Saúde Coletiva/CCBS) - Universidade Federal do Maranhão, São Luís, 2023.
dc.identifier.uri.fl_str_mv https://tedebc.ufma.br/jspui/handle/tede/tede/4745
identifier_str_mv CARVALHO, Roberta Rejane Santos de. Fatores associados à capacidade antioxidante total da dieta de gestantes brasileiras. 2023. 112 f. Dissertação (Programa de Pós-Graduação em Saúde Coletiva/CCBS) - Universidade Federal do Maranhão, São Luís, 2023.
url https://tedebc.ufma.br/jspui/handle/tede/tede/4745
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dc.publisher.none.fl_str_mv Universidade Federal do Maranhão
dc.publisher.program.fl_str_mv PROGRAMA DE PÓS-GRADUAÇÃO EM SAÚDE COLETIVA/CCBS
dc.publisher.initials.fl_str_mv UFMA
dc.publisher.country.fl_str_mv Brasil
dc.publisher.department.fl_str_mv DEPARTAMENTO DE MEDICINA III/CCBS
publisher.none.fl_str_mv Universidade Federal do Maranhão
dc.source.none.fl_str_mv reponame:Biblioteca Digital de Teses e Dissertações da UFMA
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