Estado Nutricional e sua Associação com o Consumo Alimentar em Gestantes de Município no Sul do Tocantins

Abstract

Nutritional status and gestational weight gain are associated with macro and micronutrient intake that, when inadequate throughout pregnancy, generates adverse effects on binomial mother-child health. Among the micronutrients stands out Vitamin D, which its deficiency in pregnancy is possibly involved in the pathophysiology of various gestational complications, such as preeclampsia and gestational diabetes. In this dissertation, 3 studies were carried out: the first was a systematic literature review, aiming to evaluate the epidemiology of hypovitaminosis among pregnant women, by localities in Brazil. Searches were performed in the main databases, with the descriptors: “Vitamin D”, “Pregnancy / Gestation” and “Brazil”, 267 articles were found, and after applying the exclusion criteria, 4 articles remained. The average of pregnant women with adequate nutritional status of vitamin D in Brazil was 26.9%, with prevalence of hypovitaminosis D, according to location in the country, and was higher when further from equator. The second study evaluated nutrient consumption among pregnant women in primary care in the county of Gurupi-TO, associating the inadequacies found with nutritional status. This was a cross-sectional study, with 96 pregnant women, evaluating the socioeconomic profile, maternal conditions and current pregnancy, and a 24-hour nutrient intake recall. Descriptive data analysis and association tests were performed at 5%. It was observed that most of the pregnant women were using inadequate nutrient supplementation (77%) and 44.2% had 25-hydroxycolecalciferol insufficiency. Most women (64%) presented pre-gestational overweight and 42% maintained this excess during pregnancy. Weight gain was inadequate in 74% of them and energy (p = 0.019) and lipid (p = 0.003) intakes were significantly different between pre-gestational nutritional status groups. The underweight pregnant women ingested protein, lipids and energy below the recommendation. Therefore, the daily intake of macro and micronutrients was inadequate and may have influenced the inadequacy of weight gain and the decline in nutritional status observed, and may have irreversible and harmful consequences for the binomial. The third study aimed to validate a food frequency questionnaire to estimate calcium and vitamin D intake in pregnant women. Forty-six patients participated in the study, whom answered a food frequency questionnaire consisting of 118 items, 2 24-hour recalls and underwent the dosage of biological markers: serum 25-hydroxyvitamin D, calcium, phosphorus and parathyroid hormone. Intake estimates by the two dietary surveys were correlated by paired t-test or Wilcoxon tests, Pearson or Spearman correlations, and Bland Atman method. Analysis were performed on the Statistical Package for Social Sciences 20.0, at 5% significance. The triad method was used to correlate the calcium, phosphorus and vitamin D intakes estimated by the two surveys with the serum biomarkers. The food frequency questionnaire showed a good correlation with the biological marker for vitamin D and also for the 24-hour recall estimation for calcium intake, turning out to be a low cost alternative and easy application for the diagnosis of hypovitaminosis D in pregnant women.