Baixo consumo de frutas, verduras e legumes: fatores associados em idosos em capital no centro-oeste do Brasil
Background Gestational diabetes mellitus (GDM) is a common complication of pregnancy. It may predispose offspring to increased fat mass (FM) and the development of obesity, however few data from Latin America exist. Objective To investigate the influence of GDM on newborn FM in mother-newborn pairs recruited from a public maternity care center in São Paulo, Brazil. Methods Data were collected cross-sectionally in 2013–2014 from 72 mothers diagnosed with GDM, and 211 mothers with normal glucose tolerance (NGT). Newborn FM was evaluated by air-displacement plethysmography (PEA POD), and relevant demographic and obstetric data were collected from hospital records. Associations between maternal GDM status and newborn FM were investigated by multiple linear regression analysis, with adjustment for maternal age, pre-pregnancy BMI, gestational weight gain, type of delivery, sex of the child, and gestational age. Results FM was greater in GDM versus NGT newborns in a bivariable model (Median (IQR), GDM: 0.35 (0.3) kg vs. NGT: 0.27 (0.2) kg, p = 0.02), however GDM status was not a significant predictor of FM with adjustment for other variables. Rather, pre-pregnancy BMI (coefficient (β) 1.46; 95% confidence interval (CI) 0.66, 2.27), gestational weight gain (β 1.32; 95% CI 0.49, 2.15), and male sex (β -17.8; 95% CI -27.2, -8.29) predicted newborn FM. Analyzing GDM and NGT groups separately, pre-pregnancy BMI (β 6.75; 95% CI 2.36, 11.1) and gestational weight gain (β 5.64; 95% CI 1.16, 10.1) predicted FM in the GDM group, while male sex alone predicted FM in the NGT group (β -12.3; 95% CI -18.3, -6.34). Conclusions Combined model results suggest that in our cohort, pre-pregnancy BMI and gestational weight gain are more important risk factors for increased neonatal FM than GDM. However, group-specific model results suggest that GDM status may contribute to variation in the relationship between maternal/offspring factors and FM. Our use of a binary GDM variable in the combined model may have precluded clearer results on this point. Prospective cohort studies including data on maternal pre-pregnancy BMI, GWG, and glycemic profile are needed to better understand associations among these variables and their relative influence on offspring FM.
Com muita ternura, dedico esta dissertação de mestrado à minha família por terem despertado em mim o gosto pelo estudo. Aos avôs (in memoriam) Benedito e João e às avós Adely e Eunice pela sensação de aconchego, pertencimento e raízes. Ao meu pai, Eder, por seu exemplo abundante em comprometimento, dedicação, força de vontade, persistência e superação. À minha mãe, Waldilene, pelo exemplo de disciplina, amor, cuidado e respeito. Ao meu irmão e cunhada, Victor e Elisângela, pela solicitude. Ao meu esposo, Renato, pelo amor, apoio, incentivo incondicional e inestimável companheirismo na realização dos meus ideais. AGRADECIMENTOS À minha orientadora, Profª Drª Patrícia Rondó, por sua acolhida despretensiosa, oportunidade concedida, paciência, competência e ensinamentos. Aos membros da banca de avaliação Prof. Dr Claudio Leone e Profª Drª Sandra Vivolo, por todas as contribuições dadas a este trabalho. À Drª Liania Alves, sempre prestativa, disposta a auxiliar a todos do grupo de pesquisa a qualquer momento. Aos professores da Faculdade de Saúde Pública, agentes de transformação pessoal e profissional. Em especial, ao Prof. Carlos Augusto Monteiro que muito acrescentou à minha visão crítica perante o mundo da alimentação. Aos professores de graduação que me introduziram ao universo da pesquisa científica e contribuíram fundamentalmente com minha vida profissional:
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