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INTRODUCTION: Several strategies focused on providing healthcare to premature children have been implemented. Among them, one finds breastfeeding. OBJECTIVE: Investigating the prevalence of, and factors associated with, lack of premature newborn breastfeeding at hospital discharge. METHODS: Cross-sectional study conducted with puerperal women and their preterm newborns in the public health network of Maceió, Brazil. Maternal information was obtained socioeconomic, obstetric, prenatal, and anthropometric data, through questionnaire application, where as information about newborns was collected in their medical records (gestational age at birth, sex, delivery method (vaginal birth or cesarean section), weight, and length at birth, and Apgar scores in the 1st and 5th minute of life), as well as information about the practice of breastfeeding at hospital discharge time. Poisson regression analysis in a hierarchical model was carried out to identify factors associated with the outcome of interest. Results were expressed in Prevalence Ratio (PR) and respective 95% Confidence Intervals (95%CI). RESULTS: 381 dyads were evaluated, 167 (43.8%) of them were not breastfeeding at hospital discharge time. Clinical complications observed in newborns (PR=2.20 95%CI 1.73-2.80), late postpartum contact between mother and child (PR=1.76 95%CI 1.34-2.31), low Apgar in the 1st minute of life (PR=1.44 95%CI 1.15-1.82), and small premature newborn (gestational age at birth <34 weeks) (PR=1.48 95%CI 1.18-1.84) were the factors associated with lack of breastfeeding. CONCLUSION: Lack of premature newborn breastfeeding at hospital discharge time was often observed in the current study and associated with birth-relevant factors.

INTRODUÇÃO: Diversas estratégias têm sido implementadas com enfoque na assistência à saúde da criança prematura, sendo a amamentação umas delas. OBJETIVO: Identificar a prevalência e os fatores associados à ausência de aleitamento materno na alta hospitalar de recém-nascidos prematuros. MÉTODOS: Estudo transversal realizado na rede pública de saúde de Maceió, Brasil com puérperas e seus recém-nascidos pré-termos. Foram obtidas informações maternas sobre dados socioeconômicos, obstétricos, de pré-natal e antropométricos, por meio de questionário, informações dos recém-nascidos via consulta aos prontuários médicos (idade gestacional ao nascer, sexo da criança, via de parto (vaginal ou cesariana), peso e comprimento ao nascimento e índices de Apgar no 1º e 5º minutos de vida) e sobre a prática do aleitamento materno no momento da alta hospitalar. Análise de regressão de Poisson em modelo hierarquizado foi realizada para identificação dos fatores associados ao desfecho de interesse, com os valores expressos em Razão de Prevalência (RP) e respectivos Intervalos de Confiança de 95% (IC95%). RESULTADOS: Foram avaliadas 381 díades, das quais 167 (43,8%) não estavam em aleitamento materno no momento da alta hospitalar. Intercorrências clínicas no recém-nascido (RP=2,20, IC95% 1,73-2,80), contato tardio entre mãe e filho no pós-parto (RP=1,76 IC95% 1,34-2,31), baixo Apgar no 1º minuto (RP=1,44 IC95% 1,15-1,82) e ter idade gestacional ao nascer < 34 semanas (RP=1,48 IC95% 1,18-1,84) foram fatores associados à ausência do aleitamento materno. CONCLUSÃO: A ausência de aleitamento materno na alta hospitalar de recém-nascidos prematuros foi frequente, estando associada a fatores pertinentes ao nascimento.

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N-acetylcysteine (NAC) is a medicine widely used to treat paracetamol overdose and as a mucolytic compound. It has a well-established safety profile, and its toxicity is uncommon and dependent on the route of administration and high dosages. Its remarkable antioxidant and anti-inflammatory capacity is the biochemical basis used to treat several diseases related to oxidative stress and inflammation. The primary role of NAC as an antioxidant stems from its ability to increase the intracellular concentration of glutathione (GSH), which is the most crucial biothiol responsible for cellular redox imbalance. As an anti-inflammatory compound, NAC can reduce levels of tumor necrosis factor-alpha (TNF-α) and interleukins (IL-6 and IL-1ß) by suppressing the activity of nuclear factor kappa B (NF-κB). Despite NAC's relevant therapeutic potential, in several experimental studies, its effectiveness in clinical trials, addressing different pathological conditions, is still limited. Thus, the purpose of this chapter is to provide an overview of the medicinal effects and applications of NAC to human health based on current therapeutic evidence.

RESUMO

This study analyzed the role of ultra-processed foods (UPFs) in the food and nutritional profile of pregnant women's diet. This was a cross-sectional study conducted in a representative sample of pregnant women attending primary healthcare units in Maceió, capital of the State of Alagoas, Brazil. Food consumption was assessed with the application of two 24-hour food recalls on nonconsecutive days, and the consumption items were grouped according to the NOVA classification. Overall estimates were expressed as absolute dietary consumption (mean calorie intake) and relative consumption (percentage of total energy intake according to food groups and consumption items). Analysis of variance was used to compare mean energy and nutrient intake according to food groups. The association between quintiles of the energy share from UPFs (exposure variable) and (1) consumption items and food groups, (2) percentage of total energy from macronutrients, and (3) micronutrient density was analyzed via adjusted linear regression models. Mean energy intake in pregnant women was 1,966.9Kcal/day, 22% of which from UPFs. A direct relationship was observed between the percentage of energy from UPFs and total energy consumption (ß = 228.78Kcal; SE = 21.26). In addition, an increase in the share of UPFs was associated with a statistically significant reduction in the intake of protein, fiber, magnesium, iron, potassium, zinc, selenium, folate, and vitamins D and E, as well as in the consumption of traditional foods such as protein, beans, roots, and tubers. Our data thus indicate that the consumption of UPFs reduces the overall nutritional and food quality of diet in pregnant women.

Este trabalho analisou a contribuição dos alimentos ultraprocessados (AUP) no perfil alimentar e nutricional da dieta de gestantes. Trata-se de um estudo transversal conduzido com uma amostra representativa de gestantes usuárias de unidades básicas de saúde de Maceió, Alagoas, Brasil. O consumo alimentar foi avaliado pela aplicação de dois recordatórios de 24 horas em dias não consecutivos e os itens de consumo agrupados segundo a classificação NOVA. As estimativas gerais foram expressas no consumo alimentar absoluto (média de ingestão calórica) e relativo (percentual da ingestão energética total segundo grupos de alimentos e itens de consumo). Análises de variâncias foram utilizadas para comparar as médias do consumo energético e de nutrientes, segundo grupos alimentares. A associação entre os quintis de contribuição energética dos AUP (variável de exposição) e (1) itens de consumo e grupos alimentares, (2) contribuição percentual para o total de energia de macronutrientes e (3) densidade de micronutrientes foi analisada por meio de modelos ajustados de regressão linear. O consumo médio de energia das gestantes foi de 1.966,9Kcal/dia, sendo 22% proveniente dos AUP. Observou-se relação direta entre a contribuição energética dos AUP na dieta e o consumo energético total (ß = 228,78Kcal; EP = 21,26). Ainda, o aumento da participação de AUP implicou a redução estatisticamente significativa da ingestão de proteínas, fibras, magnésio, ferro, pótassio, zinco, selênio, folato e vitaminas D e E, assim como o consumo de alimentos tradicionais, como arroz, feijão, raízes e tubérculos. Portanto, nossos dados apontam que o consumo de AUP reduz a qualidade global (nutricional e alimentar) da dieta de gestantes.

Este estudio analizó la contribución de los alimentos ultraprocesados (AUP) al perfil alimentario y nutricional de la dieta de gestantes. Se trata de un estudio transversal, realizado con una muestra representativa de gestantes usuarias de unidades básicas de salud de Maceió, Alagoas, Brasil. El consumo alimentario se evaluó mediante la aplicación de dos recordatorios de 24 horas en días no consecutivos y los ítems de consumo agrupados según la clasificación NOVA. Las estimaciones generales fueron expresadas en el consumo alimentario absoluto (media de ingestión calórica) y relativo (porcentaje de la ingestión energética total según grupos de alimentos e ítems de consumo). Se utilizaron análisis de variancias para comparar las medias del consumo energético y de nutrientes, según grupos alimentarios. La asociación entre los quintiles de contribución energética de los AUP (variable de exposición) y (1) ítems de consumo y grupos alimentarios, (2) porcentaje de contribución para el total de energía de macronutrientes y (3) se analizó la densidad de micronutrientes mediante modelos ajustados de regresión lineal. El consumo medio de energía de las gestantes fue 1.966,9Kcal/día, siendo un 22% proveniente de los AUP. Se observó una relación directa entre la contribución energética de los AUP en la dieta y el consumo energético total (ß = 228,78Kcal; EP = 21,26). Asimismo, el aumento de la participación de AUP implicó la reducción estadísticamente significativa de la ingestión de proteínas, fibras, magnesium, hierro, potasio, zinc, selenio, folato y vitaminas D y E, así como en el consumo de alimentos tradicionales como: arroz, frijoles, raíces y tubérculos. Por tanto, nuestros datos apuntan que el consumo de AUP reduce la calidad global (nutricional y alimentaria) de la dieta de gestantes.

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Este trabalho analisou a contribuição dos alimentos ultraprocessados (AUP) no perfil alimentar e nutricional da dieta de gestantes. Trata-se de um estudo transversal conduzido com uma amostra representativa de gestantes usuárias de unidades básicas de saúde de Maceió, Alagoas, Brasil. O consumo alimentar foi avaliado pela aplicação de dois recordatórios de 24 horas em dias não consecutivos e os itens de consumo agrupados segundo a classificação NOVA. As estimativas gerais foram expressas no consumo alimentar absoluto (média de ingestão calórica) e relativo (percentual da ingestão energética total segundo grupos de alimentos e itens de consumo). Análises de variâncias foram utilizadas para comparar as médias do consumo energético e de nutrientes, segundo grupos alimentares. A associação entre os quintis de contribuição energética dos AUP (variável de exposição) e (1) itens de consumo e grupos alimentares, (2) contribuição percentual para o total de energia de macronutrientes e (3) densidade de micronutrientes foi analisada por meio de modelos ajustados de regressão linear. O consumo médio de energia das gestantes foi de 1.966,9Kcal/dia, sendo 22% proveniente dos AUP. Observou-se relação direta entre a contribuição energética dos AUP na dieta e o consumo energético total (β = 228,78Kcal; EP = 21,26). Ainda, o aumento da participação de AUP implicou a redução estatisticamente significativa da ingestão de proteínas, fibras, magnésio, ferro, pótassio, zinco, selênio, folato e vitaminas D e E, assim como o consumo de alimentos tradicionais, como arroz, feijão, raízes e tubérculos. Portanto, nossos dados apontam que o consumo de AUP reduz a qualidade global (nutricional e alimentar) da dieta de gestantes.

Este estudio analizó la contribución de los alimentos ultraprocesados (AUP) al perfil alimentario y nutricional de la dieta de gestantes. Se trata de un estudio transversal, realizado con una muestra representativa de gestantes usuarias de unidades básicas de salud de Maceió, Alagoas, Brasil. El consumo alimentario se evaluó mediante la aplicación de dos recordatorios de 24 horas en días no consecutivos y los ítems de consumo agrupados según la clasificación NOVA. Las estimaciones generales fueron expresadas en el consumo alimentario absoluto (media de ingestión calórica) y relativo (porcentaje de la ingestión energética total según grupos de alimentos e ítems de consumo). Se utilizaron análisis de variancias para comparar las medias del consumo energético y de nutrientes, según grupos alimentarios. La asociación entre los quintiles de contribución energética de los AUP (variable de exposición) y (1) ítems de consumo y grupos alimentarios, (2) porcentaje de contribución para el total de energía de macronutrientes y (3) se analizó la densidad de micronutrientes mediante modelos ajustados de regresión lineal. El consumo medio de energía de las gestantes fue 1.966,9Kcal/día, siendo un 22% proveniente de los AUP. Se observó una relación directa entre la contribución energética de los AUP en la dieta y el consumo energético total (β = 228,78Kcal; EP = 21,26). Asimismo, el aumento de la participación de AUP implicó la reducción estadísticamente significativa de la ingestión de proteínas, fibras, magnesium, hierro, potasio, zinc, selenio, folato y vitaminas D y E, así como en el consumo de alimentos tradicionales como: arroz, frijoles, raíces y tubérculos. Por tanto, nuestros datos apuntan que el consumo de AUP reduce la calidad global (nutricional y alimentaria) de la dieta de gestantes.

This study analyzed the role of ultra-processed foods (UPFs) in the food and nutritional profile of pregnant women's diet. This was a cross-sectional study conducted in a representative sample of pregnant women attending primary healthcare units in Maceió, capital of the State of Alagoas, Brazil. Food consumption was assessed with the application of two 24-hour food recalls on nonconsecutive days, and the consumption items were grouped according to the NOVA classification. Overall estimates were expressed as absolute dietary consumption (mean calorie intake) and relative consumption (percentage of total energy intake according to food groups and consumption items). Analysis of variance was used to compare mean energy and nutrient intake according to food groups. The association between quintiles of the energy share from UPFs (exposure variable) and (1) consumption items and food groups, (2) percentage of total energy from macronutrients, and (3) micronutrient density was analyzed via adjusted linear regression models. Mean energy intake in pregnant women was 1,966.9Kcal/day, 22% of which from UPFs. A direct relationship was observed between the percentage of energy from UPFs and total energy consumption (β = 228.78Kcal; SE = 21.26). In addition, an increase in the share of UPFs was associated with a statistically significant reduction in the intake of protein, fiber, magnesium, iron, potassium, zinc, selenium, folate, and vitamins D and E, as well as in the consumption of traditional foods such as protein, beans, roots, and tubers. Our data thus indicate that the consumption of UPFs reduces the overall nutritional and food quality of diet in pregnant women.

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This article aims to evaluate the associated factors with excessive weight gain in pregnant women from Maceió, the capital of Alagoas, Northeastern Brazil. Cross-sectional study with pregnant women attended in public health in the city of Maceió in 2014, of which socioeconomic, clinical (glycemia, capillary hemoglobin, and blood pressure measurement), dietary, and anthropometric data, including in the latter gestational weight gain, classified as insufficient, adequate and excessive according to the US Institute of Medicine, were collected. The combination of excessive weight gain with the independent variables was tested using the Poisson regression expressed by the Prevalence Ratio (PR) and a 95% confidence interval (CI95%). We studied 403 pregnant women with a mean age of 24.08 ± 6.01 years, with 19.9% of them displayed insufficient weight gain; 14.1% displayed adequate weight gain, and 66.0% displayed excessive weight gain, that was associated with maternal hyperglycemia (PR = 1.35; CI95% = 1.17 to 1.57; p < 0.001). Excessive weight gain is common among pregnant women evaluated with the association of this variable with maternal hyperglycemia.

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Abstract This article aims to evaluate the associated factors with excessive weight gain in pregnant women from Maceió, the capital of Alagoas, Northeastern Brazil. Cross-sectional study with pregnant women attended in public health in the city of Maceió in 2014, of which socioeconomic, clinical (glycemia, capillary hemoglobin, and blood pressure measurement), dietary, and anthropometric data, including in the latter gestational weight gain, classified as insufficient, adequate and excessive according to the US Institute of Medicine, were collected. The combination of excessive weight gain with the independent variables was tested using the Poisson regression expressed by the Prevalence Ratio (PR) and a 95% confidence interval (CI95%). We studied 403 pregnant women with a mean age of 24.08 ± 6.01 years, with 19.9% of them displayed insufficient weight gain; 14.1% displayed adequate weight gain, and 66.0% displayed excessive weight gain, that was associated with maternal hyperglycemia (PR = 1.35; CI95% = 1.17 to 1.57; p < 0.001). Excessive weight gain is common among pregnant women evaluated with the association of this variable with maternal hyperglycemia.

Resumo O objetivo deste artigo é avaliar os fatores associados ao ganho ponderal excessivo em gestantes de Maceió, capital do estado de Alagoas, Nordeste do Brasil. Estudo transversal realizado com gestantes assistidas pela rede pública de saúde do município de Maceió em 2014, das quais foram coletados dados socioeconômicos, clínicos (dosagens de glicemia, hemoglobina capilar e medida de pressão arterial), dietéticos e antropométricos, incluindo neste último o ganho ponderal gestacional, classificado em insuficiente, adequado e excessivo, segundo o Instituto de Medicina dos Estados Unidos. A associação do ganho ponderal excessivo com as variáveis independentes foi testada por meio de regressão de Poisson expressa pela Razão de Prevalência (RP) e respectivos intervalos de confiança a 95% (IC95%). Foram estudadas 403 gestantes com idade média de 24,08 ± 6,01 anos, sendo que em relação ao ganho ponderal 19,9% delas o tiveram insuficiente; 14,1% adequado e 66,0% excessivo, estando este último associado à hiperglicemia materna (RP = 1,35; IC95% = 1,17-1,57; p < 0,001). O ganho ponderal excessivo foi frequente entre as gestantes avaliadas, com associação dessa variável com a hiperglicemia materna.

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A relação entre a Hipertensão Arterial Sistêmica e hipertrigliceridemia (HTG) pode ser explicada por condições multifatoriais, incluindo a dieta e o estado nutricional. Por esta razão, objetivou-se avaliar componentes nutricionais associados à HTG em indivíduos hipertensos. Trata-se de um estudo observacional, longitudinal, com coleta de dados sobre informações socioeconômicas, hábitos de vida, condições de saúde, antropométricas [peso (kg), estatura (m) e circunferência da cintura (CC) (cm)], consumo alimentar, triglicerídeos séricos e atividade física. A amostra foi composta por 200 indivíduos com média de idade de 48,7±7,9 anos, predominantemente do sexo feminino (88,5%), com prevalência de HTG em 49,0% dos casos. Aqueles com HTG apresentaram maior frequência de excesso de peso (51,7%; p<0,05) e de consumo alimentar inadequado da razão -6/-3 (50,3%; p<0,05), no entanto, sem diferença significativa para as demais variáveis avaliadas [CC (p>0,05), aporte calórico (p>0,05), carboidratos totais (p>0,05) e simples (p>0,05), gorduras totais (p>0,05) e colesterol dietético (p>0,05)]. Assim, dentre os fatores nutricionais avaliados, a presença de excesso de peso e do consumo inadequado da razão -6/-3 apresentaram associação positiva com a HTG em hipertensos da atenção básica.

The relationship between systemic arterial hypertension and hypertriglyceridemia (HTG) can be explained by multifactorial conditions, including diet and nutritional status. For this reason, the objective was to evaluate nutritional components associated with HTG in hypertensive individuals. This is an observational, longitudinal study with data collection on socioeconomic information, lifestyle, health conditions, anthropometric data [weight (kg), height (m) and waist circumference (WC) (cm)], food intake, serum triglycerides and physical activity. The sample consisted of 200 individuals with a mean age of 48.7±7.9 years, predominantly female (88.5%), with a prevalence of HT in 49.0% of the cases. Those with HTG presented higher frequency of overweight (51.7%; p <0.05) and inadequate food intake of the -6/-3 ratio (50.3%; p <0.05), however, without significant difference for the other variables evaluated [WC (p> 0.05), caloric intake (p> 0.05), total carbohydrates (p> 0.05) and simple carbohydrates (p> 0.05), and total (p> 0.05) and dietary cholesterol (p> 0.05)]. Thus, among the evaluated nutritional factors, the presence of overweight and inadequate consumption of the -6/-3 ratio were positively associated with the HTG in hypertensive primary care patients.

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OBJECTIVE: To compare redox and inflammatory markers between normal and PE-derived placentas and to evaluate the relationship between placental redox imbalance markers and perinatal outcomes in pregnancies with PE. METHODS: This was a cross-sectional study conducted at the maternity hospital of a university hospital in Maceio-Alagoas, Brazil, in 2017, including women diagnosed with PE and healthy pregnant women and their conceptuses. After screening, standardized questionnaires containing socioeconomic, clinical, obstetric and anthropometric data were applied. After delivery, placental samples were collected for quantification of biomarkers of redox imbalance (catalase - CAT; malondialdehyde - MDA; hydrogen peroxide - H2O2; superoxide dismutase - SOD; reduced glutathione - GSH; oxidized glutathione - GSSG; and their ratio - GSH/GSSG) and inflammation (myeloperoxidase - MPO; interleukin (IL)-6; IL-8; IL-10; and tumor necrosis factor-alpha - TNF-α). All biomarkers were evaluated via linear regression with adjustments of variables with measures of weight, length, head circumference (HC), chest circumference (CC) and gestational age of newborns at birth, considering p < 0.05 as significant. RESULTS: A total of 100 pregnant women with PE and 50 healthy pregnant women were studied. Higher placental levels of catalase (p = 0.018), SOD (p = 0.031), the GSH/GSSG ratio (p = 0.019) and IL-6 (p = 0.010) and lower GSSG (p = 0.001) were observed in pregnant women with PE than in the control group. Positive associations between placental GSH levels and body weight, HC, CC and gestational age at birth (p < 0.05) were identified. CONCLUSION: PE-derived placentas had high concentrations of some antioxidants (enzymes and thiols), which might be a compensation mechanism against oxidative stress. Placental GSH levels were the only biomarker, among the studied ones, related positively with beneficial perinatal outcomes, suggesting that this endogenous antioxidant plays an important role in maintaining the health of the conceptus and women with PE.

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Objetivo: Avaliar a prevalência e os fatores associados à interrupção precoce do aleitamento materno exclusivo (AME) em recém-nascidos prematuros. Métodos: Coorte prospectiva com puérperas no pós-parto prematuro e seus respectivos filhos, assistidos em hospital da rede pública de saúde, em Maceió-AL, nos anos de 2016/2017. Dados clínicos e obstétricos do binômio, além de informações sobre a prática de aleitamento materno do recém-nascido após alta hospitalar, foram obtidos por aplicação de questionário padronizado. O acompanhamento foi realizado mensalmente, por seis meses. A descontinuidade do aleitamento materno exclusivo, em qualquer momento do estudo, caracterizou a interrupção precoce. O teste de regressão de Poisson foi utilizado para avaliação dos fatores associados ao desfecho, com resultados expressos por Razão de prevalência (RP) e respectivos intervalos de confiança a 95% (IC 95%) considerando p< 0,05 como significativo. Resultados: Dos 132 recém-nascidos que receberam alta hospitalar em aleitamento materno exclusivo e que foram acompanhados até os 6 meses de vida, 94 (71,2%) deles interromperam a amamentação exclusiva precocemente. Idade materna ≥35 anos foi caracterizada como fator de proteção para a interrupção precoce do aleitamento materno exclusivo [RP: 0,591 (0,350-0,997); p= 0,049] e a via de parto cesariana, como fator de risco [RP: 1,284 (1,010-1,633); p=0,041]. Conclusão: Foi alta a prevalência de interrupção do aleitamento materno exclusivo antes dos 6 meses de vida em recém-nascidos prematuros. Foram fatores associados ao desfecho, a idade materna avançada, como fator de proteção, e parto cesáreo, como fator de risco para a interrupção precoce do aleitamento materno.

Objective: To evaluate the prevalence and associated factors with early discontinuation of exclusive breastfeeding (EBF) in preterm infants. Methods: Prospective cohort with puerperal women in the premature postpartum and their respective children, assisted at a public health hospital in Maceió-AL, in 2016/2017. Clinical and obstetric data from the binomial, as well as information about the breastfeeding practice of the newborn after hospital discharge, were obtained by applying a standardized questionnaire. Follow-up was performed monthly for six months. Discontinuity of exclusive breastfeeding at any time of the study characterized early discontinuation. Poisson regression test was used to assess outcome-associated factors, with results expressed as Prevalence Ratio (PR) and 95% confidence ratios (95% CI), considering p <0.05 as significant. Results: Of the 132 newborns who were discharged from exclusive breastfeeding and who were followed up to 6 months of age, 94 (71.2%) of premature infants stopped early exclusive breastfeeding. Maternal age ≥35 years was characterized as a protective factor for early discontinuation of exclusive breastfeeding [PR: 0.591 (0.350-0.997); p = 0.049] and cesarean section as a risk factor [PR: 1.284 (1.010-1.633); p = 0.041]. Conclusion: The prevalence of exclusive breastfeeding interruption before 6 months of life in premature newborns was high. Factors associated with the outcome were advanced maternal age as a protective factor and cesarean delivery as a risk factor for early interruption of breastfeeding.