HIV can lead to immunodeficiency, with antiretroviral therapy (ART) being an effective treatment for inhibiting the virus and preserving the immune function of people living with HIV (PLHIV). However, the viral action and adverse effects of pharmacological therapy can cause metabolic and morphological changes, increasing the risk of cardiovascular issues. In this regard, the assessment of body composition using anthropometric indicators is crucial in clinical practice due to its potential association with morbidity and mortality in PLHIV. The aim of this study was to analyze the association between anthropometric indicators and cardiovascular risk in PLHIV. It is an analytical, cross-sectional observational study conducted in two infectious disease outpatient clinics in Alagoas. The study included cisgender adults (≥18 years) of both sexes with a diagnosis of HIV infection receiving outpatient care. Sociodemographic information, personal history, anthropometric measurements (body mass, height, neck circumference, waist and hip circumference, from which 11 anthropometric indicators were calculated), viral load, CD4+ T lymphocytes, ART regimen and duration, time since diagnosis, biochemical data (blood glucose, total cholesterol, and HDL-c), and blood pressure were collected. The Framingham score was used to calculate cardiovascular risk based on variables such as gender, age, smoking, diabetes mellitus, and treatment for systemic arterial hypertension. Multivariable regression analyses were performed using STATA® v. 13.0 (p<0.05). A total of 354 PLHIV participated in the study, with 41.2% females, an average age of 42.7 ± 13.0 years, 23.8% using protease inhibitors (PIs), 71.3% with undetectable viral load, and an average of 566.4 ± 314.5 mm3 CD4+ T lymphocytes, with 79 individuals immunosuppressed and 246 without immunosuppression. Among the participants,70.1% (n=248) had a low cardiovascular risk, 16.7% (n=59) had moderate risk, and 13.3% (n=47) had high risk. Anthropometric indicators showed stronger correlations with cardiovascular risk compared to biochemical variables and blood pressure. HIVpositive men exhibited higher association coefficients than HIV-positive women. Among the anthropometric indicators analyzed by multivariable regression, adjusted for covariates (education, physical activity level, income, ART, and CD4+ T lymphocytes), the conicity index (CI), waist-to-hip ratio (WHR), body shape index (BSI), waist-to-height ratio (WHtR), and body roundness index (BRI) were the ones significantly related to risk, only in men (β*=0.4985; β*=0.4861; β*=0.4645; β*=0.4320; β*=0.4204, respectively, are the standardized betas of the indicators). No indicator showed an association with women. The anthropometric indicators CI and WHR in HIV-positive men, but not in women, are independently associated with cardiovascular risk, regardless of HIV-related clinical factors, and they exhibited stronger associations (based on effect size), with WHR being the indicator with the most potential application in clinical practice.

Inflammatory bowel disease (IBD) has been considered a health problem throughout the world, with an incidence that has continued to grow. The current pharmacological treatment of IBD is non-specific and many patients require surgery, significantly increasing the chances of negative outcomes. In this context, new therapies that act to minimize signs and symptoms and improve quality of life have been the subject of increasingly robust research. In 2015, a systematic review was published by our study group focusing on the possibilities of antioxidant therapy in IBD and due to the low number of human trials, the review was unable to recommend or discourage the use of these alternative treatments. So, 8 years later, we intend to update this review and try to answer the question posed earlier as to whether or not antioxidant therapy works in improving patients with IBD. The search was carried out in databases such as MEDLINE (via PubMed), CENTRAL, Web of Science, EMBASE and Scopus, using a combination of keywords such as Inflammatory bowel diseases; Antioxidants; Antioxidant therapy; Crohn's Disease; Ulcerative Colitis; Biomarkers; Oxidative Stress. After applying inclusion, non-inclusion and exclusion criteria, 331 studies were selected. This current systematic review consisted of 312 animal studies carried out in murine models and 19 human studies (5.7%). The systematic review with meta-analysis in humans generated an article published in the journal Pharmaceuticals, with 8 human studies making up the meta-analysis, with the outcomes evaluated among randomized clinical trials being Superoxide Dismutase (SOD) (n=6), Total Antioxidant Capacity (CATot) (n=6) and lipid peroxidation analyzed through malondialdehyde (MDA) (n=5). In this review we can conclude that the antioxidant action is widely proven in animal models.studies.

Soccer, which is an intermittent exercise, requires athletes to be able to fluctuate in levels of intensity throughout the match, which can change the concentrations of metabolites related to energy production, depending on their demands during matches. A better understanding of the contribution of energy production pathways in this process could help, along with other variables, in the prescription of training sessions aimed at women's soccer, since, although it has been described that men have a greater tendency to oxidize lipids than women, the metabolome of female athletes pre-match and post-match in championships has not yet been described. This dissertation is divided into three sections: the first is a narrative review that discusses some aspects of soccer, women's soccer, metabolomics, energy production pathways and food consumption; the second is a scientific article that aims to identify the main metabolites in the urine of female soccer players present at championship games and the energy production pathways they may be associated with; and the third presents another scientific article that points out the main associations between urinary metabolites and nutrients related to energy metabolism. To this end, pregame and post-game urine samples from national and state championships were collected. A Nuclear Magnetic Resonance metabolomic approach was used. In addition, the athletes' usual dietary intake, which may have an influence on the expression of metabolites, was analyzed using 24-hour recalls and food records. Forty-three metabolites were identified, including pyruvate, lactate, glucose, citrate, succinate, taurine and tyrosine, which may be intermediates in the metabolism of phenylalanine, tryptophan and tyrosine, the metabolism of taurine and hypotaurine and the tricarboxylic acid cycle. Positive and significant associations were observed between metabolites and nutrients related to energy metabolism, such as pyruvate with PTN and KCAL per kilogram of weight, dietary lipids, vitamins B2, B3 and B6, succinate with vitamin B2, KCAL and CHO per kilogram of weight, citrate and CHO per kilogram of weight, KCAL, PTN and CHO per kilogram of weight and malonic acid.

The evaluation of dietary patterns by main components and the Cardiovascular Health Index (CHDI) are important tools for nutritional epidemiology studies regarding Cardiovascular Diseases (CVDs). To analyze the CHDI, the Habitual Food Day (DAH) was used from the two food consumption data in a descriptive analysis in the form of absolute and relative frequency and interquartile range, while in the analysis of dietary patterns, the associations between the three dietary patterns and the independent variables were verified using the crude and adjusted prevalence ratios and the independent variables for which the crude analysis presented a significance level of up to 20% were included in the adjusted analysis. It was observed that CHDI is of intermediate quality, with possible determinants being the low consumption of nuts, fish and seafood in combination with the high consumption of sugary drinks, processed and ultra-processed foods; however, no association was found between CHDI components and markers of oxidative stress. The “fast food” dietary pattern was associated with the consumption of alcoholic beverages; the “traditional” which was associated with a sedentary lifestyle, male sex, low education and income ≤ 1 minimum wage; and “breads, coffee, milk and vegetables” were associated with alcohol consumption, low education and high waist circumference. No dietary pattern was associated with markers of oxidative damage, nor with antioxidant defense enzymes. It is concluded that OS is a phenomenon present in AMI due to pathophysiological mechanisms that are integrated and that nutritional status and lifestyle, especially diet, have a close relationship with redox imbalance. However, associations between these phenomena and conditions were not observed in the studies that make up this dissertation.

The aim of this study was to investigate the degree of association between the dietary total antioxidant capacity (TAC) of pregnant women and maternal-fetal outcomes. Cross-sectional study, carried out between 2013/2014, with pregnant women assisted in the basic health units (BHUs) belonging to the local public health system of Maceió City, Alagoas State. Pregnant women with a single fetus who lived in Maceió and were assisted in the BHUs were included; and those who had physical changes that could distort the anthropometric assessment and/or neurological problems were excluded. Socioeconomic, demographic, clinical, anthropometric and dietary data were collected and maternal-fetal outcomes of interest were collected after birth. To calculate and determine dietary TAC, the following were analyzed: the ferric reducing capacity of plasma (FRAP) and the oxygen radical absorption capacity (ORAC), including ORAC-total and total phenolics (TP). Pearson's χ2 and Fisher's exact χ2 statistical tests were performed to determine differences in maternal and neonatal outcomes in tertiles (T1, T2 and T3) of dietary TAC adjusted for energy using the residual method, adopting a significance of p<0.05. The project was approved by the Ethics and Research Committee of the Federal University of Alagoas under CAAE no. 18807113.3.0000.5013. In the adjusted model, the higher risk of gestational obesity in T1 of FRAP and the higher occurrence of vaginal birth in T2 of FRAP remained significant; the higher risk of gestational overweight, prematurity, fewer full-term births and appropriate for gestational age (AGA) in T1 of TP and higher probability of full-term birth in T2 of TP; higher chance of arterial hypertension, low birth weight (LBW), newborn small for gestational age (SGA), large for gestational age (LGA) and less AGA in T1 of ORAC-total, lower risk of premature birth and more than term at T2 of ORAC-total and higher possibility of low gestational weight at T3 of ORAC-total. The foods that most contributed to the consumption of FRAP in this population were coffee (with and without milk), fruits and fruit juices (guava, orange and apple) and couscous. While the biggest influences on TP consumption were couscous, fruits and fruit juices (guava and apple), chocolate and soups (bean and vegetable). The ORAC-total, in turn, had fruits and fruit juices (mango, guava, apple and orange), cereals (rice and couscous) and soups (beans and vegetables) as the most active foods. Finally, pregnant women in the lowest tertile of dietary TAC had a higher risk of negative maternal-fetal outcomes, unlike those in the highest tertiles. This provides evidence that dietary consumption of total antioxidants can have beneficial effects on maternal-fetal health and be used in clinical practice to prevent such outcomes.

Iron is an essential element for an individual's health and one of the ways to obtain it is through food. Knowing that dietary iron is influenced by factors for its absorption and that only a fraction of this mineral will be effectively absorbable, estimating its availability, adjusting stimulators and inhibitors of iron absorption, can help reduce the prevalence of anemia, especially in more vulnerable groups. . Thus, the objective of this work was to evaluate anemia and its association with age, food insecurity, caloric intake and dietary iron availability in socially vulnerable Brazilian children. This is a cross-sectional study carried out in favelas and urban communities in the Municipality of Maceió, Northeast Brazil, which analyzed 403 children. The study evaluated socioeconomic and health characteristics, such as age, sex, breastfeeding and per capita monthly family income; dietary, to check total caloric intake and quantitative dietary iron; food insecurity (AI), based on the Brazilian Food Insecurity Scale; presence of anemia, according to World Health Organization parameters; and iron availability (DiFe), using the algorithm proposed by Monsen and Balintfy (1982). It was identified that 55.6% of children were anemic and that the average adjusted dietary iron availability was 0.53 mg. Furthermore, it was observed that 80.1% had some degree of FI and 44.9% lived below the poverty line. With regard to dietary assessment, the average total caloric intake was 1149 ± 418 Kcal/day. In the analysis of the association between DiFe and the presence of anemia, it was possible to observe in the bivariate evaluation that the higher the DiFe, the lower the chance of children having anemia (OR: 0.49; 95% CI: 0.27 – 0.88) . In the adjusted assessment for the variables sex, age, breastfeeding, total caloric intake, AI and income, it was also possible to observe that the higher the DiFe, the lower the chance of children having anemia (OR: 0.53; 95% CI: 0 .29 – .98). Therefore, more effective actions need to be rethought in order to reduce these rates, especially among children and more vulnerable populations.

It is known that football is one of the most practiced sports in the world, being a high-intensity practice for male and female athletes. Consequently, the athlete's performance in this modality can be influenced by factors such as: anthropometric composition; metabolic composition (with possible fluctuations in the concentrations of lactate, hormones, amino acids, enzymes, ketone bodies in pre and post training) oxidative stress and energy input arising from the players' dietary pattern. In view of such bodily changes and the exponential popularity of women's football, there was a need for a more in-depth analysis of the dietary pattern of female football athletes in association with metabolomic science, since the physiological and metabolic needs between both sexes are different. Therefore, the objective of this dissertation was to evaluate the metabolomic profile of athletes in the pre- and post-game moments, in addition to the influence of food consumption during sports and its possible effects on the antioxidant metabolic profile of women's football players at the Federal University of Alagoas. The study was characterized as descriptive, cross-sectional, whose sample was composed of 14 players (aged between 19-32 years) who form the União Desportiva Alagoana (UDA) team and were followed during a season that comprised 6 games (competing at the level state and regional). From this, their respective values of body composition, food intake (through 24-hour dietary recall surveys and food records/diaries) and urine collection were assessed. The urine samples were analyzed by nuclear magnetic resonance to verify the metabolites present and whether they were related to antioxidant nutrients (vitamins A, C and E and the minerals magnesium, zinc and selenium) from the athletes' diet in the pre-season and during the games. After analysis, it was found that the athletes had adequate consumption of only 3 of the 6 micronutrients evaluated (vitamin A, C and selenium). 43 metabolites were identified in urine samples, which showed significant separation in the pre- and post-game moments in OPLS-DA graphs and discriminating metabolites related mainly to energy and protein metabolism. Furthermore, Pearson correlations and PLS-DA graph demonstrated significant and positive correlations between antioxidant micronutrients and some of the identified metabolites, with emphasis on malonic acid and pyruvate and the nutrients selenium, zinc and vitamin E. Since the present study is of a descriptive nature, more studies are necessary to evaluate these and other correlations and understand these findings in more detail.

Objective: To analyze the temporal trend of indicators of eating practices in Brazilian children under 24 months, extracted from the food consumption marker records of the Food and Nutrition Surveillance System Web, between the years 2015 to 2022. Methods: Ecological time series study with stratification by macroregion and race/skin color. Reports were extracted from the following indicators: exclusive breastfeeding; continued breastfeeding; minimum dietary diversity; and consumption of ultra-processed foods. The Annual Increment Rate was calculated using Prais-Winsten regression to verify the behavior of the temporal trend. Results: In this period, in Brazil, for the general population there was a decreasing temporal trend for the indicators of exclusive breastfeeding and ultra-processed foods and a stationary trend for the indicator of continued breastfeeding and minimum dietary diversity. With opposite behavior in black + brown race/skin color for exclusive breastfeeding and continued breastfeeding. Conclusion: Brazilian children under 24 months with black and brown race/skin color showed an increasing trend for indicators of exclusive and continued breastfeeding, while children with white race/skin color had a stationary trend.

Aging changes such as decreased visual and hearing acuity, nutritional changes, less physical activity, the emergence of chronic non-communicable diseases and the use of medications may be related to decreased functional capacity in elderly people. Furthermore, 25-hydroxyvitamin D deficiency, considered a public health problem and highly prevalent in elderly people, also appears to contribute to functional disability. It is known that this micronutrient influences the integrity of components of the musculoskeletal system and central nervous system, closely related to functional aspects. However, there are still controversial results when analyzing the relationship between 25-hydroxyvitamin D deficiency and functional disability. Aiming to contribute to the discussion of the problem, this dissertation is structured into three sections, a presentation chapter, a literature review chapter and a chapter composed of an original scientific article. The original article entitled The association between 25-hydroxyvitamin d deficiency and functional disability in the elderly is mediated by muscle mass aimed to evaluate the association between 25-hydroxyvitamin D deficiency and functional disability, taking the circumference of the calf and muscle strength as mediators of the association. This is a cross-sectional study, carried out in the state of Alagoas, which included elderly people of both sexes and community residents, participants in a macro project, with non-probabilistic convenience sampling. All participants who had 25-hydroxyvitamin D tests were included in the study. Functional capacity was assessed using KATZ scale scores that assess independence in carrying out basic activities of daily living. Muscle mass was assessed by calf circumference and muscle strength was assessed by handgrip strength. The sample consisted of 468 individuals, with a mean age of 70.8 ± 8.08 years, the majority of whom were women (69.9%; n=327). 30.1% (n=141) of participants had low strength and 33.8% (n=158) had inadequate calf circumference. Vitamin D deficiency was present in 12.2% (n=57) of the sample and 19% (n=89) had functional disability. Using linear regression, adjusted for sex, age and BMI, 25-hydroxyvitamin D deficiency was associated with the outcome variables: muscle mass, muscle strength and functional capacity. Vitamin D deficiency was a predictor of calf circumference (β=-0.8 [-1.6; -0.02]) and functional disability (β=0.27 [0.08; 0.46], but not muscle strength (β=0.81 [-2.69; 1.07]. Muscle mass, assessed by calf circumference, mediated the effect of vitamin D deficiency on functional capacity (Indirect effect β=0.04 [0.003;0.107]).

Based on the early introduction of complementary feeding, this master's thesis discusses this scenario as a public health problem, in the course of its literature review chapter, and brings a perspective from an original scientific article. The literature review chapter addresses the importance of adequate food introduction in the first years of life, directed to the Brazilian and world context in the consumption of UPF. Also adding the determining factors that favor the early introduction of UPF in childhood and its consequences listed in the literature. In the end, the main public policies aimed at promoting adequate and healthy food, aimed at children, are contemplated. In the scientific article, the introduction of ultra-processed foods in the diet of children in the first year of life of a low-income population is analyzed. The results found indicate that the socioeconomic characteristics and the home food environment in which a child is inserted acted as determinants of the early introduction of UPF. Thus, it is important to emphasize that actions to promote adequate and healthy food should strengthen and encourage the maintenance of an adequate home food environment, to provide healthy child growth and development from conception.

Type 1 Diabetes Mellitus (T1DM) is a subtype of Diabetes Mellitus that has an autoimmune etiology, characterized by the destruction of pancreatic cells via apoptosis induced by autoantibodies, making the individual unable to produce insulin. The disease appears mainly in children or adolescents and there is still no safe or effective method for its prevention. The standard and essential therapy is based on the exogenous replacement of insulin, making it a costly and difficult treatment for most individuals. Furthermore, psychosocial repercussions among patients and their families are common in the first years of the disease due to sudden appearance and economic problems due to the cost of treatment, besides the micro and macrovascular complications caused by the disease. Regarding nutritional treatment, international and national guidelines focus on controlling carbohydrate consumption, with no specific recommendations for micronutrients and other compounds. Aiming to contribute to the debate about adjuvant therapies for the treatment of T1DM, this dissertation presents an article: a systematic review that includes a meta-analysis of randomized clinical trials of oral supplementation of vitamins, minerals, trace elements, non-essential compounds with antioxidant properties, amino acids and fatty acids. This review followed the Cochrane recommendations and was reported in accordance with PRISMA 2020, with searches for reports from the MEDLINE, Embase, CENTRAL, LILACS, The Gray Literature Report and ClinicaTrials.gov databases, in addition to citations of previous reviews, including reports published up to January 2023. The Risk Of Bias 2 (RoB2) tool was used to analyze the risk of bias and GRADE to assess the quality of the results. At the end of the study selection process, 58 (n=3,038) were included in the qualitative analysis and 18 (n=497) in meta-analyses. In the qualitative analysis of the results of the included studies, it was possible to observe only punctual and isolated positive results for specific compounds and functions, not related to glycemic control. After performing seven meta-analyses for the markers HbA1c, fasting C-peptide and required insulin dose, it was possible to observe positive effects for HbA1c with omega-3 (RMD= -0.33; 95%CI: -0.53, - 0.12, p=0.002; I²=0%; GRADE: low quality) and for fasting c-peptide with vitamin D (RMD= 0.05; 95%CI: 0.01, 0.9, p=0.023; I²=0%; GRADE: very low quality). Despite these findings, it is not possible to establish a recommendation on the use of nutritional supplements in DM1, mainly due to the inconsistency of the data and the high risk of bias in the included studies, which consequently revealed a low quality of evidence according to the GRADE evaluation of the meta-analyses carried out by this search. However, this work intends to compile information about the use of nutritional supplements in DM1, in addition to opening gaps for future research with this type of intervention, mainly with the use of vitamin D in controlling the progression of DM1 in the initial phase, since the result of this work consolidates the findings of other reviews and observational studies with vitamin D and its relationship with the disease.

Poverty is a health determinant that favors the installation of the immediate causes of anemia, as well as other forms of malnutrition, contributing to the high burden of nutritional problems found in low- and middle-income countries, especially in vulnerable groups. At the same time, family income influences children's nutritional and mental health. Thus, the aim of this dissertation was to evaluate the influence of family income on the effectiveness of a nutritional supplement formulated and commercially available, containing macronutrients and multiple micronutrients, on the serum levels of hemoglobin in low-income children, aged between one and six years. and residents in a subnormal cluster located in the Brazilian capital Maceió-AL. This is a quasi-experimental, single-arm, before-and-after clinical trial. The intervention consisted of the use of a food supplement, daily for 120 days, associated with vitamin A megadose, therapeutic iron supplementation and treatment against parasites. A standardized questionnaire was applied to collect the variables of interest, the Brazilian Food Insecurity Scale (EBIA), anthropometric assessments in children and mothers, and capillary hemoglobin was measured in children. Pearson's chi-square test was applied to analyze the associations between categorical variables and the McNemar test to assess differences between prevalences. The generalized estimation equation model was used to test the effectiveness of supplementation and the Bonferroni correction to assess the effect of family income and length of follow-up on the outcome. 383 children were evaluated and an initial prevalence of anemia of 40.5% was verified, which in the end was reduced to 15.5%. In the Bonferroni post-hoc correction, it was observed that only children from families with no monthly family income did not show a significant increase in hemoglobin (p <0.09). We conclude that monthly family income influences and, therefore, can modify the expected effect of macro and micronutrient supplementation on serum hemoglobin levels in children under six years of age, indicating that children in extreme poverty may benefit less from nutritional interventions.

Adolescents living with the human immunodeficiency virus (HIV) commonly present nutritional alterations and inadequate levels of aerobic fitness. Aerobic fitness is considered an important health marker, as well as body composition, which can be interpreted by phase angle and bioelectrical impedance vector analysis (BIVA). The aim of this study was to analyze the association between aerobic fitness, phase angle and BIVA in adolescents living with HIV. This is a cross-sectional study, with the participation of 34 adolescents (10 to 18 years old) diagnosed with HIV treated at the Specialized Care Service for HIV/AIDS (SAE) in Hospital Escola Dr. Helvio José de Farias Auto (HEHA). Aerobic fitness was evaluated by the modified Canadian fitness test (mCAFT), phase angle and BIVA by bioelectric impedance (BIA). BIVA was evaluated on the confidence and tolerance ellipses, considering an Italian reference population. Multivariate linear regression analyzes were performed to test the association between oxygen consumption (peak VO2) and phase angle, considering p<0.05. The mean values of peak VO2 and phase angle were 49.3 ± 7.3 ml.kg−1.min−1; 4.7 ± 0.9 degrees, respectively. In the multivariable analysis, model 1 adjusted for physical activity, viral load, screen time, TCD4+ lymphocytes and antiretroviral therapy (ART) regimen explained 31% of the phase angle variation. The BIVA ellipses showed greater dehydration and lower body cell mass in HIV females compared to HIV males (p<0.05) and in the comparison between HIV and the Italian reference population (p<0.05). There were no significant differences between aerobic fitness subgroups (p>0.05). It was concluded that peak VO2 and covariates explain about one third of the changes in phase angle. Still, adolescents living with HIV present changes in hydration and low body cell mass compared to the reference population.

Antiretroviral therapy has reduced morbidity and mortality in individuals living with HIV. However, the treatment has adverse effects that, in addition to the metabolic alterations of the disease and the unhealthy lifestyle, such as inadequate nutrition, rich in saturated/trans fats, refined carbohydrates (CHO), low fiber intake, complex CHO and proteins (PTN), may contribute to lipodystrophy, dyslipidemia, insulin resistance and hypertension. Despite this, the evaluation of predictive diet of cardiovascular risk in adolescents with HIV is scarce in the scientific literature, making it difficult to plan prevention and control actions. The objective of this study is to evaluate cardiovascular risk factors and food consumption, based on a systematic and field review, in adolescents living with HIV assisted in a reference hospital in the state of Alagoas. From the review, it was possible to identify the inadequacy of food consumption due to the low intake of fiber and micronutrients, in addition to the low consumption of fruits and vegetables. Furthermore, the association between inadequate intake of sugar and fat, vegetables and fruits significantly associated with lipodystrophy syndrome; fat intake and plasma lipid levels; lower fiber intake and higher BMI z-score values; positive correlation between cholesterol intake and plasma triglyceride levels. This is a cross-sectional observational study involving 34 adolescents diagnosed with HIV treated at the Hospital Escola Dr. Helvio José de Farias Auto, Maceió/AL. Food consumption was obtained through the Food Frequency Questionnaire (FFQ) and analyzed according to the scoring method. Cardiovascular risk factors included anthropometric variables (body mass index, waist circumference, skinfolds [subscapular, abdominal, calf, and triceps]), systolic and diastolic blood pressure, lipid profile (total cholesterol, triglycerides, high density and low density lipoprotein cholesterol) and glycemic (glucose). A prevalence of dyslipidemia was verified, with 77.7% of the population having low values for HDL-c and, in 50.0%, high values for triglycerides. There was a higher consumption of the protective diet to the detriment of the predictor of cardiovascular risk. Despite this, it was observed that the higher consumption of predictive diet was significantly associated with lower values of systolic blood pressure (p=0.04). It is concluded that the identified dietary pattern, rich in protective foods, may be related to the food culture of the Brazilian population and the Northeastern population based on rice, beans, corn couscous, etc., despite the fact that adolescents with HIV consume high levels of some risk predictor foods, such as added sugar, sweets, fried preparations, among others. This is similar to the eating pattern of healthy adolescents. On the other hand, the association between consumption of a predictive diet and lower values of cardiometabolic risk factors may be linked to the uniqueness of the studied group, the small sample n and the cross-sectional characteristic of the study. Despite this, it is important to include nutritional guidelines for these adolescents.

The objective of this article was to verify the interaction of CYP1A2 163 C>A polymorphism in the consumption of caffeine-containing foods in physically active men. And for this, 71 young people and adults who participated in sports projects linked to the Sports Science Laboratory were evaluated. A questionnaire on caffeine consumption obtained through the chemical composition table was applied. Blood collection of the athletes was performed for DNA extraction, and were later analyzed using the Anova One Way test for statistical analysis. The habits of caffeine consumption can influence the perception of its consumption, and some people may have greater tolerance to the substance and consume higher dosages without realizing it.

Children in poverty are at increased risk for developing specific micronutrient deficiencies such as iron, zinc and vitamin A, since they are exposed to multiple adversities, with limited access to health, education, adequate housing and food. Thus, to tackle childhood anemia in countries with a prevalence of 20% or more, the World Health Organization recommends the direct addition of powdered micronutrients to food. This strategy aims to enhance full child development, prevention and control of vitamin and mineral deficiencies in childhood. The objective of this dissertation was to evaluate the effectiveness of the first sachets of powdered micronutrients produced nationally for the resumption of the supplementation cycles of the Strategy for Fortification of Infant Feeding with Micronutrients (vitamins and minerals) in Powder - NutriSUS in the prevention of anemia in children under six socially vulnerable years enrolled in a Nutritional Recovery Center. For this, we developed a single-blind randomized controlled clinical trial to evaluate effects before and after supplementation. The intervention consisted of using a supplement containing 15 powdered micronutrients, provided by the Ministry of Health, for 19 weeks in an educational environment. Biochemical (complete blood count, CRP and ferritin) and anthropometric assessments were carried out on the children. A socioeconomic questionnaire, the Brazilian Scale of Food Insecurity and the Brazilian Economic Classification were applied to those responsible. The Kaplan-Meier method was used, using the log-rank, Breslow and Tarone-Ware tests to compare the survival curves between the two groups, and the time-dependent Cox regression model to build the regression model multivariate. The study included 80 children under six years old divided into two groups, intervention group (40) and control group (40), living in peripheral neighborhoods, with unhealthy housing situations (77.5% inadequate sanitary sewage) and high food insecurity ( 91.2%). Therefore, no statistically significant differences were found between the groups after supplementation. Thus, we conclude that specific strategies aimed at fighting anemia are not efficient when they act in isolation in populations in situations of great social vulnerability, requiring intersectoral public policies to face poverty and malnutrition.

Carbohydrates (CHO) and fat are primary supplements for energy metabolism in humans during prolonged exercise. The majority of oxidized CHO comes from muscle glycogen, and muscle glycogen breakdown increases with exercise intensity and decreases due to its finite nature. With fasting and when aerobic exercise is performed under these conditions, glycogen levels decrease, increasing the use of fat as energy supplements. This dissertation aims to evaluate whether CHO supplementation can influence the use of energy substrates during prolonged exercise in conditions of hepatic glycogen depletion. The dissertation is divided into two chapters, the first consisting of a literature review that discusses the subject and the second, an original article that aimed to investigate the effect of CHO supplementation on CHO and fat feeding in condition of hepatic glycogen depletion during a long-duration cycling event, in which participants (n=7) were allowed a 12-hour overnight fast associated with arm exercise for hepatic glycogen depletion or served a breakfast without performing of arm exercise, followed by constant-load cycling exercise (105 min at 50% VO2max). CHO (8%) or placebo was consumed at rest and every 15 minutes during constant load exercise. Respiratory exchanges were measured every 15 minutes, as well as RPE and HR. CHO supplementation had an effect on the rate of CHO supply, increasing when CHO was supplemented in both the fed and depleted states (p=0.009) and there was a trend between fed state (p=0.058) and CHO supplementation condition. CHO (p=0.052) had an effect on the rate of fat presentation, monitored over time. RPE was lower in the fed state regardless of CHO or placebo supplementation (p<0.05) and HR increased over time (p<0.05).

The objective of this study is to analyze the levels of Vascular Endothelial Growth Factor (VEGF) in the placenta and umbilical cord and to evaluate their relationship with the presence of maternal and fetal outcomes in pregnancies with PE. Cross-sectional study carried out with pregnant women with and without PE. VEGF levels were obtained from placental and umbilical cord extracts using the enzyme-linked immunosorbent assay (ELISA), which were compared according to maternal and fetal variables. Statistical analyzes were performed using the Statistical Package for Social Sciences (SPSS) version 20.0, adopting an alpha equal to 5%. One hundred pregnant women with PE and fifty without the disease were evaluated, with no statistical difference regarding placental and umbilical cord VEGF levels between these groups (p>0.05). However, there was statistical significance between placental VEGF levels and black race (82.412 pg/mL PE vs 788.183 pg/mL control, p of interaction 0.02) and low apgar at the 5th minute (1806.498 pg/mL vs 57.317 pg/mL, p of interaction 0.01). The ratio between placental/umbilical cord VEGF levels was statistically significant with birth weight (p of interaction 0.04). Placental VEGF levels were related to maternal variables and fetal outcomes, however the ratio between placental/umbilical cord VEGF levels between the groups demonstrated that there is a possible adaptive mechanism between the levels of this marker and the different gestational tissues, in addition to having proved to be sensitive for detecting other outcomes associated with VEGF levels, emphasizing the importance of concomitant analysis between placenta and umbilical cord in pregnancies with PE.

The dynamics of a soccer match make a high physiological demand and it is therefore important that the soccer player develops a high level of physical fitness in line with total control of training loads (external and internal). In this sense, the acute to chronic workload ratio (ACWR) has been used as a tool for controlling workload and the incidence of injury in team sports. Therefore, with the aim of investigating whether the ACWR can be used as a tool for predicting metabolic stress through metabolomic analysis, 40 professional soccer players were monitored for 9 weeks using CATAPULT OPTIMEYE S7 GPS devices (Catapult, OPTIMEYE S7, Melbourne, Australia) during training sessions and matches to determine external loads using the ACWR-coupled and exponentially weighted moving average. Urine samples were collected 24 hours before and 24 hours after matches to determine the metabolic response (internal load) of each player before and after the match. The raw data collected was organized and analyzed using the Open Field Console software and routines programmed in the MatLab environment (MathWorks, version 2018b). The samples were analyzed using nuclear magnetic resonance (NMR-metabolomics) to verify the metabolic content. The data was analyzed using PCA and PLS-DA statistical functions to classify, discriminate and correlate the metabolites and training load, in order to verify the state of metabolic stress pre- and post-match in professional soccer players. The results showed: 1) higher loads in the second mesocycle (4-week period) in the week preceding matches with opponents considered to be of a higher technical level and matches of a decisive nature in the metrics of total distance covered (4391m) , player load (456 a.u. ) and distance at high intensity (242m); 2) ACWR was unable to discriminate the players' metabolomic profile when using the ACWR classes LOW (<0.8), SWEETSPOT (0.8 - 1.3) and HIGH (.1.3) at pre and post-match for all players and matches and; 3) when the players were separated into groups G1, G2 and G3, ACWR at pre and post-match showed little sensitivity in separating the groups, especially in the LOW and HIGH groups. It was concluded that the ACWR was only able to discriminate the metabolomic profile of soccer players when separated by match and work groups (G1, G2 and G3).

The use of the physical activity to obtain a negative energy balance is based on the linear model (additive or factorial) of the total energy expenditure (TEE), that is, from its practice, as the physical activity level (PAL) increases, the TEE it also increases. However, there are critics of this model and a second proposal to describe this relationship has emerged more recently, known as the non-linear (constrained) model. In this second model, the body adapts to higher levels of physical activity to keep the TEE within a narrow homeostatic range. Thus, based on the main article, this dissertation has as its objective to assess whether the relationship between TEE and PAL of low-income women living in an impoverished urban area behaves linearly or not. This is a cross-sectional study, which included adult women aged between 19 and 45 years, with body mass index (BMI) ≥ 18.5 kg/m2, mothers or caregivers of children with short stature attended at the Centro de Recovery and Nutrition Education (CREN). Anthropometric, hormonal (insulin and thyroid axis hormones), TEE (by double-labeled water), body composition (by deuterium) and PAL (metabolic equivalent of task (MET) by triaxial accelerometer) data were collected. Adjusted-TEE models were calculated incorporating the residuals of these variables mentioned. And the evaluation of the relationship between MET and adjusted-TEE was done through three different analyses: linear regression, non-linear regression and point-of-change regression, to identify the plateau of this relationship. Fifty-five women were included with a mean age of 31 ± 5 years, and BMI of 27.47 ± 4.59 kg/m2. It was possible to observe a positive and linear relationship between the adjusted-TEE and the MET (β = 16.10 kcal; 95% CI: 2.59; 29.60; adjusted R² = 0.08). The change point was identified at the MET value of 256.50 (SD = 4.46; adjusted R2 = 0.13). The association between the adjusted-TEE and the MET before the change point was stronger (β = 30.36 kcal; 95% CI: 5.82; 54.90; adjusted R2 = 0.11) than the association in the linear model, and this association stop existing when it was evaluated in individuals after the change point (β = -39.34 kcal; 95% CI: -99.84; 21.15; adjusted R2 = 0.08). Thus, we conclude that the non-linear model seems to be more adequate to describe the TEE of low-income women living in an impoverished urban area than the linear model, since this linear and additive relationship seems to be true only up to a certain amount of physical activity. However, we also emphasize that the practice of physical activity should clearly be recommended for all individuals, since it is superior to physical inactivity for several reasons.

Iron deficiency anemia (IDA) is among the most common micronutrient deficiencies in women of childbearing age and may affect children development. Brazil has several national programs to tackle this condition, such as food fortification and supplementation for pregnant women, but IDA prevalence in this population have not been systematically reviewed. We sought to determine the prevalence of IDA in Brazilian women of childbearing age through a systematic review. MEDLINE, Web of Science, Scopus, Lilacs, SciELO and gray literature databases were searched, looking for studies that had assessed the prevalence of IDA in women of childbearing age (10- 49 years). Meta-analyses were carried out with prevalence data. The overall IDA prevalence was 25% (95%CI: [23; 28], 83 studies), being higher in the North and Northeast regions (30%; 95%CI: [24; 37]; 7 studies, and 30%; 95%CI: [26; 34]; 27 studies, respectively). Indigenous population showed the highest pooled prevalence (53%; 95%CI: [27; 78], 4 studies). Studies that had their collections after 2015 showed a higher prevalence of IDA (28%; 95%CI: [23; 34], 9 studies). IDA in women of childbearing age remains a public health problem in Brazil. The national programs should be strengthened and more thoroughly supervised to decrease this condition nationally.

Excess weight is configured as a serious global public health problem, with a continuous increase in its prevalence. It is also known that the obesity epidemic is proven by a trend in the reduction of sleep duration, being demonstrated in international and national studies that sleep deprivation is a risk factor for weight gain in long-term studies in adults and children. . Thus, the dissertation has the problem of interest in the relationship between sleep and mass index in the first year of life and is based on the physiological aspects of sleep weight, sleep, sleep, mechanistic relationships between sleep and overweight in childhood and in documents and actions compacted within the scope of public health that focus on sleep quality. No articles occurred during the mean sleep duration, night months and date with the mean BMI at 6 and 12 and its duration in the period of 6 months. In the linear birth and multivariate variables of univariate and multivariate birth of BMI, a negative identification of sleep duration for maternal variables was identified. On the grounds of a body of mental and quality evidence of increased genesis of obesity. However, there are still few actions in the country that consider the sleep component in comprehensive child care.

Food and Nutrition Insecurity (INSAN) is a relevant public health problem in Brazil and is associated with low socioeconomic and health conditions. INSAN is heterogeneously distributed among population subgroups, afflicting more widely the most socially vulnerable families, such as those belonging to quilombola communities. The characterization of INSAN in this population is important to assist in the evaluation and implementation of strategies aimed at reducing the problem and its consequences. To address this theme, the present dissertation was carried out, which consists of two chapters, one of which is a literature review and an original article. The literature review included the conceptual approach of INSAN, its indicators and its distribution in different scenarios in Brazil, particularly in quilombola communities. The original article aimed to identify the prevalence and factors associated with INSAN in quilombo remnant communities (CRQs) in the state of Alagoas. This is a cross-sectional study, involving all resident families in a random sample of 34 of the 68 CRQs in Alagoas. Data collection was carried out through home visits. The dependent variable was INSAN, defined by the Brazilian Food Insecurity Scale (EBIA). The independent variables (socioeconomic, demographic and environmental) were analyzed for their association with the dependent variable through multivariate analysis following a hierarchical theoretical model. For this, Poisson regression with robust variance adjustment was used. The sample consisted of 2,485 families, of which 67.6% were in a situation of INSAN (32.9% mild, 20.1% moderate and 14.7% severe). The variables that remained independently associated with INSAN (moderate + severe) in the final model of the hierarchical analysis were: households with ≤4 rooms (PR=1.25; 95%CI: 1.12-1.40), garbage disposal different from public collection (PR=1.33; 95%CI: 1.16-1.52), use inadequate water for consumption (PR=1.29; 95%CI: 1.14-1.27), households with > 4 residents (PR=1.42; 95%CI: 1.27-1.60), with residents <18 years (PR=1.45; 95%CI: 1.26-1.67), illiterate head of household (PR=1.88; 95%CI: 1.46-2.43), belonging to the economic class D-E (PR=1.71; 95%CI:1.19-2.48) and being a user of the Bolsa Família Program (PR=1.71;95%CI:1.51-1.93). The prevalence of INSAN among quilombola families in Alagoas is high and is significantly associated with environmental, socioeconomic and demographic factors, which reinforces the need to prioritize intersectoral public policies that consider the inherent characteristics of this population.

Ultra-processed foods are ready-to-eat industrial formulations made from laboratory-synthesized substances derived from foods and other organic sources such as oil and coal. They are products with low nutritional quality and have high amounts of salt, fat, sugar, and food additives One of the main factors discussed in the current literature as a potential contributor to the increase in the consumption of AUP is the environmental factor. The food environment is a concept that encompasses the physical space (type, location, institutional insertion and accessibility to the food point of sale), access (price, availability and position on the shelves) and the characteristics of the food sold (nutritional quality, palatability and labeling), which in turn will influence the formation and/or maintenance of eating habits and, consequently, the health conditions of the population in this environment. The environment may or may not promote access to healthy food choices, influencing the quality of food. Thus, this study aims to evaluate the concentration of ultra-processed foods in the city of Rio Largo - AL. This is a cross-sectional study, belonging to a broader project entitled “Health, Food, Nutrition and Child Development – SAND: a cohort study”, aimed at establishing a cohort that followed children from the city of Rio Largo/AL. Data collection was carried out from 2017 to 2018. Food stores were identified by street audit, using the instrument Nutrition Environment Measurement Survey for Stores (NEMS-S) in its adapted and validated version for the Brazilian population. Descriptive analyzes were performed to assess the absolute and relative availability of the 21 ultra-processed foods present in our list, according to the types of commerce. Such statistical analyzes were performed using the Stata 13 software. Thematic maps were also drawn up in order to identify the distribution of establishments and density of commercial establishments in the municipality of Rio Largo, in addition to the clusters where the agglomerations occur. Spatial analysis was performed using QGIS software version 3.20.3 (Open Source Geospatial Foundation). A total of 574 commercial establishments in the municipality of Rio Largo were evaluated. About 32% of the establishments were of the grocery/emporium type, followed by the candy retail and wholesale trade (20.4%) and the open market/fruit stand (13.6%). Most of the points of sale had a closed environment (85.5%), were fixed points (95.85) and were mostly frequented by adults (68.5%). Regarding the classification of commercial establishments, it is possible to observe in the municipality of Rio Largo a low frequency of healthy stores and a high frequency of stores classified as ultra-processed.

Introduction: food choices and behavior emerge from the interaction of many factors, including the food environment. This is a scenario where food choices are provided and made effective, influencing the health and nutrition conditions of the population residing in a given region. Evidence shows that the greater the access to Food Points of Sale (PVA) and the less distance between them in relation to institutions, the greater the possibility of acquiring the food offered. It is currently observed the installation of obesogenic environments, characterized by a high availability of ultra-processed foods. In addition to being more prevalent, PVA with greater availability of these foods tend to be located around schools. Assessing their presence around of these institutions is essential as they are a source of food exposure for children, as food habits in this age group are under construction; and because food is an important protective factor against diseases when it is composed of healthy foods. Objective: to characterize the food environment around municipal early childhood education centers (CMEI) in the city of Rio Largo. Methods: this is an ecological study whose identification of PVA was carried out through an audit in the entire municipality. The geographic coordinates of the PVAs were obtained through the “Google Maps” application installed on smartphones. To assess the food environment, the adapted version of the Nutrition Environment Measurement Survey for Stores - NEMS-S instrument was used. The food and nutritional quality of each PVA were evaluated using the healthy food availability index. The CMEI positioning and geographic coordinates were obtained using the Google Earth Pro application. Coordinate units were extracted in universal transverse mercator (UTM). Areas of influence (buffers) with a radius of 400 meters were defined around the CMEI, and buffers with a radius of 800 meters were additionally built, in order to verify if there is a difference in the arrangement of the PVA between the areas of influence used.The geoprocessing of the information was carried out in the QGIS 2.18.2 software. The spatial distribution, proximity and density of global PVA in the buffers were analyzed according to the classification of trades in relation to the types of foods predominantly traded. Results: of the 575 PVA identified in Rio Largo, 332 (57.7%) and 505 (87.8%) were, respectively, within the CMEI's zone of influence of 400 and 800 meters. Unhealthy PVAs represented around 60% of the total number of available establishments. There was no difference in the arrangement of the PVAs between the zones of influence used. Healthy PVAs were concentrated only in the central region of the city, but unhealthy PVAs were concentrated in different parts of the city. Conclusion: there was a concentration of points of sale of unhealthy foods around the municipal schools of Rio Largo, suggesting environments with high availability of ultra-processed foods, thus not favoring healthy eating behavior by children.

This study aimed to characterize the technical-professional profile of the municipal management of the National Food and Nutrition Policy in the State of Alagoas and its involvement in actions to combat obesity. This is a descriptive cross-sectional study, in which data collection took place between December 2020 and September 2021, through a semi-structured and self-administered electronic form with questions about technical-functional aspects. The profile of the respondents (n=58) was, regardless of the population size of the municipality, of managers (91.4%), who declared themselves to be black (65.5%) and with higher education in Nutrition (84.5%). The predominant employment relationship was temporary (60.3%). Less than 50% of the municipalities had multidisciplinary teams, where the most frequent professional were nutritionists (32.4%). It was also observed that most of the goals related to food and nutrition were not included in the management plans and many managers claimed to be unaware of these instruments. The predominance of fragile bonds and short time in charge are factors that can compromise the implementation and sustainability of obesity prevention actions, and the care of the person with obesity, in addition to reflecting on the absence of these guidelines in the health agendas of municipalities.

Excess weight in childhood is related to several factors, mainly to an environment that promotes excessive and early intake of ultra-processed foods. The objective of this study was to identify whether there is an association between foods considered not recommended to be introduced in the first year of life and excess weight in children who live in a situation of social vulnerability. This cross-sectional study evaluated the current nutritional status and the introduction of 14 different foods in the first year of life of children aged between 12 and 59 months. A total of 561 children living in subnormal agglomerations of Maceió-Alagoas were studied. It was possible to identify that 89.8% of the children had consumed at least one of the foods evaluated in the first year of life, the most frequent being petit suisse cheese (72.4%), sweet/salty biscuits (64.7%), and sugar (64.0%). Excess weight was found in 19.1% of the children, and 8.0% already had obesity. In the multivariable analysis, adjusted for the child's age, breastfeeding, mother's race, being a beneficiary of the Bolsa Família program, and per capita income, an association was identified between the early introduction of soft drinks (PR = 1.34, 95%CI: 1.02; 1 .76), packaged snacks (RP = 1.25, 95%CI: 1.01; 1.56) and powdered soft drink (RP = 0.54, 95%CI: 0.38; 0.77) with the excess weight of children. From the results found, there is a need to intensify public health policies in the fight against childhood obesity, focusing on the promotion of adequate and healthy food, especially during the food introduction phase, focusing on the population of social vulnerability.

Objective: To evaluate the association between the double burden of malnutrition (DBM) and complementary feeding in children aged 6–24 months assisted by the Brazilian conditional cash transfer program, Bolsa Família (BFP). Design: Cross-sectional study. Food consumption was determined using a questionnaire to assess the eating habits of children under 2 years of age and classified according to the NOVA classification. DBM was defined as the coexistence of undernutrition (stunting or anaemia) and overweight at the individual level using anthropometric measures and haemoglobin level. A logistic regression model was used. Location: Six municipalities from the State of Alagoas, Northeast Brazil. Participants: Children aged 6–24 months assisted by the BFP. Results: The study evaluated 1587 children: 9.7% were stunted, 10.2% were overweight, 58.3% had anaemia, and 6.7% had DBM. An increased chance of DBM was associated with the greater consumption of ultra-processed foods (OR, 3.58; 95% CI, 1.61–9.81), dairy products (OR, 1.69; 95% CI, 1.01–2.81), and bottle feeding (OR, 1.61; 95%, 1.03–2.53). DBM was inversely related with breastfeeding at any time of life (OR, 0.44; 95% CI, 0.24–0.79) and breastfeeding until 2 years of age (OR, 0.10; 95% CI, 0.12–0.82). Conclusion: This study provides evidence that underscores the importance of breastfeeding and adequate and healthy complementary feeding, without the consumption of ultra-processed foods, for protection against DBM in children under 2 years old assisted by a conditional cash transfer program.

Iron is an essential nutrient for human health, as it participates in several metabolic processes. A deficiency of this mineral, if left untreated, can progress to iron deficiency anemia. Among the population groups most susceptible to developing this mineral deficiency are women of reproductive age, due to the increased need for iron, resulting from blood loss during the menstrual period. Several factors can contribute to its deficiency, such as the availability of iron (DiFe) in the diet, the presence of factors that inhibit its absorption, and the quality of the diet consumed. Thus, realizing the importance of adequate consumption of iron, and identifying the factors that can interfere with its availability, the objective of this study is to determine whether there is an association between the concentration of hemoglobin and DiFe in the diet of adult women of reproductive age, residing in in subnormal agglomerates in the city of Maceió - AL. The present dissertation was divided into two parts: the first is the literature review chapter, which seeks to clarify how dietary iron needs in different life cycles, as well as the methods available to assess its availability and the factors that may interfere in this variable. The second part is a results article in which the association between hemoglobin concentration and food insecurity (FI), caloric consumption and DiFe is described. The study was cross-sectional and partially ecological, combining exposure data at the aggregate level (environmental variables) and outcome data (availability of dietary iron and nutritional status) and covariates at the individual level. Sociodemographic, anthropometric, clinical and lifestyle, dietary, DiFe assessment and AI data were evaluated. The results obtained showed no association between hemoglobin concentration and iron availability. On the other hand, the extremely low values of DiFe draw attention, as does the high prevalence of anemia perceived through the frequency of hemoglobin concentration. Factors such as lower per capita income and presence of severe AI acted as predictors of low hemoglobin concentration. The extremes of nutritional status also influenced hemoglobin concentration, as well as caloric consumption.

These are integrative literature reviews divided into two articles that aim to analyze in vitro, preclinical and clinical studies on the use of propolis in the wound healing process and in Diabetes Mellitus and its complications. Data were selected by searching the following scientific databases: Web of Science, Pubmed Central, Scielo and Google Scholar. The search was carried out with advanced search filters, in English, using “Propolis” as the main term, associated through the Boolean operator “AND” to the following terms: a) “healing”; b) “healing”; and “Propolis”, associated through the Boolean operator “AND” to the following term: “diabetes”. In the first article, 146 studies were identified, constituting the sample with 40 studies that met the inclusion criteria of this research. Of the 40 (100%) studies analyzed, 13 (32.5%) were in vitro studies and 27 (67.5%) were preclinical and clinical studies in animals and humans. With this, 02 chapters were produced. In the second article, 280 studies were identified, constituting the sample with 30 studies. Of the 30 (100%) studies analyzed, 22 (73.3%) were in vivo and in vitro preclinical studies and 8 (26.7%) clinical studies. The in vitro, preclinical and clinical studies analyzed highlight the antimicrobial and antioxidant properties of propolis, which can help in the healing process of wounds, including diabetic wounds. In addition to causing the migration and proliferation of fibroblasts in the wound area, contributing to wound healing. In vivo studies still show evidence of its anti-inflammatory and autolytic properties. The studies in the second article bring together in vitro analyzes and in vivo animal models that show that the administration of propolis demonstrated a reduction in blood glucose levels and restoration of insulinemia with a consequent protective effect on pancreatic beta cells, high antioxidant activity, reduction of liver damage and kidneys, and improvement of the lipid profile. Clinical studies provide evidence of the effects of propolis on glucose metabolism, mainly on glycemic control, as well as improvement of the lipid profile and oxidative stress, through the hypolipidemic and antioxidant action of propolis. It can be concluded that both in vitro and in vivo studies related to the use of propolis as an alternative therapy in the healing of wounds of different etiologies, including diabetic wounds that are difficult to treat, showed positive results. Just as it is possible to conclude that propolis is a therapeutic alternative from a natural source that plays an important role in the management of diabetes and its complications.

Observing the metabolic impacts arising from a football match is of great
interest to the scientific community. Such changes are due to the movements made
during the game, in which they can occur in different magnitudes. This magnitude can
be observed, through an evaluation of the metabolites present in the urine, by the
metabolomics, as well as through perceptual responses such as the rating of perceived
exertion (RPE). Thus, aiming to contribute to the use of these methods in sports, this
study presents a review chapter, addressing the general overview of metabolomics and
its application in exercise, in addition to the use of RPE to observe perceptual responses

after physical exercise. Besides, the present dissertation also presents an experimental
article using the metabolomics technique combined with RPE, in which has the aim is to
evaluate the metabolic impact of two football matches through metabolomics and RPE
tools in young athletes of a first division soccer team of the Brazilian championship.

Physical exercise has a direct impact on thermogenesis and the inflammatory response of the immune system. As a result, the body will promote an increase in metabolic heat and dehydration and changes in blood cell counts may occur. At the same time, pain is a factor that can negatively affect performance. Acetaminophen (ACT) has been shown to have an antipyretic and analgesic effect and, although its mechanisms of action are not fully understood, it is a viable resource to try to reduce these conditions that restrict performance. However, the indiscriminate use of this drug can lead to hepatotoxicity. Therefore, understanding these physiological and hematological processes is essential to understand their influence on sports performance. Thus, this study aims to review studies that investigated the antipyretic effect of ACT and its relationship with hydration, the analgesic effect of ACT and its relationship with pain and sports performance, in addition to discussing the effect of hepatotoxicity on ACT and its influence on blood cells. Subsequently, the original article will be exposed, which aims to assess the acute effect of ACT on hydration status, thermal and painful sensations and blood cell count after exercise in thermoneutral conditions.

Inflammatory bowel disease (IBD) is a chronic inflammatory manifestation characterized by episodes of attenuation and sharpness of symptoms. It comprises Crohn's disease (CD) and idiopathic ulcerative colitis (UC). It has a multifactorial character, with contribution of environmental factors, intestinal microbiota, individual genetic susceptibility, immunological and psychological factors, with emphasis on the role of inflammation and oxidative stress in its emergence. Drug treatment, which is used for a prolonged time by patients, may occur with the appearance of adverse effects, dependence and/or refractoriness to the disease. Studies have pointed out that compounds with antioxidant effect can be considered a complementary alternative treatment for IBD. In this context, Curcuma longa stands out, a perennial shrub whose rhizome is composed, among other substances, by polyphenols called curcuminoids, being curcumin, the one with the highest biological activity. This liposoluble polyphenol has antioxidant action and interact with various gene transcription factors, enzymes, inflammatory cytokines, proteins, growth factors and receptors, and additionally, does not present toxicity, even in high doses, as indicated by studies in animal models and in humans. Aiming to contribute to the analysis of the efficacy of oral use of Curcuma longa and its curcuminoids in IBD, this dissertation presents initially a literature review, which describes the characteristics of IBD, conventional treatment and implications of prolonged use, complementary alternative treatment, characterization of antioxidant and ani-inflammatory activity of Curcuma longa compounds and mechanisms of action in IBD. The main article is a systematic review with meta-analysis, whose objective was to identify the effects of Curcuma longa, curcumin or other curcuminoids on metabolic symptoms and alterations in patients and animal models of IBD. For this review, a search was carried out in the databases PubMed, Science Direct, LILACS, CENTRAL e Clinical Trials until January 2021. The following keywords were used:" inflammatory bowel disease", “ulcerative colitis", "colitis", "Crohn Disease", "curcumin”, "curcuma", "turmeric" e "Indian saffron". Articles with experimental models of colitis and randomized clinical trials (RCTs) were eligible. The primary outcome was clinical remission and secondary endoscopic remission. Of the 997 records found, 62 articles were included, 54 with animal models and 8 RCTss, of which 5 were included in the meta-analysis. 50 studies (92.59%) in animals, they observed improvement in macroscopic, histological and/or functional activity and 81.48% (n = 44) identified a decrease in oxidative and/or inflammatory biomarkers in animals treated with curcumin. Among the RCTs, the analysis of intent to treat showed that oral curcumin, associated with traditional

pharmacological treatment, was effective in inducing clinical remission (n=281, RR: 3,15 CI 95% [1,22 - 8,10] p = 0,0017; i² = 72,2%, p = 0,006) and clinical response (n=259, RR: 1,60 CI 95% [1,09 - 2,35] p = 0,0017; i² = 59,7%, p = 0,042); but not in endoscopic remission (n= 161, RR: 2,91 CI 95% [0,58 – 14,58] p = 0,195; i² = 72,7%, p = 0,026). The results found confirm that the oral prescription of Curcuma longa or curcumin, when associated with drug therapy, is effective in the treatment of patients with IBD.

Propolis is a resinous substance of complex composition, formed by gummy and balsamic material, collected by bees (Apis mellifera) from different types of trees. Propolis has been the object of pharmacological studies due to its antibacterial, antifungal, antiviral, antiinflammatory, hepatoprotective, antioxidant, antitumor and immunomodulatory properties. Microencapsulation allows preventing the loss of substances by oxidation or volatilization, in addition to controlling the release of aromas, loss of nutrients and preserving the color and flavor of the encapsulated agent. In this work, the composition, chemical and biological properties and microencapsulation using Spray Dryer of greenish-brown propolis from União dos Palmares-Alagoas were studied for the first time. The objective of this work was to prepare and characterize microcapsules with greenish-brown propolis extract and evaluate the multiple constituents present, these analyzed by analytical methods such as UV-vis, UFLC-DAD-UV, GCMS, FTIR, SEM, Thermal Analysis , content of flavonoids and total phenols, antioxidant activity and antibacterial activity. The greenish-brown propolis extract and the microcapsules containing greenish-brown propolis extract from Alagoas presented a total flavonoid content of 5.15% and 1.13%, total phenols of 14.16 and 4.81% in in terms of gallic acid, total phenols of 16.53% and 6.00% in terms of catechin, antioxidant activity with IC50 values of 13.77 µg/mL and 60.80 µg/mL, respectively. Ultra-Efficiency Liquid Chromatography (UFLC-DAD-UV-Vis) identified the presence of chlorogenic acid, caffeic acid, ferulic acid, p-coumaric acid, naringenin, luteolin and kaempferol. The SEM and FTIR data showed encapsulation of phenolic compounds from the greenish-brown propolis from Alagoas and the thermal analysis showed the thermostability of the studied extracts. The dichloromethane fractions enriched with flavonoids from the crude extract and microcapsules demonstrated antibacterial activity against Staphylococcus aureus (ATCC 33591) and Providencia rettgeri (ATCC 29944). The data from this work demonstrate the potentials and biological properties of the greenish-brown propolis from Alagoas, as well as its spray-dryer solid products. 

The study aimed to evaluate, through the MEE, the influence of commensality on the dietary pattern of Brazilian teenagers based on third edition data from National School Health Survey (Pesquisa Nacional de Saúde do Escolar - PeNSE), carried out in 2015. PeNSE is a survey cross-sectional study of a complex probabilistic sampling plan with representation for adolescents from public and private schools in Brazil. A theoretical model was developed, based on recommendations in the Food Guide for the Brazilian Population, using structural equation modeling (stratified by sex) to investigate the relationship between sociodemographic characteristics, hygiene and body satisfaction and commensality, and their influence on teenagers’ eating pattern. For males, age interferes in a significant and inversely proportional way, in the practice of commensality (CP: -0.28, p: 0.00). Regarding females, body dissatisfaction was negatively associated with commensality, with greater effect when compared to males (CP: -0.30, p: 0.00). Commensality had a positive influence on the healthy eating pattern for males (CP: 0.42, p: 0.00) and females (CP: 0.62, p: 0.00). In conclusion, the results show that commensality influences the pattern of adolescents, behaving differently between genders. These divergent results suggest the need for gender-specific interventions. Due to the importance of the theme addressed, further investigations into the protective role of commensality on adolescents' eating patterns are necessary.

Cardiovascular diseases (CVD) are among the main causes of morbidity and mortality
in the world. An estimated 17.7 million people died from cardiovascular complications
in 2015, accounting for 31% of deaths from all causes. Considering middle and low-
income countries, the rates gain even greater proportions, such as Brazil, where more
than 200,000 deaths, registered only in 2015, were caused by diseases related to the
circulatory system. Furthermore, a higher prevalence of cardiovascular risk factors has
been reported in developing countries where systemic arterial hypertension (SAH), for
example, affects about a third of adult individuals and more than half of the total
number of elderly people, contributing directly or indirectly for about half of CVD
deaths. According to the World Health Organization (WHO), a small set of risk
predictors corresponds to a large portion of deaths from cardiovascular complications
and a considerable fraction of comorbidities attributed to these diseases. That said, this
work, structured in two parts: a literature review and an original article, aims to
investigate the temporal trend of the prevalence of cardiovascular risk factors and
associated complications in adult hypertensive individuals from Maceió, Alagoas, with
data from two surveys carried out within the scope of the Research Program for the
SUS, between 2007 and 2016. The sample of this study consisted of 246 adult
hypertensive individuals of both sexes, who had evaluated the risk factors: smoking,
sedentary lifestyle, family history (FH), short stature, overweight/obesity (OW/OB),

obesity, waist/height ratio (WHR), conicity index (CI) and abdominal obesity (AO), and
associated complications: kidney disease (KD), acute myocardial infarction, other
coronary heart diseases and stroke (stroke). Poisson regression was used, with robust
adjustment of variance in the crude and multivariate analysis, to analyze the prevalence
ratio of the studied variables. In this study, WHR, AO, CI, OW/OB and FH had the
highest prevalences: 93%, 87.9%, 87.5%, 77.2% and 55.7% respectively and, after
adjustment for sex and age, OW/OB (RP=1.22; 95%CI: 1.02-1.45) and KD (RP=9.16;
95%CI: 1.25-66.96) presented a positive and significant percentage evolution. Thus, the
high prevalence and increases in its variations reveal an important risk condition among
hypertensive individuals, locating overweight/obesity, the CVRF that has been
increasing, as well as the outcome of kidney disease resulting from poor control of
SAH. These results can guide decision-making and the development, implementation
and monitoring of more assertive public policies in dealing with cardiovascular risk
factors.

Based on the influence of social vulnerability on health and nutrition status and the response caused by the political and economic structure in this condition, this dissertation discusses this scenario as a public health problem of multifactorial etiology that affects especially people in vulnerable situations. The literature review chapter addresses the impacts of malnutrition on child growth and development, pointing to its determinants, emphasizing the underlying determinants, considering these as the main factors listed in the literature and accounting for two-thirds of the Brazilian progress in addressing this problem. In this context, it is important to highlight the approximation of the State to the public in vulnerable situations through conditional cash transfer programs, highlighting the Bolsa Família Program (BFP), since besides providing an income supplement, its conditionalities allow a more accurate surveillance and consequently a better assistance to this public in overcoming their problems. Finally, the review chapter demonstrates how the Brazilian State's choice for austerity policies puts these advances at risk. The scientific article analyzed the temporal trend of malnutrition in children under 5 years old assisted by the BFP, exploring regional inequalities from the grouping of the federative units according to the Social Vulnerability Index. In addition, we sought to determine the impact of the economic and political crises and of government adherence to fiscal austerity policies on this trend. The results found point to a reduction in this prevalence until the year 2013, followed by stabilization by the end of the period for preschoolers and an upward trend for infants, pointing to the need for constant monitoring of this condition and the reevaluation of the fiscal austerity policies adopted by the federal government, in addition to the deconstruction of economic and social structures that still produce inequality and misery.

Introduction: Coronavirus-19 disease (COVID-19) affects any person in any age group, however, studies show that the elderly and people with comorbidities constitute the highest risk segments for the development of severe forms of the disease. Objective: to evaluate the effect of SARS-CoV-2 infection on the health conditions and functional capacity of institutionalized elderly people after 6 months of infection. Methods: Prospective cohort carried out with 288 institutionalized elderly of both sexes. The elderly were evaluated for clinical conditions (diagnosis of chronic diseases and biochemical tests), functional capacity and nutritional status based on anthropometric variables (weight, height, BMI, calf and arm circumference). All assessments were repeated at two times, maintaining an interval of 6 months between them. Results: 97 elderly had a positive result for COVID and males had a higher risk of developing the disease. There was also an increase in the frequency of elderly people with functional dependence after COVID-19. The group of elderly people with the disease maintained a higher median systolic blood pressure, a higher percentage of weight loss and lower concentrations of hemoglobin and lymphocytes after diagnosis of the disease. Creatinine and AST had a higher median after the disease. Previous diabetes diagnosis and leukocyte concentrations at disease onset were associated with mortality and need for hospitalization. Conclusion: The effects of COVID-19 in institutionalized elderly go beyond acute complications and compromise blood pressure control, functional capacity, favor weight loss, lymphopenia and alter concentrations of liver function enzymes after the disease.

Esta dissertação está estruturada em duas seções, sendo um capitulo de revisão da literatura fragmentado em seis tópicos, tendo como objetivo discutir por meio de referencial teórico os inquéritos alimentares existentes, variações e erros de medidas, métodos para elaboração, validação e reprodutibilidade de questionário de frequência alimentar e questionários de frequência alimentar existentes no Brasil para a população de gestantes. Para a segunda seção, foi elaborado artigo original, objetivando verificar a validação e a reprodutibilidade de um questionário de frequência alimentar elaborado para gestantes. Trata-se de um estudo de validação de questionário de frequência alimentar, realizado com gestantes atendidas na rede pública de saúde do município de Maceió-Al. Foi desenvolvido questionário de frequência alimentar quantitativo com 112 itens alimentares, no qual apresentou coeficientes de correlação e intraclasse satisfatórios, expressando ser um bom instrumento para avaliar o consumo alimentar de gestantes.

In Brazil, more than half of the population is of black origin. However, in
relation to the white population, blacks are subjected to a series of inequities,
such as lower socioeconomic status, less education and professional training, in
addition to being subject to social and institutional discrimination. These
aspects are even more evident in the context of quilombola peoples. These are
the descendants of slaves who fled the slave quarters and took refuge in
isolated predominantly rural areas, in which were also added those who gained
freedom at the end of slavery in the country. Due to a historical context of
exclusion, this racial ethnic group is characterized by extreme social
vulnerability, being especially exposed to several risk factors, which make
them more susceptible to chronic non-communicable diseases. Among the
main risk factors for the development of chronic diseases is the excess of body
adiposity, the use of anthropometric indicators being an important strategy for
the identification of individuals who present this condition. For this purpose,
the Body Mass Index (BMI) has been widely used at the population level.
However, this measure reflects only the total body mass adjusted for height,
which, in addition to not distinguishing body composition, does not indicate
the pattern of fat distribution (whether visceral or subcutaneous). For this last
limitation, other measures have been proposed, such as waist circumference
(WC). However, this measure has a high correlation with BMI, so that its use
does not add substantial advantage. Therefore, Krakauer and Krakauer
developed the Body Shape Index (ABSI), an index based on measurements of
waist, body mass and height. Using allometric analysis, this index is able to
estimate the impact of the waist in relation to the body size. The Body Shape
Index has been used as a predictor of illness and mortality risk. However, no
investigation into its accuracy as a predictor of chronic noncommunicable
diseases in an Afro-descendant population has been carried out. Therefore, this
dissertation is performed in order to fill this gap. To address a proposed
question, a dissertation is divided into two chapters: a review of the literature
and another that deals with the original article. For a review of the literature
used as bases for PubMed, SciElo, Lilacs and CAPES thesis database. A
survey was conducted based on the keywords &quot;black population&quot;, &quot;health&quot; and
their correlates. The original article uses data from a cross-sectional study
(Nutrition and health of the maternal and child population of the remaining
quilombos in the state of Alagoas), or which investigates the population of half
of the 68 quilombola communities in the state. All women (19 to 59 years old)
living in ordained communities (n = 1661) were eligible for this study. The
following chronic conditions were assessed: systemic arterial hypertension,
diabetes mellitus and dyslipidemia. Anthropometric data of body mass, height
and WC were collected, which were used for calculations of ABSI, BMI, taper
index (C index) and waist height ratio (RCE). In addition, the body fat
percentage (% F) was estimated through bioimpedance. ABSI&#39;s predictive
ability to detect chronic diseases compared to other anthropometric parameters 

was defined based on the analysis of the ROC curve. How the areas under a
curve were calculated and compared for each of the indicators, using the
DeLong test. The level of significance considered for all statistical procedures
was 5% (p &lt;0.05). In assessing the accuracy of anthropometric parameters,%
G had the greatest predictive power for arterial hypertension; for diabetes
mellitus, a CER performed the best. For hypertriglyceridemia or index C, it
was the one that registered the largest area under the ROC curve. ABSI and C
index performed better for hypercholesterolemia and CC showed greater
discriminatory power for low HDL. In all situations analyzed, with the
exception of hypercholesterolemia, or in ABSI different from other
anthropometric indicators (p &lt;0.05), it presents the lowest AUC values. It was
concluded that in this Afro-descendant population, or ABSI was the best
predictor for hypercholesterolemia, having been inferior to the other indicators
in relation to the other analyzed outcomes.

Apesar dos inúmeros e inquestionáveis benefícios à saúde da mãe
e da criança, o aleitamento materno exclusivo (AME) por seis meses
ainda é uma meta distante de ser atingida na maioria das
populações. Para o êxito no AME é fundamental a motivação da
mãe em amamentar. Nesse aspecto, existem diversos fatores que
podem levar à interrupção precoce do AME, sendo que,
possivelmente, os transtornos mentais comuns (TMCs) seja também
um desses fatores, pois se caracterizam por sintomas depressivos,
de ansiedade e de queixas somáticas inespecíficas. Todavia,
nenhum estudo investigou se existe associação entre a prática do
AME com essa condição. Os objetivos deste estudo foram: a) investigar, na população quilombola de Alagoas, as características do AME; b) identificar se existe associação entre a interrupção precoce do AME e o TMC e; c) analisar quais os fatores de risco para a interrupção precoce do AME. Trata-se de um estudo transversal realizado em 50% das 68 comunidades quilombolas do estado. Eram elegíveis todas as crianças &lt; 24 meses e suas mães.

A variável dependente foi à interrupção precoce do AME (AME &lt;4
meses). Seis ou mais respostas afirmativas ao Self-Reporting
Questionnaire identificavam a presença de TMC. A medida de
associação utilizada foi a razão de prevalência (RP) e respectivo
IC95%, para o que se utilizou regressão de Poisson multivariável
seguindo modelo teórico hierarquizado. Foram calculadas as
prevalências de AME por 6 e 4 meses e, bem como sua duração
mediana (análise de sobrevida). Foram analisados 251 binômios
mães/crianças. As prevalências da interrupção precoce do AME e
de TMC foram 56,1% e 42,6%, respectivamente. Neste estudo não
houve associação entre interrupção precoce do AME e TMC. Foram
fatores de risco independentemente associados à interrupção
precoce do AME (RP; IC95%): residir em casa de taipa (1,84; 1,63-
2,08), mãe adolescente (1,33; 1,02-1,74), baixo peso ao nascer
(1,46; 1,15-1,86), uso de chupeta (1,28; 1,01-1,61) e de mamadeira
(2,41; 1,52-3,84). A prevalência do AME por quatro meses foi de
43,9%, enquanto que para seis meses, esse valor foi de 26,7%. A
duração mediana do AME foi de 119 dias. Os indicadores de AME
estão aquém das metas estabelecidas, justificando a
implementação de medidas de promoção. Para isso, os fatores de
risco à interrupção precoce do AME devem ser considerados, sendo
que TMC não se associa a esse desfecho.

O objetivo deste estudo foi investigar a tendência temporal da
prevalência de anemia em crianças das comunidades quilombolas
de Alagoas. Trata-se de um estudo de série temporal, baseado em
dois inquéritos domiciliares realizados em 2008 (n=950) e 2018
(n=426), envolvendo amostra representativa das crianças de seis a
59 meses. A anemia foi diagnosticada pela concentração de
hemoglobina &lt;110g/L em sangue capilar (HemoCue®). As
prevalências entre os dois inquéritos foram descritas
percentualmente e a medida de associação foi a razão de
prevalência (RP) e IC95%, calculados por regressão de Poisson
com variância robusta. As prevalências de anemia em 2008 e 2018 

foram, respectivamente, 53,0% (IC95%: 49,8-56,1) e 38,0% (IC95%:
33,4-42,7), configurando um declínio de 28% (RP=0,71; IC95%:
0,63-0,82). Na comparação segundo as faixas etárias, foram
observadas diferenças significantes, com valores mais altos entre as
crianças menores de 24 meses: 72,0% vs 44,0% em 2008
(RP=1,64; IC95%:1,47-1,83) e 54,8% vs 28,2% em 2018 (RP=1,94;
IC95%: 1,53-2,46). Quanto ao sexo, não houve diferença estatística
no inquérito de 2008, mas em 2018 os meninos foram mais
acometidos do que as meninas: 43,8% vs 32,4% (RP=1,35; IC95%:
1,00-1,84). Conclui-se que a prevalência da anemia vem
apresentando tendência de declínio nos últimos anos. No entanto,
persiste como um relevante problema de saúde pública entre as
crianças das comunidades quilombolas de Alagoas, sobretudo entre
as menores de dois anos. Gestores e profissionais de saúde devem
estar atentos aos dados aqui apresentados visando à
implementação de medidas de atenção, haja vista os danos
causados pela anemia à saúde infantil.

A anemia ferropriva é extremamente relevante no contexto da saúde pública, com alto impacto na qualidade de vida dos indivíduos e no setor econômico. Considerando a complexidade e multicausalidade deste agravo que acomete diferentes estratos da população, torna-se importante investigar os fatores preditores ao seu desenvolvimento na população de puérperas de um município alagoano, uma vez que o reconhecimento da magnitude do problema é imprescindível para o desenvolvimento de ações voltadas para o controle do agravo. Diante disso, foram elaborados um capítulo de revisão da literatura e um artigo original. O capítulo de revisão aborda o ferro e a anemia como problema de saúde pública, panorama epidemiológico, a relação da gestação e do pós-parto com a anemia e as estratégias adotadas para o enfrentamento do agravo em questão. O artigo original objetivou investigar a anemia e os fatores preditores nas mulheres no período pós-parto imediato. Trata-se de um estudo transversal, aninhado a uma coorte de nascimento, envolvendo mulheres no pós-parto imediato, realizado no ano de 2017. A análise dos fatores preditores incluiu aspectos sociodemográficos, comportamentais e de saúde. Foi realizada regressão linear, sendo calculado o coeficiente de regressão bruto e ajustado. Verificou-se maior prevalência de anemia em mulheres que não estavam inseridas em Programa Condicional de Transferência de Renda, que tiveram seus filhos por parto cesárea e que relataram presença de anemia durante a gestação. Esses achados reforçam a necessidade de medidas fundamentais em estratégias de prevenção e controle do agravo, que contribuam para reduzir a carga do mesmo e suas complicações, ainda presente de forma expressiva no país.

An adequate and healthy eating in the first years of life guarantees growth, development and
child health, and it has repercussions throughout life, contributing to the realization of the
human right to food and health. Breastfeeding is the isolated intervention with the greatest
ability to prevent deaths in children under 5 years of age. In turn, complementary feeding is
the third most effective action, with the potential to prevent 6% of deaths in children under 5
years old. Despite the recognized benefits of breastfeeding, rates of early initiation of
breastfeeding among children under 5 months of age remain below 50% in most middle- and
low-income countries. In the face of such evidence, Brazil adopts international
recommendations, advocating exclusive breastfeeding (EBF) until the sixth month and the
continuity of breastfeeding until the second year of life or more. The transition from EBF to
the introduction of food consumed by the family is the period called complementary feeding,
which should start at 6 months of age and be concluded at 24 months, which represents a
period of great vulnerability for children's nutrition and health. This period is recognized for
its importance in the formation of healthy eating habits in order to protect the child from
nutritional deficiencies, and that is why it is recommended to offer fresh and minimally
processed foods, avoiding ultra-processed foods (UP). However, food choices are influenced
by several factors such as the socioeconomic and demographic situation that will converge for
family food security (FS). In order to fight hunger and poverty, the Brazilian government has
implemented the Bolsa Família Program (PBF) since 2004, which aims to promote access to
public services, such as health, education and the social assistance network, and also promote
food and nutrition security (FNS). The present study aimed to research the association
between the consumption of UP and the practice of breastfeeding in children aged 6 to 24
months benefiting from the PBF in Alagoas. A cross-sectional study was carried out with
children aged 6 to 24 months who were beneficiaries of the PBF and residents of the 6
municipalities participating in the Early Childhood Program of the State of Alagoas, located
in the Northeast Region of Brazil. The consumption of UP and the practice of breastfeeding
were evaluated using the questionnaire to assess eating habits of children under two years of
age, adapting the questionnaire to regional foods. Prevalence Ratios (PR) and Confidence
Intervals (CI) were performed using hierarchical Poisson regression, adjusted at the last (5th)
level by socioeconomic, demographic and environmental variables. 1,604 children
participated in the study, 11.7% of whom were overweight and most had consumed UP
(90.6%) in the last 24 hours. Through multivariate analysis it was found that the consumption
of UP was lower among those children who were being breastfed aged 12 to 15 months (PR
0.93 95% CI 0.88-0.99), and those aged 20 to 24 months (RP 0.91 95% CI 0.86-0.96). Thus,
we conclude that continued breastfeeding is associated with lower consumption of UP.

Gestational diabetes mellitus (GDM) is an important global public health problem. Its increase in contemporary society has required the formulation of public policies that encompass the diversity of factors related to its occurrence. GDM is the most frequent metabolic complication in pregnancy and in recent years its prevalence has increased in several regions of the world and different countries have shown great variations in results. The absence of a universal diagnostic criterion, ethnic / racial characteristics, socioeconomic and cultural factors and different methodologies hinder the direct comparison of the available studies, as well as the evaluation of the global estimate of the rates of the referred disease. In this context, and considering the high risks of adverse pregnancy results for the maternal-fetal binomial of this condition, it is important to investigate the factors that predict its development in brazilian women, since the recognition of the magnitude of the problem is essential for the development of actions aimed at the prevention and control of the disease. In order to contribute to the discussion of the problem, a literature review chapter and an original article were prepared in this dissertation. The review chapter addresses the diagnostic criteria, the prevalence of GDM in several countries and in Brazil, the main predictive factors and the strategies adopted by the Brazilian government and the public authorities to face the disease in question. The original article aimed to describe gestational diabetes mellitus (GDM) in the immediate postpartum period and the predictive factors among women in a birth cohort in a municipality in northeastern Brazil. This is a cross-sectional study nested in a 2017 birth cohort entitled Health, Food, Nutrition and Child Development - HFND. The analysis of the prevalence and predictive factors for GDM included sociodemographic, demographic, maternal, gestational and behavioral aspects of women. Linear regression was performed to identify the predictors of GDM. Higher rates of prevalence of GDM were observed in women aged 35 years or older, who lived with a spouse, who had obesity in the immediate postpartum period and who consumed fatty meats. In the final model of linear regression, predictive factors for GDM were age greater than or equal to 35 years and obesity in the immediate postpartum period. These findings reinforce the need for measures based on strategies for the prevention and control of the disease, which contribute to reducing the burden of the disease and its complications, which is still present in a significant way in the country.

The expression head and neck cancer (HNC) refers to a group of neoplasms that may be present in the oral cavity, pharynx, larynx, nasal cavity, paranasal sinuses, thyroid and salivary glands that include a variety of histopathological tumors. Among the treatment options, there are surgery, radiation and / or chemotherapy, with surgery being the main one. However, depending on the tumor site and the disease stage, surgical resection can compromise important functions; thus, radiotherapy and chemotherapy appear as alternatives in the treatment. Malnourished patients have a worse prognosis and impaired immune function. Regarding the immune function, it has gained a significant role in cancer and this importance has given rise to a research field, which included the study of specific nutrients, capable of modulating the actions of the immune system and of influencing clinical outcome, known as immunonutrition. The triad glutamine, arginine and omega 3 has received
a great focus in surgical patients, being related to a lower number of postoperative complications, increased survival, and body weight recovery. However, studies during chemoradiotherapy are still limited in this population. In order to contribute to the problem discussion, this dissertation is divided into two topics: The first one is a literature review, adressing the main points related to the HNC, the role of the immune system in cancer and aspects related to immunonutrition, focusing on the immunonutrients arginine, glutamine and omega 3. The second topic refers to a systematic review with meta-analysis that assessed the effects of glutamine,
arginine and omega 3 supplementation on treatment tolerance, nutritional status and immune function in HNC during chemoradiotherapy. It was shown that glutamine can act on the severity of mucositis during chemoradiotherapy and that omega 3 can be promising in recovering nutritional status. However, results for
immune function were limited. These results must be interpreted with care, given the differences between the supplementation regimen and the lack of methodological rigor in an important portion of the studies. Investigations focused on elucidating the contribution of each immunonutrient during chemoradiotherapy
deserve further investigation.

Currently, the emerging face of malnutrition is mainly represented by the emergence and maintenance of excess weight (overweight and obesity). In this scenario, the establishment of this condition among children has occurred early. It is known that the process of excessive weight gain is multi-causal and complex, being related to genetic, physiological, metabolic, environmental and behavioral factors. Considering the epidemiological importance of these factors, this dissertation was prepared, in which it is divided into two sections. The first is a literature review in order to build a theoretical framework on excessive weight gain and childhood obesity. The second section brings an original article entitled “Early-life determinants of excessive weight gain among low-income children: examining the adherence of theoretical frameworks to empirical data using structural equation modeling”, which will be submitted to the journal Pediatric Obesity. This article to analyze direct and indirect effects of environmental, maternal, and individual factors on excess weight gain among low-income children during the first year of life. This is a cohort of live births (SAND Project: Health, Food, Nutrition and Child Development), consecutively recruited between February and August 2017 in the only maternity hospital in the city of Rio Largo/AL. Data were prospectively collected at birth and at 3, 6 and 12 months of life of the children. The outcome variable analyzed - conditional weight gain (CWG) - is the standardized residual of a linear regression model, generated from the difference in weight-for-age (ZPI) Z-scores between birth and the last step with available data, adjusted for birth weight, sex and age of the child. The definition of environmental, maternal and child characteristics was supported by conceptual models for determining child weight gain. For the analyses, structural equation modeling (SEM) was used, which makes it possible to jointly estimate the associations between the variables included in the model and the studied outcome. Our findings allowed us to point out the positive association between childhood consumption of ultra-processed foods and maternal obesity and excessive weight gain during the first year of life. Therefore, the identification of risk factors that can be modified is essential for the prevention and control of rapid weight gain at such a critical stage of life as the first 12 months. 

Systemic Arterial Hypertension (SAH) is classified as a chronic non-communicable disease (NCD) that is characterized by a sustained increase in blood pressure levels ≥ 140 and/or 90 mmHg. Thus considered a risk factor for the development of cardiovascular diseases. In Brazil alone, it affects about 36 million adults, and was responsible for 10.4 million deaths in 2017 alone, with a higher prevalence in low-income individuals, with around 1.04 billion people. In addition to gender and family history, several risk factors favor the development of arterial hypertension. Over the years, several researchers have been observing the impact of changes in eating habits on blood pressure control, specifically of some nutrients such as Potassium (K), Calcium (Ca) and Magnesium (Mg), which have already shown their relationship in research in research. BP control. The current Brazilian Guidelines on Arterial Hypertension (2020) provides convincing data that the consumption and/or supplementation of K have shown significant results in reducing blood pressure levels. With regard to Mg, a meta-analysis of cohort studies evidenced the protective effect of magnesium, where an increase in Mg intake by 100mg/day was associated with a 5% reduction in the risk of developing SAH. Regarding Ca, it was observed in current research that the regular consumption of calcium can contribute to the treatment and prevention of SAH in individuals with vitamin D deficiency. The present study aims to evaluate the consumption of micronutrients related to blood pressure control by assisted hypertensive women by the public health network: a time series. Data were taken from 3 surveys of three surveys carried out for the Research Program for the Unified Health System (PPSUS) between 2007 and 2016, in three time cuts. From the research database, sociodemographic, economic and food consumption data were collected, obtained from 24-hour dietary recall surveys (IDR24H). Measures of central tendency (mean) and dispersion (standard deviation) were calculated for continuous variables and frequencies were verified for categorical variables. The methodology of the EAR method was used as a cutoff point, the quantitative consumption data. 360 hypertensive women participated in the study, with a mean age of 48.99 ± 7.3 years, homogeneously distributed among the PPSSUS, showing that the consumption of Ca, K and Mg of all women studied between the years 2007 to 2016 showed intake levels well below the IOM recommendations, a result consistent with national intake data.

A vitamina D historicamente sempre foi conhecida por suas funções clássicas, ou seja, ligada ao metabolismo ósseo, contudo, as funções não clássicas desse nutriente apontam a necessidade de inúmeros tecidos para seu adequado funcionamento, já que a mesma atua como regulador neuroendócrino do corpo, agindo especialmente nos sistemas imunológico, cardiovascular, musculoesquelético, nervoso e placentário, onde a placenta foi um dos primeiros órgãos a ser estudado quanto às funções não clássicas da vitamina D, constituindose em um tecido extrarrenal capaz de converter 25 hidroxicolecalciferol em 1,25(OH)2D3, suprindo assim as necessidades do binômio. Contudo, o papel chave da vitamina D na gestação é na resposta imune desencadeada pela placentogênese, onde esse micronutriente apresenta uma funcionalidade ímpar desde a pré-concepção atuando ainda na implantação placentária, angiogênese, função imune, estresse oxidativo, função endotelial, resposta inflamatória, homeostase da glicose, consequentemente tolerância materna ao feto e, consequentemente, uma gestação saudável. Portanto, tendo em vista os efeitos não clássicos da vitamina D, em que a placenta se configura como órgão dependente desse micronutriente para boa parte de suas funções, observa-se que mulheres com deficiência dessa vitamina são mais susceptíveis a desenvolver doenças gestacionais como diabetes mellitus, pré-eclâmpsia e infecções bacterianas Dessa forma, acredita-se que a resposta para a base fisiopatológica dessas doenças possa estar ligada a algum distúrbio na cascata imunológica placentária, na qual tanto a imunidade inata quanto a adaptativa não responde como esperado, ou seja, com a finalidade de aumentar a capacidade tolerogênica do hospedeiro materno. Assim, faz-se necessário compreender qual o papel da 25-hidroxicolecalciferol sobre o perfil de citocinas produzidas pelos linfócitos Th1 e Th2 placentários, para isso, foi realizada uma revisão sistemática da literatura intitulada “Efeito das concentrações maternas de 25- hidroxicolecalciferol sobre o perfil de citocinasproduzidas pelos linfócitos (Th1 e Th2) placentários: Revisão sistemática da literatura”. Dos 15.706 artigos identificados nas bases de dados, 20 foram lidos na íntegra, e destes, 5 atenderam aos critérios de elegibilidade, sendo incluídos 3 ensaios clínicos aleatórios e 2 estudos de coorte. Os 5 estudos apresentaram adequada qualidade metodológica. Mulheres com suficiência de 25- hidroxicolecalciferol nas coortes, bem como as que receberam suplementação a partir de 2000 UI/dia, apresentaram maiores concentrações de IL-10 na placenta. Dessa forma, concluímos que a vitamina D está associada com o perfil antiinflamatório da placenta.