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Previous issue date: 2017-12-08 === Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior (CAPES) === A defici?ncia de vitamina E (DVE) est? relacionada a graves complica??es para a sa?de e o desenvolvimento de rec?m-nascidos e crian?as, produzindo efeitos subsequentes em sua vida adulta. Dentre as estrat?gias de combate a esta defici?ncia, a suplementa??o materna durante a lacta??o apresenta-se como conduta vi?vel, embora n?o haja defini??o de um protocolo ideal, principalmente devido a escassez de pesquisas em humanos. Desta forma, pela primeira vez em humanos, este estudo teve como objetivo principal analisar o efeito de dois protocolos de suplementa??o com alfa-tocoferol sobre o estado nutricional bioqu?mico materno at?
60 dias ap?s o parto. Para tanto, oitenta lactantes saud?veis foram recrutadas em duas maternidades p?blicas de Natal - RN entre 2013 e 2016. As participantes eleg?veis foram randomicamente alocadas nos grupos controle, suplementado 1 ou suplementado 2, na raz?o de 1:1:1. As informa??es diet?ticas foram coletadas no 7?, 20?, 30? e 60? dias p?s-parto. As amostras de soro e leite foram colhidas no 1? (0h), 20?, 30? e 60? dias, havendo uma coleta adicional de leite no 7? dia. Imediatamente ap?s a coleta do 1? dia, os grupos suplementado 1 e 2 receberam uma (01) dose de 400 UI de RRR-alfa-tocoferol e, ap?s a coleta do 20? dia, o grupo suplementado 2 recebeu a segunda dose da suplementa??o. Ao grupo controle n?o foi administrada suplementa??o alguma. O alfa-tocoferol foi quantificado por cromatografia l?quida de alta efici?ncia. O consumo habitual de vitamina E e o seu fornecimento atrav?s do leite foram avaliados segundo recomenda??es espec?ficas (16 mg e 4 mg ao dia, respectivamente). Com base nos resultados, tem-se que nenhuma participante apresentou adequa??o do consumo de vitamina E ao longo da lacta??o. Esta caracter?stica foi semelhante entre os grupos (~ 5,0 mg/dia; p = 0,603), garantindo, assim, a n?o influ?ncia da dieta materna sobre os resultados das suplementa??es. Para os tr?s grupos, as concentra??es s?ricas de alfa-tocoferol correspondentes aos quatro momentos p?s-parto foram indicativas de adequado estado nutricional, n?o havendo diferen?a entre eles para o soro 0h (p > 0,05). Os valores no leite 0h tamb?m n?o foram diferentes entre os grupos (p > 0,05). Com a progress?o da lacta??o, devido ao decl?nio fisiol?gico do alfa-tocoferol no soro (p < 0,01) e no leite (p < 0,01), houve aumento do percentual de DVE materna e de inadequa??o no fornecimento de vitamina E pelo leite, nos tr?s grupos, embora com menor intensidade no grupo suplementado 2 em fun??o da dupla dose de alfa-tocoferol. Este protocolo se mostrou eficaz at? o 30? dia p?s-parto, momento no qual possibilitou aumento na vitamina E do soro (36%) e do leite (160%), em rela??o ao controle, garantindo o requerimento total de vitamina E do lactente (5,2 mg/dia). E, ao 60? dia, forneceu pelo leite somente
84% da vitamina E recomendada (3,2 mg/dia), apesar desse valor ter sido 31% superior ao do grupo n?o tratado. J? a suplementa??o de dose ?nica n?o mostrou efeito no soro materno e proporcionou incremento da vitamina E no leite somente at? o 20? dia (35%), n?o sendo capaz de manter a adequa??o do fornecimento ao lactente ao final do estudo (2,5 mg/dia). Deste modo, ambos os protocolos de suplementa??o materna apresentaram efeitos restritos sobre a vitamina E do soro e do leite, embora as duas doses de 400 UI de RRR-alfa-tocoferol tenham alcan?ado resultados mais prolongados quanto a otimiza??o do estado nutricional materno e do fornecimento de vitamina E pelo leite em detrimento da dose ?nica. === Vitamin E deficiency (VED) is associated with serious complications to the health and development of newborns and children, generating subsequent effects in their adult life. Among the strategies to combat this deficiency, maternal supplementation during lactation presents itself as a viable conduct, even though there is no definition of an ideal protocol, mainly due to a lack of human studies. Thus, for the first time in humans, this study had as main objective analyzing the effect of two maternal supplementation protocols with alpha-tocopherol on the maternal biochemical nutritional status up to 60 days postpartum. For this purpose, eighty healthy lactating women were recruited at two public maternity hospitals in Natal ? RN between 2013 and 2016. Eligible participants were randomly assigned to control, supplemented 1 or supplemented 2 groups, in a 1:1:1 ratio. Dietary information was collected on the 7th, 20th, 30th and 60th days postpartum. Serum and milk samples were collected at the 1st (0h), 20th, 30th and 60th days, with an additional milk collection on the 7th day. Immediately after the collection at day 1, the supplemented groups 1 and 2 received a (01) dose of 400 IU of RRR-alpha-tocopherol, and after the collection at day 20, the supplemented group 2 received the second supplemental dose. No supplementation was given to the control group. Alpha-tocopherol was quantified by high performance liquid chromatography. The usual vitamin E intake and its supply through milk were assessed according to specific recommendations (16 mg and 4 mg daily, respectively). Based on the results, none of the participants had adequate vitamin E intake throughout lactation. This characteristic was similar between the groups (~ 5.0 mg/day, p = 0.603), thus assuring the non-influence of maternal diet on the results of the supplementation schemes. For the three groups, serum alpha-tocopherol concentrations corresponding to the four postpartum periods were indicative of adequate nutritional status, with no differences between them regarding serum 0h (p > 0.05). Values in milk 0h were also not different between the groups (p > 0.05). As lactation progressed, due to the physiological decline of alpha-tocopherol in serum (p <0.01) and breast milk (p <0.01), there was an increase in the percentage of maternal VED and inadequate supply of vitamin E through milk in all three groups. However, such increases were less intense in the supplemented group 2 as result of the double alpha-tocopherol dose. This protocol was effective until the 30th day postpartum, at which time vitamin E (36%) and milk (160%) increased, compared to control, ensuring the total vitamin E requirement of the infant (5.2 mg/day). At the 60th day, milk provided only 84% of the recommended vitamin E (3.2 mg/day), although this value was 31% higher than that of the untreated group. On the other hand, the single-dose supplementation showed no effect on maternal serum during lactation and promoted an increase in milk vitamin E only up to the 20th day (35%), not being able to maintain the adequacy of vitamin supply to the infant at the end of the study (2.5 mg/day). Thus, both maternal supplementation protocols had restricted effects on serum and milk, although the two 400 IU doses of RRR-alpha-tocopherol have achieved lasting results in optimizing maternal nutritional status and milk supply of vitamin E over single dose.
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