Influência do padrão de sono sobre o ganho de peso ao longo da gestação

Background: Excessive weight gain during pregnancy has been associated with adverse outcomes to perinatal health, as well as low sleep quality, which is frequently reported during pregnancy. Objective: Therefore, the focus of this study was to evaluate the associations between sleep patterns – time and quality – and the increase in weight during pregnancy. Methods: A prospective and longitudinal study was conducted with 63 pregnant women attending antenatal clinics of the public health service of the city of Uberlandia, Minas Gerais State, Brazil. Pregnant women were evaluated at the first, second and third trimester for subjective sleep patterns [duration and quality determined by Pittsburgh Sleep Quality Index (PSQI)] and anthropometric variables (weight and height, for body mass index (BMI). Generalized estimating equations (GEE) were used to examine the association between sleep duration, quality, and BMI over the pregnancy period, while adjusting for confounders (age, physical activity and energy intake). Results: In the GEE analysis, an effect of interaction between time of pregnancy and clusters of sleep quality was observed on the BMI (p 10) e a ingestão calórica usual. Resultados: Na análise do GEE, foi observada uma interação do efeito do tempo da gestação e clusters de qualidade do sono sobre o IMC (p < 0,05), indicando que gestantes com melhor padrão de sono ganham mais peso do segundo para o terceiro trimestre gestacional, enquanto que aquelas com pior padrão de sono ganham mais peso do primeiro para o segundo. A análise do GEE não encontrou efeito do tempo de sono sobre o ganho de peso. Contudo, foi encontrado que gestantes que mantiveram-se na mesma faixa de peso durante a gestação aumentaram o tempo de sono do primeiro para o terceiro trimestre, enquanto que gestantes que ascenderam a faixa de peso dormiram o mesmo tempo nesse período (mediana = 1,0 [0,0 – 2,0] e mediana = 0,0 [-2,0 – 1,0], respectivamente, p=0,039). Conclusão: A pior qualidade do sono parece levar a uma inadequada distribuição do ganho de peso durante a gestação. Estudos futuros que confirmem tais achados podem auxiliar na elaboração de estratégias voltadas à melhoria da saúde das gestantes

Association of social jetlag and chronotype with food consumption and weight gain during pregnancy: a prospective cohort study

Introduction: The incompatibility between circadian and social clocks leads to circadian misalignment, which has been widely measured by social jetlag (SJL). Studies have associated SJL with nutritional diseases such as obesity, but this topic has not yet been studied in pregnant women. The chronotype, which concerns the inter-individual differences in phase allocation of circadian rhythms, is one of the factors that has been associated with circadian misalignment and also with nutritional diseases. However, the effects of the chronotype on food intake and weight gain during pregnancy were also not addressed in the literature. Objective: This thesis had two main objectives: 1) to identify the occurrence of SJL during pregnancy and to describe the effect of pre-pregnancy body weight on SJL throughout pregnancy; 2) to analyse the association of the chronotype with food consumption and weight gain during pregnancy. Material and Methods: The first phase of the study was carried out with 205 pregnant women in the first trimester. Thereafter, 100 pregnant women were followed up through a prospective cohort study in the second and third gestational trimesters. The SJL was calculated based on the absolute difference between the midpoint of sleep on working days and free days. Food intake was assessed by three 24-hour food records in each trimesters, totaling nine records. The intake and distribution of energy and macronutrients were assessed at meals throughout the day and the quality of the diet was assessed by the Revised Diet Quality Index (IQD-R). The chronotype was derived from the midpoint of sleep on free days (MSF) corrected for sleep output and the scores obtained were categorized into tertiles. The pre-gestational body mass index (BMI) (kg/ m²) and the current BMI (kg/ m²) were calculated. The Institute of Medicine recommendations were used to assess the adequacy of weight gain. Linear and logistic regression and the Generalized Estimation Equations (GEE) adjusted for confounding factors were used to determine the association between SJL and gestational trimesters (time) and anthropometric variables. In addition, GEE were used to determine the effects of chronotype and gestational trimesters on dietary patterns, daily energy, macronutrient distribution and weight gain. Results: Most pregnant women (54.5%) had SJL > 1h in the first trimester of pregnancy. A positive association was found between SJL and pre-pregnancy BMI in the third trimester (β = 0.200, p = 0.046). In addition, GEE analyzes showed that pregnant women with normal pre-gestational weight showed a decrease in SJL from the second to the third trimester (1.29 ± 0.11 and 0.93 ± 0.08, respectively, p = 0.032), but this was not found in the other groups of nutritional status (underweight, overweight and obesity). In addition, we found an isolated effect of the trimester of gestation on the SJL average. In this sense, pregnant women showed a decrease in SJL from the second to the third trimester (1.33 ± 0.08 versus 1.12 ± 0.07, respectively; p = 0.012). Regarding the results related to the chronotype, pregnant women with MSF values with a tendency to evening had breakfast later and also had a higher intake of energy and carbohydrates at dinner, compared to those with a tendency to morning. Pregnant women with a tendency to maturity showed a better quality diet in the group of milk and derivatives and saturated fat evaluated by the IQD-R. In addition, despite the tendency of pregnant women of all tertiles to gain excess weight during pregnancy, it was observed that pregnant women with a tendency to evening had a worse adequacy of gestational weight gain in the third trimester when compared to pregnant women with a tendency to maturity (2.24 ± 0.25 kg versus 1.22 ± 0.14 kg, p 1h is quite prevalent during pregnancy and pre-gestational excess weight seems to lead to a greater risk of having SJL > 1h during pregnancy. In addition, pregnant women with a tendency to evening eat breakfast later and also have a higher intake of energy and carbohydrates at night, in addition to having a worse pattern of gestational weight gain in the third trimester. Our results emphasize the importance of considering chronobiological variables in prenatal nutritional guidelines to promote maternal and fetal health.Pesquisa sem auxílio de agências de fomentoTese (Doutorado)Introdução: A incompatibilidade entre os relógios circadianos e sociais leva ao desalinhamento circadiano, o qual tem sido amplamente avaliado pelo jetlag social (JLS). Estudos têm associado o JLS às doenças nutricionais como a obesidade, mas tal temática ainda não foi estudada em gestantes. O cronotipo, que diz respeito às diferenças inter individuais de alocação de fase dos ritmos circadianos, é um dos fatores que vem sendo associado ao desalinhamento circadiano e também às doenças nutricionais. Entretanto, os efeitos do cronotipo sobre a ingestão alimentar e ganho de peso durante a gestação também não foram abordados pela literatura. Objetivo: Esta tese teve dois objetivos principais: 1) identificar a ocorrência de JLS ao longo da gestação e descrever o efeito do peso corporal pré-gestacional sobre o JLS ao longo da gestação; 2) estudar a associação do cronotipo com o consumo alimentar e o ganho de peso durante a gestação. Material e Métodos: A primeira fase do estudo foi realizada com 205 gestantes no primeiro trimestre. Posteriormente, 100 gestantes foram acompanhadas por meio de um estudo de coorte prospectivo no segundo e terceiro trimestres gestacionais. O JLS foi calculado com base na diferença absoluta entre o ponto médio do sono nos dias de trabalho e dias livres. A ingestão alimentar foi avaliada por três recordatórios alimentares de 24 horas em cada trimestre, totalizando nove recordatórios. A ingestão e distribuição de energia e macronutrientes foram avaliadas nas refeições ao longo do dia e a qualidade da dieta foi avaliada pelo Índice de Qualidade da Dieta Revisado (IQD-R). O cronotipo foi derivado do ponto médio do sono em dias livres (MSF) corrigido para o débito de sono e as pontuações obtidas foram categorizadas em tercis. Foram calculados o índice de massa corporal (IMC) pré-gestacional (kg/ m²) e o IMC atual (kg/ m²). As recomendações do Institute of Medicine foram utilizadas para avaliar a adequação do ganho de peso. A regressão linear e logística e as Equações de Estimações Generalizadas (GEE) ajustadas para fatores de confusão foram utilizadas para determinar a associação entre JLS e os trimestres gestacionais (tempo) e variáveis antropométricas. Além disso, GEE foram utilizadas usadas para determinar os efeitos do cronotipo e dos trimestres gestacionais nos padrões alimentares, energia diária, distribuição de macronutrientes e ganho de peso. Resultados: A maioria das gestantes (54,5%) apresentou JLS > 1h no primeiro trimestre gestacional. Foi encontrada associação positiva entre JLS e IMC pré-gestacional no terceiro trimestre (β = 0,200, p = 0,046). Além disso, as análises de GEE mostraram que as gestantes com peso pré-gestacional normal apresentaram diminuição no JLS do segundo para o terceiro trimestre (1,29 ± 0,11 e 0,93 ± 0,08, respectivamente, p = 0,032), mas isso não foi encontrado nos outros grupos do estado nutricional (baixo peso, sobrepeso e obesidade). Em adição, encontramos um efeito isolado do tem (trimestre de gestação) na média do JLS. Nesse sentido, as gestantes apresentaram diminuição do JLS do segundo para o terceiro trimestre (1,33 ± 0,08 versus 1,12 ± 0,07, respectivamente; p = 0,012). Em relação aos resultados relacionados ao cronotipo, gestantes com valores de MSF com tendência à vespertinidade faziam o café da manhã mais tarde e também tinham maior ingestão de energia e carboidratos no jantar, em comparação àquelas com tendência à matutinidade. Gestantes com tendência à matutinidade mostraram uma dieta de melhor qualidade no grupo de leite e derivados e gordura saturada avaliados pelo IQD-R. Além disso, apesar da tendência das gestantes de todos os tercis ganharem peso excessivamente durante a gestação, observou-se que as gestantes com tendência à vespertinidade apresentaram uma pior adequação do ganho de peso gestacional no terceiro trimestre quando comparadas às gestantes com tendência à matutinidade (2,24 ± 0,25 kg versus 1,22 ± 0,14 kg, p 1h é bastante prevalente durante a gestação e o excesso de peso pré-gestacional parece levar ao maior risco de apresentar JLS > 1h ao longo da gestação. Além disso, gestantes com tendência à vespertinidade realizam o café da manhã mais tarde e também têm maior ingestão de energia e carboidratos à noite, além de apresentarem um pior padrão de ganho de peso gestacional no terceiro trimestre. Nossos resultados enfatizam a importância de considerar as variáveis cronobiológicas nas diretrizes nutricionais do pré-natal para promover a saúde materno-fetal

Does sleep influence weight gain during pregnancy? A prospective study

Objective: The focus of this study was to evaluate the associations between subjective sleep quality and duration and weight gain during pregnancy. Methods: A prospective and longitudinal study was conducted with 63 pregnant women. Pregnant women were evaluated at the first, second and third trimester for subjective sleep quality (Pittsburgh Sleep Quality Index [PSQI]) and anthropometric variables for body mass index [BMI] calculation. The sleep quality was grouped per cluster, identifying those individuals who maintained, improved or worsened their sleep quality, based on the PSQI classifications. Generalized estimating equations (GEE) were used to examine the association between sleep and BMI over the pregnancy period. Results: An effect of the interaction between time of pregnancy and clusters of sleep quality was observed on the BMI (p<0.05), which indicates that pregnant women who improved subjective sleep quality during pregnancy gained more weight from the second to third trimester, while those that worsened the subjective sleep quality gained more weight during the first to second trimester. Sleep duration was not associated with weight gain. However, pregnant women who maintained the same BMI category over the pregnancy period increased their sleep duration from the first to third trimester, while those that increased the BMI category slept the same amount of time during this period (median=1.0 [0.0–2.0] and median=0.0 [-2.0–1.0], respectively, p=0.039). Conclusions: The authors concluded that a worse subjective sleep quality seems to lead to an inadequate weight gain distribution during the period of pregnancy

Association between social jetlag food consumption and meal times in patients with obesity-related chronic diseases.

Chronic disruption of the synchronous relationship between endogenous and exogenous circadian timing is associated with the development of obesity and metabolic disease. Social jetlag is a measure of circadian misalignment and has been identified as a risk factor for overweight and related diseases. However, the mechanisms involved in this relationship remain underexplored. The objective of this study was to investigate the association between social jetlag and food consumption at late meal timing in patients with obesity-related chronic diseases. This study included 792 individuals (73% female; age 55.9 ± 12.4 years) in which the prevalence of social jetlag (>1h) was 24.4% (n = 194). Participants with social jetlag reported late meal timing for breakfast, early afternoon snack and dinner. Individuals with social jetlag also reported a higher intake of total calories (kcal), protein, total fat, saturated fat, cholesterol, and servings of meat and eggs and sweets in relation to those without social jetlag. Regarding the consumption during each meal of the day, participants with social jetlag had consumed more calories, saturated fat and cholesterol during dinner; more protein, total fat, saturated fat, and cholesterol during lunch; and more total fat and saturated fat during morning snack. In addition, individuals with social jetlag had a higher risk of inadequate consumption of total fat, saturated fat and cholesterol intake when compared with those without social jetlag. We conclude that social jetlag is associated with a poor diet and later meal times, which should be avoided in individuals with obesity-related chronic diseases. More studies are needed to confirm these findings