As doenças da tireoide durante a gestação e lactação afetam a composição nutricional do leite humano?

Lopes, Fernanda de Oliveira; Soares, Fernanda Valente Mendes; Silva, Danielle Aparecida da; Moreira, Maria Elisabeth Lopes

doi:10.1055/s-0040-1718449

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Revista Brasileira de Ginecologia e Obstetrícia

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Sumário

Review Article • Rev. Bras. Ginecol. Obstet. 42 (11) • Nov 2020 • https://doi.org/10.1055/s-0040-1718449 copiar

As doenças da tireoide durante a gestação e lactação afetam a composição nutricional do leite humano?

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

Objetivo:

Identificar se os efeitos da doença da tireoide durante a gestação e lactação afetam a composição nutricional do leite humano.

Métodos:

Revisão sistemática da literatura científica por meio das bases de dados Medical Literature Analysis and Retrieval System Online/MedLine a fim de avaliar a associação das doenças da tireoide na gestação e na lactação com a composição nutricional do leite humano. Não houve delimitação por período nem por idioma, e as buscas foram finalizadas em março de 2019. Foram aplicados os seguintes descritores: human milk AND thyroid AND composition, utilizando protocolo preferred reporting items for systematic reviews and meta-analyses (PRISMA) para a busca, seleção e extração de dados. De acordo com o fluxograma proposto, a busca bibliográfica resultou em 12 artigos e, destes, quatro foram selecionados.

Resultados:

Os artigos elegidos para a presente revisão foram publicados entre 1976 e 2018. Dois estudos verificaram diferenças significativas na composição nutricional do leite de mães com hipotireoidismo ou excesso de peso em comparação ao grupo controle sem hipotireoidismo. Os estudos demonstraram que a presença da doença levava a modificações na composição nutricional do leite humano, principalmente em relação à maior concentração da gordura.

Conclusão:

É de extrema importância que essas mulheres tenham acompanhamento nutricional contínuo a fim de minimizar o impacto dessas morbidades sobre a composição nutricional do leite humano.

Palavras-chave:
leite humano; macronutrientes; composição; doenças da glândula tireoide; hipotireoidismo

Authors	Exclusion criteria	Method used to assess the composition of human milk	Milk stage analyzed
Tyson et al.²⁵25 Tyson JE, Perez A, Zanartu J. Human lactational response to oral thyrotropin releasing hormone. J Clin Endocrinol Metab. 1976;43 (04):760-768. Doi: 10.1210/jcem-43-4-760 https://doi.org/10.1210/jcem-43-4-760...	Uninformed	Infrared milk analyzer (IRMA)	Colostrum and mature
Kivinen et al.²⁶26 Kivinen S, Ylikorkala O, Kauppila A, Timonen E, Haapalahti J. The effect of oral thyrotropin-releasing hormone on thyroid function and the composition of breast milk in puerperal women. Int J Gynaecol Obstet. 1979;16(05):377-380. Doi: 10.1002/j.1879-3479.1979.tb00468.x https://doi.org/10.1002/j.1879-3479.1979...	Uninformed	Gas-liquid chromatography	Colostrum
Motil et al.²⁷27 Motil KJ, Thotathuchery M, Montandon CM, Hachey DL, Boutton TW, Klein PD, Garza C. Insulin, cortisol and thyroid hormones modulate maternal protein status and milk production and composition in humans. J Nutr. 1994;124(08):1248-1257. Doi:10.1093/jn/124.8.1248 https://doi.org/10.1093/jn/124.8.1248...	Uninformed	Kjeldahl method e adiabatic bomb calorimetry	Colostrum
Chen et al.²⁸28 ChenL,Wang J, JiangP,RenF, LeiX,GuoH. Alterationof the colostrum whey proteome in mothers with gestational hypothyroidism. PLoS One. 2018;13(10):e0205987. Doi: 10.1371/journal.pone.0205987 Rev Bras Ginecol Obstet Vol. 42 No. 11/2020 Thyroid Diseases during Pregnancy Lopes et al. 757 https://doi.org/10.1371/journal.pone.020...	Maternal diseases, fever, mastitis, or diabetes	High resolution mass spectrometry and liquid chromatography mass.	Colostrum

Authors	Year of publication	Type of studyo	Confounding factors	Results found
Tyson et al.²⁵25 Tyson JE, Perez A, Zanartu J. Human lactational response to oral thyrotropin releasing hormone. J Clin Endocrinol Metab. 1976;43 (04):760-768. Doi: 10.1210/jcem-43-4-760 https://doi.org/10.1210/jcem-43-4-760...	1976	Cohort	Obesity	- TRH administration was not associated with changes in the percentage of protein and milk fat between groups in the postpartum period, but after the 1st and 12th postpartum weeks a significant decline in the average protein concentration was observed.- There was no difference in the weight of infants and lactating women between groups.- Lactating mothers who received TRH showed an increase in milk production
Kivinen et al.²⁶26 Kivinen S, Ylikorkala O, Kauppila A, Timonen E, Haapalahti J. The effect of oral thyrotropin-releasing hormone on thyroid function and the composition of breast milk in puerperal women. Int J Gynaecol Obstet. 1979;16(05):377-380. Doi: 10.1002/j.1879-3479.1979.tb00468.x https://doi.org/10.1002/j.1879-3479.1979...	1979	Cohort	Age and parity	It was found that the fatty acid content of milk samples from women treated with TRH did not differ from that of normal lactating women.
Motil et al.²⁷27 Motil KJ, Thotathuchery M, Montandon CM, Hachey DL, Boutton TW, Klein PD, Garza C. Insulin, cortisol and thyroid hormones modulate maternal protein status and milk production and composition in humans. J Nutr. 1994;124(08):1248-1257. Doi:10.1093/jn/124.8.1248 https://doi.org/10.1093/jn/124.8.1248...	1994	Cohort	Uninformed	- It has been found that insulin modulates the concentration of nutrients between the anabolic and catabolic aspects of mothers' protein metabolism, while thyroid hormones and cortisol modulate the partition of nutrients for milk production and protein synthesis.- It has been observed that some non-essential amino acids become limiting during lactation because of their unique contributions to milk protein synthesis.
Chen et al.²⁸28 ChenL,Wang J, JiangP,RenF, LeiX,GuoH. Alterationof the colostrum whey proteome in mothers with gestational hypothyroidism. PLoS One. 2018;13(10):e0205987. Doi: 10.1371/journal.pone.0205987 Rev Bras Ginecol Obstet Vol. 42 No. 11/2020 Thyroid Diseases during Pregnancy Lopes et al. 757 https://doi.org/10.1371/journal.pone.020...	2018	Cohort	Uninformed	The results suggest that hypothyroidism can alter the serum protein of human colostrum at the composition level, decreasing the levels of metabolic proteins and proteins of cellular structure, while increasing the levels of proteins related to the immune system, which can compromise or reflect in the health of mothers and babies.

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[1] Address for correspondence Fernanda de Oliveira Lopes, PhD Student Av. Rui Barbosa, 716, Flamengo, Rio de Janeiro, RJ, 22250-020 Brazil fernandalopesnutricionista@gmail.com