Relation between birth weight, growth, and subclinical atherosclerosis in adulthood.

BACKGROUND AND OBJECTIVES: Adverse conditions in the prenatal environment and in the first years of life are independently associated with increased risk for cardiovascular disease. This paper aims to study the relation between birthweight, growth in the first year of life, and subclinical atherosclerosis in adults. METHODS: 88 adults aged between 20 and 31 were submitted to sociodemographic qualities, anthropometric data, blood pressure measurements, metabolic profile, and evaluation of subclinical atherosclerosis. RESULTS: Birthweight<2,500 grams (g) was negatively correlated with (a) increased waist-to-hip ratio (WHR), according to regression coefficient (RC) equal to -0.323, 95% CI [-0.571, -0.075] P<0.05; (b) diastolic blood pressure (RC=-4.744, 95% CI [-9.017, -0.470] P<0.05); (c) low HDL-cholesterol (RC=-0.272, 95% CI [-0.516, -0.029] P<0.05); (d) frequency of intima-media thickness (IMT) of left carotid>75th percentile (RC=-0.242, 95% CI [-0.476, -0.008] P<0.05). Birthweight>3,500 g was associated with (a) BMI>25.0 kg/m2, (RC=0.317, 95% CI [0.782, 0.557] P<0.05); (b) increased waist circumference (RC=0.284, 95% CI [0.054, 0.513] P<0.05); (c) elevated WHR (RC=0.280, 95% CI [0.054, 0.505] P<0.05); (d) minimum subcutaneous adipose tissue (SAT) (RC=4.354, 95% CI [0.821, 7.888] P<0.05); (e) maximum SAT (RC=7.095, 95% CI [0.608, 13.583] P<0.05); (f) right lobe of the liver side (RC=6.896, 95% CI [1.946, 11.847] P<0.001); (g) frequency's right lobe of the liver>75th percentile (RC=0.361, 95% CI [0.169, 0.552] P<0.001). Weight gain in the first year of life was inversely correlated with (a) mean IMT of left carotid (RC=-0.046, 95% CI [-0.086, -0.006] P<0.05; (b) frequency IMT of left carotid>75th percentile (RC=-0.253, 95% CI [-0.487, -0.018] P<0.05); (c) mean IMT (RC=-0.038, 95% CI [0.073, -0.002] P<0.05); (d) the frequency of the mean IMT>75th percentile (RC=-0.241, 95% CI [-0.442, -0.041] P<0.05). CONCLUSIONS: Adults birthweight<2,500 g and >3,500 g and with insufficient weight gain in the first year of life have showed different metabolic phenotypes, but all of them were related to subclinical atherosclerosis.

The intergenerational effects on birth weight and its relations to maternal conditions, São Paulo, Brazil.

BACKGROUND AND OBJECTIVES: Parents' birth weight acts as a predictor for the descendant birth weight, with the correlation more strongly transmitted through maternal line. The present research aims to study the correlation between the child's low or increased birth weight, the mother's birth weight, and maternal conditions. METHODS: 773 mother-infant binomials were identified with information on both the baby's and the mother's birth weight recorded. Group studies were constituted, dividing the sample according to birth weight (<2,500 grams (g) and ≥3,500 grams (g)). The length at birth was also studied in children ≤47.5 cm (lower quartile). Chi(2) test or Fisher's exact test, Spearman's Rho, and odds ratio were performed in order to investigate the relation between the children's weight and length at birth and the mothers' and children's variables. RESULTS: The girls were heavier at birth than their mothers, with an average increase at birth weight between the generations of 79 g. The child's birth weight <2,500 g did not show any correlation with maternal birth weight <2,500 g (Fisher 0.264; Spearman's Rho 0.048; OR 2.1 and OR lower 0.7) or with maternal stature below the lower quartile (<157 cm) (Chi (2) sig 0.323; with Spearman's Rho 0.036; OR 1.5 and OR lower 0.7). The child's low birth weight (<2,500 g) was lightly correlated with drug use by the mother during pregnancy (Fisher 0.083; Spearman's Rho 0.080; OR 4.9 and OR lower 1.0). The child's birth weight <2,500 g showed increased correlation with gestational age lower than 38 weeks and 3 days (Chi (2) sig 0.002; Spearman's Rho 0.113; OR 3.2 and OR lower 1.5). The child's weight at birth ≥3,500 g showed strong correlation with maternal weight at birth ≥3,500 g (Chi (2) sig 0; Spearman's Rho +0.142; OR 0.5 and OR upper 0.7). It was also revealed that the higher the maternal prepregnancy BMI, the stronger the correlation with child's birth weight ≥3,500 g ((maternal prepregnancy BMI > 25.0 with Chi (2) sig 0.013; Spearman's Rho 0.09; OR 1.54 and OR upper 2.17) and (maternal prepregnancy BMI > 30.0 with Chi (2) sig 0 Spearman's Rho 0.137; OR 2.58 and OR upper 4.26)). The child's length at birth in the lower quartile (≤47.5 cm) showed strong correlation with drug use by the mother during pregnancy (Chi (2) sig 0.004; Spearman's Rho 0.105; OR 4.3 and OR lower 1.5). CONCLUSIONS: The mother's increased weight at birth and the prenatal overweight or obesity were correlated with increased weight and length at birth of the newborn, coupled with the tendency of increasing birth weight between generations of mothers and daughters. Also, descendants with smaller length at birth are the children of women with the lowest statures.

High abundance of Escherichia during the establishment of fecal microbiota in Brazilian children.

The sequence of bacterial events that occurs during the colonization of the gastrointestinal tract may affect the future health of the host. A clear understanding of the colonization process of the human neonatal gut in developing countries is lacking because the few available studies were mostly performed using culture techniques. Using molecular approaches, this study analyzed the fecal microbiota of children of low socioeconomic status in São Paulo, Brazil, during their first year of life. We collected fecal samples of healthy children at 3, 6, and 12 months of life. Total DNA was extracted directly from feces, and the bacteria-specific primers 27F-1492R were used to construct 16S rRNA libraries. Clones were randomly selected and partially sequenced. The main phylogenetic groups identified at 3 months were Streptococcus, unidentified bacteria, and Escherichia. At 6 months, Escherichia remained predominant, while the unidentified bacterial population increased significantly. At 12 months, a more complex composition of fecal microbiota was observed, represented by unidentified bacteria and microorganisms found at low rates at earlier ages. The genus Escherichia remained the most abundant microorganism (34% relative abundance and 75% prevalence). Principal component analysis (PCA) revealed changes in the composition of the microbiota at 6 months and an increase of diversity at 12 months of life. Bifidobacterium was identified by quantitative PCR (qPCR) and showed a high incidence in the microbiota at 3 months. The present results corroborate the global observation of inter-individual variability with an early establishment of microbial complexity at the end of the first year of life and highlight the presence of the Escherichia as abundant in microbiota composition of this group of children.

No association between low birth weight and cardiovascular risk factors in early adulthood: evidence from São Paulo, Brazil.

BACKGROUND: A growing literature suggests that low birth weight increases the risk of poor health outcomes in adulthood. We tested this hypothesis among young adults living in São Paulo State, Brazil. METHODS AND FINDINGS: To identify the effects of low birth weight on young adulthood outcomes, a medical assessment of 297 individuals born between 1977 and 1989 was conducted at a primary care unit in São Paulo State, Brazil. We analyzed body mass index (BMI), waist-hip ratio, blood pressure, fasting glucose and total cholesterol levels using linear and logistic regressions. Low birth was negatively associated with BMI (ß = -2.0, 95% CI: -3.69, -0.27, p = 0.02), fasting glucose levels (ß = -1.9, 95% CI: -3.9, -0.07, p = 0.05), waist-hip ratio (ß = -0.03, 95% CI: -0.07, -0.01, p = 0.10), systolic blood pressure (ß = -3.32, 95% CI: -7.60, 0.96, p = 0.12), and total cholesterol levels (ß = -3.19, 95% CI: -16.43, 10.05, p = 0.636). Low birth weight was also associated with lower odds of young adults being overweight and obese, but neither association was statistically significant. Weight gain in the first 12 months of life was associated with higher adult BMI (ß = 0.79, 95% CI: -0.0455, 1.623, p = 0.064) and blood pressure (ß = 2.79, 95% CI: 0.22, 5.35, p = 0.034). No associations were found between low birth weight and early life (catch-up) growth. CONCLUSIONS: Low birth weight was not associated with poor health outcomes among young adults in Brazil. These results appear inconsistent with the original Barker hypothesis, but will need to be corroborated in larger samples with longer follow-ups to allow a more general evaluation of the validity of the hypothesis in low and middle income countries.

Relação entre peso de nascimento e ganho pondoestatural no primeiro ano de vida e fatores de risco para a doença cardiovascular em adultos nascidos entre 1977 e 1989 acompanhados no Centro de Saúde-Escola "Prof. Samuel B. Pessoa" do Butantã, cidade de São Paulo / Relationship between birth weight and infant growth in the first year of life and risk factors to cardiovascular diseases of adults followed at Health Center School Prof. Samuel B. Pessoa from Butantã neighborhood, São Paulo, born between 1977 and 1989

A ocorrência de doença cardiovascular não pode ser explicada somente pelo estilo de vida do adulto. Estudos ecológicos e epidemiológicos dos últimos vinte anos demonstraram maior incidência de doenças crônicas não transmissíveis em indivíduos que nasceram com baixo peso e tiveram um ganho de peso inadequado nos dois primeiros anos de vida. A hipótese aceita atualmente é a de que agravos, principalmente nutricionais, ocorridos durante a gestação alteram a programação de órgãos e sistemas para preservar, principalmente, o desenvolvimento cerebral, levando ao sacrifício metabólico de vários órgãos, como rins, fígado, coração, pâncreas, que ao serem solicitados na vida adulta, teriam menor capacidade funcional. Esta teoria foi chamada Hipótese de Barker ou do Fenótipo Poupador. Este trabalho tem como objetivo avaliar o peso de nascimento e do primeiro ano de vida de adultos usuários do Centro de Saúde-Escola Prof. Samuel B. Pessoa, que foram matriculados quando lactentes e que estão atualmente em seguimento nesta unidade de saúde, correlacionando com a sua condição de saúde atual, para tentar demonstrar a teoria das origens desenvolvimentistas da saúde e da doença em nosso meio. A anamnese clínica, medidas da cintura abdominal, cintura quadril, pressão arterial, freqüência cardíaca, e exames laboratoriais, tais como colesterol total e frações, triglicérides, glicemia de jejum foram estudados. Constituiu-se um grupo de 298 usuários, com média de idade de 25 anos, sendo 212 mulheres e 86 homens. Após a execução do estudo observamos que não houve diferença estatisticamente significante em relação a anamnese e aos exames laboratoriais alterados dos adultos, quando se compararam aos grupos com baixo peso de nascimento, nem quando comparados aos grupos com peso baixo com um ano de idade. O acompanhamento destes de adultos, por duas a três décadas, poderá trazer dados que venham a ajudar a comprovar a teoria das origens desenvolvimentistas da saúde e da doença...

The appearance of a cardiovascular disease cannot be explained only by the adults lifestyle. Ecological and epidemiological studies from the last twenty years show a more frequent incidence of non-communicable chronic diseases in individuals that were born under the ideal weight and had an inadequate gain of weight during their first two years. The hypothesis initially accepted is that certain deficiencies, mainly nutritional, that occurred during pregnancy alter the programming of organs and systems in order to preserve the cerebral development. This process may lead to metabolic sacrifice of many organs, including liver, kidneys, heart and pancreas, which will have a worse functional capacity when necessary in adult life. This theory was called Barker Hypothesis or Thrifty Phenotype Hypothesis. This research project has for objective the comparation of the weight at birth and during the first year of life from adults whose health is followed at Health Center School Prof. Samuel B. Pessoa. This group of adults was subscripted when its members were infants. A correlation between their present health and their health conditions when infants was made during this study in order to try to demonstrate in our environment the Developmental Origins of Health and Disease. The basis of the study was the clinical anamneses, the measures of the abdominal waist, hip, arterial pressure, cardiac frequency and some laboratorial examinations, such as total and fractional cholesterol, triglycerides, fasting glucose levels. A group of 298 patients was formed, with an average age of 25 years-old members. 212 of them were women and 86 were men. After this study, it was concluded that the underweight at birth and underweight during the first year of life do not lead to alterations statistically relevant in the anamneses and in the laboratorial examinations. The following of these adults during two or three decades may bring data that might help to prove the developmental...

The etiology of extensive pleural effusions with troublesome clinical course among children

CONTEXTO: Em São Paulo, pneumonia é a principal causa infecciosa de morte infantil. Derrame pleural parapneumônico é uma complicação grave da doença e intervenção cirúrgica pode ser necessária quando o paciente não responde à antibioticoterapia. OBJETIVO: Determinar a etiologia dos derrames pleurais parapneumônicos complicados que necessitaram de intervenção cirúrgica. TIPO DE ESTUDO: Retrospectivo. LOCAL: Hospital Universitário da Universidade de São Paulo. MÉTODOS: A análise de 4.000 prontuários de crianças hospitalizadas por pneumonia de novembro de 1986 a novembro de 1996 mostrou que 115 crianças apresentaram um total de 117 casos de empiema que necessitaram de intervenção cirúrgica. Os autores analisaram os dados clínicos das crianças, correlacionando os achados radiológicos, o estado nutricional e a situação vacinal das crianças. Terapias antimicrobianas prévias e bacterioscopia do derrame pleural também foram analisadas. RESULTADOS: Streptococcus pneumoniae foi o agente mais encontrado, tanto nas hemoculturas quanto nos derrames pleurais. DISCUSSAO: A cobertura vacinal, o peso ao nascimento e o estado nutricional das crianças estudadas foram analisados e comparados aos dados encontrados em outras publicações. Observamos que derrames pleurais causam desconforto importante e, na maioria dos casos, não se trata de complicação do primeiro episódio infeccioso do aparelho respiratório. O uso prévio de antibióticos alterou o resultado das culturas. O achado de Streptococcus pneumoniae como o agente mais freqüentemente encontrado está de acordo com os resultados de outros autores. No entanto, os antibióticos utilizados após a realização do procedimento são os mesmos utilizados em pneumonias não-complicadas, fato que nos levou a concluir que a pior evolução desses casos não se deve à resistência dos agentes aos antimicrobianos. CONCLUSAO: O perfil bacteriano na nossa série de casos é semelhante ao descrito para pneumonias não complicadas. Novos estudos serão necessários para se determinar o motivo da pior evolução dessas crianças.

The etiology of extensive pleural effusions with troublesome clinical course among children.

CONTEXT: In São Paulo, pneumonia is the main infectious cause of death among children. Parapneumonic pleural effusion is a possible complication and has to be treated surgically when the patient does not respond to antibiotics. OBJECTIVE: Assessment of the etiology of complicated parapneumonic pleural effusions that needed surgical intervention. TYPE OF STUDY: Retrospective study. SETTING: University hospital of the University of São Paulo. METHOD: Analysis of 4,000 files on children hospitalized with pneumonia from November 1986 to November 1996 had shown that 115 of these children presented a total of 117 cases of pleural empyema that required surgical procedures. The children's clinical condition was assessed in relation to radiological findings and to their nutrition and immunization status. Previous antimicrobial therapy and pleural effusion bacterioscopy were also evaluated. RESULTS: Streptococcus pneumoniae was the agent found most commonly, as frequently in blood cultures as in pleural effusions. DISCUSSION: Data on vaccination coverage, birth weight and nutritional status are analyzed and compared to other publications. We observed that pleural effusion has a high potential for discomfort, and in most cases it is not a complication of the first pulmonary disease episode. Previous use of antibiotics interfered with culture positivity. The agent most frequently found was Streptococcus pneumoniae, which is in accordance with the findings from other authors. Nonetheless, the antibiotics used to treat the patients after the procedure were the same used in non-complicated pneumonias, which has led us to conclude that the worse outcome in this cases was not due to drug resistance. CONCLUSION: The bacteriological profile in our series of complicated pneumonia cases was similar to what has been described for non-complicated pneumonia cases. Future studies will be necessary to determine why these children presented a worse outcome.

A pediatria comunitária e o ensino médico em creches / Community Pediatrics and Medical Education in Day-Care Centers

Os autores apresentam o Estágio Creche da Pediatria Comunitária, da Disciplina de Pediatria Preventiva e Social, do Departamento de Pediatria da Faculdade de Medicina da Universidade de São Paulo, destinado aos médicos Residentes de Primeiro Ano de Pediatria. São discutidos os objetivos e a metodologia de ensino do estágio.

O ensino da estratégia "atenção integrada às doenças prevalentes da infância" (AIDPI) em pediatria / Teaching the Strategy \"Integrated Management of Childhood Illness\"

A mortalidade em crianças menores que 5 anos de idadeé um problema importante nos países em desenvolvimento. Com o intuito de alterar estas elevadas taxas de mortalidade, em 1996, a Organização Mundial de Saúde (OMS) e o Fundo para Crianças das Nações Unidas(UNICEF) desenvolveram a estratégia "Atenção Integrada às Doenças Prevalentes da Infância" (AIDPI), que tem como objetivo diminuir a mortalidade por meio de ações preventivas e curativas que focam um atendimento integrado da criança, aproveitando o momento da consulta por uma queixa, para a prevenção e promoção da saúde, envolvendo a família e a comunidade. Deve-se reforçar a inclusão do ensino da estratégia AIDPI para os alunos de Medicina em geral e para os de Pediatria em particular, especialmente durante o seu treinamento em atenção primária. Considera-se o ensino desta estratégia fundamental no sentido de preparar os alunos a lidar com as doenças mais prevalentes, melhorando a qualidade e resolutividade da atenção básica.

O ensino medico na atencao primaria em pediatria: um programa para os residentes no Centro de Saude-Escola da FMUSP / The medical learn in primary care center: a program of pediatrics residence on Health Service

Avaliar o programa de ensino na atencao primaria para residentes de pediatria do Instituto da Crianca do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo. O estudo foi realizado atraves da...

Fatores de risco para ocorrência de asma em crianças / Risk Factors fos Asthma in Children

Os autores realizaram estudo retrospectivo em pacientes atendidos no Centro de Saúde Escola "Samuel B. Pessoa" no ano de 1998 com o objetivo de determinar fatores de risco para asma em crianças. Foram pesquisados os fatores: ambiente físico inadequado, baixo peso da criança ao nascer, demame precose e tabagismo passivo. Encontraram associação significativa somente para o ambiente físico inadequado, o que reforça a necessidade de orientar os familiares da criança para procurar melhorar o ambiente de moradia desse pacientes.(au)

A interdisciplinaridade e a aplicaçäo da estrategia de atencao integrada as doencas prevalentes na infancia: instrumentos para a consolidacao do sistema unico de saude / The interdisciplinarity and the integrated management of childhood illness: tools for the consolidation of the national health system

Diante do desafio de adequar a assistencia a saude aos perfis de morbi-mortalidade infantis nos paises em desenvolvimento, a Organizacao Mundial da Saude e o Fundo das Nacoes Unidas para a Infancia elaboraram a proposta de Atencao Integrada as Doencas Prevalentes na Infancia. Tomando-se a interdisciplinaridade como um alicerce para o desenvolvimento dessa estrategia, em consonancia com os principios de universalidade, equidade e integralidade, estabelecidos pelo Sistema Unico de Saude, as autoras vem desenvolvendo...

Residencia basica de pediatria do Departamento de Pediatria da Faculdade de Medicina da USP: um projeto de ensino realizado em creches no municipio de Sao Paulo, vinculado a uma unidade basica de saude / Medical residence of pediatrics at the Medical College, Sao Paulo University, Pediatrics Department: a teaching project realized in day care centers in Sao Paulo, linked a basic health unit

Os autores relatam um modelo de ensino desenvolvido para o curso de residencia basica do Departamento de Pediatria da Faculdade de Medicina da Universidade de Sao Paulo. Durante o estagio realizado no Centro de Saude Escola "Prof. Samuel B. Pessoa" da USP, os residentes participam de atividades docente-assistenciais em 4 creches localizadas na area de abrangencia desta unidade basica de saude. Estas atividades tem contribuido para formar profissionais mais preparados para programar acoes de saude, de cunho educativo e preventivo, nao so individuais, mas tambem coletivas

An exanthematic disease epidemic associated with coxsackievirus B3 infection in a day care center

E descrita uma epidemia de doenca exantematica em uma creche, acometendo 10 criancas de 7 a 13 meses de idade. O quadro exantematico caracterizou-se por lesoes maculo ou maculopapulares nao confluentes, que atingiam a face, tronco e pernas. 50 por cento das criancas infectadas apresentaram febre de ate 39 graus C, no inicio da doenca. Foi isolado das fezes de uma crianca doente o coxsackievirus B3 (CB3). Foram examinados soros pareados de 8 das 10 criancas doentes e em 6 delas demonstrou-se soroconversao para CB3...

Sífilis congênita: apresentaçäo de um caso atípico em lactente jovem / Congenital syphilis: report of a atypical case in a young infant

Os autores apresentam um caso atípico e grave de lues congênita em lactante jovem, com ausência dos sinais mais característicos que usualmente sugerem o diagnóstico. Enfatizam o diagnóstico diferencial com outras infecçöes congênitas ou adquiridas e a necessidade de excluir a lues congênita em todo recém-nascido ou lactante em estado grave ou que simplesmente "näo väo bem"