Interrelatioship between Diet Quality and Depressive Symptoms in Elderly.

BACKGROUND: Several observational studies have shown association between diet quality and depression, but few studies have explored the interrelationship between these variables. OBJECTIVE: The aim of this study was to assess the interrelationship between diet quality and depressive symptoms in elderly. DESIGN: Cross-sectional study. SETTING: Population based. PARTICIPANTS: 1,378 elderly in the city of Pelotas, Brazil. MEASUREMENTS: The diet quality was assessed by a short food frequency questionnaire and the prevalence of depressive symptoms was estimated by the abbreviated Brazilian version of the Geriatric Depression Scale (GDS). The association between diet quality and depressive symptoms was assessed using logistic regression. RESULTS: The prevalence of depressive symptoms was 15.3%. Elderly with low-quality diet were more likely to experience depressive symptoms, and the association was almost twice higher in males than in females (men OR = 3.8, 95% CI 1.4, 10.6; women OR = 2.1, 95% CI: 1.4, 3.3). On the other hand, depressive elderly had higher odds of consuming a low-quality diet (OR 2.4, 95% CI: 1.7, 3.8). LIMITATIONS: Self-reported data and cross-sectional design limit our conclusions. CONCLUSIONS: The choice of a low-quality diet was associated to a higher risk of depressive symptoms in elderly, and vice-versa. These results highlight the importance of encouraging the choice of healthy food habits, especially in depressed elderly, in order to promote healthy aging.

[Opioid antagonists and alcohol consumption]. / Antagonistas opioides y consumo de alcohol.

INTRODUCTION: Alcoholism is considered a chronic, progressive and frequently mortal disease; it is a primary phenomenon rather than a sign or symptom of other diseases. With the aim to reduce the alcohol consumption and the relapse in alcoholics, several pharmacological strategies have been applied; among them the opioid antagonists have been successfully used. The scope of the present study is to show experimental evidence of the effect of different opioid antagonists on alcohol consumption on the base of their receptor specificity in different pharmacological strategies. DEVELOPMENT: Alcohol consumption increases the release of endogenous opioids; therefore, the opioid receptor blocked apparently decreases the rewarding alcohol effects. On this base, the unspecific antagonists as naloxone and naltrexone are the more used in clinic; these substances bind with different affinity to mu, delta and kappa receptors. Specific opioid receptor antagonists have been studied with the scope to clear up the participation of the different opioid receptors modulating the alcohol intake. Although, there is inconsistency in the findings, these studies suggest that the delta and mainly the mu receptors have an important participation modulating alcohol consumption. CONCLUSION: There is sufficient evidence that the opioid system play an important role in the alcohol dependence; however, it is necessary to study integrally the different neurochemistry systems with the scope to understand the neurophysiologic mechanisms underlying the alcohol addiction.

Breast-feeding and growth in Brazilian infants.

A new international growth reference is being prepared based on children who are fed according to World Health Organization recommendations, which entail exclusive breast-feeding for the first 4-6 mo of life. However, the number of exclusively breast-fed infants in most societies is small, so that selection biases may result from using such a population. We examined the variability in linear and soft tissue growth of infants according to their feeding patterns, emphasizing differences between exclusively and predominantly (breast milk plus fluids) breast-fed infants. About 650 infants from a relatively developed urban area in southern Brazil were examined at the ages of 1, 3, 6, and 12 mo, and an additional 800 infants at 6 and 12 mo. At each visit, infants were weighed and measured and a 24-h dietary recall was completed with the infants' caretakers. In the analyses of growth, care was taken to address the biases of reverse causality, regression to the mean, and confounding. There was little association between feeding pattern and growth in the first month. From 1 to 3 mo, partially breast-fed infants tended to gain more weight, followed by those who were completely weaned. From 3 to 6 mo, fully weaned infants grew fastest in weight and length and exclusively breast-fed infants grew slowest. After 6 mo of age, the growth in length of partially breast-fed and fully weaned infants was similar, but the latter gained more weight. There were virtually no differences between exclusively and predominantly breast-fed infants in the first 6 mo of life. There results suggest that both of these groups may be pooled for the purpose of constructing growth references.

PIP: Under the auspices of the World Health Organization, a new international growth reference is being developed to reflect the growth of breast-fed infants and their tendency to falter from 3-4 months onward. Of concern, however, is the small number of exclusively breast-fed infants in most societies and the potential for selection bias. A study conducted in Brazil in 1993 found no significant differences between exclusively and predominantly breast-fed infants in the first 6 months of life, suggesting that both these groups can be pooled for the purpose of growth reference construction. 650 infants from a relatively developed urban area in southern Brazil (Pelotas) were examined at 1, 3, 6, and 12 months of age and an additional 800 infants were enrolled at 6 and 12 months. There was little association between growth and feeding pattern in the first month of life. Slower growth in the first month increased the risk of subsequent weaning. From months 1-3, partially breast-fed infants tended to gain more weight, followed by those who were completely weaned. During months 3-6, fully weaned infants grew fastest in terms of both weight and length and exclusively breast-fed infants grew slowest. After 6 months of age, the growth in length of partially breast-fed and fully weaned infants was similar, but the latter group gained more weight. The tendency for breast-fed infants to grow more slowly should be considered in view of the many benefits of breast feeding, including protection against infections and diseases of the immune system, psychological advantages, and birth spacing.

Etiology of hepatocellular carcinoma in Italian patients with and without cirrhosis.

We performed a case-control study to assess the role of hepatitis B virus (HBV), hepatitis C virus (HCV), GB virus C/hepatitis G virus (HGV), TT virus, alcohol intake, and tobacco smoking as risk factors for hepatocellular carcinoma (HCC) in the presence or absence of cirrhosis. We prospectively recruited 174 patients with a first diagnosis of HCC admitted to the main hospitals in Brescia, North Italy. On the basis of histological, clinical, and radiological criteria, the presence of cirrhosis was established in 142 cases, excluded in 21 cases, and remained undefined in 11 cases. Among the HCC cases without cirrhosis, a histological picture of normal liver was found in a single patient, chronic viral hepatitis was found in 11 patients, alcoholic hepatitis was found in 5 patients, nonspecific reactive hepatitis was found in 3 patients, and hemochromatosis was found in 1 patient. As controls, we also included 610 subjects unaffected by hepatic diseases and admitted to the same hospitals as cases. The odds ratios for having HCC according to positivity for HCV RNA, HBsAg and/or HBV DNA, and alcohol intake > 80 g/day (95% confidence interval) were as follows, in the presence and absence of cirrhosis, respectively: (a) 33.5 (17.7-63.4) and 19.7 (6-64.8) for HCV RNA; (b) 17.6 (9.0-34.4) and 20.3 (5.7-72.6) for HBsAg; and (c) 5.5 (3.1-9.7) and 4.6 (1.5-13.8) for alcohol intake. No association was found with HGV or TT virus infections or tobacco. This study has shown that most HCC cases arising in the area are due to HBV, HCV, or alcohol intake, in both the presence and absence of cirrhosis.

Use of pacifiers is associated with decreased breast-feeding duration.

OBJECTIVE: To determine the relationship between pacifier use at 1 month of age to the duration of breast-feeding to 6 months of age. DESIGN: Longitudinal study of infants from birth to 6 months of age. POPULATION: Six hundred five rooming-in infants born at the largest hospital in Guarujá, São Paulo, Brazil, during January and February 1993. MAIN OUTCOME MEASURES: Prevalence of breast-feeding (exclusive, predominant, and complementary) at 1, 4, and 6 months of age. RESULTS: Relative risk for weaning between 1 and 6 months of age was 3.84 (95% confidence interval 2.65-5.50) for pacifier users at 1 month of age, compared with nonusers. When an adjustment was made for possible confounding variables through Cox regression analysis, the relative risk dropped to 2.87 (95% confidence interval 1.97-419). CONCLUSION: Pacifier use is highly correlated with early weaning, even after controlling for possible confounders. Until it is determined if pacifier use is causally related to weaning or is a marker for other undetermined causes, pacifier use probably should not be recommended for breast-fed infants.

Length and ponderal index at birth: associations with mortality, hospitalizations, development and post-natal growth in Brazilian infants.

BACKGROUND: Low birthweight infants suffer greater mortality and neonatal morbidity, grow less well in infancy and show poorer psycho-motor development. However, this simple categorization may obscure important differences in aetiology and prognosis between infants born stunted, thin, or both. METHODS: In 1993, all births in Pelotas, Brazil, were enrolled into a prospective study of health and development in infancy. Of 5249 live births, 5160 had length and weight measures at birth, and were classified into tertiles of length and ponderal index. All deaths and hospitalizations were monitored, and suspected developmental delay and attained growth at 12 months were assessed on a subsample of 1364 infants. Logistic regression was used to control for gestational age and socioeconomic status. RESULTS: There was no association between birth length and ponderal index tertiles. After adjusting for gestational age, infants in the lower tertiles of both length and ponderal index presented a 3.8-times higher risk of mortality from day 8 to day 365, and a 2.5-times higher risk of hospitalization compared to infants with greater birth lengths and/or ponderal indices. Suspected developmental delay was associated with length and, less strongly, with ponderal index, but there was no synergism between the two. Infants in the middle and upper tertiles of ponderal index at birth became thinner. CONCLUSIONS: Birth length was strongly associated with development at 12 months, but only infants born both short and thin were at increased risk of mortality and hospitalizations. The combination of the two measures provides a useful classification of the anthropometric status of the newborn.

PIP: A prospective study of all 5249 live births in Pelotas, Brazil, in 1993 examined interactions between health and development in infancy. The 5160 infants who had length and weight measurements taken at birth were classified into tertiles of length-for-age Z score and ponderal index--a measure of soft tissue growth. There was no association between these two measures. After adjustments for gestational age, infants in the lower tertiles of both length and ponderal index had a 3.8 times greater risk of mortality from day 8 to 365 and a 2.5 times higher risk of hospitalization than infants in the high tertile. However, infants born short but not thin, or thin but not short, were not at increased risk of either mortality or hospitalization. Suspected developmental delay at 12 months was associated with shorter stature at birth and, less strongly, with a lower ponderal index, but there was no synergism between the two measures. Infants in the middle and upper tertiles of ponderal index at birth became markedly thinner in the first year of life, while length changes were less strongly associated with initial status. Overall, these findings suggest that the combination of length and ponderal index at birth may provide a functionally relevant means of classifying the newborn's anthropometric status since the two measures are relatively independent of each other at the level of the individual and appear to affect different aspects of the infant's subsequent health and development.

Sex differences in alcohol drinking patterns during forced and voluntary consumption in rats.

Wistar rats were studied during forced and voluntary alcohol consumption, and continuous or periodic access to ethanol (6%) v/v with different availability of fluids. Absolute volume of alcohol consumption was not different between sexes in any condition; however, females consumed significantly more alcohol than males on a g/kg basis in all conditions. These differences were significantly more extensive during continuous free-choice to alcohol and water than during forced alcohol consumption. Females showed greater alcohol preference than males only during continuous free-choice to alcohol and water. During periodic free-choice to alcohol and water condition, alcohol consumption was distributed during more hours throughout the day in females than males. During periodic free-choice to alcohol and to an isocaloric sweetened solution (ISS), intakes of ISS were very high compared to regular intakes of daily water; nevertheless, alcohol consumption was maintained to similar levels observed in continuous free-choice to alcohol and water and represented almost 50% of regular daily consumes of water in males and females. Free-choice for alcohol and ISS modified the usual pattern of alcohol consumption during the daily light-dark cycle in males and females and reduced the time devoted to drinking alcohol compared to other conditions, in which similar intakes were observed. Results show that the extent of the higher alcohol consumption in females than males and the changes in patterns of alcohol intake were dependent on the nature of the ingestion schedule.

Alcohol treatment during lactation produces an advance in the onset of puberty in female rats.

It has been described that alcohol treatment after weaning produces a delay in the onset of puberty and a decrease in the body weight of female rats; however, during development, there are periods with different sensitivity to endogenous and exogenous substances. In this study, two daily doses of 2.5 g/kg of ethanol each administered to female pups during days 13-18 of postnatal age produced an advance in the age at vaginal opening but induced no effect on the body weight; however, the onset of sexual behavior was not advanced. Fertility and reproduction measures were not significantly impaired by this treatment. It is supported that, in this period, alcohol can produce different effects - even opposite to those described in other developmental stages - which seems to represent a critical period for alcohol action.

Tobacco smoking, occupational exposure and chronic respiratory disease in an Italian industrial area.

Tobacco smoking and occupational exposure are the major factors responsible for chronic obstructive pulmonary disease (COPD) worldwide. The prevalence of this disease and its main risk factors were investigated in an area characterized by a high density of iron- and steelworking factories in North Italy. A total of 1,497 subjects (50% male) aged 40-59 yrs underwent an interview and a physical assessment, and 1,244 of them also underwent spirometry. The prevalences of COPD and asthma were 16.1 and 5.2% among males and 4.4 and 4.0% among females. COPD and respiratory symptoms were associated with both smoking and occupational exposure in males: the odds ratios for having been occupationally exposed among males were 2.3 (95% confidence interval 1.4-3.7) for COPD and 1.7 (1.2-2.6) for respiratory symptoms. No association was found between asthma and tobacco smoking or occupational exposure. The forced expiratory volume in one second and forced vital capacity were associated negatively with smoking and not associated with occupational exposure. In females, lesser effects of cigarette smoking on both self-reported respiratory diseases and lung function tests were found. The attributable risks of chronic obstructive pulmonary disease for smoking and occupational exposure among males were 52.9 and 8.8%, respectively, and 60.3% when considered together, whereas 18.8% of chronic obstructive pulmonary disease cases among females were attributable to smoking.

[The rural labor process and health in the Southern Brazilian mountains: a descriptive study]. / Processo de produção rural e saúde na serra gaúcha: um estudo descritivo.

This cross-sectional study among rural workers in the mountainous region of the southernmost Brazilian State of Rio Grande do Sul was designed to identify the characteristics of work performed on family farms. The research focused on the socio-demographic profiles of rural workers, identifying the characteristics of rural labor and describing the prevalence of some disease entities in such populations. Some 1479 rural workers from 495 farms were interviewed. In this sample, 87% of the individuals were members of the farm-owning family, mean age was 41 years, 56% were males, and mean schooling was 5 years. Farms had a mean area of 37 hectares, 50% had at least one type of farm machinery, and fruits constituted the main crop. About 75% of workers handled several types of pesticides, while 12% reported at least one lifetime episode of pesticide poisoning. Prevalence of minor psychiatric disorders was 36%, and annual frequency of occupational injuries was 10%. There was a wide variety of activities and occupational risks. The high prevalence of health problems identified in the study calls attention to the need for measures to promote and protect rural workers' health.