Cytokine quantification and association with cervical length in a prospective cohort of pregnant women.

BACKGROUND: Preterm birth is a leading cause of infant morbidity and mortality; its multifactorial causes are an obstacle to understanding etiology and pathogenesis. The importance of cytokines and inflammation in its etiology and association with the short cervix is nowadays well-proven. To date, there are no reliable biological or biochemical markers to predict preterm birth; even though the length of the cervix has high specificity, its sensitivity with the cervix below 2.5 cm is low. OBJECTIVE: We study the association of plasma cytokine levels and cervical length in search of predictors of preterm birth. STUDY DESIGN: We evaluated a total of 1400 pregnant women carrying a single fetus between 20 and 25 weeks of gestation, and 1370 of them after childbirth in a nested case-control study of a prenatal cohort. Eligible pregnant women were interviewed and submitted to obstetric morphological and transvaginal ultrasound with cervical length measurement, gynecological examination, and blood collection. Preterm birth occurred in 133 women, 129 included in the study, and a control group randomly selected at a 2:1 ratio. A total of 41 cytokines with a higher probability of being associated with preterm birth or being of significance during labor were determined. RESULTS: Cytokine and cervical length analysis by multivariate analysis of the conditional interference tree revealed that growth-related oncogene values of less than 2293 pg/mL were significantly associated with a cervical length of less than 2.5 cm. CONCLUSIONS: As well as a cervical length shorter than 2.5 cm, growth-related oncogene levels of less than 2293 pg/ml may be associated with an increased risk of PB. Analysis based on the association of biomarkers and of the interaction between cytokines is a promising pathway in search of a predictor of preterm birth.

Maternal smoking during pregnancy and offspring overweight: is there a dose-response relationship? An individual patient data meta-analysis.

BACKGROUND/OBJECTIVES: A number of meta-analyses suggest an association between any maternal smoking in pregnancy and offspring overweight obesity. Whether there is a dose-response relationship across number of cigarettes and whether this differs by sex remains unclear. SUBJECT/METHODS: Studies reporting number of cigarettes smoked during pregnancy and offspring BMI published up to May 2015 were searched. An individual patient data meta-analysis of association between the number of cigarettes smoked during pregnancy and offspring overweight (defined according to the International Obesity Task Force reference) was computed using a generalized additive mixed model with non-linear effects and adjustment for confounders (maternal weight status, breastfeeding, and maternal education) and stratification for sex. RESULTS: Of 26 identified studies, 16 authors provided data on a total of 238,340 mother-child-pairs. A linear positive association was observed between the number of cigarettes smoked and offspring overweight for up to 15 cigarettes per day with an OR increase per cigarette of 1.03, 95% CI = [1.02-1.03]. The OR flattened with higher cigarette use. Associations were similar in males and females. Sensitivity analyses supported these results. CONCLUSIONS: A linear dose-response relationship of maternal smoking was observed in the range of 1-15 cigarettes per day equally in boys and girls with no further risk increase for doses above 15 cigarettes.

Prevalence of non-communicable diseases in Brazilian children: follow-up at school age of two Brazilian birth cohorts of the 1990's.

BACKGROUND: Few cohort studies have been conducted in low and middle-income countries to investigate non-communicable diseases among school-aged children. This article aims to describe the methodology of two birth cohorts, started in 1994 in Ribeirão Preto (RP), a more developed city, and in 1997/98 in São Luís (SL), a less developed town. METHODS: Prevalences of some non-communicable diseases during the first follow-up of these cohorts were estimated and compared. Data on singleton live births were obtained at birth (2858 in RP and 2443 in SL). The follow-up at school age was conducted in RP in 2004/05, when the children were 9-11 years old and in SL in 2005/06, when the children were 7-9 years old. Follow-up rates were 68.7% in RP (790 included) and 72.7% in SL (673 participants). The groups of low (<2500 g) and high (≥ 4250 g) birthweight were oversampled and estimates were corrected by weighting. RESULTS: In the more developed city there was a higher percentage of non-nutritive sucking habits (69.1% vs 47.9%), lifetime bottle use (89.6% vs 68.3%), higher prevalence of primary headache in the last 15 days (27.9% vs 13.0%), higher positive skin tests for allergens (44.3% vs 25.3%) and higher prevalence of overweight (18.2% vs 3.6%), obesity (9.5% vs 1.8%) and hypertension (10.9% vs 4.6%). In the less developed city there was a larger percentage of children with below average cognitive function (28.9% vs 12.2%), mental health problems (47.4% vs 38.4%), depression (21.6% vs 6.0%) and underweight (5.8% vs 3.6%). There was no difference in the prevalence of bruxism, recurrent abdominal pain, asthma and bronchial hyperresponsiveness between cities. CONCLUSIONS: Some non-communicable diseases were highly prevalent, especially in the more developed city. Some high rates suggest that the burden of non-communicable diseases will be high in the future, especially mental health problems.

Weight/length ratio references and newborn body composition estimation at birth from a Brazilian cohort.

OBJECTIVES: The objective was to calculate weight/length (W/L) ratio values and percentiles by sex and gestational age (GA) to estimate fat mass (FM), fat-free mass (FFM) and body fat percentage (BF%) as well as to compare these indices in preterm, small (SGA), and large (LGA) for GA, stunted and wasted infants from a Brazilian cohort of newborns, comparing with the INTERGROWTH-21st. METHODS: Secondary, cross-sectional analysis of data obtained of 7427 live-born infants from the BRISA Cohort Study in the city of Ribeirão Preto, SP, Brazil in 2010. For body composition estimation, W/L ratio was used in multiple regression models. The 3rd, 50th, and 97th percentiles for W/L ratio and body composition measures (FM, FFM, and BF%) were calculated using fractional polynomial regression models. RESULTS: Average W/L ratio was 6.50 kg/m (SD 0.87), while for FM, BF%, and FFM the corresponding values were 359.64 g (145.76), 10.90% (3.05) and 2798.84 g (414.84), respectively. SGA (< 3rd percentile), and wasted infants showed the lowest W/L ratios and measures of body composition. The 3rd, 50th, and 97th percentiles charts of W/L, FM, BF%, and FFM by GA and sex are presented. CONCLUSIONS: W/L ratio values of the RP-BRISA Cohort are higher than IG-21st. SGA (< 3rd) and wasted infants showed the lowest W/L ratio and measures of body composition. The body composition references presented here could be used to refine the nutritional assessment of Brazilian newborns and to facilitate comparisons across populations.

Relationship between metalloproteinase-2 and -9 levels in plasma and vaginal secretion with preterm birth.

OBJECTIVE: To study the association of plasma and vaginal levels of matrix metalloproteinases 2 (MMP-2) and 9 (MMP-9), determined between 20+0 and 25+6 weeks of gestation, with preterm birth and its predictive value. STUDY DESIGN: All 129 cases of preterm birth (cases) and 258 randomly selected term patients (control group) were included in a cohort study with a nested case-control design. Inclusion criteria were living in Ribeirão Preto, Brazil, and gestational age 20+0 to 25+6 at enrollment. Exclusion criteria were multiple fetuses, congenital malformations or chromosome syndromes, and loss to follow-up. Maternal age, parity, smoking, and previous preterm birth were included as covariates. A blood sample and vaginal secretion were obtained for the determination of MMP-2 and MMP-9; the patients were screened for urinary tract infection and bacterial vaginosis, and cervical length was measured by ultrasound. The cut-off values for matrix metalloproteinases were calculated using receiver operating characteristic (ROC) curves for logistic regression analysis (crude and adjusted odds ratios). RESULTS: According to the WHO, in this study, preterm subtypes included 3.8 % extremely preterm, 6.9 % very preterm, and 89.2 % late preterm births. The plasma MMP-9 cut-off was 63.25 ng/mL and the area under the ROC curve was 0.725 (standard error 0.03; 95 % confidence interval, 0.677-0.769). The cut-off for plasma MMP-2 was 239.4 ng/mL and the area under the ROC curve was 0.585 (standard error 0.03, 95 % confidence interval, 0.521-0.649). Crude odds ratios showed an increased risk of preterm birth associated with plasma MMP-2 (odds ratio, 1.75; 95 % confidence interval, 1.14-2.68) and plasma MMP-9 (odds ratio, 3.26, 95 % confidence interval, 2.09-5.07); no association was detected for vaginal MMP-2 or 9. For plasma, adjusted odds ratios were 1.42 (95 % confidence interval, 0.80-2.53) for MMP-2 and 2.71 (95 % confidence interval, 1 .52-4.83) for MMP-9, along with an increased risk in other covariates. CONCLUSION: Elevated plasma MMP-9 levels and decreased MMP-2 levels were positively associated with preterm birth. Plasma MMP-9 level increased nearly three times the preterm risk.

Mean birth weight among term newborns: direction, magnitude and associated factors.

A trend towards increasing birth weight has been shown, but factors that explain these trends have not been elucidated. The objectives of this study were to evaluate changes in mean birth weight of term newborns and to identify factors associated with them. All cohorts are population-based studies in which random samples of births (Ribeirão Preto, São Paulo State in 1978/1979, 1994 and 2010; Pelotas, Rio Grande do Sul State in 1982, 1993 and 2004; and São Luís, Maranhão State in 1997/1998 and 2010, Brazil). A total of 32,147 full-term, singleton live births were included. Mean birth weight reduced in the first study period (-89.1g in Ribeirão Preto from 1978/1979 to 1994, and -27.7g in Pelotas from 1982 to 1993) and increased +30.2g in Ribeirão Preto from 1994 to 2010 and +24.7g in São Luís from 1997 to 2010. In the first period, in Ribeirão Preto, mean birth weight reduction was steeper among mothers with high school education and among those born 39-41 weeks. In the second period, the increase in mean birth weight was steeper among mothers with low schooling in Ribeirão Preto and São Luís, females and those born 37-38 weeks in Ribeirão Preto and cesarean section in São Luís. Birth weight decreased in the first study period then increased thereafter. The variables that seem to have been able to explain these changes varied over time.

Resveratrol improves endothelial cell markers impaired by plasma incubation from women who subsequently develop preeclampsia.

In this study, we demonstrated that plasma collected from women who subsequently developed preeclampsia caused increased heme oxygenase-1 (HO-1) production and decreased levels of nitric oxide (NO) markers in endothelial cells (HUVECs). Conversely, no changes in HO-1 or NO markers were found when HUVECs were treated with plasma from women who remained healthy throughout pregnancy. These alterations in HO-1 and NO markers were prevented by cotreatment with the polyphenol resveratrol, which also improved GSH levels. In addition, we evaluated changes induced by plasma incubation in the expression of genes and their related pathways associated with antioxidant defenses, such as Nrf2, ARE activity, and GSR. Collectively, our findings suggest that even before the appearance of clinical symptoms of preeclampsia, plasma from affected women is able to induce modifications in endothelial cells with respect to HO-1 production and NO markers. We believe that this in vitro strategy may offer an attractive alternative to the exploitation of candidate markers or screening molecules, such as resveratrol, for the prevention and management of preeclampsia.

Prevalence and Risk Factors for Microcephaly at Birth in Brazil in 2010.

OBJECTIVES: To estimate the baseline prevalence and risk factors for microcephaly at birth before the Zika virus epidemic in 2 Brazilian cities. METHODS: We used population-based data from the Brazilian Ribeirão Preto (RP) and São Luís (SL) birth cohort studies of 2010 that included hospital deliveries by resident mothers. The final sample was 7376 live births in RP and 4220 in SL. Gestational age was based on the date of the mother's last normal menstrual period or obstetric ultrasonography, if available. Microcephaly at birth was classified according to the criteria of the International Fetal and Newborn Growth Consortium for the 21st Century and the Brazilian Ministry of Health. Risk factors for microcephaly, proportionate and disproportionate microcephaly, and severe microcephaly were estimated in a hierarchized logistic regression model. RESULTS: According to the International Fetal and Newborn Growth Consortium for the 21st Century definition, the prevalence of microcephaly (>2 SDs below the mean for gestational age and sex) was higher in SL (3.5%) than in RP (2.5%). The prevalence of severe microcephaly (>3 SDs below the mean) was higher in SL (0.7%) than in RP (0.5%). Low maternal schooling, living in consensual union or without a companion, maternal smoking during pregnancy, primiparity, vaginal delivery, and intrauterine growth restriction were consistently associated with microcephaly. The number of cases of microcephaly is grossly underestimated, with an underreporting rate of ∼90%. CONCLUSIONS: The prevalence of severe microcephaly was much higher than expected in both cities. Our findings suggest that microcephaly was endemic in both municipalities before the circulation of the Zika virus.

Preeclamptic plasma stimulates the expression of miRNAs, leading to a decrease in endothelin-1 production in endothelial cells.

Preeclampsia is a major cause of maternal and fetal morbidity and mortality worldwide. It is a multisystem pregnancy syndrome characterized by general endothelial dysfunction caused mainly by plasma factors and debris in endothelial cells. It is widely accepted that endothelin-1 (ET-1) is involved in the pathophysiology of preeclampsia, and so it is of interest to ascertain whether the ET-1 gene (EDN1) can be targeted with tools such as miRNAs. Therefore, we investigated the relationship between the expression of miRNAs that putatively target EDN1 (and so affect ET-1 levels) in HUVECs incubated with plasma from preeclamptic women. EDN1 expression and ET-1 levels in HUVECs incubated with plasma from women with preeclampsia were similar to those in plasma from healthy pregnant women. Expression of miRNAs let-7a, -7b, and -7c, and to a lesser degree 125a and 125b, was increased in preeclampsia. Expression of miRNAs of the let-7 family was significantly negatively correlated with ET-1 levels in preeclampsia. Transfection of the preeclampsia cultures with mimic miRNA let-7 decreased ET-1 levels. Our findings show that preeclamptic plasma stimulates the expression of miRNAs in HUVECs, leading to a decrease in ET-1levels, which suggests that therapeutic miRNAs may aid in the management of preeclampsia.

Nasopharyngeal colonization with Streptococcus pneumoniae in children infected with human immunodeficiency virus.

OBJECTIVES: To determine the prevalence of pneumococcus colonization among HIV-infected outpatients aged 0 to 18 years. To determine the resistance to penicillin of the microorganisms observed, to identify their serotypes, and to determine whether there are associations between known risk factors and colonization in this group. MATERIAL AND METHOD: This was an observational and cross-sectional study in which nasopharynx swabs were collected from 112 children on the occasion of their monthly appointments and a questionnaire applied to the mothers. The material collected was processed at the microbiology laboratory of the hospital in accordance with National Committee for Clinical Laboratory Standards (NCCLS) regulations and serotyping was performed at the Centers for Diseases Control and Prevention (CDC). Data were analyzed statistically using the chi-square test and with univariate and multivariate analysis with multiple logistic regression. RESULTS: The prevalence rate of nasopharyngeal colonization by pneumococci was 28.6%, with a 15.6% rate of resistance to penicillin (6.2% intermediate resistance and 9.4% full resistance). The serotypes identified were 6A, 6B, 7C, 9V, 11A, 13, 14, 15A, 16F, 18C, 19B, 19F, 23B, 23F, and 34. In this population there were no associations between pneumococcal colonization and the risk factors studied. CONCLUSIONS: The prevalence of pneumococcal colonization among HIV-infected children at our service was not higher than prevalence rates observed in healthy children and reported in the literature.

Weight/length ratio references and newborn body composition estimation at birth from a Brazilian cohort

Abstract Objectives: The objective was to calculate weight/length (W/L) ratio values and percentiles by sex and gestational age (GA) to estimate fat mass (FM), fat-free mass (FFM) and body fat percentage (BF%) as well as to compare these indices in preterm, small (SGA), and large (LGA) for GA, stunted and wasted infants from a Brazilian cohort of newborns, comparing with the INTERGROWTH-21st. Methods: Secondary, cross-sectional analysis of data obtained of 7427 live-born infants from the BRISA Cohort Study in the city of Ribeirão Preto, SP, Brazil in 2010. For body composition estimation, W/L ratio was used in multiple regression models. The 3rd, 50th, and 97th percentiles for W/L ratio and body composition measures (FM, FFM, and BF%) were calculated using fractional polynomial regression models. Results: Average W/L ratio was 6.50 kg/m (SD 0.87), while for FM, BF%, and FFM the corresponding values were 359.64 g (145.76), 10.90% (3.05) and 2798.84 g (414.84), respectively. SGA (< 3rd percentile), and wasted infants showed the lowest W/L ratios and measures of body composition. The 3rd, 50th, and 97th percentiles charts of W/L, FM, BF%, and FFM by GA and sex are presented. Conclusions: W/L ratio values of the RP-BRISA Cohort are higher than IG-21st. SGA (< 3rd) and wasted infants showed the lowest W/L ratio and measures of body composition. The body composition references presented here could be used to refine the nutritional assessment of Brazilian newborns and to facilitate comparisons across populations.

Impact of maternal diabetes mellitus on mortality and morbidity of very low birth weight infants: a multicenter Latin America study.

OBJECTIVES: To compare mortality and morbidity in very low birth weight infants (VLBWI) born to women with and without diabetes mellitus (DM). METHODS: This was a cohort study with retrospective data collection (2001-2010, n=11.991) from the NEOCOSUR network. Adjusted odds ratios and 95% confidence intervals were calculated for the outcome of neonatal mortality and morbidity as a function of maternal DM. Women with no DM served as the reference group. RESULTS: The rate of maternal DM was 2.8% (95% CI: 2.5-3.1), but a significant (p=0.019) increase was observed between 2001-2005 (2.4%, 2.1-2.8) and 2006-2010 (3.2%, 2.8-3.6). Mothers with DM were more likely to have received a complete course of prenatal steroids than those without DM. Infants of diabetic mothers had a slightly higher gestational age and birth weight than infants of born to non-DM mothers. Distribution of mean birth weight Z-scores, small for gestational age status, and Apgar scores were similar. There were no significant differences between the two groups regarding respiratory distress syndrome, bronchopulmonary dysplasia, intraventricular hemorrhage, periventricular leukomalacia, and patent ductus arteriosus. Delivery room mortality, total mortality, need for mechanical ventilation, and early-onset sepsis rates were significantly lower in the diabetic group, whereas necrotizing enterocolitis (NEC) was significantly higher in infants born to DM mothers. In the logistic regression analysis, NEC grades 2-3 was the only condition independently associated with DM (adjusted OR: 1.65 [95% CI: 1.2 -2.27]). CONCLUSIONS: VLBWI born to DM mothers do not appear to be at an excess risk of mortality or early morbidity, except for NEC.

Dairy consumption is associated with a lower prevalence of metabolic syndrome among young adults from Ribeirão Preto, Brazil.

OBJECTIVE: It has been suggested that a greater dairy consumption is a contributing factor to a lower prevalence of metabolic syndrome (MetS) as a result of the possible actions of some milk nutrients. However, results remain controversial. The aim of this study was to examine the association between dairy consumption and MetS and its components. METHODS: Dairy consumption and biochemical and anthropometric parameters were determined in 2031 young adults ages 23 to 25 y. Food consumption was assessed using a food frequency questionnaire. The estimated habitual portion of dairy products consumed daily was divided into quintiles. The criteria of the International Diabetes Federation (IDF) and of the Joint Interim Statement (JIS) were used for the classification of MetS. Nonadjusted and adjusted odds ratios (ORs) were estimated by logistic regression. RESULTS: The prevalence of MetS was 11.9% by the IDF criteria and 9% by the JIS criteria. A greater dairy consumption was associated with a lower prevalence of MetS according to both IDF (OR, 0.61; 95% confidence interval [CI], 0.38-0.97) and JIS (OR, 0.62; 95% CI, 0.39-0.98) criteria when the last quintile was compared with the first. The association persisted in the model adjusted for demographic, socioeconomic, dietary, and lifestyle variables according to the IDF (OR, 0.53; 95% CI, 0.30-0.93) and was borderline according to the JIS (OR, 0.59; 95% CI, 0.34-1.00), but lost significance when data were adjusted for calcium in both models. CONCLUSIONS: A greater dairy consumption is associated with a lower prevalence of MetS, with calcium probably being the nutrient responsible for this association.

Mean birth weight among term newborns: direction, magnitude and associated factors / Média de peso ao nascer em recém-nascidos a termo: direção, magnitude e fatores associados / Peso medio al nacer entre recién nacidos a término: tendencia, magnitud y factores asociados

Abstract: A trend towards increasing birth weight has been shown, but factors that explain these trends have not been elucidated. The objectives of this study were to evaluate changes in mean birth weight of term newborns and to identify factors associated with them. All cohorts are population-based studies in which random samples of births (Ribeirão Preto, São Paulo State in 1978/1979, 1994 and 2010; Pelotas, Rio Grande do Sul State in 1982, 1993 and 2004; and São Luís, Maranhão State in 1997/1998 and 2010, Brazil). A total of 32,147 full-term, singleton live births were included. Mean birth weight reduced in the first study period (-89.1g in Ribeirão Preto from 1978/1979 to 1994, and -27.7g in Pelotas from 1982 to 1993) and increased +30.2g in Ribeirão Preto from 1994 to 2010 and +24.7g in São Luís from 1997 to 2010. In the first period, in Ribeirão Preto, mean birth weight reduction was steeper among mothers with high school education and among those born 39-41 weeks. In the second period, the increase in mean birth weight was steeper among mothers with low schooling in Ribeirão Preto and São Luís, females and those born 37-38 weeks in Ribeirão Preto and cesarean section in São Luís. Birth weight decreased in the first study period then increased thereafter. The variables that seem to have been able to explain these changes varied over time.

Resumo: Existem evidências de uma tendência de aumento do peso ao nascer, mas pouco se sabe sobre os fatores que explicam essa tendência. Avaliar as mudanças na média de peso ao nascer e identificar os fatores associados. Foram incluídas todas as coortes de base populacional com amostras aleatórias de nascimentos (Ribeirão Preto, São Paulo em 1978/1979, 1994 e 2010; Pelotas, Rio Grande do Sul em 1982, 1993 e 2004; São Luís, Maranhão em 1997/1998 e 2010, Brasil). Foi incluído um total de 32.147 nascidos vivos a termo, de feto único. A média de peso ao nascer diminuiu no primeiro período estudado (-89,1g entre 1978/1979 e 1994 em Ribeirão Preto e -27,7g entre 1982 e 1993 em Pelotas) e aumentou no segundo período, +30,2g entre 1994 e 2010 em Ribeirão Preto e +24,7g entre 1997 e 2010 em São Luís. No primeiro período, em Ribeirão Preto, a redução na média de peso ao nascer foi maior entre mães com escolaridade mais alta e crianças nascidas com 39-41 semanas de idade gestacional. No segundo período, o aumento na média de peso ao nascer foi maior entre mães com escolaridade mais baixa em Ribeirão Preto e São Luís, crianças do sexo feminino e nascidas com 37-38 semanas em Ribeirão Preto e crianças nascidas de cesárea em São Luís. O peso ao nascer diminuiu no primeiro período e aumentou desde então. As variáveis que parecem explicar essas mudanças variaram ao longo do tempo.

Resumen: Se ha mostrado una tendencia de aumento de peso al nacer, pero los factores que explican esta tendencia todavía no han sido elucidados. Evaluar los cambios en el peso medio al nacer de los recién nacidos a término e identificar factores asociados. Se trata de un estudio de todas las cohortes basadas en población, donde existe una muestra aleatoria simple de nacimientos (Ribeirão Preto, São Paulo en 1978/1979, 1994 y 2010; Pelotas, Rio Grande do Sul en 1982, 1993 y 2004; y São Luís, Maranhão en 1997/1998 y 2010, Brasil). Se incluyeron un total de 32.147 de nacimientos a término completo con embarazo de un único feto. El peso medio al nacer se redujo en el primer estudio del período (-89,1g en Ribeirão Preto desde 1978/1979 a 1994 y -27,7g en Pelotas desde 1982 a 1993) y se incrementó +30,2g en Ribeirão Preto desde 1994 a 2010 y +24.7g en São Luís desde 1997 a 2010. En el primer periodo, en Ribeirão Preto, la reducción del peso medio al nacer fue más pronunciada entre madres con una escolarización más alta y entre aquellos nacidos con 39-41 semanas. En el segundo período, el incremento en el peso medio al nacer fue más pronunciado entre las madres con una escolarización más baja en Ribeirão Preto y São Luís, mujeres y aquellos que nacieron con 37-38 semanas en Ribeirão Preto y en el área de cesáreas en São Luís. Disminuyó el peso al nacer durante el primer período de estudio y se vio incrementado después. Las variables que parecen capaces de explicar estos cambios varían a lo largo del tiempo.

Normal weight obesity is associated with metabolic syndrome and insulin resistance in young adults from a middle-income country.

OBJECTIVE: This population-based birth cohort study examined whether normal weight obesity is associated with metabolic disorders in young adults in a middle-income country undergoing rapid nutrition transition. DESIGN AND METHODS: The sample involved 1,222 males and females from the 1978/79 Ribeirão Preto birth cohort, Brazil, aged 23-25 years. NWO was defined as body mass index (BMI) within the normal range (18.5-24.9 kg/m(2)) and the sum of subscapular and triceps skinfolds above the sex-specific 90th percentiles of the study sample. It was also defined as normal BMI and % BF (body fat) >23% in men and >30% in women. Insulin resistance (IR), insulin sensitivity and secretion were based on the Homeostasis Model Assessment (HOMA) model. RESULTS: In logistic models, after adjusting for age, sex and skin colour, NWO was significantly associated with Metabolic Syndrome (MS) according to the Joint Interim Statement (JIS) definition (Odds Ratio OR = 6.83; 95% Confidence Interval CI 2.84-16.47). NWO was also associated with HOMA2-IR (OR = 3.81; 95%CI 1.57-9.28), low insulin sensitivity (OR = 3.89; 95%CI 2.39-6.33), and high insulin secretion (OR = 2.17; 95%CI 1.24-3.80). Significant associations between NWO and some components of the MS were also detected: high waist circumference (OR = 8.46; 95%CI 5.09-14.04), low High Density Lipoprotein cholesterol (OR = 1.65; 95%CI 1.11-2.47) and high triglyceride levels (OR = 1.93; 95%CI 1.02-3.64). Most estimates changed little after further adjustment for early and adult life variables. CONCLUSIONS: NWO was associated with MS and IR, suggesting that clinical assessment of excess body fat in normal-BMI individuals should begin early in life even in middle-income countries.

Cesarean Section Is Associated with Increased Peripheral and Central Adiposity in Young Adulthood: Cohort Study.

BACKGROUND: Cesarean section (CS) has been associated with obesity, measured by body mass index (BMI), in some studies. It has been hypothesized that this association, if causal, might be explained by changes in gut microbiota. However, little is known about whether CS is also associated with increased adiposity as measured by indicators other than BMI. OBJECTIVE: To assess the association between CS and indicators of peripheral and central adiposity in young adults. METHODS: The study was conducted on 2,063 young adults aged 23 to 25 years from the 1978/79Ribeirão Preto birth cohort, São Paulo, Brazil. CS was the independent variable. The anthropometric indicators of adiposity were: waist circumference (WC), waist-height ratio (WHtR), waist-hip ratio (WHR), tricipital skinfold (TSF), and subscapular skinfold (SSF). The association between CS and indicators of adiposity was investigated using a Poisson model, with robust adjustment of variance and calculation of incidence rate ratio (IRR) with 95% confidence interval (95%CI), and adjustment for birth variables. RESULTS: Follow-up rate was 31.8%. The CS rate was 32%. Prevalences of increased WC, WHtR, WHR were 32.1%, 33.0% and 15.2%, respectively. After adjustment for birth variables, CS was associated with increased risk of adiposity when compared to vaginal delivery: 1.22 (95%CI 1.07; 1.39) for WC, 1.25 (95%CI 1.10;1.42) for WHtR, 1.45 (95%CI 1.18;1.79) for WHR, 1.36 (95%CI 1.04;1.78) for TSF, and 1.43 (95%CI 1.08;1.91) for SSF. CONCLUSION: Subjects born by CS had a higher risk for increased peripheral and central adiposity during young adult age compared to those born by vaginal delivery. The association of CS with adiposity was consistently observed for all indicators and was robust after adjustment for a variety of early life confounders.

Impact of maternal diabetes mellitus on mortality and morbidity of very low birth weight infants: a multicenter Latin America study / Impacto da diabetes mellitus maternal sobre a mortalidade e morbidade de crianças com muito baixo peso ao nascer: um estudo em diversos centros da América Latina

OBJECTIVES: To compare mortality and morbidity in very low birth weight infants (VLBWI) born to women with and without diabetes mellitus (DM). METHODS: This was a cohort study with retrospective data collection (2001-2010, n = 11.991) from the NEOCOSUR network. Adjusted odds ratios and 95% confidence intervals were calculated for the outcome of neonatal mortality and morbidity as a function of maternal DM. Women with no DM served as the reference group. RESULTS: The rate of maternal DM was 2.8% (95% CI: 2.5-3.1), but a significant (p = 0.019) increase was observed between 2001-2005 (2.4%, 2.1-2.8) and 2006-2010 (3.2%, 2.8-3.6). Mothers with DM were more likely to have received a complete course of prenatal steroids than those without DM. Infants of diabetic mothers had a slightly higher gestational age and birth weight than infants of born to non-DM mothers. Distribution of mean birth weight Z-scores, small for gestational age status, and Apgar scores were similar. There were no significant differences between the two groups regarding respiratory distress syndrome, bronchopulmonary dysplasia, intraventricular hemorrhage, periventricular leukomalacia, and patent ductus arteriosus. Delivery room mortality, total mortality, need for mechanical ventilation, and early-onset sepsis rates were significantly lower in the diabetic group, whereas necrotizing enterocolitis (NEC) was significantly higher in infants born to DM mothers. In the logistic regression analysis, NEC grades 2-3 was the only condition independently associated with DM (adjusted OR: 1.65 [95% CI: 1.2 -2.27]). CONCLUSIONS: VLBWI born to DM mothers do not appear to be at an excess risk of mortality or early morbidity, except for NEC. .

OBJETIVOS: Comparar mortalidade e morbidade em crianças de muito baixo peso (MBP) filhas de mães com e sem diabetes mellitus (DM). MÉTODOS: Estudo de coorte com coleta retrospectiva de dados (2001-2010, n = 11.991) da rede Neocosur. Odds ratios ajustados foram calculados para mortalidade e morbilidade neonatal em função da DM materna. Mulheres sem DM serviram como grupo de referência. RESULTADOS: A taxa de DM materna foi de 2,8% (IC 95% 2,5-3,1), mas um aumento significativo (p = 0,019) entre 2001-2005 (2,4%) e 2006-2010 (3,2%) foi observado. As mães com DM eram mais propensas a ter recebido um curso completo de esteroides pré-natais do que as sem DM. Os bebês de mães diabéticas tinham uma idade gestacional e peso ao nascer um pouco maior do que crianças filhas de não DM. A distribuição dos escores z do peso ao nascer, pequeno para idade gestacional e de Apgar foi semelhante. Não houve diferenças significativas entre os dois grupos em termos de síndrome do desconforto respiratório, displasia broncopulmonar, hemorragia intraventricular, leucomalácia periventricular e persistência do ductus arteriosus. Mortalidade na sala de parto, mortalidade total, necessidade de ventilação mecânica e taxas de sepse neonatal precoce foram significativamente menores no grupo diabético, enquanto enterocolite necrosante (NEC) foi significativamente maior em recém-nascidos de mães diabéticas. Em análises de regressão logística NEC foi a única condição independentemente associada com DM (OR ajustado 1,65 [IC 95% 1,21 -2,27]). CONCLUSÕES: Crianças MBP de DM não parecem estar em um excesso de risco de mortalidade ou morbidade precoce, exceto NEC. .

Nasopharyngeal colonization with Streptococcus pneumoniae in children infected with human immunodeficiency virus

OBJECTIVE: To determine the prevalence of pneumococcus colonization among HIV-infected outpatients aged 0 to 18 years. To determine the resistance to penicillin of the microorganisms observed, to identify their serotypes, and to determine whether there are associations between known risk factors and colonization in this group. MATERIAL AND METHOD: This was an observational and cross-sectional study in which nasopharynx swabs were collected from 112 children on the occasion of their monthly appointments and a questionnaire applied to the mothers. The material collected was processed at the microbiology laboratory of the hospital in accordance with National Committee for Clinical Laboratory Standards (NCCLS) regulations and serotyping was performed at the Centers for Diseases Control and Prevention (CDC). Data were analyzed statistically using the chi-square test and with univariate and multivariate analysis with multiple logistic regression. RESULTS: The prevalence rate of nasopharyngeal colonization by pneumococci was 28.6%, with a 15.6% rate of resistance to penicillin (6.2% intermediate resistance and 9.4% full resistance). The serotypes identified were 6A, 6B, 7C, 9V, 11A, 13, 14, 15A, 16F, 18C, 19B, 19F, 23B, 23F, and 34. In this population there were no associations between pneumococcal colonization and the risk factors studied. CONCLUSIONS: The prevalence of pneumococcal colonization among HIV-infected children at our service was not higher than prevalence rates observed in healthy children and reported in the literature.