Gut microbiota transfer evidence from mother to newborn.

Early life microbiota is a risk factor for future diseases. The main purpose of this study was to investigate the transfer of gut microbiota from mother to newborn. A biological sample was collected from the anal mucosa of the pregnant women before delivery and from the newborns between 24 and 48 h after delivery, as it was not possible to collect a meconium sample at that time. The microbiome of the samples was analyzed by sequencing the hypervariable regions V3-V4 of the 16S gene. To determine the likelihood of microbiota transfer from mother to newborn and examine the relationship with the mode of delivery, we utilized Fisher's exact test and odds ratio. A weighted transfer ratio was employed as a comprehensive measure of transfer. A total of 5767 ASVs were identified in newborn samples (n = 30) and 7253 in maternal samples (n = 30). In the analysis of transfer correlated with the mode of delivery, we observed significant ASVs (p < 0.05). Vaginal delivery showed a positive probability of transfer (OR = 2.184 and WTR = 1.852). We found a negative correlation (OR < 1) between the abundance of maternal ASVs and the likelihood of microbiota transfer to the newborn in both delivery modes. The relationship was inversely proportional for both cesarean section (log10 = - 0.2229) and vaginal delivery (log10 = - 0.1083), with statistical significance observed only for cesarean section (p = 0.0083).  Conclusion: In our sample, the maternal gut microbiome was found to be associated with the infant gut microbiome, indicating evidence of ASV-specific transfer from the maternal microbiome to newborns. What is Known: • There is a relationship of early-life microbiota composition with future health outcomes. What is New: • This was the first study to evaluate maternal gut microbiota transfer to newborns in Brazil.

Mother-infant bonding: The role of postpartum depression, violence, and bonding established with one's own mother during childhood.

Mother-infant bonding is influenced by several risk and protective factors, and the literature has investigated the relationships between these factors independently. This study aimed to verify the interrelationships of some of these factors and how they influence mother-infant bonding in Brazil. In this study, 361 mothers participated, and the outcome variable of mother-infant bonding was assessed using the Postpartum Bonding Questionnaire (PBQ). Multivariate regression analysis was performed using a hierarchical model with three blocks structured according to the influence exerted on mother-infant bonding. The PBQ's factor scores were estimated and used in the subsequent analyses to decrease measurement error. The variable "violence experienced by mothers" was statistically significant for explaining the second block model but not significant for the third block. Network analysis was performed after multiple regression, showing that the violence experienced by mothers does not directly influence mother-infant bonding but rather is mediated by postpartum depression. This explains why violence is not significant in the hierarchical multiple regression when maternal depression is added to the model. This study's strengths lie in its utilization of PBQ factor scores and network analysis, enabling the estimation of conditional relationships among variables. This approach provides deeper insights into factors affecting mother-infant bonding.

Varios factores de riesgo y de protección ejercen influencia sobre la unión afectiva madre­infante; la literatura disponible ha investigado las relaciones entre estos factores de una manera independiente. Este estudio se propuso verificar las interrelaciones de algunos de estos factores y cómo ellos influyen en la unión afectiva madre­infante. Se consultó un total de 361 madres y el variable resultado de afectividad madre­infante se evaluó por medio del Cuestionario de Afectividad de Postparto (PBQ). Se llevaron a cabo análisis de regresión multivariados usando un modelo jerárquico con tres estructuras de bloques de acuerdo con la influencia ejercida sobre la unión afectiva madre­infante. Se estimaron y usaron los puntajes de factores del PBQ en los análisis subsecuentes para disminuir el error en la medida. La variable "violencia experimentada por las madres" fue estadísticamente significativa para explicar el segundo modelo de bloque, pero no significativa para el tercer bloque. Se llevó a cabo un análisis de interrelaciones después de la regresión múltiple, demostrando que la violencia experimentada por las madres no influye directamente la afectividad madre­infante, sino que la misma es mediada por la depresión posterior al parto. Esto explica por qué la violencia no es significativa en la jerárquica regresión múltiple cuando la depresión materna se le agrega al modelo. Entre los puntos fuertes de este estudio se incluye el uso de los puntajes de factores del PBQ y el análisis de interrelaciones, lo cual permitió que se estimaran las relaciones condicionales existente dentro del grupo de variables, aportando una mayor comprensión de algunos factores que interfieren en la unión afectiva madre­infante.

The influence of the municipal human development index and maternal education on infant mortality: an investigation in a retrospective cohort study in the extreme south of Brazil.

BACKGROUND: Infant mortality is considered an important and sensitive health indicator in several countries, especially in underdeveloped and developing countries. Most of the factors influencing infant mortality are interrelated and are the result of social issues. Therefore, this study performed an investigation of the influence of the MHDI and maternal education on infant mortality in a capital in the extreme south of Brazil. METHODS: It is a retrospective cohort study with data on births and deaths in the first year of life for the period of 2000-2017. The association between the independent variables and the outcome was done by bivariate analysis through simple Poisson regression. The variables that can potentially be considered confounding factors were used in a multiple Poisson regression for robust variances - adjusted model. RESULTS: The study included 317,545 children, of whom 3107 died. The medium MHDI showed associated with infant death in the first year of life. Maternal education, individually and jointly analyzed with the MHDI, showed association with the outcome of infant death in the first year of life, particularly for children of mothers with lower maternal education (p < 0.001). In relation to other related factors, maternal age; number of Prenatal Care Consultations; gestational age, weight, gender and Apgar Index (5th minute) of the newborn showed association with IM (p < 0.001). CONCLUSIONS: The HDI is considered a good predictor of infant mortality by some authors and the analyzes of the present study also confirm an association of the medium MHDI and its low MHDIE component with infant mortality. In addition, it was maternal education with less than 8 years of study that that demonstrated a higher risk of death, revealing itself to be a social determinant with a relevant impact on infant mortality. Thus, it is possible to conclude that maternal education is available information, and it is superior to the MHDI to assess the infant mortality outcome.

Infant processed food consumption and their interaction to breastfeeding and growth in children up to six months old.

BACKGROUND: Evidences suggest that early processed food (PF) consumption may cause harm to infant health. During the first 6 months of life, it is not known whether the timing and quantity of this food group can impact breastfeeding and growth. The aim of the study was to analyze the associations between time of introduction and quantity of infant PF consumption with duration of breastfeeding and infant growth at 6 months of age. METHODS: Data were longitudinally collected in six interviews, from birth to 6 months, in a sample of Brazilian newborns with adverse intrauterine environments. PF consumption was calculated by gravity score of processed foods (GSPF) in relation to feeding supply quality and time. For the analysis, the scores were divided into tertiles, making scores severities: Null, Mild, Moderate, and Severe. The interaction between GSPF and breastfeeding (exclusive and non-exclusive) and growth parameters (analyzed in Z-scores, by weight for height, weight for age, and body mass index for age) was tested. RESULTS: A total of 236 infants were included in the study. Greater GSPF were associated with better rates of breastfeeding practices and higher growth indicators scores in the sixth month of infants. These findings were confirmed after adjustment for family income, maternal age, pre-gestational body mass index, and growth z scores at birth. CONCLUSION: The harms of eating PF in relation to breastfeeding and infant growth are more evident the greater and earlier they are consumed. Future studies should explore interventions to reduce and delay the consumption of these foods to prevent adverse health outcomes in later life.

Modifiable predictors to maternal visceral adipose tissue during pregnancy: A clinical, demographic, and nutritional study.

AIM: Higher amounts of maternal visceral adipose tissue were related to abnormal outcomes in pregnancy. Our objective was to evaluate the impact of modifiable and nonmodifiable predictors related to abnormal amounts of maternal visceral fat during three trimesters of pregnancy. METHODS: Visceral fat thickness was evaluated by ultrasound during three trimesters centered in the maternal epigastrium (preperitoneal m-VAT) and additionally fat thickness evaluation centered at maternal periumbilical region (periumbilical m-VAT) among cases with gestational age below 20 weeks. The fourth quartile was considered abnormal m-VAT and the first three quartiles as normal m-VAT. Nonmodifiable characteristics included maternal age, past term pregnancies, and ethnicity. Modifiable characteristics included pre-pregnancy body mass index (BMI), weight gain, usual macronutrients, and sugar consumption during pregnancy. RESULTS: Preperitoneal m-VAT was assessed in 270 pregnant women and m-VAT periumbilical assessment in 154. The fourth quartile measurement was 15 mm and 53 mm, respectively. Nonmodifiable predictors including maternal age and past term pregnancies significantly impacted the primary study outcome of abnormal periumbilical m-VAT. Having a non-Caucasian ethnicity had a significant impact on the amount of normal preperitoneal m-VAT. Among the modifiable characteristics, both pre-pregnancy BMI and pre-pregnancy obesity impacted the amount of abnormal preperitoneal and periumbilical m-VAT. CONCLUSION: Abnormal amounts of maternal visceral fat during pregnancy are related to nonmodifiable predictors and those present before pregnancy. No impact was found among weight gain during pregnancy or macronutrients and sugar consumption at pregnancy.

Maternal adipose tissue to early preeclampsia risk detection: Is the time to maternal ultrasound beyond fetal evaluation?

INTRODUCTION: This study aims to determine the predictive capacity of isolated maternal periumbilical and epigastric fat measurements during pregnancy to hypertensive outcomes. METHODS: A cohort study was conducted with pregnant women in any trimester and followed until delivery to identify the outcomes of interest, preeclampsia (PE) and gestational hypertension (GH). The predictive capacity of fourth quartile measurements was compared with the first three quartiles of maternal subcutaneous and visceral adipose tissue from the periumbilical site (periumbilical m-SAT and m-VAT) (n = 155) and maternal adipose tissue from the epigastric site (preperitoneal m-SAT and m-VAT) (n = 261). The predictive ability of prepregnant body mass index (BMI) above 30 kg/m2 for PE and GH was also assessed. RESULTS: Fourth quartiles for the periumbilical ultrasound measurements were m-VAT 52.7 mm and m-SAT 21.7 mm. Preperitoneal site presents fourth quartiles m-VAT 15.2 mm and m-SAT 18.6 mm. Both m-VAT and m-SAT maternal periumbilical and preperitoneal sites are unable to predict PE, with the utmost sensitivity attributed to the periumbilical site m-SAT at 54%. The best PE predictor odds ratio (OR) found was the prepregnant BMI consistent with obesity, with an OR of 3.2 (95% CI 1.1-9.4), whereas the best OR to GH predictor was preperitoneal m-SAT with 8.9 (95% CI 2.3-34.6). CONCLUSION: PE pathogenic mechanisms related to maternal abdominal adipose tissue include differences in molecular, cytological, and tissue levels not detected by ultrasound in a quantified gray scale assessment. Periumbilical or epigastric m-VAT use is not able to predict PE during pregnancy.

Telomere length in healthy newborns is not affected by adverse intrauterine environments.

Different intrauterine exposures are associated with different metabolic profiles leading to growth and development characteristics in children and also relate to health and disease patterns in adult life. The objective of this work was to evaluate the impact of four different intrauterine environments on the telomere length of newborns. This is a longitudinal observational study using a convenience sample of 222 mothers and their term newborns (>37 weeks of gestational age) from hospitals in Porto Alegre, Rio Grande do Sul (Brazil), from September 2011 to January 2016. Sample was divided into four groups: pregnant women with Gestational Diabetes Mellitus (DM) (n=38), smoking pregnant women (TOBACCO) (n=52), mothers with small-for-gestational age (SGA) children due to idiopathic intrauterine growth restriction (n=33), and a control group (n=99). Maternal and newborn genomic DNA were obtained from epithelial mucosal cells. Telomere length was assessed by qPCR, with the calculation of the telomere and single copy gene (T/S ratio). In this sample, there was no significant difference in telomere length between groups (p>0.05). There was also no association between childbirth weight and telomere length in children (p>0.05). For term newborns different intrauterine environments seems not to influence telomere length at birth.

Does domestic violence during pregnancy influence the beginning of complementary feeding?

BACKGROUND: This study investigate the influence of domestic violence against pregnant women on early complementary feeding and associated factors. METHODS: A longitudinal observational study was conducted with a convenience sample recruited from three public hospitals in Porto Alegre, Rio Grande do Sul, Brazil. Data on maternal age, education, marital status, breastfeeding, introduction of complementary feeding and domestic violence during pregnancy were investigated at four follow-ups points. Data on domestic violence was collected through a self-report questionnaire based on the Abuse Assessment Screen. The early introduction of complementary feeding, characterized as occurring before or at 3 months of life, was verified through a questionnaire prepared by the research group. Data analysis involved Student's t-test, the chi-square test and Cox regression and was carried out in Statistical Package for the Social Sciences program. The significance level was set at 5%. RESULTS: A total of 232 mother-infant pairs participated in the analyses, and 15.1% of the mothers reported suffering some form of violence. Domestic violence was directly associated with maternal education, marital status, and health status during pregnancy. Domestic violence was not associated with maternal age or breastfeeding at 3 months after delivery. In the univariate analysis, domestic violence during pregnancy was associated with early complementary feeding (RR = 1.74; CI: 1.01-2.98). This effect disappeared after the model was adjusted in multivariate analysis. CONCLUSIONS: There was no relationship between domestic violence during pregnancy and early complementary feeding.

Anthropometrical measurements and maternal visceral fat during first half of pregnancy: a cross-sectional survey.

BACKGROUND: Determining anthropometric measures that indicate different fat deposits can be useful to predict metabolic risk and set specific treatment goals, reducing negative consequences for maternal and fetal health. In cases where pre-gestational weight measure and subsequent body mass index (BMI) values cannot be determined, other anthropometric measurements may be ideal for measuring the nutritional status of pregnant women, especially in low- and middle-income countries. This study aims to identify which anthropometric measurements correlate better with the maternal fat deposits measured by ultrasound. METHODS: A cross-sectional study was conducted with pregnant women from the city of Porto Alegre (city), capital of Rio Grande do Sul (state), southern Brazil, from October 2016 until January 2018. Anthropometrical variables (weight, height, mid-upper arm circumference [MUAC], circumferences of calf and neck and triceps skinfolds [TSF] and subscapular skinfolds [SBSF]), and ultrasound variables (visceral adipose tissue [VAT] and total adipose tissue [TAT]) were collected. To verify the correlation of anthropometric and ultrasound measurements, a non-adjusted and adjusted Spearman correlation was used. The study was approved by the ethics committees. RESULTS: The age median of the 149 pregnant women was 25 years [21-31], pre-pregnancy BMI was 26.22 kg/m² [22.16-31.21] and gestational age was 16.2 weeks [13.05-18.10]. The best measurements correlated with VAT and TAT were MUAC and SBSF, both of which showed a higher correlation than pre-pregnancy BMI. CONCLUSIONS: It is possible to provide a practical and reliable estimate of VAT and TAT from the anthropometric evaluation (MUAC or SBSF) that is low cost, efficient and replicable in an outpatient clinic environment, especially in low- and middle-income countries.

Cesarean Delivery and Hypertension in Early Adulthood.

The rate of cesarean delivery (CD) is high in many parts of the world. Birth via CD has been associated with adverse later health outcomes, such as obesity, asthma, and type 1 diabetes mellitus. Few studies have focused on hypertension. We investigated the associations of CD with hypertension, systolic blood pressure (BP), and diastolic BP and tested whether body mass index (BMI; weight (kg)/height (m)2) was a mediator of these associations in a birth cohort (n = 2,020) assembled in 1978-1979 and followed up in 2002-2004 in Ribeirão Preto, Brazil. The CD rate was 32.0%. Hypertension was present in 11.7% of persons born via CD and 7.7% of those born vaginally. Being born by CD increased the odds of hypertension by 51% (odds ratio = 1.51, 95% confidence interval (CI): 1.10, 2.07). After adjustment for confounders, this estimate changed little (odds ratio = 1.49, 95% CI: 1.07, 2.06). In a mediation analysis, odds ratios for the indirect and direct effects were 1.18 (95% CI: 1.11, 1.25) and 1.31 (95% CI: 0.97, 1.65), respectively. CD also had indirect effects on both systolic and diastolic BP via BMI. Our findings suggest that CD is associated with young-adult hypertension and that this association is at least partially mediated by BMI. This has implications for countries struggling with the burden of noncommunicable diseases and where CD rates are high.

The relationship between the different low birth weight strata of newborns with infant mortality and the influence of the main health determinants in the extreme south of Brazil.

BACKGROUND: Low birth weight (LBW) newborns present different health outcomes when classified in different birth weight strata. This study evaluated the relationship of birth weight with Infant mortality (IM) through the influence of biological, social, and health care factors in a time series. METHODS: Retrospective cohort study with data collected from Information Systems (Live Births and Mortality). The mortality trends were performed for each birth weight stratum: extremely low, < 1000 g; very low, 1000-1499 g; low, 1500-2499 g; insufficient, 2500-2999 g; adequate, 3000-3900 g; and macrosomia, > 4000 g. Chi-square tests analyzed IM rates. Sequential Poisson regression analyzed the impact of the determinant factors. RESULTS: A total of 277,982 newborns were included in the study and 2088 died before their first year. There was a tendency for a decrease in mortality in all strata of weight. With the exception of macrosomics, all other strata had a higher risk for IM when compared with adequate birth weight. Extremely LBW newborns presented higher risk for mortality when born in a public hospital. A higher percentage of infant deaths were associated with lower maternal age and lower schooling for all strata. Prenatal care with less than three visits demonstrated a risk for IM in low, insufficient, and adequate birth weight strata. The cesarean section was a protective factor for IM in Extremely and Very LBW strata and it was a risk factor in adequate birth weight stratum. CONCLUSIONS: LBW had a greater association with IM, especially those children of younger mothers and those born in public hospitals.

Gender and social mobility modify the effect of birth weight on total and central obesity.

BACKGROUND: Little is known about the interaction between gender and low birth weight (LBW) and lifelong social mobility as an explanation of the etiology of obesity. The aim of the present study was to evaluate total and central obesity according to gender, LBW and social mobility, within the context of the epidemiological transition in middle-income countries. We hypothesize that there are more pronounced metabolic consequences of social mobility for women born with LBW. METHODS: We used data from a birth cohort study conducted in Ribeirão Preto, São Paulo, Brazil. Data regarding anthropometric measurements, schooling and smoking status were collected at 23-25 years of age. Social mobility was determined based on maternal and adult offspring schooling and categorized as Low-Low, Low-High and High-High. Analysis of covariance was performed to assess the association between social mobility and body mass index (BMI) or waist circumference (WC) in adulthood, stratified by LBW and gender. RESULTS: Data on 6827 singleton pregnancies were collected at birth in 1978/79 and a sample was followed up in 2002/04. A total of 2063 subjects were included in the study. Mean age was 23.9 ± 0.7 years, 51.8% (n = 1068) were female and the LBW was 6.2% (n = 128). There was a triple interaction between social mobility, LBW and gender. Among women born without LBW, BMI and WC were higher in the Low-Low group compared to High-High schooling group. Among LBW women, BMI and WC were higher in the Low-Low group compared to the Low-High group. CONCLUSIONS: Women born with LBW belonging to the low schooling group in early adulthood had high BMI and WC, compared to the Low-High social mobility group.

Could a remarkable decrease in leptin and insulin levels from colostrum to mature milk contribute to early growth catch-up of SGA infants?

BACKGROUND: Breast milk is known to contain many bioactive hormones and peptides, which can influence infant growth and development. In this context, the purpose of this study was to evaluate the influence of different clinical pregnancy conditions on hormone concentrations in colostrum and mature breast milk. METHODS: An observational study was performed with mother-newborn pairs divided into five groups according to maternal clinical background: diabetes (12), hypertension (5), smoking (19), intrauterine growth restriction of unknown causes with small-for-gestational-age newborns at delivery (12), and controls (21). Socioeconomic data, anthropometric measurements and breast milk samples were collected between the first 24 and 48 h and 30 days postpartum. Leptin, adiponectin, and insulin levels in breast milk were measured by immunoassays. RESULTS: A significant decrease in leptin (p = 0.050) and insulin (p = 0.012) levels from colostrum to mature breast milk in mothers of small-for-gestational-age infants was observed. Maternal body mass index was correlated with both leptin and insulin, but not with adiponectin. Insulin levels were negatively correlated to infant weight gain from birth to one month (p = 0.050). In addition, catch-up growth was verified for small-for-gestational-age infants throughout the first month of life. CONCLUSIONS: This study suggests that a remarkable decrease in leptin and insulin levels in mature milk of mothers of small-for-gestational-age newborns may be involved in the rapid weight gain of these newborns. The physiological and external mechanisms by which these significant decreases and rapid weight gains occur in this group remain to be elucidated.

Somatic growth in the first six months of life of infants exposed to maternal smoking in pregnancy.

BACKGROUND: Some studies suggest a relationship between maternal smoking during pregnancy and not only intrauterine fetal growth restriction or low birth weight, but also with changes in the postnatal growth and development. The objective of the present study was to investigate the effects of smoking during pregnancy on infants growth in the first 6 months of life compared with a control group and a group with idiopathic intrauterine growth restriction. METHODS: Longitudinal observational study using a convenience sample of newborns divided into three groups: infants of smoking mothers (tobacco), with idiopathic intrauterine growth restriction (IUGR) and a control group. The sample was selected from two hospitals in Porto Alegre, located in southern Brazil, between 2011 and 2015. Newborns were evaluated at birth, 7 and 15 days, and in the first, third, and sixth month. Anthropometric measures were weight, length and head circumference. The growth indicators used were expressed as z-scores. The analyses were performed using the generalized estimating equation method. RESULTS: The sample included 273 mother/newborn pairs: 86 tobacco group, 34 IUGR group, and 153 control group. In terms of weight at birth, all groups differed significantly (p < 0.001). The birth length of tobacco and control groups were similar, but the IUGR group was lower than both (p < 0.001). We found no differences in growth trajectory between tobacco and control group, but there were differences in the growth of the IUGR group when compared with the other groups. At 6 months of age, all groups had similar anthropometric measurements. CONCLUSION: Intrauterine growth restriction had major impact on the growth trajectory of the infants studied, regardless of other factors, such as smoking and diet.

Caffeine Intake During Pregnancy in Different Intrauterine Environments and its Association with Infant Anthropometric Measurements at 3 and 6 Months of Age.

Objective To investigate the association between maternal caffeine intake during pregnancy and infant anthropometric measurements at age 3 and 6 months. Methods Longitudinal observational study of mother-child pairs stratified into five groups: diabetic women (DM), hypertensive women (HYP), smoking mothers (SMO), mothers of infants small for gestational age (SGA), and controls (CTL). Pairs were recruited from three public hospitals in Porto Alegre, Brazil, from 2011 to 2015, using a convenience sampling strategy. The Food Frequency Questionnaire (FFQ) was administered on postpartum day 7 to evaluate maternal caffeine intake during pregnancy. The anthropometric measurements of interest (weight, length, and skinfold thickness) were assessed at birth and at age 3 and 6 months. Linear regression was used to analyze the interaction between caffeine intake and skinfold thickness. Results Overall, 272 mother-child pairs were investigated (41 DM, 26 HYP, 68 SMO, 25 SGA, and 112 CTL). There were no differences in anthropometric measurements between infants born to mothers who had and had not consumed caffeine during pregnancy (P > 0.05). Children of mothers in the DM group had the highest adjusted average skinfold thicknesses at 3 months. An interaction between maternal caffeine intake during pregnancy and the sum of skinfolds at age 3 months was found in the DM and CTL groups (P < 0.05). However, significant differences were not observed at 6 months. Conclusions Maternal caffeine intake influenced infants skinfold thickness measurements at 3 months of age. This parameter was reduced in infants born to mothers with DM and increased in those born to healthy control mothers.

Temporal evolution of the risk factors associated with low birth weight rates in Brazilian capitals (1996-2011).

OBJECTIVE: To analyze the trend of low birth weight (LBW) and its determinants in Brazilian state capitals between 1996 and 2011. We intended to determine which variables are associated with LBW during the period studied. METHODS: This is a cross-sectional study that used data from the National Information System of Live Births from 26 state capitals and Brasilia (the federal capital), divided into five geographical regions. The Average Annual Percentage of Change (AAPC) was used to assess the possible time trend in the low birth weight rates for considering all regions together and each region separately, according to each variable, and the Poisson regression was calculated in order to demonstrate time trends in low birth weight and the impact of variables (age and educational maternal level, antenatal visits, type of delivery, and gestational age) during the period. All variables were analyzed together using the Poisson regression as well. RESULTS: From the total of 11,200,255 live births used in this study, there was a significant reduction in the number of live births, especially in the more developed regions. The low birth weight rate was 8 %, and it was stable during the period. Considering regional trends, the rate was higher in the Southeast and South regions, and significantly higher in the North, Northeast, and Central West regions. Improvements in maternal education and antenatal care coverage reduced the risk for low birth weight in all regions. Also, there was an increase in caesarean sections in all regions, with a small impact on low birth weight rates. CONCLUSIONS: Improvements in education and health care reduced the risk for low birth weight in all Brazilian regions during the period of study. Trends in low birth weight rates and the associated factors differ from region to region, showing different stages of demographic, epidemiological and developmental transition in Brazil. The present study was approved by the Research Ethics Committee at the Hospital de Clínicas de Porto Alegre (Protocol 120323).

Dietary patterns are associated with excess weight and abdominal obesity in a cohort of young Brazilian adults.

PURPOSE: The objective of the present study was to investigate whether dietary patterns are associated with excess weight and abdominal obesity among young adults (23-25 years). METHODS: A cross-sectional study was conducted on 2061 participants of a birth cohort from Ribeirão Preto, Brazil, started in 1978-1979. Twenty-seven subjects with caloric intake outside ±3 standard deviation range were excluded, leaving 2034 individuals. Excess weight was defined as body mass index (BMI ≥ 25 kg/m(2)), abdominal obesity as waist circumference (WC > 80 cm for women; >90 cm for men) and waist/hip ratio (WHR > 0.85 for women; >0.90 for men). Poisson regression with robust variance adjustment was used to estimate the prevalence ratio (PR) adjusted for socio-demographic and lifestyle variables. Four dietary patterns were identified by principal component analysis: healthy, traditional Brazilian, bar and energy dense. RESULTS: In the adjusted analysis, the bar pattern was associated with a higher prevalence of excess weight (PR 1.46; 95 % CI 1.23-1.73) and abdominal obesity based on WHR (PR 2.19; 95 % CI 1.59-3.01). The energy-dense pattern was associated with a lower prevalence of excess weight (PR 0.73; 95 % CI 0.61-0.88). Men with greater adherence to the traditional Brazilian pattern showed a lower prevalence of excess weight (PR 0.65; 95 % CI 0.51-0.82), but no association was found for women. There was no association between the healthy pattern and excess weight/abdominal obesity. CONCLUSIONS: In this sample, the bar pattern was associated with higher prevalences of excess weight and abdominal obesity, while the energy-dense (for both genders) and traditional Brazilian (only for men) patterns were associated with lower prevalences of excess weight.

Association between internalizing disorders and day-to-day activities of low energetic expenditure.

The objective of this study is to compare energetic expenditure in day-to-day activities among subjects with internalizing disorders (depression and anxiety), externalizing disorders (attention deficit/hyperactivity disorder and oppositional defiant disorder) and healthy children and adolescents without any psychiatric diagnosis. One hundred and five (n = 105) students from a community sample were evaluated throughout a structured psychiatric interview and categorized into three groups: internalizing (n = 54), externalizing (n = 12) and typically developing controls (TDC, n = 39). Energetic expenditure was evaluated using 3-day physical activity record. Subjects with internalizing disorders performed activities with lower energetic expenditure as compared to those with externalizing disorders and TDC. Participants with externalizing disorders had more energetic expenditure variability. Our study suggests that internalizing disorders are associated with activities of low energetic expenditure in day-to-day activities, extending previous findings with physical exercise. These findings may further contribute to the understanding of the associated morbidity previously described in patients with internalizing disorders.

Neonatal environmental intervention alters the vulnerability to the metabolic effects of chronic palatable diet exposure in adulthood.

Previous studies have demonstrated that early environmental interventions influence the consumption of palatable food and the abdominal fat deposition in female rats chronically exposed to a highly caloric diet in adulthood. In this study, we verified the metabolic effects of chronic exposure to a highly palatable diet, and determine the response to its withdrawal in adult neonatally handled and non-handled rats. Consumption of foods (standard lab chow and chocolate), body weight gain, abdominal fat deposition, plasma triglycerides, and leptin, as well as serum butyrylcholinesterase (BuChE), and cerebral acetylcholinesterase (AChE) activities were measured during chronic chocolate exposure and after deprivation of this palatable food in female rats exposed or not to neonatal handling (10 minutes/day, 10 first days of life). Handled rats increased rebound chocolate consumption in comparison to non-handled animals after 1 week of chocolate withdrawal; these animals also decreased body weight in the first 24 hours but this effect disappeared after 7 days of withdrawal. Chocolate increased abdominal fat in non-handled females, and this effect remained after 30 days of withdrawal; no differences in plasma leptin were seen after 7 days of withdrawal. Chocolate also increased serum BuChE activity in non-handled females, this effect was still evident after 7 days of withdrawal, but it disappeared after 30 days of withdrawal. Chocolate deprivation decreased cerebral AChE activity in both handled and non-handled animals. These findings suggest that neonatal handling modulates the preference for palatable food and induces a specific metabolic response that may be more adaptive in comparison to non-handled rats.

Low birth weight in São Luís, northeastern Brazil: trends and associated factors.

BACKGROUND: To analyze trends in LBW (low birth weight) rate using birth registry data and identify factors associated with LBW in São Luís comparing two birth cohorts separated by a 12-year interval. METHODS: 2,426 births were included in 1997/98 and 5,040 in 2010. The dependent variable was LBW (<2,500 g). Multiple logistic regression was performed to determine the association of independent variables with LBW. Data were also obtained from SINASC (Brazilian National Birth Registry) to analyze stillbirth and LBW rates trends from 1996 to 2010, using 3-year moving averages. RESULTS: LBW, intrauterine growth restriction (IUGR) and preterm birth rates did not differ between the two cohorts. Despite this, birth registry data showed increasing LBW rate up to 2001, coinciding with decreasing stillbirth rate. Both stillbirth and LBW rates decreased thereafter. A significant reduction was observed in the percentage of teenage mothers, mothers with up to 4 years of education, family income up to one minimum wage and mothers who did not attend prenatal care. There was an increase in maternal age ≥35 years and schooling ≥12 years. The variables associated with LBW in 1997/98 were young maternal age (<18 years), maternal smoking during pregnancy and primiparity. Variables that remained in the adjusted model in 2010 were female gender, income <3 minimum wages, lack of prenatal care, maternal smoking during pregnancy and primiparity. CONCLUSIONS: Although LBW rate did not differ between the two cohorts, this apparent stability masked an increase up to 2001 and a decrease thereafter. The rise in LBW rate paralleled reduction in the stillbirth rate, suggesting improvement in obstetrical and newborn care. Maternal, socioeconomic and demographic factors associated with LBW differed between the two cohorts, except for smoking during pregnancy and parity that were significantly associated with LBW in both cohorts.