Early-life nutrition and adult-life outcomes.

OBJECTIVES: To verify the association between early-life nutrition and chronic adult diseases. DATA SOURCES: Medline, Embase, Cochrane Database, and Lilacs. SUMMARY OF FINDS: The Developmental Origins of Health and Disease (DOHaD) hypothesis postulates that a mismatch between early-life circumstances and later-life situations may have an impact on chronic diseases. In this review, the authors emphasize the research supporting the impact of early nutrition on the origins of adult height, obesity and metabolic syndrome, type 2 diabetes mellitus, cardiovascular diseases, and reproductive outcomes. CONCLUSION: Even though this is a new topic and there are still many research questions to be answered, there is strong evidence that both deficiency and excess nutrition in early life can cause epigenetic changes that have effects that last a lifetime and contribute to the development of chronic diseases. Public health efforts to protect adults from getting chronic diseases should focus on nutrition in the first 1000 days of life, from conception to the end of the second year of life.

Prevalence and predictors of physical inactivity in a slum in Brazil.

The aim of this study was to ascertain the prevalence of physical inactivity and examine the role of potential predictors in a very low-income adult population in a slum located in Recife city, northeast of Brazil. A cross-sectional study was conducted with 1,176 subjects aged 20-60 years residing in a slum. Using the short version of the International Physical Activity Questionnaire, 307 (26.1%) study participants-97 (23.8%) men and 210 (27.3%) women-have a low physical activity score (MET-minutes per week). Increased age was associated with physical inactivity only in people without overweight/obesity. Low physical activity was less common (i.e., respondents were more active) than in other Brazilian population-based studies. These results suggest that the relationship between physical activity and socioeconomic level is more complex and depends on the internal characteristics of the community.

Neuroimaging in Children Born With Congenital Zika Syndrome: A Cohort Study.

BACKGROUND AND PURPOSE: Neuroimaging findings have been associated with adverse neurologic outcomes in children with congenital Zika virus infection. Our purpose is to describe the brain magnetic resonance imaging (MRI) of children around 3 years of age, born with congenital Zika syndrome. METHODS: This cohort study followed 62 children born with congenital Zika syndrome who had head computed tomography (CT) performed during the first months of life. All these children had clinical, neuroimaging, and serological confirmation of congenital Zika. Around 3 years of age, these children received a brain MRI. RESULTS: In 35 children, we could perform an MRI. All these children had severe impairment in neuromotor development. In general, the examinations showed the same alterations of the CT examinations: delayed myelination (82.8%), intracranial calcification (71.4%) although with decreased intensity and size as compared with previously CT examinations, ventriculomegaly (91.4%), cerebellar hypoplasia (68.5%), and cortical development abnormalities (85.8%). CONCLUSION: The serious brain alterations observed through head CT examinations in children born with congenital Zika syndrome continued to be detected through an MRI examination carried out at around 3 years of age. This indicates a poor prognosis for these children who had a severe neuromotor development delay.

Zika virus seroprevalence in women who gave birth during Zika virus outbreak in Brazil - a prospective observational study.

BACKGROUND: The recent Zika virus (ZIKV) outbreak in Brazil started in August 2015 and ended in May 2017 without effective public health measures for its control have been taken. The immunological status of a community may not only predict future outbreaks as well to answer questions regarding ZIKV not known yet. OBJECTIVE: To verify the seroprevalence of ZIKV in a group of women who were pregnant during the Zika virus outbreak in Recife, three to nine months after the delivery, and to evaluate the neurodevelopment of their children. METHODS: A cross-sectional study enrolled participants of a cohort study held at Instituto de Medicina Integral Professor Fernando Figueira (IMIP) during the ZIKV outbreak in Recife. Mothers who gave birth between the last trimester of 2015 and the first semester of 2016, period of the peak of microcephaly outbreak in Recife, were invited. All participants had the serum tested by the anti-ZIKV IgG/IgM enzyme-liked immunosorbent assays, ELISA kit (Euroimmun, Lübeck, Germany). All children whose mothers presented positive serology for ZIKV performed the IgG/IgM ELISA test for ZIKV. These children were also evaluated by a neuropediatrician and the Denver II development screening test was applied. RESULTS: Among the 132 studied pregnant women who gave birth at the peak of ZIKV outbreak in Recife, all were ZIKV IgM negative and 81 (61,3%) had ZIKV IgG positive. Mothers ZIKV IgG positive had more fever and rash during the pregnancy as compared with mothers negative for ZIKV; respectively 27/81 (33,3%) vs 6/51 (11,7%), p = 0.005 and 22/81 (27,2%) vs 4 (7,8%), p = 0.016. Only one child had IgG positive serology for ZIKV. No children had neurodevelopment defect for the age group and the Denver II normal scores. CONCLUSIONS: A high ZIKV IgG seroprevalence in pregnant women at the end of the ZIKV outbreak in Recife was found. This finding suggests that community protective immunity may have contributed to the end of ZIKV outbreak in Recife, Brazil.

Early-life nutrition and adult-life outcomes

Abstract Objectives To verify the association between early-life nutrition and chronic adult diseases. Data Sources Medline, Embase, Cochrane Database, and Lilacs. Summary of finds The Developmental Origins of Health and Disease (DOHaD) hypothesis postulates that a mismatch between early-life circumstances and later-life situations may have an impact on chronic diseases. In this review, the authors emphasize the research supporting the impact of early nutrition on the origins of adult height, obesity and metabolic syndrome, type 2 diabetes mellitus, cardiovascular diseases, and reproductive outcomes. Conclusion Even though this is a new topic and there are still many research questions to be answered, there is strong evidence that both deficiency and excess nutrition in early life can cause epigenetic changes that have effects that last a lifetime and contribute to the development of chronic diseases. Public health efforts to protect adults from getting chronic diseases should focus on nutrition in the first 1000 days of life, from conception to the end of the second year of life.

Physical activity pattern in early pregnancy and gestational diabetes mellitus risk among low-income women: A prospective cross-sectional study.

OBJECTIVE: Gestational diabetes mellitus is increasing worldwide, mainly in developing countries, and physical activity has not been studied in gestational diabetes mellitus prevention among low-income population. This prospective cross-sectional study assessed the gestational diabetes mellitus risk related to physical activity in early pregnancy among low-income women. METHODS: A prospective cross-sectional study with 544 low-income pregnant women was conducted at the Instituto de Medicina Integral Prof. Fernando Figueira, Brazil. Gestational diabetes mellitus was diagnosed using the International Association of Diabetes and Pregnancy Study Groups criteria. Physical activity was assessed during early pregnancy using the Pregnancy Physical Activity Questionnaire and categorized as sedentary, light, moderate, or vigorous intensity. RESULTS: Gestational diabetes mellitus occurred in 95 of 544 women (17.4%). Body mass index was higher in the gestational diabetes mellitus group. Nearly half of all pregnant women studied were physically inactive, and none of them were classified as vigorous physical active. Sedentary physical activity pattern was associated with a higher odds of gestational diabetes mellitus (odds ratio = 1.8, 95% confidence interval = 1.1-2.9), which did not change after adjusting for several covariates (odds ratio = 1.9, 95% confidence interval = 1.2-3.1). CONCLUSION: Physical inactivity in early pregnancy is associated with a higher risk of gestational diabetes mellitus among low-income women.

Chikungunya infection and horner syndrome.

We describe an infant with Chikungunya virus (CHIKV) infection who developed Horner syndrome. The infant had diagnostic confirmation of CHIKV infection by IgM-ELISA positive in serum and cerebrospinal fluid, and clinical signs of Horner syndrome. Magnetic resonance angiography showed alterations in the cervical and intra cavernous portions of the internal carotid artery. To the best of our knowledge this is the first report of the association of CHIKV infection with Horner syndrome.

Dietary patterns and gestational diabetes mellitus in a low income pregnant women population in Brazila cohort study

Our aim is to verify the association between dietary patterns during early pregnancy and development of gestational diabetes mellitus (GDM) in a low income Brazilian population. A cohort study followed 841 healthy pregnant women from the 15-20th gestational week until delivery. This study was conducted at the Instituto de Medicina Integral Prof. Fernando Figueira, Brazil. 838 pregnant women during the first half of a healthy pregnancy with a monthly family income below US $ 500.00 were selected. 95 (11.3%) pregnant women developed gestational diabetes mellitus. Three dietary patterns from factor analysis were extracted. The traditional pattern was characterized by dairy products, fruits, vegetable and fish. The mixed pattern included fried food, pizza, juice, manioc flour, red meat and candies. The western pattern was characterized by eggs, white bread, cookies, pasta, pizza, fried food, chicken, candies, chocolate, salty snacks and soft drinks. There were no differences among GDM incidence according to these three dietary patterns. This finding remained after adjustment for maternal age, maternal education, body mass index pre-pregnancy and parity. We concluded that eating patterns studied during early pregnancy were not associated to the development of GDM in this sample of Brazilian pregnant women with low income(AU)

Hábitos dietéticos e diabetes mellitus gestacional em uma população de gestantes de baixa renda no Brasil estudo de coorte. Nosso objetivo foi verificar a associação entre o padrão alimentar no começo da gravidez com o desenvolvimento de diabetes mellitus gestacional (DMG) em um grupo populacional de baixa renda no Brasil. Um estudo de coorte seguiu 841 gestantes saudáveis da 15-20 semana gestacional até o parto. Esse estudo foi realizado no Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Brasil. Oitocentas e trinta e oito gestantes no curso da primeira metade da gestação e com uma renda familiar abaixo de US $ 500.00 foram selecionadas. Noventa e cinco gestantes (11.3%) desenvolveram DMG. Três padrões alimentares distintos foram extraídos através da técnica do fator de análise. O padrão alimentar tradicional foi caracterizado pela ingestão de produtos lácteos, frutas, vegetais e peixes. O padrão alimentar misto incluiu frituras, pizza, sucos, farinha de mandioca, carne vermelha e doces. O padrão alimentar ocidental foi caracterizado por ovos, pão branco, biscoitos, massa, pizza, carne de galinha, doces, chocolate, salgadinhos e refrigerantes. Não foi observado diferença na incidência de DMG entre os três padrões alimentares identificados. Esse achado permaneceu inalterado após o ajuste para a idade e nível de educação maternal, assim como para o IMC antes da gravidez e paridade. Em conclusão, o padrão alimentar materno durante o começo da gravi- dez entre gestantes de baixa renda não parece estar associado com o desenvolvimento de DMG(AU)

Epileptic seizures in children with congenital Zika virus syndrome / Crises epilépticas em crianças com síndrome congênita do Zika vírus

Abstract Objectives: to describe preliminary data referred to epileptic seizures and the probability of occurring these epileptic seizures in the infants' first months of life with congenital Zika virus (ZIKV) syndrome. Methods: concurrent cohort study including newborns and infants with congenital Zika virus syndrome attended at the specialized outpatient clinic at IMIP, Recife, Pernambuco, from October 2015 to May 2016. Results: data on 106 infants were analyzed with confirmed or suspected association to ZIKV infection. Forty children (38.7%) presented an epileptic seizure, classified at 43.3% of the cases as being spasms, 22.7% as generalized tonic seizures, 20.5% as partial and 4.5% other types of seizures. The median of days until the first report on the occurrence of epileptic seizure was 192 days of life. Conclusions: children with congenital Zika virus syndrome presented a high incidence of epileptic seizures before the end of the first semester of life, and spasm was the epileptic seizure mostly observed.

Resumo Objetivos: descrever dados preliminares referentes às crises epilépticas e à probabilidade de ocorrência dessas crises nos primeiros meses de vida em crianças com síndrome congênita do Zika vírus (ZIKV). Métodos: estudo de coorte concorrente incluindo recém-nascidos e lactentes com síndrome congênita do Zika vírus, atendidos no ambulatório especializado do IMIP, Recife, Pernambuco durante o período de outubro 2015 a maio 2016. Resultados: foram analisados dados de 106 lactentes com diagnóstico confirmado ou provável associação da infecção pelo ZIKV. Quarenta crianças (38,7%) apresentaram crise epiléptica, classificada em 43,3% dos casos como sendo espasmo, 22,7% como crise generalizada tônica, 20,5% parcial e 4,5% crises epilépticas de outros tipos. A mediana dos dias até o primeiro relato de ocorrência de crise epiléptica foi 192 dias de vida. Conclusões: crianças com síndrome congênita do Zika vírus apresentaram elevada incidência de crises epilépticas de aparecimento precoce, antes do final do primeiro semestre de vida, sendo o espasmo o tipo de crise mais observado.