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.

Dietary pattern changes, obesity and excess body fat in adults of a Brazilian birth cohort.

BACKGROUND: Few studies have assessed dietary patterns (DPs) and the changes in these patterns over time in adults. The present study aimed to investigate whether possible changes in DPs in two assessments are associated with obesity and excess body fat. METHODS: A prospective study was conducted in which data were collected from 1082 adults of a Brazilian birth cohort during two periods 15 years apart (T1: 2002-2004; T2: 2016-2017). Food consumption was assessed in both periods using validated food frequency questionnaires. Three similar DPs were found in the two assessments, and adherence to these patterns was classified as prudent, risk or mixed. Nine DPs changes were defined. At T2, subjects with a body mass index ≥ 30.0 kg m- ² were classified as obese, and men and women with a body fat (BF) percentage ≥ 25.0 and ≥ 35.0, respectively, were classified as having excess BF. A directed acyclic graph was built to adjust the association for confounding variables. RESULTS: At T2, 34.4% of the subjects were obese and 61.4% had excess BF. In the adjusted analysis, the changes associated with obesity and excess BF were prudent-mixed (prevalence ratio [PR] 1.55; 95% confidence interval [CI] = 1.04-2.29 and PR = 1.35; 95% CI = 1.10-1.65), risk-risk (PR = 1.49; 95% CI = 1.03-2.13 and PR = 1.27; 95% CI = 1.04-1.53), risk-mixed (PR = 1.56; 95% CI = 1.05-2.31 and PR = 1.33; 95% CI = 1.07-1.63) and mixed-risk (PR = 1.61; 95% CI = 1.10-2.35 and PR = 1.29; 95% CI = 1.04-1.58). CONCLUSIONS: A decline in food quality over time or stagnation in an unhealthy DP can lead to obesity and excess BF.

Association of preterm birth and intrauterine growth restriction with childhood motor development: Brisa cohort, Brazil.

The present study investigated the association between preterm birth PT conditions, intrauterine growth restriction IUGR and the combination of both PT-IUGR with infant motor development. A cohort with 1006 children was monitored during prenatal, at birth, and two years of age. Bayley-III screening was used to evaluate of fine and gross motor skills. The data did not indicate an increased risk for motor delays in the PT or IUGR, composed mainly by mild cases. However, the combination of the conditions PT-IUGR increased the risk of delays in motor, which emphasizes the importance of monitoring the motor development of the group.

Does height catch-up in schoolchildren have an effect on bone mass in adolescents? Analysis in a Brazilian birth cohort / Catch-up de estatura em escolares tem efeito sobre massa óssea em adolescentes? Análise em uma coorte brasileira de nascimento

Abstract Objective: To analyze the effect of height catch-up at school age on the bone mass of adolescents of a Brazilian birth cohort. Methods: A cohort study using data obtained from the three moments (birth, 7/9 years and 18/19 years of age) of the Cohorts-RPS study. Height catch-up was defined based on the difference between the schoolchild's z-score and birth z-score. The adolescents' bone mineral mass was analyzed using the z-score index for the lumbar spine measured by dual emission X-ray absorptiometry. A theoretical model was developed for the proposed analysis using directed acyclic graphs paired through the nearest-neighbor matching propensity score using the STATA software, version 14.0. The level of significance was set at 5%. Results: Of the 297 studied children, 24.5% achieved height catch-up. The bone mass below the expected for age was observed in 5.39% of the subjects. The mean lumbar spine z-score was −0.34 (±1.01). After the adjustment, no effect was observed between height catch-up at school age and bone mass in adolescents (Coeff = 0.598; 95% CI −0.117 to 1.313; p = 0.101). Conclusion: Even using the directed acyclic graphs and the causal inference method by adjusting the propensity score, the height catch-up did not seem to affect bone mass in adolescents, a result perhaps related to the sample size.

Resumo: Objetivo: Analisar o efeito do catch-up de estatura na idade escolar na massa óssea em adolescentes em uma coorte brasileira de nascimento. Métodos: Estudo de coorte, utilizando dados dos três momentos (nascimento, aos 7/9 anos e 18/19 anos) da pesquisa Coortes-RPS. Catch-up de estatura foi definida a partir da diferença entre o Z-score do escolar e Z-score do nascimento. Para a análise da massa óssea em adolescentes foi utilizado o índice Z-score da coluna lombar medido pela densitometria por dupla emissão de raio X. Para análise proposta, foi construído modelo teórico usando os gráficos acíclicos direcionados e pareado por escore de propensão do tipo vizinho mais próximo utilizando o software STATA versão 14.0. O nível de significância adotado foi de 5%. Resultados: Das 297 crianças, 24,58% realizaram o catch-up estatural. Massa óssea abaixo do esperado para a idade foi de 5,39%. O Z-score médio da coluna lombar foi −0,34 (± 1,01). Após ajuste, não foi observado efeito entre catch-up de estatura na idade escolar e massa óssea no adolescente (Coef = 0,598; IC 95% −0,117-1,313; p = 0,101). Conclusão: Mesmo com os gráficos acíclicos direcionados e o método de inferência causal por ajuste do escore de propensão, o catch-up de estatura parece não afetar a massa óssea em adolescentes, resultado talvez relacionado ao tamanho da amostra.

Does height catch-up in schoolchildren have an effect on bone mass in adolescents? Analysis in a Brazilian birth cohort.

OBJECTIVE: To analyze the effect of height catch-up at school age on the bone mass of adolescents of a Brazilian birth cohort. METHODS: A cohort study using data obtained from the three moments (birth, 7/9 years and 18/19 years of age) of the Cohorts-RPS study. Height catch-up was defined based on the difference between the schoolchild's z-score and birth z-score. The adolescents' bone mineral mass was analyzed using the z-score index for the lumbar spine measured by dual emission X-ray absorptiometry. A theoretical model was developed for the proposed analysis using directed acyclic graphs paired through the nearest-neighbor matching propensity score using the STATA software, version 14.0. The level of significance was set at 5%. RESULTS: Of the 297 studied children, 24.5% achieved height catch-up. The bone mass below the expected for age was observed in 5.39% of the subjects. The mean lumbar spine z-score was -0.34 (±1.01). After the adjustment, no effect was observed between height catch-up at school age and bone mass in adolescents (Coeff=0.598; 95% CI -0.117 to 1.313; p=0.101). CONCLUSION: Even using the directed acyclic graphs and the causal inference method by adjusting the propensity score, the height catch-up did not seem to affect bone mass in adolescents, a result perhaps related to the sample size.

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.

Glutamatergic and neural dysfunction in postpartum depression using magnetic resonance spectroscopy.

Although postpartum depression (PPD) is a prevalent subtype of major depressive disorder, neuroimaging studies on PPD are rare, particularly those identifying neurochemical abnormalities obtained by proton magnetic resonance spectroscopy (¹H-MRS). The dorsolateral prefrontal (DLPF) and the anterior cingulate gyrus (ACG) are part of the neural pathways involved in executive functions and emotional processing, and both structures have been implicated in the neurobiology of depressive disorders. This study aimed to evaluate brain metabolites abnormalities in women with PPD compared with healthy postpartum (HP) women. Thirty-six PPD (34 without antidepressants) and 25 HP women underwent a ¹H-MRS acquired on a 3-T MRI system, with the volume of interest positioned in ACG and DLPF. An ANCOVA was conducted with age, postpartum time, and contraceptive type as covariates. PPD group presented significantly lower Glutamate+Glutamine (Glx, -0.95mM) and N-acetylaspartate+N-acetylaspartylglutamate (NAA, -0.60mM) values in DLPF. There were no significant differences between groups in ACG, but we found a significant increase of Glutamate (Glu, 2.18mM) and Glx (1.84mM) in participants using progestogen-only contraceptives. These findings suggest glutamatergic dysfunction and neuronal damage in the DLPF of PPD patients, similarly to other subtypes of depressive disorders. Progestogens seem to interfere in the neurochemistry of ACG.

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.

The growth hormone receptor exon 3 polymorphism is not associated with height or metabolic traits in healthy young adults.

CONTEXT: The GHR polymorphisms contribution to the interindividual variability in prenatal and postnatal growth as well as to metabolic traits is controversial. OBJECTIVE: The aim of this study is to analyze the association of the GHRfl/d3 polymorphism with prenatal and postnatal growth and metabolic outcomes in adult life and to compare the genotype distribution in different populations. DESIGN: 385 community healthy subjects followed from birth to adult life (23-25years old) were grouped according to birth size: small-SGA (n=130, 62 males), appropriate-AGA (n=162, 75 males) and large for gestational age-LGA (n=93, 48 males). GHRfl/d3 genotype distribution and its potential association with anthropometric (at birth, childhood and adult life) and metabolic features (in adult life) were analyzed and compared with data obtained from a systematic review of GHRfl/d3 association studies (31 articles). RESULTS: The frequency of the GHR d3/d3 genotype was lower in the LGA (χ2 p=0.01); SGA and AGA subjects exhibited an increased chance of the d3/d3 genotype (OR=3.58; 95%CI: 1.55; 8.24) and (OR=2.39; 95%CI: 1.02; 5.62), respectively. Despite the different prevalence among different birth size groups, in adults, GHRfl/d3 genotype was not associated with height, plasma IGF1 levels or metabolic phenotype and cardiovascular risk. GHRfl/d3 genotype distributions in AGA, SGA and LGA groups were comparable with those found in subjects of European origin but not with those of Asian ancestry. CONCLUSIONS: The GHRd3 genotype was negatively associated with birth size but it was not associated with adult height or weight, plasma IGF1, metabolic phenotype or any marker of increased cardiovascular risk in young adults.

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.

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.

Perinatal and early life factors associated with symptoms of depression in Brazilian children.

BACKGROUND: Few studies have been conducted on the association between perinatal and early life factors with childhood depression and results are conflicting. Our aim was to estimate the prevalence and perinatal and early life factors associated with symptoms of depression in children aged 7 to 11 years from two Brazilian birth cohorts. METHODS: The study was conducted on 1444 children whose data were collected at birth and at school age, in 1994 and 2004/2005 in Ribeirao Preto, where they were aged 10-11 years and in 1997/98 and 2005/06 in São Luís, where children were aged 7-9 years. Depressive symptoms were investigated with the Child Depression Inventory(CDI), categorized as yes (score ≥ 20) and no (score < 20). Adjusted and non-adjusted prevalence ratios (PR) were estimated by Poisson regression with robust estimation of the standard errors. RESULTS: The prevalence of depressive symptoms was 3.9% (95%CI = 2.5-5.4) in Ribeirão Preto and 13.7% (95%CI = 11.0-16.4) in São Luís. In the adjusted analysis, in Ribeirão Preto, low birth weight (PR = 3.98; 95%CI = 1.72-9.23), skilled and semi-skilled manual occupation (PR = 5.30; 95%CI = 1.14-24.76) and unskilled manual occupation and unemployment (PR = 6.65; 95%CI = 1.16-38.03) of the household head were risk factors for depressive symptoms. In São Luís, maternal schooling of 0-4 years (PR = 2.39; 95%CI = 1.31-4.34) and of 5 to 8 years (PR = 1.80; 95%CI = 1.08-3.01), and paternal age <20 years (PR = 1.92; 95%CI = 1.02-3.61), were independent risk factors for depressive symptoms. CONCLUSIONS: The prevalence of depressive symptoms was much higher in the less developed city, São Luís, than in the more developed city, Ribeirão Preto, and than those reported in several international studies. Low socioeconomic level was associated with depressive symptoms in both cohorts. Low paternal age was a risk factor for depressive symptoms in the less developed city, São Luís, whereas low birth weight was a risk factor for depressive symptoms in the more developed city, Ribeirão Preto.

Factors associated with height catch-up and catch-down growth among schoolchildren.

In developed countries, children with intrauterine growth restriction (IUGR) or born preterm (PT) tend to achieve catch-up growth. There is little information about height catch-up in developing countries and about height catch-down in both developed and developing countries. We studied the effect of IUGR and PT birth on height catch-up and catch-down growth of children from two cohorts of liveborn singletons. Data from 1,463 children was collected at birth and at school age in Ribeirão Preto (RP), a more developed city, and in São Luís (SL), a less developed city. A change in z-score between schoolchild height z-score and birth length z-score ≥ 0.67 was considered catch-up; a change in z-score ≤ -0.67 indicated catch-down growth. The explanatory variables were: appropriate weight for gestational age/PT birth in four categories: term children without IUGR (normal), IUGR only (term with IUGR), PT only (preterm without IUGR) and preterm with IUGR; infant's sex; maternal parity, age, schooling and marital status; occupation of family head; family income and neonatal ponderal index (PI). The risk ratio for catch-up and catch-down was estimated by multinomial logistic regression for each city. In RP, preterms without IUGR (RR = 4.13) and thin children (PI<10(th) percentile, RR = 14.39) had a higher risk of catch-down; catch-up was higher among terms with IUGR (RR = 5.53), preterms with IUGR (RR = 5.36) and children born to primiparous mothers (RR = 1.83). In SL, catch-down was higher among preterms without IUGR (RR = 5.19), girls (RR = 1.52) and children from low-income families (RR = 2.74); the lowest risk of catch-down (RR = 0.27) and the highest risk of catch-up (RR = 3.77) were observed among terms with IUGR. In both cities, terms with IUGR presented height catch-up growth whereas preterms with IUGR only had height catch-up growth in the more affluent setting. Preterms without IUGR presented height catch-down growth, suggesting that a better socioeconomic situation facilitates height catch-up and prevents height catch-down growth.

Maternal smoking during pregnancy and primary headache in school-aged children: a cohort study.

BACKGROUND: It is not known whether smoking by mothers during pregnancy is associated with headache in their offspring. METHODS: Two prospective cohorts of 869 children aged 10-11 years from Ribeirão Preto (RP) and 805 children aged 7-9 years from São Luís (SL) were studied. Data on maternal smoking were collected at birth. Primary headache was defined as a reporting of ≥2 episodes of headache in the past 2 weeks, without any associated organic symptoms. RESULTS: Prevalence of headache was 28.1% in RP and 13.1% in SL as reported by the mothers and 17.5% in RP and 29.4% in SL as reported by the children. Agreement between mothers' report and children's self-report of primary headache in the child was poor. After adjustment, children whose mothers smoked ≥10 cigarettes per day during pregnancy presented higher prevalence of primary headache than their counterparts in both cohorts, as reported by the mother and in RP as reported by the children. CONCLUSIONS: Maternal smoking during pregnancy was associated with headache in 7- to 11-year-olds. With one exception, the consistency of the results, despite poor agreement between maternal and children reports of headache, indicates that maternal smoking during pregnancy may contribute to headaches in their children.

Catch-up growth in children after repair of Tetralogy of Fallot.

PURPOSE: To evaluate the growth of children after repair of Tetralogy of Fallot, as well as the influence of residual lesions and socio-economic status. METHODS: A total of 17 children, including 10 boys with a median age of 16 months at surgery, were enrolled in a retrospective cohort, in a tertiary care university hospital. Anthropometric (as z-scores), clinical, nutritional, and social data were collected. RESULTS: Weight-for-age and weight-for-height z-scores decreased pre-operatively and recovered post-operatively in almost all patients, most markedly weight for age. Weight-for-height z-scores improved, but were still lower than birth values in the long term. Long-term height-for-age z-scores were higher than those at birth, surgery, and 3 months post-operatively. Most patients showed catch-up growth for height for age (70%), weight for age (82%), and weight for height (70%). Post-operative residual lesions (76%) influenced weight-for-age z-scores. Despite the fact that most patients (70%) were from low-income families, energy intake was above the estimated requirement for age and gender in all but one patient. There was no influence of socio-economic status on pre- and post-operative growth. Bone age was delayed and long-term-predicted height was within mid-parental height limits in 16 children (93%). CONCLUSION: Children submitted to Tetralogy of Fallot repair had pre-operative acute growth restriction and showed post-operative catch-up growth for weight and height. Acute growth restriction could still be present in the long term.

Pre-hipertensión e hipertensión arterial en adultos jóvenes y su relación con la antropometría al nacimiento: estudio de cohorte / Relationship between size at birth and borderline blood pressure or hypertension in young adults: cohort study

INTRODUCCION: Varios estudios han informado que los trastornos del crecimiento fetal están asociados con las enfermedades crónicas no transmisibles en la edad adulta, entre ellos la hipertensión arterial (HT), de acuerdo con la hipótesis del origen fetal de las enfermedades de adultos.OBJETIVO: Describir la prevalencia de la presión arterial límite o pre-hipertensión (BBP) e HT entre los adultos jóvenes nacidos en la cohorte 1978-1979 de RiberÊo Preto (Brasil), y evaluar el riesgo de BBP e HT en los adultos jóvenes asociados con el tamaño al nacer, ajustado para el parto y las características de la vida adulta.METODOS: De 6.827 hijos únicos nacidos en los hospitales, 2.060 fueron evaluados a los 23/25 años. Se realizaron análisis bioquímicos y una evaluación antropométrica, y se obtuvo información sobre ocupación, educación, hábitos de vida y enfermedades crónicas. La presión arterial (PA) se clasificó en: 1) BBP: PA sistólica (PAS) ≥ 130 mmHg y/o PA diastólica (PAD) ≥ 85 mmHg, 2) HT: PAS > 140 y/o PAD > 90 mmHg. Las características sociodemográficas y clínicas en el nacimiento y en la edad adulta fueron evaluadas mediante la aplicación de un modelo de regresión logística politómica.RESULTADOS: La prevalencia de BBP fue de 13,5% (hombres 82,8%) y la prevalencia de HT fue de 9,5% (hombres 89,8%). La BBP se asoció con el sexo masculino (RAR 9,11; IC 95% 6,23 a 13,32), el Indice de Masa Corporal (IMC) > 30 kg/m2 (RAR 3,01; IC 95% 1,87-4,85) y la alteración de la circunferencia de la cintura (RAR 1,68, IC 95% 1,17-2,40); la HT se asoció con las mismas variables más alta glucemia en ayunas (RAR 2,86; IC 95% 1,42-5,76).CONCLUSIONES: La prevalencia de BBP e HT entre los adultos jóvenes fue elevada. No guardó relación con el tamaño al nacer, pero estuvo asociada con la adiposidad corporal alterada y la glucemia.

INTRODUCTION: Several studies have reported that disorders of fetal growth are associated with non-communicable chronic diseases in adulthood, among them hypertension (HT), according to the hypothesis of the fetal origin of adult diseases.OBJECTIVE: To describe the prevalence of borderline blood pressure (BBP) and HT among young adults born in the 1978-79 RiberÊo Preto cohort, and to assess the risk of BBP and HT in young adults associated with size at birth, adjusted for birth and adult life characteristics.METHODS: Of the 6.827 singletons born in hospitals, 2.060 were assessed at 23/25 years of age. Blood was collected, anthropometric assessment was performed and information was obtained regarding occupation, schooling, life habits and chronic diseases. Blood pressure (BP) was classified as: 1) BBP: systolic BP (SBP) ≥ 130 mmHg and/or diastolic BP (DBP) ≥ 85 mmHg; 2) HT: SBP > 140 and/or DBP > 90 mmHg. Socio-demographic and clinical characteristic at birth and in adulthood were evaluated applying a polytomic logistic regression model.RESULTS: BBP prevalence was 13.5% (men 82.8%) and HT prevalence was 9.5% (men 89.8%). BBP was associated with male gender (aRR 9.11; 95% CI 6.23-13.32), Body Mass Index (BMI) > 30 kg/m2 (aRR 3.01; 95% CI 1.87-4.85) and altered waist circumference (aRR 1.68; 95% CI 1.17-2.40), whilst HT was associated with the same variables plus high fasting glycemia (aRR 2.86; 95% CI 1,42-5.76)CONCLUSIONS: The prevalence of BBP and Ht among young adults was high, with no relation with size at birth but associated to altered body adiposity and glycemia.

Pre-hipertensión e hipertensión arterial en adultos jóvenes y su relación con la antropometría al nacimiento: estudio de cohorte / Relationship between size at birth and borderline blood pressure or hypertension in young adults: cohort study

INTRODUCCION: Varios estudios han informado que los trastornos del crecimiento fetal están asociados con las enfermedades crónicas no transmisibles en la edad adulta, entre ellos la hipertensión arterial (HT), de acuerdo con la hipótesis del origen fetal de las enfermedades de adultos.OBJETIVO: Describir la prevalencia de la presión arterial límite o pre-hipertensión (BBP) e HT entre los adultos jóvenes nacidos en la cohorte 1978-1979 de RiberÒo Preto (Brasil), y evaluar el riesgo de BBP e HT en los adultos jóvenes asociados con el tamaño al nacer, ajustado para el parto y las características de la vida adulta.METODOS: De 6.827 hijos únicos nacidos en los hospitales, 2.060 fueron evaluados a los 23/25 años. Se realizaron análisis bioquímicos y una evaluación antropométrica, y se obtuvo información sobre ocupación, educación, hábitos de vida y enfermedades crónicas. La presión arterial (PA) se clasificó en: 1) BBP: PA sistólica (PAS) ≥ 130 mmHg y/o PA diastólica (PAD) ≥ 85 mmHg, 2) HT: PAS > 140 y/o PAD > 90 mmHg. Las características sociodemográficas y clínicas en el nacimiento y en la edad adulta fueron evaluadas mediante la aplicación de un modelo de regresión logística politómica.RESULTADOS: La prevalencia de BBP fue de 13,5% (hombres 82,8%) y la prevalencia de HT fue de 9,5% (hombres 89,8%). La BBP se asoció con el sexo masculino (RAR 9,11; IC 95% 6,23 a 13,32), el Indice de Masa Corporal (IMC) > 30 kg/m2 (RAR 3,01; IC 95% 1,87-4,85) y la alteración de la circunferencia de la cintura (RAR 1,68, IC 95% 1,17-2,40); la HT se asoció con las mismas variables más alta glucemia en ayunas (RAR 2,86; IC 95% 1,42-5,76).CONCLUSIONES: La prevalencia de BBP e HT entre los adultos jóvenes fue elevada. No guardó relación con el tamaño al nacer, pero estuvo asociada con la adiposidad corporal alterada y la glucemia.

INTRODUCTION: Several studies have reported that disorders of fetal growth are associated with non-communicable chronic diseases in adulthood, among them hypertension (HT), according to the hypothesis of the fetal origin of adult diseases.OBJECTIVE: To describe the prevalence of borderline blood pressure (BBP) and HT among young adults born in the 1978-79 RiberÒo Preto cohort, and to assess the risk of BBP and HT in young adults associated with size at birth, adjusted for birth and adult life characteristics.METHODS: Of the 6.827 singletons born in hospitals, 2.060 were assessed at 23/25 years of age. Blood was collected, anthropometric assessment was performed and information was obtained regarding occupation, schooling, life habits and chronic diseases. Blood pressure (BP) was classified as: 1) BBP: systolic BP (SBP) ≥ 130 mmHg and/or diastolic BP (DBP) ≥ 85 mmHg; 2) HT: SBP > 140 and/or DBP > 90 mmHg. Socio-demographic and clinical characteristic at birth and in adulthood were evaluated applying a polytomic logistic regression model.RESULTS: BBP prevalence was 13.5% (men 82.8%) and HT prevalence was 9.5% (men 89.8%). BBP was associated with male gender (aRR 9.11; 95% CI 6.23-13.32), Body Mass Index (BMI) > 30 kg/m2 (aRR 3.01; 95% CI 1.87-4.85) and altered waist circumference (aRR 1.68; 95% CI 1.17-2.40), whilst HT was associated with the same variables plus high fasting glycemia (aRR 2.86; 95% CI 1,42-5.76)CONCLUSIONS: The prevalence of BBP and Ht among young adults was high, with no relation with size at birth but associated to altered body adiposity and glycemia.

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.

Cesarean delivery is associated with an increased risk of obesity in adulthood in a Brazilian birth cohort study.

BACKGROUND: Obesity is epidemic worldwide, and increases in cesarean delivery rates have occurred in parallel. OBJECTIVE: This study aimed to determine whether cesarean delivery is a risk factor for obesity in adulthood in a birth cohort of Brazilian subjects. DESIGN: We initiated a birth cohort study in Ribeirão Preto, southeastern Brazil, in 1978. A randomly selected sample of 2057 subjects from the original cohort was reassessed in 2002-2004. Type of delivery, birth weight, maternal smoking, and schooling were obtained after birth. The following data from subjects were collected at 23-25 y of age: body mass index (BMI; in kg/m(2)), physical activity, smoking, and income. Obesity was defined as a BMI ≥30. A Poisson multivariable model was performed to determine the association between cesarean delivery and BMI. RESULTS: The obesity rate in adults born by cesarean delivery was 15.2% and in those born by vaginal delivery was 10.4% (P = 0.002). Adults born by cesarean delivery had an increased risk (prevalence ratio: 1.58; 95% CI: 1.23, 2.02) of obesity at adulthood after adjustments. CONCLUSION: We hypothesize that increasing rates of cesarean delivery may play a role in the obesity epidemic worldwide.

The impact of perinatal and socioeconomic factors on mental health problems of children from a poor Brazilian city: a longitudinal study.

BACKGROUND: Low birth weight and preterm birth, and social disadvantage may negatively affect mental health of children, but findings have been inconsistent. OBJECTIVES: To assess the influence of perinatal and social factors on mental health problems in children aged 7-9 years. METHODS: A random sample of 805 births in São Luís, Brazil was studied in 1997/1998 and again in 2005/2006. Perinatal, socioeconomic and demographic variables were assessed within 24 h after delivery. The Strengths and Difficulties Questionnaire (SDQ) was used to assess mental health problems in the children. Simple and multiple Poisson regressions were used for statistical analysis. RESULTS: The overall prevalence of mental health problems in the total sample was 47.7%. The prevalences of emotional and conduct problems were 58.2 and 48.8%, respectively. Only paternal age (<20 years) was associated with mental health problems as measured by the full SDQ scale (prevalence ratio PR = 1.27). Children born to single mothers (PR = 1.31) and those with birth weight from 1,500 to 2,499 g (PR = 1.18) and from 2,500 to 2,999 g (PR = 1.17) had a higher risk of emotional problems, but those from low income families had a lower risk (PR = 0.80). Children with a father of less than 20 years had a higher risk of having problems with their peers (PR = 1.75). A maternal education of 9 years or over was inversely associated with peer (PR = 0.70) and conduct problems (PR = 0.73). Girls had a lower risk of conduct (PR = 0.77) and hyperactivity problems (PR = 0.68). A maternal education of 4 years or less increased the risk of hyperactivity (PR = 1.48). CONCLUSIONS: Socioeconomic and demographic conditions were better predictors of mental health problems in children than birth weight or preterm birth. However, since most effect sizes were small most mental health problems were, unexplained by the variables in the study.