The dietary inflammatory index and insulin resistance or metabolic syndrome in young adults.

OBJECTIVE: The aim of this study was to assess the association between the inflammatory potential of diet, as measured by the dietary inflammatory index (DII) and insulin resistance (IR) or metabolic syndrome (MetS). METHODS: A cross-sectional study (nested within a cohort) was conducted on 2017 adults 23 to 25 y of age in Ribeirão Preto, Brazil. Food consumption was assessed using a validated food frequency questionnaire. DII scores were calculated from 35 available food parameters. IR was determined from the classification of homeostatic model assessment (HOMA) values (≥2.7 uU mL-1). MetS was diagnosed based on the Joint Interim Statement (JIS) criterion. The association of DII score with IR or MetS was determined by Poisson regression analysis. The variables included in the multivariable model were selected from directed acyclic graphs. RESULTS: The diet of the young adults studied showed a high inflammatory potential, with a mean DII score of +1.10 (range: -4.69 to +5.28). The prevalence of MetS was 12.2% and IR 12.3%; both were higher in men than in women. The correlation between DII and HOMA-IR values was -0.038 (P = 0.09). The DII was not associated with IR or MetS in either sex. CONCLUSION: Although the association between DII and the outcomes was not detected in this sample, the study demonstrated that the diets of these young adult Brazilians had a high inflammatory potential when compared with other studies. Future studies, preferably using longitudinal designs, are recommended.

Waist circumference is an effect modifier of the association between bone mineral density and glucose metabolism.

OBJECTIVE: The role of bone markers on insulin resistance (IR) remains controversial. The objective of this study is to evaluate the association between bone mineral density (BMD) and glucose metabolism and investigate if visceral hyperadiposity, evaluated by waist circumference (WC), is an effect modifier of this association. SUBJECTS AND METHODS: Cross-sectional analysis with 468 young adults from the fourth follow-up of the 1978/79 Ribeirão Preto prospective birth cohort, Brazil. BMD, total osteocalcin (OC), fasting plasma glucose and insulin concentrations were assessed. IR, sensitivity (S) and secretion (ß) were estimated by homeostasis model assessment (HOMA) indexes. Multiple linear regression models were constructed to estimate the association between BMD and glucose metabolism. Beta coefficient, R2 and p-values were provided. WC was tested as an effect modifier and OC as a confounder. The covariates were selected based on Direct Acyclic Graph. RESULTS: Significant interaction between BMD (femoral neck and proximal femur areas) and WC on glucose metabolism was observed in the adjusted models. Subjects with increased WC presented a positive association between BMD and log HOMA1-IR while an inverse association was found in those with normal WC (femoral neck R2 = 0.17, p = 0.036; proximal femur R2 = 0.16, p = 0.086). BMD was negatively associated with log HOMA2-S in individuals with increased WC and positively in those with normal WC (femoral neck R2 = 0.16, p = 0.042; proximal femur R2 = 0.15, p = 0.097). No significant associations between BMD, log HOMA2-ß and OC and glucose metabolism markers were observed. CONCLUSIONS: BMD was associated with glucose metabolism, independently of OC, and WC modifies this association.

Waist circumference is an effect modifier of the association between bone mineral density and glucose metabolism

ABSTRACT Objective: The role of bone markers on insulin resistance (IR) remains controversial. The objective of this study is to evaluate the association between bone mineral density (BMD) and glucose metabolism and investigate if visceral hyperadiposity, evaluated by waist circumference (WC), is an effect modifier of this association. Subjects and methods: Cross-sectional analysis with 468 young adults from the fourth follow-up of the 1978/79 Ribeirão Preto prospective birth cohort, Brazil. BMD, total osteocalcin (OC), fasting plasma glucose and insulin concentrations were assessed. IR, sensitivity (S) and secretion (β) were estimated by homeostasis model assessment (HOMA) indexes. Multiple linear regression models were constructed to estimate the association between BMD and glucose metabolism. Beta coefficient, R2 and p-values were provided. WC was tested as an effect modifier and OC as a confounder. The covariates were selected based on Direct Acyclic Graph. Results: Significant interaction between BMD (femoral neck and proximal femur areas) and WC on glucose metabolism was observed in the adjusted models. Subjects with increased WC presented a positive association between BMD and log HOMA1-IR while an inverse association was found in those with normal WC (femoral neck R2 = 0.17, p = 0.036; proximal femur R2 = 0.16, p = 0.086). BMD was negatively associated with log HOMA2-S in individuals with increased WC and positively in those with normal WC (femoral neck R2 = 0.16, p = 0.042; proximal femur R2 = 0.15, p = 0.097). No significant associations between BMD, log HOMA2-β and OC and glucose metabolism markers were observed. Conclusions: BMD was associated with glucose metabolism, independently of OC, and WC modifies this association.

Is malnutrition associated with crowding in permanent dentition?

Evidence suggests that energy-protein malnutrition is associated with impaired growth and development of facial bones. The objective of this study was to investigate the association between nutritional status and reduced space for dental eruption (crowding) in permanent dentition. A cross-sectional study with probabilistic sampling design was used. We evaluated 2,060 students aged 12 to 15 years enrolled in schools in the northeast of Brazil. Crowding was defined according to World Health Organization (WHO) as misalignment of teeth due to lack of space for them to erupt in the correct position. Nutritional status was evaluated by means of body mass index and height-for-age, using the WHO's reference curves. Parents and adolescents responded to a questionnaire about demographic, socioeconomic, biological and behavioral characteristics. The associations were estimated by odds ratio (OR) in multivariate logistic regression analysis (alpha = 0.05). Confounding and effect-modification were taken into account. An association between low height-for-age (z-score < -1SD) and crowding was only observed in adolescents with a prolonged history of mouth breathing (OR = 3.1). No association was observed between underweight and crowding. Malnutrition is related to crowding in permanent dentition among mouth-breathing adolescents. Policy actions aimed at reducing low height-for-age and unhealthy oral habits are strongly recommended. However, further studies are needed to increase the consistency of these findings and improve understanding of the subject.

Size at birth and lipoprotein concentrations in adulthood: two prospective studies in Latin American cities.

BACKGROUND: The relationship between birth weight and plasma lipoproteins is inconsistent. AIMS: To assess the association between birth weight and (1) body mass index (BMI) at birth and (2) lipoproteins in young adults, and also to explore the possible effect of current obesity as a possible effect modifier. METHODS: Two prospective studies based on representative samples of subjects born in the 1970s were carried out in Ribeirão Preto, Brazil (n=2063) and Limache, Chile (n=999). The surveys were carried out between 2001 and 2004. RESULTS: Mean birth weights were 3267 g and 3177 g and mean adult BMIs were 24.3 kg/m2 and 25.8 kg/m2 in the Brazilian and Chilean samples, respectively. Total adult cholesterol was 4.57 mmol/l in Chileans, 0.26 mmol/l higher than in Brazilians (p<0.001). The main finding was an interaction between adult obesity (BMI 30 or over) and birth weight and also BMI at birth and low-density lipoprotein (LDL) and total cholesterol. A birth-weight increment of 1 kg was associated with a decrease in total cholesterol (-0.374 mmol/l, 95% CI -0.567 to -0.181) and LDL (-0.304 mmol/l (-0.479 to -0.129) in obese participants only. These associations persisted after allowing for gestational age in a smaller sample. This finding was consistent in separate analyses in the Brazilian and Chilean samples. No associations were found in relation to high-density lipoprotein and triglyceride concentrations. CONCLUSION: The results suggest that those who were of low birth weight and are obese are more likely to have high cholesterol and LDL concentrations. Thus preventing obesity may be especially rewarding in subjects with a low birth weight.

Risk factors for inadequate prenatal care use in the metropolitan area of Aracaju, Northeast Brazil.

BACKGROUND: The aim of prenatal care is to promote good maternal and foetal health and to identify risk factors for adverse pregnancy outcomes in an attempt to promptly manage and solve them. Although high prenatal care attendance is reported in most areas in Brazil, perinatal and neonatal mortalities are disproportionally high, raising doubts about the quality and performance of the care provided. The objective of the present study was to evaluate the adequacy of prenatal care use and the risk factors involved in inadequate prenatal care utilization in the metropolitan area of Aracaju, Northeast Brazil. METHODS: A survey was carried out with puerperal women who delivered singleton liveborns in all four maternity hospitals of Aracaju. A total of 4552 singleton liveborns were studied. The Adequacy of Prenatal Care Utilization Index, modified according to the guidelines of the Prenatal Care and Birth Humanization Programme, was applied. Socioeconomic, demographic, biological, life style and health service factors were evaluated by multiple logistic regression. RESULTS: Prenatal care coverage in Aracaju was high (98.3%), with a mean number of 6.24 visits. Prenatal care was considered to be adequate or intensive in 66.1% of cases, while 33.9% were considered to have inadequate usage. Age < 18 to 34 years at delivery, low maternal schooling, low family income, two or more previous deliveries, maternal smoking during pregnancy, having no partner and prenatal care obtained outside Aracaju were associated with inadequate prenatal care use. In contrast, private service attendance protected from inadequate prenatal care use. CONCLUSION: Prenatal care coverage was high. However, a significant number of women still had inadequate prenatal care use. Socioeconomic inequalities, demographic factors and behavioural risk factors are still important factors associated with inadequate prenatal care use.

Metabolic syndrome in young adults from two socioeconomic Latin American settings.

BACKGROUND AND AIM: Since little information on the metabolic syndrome (MS) is available in Latin America, the aim of this study was to explore whether and to what extent differing socioeconomic conditions influence the prevalence of MS and its associated factors among young adults from two towns in Latin America: semi-rural Limache (L), Chile, and urban Ribeirão Preto (RP), Brazil. METHODS AND RESULTS: A cross-sectional study based on two independent investigations of 22- to 28 year-old subjects using a common methodology. The prevalence of MS (according to the US National Cholesterol Education Program) and its risk factors (smoking habit, alcohol and caloric intake, obesity, physical activity and socioeconomic conditions) were assessed. The prevalence of MS was 10% in L and in RP men, but was lower (4.8%) in RP women. Hyperglycemia was very low (0.8% in L and 1.1% in RP), while the prevalence of low HDL cholesterol levels was high (66.7% and 42.2%, respectively). Intermediate prevalences of hypertriglyceridemia (17.9% and 12.9%), elevated blood pressure (15.5% and 23.1%) and abdominal obesity (19.3% versus 12.7%) were detected. RP subjects had a higher educational level and more qualified jobs, came from smaller families, and a higher proportion were car owners. In L, the smoking habit was more frequent, subjects had higher excess weight and caloric intake, and lower levels of physical activity. CONCLUSIONS: Metabolic changes possibly leading to cardiovascular diseases in later life were present in both populations at an early age, but were higher in the rural and less developed county. Our findings point to the existence of a cultural, educational and socioeconomic phenomenon that possibly influences the prevalence of the diagnostic components of MS through differences in lifestyles.

Are there differences in clinical and laboratory parameters between children and adults with American visceral leishmaniasis?

A prospective study on 23 patients with American visceral leishmaniasis (VL), comparing clinical and laboratory parameters of 14 children (mean age of 3.85+/-3.39 years) to nine adults (27.4+/-10.90 years) was performed in São Luís, Maranhão, Brazil, between August 2000 and July 2002. Data were collected at entrance (day 0), end of treatment, as well as 120 and 210 days after treatment using a protocol chart containing patient identification, clinical and laboratory data. N-Methylglucamine antimonate administered at the dose of 20mg/Sb5+/kg/day for 20-30 days was successfully used in all patients. Patients were followed for 1 year after treatment, and no relapses were observed. A prolonged duration of the disease, lymphadenopathy and bleeding predominated in adult patients, while hepatomegaly and skin-mucosal pallor were more frequent in children. Disease was longer and more severe in adults than in children. Although both groups exhibited a trend toward normalization of hematological and biochemical parameters, more children returned sooner to normal values than adults. Difference in clinical or laboratory parameters between children and adults did not indicate the need for different clinical or therapeutic approaches.

[Trends in AIDS incidence and mortality in Brazil, 1985 to 1998]. / Tendências da incidência e da mortalidade por Aids no Maranhão, 1985 a 1998.

INTRODUCTION: AIDS mortality is decreasing in Brazil, especially after the introduction of anti-retroviral therapy. A study was conducted to evaluate AIDS incidence and mortality in a certain area of Brazil. METHODS: The number of AIDS deaths according to sex in the study period, obtained from registry sources, were used as the numerator of mortality rates. From 1985 to 1995, deaths with underlying cause classified as code 279/1 in the 9th International Classification of Diseases (ICD) and, from 1996 onwards, B20 to B24 codes in the 10th Review were considered AIDS cases. SINAN/MS disease compulsory notification data were used as the numerator of incidence rates. Percentage of variation of the incidence and mortality rates were calculated using a Poisson regression model. RESULTS: In the study period, there were 1,211 AIDS cases and 501 deaths. AIDS incidence increased 21.6% during this period (p<0.05) in both sexes, though higher among women. The mortality rates increased exponentially (122.5%) from 1985 to 1991. From 1991 to 1998, mortality remained steady among men but continued to rise among women. CONCLUSIONS: Stabilization of AIDS mortality in men may be a reflection of large utilization of anti-retroviral therapy. Increasing mortality rate among women could be due to different epidemic dynamics according to sex. This trend is different from the observed in the rest of Brazil, where there has been a fall in AIDS mortality for both sexes since 1991.

Tendencias da incidência e da mortalidade por AIDS no Maranhäo, 1985 a 1998 / Trends in AIDS incidence and mortality in Brazil, 1985 to 1998

INTRODUÇAO: A mortalidade por Aids no Brasil está decrescendo, principalmente, após a introduçäo dos anti-retrovirais. Nesse sentido, foi realizado estudo com o objetivo de analisar a incidência e mortalidade, segundo sexo, em uma determinada regiäo do Brasil. MÉTODOS: O estudo foi realizado a partir do número de óbitos ocorrido por Aids na populaçäo residente no Estado do Maranhäo, segundo sexo, no período de 1985 a 1998. Utilizou-se como numerador a quantidade de óbitos do Sistema de Informaçäo de Mortalidade (SIM). De 1985 a 1995, foram utilizados registros com código 279/1 da nona revisäo da Classificaçäo Internacional de Doenças. A partir de 1996, foram utilizados os códigos B20 a B24 da décima revisäo dessa classificaçäo. Foram utilizados como numerador dos coeficientes de incidência os dados do Sistema de Informaçäo de Agravos de Notificaçäo Compulsória (SINAM). Os percentuais de variaçäo dos coeficientes foram calculados utilizando-se modelo de regressäo de Poisson. RESULTADOS: Ocorreram 1.211 casos e 501 óbitos por Aids no período. Os coeficientes de incidência anual mostraram crescimento de 21,6 por cento (p<0,05) em ambos os sexos, com aumento maior no sexo feminino. A mortalidade mostrou aumento do tipo exponencial de 122,5 por cento até 1991. De 1992 até 1998, a mortalidade estabilizou-se em homens, mas continuou aumentando entre as mulheres. CONCLUSOES: A estabilizaçäo da mortalidade no sexo masculino pode estar refletindo maior utilizaçäo de anti-retrovirais. O aumento da mortalidade no sexo feminino pode ser devido a diferentes dinâmicas da epidemia nesse sexo. Esta tendência difere da observada no Brasil, onde foi detectada a queda da mortalidade por Aids em ambos os sexos, principalmente após 1991

Perinatal health and mother-child health care in the municipality of Säo Luís, Maranhäo State, Brazil

Teve o objetivo de estimar indicadores sócio-econômicos, demográficos, saúde reprodutiva, utilizaçäo de serviços pré-natais e de atençäo ao parto e ao recém-nascido, dados antropométricos da mäe e da criança. Foi realizado estudo transversal em amostra sistemática de 2.831 nascimentos hospitalares ocorridos em Säo Luís, estratificada por maternidades, com partilha proporcional ao número de nascimentos em cada unidade, no período de março de 1997 a fevereiro de 1998. Utilizou-se questionário padronizado respondido pela puérpera. Analisaram-se nascimentos em dez unidades de saúde, públicas e privadas, dos quais 97,9 por cento eram nascidos vivos e 98 por cento de parto único. A cobertura do pré-natal foi de 89,5 por cento. A prevalência de cesarianas 33,8 por cento. O médico realizou 75,7 por cento do antendimento pré-natal e 73,5 por cento dos partos. O Sistema Unico de Saúde custeou 76,4 por cento do atendimento pré-natal e 89,7 por cento da assistência ao parto. O atendimento por pediatra em sala de parto foi de 50,2 por cento. A taxa de baixo peso ao nascer foi de 9,6 por cento e de prematuridade 13,9 por cento. Alta porcentagem de mäes adolescentes e sem companheiro, alta taxa de cesáreas e de partos assistidos por pessoa näo qualificado, säo razöes para preocupaçäo.

Infecçäo por Leishmania (Leishmania) chagasi em crianças de uma área endêmica de leishmaniose visceral americana na Ilha de Säo Luís-MA, Brasil / Leishmania (Leishmania) chagasi infection on childhood from endemic area of visceral leishmaniasis in the Säo Luis-MA, island

Realizou-se estudo prospectivo com 648 crianças de zero a cinco anos no município da Raposa-MA, de julho/97 a junho/98, com o objetivo de avaliar as características da infecção por L.(L.)chagasi e verificar se existe associação entre desnutrição e infecção assintomática. Utilizou-se questionário com dados socioeconômicos, ambientais e hábitos de vida; realizou-se Intradermorreação de Montenegro(IDRM) com antígeno de L. amazonensis e Enzyme Linked Immunosorbant Assay(ELISA) para detectar infecção, e exame antropométrico. A prevalência inicial, final e incidência da infecção foram 18,6 por cento, 20,6 por cento e 10,8 por cento pelo IDRM, e 13,5 por cento, 34,4 por cento e 28 por cento pelo ELISA, respectivamente. A prevalência da desnutrição crônica (altura/idade) foi 26 por cento. Não houve associação estatisticamente significante entre desnutrição e infecção assintomática por L. (L.) chagasi. A forma assintomática da doença está presente nas áreas estudadas, necessitando de medidas de controle mais efetivas

Morbimortalidade infantil por diarréia aguda em área metropolitana da regiäo Nordeste do Brasil, 1986-1989 / Infant morbimortality due to acute diarrhoea in a metropolitan area of northeastern Brazil

Foi realizado inquérito domiciliar do tipo transversal abrangendo crianças menores de cinco anos residentes em 3 áreas da ilha de Säo Luís (Brasil): Vila Palmeira, Anjo da Guarda e Säo José de Ribamar. Aplicou-se um questionário onde se perguntou à mäe ou à pessoa responsável pela criança sobre a presença de diarréia nas duas últimas semanas. Foram realizados dois estudos censitários (maio de 1986 e 1989) e quatro amostragens sazonais (novembro de 1986, 1987 e 1988 e maio de 1989). A prevalência de diarréia foi maior em maio de 1986 e novembro de 1987; Säo José de Ribamar foi o local de maior prevalência; a distribuiçäo dos casos por idades mostrou maior prevalência entre crianças de 6 a 11 meses e de 1 a 2 anos de idade; a prevalência da diarréia foi maior nas famílias que tinham como destino dos dejetos a maré e fossa negra; que se abasteciam de água de poço descoberto, nas famílias cujos pais eram desempregados e nas que depositavam o lixo na maré. A diarréia foi a principal causa de morte nos dois estudos censitários; a taxa de mortalidade infantil em maio de 1986 foi, respectivamente, de 44,0 por mil em menores de um ano e 12,8 por mil em menores de cinco anos; em maio de 1989 foi de 7,9 por mil e 4,9 por mil. As reduçöes na morbidade e mortalidade infantil por diarréia aguda entre 1986 e 1989 foram estatisticamente significantes

Saúde perinatal em Ribeiräo Preto, SP, Brasil: apresentaçäo de algumas características demografo-sociais e da atençäo médica da populaçäo estudada / Perinatal health in Ribeiräo Preto, SP, Brazil: social demographic patterns and medical care aspects

Os autores apresentam algumas características demógrafo-sociais e da atençäo médica da populaçäo de recém-nascidos dos hospitais de Ribeiräo Preto, SP, Brasil, no período de 1§ de junho de 1978 a 31 maio de 1979, englobando 98% do universo de nascidos vivos, correspondendo a um total de 9048 crianças. Säo apresentados dados referentes aos pais e mäes (idade, escolaridade, hábito de fumar, trabalho, situaçäo conjugal, número e duraçäo das gestaçöes), assitência pré-natal e ao parto (categoria de assistência ao pré-natal e ao parto (categoria de asssitência pré-natal e ao parto, número de consultas no pré-natal e tipo de parto), as crianças (sexo, peso, comprimento e perímetro craniano ao nascer, mortalidade infantil). A classe social, renda familiar e procedência. Demonstrou-se reduçäo significativa da mortalidade infantil no período de 69-70 a 78-79 (p < 0,01). Observou-se uma grande proporçäo de "fatores de risco" para a saúde perinatal, cuja ariculaçäo com as características sociais está sob investigaçäo