Risk factors for eating disorders: an umbrella review of published meta-analyses

Objective: To grade the evidence about risk factors for eating disorders (anorexia nervosa, bulimia nervosa, and binge eating disorder) with an umbrella review approach. Methods: This was a systematic review of observational studies on risk factors for eating disorders published in PubMed/PsycInfo/Embase until December 11th, 2019. We recalculated random-effect meta-analyses, heterogeneity, small-study effect, excess significance bias and 95% prediction intervals, grading significant evidence (p < 0.05) from convincing to weak according to established criteria. Quality was assessed with the Assessment of Multiple Systematic Reviews 2 (AMSTAR-2) tool. Results: Of 2,197 meta-analyses, nine were included, providing evidence on 50 risk factors, 29,272 subjects with eating disorders, and 1,679,385 controls. Although no association was supported by convincing evidence, highly suggestive evidence supported the association between childhood sexual abuse and bulimia nervosa (k = 29, 1,103 cases with eating disorders, 8,496 controls, OR, 2.73, 95%CI 1.96-3.79, p = 2.1 x 10-9, AMSTAR-2 moderate quality) and between appearance-related teasing victimization and any eating disorder (k = 10, 1,341 cases with eating disorders, 3,295 controls, OR 2.91, 95%CI 2.05-4.12, p = 1.8x10-9, AMSTAR-2 moderate quality). Suggestive, weak, or no evidence supported 11, 29, and 8 associations, respectively. Conclusions: The most credible evidence indicates that early traumatic and stressful events are risk factors for eating disorders. Larger collaborative prospective cohort studies are needed to identify risk factors for eating disorders, particularly anorexia nervosa.

Risk factors for eating disorders: an umbrella review of published meta-analyses.

OBJECTIVE: To grade the evidence about risk factors for eating disorders (anorexia nervosa, bulimia nervosa, and binge eating disorder) with an umbrella review approach. METHODS: This was a systematic review of observational studies on risk factors for eating disorders published in PubMed/PsycInfo/Embase until December 11th, 2019. We recalculated random-effect meta-analyses, heterogeneity, small-study effect, excess significance bias and 95% prediction intervals, grading significant evidence (p < 0.05) from convincing to weak according to established criteria. Quality was assessed with the Assessment of Multiple Systematic Reviews 2 (AMSTAR-2) tool. RESULTS: Of 2,197 meta-analyses, nine were included, providing evidence on 50 risk factors, 29,272 subjects with eating disorders, and 1,679,385 controls. Although no association was supported by convincing evidence, highly suggestive evidence supported the association between childhood sexual abuse and bulimia nervosa (k = 29, 1,103 cases with eating disorders, 8,496 controls, OR, 2.73, 95%CI 1.96-3.79, p = 2.1 x 10-9, AMSTAR-2 moderate quality) and between appearance-related teasing victimization and any eating disorder (k = 10, 1,341 cases with eating disorders, 3,295 controls, OR 2.91, 95%CI 2.05-4.12, p = 1.8x10-9, AMSTAR-2 moderate quality). Suggestive, weak, or no evidence supported 11, 29, and 8 associations, respectively. CONCLUSIONS: The most credible evidence indicates that early traumatic and stressful events are risk factors for eating disorders. Larger collaborative prospective cohort studies are needed to identify risk factors for eating disorders, particularly anorexia nervosa.

The relationship between morphological awareness and reading comprehension in Spanish-speaking children.

In the last decades, a series of studies has explored the role of morphological awareness on reading comprehension. Path analysis studies performed in English have shown that morphological awareness benefits reading comprehension both directly and indirectly, through word decoding. This issue has seldom been explored in Spanish. The aim of this study was to replicate in Spanish the results previously found in English. We used path analysis to assess three alternative models of the relationship between morphological awareness, word decoding and reading comprehension in 4th grade Spanish-speaking children. Contrary to English, we found that morphological awareness benefits reading comprehension only directly. We conclude that in Spanish, in which accurate and fluent pronunciation of written words can be achieved through grapheme-to-phoneme conversion rules, morphological awareness does not help the correct pronunciation of words. Thus, morphological awareness is not relevant for word decoding in Spanish but is related to reading comprehension since this type of morphological knowledge provides access to the semantic and syntactic information of new words.

Morphological De-com-pos-it-ion Helps Recognize Low-er Frequency Words in Typically Developing Spanish-Speaking Children.

Several studies in Spanish and other languages have shown that, in a lexical decision task, children are more likely to accept pseudowords with a known morphological structure as words as compared to non-morphological pseudowords. Morphology also facilitates visual word recognition of actual words in children with reading difficulties. In the present study, we explored the role of morphology, frequency and reading proficiency (measured by school grade) in visual word recognition. Typically developing readers of Spanish from 2nd, 4th and 6th grades performed a lexical decision task in which the morphological complexity and the frequency of the words were factorially manipulated. Our results showed that morphology benefited the accuracy of visual word recognition for low frequency words only. We conclude that decomposition in morphemes occurs in Spanish only for less frequent words. These results in Spanish support models that posit the decomposition of morphologically complex words in the orthographic lexicon.

The More Doctors Program and the rearrangement of medical residency education focused on Family and Community Medicine / O Programa Mais Médicos e o reordenamento da formação da residência médica com enfoque na Medicina de Família e Comunidade / El Programa Más Médicos y la reorganización de la formación de residencia médica con enfoque en Medicina de Familia y Comunidad

Abstract The More Doctors Program (PMM) was created in 2013 to address problems such as the insufficient number and unequal distribution of doctors, and their inadequate education profile to fulfill the population needs. Among other axes, it proposes changes in medical education, including the rearrangement and expansion of residency, suggesting one seat for every medical course graduate. This study reflects upon the elements that were essential to propose and implement changes in medical residency through PMM. The following advances were identified: better distribution of residency seats across Brazil; diversification of universalization strategies; regulations for residency seats focused on Family and Community Medicine; and preceptorship qualification. The conclusion section presents the challenges faced by the required institutional effort to maintain PMM's actions in order to regulate residency and expand actions to other professions.(AU)

Resumo O Programa Mais Médicos (PMM) foi criado em 2013 para enfrentar problemáticas como a insuficiência e má distribuição de médicos e o perfil de formação inadequado às necessidades da população. Entre os seus eixos está a mudança da formação médica, incluindo a reordenação e ampliação da residência, propondo uma vaga para cada egresso dos cursos de Medicina. Neste artigo, propõe-se uma reflexão sobre quais elementos foram decisivos na formulação e implementação das mudanças na residência médica pelo PMM. Identificam-se: melhor distribuição de vagas de residência entre as regiões do país; diversificação de estratégias para universalização do acesso à residência médica; regulação das vagas de residência médica com enfoque na Medicina de Família e Comunidade; e qualificação da preceptoria. Na conclusão são apontados desafios enfrentados pelo esforço institucional necessário de manter as ações do PMM visando regular a residência e expandir ações para mais profissões.(AU)

Resumen El Programa Más Médicos, creado en 2013, buscaba enfrentar problemáticas como la insuficiencia y mala distribución de médicos y el inadecuado perfil de formación para las necesidades poblacionales en Brasil. Sus ejes buscan cambios en la formación médica, reorganización y ampliación de residencias, y proponer una plaza para cada egresado del curso de medicina. Este artículo analiza documentación, bases de datos oficiales y revisa la literatura buscando evaluar propuestas y objetivos alcanzados por el programa en las residencias. Se identificaron avances importantes en: la distribución de plazas de residencia en las regiones del país, la interiorización de la formación, la regulación de las plazas de residencia médica con enfoque en medicina de familia y comunidad y la cualificación de la preceptoría. La conclusión señala los desafíos enfrentados por el programa para alcanzar efectivamente sus objetivos.(AU)

Development and Initial Validation of the Macrophage Activation Syndrome/Primary Hemophagocytic Lymphohistiocytosis Score, a Diagnostic Tool that Differentiates Primary Hemophagocytic Lymphohistiocytosis from Macrophage Activation Syndrome.

OBJECTIVE: To develop and validate a diagnostic score that assists in discriminating primary hemophagocytic lymphohistiocytosis (pHLH) from macrophage activation syndrome (MAS) related to systemic juvenile idiopathic arthritis. STUDY DESIGN: The clinical, laboratory, and histopathologic features of 362 patients with MAS and 258 patients with pHLH were collected in a multinational collaborative study. Eighty percent of the population was assessed to develop the score and the remaining 20% constituted the validation sample. Variables that entered the best fitted model of logistic regression were assigned a score, based on their statistical weight. The MAS/HLH (MH) score was made up with the individual scores of selected variables. The cutoff in the MH score that discriminated pHLH from MAS best was calculated by means of receiver operating characteristic curve analysis. Score performance was examined in both developmental and validation samples. RESULTS: Six variables composed the MH score: age at onset, neutrophil count, fibrinogen, splenomegaly, platelet count, and hemoglobin. The MH score ranged from 0 to 123, and its median value was 97 (1st-3rd quartile 75-123) and 12 (1st-3rd quartile 11-34) in pHLH and MAS, respectively. The probability of a diagnosis of pHLH ranged from <1% for a score of <11 to >99% for a score of ≥123. A cutoff value of ≥60 revealed the best performance in discriminating pHLH from MAS. CONCLUSION: The MH score is a powerful tool that may aid practitioners to identify patients who are more likely to have pHLH and, thus, could be prioritized for functional and genetic testing.

Programa Mais Médicos: elementos de tensão entre governo e entidades médicas / The More Doctors Program: elements of tension between the government and medical associations / Más Médicos: elementos de tensión entre gobierno y entidades médicas

Em 2013, chegaram os primeiros médicos pelo Programa Mais Médicos. O seu processo de implantação foi cercado de disputas judiciais e embates ideológicos advindos de médicos brasileiros e suas entidades representativas. A iniciativa de criação do programa foi creditada pelas entidades médicas como uma medida unilateral do Governo Federal, eleitoreira e sem planejamento. O artigo resgata o processo histórico que deu origem ao Programa Mais Médicos, destacando a tensão entre governo e entidades médicas. Trata-se de estudo exploratório com pesquisa bibliográfica e documental. Analisando dados e tendências nacionais e internacionais e discursos de médicos e suas entidades representativas, é possível inferir que o programa não está sendo compreendido na sua totalidade, que vai além da provisão imediata de médicos. Além disso, o papel regulador do Estado para cumprir a Constituição Federal está sendo confundido com interferência na autonomia da profissão médica.(AU)

In 2013, the first physicians arrived for the More Doctors Program. The process of implementation was engulfed in legal disputes and ideological conflicts sparked by Brazilian physicians and their representative associations. The initiative to create the program was seen by the medical associations as a unilateral measure of the federal government, lacking in planning and designed to win votes. This paper presents the historical process that gave rise to the program, highlighting the tension between the government and medical associations. It is an exploratory study with biographical and documental research. Through analyzing data and national and international trends, as well as statements from physicians and their representative associations, it can be inferred that the program is not understood in its entirety, which goes beyond the immediate provision of physicians. In addition, the regulatory role of the State, in its responsibility to comply with the Federal Constitution, is being misinterpreted as undermining the autonomy of the medical profession.(AU)

En 2013 llegaron los primeros médicos del Programa Más Médicos. Su proceso de implantación estuvo cargado por disputas judiciales y embates ideológicos provenientes de médicos brasileños y sus entidades representativas. La iniciativa de creación del Programa fue considerada por las entidades médicas como una medida unilateral del Gobierno Federal, con fines electorales y sin planificación. El artículo rescata el proceso histórico que dio origen al Programa, destacando la tensión entre gobierno y entidades médicas. Se trata de un estudio exploratorio con investigación bibliográfica y documental. Analizando datos y tendencias nacionales e internacionales y discursos de médicos y sus entidades representativas, es posible inferir que el Programa no se ha entendido en su totalidad, que va más allá de la provisión inmediata de médicos. Además, el papel regulador del estado para cumplir la Constitución Federal se está confundiendo con interferencia en la autonomía de la profesión médica.(AU)

Regulação da formação de especialistas: inter-relações com o Programa Mais Médicos / Specialists training regulation: interrelationships with the Mais Médicos Program

Resumo Até recentemente, inexistiam políticas indutoras da formação de especialistas voltadas ao SUS. Um marco foi o Programa Nacional de Apoio à Formação de Médicos Especialistas em Áreas Estratégicas - Pró-Residência, criado em 2009. Com o lançamento do Programa Mais Médicos pela Lei nº12.871/2013, novas estratégias se configuraram para aprimorar a regulação da formação de especialistas. Este artigo pretende discutir as políticas de regulação da abertura de vagas de residência médica a partir do Pró-Residência e abordar mudanças apontadas pela Lei nº 12.871/2013, como a universalização das vagas com ênfase para Medicina de Família e Comunidade. Foi realizada pesquisa bibliográfica com análise documental, além de estudo quantitativo. Os resultados evidenciam efeitos positivos de políticas públicas no número e distribuição de vagas de residência médica com a duplicação destas entre 2009 e 2014, aumento mais expressivo nas regiões Norte e Nordeste, além do surgimento de especialidades antes inexistentes nessas regiões. Novos desafios se colocam para expandir a residência com velocidade e qualidade necessárias, como a melhoria de ferramentas para a gestão de recursos humanos em saúde, com expansão e qualificação da preceptoria e campos de prática para formação.

Abstract Until recently, there were no policies that induce the formation of specialists geared to the Unified Heath System (SUS). A milestone was the National Program to Support Training of Medical Specialists in Strategic Areas - Pro-Residência, created in 2009. With the launch of the Mais Médicos Program by Law n. 12.871/2013, new strategies were shaped to enhance the regulation of training specialists. This article discusses the regulatory policies of the opening of medical residency positions from the Pro-Residência and addresses changes suggested by Law n. 12.871/2013 such as universal vacancies with emphasis on Family Medicine. This is a quantitative and qualitative study that uses bibliographic and documentary research. The results show the positive effects of public policies in the number and distribution of medical residency positions. The number of professionals has been doubled between 2009 and 2014 with more significant increase in the North and Northeast regions. Furthermore, there is also the emergence of specialties previously nonexistent in these regions. New challenges arise to expand residency with necessary quality and speed, such as improved tools for the management of health human resources, with expansion and qualification of preceptorship and practice fields for training.

Análise da implantação do programa mais médicos / Analysis of the implementation of more medical program

A Atenção Básica vem ampliando sua cobertura populacional de forma acelerada desde sua implantação no Brasil, na década de 1990. Em 20 anos, a Estratégia de Saúde da Família estendeu sua cobertura de 5% para 60%, mas a capacidade de formação de médicos para ocupar tais posições não se desenvolveu na mesma velocidade, assim como não se desenvolveram tecnologias suficientes para o planejamento adequado de recursos humanos em saúde. Neste contexto é lançado o Programa Mais Médicos em julho de 2013 com ênfase na vinda de milhares de médicos estrangeiros para atuar na Atenção Básica, causando grande reação negativa das entidades médicas com inúmeras disputas ideológicas e judiciais. Este trabalho se propõe a lançar um olhar sobre os elementos de tensão entre Entidades Médicas e Governo no processo de implantação do Programa Mais Médicos e estudar o processo de evolução da regulação da formação de especialistas no país, na modalidade Residência Médica. Para tanto, optou-se por uma abordagem qualitativa no formato de estudo exploratório, utilizando-se de pesquisa bibliográfica e documental, assim como uma abordagem quantitativa na análise dos números de vagas de residência médica no país, com análise estatística descritiva dos dados. Os resultados apontam para melhora na capacidade de regulação de vagas para formação de especialistas no Brasil nos últimos cinco anos, sobretudo com o advento do PRÓ-RESIDÊNCIA e outras políticas de incentivo de abertura de vagas. A Lei nº12.871/2013 também aponta para importante evolução nas ferramentas de gestão de recursos humanos em saúde, além de mudanças e maior rigor na aplicação das Diretrizes Curriculares Nacionais para formação de médicos no país, com importante ênfase na Atenção Básica. Os resultados...

The population coverage of Primary Care has increased rapidly since its implementation in Brazil in the 1990s. Over 20 years, the Family Health Strategy extended its coverage from 5% to 60%, but the ability to train doctors to occupy such positions did not develop at the same rate, and sufficient technology for the proper planning of human resources for health has not evolved. In this context, the Mais Médicos Program was launched in July 2013 with emphasis on the coming of thousands of foreign doctors to work in Primary Care, causing an overwhelmingly negative reaction by medical organisations with numerous ideological and legal disputes. This paper aims to cast an eye on the elements of tension between Medical Entities and Government in the implementation process of the Mais Médicos Program and to study the process of development of the regulations of training specialists in the country, in Medical Residency. Therefore, we chose a qualitative approach in the exploratory format of the research, using bibliographic and documentary research, as well as a quantitative approach in the analysis of the numbers of medical residency positions in the country, with descriptive statistical analysis. The results indicate improvement in the capacity to regulate positions for training specialists in Brazil in the last five years, particularly with the advent of PRO-RESIDÊNCIA and other vacancy incentive policies. Law no. 12.871/2013 also points to important developments in human resource management tools in health, as well as changes and stricter application of the National Curriculum Guidelines for training doctors in the country, with major emphasis on Primary Care. The results also suggest a lack of understanding, on the part of doctors, regarding the Mais Médicos Program in its entirety, not only in the immediate ...

Long-term efficacy of interleukin-1 receptor antagonist (anakinra) in corticosteroid-dependent and colchicine-resistant recurrent pericarditis.

OBJECTIVE: To evaluate the long-term response and safety of interleukin-1 receptor antagonist (anakinra) in recurrent pericarditis. STUDY DESIGN: Fifteen patients (12 children, 3 adults) were enrolled in a multicenter retrospective study. All the patients were corticosteroid-dependent and 14 had received colchicine. Anakinra was given at 1-2 mg/kg/d. The primary outcome of the study was a reduction of at least 70% of disease flares after anakinra treatment compared with the pretreatment period. Secondary outcomes were: (1) number of complete or partial responders to anakinra and time for complete response; (2) number of patients who discontinued other ongoing treatments (non-steroidal anti-inflammatory drugs, corticosteroid, colchicine) and time needed for discontinuation; (3) number of relapses during continuous anakinra treatment; and (4) number of relapses during anakinra tapering or discontinuation. RESULTS: All patients treated had a complete response within a few days and were able to rapidly withdraw concomitant treatments, including corticosteroids. During daily treatment, no patient had a relapse of the disease; 14 patients started tapering and 6 of them experienced a relapse, with a prompt response after anakinra reintroduction. Overall, after a median follow-up of 39 months (range 6-57), a 95% reduction of flares was observed compared with pretreatment period. CONCLUSION: The long-term use of anakinra in monotherapy is associated with persistent control of recurrent pericarditis.

Diagnosis of iron deficiency anemia in children of Northeast Brazil.

OBJECTIVE: To diagnose iron deficiency anemia in children. METHODS: The study was conducted with a sample of 301 children aged six to 30 months attending public daycare centers in the city of Recife, Northeast Brazil, in 2004. The diagnoses of anemia were based on a combination of different hematological and biochemical parameters: hemoglobin, mean corpuscular volume, ferritin, C-reactive protein, transferrin saturation and transferrin receptor. The chi-square test and ANOVA were used in the statistical analysis. RESULTS: Of all children studied, 92.4% had anemia (Hb<110 g/L) and 28.9% had moderate/severe anemia (Hb<90 g/L). Lower levels of hemoglobin were found in children aged 6-17 months. Iron deficiency was found in 51.5% of children using ferritin (<12 microg/L) as parameter. Taking into consideration the combination of hemoglobin level, ferritin and transferrin receptor, 58.1% had anemia with iron deficiency, 34.2% had anemia without iron deficiency and 2.3% had iron deficiency without anemia. Mean ferritin concentration was significantly higher in children with high C-reactive protein when compared with those with normal levels (22.1 vs. 14.8 microg/L). CONCLUSIONS: The use of several biochemical and hematological parameters allowed to diagnosing iron deficiency anemia in two thirds of children, suggesting a need to identify other determinants of anemia without iron deficiency.

Diagnosis of iron deficiency anemia in children of Northeast Brazil / Diagnóstico de anemia por deficiencia de hierro en niños del Noreste de Brasil

OBJETIVO: Diagnosticar anemia por deficiência de ferro em crianças. MÉTODOS: O estudo foi desenvolvido com uma amostra de 301 crianças com idade entre seis e 30 meses, usuárias de creches públicas de Recife, PE, em 2004. Para o diagnóstico da anemia utilizou-se a combinação de diferentes parâmetros hematológicos e bioquímicos: hemoglobina, volume corpuscular médio, ferritina, proteína C-reativa, saturação da transferrina e receptor da transferrina. Para a análise estatística empregou-se o teste do qui-quadrado e ANOVA. RESULTADOS: Do total de crianças, 92,4 por cento tinha anemia (Hb < 110g/L) e 28,9 por cento apresentou anemia moderada/grave (Hb<90g/L). Níveis mais baixos de hemoglobina foram observados em crianças de seis a 17 meses. Encontrou-se deficiência de ferro em 51,5 por cento das crianças, utilizando-se a ferritina (< 12µg/L) como parâmetro. Considerando a combinação da concentração de hemoglobina, ferritina e do receptor de transferrina, 58,1 por cento tinha anemia com deficiência de ferro, 34,2 por cento anemia sem déficit de ferro e 2,3 por cento deficiência de ferro sem anemia. A concentração média de ferritina foi significativamente maior em crianças com proteína C-reativa aumentada quando comparada com aqueles com níveis normais (22,1 versus 14,8 µg/L). CONCLUSÕES: A utilização de diversos parâmetros bioquímicos e hematológicos possibilitou diagnosticar anemia por deficiência de ferro em dois terços das crianças, revelando a necessidade de identificar outros determinantes de anemia sem deficiência de ferro.

OBJETIVO: Diagnosticar anemia por deficiência de ferro em crianças. MÉTODOS: O estudo foi desenvolvido com uma amostra de 301 crianças com idade entre seis e 30 meses, usuárias de creches públicas de Recife, PE, em 2004. Para o diagnóstico da anemia utilizou-se a combinação de diferentes parâmetros hematológicos e bioquímicos: hemoglobina, volume corpuscular médio, ferritina, proteína C-reativa, saturação da transferrina e receptor da transferrina. Para a análise estatística empregou-se o teste do qui-quadrado e ANOVA. RESULTADOS: Do total de crianças, 92,4% tinha anemia (Hb < 110g/L) e 28,9% apresentou anemia moderada/grave (Hb<90g/L). Níveis mais baixos de hemoglobina foram observados em crianças de seis a 17 meses. Encontrou-se deficiência de ferro em 51,5% das crianças, utilizando-se a ferritina (< 12µg/L) como parâmetro. Considerando a combinação da concentração de hemoglobina, ferritina e do receptor de transferrina, 58,1% tinha anemia com deficiência de ferro, 34,2% anemia sem déficit de ferro e 2,3% deficiência de ferro sem anemia. A concentração média de ferritina foi significativamente maior em crianças com proteína C-reativa aumentada quando comparada com aqueles com níveis normais (22,1 versus 14,8 µg/L). CONCLUSÕES: A utilização de diversos parâmetros bioquímicos e hematológicos possibilitou diagnosticar anemia por deficiência de ferro em dois terços das crianças, revelando a necessidade de identificar outros determinantes de anemia sem deficiência de ferro.

Follow-up and quality of life of patients with cryopyrin-associated periodic syndromes treated with Anakinra.

OBJECTIVE: To evaluate the quality of life and long-term follow-up of patients enrolled in the Italian registry of cryopyrin-associated periodic syndromes (CAPS). STUDY DESIGN: Since 2004, 20 patients with CAPS were enrolled in a common registry from different Italian Centers of Pediatric Rheumatology; 14 patients were treated with Anakinra in an open fashion. Both treated and untreated patients were routinely followed according to standard of care. The Child Health Questionnaire (CHQ-PF 50) was used to assess the health-related quality of life. RESULTS: The mean duration of follow-up was 37.5 months. In all treated patients, a complete and persistent control of the inflammatory manifestations was observed with no further progression of the disease. At enrollment in the registry, patients showed a poorer health-related quality of life than healthy children in both physical and the psychosocial summary scores. Treatment was associated with a dramatic and sustained amelioration of a variety of measures of poor quality of life, particularly in those concerning the global health perception, bodily pain-discomfort, and other physical domains. CONCLUSIONS: Long-term IL-1 blockade produces a significant and persistent improvement in the clinical manifestations associated with the disease and on the overall quality of life.

Regional Brazilian diet-induced pre-natal malnutrition in rats is correlated with the proliferation of cultured vascular smooth muscle cells.

OBJECTIVES: Pre-natal malnutrition induces hypertension and insulin resistance, pathologies commonly linked to atherosclerotic disease. The proliferation of vascular smooth muscle cells (SMCs) is important during development of the atherosclerotic plaque. In this work, we investigated whether the serum of pre-natal malnourished Wistar rats could alter the proliferation of aortic and renal artery SMCs in culture. Malnutrition was induced by feeding a basic regional diet available in a rural area of Pernambuco State, Brazil. This diet was rich in carbohydrates and deficient in proteins, lipids, vitamins and minerals, including sodium chloride. METHODS AND RESULTS: Serum was obtained from the blood of 90-day-old control and pre-natal undernourished rats. SMCs from control Wistar rats at the 6th passage were allowed to adhere to plates in Dulbecco's modified Eagle's medium (DMEM) supplemented with fetal calf serum (10%). Subsequently, the SMCs were maintained in DMEM supplemented with rat serum (10%). The number of cells was counted on the 3rd, 6th and 8th days of culture into rat serum. [3H]-thymidine incorporation into SMCs was evaluated after 20 h or 6 days of incubation. The birth weight of male and female undernourished offspring was 25% (p<0.05) and 46% (p<0.05) lower, respectively, than their corresponding control groups. On the 8th day of culture, the number of aortic SMCs in the serum of undernourished male and female rats, as well as renal artery SMCs in the serum of undernourished female rats, was higher than in the serum of control rats. The [3H]-thymidine incorporation was higher in aortic SMCs incubated for 6 days in the serum of undernourished male and female rats. At confluence, the density of aortic SMCs was higher than that of renal artery SMCs. CONCLUSIONS: Pre-natal malnutrition produces serum with altered properties that can affect the proliferation of SMCs and may contribute to atherosclerotic disease.

Biochemical, functional, and histochemical effects of essential fatty acid deficiency in rat kidney.

The present study was designed to examine the effects of EFA deficiency (EFAD) on biochemical, functional, and structural aspects of the kidney in growing and adult rats fed a normal or EFAD diet for 9 wk after weaning. Food and fluid intake (F1), urine volume, and Na+ and K+ excretions were measured weekly from weeks 4 to 8 by placing the rats in individual metabolic cages for 24 h. At week 9, Li+ and a 5% water load, respectively, were administered at 14 and 1.5 h prior to glomerular and proximal tubular function studies, as assessed by 3-h creatinine (C(Cr)) and Li+ (C(Li+)) clearances. Hematocrit and urine volume; serum and urine [Cr], [Li+], [Na+], and [K+]; and renal FA distribution were also measured. Data [corrected to 100 g/body weight (bw) and presented as means +/- SEM] were significant, at P< or = 0.05. Despite a similar ingestion of solids from weeks 4 to 7 (weeks 7 to 10 of life), the rats on the EFAD diet showed a decreased body weight from week 5. From weeks 4 to 8, Fl and urine volume were similar for both groups, but the Fl increased at week 6 in the EFAD group; 24-h Na+ and K+ excretions were similar at all weeks, except for an increase in the EFAD group for both ions at week 7. In the EFAD group, CCr and CLi+ decreased by 27 and 56.3%, respectively (385.7 +/- 33.4 vs. 280 +/- 21.1, and 21.0 +/- 2.1 vs. 9.2 +/- 1.1 microL/min/100 g; n = 9 vs. 10), the latter result suggesting increased proximal reabsorption. The 3-h Na+ and K+ excretions were similar, but the Li+ decreased (0.78 +/- 0.06 x 10(-2) vs. 0.32 +/- 0.03 x 10(-2) microeq/min/100 g) in the EFAD group, giving additional support to the suggestion. Renal structure was normal and similar for both groups, but the EFAD group showed a more prominent proximal tubule brush border, together with heavier periodic acid-Schiff staining in all specimens from weeks 5 to 9. In the EFAD group, FA of the n-9 and n-7 series were higher, but most of the n-6 series were lower as a percentage of total lipids in the medulla and cortex. Medullary levels of 20:4n-6 were maintained, 22:4n-6 declined twice, arachidonic acid was maintained, and 20:5n-3 was lower. The EFAD diet affected glomerular function, proximal tubular structure and function, and FA distribution in the rat kidney.

GFAP expression in astrocytes of suprachiasmatic nucleus and medial preoptic area are differentially affected by malnutrition during rat brain development.

The aim of the present study was investigate, in young rats, the effects of malnutrition on astrocyte distribution of two hypothalamic regions, the circadian pacemaker suprachiasmatic nucleus (SCN) and the medial preoptic area (MPA). Control rats were born from mothers fed on commercial diet since gestation and malnourished rats from mothers fed on multideficient diet, from the beginning of gestation (GLA group) or from the onset of lactation (LA group). After weaning, pups received ad libitum the same diet as their mothers, and were maintained under a 12/12 h light/dark cycle. The animals were analyzed either at 30-33, or 60-63 days of life. Brain coronal sections (50 microm) were processed to visualize glial fibrillary acidic protein (GFAP) immunoreactivity. Compared to control rats, both malnourished groups of 30 and 60 days exhibited a reduced number of GFAP-immunoreactive astrocytes in the SCN. The total GFAP-immunoreactive area in the SCN of the GLA group differed from the control group at both age ranges analyzed. The GFAP expression as measured by the relative optical density (ROD) exhibited a 50-60% reduction in the MPA in both malnourished groups, compared to controls. The results suggest that malnutrition early in life leads to alterations in gliogenesis or glial cell proliferation in both nuclei, being these alterations greater in the MPA. Compensatory plasticity mechanisms in the GFAP-expression seem to be developed in the astrocyte differentiation process in the SCN, especially when the malnutrition is installed from the lactation.

Saúde e nutrição de crianças de áreas urbanas da Zona da Mata Meridional de Pernambuco: resultados preliminares de um estudo de coorte / Child health and nutrition in urban areas in the South of Pernambuco: preliminary results of a cohort study

OBJETIVOS: apresentar as características socioeconômicas e demográficas, o perfil nutricional de crianças ao nascer e aos 12 meses de vida, além dos dados longitudinais sobre aleitamento, diarréia e situação vacinal durante o primeiro ano de vida. MÉTODOS: uma amostra de 652 recém-nascidos foi recrutada de setembro de 1997 a agosto de 1998 e acompanhada durante os primeiros 18 meses de vida. Essas crianças residiam nas áreas urbanas de quatro municípios da zona da mata meridional de Pernambuco. A coleta de dados foi realizada através de visitas domiciliares. RESULTADOS: cerca de 60 por cento das famílias tinham uma renda per capita ú ® salário mínimo e 41 por cento das mães referiam menos de quatro anos de escolaridade. A mediana do aleitamento materno exclusivo e total foi de 0 dias e 94 dias, respectivamente. A incidência da diarréia foi de dois episódios/criança/ano nos primeiros 12 meses de vida e a prevalência de déficit peso/idade e comprimento/idade (<-2 escores z) aos 12 meses foram de 6,8 por cento e 11 por cento, respectivamente. Apenas 66 por cento das crianças aos 12 meses tinham completado o esquema vacinal. CONCLUSÕES: o desenvolvimento desta pesquisa prospectiva contribuirá para uma maior compreensão dos problemas de saúde e nutrição da população infantil e para o adequado planejamento de intervenções na área.

Cord blood essential fatty acid and alpha-tocopherol in full-term newborns in a Northeast Brazil area.

Malnutrition of children during the first two years of life constitutes a public health concern in Brazil, particularly in the Northeast. Most of the nutrition data are concerned with protein-energy malnutrition and hypovitaminosis A. The purpose of this cross-sectional study was to assess the essential fatty acid (EFA) status, which is crucial in physical and mental development, and that of vitamin E which prevents against the oxidative loss of EFA physiological properties, in 81 full-term newborns. Blood samples were obtained from the residual blood of the umbilical cord (UC) at delivery. Fatty acid composition of UC plasma did not show any sign of EFA deficiency. The levels of docosahexanoic (DHA) and arachidonic acid (AA) appeared to be quite similar to those obtained in European populations. UC plasma vitamin E content was 6.31 +/- 1.99 mumol/L whereas the lipid-normalized vitamin E was 2.36 mumol/mmol of lipids. An interesting point was that newborns with vitamin E inferior to the median value (5.80 mumol/L) revealed significantly lower contents of linoleic acid and DHA in UC than newborns superior to the median value. Together with the absolute or normalized plasma level of vitamin E, this supports the observation that one quarter of the community's newborns is deficient in vitamin E.

Renal effects of essential fatty acid deficiency in hydropenic and volume-expanded rats.

The aim of this paper was to study the effects of essential fatty acid (EFA) on fractional sodium excretion (FE(Na(+))) and renal hemodynamics in rats during hydropenia (H) and acute volume expansion (VE), successively. Mean arterial pressure (MAP) and renal blood flow (RBF) were measured using a blood pressure transducer and a flow probe, respectively, both connected to a flowmeter. Glomerular filtration rate (GFR) was estimated by inulin clearance. The rats receiving coconut oil as only source of dietary lipids (the EFA-deficient group) presented lower levels of linoleic acid in cortex and medulla and lower body weight than the rats receiving soy oil in place of coconut oil (the control non-EFA-deficient group). During H, the EFA-deficient rats exhibited a lower level of renal vascular resistance resulting in a higher level of RBF and a higher urinary flow (V') and FE(Na(+)), although GFR was lower than in the control group. During VE, the rats of the control group responded with increased MAP, RBF, V' and FE(Na(+)), which were not found in the EFA-deficient group, suggesting an impaired hemodynamic adjustment in EFA deficiency. In conclusion, both experimental conditions revealed that EFA deficiency affects the renal hemodynamics.