How much or how often? Examining the screening properties of the DSM cross-cutting symptom measure in a youth population-based sample.

BACKGROUND: The DSM Level 1 Cross-Cutting Symptom Measure (DSM-XC) allows for assessing multiple psychopathological domains. However, its capability to screen for mental disorders in a population-based sample and the impact of adverbial framings (intensity and frequency) on its performance are unknown. METHODS: The study was based on cross-sectional data from the 1993 Pelotas birth cohort in Brazil. Participants with completed DSM-XC and structured diagnostic interviews (n = 3578, aged 22, 53.6% females) were included. Sensitivity, specificity, positive (LR+), and negative (LR-) likelihood ratios for each of the 13 DSM-XC domains were estimated for detecting five internalizing disorders (bipolar, generalized anxiety, major depressive, post-traumatic stress, and social anxiety disorders) and three externalizing disorders (antisocial personality, attention-deficit/hyperactivity, and alcohol use disorders). Sensitivities and specificities >0.75, LR+ > 2 and LR- < 0.5 were considered meaningful. Values were calculated for the DSM-XC's original scoring and for adverbial framings. RESULTS: Several DSM-XC domains demonstrated meaningful screening properties. The anxiety domain exhibited acceptable sensitivity and LR- values for all internalizing disorders. The suicidal ideation, psychosis, memory, repetitive thoughts and behaviors, and dissociation domains displayed acceptable specificity for all disorders. Domains also yielded small but meaningful LR+ values for internalizing disorders. However, LR+ and LR- values were not generally meaningful for externalizing disorders. Frequency-framed questions improved screening properties. CONCLUSIONS: The DSM-XC domains showed transdiagnostic screening properties, providing small but meaningful changes in the likelihood of internalizing disorders in the community, which can be improved by asking frequency of symptoms compared to intensity. The DSM-XC is currently lacking meaningful domains for externalizing disorders.

Prevalence of ideal cardiovascular health in young adults: A birth cohort from southern Brazil.

BACKGROUND: Ideal cardiovascular health (ICH) aims at primordial prevention of cardiovascular diseases in the population. However, there is a lack of research describing ICH in youth from middle-income countries. The aims of this study were to describe the prevalence of ICH at 18- and 22-year-old and to investigate the influence of socioeconomic status. METHODS: The sample consisted of participants from the Pelotas 1993 birth-cohort followed-up at 18- (n = 4,106) and 22-year-old (n = 3,810). Ideal metrics were created for diet, smoking, body mass index, physical activity, blood pressure, total cholesterol, and blood glucose. The presence of 4 or more ideal metrics was defined as ICH. Socioeconomic status was obtained using wealth quintiles calculated with factor analysis based on analysis based on the ownership of household and education. The impact of socioeconomic status on ICH metrics was statistically measured using the slope index of inequality. RESULTS: The prevalence of ICH was 84.5% (95% confidence interval [CI] = 82.7-86.2%) and 84.1% (82.3-85.8%) at 18-year-old and decreased to 61.1% (58.4-63.7%) and 68.7% (66.2-71.2%) at 22-years old, for male and female, respectively. Socioeconomic status influenced ICH and its components differently in males and females. Wealthiest females had ICH prevalence 19 percentage points (pp) (11-27 pp) higher compared to the poorest, whereas poorest males had ICH prevalence 12 pp (1-21 pp) higher compared to the wealthiest. Longitudinal decreases in ICH components were mostly present in the poorest females. CONCLUSIONS: In middle-income countries, the prevalence of ICH is high at 18-year-old and decreases in a 4-year follow-up. Socioeconomic status influences differently individuals' ICH between sexes. Efforts are needed to maintain ICH in youth and different strategies may be required between the social status.

Uric acid is independent and inversely associated to glomerular filtration rate in young adult Brazilian individuals.

BACKGROUND AND AIMS: Uric acid, the end-product of human purine metabolism, is associated with hypertension, diabetes and obesity. It has also been independently associated with the onset of chronic kidney disease in several populations. In this study, the association between serum uric acid (SUA) level and estimated glomerular filtration rate (eGFR) was investigated in healthy individuals belonging to two Brazilian birth cohorts. METHODS AND RESULTS: Data from 3541 to 3482 individuals, aged 30 and 22-years old, respectively, was included. eGFR was calculated using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation based on creatinine measurement. Regression analyses were sex-stratified due to interaction between SUA and sex (p < 0.001) and adjusted for perinatal, cardiometabolic and behavioral variables. We observed an inverse association between eGFR and SUA even after adjustment. In the highest tertile (3rd) of SUA, the eGFR coefficients at 30-years were-0.21 (95%CI -0.24;-0.18) for men and -0.20 (95%CI -0.23; -0.17) for women; at 22-years, were -0.09 (95%CI -0.12;-0.05) for men and -0.13 (95%CI -0.15; -0.10) for women. Higher differences among exponential means (95% CI) of eGFR between the 1st and the 3rd tertile of SUA were seen in older participants, being more pronounced in men. At 22-years, the highest difference was found in women. CONCLUSIONS: In young healthy individuals from a low-middle income country, SUA level was inversely associated with eGFR. Gender-related differences in eGFR according tertiles of SUA were higher in men at 30-years and in women at 22-years.

Association between interleukin-6, C-reactive protein and adiponectin with adiposity: Findings from the 1993 pelotas (Brazil) birth cohort at 18 and 22 years.

BACKGROUND: Most of the literature has shown a direct association between adiposity, interleukin-6 (IL-6) and C-reactive protein (CRP), and an inverse association with adiponectin. The aim of this paper was to assess the association of obesity measurements and IL-6, CRP and adiponectin. METHODS: We performed cross-sectional/longitudinal analysis in the 1993 Birth Cohort in Brazil. Associations between IL-6 (pg/mL), CRP (mg/L) and adiponectin (µg/Ml) with body mass index (BMI), waist circumference (WC), percentage total fat mass (FM) (BODPOD) and trunk FM (DXA) were verified. Four trajectory variables were generated: (a) highest tertile/obesity according to BMI in both follow-ups; (b) highest tertile/obesity only at 18 years; (c) highest tertile/obesity only at 22 years; (d) not in the highest tertile/not obese at both ages. RESULTS: We found a direct association for IL-6 and CRP and an inverse association for adiponectin with measures of adiposity. For instance, for females, the highest mean IL-6 and CRP, respectively, was for those who had been in the obese category at 18-22 years (2.49; 3.75), in the highest tertile of WC (2.11; 3.08), in the highest % of FM (1.56; 3.30 l), and in the highest tertile of trunk FM (2.07; 3.26) (p < 0.001 for all these results in the adjusted analysis). Adiponectin showed an inverse association for the above variables, with lower mean values for males than females. CONCLUSION: There was a longitudinal and direct association between adiposity and IL-6 and CRP, and an inverse association with adiponectin at 22 years.

Are cytokines (IL-6, CRP and adiponectin) associated with bone mineral density in a young adult birth cohort?

BACKGROUND: Studies have shown that cytokines play a role in bone remodeling. METHODS: In 1993, all hospital births occurred in Pelotas (Brazil) were identified and a total of 5249 newborns were included in the present cohort. Sub-samples of this cohort were visited during childhood and all members were traced at 11, 15, 18 and 22 years old. At 18 and 22 years the following biomarkers were measured: IL-6, CRP and adiponectin (the last one in a sub-sample) and bone mineral density (BMD-mg/cm2) was evaluated at 22 years. Crude regression analysis as well as adjusted for confounders (birth weight, pregnancy maternal smoking, gestational age, skin color, schooling, income, smoking, alcohol, physical activity, medical diagnosis of asthma, diabetes and hypertension, BMI, height, calcium intake, corticosteroid use, age at menarche, insulin and testosterone) were performed between the three biomarkers and the whole-body, lumbar spine and femoral BMD. RESULTS: No statistical significant association was found between IL-6 and CRP with BMD, in males. Significant inverse association in the adjusted analysis, among females, was found for the highest tertiles of CRP at 22 y (beta - 15.2 mg/cm2; 95% CI: -25.4; - 4.9; p = 004), of CRP and IL-6 at 22 years (beta - 20.0 mg/cm2; 95% CI: -31.7; - 8.3; p = 0.003), and of IL-6 and CRP at both ages (beta - 20.3 mg/cm2; 95% CI: -38.0; - 2.5; p = 0.001) with total body BMD. Significant association, among males, was also found between the highest tertile of adiponectin at 22 y (beta - 23.3 mg/cm2; 95% CI: -35.5; - 11.1; p = < 001; beta - 22.5 mg/cm2; 95% CI: -42.9; - 2.2; p = 0.03; and beta - 31.8 mg/cm2; 95% CI: -55.5; - 9.1; p = 0.006) and total body, lumbar spine and femur neck BMD, respectively; and, among females, - 17.8 mg/cm2; 95% CI: -34.9; - 0.9; p = 0.033, with lumbar spine BMD. CONCLUSION: CRP at 22 years, in females, seems to be a marker for total body BMD; adiponectin at 22 years is also a marker for BMD at the three sites, in males, and for lumbar spine BMD, in females.

African ancestry, lung function and the effect of genetics.

African-Americans have smaller lung function compared with European-Americans. The aim of this study was to disentangle the contribution of genetics from other variables on lung function. A cohort was followed from birth to 30 years of age in Brazil. Several variables were collected: genomic analysis based on DNA; forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) obtained by spirometry; height measured by anthropometrists; and thorax circumference evaluated by photonic scanner. Crude and adjusted linear regression models were calculated according to African ancestry. The sample comprised 2869 participants out of 3701 members of the cohort. Males with higher African ancestry by DNA analysis had a smaller FEV1 (-0.13 L, 95% CI -0.23- -0.03 L) and FVC (-0.21 L, 95% CI -0.32- -0.09 L) compared with those with less African ancestry, having accounted for height, sitting to standing height ratio and other confounders. Similar effects were seen in females. After adjustment, ancestry remained significantly associated with lung function, but the large effect of adjustment for confounding among males (but not females) does not allow us to exclude the possibility that residual confounding may still account for these findings.

Evaluation of genomic factors and early childhood stimulation on intelligence in children from a Brazilian birth cohort: The primary role of independent factors.

BACKGROUND: Childhood cognitive abilities are a predictor of health outcomes and adult income potential. Identifying factors associated with childhood intelligence and their interactions is essential in behavioral research. We assessed the impact of genetic variants and early child stimulation (ECS) on child intelligence and examined their possible interaction as potential modifiers of IQ in a population-based longitudinal study. METHODS: Participants of the 2004 Pelotas Birth Cohort study (N = 4231) underwent intelligent quotient (IQ) by WISC-III assessment at 6 years of age. At 24 and 48-months, mothers answered five ECS marker questions, whose sum was used to create a score. The polygenic score for intelligence (IQ-PGS) was constructed from the GWAS-weighted estimate of cognition. Association was assessed using multiple linear regression models adjusted for maternal, family, and child confounding variables. To explore the possible influence of skin color and ethnoracial classification, the regression models were stratified according to the skin color variable, as a sensitivity analysis. RESULTS: In the adjusted analysis, IQ-PGS (ß = 0.79, 95% confidence interval [95% CI] 0.26;1.31) as well as ECS (ß = 2.34; 95% CI: 1.76;2.92) were associated with IQ in this sample. The association between IQ-PGS and IQ was significant only in the white Brazilian group in the sensitivity analysis. However, there was no interaction between IQ-PGS and ECS on IQ (p(IQ-PGS x ECS) = 0.46). CONCLUSIONS: ECS did not modify the impact of genetic potential on intellectual development during childhood, suggesting that genetic factors and ECS exert independent effects on the IQ levels of children.

Physical Activity and Chronic Stress in Early Life: Findings From the 2015 Pelotas (Brazil) Birth Cohort.

BACKGROUND: The association of physical activity through early childhood on children's chronic stress still is unclear. Therefore, the aim of the present study is to test the association of physical activity through early childhood (1-4 y) with chronic stress, measured by hair cortisol at age 4. METHODS: Longitudinal study including children from the 2015 Pelotas (Brazil) Birth Cohort. Cortisol at age 4 was measured using a hair sample, which provided cortisol concentration from the past months. Physical activity was measured using accelerometers at 1, 2, and 4 years. Linear regression models were used to assess the association between physical activity and chronic stress. Trajectory models were also applied to examine chronic stress in relation to physical activity patterns throughout early childhood. RESULTS: Children with valid physical activity and hair cortisol data were included in the analyses (N = 1475). Three groups of physical activity trajectories between 1 and 4 years were identified: low, medium, and high. No association between physical activity at 1, 2, and 4 years and chronic stress at age 4 was observed. However, children in the "high" physical activity trajectory presented low cortisol concentration; the magnitude of the regression coefficient was slightly larger in girls (ß = -0.125; 95% confidence interval, -0.326 to 0.074) than boys (ß = -0.051; 95% confidence interval, -0.196 to 0.09). CONCLUSION: There was no clear association between physical activity and chronic stress in early childhood. Trajectories models suggest that higher activity throughout early childhood may positively impact chronic stress; however, more studies are needed to confirm that hypothesis.

Quality of DNA extracted from saliva samples collected with the Oragene™ DNA self-collection kit.

BACKGROUND: Large epidemiological studies in DNA biobanks have increasingly used less invasive methods for obtaining DNA samples, such as saliva collection. Although lower amounts of DNA are obtained as compared with blood collection, this method has been widely used because of its more simple logistics and increased response rate. The present study aimed to verify whether a storage time of 8 months decreases the quality of DNA from collected samples. METHODS: Saliva samples were collected with an OrageneTM DNA Self-Collection Kit from 4,110 subjects aged 14-15 years. The samples were processed in two aliquots with an 8-month interval between them. Quantitative and qualitative evaluations were carried out in 20% of the samples by spectrophotometry and genotyping. Descriptive analyses and paired t-tests were performed. RESULTS: The mean volume of saliva collected was 2.2 mL per subject, yielding on average 184.8 µg DNA per kit. Most samples showed a Ratio of OD differences (RAT) between 1.6 and 1.8 in the qualitative evaluation. The evaluation of DNA quality by TaqMan®, High Resolution Melting (HRM), and restriction fragment length polymorphism-PCR (RFLP-PCR) showed a rate of success of up to 98% of the samples. The sample store time did not reduce either the quantity or quality of DNA extracted with the Oragene kit. CONCLUSION: The study results showed that a storage period of 8 months at room temperature did not reduce the quality of the DNA obtained. In addition, the use of the Oragene kit during fieldwork in large population-based studies allows for DNA of high quantity and high quality.

Ideal cardiovascular health, inflammation, and arterial stiffness in the transition to adulthood.

BACKGROUND: Ideal cardiovascular health (ICH) promotes primordial prevention of cardiovascular diseases. However, whether ICH is associated with arterial stiffness in the transition to adulthood and the mechanisms associated have yet to be shown. The aims of this investigation were to: 1) investigate whether there is a prospective association between ICH and pulse wave velocity (PWV) in the transition to adulthood; and 2) to stablish whether the association between ICH and PWV is mediated by inflammatory markers. METHODS: Participants were part of the 1993 Pelotas Birth Cohort and follow-ups at 18- and 22-years were used in this study. At the age of 18 years, ICH was computed as the presence of ideal for the following metrics: physical activity, diet, smoking, blood cholesterol and glucose, blood pressure, and body mass index. At the age of 22 years, aortic PWV was obtained as well as interleukin-6 (IL-6) and C-reactive protein (CRP). RESULTS: A total of 3528 (1851 females) were included in the analysis. A significant linear effect was observed for ICH on PWV. After adjusting for socioeconomical status, skin colour, birth weight, and mother schooling male and female participants with better ICH profile had PWV of 0.70 m·s-1 and 0.60 m·s- slower than participants with poor ICH. No evidence for a mediating role of inflammatory markers was observed for male (<1%) and female (<5%). CONCLUSIONS: ICH is inversely associated with PWV among male and female in the transition to adulthood with no mediating role of inflammation.

Life history trade-offs associated with exposure to low maternal capital are different in sons compared to daughters: Evidence from a prospective Brazilian birth cohort.

Background: Environmental exposures in early life explain variability in many physiological and behavioural traits in adulthood. Recently, we showed that exposure to a composite marker of low maternal capital explained the clustering of adverse behavioural and physical traits in adult daughters in a Brazilian birth cohort. These associations were strongly mediated by whether or not the daughter had reproduced by the age of 18 years. Using evolutionary life history theory, we attributed these associations to trade-offs between competing outcomes, whereby daughters exposed to low maternal capital prioritised investment in reproduction and defence over maintenance and growth. However, little is known about such trade-offs in sons. Methods: We investigated 2,024 mother-son dyads from the same birth cohort. We combined data on maternal height, body mass index, income, and education into a composite "maternal capital" index. Son outcomes included reproductive status at the age of 18 years, growth trajectory, adult anthropometry, body composition, cardio-metabolic risk, educational attainment, work status, and risky behaviour (smoking, violent crime). We tested whether sons' early reproduction and exposure to low maternal capital were associated with adverse outcomes and whether this accounted for the clustering of adverse outcomes within individuals. Results: Sons reproducing early were shorter, less educated, and more likely to be earning a salary and showing risky behaviour compared to those not reproducing, but did not differ in foetal growth. Low maternal capital was associated with a greater likelihood of sons' reproducing early, leaving school, and smoking. High maternal capital was positively associated with sons' birth weight, adult size, and staying in school. However, the greater adiposity of high-capital sons was associated with an unhealthier cardio-metabolic profile. Conclusion: Exposure to low maternal investment is associated with trade-offs between life history functions, helping to explain the clustering of adverse outcomes in sons. The patterns indicated future discounting, with reduced maternal investment associated with early reproduction but less investment in growth, education, or healthy behaviour. However, we also found differences compared to our analyses of daughters, with fewer physical costs associated with early reproduction. Exposure to intergenerational "cycles of disadvantage" has different effects on sons vs. daughters, hence interventions may have sex-specific consequences.

Youth depression and inflammation: Cross-sectional network analyses of C-Reactive protein, interleukin-6 and symptoms in a population-based sample.

BACKGROUND: Inflammation-related proteins constitute a promising avenue in studying biological correlates of major depressive disorder (MDD). However, MDD is a heterogeneous condition - a crucial aspect to be considered in association studies. We examined whether inflammatory proteins are associated with categorical diagnosis, a dimensional total sum-score, and specific depressive symptoms among youths. METHODS: We analyzed data from the 1993 Pelotas Birth Cohort, a population-based study in Brazil that followed individuals up to age 22 years. Categorical psychiatric diagnoses were derived using adapted modules of the Mini International Neuropsychiatric Interview (MINI). Dimensional symptomatology was assessed using the Brazilian Portuguese version of the Center for Epidemiological Studies-Depression Scale-Revised (CESD-R). We estimated network structures that included individual depressive symptoms as measured by CESD-R items, peripheral inflammatory markers (C-Reactive Protein [CRP] and Interleukin-6 [IL-6]), as well as relevant covariates. RESULTS: We evaluated 2586 participants (mean age = 22.5[SD = 0.33]) There were no associations between concentrations of inflammatory proteins and categorical diagnosis of MDD or with CESD-R total sum-scores. In symptom-specific analysis, CRP and IL-6 were positively connected to somatic and cognitive items. DISCUSSION: We found cross-sectional connections of two commonly studied inflammatory proteins and specific depressive symptoms. Conducting symptom-specific analyses in relation to biological markers might advance our understanding of the heterogeneity of MDD.

Do inflammation and adiposity mediate the association of diet quality with depression and anxiety in young adults?

BACKGROUND & AIMS: Diet quality has been inversely associated with depression, but less is known about its association with anxiety and about the mechanisms involved in the association between diet and mental health. This study aimed to assess the associations of diet quality with major depressive disorder (MDD) and generalized anxiety disorder (GAD) in young adults, and to explore whether inflammation, indexed by interleukin-6 (IL-6) and C-reactive protein (CRP), and body mass index (BMI) mediate this association. METHODS: We used data of 3331 participants from the 1993 Pelotas Birth Cohort (Brazil). Data on dietary intake and inflammatory markers were assessed at 18 years, and information on mental disorders was obtained at both 18 and 22 years. A food frequency questionnaire was used to assess dietary intake, and diet quality was estimated using the Brazilian Healthy Eating Index - Revised (BHEI-R). The occurrence of MDD and GAD was assessed using the Mini International Neuropsychiatric Interview (MINI), conducted by psychologists. The associations of diet quality, BMI and inflammatory markers with mental disorders were explored using logistic regression. The mediation analysis was performed using structural equation modelling. RESULTS: A one standard deviation increase in the diet quality score at age 18 years was associated with both lower levels of CRP (-0.06 mg/L; 95% CI: -0.10; -0.008) at 18 years and 23% lower odds of MDD at 22 years (OR: 0.77; 95% CI: 0.61; 0.97). No association was found between diet quality score and both BMI and GAD. Obesity was associated with higher odds of MDD, but CRP and IL-6 were not associated with MDD or GAD. Our results provide no evidence that inflammatory markers and BMI mediate the association between diet quality and MDD in young adults. CONCLUSIONS: A better diet quality is associated with lower occurrence of MDD among young adults, but we did not find evidence that inflammatory markers and BMI mediate this association.

Depression in a youth population-based sample from Brazil: Prevalence and symptom structure.

BACKGROUND: We aimed to examine the occurrence of major depressive disorder (MDD) in a population-based youth sample, assessing both categorical and dimensional presentations of the disorder and its clinical and sociodemographic correlates. METHODS: We analyzed cross-sectional data from the latest assessment of the 1993 Pelotas Birth Cohort (n = 3,780), a population-based study from Brazil that followed individuals up to age 22 years. We estimated point-prevalence for categorical diagnosis of MDD and comorbid diagnoses using DSM criteria in a structured interview by trained psychologists. Dimensional symptomatology was assessed with the Brazilian Portuguese version of the Center for Epidemiological Studies-Depression Scale-Revised (CES-D-R). RESULTS: Point-prevalence of a current unipolar major depressive episode was 2.85% (95%CI 2.37-3.43%). The CES-D-R showed a mean of 9.20 (SD=9.72), with an area under the curve of 0.93 (95%CI 0.91 to 0.95) for the categorical diagnosis of MDD using a cutoff point of 16. Sad mood and somatic symptoms were the most frequent, and also had lower levels of latent values required for endorsement. Sad mood and anhedonia items were the most central items in the network structure. CONCLUSIONS: In a population-based sample of youths from a middle-income country, MDD prevalence estimates and comorbidity profile were consistent with previous global literature. A focus on symptoms might advance our understanding about MDD among youths by disentangling the heterogeneity of the disorder.

Second generation of the 1993 birth cohort, Pelotas (Brazil): Aims, design, preliminary results.

BACKGROUND AND AIMS: Longitudinal cohort studies examining different generations can explain how health problems can be transmitted through genetic and environmental mechanisms and their effects on the health of offspring. This study aimed to present the design and to describe the characteristics of the baseline sample of a second generation cohort. METHODS: The 93Cohort-II is a dynamic prospective cohort composed of a second generation from the original 1993 Pelotas Birth Cohort (offspring), whose parents had their last follow-up at 22 years old. Biological parents were asked to answer questions addressing the type of birth, general health status, family composition, dietary habits, breastfeeding habits, and child-caregiver(s), among others, and the children's anthropometric measurements were evaluated. RESULTS: Of 1650 children identified, 1212 were evaluated (response rate, 73.4%), and 21 died before the baseline assessment. The age of the offspring ranged from 0 to 10 years (mean [±SD], 2.9 ± 2.1 years); most children (65.6%) lived with both parents and were born to young mothers and poor families. One-third of the children were breastfed until 6 months of age, one-half were born by cesarean section, 63.9% had used medication in the previous 15 days, 26.4% experienced hospitalization at least once since birth, and 14% had no updated vaccination; asthma/bronchitis (20.4%) and bronchiolitis (13.4%) were the most frequently reported diseases. More than 60% consumed ultra-processed foods, and the prevalence of overweight among those <5 and ≥6 years of age was 10.2% and 18.9%, respectively. The mean total Child Behavior Checklist score was 44.1 ± 23.61 (≥16 months), and the mean intellectual quotient score in children ≥6 years of age was 97.9 ± 15.4. CONCLUSION: Despite the difficulties in conducting intergenerational cohort studies, the results of the present investigation provide evidence supporting the feasibility of performing these types of studies in middle-income countries.

Life course weight gain and C-reactive protein levels in young adults: findings from a Brazilian birth cohort.

Rapid weight gain in childhood is associated with increased risk of chronic diseases in adults. C-reactive protein (CRP) is a mediator of atherosclerosis and chronically elevated levels predict cardiovascular outcomes. The effects of life course weight gain on CRP levels are not clear. The 1982 Pelotas (Brazil) birth cohort study (n = 5,914) has prospectively collected weight and health data at several follow-ups since birth. The most recent was in 2004-05, when 77.4% of the cohort was traced and CRP levels were measured in 89% of those interviewed (n = 3827). Geometric mean (SE) C-reactive protein levels were 0.89 mg/l (0.03) and 1.66 mg/l (0.04) in men and women, respectively. In analyses adjusted for confounding variables, weight gain in infancy showed a weak negative association among males, but from the second year onwards, weight gain was positively associated with CRP levels. In females, weight gain was associated with higher CRP at every period tested. The strongest associations were observed in the most recent (18-23 years) period; CRP ratios (95% CI) per z score increase in weight gain were 1.78 (1.57-2.00) and 1.52 (1.30-1.78) for men and women, respectively. Males who were stunted at 2 years and centrally obese at 23 years had the highest CRP levels (P = 0.002 for interaction). In summary, rapid weight gain throughout life predicted higher CRP levels. Public health efforts need to tackle chronic under-nutrition in infancy, together with rapid weight gain in later childhood and adolescence, especially in countries undergoing the nutritional transition.

Association of modifiable risk factors and IL-6, CRP, and adiponectin: Findings from the 1993 Birth Cohort, Southern Brazil.

BACKGROUND: The literature on the relationship between lifestyle behaviors and inflammatory markers is scarce. METHODS: A birth cohort was followed since birth up to 22 years in Southern Brazil. Interleukin-6 (IL-6), C-reactive protein (CRP) and adiponectin were measured in nonfasting blood samples drawn at 18 and 22 years of age. Exposures including smoking, alcohol intake, physical inactivity and obesity, were collected at 15, 18 and 22 years. Cross sectional analyses were based on the number of follow-up visits with these exposures and the association with IL-6, CRP and adiponectin at 22 years old. We also carried out a longitudinal Generalized Least Squares (GLS) random-effects analysis with outcomes at 18 and at 22 years old. All analyses were adjusted for several covariates. RESULTS: The sample comprised 3,479 cohort members at 22 years. The presence of obesity at ≥ 2 follow-ups showed the highest mean values (SE) for IL-6 [2.45 (1.05)] and CRP [3.74 (1.11)] and the lowest mean value for adiponectin [8.60 (0.37)] (adjusted analyses, females) compared with other exposures; the highest mean of IL-6 [1.65 (1.05)] and CRP [1.78 (1.11)] and the lowest mean of adiponectin [9.98 (0.38)] were for the number of follow-ups with ≥2 exposures compared to those with no exposures at any follow-up (adjusted analyses, females). The longitudinal analysis showed an increase in obesity associated with IL-6 and CRP in both sexes and an inverse association with adiponectin in females; smoking (in males) was associated with IL-6 and CRP, harmful alcohol intake was associated with CRP in males, and increased in physical activity was inversely associated with CRP in men. CONCLUSION: We concluded that obesity is the main exposure positively associated with IL-6 and CRP and inversely associated with adiponectin (mainly in females). Smoking is also associated with these markers in the longitudinal analysis (in males).

Early Emotional Symptoms Predicting Carotid Atherosclerosis in Youth: Results From a Birth Cohort in Latin America.

Background Emotional disorders are risk factors for atherosclerosis and consequent cardiovascular disease. However, it is not clear whether emotional symptoms (ESs) have direct effects on cardiovascular disease. The aim of the present study is to investigate the effects of early ESs on carotid atherosclerosis in young adults. Methods and Results We tested the association between expression of ESs at 11 and 15 years of age and carotid intima-media thickness at 18 years of age in the 1993 Pelotas Birth Cohort (N=5249, n=4336 with complete mental health data). ES s were assessed using the Strengths and Difficulties Questionnaire. Propensity score weighting procedure was run using generalized boosted regression model to adjust for potential confounding between exposure and outcome. We also tested whether traditional cardiovascular risk factors could mediate this relationship. Adjusted high expression of ESs , both at 11 and 15 years of age, led to mean increases in carotid intima-media thickness of 1.84 and 2.58 µm, respectively, at 18 years of age (both P<0.001). Longitudinal effects of ESs on atherosclerosis were direct and not significantly mediated by traditional cardiovascular risk factors. Male sex at age 15 years significantly enhanced the effects of ESs on carotid intima-media thickness at age 18 years ( P<0.001 for interaction): although high expression of ESs led to mean increases of 1.14 µm in females ( P<0.05), it led to mean increases of 5.83 µm in males ( P<0.001). Conclusions In this large birth cohort, expression of ESs in adolescence was longitudinally associated with a higher carotid intima-media thickness in young adults. The association is direct and not mediated by traditional cardiovascular risk factors. Interactions by sex might have important implications for designing future interventions.

Low Maternal Capital Predicts Life History Trade-Offs in Daughters: Why Adverse Outcomes Cluster in Individuals.

Background: Some individuals appear prone to multiple adverse outcomes, including poor health, school dropout, risky behavior and early reproduction. This clustering remains poorly understood. Drawing on evolutionary life history theory, we hypothesized that maternal investment in early life would predict the developmental trajectory and adult phenotype of female offspring. Specifically, we predicted that daughters receiving low investment would prioritize the life history functions of "reproduction" and "defense" over "growth" and "maintenance," increasing the risk of several adverse outcomes. Methods: We investigated 2,091 mother-daughter dyads from a birth cohort in Pelotas, Brazil. We combined data on maternal height, body mass index, income, and education into a composite index of "maternal capital." Daughter outcomes included reproductive status at 18 years, growth, adult anthropometry, body composition, cardio-metabolic risk, educational attainment, work status, and risky behavior. We tested whether daughters' early reproduction (<18 years) and exposure to low maternal capital were associated with adverse outcomes, and whether this accounted for the clustering of adverse outcomes within individuals. Results: Daughters reproducing early were shorter, more centrally adipose, had less education and demonstrated more risky behavior compared to those not reproducing. Low maternal capital was associated with greater likelihood of the daughter reproducing early, smoking and having committed violent crime. High maternal capital was positively associated with the daughter's birth weight and adult size, and the likelihood of being in school. Associations of maternal capital with cardio-metabolic risk were inconsistent. Daughters reproducing early comprised 14.8% of the population, but accounted for 18% of obesity; 20% of violent crime, low birth weight and short stature; 32% of current smoking; and 52% of school dropout. Exposure to low maternal capital contributed similarly to the clustering of adverse outcomes among daughters. Outcomes were worst among daughters characterized by both low maternal capital and early reproduction. Conclusion: Consistent with life history theory, daughters exposed to low maternal capital demonstrate "future discounting" in behavior and physiology, prioritizing early reproduction over growth, education, and health. Trade-offs associated with low maternal capital and early reproduction contribute to clustering of adverse outcomes. Our approach provides new insight into inter-generational cycles of disadvantage.