Intergenerational transmission of birth weight: a systematic review and meta-analysis

The objectives of this study were (1) to systematically review the literature on the association between birth weight in children born in the first and second generation and (2) to quantify this association by performing a meta-analysis. A systematic review was carried out in six databases (PubMed, Science Direct, Web of Science, Embase, Scopus, CINAHL and LILACS), in January 2021, for studies that recorded the birth weight of parents and children. A meta-analysis using random effects to obtain a pooled effect of the difference in birth weight and the association of low birth weight (LBW) between generations was performed. Furthermore, univariable meta-regression was conducted to assess heterogeneity. Egger's tests were used to possible publication biases. Of the 9878 identified studies, seventy were read in full and twenty were included in the meta-analysis (ten prospective cohorts and ten retrospective cohorts), fourteen studies for difference in means and eleven studies for the association of LBW between generations (twenty-three estimates). Across all studies, there was no statistically significant mean difference (MD) birth weight between first and second generation (MD 19·26, 95 % CI 28·85, 67·36; P = 0·43). Overall, children of LBW parents were 69 % more likely to have LBW (pooled effect size 1·69, 95 % CI (1·46, 1·95); I2:85·8 %). No source of heterogeneity was identified among the studies and no publication bias. The average birth weight of parents does not influence the average birth weight of children; however, the proportion of LBW among the parents seems to affect the offspring's birth weight.

Consumption of ultra-processed foods and IL-6 in two cohorts from high- and middle-income countries

This study evaluated the association between ultra-processed foods (UPF) on serum IL-6 and to investigate the mediation role of adiposity. Participants were 524 adults from the EPITeen Cohort (Porto, Portugal) and 2888 participants from the 1982 Pelotas Birth Cohort (Pelotas, Brazil). Dietary intake was collected using FFQ when participants were 21 years of age in the EPITeen and 23 years in the Pelotas Cohort. Serum IL-6 and body fat mass were evaluated when participants were 27 and 30 years old in the EPITeen and Pelotas, respectively. Generalised linear models were fitted to test main associations. Mediation of body fat mass was estimated using G-computation. After adjustment for socio-economic and behaviour variables, among females from the EPITeen, the concentration of IL-6 (pg/ml) increased with increasing intake of UPF from 1·31 (95 % CI 0·95, 1·82) in the first UPF quartile to 2·20 (95 % CI 1·60, 3·01) and 2·64 (95 % CI 1·89, 3·69) for the third and fourth UPF quartiles, respectively. A similar result was found among males in the Pelotas Cohort, IL-6 increased from 1·40 (95 % CI 1·32, 1·49) in the first UPF quartile to 1·50 (95 % CI 1·41, 1·59) and 1·59 (95 % CI 1·49, 1·70) in the two highest UPF quartiles. The P-value for the linear trend was < 0·01 in both findings. The indirect effect through fat mass was NS. Our findings suggest that the consumption of UPF was associated with an increase in IL-6 concentration; however, this association was not explained by adiposity.

Epidemiology of interleukin-6: the 30-year follow-up of the 1982 Pelotas (Brazil) birth cohort study

BACKGROUND

Cardiovascular diseases are the main cause of death globally. Interleukin-6 (IL-6) is a biomarker of cardiovascular risk.

AIM

To investigate factors associated with IL-6 concentration in serum, from early life up to 30 years of age.

SUBJECTS AND METHODS

In the 2012-2013 follow-up, IL-6 was measured in 2809 participants of the 1982 Pelotas Birth Cohort (1369 males). Multivariable linear regressions, stratified by sex, were performed to evaluate the associations of African ancestry, family income and maternal education at birth, monthly income and education at 30 years, smoking status, harmful alcohol intake, physical activity, and body composition with IL-6, considering a conceptual hierarchical framework.

RESULTS

Males with low educational levels and current smokers had the highest mean IL-6. Among females, African ancestry and low monthly income were associated with the highest mean values for the outcome. Physical activity had an inverse association with IL-6 concentration among females. A direct relationship was observed between the measures of adiposity on IL-6, in both sexes.

CONCLUSION

Body composition was the main predictor for the outcome evaluated in males and females. Thus, the avoidance of overweight remains an important strategy for the prevention and control of cardiovascular risk and biomarkers associated with these diseases.

Omega-3 supplementation and diabetes: A systematic review and meta-analysis

This study aimed to review the literature on studies that evaluated the effects of omega-3 supplementation on parameters of diabetes in humans. An online search was conducted in the following databases: Pubmed, LILACS, Scielo, Scopus, and Web of Science. It included experimental studies that investigated the effects of omega-3 supplementation for diabetes treatment or prevention and its relationship with fasting blood glucose, insulin resistance, and glycated hemoglobin. Observational, non-human studies and non-randomized clinical trials were excluded. The Cochrane scale assessed the quality of the studies. A meta-analysis was carried out to evaluate the effect of omega-3 on fasting blood glucose, insulin resistance, and glycated hemoglobin. Thirty studies were included in the review. Almost 70% (n = 20) demonstrated at least one significant effect of the omega-3 supplementation related to diabetes. In the meta-analysis, there was a significant effect on the reduction of fasting blood glucose [SMD: -0.48; CI95%: -0.76, -0.19; p = 0.01; I2 = 88%] and insulin resistance [SMD: -0.61; CI95%: -0.98, -0.24; p = 0.01; I2 = 90%]. For glycated hemoglobin, there was no significant effect in the meta-analysis. This systematic review with meta-analysis demonstrated that supplementation with omega-3 has protective effects on diabetes parameters.

What is the effect of resveratrol on obesity? A systematic review and meta-analysis

BACKGROUND & AIMS

Obesity is increasing worldwide. Resveratrol appears as a substance capable of helping with weight loss. This study aimed to investigate the resveratrol effect in the treatment of obesity in general population.

METHODS

An online search was conducted in the following databases: Pubmed, LILACS, Scielo, Scopus and Web of Science. Experimental studies that investigated the effects between resveratrol supplementation for weight loss treatment, as well as its relationship with overweight and obesity were included. Observational and non-human studies were excluded. The Cochrane scale was used to assess the quality of the studies.

RESULTS

Nineteen studies were included, of which only three demonstrated some type of positive effect. In the meta-analysis, there was no significant effect on weight loss [SMD: 0.03; CI95%: -0,44, 0,49; p = 0,01; I2 = 82%], and body mass index (BMI) [SMD: 0.01; CI95%: -0,39, 0,41; p = 0,01; I2 = 72%]. A small effect was found on the waist circumference [SMD: -1.04; CI95%: -1,86, -0,27; p = 0,01; I2 = 87%].

CONCLUSION

This systematic review with meta-analysis demonstrated that supplementation with resveratrol does not have an anti-obesity effect.

Mental disorders, comorbidities, and suicidality at 30 years of age in a Brazilian birth cohort

BACKGROUND

Studies on mental disorders prevalence and comorbidity, including suicidality, are scarce in low and middle-income settings. We aimed to describe the pattern of comorbidity between mental disorders and their association with suicidality.

METHODS

In 1982, all hospital deliveries in Pelotas (Southern Brazil) were identified (n = 5914) and have been prospectively followed. Participants were evaluated for the presence of common mental disorders (CMD) at the ages of 18-19, 23 and 30 years. In 2012-13 (30 years of age), trained psychologists evaluated 3657 individuals for disorders using the Mini International Neuropsychiatric Interview.

RESULTS

Prevalence of suicidal wishing, suicidal planning and lifetime suicidal attempt was 4.9%, 3.8% and 6.6%, respectively. Suicidal wishing was most strongly associated with having joint major depressive episode (MD) and lifetime suicidal attempt (OR = 26.4, 95%CI:13.9-50.4) with comorbid MD with mania/hypomania (OR = 21.2, 95%CI:6.93-65.1). Suicidal planning was most strongly associated with having joint MD and lifetime suicidal attempt (OR = 44.7, 95%CI:22.6-88.4), with comorbid MD and social anxiety disorder (OR = 30.6, 95%CI:13.0-72.0), and joint social anxiety disorder with lifetime suicidal attempt (OR = 26.3, 95%CI:8.33-82.7). Independently of other disorders, prospective and cross-sectional measures of CMD were associated with higher rates of suicidality.

LIMITATIONS

We do not have data on suicide deaths in follow-up and the diagnostic instrument used at 30 years of age was not used in all previous follow-up.

CONCLUSION

MD and social anxiety have independent and combined associations with suicidality, and also with they occur with lifetime suicidal attempt and other mental disorders.

Food processing and cardiometabolic risk factors: a systematic review

OBJECTIVE To systematically review the evidence for the association between food consumption according to processing and cardiometabolic factors in adults and/or the elderly. METHOD Two independent evaluators analyzed the electronic databases PubMed, Web of Science and Lilacs until December 2018. We used the following terms: (convenience foods OR food processing OR highly-processed OR industrialized foods OR minimally-processed OR prepared foods OR processed foods OR ultra-processed OR ultraprocessed OR ultra processed OR unprocessed) AND (metabolic syndrome OR hypertension OR blood pressure OR diabetes mellitus OR glucose OR glycaemia OR insulin OR cholesterol OR triglycerides OR blood lipids OR overweight OR obesity) AND (adult OR adults OR adulthood OR aged OR elderly OR old). We assessed methodological and evidence qualities, and also extracted information for the qualitative synthesis from the selected studies. RESULTS Of the 6,423 studies identified after removing duplicates, eleven met the eligibility criteria. The main food classification we used was Nova. The consumption of ultra-processed foods was positively associated with overweight and obesity, high blood pressure and metabolic syndrome. All articles included met more than 50% of the methodological quality criteria. The quality of evidence was considered moderate for the outcome overweight and obesity and weak for hypertension and metabolic syndrome. CONCLUSIONS The Nova food classification stands out in the area of nutritional epidemiology when assessing the effects of food processing on health outcomes. Although caution is required in the interpretation, the results indicated that the consumption of ultra-processed foods can have an unfavorable impact in the health of individuals.

Violence against women in life: study among Primary Care users

This article aims to estimate the prevalence and factors associated with intimate partner violence among primary care users. Cross-sectional study with women aged 20 to 59 years. Physical, sexual and psychological violence was screened by the World Health Organization instrument. Poisson regression was used for crude and adjusted analysis. Nine hundred ninety-one women participated in the study. The prevalence of violence throughout the lifespan was: psychological 57.6% (95%CI 54.6-60.7); physical 39.3% (95%CI 36.2-42.3) and sexual 18.0% (95%CI 15.7-20.5). Women with up to eight years of schooling, divorced or separated, whose mothers suffered intimate partner violence, who reported drug use and experienced sexual violence in childhood showed a higher prevalence of the three types of violence. Religion was associated with psychological and sexual violence and the use of cigarettes to physical and psychological violence. Participants with lower household income had a higher prevalence of physical violence. A high prevalence of intimate partner violence was identified among users. Worse socioeconomic conditions, risk behaviors and a history of assault are associated with greater occurrence of this problem.

Common Mental Disorders and Contemporary Factors: 1982 Birth Cohort

OBJECTIVE

To describe the association between common mental disorders and socio-demographic variables, smoking habits and stressful events among the 30-year-old members of a 1982 cohort.

METHOD

Mental disorder was analyzed by the Self-Reporting Questionnaire (SRQ-20). Poisson regression was used to analyze the unadjusted and adjusted associations.

RESULTS

Low level of education and stressful events increased the prevalence of mental disorders for both genders. Lower income for women and unemployment for men also remained associated with CMD.

CONCLUSION

It was possible to describe the association between contemporary factors and mental disorders in a young population, to which prevention and control measures, through public policies proposed to the areas of Primary Care, Mental Health and Education, can represent a better quality of life and health.

Violence against women and its association with the intimate partner's profile: a study with primary care users

OBJECTIVE

To verify the association between the history of violence against women and the socio-demographic and behavioral characteristics of intimate partners.

METHODS

A cross-sectional study was carried out with 938 women using basic health care, aged between 20 and 59 years, who at the time of the interview had an intimate partner. Information about the sociodemographic and behavioral characteristics of the intimate partner were collected, as well as the WHO VAW Study instrument for tracking the psychological, physical and sexual violence experienced in the past year. A bivariate analysis was performed using the Pearson c2 test and multivariate analysis using Poisson regression with robust variance.

RESULTS

The highest prevalences of psychological, physical and sexual violence were significantly associated with partners who had no occupation and who refused to use condoms in sexual relationships. Men who were considered controllers and who consumed alcoholic beverages were associated with greater perpetration of psychological and physical violence (p < 0.05). Partners with up to eight years of schooling present a higher frequency of psychological violence (PR = 1.32, 95%CI 1.05 - 1.66), while sexual violence was significantly higher among women whose partners smoked: 1.94, 95%CI 1.11 - 3.38).

CONCLUSIONS

These data highlight the importance of health professionals, work together in other sectors such as education and safety, dealing with alcohol and other drugs, as well as addressing issues of gender.

[Association of excess weight and obesity and mortality in Brazilian state capitals and Argentine provinces]

This study aimed to assess the association between prevalence of excess weight and obesity and overall and disease-specific mortality rates in Brazilian state capitals and Argentine provinces. This was an ecological study with secondary data, where the principal exposures were prevalence rates for excess weight and obesity, estimated with data from Brazil's Vigitel survey (Risk and Protective Factors Surveillance System for Chronic Non-Communicable Diseases Through Telephone Interveiew) in 2014 and Argentina's National Risk Factor Survey in 2013. Overall and specific mortality rates for the year 2015 were obtained from the Brazilian Mortality Information System in the Brazilian Health Informatics Department and the Division of Health Statistics and Information of the Argentine Ministry of Health. Brazilian mortality rates were standardized with the age structure of the Argentine population as the standard. Crude and adjusted linear regressions were used to assess the association between the prevalence rates for excess weight and obesity and the overall and specific mortality rates. After adjusting for potential confounding factors, prevalence of obesity was positively associated with the overall mortality rate both in Brazil (β = 0.18; 95%CI: 0.01; 0.35) and in Argentina (β = 0.06; 95%CI: 0.01; 0.13). There was no association with the specific cardiovascular and cancer mortality rates. We conclude that the Brazilian state capitals and Argentine provinces with the highest prevalence of obesity present higher overall mortality rates, while this association was inconsistent for the specific rates.

O agente comunitário de saúde como interlocutor da alimentação complementar em Pelotas, RS, Brasil

Resumo Este artigo avalia o conhecimento dos agentes comunitários de saúde em alimentação complementar e sua associação com características sociodemográficas, rotinas de trabalho e descreve os recursos disponíveis nas unidades básicas de saúde para que tenham domínio neste tema. Foi aplicado um questionário ao responsável do serviço de saúde e outro aos agentes comunitários de saúde, este último composto pelo teste de conhecimento que permitiu o cálculo de escores conforme o número de acertos em questões de múltipla escolha. Houve associação positiva com idade, tempo de profissão, visitas domiciliares a crianças com até 24 meses, realizar orientações e buscar informações sobre alimentação complementar com o conhecimento em alimentação nos primeiros 24 meses de vida. Evidenciou-se desacordo entre as respostas do serviço de saúde e dos agentes comunitários de saúde quanto a treinamentos, materiais governamentais e acompanhamento do crescimento infantil. Verificou-se maior domínio em aleitamento materno em relação à alimentação complementar, portanto, a unidade básica de saúde deve oferecer respaldo e recursos que ampliem o conhecimento em alimentação complementar, mediante treinamentos e acesso facilitado aos materiais governamentais.

The Controlled Direct Effect of Early-Life Socioeconomic Position on Periodontitis in a Birth Cohort

This study used data from the 1982 Pelotas Birth Cohort Study, Brazil, to estimate the controlled direct effect of early-life socioeconomic position (SEP) on periodontitis at age 31 years, controlling for adulthood income and education, smoking, and dental hygiene. Sex was included as a covariate. Early-life SEP was measured at participant birth based on income, health services payment mode, maternal education, height, and skin color (lower versus middle/higher SEP). Periodontitis was assessed through clinical examination at age 31 years (healthy, mild periodontitis, or moderate-to-severe disease). Adulthood behaviors (smoking, dental hygiene) were the mediators, and adulthood SEP (education and income) represented the exposure-induced mediator-outcome confounders. A regression-based approach was used to assess the controlled direct effect of early-life SEP on periodontitis. Multinomial regression models were used to estimate risk ratios and their 95% confidence intervals. The prevalences of mild and moderate-to-severe periodontitis were 23.0% and 14.3%, respectively (n = 539). Individuals from the lowest early-life SEP had a higher risk of moderate-to-severe periodontitis controlled for mediators and exposure-induced mediator-outcome confounders: risk ratio = 1.85 (95% confidence interval: 1.06, 3.24), E value 3.1. We found that early-life SEP was associated with the development of periodontitis in adulthood that was not mediated by adulthood SEP and behaviors.

Factors associated with having mammography examinations in primary health care users in Vitória, Espírito Santo, Brazil

OBJECTIVES

to estimate prevalence and factors associated with having mammography examinations among adult women aged 40 to 59 years old in primary health care services.

METHODS

a cross-sectional study was performed in 26 health centers in Vitória, Espírito Santo, Brazil; data were collected from March to September 2014; the independent variables described sociodemographic, behavioral and reproductive characteristics, having mammography performed every two years as the outcome.

RESULTS

400 users participated, 57.8% of whom undergo mammography every two years; having the examination was more prevalent among women aged 50-59 years (PR=1.48 - 95%CI 1.25;1.75), those belonging to economic class A/B (PR=1.81 - 95%CI 1.22;2.68) and those who no longer menstruate (PR=1.31 - 95%CI 1.08;1.60).

CONCLUSION

although the proportion of mammography examinations performed is in keeping with recommended levels, a higher frequency was found among the 50-59 age group belonging to class A/B, suggesting unequal access to this examination.

Overweight trajectory and cardio metabolic risk factors in young adults

BACKGROUND

Obesity is one of the conditions that increases the risk of cardiovascular disease. Studies about obesity trajectory and cardio metabolic outcomes at adulthood are still scarce. Therefore, we aimed to assess the association between patterns of overweight over the life-course and cardio metabolic risk factors in young adults.

METHODS

In 1982, the maternity hospitals in Pelotas were visited daily and those newborns whose family lived in the urban area of the city were identified (n = 5914), and have prospectively followed for several occasions. Weight and height were measured at every visit. BMI-for-age z-score was calculated using the WHO Child Growth Standards. Overweight and obesity were defined as a BMI greater than or equal to 25 kg/m2 and 30 kg/m2 respectively. This was the definition adopted for evaluations overweight and obesity at 30 years. The participants were divided into eight groups according to the presence of overweight or obesity in childhood, adolescence and adulthood. Blood pressure, random blood glucose, HDL cholesterol, LDL cholesterol triglycerides and fat mass were measured.

RESULTS

From 2219 participants with anthropometric data in childhood, adolescence and adulthood, 25% never had been overweight, whereas 11.6% were overweight in the three periods. Random blood glucose, SBP and DBP were higher among those subjects who were always overweight/ obese or only overweight/obese during adolescence and adulthood. The participants who were never overweight/obese or only in childhood or adolescence had a lower cardiovascular risk profile (higher HDL cholesterol, lower blood pressure, lower random glucose, lower LDL cholesterol) at 30 years. Fat mass captured from 25 to 100% of the association of overweight and obesity trajectory with cardiometabolic risk factors.

CONCLUSIONS

The tracking of overweight/obesity is associated with an adverse cardio metabolic profile and this association is largely mediated by fat mass in adulthood.

Implication of violence against women on not performing the cytopathologic test

OBJECTIVE

To analyze the association between intimate partner violence and not performing the cytopathologic test in the last three years.

METHODS

It is a transversal study, performed in 26 health units in the city of Vitória, state Espírito Santo, from march to September 2014. The sample was constituted by 106 primary care female users, aging from 30 to 59 years-old. Data on cervical cancer screening were collected, besides the women’s sociodemographic, behavior, obstetric, and gynecological characteristics by an interview, and the World Health Organization recommended tool for identifying violence experiences was applied. The analysis was performed through the chi-square test for association, linear trend for ordinal variables, and the Poisson regression analysis with robust variance.

RESULTS

Among the participating women, 14% (95%CI 12.0–17.2) had overdue Pap tests. Most women who did not perform the test had lower schooling levels, lower income, were smokers, in an unmarried union, having had their sexual debut before 15 years-old, three or more pregnancies, and two or more partners in the last 12 months. Women who suffered intimate partner sexual and physical violence were, respectively, 1.64 (95%CI -1.03–2.62) and 1.94 (95%CI 1.28–2.93) times more delayed in the Pap tests than non-victims.

CONCLUSIONS

Violence is a significant exacerbating factor and affects women’s health negatively. Women who are physically or sexually victimized by their partners are more vulnerable to not performing Pap tests and, consequently, have fewer chances of early diagnosing cervical cancer.

Adolescent parenthood associated with adverse socio-economic outcomes at age 30 years in women and men of the Pelotas, Brazil: 1982 Birth Cohort Study

OBJECTIVE

To investigate the potential long-term effects of adolescent parenthood on completed education and income.

DESIGN

Population-based birth cohort study.

SETTING

All live births in 1982, whose mothers lived in the urban area of Pelotas, southern Brazil.

SAMPLE

A total of 3701 participants: 1914 women and 1787 men at age 30 years.

METHODS

Questionnaires were completed by the mothers in the early phases of this study, and by the cohort members in adolescence and adulthood. Linear regression models and G-computation were used in the analyses.

MAIN OUTCOME MEASURES

Educational attainment and income at age 30 years.

RESULTS

In women, adolescent parenthood was associated with lower attained education compared with women without adolescent maternity: by -2.8 years [95% confidence interval (CI) -3.2 to -2.3] if their first birth was at age 16-19, and by -4.4 years (-5.5 to -3.3) at age 11-15. These effects were greater among women who had three or more children. Women with adolescent parenthood also had 49 or 33% lower income at age 30 if their first child was born when aged 16-19 or 11-15, respectively. In men, the adverse effect of adolescent parenthood on education appeared to be mediated by a higher number of children and there was no effect of adolescent paternity on income at age 30 years.

CONCLUSION

These findings suggest lasting socio-economic disadvantages of adolescent parenthood, with larger effects being apparent in women than in men.

TWEETABLE ABSTRACT

Adolescent parenthood has an adverse effect on educational attainment later in life, and on household income among women.

Obesity-induced hypoadiponectinaemia: the opposite influences of central and peripheral fat compartments

Background and Aims

The substantial reduction in adiponectin concentration among obese individuals seems to depend on fat distribution and is a marker of metabolic and adipose tissue dysfunction. We aimed to: (i) address whether abdominal fat from different compartments (visceral, deep subcutaneous abdominal and superficial subcutaneous abdominal) and gluteofemoral fat are independently associated with blood adiponectin concentration; and (ii) investigate whether abdominal (proxied by waist circumference) and gluteofemoral fat (proxied by hip circumference) accumulation causally determine blood adiponectin concentration.

Methods

To investigate the independent association of abdominal and gluteofemoral fat with adiponectin concentration, we used multivariable regression and data from 30-year-old adults from the 1982 Pelotas Birth Cohort (n = 2,743). To assess the causal role of abdominal and gluteofemoral fat accumulation on adiponectin concentration, we used Mendelian randomization and data from two consortia of genome-wide association studies-the GIANT (n > 210 000) and ADIPOGen consortia (n = 29 347).

Results

In the multivariable regression analysis, all abdominal fat depots were negatively associated with adiponectin concentration, specially visceral abdominal fat [men: β = -0.24 standard unit of log adiponectin per standard unit increase in abdominal fat; 95% confidence interval (CI) = -0.31, -0.18; P = 8*10-13; women: β = -0.31; 95% CI = -0.36, -0.25; P = 7*10-27), whereas gluteofemoral fat was positively associated with adiponectin concentration (men: β = 0.13 standard unit of log adiponectin per standard unit increase in gluteofemoral fat; 95% CI = 0.03, 0.22; P = 0.008; women: β = 0.24; 95% CI = 0.17, 0.31; P = 7*10-11). In the Mendelian randomization analysis, genetically-predicted waist circumference was inversely related to blood adiponectin concentration (β = -0.27 standard unit of log adiponectin per standard unit increase in waist circumference; 95% CI = -0.36, -0.19; P = 2*10-11), whereas genetically-predicted hip circumference was positively associated with blood adiponectin concentration (β = 0.17 standard unit of log adiponectin per standard unit increase in hip circumference; 95% CI = 0.11, 0.24; P = 1*10-7).

Conclusions

These results support the hypotheses that there is a complex interplay between body fat distribution and circulating adiponectin concentration, and that whereas obesity-induced hypoadiponectinaemia seems to be primarily attributed to abdominal fat accumulation, gluteofemoral fat accumulation is likely to exert a protective effect.

An empirical assessment of the Healthy Early Childhood Program in Rio Grande do Sul State, Brazil

We investigate the effect of a family-based primary health care program (Healthly Early Childhood Program) on infant mortality in the state of Rio Grande do Sul, Brazil. We estimate infant mortality's counterfactual trajectories using the differences-in-differences approach, combined with the use of longitudinal data for all municipalities in the state of Rio Grande do Sul. Our main result is that the program reduced the number of deaths caused by external causes. The length of exposure to the program seems to potentiate the effects. For the number of deaths by general causes, there is no evidence of impact. Our findings are consistent with the nature of the program that aims to improve adults care with children. The Healthly Early Childhood Program is effective in reducing the number of avoidable deaths in infants.

Conditions of gestation, childbirth and childhood associated with C-peptide in young adults in the 1982 Birth Cohort in Pelotas-RS; Brazil

BACKGROUND

The connecting peptide in insulin has been associated with cardiovascular risk and overall mortality in the adult population. However, its early determinants are unknown. Assess the association of exposures during pregnancy, delivery, and childhood with C-peptide among 22-23 years old individuals prospectively followed since birth, in a southern Brazilian city.

METHODS

In 1982, all hospital births in the city were identified and those livebirths whose families lived in the urban area were evaluated (n = 5914). The 1982 Pelotas Birth Cohort has prospectively followed these subjects at different moments. In this study, we evaluated the association of C-peptide with exposures occurring during pregnancy, delivery and childhood. In the 22-23 years follow-up visit, we tried to follow the whole cohort and the subjects were interviewed, examined and donated a blood sample. C-peptide was measured using the chemiluminescence immunoassay technique (Immulite®-Siemens, Germany).

RESULTS

In the 22-23 years visit, 4297 subjects were interviewed and the C-peptide was measured in 3807. The geometric mean of C-peptide was 0.83 ng/mL and the mean was higher among women. In the adjusted analysis, C-peptide was positively associated with family income at birth, lower among children of non-white mothers (0.90; CI95% 0.84-0.96), higher among females (1.22; CI95% 1.16-1.28), and positively associated with rapid weight gain between two and four years of age (1.18; CI95% 1.05-1.32).

CONCLUSION

Family income at birth, non-white maternal skin color, and rapid weight gain between two and four years of age were associated with high levels of C-peptide.

Genomic ancestry and education level independently influence abdominal fat distributions in a Brazilian admixed population

We aimed to identify the independent associations of genomic ancestry and education level with abdominal fat distributions in the 1982 Pelotas birth cohort study, Brazil. In 2,890 participants (1,409 men and 1,481 women), genomic ancestry was assessed using genotype data on 370,539 genome-wide variants to quantify ancestral proportions in each individual. Years of completed education was used to indicate socio-economic position. Visceral fat depth and subcutaneous abdominal fat thickness were measured by ultrasound at age 29–31y; these measures were adjusted for BMI to indicate abdominal fat distributions. Linear regression models were performed, separately by sex. Admixture was observed between European (median proportion 85.3), African (6.6), and Native American (6.3) ancestries, with a strong inverse correlation between the African and European ancestry scores (ρ = -0.93; p<0.001). Independent of education level, African ancestry was inversely associated with both visceral and subcutaneous abdominal fat distributions in men (both P = 0.001), and inversely associated with subcutaneous abdominal fat distribution in women (p = 0.009). Independent of genomic ancestry, higher education level was associated with lower visceral fat, but higher subcutaneous fat, in both men and women (all p<0.001). Our findings, from an admixed population, indicate that both genomic ancestry and education level were independently associated with abdominal fat distribution in adults. African ancestry appeared to lower abdominal fat distributions, particularly in men.

Violence against women, Espírito Santo, Brazil

OBJECTIVE

To estimate the prevalence and factors associated with psychological, physical and sexual violence in women victims of intimate partner violence assisted in the primary care services.

METHODS

This is a cross-sectional study, conducted in 26 health units in Vitória, State of Espírito Santo, from March to September 2014. We interviewed 991 women aged 20-59 years. To classify the psychological, physical and sexual violence, the World Health Organization instrument on violence against women was used and a questionnaire to investigate the sociodemographic, behavioral characteristics, and the women’s family and life history was developed. The statistical analyzes used were Poisson regression, Fisher’s exact test and Chi-square.

RESULTS

The prevalence we observed were psychological 25.3% (95%CI 22.6–28.2); physical 9.9% (95%CI 8.1–11.9) and sexual 5.7% (95%CI 4.3–7.3). Psychological violence remained associated with education, marital status, maternal history of intimate partner violence, sexual violence in childhood and drug use, while physical assault was related to age, education, marital status and maternal history of intimate partner violence. Sexual violence occurred the most among women with low income, and victims of sexual violence in childhood.

CONCLUSIONS

Psychological, physical and sexual violence showed highly frequency among women assisted by primary care services. Sociodemographic and behavioral factors, personal experiences, and maternal violence influence the phenomenon.

Social mobility and smoking: a systematic review

The purpose of this study is to review the literature on longitudinal studies that have evaluated the effect of social mobility on the occurrence of smoking in various populations. Articles were selected from the web databases PubMed and Web of Science using the words: follow up, cohort longitudinal prospective, social mobility, social change life, course socioeconomic, smoking, and tobacco. Of the six studies identified in this review, four used occupational classification to measure social mobility. All six were carried out on the continent of Europe. The results indicate higher proportions of tobacco users among those with lower socioeconomic level during the whole period of observation (for all variables analyzed); and that people who suffered downward mobility, that is to say people who were classified as having a higher socioeconomic level at the beginning of life, tended to mimic habits of the new group when they migrated to a lower social group.

Food consumption of children younger than 6 years according to the degree of food processing

OBJECTIVE

To evaluate food intake according to the degree of processing, stratified by family income and age, in a representative sample of children younger than 6 years in the city of Pelotas, RS, Brazil.

METHODS

Cross-sectional population-based study carried out with 770 children aged 0-72 months of age living in the urban area of Pelotas. The dietary intake of children was assessed by 24-h recall administered to mothers or guardians. The energy intake was estimated and each food item was classified according to the food processing degree. Food consumption was stratified by age (younger than 24 months; 24 months or older) and associations between quintiles of family income and relative contribution of each food to total energy were performed by linear regression. The Wald test was applied to test linear trend across groups.

RESULTS

The mean energy intake was 1725.7kcal/day. The mean contribution of processed and ultraprocessed foods was 19.7% among children younger than 24 months and 37% in those aged 24 months or older, while the mean consumption of natural and minimally processed food was 61% and 44%, respectively. Among children aged 24 months or older, a greater consumption of canned foods, cheese and sweets was observed as family income quintiles increased, while breads were more consumed by those children belonging to the lower income quintiles.

CONCLUSION

A high caloric contribution of ultraprocessed foods in detriment to a lower consumption of natural and minimally processed foods was observed in the diet of children younger than 6 years.

Is adductor pollicis muscle thickness a good predictor of lean mass in adults?

BACKGROUND & AIMS

Lean mass (LM) is an important parameter in clinical outcomes, which highlights the necessity of reliable tools for its estimation. The adductor pollicis muscle thickness (APMT) is easily accessible and suffers minimal interference from the adjacent subcutaneous fat tissue.

OBJECTIVE

To assess the relationship between the APMT and LM in a sample of Southern Brazilian adults.

METHODS

Participants were adults from the 1982 Pelotas (Brazil) Birth Cohort. LM was measured by dual energy X-ray absorptiometry (DXA). LM and lean mass index (LMI - LM divided by the square of height - kg/m(2)) were the outcomes. APMT was measured using a skinfold caliper. The mean of three measurements in the non-dominant hand was used in the analyses. APMT was described according to socio-demographic characteristics and nutritional status. The relationship between APMT and both LM and LMI was evaluated by correlation coefficient and linear regression using APMT as a single anthropometric parameter and also in addition to BMI.

RESULTS

APMT was assessed in 3485 participants. APMT was higher in males, non-whites, less-schooled and obese individuals. APMT was moderately correlated to LM and LMI (ranged from 0.44 to 0.57). Correlation coefficients were higher for LMI as outcome and in females (LM: 0.51 and LMI: 0.57). APMT explained 19% and 26% of the variance in LM in males and females, respectively, whereas it explained 26% and 33% of the variance in LMI. APMT increased the prediction for LM in 3 and 4 percentage points in males and females, in comparison to explained by BMI. BMI explained 48% and 59% of the variance of LMI in males and females whereas APMT increased it to 51% and 62% for both sexes, respectively.

CONCLUSIONS

Results were not good enough to promote the APMT as a single predictor of LM or LMI in epidemiological studies. APMT has a little predictive capacity in estimating LM or LMI when BMI is also considered.

Breastfeeding and mental health in adulthood: A birth cohort study in Brazil

BACKGROUND

Breastfeeding is negatively associate with behavioral and internalization problems, psychological stress, and depressive/anxiety symptoms. However, studies evaluating specific mental health disorders are scarce. We aimed to assess the association between breastfeeding and mental health outcomes in young adults.

METHODS

In 1982, hospital deliveries in Pelotas (Southern Brazil) were identified; liveborns were examined and their mothers interviewed (n=5914). Information on breastfeeding was collected in early childhood. In 2012-13, at 30 years of age, we used the Mini International Neuropsychiatric Interview (MINI) for the diagnosis of major depression (MD), generalized anxiety disorder (GAD) and social anxiety disorder (SAD). In addition, we used the Beck Depression Inventory (BDI-II) and the Self-reported Questionnaire (SRQ-20), to evaluate depressive symptoms severity and common mental disorders (CMD), respectively. We used multivariable regression models to evaluate the association between breastfeeding and mental health outcomes.

RESULTS

We evaluated 3657 individuals. Prevalence of CMD, MD, GAD and SAD was 24.3%, 7.9%, 12.7% and 3.6%, respectively. In multivariable models the odds of having a more severe case of depression (BDI-II) was smaller among those breastfed for 6 or more months (OR=0.69 95%CI [0.53-0.89]). We observed a similar pattern for MD and CMD, however, confidence intervals included the reference.

LIMITATIONS

We had no information on home environment characteristics during childhood. Lack of power and a small effect size could explain why we did not detect an association between breastfeeding and MD.

CONCLUSION

Breastfeeding reduced the odds of having more severe depressive symptoms.

Genomic ancestry and the social pathways leading to major depression in adulthood: the mediating effect of socioeconomic position and discrimination

BACKGROUND

Evidence suggests that there is an association between ethnicity/skin color and depression; however, many contextual and individual variables, like sense of discrimination and socioeconomic position (SEP), might influence the direction of this association. We assessed the association between African ancestry and major depression among young adults that have been followed-up since birth in a Southern Brazilian city, and the mediating effect of SEP and discrimination.

METHODS

In 1982, all hospital deliveries in Pelotas (Southern Brazil) were identified; liveborns were examined and their mothers interviewed (n = 5914). In 2012-13, at 30 years of age, we used the Mini International Neuropsychiatric Interview (MINI) for major depression diagnosis. In addition, DNA samples were genotyped for approximately 2.5 million single nucleotide polymorphisms (SNPs) using Illumina (CA, USA) HumanOmni2.5-8v1 array. Genomic ancestry estimation was based on approximately 370 000 single nucleotide polymorphisms (SNPs) mutually available for the Pelotas cohort and selected samples (used as reference panels) of the HapMap and Human Genome Diversity (HGDP). We estimated prevalence ratios (PR) using Poisson regression models and evaluated the association between percentage of African ancestry and major depression. We used G-computation for mediation analysis.

RESULTS

At 30 years, 3576 individuals were evaluated for major depression (prevalence = 7.9 %). Only individuals in the highest SEP, who had a percentage of African ancestry between >5-30 % and >30 % had a prevalence of major depression 2.16 (PR = 2.16 95 % CI [1.05-4.45]) and 2.74 (PR = 2.74 95 % CI [1.06-7.06]) times higher, than those with 5 % or less, respectively. Among these subjects, sense of discrimination by skin color, captured 84 % of the association between African ancestry and major depression.

CONCLUSION

SEP is an important effect modifier of the positive association between African ancestry and major depression. In addition, this association is predominantly mediated by the sense of feeling discriminated by skin color.

[Social impact of literacy in the household: analysis of the association with smoking in illiterate co-residents in Brazil]

Objective To investigate the social impact of literacy on the smoking behavior of illiterate individuals who share the household with literate individuals. Method This cross-sectional study employed data from the 2008 Brazilian National Household Survey (Pesquisa Nacional por Amostra de Domicílios, PNAD). Smokers were defined as individuals reporting use of any tobacco product daily or less than daily. The literacy profiles of residents were identified. Poisson regressions adjusted for skin color, age, and maximum level of literacy in the household were performed. Four groups were analyzed: men living in rural areas, men living in urban areas, women living in rural areas, and women living in urban areas. Results For urban men, the presence of literate women only in the household was a protection factor against smoking (prevalence ratio, PR: 0.77; 95%CI: 0.71-0.82) vs. households in which all the males were illiterate. The same protective effect was found for rural men (PR: 0.79; 95%CI: 0.73-0.85). In turn, the presence of literate men only living in the same household with illiterate men did not provide protection against smoking in any case (PR: 0.93; 95%CI: 0.83-1.03 for the urban subsample; and PR: 0.99; 95%CI: 0.88-1.11 for the rural subsample). Illiterate women benefited from the presence of both literate men (PR: 0.77; 95%CI: 0.71-0.84 for the urban sample; and PR: 0.78; 95%CI: 0.69-0.89 for the rural subsample) and literate women (PR: 0.81; 95%CI: 0.72-0.92 for the urban subsample; and PR: 0.75; IC95%: 0.60-0.93 for the rural subsample). Conclusions Literate women seem to have positively affected illiterate co-residents of both sexes. This result is in agreement with reports showing broad advantages of female schooling.

Desenho de um questionário de frequência alimentar digital autoaplicado para avaliar o consumo alimentar de adolescentes e adultos jovens: coortes de nascimentos de Pelotas, Rio Grande do Sul

RESUMO: Objetivo: Artigo metodológico com o objetivo de descrever a construção de um questionário de frequência alimentar (QFA) digital autoaplicado, desenvolvido para as coortes de nascimentos de Pelotas de 1982 e 1993. Métodos: O instrumento foi criado com base em QFAs anteriormente utilizados nas duas coortes em acompanhamentos nos anos de 2004 e 2008. O QFA foi elaborado incluindo 88 alimentos e/ou preparações cujas frequências foram agrupadas em categorias desde o valor mínimo de consumo de nunca ou < 1 vez/mês até o máximo de ≥ 5 vezes/dia. As opções fechadas relativas à porção foram construídas considerando recordatórios de 24 horas (R24Hs) anteriormente aplicados à subamostra da coorte de 1993. Três alternativas de porção foram construídas: igual, menos ou mais. A porção igual foi descrita com base no percentil 50 do consumo de cada alimento, obtido a partir das distribuições das porções constantes nos R24H. Fotos das porções relativas ao percentil 50 de cada alimento foram também incluídas ao formato do programa. Resultados: Esse QFA digital incluiu alimentos e preparações que atendem aos objetivos das pesquisas atuais. A aparência do programa foi atrativa à equipe de trabalho e também aos participantes do estudo. O tempo médio de aplicação de 12 minutos e a facilidade de preenchimento possibilitaram que vários participantes respondessem às questões ao mesmo tempo. Além disso, o instrumento dispensou a necessidade de entrevistador e a dupla entrada de dados em programa específico. Conclusão: Recomenda-se o uso dessa mesma estratégia em outros estudos, adaptando-a aos diferentes contextos e situações.

Childhood stunting and the metabolic syndrome components in young adults from a Brazilian birth cohort study

BACKGROUND/OBJECTIVES

The aim of this study was to investigate the association between stunting in the second year of life and metabolic syndrome components in early adulthood among subjects who have been prospectively followed-up since birth, in a city in Southern Brazil.

SUBJECTS/METHODS

In 1984, we attempted to follow-up the entire cohort; the subjects were examined and their mothers interviewed. Stunting was defined by a length-for-age Z-score 2 s.d. or more below the mean, in accordance with the World Health Organization reference. Between 2004 and 2005, we again tried to follow the entire cohort; during this period the subjects were evaluated for the following metabolic syndrome components: high-density lipoprotein (HDL) cholesterol, triglycerides, random blood glucose, waist circumference and systolic and diastolic blood pressure. Family income at the time of the baby's birth, asset index, mother's education, mother's smoking during pregnancy and duration of breastfeeding were considered possible confounders. Linear regression was used in the unadjusted and adjusted analyses.

RESULTS

Among men, stunting was inversely associated with triglycerides (β=-11.90, confidence interval (CI)=-22.33 to -1.48) and waist circumference (β=-4.29, CI=-5.62 to -2.97), whereas for women stunting was negatively related to HDL-cholesterol (β=-4.50, CI=-6.47 to -2.52), triglycerides (β=-9.61, CI=-17.66 to -1.56) and waist circumference (β=-1.14, CI=-4.22 to -1.02). However, after controlling for confounding variables, these associations vanished.

CONCLUSIONS

The findings suggest that stunting in childhood is not associated with metabolic syndrome components in young adults.

Pulse Wave Velocity at Early Adulthood: Breastfeeding and Nutrition during Pregnancy and Childhood

BACKGROUND

Pulse wave velocity (PWV) is an early marker of arterial stiffness. Low birthweight, infant feeding and childhood nutrition have been associated with cardiovascular disease in adulthood. In this study, we evaluated the association of PWV at 30 years of age with birth condition and childhood nutrition, among participants of the 1982 Pelotas birth cohort.

METHODS

In 1982, the hospital births in Pelotas, southern Brazil, were identified just after delivery. Those liveborn infants whose family lived in the urban area of the city were examined and have been prospectively followed. At 30 years of age, we tried to follow the whole cohort and PWV was assessed in 1576 participants.

RESULTS

Relative weight gain from 2 to 4 years was positively associated with PWV. Regarding nutritional status in childhood, PWV was higher among those whose weight-for-age z-score at 4 years was >1 standard deviation above the mean. On the other hand, height gain, birthweight and duration of breastfeeding were not associated with PWV.

CONCLUSION

Relative weight gain after 2 years of age is associated with increased PWV, while birthweight and growth in the first two years of life were not associated. These results suggest that the relative increase of weight later in childhood is associated with higher cardiovascular risk.

[Evolution of overweight and obesity into adulthood, Pelotas, Rio Grande do Sul State, Brazil, 1982-2012]

This study assessed the prevalence of overweight and obesity in adolescence and adulthood among subjects enrolled in the 1982 Pelotas Birth Cohort, Rio Grande do Sul State, Brazil, according to social and demographic characteristics. In 1982, hospital births in Pelotas were identified and all live born infants (n = 5,914) were examined and have been followed since. The data were collected at 15, 18, 23, and 30 years of age. In women, prevalence of overweight increased from 23.6% at 15 years to 52.4% at 30 years of age, while obesity increased from 6.6% to 23.8%. In men, overweight increased from 22.9% to 62.9%, and obesity from 7.5% to 22.1%. Overweight and obesity increased more among individuals of both sexes with lower socioeconomic status, which can lead to more inequality in the occurrence of chronic diseases.

[Effects of social mobility on adult mental health:a systematic review of the literature]

The scope of this study was to identify longitudinal studies evaluating the relationship between social mobility and mental disorders in adults. An electronic review of the literature was conducted in the PubMed/Medline and PsycINFO databases. The bibliographic references of the articles selected for analysis were also examined for eligibility. Cohort studies were selected taking social mobility as exposure category and mental health-related disorders as the outcome. Seven studies were reviewed and their definition and categorization of exposure and outcome were found to be heterogeneous, thus rendering analysis and comparison of the results found in the various studies difficult. Mental health-related disorders were more common in individuals belonging to lower socio-economic classes, regardless of having upward, stable or downward social mobility. Moreover, the influence of individual socio-economic conditions, assessed in adulthood, appears to be greater than the effect of parental economic status on the mental health of individuals. This review indicates that it is possible to find a relationship between socio-economic status during the course of life and mental health in adulthood. However, the direction taken by this relationship remains unclear.

Tendências e desigualdades nos comportamentos de risco em adolescentes: comparação das coortes de nascimentos de Pelotas, Rio Grande do Sul, Brasil

Resumo: O objetivo do presente trabalho é descrever tendências e desigualdades nos comportamentos de risco à saúde em adolescentes. Estudo transversal, comparando duas coortes de nascimentos da cidade de Pelotas, Rio Grande do Sul, Brasil. Foram incluídos 1.281 adolescentes da coorte de 1982 e 4.106 da coorte de 1993 acompanhados em 2001 e 2011, respectivamente. Foi avaliado o consumo de álcool, uso de drogas ilícitas, uso de tabaco, iniciação sexual < 16 anos, não uso de preservativo e múltiplos parceiros sexuais. Foram calculadas prevalências totais para cada coorte, estratificadas por sexo e renda per capita, e medidas de desigualdades absoluta e relativa. Houve diminuição, de 2001 para 2011, na prevalência de uso experimental de álcool, uso de drogas, fumo e não uso de preservativos, e aumento no número de parceiros sexuais. O gap na prevalência conforme sexo aumentou para o não uso de preservativo, e para os outros aumentou. O gap entre grupos de renda diminuiu para iniciação sexual < 16 anos e aumentou para episódios de embriaguez. Apesar da tendência de diminuição na prevalência dos comportamentos de risco, as desigualdades socioeconômicas persistiram.

Objectively measured physical activity and sedentary-time are associated with arterial stiffness in Brazilian young adults

OBJECTIVE

To examine the associations between objectively measured physical activity and sedentary time with pulse wave velocity (PWV) in Brazilian young adults.

METHODS

Cross-sectional analysis with participants of the 1982 Pelotas (Brazil) Birth Cohort who were followed-up from birth to 30 years of age. Overall physical activity (PA) assessed as the average acceleration (mg), time spent in moderate-to-vigorous physical activity (MVPA - min/day) and sedentary time (min/day) were calculated from acceleration data. Carotid-femoral PWV (m/s) was assessed using a portable ultrasound. Systolic and diastolic blood pressure (SBP/DBP), waist circumference (WC) and body mass index (BMI) were analyzed as possible mediators. Multiple linear regression and g-computation formula were used in the analyses.

RESULTS

Complete data were available for 1241 individuals. PWV was significantly lower in the two highest quartiles of overall PA (0.26 m/s) compared with the lowest quartile. Participants in the highest quartile of sedentary time had 0.39 m/s higher PWV (95%CI: 0.20; 0.57) than those in the lowest quartile. Individuals achieving ≥30 min/day in MVPA had lower PWV (β = -0.35; 95%CI: -0.56; -0.14). Mutually adjusted analyses between MVPA and sedentary time and PWV changed the coefficients, although results from sedentary time remained more consistent. WC captured 44% of the association between MVPA and PWV. DBP explained 46% of the association between acceleration and PWV.

CONCLUSIONS

Physical activity was inversely related to PWV in young adults, whereas sedentary time was positively associated. Such associations were only partially mediated by WC and DBP.

The Effect of Fetal and Childhood Growth over Depression in Early Adulthood in a Southern Brazilian Birth Cohort

BACKGROUND

Poor nutrition and growth during fetal life and childhood might be associated with depression in adulthood; however, studies evaluating these associations present controversial results, especially when comparing studies using different proxies for fetal growth. We evaluated the association of fetal and childhood growth/nutrition with depression, in adulthood, using different approaches and measurement methods.

METHOD

In 1982, hospital births (n = 5914) in Pelotas, southern Brazil, were examined and have been prospectively followed. At 30 years, the presence of major depression and depressive symptoms severity was evaluated using the Mini International Neuropsychiatric Interview (MINI) and Beck Depression Inventory (BDI-II). The present study assessed their association with birth weight, premature birth, small for gestational age (SGA), stunting and conditional growth during childhood.

RESULTS

At 30 years, 3576 individuals were evaluated and 7.9% had major depression. Low birth weight (PR = 1.01 95%CI [0.64-1.60]), having been born SGA (PR = 0.87 95%CI [0.64-1.19]) and premature birth (PR = 1.22 95%CI [0.72-2.07]) were not associated with major depression in multivariable models. However, those born SGA who were also stunted in childhood had a higher prevalence of major depression (PR = 1.87 95%CI [1.06-3.29]) and greater odds of scoring a higher level of depression in the BDI-II (OR = 2.18 95%CI [1.34-3.53]).

CONCLUSION

In this Brazilian cohort of young adults, those born SGA who were also stunted during childhood had a higher risk of depression in adulthood. Our results show that the effect of growth impairment on depression is cumulative.

Social Mobility and Mental Disorders at 30 Years of Age in Participants of the 1982 Cohort, Pelotas, Rio Grande Do Sul - RS

This study aimed to evaluate the relationship between mental disorders at 30 years of age and social mobility by formally testing three hypotheses: Risk Accumulation; Critical Period; and Social Mobility. The study was performed using data from the 30-year follow-up of the Pelotas Birth Cohort Study, conducted in 1982, and data from previous follow-ups. The tool used to evaluate mental health was the Self Report Questionnaire (SRQ-20). For the statistical analysis, the chi-square test with the Yates correction was used to estimate the prevalence of mental disorder, and the Poisson regression with robust variance was used to formally test the hypotheses according to the Risk Accumulation, Critical Period and Social Mobility Models. The analyses were stratified by gender. The prevalence of Common Mental Disorders (CMDs) was 24.3% (95% CI 22.9–25.7) when the whole sample was considered. The highest prevalence, 27.1% (95% CI 25.1–29.2), was found in women, and the difference between genders was significant (p < 0.001). CMDs were more frequent in participants who remained “poor” in the three follow-ups. In both men and women, the best fit was obtained with the Risk Accumulation Model, with p = 0.6348 and p = 0.2105, respectively. The results indicate the need to rethink public income maintenance policies. Finally, we suggest further studies to investigate the role of different public policies in decreasing the prevalence of mental disorders and thus contribute proposals of new policies that may contribute to the prevention of these disorders.

Relationship between food insecurity and nutritional status of Brazilian children under the age of five

OBJECTIVE

The aim of this study was to investigate the relationship between food insecurity and nutritional status of Brazilian children.

METHODS

The National Demographic and Health Survey 2006 database is available on the worldwide web. Thus, the analyzed variables were obtained in this study, including nutritional indices, food insecurity and other socioeconomic and demographic variables. The height-for-age, weight-for-age and weight-for-height indices were evaluated as the Z-score of the World Health Organization reference curves. Food insecurity was defined by using the Brazilian Food Insecurity Scale. Averages of three indices according to the presence of food insecurity were analyzed, including other variables. Linear regression evaluated the effect of food insecurity on the Z-score of the three nutritional indices.

RESULTS

The sample included 4,817 children, out of whom 7% had deficit in height, 7% were overweight and 47% had food insecurity. It was found that the average of height-for-age, weight-for-age and weight-for-height were -0.31, 0.12 and 0.40, respectively, being lower among children with food insecurity.

CONCLUSION

The regression analysis showed that children living with some level of food insecurity have worse rates of height-for-age, even controlling for demographic and socioeconomic factors.

Birth weight, intrauterine growth restriction and nutritional status in childhood in relation to grip strength in adults: from the 1982 Pelotas (Brazil) birth cohort

Objective

The aim of this study was to evaluate the association among birth weight, intrauterine growth, and nutritional status in childhood with grip strength in young adults from the 1982 Pelotas (Brazil) birth cohort.

Methods

In 1982, the hospital live births of Pelotas were followed. In 2012, grip strength was evaluated using a hand dynamometer and the best of the six measurements was used. Birth weight was analyzed as z-score for gestational age according to Williams (1982) curve. Weight-for-age, weight-for-length/height, and length/height-for-age at 2 and 4 y were analyzed in z-scores according to 2006 World Health Organization Child Growth Standards. Lean mass at 30 y was included as possible mediator using the g-computation formula.

Results

In 2012, 3701 (68.1%) individuals were interviewed and 3470 were included in the present analyses. An increase of 1 z-score in birth weight was associated with an increase of 1.5 kg in grip strength in males (95% confidence interval, 1.1–1.9). Positive effect of birth weight on grip strength was found in females. Grip strength was greater in individuals who were born with appropriate size for gestational age and positively associated with weight- and length/height-for-age z-score at 2 and 4 y of age. A positive association between birth weight and grip strength was only partially mediated by adult lean mass (50% and 33% of total effect in males and females), whereas direct effect of weight at 2 y was found only in males.

Conclusions

It is suggested that good nutrition in prenatal and early postnatal life has a positive influence on adult muscle strength. The results from birth weight were suggestive of fetal programming on grip strength measurement.

•

Newborns from southern Brazil were followed for 30 y.

•

Birth weight and nutritional status in childhood were prospectively measured.

•

Grip strength was positively related to birth weight and early nutritional status.

•

Coefficients of the association between birth weight and grip strength were higher in males.

•

Birth weight was associated with adult grip strength independent of current lean mass.

Proposal of a short-form version of the Brazilian food insecurity scale

OBJECTIVE

To propose a short version of the Brazilian Food Insecurity Scale.

METHODS

Two samples were used to test the results obtained in the analyses in two distinct scenarios. One of the studies was composed of 230 low income families from Pelotas, RS, Southern Brazil, and the other was composed of 15,575 women, whose data were obtained from the 2006 National Survey on Demography and Health. Two models were tested, the first containing seven questions, and the second, the five questions that were considered the most relevant ones in the concordance analysis. The models were compared to the Brazilian Food Insecurity Scale, and the sensitivity, specificity and accuracy parameters were calculated, as well as the kappa agreement test.

RESULTS

Comparing the prevalence of food insecurity between the Brazilian Food Insecurity Scale and the two models, the differences were around 2 percentage points. In the sensitivity analysis, the short version of seven questions obtained 97.8% and 99.5% in the Pelotas sample and in the National Survey on Demography and Health sample, respectively, while specificity was 100% in both studies. The five-question model showed similar results (sensitivity of 95.7% and 99.5% in the Pelotas sample and in the National Survey on Demography and Health sample, respectively). In the Pelotas sample, the kappa test of the seven-question version totaled 97.0% and that of the five-question version, 95.0%. In the National Survey on Demography and Health sample, the two models presented a 99.0% kappa.

CONCLUSIONS

We suggest that the model with five questions should be used as the short version of the Brazilian Food Insecurity Scale, as its results were similar to the original scale with a lower number of questions. This version needs to be administered to other populations in Brazil in order to allow for the adequate assessment of the validity parameters.

[Diet quality of preschool children aged 2 to 5 years living in the urban area of Pelotas, Brazil]

OBJECTIVE

To assess the dietary quality of preschool children in the urban area of Pelotas, Rio Grande do Sul, southern Brazil.

METHODS

Dietary quality was measured according to the Healthy Eating Index (HEI), adapted to Brazil. Food consumption was obtained using the Food Frequency Questionnaire (FFQ). The index score was obtained by a score, ranging from 0 to 100, distributed in 13 food groups that characterize different components of a healthy diet. The better the quality of the diet, the closer the score is to 100.

RESULTS

Dietary was evaluated in 556 preschoolers. The mean HEI score value was 74.4 points, indicating that diets need improvement. The mean scores were significantly higher among girls and in children from families with income between one and less than three minimum wages.

CONCLUSIONS

The children showed vegetable consumption below the recommended level, while the food group of oils and fats, as well as the group of sugars, candies, chocolates and snacks were consumed in excess. It is important to reinforce guidelines to promote healthier eating habits, which may persist later in life.

Breastfeeding and bone mass at the ages of 18 and 30: prospective analysis of live births from the Pelotas (Brazil) 1982 and 1993 cohorts

OBJECTIVE

To evaluate the effect of total breastfeeding, breastfeeding duration and type of breastfeeding at 3 months of age on bone mass at 18 and 30 years.

STUDY DESIGN

A prospective, longitudinal study was conducted with two birth cohorts (1982 and 1993) in Pelotas, Southern Brazil. Measurements of bone mineral content (BMC) and bone mineral density (BMD) at 18 and 30 years of age were obtained by dual-energy X-ray absorptiometry (DXA). Information on breastfeeding was collected during the first 4 years of life. Analyses were performed by linear regression and stratified by sex.

RESULTS

A total of 1109 and 3226 participants provided complete information on breastfeeding in early life and bone mass at 18 and 30 years, respectively. No association between breastfeeding and bone mass was observed in women at both ages nor among men at age 30. Among men at the age of 18, BMC and BMD were higher among those breastfed regardless of duration (p=0.032 and p=0.043, respectively).

CONCLUSIONS

Despite a very weak positive effect of breastfeeding (yes/no) on BMC and BMD at age 18 in men, most findings pointed to a lack of association between breastfeeding and bone mass until young adulthood.

Change in body weight and body image in young adults: a longitudinal study

BACKGROUND

The goal of this study was to identify the effect of the change in body mass index (BMI) from childhood to adulthood on body image satisfaction at 23 years of age in members of the 1982 Pelotas Birth Cohort in Pelotas, RS, Brazil.

METHODS

The study used data from the 1986 and 2004-5 follow-up studies. Body shape satisfaction was evaluated using the Stunkard scale. Body shape dissatisfaction was defined as the difference between the figures chosen for the current and ideal body size. BMI z-score changes were calculated as the difference between z-score values at 4 and 23 years of age, using the population internal z-score as standard. The analysis was stratified by sex, and multinomial logistic regression was used in crude and adjusted analyses.

RESULTS

A total of 1963 men and 1739 women were analyzed. The mean age of the participants in 2004-5 was 22.7 years. Of the participants exhibiting increased BMI z-scores, 17% perceived themselves as thinner than ideal, whereas 48% perceived themselves as fatter than ideal. The prevalence of dissatisfaction was higher in women because they perceived themselves as fatter than ideal on the three categories of z-score change (≥ + 0.5 sd; -0.49 to + 0.49 sd and ≤ -0.5 sd); 81% of women exhibiting an increased BMI z-score reported dissatisfaction. The analysis adjusted for confounding factors revealed that women with increased BMI z-scores were less prone to feel thinner than ideal. Additionally, the increased risk of dissatisfaction due to perceiving oneself as fatter than ideal was similar between men and women (RRR = 3.52 95% CI: 2.17 to 4.56 and RRR = 4.08 95% CI: 3.00 to 5.56, respectively) using -0.49 to +0.49 sd as the reference category.

CONCLUSIONS

Individuals exhibiting increased BMI z-scores between 4 and 23 years of age reported higher risks of body dissatisfaction at 23 years of age. This finding is important because body dissatisfaction can cause psychological, social, self-esteem problems, and well-being.

[Children's eating behaviour: comparison between normal and overweight children from a school in Pelotas, Rio Grande do Sul, Brazil]

OBJECTIVE:

To evaluate differences in children's eating behavior in relation to their nutritional status, gender and age.

METHODS:

Male and female children aged six to ten years were included. They were recruited from a private school in the city of Pelotas, Rio Grande do Sul, southern Brazil, in 2012. Children´s Eating Behaviour Questionnaire (CEBQ) subscales were used to assess eating behaviors: Food Responsiveness (FR), Enjoyment of Food (EF), Desire to Drink (DD), Emotional Overeating (EOE), Emotional Undereating (EUE), Satiety Responsiveness (SR), Food Fussiness (FF) and Slowness in Eating (SE). Age-adjusted body mass index (BMI) z-scores were calculated according to the WHO recommendations to assess nutritional status.

RESULTS:

The study sample comprised 335 children aged 87.9±10.4 months and 49.3% had normal weight (n=163), 26% were overweight (n=86), 15% were obese (n=50) and 9.7% were severely obese (n=32). Children with excess weight showed higher scores at the CEBQ subscales associated with "food approach" (FR, EF, DD, EOE, p<0.001) and lower scores on two "food avoidance" subscales (SR and SE, p<0.001 and p=0.003, respectively) compared to normal weight children. Differences in the eating behavior related to gender and age were not found.

CONCLUSIONS:

"Food approach" subscales were positively associated to excess weight in children, but no associations with gender and age were found.

Carotid intima-media thickness at age 30, birth weight, accelerated growth during infancy and breastfeeding: a birth cohort study in Southern Brazil

Objective

To examine the relationship between carotid intima-media thickness (IMT) at age 30 and birth characteristics, growth during infancy, and breastfeeding duration, among subjects who have been prospectively followed since birth.

Methods and Results

In 1982, all births in the city of Pelotas, southern Brazil, were identified and those children (n = 5,914) whose families lived in the urban area of the city have been followed and evaluated at several time points. The cohort participants were evaluated in 2012–13, and IMT was measured at the posterior wall of the right and left common carotid arteries in longitudinal planes using ultrasound imaging. We obtained valid IMT measurements for 3,188 individuals. Weight-for-age z-score (WAZ) at age 2 years, weight-for-height z-score (WHZ) at age 4, height-for-age z-score (HAZ) at 4 years, WAZ at age 4 and relative conditional weight at 4 years were positively associated with IMT, even after controlling for confounding variables. The beta-coefficient associated with ≥1 s.d. WAZ at age 2 (compared to those with a <–1 s.d.) was 3.62 μm (95% CI 0.86 to 6.38). The beta-coefficient associated with ≥1 s.d. WHZ at 4 (in relation to <–1 s.d) was 3.83 μm (95% CI 0.24 to 7.42). For HAZ at 4, the beta-coefficient for ≥1 s.d. in relation to <–1 s.d. was 4.19 μm (95% CI 1.14 to 7.25). For WAZ at 4, the beta-coefficient associated with ≥1 s.d. in relation to <–1 s.d. was 4.28 μm (95% CI 1.59 to 6.97). The beta-coefficient associated with conditional weight gain at age 2–4 was 1.26 μm (95% CI 0.49 to 2.02).

Conclusion

IMT at age 30 was positively associated with WAZ at age 2 years, WHZ at age 4, HAZ at age 4, WAZ at age 4 and conditional weight gain at age 4 years.