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BACKGROUND: Preterm birth is a leading cause of infant morbidity and mortality; its multifactorial causes are an obstacle to understanding etiology and pathogenesis. The importance of cytokines and inflammation in its etiology and association with the short cervix is nowadays well-proven. To date, there are no reliable biological or biochemical markers to predict preterm birth; even though the length of the cervix has high specificity, its sensitivity with the cervix below 2.5 cm is low. OBJECTIVE: We study the association of plasma cytokine levels and cervical length in search of predictors of preterm birth. STUDY DESIGN: We evaluated a total of 1400 pregnant women carrying a single fetus between 20 and 25 weeks of gestation, and 1370 of them after childbirth in a nested case-control study of a prenatal cohort. Eligible pregnant women were interviewed and submitted to obstetric morphological and transvaginal ultrasound with cervical length measurement, gynecological examination, and blood collection. Preterm birth occurred in 133 women, 129 included in the study, and a control group randomly selected at a 2:1 ratio. A total of 41 cytokines with a higher probability of being associated with preterm birth or being of significance during labor were determined. RESULTS: Cytokine and cervical length analysis by multivariate analysis of the conditional interference tree revealed that growth-related oncogene values of less than 2293 pg/mL were significantly associated with a cervical length of less than 2.5 cm. CONCLUSIONS: As well as a cervical length shorter than 2.5 cm, growth-related oncogene levels of less than 2293 pg/ml may be associated with an increased risk of PB. Analysis based on the association of biomarkers and of the interaction between cytokines is a promising pathway in search of a predictor of preterm birth.

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

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

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

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

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

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OBJECTIVES: To estimate the baseline prevalence and risk factors for microcephaly at birth before the Zika virus epidemic in 2 Brazilian cities. METHODS: We used population-based data from the Brazilian Ribeirão Preto (RP) and São Luís (SL) birth cohort studies of 2010 that included hospital deliveries by resident mothers. The final sample was 7376 live births in RP and 4220 in SL. Gestational age was based on the date of the mother's last normal menstrual period or obstetric ultrasonography, if available. Microcephaly at birth was classified according to the criteria of the International Fetal and Newborn Growth Consortium for the 21st Century and the Brazilian Ministry of Health. Risk factors for microcephaly, proportionate and disproportionate microcephaly, and severe microcephaly were estimated in a hierarchized logistic regression model. RESULTS: According to the International Fetal and Newborn Growth Consortium for the 21st Century definition, the prevalence of microcephaly (>2 SDs below the mean for gestational age and sex) was higher in SL (3.5%) than in RP (2.5%). The prevalence of severe microcephaly (>3 SDs below the mean) was higher in SL (0.7%) than in RP (0.5%). Low maternal schooling, living in consensual union or without a companion, maternal smoking during pregnancy, primiparity, vaginal delivery, and intrauterine growth restriction were consistently associated with microcephaly. The number of cases of microcephaly is grossly underestimated, with an underreporting rate of ∼90%. CONCLUSIONS: The prevalence of severe microcephaly was much higher than expected in both cities. Our findings suggest that microcephaly was endemic in both municipalities before the circulation of the Zika virus.

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OBJECTIVE: It has been suggested that a greater dairy consumption is a contributing factor to a lower prevalence of metabolic syndrome (MetS) as a result of the possible actions of some milk nutrients. However, results remain controversial. The aim of this study was to examine the association between dairy consumption and MetS and its components. METHODS: Dairy consumption and biochemical and anthropometric parameters were determined in 2031 young adults ages 23 to 25 y. Food consumption was assessed using a food frequency questionnaire. The estimated habitual portion of dairy products consumed daily was divided into quintiles. The criteria of the International Diabetes Federation (IDF) and of the Joint Interim Statement (JIS) were used for the classification of MetS. Nonadjusted and adjusted odds ratios (ORs) were estimated by logistic regression. RESULTS: The prevalence of MetS was 11.9% by the IDF criteria and 9% by the JIS criteria. A greater dairy consumption was associated with a lower prevalence of MetS according to both IDF (OR, 0.61; 95% confidence interval [CI], 0.38-0.97) and JIS (OR, 0.62; 95% CI, 0.39-0.98) criteria when the last quintile was compared with the first. The association persisted in the model adjusted for demographic, socioeconomic, dietary, and lifestyle variables according to the IDF (OR, 0.53; 95% CI, 0.30-0.93) and was borderline according to the JIS (OR, 0.59; 95% CI, 0.34-1.00), but lost significance when data were adjusted for calcium in both models. CONCLUSIONS: A greater dairy consumption is associated with a lower prevalence of MetS, with calcium probably being the nutrient responsible for this association.

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

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BACKGROUND: Cesarean section (CS) has been associated with obesity, measured by body mass index (BMI), in some studies. It has been hypothesized that this association, if causal, might be explained by changes in gut microbiota. However, little is known about whether CS is also associated with increased adiposity as measured by indicators other than BMI. OBJECTIVE: To assess the association between CS and indicators of peripheral and central adiposity in young adults. METHODS: The study was conducted on 2,063 young adults aged 23 to 25 years from the 1978/79Ribeirão Preto birth cohort, São Paulo, Brazil. CS was the independent variable. The anthropometric indicators of adiposity were: waist circumference (WC), waist-height ratio (WHtR), waist-hip ratio (WHR), tricipital skinfold (TSF), and subscapular skinfold (SSF). The association between CS and indicators of adiposity was investigated using a Poisson model, with robust adjustment of variance and calculation of incidence rate ratio (IRR) with 95% confidence interval (95%CI), and adjustment for birth variables. RESULTS: Follow-up rate was 31.8%. The CS rate was 32%. Prevalences of increased WC, WHtR, WHR were 32.1%, 33.0% and 15.2%, respectively. After adjustment for birth variables, CS was associated with increased risk of adiposity when compared to vaginal delivery: 1.22 (95%CI 1.07; 1.39) for WC, 1.25 (95%CI 1.10;1.42) for WHtR, 1.45 (95%CI 1.18;1.79) for WHR, 1.36 (95%CI 1.04;1.78) for TSF, and 1.43 (95%CI 1.08;1.91) for SSF. CONCLUSION: Subjects born by CS had a higher risk for increased peripheral and central adiposity during young adult age compared to those born by vaginal delivery. The association of CS with adiposity was consistently observed for all indicators and was robust after adjustment for a variety of early life confounders.

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OBJECTIVE: This population-based birth cohort study examined whether normal weight obesity is associated with metabolic disorders in young adults in a middle-income country undergoing rapid nutrition transition. DESIGN AND METHODS: The sample involved 1,222 males and females from the 1978/79 Ribeirão Preto birth cohort, Brazil, aged 23-25 years. NWO was defined as body mass index (BMI) within the normal range (18.5-24.9 kg/m(2)) and the sum of subscapular and triceps skinfolds above the sex-specific 90th percentiles of the study sample. It was also defined as normal BMI and % BF (body fat) >23% in men and >30% in women. Insulin resistance (IR), insulin sensitivity and secretion were based on the Homeostasis Model Assessment (HOMA) model. RESULTS: In logistic models, after adjusting for age, sex and skin colour, NWO was significantly associated with Metabolic Syndrome (MS) according to the Joint Interim Statement (JIS) definition (Odds Ratio OR = 6.83; 95% Confidence Interval CI 2.84-16.47). NWO was also associated with HOMA2-IR (OR = 3.81; 95%CI 1.57-9.28), low insulin sensitivity (OR = 3.89; 95%CI 2.39-6.33), and high insulin secretion (OR = 2.17; 95%CI 1.24-3.80). Significant associations between NWO and some components of the MS were also detected: high waist circumference (OR = 8.46; 95%CI 5.09-14.04), low High Density Lipoprotein cholesterol (OR = 1.65; 95%CI 1.11-2.47) and high triglyceride levels (OR = 1.93; 95%CI 1.02-3.64). Most estimates changed little after further adjustment for early and adult life variables. CONCLUSIONS: NWO was associated with MS and IR, suggesting that clinical assessment of excess body fat in normal-BMI individuals should begin early in life even in middle-income countries.

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