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This study aimed to explore the association between pre-pregnancy BMI and longitudinal changes in inflammatory markers from the second trimester of pregnancy to 6-8 weeks postpartum in women with periodontitis. This is a secondary exploratory analysis of 68 women who took part in a feasibility clinical trial in Rio de Janeiro, Brazil. Inflammatory markers included C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-10 (IL-10), and matrix metalloproteinase-9 (MMP-9) blood concentrations at 11-22 (T0) and 30-36 gestational weeks (T1), and 6-8 weeks postpartum (T3). Longitudinal generalised linear mixed-effects models were used to identify possible associations between pre-pregnancy BMI and changes in concentrations of inflammatory markers. Pre-pregnancy excess weight (ß = 4.39; 95% CI, 2.12-6.65) was significantly associated with increased CRP levels from pregnancy to postpartum. There were no significant associations between pre-pregnancy BMI and longitudinal changes in IL-6, IL-10 and MMP-9. Our findings provide evidence that a higher pre-pregnancy BMI may lead to increases in CRP levels during pregnancy in women with periodontitis, irrespective of the severity of clinical periodontal parameters. Further studies need to investigate if predictors of changes in inflammatory markers can be used as prognostic factors for gestational outcomes.
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Interleucina-10 , Periodontite , Biomarcadores , Índice de Massa Corporal , Brasil/epidemiologia , Feminino , Humanos , Interleucina-6 , Metaloproteinase 9 da Matriz , Periodontite/epidemiologia , Período Pós-Parto , GravidezRESUMO
An amendment to this paper has been published and can be accessed via the original article.
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This study aims to assess the acceptability, adherence, and retention of a feasibility trial on milk fortification with calcium and vitamin D (Ca+VitD) and periodontal therapy (PT) among low income Brazilian pregnant women with periodontitis (IMPROVE trial). This 2 × 2 factorial feasibility trial used a mixed-methods evaluation. In total, 69 pregnant women were randomly allocated to four groups: 1. fortified sachet with Ca+VitD and milk plus early PT (throughout gestation); 2. placebo and milk plus early PT; 3. fortified sachet with Ca+VitD and milk plus late PT after childbirth; 4. placebo and milk plus late PT. Data were collected via questionnaires, field notes, participant flow logs, treatment diary, and focal group discussions. Quantitative and qualitative data were analysed using appropriate descriptive statistics and content analysis, respectively. Eligibility rate (12%) was below the target of 15%, but participation (76.1%) and recruitment rate (2 women/week) exceeded the targets. Retention rate (78.6%) was slightly below the target (80%). Adherence to the PT was significantly higher in the early treatment groups (98.8%) compared to the late treatment groups (29%). All women accepted the random allocation, and baseline groups were balanced. There was no report of adverse events. This multi-component intervention is acceptable, well-tolerated, and feasible among low-risk pregnant women in Brazil.
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Alimentos Fortificados , Leite , Periodontite , Complicações na Gravidez , Vitamina D , Vitaminas , Animais , Brasil , Carbonato de Cálcio , Estudos de Viabilidade , Feminino , Humanos , Periodontite/terapia , Gravidez , Complicações na Gravidez/terapia , Gestantes , Vitamina D/uso terapêutico , Vitaminas/uso terapêuticoRESUMO
BACKGROUND: Dietary intake may be associated with neonatal outcomes, yet little is known about the influence of prepregnancy dietary pattern (DP). OBJECTIVES: To evaluate the association between prepregnancy DPs and perinatal outcomes. DESIGN: Prospective cohort study during pregnancy (baseline between 5 and 13 gestational week and three follow-up visits: 20 to 26 gestational weeks, 30 to 36 gestational weeks, and 30 to 40 days postpartum, respectively). Diet was assessed in the first trimester using a food frequency questionnaire and having prepregnancy as the time frame. PARTICIPANTS/SETTING: Two hundred fifty-three pregnant women met the following eligibility criteria (20 to 40 years of age, 5 to 13 weeks of gestation at baseline, free of chronic [except obesity] or infectious diseases, and with a singleton pregnancy). The final sample was composed of 193 pregnant women attending a public health care center in Rio de Janeiro, Brazil, from 2009 to 2012. MAIN OUTCOME MEASURES: Type of delivery, large for gestational age (LGA), birth length (BL)>90th percentile, Apgar score<7 at 1 minute, and preterm birth. STATISTICAL ANALYSES: Reduced rank regression was used to identify prepregnancy DPs that explain the following response variables: fiber density (daily dietary fiber intake in grams, divided by total daily energy intake in kilocalories), dietary energy density, and percent energy from saturated fat. Statistical analyses included multiple logistic regression models. The following covariates were defined as confounders based on a unique Direct Acyclic Graph for each outcome: maternal age, current smoker, alcohol consumption, years of education, and first-trimester leisure physical activity. RESULTS: The prevalence of normal delivery was 56.7%. LGA occurred in 16%, BL>90th percentile in 24.3%, Apgar score<7 at 1 minute in 14.2%, and preterm birth in 9.5% of the study population. Three DPs were identified: "fast food and candies" was associated with higher odds of LGA (odds ratio [OR]=4.38, 95% CI: 1.32 to 14.48) and BL>90th percentile (OR=4.81, 95% CI: 1.77 to 13.07); "beans, bread, and fat" was inversely associated with Apgar score<7 at 1 minute (OR=0.14, 95% CI: 0.03 to 0.70); and "vegetables and dairy" was inversely associated with preterm birth (OR=0.24, 95% CI: 0.06 to 0.97). There was no association between adherence to DPs and type of delivery. CONCLUSIONS: Higher adherence to fast food and candies prepregnancy DP increased the odds of LGA birth, while a higher adherence to vegetables and dairy DP decreased the odds of preterm birth.
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Dieta , Cuidado Pré-Concepcional , Resultado da Gravidez , Adulto , Índice de Apgar , Peso ao Nascer , Brasil/epidemiologia , Doces , Estudos de Coortes , Laticínios , Parto Obstétrico/métodos , Fast Foods , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Razão de Chances , Gravidez , Nascimento Prematuro/epidemiologia , Estudos Prospectivos , VerdurasRESUMO
BACKGROUND: Periodontitis is a common oral inflammation, which is a risk factor for adverse pregnancy outcomes. Intakes of vitamin D and calcium are inversely associated with occurrence and progression of periodontitis. This study aims to assess the feasibility of a multi-component intervention, including provision of milk powder supplemented with calcium and vitamin D and periodontal therapy (PT), for improving maternal periodontal health and metabolic and inflammatory profiles of low-income Brazilian pregnant women with periodontitis. METHODS: The IMPROVE trial is a feasibility randomised controlled trial (RCT) with a 2 × 2 factorial design with a parallel process evaluation. Pregnant women with periodontitis, aged 18-40 years and with < 20 gestational weeks (n = 120) were recruited and randomly allocated into four groups: (1) fortified sachet (vitamin D and calcium) and powdered milk plus PT during pregnancy, (2) placebo sachet and powdered milk plus PT during pregnancy, (3) fortified sachet (vitamin D and calcium) and powdered milk plus PT after delivery and (4) placebo sachet and powdered milk plus PT after delivery. Dentists and participants are blinded to fortification. Acceptability of study design, recruitment strategy, random allocation, data collection procedures, recruitment rate, adherence and attrition rate will be evaluated. Data on serum levels of vitamin D, calcium and inflammatory biomarkers; clinical periodontal measurements; anthropometric measurements; and socio-demographic questionnaires are collected at baseline, third trimester and 6-8 weeks postpartum. Qualitative data are collected using focus group, for analysis of favourable factors and barriers related to study adherence. DISCUSSION: Oral health and mineral/vitamin supplementation are much overlooked in the public prenatal assistance in Brazil and of scarcity of clinical trials addressing these issues in low and middle-income countries,. To fill this gap the present study was designed to assess the feasibility of a RCT on acceptability of a multi-component intervention combining conventional periodontal treatment and consumption of milk fortified with calcium-vitamin D for improving periodontal conditions and maternal metabolic and inflammation status, among Brazilian low-income pregnant women with periodontitis. Thus, we hope that this relatively low-cost and safe multicomponent intervention can help reduce inflammation, improve maternal periodontal health and metabolic profile and consequently prevent negative gestational outcomes. TRIAL REGISTRATION: NCT, NCT03148483. Registered on May 11, 2017.
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This study aimed to evaluate the longitudinal association of vitamin D status with glycaemia, insulin, homoeostatic model assessment of insulin resistance, adiponectin and leptin. A prospective cohort with 181 healthy, pregnant Brazilian women was followed at the 5th-13th, 20th-26th and 30th-36th gestational weeks. In this cohort, 25-hydroxyvitamin D (25(OH)D) plasma concentrations were analysed using liquid chromatography-tandem MS. Vitamin D status was categorised as sufficient or insufficient using the Endocrine Society Practice Guidelines (≥75/<75 nmol/l) and the Institute of Medicine (≥50/<50 nmol/l) thresholds. Linear mixed-effect regression models were employed to evaluate the association between vitamin D status and each outcome, considering interaction terms between vitamin D status and gestational age (P<0·1). At baseline, 70·7 % of pregnant women had 25(OH)D levels <75 nmol/l and 16 % had levels <50 nmol/l. Women with sufficient vitamin D status at baseline, using both thresholds, presented lower glycaemia than those with insufficient 25(OH)D. Pregnant women with 25(OH)D concentrations <75 nmol/l showed lower insulin (ß=-0·12; 95 % CI -0·251, 0·009; P=0·069) and adiponectin (ß=-0·070; 95 % CI -0·150, 0·010; P=0·085) concentrations throughout pregnancy than those with 25(OH)D levels ≥75 nmol/l. Pregnant women with 25(OH)D <50 nmol/l at baseline presented significantly higher leptin concentrations than those with 25(OH)D levels ≥50 nmol/l (ß=-0·253; 95 % CI -0·044, 0·550; P=0·095). The baseline status of vitamin D influences the biomarkers involved in glucose metabolism. Vitamin D-sufficient women at baseline had higher increases in insulin and adiponectin changes throughout gestation than those who were insufficient.
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Adipocinas/sangue , Glicemia/metabolismo , Vitamina D/análogos & derivados , Adiponectina/sangue , Adulto , Brasil , Estudos de Coortes , Diabetes Gestacional/sangue , Diabetes Gestacional/prevenção & controle , Dieta , Feminino , Idade Gestacional , Humanos , Insulina/sangue , Resistência à Insulina , Leptina/sangue , Gravidez , Complicações na Gravidez/sangue , Estudos Prospectivos , Vitamina D/sangue , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/complicaçõesRESUMO
PURPOSE: To characterize the physiological changes in 25-hydroxyvitamin D [25(OH)D] and 1,25-dihydroxyvitamin D [1,25(OH)2D] throughout pregnancy. METHODS: Prospective cohort of 229 apparently healthy pregnant women followed at 5th-13th, 20th-26th, and 30th-36th gestational weeks. 25(OH)D and 1,25(OH)2D concentrations were measured by LC-MS/MS. Statistical analyses included longitudinal linear mixed-effects models adjusted for parity, season, education, self-reported skin color, and pre-pregnancy BMI. Vitamin D status was defined based on 25(OH)D concentrations according to the Endocrine Society Practice Guideline and Institute of Medicine (IOM) for adults. RESULTS: The prevalence of 25(OH)D <75 nmol/L was 70.4, 41.0, and 33.9%; the prevalence of 25(OH)D <50 nmol/L was 16.1, 11.2, and 10.2%; and the prevalence of 25(OH)D <30 nmol/L was 2, 0, and 0.6%, at the first, second, and third trimesters, respectively. Unadjusted analysis showed an increase in 25(OH)D (ß = 0.869; 95% CI 0.723-1.014; P < 0.001) and 1,25(OH)2D (ß = 3.878; 95% CI 3.136-4.620; P < 0.001) throughout pregnancy. Multiple adjusted analyses showed that women who started the study in winter (P < 0.001), spring (P < 0.001), or autumn (P = 0.028) presented a longitudinal increase in 25(OH)D concentrations, while women that started during summer did not. Increase of 1,25(OH)2D concentrations over time in women with insufficient vitamin D (50-75 nmol/L) at baseline was higher compared to women with sufficient vitamin D (≥75 nmol/L) (P = 0.006). CONCLUSIONS: The prevalence of vitamin D inadequacy varied significantly according to the adopted criteria. There was a seasonal variation of 25(OH)D during pregnancy. The women with insufficient vitamin D status present greater longitudinal increases in the concentrations of 1,25(OH)2D in comparison to women with sufficiency.
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25-Hidroxivitamina D 2/sangue , Calcifediol/sangue , Calcitriol/sangue , Ergocalciferóis/sangue , Fenômenos Fisiológicos da Nutrição Materna , Complicações na Gravidez/sangue , Deficiência de Vitamina D/sangue , Adulto , Brasil/epidemiologia , Estudos de Coortes , Dieta/efeitos adversos , Suplementos Nutricionais , Feminino , Humanos , Estudos Longitudinais , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/etiologia , Complicações na Gravidez/prevenção & controle , Prevalência , Estudos Prospectivos , Estações do Ano , Autorrelato , Vitamina D/administração & dosagem , Vitamina D/uso terapêutico , Deficiência de Vitamina D/epidemiologia , Deficiência de Vitamina D/etiologia , Deficiência de Vitamina D/prevenção & controle , Adulto JovemRESUMO
OBJECTIVE: To estimate food intake changes from pre-conception to gestational period according to the degree of food processing. METHODS: Prospective cohort conducted in a public health care center in Rio de Janeiro with Brazilian pregnant women (n = 189). A food frequency questionnaire was applied at the first (5(th)-13(th)) and third (30(th)-36(th)) gestational trimesters. The food items were classified according to characteristics of food processing in four groups: unprocessed/minimally processed foods; sugar/fat; processed foods and ultra-processed foods. The variation of food intake according to the degree of processing between the pre-conception and gestational period was compared using paired Student's t-test. Linear regression models were performed to estimate the association of mother's characteristics on the variation of food group contribution to the total energy intake between periods. RESULTS: Total energy intake was 2415 (SD = 813) in the pre-conception and 2379 (750) kcal in the gestational period. We excluded women who had implausible total energy intake (<600 and >6000 kcal/day). The contribution of unprocessed/minimally processed food group to total energy intake during pregnancy when compared to the pre-conception period was higher [50.5 (14.1) vs. 48.8 (12.4), p-value = 0.048], while the caloric share of ultra-processed food group was lower [41.3 (14.6) vs. 43.1 (12.5), p-value = 0.032]. We observed a negative association of age (p-value = 0.009) and a positive association of pre-pregnancy BMI (p-value = 0.060) with the variation of ultra-processed food intake. CONCLUSIONS: Ultra-processed food intake decreased, while minimally/unprocessed food intake slightly increased from the pre-conception to gestational period. These results indicate potential for a larger improvement in the women's diet quality and that nutritional counseling interventions in pregnant women are still needed.
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Dieta Saudável , Manipulação de Alimentos , Fenômenos Fisiológicos da Nutrição Materna , Cooperação do Paciente , Saúde da População Urbana , Adulto , Fatores Etários , Índice de Massa Corporal , Brasil , Estudos de Coortes , Dieta Saudável/etnologia , Ingestão de Energia/etnologia , Feminino , Humanos , Fenômenos Fisiológicos da Nutrição Materna/etnologia , Sobrepeso/etnologia , Sobrepeso/fisiopatologia , Cooperação do Paciente/etnologia , Gravidez , Complicações na Gravidez/etnologia , Complicações na Gravidez/fisiopatologia , Primeiro Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Estudos Prospectivos , Autorrelato , Magreza/etnologia , Magreza/fisiopatologia , Saúde da População Urbana/etnologia , Adulto JovemRESUMO
O objetivo desta revisão foi apresentar e discutir a influência do exercício físico nas concentrações sanguíneas de adiponectina e a associação com a sensibilidade insulínica. Estudos realizados nos últimos 10 anos mostram que o exercício agudo, de intensidade alta, provoca redução nas concentrações sanguíneas de adiponectina, sem alterar as concentrações de insulina. Porém, exercícios agudos de intensidade moderada não alteram as concentrações sanguíneas de adiponectina, apesar de proporcionar melhoria na sensibilidade insulínica. O exercício crônico, por sua vez, aumenta os níveis sanguíneos de adiponectina, melhora a sensibilidade insulínica, mas altera a composição corporal em indivíduos obesos. Em indivíduos eutróficos, todavia, os níveis de adiponectina não são afetados, apesar dos benefícios do exercício crônico para a composição corporal e sensibilidade insulínica.
The aim of this review was to present and discuss the influence of exercise on blood concentrations of adiponectin and its association with insulin sensitivity. Studies conducted over the past 10 years showed that acute exercise of high intensity causes a decrease in blood adiponectin concentrations without changing insulin concentrations. However, acute exercise of moderate intensity does not alter the blood concentrations of adiponectin, though it improves insulin sensitivity. Chronic exercise, nevertheless, increases blood levels of adiponectin, improves insulin sensitivity but alters body composition in obese individuals. In normal weight individuals, however, the blood levels of adiponectin are not affected, despite the benefits of chronic exercise to body composition and insulin sensitivity.
El objetivo de esta revisión fue presentar y discutir la influencia del ejercicio sobre las concentraciones séricas de adiponectina y su asociación con sensibilidad a la insulina. Los estudios realizados en los últimos 10 años muestran que el ejercicio agudo de alta intensidad causa una reducción en las concentraciones sanguíneas de adiponectina, sin cambiar las concentraciones de insulina. Sin embargo, el ejercicio agudo de intensidad moderada no altera las concentraciones sanguíneas de adiponectina, aunque proporciona sensibilidad a la insulina. Ejercicio crónico, a su vez, aumenta los niveles sanguíneos de adiponectina mejora la sensibilidad a la insulina, sino que altera la composición corporal en sujetos obesos. En individuos normales, sin embargo, los niveles de adiponectina no se ven afectados, a pesar de los beneficios del ejercicio crónica de la composición corporal y la sensibilidad a la insulina.
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A prevalência da obesidade vem aumentando consideravelmente no mundo, afetando todos os níveis sociais, sendo considerada atualmente uma epidemia global. O objetivo deste estudo foi verificar a ocorrência de sobrepeso e obesidade de crianças de 7 a 10 anos que estudam em uma escola da rede pública da cidade de Ubá-MG. Foi realizada uma pesquisa observacional de corte transversal, no qual foi verificada a ocorrência de sobrepeso e obesidade em crianças de uma escola da rede pública de Ubá-MG. A amostra foi composta por 126 crianças de 7 a 10 anos, sendo que 53 eram meninos e 73 eram meninas. Verificou-se que o índice de massa corporal (IMC) dos meninos com faixa etária entre 7 e 10 anos foi significativamente superior ao das meninas (18,14 ± 3,24 vs.16,48 ± 3,87 kg/m2, P=0,026). Em relação à comparação do IMC de meninos e meninas de 7 anos, observou-se também que os meninos apresentaram este valor superior ao das meninas (18,05 ± 3,8 vs. 14,51 ± 3,54 kg/m2, P=0,011). Concluiu-se que a ocorrência de sobrepeso e obesidade na escola estudada foi expressiva diante de outros estudos nacionais. Verificou-se, ainda, uma maior ocorrência de sobrepeso e obesidade entre os meninos em comparação com as meninas. A partir desses resultados, observa-se a necessidade de intervenção imediata na escola por meio do incentivo à prática de atividades físicas e alimentação equilibrada.