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Background and objective: Imprinted genes are important for the offspring development. To assess the relationship between obesity-related H19DMR methylation and H19 and IGF2 gene expression and offspring growth and body composition. Methods: Thirty-nine overweight/obese and 25 normal weight pregnant women were selected from the "Araraquara Cohort Study" according to their pre-pregnancy BMI. Fetal growth and body composition and newborn growth were assessed, respectively, by ultrasound and anthropometry. The methylation of H19DMR in maternal blood, cord blood, maternal decidua and placental villi tissues was evaluated by methylation-sensitive restriction endonuclease qPCR, and H19 and IGF2 expression by relative real-time PCR quantification. Multiple linear regression models explored the associations of DNA methylation and gene expression with maternal, fetal, and newborn parameters. Results: H19DMR was less methylated in maternal blood of the overweight/obese group. There were associations of H19DMR methylation in cord blood with centiles of fetal biparietal diameter (BPD) and abdominal subcutaneous fat thickness and newborn head circumference (HC); H19DMR methylation in maternal decidua with fetal occipitofrontal diameter (OFD), HC, and length; H19DMR methylation in placental villi with fetal OFD, HC and abdominal subcutaneous fat thickness and with newborn HC. H19 expression in maternal decidua was associated with fetal BPD and femur length centiles and in placental villi with fetal OFD and subcutaneous arm fat. IGF2 expression in maternal decidua was associated with fetal BPD and in placental villi with fetal OFD. Conclusion: To our knowledge, this is the first study to demonstrate associations of imprinted genes variations at the maternal-fetal interface of the placenta and in cord blood with fetal body composition, supporting the involvement of epigenetic mechanisms in offspring growth and body composition.

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Estudo de delineamento transversal que teve como objetivo descrever o cuidado pré-hospitalar a pacientes hospitalizados com úlcera do pé diabético. Entre junho e dezembro de 2019, 159 pacientes adultos e idosos internados em hospital geral do interior do nordeste1 responderam a um formulário aplicado pela equipe de pesquisa. Questões referentes aos cuidados pré-hospitalares e ao autocuidado, bem como informações sociodemográficas foram coletadas. Medidas de associação foram calculadas através da determinação da razão de chances. As estimativas da associação foram calculadas por pontos e por intervalos com 95% de confiança. Apesar de a maioria dos pacientes relatarem acesso adequado aos itens pesquisados, ficou evidente que o acompanhamento prévio à hospitalização carece de melhoria1. Houve associação positiva entre frequentar regularmente os serviços de saúde (RC 4,2; IC 2,1 ­ 8,5), hospitalização anterior (RC 7,1; IC 2,6 ­ 19,2), hospitalização anterior pelo diabetes (RC 2,3; IC 1,2 ­ 4,5) e ter realizado exames dos pés nos últimos seis meses (RC 2,7; IC 1,4 ­ 5,2) com ter recebido orientações em relação aos cuidados com os pés. Conclui-se que a maior parte dos hospitalizados por úlcera do pé diabético não foi corretamente acompanhada antes da sua hospitalização. Sugere-se que uma qualificação da assistência ao paciente diabético na atenção básica contribua para a redução das hospitalizações por complicações da doença.

Cross-sectional study that aimed to describe pre-hospital care for hospitalized patients with diabetic foot ulcers. From June to December 2019, 159 adult and elderly patients admitted in a general hospital in the northeastern interior were interviewed. Questions regarding pre-hospital care, self-care, as well as sociodemographic information were collected. Even though most patients report adequate access to the researched items, it was evident that the pre-hospitalization follow-up needs improvement. There was a positive association between regularly attending health services (OR 4,2; CI 2,1 ­ 8,5), previous hospitalizations (OR 7,1; CI 2,6 ­ 19,2), previous hospitalization for diabetes (OR 2,3; CI 1,2 ­ 4,5) and performing foot examinations in the last six months meses (OR 2,7; CI 1,4 ­ 5,2) with receiving guidance regarding foot care. It is concluded that most of those hospitalized for diabetic foot ulcers were not properly followed up before their hospitalization. It is suggested that a qualification of assistance to diabetic patients in primary care contributes to the reduction of hospitalizations due to complications of the disease.

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Abstract Objective To investigate associations of maternal and cord blood cytokine patterns with newborn size and body composition. Methods This cross-sectional study involved 70 pregnant women and their healthy newborns selected from the "Araraquara Cohort Study". Newborn anthropometric measurements were recorded at birth. Body composition was evaluated by air displacement plethysmography. Maternal blood samples were collected from pregnant women between 30 and 36 weeks of gestation, and umbilical cord blood samples were collected immediately after placenta discharge. The concentrations of the cytokines were determined in plasma by ELISA. Multiple linear regression models were used to assess associations between maternal and cord blood cytokine concentrations and newborn anthropometry and body composition measurements. Results Maternal plasma TGF-β1 concentration was inversely associated with newborn weight (β= -43.0; p= 0.012), length (β= -0.16, p= 0.028), head circumference (β= -0.13, p= 0.004), ponderal index (β= -0.32, p= 0.011) and fat-free mass (β= -0.05, p= 0.005). However, the association persisted just for head circumference (β= -0.26; p= 0.030) and ponderal index (β= - 0.28; p= 0.028), after adjusting for pre-gestational BMI, gestational weight gain, gestational age, hours after delivery, newborn sex, smoking and alcohol consumption. Conclusions Maternal plasma TGF-β1 concentration may be involved in the regulation of newborn size, mainly head circumference and ponderal index. Further cohort studies are necessary to investigate the role of TGF-β1 in different trimesters of pregnancy and its effect during the early stages of fetal development.

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OBJECTIVE: To investigate associations of maternal and cord blood cytokine patterns with newborn size and body composition. METHODS: This cross-sectional study involved 70 pregnant women and their healthy newborns selected from the "Araraquara Cohort Study". Newborn anthropometric measurements were recorded at birth. Body composition was evaluated by air displacement plethysmography. Maternal blood samples were collected from pregnant women between 30 and 36 weeks of gestation, and umbilical cord blood samples were collected immediately after placenta discharge. The concentrations of the cytokines were determined in plasma by ELISA. Multiple linear regression models were used to assess associations between maternal and cord blood cytokine concentrations and newborn anthropometry and body composition measurements. RESULTS: Maternal plasma TGF-ß1 concentration was inversely associated with newborn weight (ß = -43.0; p = 0.012), length (ß = -0.16, p = 0.028), head circumference (ß = -0.13, p = 0.004), ponderal index (ß = -0.32, p = 0.011) and fat-free mass (ß = -0.05, p = 0.005). However, the association persisted just for head circumference (ß = -0.26; p = 0.030) and ponderal index (ß = - 0.28; p = 0.028), after adjusting for pre-gestational BMI, gestational weight gain, gestational age, hours after delivery, newborn sex, smoking and alcohol consumption. CONCLUSIONS: Maternal plasma TGF-ß1 concentration may be involved in the regulation of newborn size, mainly head circumference and ponderal index. Further cohort studies are necessary to investigate the role of TGF-ß1 in different trimesters of pregnancy and its effect during the early stages of fetal development.

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Introdução: As alterações hormonais, sobretudo resistência a glicocorticoides, que ocorrem no período gestacional, podem estar envolvidas na adiposidade do concepto, mediante mecanismos inflamatórios desencadeados pelo estresse e distresse (depressão e ansiedade) que envolvem hiperatividade do eixo hipotálamo-pituitária-adrenal (HPA). Objetivo: Avaliar a relação entre fatores psicológicos e perfil glicêmico maternos em 3 períodos da gestação (<= 19, 20-29 e 30-39 semanas) e adiposidade do concepto nos períodos fetal e neonatal. Métodos: Trata-se de estudo epidemiológico, coorte prospectivo, desenvolvido em Unidades de Saúde da Rede de Atenção Básica de Araraquara, São Paulo, e de outros 7 municípios da região, o Serviço Especial de Saúde de Araraquara e Maternidade Municipal "Gota de Leite", que incluiu respectivamente 768, 745 e 681 mulheres nos 3 períodos da gestação, até nascimento dos conceptos. O estresse e distresse maternos foram avaliados pelos seguintes instrumentos: General Health Questionnaire - Edinburgh Postnatal Depression Scale - State-Trait Anxiety Inventory - Perceived Stress Scale. O perfil glicêmico foi avaliado por glicemia, insulina e hemoglobina glicada, respectivamente, pelos métodos ensaio UV enzimático de referência com hexoquinase, método de quimioluminescência e cromatografia líquida de alta eficiência, calculando-se o índice HOMA-IR. A adiposidade do feto foi avaliada por ultrassonografia e a do neonato por pletismografia. A análise estatística envolveu regressão linear múltipla de efeitos mistos, considerando o aspecto longitudinal do estudo. O nível de significância adotado em todos os testes foi p <= 0,05. Resultados: Houve associação da hemoglobina glicada materna com o tecido adiposo subcutâneo da coxa do feto no período de 30-39 semanas da gestação. Para cada 1 mg/dL de hemoglobina glicada houve aumento de 12,91 cm2 no tecido adiposo da coxa (p < 0,001). A glicemia materna foi associada com o percentual de massa gorda do neonato. Para cada 1 mg/dL na glicemia houve aumento de 0,23% na massa gorda do neonato (p< 0,003). Conclusão: O perfil glicêmico materno foi importante preditor para o aumento de adiposidade do feto e neonato. No entanto, os resultados deste estudo não permitiram apoiar a hipótese de que o estresse e distresse maternos durante a gestação se relacionam a adiposidade da criança nas fases fetal e neonatal. Pode ser que a associação exista para outro tecido adiposo - o visceral - mais comumente envolvido nos distúrbios metabólicos do adulto.

Introduction: Hormonal changes, especially resistance to glucocorticoids, which occur during pregnancy, may be involved in the conceptus adiposity through inflammatory mechanisms triggered by stress and distress (depression and anxiety) involving hyperactivity of the hypothalamic-pituitary-adrenal axis (HPA). Objective: To evaluate the relationship between maternal psychological factors and glycemic profile in 3 gestational periods (<= 19, 20-29 and 30-39 weeks) and concept adiposity in the fetal and neonatal periods. Methods: This is an epidemiological study, prospective cohort, developed in Health Units of the Primary Care Network of Araraquara, São Paulo, and in 7 other municipalities in the region, the Special Health Service of Araraquara and Municipal Maternity "Gota de Leite". Which included 768, 745 and 681 women respectively in the 3 gestational periods, until the birth of the child. Maternal stress and distress were assessed by the following instruments: General Health Questionnaire - Edinburgh Postnatal Depression Scale - State-Trait Anxiety Inventory - Perceived Stress Scale. The glycemic profile was evaluated by glycemia, insulin and glycated hemoglobin, respectively, by the reference enzymatic UV assay with hexokinase assay, chemiluminescence method and high performance liquid chromatography, calculating the HOMA-IR index. The adiposity of the fetus was evaluated by ultrasound and that of the newborn by plethysmography. Statistical analysis involved multiple linear mixed effects regression considering the longitudinal aspect of the study. The significance level adopted in all tests was p <= 0.05. Results: There was an association of maternal glycated hemoglobin with subcutaneous adipose tissue of the thigh of the fetus within 30-39 weeks of gestation. For each 1 mg/dL glycated hemoglobin there was an increase of 12.91cm2 in the thigh adipose tissue (p<0.001). Maternal glycemia was associated with the newborn's fat mass percentage. For each 1 mg/dL in blood glucose there was a 0.23% increase in neonate fat mass (p<0.003). Conclusion: The maternal glycemic profile was an important predictor for increased adiposity of the fetus and neonate. However, the results of this study did not support the hypothesis that maternal stress and distress during pregnancy are related to the child's adiposity in the fetal and neonatal phases. It may be that the association exists for another adipose tissue - visceral tissue - most commonly involved in adult metabolic disorders.

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OBJECTIVE: To determine the relationship between metabolic syndrome (MS) and socioeconomic level, life style, health status, family history of morbidity, and residence areas. METHODS: This is a cross-sectional cohort study. The random sample consisted of users of two primary health care units (Unidades Básicas de Saúde--UBSs) in the city of São Paulo--Jardim Comercial (UBS1), and Jardim Germânia (UBS2), a total of 452 subjects. The NCEP ATP IIIcriterion was used to diagnose MS. Weight, height, abdominal and hip circumferences were measured for the anthropometric evaluation. A general questionnaire was used to obtain sociodemographic and socioeconomic data; family history; medical history; behavioral habits such as smoking, drinking, and physical activity. Multivariate logistic regression was used to establish the association between explanatory variables of interest and MS. RESULTS: At UBS1, MS percentage was 56.1%; at UBS2, 34.0%. There was a direct and significant association between MS and age, female gender, race, smoking, drinking, physical activity level, stress, and family history of heart disease and diabetes mellitus. Education level showed an inverse association. Subjects living in a lower socioeconomic level neighborhood had a higher MS risk. CONCLUSION: The results suggest that the morbidities that compose MS are a serious publichealth problem in that population.

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OBJETIVO: Determinar a relação da síndrome metabólica (SM) com o nível socioeconómico, hábitos comportamentais, condições de saúde, antecedentes familiares de morbidades e áreas de residência. MÉTODOS: Trata-se de um estudo de corte transversal. A amostra aleatória foi constituída por usuários de duas Unidades Básicas de Saúde da cidade de São Paulo - Jardim Comercial (UBS1) e Jardim Germânia (UBS2) -, totalizando 452. Para o diagnóstico de SM utilizou-se o critério do Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (NCEP-ATP III). Na avaliação antropométrica foram aferidas medidas de peso, estatura, circunferências abdominal e do quadril. Foi utilizado questionário geral para obtenção de dados sociodemográficos, socioeconómicos, antecedentes familiares e pessoais de morbidades, hábitos comportamentais como tabagismo, etilismo e nível de atividade física. Foi estabelecida associação entre as variáveis explicativas de interesse e SM, empregando-se a regressão logística multivariada. RESULTADOS: Na UBS1, o percentual de SM foi de 56,1 por cento e na UBS2, de 34,0 por cento. Houve associação direta e significativa entre SM e idade, sexo feminino, cor, tabagismo, etilismo, nível de atividade física, estresse e antecedentes familiares de doença cardíaca e de diabetes mellitus. A escolaridade apresentou associação inversa: morar no bairro de menor nível socioeconómico aumentou a chance de SM. CONCLUSÃO: Os resultados sugerem que as morbidades que compõem a SM são um grave problema de saúde pública nessa população.

OBJECTIVE: To determine the relationship between metabolic syndrome (MS) and socioeconomiclevel, life style, health status, family history of morbidity, and residence areas. METHODS: This is a cross-sectional cohort study. The random sample consisted of users of two primary health care units (Unidades Básicas de Saúde - UBSs) in the city of São Paulo - Jardim Comercial (UBS1), and Jardim Germânia (UBS2), a total of 452 subjects. The NCEP ATP IIIcriterion was used to diagnose MS. Weight, height, abdominal and hip circumferences were measured for the anthropometric evaluation. A general questionnaire was used to obtain sociodemographicand socioeconomic data; family history; medical history; behavioral habitssuch as smoking, drinking, and physical activity. Multivariate logistic regression was used to establish the association between explanatory variables of interest and MS. RESULTS: At UBS1, MS percentage was 56.1 percent; at UBS2, 34.0 percent. There was a direct and significant association between MS and age, female gender, race, smoking, drinking, physical activity level, stress, and family history of heart disease and diabetes mellitus. Education level showed an inverse association. Subjects living in a lower socioeconomic level neighborhood had a higher MS risk. CONCLUSION: The results suggest that the morbidities that compose MS are a serious publichealth problem in that population.

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Introdução: Entre os principais fatores que contribuem para o surgimento da Síndrome metabólica (SM) estão a predisposição genética, inatividade física, distúrbios da homeostase da glicose, hipertensão arterial, obesidade centralizada e dislipidemias. Por outro lado, o stress tem sido apontado como fator de risco para a obesidade centralizada e para a hipertensão arterial. A SM e o stress tem sido pouco avaliados em estudos populacionais. Objetivo: Verificar a prevalência de síndrome metabólica e do stress e a relação de ambos com o nível socioeconômico, hábitos comportamentais, condições de saúde e áreas de residência em usuários de Unidades Básicas de Saúde da zona sul de São Paulo. Métodos: Trata-se de um estudo de corte transversal, cuja amostra aleatória foi constituída por usuários, maiores de 20 anos, de Unidades Básicas de Saúde, situadas no Jardim Germânia, 187 usuários (com predominância de classe média) e no Jardim Comercial, 265 usuários (com predominância de classe pobre), totalizando 452 usuários. Os indivíduos que concordaram em participar do estudo assinaram o Termo de Consentimento Livre e Esclarecido. Para detectar a presença de stress foi utilizado o Inventário de Sintomas de Stress para Adultos de Lipp (ISSL). Para o diagnóstico da SM utilizou-se o critério proposto pela International Diabetes Federation (circunferência da cintura com valores étnicos especificados, sendo para os sul americanos, cintura abdominal 80 cm para mulheres e 90 cm para homens), mais dois quaisquer dos quatro seguintes critérios: glicemia de jejum 100 mg/dL; triglicerídeos 150 mg/dL; colesterol HDL 88 cm e glicemia de jejum 110 mg/dL. A avaliação laboratorial e clínica constou dos seguintes exames: glicemia de jejum, colesterol total e frações, triglicerídeos e mensuração da pressão arterial. Na avaliação antropométrica foram aferidas medidas de peso, estatura, circunferências abdominal e do quadril. Foi utilizado questionário geral para obtenção de dados sociodemo...

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