Hipertensão arterial sistêmica em área urbana no sul do Brasil: prevalência e fatores de risco

Knowledge of the prevalence of systemic arterial hypertension and its risk factors can be of great value to health policy and planning activities. A cross-sectional study was carried out in Pelotas, southern Brazil, for the purpose of discovering the prevalence of hypertension and selected risk factors. A representative sample of 1,675 adults were studied. The prevalence of hypertension was of 19.8%. The following variables were significantly associated with hypertension after adjustment for confounding variables: black race, advanced age, low educational level, paternal and maternal history of hypertension, use of additional salt on cooked foods, and obesity. The strong association between social class and hypertension found by bivariant analysis was reduced in the multivariate analysis after adjustment for age, sex and race.O conhecimento da prevalência de hipertensão arterial sistêmica (HAS) e de seus fatores de risco pode ser de grande valor para orientar o planejamento das políticas de saúde. Para identificar a prevalência de HAS, e sua associação com fatores de risco, foi realizado estudo transversal de base populacional na cidade de Pelotas, no sul do Brasil, onde foram examinadas 1.657 pessoas. A prevalência de HAS foi de 19,8%. Os fatores de risco significativamente associados, após controle para fatores de confusão, foram: cor preta, idade avançada, baixa escolaridade, história paterna e materna de HAS, uso de sal adicional à mesa e obesidade. A classe social, que mostrou forte associação com HAS na análise bivariada, teve seu efeito reduzido na análise multivariada, quando houve ajuste por sexo, cor e idade

Causas de mortalidade perinatal em Pelotas, RS (Brasil): utilização de uma classificação simplificada

The causes of perinatal mortality among the 7,392 hospital births which occurred in Pelotas, RS, Brazil, during 1982, were analysed using the simplified classification described by Wigglesworth. The main advantage of this classification is that it can be used even in places where post-mortems are seldom performed. The perinatal deaths were classified into five groups: a) macerated fetuses without malformations, b) congenital malformations, c) immaturity, d) asphyxia and e) other causes of death. The perinatal mortality rate was 33.7 per 1,000 births, nearly equally divided between fetal and early neonatal deaths, and 8.8% of the babies were of low birthweight. Thirty-six percent of the perinatal deaths were antepartum stillbirths, and 60% of these weighed 2,000 g. or more. The second most important cause was immaturity, which accounted for 31% of the deaths. In this latter group 21% weighed 2,000 g or more at birth. These findings, as well as the high birthweight-specific perinatal mortality rates, strongly suggest that there are deficiencies in the antenatal and delivery care in Pelotas that need to be promptly corrected. Policies that should be implemented by health planners include: decentralization of antenatal care clinics; utilization in these clinics of the "at-risk concept" to identify women at high risk of delivering low birthweight babies, efforts to increase community participation and home visits in order to attract those pregnant women who do not attend the clinics. In addition, it is mandatory that well trained doctors (obstetricians and paediatricians) should to be available 24 hours a day at the maternity hospitals to assist mothers and babies identified as at high risk.O coeficiente de mortalidade perinatal dos 7.392 nascimentos ocorridos nos hospitais de Pelotas, RS, (Brasil) no ano de 1982, foi de 33,7 por 1.000, e 8,8% dos recém-nascidos pesaram menos de 2.500 g. As causas de mortalidade perinatal foram analisadas utilizando-se a classificação simplifícada proposta por Wigglesworth. Trinta e seis por cento dos óbitos perinatais ocorreram antes do início do trabalho de parto (natimortos antepartum), e destes, 60% pesaram mais de 2.000 g. A segunda causa mais importante de morte foi imaturidade, com 31% dos óbitos. Neste grupo, 21% pesaram mais de 2.000 g. Estes achados, assim como as altas taxas de mortalidade perinatal para grupos específicos de peso ao nascer, sugerem que algumas falhas estão ocorrendo no atendimento de saúde da população materno-infantil em Pelotas, tanto em clínicas de pré-natal como no atendimento do parto

Breastfeeding effects on DNA methylation in the offspring::A systematic literature review

BACKGROUND:Breastfeeding benefits both infants and mothers. Recent research shows long-term health and human capital benefits among individuals who were breastfed. Epigenetic mechanisms have been suggested as potential mediators of the effects of early-life exposures on later health outcomes. We reviewed the literature on the potential effects of breastfeeding on DNA methylation. METHODS:Studies reporting original results and evaluating DNA methylation differences according to breastfeeding/breast milk groups (e.g., ever vs. never comparisons, different categories of breastfeeding duration, etc) were eligible. Six databases were searched simultaneously using Ovid, and the resulting studies were evaluated independently by two reviewers. RESULTS:Seven eligible studies were identified. Five were conducted in humans. Studies were heterogeneous regarding sample selection, age, target methylation regions, methylation measurement and breastfeeding categorisation. Collectively, the studies suggest that breastfeeding might be negatively associated with promoter methylation of LEP (which encodes an anorexigenic hormone), CDKN2A (involved in tumour suppression) and Slc2a4 genes (which encodes an insulin-related glucose transporter) and positively with promoter methylation of the Nyp (which encodes an orexigenic neuropeptide) gene, as well as influence global methylation patterns and modulate epigenetic effects of some genetic variants. CONCLUSIONS:The findings from our systematic review are far from conclusive due to the small number of studies and their inherent limitations. Further studies are required to understand the actual potential role of epigenetics in the associations of breastfeeding with later health outcomes. Suggestions for future investigations, focusing on epigenome-wide association studies, are provided

Effect modification of FADS2 polymorphisms on the association between breastfeeding and intelligence:protocol for a collaborative meta-analysis

INTRODUCTION: Evidence from observational studies and randomised controlled trials suggests that breastfeeding is positively associated with IQ, possibly because breast milk is a source of long-chain polyunsaturated fatty acids. Different studies have detected gene-breastfeeding interactions involving FADS2 variants and intelligence. However, findings are inconsistent regarding the direction of such effect modification. METHODS/DESIGN: To clarify how FADS2 and breastfeeding interact in their association with IQ, we are conducting a consortium-based meta-analysis of independent studies. Results produced by each individual study using standardised analysis scripts and harmonised data will be used. Inclusion criteria: breastfeeding, IQ and either rs174575 or rs1535 polymorphisms available; and being of European ancestry. Exclusion criteria: twin studies; only poorly imputed genetic data available; or unavailability of proper ethics approval. Studies will be invited based on being known to have at least some of the required data, or suggested by participating studies as potentially eligible. This inclusive approach will favour achieving a larger sample size and be less prone to publication bias. DISCUSSION: Improving current understanding of FADS2-breastfeeding interaction may provide important biological insights regarding the importance of long-chain polyunsaturated fatty acids for the breastfeeding-IQ association. This meta-analysis will help to improve such knowledge by replicating earlier studies, conducting additional analysis and evaluating different sources of heterogeneity. Publishing this protocol will minimise the possibility of bias due to post hoc changes to the analysis protocol

Association of lactase persistence genotype with milk consumption, obesity and blood pressure:a Mendelian randomization study in the 1982 Pelotas (Brazil) Birth Cohort with a systematic review and meta-analysis.

Background: Milk intake has been associated with lower blood pressure (BP) in observational studies, and randomized controlled trials suggested that milk-derived tripeptides have BP-lowering effects. Milk intake has also been associated with body mass index (BMI). Nevertheless, it is unclear whether increasing milk consumption would reduce BP in the general population. Methods: We investigated the association of milk intake with obesity and BP using genetically-defined lactase persistence (LP) based on the rs4988235 polymorphism in a Mendelian randomization design in the 1982 Pelotas (Southern Brazil) Birth Cohort. These results were combined with published reports identified through a systematic review using meta-analysis. Results: In the 1982 Pelotas Birth Cohort, milk intake was 42 [95% confidence interval (CI): 18; 67) ml/day higher in LP individuals. In conventional observational analysis, each 1-dl/day increase in milk intake was associated with −0.26 (95% CI: −0.33; −0.19) kg/m(2) in BMI and −0.31 (95% CI: −0.46; −0.16) and -0.35 (95% CI: −0.46; −0.23) mmHg in systolic and diastolic BP, respectively. These results were not corroborated when analysing LP status, but confidence intervals were large. In random effects meta-analysis, LP individuals presented higher BMI [0.17 (95% CI: 0.07; 0.27) kg/m(2)] and higher odds of overweight-obesity [1.09 (95% CI: 1.02; 1.17)]. There were no reliable associations for BP. Conclusions: Our study supports that LP is positively associated with obesity, suggesting that the negative association of milk intake with obesity is likely due to limitations of conventional observational studies. Our findings also do not support that increased milk intake leads to lower BP

"Registries are not only a tool for data collection, they are for action": Cancer registration and gaps in data for health equity in six population-based registries in India.

In India, population-based cancer registries (PBCRs) cover less than 15% of the urban and 1% of the rural population. Our study examines practices of registration in PBCRs in India to understand efforts to include rural populations in registries and efforts to measure social inequalities in cancer incidence. We selected a purposive sample of six PBCRs in Maharashtra, Kerala, Punjab and Mizoram and conducted semistructured interviews with staff to understand approaches and challenges to cancer registration, and the sociodemographic information collected by PBCRs. We also conducted a review of peer-reviewed literature utilizing data from PBCRs in India. Findings show that in a context of poor access to cancer diagnosis and treatment and weak death registration, PBCRs have developed additional approaches to cancer registration, including conducting village and home visits to interview cancer patients in rural areas. Challenges included PBCR funding and staff retention, abstraction of data in medical records, address verification and responding to cancer stigma and patient migration. Most PBCRs published estimates of cancer outcomes disaggregated by age, sex and geography. Data on education, marital status, mother tongue and religion were collected, but rarely reported. Two PBCRs collected information on income and occupation and none collected information on caste. Most peer-reviewed studies using PBCR data did not publish estimates of social inequalities in cancer outcomes. Results indicate that collecting and reporting sociodemographic data collected by PBCRs is feasible. Improved PBCR coverage and data will enable India's cancer prevention and control programs to be guided by data on cancer inequities

Association between breastfeeding and DNA methylation over the life course:findings from the Avon Longitudinal Study of Parents and Children (ALSPAC)

Background: Breastfeeding is associated with short and long-term health benefits. Long-term effects might be mediated by epigenetic mechanisms, yet the literature on this topic is scarce. We performed the first epigenome-wide association study of infant feeding, comparing breastfed vs non-breastfed children. We measured DNA methylation in children from peripheral blood collected in childhood (age 7 years, N = 640) and adolescence (age 15–17 years, N = 709) within the Accessible Resource for Integrated Epigenomic Studies (ARIES) project, part of the larger Avon Longitudinal Study of Parents and Children (ALSPAC) cohort. Cord blood methylation (N = 702) was used as a negative control for potential pre-natal residual confounding. Results: Two differentially-methylated sites presented directionally-consistent associations with breastfeeding at ages 7 and 15–17 years, but not at birth. Twelve differentially-methylated regions in relation to breastfeeding were identified, and for three of them there was evidence of directional concordance between ages 7 and 15–17 years, but not between birth and age 7 years. Conclusions: Our findings indicate that DNA methylation in childhood and adolescence may be predicted by breastfeeding, but further studies with sufficiently large samples for replication are required to identify robust associations

Uso de chupeta em crianças: contaminação fecal e associação com diarréia

A cross-sectional study of 354 children under two years of age was carried out in two periurban slums, with poor sanitary and socioeconomic conditions, located in Pelotas, southern Brazil. Most (79%) of the children studied were current users of pacifiers, 15% had never used one and the remaining 6% were ex-users. Among current users, 38% sucked a pacifier most of the time ("constant users"). Of the pacifiers in constant use, 93% were cultured for evidence of fecal contamination. Fecal coliforms were present in 49% of these. Diarrhoea was reported in 35% of all the children in the two weeks preceding the survey. Among constant pacifiers users, 40% had had diarrhoea in the preceding fortnight; this proportion was 32% for occasional users and 37% for non-users. These diferences were not statistically significant.Inexistem na literatura estudos sobre o possível papel das chupetas na transmissão da diarréia. Realizou-se um estudo transversal em 354 crianças menores de dois anos em duas vilas da periferia urbana de Pelotas, RS, Brasil, com precárias condições socioeconómicas. A maioria das crianças (79%) usava chupeta, 15% nunca as haviam utilizado e 6% já haviam abandonado o hábito. Dentre os usuários, 38% passavam a maior parte do tempo fazendo uso da chupeta (uso intenso). Foram realizadas culturas para coliformes fecais em 93% das chupetas em uso, indicando que 49% estavam contaminadas. Nas duas semanas anteriores à entrevista, 35% das crianças apresentaram diarréia - 40% entre as de uso intenso, 32% entre usuárias em tempo parcial e 37% entre não usuárias. Apesar da forte presença de coliformes fecais, parece não existir associação entre uso de chupeta e diarréia

Do mothers remember their children's birth weights?

A representative cohort of approximately 1,800 children born in Pelotas, Southern Brazil, in 1982, is being studied prospectively. Approximately 81% of them were located at home at ages 9 to 15 months. During these interviews mothers or guardians were asked about the child's birth weight. This figure was later compared to the actual birth weight which was available from the previous phase of the study. Just over 60% of the mothers recalled the exact weight, about 80% gave weights within 100 g of the real value and 90% were within 250 g. Reported birth weights were not biased towards increasing or decreasing the true birth weight. Answers were less accurate in low-income families but these differences were not very marked, with 76% of the poorest mothers being within 100 g of the real weight, against 82 to 86% among the richest mothers. On the other hand, mothers who never attended school were more likely to be significantly off the mark in the information provided - 63% within 100 g - than mothers with complete secondary education - 84% within 100 g. It is suggested that recall information on birth weight may be useful for children under one year in similar populations within the context of epidemiological studies, but that the use of such data for individual clinical decisions may be unwarranted.Uma coorte de cerca de 1.800 crianças urbanas nascidas em 1982 em Pelotas, RS, está sendo estudada prospectivamente. Através de visitas domiciliares, quando as crianças estavam com 9 a 15 meses de idade, perguntou-se às mães ou responsáveis qual havia sido o peso ao nascer destas crianças. Esta informação foi comparada com o dado verdadeiro, obtido por ocasião do nascimento. Cerca de 80% das respostas apresentaram um erro menor do que 100 g, e 90% um erro inferior a 250 g. Não se observou qualquer tendência importante no sentido de aumentar ou diminuir os pesos verdadeiros. As respostas foram menos precisas em famílias de baixa renda, mas as diferenças não foram marcantes. O mesmo não ocorreu em relação à escolaridade materna, onde as respostas de mães que nunca haviam comparecido à escola foram bem menos exatas. Sugere-se que a investigação retrospectiva do peso ao nascer de crianças menores de um ano em populações comparáveis à presente se justifica no caso de estudos epidemiológicos, mas deve ser usada cautelosamente no contexto clínico em que se deseje avaliar cada criança individualmente

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