Could vitamin D reduce obesity-associated inflammation? Observational and Mendelian randomization study.

BACKGROUND: Obesity is associated with inflammation but the role of vitamin D in this process is not clear. OBJECTIVES: We aimed to assess the associations between serum 25-hydroxyvitamin D [25(OH)D], BMI, and 16 inflammatory biomarkers, and to assess the role of vitamin D as a potential mediator in the association between higher BMI and inflammation. METHODS: Northern Finland Birth Cohort 1966 (NFBC1966) 31-y data on 3586 individuals were analyzed to examine the observational associations between BMI, 25(OH)D, and 16 inflammatory biomarkers. Multivariable regression analyses and 2-sample regression-based Mendelian randomization (MR) mediation analysis were performed to assess any role of vitamin D in mediating a causal effect of BMI on inflammatory biomarkers [soluble intercellular adhesion molecule 1 (sICAM-1), high sensitivity C-reactive protein (hs-CRP), and α1-acid glycoprotein (AGP)] for which observational associations were detected. For MR, genome-wide association study summary results ranging from 5163 to 806,834 individuals were used for biomarkers, 25(OH)D, and BMI. Findings were triangulated with a literature review of vitamin D supplementation trials. RESULTS: In NFBC1966, mean BMI (kg/m2) was 24.8 (95% CI: 24.7, 25.0) and mean 25(OH)D was 50.3 nmol/L (95% CI: 49.8, 50.7 nmol/L). Inflammatory biomarkers correlated as 4 independent clusters: interleukins, adhesion molecules, acute-phase proteins, and chemokines. BMI was positively associated with 9 inflammatory biomarkers and inversely with 25(OH)D (false discovery rate < 0.05). 25(OH)D was inversely associated with sICAM-1, hs-CRP, and AGP, which were positively associated with BMI. The MR analyses showed causal association of BMI on these 3 inflammatory biomarkers. There was no observational or MR evidence that circulating 25(OH)D concentrations mediated the association between BMI and these 3 inflammatory markers. Review of randomized controlled trials (RCTs) supported our findings showing no impact of vitamin D supplementation on inflammatory biomarkers. CONCLUSIONS: The findings from our observational study and causal MR analyses, together with data from RCTs, do not support a beneficial role of vitamin D supplementation on obesity-related inflammation

Avaliação da efetividade da assistência pré-natal de uma Unidade de Saúde da Família em um município da Grande São Paulo Evaluación de la efectividad de la asistencia prenatal de una Unidad de Salud de la Familia en un municipio del Estado de São Paulo Evaluation of effectivenness of prenatal assistance in a health Family Unit in a city of the São Paulo State

Dada a importância da qualidade do cuidado pré-natal na redução da morbi-mortalidade materna e perinatal, este estudo objetivou avaliar a qualidade da assistência prestada à gestantes de baixo risco por meio dos indicadores de qualidade preconizados pelo Ministério da Saúde. Trata-se de um estudo avaliativo, quantitativo e retrospectivo realizado em um Serviço de Pré-Natal de uma Unidade de Saúde da Família de um Município da Grande São Paulo. Os resultados evidenciaram que o Programa de Saúde da Família propicia assistência pré-natal de qualidade, e que o vínculo estabelecido entre os profissionais da Unidade e os Agentes Comunitários de Saúde com as gestantes é imprescindível para a adesão das mesmas ao Programa de Assistência Pré-Natal.<br>Visto la importancia de la calidad del cuidado prenatal en la reducción de la morbidad y mortalidad materna y perinatal, este estudio tuvo como objetivo evaluar la calidad de la asistencia prestada a las mujeres embarazadas de bajo riesgo por medio de los indicadores de calidad preconizados por el Ministerio de la salud. Este es un estudio evaluativo, cuantitativo y retrospectivo realizado en un Servicio Prenatal de una Unidad de Salud de la Familia de un Municipio del Estado de São Paulo. Los resultados mostraron que el Programa de Salud de la Familia propicia asistencia prenatal de calidad y que el vínculo establecido entre los profesionales de la Unidad y los Agentes Comunitarios de la salud con las mujeres embarazadas es imprescindible para la adhesión de las mismas al programa de Asistencia Prenatal.<br>Considering the importance of prenatal care quality to reduce maternal and perinatal morbidity and mortality, the aim of this study was to evaluate quality in the assistance to low-risk pregnant women by means of quality indicators stated by the Health Ministry. This is an evaluating, quantitative and retrospective study carried out in a Prenatal Service in a Family Health Unit in a city in the state of São Paulo. The results showed that the Family Health Program provides a quality prenatal assistance and that the link established between the Unit professionals and the Health Community Agents with pregnant women is imperative for the adherence to the Prenatal Assistance Program