RESUMEN
From 1960 through 1992, 67 children with congenital aortic stenosis aged 6-228 months (M 105.7 +/- 52) were submitted to aortic valvuloplasty at our institution. There was no hospital mortality. During the follow-up of 127.5 +/- 66.7 months, there were two late valve related deaths. Eight patients (11.9%) developed aortic regurgitation 5 to 125 months (M 66.6 +/- 35) following surgical valvuloplasty and one of them required aortic valve replacement. Because of restenosis, 15 patients required a second operation. Of them five children underwent a second aortic valvuloplasty without mortality and, in four of them, the functional result has been excellent after a mean follow-up of 75.4 +/- 12 months. Ten patients required an aortic valve replacement 62 to 208 months post-op (M 100.9 +/- 50.8). Mechanical prosthesis were used in 6 and bioprosthesis in 4. Two patients required a Konno and one patient a Ross procedure. There were no early nor late deaths following reoperations. The 20 year survival rate following the first valvuloplasty was 94%, the freedom from reoperation 63% and the freedom from aortic valve replacement 73% for the same time period. Our results demonstrate that congenital aortic valvar stenosis in children can be surgically well controlled until adulthood. Our study also illustrates that surgical valvuloplasty is a safe and efficacious procedure and that its beneficial effect is maintained over 20 years in the majority of children.
Asunto(s)
Estenosis de la Válvula Aórtica/cirugía , Análisis Actuarial , Adolescente , Adulto , Estenosis de la Válvula Aórtica/complicaciones , Niño , Preescolar , Desbridamiento/efectos adversos , Desbridamiento/métodos , Desbridamiento/mortalidad , Dilatación/efectos adversos , Dilatación/métodos , Dilatación/mortalidad , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Implantación de Prótesis de Válvulas Cardíacas/estadística & datos numéricos , Humanos , Masculino , Recurrencia , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
The surgical treatment of Ebstein's anomaly is still controversial. Therefore we have retrospectively studied the results of tricuspid valve replacement (TVR) performed for this anomaly at Sainte Justine Hospital. From October 1977 to December 1997, 9 patients with Ebstein's anomaly, aged from 31 to 248 months (mean 176 +/- 66), have undergone TVR. Eight children were in functional class III or IV (NYHA), while one was in class II. Seven patients underwent plication of the atrialized right ventricular segment. Eight bioprostheses (ranging in diameter from 31 to 35 mm) and one mechanical prosthesis (21 mm) were used. The valve was implanted on the tricuspid annulus in six cases. There was no operative death, nor postoperative complete heart block. Follow-up ranged from 11 to 264 months (mean 91 +/- 84). One late death occurred unrelated to surgery. The probability of 20 years survival is 88%. One patient required a second TVR 162 months after the first surgery because of bioprosthesis failure. Seven of the surviving patients are in functional class I, while one patient is in class II. This experience suggests that TVR with bioprosthesis is a good therapeutical option for children with Ebstein's anomaly since the operative risk is low, the functional status improved in all patients and the durability of bioprosthesis in tricuspid position has been good.
Asunto(s)
Anomalía de Ebstein/cirugía , Implantación de Prótesis de Válvulas Cardíacas/métodos , Válvula Tricúspide/cirugía , Análisis Actuarial , Adolescente , Adulto , Niño , Preescolar , Anomalía de Ebstein/clasificación , Anomalía de Ebstein/diagnóstico , Femenino , Humanos , Masculino , Falla de Prótesis , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Análisis de Supervivencia , Técnicas de Sutura , Resultado del TratamientoRESUMEN
BACKGROUND: To question the validity of surgical aortic valvuloplasty for congenital aortic valve stenosis, a retrospective study was undertaken to determine the long-term survival, the incidence of valve restenosis or insufficiency, and the freedom of reoperation or valve replacement. METHODS: From January 1960 through 1992, 67 consecutive children diagnosed with congenital aortic valve stenosis underwent an open aortic valvuloplasty at our institution. Ages at operation ranged from 6 to 228 months (mean 105.7 +/- 52 months). The mean follow-up of these patients has been 127.5 +/- 66.7 months. RESULTS: There was no hospital mortality, but two late valve-related deaths occurred. Eight patients developed aortic regurgitation 5 to 125 months (mean 66.6 +/- 35 months) after surgical valvuloplasty, and 1 of them required aortic valve replacement. Because of restenosis, 16 patients required a second operation. Of them, 5 children underwent a second aortic valvuloplasty without mortality and, in 4 of them, the functional result has been excellent after a mean follow-up of 75.4 +/- 12 months. Eleven patients required an aortic valve replacement 62 to 208 months postop (mean 100.9 +/- 50.8 months). Mechanical prosthesis were used in 7 and bioprosthesis in 4. Two patients required a Konno and 1 required a Ross procedure. There were no early nor late deaths after reoperations. The probability of 20-year survival after the first valvuloplasty was 94%, the freedom of reoperation 63%, and the freedom of aortic valve replacement 73% for the same time period. CONCLUSIONS: Our results demonstrate that congenital aortic valvar stenosis in children can be surgically well controlled until adulthood. Our study also shows that surgical valvuloplasty is a safe and efficacious procedure and that its beneficial effect is maintained over 20 years in the majority of children.
Asunto(s)
Estenosis de la Válvula Aórtica/congénito , Válvula Aórtica/cirugía , Adolescente , Estenosis de la Válvula Aórtica/mortalidad , Estenosis de la Válvula Aórtica/cirugía , Bioprótesis , Niño , Preescolar , Estudios de Seguimiento , Implantación de Prótesis de Válvulas Cardíacas , Humanos , Lactante , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/cirugía , Reoperación , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
The consumption of a low-fat diet is advocated as beneficial in the prevention of cardiovascular disease. Because of still existing controversy the hypothesis whether low fat intake < or = 30% of total calories can maintain optimal growth and supply the desirable quantity of micronutrients was tested in a cohort of 500 children in preschool age. The children, apparently in good health and without any special dietary regimen, were stratified according to fat intake in three groups: < 30, 30-40 and > or = 40% of calories provided by fat. Our findings indicate that children with low fat intake were at a quite important risk of unsatisfactory intakes of fat-soluble vitamins, and also the nutritional density of consumed food was lower. The proportions of saturated (SFA), polyunsaturated and monounsaturated fatty acids were rather similar in all three groups, but cholesterol and SFA intakes decreased significantly in those with low fat intake. Serum cholesterol and triglyceride levels were however not significantly influenced.
Asunto(s)
Envejecimiento/metabolismo , Fenómenos Fisiológicos Nutricionales Infantiles , Dieta con Restricción de Grasas/efectos adversos , Dieta con Restricción de Grasas/normas , Estado Nutricional , Envejecimiento/sangre , Antropometría , Enfermedades Cardiovasculares/prevención & control , Niño , Preescolar , Colesterol/sangre , Colesterol en la Dieta/administración & dosificación , Estudios de Cohortes , Ingestión de Energía , Ácidos Grasos/sangre , Ácidos Grasos Monoinsaturados/sangre , Ácidos Grasos Insaturados/sangre , Femenino , Humanos , Estudios Longitudinales , Masculino , Evaluación Nutricional , Grosor de los Pliegues Cutáneos , Triglicéridos/sangre , Vitaminas/administración & dosificaciónRESUMEN
The relationship between nutritional factors including eating habits and the presence or absence of fibrocystic breast disease (FBD) with regard to other known risk factors has been investigated in women participating in the National Breast Screening Study (NBSS) in Montreal, Canada. Included in this case-control study were 334 patients with FBD aged 40-59 years at entry to NBSS and 340 controls. Personal and family history was collected from medical records and by interview conducted by a research nurse. Nutritional assessment was done by 24-hour dietary recall, by a food frequency questionnaire and by identification of changes in eating habits 5 years prior to diagnosis. Women > or = 50 years with FBD had higher intake of energy, carbohydrate, fibre, vitamin D, free folacin, calcium, sodium, potassium and magnesium but lower intake of cholesterol than controls. In women < 50 years body mass index and lower protein, niacin and zinc intake, were associated with FBD. In logistic regression analysis, breast pain and education > 12 years were among the most important predictive variables for FBD. The use of oral contraceptives, cholesterol intake > or = 300 mg/day, the proportion of energy provided by fat and saturated fatty acid intake above 10% of energy had a protective effect. The comparison of FBD patients diagnosed by biopsy and those by clinical examination indicated that increasing age had a significant association with the risk of biopsy and a rather weak association with the percentage of energy supplied by fat.
Asunto(s)
Dieta , Enfermedad Fibroquística de la Mama/etiología , Adulto , Análisis de Varianza , Estudios de Casos y Controles , Carbohidratos de la Dieta/administración & dosificación , Grasas de la Dieta/administración & dosificación , Fibras de la Dieta , Ingestión de Energía , Femenino , Enfermedad Fibroquística de la Mama/epidemiología , Humanos , Persona de Mediana Edad , Evaluación Nutricional , Quebec/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Encuestas y CuestionariosRESUMEN
The development of atherosclerotic vascular disease is influenced by multiple factors present since early age. Abnormal lipid metabolism, a major cause of atherosclerosis, results from genetic predisposition and is influenced by a variety of exogenous conditions. This article reviews the published studies of serum cholesterol tracking. The Sherbrooke cohort study on serum cholesterol tracking from early infancy to adolescence is described. The role of dietary habits, nutrient intake and other lifestyle-associated factors are scrutinized. Finally, a family-oriented detection of coronary risk factors in adolescence is discussed with emphasis on the future implementation of new genetic techniques.
Asunto(s)
Arteriosclerosis/epidemiología , Arteriosclerosis/etiología , Protección a la Infancia , Grasas de la Dieta/efectos adversos , Grasas de la Dieta/análisis , Ingestión de Energía , Hipercolesterolemia/complicaciones , Hipercolesterolemia/epidemiología , Vigilancia de la Población , Adolescente , Adulto , Arteriosclerosis/genética , Arteriosclerosis/metabolismo , Arteriosclerosis/prevención & control , Niño , Preescolar , Colesterol/sangre , Estudios de Cohortes , Conducta Alimentaria , Femenino , Humanos , Hipercolesterolemia/sangre , Lactante , Recién Nacido , Estilo de Vida , Metabolismo de los Lípidos , Lípidos/sangre , Masculino , Factores de Riesgo , Estudios SeroepidemiológicosRESUMEN
An epidemiological case-control study of FBD has been conducted to evaluate the differences observed between cases and controls in relation to the presence or absence of clinical findings and risk factors for fibrocystic breast disease (FBD). A total of 334 patients with FBD were identified among 6,232 women aged 40-59 who had participated in the National Breast Screening Study in Montréal while 340 age-matched controls were selected at random from the same cohort. All women were interviewed by a well trained nurse. Controls were significantly heavier and had a higher body mass index (BMI) than cases; however, cases had longer school attendance than controls. The menstrual cycle was shorter in cases and the number of pregnancies was greater in controls. Significant odds ratios were observed for BMI (O.R. = 0.72, 95% CI = 0.51 - 1.02) suggesting that a higher value of BMI had a rather protective effect; a similar pattern was observed in women using oral contraceptives. Since nodularity was strongly associated with FBD, it was excluded from a model of logistic regression; in this instance, longer school attendance (> 12 years), older age at menopause (> 45 years) and breast pain were significantly associated with an increased risk of FBD.
Asunto(s)
Enfermedad Fibroquística de la Mama/epidemiología , Adulto , Índice de Masa Corporal , Estudios de Casos y Controles , Escolaridad , Femenino , Enfermedad Fibroquística de la Mama/etiología , Humanos , Ciclo Menstrual , Persona de Mediana Edad , Oportunidad Relativa , Paridad , Quebec/epidemiología , Factores de RiesgoRESUMEN
Because of the high operative mortality in newborn infants with critical aortic stenosis, new therapeutic modalities have emerged. The authors reviewed their results of surgery for this condition in newborn infants between January 1964 and December 1990. Thirty-seven infants were operated on for critical aortic stenosis, which was diagnosed at a mean patient age of 14.5 days. The surgical procedure was done at a mean patient age of 37 days. Five infants died intraoperatively of ventricular fibrillation at the time of incision. Transventricular valvotomy was attempted in 4 infants, and the remaining 28 infants underwent transaortic valvuloplasty. Overall survival improved markedly in the last 5 years of the study, from 31% to 75%. All patients who had transventricular valvotomy died, as did the only infant with previous percutaneous aortic valvuloplasty. Of the infants who died, 38% weighed less than 3000 g at the time of operation compared with 13% of the survivors (p < 0.05). The duration of cardiopulmonary bypass was also identified as a risk factor (p = 0.001). Of the surviving infants, 93% were followed up at a mean of 66 months. All but one were in New York Heart functional class I or II. The following risk factors were identified for operative mortality: year of surgery, preoperative hemodynamic condition, associated anomalies of the left ventricle, surgical weight less than 3000 g, transventricular valvotomy, year of surgery and prolonged cardiopulmonary bypass. Because of the much improved survival recently, surgery remains a good therapeutic choice for critical aortic stenosis in the newborn infant.
Asunto(s)
Estenosis de la Válvula Aórtica/congénito , Estenosis de la Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/mortalidad , Estudios de Seguimiento , Humanos , Lactante , Recién Nacido , Factores de RiesgoAsunto(s)
Grasas de la Dieta , Estado Nutricional , Vitamina A , Vitamina D , Vitamina E , Canadá , Niño , Preescolar , Estudios de Cohortes , Femenino , Humanos , Masculino , Necesidades Nutricionales , Oportunidad Relativa , Quebec , Factores de Riesgo , Deficiencia de Vitamina A/epidemiología , Deficiencia de Vitamina D/epidemiología , Deficiencia de Vitamina E/epidemiologíaRESUMEN
It has been stated recently that atmospheric acid haze containing sulfur dioxide and sulfate crystals may lead to vitamin D deficiencies in exposed populations and increase breast cancer mortality, especially in Montréal. In view of the implications of this hypothesis, we have done a case-control study within the same cohort of women attending the Canadian National Breast Screening Study to check whether a depletion of vitamin D could be detected in the diet of breast cancer patients (n = 108) as compared to controls (n = 322) or a random sample of 1,141 women in our Montréal centre as well as 40 breast cancer cases for which precise food intake data were available by way of a 24-hour dietary journal. The mean daily intake of vitamin D of breast cancer cases was 1.65 +/- 2.48 I.U./kg while in 322 controls matched for age the mean intake was 1.34 +/- 1.17 (S.D.). It has to be pointed out that in the 5 years before diagnosis, cancer patients had not increased significantly their consumption of foods rich in vitamin D, namely milk, cheese, yoghurt, butter and fish. It has also to be stressed that, in relation to the recommended daily intake, twice as many breast cancer patients than controls had a higher consumption of vitamin D.
Asunto(s)
Contaminantes Atmosféricos/efectos adversos , Neoplasias de la Mama/etiología , Dióxido de Azufre/efectos adversos , Deficiencia de Vitamina D/complicaciones , Adulto , Neoplasias de la Mama/epidemiología , Estudios de Casos y Controles , Femenino , Humanos , Persona de Mediana Edad , Encuestas Nutricionales , Quebec/epidemiología , Deficiencia de Vitamina D/diagnóstico , Deficiencia de Vitamina D/etiologíaRESUMEN
Within a study on diet as a risk factor for fibrocystic disease and breast cancer, 68 patients with breast cancer, aged from 40 to 59, participating in the National Breast Screening Study in Montreal, were compared to 340 patients with fibrocystic disease and to 343 controls. The personal and family history was collected from medical records and completed by an interview. The nutritional assessment was done by a food frequency questionnaire with a special attention to the quantity and quality of fat, vitamins A, C, E, as well as life style habits. The cancer patients were significantly heavier (64.9 vs. 60.8 kg), had higher body mass index (24.9 vs. 23.4), menstrual cycle more often irregular, later menopause (47.5 vs. 44.5 years), and shorter school attendance (10.3 vs. 12.6 years). No significant differences were found in the use of contraceptives, menopausal hormones, analgesics and tobacco, marital status, number of pregnancies and children, age at menarche, duration of menstrual cycle, and the age at the first pregnancy. The cancer patients consumed significantly more poultry, fish, pastry, margarine, and alcohol and less milk, raw vegetables, pastas, sugar, butter, and coffee.
Asunto(s)
Neoplasias de la Mama/etiología , Enfermedad Fibroquística de la Mama/etiología , Estilo de Vida , Estado Nutricional , Adulto , Índice de Masa Corporal , Estudios de Casos y Controles , Escolaridad , Femenino , Humanos , Menopausia , Ciclo Menstrual , Persona de Mediana Edad , Factores de RiesgoRESUMEN
The diagnosis of colorectal adenocarcinoma is generally considered as being reliable. However, the reproducibility of the classification of specific histologic patterns and the interrater agreement on the gradings have not been firmly established. A panel of three independent expert pathologists reviewed histologic sections from 128 patients selected among 1848 with colorectal cancer, diagnosed in 11 hospitals of the same region. The panel agreed with 92.6% of the original diagnoses of colorectal adenocarcinoma. As for agreement between panel members, the kappa value was 0.78 for the diagnosis of adenocarcinoma and 0.62 for confirmation of colorectal origin. The intraclass correlation coefficient for tumor differentiation features was 0.75. The proportion of villous and adenomatous components also generated good agreement. However, the grading of mucin secretion showed poor agreement (intraclass correlation coefficient = 0.44). Results confirm the reliability of routine pathological diagnosis and also demonstrate the reproducibility of basic diagnostic categories and pathognomonic features. Thus, to obtain reliable information from medical records for epidemiologic and clinical studies, data should be limited to well-defined diagnostic and histopathologic categories.
Asunto(s)
Adenocarcinoma/patología , Neoplasias Colorrectales/patología , Adenocarcinoma/metabolismo , Anciano , Neoplasias del Apéndice/patología , Tumor Carcinoide/patología , Neoplasias Colorrectales/metabolismo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mucinas/metabolismo , Valor Predictivo de las Pruebas , Neoplasias del Recto/patología , Neoplasias Gástricas/patologíaRESUMEN
According to the hypothesis that atherosclerosis originates in childhood, it would be important for preventive purpose to identify and correct its risk factors among children, particularly hypercholesterolemia; 116 children belonging to a cohort of 556 children were found with total cholesterol level of greater than or equal to 200 mg/dl at least once during the first three years of life. These children at risk for hypercholesterolemia were followed up after nine years and compared with a control group of children having total cholesterol level of below 200 mg/dl and matched by sex and age. Both groups were submitted to a clinical examination, blood lipid determination, anthropometric measurements and were tested for food consumption. The average levels of total cholesterol (CT), triglycerides (TG), LDL-cholesterol, Apo B and CT/HDL-cholesterol (IA), Apo A/Apo B ratios were significantly higher among the children at risk, but HDL-cholesterol was lower. Forty per cent of children at risk had the CT level greater than or equal to 190 mg/dl in comparison with 15% of controls. The proportion of IA greater than or equal to 4.5 was 30% for the group at risk versus 8% for controls. The supra-iliac skinfold thickness was higher among the children at risk. Likewise the mothers of children at risk had higher weight and Quetelet index than the controls. The energy intake provided by the saturated fatty acids was higher for the group at risk, having a CT greater than or equal to 200 mg/dl. The intake of proteins, carbohydrates and fibres was significantly different in the two groups. Amino-acids were consumed less among the children at risk. Only 10% of children follow the recommendation for the proportion of calories supplied by fats. These results suggest that the intervention should be undertaken on dietary habits of the child as well as of its family in order to lower the risk of hypercholesterolemia.
Asunto(s)
Hipercolesterolemia/sangre , Antropometría , Niño , Grasas de la Dieta , Conducta Alimentaria , Femenino , Humanos , Hipercolesterolemia/etiología , Lípidos/sangre , Lipoproteínas/sangre , Estudios Longitudinales , Masculino , Ciencias de la Nutrición/educación , Padres/educación , Factores de Riesgo , Grosor de los Pliegues CutáneosRESUMEN
This study raises the question of the validity of conclusions based on recalled data by testing the maternal ability to report vital events on her newborn infant after 8 years. First, the retrospective information given by the mother was compared to the prospective data collected immediately after birth. Second, the validity of statistical analyses based on retrospective data was discussed. A dispersion model was used and discrepancies were found between the two sets of data collected in two different ways on the same subjects. It was concluded that the use of retrospective information can lead to false results in regression analyses and could invalidate comparisons in case-control studies because of the difference in variability between cases and controls.
Asunto(s)
Fenómenos Fisiológicos Nutricionales del Lactante , Memoria , Madres/psicología , Estado Nutricional , Adulto , Niño , Femenino , Humanos , Lactante , Estudios Prospectivos , Quebec , Estudios Retrospectivos , Factores SocioeconómicosRESUMEN
Because the origin of atherosclerosis is often in childhood, an early identification of future adults at risk can contribute to the prevention of atherosclerosis. In a prospective study on nutrition and health, a cohort of 556 infants was followed from birth to 3 years. Among them, 116 were found at risk for hypercholesterolemia with a cholesterol level greater than or equal to 200 mg/dl. Nine years later, these children at risk and their controls were invited to a follow-up examination of blood lipids, of nutritional status, by anthropometric measurements and personal and family history. From 32.7 to 48.7% of children at risk remained with a high cholesterol level (greater than or equal to 190 mg/dl) in comparison with 15% of controls. The nutritional profile was evidently different, especially the food frequency. The results strongly suggest that the early identification of children at risk and the screening of other family members, siblings and parents for hypercholesterolemia can serve for a sound intervention on nutritional habits.
Asunto(s)
Adolescente , Colesterol/sangre , Conducta Alimentaria , Hipercolesterolemia/prevención & control , Arteriosclerosis/prevención & control , Canadá , Niño , Preescolar , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Masculino , Estado Nutricional , Factores de RiesgoRESUMEN
The incidence pattern of oesophageal cancer varies across the world with roughly a 500-fold difference in rates (truncated) between the highest and lowest areas. The incidence rate of this disease is rising in many countries, especially in males. Although ethnicity is a strong indicator of risk of this disease, no specific genetic factor except the occurrence of this cancer among the members of families with tylosis has been identified. The frequency of oesophageal cancer varies among the native and immigrant populations in different countries. Oesophageal cancer was found to be strongly associated with the consumption of alcohol and tobacco, especially in combination. A low socioeconomic level and poor diet, particularly deficiencies of vitamins A, C, and riboflavin, are other characteristics of the regions of highest incidence. Physical damage of the oesophagus caused by ingesting hard foods and/or hot liquids could be another factor. Intensive research in high-risk regions failed to reveal the presence of nitrosocompounds except at a very low level or other known carcinogens. The mutagenicity of pickled vegetables commonly consumed in the high-risk regions of China and high frequency of oesophageal cancer among chickens in the same regions suggest the existence of "common" carcinogens. It seems probable that in Iran an initiating carcinogenic factor may be the custom of eating opium dross, which has been shown to be mutagenic, as well as consumption of contaminated bread with extraneous seeds containing a large quantity of silica fibres, which is a strong stimulant of growth.
Asunto(s)
Neoplasias Esofágicas/epidemiología , Dieta , Neoplasias Esofágicas/etiología , Femenino , Humanos , Masculino , Factores de RiesgoRESUMEN
The maternal nutritional status is considered as one of the most important factors influencing the pregnancy and the state of the offspring. There are limited data available on inadequate intake, especially before conception. A variety of nutritional and non-nutritional factors can act during the preconceptional period. Prepregnancy body weight and gestational weight gain have an independent but cumulative influence on the birth weight. The vitamin deficiency in preconceptional period, especially of folates, seems to be associated with neural tube defects. The infants of women with total gestational weight gain below 9 kg have the mean birth weight always lower than those of women with weight gain more than 9 kg in all three categories of preconceptional relative weight (i.e. less than 95%, from 95% to 105% and greater than 105%). Also the proportion of infants with birth-weight greater than 2500 g is higher in average (6.2%) and under-weight (4.4%) groups than in those over-weight (1.8%). Several other maternal nutritional as well as non nutritional variables are related with the pregnancy outcome. Among those with harmful effect on pregnancy outcome since preconceptional period, are alcohol drinking and smoking. Work outside the home can be associated with preterm deliveries and low-birth-weight infants, but the results are not consistent. Nutritional intervention, energy and/or protein supplementation also contribute to an increase of the birth-weight. As far as the antenatal care is concerned, only few studies investigated, with a scientific rigour the relation if any between prenatal care and pregnancy outcome. We concluded that the available evidence confirms a significant impact of preconceptional nutrition on pregnancy outcome. A sensitive evaluation of nutritional status in preconceptional period seems to be a positive strategy for prevention of at risk pregnancies. There is a clear need of prospective human studies with aim to relate the nutrient status of future mother to the evolution of her pregnancy.