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INTRODUCTION: Neisseria gonorrhoeae causes gonorrhoea, a globally neglected but increasing disease. This systematic review and meta-analysis reviewed the epidemiology and economic burden of gonorrhoea in Latin America and the Caribbean (LAC). METHODS: We searched PubMed, EMBase, Cochrane Library, EconLIT, CINAHL, CRD, LILACS, Global Health, Global Dissertations and Theses, SciELO, Web of Science databases, countries' ministries of health, and the IHME's Global Burden of Disease databases. Studies published in the last 10 years (20 years for economic studies) were included if conducted in any LAC country, without language restrictions. The main outcome measures were incidence/prevalence, proportion of co-infections, case fatality rates, specific mortality/hospitalisation rates, direct/indirect costs, and impact of gonorrhoea on quality of life. To assess evidence quality, we used a checklist developed by the US National Heart, Lung, and Blood Institute for observational studies and trial control arms, the Cochrane Effective Practice Organization of Care Group tool for randomised controlled trials, and the CICERO checklist for economic studies. RESULTS: We identified 1290 articles; 115 included epidemiological studies and one included an economic study. Ministry of health data from Argentina, Brazil, Chile, Colombia, Mexico, and Uruguay were identified. Gonorrhoea prevalence was 1.46% (95% confidence interval [CI] 1.00-2.00%) from 48 studies and 5.68% (95% CI 4.23-7.32%) from 58 studies for non-high-risk and high-risk populations, respectively. Cumulative incidence for the high-risk population was 2.05 cases per 100 persons/year. Few published studies were rated as "good" in the risk of bias assessments. Variations in the methodology of the sources and limited information found in the countries' surveillance systems hinder the comparison of data. CONCLUSION: The burden of gonorrhoea in LAC is not negligible. Our results provide public health and clinical decision support to assess potential interventions to prevent gonorrhoea. TRIAL REGISTRATION: The protocol is registered on PROSPERO (CRD42021253342). The study was funded by GlaxoSmithKline Biologicals SA (GSK study identifier VEO-000025).
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BACKGROUND: Detailed information is needed on the dynamic pattern of antimicrobial resistance (AMR) in Neisseria gonorrhoeae in Latin America and the Caribbean (LAC). OBJECTIVES: To conduct a systematic review of AMR in N. gonorrhoeae in LAC. METHODS: Electronic searches without language restrictions were conducted in PubMed, Embase, Cochrane Library, EconLIT, Cumulative Index of Nursing and Allied Health Literature, Centre for Reviews and Dissemination, and Latin American and Caribbean Literature in Health Sciences. Studies were eligible if published between 1 January 2011 and 13 February 2021, conducted in any LAC country (regardless of age, sex and population) and measured frequency and/or patterns of AMR to any antimicrobial in N. gonorrhoeae. The WHO Global Gonococcal Antimicrobial Surveillance Programme (WHO-GASP) for LAC countries and Latin American AMR SurveillanceNetwork databases were searched. AMR study quality was evaluated according to WHO recommendations. RESULTS: AMR data for 38,â417 isolates collected in 1990-2018 were included from 31 publications, reporting data from Argentina, Brazil, Colombia, Peru, Uruguay, Venezuela and WHO-GASP. Resistance to extended-spectrum cephalosporins was infrequent (0.09%-8.5%). Resistance to azithromycin was up to 32% in the published studies and up to 61% in WHO-GASP. Resistance to penicillin, tetracycline and ciprofloxacin was high (17.6%-98%, 20.7%-90% and 5.9%-89%, respectively). Resistance to gentamicin was not reported, and resistance to spectinomycin was reported in one study. CONCLUSIONS: This review provides data on resistance to azithromycin, potentially important given its use as first-line empirical treatment, and indicates the need for improved surveillance of gonococcal AMR in LAC. Trial registration: Registered in PROSPERO, CRD42021253342.
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Anti-Infecciosos , Gonorreia , Humanos , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Neisseria gonorrhoeae , Azitromicina , América Latina/epidemiologia , Farmacorresistência Bacteriana , Testes de Sensibilidade Microbiana , Gonorreia/tratamento farmacológico , Gonorreia/epidemiologiaRESUMO
Abstract Objectives: to evaluate the association of pre-pregnancy and current body mass index and the density of dietary macronutrients on underreporting of energy intake at pregnancy. Methods: cross-sectional analysis of 327 postpartum women from the city of Mesquita, in Rio de Janeiro. A food frequency questionnaire was administered at maternity ward having the last six months of the pregnancy as the time frame. Energy balance was considered as the outcome, and it was calculated as the division of energy intake by basal metabolic rate (underreport <1.35). Multivariate logistic regression was applied to test the associations between body mass index (pre-gestational and postpartum) on energy balance (underreport or not). Dietary density of protein (4th quartile), carbohydrate (1st quartile) and fat intake (1st quartile) were tested. Results: mean energy intake was 2,894 kcal and near of 25% of the women were considered as underreported during pregnancy. Obese women had higher chance (OR=1.90; CI95%=1.09-3.33) of being underreported at pregnancy. Underreported women presented greater chance of report dietary intake with higher contents of protein (OR=2.37; CI95%=1.37-4.09) and lower density of fat (OR= .81; CI95%=1.04-3.15). Conclusion: underreported pregnant women had higher chance of report great and lower amounts of protein and fat dietary densities.
Resumo Objetivos: avaliar a associação entre o índice de massa corporal pré-gestacional e pós-parto e a densidade de macronutrientes da dieta com o sub-relato de energia da dieta na gestação. Métodos: análise transversal com 327 puérperas da cidade de Mesquita, no Rio de Janeiro. Aplicou-se o questionário de frequência alimentar na primeira semana após o parto tendo como base o consumo dos dois últimos trimestres gestacionais. O balanço energético foi calculado a partir da divisão da ingestão de energia pela taxa metabólica basal (sub-relato<1,35). Adotou-se a regressão logística multivariada para analisar as associações entre os índices de massa corporal e a densidade dos macronutrientes da dieta (proteína, carboidratos e lipídios) com o balanço energético (sub-relato ou não). Resultados: a ingestão média de energia foi de 2.894 kcal e 25% das mulheres foram classificadas com sub-relato. Mulheres obesas no pós-parto tiveram maiores chances (OR=1,90; IC95%=1,09-3,33) de sub-relato de energia na gravidez e gestantes com balanço energético <1,35 apresentaram dieta com maior densidade de proteína (OR=2,37; IC95%=1,37-4,09) e menor densidade de gordura (OR=1,81; IC95%=1,04-3,15). Conclusão: a obesidade no pós-parto foi associada ao sub-relato de energia na gravidez e o balanço energético associou-se a densidade dos macronutrientes da dieta
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Humanos , Feminino , Gravidez , Ingestão de Energia/fisiologia , Gorduras na Dieta , Índice de Massa Corporal , Comportamento Alimentar , Ganho de Peso na Gestação , Obesidade Materna , BrasilRESUMO
ABSTRACT Objective This study aimed to verify the association between rural characteristics and the nutritional status of adolescents from the rural area of Macaé, a municipality in Rio de Janeiro, Southeast Brazil. Methods This is a cross-sectional study based on secondary anthropometric data, collected at the Macaé Municipal Department of Education between 2013 and 2014. The database refers to the total number of adolescents in the only high school in the rural area of the city. Poisson logistic regression was performed, having excess weight (overweight or obesity- Body Mass Index-for-age equal to or greater than one Z-score) as the dependent variable, used dichotomously. The independent variables were sex, socioeconomic status and three "yes or no" variables that express rural characteristics. Results The adolescents (total=109) were between 14 and 18 years old (mean=16.6 years), 64.2% were girls, 52.3% had vegetable gardens or orchards in their household, 19.4% had animal breeding for consumption purposes and 17.6% had parents/guardians working in the agricultural sector. The prevalence of excess weight was 18.0% in boys and 20.0% in girls. Having a garden/orchard implied a significantly higher chance of having excess weight, both in the bivariate analysis and in the sex-adjusted model (Prevalence Ratio=2.95; Confidence Interval=1.17-7.44). Conclusions Based on a significant association at the municipal level, the results highlight nutritional differences between local and large-scale studies, as well as variations within the same rural area. These findings point out the need to evaluate rural aspects in more detail in studies on underlying determinants of nutritional status.
RESUMO Objetivo Este trabalho visou verificar a associação entre as características rurais e o estado nutricional de adolescentes da zona rural do município de Macaé, RJ. Métodos Trata-se de um estudo transversal com dados antropométricos secundários, coletados no âmbito da Secretaria Municipal de Educação de Macaé entre 2013 e 2014. A base de dados refere-se ao total de adolescentes da única escola de ensino médio do meio rural da cidade. Fez-se regressão logística de Poisson, tendo o excesso de peso (sobrepeso ou obesidade - Índice de massa-corporal-para-idade igual ou maior que um escore-Z) como variável resposta, usada de forma dicotômica. As variáveis independentes foram: sexo, situação socioeconômica e três variáveis "sim ou não", que expressam características rurais. Resultados Os adolescentes (total=109) tinham idade entre 14 e 18 anos (média=16,6 anos); 64,2% eram meninas, 52,3% apresentavam com horta ou pomar em seus domicílios, 19,4% possuíam criação de animais para fins de consumo e 17,6% tinham pais/responsáveis com ocupação agrícola. A prevalência de excesso de peso foi 18,0% nos meninos e 20,0% nas meninas. Ter horta/pomar implicou em significativa maior chance de excesso de peso, tanto na análise bivariada quanto no modelo ajustado por sexo (Razão de Prevalência=2,95; Intervalo de Confiança=1,17-7,44). Conclusão Com base em uma associação significativa em nível municipal, os resultados ressaltam diferenças nutricionais entre estudos locais e de maior âmbito, bem como variações dentro de uma mesma área rural. Estes achados apontam a necessidade de se avaliar mais detalhadamente aspectos rurais em estudos sobre determinantes causais do estado nutricional.
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Humanos , Masculino , Feminino , Adolescente , População Rural , Estado Nutricional , Comportamento Alimentar , Adolescente , SobrepesoRESUMO
There is an increasing interest in the study of the aggregation of risk factors for noncommunicable chronic diseases. However, there are no studies among adolescents stratified by alcohol use. This study investigated the aggregation of cardiovascular risk factors in adolescents considering the use or not of alcohol. A total of 73,624 Brazilian adolescents aged 12-17 years from public and private schools were evaluated in a national cross-sectional study (March-2013 to December-2014). The aggregation of cardiovascular risk factors was the main outcome. The regression model was adjusted for sex, age, region of Brazil, and school type. Most alcohol users were 16 to 17 years old, while nonusers were between 12 and 13 years. Alcohol users showed a higher prevalence of smoking (8.1% vs. 0.8%) and sleep inadequacy (59.9% vs. 51.4%) than nonusers did. On the other hand, a sufficient level of physical activity was more frequent among alcohol users (51.2% vs. 44.2%). The presence of only one cardiovascular risk factor was more frequent in nonusers (42.3%) than alcohol users (38.9%). Alcohol users tended to aggregate more for the category of 3-4 cardiovascular risk factors when compared with the non-alcohol-using population (10.9% vs. 7.9%). Aggregation of three cardiovascular risk factors was more likely to be observed among male adolescent alcohol users. Inadequate sleep and smoking habit tended to aggregate among alcohol users. This finding highlights the importance of public policies aiming to reduce alcohol consumption at early ages and, consequently, to decrease the risk of future morbimortality of noncommunicable chronic diseases.
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Doença Crônica , Fatores de Risco , Instituições Acadêmicas , Adolescente , Brasil/epidemiologia , Criança , Estudos Transversais , Comportamentos Relacionados com a Saúde , Humanos , Masculino , PrevalênciaRESUMO
Introdução: As doenças crônicas não transmissíveis estão entre as principais causas de morbimortalidade no mundo, especialmente o câncer. Para a sua prevenção, a atividade física figura como uma das estratégias. Objetivo: Apresentar e discutir evidências científicas recentes acerca da atividade física para a prevenção de câncer e expor reflexões e apontamentos sobre as complexidades e iniquidades relacionadas à atividade física no Sistema Único de Saúde. Método: Foram selecionadas referências atuais de instituições de vanguarda na pesquisa sobre atividade física, prevenção de câncer e temas correlatos: a) Sumário do III Relatório de Especialistas sobre Alimentação, Nutrição, Atividade Física e Câncer; b) Relatório Científico do Comitê Consultivo das Diretrizes de Atividade Física dos EUA; c) Mesa- -redonda do Colégio Americano de Medicina do Esporte. Sua relevância está na reunião de evidências sistematicamente revisadas por uma ampla comunidade científica de especialistas. Resultado: A atividade física é uma importante ação de saúde para a prevenção do câncer, contudo não foi possível identificar a quantidade específica, já que a comparação é entre níveis mais altos versus mais baixos de atividade física. Conclusão: Háfortes evidências para a relação entre atividade física e prevenção de câncer de mama, cólon, endométrio, esôfago, estômago, rim, bexiga, fígado. Para efetivá-las, é necessário reconhecer que a atividade física é relacionada a diferentes determinantes e condicionantes da saúde e que programas públicos no Sistema Único de Saúde têm grande potencial para a ampliação dessa prática pela população
Introduction: Chronic Noncommunicable Diseases are among the main causes of morbidity and mortality in the world, especially for cancer. For its prevention, physical activity appears as one of the strategies. Objective: To present and discuss recent scientific evidences about physical activity for the prevention of cancer and to expose reflections and notes on the complexities and inequities related to physical activity in the Unified Health System. Method: Current references from cutting edge institutions in research on physical activity, cancer prevention and related topics were selected: a) Summary of the III Expert Report on Food, Nutrition, Physical Activity and Cancer; b) Scientific Report of the US Physical Activity Guidelines Advisory Committee; c) Round Table of the American College of Sports Medicine. Its relevance lies in the gathering of evidence systematically reviewed by a wide scientific community of experts. Result: Physical activity is an important health action for cancer prevention, however it was not possible to identify the specific amount since the comparison is between higher versus lower levels of physical activity. Conclusion: There are strong evidences about the relationship between physical activity and cancer prevention for breast, colon, endometrium, esophagus, stomach, kidney, bladder, liver. To carry them out, it is necessary to recognize that physical activity is related to different health determinants and conditions and that public programs in the Unified Health System have great potential for the expansion of this practice by the population
Introducción: Las enfermedades crónicas no transmisibles se encuentran entre las principales causas de morbilidad y mortalidad en el mundo, especialmente el cáncer. Para su prevención, la actividad física aparece como una de las estrategias. Objetivo: Presentar y discutir evidencia científica reciente sobre la actividad física para la prevención del cáncer y exponer reflexiones y notas sobre las complejidades e inequidades relacionadas con la actividad física en el Sistema Único de Salud. Método: Referencias actuales de instituciones de vanguardia en la investigación sobre actividad física, prevención del cáncer y temas relacionados: a) Resumen del III Informe de Expertos en Alimentación, Nutrición, Actividad Física y Cáncer; b) Informe Científico del Comité Asesor de Pautas de Actividad Física de EEUU; c) Mesa-redonda del Colegio Americano de Medicina del Deporte. Su relevancia radica en la recopilación de evidencia revisada sistemáticamente por una amplia comunidad científica de expertos. Resultado: La actividad física es una acción de salud importante para la prevención del cáncer, sin embargo, no fue posible identificar la cantidad específica ya que la comparación es entre niveles más altos versus más bajos de actividad física. Conclusión: Existe una fuerte evidencia de la relación entre la actividad física y la prevención del cáncer de: mama, colon, endometrio, esófago, estómago, riñón, vejiga, hígado. Para llevarlos a cabo, es necesario reconocer que la actividad física está relacionada con diferentes determinantes y condiciones de salud y que los programas públicos en el Sistema Único de Salud tienen un gran potencial para la expansión de esta práctica por parte de la población
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Humanos , Masculino , Feminino , Exercício Físico , Doença Crônica/prevenção & controle , Disparidades nos Níveis de Saúde , Política de Saúde , Neoplasias/prevenção & controleRESUMO
Dietary patterns (DPs) have been described as an important factor that may influence polyunsaturated fatty acid (PUFA) concentrations and body mass index (BMI) during pregnancy. We aim to evaluate the association between pre-pregnancy DPs and serum PUFA percentages throughout pregnancy considering early pregnancy BMI as a possible effect modifier. A prospective cohort of 154 pregnant women was followed (5th-13th, 20th-26th, and 30th-36th gestational weeks). Serum PUFA concentrations (total n-3 and total n-6, eicosapentaenoic + docosahexaenoic acids) were measured in each trimester and expressed as percentages. The n-6/n-3 ratio was calculated. Longitudinal linear mixed-effects models including interaction terms between DPs and early pregnancy BMI were employed. Serum PUFA percentages declined, whereas the n-6/n-3 ratio, monounsaturated, and saturated percentages increased throughout pregnancy for all BMI categories. Three pre-pregnancy DPs were identified by principal component analysis (common Brazilian, healthy, and processed). Overweight women with higher adherence to the common-Brazilian and to the healthy DPs presented reduced n-3 PUFA percentage and increased n-6 percentages and n-6/n-3 ratio compared to under or normal weight women. Obese women with higher adherence to the processed DP presented a more pronounced decrease of total n-3 percentage compared to under or normal weight women. Early pregnancy BMI modified the effect of pre-pregnancy DPs on PUFA profile throughout gestation. Higher adherence to the healthy pattern was associated with increased n-3 percentage, except for overweight women. Only for processed DP was the behaviour of PUFA the same for all BMI categories, showing a worse evolution profile, that is, increased n-6 and reduced n-3 fractions.
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Dieta/efeitos adversos , Ácidos Graxos Insaturados/sangue , Fenômenos Fisiológicos da Nutrição Materna , Obesidade/sangue , Sobrepeso/sangue , Complicações na Gravidez/sangue , Adulto , Biomarcadores/sangue , Índice de Massa Corporal , Brasil/epidemiologia , Estudos de Coortes , Dieta Saudável , Feminino , Humanos , Incidência , Estudos Longitudinais , Obesidade/epidemiologia , Obesidade/etiologia , Obesidade/prevenção & controle , Sobrepeso/epidemiologia , Sobrepeso/etiologia , Sobrepeso/prevenção & controle , Cooperação do Paciente , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/etiologia , Complicações na Gravidez/prevenção & controle , Análise de Componente Principal , Estudos Prospectivos , Magreza/sangue , Magreza/epidemiologia , Magreza/etiologia , Magreza/prevenção & controle , Aumento de PesoRESUMO
The change in maternal lipid, leptin and adiponectin concentrations during pregnancy and infant birth weight (BW) is still poorly characterized. Thus, the aim of the study was to evaluate the association of maternal lipids, leptin and adiponectin throughout pregnancy with large-for-gestational-age (LGA) births and BW z-score. A prospective cohort of 199 mothers was followed during pregnancy in Rio de Janeiro, Brazil. The statistical analyses comprised multiple logistic and linear regression. Women delivered 36 LGA and 11 small-for-gestational-age newborns. HDL-c rate of change throughout pregnancy was negatively associated with BW z-score (ß = -1.99; p = 0.003) and the delivery of a LGA newborn (OR = 0.02; p = 0.043). Pregnancy baseline concentration of log leptin was positively associated (OR = 3.92; p = 0.025) with LGA births. LDL-c rate of change throughout pregnancy was positively associated with BW z-score (ß = 0.31; p = 0.004). Log triglycerides and log adiponectin were not significantly associated with BW z-score or LGA birth. In conclusion, a higher log leptin pregnancy baseline concentration and a lower HDL-c rate of change during pregnancy were associated with higher odds of having a LGA newborn. These maternal biomarkers are important to foetal growth and could be used in prenatal care as an additional strategy to screen women at risk of inadequate BW.
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Adiponectina/sangue , Peso ao Nascer , Leptina/sangue , Lipídeos/sangue , Adulto , Biomarcadores/sangue , Feminino , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional/sangue , GravidezRESUMO
OBJECTIVE: The aim of this study was to investigate whether serum concentrations of total saturated fatty acids (SFAs), polyunsaturated fatty acids (PUFAs), and their fractions are associated with plasma adiponectin and leptin concentrations throughout pregnancy. METHODS: A prospective cohort of 201 pregnant women was followed from gestational weeks 5 to 13, 20 to 26, and 30 to 36. Blood samples were collected at the three visits after 12 h of fasting. Fatty acid concentrations were determined using fast gas-liquid chromatography. Plasma adiponectin (µg/mL) and leptin (ng/dL) concentrations were evaluated using enzyme-linked immunosorbent assay kits. Statistical analyses included median adipokine concentrations according to the tertiles of fatty acid distribution and multiple linear mixed-effect models adjusted for body mass index, gestational age, total energy intake, alcohol consumption, and smoking. RESULTS: Women classified in the third SFA concentration tertile had lower median values of adiponectin compared with those in the first tertile ([first trimester: first tertile = 5.36; third tertile = 5.00]; [second trimester: first tertile = 6.39; third tertile = 4.47]; [third trimester: first tertile = 6.46; third tertile = 4.60]). Similar trends were observed for the 14:0, 16:0 and 18:0 fractions. In the multiple longitudinal models, total SFA (ß = -41.039; P = 0.008) and 16:0 were negatively associated with plasma adiponectin (16:0, ß = -0.511; P = 0.001). Total PUFA ω-6 (ß = 28.961; P = 0.002) and 18:2 ω-6 (ß = 0.259, P = 0.006) were positively associated with the adiponectin. Total SFA (ß = 0.110, P = 0.007), 14:0 (ß = 0.072, P = 0.011), and 20:3 ω-6 (ß = 0.039; P = 0.035) were positively associated with plasma leptin. CONCLUSIONS: Total serum SFA and the 16:0 fraction were negatively associated with plasma adiponectin and positively associated with leptin concentrations. Total ω-6 PUFA was positively associated only with plasma adiponectin concentrations throughout pregnancy.
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Adiponectina/sangue , Ácidos Graxos/sangue , Leptina/sangue , Adulto , Índice de Massa Corporal , Brasil , Cromatografia Gasosa , Estudos de Coortes , Ensaio de Imunoadsorção Enzimática , Ácidos Graxos Insaturados/sangue , Feminino , Humanos , Gravidez , Estudos Prospectivos , Adulto JovemRESUMO
OBJECTIVE: To analyze serum fatty acids concentrations during healthy pregnancy and evaluate whether socioeconomic, demographic, obstetric, nutritional, anthropometric and lifestyle factors are associated with their longitudinal changes. STUDY DESIGN: A prospective cohort of 225 pregnant women was followed in the 5th-13th, 20th-26th and 30th-36th weeks of gestation. Serum samples were collected in each trimester of pregnancy and analyzed to determine the fatty acids composition using a high-throughput robotic direct methylation method coupled with fast gas-liquid chromatography. The independent variables comprised the subjects' socioeconomic and demographic status, obstetric history, early pregnancy body mass index (BMI), dietary and lifestyle parameters. Analyses were performed using linear mixed-effects models. RESULTS: The overall absolute concentrations of fatty acids increased from the 1st to the 2nd trimester and slightly increased from the 2nd to the 3rd trimester. Early pregnancy BMI, inter-partum interval and weekly fish intake were the factors associated with changes in eicosapentaenoic + docosahexaenoic acids (EPA+DHA) and total n-3 polyunsaturated fatty acids (PUFAs). Early pregnancy BMI, age and monthly per-capita income were inversely associated with the changes in the n-6/n-3 ratio. Alcohol consumption was positively associated with the n-6/n-3 ratio. CONCLUSION: Early pregnancy BMI was positively associated with EPA+DHA and total n-3 PUFAs, while presenting a reduced weekly fish intake and a lower inter-partum interval were associated with lower levels of n-3 PUFAs. A lower per-capita family income and a drinking habit were factors that were positively associated with a higher n-6/n-3 ratio.
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Intervalo entre Nascimentos , Ácidos Graxos Essenciais/sangue , Estilo de Vida , Gravidez/sangue , Índice de Massa Corporal , Brasil , Cromatografia Gasosa , Estudos de Coortes , Demografia , Feminino , Ensaios de Triagem em Larga Escala , Humanos , Modelos Lineares , Estudos Prospectivos , Fatores Socioeconômicos , Inquéritos e Questionários , Fatores de TempoRESUMO
BACKGROUND: Adherence to unhealthy dietary patterns may alter the risk of mental disorders during pregnancy and the postpartum period. OBJECTIVE: To analyze the association between prepregnancy dietary patterns and prospective variations on anxiety symptoms from midpregnancy to early postpartum. METHODS: A prospective cohort of 207 healthy pregnant women was followed at 5 to 13, 20 to 26, and 30 to 36 gestational weeks, and once at 30 to 45 days postpartum. The State-Trait Anxiety Inventory was used to evaluate anxiety symptoms at the second and third gestational trimesters and during the postpartum period. Dietary intake was assessed using a food frequency questionnaire administered during the first trimester of pregnancy that referred to the 6 months before pregnancy. Principal components analysis was used to identify dietary patterns and three prepregnancy dietary patterns were identified: common-Brazilian, healthy, and processed. Three longitudinal mixed-effect models were estimated to verify the association between dietary patterns and anxiety symptoms, adjusted for confounding variables. RESULTS: The mean anxiety symptom scores were 40.4, 40.5, and 37.2 for the second trimester, third trimester, and postpartum, respectively. The rate of variation of the State-Trait Anxiety Inventory score was 0.535 (95% CI -0.035 to 1.107; P=0.066) and -0.010 (95% CI -0.018 to -0.002; P=0.019) when accounting for gestational age and quadratic gestational age, respectively. The common-Brazilian pattern, comprised mainly of rice and beans (ß=-1.200, 95% CI -2.220 to -0.181; P=0.021), and the healthy pattern comprised mostly of vegetables, fruits, fish, and tea (ß=-1.290, 95% CI -2.438 to -0.134; P=0.029), were negatively associated with prospective changes in anxiety symptoms. CONCLUSIONS: High adherence to the common-Brazilian or healthy patterns was negatively associated with higher anxiety symptom scores from mid-pregnancy to early postpartum in this group of Brazilian women.
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Ansiedade/epidemiologia , Comportamento Alimentar , Fenômenos Fisiológicos da Nutrição Materna , Período Pós-Parto , Adulto , Índice de Massa Corporal , Brasil/epidemiologia , Ingestão de Energia , Feminino , Seguimentos , Frutas , Humanos , Estilo de Vida , Modelos Lineares , Avaliação Nutricional , Gravidez , Estudos Prospectivos , Fatores Socioeconômicos , Inquéritos e Questionários , Verduras , Adulto JovemRESUMO
Little is known about the association between polyunsaturated fatty acids (PUFAs) and anxiety disorders during pregnancy. We evaluated this association at the first pregnancy trimester in 228 women. The study endpoint was the diagnosis of any anxiety disorder assessed by the Mini International Neuropsychiatric Interview. The independent variables were the serum concentrations of total n-3 and fractions (18:2, 20:5, 22:5, 22:6), total n-6 and fractions (18:2, 18:3, 20:2, 20:3, 20:4, 22:4, 22:5) and the n-6/n-3 ratio PUFAs. The prevalence of any anxiety disorders was 25%. The first tertile of the docosahexaenoic acid (DHA, 22:6 n-3) distribution represented 1.95 (95% CI: 1.00-3.77) higher chance of having an anxiety disorder diagnosis, compared to those in the second and third tertiles after adjusting the analyses for parity, family income, early pregnancy BMI and gestational age at the blood sampling. Serum concentrations of DHA were inversely associated with the occurrence of early pregnancy anxiety disorders.
Assuntos
Transtornos de Ansiedade/etiologia , Ácidos Graxos Ômega-6/sangue , Complicações na Gravidez/etiologia , Adulto , Transtornos de Ansiedade/sangue , Estudos Transversais , Ácidos Docosa-Hexaenoicos/sangue , Feminino , Humanos , Gravidez , Complicações na Gravidez/sangue , Primeiro Trimestre da Gravidez , Adulto JovemRESUMO
Antenatal anxiety may increase the risk of undesirable birth outcomes. Studies have demonstrated an association between adiponectin and anxiety, but this issue has not been investigated during pregnancy. This study aimed to evaluate the association between plasma adiponectin, measured throughout gestation, and the occurrence of anxiety at late pregnancy (30-36th weeks). A prospective cohort was investigated in Rio de Janeiro, Brazil. Healthy pregnant women, aged 20-40 years, were evaluated between gestational weeks 5-13, 22-26 and 30-36. State anxiety was measured using a validated version of the State-Trait Anxiety Inventory, and women were categorized as high (score≥50, n=30) or low anxiety (score<50, n=129). Plasma samples for all trimesters were analyzed using commercial ELISA kits to determine adiponectin concentrations (U/mL). Statistical analysis involved student's t-tests, chi-square, Pearson correlation, multiple logistic regression and linear mixed effects (LME) regression to model longitudinal trends of adiponectin, stratified for anxiety categories. Women with higher anxiety scores had lower mean concentrations of 3rd trimester adiponectin compared with those with lower scores (7.9; 95% CI: 7.0-8.9 vs. 9.9; 95% CI: 9.1-10.7). Women with 3rd trimester adiponectin values within the third tertile (10.47-26.57U/mL) were less likely to have high antenatal anxiety (adjusted OR=0.30; 95% CI: 0.09-0.98) compared with those within the first tertile (2.25-7.08U/mL). Unlike women with low levels of anxiety, those with high levels had a significant decrease of plasma adiponectin throughout pregnancy (ß=-0.07; 95% CI: -0.13-[-0.01] vs. ß=-0.01; 95% CI: -0.05 to 0.03). Multiple LME model indicated higher adiponectin throughout pregnancy for women with low anxiety (ß=-1.57; 95% CI: -2.78-[-0.37]). In conclusion, plasma adiponectin throughout pregnancy was inversely associated with antenatal anxiety.
Assuntos
Adiponectina/sangue , Ansiedade/sangue , Complicações na Gravidez/sangue , Adulto , Ansiedade/diagnóstico , Brasil , Estudos de Coortes , Feminino , Humanos , Gravidez , Escalas de Graduação Psiquiátrica , Adulto JovemRESUMO
BACKGROUND: Leptin concentrations increase throughout pregnancy but little is known about factors that influence this physiological change and whether they differ according to pregestational body mass index (BMI). OBJECTIVE: To assess whether longitudinal trends of leptin in pregnancy are influenced by biochemical, anthropometric and lifestyle factors in women with normal weight (NW), overweight (OW) or obese (OB) pregestational BMI. DESIGN AND METHODS: Prospective cohort of 232 pregnant women followed at 5-13th, 20-26th and 30-36th gestational weeks. The effect of selected variables on longitudinal behaviour of plasma leptin concentrations, stratifying for NW (18·5-24·9 kg/m(2) ), OW (25-29·9 kg/m(2) ) and OB (≥30·0 kg/m(2) ) pregestational BMI was assessed through longitudinal linear mixed-effects models. RESULTS: The multiple regression model for women with NW revealed associations of maternal body weight (ß = 0·714, CI = 0·491 to 0·937), serum HDL-cholesterol (ß = 0·239, CI =0·089 to 0·388) and C-reactive protein (CRP) (ß = -0·138, CI = -0·272 to -0·004) with plasma leptin concentrations. Maternal body weight (ß = -0·871, CI = 0·475 to 1·267) and serum HDL-cholesterol concentrations (ß = 0·315, CI = -0·022 to 0·651) were also associated with leptin in OW women. In OB women, serum HDL-cholesterol (ß = 0·722, CI = 0·219 to 1·226), maternal body weight (ß = 0·666, CI = 0·187 to 1·145), triglycerides concentrations (ß = -0·130, CI = -0·241 to -0·020) and dietary carbohydrate (ß = 0·075, CI = 0·023 to 0·126) were significantly associated with plasma leptin. CONCLUSION: Maternal body weight and serum concentrations of HDL-cholesterol were associated with leptin changes independent of pregestational BMI. Serum CRP concentrations were associated with leptin only in NW women and serum triglycerides concentrations and dietary carbohydrate only in OB. These results indicate that factors that influence leptin concentrations differ according to pregestational BMI.
Assuntos
Peso Corporal/fisiologia , Leptina/sangue , Sobrepeso/sangue , Gravidez/sangue , Adulto , Feminino , Idade Gestacional , Humanos , Obesidade/sangue , Estudos Prospectivos , Adulto JovemRESUMO
Serum lipids have been associated with depression in the adult population; however, this association during pregnancy remains unclear. The aim of this study was to evaluate the association between serum lipids and depressive symptom scores during pregnancy. A prospective cohort of 238 pregnant women was followed at the 5th-13th, 20th-26th and 30th-36th weeks of gestation. Depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS). Serum concentrations (mg/dL) of triglycerides, total cholesterol, and low- and high-density lipoproteins (LDL-c; HDL-c) were the main exposures. Marital status (married/single), physical activity (active or very active/low or very low active), unplanned pregnancy (no/yes), pre-pregnancy BMI (<25/≥ 25 kg/m(2)), generalized anxiety disorder (no/yes) and current suicidal ideation (no/yes) were considered as potential confounders. Analyses were performed using linear mixed-effects models. The results showed that the EPDS mean score (95%CI) decreased with time during pregnancy trimesters [1st: 8.89 (95%CI = 8.28-9.51), 2nd: 7.32 (95%CI = 6.67-7.97) and 3rd: 7.08 (95%CI = 6.41-7.74)]. Suicidal ideation frequency at baseline was 18%. HDL-c concentrations were inversely associated with changes in EPDS score (ß = -0.080, 95%CI = -0.157 to -0.002), while low or very low active women (ß = 1.288, 95%CI = 0.630-1.946), with single marital status (ß = 1.348, 95%CI = 0.163-2.534), unplanned pregnancy (ß = 1.922, 95%CI = 0.714-3.131), generalized anxiety disorder (ß = 2.139, 95%CI = 0.410-3.868) and current suicidal ideation (ß = 1.927, 95%CI = 0.596-3.258) tended to have higher EPDS scores. No relationship was observed between other lipids and EPDS scores. HDL-c concentration was inversely associated with changes in depressive symptom scores during pregnancy after adjusting for socio-economic, demographic, behavioral, nutritional, biochemical and mental health disorders.
Assuntos
HDL-Colesterol/sangue , Depressão Pós-Parto/sangue , Depressão Pós-Parto/diagnóstico , Escalas de Graduação Psiquiátrica , Estatística como Assunto , Adulto , Brasil , Colesterol/sangue , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Gravidez , Triglicerídeos/sangue , Adulto JovemRESUMO
This study aimed to describe the prevalence of psychiatric disorders and to identify the factors associated with Current Suicide Risk (CSR) in the first trimester of pregnancy. The Mini-International Neuropsychiatric Interview (M.I.N.I.) was employed to diagnose mental disorders in 239 women enrolled in a prospective cohort in Rio de Janeiro, Brazil. Serum lipids, leptin and socio-economic status were the independent variables. CSR, the dependent variable, was entered as binary (yes/no) variable into crude and adjusted Poisson regression models with robust variances. CSR was found to be the main psychiatric syndrome (18.4%), followed by agoraphobia (17.2%), major depressive disorder (15.1%) and generalized anxiety disorder (10.5%). Women with CSR showed higher mean levels of cholesterol (169.2 vs. 159.2; p=0.017), high density lipoprotein (50.4 vs. 47.7; p=0.031) and low density lipoprotein (102.8 vs. 95.6; p=0.022) when compared to women without CSR. The adjusted regression model showed a higher prevalence ratio (PR) of CSR among pregnant women with generalized anxiety disorder (PR=2.70, 95% CI: 1.36-5.37), with ≥ two parturitions (PR=2.46, 95% CI: 1.22-4.93), and with major depressive disorder (PR=2.11, 95% CI: 1.08-4.12). We have shown that generalized anxiety disorder, major depressive disorder and higher parity are associated with CSR in the first trimester of pregnancy.
Assuntos
Leptina/sangue , Lipídeos/sangue , Transtornos Mentais/epidemiologia , Primeiro Trimestre da Gravidez/psicologia , Suicídio/psicologia , Adulto , Agorafobia , Brasil/epidemiologia , Estudos Transversais , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/psicologia , Feminino , Humanos , Transtornos Mentais/sangue , Transtornos Mentais/psicologia , Testes Neuropsicológicos , Gravidez , Prevalência , Estudos Prospectivos , Fatores de Risco , Fatores Socioeconômicos , Violência , Adulto JovemRESUMO
Os insulinomas são tumores malignos raros em cães, oriundos das células beta pancreáticas que produzeminsulina e levam a hipoglicemia. O objetivo do presente estudo retrospectivo foi descrever seiscasos de insulinoma canino. Os cães incluídos no estudo apresentavam faixa etária entre 7 e 16 anos,sendo 4 fêmeas e 2 machos. O diagnóstico baseou-se nos sinais clínicos e dosagem de insulina sérica porradioimunoensaio no momento de hipoglicemia (n=6), além da presença de massa pancreática por examede imagem (n=4). Todos os cães apresentaram como sinais iniciais a incoordenação, fraqueza e/ouconvulsões e a média de tempo até o diagnóstico foi de 2,2 meses. A hipoglicemia (média 34,67 ± 13,54mg/dL referência 70 110mg/dL) era a única alteração laboratorial presente e a hiperinsulinemia acimade 20 μu/mL (média 118 ± 75,11 μu/mL) se confirmou em todos dos cães. Apenas 4 apresentavamtumor visível no momento do diagnóstico. O exame histopatológico realizado em 3 cães confirmou ocaráter maligno dos tumores (carcinomas neuroendócrinos) e a avaliação imunohistoquímica de doiscasos demonstrou marcação positiva somente para insulina. Cães com sinais de fraqueza ou convulsãodevem ser sempre submetidos à avaliação glicêmica. Naqueles em que a hipoglicemia, mesmo que leve,for documentada, a dosagem de insulina sérica se faz necessária.(AU)
Insulinomas are rare malignant tumors in dogs, originating from pancreatic β cells that produceinsulin and lead to hypoglycemia. The aim of this retrospective study is to evaluate six cases ofcanine insulinomas. We included six diagnosed dogs aged between 7 and 16 years (4 females and 2males). The diagnosis was based on clinical signs associated with the measurement of serum insulinby radioimmunoassay at the time of hypoglycemia (n = 6), and the presence of pancreatic mass byimaging exams (n = 4). All dogs showed initial signs of lack of coordination, weakness, and / orseizures. The average time to diagnosis was 2.2 months. Hypoglycemia (mean 34.67 ± 13.54 mg/dL - Reference 70 110 mg/dL) was the only laboratory abnormality present and hyperinsulinemia above 20 μU/mL (mean 118 ± 75.11 μU/mL) was confirmed in all of the dogs. Only 4 dogs hadvisible tumor at the time of diagnosis. The histopathological examination confirmed the malignanttumors in 3 dogs (neuroendocrine carcinomas) and immunohistochemical evaluation of two casesshowed positive staining only for insulin. Dogs showing signs of weakness or seizure should alwaysbe evaluated for glucose levels. Those in whom hypoglycemia, even if mild, is documented, shouldcheck serum insulin levels.(AU)
Assuntos
Cães , Cães , Insulinoma/diagnóstico , Insulinoma/veterinária , Pâncreas , Hipoglicemia/veterináriaRESUMO
Os insulinomas são tumores malignos raros em cães, oriundos das células beta pancreáticas que produzeminsulina e levam a hipoglicemia. O objetivo do presente estudo retrospectivo foi descrever seiscasos de insulinoma canino. Os cães incluídos no estudo apresentavam faixa etária entre 7 e 16 anos,sendo 4 fêmeas e 2 machos. O diagnóstico baseou-se nos sinais clínicos e dosagem de insulina sérica porradioimunoensaio no momento de hipoglicemia (n=6), além da presença de massa pancreática por examede imagem (n=4). Todos os cães apresentaram como sinais iniciais a incoordenação, fraqueza e/ouconvulsões e a média de tempo até o diagnóstico foi de 2,2 meses. A hipoglicemia (média 34,67 ± 13,54mg/dL referência 70 110mg/dL) era a única alteração laboratorial presente e a hiperinsulinemia acimade 20 μu/mL (média 118 ± 75,11 μu/mL) se confirmou em todos dos cães. Apenas 4 apresentavamtumor visível no momento do diagnóstico. O exame histopatológico realizado em 3 cães confirmou ocaráter maligno dos tumores (carcinomas neuroendócrinos) e a avaliação imunohistoquímica de doiscasos demonstrou marcação positiva somente para insulina. Cães com sinais de fraqueza ou convulsãodevem ser sempre submetidos à avaliação glicêmica. Naqueles em que a hipoglicemia, mesmo que leve,for documentada, a dosagem de insulina sérica se faz necessária.
Insulinomas are rare malignant tumors in dogs, originating from pancreatic β cells that produceinsulin and lead to hypoglycemia. The aim of this retrospective study is to evaluate six cases ofcanine insulinomas. We included six diagnosed dogs aged between 7 and 16 years (4 females and 2males). The diagnosis was based on clinical signs associated with the measurement of serum insulinby radioimmunoassay at the time of hypoglycemia (n = 6), and the presence of pancreatic mass byimaging exams (n = 4). All dogs showed initial signs of lack of coordination, weakness, and / orseizures. The average time to diagnosis was 2.2 months. Hypoglycemia (mean 34.67 ± 13.54 mg/dL - Reference 70 110 mg/dL) was the only laboratory abnormality present and hyperinsulinemia above 20 μU/mL (mean 118 ± 75.11 μU/mL) was confirmed in all of the dogs. Only 4 dogs hadvisible tumor at the time of diagnosis. The histopathological examination confirmed the malignanttumors in 3 dogs (neuroendocrine carcinomas) and immunohistochemical evaluation of two casesshowed positive staining only for insulin. Dogs showing signs of weakness or seizure should alwaysbe evaluated for glucose levels. Those in whom hypoglycemia, even if mild, is documented, shouldcheck serum insulin levels.