This study evaluated the influence of iron supplementation in pregnancy and breastfeeding on iron status of lactating women from a Brazilian Human Milk Bank. Blood and mature breast milk samples were ...collected from 145 women for assessment of iron status, as well as copper and zinc status. Haemoglobin, serum iron and ferritin were determined, respectively, by electronic counting, colorimetry and chemiluminescence. Transferrin and ceruloplasmin were analysed by nephelometry. Serum copper and zinc were measured by atomic absorption spectrophotometry, and serum alkaline phosphatase was measured by a colorimetric method. Iron, zinc and copper in breast milk were determined by spectrometry. Mean values of iron, copper and zinc (blood and breast milk) were compared by ANOVA, followed by Tukey's test. Iron supplementation was beneficial to prevent anaemia in pregnancy but not effective to treat anaemia. During breastfeeding, iron supplementation had a negative effect on maternal copper status, confirming an interaction between these micronutrients.
The objective of this cross-sectional study was to assess the nutritional status of children and adolescents with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) receiving ...highly active antiretroviral therapy (HAART). One hundred and eighteen subjects aged 6-19 years attending an outpatient clinic in São Paulo city were involved in the study. The following anthropometric measurements were assessed: weight, height, waist circumference and triceps and subscapular skinfold thickness. One (0.9%) adolescent was diagnosed with abdominal obesity based on waist circumference measurement; three (2.5%) adolescents were obese based on subscapular skinfold thickness. According to the body mass index, the population studied was mainly eutrophic. The prevalence of fat redistribution, a characteristic of patients with HIV/AIDS under HAART, was low. We advise the development of further studies to assess the nutritional status of children and adolescents with HIV/AIDS using anthropometric measurements as well as computed tomography to detect fat redistribution.
A case-control study was performed to investigate the risk of cervical
cancer associated with p53 polymorphism at codon 72,
encoding either arginine or proline. It has been recently
suggested that ...the arginine isoform increases the susceptibility
to invasive cervical cancer; however, data remain controversial. The
polymorphism was examined by both allele-specific PCR and RFLP analysis
in 101 patients with primary cervical cancer and in 140 healthy women
of the same age and from the same geographical area. The distribution
of p53 genotypes in cervical cancer patients and in
controls was not significantly different ( P = 0.445),
and homozygosity for arginine at residue 72 was not associated with an
increased risk for cervical cancer (odds ratio, 0.81; 95% confidence
interval, 0.47–1.42; P = 0.52). Similarly, different
genotype distribution and increased risk were not observed when
patients versus controls were analyzed according to human
papillomavirus status and cancer histotype. Therefore, no
evidence of association between homozygosity for p53
arginine and cervical cancer was found in our population sample.
To estimate the associations between gestational weight gain (GWG) during pregnancy and neonatal outcomes in low and middle income countries.
Individual participant data meta-analysis.
Prospective ...pregnancy studies from 24 low and middle income countries.
Nine neonatal outcomes related to timing (preterm birth) and anthropometry (weight, length, and head circumference) at birth, stillbirths, and neonatal death.
A systematic search was conducted in PubMed, Embase, and Web of Science which identified 53 prospective pregnancy studies published after the year 2000 with data on GWG, timing and anthropometry at birth, and neonatal mortality. GWG adequacy was defined as the ratio of the observed maternal weight gain over the recommended weight gain based on the Institute of Medicine body mass index specific guidelines, which are derived from data in high income settings, and the INTERGROWTH-21st GWG standards. Study specific estimates, adjusted for confounders, were generated and then pooled using random effects meta-analysis models. Maternal age and body mass index before pregnancy were examined as potential modifiers of the associations between GWG adequacy and neonatal outcomes.
Overall, 55% of participants had severely inadequate (<70%) or moderately inadequate (70% to <90%) GWG, 22% had adequate GWG (90-125%), and 23% had excessive GWG (≥125%). Severely inadequate GWG was associated with a higher risk of low birthweight (adjusted relative risk 1.62, 95% confidence interval 1.51 to 1.72; 48 studies, 93 337 participants; τ
=0.006), small for gestational age (1.44, 1.36 to 1.54; 51 studies, 93 191 participants; τ
=0.016), short for gestational age (1.47, 1.29 to 1.69; 40 studies, 83 827 participants; τ
=0.074), and microcephaly (1.57, 1.31 to 1.88; 31 studies, 80 046 participants; τ
=0.145) compared with adequate GWG. Excessive GWG was associated with a higher risk of preterm birth (1.22, 1.13 to 1.31; 48 studies, 103 762 participants; τ
=0.008), large for gestational age (1.44, 1.33 to 1.57; 47 studies, 90 044 participants; τ
=0.009), and macrosomia (1.52, 1.33 to 1.73; 29 studies, 68 138 participants; τ
=0) compared with adequate GWG. The direction and magnitude of the associations between GWG adequacy and several neonatal outcomes were modified by maternal age and body mass index before pregnancy.
Inadequate and excessive GWG are associated with a higher risk of adverse neonatal outcomes across settings. Interventions to promote optimal GWG during pregnancy are likely to reduce the burden of adverse neonatal outcomes, however further research is needed to assess optimal ranges of GWG based on data from low and middle income countries.
To estimate the prevalence of preterm birth by categories of birth weight, and to obtain an equation to correct the estimates.
Systematic review of the Brazilian literature published from 1990 to ...2012, to identify studies with primary collection of data on birth weight and gestational age. Twelve studies were selected and contributed for tabulations of preterm prevalence according to 100 g birth weight categories. These results were combined using sex-specific fractional polynomial equations and the resulting curves were compared with results from the Live Birth Information System for the years 2000, 2005, 2010 and 2011.
For all birth weight categories, preterm prevalence estimates based on primary studies had a higher prevalence than those of the the Live Birth Information System. The prevalence reported by the Live Birth Information System was of 7.2% in 2010, about 38.0% lower than the estimated prevalence of 11.7% obtained with the correctional equation.
Information reported by the Live Birth Information System on preterm prevalence does not reflect the true magnitude of the problem in Brazil, and should not be used without the correction factors proposed in the present analyses.
(i) To evaluate the relationship between the levels of vitamin A, folate and iron in maternal blood and cord blood from mother-baby pairs who had intra-uterine growth retardation (IUGR) and ...appropriate birth weight (ABW) for gestational age. (ii) To assess low or marginal levels of vitamin A, folate and iron as risk factors for IUGR.
Retrospective unmatched case-control study.
Maternidade de Campinas, Universidade Estadual de Campinas, Pontificia Universidade Catolica de Campinas, Hospital Albert Sabin.
356 mother-baby pairs who had IUGR and 356 mother-baby pairs who had ABW for gestational age.
Newborns were classified as being IUGR according to the Lubchenco classification. Gestational age of the newborns was evaluated by the Capurro method. Vitamin A, folate, ferritin, and haemoglobin were measured respectively by high performance liquid chromatography (HPLC), radioimmunoassay, immunoenzymetric assay and by the cyanmethaemoglobin method.
The percentages of IUGR babies with abnormal levels of nutritional indices compared with ABW babies were 33.1 vs 14.6 for vitamin A, 25.7 vs 19.9 for red blood cell (RBC) folate, 37.0 vs 21.4 for haemoglobin, but similar for ferritin. The percentages of IUGR mothers with abnormal levels of nutritional indices compared to ABW mothers were similar (1.1 vs 1.4) for vitamin A, and 36.8 vs 32.1 for RBC folate. IUGR mothers were less often anaemic (43.2 vs 50.8), but tended to have higher levels of ferritin (37.6 vs 23.9) compared to ABW mothers.
These results indicate marked differences in cord blood between IUGR and ABW with small differences in maternal levels. They suggest that micronutrient deficiency is the result of being born small rather than vice versa. The high levels of ferritin in IUGR mothers may reflect subclinical maternal infection contributing to IUGR. Maternal micronutrient deficiency is unlikely to be a causative factor for IUGR in this population.
ODA (Overseas Development Agency), United Kingdom; CNPq (Conselho Nacional de Desenvolvimento Cientifico e Tecnologico), Brazil.
To evaluate the feasibility of allogeneic peripheral-blood progenitor-cell (PBPC) transplantation and to assess graft-versus-tumor effects in patients with metastatic breast cancer.
Ten patients with ...metastatic breast cancer that involved the liver or bone marrow were treated with high-dose chemotherapy and allogeneic PBPC transplantation. The median age was 42 years (range, 29 to 55). The median number of metastatic sites was three (range, one to five). The conditioning regimen was cyclophosphamide (6,000 mg/m2), carmustine (BCNU; 450 mg/m2), and thiotepa (720 mg/m2) (CBT regimen). Patients received graft-versus-host disease (GVHD) prophylaxis using cyclosporine- or tacrolimus-based regimens.
All patients had engraftment and hematologic recovery. Three patients developed grade > or = 2 acute GVHD and four patients had chronic GVHD. After transplantation, one patient was in complete remission (CR), five achieved a partial remission (PR), and four had stable disease (SD). In two patients, metastatic liver lesions regressed in association with skin GVHD after withdrawal of immunosuppressive therapies. The median follow-up time was 408 days (range, 53 to 605). The median progression-free survival duration was 238 days (range, 53 to 510).
We conclude that allogeneic PBPC transplantation is a feasible procedure for patients with poor-risk metastatic breast cancer. The regression of tumor associated with GVHD provides suggestive clinical evidence that graft-versus-tumor effects may occur against breast cancer. Compared with autologous transplantation, allogeneic PBPC transplantation is associated with the additional risks of GVHD and related infections. Allogeneic transplantation should only be performed in the context of clinical trials and its ultimate role requires demonstration of improved progression-free survival.
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