Nutrition and Cardiovascular Diseases: Programming and Reprogramming

Abstract The Developmental Origin of Health and Disease (DOHaD) is an area of science dedicated to studying the processes by which insults during critical periods of mammals development leading to physiological changes resultig in diseases throughout life. Studies point to a complex interaction between nutritional status in early life and cardiovascular system homeostasis in which maternal malnutrition during gestation and/or lactation, as well as early weaning, are associated with development of cardiovascular diseases in adulthood. In this context, epigenetic changes, such as DNA methylation, histone acetylation, and change in microRNA expression have been considered molecular bases of cellular plasticity, which can also be gender-dependent. Experimental studies have demonstrated that interventions encompassing the consumption of functional food/bioactive compounds, as well as energetic and nutrients adjustments on the diet, may attenuate or even prevent consequences associated with plasticity of development, improving cardiovascular health. This review aimed to gather and discuss the findings within this context, published over the last ten years.

Programación fetal / Fetal programming

El término Origen Temprano de las Enfermedades del Adulto explica la aparición temprana de las condiciones anormales cardiovasculares y metabólicas en la vida adulta, mayor riesgo de morbilidad y muerte asociados a factores ambientales, especialmente nutricionales, que actúan en las primeras etapas de la vida. Estas respuestas programadas dependen de la naturaleza del estímulo o noxa, del tiempo de exposición y del momento de ocurrencia de la noxa, pudiendo un solo genotipo original varios fenotipos y estarían condicionadas por criterios críticos en los cuales se desarrollarían cambios a largo plazo pudiendo ser reversibles o no. La Programación Fetal explica que respuestas adaptativas embrionarias y fetales en un ambiente subóptimo genera consecuencias adversas permanentes. La desnutrición, así como la sobrenutrición fetal aumenta el riesgo de desarrollar alteraciones en el peso y composición corporal fetal, y posteriormente obesidad, síndrome metabólico, incremento en la adiposidad, alteración en el metabolismo de la glucosa y / o insulina, alteración del metabolismo lipídico, alteraciones hepáticas y de las cifras tensionales. La impronta genómica es esencial para el desarrollo y defectos en la misma puede originar alteraciones de la identidad parental transmisibles a las siguientes generaciones. Esta programación fetal puede ser explicada por la epigenética, definida como la serie de alteraciones hereditarias de la expresión genética a través de modificaciones del ADN y las histonas centrales sin cambios en la secuencia de ADN. Estas modificaciones epigenéticas alteran la estructura y condensación de la cromatina, afectando la expresión del genotipo y fenotipo. Este artículo desarrolla los aspectos involucrados en la Programación Fetal y los posibles mecanismos sobre la misma(AU)

The term Early Origin of Adult Diseases explains the early onset of abnormal cardiovascular and metabolic conditions in adult life, increased risk of morbidity and death associated with environmental factors, especially nutritional factors, that act in the early stages of life. These programmed responses depend on the nature of the stimulus or noxa, the time of exposure and the moment of occurrence of the noxa, with a single original genotype being able to have several phenotypes and would be conditioned by critical criteria in which long-term changes could develop, reversibles or not. Fetal Programming explains that embryonic and fetal adaptive responses in a suboptimal environment generate permanent adverse consequences. Fetal malnutrition as overnutrition increases the risk of developing alterations in fetal body weight and composition, and subsequently obesity, metabolic syndrome, increased adiposity, impaired glucose and / or insulin metabolism, impaired lipid metabolism, liver disorders and altered blood pressure. The genomic imprint is essential for development and defects in it can cause alterations of the parental identity and are transmitted to the following generations. This fetal programming can be explained by epigenetics, defined as the series of inherited alterations of genetic expression through modifications of DNA and central histones without changes in the DNA sequence. These epigenetic modifications alter the structure and condensation of chromatin, affecting the expression of the genotype and phenotype. This article develops the aspects involved in Fetal Programming and the possible mechanisms on it(AU)

Fetal malnutrition assessment program / 中国当代儿科杂志

OBJECTIVE@#To study the application of ponderal index (PI), body mass index (BMI), mid-arm circumference/head circumference (MAC/HC), and Clinical Assessment of Nutritional Status (CANS) score in assessing the nutritional status of neonates at birth, and to find a simple and reliable scheme for the assessment of fetal nutritional status.@*METHODS@#PI, BMI, MAC/HC, and CANS were used to assess the nutritional status of full-term infants and preterm infants shortly after birth. The assessment results of these methods were analyzed.@*RESULTS@#Among the 678 full-term infants, 61, 102, 47, and 131 were diagnosed with malnutrition by PI, BMI, MAC/HC, and CANS respectively. Among the 140 preterm infants, 30, 87, 9, and 112 were diagnosed with malnutrition by PI, BMI, MAC/HC, and CANS respectively. The combination of BMI and CANS had a detection rate of 99.3% in full-term infants and 100% in preterm infants. Compared with the single method, the combination significantly improved the detection rate of malnutrition (@*CONCLUSIONS@#The combination of BMI+CANS can reduce the rate of missed diagnosis of fetal malnutrition. It is therefore a simple and reliable method for the assessment of fetal malnutrition.

Avaliação do estado nutricional de recém-nascidos nas 48 horas de vida em maternidade pública de São Paulo: estudo transversal / Evaluation of the Nutritional Status of newborns in the 48 hours of life in Public maternity of São Paulo: cross-sectional study

Objetivo: Avaliar o estado nutricional dos recém-nascidos nas primeiras 48 horas de vida e identificar a frequência da desnutrição intrauterina. Material e Métodos: Trata-se de um estudo transversal, com abordagem quantitativa. Foram coletados dados das mães e dos recém-nascidos através de prontuário e realizou-se a avaliação nutricional dos recém-nascidos através do cálculo do índice ponderal e avaliação clínica do estado nutricional-escore ACENESCORE observando os nove sinais corporais. Foram avaliados 122 recém-nascidos em maternidade pública de nível terciário, no período de janeiro a setembro de 2018. Resultado: Dos recém-nascidos avaliados, 72 eram a termo e 50, pré-termo. Destes, 52% apresentaram desnutrição com ACENESCORE e com índice ponderal 18% pré-termo eram desnutridos. Com relação a análise estatística, a média do peso ao nascer dos recém-nascidos a termo do sexo masculino apresentou-se maior que o feminino (p>0,0026). Assim como os pré-termo (p>0,0179). Quanto ao comprimento, o termo do sexo masculino foi maior que o feminino (p>0,0411). Não houve diferença estatística na média do comprimento dos pré-termo. Conclusão: A avaliação clínica do estado nutricional-escore, identifica precocemente a perda visível dos sinais de gordura e músculo observados nos recém-nascidos desnutridos, o uso de múltiplos métodos antropométricos para determinar desnutrição fetal, aumentará a probabilidade de identificação. A frequência de desnutrição fetal foi relevante, deste modo, ressalta-se a importância de avaliar, detectar e monitorar a nutrição intrauterina desses recém-nascidos, para auxiliar na intervenção precoce, com a possibilidade da reversão da desnutrição e a consequente diminuição dos seus malefícios a criança, durante o seu desenvolvimento e crescimento. DESCRITORES: Recém-nascido. Avaliação Nutricional. Estado Nutricional. Desnutrição fetal.

Intérêt et limite de la prédiction de l'anémie fœtale par la mesure du pic systolique de vélocité dans l'artère cérébrale moyenne. A propos d'un cas d'anémie fœtale d'origine mixte

Objectif : Le but de notre travail était de décrire les difficultés diagnostiques et thérapeutiques d'un cas d'anémie fœtale dans un contexte mixte d'allo-immunisation anti-Rhésus D et d'infection materno-fœtale à cytomégalovirus (CMV).Observation : Nous rapportons un cas de grossesse avec allo-immunisation anti-D+C au cours de laquelle les mesures du pic systolique de vélocité de l'artère cérébrale moyenne n'ont jamais dépassé le seuil de 1,5 MoM (multiple de la médiane) justifiant habituellement une cordocentèse pour une transfusion in utero. L'issue néonatale a été marquée par une anémie importante à 8,2 g/dl avec transfusion sanguine ainsi que le diagnostic post-natal d'une transmission materno-fœtale d'infection à cytomégalovirus. Ce cas pose la question de la valeur du pic systolique de vélocité de l'artère cérébrale moyenne (PSV-ACM) fœtale dans les anémies d'origine autre que l'allo-immunisation érythrocytaire.Conclusion : La mesure du PSV-ACM reste une méthode efficace et non-invasive pour le diagnostic des anémies par allo-immunisation. Cependant, il n'est pas actuellement évalué pour le dépistage de l'anémie par infection à CMV. Une vigilance particulière est donc indispensable dans les anémies fœtales d'origine mixte

What is fetal programming?: a lifetime health is under the control of in utero health

The “Barker hypothesis” postulates that a number of organ structures and associated functions undergo programming during embryonic and fetal life, which determines the set point of physiological and metabolic responses that carry into adulthood. Hence, any stimulus or insult at a critical period of embryonic and fetal development can result in developmental adaptations that produce permanent structural, physiological and metabolic changes, thereby predisposing an individual to cardiovascular, metabolic and endocrine disease in adult life. This article will provide evidence linking these diseases to fetal undernutrition and an overview of previous studies in this area as well as current advances in understanding the mechanism and the role of the placenta in fetal programming.

A doença celíaca como causa de infertilidade feminina: uma revisão sistemática / Celiac disease as a cause of women infertility: a systematic review

A doença celíaca (DC) apresenta, além de alterações gastrintestinais, manifestações atípicas, como infertilidade. O trabalho objetivou demonstrar a relação entre DC e infertilidade feminina, bem como elucidar a importância de sua triagem, por via sorológica, em mulheres com infertilidade de causa desconhecida. Revisão sistemática de 40 artigos publicados entre 1999 e 2014, por meio de buscas sistemáticas utilizando as bases de dados MEDLINE (via PUBMED), LILACS e SciELO. A prevalência de DC no Brasil foi de um para 681 em grupos presumivelmente sadios e 1 para 293 em adultos e crianças sem queixas gastrintestinais. Foi descrito relação entre anticorpos presentes na DC e desordens do aparelho reprodutor feminino, determinando supressão de fatores de crescimento, alterações das funções secretoras da placenta, dano trofoblástico e apoptose tecidual. Além disso, a atrofia das vilosidades na DC promove deficiência nutricional, determinando oligomenorreia, metrorragia e dismenorreia. No recém-nascido, observou-se prematuridade, pré-eclâmpsia e indivíduos pequenos para idade gestacional. A grande relevância do diagnóstico se dá pelo fato de o tratamento poder prevenir danos tanto para o feto quanto para a mãe. Existe relação entre DC e infertilidade e a triagem sorológica em mulheres com infertilidade de causa desconhecida está indicada.(AU)

The celiac disease (DC) presents gastrintestinal alterations, as well as unusual signs such as infertility. The objective of this review is to demonstrate the relation between DC and woman infertility, and show the importance of its screening through serological methods in women with unexplained infertility. Systematic review of 40 published articles between 1999 and 2014, through systematic search using MEDLINE (via PUBMED), LILACS e SciELO databases. The prevalence of DC in Brazil was from one to 681 in healthy groups and from one to 293 in adults and children without gastrointestinal complaints. It was described a relation between antibodies present in DC and women reproductive system disorders, determining suppression of growth factors, alterations in the secretory placenta functions, trophoblastic damage and tissue apoptosis. Besides that, the atrophy of intestinal villus in DC promotes nutritional deficiency, determining oligomenorrhea, metrorrhagia e dysmenorrhea. In newborns, it was observed prematurity, pre-eclampsia and small individuals for gestational age. The biggest relevance of the diagnosis is due to the fact of the treatment to prevent damage for the fetus as well as the mother. There is a relation between DC and infertility so, the sorological screening in women with unexplained infertility is recommended.(AU)

Impacto da exposição pós-natal crônica ao estresse sobre o comportamento ansiogênico de ratos jovens induzidos pela desnutrição in utero / Impact of chronic postnatal exposure to stress on the anxiogenic behavior of young rats induced by undernutrition in utero

Exposure to stress and undernutrition alone are important risk factors in the development of neurobehavioral disorders. However, few studies focus on how chronic postnatal stress affects adaptive behavioral response to undernutrition in utero. OBJECTIVE: to investigate whether chronic postnatal stress exposure constitutes a risk factor in addition to undernutrition in utero to developing neurobehavioral disorders in young rats. METHODS: we evaluated the overall activity in the Open Field, and anxiety in the Elevated Plus Maze of male Wistar rats (35 days) from dams submitted or not to food restriction (50%) throughout pregnancy and exposed or not to restraint stress (single sections 1 h/day, 5 days/week for 2 weeks from weaning). RESULTS: postnatal stress and undernutrition in utero, alone and in combination, did not cause changes to the young rats behavior, except for a decrease of locomotion in the central and middle zone of the Open Field in the offsprings subjected to undernutrition in utero. The postnatal stress, alone and in combination, did not change the activity in Elevated Plus Maze. However, the time spent in the open arms decreased while the time in the closed arms increased in undernourished rats in utero. The anxiety index was decreased by undernutrition in utero. CONCLUSION: the absence of behavioral changes in young rats exposed to undernutrition in utero in association with chronic postnatal stress suggests that the physiological changes that lead to anxiogenic condition induced by undernutrition in utero alone take place mainly during the postnatal development

Exposição ao estresse e desnutrição, isoladamente, são importantes fatores de risco no desenvolvimento de transtornos neurocomportamentais. Entretanto, poucos estudos focam como o estresse pós-natal crônico afeta a resposta comportamental adaptativa à desnutrição in utero. OBJETIVO: investigar se a exposição pós-natal crônica ao estresse constitui-se em fator de risco adicional à desnutrição in utero para o desenvolvimento de transtornos neurocomportamentais em ratos jovens. MÉTODOS: avaliou-se a atividade geral, em Campo Aberto, e a ansiedade, no Labirinto em Cruz Elevado, de ratos machos Wistar (35 dias) provenientes de ratas submetidas ou não à restrição alimentar (50%) durante toda a prenhez, e expostos ou não ao estresse de contenção (seções únicas 1 h/dia, 5 dias/semana, durante 2 semanas a partir do desmame). RESULTADOS: o estresse pós-natal e a desnutrição in utero, isoladamente e em associação, não determinaram alterações no comportamento de ratos jovens, exceto pela diminuição da locomoção na zona central e mediana do Campo Aberto em proles submetidas à desnutrição in utero. O estresse pós-natal, isoladamente e em associação, não alterou a atividade no Labirinto em Cruz Elevado. Entretanto, o tempo de permanência nos braços abertos diminuiu enquanto o tempo nos braços fechados aumentou em ratos desnutridos in utero. O índice de ansiedade foi diminuído pela desnutrição in utero. CONCLUSÃO: a ausência de alterações comportamentais em ratos jovens expostos à desnutrição in utero em associação ao estresse pós-natal crônico sugere que as alterações fisiológicas que levam à condição ansiogênica induzida pela desnutrição in utero, isoladamente, têm lugar principalmente durante o desenvolvimento pós-natal

A developmental perspective on the origins of obesity and metabolic syndrome

Metabolic syndrome comprises central obesity, dyslipidemia, hypertension, glucose intolerance, and insulin resistance. Children sometimes develop metabolic syndrome, and it is strongly associated with the same syndrome in adulthood. Recently, there is evidence that obesity and metabolic syndrome originate from fetal life. Possible explanations of fetal and developmental origin of metabolic syndrome are the thrifty genotype and thrifty phenotype hypothesis, which together confer insulin resistance on developing fetus. Poor nutrition in utero as well as extrauterine growth restriction of preterm infants are important triggers of this hypothesis. Like metabolic syndrome in adulthood, the high levels of inflammatory cytokines and adipokines are certainly characteristic in pediatric patients. Increased fat mass was also observed in these patients, although their birth weight was lower than average. The mitochondrial genome is responsible for the inheritance of obesity from the maternal line. This can be a key as to why the phenotypes of obesity and metabolic syndrome start in fetal life with an association with poor maternal nutrition. In such circumstances, catch-up growth with an over-nutrition strategy can aggravate those features, suggesting that rapid catch-up growth in early infancy should not be encouraged.

Deficiencia de oligoelementos durante el primer trimestre del embarazo en maracaibo, venezuela / Deficiencies of trace elements during the first trimester of pregnancy at maracaibo, venezuela

Las deficiencias de oligoelementos es un importante problema de salud pública, que pone en riesgo principalmente a las embarazadas y a sus productos; por tanto se propuso determinar las concentraciones séricas de Hierro (Fe), Zinc (Zn) y Cobre (Cu) durante el primer trimestre del embarazo e identificar las patologías asociadas con su deficiencia durante el primer trimestre del embarazo, en embarazadas que acudían a la consulta prenatal de la Maternidad Dr. Armando Castillo Plaza del Hospital Universitario de Maracaibo, Venezuela durante el año 2012. Investigación fue de tipo descriptiva y aplicada; con un diseño de tipo no experimental y prospectivo, que incluyo una muestra no probabilística e intencionada de 70 mujeres en el primer trimestre del embarazo, a las cuales se les determinaron las concentraciones séricas de Fe, Zn y Cu. Se encontró que la edad promedio fue de 20,5± 6 años; 42,85% eran adolescentes y 57,15% adultas. Se determinó una media de FE, Zn y Cu de 40,04 ± 1,212 μg/dL, 0,566 ± 0,130 μg/mL y 1,326 ± 0,878 μg/mL, respectivamente; siendo las concentraciones de Fe y Zn más bajos en las adolescentes (< 0,001). Asimismo, se demostró que el 67%, 57% y 14% de estas embarazadas presentaban deficiencia de Fe, Zn y Cu, respectivamente; sin diferencias significativas entre adolescentes o adultas (p >0,05). Se concluye que existe una alta prevalencia de deficiencias de oligoelementos (Zn, Cu y Fe) en gestantes sin patologías asociadas y aparentemente sanas al inicio de su embarazo(AU)

Deficiencies of trace elements is an important public health problem that threatens mainly pregnant women and their products; we propose to determine serum iron (Fe), Zinc (Zn) and copper (Cu) during the first trimester of pregnancy and identify the pathologies associated with a deficiency during the first trimester of pregnancy in pregnant women attending antenatal care at Maternity Dr. Armando Castillo Plaza, University Hospital of Maracaibo, Venezuela during 2012. A descriptive and applied type research, with a non-experimental and prospective design, which includes a non-probabilistic intentional sample of 70 women during the first trimester of pregnancy, which were measured in serum Fe, Zn and Cu. We found that the age mean was 20,5± 6 years; in terms of the concentrations of these trace elements was determined an average of Fe, Zn and Cu of 40,04 ± 1,212 μg/dL, 0,566 ± 0,130 μg/mL and 1,326 ± 0,878μg/mL, respectively; with concentrations of Fe and Zn lower in adolescents (<0,001). It also showed that 67%, 57% and 14% of these pregnant women were deficient in Fe, Zn and Cu, respectively; without not significant differences between adolescents and adults patients (p> 0,05). Its concluded that exist a high prevalence of deficiencies of trace elements (Zn, Cu and Fe) in patients without associated diseases and apparently healthy at the beginning of her pregnancy(AU)

Impact of prenatal protein-calorie malnutrition on the odontogenesis of wistar rats / Impacto da desnutrição protéico-calórica pré-natal sobre a odontogênese de ratos wistar

Objetivo: Este trabalho teve por objetivo determinar alterações na odontogênese decorrentes da desnutrição protéico-calórica pré e pós-natal. Foram selecionados 12 ratos Wistar adultos, 8 fêmeas e 4 machos. As fêmeas foram divididas em dois grupos, sendo que um deles recebeu dieta normoprotéica (G1) e o outro recebeu dieta hipoprotéica (G2). Material e Métodos: Após o nascimento das ninhadas, foram separados aleatoriamente 24 filhotes de cada grupo. Os animais foram sacrificados, 12 aos 5 dias de vida e 12 aos 8, e suas mandíbulas submetidas à preparação histológica para a obtenção de cortes dos germes dentários. Foram selecionadas 48 lâminas que apresentavam os germes adequadamente cortados (24 de cada grupo), as quais foram analisadas em microscópio e medidas por um examinador calibrado utilizando-se o software Image Pro Plus for Windows, versão 6.0. As diferenças entre as médias foram verificadas mediante o teste não paramétrico de Mann Whitney. Resultados: Os resultados obtidos demonstram que, aos 5 dias, as diferenças de espessura de esmalte e dentina foram estatisticamente significantes entre G1 (84,08 ± 28,9 e 141,51 ± 33,2; p = 0,026) e G2 (47,26 ± 43,8 e 91,19 ± 54,7; p = 0,006). Aos 8 dias de vida não foram identificadas diferenças significativas entre os grupos. Conclusão: Os resultados demonstraram indícios de impacto da desnutrição sobre a espessura dos tecidos dentários. Sugere-se o aprofundamento desta linha de investigação com delineamentos mais complexos.

Objective: This study aimed to determine changes in odontogenesis arising from prenatal and postnatal protein-calorie malnutrition. Material and Methods: Twelve adult Wistar rats were selected; 8 females and 4 males. The females were divided into two groups, one of which received a normoproteic diet (NG) and the other received a hypoproteic diet (HG). After the birth of the litters, 24 pups were randomly separated from each group. The animals were sacrificed, 12 at five-days old and 12 at eight-days old, and their jaws were subjected to histological preparation to obtain cuts of tooth germs. Forty-eight slides were selected that presented the germs properly cut (24 from each group), which were analyzed by microscopy and measured by a calibrated examiner. The differences between means were verified by the nonparametric Mann-Whitney test. Results: The results showed that at 5 days the differences in thickness of enamel and dentin were statistically significant between NG (84.08 ± 28.9 and 141.51 ± 33.2; p = 0.026) and HG (47.26 ± 43.8 and 91.19 ± 54.7; p = 0.006). At 8 days of life there were no significant differences between the groups. Conclusion: The results showed evidence of the impact of malnutrition on the thickness of dental tissues. It is suggested that further work should be carried out in this line of research with more complex designs.

Desnutrição perinatal e o controle hipotalâmico do comportamento alimentar e do metabolismo do músculo esquelético / Perinatal undernutrition and hypothalamic control of food intake and energy metabolism in the skeletal muscle

A deficiência de nutrientes durante os períodos críticos do desenvolvimento tem sido associada com maior risco para desenvolver obesidade e diabetes Mellitus na vida adulta. Um dos mecanismos propostos refere-se à regulação do comportamento alimentar e às alterações do metabolismo energético do músculo esquelético. Recentemente, tem sido proposta a existência de uma comunicação entre o hipotálamo e o músculo esquelético a partir de sinais autonômicos que podem explicar as repercussões da desnutrição perinatal. Assim, esta revisão tem como objetivo discutir as repercussões da desnutrição perinatal sobre o comportamento alimentar e o metabolismo energético muscular e a comunicação existente entre o hipotálamo e o músculo via sinais adrenérgicos. Foram utilizadas as bases de dados MedLine/PubMed, Lilacs e Bireme, com publicações entre 2000 e 2011. Os termos de indexação utilizados foram: feeding behavior, energy metabolism, protein malnutrition, developmental plasticity, skeletal muscle e autonomic nervous system. Concluiu-se que a desnutrição perinatal pode atuar no controle hipotalâmico do comportamento alimentar e no metabolismo energético muscular, e a comunicação hipotálamo-músculo pode favorecer o desenvolvimento de obesidade e comorbidades durante o desenvolvimento.

Undernutrition during the critical period of development has been associated with susceptibility to obesity and diabetes Mellitus in adulthood. One of the underlying mechanisms can be related with the relationship between the food intake and the metabolism of skeletal muscle. A communication between the hypothalamus and skeletal muscle has been recently proposed, which can explain the repercussion of perinatal undernutrition. Thus, this review aims mainly to discuss the repercussions of perinatal undernutrition on food intake and skeletal muscle metabolism by adrenergic signals. Articles published from 2000 to 2011 were searched in the Medline/Pubmed, Lilacs and Bireme databases using the following keywords: feeding behavior, energy metabolism, protein malnutrition, developmental plasticity, skeletal muscle and autonomic nervous system. In conclusion, perinatal undernutrition can alter the hypothalamic control of food intake and skeletal muscle metabolism. Additionally, communication between the hypothalamus and skeletal muscle can promote the development of obesity and associated diseases.

Restricción del crecimiento intrauterino: Complicaciones inmediatas unidad neonatal, Hospital de San José, Bogotá DC / Immediate complications of intrauterine growth restriction neonatal unit - Hospital de San José Bogotá DC

Identificar las complicaciones de los recién nacidos (RN) con restricción del crecimiento intrauterino (RCIU) en un período de dos años y describir la mortalidad, características maternas y tiempo de inicio del aporte enteral. Métodos: estudio observacional descriptivo en todos los neonatos hospitalizados en la unidad de RN con RCIU en el Hospital de San José, Bogotá, DC, Colombia, entre abril 2009 y marzo 2011. Resultados: de 7.263 nacimientos, se identificaron 140 hospitalizados con RCIU, de estos 81 simétrico (57.8%) y 59 asimétrico (42.2%). Las complicaciones más frecuentes fueron dificultad respiratoria (50.7%), ictericia (48.5%) e hipoglicemia (17.8%). Se registraron cinco muertes (3.5%) y seis casos de enterocolitis necrosante (4.2%). El estrato socioeconómico bajo (56.4%) y la desnutrición (23.5%) fueron las características maternas más frecuentes. El inicio del aporte enteral fue más común en las primeras 24 horas de vida (77.1%), sin relación directa con el desarrollo de enterocolitis. Conclusión: es muy importante conocer los factores de riesgo que conducen a RCIU y sus complicaciones. La desnutrición materna y estrato socioeconómico pueden jugar un papel importante en su desarrollo y en el futuro el control puede ser la base para la prevención.

To describe the immediate (neonatal) complications of intrauterine growth restriction (IUGR), alongsidewith mortality rates, maternal factors and the initiation time of enteric feeding, in a two-year period. Methods: anobservational descriptive trial was conducted including the newborn babies with IUGR hospitalized in the neonatalunit at Hospital de San José, Bogotá, DC, Colombia, between April 2009 and March 2011. Results: out of 7,263 births140 neonates were diagnosed with IUGR and were admitted to the neonatal unit, 81 were classified as symmetricIURG (57.8%) and 59 as asymmetric IUGR (42.2%). The most common complications were respiratory distresssyndrome (50.7%), jaundice (48.5%) and hypoglycemia (17.8%). Five deaths were registered (3.5%) and six cases ofnecrotizing enterocolitis (4.2%) were identified. The most significant maternal factors associated with IUGR were alow socioeconomic status (56.4%) and poor nutrition (23.5%). Enteric support was most often initiated during the first24 hours after birth (77.1%), with no direct relation with the development of enterocolitis. Conclusions: it is extremelyimportant to know the factors that can contribute to IUGR and subsequent complications. Maternal malnutrition andlow socioeconomic status may play an important role in the development of IUGR. Adequate prenatal care may bethe base for prevention in the future.

Mortalidad neonatal: enfrentando el futuro / Neonatal mortality: confronting the future

El objetivo fue estudiar la mortalidad neonatal de los años 2005 a 2008, conocer su ocurrencia, determinar características maternas, condiciones obstétricas y factores relacionados. Es un estudio observacional analítico de 164 neonatos. Para el lapso hubo 10180 recién nacidos vivos en el Departamento de Obstetricia y Ginecología. Departamento Clínico Integral de la Costa. Universidad de Carabobo. Hospital Dr. Adolfo Prince Lara, Puerto Cabello, Estado Carabobo. La mortalidad neonatal fue 16.11 por mil recién nacidos vivos o una muerte cada 62 nacidos vivos. Hubo predominio de madres de 24 años y menos (55,56%), en antecedentes familiares destacó la hipertensión arterial (30,86%) y diabetes (4,3%), en antecedentes personales la prematurez (16,1%). El diagnóstico de ingreso fue amenaza de parto prematuro 21,61%, trabajo de parto pre-término 19,14% y rotura prematura de membrana 19,75%. No realizaron control prenatal 64,2%; eran multigestas 63,6%, con edad de embarazo menor igual 36 a semanas 72,22% y resultado en parto normal 71,61%. Predominaron los fetos masculinos (53,66%), con peso menor igual 2.500 g (78,66%) y talla menor igual 49 cm (88,4%), el índice Apgar de 7 y menos (84,75%). El factor de muerte directo conocido prevaleciente en 164 casos fue la insuficiencia repiratoria (53,66%), seguida de sepsis (21,95%) y asfixia perinatal (19,51%).

El objetive was to study the neonatal mortality of the years 2005-2008, knowing its impact, determine the material characteristics, obstetric conditions and related factors. It is a observational and analytical study of 164 neonatal death. For the period there were 10.180 live births in the Department of Obstetrics and Gynecology, Hospital "Dr. Adolfo Prince Lara", Puerto Cabello, Estado Carabobo. The neonatal mortality was 16,11 per thousand live births, or one death every 62 births. There were more mothers 24 years or less (55.56%), in personal prematurity (16.1%). The initial diagnosis was premature labor 21.61%, labor preterm 19.14% and pre-term premature rupture of membranes 19.75%. No prenatal care 64.2%, were multiparous 63.6%, with gestational age minor igual 36 weeks 72.22%, and ended in normal delivery 71.61%. A predominance of male fetuses (53,66%) with weight minor igual 2500 g (78.66%) and height minor igual 49 cm (88.4%), Apgar Index of 7 or less (84.75%). Factor prevalent direct death in 164 cases was respiratory failure (53.66%), followed by sepsis (21.95%) and perinatal asphyxia (19.51%).

Effects of intrauterine malnutrition on the renal morphology of Wistar rats: a systematic review

Introduction: Many epidemiological studies suggest that the intrauterine environment is extremely importantto the determination of the individual’s future health. Alterations in the maternal nutritional state, reflectedon the weight on birth, may program the litter for the development of diseases on the adult age. Studies withanimals exposed to intrauterine malnutrition have suggested a reduction in the number of glomeruli, as wellas arterial pressure increase. To review in the literature the alterations of the renal physiology of adult Wistarrats exposed to malnourishment during intrauterine life. Material and methods: A search was performedin the following databases: SciELO, MEDLINE, PUBMED, SCIENCE DIRECT and LILACS. The mainsearch terms were “malnutrition” and “renal function” both in Portuguese and in English. Were includedoriginal articles involving albino rats. Were excluded the review articles as well as those involving humanbeings. Results: According to Franco et al. (2009) the renal function and the number of glomeruli werereduced by the intrauterine malnutrition, predisposing the adult animals to renal diseases. For Chen and Chou(2009) the glomerular ultrastructure is not affected by maternal undernutrition, suggesting that this factordoes not contribute to the hypertension pathogenesis after maternal malnutrition. Conclusion: Intrauterinemalnourishment seems to interfere in the renal functions programming with alterations to the glomerulimorphology, but its mechanisms are yet uncertain. More randomized studies and clinical essays are suggestedin order to comprehend the factors that cause such process.

Restrição proteica materna e alteração do desenvolvimento das artérias coronárias em camundongos / Maternal protein restriction and alteration of the development of coronary arteries in mice

O desenvolvimento da programação fetal é considerado um importante fator de risco para doenças não-transmissíveis da vida adulta, incluindo doença cardíaca coronariana. Com o objetivo de investigar a associação entre nutrição materna e o desenvolvimento das artérias coronárias (AC) em embriões de camundongos estadiados; embriões de camundongos C57BL/6 nos estádios de 16-23 foram retirados de mães alimentadas com dietas de proteína normal (NP) ou de baixa proteína (LP), e as AC foram estudadas. Embora os embriões LP possuam massa corporal menor, entretanto tinham taxas de crescimento cardíaco maior, quando comparados com os embriões NP. O Plexo subepicárdico foi observado no início do período pós-somítico (estádio 16) em embriões NP, enquanto que nos embriões LP apenas no estádio 17 (P <0,01), persistindo até o estádio 18 (P <0,01). As artérias coronárias foram detectadas inicialmente no estádio 18 dos embrioes NP, já nos embriões LP foram encontradas a partir do estádio 19 (P <0,01). Núcleos apoptóticos foram observados em torno do anel aórtico peritruncal no estádio 18 em embriões NP e LP. Células FLK1+ (Fetal Liver Kinase 1 = VEGFr2 = Vascular Endothelial Growth Factor Receptor 2) apresentaram uma distribuição homogênea nos embriões NP já no estádio 18, enquanto uma distribuição semelhante nos embriões LP foi visto apenas nos estádios 22 e 23. A restrição proteica materna em camundongos leva a um atraso no crescimento do coração no período embrionário modificando o desenvolvimento do plexo peritruncal subepicárdica e diminuindo a taxa de apoptose na região do futuro orifício coronariano

Programming of fetal development is considered to be an important risk factor for non-communicable diseases of adulthood, including coronary heart disease (CHD). Aiming to investigate the association between maternal nutrition and the development of the coronary arteries (CA) in staged mice embryos, C57BL/6 mice embryos from stages 16 to 23 were taken from mothers fed a normal protein (NP) or low protein (LP) diet, and the CA were studied. Although the LP embryos had lower masses, they had faster heart growth rates when compared to the NP embryos. The subepicardial plexuses were observed earlier in the NP embryos (stage 20) than in the LP ones (stage 22) (P<0.01). Apoptotic nuclei were seen around the aortic peritruncal ring beginning at stage 18 in the NP and LP embryos. FLK1+ (fetal liver kinase 1 = VEGFr2 or vascular endothelial growth factor receptor 2) cells had a homogeneous distribution in the NP embryos as early as stage 18, whereas a similar distribution in the LP embryos was only seen at stages 22 and 23. Maternal protein restriction in mice leads to a delay in the growth of the heart in the embryonic period modifying the development of the subepicardial peritruncal plexus and the apoptosis in the future coronary orifice region

Mitochondrial Dysfunction and Insulin Resistance: The Contribution of Dioxin-Like Substances

Persistent organic pollutants (POPs) are known to cause mitochondrial dysfunction and this in turn is linked to insulin resistance, a key biochemical abnormality underlying the metabolic syndrome. To establish the cause and effect relationship between exposure to POPs and the development of the metabolic syndrome, Koch's postulates were considered. Problems arising from this approach were discussed and possible solutions were suggested. In particular, the difficulty of establishing a cause and effect relationship due to the vagueness of the metabolic syndrome as a disease entity was discussed. Recently a bioassay, aryl-hydrocarbon receptor (AhR) trans-activation activity using a cell line expressing AhR-luciferase, showed that its activity is linearly related with the parameters of the metabolic syndrome in a population. This finding suggests the possible role of bioassays in the analysis of multiple pollutants of similar kinds in the pathogenesis of several closely related diseases, such as type 2 diabetes and the metabolic syndrome. Understanding the effects of POPs on mitochondrial function will be very useful in understanding the integration of various factors involved in this process, such as genes, fetal malnutrition and environmental toxins and their protectors, as mitochondria act as a unit according to the metabolic scaling law.

Developmental origins of adult disease

Variation in the quality or quantity of nutrients consumed during pregnancy can exert permanent and powerful effects upon the developing fetus. This programming of fetal development is emerging as a new risk factor for non-communicable diseases of adulthood, including coronary heart disease and the metabolic syndrome. Epidemiological studies show that indicators of nutritional deficit in pregnancy are associated with greater risk of diabetes and cardiovascular mortality. The study of programming in relation to disease processes has been advanced by the development of animal models, which have utilized both under- and overfeeding of specific nutrients in pregnancy. Studies of this nature support the nutritional programming hypothesis and provide tools with which to examine the mechanisms through which programming may occur. Studies of animals subject to undernutrition in utero generally exhibit changes in the structure of key organs, such as the kidney and pancreas. These effects are consistent with the concept that programming influences remodel the development of organs. The causal pathways which extend from tissue remodelling to disease processes are relatively well characterised. In contrast, the processes which drive disordered organ development are poorly understood. It is noteworthy that minor perturbation of maternal nutritional status can programme fetal development. It is suggested therefore that programming is a product of altered expression of key genes. This drives the tissue remodelling response and future disease risk

Detection of fetal malnutrition using “CAN score”.

Objective. Use of clinical assessment of nutrition status (CAN) score to assess the prevalence of fetal malnutrition among term newborns and to compare other anthropometric criteria used to assess fetal growth. Methods. Prospective study of 529 term healthy newborns assessed using CAN score .Complete anthropometric assessment and determination of weight for gestation was done. Using CAN score as a standard, the usefulness of birth weight, weight for gestation, length, head circumference (HC), mid arm circumference (MAC), MAC/HC ratio and Ponderal index to assess fetal nutrition was determined. Results. With a cut off value of 25, CAN score identified 148 (27.97%) malnourished neonates. 4% of appropriate for gestational age neonate were malnourished and 42.9 % of small for gestational age neonates were well nourished. When CAN score was taken as a standard, weight for gestation and MAC/HC had the highest sensitivity to identify malnourished neonates (92.5% & 90.5%). Conclusion. CAN score identifies malnourished neonates which can be missed by other methods and identifies well nourished neonates classified as growth retarded by other methods.