Population-based study of alpha- and gamma-tocopherol in plasma and adipose tissue as biomarkers of intake in Costa Rican adults.

BACKGROUND: gamma-Tocopherol is the most abundant form of vitamin E in the US diet, but alpha-tocopherol concentrations are the highest in plasma and tissues. Although plasma and adipose tissue concentrations of alpha-tocopherol have been used as biomarkers of intake, the relation between gamma-tocopherol intake and concentrations in plasma and adipose tissue is unknown. OBJECTIVE: Our goal was to investigate in a randomly selected population from Costa Rica whether plasma or adipose tissue concentrations of alpha- and gamma-tocopherol are suitable biomarkers of intake. DESIGN: A total of 361 men (x +/- SD age: 55 +/- 11 y) and 121 women (aged 59 +/- 10 y) completed a 135-item food-frequency questionnaire and provided a fasting blood sample and adipose tissue biopsy sample. RESULTS: Dietary gamma-tocopherol correlated with adipose tissue (r = 0.37, P < 0.001) and plasma (r = 0.42, P < 0.001) concentrations, regardless of supplement use. Dietary alpha-tocopherol correlated poorly with adipose tissue (r = 0.15, P < 0.01) and plasma (r = 0.16, P < 0.001) concentrations, and these correlations were even lower when users of vitamin supplements (n = 24) were excluded (adipose tissue: r = 0.10, P < 0.05; plasma: r = 0.09, P < 0.05). Compared with subjects who reported palm shortening (36%) as the major type of fat used for cooking, subjects using soybean oil (52%) had higher amounts of both alpha- and gamma-tocopherol in their diets. However, only gamma-tocopherol concentrations were higher in the plasma and adipose tissue of soybean oil users. CONCLUSIONS: Plasma and adipose tissue concentrations of gamma-tocopherol are equally good biomarkers of intake. The weak associations between alpha-tocopherol intake and plasma or adipose tissue concentrations suggest that these biomarkers are influenced more by factors other than alpha-tocopherol intake.

Circumstances of post-neonatal deaths in Ceara, Northeast Brazil: mothers' health care-seeking behaviors during their infants' fatal illness.

Promotion of oral rehydration therapy (ORT) for the treatment of diarrheal diseases and the WHO case management strategy for acute respiratory infections (ARI) have contributed to significant reductions in infant mortality, but these two conditions remain the leading causes of infant deaths in most developing countries. Identification of the factors contributing to these deaths may contribute to reduce infant mortality from preventable causes. To gain insight into the circumstances and maternal and health services factors that may contribute to infant deaths we used a verbal autopsy method to interview mothers of all infants who died during the previous 12 months (June 1995-May 1996) in 11 municipalities in the State of Ceara, Northeast Brazil. Our results revealed that one-third of the deaths occurred in a hospital and two-thirds at home. Almost all the infants who died at home, however, had been examined one or more times by a doctor, and 36% of them had been hospitalized during the disease episode that resulted in death. For most (85%) of these children the causes of death were diarrhea or acute respiratory infection, and it is likely that death could have been averted if appropriate treatment had been initiated promptly. Three major groups of factors that alone or in combination appeared to contribute to most deaths were delays in seeking medical care on behalf of the parents, medical interventions reported as ineffective by mothers and delays in providing medical care to children who arrived at the hospital too late in the day to be scheduled for consultation. Our findings suggest that government efforts to further reduce infant mortality in Ceara should focus on health education interventions that address quality of home care, recognition of signs of severity and danger and importance of seeking timely medical care: and on improving the quality of care provided at community health centers and hospitals. Measures likely to improve infants' chance of survival include: ensuring prompt access to medical consultation for young children brought to health centers or hospitals with potentially life-threatening symptoms related to infections, health education to mothers on the need for continued home care after discharge and to return to the medical care facility if the child does not recover, and that they have access to medicine prescribed by hospital physicians. Further benefits could be obtained by using community health workers, now integrated into the Family Medicine Program (PSF) health teams, to provide health education, supervise home care, refer mothers to health centers and facilitate their access to hospitals.

Frequency of food consumption and lipoprotein serum levels in the population of an urban area, Brazil.

OBJECTIVE: To identify the association between food group consumption frequency and serum lipoprotein levels among adults. METHODS: The observations were made during a cross-sectional survey of a representative sample of men and women over 20 years old living in Cotia county, S. Paulo, Brazil. Data on food frequency consumption, serum lipids, and other covariates were available for 1, 045 adults. Multivariate analyses adjusted by age, gender, body mass index, waist-to-hip ratio, educational level, family income, physical activity, smoking, and alcohol consumption were performed. RESULTS: Consumption of processed meat, chicken, red meat, eggs and dairy foods were each positively and significantly correlated with LDL-C, whereas the intake of vegetables and fruits showed an inverse correlation. Daily consumption of processed meat, chicken, red meat, eggs, and dairy foods were associated with 16.6 mg/dl, 14.5 mg/dl, 11.1 mg/dl, 5.8 mg/dl, and 4.6 mg/dl increase in blood LDL-C, respectively. Increases of daily consumption of fruit and vegetables were associated with 5.2 mg/dl and 5.5 mg/dl decreases in LDL-C, respectively. Alcohol beverage consumption showed a significant positive correlation with HDL-C. CONCLUSIONS: Dietary habits in the study population seem to contribute substantially to the variation in blood LDL and HDL concentrations. Substantially CHD risk reduction could be achieved with dietary changes.

Short stature and hypertension in the city of Rio de Janeiro, Brazil.

OBJECTIVE: Stature is a powerful indicator of poor nutrition early in life in nations where undernutrition is a public health problem. Hypertension in adults has been associated with factors present early in life such as low birth weight. We tested the hypothesis that short stature is associated with hypertension among adults. DESIGN AND SETTING: A household survey of representative adults in Rio de Janeiro city, Brazil was carried out in 1996. SUBJECTS: Blood pressure and anthropometric measures were collected from 2802 adults in their own households. Prevalence estimates and modelling incorporated the sample design and weights. RESULTS: Age-adjusted prevalence of hypertension for both sexes was lower in the third quartile of stature distribution. In women, but not in men, the odds ratio comparing the first quartile of stature with the fourth quartile was statistically significant with an odds ratio of 1.68 (95%CI 1.02-2.76). Adjusting for known risk factors for hypertension such as age, income, smoking, sodium and alcohol intake and race, the association among women, comparing the first with the fourth quartile for stature, was 1.84 (95%CI 1.03-3.30). With further adjustment for residual of weight on height the ratio reduced to 1.76 (95% CI 0.97-3.19, P value of trend = 0.03). Systolic blood pressure showed a U-shaped association with quartiles of stature, mainly among women, with a beta-coefficient significantly lower at the third quartile. CONCLUSIONS: This association of stature with hypertension supports the theory of an important ontogenetic dependence of adult blood pressure, at least among women.

Relationship between health services, socioeconomic variables and inadequate weight gain among Brazilian children.

This ecological analysis assessed the relative contribution of behavioural, health services and socioeconomic variables to inadequate weight gain in infants (0-11 months) and children (12-23 months) in 140 municipalities in the State of Ceara, north-east Brazil. To assess the total effect of selected variables, we fitted three unique sets of multivariate linear regression models to the prevalence of inadequate weight gain in infants and in children. The final predictive models included variables from the three sets. Findings showed that participation in growth monitoring and urbanization were inversely and significantly associated with the prevalence of inadequate weight gain in infants, accounting for 38.3% of the variation. Female illiteracy rate, participation in growth monitoring and degree of urbanization were all positively associated with prevalence of inadequate weight gain in children. Together, these factors explained 25.6% of the variation. Our results suggest that efforts to reduce the average municipality-specific female illiteracy rate, in combination with participation in growth monitoring, may be effective in reducing municipality-level prevalence of inadequate weight gain in infants and children in Ceara.

PIP: This article assesses the relationship between health services, socioeconomic variables, and inadequate weight gain among Brazilian children. The study used ecological analysis to assess the relative contributions of these variables to variations in the prevalence of inadequate weight gain among infants and young children in 140 municipalities in the State of Caera, northeast Brazil. The assessment of the total effect of selected variables involved fitting three unique sets of multivariate linear regression models to the prevalence of inadequate weight gain among infants and children. Findings showed several significant predictors of the prevalence of inadequate weight gains. These include participation in growth monitoring and a degree of urbanization, which together account for 38.3% of the variation, and female illiteracy rate (9.7% of the variation). Overall, these factors explain 25.6% of the variation in child growth. In conclusion, the study suggests that efforts to reduce the average municipality-specific female illiteracy rate, in combination with participation in growth monitoring may be effective in reducing municipality-level prevalence of inadequate weight gain among infants and children in Caera.

Variations in infant mortality rates among municipalities in the state of Ceará, Northeast Brazil: an ecological analysis.

BACKGROUND: Infant mortality rates vary substantially among municipalities in the State of Ceará, from 14 to 193 per 1000 live births. Identification of the determinants of these differences can be of particular importance to infant health policy and programmes in Brazil where local governments play a pivotal role in providing primary health care. METHODS: Ecological study across 140 municipalities in the State of Ceará, Brazil. RESULTS: To determine the interrelationships between potential predictors of infant mortality, we classified 11 variables into proximate determinants (adequate weight gain and exclusively breastfeeding), health services variables (prenatal care up-to-date, participation in growth monitoring, immunization up-to-date, and decentralization of health services), and socioeconomic factors (female literacy rate, household income, adequate water supply, adequate sanitation, and per capita gross municipality product), and included the variables in each group simultaneously in linear regression models. In these analyses, only one of the proximate determinants (exclusively breastfeeding (inversely), R2 = 9.3) and one of the health services variables (prenatal care up-to-date (inversely), R2 = 22.8) remained significantly associated with infant mortality. In contrast, female literacy rate (inversely), household income (directly) and per capita GMP (inversely) were independently associated with the infant mortality rate (for the model including the three variables R2 = 25.2). Finally, we considered simultaneously the variables from each group, and selected a model that explained 41% of the variation in infant mortality rates between municipalities. The paradoxical direct association between household income and infant mortality was present only in models including female illiteracy rate, and suggests that among these municipalities, increases in income unaccompanied by improvements in female education may not substantially reduce infant mortality. The lack of independent associations between inadequate sanitation and infant mortality rates may be due to the uniformly poor level of this indicator across municipalities and provides no evidence against its critical role in child survival. CONCLUSIONS: These results suggest that promotion of exclusive breastfeeding and increased prenatal care utilization, as well as investments in female education would have substantial positive effects in further reducing infant mortality rates in the State of Ceará.