Abstract Objective: To study the association between placental efficiency with anthropometry and nutritional phenotypes in full-term newborns from a birth cohort. Method: This was a secondary cross-sectional analysis of data obtained in a cohort study (Brazilian RibeirãoPreto and São Luís Birth Cohort Studies - BRISA), whose deliveries were performed between 2010 and 2011. Standardized questionnaires were applied to mothers, and placentas and newborns were evaluated shortly after delivery. Placental efficiency was assessed using the ratio between birth weight and placental weight (BW/PW ratio); values below the lower quartile (25th percentile for gestational age) were considered to have low placental efficiency. Newborn phenotypes were small and large for gestational age, stunted and wasted, evaluated using the INTERGROWTH-21 growth standard. To identify the confounding variables theoretical model was constructed using Directed Acyclic Graphs, and unadjusted and adjusted logistic regression were performed. Placental measurements were obtained blindly from pregnancy and delivery data. Results: 723 mother-placenta-child triads were studied. 3.2 % of newborns were small-for-gestational-age (SGA), 6.5 %large-for-gestational-age (LGA), 5.7 %had stunting, and 0.27 % wasting. A significantly higher risk was found between low placental efficiency and SGA (OR 2.82;95 % CI 1.05-7.57), stunting (OR 2.23; 95 % CI 1.07-4.65), and wasting (OR 8.22; 95 % CI 1.96-34.37). No relationship was found between LGA and placental efficiency. Conclusions: Low placental efficiency was associated with increased risk for small-for-gestational-age, stunting, and wasting. Placental morphometry can provide valuable information on intrauterine conditions and neonatal health, helping to identify newborns at higher risk of future comorbidities. Objective fullterm full term Method crosssectional cross sectional Brazilian BRISA, BRISA , BRISA) 201 2011 mothers BW/PW BWPW BW PW ratio) 25th th age wasted INTERGROWTH21 INTERGROWTH 21 INTERGROWTH-2 standard Graphs Results 72 motherplacentachild mother placenta child studied 32 3 2 3. smallforgestationalage SGA, (SGA) 65 6 5 6. %largeforgestationalage largeforgestationalage %large LGA, (LGA) 57 7 5. had 027 0 27 0.2 OR 2.8295 28295 2.82 82 2.82;9 1.057.57, 105757 1.05 7.57 1 05 1.05-7.57) 2.23 223 23 9 1.074.65, 107465 1.07 4.65 07 4 1.07-4.65) 8.22 822 8 22 1.9634.37. 1963437 1.96 34.37 . 96 34 37 1.96-34.37) Conclusions smallforgestationalage, health comorbidities 20 INTERGROWTH2 INTERGROWTH- (SGA (LGA 02 0. 8295 2.829 2829 282 2.8 2.82; 057 1.057.57 10575 105 1.0 757 7.5 1.05-7.57 2.2 074 1.074.65 10746 107 465 4.6 1.07-4.65 8.2 9634 1.9634.37 196343 196 1.9 3437 34.3 1.96-34.37 829 28 2. 1.057.5 1057 10 1. 75 7. 1.05-7.5 1.074.6 1074 46 4. 1.07-4.6 8. 963 1.9634.3 19634 19 343 34. 1.96-34.3 1.057. 1.05-7. 1.074. 1.07-4. 1.9634. 1963 1.96-34. 1.057 1.05-7 1.074 1.07-4 1.9634 1.96-34 1.05- 1.07- 1.963 1.96-3 1.96-

Resumo O objetivo deste artigo é avaliar associação entre peso ao nascer e asma na vida adulta pela análise de equações estruturais. Estudo de coorte com 1.958 participantes de 23-25 anos, residentes em Ribeirão Preto, São Paulo, Brasil. Foram aplicados questionários padronizados e avaliado a função pulmonar, incluindo hiper-reatividade brônquica com metacolina. O modelo teórico foi proposto para explorar os efeitos do peso ao nascer e asma na vida adulta. Asma, status socioeconômico ao nascimento (SES Nascimento) e status socioeconômico adulto (SES adulto) foram obtidos por um construto. Variáveis estudadas: idade materna, idade, sexo, cor da pele, índice de massa corporal (IMC), tabagismo, história de asma dos pais, história de infecção respiratória antes dos cinco anos, história de internação por doença pulmonar antes dos dois anos e atopia. 14,1% dos participantes foram diagnosticados com asma. Peso ao nascer foi associado com asma (Coeficiente Padronizado - CPtotal=-0,110; p=0,030), e foi observado efeito indireto (CPindireto=-0,220; p=0,037), mediado por internação antes dos dois anos e infecção respiratória antes dos 5 anos. Menor peso ao nascer aumentou o risco para asma na vida adulta e as variáveis SES Nascimento e SES adulto foram subjacentes a esta associação.

Abstract This article aims to evaluate the association between birth weight and asthma in adulthood, estimated by employing structural equation modeling. Cohort study with 1,958 participants aged 23-25 years from Ribeirão Preto, São Paulo, Brazil. Standardized questionnaires were applied and pulmonary function evaluated, including bronchial reactivity with methacholine. A theoretical model was proposed to explore the effects of birth weight and asthma in adulthood. Asthma, socioeconomic status at birth (Birth SES), and current socioeconomic status (Adult SES) were obtained by constructs. Maternal age, sex, skin color, body mass index (BMI), smoking, parental asthma history, history of respiratory infection before five years old, history of hospitalization for lung disease before two years old, and atopy were the studied variables. 14.1% of participants were diagnosed with asthma. Birth weight was associated with asthma (Standardized Coefficient - SCtotal=-0.110; p=0.030), and an indirect effect was also observed (SCindirect=-0.220; p=0.037), mediated by hospitalization before two years and respiratory infection before five years. Lower birth weight showed an increased risk of asthma in adulthood and the SES Birth and Adult SES variables underlie this association.

Resumo O objetivo deste artigo é avaliar associação entre peso ao nascer e asma na vida adulta pela análise de equações estruturais. Estudo de coorte com 1.958 participantes de 23-25 anos, residentes em Ribeirão Preto, São Paulo, Brasil. Foram aplicados questionários padronizados e avaliado a função pulmonar, incluindo hiper-reatividade brônquica com metacolina. O modelo teórico foi proposto para explorar os efeitos do peso ao nascer e asma na vida adulta. Asma, status socioeconômico ao nascimento (SES Nascimento) e status socioeconômico adulto (SES adulto) foram obtidos por um construto. Variáveis estudadas: idade materna, idade, sexo, cor da pele, índice de massa corporal (IMC), tabagismo, história de asma dos pais, história de infecção respiratória antes dos cinco anos, história de internação por doença pulmonar antes dos dois anos e atopia. 14,1% dos participantes foram diagnosticados com asma. Peso ao nascer foi associado com asma (Coeficiente Padronizado - CPtotal=-0,110; p=0,030), e foi observado efeito indireto (CPindireto=-0,220; p=0,037), mediado por internação antes dos dois anos e infecção respiratória antes dos 5 anos. Menor peso ao nascer aumentou o risco para asma na vida adulta e as variáveis SES Nascimento e SES adulto foram subjacentes a esta associação. estruturais 1958 1 958 1.95 2325 23 25 23-2 Preto Paulo Brasil hiperreatividade hiper reatividade metacolina Asma construto estudadas materna sexo pele IMC, IMC , (IMC) tabagismo pais atopia 141 14 14,1 Coeficiente CPtotal=0,110 CPtotal0110 CPtotal CPtotal= 0,110 0 110 CPtotal=-0,110 p=0,030, p0030 p p=0,030 030 p=0,030) CPindireto=0,220 CPindireto0220 CPindireto CPindireto= 0,220 220 (CPindireto=-0,220 p=0,037, p0037 p=0,037 037 p=0,037) 195 95 1.9 232 2 23- (IMC 14, CPtotal=0,11 CPtotal011 0110 0,11 11 CPtotal=-0,11 p003 p=0,03 03 CPindireto=0,22 CPindireto022 0220 0,22 22 (CPindireto=-0,22 19 9 1. CPtotal=0,1 CPtotal01 011 0,1 CPtotal=-0,1 p00 p=0,0 CPindireto=0,2 CPindireto02 022 0,2 (CPindireto=-0,2 CPtotal=0, CPtotal0 01 0, CPtotal=-0, p0 p=0, CPindireto=0, CPindireto0 02 (CPindireto=-0, CPtotal=0 CPtotal=-0 p=0 CPindireto=0 (CPindireto=-0 CPtotal=- p= (CPindireto=- (CPindireto= (CPindireto

Abstract This article aims to evaluate the association between birth weight and asthma in adulthood, estimated by employing structural equation modeling. Cohort study with 1,958 participants aged 23-25 years from Ribeirão Preto, São Paulo, Brazil. Standardized questionnaires were applied and pulmonary function evaluated, including bronchial reactivity with methacholine. A theoretical model was proposed to explore the effects of birth weight and asthma in adulthood. Asthma, socioeconomic status at birth (Birth SES), and current socioeconomic status (Adult SES) were obtained by constructs. Maternal age, sex, skin color, body mass index (BMI), smoking, parental asthma history, history of respiratory infection before five years old, history of hospitalization for lung disease before two years old, and atopy were the studied variables. 14.1% of participants were diagnosed with asthma. Birth weight was associated with asthma (Standardized Coefficient - SCtotal=-0.110; p=0.030), and an indirect effect was also observed (SCindirect=-0.220; p=0.037), mediated by hospitalization before two years and respiratory infection before five years. Lower birth weight showed an increased risk of asthma in adulthood and the SES Birth and Adult SES variables underlie this association. modeling 1958 1 958 1,95 2325 23 25 23-2 Preto Paulo Brazil evaluated methacholine Asthma SES, , constructs age sex color BMI, BMI (BMI) smoking old 141 14 14.1 SCtotal=0.110 SCtotal0110 SCtotal SCtotal= 0.110 0 110 SCtotal=-0.110 p=0.030, p0030 p p=0.030 030 p=0.030) SCindirect=0.220 SCindirect0220 SCindirect SCindirect= 0.220 220 (SCindirect=-0.220 p=0.037, p0037 p=0.037 037 p=0.037) 195 95 1,9 232 2 23- (BMI 14. SCtotal=0.11 SCtotal011 0110 0.11 11 SCtotal=-0.11 p003 p=0.03 03 SCindirect=0.22 SCindirect022 0220 0.22 22 (SCindirect=-0.22 19 9 1, SCtotal=0.1 SCtotal01 011 0.1 SCtotal=-0.1 p00 p=0.0 SCindirect=0.2 SCindirect02 022 0.2 (SCindirect=-0.2 SCtotal=0. SCtotal0 01 0. SCtotal=-0. p0 p=0. SCindirect=0. SCindirect0 02 (SCindirect=-0. SCtotal=0 SCtotal=-0 p=0 SCindirect=0 (SCindirect=-0 SCtotal=- p= (SCindirect=- (SCindirect= (SCindirect

Abstract Objective To assess a panel of cytokines and placental insufficiency with the risk of preterm delivery (PTD). Methods Nested case-control study into the BRISA birth cohort. Eighty-two mother-infant-placenta pairs were selected at 20+0 to 25+6 weeks. Circulating biomarker levels were performed using Luminex flowmetric xMAP technology. Cytokines classified as Th1, Th2 or Th17 and other biomarkers were selected. The ratio between birth weight and placental weight (BW/PW) was used as a proxy for placental efficiency. Spearman correlation, univariate analyses and logistic regression models were calculated. Sensitivity, specificity, positive and negative likelihood ratios were calculated using the Receiver Operating Characteristic curve. Results Mean gestational age was 250 days, 14,6% were small for gestational age, 4,8% large for gestational age and 13,4% stunted. Placental efficiency was higher for term newborns (p<0,001), and 18/22 (81%) preterm biomarker values were higher than the control group. Th1 cytokines were highly correlated, while the weakest correlation was observed in other biomarkers. Less education was associated with a higher risk of PTD (p = 0.046), while there was no appreciable difference in the risk of PTD for placental insufficiency. Biomarkers showed negligible adjusted OR of PTD (0.90 to 1.02). IL-6, IL-8, IL-1β, TNFβ, IL-4, IL-13, GCSF, MIP1A, VEGF, EGF, and FGF2 presented a higher sensitivity ranging from 75.56% to 91.11%. Conclusion IL-8, IL-12p40, IL-4, IL-13, GCSF, MIP1B, and GMSF in asymptomatic pregnant women were associated with PTD. This finding suggests an activation of maternal inflammatory response. . (PTD) casecontrol case cohort Eightytwo Eighty two motherinfantplacenta mother infant placenta 200 20 0 20+ 256 25 6 25+ weeks technology Th BW/PW BWPW BW PW (BW/PW Sensitivity specificity curve days 146 14 14,6 48 4 8 4,8 134 13 13,4 stunted p<0,001, p0001 p p<0,001 , 001 (p<0,001) 1822 18 22 18/2 81% 81 (81% group correlated 0.046, 0046 0.046 046 0.046) 0.90 090 90 (0.9 1.02. 102 1.02 1 02 1.02) IL6, IL6 IL 6, IL-6 IL8, IL8 8, IL-8 IL1β, IL1β ILβ 1β, 1β β IL-1β TNFβ IL4, IL4 4, IL-4 IL13, IL13 13, IL-13 GCSF MIP1A MIPA MIP A VEGF EGF FGF 7556 75 56 75.56 9111 91 11 91.11% IL12p40, IL12p40 ILp 12p40, 12p40 IL-12p40 MIP1B MIPB B response (PTD 2 14, p000 p<0,00 00 (p<0,001 182 18/ (81 004 0.04 04 0.9 09 9 (0. 10 1.0 IL- IL1 IL-1 755 7 5 75.5 911 91.11 IL12p4 12p4 IL-12p4 p00 p<0,0 (p<0,00 (8 0.0 0. (0 1. 75. 91.1 IL12p 12p IL-12p p0 p<0, (p<0,0 ( 91. p<0 (p<0, p< (p<0 (p<

Abstract Objective: To assess the predictive value of selected growth phenotypes for neonatal morbidity and mortality in preterm infants < 30 weeks and to compare them with INTERGROWTH-21st (IG21). Methods: Retrospective analysis of data from the Brazilian Neonatal Research Network (BNRN) database for very low birth weight (VLBW) at 20 public tertiary-care university hospitals. Outcome: the composite neonatal morbidity and mortality (CNMM) consisted of in-hospital death, oxygen use at 36 weeks, intraventricular hemorrhage grade 3 or 4, and Bell stage 2 or 3 necrotizing enterocolitis. Selected growth phenotypes: small-for-gestational-age (SGA) defined as being < 3rd (SGA3) or 10th (SGA10) percentiles of BW, and large-for-gestational-age (LGA) as being > 97th percentile of BW. Stunting as being < 3rd percentile of the length and wasting as being < 3rd percentile of BMI. Single and multiple log-binomial regression models were fitted to estimate the relative risks of CNMM, comparing them to IG21. Results: 4,072 infants were included. The adjusted relative risks of CNMM associated with selected growth phenotypes were (BNRN/IG21): 1.45 (0.92–2.31)/1.60 (1.27–2.02) for SGA; 0.90 (0.55–1.47)/1.05 (0.55–1.99) for LGA; 1.65 (1.08–2.51)/1.58 (1.28–1.96) for stunting; and 1.48 (1.02–2.17) for wasting. Agreement between the two references was variable. The growth phenotypes had good specificity (>95%) and positive predictive value (70-90%), with poor sensitivity and low negative predictive value. Conclusion: The BNRN phenotypes at birth differed markedly from the IG21 standard and showed poor accuracy in predicting adverse neonatal outcomes. Objective INTERGROWTH21st INTERGROWTHst INTERGROWTH 21st st IG . (IG21) Methods (BNRN VLBW (VLBW tertiarycare tertiary care hospitals Outcome (CNMM inhospital hospital death 4 enterocolitis smallforgestationalage small gestational age SGA (SGA rd SGA3 (SGA3 th SGA10 (SGA10 BW largeforgestationalage large LGA (LGA BMI logbinomial log binomial Results 4072 072 4,07 included BNRN/IG21 BNRNIG21 BNRNIG (BNRN/IG21) 145 1 45 1.4 0.92–2.31/1.60 092231160 0.92–2.31 /1.60 0 92 31 60 (0.92–2.31)/1.6 1.27–2.02 127202 27 02 (1.27–2.02 090 90 0.9 0.55–1.47/1.05 055147105 0.55–1.47 /1.05 55 47 05 (0.55–1.47)/1.0 0.55–1.99 055199 99 (0.55–1.99 165 65 1.6 1.08–2.51/1.58 108251158 1.08–2.51 /1.58 08 51 58 (1.08–2.51)/1.5 1.28–1.96 128196 28 96 (1.28–1.96 stunting 148 48 1.02–2.17 102217 17 (1.02–2.17 variable >95% 95 (>95% 7090%, 7090 70 90% , (70-90%) Conclusion IG2 outcomes (IG21 SGA1 (SGA1 407 07 4,0 BNRN/IG2 BNRNIG2 (BNRN/IG21 14 1. 0.92–2.31/1.6 09223116 092231 0.92–2.3 160 /1.6 9 6 (0.92–2.31)/1. 1.27–2.0 12720 (1.27–2.0 09 0. 0.55–1.47/1.0 05514710 055147 0.55–1.4 105 /1.0 5 (0.55–1.47)/1. 0.55–1.9 05519 (0.55–1.9 16 1.08–2.51/1.5 10825115 108251 1.08–2.5 158 /1.5 (1.08–2.51)/1. 1.28–1.9 12819 (1.28–1.9 1.02–2.1 10221 (1.02–2.1 >95 (>95 7090% 709 7 (70-90% (IG2 40 BNRN/IG (BNRN/IG2 0.92–2.31/1. 0922311 09223 0.92–2. /1. (0.92–2.31)/1 1.27–2. 1272 (1.27–2. 0.55–1.47/1. 0551471 05514 0.55–1. 10 (0.55–1.47)/1 0551 (0.55–1. 1.08–2.51/1. 1082511 10825 1.08–2. 15 (1.08–2.51)/1 1.28–1. 1281 (1.28–1. 1.02–2. 1022 (1.02–2. >9 (>9 (70-90 (IG (BNRN/IG 0.92–2.31/1 0922 0.92–2 /1 (0.92–2.31)/ 1.27–2 127 (1.27–2 0.55–1.47/1 0.55–1 (0.55–1.47)/ 055 (0.55–1 1.08–2.51/1 1082 1.08–2 (1.08–2.51)/ 1.28–1 128 (1.28–1 1.02–2 102 (1.02–2 (> (70-9 0.92–2.31/ 092 0.92– / (0.92–2.31) 1.27– 12 (1.27– 0.55–1.47/ 0.55– (0.55–1.47) (0.55– 1.08–2.51/ 108 1.08– (1.08–2.51) 1.28– (1.28– 1.02– (1.02– ( (70- 0.92 (0.92–2.31 1.27 (1.27 0.55 (0.55–1.47 (0.55 1.08 (1.08–2.51 1.28 (1.28 1.02 (1.02 (70 (0.92–2.3 1.2 (1.2 0.5 (0.55–1.4 (0.5 1.0 (1.08–2.5 (1.0 (7 (0.92–2. (1. (0. (1.08–2. (0.92–2 (1 (0 (1.08–2 (0.92– (1.08– (0.92 (1.08 (0.9

Resumo O objetivo do estudo foi estimar percepção e ocorrência de situações de abuso, desrespeito e maltrato (ADM) na assistência ao parto de 745 mulheres pertencentes às coortes de nascimentos de Ribeirão Preto. Foram aplicados questionários sigilosos contendo uma pergunta sobre percepção de maltrato na assistência ao parto e outras sobre exposição a situações de ADM. Utilizou-se o teste qui-quadrado para comparar as situações apresentadas entres as mulheres que relataram ou não maltrato. A análise foi realizada por meio do programa Stata 14. Das 745 mulheres avaliadas, 66,2% foram expostas a alguma situação de ADM e 8,3% referiram ter percebido ADM. As situações mais frequentes foram: 30,5% não puderam comer nem beber nada; 27,5% tiveram sua barriga apertada para ajudar a criança a nascer; e 25,5% não puderam ficar com acompanhante de sua escolha. Mulheres que afirmaram ter sofrido maltrato apresentaram maiores frequências de respostas positivas a todas situações de ADM quando comparadas com às demais, exceto para os seguintes relatos: “Não me deixaram comer nem beber nada” (p = 0,975) e “Fui forçada a ter parto cesáreo contra minha vontade” (p = 0,073). Apesar de a maior parte das mulheres pertencentes às coortes de Ribeirão Preto relatarem exposição a situações de ADM durante a assistência ao parto, uma minoria percebeu desrespeito ou maltrato.

Abstract This study aimed to estimate the perception and frequency of abuse, disrespect and mistreatment (ADM) situations during childbirth care of 745 women from the Ribeirão Preto birt cohorts. Confidential questionnaires containing one question regarding perceived abuse during childbirth care and other questions addressing exposure to ADM situations were applied. The chi-squared test was used to compare the situations presented between women who did and did not report mistreatment using the Stata 14.0 software. Among the 745 women evaluated, 66.2% were exposed to some situation of ADM and 8.3% reported having perceived ADM. The most frequent situations were that the woman could not eat or drink (30.5%), the woman had her belly squeezed to help the child be born (27.5%), and the woman could not stay with a companion of her choice (25.5%). Women who reported to have suffered maltreatment more frequently responded positively to all situations of ADM when compared to the other participants, except for the following statements: “I was not allowed to eat or drink anything” (p = 0.975) and “I was forced to have a cesarean delivery against my will” (p = 0.073). Although most women of the Ribeirão Preto cohorts reported exposure to ADM situations during childbirth care, a minority perceived disrespect or mistreatment.

Resumo O objetivo do estudo foi estimar percepção e ocorrência de situações de abuso, desrespeito e maltrato (ADM) na assistência ao parto de 745 mulheres pertencentes às coortes de nascimentos de Ribeirão Preto. Foram aplicados questionários sigilosos contendo uma pergunta sobre percepção de maltrato na assistência ao parto e outras sobre exposição a situações de ADM. Utilizou-se o teste qui-quadrado para comparar as situações apresentadas entres as mulheres que relataram ou não maltrato. A análise foi realizada por meio do programa Stata 14. Das 745 mulheres avaliadas, 66,2% foram expostas a alguma situação de ADM e 8,3% referiram ter percebido ADM. As situações mais frequentes foram: 30,5% não puderam comer nem beber nada; 27,5% tiveram sua barriga apertada para ajudar a criança a nascer; e 25,5% não puderam ficar com acompanhante de sua escolha. Mulheres que afirmaram ter sofrido maltrato apresentaram maiores frequências de respostas positivas a todas situações de ADM quando comparadas com às demais, exceto para os seguintes relatos: “Não me deixaram comer nem beber nada” (p = 0,975) e “Fui forçada a ter parto cesáreo contra minha vontade” (p = 0,073). Apesar de a maior parte das mulheres pertencentes às coortes de Ribeirão Preto relatarem exposição a situações de ADM durante a assistência ao parto, uma minoria percebeu desrespeito ou maltrato.

Abstract This study aimed to estimate the perception and frequency of abuse, disrespect and mistreatment (ADM) situations during childbirth care of 745 women from the Ribeirão Preto birt cohorts. Confidential questionnaires containing one question regarding perceived abuse during childbirth care and other questions addressing exposure to ADM situations were applied. The chi-squared test was used to compare the situations presented between women who did and did not report mistreatment using the Stata 14.0 software. Among the 745 women evaluated, 66.2% were exposed to some situation of ADM and 8.3% reported having perceived ADM. The most frequent situations were that the woman could not eat or drink (30.5%), the woman had her belly squeezed to help the child be born (27.5%), and the woman could not stay with a companion of her choice (25.5%). Women who reported to have suffered maltreatment more frequently responded positively to all situations of ADM when compared to the other participants, except for the following statements: “I was not allowed to eat or drink anything” (p = 0.975) and “I was forced to have a cesarean delivery against my will” (p = 0.073). Although most women of the Ribeirão Preto cohorts reported exposure to ADM situations during childbirth care, a minority perceived disrespect or mistreatment.

Abstract Objectives: The objective was to calculate weight/length (W/L) ratio values and percentiles by sex and gestational age (GA) to estimate fat mass (FM), fat-free mass (FFM) and body fat percentage (BF%) as well as to compare these indices in preterm, small (SGA), and large (LGA) for GA, stunted and wasted infants from a Brazilian cohort of newborns, comparing with the INTERGROWTH-21st. Methods: Secondary, cross-sectional analysis of data obtained of 7427 live-born infants from the BRISA Cohort Study in the city of Ribeirão Preto, SP, Brazil in 2010. For body composition estimation, W/L ratio was used in multiple regression models. The 3rd, 50th, and 97th percentiles for W/L ratio and body composition measures (FM, FFM, and BF%) were calculated using fractional polynomial regression models. Results: Average W/L ratio was 6.50 kg/m (SD 0.87), while for FM, BF%, and FFM the corresponding values were 359.64 g (145.76), 10.90% (3.05) and 2798.84 g (414.84), respectively. SGA (< 3rd percentile), and wasted infants showed the lowest W/L ratios and measures of body composition. The 3rd, 50th, and 97th percentiles charts of W/L, FM, BF%, and FFM by GA and sex are presented. Conclusions: W/L ratio values of the RP-BRISA Cohort are higher than IG-21st. SGA (< 3rd) and wasted infants showed the lowest W/L ratio and measures of body composition. The body composition references presented here could be used to refine the nutritional assessment of Brazilian newborns and to facilitate comparisons across populations.

RESUMO - RACIONAL: A etiopatogenia da colite por desuso (DC) ainda não foi totalmente elucidada. As principais teorias consideram que a doença pode estar relacionada ao aumento de bactérias anaeróbias, falta de suprimento de ácidos graxos de cadeia curta (AGCC) e distúrbios imunológicos que se desenvolvem em segmentos colorretais desprovidos de trânsito fecal. OBJETIVO: Verificar se a aplicação de infliximabe modifica o conteúdo tecidual das proteínas E-caderina e claudina-3 no epitélio cólico de ratos sem trânsito intestinal. MÉTODOS: Vinte dois ratos foram submetidos a derivação do trânsito intestinal pelo procedimento de Hartmann. Eles permaneceram com o ostoma por 12 semanas para permitir o desenvolvimento da colite de exclusão. Em seguida, foram divididos em três grupos experimentais: seis animais receberam 2,0 ml de solução salina/semana, oito infliximabe na dose de 5 mg/Kg/semana e, os demais, infliximabe na dose de 10 mg/Kg/semana por 5 semanas consecutivas. Em seguida, os animais foram eutanasiados e os segmentos cólicos com e sem trânsito intestinal foram removidos. A colite por desuso foi diagnosticada pelas alterações histológicas definidas por uma escala previamente validada. Expressão tecidual de E-caderina e claudina-3 foi avaliada por imuno-histoquímica, e o conteúdo tecidual de ambas as proteínas foi quantificado por análise de imagem assistida por computador. RESULTADOS: Segmentos cólicos exclusos de trânsito fecal apresentaram maior grau de inflamação do que os expostos ao trânsito fecal. Inflamação foi menor nos animais tratados com infliximabe, independente da dose utilizada. Níveis de E-caderina e claudina-3 estavam reduzidos no cólon excluso. O tratamento com infliximabe aumentou os níveis das proteínas em segmentos do cólon sem trânsito intestinal, principalmente nos animais que receberam a dose de 10mg/kg/semana. CONCLUSÃO: Infliximabe reduz inflamação nos segmentos do cólon excluso e aumenta o conteúdo tecidual de E-caderina e claudina-3, especialmente na concentração de 10mg/kg/semana.

ABSTRACT - BACKGROUND: The etiopathogenesis of disuse colitis (DC) has not yet been fully elucidated. The main theories consider that the disease may be related to an increase in anaerobic bacteria, the lack of short-chain fatty acid (SCFA) supply, and immunological disorders that develop in the colorectal segments devoid of fecal transit. AIM: The aim of this study was to verify whether the application of infliximab modifies the tissue content of E-cadherin and claudin-3 proteins in colonic epithelium of rats devoid of intestinal transit. METHODS: A total of 22 rats underwent intestinal transit bypass using Hartmann’s procedure. They remained with the shunt for 12 weeks to allow the development of DC. Later, they were divided into three experimental groups: six animals received 2.0 mL saline solution/week, eight received infliximab at a dose of 5 mg/kg/week, and eight received infliximab at a dose of 10 mg/kg/week for 5 consecutive weeks. At the end of this period, the animals were euthanized, and the colonic segments with and without intestinal transit were removed. DC was diagnosed based on the histological changes defined by a previously validated scale. The tissue expression of E-cadherin and claudin-3 was assessed by immunohistochemistry, and the tissue content of both proteins was quantified by computer-aided image analysis. RESULTS: The colonic segments excluded from fecal transit showed a higher degree of inflammation than those exposed to fecal transit. The degree of inflammation was lower in animals treated with infliximab, regardless of the dose used. The levels of E-cadherin and claudin-3 were reduced in the excluded colon. Treating animals with infliximab increased the levels of both proteins in the colonic segments without intestinal transit, especially in animals receiving a dose of 10 mg/kg/week. CONCLUSION: Infliximab therapy reduces inflammation in the colonic segments excluded from intestinal transit and increases the tissue content of E-cadherin and claudin-3 proteins, especially when used at a concentration of 10 mg/kg/week.

ABSTRACT Purpose Quantify the tissue content of metalloproteinase-9 (MMP-9) and collagen in colic mucosa with and without intestinal transit after infliximab administration in rats subjected to Hartmann’s surgery. Methods Twenty-two rats underwent colon diversion by Hartmann’s surgery. Animals were maintained with intestinal bypass for 12 weeks to induce development of diversion colitis (DC). Afterwards, animals were divided into three groups: first group received subcutaneous application of saline solution (SS) 0.9%, while the remaining two groups received infliximab subcutaneously at doses of 5 or 10 mg·kg–1·week–1 for five consecutive weeks. After the intervention, animals were sacrificed, removing the segments with and without intestinal transit. Diversion colitis was diagnosed by histological study, and its intensity was determined by a validated inflammatory scale. Tissue expression of MMP-9 was assessed byimmunohistochemistry, while total collagen was assessed by histochemistry. Tissue content of both was measuredby computerized morphometry. Results Colon segments without intestinal transit had a higher degree of inflammation, which improved in animals treated with infliximab. Collagen content was always lower in those without intestinal transit. There was an increase in the collagen content in the colon without transit in animals treated with infliximab, primarily at a dose of 10 mg·kg–1·week–1. There was an increase in the content of MMP-9 in the colon without fecal transit, and a reduction was observed in animals treated with infliximab, regardless of the dose used. Conclusions Application of infliximab reduces inflammation, increases the total collagen content and decreases the content of MMP-9 in the colon without intestinal transit.

Resumo Nas últimas décadas, inúmeros estudos têm sido desenvolvidos a respeito de estruturas de pórticos preenchidos com alvenaria participante, comprovando o aumento de rigidez lateral proporcionado por esta. Neste trabalho, análise foi realizada, baseada em prescrições normativas que adotam o método da barra diagonal equivalente, com o objetivo de comparação aos resultados experimentais de ensaios de pórtico de aço preenchido com alvenaria de blocos de concreto. Duas das três normas técnicas estudadas sugeriram valores de rigidez lateral inferiores aos resultados experimentais, como condição de segurança ao dimensionamento. Sobre as forças de ruptura da alvenaria, os dois procedimentos analisados apresentaram valores próximos de força crítica, embora tenham apontado modos críticos de colapso distintos. O método da barra diagonal equivalente se mostrou uma ferramenta útil e simples para a consideração da alvenaria participante, devendo ser empregado em caso de ações horizontais reduzidas, prévias ao estágio inicial de fissuração do painel.

Abstract In the last decades, several studies have been developed regarding structures composed by frames infilled with masonry walls, proving the increase of lateral stiffness by the infill. In this work, an analysis was carried out, based on design codes which adopt the equivalent diagonal strut method, to compare theoretical results with experimental ones of tests performed on steel frames infilled with concrete block masonry. Two of the three assessed codes specify lateral stiffness smaller than that measured from experimental testing, as safety measures for design. Regarding the masonry ultimate loads, the two specifications analyzed yielded similar values of critical force, although they pointed out different failure modes. The equivalent diagonal strut method has been proved to be a simple and useful tool for considering masonry walls and it should be used in case of reduced horizontal loads, prior to initial cracks of the infill wall.

Resumo Objetivos: Determinar os percentis 3, 50 e 97 de peso, comprimento e perímetro cefálico de recém-nascidos da Coorte BRISA Ribeirão Preto, segundo sexo e idade gestacional, e comparar com o padrão Intergrowth-21st; b) Estimar os fenótipos pequeno para idade gestacional (< percentil 3), grande para idade gestacional (> percentil 97), stunting (comprimento < percentil 3) e waisting (índice de massa corporal < percentil 3). Método: Estudo observacional de uma coorte de 7.702 recém-nascidos entre 01/01 e 31/12/2010 na cidade de Ribeirão Preto, SP, Brasil. Os percentis 3, 50 e 97 para as medidas antropométricas foram determinados com regressão polinomial fracionária. Resultados: A diferença de peso entre Ribeirão Preto e Intergrowth-21st foi pequena, mais acentuada nos recém-nascidos pré-termo (diferença média entre as duas populações foi de + 266 gramas); para os recém-nascidos a termo a diferença média foi de + 66 gramas e para os pós-termo de -113 gramas. Para comprimento, a variação média foi sempre < 1 cm; enquanto que para perímetro cefálico os recém-nascidos pré-termo apresentaram variação > 1 cm e os recém-nascidos a termo e pós-termo tiveram variação < 1 cm. As taxas de detecção de pequeno e grande para idade gestacional foram 2,9% e 4,3%, respectivamente. Stunting afetou 6,5% de todos os recém-nascidos e waisting 1,5%, com predomínio em meninas e em gestações a termo; ambas as condições estavam presentes em 0,4% da amostra. Conclusões: Os recém-nascidos de Ribeirão Preto, quando comparados com o padrão Intergrowth-21st, apresentam-se mais pesados, mais longos e com maior circunferência craniana até chegarem a termo.

Abstract Objectives: (a) To determine the 3rd, 50th, and 97th percentiles of weight, length, and head circumference of newborns from the Ribeirão Preto BRISA cohort, according to gender and gestational age, and compare them with the Intergrowth-21st standard; (b) To estimate the small for gestational age ( < 3rd percentile), large for gestational age ( > 97th percentile), stunting (length < 3rd percentile), and wasting (body mass index < 3rd percentile). Methods: Observational study of a cohort of 7702 newborns between 01/01/2010 and 12/31/2010 in the city of Ribeirão Preto, SP, Brazil. The 3rd, 50th, and 97th percentiles were determined for the anthropometric measurements using fractional polynomial regression. Results: The weight difference between Ribeirão Preto and Intergrowth-21st was small, being more pronounced in preterm infants (mean difference between the two populations of +266 g); for full-term newborns, there was a mean difference of +66 g, and for post-term infants, of -113 g. For length, the mean variation was always <1 cm; whereas for head circumference, preterm newborns showed a variation >1 cm, and full-term and post-term newborns showed a variation of <1 cm. The small and large for gestational age detection rates were 2.9% and 4.3%, respectively. Stunting affected 6.5% of all newborns and wasting, 1.5%, with a predominance in girls and in full-term pregnancies; both conditions were present in 0.4% of the sample. Conclusions: Newborns from Ribeirão Preto, when compared to the Intergrowth-21 standard, are heavier, longer, and have a larger head circumference until they reach full-term.

RESUMO: Introdução: Estudos epidemiológicos demonstraram associações entre medidas placentárias, resultados perinatais e futuros. Objetivos: Descrever medidas placentárias e avaliar suas associações com peso ao nascer numa coorte de nascimentos brasileira. Metodologia: Estudo de coorte retrospectiva de 958 mães, placentas e recém-nascidos no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Brasil, em 2010 e 2011. As informações foram coletadas por entrevistas, prontuários médicos e laudos de patologia. As medidas placentárias foram: peso, diâmetros maior e menor, excentricidade, espessura, forma, área, relações peso ao nascer/ peso da placenta e peso da placenta/ peso ao nascer. As associações entre peso ao nascer e medidas placentárias foram examinadas por meio de regressão linear múltipla. Resultados: O peso da placenta foi responsável por 48% da variabilidade do peso ao nascer (p < 0,001), enquanto o conjunto de medidas placentárias (peso, diâmetros maior e menor e espessura) foi responsável por 50% (p < 0,001). Quando ajustadas pelas características maternas e neonatais, as medidas placentárias explicaram 74% da variabilidade do peso ao nascer (p < 0,001). Conclusão: medidas placentárias são preditores independentes do peso ao nascer. O peso placentário é o mais forte preditor dentre elas, seguido pelo diâmetro menor.

ABSTRACT: Introduction: Epidemiological studies have shown associations between placental measurements and perinatal and later life outcomes. Objectives: To report placental measurements and evaluate their association with birth weight in a Brazilian birth cohort. Methods: Retrospective cohort study with 958 mothers, placentas, and newborns delivered at the Ribeirão Preto Medical School Hospital, Universidade de São Paulo, Brazil, in 2010 and 2011. The information was collected from interviews, medical records, and pathology reports. The placental measurements were: weight, largest and smallest diameters, eccentricity, thickness, shape, area, and birth weight/placental weight and placental weight/birth weight ratios. We analyzed the associations between birth weight and placental measurements using multiple linear regression. Results: Placental weight alone accounted for 48% of birth weight variability (p < 0.001), whereas placental measurements combined (placental weight, largest and smallest diameters, and thickness) were responsible for 50% (p < 0.001). When adjusted for maternal and neonatal characteristics, placental measurements explained 74% of birth weight variability (p < 0.001). Conclusion: Placental measurements are powerful independent predictors of birth weight. Placental weight is the most predictive of them, followed by the smallest diameter.

RESUMO: Introdução: Estudos epidemiológicos demonstraram associações entre medidas placentárias, resultados perinatais e futuros. Objetivos: Descrever medidas placentárias e avaliar suas associações com peso ao nascer numa coorte de nascimentos brasileira. Metodologia: Estudo de coorte retrospectiva de 958 mães, placentas e recém-nascidos no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Brasil, em 2010 e 2011. As informações foram coletadas por entrevistas, prontuários médicos e laudos de patologia. As medidas placentárias foram: peso, diâmetros maior e menor, excentricidade, espessura, forma, área, relações peso ao nascer/ peso da placenta e peso da placenta/ peso ao nascer. As associações entre peso ao nascer e medidas placentárias foram examinadas por meio de regressão linear múltipla. Resultados: O peso da placenta foi responsável por 48% da variabilidade do peso ao nascer (p < 0,001), enquanto o conjunto de medidas placentárias (peso, diâmetros maior e menor e espessura) foi responsável por 50% (p < 0,001). Quando ajustadas pelas características maternas e neonatais, as medidas placentárias explicaram 74% da variabilidade do peso ao nascer (p < 0,001). Conclusão: medidas placentárias são preditores independentes do peso ao nascer. O peso placentário é o mais forte preditor dentre elas, seguido pelo diâmetro menor.

ABSTRACT: Introduction: Epidemiological studies have shown associations between placental measurements and perinatal and later life outcomes. Objectives: To report placental measurements and evaluate their association with birth weight in a Brazilian birth cohort. Methods: Retrospective cohort study with 958 mothers, placentas, and newborns delivered at the Ribeirão Preto Medical School Hospital, Universidade de São Paulo, Brazil, in 2010 and 2011. The information was collected from interviews, medical records, and pathology reports. The placental measurements were: weight, largest and smallest diameters, eccentricity, thickness, shape, area, and birth weight/placental weight and placental weight/birth weight ratios. We analyzed the associations between birth weight and placental measurements using multiple linear regression. Results: Placental weight alone accounted for 48% of birth weight variability (p < 0.001), whereas placental measurements combined (placental weight, largest and smallest diameters, and thickness) were responsible for 50% (p < 0.001). When adjusted for maternal and neonatal characteristics, placental measurements explained 74% of birth weight variability (p < 0.001). Conclusion: Placental measurements are powerful independent predictors of birth weight. Placental weight is the most predictive of them, followed by the smallest diameter.

Resumo Objetivo: Avaliar a prevalência e os riscos de recém-nascidos abaixo do peso, baixa estatura e emaciação por idade gestacional da Província de Jujuy, Argentina, em diferentes níveis de altitude. Métodos: Recém-nascidos vivos (n = 48.656) nascidos entre 2009 e 2014 em instalações públicas entre 24+0-42+6 semanas de idade gestacional. Os fenótipos de abaixo do peso (< P3 peso/idade), baixa estatura (< P3 comprimento/idade) e emaciação (< P3 índice de massa corporal/idade) foram calculados com os padrões do INTERGROWTH-21st. Os fatores de risco foram idade materna, escolaridade, índice de massa corporal, paridade, diabetes, hipertensão, pré-eclâmpsia, tuberculose, prematuridade e malformações congênitas. Os dados foram agrupados pela altitude geográfica: ≥ 2.000 ou < 2.000 m.a.s.l. O teste qui-quadrado e a análise de regressão logística multivariada foram feitos para estimar o risco dos fenótipos associados ao nível de altitude ≥ 2.000 m.a.s.l. Resultados: A prevalência de abaixo do peso, baixa estatura e emaciação foi de 1,27%, 3,39% e 4,68%, respectivamente, significativamente maiores em > 2.000 m.a.s.l. A idade materna, índice de massa corporal > 35 kg/m2, hipertensão, malformações congênitas e prematuridade foram mais fortemente associados a abaixo do peso e não a baixa estatura ou emaciação em ≥ 2.000 m.a.s.l. Conclusões: Os riscos de abaixo do peso, baixa estatura e emaciação foram maiores em altitude mais elevada e foram associados a condições maternas e fetais reconhecidas. O uso desses três fenótipos ajudará a priorizar as intervenções preventivas e focar no manejo da desnutrição fetal.

Abstract Objective: To assess the prevalence and risks of underweight, stunting and wasting by gestational age in newborns of the Jujuy Province, Argentina at different altitude levels. Methods: Live newborns (n = 48,656) born from 2009–2014 in public facilities with a gestational age between 24+0 to 42+6 weeks. Phenotypes of underweight (<P3 weight/age), stunting (<P3 length/age) and wasting (<P3 body mass index/age) were calculated using Intergrowth-21st standards. Risk factors were maternal age, education, body mass index, parity, diabetes, hypertension, preeclampsia, tuberculosis, prematurity, and congenital malformations. Data were grouped by the geographic altitude: ≥2.000 or <2.000 m.a.s.l. Chi-squared test and a multivariate logistic regression analysis were performed to estimate the risk of the phenotypes associated with an altitudinal level ≥2.000 m.a.s.l. Results: The prevalence of underweight, stunting and wasting were 1.27%, 3.39% and 4.68%, respectively, and significantly higher at >2.000 m.a.s.l. Maternal age, body mass index >35 kg/m2, hypertension, congenital malformations, and prematurity were more strongly associated with underweight rather than stunting or wasting at ≥2.000 m.a.s.l. Conclusions: Underweight, stunting, and wasting risks were higher at a higher altitude, and were associated with recognized maternal and fetal conditions. The use of those three phenotypes will help prioritize preventive interventions and focus the management of fetal undernutrition.