We examined the association of nutritional factors with body fat deposition in a representative sample (n=530, aged 40-79 years) of first and second-generation Japanese-Brazilian population who was submitted to standardized questionnaires, including nutritional data, clinical examination and laboratory procedures. Dietary data were compared between groups of subjects defined by the presence of obesity or central adiposity. Associations of body mass index or waist circumference (dependent variables) with energy and nutrient intakes (main exposure of interest) were analyzed by multiple linear regression, with adjustment for gender, age, physical activity and generation. Groups of obese subjects and those with central adiposity consumed higher proportions of energy as fat and lower as carbohydrate than those without obesity and central adiposity (p<0.05). Stratifying by generation, second-generation was shown to take more energy as fat than the first-generation (p<0.05). In the regression models, protein intake was the only variable significantly associated with body mass index. Replacing body mass index by the waist circumference, male sex and protein intake were shown to be independent predictors of central adiposity. When second-generation was taken, total energy intake and all macronutrient intakes became significantly associated with body mass index (p<0.05) but only protein intake predicted waist circumference. We speculate that Japanese-Brazilians, genetically prone to insulin resistance, when exposed to unfavorable environment will express a number of metabolic disturbances. A deleterious dietary pattern may contribute to weight gain, was associated with abdominal fat deposition in particular a protein-rich diet, and reflected by their waist circumference. Intra-abdominal fat could be triggering insulin resistance, which would explain the increased prevalence rates of diabetes, dyslipidemia and hypertension seen in Japanese-Brazilians.

Background: It is challenging to decrease neonatal mortality in middle-income countries, where perinatal asphyxia is an important cause of death. This study aims to analyze the annual trend of neonatal mortality with perinatal asphyxia according to gestational age in São Paulo State, Brazil, during a 10-year period and to verify demographic, maternal and neonatal characteristics associated with these deaths. Methods: Population-based study of neonatal deaths associated with perinatal asphyxia from 0 to 27 days in São Paulo State, Brazil, from 2004 to 2013. Perinatal asphyxia was considered as associated to death if intrauterine hypoxia, birth asphyxia or neonatal aspiration of meconium were noted in any line of the Death Certificate according to ICD-10. Poisson Regression was applied to analyze the annual trend of neonatal mortality rate according to gestational age. Kaplan-Meier curve was used to assess age at death during the 10-year study period. Hazard ratio of death during the neonatal period according to gestational age was analyzed by Cox regression adjusted by year of birth and selected epidemiological factors. Results: Among 74,002 infant deaths in São Paulo State, 6648 (9%) neonatal deaths with perinatal asphyxia were studied. Neonatal mortality rate with perinatal asphyxia fell from 1.38‰ in 2004 to 0.95‰ in 2013 (p = 0.002). Reduction started in 2008 for neonates with 32–41 weeks, in 2009 for 28–31 weeks, and in 2011 for 22–27 weeks. Median time until 50% of deaths occurred was 25.3 h (95%CI: 24.0; 27.2). Variables independently associated with higher risk of death were < 7 prenatal visits, 1st minute Apgar score 0–3, and death at the same place of birth. Cesarean delivery compared to vaginal was protective against death with perinatal asphyxia for infants at 28–36 weeks. Conclusions: There was an expressive reduction in neonatal mortality rates associated with perinatal asphyxia during this 10-year period in São Paulo State, Brazil. Variables associated with these deaths highlight the need of public health policies to improve quality of regionalized perinatal care.