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Wang Y, Gui J, Howe CG, Emond JA, Criswell RL, Gallagher LG, Huset CA, Peterson LA, Botelho JC, Calafat AM, Christensen B, Karagas MR, Romano ME. Association of diet with per- and polyfluoroalkyl substances in plasma and human milk in the New Hampshire Birth Cohort Study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 933:173157. [PMID: 38740209 PMCID: PMC11247473 DOI: 10.1016/j.scitotenv.2024.173157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/09/2024] [Accepted: 05/09/2024] [Indexed: 05/16/2024]
Abstract
Per- and polyfluoroalkyl substances (PFAS) are related to various adverse health outcomes, and food is a common source of PFAS exposure. Dietary sources of PFAS have not been adequately explored among U.S. pregnant individuals. We examined associations of dietary factors during pregnancy with PFAS concentrations in maternal plasma and human milk in the New Hampshire Birth Cohort Study. PFAS concentrations, including perfluorohexane sulfonate (PFHxS), perfluorooctane sulfonate (PFOS), perfluorooctanoate (PFOA), perfluorononanoate (PFNA), and perfluorodecanoate (PFDA), were measured in maternal plasma collected at ∼28 gestational weeks and human milk collected at ∼6 postpartum weeks. Sociodemographic, lifestyle and reproductive factors were collected from prenatal questionnaires and diet from food frequency questionnaires at ∼28 gestational weeks. We used adaptive elastic net (AENET) to identify important dietary variables for PFAS concentrations. We used multivariable linear regression to assess associations of dietary variables selected by AENET models with PFAS concentrations. Models were adjusted for sociodemographic, lifestyle, and reproductive factors, as well as gestational week of blood sample collection (plasma PFAS), postpartum week of milk sample collection (milk PFAS), and enrollment year. A higher intake of fish/seafood, eggs, coffee, or white rice during pregnancy was associated with higher plasma or milk PFAS concentrations. For example, every 1 standard deviation (SD) servings/day increase in egg intake during pregnancy was associated with 4.4 % (95 % CI: 0.6, 8.4), 3.3 % (0.1, 6.7), and 10.3 % (5.6, 15.2) higher plasma PFOS, PFOA, and PFDA concentrations respectively. Similarly, every 1 SD servings/day increase in white rice intake during pregnancy was associated with 7.5 % (95 % CI: -0.2, 15.8) and 12.4 % (4.8, 20.5) greater milk PFOS and PFOA concentrations, respectively. Our study suggests that certain dietary factors during pregnancy may contribute to higher PFAS concentrations in maternal plasma and human milk, which could inform interventions to reduce PFAS exposure for both birthing people and offspring.
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Affiliation(s)
- Yuting Wang
- Department of Epidemiology, The Geisel School of Medicine at Dartmouth, Lebanon, NH 03755, USA.
| | - Jiang Gui
- Department of Biomedical Data Science, The Geisel School of Medicine at Dartmouth, Lebanon, NH 03755, USA
| | - Caitlin G Howe
- Department of Epidemiology, The Geisel School of Medicine at Dartmouth, Lebanon, NH 03755, USA
| | - Jennifer A Emond
- Department of Biomedical Data Science, The Geisel School of Medicine at Dartmouth, Lebanon, NH 03755, USA
| | - Rachel L Criswell
- Department of Epidemiology, The Geisel School of Medicine at Dartmouth, Lebanon, NH 03755, USA; Skowhegan Family Medicine, Redington-Fairview General Hospital, Skowhegan, ME 04976, USA
| | - Lisa G Gallagher
- Department of Epidemiology, The Geisel School of Medicine at Dartmouth, Lebanon, NH 03755, USA
| | - Carin A Huset
- Minnesota Department of Health, St. Paul, MN 55101, USA
| | - Lisa A Peterson
- Division of Environmental Health Sciences, University of Minnesota, Minneapolis, MN 55455, USA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA
| | - Julianne Cook Botelho
- Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Antonia M Calafat
- Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Brock Christensen
- Department of Epidemiology, The Geisel School of Medicine at Dartmouth, Lebanon, NH 03755, USA
| | - Margaret R Karagas
- Department of Epidemiology, The Geisel School of Medicine at Dartmouth, Lebanon, NH 03755, USA
| | - Megan E Romano
- Department of Epidemiology, The Geisel School of Medicine at Dartmouth, Lebanon, NH 03755, USA
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An Z, Li Y, Li J, Jiang Z, Duan W, Guo M, Zhu Y, Zeng X, Wang L, Liu Y, Li A, Guo H, Zhang X. Associations between co-exposure to per- and polyfluoroalkyl substances and organophosphate esters and erythrogram in Chinese adults. CHEMOSPHERE 2024; 362:142750. [PMID: 38960049 DOI: 10.1016/j.chemosphere.2024.142750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 03/31/2024] [Accepted: 06/30/2024] [Indexed: 07/05/2024]
Abstract
Erythrogram, despite its prevalent use in assessing red blood cell (RBC) disorders and can be utilized to evaluate various diseases, still lacks evidence supporting the effects of per- and polyfluoroalkyl substances (PFASs) and organophosphate esters (OPEs) on it. A cross-sectional study involving 467 adults from Shijiazhuang, China was conducted to assess the associations between 12 PFASs and 11 OPEs and the erythrogram (8 indicators related to RBC). Three models, including multiple linear regression (MLR), sparse partial least squares regression, and Bayesian kernel machine regression (BKMR) were employed to evaluate both the individual and joint effects of PFASs and OPEs on the erythrogram. Perfluorohexane sulfonic acid (PFHxS) showed the strongest association with HGB (3.68%, 95% CI: 2.29%, 5.10%) when doubling among PFASs in MLR models. BKMR indicated that PFASs were more strongly associated with the erythrogram than OPEs, as evidenced by higher group posterior inclusion probabilities (PIPs) for PFASs. Within hemoglobin and hematocrit, PFHxS emerged as the most significant component (conditional PIP = 1.0 for both). Collectively, our study emphasizes the joint effect of PFASs and OPEs on the erythrogram and identified PFASs, particularly PFHxS, as the pivotal contributors to the erythrogram. Nonetheless, further investigations are warranted to elucidate the underlying mechanisms.
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Affiliation(s)
- Ziwen An
- Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang, 050017, China
| | - Yanbing Li
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100005, China
| | - Jing Li
- Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang, 050017, China
| | - Zexuan Jiang
- Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang, 050017, China
| | - Wenjing Duan
- Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang, 050017, China
| | - Mingmei Guo
- Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang, 050017, China
| | - Yiming Zhu
- Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang, 050017, China
| | - Xiuli Zeng
- Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang, 050017, China
| | - Linfeng Wang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
| | - Yi Liu
- Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang, 050017, China; Hebei Key Laboratory of Environment and Human Health, Hebei Province, Shijiazhuang, 050017, China
| | - Ang Li
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100005, China; Hebei Key Laboratory of Environment and Human Health, Hebei Province, Shijiazhuang, 050017, China
| | - Huicai Guo
- Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang, 050017, China; Hebei Key Laboratory of Environment and Human Health, Hebei Province, Shijiazhuang, 050017, China.
| | - Xiaoguang Zhang
- Core Facilities and Centers of Hebei Medical University, 361 East Zhongshan Road, Shijiazhuang, 050017, Hebei Province, China.
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Tao L, Tang W, Xia Z, Wu B, Liu H, Fu J, Lu Q, Guo L, Gao C, Zhou Q, Fan Y, Xu DX, Huang Y. Machine learning predicts the serum PFOA and PFOS levels in pregnant women: Enhancement of fatty acid status on model performance. ENVIRONMENT INTERNATIONAL 2024; 190:108837. [PMID: 38909401 DOI: 10.1016/j.envint.2024.108837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/28/2024] [Accepted: 06/18/2024] [Indexed: 06/25/2024]
Abstract
Human exposure to per- and polyfluoroalkyl substances (PFASs) has received considerable attention, particularly in pregnant women because of their dramatic changes in physiological status and dietary patterns. Predicting internal PFAS exposure in pregnant women, based on external and relevant parameters, has not been investigated. Here, machine learning (ML) models were developed to predict the serum concentrations of PFOA and PFOS in a large population of 588 pregnant participants. Dietary exposure characteristics, demographic parameters, and in particular, serum fatty acid (FA) data were used for the model development. The fitting results showed that the inclusion of FAs as covariates significantly improved the performance of the ML models, with the random forest (RF) model having the best predictive performance for PFOA (R2 = 0.33, MAE = 1.51 ng/mL, and RMSE = 1.89 ng/mL) and PFOS (R2 = 0.12, MAE = 2.65 ng/mL, and RMSE = 3.37 ng/mL). The feature importance analysis revealed that serum FAs greatly affected PFOA concentration in the pregnant women, with saturated FAs being associated with decreased PFOA levels and unsaturated FAs with increased levels. Comparison with one-compartment pharmacokinetic model further demonstrated the advantage of the ML models in predicting PFAS exposure in pregnant women. Our models correlate for the first time blood chemical concentrations with human FA status using ML, introducing a novel perspective on predicting PFAS levels in pregnant women. This study provides valuable insights concerning internal exposure of PFASs generated from external exposure, and contributes to risk assessment and management in pregnant populations.
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Affiliation(s)
- Lin Tao
- Department of Toxicology, School of Public Health, Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - Weitian Tang
- Department of Toxicology, School of Public Health, Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - Zhicai Xia
- Xuancheng Center for Disease Control and Prevention, Xuancheng, China
| | - Bing Wu
- Xuancheng Center for Disease Control and Prevention, Xuancheng, China
| | - Heng Liu
- Faculty of Information Technology, Beijing University of Technology, Beijing, China
| | - Juanjuan Fu
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital, Anhui Medical University, Hefei, China
| | - Qiufang Lu
- Xuancheng Center for Disease Control and Prevention, Xuancheng, China
| | - Liyan Guo
- Department of Toxicology, School of Public Health, Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - Chang Gao
- Department of Toxicology, School of Public Health, Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - Qiang Zhou
- Department of Clinical Laboratory, The Second Affiliated Hospital, Anhui Medical University, Hefei, China
| | - Yijun Fan
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital, Anhui Medical University, Hefei, China
| | - De-Xiang Xu
- Department of Toxicology, School of Public Health, Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China.
| | - Yichao Huang
- Department of Toxicology, School of Public Health, Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China; Department of Gynecology and Obstetrics, The Second Affiliated Hospital, Anhui Medical University, Hefei, China; Clinical Research Center, Suzhou Hospital of Anhui Medical University, Anhui Medical University, Suzhou, China.
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Chen T, Wu J, Pan Q, Dong M. The association of female reproductive factors with history of cardiovascular disease: a large cross-sectional study. BMC Public Health 2024; 24:1616. [PMID: 38886693 PMCID: PMC11181605 DOI: 10.1186/s12889-024-19130-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 06/13/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND This study aimed to explore the association of female reproductive factors (age at first birth (AFB), age at last birth (ALB), number of pregnancies, and live births) with history of cardiovascular disease (CVD). METHODS A total of 15,715 women aged 20 years or over from the National Health and Nutrition Examination Surveys from 1999 to 2018 were included in our analysis. Weighted multivariable logistic regression analysis and restricted cubic spline (RCS) model were used to evaluate the association of AFB and ALB with history of CVD in women. Additionally, the relationship between the number of pregnancies, and live births and history of CVD was also explored. RESULTS After adjusting for potential confounding factors, the RCS plot showed a U-curve relationship between AFB, ALB and history of CVD. Among them, AFB was associated with congestive heart failure (CHF), heart attack, and stroke in a U-shaped curve. Additionally, this U-shaped correlation also exists between ALB and CHF and stroke. However, the number of pregnancies and live births was liner positive associated with history of CVD, including coronary heart disease, CHF, angina pectoris, heart attack, and stroke. CONCLUSIONS Women with younger or later AFB and ALB have higher odds of CVD in later life. Further study is warranted to verify the underlying mechanisms of this association.
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Affiliation(s)
- Tiehan Chen
- Department of Internal Medicine, Lianyungang Maternal and Child Health Hospital, Lianyungang, Jiangsu, 222000, China.
| | - Jingwen Wu
- Department of Cardiology, Lianyungang First People's Hospital, Lianyungang, Jiangsu, 222000, China
| | - Qinyuan Pan
- Department of Intensive Care Unit, Lianyungang First People's Hospital, Lianyungang, Jiangsu, 222000, China
| | - Mingmei Dong
- Department of Internal Medicine, Lianyungang Maternal and Child Health Hospital, Lianyungang, Jiangsu, 222000, China
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Wang M, Wang X, Huang K, Han B, Li R, Shen Y, Zhuang Z, Wang Z, Wang L, Zhou Y, Jing T. Human Biomonitoring of Environmental Chemicals among Elderly in Wuhan, China: Prioritizing Risks Using EPA's ToxCast Database. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2024; 58:10001-10014. [PMID: 38788169 DOI: 10.1021/acs.est.4c00362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
In line with the "healthy aging" principle, we aim to assess the exposure map and health risks of environmental chemicals in the elderly. Blood samples from 918 elderly individuals in Wuhan, China, were analyzed using the combined gas/liquid-mass spectrometry technology to detect levels of 118 environmental chemicals. Cluster analysis identified exposure profiles, while risk indexes and bioanalytical equivalence percentages were calculated using EPA's ToxCast database. The detection rates for 87 compounds exceeded 70%. DEHP, DiBP, naphthalene, phenanthrene, DnBP, pyrene, anthracene, permethrin, fluoranthene, and PFOS showed the highest concentrations. Fat-soluble pollutants varied across lifestyles. In cluster 2, which was characterized by higher concentrations of fat-soluble substances, the proportion of smokers or drinkers was higher than that of nonsmokers or nondrinkers. Pesticides emerged as the most active environmental chemicals in peroxisome proliferator-activated receptor gamma antagonist, thyroid hormone receptor (TR) antagonist, TR agonist, and androgen receptor (AR) agonist activity assays. Additionally, PAEs and polycyclic aromatic hydrocarbons played significant roles as active contaminants for the corresponding targets of AR antagonists and estrogen receptor alpha. We proposed a list of priority pollutants linked to endocrine-disrupting toxic effects in the elderly, which may provide the groundwork for further research into environmental etiology.
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Affiliation(s)
- Mengyi Wang
- State Key Laboratory of Environment Health (Incubation), Key Laboratory of Environment and Health, Ministry of Education, Key Laboratory of Environment and Health (Wuhan), Ministry of Environmental Protection, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, #13 Hangkong Road, Wuhan, Hubei 430030, China
| | - Xiu Wang
- State Key Laboratory of Environment Health (Incubation), Key Laboratory of Environment and Health, Ministry of Education, Key Laboratory of Environment and Health (Wuhan), Ministry of Environmental Protection, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, #13 Hangkong Road, Wuhan, Hubei 430030, China
- The State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, PR China
| | - Kai Huang
- State Key Laboratory of Environment Health (Incubation), Key Laboratory of Environment and Health, Ministry of Education, Key Laboratory of Environment and Health (Wuhan), Ministry of Environmental Protection, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, #13 Hangkong Road, Wuhan, Hubei 430030, China
| | - Bin Han
- State Key Laboratory of Environment Health (Incubation), Key Laboratory of Environment and Health, Ministry of Education, Key Laboratory of Environment and Health (Wuhan), Ministry of Environmental Protection, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, #13 Hangkong Road, Wuhan, Hubei 430030, China
| | - Ruifang Li
- State Key Laboratory of Environment Health (Incubation), Key Laboratory of Environment and Health, Ministry of Education, Key Laboratory of Environment and Health (Wuhan), Ministry of Environmental Protection, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, #13 Hangkong Road, Wuhan, Hubei 430030, China
| | - Yang Shen
- State Key Laboratory of Environment Health (Incubation), Key Laboratory of Environment and Health, Ministry of Education, Key Laboratory of Environment and Health (Wuhan), Ministry of Environmental Protection, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, #13 Hangkong Road, Wuhan, Hubei 430030, China
| | - Zhijia Zhuang
- State Key Laboratory of Environment Health (Incubation), Key Laboratory of Environment and Health, Ministry of Education, Key Laboratory of Environment and Health (Wuhan), Ministry of Environmental Protection, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, #13 Hangkong Road, Wuhan, Hubei 430030, China
| | - Zhu Wang
- State Key Laboratory of Environment Health (Incubation), Key Laboratory of Environment and Health, Ministry of Education, Key Laboratory of Environment and Health (Wuhan), Ministry of Environmental Protection, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, #13 Hangkong Road, Wuhan, Hubei 430030, China
| | - Lulu Wang
- State Key Laboratory of Environment Health (Incubation), Key Laboratory of Environment and Health, Ministry of Education, Key Laboratory of Environment and Health (Wuhan), Ministry of Environmental Protection, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, #13 Hangkong Road, Wuhan, Hubei 430030, China
| | - Yikai Zhou
- State Key Laboratory of Environment Health (Incubation), Key Laboratory of Environment and Health, Ministry of Education, Key Laboratory of Environment and Health (Wuhan), Ministry of Environmental Protection, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, #13 Hangkong Road, Wuhan, Hubei 430030, China
| | - Tao Jing
- State Key Laboratory of Environment Health (Incubation), Key Laboratory of Environment and Health, Ministry of Education, Key Laboratory of Environment and Health (Wuhan), Ministry of Environmental Protection, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, #13 Hangkong Road, Wuhan, Hubei 430030, China
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Niu Z, Duan Z, He W, Chen T, Tang H, Du S, Sun J, Chen H, Hu Y, Iijima Y, Han S, Li J, Zhao Z. Kidney function decline mediates the adverse effects of per- and poly-fluoroalkyl substances (PFAS) on uric acid levels and hyperuricemia risk. JOURNAL OF HAZARDOUS MATERIALS 2024; 471:134312. [PMID: 38640681 DOI: 10.1016/j.jhazmat.2024.134312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 03/30/2024] [Accepted: 04/14/2024] [Indexed: 04/21/2024]
Abstract
Previous studies indicated per- and poly-fluoroalkyl substances (PFAS) were related to uric acid and hyperuricemia risk, but evidence for the exposure-response (E-R) curves and combined effect of PFAS mixture is limited. Moreover, the potential mediation effect of kidney function was not assessed. Hence, we conducted a national cross-sectional study involving 13,979 US adults in NHANES 2003-2018 to examine the associations of serum PFAS with uric acid and hyperuricemia risk, and the mediation effects of kidney function. Generalized linear models and E-R curves showed positive associations of individual PFAS with uric acid and hyperuricemia risk, and nearly linear E-R curves indicated no safe threshold for PFAS. Weighted quantile sum regression found positive associations of PFAS mixture with uric acid and hyperuricemia risk, and PFOA was the dominant contributor to the adverse effect of PFAS on uric acid and hyperuricemia risk. Causal mediation analysis indicated significant mediation effects of kidney function decline in the associations of PFAS with uric acid and hyperuricemia risk, with the mediated proportion ranging from 19 % to 57 %. Our findings suggested that PFAS, especially PFOA, may cause increased uric acid and hyperuricemia risk increase even at low levels, and kidney function decline plays a crucial mediation effect.
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Affiliation(s)
- Zhiping Niu
- Department of Environmental Health, School of Public Health, NHC Key Laboratory of Health Technology Assessment, Key Laboratory of Public Health Safety of the Ministry of Education, Fudan University, Shanghai 200032, China
| | - Zhizhou Duan
- Preventive Health Service, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, 152 Aiguo Road, Nanchang, Jiangxi, China
| | - Weixiang He
- Department of Urology, Xijing Hospital, The Fourth Military Medical University, 127 West Changle Road, Xi'an 710032, China
| | - Tianyi Chen
- Department of Environmental Health, School of Public Health, NHC Key Laboratory of Health Technology Assessment, Key Laboratory of Public Health Safety of the Ministry of Education, Fudan University, Shanghai 200032, China
| | - Hao Tang
- Department of Environmental Health, School of Public Health, NHC Key Laboratory of Health Technology Assessment, Key Laboratory of Public Health Safety of the Ministry of Education, Fudan University, Shanghai 200032, China
| | - Shuang Du
- Department of Environmental Health, School of Public Health, NHC Key Laboratory of Health Technology Assessment, Key Laboratory of Public Health Safety of the Ministry of Education, Fudan University, Shanghai 200032, China
| | - Jin Sun
- Department of Environmental Health, School of Public Health, NHC Key Laboratory of Health Technology Assessment, Key Laboratory of Public Health Safety of the Ministry of Education, Fudan University, Shanghai 200032, China
| | - Han Chen
- Department of Environmental Health, School of Public Health, NHC Key Laboratory of Health Technology Assessment, Key Laboratory of Public Health Safety of the Ministry of Education, Fudan University, Shanghai 200032, China
| | - Yuanzhuo Hu
- Department of Environmental Health, School of Public Health, NHC Key Laboratory of Health Technology Assessment, Key Laboratory of Public Health Safety of the Ministry of Education, Fudan University, Shanghai 200032, China
| | - Yuka Iijima
- Department of Clinical Medicine, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Shichao Han
- Department of Urology, Xijing Hospital, The Fourth Military Medical University, 127 West Changle Road, Xi'an 710032, China.
| | - Jiufeng Li
- Department of Environmental Health, School of Public Health, NHC Key Laboratory of Health Technology Assessment, Key Laboratory of Public Health Safety of the Ministry of Education, Fudan University, Shanghai 200032, China.
| | - Zhuohui Zhao
- Department of Environmental Health, School of Public Health, NHC Key Laboratory of Health Technology Assessment, Key Laboratory of Public Health Safety of the Ministry of Education, Fudan University, Shanghai 200032, China; Shanghai Typhoon Institute/CMA, Shanghai Key Laboratory of Meteorology and Health, Shanghai 200030, China; IRDR International Center of Excellence on Risk Interconnectivity and Governance on Weather/Climate Extremes Impact and Public Health, Fudan University, Shanghai 200438, China; WMO/IGAC MAP-AQ Asian Office Shanghai, Fudan University, Shanghai 200438, China.
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7
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Makris KC, Chourdakis M. The Need for an Alternative Health Claim Process for Foods Based on Both Nutrient and Contaminant Profiles. Curr Dev Nutr 2024; 8:103764. [PMID: 38813480 PMCID: PMC11134546 DOI: 10.1016/j.cdnut.2024.103764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 04/16/2024] [Accepted: 04/23/2024] [Indexed: 05/31/2024] Open
Abstract
Most authorized health claims on foods have been established on the basis of single dietary components, mainly micronutrients, such as vitamins, minerals, and possibly bioactives. Failure to sufficiently define and characterize the nutritional profile of a food product is one of the main reasons for rejection or incomplete status for thousands of health claim applications, whereas the food's contaminant profile is simply not accounted for. The objective of this work was to highlight the accumulating scientific evidence supporting a reform of the health claim evaluation process for foods toward more holistic approaches. This would entail the characterization of multiple nutrient-contaminant pairs and contaminant mixture profiles at contaminant levels currently considered "safe," including their interactions that would impact human health outcome(s) in a net positive or negative direction. The notion of a stable nutritional profile in food commodities has been challenged by studies reporting a variable food contaminant content and a declining content of proteins/micronutrients in crops due to anthropogenic greenhouse gas emissions. A holistic approach in the health claim process for foods would entail the incorporation of cumulative risk assessment and/or risk-benefit protocols that effectively combine health risks and benefits associated with multiple nutritional and contaminant attributes of the food/diet under evaluation.
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Affiliation(s)
- Konstantinos Christos Makris
- Cyprus International Institute for Environmental and Public Health, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Michael Chourdakis
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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8
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Sámano R, Martínez-Rojano H, Chico-Barba G, Gamboa R, Tolentino M, Toledo-Barrera AX, Ramírez-González C, Mendoza-Flores ME, Hernández-Trejo M, Godínez-Martínez E. Serum Folate, Red Blood Cell Folate, and Zinc Serum Levels Are Related with Gestational Weight Gain and Offspring's Birth-Weight of Adolescent Mothers. Nutrients 2024; 16:1632. [PMID: 38892565 PMCID: PMC11174574 DOI: 10.3390/nu16111632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/18/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Gestational weight gain below or above the Institute of Medicine recommendations has been associated with adverse perinatal and neonatal outcomes. Very few studies have evaluated the association between serum and red blood cell folate concentrations and gestational weight gain in adolescents. Additionally, zinc deficiency during pregnancy has been associated with impaired immunity, prolonged labor, preterm and post-term birth, intrauterine growth restriction, low birth weight, and pregnancy-induced hypertension. OBJECTIVE The purpose of our study is to evaluate the association between serum concentrations of zinc, serum folate, and red blood cell folate, with the increase in gestational weight and the weight and length of the newborn in a group of adolescent mothers from Mexico City. RESULTS In our study, 406 adolescent-neonate dyads participated. The adolescents' median age was 15.8 years old. The predominant socioeconomic level was middle-low (57.8%), single (57%), 89.9% were engaged in home activities, and 41.3% completed secondary education. Excessive gestational weight gain was observed in 36.7% of cases, while insufficient gestational weight gain was noted in 38.4%. Small for gestational age infants were observed in 20.9% of the sample. Low serum folate (OR 2.1, 95% CI 1.3-3.3), decreased red blood cell folate (OR 1.6, 95% CI 1.0-2.6), and reduced serum zinc concentrations (OR 3.3, 95% CI 2.1-5.2) were associated with insufficient gestational weight gain. Decreased serum zinc levels (OR 1.2, 95% CI 1.2-3.4) were linked to an increased probability of delivering a baby who is small for their gestational age. CONCLUSIONS Low serum folate, red blood cell folate, and serum zinc concentrations were associated with gestational weight gain and having a small gestational age baby. Both excessive and insufficient gestational weight gain, as well as having a small gestational age baby, are frequent among adolescent mothers.
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Affiliation(s)
- Reyna Sámano
- Coordinación de Nutrición y Bioprogramación, Instituto Nacional de Perinatología, Secretaría de Salud, México City 11000, Mexico; (G.C.-B.); (M.T.); (C.R.-G.); (M.E.M.-F.); (E.G.-M.)
| | - Hugo Martínez-Rojano
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina del Instituto Politécnico Nacional, México City 11340, Mexico
- Coordinación de Medicina Laboral, Instituto de Diagnóstico y Referencia Epidemiológicos (InDRE) “Dr. Manuel Martínez Báez”, Secretaría de Salud, México City 01480, Mexico
| | - Gabriela Chico-Barba
- Coordinación de Nutrición y Bioprogramación, Instituto Nacional de Perinatología, Secretaría de Salud, México City 11000, Mexico; (G.C.-B.); (M.T.); (C.R.-G.); (M.E.M.-F.); (E.G.-M.)
| | - Ricardo Gamboa
- Departamento de Fisiología, Instituto Nacional de Cardiología, México City 14080, Mexico;
| | - Maricruz Tolentino
- Coordinación de Nutrición y Bioprogramación, Instituto Nacional de Perinatología, Secretaría de Salud, México City 11000, Mexico; (G.C.-B.); (M.T.); (C.R.-G.); (M.E.M.-F.); (E.G.-M.)
| | | | - Cristina Ramírez-González
- Coordinación de Nutrición y Bioprogramación, Instituto Nacional de Perinatología, Secretaría de Salud, México City 11000, Mexico; (G.C.-B.); (M.T.); (C.R.-G.); (M.E.M.-F.); (E.G.-M.)
| | - María Eugenia Mendoza-Flores
- Coordinación de Nutrición y Bioprogramación, Instituto Nacional de Perinatología, Secretaría de Salud, México City 11000, Mexico; (G.C.-B.); (M.T.); (C.R.-G.); (M.E.M.-F.); (E.G.-M.)
| | - María Hernández-Trejo
- Departamento de Neurobiología del Desarrollo, Instituto Nacional de Perinatología, Secretaría de Salud, México City 11000, Mexico;
| | - Estela Godínez-Martínez
- Coordinación de Nutrición y Bioprogramación, Instituto Nacional de Perinatología, Secretaría de Salud, México City 11000, Mexico; (G.C.-B.); (M.T.); (C.R.-G.); (M.E.M.-F.); (E.G.-M.)
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9
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Tang C, Wang Y, Hong H. Unraveling the link between heavy metals, perfluoroalkyl substances and depression: Insights from epidemiological and bioinformatics strategies. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2024; 279:116482. [PMID: 38772142 DOI: 10.1016/j.ecoenv.2024.116482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 05/17/2024] [Accepted: 05/18/2024] [Indexed: 05/23/2024]
Abstract
Heavy metals and per- and polyfluoroalkyl substances (PFASs) have become particularly important when studying the development of depression, a common illness that severely restricts psychosocial functioning and diminishes quality of life. Therefore, the potential joint effects of heavy metal and PFAS exposure on depression, as well as the underlying mechanisms involved, were investigated by using integrated epidemiological and bioinformatic approaches in the present study. A thorough analysis of 7301 samples from the National Health and Nutrition Examination Survey (NHANES) cycles that occurred between 2005 and 2018 was performed. Single-exposure studies have shown that cadmium exposure is positively associated with depression, whereas perfluorooctanesulfonic acid (PFOS) exposure and perfluorodecanoic acid (PFDE) exposure are negatively associated with depression. Furthermore, the Bayesian kernel machine regression (BKMR) and quantile g-computation (QGcomp) models were employed to investigate the collective impact of exposure to mixed metals on depression. Cadmium emerged as the principal contributor to depression. Moreover, the addition of PFAS to the metal mixture had an antagonistic effect on depression, with PFOS having the most prominent influence. Analysis of the effects of co-exposure to cadmium and PFOS confirmed the presence of an antagonistic effect. The inflection points of cadmium and PFOS were determined to be -1.11 and 2.27, respectively. Additionally, exposure to cadmium and PFOS had the opposite effects on two crucial pathways, namely, the rap1 and calcium signaling pathways, which involve core genes related to depression such as ADORA2A, FGF2, and FGFR1. These findings have significant implications for future studies and provide new strategies for exploring the mechanisms underlying co-exposure effects.
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Affiliation(s)
- Chunlan Tang
- School of Public Health, Health Science Center, Ningbo University, Ningbo, Zhejiang 315211, China; Zhejiang Engineering Research Center of Advanced Mass Spectrometry and Clinical Application, Ningbo University, Ningbo, Zhengjiang 315211, China
| | - Yucheng Wang
- The Affiliated Kangning Hospital, Ningbo University, Ningbo, Zhejiang 315201, China
| | - Hang Hong
- School of Public Health, Health Science Center, Ningbo University, Ningbo, Zhejiang 315211, China.
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10
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Mustieles V, Fernández MF, Messerlian C. In Utero Metabolic Disruption-A Preventable Antecedent of Adult Disease? JAMA Netw Open 2024; 7:e2412022. [PMID: 38780945 DOI: 10.1001/jamanetworkopen.2024.12022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Affiliation(s)
- Vicente Mustieles
- Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Biomedical Research Center (CIBM), University of Granada, Granada, Spain
| | - Mariana F Fernández
- Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Biomedical Research Center (CIBM), University of Granada, Granada, Spain
| | - Carmen Messerlian
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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11
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Zhang Y, Sun Q, Mustieles V, Martin L, Sun Y, Bibi Z, Torres N, Coburn-Sanderson A, First O, Souter I, Petrozza JC, Botelho JC, Calafat AM, Wang YX, Messerlian C. Predictors of Serum Per- and Polyfluoroalkyl Substances Concentrations among U.S. Couples Attending a Fertility Clinic. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2024; 58:5685-5694. [PMID: 38502775 DOI: 10.1021/acs.est.3c08457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Previous studies have examined the predictors of PFAS concentrations among pregnant women and children. However, no study has explored the predictors of preconception PFAS concentrations among couples in the United States. This study included 572 females and 279 males (249 couples) who attended a U.S. fertility clinic between 2005 and 2019. Questionnaire information on demographics, reproductive history, and lifestyles and serum samples quantified for PFAS concentrations were collected at study enrollment. We examined the PFAS distribution and correlation within couples. We used Ridge regressions to predict the serum concentration of each PFAS in females and males using data of (1) socio-demographic and reproductive history, (2) diet, (3) behavioral factors, and (4) all factors included in (1) to (3) after accounting for temporal exposure trends. We used general linear models for univariate association of each factor with the PFAS concentration. We found moderate to high correlations for PFAS concentrations within couples. Among all examined factors, diet explained more of the variation in PFAS concentrations (1-48%), while behavioral factors explained the least (0-4%). Individuals reporting White race, with a higher body mass index, and nulliparous women had higher PFAS concentrations than others. Fish and shellfish consumption was positively associated with PFAS concentrations among both females and males, while intake of beans (females), peas (male), kale (females), and tortilla (both) was inversely associated with PFAS concentrations. Our findings provide important data for identifying sources of couples' PFAS exposure and informing interventions to reduce PFAS exposure in the preconception period.
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Affiliation(s)
- Yu Zhang
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115, United States
| | - Qi Sun
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115, United States
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, United States
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115, United States
| | - Vicente Mustieles
- Instituto de Investigación Biosanitaria Ibs GRANADA, Granada 18012, Spain
- University of Granada, Center for Biomedical Research (CIBM), Spain. Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid 28029, Spain
| | - Leah Martin
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115, United States
| | - Yang Sun
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115, United States
| | - Zainab Bibi
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115, United States
| | - Nicole Torres
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115, United States
| | - Ayanna Coburn-Sanderson
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115, United States
| | - Olivia First
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115, United States
| | - Irene Souter
- Department of Obstetrics and Gynecology, Vincent Center for Reproductive Biology, Massachusetts General Hospital Fertility Center, Boston, Massachusetts 02113, United States
| | - John C Petrozza
- Department of Obstetrics and Gynecology, Vincent Center for Reproductive Biology, Massachusetts General Hospital Fertility Center, Boston, Massachusetts 02113, United States
| | - Julianne C Botelho
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, United States
| | - Antonia M Calafat
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, United States
| | - Yi-Xin Wang
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115, United States
| | - Carmen Messerlian
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115, United States
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115, United States
- Department of Obstetrics and Gynecology, Vincent Center for Reproductive Biology, Massachusetts General Hospital Fertility Center, Boston, Massachusetts 02113, United States
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12
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Maitin-Shepard M, Werner EF, Feig LA, Chavarro JE, Mumford SL, Wylie B, Rando OJ, Gaskins AJ, Sakkas D, Arora M, Kudesia R, Lujan ME, Braun J, Mozaffarian D. Food, nutrition, and fertility: from soil to fork. Am J Clin Nutr 2024; 119:578-589. [PMID: 38101699 DOI: 10.1016/j.ajcnut.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 11/22/2023] [Accepted: 12/11/2023] [Indexed: 12/17/2023] Open
Abstract
Food and nutrition-related factors, including foods and nutrients consumed, dietary patterns, use of dietary supplements, adiposity, and exposure to food-related environmental contaminants, have the potential to impact semen quality and male and female fertility; obstetric, fetal, and birth outcomes; and the health of future generations, but gaps in evidence remain. On 9 November 2022, Tufts University's Friedman School of Nutrition Science and Policy and the school's Food and Nutrition Innovation Institute hosted a 1-d meeting to explore the evidence and evidence gaps regarding the relationships between food, nutrition, and fertility. Topics addressed included male fertility, female fertility and gestation, and intergenerational effects. This meeting report summarizes the presentations and deliberations from the meeting. Regarding male fertility, a positive association exists with a healthy dietary pattern, with high-quality evidence for semen quality and lower quality evidence for clinical outcomes. Folic acid and zinc supplementation have been found to not impact male fertility. In females, body weight status and other nutrition-related factors are linked to nearly half of all ovulation disorders, a leading cause of female infertility. Females with obesity have worse fertility treatment, pregnancy-related, and birth outcomes. Environmental contaminants found in food, water, or its packaging, including lead, perfluorinated alkyl substances, phthalates, and phenols, adversely impact female reproductive outcomes. Epigenetic research has found that maternal and paternal dietary-related factors can impact outcomes for future generations. Priority evidence gaps identified by meeting participants relate to the effects of nutrition and dietary patterns on fertility, gaps in communication regarding fertility optimization through changes in nutritional and environmental exposures, and interventions impacting germ cell mechanisms through dietary effects. Participants developed research proposals to address the priority evidence gaps. The workshop findings serve as a foundation for future prioritization of scientific research to address evidence gaps related to food, nutrition, and fertility.
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Affiliation(s)
| | - Erika F Werner
- Tufts University School of Medicine, Boston, MA, United States
| | - Larry A Feig
- Department of Developmental, Molecular, and Chemical Biology, Tufts University School of Medicine, Boston, MA, United States
| | - Jorge E Chavarro
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Sunni L Mumford
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, United States
| | - Blair Wylie
- Collaborative for Women's Environmental Health, Columbia University, New York, NY, United States
| | - Oliver J Rando
- Department of Biochemistry and Molecular Biotechnology, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Audrey J Gaskins
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, United States
| | | | - Manish Arora
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - Marla E Lujan
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States
| | - Joseph Braun
- Department of Epidemiology, Brown University, Providence, RI, United States
| | - Dariush Mozaffarian
- Tufts University School of Medicine, Boston, MA, United States; Food is Medicine Institute, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States.
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13
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Zhang M, Li R, Fan X, Zhang S, Liao L, Xu X, Guo Y. Correlation of several forms of folic acid with endometrial cancer: cross-sectional data from the National Health and Nutrition Examination Surveys (NHANES) 2011-2018. J Cancer Res Clin Oncol 2023; 149:13619-13629. [PMID: 37515615 DOI: 10.1007/s00432-023-05177-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 07/10/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVE Endometrial cancer (EC) is a common malignancy of the female reproductive system and although most patients have a good prognosis, 20-30% of patients with advanced disease have a poor prognosis. There are currently no reliable biomarkers for early diagnosis and effective prognostic improvement of the disease. The purpose of this study was to explore the correlation between different forms of folic acid and endometrial cancer. METHODS This study included 8809 female subjects aged ≥ 20 years in the NHANES database from 2011 to 2018, including 8738 non-oncology patients and 71 EC patients. Selection bias was reduced using 1:1 propensity score matching (PSM) method. Restricted cubic spline (RCS) was plotted to explore the non-linear relationship between different forms of folic acid and EC. RESULT Using data from the NHANES database from 2011 to 2018, the association between folic acid and the risk of developing EC was assessed. The results of the 1:1 ratio propensity score matching (PSM) showed 68 each for EC patients and non-oncology participants. Total serum folate, 5-methyltetrahydrofolate (5-methylTHF), 5-formyltetrahydrofolate (5-formylTHF), tetrahydrofolate (THF) and 5,10-methylenetetrahydrofolate (5,10-methenylTHF) were significantly correlated with EC (p < 0.05). In addition, the RCS showed a significant non-linear correlation between THF and 5,10-formyl THF and the risk of developing EC. CONCLUSION The results of this study showed that changes in serum total folate, 5-methylTHF, 5-formylTHF, THF and 5,10-methenylTHF were related to EC.
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Affiliation(s)
- Meng Zhang
- Department of Gynecology, Second Hospital of Lanzhou University, Cuiyingmen No. 82, Chengguan District, 730000, Lanzhou, Gansu, People's Republic of China
| | - Ruiping Li
- Department of Gynecology, Second Hospital of Lanzhou University, Cuiyingmen No. 82, Chengguan District, 730000, Lanzhou, Gansu, People's Republic of China
| | - Xuefen Fan
- Department of Gynecology, Second Hospital of Lanzhou University, Cuiyingmen No. 82, Chengguan District, 730000, Lanzhou, Gansu, People's Republic of China
| | - Shan Zhang
- Department of Gynecology, Second Hospital of Lanzhou University, Cuiyingmen No. 82, Chengguan District, 730000, Lanzhou, Gansu, People's Republic of China
| | - Lixin Liao
- Department of Gynecology, Second Hospital of Lanzhou University, Cuiyingmen No. 82, Chengguan District, 730000, Lanzhou, Gansu, People's Republic of China
| | - Xin Xu
- Department of Gynecology, Second Hospital of Lanzhou University, Cuiyingmen No. 82, Chengguan District, 730000, Lanzhou, Gansu, People's Republic of China
| | - Yuzhen Guo
- Department of Gynecology, Second Hospital of Lanzhou University, Cuiyingmen No. 82, Chengguan District, 730000, Lanzhou, Gansu, People's Republic of China.
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