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Xia YY, de Seymour JV, Yang XJ, Zhou LW, Liu Y, Yang Y, Beck KL, Conlon CA, Mansell T, Novakovic B, Saffery R, Han TL, Zhang H, Baker PN. Hair and cord blood element levels and their relationship with air pollution, dietary intake, gestational diabetes mellitus, and infant neurodevelopment. Clin Nutr 2023; 42:1875-1888. [PMID: 37625317 DOI: 10.1016/j.clnu.2023.08.009] [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: 04/09/2023] [Revised: 07/30/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND & AIMS Exposure to a range of elements, air pollution, and specific dietary components in pregnancy has variously been associated with gestational diabetes mellitus (GDM) risk or infant neurodevelopmental problems. We measured a range of pregnancy exposures in maternal hair and/or infant cord serum and tested their relationship to GDM and infant neurodevelopment. METHODS A total of 843 pregnant women (GDM = 224, Non-GDM = 619) were selected from the Complex Lipids in Mothers and Babies cohort study. Forty-eight elements in hair and cord serum were quantified using inductively coupled plasma-mass spectrometry analysis. Binary logistic regression was used to estimate the associations between hair element concentrations and GDM risk, while multiple linear regression was performed to analyze the relationship between hair/cord serum elements and air pollutants, diet exposures, and Bayley Scales of infant neurodevelopment at 12 months of age. RESULTS After adjusting for maternal age, BMI, and primiparity, we observed that fourteen elements in maternal hair were associated with a significantly increased risk of GDM, particularly Ta (OR = 9.49, 95% CI: 6.71, 13.42), Re (OR = 5.21, 95% CI: 3.84, 7.07), and Se (OR = 5.37, 95% CI: 3.48, 8.28). In the adjusted linear regression model, three elements (Rb, Er, and Tm) in maternal hair and infant cord serum were negatively associated with Mental Development Index scores. For dietary exposures, elements were positively associated with noodles (Nb), sweetened beverages (Rb), poultry (Cs), oils and condiments (Ca), and other seafood (Gd). In addition, air pollutants PM2.5 (LUR) and PM10 were negatively associated with Ta and Re in maternal hair. CONCLUSIONS Our findings highlight the potential influence of maternal element exposure on GDM risk and infant neurodevelopment. We identified links between levels of these elements in both maternal hair and infant cord serum related to air pollutants and dietary factors.
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Affiliation(s)
- Yin-Yin Xia
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Department of Occupational and Environmental Hygiene, School of Public Health, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China; Mass Spectrometry Center of Maternal Fetal Medicine, Chongqing Medical University, Chongqing, China
| | - Jamie V de Seymour
- School of Sport, Exercise and Nutrition, College of Health, Massey University, Auckland, New Zealand
| | - Xiao-Jia Yang
- Department of Occupational and Environmental Hygiene, School of Public Health, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China
| | - Lin-Wei Zhou
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yue Liu
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Department of Occupational and Environmental Hygiene, School of Public Health, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China; Mass Spectrometry Center of Maternal Fetal Medicine, Chongqing Medical University, Chongqing, China
| | - Yang Yang
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Mass Spectrometry Center of Maternal Fetal Medicine, Chongqing Medical University, Chongqing, China
| | - Kathryn L Beck
- School of Sport, Exercise and Nutrition, College of Health, Massey University, Auckland, New Zealand
| | - Cathryn A Conlon
- School of Sport, Exercise and Nutrition, College of Health, Massey University, Auckland, New Zealand
| | - Toby Mansell
- Molecular Immunity, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Boris Novakovic
- Molecular Immunity, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Richard Saffery
- Molecular Immunity, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Ting-Li Han
- Mass Spectrometry Center of Maternal Fetal Medicine, Chongqing Medical University, Chongqing, China; Department of Obstetrics and Gynaecology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China; Institute of Life Sciences, Chongqing Medical University, Chongqing, China.
| | - Hua Zhang
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Mass Spectrometry Center of Maternal Fetal Medicine, Chongqing Medical University, Chongqing, China.
| | - Philip N Baker
- College of Life Sciences, University of Leicester, Leicester, United Kingdom
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Al-Saleh I, Elkhatib R, Alnuwaysir H, Aldhalaan H, Alismail E, Binmanee A, Hawari A, Alhazzani F, Jabr MB, Mohamed G. Exposure of preterm neonates receiving total parenteral nutrition to phthalates and its impact on neurodevelopment at the age of 2 months. Sci Rep 2023; 13:6969. [PMID: 37117441 PMCID: PMC10141929 DOI: 10.1038/s41598-023-33715-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 04/18/2023] [Indexed: 04/30/2023] Open
Abstract
This prospective study assessed the exposure to phthalates of preterm neonates who received total parenteral nutrition (TPN) during their stay in the neonatal intensive care unit (NICU) and the risk of neurodevelopment delays at the age of 2 months. Our study recruited 33 preterm neonates who required TPN upon NICU admission. Urine samples for analyzing phthalate metabolites were obtained at admission and then daily until the last day of receiving TPN. Phthalates in the daily TPN received by the preterm neonates were analyzed. The neurodevelopment of the neonates was assessed using the Ages and Stages Questionnaire Edition 3 (ASQ-3). Diethyl phthalate and butyl benzyl phthalate were found in all TPN samples, while 27% and 83% contained dibutyl phthalate and di-(2-ethylhexyl) phthalate (DEHP), respectively. Yet, the daily dose of each phthalate that our preterm neonates received from TPN was much lower than the recommended tolerable limit. Urinary levels of monobenzyl phthalate and four metabolites of DEHP [i.e., mono-(2-ethylhexyl) phthalate (MEHP), mono-(2-ethyl-5-hydroxyhexyl) phthalate, mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP), and mono-(2-ethyl-5-carboxypentyl) phthalate (MECPP)] and the sum of four DEHP metabolites (∑4DEHP) increased significantly in preterm neonates before discharge. However, these levels were not correlated with their phthalate parent compounds in TPN, suggesting other sources of exposure in the NICU. At 2 months, we found that urinary levels of mono-iso-butyl phthalate (MiBP), MECPP, MEHP, and ∑4DEHP were inversely related to fine motor skills. After adjusting for head circumference, the inverse relationships remained significant, suggesting direct effects from phthalates. Given the extreme vulnerability of our population, it is critical to minimize exposure to phthalates during their NICU stay.
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Affiliation(s)
- Iman Al-Saleh
- King Faisal Specialist Hospital and Research Centre, Environmental Health Program (MBC#03), P.O. Box: 3354, Riyadh, 11211, Saudi Arabia.
| | - Rola Elkhatib
- King Faisal Specialist Hospital and Research Centre, Environmental Health Program (MBC#03), P.O. Box: 3354, Riyadh, 11211, Saudi Arabia
| | - Hissah Alnuwaysir
- King Faisal Specialist Hospital and Research Centre, Environmental Health Program (MBC#03), P.O. Box: 3354, Riyadh, 11211, Saudi Arabia
| | - Hesham Aldhalaan
- Center for Autism Research, King Faisal Specialist Hospital and Research Centre, P.O. Box: 3354, Riyadh, 11211, Saudi Arabia
| | - Eiman Alismail
- Center for Autism Research, King Faisal Specialist Hospital and Research Centre, P.O. Box: 3354, Riyadh, 11211, Saudi Arabia
| | - Abdulaziz Binmanee
- Neonatal Critical Care Section, Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, P.O. Box: 3354, Riyadh, 11211, Saudi Arabia
| | - Amal Hawari
- Neonatal Critical Care Section, Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, P.O. Box: 3354, Riyadh, 11211, Saudi Arabia
| | - Fahad Alhazzani
- Neonatal Critical Care Section, Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, P.O. Box: 3354, Riyadh, 11211, Saudi Arabia
| | - Mohammad Bin Jabr
- Neonatal Critical Care Section, Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, P.O. Box: 3354, Riyadh, 11211, Saudi Arabia
| | - Gamal Mohamed
- Biostatistics, Epidemiology and Scientific Computing Department, King Faisal Specialist Hospital and Research Centre, P.O. Box: 3354, Riyadh, 11211, Saudi Arabia
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Wylie AC, Short SJ. Environmental Toxicants and the Developing Brain. Biol Psychiatry 2023; 93:921-933. [PMID: 36906498 DOI: 10.1016/j.biopsych.2023.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 01/05/2023] [Accepted: 01/11/2023] [Indexed: 01/19/2023]
Abstract
Early life represents the most rapid and foundational period of brain development and a time of vulnerability to environmental insults. Evidence indicates that greater exposure to ubiquitous toxicants like fine particulate matter (PM2.5), manganese, and many phthalates is associated with altered developmental, physical health, and mental health trajectories across the lifespan. Whereas animal models offer evidence of their mechanistic effects on neurological development, there is little research that evaluates how these environmental toxicants are associated with human neurodevelopment using neuroimaging measures in infant and pediatric populations. This review provides an overview of 3 environmental toxicants of interest in neurodevelopment that are prevalent worldwide in the air, soil, food, water, and/or products of everyday life: fine particulate matter (PM2.5), manganese, and phthalates. We summarize mechanistic evidence from animal models for their roles in neurodevelopment, highlight prior research that has examined these toxicants with pediatric developmental and psychiatric outcomes, and provide a narrative review of the limited number of studies that have examined these toxicants using neuroimaging with pediatric populations. We conclude with a discussion of suggested directions that will move this field forward, including the incorporation of environmental toxicant assessment in large, longitudinal, multimodal neuroimaging studies; the use of multidimensional data analysis strategies; and the importance of studying the combined effects of environmental and psychosocial stressors and buffers on neurodevelopment. Collectively, these strategies will improve ecological validity and our understanding of how environmental toxicants affect long-term sequelae via alterations to brain structure and function.
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Affiliation(s)
- Amanda C Wylie
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Sarah J Short
- Department of Educational Psychology, University of Wisconsin-Madison, Madison, Wisconsin; Center for Health Minds, University of Wisconsin-Madison, Madison, Wisconsin.
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Wei L, Huang H, Chen X, Wang X, Zhang R, Su L, Duan W, Rahman M, Golam Mostofa M, Qamruzzaman Q, Shen H, Hu Z, Wei Y, Christiani DC, Chen F. Umbilical cord serum elementomics of 52 trace elements and early childhood neurodevelopment: Evidence from a prospective birth cohort in rural Bangladesh. ENVIRONMENT INTERNATIONAL 2022; 166:107370. [PMID: 35772314 PMCID: PMC9926395 DOI: 10.1016/j.envint.2022.107370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/13/2022] [Accepted: 06/21/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Prenatal exposures to neurotoxic metals and trace elements are associated with early childhood neurodevelopmental outcomes. However, consequences of simultaneous exposure to mixtures of elements remain unclear. OBJECTIVE To examine individual and joint effects of prenatal trace element exposure on early childhood neurodevelopment. METHODS Using a well-established Bangladesh prospective birth cohort (2008-2011), we measured concentrations of 52 trace elements in umbilical cord serum of 569 mother-infant pairs using inductively coupled plasma mass spectrometry. Neurodevelopment was evaluated at 20-40 months of age using Bayley Scales of Infant and Toddler Development, Third Edition. Stability elastic net (ENET) was used to screen elements individually associated with the outcome; candidate exposures were combined by weighted linear combination to form a risk score representing their mixture effect on early childhood neurodevelopment. RESULTS Stability ENET identified 15 trace elements associated with cognitive composite score and 14 associated with motor composite score, which were linearly combined to form the element risk score (ERS). Children with higher ERScognitive had lower probability of cognitive developmental delay (ORhighest vs lowest: 0.21; 95 %CI: 0.10, 0.40; P < 0.001; Ptrend < 0.001). Children with ERSmotor in the top quintile had a significantly lower risk of motor developmental delay (OR: 0.16; 95 %CI: 0.09, 0.31; P < 0.001; Ptrend < 0.001) versus the lowest quintile. In Bayesian kernel machine regression analyses, lithium [conditional posterior inclusion probability (cPIP) = 0.68], aluminum (cPIP = 0.83) and iron (cPIP = 1.00) contributed most to the lower cognitive composite score; zinc (cPIP = 1.00), silver (cPIP = 0.81), and antimony (cPIP = 0.65) mainly contributed to the change of motor composite score. CONCLUSION Co-exposure to lithium/aluminum/iron or zinc/silver/antimony appears to impact children's neurodevelopment. ERS score reflecting maternal exposure could indicate children's risk of neurodevelopmental delay, warranting further studies to explore the underlying mechanism.
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Affiliation(s)
- Liangmin Wei
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Hui Huang
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Xin Chen
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Xiang Wang
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Ruyang Zhang
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Li Su
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Weiwei Duan
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | | | | | | | - Hongbing Shen
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing 211166, China; Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing 211166, China; China International Cooperation Center for Environment and Human Health, Center of Global Health, Nanjing Medical University, Nanjing 211166, China
| | - Zhibin Hu
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing 211166, China; Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing 211166, China; China International Cooperation Center for Environment and Human Health, Center of Global Health, Nanjing Medical University, Nanjing 211166, China
| | - Yongyue Wei
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China; China International Cooperation Center for Environment and Human Health, Center of Global Health, Nanjing Medical University, Nanjing 211166, China.
| | - David C Christiani
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; China International Cooperation Center for Environment and Human Health, Center of Global Health, Nanjing Medical University, Nanjing 211166, China.
| | - Feng Chen
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing 211166, China; Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China; China International Cooperation Center for Environment and Human Health, Center of Global Health, Nanjing Medical University, Nanjing 211166, China.
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Xun X, Qin X, Layden AJ, Yin Q, Swan SH, Barrett ES, Bush NR, Sathyanarayana S, Adibi JJ. Application of 4-way decomposition to the analysis of placental-fetal biomarkers as intermediary variables between maternal body mass index and birthweight. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 4:994436. [PMID: 36545491 PMCID: PMC9760955 DOI: 10.3389/frph.2022.994436] [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: 07/14/2022] [Accepted: 10/24/2022] [Indexed: 12/12/2022] Open
Abstract
Human chorionic gonadotropin (hCG) is a placental hormone measured in pregnancy to predict individual level risk of fetal aneuploidy and other complications; yet may be useful in understanding placental origins of child development more generally. hCG was associated with maternal body mass index (BMI) and with birthweight. The primary aim here was to evaluate hCG as a mediator of maternal BMI effects on birthweight by causal mediation analysis. Subjects were 356 women from 3 U.S. sites (2010-2013). The 4-way decomposition method using med4way (STATA) was applied to screen for 5 types of effects of first trimester maternal BMI on birthweight: the total effect, the direct effect, mediation by hCG, additive interaction of BMI and hCG, and mediation in the presence of an additive interaction. Effect modification by fetal sex was evaluated, and a sensitivity analysis was performed to evaluate the assumption of unmeasured confounding. Additional placental-fetal biomarkers [pregnancy associated plasma protein A (PAPPA), second trimester hCG, inhibin-A, estriol, alpha fetoprotein] were analyzed for comparison. For first trimester hCG, there was a 0.20 standard deviation increase in birthweight at the 75th vs. 25th percentile of maternal BMI (95% CI 0.04, 0.36). Once stratified, the direct effect association was null in women carrying females. In women carrying males, hCG did not mediate the relationship. In women carrying females, there was a mediated effect of maternal BMI on birthweight by hCG in the reverse direction (-0.06, 95% CI: -0.12, 0.01), and a mediated interaction in the positive direction (0.06, 95% CI 0.00, 0.13). In women carrying males, the maternal BMI effect on birthweight was reverse mediated by PAPPA (-0.09, 95% CI: -0.17, 0.00). Sex-specific mediation was mostly present in the first trimester. Second trimester AFP was a positive mediator of maternal BMI effects in male infants only (0.06, 95% CI: -0.01, 0.13). Effect estimates were robust to potential bias due to unmeasured confounders. These findings motivate research to consider first trimester placental biomarkers and sex-specific mechanisms when quantifying the effects of maternal adiposity on fetal growth.
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Affiliation(s)
- Xiaoshuang Xun
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Xu Qin
- Department of Health and Human Development, School of Education, University of Pittsburgh, Pittsburgh, PA, United States
| | - Alexander J Layden
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Qing Yin
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Shanna H Swan
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Emily S Barrett
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Rutgers University, Piscataway, NJ, United States
| | - Nicole R Bush
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, United States
| | | | - Jennifer J Adibi
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, United States
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Cong L, Lei MY, Liu ZQ, Liu ZF, Ma Z, Liu K, Li J, Deng Y, Liu W, Xu B. Resveratrol attenuates manganese-induced oxidative stress and neuroinflammation through SIRT1 signaling in mice. Food Chem Toxicol 2021; 153:112283. [PMID: 34029668 DOI: 10.1016/j.fct.2021.112283] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/12/2021] [Accepted: 05/13/2021] [Indexed: 12/14/2022]
Abstract
Exposure to excess levels of manganese (Mn) leads to neurotoxicity. Increasing evidence demonstrates that oxidative stress and neuroinflammation are important pathological causes of neurotoxicity. Resveratrol (Rsv), a sirtuin-1 (SIRT1) activator, plays an important role in neuroprotection. However, the molecular mechanisms of Rsv alleviating Mn-induced oxidative stress and neuroinflammation are not fully understood. To evaluate whether Rsv treatment relieves the oxidative stress and neuroinflammation in the hippocampus after Mn exposure through SIRT1 signaling, C57BL/6 adult mice were exposed to MnCl2 (200 μmol/kg), Rsv (30 mg/kg), and EX527 (5 mg/kg). Our results showed that administering MnCl2 for 6 weeks caused behavioral impairment and nerve cell injury in hippocampal tissue, which was related to oxidative stress and neuroinflammation. Activating Mn-induced JNK and inhibiting SIRT1 increased the phosphorylated and acetylated levels of NF-κB and STAT3, respectively. However, Rsv reduced the phosphorylated and acetylated levels of NF-κB and STAT3, and attenuated Mn-induced oxidative stress and inflammatory cytokines by activating SIRT1 signaling. Most importantly, EX527, a potent SIRT1 inhibitor, inactivated SIRT1, which prevented Rsv from exerting its beneficial effects. Taken together, our findings revealed that Rsv alleviated Mn-induced oxidative stress and neuroinflammation in adult mice by activating SIRT1.
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Affiliation(s)
- Lin Cong
- Department of Environmental Health, School of Public Health, China Medical University, Address:No.77 Puhe Road, Shenyang North New Area, Shenyang,110122, Liaoning, China
| | - Meng-Yu Lei
- Department of Environmental Health, School of Public Health, China Medical University, Address:No.77 Puhe Road, Shenyang North New Area, Shenyang,110122, Liaoning, China
| | - Zhi-Qi Liu
- Department of Environmental Health, School of Public Health, China Medical University, Address:No.77 Puhe Road, Shenyang North New Area, Shenyang,110122, Liaoning, China
| | - Zhuo-Fan Liu
- Department of Environmental Health, School of Public Health, China Medical University, Address:No.77 Puhe Road, Shenyang North New Area, Shenyang,110122, Liaoning, China
| | - Zhuo Ma
- Department of Environmental Health, School of Public Health, China Medical University, Address:No.77 Puhe Road, Shenyang North New Area, Shenyang,110122, Liaoning, China
| | - Kuan Liu
- Department of Environmental Health, School of Public Health, China Medical University, Address:No.77 Puhe Road, Shenyang North New Area, Shenyang,110122, Liaoning, China
| | - Jing Li
- Department of Environmental Health, School of Public Health, China Medical University, Address:No.77 Puhe Road, Shenyang North New Area, Shenyang,110122, Liaoning, China
| | - Yu Deng
- Department of Environmental Health, School of Public Health, China Medical University, Address:No.77 Puhe Road, Shenyang North New Area, Shenyang,110122, Liaoning, China
| | - Wei Liu
- Department of Environmental Health, School of Public Health, China Medical University, Address:No.77 Puhe Road, Shenyang North New Area, Shenyang,110122, Liaoning, China
| | - Bin Xu
- Department of Environmental Health, School of Public Health, China Medical University, Address:No.77 Puhe Road, Shenyang North New Area, Shenyang,110122, Liaoning, China.
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High Concentration of Heavy Metal and Metalloid Levels in Edible Campomanesia adamantium Pulp from Anthropic Areas. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115503. [PMID: 34063746 PMCID: PMC8196635 DOI: 10.3390/ijerph18115503] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/15/2021] [Accepted: 05/16/2021] [Indexed: 01/06/2023]
Abstract
This study aimed to quantify the extent of heavy metal, non-metal and metalloid levels in the Campomanesia adamantium pulp obtained from an area crossed by road experiencing high large vehicle traffic and intensive agriculture modern farming, to monitor the health risks associated with pulp consumption by humans. For this purpose, in three spots located within this area, ripe fruits were collected on the roadside, bush and farm-margin. Pulp samples were digested by microwave-assisted equipment, and chemical elements were quantified by ICP OES. The concentrations of K, Pb, Se, Fe, Mo, Zn, Co, Ni and Mn in the pulp collected in roadside/bush points showed statistical differences (p < 0.05). The heavy metals and metalloid concentrations that exceeded FAO/WHO standards were ordered Pb > As > Mo > Co > Ni > Mn > Cr. Therefore, among these metalloid and heavy metals, As, Pb and Cr were found to be higher in farm-margin > roadside > bush (1.5 × 10−3, 1.1 × 10−3 and 6.2 × 10−4), respectively. Therefore, As is the most important metalloid with higher levels in farm-margin, roadside and bush (1.5 × 10−3, 1.0 × 10−3 and 6.0 × 10−4 > 10−6–10−4 and 3.33, 2.30 and 1.34 > 1), respectively, to total cancer risk and hazard quotient, if 10 g daily of pulp are consumed.
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Gleason KM, Valeri L, Shankar AH, Obrycki JF, Ibne Hasan MOS, Mostofa G, Quamruzzaman Q, Wright RO, Christiani DC, Bellinger DC, Mazumdar M. Stunting and lead: using causal mediation analysis to better understand how environmental lead exposure affects cognitive outcomes in children. J Neurodev Disord 2020; 12:39. [PMID: 33327931 PMCID: PMC7745460 DOI: 10.1186/s11689-020-09346-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 11/18/2020] [Indexed: 11/10/2022] Open
Abstract
Background Many children in Bangladesh experience poor nutritional status and environmental lead exposure, both of which are associated with lower scores on neurodevelopmental assessments. Recent studies have suggested that part of lead’s adverse effects on neurodevelopment are caused in part by lead’s effect on growth. New statistical methods are now available to evaluate potential causal pathways in observational studies. This study used a novel statistical method to test the hypothesis that stunting, a measure of linear growth related to poor nutrition, is a mediator and/or an effect modifier of the lead exposure’s adverse effect on cognitive development. Methods Participants were 734 children from a longitudinal birth cohort established in rural Bangladesh to study the health effects of prenatal and early childhood environmental metal exposures. Lead exposure was estimated using umbilical cord blood samples obtained at birth and blood obtained via venipuncture at age 20–40 months. Stunting was determined using the World Health Organization’s standards. Neurodevelopment was assessed at age 20–40 months years using the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III). We evaluated the effect of lead on stunting and whether the effect of lead on cognitive scores is modified by stunting status in multivariable regression analyses. We then conducted a novel 4-way mediation analysis that allows for exposure-mediator interaction to assess how much of the effect of lead on cognitive scores is explained by the pathway through stunting (mediation) and how much is explained by the interaction between lead and stunt (effect modification). Results Stunting was not a mediator of the effect of lead in our analyses. Results suggested effect modification by stunting. In an area of Bangladesh with lower lead exposures (median umbilical cord blood lead concentration, 1.7 μg/dL), stunting modified the relationship between prenatal blood lead concentrations and cognitive score at age 2–3 years. A 1-unit increase in natural log cord blood lead concentration in the presence of stunting was associated with a 2.1-unit decrease in cognitive scores (β = − 2.10, SE = 0.71, P = 0.003). This interaction was not found in a second study site where lead exposures were higher (median umbilical cord blood lead concentration, 6.1 μg/dL, β = − 0.45, SE = 0.49, P = 0.360). Conclusions We used a novel method of mediation analysis to test whether stunting mediated the adverse effect of prenatal lead exposure on cognitive outcomes in Bangladesh. While we did not find that stunting acted as mediator of lead’s effect on cognitive development, we found significant effect modification by stunting. Our results suggest that children with stunting are more vulnerable to the adverse effects of low-level lead exposure.
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Affiliation(s)
- Kelsey M Gleason
- Department of Medicine, Robert Larner M.D. College of Medicine, Burlington, VT, USA
| | - Linda Valeri
- Department of Biostatistics, Columbia Mailman School of Public Health, New York, NY, USA
| | - Anuraj H Shankar
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - John F Obrycki
- Department of Neurology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | | | | | | | - Robert O Wright
- Department of Preventive Medicine, Icahn School of Medicine at Mt. Sinai, New York, NY, USA.,Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David C Christiani
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - David C Bellinger
- Department of Neurology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Maitreyi Mazumdar
- Department of Neurology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA. .,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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9
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Abstract
Objective: To summarise the existing evidence of development, validation and current status of utilisation of dish-based dietary assessment tools. Design: Scoping review. Setting: Systematic search using PubMed and Web of Science. Results: We identified twelve tools from seventy-four eligible publications. They were developed for Koreans (n 4), Bangladeshis (n 2), Iranians (n 1), Indians/Malays/Chinese (n 1), Japanese (n 3) and Chinese Americans (n 1). Most tools (10/12) were composed of a dish-based FFQ. Although the development process of a dish list varied among the tools, six studies classified mixed dishes based on the similarity of their characteristics such as food ingredients and cooking methods. Tools were validated against self-reported dietary information (n 9) and concentration biomarkers (n 1). In the eight studies assessing the differences between the tool and a reference, the mean (or median) intake of energy significantly differed in five studies, and 26–83 % of nutrients significantly differed in eight studies. Correlation coefficients for energy ranged from 0·15 to 0·87 across the thirteen studies, and the median correlation coefficients for nutrients ranged from 0·12 to 0·77. Dish-based dietary assessment tools were used in fifty-nine studies mainly to assess diet–disease relationships in target populations. Conclusions: Dish-based dietary assessment tools have exclusively been developed and used for Asian-origin populations. Further validation studies, particularly biomarker-based studies, are needed to assess the applicability of tools.
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10
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Zhou T, Guo J, Zhang J, Xiao H, Qi X, Wu C, Chang X, Zhang Y, Liu Q, Zhou Z. Sex-Specific Differences in Cognitive Abilities Associated with Childhood Cadmium and Manganese Exposures in School-Age Children: a Prospective Cohort Study. Biol Trace Elem Res 2020; 193:89-99. [PMID: 30977088 DOI: 10.1007/s12011-019-01703-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 03/19/2019] [Indexed: 01/06/2023]
Abstract
To examine sex-specific associations of neonatal and childhood exposure to eight trace elements with cognitive abilities of school-age children. The association between exposure and effects was assessed among 296 school-age children from a population-based birth cohort study, who had manganese (Mn), cadmium (Cd), and lead (Pb) exposure measured in cord blood and chromium (Cr), manganese, cobalt (Co), copper (Cu), arsenic (As), selenium (Se), cadmium, and lead exposure quantified in spot urine. Cognitive abilities were assessed using the Wechsler Intelligence Scale for Children-Chinese Revised (WISC-CR). Generalized linear models were performed to analyze associations of intelligence quotient (IQ) with trace element concentrations in cord blood and urinary trace element levels. General linear models were used to evaluate association between exposure fluctuation and children's IQ. Urinary Cd concentrations were negatively associated with full-scale IQ (β = - 3.469, 95% confidence interval (CI) - 6.291, - 0.647; p = 0.016) and performance IQ (β = - 4.012, 95% CI - 7.088, - 0.936; p = 0.011) in girls; however, neonatal Cd exposure expressed as Cd concentrations in cord blood was in inverse associations with verbal IQ (β = - 2.590, 95% CI - 4.570, - 0.609; p = 0.010) only in boys. Positive association between urinary Mn concentrations and performance IQ (β = 1.305, 95% CI 0.035, 2.575; p = 0.044) of children was observed, especially in girls. In addition, inverse association of urinary Cu concentrations with verbal IQ (β = - 2.200, 95% CI - 4.360, - 0.039; p = 0.046) was only found in boys. Childhood Cd exposure may adversely affect cognitive abilities, while Mn exposure may beneficially modify cognitive abilities of school-age children, particularly in girls.
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Affiliation(s)
- Tong Zhou
- School of Public Health/Key Laboratory of Public Health Safety of Ministry of Education/Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China, Fudan University, No. 130 Dong'an Road, Shanghai, 200032, China
| | - Jianqiu Guo
- School of Public Health/Key Laboratory of Public Health Safety of Ministry of Education/Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China, Fudan University, No. 130 Dong'an Road, Shanghai, 200032, China
| | - Jiming Zhang
- School of Public Health/Key Laboratory of Public Health Safety of Ministry of Education/Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China, Fudan University, No. 130 Dong'an Road, Shanghai, 200032, China
| | - Hongxi Xiao
- School of Public Health/Key Laboratory of Public Health Safety of Ministry of Education/Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China, Fudan University, No. 130 Dong'an Road, Shanghai, 200032, China
| | - Xiaojuan Qi
- School of Public Health/Key Laboratory of Public Health Safety of Ministry of Education/Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China, Fudan University, No. 130 Dong'an Road, Shanghai, 200032, China
- Zhejiang Provincial Center for Disease Control and Prevention, No. 3399, Binsheng Road, Hangzhou, 310051, China
| | - Chunhua Wu
- School of Public Health/Key Laboratory of Public Health Safety of Ministry of Education/Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China, Fudan University, No. 130 Dong'an Road, Shanghai, 200032, China
| | - Xiuli Chang
- School of Public Health/Key Laboratory of Public Health Safety of Ministry of Education/Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China, Fudan University, No. 130 Dong'an Road, Shanghai, 200032, China
| | - Yubin Zhang
- School of Public Health/Key Laboratory of Public Health Safety of Ministry of Education/Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China, Fudan University, No. 130 Dong'an Road, Shanghai, 200032, China
| | - Qiang Liu
- School of Public Health/Key Laboratory of Public Health Safety of Ministry of Education/Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China, Fudan University, No. 130 Dong'an Road, Shanghai, 200032, China
| | - Zhijun Zhou
- School of Public Health/Key Laboratory of Public Health Safety of Ministry of Education/Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China, Fudan University, No. 130 Dong'an Road, Shanghai, 200032, China.
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11
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Tsai MS, Chen MH, Lin CC, Liu CY, Chen PC. Children's environmental health based on birth cohort studies of Asia (2) - air pollution, pesticides, and heavy metals. ENVIRONMENTAL RESEARCH 2019; 179:108754. [PMID: 31563033 DOI: 10.1016/j.envres.2019.108754] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 06/16/2019] [Accepted: 09/17/2019] [Indexed: 06/10/2023]
Abstract
The life style and child raising environment in Asia are quite different compared with Western countries. Besides, the children's environmental threats and difficulties in conducting studies could be different. To address children's environmental health in Asia area, the Birth Cohort Consortium of Asia (BiCCA) was co-established in 2011. We reviewed the mercury, polychlorinated biphenyls, perfluoroalkyl substances, phthalates, and environmental tobacco smoke in pervious based on birth cohort studies in Asia. The aim of this study was to summarize the traditional environmental pollution and the target subjects were also based on the birth cohort in Asia area. Environmental pollutants included air pollutants, pesticides focusing on organochlorine pesticides, diakylphosphates, and pyrethroid, and heavy metals including lead, arsenic, cadmium, manganese, vanadium, and thallium. Fetal growth and pregnancy outcomes, childhood growth and obesity, neurodevelopment and behavioral problems, and allergic disease and immune function were classified to elucidate the children's health effects. In total, 106 studies were selected in this study. The evidences showed air pollution or pesticides may affect growth during infancy or childhood, and associated with neurodevelopmental or behavioral problems. Prenatal exposure to lead or manganese was associated with neurodevelopmental or behavioral problems, while exposure to arsenic or cadmium may influence fetal growth. In addition to the harmonization and international collaboration of birth cohorts in Asia; however, understand the whole picture of exposure scenario and consider more discipline in the research are necessary.
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Affiliation(s)
- Meng-Shan Tsai
- Institute of Environmental and Occupational Health Sciences, National Taiwan University College of Public Health, Taipei, Taiwan
| | - Mei-Huei Chen
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan; Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ching-Chun Lin
- Institute of Environmental and Occupational Health Sciences, National Taiwan University College of Public Health, Taipei, Taiwan
| | - Chen-Yu Liu
- Institute of Environmental and Occupational Health Sciences, National Taiwan University College of Public Health, Taipei, Taiwan
| | - Pau-Chung Chen
- Institute of Environmental and Occupational Health Sciences, National Taiwan University College of Public Health, Taipei, Taiwan; Department of Public Health, National Taiwan University, College of Public Health, Taipei, Taiwan; Department of Environmental and Occupational Medicine, National Taiwan University Hospital and National Taiwan University, College of Medicine, Taipei, Taiwan; Office of Occupational Safety and Health, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan; Innovation and Policy Center for Population Health and Sustainable Environment, National Taiwan University, College of Public Health, Taipei, Taiwan.
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12
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Frisbie SH, Mitchell EJ, Roudeau S, Domart F, Carmona A, Ortega R. Manganese levels in infant formula and young child nutritional beverages in the United States and France: Comparison to breast milk and regulations. PLoS One 2019; 14:e0223636. [PMID: 31689314 PMCID: PMC6830775 DOI: 10.1371/journal.pone.0223636] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 09/20/2019] [Indexed: 11/27/2022] Open
Abstract
Exposure to high levels of manganese (Mn) in children has recently been associated with adverse neurodevelopmental effects. Current infant formula regulations for Mn content were set between 1981 (United States), 2006 (European Union, France), and 2007 (Codex Alimentarius) prior to the publication of much of the growing body of research on the developmental neurotoxicity of Mn. In this study, we sought to measure the concentrations of Mn in some infant formulas and young child nutritional beverages available on the United States (US) and French markets using ion beam analysis by particle induced X-ray emission (PIXE) spectrometry and then compare the analytical results to concentrations reported in the literature for breast milk and applicable infant formula regulations and guidelines. We were particularly interested in measuring Mn concentrations in product types for which there is very little data from previous surveys, especially soy-based, rice-based, goat-milk based, chocolate-flavored, and nutritional beverages for young children that are not regulated as infant or follow-on formulas (e.g. “toddler formulas” and “toddler powders”). We purchased 44 infant formulas and young child nutritional beverage products in the US and France with varying protein sources (cow-milk, goat-milk, soy, rice) labelled for birth to 3 years. We selected these samples using maximum variation sampling to explore market extremes to facilitate comparisons to regulatory limits. Since this sampling method is non-probabilistic, other inferences cannot be made beyond this set of samples to the overall markets. We used ion beam analysis to measure the concentrations of Mn in each product. The range of measured Mn concentrations in the products is 160–2,800 μg/L, substantially higher than the 3–6 μg/L mean Mn concentration reported in human breast milk. All products satisfied national and Codex Alimentarius Commission (CAC) international standards for minimum Mn content in infant formulas; however, 7/25 of the products purchased in the US exceeded the CAC Guidance Upper Level of 100 μg Mn/kcal for infant formula.
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Affiliation(s)
- Seth H. Frisbie
- Department of Chemistry and Biochemistry, Norwich University, Northfield, VT, United States of America
- * E-mail:
| | - Erika J. Mitchell
- Better Life Laboratories, Incorporated, East Calais, VT, United States of America
| | - Stéphane Roudeau
- University of Bordeaux, Centre d’Etudes Nucléaires de Bordeaux Gradignan (CENBG), Gradignan, France
- Centre National de la Recherche Scientifique (CNRS), Institut National de Physique Nucléaire et de Physique des Particules (IN2P3), CENBG, Gradignan, France
| | - Florelle Domart
- University of Bordeaux, Centre d’Etudes Nucléaires de Bordeaux Gradignan (CENBG), Gradignan, France
- Centre National de la Recherche Scientifique (CNRS), Institut National de Physique Nucléaire et de Physique des Particules (IN2P3), CENBG, Gradignan, France
| | - Asuncion Carmona
- University of Bordeaux, Centre d’Etudes Nucléaires de Bordeaux Gradignan (CENBG), Gradignan, France
- Centre National de la Recherche Scientifique (CNRS), Institut National de Physique Nucléaire et de Physique des Particules (IN2P3), CENBG, Gradignan, France
| | - Richard Ortega
- University of Bordeaux, Centre d’Etudes Nucléaires de Bordeaux Gradignan (CENBG), Gradignan, France
- Centre National de la Recherche Scientifique (CNRS), Institut National de Physique Nucléaire et de Physique des Particules (IN2P3), CENBG, Gradignan, France
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13
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Credo J, Torkelson J, Rock T, Ingram JC. Quantification of Elemental Contaminants in Unregulated Water across Western Navajo Nation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2727. [PMID: 31370179 PMCID: PMC6696199 DOI: 10.3390/ijerph16152727] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/26/2019] [Accepted: 07/27/2019] [Indexed: 01/09/2023]
Abstract
The geologic profile of the western United States lends itself to naturally elevated levels of arsenic and uranium in groundwater and can be exacerbated by mining enterprises. The Navajo Nation, located in the American Southwest, is the largest contiguous Native American Nation and has over a 100-year legacy of hard rock mining. This study has two objectives, quantify the arsenic and uranium concentrations in water systems in the Arizona and Utah side of the Navajo Nation compared to the New Mexico side and to determine if there are other elements of concern. Between 2014 and 2017, 294 water samples were collected across the Arizona and Utah side of the Navajo Nation and analyzed for 21 elements. Of these, 14 elements had at least one instance of a concentration greater than a national regulatory limit, and six of these (V, Ca, As, Mn, Li, and U) had the highest incidence of exceedances and were of concern to various communities on the Navajo Nation. Our findings are similar to other studies conducted in Arizona and on the Navajo Nation and demonstrate that other elements may be a concern for public health beyond arsenic and uranium.
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Affiliation(s)
- Jonathan Credo
- College of Medicine Clinical Translational Science Graduate Program, University of Arizona, Tucson, AZ 85721, USA
| | - Jaclyn Torkelson
- Department of Chemistry & Biochemistry, Northern Arizona University, P.O. Box 5698, Flagstaff, AZ 86011, USA
| | - Tommy Rock
- Department of Chemistry & Biochemistry, Northern Arizona University, P.O. Box 5698, Flagstaff, AZ 86011, USA
| | - Jani C Ingram
- Department of Chemistry & Biochemistry, Northern Arizona University, P.O. Box 5698, Flagstaff, AZ 86011, USA.
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14
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Kac G, Arnold CD, Matias SL, Mridha MK, Dewey KG. Gestational weight gain and newborn anthropometric outcomes in rural Bangladesh. MATERNAL AND CHILD NUTRITION 2019; 15:e12816. [PMID: 30903801 DOI: 10.1111/mcn.12816] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 02/07/2019] [Accepted: 03/15/2019] [Indexed: 12/17/2022]
Abstract
Low gestational weight gain (GWG) is a known predictor of fetal growth restriction in higher income countries, but there is little information on this association in lower income countries. Our objective is to describe the association between GWG and birth outcomes among pregnant women in rural Bangladesh. Pregnant women were identified in a community-based programme and enrolled into the study at an average of 13 weeks' gestation (n = 4,011). Maternal weight and height were measured at enrolment, maternal weight was measured at 36 weeks' gestation, and newborns were measured after birth. Rate of GWG (g/weeks) was calculated, and women were categorized as having adequate or inadequate GWG (Institute of Medicine recommendations). Newborn anthropometric outcomes included weight-for-age z score (WAZ), length-for-age z score (LAZ), head-circumference-for-age z score (HCZ), body mass index (BMI)-for-age z score (BMIZ), low birthweight (LBW < 2,500 g), WAZ < -2, LAZ < -2, HCZ < -2, BMIZ < -2, and small for gestational age (SGA: <10th percentile). Multivariate models were adjusted for confounders. Only 26% of the 2,562 women in these analyses had adequate GWG. Compared with newborns of women with inadequate GWG, infants of women with adequate GWG had a lower risk of adverse anthropometric outcomes (relative risk [95% confidence interval]: LBW = 0.68 [0.59, 0.80], LAZ < -2 = 0.64 [0.51, 0.80], HCZ < -2 = 0.75 [0.60, 0.93], BMIZ < -2 = 0.70 [0.59, 0.83], and SGA = 0.80 [0.73, 0.86]), but there was no significant difference in mean (SE) duration of gestation, 39.7 (0.08) versus 39.7 (0.05) weeks. In this population, GWG rate is a strong predictor of newborn anthropometric outcomes, but not duration of gestation.
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Affiliation(s)
- Gilberto Kac
- Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Charles D Arnold
- Department of Nutrition, University of California, Davis, Davis, California
| | - Susana L Matias
- Department of Nutrition, University of California, Davis, Davis, California
| | - Malay K Mridha
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Kathryn G Dewey
- Department of Nutrition, University of California, Davis, Davis, California
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15
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Discacciati A, Bellavia A, Lee JJ, Mazumdar M, Valeri L. Med4way: a Stata command to investigate mediating and interactive mechanisms using the four-way effect decomposition. Int J Epidemiol 2018; 48:5187413. [PMID: 30452641 DOI: 10.1093/ije/dyy236] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2018] [Indexed: 11/15/2022] Open
Abstract
The overall effect of an exposure on an outcome, in the presence of a mediator with which the exposure may interact, can be decomposed into four components that correspond to the portion of the effect that is due: (i) to neither mediation nor interaction; (ii) to just interaction (but not mediation); (iii) to both mediation and interaction; and (iv) to just mediation (but not interaction). This four-way decomposition unifies methods to attribute effects to interactions and methods that assess mediation. We introduce the Stata command med4way to estimate the causal contrasts that arise in this decomposition. Med4way is implemented as a Stata stand-alone command requiring Stata version 10 or higher (StataCorp, College Station, TX, USA), and allows estimating the four-way decomposition using parametric regression models. Med4way can be used when the outcome is continuous, dichotomous, count or survival time, and the mediator is continuous or binary. The command accommodates cohort and case-control designs. We present two examples of application of the command to gain insight on important public health problems. In the first application, we employ med4way to investigate the role of birth outcomes in explaining the effect of maternal exposure to manganese on child neurodevelopment. In the second application, we investigate the role of stage at diagnosis in explaining income disparities in colorectal cancer survival. The command is freely available on GitHub [https://github.com/anddis/med4way] and has been published under General Public License (GPL) version 3.
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Affiliation(s)
- Andrea Discacciati
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Andrea Bellavia
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jane J Lee
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Maitreyi Mazumdar
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Linda Valeri
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
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