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Batzella E, Rosato I, Pitter G, Da Re F, Russo F, Canova C, Fletcher T. Determinants of PFOA Serum Half-Life after End of Exposure: A Longitudinal Study on Highly Exposed Subjects in the Veneto Region. Environ Health Perspect 2024; 132:27002. [PMID: 38306197 PMCID: PMC10836585 DOI: 10.1289/ehp13152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND Perfluoroalkyl substances (PFAS) are widely used, ubiquitous, and highly persistent man-made chemicals. Groundwater of a vast area of the Veneto Region (northeastern Italy) was found to be contaminated by PFAS from a manufacturing plant active since the late 1960s. As a result, residents were overexposed to PFAS through drinking water until 2013, mainly to perfluorooctanoic acid (PFOA). OBJECTIVES The aim of the present study was to estimate the rates of decline in serum PFOA and their corresponding serum half-lives, while characterizing their determinants. METHODS We investigated 5,860 subjects more than 14 years of age who enrolled in the second surveillance round of the regional health surveillance program. Two blood samples were collected between 2017 and 2022 (average time between measurements: 4 years). Serum PFOA excretion rates and half-lives were estimated based on linear mixed effect models, modeling subject-specific serum PFOA concentrations over time and correcting for background concentrations. For modeling determinants of half-life [age, sex, body mass index (BMI), smoking-habit, alcohol consumption, and estimated glomerular filtration rate (eGFR)], we added interaction terms between each covariate and the elapsed time between measurements. Perfluorooctanesulfonate (PFOS) and perfluorohexanesulfonic acid (PFHxS) apparent half-lives were also estimated. A separate analysis was conducted in children (n = 480 ). All analyses were stratified by sex. RESULTS Median initial serum concentrations of PFOA was 49 ng / mL (range: 0.5-1,090), with a median reduction of 62.45%. The mean estimated PFOA half-life was 2.36 years [95% confidence interval (CI): 2.33, 2.40], shorter in women (2.04; 95% CI: 2.00, 2.08) compared to men (2.83; 95% CI: 2.78, 2.89). Half-lives varied when stratified by some contributing factors, with faster excretion rates in nonsmokers and nonalcohol drinkers (especially in males). CONCLUSIONS This study, to our knowledge the largest on PFOA half-life, provides precise estimates in young adults whose exposure via drinking water has largely ceased. For other PFAS, longer half-lives than reported in other studies can be explained by some ongoing exposure to PFAS via other routes. https://doi.org/10.1289/EHP13152.
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Affiliation(s)
- Erich Batzella
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Isabella Rosato
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Gisella Pitter
- Screening Unit, Azienda Zero-Veneto Region, Padova, Italy
| | - Filippo Da Re
- Directorate of Prevention, Food Safety, and Veterinary Public Health-Veneto Region, Venice, Italy
| | - Francesca Russo
- Directorate of Prevention, Food Safety, and Veterinary Public Health-Veneto Region, Venice, Italy
| | - Cristina Canova
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Tony Fletcher
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Gagliotti C, Banchelli F, De Paoli A, Buttazzi R, Narne E, Ricchizzi E, Schievano E, Bellio S, Pitter G, Tonon M, Canziani LM, Rolli M, Tacconelli E, Berti E, Russo F, Moro ML. The incidence and risk factors of selected drug prescriptions and outpatient care after SARS-CoV-2 infection in low-risk subjects: a multicenter population-based cohort study. Front Public Health 2023; 11:1241401. [PMID: 37860802 PMCID: PMC10582710 DOI: 10.3389/fpubh.2023.1241401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/20/2023] [Indexed: 10/21/2023] Open
Abstract
Background Knowledge about the dynamics of transmission of SARS-CoV-2 and the clinical aspects of COVID-19 has steadily increased over time, although evidence of the determinants of disease severity and duration is still limited and mainly focused on older adult and fragile populations. Methods The present study was conceived and carried out in the Emilia-Romagna (E-R) and Veneto Regions, Italy, within the context of the EU's Horizon 2020 research project called ORCHESTRA (Connecting European Cohorts to increase common and effective response to SARS-CoV-2 pandemic) (www.orchestra-cohort.eu). The study has a multicenter retrospective population-based cohort design and aimed to investigate the incidence and risk factors of access to specific healthcare services (outpatient visits and diagnostics, drug prescriptions) during the post-acute phase from day-31 to day-365 after SARS-CoV-2 infection, in a healthy population at low risk of severe acute COVID-19. The study made use of previously recorded large-scale healthcare data available in the administrative databases of the two Italian Regions. The statistical analysis made use of methods for competing risks. Risk factors were assessed separately in the two Regions and results were pooled using random effects meta-analysis. Results There were 35,128 subjects in E-R and 88,881 in Veneto who were included in the data analysis. The outcome (access to selected health services) occurred in a high percentage of subjects in the post-acute phase (25% in E-R and 21% in Veneto). Outpatient care was observed more frequently than drug prescriptions (18% vs. 12% in E-R and 15% vs. 10% in Veneto). Risk factors associated with the outcome were female sex, age greater than 40 years, baseline risk of hospitalization and death, moderate to severe acute COVID-19, and acute extrapulmonary complications. Conclusion The outcome of interest may be considered as a proxy for long-term effects of COVID-19 needing clinical attention. Our data suggest that this outcome occurs in a substantial percentage of cases, even among a previously healthy population with low or mild severity of acute COVID-19. The study results provide useful insights into planning COVID-19-related services.
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Affiliation(s)
- Carlo Gagliotti
- Department of Innovation in Healthcare and Social Services, Emilia-Romagna Region, Bologna, Italy
| | - Federico Banchelli
- Department of Innovation in Healthcare and Social Services, Emilia-Romagna Region, Bologna, Italy
| | | | - Rossella Buttazzi
- Department of Innovation in Healthcare and Social Services, Emilia-Romagna Region, Bologna, Italy
| | | | - Enrico Ricchizzi
- Department of Innovation in Healthcare and Social Services, Emilia-Romagna Region, Bologna, Italy
| | | | | | | | - Michele Tonon
- Directorate of Prevention, Food Safety, and Veterinary Public Health, Venezia, Italy
| | | | - Maurizia Rolli
- Department of Innovation in Healthcare and Social Services, Emilia-Romagna Region, Bologna, Italy
| | - Evelina Tacconelli
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Elena Berti
- Department of Innovation in Healthcare and Social Services, Emilia-Romagna Region, Bologna, Italy
| | - Francesca Russo
- Directorate of Prevention, Food Safety, and Veterinary Public Health, Venezia, Italy
| | - Maria Luisa Moro
- Department of Innovation in Healthcare and Social Services, Emilia-Romagna Region, Bologna, Italy
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Baldovin T, Amoruso I, Fonzo M, Bertoncello C, Groppi V, Pitter G, Russo F, Baldo V. Trends in SARS-CoV-2 clinically confirmed cases and viral load in wastewater: A critical alignment for Padua city (NE Italy). Heliyon 2023; 9:e20571. [PMID: 37822618 PMCID: PMC10562905 DOI: 10.1016/j.heliyon.2023.e20571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 10/13/2023] Open
Abstract
Since the beginning of the COVID-19 pandemic, wastewater-based epidemiology (WBE) has been depicted as a promising environmental surveillance tool and early warning system. Predictive models for the estimate of COVID-19 cases from wastewater viral loads also earned lot of interest and are currently under development. Hereby a pilot study that compares WBE surveillance data with confirmed cases, total hospitalizations, doses of vaccine administered and predominance of coronavirus variants. Composite 24hrs wastewater samples were collected weekly between September 2021 and July 2022 from Padua wastewater treatment plant. Samples were processed following a previously published method. One-step RT-qPCR was performed for quantification, adapting an Orf1b-nsp14 gene assay. Variant replacement was derived from the monthly bulletins of the Italian National Health Institute. Aggregate data on vaccine doses administered and on COVID-19 prevalence and hospitalizations were retrieved from official reports. Eighty-two samples were processed. Viral loads highlighted 3 major peaks in January, April and July 2022. Quantitation of SARS-CoV-2 in wastewater and clinical surveillance resulted temporally juxtaposable. However, variation of the two curves is not proportional. SARS-CoV-2 showed its highest peak in April, whereas maximum COVID-19 prevalence was achieved in January. Total hospitalizations followed the prevalence trend. Omicron BA.1 started to replace the Delta variant in December 2021. Subsequently, the shift towards Omicron BA.2 occurred between February and April 2022. Finally, BA.4/5 attested around June, somehow preceding the summer peak. Emergence of Omicron BA.1 over Delta could be a possible driver of the increase in both clinical cases and wastewater viral load in January 2022. In late March 2022, Omicron BA.2 replaced BA.1: this reflected in a steep increase of wastewater viral load, but not of COVID-19 confirmed cases. When a dramatic drop in the testing capacity of clinical surveillance occurred, WBE was possibly capable of detecting a substantial increase in viral circulation.
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Affiliation(s)
- Tatjana Baldovin
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Hygiene and Public Health, University of Padua, Padua, Italy
| | - Irene Amoruso
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Hygiene and Public Health, University of Padua, Padua, Italy
| | - Marco Fonzo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Hygiene and Public Health, University of Padua, Padua, Italy
| | - Chiara Bertoncello
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Hygiene and Public Health, University of Padua, Padua, Italy
| | - Vanessa Groppi
- UO Prevenzione, Sicurezza Alimentare, Veterinaria, Regione Del Veneto, Venice, Italy
| | - Gisella Pitter
- UOC Screening e Valutazione Impatto Sanitario, Azienda Zero, Regione Del Veneto, Venice, Italy
| | - Francesca Russo
- UO Prevenzione, Sicurezza Alimentare, Veterinaria, Regione Del Veneto, Venice, Italy
| | - Vincenzo Baldo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Hygiene and Public Health, University of Padua, Padua, Italy
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Dalla Zuanna T, Batzella E, Russo F, Pitter G, Canova C. Migrant status disparities in blood pressure: a multiple mediation analysis of modifiable factors. J Epidemiol Glob Health 2023; 13:547-556. [PMID: 37421555 PMCID: PMC10468480 DOI: 10.1007/s44197-023-00136-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 06/25/2023] [Indexed: 07/10/2023] Open
Abstract
BACKGROUND We examined differences in blood pressure (BP) levels between first-generation immigrants and natives in adult residents in Northeast Italy, and investigated the role of lifestyle behaviors, body mass index (BMI), and education as potentially modifiable mediating factors. METHODS We included 20-69-year-old participants from the Health Surveillance Program of the Veneto Region (n = 37,710). Immigrants born in a high migratory pressure country (HMPC) were further grouped into geographical macro-areas. The outcomes were systolic BP (SBP) and hypertension. Multiple mediation analyses were performed to determine the contribution of each mediator of the SBP/migrant status association. RESULTS Of the 37,380 subjects included, 8.7% were born in an HMPC. BMI, education, alcohol, sweets and meat consumption were included as potential mediators. A small advantage in SBP was seen for immigrants compared to natives (β = - 0.71,95%CI - 1.30; - 0.10). The direct effect (net of the covariates) of immigrant status on SBP was a reduction of 1.62 mmHg (95%CI - 2.25; - 0.98). BMI played the highest suppressive role (β = 1.14,95%CI 0.99; 1.35), followed by education. Alcohol consumption amplified the health advantage of immigrants. The suppressing effect of BMI was particularly evident among women and North Africans compared to natives. Similar results were seen for hypertension rates. CONCLUSIONS Although causation cannot be proven given the cross-sectional design, our findings identify BMI as the most effective target to preserve the health advantage of immigrants with respect to BP levels.
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Affiliation(s)
- Teresa Dalla Zuanna
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Via Loredan 18, 35100, Padua, Italy
| | - Erich Batzella
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Via Loredan 18, 35100, Padua, Italy
| | - Francesca Russo
- Directorate of Prevention, Food Safety, and Veterinary Public Health-Veneto Region, Venice, Italy
| | - Gisella Pitter
- Screening and Health Impact Assessment Unit, Azienda Zero-Veneto Region, Padua, Italy
| | - Cristina Canova
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Via Loredan 18, 35100, Padua, Italy.
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Dalla Zuanna T, Batzella E, Pitter G, Russo F, Spadea T, Canova C. Adult first-generation immigrants and cardiovascular risk factors in the Veneto Region, Northeast Italy. Front Public Health 2023; 11:956146. [PMID: 36875357 PMCID: PMC9975734 DOI: 10.3389/fpubh.2023.956146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 01/24/2023] [Indexed: 02/17/2023] Open
Abstract
Introduction The health condition of immigrants traditionally follows a transition from a low disease occurrence to the epidemiological profile of the deprived groups in the host country. In the Europe, studies examining differences in biochemical and clinical outcomes among immigrants and natives are lacking. We examined differences in cardiovascular risk factors between first-generation immigrants and Italians, and how migration pattern variables could affect health outcomes. Material and methods We included participants between 20 and 69 years recruited from a Health Surveillance Program of the Veneto Region. Blood pressure (BP), total cholesterol (TC) and LDL cholesterol levels were measured. Immigrant status was defined by being born in a high migratory pressure country (HMPC) and subdivided by geographical macro-areas. We used generalized linear regression models to investigate differences between these outcomes among immigrants compared to native-born, adjusting for age, sex, education, BMI, alcohol consumption, smoking status, food consumption, salt consumption in the BP analysis and the laboratory in charge for cholesterol analysis. Within immigrant subjects, the results were stratified by variables of the migration pattern: age at immigration and length of residence in Italy. Results Thirty seven thousand three hundred and eighty subjects were included in the analysis, 8.6% were born in an HMPC. Heterogeneous results were seen by the macro-areas of origin and sex, with male immigrants from CE Europe (β = 8.77 mg/dl) and Asia (β = 6.56 mg/dl) showing higher levels of TC than native-born, while female immigrants from Northern Africa showed lower levels of TC (β = -8.64 mg/dl). BP levels were generally lower among immigrants. Immigrants residing in Italy for more than 20 years had lower levels of TC (β = -2.9 mg/dl) than native-born. In contrast, immigrants who arrived <20 years ago or arrived older than 18 years had higher levels of TC. This trend was confirmed for CE Europeans and was inverted for Northern Africans. Conclusions The large heterogeneity in the results depending on sex and macro-area of origin indicates the need for targeted intervention in each specific immigrant group. The results confirm that acculturation leads to a convergence toward the epidemiological profile of the host population that depends on the starting condition of the immigrant group.
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Affiliation(s)
- Teresa Dalla Zuanna
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Erich Batzella
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Gisella Pitter
- Screening and Health Impact Assessment Unit, Azienda Zero, Padova, Italy
| | - Francesca Russo
- Directorate of Prevention, Food Safety, and Veterinary Public Health-Veneto Region, Venice, Italy
| | | | - Cristina Canova
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padova, Italy
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Batzella E, Zare Jeddi M, Pitter G, Russo F, Fletcher T, Canova C. Associations between Mixture of Perfluoroalkyl Substances and Lipid Profile in a Highly Exposed Adult Community in the Veneto Region. Int J Environ Res Public Health 2022; 19:12421. [PMID: 36231722 PMCID: PMC9566306 DOI: 10.3390/ijerph191912421] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/23/2022] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Residents of a large area in the Veneto Region (Northeastern Italy) were exposed to drinking water contaminated by perfluoroalkyl substances (PFAS) for decades. While exposure to PFAS has been consistently associated with elevated serum lipids, combined exposures to multiple PFASs have been poorly investigated. Utilising different statistical approaches, we examine the association between chemical mixtures and lipid parameters. METHODS Cross-sectional data from the regional health surveillance program (34,633 individuals aged 20-64 years) were used to examine the combined effects of PFAS mixture (Perfluorooctanoic acid (PFOA), perfluorooctane sulfonate (PFOS), perfluorononanoic acid (PFNA) and perfluorohexane sulfonate (PFHxS)) on total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). Weighted Quantile Sum (WQS) regression, Quantile-based G-computation (Q-Gcomp) and Bayesian Kernel Machine Regression (BKMR) were used based on their ability to handle highly correlated chemicals. RESULTS We observed that each quartile increase in the WQS index was associated with an increase in the levels of TC (β: 4.09, 95% CI: 3.47-4.71), HDL-C (β: 1.13, 95% CI: 0.92-1.33) and LDL-C (β: 3.14, 95% CI: 2.65-3.63). Q-Gcomp estimated that a quartile increase in the PFAS mixture was associated with increased TC (ψ: 4.04, 95% CI 3.5-4.58), HDL-C (ψ: 1.07, 95% CI 20.87-1.27) and LDL-C (ψ: 2.71, 95% CI 2.23-3.19). In the BKMR analysis, the effect of PFAS mixture on serum lipids increased significantly when their concentrations were at their 75th percentiles or above, compared to those at their 50th percentile. All methods revealed a major contribution of PFOS and PFNA, although the main exposure was due to PFOA. We found suggestive evidence that associations varied when stratified by gender. CONCLUSIONS The PFAS mixture was positively associated with lipid parameters, regardless of the applied method. Very similar results obtained from the three methods may be attributed to the linear positive association with the outcomes and no interaction between each PFAS.
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Affiliation(s)
- Erich Batzella
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, 35131 Padova, Italy
| | - Maryam Zare Jeddi
- RIVM-National Institute for Public Health and the Environment, 3720 Bilthoven, The Netherlands
| | - Gisella Pitter
- Screening and Health Impact Assessment Unit, Azienda Zero-Veneto Region, 35131 Padua, Italy
| | - Francesca Russo
- Directorate of Prevention, Food Safety, Veterinary Public Health-Veneto Region, 30123 Venice, Italy
| | - Tony Fletcher
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Cristina Canova
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, 35131 Padova, Italy
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Batzella E, Girardi P, Russo F, Pitter G, Da Re F, Fletcher T, Canova C. Perfluoroalkyl substance mixtures and cardio-metabolic outcomes in highly exposed male workers in the Veneto Region: A mixture-based approach. Environ Res 2022; 212:113225. [PMID: 35390304 DOI: 10.1016/j.envres.2022.113225] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Perfluoroalkyl substances (PFAS) have been consistently associated with cardio-metabolic traits. Occupational exposures to multiple PFAS with health outcomes have been poorly investigated. The aim of the present study was to examine these associations among former workers involved in PFAS production. METHODS We considered 232 male ex-employees who had worked in a factory (Trissino, Veneto Region, Italy), which produced PFAS and other chemicals during 1968-2018. Out of twelve serum PFAS, only four (PFOA, PFOS, PFHxS, and PFNA) were quantifiable in at least 50% of samples. Non-fasting serum total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured. The associations between serum PFAS mixture and considered outcomes were assessed through linear regression mixed models and Weighted Quantile Sum (WQS) regression, adjusting for potential confounders. RESULTS PFOA was detected at the highest level, with a median concentration (in ng/mL) of 80.8 (min-max: 0.35-13,033), followed by PFOS (median: 8.55, min-max: 0.35-343), PFHxS (median: 6.8, min-max: 0.35-597) and PFNA (median: 0.8, min-max: 0.35-5). We observed that each A quartile increase in the WQS index was positively associated with the levels of TC (β: 8.41, 95% IC: 0.78-16.0), LDL-C (β: 8.02, 95% IC: 1-15.0) and SBP (β: 3.21, 95% IC: 0.82-5.60). No association of serum PFAS concentration on HDL cholesterol and DBP emerged. WQS analyses revealed a major contribution of PFNA and PFHxS for the cholesterol levels, although PFOA reported the highest concentration. PFOA and PFOS emerged as chemicals of concern regarding the association with SBP. CONCLUSIONS The results showed a clear association between serum PFAS levels and markers of cardiovascular risk and support the importance of clinical surveillance of cardiovascular risk factors in population with a high exposure to PFAS, especially in the occupational setting.
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Affiliation(s)
- Erich Batzella
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, Padova, Italy
| | - Paolo Girardi
- Department of Developmental Psychology and Socialization, University of Padua, Padua, Italy & Department of Statistical Sciences, University of Padua, Italy
| | - Francesca Russo
- Regional Directorate of Prevention, Food Safety, and Veterinary Public Health-Veneto Region, Venice, Italy
| | - Gisella Pitter
- Screening and Health Impact Assessment Unit, Azienda Zero-Veneto Region, Padua, Italy
| | - Filippo Da Re
- Regional Directorate of Prevention, Food Safety, and Veterinary Public Health-Veneto Region, Venice, Italy
| | - Tony Fletcher
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Cristina Canova
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, Padova, Italy.
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Zare Jeddi M, Soltanmohammadi R, Barbieri G, Fabricio ASC, Pitter G, Dalla Zuanna T, Canova C. To which extent are per-and poly-fluorinated substances associated to metabolic syndrome? Rev Environ Health 2022; 37:211-228. [PMID: 34036763 DOI: 10.1515/reveh-2020-0144] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 04/28/2021] [Indexed: 06/12/2023]
Abstract
Exposure to per- and polyfluoroalkyl substances (PFAS), ubiquitous persistent environmental contaminants, has led to substantial global concern due to their potential environmental and human health effects. Several epidemiological studies have assessed the possible association between PFAS exposure and risk of metabolic syndrome (MetS), however, the results are ambiguous. The aim of this study was to assess the current human epidemiologic evidence on the association between exposure to PFAS and MetS. We performed a systematic search strategy using three electronic databases (PubMed, Scopus, and Web of Science) for relevant studies concerning the associations of PFAS with MetS and its clinical relevance from inception until January 2021. We undertook meta-analyses where there were five or more studies with exposure and outcomes assessments that were reasonably comparable. The pooled odd ratios (ORs) were calculated using random effects models and heterogeneity among studies was assessed by I2 index and Q test. A total of 12 cross-sectional studies (10 studies on the general population and two studies in the occupational settings) investigated the association between PFAS exposure and MetS. We pooled data from seven studies on the general population for perfluorooctanoic acid (PFOA) and perfluorooctanesulfonate (PFOS) and five studies for perfluorohexanesulfonate (PFHxS) and perfluorononanoic acid (PFNA). Predominately, most studies reported no statistically significant association between concentrations of PFAS and MetS. In the meta-analysis, the overall measure of effect was not statistically significant, showing no evidence of an association between concentrations of PFOA, PFOS, PFNA, and PFHxS and the risk of MetS. Based on the results of the meta-analysis, current small body of evidence does not support association between PFAS and MetS. However, due to limited number of studies and substantial heterogeneity, results should be interpreted with caution. Further scrutinizing cohort studies are needed to evaluate the association between various and less well-known PFAS substances and their mixture with MetS and its components in both adults and children in different settings.
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Affiliation(s)
- Maryam Zare Jeddi
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Rozita Soltanmohammadi
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Giulia Barbieri
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Aline S C Fabricio
- Regional Center for Biomarkers, Department of Clinical Pathology, Azienda ULSS 3 Serenissima, Venice, Italy
| | - Gisella Pitter
- Screening and Health Impact Assessment Unit, Azienda Zero-Veneto Region, Padova, Italy
| | - Teresa Dalla Zuanna
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Cristina Canova
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padova, Italy
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Rosato I, Zare Jeddi M, Ledda C, Gallo E, Fletcher T, Pitter G, Batzella E, Canova C. How to investigate human health effects related to exposure to mixtures of per- and polyfluoroalkyl substances: A systematic review of statistical methods. Environ Res 2022; 205:112565. [PMID: 34915031 DOI: 10.1016/j.envres.2021.112565] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/10/2021] [Accepted: 12/11/2021] [Indexed: 05/23/2023]
Abstract
BACKGROUND Humans are exposed to several per- and polyfluoroalkyl substances (PFAS) daily; however, most previous studies have focused on individual PFAS. Although attention to effects of exposure to mixtures of PFAS has grown in recent years, there is no consensus on the appropriate statistical methods that can be used to assess their combined effect on human health. OBJECTIVES We aim to perform a comprehensive review of the statistical methods used in the existing studies which evaluate the association between exposure to mixtures of PFAS and any adverse human health effect. METHODS The online databases PubMed, Embase and Scopus were searched for eligible studies, published during the last ten years (last search performed on April 08, 2021). Covidence software was used by two different reviewers to perform a title/abstract screening, followed by a full text revision of the selected papers. RESULTS A total of 3640 papers were identified, and after the screening process, 53 papers were included in the current review. Most of the studies were published between 2019 and 2021 and were conducted mainly in North America and Europe; more than half of the studies (28 out of 53) were conducted on mother and child pairs. WQS (Weighted Quantile Sum) Regression and BKMR (Bayesian Kernel Machine Regression) were used in 36 out of 53 papers to model mixtures' effects. Health outcomes included in the studies are immunotoxicity (n = 8), fetal development (n = 7), neurodevelopment (n = 9), reproductive hormones (n = 6), thyroid hormones (n = 7), outcomes related to metabolic pathways (n = 16). CONCLUSION Studies on human exposure to PFAS as complex mixtures and health consequences have substantially increased in the last few years. Based on our findings, we propose that addressing risk from PFAS mixtures will likely require combinations of approaches and implementation of constantly evolving statistical methods. Specific guidelines and tools for quality assessment and publication of mixture observational studies are warranted.
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Affiliation(s)
- Isabella Rosato
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Maryam Zare Jeddi
- RIVM-National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Caterina Ledda
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padova, Italy; Occupational Medicine, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Elisa Gallo
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Tony Fletcher
- Screening and Health Impact Assessment Unit, Azienda Zero-Veneto Region, Padova, Italy
| | - Gisella Pitter
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Erich Batzella
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Cristina Canova
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padova, Italy.
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10
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Gallo E, Barbiellini Amidei C, Barbieri G, Fabricio ASC, Gion M, Pitter G, Daprà F, Russo F, Gregori D, Fletcher T, Canova C. Perfluoroalkyl substances and thyroid stimulating hormone levels in a highly exposed population in the Veneto Region. Environ Res 2022; 203:111794. [PMID: 34358507 DOI: 10.1016/j.envres.2021.111794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/12/2021] [Accepted: 07/26/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Per- and poly-fluoroalkyl substances (PFAS) are persistent and widespread environmental pollutants. People living in Veneto Region (Italy) have been exposed from the late 1970s to 2013 to elevated concentrations of PFAS through drinking water. The effect of PFAS on thyroid function is still controversial and studies focusing on thyroid stimulating hormone (TSH) have shown inconsistent results. The aim of this study was to evaluate the association between serum PFAS and TSH levels and its dose-response relationship in a large population of highly exposed individuals. METHODS A cross-sectional study was conducted on 21,424 individuals aged 14-39 living in the contaminated area. In the main analysis, participants with prevalent thyroid disease and pregnant women were excluded. Serum levels of perfluorooctanoic acid (PFOA), perfluorooctanesulfonic acid (PFOS), perfluorohexanesulfonic acid (PFHxS) and perfluorononanoic acid (PFNA) were measured. Generalized Additive Models were used to evaluate the association between TSH levels and serum PFAS, using thin plate spline smooth terms to model the potential non-linear relationship. Models were stratified by sex and age group and adjusted for potential confounders. A secondary analysis was conducted to evaluate the association between PFAS with prevalent self-reported thyroid disorders. RESULTS We found no association between TSH and any type of PFAS among adolescents or women. A decrease in TSH concentration was observed in association with an IQR increase in PFHxS and a mild decrease in TSH at low levels of PFOA, PFOS and PFHxS among male adults. Self-reported thyroid disease was more common among women with higher levels of PFNA concentrations, whereas all other PFAS were not associated with thyroid diseases regardless of sex or age. CONCLUSIONS Overall there is no evidence of an association between TSH and PFAS. However, some results are suggestive of a possible inverse association of TSH with PFOA, PFOS and PFHxS among adult males.
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Affiliation(s)
- Elisa Gallo
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Claudio Barbiellini Amidei
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Giulia Barbieri
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Aline S C Fabricio
- Regional Center for Biomarkers, Department of Clinical Pathology, Azienda ULSS 3 Serenissima, Venice, Italy; Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Massimo Gion
- Regional Center for Biomarkers, Department of Clinical Pathology, Azienda ULSS 3 Serenissima, Venice, Italy
| | - Gisella Pitter
- Screening and Health Impact Assessment Unit, Azienda Zero-Veneto Region, Padova, Italy
| | - Francesca Daprà
- Laboratory Department-Regional Agency for Environmental Prevention and Protection-Veneto Region, Venice, Italy
| | - Francesca Russo
- Directorate of Prevention, Food Safety and Veterinary Public Health-Veneto Region, Venice, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Tony Fletcher
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Cristina Canova
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy.
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11
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Canova C, Di Nisio A, Barbieri G, Russo F, Fletcher T, Batzella E, Dalla Zuanna T, Pitter G. PFAS Concentrations and Cardiometabolic Traits in Highly Exposed Children and Adolescents. Int J Environ Res Public Health 2021; 18:ijerph182412881. [PMID: 34948492 PMCID: PMC8701234 DOI: 10.3390/ijerph182412881] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/30/2021] [Accepted: 12/02/2021] [Indexed: 02/07/2023]
Abstract
Background: Residents of a large area of north-eastern Italy were exposed for decades to high concentrations of perfluoroalkyl and polyfluoroalkyl substances (PFAS) via drinking water. Despite the large amount of evidence in adults of a positive association between serum PFAS and metabolic outcomes, studies focusing on children and adolescents are limited. We evaluated the associations between serum PFAS concentrations that were quantifiable in at least 40% of samples and lipid profile, blood pressure (BP) and body mass index (BMI) in highly exposed adolescents and children. Methods: A cross-sectional analysis was conducted in 6669 adolescents (14–19 years) and 2693 children (8–11 years) enrolled in the health surveillance program of the Veneto Region. Non-fasting blood samples were obtained and analyzed for perfluorooctanoic acid (PFOA), perfluorooctane sulfonate (PFOS), perfluorohexanesulfonic acid (PFHxS), perfluorononanoic acid (PFNA), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and triglycerides. Low-density lipoprotein cholesterol (LDL-C) was calculated. Systolic and diastolic BP were measured, and BMI z-score accounting for age and sex was estimated. The associations between ln-transformed PFAS (and categorized into quartiles) and continuous outcomes were assessed using generalized additive models. The weighted quantile sum regression approach was used to assess PFAS-mixture effects for each outcome. Analyses were stratified by gender and adjusted for potential confounders. Results: Among adolescents, significant associations were detected between all investigated PFAS and TC, LDL-C, and to a lesser extent HDL-C. Among children, PFOS and PFNA had significant associations with TC, LDL-C and HDL-C, while PFOA and PFHxS had significant associations with HDL-C only. Higher serum concentrations of PFAS, particularly PFOS, were associated with lower BMI z-score. No statistically significant associations were observed between PFAS concentrations and BP. These results were confirmed by the multi-pollutant analysis. Conclusions: Our study supports a consistent association between PFAS concentration and serum lipids, stronger for PFOS and PFNA and with a greater magnitude among children compared to adolescents, and a negative association of PFAS with BMI.
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Affiliation(s)
- Cristina Canova
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy; (G.B.); (E.B.); (T.D.Z.)
- Correspondence:
| | - Andrea Di Nisio
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, 35131 Padova, Italy;
| | - Giulia Barbieri
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy; (G.B.); (E.B.); (T.D.Z.)
- Eurac Research, Institute for Biomedicine, 39100 Bolzano, Italy
| | - Francesca Russo
- Directorate of Prevention, Food Safety, and Veterinary Public Health-Veneto Region, 30123 Venice, Italy;
| | - Tony Fletcher
- Public Health, Environments and Society Department, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK;
| | - Erich Batzella
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy; (G.B.); (E.B.); (T.D.Z.)
| | - Teresa Dalla Zuanna
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy; (G.B.); (E.B.); (T.D.Z.)
| | - Gisella Pitter
- Screening and Health Impact Assessment Unit, Azienda Zero-Veneto Region, 35131 Padua, Italy;
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12
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Germana’ B, Bellio S, Barbiellini Amidei C, Capodaglio G, Avossa F, Narne E, Pitter G, Fedeli U, Zorzi M, Rosa–Rizzotto E, Pantalena M, Saia M. PC.01.11 IMPACT OF COVID-19 PANDEMIC ON COLONOSCOPY AND SURGICAL INTERVENTIONS FOR COLORECTAL CANCER IN VENETO REGION. Dig Liver Dis 2021. [PMCID: PMC8451198 DOI: 10.1016/s1590-8658(21)00471-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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13
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Fedeli U, Schievano E, Avossa F, Pitter G, Barbiellini Amidei C, Grande E, Grippo F. Different approaches to the analysis of causes of death during the COVID-19 epidemic. Eur Rev Med Pharmacol Sci 2021; 25:3610-3613. [PMID: 34002836 DOI: 10.26355/eurrev_202105_25844] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The aim of the study is to assess the impact of the COVID-19 pandemic on causes of mortality through multiple methodological approaches. MATERIALS AND METHODS The causes of mortality in the Veneto region (Italy) during the first epidemic wave, March-April 2020, were compared with the corresponding months of the previous two years. Both the underlying cause of death (UCOD), and all diseases reported in the death certificate (multiple causes of death) were investigated; a further analysis was carried out through a simulation where the UCOD was selected after substituting ICD-10 codes for COVID with unspecified pneumonia. RESULTS Overall 10,222 deaths were registered in March-April 2020, corresponding to a 24% increase compared to the previous two years. COVID-19 was mentioned in 1,444 certificates, and selected as the UCOD in 1,207 deaths. Based on the UCOD, the increases in mortality were observed for COVID and related respiratory conditions, diabetes mellitus, hypertensive heart diseases, cerebrovascular diseases, and ill-defined causes. Multiple causes of death and the simulation analysis demonstrated further increases in mortality related to dementia/Alzheimer and chronic lower respiratory diseases. CONCLUSIONS This first report demonstrates an increase of several causes of death during the pandemic, underlying the need of a continuous surveillance of mortality records through different analytic strategies.
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Affiliation(s)
- U Fedeli
- Epidemiological Department, Azienda Zero, Veneto Region, Italy.
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14
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Dalla Zuanna T, Savitz DA, Barbieri G, Pitter G, Zare Jeddi M, Daprà F, Fabricio ASC, Russo F, Fletcher T, Canova C. The association between perfluoroalkyl substances and lipid profile in exposed pregnant women in the Veneto region, Italy. Ecotoxicol Environ Saf 2021; 209:111805. [PMID: 33360787 DOI: 10.1016/j.ecoenv.2020.111805] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/30/2020] [Accepted: 12/10/2020] [Indexed: 05/27/2023]
Abstract
BACKGROUND Residents of a large area of North-Eastern Italy were exposed for decades to high concentrations of perfluoroalkyl and polyfluoroalkyl substances (PFAS) via drinking water. Serum PFAS levels have been consistently associated with elevated serum lipids, but few studies have been conducted among pregnant women, and none has stratified analyses by trimester of gestation. Elevated serum lipid levels during pregnancy can have both immediate and long-lasting effects on pregnant women and the developing fetus. We evaluated the association between perfluorooctane sulfonate (PFOS), perfluorooctanoic acid (PFOA), and perfluoro-hexanesulfonate (PFHxS) levels in relation to lipid profiles in highly-exposed pregnant women. METHODS A cross-sectional analysis was conducted in 319 pregnant women (age 14-48 years) enrolled in the Regional health surveillance program. Non-fasting blood samples were obtained in any trimester of pregnancy and analyzed for PFOA, PFOS and PFHxS, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C). Low-density lipoprotein cholesterol (LDL-C) was calculated. The associations between ln-transformed PFAS (and categorized into quartiles) and lipids were assessed using generalized additive models. Analyses were adjusted for potential confounders and stratified according to pregnancy trimester. RESULTS The geometric means of PFOA, PFOS and PFHxS were 14.78 ng/mL, 2.67 ng/mL and 1.89 ng/mL, respectively. The plasma levels of TC, HDL-C and LDL-C increased steadily throughout the trimesters. In the 1st trimester, PFOS was positively associated with TC and PFHxS with HDL-C. In the 3rd trimester, instead, an inverse relationship was seen between PFOA and PFHxS and both TC and LDL-C. CONCLUSIONS Results suggest the associations between PFAS concentrations and lipid profiles in pregnant women might differ by trimesters of pregnancy. In the first trimester, patterns are similar to those of non-pregnant women, while they differ late in pregnancy. Different independent behavior of PFAS and lipid levels throughout the pregnancy might explain our observations. These findings support the ubiquitous exposure to PFAS and possible influence on lipid metabolisms during pregnancy and suggest a careful evaluation of the timing of PFAS measurement, when examining effects of PFAS during pregnancy on gestational outcomes related to serum lipids amounts.
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Affiliation(s)
- Teresa Dalla Zuanna
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Università di Padova, Via Loredan 18, 35131 Padova, Italy.
| | - David A Savitz
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States.
| | - Giulia Barbieri
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Università di Padova, Via Loredan 18, 35131 Padova, Italy
| | - Gisella Pitter
- Screening and Health Impact Assessment Unit, Azienda Zero-Veneto Region, Passaggio L. Gaudenzio 1, 35100 Padova, Italy.
| | - Maryam Zare Jeddi
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Università di Padova, Via Loredan 18, 35131 Padova, Italy
| | - Francesca Daprà
- Laboratory Department-Regional Agency for Environmental Prevention and Protection, Veneto Region, Verona, Italy.
| | - Aline S C Fabricio
- Regional Center for Biomarkers, Department of Clinical Pathology, Azienda ULSS 3 Serenissima, Venice, Italy.
| | - Francesca Russo
- Directorate of Prevention, Food Safety, and Veterinary Public Health, Veneto Region, Dorsoduro, 3493 - Rio Nuovo, 30123 Venice, Italy.
| | - Tony Fletcher
- London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Cristina Canova
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Università di Padova, Via Loredan 18, 35131 Padova, Italy.
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15
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Zare Jeddi M, Dalla Zuanna T, Barbieri G, Fabricio ASC, Daprà F, Fletcher T, Russo F, Pitter G, Canova C. Associations of Perfluoroalkyl Substances with Prevalence of Metabolic Syndrome in Highly Exposed Young Adult Community Residents-A Cross-Sectional Study in Veneto Region, Italy. Int J Environ Res Public Health 2021; 18:ijerph18031194. [PMID: 33572770 PMCID: PMC7908308 DOI: 10.3390/ijerph18031194] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/21/2021] [Accepted: 01/23/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Studies on the association between perfluoroalkyl substances (PFAS) and metabolic syndrome (MetS) are limited, and results are inconsistent. We aimed to examine the associations between PFAS serum levels and the prevalence of MetS among highly exposed young adults (ages 20-39) residents of a large area of the Veneto Region (North-Eastern Italy) primarily stemming from PFAS water contamination before September 2013. A total of 15,876 eligible young adult residents living in the investigated municipalities were enrolled in the study from January 2017 to July 2019. METHODS MetS was defined by using a modified harmonized definition requiring the presence of 3 of the following: obesity (body mass index ≥30), elevated triglyceride (TG), reduced high-density lipoprotein cholesterol, elevated blood pressure, and hemoglobin A1c ≥ 6.1% or self-reported diabetes mellitus or drug treatment for hyperglycemia. Multivariable generalized additive models were performed to identify the associations between four serum PFAS, including perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA), perfluorohexane sulfonic acid (PFHxS), and perfluorononanoic acid (PFNA), and risk of MetS controlling for potential confounders. RESULTS A total of 1282 participants (8.1%) met the criteria of MetS with a higher prevalence among men. PFOA, PFHxS, and PFNA were not associated with the risk of MetS, whereas PFOS showed a consistent protective effect against the risk of MetS (OR 0.76, (95% CI: 0.69, 0.85) per ln-PFOS). However, we found statistically significant positive associations between PFAS serum levels and individual components of MetS, mainly elevated blood pressure and elevated TG. CONCLUSION Our results did not support a consistent association between PFAS and MetS and conflicting findings were observed for individual components of MetS.
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Affiliation(s)
- Maryam Zare Jeddi
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, 35131 Padova, Italy; (M.Z.J.); (T.D.Z.); (G.B.)
| | - Teresa Dalla Zuanna
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, 35131 Padova, Italy; (M.Z.J.); (T.D.Z.); (G.B.)
| | - Giulia Barbieri
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, 35131 Padova, Italy; (M.Z.J.); (T.D.Z.); (G.B.)
| | | | - Francesca Daprà
- Laboratory Department-Regional Agency for Environmental Prevention and Protection-Veneto Region, 37135 Verona, Italy;
| | - Tony Fletcher
- London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK;
| | - Francesca Russo
- Directorate of Prevention, Food Safety, and Veterinary Public Health-Veneto Region, 30123 Venice, Italy;
| | - Gisella Pitter
- Screening and Health Impact Assessment Unit, Azienda Zero-Veneto Region, 35131 Padova, Italy;
| | - Cristina Canova
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, 35131 Padova, Italy; (M.Z.J.); (T.D.Z.); (G.B.)
- Correspondence:
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16
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Russo F, Pitter G, Da Re F, Tonon M, Avossa F, Bellio S, Fedeli U, Gubian L, Monetti D, Saia M, Zanella F, Zorzi M, Narne E, Mantoan D. Epidemiology and public health response in early phase of COVID-19 pandemic, Veneto Region, Italy, 21 February to 2 April 2020. ACTA ACUST UNITED AC 2020; 25. [PMID: 33243356 PMCID: PMC7693165 DOI: 10.2807/1560-7917.es.2020.25.47.2000548] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Veneto was one of the Italian regions hit hardest by the early phase of the coronavirus disease (COVID-19) pandemic. Aim This paper describes the public health response and epidemiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in the Veneto Region from 21 February to 2 April 2020. Methods Information on the public health response was collected from regional health authorities’ official sources. Epidemiological data were extracted from a web-based regional surveillance system. The epidemic curve was represented by date of testing. Characteristics of hospitalised COVID-19 cases were described and compared to those never admitted to hospital. Age- and sex-stratified case-fatality ratios (CFRs) were calculated. Results Key elements of the regional public health response were thorough case-finding and contact tracing, home care for non-severe cases, creation of dedicated COVID-19 healthcare facilities and activation of sub-intensive care units for non-invasive ventilation. As at 2 April 2020, 91,345 individuals were tested for SARS-CoV-2 and 10,457 (11.4%) were positive. Testing and attack rates were 18.6 per 1,000 and 213.2 per 100,000 population, respectively. The epidemic peaked around 20 to 24 March, with case numbers declining thereafter. Hospitalised cases (n = 3,623; 34.6%) were older and more frequently male compared with never-hospitalised cases. The CFR was 5.6% overall, and was higher among males and people > 60 years of age. Conclusion In the Veneto Region, the strict social distancing measures imposed by the Italian government were supported by thorough case finding and contact tracing, as well as well-defined roles for different levels of care.
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Affiliation(s)
- Francesca Russo
- Regional Directorate of Prevention, Food Safety, Veterinary Public Health, Regione del Veneto, Padova, Italy
| | - Gisella Pitter
- Screening and Health Impact Assessment Unit, Azienda Zero, Regione del Veneto, Padova, Italy
| | - Filippo Da Re
- These authors contributed equally.,Regional Directorate of Prevention, Food Safety, Veterinary Public Health, Regione del Veneto, Padova, Italy
| | - Michele Tonon
- These authors contributed equally.,Regional Directorate of Prevention, Food Safety, Veterinary Public Health, Regione del Veneto, Padova, Italy
| | - Francesco Avossa
- Regional Epidemiological Service Unit, Azienda Zero, Regione del Veneto, Padova, Italy
| | - Stefania Bellio
- Hygiene and Public Health Unit, Department of Cardiovascular Medicine and Public Health, University of Padova, Padova, Italy
| | - Ugo Fedeli
- Regional Epidemiological Service Unit, Azienda Zero, Regione del Veneto, Padova, Italy
| | - Lorenzo Gubian
- Informative Systems Unit, Azienda Zero, Regione del Veneto, Padova, Italy
| | - Daniele Monetti
- Regional Epidemiological Service Unit, Azienda Zero, Regione del Veneto, Padova, Italy
| | - Mario Saia
- Clinical Governance Unit, Azienda Zero, Regione del Veneto, Padova, Italy
| | - Francesca Zanella
- Regional Directorate of Prevention, Food Safety, Veterinary Public Health, Regione del Veneto, Padova, Italy
| | - Manuel Zorzi
- Regional Epidemiological Service Unit, Azienda Zero, Regione del Veneto, Padova, Italy
| | - Elena Narne
- Screening and Health Impact Assessment Unit, Azienda Zero, Regione del Veneto, Padova, Italy
| | - Domenico Mantoan
- Director General, Health and Social Area, Regione del Veneto, Padova, Italy
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17
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Ferroni E, Giorgi Rossi P, Spila Alegiani S, Trifirò G, Pitter G, Leoni O, Cereda D, Marino M, Pellizzari M, Fabiani M, Riccardo F, Sultana J, Massari M. Survival of Hospitalized COVID-19 Patients in Northern Italy: A Population-Based Cohort Study by the ITA-COVID-19 Network. Clin Epidemiol 2020; 12:1337-1346. [PMID: 33335428 PMCID: PMC7737545 DOI: 10.2147/clep.s271763] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/19/2020] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION COVID-19 case fatality rate in hospitalized patients varies across countries and studies. Reliable estimates, specific for age, sex, and comorbidities, are needed to monitor the epidemic, to compare the outcome in different settings, and to correctly design trials for COVID-19 interventions. The aim of this study was to provide population-based survival curves of hospitalized COVID-19 patients. MATERIALS AND METHODS A cohort study was conducted in three areas of Northern Italy, heavily affected by SARS-CoV-2 infection (Lombardy and Veneto Regions, and Reggio Emilia province), using a loco-regional COVID-19 surveillance system, linked to hospital discharge databases. We included all patients testing positive for SARS-CoV-2 RNA by RT-PCR on nasopharyngeal/throat swab samples who were hospitalized from 21 February to 21 April 2020. Kaplan-Meier survival estimates were calculated at 14 and 30 days for death in any setting, stratifying by age, sex, and the Charlson Index. RESULTS Overall, 42,926 hospitalized COVID-19 patients were identified. Patients' median age was 69 years (IQR: 57-79), 62.6% were males, and 6.0% had a Charlson Index ≥3. Survival curves showed that 22.0% (95% CI 21.6-22.4) of patients died within 14 days and 27.6% (95% CI 27.2-28.1) within 30 days from hospitalization. Survival was higher in younger patients and in females. The negative impact of comorbidities on survival was more pronounced in younger age groups. CONCLUSION The high fatality rate observed in the study (28% at 30 days) suggests that studies should focus on death as primary endpoint during a follow-up of at least one month.
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Affiliation(s)
| | | | | | - Gianluca Trifirò
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging – University of Messina, Messina, Italy
| | | | - Olivia Leoni
- Department of Health of Lombardy Region, Milan, Italy
| | - Danilo Cereda
- Department of Health of Lombardy Region, Milan, Italy
| | | | | | - Massimo Fabiani
- Department of Infectious Diseases, Istituto Superiore Di Sanità, Rome, Italy
| | - Flavia Riccardo
- Department of Infectious Diseases, Istituto Superiore Di Sanità, Rome, Italy
| | - Janet Sultana
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging – University of Messina, Messina, Italy
| | - Marco Massari
- National Center for Drug Research and Evaluation, Istituto Superiore Di Sanità, Rome, Italy
| | - On behalf of The ITA-COVID Working Group
- Azienda Zero of the Veneto Region, Padua, Italy
- Azienda Unità Sanitaria Locale – IRCCS, Reggio Emilia, Italy
- National Center for Drug Research and Evaluation, Istituto Superiore Di Sanità, Rome, Italy
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging – University of Messina, Messina, Italy
- Department of Health of Lombardy Region, Milan, Italy
- Department of Infectious Diseases, Istituto Superiore Di Sanità, Rome, Italy
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Canova C, Barbieri G, Zare Jeddi M, Gion M, Fabricio A, Daprà F, Russo F, Fletcher T, Pitter G. Associations between perfluoroalkyl substances and lipid profile in a highly exposed young adult population in the Veneto Region. Environ Int 2020; 145:106117. [PMID: 32971418 DOI: 10.1016/j.envint.2020.106117] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 05/28/2023]
Abstract
BACKGROUND Residents of a large area of the Veneto Region (North-Eastern Italy) were exposed for decades to drinking water contaminated by perfluoroalkyl substances (PFAS). PFAS have been consistently associated with raised serum lipids, mainly in cross-sectional studies and in background exposure contexts, but the shape of the dose-response relationships has been poorly investigated. The objectives of our study were to evaluate the association between serum PFAS and serum lipids and their dose-response patterns in a large exposed population. METHODS A cross-sectional study was conducted in 16,224 individuals aged 20-39 years recruited in the regional health surveillance program. 15,720 subjects were analysed after excluding pregnant women (n = 327), participants reporting use of cholesterol lowering medications (n = 67) or with missing information on the selected covariates (n = 110). Twelve PFAS were measured by HPLC-MS in serum; three (PFOA, PFOS and PFHxS) were quantifiable in at least 50% of samples. Non-fasting serum total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and triglycerides were measured by enzymatic assays in automated analysers and low-density lipoprotein cholesterol (LDL-C), non-HDL cholesterol and total/HDL cholesterol ratio were calculated. The associations between natural log (ln) transformed PFAS and lipids were assessed through generalized additive models using linear regression and smoothing thin plate splines, adjusted for potential confounders. RESULTS There were strong positive associations between the ln-transformed PFOA, PFOS, and PFHxS and TC, HDL-C, and LDL-C, and between ln PFOA and PFHxS and triglycerides. Each ln-increase in PFOA was associated with an increase of 1.94 mg/dL (95% CI 1.48-2.41) in TC, with 4.99 mg/dL (CI 4.12-5.86) for PFOS and 2.02 mg/dL (CI 1.45-2.58) for PFHxS. CONCLUSIONS Investigation of the shape of exposure-response associations using splines showed a positive association with the largest increases per unit of PFAS in cholesterol levels occurring at the lower range of PFAS concentrations for each compound.
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Affiliation(s)
- Cristina Canova
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, Padova, Italy.
| | - Giulia Barbieri
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, Padova, Italy
| | - Maryam Zare Jeddi
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, Padova, Italy
| | - Massimo Gion
- Regional Center for Biomarkers, Department of Clinical Pathology, Azienda ULSS 3 Serenissima, Venice, Italy
| | - Aline Fabricio
- Regional Center for Biomarkers, Department of Clinical Pathology, Azienda ULSS 3 Serenissima, Venice, Italy
| | - Francesca Daprà
- Laboratory Department-Regional Agency for Environmental Prevention and Protection-Veneto Region, Venice, Italy
| | - Francesca Russo
- Directorate of Prevention, Food Safety, and Veterinary Public Health-Veneto Region, Venice, Italy
| | - Tony Fletcher
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Gisella Pitter
- Screening and Health Impact Assessment Unit, Azienda Zero-Veneto Region, Padova, Italy
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19
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Pitter G, Zare Jeddi M, Barbieri G, Gion M, Fabricio ASC, Daprà F, Russo F, Fletcher T, Canova C. Perfluoroalkyl substances are associated with elevated blood pressure and hypertension in highly exposed young adults. Environ Health 2020; 19:102. [PMID: 32958007 PMCID: PMC7507812 DOI: 10.1186/s12940-020-00656-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 09/11/2020] [Indexed: 05/25/2023]
Abstract
BACKGROUND Residents in a large area of North-Eastern Italy were exposed to perfluoroalkyl substances (PFAS) via drinking water. Studies on the association between PFAS and blood pressure levels are limited, and results are inconsistent. Using cross-sectional data from the Regional health surveillance program, we aimed to quantify the associations between PFAS serum concentrations and blood pressure and hypertension prevalence. METHODS The study comprised 16,224 individuals aged 20-39 years. Pregnant women (n = 327), or individuals with missing information on the selected covariates (n = 111) were excluded, leaving 15,786 subjects for the analyses. Hypertension was defined as any self-reported diagnosis, use of antihypertensive drugs, or elevated systolic blood pressure (SBP ≥ 140 mmHg)/diastolic blood pressure (DBP ≥ 90 mmHg). Generalized additive models were used to investigate the relation between perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), perfluorohexane sulfonic acid (PFHxS), and perfluorononanoic acid (PFNA)) natural log (ln) transformed and by decile, and SBP, DBP, hypertension, adjusted for potential confounders. RESULTS Both SBP and DBP increased significantly with an increase in the ln-transformed serum PFAS concentrations in a monotonic way. The predicted increase in SBP and DBP were 1.54 mmHg (95%CI 0.61-2.47), 1.60 mmHg (95%CI 0.92-2.27) from lowest to highest decile of PFOA. The associations were stronger for SBP in men and for DBP in women. One unit increase in each In-transformed PFAS was positively associated with an increased odd of hypertension in men: PFOA OR = 1.06 (1.01-1.11), PFOS OR = 1.13 (1.03-1.23), PFHxS OR = 1.08 (1.02-1.15), PFNA OR = 1.20 (1.02-1.40). CONCLUSIONS Our findings suggest that serum PFAS concentrations were associated with increased systolic and diastolic blood pressure in a large highly exposed young adult population. Although the magnitude of the observed effect was relatively small, if confirmed it would be of public health relevance since even small increases in blood pressure levels at the population level may be associated to a raised risk of adverse outcomes such as cardiovascular disease and target organ damage.
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Affiliation(s)
- Gisella Pitter
- Screening and Health Impact Assessment Unit, Azienda Zero-Veneto Region, Padova, Italy
| | - Maryam Zare Jeddi
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, Via Loredan 18, 35131 Padova, Italy
| | - Giulia Barbieri
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, Via Loredan 18, 35131 Padova, Italy
| | - Massimo Gion
- Regional Center for Biomarkers, Department of Clinical Pathology, Azienda ULSS 3 Serenissima, Venice, Italy
| | - Aline S. C. Fabricio
- Regional Center for Biomarkers, Department of Clinical Pathology, Azienda ULSS 3 Serenissima, Venice, Italy
| | - Francesca Daprà
- Laboratory Department-Regional Agency for Environmental Prevention and Protection-Veneto Region, Venice, Italy
| | - Francesca Russo
- Directorate of Prevention, Food Safety, and Veterinary Public Health-Veneto Region, Venice, Italy
| | - Tony Fletcher
- London School of Hygiene and Tropical Medicine, London, UK
| | - Cristina Canova
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, Via Loredan 18, 35131 Padova, Italy
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Dalla Zuanna T, Barbieri G, Pitter G, Zare Jeddi M, Daprà F, Savitz D, Fabricio A, Russo F, Fletcher T, Canova C. Perfluoroalkyl substances and lipid profile in exposed pregnant women in the Veneto Region, Italy. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Perfluoroalkyl substances (PFASs) are persistent and widespread environmental pollutants. Residents of a large area of the Veneto Region (North-Eastern Italy) were exposed to high concentrations of PFASs through drinking water from the late-1970s to 2013. PFASs have been consistently associated with raised serum lipids, but only few studies have been conducted among pregnant women, and none has stratified analyses by trimesters of gestation. Our main objective was to evaluate the association between perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA) levels and lipid profiles in high-exposed pregnant women.
Methods
A cross-sectional analysis was conducted in 319 pregnant women (age 14-48 years) recruited in the Regional health surveillance program. Serum PFASs were measured by HPLC-MS/MS. Non-fasting serum total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C) were measured by enzymatic assays in automated analysers, and low-density lipoprotein cholesterol (LDL-C) was calculated. The associations between ln-transformed PFASs (and categorized into quartiles) and lipids were assessed using generalized additive models. Analyses were adjusted for potential confounders and stratified according to pregnancy trimester.
Results
In the first trimester, plasma concentrations of both PFOA and PFOS were positively associated with TC. However in the third trimester PFOA levels were instead inversely significantly associated with TC and LDL-C levels. Overall, both PFOA and PFOS were positively associated with HDL-C, and PFOA negatively with LDL-C.
Conclusions
In a small highly exposed population of pregnant women, the associations between PFASs concentrations and lipid profile were modified by trimester of gestation. Patterns late in pregnancy were different to the positive associations with LDL-C generally found. Differential transfer and bioaccumulation of lipids and PFAS in the placenta across gestation might explain our findings.
Key messages
This study provides evidence of different patterns of PFAS associations with lipids in pregnant women across the trimesters of gestation. The different patterns of association from general population studies sheds light on the role of fetal nutrition during pregnancy affecting both lipids and PFAS in serum.
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Affiliation(s)
- T Dalla Zuanna
- Unit of Biostatistics, Epidemiology and Public Health, Università di Padova, Padua, Italy
| | - G Barbieri
- Unit of Biostatistics, Epidemiology and Public Health, Università di Padova, Padua, Italy
| | - G Pitter
- Screening and Health Impact Assessment Unit, Azienda Zero-Veneto Region, Padua, Italy
| | - M Zare Jeddi
- Unit of Biostatistics, Epidemiology and Public Health, Università di Padova, Padua, Italy
| | - F Daprà
- Laboratory Department-Regional Agency for Environmental Prevention and Protection-Veneto Region, Venice, Italy
| | - D Savitz
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - A Fabricio
- Regional Center for Biomarkers, Department of Clinical Pathology, Azienda ULSS 3 Serenissima, Venice, Italy
| | - F Russo
- Directorate of Prevention, Food Safety, andVeterinary Public Health-Veneto Region, Venice, Italy
| | | | - C Canova
- Unit of Biostatistics, Epidemiology and Public Health, Università di Padova, Padua, Italy
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21
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Canova C, Jare Zeddi M, Barbieri G, Gion M, Daprà F, Russo F, Fletcher T, Pitter G. Perfluoroalkyl substances and blood pressure in exposed young population in the Veneto Region, Italy. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Residents in a large area of the Veneto Region (North-Eastern Italy) were exposed to perfluoroalkyl substances (PFASs) via drinking water. Studies on the association between PFASs and blood pressure (BP) levels are limited and results are inconsistent. Using cross-sectional data from the Regional health surveillance program, we aimed to quantify the associations between PFAS serum concentrations and blood pressure and hypertension prevalence.
Methods
The study included 16,224 individuals aged 20-39 years. Pregnant women (n = 327), participants with self-reported diagnosis or under treatment (n = 296) or with missing information on the selected covariates (n = 114) were excluded, leaving 15,487 subjects. Hypertension (HYP) was defined as any self-reported diagnosis, use of antihypertensive drugs, or raised systolic/diastolic blood pressure (SBP)≥140, DBP ≥90 mmHg). Serum PFASs were measured by HPLC-MS. Generalized additive models were used to investigate the relation between each PFAS (perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), perfluorohexane sulfonic acid (PFHxS), and perfluorononanoic acid (PFNA)) ln transformed and by decile, and SBP, DBP, HYP, adjusted for potential confounders.
Results
Both SBP and DBP increased significantly with an increase in the ln-transformed serum PFASs concentration in a monotonic way. The predicted increase in SBP and DBP were 1.62 (95% CI = 0.69, 2.55), 1.64 mmHg (95% CI = 0.96, 2.31) from lowest to highest decile of PFOA. The associations were stronger for SBP in men and DBP in women. One unit increase in each ln-PFAS was positively associated with an increased odds of HYP in men: PFOA OR = 1.07 (1.01-1.14), PFOS OR = 1.18 (1.05-1.32), PFHxS OR = 1.11 (1.03-1.19), PFNA OR = 1.19 (1.01-1.41).
Conclusions
Our findings suggest that exposure to PFAS is associated with increased blood pressure and thus may contribute as a risk factor for the development of cardiovascular diseases.
Key messages
Serum PFASs were associated with raised systolic blood pressure in men and diastolic blood pressure in women in a large highly exposed young adult population. Serum PFASs were associated with raised prevalence of hypertension in men.
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Affiliation(s)
- C Canova
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, Padua, Italy
| | - M Jare Zeddi
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, Padua, Italy
| | - G Barbieri
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, Padua, Italy
| | - M Gion
- Regional Center for Biomarkers, Department of Clinical Pathology, Azienda ULSS 3 Serenissima, Venice, Italy
| | - F Daprà
- Laboratory Department-Regional Agency for Environmental Prevention and Protection-Veneto Region, Venice, Italy
| | - F Russo
- Directorate of Prevention, Food Safety, andVeterinary Public Health-Veneto Region, Venice, Italy
| | | | - G Pitter
- Screening and Health Impact Assessment Unit, Azienda Zero-Veneto Region, Padua, Italy
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Canova C, Simonato L, Barbiellini Amidei C, Baldi I, Dalla Zuanna T, Gregori D, Danieli S, Buja A, Lorenzoni G, Pitter G, Costa G, Gnavi R, Corrao G, Rea F, Gini R, Hyeraci G, Roberto G, Spini A, Lucenteforte E, Agabiti N, Davoli M, Di Domenicantonio R, Cappai G. A Systematic Review of Case-Identification Algorithms for 18 Conditions Based on Italian Healthcare Administrative Databases: A Study Protocol. Epidemiol Prev 2020; 43:17-36. [PMID: 31650803 DOI: 10.19191/ep19.4.s2.p008.089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND there has been a long-standing, consistent use worldwide of Healthcare Administrative Databases (HADs) for epidemiological purposes, especially to identify acute and chronic health conditions. These databases are able to reflect health-related conditions at a population level through disease-specific case-identification algorithms that combine information coded in multiple HADs. In Italy, in the past 10 years, HAD-based case-identification algorithms have experienced a constant increase, with a significant extension of the spectrum of identifiable diseases. Besides estimating incidence and/or prevalence of diseases, these algorithms have been used to enroll cohorts, monitor quality of care, assess the effect of environmental exposure, and identify health outcomes in analytic studies. Despite the rapid increase in the use of case-identification algorithms, information on their accuracy and misclassification rate is currently unavailable for most conditions. OBJECTIVES to define a protocol to systematically review algorithms used in Italy in the past 10 years for the identification of several chronic and acute diseases, providing an accessible overview to future users in the Italian and international context. METHODS PubMed will be searched for original research articles, published between 2007 and 2017, in Italian or English. The search string consists of a combination of free text and MeSH terms with a common part on HADs and a disease-specific part. All identified papers will be screened for eligibility by two independent reviewers. All articles that used/defined an algorithm for the identification of each disease of interest using Italian HADs will be included. Algorithms with exclusive use of death certificates, pathology register, general practitioner or pediatrician data will be excluded. Pertinent papers will be classified according to the objective for which the algorithm was used, and only articles that used algorithms with "primary objectives" (I disease occurrence; II population/cohort selection; III outcome identification) will be considered for algorithm extraction. The HADs used (hospital discharge records, drug prescriptions, etc.), ICD-9 and ICD-10 codes, ATC classification of drugs, follow-back periods, and age ranges applied by the algorithms will be collected. Further information on specific accuracy measures from external validations, sensitivity analyses, and the contribution of each source will be recorded. This protocol will be applied for 16 different systematic reviews concerning eighteen diseases (Hypothyroidism, Hyperthyroidism, Diabetes mellitus, Type 1 diabetes mellitus, Acute myocardial infarction, Ischemic heart disease, Stroke, Hypertension, Heart failure, Congenital heart anomalies, Parkinson's disease, Multiple sclerosis, Epilepsy, Chronic obstructive pulmonary disease, Asthma, Inflammatory bowel disease, Celiac disease, Chronic kidney failure). CONCLUSION this protocol defines a standardized approach to extensively examine and compare all experiences of case identification algorithms in Italy, on the 18 abovementioned diseases. The methodology proposed may be applied to other systematic reviews concerning diseases not included in this project, as well as other settings, including international ones. Considering the increasing availability of healthcare data, developing standard criteria to describe and update characteristics of published algorithms would be of great use to enhance awareness in the choice of algorithms and provide a greater comparability of results.
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Affiliation(s)
- Cristina Canova
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padua (Italy)
| | - Lorenzo Simonato
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padua (Italy)
| | | | - Ileana Baldi
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padua (Italy)
| | - Teresa Dalla Zuanna
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padua (Italy)
| | - Dario Gregori
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padua (Italy)
| | - Silvia Danieli
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padua (Italy)
| | - Alessandra Buja
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padua (Italy)
| | - Giulia Lorenzoni
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padua (Italy)
| | - Gisella Pitter
- Local Health Unit "Azienda ULSS 2 Marca Trevigiana", Veneto Region (Italy)
| | - Giuseppe Costa
- Epidemiology Unit, ASL TO3, Piedmont Region, Grugliasco, Turin (Italy)
| | - Roberto Gnavi
- Epidemiology Unit, ASL TO3, Piedmont Region, Grugliasco, Turin (Italy)
| | - Giovanni Corrao
- National Centre for Healthcare Research and Pharmacoepidemiology, Milan (Italy).,Laboratory of Healthcare Research & Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan (Italy)
| | - Federico Rea
- National Centre for Healthcare Research and Pharmacoepidemiology, Milan (Italy).,Laboratory of Healthcare Research & Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan (Italy)
| | - Rosa Gini
- Regional Agency for Healthcare Services of Tuscany, Epidemiology Unit, Florence (Italy)
| | - Giulia Hyeraci
- Regional Agency for Healthcare Services of Tuscany, Epidemiology Unit, Florence (Italy)
| | - Giuseppe Roberto
- Regional Agency for Healthcare Services of Tuscany, Epidemiology Unit, Florence (Italy)
| | - Andrea Spini
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena (Italy)
| | - Ersilia Lucenteforte
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, (Italy)
| | - Nera Agabiti
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Rome (Italy)
| | - Marina Davoli
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Rome (Italy)
| | | | - Giovanna Cappai
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Rome (Italy)
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23
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Pitter G, Da Re F, Canova C, Barbieri G, Zare Jeddi M, Daprà F, Manea F, Zolin R, Bettega AM, Stopazzolo G, Vittorii S, Zambelli L, Martuzzi M, Mantoan D, Russo F. Serum Levels of Perfluoroalkyl Substances (PFAS) in Adolescents and Young Adults Exposed to Contaminated Drinking Water in the Veneto Region, Italy: A Cross-Sectional Study Based on a Health Surveillance Program. Environ Health Perspect 2020; 128:27007. [PMID: 32068468 PMCID: PMC7064325 DOI: 10.1289/ehp5337] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 01/16/2020] [Accepted: 01/17/2020] [Indexed: 05/19/2023]
Abstract
BACKGROUND In spring 2013, groundwater of a vast area of the Veneto Region (northeastern Italy) was found to be contaminated by perfluoroalkyl substances (PFAS) from a PFAS manufacturing plant active since the late 1960s. Residents were exposed to high concentrations of PFAS, particularly perfluorooctanoic acid (PFOA), through drinking water until autumn 2013. A publicly funded health surveillance program is under way to aid in the prevention, early diagnosis, and treatment of chronic disorders possibly associated with PFAS exposure. OBJECTIVES The objectives of this paper are: a) to describe the organization of the health surveillance program, b) to report serum PFAS concentrations in adolescents and young adults, and c) to identify predictors of serum PFAS concentrations in the studied population. METHODS The health surveillance program offered to residents of municipalities supplied by contaminated waterworks includes a structured interview, routine blood and urine tests, and measurement of 12 PFAS in serum by high-performance liquid chromatography-tandem mass spectrometry. We studied 18,345 participants born between 1978 and 2002, 14-39 years of age at recruitment. Multivariable linear regression was used to identify sociodemographic, lifestyle, dietary, and reproductive predictors of serum PFAS concentrations. RESULTS The PFAS with the highest serum concentrations were PFOA [median 44.4 ng / mL , interquartile range (IQR) 19.3-84.9], perfluorohexanesulfonic acid (PFHxS) (median 3.9 ng / mL , IQR 1.9-7.4), and perfluorooctanesulfonic acid (PFOS) (median 3.9 ng / mL , IQR 2.6-5.8). The major predictors of serum levels were gender, municipality, duration of residence in the affected area, and number of deliveries. Overall, the regression models explained 37%, 23%, and 43% of the variance of PFOA, PFOS, and PFHxS, respectively. CONCLUSIONS Serum PFOA concentrations were high relative to concentrations in populations with background residential exposures only. Interindividual variation of serum PFAS levels was partially explained by the considered predictors. https://doi.org/10.1289/EHP5337.
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Affiliation(s)
- Gisella Pitter
- Screening and Health Impact Assessment Unit, Azienda Zero—Veneto Region, Padua, Italy
| | - Filippo Da Re
- Directorate of Prevention, Food Safety, and Veterinary Public Health—Veneto Region, Venice, Italy
| | - Cristina Canova
- Unit of Biostatistics, Epidemiology, and Public Health—University of Padua, Padua, Italy
| | - Giulia Barbieri
- Unit of Biostatistics, Epidemiology, and Public Health—University of Padua, Padua, Italy
| | - Maryam Zare Jeddi
- Unit of Biostatistics, Epidemiology, and Public Health—University of Padua, Padua, Italy
| | - Francesca Daprà
- Laboratory Department—Regional Agency for Environmental Prevention and Protection—Veneto Region, Venice, Italy
| | - Flavio Manea
- Laboratory Department—Regional Agency for Environmental Prevention and Protection—Veneto Region, Venice, Italy
| | - Rinaldo Zolin
- PFAS Team—Local Health Unit “Azienda ULSS 8 Berica”, Vicenza, Italy
| | | | | | - Silvia Vittorii
- PFAS Team—Local Health Unit “Azienda ULSS 8 Berica”, Vicenza, Italy
| | - Lorena Zambelli
- Epidemiology, Prevention of Chronic Disorders, Screening and Health Promotion Unit—Local Health Unit “Azienda ULSS 9 Scaligera”, Verona, Italy
| | - Marco Martuzzi
- Regional Office for Western Pacific—World Health Organization, Seoul, Republic of Korea
| | | | - Francesca Russo
- Directorate of Prevention, Food Safety, and Veterinary Public Health—Veneto Region, Venice, Italy
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Di Domenicantonio R, Cappai G, Agabiti N, Marino C, Simonato L, Canova C, Pitter G. A Systematic Review of Case-Identification Algorithms Based on Italian Healthcare Administrative Databases for Three Relevant Diseases of the Digestive and Genitourinary System: Inflammatory Bowel Diseases, Celiac Disease, and Chronic Kidney Disease. Epidemiol Prev 2019; 43:88-98. [PMID: 31650809 DOI: 10.19191/ep19.4.s2.p088.095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES to identify and describe all Inflammatory Bowel Disease (IBD), Celiac Disease (CD), and Chronic Kidney Disease (CKD) case-identification algorithms by means of Italian Healthcare Administrative Databases (HADs), through a review of papers published in the past 10 years. METHODS this study is part of a project that systematically reviewed case-identification algorithms for 18 acute and chronic conditions by means of HADs in Italy. PubMed was searched for original articles, published between 2007 and 2017, in Italian or English. The search string consisted of a combination of free text and MeSH terms with a common part that focused on HADs and a disease-specific part. All identified papers were screened by two independent reviewers; exclusion criteria were the following: no details of algorithms reported, algorithm not developed in the Italian context, exclusive use of data from the death certificate register, or from general practitioner or pediatrician databases. Pertinent papers were classified according to the objective for which the algorithm had been used, and only articles that used algorithms for primary objectives (I disease occurrence, II population/cohort selection, III outcome identification) were considered for algorithm extraction. The HADs used (hospital discharge records, drug prescriptions, etc.), ICD-9 and ICD-10 codes, ATC classification of drugs, followback periods, and age ranges applied by the algorithms have been reported. Further information on specific objective(s), accuracy measures, sensitivity analyses and the contribution of each HAD, have also been recorded. RESULTS the search string led to the identification of 98 articles for IBD, 42 articles for CD, and 390 for CKD. By screening the references, one paper for IBD was added. Finally, this led to 5, 9, and 8 pertinent papers respectively for IBD, CD, and CKD. Considering the papers on IBD and CD, specific age selections were applied to focus on children and young adult populations. When a selection on age was applied for CKD, instead, it mostly considered individuals aged more than 18 years. Three algorithms for IBD, 4 for CD, and 5 for CKD were extracted from papers and characterized. Drug prescription databases were used for both IBD and CKD algorithms, whereas the hospital discharge database and co-payment exemption database were used for IBD and CD. Pathology records and specialist visit databases were also used for CD and CKD, respectively. For each disease only one algorithm applied criteria for the exclusion of prevalent cases. External validation was performed only for Crohn's disease among IBDs, in one algorithm. CONCLUSIONS the results of this review indicate that case identification for IBD and CD from routinely collected data can be considered feasible and can be used to perform different kinds of epidemiological studies. The same is not true for CKD, which requires further efforts, mainly to improve the detection of early stage patients.
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Affiliation(s)
| | - Giovanna Cappai
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Rome (Italy)
| | - Nera Agabiti
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Rome (Italy)
| | - Claudia Marino
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Rome (Italy)
| | - Lorenzo Simonato
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padua (Italy)
| | - Cristina Canova
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padua (Italy)
| | - Gisella Pitter
- Local Health Unit "Azienda ULSS 2 Marca Trevigiana", Veneto Region, Treviso (Italy)
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Canova C, Pitter G, Zanier L, Simonato L, Michaelsson K, Ludvigsson JF. Risk of Fractures in Youths with Celiac Disease-A Population-Based Study. J Pediatr 2018; 198:117-120. [PMID: 29681452 DOI: 10.1016/j.jpeds.2018.02.070] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/16/2018] [Accepted: 02/28/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To assess the risk of any fracture requiring hospital care in a cohort of individuals with celiac disease diagnosed in childhood/adolescence compared with reference individuals matched by age and sex. STUDY DESIGN Our study cohort consisted of 213 635 people born and residing in Friuli-Venezia Giulia Region, Italy, in 1989-2011. We selected, through pathology reports, hospital discharge records, or co-payment exemptions, 1233 individuals with celiac disease (aged 0-17 years at diagnosis) and compared them with 6167 reference individuals matched by sex and year of birth. Fractures were identified through hospital discharge records. We calculated hazard ratios (HRs) for any fracture after celiac disease diagnosis (or index date for reference individuals) with Cox regression and ORs for any fracture before celiac disease diagnosis with conditional logistic regression. RESULTS During the follow-up period (maximum 23 years), 22 individuals with celiac disease (9394 person-years) and 128 reference individuals (47 308 person-years) experienced a fracture, giving an overall HR of 0.87 (95% CI 0.55-1.37). The risk was not modified by sex, age at diagnosis, or calendar period of diagnosis. We obtained similar HRs when excluding fractures occurring after the age of 18 years and adjusting for maternal education or vitamin D supplementation. The odds of previous fracture also did not differ between subjects with celiac disease and reference individuals (22 and 96 cases, respectively: OR 1.15; 95% CI 0.72-1.84). CONCLUSIONS We did not find any evidence of an increased risk of fractures during childhood and youth among patients with celiac disease.
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Affiliation(s)
- Cristina Canova
- Department of Cardiological, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
| | - Gisella Pitter
- Department of Cardiological, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Loris Zanier
- Epidemiological Service, Health Directorate, Friuli Venezia-Giulia Region, Udine, Italy
| | - Lorenzo Simonato
- Department of Cardiological, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Karl Michaelsson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Jonas F Ludvigsson
- Department Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom; Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
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Canova C, Pitter G, Schifano P. [A systematic review of epidemiological cohort studies based on the Italian Medical Birth Register. Is it time to think of a multicentric birth cohort?]. Epidemiol Prev 2018; 40:439-452. [PMID: 27919151 DOI: 10.19191/ep16.6.p439.125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION birth cohorts are a necessary tool for the study of the effects of exposures which can occur during pregnancy and early life on the development and health status in paediatric and adult life. The Italian Medical Birth Register (CeDAP), linked with other health administrative data, allows to build population based births cohorts to be followed over time. OBJECTIVES to sistematically review all published scientific papers using data extracted from the (CeDAP) in order to give a picture of their current use for epidemiological aims; to describe advantages and limits of these data and possible future developments for epidemiological purposes. METHODS a systematic review was conducted using PubMed, identifying all peer-reviewed research papers in English or Italian published by November 2015, by combining of free text and MeSH terms, where available. Features of included papers have been double checked and possible disagreements have been discussed to reach consensus. RESULTS the research strategy found 720 papers, 35 of which fulfilling the required criteria. Only few Italian regions used CeDAP data for epidemiological studies, particularly Lazio and Umbria (Central Italy) and Emilia-Romagna and Friuli Venezia Giulia (Northern Italy). About half of the included papers were analytical, while the others were descriptive. Occurrence of caesarean deliveries and the prevalence of malformations were the most recurrent topics. Almost all papers used only data at delivery, whereas 5 papers used a longitudinal design with follow-up after birth. CONCLUSIONS the Italian CeDAP registry is an important source of information for epidemiological research and its use for both aetiological aims and health services assessment should be enhanced. Furthermore, its characteristics, in particular its homogeneity among all Italian regions, might allow to create a multiregional birth cohort to be regularly followed up.
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Affiliation(s)
- Cristina Canova
- Dipartimento di medicina molecolare, Università degli Studi di Padova
| | - Gisella Pitter
- Scuola di specializzazione in igiene e medicina preventiva, Università degli Studi di Padova
| | - Patrizia Schifano
- Dipartimento di epidemiologia del Servizio sanitario regionale, Regione Lazio, ASL RM1
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Pitter G, Gnavi R, Romor P, Zanotti R, Simonato L, Canova C. [Assessment of an algorithm to identify paediatric-onset celiac disease cases through administrative healthcare databases]. Epidemiol Prev 2017. [PMID: 28627151 DOI: 10.19191/ep17.2.p102.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES to assess the role of four administrative healthcare databases (pathology reports, copayment exemptions, hospital discharge records, gluten-free food prescriptions) for the identification of possible paediatric cases of celiac disease. DESIGN population-based observational study with record linkage of administrative healthcare databases. SETTING AND PARTICIPANT S: children born alive in the Friuli Venezia Giulia Region (Northern Italy) to resident mothers in the years 1989-2012, identified using the regional Medical Birth Register. MAIN OUTCOME MEASURES we defined possible celiac disease as having at least one of the following, from 2002 onward: 1. a pathology report of intestinal villous atrophy; 2. a copayment exemption for celiac disease; 3. a hospital discharge record with ICD-9-CM code of celiac disease; 4. a gluten-free food prescription. We evaluated the proportion of subjects identified by each archive and by combinations of archives, and examined the temporal relationship of the different sources in cases identified by more than one source. RESULT S: out of 962 possible cases of celiac disease, 660 (68.6%) had a pathology report, 714 (74.2%) a copayment exemption, 667 (69.3%) a hospital discharge record, and 636 (66.1%) a gluten-free food prescription. The four sources coexisted in 42.2% of subjects, whereas 30.2% were identified by two or three sources and 27.6% by a single source (16.9% by pathology reports, 4.2% by hospital discharge records, 3.9% by copayment exemptions, and 2.6% by gluten-free food prescriptions). Excluding pathology reports, 70.6% of cases were identified by at least two sources. A definition based on copayment exemptions and discharge records traced 80.5% of the 962 possible cases of celiac disease; whereas a definition based on copayment exemptions, discharge records, and gluten-free food prescriptions traced 83.1% of those cases. The temporal relationship of the different sources was compatible with the typical diagnostic pathway of subjects with celiac disease. CONCLUSIONS the four sources were only partially consistent. A relevant proportion of all possible cases of paediatric celiac disease were identified exclusively by pathology reports.
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Affiliation(s)
- Gisella Pitter
- Dipartimento di scienze cardiologiche, toraciche e vascolari, Università degli studi di Padova
| | - Roberto Gnavi
- Servizio sovrazonale di epidemiologia ASL TO3, Regione Piemonte
| | - Pierantonio Romor
- Informatica per il sistema degli enti locali (INSIEL) S.p.A., Sistema informatico sanitario regionale Friuli Venezia Giulia
| | - Renzo Zanotti
- Dipartimento di medicina molecolare, Università degli studi di Padova
| | - Lorenzo Simonato
- Dipartimento di scienze cardiologiche, toraciche e vascolari, Università degli studi di Padova
| | - Cristina Canova
- Dipartimento di medicina molecolare, Università degli studi di Padova.
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Canova C, Pitter G, Ludvigsson JF, Romor P, Zanier L, Zanotti R, Simonato L. Celiac Disease and Risk of Autoimmune Disorders: A Population-Based Matched Birth Cohort Study. J Pediatr 2016; 174:146-152.e1. [PMID: 27021409 DOI: 10.1016/j.jpeds.2016.02.058] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 01/22/2016] [Accepted: 02/23/2016] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To estimate the relative risk of developing type 1 diabetes mellitus (T1DM) and autoimmune thyroid disease in children with celiac disease (CD). STUDY DESIGN A matched cohort design with linkage of administrative data was adopted. A total of 1215 cases of CD and 6075 references matched by sex and year of birth born in Friuli Venezia Giulia Region (Italy) between 1989 and 2011 were included. Cox regression models were used to estimate hazard ratios (HRs) for autoimmune diseases in patients with CD compared with references, stratified by sex and age at diagnosis. RESULTS Individuals with CD had an increased risk of subsequent hypothyroidism (HR 4.64 [95% CI 2.88-7.46]) and T1DM (HR 2.50 [95% CI 0.94-6.66]), the latter not statistically significant. Risk of hypothyroidism was higher in males (HR 20.00; 95% CI 5.64-70.87) than females (HR 3.21; 95% CI 1.85-5.57) (P value <.01). No differences were observed between males and females risks for diabetes or age at CD diagnosis. The small number of hyperthyroidism cases identified precluded any statistical analysis. CONCLUSIONS Children and youth with CD are at increased risk of developing autoimmune hypothyroidism and to some extent T1DM. This suggests the need for surveillance of children with CD in order to timely detect the onset of such comorbidities.
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Affiliation(s)
- Cristina Canova
- Laboratory of Public Health and Population Studies, Department of Molecular Medicine, University of Padua, Padua, Italy.
| | - Gisella Pitter
- Laboratory of Public Health and Population Studies, Department of Molecular Medicine, University of Padua, Padua, Italy
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden
| | - Pierantonio Romor
- Friuli-Venezia Giulia Regional Health Information System, Informatica per il Sistema degli Enti Locali (INSIEL) S.p.A., Udine, Italy
| | - Loris Zanier
- Epidemiological Service, Health Directorate, Friuli Venezia-Giulia Region, Udine, Italy
| | - Renzo Zanotti
- Laboratory of Public Health and Population Studies, Department of Molecular Medicine, University of Padua, Padua, Italy
| | - Lorenzo Simonato
- Laboratory of Public Health and Population Studies, Department of Molecular Medicine, University of Padua, Padua, Italy
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Pitter G, Canova C. Reply to Bianchi et al.: In Italy anti-asthmatic drug prescription is not always a reliable proxy of asthma. Eur J Epidemiol 2016; 31:533. [PMID: 27100948 DOI: 10.1007/s10654-016-0150-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 04/13/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Gisella Pitter
- Laboratory of Public Health and Population Studies, Department of Molecular Medicine, University of Padova, Via Loredan, 18, 35131, Padua, Italy
| | - Cristina Canova
- Laboratory of Public Health and Population Studies, Department of Molecular Medicine, University of Padova, Via Loredan, 18, 35131, Padua, Italy.
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Canova C, Pitter G, Ludvigsson JF, Romor P, Zanier L, Zanotti R, Simonato L. Risks of hospitalization and drug consumption in children and young adults with diagnosed celiac disease and the role of maternal education: a population-based matched birth cohort study. BMC Gastroenterol 2016; 16:1. [PMID: 26796772 PMCID: PMC4722621 DOI: 10.1186/s12876-015-0415-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 12/23/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Celiac disease (CD) may affect healthcare use in children and young adults. Socio-economic factors may act as a confounder or effect modifier. We assessed such hypotheses in a population-based birth cohort of young celiac subjects and references matched by maternal education. METHODS The cohort included all newborns recorded in the Medical Birth Register of Friuli-Venezia Giulia Region (Italy) between 1989 and 2011. CD incident cases were identified through pathology reports, hospital discharges and copayment exemptions and matched with up to five references by sex, year of birth and maternal education. Cox regression models were used to estimate Hazard Ratios (HRs) for major causes of inpatient diagnosis and drug prescription occurring after diagnosis in CD patients compared to references, stratifying by time of first event and maternal education. RESULTS We identified 1294 CD cases and 5681 references. CD cases had a higher risk of hospital admission for any cause (HR: 2.34; 95 % CI 2.08-2.63) and for all major ICD9-CM categories except obstetric complications, skin and musculoskeletal diseases, and injuries and poisoning. Prescription of all major ATC drug categories, except dermatologicals and genito-urinary medications, was significantly increased in CD subjects. For most outcomes, HRs were highest in the first year after CD diagnosis but remained significant after five or more years. HRs were similar across different categories of maternal education. CONCLUSIONS Diagnosed CD subjects had a higher risk of hospitalization and medication use compared to the general population, even five or more years after diagnosis, with no effect modification of maternal education.
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Affiliation(s)
- Cristina Canova
- Laboratory of Public Health and Population Studies, Department of Molecular Medicine, University of Padua, via Loredan 18, 35131, Padua, Italy.
| | - Gisella Pitter
- Laboratory of Public Health and Population Studies, Department of Molecular Medicine, University of Padua, via Loredan 18, 35131, Padua, Italy.
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 17177, Stockholm, Sweden. .,Department of Pediatrics, Örebro university Hospital, Örebro, 70185, Sweden.
| | - Pierantonio Romor
- Friuli-Venezia Giulia Regional Health Information System, Informatica per il Sistema degli Enti Locali (INSIEL) S.p.A., Udine, Italy.
| | - Loris Zanier
- Epidemiological Service, Health Directorate, Friuli Venezia-Giulia Region, Udine, Italy.
| | - Renzo Zanotti
- Laboratory of Public Health and Population Studies, Department of Molecular Medicine, University of Padua, via Loredan 18, 35131, Padua, Italy.
| | - Lorenzo Simonato
- Laboratory of Public Health and Population Studies, Department of Molecular Medicine, University of Padua, via Loredan 18, 35131, Padua, Italy.
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Canova C, Pitter G, Ludvigsson J, Romor P, Zanier L, Zanotti R, Simonato L. Risks of hospitalization and drug consumption associated with Coeliac Disease in a birth cohort study. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv176.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pitter G, Ludvigsson JF, Romor P, Zanier L, Zanotti R, Simonato L, Canova C. Antibiotic exposure in the first year of life and later treated asthma, a population based birth cohort study of 143,000 children. Eur J Epidemiol 2015; 31:85-94. [PMID: 25957084 DOI: 10.1007/s10654-015-0038-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 04/25/2015] [Indexed: 12/16/2022]
Abstract
Several epidemiological studies reported an association between antibiotic consumption in the first year of life and later asthma, but results are conflicting and affected by potential biases. We examined this controversial issue in a population-based birth cohort. Using administrative data, we identified 143,163 children born in 1995-2011 in Friuli-Venezia Giulia (Italy) (median follow-up 5.25 years, 927,350 person-years). Antibiotic prescriptions in the first year of life and subsequent treated asthma (defined as ≥2 anti-asthmatic drug prescriptions within a 12-month period) were retrieved from drug prescription records. We estimated incidence rate ratios (IRR) using Poisson regression models, adjusted for perinatal variables and for hospitalizations for infections in the first year of life. We identified 34,957 new-onset asthma cases. Antibiotic consumption in the first year of life increased the risk of new-onset asthma [IRR 1.51, 95% confidence interval (CI) 1.48-1.54] with a dose-response relationship (p-trend <0.001). The risk was highest for asthma identified at 13-35 months of life (IRR 2.07, 95% CI 2.00-2.14), but remained statistically significant for asthma identified at 36-71 months (IRR 1.17, 95% CI 1.14-1.21) and at ≥72 months (IRR 1.15, 95% CI 1.08-1.22). Antibiotics increased the risk of current asthma at ≥6 years (IRR 1.35, 95% CI 1.30-1.41) and at ≥13 years of age (IRR 1.19, 95% CI 1.08-1.33). Antibiotic exposure in infancy is associated with an increased risk of asthma up to adolescence. The association detected at older ages is not explained by reverse causation; however, confounding by respiratory infections not leading to hospital admission cannot be excluded.
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Affiliation(s)
- Gisella Pitter
- Laboratory of Public Health and Population Studies, Department of Molecular Medicine, University of Padua, Via Loredan, 18, 35131, Padua, Italy
| | - Jonas Filip Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 17177, Stockholm, Sweden.,Department of Pediatrics, Örebro University Hospital, 70185, Örebro, Örebro, Sweden
| | - Pierantonio Romor
- Friuli-Venezia Giulia Regional Health Information System, Informatica per il Sistema degli Enti Locali (INSIEL) S.p.A., Udine, Italy
| | - Loris Zanier
- Epidemiological Service, Health Directorate, Friuli Venezia-Giulia Region, Udine, Italy
| | - Renzo Zanotti
- Laboratory of Public Health and Population Studies, Department of Molecular Medicine, University of Padua, Via Loredan, 18, 35131, Padua, Italy
| | - Lorenzo Simonato
- Laboratory of Public Health and Population Studies, Department of Molecular Medicine, University of Padua, Via Loredan, 18, 35131, Padua, Italy
| | - Cristina Canova
- Laboratory of Public Health and Population Studies, Department of Molecular Medicine, University of Padua, Via Loredan, 18, 35131, Padua, Italy.
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Canova C, Pitter G, Ludvigsson JF, Romor P, Zanier L, Zanotti R, Simonato L. Coeliac disease and asthma association in children: the role of antibiotic consumption. Eur Respir J 2015; 46:115-22. [PMID: 25929947 DOI: 10.1183/09031936.00185714] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 01/27/2015] [Indexed: 12/18/2022]
Abstract
The relationship between coeliac disease and asthma has been scarcely investigated. Infant antibiotic exposure has been linked to both diseases. We evaluated the association between childhood coeliac disease and asthma and the role of antibiotics in the first year of life. We followed a cohort of children born in 1995-2011 in the Friuli-Venezia Giulia region (Italy). Prescriptions for antibiotics in the first year of life and subsequent treated asthma were retrieved from drug prescription records; coeliac disease incident cases were identified from pathology reports, hospital discharges and exemption from prescription charges for clinical tests. We estimated incidence rate ratios (IRRs) using multivariate Poisson regression models. Among the 143,144 children, we identified 717 coeliac children and 34,969 asthmatics. Children with asthma were at increased risk of coeliac disease (IRR 1.46, 95% CI 1.25-1.67). Restricting the analysis to asthma that occurred before the diagnosis of coeliac disease, the excess risk disappeared, except for coeliac disease diagnosed after 5 years of age (IRR 1.37, 95% CI 1.09-1.71). Antibiotics were not a confounding factor in these associations. Childhood treated asthma and coeliac disease are significantly associated. This association is not confounded by antibiotic exposure in the first year of life and may be explained by other shared risk factors.
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Affiliation(s)
- Cristina Canova
- Laboratory of Public Health and Population Studies, Department of Molecular Medicine, University of Padua, Padua, Italy
| | - Gisella Pitter
- Laboratory of Public Health and Population Studies, Department of Molecular Medicine, University of Padua, Padua, Italy
| | - Jonas F Ludvigsson
- Dept of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden Dept of Pediatrics, Örebro University Hospital, Örebro, Sweden
| | - Pierantonio Romor
- Friuli-Venezia Giulia Regional Health Information System, Informatica per il Sistema degli Enti Locali (INSIEL) S.p.A., Udine, Italy
| | - Loris Zanier
- Epidemiological Service, Health Directorate Friuli-Venezia Giulia Region, Udine, Italy
| | - Renzo Zanotti
- Laboratory of Public Health and Population Studies, Department of Molecular Medicine, University of Padua, Padua, Italy
| | - Lorenzo Simonato
- Laboratory of Public Health and Population Studies, Department of Molecular Medicine, University of Padua, Padua, Italy
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Canova C, Zabeo V, Pitter G, Romor P, Baldovin T, Zanotti R, Simonato L. Association of maternal education, early infections, and antibiotic use with celiac disease: a population-based birth cohort study in northeastern Italy. Am J Epidemiol 2014; 180:76-85. [PMID: 24853109 DOI: 10.1093/aje/kwu101] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
We conducted a population-based birth cohort study of approximately 203,000 babies born in northeastern Italy (1989-2012) to investigate perinatal variables, early infections leading to hospital admission, and antibiotic use in the first 12 months of life as possible risk factors for celiac disease (CD). Incident CD cases were identified from pathology reports, hospital discharge records, and exemptions from prescription charges for clinical tests. Multivariate Poisson regression models were fitted to estimate incidence rate ratios (IRRs). A total of 1,227 children had CD; CD was histopathologically confirmed in 866 (71%). Female sex, maternal age, and high maternal educational level were found to be significantly associated with CD. Gastrointestinal infections were strongly associated with a subsequent diagnosis of CD (IRR = 2.04, 95% confidence interval (CI): 1.30, 3.22). Antibiotic use was significantly associated with CD onset (IRR = 1.24, 95% CI: 1.07, 1.43), with a dose-response relationship for number of courses (P-trend < 0.01). Cephalosporin use strongly increased the risk of CD (IRR = 1.42, 95% CI: 1.18, 1.73). Use of antibiotics (supported by the dose-response relationship) and gastrointestinal infections in the first year of life may facilitate the early onset of CD by altering intestinal microflora and the gut mucosal barrier. Perinatal factors, including cesarean section, had little influence on the risk of childhood CD.
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Rossi GP, Pitter G, Gallina V, Rossitto G, Pessina AC. PREVALENCE OF OBSTRUCTIVE SLEEP APNEA SYNDROME IN HYPERTENSIVE PATIENTS REFERRED TO A SPECIALIZED OUTPATIENT CLINIC AND ASSOCIATION WITH PRIMARY ALDOSTERONISM. J Hypertens 2011. [DOI: 10.1097/00004872-201106001-00082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Miotto D, De Toni R, Pitter G, Seccia TM, Motta R, Vincenzi M, Feltrin G, Rossi GP. Impact of Accessory Hepatic Veins on Adrenal Vein Sampling for Identification of Surgically Curable Primary Aldosteronism. Hypertension 2009; 54:885-9. [DOI: 10.1161/hypertensionaha.109.134759] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Diego Miotto
- From the Dipartimento di Scienze Medico-Diagnostiche e Terapie Speciali (D.M., R.M., M.V., G.F.), Department of Clinical and Experimental Medicine-Clinica Medica 4 (R.D.T., G.P., T.M.S., G.P.R.), University Hospital, Padova, Italy
| | - Renzo De Toni
- From the Dipartimento di Scienze Medico-Diagnostiche e Terapie Speciali (D.M., R.M., M.V., G.F.), Department of Clinical and Experimental Medicine-Clinica Medica 4 (R.D.T., G.P., T.M.S., G.P.R.), University Hospital, Padova, Italy
| | - Gisella Pitter
- From the Dipartimento di Scienze Medico-Diagnostiche e Terapie Speciali (D.M., R.M., M.V., G.F.), Department of Clinical and Experimental Medicine-Clinica Medica 4 (R.D.T., G.P., T.M.S., G.P.R.), University Hospital, Padova, Italy
| | - Teresa Maria Seccia
- From the Dipartimento di Scienze Medico-Diagnostiche e Terapie Speciali (D.M., R.M., M.V., G.F.), Department of Clinical and Experimental Medicine-Clinica Medica 4 (R.D.T., G.P., T.M.S., G.P.R.), University Hospital, Padova, Italy
| | - Raffaella Motta
- From the Dipartimento di Scienze Medico-Diagnostiche e Terapie Speciali (D.M., R.M., M.V., G.F.), Department of Clinical and Experimental Medicine-Clinica Medica 4 (R.D.T., G.P., T.M.S., G.P.R.), University Hospital, Padova, Italy
| | - Matteo Vincenzi
- From the Dipartimento di Scienze Medico-Diagnostiche e Terapie Speciali (D.M., R.M., M.V., G.F.), Department of Clinical and Experimental Medicine-Clinica Medica 4 (R.D.T., G.P., T.M.S., G.P.R.), University Hospital, Padova, Italy
| | - Gianpietro Feltrin
- From the Dipartimento di Scienze Medico-Diagnostiche e Terapie Speciali (D.M., R.M., M.V., G.F.), Department of Clinical and Experimental Medicine-Clinica Medica 4 (R.D.T., G.P., T.M.S., G.P.R.), University Hospital, Padova, Italy
| | - Gian Paolo Rossi
- From the Dipartimento di Scienze Medico-Diagnostiche e Terapie Speciali (D.M., R.M., M.V., G.F.), Department of Clinical and Experimental Medicine-Clinica Medica 4 (R.D.T., G.P., T.M.S., G.P.R.), University Hospital, Padova, Italy
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Seccia TM, Miotto D, De Toni R, Pitter G, Mantero F, Pessina AC, Rossi GP. Adrenocorticotropic Hormone Stimulation During Adrenal Vein Sampling for Identifying Surgically Curable Subtypes of Primary Aldosteronism. Hypertension 2009; 53:761-6. [DOI: 10.1161/hypertensionaha.108.128553] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Adrenocorticotropic hormone administration was proposed to overcome the biases associated with pulsatile aldosterone secretion during adrenal venous sampling, but the usefulness of different protocols of stimulation was never systematically assessed. We, therefore, compared the effects of a high dose (HD; 250 μg IV as a bolus), a very low dose (VLD; 250 pg IV), and an intermediate dose (ID; 50 μg/h) of adrenocorticotropic hormone on the selectivity index (SI) and the lateralization index in primary aldosteronism patients, using the diagnosis of aldosterone-producing adenoma, based on pathology and follow-up data, as a reference. The HD (n=47) significantly increased plasma cortisol concentration in infrarenal inferior vena cava (+79%) blood and the SI on both sides (SI
RIGHT
+113% and SI
LEFT
+131%), as compared with baseline values. The ID (n=14) also markedly increased both plasma cortisol concentration inferior vena cava (+93%) and the SI (SI
RIGHT
+690% and SI
LEFT
+410%); the very low dose (n=6) had no effect on either the plasma cortisol concentration or SI. In the patients with unilateral aldosterone-producing adenoma, the increase of selectivity with the HD and ID was counterbalanced by a confounding effect on the correct identification of the aldosterone-producing adenoma side, which was attributed to the wrong side in 3.0% and 12.5% with HD and ID, respectively. In conclusion, the HD and the ID, but not the very low dose, adrenocorticotropic hormone stimulation protocol facilitated the ascertainment of selectivity of adrenal vein catheterization. However, this favorable effect was overridden by a confounding effect on the identification of lateralized aldosterone excess to the aldosterone-producing adenoma side. Hence, we do not recommend adrenocorticotropic hormone stimulation.
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Affiliation(s)
- Teresa M. Seccia
- From the Department of Clinical and Experimental Medicine-Internal Medicine 4 (T.M.S., R.D.T., G.P., A.C.P., G.P.R.), Institute of Radiology (D.M.), and Department of Medical and Surgical Sciences (F.M.), University of Padua School of Medicine, Padua, Italy
| | - Diego Miotto
- From the Department of Clinical and Experimental Medicine-Internal Medicine 4 (T.M.S., R.D.T., G.P., A.C.P., G.P.R.), Institute of Radiology (D.M.), and Department of Medical and Surgical Sciences (F.M.), University of Padua School of Medicine, Padua, Italy
| | - Renzo De Toni
- From the Department of Clinical and Experimental Medicine-Internal Medicine 4 (T.M.S., R.D.T., G.P., A.C.P., G.P.R.), Institute of Radiology (D.M.), and Department of Medical and Surgical Sciences (F.M.), University of Padua School of Medicine, Padua, Italy
| | - Gisella Pitter
- From the Department of Clinical and Experimental Medicine-Internal Medicine 4 (T.M.S., R.D.T., G.P., A.C.P., G.P.R.), Institute of Radiology (D.M.), and Department of Medical and Surgical Sciences (F.M.), University of Padua School of Medicine, Padua, Italy
| | - Franco Mantero
- From the Department of Clinical and Experimental Medicine-Internal Medicine 4 (T.M.S., R.D.T., G.P., A.C.P., G.P.R.), Institute of Radiology (D.M.), and Department of Medical and Surgical Sciences (F.M.), University of Padua School of Medicine, Padua, Italy
| | - Achille C. Pessina
- From the Department of Clinical and Experimental Medicine-Internal Medicine 4 (T.M.S., R.D.T., G.P., A.C.P., G.P.R.), Institute of Radiology (D.M.), and Department of Medical and Surgical Sciences (F.M.), University of Padua School of Medicine, Padua, Italy
| | - Gian Paolo Rossi
- From the Department of Clinical and Experimental Medicine-Internal Medicine 4 (T.M.S., R.D.T., G.P., A.C.P., G.P.R.), Institute of Radiology (D.M.), and Department of Medical and Surgical Sciences (F.M.), University of Padua School of Medicine, Padua, Italy
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Seccia M, Miotto D, Mantero F, Pitter G, Patalano A, Pessina A, Rossi G. 6.2 Comparison of Three Different Doses of ACTH Stimulation During Adrenal Vein Sampling (AVS) in the Work-Up of Primary Aldosteronism. High Blood Press Cardiovasc Prev 2008. [DOI: 10.1007/bf03263649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Rossi E, Regolisti G, Nicoli D, Rossi GP, Pitter G, Negro A, Perazzoli F, Santi R, Farnetti E, Casali B. Increased Levels of Autoantibodies Against AT1 Receptor in Conn Syndrome. High Blood Press Cardiovasc Prev 2007. [DOI: 10.2165/00151642-200714030-00101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Pitter G, Montemurro D, Bernante P, Miotto D, Pessina AC, Rossi GP. Assessment of the Selectivity and Lateralisation Index for Adrenal Vein Sampling in Primary Aldosteronism. High Blood Press Cardiovasc Prev 2007. [DOI: 10.2165/00151642-200714030-00093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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P. Rossi G, Bolognesi M, Rizzoni D, Piva A, Porteri E, Bernante P, Pitter G, Agabiti-Rosei E, C. Pessina A. Vascular Remodelling and Duration of Hypertension Predicts Blood Pressure Response to Adrenalectomy in Aldosterone-Producing Adenoma Patients. High Blood Press Cardiovasc Prev 2007. [DOI: 10.2165/00151642-200714030-00183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Abstract
Endothelin-1 (ET-1) exerts multiple biological effects, including vasoconstriction and the stimulation of cell proliferation in tissues both within and outside of the cardiovascular system. ET-1 is synthesized by ET-converting enzymes (ECE), chymases (CMAs), and non-ECE metalloproteases through a process regulated in an autocrine fashion in vascular and nonvascular cells. ET-1 acts through the activation of G(i)protein-coupled receptors. ET(A) receptors mediate vasoconstriction and cell proliferation, whereas ET(B) receptors are important for aldosterone secretion, endothelial cell (EC) migration, the release of nitric oxide (NO) and prostacyclin, the clearance of ET-1, and the inhibition of ECE-1. ET is activated in scleroderma, hypertension, atherosclerosis, restenosis, heart failure, idiopathic cardiomyopathy, and renal failure. Tissue concentrations more reliably reflect the activation of the ET system because of the predominantly abluminal secretion of the peptide. Experimental studies and clinical trials have demonstrated that ET-1 plays a major role in normal cardiovascular homeostasis and in the functional and structural changes observed in arterial and pulmonary hypertension, glomerulosclerosis, atherosclerosis, and heart failure. Accordingly, ET antagonists are promising new agents in the treatment of cardiovascular diseases. Single nucleotide polymorphisms (SNPs) of the genes of preproET-1, ECE-1, CMA, ET(A) and ET(B) receptors have been identified and can be important for their functional regulation. However, for most of them the association with disease conditions and the evidence for a functional role remain controversial. Thus, even though ET antagonists are being used for the treatment of pulmonary hypertension, there is no convincing evidence for a role of SNPs in affecting the therapeutic strategies.
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Affiliation(s)
- Gian Paolo Rossi
- Department of Clinical and Experimental Medicine, Clinica Medica 4, University of Padova, Padova, Italy.
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