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Costopoulou D, Kedikoglou K, Vafeiadi M, Roumeliotaki T, Margetaki K, Stephanou EG, Myridakis A, Leondiadis L. Systematic investigation of organochlorine pesticides and polychlorinated biphenyls blood levels in Greek children from the Rhea birth cohort suggests historical exposure to DDT and through diet to DDE. Environ Int 2024; 187:108686. [PMID: 38669722 DOI: 10.1016/j.envint.2024.108686] [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] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 04/08/2024] [Accepted: 04/21/2024] [Indexed: 04/28/2024]
Abstract
The blood levels of organochlorine pesticides (OCPs) and polychlorinated biphenyls (PCBs) have been thoroughly investigated in Greek children from the Rhea birth cohort study. This investigation aimed to assess exposure levels, explore their possible relationship with children's age and sex, and indicate potential sources of exposure. Exposure patterns and common sources of PCBs and OCPs were analyzed using bivariate and multivariate statistics. A total of 947 blood samples from study participants were analyzed for OCP and PCB exposure, with 375 samples collected at 4 years old, 239 at 6.5 years old, and 333 at 11 years old. Elevated levels of DDE were observed in 6.5-year-old children compared to corresponding levels in other European countries. Higher levels of DDE were found in 4-year-old children, with the lowest concentrations in the 11-year-old group. The DDT/DDE ratio was consistently less than 1 among all the examined subjects. These results indicate exposure to DDT and DDE both in utero and through breastfeeding and dietary intake. For the entire cohort population, the highest concentration was determined for PCB 28, followed by PCBs 138, 153, and 180. The sum of the six indicator PCBs implied low exposure levels for the majority of the cohort population. Spearman correlations revealed strong associations between PCBs and OCPs, while principal component analysis identified two different groupings of exposure. DDE exhibited a correlation with a series of PCBs (153, 156, 163, 180), indicating a combined OCP-PCB source, and an anticorrelation with others (52, 28, 101), implying a separate and competing source.
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Affiliation(s)
- Danae Costopoulou
- Mass Spectrometry and Dioxin Analysis Laboratory, INRASTES, NCSR "Demokritos", Neapoleos 27, 15310 Athens, Greece.
| | - Kleopatra Kedikoglou
- Mass Spectrometry and Dioxin Analysis Laboratory, INRASTES, NCSR "Demokritos", Neapoleos 27, 15310 Athens, Greece
| | - Marina Vafeiadi
- Department of Social Medicine, Faculty of Medicine, University of Crete, Voutes University Campus, 70013 Heraklion, Greece
| | - Theano Roumeliotaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Voutes University Campus, 70013 Heraklion, Greece
| | - Katerina Margetaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Voutes University Campus, 70013 Heraklion, Greece
| | - Euripides G Stephanou
- Department of Chemistry, University of Crete, Voutes University Campus, 70013 Heraklion, Greece.
| | - Antonis Myridakis
- Centre for Pollution Research & Policy, Environmental Sciences, Brunel University London, UB8 3PH, United Kingdom
| | - Leondios Leondiadis
- Mass Spectrometry and Dioxin Analysis Laboratory, INRASTES, NCSR "Demokritos", Neapoleos 27, 15310 Athens, Greece
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Margetaki K, Bempi V, Michalaki E, Roumeliotaki T, Iakovides M, Stephanou E, Kogevinas M, Chatzi L, Vafeiadi M. Prenatal air pollution exposure and childhood obesity: Effect modification by maternal fruits and vegetables intake. Int J Hyg Environ Health 2024; 256:114314. [PMID: 38183793 DOI: 10.1016/j.ijheh.2023.114314] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 12/14/2023] [Accepted: 12/20/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND & AIMS Prenatal exposure to air pollution is robustly associated with fetal growth restriction but the extent to which it is associated with postnatal growth and the risk of childhood obesity remains unknown. We examined the association of prenatal exposure to air pollution with offspring obesity related measures and evaluated the possible protective effect of maternal fruits and vegetables intake (FV). METHODS We included 633 mother-child pairs from the Rhea pregnancy cohort in Crete, Greece. Fine particles (PM2.5 and PM10) exposure levels during pregnancy were estimated using land-use regression models. We measured weight, height and waist circumference at 4 and 6 years of age, and body composition analysis was performed at 6 years using bioimpedance. Maternal diet was evaluated by means of a semi-quantitative food frequency questionnaire in mid-pregnancy. Adjusted associations were obtained via multivariable regression analyses and multiplicative interaction was used to evaluate the potential modifying role of FV intake. RESULTS Exposure to PMs in utero was not associated with measures of adiposity at 4 or 6 years of age. Associations at 4 years did not differ according to maternal consumption of FV. However, at 6 years, among children whose mothers reported consuming less than 5 servings of FV per day, one SD increase in PM10 during pregnancy was associated with increased BMI (beta 0.41 kg/m2, 95% CI: -0.06, 0.88, p-interaction = 0.037) and increased waist circumference (beta 0.83 cm, 95% CI: -0.38, 2.05, p-interaction = 0.043) and one SD increase in PM2.5 was associated with increased fat mass (beta 0.5 kg, 95% CI: 0.0, 0.99, p-interaction = 0.039) and increased percentage of body fat (beta 1.06%, 95% CI: -0.06, 2.17, p-interaction = 0.035). Similarly, higher prenatal PM2.5 and PM10 exposure was associated with increased risk for obesity and abdominal obesity at 6 years only in the low FV group. CONCLUSIONS Exposure to fine particulate matter during pregnancy was not associated with obesity-related measures at 4 and 6 years. However, only among offspring of mothers who consumed inadequate FV, we observed higher obesity-related measures at 6 years. Our results indicate that mothers' diet during pregnancy may play a role in the relationship between air-pollution and childhood obesity.
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Affiliation(s)
- Katerina Margetaki
- Clinic of Preventive Medicine and Nutrition, Faculty of Medicine, University of Crete, Greece.
| | - Vicky Bempi
- Clinic of Preventive Medicine and Nutrition, Faculty of Medicine, University of Crete, Greece
| | - Eirini Michalaki
- Clinic of Preventive Medicine and Nutrition, Faculty of Medicine, University of Crete, Greece
| | - Theano Roumeliotaki
- Clinic of Preventive Medicine and Nutrition, Faculty of Medicine, University of Crete, Greece
| | - Minas Iakovides
- Environmental Chemical Processes Laboratory (ECPL), Department of Chemistry, University of Crete, Greece
| | - Euripides Stephanou
- Environmental Chemical Processes Laboratory (ECPL), Department of Chemistry, University of Crete, Greece
| | - Manolis Kogevinas
- Barcelona Institute for Global Health (ISGlobal), Non-Communicable Diseases Programme, Barcelona, Spain; Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain; Hospital del Mar Research Institute (IMIM), Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain
| | - Lida Chatzi
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, USA
| | - Marina Vafeiadi
- Clinic of Preventive Medicine and Nutrition, Faculty of Medicine, University of Crete, Greece
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Bouloukaki I, Christodoulakis A, Margetaki K, Aravantinou Karlatou A, Tsiligianni I. Exploring the Link between Social Support and Patient-Reported Outcomes in Chronic Obstructive Pulmonary Disease Patients: A Cross-Sectional Study in Primary Care. Healthcare (Basel) 2024; 12:544. [PMID: 38470655 PMCID: PMC10930953 DOI: 10.3390/healthcare12050544] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 02/20/2024] [Accepted: 02/23/2024] [Indexed: 03/14/2024] Open
Abstract
We aimed to explore the link between social support and various patient-reported outcome measures (PROMs) in primary care patients with COPD. This was a cross-sectional study with 168 patients with COPD from six primary care centers in Crete, Greece. We collected data on sociodemographic characteristics, medical history, disease-specific quality of life, the COPD Assessment Test (CAT), fatigue, the Fatigue Severity Scale (FSS), phycological parameters, Patient Health Questionnaire-9, General Anxiety Disorder-7, sleep complaints, the Pittsburg Sleep Quality Index, the Athens Insomnia scale (AIS), and the Epworth Sleepiness Scale. Social support was measured using the Multidimensional Scale of Perceived Social Support (MSPSS). Out of 168 patients with COPD, 114 (68.9%) exhibited low levels of social support. Low social support (MSPSS total ≤ 5) was positively associated with COPD symptoms (CAT score ≥ 10) (OR = 3.97, 95%CI:1.86-8.44; p < 0.01), fatigue (FSS ≥ 36) (OR = 2.74, 95%CI:1.31-5.74; p = 0.01), and insomnia symptoms (AIS ≥ 6) (OR = 5.17 95%CI:2.23-12.01; p < 0.01), while the association with depressive symptoms (PHQ-9 ≥ 10) was marginally significant (OR = 3.1, 95%CI:0.93-10.36; p = 0.07). Our results suggest that lower levels of social support are positively associated with PROMs in patients with COPD. Therefore, our findings show an additional way to improve the overall health of patients with COPD in primary care by putting social support at the epicenter of actions.
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Affiliation(s)
- Izolde Bouloukaki
- Department of Social Medicine, School of Medicine, University of Crete, 71003 Heraklion, Greece; (A.C.); (K.M.); (A.A.K.); (I.T.)
| | - Antonios Christodoulakis
- Department of Social Medicine, School of Medicine, University of Crete, 71003 Heraklion, Greece; (A.C.); (K.M.); (A.A.K.); (I.T.)
- Department of Nursing, School of Health Sciences, Hellenic Mediterranean University, 71410 Heraklion, Greece
| | - Katerina Margetaki
- Department of Social Medicine, School of Medicine, University of Crete, 71003 Heraklion, Greece; (A.C.); (K.M.); (A.A.K.); (I.T.)
| | - Antonia Aravantinou Karlatou
- Department of Social Medicine, School of Medicine, University of Crete, 71003 Heraklion, Greece; (A.C.); (K.M.); (A.A.K.); (I.T.)
| | - Ioanna Tsiligianni
- Department of Social Medicine, School of Medicine, University of Crete, 71003 Heraklion, Greece; (A.C.); (K.M.); (A.A.K.); (I.T.)
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Christodoulakis A, Bouloukaki I, Aravantinou-Karlatou A, Margetaki K, Zografakis-Sfakianakis M, Tsiligianni I. The Effectiveness of Teaching the Teacher Interventions in Improving the Physical Activity among Adolescents in Schools: A Scoping Review. Healthcare (Basel) 2024; 12:151. [PMID: 38255040 PMCID: PMC10815162 DOI: 10.3390/healthcare12020151] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 12/28/2023] [Accepted: 01/06/2024] [Indexed: 01/24/2024] Open
Abstract
Physical inactivity is a leading risk factor for global mortality as it increases the risk of non-communicable diseases and decreases overall health. Therefore, increasing physical activity (PA) is strongly recommended, particularly in adolescents. The Teaching the Teachers (TTT) approach is a prominent example of an intervention that could enhance PA levels in adolescents. However, available evidence on the efficacy of TTT interventions in promoting PA among adolescents is either limited or inconclusive. Therefore, a scoping review was conducted to provide an overview of the current state of knowledge regarding the effectiveness of TTT interventions in improving the PA of adolescent students. The PRISMA-Scoping methodology was employed, and articles in the Medline database were searched. We screened 2357 articles for inclusion, and finally included 16 articles. Most articles were conducted in European countries. The TTT interventions appeared to positively affect various aspects of PA. These aspects include support for personal autonomy, intent to engage in PA, improvements in body composition and fitness level, social support, enjoyment of Physical Education (PE), and positive attitudes towards PE. Consequently, policymakers could utilize TTT interventions to improve the physical activity of adolescents, which may reduce the burden of non-communicable diseases and foster healthier societies.
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Affiliation(s)
- Antonios Christodoulakis
- Department of Social Medicine, School of Medicine, University of Crete, 71003 Heraklion, Greece; (I.B.); (A.A.-K.); (K.M.); (I.T.)
- Department of Nursing, School of Health Sciences, Hellenic Mediterranean University, 71410 Heraklion, Greece;
| | - Izolde Bouloukaki
- Department of Social Medicine, School of Medicine, University of Crete, 71003 Heraklion, Greece; (I.B.); (A.A.-K.); (K.M.); (I.T.)
| | - Antonia Aravantinou-Karlatou
- Department of Social Medicine, School of Medicine, University of Crete, 71003 Heraklion, Greece; (I.B.); (A.A.-K.); (K.M.); (I.T.)
| | - Katerina Margetaki
- Department of Social Medicine, School of Medicine, University of Crete, 71003 Heraklion, Greece; (I.B.); (A.A.-K.); (K.M.); (I.T.)
| | | | - Ioanna Tsiligianni
- Department of Social Medicine, School of Medicine, University of Crete, 71003 Heraklion, Greece; (I.B.); (A.A.-K.); (K.M.); (I.T.)
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Descarpentrie A, Calas L, Cornet M, Heude B, Charles MA, Avraam D, Brescianini S, Cadman T, Elhakeem A, Fernández-Barrés S, Harris JR, Inskip H, Julvez J, Llop S, Margetaki K, Maritano S, Nader JLT, Roumeliotaki T, Salika T, Subiza-Pérez M, Vafeiadi M, Vrijheid M, Wright J, Yang T, Dargent-Molina P, Lioret S. Lifestyle patterns in European preschoolers: Associations with socio-demographic factors and body mass index. Pediatr Obes 2023; 18:e13079. [PMID: 37795656 DOI: 10.1111/ijpo.13079] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/30/2023] [Accepted: 09/16/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Energy balance-related behaviours (EBRBs), that is, dietary intake, screen, outdoor play and sleep, tend to combine into 'lifestyle patterns', with potential synergistic influences on health. To date, studies addressing this theme mainly focused on school children and rarely accounted for sleep, with a cross-country perspective. OBJECTIVES We aimed at comparing lifestyle patterns among preschool-aged children across Europe, their associations with socio-demographic factors and their links with body mass index (BMI). METHODS Harmonized data on 2-5-year-olds participating in nine European birth cohorts from the EU Child Cohort Network were used (EBRBs, socio-demographics and anthropometrics). Principal component analysis and multivariable linear and logistic regressions were performed. RESULTS The most consistent pattern identified across cohorts was defined by at least three of the following EBRBs: discretionary consumption, high screen time, low outdoor play time and low sleep duration. Consistently, children from low-income households and born to mothers with low education level had higher scores on this pattern compared to their socioeconomically advantaged counterparts. Furthermore, it was associated with higher BMI z-scores in the Spanish and Italian cohorts (β = 0.06, 95% CI = [0.02; 0.10], both studies). CONCLUSION These findings may be valuable in informing early multi-behavioural interventions aimed at reducing social inequalities in health at a European scale.
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Affiliation(s)
- Alexandra Descarpentrie
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Paris, France
| | - Lucinda Calas
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Paris, France
| | - Maxime Cornet
- Télécom-Paris, Département SES, Institut Polytechnique de Paris, Palaiseau Cedex, France
| | - Barbara Heude
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Paris, France
| | - Marie-Aline Charles
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Paris, France
| | - Demetris Avraam
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Sonia Brescianini
- Centre of Behavioral Science and Mental Health, Istituto Superiore di Sanità, Rome, Italy
| | - Tim Cadman
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ahmed Elhakeem
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sílvia Fernández-Barrés
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - Jennifer R Harris
- Centre for Fertility and Health, The Norwegian Institute of Public Health, Oslo, Norway
| | - Hazel Inskip
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Jordi Julvez
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Clinical and Epidemiological Neuroscience Group (NeuroÈpia), Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain
| | - Sabrina Llop
- CIBER Epidemiologa y Salud Pública (CIBERESP), Madrid, Spain
- Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I-Universitat de Valencia, Valencia, Spain
| | - Katerina Margetaki
- Department of Social Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Silvia Maritano
- Cancer Epidemiology Unit-Department of Medical Sciences, University of Turin, Turin, Italy
- University School for Advanced Studies IUSS Pavia, Pavia PV, Italy
| | - Johanna Lucia Thorbjornsrud Nader
- Department of Genetics and Bioinformatics, Division of Health Data and Digitalization, Norwegian Institute of Public Health, Oslo, Norway
| | - Theano Roumeliotaki
- Department of Social Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Theodosia Salika
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Mikel Subiza-Pérez
- CIBER Epidemiologa y Salud Pública (CIBERESP), Madrid, Spain
- Department of Clinical and Health Psychology and Research Methods, University of the Basque Country UPV/EHU, Donostia-San Sebastián, Spain
- Group of Environmental Epidemiology and Child Development, Biodonostia Health Research Institute, Donostia-San Sebastián, Spain
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Marina Vafeiadi
- Department of Social Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Martine Vrijheid
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- CIBER Epidemiologa y Salud Pública (CIBERESP), Madrid, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - John Wright
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Tiffany Yang
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Patricia Dargent-Molina
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Paris, France
| | - Sandrine Lioret
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Paris, France
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Koutra K, Margetaki K, Kampouri M, Kyriklaki A, Roumeliotaki T, Vafeiadi M, Bitsios P, Kogevinas M, Chatzi L. Maternal sleep disturbances during late pregnancy and child neuropsychological and behavioral development in early childhood. Eur Child Adolesc Psychiatry 2023; 32:2139-2150. [PMID: 35927528 DOI: 10.1007/s00787-022-02053-z] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 07/16/2022] [Indexed: 11/25/2022]
Abstract
The present study aims to explore the association of maternal sleep disturbances during late pregnancy on child neuropsychological and behavioral development in preschool years. The study included 638 mother-child pairs from the prospective Rhea mother-child cohort in Crete, Greece. Information on antenatal sleep disturbances was collected through a computer-assisted interview. Children's neuropsychological and behavioral development was assessed using the McCarthy Scales of Children's Abilities (MSCA), the Attention-Deficit Hyperactivity Disorder Test (ADHDT), and the Strengths and Difficulties Questionnaire (SDQ). Multivariate analysis showed that maternal sleep duration less than 8 h was associated with reduced scores in the general cognitive scale (β = -2.28, 95% CI -4.54, -0.02, R2 = 0.417) and memory span (β = -3.24, 95% CI -5.72, -0.77, R2 = 0.304), while mild-severe daytime sleepiness was associated with reduced scores in the memory scale (β = -5.42, 95% CI -10.47, -0.37, R2 = 0.304), memory span (β = -5.44, 95% CI -10.68, -0.21, R2 = 0.304), nd functions of posterior cortex (β = -5.55, 95% CI -10.40, -0.70, R2 = 0.393) of MSCA. Snoring in late pregnancy was related to higher child hyperactivity scores in SDQ (β = 1.05, 95% CI 0.16, 1.95, R2 = 0.160). An interaction between child sex and maternal sleep duration in response to ADHD symptoms was also found (p for interaction < 0.05). Stratified analysis revealed increased hyperactivity, inattention, and ADHD total scores for girls of mothers with sleep duration less than 8 h. Maternal sleep disturbances during pregnancy may be associated with impaired child neuropsychological and behavioral development during the preschool years. Early detection and intervention is necessary to reduce sleep disturbances habits in pregnancy and improve child neurodevelopment.
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Affiliation(s)
- Katerina Koutra
- Department of Psychology, School of Social Sciences, University of Crete, Gallos Campus Crete, 74100, Rethymno, Greece.
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.
| | - Katerina Margetaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
- Department of Preventive Medicine, Division of Environmental Health, University of Southern California, Los Angeles, CA, USA
| | - Mariza Kampouri
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Andriani Kyriklaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Theano Roumeliotaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Marina Vafeiadi
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Panos Bitsios
- Department of Psychiatry and Behavioral Sciences, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Manolis Kogevinas
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- ISGlobal, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Leda Chatzi
- Department of Preventive Medicine, Division of Environmental Health, University of Southern California, Los Angeles, CA, USA
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Karachaliou M, Damianaki I, Moudatsaki M, Margetaki K, Roumeliotaki T, Bempi V, Moudatsaki M, Chatzi LV, Vafeiadi M, Kogevinas M. Influenza Vaccination Coverage Rates and Determinants in Greek Children until the Age of Ten (2008-2019), the Rhea Mother-Child Cohort. Vaccines (Basel) 2023; 11:1241. [PMID: 37515056 PMCID: PMC10384674 DOI: 10.3390/vaccines11071241] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/04/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND In Greece, influenza vaccination is currently recommended for children with high-risk conditions. There are limited data on influenza vaccination uptake among Greek children with and without high-risk conditions. We aim to describe the annual influenza vaccination uptake until the age of ten in a population-based mother-child cohort and identify the factors influencing vaccination rates. METHODS Immunization data from the child's health cards at 4 and 10 years were available for 830 and 298 children participating in the Rhea cohort (2008-2019). We calculated vaccination coverage by age, winter season and among children with asthma and obesity for whom the vaccine is indicated. Univariable and multivariable stepwise logistic regression models were utilized to identify the association between several sociodemographic, lifestyle and health-related variables and vaccine uptake by age four. RESULTS By the ages of four and ten, 37% and 40% of the children, respectively, had received at least one influenza vaccination. Only 2% of the children were vaccinated for all winter seasons during their first four years of life. The vaccination rate was highest at the age of two and during the 2009-2010 season. Vaccination rates for children with asthma and obesity were 18.2% and 13.3% at age four and 8.3% and 2.9% at age ten. About 10% of all vaccines were administered after December and 24% of the children received only one dose upon initial vaccination. Children with younger siblings and those who had experienced more respiratory infections were more likely to be vaccinated by the age of four, while children exposed to smoking were less likely to be vaccinated. CONCLUSIONS Children in our study were more likely to be vaccinated against influenza at an early age with the peak occurring at the age of two. Nonetheless, annual vaccination uptake was uncommon. Vaccination rates of children with asthma and obesity were well below the national target of 75% for individuals with chronic conditions. Certain groups may merit increased attention in future vaccination campaigns such as children raised in families with unfavourable health behaviours.
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Affiliation(s)
| | | | - Maria Moudatsaki
- Department of Pediatrics, University Hospital of Heraklion, 71500 Heraklion, Greece
| | - Katerina Margetaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, 71500 Heraklion, Greece
| | - Theano Roumeliotaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, 71500 Heraklion, Greece
| | - Vicky Bempi
- Department of Social Medicine, Faculty of Medicine, University of Crete, 71500 Heraklion, Greece
| | - Marina Moudatsaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, 71500 Heraklion, Greece
| | - Lida Vaia Chatzi
- Department of Preventive Medicine, Division of Environmental Health, University of Southern California, Los Angeles, CA 90033, USA
| | - Marina Vafeiadi
- Department of Social Medicine, Faculty of Medicine, University of Crete, 71500 Heraklion, Greece
| | - Manolis Kogevinas
- Barcelona Institute for Global Health, 08036 Barcelona, Spain
- CIBER Epidemiologia y Salud Pública, 28029 Madrid, Spain
- Campus del Mar, Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain
- Hospital del Mar Medical Research Institute, 08003 Barcelona, Spain
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Stratakis N, Siskos AP, Papadopoulou E, Nguyen AN, Zhao Y, Margetaki K, Lau CHE, Coen M, Maitre L, Fernández-Barrés S, Agier L, Andrusaityte S, Basagaña X, Brantsaeter AL, Casas M, Fossati S, Grazuleviciene R, Heude B, McEachan RRC, Meltzer HM, Millett C, Rauber F, Robinson O, Roumeliotaki T, Borras E, Sabidó E, Urquiza J, Vafeiadi M, Vineis P, Voortman T, Wright J, Conti DV, Vrijheid M, Keun HC, Chatzi L. Urinary metabolic biomarkers of diet quality in European children are associated with metabolic health. eLife 2022; 11:e71332. [PMID: 35076016 PMCID: PMC8789316 DOI: 10.7554/elife.71332] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 01/02/2022] [Indexed: 11/13/2022] Open
Abstract
Urinary metabolic profiling is a promising powerful tool to reflect dietary intake and can help understand metabolic alterations in response to diet quality. Here, we used 1H NMR spectroscopy in a multicountry study in European children (1147 children from 6 different cohorts) and identified a common panel of 4 urinary metabolites (hippurate, N-methylnicotinic acid, urea, and sucrose) that was predictive of Mediterranean diet adherence (KIDMED) and ultra-processed food consumption and also had higher capacity in discriminating children's diet quality than that of established sociodemographic determinants. Further, we showed that the identified metabolite panel also reflected the associations of these diet quality indicators with C-peptide, a stable and accurate marker of insulin resistance and future risk of metabolic disease. This methodology enables objective assessment of dietary patterns in European child populations, complementary to traditional questionary methods, and can be used in future studies to evaluate diet quality. Moreover, this knowledge can provide mechanistic evidence of common biological pathways that characterize healthy and unhealthy dietary patterns, and diet-related molecular alterations that could associate to metabolic disease.
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Affiliation(s)
- Nikos Stratakis
- Department of Preventive Medicine, Keck School of Medicine, University of Southern CaliforniaLos AngelesUnited States
| | - Alexandros P Siskos
- Cancer Metabolism & Systems Toxicology Group, Division of Cancer, Department of Surgery & Cancer and Division of Systems Medicine, Department of Metabolism, Digestion & Reproduction, Imperial College London, Hammersmith Hospital CampusLondonUnited Kingdom
| | | | - Anh N Nguyen
- Department of Epidemiology, Erasmus University Medical CenterRotterdamNetherlands
| | - Yinqi Zhao
- Department of Preventive Medicine, Keck School of Medicine, University of Southern CaliforniaLos AngelesUnited States
| | - Katerina Margetaki
- Department of Preventive Medicine, Keck School of Medicine, University of Southern CaliforniaLos AngelesUnited States
| | - Chung-Ho E Lau
- Cancer Metabolism & Systems Toxicology Group, Division of Cancer, Department of Surgery & Cancer and Division of Systems Medicine, Department of Metabolism, Digestion & Reproduction, Imperial College London, Hammersmith Hospital CampusLondonUnited Kingdom
- MRC Centre for Environment and Health, School of Public Health, Imperial College LondonLondonUnited Kingdom
| | - Muireann Coen
- Cancer Metabolism & Systems Toxicology Group, Division of Cancer, Department of Surgery & Cancer and Division of Systems Medicine, Department of Metabolism, Digestion & Reproduction, Imperial College London, Hammersmith Hospital CampusLondonUnited Kingdom
- Oncology Safety, Clinical Pharmacology and Safety Sciences, R&D, AstraZenecaCambridgeUnited Kingdom
| | - Lea Maitre
- ISGlobalBarcelonaSpain
- Universitat Pompeu FabraBarcelonaSpain
- CIBER Epidemiologia y Salud PúblicaMadridSpain
| | - Silvia Fernández-Barrés
- ISGlobalBarcelonaSpain
- Universitat Pompeu FabraBarcelonaSpain
- CIBER Epidemiologia y Salud PúblicaMadridSpain
| | - Lydiane Agier
- Inserm, CNRS, University Grenoble Alpes, Team of environmental epidemiology applied to reproduction and respiratory health, IABGrenobleFrance
| | - Sandra Andrusaityte
- Department of Environmental Sciences, Vytautas Magnus UniversityKaunasLithuania
| | - Xavier Basagaña
- ISGlobalBarcelonaSpain
- Universitat Pompeu FabraBarcelonaSpain
- CIBER Epidemiologia y Salud PúblicaMadridSpain
| | | | - Maribel Casas
- ISGlobalBarcelonaSpain
- Universitat Pompeu FabraBarcelonaSpain
- CIBER Epidemiologia y Salud PúblicaMadridSpain
| | - Serena Fossati
- ISGlobalBarcelonaSpain
- Universitat Pompeu FabraBarcelonaSpain
- CIBER Epidemiologia y Salud PúblicaMadridSpain
| | | | - Barbara Heude
- Centre for Research in Epidemiology and Statistics, Université de Paris, Inserm, InraParisFrance
| | - Rosemary RC McEachan
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation TrustBradfordUnited Kingdom
| | | | - Christopher Millett
- Public Health Policy Evaluation Unit, School of Public Health, Imperial CollegeLondonUnited Kingdom
- Department of Preventive Medicine, School of Medicine, University of São PauloSão PauloBrazil
| | - Fernanda Rauber
- Public Health Policy Evaluation Unit, School of Public Health, Imperial CollegeLondonUnited Kingdom
- Department of Preventive Medicine, School of Medicine, University of São PauloSão PauloBrazil
- Center for Epidemiological Research in Nutrition and Health, University of São PauloSão PauloBrazil
| | - Oliver Robinson
- MRC Centre for Environment and Health, School of Public Health, Imperial College LondonLondonUnited Kingdom
| | - Theano Roumeliotaki
- Department of Social Medicine, Faculty of Medicine, University of CreteHeraklionGreece
| | - Eva Borras
- ISGlobalBarcelonaSpain
- Centre for Genomic Regulation, The Barcelona Institute of Science and TechnologyBarcelonaSpain
| | - Eduard Sabidó
- ISGlobalBarcelonaSpain
- Centre for Genomic Regulation, The Barcelona Institute of Science and TechnologyBarcelonaSpain
| | - Jose Urquiza
- ISGlobalBarcelonaSpain
- Universitat Pompeu FabraBarcelonaSpain
- CIBER Epidemiologia y Salud PúblicaMadridSpain
| | - Marina Vafeiadi
- Department of Social Medicine, Faculty of Medicine, University of CreteHeraklionGreece
| | - Paolo Vineis
- MRC Centre for Environment and Health, School of Public Health, Imperial College LondonLondonUnited Kingdom
| | - Trudy Voortman
- Department of Epidemiology, Erasmus University Medical CenterRotterdamNetherlands
| | - John Wright
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation TrustBradfordUnited Kingdom
| | - David V Conti
- Department of Preventive Medicine, Keck School of Medicine, University of Southern CaliforniaLos AngelesUnited States
| | - Martine Vrijheid
- ISGlobalBarcelonaSpain
- Universitat Pompeu FabraBarcelonaSpain
- CIBER Epidemiologia y Salud PúblicaMadridSpain
| | - Hector C Keun
- Cancer Metabolism & Systems Toxicology Group, Division of Cancer, Department of Surgery & Cancer and Division of Systems Medicine, Department of Metabolism, Digestion & Reproduction, Imperial College London, Hammersmith Hospital CampusLondonUnited Kingdom
| | - Leda Chatzi
- Department of Preventive Medicine, Keck School of Medicine, University of Southern CaliforniaLos AngelesUnited States
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9
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Margetaki K, Stratakis N, Roumeliotaki T, Karachaliou M, Alexaki M, Kogevinas M, Chatzi L, Vafeiadi M. Prenatal and infant antibiotic exposure and childhood growth, obesity and cardiovascular risk factors: The Rhea mother-child cohort study, Crete, Greece. Pediatr Obes 2022; 17:e12843. [PMID: 34369080 DOI: 10.1111/ijpo.12843] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 07/22/2021] [Accepted: 07/22/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Early-life antibiotic use has been hypothesized to promote weight gain and increase the risk of childhood obesity. OBJECTIVES To examine the associations of prenatal and infant antibiotics with childhood growth, adiposity and cardiometabolic traits in the Greek Rhea cohort. METHODS We used data from 747 mother-child pairs with anthropometric measurements drawn from medical records or measured at 4 and 6 years of age. Antibiotic exposure was assessed by maternal report during pregnancy and at the first year of life. Children were classified as exposed to antibiotics prenatally if the mother received at least one course of oral antibiotics during pregnancy and postnatally if the mother reported that the child received at least one oral antibiotic treatment during the first year of life. Outcomes included repeated weight, body mass index (BMI), waist circumference, body fat (%), total cholesterol and blood pressure. We applied mixed effects, linear and log-binomial regression models after adjusting for important covariates. RESULTS Around 14.6% of the participating children were prenatally exposed to antibiotics and 32.4% received antibiotics during the first year of life. Prenatal exposure to antibiotics was associated with a twofold increase in the risk for obesity (risk ratio [RR]; 95% confidence interval [CI]: 2.09 [1.58, 2.76]) and abdominal obesity (RR [95% CI]: 2.56 [1.89, 3.47]) at 6 years. Postnatal exposure to antibiotics was associated with increased weight (beta [95% CI]: 00.25 [0.06, 0.44]) and BMI (beta [95% CI]: 0.23 [0.003, 0.45]) SD scores from 2 to 7 years of life. CONCLUSION Early-life antibiotic use was associated with accelerated childhood growth and higher adiposity.
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Affiliation(s)
- Katerina Margetaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.,Department of Preventive Medicine, Division of Environmental Health, University of Southern California, Los Angeles, California, USA
| | - Nikos Stratakis
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.,Department of Preventive Medicine, Division of Environmental Health, University of Southern California, Los Angeles, California, USA
| | - Theano Roumeliotaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Marianna Karachaliou
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Maria Alexaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Manolis Kogevinas
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain.,Centro de Investigación Biomédicaen Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Leda Chatzi
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.,Department of Preventive Medicine, Division of Environmental Health, University of Southern California, Los Angeles, California, USA
| | - Marina Vafeiadi
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
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10
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Margetaki K, Vafeiadi M, Kampouri M, Roumeliotaki T, Karakosta P, Daraki V, Kogevinas M, Hu H, Kippler M, Chatzi L. Associations of exposure to cadmium, antimony, lead and their mixture with gestational thyroid homeostasis. Environ Pollut 2021; 289:117905. [PMID: 34371266 DOI: 10.1016/j.envpol.2021.117905] [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] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/29/2021] [Accepted: 08/02/2021] [Indexed: 06/13/2023]
Abstract
Maintaining thyroid homeostasis during pregnancy is vital for fetal development. The few studies that have investigated associations between metal exposure and gestational thyroid function have yielded mixed findings. To evaluate the association of exposure to a mixture of toxic metals with thyroid parameters in 824 pregnant women from the Rhea birth cohort in Crete, Greece. Concentrations of three toxic metals [cadmium (Cd), antimony (Sb), lead (Pb)] and iodine were measured in urine using inductively coupled plasma mass spectrometry and thyroid hormones [Thyroid Stimulating Hormone (TSH), free thyroxine (fT4), and free triiodothyronine (fT3)] were measured in serum in early pregnancy. Associations of individual metals with thyroid parameters were assessed using adjusted regression models, while associations of the metal mixture with thyroid parameters were assessed using Bayesian Kernel Machine Regression (BKMR).Women with high (3rd tertile) concentrations of urinary Cd, Sb and Pb, respectively, had 13.3 % (95%CI: 2.0 %, 23.2 %), 12.5 % (95%CI: 1.8 %, 22.0 %) and 16.0 % (95%CI: 5.7 %, 25.2 %) lower TSH compared to women with low concentrations (2nd and 1st tertile). In addition, women with high urinary Cd had 2.2 % (95%CI: 0.0 %, 4.4 %) higher fT4 and 4.0 % (95%CI: -0.1 %, 8.1 %) higher fT3 levels, and women with high urinary Pb had 4 % (95%CI: 0.2 %, 8.0 %) higher fT3 levels compared to women with low exposure. The negative association of Cd with TSH persisted only when iodine sufficiency was unfavorable. BKMR attested that simultaneous exposure to toxic metals was associated with decreased TSH and increased fT3 and revealed a potential synergistic interaction of Cd and Pb in association with TSH. The present results suggest that exposure to toxic metals even at low levels can alter gestational thyroid homeostasis.
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Affiliation(s)
- Katerina Margetaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Marina Vafeiadi
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.
| | - Mariza Kampouri
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Theano Roumeliotaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Polyxeni Karakosta
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Vasiliki Daraki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Manolis Kogevinas
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Howard Hu
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Maria Kippler
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Leda Chatzi
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, USA
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11
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Alemany S, Avella-García C, Liew Z, García-Esteban R, Inoue K, Cadman T, López-Vicente M, González L, Riaño Galán I, Andiarena A, Casas M, Margetaki K, Strandberg-Larsen K, Lawlor DA, El Marroun H, Tiemeier H, Iñiguez C, Tardón A, Santa-Marina L, Júlvez J, Porta D, Chatzi L, Sunyer J. Prenatal and postnatal exposure to acetaminophen in relation to autism spectrum and attention-deficit and hyperactivity symptoms in childhood: Meta-analysis in six European population-based cohorts. Eur J Epidemiol 2021; 36:993-1004. [PMID: 34046850 PMCID: PMC8542535 DOI: 10.1007/s10654-021-00754-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 04/20/2021] [Indexed: 12/05/2022]
Abstract
The potential etiological role of early acetaminophen exposure on Autism Spectrum Conditions (ASC) and Attention-Deficit/Hyperactivity Disorder (ADHD) is inconclusive. We aimed to study this association in a collaborative study of six European population-based birth/child cohorts. A total of 73,881 mother-child pairs were included in the study. Prenatal and postnatal (up to 18 months) acetaminophen exposure was assessed through maternal questionnaires or interviews. ASC and ADHD symptoms were assessed at 4-12 years of age using validated instruments. Children were classified as having borderline/clinical symptoms using recommended cutoffs for each instrument. Hospital diagnoses were also available in one cohort. Analyses were adjusted for child and maternal characteristics along with indications for acetaminophen use. Adjusted cohort-specific effect estimates were combined using random-effects meta-analysis. The proportion of children having borderline/clinical symptoms ranged between 0.9 and 12.9% for ASC and between 1.2 and 12.2% for ADHD. Results indicated that children prenatally exposed to acetaminophen were 19% and 21% more likely to subsequently have borderline or clinical ASC (OR = 1.19, 95% CI 1.07-1.33) and ADHD symptoms (OR = 1.21, 95% CI 1.07-1.36) compared to non-exposed children. Boys and girls showed higher odds for ASC and ADHD symptoms after prenatal exposure, though these associations were slightly stronger among boys. Postnatal exposure to acetaminophen was not associated with ASC or ADHD symptoms. These results replicate previous work and support providing clear information to pregnant women and their partners about potential long-term risks of acetaminophen use.
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Affiliation(s)
- Silvia Alemany
- ISGlobal, Barcelona Institute for Global Health, C. Doctor Aiguader 88, 08003, Barcelona, Spain.
- Universitat Pompeu Fabra (UPF), Barcelona, Spain.
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain.
| | - Claudia Avella-García
- ISGlobal, Barcelona Institute for Global Health, C. Doctor Aiguader 88, 08003, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Hospital Sagrat Cor, Martorell, Spain
| | - Zeyan Liew
- Departmen of Environmental Health Sciences, Yale School of Public Health, New Haven, USA
- Yale Center for Perinatal, Pediatric, and Environmental Epidemiology, Yale School of Public Health, New Haven, USA
| | - Raquel García-Esteban
- ISGlobal, Barcelona Institute for Global Health, C. Doctor Aiguader 88, 08003, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Kosuke Inoue
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, USA
| | - Tim Cadman
- MRC Integrative Epidemiology Unit (IEU) and School of Social and Community Medicine, University of Bristol, Bristol, UK
- Bristol Medical School, Population Health Science, Bristol, UK
| | - Mònica López-Vicente
- Department of Child and Adolescent Psychiatry, Erasmus MC-Sophia, Rotterdam, The Netherlands
| | - Llúcia González
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I-Universitat de València, Valencia, Spain
| | - Isolina Riaño Galán
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Paediatrics, Hospital Universitario Central de Asturias, University of Oviedo and ISPA, Oviedo, Spain
| | - Ainara Andiarena
- Faculty of Psychology, University of the Basque Country, Gipuzkoa, Spain
- Health Research Institute, Biodonostia, San Sebastian, Spain
| | - Maribel Casas
- ISGlobal, Barcelona Institute for Global Health, C. Doctor Aiguader 88, 08003, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | | | - Katrine Strandberg-Larsen
- Section for Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Deborah A Lawlor
- MRC Integrative Epidemiology Unit (IEU) and School of Social and Community Medicine, University of Bristol, Bristol, UK
- Bristol Medical School, Population Health Science, Bristol, UK
- Bristol NIHR Biomedical Research Centre, Bristol, UK
| | - Hanan El Marroun
- Department of Child and Adolescent Psychiatry, Erasmus MC-Sophia, Rotterdam, The Netherlands
- Department of Pediatrics, University Medical Center Rotterdam, Erasmus MC, Rotterdam, The Netherlands
- Department of Psychology, Education and Child Studies, Erasmus School of Social and Behavioral Sciences, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry, Erasmus MC-Sophia, Rotterdam, The Netherlands
- Department of Social and Behavioral Science, Harvard TH Chan School of Public Health, Boston, USA
| | - Carmen Iñiguez
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I-Universitat de València, Valencia, Spain
- Department of Statistics and Computational Research, Universitat de València, València, Spain
| | - Adonina Tardón
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Health Research Institute of the Principality of Asturias (ISPA), IUOPA, University of Oviedo, Oviedo, Spain
| | - Loreto Santa-Marina
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Health Research Institute, Biodonostia, San Sebastian, Spain
- Public Health Division of Gipuzkoa, Basque Government, Gipuzkoa, Spain
| | - Jordi Júlvez
- ISGlobal, Barcelona Institute for Global Health, C. Doctor Aiguader 88, 08003, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Hospital Universitari Sant Joan de Reus, Reus, Catalonia, Spain
| | - Daniela Porta
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Leda Chatzi
- Department of Preventive Medicine, University of Southern California, University Park Campus, Los Angeles, USA
| | - Jordi Sunyer
- ISGlobal, Barcelona Institute for Global Health, C. Doctor Aiguader 88, 08003, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
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12
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Stratakis N, Golden-Mason L, Margetaki K, Zhao Y, Valvi D, Garcia E, Maitre L, Andrusaityte S, Basagana X, Borràs E, Bustamante M, Casas M, Fossati S, Grazuleviciene R, Haug LS, Heude B, McEachan RR, Meltzer HM, Papadopoulou E, Roumeliotaki T, Robinson O, Sabidó E, Urquiza J, Vafeiadi M, Varo N, Wright J, Vos MB, Hu H, Vrijheid M, Berhane KT, Conti DV, McConnell R, Rosen HR, Chatzi L. In Utero Exposure to Mercury Is Associated With Increased Susceptibility to Liver Injury and Inflammation in Childhood. Hepatology 2021; 74:1546-1559. [PMID: 33730435 PMCID: PMC8446089 DOI: 10.1002/hep.31809] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/21/2021] [Accepted: 02/23/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS Nonalcoholic fatty liver disease (NAFLD) is the most prevalent cause of liver disease in children. Mercury (Hg), a ubiquitous toxic metal, has been proposed as an environmental factor contributing to toxicant-associated fatty liver disease. APPROACH AND RESULTS We investigated the effect of prenatal exposure to Hg on childhood liver injury by combining epidemiological results from a multicenter mother-child cohort with complementary in vitro experiments on monocyte cells that are known to play a key role in liver immune homeostasis and NAFLD. We used data from 872 mothers and their children (median age, 8.1 years; interquartile range [IQR], 6.5-8.7) from the European Human Early-Life Exposome cohort. We measured Hg concentration in maternal blood during pregnancy (median, 2.0 μg/L; IQR, 1.1-3.6). We also assessed serum levels of alanine aminotransferase (ALT), a common screening tool for pediatric NAFLD, and plasma concentrations of inflammation-related cytokines in children. We found that prenatal Hg exposure was associated with a phenotype in children that was characterized by elevated ALT (≥22.1 U/L for females and ≥25.8 U/L for males) and increased concentrations of circulating IL-1β, IL-6, IL-8, and TNF-α. Consistently, inflammatory monocytes exposed in vitro to a physiologically relevant dose of Hg demonstrated significant up-regulation of genes encoding these four cytokines and increased concentrations of IL-8 and TNF-α in the supernatants. CONCLUSIONS These findings suggest that developmental exposure to Hg can contribute to inflammation and increased NAFLD risk in early life.
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Affiliation(s)
- Nikos Stratakis
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Lucy Golden-Mason
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Katerina Margetaki
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Yinqi Zhao
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Damaskini Valvi
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Erika Garcia
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Léa Maitre
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY,Universitat Pompeu Fabra, Barcelona, Spain,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Sandra Andrusaityte
- Department of Environmental Sciences, Vytautas Magnus University, Kaunas, Lithuania
| | - Xavier Basagana
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY,Universitat Pompeu Fabra, Barcelona, Spain,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Eva Borràs
- Universitat Pompeu Fabra, Barcelona, Spain,Proteomics Unit, Centre de Regulació Genòmica, Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Mariona Bustamante
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY,Universitat Pompeu Fabra, Barcelona, Spain,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Maribel Casas
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY,Universitat Pompeu Fabra, Barcelona, Spain,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Serena Fossati
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY,Universitat Pompeu Fabra, Barcelona, Spain,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | | | | | - Barbara Heude
- Université de Paris, Centre for Research in Epidemiology and Statistics (CRESS), INSERM, INRAE, Paris, France
| | - Rosemary R.C. McEachan
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | | | | | - Theano Roumeliotaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Oliver Robinson
- MRC Centre for Environment and Health, Imperial College London, London, UK
| | - Eduard Sabidó
- Universitat Pompeu Fabra, Barcelona, Spain,Proteomics Unit, Centre de Regulació Genòmica, Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Jose Urquiza
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY,Universitat Pompeu Fabra, Barcelona, Spain,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Marina Vafeiadi
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Nerea Varo
- Laboratorio de Bioquímica, Clínica Universidad de Navarra, Pamplona, Spain
| | - John Wright
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Miriam B. Vos
- Department of Pediatrics, School of Medicine and Nutrition Health Sciences, Emory University, Atlanta, GA,Children’s Healthcare of Atlanta, Atlanta, GA
| | - Howard Hu
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Martine Vrijheid
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY,Universitat Pompeu Fabra, Barcelona, Spain,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Kiros T. Berhane
- Mailman School of Public Health, Columbia University, New York, NY
| | - David V. Conti
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Rob McConnell
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Hugo R. Rosen
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Lida Chatzi
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
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13
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Goodrich JA, Alderete TL, Baumert BO, Berhane K, Chen Z, Gilliland FD, Goran MI, Hu X, Jones DP, Margetaki K, Rock S, Stratakis N, Valvi D, Walker DI, Conti DV, Chatzi L. Exposure to Perfluoroalkyl Substances and Glucose Homeostasis in Youth. Environ Health Perspect 2021; 129:97002. [PMID: 34468161 PMCID: PMC8409228 DOI: 10.1289/ehp9200] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND Exposure to per- and polyfluoroalkyl substances (PFAS), a prevalent class of persistent pollutants, may increase the risk of type 2 diabetes. OBJECTIVE We examined associations between PFAS exposure and glucose metabolism in youth. METHODS Overweight/obese adolescents from the Study of Latino Adolescents at Risk of Type 2 Diabetes (SOLAR; n=310) participated in annual visits for an average of 3.3±2.9y. Generalizability of findings were tested in young adults from the Southern California Children's Health Study (CHS; n=135) who participated in a clinical visit with a similar protocol. At each visit, oral glucose tolerance tests were performed to estimate glucose metabolism and β-cell function via the insulinogenic index. Four PFAS were measured at baseline using liquid chromatography-high-resolution mass spectrometry; high levels were defined as concentrations >66th percentile. RESULTS In females from the SOLAR, high perfluorohexane sulfonate (PFHxS) levels (≥2.0 ng/mL) were associated with the development of dysregulated glucose metabolism beginning in late puberty. The magnitude of these associations increased postpuberty and persisted through 18 years of age. For example, postpuberty, females with high PFHxS levels had 25-mg/dL higher 60-min glucose (95% CI: 12, 39mg/dL; p<0.0001), 15-mg/dL higher 2-h glucose (95% CI: 1, 28mg/dL; p=0.04), and 25% lower β-cell function (p=0.02) compared with females with low levels. Results were largely consistent in the CHS, where females with elevated PFHxS levels had 26-mg/dL higher 60-min glucose (95% CI: 6.0, 46mg/dL; p=0.01) and 19-mg/dL higher 2-h glucose, which did not meet statistical significance (95% CI: -1, 39mg/dL; p=0.08). In males, no consistent associations between PFHxS and glucose metabolism were observed. No consistent associations were observed for other PFAS and glucose metabolism. DISCUSSION Youth exposure to PFHxS was associated with dysregulated glucose metabolism in females, which may be due to changes in β-cell function. These associations appeared during puberty and were most pronounced postpuberty. https://doi.org/10.1289/EHP9200.
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Affiliation(s)
- Jesse A. Goodrich
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Tanya L. Alderete
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA
| | - Brittney O. Baumert
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Kiros Berhane
- Department of Biostatistics, Columbia University, New York, New York, USA
| | - Zhanghua Chen
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Frank D. Gilliland
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Michael I. Goran
- Department of Pediatrics, Keck School of Medicine, Los Angeles, California, USA
- Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, California, USA
| | - Xin Hu
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Dean P. Jones
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Katerina Margetaki
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Sarah Rock
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Nikos Stratakis
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Damaskini Valvi
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Douglas I. Walker
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - David V. Conti
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Leda Chatzi
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
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14
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Karachaliou M, de Sanjose S, Roumeliotaki T, Margetaki K, Vafeiadi M, Waterboer T, Chatzi L, Kogevinas M. Heterogeneous associations of polyomaviruses and herpesviruses with allergy-related phenotypes in childhood. Ann Allergy Asthma Immunol 2021; 127:191-199.e3. [PMID: 33895421 DOI: 10.1016/j.anai.2021.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/12/2021] [Accepted: 04/16/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Evidence suggests a complex interplay between infections and allergic diseases. OBJECTIVE To explore the association of 14 common viruses with eczema, asthma, and rhinoconjunctivitis in childhood. METHODS We used cross-sectional (n = 686) and prospective (n = 440) data from children participating in the Rhea birth cohort. Immunoglobulin G to polyomaviruses (BK polyomavirus, JC polyomavirus, KI polyomavirus [KIPyV], WU polyomavirus [WUPyV], human polyomavirus 6, human polyomavirus 7, Trichodysplasia spinulosa polyomavirus, Merkel cell polyomavirus, human polyomavirus 9, and human polyomavirus 10) and herpesviruses (Epstein-Barr virus, Cytomegalovirus, Herpes simplex virus-1, Herpes simplex virus-2) were measured at age 4 years by fluorescent bead-based multiplex serology. Definitions of eczema, asthma, and rhinoconjunctivitis at ages 4 and 6 years were based on questionnaires. Mediation of the associations by immune biomarkers was tested. RESULTS Less likely to have eczema at age 4 years were KIPyV-seropositive (odds ratio [OR], 0.47; 95% confidence interval [CI], 0.27-0.82) and human polyomavirus 6 (OR, 0.44; 95% CI, 0.26-0.73) compared with their seronegative counterparts. Seropositivity to Epstein-Barr virus was negatively associated with eczema at age 4 years (OR, 0.39; 95% CI, 0.22-0.67) and 6 years (OR, 0.50; 95% CI, 0.25-0.99). Children with a higher burden of herpesviruses or of skin polyomaviruses had the lowest odds of eczema at age 4 years. Higher odds for asthma at age 4 years were found for WUPyV-seropositive children (OR, 3.98; 95% CI, 1.38-11.51), and for children seropositive to both respiratory polyomaviruses (KIPyV and WUPyV) (OR, 7.35; 95% CI, 1.66-32.59) compared with children seronegative to both. No associations were observed for rhinoconjunctivitis. There was no evidence of mediation by immune biomarkers. CONCLUSION A heterogeneous pattern of infections and allergic diseases was observed with common infections associated with a decreased eczema risk and an increased asthma risk in children.
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Affiliation(s)
- Marianna Karachaliou
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.
| | | | - Theano Roumeliotaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Katerina Margetaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Marina Vafeiadi
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Tim Waterboer
- Infections and Cancer Division, Infection, Inflammation, and Cancer Research Program, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Leda Chatzi
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Manolis Kogevinas
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain
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15
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Harskamp-van Ginkel MW, Ierodiakonou D, Margetaki K, Vafeiadi M, Karachaliou M, Kogevinas M, Vrijkotte TGM, Chatzi L. Gestational sleep deprivation is associated with higher offspring body mass index and blood pressure. Sleep 2021; 43:5851407. [PMID: 32496519 PMCID: PMC7734474 DOI: 10.1093/sleep/zsaa110] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 12/16/2019] [Revised: 05/20/2020] [Indexed: 12/26/2022] Open
Abstract
Study Objectives The objective of this study was to evaluate the association between gestational sleep deprivation and childhood adiposity and cardiometabolic profile. Methods Data were used from two population-based birth cohorts (Rhea study and Amsterdam Born Children and their Development study). A total of 3,608 pregnant women and their children were followed up until the age of 11 years. Gestational sleep deprivation was defined as 6 or fewer hours of sleep per day, reported by questionnaire. The primary outcomes included repeated measures of body mass index (BMI), waist circumference, body fat, serum lipids, systolic and diastolic blood pressure (DBP) levels in childhood. We performed a pooled analysis with adjusted linear mixed effect and Cox proportional hazards models. We tested for mediation by birthweight, gestational age, and gestational diabetes. Results Gestational sleep deprivation was associated with higher BMI (beta; 95% CI: 0.7; 0.4, 1.0 kg/m2) and waist circumference (beta; 95% CI: 0.9; 0.1, 1.6 cm) in childhood, and increased risk for overweight or obesity (HR; 95% CI: 1.4; 1.1, 2.0). Gestational sleep deprivation was also associated with higher offspring DBP (beta; 95% CI: 1.6; 0.5, 2.7 mmHg). The observed associations were modified by sex (all p-values for interaction < 0.05); and were more pronounced in girls. Gestational diabetes and shorter gestational age partly mediated the seen associations. Conclusions This is the first study showing that gestational sleep deprivation may increase offspring’s adiposity and blood pressure, while exploring possible mechanisms. Attention to glucose metabolism and preterm birth might be extra warranted in mothers with gestational sleep deprivation.
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Affiliation(s)
- Margreet W Harskamp-van Ginkel
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Despo Ierodiakonou
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Katerina Margetaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece.,Department of Preventive Medicine, Division of Environmental Health, University of Southern California, Los Angeles, CA
| | - Marina Vafeiadi
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Marianna Karachaliou
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Manolis Kogevinas
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,ISGlobal, Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Tanja G M Vrijkotte
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Leda Chatzi
- Department of Preventive Medicine, Division of Environmental Health, University of Southern California, Los Angeles, CA
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16
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Howe CG, Margetaki K, Vafeiadi M, Roumeliotaki T, Karachaliou M, Kogevinas M, McConnell R, Eckel SP, Conti DV, Kippler M, Farzan SF, Chatzi L. Prenatal metal mixtures and child blood pressure in the Rhea mother-child cohort in Greece. Environ Health 2021; 20:1. [PMID: 33407552 PMCID: PMC7789252 DOI: 10.1186/s12940-020-00685-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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: 08/07/2020] [Accepted: 12/07/2020] [Indexed: 05/10/2023]
Abstract
BACKGROUND Child blood pressure (BP) is predictive of future cardiovascular risk. Prenatal exposure to metals has been associated with higher BP in childhood, but most studies have evaluated elements individually and measured BP at a single time point. We investigated impacts of prenatal metal mixture exposures on longitudinal changes in BP during childhood and elevated BP at 11 years of age. METHODS The current study included 176 mother-child pairs from the Rhea Study in Heraklion, Greece and focused on eight elements (antimony, arsenic, cadmium, cobalt, lead, magnesium, molybdenum, selenium) measured in maternal urine samples collected during pregnancy (median gestational age at collection: 12 weeks). BP was measured at approximately 4, 6, and 11 years of age. Covariate-adjusted Bayesian Varying Coefficient Kernel Machine Regression and Bayesian Kernel Machine Regression (BKMR) were used to evaluate metal mixture impacts on baseline and longitudinal changes in BP (from ages 4 to 11) and the development of elevated BP at age 11, respectively. BKMR results were compared using static versus percentile-based cutoffs to define elevated BP. RESULTS Molybdenum and lead were the mixture components most consistently associated with BP. J-shaped relationships were observed between molybdenum and both systolic and diastolic BP at age 4. Similar associations were identified for both molybdenum and lead in relation to elevated BP at age 11. For molybdenum concentrations above the inflection points (~ 40-80 μg/L), positive associations with BP at age 4 were stronger at high levels of lead. Lead was positively associated with BP measures at age 4, but only at high levels of molybdenum. Potential interactions between molybdenum and lead were also identified for BP at age 11, but were sensitive to the cutoffs used to define elevated BP. CONCLUSIONS Prenatal exposure to high levels of molybdenum and lead, particularly in combination, may contribute to higher BP at age 4. These early effects appear to persist throughout childhood, contributing to elevated BP in adolescence. Future studies are needed to identify the major sources of molybdenum and lead in this population.
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Affiliation(s)
- Caitlin G. Howe
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Dartmouth College, 1 Medical Center Dr, Lebanon, NH 03766 USA
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA USA
| | - Katerina Margetaki
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA USA
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Crete Greece
| | - Marina Vafeiadi
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Crete Greece
| | - Theano Roumeliotaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Crete Greece
| | - Marianna Karachaliou
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Crete Greece
| | - Manolis Kogevinas
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Rob McConnell
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA USA
| | - Sandrah P. Eckel
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA USA
| | - David V. Conti
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA USA
| | - Maria Kippler
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Shohreh F. Farzan
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA USA
| | - Leda Chatzi
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA USA
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17
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Stratakis N, Conti DV, Jin R, Margetaki K, Valvi D, Siskos AP, Maitre L, Garcia E, Varo N, Zhao Y, Roumeliotaki T, Vafeiadi M, Urquiza J, Fernández-Barrés S, Heude B, Basagana X, Casas M, Fossati S, Gražulevičienė R, Andrušaitytė S, Uppal K, McEachan RR, Papadopoulou E, Robinson O, Haug LS, Wright J, Vos MB, Keun HC, Vrijheid M, Berhane KT, McConnell R, Chatzi L. Prenatal Exposure to Perfluoroalkyl Substances Associated With Increased Susceptibility to Liver Injury in Children. Hepatology 2020; 72:1758-1770. [PMID: 32738061 PMCID: PMC7723317 DOI: 10.1002/hep.31483] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 05/26/2020] [Accepted: 07/01/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Per- and polyfluoroalkyl substances (PFAS) are widespread and persistent pollutants that have been shown to have hepatotoxic effects in animal models. However, human evidence is scarce. We evaluated how prenatal exposure to PFAS associates with established serum biomarkers of liver injury and alterations in serum metabolome in children. APPROACH AND RESULTS We used data from 1,105 mothers and their children (median age, 8.2 years; interquartile range, 6.6-9.1) from the European Human Early-Life Exposome cohort (consisting of six existing population-based birth cohorts in France, Greece, Lithuania, Norway, Spain, and the United Kingdom). We measured concentrations of perfluorooctane sulfonate, perfluorooctanoate, perfluorononanoate, perfluorohexane sulfonate, and perfluoroundecanoate in maternal blood. We assessed concentrations of alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyltransferase in child serum. Using Bayesian kernel machine regression, we found that higher exposure to PFAS during pregnancy was associated with higher liver enzyme levels in children. We also measured child serum metabolomics through a targeted assay and found significant perturbations in amino acid and glycerophospholipid metabolism associated with prenatal PFAS. A latent variable analysis identified a profile of children at high risk of liver injury (odds ratio, 1.56; 95% confidence interval, 1.21-1.92) that was characterized by high prenatal exposure to PFAS and increased serum levels of branched-chain amino acids (valine, leucine, and isoleucine), aromatic amino acids (tryptophan and phenylalanine), and glycerophospholipids (phosphatidylcholine [PC] aa C36:1 and Lyso-PC a C18:1). CONCLUSIONS Developmental exposure to PFAS can contribute to pediatric liver injury.
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Affiliation(s)
- Nikos Stratakis
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA,Department of Complex Genetics and Epidemiology, CAPHRI School for Public Health and Primary Care, University of Maastricht, Maastricht, the Netherlands
| | - David V. Conti
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Ran Jin
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Katerina Margetaki
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Damaskini Valvi
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alexandros P. Siskos
- Department of Surgery & Cancer and Department of Metabolism, Digestion & Reproduction, Imperial College London, London, United Kingdom
| | - Léa Maitre
- ISGlobal, Barcelona, Spain,Universitat Pompeu Fabra (UPF), Barcelona, Spain,Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
| | - Erika Garcia
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Nerea Varo
- Laboratory of Biochemistry, University Clinic of Navarra, Pamplona, Spain
| | - Yinqi Zhao
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Theano Roumeliotaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Marina Vafeiadi
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Jose Urquiza
- ISGlobal, Barcelona, Spain,Universitat Pompeu Fabra (UPF), Barcelona, Spain,Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
| | - Silvia Fernández-Barrés
- ISGlobal, Barcelona, Spain,Universitat Pompeu Fabra (UPF), Barcelona, Spain,Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
| | - Barbara Heude
- Center of Research in Epidemiology and Statistics, INSERM, INRAe, University of Paris, Paris, France
| | - Xavier Basagana
- ISGlobal, Barcelona, Spain,Universitat Pompeu Fabra (UPF), Barcelona, Spain,Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
| | - Maribel Casas
- ISGlobal, Barcelona, Spain,Universitat Pompeu Fabra (UPF), Barcelona, Spain,Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
| | - Serena Fossati
- ISGlobal, Barcelona, Spain,Universitat Pompeu Fabra (UPF), Barcelona, Spain,Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
| | - Regina Gražulevičienė
- Department of Environmental Sciences, Vytauto Didžiojo Universitetas, Kaunas, Lithuania
| | - Sandra Andrušaitytė
- Department of Environmental Sciences, Vytauto Didžiojo Universitetas, Kaunas, Lithuania
| | - Karan Uppal
- Clinical Biomarkers Laboratory, Division of Pulmonary, Allergy, and Critical Care Medicine, School of Medicine, Emory University, Atlanta, GA
| | - Rosemary R.C. McEachan
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | | | - Oliver Robinson
- MRC Centre for Environment and Health, Imperial College London, London, United Kingdom
| | | | - John Wright
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - Miriam B. Vos
- Department of Pediatrics, School of Medicine and Nutrition Health Sciences, Emory University, Atlanta, GA,Children’s Healthcare of Atlanta, Atlanta, GA
| | - Hector C. Keun
- Department of Surgery & Cancer and Department of Metabolism, Digestion & Reproduction, Imperial College London, London, United Kingdom
| | - Martine Vrijheid
- ISGlobal, Barcelona, Spain,Universitat Pompeu Fabra (UPF), Barcelona, Spain,Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
| | - Kiros T. Berhane
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Rob McConnell
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Lida Chatzi
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA,Department of Complex Genetics and Epidemiology, CAPHRI School for Public Health and Primary Care, University of Maastricht, Maastricht, the Netherlands
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18
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Kampouri M, Margetaki K, Koutra K, Kyriklaki A, Karakosta P, Anousaki D, Chalkiadaki G, Vafeiadi M, Kogevinas M, Chatzi L. Maternal mild thyroid dysfunction and offspring cognitive and motor development from infancy to childhood: the Rhea mother-child cohort study in Crete, Greece. J Epidemiol Community Health 2020; 75:29-35. [PMID: 32907915 DOI: 10.1136/jech-2019-213309] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 05/12/2020] [Accepted: 08/12/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Maternal thyroid hormones' supply is crucial for fetal neurodevelopment; however, the role of maternal mild thyroid dysfunction is not clear. We aimed to assess the association of maternal mild thyroid dysfunction with child neuropsychological development from infancy to early childhood. METHODS We included 757 mother-child pairs from the prospective 'Rhea' cohort on Crete, Greece. Maternal thyroid functioning was assessed by quantitative analysis of serum thyroid-stimulating hormone, free thyroxine, thyroid peroxidase antibodies and thyroglobulin antibodies at early gestation (mean=14 weeks). Neuropsychological assessment was based on Bayley Scales of Infant Development (18 months of age), McCarthy Scales of Children's Abilities (4 years of age), Raven's Coloured Progressive Matrices, Trail Making Test and Finger Tapping Test (6 years of age). RESULTS In multivariate adjusted linear regression analyses, maternal hypothyroxinemia was associated with decreased verbal scores at 4 years and reduced motor speed at 6 years of age. Maternal thyroid autoimmunity was associated with decreased child perceptual and motor ability at 4 years of age. Four trajectories of longitudinal non-verbal cognitive development were identified and children exposed to maternal thyroid autoimmunity had increased risk for belonging to an adverse trajectory ('low': adjusted relative risk ratio (RRR) = 2.7 95% CI: (1.4, 5.2), 'high-decreasing': adjusted RRR = 2.2 95% CI: (1.2, 4.0), 'low-increasing': adjusted RRR = 1.8 95% CI: (1.0, 3.2)). CONCLUSION Maternal hypothyroxinemia is associated with reduced offspring verbal and motor ability. Maternal thyroid autoimmunity is associated with decreased offspring perceptual performance and motor ability and increased risk for adverse non-verbal cognitive development from infancy to childhood.
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Affiliation(s)
- Mariza Kampouri
- Department of Social Medicine, University of Crete School of Medicine, Heraklion, Greece
| | - Katerina Margetaki
- Department of Social Medicine, University of Crete School of Medicine, Heraklion, Greece
| | - Katerina Koutra
- Department of Social Medicine, University of Crete School of Medicine, Heraklion, Greece.,Department of Psychology, University of Crete School of Social Sciences, Rethimno, Greece
| | - Andriani Kyriklaki
- Department of Social Medicine, University of Crete School of Medicine, Heraklion, Greece
| | - Polyxeni Karakosta
- Department of Social Medicine, University of Crete School of Medicine, Heraklion, Greece
| | - Despoina Anousaki
- Department of Social Medicine, University of Crete School of Medicine, Heraklion, Greece
| | - Georgia Chalkiadaki
- Department of Social Medicine, University of Crete School of Medicine, Heraklion, Greece
| | - Marina Vafeiadi
- Department of Social Medicine, University of Crete School of Medicine, Heraklion, Greece
| | - Manolis Kogevinas
- Instituto de Salud Global Barcelona, Barcelona, Spain.,Hospital del Mar Institute for Medical Research, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Leda Chatzi
- Department of Social Medicine, University of Crete School of Medicine, Heraklion, Greece.,Preventive Medicine, University of Southern California, Los Angeles, California, USA.,Department of Genetics and Cell Biology, Maastricht University Faculty of Health Medicine and Life Sciences, Maastricht, Netherlands
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19
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Kampouri M, Margetaki K, Koutra K, Kyriklaki A, Karakosta P, Sarri K, Anousaki D, Chalkiadaki G, Vafeiadi M, Kogevinas M, Chatzi L. Maternal mild thyroid dysfunction and child behavioral and emotional difficulties at 4 and 6 years of age: The Rhea mother-child cohort study, Crete, Greece. Horm Behav 2019; 116:104585. [PMID: 31476313 PMCID: PMC8801161 DOI: 10.1016/j.yhbeh.2019.104585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 08/11/2019] [Accepted: 08/20/2019] [Indexed: 12/21/2022]
Affiliation(s)
- Mariza Kampouri
- Department of Social Medicine, Faculty of Medicine, University of Crete, Greece.
| | - Katerina Margetaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Greece
| | - Katerina Koutra
- Department of Social Medicine, Faculty of Medicine, University of Crete, Greece
| | - Andriani Kyriklaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Greece
| | - Polyxeni Karakosta
- Department of Social Medicine, Faculty of Medicine, University of Crete, Greece
| | - Katerina Sarri
- Department of Social Medicine, Faculty of Medicine, University of Crete, Greece
| | - Despoina Anousaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Greece
| | - Georgia Chalkiadaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Greece
| | - Marina Vafeiadi
- Department of Social Medicine, Faculty of Medicine, University of Crete, Greece
| | - Manolis Kogevinas
- Instituto de Salud Global Barcelona, Spain; Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Leda Chatzi
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, USA; Department of Genetics & Cell Biology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
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20
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Karakosta P, Margetaki K, Fthenou E, Kampouri M, Kyriklaki A, Koutra K, Chalkiadaki G, Roumeliotaki T, Vafeiadi M, Kogevinas M, Mantzoros C, Chatzi L. Cord Leptin is Associated with Neuropsychomotor Development in Childhood. Obesity (Silver Spring) 2019; 27:1693-1702. [PMID: 31479200 PMCID: PMC6756960 DOI: 10.1002/oby.22571] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 06/06/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Leptin is critical for central nervous system development and maturation. This study aimed to evaluate the potential regulatory role of cord leptin in the neuropsychomotor development of children ages 18 months to 6 years. METHODS This study included 424 children from a prospective mother-child cohort (Rhea Study; Crete, Greece) with available cord leptin levels and data on neurodevelopmental outcomes at 18 months (Bayley Scales of Infant and Toddler Development, Third Edition), 4 years (McCarthy Scales of Children's Abilities), and 6 years (Raven's Coloured Progressive Matrices and Trail Making Test). Multivariable linear regression models were used to explore the associations. RESULTS Each 10-ng/mL increase in the cord leptin level was associated with increased scores on the gross motor scale at 18 months (β coefficient: 3.8; 95% CI: 0.0-7.5), with decreased scores in the general cognitive performance (β coefficient: -3.0; 95% CI: -5.5 to -0.4), perceptual performance (β coefficient: -3.4; 95% CI: -6.0 to -9.9), working memory (β coefficient: -3.1; 95% CI: -5.7 to -0.4), executive function (β coefficient -3.1; 95% CI: -5.7 to -0.5), and functions of the posterior cortex (β coefficient: -2.7; 95% CI: -5.2 to -0.1) scales at 4 years, and with a 3.7-unit decrease in the Raven's Coloured Progressive Matrices score at 6 years (β coefficient: -3.7; 95% CI: -6.9 to -0.5). CONCLUSIONS Increased cord leptin levels are associated with enhanced gross motor development at 18 months but decreased cognitive performance in early and middle childhood.
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Affiliation(s)
- Polyxeni Karakosta
- Department of Social Medicine, School of Medicine,
University of Crete, Heraklion, Greece
- Clinical Microbiology Laboratory, Attikon University
Hospital, National and Kapodistrian University of Athens, Greece
| | - Katerina Margetaki
- Department of Social Medicine, School of Medicine,
University of Crete, Heraklion, Greece
| | - Eleni Fthenou
- Qatar Biobank for Medical Research, Qatar Foundation for
Education, Science and Community, Doha, Doha, Qatar
| | - Mariza Kampouri
- Department of Social Medicine, School of Medicine,
University of Crete, Heraklion, Greece
| | - Andriani Kyriklaki
- Department of Social Medicine, School of Medicine,
University of Crete, Heraklion, Greece
| | - Katerina Koutra
- Department of Psychology, School of Social Sciences,
University of Crete, Rethymnon, Greece
| | - Georgia Chalkiadaki
- Department of Social Medicine, School of Medicine,
University of Crete, Heraklion, Greece
| | - Theano Roumeliotaki
- Department of Social Medicine, School of Medicine,
University of Crete, Heraklion, Greece
| | - Marina Vafeiadi
- Department of Social Medicine, School of Medicine,
University of Crete, Heraklion, Greece
| | - Manolis Kogevinas
- ISGlobal, Centre for Research in Environmental
Epidemiology (CREAL), Barcelona, Spain
| | - Christos Mantzoros
- Division of Endocrinology, Diabetes, and Metabolism,
Department of Medicine, Beth Israel, Deaconess Medical Center, Harvard Medical
School, Boston, Massachusetts, United States
| | - Lida Chatzi
- Department of Preventive Medicine, University of Southern
California, Los Angeles, CA, United States
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21
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Papadopoulou Z, Vlaikou AM, Theodoridou D, Komini C, Chalkiadaki G, Vafeiadi M, Margetaki K, Trangas T, Turck CW, Syrrou M, Chatzi L, Filiou MD. Unraveling the Serum Metabolomic Profile of Post-partum Depression. Front Neurosci 2019; 13:833. [PMID: 31507354 PMCID: PMC6716353 DOI: 10.3389/fnins.2019.00833] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 03/01/2019] [Accepted: 07/25/2019] [Indexed: 12/13/2022] Open
Abstract
Post-partum depression (PPD) is a severe psychiatric disorder affecting ∼15% of young mothers. Early life stressful conditions in periconceptual, fetal and early infant periods or exposure to maternal psychiatric disorders, have been linked to adverse childhood outcomes interfering with physiological, cognitive and emotional development. The molecular mechanisms of PPD are not yet fully understood. Unraveling the molecular underpinnings of PPD will allow timely detection and establishment of effective therapeutic approaches. To investigate the underlying molecular correlates of PPD in peripheral material, we compared the serum metabolomes of an in detail characterized group of mothers suffering from PPD and a control group of mothers, all from Heraklion, Crete in Greece. Serum samples were analyzed by a mass spectrometry platform for targeted metabolomics, based on selected reaction monitoring (SRM), which measures the levels of up to 300 metabolites. In the PPD group, we observed increased levels of glutathione-disulfide, adenylosuccinate, and ATP, which associate with oxidative stress, nucleotide biosynthesis and energy production pathways. We also followed up the metabolomic findings in a validation cohort of PPD mothers and controls. To the very best of our knowledge, this is the first metabolomic serum analysis in PPD. Our data show that molecular changes related to PPD are detectable in peripheral material, thus paving the way for additional studies in order to shed light on the molecular correlates of PPD.
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Affiliation(s)
- Zoe Papadopoulou
- Laboratory of Biology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Angeliki-Maria Vlaikou
- Laboratory of Biochemistry, Department of Biological Applications and Technology, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Daniela Theodoridou
- Laboratory of Biology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Chrysoula Komini
- Laboratory of Biochemistry, Department of Biological Applications and Technology, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Georgia Chalkiadaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Marina Vafeiadi
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Katerina Margetaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Theoni Trangas
- Laboratory of Biochemistry, Department of Biological Applications and Technology, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Chris W Turck
- Proteomics and Biomarkers, Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| | - Maria Syrrou
- Laboratory of Biology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Leda Chatzi
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, United States
| | - Michaela D Filiou
- Laboratory of Biochemistry, Department of Biological Applications and Technology, School of Health Sciences, University of Ioannina, Ioannina, Greece.,Department of Stress Neurobiology and Neurogenetics, Max Planck Institute of Psychiatry, Munich, Germany
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22
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Kyriklaki A, Margetaki K, Kampouri M, Koutra K, Bitsios P, Chalkiadaki G, Dermitzaki E, Venihaki M, Sarri K, Anousaki D, Kogevinas M, Chatzi L. Association between high levels of inflammatory markers and cognitive outcomes at 4 years of age: The Rhea mother-child cohort study, Crete, Greece. Cytokine 2019; 117:1-7. [PMID: 30772773 PMCID: PMC8801160 DOI: 10.1016/j.cyto.2019.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 08/12/2018] [Revised: 12/28/2018] [Accepted: 01/16/2019] [Indexed: 01/01/2023]
Abstract
There is growing evidence associating inflammatory markers in complex, higher order neurological functions, such as cognition and memory. We examined whether high levels of various inflammatory markers are associated with cognitive outcomes at 4 years of age in a mother-child cohort in Crete, Greece (Rhea study). We included 642 children in this cross-sectional study. Levels of several inflammatory markers (IFN-γ, IL-1β, IL-6, IL-8, IL-17α, IL-10, MIP-1α, TNF-α and the ratios of IL-6 to IL-10 and TNF-α to IL-10) were determined in child serum via immunoassay. Neurodevelopment at 4 years was assessed by means of the McCarthy Scales of Children's Abilities. Multivariate linear regression analyses were used to estimate the associations between the exposures and outcomes of interest after adjustment for various confounders. Our results indicate that children with high TNF-α concentrations (≥90th percentile) in serum demonstrated decreased scores in memory (adjusted β = -4.0; 95% CI: -7.7, -0.2), working memory (adjusted β = -4.0; 95% CI: -8.0, -0.1) as well as in memory span scale (adjusted β = -4.0; 95% CI: -7.9, -0.1). We also found that children with high IFN-γ serum levels showed lower scores in memory span scale (adjusted β = -3.4; 95% CI: -7.3, -0.4). Children with elevated TNF-α/IL-10 ratio demonstrated decreased quantitative (adjusted β = -4.3; 95% CI: -8.2, -0.4), motor (adjusted β = -3.5; 95% CI: -7.5, -0.5), executive function (adjusted β = -4.8; 95% CI: -8.5, -1.1), general cognitive (adjusted β = -3.6; 95% CI: -7.3, -0.1), memory (adjusted β = -3.8; 95% CI: -7.6, -0), working memory (adjusted β = -3.5; 95% CI: -7.5, -0.5) and memory span scores (adjusted β = -5.3; 95% CI: -9.1, -1.4) The findings suggest that high levels of TNF-α may contribute to reduced memory performance at preschool age.
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Affiliation(s)
- Andriani Kyriklaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece.
| | - Katerina Margetaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Mariza Kampouri
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Katerina Koutra
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Panos Bitsios
- Department of Psychiatry & Behavioral Sciences, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Georgia Chalkiadaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Eirini Dermitzaki
- Department of Clinical Chemistry, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Maria Venihaki
- Department of Clinical Chemistry, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Katerina Sarri
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Despoina Anousaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Manolis Kogevinas
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Leda Chatzi
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece; Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, USA
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23
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Chatzi L, Ierodiakonou D, Margetaki K, Vafeiadi M, Chalkiadaki G, Roumeliotaki T, Fthenou E, Pentheroudaki E, McConnell R, Kogevinas M, Kippler M. Associations of Prenatal Exposure to Cadmium With Child Growth, Obesity, and Cardiometabolic Traits. Am J Epidemiol 2019; 188:141-150. [PMID: 30252047 DOI: 10.1093/aje/kwy216] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 09/14/2018] [Indexed: 12/18/2022] Open
Abstract
Prenatal cadmium exposure has been associated with impaired fetal growth; much less is known about the impact during later childhood on growth and cardiometabolic traits. To elucidate the associations of prenatal cadmium exposure with child growth, adiposity, and cardiometabolic traits in 515 mother-child pairs in the Rhea Mother-Child Study cohort (Heraklion, Greece, 2007-2012), we measured urinary cadmium concentrations during early pregnancy and assessed their associations with repeated weight and height measurements (taken from birth through childhood), waist circumference, skinfold thickness, blood pressure, and serum lipid, leptin, and C-reactive protein levels at age 4 years. Adjusted linear, Poisson, and mixed-effects regression models were used, with interaction terms for child sex and maternal smoking added. Elevated prenatal cadmium levels (third tertile of urinary cadmium concentration (0.571-2.658 μg/L) vs. first (0.058-0.314 μg/L) and second (0.315-0.570 μg/L) tertiles combined) were significantly associated with a slower weight trajectory (per standard deviation score) in all children (β = -0.17, 95% confidence interval (CI): -0.32, -0.02) and a slower height trajectory in girls (β = -0.30, 95% CI: -0.52,-0.09; P for interaction = 0.025) and in children born to mothers who smoked during pregnancy (β = -0.48, 95% CI: -0.83, -1.13; P for interaction = 0.027). We concluded that prenatal cadmium exposure was associated with delayed growth in early childhood. Further research is needed to understand cadmium-related sex differences and the role of coexposure to maternal smoking during early pregnancy.
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Affiliation(s)
- Leda Chatzi
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
- Division of Environmental Health, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
- Department of Genetics and Cell Biology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Despo Ierodiakonou
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Katerina Margetaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Marina Vafeiadi
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Georgia Chalkiadaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Theano Roumeliotaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Eleni Fthenou
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Eirini Pentheroudaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Rob McConnell
- Division of Environmental Health, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Manolis Kogevinas
- ISGlobal, Centre for Research in Environmental Epidemiology
- Hospital del Mar Research Institute
- Consorcio Centro de Investigación Biomédica en Red Epidemiología y Salud Pública
| | - Maria Kippler
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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24
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Vafeiadi M, Myridakis A, Roumeliotaki T, Margetaki K, Chalkiadaki G, Dermitzaki E, Venihaki M, Sarri K, Vassilaki M, Leventakou V, Stephanou EG, Kogevinas M, Chatzi L. Association of Early Life Exposure to Phthalates With Obesity and Cardiometabolic Traits in Childhood: Sex Specific Associations. Front Public Health 2018; 6:327. [PMID: 30538977 PMCID: PMC6277685 DOI: 10.3389/fpubh.2018.00327] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [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: 02/05/2018] [Accepted: 10/25/2018] [Indexed: 01/21/2023] Open
Abstract
Few studies have investigated longitudinal associations between early life phthalate exposure and subsequent obesity and cardiovascular risks in children with inconsistent results. We aimed to evaluate the associations between phthalate exposure during gestation and childhood with offspring obesity and cardiometabolic risk factors in 500 mother-child pairs from the Rhea pregnancy cohort in Crete, Greece. Seven phthalate metabolites [monoethyl phthalate (MEP), mono-n-butyl phthalate (MnBP), mono-isobutyl phthalate (MiBP), monobenzyl phthalate (MBzP), mono(2-ethylhexyl) phthalate (MEHP), mono(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), and mono(2-ethyl-5-oxohexyl) phthalate (MEOHP)] were quantified in spot urine samples collected from mothers (1st trimester) and their children at 4 years of age. We calculated the molar sum of DEHP metabolites (MEHP, MEHHP, MEOHP). We measured child weight, height, waist circumference, skinfold thicknesses, blood pressure (BP), and lipids at 4 and 6 years and leptin, adiponectin, and C-reactive protein at 4 years. We used generalized estimating equations to examine associations at each age and tested for interaction by sex. Child exposure to phthalate metabolites was associated with lower BMI z-scores in boys and higher BMI z-scores in girls. Each 10-fold increase in ΣDEHP was associated with a change in waist circumference of −2.6 cm (95% CI: −4.72, −0.48) in boys vs. 2.14 cm (95% CI: −0.14, 4.43) in girls (p-sex interaction = 0.003) and a change in waist-to-height ratio of −0.01 (95% CI: −0.03, 0.01) in boys vs. 0.02 (95% CI: 0.01, 0.04) in girls (p-sex interaction = 0.006). Phthalate metabolite concentrations at age 4 were negatively associated with systolic and diastolic blood pressure. MEP was associated with lower systolic BP z-scores (adj. β = −0.22; 95% CI: −0.36, −0.08) at 4 years. MnBP and MBzP were associated with lower diastolic BP z-scores (adj. β = −0.13; 95%CI: −0.23, −0.04, and adj. β = −0.11; 95% CI: −0.21, −0.01, respectively). A 10-fold increase in MiBP was associated with 4.4% higher total cholesterol levels (95% CI: 0.2, 8.7). Prenatal phthalate exposure was not consistently associated with child adiposity and cardiometabolic measures. Our findings suggest that early life phthalate exposure may affect child growth and adiposity in a sex-specific manner and depends on the timing of exposure.
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Affiliation(s)
- Marina Vafeiadi
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Antonis Myridakis
- Environmental Chemical Processes Laboratory (ECPL), Department of Chemistry, University of Crete, Heraklion, Greece
| | - Theano Roumeliotaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Katerina Margetaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Georgia Chalkiadaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Eirini Dermitzaki
- Department of Clinical Chemistry, School of Medicine, University of Crete, Heraklion, Greece
| | - Maria Venihaki
- Department of Clinical Chemistry, School of Medicine, University of Crete, Heraklion, Greece
| | - Katerina Sarri
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Maria Vassilaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.,Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - Vasiliki Leventakou
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Euripides G Stephanou
- Environmental Chemical Processes Laboratory (ECPL), Department of Chemistry, University of Crete, Heraklion, Greece
| | - Manolis Kogevinas
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain.,Hospital del Mar Research Institute (IMIM), Barcelona, Spain
| | - Leda Chatzi
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, MN, United States.,Department of Genetics & Cell Biology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
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25
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Daraki V, Roumeliotaki T, Koutra K, Chalkiadaki G, Katrinaki M, Kyriklaki A, Kampouri M, Margetaki K, Vafeiadi M, Papavasiliou S, Kogevinas M, Chatzi L. High maternal vitamin D levels in early pregnancy may protect against behavioral difficulties at preschool age: the Rhea mother-child cohort, Crete, Greece. Eur Child Adolesc Psychiatry 2018; 27:79-88. [PMID: 28685401 DOI: 10.1007/s00787-017-1023-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [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: 03/19/2017] [Accepted: 06/29/2017] [Indexed: 02/07/2023]
Abstract
Animal studies suggest that prenatal vitamin D status may affect fetal brain growth. However, human studies are scarce with conflicting results. We aimed to investigate the association of maternal 25-hydroxyvitamin D [25(OH) D] levels with multiple neurodevelopmental outcomes at 4 years of age. We included 487 mother-child pairs from the prospective pregnancy cohort, "Rhea" in Crete, Greece. Maternal serum 25(OH) D concentrations were measured at the first prenatal visit (13 ± 2.4 weeks). Cognitive functions at 4 years were assessed by means of the McCarthy Scales of Children's Abilities. Behavioral difficulties were assessed by means of Strengths and Difficulties Questionnaire and Attention Deficit Hyperactivity Disorder Test. Children of women in the high 25(OH) D tertile (>50.7 nmol/l) had 37% decreased number of hyperactivity-impulsivity symptoms (IRR 0.63, 95% CI 0.39, 0.99, p trend = 0.05) and 40% decreased number of total ADHD-like symptoms (IRR 0.60, 95% CI 0.37, 0.95, p trend = 0.03) at 4 years of age, compared to children of women in the low 25(OH) D tertile (<38.4 nmol/l), after adjustment for several confounders. Similar associations were found with the hyperactivity/inattention score of the SDQ questionnaire. Children of mothers with high 25(OH) D levels had also fewer total behavioral difficulties (beta-coeff: -1.25, 95% CI -2.32, -0.19) and externalizing symptoms (beta-coeff: -0.87, 95% CI -1.58, -0.15) at preschool age. The observed associations were stronger in girls than in boys (p for interaction < 0.1). No association was observed between maternal 25(OH) D concentrations and cognitive function in preschoolers. Our results suggest that high maternal vitamin D levels in early pregnancy may protect against behavioral difficulties, especially ADHD-like symptoms at preschool age.
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Affiliation(s)
- Vasiliki Daraki
- Department of Social Medicine, Faculty of Medicine, University of Crete, P.O. Box 2208, 71003, Heraklion, Crete, Greece. .,Department of Endocrinology, Diabetes and Metabolic Diseases, University Hospital of Crete, Heraklion, Crete, Greece.
| | - Theano Roumeliotaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, P.O. Box 2208, 71003, Heraklion, Crete, Greece
| | - Katerina Koutra
- Department of Social Medicine, Faculty of Medicine, University of Crete, P.O. Box 2208, 71003, Heraklion, Crete, Greece
| | - Georgia Chalkiadaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, P.O. Box 2208, 71003, Heraklion, Crete, Greece
| | - Marianna Katrinaki
- Laboratory of Clinical Chemistry-Biochemistry, University Hospital of Crete, Heraklion, Crete, Greece
| | - Andriani Kyriklaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, P.O. Box 2208, 71003, Heraklion, Crete, Greece
| | - Mariza Kampouri
- Department of Social Medicine, Faculty of Medicine, University of Crete, P.O. Box 2208, 71003, Heraklion, Crete, Greece
| | - Katerina Margetaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, P.O. Box 2208, 71003, Heraklion, Crete, Greece
| | - Marina Vafeiadi
- Department of Social Medicine, Faculty of Medicine, University of Crete, P.O. Box 2208, 71003, Heraklion, Crete, Greece
| | - Stathis Papavasiliou
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Hospital of Crete, Heraklion, Crete, Greece
| | - Manolis Kogevinas
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Leda Chatzi
- Department of Social Medicine, Faculty of Medicine, University of Crete, P.O. Box 2208, 71003, Heraklion, Crete, Greece.,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Department of Genetics and Cell Biology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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26
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Stratakis N, Gielen M, Margetaki K, Godschalk RW, van der Wurff I, Rouschop S, Ibrahim A, Antoniou E, Chatzi L, de Groot RHM, Zeegers MP. Polyunsaturated fatty acid levels at birth and child-to-adult growth: Results from the MEFAB cohort. Prostaglandins Leukot Essent Fatty Acids 2017; 126:72-78. [PMID: 29031398 DOI: 10.1016/j.plefa.2017.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 09/06/2017] [Accepted: 09/09/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Prenatal exposure to polyunsaturated fatty acids (PUFAs) may influence childhood growth. However, available evidence mostly derived from short-term studies is inconsistent. OBJECTIVE To assess whether fetal PUFA exposure is associated with height and body mass index (BMI), a common measure of adiposity, from 6 months to 23 years of age. METHODS In the MEFAB cohort, we assessed cord blood phospholipid n-3 and n-6 PUFA levels, reflecting fetal exposure in late pregnancy. For 250 (45.2% females) participants, we collected a total of 1770 (n= 802 for females) repeated growth measurements from infancy to young adulthood. We examined sex-specific associations of PUFAs with height and BMI at different developmental ages (infant: 6 months; toddler: 2 years; pre-schooler: 4 years; school-aged child: 7 years; adolescent: 12 years; and young adult: 23 years) using fractional polynomial mixed models adjusted for important covariates. RESULTS Higher n-3 PUFA levels were associated with higher infant length in males (β= 0.44cm [95% CI: 0.07, 0.82] per SD increase), whereas, for females, higher n-6 PUFA concentrations were associated with lower length in infancy (β= -0.69cm [95% CI: -1.08, -0.30] per SD increase). A higher ratio of n-3 to n-6 PUFAs was associated with higher infant length in both sexes (β= 0.40cm [95% CI: 0.01, 0.78] and 0.42cm [95% CI: 0.05, 0.79] per unit increase for males and females, respectively). These associations were not detectable later in childhood and young adulthood. No associations with BMI were found at any time point examined. CONCLUSIONS Our findings suggest a small sex-specific influence of PUFA status at birth on length in infancy, but this does not persist in later life up to young adulthood. PUFA status at birth does not seem to affect BMI from infancy till young adulthood.
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Affiliation(s)
- N Stratakis
- School for Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands; Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.
| | - M Gielen
- School for Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - K Margetaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - R W Godschalk
- Department of Pharmacology & Toxicology, School for Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - I van der Wurff
- Welten Institute - Research Centre for Learning, Teaching and Technology, Open University of the Netherlands, Heerlen, Netherlands
| | - S Rouschop
- Department of Pharmacology & Toxicology, School for Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - A Ibrahim
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - E Antoniou
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - L Chatzi
- School for Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands; Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece; Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - R H M de Groot
- School for Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands; Welten Institute - Research Centre for Learning, Teaching and Technology, Open University of the Netherlands, Heerlen, Netherlands
| | - M P Zeegers
- School for Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands; Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
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