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Liu N, Liu W, Deng F, Liu Y, Gao X, Fang L, Chen Z, Tang H, Hong S, Pan M, Liu W, Huo X, Guo K, Ruan F, Zhang W, Zhao B, Mo J, Huang C, Su C, Sun C, Zou Z, Li H, Sun Y, Qian H, Zheng X, Zeng X, Guo J, Bu Z, Mandin C, Hänninen O, Ji JS, Weschler LB, Kan H, Zhao Z, Zhang Y. The burden of disease attributable to indoor air pollutants in China from 2000 to 2017. Lancet Planet Health 2023; 7:e900-e911. [PMID: 37940210 DOI: 10.1016/s2542-5196(23)00215-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/04/2023] [Accepted: 09/06/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND High-level exposure to indoor air pollutants (IAPs) and their corresponding adverse health effects have become a public concern in China in the past 10 years. However, neither national nor provincial level burden of disease attributable to multiple IAPs has been reported for China. This is the first study to estimate and rank the annual burden of disease and the financial costs attributable to targeted residential IAPs at the national and provincial level in China from 2000 to 2017. METHODS We first did a systematic review and meta-analysis of 117 articles from 37 231 articles identified in major databases, and obtained exposure-response relationships for the candidate IAPs. The exposure levels to these IAPs were then collected by another systematic review of 1864 articles selected from 52 351 articles. After the systematic review, ten IAPs with significant and robust exposure-response relationships and sufficient exposure data were finally targeted: PM2·5, nitrogen dioxide, sulphur dioxide, ozone, carbon monoxide, radon, formaldehyde, benzene, toluene, and p-dichlorobenzene. The annual exposure levels in residences were then evaluated in all 31 provinces in mainland China continuously from 2000 to 2017, using the spatiotemporal Gaussian process regression model to analyse indoor originating IAPs, and the infiltration factor method to analyse outdoor originating IAPs. The disability-adjusted life-years (DALYs) attributable to the targeted IAPs were estimated at both national and provincial levels in China, using the population attributable fraction method. Financial costs were estimated by an adapted human capital approach. FINDINGS From 2000 to 2017, annual DALYs attributable to the ten IAPs in mainland China decreased from 4620 (95% CI 4070-5040) to 3700 (3210-4090) per 100 000. Nevertheless, in 2017, IAPs still ranked third among all risk factors, and their DALYs and financial costs accounted for 14·1% (95% CI 12·3-15·6) of total DALYs and 3·45% (3·01-3·82) of the gross domestic product. Specifically, the rank of ten targeted IAPs in order of their contribution to DALYs in 2017 was PM2·5, carbon monoxide, radon, benzene, nitrogen dioxide, ozone, sulphur dioxide, formaldehyde, toluene, and p-dichlorobenzene. The DALYs attributable to IAPs were 9·50% higher than those attributable to outdoor air pollution in 2017. For the leading IAP, PM2·5, the DALYs attributable to indoor origins are 18·3% higher than those of outdoor origins. INTERPRETATION DALYs attributed to IAPs in China have decreased by 20·0% over the past two decades. Even so, they are still much higher than those in the USA and European countries. This study can provide a basis for determining which IAPs to target in various indoor air quality standards and for estimating the health and economic benefits of various indoor air quality control approaches, which will help to reduce the adverse health effects of IAPs in China. FUNDING The National Key Research and Development Program of China and the National Natural Science Foundation of China.
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Affiliation(s)
- Ningrui Liu
- Department of Building Science, Tsinghua University, Beijing, China; Beijing Key Laboratory of Indoor Air Quality Evaluation and Control, Beijing, China
| | - Wei Liu
- Institute for Health and Environment, Chongqing University of Science and Technology, Chongqing, China
| | - Furong Deng
- School of Public Health, Peking University, Beijing, China
| | - Yumeng Liu
- Department of Building Science, Tsinghua University, Beijing, China
| | - Xuehuan Gao
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Lin Fang
- Department of Building Science, Tsinghua University, Beijing, China; Beijing Key Laboratory of Indoor Air Quality Evaluation and Control, Beijing, China
| | - Zhuoru Chen
- School of Public Health, Fudan University, Shanghai, China
| | - Hao Tang
- School of Public Health, Fudan University, Shanghai, China
| | - Shijie Hong
- School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, China
| | - Minyi Pan
- School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, China
| | - Wei Liu
- School of Environmental Science and Engineering, Tianjin University, Tianjin, China
| | - Xinyue Huo
- School of Environmental Science and Engineering, Tianjin University, Tianjin, China
| | - Kangqi Guo
- School of Energy and Environment, Southeast University, Nanjing, China
| | - Fangfang Ruan
- School of Environment and Natural Resources, Renmin University of China, Beijing, China
| | - Wenlou Zhang
- School of Public Health, Peking University, Beijing, China
| | - Bin Zhao
- Department of Building Science, Tsinghua University, Beijing, China
| | - Jinhan Mo
- Department of Building Science, Tsinghua University, Beijing, China; Beijing Key Laboratory of Indoor Air Quality Evaluation and Control, Beijing, China
| | - Chen Huang
- School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, China
| | - Chunxiao Su
- School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, China
| | - Chanjuan Sun
- School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, China
| | - Zhijun Zou
- School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, China
| | - Hao Li
- School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, China
| | - Yuexia Sun
- School of Environmental Science and Engineering, Tianjin University, Tianjin, China
| | - Hua Qian
- School of Energy and Environment, Southeast University, Nanjing, China
| | - Xiaohong Zheng
- School of Energy and Environment, Southeast University, Nanjing, China
| | - Xiangang Zeng
- School of Environment and Natural Resources, Renmin University of China, Beijing, China
| | - Jianguo Guo
- Institute of Laboratory Animal Science, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhongming Bu
- Department of Energy and Environmental System Engineering, Zhejiang University of Science and Technology, Hangzhou, China
| | - Corinne Mandin
- Institute for Radiation Protection and Nuclear Safety, Fontenay-aux-Roses Cedex, Marne-la-Vallée, France
| | - Otto Hänninen
- Finnish Institute for Health and Welfare, Department of Health Security, Kuopio, Finland
| | - John S Ji
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | | | - Haidong Kan
- School of Public Health, Fudan University, Shanghai, China; Shanghai Institute of Pollution Control and Ecological Security, Shanghai, China.
| | - Zhuohui Zhao
- School of Public Health, Fudan University, Shanghai, China; Key Laboratory of Public Health Safety of the Ministry of Education, NHC Key Laboratory of Health Technology Assessment (Fudan University), Shanghai Typhoon Institute/CMA, Shanghai Key Laboratory of Meteorology and Health, Shanghai, China; IRDR International Center of Excellence on Risk Interconnectivity and Governance on Weather/Climate Extremes Impact and Public Health, Fudan University, Shanghai China; WMO/IGAC MAP-AQ Asian Office Shanghai, Fudan University, Shanghai, China.
| | - Yinping Zhang
- Department of Building Science, Tsinghua University, Beijing, China; Beijing Key Laboratory of Indoor Air Quality Evaluation and Control, Beijing, China.
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Zhang R, Weschler LB, Ye J, Wang Z, Deng Q, Li B, HuaQian, Zhao Z, Zhang Y, Huang S, Hong C. Associations between home environmental factors and childhood eczema and related symptoms in different cities in China. Heliyon 2023; 9:e21718. [PMID: 38027650 PMCID: PMC10661510 DOI: 10.1016/j.heliyon.2023.e21718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Previous studies have shown significant associations between home environmental factors and childhood eczema. However, few studies have compared how associations differ in different regions. This study investigated associations between home environmental factors and childhood eczema ever, and related symptoms including itchy rash (IR) and being awakened by itchy rash at night (awake by IR) in 4 cities located in different regions of China, based on cross-sectional investigations during 2010-2012. We used two-step analysis to explore the associations between influencing factors and eczema/related symptoms: first, group Least Absolute Shrinkage and Selection Operator (LASSO) was conducted to identify important factors among a list of candidates; then, the associations in total study population and in each city were estimated using logistic regression. We found these home environmental factors to be risk factors for eczema or related symptoms: large residence size, shared room, air cleaner at home, abnormal smell, perceived dry air, visible mold or damp stains, cooking with coal or wood, painted wall, incense, mice, new furniture during pregnancy, abnormal smell at birth, window condensation at birth and environmental tobacco smoke at birth. Environmental protective factors were rural house location and window ventilation. Associations of factors with eczema/related symptoms differed across cities. For example, air conditioning was protective for eczema in Beijing and awakening by IR in Shanghai with ORs of 0.70 (95%CI: 0.52, 0.95) and 0.33 (95%CI: 0.14, 0.81) respectively, but not significant in other cities. Our results have implications for improving home environments to reduce the risk of childhood eczema/related symptoms in different regions of China.
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Affiliation(s)
- Ruosu Zhang
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, 100191, China
| | | | - Jin Ye
- School of Energy and Power, Jiangsu University of Science and Technology, Zhenjiang, 212100, China
| | - Zhaokun Wang
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, 100191, China
| | - Qihong Deng
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Baizhan Li
- Key Laboratory of Three Gorges Reservoir Region's Eco-Environment, Chongqing University, Chongqing 400030, China
| | - HuaQian
- School of Energy & Environment, Southeast University, Nanjing 210096, China
| | - Zhuohui Zhao
- School of Public Health, Fudan University, Shanghai 200032, China
| | - Yinping Zhang
- Department of Building Science, Tsinghua University, Beijing 100084, China
| | - Shaodan Huang
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, 100191, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, China
| | - Chuan Hong
- Department of Biostatistics & Bioinformatics, School of Medicine, Duke University, North Carolina, USA
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3
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Qu F, Weschler LB, Zhang Y, Spengler JD. Childhood pneumonia in Beijing: Associations and interactions among selected demographic and environmental factors. Environ Res 2023; 231:116211. [PMID: 37257739 DOI: 10.1016/j.envres.2023.116211] [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: 11/22/2022] [Revised: 05/02/2023] [Accepted: 05/20/2023] [Indexed: 06/02/2023]
Abstract
Among infectious diseases, pneumonia is the greatest cause of mortality in children less than 5 years old. Approximately 27% of Beijing's 3-8 year-old children have had pneumonia at least once. The sole reservoir of pneumonia pathogens is the human nasopharynx. We investigated associations and interactions among two kinds of environmental risk factors: i) airborne pathogens, namely closed bedroom window and shared bedroom and ii) pollutants, namely traffic pollution and environmental tobacco smoke (ETS). We evaluated breastfeeding's (BF) protective value against childhood pneumonia. The database consists of responses to a questionnaire in a cross-sectional study. Crude and adjusted Odds Ratios were assessed independently for each risk factor. Combinations of the studied risk factors were analyzed using multivariate logistic regression. Risk factors were evaluated for interactions on the additive scale using the metrics Relative Excess Risk due to Interaction (RERI), Attributable Proportion (AP) and Synergy Index (S). All independent risk factors were significant for children's pneumonia. We also found evidence of possible synergistic interaction between pairs of risk factors that was stronger when one of the risk factors was a closed bedroom window. Remarkably, window opening was associated with reduced risk of pneumonia for children living near heavy traffic pollution. Longer duration BF was more protective than shorter, and exclusive BF was more protective than partial BF against childhood pneumonia. In conclusion, low ventilation (closed bedroom windows), shared bedroom, ETS, and traffic exposure were associated with increased risk of pneumonia. Exclusive BF for more than six months had the greatest protective value against pneumonia.
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Affiliation(s)
- Fang Qu
- China Meteorological Administration Training Center, China Meteorological Administration, Beijing, 100081, China; Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, 02115, United States
| | - Louise B Weschler
- Independent Researcher, 161 Richdale Road, Colts Neck, NJ, 07722, United States.
| | - Yinping Zhang
- Department of Building Science, Tsinghua University, Beijing, 100084, China
| | - John D Spengler
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, 02115, United States
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Liu N, Bu Z, Liu W, Kan H, Zhao Z, Deng F, Huang C, Zhao B, Zeng X, Sun Y, Qian H, Mo J, Sun C, Guo J, Zheng X, Weschler LB, Zhang Y. Indoor exposure levels and risk assessment of volatile organic compounds in residences, schools, and offices in China from 2000 to 2021: A systematic review. Indoor Air 2022; 32:e13091. [PMID: 36168233 DOI: 10.1111/ina.13091] [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: 02/11/2022] [Revised: 07/20/2022] [Accepted: 07/24/2022] [Indexed: 06/16/2023]
Abstract
The last two decades have witnessed rapid urbanization and economic growth accompanied by severe indoor air pollution of volatile organic compounds (VOCs) in China. However, indoor VOC pollution across China has not been well characterized and documented. This study is a systematic review of field measurements of eight target VOCs (benzene, toluene, xylenes, acetaldehyde, p-dichlorobenzene, butadiene, trichloroethylene, and tetrachloroethylene) in residences, offices, and schools in China from 2000 to 2021. The results show that indoor pollution of benzene, toluene, and xylenes has been more serious in China than in other countries. Spatiotemporal distribution shows lower indoor VOC levels in east and south-east regions and a declining trend from 2000 to 2021. Moving into a dwelling more than 1 year after decoration and improving ventilation could significantly reduce exposure to indoor VOCs. Reducing benzene exposure is urgently needed because it is associated with greater health risks (4.5 × 10-4 for lifetime cancer risk and 8.3 for hazard quotient) than any other VOCs. The present study enriches the database of indoor VOC levels and provides scientific evidence for improving national indoor air quality standards as well as estimating the attributable disease burden caused by VOCs in China.
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Affiliation(s)
- Ningrui Liu
- Department of Building Science, Tsinghua University, Beijing, China
- Beijing Key Laboratory of Indoor Air Quality Evaluation and Control, Beijing, China
| | - Zhongming Bu
- Department of Energy and Environmental System Engineering, Zhejiang University of Science and Technology, Hangzhou, China
| | - Wei Liu
- Institute for Health and Environment, Chongqing University of Science and Technology, Chongqing, China
| | - Haidong Kan
- School of Public Health, Fudan University, Shanghai, China
| | - Zhuohui Zhao
- School of Public Health, Fudan University, Shanghai, China
| | - Furong Deng
- School of Public Health, Peking University, Beijing, China
| | - Chen Huang
- School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, China
| | - Bin Zhao
- Department of Building Science, Tsinghua University, Beijing, China
| | - Xiangang Zeng
- School of Environment and Natural Resources, Renmin University of China, Beijing, China
| | - Yuexia Sun
- School of Environmental Science and Engineering, Tianjin University, Tianjin, China
| | - Hua Qian
- School of Energy and Environment, Southeast University, Nanjing, China
| | - Jinhan Mo
- Department of Building Science, Tsinghua University, Beijing, China
- Beijing Key Laboratory of Indoor Air Quality Evaluation and Control, Beijing, China
| | - Chanjuan Sun
- School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, China
| | - Jianguo Guo
- Institute of Laboratory Animal Science, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiaohong Zheng
- School of Energy and Environment, Southeast University, Nanjing, China
| | | | - Yinping Zhang
- Department of Building Science, Tsinghua University, Beijing, China
- Beijing Key Laboratory of Indoor Air Quality Evaluation and Control, Beijing, China
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Liu N, Bu Z, Liu W, Kan H, Zhao Z, Deng F, Huang C, Zhao B, Zeng X, Sun Y, Qian H, Mo J, Sun C, Guo J, Zheng X, Weschler LB, Zhang Y. Health effects of exposure to indoor volatile organic compounds from 1980 to 2017: A systematic review and meta-analysis. Indoor Air 2022; 32:e13038. [PMID: 35622720 DOI: 10.1111/ina.13038] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 06/15/2023]
Abstract
Exposure to volatile organic compounds (VOCs) indoors is thought to be associated with several adverse health effects. However, we still lack concentration-response (C-R) relationships between VOC levels in civil buildings and various health outcomes. For this paper, we conducted a systematic review and meta-analysis of observational studies to summarize related associations and C-R relationships. Four databases were searched to collect all relevant studies published between January 1980 and December 2017. A total of 39 studies were identified in the systematic review, and 32 of these were included in the meta-analysis. We found that the pooled relative risk (RR) for leukemia was 1.03 (95% CI: 1.01-1.05) per 1 μg/m3 increase of benzene and 1.25 (95%CI: 1.14-1.37) per 0.1 μg/m3 increase of butadiene. The pooled RRs for asthma were 1.08 (95% CI: 1.02-1.14), 1.02 (95% CI: 1.00-1.04), and 1.04 (95% CI: 1.02-1.06) per 1 μg/m3 increase of benzene, toluene, and p-dichlorobenzene, respectively. The pooled RR for low birth weight was 1.12 (95% CI: 1.05-1.19) per 1 μg/m3 increase of benzene. Our findings provide robust evidence for associations between benzene and leukemia, asthma, and low birth weight, as well as for health effects of some other VOCs.
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Affiliation(s)
- Ningrui Liu
- Department of Building Science, Tsinghua University, Beijing, China
- Beijing Key Laboratory of Indoor Air Quality Evaluation and Control, Beijing, China
| | - Zhongming Bu
- Department of Energy and Environmental System Engineering, Zhejiang University of Science and Technology, Hangzhou, China
| | - Wei Liu
- Institute for Health and Environment, Chongqing University of Science and Technology, Chongqing, China
| | - Haidong Kan
- School of Public Health, Fudan University, Shanghai, China
| | - Zhuohui Zhao
- School of Public Health, Fudan University, Shanghai, China
| | - Furong Deng
- School of Public Health, Peking University, Beijing, China
| | - Chen Huang
- School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, China
| | - Bin Zhao
- Department of Building Science, Tsinghua University, Beijing, China
| | - Xiangang Zeng
- School of Environment and Natural Resources, Renmin University of China, Beijing, China
| | - Yuexia Sun
- School of Environmental Science and Engineering, Tianjin University, Tianjin, China
| | - Hua Qian
- School of Energy and Environment, Southeast University, Nanjing, China
| | - Jinhan Mo
- Department of Building Science, Tsinghua University, Beijing, China
- Beijing Key Laboratory of Indoor Air Quality Evaluation and Control, Beijing, China
| | - Chanjuan Sun
- School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, China
| | - Jianguo Guo
- Institute of Laboratory Animal Science, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiaohong Zheng
- School of Energy and Environment, Southeast University, Nanjing, China
| | | | - Yinping Zhang
- Department of Building Science, Tsinghua University, Beijing, China
- Beijing Key Laboratory of Indoor Air Quality Evaluation and Control, Beijing, China
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Huang S, Song S, Nielsen CP, Zhang Y, Xiong J, Weschler LB, Xie S, Li J. Residential building materials: An important source of ambient formaldehyde in mainland China. Environ Int 2022; 158:106909. [PMID: 34619531 DOI: 10.1016/j.envint.2021.106909] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 09/03/2021] [Accepted: 09/27/2021] [Indexed: 06/13/2023]
Abstract
This study investigates the contribution of formaldehyde from residential building materials to ambient air in mainland China. Based on 265 indoor field tests in 9 provinces, we estimate that indoor residential sources are responsible for 6.66% of the total anthropogenic formaldehyde in China's ambient air (range for 31 provinces: 1.88-18.79%). Residential building materials rank 6th among 81 anthropogenic sources (range: 2nd-10th for 31 provinces). Emission intensities show large spatial variability between and within regions due to different residential densities, emission characteristics of building materials, and indoor thermal conditions. Our findings indicate that formaldehyde from the indoor environment is a significant source of ambient formaldehyde, especially in urban areas. This study will help to more accurately evaluate exposure to ambient formaldehyde and its related pollutants, and will assist in formulating policies to protect air quality and public health.
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Affiliation(s)
- Shaodan Huang
- School of Public Health, Peking University, Beijing 100871, China; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston 02115, USA
| | - Shaojie Song
- Harvard John A. Paulson School of Engineering and Applied Sciences, Boston 02138, USA
| | - Chris P Nielsen
- Harvard John A. Paulson School of Engineering and Applied Sciences, Boston 02138, USA
| | - Yuqiang Zhang
- Nicholas School of the Environment, Duke University, Durham 27708, USA
| | - Jianyin Xiong
- School of Mechanical Engineering, Beijing Institute of Technology, Beijing 100081, China
| | | | - Shaodong Xie
- College of Environmental Sciences and Engineering, State Key Joint Laboratory of Environmental Simulation and Pollution Control, Peking University, Beijing 100871, China
| | - Jing Li
- School of Public Health, Peking University, Beijing 100871, China; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston 02115, USA; College of Environmental Sciences and Engineering, State Key Joint Laboratory of Environmental Simulation and Pollution Control, Peking University, Beijing 100871, China.
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Zhang N, Chen X, Jia W, Jin T, Xiao S, Chen W, Hang J, Ou C, Lei H, Qian H, Su B, Li J, Liu D, Zhang W, Xue P, Liu J, Weschler LB, Xie J, Li Y, Kang M. Evidence for lack of transmission by close contact and surface touch in a restaurant outbreak of COVID-19. J Infect 2021; 83:207-216. [PMID: 34062182 PMCID: PMC8164346 DOI: 10.1016/j.jinf.2021.05.030] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/23/2021] [Accepted: 05/26/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is primarily a respiratory disease that has become a global pandemic. Close contact plays an important role in infection spread, while fomite may also be a possible transmission route. Research during the COVID-19 pandemic has identified long-range airborne transmission as one of the important transmission routes although lack solid evidence. METHODS We examined video data related to a restaurant associated COVID-19 outbreak in Guangzhou. We observed more than 40,000 surface touches and 13,000 episodes of close contacts in the restaurant during the entire lunch duration. These data allowed us to analyse infection risk via both the fomite and close contact routes. RESULTS There is no significant correlation between the infection risk via both fomite and close contact routes among those who were not family members of the index case. We can thus rule out virus transmission via fomite contact and interpersonal close contact routes in the Guangzhou restaurant outbreak. The absence of a fomite route agrees with the COVID-19 literature. CONCLUSIONS These results provide indirect evidence for the long-range airborne route dominating SARS-CoV-2 transmission in the restaurant. We note that the restaurant was poorly ventilated, allowing for increasing airborne SARS-CoV-2 concentration.
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Affiliation(s)
- Nan Zhang
- Beijing Key Laboratory of Green Built Environment and Energy Efficient Technology, Beijing University of Technology, Beijing, China
| | - Xuguang Chen
- Guangdong Provincial Center for Disease Control and Prevention, Guangdong province, China
| | - Wei Jia
- Department of Mechanical Engineering, The University of Hong Kong, Pokfulam Road, Hong Kong
| | - Tianyi Jin
- Beijing Key Laboratory of Green Built Environment and Energy Efficient Technology, Beijing University of Technology, Beijing, China
| | - Shenglan Xiao
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, China
| | - Wenzhao Chen
- Department of Mechanical Engineering, The University of Hong Kong, Pokfulam Road, Hong Kong
| | - Jian Hang
- School of Atmospheric Sciences, Sun Yat-sen University, Guangzhou, China
| | - Cuiyun Ou
- School of Atmospheric Sciences, Sun Yat-sen University, Guangzhou, China
| | - Hao Lei
- School of Public Health, Zhejiang University, Hangzhou, Zhejiang, China
| | - Hua Qian
- School of Energy and Environment, Southeast University, Nanjing, China
| | - Boni Su
- China Electric Power Planning & Engineering Institute, Beijing, China
| | - Jiansen Li
- Guangdong Provincial Center for Disease Control and Prevention, Guangdong province, China
| | - Dongmei Liu
- Fogang County Center for Disease Control and Prevention, Guangdong, China
| | - Weirong Zhang
- Beijing Key Laboratory of Green Built Environment and Energy Efficient Technology, Beijing University of Technology, Beijing, China
| | - Peng Xue
- Beijing Key Laboratory of Green Built Environment and Energy Efficient Technology, Beijing University of Technology, Beijing, China
| | - Jiaping Liu
- Beijing Key Laboratory of Green Built Environment and Energy Efficient Technology, Beijing University of Technology, Beijing, China
| | | | - Jingchao Xie
- Beijing Key Laboratory of Green Built Environment and Energy Efficient Technology, Beijing University of Technology, Beijing, China.
| | - Yuguo Li
- Department of Mechanical Engineering, The University of Hong Kong, Pokfulam Road, Hong Kong; School of Public Health, The University of Hong Kong, Pokfulam Road, Hong Kong.
| | - Min Kang
- Guangdong Provincial Center for Disease Control and Prevention, Guangdong province, China; School of Public Health, Southern Medical University, Guangzhou, China.
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8
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Yang F, Sun Y, Wang P, Weschler LB, Sundell J. Spread of respiratory infections in student dormitories in China. Sci Total Environ 2021; 777:145983. [PMID: 33677292 DOI: 10.1016/j.scitotenv.2021.145983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/14/2021] [Accepted: 02/15/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Student dormitory rooms in China are characterized by small space and high occupancy. This study aims to investigate infection rates for common colds and influenza among college students in a Chinese university and their association with the dormitory environment. METHODS This study involved two phases. In Phase I, 2978 students living in 998 dorm rooms in 12 buildings responded to a questionnaire survey on infections in four seasons. In Phase II, based on the data obtained from the questionnaire survey, we selected 242 dorm rooms to measure air temperature, relative humidity and CO2 concentration in both summer and winter. Ventilation rates at night were calculated based on measured CO2 concentrations. RESULTS We found that students had infections more often in winter, and in rooms with higher occupancy and dampness problems. The median value of the ventilation rate in dorm rooms in summer was 10.7 L/s per person, while it was 4.10 L/s per person in winter. There were significant associations between ventilation rate per person at night and common cold and influenza both in summer and winter (p < 0.05). A combination of dampness and low ventilation rate significantly increased the risk of common colds (adjusted odds ratios, AOR: 1.26-1.91) and influenza (AOR: 1.49-2.20). CONCLUSION College students living in a crowded dormitory room with low ventilation and dampness problems had more common colds and influenza infections.
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Affiliation(s)
- Feihu Yang
- Tianjin Key Laboratory of Built Environment and Energy Application, School of Environmental Science and Engineering, Tianjin University, China
| | - Yuexia Sun
- Tianjin Key Laboratory of Built Environment and Energy Application, School of Environmental Science and Engineering, Tianjin University, China.
| | - Pan Wang
- Tianjin Key Laboratory of Built Environment and Energy Application, School of Environmental Science and Engineering, Tianjin University, China
| | | | - Jan Sundell
- Tianjin Key Laboratory of Built Environment and Energy Application, School of Environmental Science and Engineering, Tianjin University, China
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Guo Y, Qian H, Sun Z, Cao J, Liu F, Luo X, Ling R, Weschler LB, Mo J, Zhang Y. Assessing and controlling infection risk with Wells-Riley model and spatial flow impact factor (SFIF). Sustain Cities Soc 2021; 67:102719. [PMID: 33520610 PMCID: PMC7834120 DOI: 10.1016/j.scs.2021.102719] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/31/2020] [Accepted: 01/12/2021] [Indexed: 05/13/2023]
Abstract
The ongoing COVID-19 epidemic has spread worldwide since December 2019. Effective use of engineering controls can prevent its spread and thereby reduce its impact. As airborne transmission is an important mode of infectious respiratory disease transmission, mathematical models of airborne infection are needed to develop effective engineering control. We developed a new approach to obtain the spatial distribution for the probability of infection (PI) by combining the spatial flow impact factor (SFIF) method with the Wells-Riley model. Our method can be combined with the anti-problem approach, in order to determine the optimized arrangement of people and/or air purifiers in a confined space beyond the ability of previous methods. This method was validated by a CFD-integrated method, and an illustrative example is presented. We think our method can be helpful in controlling infection risk and making the best use of the space and equipment in built environments, which is important for preventing the spread of COVID-19 and other infectious respiratory diseases, and promoting the development of sustainable cities and society.
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Affiliation(s)
- Yong Guo
- Department of Building Science, Tsinghua University, Beijing, China
- Beijing Key Laboratory of Indoor Air Quality Evaluation and Control, Beijing, China
| | - Hua Qian
- School of Energy and Environment, Southeast University, Nanjing, China
| | - Zhiwei Sun
- Department of Building Science, Tsinghua University, Beijing, China
- Beijing Key Laboratory of Indoor Air Quality Evaluation and Control, Beijing, China
| | - Jianping Cao
- School of Environmental Science and Engineering, Sun Yat-Sen University, Guangzhou, China
| | - Fei Liu
- Hubei Provincial Hospital of Integrated Chinese and Western Medicine, Wuhan, China
| | - Xibei Luo
- Hubei Provincial Hospital of Integrated Chinese and Western Medicine, Wuhan, China
| | - Ruijie Ling
- Hubei Provincial Hospital of Integrated Chinese and Western Medicine, Wuhan, China
| | | | - Jinhan Mo
- Department of Building Science, Tsinghua University, Beijing, China
- Beijing Key Laboratory of Indoor Air Quality Evaluation and Control, Beijing, China
| | - Yinping Zhang
- Department of Building Science, Tsinghua University, Beijing, China
- Beijing Key Laboratory of Indoor Air Quality Evaluation and Control, Beijing, China
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10
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Huang C, Zhang J, Sun C, Liu W, Zhang Y, Li B, Zhao Z, Deng Q, Zhang X, Qian H, Zou Z, Yang X, Sun Y, Xia Z, Weschler LB, Sundell J. Associations between household renovation and rhinitis among preschool children in China: A cross-sectional study. Indoor Air 2020; 30:827-840. [PMID: 32297363 DOI: 10.1111/ina.12675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 02/12/2020] [Accepted: 04/08/2020] [Indexed: 06/11/2023]
Abstract
During 2010-2012, we surveyed 40,010 3- to 6-year-old children in seven Chinese cities (Beijing, Taiyuan, Urumqi, Shanghai, Nanjing, Changsha, and Chongqing). Their parents reported information on household renovation, including the timing of renovation and the choice of materials for walls and floors in the child's room, and the incidence of their child's rhinitis. Multivariate and two-level (city-child) logistic regression analyses yielding adjusted odds ratios (AOR) with 95% confidence intervals were performed. Sensitivity analyses stratifying data for location and economic level were also performed. About 48.0% of the children had ever had allergic rhinitis, 41.2% had current allergic rhinitis, and 9.0% had had doctor-diagnosed rhinitis. Exposure to household renovation during early lifetime (birth to 1-year-old) had an AOR of 1.43 (1.04-1.9) for allergic rhinitis. The incidence of allergic rhinitis was significantly different in children exposed to different floor and wall covering materials. Floor or wall covering material composed of organic materials significantly increased the risk of childhood allergic rhinitis compared with tile flooring or lime wall covering. Oil paint had an AOR of 1.66 (1.28-2.14) for diagnosed rhinitis compared with lime wall covering. Adding new furniture the year before pregnancy was associated with an AOR of 1.18 (1.10-1.27) and 1.18 (1.11-1.25) for lifetime and current rhinitis. Solid wood or tiles/ceramic as floor materials, and using wallpaper, oil paint, or emulsion panels as wall materials were risk factors for doctor-diagnosed rhinitis. Sensitivity analyses showed that children living in southern or higher economic level China cities were more likely to have allergic rhinitis with household renovation.
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Affiliation(s)
- Chen Huang
- School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, China
| | - Jialing Zhang
- School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, China
| | - Chanjuan Sun
- School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, China
| | - Wei Liu
- School of Architecture, Tsinghua University, Beijing, China
| | - Yinping Zhang
- School of Architecture, Tsinghua University, Beijing, China
| | - Baizhan Li
- Key Laboratory of Three Gorges Reservoir Region's Eco-Environment, Chongqing University, Chongqing, China
| | - Zhuohui Zhao
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, Key Lab of Health Technology Assessment, National Health and Family Planning Commission of the People's Republic of China, Fudan University, Shanghai, China
| | - Qihong Deng
- School of Public Health, Central South University, Changsha, China
| | - Xin Zhang
- Research Center for Environmental Science and Engineering, Shanxi University, Taiyuan, China
| | - Hua Qian
- School of Energy and Environment, Southeast University, Nanjing, China
| | - Zhijun Zou
- School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, China
| | - Xu Yang
- College of Life Sciences, Central China Normal University, Wuhan, China
| | - Yuexia Sun
- School of Environmental Science and Engineering, Tianjin University, Tianjin, China
| | - Zhenzhen Xia
- School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, China
| | | | - Jan Sundell
- School of Environmental Science and Engineering, Tianjin University, Tianjin, China
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11
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Liu W, He Z, Chen W, Li C, Kan H, Weschler LB, Bai L, Zhang Y. Birth month is associated with learning capacity in childhood in Northeast China. Indoor Air 2020; 30:31-39. [PMID: 31541483 DOI: 10.1111/ina.12604] [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: 05/28/2019] [Revised: 09/13/2019] [Accepted: 09/15/2019] [Indexed: 06/10/2023]
Abstract
It is difficult to evaluate long-term ventilation and indoor-outdoor temperature variation on-site in the birth residence so as to investigate their associations with learning capacity from childhood through adolescence. Here, we conducted a questionnaire-based retrospective cohort study in ten schools from two northeast China cities with warm summers and severe cold winters when residences had very low air exchange rates. Scores for Chinese, Mathematics, and English in the final exams of the summer semester in June 2018 were collected to evaluate learning capacity. We surveyed 6238 students aged 14.7 (SD: 2.1) years old. Using the 2nd quarter (April-May-June) birth as reference, 4th quarter (October-November-December) birth consistently was significantly associated with lower scores in Chinese in bivariate (β, 95%CI: -3.2, -4.3 to -2.0) and multivariate (-1.8, -2.4 to -0.8) linear regression analyses. Stratified sub-analyses showed significant associations for male (-2.4, -3.7 to -1.1), urban (-2.4, -3.4 to -1.4), and primary students (-2.9, -4.5 to -1.4). Since household ventilation and indoor-outdoor temperature variation had great differences between the 2nd and 4th quarter of year, our results suggest that these two factors in the birth residence could be associated with learning capacity in childhood, especially for male and primary students in northeast China.
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Affiliation(s)
- Wei Liu
- Department of Building Science, School of Architecture, Tsinghua University, Beijing, China
- Beijing Key Lab of Indoor Air Quality Evaluation and Control, Beijing, China
- Institute for Health and Environment, Chongqing University of Science and Technology, Chongqing, China
| | - Zijian He
- School of Municipal and Environmental Engineering, Jilin Jianzhu University, Changchun, China
| | - Wanyue Chen
- School of Municipal and Environmental Engineering, Jilin Jianzhu University, Changchun, China
| | - Chunhui Li
- School of Municipal and Environmental Engineering, Jilin Jianzhu University, Changchun, China
| | - Haidong Kan
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, China
| | - Louise B Weschler
- Department of Building Science, School of Architecture, Tsinghua University, Beijing, China
- Beijing Key Lab of Indoor Air Quality Evaluation and Control, Beijing, China
| | - Li Bai
- School of Municipal and Environmental Engineering, Jilin Jianzhu University, Changchun, China
| | - Yinping Zhang
- Department of Building Science, School of Architecture, Tsinghua University, Beijing, China
- Beijing Key Lab of Indoor Air Quality Evaluation and Control, Beijing, China
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12
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Huang S, Garshick E, Weschler LB, Hong C, Li J, Li L, Qu F, Gao D, Zhou Y, Sundell J, Zhang Y, Koutrakis P. Home environmental and lifestyle factors associated with asthma, rhinitis and wheeze in children in Beijing, China. Environ Pollut 2020; 256:113426. [PMID: 31672368 PMCID: PMC7050389 DOI: 10.1016/j.envpol.2019.113426] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 10/15/2019] [Accepted: 10/15/2019] [Indexed: 05/04/2023]
Abstract
BACKGROUND The prevalence of asthma and allergic diseases has increased rapidly in urban China since 2000. There has been limited study of associations between home environmental and lifestyle factors with asthma and symptoms of allergic disease in China. METHODS In a cross-sectional analysis of 2214 children in Beijing, we applied a two-step hybrid Least Absolute Shrinkage and Selection Operator (LASSO) algorithm to identify environmental and lifestyle-related factors associated with asthma, rhinitis and wheeze from a wide range of candidates. We used group LASSO to select variables, using cross-validation as the criterion. Effect estimates were then calculated using adaptive LASSO. Model performance was assessed using Area Under the Curve (AUC) values. RESULTS We found a number of environmental and lifestyle-related factors significantly associated with asthma, rhinitis or wheeze, which changed the probability of asthma, rhinitis or wheeze from -5.76% (95%CI: -7.74%, -3.79%) to 27.4% (95%CI: 16.6%, 38.3%). The three factors associated with the largest change in probability of asthma were short birth length, carpeted floor and paternal allergy; for rhinitis they were maternal smoking during pregnancy, paternal allergy and living close to industrial area; and for wheeze they were carpeted floor, short birth length and maternal allergy. Other home environmental risk factors identified were living close to a highway, industrial area or river, sharing bedroom, cooking with gas, furry pets, cockroaches, incense, printer/photocopier, TV, damp, and window condensation in winter. Lifestyle-related risk factors were child caretakers other than parents, and age<3 for the day-care. Other risk factors included use of antibiotics, and mother's occupation. Major protective factors for wheeze were living in a rural/suburban region, air conditioner use, and mother's occupation in healthcare. CONCLUSIONS Our findings suggest that changes in lifestyle and indoor environments associated with the urbanization and industrialization of China are associated with asthma, rhinitis, and wheeze in children.
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Affiliation(s)
- Shaodan Huang
- Department of Building Science, Tsitnghua University, Beijing, 100084, China; Beijing Key Lab of Indoor Air Quality Evaluation and Control, Beijing, 100084, China; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, 02115, USA
| | - Eric Garshick
- Pulmonary, Allergy, Sleep, and Critical Care Medicine Section, Medical Service, VA Boston Healthcare System, Boston, MA, 02132, USA; Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Louise B Weschler
- Department of Building Science, Tsitnghua University, Beijing, 100084, China; 161 Richdale Road, Colts Neck, NJ, 07722, USA
| | - Chuan Hong
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, 02115, USA
| | - Jing Li
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, 02115, USA.
| | - Linyan Li
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, 02115, USA
| | - Fang Qu
- Department of Building Science, Tsitnghua University, Beijing, 100084, China; China Meteorological Administration Training Centre, China Meteorological Administration, Beijing, 100081, China
| | - Dewen Gao
- Beijing Key Lab of Indoor Air Quality Evaluation and Control, Beijing, 100084, China
| | - Yanmin Zhou
- School of Architecture, Tsinghua University, Beijing, 100084, China; Beijing Key Lab of Indoor Air Quality Evaluation and Control, Beijing, 100084, China
| | - Jan Sundell
- School of Environmental Science and Engineering, Tianjin University, Tianjing, 300072, China
| | - Yinping Zhang
- Department of Building Science, Tsitnghua University, Beijing, 100084, China; Beijing Key Lab of Indoor Air Quality Evaluation and Control, Beijing, 100084, China.
| | - Petros Koutrakis
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, 02115, USA
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13
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Liu W, Huang C, Li B, Zhao Z, Yang X, Deng Q, Zhang X, Qian H, Sun Y, Qu F, Wang L, Lin Z, Lu C, Wang H, Wang J, Cai J, Zhang J, Sun C, Mo J, Weschler LB, Norbäck D, Sundell J, Zhang Y. Household renovation before and during pregnancy in relation to preterm birth and low birthweight in China. Indoor Air 2019; 29:202-214. [PMID: 30597644 DOI: 10.1111/ina.12534] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 12/21/2018] [Indexed: 06/09/2023]
Abstract
From October 2010 to April 2012, we conducted a cross-sectional study of associations between household environments and childhood health among preschool children in eight Chinese cities. Here, we analyze associations of early household renovation with preterm birth (PTB), low birthweight (LBW), term low birthweight (Term-LBW), and small for gestational age (SGA). Parents responded to questions about household renovation and their children's gestational age and birthweight. In the multivariate logistic regression analyses, household renovation in the year before pregnancy was significantly associated with LBW (sample size: N = 25 813; adjusted odds ratio (OR) with 95% confidence intervals (CIs): 1.23, 1.01-1.50) and Term-LBW (N = 24 823; 1.29, 1.01-1.67). Household renovation during pregnancy was significantly associated with PTB (N = 25 202; 1.28, 1.01-1.69). These significant associations were also found in the two-level (city-child) logistic regression analyses and in the sensitivity analyses among 21 009 children with complete data in all studied variates. Stronger associations were found in certain subgroups. Our findings indicate that household renovation within one year before pregnancy might be a risk factor for LBW and Term-LBW, while household renovation during pregnancy could be a risk factor for PTB.
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Affiliation(s)
- Wei Liu
- Department of Building Science, Tsinghua University, Beijing, China
- Beijing Key Laboratory of Indoor Air Quality Evaluation and Control, Tsinghua University, Beijing, China
| | - Chen Huang
- School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, China
| | - Baizhan Li
- Joint International Research Laboratory of Green Buildings and Built Environments (Ministry of Education), Chongqing University, Chongqing, China
| | - Zhuohui Zhao
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, China
| | - Xu Yang
- College of Life Sciences, Central China Normal University, Wuhan, China
| | - Qihong Deng
- School of Energy Science and Engineering, Central South University, Changsha, China
| | - Xin Zhang
- Research Center for Environmental Science and Engineering, Shanxi University, Taiyuan, China
| | - Hua Qian
- School of Energy and Environment, Southeast University, Nanjing, China
| | - Yuexia Sun
- School of Environmental Science and Technology, Tianjin University, Tianjin, China
| | - Fang Qu
- China Meteorological Administration Training Centre, China Meteorological Administration, Beijing, China
| | - Lifang Wang
- School of Energy and Environment, Inner Mongolia University of Science and Technology, Baotou, China
| | - Zhijing Lin
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, China
| | - Chan Lu
- School of Energy Science and Engineering, Central South University, Changsha, China
| | - Han Wang
- Joint International Research Laboratory of Green Buildings and Built Environments (Ministry of Education), Chongqing University, Chongqing, China
| | - Juan Wang
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden
| | - Jiao Cai
- Joint International Research Laboratory of Green Buildings and Built Environments (Ministry of Education), Chongqing University, Chongqing, China
| | - Jialing Zhang
- School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, China
| | - Chanjuan Sun
- School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, China
| | - Jinhan Mo
- Department of Building Science, Tsinghua University, Beijing, China
- Beijing Key Laboratory of Indoor Air Quality Evaluation and Control, Tsinghua University, Beijing, China
| | | | - Dan Norbäck
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden
| | - Jan Sundell
- Department of Building Science, Tsinghua University, Beijing, China
- Beijing Key Laboratory of Indoor Air Quality Evaluation and Control, Tsinghua University, Beijing, China
- School of Environmental Science and Technology, Tianjin University, Tianjin, China
| | - Yinping Zhang
- Department of Building Science, Tsinghua University, Beijing, China
- Beijing Key Laboratory of Indoor Air Quality Evaluation and Control, Tsinghua University, Beijing, China
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Huang S, Wei W, Weschler LB, Salthammer T, Kan H, Bu Z, Zhang Y. Indoor formaldehyde concentrations in urban China: Preliminary study of some important influencing factors. Sci Total Environ 2017; 590-591:394-405. [PMID: 28291616 DOI: 10.1016/j.scitotenv.2017.02.187] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 02/16/2017] [Accepted: 02/23/2017] [Indexed: 06/06/2023]
Abstract
The Huai River and Qingling Mountain divide (H-Q) divide China into north and south with respect to public policies for building construction and operation practises. China's building energy efficiency standard mandates that air exchange rates be 0.5h-1 north of the H-Q divide and 1h-1 south of the divide. China's heating policy allows space heating systems only north of the H-Q divide. Consequently, indoor temperature and humidity differ considerably between north and south. A theoretical model using indoor temperature, humidity, and air change rate was developed to predict indoor formaldehyde concentrations. Data for 39 cities were obtained from 42 studies. There was good agreement between the literature and modelling in a theoretical reference room. The United States Environmental Protection Agency (U.S.EPA) model was applied to estimate cancer risk from formaldehyde exposure indoors. The median indoor formaldehyde concentration for renovation ever from 2002 to 2015 in Chinese cities was 125μg/m3, which is higher than the WHO threshold, 100μg/m3. The median indoor formaldehyde concentrations in the north were higher than in the south (0.5 times higher for dwellings renovated within the past year and 0.2 times higher for renovation ever), driven by the much higher northern winter concentrations (40-1320%). The U.S.EPA model predicts that the lifetime formaldehyde related cancer risk for people living north of the H-Q divide is 1.2 times greater than for people living south. This can be partly explained by greater indoor exposure to formaldehyde for Chinese living north of the H-Q divide.
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Affiliation(s)
- Shaodan Huang
- Department of Building Science, Tsinghua University, Beijing 100084, China; Beijing Key Lab of Indoor Air Quality Evaluation and Control, Beijing 100084, China; Department of Environmental Science, Harvard T.H. Chan School of Public Health, Boston 02115, USA
| | - Wenjuan Wei
- Department of Building Science, Tsinghua University, Beijing 100084, China; University of Paris-Est, Scientific and Technical Center for Building (CSTB), Health and Comfort Department, French Indoor Air Quality Observatory (OQAI), 84 Avenue Jean Jaurès, Champs sur Marne, 77447 Marne la Vallée Cedex 2, France
| | - Louise B Weschler
- Department of Building Science, Tsinghua University, Beijing 100084, China; Independent Researcher, 161 Richdale Road, Colts Neck, NJ 07722, USA
| | - Tunga Salthammer
- Fraunhofer WKI, Department of Material Analysis and Indoor Chemistry, 38108 Braunschweig, Germany
| | - Haidong Kan
- School of Public Health, Fudan University, Shanghai 200032, China
| | - Zhongming Bu
- Key Laboratory of Three Gorges Reservoir Region's Eco-Environment, Ministry of Education, Chongqing University, Chongqing 400045, China
| | - Yinping Zhang
- Department of Building Science, Tsinghua University, Beijing 100084, China; Beijing Key Lab of Indoor Air Quality Evaluation and Control, Beijing 100084, China.
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15
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Qu F, Weschler LB, Sun Y, Sundell J. High pneumonia lifetime-ever incidence in Beijing children compared with locations in other countries, and implications for national PCV and Hib vaccination. PLoS One 2017; 12:e0171438. [PMID: 28166256 PMCID: PMC5293229 DOI: 10.1371/journal.pone.0171438] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 01/20/2017] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES To compare the proportion of Beijing children who have ever had pneumonia (%Pneumonia) to those in other locations, and to estimate by how much national vaccine coverage with Pneumococcal Conjugate Vaccine (PCV) and Haemophilus Influenzae Type b (Hib) could reduce Beijing %Pneumonia. METHODS %Pneumonia was obtained for each age group from 1 to 8 years inclusive from 5,876 responses to a cross-sectional questionnaire. Literature searches were conducted for world-wide reports of %Pneumonia. Previous vaccine trials conducted worldwide were used to estimate the pneumococcal (S. pneumoniae) and Hib (H. influenzae) burdens and %Pneumonia as well as the potential for PCV and Hib vaccines to reduce Beijing children's %Pneumonia. FINDINGS The majority of pneumonia cases occurred by the age of three. The cumulative %Pneumonia for 3-8 year-old Beijing children, 26.9%, was only slightly higher than the 25.4% for the discrete 3 year-old age group, similar to trends for Tianjin (China) and Texas (USA). Beijing's %Pneumonia is disproportionally high relative to its Gross National Income (GNI) per capita, and markedly higher than %Pneumonia in the US and other high GNI per capita countries. Chinese diagnostic guidelines recommend chest X-ray confirmation while most other countries discourage it in favor of clinical diagnosis. Literature review shows that chest X-ray confirmation returns far fewer pneumonia diagnoses than clinical diagnosis. Accordingly, Beijing's %Pneumonia is likely higher than indicated by raw numbers. Vaccine trials suggest that national PCV and Hib vaccination could reduce Beijing's %Pneumonia from 26.9% to 19.7% and 24.9% respectively. CONCLUSION National PCV and Hib vaccination programs would substantially reduce Beijing children's pneumonia incidence.
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Affiliation(s)
- Fang Qu
- China Meteorological Administration Training Centre, China Meteorological Administration, Beijing, China
- Department of Building Science, Tsinghua University, Beijing, China
| | - Louise B. Weschler
- Independent Researcher, Colts Neck, New Jersey, United States of America
| | - Yuexia Sun
- School of Environmental Science and Engineering, Tianjin University, Tianjin, China
| | - Jan Sundell
- Department of Building Science, Tsinghua University, Beijing, China
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16
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Liu W, Huang C, Wang X, Cai J, Hu Y, Zou Z, Weschler LB, Shen L, Sundell J. Multimorbidities of asthma, allergies, and airway illnesses in childhood: Chance or not chance? J Asthma 2016; 54:687-698. [PMID: 27880051 DOI: 10.1080/02770903.2016.1263648] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES We investigated patterns of multimorbidities among asthma, allergies, and respiratory illnesses in preschool children. We investigated multimorbidities of lifetime asthma, allergic rhinitis, eczema, food allergy, pneumonia, and ear infections; and multimorbidities of current (in the last year before the survey) wheeze, dry cough, rhinitis, eczema, and common cold during childhood. We further analyzed whether prevalences of these multimorbidities were due to chance. METHODS A cross-sectional study was conducted in 72 kindergartens of Shanghai, China. Parents of preschool children were surveyed with a modified ISAAC questionnaire. Observed prevalences (OPs), expected prevalences (EPs), absolute excess comorbidities (AECs), and relative excess comorbidities (RECs) of various combinations of illnesses were calculated to indicate whether the combined illnesses were related. RESULTS We analyzed questionnaires for children aged 4-6 years, whose 13,335 questionnaires were the majority of the total 15,266 returned questionnaires (response rate: 85.3%). The studied illnesses were common. For children who had more than three lifetime or current illnesses, OPs tended to be higher than EPs. Most OPs and EPs were higher in boys than in girls, and were higher in children with a family history of atopy (FHA) than in children without FHA. AECs and RECs between boys and girls as well as between children with and without FHA were substantially different. CONCLUSIONS Our findings suggest that multimorbidities among childhood asthma, allergies, and respiratory illnesses are likely not random, but rather share etiology. Specific patterns of childhood asthma multimorbidities perhaps differ between boys and girls and between children with and without FHA.
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Affiliation(s)
- Wei Liu
- a Department of Building Environment and Energy Engineering , School of Environment and Architecture, University of Shanghai for Science and Technology , Shanghai , China
| | - Chen Huang
- a Department of Building Environment and Energy Engineering , School of Environment and Architecture, University of Shanghai for Science and Technology , Shanghai , China
| | - Xueying Wang
- a Department of Building Environment and Energy Engineering , School of Environment and Architecture, University of Shanghai for Science and Technology , Shanghai , China
| | - Jiao Cai
- a Department of Building Environment and Energy Engineering , School of Environment and Architecture, University of Shanghai for Science and Technology , Shanghai , China
| | - Yu Hu
- a Department of Building Environment and Energy Engineering , School of Environment and Architecture, University of Shanghai for Science and Technology , Shanghai , China
| | - Zhijun Zou
- a Department of Building Environment and Energy Engineering , School of Environment and Architecture, University of Shanghai for Science and Technology , Shanghai , China
| | | | - Li Shen
- a Department of Building Environment and Energy Engineering , School of Environment and Architecture, University of Shanghai for Science and Technology , Shanghai , China
| | - Jan Sundell
- a Department of Building Environment and Energy Engineering , School of Environment and Architecture, University of Shanghai for Science and Technology , Shanghai , China.,c Department of Building Science , Tsinghua University , Beijing , China
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Huang C, Liu W, Cai J, Weschler LB, Wang X, Hu Y, Zou Z, Shen L, Sundell J. Breastfeeding and timing of first dietary introduction in relation to childhood asthma, allergies, and airway diseases: A cross-sectional study. J Asthma 2016; 54:488-497. [PMID: 27603296 DOI: 10.1080/02770903.2016.1231203] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES We investigated associations of breastfeeding (BF) durations and patterns and of timing of other dietary introductions with prevalence of asthma, wheeze, hay fever, rhinitis, pneumonia, and eczema among preschool children. METHODS During April 2011-April 2012, we conducted a cross-sectional study in 72 kindergartens from five districts of Shanghai, China and obtained 13,335 questionnaires of children 4-6-years-old. We used multiple logistic regression models to evaluate the target associations. RESULTS Compared to children who were never BF, children who were exclusively breastfed 3-6 months had the lowest risk of asthma (adjusted odds ratio and 95% confidence interval: 0.81, 0.72-0.91) and wheeze (0.93, 0.87-0.99); and exclusive BF >6 months was significantly associated with a reduced risk of hay fever (0.93, 0.89-0.97), rhinitis (0.97, 0.94-0.99), pneumonia (0.97, 0.94-0.99), and eczema (0.96, 0.93-0.99). No significant associations were found between time when fruits or vegetables were introduced and the studied diseases. Associations were independent of the child's sex and parent's ownership of the current residence. Longer duration BF was only significantly protective when there was no family history of atopy. CONCLUSIONS This study suggests that heredity, but not sex and socioeconomic status, may negatively impact the effect of BF on childhood airway and allergic diseases. Our findings support China's national recommendation that mothers provide exclusive BF for the first four months, and continue partial BF for more than 6 months.
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Affiliation(s)
- Chen Huang
- a Department of Building Environment and Energy Engineering , School of Environment and Architecture, University of Shanghai for Science and Technology , Shanghai , China
| | - Wei Liu
- a Department of Building Environment and Energy Engineering , School of Environment and Architecture, University of Shanghai for Science and Technology , Shanghai , China
| | - Jiao Cai
- a Department of Building Environment and Energy Engineering , School of Environment and Architecture, University of Shanghai for Science and Technology , Shanghai , China
| | | | - Xueying Wang
- a Department of Building Environment and Energy Engineering , School of Environment and Architecture, University of Shanghai for Science and Technology , Shanghai , China
| | - Yu Hu
- a Department of Building Environment and Energy Engineering , School of Environment and Architecture, University of Shanghai for Science and Technology , Shanghai , China
| | - Zhijun Zou
- a Department of Building Environment and Energy Engineering , School of Environment and Architecture, University of Shanghai for Science and Technology , Shanghai , China
| | - Li Shen
- a Department of Building Environment and Energy Engineering , School of Environment and Architecture, University of Shanghai for Science and Technology , Shanghai , China
| | - Jan Sundell
- a Department of Building Environment and Energy Engineering , School of Environment and Architecture, University of Shanghai for Science and Technology , Shanghai , China.,c Department of Building Science , Tsinghua University , Beijing , China
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Huang C, Liu W, Hu Y, Zou Z, Zhao Z, Shen L, Weschler LB, Sundell J. Updated prevalences of asthma, allergy, and airway symptoms, and a systematic review of trends over time for childhood asthma in Shanghai, China. PLoS One 2015; 10:e0121577. [PMID: 25875829 PMCID: PMC4395352 DOI: 10.1371/journal.pone.0121577] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 01/23/2015] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The prevalence of asthma among Shanghai children has increased over time. This increase might be associated with changes in environmental exposures. Investigation of the time-trend of asthma and current prevalences is essential to understanding the causes. OBJECTIVE To estimate the current prevalences of asthma, allergies and other respiratory symptoms among Shanghai preschool children, and to investigate the time-trend of childhood asthma prevalence of from 1990 to 2011. METHODS From April 2011 to April 2012, the CCHH (China, Children, Homes, Health) cross-sectional study was conducted in Shanghai. Questionnaires were distributed to 17,898 parents or guardians of preschool children from 72 kindergartens in 5 districts. Previous similar studies were also summarized by a systematic literature review. RESULTS From a total of 14,884 questionnaires for 3-7 year old children, prevalences of the following diseases and symptoms were calculated: asthma 10.2%, wheeze (ever) 28.1%, pneumonia (ever) 33.5%, otitis media 11.0%, rhinitis (ever) 54.1%, hay fever 12.2%, eczema (ever) 22.7%, and food allergy 15.7%. Urban children had higher prevalences of most symptoms than suburban children. The prevalence of asthma has increased significantly, almost five-fold, from 2.1% in 1990 to 10.2% in the present study. The prevalence of asthma in boys was higher than in girls in the present study and in all reviewed studies. CONCLUSIONS Asthma, allergy and airway symptoms are common among preschool children in Shanghai. The prevalence of childhood asthma in Shanghai has increased rapidly from 1990 to 2011.
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Affiliation(s)
- Chen Huang
- Department of Building Environment and Energy Engineering, School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, PR China
| | - Wei Liu
- Department of Building Environment and Energy Engineering, School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, PR China
| | - Yu Hu
- Tongji Architectural Design (Group) Co. Ltd. (TJAD), Shanghai, PR China
| | - Zhijun Zou
- Department of Building Environment and Energy Engineering, School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, PR China
| | - Zhuohui Zhao
- Department of Environmental Health, School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, PR China
| | - Li Shen
- Department of Building Environment and Energy Engineering, School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, PR China
| | - Louise B. Weschler
- 161 Richdale Road, Colts Neck, New Jersey, 07722, United States of America
| | - Jan Sundell
- Department of Building Science, School of Architecture, Tsinghua University, Beijing, PR China
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Abstract
UNLABELLED Carbon dioxide (CO2 ) metabolically produced by humans has been widely used as a tracer gas for determining ventilation rates in occupied rooms. Among other necessities, the method requires good estimates of human CO2 generation rates. An empirically derived equation is widely used to calculate the CO2 generation rate. However, there are indications that this equation is not valid for young Chinese people. In this study, we measured the CO2 generation rate of 44 young Chinese people at two typical activity levels, quiet sitting and relaxed standing. We found that the commonly used empirical equation overpredicted CO2 generation rates, but could be corrected with a factor of 0.75 for Chinese females and of 0.85 for Chinese males. The variance for measured CO2 sitting was much smaller than for standing, and hence, we concluded that sitting yields more precise CO2 generation estimates. The relative contributions of sex, height, weight, and metabolic rate were analyzed. We concluded that the error in estimating metabolic rate is responsible for most of the difference in measured generation of CO2 from the empirical equation's predictions. PRACTICAL IMPLICATIONS The tracer gas method using CO2 generated by people is widely used to calculate ventilation rate. However, the empirically derived equation that is normally used to estimate CO2 generation rate is not suitable for young Chinese people at rest. To estimate the CO2 generation rate in Chinese people under low-activity conditions, the empirical equation should be multiplied by correction factors of 0.75 and 0.85 for females and males, respectively.
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Affiliation(s)
- M W Qi
- Department of Building Science, School of Architecture, Tsinghua University, Beijing, China
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Stuempfle KJ, Hoffman MD, Weschler LB, Rogers IR, Hew-Butler T. Race diet of finishers and non-finishers in a 100 mile (161 km) mountain footrace. J Am Coll Nutr 2012; 30:529-35. [PMID: 22331688 DOI: 10.1080/07315724.2011.10719999] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To determine if food and fluid intake is related to completion of a 161-km ultramarathon. METHODS Sixteen consenting runners in the Western States Endurance Run participated in the study. Race diets were analyzed using Nutritionist Pro software. Both total intake and intake by race segment (3 total) were evaluated. RESULTS Six of 16 subjects completed the race (finishers) in 27.0 ± 2.3 hours (mean ± SD). Non-finishers completed 96.5 ± 20.5 km in 17.0 ± 3.9 h. Overall consumption rates of kilocalories, carbohydrate, fat, and sodium were significantly greater (P < 0.05) in finishers (4.6 ± 1.7 kcal/kg/h, 0.98 ± 0.43 g carbohydrate/kg/h, 0.06 ± 0.03 g fat/kg/h, 10.2 ± 6.0 mg sodium/kg/h) versus non-finishers (2.5 ± 1.3 kcal/kg/h, 0.56 ± 0.32 g carbohydrate/kg/h, 0.02 ± 0.02 g fat/kg/h, 5.2 ± 3.0 mg sodium/kg/h). Kilocalorie, fat, fluid, and sodium consumption rates during segment 1 (first 48 km) were significantly greater in finishers than in non-finishers. CONCLUSIONS Completion of this 161-km race was related to greater fuel, fluid, and sodium consumption rates. However, intake ranges for the finishers were large, so factors other than race diet may have contributed to the successful completion of the race.
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Affiliation(s)
- Kristin J Stuempfle
- Health Sciences Department, Gettysburg College, Gettysburg, Pennsylvania 17325, USA.
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Weschler LB. Letter to the Editor: “The Edelman equation as it applies to acute and chronic hyponatremia”. Am J Physiol Regul Integr Comp Physiol 2012; 302:R896-7; author reply R898, R899-901. [DOI: 10.1152/ajpregu.00547.2011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Hoffman MD, Hew-Butler T, Stuempfle K, Weschler LB, Rogers IR. Oral versus Intravenous Hypertonic Saline in the Treatment of Exercise-Associated Hyponatremia Without Altered Mental Status. Med Sci Sports Exerc 2010. [DOI: 10.1249/01.mss.0000384826.41509.e0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Stuempfle K, Hoffman MD, Weschler LB, Rogers IR, Hew-Butler T. Food And Fluid Intake In Finishers And Non-finishers In A 160 Km Mountain Footrace. Med Sci Sports Exerc 2010. [DOI: 10.1249/01.mss.0000384819.03391.3a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Hew-Butler T, Stuempfle K, Weschler LB, Rogers IR, Hoffman MD. Sodium Balance In Finishers And Non-finishers Competing In A 161km Mountain Footrace. Med Sci Sports Exerc 2010. [DOI: 10.1249/01.mss.0000384821.11015.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Weschler LB. Comments on Baker et al.'s “Quantitative analysis of serum sodium concentration after prolonged running in the heat”. J Appl Physiol (1985) 2008; 105:1692; author reply 1693. [DOI: 10.1152/japplphysiol.zdg-8198.2008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Weschler LB. Last Word on Viewpoint: Sweat electrolyte concentrations obtained from within occlusive coverings are falsely high because sweat itself leaches skin electrolytes. J Appl Physiol (1985) 2008. [DOI: 10.1152/japplphysiol.90544.2008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Weschler LB. Sweat electrolyte concentrations obtained from within occlusive coverings are falsely high because sweat itself leaches skin electrolytes. J Appl Physiol (1985) 2008; 105:1376-7. [PMID: 18292300 DOI: 10.1152/japplphysiol.00924.2007] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Weschler LB. UNDER WHAT CONDITIONS IS INGESTED SODIUM RENDERED OSMOTICALLY INACTIVE? Am J Physiol Regul Integr Comp Physiol 2006; 291:R856-7; author reply R857-9. [PMID: 16627694 DOI: 10.1152/ajpregu.00135.2006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Abstract
This study assessed whether replacing sweat losses with sodium-free fluid can lower the plasma sodium concentration and thereby precipitate the development of hyponatremia. Ten male endurance athletes participated in one 1-h exercise pretrial to estimate fluid needs and two 3-h experimental trials on a cycle ergometer at 55% of maximum O2 consumption at 34°C and 65% relative humidity. In the experimental trials, fluid loss was replaced by distilled water (W) or a sodium-containing (18 mmol/l) sports drink, Gatorade (G). Six subjects did not complete 3 h in trial W, and four did not complete 3 h in trial G. The rate of change in plasma sodium concentration in all subjects, regardless of exercise time completed, was greater with W than with G (−2.48 ± 2.25 vs. −0.86 ± 1.61 mmol·l−1·h−1, P = 0.0198). One subject developed hyponatremia (plasma sodium 128 mmol/l) at exhaustion (2.5 h) in the W trial. A decrease in sodium concentration was correlated with decreased exercise time ( R = 0.674; P = 0.022). A lower rate of urine production correlated with a greater rate of sodium decrease ( R = −0.478; P = 0.0447). Sweat production was not significantly correlated with plasma sodium reduction. The results show that decreased plasma sodium concentration can result from replacement of sweat losses with plain W, when sweat losses are large, and can precipitate the development of hyponatremia, particularly in individuals who have a decreased urine production during exercise. Exercise performance is also reduced with a decrease in plasma sodium concentration. We, therefore, recommend consumption of a sodium-containing beverage to compensate for large sweat losses incurred during exercise.
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Abstract
In 1958, Edelman and colleagues empirically showed plasma sodium concentration ([Na+]p) to be primarily a function of the sum of exchangeable sodium and potassium (E) divided by total body water (TBW). Based on Edelman's equation, Nguyen and Kurtz derived an equation to show how [Na+]p changes as a function of TBW, change in TBW (DeltaTBW), and change in the sum of exchangeable sodium and potassium (DeltaE). Using the Nguyen-Kurtz equation, the present study examines the sensitivity of [Na+]p to these parameters: [Na+]p is very sensitive to DeltaTBW and moderately sensitive to DeltaE, and is modulated by TBW. For example, for a person with 50 L TBW, a net increase of 1L water lowers [Na+]p by 3.2 mEq/L, but for a person with 25 L TBW it lowers [Na+]p by 6.3 mEq/L (assuming initial [Na+]p is 140 mEq/L). In each case, a loss of 159 mEq of sodium plus potassium (roughly equivalent to 1.5 teaspoons of table salt) would be required to produce the same effect as the net increase of 1 L water. The present review demonstrates why fluid overload predominates over electrolyte loss in the aetiology of exercise-associated hyponatraemia (EAH), and why the excretion of electrolyte-dilute urine is highly effective in correcting EAH (nonetheless, loss of sodium and potassium is significant in long events in warm weather). Sports drinks will, if overconsumed, result in hyponatraemia. Administration of a sports drink to an athlete with fluid overload hyponatraemia further lowers [Na+]p and increases fluid overload. Administration of either a sports drink or normal (0.9%) saline increases fluid overload.
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