Altered Sex Ratio at Birth with Maternal Exposure to Dioxins in Vietnamese Infants

Excess female births (lower sex ratio at birth) associated with paternal exposure to 2,3,7,8-tetrachlordibenzo-p-dioxin (TCDD) have been reported in Italy. However, no significant effects of maternal TCDD exposure on the sex ratio were reported. We investigated the effects of maternal TCDD exposure and the toxic equivalent quantity of polychlorinated dibenzo-p-dioxins/dibenzofurans (TEQ-PCDD/Fs) on the sex ratio at birth in 576 Vietnamese infants from three birth cohorts. TCDD and TEQ-PCDD/Fs in breast milk were stratified (low, mild, moderate, and high) as maternal exposure markers. Logistic regression analysis was used to investigate associations between female birth and dioxin exposure groups after adjusting for confounders. In sprayed and unsprayed areas, adjusted odds ratios (ORs) of female birth (reference: low-TCDD group) were 2.11 in the moderate-TCDD group and 2.77 in the high-TCDD group, which were significantly associated with increased TCDD exposure. In sprayed areas, a significantly increased OR in the high-TCDD group was observed. No significant associations, however, were found between having a girl and TEQ-PCDD/F levels. These results suggest that maternal TCDD exposure may alter the sex ratio at birth among Vietnamese residents of areas with high dioxin contamination.

The role of zinc on nutritional status, sarcopenia, and frailty in older adults: a scoping review

BACKGROUND

Zinc (Zn) deficiency, malnutrition, sarcopenia, and frailty are prevalent among older adults and are prominent factors contributing to disability and mortality.

OBJECTIVE

This scoping review was conducted to aid understanding of the extent and types of research addressing the role of Zn in nutritional status, sarcopenia, and frailty, among older individuals.

METHOD

A systematic search was performed in August 2022 of 3 electronic databases (PubMed, Web of Science, and ProQuest) using predefined search terms. The review was conducted referring to the Arksey and O'Malley framework and PRISMA-ScR.

RESULTS

The search retrieved 16 018 records, and a total of 49 studies were included in this review after the screening. Of those, 30 were based on dietary Zn intake, 18 on tissue Zn levels, and 1 on both. Most studies were based on cross-sectional data from community-dwelling older adults. Studies addressing the associations between Zn status and individual anthropometric and sarcopenia-related variables reported inconsistent results. However, most studies reported inverse associations between malnutrition, frailty, and Zn status.

CONCLUSION

There was more consistent evidence of the relationship of Zn status with malnutrition, sarcopenia, and frailty rather than with individual nutritional parameters. Validated screening and assessment tools and criteria and prospective studies are required to elucidate the relationship of Zn with sarcopenia and frailty in the older population.

Combined changes in albuminuria and kidney function and subsequent risk for kidney failure in type 2 diabetes

INTRODUCTION

Changes in albuminuria or estimated glomerular filtration rate (eGFR) can be used as a surrogate endpoint of end-stage kidney disease (ESKD) in people with type 2 diabetes. We investigated whether the combined changes in albuminuria and eGFR are more strongly associated with future risk of ESKD.

RESEARCH DESIGN AND METHODS

Using data from a multicenter observational cohort study of people with type 2 diabetes, we evaluated the association of percentage change in urine albumin to creatinine ratio (UACR) and/or annual change in eGFR over 2 years with subsequent ESKD risk.

RESULTS

Among 1417 patients with repeated albuminuria and eGFR over 2 years, 129 (9.1%) developed ESKD. Patients with >30% UACR decline had lower ESKD risk (HR 0.47; 95% CI 0.29 to 0.77), whereas those with >30% UACR increase had higher ESKD risk (HR 2.31; 95% CI 1.52 to 3.51), compared with those with minor UACR change. Patients with greater eGFR decline had an increased ESKD risk than those with minor eGFR change (a decline of <2.5 mL/min/1.73 m²/year): HR 4.19 (95% CI 1.87 to 9.38) and 2.89 (95% CI 1.32 to 6.33) for those with a decline of >5 and 2.5-5 mL/min/1.73 m²/year, respectively. When the combined changes in UACR and eGFR were used, the highest ESKD risk (HR 5.60; 95% CI 2.08 to 15.09) was observed among patients with >30% UACR increase and an eGFR decline of >5 mL/min/1.73 m²/year compared with those with a minor change in UACR and eGFR.

CONCLUSIONS

Combined changes in albuminuria and eGFR over 2 years were strongly associated with future risk of kidney failure in patients with type 2 diabetes.