Prenatal fish intake is a key source of omega-3 (ω-3) polyunsaturated fatty acids needed for brain development, yet intake is generally low, and studies addressing associations with autism spectrum ...disorder (ASD) and related traits are lacking.
This study aimed to examine associations of prenatal fish intake and ω-3 supplement use with both autism diagnosis and broader autism-related traits.
Participants were drawn from 32 cohorts in the Environmental influences on Child Health Outcomes Cohort Consortium. Children were born between 1999 and 2019 and part of ongoing follow-up with data available for analysis by August 2022. Exposures included self-reported maternal fish intake and ω-3/fish oil supplement use during pregnancy. Outcome measures included parent report of clinician-diagnosed ASD and parent-reported autism-related traits measured by the Social Responsiveness Scale (SRS)-second edition (n = 3939 and v3609 for fish intake analyses, respectively; n = 4537 and n = 3925 for supplement intake analyses, respectively).
In adjusted regression models, relative to no fish intake, fish intake during pregnancy was associated with reduced odds of autism diagnosis (odds ratio: 0.84; 95% confidence interval CI: 0.77, 0.92), and a modest reduction in raw total SRS scores (β: −1.69; 95% CI: −3.3, −0.08). Estimates were similar across categories of fish consumption from “any” or “less than once per week” to “more than twice per week.” For ω-3 supplement use, relative to no use, no significant associations with autism diagnosis were identified, whereas a modest relation with SRS score was suggested (β: 1.98; 95% CI: 0.33, 3.64).
These results extend previous work by suggesting that prenatal fish intake, but not ω-3 supplement use, may be associated with lower likelihood of both autism diagnosis and related traits. Given the low-fish intake in the United States general population and the rising autism prevalence, these findings suggest the need for better public health messaging regarding guidelines on fish intake for pregnant individuals.
Objective
The aim of this study was to describe the association of individual‐level characteristics (sex, race/ethnicity, birth weight, maternal education) with child BMI within each US Census region ...and variation in child BMI by region.
Methods
This study used pooled data from 25 prospective cohort studies. Region of residence (Northeast, Midwest, South, West) was based on residential zip codes. Age‐ and sex‐specific BMI z scores were the outcome.
Results
The final sample included 14,313 children with 85,428 BMI measurements, 49% female and 51% non‐Hispanic White. Males had a lower average BMI z score compared with females in the Midwest (β = −0.12, 95% CI: −0.19 to −0.05) and West (β = −0.12, 95% CI: −0.20 to −0.04). Compared with non‐Hispanic White children, BMI z score was generally higher among children who were Hispanic and Black but not across all regions. Compared with the Northeast, average BMI z score was significantly higher in the Midwest (β = 0.09, 95% CI: 0.05 to 0.14) and lower in the South (β = −0.12, 95% CI: −0.16 to −0.08) and West (β = −0.14, 95% CI: −0.19 to −0.09) after adjustment for age, sex, race/ethnicity, and birth weight.
Conclusions
Region of residence was associated with child BMI z scores, even after adjustment for sociodemographic characteristics. Understanding regional influences can inform targeted efforts to mitigate BMI‐related disparities among children.
Phthalates are synthetic chemicals widely used in consumer products and have been identified to contribute to preterm birth. Existing studies have methodological limitations and potential effects of ...di-2-ethylhexyl phthalate (DEHP) replacements are poorly characterised. Attributable fractions and costs have not been quantified, limiting the ability to weigh trade-offs involved in ongoing use. We aimed to leverage a large, diverse US cohort to study associations of phthalate metabolites with birthweight and gestational age, and estimate attributable adverse birth outcomes and associated costs.
In this prospective analysis we used extant data in the US National Institutes of Health Environmental influences on Child Health Outcomes (ECHO) Program from 1998 to 2022 to study associations of 20 phthalate metabolites with gestational age at birth, birthweight, birth length, and birthweight for gestational age z-scores. We also estimated attributable adverse birth outcomes and associated costs. Mother–child dyads were included in the study if there were one or more urinary phthalate measurements during the index pregnancy; data on child's gestational age and birthweight; and singleton delivery.
We identified 5006 mother–child dyads from 13 cohorts in the ECHO Program. Phthalic acid, diisodecyl phthalate (DiDP), di-n-octyl phthalate (DnOP), and diisononyl phthalate (DiNP) were most strongly associated with gestational age, birth length, and birthweight, especially compared with DEHP or other metabolite groupings. Although DEHP was associated with preterm birth (odds ratio 1·45 95% CI 1·05–2·01), the risks per log10 increase were higher for phthalic acid (2·71 1·91–3·83), DiNP (2·25 1·67–3·00), DiDP (1·69 1·25–2·28), and DnOP (2·90 1·96–4·23). We estimated 56 595 (sensitivity analyses 24 003–120 116) phthalate-attributable preterm birth cases in 2018 with associated costs of US$3·84 billion (sensitivity analysis 1·63– 8·14 billion).
In a large, diverse sample of US births, exposure to DEHP, DiDP, DiNP, and DnOP were associated with decreased gestational age and increased risk of preterm birth, suggesting substantial opportunities for prevention. This finding suggests the adverse consequences of substitution of DEHP with chemically similar phthalates and need to regulate chemicals with similar properties as a class.
National Institutes of Health.
Societal changes during the COVID-19 pandemic may affect children's health behaviors and exacerbate disparities. This study aimed to describe children's health behaviors during the COVID-19 pandemic, ...how they vary by sociodemographic characteristics, and the extent to which parent coping strategies mitigate the impact of pandemic-related financial strain on these behaviors.
This study used pooled data from 50 cohorts in the Environmental influences on Child Health Outcomes Program. Children or parent proxies reported sociodemographic characteristics, health behaviors, and parent coping strategies.
Of 3315 children aged 3-17 years, 49% were female and 57% were non-Hispanic white. Children of parents who reported food access as a source of stress were 35% less likely to engage in a higher level of physical activity. Children of parents who changed their work schedule to care for their children had 82 fewer min/day of screen time and 13 more min/day of sleep compared with children of parents who maintained their schedule. Parents changing their work schedule were also associated with a 31% lower odds of the child consuming sugar-sweetened beverages.
Parents experiencing pandemic-related financial strain may need additional support to promote healthy behaviors. Understanding how changes in parent work schedules support shorter screen time and longer sleep duration can inform future interventions.
Coronary heart disease is the major cause of morbidity and mortality throughout the world, and is responsible for approximately one of every six deaths in the US. Angina pectoris is a clinical ...syndrome characterized by discomfort, typically in the chest, neck, chin, or left arm, induced by physical exertion, emotional stress, or cold, and relieved by rest or nitroglycerin. The main goals of treatment of stable angina pectoris are to improve quality of life by reducing the severity and/or frequency of symptoms, to increase functional capacity, and to improve prognosis. Ranolazine is a recently developed antianginal with unique methods of action. In this paper, we review the pharmacology of ranolazine, clinical trials supporting its approval for clinical use, and studies of its quality of life benefits. We conclude that ranolazine has been shown to be a reasonable and safe option for patients who have refractory ischemic symptoms despite the use of standard medications (for example, nitrates, beta-adrenergic receptor antagonists, and calcium channel antagonists) for treatment of anginal symptoms, and also provides a modestly improved quality of life.
Obesity has increased > 20% in the past decade in the United States, and more than one-half of US adults are overweight or obese.
Our objective was to further elucidate the nutritional etiology of ...changes in body mass index (BMI; in kg/m(2)) and waist circumference by dietary intake pattern. We hypothesized that a healthy dietary pattern would lead to smaller changes in BMI and waist circumference than would other dietary patterns.
Subjects were 459 healthy men and women participating in the ongoing Baltimore Longitudinal Study of Aging. Diet was assessed with the use of 7-d dietary records, from which 41 food groups were created and entered into a cluster analysis.
Five dietary patterns were derived (healthy, white bread, alcohol, sweets, and meat and potatoes). The mean annual change in BMI was 0.30 +/- 0.06 for subjects in the meat-and-potatoes cluster and 0.05 +/- 0.06 for those in the healthy cluster (P < 0.01). The mean annual change in waist circumference was more than 3 times as great for subjects in the white-bread cluster (1.32 +/- 0.29 cm) as for those in the healthy cluster (0.43 +/- 0.27 cm) (P < 0.05).
Consuming a diet high in fruit, vegetables, reduced-fat dairy, and whole grains and low in red and processed meat, fast food, and soda was associated with smaller gains in BMI and waist circumference. Because foods are not consumed in isolation, dietary pattern research based on natural eating behavior may be useful in understanding dietary causes of obesity and in helping individuals trying to control their weight.
Glycoprotein IIb/IIIa inhibitors are indicated in patients with acute coronary syndromes who are undergoing an invasive procedure. The optimal timing of the initiation of such therapy is unknown.
We ...compared a strategy of early, routine administration of eptifibatide with delayed, provisional administration in 9492 patients who had acute coronary syndromes without ST-segment elevation and who were assigned to an invasive strategy. Patients were randomly assigned to receive either early eptifibatide (two boluses, each containing 180 microg per kilogram of body weight, administered 10 minutes apart, and a standard infusion > or = 12 hours before angiography) or a matching placebo infusion with provisional use of eptifibatide after angiography (delayed eptifibatide). The primary efficacy end point was a composite of death, myocardial infarction, recurrent ischemia requiring urgent revascularization, or the occurrence of a thrombotic complication during percutaneous coronary intervention that required bolus therapy opposite to the initial study-group assignment ("thrombotic bailout") at 96 hours. The key secondary end point was a composite of death or myocardial infarction within the first 30 days. Key safety end points were bleeding and the need for transfusion within the first 120 hours after randomization.
The primary end point occurred in 9.3% of patients in the early-eptifibatide group and in 10.0% in the delayed-eptifibatide group (odds ratio, 0.92; 95% confidence interval CI, 0.80 to 1.06; P=0.23). At 30 days, the rate of death or myocardial infarction was 11.2% in the early-eptifibatide group, as compared with 12.3% in the delayed-eptifibatide group (odds ratio, 0.89; 95% CI, 0.79 to 1.01; P=0.08). Patients in the early-eptifibatide group had significantly higher rates of bleeding and red-cell transfusion. There was no significant difference between the two groups in rates of severe bleeding or nonhemorrhagic serious adverse events.
In patients who had acute coronary syndromes without ST-segment elevation, the use of eptifibatide 12 hours or more before angiography was not superior to the provisional use of eptifibatide after angiography. The early use of eptifibatide was associated with an increased risk of non-life-threatening bleeding and need for transfusion. (ClinicalTrials.gov number, NCT00089895.)
Sixty-five percent of US adults are overweight, and 31% of these adults are obese. Obesity results from weight gains over time; however, dietary determinants of weight gain remain controversial.
Our ...objective was to examine whether food patterns derived from exploratory factor analysis are related to anthropometric changes. We hypothesized that we would derive a healthy food pattern and that it would predict smaller changes in body mass index (BMI; in kg/m(2)) and waist circumference (in cm) than would other food patterns in models adjusted for baseline anthropometric measures.
The subjects were 459 healthy men and women participating in the Baltimore Longitudinal Study of Aging. Diet was assessed by using 7-d dietary records, from which 40 food groups were formed and entered into a factor analysis.
Six food patterns were derived. Factor 1 (reduced-fat dairy products, fruit, and fiber) was most strongly associated with fiber (r = 0.39) and loaded heavily on reduced-fat dairy products, cereal, and fruit and loaded moderately on fruit juice, nonwhite bread, nuts and seeds, whole grains, and beans and legumes. In a multivariate-adjusted model in which the highest and lowest quintiles were compared, factor 1 was inversely associated with annual change in BMI (beta = -0.51; 95% CI: -0.82, -0.20; P < 0.05; P for trend < 0.01) in women and inversely associated with annual change in waist circumference (beta = -1.06 cm; 95% CI: -1.88, -0.24 cm; P < 0.05; P for trend = 0.04) in both sexes.
Our results suggest that a pattern rich in reduced-fat dairy products and high-fiber foods may lead to smaller gains in BMI in women and smaller gains in waist circumference in both women and men.
The prevalence of obesity is increasing in most parts of the world. The objective of this study was to examine whether changes in food patterns were associated with changes in BMI among women over 9 ...y. Data were from 33,840 women participating in the Swedish Mammography Cohort in 1987 and 1997. Diet was assessed with a FFQ at both time points and 4 food patterns were derived using confirmatory factor analysis (Healthy, Western/Swedish, Alcohol, and Sweets). Our exposure variables were defined as change in factor score for each food pattern from 1987 to 1997. Our outcome variable was defined as change in BMI during the same period, and we also examined change in weight. Normal weight and overweight women had positive changes in weight and BMI during follow-up, whereas obese women had negative changes in BMI and weight; we observed a significant interaction between change in food patterns and baseline BMI. Obese subjects who increased their factor score for the Healthy pattern had larger decreases in BMI (β = -0.18 kg/m2 for a 1 unit increase in SD score, CI: -0.26 to -0.10; P < 0.0001), whereas normal weight and overweight women who increased their Healthy pattern score had smaller increases in BMI (-0.05 kg/m2 and -0.11 kg/m2, respectively; P < 0.05 for both). Obese women who increased their Healthy pattern score >3 SD had almost a 4 kg decrease in weight and a 1 unit decrease in BMI at follow-up. In conclusion, changes in eating patterns were significantly related to changes in BMI over 9 y and the effect was modified by baseline BMI. Pattern analysis is helpful in generating hypotheses regarding the role of diet in obesity, and additional research is needed to understand which elements of our patterns are protective or risk factors for weight gain.
Limited data exist on the reproducibility of food patterns measured by factor analysis as well as on the use of stability of patterns over time. Our primary objective was to explore the long-term ...stability of food patterns derived by confirmatory factor analysis among 33,840 women participating in the Swedish Mammography Cohort. Our secondary objective was to compare factor solutions from confirmatory factor analysis with those derived by use of exploratory factor analysis. Diet was assessed by a food frequency questionnaire in 1987 and 1997, and food patterns were derived by the use of exploratory and confirmatory factor analysis. We observed four major food patterns (Healthy, Western/Swedish, Alcohol, and Sweets) at both time points. Correlations between confirmed food patterns in 1987 and 1997 were 0.37 for the Healthy pattern, 0.27 for the Western/Swedish pattern, 0.54 for the Alcohol pattern, and 0.44 for the Sweets pattern (P < 0.0001 for all associations). Patterns derived by the use of exploratory factor analysis were strongly associated with those derived by the use of confirmatory factor analysis (r >/= 0.90, P < 0.0001, for all associations). The patterns derived in this study were similar to those derived in other studies, indicating reproducibility of food patterns across populations. Our study suggests that food patterns measured by the use of confirmatory factor analysis are reproducible over time, and weaker correlations observed may reflect natural changes in eating behavior, the food supply, and/or perceptions of what is considered healthy. Testing whether patterns measured over a long time period can be used in analytic studies is the next step in assessing the validity of this method.
PDF
