Viral bronchiolitis affects 20%-30% of infants; because there is no known effective treatment, it is important to identify risk factors that contribute to its pathogenesis. Although adequate folate ...intake during the periconceptional period prevents neural tube defects, animal data suggest that higher supplementation may be a risk factor for child respiratory diseases. Using a population-based retrospective cohort of 167,333 women and infants, born in 1995-2007 and enrolled in the Tennessee Medicaid program, we investigated the association between the filling of folic acid-containing prescriptions and infant bronchiolitis. We categorized women into the following 4 groups in relation to the first trimester: "none" (no prescription filled), "first trimester only," "after first trimester," and "both" (prescriptions filled both during and after the first trimester). Overall, 21% of infants had a bronchiolitis diagnosis, and 5% were hospitalized. Most women filled their first prescriptions after the fifth to sixth weeks of pregnancy, and most prescriptions contained 1,000 µg of folic acid. Compared with infants born to women in the "none" group, infants born to women in the "first trimester only" group had higher relative odds of bronchiolitis diagnosis (adjusted odds ratio = 1.17, 95% confidence interval: 1.11, 1.22) and greater severity (adjusted odds ratio = 1.16, 95% confidence interval: 1.11, 1.22). This study's findings contribute to an understanding of the implications of prenatal nutritional supplement recommendations for infant bronchiolitis.
Objectives
To examine the association between dietary factors to daily activity energy expenditure (DAEE) and mortality among older adults.
Design and setting
A sub-study of Health, Aging, and Body ...Composition study.
Participants
298 older participants (aged 70–82 years) in the Health, Aging, and Body Composition Energy Expenditure sub-study.
Measurements
Dietary factors, DAEE, and all-cause mortality were measured in 298 older participants. Dietary factors include dietary intake assessed by the Block Food Frequency Questionnaire (FFQ), Healthy Eating Index (HEI), and self-reported appetite and enjoyment of eating. DAEE was assessed using doubly labeled water. All-cause mortality was evaluated over a 9 year period.
Results
Participants in the highest tertile of DAEE were more likely to be men and to report having a ‘good’ appetite; BMI among men, proportion married, IL-6 and CRP levels and energy intake were also higher. Fewer black participants were in the ‘good’ HEI category. Participants in the ‘good’ HEI category had higher cognitive scores and a higher education level. Participants who reported improvement in their appetite as well as participants who reported a ‘good’ appetite were at lower risk for mortality (HR (95% CI): 0.42 (0.24–0.74) and 0.50 (0.26–0.88), respectively) even after adjusting for DAEE, demographic, nutritional and health indices.
Conclusions
We showed an association between DAEE and appetite and mortality among well-functioning, community-dwelling older adults. These findings may have some practical use for the health providers. Inclusion of a question regarding appetite of an elderly patient may provide important information regarding risk for health deterioration and mortality.
Background. Obesity increases the risk for functional decline in later years, but the functional consequences of weight change in older adults are currently unclear. The aim of this study was to ...determine whether weight, weight change, and weight change intention are associated with risk for mobility limitation in elderly persons. Methods. This study included 2932 well-functioning black and white men and women aged 70 to 79 years, participating in the Health, Aging and Body Composition (Health ABC) Study, who were followed for 30 months. At baseline, reported weight change of 5 or more pounds during the previous year and weight change intention were assessed. Mobility limitation was defined as reported difficulty or inability to walk one-quarter mile or to climb 10 steps during two consecutive semiannual assessments during a period of 30 months. Results. Approximately 30% of participants developed mobility limitation. Higher body mass index (BMI) was associated with increased risk for mobility limitation. Unintentional weight loss in the previous year was associated with increased risk for mobility limitation in the extremely obese, which was defined as BMI ≥ 35 (hazard ratios HR, = 3.79; 95% confidence interval CI, 1.84–7.79), and the normal BMI, which was defined as BMI < 25 (HR, 2.55; 95% CI, 1.80–3.60). In persons with BMI 25 to 29.9, intentional weight loss (HR, 1.59; 95% CI, 1.12–2.25) and weight fluctuation with any intention (HR, 1.59; 95% CI, 1.10–2.28) increased the risk for mobility limitation. Unintentional weight gain or fluctuation did not confer additional risk for mobility limitation compared with weight stability, regardless of the level of body weight. Conclusion. In this cohort of well-functioning elderly persons, functional consequences of past weight change depended on the type of weight change, intentionality, and current measured body weight.
Background: Adequate intakes of fruit and vegetables are recommended for optimum health in children. Objective: The objective of this study was to determine whether consuming fruit and vegetables >3 ...times per day is beneficial to bone mass in children. Design: Fifty-six white females (Tanner stage 2) recorded dietary intake on 3 independent days. The numbers of servings of fruit and vegetables were recorded for each day and tallied, and the subjects were divided into 2 consumption groups for analysis (low consumption: <3 servings/d, n = 22; high consumption: greater than or equal to 3 servings/d, n = 34). Bone area and the bone mineral content of the whole body and radius were assessed by using dual-energy X-ray absorptiometry. Radioimmunoassays measured serum parathyroid hormone and 25-hydroxyvitamin D. Twenty-four-hour urine samples were assessed for calcium, sodium, and creatinine. Results: After adjustment for age, body mass index, and physical activity, those children who reported consuming greater than or equal to 3 servings fruit and vegetables/d had more bone area of the whole body (6.0%; P = 0.03) and radius (8.3%; P = 0.03), lower urinary calcium excretion (2.6 +/- 0.2 compared with 1.8 +/- 0.3 mg/kg; P = 0.04), and lower parathyroid hormone (19.6 +/- 1.9 compared with 25.0 +/- 1.6 pg/mL; P = 0.01) than did those children who reported consuming <3 servings fruit and vegetables/d. Conclusions: High fruit and vegetable intakes have beneficial effects on the bone area of the radius and whole body in early pubertal girls. The lower urinary calcium output associated with higher fruit and vegetable intakes may be a modulating factor.
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.
Objective
To determine whether there is an association between body mass index (BMI) and body esteem in young overweight and obese urban children, and to test peer relationship difficulties and ...perceived physical health as mediators of this relationship.
Methods
Child self‐reported body esteem, and parent‐reported child peer relationship difficulties (being bullied by peers and peer rejection) and physical health perceptions were obtained from 218 overweight and obese children aged 5–7 years (81% racial/ethnic minority, M BMI = 25.3) and their primary caregivers.
Results
Higher BMI was associated with lower body esteem for both girls and boys. This relation was mediated by poor physical health for boys but not for girls. Peer relationship difficulties did not mediate the observed association between BMI and body esteem in either group; however, girls with higher BMI experienced more bullying and being bullied by peers was associated with lower body esteem in girls.
Conclusions
Intervening with perceptions of physical health may buffer overweight and obese boys from developing low body esteem in early childhood.
The association between type 2 diabetes, BMD, and bone volume was examined to determine the effect of lean and fat mass and fasting insulin in the Health, Aging, and Body Composition Study, which ...included white and black well‐functioning men and women 70‐79 years of age (N = 2979). Diabetes predicted higher hip, whole body, and volumetric spine BMD, and lower spine bone volume, independent of body composition and fasting insulin.
Introduction: The purpose of this study was to determine if the association between type 2 diabetes and higher BMD observed in older white women is seen in elderly white men and blacks and to evaluate if higher BMD in diabetic individuals is accounted for by lean mass, fat mass, or fasting insulin differences.
Materials and Methods: In the Health, Aging, and Body Composition Study, which included white and black well‐functioning men and women 70‐79 years of age (N = 2979), 19% of participants had diabetes at baseline. Of those with diabetes, 57% were men, and 62% were black. Multivariate linear regression models examined independent effects of diabetes, lean mass, fat mass, visceral fat, and fasting insulin on BMD and bone volume while adjusting for relevant covariates.
Results and Conclusions: Fasting insulin, visceral fat, and volumetric spine BMD, assessed by CT, and lean mass, fat mass, and total hip and whole body BMD, assessed by DXA, were higher (p ≤ 0.05 for all) for those with diabetes. Hip BMD was higher in white men (0.99 ± 0.14 versus 0.93 ± 0.14 g/cm2, p < 0.001), black men (1.06 ± 0.17 versus 1.00 ± 0.15 g/cm2, p < 0.001), white women (0.83 ± 0.13 versus 0.76 ± 0.13 g/cm2, p < 0.001), and black women (0.90 ± 0.15 versus 0.85 ± 0.15 g/cm2, p < 0.001) with diabetes compared with those without diabetes, although the relationship was attenuated by body composition. In multiple regression models, diabetes was an independent predictor of higher hip, whole body, and volumetric spine BMD in all participants (p ≤ 0.001), but lower spine volume (p = 0.01) and higher hip BMD for each race‐gender group (p ≤ 0.01). Type 2 diabetes was associated with a 4‐5% higher total hip BMD in all race‐gender groups of elderly adults, independent of body composition and fasting insulin levels.
Introduction: Effective methods for assessing visceral fat are important to investigate the role of visceral fat for the increased health risks in obesity. Techniques for direct measurement of soft ...tissue composition such as CT or MRI are expensive, time-consuming or require a relatively high radiation dose. Simple anthropometric methods, such as waist-to-hip ratio, waist circumference or sagittal diameter are widely used. However, these methods cannot differentiate between visceral and subcutaneous fat and are less accurate. The aim of the present study is to investigate whether the dual-energy X-ray absorptiometry (DXA) method, possibly combined with anthropometry, offers a good alternative to CT for the prediction of visceral fat in the elderly. Methods: Subjects were participants in the Health ABC-study, a cohort study of black and white men and women aged 70-79, investigating the effect of weight-related health conditions on disablement. Total body fat and trunk fat were measured by DXA using a Hologic QDR 1500. A 10 mm CT scan at the L4-L5 level was acquired to measure visceral fat and total abdominal fat. Weight, height, sagittal diameter and waist circumference were measured using standard methods. Fat in a manually defined DXA subregion (4 cm slice at the top of iliac crest) at the abdomen was calculated in a sub-group of participants (n=150; 50% male; 45.3% Afro-American/54.7% Caucasian, age 70-79 y). This subregion, the standard trunk region and total fat were used as indicators of visceral fat. Results: Total abdominal fat by DXA (subregion) was strongly correlated with total abdominal fat by CT (r ranging from 0.87 in white men to 0.98 in black women). The DXA subregion underestimated total abdominal fat by 10% compared to the CT slice. The underestimation by DXA was seen especially in people with less abdominal fat. The association of visceral fat by CT with the DXA subregion (r=0.66, 0.78, 0.79 and 0.65 for white and black men and women, respectively) was comparable with the association of the CT measure with the sagittal diameter (r=0.74, 0.70, 0.84 and 0.68). Combining DXA measurements with anthropometry gave only limited improvement for the prediction of visceral fat by CT compared to univariate models (maximal increase of r2 4%). Conclusion: DXA is a good alternative to CT for predicting total abdominal fat in an elderly population. For the prediction of visceral fat the sagittal diameter, which has a practical advantage compared to DXA, is just as effective.
Type 2 diabetes may be associated with elevated fracture risk, but the impact on bone loss is unknown. Analysis of 4‐year change in hip BMD data from a cohort of white and black well‐functioning men ...and women 70‐79 years of age found that white women with diabetes had more rapid bone loss at the femoral neck than those with normal glucose metabolism.
Introduction: Type 2 diabetes may be associated with elevated fracture risk in older adults. Although type 2 diabetes is not associated with lower BMD, older diabetic adults have a higher prevalence of other risk factors for fracture, including more frequent falls, functional limitations, and diabetic complications. With this burden of risk factors, loss of BMD could place older adults with diabetes at higher risk of sustaining a fracture.
Materials and Methods: To determine if bone loss is increased with type 2 diabetes, we analyzed data from the Health, Aging, and Body Composition Study of white and black well‐functioning men and women 70‐79 years of age. Hip BMD was measured at baseline and 4 years later in 480 (23%) participants with diabetes, 439 with impaired glucose metabolism, and 1172 with normal glucose homeostasis (NG).
Results: Those with diabetes had higher baseline hip BMD and weight, but among white women, had more weight loss over 4 years. White women with diabetes lost more femoral neck and total hip BMD than those with NG in age‐adjusted models. After multivariable adjustment, diabetes was associated with greater loss of femoral neck BMD (−0.32%/year; 95% CI: −0.61, −0.02) but not total hip BMD. In men and black women, change in hip BMD was similar for participants with diabetes and NG.
Conclusions: Despite having higher baseline BMD, diabetic white women, but not men or black women, had more rapid bone loss at the femoral neck than those with NG. This increased bone loss may contribute to the higher fracture risk observed in older diabetic women.
Objectives: To determine the prevalence of and risk factors for hearing loss in a sample of 2,052 older adults (aged 73–84; 46.9% male, 37.3% black) enrolled in the Health, Aging and Body Composition ...(Health ABC) Study.
Design: Cross‐sectional analysis of a longitudinal cohort study.
Setting: Pittsburgh, Pennsylvania, and Memphis, Tennessee, areas.
Participants: Random sample of Medicare beneficiary subjects enrolled in the Health ABC program from 1997 to 1998. They included 2,052 individuals: 660 white men (32.2%), 631 white women (30.8%), 310 black men (15.1%), and 451 black women (22.0%). Participants ranged in age from 73 to 84, with a mean age of 77.5.
Measurements: Hearing sensitivity was measured using pure‐tone threshold testing. Hearing loss was defined based on two averages of hearing thresholds: 500, 1,000, and 2,000 Hz greater than 25‐decibel (dB) hearing level (HL) (hearing loss); and 2,000, 4,000, and 8,000 Hz greater than 40‐dB HL (high‐frequency hearing loss). Potential hearing loss correlates, including demographics, medical history, ototoxic medication use, occupational noise exposure, and lifestyle factors, were collected via questionnaire.
Results: The prevalence of hearing loss was 59.9%; the prevalence of high‐frequency hearing loss was 76.9%. Hearing loss was most common in white men, followed by white women, black men, and black women. Older age, white race, diabetes mellitus, cerebrovascular disease, smoking, poorer cognitive status, occupational noise exposure, and ear surgery were associated with hearing loss after multivariable adjustment. Race‐ and sex‐specific risk factors included higher blood pressure and occupational noise exposure (white men), poorer cognitive status and smoking (black women), and low total hip bone mineral density (black men). Possible protective factors included salicylate use (overall sample, black men) and moderate alcohol intake (black women).
Conclusion: Hearing loss was extremely common in this population. Because many of the identified hearing loss risk factors are modifiable, some of the burden associated with hearing loss in older people should be preventable.
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