Faculty Bibliography

Cadmium (Cd) is a toxic metal associated with adverse health effects, including kidney injury or disease. The aims of this study were to estimate dietary Cd exposure during childhood, and to evaluate the association of early-life dietary Cd with biomarkers of glomerular kidney function in 9-year-old Mexican children. Our study included 601 children from the Programming Research in Obesity, Growth, Environment and Social Stressors (PROGRESS) cohort with up to five follow-up food frequency questionnaires from 1 to 9 years of age; and 480 children with measures of serum creatinine, cystatin C, and blood nitrogen urea (BUN), as well as 9-year-old estimated glomerular filtration rate. Dietary Cd was estimated through food composition tables. Multiple linear regression models were used to analyze the association between 1 and 9 years, cumulative dietary Cd, and each kidney parameter. Dietary Cd exposure increased with age and exceeded the tolerable weekly intake (TWI = 2.5 µg/kg body weight) by 16-64% at all ages. Early-life dietary Cd exposure was above the TWI and we observed inverse associations between dietary Cd exposure and kidney function parameters. Additional studies are needed to assess kidney function trajectories through adolescence. Identifying preventable risk factors including environmental exposures in early life can contribute to decreasing the incidence of adult kidney disease.

Obesity is a risk factor for severe complications and death from the coronavirus disease 2019 (COVID-19). Public health efforts to control the pandemic may alter health behaviors related to weight gain, inflammation, and poor cardiometabolic health, exacerbating the prevalence of obesity, poor immune health, and chronic diseases. We reviewed how the pandemic adversely influences many of these behaviors, specifically physical activity, sedentary behaviors, sleep, and dietary intakes, and provided individual level strategies that may be used to mitigate them. At the community level and higher, public health and health care professionals need to advocate for intervention strategies and policy changes that address these behaviors, such as increasing nutrition assistance programs and creating designated areas for recreation and active transportation, to reduce disparities among vulnerable populations. The long-lasting impact of the pandemic on health behaviors, and the possibility of a second COVID-19 wave, emphasize the need for creative and evolving, multi-level approaches to assist individuals in adapting their health behaviors to prevent both chronic and infectious diseases.

BACKGROUND:Experimental evidence suggests that exposures to phthalates and bisphenols may interfere with processes related to glucose and lipid metabolism, insulin sensitivity, and body weight. Few studies have considered the possible influence of chemical exposures during pregnancy on maternal weight gain or metabolic health outcomes postpartum. OBJECTIVE:To examine the associations of early and mid-pregnancy bisphenol and phthalate urine concentrations with maternal weight gain 6 years postpartum. METHODS:We analyzed urine samples for bisphenol, phthalate and creatinine concentrations from early and mid-pregnancy in 1192 women in a large, population-based birth cohort in Rotterdam, the Netherlands, and examined postpartum weight gain using maternal anthropometrics before pregnancy and 6 years postpartum. We have used covariate-adjusted linear regressions to evaluate associations of early and mid-pregnancy bisphenols and phthalate metabolites with weight change. Mediator and interaction models have been used to assess the role of gestational weight gain and breastfeeding, respectively. Sensitivity analysis is performed among women without subsequent pregnancies. RESULTS:Among all 1192 mothers included in the analysis, each log unit increase in the average bisphenol A and all assessed phthalate groupings were associated with increased maternal weight gain. As a proxy for phthalate exposure, each log unit increase in averaged phthalic acid was associated with 734 g weight gain (95% CI 273-1196 g) between pre-pregnancy and 6 years postpartum. Mediation by gestational weight gain was not present. Breastfeeding and ethnicity did not modify the effects. Stratification revealed these associations to be strongest among overweight and obese women. Among women without subsequent pregnancies (n = 373) associations of bisphenols, HMW phthalate metabolites and di-2-ethylhexylphthalate metabolites attenuated. For phthalic acid, LMW phthalate metabolites and di-n-octylphthalate metabolites associations increased. Similarly to the whole group, stratification yielded significant results among overweight and obese women. DISCUSSION/CONCLUSIONS:In a large population-based birth cohort, early and mid-pregnancy phthalate exposures are associated with weight gain 6 years postpartum, particularly among overweight and obese women. These data support ongoing action to replace phthalates with safer alternatives.

Women's diet quality during reproductive years and children's diet quality during early life influence long term health. Few studies have evaluated the impact of food assistance programs and income on the diet quality of grocery purchases made by households consisting of women of reproductive age and young children. We used data from the Food Acquisition and Purchase Survey 2012-2013 (FoodAPS) to evaluate how household income, Special Supplemental Nutrition Assistance Program for Women, Infants and Children (WIC) participation, and Supplemental Nutrition Assistance Program (SNAP) participation are related to the diet quality of grocery purchases made by households that include women of reproductive age or young children (n = 2436). The diet quality of household grocery purchases was assessed with the Healthy Eating Index (HEI) 2015. HEI-2015 total score (0-100) and component scores were evaluated according to household income (eligible for WIC: income-to-poverty ratio ≤ 185%; ineligible for WIC: income-to-poverty ratio > 185%) and WIC, SNAP, and WIC + SNAP participation. Median HEI-2015 total score was lowest among SNAP households and highest among income ineligible for WIC and WIC households (47.2 and 54.1, respectively). Compared to income ineligible for WIC households, WIC + SNAP and SNAP households had lower HEI-2015 whole fruit (β = -0.30, 95% CI: -0.59, -0.01 and β = -0.41, 95% CI: -0.63, -0.20, respectively) and total vegetable scores (β = -0.58, 95% CI: -0.83, -0.32 and β = -0.27, 95% CI: -0.45, -0.08, respectively). The diet quality of grocery purchases in this population varies according to household income and food assistance participation.

BACKGROUND:In utero dietary exposures may influence childhood obesity. OBJECTIVES/OBJECTIVE:To evaluate the relationship between prenatal dietary exposures and offspring body size from 6 months to 18 years. DATA SOURCES/METHODS:Articles were identified in PubMed and Web of Science (January 2010-March 2018) using the PRISMA guidelines. Additional studies were identified through a reference review of articles that met the inclusion criteria and related reviews. STUDY SELECTION/METHODS:Prospective cohort studies that assessed dietary patterns, foods, macronutrients, or beverages during healthy pregnancy and offspring body size. The extraction of articles was done using predefined data fields. SYNTHESIS/RESULTS:One author extracted all information and evaluated bias with the NHLBI's Quality Assessment Tool. RESULTS:A total of 851 research articles were evaluated. Twenty-one studies assessing dietary patterns, macronutrients, foods, and beverages met inclusion criteria. Consumption of a Mediterranean dietary pattern during pregnancy was associated with reduced body size, while refined carbohydrates were associated with offspring obesity. No association was observed between data-driven dietary patterns and offspring body size, as well as a pro-inflammatory diet pattern and offspring body size. Mixed and null findings were observed for the relationship between total carbohydrates, n-3 polyunsaturated fatty acids, protein, sugar-sweetened beverages, and artificially sweetened beverages and offspring body size. CONCLUSIONS:Adhering to a Mediterranean diet and limiting refined carbohydrates during pregnancy may influence offspring body size between 6 months and 18 years. The diverging results that exist between studies highlight the complexity of this topic.

OBJECTIVE:To describe total and trimester-specific gestational weight gain (GWG) among low-income Hispanic women and determine whether these GWG exposures are associated with infant anthropometric outcomes at birth and 6 months. STUDY DESIGN/METHODS:trimester GWG rates (kg/week) and categorized as inadequate, adequate, and excessive according to the 2009 Institute of Medicine recommendations. Multivariable linear and modified Poisson regressions estimated associations of infant anthropometric outcomes (birthweight, small-for-gestational age [SGA], large-for-gestational age [LGA], rapid weight gain, and weight-for-age, length-for-age, and weight-for-length z-scores at 6 months) with GWG categories. RESULTS:trimesters were associated with greater weight outcomes at birth and 6 months (ß range for z-scores = 0.24 to 0.35, p < 0.05). CONCLUSIONS:Counseling women about health behaviors and closely monitoring GWG beginning in early pregnancy is necessary, particularly among populations at high-risk of obesity.

Phthalates are associated with several adverse health outcomes, but few studies have evaluated phthalate exposures in Mexican populations, particularly pregnant women. Between 2007 and 2011, 948 pregnant women from Mexico City were recruited as part of the PROGRESS cohort. We quantified 17 metabolites of phthalates and phthalate alternatives in urine samples collected during the second and third trimesters and examined temporal trends of metabolite concentrations, within-person reproducibility, and relations of individual metabolites with sociodemographic, lifestyle, and occupational factors. Concentrations of mono-2-ethyl-5-carboxypentyl terephthalate, a metabolite of the alternative phthalate di-2-ethylhexyl terephthalate, increased monotonically from 2007 to 2010 (31% per year; 95% confidence interval = 23 and 39%). We observed moderate to high correlations among metabolites collected at the same visit, but there was high variability between second and third trimester phthalate metabolite concentrations (intraclass correlation coefficients = 0.17-0.35). In general, higher socioeconomic status was associated with higher phthalate concentrations. Some metabolites were associated with maternal age and education, but no consistent patterns were observed. Women working in the home and those who worked in administration had higher concentrations of several phthalate metabolites relative to students, professionals, and those in customer service. Biomonitoring efforts are warranted to investigate present and future exposure trends and patterns.

Pregnancy is a contributor to the obesity epidemic in women, probably through postpartum weight retention (PPWR), weight gain (PPWG), or a combination of both (PPWR + WG). The contribution of these patterns of postpartum weight change to long-term maternal health remains understudied. In a secondary analysis of 361 women from the prospective cohort PROGRESS, we evaluated the associations between patterns of weight change one year after delivery and cardiometabolic risk factors at six years postpartum. Using principal component analysis, we grouped cardiometabolic risk factors into: (1) body mass index (BMI), waist circumference (WC), homeostatic model assessment of insulin resistance (HOMA-IR), high-density lipoprotein cholesterol (HDL-c), triglycerides (TG), and glucose; (2) systolic (SBP) and diastolic blood pressure (DBP); and (3) low-density lipoprotein cholesterol and total cholesterol. Using path analysis, we studied direct (patterns of weight change-outcomes) and indirect associations through BMI at six years postpartum. Around 60% of women returned to their pregestational weight (reference) by one year postpartum, 6.6% experienced PPWR, 13.9% PPWG, and 19.9% PPWR + WG. Women with PPWR + WG, vs. the reference, had higher BMI and WC at six years (2.30 kg/m², 95% CI [1.67, 2.93]; 3.38 cm [1.14, 5.62]). This was also observed in women with PPWR (1.80 kg/m² [0.80, 2.79]; 3.15 cm [-0.35, 6.65]) and PPWG (1.22 kg/m² [0.53, 1.92]; 3.32 cm [0.85, 5.78]). PPWR + WG had a direct association with HOMA-IR (0.21 units [0.04, 0.39]). The three patterns of weight change, vs. the reference, had significant indirect associations with HOMA-IR, glucose, TG, HDL-c, SBP, and DBP through BMI at six years. In conclusion, women with PPWR + WG are at high-risk for obesity and insulin resistance. Interventions targeting women during pregnancy and the first year postpartum may have implications for their long-term risk of obesity and cardiovascular disease.

Hispanic women have a higher prevalence of weight associated complications in pregnancy. This ethnic disparity is likely related to behavior patterns, social circumstances, environmental exposures, and access to healthcare, rather than biologic differences. The objective was to determine associations between sociodemographic characteristics, health behaviors, and psychosocial stressors and gestational weight gain (GWG) in low-income Hispanic women. During pregnancy, information on sociodemographic characteristics, health behaviors, and psychosocial stressors were collected. Linear regression estimated mean differences in GWG by selected predictors. Multinomial logistic regression estimated odds of inadequate and excessive GWG by selected predictors. Five-hundred and eight women were included, 38% had inadequate and 28% had excessive GWG; 57% with a normal pre-pregnancy BMI had inadequate GWG. Compared to women with normal BMI, women with overweight or obesity were more likely to have excessive GWG (aRRR = 1.88, 95% CI: 1.04, 3.40 and aRRR = 1.98, 95% CI: 1.08, 3.62, respectively). Mean total GWG was higher among women who were nulliparous (ß = 1.34 kg, 95% CI: 0.38, 2.29) and those who engaged in ≥3 h of screen time daily (ß = 0.98 kg, 95% CI: 0.02, 1.94), and lower among women who were physically active during pregnancy (ß = -1.00 kg, 95% CI: -1.99, -0.03). Eating breakfast daily was associated with lower risk of inadequate GWG (aRRR = 0.47, 95% CI: 0.26, 0.83). Depressive symptoms and poor adherence to dietary recommendations were prevalent, but none of the psychosocial or dietary variables were associated with GWG. In this cohort of primarily immigrant, low-income, Hispanic women, there were high rates of poor adherence to diet and physical activity recommendations, and a majority of women did not meet GWG guidelines. Modifiable health behaviors were associated with GWG, and their promotion should be included in prenatal care.

Objective: We examined types and frequency of meats and meat alternatives offered to children attending New York City public and private elementary and middle schools. Methods: Weekly public and private school breakfast and lunch menus were collected 3 times from each school during the 2018-2019 academic year. Menu options were reviewed and categorized as containing processed meat, unprocessed red meat, unprocessed poultry, breaded/fried poultry, fish, and meat alternatives. Results: Public school hot breakfast menus offered 2.0 options per week of processed meats and lunch menus offered an average of 4.0, 1.3, 1.7, and 2.0 options per week of processed, red, unprocessed poultry, and breaded poultry meats, respectively. Private school lunch menus offered an average of 1.0, 1.5, 2.1, and 0.4 options per week of processed, red, unprocessed poultry, and breaded poultry meats, respectively. The majority of private schools, 75% of those serving grades K-5 and 64% of those serving grades 6-8, offered a daily salad bar and/or sandwich bar with processed meats. Conclusions: The school food environment influences and contributes to children"™s dietary intakes. We suggest removing processed meats from meals, reducing red meat-based meals, increasing vegetable-and grain-based alternatives in recipes, and instituting meatless meal days.