PFAS Concentrations and Cardiometabolic Traits in Highly Exposed Children and Adolescents

Background: Residents of a large area of north-eastern Italy were exposed for decades to high concentrations of perfluoroalkyl and polyfluoroalkyl substances (PFAS) via drinking water. Despite the large amount of evidence in adults of a positive association between serum PFAS and metabolic outcomes, studies focusing on children and adolescents are limited. We evaluated the associations between serum PFAS concentrations that were quantifiable in at least 40% of samples and lipid profile, blood pressure (BP) and body mass index (BMI) in highly exposed adolescents and children. Methods: A cross-sectional analysis was conducted in 6669 adolescents (14–19 years) and 2693 children (8–11 years) enrolled in the health surveillance program of the Veneto Region. Non-fasting blood samples were obtained and analyzed for perfluorooctanoic acid (PFOA), perfluorooctane sulfonate (PFOS), perfluorohexanesulfonic acid (PFHxS), perfluorononanoic acid (PFNA), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and triglycerides. Low-density lipoprotein cholesterol (LDL-C) was calculated. Systolic and diastolic BP were measured, and BMI z-score accounting for age and sex was estimated. The associations between ln-transformed PFAS (and categorized into quartiles) and continuous outcomes were assessed using generalized additive models. The weighted quantile sum regression approach was used to assess PFAS-mixture effects for each outcome. Analyses were stratified by gender and adjusted for potential confounders. Results: Among adolescents, significant associations were detected between all investigated PFAS and TC, LDL-C, and to a lesser extent HDL-C. Among children, PFOS and PFNA had significant associations with TC, LDL-C and HDL-C, while PFOA and PFHxS had significant associations with HDL-C only. Higher serum concentrations of PFAS, particularly PFOS, were associated with lower BMI z-score. No statistically significant associations were observed between PFAS concentrations and BP. These results were confirmed by the multi-pollutant analysis. Conclusions: Our study supports a consistent association between PFAS concentration and serum lipids, stronger for PFOS and PFNA and with a greater magnitude among children compared to adolescents, and a negative association of PFAS with BMI.

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PFAS Concentrations and Cardiometabolic Traits in Highly Exposed Children and Adolescents

10.20944/preprints202110.0329.v1 ◽

2021 ◽

Author(s):

Cristina Canova ◽

Andrea Di Nisio ◽

Giulia Barbieri ◽

Francesca Russo ◽

Tony Fletcher ◽

...

Keyword(s):

Blood Pressure ◽

Children And Adolescents ◽

Density Lipoprotein ◽

Positive Association ◽

Additive Models ◽

Lipoprotein Cholesterol ◽

Surveillance Program ◽

Z Score ◽

Large Area ◽

Cross Sectional

Background: Residents of a large area of North-Eastern Italy were exposed for decades to high concentrations of perfluoroalkyl and polyfluoroalkyl substances (PFAS) via drinking water. Despite the large amount of evidence in adults of a positive association between serum PFAS and metabolic outcomes, studies focusing on children and adolescents are limited. We evaluated the associations between serum PFAS concentrations and lipid profile, blood pressure and body mass index (BMI) in highly exposed adolescents and children. Methods: A cross-sectional analysis was conducted in 6669 adolescents (14-19 years) and 2693 children (8-11 years) enrolled in the health surveillance program of the Veneto Region. Non-fasting blood samples were obtained and analyzed for perfluorooctanoic acid (PFOA) perfluorooctane sulfonate (PFOS), perfluorohexanesulfonic acid (PFHxS), perfluorononanoic acid (PFNA), total cholesterol (TC) high-density lipoprotein cholesterol (HDL-C) and triglycerides. Low-density lipoprotein cholesterol (LDL-C) was calculated. Systolic and diastolic blood pressure (BP) were measured and BMI z-score accounting for age and sex was estimated. The associations between ln-transformed PFAS (and categorized into quartiles) and continuous outcomes were assessed using generalized additive models. Analyses were stratified by gender and adjusted for potential confounders. Results: Among adolescents, significant associations were detected between all investigated PFAS and TC, LDL-C, and to a fewer extent HDL-C. Among children, PFOS and PFNA had significant associations with TC, LDL-C and HDL-C, while PFOA and PFHxS had significant associations with HDL-C only. Increased serum concentrations of PFAS, particularly PFOS, were associated with decreased BMI z-score. No statistically significant associations were observed between PFAS concentrations and BP. Conclusions: Our study supports a consistent association between PFAS concentration and serum lipids, stronger for PFOS and PFNA and with a greater magnitude among children compared to adolescents, and a negative association of PFAS with BMI.

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Perfluoroalkyl substances and lipid profile in exposed pregnant women in the Veneto Region, Italy

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.109 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

T Dalla Zuanna ◽

G Barbieri ◽

G Pitter ◽

M Zare Jeddi ◽

F Daprà ◽

...

Keyword(s):

Pregnant Women ◽

Lipid Profile ◽

Plasma Concentrations ◽

Density Lipoprotein ◽

Additive Models ◽

Lipoprotein Cholesterol ◽

Perfluoroalkyl Substances ◽

Surveillance Program ◽

Veneto Region ◽

Exposed Population

Abstract Background Perfluoroalkyl substances (PFASs) are persistent and widespread environmental pollutants. Residents of a large area of the Veneto Region (North-Eastern Italy) were exposed to high concentrations of PFASs through drinking water from the late-1970s to 2013. PFASs have been consistently associated with raised serum lipids, but only few studies have been conducted among pregnant women, and none has stratified analyses by trimesters of gestation. Our main objective was to evaluate the association between perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA) levels and lipid profiles in high-exposed pregnant women. Methods A cross-sectional analysis was conducted in 319 pregnant women (age 14-48 years) recruited in the Regional health surveillance program. Serum PFASs were measured by HPLC-MS/MS. Non-fasting serum total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C) were measured by enzymatic assays in automated analysers, and low-density lipoprotein cholesterol (LDL-C) was calculated. The associations between ln-transformed PFASs (and categorized into quartiles) and lipids were assessed using generalized additive models. Analyses were adjusted for potential confounders and stratified according to pregnancy trimester. Results In the first trimester, plasma concentrations of both PFOA and PFOS were positively associated with TC. However in the third trimester PFOA levels were instead inversely significantly associated with TC and LDL-C levels. Overall, both PFOA and PFOS were positively associated with HDL-C, and PFOA negatively with LDL-C. Conclusions In a small highly exposed population of pregnant women, the associations between PFASs concentrations and lipid profile were modified by trimester of gestation. Patterns late in pregnancy were different to the positive associations with LDL-C generally found. Differential transfer and bioaccumulation of lipids and PFAS in the placenta across gestation might explain our findings. Key messages This study provides evidence of different patterns of PFAS associations with lipids in pregnant women across the trimesters of gestation. The different patterns of association from general population studies sheds light on the role of fetal nutrition during pregnancy affecting both lipids and PFAS in serum.

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Prevalence and Predictors of Dyslipidemia in Children and Adolescents in Yazd Greater Area, Yazd, Iran

10.32592/ircmj.2021.23.4.222 ◽

2021 ◽

Keyword(s):

High Density Lipoprotein ◽

Children And Adolescents ◽

Lifestyle Modification ◽

Age Groups ◽

Density Lipoprotein ◽

Hdl Cholesterol ◽

High Density ◽

Lipoprotein Cholesterol ◽

Cluster Sampling ◽

Cross Sectional

Background: Dyslipidemia, a genetic and multifactorial disorder of lipoprotein metabolism, is defined by elevations in levels of total cholesterol, low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non–HDL-C), triglyceride, or some combination thereof, as well as lower levels of high-density lipoprotein (HDL) cholesterol. Objectives: This study aimed to investigate the prevalence and predictors of dyslipidemia in children and adolescents in the Yazd Greater Area, Yazd, Iran. Methods: This cross-sectional study was conducted as a part of the national project implemented in Yazd Greater Area, Yazd, Iran. The sampling was performed using a multi-stage cluster sampling method on three age groups of girls and boys (6-9, 10-14, and 15-18 years old). Out of the total 1,035 children and adolescents who participated in this study, only 784 participants remained in the study until the end. Data collection was performed using lifestyle questionnaires including Kiddie-SADS-Present and Lifetime Version. Results: The prevalence of high triglyceride was estimated at 1.4% and 4.2% in 6-9 and 10-18 years old children and adolescents, respectively. The prevalence of high cholesterol, LDL, and HDL was 3.2%, 3.2%, and 25.6%, respectively. The prevalence of dyslipidemia in the total population of children and adolescents in terms of demographic variables was 64.6% and 57.3% in boys and girls, respectively (P=0.038). Gender and increase in body mass index were significantly associated with dyslipidemia with OR=1.35; 95% CI: 1.01-1.81 and OR=13.781; 95% CI: 3.78- 46.43, respectively. However, after adjustment for other factors, only an increase in BMI was significantly associated with dyslipidemia (OR=16.08; 95% CI: 4.49-57.59). Conclusions: Overweight and obese adolescents had a higher concentration of serum blood triglycerides, compared to other adolescents. Weight control, lifestyle modification, and diet are three ways to reduce lipid disorders in adolescents.

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Evaluation of lipid profile among children and adolescents with type 1 diabetes mellitus in Bangladesh

Mediscope ◽

10.3329/mediscope.v5i1.36721 ◽

2018 ◽

Vol 5 (1) ◽

pp. 15-21

Author(s):

M Parveen ◽

MA Muttalib ◽

ST Huq ◽

N Nazneen ◽

MA Kabir ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Type 1 Diabetes Mellitus ◽

Children And Adolescents ◽

Density Lipoprotein ◽

Lipoprotein Cholesterol ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Detailed Medical History

The study, a cross-sectional survey, was carried out at the Department of Biochemistry in Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) General Hospital from July 2015 to June 2016. A total of 576 clinically diagnosed children and adolescents with type 1 diabetes mellitus (T1DM) aged 10-18 years attending in ‘Changing Diabetes in Children’ clinic, BIRDEM-2, Dhaka were selected according to appropriate inclusion and exclusion criteria. The study subjects underwent detailed medical history and examination. Fasting blood samples were drawn from the participants for biochemical assays such as fasting blood sugar (FBS), glycated haemoglobin (HbA1c), total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglycerides. Anthropometric data and blood pressures both systolic and diastolic were measured. Student unpaired t-test and Chi-square test were used to determine the association between different groups. Out of 576 T1DM patients, 45.0% (259) were male and 55.0% (317) were female. Of the 576 T1DM patients, 35.1% were without dyslipidemia (DLP) and 64.9% were with DLP. Study revealed that the patients with DLP were more likely to have higher values of HbA1c (10.1±2.2% vs 9.4±1.9%, p < 0.001) and FBS (13.0±4.4 mmol/L vs 10.2±2.9 mmol/L, p < 0.001). A substantial proportion of children and adolescents with T1DM had DLP. We found an association between poor glycemic control and abnormal lipid profiles in those patients. Mediscope Vol. 5, No. 1: Jan 2018, Page 15-21

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Telomere length is associated with growth in children in rural Bangladesh

eLife ◽

10.7554/elife.60389 ◽

2021 ◽

Vol 10 ◽

Author(s):

Audrie Lin ◽

Andrew N Mertens ◽

Benjamin F Arnold ◽

Sophia Tan ◽

Jue Lin ◽

...

Keyword(s):

Telomere Length ◽

Generalized Additive Models ◽

Nutritional Intervention ◽

Additive Models ◽

P Value ◽

Z Score ◽

Cross Sectional ◽

Telomere Attrition ◽

Healthy Growth ◽

Gates Foundation

Background: Previously, we demonstrated that a water, sanitation, handwashing, and nutritional intervention improved linear growth and was unexpectedly associated with shortened childhood telomere length (TL) (Lin et al., 2017). Here, we assessed the association between TL and growth. Methods: We measured relative TL in whole blood from 713 children. We reported differences between the 10th percentile and 90th percentile of TL or change in TL distribution using generalized additive models, adjusted for potential confounders. Results: In cross-sectional analyses, long TL was associated with a higher length-for-age Z score at age 1 year (0.23 SD adjusted difference in length-for-age Z score (95% CI 0.05, 0.42; FDR-corrected p-value = 0.01)). TL was not associated with other outcomes. Conclusions: Consistent with the metabolic telomere attrition hypothesis, our previous trial findings support an adaptive role for telomere attrition, whereby active TL regulation is employed as a strategy to address 'emergency states' with increased energy requirements such as rapid growth during the first year of life. Although short periods of active telomere attrition may be essential to promote growth, this study suggests that a longer overall initial TL setting in the first two years of life could signal increased resilience against future telomere erosion events and healthy growth trajectories. Funding: Funded by the Bill and Melinda Gates Foundation.

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Abstract P267: Cardiorespiratory Fitness Does not Attenuate the Association Between Adiposity and Blood Lipids in Children and Adolescents: Project HeartBeat! (1991-1995)

Circulation ◽

10.1161/circ.129.suppl_1.p267 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Olakunle A Folorunso ◽

Christina M Shay ◽

Kai Ding ◽

Susan B Sisson ◽

Sheryl L Magzamen ◽

...

Keyword(s):

Children And Adolescents ◽

Cardiorespiratory Fitness ◽

Blood Lipids ◽

Density Lipoprotein ◽

Blood Lipid ◽

Tanner Stage ◽

Lipoprotein Cholesterol ◽

Cross Sectional ◽

Pubertal Boys ◽

Project Heartbeat

Background: Higher levels of adiposity are associated with unfavorable blood lipid levels in pediatric populations. However, little is known about the extent to which cardiorespiratory fitness attenuates this association. Methods: Participants ages 8-16 years (n=256) with valid measures of blood lipids, cardiorespiratory fitness (CRF) and adiposity were examined from Project Heartbeat!, a longitudinal study of cardiovascular risk factors among children and adolescents. CRF was assessed by maximum oxygen uptake: VO 2max (mL/kg/min) measured during treadmill testing and adiposity was assessed by percent body fat (PBF) estimated using sex-specific formulas incorporating bioelectric impedance and six-site skinfold measures. Fasting blood lipids included total cholesterol (TC), triglycerides (TG), low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C). Linear regression was used to quantify cross-sectional associations between CRF and adiposity with blood lipids by sex and pubertal status (Tanner stage 1 vs. 2-5). Results: When examined individually, higher PBF and lower VO 2max were associated with more favorable levels of blood lipids in pre-pubertal boys, however, the associations were not consistent across all sex/puberty groups (Table 1). In multivariate models where both VO 2max and PBF were included, PBF remained significant for all blood lipids in pre-pubertal boys but only with TC and LDL-C in pre-pubertal girls. Among pubertal participants, only TG remained significantly associated with PBF when similarly accounting for VO 2max . Conclusions: Prior to the onset of puberty, higher adiposity is independently associated with more favorable levels of TG and HDL-C in boys and TC and LDL-C in girls even after accounting for CRF. During puberty, the majority of these associations are greatly attenuated, which further highlights the complexities associated with examining correlates of blood lipids in developing children.

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Association of Circulating Cholesterol Level with Cognitive Function and Mild Cognitive Impairment in the Elderly: A Community-based Population Study

Current Alzheimer Research ◽

10.2174/1567205017666200810165758 ◽

2020 ◽

Vol 17 (6) ◽

pp. 556-565

Author(s):

Yujie Guo ◽

Pengfei Li ◽

Xiaojun Ma ◽

Xiaochen Huang ◽

Zhuoheng Liu ◽

...

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Cognitive Function ◽

Cholesterol Level ◽

Density Lipoprotein ◽

Lipoprotein Cholesterol ◽

Cross Sectional ◽

Increased Risk ◽

Aging Adults ◽

Female Subjects

Background: The present study was designed to examine the association of circulating cholesterol with cognitive function in non-demented community aging adults. Methods: This was a cross-sectional study including 1754 Chinese adults aged 55-80 years. The association between serum cholesterol levels and cognitive function was examined. Participants were categorized into four groups according to the quartile of circulating TC (total cholesterol), High Density Lipoprotein Cholesterol (HDL-c), Low Density Lipoprotein Cholesterol (LDL-c) levels and HDLc/ LDL-c ratio. The difference in cognitive performance among the groups was compared. Logistic regression model was used to determine the association of circulating cholesterol level with the risk of Mild Cognitive Impairment (MCI). Results: Mild increase of serum LDL-c level correlated with better visual and executive, language, memory and delayed recall abilities. Higher circulating TC and HDL-c levels were found to be associated with poorer cognitive function, especially in aging female subjects. Higher circulating TC, HDL-c and HDL/LDL ratio indicated an increased risk of MCI, especially in female subjects. Conclusion: Slight increase in circulating LDL-c level might benefit cognitive function in aging adults. However, higher circulating TC and HDL-c levels might indicate a decline of cognitive function, especially in aging female subjects.

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Perfluoroalkyl substances and blood pressure in exposed young population in the Veneto Region, Italy

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.107 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

C Canova ◽

M Jare Zeddi ◽

G Barbieri ◽

M Gion ◽

F Daprà ◽

...

Keyword(s):

Blood Pressure ◽

Diastolic Blood Pressure ◽

Sulfonic Acid ◽

Antihypertensive Drugs ◽

Adult Population ◽

Additive Models ◽

Perfluoroalkyl Substances ◽

Surveillance Program ◽

Veneto Region ◽

Large Area

Abstract Background Residents in a large area of the Veneto Region (North-Eastern Italy) were exposed to perfluoroalkyl substances (PFASs) via drinking water. Studies on the association between PFASs and blood pressure (BP) levels are limited and results are inconsistent. Using cross-sectional data from the Regional health surveillance program, we aimed to quantify the associations between PFAS serum concentrations and blood pressure and hypertension prevalence. Methods The study included 16,224 individuals aged 20-39 years. Pregnant women (n = 327), participants with self-reported diagnosis or under treatment (n = 296) or with missing information on the selected covariates (n = 114) were excluded, leaving 15,487 subjects. Hypertension (HYP) was defined as any self-reported diagnosis, use of antihypertensive drugs, or raised systolic/diastolic blood pressure (SBP)≥140, DBP ≥90 mmHg). Serum PFASs were measured by HPLC-MS. Generalized additive models were used to investigate the relation between each PFAS (perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), perfluorohexane sulfonic acid (PFHxS), and perfluorononanoic acid (PFNA)) ln transformed and by decile, and SBP, DBP, HYP, adjusted for potential confounders. Results Both SBP and DBP increased significantly with an increase in the ln-transformed serum PFASs concentration in a monotonic way. The predicted increase in SBP and DBP were 1.62 (95% CI = 0.69, 2.55), 1.64 mmHg (95% CI = 0.96, 2.31) from lowest to highest decile of PFOA. The associations were stronger for SBP in men and DBP in women. One unit increase in each ln-PFAS was positively associated with an increased odds of HYP in men: PFOA OR = 1.07 (1.01-1.14), PFOS OR = 1.18 (1.05-1.32), PFHxS OR = 1.11 (1.03-1.19), PFNA OR = 1.19 (1.01-1.41). Conclusions Our findings suggest that exposure to PFAS is associated with increased blood pressure and thus may contribute as a risk factor for the development of cardiovascular diseases. Key messages Serum PFASs were associated with raised systolic blood pressure in men and diastolic blood pressure in women in a large highly exposed young adult population. Serum PFASs were associated with raised prevalence of hypertension in men.

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Modelling the Reallocation of Time Spent Sitting into Physical Activity: Isotemporal Substitution vs. Compositional Isotemporal Substitution

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18126210 ◽

2021 ◽

Vol 18 (12) ◽

pp. 6210

Author(s):

Gregory J. H. Biddle ◽

Joseph Henson ◽

Stuart J. H. Biddle ◽

Melanie J. Davies ◽

Kamlesh Khunti ◽

...

Keyword(s):

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Lipoprotein Cholesterol ◽

Future Research ◽

Cardiometabolic Health ◽

Low Density Lipoprotein Cholesterol ◽

Cross Sectional ◽

Randomised Control Trials ◽

Data Driven Decisions

Isotemporal substitution modelling (ISM) and compositional isotemporal modelling (CISM) are statistical approaches used in epidemiology to model the associations of replacing time in one physical behaviour with time in another. This study’s aim was to use both ISM and CISM to examine and compare associations of reallocating 60 min of sitting into standing or stepping with markers of cardiometabolic health. Cross-sectional data collected during three randomised control trials (RCTs) were utilised. All participants (n = 1554) were identified as being at high risk of developing type 2 diabetes. Reallocating 60 min from sitting to standing and to stepping was associated with a lower BMI, waist circumference, and triglycerides and higher high-density lipoprotein cholesterol using both ISM and CISM (p < 0.05). The direction and magnitude of significant associations were consistent across methods. No associations were observed for hemoglobin A1c, total cholesterol, or low-density lipoprotein cholesterol for either method. Results of both ISM and CISM were broadly similar, allowing for the interpretation of previous research, and should enable future research in order to make informed methodological, data-driven decisions.

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Liver fat content is independently associated with microalbuminuria in a normotensive, euglycaemic Chinese population: a community-based, cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2020-044237 ◽

2021 ◽

Vol 11 (6) ◽

pp. e044237

Author(s):

Xiaoming Li ◽

Mingfeng Xia ◽

Hui Ma ◽

Yu Hu ◽

Hongmei Yan ◽

...

Keyword(s):

Logistic Regression ◽

Blood Glucose ◽

Density Lipoprotein ◽

Fat Content ◽

Lipoprotein Cholesterol ◽

Liver Fat ◽

Community Based ◽

Liver Fat Content ◽

Cross Sectional ◽

Multivariable Logistic Regression

ObjectiveNon-alcoholic fatty liver disease (NAFLD) is associated with microalbuminuria (MA) in patients with diabetes/pre-diabetes. Whether this association is mediated by blood glucose and blood pressure (BP) remains unclear. This study investigated whether liver fat content (LFC) was associated with MA in a normotensive and non-diabetic population.DesignA cross-sectional substudy.SettingsLFC was determined from the hepatic/renal echogenicity ratio at ultrasound. MA was defined as an albumin-to-creatinine ratio (ACR) of 30–300 µg/mg (early- morning urine sample). Multivariable logistic regression and receiver operating characteristic (ROC) curve analyses were used to evaluate LFC as a predictor of MA.ParticipantsBetween May 2010 and June 2011, this cross-sectional, community-based study enrolled residents from Shanghai (China), aged ≥40 years and with normal glucose tolerance and BP.ResultsA total of 550 residents (median age, 57 years; 174 men) were enrolled and stratified according to LFC quartiles. ACR (p<0.001) and MA prevalence (p=0.012) increased across the LFC quartiles. Multivariable logistic regression showed that the OR for MA (per SD increase in LFC) was 1.840 (95% CI 1.173 to 2.887, p=0.008) after adjustment for potential confounders including age, gender, waist-hip ratio, blood urea nitrogen, systolic and diastolic BP, fasting blood glucose, postprandial glucose, low-density lipoprotein-cholesterol, triglycerides, high-density lipoprotein-cholesterol, total cholesterol, estimated glomerular filtration rate and lipid-lowering drugs. The ROC analysis revealed that the optimal LFC cut-off value for predicting MA was 6.82%.ConclusionLFC is independently associated with MA in normotensive, euglycaemic middle-aged and elderly Chinese individuals. Screening for MA in people with NAFLD might facilitate early intervention to minimise kidney disease risk.

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