Urinary concentrations of phthalate metabolites during gestation and intrahepatic cholestasis of pregnancy: a population-based birth cohort study.

Phthalates, a class of widely used endocrine-disrupting chemicals (EDCs), are toxic to various organ systems in animals and humans. Intrahepatic cholestasis of pregnancy (ICP) is a reversible liver dysfunction causing cholestasis in late pregnancy. Evidence on the associations between exposure to phthalates and ICP is still lacking. In the present study, we investigated the relationships between urinary concentrations of phthalate metabolites and the risk of ICP in a Chinese population-based birth cohort. Pregnant women participated in the Ma'anshan Birth Cohort (MABC) study in China. Seven phthalate metabolites were detected in a urine sample in early pregnancy. Chemical concentrations were grouped by quartiles, and associations with outcomes were examined using logistic regression with adjustment for urine creatinine, race, education, poverty status, smoking status, alcohol consumption, maternal age, prepregnancy body mass index (BMI), parity, twin pregnancy, and pregnancy-related liver complications. Of 3474 women recruited into the Ma'anshan Birth Cohort, 2760 met the inclusion criteria and contributed to further analysis and biomonitoring data. Elevated odds ratios (ORs) of ICP were observed in the highest quartiles of monomethyl phthalate (MMP) exposure (OR = 1.59, 95% confidence intervals (CI) = 1.01-2.51) and monobutyl phthalate (MBP) exposure (OR = 1.82, 95% CI = 1.16-2.85) in the adjusted analyses. Our findings add to the evidence that supports the role of maternal phthalate exposure in the first trimester of gestation as a risk factor for ICP.

Temporal Variability of Cumulative Risk Assessment on Phthalates in Chinese Pregnant Women: Repeated Measurement Analysis.

The assessment of the combined effects of multiple phthalate exposures at low levels is a newly developed concept to avoid underestimating their actual cumulative health risk. A previous study included 3455 Chinese pregnant women. Each woman provided up to three urine samples (in total 9529). This previous study characterized the concentrations of phthalate metabolites. In the present study, the data from 9529 samples was reanalyzed to examine the cumulative risk assessment (CRA) with two models: (1) the creatinine-based and (2) the volume-based. Hazard index (HI) values for three phthalates, dibutyl phthalate, butyl benzyl phthalate, and di(2-ethylhexyl) phthalate, in the first, second, and third trimesters of pregnancy, were calculated, respectively. In creatinine-based model, 3.43%, 14.63%, and 17.28% of women showed HI based on the European Food Safety Authority tolerable daily intake exceeding 1 in the first, second, and third trimester of pregnancy, respectively. The intraclass correlation coefficient of HI was 0.49 (95% confidence interval: 0.46-0.53). Spearman correlations between HI of the creatinine model and ∑androgen disruptor (a developed potency weighted approach) ranged from 0.824 to 0.984. In summary, this study suggested a considerable risk of cumulative exposure to phthalates during the whole gestation in Chinese pregnant women. In addition, moderate temporal reproducibility indicated that single HI, estimated by the phthalate concentration in single spot of urine, seemed representative to describe the throughout pregnancy CRA. Finally, strong correlation between HI of the creatinine model and ∑androgen disruptor revealed that the creatinine-based model was more appropriate to evaluate the CRA.

Effects of the phthalate exposure during three gestation periods on birth weight and their gender differences: A birth cohort study in China.

Phthalate has been widely used as a type of plasticiser in various consuming products in daily life. Recent studies have suggested that prenatal phthalate exposure may have adverse effects on fetal development. We aimed to identify the effects of in utero phthalate exposure on birth weight (BW). We evaluated a birth cohort comprising 3474 pregnant women and their single infants; 3103, 2975 and 2838 urine samples were collected in the first, second and third trimesters, respectively. Phthalate metabolites included monomethyl phthalate (MMP), monoethyl phthalate (MEP), mono-n-butyl phthalate (MBP), monobenzyl phthalate (MBzP), mono-(2-ethylhexyl) phthalate (MEHP), mono-(2-ethyl-5-oxohexyl) phthalate (MEHHP), and mono-(2-ethyl-5-hydroxylhexyl) phthalate (MEOHP), which were analysed in the urine by using high performance liquid chromatography-tandem mass spectrometry. Mixed linear model was used in the statistical analysis. Generally, MMP and MEP exposure during pregnancy was associated with decreased birth weight of infants (MMP, ß=-12.192, p=0.009; MEP, ß=-11.876, p=0.014). Hierarchical analysis found that MMP and MEOHP exposure was associated with decreased infants' birth weight only in low birth weight groups (MMP, ß=-42.538, p=0.005; MEOHP, ß=-63.224, p=0.008); MEHP and MEHHP exposure was associated with decreased infants' birth weight in both low birth weight group (MEHP, ß=-42.348, p=0.035; MEHHP, ß=-50.485, p=0.006) and high birth weight group (MEHP, ß=-16.580, p=0.034; MEHHP, ß=-18.009, p=0.040), MBP and MEHP exposure were associated with increased infants' birth weight in male NBW group (MBP, ß=10.438, p=0.039; MEHP, ß=13.223, p=0.017). Moreover, the effect has sex difference. The reduction of birth weight associated with MEHP and MEOHP exposure was stronger in male infants, while MMP and MEP exposure was more significant in female infants.

Weight changes since age 20 and cardiovascular risk factors in a middle-aged Chinese population.

Background: Little is known about the association between weight changes and adverse health outcomes among Chinese adults. Methods: A total of 1715 Chinese adults, 45-60 years of age, have been recruited to participate in the Hefei Nutrition and Health Study started in 2012. Multivariate logistic regression analysis was performed to determine the association of weight changes since age 20 (loss ≥5.0 kg; maintain [±4.9 kg]; gain 5.0-9.9 kg; gain ≥10.0 kg) with cardiovascular risk factors. Results: Men who gained 10.0 kg or more had increased risks of hypertension (odds ratios (OR) = 3.07; 95% CI: 1.98-4.76), impaired fasting glucose (OR = 1.74; 95% CI: 1.02-2.97), reduced high-density lipoprotein (HDL) cholesterol levels (OR = 2.77; 95% CI: 1.42-5.40) and elevated triglyceride levels (OR = 5.72; 95% CI: 2.94-11.12). Women who gained 10.0 kg or more had increased risks of hypertension, elevated low-density lipoprotein (LDL) cholesterol levels and elevated triglycerides levels of 2.01(95% CI: 1.18-3.42), 3.40 (95% CI: 1.18-9.82) and 5.60 (95% CI: 1.59-19.61), respectively. Conclusion: Weight gain during adulthood was associated with increased risks of high triglycerides, hypertension, impaired fasting glucose and risk of reduced HDL cholesterol in men. Furthermore, weight gain was a predictor of high-risk triglycerides, hypertension and elevated LDL cholesterol in women.

Pre-pregnancy BMI, gestational weight gain and breast-feeding: a cohort study in China.

OBJECTIVE: The purpose of the present study was to examine the influence of maternal pre-pregnancy BMI and gestational weight gain (GWG) on initiation and duration of infant breast-feeding in a prospective birth cohort study. DESIGN: Breast-feeding information was collected at 1, 3, 6 and 12 months postpartum. The association of pre-pregnancy BMI and GWG with delayed lactogenesis II and termination of exclusive breast-feeding was assessed with logistic regression analysis. The risk of early termination of any breast-feeding during the first year postpartum was assessed with Cox proportional hazards models. SETTING: Urban city in China. SUBJECTS: Women with infants from the Ma'anshan Birth Cohort Study (n 3196). RESULTS: The median duration of any breast-feeding in this cohort was 7·0 months. Pre-pregnancy obese women had higher risks of delayed lactogenesis II (risk ratio=1·89; 95 % CI 1·04, 3·43) and early termination of any breast-feeding (hazard ratio=1·38; 95 % CI 1·09, 1·75) adjusted for potential maternal and infant confounders, when compared with normal-weight women. No differences in breast-feeding initiation or duration of exclusive breast-feeding according to pre-pregnancy BMI were found. Moreover, GWG was not associated with any poor breast-feeding outcomes. CONCLUSIONS: The present study indicated that pre-pregnancy obesity increases the risks of delayed lactogenesis II and early termination of any breast-feeding in Chinese women.

[Factors related to HIV-associated lipodystrophy among patients on antiretroviral therapy].

UNLABELLED: To describe the distribution and related risk factors of lipodystrophy (LD)among AIDS patients treated with antiretroviral drugs. METHODS: A cross-sectional study was performed on 261 AIDS patients treated with antiretroviral drugs. All the subjects were followed in the Center for Disease Control and Prevention of two counties in northern Anhui province from May 25 to 30, 2012. Data related to demography, physical examination, history of antiretroviral treatment, HIV plasma viral load, and CD4 + T cell count were collected. Clinical examination was based on an assessment of changes in face, legs, arms, buttocks(peripheral sites), back, chest, neck or abdomen or change in waist size (central sites)as quoted by the clinicians. RESULTS: LD was observed in 147 (56.3%) patients. The differences of age , gender, quality of sleep, weight and time of treatment between LD and non-lipodystrophy (NLD)groups were statistically significant (P < 0.05). Results from the Multivariate logistic regression analysis showed that the risk of women suffering from LD was 1.894 times of thd males (95%CI:1.075-3.338). The risk of those with LD showed an 1.448-fold increase regarding the time of treatment for each additional year (95%CI:1.267-1.654). Patients with poor quality of sleep were prone to LD with 11.901 times more than those with good quality of sleep (95%CI:2.701-52.441). CONCLUSION: LD was commonly observed in AIDS patients who were under antiretroviral therapy. Gender, tine of treatment and the quality of sleep appeared the main factors related to the results of observation.

[Relationship between deliberate self-harm and suicidal behaviors in college students].

OBJECTIVE: To describe the prevalence of deliberate self-harm (DSH) and suicidal behaviors (SIB) as well as the relationship between them in a college student population. METHODS: A total of 4063 medical students were selected under the cluster sampling method in Anhui province. Data were analyzed by Pearson Chi-square and logistic regression. RESULTS: A total of 4063 (13.4%) students reported that they had deliberately harmed themselves during the past 12 months. The acts of DSH with 1 and more than or equal to 2 times occurrence accounted for 3.7% and 9.6% among all the respondents. The act of DSH was significantly higher among boys than that among girls. Rates of suicide ideation, suicide plan, attempted suicide and SIB in the last year were 4.5%, 1.4%, 0.6% and 4.9%, respectively. However no statistically significant difference was found in different sex. Students in the DSH group that with SIB were found to have lower positive coping levels (OR=0.5, 95%CI: 0.3-0.8), getting less support from friends (3-5 vs. less than or equal to 2: OR=0.6, 95%CI: 0.3-0.9; more than or equal to 6 vs. less than or equal to 2: OR=0.4, 95%CI: 0.2-0.8), with higher negative coping levels (OR=2.1, 95%CI: 1.2-3.7), having more serious depressive symptoms (OR=2.9, 95%CI: 1.6-5.2) and anxiety symptoms (OR=2.2, 95%CI: 1.2-3.8), having more serious sleeping problems (OR=1.7, 95%CI: 1.1-2.8) and perceived fat (fat vs. moderate: OR=2.0, 95%CI: 1.1-3.6) than the DSH group without SIB. The rates of SIB in students with DSH behavior were significantly higher than those in students without those behaviors (OR=4.7, 95%CI: 3.5-6.4). Psychosocial variables could attenuate the relationship between the DSH status and suicidal events (OR=3.3, 95%CI: 2.4-4.5). The DSH frequency exhibited a curvilinear relationship to SIB (OR=3.1-10.0) and psychosocial variables also attenuated this relationship (OR=2.4-5.9). CONCLUSION: It was well known that SIB was not a suicidal gesture but our findings suggested that the presence of DSH might trigger the suicidal attempts.

Association of tumor necrosis factor-α gene promoter polymorphism at sites -308 and -238 with non-alcoholic fatty liver disease: a meta-analysis.

BACKGROUND AND AIM: Environmental and genetic factors play a role in the pathogenesis and natural history of non-alcoholic fatty liver disease (NAFLD). The objective of this study was to quantitatively evaluate the association between tumor necrosis factor (TNF)-α gene promoter polymorphism at sites -308 and -238 and NAFLD susceptibility. METHODS: We performed an extensive search of relevant studies and made a meta-analysis, including eight studies with 837 NAFLD cases and 990 controls in the association between TNF-α -308 polymorphism and NAFLD; and seven studies with 771 cases and 787 controls in TNF-α -238 polymorphism. RESULTS: The combined results showed that there was a significant difference in TNF-α-238 genotype distribution between NAFLD and control based on all studies (GA/AA vs GG [odds ratio = 2.06, 95% confidence interval = 1.58-2.69, P < 0.000,01]). However, the combined results based on all studies showed there was no evidence of association of TNF-α-308 genotype distribution between NAFLD cases and controls (GA/AA vs GG [odds ratio = 1.08, 95% confidence interval = 0.82-1.42, P = 0.60]). When stratifying for race, the significant results did not change materially compared with whole populations. CONCLUSION: This meta-analysis suggested that TNF-α gene promoter polymorphism at position -238 but not -308 might be a risk factor for NAFLD.

[Risk factors on road traffic accidents in middle school students: a matched case-control study].

OBJECTIVE: To investigate the predictors of road traffic accidents (RTAs) in middle school students, a case-control study was designed to seek new clues for prevention and control on RTAs in this population. METHODS: Cases were 116 students who experienced RTAs from 2005/01/01 to 2005/12/31. 116 students were served as controls who were from the same class of the cases and matched by age and sex. Information on personal behavior, family conditions, and knowledge, attitude, practice (KAB) on road traffic of these children were collected and compared. Conditional logistic regressions were conducted to analyze the relationship between these factors and RTAs. RESULTS: Compared to the controls, the cases showed more negative attitude and risk-taking-behaviors especially in riding bicycle. However, knowledge on road safety showed less significant differences between case and control groups. The negative attitude and risk-taking-behaviors were independent risk factors for RTAs by logistic regression. In addition, distance from home to school that longer than 1000 m seemed a risk factors for RTAs, while high education levels among mothers was a protective factor. CONCLUSION: Road safety attitude and behavior, distance from home to school were the main influence factors for RTAs among middle school students. It seemed more important in improving the attitude and behavior on road safety than to enhance the knowledge for prevention and control of RTAs among middle school students.