National population-based estimates for major birth defects, 2016-2020.

BACKGROUND: We provide updated crude and adjusted prevalence estimates of major birth defects in the United States for the period 2016-2020. METHODS: Data were collected from 13 US population-based surveillance programs that used active or a combination of active and passive case ascertainment methods to collect all birth outcomes. These data were used to calculate pooled prevalence estimates and national prevalence estimates adjusted for maternal race/ethnicity for all conditions, and maternal age for trisomies and gastroschisis. Prevalence was compared to previously published national estimates from 1999 to 2014. RESULTS: Adjusted national prevalence estimates per 10,000 live births ranged from 0.63 for common truncus to 18.65 for clubfoot. Temporal changes were observed for several birth defects, including increases in the prevalence of atrioventricular septal defect, tetralogy of Fallot, omphalocele, trisomy 18, and trisomy 21 (Down syndrome) and decreases in the prevalence of anencephaly, common truncus, transposition of the great arteries, and cleft lip with and without cleft palate. CONCLUSION: This study provides updated national estimates of selected major birth defects in the United States. These data can be used for continued temporal monitoring of birth defects prevalence. Increases and decreases in prevalence since 1999 observed in this study warrant further investigation.

Relationships between chronotype, social jetlag, sleep, obesity and blood pressure in healthy young adults.

Sleep disturbances, chronotype and social jetlag (SJL) have been associated with increased risks for major chronic diseases that take decades to develop, such as obesity, metabolic syndrome and cardiovascular disease. Potential relationships between poor sleep, chronotype and SJL as they relate to metabolic risk factors for chronic disease have not been extensively investigated. This prospective study examined chronotype, SJL and poor sleep in relation to both obesity and elevated blood pressure among healthy young adults. SJL and objective sleep measures (total sleep time, sleep onset latency, wake after sleep onset and sleep efficiency) were derived from personal rest/activity monitoring (armband actigraphy) among 390 healthy adults 21-35 years old. Participants wore the device for 6-10 days at 6-month intervals over a 2-year period (n = 1431 repeated observations). Chronotypes were categorized into morning, intermediate and evening groups using repeated measures latent class analysis. Means of SJL and sleep measures among latent chronotype groups were compared using partial F-tests in generalized linear mixed models. Generalized linear mixed models also were used to generate odds ratios (ORs) with 95% confidence intervals (CIs) examining the relationship between repeated measures of chronotype, SJL, sleep and concurrent anthropometric outcome measures (body mass index, percentage of body fat, waist-to-hip ratio, waist-to-height ratio), systolic blood pressure and diastolic blood pressure. Sleep latency ≥12 min was associated with increased odds of a high waist-to-height ratio (OR = 1.37; CI: 1.03-1.84). Neither chronotype nor SJL was independently associated with anthropometric outcomes or with blood pressure. Relationships between poor sleep and anthropometric outcomes or blood pressure varied by chronotype. Morning types with total sleep time <6 h, sleep efficiency <85% or wake after sleep onset ≥60 min were more likely to have an increased percentage of body fat, waist-to-hip ratio and waist-to-height ratio relative to those with an intermediate chronotype. Similarly, sleep latency ≥12 min was associated with increased odds of elevated systolic blood pressure (OR = 1.90; CI: 1.15-3.16, pinteraction = 0.02) among morning versus intermediate chronotypes. No relationships between poor sleep and obesity or elevated blood pressure were observed among evening chronotypes. The results from this study among healthy young adults suggest that poor sleep among morning types may be more strongly associated with obesity and elevated blood pressure relative to those with an intermediate (neutral) chronotype. Sleep-related metabolic alterations among different chronotypes warrant further investigation.

Diet-related inflammation and risk of prostate cancer in the California Men's Health Study.

PURPOSE: The purpose of the study was to examine the relationship between proinflammatory diet and prostate cancer risk. METHODS: Energy-adjusted Dietary Inflammatory Index (E-DII) scores were computed among 40,161 participants in the California Men's Health Study. Over 9.7 ± 3.8 years of follow-up, 2707 incident prostate cancer cases were diagnosed and categorized as low-, intermediate-, or high-risk, based on disease grade and stage. Accelerated failure-time models assessed time to diagnosis of prostate cancer. Cox proportional hazard models estimated hazard ratios (HR) and 95% confidence intervals (95% CI). Nonlinear effects of E-DII were modeled as third-order polynomials. RESULTS: Time to prostate cancer diagnosis did not differ by E-DII quartile. The HR for high-risk prostate cancer increased in the third E-DII quartile (HRQ3 vs. Q1 = 1.36; 95% CI: 1.04-1.76), but not in the fourth (HRQ4 vs. Q1 = 0.99; 95% CI: 0.74-1.32, Ptrend = .74), suggesting a nonlinear dose-response. HR curves for prostate cancer increased exponentially above an E-DII threshold of ≈+3.0. HR curves for high-risk prostate cancer had a much steeper incline above an E-DII threshold of ≈+2.5. Curves were higher among Blacks and Whites relative to other races and among overweight or obese men. No relationship was observed between E-DII scores and intermediate- or low-risk disease. CONCLUSIONS: Relationships between proinflammatory diet and prostate cancer risk may be nonlinear, with an increased risk above an E-DII threshold of ≈+2.5.

Persistence of social jetlag and sleep disruption in healthy young adults.

Sleep disruption has been associated with increased risks for several major chronic diseases that develop over decades. Differences in sleep/wake timing between work and free days can result in the development of social jetlag (SJL), a chronic misalignment between a person's preferred sleep/wake schedule and sleep/wake timing imposed by his/her work schedule. Only a few studies have examined the persistence of SJL or sleep disruption over time. This prospective investigation examined SJL and sleep characteristics over a 2-year period to evaluate whether SJL or poor sleep were chronic conditions during the study period. SJL and sleep measures (total sleep time [TST], sleep onset latency [SOL], wake after sleep onset [WASO]), and sleep efficiency [SE]), were derived from armband monitoring among 390 healthy men and women 21-35 years old. Participants wore the armband for periods of 4-10 days at 6-month intervals during the follow-up period (N = 1431 repeated observations). The consistency of SJL or sleep disruption over time was analyzed using generalized linear mixed models (GLMMs) for repeated measures. Repeated measures latent class analysis (RMLCA) was then used to identify subgroups among the study participants with different sleep trajectories over time. Individuals in each latent group were compared using GLMMs to identify personal characteristics that differed among the latent groups. Minor changes in mean SJL, chronotype, or TST were observed over time, whereas no statistically significant changes in SOL, WASO, or SE were observed during the study period. The RMLCA identified two groups of SJL that remained consistent throughout the study (low SJL, mean ± SE: 0.4 ± 0.04 h, 42% of the study population; and high SJL, 1.4 ± 0.03 h, 58%). Those in the SJL group with higher values tended to be employed and have an evening chronotype. Similarly, two distinct subgroups were observed for SOL, WASO, and SE; one group with a pattern suggesting disrupted sleep over time, and another with a consistently normal sleep pattern. Analyses of TST identified three latent groups with relatively short (5.6 ± 1.0 h, 21%), intermediate (6.5 ± 1.0 h, 44%), and long (7.3 ± 1.0 h, 36%) sleep durations, all with temporally stable, linear trajectories. The results from this study suggest that sleep disturbances among young adults can persist over a 2 year period. Latent groups with poor sleep tended to be male, African American, lower income, and have an evening chronotype relative to those with more normal sleep characteristics. Characterizing the persistence of sleep disruption over time and its contributing factors could be important for understanding the role of poor sleep as a chronic disease risk factor.

Dietary supplementation with radionuclide free food improves children's health following community exposure to (137)Cesium: a prospective study.

BACKGROUND: Following the Chernobyl nuclear disaster of 1986, vast areas of Ukraine became contaminated with radionuclides. We examined health effects of school-based food intervention for children in a rural region Narodichi, Ukraine, exposed to low-level radiation through diet of locally produced foods. Until 1995, children received three daily meals with low content of artificial radionuclides which were subsequently reduced to two. METHODS: Annual health screening data (1993-1998) were examined using a quasi-experimental regression discontinuity analysis (n = 947 children; 3,573 repeated measurements). Generalized Estimating Equation models evaluated effect of the food supplementation reduction on hematologic measures and prevalence of anemia, acute respiratory illnesses and diseases of immune system. RESULTS: Prior improvement of several hematologic parameters diminished after food supplementation was reduced. From 1995 to 1996, levels of hemoglobin and erythrocytes decreased from 12.63 (95% CI: 12.56-12.71) to 12.46 g/dL (% CI: 12.39-12.52) and from 4.10 (95% CI: 4.07-4.12) to 4.02 (95% CI: 4.00-4.04) × 10(12)/L, respectively. In agreement, the prevalence ratio (PR) of previously declining anemia increased from 0.57 to 1.31 per year (p(interaction )< .0001). The relation between food supplementation and hemoglobin levels was modified by residential (137)Cs soil levels. After food supply reduction, PR of common cold and bronchitis increased from 1.27 to 2.32 per year (p(interaction) = 0.01) and from 1.09 to 1.24 per year (p(interaction) = 0.43), respectively. CONCLUSIONS: Food supplementation provided by the Ukrainian government likely prevented development of anemia in many of the children residing in the contaminated district. Food supplementation after the community exposure to radioactivity through a diet of locally grown foods should be considered as an effective approach to reduce adverse health effects of radiation.

Reduced lung function in children associated with cesium 137 body burden.

RATIONALE: We previously reported that obstructive and restrictive lung function findings were associated with radioactive Cesium 137 ((137)Cs) soil contamination from the 1986 Chernobyl disaster in a pediatric cohort residing in the Narodichesky district of Ukraine from 1993 to 1998. OBJECTIVES: To determine whether these associations persist, we repeated the study and refined the exposure by measuring individual radiation concentration with a whole-body counter. METHODS: Basic and post-bronchodilator spirometry measurements were made for 517 children aged 8 to 17 years born in and living within this differentially contaminated study area during 2008 to 2010. MEASUREMENTS AND MAIN RESULTS: A γ-spectrometer equipped with a collimator was used for the measurement of whole-body radiation and adjusted for weight. General linear and logistic regression models were used to estimate the association between spirometry measures and the weight-adjusted (137)Cs whole-body burden (Bq/kg) while controlling for potential confounders. The geometric median weight-adjusted radiation concentration was 65.96 Bq/kg (95% confidence interval, 14.98-240.9 Bq/kg), equivalent to a geometric mean internal dose estimate of 0.165 mSv/yr (95% confidence interval, 0.037-0.602 mSv/yr). Decrements in percentage predicted FEV1/FVC and an increased odds of bronchodilator responsiveness, restrictive impairment, and FVC less than lower limit of normal were associated with a log increase in weight-adjusted (137)Cs whole-body burden after adjusting for potential confounders. CONCLUSIONS: Our previous study of soil (137)Cs exposure and reduced lung function was corroborated herein with individual (137)Cs whole-body burden, although low, and annual internal dose data. Children in a region just outside of the closed Chernobyl contamination zone continued to have respiratory health deficits associated with (137)Cs whole-body burden as recently as 2010.

Effects of long-term low-level radiation exposure after the Chernobyl catastrophe on immunoglobulins in children residing in contaminated areas: prospective and cross-sectional studies.

BACKGROUND: After the Chernobyl nuclear incident in 1986, children in the Narodichesky region, located 80 km west of the Chernobyl Power Plant, were exposed to 137Cesium (137Cs). Little is known about the effects of chronic low-level radiation on humoral immune responses in children residing in contaminated areas. METHODS: In four different approaches we investigated the effect of residential 137Cs exposure on immunoglobulins A, G, M, and specific immunoglobulin E in children. In a dynamic cohort (1993-1998) we included 617 children providing 2,407 repeated measurements; 421 and 523 children in two cross-sectional samples (1997-1998 and 2008-2010, respectively); and 25 participants in a small longitudinal cohort (1997-2010). All medical exams, blood collections, and analyses were conducted by the same team. We used mixed linear models to analyze repeated measurements in cohorts and general linear regression models for cross-sectional studies. RESULTS: Residential soil contamination in 2008 was highly correlated with the individual body burden of 137Cs. Serum IgG and IgM concentrations increased between 1993 and 1998. Children with higher 137Cs soil exposure had lower serum IgG levels, which, however, increased in the small cohort assessed between 1997 and 2010. Children within the fourth quintile of 137Cs soil exposure (266-310 kBq/m2) had higher IgM serum concentrations between 1993 and 1998 but these declined between 1997 and 2010. IgA remained stable with median 137Cs exposures related to higher IgA levels, which was corroborated in the cross-sectional study of 2008-2010. Specific IgE against indoor allergens was detected less often in children with higher 137Cs exposure. CONCLUSIONS: Our findings show radiation-related alterations of immunoglobulins which by themselves do not constitute adverse health effects. Further investigations are necessary to understand how these changes affect health status.

Maternal obesity, folate intake, and neural tube defects in offspring.

BACKGROUND: We investigated the association between maternal obesity (body mass index [BMI] ≥ 30) and the risk of a neural tube defect affected pregnancy (NTD). We also studied relationships between perinatal folate intake from food and the NTD risk by maternal BMI. METHODS: Data came from a state-wide case-control study conducted between 1992 and 1997 in South Carolina including 179 women with NTD-affected pregnancies and 288 women without NTD-affected births. A majority of case mothers (77%) and controls (86%) were interviewed within 6 months after delivery or pregnancy termination. Logistic regression models were used to examine the association between maternal obesity and the NTD risk after adjusting for maternal race, age, education, smoking, alcohol/drug use, chronic conditions, and multivitamin use within six periconceptional months. Stratified analysis by maternal BMI (≥25 vs. <25) was conducted for the association between food folate and the NTD risk. RESULTS: After adjustment for confounders, obese women (BMI ≥ 30) had twice higher odds of having an NTD-affected pregnancy (odds ratios [OR] = 2.06, 95% confidence interval [CI] = 1.12, 3.81) than normal weight women (BMI: 18.0-24.9). Compared to the lowest quartile of average daily folate intake from food, the upper three quartiles had lower odds of NTDs in offspring. The NTD-protective association was stronger in overweight/obese women (BMI ≥ 25) than in normal/underweight women (BMI < 25). CONCLUSIONS: These results support previous studies suggesting maternal obesity as a risk factor for NTDs. Higher intakes of dietary folate were associated with decreased NTD risk that was stronger in overweight and obese women.