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Xie C, Chen J, Chen H, Zhang N. Association of eosinophil-to-monocyte ratio with asthma exacerbations in adults: a cross-sectional analysis of NHANES data. BMC Pulm Med 2025; 25:172. [PMID: 40217197 PMCID: PMC11992703 DOI: 10.1186/s12890-025-03617-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2024] [Accepted: 03/24/2025] [Indexed: 04/14/2025] Open
Abstract
BACKGROUND The eosinophil-to-monocyte ratio (EMR) has emerged as a promising biomarker for assessing inflammation in various diseases, and this study aims to investigate its potential in predicting asthma exacerbations. METHODS This cross-sectional study used data from the National Health and Nutrition Examination Survey (NHANES) 1999-2020. A total of 4,738 adults were included in the analysis, and weighted analyses were performed to ensure a representative sample of the general population. The relationship between EMR and asthma exacerbation risk was assessed using multivariable logistic regression with progressively adjusted covariates across multiple models. Subgroup analyses were performed by stratifying key covariates to explore interactions. Restricted cubic spline (RCS) analysis was applied to evaluate non-linear relationships. Sensitivity analyses confirmed the robustness and reliability of the results. RESULTS Elevated EMR levels were significantly associated with an increased risk of asthma exacerbations (p < 0.001 in all models). In the highest EMR quartile (Q4), the odds ratio for exacerbation compared to the lowest quartile (Q1) was 1.54 (95% CI: 1.23, 1.93) in Model 1, increasing to 1.56 (95% CI: 1.24, 1.97) in Model 2 and 1.58 (95% CI: 1.24, 2.02) in Model 3, after further adjustments. Subgroup analyses showed consistent associations across various characteristics (all p for interaction > 0.05), while RCS analysis revealed a linear relationship without threshold effects (p for nonlinear > 0.05). CONCLUSION EMR demonstrates strong potential as a biomarker for predicting asthma exacerbations, with implications for personalized asthma management.
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Affiliation(s)
- Congyi Xie
- Department of Pulmonary Medicine, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, 361015, China
| | - Jinzhan Chen
- Department of Pulmonary Medicine, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, 361015, China
| | - Haiyan Chen
- Department of Pulmonary Medicine, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, 361015, China
| | - Ning Zhang
- Department of Pulmonary Medicine, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, 361015, China.
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
- Fudan Zhangjiang Institute, Shanghai, 201203, China.
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Gao X, Wang T, Xu S, Chai X, Wang P, Gu H, Ma H, Wang Z, Chang F. Association between milk consumption and migraines among American adults: national health and nutrition examination survey. BMC Nutr 2025; 11:70. [PMID: 40200386 PMCID: PMC11980263 DOI: 10.1186/s40795-025-01052-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2024] [Accepted: 03/24/2025] [Indexed: 04/10/2025] Open
Abstract
BACKGROUND Migraines have been associated with nutritional imbalances within the brain, sparking ongoing interest in the possible association between dietary elements, including milk intake, and the occurrence of migraines. Nevertheless, the exact nature of the connection between milk consumption and migraines remains unclear. METHODS This cross-sectional analysis sought to explore the association between milk intake and the prevalence of migraines. The study utilized data from individuals aged 20 and above who participated in the National Health and Nutrition Examination Survey from 1999 to 2004. In our study, we meticulously gathered comprehensive data on severe headaches or migraines, milk consumption, along with critical variables such as age, sex, marital status, and body mass index, among others. Milk consumption among participants was ascertained through a questionnaire. Logistic regression modeling and subgroup analyses were employed to evaluate the association between milk consumption and the incidence of severe headaches or migraines. RESULTS Among the 8850 participants, 19.98% (1768/8850) were identified as having migraines. Compared to individuals with only regular/whole milk consumption in the past 30 days, the adjusted OR values for only skim milk consumption in the past 30 days were 0.73 (95%CI: 0.60-0.89, p = 0.001), 0.78 (95%CI: 0.64-0.95, p = 0.014), and 0.77 (95%CI: 0.63-0.93, p = 0.009), respectively. CONCLUSION A notable association was detected between the type of milk intake and the occurrence of migraines. These results lay the groundwork for future investigations into the role of milk consumption in migraine management, potentially informing strategies for alleviating migraine symptoms.
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Affiliation(s)
- Xiwang Gao
- Department of Health Management, The Second People's Hospital of Liaocheng, Liaocheng, 252600, China
| | - Tingting Wang
- Department of Intensive Care Unit, The Second People's Hospital of Liaocheng, Liaocheng, 252600, China
| | - Sha Xu
- Department of Cardiology, The Second People's Hospital of Liaocheng, Liaocheng, 252600, China.
| | - Xiuping Chai
- Department of Nursing Management, The Second People's Hospital of Liaocheng, Liaocheng, 252600, China
| | - Pingfan Wang
- Department of Nursing Management, The Second People's Hospital of Liaocheng, Liaocheng, 252600, China
| | - Huanhua Gu
- Department of Cardiology, The Second People's Hospital of Liaocheng, Liaocheng, 252600, China
| | - Hongna Ma
- Department of Cardiology, The Second People's Hospital of Liaocheng, Liaocheng, 252600, China
| | - Zhimin Wang
- Department of Cardiology, The Second People's Hospital of Liaocheng, Liaocheng, 252600, China
| | - Fangyuan Chang
- Department of Cardiology, The Second People's Hospital of Liaocheng, Liaocheng, 252600, China
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Cao X, Lu T, Tu Y, Zhou R, Li X, Du L. The association between adult asthma in the United States and dietary total energy intake: a retrospective cross-sectional analysis from NHANES. BMC Nutr 2024; 10:128. [PMID: 39334497 PMCID: PMC11437793 DOI: 10.1186/s40795-024-00938-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 09/23/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Epidemiological research links asthma progression to dietary nonallergic factors, particularly high-calorie intake. However, evidence supporting the relationship with total dietary calorie consumption remains scarce. OBJECTIVE This study aimed to explore the potential correlation between asthma occurrence and total dietary energy intake. METHODS A retrospective cross-sectional study of 21,354 US adults collected comprehensive participant data, including demographics, blood parameters, fatty acids, zinc, fiber intake, and asthma outcomes. Statistical analyses included interaction effects analysis, smooth curve fitting, and logistic regression. RESULTS Of 21,354 participants, 14.77% self-reported asthma diagnosis. After adjusting for confounders, odds ratios (OR) for asthma decreased with higher energy intake: Q2 (OR = 0.77, 95% CI: 0.69-0.86, p < .001), Q3 (OR = 0.66, 95% CI: 0.59-0.75, p < .001), and Q4 (OR = 0.61, 95% CI: 0.53-0.69, p < .001) compared to Q1 (< 17.73 kcal/kg/day). A non-linear (L-shaped) association between energy intake and asthma was observed (p < .001), with a critical threshold around 24 kcal/kg/day, supported by subgroup and sensitivity analyses. CONCLUSION This study reveals an L-shaped trend between total energy intake and asthma in US adults, with a significant threshold at approximately 24 kcal/kg/day.
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Affiliation(s)
- Xianghua Cao
- Dongguan Key Laboratory of Anesthesia and Enhanced Recovery after surgery, Department of Anesthesiology, Dongguan Tungwah Hospital, Dongguan, China
| | - Tong Lu
- Maternal and Child Health Hospital, Shandong Province, China
| | - Yunyun Tu
- Department of Anesthesia, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, 364000, China
| | - Rongguan Zhou
- The Third People's Hospital of Rui'an, Zhejiang Province, China
| | - Xueping Li
- Dongguan Key Laboratory of Anesthesia and Enhanced Recovery after surgery, Department of Anesthesiology, Dongguan Tungwah Hospital, Dongguan, China.
| | - Linjun Du
- The Third People's Hospital of Liaocheng City, Shandong Province, China.
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Wang X, Wang X, Cheng Y, Luo C, Xia W, Gao Z, Bu W, Jiang Y, Fei Y, Shi W, Tang J, Liu L, Zhu J, Zhao X. Construction of metal interpretable scoring system and identification of tungsten as a novel risk factor in COPD. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2024; 283:116842. [PMID: 39106568 DOI: 10.1016/j.ecoenv.2024.116842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 07/24/2024] [Accepted: 08/02/2024] [Indexed: 08/09/2024]
Abstract
Numerous studies have highlighted the correlation between metal intake and deteriorated pulmonary function, emphasizing its pivotal role in the progression of Chronic Obstructive Pulmonary Disease (COPD). However, the efficacy of traditional models is often compromised due to overfitting and high bias in datasets with low-level exposure, rendering them ineffective in delineating the contemporary risk trends associated with pulmonary diseases. To address these limitations, we embarked on developing advanced, interpretable models, crucial for elucidating the intricate mechanisms of metal toxicity and enriching the domain knowledge embedded in toxicity models. In this endeavor, we scrutinized extensive, long-term metal exposure datasets from NHANES to explore the interplay between metal and pulmonary functionality. Employing a variety of machine-learning approaches, we opted for the "Mixer of Experts" model for its proficiency in identifying a myriad of toxicological trends and sensitivities. We conceptualized and illustrated the TSAP (Toxicity Score at Population-level), a metal interpretable scoring system offering performance nearly equivalent to the amalgamation of standard interpretable methods addressing the "black box" conundrum. This streamlined, bifurcated procedural analysis proved instrumental in discerning established risk factors, thereby uncovering Tungsten as a novel contributor to COPD risk. SYNOPSIS: TSAP achieved satisfied performance with transparent interpretability, suggesting tungsten intake need further action for COPD prevention.
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Affiliation(s)
- Xuehai Wang
- Department of Occupational Medicine and Environmental Toxicology, Nantong Key Laboratory of Environmental Toxicology, School of Public Health, Nantong University, Nantong 226019, China
| | - Xiangdong Wang
- Department of Occupational Medicine and Environmental Toxicology, Nantong Key Laboratory of Environmental Toxicology, School of Public Health, Nantong University, Nantong 226019, China
| | - Yulan Cheng
- Department of Occupational Medicine and Environmental Toxicology, Nantong Key Laboratory of Environmental Toxicology, School of Public Health, Nantong University, Nantong 226019, China
| | - Chao Luo
- Department of Occupational Medicine and Environmental Toxicology, Nantong Key Laboratory of Environmental Toxicology, School of Public Health, Nantong University, Nantong 226019, China
| | - Weiyi Xia
- Department of Occupational Medicine and Environmental Toxicology, Nantong Key Laboratory of Environmental Toxicology, School of Public Health, Nantong University, Nantong 226019, China
| | - Zhengnan Gao
- Department of Occupational Medicine and Environmental Toxicology, Nantong Key Laboratory of Environmental Toxicology, School of Public Health, Nantong University, Nantong 226019, China
| | - Wenxia Bu
- Department of Occupational Medicine and Environmental Toxicology, Nantong Key Laboratory of Environmental Toxicology, School of Public Health, Nantong University, Nantong 226019, China
| | - Yichen Jiang
- Department of Occupational Medicine and Environmental Toxicology, Nantong Key Laboratory of Environmental Toxicology, School of Public Health, Nantong University, Nantong 226019, China
| | - Yue Fei
- Department of Occupational Medicine and Environmental Toxicology, Nantong Key Laboratory of Environmental Toxicology, School of Public Health, Nantong University, Nantong 226019, China
| | - Weiwei Shi
- Nantong Hospital to Nanjing University of Chinese Medicine, China
| | - Juan Tang
- Department of Occupational Medicine and Environmental Toxicology, Nantong Key Laboratory of Environmental Toxicology, School of Public Health, Nantong University, Nantong 226019, China
| | - Lei Liu
- Department of Occupational Medicine and Environmental Toxicology, Nantong Key Laboratory of Environmental Toxicology, School of Public Health, Nantong University, Nantong 226019, China; Department of Pathology, Affiliated Hospital of Nantong University, Nantong 226001, China.
| | - Jinfeng Zhu
- Nantong Hospital to Nanjing University of Chinese Medicine, China.
| | - Xinyuan Zhao
- Department of Occupational Medicine and Environmental Toxicology, Nantong Key Laboratory of Environmental Toxicology, School of Public Health, Nantong University, Nantong 226019, China.
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Huang S, He Q, Wang X, Choi S, Gong H. Associations of the planetary health diet index (PHDI) with asthma: the mediating role of body mass index. BMC Public Health 2024; 24:2305. [PMID: 39187832 PMCID: PMC11346270 DOI: 10.1186/s12889-024-19856-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Accepted: 08/22/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND Given the global shifts in environmental conditions and dietary habits, understanding the potential impact of dietary factors and body mass index (BMI) on respiratory diseases, including asthma, is paramount. Investigating these relationships can contribute to the formulation of more effective prevention strategies. The Planetary Health Diet Index (PHDI), a dietary scoring system that balances human health with environmental sustainability, underscores the importance of increasing the consumption of plant-based foods while reducing the intake of red meat, sugar, and highly processed foods. The objective of this study was to assess the association between PHDI and the prevalence of asthma and the mediation effect of BMI in a US general population. METHODS This study utilized data from 32,388 participants in the National Health and Nutrition Examination Survey (NHANES) spanning from 2005 to 2018. Multivariate logistic regression and weighted quantile sum (WQS) regressions were employed to investigate the association between PHDI, individual nutrients, and asthma. Restricted cubic spline (RCS) analysis explored the linear or non-linear relationship between PHDI and asthma. Interaction analyses were conducted on subgroups to validate the findings. Mediation analysis was performed to examine the effect of BMI on the relationship between PHDI and asthma. RESULTS There was a significant negative association between PHDI and asthma. After adjusting for covariates, for every 10-point increase in PHDI, there was a 4% decrease in the prevalence of asthma (P = 0.025). Moreover, as PHDI increased, there was a trend towards lower asthma prevalence (P for trend < 0.05). WQS analyses showed consistent associations (OR = 0.93, 95%CI: 0.88, 0.98), with Fiber, Vitamin C, and Protein significant factors. The dose-response curve indicated a linear association between PHDI and asthma, with higher PHDI associated with lower asthma prevalence. Additionally, BMI is significantly positively associated with asthma (P < 0.001), and BMI decreases as the PHDI increases (β = -0.64, P < 0.001). Mediation analysis indicates that BMI significantly mediates the relationship between PHDI and asthma, with a mediation proportion of 33.85% (P < 0.001). CONCLUSION The results of this study show a strong negative correlation between PHDI and the prevalence of asthma. In addition, BMI mediated this negative relationship.
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Affiliation(s)
- Shaoqun Huang
- Department of Oncology Surgery, Fuzhou Hospital of Traditional Chinese Medicine Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou City, Fujian Province, China
| | - Qiao He
- Graduate School of Tianjin, University of Traditional Chinese Medicine, Tianjin City, China
| | - Xiaoxuan Wang
- Graduate School of Tianjin, University of Traditional Chinese Medicine, Tianjin City, China
| | - Seok Choi
- Department of Physiology, College of Medicine, Chosun University, Gwangju, Korea
| | - Hongyang Gong
- Department of Physiology, College of Medicine, Chosun University, Gwangju, Korea.
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He F, Zhang Y, Ming L. Association between dietary carotenoid intakes and the risk of asthma in children and adolescents: evidence from the National Health and Nutrition Examination Survey 2007-2016. Transl Pediatr 2024; 13:1141-1151. [PMID: 39144429 PMCID: PMC11319997 DOI: 10.21037/tp-24-117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 06/28/2024] [Indexed: 08/16/2024] Open
Abstract
Background In recent years, the incidence of asthma in children has been increasing. As a chronic disease, in addition to drug treatment, dietary management is also important. However, studies of carotenoids and asthma have shown mixed results. This study aimed to evaluate whether the relationship between carotenoid intake and current asthma holds significant importance. Methods We studied 9,118 children aged 6-16 years in the National Health and Nutrition Examination Survey (NHANES) of US from 2007 to 2016, and the relationship of dietary carotenoid and its subgroup with pediatric asthma. Current asthma was assessed by parent-reported, doctor-diagnosed, asthma using a standardized questionnaire. We used multivariate logistic regression to calculate the odds ratio (OR) for current asthma with a 95% confidence interval (CI). Results Total carotenoid intake was not associated with the risk of current asthma. Compared with the first quantile, the second quantile of β-cryptoxanthin intake was positively correlated with current asthma (Q2: 1.227; 95% CI: 1.025-1.470; P=0.03). The test of trend showed that, as the α-carotene intake increased, the risk of current asthma showed a decreasing trend, which was very close to the statistic confidence cutoff (Model I: P for trend =0.001; Model II: P for trend =0.003; Model III: P for trend =0.08). In subgroup analysis, family history of asthma interacted with carotenoid intake (P=0.005). The population without a family history of asthma, there were significant negative associations between carotenoid intakes and asthma (quartile 4: Model III: 0.720; 95% CI: 0.549-0.943; P=0.02). Conclusions In this study, pediatric current asthma was not related to total carotenoids in our total participants. Total dietary carotenoid intake has a protective effect on children without a family history of asthma. Meanwhile, β-cryptoxanthin intake is positively correlated with asthma.
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Affiliation(s)
- Fei He
- Department of Pediatrics, Second Affiliated Hospital of the Army Medical University, Chongqing, China
| | - Yuping Zhang
- Department of Pediatrics, Second Affiliated Hospital of the Army Medical University, Chongqing, China
| | - Li Ming
- Department of Pediatrics, Second Affiliated Hospital of the Army Medical University, Chongqing, China
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Guo J, Shi L, Sun Y. Association of composite dietary antioxidant index and muscle mass in individuals with metabolic associated fatty liver disease. Clin Res Hepatol Gastroenterol 2024; 48:102284. [PMID: 38232899 DOI: 10.1016/j.clinre.2024.102284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/06/2024] [Accepted: 01/14/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND There is mounting evidence indicating the association between oxidative stress and the detrimental effect it poses on muscle mass. However, the crucial interplay between the Composite Dietary Antioxidant Index (CDAI), a key metric of antioxidant-rich diets, and the occurrence of muscle loss has remained largely unexplored. Hence, in this study, we aim to investigate the potential relationship between CDAI and muscle loss METHODS: This cross-sectional investigation harnessed data sourced from the National Health and Nutrition Examination Survey (2017 and 2018) to meticulously scrutinize the correlation between the CDAI and the occurrence of muscle loss. To unravel this intricate relationship, we engaged in multivariate weighted logistic regression analysis and employed smooth curve fitting techniques. Additionally, subgroup analyses were meticulously performed. RESULTS A total of 956 participants, with an average age of 42.15 years, were included in the final analysis, of which 52.19 % were males. Notably, the prevalence of low muscle mass among the study population was observed to be 15.48 %. The utilization of smooth curve fitting analysis underscored a nearly linear association between the CDAI and the presence of low muscle mass. Employing multivariate weighted logistic regression analysis, it was determined that the odds ratio (OR) between CDAI and low muscle mass was 0.88 (95 % [CI], 0.73-0.95). Through subgroup analyses, we further validated that CDAI independently mitigated the risk of muscle loss. CONCLUSION Higher CDAI levels were found to be associated with an reduced risk of low muscle mass in adults with metabolic associated fatty liver disease (MAFLD).
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Affiliation(s)
- Jing Guo
- Department of Clinical Laboratory, Xuzhou Central Hospital, Xuzhou, Jiangsu, China
| | - Lin Shi
- Department of Gastroenterology, Xuzhou Central Hospital, Xuzhou, Jiangsu, China
| | - Yan Sun
- Department of Endocrinology, Xuzhou Central Hospital, Xuzhou, Jiangsu, China.
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Chen Y, Wu J, Li R, Kang W, Zhao A, Yin Y, Tong S, Yuan J, Li S. Individual and joint association of phenols, parabens, and phthalates with childhood lung function: Exploring the mediating role of peripheral immune responses. JOURNAL OF HAZARDOUS MATERIALS 2023; 454:131457. [PMID: 37099904 DOI: 10.1016/j.jhazmat.2023.131457] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 05/19/2023]
Abstract
The functioning of the respiratory system can be interfered with by exposure to mixtures of environmental chemicals, however, the evidence is still ambiguous. We evaluated the association of exposure to mixtures of 14 chemicals, including 2 phenols, 2 parabens, and 10 phthalates, with four major lung function metrics. Based on data from the National Health and Nutrition Examination Survey 2007-2012, this analysis was conducted among 1462 children aged 6-19 years. Linear regression, Bayesian kernel machine regression, quantile-based g-computation regression, and a generalized additive model were performed to estimate the associations. Mediation analyses were performed to investigate plausible biological pathways mediated by immune cells. Our results indicated that the phenols, parabens, and phthalates mixture was negatively related to lung function parameters. And BPA and PP were identified as important contributors to negative associations with FEV1, FVC, and PEF, with non-linear relationships observed between BPA and those outcomes. The most influential factor for a probable FEF25-75 % decline was MCNP. BPA, and MCNP had an interaction effect on FEF25-75 %. The association of PP with FVC and FEV1 has been postulated to be mediated by neutrophils and monocytes. The findings offer insights into the associations of chemical mixtures with respiratory health and the possible driving mechanism, which would be of significance in adding novel evidence of the role of peripheral immune responses, as well as calling for remediation actions to be prioritized during childhood.
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Affiliation(s)
- Yiting Chen
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinhong Wu
- Department of Respiratory Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rong Li
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenhui Kang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Anda Zhao
- Department of Nutrition, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yong Yin
- Department of Respiratory Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shilu Tong
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Biostatistics, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; School of Public Health, Institute of Environment and Population Health, Anhui Medical University, Hefei, China; School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Jiajun Yuan
- Child Health Advocacy Institute, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shenghui Li
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China; MOE-Shanghai Key Laboratory of Children's Environmental Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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