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Lin B, Middleton RR, Terefe B, Appleton AA, Feingold BJ, Lynch T, Pieterse AL, Rogers R, Armah AE, Bierce LF, Flagg AM, McCarthy S. The Birth and Beyond (BABY) study: protocol for a birth cohort study investigating the social and environmental determinants of pregnancy-related outcomes in Black American families. BMJ Open 2024; 14:e087141. [PMID: 38658013 PMCID: PMC11043692 DOI: 10.1136/bmjopen-2024-087141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 04/05/2024] [Indexed: 04/26/2024] Open
Abstract
INTRODUCTION In the USA, Black birthing people and infants experience disproportionately worse pregnancy-related health outcomes. The causes for these disparities are unknown, but evidence suggests that they are likely socially and environmentally based. Efforts to identify the determinants of these racial disparities are urgently needed to elucidate the highest priority targets for intervention. The Birth and Beyond (BABY) study evaluates how micro-level (eg, interpersonal and family) and macro-level (eg, neighbourhood and environmental) risk and resiliency factors transact to shape birth person-infant health, and underlying psychobiological mechanisms. METHODS AND ANALYSIS The BABY study will follow 350 Black families (birthing parents, non-birthing parents and infants) from pregnancy through the first postpartum year, with research visits during pregnancy and at infant ages 6 and 12 months. Research visits comprise a combination of interview about a range of recent and life course stress and resiliency exposures and supports, psychophysiological (sympathetic, parasympathetic and adrenocortical) assessment and behavioural observations of parent-infant coregulatory behaviours. Spatial analyses are completed by mapping parent current and past residential addresses onto archival public data (eg, about neighbourhood quality and racial segregation). Finally, EMRs are abstracted for information about birthing parent relevant medical history, pregnancy conditions and infant birth outcomes. Analyses will evaluate the risk and resiliency mechanisms that contribute to pregnancy and birth-related outcomes for Black birthing people and their infants, and the protective role of individual, familial, cultural, and community supports. ETHICS AND DISSEMINATION The BABY study has been approved by the Institutional Review Board at Albany Medical Centre. The study team consulted with local organisations and groups comprised of stakeholders and community leaders and continues to do so throughout the study. Research results will be disseminated with the scientific and local community as appropriate.
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Affiliation(s)
- Betty Lin
- Department of Psychology, College of Arts and Sciences, University at Albany, Albany, New York, USA
- Obstetrics and Gynecology, Albany Medical Center, Albany, New York, USA
| | - Rachel R Middleton
- Department of Psychology, College of Arts and Sciences, University at Albany, Albany, New York, USA
| | - Bethlehem Terefe
- Obstetrics and Gynecology, Albany Medical Center, Albany, New York, USA
| | - Allison A Appleton
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Albany, New York, USA
| | - Beth J Feingold
- Department of Environmental Health Sciences, School of Public Health, University at Albany, Albany, New York, USA
| | - Tara Lynch
- Obstetrics and Gynecology, Albany Medical Center, Albany, New York, USA
| | - Alex L Pieterse
- Department of Counseling, Educational and Developmental Psychology, Boston College Carolyn A and Peter S Lynch School of Education and Human Development, Chestnut Hill, Massachusetts, USA
| | - Rebecca Rogers
- Obstetrics and Gynecology, Albany Medical Center, Albany, New York, USA
| | - Annabelle E Armah
- Department of Psychology, College of Arts and Sciences, University at Albany, Albany, New York, USA
| | - Lydia F Bierce
- Department of Psychology, College of Arts and Sciences, University at Albany, Albany, New York, USA
| | - Amanda M Flagg
- Department of Psychology, College of Arts and Sciences, University at Albany, Albany, New York, USA
| | - Sarah McCarthy
- Department of Sociology, University at Albany College of Arts and Sciences, Albany, New York, USA
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Frongillo EA, Bethancourt HJ, Norcini Pala A, Maya S, Wu KC, Kizer JR, Tien PC, Kempf MC, Hanna DB, Appleton AA, Merenstein D, D'Souza G, Ofotokun I, Konkle-Parker D, Michos ED, Krier S, Stosor V, Turan B, Weiser SD. Complementing the United States Household Food Security Survey Module with Items Reflecting Social Unacceptability. J Nutr 2024; 154:1428-1439. [PMID: 38408732 PMCID: PMC11007734 DOI: 10.1016/j.tjnut.2024.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/11/2024] [Accepted: 02/21/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Social unacceptability of food access is part of the lived experience of food insecurity but is not assessed as part of the United States Household Food Security Survey Module (HFSSM). OBJECTIVES The objectives were as follows: 1) to determine the psychometric properties of 2 additional items on social unacceptability in relation to the HFSSM items and 2) to test whether these 2 items provided added predictive accuracy to that of the HFSSM items for mental health outcomes. METHODS Cross-sectional data used were from the Intersection of Material-Need Insecurities and HIV and Cardiovascular Health substudy of the Multicenter AIDS Cohort Study/Women's Interagency HIV Study Combined Cohort Study. Data on the 10-item HFSSM and 2 new items reflecting social unacceptability were collected between Fall 2020 and Fall 2021 from 1342 participants from 10 United States cities. The 2 social unacceptability items were examined psychometrically in relation to the HFSSM-10 items using models from item response theory. Linear and logistic regression was used to examine prediction of mental health measured by the 20-item Center for Epidemiologic Studies Depression scale and the 10-item Perceived Stress Scale. RESULTS The social unacceptability items were affirmed throughout the range of severity of food insecurity but with increasing frequency at higher severity of food insecurity. From item response theory models, the subconstructs reflected in the HFSSM-10 and the subconstruct of social unacceptability were distinct, not falling into one dimension. Regression models confirmed that social unacceptability was distinct from the subconstructs reflected in the HFSSM-10. The social unacceptability items as a separate scale explained more (∼1%) variation in mental health than when combined with the HFSSM-10 items in a single scale, and the social unacceptability subconstruct explained more (∼1%) variation in mental health not explained by the HFSSM-10. CONCLUSIONS Two social unacceptability items used as a separate scale along with the HFSSM-10 predicted mental health more accurately than did the HFSSM-10 alone.
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Affiliation(s)
- Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.
| | - Hilary J Bethancourt
- Department of Medicine, University of California San Francisco, San Franciso, CA, United States
| | | | - Sigal Maya
- Department of Medicine, University of California San Francisco, San Franciso, CA, United States
| | - Katherine C Wu
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
| | - Jorge R Kizer
- Department of Medicine, Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States; Cardiology Section, San Francisco Veterans Affairs Health System, San Francisco, CA, United States
| | - Phyllis C Tien
- Department of Medicine, University of California San Francisco, San Franciso, CA, United States; Infectious Diseases Section, San Francisco Veterans Affairs Health System, San Francisco, CA, United States
| | - Mirjam-Colette Kempf
- Schools of Nursing and Medicine, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - David B Hanna
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Allison A Appleton
- Epidemiology & Biostatistics, University at Albany School of Public Health, Albany, NY, United States
| | - Daniel Merenstein
- Department of Family Medicine, Georgetown University, Washington, DC, United States
| | - Gypsyamber D'Souza
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, United States
| | - Igho Ofotokun
- School of Medicine, Emory University, Atlanta, GA, United States
| | - Deborah Konkle-Parker
- Schools of Nursing, Medicine, and Population Health, University of Mississippi Medical Center, Jackson, MS, United States
| | - Erin D Michos
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States; Department of Epidemiology, Johns Hopkins University, Baltimore, MD, United States
| | - Sarah Krier
- Infectious Diseases & Microbiology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Valentina Stosor
- School of Medicine, Northwestern University, Evanston, IL, United States
| | - Bulent Turan
- Department of Psychology, Koc University, Istanbul, Turkey; Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Sheri D Weiser
- Department of Medicine, University of California San Francisco, San Franciso, CA, United States
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Appleton AA, Kuniholm MH, Vásquez E, Cohen MH, Donohue J, Floris-Moore M, Friedman MR, Hanna DB, Mimiaga MJ, Moran CA, Plankey MW, Teplin LA, Shitole SG, Ware D, Jones DL, Wise J. Life course history of physical and sexual abuse is associated with cardiovascular disease risk among women living with and without HIV. AIDS 2024; 38:739-750. [PMID: 38126350 PMCID: PMC10939824 DOI: 10.1097/qad.0000000000003822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Sexual and physical abuse predict cardiovascular disease (CVD) among women in the general population. Women living with HIV (WLWH) report more abuse and have higher CVD risk compared with other women, yet associations between abuse history and CVD have not been considered among WLWH. This study fills this gap, and describes possible pathways linking abuse to CVD risk among WLWH and women living without HIV (WLWOH). METHODS Using 25 years of data from the Women's Interagency HIV Study (WIHS; n = 2734; WLWH n = 1963; WLWOH n = 771), we used longitudinal generalized estimating equations (GEE) to test associations between sexual and physical abuse with CVD risk. Framingham (FRS-H) and the American College of Cardiology/American Heart Association-Pooled Cohort Equation (ACC/AHA-PCE) scores were examined. Analyses were stratified by HIV-serostatus. RESULTS Among WLWH, childhood sexual abuse was associated with higher CVD risk ( βFRS-H = 1.25, SE = 1.08, P = 0.005; βACC/AHA-PCE = 1.14, SE = 1.07, P = 0.04) compared with no abuse. Adulthood sexual abuse was associated with higher CVD risk for WLWH ( βFRS-H = 1.39, SE = 1.08, P < 0.0001) and WLWOH ( βFRS-H = 1.58, SE = 1.14, P = 0.0006). Childhood physical abuse was not associated with CVD risk for either group. Adulthood physical abuse was associated with CVD risk for WLWH ( βFRS-H = 1.44, SE = 1.07; P < 0.0001, βACC/AHA-PCE = 1.18, SE = 1.06, P = 0.002) and WLWOH ( βFRS-H = 1.68, SE = 1.12, P < 0.0001; βACC/AHA-PCE = 1.24, SE = 1.11, P = 0.03). Several pathway factors were significant, including depression, smoking, and hepatitis C infection. CONCLUSION Life course abuse may increase CVD risk among WLWH and women at high risk of acquiring HIV. Some comorbidities help explain the associations. Assessing abuse experiences in clinical encounters may help contextualize cardiovascular risk among this vulnerable population and inform intervention.
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Affiliation(s)
- Allison A Appleton
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY
| | - Mark H Kuniholm
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY
| | - Elizabeth Vásquez
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY
| | - Mardge H Cohen
- Department of Medicine, Stroger Hospital of Cook County, Chicago, IL
| | - Jessica Donohue
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Michelle Floris-Moore
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - M Reuel Friedman
- Department of Urban-Global Public Health, School of Public Health, Rutgers University, New Brunswick, NJ
| | - David B Hanna
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Matthew J Mimiaga
- Department of Epidemiology, University of California Los Angeles Fielding School of Public Health, Los Angeles, CA
| | - Caitlin A Moran
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Michael W Plankey
- Department of Medicine, Georgetown University Medical Center, Washington, DC
| | - Linda A Teplin
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sanyog G Shitole
- Cardiology Section, San Francisco Veterans Affairs Healthcare System
- Department of Medicine, University of California San Francisco, San Francisco, CA
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Deanna Ware
- Department of Medicine, Georgetown University Medical Center, Washington, DC
| | - Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Jenni Wise
- Department of Family, Community, and Health Systems, School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
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Hu X, Lin Y, Appleton AA, Wang W, Yu B, Zhou L, Li G, Zhou Y, Ou Y, Dong H. Remnant cholesterol, iron status and diabetes mellitus: a dose-response relationship and mediation analysis. Diabetol Metab Syndr 2024; 16:65. [PMID: 38475846 DOI: 10.1186/s13098-024-01304-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 03/04/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Remnant cholesterol (RC) is recognized as a risk factor for diabetes mellitus (DM). Although iron status has been shown to be associated with cholesterol metabolism and DM, the association between RC, iron status, and DM remains unclear. We examined the relationship between RC and iron status and investigated the role of iron status in the association between RC and DM. METHODS A total of 7308 patients were enrolled from the China Health and Nutrition Survey. RC was calculated as total cholesterol minus low-density lipoprotein cholesterol and high-density lipoprotein cholesterol. Iron status was assessed as serum ferritin (SF) and total body iron (TBI). DM was ascertained by self-reported physician diagnosis and/or antidiabetic drug use and/or fasting plasma glucose ≥ 126 mg/dL and/or glycated haemoglobin ≥ 6.5%. General linear models were used to evaluate the relationships between RC and iron status. Restricted cubic splines were used to assess the association between RC and DM. Mediation analysis was used to clarified the mediating role of iron status in the association between the RC and DM. RESULTS The average age of the participants was 50.6 (standard deviation = 15.1) years. Higher RC was significantly associated with increased SF (β = 73.14, SE = 3.75, 95% confidence interval [CI] 65.79-80.49) and TBI (β = 1.61, SE = 0.08, 95% CI 1.44-1.78). J-shape relationships were found in the association between RC levels with DM, as well as iron status with DM. Significant indirect effects of SF and TBI in the association between RC and DM were found, with the index mediated at 9.58% and 6.37%, respectively. CONCLUSIONS RC has a dose-response relationship with iron status. The association between RC and DM was mediated in part by iron status. Future studies are needed to confirm these findings and further clarify the underlying mechanism.
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Affiliation(s)
- Xiangming Hu
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
- Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Lin
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
- Shantou University Medical College, Shantou, Guangdong, China
| | - Allison A Appleton
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, 1 University Place, Rensselaer, NY, USA
| | - Weimian Wang
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Bingyan Yu
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Langping Zhou
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
- Department of Cardiology, Baoan District Central Hospital, Shenzhen, Guangdong, China
| | - Guang Li
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Yingling Zhou
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Yanqiu Ou
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China.
| | - Haojian Dong
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China.
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Peters BA, Hanna DB, Wang Y, Weber KM, Topper E, Appleton AA, Sharma A, Hodis HN, Santoro N, Guillemette C, Caron P, Knight R, Burk RD, Kaplan RC, Qi Q. Sex Hormones, the Stool Microbiome, and Subclinical Atherosclerosis in Women With and Without HIV. J Clin Endocrinol Metab 2024; 109:483-497. [PMID: 37643897 PMCID: PMC11032255 DOI: 10.1210/clinem/dgad510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/07/2023] [Accepted: 08/24/2023] [Indexed: 08/31/2023]
Abstract
CONTEXT Cardioprotective roles of endogenous estrogens may be particularly important in women with HIV, who have reduced estrogen exposure and elevated cardiovascular disease risk. The gut microbiome metabolically interacts with sex hormones, but little is known regarding possible impact on cardiovascular risk. OBJECTIVE To analyze potential interplay of sex hormones and gut microbiome in cardiovascular risk. METHODS Among 197 postmenopausal women in the Women's Interagency HIV Study, we measured 15 sex hormones in serum and assessed the gut microbiome in stool. Presence of carotid artery plaque was determined (B-mode ultrasound) in a subset (n = 134). We examined associations of (i) sex hormones and stool microbiome, (ii) sex hormones and plaque, and (iii) sex hormone-related stool microbiota and plaque, adjusting for potential confounders. RESULTS Participant median age was 58 years and the majority were living with HIV (81%). Sex hormones (estrogens, androgens, and adrenal precursors) were associated with stool microbiome diversity and specific species, similarly in women with and without HIV. Estrogens were associated with higher diversity, higher abundance of species from Alistipes, Collinsella, Erysipelotrichia, and Clostridia, and higher abundance of microbial β-glucuronidase and aryl-sulfatase orthologs, which are involved in hormone metabolism. Several hormones were associated with lower odds of carotid artery plaque, including dihydrotestosterone, 3α-diol-17G, estradiol, and estrone. Exploratory mediation analysis suggested that estrone-related species, particularly from Collinsella, may mediate the protective association of estrone with plaque. CONCLUSION Serum sex hormones are significant predictors of stool microbiome diversity and composition. The gut microbiome may play a role in estrogen-related cardiovascular protection.
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Affiliation(s)
- Brandilyn A Peters
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - David B Hanna
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Yi Wang
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Kathleen M Weber
- Cook County Health/Hektoen Institute of Medicine, Chicago, IL 60608, USA
| | - Elizabeth Topper
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Allison A Appleton
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Rensselaer, NY 12144, USA
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Howard N Hodis
- Departments of Medicine and Population and Public Health Sciences, Atherosclerosis Research Unit, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Chantal Guillemette
- Centre Hospitalier Universitaire (CHU) de Québec—Université Laval Research Center, Cancer research center (CRC) and Faculty of Pharmacy, Université Laval, Québec City, QC G1V 0A6, Canada
| | - Patrick Caron
- Centre Hospitalier Universitaire (CHU) de Québec—Université Laval Research Center, Cancer research center (CRC) and Faculty of Pharmacy, Université Laval, Québec City, QC G1V 0A6, Canada
| | - Rob Knight
- Departments of Pediatrics, Computer Science and Engineering, Bioengineering, and Center for Microbiome Innovation, University of California San Diego, La Jolla, CA 92093, USA
| | - Robert D Burk
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Departments of Microbiology and Immunology and Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Robert C Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Qibin Qi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
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Wang Y, Sharma A, Weber KM, Topper E, Appleton AA, Gustafson D, Clish CB, Kaplan RC, Burk RD, Qi Q, Peters BA. The menopause-related gut microbiome: associations with metabolomics, inflammatory protein markers, and cardiometabolic health in women with HIV. Menopause 2024; 31:52-64. [PMID: 38086007 PMCID: PMC10841550 DOI: 10.1097/gme.0000000000002287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
OBJECTIVE This study aimed to identify menopause-related gut microbial features, as well as their related metabolites and inflammatory protein markers, and link with cardiometabolic risk factors in women with and without HIV. METHODS In the Women's Interagency HIV Study, we performed shotgun metagenomic sequencing on 696 stool samples from 446 participants (67% women with HIV), and quantified plasma metabolomics and serum proteomics in a subset (~86%). We examined the associations of menopause (postmenopausal vs premenopausal) with gut microbial features in a cross-sectional repeated-measures design and further evaluated those features in relation to metabolites, proteins, and cardiometabolic risk factors. RESULTS Different overall gut microbial composition was observed by menopausal status in women with HIV only. We identified a range of gut microbial features that differed between postmenopausal and premenopausal women with HIV (but none in women without HIV), including abundance of 32 species and functional potentials involving 24 enzymatic reactions and lower β-glucuronidase bacterial gene ortholog. Specifically, highly abundant species Faecalibacterium prausnitzii , Bacteroides species CAG:98 , and Bifidobacterium adolescentis were depleted in postmenopausal versus premenopausal women with HIV. Menopause-depleted species (mainly Clostridia ) in women with HIV were positively associated with several glycerophospholipids, while negatively associated with imidazolepropionic acid and fibroblast growth factor 21. Mediation analysis suggested that menopause may decrease plasma phosphatidylcholine plasmalogen C36:1 and C36:2 levels via reducing abundance of species F. prausnitzii and Acetanaerobacterium elongatum in women with HIV. Furthermore, waist-to-hip ratio was associated with menopause-related microbes, metabolites, and fibroblast growth factor 21 in women with HIV. CONCLUSIONS Menopause was associated with a differential gut microbiome in women with HIV, related to metabolite and protein profiles that potentially contribute to elevated cardiometabolic risk.
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Affiliation(s)
- Yi Wang
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Elizabeth Topper
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Allison A. Appleton
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Rensselaer, NY, USA
| | - Deborah Gustafson
- Department of Neurology, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | | | - Robert C. Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Robert D. Burk
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Obstetrics & Gynecology and Women’s Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Qibin Qi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Brandilyn A. Peters
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
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7
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Vásquez E, Kuniholm MH, Appleton AA, Rubin LH, Adimora AA, Fischl MA, Fox E, Mack WJ, Holman S, Moran CA, Minkoff H, Plankey MW, Sharma A, Tien PC, Weber KM, Gustafson DR. Midlife body mass index, central adiposity and neuropsychological performance over 10 years in women living with and without HIV. Front Endocrinol (Lausanne) 2023; 14:1108313. [PMID: 37484940 PMCID: PMC10361616 DOI: 10.3389/fendo.2023.1108313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 06/09/2023] [Indexed: 07/25/2023] Open
Abstract
Background and objective Observations of overweight and obesity in association with neuropsychological performance (NP) vary over the adult life course depending on baseline levels, biological sex, age, race, temporality of measurements, and other factors. Therefore, similar published analyses across cohorts are inconsistent. In our sample of women living with HIV (WLWH) and women without HIV (WWOH), we conducted comparable analyses as those published in men with and without HIV. We examined cross-sectional and longitudinal associations between body mass index (BMI) and waist circumference (WC) and NP. Methods Four hundred thirty two 432 virologically-suppressed WLWH and 367 WWOH, ≥40 years in the Women's Interagency HIV Study (WIHS) with anthropometry and NP assessments every two years from 2009-2019 were included in the study. Demographically-adjusted T-scores were calculated for six NP domains: learning, memory, executive function, processing speed, attention and working memory, and motor function. Multivariable linear regression models stratified by HIV status were used to examine cross-sectional associations of BMI and WC by NP domain; repeated measures analyses assessed baseline BMI and WC in association with longitudinal change in NP. Covariates included sociodemographic, behavioral, and HIV-related characteristics. Results At baseline among all women, the median age was 45 years, 65% were Non-Latinx Black women, and 45% were obese women. Obese WLWH (BMI≥30.0 kg/m2) had poorer executive function (β=-2.27, 95%CI [-4.46, -0.07]) versus WLWH with healthy BMI (18.5-24.9 kg/m2). Longitudinally over ~8 years, obese versus overweight WWOH improved on memory (β=2.19, 95%CI [0.13, 4.26]), however overweight versus healthy WWOH experienced declining memory (β= -2.67, 95%CI [-5.40, -0.07]). Increasing WC was associated with declining executive, processing speed, and motor function (p's<0.05); an at-risk WC was associated with improved memory (β=1.81, 95%CI [0.19, 3.44]) among WWOH. Among WLWH, increasing BMI was associated with improved learning (β=0.07, 95%CI [0.00, 0.15]. Conclusion Our cross-sectional and longitudinal analyses evaluating the associations of BMI and WC and NP were mixed compared to previous reports. This illustrates the importance of sociodemographic characteristics, baseline levels of exposures and outcomes, HIV status, temporality of measurements, and other factors when evaluating aging HIV epidemiology study results.
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Affiliation(s)
- Elizabeth Vásquez
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health State University of New York, Rensselaer, NY, United States
| | - Mark H. Kuniholm
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health State University of New York, Rensselaer, NY, United States
| | - Allison A. Appleton
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health State University of New York, Rensselaer, NY, United States
| | - Leah H. Rubin
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
- Department of Psychology, Johns Hopkins University, Baltimore, MD, United States
- Department Epidemiology, Johns Hopkins University, Baltimore, MD, United States
| | - Ada A. Adimora
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Margaret A. Fischl
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Ervin Fox
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, United States
| | - Wendy J. Mack
- Population and Public Health Sciences, University of Southern California, Los Angeles, CA, United States
| | - Susan Holman
- Department of Medicine/STAR Program, State University of New York Health Sciences University, Brooklyn, NY, United States
| | - Caitlin Anne Moran
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
- Grady Healthcare System, Infectious Diseases Program, Atlanta, United States
| | - Howard Minkoff
- Department of Neurology, State of New York Downstate Health Sciences University, Brooklyn, NY, United States
| | - Michael W. Plankey
- Department of Medicine, Georgetown University, Washington, DC, United States
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Phyllis C. Tien
- Department of Medicine, University of California, San Francisco, CA, United States
- Department of Veterans Affairs, San Francisco, CA, United States
| | - Kathleen M. Weber
- Cook County Health/Hektoen Institute of Medicine, Chicago, IL, United States
| | - Deborah R. Gustafson
- Department of Neurology, State of New York Downstate Health Sciences University, Brooklyn, NY, United States
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Holdsworth EA, Schell LM, Appleton AA. Maternal-infant interaction quality is associated with child NR3C1 CpG site methylation at 7 years of age. Am J Hum Biol 2023; 35:e23876. [PMID: 36779373 PMCID: PMC10909417 DOI: 10.1002/ajhb.23876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 01/04/2023] [Accepted: 01/23/2023] [Indexed: 02/14/2023] Open
Abstract
OBJECTIVE Infancy is both a critical window for hypothalamic-pituitary-adrenal (HPA) axis development, and a sensitive period for social-emotional influences. We hypothesized that the social-emotional quality of maternal-infant interactions are associated with methylation of HPA-axis gene NR3C1 later in childhood. METHODS Using a subsample of 114 mother-infant pairs from the Avon Longitudinal Study of Parents and Children (ALSPAC), linear regression models were created to predict variance in methylation of seven selected CpG sites from NR3C1 in whole blood at age 7 years, including the main predictor variable of the first principal component score of observed maternal-infant interaction quality (derived from the Thorpe Interaction Measure at 12 months of age) and covariates of cell-type proportion, maternal financial difficulties and marital status at 8 months postnatal, child birthweight, and sex. RESULTS CpG site cg27122725 methylation was negatively associated with warmer, more positive maternal interaction with her infant (β = 0.19, p = .02, q = 0.13). In sensitivity analyses, the second highest quartile of maternal behavior (neutral, hesitant behavior) was positively associated with cg12466613 methylation. The other five CpG sites were not significantly associated with maternal-infant interaction quality. CONCLUSIONS Narrow individual variation of maternal interaction with her infant is associated with childhood methylation of two CpG sites on NR3C1 that may be particularly sensitive to environmental influences. Infancy may be a sensitive period for even small influences from the social-emotional environment on the epigenetic determinants of HPA-axis function.
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Affiliation(s)
- Elizabeth A. Holdsworth
- Department of AnthropologyWashington State UniversityPullmanWashingtonUSA
- Department of AnthropologyUniversity at Albany State University of New YorkAlbanyNew YorkUSA
| | - Lawrence M. Schell
- Department of AnthropologyUniversity at Albany State University of New YorkAlbanyNew YorkUSA
- Department of Epidemiology & BiostatisticsUniversity at Albany State University of New YorkRensselaerNew YorkUSA
| | - Allison A. Appleton
- Department of Epidemiology & BiostatisticsUniversity at Albany State University of New YorkRensselaerNew YorkUSA
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9
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Sun F, Yao J, Du S, Qian F, Appleton AA, Tao C, Xu H, Liu L, Dai Q, Joyce BT, Nannini DR, Hou L, Zhang K. Social Determinants, Cardiovascular Disease, and Health Care Cost: A Nationwide Study in the United States Using Machine Learning. J Am Heart Assoc 2023; 12:e027919. [PMID: 36802713 PMCID: PMC10111459 DOI: 10.1161/jaha.122.027919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Background Existing studies on cardiovascular diseases (CVDs) often focus on individual-level behavioral risk factors, but research examining social determinants is limited. This study applies a novel machine learning approach to identify the key predictors of county-level care costs and prevalence of CVDs (including atrial fibrillation, acute myocardial infarction, congestive heart failure, and ischemic heart disease). Methods and Results We applied the extreme gradient boosting machine learning approach to a total of 3137 counties. Data are from the Interactive Atlas of Heart Disease and Stroke and a variety of national data sets. We found that although demographic composition (eg, percentages of Black people and older adults) and risk factors (eg, smoking and physical inactivity) are among the most important predictors for inpatient care costs and CVD prevalence, contextual factors such as social vulnerability and racial and ethnic segregation are particularly important for the total and outpatient care costs. Poverty and income inequality are the major contributors to the total care costs for counties that are in nonmetro areas or have high segregation or social vulnerability levels. Racial and ethnic segregation is particularly important in shaping the total care costs for counties with low poverty rates or social vulnerability level. Demographic composition, education, and social vulnerability are consistently important across different scenarios. Conclusions The findings highlight the differences in predictors for different types of CVD cost outcomes and the importance of social determinants. Interventions directed toward areas that have been economically and socially marginalized may aid in reducing the impact of CVDs.
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Affiliation(s)
- Feinuo Sun
- Global Aging and Community Initiative Mount Saint Vincent University Halifax Nova Scotia Canada
| | - Jie Yao
- Department of Epidemiology and Biostatistics, School of Public Health University at Albany, State University of New York Albany NY
| | - Shichao Du
- Department of Sociology University at Albany, State University of New York Albany NY
| | - Feng Qian
- Department of Health Policy, Management and Behavior, School of Public Health University at Albany, State University of New York Albany NY
| | - Allison A Appleton
- Department of Epidemiology and Biostatistics, School of Public Health University at Albany, State University of New York Albany NY
| | - Cui Tao
- School of Biomedical Informatics The University of Texas Health Science Center at Houston Houston TX
| | - Hua Xu
- School of Biomedical Informatics The University of Texas Health Science Center at Houston Houston TX
| | - Lei Liu
- Division of Biostatistics Washington University in St. Louis St. Louis MO
| | - Qi Dai
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, School of Medicine Vanderbilt University, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center Nashville TN
| | - Brian T Joyce
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Drew R Nannini
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Lifang Hou
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Kai Zhang
- Department of Environmental Health Sciences, School of Public Health University at Albany, State University of New York Albany NY
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10
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Rodríguez-Rabassa M, Torres-Marrero E, López P, Muniz-Rodriguez K, Borges-Rodríguez M, Appleton AA, Avilés-Santa L, Alvarado-Domenech LI. Stressors and Impact of the COVID-19 Pandemic on Vulnerable Hispanic Caregivers and Children. Int J Environ Res Public Health 2023; 20:1838. [PMID: 36767218 PMCID: PMC9914744 DOI: 10.3390/ijerph20031838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 12/26/2022] [Accepted: 12/31/2022] [Indexed: 06/18/2023]
Abstract
Psychological sequelae are important elements of the burden of disease among caregivers. Recognition of the impact of adversity and stress biomarkers is important to prevent mental health problems that affect rearing practices and child well-being. This cross-sectional study explored social determinants of health (SDoH)-mediated stressors during COVID-19 and risks for mental health problems among caregivers of children with prenatal Zika virus exposure. Twenty-five Hispanic caregivers completed surveys assessing SDoH vulnerabilities, COVID-exposures and impact, post-traumatic stress disorder (PTSD) symptomatology, and provided a hair sample for cortisol concentration (HCC). Most caregivers had low education, household income < $15,000/year, and were unemployed. Stressors included disrupted child education and specialized services, and food insecurity. While most reported PTSD symptomatology, multivariate linear regression models adjusted for the caregiver's age, education, and the child's sex, revealed that caregivers with high symptomatology had significantly lower HCC than those with low symptomatology and those with food insecurity had significantly higher HCC than participants without food insecurity. The impact of COVID-19 on daily life was characterized on average between worse and better, suggesting variability in susceptibility and coping mechanisms, with the most resilient identifying community support and spirituality resources. SDoH-mediators provide opportunities to prevent adverse mental health outcomes for caregivers and their children.
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Affiliation(s)
- Mary Rodríguez-Rabassa
- Clinical Psychology Program, Ponce Health Sciences University, P.O. Box 7004, Ponce, PR 00732, USA
- RCMI Center for Research Resources, Ponce Health Sciences University, P.O. Box 7004, Ponce, PR 00732, USA
- Department of Pediatrics, Ponce Health Sciences University, P.O. Box 7004, Ponce, PR 00732, USA
| | - Estefanía Torres-Marrero
- Clinical Psychology Program, Ponce Health Sciences University, P.O. Box 7004, Ponce, PR 00732, USA
| | - Pablo López
- RCMI Center for Research Resources, Ponce Health Sciences University, P.O. Box 7004, Ponce, PR 00732, USA
| | | | | | - Allison A. Appleton
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, 1 University Place, Rensselaer, NY 12144, USA
| | - Larissa Avilés-Santa
- Division of Clinical and Health Services Research, National Institute on Minority Health and Health Disparities, 6707 Democracy Blvd. Suite 800, Bethesda, MD 20892, USA
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11
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Appleton AA, Lin B, Kennedy EM, Holdsworth EA. Maternal depression and adverse neighbourhood conditions during pregnancy are associated with gestational epigenetic age deceleration. Epigenetics 2022; 17:1905-1919. [PMID: 35770941 PMCID: PMC9665127 DOI: 10.1080/15592294.2022.2090657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Gestational epigenetic age (GEA) acceleration and deceleration can indicate developmental risk and may help elucidate how prenatal exposures lead to offspring outcomes. Depression and neighbourhood conditions during pregnancy are well-established determinants of birth and child outcomes. Emerging research suggests that maternal depression may contribute to GEA deceleration. It is unknown whether prenatal neighbourhood adversity would likewise influence GEA deceleration. This study examined whether maternal depression and neighbourhood conditions independently or jointly contributed to GEA deceleration, and which social and environmental neighbourhood conditions were associated with GEA. Participants were from the Albany Infant and Mother Study (n = 204), a prospective non-probability sampled cohort of higher risk racial/ethnic diverse mother/infant dyads. GEA was estimated from cord blood. Depressive symptoms and census-tract level neighbourhood conditions were assessed during pregnancy. Maternal depression (β = -0.03, SE = 0.01, p = 0.008) and neighbourhood adversity (β = -0.32, SE = 0.14, p = 0.02) were independently associated with GEA deceleration, controlling for all covariates including antidepressant use and cell type proportions. Neighbourhood adversity did not modify the association of maternal depression and GEA (β = 0.003, SE = 0.03, p = 0.92). igher levels of neighbourhood poverty, public assistance, and lack of healthy food access were each associated with GEA deceleration; higher elementary school test scores (an indicator of community tax base) were associated with GEA acceleration (all p < 0.001). The results of this study indicated that maternal depression and neighbourhood conditions were independently and cumulatively associated GEA in this diverse population.
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Affiliation(s)
- Allison A. Appleton
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Rensselaer, NY, USA,CONTACT Allison A. Appleton Department of Epidemiology and Biostatistics, University at Albany School of Public Health, 1 University Place, Rensselaer12144
| | - Betty Lin
- Department of Psychology, University at Albany College of Arts and Sciences, Albany, NY, USA
| | - Elizabeth M. Kennedy
- Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA, USA
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Chong LS, Gordis E, Hunter L, Amoh J, Strully K, Appleton AA, Tracy M. Childhood violence exposure and externalizing behaviors: A systematic review of the role of physiological biomarkers. Psychoneuroendocrinology 2022; 145:105898. [PMID: 36087419 PMCID: PMC9840871 DOI: 10.1016/j.psyneuen.2022.105898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 08/19/2022] [Accepted: 08/19/2022] [Indexed: 01/17/2023]
Abstract
Childhood exposure to violence has been consistently linked to externalizing behaviors like delinquency and aggression. Growing evidence indicates that physiological biomarkers from the parasympathetic and sympathetic nervous systems (PNS and SNS) and hypothalamic-pituitary-adrenal (HPA) axis may moderate or mediate the relation between childhood violence exposure and externalizing behaviors. We conducted a systematic review to synthesize recent findings on physiological biomarkers as mediators and/or moderators of this association across the life course, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Our search yielded 3878 articles, of which 44 met inclusion criteria (describing a total of 46 independent studies). We found consistent evidence for blunted HPA-axis reactivity as a mediator of the relation between childhood violence exposure and subsequent externalizing behaviors, and for non-reciprocal PNS/SNS activation as moderators exacerbating this relation. However, the results of the majority of included studies that demonstrated significant moderating effects of physiological biomarkers varied by participant sex, type of childhood violence exposure, and type of stimuli used to induce physiological reactivity. The observed mixed findings are consistent with some theories that emphasize that both high and low stress reactivity can be adaptive depending on one's early environment. These findings highlight the need for systematic explorations of heterogeneity, theory-driven research questions, and longitudinal studies that span multiple developmental periods and multiple biological systems. Clinical implications include the need to assess physiological biomarkers in treatment and intervention studies and the potential to target interventions based on both autonomic functioning and environmental contexts.
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Affiliation(s)
- Li Shen Chong
- Department of Psychology, University at Albany, State University of New York, 1400 Washington Ave, Albany, NY 12222, United States
| | - Elana Gordis
- Department of Psychology, University at Albany, State University of New York, 1400 Washington Ave, Albany, NY 12222, United States
| | - Laura Hunter
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, 1 University Place, Rensselaer, NY 12144, United States
| | - Jennifer Amoh
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, 1 University Place, Rensselaer, NY 12144, United States
| | - Kate Strully
- Department of Sociology, University at Albany, State University of New York, 1400 Washington Ave, Albany, NY 12222, United States
| | - Allison A Appleton
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, 1 University Place, Rensselaer, NY 12144, United States
| | - Melissa Tracy
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, 1 University Place, Rensselaer, NY 12144, United States.
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13
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Alvarado-Domenech LI, Rivera-Amill V, Appleton AA, Rosario-Villafañe V, Repollet-Carrer I, Borges-Rodríguez M, Pérez-Rodríguez NM, Olivieri-Ramos O, González M, González-Montalvo C, Muñiz-Forestier W, Vargas-Lasalle L, Pérez-Padilla J, Paz-Bailey G, Rodríguez-Rabassa M. Early Childhood Neurodevelopmental Outcomes in Children with Prenatal Zika Virus Exposure: A Cohort Study in Puerto Rico. J Pediatr 2022; 247:38-45.e5. [PMID: 35577118 PMCID: PMC10188121 DOI: 10.1016/j.jpeds.2022.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 04/27/2022] [Accepted: 05/10/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To describe anthropometric, sensory, and neurodevelopmental outcomes of children who were Zika virus-exposed from birth to 36 months. STUDY DESIGN The study cohort included 114 children born to mothers with confirmed and probable Zika virus pregnancy infection in 2016-2017. Children attending study visits from May 2017 through February 2020 underwent physical/neurologic, sensory examinations, and neurodevelopmental assessments with the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III) and Ages and Stages Questionnaires, Third Edition (ASQ-3). RESULTS Three of the 114 children (2.6%) had microcephaly (z-score for head circumference ≤-2) at birth, 19 of 35 (54.3%) had posterior eye abnormalities in retinal images, and 11 of 109 (10.1%) had nonspecific findings on brain ultrasound. Three of 107 children (2.8%) failed hearing screening at birth. Of those children with follow-up data, 17 of 97 (17.5%) failed age-appropriate vision screening. The BSID-III identified developmental delay in at least 1 domain in at least one-third of children, with higher prevalence in the language domain. ASQ-3 screen positive delay peaked at around 24 or 36 months, with some domains showing a decrease at older ages. Correlations among BSID-III and ASQ-3 scores were observed, representing professional and parental perspectives at 24 and 36 months (r = 0.32-0.78; P < .05). CONCLUSIONS The presence of neurodevelopmental sequelae in early childhood suggests that identification of long-term impairment remains critical to attaining optimal child development. Long-term follow-up highlights vulnerability in the language domain, which likely could be influenced by early intervention, promoting cognitive development and school readiness in exposed children.
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Affiliation(s)
| | | | - Allison A Appleton
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer, NY
| | | | | | | | | | | | - Marielly González
- Clinical Psychology Program, Ponce Health Sciences University, Ponce, PR
| | | | | | | | - Janice Pérez-Padilla
- Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, PR
| | - Gabriela Paz-Bailey
- Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, PR
| | - Mary Rodríguez-Rabassa
- RCMI Center for Research Resources, Ponce Health Sciences University, Ponce, PR; Clinical Psychology Program, Ponce Health Sciences University, Ponce, PR
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Abstract
Violence and other antisocial behaviors, including fighting and weapon carrying, are highly prevalent among adolescents but usually decrease in young adulthood. Childhood adversities, including exposure to abuse, intimate partner violence, and household substance use and mental health problems, have been linked to violent behaviors in adolescence and adulthood. However, few studies of childhood adversity as determinants of persistent violent behavior among community-based samples have been conducted. Furthermore, the effects of adversity timing and duration on subsequent violent behaviors are unclear. We examined the association between five childhood adversity trajectories (representing stable-low, stable-mild, decreasing, increasing, and stable-high adversity from birth through age 11.5 years) and physical fighting and weapon carrying at ages 13-20 years among a sample of young adults followed continuously since birth from the Avon Longitudinal Study of Parents and Children (n = 9,665). The prevalence of violent behaviors declined sharply as participants aged (e.g., whereas 42.8% reported engaging in physical fighting in the past year at ages 13-15 years, this dropped to 10.4% at ages 17-20 years). Childhood adversity trajectories exhibited a strong dose-response relation with physical fighting and weapon carrying, with particularly pronounced relations for violent behaviors persisting across both adolescence and early adulthood (e.g., for physical fighting at both ages 13-15 years and 17-20 years compared to no fighting at either period, adjusted odds ratio [aOR] = 1.62, 95% confidence interval [CI] = 1.31-2.00 for stable-mild; aOR = 2.33, 95% CI = 1.64-3.33 for decreasing; aOR = 3.18, 95% CI = 2.20-4.60 for increasing; and aOR = 3.73, 95% CI = 2.13-6.52 for stable-high adversity, compared to stable-low adversity). This work highlights the substantial implications of exposure to childhood adversity for youth violence prevention.
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Affiliation(s)
- Madeleine Salo
- University at Albany School of Public Health, State University of New York, USA
| | - Allison A. Appleton
- University at Albany School of Public Health, State University of New York, USA
| | - Melissa Tracy
- University at Albany School of Public Health, State University of New York, USA
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Lin B, Appleton AA. Developmental Origins of Pregnancy-Related Morbidity and Mortality in Black U.S. Women. Front Public Health 2022; 10:853018. [PMID: 35769781 PMCID: PMC9234444 DOI: 10.3389/fpubh.2022.853018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
In the US, Black women are at disproportionate risk for pregnancy-related morbidity and mortality (PRMM). Disparities in PRMM have been tied to elevated rates of obstetric cardiometabolic complications for Black women. Research seeking to elucidate the determinants of Black PRMM to date have focused predominantly on risk factors occurring during pregnancy (e.g., health risk behaviors, quantity and quality of prenatal care, provider behaviors, and attitudes). Meanwhile, other research investigating the developmental origins of health and disease (DOHaD) model indicates that the origins of adult cardiometabolic health can be traced back to stress exposures occurring during the intrauterine and early life periods. Despite the relevancy of this work to Black PRMM, the DOHaD model has never been applied to investigate the determinants of Black PRMM. We argue that the DOHaD model represents a compelling theoretical framework from which to conceptualize factors that drive racial disparities PRMM. Research and intervention working from a developmental origins orientation may help address this urgent public health crisis of Black PRMM.
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Affiliation(s)
- Betty Lin
- Department of Psychology, College of Arts and Sciences, University at Albany, State University of New York, Albany, NY, United States
- *Correspondence: Betty Lin
| | - Allison A. Appleton
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, Rensselaer, NY, United States
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16
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Hu X, Appleton AA, Ou Y, Zhang Y, Cai A, Zhou Y, Dong H. Abdominal volume index trajectories and risk of diabetes mellitus: Results from the China Health and Nutrition Survey. J Diabetes Investig 2022; 13:868-877. [PMID: 34902230 PMCID: PMC9077741 DOI: 10.1111/jdi.13733] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/14/2021] [Accepted: 12/08/2021] [Indexed: 12/18/2022] Open
Abstract
AIMS/INTRODUCTION Abdominal obesity is a risk factor for developing diabetes mellitus, but trajectories of abdominal obesity over time and incident diabetes mellitus have not been considered. We derived trajectories of abdominal volume index (AVI) over 16 years of follow up, and examined the associations between AVI trajectories and risk of diabetes mellitus. MATERIALS AND METHODS Data were used from the China Health and Nutrition Survey, and 5,267 participants were enrolled to fit the trajectory of AVI by using latent class growth models. Multivariate logistic regression models explored the relationship between different AVI trajectories and risk of diabetes mellitus. In addition, we examined the slope of the AVI trajectories in relation to age to identify appropriate life course intervention opportunities for the prevention of diabetes mellitus. RESULTS Three trajectories were derived reflecting graded categories in the speed and slope of increase in AVI over time: slow, intermediate and fast increase group, respectively. After multivariate adjustment, the odds ratios for diabetes mellitus among those in the intermediate and fast increase groups were 1.81 (95% confidence interval 1.37-2.38, P < 0.001) and 2.80 (95% confidence interval 1.85-4.24, P < 0.001) respectively, relative to the slow increase group. The distribution of AVI slope in the slow increase group showed an inverted "U" shape, whereas the fast increase group presented a "U" shape. CONCLUSIONS AVI trajectory is associated with an increased risk of diabetes mellitus. These results provide new insights on the relationship between abdominal adiposity and diabetes mellitus, which in turn can help improve clinical and public health intervention for diabetes mellitus prevention.
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Affiliation(s)
- Xiangming Hu
- The Second School of Clinical MedicineSouthern Medical UniversityGuangzhouChina
- Department of CardiologyGuangdong Cardiovascular InstituteGuangdong Provincial People's Hospital, Guangdong Academy of Medical SciencesGuangzhouChina
| | - Allison A Appleton
- Department of Epidemiology and BiostatisticsUniversity at Albany School of Public HealthState University of New YorkRensselaerNew YorkUSA
| | - Yanqiu Ou
- Department of EpidemiologyGuangdong Cardiovascular InstituteGuangdong Provincial People's Hospital, Guangdong Academy of Medical SciencesGuangzhouChina
| | - Ying Zhang
- Department of CardiologyGuangdong Cardiovascular InstituteGuangdong Provincial People's Hospital, Guangdong Academy of Medical SciencesGuangzhouChina
| | - Anping Cai
- Department of CardiologyGuangdong Cardiovascular InstituteGuangdong Provincial People's Hospital, Guangdong Academy of Medical SciencesGuangzhouChina
| | - Yingling Zhou
- Department of CardiologyGuangdong Cardiovascular InstituteGuangdong Provincial People's Hospital, Guangdong Academy of Medical SciencesGuangzhouChina
| | - Haojian Dong
- Department of CardiologyGuangdong Cardiovascular InstituteGuangdong Provincial People's Hospital, Guangdong Academy of Medical SciencesGuangzhouChina
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Appleton AA. Editorial: Identifying the Interdisciplinary Determinants, Biologic Mechanisms, and Best Practices for the Prevention and Elimination of Minority Health Disparities. Front Public Health 2022; 10:863011. [PMID: 35372178 PMCID: PMC8974597 DOI: 10.3389/fpubh.2022.863011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Allison A. Appleton
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Rensselaer, NY, United States
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18
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Kuniholm MH, Vásquez E, Appleton AA, Kingsley L, Palella FJ, Budoff M, Michos ED, Fox E, Jones D, Adimora AA, Ofotokun I, D'souza G, Weber KM, Tien PC, Plankey M, Sharma A, Gustafson DR. Cardiovascular risk score associations with frailty in men and women with or at risk for HIV. AIDS 2022; 36:237-347. [PMID: 34934019 PMCID: PMC8711611 DOI: 10.1097/qad.0000000000003107] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To understand the relationship between cardiovascular disease (CVD) risk and frailty among men (MWH) and women living with HIV (WWH), or at risk for HIV. DESIGN We considered 10-year coronary heart disease and atherosclerotic CVD risk by Framingham risk score (FRS, 2001 National Cholesterol Education Program Adult Treatment Program III) and Pooled Cohort Equations (PCE, 2013 American College of Cardiology/American Heart Association) in relation to the Fried Frailty Phenotype (FFP) in the Multicenter AIDS Cohort Study (MACS) and Women's Interagency HIV Study (WIHS). METHODS FFP was ascertained in MACS from 2004 to 2019 and in WIHS from 2005 to 2006 and 2011-2019. FFP score at least three of five components defined frailty. Repeated measures logistic regression (both cohorts) and Cox proportional hazards regression (MACS) were performed, controlled for education, income, cholesterol medication and hepatitis C virus serostatus, and among MWH and WWH, CD4+ cell count/μl, antiretroviral therapy, and HIV viral load. RESULTS There were 5554 participants (1265 HIV seronegative/1396 MWH; 768 seronegative/1924 WWH) included. Among men, high-risk FRS was associated with increased risk of incident frailty among seronegative [adjusted hazard ratio (aHR)) = 2.12, 95% confidence interval (CI):1.22-3.69] and MWH (aHR = 2.19, 95% CI: 1.33-3.61). Similar associations were seen with high-risk PCE and incident frailty among SN (aHR = 1.88, 95% CI: 1.48-2.39) and MWH (aHR = 1.59, 95% CI: 1.26-2.00). Among women, high-risk PCE was associated with frailty in SN [adjusted odds ratio (aOR) = 1.43, 95% CI: 1.02-2.00] and WWH (aOR = 1.36, 95% CI: 1.08-1.71); however, high-risk FRS was not (seronegative: aOR = 1.03, 95% CI: 0.30-3.49; WWH: aOR = 0.86, 95% CI: 0.23-3.20). CONCLUSION Higher CVD risk was associated with increased frailty regardless of HIV serostatus among men and women. These findings may inform clinical practices of screening for frailty.
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Affiliation(s)
- Mark H Kuniholm
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, New York
| | - Elizabeth Vásquez
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, New York
| | - Allison A Appleton
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, New York
| | - Lawrence Kingsley
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Frank J Palella
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Matthew Budoff
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
| | | | - Ervin Fox
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Deborah Jones
- Department of Psychiatry & Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, Florida
| | - Adaora A Adimora
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Igho Ofotokun
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Gypsyamber D'souza
- Department of Epidemiology, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Kathleen M Weber
- Cook County Health/Hektoen Institute of Medicine, Chicago, Illinois
| | - Phyllis C Tien
- Department of Medicine, University of California, San Francisco, and Department of Veterans Affairs, San Francisco, California
| | - Michael Plankey
- Department of Medicine, Georgetown University Medical Center, Washington, DC
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx
| | - Deborah R Gustafson
- Department of Neurology, State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
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Suglia SF, Appleton AA, Bleil ME, Campo RA, Dube SR, Fagundes CP, Heard-Garris NJ, Johnson SB, Slopen N, Stoney CM, Watamura SE. Timing, duration, and differential susceptibility to early life adversities and cardiovascular disease risk across the lifespan: Implications for future research. Prev Med 2021; 153:106736. [PMID: 34293381 PMCID: PMC8595689 DOI: 10.1016/j.ypmed.2021.106736] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 12/13/2022]
Abstract
Early life adversities (ELA), include experiences such as child maltreatment, household dysfunction, bullying, exposure to crime, discrimination, bias, and victimization, and are recognized as social determinants of cardiovascular disease (CVD). Strong evidence shows exposure to ELA directly impacts cardiometabolic risk in adulthood and emerging evidence suggests there may be continuity in ELA's prediction of cardiometabolic risk over the life course. Extant research has primarily relied on a cumulative risk framework to evaluate the relationship between ELA and CVD. In this framework, risk is considered a function of the number of risk factors or adversities that an individual was exposed to across developmental periods. The cumulative risk exposure approach treats developmental periods and types of risk as equivalent and interchangeable. Moreover, cumulative risk models do not lend themselves to investigating the chronicity of adverse exposures or consider individual variation in susceptibility, differential contexts, or adaptive resilience processes, which may modify the impact of ELA on CVD risk. To date, however, alternative models have received comparatively little consideration. Overall, this paper will highlight existing gaps and offer recommendations to address these gaps that would extend our knowledge of the relationship between ELA and CVD development. We focus specifically on the roles of: 1) susceptibility and resilience, 2) timing and developmental context; and 3) variation in risk exposure. We propose to expand current conceptual models to incorporate these factors to better guide research that examines ELA and CVD risk across the life course.
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Affiliation(s)
- Shakira F Suglia
- Department of Epidemiology, Emory University, Atlanta, GA, United States of America.
| | - Allison A Appleton
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Albany, NY, United States of America
| | - Maria E Bleil
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, WA, United States of America
| | - Rebecca A Campo
- National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD, United States of America
| | - Shanta R Dube
- Public Health Program, Levine College of Health Sciences, Wingate University, Wingate, NC, United States of America
| | - Christopher P Fagundes
- Department of Psychological Sciences, Rice University, Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Department of Psychiatry, Baylor College of Medicine, Houston, TX, United States of America
| | - Nia J Heard-Garris
- Division of Advanced General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Mary Ann & J. Milburn Smith Child Health Research, Outreach, and Advocacy Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States of America
| | - Sara B Johnson
- Division of General Pediatrics, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, United States of America
| | - Natalie Slopen
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, United States of America
| | - Catherine M Stoney
- National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD, United States of America
| | - Sarah E Watamura
- Department of Psychology, University of Denver, Denver, CO, United States of America
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Appleton AA, Lin B, Holdsworth EA, Feingold BJ, Schell LM. Prenatal Exposure to Favorable Social and Environmental Neighborhood Conditions Is Associated with Healthy Pregnancy and Infant Outcomes. Int J Environ Res Public Health 2021; 18:6161. [PMID: 34200387 PMCID: PMC8200992 DOI: 10.3390/ijerph18116161] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/03/2021] [Accepted: 06/03/2021] [Indexed: 01/14/2023]
Abstract
Neighborhood and individual level risks commonly co-occur for pregnant women and may cumulatively contribute to birth outcomes. Moreover, the relationship between favorable social and environmental neighborhood conditions and perinatal outcomes has been understudied. This study considered the accumulated impact of prenatal exposure to positive neighborhood social, environmental, and educational conditions in relation to maternal health during pregnancy and birth size outcomes. In a prospective study of a multi-ethnic and socioeconomically diverse cohort (n = 239) of pregnant women and their infants, neighborhoods were characterized by the Child Opportunity Index (COI), a census-tract composite indicator representing favorable social, environmental, and educational community conditions. Adjusted generalized estimating equations showed that favorable neighborhood conditions promoted the growth of longer and heavier infant bodies, and reduced the risk of intrauterine growth restriction. The associations were stronger for female versus male infants, though not significantly different. Moreover, COI was associated with better maternal mental health and diet during pregnancy; diet significantly mediated the association between COI and birth size outcomes. This study underscores the importance of considering the accumulated benefit of neighborhood assets for maternal and infant health. Interventions that capitalizes on the full range of contextual assets in which mothers live may promote pregnancy health and fetal growth.
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Affiliation(s)
- Allison A. Appleton
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Rensselaer, NY 12144, USA;
| | - Betty Lin
- Department of Psychology, University at Albany College of Arts and Sciences, 1400 Washington Street, Albany, NY 12222, USA;
| | - Elizabeth A. Holdsworth
- Department of Anthropology, University at Albany College of Arts and Sciences, 1400 Washington Street, Albany, NY 12222, USA;
| | - Beth J. Feingold
- Department of Environmental Health Sciences, University at Albany School of Public Health, Rensselaer, NY 12144, USA;
| | - Lawrence M. Schell
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Rensselaer, NY 12144, USA;
- Department of Anthropology, University at Albany College of Arts and Sciences, 1400 Washington Street, Albany, NY 12222, USA;
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21
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Versteegen M, Bozlak CT, Larkin H, Appleton AA. Maternal depression, adverse childhood experiences, and social support in relation to gestational diabetes risk: results from the Albany Infant and Mother Study (AIMS). BMC Pregnancy Childbirth 2021; 21:335. [PMID: 33906618 PMCID: PMC8077784 DOI: 10.1186/s12884-021-03814-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/20/2021] [Indexed: 11/29/2022] Open
Abstract
Background Psychosocial factors are of increasing interest as potential influencers in disease development. This study explores associations between gestational diabetes mellitus (GDM) and maternal depression, adverse childhood experiences (ACEs), and social support, in response to emerging evidence in these areas. Methods An observational, prospective cohort study (AIMS) served as the source of secondary data for this study. Participants included 300 pregnant women aged 18–40 years at an upstate New York prenatal care clinic, who completed a set of self-report questionnaires assessing exposures and stressors both during and prior to their pregnancy. Data were also abstracted from infant and maternal medical records. Results Logistic regression modeling estimated the odds ratios (ORs) of developing GDM in relation to psychosocial factors. There was a significant association between depression and GDM (OR = 2.85, 95% CI: 1.15, 7.06), which persisted in the model adjusted for age and BMI (aOR = 3.19, 95% CI: 1.25, 8.10). No significant associations were found between ACEs or social support with GDM. Conclusions Study findings support an association between maternal depression and GDM development. This study underscores the need for additional research on psychosocial factors and connections to health risks.
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Affiliation(s)
| | - Christine T Bozlak
- Health Policy, Management, and Behavior, University at Albany School of Public Health, Rensselaer, USA
| | - Heather Larkin
- University at Albany School of Social Welfare, Albany, USA
| | - Allison A Appleton
- Epidemiology and Biostatistics, University at Albany School of Public Health, Rensselaer, USA
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22
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Cong X, Hosler AS, Tracy M, Appleton AA. The relationship between parental involvement in childhood and depression in early adulthood. J Affect Disord 2020; 273:173-182. [PMID: 32421599 DOI: 10.1016/j.jad.2020.03.108] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 02/01/2020] [Accepted: 03/28/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Positive early life experiences may help prevent depression later in life. We examined the accumulated benefit, timing, and trajectories of positive parental involvement in childhood in association with incident depression in early adulthood. METHODS Prospectively assessed Avon Longitudinal Study of Parents and Children (ALSPAC) data (n = 7120) were analyzed. Overall and developmental stage-specific parental involvement scores were estimated from multiple measures from birth to age 7 years. Trajectory groups of parental involvement were derived via latent class growth analysis. At 18 years, depression cases were identified with diagnostic instruments. Multiple imputation was used to handle missingness. We constructed logistic regression models with potential confounders adjusted. RESULTS Participants from trajectory groups with higher average parenting scores over time had 30% to 40% lower odds of developing depression in early adulthood than participants from the group with the lowest average parenting score over time. However, the relationship became non-significant when all covariates were adjusted. A one-unit increase in the overall parenting score corresponded to 12% lower odds of developing depression (adjusted OR=0.88 [0.79-0.98]). Protective effects on incident depression in early adulthood from parental involvement in school age (5-7 years), and not at other ages, were observed (OR=0.87 [0.77-0.99] for a one-unit increase in the parenting score at school age). However, the relationship became non-significant when all covariates were adjusted (OR=0.91 [0.80-1.03]). LIMITATIONS Measurements of parental involvement were only based on maternal report. The study has limited generalizability to other racial/ethnic groups. CONCLUSION Higher level of parental involvement during childhood lowers the risk of developing depression in early adulthood. These results suggest positive early life experiences may promote mental health across the life course.
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Affiliation(s)
- Xiao Cong
- Department of Epidemiology and Biostatistics, School of Public Health, State University of New York at Albany, One University Place, Rensselaer 12144-3456, NY, United States.
| | - Akiko S Hosler
- Department of Epidemiology and Biostatistics, School of Public Health, State University of New York at Albany, One University Place, Rensselaer 12144-3456, NY, United States.
| | - Melissa Tracy
- Department of Epidemiology and Biostatistics, School of Public Health, State University of New York at Albany, One University Place, Rensselaer 12144-3456, NY, United States.
| | - Allison A Appleton
- Department of Epidemiology and Biostatistics, School of Public Health, State University of New York at Albany, One University Place, Rensselaer 12144-3456, NY, United States.
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23
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Xu SL, Liu AP, Wu QZ, Marks T, He ZZ, Qian Z, McMillin SE, Sun J, Appleton AA, Bloom MS, Lin S, Yu HY, Zhou Y, Liu RQ, Feng D, Hu LW, Yang BY, Zeng XW, Sun X, Dong GH. Pet ownership in utero and in childhood decreases the effects of environmental tobacco smoke exposure on hypertension in children: A large population based cohort study. Sci Total Environ 2020; 715:136859. [PMID: 32014767 DOI: 10.1016/j.scitotenv.2020.136859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/30/2019] [Accepted: 01/20/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Little is known about whether exposure to pets influences the association between hypertension and environmental tobacco smoke (ETS). The current study aims to examine the interaction of pet ownership on ETS exposure and the development of hypertension in children. METHODS From 2012 to 2013, a total of 9354 children, 5 to 17 years of age, were recruited from 62 schools in seven northeastern cities. BP in children was measured and hypertension was defined as an average diastolic blood pressure (DBP) or systolic blood pressure (SBP) at or above the 95th percentile for that child's age, sex, and height. Pet ownership in three different time periods (in utero, past 2 years, and currently) and ETS exposure data were collected from parents via a questionnaire. Two-level regressions were used for the data analyses. RESULTS The data show consistent, significant interactions between exposure to pets and effects from ETS. Children who were not exposed to pets experienced stronger effects from ETS on hypertension when compared to those exposed to pets, and the protective effect of pet ownership became stronger with a greater number of pets in the home. Exposure to in utero ETS was associated with hypertension [adjusted odds ratio (aOR) = 1.32, 95% confidence interval (CI): 1.13-1.54] only for those children without pet exposure in utero but not for those with pets (aOR = 0.75; 95% CI: 0.49-1.15) (pinteraction < 0.05). Moreover, household dog ownership was related to significantly lower effects of current ETS on hypertension (aOR = 0.80, 95% CI: 0.61-1.05) compared with children without dogs (aOR = 1.26, 95% CI: 1.11-1.44) (pinteraction = 0.001). Interaction associations between ETS and pet ownership were more robust for girls than for boys and for younger than older children. CONCLUSION This study indicates an inverse relationship between pet ownership and ETS, potentially pointing to pet ownership as protecting against the development of hypertension in children.
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Affiliation(s)
- Shu-Li Xu
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Ai-Ping Liu
- Department of Clinical Laboratory, Shiyan Prevention and Health Care Center of Baoan, Shenzhen 518101, China
| | - Qi-Zhen Wu
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Tia Marks
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY 12144, USA
| | - Zhi-Zhou He
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Zhengmin Qian
- Department of Epidemiology and Biostatistics, College for Public Health & Social Justice, Saint Louis University, Saint Louis, MO 63104, USA
| | - Stephen Edward McMillin
- School of Social Work, College for Public Health & Social Justice, Saint Louis University, Saint Louis, MO 63104, USA
| | - Jia Sun
- Department of Epidemiology and Biostatistics, College for Public Health & Social Justice, Saint Louis University, Saint Louis, MO 63104, USA
| | - Allison A Appleton
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY 12144, USA
| | - Michael S Bloom
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY 12144, USA; Department of Environmental Health Sciences, University at Albany, State University of New York, Rensselaer, NY 12144, USA
| | - Shao Lin
- School of Social Work, College for Public Health & Social Justice, Saint Louis University, Saint Louis, MO 63104, USA; Department of Environmental Health Sciences, University at Albany, State University of New York, Rensselaer, NY 12144, USA
| | - Hong-Yao Yu
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Yang Zhou
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Ru-Qing Liu
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Dan Feng
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Li-Wen Hu
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Bo-Yi Yang
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Xiao-Wen Zeng
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Xiao Sun
- Department of Internal Medicine, Shenyang Women's and Children's Hospital, Shenyang 110011, China.
| | - Guang-Hui Dong
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
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Suglia SF, Campo RA, Brown AGM, Stoney C, Boyce CA, Appleton AA, Bleil ME, Boynton-Jarrett R, Dube SR, Dunn EC, Ellis BJ, Fagundes CP, Heard-Garris NJ, Jaffee SR, Johnson SB, Mujahid MS, Slopen N, Su S, Watamura SE. Social Determinants of Cardiovascular Health: Early Life Adversity as a Contributor to Disparities in Cardiovascular Diseases. J Pediatr 2020; 219:267-273. [PMID: 32111376 PMCID: PMC7883398 DOI: 10.1016/j.jpeds.2019.12.063] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 12/16/2019] [Accepted: 12/30/2019] [Indexed: 12/22/2022]
Affiliation(s)
| | - Rebecca A Campo
- National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Alison G M Brown
- National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Catherine Stoney
- National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Cheryl A Boyce
- National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Allison A Appleton
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Albany, NY
| | - Maria E Bleil
- Department of Family and Child Nursing, University of Washington, Seattle, WA
| | - Renée Boynton-Jarrett
- Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston, MA
| | - Shanta R Dube
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA
| | - Erin C Dunn
- Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA; Stanley Center for Psychiatric Research, The Broad Institute of Harvard and MIT, Boston, MA
| | - Bruce J Ellis
- Departments of Psychology and Anthropology, University of Utah, Salt Lake City, UT
| | - Christopher P Fagundes
- Department of Psychology, Rice University, Houston, TX; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Psychiatry, Baylor College of Medicine, Waco, TX
| | - Nia J Heard-Garris
- Division of Academic General Pediatrics, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, IL; Mary Ann and J. Milburn Smith Child Health Research, Outreach, and Advocacy Center, Stanley Manne Children's Research Institute, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Sara R Jaffee
- Department of Psychology, University of Pennsylvania, Philadelphia, PA
| | - Sara B Johnson
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
| | - Mahasin S Mujahid
- Division of Epidemiology, Berkeley School of Public Health, University of California, Berkeley CA
| | - Natalie Slopen
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD
| | - Shaoyong Su
- Department of Population Health Sciences, Medical College of Georgia, Georgia Prevention Institute, Augusta University, Augusta, GA
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Cai D, Li QQ, Chu C, Wang SZ, Tang YT, Appleton AA, Qiu RL, Yang BY, Hu LW, Dong GH, Zeng XW. High trans-placental transfer of perfluoroalkyl substances alternatives in the matched maternal-cord blood serum: Evidence from a birth cohort study. Sci Total Environ 2020; 705:135885. [PMID: 31841927 DOI: 10.1016/j.scitotenv.2019.135885] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/27/2019] [Accepted: 11/30/2019] [Indexed: 04/15/2023]
Abstract
BACKGROUND Recent studies suggest that perfluoroalkyl substances (PFAS) and PFAS alternatives can cross the placental barrier. However, little is known on the differential patterns of trans-placental transfer (TPT) among conventional PFAS and PFAS alternatives in epidemiological study. OBJECTIVES We aimed to characterize comprehensive TPT patterns in conventional PFAS and PFAS alternatives using matched maternal-cord blood serum from a birth cohort. METHODS A total of 424 mother-fetus pairs were recruited from the Maoming Birth Cohort during 2015-2018. We detected 20 PFAS in cord and maternal serum using an ultraperformance liquid chromatography tandem mass spectrometry (UPLC-MS/MS). TPT of PFAS was calculated via cord to maternal serum concentration ratios. RESULTS Both of PFOS alternatives (chlorinated polyfluorinated ether sulfonates, Cl-PFESAs) and PFOA short-chain alternative (perfluorobutanoic acid, PFBA) were widely detected in the cord and maternal serum. In cord serum, the predominant PFAS was PFOS (1.93 ng/mL), followed by PFBA (1.45 ng/mL), PFOA (0.75 ng/mL) and 6:2 Cl-PFESA (0.32 ng/mL). We found that the PFAS alternatives had higher TPT than PFOS and PFOA, such as PFBA vs. PFOA (median: 1.41 vs. 0.73, P < 0.001) and 8:2 Cl-PFESA vs. PFOS (median: 0.98 vs. 0.42, P < 0.001). Moreover, the TPT of 8:2 Cl-PFESA was higher than the precursor, linear and isomeric PFOS, respectively (P < 0.01). Furthermore, we found a U-shaped pattern for TPT in perfluorocarboxylic acid compounds (PFCAs) across different length of carbon chain. CONCLUSION Our findings suggest that PFAS alternatives may be more easily across the placenta than conventional PFAS. Given the widespread usage of PFAS alternatives, our results indicate that more research is needed to assess the potential health risks of prenatal exposure to PFAS alternatives in children.
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Affiliation(s)
- Dan Cai
- School of Environmental Science and Engineering, Sun Yat-sen University, Guangzhou 510006, China
| | - Qing-Qing Li
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Chu Chu
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Shi-Zhong Wang
- School of Environmental Science and Engineering, Sun Yat-sen University, Guangzhou 510006, China; Guangdong Provincial Key Laboratory of Environmental Pollution and Remediation Technology, Sun Yat-sen University, Guangzhou 510275, China
| | - Ye-Tao Tang
- School of Environmental Science and Engineering, Sun Yat-sen University, Guangzhou 510006, China; Guangdong Provincial Key Laboratory of Environmental Pollution and Remediation Technology, Sun Yat-sen University, Guangzhou 510275, China
| | - Allison A Appleton
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY 12144, USA
| | - Rong-Liang Qiu
- School of Environmental Science and Engineering, Sun Yat-sen University, Guangzhou 510006, China; Guangdong Provincial Key Laboratory of Environmental Pollution and Remediation Technology, Sun Yat-sen University, Guangzhou 510275, China
| | - Bo-Yi Yang
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Li-Wen Hu
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Guang-Hui Dong
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Xiao-Wen Zeng
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
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Cong X, Tracy M, Edmunds LS, Hosler AS, Appleton AA. The relationship between inflammatory dietary pattern in childhood and depression in early adulthood. Brain Behav Immun Health 2020; 2:100017. [PMID: 32140686 PMCID: PMC7043331 DOI: 10.1016/j.bbih.2019.100017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/03/2019] [Accepted: 12/04/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Inflammation may be a hidden process in the relationship between dietary intake and depression, but no study has evaluated the role of diet and inflammation jointly in explaining depression risk in early life. The current study aims to investigate the relationship between inflammatory dietary pattern (IDP) in childhood and depression in early adulthood. METHODS This study used data prospectively collected over 10 years from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort (n = 6939) free from depression at baseline (age 8.5 years). An IDP score was empirically derived via reduced rank regression and stepwise linear regression based on dietary intake data from the food frequency questionnaire at 8.5 years and levels of inflammatory biomarkers, C-reactive protein and interleukin-6, at 9.5 years. At age 18 years, depression cases were identified via the International Statistical Classification of Diseases, 10th Revision (ICD-10) diagnosis and the Clinical Interview Schedule-Revised (CIS-R) depression score. Logistic regression models were constructed to examine the relationship between the IDP score and risk of depression adjusted for potential confounders. Analyses stratified by weight status were also conducted. Multiple imputations were utilized to minimize bias due to loss-to-follow-up. RESULTS Participants in the highest tertile of IDP score had 1.34 times odds to develop depression compared to those in the lowest tertile (95% CI, 1.08-1.66; P-trend<0.01), after dietary misreporting status and energy intake were adjusted. After all covariates were adjusted, the relationship between IDP tertiles and depression was attenuated (highest tertile vs. lowest tertile: OR = 1.21; 95% CI, 0.96-1.51); in addition, the relationship was marginally significant among participants who were not overweight or obese (p < 0.10) but not significant among participants who were overweight or obese. CONCLUSIONS Higher IDP in childhood seems to be associated with higher depression risk in early adulthood. The study provides preliminary evidence that chronic inflammation may underlie the relationship between diet and depression even for children, especially those who are not overweight or obese.
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Affiliation(s)
- Xiao Cong
- Department of Epidemiology and Biostatistics, School of Public Health, State University of New York at Albany, 1 University Place, Rensselaer, NY 12144, United States
| | - Melissa Tracy
- Department of Epidemiology and Biostatistics, School of Public Health, State University of New York at Albany, 1 University Place, Rensselaer, NY 12144, United States
| | - Lynn S. Edmunds
- Division of Nutrition, New York State Department of Health, USA
| | - Akiko S. Hosler
- Department of Epidemiology and Biostatistics, School of Public Health, State University of New York at Albany, 1 University Place, Rensselaer, NY 12144, United States
| | - Allison A. Appleton
- Department of Epidemiology and Biostatistics, School of Public Health, State University of New York at Albany, 1 University Place, Rensselaer, NY 12144, United States
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Holdsworth EA, Appleton AA. Adverse childhood experiences and reproductive strategies in a contemporary U.S. population. Am J Phys Anthropol 2019; 171:37-49. [DOI: 10.1002/ajpa.23967] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 09/25/2019] [Accepted: 10/22/2019] [Indexed: 02/04/2023]
Affiliation(s)
- Elizabeth A. Holdsworth
- Department of Anthropology, College of Arts & SciencesUniversity at Albany, SUNY Albany New York
| | - Allison A. Appleton
- Department of Epidemiology and Biostatistics, School of Public HealthUniversity at Albany, SUNY Albany New York
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Fuller CH, Appleton AA, Bulsara PJ, O'Neill MS, Chang HH, Sarnat JA, Falcón LM, Tucker KL, Brugge D. Sex differences in the interaction of short-term particulate matter exposure and psychosocial stressors on C-reactive protein in a Puerto Rican cohort. SSM Popul Health 2019; 9:100500. [PMID: 31709298 PMCID: PMC6831870 DOI: 10.1016/j.ssmph.2019.100500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 07/08/2019] [Accepted: 10/10/2019] [Indexed: 12/29/2022] Open
Abstract
There is substantial evidence linking particulate matter air pollution with cardiovascular morbidity and mortality. However, health disparities between populations may exist due to imprecisely defined non-innate susceptibility factors. Psychosocial stressors are associated with cardiovascular disease and may increase non-innate susceptibility to air-pollution. We investigated whether the association between short-term changes in ambient particulate matter and cardiovascular health risk differed by psychosocial stressors in a Puerto Rican cohort, comparing women and men. We used data from the Boston Puerto Rican Health Study (BPRHS), a longitudinal study of cardiovascular health among adults, collected between 2004 and 2013. We used mixed effect models to estimate the association of current-day ambient particle number concentration (PNC) on C-reactive protein (CRP), a marker of systemic inflammation, and effect modification by psychosocial stressors (depression, acculturation, perceived stress, discrimination, negative life events and a composite score). Point estimates of percent difference in CRP per interquartile range change in PNC varied among women with contrasting levels of stressors: negative life events (15.7% high vs. 6.5% low), depression score (10.6% high vs. 4.6% low) and composite stress score (16.2% high vs. 7.0% low). There were minimal differences among men. For Puerto Rican adults, cardiovascular non-innate susceptibility to adverse effects of ambient particles may be greater for women under high stress. This work contributes to understanding health disparities among minority ethnic populations. Psychosocial stress is associated with disease and thus may enhance cardiovascular susceptibility to air pollution exposure. Point estimates of association between particle matter (PM) and C-reactive protein differed by stress in Puerto Ricans. Effects of PM on C-reactive protein were higher for Puerto Rican women under high stress compared to this with lower stress.
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Affiliation(s)
- Christina H Fuller
- Georgia State University School of Public Health, Department of Population Health Sciences, Atlanta, GA, USA
| | - Allison A Appleton
- University at Albany School of Public Health, Department of Epidemiology and Biostatistics, Rensselaer, NY, USA
| | - Purva J Bulsara
- Georgia State University School of Public Health, Department of Population Health Sciences, Atlanta, GA, USA
| | - Marie S O'Neill
- University of Michigan School of Public Health, Departments of Environmental Health Sciences and Epidemiology, Ann Arbor, MI, USA
| | - Howard H Chang
- Emory University, Rollins School of Public Health, Department of Biostatistics, Atlanta, GA, USA
| | - Jeremy A Sarnat
- Emory University, Rollins School of Public Health, Department of Environmental Health, Atlanta, GA, USA
| | - Luis M Falcón
- University of Massachusetts Lowell, Fine Arts, Humanities and Social Sciences, Lowell, MA, USA
| | - Katherine L Tucker
- University of Massachusetts Lowell, Department of Biomedical and Nutritional Sciences, Lowell, MA, USA
| | - Doug Brugge
- University of Connecticut Department of Community Medicine and Health Care, Farmington, CT, USA.,Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
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Tracy M, Salo M, Slopen N, Udo T, Appleton AA. Trajectories of childhood adversity and the risk of depression in young adulthood: Results from the Avon Longitudinal Study of Parents and Children. Depress Anxiety 2019; 36:596-606. [PMID: 30884010 PMCID: PMC6602824 DOI: 10.1002/da.22887] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/06/2019] [Accepted: 02/25/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The significance of the timing and chronicity of childhood adversity for depression outcomes later in life is unclear. Identifying trajectories of adversity throughout childhood would allow classification of children according to the accumulation, timing, and persistence of adversity, and may provide unique insights into the risk of subsequent depression. METHODS Using data from the Avon Longitudinal Study of Parents and Children, we created a composite adversity score comprised of 10 prospectively assessed domains (e.g., violent victimization, inter-parental conflict, and financial hardship) for each of eight time points from birth through age 11.5 years. We used semiparametric group-based trajectory modeling to derive childhood adversity trajectories and examined the association between childhood adversity and depression outcomes at the age of 18 years. RESULTS Among 9,665 participants, five adversity trajectories were identified, representing stable-low levels (46.3%), stable-mild levels (37.1%), decreasing levels (8.9%), increasing levels (5.3%), and stable-high levels of adversity (2.5%) from birth through late childhood. Approximately 8% of the sample met criteria for probable depression at 18 years and the mean depression severity score was 3.20 (standard deviation = 3.95, range 0-21). The risk of depression in young adulthood was elevated in the decreasing (odds ratio [OR] = 1.72, 95% confidence interval [CI] = 1.19-2.48), increasing (OR = 1.81, 95% CI = 1.15-2.86), and stable-high (OR = 1.80, 95% CI = 1.00-3.23) adversity groups, compared to those with stable-low adversity, when adjusting for potential confounders. CONCLUSIONS Children in trajectory groups characterized by moderate or high levels of adversity at some point in childhood exhibited consistently greater depression risk and depression severity, regardless of the timing of adversity.
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Affiliation(s)
- Melissa Tracy
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer, NY 12144, United States
| | - Madeleine Salo
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer, NY 12144, United States
| | - Natalie Slopen
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD 20742, United States
| | - Tomoko Udo
- Department of Health Policy, Management, and Behavior, University at Albany School of Public health, State University of New York, Rensselaer, NY 12144, United States
| | - Allison A. Appleton
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer, NY 12144, United States
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Appleton AA, Kiley K, Holdsworth EA, Schell LM. Social Support During Pregnancy Modifies the Association Between Maternal Adverse Childhood Experiences and Infant Birth Size. Matern Child Health J 2019; 23:408-415. [PMID: 30627949 DOI: 10.1007/s10995-018-02706-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Introduction Adverse childhood experiences (ACEs) can deleteriously affect health, including pregnancy and birth outcomes occurring later in life. Identification of modifiable factors during pregnancy that buffer the ill effects of adversity is warranted. Social support during pregnancy can promote better birth outcomes, yet it is unknown whether it could also mitigate perinatal risks stemming from ACEs. Thus, this study considers multiple forms of social support in pregnancy as modifiers of an ACEs and fetal growth association. Methods Data were collected from mother and infant pairs from an ongoing prospective birth cohort. Women enrolled around 27 weeks gestation and completed gold-standard assessments of ACEs and social support. Infant cephalization index scores [(head circumference /birthweight) × 100; a marker of asymmetric fetal growth] were derived. Multivariable regression models tested main effects and interaction between ACEs and social support in relation to infant cephalization. Results Higher levels of ACEs were associated with higher cephalization scores (β = 0.01, SE = 0.01, p < 0.05) whereas higher social support was associated with lower cephalization scores (β = - 0.03, SE = 0.01, p < 0.05). A significant interaction was observed showing a protective effect of social support among those with low (0 events) and moderate (1-3 events) ACEs but not among those with high ACEs (4 + events; p < 0.05). Tangible and emotional support, but not information support, contributed to the associations. Discussion Maternal ACEs can deleteriously affect birth size, yet social support during pregnancy provides some buffer from its enduring effects. Interventions designed to enhance pregnancy social support may not only improve maternal wellbeing, but may also safeguard infant health.
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Affiliation(s)
- Allison A Appleton
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, 1 University Place, Rensselaer, NY, 12144, USA.
| | - Kevin Kiley
- Department of Obstetrics and Gynecology, Albany Medical College, 391 Myrtle Avenue, Albany, NY, 12208, USA
| | - Elizabeth A Holdsworth
- Department of Anthropology, University at Albany College of Arts and Sciences, 1400 Washington Avenue, Albany, NY, 12222, USA
| | - Lawrence M Schell
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, 1 University Place, Rensselaer, NY, 12144, USA.,Department of Anthropology, University at Albany College of Arts and Sciences, 1400 Washington Avenue, Albany, NY, 12222, USA
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Olvera Alvarez HA, Appleton AA, Fuller CH, Belcourt A, Kubzansky LD. An Integrated Socio-Environmental Model of Health and Well-Being: a Conceptual Framework Exploring the Joint Contribution of Environmental and Social Exposures to Health and Disease Over the Life Span. Curr Environ Health Rep 2018; 5:233-243. [PMID: 29574677 DOI: 10.1007/s40572-018-0191-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF THE REVIEW Environmental and social determinants of health often co-occur, particularly among socially disadvantaged populations, yet because they are usually studied separately, their joint effects on health are likely underestimated. Building on converging bodies of literature, we delineate a conceptual framework to address these issues. RECENT FINDINGS Previous models provided a foundation for study in this area, and generated research pointing to additional important issues. These include a stronger focus on biobehavioral pathways, both positive and adverse health outcomes, and intergenerational effects. To accommodate the expanded set of issues, we put forward the Integrated Socio-Environmental Model of Health and Well-Being (ISEM), which examines how social and environmental factors combine and potentially interact, via multi-factorial pathways, to affect health and well-being over the life span. We then provide applied examples including the study of how food environments affect dietary behavior. The ISEM provides a comprehensive, theoretically informed framework to guide future research on the joint contribution of social and environmental factors to health and well-being across the life span.
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Affiliation(s)
- Hector A Olvera Alvarez
- School of Nursing, University of Texas El Paso, 500 W. University Ave, El Paso, TX, 79968, USA.
| | - Allison A Appleton
- School of Public Health, Department of Epidemiology and Biostatistics, University at Albany, 1 University Place, Rensselaer, NY, 12144, USA
| | - Christina H Fuller
- School of Public Health, Division of Environmental Health, Georgia State University, P.O. Box 3995, Atlanta, GA, 30302, USA
| | - Annie Belcourt
- School of Community and Public Health Sciences/Pharmacy Practice, University of Montana, 32 Campus Drive, Missoula, MT, 59812, USA
| | - Laura D Kubzansky
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
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Tracy M, Salo M, Appleton AA. The mitigating effects of maternal social support and paternal involvement on the intergenerational transmission of violence. Child Abuse Negl 2018; 78:46-59. [PMID: 28974320 PMCID: PMC5857207 DOI: 10.1016/j.chiabu.2017.09.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 08/16/2017] [Accepted: 09/18/2017] [Indexed: 05/12/2023]
Abstract
Childhood maltreatment is a strong risk factor for subsequent violence, including violent behaviors in young adulthood and offspring maltreatment after becoming a parent. Little is known about the specific circumstances under which supportive relationships may help disrupt this cycle of violence throughout the life course. We conducted two complementary analyses to assess whether maternal social support in early childhood, and also paternal involvement in middle childhood, could prevent the intergenerational transmission of violence, using data from the Avon Longitudinal Study of Parents and Children (n=11,384). We found that higher levels of maternal social support in the postpartum period reduced the odds of offspring maltreatment at ages 0-8 years (OR=0.95, 95% CI 0.93-0.96). When classifying mothers according to their abuse history, this protective association of social support was observed among mothers with no history of childhood maltreatment and among those with only childhood maltreatment (and not postpartum intimate partner violence [IPV]), but not among mothers who reported IPV since the child's birth. We then extended our analysis of these offspring forward in time and found that paternal involvement at ages 9-10 years was associated with a reduced risk of offspring self-reported violent perpetration at ages 18-20 years (OR=0.85, 95% CI=0.77-0.94). This protective association was generally apparent among all subgroups of children, including those with a history of childhood maltreatment. Together these results highlight the protective influence of supportive relationships against the intergenerational transmission of violence, depending on abuse history, context, and timing, with important implications for the prevention of childhood maltreatment and mitigation of its negative effects.
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Affiliation(s)
- Melissa Tracy
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, 1 University Place, Rensselaer, NY 12144, United States.
| | - Madeleine Salo
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, 1 University Place, Rensselaer, NY 12144, United States
| | - Allison A Appleton
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, 1 University Place, Rensselaer, NY 12144, United States
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Appleton AA, Jackson BP, Karagas M, Marsit CJ. Prenatal exposure to neurotoxic metals is associated with increased placental glucocorticoid receptor DNA methylation. Epigenetics 2017; 12:607-615. [PMID: 28548590 DOI: 10.1080/15592294.2017.1320637] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Epigenetic alterations related to prenatal neurotoxic metals exposure may be key in understanding the origins of cognitive and neurobehavioral problems in children. Placental glucocorticoid receptor (NR3C1) methylation has been linked to neurobehavioral risk in early life, but has not been examined in response to neurotoxic metals exposure despite parallel lines of research showing metals exposure and NR3C1 methylation each contribute to a similar set of neurobehavioral phenotypes. Thus, we conducted a study of prenatal neurotoxic metals exposure and placental NR3C1 methylation in a cohort of healthy term singleton pregnancies from Rhode Island, USA (n = 222). Concentrations of arsenic (As; median 0.02 ug/g), cadmium (Cd; median 0.03 μg/g), lead (Pb; median 0.40 μg/g), manganese (Mn; median 0.56 μg/g), mercury (Hg; median 0.02 μg/g), and zinc (Zn; 145.18 μg/g) measured in infant toenails were categorized as tertiles. Multivariable linear regression models tested the independent associations for each metal with NR3C1 methylation, as well as the cumulative risk of exposure to multiple metals simultaneously. Compared to the lowest exposure tertiles, higher levels of As, Cd, Pb, Mn, and Hg were each associated with increased placental NR3C1 methylation (all P<0.02). Coefficients for these associations corresponded with a 0.71-1.41 percent increase in NR3C1 methylation per tertile increase in metals concentrations. For Zn, the lowest exposure tertile compared with the highest tertile was associated with 1.26 percent increase in NR3C1 methylation (P=0.01). Higher cumulative metal risk scores were marginally associated with greater NR3C1 methylation. Taken together, these results indicate that prenatal exposure to neurotoxic metals may affect the offspring's NR3C1 activity, which may help explain cognitive and neurodevelopmental risk later in life.
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Affiliation(s)
- Allison A Appleton
- a Department of Epidemiology and Biostatistics , University at Albany School of Public Health , Rensselaer , NY , USA
| | - Brian P Jackson
- b Department of Earth Sciences, Dartmouth College , Hanover , NH , USA
| | - Margaret Karagas
- c Department of Epidemiology , Geisel School of Medicine at Dartmouth , One Medical Center Drive, Lebanon , NH , USA
| | - Carmen J Marsit
- d Department of Environmental Health, Rollins School of Public Health , Emory University , Atlanta , GA , USA
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Susko ML, Bloom MS, Neamtiu IA, Appleton AA, Surdu S, Pop C, Fitzgerald EF, Anastasiu D, Gurzau ES. Low-level arsenic exposure via drinking water consumption and female fecundity - A preliminary investigation. Environ Res 2017; 154:120-125. [PMID: 28061371 PMCID: PMC5328919 DOI: 10.1016/j.envres.2016.12.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 12/05/2016] [Accepted: 12/26/2016] [Indexed: 05/11/2023]
Abstract
High level arsenic exposure is associated with reproductive toxicity in experimental and observational studies; however, few data exist to assess risks at low levels. Even less data are available to evaluate the impact of low level arsenic exposure on human fecundity. Our aim in this pilot study was a preliminary evaluation of associations between low level drinking water arsenic contamination and female fecundity. This retrospective study was conducted among women previously recruited to a hospital-based case-control study of spontaneous pregnancy loss in Timiṣ County, Romania. Women (n=94) with planned pregnancies of 5-20 weeks gestation completed a comprehensive physician-administered study questionnaire and reported the number of menstrual cycles attempting to conceive as the time to pregnancy (TTP). Drinking water samples were collected from residential drinking water sources and we determined arsenic levels using hydride generation-atomic absorption spectrometry (HG-AAS). Multivariable Cox-proportional hazards regression with Efron approximation was employed to evaluate TTP as a function of drinking water arsenic concentrations among planned pregnancies, adjusted for covariates. There was no main effect for drinking water arsenic exposure, yet the conditional probability for pregnancy was modestly lower among arsenic exposed women with longer TTPs, relative to women with shorter TTPs, and relative to unexposed women. For example, 1µg/L average drinking water arsenic conferred 5%, 8%, and 10% lower likelihoods for pregnancy in the 6th, 9th, and 12th cycles, respectively (P=0.01). While preliminary, our results suggest that low level arsenic contamination in residential drinking water sources may further impair fecundity among women with longer waiting times; however, this hypothesis requires confirmation by a future, more definitive study.
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Affiliation(s)
- Michele L Susko
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, New York, United States
| | - Michael S Bloom
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, New York, United States; Department of Environmental Health Sciences, University at Albany, State University of New York, Rensselaer, New York, United States.
| | - Iulia A Neamtiu
- Health Department, Environmental Health Center, Cluj-Napoca, Romania; IMOGEN Research Institute, Cluj-Napoca, Romania
| | - Allison A Appleton
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, New York, United States
| | - Simona Surdu
- Department of Environmental Health Sciences, University at Albany, State University of New York, Rensselaer, New York, United States
| | - Cristian Pop
- Physico-chemical and Biotoxicological Analysis Laboratory, Environmental Health Center, Cluj-Napoca, Romania; Cluj School of Public Health - College of Political, Administrative and Communication Sciences, Babeṣ-Bolyai University, Cluj-Napoca, Romania; Faculty of Environmental Science and Engineering, Babeṣ-Bolyai University, Cluj-Napoca, Romania
| | - Edward F Fitzgerald
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, New York, United States; Department of Environmental Health Sciences, University at Albany, State University of New York, Rensselaer, New York, United States
| | - Doru Anastasiu
- University of Medicine and Pharmacy "Victor Babeṣ", Timiṣoara, Romania; Obstetrics and Gynecology Department of the Emergency County Hospital, Timiṣoara, Romania
| | - Eugen S Gurzau
- Health Department, Environmental Health Center, Cluj-Napoca, Romania; IMOGEN Research Institute, Cluj-Napoca, Romania; University of Medicine and Pharmacy "Iuliu Haṭieganu", Cluj-Napoca, Romania
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Appleton AA, Murphy MA, Koestler DC, Lesseur C, Paquette AG, Padbury JF, Lester BM, Marsit CJ. Prenatal Programming of Infant Neurobehaviour in a Healthy Population. Paediatr Perinat Epidemiol 2016; 30:367-75. [PMID: 27004434 PMCID: PMC5054721 DOI: 10.1111/ppe.12294] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Identifying the prenatal origins of mental conditions is of increasing interest, yet most studies have focused on high-risk populations and cannot disentangle prenatal and postnatal programming effects. Thus, we examined whether profiles of neurobehaviour indicative of future risk could be identified in healthy 1-3-day-old infants, and examined associations with perinatal risk factors. METHODS Participants included 627 healthy mothers and term infants from a population-based US cohort. Neurobehaviour was assessed within 24-72 h after delivery with the NICU Network Neurobehavioural Scales (NNNS). A model-based clustering algorithm was used to derive neurobehavioural profiles from NNNS scores. Maternal health histories, pregnancy conditions and behaviours, labour/delivery factors, and infant attributes were examined in relation to the neurobehavioural profiles. RESULTS Seven discrete neurobehavioural profiles were identified, including one average functioning profile, and two inversely patterned below and above average profiles. Higher pregnancy weight gain (OR 1.44, 95% CI 1.10, 1.88) and birthweight percentiles (OR 1.46, 95% CI 1.10, 1.95) were associated with greater odds of below average newborn neurobehaviour. Above average neurobehaviour was associated with experiencing longer gestations (OR 1.29, 95% CI 1.02, 1.64) and higher 5-min APGAR scores (OR 2.43, 95% CI 1.07, 5.52). Maternal pregnancy alcohol use (OR 0.54, 95% CI 0.33, 0.89), and fetal distress (OR 0.10, 95% CI 0.01, 0.72) were associated with lower likelihood of having average neurobehaviour. CONCLUSION Distinct profiles of neurobehaviour can be derived in a healthy population of newborns, with different sets of perinatal factors predicting different patterns of neurobehaviour. These findings suggest a potential in utero origin for mental health risk.
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Affiliation(s)
- Allison A. Appleton
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer, NY
| | - Megan A. Murphy
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Devin C. Koestler
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS
| | - Corina Lesseur
- Department of Pharmacology and Toxicology, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Alison G. Paquette
- Department of Pharmacology and Toxicology, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - James F. Padbury
- Department of Pediatrics, Women and Infants Hospital, Providence, RI
| | - Barry M. Lester
- Department of Pediatrics, Women and Infants Hospital, Providence, RI,Center for the Study of Children at Risk, Brown Alpert Medical School and Women and Infants Hospital, Providence, RI
| | - Carmen J. Marsit
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH,Department of Pharmacology and Toxicology, Geisel School of Medicine at Dartmouth, Hanover, NH
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Bloom MS, Neamtiu IA, Surdu S, Pop C, Anastasiu D, Appleton AA, Fitzgerald EF, Gurzau ES. Low level arsenic contaminated water consumption and birth outcomes in Romania-An exploratory study. Reprod Toxicol 2016; 59:8-16. [PMID: 26518419 PMCID: PMC4783180 DOI: 10.1016/j.reprotox.2015.10.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 10/02/2015] [Accepted: 10/20/2015] [Indexed: 11/29/2022]
Abstract
Women are exposed to drinking water with low arsenic concentrations (<10.0μg/L) worldwide, yet little work has been done to assess the risk. To begin to address this data gap, we conducted an exploratory study of birth outcomes in Timis County, Romania. We prospectively followed 122 women with singleton deliveries, for whom we constructed individual exposure indicators using self-reported water consumption weighted by arsenic measured in drinking water sources. There were no overall confounder-adjusted effects for arsenic exposure on birth outcomes. Yet, higher average arsenic (10μg/L) was associated with a -2.45 lower birth weight Z-score (P=0.021) and a -1.17 shorter birth length Z-score (P=0.029) among smokers. Higher average iAs (10μg/L) was also associated with smaller ponderal index in boys (P=0.023). Our results suggest smoking may potentiate an otherwise benign arsenic exposure. A larger, more definitive biomarker-based study is needed to investigate the potential risks in conjunction with smoking.
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Affiliation(s)
- Michael S Bloom
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Rensselaer, NY, USA; Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, Rensselaer, NY, USA.
| | | | - Simona Surdu
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Rensselaer, NY, USA
| | - Cristian Pop
- Environmental Health Center, Cluj-Napoca, Romania
| | - Doru Anastasiu
- University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania; Gynecology Department of the Emergency County Hospital, Timisoara, Romania
| | - Allison A Appleton
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, Rensselaer, NY, USA
| | - Edward F Fitzgerald
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Rensselaer, NY, USA; Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, Rensselaer, NY, USA
| | - Eugen S Gurzau
- Environmental Health Center, Cluj-Napoca, Romania; University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
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Appleton AA, Loucks EB, Buka SL, Kubzansky LD. Divergent associations of antecedent- and response-focused emotion regulation strategies with midlife cardiovascular disease risk. Ann Behav Med 2015; 48:246-55. [PMID: 24570218 DOI: 10.1007/s12160-014-9600-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND It is not known whether various forms of emotion regulation are differentially related to cardiovascular disease risk. PURPOSE The purpose of this study is to assess whether antecedent and response-focused emotion regulation would have divergent associations with likelihood of developing cardiovascular disease. METHODS Two emotion regulation strategies were examined: reappraisal (antecedent-focused) and suppression (response-focused). Cardiovascular disease risk was assessed with a validated Framingham algorithm that estimates the likelihood of developing CVD in 10 years. Associations were assessed among 373 adults via multiple linear regression. Pathways and gender-specific associations were also considered. RESULTS One standard deviation increases in reappraisal and suppression were associated with 5.9 % lower and 10.0 % higher 10-year cardiovascular disease risk, respectively, in adjusted analyses. CONCLUSIONS Divergent associations of antecedent and response-focused emotion regulation with cardiovascular disease risk were observed. Effective emotion regulation may promote cardiovascular health.
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Affiliation(s)
- Allison A Appleton
- School of Public Health, Department of Epidemiology and Biostatistics, University at Albany, State University of New York, One University Place, Rensselaer, NY, 12144-3456, USA,
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Paquette AG, Lester BM, Lesseur C, Armstrong DA, Guerin DJ, Appleton AA, Marsit CJ. Placental epigenetic patterning of glucocorticoid response genes is associated with infant neurodevelopment. Epigenomics 2015; 7:767-79. [PMID: 26343289 DOI: 10.2217/epi.15.28] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AIM To determine associations between methylation of NR3C1, HSD11B2, FKBP5 and ADCYAP1R1 and newborn neurobehavioral outcomes. METHODS In 537 newborns, placental methylation was quantified using bisulfite pyrosequencing. Profiles of neurobehavior were derived via the Neonatal Intensive Care Unit Network Neurobehavioral Scales. Using exploratory factor analysis, the relationships between methylation factor scores and neurobehavioral profiles were examined. RESULTS Increased scores of the factor characterized by NR3C1 methylation were associated with membership in a reactive, poorly regulated profile (odds ratio: 1.47; 95% CI: 1.00-2.18), while increased scores of the factor characterized by HSD11B2 methylation reduced this risk. CONCLUSION These results suggest that coordinated regulation of these genes influences neurobehavior and demonstrates the importance of examining these alterations in a harmonized fashion.
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Affiliation(s)
- Alison G Paquette
- Department of Pharmacology & Toxicology, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA
| | - Barry M Lester
- Department of Pediatrics, Center for the Study of Children at Risk, Women & Infants Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Corina Lesseur
- Department of Pharmacology & Toxicology, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA
| | - David A Armstrong
- Department of Pharmacology & Toxicology, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA
| | - Dylan J Guerin
- Department of Pharmacology & Toxicology, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA
| | - Allison A Appleton
- Department of Epidemiology & Biostatistics, University at Albany School of Public Health, Rensselaer, NY, USA
| | - Carmen J Marsit
- Department of Pharmacology & Toxicology, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA.,Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
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Appleton AA, Lester BM, Armstrong DA, Lesseur C, Marsit CJ. Examining the joint contribution of placental NR3C1 and HSD11B2 methylation for infant neurobehavior. Psychoneuroendocrinology 2015; 52:32-42. [PMID: 25459891 PMCID: PMC4350656 DOI: 10.1016/j.psyneuen.2014.11.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 10/24/2014] [Accepted: 11/03/2014] [Indexed: 11/28/2022]
Abstract
Infant neurobehavior, a potential sentinel of future mental and behavioral morbidity characterized in part by reflex symmetry, excitability and habituation to stimuli, is influenced by aspects of the intrauterine environment partially through epigenetic alterations of genes involved in the stress response. DNA methylation of two related cortisol response genes, the glucocorticoid receptor (NR3C1), a nuclear receptor to which cortisol binds, and 11-beta hydroxysteroid dehydrogenase (HSD11B2), the enzyme responsible for conversion of cortisol into inactive cortisone, independently associate with infant neurobehavior. Although these factors are part of a common cortisol regulation pathway, the combined effect of DNA methylation of these factors on infant neurobehavior has not been characterized. Therefore, we conducted an examination of the joint contribution of NR3C1 and HSD11B2 DNA methylation on infant neurobehavior. Among 372 healthy term newborns, we tested the interaction between placental NR3C1 and HSD11B2 DNA methylation in association with neurobehavior as assessed with the validated NICU Network Neurobehavioral Scales. Controlling for confounders, interactions between DNA methylation of these genes were detected for distinct domains of neurobehavior (habituation, excitability, asymmetrical reflexes). Moreover, different patterns of DNA methylation across the cortisol regulation pathway associated with different neurobehavioral phenotypes. Those with low NR3C1 methylation but high HSD11B2 methylation had lower excitability scores; those with high NR3C1 methylation but low HSD11B2 methylation had more asymmetrical reflexes; those with high DNA methylation across the entire pathway had higher habituation scores. These results suggest that epigenetic alterations across the cortisol regulation pathway may contribute to different neurobehavioral phenotypes, likely though varying degrees of glucocorticoid exposure during gestation. While the postnatal environment may continue to affect neurobehavioral risk, this study provides novel insights into the molecular basis for fetal origins of mental conditions.
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Affiliation(s)
- Allison A. Appleton
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer, New York, USA,Correspondence and reprint requests: Allison A. Appleton, Department of Epidemiology and Biostatistics, University at Albany, State University of New York; phone: 518-402-0402; fax: 518-402-0380;
| | - Barry M. Lester
- Department of Psychiatry and Department of Pediatrics, Brown Center for the Study of Children at Risk, Alpert Medical School of Brown University and Women and Infants Hospital, Providence, Rhode Island, USA
| | - David A. Armstrong
- Department of Pharmacology and Toxicology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Corina Lesseur
- Department of Pharmacology and Toxicology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Carmen J. Marsit
- Department of Pharmacology and Toxicology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
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Non AL, Rewak M, Kawachi I, Gilman SE, Loucks EB, Appleton AA, Román JC, Buka SL, Kubzansky LD. Childhood social disadvantage, cardiometabolic risk, and chronic disease in adulthood. Am J Epidemiol 2014; 180:263-71. [PMID: 24970845 DOI: 10.1093/aje/kwu127] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Adverse social environments in early life are hypothesized to become biologically embedded during the first few years of life, with potentially far-reaching implications for health across the life course. Using prospective data from a subset of a US birth cohort, the Collaborative Perinatal Project, started in 1959-1966 (n = 566), we examined associations of social disadvantage assessed in childhood with cardiometabolic function and chronic disease status more than 40 years later (in 2005-2007). Social disadvantage was measured with an index that combined information on adverse socioeconomic and family stability factors experienced between birth and age 7 years. Cardiometabolic risk (CMR) was assessed by combining information from 8 CMR biomarkers; an index of chronic disease status was derived by assessing 8 chronic diseases. Poisson models were used to investigate associations between social disadvantage and CMR or chronic disease scores while adjusting for childhood covariates and potential pathway variables. A high level of social disadvantage was significantly associated with both higher CMR (incident rate ratio = 1.69, 95% confidence interval: 1.19, 2.39) and with a higher number of chronic diseases (incident rate ratio = 1.39, 95% confidence interval: 1.00, 1.92) in minimally adjusted models. Associations with CMR persisted even after accounting for childhood and adult covariates.
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Lesseur C, Armstrong DA, Murphy MA, Appleton AA, Koestler DC, Paquette AG, Lester BM, Marsit CJ. Sex-specific associations between placental leptin promoter DNA methylation and infant neurobehavior. Psychoneuroendocrinology 2014; 40:1-9. [PMID: 24485470 PMCID: PMC3912462 DOI: 10.1016/j.psyneuen.2013.10.012] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 09/27/2013] [Accepted: 10/21/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND Leptin (LEP) is a hormone central for energy homeostasis and has been implicated in neurodevelopment. This adipokine is produced by the placenta and is epigenetically regulated by promoter DNA methylation. Recent evidence has suggested a role for LEP in behavioral development. In this study, we investigated associations between profiles of human newborn neurobehavior and placental LEP DNA methylation. METHODS We determined LEP promoter methylation in 444 placental samples from healthy term infants and measured LEP gene expression in a random subset of these samples. Infant neurobehavior was assessed with the NICU Network Neurobehavioral Scales (NNNS) and we examined the relationship between LEP promoter methylation and profiles of infant neurobehavior derived from these scores generated using a hierarchical model-based clustering method. RESULTS LEP methylation is negatively correlated with gene expression only in placentas from male infants (r=-0.6, P=0.006). A 10% increase in LEP DNA methylation was associated with membership in a profile of infant neurobehavior marked by increased lethargy and hypotonicity (OR=1.9; 95% CI: 1.07-3.4), and consistently with reduced risk of membership in a profile characterized by decreased lethargy and hypotonicity (OR=0.54; 95% CI: 0.3-0.94) only in male infants (n=223). No statistically significant associations were observed amongst female infants. DISCUSSION These results suggest that increased placental LEP DNA methylation, related to reduced expression, may play a role in human newborn neurodevelopment, particularly in reactivity to various stimuli, but that these effects may be sexually dimorphic.
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Affiliation(s)
- Corina Lesseur
- Department of Pharmacology and Toxicology, Geisel School of Medicine at Dartmouth, 7650 Remsen, Hanover, NH 03755, USA.
| | - David A. Armstrong
- Department of Pharmacology and Toxicology, Geisel School of Medicine at Dartmouth, 7650 Remsen, Hanover, NH 03755, USA
| | - Megan A. Murphy
- Section of Biostatistics and Epidemiology, Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, 1 Medical Center Drive, 7927 Rubin Building, Lebanon, NH 03756, USA
| | - Allison A. Appleton
- Section of Biostatistics and Epidemiology, Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, 1 Medical Center Drive, 7927 Rubin Building, Lebanon, NH 03756, USA
| | - Devin C. Koestler
- Section of Biostatistics and Epidemiology, Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, 1 Medical Center Drive, 7927 Rubin Building, Lebanon, NH 03756, USA
| | - Alison G. Paquette
- Department of Pharmacology and Toxicology, Geisel School of Medicine at Dartmouth, 7650 Remsen, Hanover, NH 03755, USA
| | - Barry M. Lester
- The Brown Center for the Study of Children at Risk, Warren Alpert Medical School of Brown University, Women and Infants Hospital of Rhode Island, Providence, RI 02903, USA
| | - Carmen J. Marsit
- Department of Pharmacology and Toxicology, Geisel School of Medicine at Dartmouth, 7650 Remsen, Hanover, NH 03755, USA,Section of Biostatistics and Epidemiology, Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, 1 Medical Center Drive, 7927 Rubin Building, Lebanon, NH 03756, USA,Corresponding author at: Department of Pharmacology and Toxicology, Geisel School of Medicine at Dartmouth, 7650 Remsen, Hanover, NH 03755, USA. Tel.: +1 603 6501825; fax: +1 603 6501129. (C. Lesseur), (C.J. Marsit)
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Conradt E, Lester BM, Appleton AA, Armstrong DA, Marsit CJ. The roles of DNA methylation of NR3C1 and 11β-HSD2 and exposure to maternal mood disorder in utero on newborn neurobehavior. Epigenetics 2013; 8:1321-9. [PMID: 24135662 PMCID: PMC3933492 DOI: 10.4161/epi.26634] [Citation(s) in RCA: 218] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 09/18/2013] [Accepted: 09/26/2013] [Indexed: 11/19/2022] Open
Abstract
Exposure to maternal mood disorder in utero may program infant neurobehavior via DNA methylation of the glucocorticoid receptor (NR3C1) and 11β-hydroxysteroid dehydrogenase type 2 ( 11β-HSD-2), two placental genes that have been implicated in perturbations of the hypothalamic pituitary adrenocortical (HPA) axis. We tested the relations among prenatal exposure to maternal depression or anxiety, methylation of exon 1F of NR3C1 and 11β-HSD-2, and newborn neurobehavior. Controlling for relevant covariates, infants whose mothers reported depression during pregnancy and showed greater methylation of placental NR3C1 CpG2 had poorer self-regulation, more hypotonia, and more lethargy than infants whose mothers did not report depression. On the other hand, infants whose mothers reported anxiety during pregnancy and showed greater methylation of placental 11β-HSD-2 CpG4 were more hypotonic compared with infants of mothers who did not report anxiety during pregnancy. Our results support the fetal programming hypothesis and suggest that fetal adjustments to cues from the intrauterine environment, in this case an environment that could be characterized by increased exposure to maternal cortisol, may lead to poor neurodevelopmental outcomes.
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Affiliation(s)
- Elisabeth Conradt
- Brown Center for the Study of Children at Risk; Department of Pediatrics; Women & Infants Hospital of Rhode Island; Providence, RI USA
- Department of Psychiatry; Warren Alpert Medical School of Brown University; Providence, RI USA
| | - Barry M Lester
- Brown Center for the Study of Children at Risk; Department of Pediatrics; Women & Infants Hospital of Rhode Island; Providence, RI USA
- Department of Psychiatry; Warren Alpert Medical School of Brown University; Providence, RI USA
- Department of Pediatrics; Warren Alpert Medical School of Brown University; Providence, RI USA
| | - Allison A Appleton
- Department of Community and Family Medicine; Section of Biostatistics and Epidemiology; Geisel School of Medicine at Dartmouth; Hanover, NH USA
| | - David A Armstrong
- Department of Community and Family Medicine; Section of Biostatistics and Epidemiology; Geisel School of Medicine at Dartmouth; Hanover, NH USA
| | - Carmen J Marsit
- Department of Community and Family Medicine; Section of Biostatistics and Epidemiology; Geisel School of Medicine at Dartmouth; Hanover, NH USA
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Appleton AA, Buka SL, Loucks EB, Gilman SE, Kubzansky LD. Divergent associations of adaptive and maladaptive emotion regulation strategies with inflammation. Health Psychol 2013; 32:748-56. [PMID: 23815767 DOI: 10.1037/a0030068] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Recent work suggests effective emotion regulation may protect against risk of developing coronary heart disease (CHD), but the mechanisms remain unknown. Strategies for regulating emotions vary in how effectively they mitigate potentially toxic effects of stressful life experiences, and therefore may be differentially associated with CHD risk. In this study, we examined the emotion regulation strategies of reappraisal and suppression in relation to inflammation, a biological state associated with both stress and CHD. We hypothesized that suppression would be associated with elevated inflammation and reappraisal would be associated with lower levels of inflammation. METHODS We studied adult offspring (n = 379; mean age = 42.2 years) of Collaborative Perinatal Project participants, a national cohort of pregnant women enrolled in 1959-1966. Validated measures of two emotion regulation strategies were examined: reappraisal and suppression. Inflammation was measured as plasma C-reactive protein (CRP) levels. We fit multiple linear regression models predicting CRP while controlling for demographic, socioeconomic, and health factors, including depressive symptoms, measured across the life course. RESULTS A 1 standard deviation increase in reappraisal was associated with significantly lower CRP (b = -0.18, SE = 0.06, p < .01) controlling for demographics. This relation was somewhat attenuated in life course models, with adulthood body mass index partially explaining the association. A 1 standard deviation increase in suppression was associated with significantly higher CRP (b = 0.21, SE = 0.05, p < .001), and this association was not substantively attenuated with further covariate adjustment. CONCLUSION Adaptive emotion regulation was associated with lower levels of inflammation and maladaptive emotion regulation was associated with higher levels of inflammation. If these associations are confirmed by prospective and experimental studies, such evidence may provide insight into novel targets for interventions to promote health and reduce cardiovascular risk.
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Affiliation(s)
- Allison A Appleton
- Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA.
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Appleton AA, Armstrong DA, Lesseur C, Lee J, Padbury JF, Lester BM, Marsit CJ. Patterning in placental 11-B hydroxysteroid dehydrogenase methylation according to prenatal socioeconomic adversity. PLoS One 2013; 8:e74691. [PMID: 24040322 PMCID: PMC3764127 DOI: 10.1371/journal.pone.0074691] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 08/07/2013] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Prenatal socioeconomic adversity as an intrauterine exposure is associated with a range of perinatal outcomes although the explanatory mechanisms are not well understood. The development of the fetus can be shaped by the intrauterine environment through alterations in the function of the placenta. In the placenta, the HSD11B2 gene encodes the 11-beta hydroxysteroid dehydrogenase enzyme, which is responsible for the inactivation of maternal cortisol thereby protecting the developing fetus from this exposure. This gene is regulated by DNA methylation, and this methylation and the expression it controls has been shown to be susceptible to a variety of stressors from the maternal environment. The association of prenatal socioeconomic adversity and placental HSD11B2 methylation has not been examined. Following a developmental origins of disease framework, prenatal socioeconomic adversity may alter fetal response to the postnatal environment through functional epigenetic alterations in the placenta. Therefore, we hypothesized that prenatal socioeconomic adversity would be associated with less HSD11B2 methylation. METHODS AND FINDINGS We examined the association between DNA methylation of the HSD11B2 promoter region in the placenta of 444 healthy term newborn infants and several markers of prenatal socioeconomic adversity: maternal education, poverty, dwelling crowding, tobacco use and cumulative risk. We also examined whether such associations were sex-specific. We found that infants whose mothers experienced the greatest levels of socioeconomic adversity during pregnancy had the lowest extent of placental HSD11B2 methylation, particularly for males. Associations were maintained for maternal education when adjusting for confounders (p<0.05). CONCLUSIONS Patterns of HSD11B2 methylation suggest that environmental cues transmitted from the mother during gestation may program the developing fetus's response to an adverse postnatal environment, potentially via less exposure to cortisol during development. Less methylation of placental HSD11B2 may therefore be adaptive and promote the effective management of stress associated with social adversity in a postnatal environment.
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Affiliation(s)
- Allison A. Appleton
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States of America
| | - David A. Armstrong
- Department of Pharmacology and Toxicology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States of America
| | - Corina Lesseur
- Department of Pharmacology and Toxicology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States of America
| | - Joyce Lee
- Department of Pediatrics, Women and Infants Hospital, Providence, Rhode Island, United States of America
- Brown Center for the Study of Children at Risk, Women and Infants Hospital, Providence, Rhode Island, United States of America
| | - James F. Padbury
- Department of Pediatrics, Women and Infants Hospital, Providence, Rhode Island, United States of America
| | - Barry M. Lester
- Department of Pediatrics, Women and Infants Hospital, Providence, Rhode Island, United States of America
- Brown Center for the Study of Children at Risk, Women and Infants Hospital, Providence, Rhode Island, United States of America
| | - Carmen J. Marsit
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States of America
- Department of Pharmacology and Toxicology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States of America
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Paquette AG, Lesseur C, Armstrong DA, Koestler DC, Appleton AA, Lester BM, Marsit CJ. Placental HTR2A methylation is associated with infant neurobehavioral outcomes. Epigenetics 2013; 8:796-801. [PMID: 23880519 DOI: 10.4161/epi.25358] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The serotonin receptor, HTR2A, exhibits placental expression and function and can be controlled through DNA methylation. The relationship between methylation of HTR2A in the placenta and neurodevelopmental outcomes, evaluated using the NICU Network Neurobehavioral Scales (NNNS), was assessed in newborn infants (n = 444). HTR2A methylation was significantly higher in males and marginally higher in infants whose mothers reported tobacco use during pregnancy. Controlling for confounding variables, HTR2A methylation was negatively associated with infant quality of movement (p = 0.05) and positively associated with infant attention (p = 0.0001). These results suggest that methylation of the HTR2A gene can be biologically and environmentally modulated and is associated with key measures of neurodevelopment.
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Affiliation(s)
- Alison G Paquette
- Department of Pharmacology and Toxicology; Geisel School of Medicine at Dartmouth; Dartmouth, NH USA
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Appleton AA, Buka SL, Loucks EB, Rimm EB, Martin LT, Kubzansky LD. A prospective study of positive early-life psychosocial factors and favorable cardiovascular risk in adulthood. Circulation 2013; 127:905-12. [PMID: 23339873 DOI: 10.1161/circulationaha.112.115782] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The American Heart Association's national goals for cardiovascular health promotion emphasize that cardiovascular risk originates early in life, but little is known about childhood factors that may increase the likelihood of having a favorable cardiovascular risk (FCR) in adulthood. We examined the prospective association between positive childhood factors and the likelihood of midlife FCR. We also considered pathways through which childhood factors may influence FCR. METHODS AND RESULTS We studied 415 adults (mean age=42.2 years) of the Collaborative Perinatal Project, a national cohort initiated in 1959 to 1966. We examined 3 positive childhood factors assessed at age 7 years: attention regulation (ability to stay focused), cognitive ability, and positive home environment. Of these adults, 10.6% had FCR in midlife. Adjusting for demographics and childhood cardiovascular health, a 1-unit increase in childhood attention regulation, cognitive ability, and positive home environment was associated with 2.4 (95% confidence interval, 1.1-4.7), 1.8 (95% confidence interval, 1.1-2.9), and 1.3 (95% confidence interval, 1.1-1.6) higher respective odds of having midlife FCR. The association with childhood attention regulation was maintained when accounting for adulthood factors; education and diet in part explained the associations with childhood cognitive ability and home environment. The effect of each attribute was additive as those with high levels of each childhood factor had 4.3 higher odds (95% confidence interval, 1.01-18.2) of midlife FCR in comparison with those low in all factors. CONCLUSIONS Positive childhood psychosocial factors may promote healthy adult cardiovascular functioning. Primordial prevention efforts aimed at preventing the development of cardiovascular risk should consider building on childhood psychosocial resources.
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Affiliation(s)
- Allison A Appleton
- Geisel School of Medicine at Dartmouth, Department of Community and Family Medicine, Hanover, NH 03755, USA.
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Appleton AA, Loucks EB, Buka SL, Rimm E, Kubzansky LD. Childhood emotional functioning and the developmental origins of cardiovascular disease risk. J Epidemiol Community Health 2013; 67:405-11. [PMID: 23322856 DOI: 10.1136/jech-2012-201008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Dysregulated emotional functioning has been linked with higher cardiovascular disease (CVD) risk among adults. Early life experiences may influence the development of adulthood CVD, but few studies have examined whether potential damaging effects of dysregulated emotional function begin earlier in life. Therefore, we examined associations of child emotional functioning and the 10-year risk of developing CVD in midlife. METHODS We studied 377 adult offspring (mean age=42.2) of Collaborative Perinatal Project participants, a US cohort of pregnant women enrolled in 1959-1966. Three measures of child emotional functioning derived from psychologist ratings of behaviour at 7 years of age were examined: distress proneness, attention and inappropriate self-regulation. Adulthood 10-year CVD risk was calculated with the validated Framingham general CVD risk algorithm. Gender-specific multiple regression models assessed associations of childhood emotion and adulthood CVD risk independent of covariates measured across the life course. Potential mediators of the associations were also examined. RESULTS Women had 31% higher CVD risk per SD increase in childhood distress proneness (p=0.03) and 8% reduced risk per SD increase in attention (p=0.09). For men, each SD increase in childhood distress proneness was associated with 17% higher CVD risk (p=0.02). Associations were partly explained by adulthood body mass index and depressive symptoms in women but not in men. Inappropriate self-regulation was not associated with CVD risk. CONCLUSIONS Several aspects of childhood emotional functioning was associated with adulthood CVD risk, particularly for women. As such, primary prevention of CVD may be associated with addressing early life emotional functioning.
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Affiliation(s)
- Allison A Appleton
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA.
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Kubzansky LD, Mendes WB, Appleton AA, Block J, Adler GK. A heartfelt response: Oxytocin effects on response to social stress in men and women. Biol Psychol 2012; 90:1-9. [PMID: 22387929 DOI: 10.1016/j.biopsycho.2012.02.010] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 01/25/2012] [Accepted: 02/15/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Animal research indicates that oxytocin is involved in social behavior, stress regulation, and positive physiologic adaptation. This study examines whether oxytocin enhances adaptive responses to social stress and compares effects between men and women. METHODS Hypotheses were tested with a placebo-controlled, double-blind experiment. Social stress was induced. Changes in cardiovascular reactivity, affect, and behavior were assessed. RESULTS Participants given oxytocin, relative to placebo, responded to social stress with a challenge orientation characterized by a benign pattern of cardiovascular reactivity. Gender differences emerged. Men given oxytocin reported less negative affect and had greater vagal rebound, while women given oxytocin reported more anger and had better math performance following social stress. DISCUSSION Findings indicate oxytocin stimulates an approach-oriented cardiovascular profile during social stress, suggesting mechanisms by which oxytocin might improve physical health. However, before considering oxytocin as therapeutic or uniformly enhancing health, greater understanding of possible gender differences in effects is needed.
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Affiliation(s)
- Laura D Kubzansky
- Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, MA 02115, USA.
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Appleton AA, Buka SL, McCormick MC, Koenen KC, Loucks EB, Kubzansky LD. The association between childhood emotional functioning and adulthood inflammation is modified by early-life socioeconomic status. Health Psychol 2012; 31:413-22. [PMID: 22329424 DOI: 10.1037/a0027300] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Identifying interrelationships among childhood social disadvantage, emotional functioning and adult health may help illustrate how health disparities may become embedded early in life, yet few have considered how these factors are associated. We examined whether the association of child emotional functioning and adult health risk was modified by child socioeconomic status (CSES), or whether child emotional functioning mediated the association of CSES and adult health risk. METHOD We studied 430 adult offspring (mean age 42 years) of Collaborative Perinatal Project participants, a cohort of pregnant women enrolled in 1959-1966 (Broman, Nichols, & Kennedy, 1975; Niswander & Gordon, 1972). Child emotional functioning was assessed by psychologist ratings at age 7 and included inappropriate self regulation (ISR) and distress proneness. CSES measures included parental education, household income, and parental occupation. Adult health risk was measured by the inflammatory marker C-reactive protein (CRP). Hypotheses were tested with multiple linear regression. Effect modification was evaluated via interaction terms and stratification of fully adjusted models by CSES. Mediation by child emotional functioning was evaluated via coefficient changes. RESULTS There was no evidence that child emotional functioning mediated the association of CSES and CRP. Significant interactions were observed for ISR and low income (b = 1.67, SE = 0.70, p < .05), and distress proneness and low (b = 3.14, SE = 1.47, p < .05) and middle (b = 3.52, SE = 1.46, p < .05) income. Stratified models indicated that associations of child emotion with CRP varied significantly by level of parental education, household income and occupation. CONCLUSION The highest levels of adult inflammation were observed among those with childhood emotional problems who were also exposed to low socioeconomic status as children. This study suggests adulthood disparities in CRP may have developmental origins in childhood adversity.
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Affiliation(s)
- Allison A Appleton
- Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA.
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Munjack DJ, Baltazar PL, Bohn PB, Cabe DD, Appleton AA. Clonazepam in the treatment of social phobia: a pilot study. J Clin Psychiatry 1990; 51 Suppl:35-40; discussion 50-3. [PMID: 2186023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Twenty-three patients who met DSM-III-R criteria for social phobia were randomly assigned either to a clonazepam treatment group or to a nontreatment control group in an 8-week pilot study. Clonazepam was found to have a significant effect on the treated patients, as demonstrated by scores on a variety of instruments measuring overall anxiety and phobic avoidance, and social phobic symptoms. Initial sedation, which was experienced by 70% of the treated subjects, was the most common side effect of clonazepam treatment and usually resolved spontaneously or with dose reduction. The preliminary findings of this pilot study are sufficiently promising to warrant further study of the efficacy of clonazepam in this condition.
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Affiliation(s)
- D J Munjack
- Department of Psychiatry, University of Southern California, Los Angeles
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