Maternal Iodine Intake and Neurodevelopment of Offspring: The Japan Environment and Children’s Study

Inadequate maternal iodine intake affects thyroid function and may impair fetal brain development. This study investigated the association between maternal iodine intake during pregnancy and neurodevelopmental delay in offspring at 1 and 3 years of age using a nationwide birth cohort: the Japan Environment and Children’s Study. We assessed dietary iodine intake during pregnancy using a food frequency questionnaire and child neurodevelopment using the Japanese translation of the Ages and Stages Questionnaire, Third Edition. The risk of delay (score below the cut-off value) for fine motor domain at 1 year of age was increased in the lowest quintile iodine intake group compared with the fourth quintile iodine intake group. The risk of delay for problem-solving at 1 year of age was increased in the lowest and second quintile iodine intake group and decreased in the highest quintile iodine intake group. The risk of delay for communication, fine motor, problem-solving, and personal–social domains at 3 years of age was increased in the lowest and second quintile iodine intake group compared with the fourth quintile iodine intake group, while the risk of delay for fine motor and problem-solving domains was decreased in the highest quintile iodine intake group. Low iodine intake levels in pregnancy may affect child neurodevelopment.     

Study Design and Participants’ Profile in the Sub-Cohort Study in the Japan Environment and Children’s Study (JECS)

BackgroundThe Japan Environment and Children’s Study (JECS) is a nationwide birth cohort study investigating environmental effects on children’s health and development. A Sub-Cohort Study has begun, conducting extended exposure and outcome measurements by targeting a subgroup randomly selected from the JECS Main Study. We report the Sub-Cohort Study methodology and participants’ baseline profiles.MethodsOf 100,148 children in the JECS Main Study, children born after April 1, 2013 who met eligibility criteria ([1] all questionnaire and medical record data from children and their mothers collected from the first trimester to 6 months of age, [2] biospecimens [except umbilical cord blood] from children and their mothers collected at first to second/third trimester and delivery) were randomly selected for each Regional Centre at regular intervals. Face-to-face assessment of neuropsychiatric development, body measurement, paediatrician’s examination, blood/urine collection for clinical testing and chemical analysis, and home visits (ambient and indoor air measurement and dust collection) are conducted. Participants are followed up at 1.5 and 3 years old for home visits, and 2, 4, 6, and 8 years old for developmental/medical examination. The details of protocols after age 10 are under discussion.ResultsOf 10,302 selected children, 5,017 participated. The profiles of the participating mothers, fathers and children did not substantially differ between the Main Study and Sub-Cohort Study.ConclusionThe JECS Sub-Cohort Study offers a platform for investigating associations between environmental exposure and outcomes.Key words: birth cohort, profile, environmental exposure     

Impact of Ready-Meal Consumption during Pregnancy on Birth Outcomes: The Japan Environment and Children’s Study

Ready-meal consumption is increasing worldwide; however, its impact on human health remains unclear. We aimed to examine the association between processed food and beverage consumption during pregnancy and pregnancy outcomes. Pregnant women were recruited for the Japan Environment and Children’s Study (JECS), a nationwide, large-scale, prospective cohort study. This study included 104,102 registered children (including fetuses or embryos) and collected questionnaire-based data during the first and second/third trimester of pregnancy. Participants’ medical records were transcribed at pregnancy registration, immediately after delivery, and 1 month after delivery. Logistic regression analysis was used to estimate the association between processed food consumption and pregnancy outcomes. The incidence of stillbirth was higher in the group that consumed moderate (1–2 times per week) and high (≥3–7 times per week) amounts of ready-meals (adjusted odds ratio (aOR) = 2.054, 95% confidence interval (CI): 1.442–2.926, q = 0.002; aOR = 2.632, 95% CI: 1.507–4.597, q = 0.007, respectively) or frozen meals (aOR = 2.225, 95% CI: 1.679–2.949, q < 0.001; aOR = 2.170, 95% CI: 1.418–3.322, q = 0.005, respectively) than in the group that rarely consumed such foods. Processed food consumption during pregnancy should be carefully considered.     

Allergic Disorders and Risk of Anemia in Japanese Children: Findings from the Japan Environment and Children’s Study

Previous epidemiological studies have reported an increased risk of anemia in people with allergic disorders. However, previous studies have followed a cross-sectional design. The aim of this study was to investigate the association between the two conditions with a cohort dataset. We used data of 80,943 children in the Japan Environment and Children’s Study, the largest birth cohort in Japan. The association between anemia and allergic disorders was evaluated with a logistic regression model and propensity score analysis. After adjusting for potential confounders, children with asthma (odds ratio [OR], 1.85; 95% confidence interval [CI], 1.32–2.60), atopic dermatitis (OR, 2.18; 95% CI, 1.66–2.85), allergic rhinitis (OR, 1.35; 95% CI, 1.05–1.74), allergic rhinoconjunctivitis (OR, 2.95; 95% CI, 1.91–4.54), and food allergies (OR, 1.92; 95% CI, 1.44–2.56) at 2 years of age predicted high odds of developing anemia in the next year. Any allergy at 2 years of age was associated with an increased risk of anemia at the age of 3 years (OR, 1.80; 95% CI, 1.41–2.29). The findings remained stable in the propensity score analysis. Results suggest that allergic diseases were related to caregiver-reported anemia in children.     

Dietary Inflammatory Index during Pregnancy and the Risk of Intrapartum Fetal Asphyxia: The Japan Environment and Children’s Study

We aimed to examine the impact of a daily pro-inflammatory diet during pregnancy on intrapartum fetal acidemia using a large birth cohort study in Japan. We used data on singleton pregnancies in the Japan Environment and Children’s Study (JECS) involving births from 2011 to 2014 through vaginal delivery to calculate the maternal dietary inflammatory index (DII). Participants were categorized according to DII quintiles. A multiple logistic regression model was used to estimate the risk of a pro-inflammatory diet on fetal umbilical artery pH. In total, 56,490 participants were eligible for this study. Multiple regression analysis showed that nulliparous women who had undergone vaginal delivery and were consuming a pro-inflammatory diet had an increased risk of pH < 7.10 (adjusted odds ratio [aOR]: 1.64, 95% confidence interval [CI]: 1.12–2.39). Among these women, the risk of pH < 7.10 was not affected by the duration of labor (aOR: 1.64, 95% CI: 1.11–2.42). In conclusion, following a pro-inflammatory diet during pregnancy is a risk factor for fetal acidosis among nulliparous women undergoing vaginal delivery. A high DII diet during pregnancy may modify the intrapartum fetal heart rate pattern via intrauterine inflammation.     

Hypertensive Disorders of Pregnancy in Relation to Coffee and Tea Consumption: The Japan Environment and Children’s Study

Background: The association between coffee/tea intake and hypertensive disorders of pregnancy (HDP) remains unclear. This study aimed to investigate the association of caffeine, coffee, and tea intake during pregnancy with the risk of HDP. Methods: We assessed this association in 85,533 singleton pregnant women with live births in the Japan Environment and Children’s Study, a prospective cohort in Japan that included women from early pregnancy onward. Caffeinated and decaffeinated coffee and tea (green, oolong, and black) consumption during pregnancy was assessed using a validated food frequency questionnaire conducted at mid-pregnancy, and caffeine intake was calculated based on coffee and tea consumption. Multivariable logistic regression was used to assess the association with the risk of HDP. Results: HDP developed in 2222 women (2.6%). Caffeine intake was weakly associated with increased risk of HDP; the multivariable odds ratio of HDP for the highest versus the lowest quartile was 1.26 (95% confidence interval: 1.11, 1.43). Coffee drinkers of two or more cups per day showed a decreased risk compared with non-drinkers (multivariable odds ratio 0.79; 0.62, 0.99) even after adjustment for total caffeine intake. Tea consumption was not associated with the risk of HDP. Conclusions: Our study suggests that higher caffeine intake may increase HDP risk, while coffee drinkers had a lower risk. Further high-quality studies are needed to replicate these findings, and to elucidate if other substances in coffee may be protective against HDP.     

Association between Parents’ Perceptions of Preschool Children’s Weight,Feeding Practices and Children’s Dietary Patterns: A Cross-Sectional Study in China

Parental perception of children’s weight may influence parents’ feeding practices, and in turn, child dietary intake and weight status; however, there is limited evidence generated for preschoolers. The aim of this cross-sectional study was to investigate associations between Chinese parents’ perceptions of child weight, feeding practices and preschoolers’ dietary patterns. Participants (1616 parent-child pairs) were recruited from six kindergartens in Hunan, China. Parents’ misperception, concern, and dissatisfaction on child weight were collected through a self-administered caregiver questionnaire. Parental feeding practices and children’s dietary intake were, respectively, assessed using the Child Feeding Questionnaire and a Food Frequency Questionnaire. Linear regression models were applied to analyze associations between parental weight perceptions, feeding practices, and preschooler’s dietary patterns. Associations between parents’ weight perceptions and dietary patterns were significant only among underweight children. Regardless of child weight status, parental weight underestimation and preference for a heavier child were positively associated with pressure-to-eat. Parental weight concern was positively associated with restriction in normal weight child, but this was not found in other weight groups. In conclusion, Parents’ misperception, concern, and dissatisfaction about child weight are associated with parents’ feeding practices and may influence preschoolers’ dietary quality, but the relationships vary by children’s actual weight status.     

Serum 25-Hydroxyvitamin D Concentrations and Atopic Dermatitis in Early Childhood: Findings from the Japan Environment and Children’s Study

Vitamin D (VitD) may affect immune system modulation and result in the development of atopic dermatitis (AD). However, published findings have remained controversial. We investigated the association between early-life 25-hydroxyvitamin D (25(OH)D) levels and AD risk at childhood with a birth cohort. The data were obtained from “the Japan Environment and Children’s Study (JECS)” and “the Sub-Cohort study of JECS” performed with children aged 2 years. “Liquid chromatography-tandem mass spectrometry” was used to measure VitD. The information on AD was obtained from parents’ answers to a questionnaire when their children were aged 3 years. In order to explain the seasonal effects on VitD levels, a deseasonalized continuous variable was further calculated. The logistic regression models were fitted to evaluate the effect of VitD on childhood AD. The study included 4378 children with complete data on VitD and AD. The results from models indicated that low VitD at 2 years was not a risk factor for the development of AD at 3 years, after adjusting for potential confounders. Moreover, there was no U-shape relationship between deseasonalized VitD and childhood AD. Overall, early-life 25(OH)D levels were not link to the increased risk of developing childhood AD.     

婴幼儿急性下呼吸道感染的病原学研究

目的探婴幼儿急性下呼吸道感染(ALRI)的病毒病原学.方法采用直接免疫荧光法检测2209例急性下呼吸道感染患儿呼吸道诱导痰中脱落纤毛柱状上皮细胞中的呼吸道合胞病毒、流感病毒A型及B型、副流感病毒l、2、3型、腺病毒.结果2209例ALRI患儿中,病毒感染阳性率46.22%,其中主要为呼吸道合胞病毒(RSV)感染,其次为流感病毒和副流感病毒.婴幼儿病毒性ALRI好发于冬春季节.结论病毒感染在本地区ALRI中占重要地位.RSV是冬春季节婴幼儿ALRI的主要病原体,其次是流感病毒和副流感病毒.     

How a Family History of Allergic Diseases Influences Food Allergy in Children: The Japan Environment and Children’s Study

The influence of family allergic history on food allergy in offspring in Japan is unknown. We analyzed data from a nationwide birth cohort study using logistic regression models to examine the associations of maternal, paternal, and both parental histories of allergic diseases (food allergy, atopic dermatitis, asthma, and rhinitis) with their child’s food allergy at 1.5 and 3 years of age. This analysis included 69,379 singleton full-term mothers and 37,179 fathers and their children. All parental histories of allergic diseases showed significant positive associations with their child’s food allergy. When both parents had a history of allergic diseases, the adjusted odds ratio (aOR) tended to be higher than when either parent had allergic diseases (p for trend < 0.0001). The highest aOR was detected when both parents had food allergy (2.60; 95% confidential interval, 1.58–4.27), and the aOR was 1.71 when either parent had food allergy (95% confidential interval, 1.54–1.91). The aORs were attenuated but still had significant positive associations after adjusting for the child’s atopic dermatitis, a risk factor for allergy development. In conclusion, all parental allergic diseases were significantly positively associated with their child’s food allergy. The effect of family history showed a stepwise increase in risk from either parent to both parents, and the highest risk of allergic disease was a parental history of food allergy.     

Smoking Exposure Is Associated with Serum Vitamin D Deficiency in Children: Evidence from the Japan Environment and Children’s Study

Tobacco smoke exposure is known to lower serum 25-hydroxyvitamin D (25(OH)D) concentrations. This study evaluated the association between passive smoking and vitamin D deficiency (VDD) in young children using data from the Japan Environment and Children’s Study (JECS), the largest birth cohort study in Japan. Information on parental smoking status was extracted from a survey of JECS for children aged 1.5 years and data for serum 25(OH)D concentrations were obtained from blood tests in the Sub-Cohort Study of JECS performed at age 2 years. Logistic regression and linear models were fitted to evaluate the association between these variables. Data were analyzed for 4593 children. After adjusting for covariates, smoke exposure was significantly associated with increased incidence of VDD (OR 1.35; 95% CI, 1.14–1.59) according to the logistic model. The linear model indicated that passive smoking negatively predicted de-seasonalized serum 25(OH)D concentrations (β −0.5; 95% CI −0.95 to −0.08) in children aged 2 years. The results suggest that smoke exposure is a risk factor for VDD in children. Given that VD plays a crucial role in bone metabolism and the immune system, our findings are significant for clinical and public health.     

呼吸功能不全患者下呼吸道感染菌的研究

目的 了解呼吸重症监护室(RICU)中呼吸功能不全患者下呼吸道感染病原菌的流行状况及来源。方法 对1999年10月～2000年3月入住RICU患者的痰及相关部位的标本(氧气湿化瓶、呼吸机管道、留置导尿的尿标本等)采样送检。结果 RICU26例患者，发生下呼吸道感染18例(69．23％)，其中16例为有创机械通气患者(88．89％)；病原菌多数为非发酵菌(41．84％)。结论 RICU内下呼吸道感染发生率高，多为有创机械通气患者，病原菌多为非发酵菌。     

Association Between Interpregnancy Interval and Risk of Preterm Birth and Its Modification by Folate Intake: The Japan Environment and Children’s Study

BackgroundBoth short and long interpregnancy intervals (IPIs) have been associated with risk of preterm birth, but the evidence is limited in Asians. It is also uncertain whether the association is modified by dietary folate intake or folic acid supplementation during pregnancy. Thus, we examined associations between IPI and risk of preterm birth and effect modification of those associations by dietary intake of folate and supplementation with folic acid on the basis of a nationwide birth cohort study.MethodsAmong 103,062 pregnancies registered in the Japan Environment and Children’s Study, 55,203 singleton live-birth pregnancies were included in the analysis. We calculated IPI using birth date, gestational age at birth of offspring, and birth data of the latest offspring. Odds ratios (ORs) and 95% confidence intervals (CIs) of the risk of preterm birth were estimated according to IPI categories.ResultsBoth <6-month and ≥120-month IPIs were associated with an increased risk of preterm birth, compared with an 18–23-month IPI. The multivariable ORs were 1.63 (95% CI, 1.30–2.04) for <6-month and 1.41 (95% CI, 1.11–1.79) for ≥120-month IPIs. These associations were confined to women with inadequate intake of dietary folate and folic acid supplementation during pregnancy. Multivariable ORs were 1.76 (95% CI, 1.35–2.29) for <6-month IPI and 1.65 (95% CI, 1.24–2.19) for ≥120-month IPI.ConclusionBoth <6-month and ≥120-month IPIs were associated with an increased risk of preterm birth. These higher risks were confined to women with inadequate intake of dietary folate and folic acid supplementation during pregnancy.Key words: interpregnancy interval, preterm birth, folate, folic acid, prospective studies     

莫西沙星治疗下呼吸道感染效果观察

目的 观察莫西沙星(moxifloxacin)治疗下呼吸道感染的效果。方法 采用随机对照的方法用左氧氟沙星为对照药；两组共92例，奠西沙星组和左氧氟沙星组各46例。结果莫西沙星临床总有效率75．00％。左氧氟沙星为75．7％；两组的细菌清除率分别为91．67％和100．00％。不良反应发生率分别为10．9％和17．4％。结论 结果表明莫西沙星临床疗效、不良反应发生率与左氧氟沙星相似。是治疗下呼吸道感染的一个安全、有效的广谱抗菌药物。     

老年患者下呼吸道感染痰培养前瞻性研究

目的探讨老年患者下呼吸道感染常见病原菌分布. 方法对982份下呼吸道感染老年患者的痰进行针对性细菌培养,肠杆菌科、不动杆菌属、葡萄球菌属细菌采用全自动细菌鉴定仪鉴定和药敏,铜绿假单胞菌和嗜麦芽寡养单胞菌、肺炎链球菌、流感嗜血菌和黏膜炎莫拉菌用手工MIC法试验. 结果感染病原菌以革兰阴性杆菌为主,占总例数的76.3%;革兰阳性球菌占16.7%;念珠菌属占7.0%,其中铜绿假单胞菌检出率占首位达21.70%;革兰阳性球菌中检出耐甲氧西林金黄色葡萄球菌占金黄色葡萄球菌总数的54.4%. 结论微生物室必须做好老年患者下呼吸道感染病原菌的针对性检测工作,及时指导临床医师合理用药.