Milk Consumption and Respiratory Function in Asthma Patients: NHANES Analysis 2007–2012

Per the Centers for Disease Control and Prevention, asthma prevalence has steadily risen since the 1980s. Using data from the National Health and Nutrition Examination Survey (NHANES), we investigated associations between milk consumption and pulmonary function (PF). Multivariable analyses were performed, adjusted for a priori potential confounders for lung function, within the eligible total adult population (n = 11,131) and those self-reporting asthma (n = 1,542), included the following variables: milk-consumption, asthma diagnosis, forced vital capacity (FVC), FVC%-predicted (%), forced expiratory volume in one-second (FEV₁), FEV₁% and FEV₁/FVC. Within the total population, FEV₁% and FVC% were significantly associated with regular (5+ days weekly) consumption of exclusively 1% milk in the prior 30-days (β:1.81; 95% CI: [0.297, 3.325]; p = 0.020 and β:1.27; [0.16, 3.22]; p = 0.046). Among participants with asthma, varied-regular milk consumption in a lifetime was significantly associated with FVC (β:127.3; 95% CI: [13.1, 241.4]; p = 0.002) and FVC% (β:2.62; 95% CI: [0.44, 4.80]; p = 0.006). No association between milk consumption and FEV₁/FVC was found, while milk-type had variable influence and significance. Taken together, we found certain milk consumption tendencies were associated with pulmonary function values among normal and asthmatic populations. These findings propound future investigations into the potential role of dairy consumption in altering lung function and asthma outcomes, with potential impact on the protection and maintenance of pulmonary health.     

Lung function, smoking and survival in severe alpha1-antitrypsin deficiency, PiZZ

Lung function, smoking, age and mortality data in 158 adult severe alpha₁-antitrypsin deficient, PiZZ individuals, followed from 1963 to 1982 were analyzed. Low initial FEV₁ value was significantly associated with increased mortality (p < 0.005). A 3 yr mortality rate of 40% was found in individuals whose initial FEV₁ values were less than 30% of that predicted. In contrast, the corresponding 3-yr mortality among those whose initial FEV₁ values were between 30 and 65% of that predicted was only 7%. Smokers were found to have significantly lower FEV₁ levels (p = 0.008) and higher mortality (p < 0.005) than non-smokers. The difference between current and ex-smokers in mortality and FEV₁ level were not statistically significant (p = 0.9 and p>0.25, respectively). Cross-sectional analysis of the initial FEV₁ values indicated a significant decline (p < 0.005) of FEV₁ with increasing age. This decline was greater among smokers than non-smokers. Longitudinal analysis of FEV₁ rates of decline in 80 cases with follow-up FEV₁ measurements failed to detect any significant differences between smokers and non-smokers, but was performed late in the disease process. The application of these results to the planning of studies on replacement therapy, smoking intervention strategy and longitudinal follow-up is discussed.     

Long-Term Traffic-Related Exposures and Asthma Onset in Schoolchildren in Oslo,Norway

Background

Whether there is a causal relation between long-term exposure to traffic and asthma development is so far not clear. This may be explained by inaccurate exposure assessment.

Objective

We investigated the associations of long-term traffic-related exposures with asthma onset assessed retrospectively and respiratory symptoms in 9- to 10-year-old children.

Methods

We collected information on respiratory outcomes and potential confounding variables by parental questionnaire in 2,871 children in Oslo. Nitrogen dioxide exposure was assessed by the EPISODE dispersion model and assigned at updated individual addresses during lifetime. Distance to major road was assigned at birth address and address by date of questionnaire. Cox proportional hazard regression and logistic regression were used.

Results

We did not find positive associations between any long-term traffic-related exposure and onset of doctor-diagnosed asthma. An interquartile range (IQR) increase of NO₂ exposure before asthma onset was associated with an adjusted risk ratio of 0.82 [95% confidence interval (CI), 0.67–1.02]. Handling early asthma cases (children < 4 years of age) with recovery during follow-up as noncases gave a less negative association. The associations for late asthma onset (≥ 4 years of age) were positive but not statistically significant. For current symptoms, an IQR increase of previous year’s NO₂ exposure was associated with adjusted odds ratios of 1.01 (95% CI, 0.83–1.23) for wheeze, 1.10 (95% CI, 0.79–1.51) for severe wheeze, and 1.01 (95% CI, 0.84–1.21) for dry cough.

Conclusions

We were not able to find positive associations of long-term traffic-related exposures with asthma onset or with current respiratory symptoms in 9- to 10-year-old children in Oslo.     

Nested case-control study on associations between lung function, smoking and mortality in Japanese population

Objectives Only a few long-term follow-up studies with a focus on the association between lung function and mortality in the Japanese population have been undertaken. In this study, we examined the associations of lung function, smoking and the results of allergy skin tests with mortality in a longitudinal study of the Japanese population. Methods Baseline measurements were performed on residents of Fukui, Japan in 1972, and a follow-up survey was conducted in 2002. By employing a nested case-control design, 596 cases (deaths) and 596 age and sex-matched controls (survivals) were selected. Lung function was assessed using forced vital capacity (FVC) expressed as the normal percent predicted (FVC %pred) and the ratio of forced expiratory volume in 1 second (FEV₁) to FVC (FEV₁/FVC). Allergy skin tests were performed with extracts of house dust, candidia and mixed fungal samples (bronchomycosis). The Brinkman index was used to assess smoking intensity. The Cox proportional hazards model was used to evaluate whether lung function was associated with mortality after adjustment for other potential confounding variables. Results Those categorized into the first- or second-lowest quartile of FVC %pred had a higher mortality [hazard ratios (HRs) and 95% confidence intervals (CIs): 2.01 (1.26–3.19) and 1.84 (1.11–3.05)], respectively. On top of these, heavy smoking (BI≥400) was associated with a higher mortality [HR and 95% CI: 1.73 (1.18–2.53)]. There were only weak of associations between the results of allergy skin tests and mortality. Conclusions These results suggest that FVC %pred of lung function and smoking can serve as long-term independent predictors of mortality.     

Effects of ambient air pollution on pulmonary function among schoolchildren

Literature has shown adverse effects of ambient air pollution exposure on various asthma related outcomes in childhood. However, the associated evidence on pulmonary function effects is still inconsistent.We conducted a population-based study comprised of seventh-grade children in 14 Taiwanese communities. Pulmonary function tests and questionnaires were completed on 3957 subjects. We evaluated the effects of ambient air pollution exposures based on the data collected in 2005–2007 by existing air monitoring stations. Multiple linear mixed effect models were fitted to estimate the relationship between community pollutant levels and pulmonary function indices. After adjustment for individual-level confounders, pulmonary function differed only slightly between communities with different levels of air pollution. We found greater effects of ambient air pollutants on pulmonary function for boys than for girls. Among boys, traffic-related pollutants CO, NOx, NO₂, and NO were generally associated with chronic adverse effects on FVC and FEV₁, and subchronic adverse effects mainly on maximal mid-expiratory flow (MMEF) and peak expiratory flow rate. Among girls, only NOx and NO₂ showed subchronic adverse effects on MMEF. Although effect estimates of SO₂, PM₁₀, and PM_2.5 were generally negative for boys, none achieved statistical significance.Our data suggests that ambient traffic-related pollution had chronic adverse effects on pulmonary function in schoolchildren, especially for boys.     

Glutathione S-Transferase Polymorphisms,Passive Smoking,Obesity, and Heart Rate Variability in Nonsmokers

Background

Disturbances of heart rate variability (HRV) may represent one pathway by which second-hand smoke (SHS) and air pollutants affect cardiovascular morbidity and mortality. The mechanisms are poorly understood.

Objectives

We investigated the hypothesis that oxidative stress alters cardiac autonomic control. We studied the association of polymorphisms in oxidant-scavenging glutathione S-transferase (GST) genes and their interactions with SHS and obesity with HRV.

Methods

A total of 1,133 nonsmokers > 50 years of age from a population-based Swiss cohort underwent ambulatory 24-hr electrocardiogram monitoring and reported on lifestyle and medical history. We genotyped GSTM1 and GSTT1 gene deletions and a GSTP1 (Ile105Val) single nucleotide polymorphism and analyzed genotype–HRV associations by multiple linear regressions.

Results

Homozygous GSTT1 null genotypes exhibited an average 10% decrease in total power (TP) and low-frequency-domain HRV parameters. All three polymorphisms modified the cross-sectional associations of HRV with SHS and obesity. Homozygous GSTM1 null genotypes with > 2 hr/day of SHS exposure exhibited a 26% lower TP [95% confidence interval (CI), 11 to 39%], versus a reduction of −5% (95% CI, −22 to 17%) in subjects with the gene and the same SHS exposure compared with GSTM1 carriers without SHS exposure. Similarly, obese GSTM1 null genotypes had, on average, a 22% (95% CI, 12 to 31%) lower TP, whereas with the gene present obesity was associated with only a 3% decline (95% CI, −15% to 10%) compared with nonobese GSTM1 carriers.

Conclusions

GST deficiency is associated with significant HRV alterations in the general population. Its interaction with SHS and obesity in reducing HRV is consistent with an impact of oxidative stress on the autonomous nervous system.     

Pulmonary function in firefighters: A six-year follow-up in the boston fire department

Tests of ventilatory capacity, objective cough, and standardized respiratory questionnaires were used in a prospective study to measure the effect of firefighting on pulmonary function in a cohort of 951 white Boston firefighters between 1970-1976. During the six years of follow-up, the mean annual decrements in forced expiratory volume in one second (FEV₁) and forced vital capacity (FVC) were 36 and 29 ml per year, respectively. At the end of the study in 1976, the mean FEV₁ for this group was 98.3% of the level predicted for healthy nonsmoking adults, while the FVC was 97.8%. Current cigarette smoking was associated with an increased prevalence of bronchitis, a loose cough, reduced levels of FEV₁ and FVC, and increased longitudinal changes in FEV₁ and FVC. The longitudinal changes and current levels of FEV₁ and FVC were not correlated with any index of firefighting exposure in active firefighters. Increased use of protective respiratory apparatus and previously described selection effects within the Boston Fire Department appear to be protecting this group of firefighters from long-term effects of smoke exposure as measured by these techniques.     

A Pilot,Randomized, Placebo-Controlled,Double-Blind Phase 0/Biomarker Study on Effect of Artepillin C–Rich Extract of Brazilian Propolis in Frequent Colorectal Adenoma Polyp Patients

Objective: Breastfeeding reduces the risk of asthma and respiratory infections in infants. Since respiratory infections are associated with reduced pulmonary function in adolescents, pulmonary function impairment may be carried into adulthood. Our aim was to determine whether a history of having been breastfed as an infant is a determinant of adult pulmonary function.

Methods: We analyzed data from a general population sample of residents of Erie and Niagara Counties between September 1995 and December 1999. We calculated forced expiratory volume in one second (FEV₁) and forced vital capacity (FVC) prediction equations and used multiple linear regression models to study the association between having been breastfed as an infant and percentage predicted FEV₁ (FEV₁%) and percentage predicted FVC (FVC%) after adjustment for covariates.

Results: Of 2305 subjects, 62% reported having been breastfed. After controlling for age, gender, weight, smoking status, pack-years of smoking, eosinophil counts and dietary factors, there was no association between having been breastfed (yes/no) and FEV₁% or FVC% (regression coefficients 0.0049, p = 0.46 and 0.0055, p = 0.43, respectively).

Conclusions: We did not find a strong or consistent association between having been breastfed as an infant and pulmonary function in adulthood.     

Asthma, atopy, and lung function among racially diverse, poor inner-urban Minneapolis schoolchildren

As part of an assessment of schoolchildren's environmental exposures and health, a probability sample of 136 children from diverse racial/ethnic backgrounds was drawn from grades 2-5 of two inner-urban Minneapolis schools (Whittier, Lyndale). Questionnaires were administered to a parent/guardian; blood samples for IgE and lung function tests were obtained. Overall adjusted rates for lifetime asthma (15.4%; 95%CI 9.3-21.5%), asthma in the last 12 months (13.6%; 7.8-19.4%), and current asthma medication use (10.5%; 5.3-15.7%) were higher than reported US national rates. Adjusted rates for lifetime physician-diagnosed asthma differed significantly among racial/ethnic groups (P<0.01): African-Americans (25.9%), White/Others (25.8%), Hispanics (9.3%), Somalis (1.8%), Asians (0%). Corresponding rates for atopy (total IgE>100 IU/mL or an allergen-specific IgE>0.35 IU/mL) were: African-Americans (66.6%), White/Others (100%), Hispanics (77.2%), Somalis (78.1%), Asians (81.8%). Lung function (FEV₁, FVC) was analyzed by linear regression using log-transformed data: significant race-specific differences in lung function were found relative to White/Others (P<0.001 for each racial/ethnic group): African-Americans (FEV₁ −16.5%, FVC −16.9%), Somalis (−22.7%, −26.8%), Hispanics (−12.2%, −11.4%) and Asians (−11.1%, −12.4%). Females had significantly lower FEV₁ (−8.8%) and FVC (−11.0%) than males. An unexplained, significant difference in children's lung function was found between the two schools. A history of physician-diagnosed asthma was not associated with decreased lung function. Factors other than poverty, inner-urban living, and IgE levels (atopy) need to be considered in the development of childhood asthma.     

Healthy Eating Index 2005 and selected macronutrients are correlated with improved lung function in humans

A number of dietary components have been associated with lung function. However, a comprehensive measure of a healthy diet has not been compared with lung function. Herein, we test the hypothesis that a healthy overall diet, as assessed by the Healthy Eating Index 2005 (HEI-2005), will be associated with increased lung function. This is an investigation using the Atherosclerosis Risk in Communities Research Materials obtained from the National Heart Lung Blood Institute. The study surveyed dietary habits of 15 567 American subjects from 4 communities in 1987 to 1990. Spirometric measures of lung function were also taken at entry to the study and a second time 3 years later. Based on food and nutritional data collected by food frequency questionnaire, an HEI-2005 score was calculated for each subject. This total score, together with its 12 components scores and associated macronutrient, was compared with lung function results by linear regression. Models were controlled for smoking behavior, demographics, and other important covariates. The HEI-2005 total scores were positively associated with forced expiratory volume in 1 second per forced vital capacity (FEV(1)/FVC) at visit 1 (β = .101 per increase in 1 quintile of HEI-2005) and visit 2 (β = .140), and FEV(1) as percentage of the predicted FEV(1) at visit 2 (β = .215) (P < .05). In addition, HEI-2005 component scores that represented high intakes of whole grains (β = .127 and .096); saturated fats (β = −.091); and solid fats, alcohol, and added sugar (β = −.109 and −.131) were significantly associated with FEV(1)/FVC at either visit 1 or visit 2. Intakes of total calories (β =−.082 at visit 1) and saturated fatty acids (β = −.085 at visit 2) were negatively associated with FEV(1)/FVC. Dietary polyunsaturated fatty acids (β = .085 and .116) and long-chain omega-3 fatty acids (β = .109 and .103), animal protein (β = .132 and .093), and dietary fiber (β = .129) were positively associated with lung health. An overall healthy diet is associated with higher lung function.     

Prognostic association of HbA1c and fasting plasma glucose with reduced kidney function in subjects with and without diabetes mellitus. Results from a population-based cohort study from Germany

Objective

To determine the risk for incident reduced kidney function (RKF) of subjects with pre-diabetes (impaired fasting glucose (IFG, 5.6–6.9 mmol/L)) or HbA_1c-defined pre-diabetes (5.7%–6.4%) and to determine dose–response relationships of fasting glucose and HbA_1c with RKF in subjects with manifest diabetes mellitus.

Method

In a German population-based cohort, recruited 2000–2002 with ages 50–74 years, log-binomial regression was used to estimate relative risks (RR) with 95% confidence intervals (95%CI) and restricted cubic splines to plot dose–response relationships.

Results

During 8 years of follow-up, 678 of 3538 study participants developed primary RKF. Although RKF risk factor prevalences and RKF incidences were higher in subjects with pre-diabetes than in subjects with normal FPG and/or HbA_1c levels, an increased risk did not persist after adjusting for established cardiovascular risk factors (RR(IFG): 0.97 (95% CI: 0.75–1.25) and RR(HbA_1c-defined pre-diabetes): 1.03 (95% CI: 0.86–1.23)). In subjects with manifest diabetes, RKF risk increased linearly to a more than three-fold risk with increasing fasting glucose and HbA_1c levels (at HbA_1c > 6.4%).

Conclusion

This study provides further evidence that pre-diabetes may not directly contribute to the development of kidney disease. Subjects with pre-diabetes might nevertheless profit from preventive efforts reducing their cardiovascular risk profile because cardiovascular and kidney disease share common risk factors.     

Predictors of indoor fine particulate matter in infants’ bedrooms in Denmark

Background

Particulate matter (PM) in ambient air is responsible for adverse health effects in adults and children. Relatively little is known about the concentrations, sources and health effects of PM in indoor air.

Objective

To identify sources of fine PM in infants’ bedrooms.

Methods

We conducted 1122 measurements of fine PM (PM_2.5 and black smoke) in the bedrooms of 389 infants and registered indoor activities and characteristics of the house. We used mixed models to identify and quantify associations between predictors and concentrations.

Results

The concentration of PM_2.5 was 2.8 times (95% confidence interval [CI], 1.4–5.5 times) higher in houses where people smoked; the concentration increased by 19% (95% CI, 15–23%) per doubling of the amount of tobacco smoked and decreased by 16% (95% CI, 9–27%) per 5-m increase in the distance between the smoking area and the infant’s bedroom. Frying without a range hood was associated with a 32% (95% CI, 12–54%) higher PM_2.5 concentration per time per day, whereas frying with use of a range hood did not increase the concentration in the infant’s bedroom. Use of a fireplace, stove, candles or vacuum-cleaner, interior rebuilding or renovation, local traffic, inner city residence and cold season increased the fine PM concentration. Open windows decreased the PM_2.5 concentration in homes with smokers but increased the concentration in non-smoking homes.

Conclusions

We identified several sources of fine PM in infants’ bedrooms. The concentrations can be reduced by use of a range hood for frying, by not using candles, a fireplace or a stove, by increasing the distance between the bedroom and the smoking area and by opening windows in houses of smokers. Smoking is a strong predictor of fine PM in infants’ bedrooms and should be avoided.     

Parental Prepuberty Overweight and Offspring Lung Function

In a recent study we found that fathers’ but not mothers’ onset of overweight in puberty was associated with asthma in adult offspring. The potential impact on offspring’s adult lung function, a key marker of general and respiratory health, has not been studied. We investigated the potential causal effects of parents’ overweight on adult offspring’s lung function within the paternal and maternal lines. We included 929 offspring (aged 18–54, 54% daughters) of 308 fathers and 388 mothers (aged 40–66). Counterfactual-based multi-group mediation analyses by offspring’s sex (potential moderator) were used, with offspring’s prepubertal overweight and/or adult height as potential mediators. Unknown confounding was addressed by simulation analyses. Fathers’ overweight before puberty had a negative indirect effect, mediated through sons’ height, on sons’ forced expiratory volume in one second (FEV₁) (beta (95% CI): −144 (−272, −23) mL) and forced vital capacity (FVC) (beta (95% CI): −210 (−380, −34) mL), and a negative direct effect on sons’ FVC (beta (95% CI): −262 (−501, −9) mL); statistically significant effects on FEV₁/FVC were not observed. Mothers’ overweight before puberty had neither direct nor indirect effects on offspring’s lung function. Fathers’ overweight starting before puberty appears to cause lower FEV₁ and FVC in their future sons. The effects were partly mediated through sons’ adult height but not through sons’ prepubertal overweight.     

Efficacy of different pneumococcal conjugate vaccine schedules against pneumonia,hospitalisation, and mortality: Re-analysis of a randomised trial in The Gambia

Background

Pneumococcal conjugate vaccines (PCV) reduce disease due to Streptococcus pneumoniae. We aimed to determine the efficacy of different PCV schedules in Gambian children.

Methods

We reanalysed data from a randomised placebo-controlled trial. Infants aged 6–51 weeks were allocated to three doses of nine-valent PCV (n = 8718) or placebo (n = 8719) and followed until age 30 months. We categorised participants to compare: (a) a first dose at age 6 or 10 weeks, (b) intervals of 1 or 2 months between doses, and (c) different intervals between second and third doses. The primary endpoint was first episode of radiologic pneumonia; other endpoints were hospitalisation and mortality. Using the placebo group as the reference population, Poisson regression models were used with follow-up after the first dose to estimate the efficacy of each schedule and from age 6 weeks to estimate the incidence rate difference between schedules.

Results

Predicted efficacy in the groups aged 6 weeks (n = 2467, 154 events) or 10 weeks (n = 2420, 106 events) at first dose against radiologic pneumonia were 32% (95% CI 19–43%) and 33% (95% CI 21–44%), against hospitalisation 14% (95% CI 3–23%) and 17% (95% CI 7–26%), and against mortality 17% (95% CI −3 to 33%) and 16% (95% CI −3 to 32%) respectively. Predicted efficacy in the groups with intervals of 1 month (n = 2701, 133 events) or 2 months (n = 1351, 58 events) between doses against radiologic pneumonia were 33% (95% CI 20–44%) and 36% (95% CI 24–46%), against hospitalisation 15% (95% CI 5–24%) and 18% (95% CI 8–27%), and against mortality 17% (95% CI −2 to 33%) and 13% (95% CI −8 to 29%) respectively. Efficacy did not differ by interval between second and third doses, nor did the incidence rate difference between schedules.

Conclusions

We found no evidence that efficacy or effectiveness of PCV9 differed when doses were given with modest variability around the scheduled ages or intervals between doses.     

Safety and immunogenicity of three tetravalent dengue vaccine formulations in healthy adults in the USA

Background

A candidate recombinant, live-attenuated, CYD tetravalent dengue vaccine (CYD-TDV) has recently demonstrated immunogenicity, efficacy and good tolerability. This study was performed to evaluate three CYD-TDV formulations in adults.

Methods

This was a randomized, double-blind, multicenter, phase II trial. The vaccine formulations were: CYD-TDV 5555 (≈5 log₁₀ tissue culture infectious dose 50% [TCID₅₀] of serotypes 1–4); CYD-TDV 5553 (≈5 log₁₀ TCID₅₀ of serotypes 1–3 and ≈3 log₁₀ TCID₅₀ of serotype 4); and CYD-TDV 4444 (≈4 log₁₀ TCID₅₀ of serotypes 1–4). Vaccinations were administered at 0, 6 and 12 months. Immunogenicity was assessed using the plaque reduction neutralization test.

Results

In total, 260 individuals were enrolled. The 5555 formulation elicited a superior serotype 4 response versus the 5553 formulation, with seropositivity rates of 89.7% and 58.3%, respectively, after the second dose (between-group difference 31.4%; 95% confidence interval 18.2–43.2). After each of the three doses, seropositivity rates for serotypes 1–3 were numerically highest with CYD-TDV 5553 and lowest with the 4444 formulation; seropositivity rates for serotype 4 were similar with the 5555 and 4444 formulations, and much lower among recipients of CYD-TDV 5553. Geometric mean titers followed the same pattern as that seen with seropositivity rates. Safety/reactogenicity results were similar for all three vaccine formulations, although the percentage of participants reporting solicited injection site reactions was lower with CYD-TDV 4444 than with the other two formulations. All serious adverse events were unrelated to vaccination.

Conclusions

Reducing the dose of serotype 4 antigen (5553 formulation) creates an imbalance in the immune response to CYD-TDV. Immune responses to CYD-TDV 5555 were slightly higher than to the 4444 formulation. Development of CYD-TDV 5555 has subsequently been pursued.     

Intake of milk with added micronutrients increases the effectiveness of an energy-restricted diet to reduce body weight: a randomized controlled clinical trial in Mexican women

Background

Micronutrient deficiencies have been associated with an increase in fat deposition and body weight; thus, adding them to low-fat milk may facilitate weight loss when accompanied by an energy-restricted diet.

Objective

The objective was to evaluate the effect of the intake of low-fat milk and low-fat milk with added micronutrients on anthropometrics, body composition, blood glucose levels, lipids profile, C-reactive protein, and blood pressure of women following an energy-restricted diet.

Design

A 16-week randomized, controlled intervention study.

Participants/settings

One hundred thirty-nine obese women (aged 34±6 years) from five rural communities in Querétaro, Mexico.

Intervention

Women followed an energy-restricted diet (−500 kcal) and received in addition one of the following treatments: 250 mL of low-fat milk (LFM) three times/day, 250 mL of low-fat milk with micronutrients (LFM+M) three times/day, or a no milk control group (CON). Weight, height, and hip and waist circumferences were measured at baseline and every 4 weeks. Body composition measured by dual-energy x-ray absorptiometry, blood pressure, and blood analysis were done at baseline and at the end of the 16 weeks.

Main outcome measures

Changes in weight and body composition.

Statistical analysis

One-factor analysis of variance, adjusted by age, baseline values, and community random effects.

Results

After the 16-week intervention, participants in the LFM+M group lost significantly more weight (−5.1 kg; 95% CI: −6.2 to −4.1) compared with LFM (−3.6 kg; 95% CI: −4.7 to −2.6) and CON (−3.2 kg; 95% CI: −4.3 to −2.2) group members (P=0.035). Body mass index change in the LFM+M group (−2.3; 95% CI: −2.7 to −1.8) was significantly greater than LFM group members (−1.5; 95% CI: −2.0 to −1.1) and CON group members (−1.4; 95% CI: −1.9 to −0.9) (P=0.022). Change in percent body fat among LFM+M group members (−2.7%; 95% CI: −3.2 to −2.1) was significantly higher than LFM group members (−1.8%; 95% CI: −2.3 to −1.3) and CON group members (−1.6%; 95% CI: −2.2 to −1.0) (P=0.019). Change in bone mineral content was significantly higher in LFM group members (29 mg; 95% CI: 15 to 44) and LFM+M group members (27 mg; 95% CI: 13 to 41) compared with CON group members (−2 mg; 95% CI: −17 to −14) (P=0.007). No differences were found between groups in glucose level, blood lipid profile, C-reactive protein level, or blood pressure.

Conclusions

Intake of LFM+M increases the effectiveness of an energy-restricted diet to treat obesity, but had no effect on blood lipid levels, glucose levels, C-reactive protein, or blood pressure.     

Relationship between pulmonary function and elevated glycated hemoglobin levels in health checkups: A cross-sectional observational study in Japanese participants

Background

Insulin resistance has been associated with cytokines, including interleukin-6 and tumor necrosis factor alpha soluble receptor, both of which are elevated in chronic obstructive pulmonary disease (COPD). Few studies have investigated the relationship between pulmonary function tests using spirometry (PFT) and fasting plasma glucose (FPG) or glycated hemoglobin (HbA_1c) levels in Japanese participants. The purpose of this study was to clarify the relationship between PFT in Japanese people who had health checkups and their FPG or HbA_1c levels. In the context of preventative medicine, we intend to connect early detection of COPD to an index of blood sugar.

Risk-Based Prioritization among Air Pollution Control Strategies in the Yangtze River Delta,China

Background

The Yangtze River Delta (YRD) in China is a densely populated region with recent dramatic increases in energy consumption and atmospheric emissions.

Objectives

We studied how different emission sectors influence population exposures and the corresponding health risks, to inform air pollution control strategy design.

Methods

We applied the Community Multiscale Air Quality (CMAQ) Modeling System to model the marginal contribution to baseline concentrations from different sectors. We focused on nitrogen oxide (NO_x) control while considering other pollutants that affect fine particulate matter [aerodynamic diameter ≤ 2.5 μm (PM_2.5)] and ozone concentrations. We developed concentration–response (C-R) functions for PM_2.5 and ozone mortality for China to evaluate the anticipated health benefits.

Results

In the YRD, health benefits per ton of emission reductions varied significantly across pollutants, with reductions of primary PM_2.5 from the industry sector and mobile sources showing the greatest benefits of 0.1 fewer deaths per year per ton of emission reduction. Combining estimates of health benefits per ton with potential emission reductions, the greatest mortality reduction of 12,000 fewer deaths per year [95% confidence interval (CI), 1,200–24,000] was associated with controlling primary PM_2.5 emissions from the industry sector and reducing sulfur dioxide (SO₂) from the power sector, respectively. Benefits were lower for reducing NO_x emissions given lower consequent reductions in the formation of secondary PM_2.5 (compared with SO₂) and increases in ozone concentrations that would result in the YRD.

Conclusions

Although uncertainties related to C-R functions are significant, the estimated health benefits of emission reductions in the YRD are substantial, especially for sectors and pollutants with both higher health benefits per unit emission reductions and large potential for emission reductions.     

Association between physical activity and major depressive disorder among current or former smokers with pulmonary disease

Objective

To examine the association between physical activity and major depressive disorder (MDD) in a nationally representative sample of current or former smokers with pulmonary impairments.

Methods

The analyzed sample from the National Health and Nutrition Examination Survey (NHANES) 2007–2010 included 536 adults who indicated that they were current or former smokers, had at least mild pulmonary impairment (FEV₁/FVC < 0.70), and provided depression and physical activity data.

Results

After controlling for asthma status, pulmonary impairment, age, poverty-to-income ratio (PIR), education, gender, marital status, body mass index (BMI), cotinine, comorbidity index, race-ethnicity, and smoking status, those who met physical activity guidelines had a 59% (odds ratio (OR) = 0.41; 95% confidence interval (CI): 0.18–0.94) lower odds of having MDD. Using multivariate linear regression with depression symptoms as the outcome variable, and after adjustments, physical activity was inversely associated with depression symptoms in a dose–response manner; lowest tertile was the referent group, middle tertile coefficient: − 1.06 (95% CI: − 1.98 to − 0.14), and highest tertile coefficient: − 1.10 (95% CI: − 1.84 to − 0.34).

Conclusions

Physical activity inversely associates with MDD in adults with pulmonary impairments, and does so in a dose–response manner. This suggests that individuals with pulmonary impairments should be encouraged to engage in enjoyable, safe forms of physical activity in a progressive manner.     

Particulate air pollution, oxidative stress genes, and heart rate variability in an elderly cohort

BACKGROUND AND OBJECTIVES: We have previously shown that reduced defenses against oxidative stress due to glutathione S-transferase M1 (GSTM1) deletion modify the effects of PM(2.5) (fine-particulate air pollution of < 2.5 microm in aerodynamic diameter) on heart rate variability (HRV) in a cross-sectional analysis of the Normative Aging Study, an elderly cohort. We have extended this to include a longitudinal analysis with more subjects and examination of the GT short tandem repeat polymorphism in the heme oxygenase-1 (HMOX-1) promoter. METHODS: HRV measurements were taken on 539 subjects. Linear mixed effects models were fit for the logarithm of HRV metrics-including standard deviation of normal-to-normal intervals (SDNN), high frequency (HF), and low frequency (LF)-and PM(2.5) concentrations in the 48 hr preceding HRV measurement, controlling for confounders and a random subject effect. RESULTS: PM(2.5) was significantly associated with SDNN (p = 0.04) and HF (p = 0.03) in all subjects. There was no association in subjects with GSTM1, whereas there was a significant association with SDNN, HF, and LF in subjects with the deletion. Similarly, there was no association with any HRV measure in subjects with the short repeat variant of HMOX-1, and significant associations in subjects with any long repeat. We found a significant three-way interaction of PM(2.5) with GSTM1 and HMOX-1 determining SDNN (p = 0.008), HF (p = 0.01) and LF (p = 0.04). In subjects with the GSTM1 deletion and the HMOX-1 long repeat, SDNN decreased by 13% [95% confidence interval (CI), -21% to -4%], HF decreased by 28% (95% CI, -43% to -9%), and LF decreased by 20% (95% CI, -35% to -3%) per 10 microg/m(3) increase in PM. CONCLUSIONS: Oxidative stress is an important pathway for the autonomic effects of particles.