Wei Bao

The racial/ethnic disparities in the prevalence of obesity, diabetes, and adverse birth outcomes such as preterm delivery indicate that it is essential to account for the varying risks associated with pregnant women of different races and ethnics during clinical prenatal examinations. However, the racial and ethnic disparities in how pre-pregnancy diabetes in mothers relates to preterm birth as well as the combined association of maternal diabetes and pre-pregnancy obesity with preterm birth remain unclear. In this study, we aimed to 1) examine the racial/ethnic disparities in the association of maternal diabetes including gestational diabetes mellitus (GDM) and pre-pregnancy diabetes with preterm birth 2) and the racial/ethnic disparities in the joint associations of maternal diabetes and pre-pregnancy obesity with preterm birth. In this population-based cohort study, we included 17,027,792 mothers documented in the National Vital Statistic System in the U.S. from 2016 to 2020. All these data were analyzed in 2021. Maternal pre-pregnancy diabetes was defined as having diabetes diagnosed prior to this pregnancy, and GDM was defined as having newly diagnosed diabetes in this pregnancy. Pre-pregnancy BMI (kg/m2) was classified as underweight (< 18.5 kg/ m2), normal weight (18.5–24.9 kg/m2), overweight (25.0–29.9 kg/m2), obesity class I (30.0–34.9 kg/m2), obesity class II (35.0–39.9 kg/m2), and obesity class III (≥ 40 kg/m2). Preterm birth, defined as delivery occurring at less than 37 weeks of gestation, was the main outcome of interest. We further categorized preterm birth into three subtypes: extremely (< 28 weeks), very (28–31 weeks), and moderately (32–36 weeks) preterm birth. Logistic regression models were used for association analyses in this study. Among 17,027,792 mothers (mean age: 29.4 ± 5.4 years), 1,374,286 (8.07%) mothers delivered a preterm infant. Women with pre-pregnancy diabetes had the highest risk of preterm birth followed by women with GDM overall and across all racial/ ethnic groups. However, from pre-pregnancy underweight to obesity III, the magnitude of the association between pre-pregnancy diabetes and preterm birth decreased for non-Hispanic Black women (underweight, 4.47 [3.34–5.99], normal weight 4.28 [3.98–4.60], overweight 3.29 [3.11–3.49], obesity I 3.09 [2.93–3.26], obesity II 2.98 [2.82–3.16], obesity III 3.19 [3.04–3.35]), while it showed an increasing trend for non-Hispanic Asians ( underweight 1.45 [0.91–2.30], normal weight 2.16 [1.90–2.47], overweight 2.71 [2.47–2.97], obesity I 3.10 [2.82–3.41], obesity II 3.58 [3.13–4.09], obesity III 3.99 [3.34–4.77]). The corresponding OR was (underweight 4.33 [3.21–5.83], normal weight 3.69 [3.47–3.93], overweight 3.26 [3.10–3.42], obesity I 3.33 [3.19–3.49], obesity II 3.47 [3.29–3.65], obesity III 3.89 [3.68–4.11]) among Hispanics and (underweight 5.17 [4.34–6.17], normal weight 5.01 [4.83–5.21], overweight 4.98 [4.80–5.17], obesity I 4.66 [4.48–4.85], obesity II 4.58 [4.38–4.79], obesity III 4.50 [4.31–4.69]) among non-Hispanic White. Comprehensive analysis of the association between diabetes, pre-pregnancy diabetes, obesity, ethnicity, and preterm birth found that compared to white women with normal weight and normal blood glucose levels, any other racial\ethnic group has an elevated risk of preterm birth, particularly when accompanied by unhealthy weight, GDM, or pre-pregnancy diabetes. Specifically, non-Hispanic Black individuals with normal blood sugar levels (1.69 [1.67–1.70]) have a higher risk of preterm birth than non-Hispanic White individuals with GDM (1.37 [1.35–1.40]). Similarly, Asian pregnant women with class 2 and class 3 obesity (1.72 [1.65–1.78], 1.96 [1.83–2.10]), as well as Hispanic pregnant women with class 2 and class 3 obesity (1.46 [1.44–1.48], 1.64 [1.61–1.67]), also have a higher risk of preterm birth than white women with GDM 1.37 [1.35–1.40]. In conclusion, while both pre-pregnancy diabetes and GDM were significantly associated with preterm birth, the associations varied by race/ethnicity. The risk of preterm birth for GDM increased with increasing BMI in all race/ethnicity groups. However, the pattern of the joint association of pre-pregnancy diabetes and BMI levels with preterm birth differed by race/ethnicity. Future studies on the underlying mechanisms of the racial/ethnic disparities in the association of diabetes and obesity with preterm birth are needed.

Polybrominated diphenyl ethers (PBDEs) are a group of persistent organic pollutants that represent a substantial environmental and human health concern.^1,2 Since the 1970s, PBDEs have been used as flame retardants in a wide array of consumer products, such as building materials, furnishings, and electronics.³ PBDEs enter the environment at sites of production, use, and disposal of PBDE-containing products. PBDEs strongly bind to sediments and soils because of their low water solubility and high lipophilicity.⁴ They degrade in the environment by debromination reactions, forming more toxic, lower brominated PBDE congeners.

Objective: Oleic acid, a subtype of monounsaturated fatty acid (MUFA), is present in abundance in certain edible oils, particularly olive oils. Epidemiological evidence concerning dietary oleic acid intake and the long-term risk of mortality is lacking. This study aimed to evaluate the associations of the dietary intake of oleic acid and other specific subtypes of MUFAs, olive oil, and other vegetable oils with cardiovascular disease (CVD) and all-cause mortality. Methods: This prospective cohort study included adults aged 40 years or older who participated in the included U.S. adults National Health and Nutrition Examination Survey (NHANES). Dietary MUFA intake was assessed via 24-h dietary recall interviews in NHANES 1999–2018, and the consumption of olive oil and other vegetable oils was assessed via a food frequency questionnaire in NHANES 2003–2006. Deaths and underlying causes of death were ascertained by linkage to the National Death Index through December 31, 2019. Weighted Cox proportional hazards regression models were used to estimate the hazard ratio (HR) and 95% CIs. Results: Dietary intake of total MUFAs and oleic acid was associated with a lower risk of CVD mortality, with HRs (95% CI) of 0.62 (0.39–0.99) and 0.61 (0.39–0.97), respectively. Total MUFA and oleic acid intake were inversely associated with all-cause mortality; the multivariable-adjusted HRs were 0.77 (95% CI: 0.60–0.99) and 0.78 (95% CI: 0.62–0.99), respectively. There was no significant association between palmitoleic acid intake and all-cause mortality. The habitual consumption of olive oil, but not the consumption of other vegetable oils, was inversely associated with the risk of cardiovascular mortality. In the joint association analysis, the HRs (95% CI) of cardiovascular mortality were 0.36 (0.19–0.69) for people who exclusively consumed olive oil, 0.59 (0.27–1.32) for people who consumed both olive oil and other vegetable oils, and 0.73 (0.46–1.14) for people who exclusively consumed other vegetable oils compared with people who never consumed vegetable oils. Conclusions: In a U.S. nationally representative prospective cohort, higher dietary oleic acid intake and olive oil consumption were associated with a lower risk of cardiovascular mortality.

Iron is an essential micronutrient that is necessary for proper cognitive function. However, the dose-response relationship between body iron status and cognitive function remains unclear. The objective of this study was to investigate the association between serum ferritin concentrations, an indicator of body iron status, and cognitive function in older adults. Based on the National Health and Nutrition Examination Survey (NHANES) 1999-2002 in the United States, nationally representative data was collected from 2,567 adults aged 60 years and older who had objectively measured serum ferritin levels and cognitive performance. High ferritin levels were defined as a serum ferritin level >200 ng/mL in women and >300 ng/mL in men. Low ferritin levels were defined as a serum ferritin level <30 ng/mL. The digit symbol substitution test (DSST) was employed to assess cognitive function. Multivariable logistic regression analyses with survey weights were performed after the DSST was dichotomized at the median score. The weighted prevalence of adults with normal, low, and high serum ferritin levels were 73.98%, 9.12%, and 16.91%, respectively. A U-shaped association between serum ferritin concentrations and cognitive task performance was observed. After adjusting for demographic, socioeconomic, lifestyle, and C-reactive protein factors, the odds ratio (95% confidence intervals) for lower cognitive performance was 1.39 (1.11, 1.74) in adults with high ferritin levels and 1.38 (0.86, 2.22) in adults with low ferritin levels, compared with those with normal ferritin levels. The association between serum ferritin levels and lower cognitive performance was stronger in adults aged 60 to 69 years old than those aged 70 years and older. In conclusion, in a nationally representative sample of older adults in the United States, a high serum ferritin level was significantly associated with worse cognitive task performance. Thus, the relationship between low serum ferritin concentrations and cognitive task performance warrants further investigation.

Background: Previous experimental studies showed that limiting methionine in the diet of animals or in cell culture media suppresses mammary cancer cell proliferation or metastasis. However, no previous study has investigated the associations of changes in methionine intake with survival among breast cancer survivors. We aimed to examine the association between changes in dietary intake of methionine, folate/folic acid, and vitamin B12 from before to after diagnosis of breast cancer, and mortality among breast cancer survivors. Methods: We included 1553 postmenopausal women from the Women’s Health Initiative who were diagnosed with invasive breast cancer and completed a food frequency questionnaire both before and after breast cancer diagnosis. Multivariable Cox proportional hazards regression models were used to estimate adjusted hazard ratios (HRs) and 95% confidence (CIs) of all-cause and breast cancer mortality associated with changes in methionine intake and changes in folate/folic acid and vitamin B12 intake. Results: Relative to pre-diagnosis, 28% of women decreased methionine intake by ≥20%, 30% of women increased methionine intake by ≥20%, and 42% of women had a relatively stable methionine intake (±19.9%) following breast cancer diagnosis. During a mean 16.1 years of follow up, there were 772 deaths in total, including 195 deaths from breast cancer. Compared to women with relatively stable methionine intake, women with decreased methionine intake had lower risks of all-cause (HR 0.78, 95% CI 0.62–0.97) and breast cancer mortality (HR 0.58, 95% CI 0.37–0.91) in fully adjusted models. In contrast, increased methionine intake or changes in folate/folic acid or vitamin B12 intake were not associated with all-cause or breast cancer mortality. Conclusions: Among breast cancer survivors, decreased methionine intake after breast cancer diagnosis was associated with lower risk of all-cause and breast cancer mortality.