Health Consequences of Environmental Exposures in Early Life: Coping with
                        a Changing World in the Post-MDG Era

Suk, William A.; Ruchirawat, Mathuros; Stein, Renato T.; Dı́az-Barriga, Fernando; Carpenter, David O.; Neira, María; Sly, Peter D.

doi:10.1016/j.aogh.2016.01.006

Cited by 8 publications

(7 citation statements)

References 37 publications

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“…This approach is shown schematically in Figure 1 and discussed in more detail in the review by Suk et al in this edition. 41 Using chronic lung disease as an example, low lung function is a known risk factor for acute and chronic lung disease 42 ; however, methods for measuring lung function in infants have been limited and not suitable for large-scale epidemiological studies. Recent developments have seen new methods for measuring the mechanical properties of the airway and lungs in unsedated infants during natural sleep.…”

Section: F U T U R E D I R E C T I O N Smentioning

confidence: 99%

Health Consequences of Environmental Exposures: Causal Thinking in Global Environmental Epidemiology

Sly

Carpenter

Berg

et al. 2016

Annals of Global Health

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The 2010 Global Burden of Disease estimates indicate a trend toward increasing years lived with disability from chronic noncommunicable diseases (NCDs). Risk factors examined included smoking, diet, alcohol, drug abuse, and physical inactivity. By contrast, little consideration was given to accumulating evidence that exposures to environmental chemicals, psychosocial stress, and malnutrition during fetal development and across the life span also increase risk of NCDs. To address this gap, we undertook a narrative review of early-life environmental contributions to disease. We documented numerous etiologic associations. We propose that future GBD estimates use an expanded approach for assessing etiologic contributions of environmental exposures to recognized disease risk factors. We argue that broadening the definition of environmental disease, together with improved methods of assessing early life exposures and their health outcomes across the life span, will allow better understanding of causal associations and provide the incentives required to support strategies to control avoidable exposures and reduce disease risk.

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Section: F U T U R E D I R E C T I O N Smentioning

confidence: 99%

Health Consequences of Environmental Exposures: Causal Thinking in Global Environmental Epidemiology

Sly

Carpenter

Berg

et al. 2016

Annals of Global Health

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“…Despite sustained efforts to address this, lower respiratory tract infections (LRTI) remain the leading cause of childhood mortality, particularly in this region [ 23 ]. However, the burden of non-communicable diseases is also increasing, with asthma being the most common chronic respiratory disease in children [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ].…”

Section: Introductionmentioning

confidence: 99%

Lung Health in Children in Sub-Saharan Africa: Addressing the Need for Cleaner Air

Masekela

Vanker

2020

IJERPH

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Air pollution is increasingly recognized as a global health emergency with its impacts being wide ranging, more so for low- and middle-income countries where both indoor and outdoor pollution levels are high. In Africa, more than 80% of children live in households which use unclean sources of energy. The effects of both indoor and outdoor pollution on lung health on children who are the most vulnerable to their effects range from acute lower respiratory tract infections to long-term chronic health effects. We reviewed the literature on the effects of air pollution in children in Sub-Saharan Africa from prenatal exposure, infancy and school-going children. Data from Sub-Saharan Africa on quantification of exposures both indoor and outdoor mainly utilizes modelling or self-reporting. Exposures to biomass not only increases the risk of acute respiratory tract infections in young children but also increases the risk of carriage of pathogenic bacteria in the upper respiratory tract. Although there is limited evidence of association between asthma and pollution in African children, airway hyper-responsiveness and lower lung function has been demonstrated in children with higher risk of exposure. Interventions at a policy level to both quantify the exposure levels at a population level are urgently needed to address the possible interventions to limit exposure and improve lung health in children in Sub-Saharan Africa.

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“…Some exposures like polychlorinated biphenyls have strong associations with reduced responses that are observed in multiple populations [1,2], while for others, including heavy metals, associations have only been observed under certain conditions, such as malnutrition. Health impacts associated with environmental pollutant exposure may be overlooked due to these relationships being confounded by factors such as malnutrition that have the potential to interact with the exposure [3,4]. These complex interactions can occur through a toxicant influencing nutrient metabolism, nutritional status affecting toxicant absorption or excretion, or both influencing the same endpoint [5].…”

Section: Introductionmentioning

confidence: 99%

Mercury Exposure and Poor Nutritional Status Reduce Response to Six Expanded Program on Immunization Vaccines in Children: An Observational Cohort Study of Communities Affected by Gold Mining in the Peruvian Amazon

Wyatt

Permar

Ortiz

et al. 2019

IJERPH

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Background: Poor nutritional status combined with mercury exposure can generate adverse child health outcomes. Diet is a mediator of mercury exposure and evidence suggests that nutritional status modifies aspects of mercury toxicity. However, health impacts beyond the nervous system are poorly understood. This study evaluates antibody responses to six vaccines from the expanded program on immunization (EPI), including hepatitis B, Haemophilus influenzae type B, measles, pertussis, tetanus, and diphtheria in children with variable hair mercury and malnutrition indicators. Methods: An observational cohort study (n = 98) was conducted in native and non-native communities in Madre de Dios, Peru, a region with elevated mercury exposure from artisanal and small-scale gold mining. Adaptive immune responses in young (3–48 months) and older children (4–8 year olds) were evaluated by vaccine type (live attenuated, protein subunits, toxoids) to account for differences in response by antigen, and measured by total IgG concentration and antibody (IgG) concentrations of each EPI vaccine. Mercury was measured from hair samples and malnutrition determined using anthropometry and hemoglobin levels in blood. Generalized linear mixed models were used to evaluate associations with each antibody type. Results: Changes in child antibodies and protection levels were associated with malnutrition indicators, mercury exposure, and their interaction. Malnutrition was associated with decreased measles and diphtheria-specific IgG. A one-unit decrease in hemoglobin was associated with a 0.17 IU/mL (95% CI: 0.04–0.30) decline in measles-specific IgG in younger children and 2.56 (95% CI: 1.01–6.25) higher odds of being unprotected against diphtheria in older children. Associations between mercury exposure and immune responses were also dependent on child age. In younger children, one-unit increase in log10 child hair mercury content was associated with 0.68 IU/mL (95% CI: 0.18–1.17) higher pertussis and 0.79 IU/mL (95% CI: 0.18–1.70) higher diphtheria-specific IgG levels. In older children, child hair mercury content exceeding 1.2 µg/g was associated with 73.7 higher odds (95% CI: 2.7–1984.3) of being a non-responder against measles and hair mercury content exceeding 2.0 µg/g with 0.32 IU/mL (95% CI: 0.10–0.69) lower measles-specific antibodies. Log10 hair mercury significantly interacted with weight-for-height z-score, indicating a multiplicative effect of higher mercury and lower nutrition on measles response. Specifically, among older children with poor nutrition (WHZ = −1), log10 measles antibody is reduced from 1.40 to 0.43 for low (<1.2 µg/g) vs. high mercury exposure, whereas for children with good nutritional status (WHZ = 1), log10 measles antibody is minimally changed for low vs. high mercury exposure (0.72 vs. 0.81, respectively). Conclusions: Child immune response to EPI vaccines may be attenuated in regions with elevated mercury exposure risk and exacerbated by concurrent malnutrition.

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Health Consequences of Environmental Exposures in Early Life: Coping with a Changing World in the Post-MDG Era

Cited by 8 publications

References 37 publications

Health Consequences of Environmental Exposures: Causal Thinking in Global Environmental Epidemiology

Health Consequences of Environmental Exposures: Causal Thinking in Global Environmental Epidemiology

Lung Health in Children in Sub-Saharan Africa: Addressing the Need for Cleaner Air

Mercury Exposure and Poor Nutritional Status Reduce Response to Six Expanded Program on Immunization Vaccines in Children: An Observational Cohort Study of Communities Affected by Gold Mining in the Peruvian Amazon

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