Agnieszka Pac

Prenatal ambient air exposure to polycyclic aromatic hydrocarbons and the occurrence of respiratory symptoms over the first year of life.

The purpose of the study was to test the hypothesis that infants with higher levels of prenatal exposure to polycyclic aromatic hydrocarbons (PAHs) from fossil fuel combustion may be at greater risk of developing respiratory symptoms. The study was carried out in a cohort of 333 newborns in Krakow, Poland, followed over the first year of life, for whom data from prenatal personal air monitoring of mothers in the second trimester of pregnancy were available. The relative risks of respiratory symptoms due to prenatal PAHs exposure were adjusted for potential confounders (gender of child, birth weight, maternal atopy, maternal education as a proxy for the socio-economic status, exposure to postnatal environmental tobacco smoke, and moulds in households) in the Poisson regression models. Increased risk related to prenatal PAH exposure was observed for various respiratory symptoms such as barking cough (RR = 4.80; 95% CI: 2.73–8.44), wheezing without cold (RR = 3.83; 95% CI: 1.18–12.43), sore throat (RR = 1.96; 95% CI: 1.38–2.78), ear infection (RR = 1.82; 95% CI: 1.03–3.23), cough irrespective of respiratory infections (RR=1.27; 95% CI: 1.07–1.52), and cough without cold (RR = 1.72; 95% CI: 1.02–2.92). The exposure to PAHs also had impact on the duration of respiratory symptoms. The effect of PAHs exposure on the occurrence of such symptoms as runny nose or cough was partly modified by the simultaneous exposure to postnatal passive smoking. The analysis performed for the duration of respiratory symptoms confirmed significant interaction between PAHs exposure and postnatal ETS for runny or stuffy nose (RR = 1.82; 95% CI: 1.57–2.10), cough (RR = 1.18; 95% CI: 0.99–1.40), difficulty in breathing (RR = 1.39; 95% CI: 1.01–1.92) and sore throat (RR = 1.74; 1.26–2.39). Obtained results support the hypothesis that prenatal exposure to immunotoxic PAHs may impair the immune function of the fetus and subsequently may be responsible for an increased susceptibility of newborns and young infants to respiratory infections.

Estimating Individual-Level Exposure to Airborne Polycyclic Aromatic Hydrocarbons throughout the Gestational Period Based on Personal, Indoor, and Outdoor Monitoring

Objectives Current understanding on health effects of long-term polycyclic aromatic hydrocarbon (PAH) exposure is limited by lack of data on time-varying nature of the pollutants at an individual level. In a cohort of pregnant women in Krakow, Poland, we examined the contribution of temporal, spatial, and behavioral factors to prenatal exposure to airborne PAHs within each trimester and developed a predictive model of PAH exposure over the entire gestational period. Methods We monitored nonsmoking pregnant women (n = 341) for their personal exposure to pyrene and eight carcinogenic PAHs—benz[a]anthracene, chrysene/isochrysene, benzo[b]fluoranthene, benzo[k]fluoranthene, benzo[a]pyrene [B(a)P], indeno[1,2,3-c,d]pyrene, dibenz[a,h]anthracene, and benzo[g,h,i]perylene—during their second trimester for a consecutive 48-hr period. In a subset (n = 78), we monitored indoor and outdoor levels simultaneously with the personal monitoring during the second trimester with an identical monitor. The subset of women was also monitored for personal exposure for a 48-hr period during each trimester. We repeatedly administered a questionnaire on health history, lifestyle, and home environment. Results The observed personal, indoor, and outdoor B(a)P levels we observed in Krakow far exceed the recommended Swedish guideline value for B(a)P of 0.1 ng/m3. Based on simultaneously monitored levels, the outdoor PAH level alone accounts for 93% of total variability in personal exposure during the heating season. Living near the Krakow bus depot, a crossroad, and the city center and time spent outdoors or commuting were not associated with higher personal exposure. During the nonheating season only, a 1-hr increase in environmental tobacco smoke (ETS) exposure was associated with a 10–16% increase in personal exposure to the nine measured PAHs. A 1°C decrease in ambient temperature was associated with a 3–5% increase in exposure to benz[a]anthracene, benzo[k]fluoranthene, and dibenz[a,h]anthracene, after accounting for the outdoor concentration. A random effects model demonstrated that mean personal exposure at a given gestational period depends on the season, residence location, and ETS. Conclusion Considering that most women reported spending < 3 hr/day outdoors, most women in the study were exposed to outdoor-originating PAHs within the indoor setting. Cross-sectional, longitudinal monitoring supplemented with questionnaire data allowed development of a gestation-length model of individual-level exposure with high precision and validity. These results are generalizable to other nonsmoking pregnant women in similar exposure settings and support reduction of exposure to protect the developing fetus.

Case-control study on beneficial effect of regular consumption of apples on colorectal cancer risk in a population with relatively low intake of fruits and vegetables.

Laboratory in-vitro studies and animal experiments showing the potential health benefits from apples raises the question to what extent the regular consumption of apples in humans may have a beneficial effect on colorectal cancer risk. A total of 592 incident cases of colorectal cancer have been enrolled in a hospital-based case–control study. The comparison group included 765 controls chosen from the patients of the same hospital without history of cancer and admitted for treatment of nonneoplastic conditions. Interviews of both cases and controls were conducted in the hospital setting by trained interviewers. The median intake of fruits among cases was lower than in controls (9.5 vs. 11 servings/week) and the difference was statistically significant. Apples were the most frequent fruit consumed by the study participants and about 80% of variability in the total fruit consumption resulted from the intake of apples. We did not observe any significant statistical differences in consumption of berries, citrus, or stone fruits and other kinds of fruits across cases and controls. The adjusted estimates of colorectal cancer risk related to the daily consumption of apples (in quintiles) were based on the unconditional multivariate logistic model, which considered the set of potential confounding variables such as demographic characteristics of participants (age, gender, place of residency, marital status, tobacco smoking), total energy intake, intake of vegetables and fruits without apples. The results of the logistic analysis showed that the adjusted risk of colorectal cancer inversely correlated with daily number of apple servings. The reduced risk of colorectal cancer of border significance level was already observed at the consumption of at least one apple a day (odds ratio=0.65, 95% CI: 0.39–1.09), but at the intake of more than one apple a day the risk was reduced by about 50% (odds ratio=0.53, 95% CI: 0.35–0.79). Neither the consumption of vegetables nor other fruits have shown beneficial effects on the risk of colorectal cancer. The observed protective effect of apple consumption on colorectal risk may result from their rich content of flavonoid and other polyphenols, which can inhibit cancer onset and cell proliferation.

Protective Effect of Fish Consumption on Colorectal Cancer Risk

Background/Aims: Current epidemiologic studies investigating the effect of fish intake on colorectal cancer (CRC) risk are scarce. Therefore, the aim of this study was to elucidate the relationship between fish consumption and CRC risk. Methods: This hospital-based case-control study was performed in 548 CRC patients (Surgery Clinic, University Hospital in Krakow, Poland) between November 2000 and May 2008. Histological findings, information on anatomic location and stage of cancer were available for all the patients enrolled in this study. The control group consisted of 745 patients of the same hospital with no history of cancer admitted for treatment of non-neoplastic conditions. During the 5-year study period, the food frequency questionnaire used focused on the reference period that was defined as 1–5 years prior to CRC diagnosis for the CRC cases and the date of hospital admission for the controls. Results: Thecrude odds ratio (OR) was inversely related to fish consumption (z for trend in quartiles of intake = –2.31, p = 0.021; OR = 0.89; 95% confidence interval, CI: 0.81–0.98). The risk of CRC increased with intake of stewed or cooked meat (z for trend in quartiles of intake = 2.14; p = 0.032; OR = 1.11; 95% CI: 1.01–1.23). The adjusted OR showed a significant reduction in CRC already at the moderate fish intake of one or two servings per week (OR = 0.70; 95% CI: 0.51–0.94), but it was even lower at higher fish intake (OR = 0.56; 95% CI: 0.39–0.86). All multivariate statistical models employed in the analysis considered potential confounders, such as demographic characteristics of subjects, body mass index, smoking status, leisure time physical activity, energy consumption and intake of meat products. Conclusions: The study results indicate that increased fish intake may have a preventive effect on CRC and modulate the effect of meat consumption. To our knowledge, this is the first large epidemiologic study on dietary habits and CRC incidence in Eastern Europe.

Pre-pregnancy Dietary Vitamin A Intake May Alleviate the Adverse Birth Outcomes Associated with Prenatal Pollutant Exposure: Epidemiologic Cohort Study in Poland

Abstract A cohort study assessed the relationship between dietary intake of vitamin A in 493 healthy mothers before and around conception and adverse birth outcomes associated with environmental toxicant exposures. The cohort, non-smoking women with singleton pregnancies, aged 18-35 years, gave birth at 34–43 weeks of gestation. The women were asked about their diets over one year preceding pregnancy. Measurements of PM2.5 were carried out during the second trimester. Birth outcomes were adjusted for potential confounding factors, including gestational age. Standardized beta regression coefficients confirmed an inverse association between PM2.5 and birth weight (beta = −172.4, P = 0.02), but the effect of vitamin A on birth weight was positive (beta = 176.05, P = 0.05), when the two were adjusted for each other. The negative effect of higher prenatal PM2.5 exposures (above third tertile) on birth weight was significant in women below the third tertile of vitamin A intakes (beta = −185.1, P = 0.00), but notin women with higher intakes (beta = 38.6, P = 0.61). The negative effect of higher PM2.5 exposure on length at birth was significant with lower vitamin A intakes (beta = −1.1, P = 0.00) but not with higher intakes (beta = −0.3, P = 0.56). Prepregnancy nutrition of mothers may modulate the harmful effects of prenatal exposures to pollutants on birth outcomes.

Relative validity of a semi-quantitative FFQ in 3-year-old Polish children

OBJECTIVES The aim of the study was to assess the relative validity of a semi-quantitative FFQ (SFFQ) which measures the usual dietary intake of 3-year-old children. DESIGN The childrens daily dietary intake was measured using the SFFQ. The average intake of three 24 h dietary recalls (24hDR) was calculated as a reference method. Wilcoxons rank test and Spearmans rank-correlation coefficient were used to compare nutrient intakes assessed by both methods. The level of agreement between the SFFQ and the repeated 24hDR was determined by the Bland-Altman method. To assess the agreement in quartile distribution, the weighted kappa coefficient (κ w) was used. SETTING Krakow, Poland. SUBJECTS One hundred and forty-three 3-year-old children and their mothers, participants of a prospective cohort study. RESULTS Overall, the SFFQ overestimated energy and nutrient intakes compared with the repeated 24hDR. The median correlation coefficient for energy and nutrient intakes was 0·456, with higher results for Ca, P and riboflavin. Although the κ w value showed only slight to fair agreement between the two methods, about 75 % of the children were classified into the same or adjacent quartile and the level of agreement assessed by the Bland-Altman method for most of the nutrients investigated was good. CONCLUSIONS The study indicated that the SFFQ might be a useful tool to assess dietary intakes of nutrients by small children, especially for ranking them according their nutrient intake.

The role of different predictors in 20-year mortality among Krakow older citizens

BACKGROUND The aim of this study was to assess the change in the predictive ability of gender-related 20-year all-cause mortality in community-dwelling older people. METHODS The baseline investigation was conducted in 1986-1987 and survival of 2472 subjects aged 65 years and older was followed up for 20 years. The associations of socioeconomic conditions and health measures with mortality were assessed using Cox hazard model with time-dependent covariates. RESULTS Our study confirmed that higher education and being employed during the baseline were protective factors in males, but not among females. Healthy lifestyle was a predictive factor for all-cause mortality for both men and women and its predictive value was strong over the whole observation period. The study showed that poor self-rated health (SRH) was a valid predictor of mortality in elderly women, but not in men, and the effect of the length of follow-up on mortality was not observed. Overall, different sets of all-cause mortality predictors were found for men and women. For men the role of socioeconomic status factors was confirmed as well as healthy lifestyle and presence of chronic conditions, especially coronary heart disease (CHD) and asthma. For women the most important predictors were lifestyle factors and the feeling of life-weariness as well as SRH and diabetes mellitus present during the baseline study. CONCLUSIONS The impact of most of the examined factors on mortality was found to be stable over the twenty years of observation with the exception of the self-reported CHD, whose predictive value decreased over time.

Reduced risk of colorectal cancer and regular consumption of apples: Hospital based case-control study in Poland

Experimental studies in animals and epidemiological evidence supporting the health benefits from apples encouraged the authors to assess the potential protective impact of apples on the risk of colorectal cancer in the course of the hospital based case-control study. A total of 186 incident cases of colorectal cancer — for which the information on histology, anatomic location, and stage of cancer were available — have been enrolled to the study. The comparison group included 211 controls chosen from the patients of the same hospital with no history of cancer and admitted for treatment of non-neoplastic conditions. Interviews of both cases and controls were conducted in hospital settings by trained interviewers. The results showed that the risk of colorectal cancer inversely correlated with daily number of apple servings, but the significant reduction of OR estimates were observed for an intake of one or more apple servings daily (OR = 0.37, 95%CI: 0.15 − 0.91). The risk of colorectal cancer was estimated from the multivariate logistic model including a set of potential confounding variables, such as, demographic characteristics of subjects (age, gender, place of residency, marital status and occupational activity), total energy intake (in tertiles) and intake of vegetables (number of servings per day). No fruits except for apples were significantly associated with the reduced risk of colorectal cancer. The reduction of colorectal risk associated with apple consumption may result from their rich content of flavonoid and other polyphenols, which can inhibit cancer onset and cell proliferation.

Clustering of geriatric deficits emerges to be an essential feature of ageing - results of a cross-sectional study in Poland

The majority of old people suffer from various clinical conditions that affect health, functioning and quality of life. This research is a part of a cross-sectional, nationwide PolSenior Study that provides a comprehensive assessment of eight geriatric impairments and their co-occurrence in a representative sample (3471 participant aged 65-104 years, mean age 78.3 years) of the old adults living in the community in Poland. The participants were recruited randomly from all administrative regions of Poland by a three-stage, proportional, stratified-by-age group selection process. Eight geriatric conditions were assessed: falls, incontinences, cognitive impairment, mood disorders, vision and hearing impairments, malnutrition, and functional dependence. We showed that the most common deficits causing disability were vision and hearing impairments, and mood disorders, with more than two thirds of the participants presented at least one geriatric deficit. We showed that presence any of the analyzed conditions significantly increased the risk for co-occurrence of other examined weaknesses. The highest prevalence odds ratios were for functional dependence and, respectively: malnutrition (8.61, 95%CI:4.70-15.80), incontinences (8.0, 95%CI:5.93-10.70), and cognitive impairment (7.22; 95%CI:5.91-8.83). We concluded that the majority of the old people living in the community present various clinical conditions that prompt disability.The majority of old people suffer from various clinical conditions that affect health, functioning and quality of life. This research is a part of a cross-sectional, nationwide PolSenior Study that provides a comprehensive assessment of eight geriatric impairments and their co-occurrence in a representative sample (3471 participant aged 65-104 years, mean age 78.3 years) of the old adults living in the community in Poland. The participants were recruited randomly from all administrative regions of Poland by a three-stage, proportional, stratified-by-age group selection process. Eight geriatric conditions were assessed: falls, incontinences, cognitive impairment, mood disorders, vision and hearing impairments, malnutrition, and functional dependence. We showed that the most common deficits causing disability were vision and hearing impairments, and mood disorders, with more than two thirds of the participants presented at least one geriatric deficit. We showed that presence any of the analyzed conditions significantly increased the risk for co-occurrence of other examined weaknesses. The highest prevalence odds ratios were for functional dependence and, respectively: malnutrition (8.61, 95%CI: 4.70-15.80), incontinences (8.0, 95%CI:5.93-10.70), and cognitive impairment (7.22; 95%CI:5.91-8.83). We concluded that the majority of the old people living in the community present various clinical conditions that prompt disability.

Effect of prenatal exposure to fine particles and postnatal indoor air quality on the occurrence of respiratory symptoms in the first two years of life

The purpose of this study was to assess an impact of prenatal exposure to fine particles (PM2.5) on the risk of developing respiratory symptoms in early childhood. The study was carried out in a cohort of 465 newborns in Krakow (Poland) who have been followed over the first two years of life. The children exposed to medium level of PM2.5 (>35.3?53.4 µg/m³) had 13% more wheezing days (IRR = 1.13; 95% CI: 1.03?1.23), and those exposed to higher PM2.5 (>53.4 µg/m³) had on average 62% more wheezing days (IRR = 1.62; 95% CI: 1.42?1.86) compared with the low exposure group (≤35.3 µg/m³). The presence of moulds in the household (IRR = 1.13; 95% CI: 1.03?1.24), parity (IRR = 1.18; 95% CI: 1.10?1.28), and maternal atopy (IRR = 1.45; 95% CI: 1.28?1.63) were also significantly associated with the number of wheezing days. Children only exposed to higher PM2.5 (>53.4 µg/m³) had significantly more days with difficult breathing (IRR = 1.54; 95% CI: 1.34?1.78). Since that prenatal exposure to fine particles increases burden of respiratory symptoms among infants and young children the current PM2.5 health air quality guidelines may be too high to protect the sensitive subgroups of population.