Jessica Leighton

The effect of prenatal dietary protein intake on birth weight

Abstract From 1940 to 1980, protein deficiency was implicated in depressed fetal growth and impaired infant development. Consequently, increasing protein intake in pregnancy was recommended. In 1980, a randomized controlled trial found high protein supplements to be associated with depressed birth weight in low-income pregnant women. The objective of this study was to assess the role of dietary protein during pregnancy in women consuming a self-selected diet. The relation between dietary protein intake and pregnancy outcome was explored in an observational, longitudinal study of low income, mostly urban women. Protein intake was estimated using the average of two 24-hour dietary recalls, the first generally completed between months 4 to 6 and the second in month 8 of pregnancy. Hierarchical multiple regression analyses were conducted, adjusted for maternal, infant and socio-demographic characteristics and for duration of gestation and maternal energy intake. This study found that mean protein intake ≥85 g/day was associated with a 71 g decrement in birth weight ( n = 2163, p = 0.009) compared to intermediate (50–84.9 g/day) average protein intake. About 36% of the women studied reported mean intakes of ≥85 g protein daily during pregnancy, whereas only 12% had low protein intakes (

Pesticide spraying for West Nile virus control and emergency department asthma visits in New York City, 2000

Pyrethroid pesticides were applied via ground spraying to residential neighborhoods in New York City during July–September 2000 to control mosquito vectors of West Nile virus (WNV). Case reports link pyrethroid exposure to asthma exacerbations, but population-level effects on asthma from large-scale mosquito control programs have not been assessed. We conducted this analysis to determine whether widespread urban pyrethroid pesticide use was associated with increased rates of emergency department (ED) visits for asthma. We recorded the dates and locations of pyrethroid spraying during the 2000 WNV season in New York City and tabulated all ED visits for asthma to public hospitals from October 1999 through November 2000 by date and ZIP code of patients’ residences. The association between pesticide application and asthma-related emergency visits was evaluated across date and ZIP code, adjusting for season, day of week, and daily temperature, precipitation, particulate, and ozone levels. There were 62,827 ED visits for asthma during the 14-month study period, across 162 ZIP codes. The number of asthma visits was similar in the 3-day periods before and after spraying (510 vs. 501, p = 0.78). In multivariate analyses, daily rates of asthma visits were not associated with pesticide spraying (rate ratio = 0.92; 95% confidence interval, 0.80–1.07). Secondary analyses among children and for chronic obstructive pulmonary disease yielded similar null results. This analysis shows that spraying pyrethroids for WNV control in New York City was not followed by population-level increases in public hospital ED visit rates for asthma.

The effect of lead-based paint hazard remediation on blood lead levels of lead poisoned children in New York City.

Despite the widespread use of lead paint hazard control for children with lead poisoning, few controlled studies that estimate the effect of such control on childrens blood lead levels have been published. This retrospective follow-up study examined the effects of lead hazard remediation and its timing on the blood lead levels of lead-poisoned children. From the New York City child blood lead registry, 221 children were selected who had an initial blood lead level of 20-44 micro g/dL between 1 July 1994 and 31 December 1996; were 6 months to 6 years of age; had a report of a follow-up blood lead test between 10 and 14 months after the initial test; had a lead-based paint hazard identified in the primary dwelling unit prior to the 10- to 14-month follow-up blood lead test; had resided or spent time at only one address with an identified lead-based paint hazard; and were not chelated. The decline in geometric mean blood lead levels from baseline to 10-14 months later was compared for children whose homes were remediated and whose homes were not remediated during the follow-up period. Regardless of remediation, geometric mean blood lead levels declined significantly from 24.3 micro g/dL at the initial diagnosis to 12.3 micro g/dL at the 10- to 14-month follow-up blood lead test (P<0.01). Among the 146 children whose homes were remediated the geometric mean blood lead levels declined 53% compared to 41% among the 75 children whose homes were not remediated by the follow-up blood lead test, a remediation effect of approximately 20% (P<0.01). After adjusting for potential confounders, the remediation effect was 11%, although it was no longer significant. Race was the only factor that appeared to confound the relationship: Black children had higher follow-up blood lead levels even after controlling for other factors, including the natural logarithm of the initial blood lead level. The effect of remediation appeared to be stronger for younger (10 to <36 months old) than for older (36 to 72 months old) children (P=0.06). While children in homes with earlier remediation (within less than 3 months) appeared to have greater declines in blood lead levels at the follow-up test than children in homes with later remediation (after 3 or more months), this trend was not significant when controlling for confounding factors. The findings of this study suggest that early identification of lead-poisoned children and timely investigation and abatement of hazards contribute to reducing blood lead levels. However, the apparent effect is modest and further research is needed to systematically test and improve the effectiveness of lead hazard controls.

Lead poisoning among pregnant women in New York City: risk factors and screening practices.

This article presents information on pregnant women with incident blood lead levels (BLLs) of 20 μg per deciliter or greater as reported to the New York City Department of Health between September 1996 and June 1999 (n=33). Almost half of the women were diagnosed during their third trimester of pregnancy, often at their first prenatal visit. The median BLLs at incidence and at last report among women who were retested were 25 and 15 γ/dL, respectively, a 40% decline. The median incident BLL among newborns (n=25) was 12 μg/dL. The BLLs were inversely associated with maternal age and length of time in the United States and directly associated with gestational age and pica behavior. Cases were more than twice as likely to be foreign-born women than all women who gave birth in New York City. Prenatal care facilities employing a policy of universal blood lead testing of all pregnant women at the time of their first visit reported disproportionate numbers of cases, accounting for 77% of cases yet only 11% of all births citywide. The findings suggest that (1) the promulgation of recent rules and guidelines for lead risk assessment and screening among pregnant women appears to have been effective in identifying cases that might not have otherwise come to light; (2) case management and environmental interventions were initiated promptly; (3) cases experienced, on average, significant BLL reductions over time; and (4) there is a need for additional public health interventions for pregnant women in urban, multicultural centers. While the data suggest that universal screening may increase case finding among high-risk, immigrant populations, further studies and surveillance are needed to determine systematically the most effective approach.

Is home renovation or repair a risk factor for exposure to lead among children residing in New York City

Children can be lead poisoned when leaded paint is disturbed during home renovation or repair. We conducted a case-control study to assess the association between elevated blood lead levels (BLLs) in children younger than 5 years of age and renovation or repair of homes built before 1950 in New York City. In 1998, we interviewed parents of 106 case children (BLLs)≥10 μg/dL) and 159 control children (BLLs≤5 μg/dL) living in selected New York City neighborhoods. We then used logistic regression methods to estimate odds ratios (ORs) for elevated BLLs among children living in housing that had undergone varous renovations or repairs in the 6 months before the blood lead test, and we adjusted for age and test month. Case children were only slightly more likely than control children to live in a house that had undergone any renovation (OR=1.2, 95% confidence interval [95% CI]=0.7, 2.1). Case children were more likely to (1) live in housing that had interior surfaces prepared for painting, especially by hand sanding (OR=3.5, 95% CI=1.1, 10.9; population attributable risk [PAR%]=10.4%, 95% CI=0.5% 19.3%); and (2) have work-created dust throughout their housing unit (OR =6.3, 95% CI=1.2, 32.3; PAR%=6.8%, 95% CI=0.0%, 13.1%). The risk for excess lead exposure is increased by home renovation or repair work involving interior paint preparation or reported dispersal of dust beyond the work area. The proportion of cases related to this exposure is high enough to merit preventive measures.

Developing a comprehensive pesticide health effects tracking system for an urban setting: New York City's approach.

In recent years, there have been substantial investments and improvements in federal and state surveillance systems to track the health effects from pesticide exposure. These surveillance systems help to identify risk factors for occupational exposure to pesticides, patterns in poisonings, clusters of disease, and populations at risk of exposure from pesticide use. Data from pesticide use registries and recent epidemiologic evidence pointing to health risks from urban residential pesticide use make a strong case for understanding better the sale, application, and use of pesticides in cities. In this article, we describe plans for the development of a pesticide tracking system for New York City that will help to elucidate where and why pesticides are used, potential risks to varied populations, and the health consequences of their use. The results of an inventory of data sources are presented along with a description of their relevance to pesticide tracking. We also discuss practical, logistical, and methodologic difficulties of linking multiple secondary data sources with different levels of person, place, and time descriptors.

THE RELATIONSHIP OF WIC BENEFITS TO THE DIETS OF PRESCHOOL CHIDREN: THE NATIONAL WIC EVALUATION

We here report on the effects of the Special Supplemental Food Program for Women, Infants and Children (WIC) for 2991 randomly recruited poor preschool children, from 59 areas nationwide. Total nutrient intake, nutrient density, and intake from foods available from WIC were assessed by quantitative 24 hour diet recall. Differences between current WIC recipients (n=711), past recipients (n=637), and controls (n=762) were adjusted for age and sex, and also for social and demographic characteristics, and height. Current WIC benefits strongly and significantly affected the quality of diet, with little residuum from past WIC participation. Current WIC recipients ate no more calories or protein, but significantly more iron, thiamin, niacin, Vit. B6 and Vit. C than controls. Current WIC recipients ate 30% (3 mg) more iron, with greatest differences under one year of age. Increased intake of other micronutrients was more evenly distributed throughout the preschool years. AFDC and WIC were both associated with better diet, but WIC was particularly important for children not receiving AFDC. WIC improved black and hispanic childrens diets more than that of non hispanic whites.Observed differences are minimal estimates, given likely measurement error in this large scale field study, and since controls were more socially privileged than WIC recipients (they were nearly a cm. taller). We conclude that the WIC program has a marked beneficial effect on the diets of currently enrolled preschool children.