The Effect of Obesity on Fractional Exhaled Nitric Oxide in School-Aged Children.

BACKGROUND: Fractional exhaled nitric oxide (FeNO) is recognized as a biomarker of eosinophilic inflammation. Current literature shows evidence that FeNO is influenced by many factors. Obesity is a chronic inflammatory state. In this study, we considered obesity as a potential factor that influences FeNO levels. The aim of the study was to analyze the association between body mass index (BMI, body mass (kg)/height (m)2) and FeNO levels in a young group of children. METHODS: The participants in the study were 506 school-aged children who were randomly selected from primary schools located in Silesian Voivodship (Poland). The modified version of the Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was used to assess the respiratory system status of children. FeNO was measured in 447 children according to European Respiratory Society and America Thoracic Society (ERS/ATS) recommendations. Body mass and height were measured by a medical body composition analyzer. BMI was defined and interpreted with Palczewska's percentile charts. RESULTS: In the study group there were 49.9% (n = 223) boys and 50.1% (n = 224) girls. The frequency of normal BMI was 76.8% (n = 172), overweight 13.7% (n = 31) and obesity 9.4% (n = 21) in girls, while the normal BMI was found in 71.3% (n = 159), overweight 11.6% (n = 26) and obesity 17% (n = 38) in boys, the differences not statistically significant (p = 0.05). The mean FeNO value in children with obesity was 16.1 ± 12.5 ppb, in children with normal BMI 15.8 ± 15.5 ppb and the lowest FeNO values were in children with overweight 15.3 ± 13.0 ppb; p = 0.9. The FeNO values after adjusting for age, sex, BMI and symptoms from respiratory system were depended on age and respiratory symptoms only. CONCLUSIONS: In 6-9 year old school children, FeNO levels are associated with age and health in relation to the respiratory system. The BMI should not be included when considering reference values for FeNO.

The relationship between ambient air pollution and life expectancy - an ecological fallacy revisted.

INTRODUCTION: The results of multiple studies indicate the negative impact of exposure to air pollution on human life expectancy. Epidemiological evidence on this relation is in large proportion provided by ecological studies, what causes interpretation difficulties. Poland is a country characterized by large territorial differences in ambient air pollution and in life expectancy. This promotes analyses of the mentioned relationship based on ecological model. AIM: The aim of the study was to analyse the results of a simple ecological study concerning the relationship between life expectancy and air pollution with the focus on the difficulties in interpretation of the results. MATERIAL AND METHODS: The study used a simple ecological study approach. We used the official data on sex-specific life expectancy for year 2018 and annual average ambient air concentrations of PM2.5 in years 2010-2018 for 10 large metropolitan areas in Poland. The data was used as a marker of long-term air pollution levels in particular areas. Associations between life expectancy and air pollution levels were assessed using Spearman correlation analysis. RESULTS: The analysis concerning exposure to air pollution and life-expectancy in several Polish large agglomerations did not show statistically significant associations. CONCLUSIONS: Our ecological study did not show statistically significant associations between life expectancy and ambient air pollution levels measured by means of PM2.5 concentrations. Ecological nature of the population's exposure marker, without considering many important factors influencing length of life, may explain the negative results of the correlation analysis. This is an example of so called ecological fallacy, affecting the used model of epidemiological study.

Acute cardiorespiratory response to ambient air pollution exposure during short-term physical exercise in young males.

BACKGROUND: Physical exercise in the presence of ambient air pollution may increase the absorbed dose of air pollutants. The combined effect of such exposure on cardiorespiratory function in young adults remains unclear. AIM: To determine the acute cardiorespiratory responses in healthy young adults preforming submaximal physical exercise under exposure to high level winter-type ambient air pollution. METHODS: Healthy young males (n=30) performed two separate 15-minute submaximal exercise trials on a cycle ergometer - when air pollutants' concentrations were increased (exposure trial) and when air quality was good (control trial). Each time blood pressure, pulse oximetry, spirometry and fractional exhaled nitric oxide (FeNO) were measured at baseline, directly after exercise and after 15-min of rest. RESULTS: High air pollutants concentrations were observed during exposure trials (PM2.5 24.0-157.0 µg/m3, SO2 8.7-85.8 µg/m3). Group-based correlation analysis showed statistically significant negative correlations between post-exercise declines in FEV1/FVC and SO2, PM10 and PM2.5 concentrations. In individual cases the decrease was recorded only in subjects who exercised under particularly high exposure, and was not related to their BMI, physical activity pattern or allergy status. In multivariate analysis SO2 was a statistically significant predictor of both immediate (OR: 1.09, 95%CI: 1.01-1.17) and delayed decrease in airflow (OR: 1.08, 95%CI: 1.01-1.16), and PM2.5 was also a statistically significantly explanatory variable of post-exercise decline in FEV1/FVC (OR: 1.03, 95%CI: 1.00-1.06). CONCLUSION: In young and healthy males exposure to ambient air pollution during short-term submaximal exercise is associated with a decrease in airflow (FEV1/FVC) and the decrease is more apparent when the exercise takes place under particularly high exposure conditions.

Acute FeNO and Blood Pressure Responses to Air Pollution Exposure in Young Adults during Physical Activity.

During physical exercise, the absorbed dose of air pollutants increases. Acute effects of exposure to air pollutants during exercise in healthy young adults remain poorly documented. The aim of this study was to assess the acute responses in fractionated exhaled nitric oxide (FeNO) and blood pressure to air pollution exposure during exercise in young adults with different physical activity levels (low or high). In this study, 76 healthy university students participating in physical activity classes (low level of physical activity) and attending sports training (high level of physical activity) completed two indoor exercise trials when air pollutant concentrations were high (exposure trial) and when the quality of the air was good (control trial). We monitored indoor particulate matter with diameter <10 µm and <2.5 µm (PM10 and PM2.5) and outdoor PM10, nitric oxides (NO2, NOx, NO), and sulfur dioxide (SO2) concentrations. Systolic and diastolic blood pressure (SBP and DBP), heart rate (HR), oxygen saturation (SpO2), and FeNO were measured at baseline and after 45-60 min of physical activity. There were no significant differences between physiological responses to training performed under different exposure conditions in blood pressure, HR, and SpO2. Significant positive correlations between post-exercise ΔFeNO during exposure trials and ambient air pollutants were found. FeNO increase during the exposure trial was associated with a higher physical activity level and higher outdoor PM10 and NO2 concentrations. In young and healthy adults, some differences in physiological responses to physical activity between polluted and control environments could be observed. Participants with a high physical activity level were more likely to have an increase in FeNO after exercise in a polluted environment but not after the control exercise trials.

The effect of upper respiratory allergy on acute respiratory response to ambient air pollution during physical exercise.

OBJECTIVES: Ambient air pollution is related to adverse respiratory effects. Because of a popular habit of recreational physical activity, the effects of exposure to increased levels of air pollution attract increasing attention. It remains unclear whether the allergy status has an impact on acute responses to air pollution exposure during brief exercise in young adults. The aim of the study was to determine if acute respiratory responses to ambient air pollution during physical exercise differ between young subjects with and without a history of upper respiratory allergy. MATERIAL AND METHODS: Overall, 41 young males with (N = 15, 36.6%) and without allergy (N = 26, 63.4%) performed short moderate-intensive cycle-ergometer sessions in winter air pollution exposure conditions. Associations were analyzed between environmental conditions and acute physiological changes in spirometry, fractioned exhaled nitric oxide (FeNO) levels, blood pressure and pulse oximetry. RESULTS: No associations between air pollution concentrations and changes in forced vital capacity, forced expiratory volume in 1 s and the Tiffeneau index were found. In the subjects without allergy, the increased air pollution concentrations recorded during exercise were associated with a post-exercise increase/a smaller decrease in FeNO (SO2: Spearman's ρ = 0.44, NOx: ρ = 0.51, and particulate matter [PM] levels - PM10: ρ = 0.51, PM2.5: ρ = 0.52). This effect was not observed in the subjects with allergy. CONCLUSIONS: Upper-respiratory allergy may be a modifying factor in human response to air pollution during exercise. Exposure to air pollution during brief moderate-intensive exercise did not have any acute negative impact on respiratory and cardiovascular function in young males. However, in the case of FeNO, subclinical post-exercise changes related to air pollution were observed in volunteers without allergy. Int J Occup Med Environ Health. 2020;33(5):649-60.

Low molecular weight heparin in surgical valve procedures: When and how much for an optimal prophylaxis?

BACKGROUND: Periprocedural antithrombotic prophylaxis in patients undergoing surgical valve procedures (SVP) is insufficiently investigated. Low molecular weight heparin (LMWH) has been considered as an alternative to unfractionated heparin (UFH). However, safety and efficacy of this prophylaxis strategy is unknown. This study aimed to investigate safety and efficacy of periprocedural LMWH prophylaxis and determine optimal dosage and timing for periprocedural cessation and initiation. METHODS: The present study is a retrospective, single-center observational analysis of 388 patients who underwent SVP (valve replacement or valvuloplasty) between 2015 and 2016. In-hospital endpoints were bleeding, transfusions, reoperation due to bleeding, and thromboembolic events. RESULTS: Giving the first dose of LMWH on the day of SVP was a risk factor for bleeding (OR 1.07; 95% CI 1.04-1.10; p < 0.001), transfusions (OR 1.04; 95% CI 1.01-1.07; p = 0.008) and reoperation due to bleeding (OR 1.20; 95% CI 1.12-1.28; p < 0.001), with > 40 mg/day as a predictor. A higher dosage of LMWH premedication was an independent risk factor for bleeding (OR 1.02; 95% CI 1.00-1.04; p = 0.03) and transfusion (OR 1.03; 95% CI 1.01-1.05; p = 0.01), with > 60 mg/day as a predictor for these events. LMWH dosed within 24 h prior to SVP increased the risk of transfusion (AUC 0.636; 95% CI 0.496-0.762; p = 0.04). CONCLUSIONS: Bleeding is an important early concern after surgical valve procedures. Safety and efficacy of periprocedural prophylaxis with LMWH depends on dosage and the timing of its administration. The most optimal periprocedural prophylaxis in the SVP population appears to be LMWH in dosage of 40-60 mg/day, which is recommended for deep vein thrombosis prophylaxis, ceased at least one day before SVP.

Recreational physical activity and the problem of particulate matter air pollution

Studies reveal the negative impact of exposure to particulate air pollution on human health, especially on respiratory and circulatory systems. At the same time the beneficial effects of maintaining adequate level of physical activity are well known. In this review author presents analysis of chosen current articles about health effects of recreational physical activity in the environment of high level of ambient particulate matter air pollution. Available data suggests that there are complex relations between physical activity and exposure to air pollution. The direct positive effects of recreational physical activity include decrease of diastolic blood pressure and bronchial dilatation. It is proven that particulate air pollution show contrary impact on respiratory and cardiovascular systems. The mechanisms of this influence consist of induction of inflammation in respiratory epithelial cells, increase of oxidative stress and alterations in autonomic nervous system regulation. Changes induced by air pollution, expressed by the decrease of spirometry parameters (most commonly FEV1 decrease) were observed even in young and healthy adults doing recreational physical activity. Nevertheless, several studies suggest modulatory impact of physical exercises, which may limit the pro-inflammatory influence of particulate air pollution. Less expressed short-term negative effects of exposure have been observed in people doing physical exercise in comparison to those being inactive at the same time. In addition, apart from direct health effects, air pollution may also discourage exposed people from doing physical activity. Therefore, balanced choices regarding physical activity are needed, in order to decrease the negative impact of exposure to air pollution, without limiting the positive impact of physical activity. Still, new research is needed in order to fully explain relations between physical activity and exposure to air pollution. This will allow to elaborate physical activity guidelines including current air pollution level, better risk communication and promotion of safe ways of exercise.

Dietary supplementation usage by pregnant women in Silesia - population based study.

OBJECTIVES: Despite wide access to gynecological and obstetric advice, informational campaigns, and information online and in magazines aimed at pregnant women, there is a worryingly high percentage of women who still do not use recommended dietary supplementation. The aim of this study was to assess the frequency of micronutrient supplementation by pregnant women and to specify the determinants that impact decisions concerning supplementation. MATERIAL AND METHODS: A cross-sectional survey was conducted between June 2016 and May 2017 among a group of pregnant women visiting gynecological and obstetric clinics in the Silesia region, who have completed an authorized questionnaire developed for the purpose of this study. The questionnaire addressed the women's dietary habits, micronutrient supplementation use, as well as their socio-economic status. Completed questionnaires were obtained from 505 pregnant women. RESULTS: Microminerals and vitamins supplementation during pregnancy was declared by 410 (81.2%) women. The most often used supplement was folic acid (62%). More than one-third of pregnant women (38.4%) declared vitamin D intake. Among the recommended supplements, the least commonly used (30.3%) were polyunsaturated fatty acids (PUFA). Factors contributing to supplementation use during pregnancy are past history of miscarriage and socioeconomic factors, such as: place of residence, financial situation and level of education. Inhabitants of larger cities, women with better self-perceived financial situations, higher education levels and those presenting past history of miscarriage took the supplements significantly more often. CONCLUSIONS: Lower levels of education, low-income financial status and living in rural localities are among the factors correlating with worse adherence to supplementation guidelines.

Short-term exposure to ambient fine particulate matter (PM2,5 and PM10) and the risk of heart rhythm abnormalities and stroke.

Results of epidemiological studies suggest a significant impact of ambient particulate matter air pollution (PM10 and PM2,5) on the health of the population. Increased level of these pollutants is connected with increased rate of daily mortality and hospitalizations due to cardiovascular diseases. Among analyzed health effects, heart arrhythmias and stroke are mentioned most frequently. The aim of the study was to present the current knowledge of potential influence of the exposure to fine particulate matter on the presence of arrhythmias and strokes. Subject literature review suggests, that there is a link between short-term exposure to fine dust and the occurrence of arrhythmias. Results of previous studies indicates that this exposure may lead to significant electrophysiological changes in heart, resulting in higher susceptibility to cardiac rhythm abnormalities. In case of stroke, a stronger correlation between number of hospitalizations and death cases and exposure to fine dust was seen for ischaemic stroke than for haemorhhagic stroke. In addition, a significantly more harmful impact of the exposure to ultra particles (particles of aerodynamic diameter below 2,5 µm) has been confirmed. Among important mechanisms responsible for observed health impact of particulate matter there are: induction and intensification of inflammation, increased oxidative stress, increased autonomic nervous system activity, vasoconstriction, rheological changes and endothelial dysfunction. Among people of higher susceptibility to fine dust negative health impact are: elderly (over 65 years old), obese people, patients with respiratory and cardiovascular diseases, patients with diabetes and those with coagulation disorders. For further improvement of general health status, actions aimed at reducing the risk associated with fine dust and at the same time at continuing studies to clarify the biological mechanisms explaining the influence of fine dust on human health are necessary.