Raquel García‐Esteban

Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública

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Jordi Sunyer

Pompeu Fabra University

119

Jordi Júlvez

Instituto de Salud Carlos III

Mònica Guxens

Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública

Joan Forns

RTI Health Solutions

Martine Vrijheid

Pompeu Fabra University

Maties Torrent

Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública

Joachim Heinrich

LMU Klinikum

Xavier Basagaña

Barcelona Institute for Global Health

Adonina Tardón

Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública

Maribel Casas

Barcelona Institute for Global Health

Cooperative Institutions

Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública

141

Barcelona Institute for Global Health

105

Pompeu Fabra University

104

Instituto de Salud Carlos III

Center for Research in Environmental Epidemiology

Municipal Institute for Medical Research

Inserm

Barcelona Biomedical Research Park

Hospital Del Mar

Universitat de Barcelona

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Use of household cleaning products, exhaled nitric oxide and lung function in children: Table 1–

European Respiratory Journal (2013)

Lídia Casas Jan‐Paul Zock Maties Torrent Raquel García‐Esteban Esther Gràcia-Lavedán

To the Editor : The application of domestic cleaning agents increases the risk of asthma and respiratory symptoms in adults [1], in particular when products are applied in spray form [2]. Despite the associations observed in adults, the potential effects of passive exposure on children’s respiratory health have not been extensively explored. Analyses of data from birth cohorts have suggested that frequent use of cleaning agents and their use in spray form increased the risk of wheezing and lower respiratory tract infections (LRTIs) during the first year of life [3, 4] and the risk of persistent wheezing at school age [5, 6]. By contrast, a cross-sectional study reported protective effects of using bleach at home on the prevalence of asthma and allergic sensitisation at school age [7]. Our study investigates the effects of the use of 10 common cleaning products on exhaled nitric oxide fraction ( F eNO) and on lung function (forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1)) during childhood in a population-based birth cohort in Menorca, Spain [8]. Recruitment was performed during pregnancy and 482 children were enrolled at birth. Written informed consent was obtained from all participants and the study was approved by a committee on ethical practice. Questionnaires on wheezing, asthma, treatment and allergies (rhinitis, eczema or hay fever) were administered by the mother repeatedly from birth until the age of 10 years. At the age of 10–13 years, F eNO (NIOX MINO; Aerocrine AB, Solna, Sweden) and forced spirometry (EasyOne; ndd Medical Technologies, Inc., Andover, MA, USA) testing was carried out. In addition, an interviewer-led questionnaire on the frequency of use of 10 different cleaning products (bleach, …

Hay fever

Wheeze

10.1183/09031936.00066313

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Citations (22)

Prenatal head growth and child neuropsychological development at age 14 months

American Journal of Obstetrics and Gynecology (2014)

Dolores Álamo-Junquera Jordi Sunyer Carmen Íñiguez Ferrán Ballester Raquel García‐Esteban

10.1016/j.ajog.2014.12.001

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Citations (14)

Iodine sources and iodine levels in pregnant women from an area without known iodine deficiency

Clinical Endocrinology (2009)

Mar Álvarez‐Pedrerol Núria Ribas‐Fitó Raquel García‐Esteban Àgueda Rodríguez Dolors Soriano

An adequate iodine intake during pregnancy is essential for normal development of the foetus. The World Health Organization (WHO) recommends that the median urinary iodine concentration (UIC) in a population of pregnant women should range between 150 and 249 microg/l. The aim of this study was to evaluate iodine status and to examine the main sources of iodine in pregnant women from an apparently iodine-sufficient area.Six hundred pregnant women in the third trimester completed a food frequency questionnaire, and iodine was measured in urine samples. Urinary iodine concentrations were described in the whole population and in subgroups according to their frequency of intake of milk, fish, eggs, bread and iodized salt, as iodine supplements.The median UIC was 104 microg/l (n = 600), however, the median was higher among women who had a high milk intake (117 microg/l), used iodized salt (117 microg/l) or who were supplemented with iodine (141 microg/l). Women receiving iodine supplementation who also consumed more than one cup of milk per day had median UIC higher than 150 microg/l. In multivariate models, women with moderate and high milk intake had lower risk of having UIC below 150 microg/l [OR (95% CI): 0.42 (0.22-0.82) and 0.29 (0.15-0.55) respectively], after adjustment for potential confounders.On the basis of WHO criteria, the iodine status of pregnant women was inadequate in this area. Milk was the most important dietary source of iodine, and iodine supplementation was also an important source of iodine, although not enough to reach the current recommendations.

Iodised salt

Food frequency questionnaire

10.1111/j.1365-2265.2009.03588.x

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Ambient Air Pollution and the Progression of Atherosclerosis in Adults

PLoS ONE (2010)

Nino Künzli Michael Jerrett Raquel García‐Esteban Xavier Basagaña Bernardo Beckermann

Cross-sectional studies suggest an association between exposure to ambient air pollution and atherosclerosis. We investigated the association between outdoor air quality and progression of subclinical atherosclerosis (common carotid artery intima-media thickness, CIMT).We examined data from five double-blind randomized trials that assessed effects of various treatments on the change in CIMT. The trials were conducted in the Los Angeles area. Spatial models and land-use data were used to estimate the home outdoor mean concentration of particulate matter up to 2.5 micrometer in diameter (PM2.5), and to classify residence by proximity to traffic-related pollution (within 100 m of highways). PM2.5 and traffic proximity were positively associated with CIMT progression. Adjusted coefficients were larger than crude associations, not sensitive to modelling specifications, and statistically significant for highway proximity while of borderline significance for PM2.5 (P = 0.08). Annual CIMT progression among those living within 100 m of a highway was accelerated (5.5 micrometers/yr [95%CI: 0.13-10.79; p = 0.04]) or more than twice the population mean progression. For PM2.5, coefficients were positive as well, reaching statistical significance in the socially disadvantaged; in subjects reporting lipid lowering treatment at baseline; among participants receiving on-trial treatments; and among the pool of four out of the five trials.Consistent with cross-sectional findings and animal studies, this is the first study to report an association between exposure to air pollution and the progression of atherosclerosis--indicated with CIMT change--in humans. Ostensibly, our results suggest that air pollution may contribute to the acceleration of cardiovascular disease development--the main causes of morbidity and mortality in many countries. However, the heterogeneity of the volunteering populations across the five trials, the limited sample size within trials and other relevant subgroups, and the fact that some key findings reached statistical significance in subgroups rather than the sample precludes generalizations to the general population.

Intima-media thickness

10.1371/journal.pone.0009096

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Citations (252)

Early-Life Exposure to Outdoor Air Pollution and Respiratory Health, Ear Infections, and Eczema in Infants from the INMA Study

Environmental Health Perspectives (2012)

Inmaculada Aguilera Marie Pedersen Raquel García‐Esteban Ferrán Ballester Mikel Basterrechea

Prenatal and early-life periods may be critical windows for harmful effects of air pollution on infant health.We studied the association of air pollution exposure during pregnancy and the first year of life with respiratory illnesses, ear infections, and eczema during the first 12-18 months of age in a Spanish birth cohort of 2,199 infants.We obtained parentally reported information on doctor-diagnosed lower respiratory tract infections (LRTI) and parental reports of wheezing, eczema, and ear infections. We estimated individual exposures to nitrogen dioxide (NO(2)) and benzene with temporally adjusted land use regression models. We used log-binomial regression models and a combined random-effects meta-analysis to estimate the effects of air pollution exposure on health outcomes across the four study locations.A 10-µg/m(3) increase in average NO(2) during pregnancy was associated with LRTI [relative risk (RR) = 1.05; 95% CI: 0.98, 1.12] and ear infections (RR = 1.18; 95% CI: 0.98, 1.41). The RRs for an interquartile range (IQR) increase in NO(2) were 1.08 (95% CI: 0.97, 1.21) for LRTI and 1.31 (95% CI: 0.97, 1.76) for ear infections. Compared with NO(2), the association for an IQR increase in average benzene exposure was similar for LRTI (RR = 1.06; 95% CI: 0.94, 1.19) and slightly lower for ear infections (RR = 1.17; 95% CI: 0.93, 1.46). Associations were slightly stronger among infants whose mothers spent more time at home during pregnancy. Air pollution exposure during the first year was highly correlated with prenatal exposure, so we were unable to discern the relative importance of each exposure period.Our findings support the hypothesis that early-life exposure to ambient air pollution may increase the risk of upper and lower respiratory tract infections in infants.

Interquartile range

Ear infection

10.1289/ehp.1205281

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Citations (138)

Early life mite allergens and respiratory and allergic health

Lídia Casas Raquel García‐Esteban Christina Tischer Joachim Heinrich Irina Lehmann

We aimed to assess the associations between early life concentrations of house dust mite (HDM) allergens in home dust and respiratory health and allergic sensitization to HDM from birth to school age. A total of 4,293 children from 5 European birth cohorts participating in the MeDALL project were included: INMA (ES), BAMSE (SE), PIAMA (NL), LISA and MAS (DE). Dust samples were collected during early life from bedrooms and analyzed for HDM allergens: Der p1 and Der f1 . The concentrations were categorized in low, medium and high, using cohort-specific cut-offs. Information on wheezing and asthma up to 8/10 years old was prospectively collected through questionnaires. Specific IgE was used to determine HDM sensitization. We performed multivariable log-binomial regression models per cohort obtaining adjusted RR. The concentrations of allergens, incidence of health outcomes and direction of the adjusted associations varied across cohorts. The highest median HDM concentrations were found in INMA, and the lowest in BAMSE, where respiratory outcomes were most frequent and sensitization least. In INMA, inverse associations were shown between medium versus low HDM concentrations and health outcomes, although only sensitization was significantly associated (RR=0.3; 95%CI 0.1-0.9). In MAS and PIAMA, we found significant 2 to 3 fold increased risk of wheezing, asthma or sensitization for medium or high versus low HDM concentrations. Associations in LISA and BAMSE were not significant. In conclusion, the associations between early life HDM and later respiratory and allergic outcomes vary across regions. We hypothesize that the possible associations are not linear and show up depending on the range of values observed in each region.

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Citations (1)

The Causes of New-Onset Asthma in Adults: A Population-Based International Cohort Study.

J. M. Antó Jordi Sunyer Xavier Basagaña Raquel García‐Esteban Isa Cerveri

10.1164/ajrccm-conference.2009.179.1_meetingabstracts.a4749

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Geographic variations in the effect of atopy on asthma in the European Community Respiratory Health Study

Journal of Allergy and Clinical Immunology (2004)

Jordi Sunyer Deborah Jarvis Juha Pekkanen S Chinn Christer Janson

Atopy

Methacholine

Bronchial hyperresponsiveness

10.1016/j.jaci.2004.05.072

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Citations (148)

Head circumference and child ADHD symptoms and cognitive functioning: results from a large population-based cohort study

European Child & Adolescent Psychiatry (2018)

Muriel Ferrer Raquel García‐Esteban Carmen Íñiguez Olga Costa Ana Fernández‐Somoano

Generation R

10.1007/s00787-018-1202-4

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Citations (14)

Gender differences in prevalence, diagnosis and incidence of allergic and non-allergic asthma: a population-based cohort

Thorax (2012)

Bénédicte Leynaert Jordi Sunyer Raquel García‐Esteban Cecilie Svanes Deborah Jarvis

Background

Although women with severe non-allergic asthma may represent a substantial proportion of adults with asthma in clinical practice, gender differences in the incidence of allergic and non-allergic asthma have been little investigated in the general population.

Methods

Gender differences in asthma prevalence, reported diagnosis and incidence were investigated in 9091 men and women randomly selected from the general population and followed up after 8–10 years as part of the European Community Respiratory Health Survey. The protocol included assessment of bronchial responsiveness, IgE specific to four common allergens and skin tests to nine allergens.

Results

Asthma was 20% more frequent in women than in men over the age of 35 years. Possible under-diagnosis of asthma appeared to be particularly frequent among non-atopic individuals, but was as frequent in women as in men. The follow-up of subjects without asthma at baseline showed a higher incidence of asthma in women than in men (HR 1.94; 95% CI 1.40 to 2.68), which was not explained by differences in smoking, obesity or lung function. More than 60% of women and 30% of men with new-onset asthma were non-atopic. The incidence of non-allergic asthma was higher in women than in men throughout all the reproductive years (HR 3.51; 95% CI 2.21 to 5.58), whereas no gender difference was observed for the incidence of allergic asthma.

Conclusions

This study shows that female sex is an independent risk factor for non-allergic asthma, and stresses the need for more careful assessment of possible non-allergic asthma in clinical practice, in men and women.

10.1136/thoraxjnl-2011-201249

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Citations (241)