Urinary Heavy Metals and Associations with Body Mass Index and Waist Circumference Among Adolescents and Adults: National Health and Nutrition Examination Survey 2011-2012

s / Annals of Epidemiology 25 (2015) 702e719 709 P27. Urinary Heavy Metals and Associations with Body Mass Index and Waist Circumference Among Adolescents and Adults: National Health and Nutrition Examination Survey 2011-2012 Francesca Branch MSPH, Maya Shimony MPH, Melissa J. Perry ScD, MHS. George Washington University Purpose: The role that environmental heavy metal exposures play on fat metabolism and fat storage remains unclear. Although the effects of organic tin compounds have been examined in animal studies, no prior study has examined the effects of tin exposure on human body mass. In this study, we evaluated whether urinary total tin and other heavy metals are associated with body mass index (BMI) and waist circumference (WC) within a nationally-representative sample. Methods:Weconducted a cross-sectional studyof 1790 adolescents(aged6-19) and adults (aged 20-59) using the 2011-2012 cycle of the National Health and Nutrition Examination Survey (NHANES) and examined whether urinary total tin, lead, barium, cadmium, and thallium independently predict WC and BMI. Results: Preliminary results suggest that higher quartiles of urinary tin, lead, and cadmiumwere associated with lower BMI and WC (ptrend <0.05), based on multiple variable linear regression models adjusted for race, age, gender, SES, physical activity, dietary factors, and urinary creatinine. There were significant decreases inWC across the four quartiles of urinary tin exposure (beta 1⁄4 -3.26, -4.57, and -5.42 for 2nd, 3rd, and 4th quartiles, respectively; p<0.05), and similar statistically significant downward trends for lead and cadmium for both BMI and WC. Barium and thallium were not significant. Conclusions: These findings suggest exposure to certain heavymetals, such as tin, lead, and cadmium, are associated with waist circumference and body mass index. The role of heavy metals in the environment and their influence on fat metabolism and storage need further study. P28. Mortality Among OEF/OIF/OND Veterans Diagnosed with Traumatic Brain Injury (TBI) and/or Post Traumatic Stress Disorder (PTSD) Using VA Health Care System Erick Ishii PhD, MPH, Gregory Fant PhD, MSHS, Robert M. Bossarte PhD. Department of Veterans Affairs Purpose: TBI and PTSD prevalence increases in Veterans who incurred blast injuries. Little is known about the relationship between the comorbidity of TBI and PTSD in the Veteran population. Characterizing TBI and PTSD among Veterans could guide resource allocation decisions to support health service delivery within VHA. This retrospective, descriptive study characterized Veterans with TBI and/or PTSD using demographic and service attributes. Methods: Data included 326,059 records fromOperations Enduring Freedom/ Iraqi Freedom/New Dawn (OEF/OIF/OND) Veterans who separated from service between January 2002 and June 2009 and visited VHA within a year. ICD9 codes found in the inpatient and outpatient health care records placed Veterans into one of four study groups. Cause of death was extracted from the suicide data repository and categorized using the NIOSH Life Table Analysis System. Frequencies and proportions were used to describe the four study groups. Odds ratios were calculated to facilitate an initial comparison of mortality across the four study groups. Results: PTSD-only group contained higher proportions of males and females, each racial/ethnic group; Veterans ages 18-24 or 25-34; Army/Marine Corps service members. The prevalence of mortality was estimated to be 0.6% among Veterans who had neither TBI nor PTSD. The PTSD-only or TBI-PTSD groups had a greater likelihood of mortality compared to Veterans with neither condition (O.R. 1.79 [1.63-1.97], 1.75 [1.14-2.17] respectively). Conclusions: Veterans diagnosed with TBI, PTSD or PTSD/TBI decreased by age and was higher among males and specific branches of service. Increased mortality was observed among PTSD Veterans. P29. Preterm Birth and Criteria Air Pollutant Exposure in the Last Completed Week of Pregnancy e Does Maternal Asthma Play a Role? Pauline Mendola, Maeve Wallace, Rajeshwari Sundaram, Danping Liu, Katherine L. Grantz. NICHD Purpose: Air pollution may influence vascular and inflammatory pathways leading topretermbirth (PTB)<37weeks.Maternal asthmamay interactwith air pollution exposure to increase risk further. We explored the interaction of asthma and air pollutants in the lastweek of pregnancy in relation to PTB risk. Methods: Electronic medical records for 223,502 U.S. deliveries were linked with modified Community Multiscale Air Quality model outputs. Logistic regression with generalized estimating equations calculated the odds ratio (OR) and 95% confidence interval (CI) for PTB based on the interaction of maternal asthma and particulate matter <2.5 microns (PM2.5) and <10 microns (PM10), ozone, nitric oxides (NOx), sulfur dioxide (SO2) and carbon monoxide (CO) per interquartile range after adjustment for site, demographics and clinical factors. Each gestational week 23-36 was analyzed separately using a fetus-at-risk approach, comparing exposure among deliveries and ongoing pregnancies at that week. Results: Asthma exacerbated NOx, CO and SO2 associated PTB risk during weeks 34-36. Significant interactions were also found at 23, 26 and 29 weeks although deliveries were less common. Among asthmatics, PTB was elevated by PM2.5 exposure at week 26 (OR1⁄41.52, CI:1.08-2.15), 28 (OR1⁄41.43, CI:1.071.92) and 29 (OR1⁄41.38, CI:1.10-1.73). Ozone increased risk for asthmatics at 33 weeks (OR1⁄41.27, CI:1.03-1.56) but risk was lower than non-asthmatics at week 34. Inweek 36, CO (OR1⁄41.14,CI:1.04-1.26), PM10 (OR1⁄41.10, CI:1.01-1.19) and SO2 (OR1⁄41.10, CI:1.01-1.19) increased PTB among asthmatics while effects for non-asthmatics were null. Conclusions: Short-term exposure to traffic-related air pollutants appears to increase PTB risk among asthmatics. P30. Medical Visits Among Nicaraguan Sugarcane Workers: Uncommon UTI Diagnoses and Subclinical Findings Tiffany L. Stallings PhD, Ann Aschengrau ScD, Alejandro Riefkohl MD, Oriana Ramirez Rubio MD, PhD, MPH, Daniel R. Brooks DSc, MPH, Daniel Weiner MD, Juan Jose Amador MD, Damaris Lopez, James Kaufman MD, Rebecca Laws MPH, Michael Winter MPH, Katie M. Applebaum ScD, MSPH. George Washington University Purpose: Researchers have identified elevated prevalence of chronic kidney disease (CKD) in northwestern Nicaragua, often among sugarcane workers. Our prior review of sugarcane workers’ hospital charts evaluated kidney outcomes by total medical visits, while the current analysis evaluates signs and symptoms of kidney problems among individual workers. Methods: We randomly sampled a cohort of male sugar cane workers at the Ingenio San Antonio (ISA) from 1997-2010. A pilot subset (n1⁄475) was selected to test medical record linkage to the ISA Hospital. Results report proportions of workers in the pilot study with kidney-related problems. Results:Medical recordswere successfully linked for 61workers,whoaveraged 1.98 visits/year. Disorders of the kidney and urinary tract were diagnosed in 70.5% ofworkers. Although typical CKD risk factorswere uncommon (diabetes: 3.3%, hypertension: 8.2%), sevenworkers had CKD, onewithhypertensionprior to CKD. 68.9% of workers had 1 urinary tract infection (UTI) diagnosis (median: 1.5) with dysuria commonly reported (54.8%). However, among workers with UTI diagnosis, only two-thirds had any accompanying urinalysis (andnonehad urine culture). Among thosewith urinalysis, 75.0%had evidence of white blood cells, 35.7% leukocyte casts, and 53.6% crystalluria. Four of ten workers undergoing an ultrasound had reduced kidney size. Conclusions: Although UTI is commonly diagnosed in sugarcane workers, infrequent culture and non-specific dysuria and urinalysis findings may be more consistent with sterile pyuria, rather than true UTIs. Further work is needed to define the frequency of positive urine cultures and avoid possible unnecessary antibiotic use.