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Healthy dietary patterns are associated with exposure to environmental chemicals in a pregnancy cohort

Healthy dietary patterns are associated with exposure to environmental chemicals in a pregnancy cohort

In this large multi-racial pregnancy cohort in the United States, we observed that greater adherence to aMED, aHEI and DASH in peri-conception and early pregnancy was significantly associated with higher levels of plasma chemical concentrations. The associations were most pronounced for aMED and aHEI with PCBs and PFASs and appeared driven mainly by the associations with fish, EPA + DHA, the MUFA:SFA ratio and vegetables. These associations were more pronounced in the Asian and Pacific Islander population. Given that the World Health Organization and the Food and Agricultural Organization of the United Nations both recommend the consumption of a combination of healthy foods rather than single foods to avoid over-nutrition or nutritional deficiency9, findings from this study provide a more holistic portrayal of the interplay between diet and chemicals coming from diet.

Our study systematically examined the associations between dietary patterns and concentrations of diverse chemicals in a large sample of women. Our findings provide a significant clue for future investigations into the joint impacts of these factors on pregnancy and foetal outcomes. Only one previous study examined such associations, albeit using umbilical cord blood10. Studies among non-pregnant individuals are sparse, too, with only two studies identified and inconsistent associations reported11,12. Inferences from these studies were limited by their relatively small sample size, measured chemical classes, absence of food groups/nutrients and diet variations by regions and populations. The present study examined multiple purportedly healthy dietary patterns and diverse classes of chemicals comprehensively, which can facilitate the identification of toxic chemicals associated with healthy dietary patterns, shedding light on the previously overlooked aspect of single pattern or chemical class in similar investigations.

Seafood and aquatic products may have driven the associations of aMED and aHEI with PFASs and PCBs as the calculation of dietary pattern scores include fish and EPA + DHA (supplemental use was not included) for aMED and aHEI, respectively. The majority of EPA + DHA comes from fish and other seafood consumption. Fish consumption is one of the major sources of exposure to PFAS and PCB in humans among diverse populations of different ages13,14. Besides, inverse associations of aHEI, fish and EPA + DHA with the precursor NMeFOSAA suggest that the transformation reactions may have occurred already. While specific PFAS control standards for human blood have not been established, the US Environmental Protection Agency is consistently lowering environmental limits for PFAS exposures from food sources due to a growing body of evidence indicating their potential metabolic and reproductive toxicity, even at low dose15. Similarly, PCB concentrations in marine fish are generally higher than in other foods. Despite that most of the PCBs have been phased out for many years, people are still at risk of exposure due to historical emission and multi-media transportation16.

Even though fish is generally regarded as healthy food, it also carries specific heavy metals such as As and Hg owing to their bioaccumulation along the food chain17. Women with high aHEI scores in our study have comparable metal concentrations to participants of the National Health and Nutrition Examination Survey (NHANES) conducted in the same study period (2009–2012)18. Despite the low detection rates of toxic heavy metals in our present study, the extrapolation to the broader population suggests a potential public health threat and that raising the awareness of heavy metal contamination for healthy food in the general public is needed. Similarly, associations between OCPs and vegetable, whole fruit and the MUFA:SFA ratio in this study have shown that, even though some OCPs have been phased out, the US population is still at risk due to their historical release or transportation globally through various environmental media. Consistent associations were found in European and Asian populations14,19, suggesting a potentially worldwide threat to food safety.

The more pronounced associations among Asians and Pacific Islanders may be due to higher consumption of fish and EPA + DHA among the Asian and Pacific Islander ethnic groups than other races and ethnicities16. Thus, the health benefits of a given healthy dietary pattern may vary across ethnic groups, and population-specific targeted dietary guidance that considers the burden from potential pollutant exposure is needed to optimize health interventions.

This study is distinguished by several notable strengths. First, this study examined the association of three of the most widely recommended dietary patterns with a comprehensive profile of environmental chemicals in a relatively large multi-racial population. Second, we used a well-validated food frequency questionnaire (FFQ) to capture long-term habitual dietary patterns, and detailed information on covariates was assessed to control potential confounders. Third, we examined the associations of healthy dietary patterns with multiple chemicals simultaneously and further examined the associated drivers of food groups and nutrients.

Several potential limitations merit consideration. First, as with the nature of other observational studies, we cannot completely rule out the possibility of impacts from unmeasured confounders such as variables related to air and water sources of chemicals and chemical accumulation across organs. Second, given that our study was conducted on multi-racial cohort, it is possible that FFQ may not capture all the commonly consumed foods in each race and ethnicity group. It would be optimal to develop and apply race- and ethnicity-specific FFQ to assess habitual dietary patterns. Third, it is noteworthy that our population was exposed to relatively low chemical levels compared with other populations at the same period. Thus, caution should be exercised when extrapolating our findings. Though the effect size of associations was modest, considering the long-term and gradual accumulation of chemicals from diet over years, it underscores the significance of considering the combined impact of chemicals and dietary patterns on human health, particularly for countries where pollution levels are rising.

In conclusion, we observed that greater adherence to healthy dietary patterns was associated with higher chemical exposure, especially aMED and aHEI dietary patterns with PCBs and PFASs. The associations were probably driven by the consumption of fish and related ingredients and appeared to be more pronounced among Asian and Pacific Islanders. Strengthening the regulation and supervision of chemicals in fish (PCBs and PFASs) and vegetables (OCPs) is critical, especially for unregulated seafood markets, coastal dwellers and farmers. Collective efforts from both government and society along with unified worldwide regulatory efforts are pivotal in mitigating exposure to hazardous chemicals, particularly for vulnerable populations such as pregnant women. Findings from the present study suggest that future studies characterizing healthy diets should consider both healthy food and nutrient components and related chemical exposure to better optimize the health benefits of healthy diets.

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