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"documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Med Clin. 2017;148:495-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Brief report</span>" "titulo" => "Androgen deprivation therapy in prostate cancer and risk of developing renal calculi: Results of a case–control study" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "495" "paginaFinal" => "497" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Deprivación androgénica en cáncer de próstata y riesgo de aparición de litiasis renal. Resultados de un estudio de casos y controles" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Enrique Javier Díaz Convalía, María del Carmen Cano-García, José Luis Miján-Ortiz, Miguel Arrabal-Martín, Miguel Ángel Arrabal-Polo, José Manuel Cózar-Olmo" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Enrique Javier" "apellidos" => "Díaz Convalía" ] 1 => array:2 [ "nombre" => "María del Carmen" "apellidos" => "Cano-García" ] 2 => array:2 [ "nombre" => "José Luis" "apellidos" => "Miján-Ortiz" ] 3 => array:2 [ "nombre" => "Miguel" "apellidos" => "Arrabal-Martín" ] 4 => array:2 [ "nombre" => "Miguel Ángel" "apellidos" => "Arrabal-Polo" ] 5 => array:2 [ "nombre" => "José Manuel" "apellidos" => "Cózar-Olmo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775317300921" "doi" => "10.1016/j.medcli.2017.01.021" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775317300921?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020617303431?idApp=UINPBA00004N" "url" => "/23870206/0000014800000011/v1_201706250038/S2387020617303431/v1_201706250038/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial article</span>" "titulo" => "Birth month, a simple demographic indicator of early environmental exposures and risk of chronic diseases" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "498" "paginaFinal" => "500" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "José R. Banegas" "autores" => array:1 [ 0 => array:3 [ "nombre" => "José R." "apellidos" => "Banegas" "email" => array:1 [ 0 => "joseramon.banegas@uam.es" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Departamento de Medicina Preventiva, Salud Pública y Microbiología, Universidad Autónoma de Madrid/IdiPAZ y CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Mes de nacimiento, un sencillo indicador demográfico de exposiciones ambientales tempranas y de riesgo de enfermedad crónica" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The relationship between the month of birth and the occurrence of some diseases and health problems has aroused human curiosity for many centuries. The findings in the last decades, with rigorous scientific approaches, of a higher frequency or risk of certain diseases in specific months or birth seasons are, in our opinion, one more route investigating in the early stages of life the determinants of health problems occurring in subsequent stages of life. We will try briefly to analyze in this paper whether or not this route of research allows progressing in the knowledge and if it is sensible in its practical application.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a> In other words, is it scientifically credible, useful in practice, serious and wise to report to the population that, for example, in some studies<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">2</span></a> individuals born in May have the lowest risk of disease and those born in October the highest risk?</p><p id="par0010" class="elsevierStylePara elsevierViewall">Earth rotations are primarily responsible for the circadian rhythm and the circannual rhythm, with its four seasons. In view of some obvious general similarities, in human terms, between the daily and annual cycles, it would be surprising that the same homeostatic systems would not show circannual rhythms. Thus, for example, blood pH and hematocrit, or potassium excretion and beard growth, generally spike in the late summer, while other variables tend to be higher during the winter, such as blood pressure or some stress hormones.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The frequency of births is usually higher in spring, and birth weights are usually highest in babies born in the early summer. It should be noted that the distribution of the month of birth for subjects who commit suicide is significantly different from individuals in the normal healthy population, and is more frequent in those born from April to June.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">4</span></a> This seasonality per month of birth also occurs with many other diseases and health problems. This includes various neurological, cardiovascular, reproductive, endocrine, oncological, mental, immunological/inflammatory, anthropometric and biological disorders, and in cases of longevity.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">2,4–9</span></a> Spanish studies on these relationships are limited.<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">10,11</span></a> This makes Quesada and Nolasco's study published in this issue of Clinical Medicine be particularly welcome.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Epidemiology classically assumes risk of disease over time, and chronobiology<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a> considers the temporal variability of pathophysiological mechanisms and subsequent risk of disease. For example, blood pressure varies temporarily from seconds, minutes, to 24<span class="elsevierStyleHsp" style=""></span>h (circadian) and up to one year (seasonal), depending on multiple circumstances such as intrinsic factors and extrinsic factors such as physical and mental activity, behaviors such as salt, caffeine and alcohol intake and pathological conditions.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">13</span></a> The study of these rhythms may shed light on the underlying biological phenomena. In a study of our group it was found that the most significant differences in systolic blood pressure in adults occur shortly before the months of birth with highest difference in sunlight.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a> This is compatible, but does not prove the hypothesis of sunlight mediation 1–3 months after birth. In the early postneonatal period, daily and seasonal variations of blood pressure might begin in progressive synchronization with the environment. We postulate, therefore, the season or month of birth as an early indicator of adult blood pressure, and sunlight as an underlying reasonable candidate acting at a critical period in early postneonatal life. Since this relationship does not depend on the seasonal variations of blood pressure throughout life (when studying the pressure of all subjects in the same season), we proposed a mechanism of photoprogramming blood pressure during perinatal period (pressure programming, mediated by light acting on the biological clock, in the perinatal period). However, as in other health problems, there may be some other alternative or complementary explanations such as temperature, early nutrition, birth weight, or long-term determinants of blood pressure (age, body mass, socioeconomic level). Another example is the association between coronary arteriosclerosis and late winter and early spring months of birth, which led to suggest mother's poor vitamin D intake and influenza infection as producer mechanisms.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">14</span></a> This latter study is part of the so-called Season-wide Association Study (SeaWAS), a hypothesis-free, computer-based method that uses large clinical databases to systematically study month-of-birth associations with many chronic diseases, with seasonal components related to early development, and which may indicate underlying biological mechanisms.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">2,14</span></a> These new methods of high-performance SeaWAS disease identification linked to prenatal environmental factors might be combined in the future with phenome-wide (PheWAS) and genome-wide (GWAS) studies of genetic factors underlying early seasonal effects, to better understanding the underlying biology of the disease.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">2,15</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">There are several early and late environmental factors and genetic factors that promote the development and persistence of many chronic morbid conditions.<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">5,16</span></a> One of the early environmental determinants is malnutrition during gestation and childhood (“critical periods”), a major factor,<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">5,16</span></a> being Mao's Chinese famine<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">17</span></a> a terrible but clarifying paradigm. However, further research is required to identify specific components of the mother's and child's diet, and additional environmental and socioeconomic external factors,<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">5,11,16</span></a> and the combined effects of early and adult determinants.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Most of the relatively numerous previous studies on the relationship between the seasonal characteristics of birth and various health problems have been focused on specific diseases.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">4–8,10,11</span></a> Unlike these studies, the study by Quesada and Nolasco<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a> addresses a wide range of common and varied chronic diseases, a total of 27, with the disadvantage of not being able to go deeper into the alleged underlying factors and mechanisms of so many and diverse entities. These authors have reported a significant association between the month of birth and the risk of having various diseases and chronic health problems using data from the National Health Survey of Spain, a large health interview survey (29,478 adults aged over 16 years of age) and standardized methodology for the year 2006. It is particularly interesting that the risk of prevalence of “global chronicity” (having suffered from any of the 27 chronic diseases studied) was only statistically significant in males, with a lower risk in the months of April and September. This differential by sex has also been reported in other studies,<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">18</span></a> indicating a different vulnerability between both sexes to early environmental factors. On the other hand, the use of a demanding p-value of 0.01 in this study eases the problem of the many statistical comparisons performed. Finally, this study adjusted the relationship studied by important potential confounders, such as age, body mass index, smoking, physical activity, sleep and place of residence, but did not consider other relevant confounders such as alcohol, dietary factors or socioeconomic level. This study has used data from the 2006 Spanish National Health Survey. A wide range of similar surveys have been available for over 30 years. Therefore, a temporal trend might be traced to analyze replication and consistency in the analyses performed and to delve into the potential determinants here mentioned.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Although there are necessarily inconsistencies in the findings between the various studies, in part because seasonal factors may vary in different geographical areas, there may also be methodological differences. For example, while in the study by Quesada and Nolasco no significant differences were reported in high blood pressure per month of birth in males, in a previous study they were reported, with lower blood pressure in adults born in spring and summer.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a> In the latter study, blood pressure was measured, whereas in the former study, hypertension was self-reported. In addition, in this study<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a> adult height was adjusted as a proxy for early socioeconomic status. In all these studies, the relationships detected can only suggest, but not corroborate causality. Actually, since the month of birth is a fixed characteristic, temporary nature is guaranteed as a necessary requirement of causality. However, the associations found may be due to many circumstances. Therefore, the variable “month of birth” is only intended to indicate underlying factors and mechanisms of disease production, which is already quite important. Ultimately, the month of birth acts as a risk indicator or marker that allows identifying groups with higher (or lower) risk of disease and allows to propose potential determinants susceptible of more investigation and, perhaps, preventive action. Furthermore, even if other circumstances other than the month of birth fit, this would be a vague indicator of disease, since it only denotes an unspecified and varied complex of early influences of disease, which have to be studied separately.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The month of birth is obviously not a modifying feature and, although it may be “eligible” by the “parents”, this would probably not meet their expectations. There are several reasons that in our opinion support that this indicator should be used only as a gateway to deeper research. As noted above, the month of birth is only an inaccurate risk indicator. It summarizes information on an unspecified set of early exposures causing or not disease. It is not modifiable after birth, but it can point to routed of progress in understanding early factors influencing the development of a disease years later. In addition, a particularly interesting application of the study discussed<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a> is that it indicates that the month of birth, a simple demographic indicator of seasonally varying perinatal environmental exposures and risk of chronic disease, might be used as a potential confounder in more specific etiological studies on many chronic diseases. By adjusting for the month of birth we would be partially controlling an unspecified set of early environmental factors associated with these chronic diseases.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The studies discussed raise some implications in the communication to citizens. News about diseases and phenomena related to the month of birth that were not well explained in the media might lead to believe that it is almost astrological speculation. Even if the evidence of the relationships between birth month and disease is taken seriously (the studies are usually rigorous, although the strength of evidence is usually only moderate), the lay users of this information should be cautious and reassured. Nothing can be done to change the month of birth and we should not worry about whether we were born in months with a higher tendency to certain disorders (e.g., October), or in others where health is “falsely” guaranteed (e.g., May). In almost every month there are risk differences in some disease, and there are months at risk for some disorders and protected against others. Reproductive calendars do not appear to be reasonable either: it simply is not necessary. The influence of life behaviors on health (smoking, alcohol, diet, physical exercise) and biological factors (blood pressure, obesity or cholesterol) is much more significant than the month of birth.<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">19,20</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In short, having a genetic predisposition to a disease or being born in an “unhealthy” month is not so important: the future of health is open and is, to some extent modifiable through action on environmental factors. What does seem important is to deepen in understanding the complex and varied causes and mechanisms of disease, to which the demographic data “month of birth” might be very helpful.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0055" class="elsevierStylePara elsevierViewall">This work has received FIS PI13/02321 and PI16/01460 grants (Carlos III Health Institute and FEDER/FSE).</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Banegas JR. Mes de nacimiento, un sencillo indicador demográfico de exposiciones ambientales tempranas y de riesgo de enfermedad crónica. Med Clin (Barc). 2017;148:498–500.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:20 [ 0 => array:3 [ "identificador" => "bib0105" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Relación entre el mes de nacimiento y la prevalencia de enfermedades crónicas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.A. Quesada" 1 => "A. 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Journal Information
Vol. 148. Issue 11.
Pages 498-500 (June 2017)
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Vol. 148. Issue 11.
Pages 498-500 (June 2017)
Editorial article
Birth month, a simple demographic indicator of early environmental exposures and risk of chronic diseases
Mes de nacimiento, un sencillo indicador demográfico de exposiciones ambientales tempranas y de riesgo de enfermedad crónica
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José R. Banegas
Departamento de Medicina Preventiva, Salud Pública y Microbiología, Universidad Autónoma de Madrid/IdiPAZ y CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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