Andrea L Deierlein

Andrea L. Deierlein

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Director of Public Health Nutrition

Associate Professor of Public Health Nutrition

Dr. Andrea Deierlein’s research focuses on examining how dietary, behavioral, and
environmental factors contribute to reproductive health outcomes and chronic-disease
development throughout the lifespan.

Dr. Deierlein is trained as a nutritional epidemiologist. Much of her research has
examined predictors and outcomes of maternal metabolic health-related conditions during
pregnancy and the postpartum, specifically, excessive gestational weight gain,
hyperglycemia, and obesity. She contributed to a systematic evidence-based review
examining outcomes of weight gain during pregnancy at the Agency of Healthcare
Research and Quality. This review informed the development of the 2009 Institute of
Medicine Gestational Weight Gain Guidelines. Dr. Deierlein received the K99/R00
Pathway to Independence Award to expand her training to include the study of toxic
environmental chemicals and metals. She conducted research examining associations of
endocrine-disrupting toxicant exposures during childhood and changes in anthropometric
measurements through adolescence among girls. She also conducted a series of analyses
examining maternal prenatal exposures to phthalates with weight gain and biomarkers of
cardiometabolic health in women during pregnancy and throughout the postpartum.
Recently, Dr. Deierlein has expanded her research to include disability-related disparities
in nutrition and reproductive health.

Education

BS, Animal Science, Cornell University, Ithaca, NY

MS, Health Nutrition, Columbia University, New York, NY

MPH, Epidemiology, Columbia University, New York, NY

PhD, Nutrition Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC

Honors and awards

Travel Scholarship, Be Our Voice Childhood Obesity Prevention Advocacy Training, Robert Wood Johnson Foundation (2013)

New York Academy of Sciences Education Fellowship (2012)

Postdoctoral Fellowship in Pediatric Environmental Health, Icahn School of Medicine at Mount Sinai (2010)

Travel Scholarship, Researching Women’s Environmental Health: Food, Nutrition, and Obesity, University of Rochester Medical Center (2010)

Travel Scholarship, Childhood Obesity Symposium, University of Southern California (2010)

Areas of research and study

Environmental Public Health Services

Epidemiology

Maternal and Child Health

Nutrition

Women's Health

Publications

Preconception Health and Disability Status Among Women of Reproductive Age Participating in the National Health and Nutrition Examination Surveys, 2013-2018

Deierlein, A. L., Litvak, J., & Stein, C. R. (n.d.).

Publication year

2022

Journal title

Journal of Women's Health

Volume

Issue

Page(s)

1320-1333

10.1089/jwh.2021.0420

Abstract

Abstract

Background: Preconception health is a critical determinant of health outcomes for women and their offspring. Given higher rates of prenatal and postpartum complications among women with disabilities, it is important to investigate a range of preconception health indicators in this population. Materials and Methods: Data were from women of reproductive age (18-44 years) who participated in the National Health and Nutrition Examination Surveys, 2013-2018. Disability was self-reported as serious difficulty hearing, seeing, concentrating, walking, dressing, and/or running errands due to physical, mental, or emotional conditions. Preconception health indicators were adapted from those developed by the Core State Preconception Health Indicators Working Group. Multivariable Poisson regression estimated adjusted prevalence ratios (aPRs) and 95% confidence intervals of preconception health indicators among women with disabilities compared with those without disabilities. Results: Of 4055 women, 601 (15%, weighted) reported having any disabilities, and of these women, 220 (6%) reported having 2 or more types of disabilities. Women with any disabilities were more likely to have suboptimal preconception health indicators compared with women without disabilities, including low education and household income, no recent dental visit, difficulty getting pregnant, current smoking, binge drinking, drug use, obesity, no multivitamin use, physical inactivity, long sleep durations, asthma, hypertension, and sexually transmitted infections (aPRs from 1.1 to 2.0). The greatest disparities between women with and without disabilities were for indicators of self-rated poor or fair general health, depression, and diabetes, with aPRs ranging from 2.4 to 3.8. Conclusions: Disparities in preconception health indicators are modifiable and may be addressed through adequate access to health care, interventions targeting lifestyle and health behaviors, and education and training for all health practitioners.

Predictors of gestational weight gain in a low-income hispanic population : Sociodemographic characteristics, health behaviors, and psychosocial stressors

Dolin, C. D., Gross, R. S., Deierlein, A. L., Berube, L. T., Katzow, M., Yaghoubian, Y., Brubaker, S. G., & Messito, M. J. (n.d.).

Publication year

2020

Journal title

International journal of environmental research and public health

Volume

Issue

10.3390/ijerph17010352

Abstract

Abstract

Hispanic women have a higher prevalence of weight associated complications in pregnancy. This ethnic disparity is likely related to behavior patterns, social circumstances, environmental exposures, and access to healthcare, rather than biologic differences. The objective was to determine associations between sociodemographic characteristics, health behaviors, and psychosocial stressors and gestational weight gain (GWG) in low-income Hispanic women. During pregnancy, information on sociodemographic characteristics, health behaviors, and psychosocial stressors were collected. Linear regression estimated mean differences in GWG by selected predictors. Multinomial logistic regression estimated odds of inadequate and excessive GWG by selected predictors. Five-hundred and eight women were included, 38% had inadequate and 28% had excessive GWG; 57% with a normal pre-pregnancy BMI had inadequate GWG. Compared to women with normal BMI, women with overweight or obesity were more likely to have excessive GWG (aRRR = 1.88, 95% CI: 1.04, 3.40 and aRRR = 1.98, 95% CI: 1.08, 3.62, respectively). Mean total GWG was higher among women who were nulliparous (ß = 1.34 kg, 95% CI: 0.38, 2.29) and those who engaged in ≥3 h of screen time daily (ß = 0.98 kg, 95% CI: 0.02, 1.94), and lower among women who were physically active during pregnancy (ß = −1.00 kg, 95% CI: −1.99, −0.03). Eating breakfast daily was associated with lower risk of inadequate GWG (aRRR = 0.47, 95% CI: 0.26, 0.83). Depressive symptoms and poor adherence to dietary recommendations were prevalent, but none of the psychosocial or dietary variables were associated with GWG. In this cohort of primarily immigrant, low-income, Hispanic women, there were high rates of poor adherence to diet and physical activity recommendations, and a majority of women did not meet GWG guidelines. Modifiable health behaviors were associated with GWG, and their promotion should be included in prenatal care.

Pregnancy-related outcomes among women with physical disabilities : A systematic review

Deierlein, A. L., Antoniak, K., Chan, M., Sassano, C., & Stein, C. R. (n.d.).

Publication year

2021

Journal title

Paediatric and Perinatal Epidemiology

Volume

Issue

Page(s)

758-778

10.1111/ppe.12781

Abstract

Abstract

Background: Disability among women of reproductive age is common; many of these women desire children and do not have impaired fertility. Objectives: To examine the epidemiological literature on perinatal health outcomes among women with physical disabilities. Data sources: We searched Medline and CINAHL for articles published January 2009–April 2020 following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Study selection and data extraction: Eligible studies were observational, quantitative, and reported on physical disabilities in association with prenatal, perinatal, postpartum, and/or infant health outcomes. We included studies that grouped physical and non-physical disabilities, such as surveys that queried only about general daily life limitations. We excluded case reports, descriptive studies without comparison groups, and studies conducted in low- or middle-income countries. Data extraction was done using predefined data fields. Synthesis: All authors were involved in screening activities, data extraction, and/or quality assessment (rating and areas for bias). Results: A total of 2650 articles were evaluated, of which sixteen met inclusion criteria (8 cross-sectional studies and 8 retrospective cohort studies). Assessments of disability status and perinatal outcomes widely varied across studies. Studies were rated as poor (n = 8) or fair quality (n = 8). Findings suggested that women with physical disabilities were at risk of several adverse outcomes, including caesarean delivery, infections, preterm complications, and maternal post-delivery hospitalisations, while their infants may be at risk of low birthweight and small-for-gestational age. Women classified as having complex/severe disabilities were often observed to be at higher risk of adverse outcomes compared to women with less severe disabilities. Conclusions: Research assessing how physical, functional, and medical restrictions influence health outcomes among women with physical disabilities, from preconception through postpartum, is limited. Longitudinal studies with comprehensive data collection that accurately identify women with physical disabilities are critical to understanding their reproductive health risks and outcomes.

Prenatal dietary exposures and offspring body size from 6 months to 18 years : A systematic review

Litvak, J., Parekh, N., & Deierlein, A. L. (n.d.).

Publication year

2020

Journal title

Paediatric and Perinatal Epidemiology

Volume

Issue

Page(s)

171-189

10.1111/ppe.12629

Abstract

Abstract

Background: In utero dietary exposures may influence childhood obesity. Objectives: To evaluate the relationship between prenatal dietary exposures and offspring body size from 6 months to 18 years. Data sources: Articles were identified in PubMed and Web of Science (January 2010-March 2018) using the PRISMA guidelines. Additional studies were identified through a reference review of articles that met the inclusion criteria and related reviews. Study selection: Prospective cohort studies that assessed dietary patterns, foods, macronutrients, or beverages during healthy pregnancy and offspring body size. The extraction of articles was done using predefined data fields. Synthesis: One author extracted all information and evaluated bias with the NHLBI's Quality Assessment Tool. Results: A total of 851 research articles were evaluated. Twenty-one studies assessing dietary patterns, macronutrients, foods, and beverages met inclusion criteria. Consumption of a Mediterranean dietary pattern during pregnancy was associated with reduced body size, while refined carbohydrates were associated with offspring obesity. No association was observed between data-driven dietary patterns and offspring body size, as well as a pro-inflammatory diet pattern and offspring body size. Mixed and null findings were observed for the relationship between total carbohydrates, n-3 polyunsaturated fatty acids, protein, sugar-sweetened beverages, and artificially sweetened beverages and offspring body size. Conclusions: Adhering to a Mediterranean diet and limiting refined carbohydrates during pregnancy may influence offspring body size between 6 months and 18 years. The diverging results that exist between studies highlight the complexity of this topic.

Prenatal Dietary Patterns and Associations With Weight-Related Pregnancy Outcomes in Hispanic Women With Low Incomes

Berube, L. T., Deierlein, A. L., Woolf, K., Messito, M. J., & Gross, R. S. (n.d.).

Publication year

2023

Journal title

Childhood Obesity

10.1089/chi.2022.0227

Abstract

Abstract

Background: Dietary patterns during pregnancy may contribute to gestational weight gain (GWG) and birthweight, but there is limited research studying these associations in racial and ethnic minority groups. The objective of this study was to evaluate associations between prenatal dietary patterns and measures of GWG and birthweight in a cohort of culturally diverse Hispanic women with low incomes. Methods: Data were analyzed from 500 mother-infant dyads enrolled in the Starting Early Program, a childhood obesity prevention trial. Diet over the previous year was assessed in the third trimester of pregnancy using an interviewer-administered food frequency questionnaire. Dietary patterns were constructed using the Healthy Eating Index-2015 (HEI-2015) and principal components analysis (PCA) and analyzed as tertiles. GWG and birthweight outcomes were abstracted from medical records. Associations between dietary pattern tertiles and outcomes were assessed by multivariable linear and multinomial logistic regression analyses. Results: Dietary patterns were not associated with measures of GWG or adequacy for gestational age. Greater adherence to the HEI-2015 and a PCA-derived dietary pattern characterized by nutrient-dense foods were associated with higher birthweight z-scores [β: 0.2; 95% confidence interval (CI): 0.04 to 0.4 and β: 0.3; 95% CI: 0.1 to 0.5, respectively], but in sex-specific analyses, these associations were only evident in male infants (β: 0.4; 95% CI: 0.03 to 0.7 and β: 0.3; 95% CI: 0.03 to 0.6, respectively). Conclusions: Among a cohort of culturally diverse Hispanic women, adherence to healthy dietary patterns during pregnancy was modestly positively associated with increased birthweight, with sex-specific associations evident only in male infants.

Prenatal maternal phthalate exposures and child lipid and adipokine levels at age six : A study from the PROGRESS cohort of Mexico City

Kupsco, A., Wu, H., Calafat, A. M., Kioumourtzoglou, M. A., Tamayo-Ortiz, M., Pantic, I., Cantoral, A., Tolentino, M., Oken, E., Braun, J. M., Deierlein, A. L., Wright, R. O., Téllez-Rojo, M. M., Baccarelli, A. A., & Just, A. C. (n.d.).

Publication year

2021

Journal title

Environmental Research

Volume

192

10.1016/j.envres.2020.110341

Abstract

Abstract

Background: Prenatal phthalate exposures may affect processes that underlie offspring cardiometabolic health, but findings from studies examining these associations are conflicting. We examined associations between biomarkers of phthalate exposures during pregnancy with child lipid and adipokine levels. Methods: Data were from 463 mother-child pairs in the PROGRESS cohort of Mexico City. We quantified 15 phthalate metabolites in 2nd and 3rd trimester maternal urine samples and created an average pregnancy measure using the geometric mean. We evaluated the 15 metabolites as nine biomarkers, including four metabolite molar sums. We measured fasting serum triglycerides, non-HDL cholesterol, leptin, and adiponectin in children at the six-year follow-up visit (mean = 6.8 years). We estimated associations using linear regression, Bayesian kernel machine regression (BKMR), and weighted quantile sum (WQS) and assessed effect modification by sex. Results: In BKMR and WQS models, higher concentrations of the total mixture of phthalate biomarkers were associated with lower triglycerides (β = −3.7% [-6.5, −0.78] per 1 unit increase in WQS biomarker index) and non-HDL cholesterol (β = −2.0 [-3.7, −0.25] ng/ml per increase in WQS biomarker index). Associations between individual biomarkers and child outcomes were largely null. We observed some evidence of effect modification by child sex for mono-3-carboxypropyl phthalate (β = 19.4% [1.26, 40.7] per doubling of phthalate) and monobenzyl phthalate (β = −7.6% [-14.4, -0.23]) in girls for adiponectin. Conclusions: Individual prenatal phthalate biomarkers were not associated with child lipid or adipokine levels. Contrary to our hypothesis, the total phthalate mixture was associated with lower child triglycerides and non-HDL cholesterol.

Prenatal maternal phthalate exposures and trajectories of childhood adiposity from four to twelve years

Kupsco, A., Wu, H., Calafat, A. M., Kioumourtzoglou, M. A., Cantoral, A., Tamayo-Ortiz, M., Pantic, I., Pizano-Zárate, M. L., Oken, E., Braun, J. M., Deierlein, A. L., Wright, R. O., Téllez-Rojo, M. M., Baccarelli, A. A., & Just, A. C. (n.d.).

Publication year

2022

Journal title

Environmental Research

Volume

204

10.1016/j.envres.2021.112111

Abstract

Abstract

Background/Aim: Adiposity trajectories reflect dynamic process of growth and may predict later life health better than individual measures. Prenatal phthalate exposures may program later childhood adiposity, but findings from studies examining these associations are conflicting. We investigated associations between phthalate biomarker concentrations during pregnancy with child adiposity trajectories. Methods: We followed 514 mother-child pairs from the Mexico City PROGRESS cohort from pregnancy through twelve years. We measured concentrations of nine phthalate biomarkers in 2nd and 3rd trimester maternal urine samples to create a pregnancy average using the geometric mean. We measured child BMI z-score, fat mass index (FMI), and waist-to-height ratio (WHtR) at three study visits between four and 12 years of age. We identified adiposity trajectories using multivariate latent class growth modeling, considering BMI z-score, FMI, and WHtR as joint indicators of latent adiposity. We estimated associations of phthalates biomarkers with class membership using multinomial logistic regression. We used quantile g-computation to estimate the potential effect of the total phthalate mixture and assessed effect modification by sex. Results: We identified three trajectories of child adiposity, a “low-stable”, a “low-high”, and a “high-high” group. A doubling of the sum of di (2-ethylhexyl) phthalate metabolites (ΣDEHP), was associated with 1.53 (1.08, 2.19) greater odds of being in the “high-high” trajectory in comparison to the “low-stable” group, whereas a doubling in di-isononyl phthalate metabolites (ΣDiNP) was associated with 1.43 (1.02, 2.02) greater odds of being in the “low-high” trajectory and mono (carboxy-isononyl) phthalate (MCNP) was associated with 0.66 (0.45, 97) lower odds of being in the “low-high” trajectory. No sex-specific associations or mixture associations were observed. Conclusions: Prenatal concentrations of urinary DEHP metabolites, DiNP metabolites, and MCNP, a di-isodecyl phthalate metabolite, were associated with trajectories of child adiposity. The total phthalate mixture was not associated with early life child adiposity.

Prenatal phthalates, gestational weight gain, and long-term weight changes among Mexican women

Deierlein, A. L., Wu, H., Just, A. C., Kupsco, A. J., Braun, J. M., Oken, E., Soria-Contreras, D. C., Cantoral, A., Pizano, M. L., McRae, N., Téllez-Rojo, M. M., Wright, R. O., & Baccarelli, A. A. (n.d.).

Publication year

2022

Journal title

Environmental Research

Volume

209

10.1016/j.envres.2022.112835

Abstract

Abstract

Background: Phthalates are endocrine disrupting chemicals that may influence weight status; however, few studies have considered weight gain during pregnancy and subsequent long-term weight changes in women. Objective: To determine associations of prenatal phthalate exposure with maternal weight during pregnancy and through up to seven years post-delivery. Methods: We analyzed 15 urinary phthalate biomarker concentrations during the 2nd and 3rd trimesters among 874 pregnant women enrolled in the Programming Research in Obesity, Growth Environment and Social Stress Study in Mexico City. We examined three time-specific maternal weight outcomes: gestational weight gain (between 2nd and 3rd trimesters), short-term weight (between 3rd trimester and 12 months post-delivery), and long-term weight (between 18 months and 6–7 years post-delivery). We used Bayesian Kernel Machine Regression (BKMR) to estimate associations for the total phthalate mixture, as well as multivariable linear mixed models for individual phthalate biomarkers. Results: As a mixture, 2nd trimester urinary phthalate biomarker concentrations were associated with somewhat lower gestational weight gain between the 2nd and 3rd trimesters (interquartile range, IQR, difference: −0.07 standard deviations, SD; 95% credible interval, CrI: −0.20, 0.06); multivariable regression and BKMR models indicated that this inverse association was primarily driven by mono-2-ethyl-5-carboxypentyl terephthalate (MECPTP). Prenatal (2nd and 3rd trimesters) urinary phthalate mixture concentrations were positively associated with maternal weight change through 12 months postpartum (IQR difference: 0.11 SD; 95% CrI: 0.00, 0.23); these associations persisted from 18 months to 6–7 years follow-up (IQR difference: 0.07 SD; 95% CrI: 0.04, 0.10). Postpartum weight changes were associated with mono-3-carboxypropyl phthalate (MCPP) and MECPTP. Conclusions: Prenatal phthalate exposure was inversely associated with gestational weight gain and positively associated with long-term changes in maternal weight. Further investigation is required to understand how phthalates may influence body composition and whether they contribute to the development of obesity and other cardiometabolic diseases in women.

Prenatal urinary concentrations of phthalate metabolites and behavioral problems in Mexican children : The Programming Research in Obesity, Growth Environment and Social Stress (PROGRESS) study

Colicino, E., de Water, E., Just, A. C., Navarro, E., Pedretti, N. F., McRae, N., Braun, J. M., Schnaas, L., Rodríguez-Carmona, Y., Hernández, C., Tamayo-Ortiz, M., Téllez-Rojo, M. M., Deierlein, A. L., Calafat, A. M., Baccarelli, A., Wright, R. O., & Horton, M. K. (n.d.).

Publication year

2021

Journal title

Environmental Research

Volume

201

10.1016/j.envres.2021.111338

Abstract

Abstract

Background: Phthalate exposure has been associated with increased childhood behavioral problems. Existing studies failed to include phthalate replacements and did not account for high correlations among phthalates. Phthalates’ exposure is higher in Mexico than in U.S. locations, making it an ideal target population for this study. Aim: To examine associations between 15 maternal prenatal phthalate metabolite concentrations and children's behavioral problems. Methods: We quantified phthalate metabolites in maternal urine samples from maternal-child dyads (n = 514) enrolled in the Programming Research in Obesity, Growth Environment and Social Stress (PROGRESS) birth cohort in Mexico City. We performed least absolute shrinkage and selection operator (LASSO) regressions to identify associations between specific-gravity adjusted log2-transformed phthalate metabolites and parent-reported 4–6 year old behavior on the Behavior Assessment System for Children (BASC-2), accounting for metabolite correlations. We adjusted for socio-demographic and birth-related factors, and examined associations stratified by sex. Results: Higher prenatal mono-2-ethyl-5-carboxypentyl terephthalate (MECPTP) urinary concentrations were associated with increased hyperactivity scores in the overall sample (β = 0.57, 95% CI = 0.17, 1.13) and in girls (β = 0.54, 95% CI = 0.16, 1.08), overall behavioral problems in boys (β = 0.58, 95% CI = 0.20, 1.15), and depression scores in boys (β = 0.44, 95% CI = 0.06, 0.88). Higher prenatal monobenzyl phthalate (MBzP) concentrations were associated with reduced hyperactivity scores in girls (ß = −0.54, 95% CI = −1.08, −0.21). Discussion: Our findings suggested that prenatal concentrations of phthalates and their replacements altered child neurodevelopment and those associations may be influenced sex.

Prevalence of meats offered during meals at New York city schools

Borkowski, S., Rubenstein, W., Galvez, M., & Deierlein, A. L. (n.d.).

Publication year

2020

Journal title

Health Behavior and Policy Review

Volume

Issue

Page(s)

146-153

10.14485/HBPR.7.2.7

Abstract

Abstract

Objective: We examined types and frequency of meats and meat alternatives offered to children attending New York City public and private elementary and middle schools. Methods: Weekly public and private school breakfast and lunch menus were collected 3 times from each school during the 2018-2019 academic year. Menu options were reviewed and categorized as containing processed meat, unprocessed red meat, unprocessed poultry, breaded/fried poultry, fish, and meat alternatives. Results: Public school hot breakfast menus offered 2.0 options per week of processed meats and lunch menus offered an average of 4.0, 1.3, 1.7, and 2.0 options per week of processed, red, unprocessed poultry, and breaded poultry meats, respectively. Private school lunch menus offered an average of 1.0, 1.5, 2.1, and 0.4 options per week of processed, red, unprocessed poultry, and breaded poultry meats, respectively. The majority of private schools, 75% of those serving grades K-5 and 64% of those serving grades 6-8, offered a daily salad bar and/or sandwich bar with processed meats. Conclusions: The school food environment influences and contributes to children’s dietary intakes. We suggest removing processed meats from meals, reducing red meat-based meals, increasing vegetable-and grain-based alternatives in recipes, and instituting meatless meal days.

Processing level and diet quality of the US grocery cart : Is there an association?

Juul, F. C., Simões, B. D., Litvak, J., Martinez-Steele, E., Deierlein, A. L., Vadiveloo, M., & Parekh, N. (n.d.).

Publication year

2019

Journal title

Public Health Nutrition

Volume

Issue

Page(s)

2357-2366

10.1017/S1368980019001344

Abstract

Abstract

Objective: The majority of groceries purchased by US households are industrially processed, yet it is unclear how processing level influences diet quality. We sought to determine if processing level is associated with diet quality of grocery purchases. Design: We analysed grocery purchasing data from the National Household Food Acquisition and Purchase Survey 2012-2013. Household grocery purchases were categorized by the NOVA framework as minimally processed, processed culinary ingredients, processed foods or ultra-processed foods. The energy share of each processing level (percentage of energy; %E) and Healthy Eating Index-2015 (HEI-2015) component and total scores were calculated for each household's purchases. The association between %E from processed foods and ultra-processed foods, respectively, and HEI-2015 total score was determined by multivariable linear regression. Foods purchased by households with the highest v. lowest ultra-processed food purchases and HEI-2015 total score

Sociodemographic, perinatal, behavioral, and psychosocial predictors of weight retention at 3 and 12 months postpartum

Siega-Riz, A. M., Herring, A. H., Carrier, K., Evenson, K. R., Dole, N., & Deierlein, A. L. (n.d.).

Publication year

2010

Journal title

Obesity

Volume

Issue

Page(s)

1996-2003

10.1038/oby.2009.458

Abstract

Abstract

Postpartum weight retention plays an important role in the pathway leading to obesity among women of childbearing age. The objective of this study was to examine predictors of moderate (1-10 pounds) and high (>10 pounds) postpartum weight retention using data from a prospective pregnancy cohort that followed women into the postpartum period; n = 688 and 550 women at 3 and 12 months, respectively. Analysis included descriptive statistics and predictive modeling using log-binomial techniques. The average weight retained at 3 and 12 months postpartum in this population was 9.4lb (s.d. = 11.4) and 5.7lb (s.d. = 13.2), respectively. At 3 months postpartum, prepregnancy weight, gestational weight gain, and hours slept during the night were associated with moderate or high weight retention, whereas having an infant hospitalized after going home and scoring in the upper 75th percentile of the Eating Attitudes Test (EAT) were associated only with high weight retention. At 12 months postpartum, prepregnancy weight, gestational weight gain, and maternal education were associated with moderate weight retention; and gestational weight gain, maternal age, race, employment status, and having an infant hospitalized at birth were associated with high weight retention. The results of this study illustrate the importance of prepregnancy weight and gestational weight gain in predicting postpartum weight retention. Furthermore, given the lack of successful intervention studies that exist to date to help women lose weight in the postpartum period, the results of this study may help to inform future interventions that focus on such aspects as hours of sleep, dealing with stress associated with a hospitalized infant, and nonclinical eating disorder symptomatology.

Socioeconomic Characteristics, Lifestyle Behaviors, and Health Conditions Among Males of Reproductive Age With and Without Disabilities, NHANES 2013–2018

Deierlein, A. L., Sun, Y., Prado, G., & Stein, C. R. (n.d.).

Publication year

2023

Journal title

American Journal of Men's Health

Volume

Issue

10.1177/15579883221138190

Abstract

Abstract

Health status during the reproductive years influences fecundity, fertility, and the future health of males and their offspring. There remains a dearth of literature examining men’s preconception health, especially among high-risk populations, such as those with disabilities. The objective of this study was to examine indicators of preconception health, including chronic medical conditions, lifestyle behaviors, and health care utilization, among males of reproductive age with and without disabilities in the United States. Data were from 3,702 males of reproductive age (18–44 years) who participated in the National Health and Nutrition Examination Surveys, 2013–2018. Approximately 14% of males reported having at least one disability related to vision, hearing, cognition, mobility, self-care, or independent living. Among all men, suboptimal preconception health indicators were prevalent including poor or fair self-rated health; low education and household income status; lack of health insurance and no recent utilization of health care and dental care; cigarette smoking; frequent alcohol consumption and binge drinking; marijuana and illegal drug use; obesity; low fruit and vegetable intake and no multi-vitamin use; low physical activity; short sleep durations; depressive symptoms; and hypertension and asthma. Compared to males with no disabilities, males with any disabilities were more likely to have suboptimal preconception health indicators. Strategies to promote and improve sexual health, preconception care, and family planning services among all men are needed. For males with disabilities, specifically, further investigation of their specific health needs related to sex, reproduction, family planning, and fatherhood, as well as interactions with health care providers, is required.

The association between maternal glucose concentration and child BMI at age 3 years

Deierlein, A. L., Siega-Riz, A. M., Chantala, K., & Herring, A. H. (n.d.).

Publication year

2011

Journal title

Diabetes Care

Volume

Issue

Page(s)

480-484

10.2337/dc10-1766

Abstract

Abstract

OBJECTIVE - The objective of the study was to determine the association between child BMI at age 3 years and maternal glucose concentration among women without pre-existing diabetes or a gestational diabetes mellitus (GDM) diagnosis. RESEARCH DESIGN AND METHODS - Data are from the Pregnancy Infection and Nutrition and Postpartum studies and include 263 mother-child pairs. Measured weights and heights at 3 years were used to calculate age- and sex-specific BMI z scores and percentiles. Multivariable linear regression models were used to examine associations of continuous BMI z scores with maternal glucose concentration. Modified Poisson regression estimated risk ratios of child overweight/obesity (BMI ≥85th percentile). RESULTS - The mean (SD) maternal glucose concentration and prepregnancy BMI were 103.8 (23.7) mg/dL and 24.3 (5.9) kg/m 2, respectively. At 3 years, the mean (SD) child BMI z score was 0.29 (0.99), 20.9% were overweight/obese and 5.3% were obese. In the adjusted model, when compared with glucose concentration

The associations of phthalate biomarkers during pregnancy with later glycemia and lipid profiles

Wu, H., Just, A. C., Colicino, E., Calafat, A. M., Oken, E., Braun, J. M., McRae, N., Cantoral, A., Pantic, I., Pizano-Zárate, M. L., Tolentino, M. C., Wright, R. O., Téllez-Rojo, M. M., Baccarelli, A. A., & Deierlein, A. L. (n.d.).

Publication year

2021

Journal title

Environment international

Volume

155

10.1016/j.envint.2021.106612

Abstract

Abstract

Background: Pregnancy induces numerous cardiovascular and metabolic changes. Alterations in these sensitive processes may precipitate long-term post-delivery health consequences. Studies have reported associations between phthalates and metabolic complications of pregnancy, but no study has investigated metabolic outcomes beyond pregnancy. Objectives: To examine associations of exposure to phthalates during pregnancy with post-delivery metabolic health. Design: We quantified 15 urinary phthalate biomarker concentrations during the second and third trimesters among 618 pregnant women from Mexico City. Maternal metabolic health biomarkers included fasting blood measures of glycemia [glucose, insulin, Homeostatic Model Assessment of Insulin Resistance [HOMA-IR], % hemoglobin A1c (HbA1c%)] and lipids (total, high-density lipoprotein (HDL), low-density lipoprotein (LDL) cholesterol, triglycerides), at 4–5 and 6–8 years post-delivery. To estimate the influence of the phthalates mixture, we used Bayesian weighted quantile sum regression and Bayesian kernel machine regression; for individual biomarkers, we used linear mixed models. Results: As a mixture, higher urinary phthalate biomarker concentrations during pregnancy were associated with post-delivery concentrations of plasma glucose (interquartile range [IQR] difference: 0.13 SD, 95%CrI: 0.05, 0.20), plasma insulin (IQR difference: 0.06 SD, 95%CrI: −0.02, 0.14), HOMA-IR (IQR difference: 0.08 SD, 95% CrI: 0.01, 0.16), and HbA1c% (IQR difference: 0.15 SD, 95%CrI: 0.05, 0.24). Associations were primarily driven by mono-2-ethyl-5-carboxypentyl terephthalate (MECPTP) and the sum of dibutyl phthalate biomarkers (∑DBP). The phthalates mixture was associated with lower HDL (IQR difference: −0.08 SD, 95%CrI: −0.16, −0.01), driven by ∑DBP and monoethyl phthalate (MEP), and higher triglyceride levels (IQR difference: 0.15 SD, 95%CrI: 0.08, 0.22), driven by MECPTP and MEP. The overall mixture was not associated with total cholesterol and LDL. However, ∑DBP and MEP were associated with lower and higher total cholesterol, respectively, and MECPTP and ∑DBP were associated with lower LDL. Conclusions: Phthalate exposure during pregnancy is associated with adverse long-term changes in maternal metabolic health. A better understanding of timing of the exact biological changes and their implications on metabolic disease risk is needed.

The nutritional characteristics and experiences of survivors of critical illness after hospital discharge : A multi-method narrative review

Dudzik, J. M., Balk, E. K., & Deierlein, A. L. (n.d.).

Publication year

2025

Journal title

Clinical Nutrition ESPEN

Volume

Page(s)

612-625

10.1016/j.clnesp.2025.03.171

Abstract

Abstract

Background & aims: Many survivors of critical illness experience long-term functional, cognitive, and psychological impairments known as post-intensive care syndrome (PICS). Yet, the nutritional recovery experiences of intensive care unit (ICU) survivors after hospital discharge remain underrecognized and poorly understood. The objective of this review was to characterize nutritional indices and nutrition-related outcomes in survivors of critical illness, and to understand the nutritional recovery experience after hospital discharge. Methods: Searches were conducted for eligible quantitative and qualitative studies between June and August 2024 using PubMed, CINAHL Complete, and Scopus electronic databases. Abstracts and full texts were screened against predetermined inclusion and exclusion criteria. Primary research analyzing anthropometric, nutritional, and/or experiential data of adult survivors of critical illness after hospital discharge were included in this review. Results: 21 quantitative (n = 3054) and 7 qualitative (n = 162) studies were included. After hospital discharge, ICU survivors seldom returned to their baseline weight with many having small to modest weight gains in the first months of recovery. Average calorie (18–33.5 calories/kilogram/day) and protein (0.96–1.6 g/kg/day) intakes largely did not meet requirements needed to facilitate recovery, resulting in high rates of malnutrition, ranging from 16.8 to 63 % 3 months after discharge. A multitude of barriers to nutritional recovery were faced in the post-discharge period resulting from persistent physical and functional limitations due to critical illness. Ongoing individualized nutrition monitoring and follow-up from dietetic professionals knowledgeable in post-ICU care has the potential to improve nutrition-related outcomes for survivors yet remains underutilized. Improving the availability and affordability of such services is a key facilitator to improve the nutritional recovery experience for ICU survivors. Conclusions: After hospital discharge, many survivors of critical illness face numerous barriers to nutritional recovery resulting in long-term nutritional complications. Future research efforts should target nutritional characterization, associations between nutritional variables and PICS, and the identification and development of effective nutrition interventions to improve long-term outcomes for survivors of critical illness after hospital discharge.

The nutritional characteristics and experiences of survivors of critical illness after hospital discharge: A multi-method narrative review

Deierlein, A. L., Dudzik, J. M., Balk, E. K., & Deierlein, A. L. (n.d.).

Publication year

2025

Journal title

Clinical nutrition ESPEN

Volume

Page(s)

612-625

Abstract

Abstract

Many survivors of critical illness experience long-term functional, cognitive, and psychological impairments known as post-intensive care syndrome (PICS). Yet, the nutritional recovery experiences of intensive care unit (ICU) survivors after hospital discharge remain underrecognized and poorly understood. The objective of this review was to characterize nutritional indices and nutrition-related outcomes in survivors of critical illness, and to understand the nutritional recovery experience after hospital discharge.

Timing of eating and glycemic control during pregnancy : A systematic review

Boege, H. L., Park, C., Gagnier, R., & Deierlein, A. L. (n.d.).

Publication year

2025

Journal title

Nutrition, Metabolism and Cardiovascular Diseases

10.1016/j.numecd.2025.104094

Abstract

Abstract

Aims: Glycemic dysregulation during pregnancy is common and increases risk of adverse birth outcomes and future chronic disease. Timing of eating is known to influence glycemic control but has not been thoroughly examined in the context of pregnancy. We systematically reviewed the literature assessing timing of eating and glycemic outcomes during pregnancy. Data synthesis: PubMed, CINAHL, EMBASE, and Web of Science were searched for studies published before March 2024. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered the review with PROSPERO (CRD42024574992). Eligible studies were interventional or observational and collected quantitative data on the association of timing of eating with glycemic outcomes in pregnant persons with or without gestational diabetes mellitus (GDM). 1804 articles were evaluated for inclusion, of which 14 articles met criteria (from 5 interventional and 8 observational studies). Conclusions: Timing of eating was associated with glycemic outcomes independent of GDM status; later timing and a shorter overnight fasting duration were associated with poorer glycemic control. Timing considerations may be a valuable addition to recommendations for glycemia management during pregnancy.

Timing of Eating and Glycemic Control During Pregnancy: A Systematic Review

Boege, H., & Deierlein, A. L. (n.d.).

Publication year

2025

Journal title

Nutrition Metabolism & Cardiovascular Diseases

Abstract

Abstract

Total and trimester-specific gestational weight gain and infant anthropometric outcomes at birth and 6 months in low-income Hispanic families

Deierlein, A. L., Messito, M. J., Katzow, M., Berube, L. T., Dolin, C. D., & Gross, R. S. (n.d.).

Publication year

2020

Journal title

Pediatric Obesity

Volume

Issue

10.1111/ijpo.12589

Abstract

Abstract

Objective: To describe total and trimester-specific gestational weight gain (GWG) among low-income Hispanic women and determine whether these GWG exposures are associated with infant anthropometric outcomes at birth and 6 months. Study Design: Data were from 448 mother-infant pairs enrolled in the Starting Early child obesity prevention trial. Prenatal weights were used to calculate total GWG and 2nd and 3rd trimester GWG rates (kg/week) and categorized as inadequate, adequate, and excessive according to the 2009 Institute of Medicine recommendations. Multivariable linear and modified Poisson regressions estimated associations of infant anthropometric outcomes (birthweight, small-for-gestational age [SGA], large-for-gestational age [LGA], rapid weight gain, and weight-for-age, length-for-age, and weight-for-length z-scores at 6 months) with GWG categories. Results: For total GWG, 39% and 27% of women had inadequate and excessive GWG, respectively. 57% and 46% had excessive GWG rates in the 2nd and 3rd trimesters, respectively, with 29% having excessive rates in both trimesters. Inadequate total GWG was associated with lower infant weight and length outcomes (ß range for z-scores = −0.21 to −0.46, p < 0.05) and lower risk of LGA (adjusted Relative Risk, aRR = 0.38; 95% confidence intervals, CI: 0.16, 0.95) and rapid weight gain (aRR = 0.72; 95%CI: 0.51, 1.00). GWG rates above recommendations in the 2nd trimester or 2nd/3rd trimesters were associated with greater weight outcomes at birth and 6 months (ß range for z-scores = 0.24 to 0.35, p < 0.05). Conclusions: Counseling women about health behaviors and closely monitoring GWG beginning in early pregnancy is necessary, particularly among populations at high-risk of obesity.

Trends and Patterns of Phthalates and Phthalate Alternatives Exposure in Pregnant Women from Mexico City during 2007-2010

Wu, H., Kupsco, A. J., Deierlein, A. L., Just, A. C., Calafat, A. M., Oken, E., Braun, J. M., Mercado-Garcia, A., Cantoral, A., Téllez-Rojo, M. M., Wright, R. O., & Baccarelli, A. A. (n.d.).

Publication year

2020

Journal title

Environmental Science and Technology

Volume

Issue

Page(s)

1740-1749

10.1021/acs.est.9b05836

Abstract

Abstract

Phthalates are associated with several adverse health outcomes, but few studies have evaluated phthalate exposures in Mexican populations, particularly pregnant women. Between 2007 and 2011, 948 pregnant women from Mexico City were recruited as part of the PROGRESS cohort. We quantified 17 metabolites of phthalates and phthalate alternatives in urine samples collected during the second and third trimesters and examined temporal trends of metabolite concentrations, within-person reproducibility, and relations of individual metabolites with sociodemographic, lifestyle, and occupational factors. Concentrations of mono-2-ethyl-5-carboxypentyl terephthalate, a metabolite of the alternative phthalate di-2-ethylhexyl terephthalate, increased monotonically from 2007 to 2010 (31% per year; 95% confidence interval = 23 and 39%). We observed moderate to high correlations among metabolites collected at the same visit, but there was high variability between second and third trimester phthalate metabolite concentrations (intraclass correlation coefficients = 0.17-0.35). In general, higher socioeconomic status was associated with higher phthalate concentrations. Some metabolites were associated with maternal age and education, but no consistent patterns were observed. Women working in the home and those who worked in administration had higher concentrations of several phthalate metabolites relative to students, professionals, and those in customer service. Biomonitoring efforts are warranted to investigate present and future exposure trends and patterns.

Trends in food consumption by degree of processing and diet quality over 17 years : Results from the Framingham Offspring Study

Juul, F. C., Lin, Y., Deierlein, A. L., Vaidean, G., & Parekh, N. (n.d.).

Publication year

2021

Journal title

British Journal of Nutrition

Volume

126

Issue

Page(s)

1861-1871

10.1017/S000711452100060X

Abstract

Abstract

Ultraprocessed foods provide the majority of energy content in the American diet, yet little is known regarding consumption trends over time. We determined trends in diet processing level and diet quality from 1991 to 2008 within the prospective Framingham Offspring Cohort. Dietary intakes were collected by FFQ quadrennially 1991-2008 (total of four examinations). The analytical sample included 2893 adults with valid dietary data for ≥3 examinations (baseline mean age = 54 years). Based on the NOVA framework, we classified foods as: unprocessed/minimally processed foods; processed culinary ingredients (salt/sugar/fats/oils); and processed foods and ultraprocessed foods. We evaluated diet quality using the Dietary Guidelines for Americans Adherence Index (DGAI) 2010. Trends in consumption of foods within each processing level (servings/d) and diet quality over the four examinations were evaluated using mixed effects models with subject-specific random intercepts. Analyses were stratified by sex, BMI (

Ultra-processed food intake among South Asians in the United States : Specific vulnerabilities of a growing immigrant population group

Hussain, B. M., Juul, F. C., Deierlein, A. L., & Parekh, N. (n.d.).

Publication year

2024

Journal title

Nutrition Reviews

Volume

Issue

Page(s)

1402-1406

10.1093/nutrit/nuad126

Abstract

Abstract

South Asians are among the fastest growing immigrant population groups in the United States. Their traditional diets are rich in minimally processed fruits, vegetables, grains, herbs, and spices. However, the proliferation of ultra-processed foods (highly processed, industrially manufactured formulations) around the globe may compromise the nutrition profile of South Asians, threatening to increase their risk of noncommunicable diseases. This commentary discusses the rise in ultra-processed food consumption among South Asians in the United States and hypothesizes that South Asians may be especially vulnerable to the effects of ultra-processed foods due to their unique cardiovascular disease risk profiles. Using these emerging data, we propose several strategies for preventing the overconsumption of ultra-processed foods among South Asian Americans. These include the implementation of policies to encourage the consumption of whole foods over ultra-processed foods and the development of culturally tailored interventions, which include promoting consumption of traditional diets, improving affordability of healthful, culturally appropriate foods, and cultivating healthier food environments for South Asians living in the United States.

Ultra-processed Foods and Cardiometabolic Health Outcomes : from Evidence to Practice

Juul, F. C., Deierlein, A. L., Vaidean, G., Quatromoni, P. A., & Parekh, N. (n.d.).

Publication year

2022

Journal title

Current atherosclerosis reports

Volume

Issue

Page(s)

849-860

10.1007/s11883-022-01061-3

Abstract

Abstract

Purpose of Review: Poor diet quality is the leading risk factor related to the overall cardiometabolic disease burden in the USA and globally. We review the current evidence linking ultra-processed foods and cardiometabolic health risk and provide recommendations for action at the clinical and public health levels. Recent Findings: A growing body of evidence conducted in a variety of study populations supports an association between ultra-processed food intake and increased risk of metabolic syndrome, hypertension, type 2 diabetes, overweight and obesity trajectories, and cardiovascular disease. The strongest evidence is observed in relation to weight gain and obesity among adults, as this association is supported by high-quality epidemiological and experimental evidence. Summary: Accumulating epidemiologic evidence and putative biological mechanisms link ultra-processed foods to cardiometabolic health outcomes. The high intake of ultra-processed foods in all population groups and its associated risks make ultra-processed foods an ideal target for intensive health promotion messaging and interventions.

Ultra-Processed Foods and Incident Cardiovascular Disease in the Framingham Offspring Study

Juul, F. C., Vaidean, G., Lin, Y., Deierlein, A. L., & Parekh, N. (n.d.).

Publication year

2021

Journal title

Journal of the American College of Cardiology

Volume

Issue

Page(s)

1520-1531

10.1016/j.jacc.2021.01.047

Abstract

Abstract

Background: Ultra-processed foods provide 58% of total energy in the U.S. diet, yet their association with cardiovascular disease (CVD) remains understudied. Objectives: The authors investigated the associations between ultra-processed foods and CVD incidence and mortality in the prospective Framingham Offspring Cohort. Methods: The analytical sample included 3,003 adults free from CVD with valid dietary data at baseline. Data on diet, measured by food frequency questionnaire, anthropometric measures, and sociodemographic and lifestyle factors were collected quadrennially from 1991 to 2008. Data regarding CVD incidence and mortality were available until 2014 and 2017, respectively. Ultra-processed foods were defined according to the NOVA framework. The authors used Cox proportional hazards models to determine the multivariable association between ultra-processed food intake (energy-adjusted servings per day) and incident hard CVD, hard coronary heart disease (CHD), overall CVD, and CVD mortality. Multivariable models were adjusted for age, sex, education, alcohol consumption, smoking, and physical activity. Results: During follow-up (1991 to 2014/2017), the authors identified 251, 163, and 648 cases of incident hard CVD, hard CHD, and overall CVD, respectively. On average, participants consumed 7.5 servings per day of ultra-processed foods at baseline. Each additional daily serving of ultra-processed foods was associated with a 7% (95% confidence interval [CI]: 1.03 to 1.12), 9% (95% CI: 1.04 to 1.15), 5% (95% CI: 1.02 to 1.08), and 9% (95% CI: 1.02 to 1.16) increase in the risk of hard CVD, hard CHD, overall CVD, and CVD mortality, respectively. Conclusions: The current findings support that higher consumption of ultra-processed foods is associated with increased risk of CVD incidence and mortality. Although additional research in ethnically diverse populations is warranted, these findings suggest cardiovascular benefits of limiting ultra-processed foods.