Interactions of iron with manganese, zinc, chromium, and selenium as related to prophylaxis and treatment of iron deficiency

Selenium status in lactating mothers-infants and its potential protective role against the neurotoxicity of methylmercury, lead, manganese, and DDT

A total of 206 lactating mothers and their infants (3-12 months) were included in this study to evaluate postnatal exposure to neurotoxic pollutants such as methylmercury (MeHg), lead (Pb), manganese (Mn), dichlorodiphenyltrichloroethane (DDT) and its metabolites [dichlorodiphenyldichloroethane (DDD), and dichlorodiphenyldichloroethylene (DDE)] and their association with delayed neurological development and to explore the protective role of selenium (Se) against chemical neurotoxicity. Neurodevelopmental performance was evaluated using Denver Developmental Screening Test II and Parents' Evaluation of Developmental Status (PEDS). Multivariate log-binomial regression modeling was applied for both single and multiple exposures to chemicals using a principal component analysis that generated six principal components. Both mothers and their infants had been exposed to metals and DDT metabolites, with some exceeding the accepted permissible limits. The geometric means of MeHg, Pb, Mn, DDD, DDE and DDT levels in breast milk were 1.333, 45.327, 15.576, 0.069, 0.542 and 1.08 μg/l, respectively. A single-exposure model identified a high risk of reduced PEDS performance significantly associated with DDD in breast milk [relative risk (RR) = 1.484; 95% confidence interval (95%CI) = 1.091-2.019] and marginally significantly associated with Pb in the mothers' blood (RR = 2.164; 95%CI = 0.87-5.382). We did not find a protective role of Se in neurodevelopment due to its high levels in the mothers. Models of multi-chemical exposure indicated that Mn in blood and breast milk, Se in blood and Pb in the mothers' urine were marginally significantly associated with a high risk of reduced PEDS performance (RR = 0.424; 95%CI = 0.176-1.022). The use of multi-chemical exposure approach in early life risk assessments is important because it indicates real-world exposure. Our results were not conclusive because the sample size was small, so future studies examining the implications to health of the impact of prenatal/postnatal exposure to a mixture of chemicals in the Saudi population are merited.

Serum trace elements profile in the pediatric inflammatory bowel disease progress evaluation

INTRODUCTION

Inflammatory bowel disease (IBD), a chronic inflammatory disorder of gastrointestinal tract, arises from complex interaction between genetics, environment, gut microbiota and mucosal immune response. Along with clinical, endoscopic and radiological evaluation various biomarkers are needed as an additional diagnostic tool, as well as to predict disease course and therapeutic outcomes.

AIM

The aim of this study was to evaluate clinical value of essential trace elements (ETEs) serum concentration profile in the assessment of pediatric IBD diseases development.

MATERIALS AND METHODS

Concentration of five ETEs: iron (Fe), zinc (Zn), copper (Cu), manganese (Mn) and selenium (Se) in serum of 41 children with newly diagnosed IBD (27 CD and 14 UC) and 20 healthy controls were determined by inductively coupled plasma mass spectrometry (ICP-MS) and atomic fluorescence spectrometry (AFS) at the moment of diagnosis and after one year of treatment.

RESULTS

The obtained results revealed significant differences in serum concentration profile of studied ETEs' for IBD pediatric patients and healthy controls. Decrease of iron, zinc and selenium and increase of copper and manganese serum concentration were observed in IBD patients at the time of diagnosis. The changes were reversible and after one year of treatment the studied ETEs serum concentration profile resembled much more that observed for healthy controls. Correlations between studied ETEs levels within cases (IBD, CD, UC) were also found to be different from those in healthy controls (HC).

CONCLUSION

Although much more studies are required on the subject our results demonstrate a clinical value of ETEs serum concentration profile in pediatric IBD patients regarding disease development.

Association of serum chromium levels with malnutrition in hemodialysis patients

BACKGROUND

Chromium is an essential trace metal that reduces oxidative stress and inflammation. In patients undergoing maintenance hemodialysis (MHD), a correlation among chromium exposure, inflammation, and malnutrition remains unclear. This study examined the possible effects of serum chromium levels (SCLs) in MHD patients.

METHODS

Initially, 732 MHD patients in dialysis centers were recruited. A total of 647 patients met the inclusion criteria and were stratified by SCL into four equal-sized groups: first quartile (< 0.29 μg/L), second quartile (0.29-0.56 μg/L), third quartile (0.57-1.06 μg/L), and fourth quartile (> 1.06 μg/L). Demographic, biochemical, and dialysis-related data were obtained for analyses. The analysis included nutritional and inflammatory markers.

RESULTS

As compared with the highest quartile group, more subjects in the lowest quartile group were of an older age; had lower hemoglobin and creatinine levels; had a higher prevalence of DM and malnutrition (serum albumin level < 3.6 g/dL); and higher serum transferrin saturation and ferritin levels. A stepwise multiple linear regression analysis revealed a significant negative correlation between malnutrition and SCL (β coefficient = - 0.129, p = 0.012) and negative associations among body mass index (β coefficient = - 0.010, p = 0.041), ferritin (β coefficient = - 0.107, p = 0.001) and SCL. A multivariate logistic regression analysis also demonstrated a negative correlation between malnutrition and SCL. With a 10-fold increase in SCL, the risk ratio of malnutrition was 0.49 (95% confidence interval: 0.25-0.96; p = 0.039).

CONCLUSIONS

SCL is significantly associated with malnutrition in MHD patients. Further evaluation of the relationship between clinical outcomes (morbidity/mortality) and SCL is necessitated.

Long-term effects of chromium on morphological and immunological parameters of Wistar rats

Hexavalent chromium raises high concern because of its wide industrial applications and reported toxicity. Long-term (135 days) oral exposure of Wistar rats to chromium in the form of K₂Cr₂O₇ (exposed group~20 mg/kg/day) led to a decrease in thymus mass and thymocytes' number and caused structural and functional changes in the lymph nodes and spleen, namely lymphoreticular hyperplasia and plasmocytic macrophage transformation. Programmed cell death was increased in both thymocytes and splenocytes and decreased in lymphocytes in the T-zones of spleen and lymph nodes. Moreover, Cr (VI) administration decreased myeloid cells' and neutrophils' number, while it increased lymphoid and erythroid cells' number in bone marrow. Cr (VI) immune system effects seem to be related to oxidative stress induction, as depicted by the increased levels of diene conjugates and malondialdehyde in the spleen and liver and by the decreased activity of catalase and superoxide dismutase in rats' erythrocytes. In addition, exposure to Cr (VI) decreased copper, nickel and iron concentrations in blood and liver, while Cr levels in blood, spleen and liver were increased, as expected. The observed changes in the series of immunological parameters studied contribute to the development of new approaches for the prevention of low level Cr exposure toxicity.

The Combined Effects of Cr(III) Supplementation and Iron Deficiency on the Copper and Zinc Status in Wistar Rats

The aim of the study was to assess the combined effects of chromium(III) supplementation and iron deficiency on the copper (Cu) and zinc (Zn) status in female rats. The Cr, Fe, Cu and Zn dietary and tissular levels were measured by Atomic Absorption Spectrometry (AAS) method. The data show that chromium(III) supplementation compensated for the negative effects of Fe deficiency on the Cu content but it deepened the effect on Zn levels in the female rats. Detailed data on the status of trace elements and their interactions in healthy subjects and patients with metabolic disorders (e.g. anaemia, diabetes mellitus) are strongly required for effective nutritional and therapeutic strategies.

Dietary Manganese Exposure in the Adult Population in Germany-What Does it Mean in Relation to Health Risks?

Manganese is both an essential nutrient and a potential neurotoxicant. Therefore, the question arises whether the dietary manganese intake in the German population is on the low or high side. Results from a pilot total diet study in Germany presented here reveal that the average dietary manganese intake in the general population in Germany aged 14-80 years is about 2.8 mg day^-1 for a person of 70 kg body weight. This exposure level is within the intake range of 2-5 mg per person and day as recommended by the societies for nutrition in Germany, Austria, and Switzerland. No information on the dietary exposure of children in Germany can be provided so far. Although reliable information on health effects related to oral manganese exposure is limited, there is no indication from the literature that these dietary intake levels are associated with adverse health effects either by manganese deficiency or excess. However, there is limited evidence that manganese taken up as a highly bioavailable bolus, for example, uptake via drinking water or food supplements, could pose a potential risk to human health-particularly in certain subpopulations-when certain intake amounts, which are currently not well defined, are exceeded.

The combined effects of Cr(III) propionate complex supplementation and iron excess on copper and zinc status in rats

It is suggested that both iron overload and chromium(III) deficiency may be risk factors of diabetes. It seems that both Fe and Cr(III) metabolism as well as copper and zinc metabolism are interrelated. However, the direction of these changes may depend on mutual proportions of these elements in the diet and organism. The aim of the study was to evaluate the combined effects of Cr(III) supplementation with Fe excess on the Cu and Zn status in female rats. Thirty-six healthy rats were divided into 6 experimental groups with different Fe levels in the diet. Groups marked with C (control) contained Fe at the recommended level (45 mg kg^-1). The excess groups (E) contained Fe at 180 mg kg^-1. At the same time the animals were supplemented with Cr(III) of doses 1, 50 and 500 mg kg^-1 of diet. The Cr, Fe, Cu and Zn dietary and tissular contents were measured with the AAS method.The excess Fe in the diet significantly decreased the Cu content in the liver and kidneys, but it increased the spleen Cu level. The Cr(III) supplementary did not affect the tissular Cu levels, regardless of Fe supply with diet. The experimental factors did not have significant interactional effect on the Cu status parameters under study.The Fe excess in the diet reduced the renal and splenic Zn content, but increased the heart Zn content. The Cr(III) supplementation decreased the Zn content in the kidneys. The Zn content in the liver and spleen tended to decrease as the Cr(III) supply in the diet increased. There was no significant interactional effect of Cr(III) supplementation and the Fe excessive supply in diet on the parameters of Zn metabolism in Wistar rats. Iron oversupply disturbed the rat's Cu and Zn status. However, Cr(III) supplementation did not affect the tissular levels of these elements, except the kidney Zn content. Simultaneous supplementation with the Cr(III) propionate complex did not deepen changes in tissular Cu and Zn levels caused by the Fe excess in the diet.

In vitro gastrointestinal digestion to evaluate the total, bioaccessible and bioavailable concentrations of iron and manganese in açaí (Euterpe oleracea Mart.) pulps

Açaí pulp consumption has increased in Brazil and worldwide. Recently, a high average content of manganese (450 mg/kg) was observed in açaí pulp, raising the hypothesis of toxicological effects associated to its ingestion. However, the total concentration of an element does not reflect the real benefits and risks of consuming a food. In this context, the total, bioaccessible and bioavailable concentrations of Fe and Mn were assessed in 9 açaí pulps. Fe and Mn contents ranged from 27.6 to 73 and from 145 to 1197 mg kg^-1, respectively. Fe and Mn bioaccessibilities represented from 29 to 40 and from 39 to 55% of total amounts. Fe bioavailabilities were lower than LOQ and those of Mn varied from 8 to 17% of total. A daily consumption of 100 g of açaí pulp exceeds by at least 1.5-fold the recommended Mn daily intakes for adults whereas poorly contributes to Fe intakes. Since the lowest Mn bioaccessible and bioavailable fraction corresponded to a Mn intake value higher than the tolerable upper intakes for children and that high amounts of Mn intake may impair Fe absorption, higher açaí consumption may be worrisome. Future nutritional, toxicological and speciation studies must be undertaken.

Iron Metabolism and Brain Development in Premature Infants

Iron is important for a remarkable array of essential functions during brain development, and it needs to be provided in adequate amounts, especially to preterm infants. In this review article, we provide an overview of iron metabolism and homeostasis at the cellular level, as well as its regulation at the mRNA translation level, and we emphasize the importance of iron for brain development in fetal and early life in preterm infants. We also review the risk factors for disrupted iron metabolism that lead to high risk of developing iron deficiency and subsequent adverse effects on neurodevelopment in preterm infants. At the other extreme, iron overload, which is usually caused by excess iron supplementation in iron-replete preterm infants, might negatively impact brain development or even induce brain injury. Maintaining the balance of iron during the fetal and neonatal periods is important, and thus iron status should be monitored routinely and evaluated thoroughly during the neonatal period or before discharge of preterm infants so that iron supplementation can be individualized.

Iron Deficiency, Cognitive Functions, and Neurobehavioral Disorders in Children

More than 25% of the world's population is affected by anemia, of which more than 50% suffers from iron deficiency anemia (IDA). Children below 7 years of age are the population group that is most vulnerable to iron deficiency. Iron is an essential element in brain metabolism. Iron deficiency can cause changes in neurotransmitter homeostasis, decrease myelin production, impair synaptogenesis, and decline the function of the basal ganglia. Therefore, IDA adversely affects cognitive functions and psychomotor development. Research has shown that iron deficiency is a frequent comorbidity in attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder. Iron deficiency may also induce or exacerbate deficiency of other essential nutrients, which may have a negative impact on the developing brain and other organs in infants. Many nations of the world have programs to control IDA based on the use of iron supplementation, intake of fortified food and drinks, improved food safety, and monitoring of dietary diversity. Based on the current recommendations of the World Health Organization on cost-effectiveness (WHO-CHOICE), iron fortification and iron supplementation programs can be considered cost-effective or even highly cost-effective in most countries of the world to averting cognitive impairment.

Urban and rural area differences in the interaction between oxidative process elements in human femoral bone

Elements in the human body come from contaminated food, water, and air from the living area. Bones are a marker of long-term exposure to elements and show a relationship between them. The aim of the study was to analyze the correlation between the contents of Zn, Cu, Fe, Mo, Cr, Ni, Ba, Sr, and Pb in the proximal femoral head (cancellous bone) and femoral neck (cortical bone) in rural and urban populations. The study included 96 patients who were operated on for total hip replacement (THR), acquired in a surgical procedure with atomic absorption spectrometry, and the content of Zn, Cu, Fe, Mo, Cr, Ni, Ba, Sr, and Pb was evaluated. In rural areas, significant negative correlations were observed for Mo/Cr, Mo/Cu, and Ni/Fe, and positive correlations were observed for Fe/Zn and Pb/Zn. In urban areas, a negative correlation was found for Pb/Mo. Pb and Ni increased with age only in villagers, and Zn and Sr decreased with age in urban citizens. Ba decreased with age in people from rural areas. The correlation showed variances mainly in molybdenum, nickel, and oxidative elements between rural and urban populations.

The Combined Effects of Iron Excess in the Diet and Chromium(III) Supplementation on the Iron and Chromium Status in Female Rats

Inadequate iron supply has significant consequences to health. There are some relations between the metabolism of different trace elements, such as iron, zinc, copper and chromium. However, the direction of these interactions can be antagonistic or synergistic, and it depends on many factors. The aim of the study was to evaluate the combined effects of supplementary of chromium(III) propionate complex (Cr3) with iron excess on the Cr and Fe status in healthy female rats. The 36 healthy female Wistar rats were divided into six experimental groups (six animals in each) with different Fe levels-adequate (45 mg kg^-1-100% RDA) and high (excessive-180 mg kg^-1-400% RDA). At the same time, they were supplemented with Cr(III) at doses of 1, 50 and 500 mg kg^-1 of diet: C1-control (Fe 45 mg kg^-1, Cr 1 mg kg^-1); C50 (Fe 45 mg kg^-1, Cr 50 mg kg^-1); C500 (Fe 45 mg kg^-1, Cr 500 mg kg^-1); H1 (Fe 180 mg kg^-1, Cr 1 mg kg^-1); H50 (Fe 180 mg kg^-1, Cr 50 mg kg^-1); H500 (Fe 180 mg kg^-1, Cr 500 mg kg^-1). The serum iron level and total iron binding capacity (TIBC) were measured with colorimetric methods. The serum ferritin level was measured by means of electrochemiluminescence immunoassay. The serum transferrin level was measured with the ELISA method. Haematological measurements were made with an automated blood analyser. The Cr and Fe tissular levels were measured with the AAS method. The exposure to a high level of Fe(III) alone or in combination with Cr caused Fe accumulation in tissues, especially in the liver and kidneys, but there were no significant changes in the TIBC, transferrin, ferritin concentration in the serum and most haematological parameters. Moreover, the serum, hepatic and renal Cr concentrations decreased. The doses of supplementary Cr(III) given separately or in combination with high level of Fe(III) disturbed the Cr content in the liver and kidneys of healthy female rats. However, they did not change most of the parameters of Fe metabolism, except the Fe kidney concentration. Supplementary Cr3 decreased the renal Fe level in groups with adequate Fe content in the diet. However, the renal Fe levels increased along with a higher Cr level in the diet in groups with high Fe content. The findings proved a relationship between Fe(III) and Cr(III) metabolism in healthy female rats. However, the direction of change varied and depended on relative amounts of these elements in the diet.

Effect of hypotensive therapy combined with modified diet or zinc supplementation on biochemical parameters and mineral status in hypertensive patients

BACKGROUND

Hypotensive therapy leads to a number of trace elements metabolism disturbances. Zinc balance is frequently affected by antihypertensive treatment.

AIM

To evaluate the effect of a hypotensive treatment, modified diet and zinc supplementation on mineral status and selected biochemical parameters in newly diagnosed hypertensive patients on monotherapy.

METHODS

In the first stage, arterial hypertension in ninety-eight human subjects was diagnosed. In the second stage, antihypertensive monopharmacotherapy was implemented. In the third stage, patients were randomized into three groups and continued antihypertensive monotherapy: group D received an optimal-mineral-content diet, group S received zinc supplementation, and group C had no changes in diet or zinc supplementation. Iron, zinc, and copper concentrations in serum, erythrocytes, urine, and hair were determined. Lipids, glucose, ceruloplasmin, ferritin, albumin, C-reactive protein (CRP), tumor necrosis factor α (TNF-α), nitric oxide (NO), superoxide dismutase (SOD) and catalase (CAT) were assayed in serum.

RESULTS

Antihypertensive monotherapy decreased zinc concentration in serum and erythrocytes and increased the level of zinc in urine, decreased CAT and SOD activity, TNF-α concentration in serum, and increased the level of NO in the serum. Zinc supply led to an increase in zinc concentration in serum, erythrocytes, and hair (in group S only). In the groups with higher zinc intake, decreased glucose concentration in the serum was observed. Significant correlation was seen between the zinc and glucose serum concentrations.

CONCLUSION

Hypotensive drugs disturb zinc status in newly diagnosed hypertensive patients. Antihypertensive monotherapy combined with increased zinc supply in the diet or supplementation favorably modify zinc homeostasis and regulate glucose status without blood pressure affecting in patients with hypertension.

The effect of dietary selenium addition on the concentrations of heavy metals in the tissues of fallow deer (Dama dama L.) in Croatia

The aim of this research was to determine the concentrations of cadmium, lead, mercury, and arsenic and the essential elements iron and selenium in the tissues (muscle, kidney, liver, spleen, and fat) of fallow deer (Dama dama L.) without and with supplemental selenium addition. Another aim was to determine the effect of selenium addition on the indicators of oxidative stress, namely, the levels of superoxide dismutase, glutathione peroxidase, glutathione, and vitamin E. The research was carried out with 40 fallow deer during two research periods. Supplemental feed without selenium addition was provided during the first research period, and supplemental feed with added selenium (3 mg/kg) was provided for 60 days during the second research period. The concentration of selenium in tissues was higher in the second research period than in the first research period (in kidney tissue, 0.957 vs. 0.688 mg/kg, P < 0.05). The dietary addition of selenium decreased (P < 0.05) the concentrations of some heavy metals (lead in the spleen = 0.06 vs. 0.27 mg/kg and in the fatty tissue = 0.17 vs. 0.69 mg/kg; arsenic in the muscle tissue = 0.005 vs. 0.014 mg/kg, liver = 0.003 vs. 0.009 mg/kg, spleen = 0.004 vs. 0.013 mg/kg, and fat = 0.008 vs. 0.016 mg/kg). The activity of glutathione peroxidase was significantly higher (P < 0.05) in the second research period than in the first research period (1375.36 vs. 933.23 U/L).

Assessment of dietary intake and mineral status in pregnant women

Purpose

To evaluate the dietary intake of pregnant women and their nutritional status of Ca, Mg, Fe, Zn, and Cu, as the nutritional status of pregnant women is an important factor for the proper progression of a pregnancy and the development and health of the foetus.

Methods

The study was conducted on 108 pregnant women ages 18–42, at 6–32 weeks of gestation. We used a questionnaire and a 24-h recall nutrition interview. Hair samples were taken for testing and the level of each mineral was assessed using atomic absorption spectrometry. The results were analysed using the Dietetyk and Statistica 10 software.

Results

Low levels of Fe, Zn, Ca, Mg, vitamin D, and folic acid intake were seen in the pregnant women, with the use of dietary supplements significantly increasing their intake of Fe, Zn, and folic acid. The concentration of zinc and magnesium in the women’s hair was shown to be affected by their age and, in the case of magnesium, by the week of pregnancy.

Conclusions

It was observed that the diet of pregnant women is characterised by low levels of Fe, Zn, Ca, Mg, vitamin D, and folic acid. Dietary supplementation with vitamins and minerals significantly increases the daily Fe and folic acid intake in pregnant women. The concentration of Zn and Mg in hair depends on the age of pregnant women and Mg level in the hair of women decreases during pregnancy.

Levels of aqueous humor trace elements in patients with open-angle glaucoma

PURPOSE

Trace elements might play a role in the complex multifactorial pathogenesis of open-angle glaucoma. The aim of this study was to analyze concentrations of trace elements in aqueous humor samples of patients with primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PEXG).

PATIENTS AND METHODS

Thirty-three aqueous humor samples were obtained from patients undergoing cataract surgery: 12 patients with POAG (age 65.3±10.50, female 8, male 4), 10 patients with PEXG (age 65.9±11.27, female 6, male 4) and 11 patients without glaucoma (age 69.5±13.70, female 7, male 4) serving as controls. Aqueous humor levels of cadmium, iron, manganese, cobalt, copper and zinc were measured by Flow-Injection-Inductively-Coupled-Plasma-Mass-Spectrometry (FI-ICP-MS).

RESULTS

From the statistical evaluation, we observed that patients with POAG had significantly higher aqueous humor levels of zinc (p=0.006) compared to controls. Increased aqueous humor levels of zinc were also observed in patients with PEXG in relation to control (p=0.0006). For iron we observed a significantly reduction in PEXG compared to control (p=0.002) and a significant difference between POAG and PEXG (p=0.0091). No significant differences were observed in aqueous humor levels of manganese, cobalt, copper, cadmium between glaucoma and control patients. No differences were seen for iron (POAG vs. controls). Analysis of trace element ratios was added.

CONCLUSION

Significant differences in aqueous humor levels of zinc and iron between glaucoma and control patients support the hypothesis that these trace elements are involved in the pathogenesis of open-angle glaucoma.

The combined effect of supplementary Cr(III) propionate complex and iron deficiency on the chromium and iron status in female rats

The aim of the study was to evaluate the combined effect of supplementary chromium(III) and iron deficiency on the chromium and iron status in female rats. The study was carried out on female Wistar rats, which were divided into 6 experimental groups with different Fe levels (deficient 10% RDA and recommended (adequate) 100% RDA). Simultaneously, for six weeks their diets were supplemented with Cr(III) at doses of 1, 50 and 500mgkg^-1. The tissular chromium and iron levels were measured with the AAS method. The serum iron and TIBC were measured with colorimetric methods The serum ferritin level was measured by means of electrochemiluminescence immunoassay. The serum transferrin level was measured with the ELISA method. The haematology was measured with an automated blood analyser. Supplementary Cr3 increased the Cr content in the tissues. This effect was weaker in the Fe-deficient groups than in those with the recommended Fe level, but it did not affect the Fe status. Fe deficiency significantly reduced the Fe content in the tissues. Simultaneously, Cr3 supplementation mitigated the symptoms of Fe deficiency. Fe deficiency increased TIBC and transferrin levels but reduced ferritin and most haematological parameters. However, simultaneous addition of high doses of Cr3 did not deepen these adverse changes. Our results show that the trend of changes in the Fe-Cr interaction depends on the content of these elements in the body.

Neurological effects of iron supplementation in infancy: finding the balance between health and harm in iron-replete infants

Iron mediates many biochemical processes in neural networks that proliferate during brain development. Insufficient iron causes irreversible neurodevelopmental deficits, and most high-income countries recommend that infants older than 4-6 months receive additional iron via food fortification or supplementation to prevent iron-deficiency anaemia. Now that the prevalence of iron-deficiency anaemia in children has decreased to less than 10% in most developed countries, concerns that the recommended intakes far exceed those required to prevent iron-deficiency anaemia have been raised, and emerging evidence suggests that iron overexposure could be linked to adverse outcomes later in life. In this Viewpoint, we discuss the importance of iron for neurodevelopment, investigate the biochemical markers used to assess iron stores, summarise the disparity in public health policies among high-income countries, and discuss the potential association between iron overexposure and adverse neurological outcomes later in life. We present a case for new studies to establish the optimal amount of iron that both prevents deficiency and reduces the potential risk of long-term negative health outcomes.

Blood levels of toxic metals and rare earth elements commonly found in e-waste may exert subtle effects on hemoglobin concentration in sub-Saharan immigrants

Pollution by heavy metals and more recently by rare earth elements (REE) and other minor elements (ME) has increased due in part to their high use in technological and electronic devices. This contamination can become very relevant in those sites where e-waste is improperly processed, as it is the case in many countries of the African continent. Exposure to some toxic elements has been associated to certain hematological disorders, specifically anemia. In this study, the concentrations of 48 elements (including REE and other ME) were determined by ICP-MS in whole blood samples of sub-Saharan immigrants with anemia (n=63) and without anemia (n=78). We found that the levels of Fe, Cr, Cu, Mn, Mo, and Se were significantly higher in the control group than in the anemia group, suggesting that anemia was mainly due to nutritional deficiencies. However, since other authors have suggested that in addition to nutritional deficiency, exposure to some elements may influence hemoglobin levels, we wanted to explore the role of a broad panel of toxic and "emerging" elements in hemoglobin deficiency. We found that the levels of Ag, As, Ba, Bi, Ce, Eu, Er, Ga, La, Nb, Nd, Pb, Pr, Sm, Sn, Ta, Th, Tl, U and V were higher in anemic participants than in controls. For most of these elements an inverse correlation with hemoglobin concentration was found. Some of them also correlated inversely with blood iron levels, pointing to the possibility that a higher rate of intestinal uptake of these could exist in relation to a nutritional deficiency of iron. However, the higher levels of Pb, and the group of REE and other ME in anemic participants were independent of iron levels, pointing to the possibility that these elements could play a role in the development of anemia.

Manganese exposure and neurotoxic effects in children

Manganese (Mn) is the fifth most abundant metal on earth. Although it is a well understood essential trace element, in excess, Mn is neurotoxic. Initial toxic symptoms associated with Mn are of psychiatric nature and are clinically defined as locura manganica. Neurological signs of Mn toxicity include dystonia, progressive bradykinesia, and disturbance of gait, slurring, and stuttering of speech with diminished volume. Studies indicate that children who ingested Mn in the drinking water (WMn) at or above a level of 0.241mg/L for a minimum of three years performed more poorly in school as measured by mastery of language, mathematics, and in their overall grade average. The Mn-exposed children also performed more poorly on a battery of neurobehavioral tests. It was also found a significant association between higher WMn and lower cognitive performance, verbal function, and full-scale intelligence quotient (IQ) scores. Young children appear to make up a vulnerable group in exposed populations. Toxicity of WMn is a problem particularly in areas of industrial waste or where Mn is leaching from the soil into public drinking water. Practical and cost-effective approaches are available to remove Mn from drinking water. It is crucial to protect developing brains against Mn toxicity.