The Relationship of Children's Intelligence Quotient and Blood Lead and Zinc Levels: a Meta-analysis and System Review

Airborne Lead Exposure and Childhood Cognition: The Environmental Influences on Child Health Outcomes (ECHO) Cohort (2003-2022)

Objectives. To examine whether a previously reported association between airborne lead exposure and children's cognitive function replicates across a geographically diverse sample of the United States. Methods. Residential addresses of children (< 5 years) were spatially joined to the Risk-Screening Environmental Indicators model of relative airborne lead toxicity. Cognitive outcomes for children younger than 8 years were available for 1629 children with IQ data and 1476 with measures of executive function (EF; inhibitory control, cognitive flexibility). We used generalized linear models using generalized estimating equations to examine the associations of lead, scaled by interquartile range (IQR), accounting for individual- and area-level confounders. Results. An IQR increase in airborne lead was associated with a 0.74-point lower mean IQ score (b = -0.74; 95% confidence interval = -1.00, -0.48). The association between lead and EF was nonlinear and was modeled with a knot at the 97.5th percentile of lead in our sample. Lead was significantly associated with lower mean inhibitory control but not with cognitive flexibility. This effect was stronger among males for both IQ and inhibitory control. Conclusions. Early-life exposure to airborne lead is associated with lower cognitive functioning. (Am J Public Health. 2024;114(3):309-318. https://doi.org/10.2105/AJPH.2023.307519).

The association of high-fluoride and high-iodine combined exposure with dental fluorosis and goiter: a meta-analysis

It is controversial that high-fluoride and high-iodine combined exposure affects the prevalence of dental fluorosis and goiter. The aim of this study was to explore the potential association between high-fluoride and high-iodine combined exposure with dental fluorosis and goiter. We retrieved relevant articles from PubMed, Cochrane Library, China National Knowledge Infrastructure, Wanfang Database and China Science and Technology Journal Database (VIP). The query format was 1 # "Fluorosis" OR "Fluoride," 2 # "Iodine" OR "Iodide," and 3 # 1 AND 2. A total of 20 papers were included in this study after independent review by two investigators. Our analysis showed that high-fluoride and high-iodine biphasic exposure was significantly associated with the prevalence of goiter (OR = 4.69, 95% CI 2.82-7.80, P < 0.001). The prevalence of dental fluorosis was also significantly raised (OR = 11.71, 95% CI 7.57-18.14, P < 0.001). Sensitivity analysis suggested that combined statistics of multiple studies were reliable. For goiter, subgroup analysis revealed study province, sample size and published year as sources of heterogeneity (P < 0.001). For dental fluorosis, only sample size was the impact factor of heterogeneity. As well, funnel plot, Begg's test and Egger's test suggested there was no publication bias (P > 0.05). Overall, our study demonstrates that high-fluoride and high-iodine combined exposure is a risk factor for occurrence of dental fluorosis and goiter. The chronic of high-fluoride and high-iodine combined exposure is a significant higher risk of disease than normal.

The relationship between childhood blood lead levels below 5 µg/dL and childhood intelligence quotient (IQ): Protocol for a systematic review and meta-analysis

BACKGROUND

The causal association between childhood lead (Pb) exposure and decrements in intelligence quotient (IQ) is well-established, and no safe blood lead level (BLL) in children has been identified. An international pooled analysis of seven prospective studies published by Lanphear et al. in 2005 quantified the relationship between childhood BLL and IQ. Further studies of Pb and IQ have been published more recently with mean BLLs generally lower than in the studies analyzed by Lanphear et al. In this article, we present the protocol for a systematic review to estimate an updated Pb-IQ relationship focusing on BLLs below 5 µg per deciliter (µg/dL).

STUDY QUESTION

What is the quantitative relationship between childhood BLLs and IQ at ages 3-17 years at BLLs below 5 μg/dL?

DATA SOURCES

A comprehensive search of the scientific literature will utilize citation mapping and key word searching. In the citation mapping approach, we will identify seed references that are relevant to our study question, and will then identify more recent references that have cited at least one of the seed references. The key word search will be conducted in the PubMed, Biosis Previews, Scopus, and Web of Science databases. We will also search electronic grey literature databases for conference proceedings, dissertations, and preprints.

STUDY ELIGIBILITY CRITERIA, STUDY SCREENING AND DATA EXTRACTION

We will include studies that measured BLL in children at any age, assessed full-scale IQ of the same children (concurrent with or subsequent to BLL sample collection) at ages 3-17, and estimated a continuous quantitative relationship between BLL and IQ. We will consider only studies with a central tendency BLL < 10 µg/dL. The title and abstract of each record will be reviewed independently by two authors to determine whether the study in question satisfies the inclusion criteria. The full text of each article remaining after title-abstract screening will be reviewed independently by two authors to determine whether the study in question satisfies the inclusion criteria. Two authors will independently extract study characteristics and data from each included study.

RISK OF BIAS ASSESSMENT

Studies meeting inclusion criteria will be evaluated for risk of bias (RoB) using the Navigation Guide method applied in a previous systematic review of neurodevelopmental effects (Lam et al., 2017), with adaptation to our study question. Each study will be independently evaluated by two review authors.

DATA ANALYSIS AND SYNTHESIS

We intend to conduct a random-effects meta-analysis to summarize the effects of children's exposure to Pb on IQ scores. Additionally, we plan to perform sensitivity analyses using sub-group analyses and/or meta-regression techniques to assess the impact of study design and study population characteristics to examine potential heterogeneity of results across studies. We will assign a confidence level rating (high, moderate, low, or very low) to the effect estimate from the meta-analyses/meta-regressions.

Urinary Pb levels in schoolchildren from the largest coal mining area in Brazil and its associated factors: a cross-sectional study

Candiota region has the largest coal reserve in Brazil, and previous studies have shown moderate-high levels of metals in the environment, including Pb. On the other hand, there are no studies investigating the factors associated with high levels of urinary Pb in children in the region. To investigate this issue, a cross-sectional study was conducted with 92 schoolchildren from 7 cities comprising this coal-mining region. Socioeconomic and demographic information and parental life habits and children's health information were collected using a semi-structured questionnaire. Diurnal urine samples were collected to quantify Pb levels (µg/g creatinine). Bi- and multivariate Poisson regression with a robust estimator was used to assess factors associated with high levels of Pb. Urinary Pb levels in children in the region vary from not detected to 21.6 µg/g of creatinine. The spatial distribution of urinary Pb levels in children indicated an influence of proximity to mining areas, and this factor was confirmed by Poisson regression analysis (bivariate). Other factors associated with high levels of urinary Pb were non-white mothers, paternal occupational exposure, and low BMI. The findings of this study reveal that the Candiota region is a hotspot for high levels of urinary Pb in children (geometric mean: 3.82 µg/g creatinine) and that, in addition to the proximity to mining areas, factors socioeconomic and health conditions may be associated with these high levels.

Effects of marginal zinc deficiency on learning and memory ability after birth

Zinc deficiency during pregnancy and severe zinc deficiency after birth both impaired learning and memory ability, but the effects of marginal zinc deficiency (MZD) after birth on learning and memory are unclear. In the first experiment, 4-week-old male rats were randomly divided into three groups: the marginal zinc-deficient group (MZG, 10 mg kg^-1, 1/3 RNI), normal zinc group (NZG, 30 mg kg^-1, RNI), and paired zinc group (PZG, 30 mg kg^-1). After a 4-week feeding period, the brain weight, brain coefficient, and serum zinc concentration were measured, and hippocampal proteomics analysis was performed. In the second experiment, 4-week-old male rats were fed the same diet for 8 weeks. In addition to the previously mentioned indicators, the Morris water maze results, brain pathology, post-translational modifications (PTMs) of hippocampal proteins, and the concentrations of indicators known to be related to learning and memory were analyzed. In both experiments, compared with those of the NZG, the food intake, body weight and serum zinc of the MZG were significantly decreased, and the brain weight was unchanged, but the brain coefficient was increased. Two hippocampal proteomics analyses and PTM screening showed that MZD did not change the expression and PTM of proteins. The brain pathology, learning, memory and the concentrations of indicators known to be related to learning and memory were not changed by MZD. Our study confirmed that marginal zinc deficiency (10 mg kg^-1, 1/3 RNI) had no effect on the learning and memory abilities of rats after birth.

Correlation between As, Cd, Hg, Pb and Sn concentration in human milk and breastfeeding mothers' food consumption: a systematic review and infants' health risk assessment

Mothers' food and water consumption appear to be determining factors for infants' potentially toxic elements exposure through human milk. Therefore, this systematic review aimed to assess correlations between As, Cd, Hg, Pb and/or Sn concentration in human milk and breastfeeding mothers' food consumption, with later infants' health risk assessment. Estimated Daily Intakes of such elements by infants were also calculated and compared with reference values (RfD or BMDL01). Among 5.663 identified studies, 23 papers remained for analysis. Potentially toxic elements concentration in human milk presented positive correlation with seafood (As, Hg), fresh vegetables (Hg, Cd), cereals (Hg, Cd), cheese, rice, potatoes, private and well-water supply (Pb), wild meat (Pb, Cd) and milk, dairy products, dried fruits and oilseeds (Cd) mothers' consumption. Red meat, caffeinated drinks, and dairy products consume presented negative correlations (Pb). No correlations were found for Sn. Infants from three studies presented high Hg exposition through human milk (> 0. 1 μg/kg PC-1 day-1), as well as observed for Pb in one study (> 0. 5 μg/kg PC-1 day-1). Potentially toxic elements can damage infants' health when they are present in mothers' diet due to the infants' high vulnerability. Therefore, these results raise important issues for public health.Supplemental data for this article is available online at https://doi.org/10.1080/10408398.2022.2056869 .

IQ alteration induced by lead in developed and underdeveloped/developing countries: A systematic review and a meta-analysis

The aim of this study was to evaluate the effects of Pb exposure on full-scale IQ score in pediatric subjects. Following PRISMA guidelines, the data from January 2010 to April 2020 were systematically searched and collected on electronic databases (PubMed, Scopus, and Embase). The eligibility criteria included cross-sectional, cohort, and case-control studies that were published in English, from 2010 to 2020, that analyzed the blood Pb levels of pediatric subjects (0-19 years) and possible changes in the full-scale IQ score. In this study, 2174 scientific papers were collected from three electronic databases. From those, 726 were duplicates and 1421 were excluded because they did not meet the eligibility criteria, resulting in a total of 27 papers, from which, seven were used to perform the meta-analysis. The 27 scientific papers systematically selected for this study were separated by the country where the study was realized in developed and underdeveloped/developing countries. In the underdeveloped/developing countries the blood Pb levels are higher and showed a greater variation (1.30-11.66 μgPb/dL of blood) than in countries with higher development index (0.57-4.80 μgPb/dL of blood). The full-scale IQ score are inversely proportional to the blood Pb values, and it is possible to see that in the underdeveloped/developing countries the full-scale IQ score showed lower values and greater variation (59.2-111) compared to the individuals from developed countries (91.9-114.5). In conclusion, it was observed that blood Pb levels alter the full-scale IQ score. Thus, policies for the prevention of environmental contamination and the reduction of Pb exposure must be taken, mainly, in underdeveloped/developing countries.

Firearm licenses associated with elevated pediatric blood lead levels in Massachusetts

OBJECTIVE

To determine the association between firearm-related lead exposure and pediatric blood lead levels.

METHODS

Using data available through the Massachusetts Departments of Public Health and Criminal Justice Information Services, we examined the association between active class A firearm licenses in a community with the prevalence of elevated blood lead levels in children aged 0-4. Correlational and hierarchical multiple regression analyses were conducted with potential confounders and other exposures such as lead paint, lead in water, presence of firing ranges, and social, economic, and occupational variables.

RESULTS

Data from 351 Massachusetts sub-counties were examined. Sub-counties with higher rates of firearm licensure also report higher rates of lead exposure among children. Children in the highest quartile communities were 2.16 times more likely to have elevated BLLs when compared to their peers in the lower quartiles. A one standard deviation change in firearm licensure percentage was found to reflect a 0.96% increase in elevated pediatric blood lead levels. Regression analyses demonstrated that the inclusion of firearm licensure significantly improved the prediction of pediatric BLL. Models were adjusted for percent of a population employed in construction, agriculture, forestry, fishing, hunting, and mining, income distribution, and potential lead paint exposure, which were found to be the primary predictors of elevated pediatric blood lead levels.

DISCUSSION

Firearm use and ownership remains one of the least researched areas in the public health sphere. While the risks of childhood lead exposure are widely understood, including the mechanisms of firearm-related lead exposure and tracking, to date no research has extensively examined it in children and on the community level. Our findings indicate a dire need for continued research on the risks associated with firearm use, ownership, and lead exposure.

Proximity to sources of airborne lead is associated with reductions in Children's executive function in the first four years of life

Although policies to remove lead from gasoline have resulted in a substantial reduction in airborne lead, multiple industries are known to generate lead that is released in the air. The present study examines the extent to which residential proximity to a documented source of airborne lead is associated with intellectual and executive function in children. Data were available for n = 849 children from the Family Life Project. Geolocation for children's residences between birth and 36 months were referenced against the Environmental Protection Agency's Risk Screening Environmental Indicators (RSEI) database, which estimates exposure for each ½ mile grid in the contiguous United States. Instrumental variable models were employed to estimate causal associations between exposure and cognitive outcomes measured at 36, 48, and 60 months, using census-documented density of manufacturing employment as the instrument. Models of continuous lead dosage indicated small negative effects for both child IQ and executive function (EF). These results indicate that RSEI estimates of airborne lead exposure are meaningfully associated with decrements in cognitive development.

The association between serum zinc level and overweight/obesity: a meta-analysis

PURPOSE

The association between serum zinc level and overweight/obesity remains controversial. Hence, we performed a meta-analysis to summarize the relationships.

METHODS

A systematic literature search was performed in PubMed, Web of Science and Embase for relevant English articles up to April 20, 2018. The pooled standardized mean difference (SMD) with 95% confidence interval (CI) was calculated with the random-effect model.

RESULTS

For children and adults, the results showed that serum zinc level was significantly lower in the cases compared to controls ([SMD (95% CI): - 1.13 (- 2.03, - 0.23), Z = 2.45, P for Z = 0.014; I² = 97.1%, P for I² < 0.001] and [SMD (95% CI): - 0.41 (- 0.68, - 0.15), Z = 3.03, P for Z = 0.002; I² = 62.9%, P for I² = 0.009], respectively). The difference of serum zinc level between overweight adults and controls was not statistically significant [SMD (95% CI): - 0.09 (- 0.27, 0.09), Z = 0.97, P for Z = 0.334; I² = 0.0%, P for I² = 0.411]. In subgroup analyses, a lower serum zinc level in obese children compared with non-obese controls was observed [SMD (95% CI): - 2.14 (- 3.20, - 1.09)], and the SMD differ significantly between obese adults and controls in the case-control studies [SMD (95% CI): - 0.49 (- 0.90, - 0.08)].

CONCLUSION

Our meta-analysis suggested that the serum zinc level was significantly lower in obese children and adults. More large observational studies are required to confirm these results in future research.