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Fu M, Zhu Z, Xiang Y, Yang Q, Yuan Q, Li X, Yu G. Associations of Blood and Urinary Heavy Metals with Stress Urinary Incontinence Risk Among Adults in NHANES, 2003-2018. Biol Trace Elem Res 2024:10.1007/s12011-024-04264-8. [PMID: 38884860 DOI: 10.1007/s12011-024-04264-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 06/05/2024] [Indexed: 06/18/2024]
Abstract
People come into contact with heavy metals in various ways in their daily lives. Accumulating evidence shows that toxic metal exposure is hazardous to human health. However, limited information is available regarding the impact of metal mixtures on stress urinary incontinence (SUI). Therefore, we used data from 10,622 adults from the 2003-2018 National Health and Nutrition Examination Survey (NHANES) to investigate the independent and comprehensive association between heavy metal co-exposure and SUI. Among them, 2455 (23.1%) had been diagnosed with SUI, while the rest had no SUI. We evaluated the independent and combined associations of 3 blood metals and 10 urinary metals with SUI risk, along with subgroup analyses according to age and gender. In the single-exposure model, blood cadmium (Cd), lead (Pb), mercury (Hg), urinary Cd, Pb, and cesium (Cs) were found to be positively connected with SUI risk. Moreover, weighted quantile sum (WQS) regression, quantile-based g-computation (qgcomp), and Bayesian kernel machine regression (BKMR) consistently demonstrated blood and urinary metal-mixed exposure were positively associated with the risk of SUI, and emphasized that blood Pb and Cd and urinary Cd and Cs were the main positive drivers, respectively. This association was more pronounced in the young and middle-aged group (20-59 years old) and the female group. Nevertheless, further research is necessary to validate these significant findings.
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Affiliation(s)
- Maoling Fu
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Road, Wuhan, 430030, Hubei, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, 13 Aviation Road, Wuhan, 430030, Hubei, China
| | - Zifan Zhu
- School of Mental Health and Psychological Science, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Yechen Xiang
- Department of Urology, Hunan University of Medicine General Hospital, Hunan University of Medicine, 370 Jinxi South Road, Huaihua, 418000, Hunan, China
| | - Qiaoyue Yang
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Road, Wuhan, 430030, Hubei, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, 13 Aviation Road, Wuhan, 430030, Hubei, China
| | - Quan Yuan
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, 13 Aviation Road, Wuhan, 430030, Hubei, China
| | - Xinyu Li
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Road, Wuhan, 430030, Hubei, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, 13 Aviation Road, Wuhan, 430030, Hubei, China
| | - Genzhen Yu
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Road, Wuhan, 430030, Hubei, China.
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Wang H, Zhang Y, Sun L, Guo X, Liu Q, Li J, Tian Z, Cheng X, Wang Y, Li H, Hu B, Sheng J, Qu G, Chen G, Liu X, Lin W, Tao F, Yang L. Associations of toxic metals and their mixture with hyperuricemia in Chinese rural older adults. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2024; 46:256. [PMID: 38884822 DOI: 10.1007/s10653-024-02035-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/14/2024] [Indexed: 06/18/2024]
Abstract
Previous studies have related single toxic metals (TMs) to hyperuricemia (HUA) among the general population, however, the association of the TM mixture with HUA, especially in older adults, remains poorly understood. We aimed to examine the relationships between individual TMs and their mixture and HUA in Chinese rural older adults. This study consisted of 2075 rural older adults aged 60 years or over. Blood concentrations of aluminum (Al), arsenic (As), barium (Ba), cadmium (Cd), cesium (Cs), gallium (Ga), mercury (Hg), lead (Pb), thallium (Tl), and uranium (U) were detected using inductively coupled plasma mass spectrometry. The associations of single TMs with HUA were assessed using logistic regression and restricted cubic spline (RCS) models, and the association of TM mixture with HUA was explored using the elastic net with environmental risk score (ENET-ERS), quantile g-computation (QGC), and Bayesian kernel machine regression (BKMR) models, respectively. Adjusted logistic regression model showed that Cs (OR = 1.65, 95% CI 1.37-1.99) and Pb (OR = 1.46, 95% CI 1.28-1.67) were positively related to HUA, and RCS model exhibited a positive linear association of Cs and Pb with HUA. ENET-ERS and QGC models quantified a positive correlation between the TM mixture and the odds of HUA, with estimated ORs of 1.15 (95% CI 1.11-1.19) and 1.84 (95% CI 1.37-2.47), respectively, and Cs and Pb had the most weight. BKMR model demonstrated a significant linear association between the TM mixture and increased odds of HUA, with the posterior inclusion probabilities (PIPs) of both Cs and Pb being 1.00. Moreover, we observed a positive interaction between Cs and Pb on HUA. The TM mixture is associated with increased odds of HUA in rural older adults, which may mainly be driven by Cs and Pb. Subsequent studies are warranted to confirm these findings and clarify the mechanisms linking multiple TMs with HUA.
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Affiliation(s)
- Hongli Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Meishan Road 81, Hefei, 230032, Anhui, China
- Center for Big Data and Population Health of IHM, Anhui Medical University, Hefei, 230032, Anhui, China
- Scientific Research Center in Preventive Medicine, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Yan Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Meishan Road 81, Hefei, 230032, Anhui, China
- Center for Big Data and Population Health of IHM, Anhui Medical University, Hefei, 230032, Anhui, China
- Scientific Research Center in Preventive Medicine, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Liang Sun
- Fuyang Center for Diseases Prevention and Control, Fuyang, 236069, Anhui, China
| | - Xianwei Guo
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Meishan Road 81, Hefei, 230032, Anhui, China
| | - Qiang Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Meishan Road 81, Hefei, 230032, Anhui, China
- Center for Big Data and Population Health of IHM, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Junzhe Li
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Meishan Road 81, Hefei, 230032, Anhui, China
- Center for Big Data and Population Health of IHM, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Ziwei Tian
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Meishan Road 81, Hefei, 230032, Anhui, China
- Center for Big Data and Population Health of IHM, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Xuqiu Cheng
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Meishan Road 81, Hefei, 230032, Anhui, China
- Center for Big Data and Population Health of IHM, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Yuan Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Meishan Road 81, Hefei, 230032, Anhui, China
- Center for Big Data and Population Health of IHM, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Huaibiao Li
- Fuyang Center for Diseases Prevention and Control, Fuyang, 236069, Anhui, China
| | - Bing Hu
- Fuyang Center for Diseases Prevention and Control, Fuyang, 236069, Anhui, China
| | - Jie Sheng
- Scientific Research Center in Preventive Medicine, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Guangbo Qu
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Meishan Road 81, Hefei, 230032, Anhui, China
| | - Guimei Chen
- School of Health Services Management, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Xuechun Liu
- Department of Neurology, The Second People's Hospital of Hefei, Hefei, 230011, Anhui, China
| | - Wenbo Lin
- Second School of Clinical Medicine, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Fangbiao Tao
- Center for Big Data and Population Health of IHM, Anhui Medical University, Hefei, 230032, Anhui, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, 230032, Anhui, China
| | - Linsheng Yang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Meishan Road 81, Hefei, 230032, Anhui, China.
- Center for Big Data and Population Health of IHM, Anhui Medical University, Hefei, 230032, Anhui, China.
- Scientific Research Center in Preventive Medicine, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China.
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, 230032, Anhui, China.
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Li Y, Lv Y, Jiang Z, Ma C, Li R, Zhao M, Guo Y, Guo H, Zhang X, Li A, Liu Y. Association of co-exposure to organophosphate esters and per- and polyfluoroalkyl substances and mixture with cardiovascular-kidney-liver-metabolic biomarkers among Chinese adults. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2024; 280:116524. [PMID: 38838464 DOI: 10.1016/j.ecoenv.2024.116524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 05/14/2024] [Accepted: 05/27/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Organophosphate esters (OPEs) and Per- and polyfluoroalkyl substances (PFAS) are ubiquitous environmental contaminants with common exposure sources, leading to their widespread presence in human body. However, evidence on co-exposure to OPEs and PFAS and its impact on cardiovascular-kidney-liver-metabolic biomarkers remains limited. METHODS In this cross-sectional study, 467 adults were enrolled from January to May 2022 during physical visits in Shijiazhuang, Hebei province. Eleven types of OPEs and twelves types of PFAS were detected, among which eight OPEs and six PFAS contaminants were detected in more than 60% of plasma samples. Seventeen biomarkers were assessed to comprehensively evaluate the cardiovascular-kidney-liver-metabolic function. Multiple linear regression, multipollutant models with sparse partial least squares, and Bayesian kernel machine regression (BKMR) models were applied to examine the associations of individual OPEs and PFAS and their mixtures with organ function and metabolism, respectively. RESULTS Of the over 400 exposure-outcome associations tested when modelling, we observed robust results across three models that perfluorohexanoic acid (PFHxS) was significantly positively associated with alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), and indirect bilirubin (IBIL). Perfluorononanoic acid was significantly associated with decreased AST/ALT and increased very-low-density lipoprotein cholesterol levels. Besides, perfluorodecanoic acid was correlated with increased high lipoprotein cholesterol and perfluoroundecanoic acid was consistently associated with lower glucose level. BKMR analysis showed that OPEs and PFAS mixtures were positively associated with IBIL and TBIL, among which PFHxS was the main toxic chemicals. CONCLUSIONS Our findings suggest that exposure to OPEs and PFAS, especially PFHxS and PFNA, may disrupt organ function and metabolism in the general population, providing insight into the potential pathophysiological mechanisms of OPEs and PFAS co-exposure and chronic diseases.
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Affiliation(s)
- Yanbing Li
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing 100005, PR China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100005, PR China
| | - Yi Lv
- Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang 050017, PR China
| | - Zexuan Jiang
- Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang 050017, PR China
| | - Chaoying Ma
- Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang 050017, PR China
| | - Ran Li
- Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang 050017, PR China
| | - Mengwei Zhao
- Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang 050017, PR China
| | - Yi Guo
- Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang 050017, PR China
| | - Huicai Guo
- Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang 050017, PR China; Hebei Key Laboratory of Environment and Human Health, Shijiazhuang, Hebei Province 050017, PR China; The Key Laboratory of Neural and Vascular Biology, Ministry of Education, Shijiazhuang 050017, PR China
| | - Xiaoguang Zhang
- Core Facilities and Centers of Hebei Medical University, Shijiazhuang 050017, PR China
| | - Ang Li
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing 100005, PR China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100005, PR China; Hebei Key Laboratory of Environment and Human Health, Shijiazhuang, Hebei Province 050017, PR China.
| | - Yi Liu
- Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang 050017, PR China; Hebei Key Laboratory of Environment and Human Health, Shijiazhuang, Hebei Province 050017, PR China.
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Ye X, Xu T, Yang L, Hu X, Xie X, Lan G, Lu X, Huang Z, Wang T, Wu J, Lan J, Zhang Q, Zhan Z, Guo Y, Xie X. Association between plasma metal exposure and health span in very elderly adults: a prospective cohort study with mixture statistical approach. BMC Geriatr 2024; 24:388. [PMID: 38693478 PMCID: PMC11064295 DOI: 10.1186/s12877-024-05001-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 04/22/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND Metals have been linked to a diverse spectrum of age-related diseases; however, the effects of metal exposure on health span remains largely unknown. This cohort study aims to determine the association between plasma metal and health span in elder adults aged ≥ 90 years. METHODS The plasma concentrations of seven metals were measured at baseline in 300 elder adults. The end of the health span (EHS) was identified as the occurrence of one of eight major morbidities or mortality events. We used Cox regression to assess hazard ratios (HR). The combined effects of multiple metal mixtures were estimated using grouped-weighted quantile sum (GWQS), quantile g-computation (Q-gcomp), and Bayesian kernel machine regression (BKMR) methods. RESULTS The estimated HR for EHS with an inter-quartile range (IQR) increment for selenium (Se) was 0.826 (95% confidence interval [CI]: 0.737-0.926); magnesium (Mg), 0.806 (95% CI: 0.691-0.941); iron (Fe), 0.756 (95% CI: 0.623-0.917), and copper (Cu), 0.856 (95% CI: 0.750-0.976). The P for trend of Se, Mg, and Fe were all < 0.05. In the mixture analyses, Q-gcomp showed a negative correlation with EHS (P = 0.904), with the sum of the negative coefficients being -0.211. CONCLUSION Higher plasma Se, Mg, and Fe reduced the risk of premature end of health span, suggesting that essential metal elements played a role in health maintenance in elder adults.
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Affiliation(s)
- Xiaoying Ye
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Tingting Xu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Le Yang
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Xiangju Hu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
- Department for Chronic and Noncommunicable Disease Control and Prevention, Fujian Provincial Center for Disease Control and Prevention, Fuzhou, China
| | - Xiaowei Xie
- The First Clinical Medical School, Shanxi Medical University, Taiyuan, China
| | - Guohui Lan
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Xiaoli Lu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Zelin Huang
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Tinggui Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Jieyu Wu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Jieli Lan
- Clinical Research Unit, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, China
| | - Qian Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Zhiying Zhan
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Yansong Guo
- Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China.
- Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Provincial Center for Geriatrics, Fujian Provincial Clinical Research Center for Severe Acute Cardiovascular Diseases, Fuzhou, China.
- Fujian Heart Failure Center Alliance, Fuzhou, China.
| | - Xiaoxu Xie
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China.
- Clinical Research Unit, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, China.
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5
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Wang Y, Liu Q, Tian Z, Cheng B, Guo X, Wang H, Zhang B, Xu Y, Sun L, Hu B, Chen G, Sheng J, Liang C, Tao F, Wei J, Yang L. Short-term effects of ambient PM 1, PM 2.5, and PM 10 on internal metal/metalloid profiles in older adults: A distributed lag analysis in China. ENVIRONMENT INTERNATIONAL 2023; 182:108341. [PMID: 38006770 DOI: 10.1016/j.envint.2023.108341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 10/24/2023] [Accepted: 11/20/2023] [Indexed: 11/27/2023]
Abstract
There is limited evidence linking exposure to ambient particulate matter (PM) with internal doses of metals and metalloids (metal(loid)s). This study aimed to evaluate the effects of short-term exposure to ambient PM on urine metal(loid)s among Chinese older adults. Biological monitoring data of 15 urine metal(loid)s collected in 3, 970 community-dwelling older adults in Fuyang city, Anhui Province, China, from July to September 2018, were utilized. PMs with an aerodynamic diameter ≤ 1 µm (PM1), ≤ 2.5 µm (PM2.5), and ≤ 10 µm (PM10) up to eight days before urine collection were estimated by space-time extremely randomized trees (STET) model. Residential greenness was reflected by Normalized Difference Vegetation Index (NDVI). We used generalized additive model (GAM) combined with distributed lag linear/non-linear models (DLMs/DLNMs) to estimate the associations between short-term PM exposure and urine metal(loid)s. The results suggested that the cumulative exposures to PM1, PM2.5, or PM10 over two days (lag0-1 days) before urine collection were associated with elevated urine metal(loid)s in DLMs, while exhibited linear or "inverted U-shaped" relationships with seven urine metal(loid)s in DLNMs, including Gallium (Ga), Arsenic (As), Aluminum (Al), Magnesium (Mg), Calcium (Ca), Uranium (U), and Barium (Ba). Aforementioned results indicated robust rather than spurious associations between PMs and these seven metal(loid)s. After standardizations for three PMs, PM1 was the greatest contributor to U, PM2.5 made the greatest contributions to Ga, As, Al, and Ba, and PM10 contributed the most to Mg and Ca. Furthermore, the effects of three PMs on urine Ga, As, Al, Mg, Ca, and Ba were reduced when exposed to higher levels of NDVI. Overall, short-term exposures to ambient PMs contribute to elevated urinary metal(loid) levels in older adults, and three PMs exhibit various contributions to different urine metal(loid)s. Moreover, residential greenness may attenuate the effects of PMs on urine metal(loid)s.
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Affiliation(s)
- Yuan Wang
- School of Public Health, Department of Epidemiology and Health Statistics, Anhui Medical University, Hefei 230032, Anhui, China; Scientific Research Center in Preventive Medicine, School of Public Health, Anhui Medical University, Hefei 230032, Anhui, China
| | - Qiang Liu
- School of Public Health, Department of Epidemiology and Health Statistics, Anhui Medical University, Hefei 230032, Anhui, China; Scientific Research Center in Preventive Medicine, School of Public Health, Anhui Medical University, Hefei 230032, Anhui, China
| | - Ziwei Tian
- School of Public Health, Department of Epidemiology and Health Statistics, Anhui Medical University, Hefei 230032, Anhui, China; Scientific Research Center in Preventive Medicine, School of Public Health, Anhui Medical University, Hefei 230032, Anhui, China
| | - Beijing Cheng
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, Jiangsu, China
| | - Xianwei Guo
- School of Public Health, Department of Epidemiology and Health Statistics, Anhui Medical University, Hefei 230032, Anhui, China
| | - Hongli Wang
- School of Public Health, Department of Epidemiology and Health Statistics, Anhui Medical University, Hefei 230032, Anhui, China
| | - Bo Zhang
- School of Public Health, Department of Epidemiology and Health Statistics, Anhui Medical University, Hefei 230032, Anhui, China
| | - Yan Xu
- School of Public Health, Department of Epidemiology and Health Statistics, Anhui Medical University, Hefei 230032, Anhui, China
| | - Liang Sun
- Fuyang Center for Diseases Prevention and Control, Fuyang, Anhui 236069, China
| | - Bing Hu
- Fuyang Center for Diseases Prevention and Control, Fuyang, Anhui 236069, China
| | - Guimei Chen
- School of Health Services Management, Anhui Medical University, Hefei, Anhui 230032, China
| | - Jie Sheng
- Scientific Research Center in Preventive Medicine, School of Public Health, Anhui Medical University, Hefei 230032, Anhui, China
| | - Chunmei Liang
- School of Public Health, Department of Hygiene Inspection and Quarantine, Anhui Medical University, Hefei, Anhui 230032, China
| | - Fangbiao Tao
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei 230032, Anhui, China
| | - Jing Wei
- Department of Atmospheric and Oceanic Science, Earth System Science Interdisciplinary Center, University of Maryland, College Park, MD 20740, USA.
| | - Linsheng Yang
- School of Public Health, Department of Epidemiology and Health Statistics, Anhui Medical University, Hefei 230032, Anhui, China; Scientific Research Center in Preventive Medicine, School of Public Health, Anhui Medical University, Hefei 230032, Anhui, China.
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Wang X, Li A, Zhao M, Xu J, Mei Y, Xu Q. Differential effects of PM 2.5 and its carbon components on blood pressure in hypertensive and non-hypertensive populations: a panel study in Beijing. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:123226-123236. [PMID: 37981604 DOI: 10.1007/s11356-023-30532-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 10/13/2023] [Indexed: 11/21/2023]
Abstract
Published literature considering the association between ambient air pollution and blood pressure is highly inconsistent, which may be explained by the different proportions of susceptible subpopulations. We hypothesized that hypertensive patients are more sensitive to air pollution due to the disruption of neurohumoral system. The study aimed to reveal the association between PM2.5 and its carbon components and blood pressure, and whether this association is modified by hypertension status. We conducted a panel study in Beijing, China. Four repeated measurements were performed from 2016 to 2018. Linear mixed-effects models and generalized additive mixed models were performed to investigate the associations between PM2.5 and its carbon components and blood pressure. Subgroup analyses were performed by hypertension status to reveal potential effect modification. Among hypertensive patients, for every 1 μg/m3 increment of PM2.5, TC, OC, and EC in 1-day to 2-day MA, SBP increased from 0.16 mmHg (95% CI, 0.03 to 0.29) to 6.75 mmHg (95% CI, 2.82 to 10.68), and PP increased from 0.14 mmHg (95% CI, 0.02 to 0.26) to 6.03% (95% CI, 2.46 to 9.59%), but no significant association was observed among non-hypertensive subjects. The p values for the interaction between pollutants and hypertension status in 1-day to 2-day MA were less than 0.05. These findings suggest that hypertensive patients may be more susceptible to the adverse effects of air pollution than non-hypertensive subjects, which might provide guidance to hypertensive patients living in areas with high levels of particle pollution.
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Affiliation(s)
- Xue Wang
- Department of Allergy and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, National Clinical Research Center for Immunologic Diseases, Beijing, 100730, China
| | - Ang Li
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China
- Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100005, China
| | - Meiduo Zhao
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China
- Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100005, China
| | - Jing Xu
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China
- Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100005, China
| | - Yayuan Mei
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China
- Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100005, China
| | - Qun Xu
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China.
- Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100005, China.
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7
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Zha B, Liu Y, Xu H. Associations of mixed urinary metals exposure with metabolic syndrome in the US adult population. CHEMOSPHERE 2023; 344:140330. [PMID: 37783357 DOI: 10.1016/j.chemosphere.2023.140330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 09/19/2023] [Accepted: 09/28/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Metals are harmful to human health in many ways. However, the association between metals and metabolic syndrome (MetS) remains unclear. Aims of this study is to discuss the relationship between urinary metal and MetS. METHODS This study included 3419 adult participants from the National Health and Nutrition Examination Survey (NHANES) (2005-2018). Logistic regression analysis, Bayesian kernel machine regression (BKMR), weighted quantile sum (WQS), and restricted cubic spline (RCS) were used to explore the associations of nine urinary metal and MetS. RESULTS BKMR and WQS showed the effects of combined nine urinary metal were negatively correlated with MetS. Logistic regression analysis, WQS, and BKMR all suggested that cesium (Cs) and lead (Pb) were negatively correlated with MetS (all PFDCR <0.05). And RCS suggested log2-transformed Cs (χ2 = 20, P < 0.001) and log2-transformed Pb (χ2 = 19.9, P < 0.001) were negatively and linearly associated with MetS. CONCLUSION Existing evidence suggests that urine metal content is related to MetS. Cs and Pb are negatively related to MetS. It is still necessary to study and further discuss the causal relationship and mechanism.
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Affiliation(s)
- Bowen Zha
- Department of Education, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, PR China; Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, PR China.
| | - Yuqi Liu
- Department of Education, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149, PR China
| | - Huanchang Xu
- Department of Education, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149, PR China
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Luo KH, Wu CH, Yang CC, Chen TH, Tu HP, Yang CH, Chuang HY. Exploring the association of metal mixture in blood to the kidney function and tumor necrosis factor alpha using machine learning methods. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2023; 265:115528. [PMID: 37783110 DOI: 10.1016/j.ecoenv.2023.115528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 09/09/2023] [Accepted: 09/25/2023] [Indexed: 10/04/2023]
Abstract
This research aimed to approach relationships between metal mixture in blood and kidney function, tumor necrosis factor alpha (TNF-α) by machine learning. Metals levels were measured by Inductively Couple Plasma Mass Spectrometry in blood from 421 participants. We applied K Nearest Neighbor (KNN), Naive Bayes classifier (NB), Support Vector Machines (SVM), random forest (RF), Gradient Boosting Decision Tree (GBDT), Categorical boosting (CatBoost), eXtreme Gradient Boosting (XGBoost), Whale Optimization-based XGBoost (WXGBoost) to identify the effect of plasma metals, TNF-α, and estimated glomerular filtration rate (eGFR by CKD-EPI equation). We conducted not only toxic metals, lead (Pb), arsenic (As), cadmium (Cd) but also included trace essential metals, selenium (Se), copper (Cu), zinc (Zn), cobalt (Co), to predict the interaction of TNF-α, TNF-α/white blood count, and eGFR. The high average TNF-α level group was observed among subjects with higher Pb, As, Cd, Cu, and Zn levels in blood. No associations were shown between the low and high TNF-α level group in blood Se and Co levels. Those with lower eGFR group had high Pb, As, Cd, Co, Cu, and Zn levels. The crucial predictor of TNF-α level in metals was blood Pb, and then Cd, As, Cu, Se, Zn and Co. The machine learning revealed that As was the major role among predictors of eGFR after feature selection. The levels of kidney function and TNF-α were modified by co-exposure metals. We were able to acquire highest accuracy of over 85% in the multi-metals exposure model. The higher Pb and Zn levels had strongest interaction with declined eGFR. In addition, As and Cd had synergistic with prediction model of TNF-α. We explored the potential of machine learning approaches for predicting health outcomes with multi-metal exposure. XGBoost model added SHAP could give an explicit explanation of individualized and precision risk prediction and insight of the interaction of key features in the multi-metal exposure.
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Affiliation(s)
- Kuei-Hau Luo
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medicine University, Kaohsiung City 807, Taiwan
| | - Chih-Hsien Wu
- Department of Electronic Engineering, National Kaohsiung University of Science and Technology, Kaohsiung 80778, Taiwan
| | - Chen-Cheng Yang
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medicine University, Kaohsiung City 807, Taiwan; Department of Occupational Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan
| | - Tzu-Hua Chen
- Department of Family Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung 801, Taiwan
| | - Hung-Pin Tu
- Department of Public Health and Environmental Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Cheng-Hong Yang
- Department of Electronic Engineering, National Kaohsiung University of Science and Technology, Kaohsiung 80778, Taiwan; Department of Information Management, Tainan University of Technology, Tainan 71002, Taiwan; Drug Development and Value Creation Research Center, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; Ph. D. Program in Biomedical Engineering, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; School of Dentistry, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Hung-Yi Chuang
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medicine University, Kaohsiung City 807, Taiwan; Department of Public Health and Environmental Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan; Department of Occupational and Environmental Medicine, Kaohsiung Medicine University Hospital, Kaohsiung Medicine University, Kaohsiung City 807, Taiwan; Ph.D. Program in Environmental and Occupational Medicine, and Research Center for Precision Environmental Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
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9
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Li A, Zhou Q, Mei Y, Zhao J, Zhao M, Xu J, Ge X, Li Y, Li K, Yang M, Xu Q. Thyroid disrupting effects of multiple metals exposure: Comprehensive investigation from the thyroid parenchyma to hormonal function in a prospective cohort study. JOURNAL OF HAZARDOUS MATERIALS 2023; 459:132115. [PMID: 37499494 DOI: 10.1016/j.jhazmat.2023.132115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 07/01/2023] [Accepted: 07/20/2023] [Indexed: 07/29/2023]
Abstract
This study aimed to investigate the thyroid disrupting effects of multiple metals exposure with comprehensive investigation from the thyroid parenchyma to hormonal function. In this prospective cohort study of in-service staff of the Baoding Power Supply, we found that arsenic was negatively associated with total thyroxine (TT4) [βAs = -0.075, 95% confidence interval (CI): -0.129, -0.020, Padj = 0.04]. Similarly, selenium was negatively correlated with TT4 (βSe = -0.134, 95% CI: -0.211, -0.058, Padj < 0.01) and peripheral deiodinase activity (GT) (βSe = -0.133, 95% CI: -0.210, -0.056, Padj = 0.01). With respect to strontium, there were positive associations of strontium with thyroid-stimulating hormone (βSr = 0.263, 95% CI: 0.112, 0.414, Padj = 0.01), and negative associations of strontium with TT4 (βSr = -0.099, 95% CI: -0.150, -0.048, Padj < 0.01) and GT (βSr = -0.102, 95% CI: -0.153, -0.050, Padj < 0.01). We also observed negative associations of metal mixtures with TT4 and GT and potential interactions. Increased risks of thyroid nodule associated with aluminum, cobalt and nickel were also observed. Our findings suggest that multiple metals exposure leads to a multi-pronged assault to thyroid from the thyroid parenchyma to hormonal function. Future large-scale prospective cohort studies of general population and experimental studies were warranted.
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Affiliation(s)
- Ang Li
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100005, China
| | - Quan Zhou
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100005, China
| | - Yayuan Mei
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100005, China
| | - Jiaxin Zhao
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100005, China
| | - Meiduo Zhao
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100005, China
| | - Jing Xu
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100005, China
| | - Xiaoyu Ge
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100005, China
| | - Yanbing Li
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100005, China
| | - Kai Li
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100005, China
| | - Ming Yang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100005, China
| | - Qun Xu
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100005, China.
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10
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Yang M, Su W, Li H, Li L, An Z, Xiao F, Liu Y, Zhang X, Liu X, Guo H, Li A. Association of per- and polyfluoroalkyl substances with hepatic steatosis and metabolic dysfunction-associated fatty liver disease among patients with acute coronary syndrome. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2023; 264:115473. [PMID: 37722302 DOI: 10.1016/j.ecoenv.2023.115473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 09/02/2023] [Accepted: 09/11/2023] [Indexed: 09/20/2023]
Abstract
Etiology of hepatic steatosis and metabolic dysfunction-associated fatty liver disease (MAFLD) among acute coronary syndrome (ACS) remains unclear. Existing studies suggested the potential role of per- and polyfluoroalkyl substances (PFAS) in comorbidity of hepatic steatosis among ACS patients. Therefore, we conducted a cross-sectional study based on the ACS inpatients to assess the associations of plasma PFAS congeners and mixtures with hepatic steatosis and MAFLD. This study included 546 newly diagnosed ACS patients. Twelve PFAS were quantified using ultra-high-performance liquid chromatography-tandem mass spectrometry. Hepatic steatosis was defined by hepatic steatosis index (HSI). MAFLD was defined as the combination of hepatic steatosis based on the risk factor calculation with metabolic abnormalities. Generalized linear model was used to examine the associations of PFAS congeners with HSI and MAFLD. Adaptive elastic net (AENET) was further used for PFAS congeners selection. Mixture effects were also assessed with Bayesian kernel machine regression model (BKMR). Congeners analysis observed significant greater percent change of HSI for each doubling in PFOS (1.82%, 95% CI: 0.87%, 2.77%), PFHxS (1.17%, 95% CI: 0.46%, 1.89%) and total PFAS (1.84%, 95% CI: 0.56%, 3.14%). Moreover, each doubling in PFOS (OR=1.42, 95% CI: 1.13, 1.81), PFHxS (OR=1.31, 95% CI: 1.09, 1.59) and total PFAS (OR=1.43, 95% CI: 1.06, 1.94) was associated with increased risk of MAFLD. In AENET regression, only PFOS presented significant positive associations with HSI. Mixture analysis indicated significant positive associations between PFAS mixtures and HSI. This is the first study to demonstrate associations of PFAS congeners and mixtures with hepatic steatosis and MAFLD among ACS patients, which provides hypothesis into the mechanisms behind comorbidity of hepatic steatosis among ACS patients, as well as tertiary prevention of ACS.
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Affiliation(s)
- Ming Yang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing 100005, PR China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100005, PR China
| | - Weitao Su
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, PR China
| | - Haoran Li
- Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang 050017, PR China; Department of Pharmacy, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, PR China
| | - Longfei Li
- Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang 050017, PR China; Hebei Key Laboratory of Environment and Human Health, Hebei Province, Shijiazhuang 050017, PR China
| | - Ziwen An
- Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang 050017, PR China; Hebei Key Laboratory of Environment and Human Health, Hebei Province, Shijiazhuang 050017, PR China
| | - Fang Xiao
- Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang 050017, PR China; Hebei Key Laboratory of Environment and Human Health, Hebei Province, Shijiazhuang 050017, PR China
| | - Yi Liu
- Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang 050017, PR China; Hebei Key Laboratory of Environment and Human Health, Hebei Province, Shijiazhuang 050017, PR China
| | - Xiaoguang Zhang
- Core Facilities and Centers of Hebei Medical University, Shijiazhuang 050017, PR China
| | - Xuehui Liu
- Hebei Key Laboratory of Environment and Human Health, Hebei Province, Shijiazhuang 050017, PR China
| | - Huicai Guo
- Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang 050017, PR China; Hebei Key Laboratory of Environment and Human Health, Hebei Province, Shijiazhuang 050017, PR China.
| | - Ang Li
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing 100005, PR China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100005, PR China.
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11
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Mei Y, Li A, Zhao J, Zhou Q, Zhao M, Xu J, Li Y, Li K, Xu Q. Association of Long-term exposure to air pollution and residential greenness with lipid profile: Mediating role of inflammation. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2023; 257:114920. [PMID: 37105095 DOI: 10.1016/j.ecoenv.2023.114920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/22/2023] [Accepted: 04/15/2023] [Indexed: 05/08/2023]
Abstract
Lipidemic effect of air pollutants are still inconsistent and their joint effects are neglected. Meanwhile, identified inflammation pathways in animal have not been applied in epidemiological studies, and beneficial effect of residential greenness remained unclear. Therefore, we used data from typically air-polluted Chinese cities to answer these questions. Particulate matter (PM) with a diameter of ≤ 1 µm (PM1), PM with a diameter of ≤ 2.5 µm (PM2.5), PM with a diameter of ≤ 10 µm (PM10), sulphur dioxide (SO2), nitrogen dioxide (NO2), and ozone (O3) were predicted by space-time extremely randomized trees model. Residential greenness was reflected by Normalized Difference Vegetation Index (NDVI). Total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were measured, and atherogenic coefficient (AC) and TG/HDL-C (TGH) ratio were calculated to indicate lipid metabolism. Generalized additive mixed model and quantile g-computation were respectively conducted to investigate individual and joint lipidemic effect of air pollutants. Covariates including demographical characteristics, living habits, meteorological factors, time trends, and disease information were considered to avoid confounding our results. Complement C3 and high-sensitivity C-reactive protein (hsCRP) were analyzed as potential mediators. Finally, association between NDVI and lipid markers were explored. We found that long-term air pollutants exposure were positively associated with lipid markers. Complement C3 mediated 54.72% (95% CI: 0.30, 63.10) and 72.53% (95% CI: 0.65, 77.61) of the association between PM1 and TC and LDL-C, respectively. We found some significant associations of lipid markers with NDVI1000 m rather than NDVI500 m. BMI, disease status, smoke/drink habits are important effect modifiers. Results are robust in sensitive analysis. Our study indicated that air pollutants exposure may detriment lipid metabolism and inflammation may be the potential triggering pathways, while greenness may exert beneficial effects. This study provided insights for the lipidemic effects of air pollution and greenness.
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Affiliation(s)
- Yayuan Mei
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100005, China
| | - Ang Li
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100005, China
| | - Jiaxin Zhao
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100005, China
| | - Quan Zhou
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100005, China
| | - Meiduo Zhao
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100005, China
| | - Jing Xu
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100005, China
| | - Yanbing Li
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100005, China
| | - Kai Li
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100005, China
| | - Qun Xu
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100005, China.
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12
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Li A, Li Y, Mei Y, Zhao J, Zhou Q, Li K, Zhao M, Xu J, Ge X, Xu Q. Associations of metals and metals mixture with lipid profiles: A repeated-measures study of older adults in Beijing. CHEMOSPHERE 2023; 319:137833. [PMID: 36693480 DOI: 10.1016/j.chemosphere.2023.137833] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/25/2022] [Accepted: 01/10/2023] [Indexed: 06/17/2023]
Abstract
Metals inevitably and easily enter into human bodies and can induce a series of pathophysiological changes, such as oxidative stress damage and lipid peroxidation, which then may further induce dyslipidemia. However, the effects of metals and metals mixture on the lipid profiles are still unclear, especially in older adults. A three-visits repeated measurement of 201 older adults in Beijing was conducted from November 2016 to January 2018. Linear Mixed Effects models and Bayesian kernel machine regression models were used to estimate associations of eight blood metals and metals mixture with lipid profiles, including total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), Castelli risk indexes I (CRI-1), Castelli risk indexes II (CRI-2), atherogenic coefficient (AC), and non-HDL cholesterol (NHC). Cesium (Cs) was positively associated with TG (βCs = 0.14; 95% CI: 0.02, 0.26) whereas copper (Cu) was inversely related to TG (βCu = -0.65; 95%CI: -1.14, -0.17) in adjusted models. Manganese (Mn) was mainly related to higher HDL-C (βMn = 0.14; 95% CI: 0.07, 0.21) whereas molybdenum showed opposite association. Metals mixture was marginally positive associated with HDL-C, among which Mn played a crucial role. Our findings suggest that the effects of single metal on lipid profiles may be counteracted in mixtures in the context of multiple metal exposures; however, future studies with large sample size are still needed to focus on the detrimental effects of single metals on lipid profiles as well as to identify key components.
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Affiliation(s)
- Ang Li
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100005, China
| | - Yanbing Li
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100005, China
| | - Yayuan Mei
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100005, China
| | - Jiaxin Zhao
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100005, China
| | - Quan Zhou
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100005, China
| | - Kai Li
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100005, China
| | - Meiduo Zhao
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100005, China
| | - Jing Xu
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100005, China
| | - Xiaoyu Ge
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100005, China
| | - Qun Xu
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100005, China.
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13
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Mei Y, Li A, Zhao J, Zhou Q, Zhao M, Xu J, Li R, Li Y, Li K, Ge X, Guo C, Wei Y, Xu Q. Association of long-term air pollution exposure with the risk of prediabetes and diabetes: Systematic perspective from inflammatory mechanisms, glucose homeostasis pathway to preventive strategies. ENVIRONMENTAL RESEARCH 2023; 216:114472. [PMID: 36209785 DOI: 10.1016/j.envres.2022.114472] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 08/29/2022] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Limited evidence suggests the association of air pollutants with a series of diabetic cascades including inflammatory pathways, glucose homeostasis disorder, and prediabetes and diabetes. Subclinical strategies for preventing such pollutants-induced effects remain unknown. METHODS We conducted a cross-sectional study in two typically air-polluted Chinese cities in 2018-2020. One-year average PM1, PM2.5, PM10, SO2, NO2, and O3 were calculated according to participants' residence. GAM multinomial logistic regression was performed to investigate the association of air pollutants with diabetes status. GAM and quantile g-computation were respectively performed to investigate individual and joint effects of air pollutants on glucose homeostasis markers (glucose, insulin, HbA1c, HOMA-IR, HOMA-B and HOMA-S). Complement C3 and hsCRP were analyzed as potential mediators. The ABCS criteria and hemoglobin glycation index (HGI) were examined for their potential in preventive strategy. RESULTS Long-term air pollutants exposure was associated with the risk of prediabetes [Prevalence ratio for O3 (PR_O3) = 1.96 (95% CI: 1.24, 3.03)] and diabetes [PR_PM1 = 1.18 (95% CI: 1.05, 1.32); PR_PM2.5 = 1.08 (95% CI: 1.00, 1.16); PR_O3 = 1.35 (95% CI: 1.03, 1.74)]. PM1, PM10, SO2 or O3 exposure was associated with glucose-homeostasis disorder. For example, O3 exposure was associated with increased levels of glucose [7.67% (95% CI: 1.75, 13.92)], insulin [19.98% (95% CI: 4.53, 37.72)], HOMA-IR [34.88% (95% CI: 13.81, 59.84)], and decreased levels of HOMA-S [-25.88% (95% CI: -37.46, -12.16)]. Complement C3 and hsCRP played mediating roles in these relationships with proportion mediated ranging from 6.95% to 60.64%. Participants with HGI ≤ -0.53 were protected from the adverse effects of air pollutants. CONCLUSION Our study provides comprehensive insights into air pollutant-associated diabetic cascade and suggests subclinical preventive strategies.
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Affiliation(s)
- Yayuan Mei
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100005, China
| | - Ang Li
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100005, China
| | - Jiaxin Zhao
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100005, China
| | - Quan Zhou
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100005, China
| | - Meiduo Zhao
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100005, China
| | - Jing Xu
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100005, China
| | - Runkui Li
- College of Resources and Environment, University of Chinese Academy of Sciences, Beijing, 100049, China; State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, 100101, China
| | - Yanbing Li
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100005, China
| | - Kai Li
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100005, China
| | - Xiaoyu Ge
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100005, China
| | - Chen Guo
- State Key Laboratory of Environmental Criteria and Risk Assessment, Chinese Research Academy of Environment Sciences, Beijing, 100012, China
| | - Yongjie Wei
- State Key Laboratory of Environmental Criteria and Risk Assessment, Chinese Research Academy of Environment Sciences, Beijing, 100012, China.
| | - Qun Xu
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100005, China.
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14
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Mei Y, Zhao J, Zhou Q, Zhao M, Xu J, Li Y, Li K, Xu Q. Residential greenness attenuated association of long-term air pollution exposure with elevated blood pressure: Findings from polluted areas in Northern China. Front Public Health 2022; 10:1019965. [PMID: 36249254 PMCID: PMC9557125 DOI: 10.3389/fpubh.2022.1019965] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/12/2022] [Indexed: 01/28/2023] Open
Abstract
Background Evidence on the hypertensive effects of long-term air pollutants exposure are mixed, and the joint hypertensive effects of air pollutants are also unclear. Sparse evidence exists regarding the modifying role of residential greenness in such effects. Methods A cross-sectional study was conducted in typically air-polluted areas in northern China. Particulate matter with diameter < 1 μm (PM1), particulate matter with diameter < 2.5 μm (PM2.5), particulate matter with diameter < 10 μm (PM10), nitrogen dioxide (NO2), sulfur dioxide (SO2), and ozone (O3) were predicted by space-time extremely randomized trees model. We used the Normalized Difference Vegetation Index (NDVI) to reflect residential green space. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were examined. We also calculated the pulse pressure (PP) and mean arterial pressure (MAP). Generalized additive model and quantile g-computation were, respectively, conducted to investigate individual and joint effects of air pollutants on blood pressure. Furthermore, beneficial effect of NDVI and its modification effect were explored. Results Long-term air pollutants exposure was associated with elevated DBP and MAP. Specifically, we found a 10-μg/m3 increase in PM2.5, PM10, and SO2 were associated with 2.36% (95% CI: 0.97, 3.76), 1.51% (95% CI: 0.70, 2.34), and 3.54% (95% CI: 1.55, 5.56) increase in DBP; a 10-μg/m3 increase in PM2.5, PM10, and SO2 were associated with 1.84% (95% CI: 0.74, 2.96), 1.17% (95% CI: 0.52, 1.83), and 2.43% (95% CI: 0.71, 4.18) increase in MAP. Air pollutants mixture (one quantile increase) was positively associated with increased values of DBP (8.22%, 95% CI: 5.49, 11.02) and MAP (4.15%, 95% CI: 2.05, 6.30), respectively. These identified harmful effect of air pollutants mainly occurred among these lived with low NDVI values. And participants aged ≥50 years were more susceptible to the harmful effect of PM2.5 and PM10 compared to younger adults. Conclusions Our study indicated the harmful effect of long-term exposure to air pollutants and these effects may be modified by living within higher green space place. These evidence suggest increasing residential greenness and air pollution control may have simultaneous effect on decreasing the risk of hypertension.
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Affiliation(s)
- Yayuan Mei
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China,Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jiaxin Zhao
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China,Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Quan Zhou
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China,Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Meiduo Zhao
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China,Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jing Xu
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China,Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yanbing Li
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China,Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Kai Li
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China,Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Qun Xu
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China,Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China,*Correspondence: Qun Xu
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15
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Li A, Zhou Q, Mei Y, Zhao J, Liu L, Zhao M, Xu J, Ge X, Xu Q. The effect of urinary essential and non-essential elements on serum albumin: Evidence from a community-based study of the elderly in Beijing. Front Nutr 2022; 9:946245. [PMID: 35923200 PMCID: PMC9342688 DOI: 10.3389/fnut.2022.946245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 06/24/2022] [Indexed: 11/16/2022] Open
Abstract
Background & aims Few epidemiological studies have investigated the relationships of urinary essential and non-essential elements with serum albumin, an indicator of nutritional status, especially for the elderly in China. Methods A community-based study among elderly participants (n = 275) was conducted in Beijing from November to December 2016. We measured 15 urinary elements concentrations and serum albumin levels. Three statistical methods including the generalized linear model (GLM), quantile g-computation model (qgcomp) and bayesian kernel machine regression (BKMR) were adapted. Results In GLM analysis, we observed decreased serum albumin levels associated with elevated urinary concentrations of aluminum, arsenic, barium, cobalt, chromium, copper, iron, manganese, selenium, strontium, and zinc. Compared with the lowest tertile, the highest tertile of cadmium and cesium was also negatively associated with serum albumin. Urinary selenium concentration had the most significant negative contribution (30.05%) in the qgcomp analysis. The negative correlations of element mixtures with serum albumin were also observed in BKMR analysis. Conclusions Our findings suggested the negative associations of essential and non-essential elements with serum albumin among the elderly. Large-scare cohort studies among the general population are required to validate our findings and elucidate the relevant underlying mechanisms.
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Affiliation(s)
- Ang Li
- Department of Epidemiology and Biostatistics, School of Basic Medicine Peking Union Medical College, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, Beijing, China
- Center of Environmental and Health Sciences, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Quan Zhou
- Department of Epidemiology and Biostatistics, School of Basic Medicine Peking Union Medical College, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, Beijing, China
- Center of Environmental and Health Sciences, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yayuan Mei
- Department of Epidemiology and Biostatistics, School of Basic Medicine Peking Union Medical College, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, Beijing, China
- Center of Environmental and Health Sciences, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jiaxin Zhao
- Department of Epidemiology and Biostatistics, School of Basic Medicine Peking Union Medical College, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, Beijing, China
- Center of Environmental and Health Sciences, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Liu Liu
- Chaoyang District Center for Disease Control and Prevention, Beijing, China
| | - Meiduo Zhao
- Department of Epidemiology and Biostatistics, School of Basic Medicine Peking Union Medical College, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, Beijing, China
- Center of Environmental and Health Sciences, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jing Xu
- Department of Epidemiology and Biostatistics, School of Basic Medicine Peking Union Medical College, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, Beijing, China
- Center of Environmental and Health Sciences, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoyu Ge
- Department of Epidemiology and Biostatistics, School of Basic Medicine Peking Union Medical College, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, Beijing, China
- Center of Environmental and Health Sciences, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Qun Xu
- Department of Epidemiology and Biostatistics, School of Basic Medicine Peking Union Medical College, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, Beijing, China
- Center of Environmental and Health Sciences, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- *Correspondence: Qun Xu
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