High blood lead levels are associated with lead concentrations in households and day care centers attended by Brazilian preschool children

A comprehensive analysis of children's blood lead levels in Latin America and the Caribbean over the last eight years: Progress and recommendations

In 2017 we published a review on blood lead levels (BLL) in children from Latin America and the Caribbean (LAC) for data available up to 14th of March 2014 and recommended the identification and control of "lead hot spots". In the present study, an evaluation of progress toward reducing BLL in the region was carried out. A systematic review of the latest literature on lead exposure in the LAC region held on the PubMed, Web of Science and LILACS databases (January 2014 to March 2022) was conducted using the PRISMA methodology. Only original papers published in peer-reviewed English, Spanish, or Portuguese journals were eligible. A total of 558 papers were retrieved, 77 of which met the selection criteria and 31 (40.25 %) were carried out in Mexico. The prevalence of children with BLL above 10 μg. dL-1 was 22.08 % in the previous review versus 6.78 % in the current study. In the present review, the prevalence of children with BLL above 5 μg. dL-1 was 29.62 %, and only one study reported a BLL prevalence rate between 3.3 and 5 μg. dL-1. The highest BLLs were associated with well-known sources or occupational exposures. The number of countries (n = 13) that published data on BLL in children was lower compared to the previous review (n = 16). Most studies were conducted in areas with known lead exposure sources, similar to the earlier review. The percentage of children at risk of lead poisoning in the region remains unknown because few studies have published data on environmental exposure levels and most samples were relatively small. The recommendation to identify and control sources of lead exposure was maintained, while further suggestions for establishing a systematic public health surveillance system for lead were proposed to help reduce the knowledge gap and inform public health policy-making in LAC.

Indoor air quality in day-care centres: a global review

A healthy indoor environment is critical for children due to the severe effect of poor indoor air quality (IAQ) on their overall well-being. Day-care centres (DCCs) are important indoor microenvironments for children apart from their homes. Therefore, monitoring IAQ in this microenvironment is vital because of the vulnerability of the occupants. This review gives a global overview of the predominant indoor chemical pollutant levels monitored in DCCs, compares their concentration with available regulations for IAQ, evaluates the sources and health risk effects of chemical pollutants and proposes strategies for enhancing IAQ in DCCs. Thirty-seven (37) articles were used based on specific stated inclusion and exclusion criteria. Continents like Europe and Asia have the most published studies in indoor DCCs. The decreasing trend of pollutants examined in most studies include particulate matter > carbon dioxide > formaldehyde > carbon monoxide > total volatile organic compounds > volatile organic compounds > nitrogen dioxide > ozone > benzene > sulphur dioxide = radon. Particulate matter in the size and mass concentration range of PM₁₀ (0.116-1920.71 μg/m³) > PM_2.5 (0.279.2-260.74 μg/m³) was the most investigated pollutant. While nitrogen dioxide, radon and carbon monoxide were consistent with the existing national and international reference values for IAQ across the continents, exceedances occurred in other pollutants. The limited number of indoor chemical pollutant studies suggests the need for more comprehensive studies on IAQ in DCC globally. Further studies should highlight the availability of low-cost sensors and mobile analytical equipment that will promote affordable ground-level data accessibility.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11869-023-01320-5.

Potentially Toxic Elements in Costume Cosmetics Used by Children and Adults Are Associated with Cancer Risk

(1) Background: Costume cosmetics, such as face paints and pancakes, are used by adults and children during Halloween, Carnival, or children's parties. However, the metallic-based pigments used as dyes in these products may contain toxic elements associated with different levels of exposure. Objectives: (a) to determine the Al, As, Ba, Cd, Co, Cr, Cu, Ni, Pb, Sb, Sn, and Sr concentrations in face paints and pancakes; and (b) to estimate cancer and non-cancer risks posed by the concentrations of each element in these products for dermal and ingestion exposure scenarios during children and adult use. (2) Methods: A total of 95 samples of face paints and pancakes (four brands in different textures and colors) were purchased at the largest high-street commercial center in São Paulo city, Brazil. An extraction procedure with nitric acid was carried out using a graphite-covered digester block. Toxic element determinations were performed using an ICP-MS. (3) Results: The non-cancer risks estimated were lower than 1, except for dermal exposure in adults for some target systems. High cancer risk values raise concerns in both groups. The risk for children ranged from 10^-8 to 10^-5 and proved higher in cases of accidental exposure by ingestion. For occupational exposure in adults, cancer risks were even higher, ranging from 10^-3 to 10^-5, with the highest values associated with dermal exposure. (4) Conclusions: The study results suggest the presence of potentially toxic elements (PTEs) in cosmetics should be regulated/monitored to protect human health, especially for occupational exposure and use by children.

A Low-Cost Method Shows Potentially Toxic Element Levels in Dust Correlated with Elevated Blood Levels of These Chemicals in Children Exposed to an Informal Home-Based Production Environment

Dust is recognized as a route of exposure to environmental pollutants. The city of Limeira, Sao Paulo state, Brazil, is a production center for jewelry and fashion jewelry, where part of this jewelry production is home-based, informal, and outsourced. The aim of this study was to evaluate exposure to Potentially Toxic Elements (PTE: Cr, Sn, Mn, Sb, Ni, Cu, Zn, Cd, Pb, and As) in dust among children from households of informal workers using electrostatic dust cloths (EDC). Dust samples were collected in 21 exposed and 23 control families using EDC from surfaces where dust deposits had accumulated for approximately 14 days. In exposed families, dust samples were also collected from welders’ workstations. PTE concentrations were then determined using inductively coupled mass spectrometry (ICP-MS). The results raised concerns in relation to Cr, As, and Cd exposure among children within the informal home-based production environment. Blood PTE concentrations in children showed a moderate correlation with levels of Cr (Rho 0.40), Zn (Rho −0.43), and As (Rho 0.40), and a strong correlation with Cd (Rho 0.80) (p < 0.05), detected in dust. In conclusion, analyzing dust collected using EDC proved a potentially low-cost tool for determining PTE in dust. In addition, the results confirmed that informal home-based work poses a risk for children residing in these households. Public policies are needed to assist these families and promote better conditions of occupational health and safety for the whole family.

Study of controlled migration of cadmium and lead into foods from plastic utensils for children

Lead (Pb) is a highly neurotoxic chemical element known for reducing intelligence quotient (IQ) and promoting antisocial behavior in children and adolescents, while cadmium (Cd) is a carcinogenic bioaccumulative element. Both these metals are included in the priority pollutant list of the United States Environmental Protection Agency and in the WHO List of Chemicals of Major Public Health Concern, where contaminated foods and beverages are the most common pathways of exposure. The objective of this study was to determine total Cd and Pb levels in colored plastic utensils (cups, mugs, bowls, feeding bottles, and plates) for use by children and to measure the specific migration of these elements into beverages and foods. Total contaminant levels were determined using a handheld X-ray fluorescence analyzer. Specific migration tests were conducted using the simulant solutions acetic acid 3% (m/v) and water. Migration levels were determined by ICP-MS. Specific migration tests for Pb were also performed on commercially available samples (cola soft drink, orange juice, vinegar, and milk), with levels determined by graphite-furnace atomic absorption spectrometry (GF-AAS). A total of 674 utensils were analyzed in loco at major commercial centers in Greater São Paulo, of which 87 were purchased for containing Cd and Pb concentrations above permitted limits. Mean concentrations of the metals detected in the purchased utensils were 1110 ppm for Pb and 338 ppm for Cd. For specific migration assays, Pb levels were 187, 13, and 380 times above the permitted limit (0.01 mg.kg -1) for acetic acid, water, and orange juice, respectively. Cd levels were 50 and 2.4 times above the maximum permitted limit (0.005 mg.kg -1) for acetic acid and water, respectively. The districts where the utensils were purchased were grouped according to their social vulnerability index and compared using ANOVA. Pb levels were different between low and medium/high social vulnerability groups (p = 0.006). The findings corroborate the initial hypothesis that these utensils constitute a major source of exposure to PTEs such as Cd and Pb, pointing to the need for stricter regulation and inspection by the Brazilian regulatory agencies.

Heavy Metals in Acrylic Color Paints Intended for the School Children Use: A Potential Threat to the Children of Early Age

Heavy metals are the harmful elements, regarded as carcinogens. Nevertheless, owing to their physical and chemical properties, they are still used in the production of several commercial products. Utilization of such products increases the chance for the exposure of heavy metals, some of them are categorized as probable human carcinogens (Group 1) by the International Agency for Research on Cancer. Exposure of heavy metals to school children at early age can result severe life time health issues and high chance of emerging cancer. Thus, we have performed study relating to the presence of heavy metals in acrylic color paints commonly used by the school children. Acrylic paints of different colors were assayed for seven potential heavy metals manganese (Mn), cobalt (Co), nickel (Ni), zinc (Zn), arsenic (As), cadmium (Cd) and lead (Pb) using microwave digestion and iCAPQ inductively coupled plasma mass spectrometry (ICP-MS) system. The optimized method including paints digestion reagents nitric acid (HNO3, 65%, 5 mL) and hydrofluoric acid (HF, 40%, 2 mL) have offered excellent method performance with recovery values ranged between 99.33% and 105.67%. The elements were identified in all of the analyzed samples with concentrations ranged from 0.05 to 372.59 µg/g. Cd constitutes the lower percentage (0.05%), whereas Zn constitutes high ratio contribution which was tremendously high (68.33%). Besides, the paints contamination was also color specific, with considerably total heavy metal concentrations found in brunt umber (526.57 µg/g) while scarlet color (12.62 µg/g) contained lower amounts. The outcomes of our investigation highlight the necessity for guidelines addressing the heavy metals in acrylic color paints intended for the school children usage.

The applicability of fingernail lead and cadmium levels as subchronic exposure biomarkers for preschool children

Preschool children are exposed daily to metals in their homes and at daycare centers (DCC). Metal exposure and health effects are associated even at low levels, and children comprise a group of public health concern. Nail metals have been studied for exposure biomonitoring and compared to other biological media. The aim of this study was to explore the applicability of preschool fingernail lead and cadmium as subchronic exposure biomarkers. Nail lead and cadmium levels (NLL and NCL) of 602 preschool children (age: 1-4 years) who attended 21 DCC in São Paulo, Brazil, in 2013 were analyzed. Results were compared against blood lead and cadmium levels (BLL and BCL) found in a previous study. Inductively coupled plasma mass spectrometry (ICP-MS) analyses were performed for both samples. DCC and metal contaminated sites (MCS) were georeferencing. Logistic regression tests were applied to verify associations between nail metal levels and risk factors (sex, age, maternal education, secondary smoking, DCC geographic district, vehicle flow density, relative altitude and distance between DCC and nearest MCS) (p < 0.05). BLL was stratified by exposure level (low: <5 μg.dL^-1; high: >13.9 μg.dL^-1; medium: ≥5 μg.dL^-1 and ≤13.9 μg.dL^-1) and also tested the associations in order to verify if nail lead levels are affected by exposure intensity defined by blood metals concentrations. Radius distance and relative altitude of DCC to nearest MCS were associated with high NLL and NCL. Abnormal appearance of nails was associated with high NLL and low NCL. Lead and cadmium exposure magnitude had no significant impact on NLL. NLL should only be used for initial screening, and when financial resources are scarce, especially in areas located near contaminated sites. Preschool children were co-exposed to both lead and cadmium, reinforcing the need for broader studies evaluating exposure to environmental pollutants for more than one chemical element.

Integrated measures of lead and manganese exposure improve estimation of their joint effects on cognition in Italian school-age children

Every day humans are exposed to mixtures of chemicals, such as lead (Pb) and manganese (Mn). An underappreciated aspect of studying the health effects of mixtures is the role that the exposure biomarker media (blood, hair, etc.) may play in estimating the effects of the mixture. Different biomarker media represent different aspects of each chemical's toxicokinetics, thus no single medium can fully capture the toxicokinetic profile for all the chemicals in a mixture. A potential solution to this problem is to combine exposure data across different media to derive integrated estimates of each chemical's internal concentration. This concept, formalized as a multi-media biomarker (MMB) has proven effective for estimating the health impacts of Pb exposure, but may also be useful to estimate mixture effects, such as the joint effects of metals like Pb and Mn, while factoring in how the association changes based upon the biomarker media. Levels of Pb and Mn were quantified in five media: blood, hair, nails, urine, and saliva in the Public Health Impact of Metals Exposure (PHIME) project, a study of Italian adolescents aged 10-14 years. MMBs were derived for both metals using weighted quantile sum (WQS) regression across the five media. Age-adjusted Wechsler Intelligence Scale for Children (WISC) IQ scores, measured at the same time as the exposure measures, were the primary outcome and models were adjusted for sex and socioeconomic status. The levels Pb and Mn were relatively low, with median blood Pb of 1.27 (IQR: 0.84) μg/dL and median blood Mn of 1.09 (IQR: 0.45) μg/dL. Quartile increases in a Pb-Mn combination predicted decreased Full Scale IQ of 1.9 points (95% CI: 0.3, 3.5) when Pb and Mn exposure levels were estimated using MMBs, while individual regressions for each metal were not associated with Full Scale IQ. Additionally, a quartile increase in the WQS index of Pb and Mn, measured using MMBs, were associated with reductions in Verbal IQ by 2.8 points (1.0, 4.5). Weights that determine the contributions of the metals to the joint effect highlighted that the contribution of the Pb-Mn was 72-28% for Full Scale IQ and 42-58% for Verbal IQ. We found that the joint effects of Pb and Mn are strongly affected by the medium used to measure exposure and that the joint effects of the Pb and Mn MMBs on cognition were the stronger than any individual biomarker. Thus, increase power and accuracy for measuring mixture effects compared to individual biomarkers. As the number of chemicals in mixtures increases, appropriate biomarker selection will become increasingly important and MMBs are a natural way to reduce bias in such analyses.

Are fingernail lead levels a reliable biomarker of lead internal dose?

BACKGROUND

Potentially toxic elements, such as lead, can bioaccumulate and alter human physiology. Human biomonitoring is an essential tool to evaluate chemical exposures in different biological matrices (blood, urine, saliva, nails, and hair). Of these biological matrices, nails are favorable for their ease of sampling, transport and storage. The aim of this study was to investigate possible correlations between blood lead levels (BLL) and washed and non-washed fingernail lead levels (FLL) in 55 adults living in a lead-contaminated area.

METHOD

Venous blood and fingernail (thumbs and forefingers) samples were collected. Nails from the left hand were washed with Triton X-100 (0.5 % m/v) and HNO₃ solution, while nails from the right hand were not submitted to the pre-analytical procedures. Samples were analyzed by graphite furnace atomic absorption spectrometry, and pairwise correlations were used to correlate lead concentrations between BLL and FLL; nails from fingers of the same hand and between washed and unwashed fingernails. Principal component analysis was performed and scatter diagrams were plotted to investigate correlations.

RESULTS

A non-significant positive correlation was found between BLL and washed forefinger nails lead (r = 0.219, p = 0.112) and between BLL and thumbnail lead levels (r = 0.182, p = 0.191). Comparison of fingernails from the same hand (thumb and forefinger), showed that lead concentrations of non-washed nails varied widely, even on analyses of transversal fragments from the same nail. Lead levels in non-washed forefinger nails were not correlated with non-washed thumbnails (r = 0.169, p = 0.219). Conversely, washed thumb and forefinger nails were found to be correlated (r = 0.39, p = 0.003). Washed and non-washed nails were also found to be correlated (p < 0.0001).

CONCLUSION

In conclusion, the results showed that non-washed nails are not a reliable biomarker for lead exposure. Although washing nails before analysis may reduce external contamination, the correlation of lead concentrations between fingers is poor for fingernail lead levels to serve as an internal dose biomarker to lead exposure. In addition, levels in washed nails were not significantly correlated with blood lead levels. Fingernail lead levels seem to serve as an indicator of lead exposure sources in contact with the individual, but not as a reliable biomarker of internal dose.

Impact of Lead Exposure on Thyroid Status and IQ Performance among School-age Children Living Nearby a Lead-Zinc Mine in China

BACKGROUND

Lead exposure is one of the most concerning public health problems worldwide, particularly among children. Yet the impact of chronic lead exposure on the thyroid status and related intelligence quotient performance among school-age children remained elusive.

OBJECTIVE

The aim of this study was to evaluate the influence of lead exposure on the thyroid hormones, amino acid neurotransmitters balances, and intelligence quotient (IQ) among school-age children living nearby a lead-zinc mining site. Other factors such as rice lead levels, mothers' smoking behavior, and diet intake were also investigated.

METHODS

A total of 255 children aged 7-12 years old were recruited in this study. Blood lead level (BLL), thyroid hormones including free triiodothyronine (FT3), free thyroxine (FT4) and thyroid stimulating hormone (TSH), and amino acid neurotransmitters such as glutamate (Glu), glutamine (Gln), and γ-aminobutyric acid (GABA) were measured using graphite furnace atomic absorption spectroscopy (GFAAS), chemiluminescence immunoassay, high performance liquid chromatography (HPLC). Raven's standard progressive matrices (SPM) and the questionnaire were used to determine IQ and collect related influence factors.

RESULTS

The average BLL of children was 84.8 μg/L. The occurrence of lead intoxication (defined as the BLL ≥ 100 μg/L) was 31.8%. Serum TSH levels and IQ of lead-intoxicated children were significantly lower than those without lead toxicity. The GABA level of girls with the lead intoxication was higher than those with no lead-exposed group. Correlation analyses revealed that BLL were inversely associated with the serum TSH levels (R= -0.186, p < 0.05), but positively related with IQ grades (R = 0.147, p < 0.05). Moreover, BLL and Glu were inversely correlated with IQ. In addition, this study revealed four factors that may contribute to the incidence of lead intoxication among children, including the frequency of mother smoking (OR = 3.587, p < 0.05) and drinking un-boiled stagnant tap water (OR = 3.716, p < 0.05); eating fresh fruits and vegetables (OR = 0.323, p < 0.05) and soy products regularly (OR = 0.181, p < 0.05) may protect against lead intoxication.

CONCLUSION

Lead exposure affects the serum TSH, GABA levels and IQ of school-aged children. Developing good living habits, improving environment, increasing the intake of high-quality protein and fresh vegetable and fruit may improve the condition of lead intoxication.

Potentially toxic elements in toys and children's jewelry: A critical review of recent advances in legislation and in scientific research

Contamination by potentially toxic elements (PTEs) in children's toys and jewelry is an ongoing problem where PTEs can become bioavailable especially via oral pathway (ingestion as a whole or of parts, and mouthing) and may cause adverse health effects for children. In the present review, legislation updates from the last decade in the United States (U.S.), Canada, and the European Union (E.U.) on PTEs in toys and jewelry are presented. Then, a literature review mostly covering the last decade on the total concentration, bioavailability, children's exposure, and bioaccessibility of PTEs in toys and jewelry is provided. The U.S. and Canadian legislations mainly focus on lead (Pb) and cadmium (Cd) total/soluble concentration limits to prevent exposure and have received several updates within the last decade, extending particularly the covered span of children's products. It seems that the introduction, subsequent enforcement, and update of regulations in developed countries have shifted the problem towards developing countries. In terms of categories, metallic toys and children's jewelry still have the most severe PTE contamination and the presence of Pb and Cd in these articles is an ongoing issue. Some studies suggest that color can be used as an indicator for the potential presence of PTEs (linked to chemicals such as lead chromate, cadmium sulfide) but the evidence is not always clear. Another concern is vintage/second-hand toys and jewelry as those items might have been produced before the legislation was present. As total and bioaccessible concentrations of PTEs in toys and jewelry do not always correlate, approaches considering bioaccessibility (e.g. of the E.U.) are more scientifically appropriate and help with better estimation of risk from exposure. Studies on toy and jewelry contamination using in vitro bioaccessibility techniques has become more common, however, there is still no in vitro test specifically designed and validated for toys and jewelry.

Cumulative Effects of Low-Level Lead Exposure and Chronic Physiological Stress on Hepatic Dysfunction-A Preliminary Study

Chronic physiological stress and hepatic injury were explored in this cross-sectional study using data from the National Health and Nutrition Examination Survey (NHANES) 2007–2010. Lead exposure was measured using Blood Lead Levels (BLL), which were divided into quartiles of exposure based on the distribution within the database. Allostatic load (AL), a variable representing chronic physiological stress, was operationalized using ten clinical markers. The geometric mean values for markers of liver injury of interest (a) Aspartate Aminotransferase (AST), (b) Alanine Aminotransferase (ALT), (c) Alkaline Phosphatase (ALP), and (d) Gamma glutamyl-transferase (GGT) were explored in quartiles of lead exposure. Associations between AL and AST, ALT, ALP, and GGT among those exposed to lead were analyzed using linear regression models. In examining lead exposure in increasing quartiles, the geometric mean of the liver injury markers showed significant elevations as lead exposure levels increased. Simple linear regression revealed AL was positively associated with several markers of hepatic injury in all degrees of lead exposure. This study demonstrates the potential dangers of social and environmental exposures to liver health.

A 25-year record of childhood blood lead exposure and its relationship to environmental sources

Broken Hill, the oldest silver (Ag)-zinc (Zn)-lead (Pb) mining community in Australia, has a legacy and ongoing problem of environmental Pb exposure that was identified as early as 1893. To reduce Pb exposure risks, identifying potential exposure pathways and related factors is a critical first step. This study examined blood lead (PbB) levels of children ≤60 months old (n = 24,106 samples), along with Pb concentrations in corresponding soil (n = 10,160 samples), petri-dish dust (n = 106 houses) and ceiling dust (n = 80 houses) over a 25-year period from 1991 to 2015. Regression analysis was used to examine the relationships between environmental Pb sources and children's blood lead (PbB) outcomes. Analysis of the dataset showed Aboriginal children in Broken Hill had a geometric mean PbB of 7.4 μg/dL (95% CI: 6.7-7.4) being significantly higher (p < 0.01) than non-Aboriginal children (PbB 6.2 μg/dL, 95% CI: 6.2-6.3) for all years between 1991 and 2015. Children at the age of 24-36 months had a higher PbB compared with other age groups. Higher PbB levels were also statistically associated with lower socio-economic status and children living in houses built before 1940 (p < 0.01). Blood Pb was also significantly correlated with both soil Pb and indoor petri-dish dust Pb loadings, confirming that these are important pathways for exposure in Broken Hill. A 100 mg/kg increase in soil Pb was associated with a 0.12 μg/dL increase in childhood PbB. In addition, PbB concentrations increased with indoor petri-dish dust Pb loadings (i.e., 0.08 μg/dL per 100 μg/m²/30 days). The 25-year data show that the risk of exposure at ≥ 10 μg/dL was seemingly unavoidable irrespective of residential address (i.e., children of all ages presenting with a ≥10 μg/dL across the whole city area). In terms of moving forward and mitigating harmful early-life Pb exposures, all children aged 24-36 months should be prioritised for feasible and effective intervention practices. Primary intervention must focus on mitigating contemporary ongoing dust emissions from the mining operations and the associated mine-lease areas along with household soil remediation, to help prevent recontamination of homes. Additional practices of dust cleaning using wet mopping and wiping techniques, vacuuming of carpets and furnishings, ongoing monitoring of children and household dust remain important but short-lived abatement strategies. Overall, the key goal should be to eliminate risk by removing contamination in the wider environment as well as in individual homes.

Multi-media biomarkers: Integrating information to improve lead exposure assessment

Exposure assessment traditionally relies on biomarkers that measure chemical concentrations in individual biological media (i.e., blood, urine, etc.). However, chemicals distribute unevenly among different biological media; thus, each medium provides incomplete information about body burden. We propose that machine learning and statistical approaches can create integrated exposure estimates from multiple biomarker matrices that better represent the overall body burden, which we term multi-media biomarkers (MMBs). We measured lead (Pb) in blood, urine, hair and nails from 251 Italian adolescents aged 11-14 years from the Public Health Impact of Metals Exposure (PHIME) cohort. We derived aggregated MMBs from the four biomarkers and then tested their association with Wechsler Intelligence Scale for Children (WISC) IQ scores. We used three approaches to derive the Pb MMB: one supervised learning technique, weighted quantile sum regression (WQS), and two unsupervised learning techniques, independent component analysis (ICA) and non-negative matrix factorization (NMF). Overall, the Pb MMB derived using WQS was most consistently associated with IQ scores and was the only method to be statistically significant for Verbal IQ, Performance IQ and Total IQ. A one standard deviation increase in the WQS MMB was associated with lower Verbal IQ (β [95% CI] = -2.2 points [-3.7, -0.6]), Performance IQ (-1.9 points [-3.5, -0.4]) and Total IQ (-2.1 points [-3.8, -0.5]). Blood Pb was negatively associated with only Verbal IQ, with a one standard deviation increase in blood Pb being associated with a -1.7 point (95% CI: [-3.3, -0.1]) decrease in Verbal IQ. Increases of one standard deviation in the ICA MMB were associated with lower Verbal IQ (-1.7 points [-3.3, -0.1]) and lower Total IQ (-1.7 points [-3.3, -0.1]). Similarly, an increase of one standard deviation in the NMF MMB was associated with lower Verbal IQ (-1.8 points [-3.4, -0.2]) and lower Total IQ (-1.8 points [-3.4, -0.2]). Weights highlighting the contributions of each medium to the MMB revealed that blood Pb was the largest contributor to most MMBs, although the weights varied from more than 80% for the ICA and NMF MMBs to between 30% and 54% for the WQS-derived MMBs. Our results suggest that MMBs better reflect the total body burden of a chemical that may be acting on target organs than individual biomarkers. Estimating MMBs improved our ability to estimate the full impact of Pb on IQ. Compared with individual Pb biomarkers, including blood, a Pb MMB derived using WQS was more strongly associated with IQ scores. MMBs may increase statistical power when the choice of exposure medium is unclear or when the sample size is small. Future work will need to validate these methods in other cohorts and for other chemicals.

Lead Exposure and Cardiovascular Disease among Young and Middle-Aged Adults

Lead and its effects on cardiovascular-related markers were explored in this cross-sectional study of young adults (18–44 years) and middle-aged adults (45–65 years) from the United States using the National Health and Nutrition Examination Survey (NHANES), 2009–2016. Degrees of exposure were created using blood lead level (BLL) as the biomarker of exposure based on the epidemiologically relevant threshold of BLL > 5 μg/dL. The mean values, in addition to the percentages of people represented for the markers of interest (systolic blood pressure [SBP], diastolic blood pressure [DBP], gamma-glutamyl transferase [GGT], non-high-density lipoprotein cholesterol [non-HDL-C]) were explored. Among those exposed to lead, the likelihood of elevated clinical markers (as defined by clinically relevant thresholds of above normal) were examined using binary logistic regression. In exploring exposure at the 5 μg/dL levels, there were significant differences in all the mean variables of interest between young and middle-aged adults. The binary logistic regression showed young and middle-aged adults exposed to lead were significantly more likely to have elevated markers (apart from DBP). In all, lead affects cardiovascular-related markers in young and middle-aged U.S. adults and thus we must continue to monitor lead exposure to promote health.

Globally temporal transitions of blood lead levels of preschool children across countries of different categories of Human Development Index

In the past decades, efforts to eliminate lead from gasoline, paint and drinking water around the world have substantially reduced human blood lead levels. This study was therefore aimed at examining the global temporal trends in the blood lead levels of preschool children by the category of UN Human Development Index (HDI). In total, 103 blood lead records were retrieved from 51 articles searched from PubMed and Google Scholar, with study subjects aged up to 8years old. Collected preschool children blood lead levels were plotted chronologically by HDI category and their reciprocals were used in regression analysis against calendar year to establish their temporal transition trends in the past decades. Results show that the modes of blood lead level of the preschool children were reduced from 4-6μg/dL to 0.8-1.5μg/dL, from 6-15μg/dL to 3-6μg/dL and from 12-16 to 5-6μg/dL for the very high HDI countries, the high HDI countries and the medium/low HDI countries, respectively. The highest correlation coefficient, 0.849, between the reciprocal of blood lead level and the calendar year was found for the very high HDI countries. Based on the regression lines, the predicted preschool children mean blood lead levels in the year of 2030 are 0.74μg/dL, 2.21μg/dL and 2.86μg/dL, respectively, for the very high HDI countries, the high HDI countries and the medium/low HDI countries. Persistent differences in blood lead level prevailed among countries of different HDI category, suggesting the effects of disparities and inequalities, at the state level, on preschool children blood lead levels. Further action is warranted to reduce the already low environmental lead exposure to eliminate the developmental burden of lead on children through (1) identification of individual local factors for lead exposure and (2) averting health disparity and inequalities at the state level.

Cholesterol and Oxidative Stress in U.S. Pregnant Women Exposed to Lead

Lead exposure among pregnant U.S. women was examined via the National Health and Nutrition Examination Survey (NHANES) 2009–2016 data to examine its role in bad cholesterol and oxidative stress. Mean values of the clinical markers non-high density lipoprotein cholesterol (non-HDL-c) and gamma-glutamyl transferase (GGT), a marker of oxidative stress, were explored. In four quartiles of lead exposure, clinical makers were compared. Binary logistic regression predicted the likelihood of elevated clinical markers in pregnant compared to non-pregnant women, while linear regression was used to examine associations between blood lead levels (BLL) and the clinical markers of interest. Mean non-HDL-c was statistically significantly more elevated in pregnant women than non-pregnant women. Mean GGT levels were more statistically significantly elevated in the highest quartile of BLL exposure among pregnant women than in the lower quartiles. In binary logistic regression models, pregnant women were statistically significantly more likely to have elevated non-HDL-c, while in linear regression BLL was statistically significantly associated with GGT levels in pregnant women. Lead exposure in pregnant women is an issue of public health concern that must continue to be studied.

Lead exposure from households and school settings: influence of diet on blood lead levels

Lead is known as a potent toxicant to human health, particularly for children while their central nervous system is developing. The aim of this study was to investigate the associations between blood lead levels (BLLs) and lead exposure in the children's diet, home, and school environments. A cross-sectional study was conducted with 153 children aged 1-4 years, in four day care centers (DCCs), where a high prevalence of lead exposure was previously found. Lead determination by graphite furnace atomic absorption spectrometry (GF-AAS) was performed for venous blood, drinking water collected in the DCCs, and the 24-h diet (n = 64). Environmental screenings were conducted to evaluate lead concentrations in the tableware, buildings, and playground items in all DCCs and children's homes (n = 18) by using a field-portable X-ray fluorescence analyzer (FP-XRF). The BLL mean was 2.71 μg dL^-1. Means for 24-h lead concentrations in the diet were 1.61 and 2.24 μg kg^-1 of body weight (BW) in two DCCs. Lead concentrations in the water supply were lower than 2 μg L^-1. More than 11% of the DCCs' environmental analyses presented lead concentrations higher than or equal to 1 mg cm^-2, as defined by the USEPA. The diet was not found to be a risk factor for lead exposure, but households and DCC settings raised concern. Children's exposure to lead in DCC environments, where they spend the most part of their weekdays, appeared to be relevant. Graphical abstract ᅟ.

Blood lead and cadmium levels in preschool children and associated risk factors in São Paulo, Brazil

In Brazil, there are scarce data on lead (Pb) and cadmium (Cd) contamination, especially for more vulnerable populations such as preschool children. In this paper, we answer two questions: (1) What are the exposure levels of lead and cadmium in preschool children, in Sao Paulo, Brazil? and (2) What are the risk factors associated with this exposure? This cross-sectional study included 50 day care centers (DCCs), totaling 2463 children aged 1-4 years. Venous blood samples were analyzed by ICP-MS. Questionnaires were administered to the parents. Multiple logistic regression models were used to identify associations between blood lead levels (BLLs) and blood cadmium levels (BCLs) and potential risk factors. The geometric mean for BLLs was 2.16 μg/dL (95% CI: 2.10-2.22 μg/dL), and the 97.5th percentile was 13.9 μg/dL (95% CI: 10.0-17.3 μg/dL). For cadmium exposure, the geometric mean for BCLs was 0.48 μg/L (95% CI: 0.47-0.50 μg/L), and the 95th percentile was 2.57 μg/L (95% CI: 2.26-2.75 μg/L). The DCCs' geographic region was associated with high BLLs and BCLs, indicating hot spots for lead and cadmium exposures. In addition, it was found that the higher the vehicles flow, the higher were the BLLs in children. Red lead in household gates was also an important risk factor for lead exposure. Comparing these results with the findings of the Fourth National Report on Human Exposure to Environmental Chemicals by CDC-2013, it was found that in Brazilian preschool children the BLLs are almost three times higher (97.5th percentile) and the BCLs are almost twelve times higher (95th percentile) than those in U.S. children. This information is essential to formulate public health policies.

Lead, Cadmium, and Arsenic Bioaccessibility of 24 h Duplicate Diet Ingested by Preschool Children Attending Day Care Centers in Brazil

Lead, known as a metal with high neurotoxicity to children, cadmium, which is a carcinogenic and bioaccumulative contaminant, and arsenic, a class 1 carcinogenic according to the International Agency for Research on Cancer, are toxic elements (TEs) whose relevant route of exposure may be diet. We determined the bio-accessible fraction of lead, cadmium, and arsenic from the diet of preschool children from two day care centers (DCC). A cross-sectional study was conducted with 64 one–four-year-old children from two DCCs where the 24-h duplicate diet samples were collected. The diet samples were analyzed by ICP-MS for lead, cadmium, and arsenic total concentrations (n = 64) and their bio-accessibility were analyzed for a subsample (n = 10). The dietary intake (DI) mean for lead, cadmium, and arsenic were 0.18 ± 0.11 µg kg⁻¹ bw, 0.08 ± 0.04 µg kg⁻¹ bw, and 0.61 ± 0.41 µg kg⁻¹ bw, respectively. All DI calculated for TEs, considering total intake, were found lower than the tolerable limits (TL) (European Union, or World Health Organization, WHO, when applicable) except for one child’s Pb intake. Bio-accessibilities ranged between 0% to 93%, 0% to 103%, and 0% to 69%, for lead, cadmium, and arsenic, respectively. Although DI for TEs has been found lower than TL, these reference values have been recently decreased or withdrawn since it was for lead and arsenic whose TL were withdrawn by WHO.