Blood and hair lead in children with different extents of iron deficiency in Karachi

Assessing the mediating role of iron status on associations between an industry-relevant metal mixture and verbal learning and memory in Italian adolescents

BACKGROUND

Metals, including lead (Pb), manganese (Mn), chromium (Cr) and copper (Cu), have been associated with neurodevelopment; iron (Fe) plays a role in the metabolism and neurotoxicity of metals, suggesting Fe may mediate metal-neurodevelopment associations. However, no study to date has examined Fe as a mediator of the association between metal mixtures and neurodevelopment.

OBJECTIVE

We assessed Fe status as a mediator of a mixture of Pb, Mn, Cr and Cu in relation to verbal learning and memory in a cohort of Italian adolescents.

METHODS

We used cross-sectional data from 383 adolescents (10-14 years) in the Public Health Impact of Metals Exposure Study. Metals were quantified in blood (Pb) or hair (Mn, Cr, Cu) using ICP-MS, and three markers of Fe status (blood hemoglobin, serum ferritin and transferrin) were quantified using luminescence assays or immunoassays. Verbal learning and memory were assessed using the California Verbal Learning Test for Children (CVLT-C). We used Bayesian Kernel Machine Regression Causal Mediation Analysis to estimate four mediation effects: the natural direct effect (NDE), natural indirect effect (NIE), controlled direct effect (CDE) and total effect (TE). Beta (β) coefficients and 95 % credible intervals (CIs) were estimated for all effects.

RESULTS

The metal mixture was jointly associated with a greater number of words recalled on the CVLT-C, but these associations were not mediated by Fe status. For example, when ferritin was considered as the mediator, the NIE for long delay free recall was null (β = 0.00; 95 % CI = -0.22, 0.23). Conversely, the NDE (β = 0.23; 95 % CI = 0.01, 0.44) indicated a beneficial association of the mixture with recall that operated independently of Fe status.

CONCLUSION

An industry-relevant metal mixture was associated with learning and memory, but there was no evidence of mediation by Fe status. Further studies in populations with Fe deficiency and greater variation in metal exposure are warranted.

Effect of lead, calcium, iron, zinc, copper and magnesium on anemia in children with BLLs ≥ 100 μg/L

OBJECTIVE

Adverse effects of lead exposure on children's health have been demonstrated. While studies have examined the relationship between iron status and low-level lead exposure in children with blood lead levels (BLLs) < 100 μg/L, few have investigated the association between blood lead and other trace elements and anemia in children with BLLs ≥ 100 μg/L. This study aimed to assess the levels of lead, iron, copper, zinc, magnesium, and calcium in children aged 0-14 with BLLs≥ 100 μg/L between 2009 and 2021, and to examine the relationship between blood lead, trace elements and anemia.

METHODS

A total of 11,541 children with BLLs ≥ 100 μg/L were included in this study. Venous blood samples were collected to measure blood lead levels, hemoglobin levels, and trace element levels. According to the World Health Organization standard, outpatients with hemoglobin levels < 110 g / L were defined as having anemia.

RESULTS

The study results found that high BLLs and blood calcium had a negative influence on Hb with odds ratios (95% confidence interval) of 1.411(1.208, 1.649) and 1.219(1.043, 1.424). High blood iron had a positive influence on Hb with odds ratios of 0.421(0.355, 0.499).

CONCLUSION

The results suggest that the risk of anemia rose significantly with higher BLLs, blood copper, and blood calcium levels, and decreases considerably with higher blood iron levels.

Blood lead concentrations in children with iron deficiency anemia: a systematic review and meta-analysis

Iron deficiency is the most common nutritional disorder detrimental to the behavior, cognitive performance, immune system, and physical growth of infants and preschool- and school-age children. Iron deficiency anemia (IDA) increases children's susceptibility to some metals, including the highly toxic lead (Pb), but the character of this relationship is still disputed. Thus, this study aimed to review and meta-analyze the association between the IDA and blood lead levels (BLL) among children, based on papers indexed by international scientific databases and published up to September 2021. A search was performed of the literature in several databases including the ISI Web of Science, PubMed, and Scopus. The final papers were assessed concerning their quality based on the Newcastle-Ottawa Scale (NOS) for cross-sectional studies. Moreover, analyses were performed using R statistical software with the "meta" package. Of the 1528 articles found, only 12 studies met the inclusion criteria and were considered in the meta-analysis. Significantly higher BLL in IDA children (SMD = 2.40; CI 95%, 0.93-3.87 µg/L; p = 0.0014) was seen when compared to non-IDA children. Moreover, the pooled OR is equal to 2.75 (CI 95%, 1.10-6.85 µg/L; p = 0.0303) suggesting a higher risk of IDA development among children with BLL > 10 µg/dL. Thus, we recommend systematic monitoring of Fe and Pb levels among children, especially in countries with limited sources of nutritious food. Since only a few studies were available for this meta-analysis, further studies are necessary to examine the association between IDA and BLL in detail.

Human Biomonitoring of Trace Elements in Scalp Hair from Healthy Population of Pakistan

The present study deals with the assessment of essential trace and toxic elements in biological samples (scalp hair) of healthy smoker and non-smoker residents of Lahore (the second most populous city), Pakistan. Human biomonitoring of various trace elements like zinc (Zn), iron (Fe), copper (Cu), chromium (Cr), cadmium (Cd), nickel (Ni), lead (Pb), and arsenic (As) was evaluated in human hair samples of smokers and non-smokers (males and females) as per IFCC criteria. For the purpose of comparison, scalp hair samples of age- and sex-equivalent healthy persons were also analyzed. The results of this study show that the concentrations (P95 values) of As (0.17, 0.81, and 0.91 μg/g), Cd (2.80, 3.81, and 3.16 μg/g), Cr (4.1, 4.2, and 5.3 μg/g), Cu (20.0, 21.0, and 21.9 μg/g), Ni (3.9, 4.6, and 4.3 μg/g), Pb (4.0, 4.8, and 5.0 μg/g), and Fe (49.0, 49.0, and 59.3 μg/g) were significantly higher in scalp hair samples of smokers than in referents, for various age groups (16-32 years, 33-50 years, and 51-62 years), respectively. The concentrations of Zn (165, 163, and 173 μg/g various age groups, respectively) in similar age group were found lower in the scalp hair samples of smokers than referents. Exposure of high toxic metal level through smoking and deficiency of Zn could be synergistic with the risk factors associated with the use of tobacco. Correlation studies for the elements in cigarette with the elements in scalp hair of male smokers show a highly positive correlation between Cr-Cd, Cr-Ni, Cu-Fe, and Ni-Zn.

Intelligence, democracy, and international environmental commitment

This paper investigates the determinants of nations' commitment to environmental protection at the international level by focusing on the role of national intelligence and the level of democracy. The national intelligence is measured by nation's IQ scores. The findings based on a sample of 152 nations provide strong evidence that intelligence has statistically significant impact on ratification of international environmental agreements, and the countries with IQ 10-points above global average are 23% more likely to sign multilateral environmental agreements than others. The findings also demonstrate that it is the combination of high-level of intelligence of nations and democracy, that likely result in international environmental commitments.

Blood Lead Levels in Andean Infants and Young Children in Ecuador: An International Comparison

Lead (Pb) exposure in infants and children remains an international health concern. Blood lead (PbB) levels of a cohort of 130 Ecuadorian infants and young children aged 0.33 to 5.8 yr were compared to values reported for similar age groups in Africa, Asia, Europe, Latin America, and the United States. The mean PbB level for the total group of 130 Ecuadorian infants and young children in this study was 29.4 μg/dl (SD: 24.3; range: 3.0-128.2; median: 21.7; geometric mean: 20.7 μg/dl). The mean PbB level for the 0-2 yr age group (infants) was 33.6 μg/dl (SD: 28.9; median: 22.0; range: 3.9-119.7; geometric mean: 23.6 μg/dl), while the average PbB level for the 3-5 yr age group (young children) was 27.9 μg/dl (SD: 22.5: median: 22; range: 3-128.2; geometric mean: 19.8 μg/dl). The difference between the mean PbB levels for the infants and young children was not statistically significant. The average PbB level of 32.6 μg/dl for males was not statistically different from the mean PbB level of 26.3 μg/dl for females. The PbB levels observed in Ecuadorian infants and young children in this investigation were elevated above the World Health Organization (WHO) level of concern of 10 μg/dl and Centers for Disease Control and Prevention (CDC) current reference value of 5 μg/dl. Values were comparable to concentrations found in Pakistan, where occupational use of Pb is prevalent. These findings further indicate that infants and young children exposed to Pb from Pb glazing of ceramics in Andean Ecuadorian villages exhibit greater potential metal-mediated poisoning than children of similar ages in Asia, Europe, other Latin American countries, and the United States.

Evidence that cognitive deficit in children is associated not only with iron deficiency, but also with blood lead concentration: a preliminary study

OBJECTIVE

To investigate whether blood lead concentrations are elevated in iron-deficient children, and to examine the association between iron deficiency and/or elevated blood lead concentration and cognitive deficits in children.

METHOD

The present study is a component of the Mothers' and Children's Environmental Health (MOCEH) study, a multi-center birth cohort project in Korea that began in 2006. The study cohort consisted of 194 children who underwent testing of blood lead and serum C-reactive proteins (CRPs) and ferritin concentrations, and the Korean version of the Wechsler Preschool and Primary Scale of Intelligence, revised edition (WPPSI-R), at 60 months of age. In addition, the mothers' blood lead concentrations during pregnancy were included in the analyses. Multivariate linear regression analysis was performed to analyze the correlation between high blood lead and low serum ferritin concentrations, after adjustment for covariates, in children, as well as to analyze the association of verbal IQ with serum ferritin and blood lead concentrations.

RESULTS

Lead and ferritin concentrations were inversely and significantly associated in children after adjustment for covariates. Moreover, both concentrations were associated with verbal IQ, after adjustment for covariates, and each was associated with cognitive deficits after adjustment for the other. Sobel test statistics showed that blood lead concentration was a significant partial mediator for the relationship between iron deficiency and verbal IQ.

CONCLUSION

Due to the results discussed in the present study, cognitive deficit in children seems to be associated not only with iron deficiency, but also with blood lead concentration.

Domain-specific effects of prenatal exposure to PCBs, mercury, and lead on infant cognition: results from the Environmental Contaminants and Child Development Study in Nunavik

BACKGROUND

Polychlorinated biphenyls (PCBs), methylmercury (MeHg), and lead (Pb) are environmental contaminants known for their adverse effects on cognitive development.

OBJECTIVES

In this study we examined the effects of prenatal exposure to PCBs, MeHg, and Pb on cognitive development in a sample of Inuit infants from Arctic Québec.

METHODS

Mothers were recruited at local prenatal clinics. PCBs, mercury (Hg), Pb, and two seafood nutrients-docosahexaenoic acid (DHA) and selenium (Se)-were measured in umbilical cord blood. Infants (n = 94) were assessed at 6.5 and 11 months of age on the Fagan Test of Infant Intelligence (FTII), A-not-B test, and Bayley Scales of Infant Development-2nd Edition (BSID-II).

RESULTS

Multiple regression analyses revealed that higher prenatal PCB exposure was associated with decreased FTII novelty preference, indicating impaired visual recognition memory. Prenatal Hg was associated with poorer performance on A-not-B, which depends on working memory and is believed to be a precursor of executive function. Prenatal Pb was related to longer FTII fixation durations, indicating slower speed of information processing.

CONCLUSIONS

PCBs, MeHg, and Pb each showed specific and distinct patterns of adverse associations with the outcomes measured during infancy. By contrast, none of these exposures was associated with performance on the BSID-II, a global developmental measure. The more focused, narrow band measures of cognitive function that appeared to be sensitive to these exposures also provide early indications of long-term impairment in specific domains that would otherwise not likely be evident until school age.

CITATION

Boucher O, Muckle G, Jacobson JL, Carter RC, Kaplan-Estrin M, Ayotte P, Dewailly É, Jacobson SW. 2014. Domain-specific effects of prenatal exposure to PCBs, mercury, and lead on infant cognition: results from the Environmental Contaminants and Child Development Study in Nunavik. Environ Health Perspect 122:310-316; http://dx.doi.org/10.1289/ehp.1206323.

Effects of iron therapy on blood lead concentrations in infants

To determine whether blood lead concentration is elevated in iron-deficient infants, blood lead and serum ferritin concentrations, serum iron/transferring iron-binding capacity (Fe/TIBC) and complete blood counts were measured in 30 iron deficient and 35 control infants, aged 6-24 months. All 30 iron-deficient infants received iron supplementation (ferric hydroxide-polymaltose complex, 6mg/kg Fe(3+)/day) for 1-6 months. Blood lead concentrations were measured in 18 of the iron deficient infants after their ferritin levels returned to the normal range. The geometric mean blood lead concentration was higher in iron deficient than in control infants (1.846 vs. 1.416μg/dL). After iron therapy, the blood lead levels of iron-deficient infants decreased significantly compared with pre-treatment levels (1.785 vs. 2.386μg/dL), and the hemoglobin and ferritin concentrations increased significantly. These findings indicate that iron deficiency increases blood lead concentrations in infants with very low blood lead concentrations.

Toenail metal concentration as a biomarker of occupational welding fume exposure

In populations exposed to heavy metals, there are few biomarkers that capture intermediate exposure windows. We sought to determine the correlation between toenail metal concentrations and prior 12-month work activity in welders with variable, metal-rich, welding fume exposures. Forty-eight participants, recruited through a local union, provided 69 sets of toenail clippings. Union-supplied and worker-verified personal work histories were used to quantify hours welded and respirator use. Toenail samples were digested and analyzed for lead (Pb), manganese (Mn), cadmium (Cd), nickel (Ni), and arsenic (As) using ICP-MS. Spearman correlation coefficients were used to examine the correlation between toenail metal concentrations. Using mixed models to account for multiple participation times, we divided hours welded into three-month intervals and examined how weld hours correlated with log-transformed toenail Pb, Mn, Cd, Ni, and As concentrations. Highest concentrations were found for Ni, followed by Mn, Pb and As, and Cd. All the metals were significantly correlated with one another (rho range = 0.28-0.51), with the exception of Ni and As (rho = 0.20, p = 0.17). Using mixed models adjusted for age, respirator use, smoking status, and BMI, we found that Mn was associated with weld hours 7-9 months prior to clipping (p = 0.003), Pb was associated with weld hours 10-12 months prior to clipping (p = 0.03) and over the entire year (p = 0.04). Cd was associated with weld hours 10-12 months prior to clipping (p = 0.05), and also with the previous year's total hours welded (p = 0.02). The association between Ni and weld hours 7-9 months prior to clipping approached significance (p = 0.06). Toenail metal concentrations were not associated with the long-term exposure metric, years as a welder. Results suggest Mn, Pb, and Cd may have particular windows of relevant exposure that reflect work activity. In a population with variable exposure, toenails may serve as useful biomarkers for occupational metal fume exposures to Mn, Pb, and Cd during distinct periods over the year prior to sample collection.

Human health risk assessment of lead from mining activities at semi-arid locations in the context of total lead exposure

Lead from historical mining and mineral processing activities may pose potential human health risks if materials with high concentrations of bioavailable lead minerals are released to the environment. Since the Joint Expert Committee on Food Additives of Food and Agriculture Organization/World Health Organization withdrew the Provisional Tolerable Weekly Intake of lead in 2011, an alternative method was required for lead exposure assessment. This study evaluated the potential lead hazard to young children (0-7 years) from a historical mining location at a semi-arid area using the U.S. EPA Integrated Exposure Uptake Biokinetic (IEUBK) Model, with selected site-specific input data. This study assessed lead exposure via the inhalation pathway for children living in a location affected by lead mining activities and with specific reference to semi-arid conditions and made comparison with the ingestion pathway by using the physiologically based extraction test for gastro-intestinal simulation. Sensitivity analysis for major IEUBK input parameters was conducted. Three groups of input parameters were classified according to the results of predicted blood concentrations. The modelled lead absorption attributed to the inhalation route was lower than 2 % (mean ± SE, 0.9 % ± 0.1 %) of all lead intake routes and was demonstrated as a less significant exposure pathway to children's blood, compared with ingestion. Whilst dermal exposure was negligible, diet and ingestion of soil and dust were the dominant parameters in terms of children's blood lead prediction. The exposure assessment identified the changing role of dietary intake when house lead loadings varied. Recommendations were also made to conduct comprehensive site-specific human health risk assessment in future studies of lead exposure under a semi-arid climate.