The role of biological monitoring in the health management of lead-exposed workers

Environmental exposure of heavy metal (lead and cadmium) and hearing loss: data from the Korea National Health and Nutrition Examination Survey (KNHANES 2010-2013)

BACKGROUND

Lead and cadmium have been identified as risk factors for hearing loss in animal studies, but large-scale studies targeting the general human population are rare. This study was conducted to investigate the link between heavy metal concentrations in blood and hearing impairment, using a national population-based survey.

METHODS

The study participants comprised 6409 Koreans aged 20 or older, who were included in the Fifth and Sixth Korea National Health and Nutrition Examination Surveys (KNHANES 2010-2013). Hearing impairment was categorized into two types, low- and high-frequency hearing impairment, using pure tone audiometry. Low-frequency hearing impairment was defined as having a binaural average of hearing thresholds for 0.5, 1, and 2 kHz exceeding 25 dB, and high-frequency hearing impairment was defined as having a binaural average of hearing thresholds for 3, 4, and 6 kHz exceeding 25 dB. The blood levels of heavy metals (lead and cadmium) were classified into quartiles. Cross-sectional association between hearing impairment and the level of heavy metals (lead and cadmium) was examined in both sexes. Multivariate logistic regression was used to obtain adjusted odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

Among men, the prevalence of low- and high- frequency hearing impairment was 13.9% and 46.7%, respectively, which was higher than the prevalence among women (11.8% and 27.0%, respectively). Regarding lead, the adjusted OR of high-frequency hearing impairment for the highest blood level group versus the lowest group was significant in both men (OR = 1.629, 95% CI = 1.161-2.287) and women (OR = 1.502, 95% CI = 1.027-2.196), after adjusting for age, body mass index, education, smoking, alcohol consumption, exercise, diagnosis of diabetes mellitus, hypertension, and noise exposure (occupational, loud, firearm noises). No links were found between blood lead levels and low-frequency hearing impairment, or between blood cadmium levels and low- or high-frequency hearing impairment in either sex.

CONCLUSIONS

The present study findings suggest that even exposure to low-level lead is a risk factor for high-frequency hearing loss. A prospective epidemiologic study should be conducted to identify the causal relationship between human health and exposure to heavy metals, and efforts to reduce heavy metal exposure in the general population should continue.

Design of Carrageenan-Based Heparin-Mimetic Gel Beads as Self-Anticoagulant Hemoperfusion Adsorbents

The currently used hemoperfusion adsorbents such as activated carbon and ion-exchange resin show dissatisfactory hemocompatibility, and a large dose of injected heparin leads to the increasing cost and the risk of systematic bleeding. Natural polysaccharide adsorbents commonly have good biocompatibility, but their application is restricted by the poor mechanical strength and low content of functional groups. Herein, we developed an efficient, self-anticoagulant and blood compatible hemoperfusion adsorbent by imitating the structure and functional groups of heparin. Carrageenan and poly(acrylic acid) (PAA) cross-linked networks were built up by the combination of phase inversion of carrageenan and post-cross-linking of AA, and the formed dual-network structure endowed the beads with improved mechanical properties and controlled swelling ratios. The beads exhibited low protein adsorption amounts, low hemolysis ratios, low cytotoxicity, and suppressed complement activation and contact activation levels. Especially, the activated partial thromboplastin time, prothrombin time, and thrombin time of the gel beads were prolonged over 13, 18, and 4 times than those of the control. The self-anticoagulant and biocompatible beads showed good adsorption capacities toward exogenous toxins (560.34 mg/g for heavy metal ions) and endogenous toxins (14.83 mg/g for creatinine, 228.16 mg/g for bilirubin, and 18.15 mg/g for low density lipoprotein (LDL)), thus, highlighting their potential usage for safe and efficient blood purification.

Environmental exposures to lead, mercury, and cadmium among South Korean teenagers (KNHANES 2010-2013): Body burden and risk factors

INTRODUCTION

Limited information is available on the association of age and sex with blood concentrations of heavy metals in teenagers. In addition, factors such as a shared family environment may have an association. We analyzed data from the Korean National Health and Nutrition Examination Survey (KNHANES, 2010-2013) to determine whether blood levels of heavy metals differ by risk factors such as age, sex, and shared family environment in a representative sample of teenagers.

METHODS

This study used data obtained in the KNHANES 2010-2013, which had a rolling sampling design that involved a complex, stratified, multistage, probability-cluster survey of a representative sample of the non-institutionalized civilian population in South Korea. Our cross-sectional analysis was restricted to teenagers and their parents who completed the health examination survey, and for whom blood measurements of cadmium, lead, and mercury were available. The final analytical sample consisted of 1585 teenagers, and 376 fathers and 399 mothers who provided measurements of blood heavy metal concentrations.

RESULTS

Male teenagers had greater blood levels of lead and mercury, but sex had no association with blood cadmium level. There were age-related increases in blood cadmium, but blood lead decreased with age, and age had little association with blood mercury. The concentrations of cadmium and mercury declined from 2010 to 2013. The blood concentrations of lead, cadmium, and mercury in teenagers were positively associated with the levels in their parents after adjustment for covariates.

CONCLUSION

Our results show that blood heavy metal concentrations differ by risk factors such as age, sex, and shared family environment in teenagers.

Association of Blood Cadmium Level with Metabolic Syndrome After Adjustment for Confounding by Serum Ferritin and Other Factors: 2008-2012 Korean National Health and Nutrition Examination Survey

We examined the association of metabolic syndrome (MS) with blood levels of cadmium (Cd), lead (Pb), and mercury (Hg) using adjustment for confounding by serum ferritin, in a representative sample of the adult population of South Korea. This cross-sectional study enrolled subjects who were at least 20 years old, completed the health examination survey, and had blood measurements of Pb, Cd, and Hg. In males, adjusted odds ratios (ORs) indicated that a doubling of blood Cd resulted in a 26.4-31.0 % increased risk of MS, and subjects in the highest tertile of blood Cd were 35.8 % more likely to have MS than those in the lowest tertile after adjustment for blood Pb, blood Hg, and serum ferritin. Serum ferritin was also associated with MS. No significant results were observed in females. There were no significant associations of MS with blood Pb or blood Hg. The present study confirms our previous findings, which had a smaller sample size and a shorter study period.

Sex differences in the relationship between blood mercury concentration and metabolic syndrome risk

BACKGROUND

Mercury exposure enhances free radical production and reduces activity of anti-oxidant enzymes, resulting in detrimental health effects. Some researchers have reported an association between blood mercury and increased risk of metabolic syndrome (MetS); however, sex differences in the relationship were not fully considered.

AIM

To examine the sex differences in the relationship between blood mercury concentration and the increased risk of MetS in Korean men and women.

MATERIALS AND METHODS

A nationwide cross-sectional study was conducted to examine the relationship between blood mercury concentration and MetS in 2,976 men and 3,074 women over 19 years of age (aged 19-87 years), using data from the 2010-2012 Korean National Health and Nutrition Examination Survey (KNHANES-V). Multiple logistic regression analysis was used to assess the relationship between blood mercury concentration and the prevalence risk of MetS after adjusting for confounding variables.

RESULTS

Compared to the lowest quartile of blood mercury concentration, the OR (95 % CI) for MetS of the highest quartile in men was 1.62 (1.15-2.28) after adjusting for age, smoking status, alcohol consumption, regular exercise, and BMI. Similarly, in multiple logistic regression analysis using log2-transformed blood mercury as a continuous variable, the OR (95 % CI) for having MetS with doubling of blood mercury was 1.20 (1.05-1.36) after adjusting for the same co-variables. However, the relationship was not observed in women after adjusting for the same co-variables.

CONCLUSIONS

Blood mercury concentration was independently associated with an increased risk of MetS in men.

Additive effect of heavy metals on metabolic syndrome in the Korean population: the Korea National Health and Nutrition Examination Survey (KNHANES) 2009-2010

There have been increasing concerns regarding health problems due to endocrine disrupting chemicals (EDCs). We investigated association of heavy metals, including lead, mercury, and cadmium, with metabolic syndrome (MS) and its individual components in the Korean population. Participants included 1,961 males and 1,989 females 20 years of age or older from the fourth and fifth Korea National Health and Nutritional Examination Surveys of the Korean population (2009 and 2010). We examined the relationship of blood lead, mercury, and cadmium levels with MS and the additive effect of three heavy metals on MS after adjustment for age, sex, body mass index (BMI), region, smoking, alcohol consumption, and regular exercise. Blood concentration of lead showed a significant but modest association with prevalence of MS (P = 0.04). Other heavy metals did not show such a relationship with MS. When the participants were classified according to the sum of category numbers of the three heavy metals, adjusted odds ratios were 1.0, 1.355, 1.638, and 1.556 (P < 0.01). Among components of MS, significant relationship of the sum of heavy metals with hypertension and elevated triglyceride was demonstrated. Blood concentration of lead was positively associated with the prevalence of MS. Of particular interest, cumulative effect of a mixture of lead, mercury, and cadmium on prevalence of MS was stronger than the sum of effect of each heavy metal. Accumulative effect of exposure to heavy metals could be more additive or synergistic than individual exposure in the general population.

Relationship between blood mercury concentrations and serum γ-glutamyltranspeptidase level in Korean adults using data from the 2010 Korean National Health and Nutrition Examination Survey

BACKGROUND

Mercury and serum γ-glutamyltranspeptidase (GGT) play an important role in anti-oxidant mechanisms. This study aimed to investigate the association between blood mercury concentrations and GGT in Korean men and women.

METHODS

A nationwide cross-sectional study was conducted to examine the relationship between blood mercury concentration and serum GGT among 1959 subjects (aged 20-87 y; 965 men, 994 women), using data from the 2010 Korean National Health and Nutrition Examination Survey. The odds ratios (ORs) and 95% confidence intervals (CIs) for high GGT (≥ 75 th percentile) for both men and women were calculated across blood mercury quartiles using multiple logistic regression analyses.

RESULTS

The mean values of BMI, waist circumference, diastolic blood pressure, total cholesterol, and triglycerides were highest in the highest quartile of blood mercury concentrations in both sexes. GGT levels gradually increased in accordance with blood mercury quartiles. Compared to the lowest quartile of blood mercury concentrations, the adjusted OR (95% CI) for high GGT of the highest quartile was 2.59 (1.51-4.43) in men and 2.03 (1.13-3.67) in women.

CONCLUSION

We found a positive relationship between blood mercury concentration and serum GGT level in a representative population sample of Korean adults.

Blood cadmium, mercury, and lead and metabolic syndrome in South Korea: 2005-2010 Korean National Health and Nutrition Examination Survey

INTRODUCTION

We present data from the Korean National Health and Nutrition Examination Survey 2005-2010 regarding the association between levels of blood cadmium, mercury, and lead and metabolic syndrome (MS) in a representative sample of the adult South Korean population. MS is defined as a cluster of disorders including central obesity, glucose intolerance, hypertension, low high-density lipoprotein cholesterol, and high triglycerides.

METHODS

The analysis was restricted to participants ≥20 years of age who completed the health examination survey, including blood lead, cadmium, and mercury measurements. Odds ratios (ORs) for MS were calculated for log2 -transformed blood metal levels and tertiles thereof after covariate adjustment.

RESULTS

No significant results were observed in females. In males, adjusted ORs indicated that a doubling of blood cadmium resulted in a 23.0% increase in the risk of MS. Male subjects in the highest tertile of blood cadmium were 36.7% more likely to have MS versus those in the lowest tertile. There were no significant ORs for having MS or its components in any of the models of blood lead and mercury levels after covariate adjustment.

CONCLUSION

The association between blood cadmium level and MS was significant regardless of the type of variable (continuous or categorical) among men with lower blood cadmium levels. Thus, blood cadmium levels were robust risk factors for MS in men. To our knowledge, this is the first report of an association between cadmium exposure and MS.

Association of blood cadmium with hypertension in the Korean general population: analysis of the 2008-2010 Korean National Health and Nutrition Examination Survey data

INTRODUCTION

We present data from the Korean National Health and Nutrition Examination Survey 2008-2010 regarding the association between blood cadmium levels and blood pressure in a representative sample of the adult South Korean population.

METHODS

We restricted the analysis to participants ≥20 years of age who completed the health examination survey, including blood cadmium measurements (n = 5,919). We performed multivariate linear regression analyses to estimate adjusted mean differences in diastolic and systolic blood pressure associated with doubling of, or quartiles of, cadmium levels after covariate adjustment. We calculated odds ratios (ORs) for hypertension and prehypertension for log-transformed blood cadmium levels and quartiles thereof after covariate adjustment.

RESULTS

We observed a twofold increase in blood cadmium associated with 0.755 and 1.007 mmHg increases in diastolic pressure in women and men, respectively. We observed 2.243 and 1.975 mmHg increases in diastolic pressure in women and men, respectively, in the highest compared with the lowest quartile of blood cadmium. Systolic pressure showed results similar to those of diastolic pressure. Based on ORs, a doubling of blood cadmium resulted in 18.6% and 31.5% increases in the risk of hypertension in women and men, respectively. Doubling of blood cadmium resulted in a 23.5% and 22.9% increase in the risk of prehypertension in women and men, respectively.

CONCLUSION

We found a significant association between blood cadmium levels and elevated blood pressure regardless of the type of variable (continuous or categorical) in women and men with a lower blood cadmium level compared to previous Korean studies. This study also showed that blood cadmium levels were robust risk factors for prehypertension in both women and men.

Occupational health management in the lead industry: the korean experience

In 1967, the problem of occupational lead exposure came to public attention in Korea. Since then, regular progress has been made in lowering workplace lead exposures, instituting new workplace controls, and implementing health examinations of exposed workers. Past serious lead poisoning episodes made it possible to introduce biological monitoring programs on a voluntary basis in high-lead-exposure facilities in Korea. Industry-specific occupational health services for lead workers in Korea during the last 22 years can be categorized into three phases. During the first phase (1988-1993), efforts were directed at increasing awareness among workers about the hazards of lead exposure, biological monitoring of blood zinc protoporphyrin began, and a respiratory protection program was introduced. During the second phase (1994-1997), a computerized health management system for lead workers was developed, blood-lead measurement was added to biologic monitoring, and engineering controls were introduced in the workplace to lower air-lead levels to comply with air-lead regulations. Finally, during the third phase (1998-present), a new biomarker, bone-lead measurement by X-ray fluorescence, was introduced. Bone-lead measurement proved to be useful for assessing body burden and to demonstrate past lead exposure in retired workers. Occupational health service practice for lead workers, including the industry-specific group occupational health system, has brought considerable success in the prevention of lead poisoning and in reducing the lead burden in Korean lead workers during the last several decades. The successful achievement of prevention of lead poisoning in Korea was a result of the combined efforts of lead workers, employers, relevant government agencies, and academic institutes.

A comparison of blood lead levels between migrant and native lead workers before and after implementation of a new employment permit system for migrant workers

We compared the blood lead and other lead biomarkers between migrant and native workers with a focus on the impact of the legal employment permit system that was effective from 2003, which required employers to provide mandatory annual health examinations for migrant workers on lead biomarkers in 1997 and 2005. The mean blood lead level of migrant workers was 59.5 ± 19.4 μg/dl, yielding 47% of lead poisoning cases, which was significantly higher than that of native workers (36.8 ± 14.5 μg/dl; 11% of lead poisoning cases) in 1997 before enactment of the act. The overall mean blood ZPP levels and ALAU of migrant workers were significantly higher than those of native workers. In 2005, after new migrant worker regulations were instituted, the mean value of above lead biomarkers workers was still significantly higher than that of native workers, but the magnitude of the differences was smaller compared with the difference in 1997. We confirmed that the 2003 regulations played an important role in improving the health of migrant workers in the lead industry in terms of their blood lead levels and other lead biomarkers.

Use of field-portable X-ray fluorescence (FPXRF) analyzer to measure airborne lead levels in Korean workplaces

We evaluated the possibility of applying field-portable x-ray fluorescence (FPXRF) analysis as a rapid, on-site and near real-time method for evaluating airborne lead contamination in Korean workplaces. A total of 287 airborne lead filter samples were measured in 12 lead-using workplaces during routine industrial hygienic monitoring procedures as required by Korean government regulations. All filter samples were collected using the standard industrial hygiene sampling protocol described in NIOSH Method 7300 using closed-face 37-mm cassettes with preloaded cellulose ester membrane filters with a pore size of 0.8 microm. The samples were first analyzed using the non-destructive, FPXRF analytical method (NIOSH method 7702), and then subsequently analyzed using inductively coupled plasma atomic emission spectrophotometry (ICP) (NIOSH method 7300) as a reference analytical method. Pair-wise comparison of filter samples using the paired t-test revealed no statistically significant differences between the two methods over a wide range of airborne lead levels (0.018-0.201 microg/m(3)) either over the industries assessed or separately in the 12 lead-using workplaces. Linear regression of the data between the ICP and FPXRF methods produced a slope of 1.03, a y-intercept of 0.13 microg/sample, and a coefficient of determinant (r(2)) of 0.975 for all the data. For samples in the range from 0 to 100 microg, the corresponding values were 1.07, -1.20 microg/sample, and 0.925, respectively. There were no significant differences in the regression analyses of the three industry types (r(2)=0.964-0.982). Our data suggest that FPXRF data are highly correlated with those from the laboratory-based ICP method in terms of accuracy, precision, and bias. Therefore, FPXRF can be used for the rapid, on-site analysis of lead air-filter samples for values up to 26 microg/sample prior to laboratory confirmation by the ICP method.

Lead intoxication: A summary of the clinical presentation among Thai patients

Lead is an important toxic metal found in industrial communities. Due to the industrialization in the recent decade in Thailand, lead intoxication as a toxicant-related disorder becomes a new public health problem. A retrospective study on clinical presentation of hospitalized patients with diagnosis of lead intoxication during year 1990-1999 in King Chulalongkorn Memorial hospital, the largest Thai Red Cross Society Hospital, was performed. All 14 cases diagnosed with lead intoxication were identified in our series. Average age of the subjects was 25.55 +/- 21.93 years old. Male predominance was detected in our series (male:female = 12:2). Two main groups of subjects as; (1) childhood aged below 10 years old (male:female = 4:2) and (2) adult aged between 24 and 60 years old (n = 8, all male), can be identified. For the first group, the clinical presentations were convulsion (n = 3), unexplained anemia (n = 1), attention deficit (n = 1) and asymptomatic (n = 1), respectively. All of the subjects in this group presented the history of living at the old battery plant area. Five of the six cases came from the same village. For the second group, the clinical presentations were unexplained abdominal pain (n = 5), chronic renal failure (n = 1), unexplained anemia (n = 1) and asymptomatic (n = 1), respectively. Most of the subjects (75%) in this group presented the history of working in the battery plant for more than 10 years. Another case presented the history of gunshot and residual bullet in the bone marrow. The other one left is an interesting case with the history of prolonged usage of ritual pill and holy paper incineration. Like other studies, battery plant had strong relation with the lead intoxication. Although the total identified cases are rather few, there may be more undetected asymptomatic lead intoxication cases in the community. Specific control of lead resulted from battery plant and monitoring of the workers as public health strategies are still recommended.