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Byun G, Kim S, Kim SY, Park D, Shin MJ, Oh H, Lee JT. Blood Lead Concentrations and Mortality in Korean Adults: the Korea National Health and Nutrition Examination Survey with Mortality Follow-Up. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186898. [PMID: 32967243 PMCID: PMC7557382 DOI: 10.3390/ijerph17186898] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/15/2020] [Accepted: 09/18/2020] [Indexed: 11/29/2022]
Abstract
Previous studies have consistently reported an increase in mortality risk, even at low levels of blood lead. The average blood lead concentration in the Korean population has steadily decreased but is still higher than that of developed countries. The purpose of this study was to examine the associations between mortality and blood lead concentrations for adults in Korea. We used the Korea National Health and Nutrition Examination Survey (2008–2013) linked Cause of Death data, which are followed by 2018. A total of 7308 subjects who aged over 30 at the baseline examination were included in the analyses. Cox proportional hazard model was used to estimate the hazard ratios of mortality from non-accidental causes and cancer mortality. The estimated hazard ratios (95% CI) for comparison of the second and third tertile group with the lowest tertile group were 2.01 (1.20, 3.40) and 1.91 (1.13, 3.23) for non-accidental mortality and 3.42 (95% CI: 1.65, 7.08) and 2.27 (95% CI: 1.09, 4.70) for cancer mortality, respectively. The dose–response relationship also showed significant increase in the risk of mortality at blood lead level between 1.5 and 6.0 μg/dL. Our findings suggest that potent policies to lower lead exposure are required for the general Korean population.
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Affiliation(s)
- Garam Byun
- Department of Public Health Science, Graduate School, Korea University, Seoul 02841, Korea; (G.B.); (S.-Y.K.)
| | - Sera Kim
- Interdisciplinary Program in Precision Public Health, Korea University, Seoul 02841, Korea; (S.K.); (D.P.); (M.-J.S.); (H.O.)
| | - Soo-Yeon Kim
- Department of Public Health Science, Graduate School, Korea University, Seoul 02841, Korea; (G.B.); (S.-Y.K.)
| | - Dahyun Park
- Interdisciplinary Program in Precision Public Health, Korea University, Seoul 02841, Korea; (S.K.); (D.P.); (M.-J.S.); (H.O.)
| | - Min-Jeong Shin
- Interdisciplinary Program in Precision Public Health, Korea University, Seoul 02841, Korea; (S.K.); (D.P.); (M.-J.S.); (H.O.)
- School of Biosystems and Biomedical Sciences, College of Health Science Korea University, Seoul 02841, Korea
| | - Hannah Oh
- Interdisciplinary Program in Precision Public Health, Korea University, Seoul 02841, Korea; (S.K.); (D.P.); (M.-J.S.); (H.O.)
- School of Health Policy and Management, College of Health Science, Korea University, Seoul 02841, Korea
| | - Jong-Tae Lee
- Interdisciplinary Program in Precision Public Health, Korea University, Seoul 02841, Korea; (S.K.); (D.P.); (M.-J.S.); (H.O.)
- School of Health Policy and Management, College of Health Science, Korea University, Seoul 02841, Korea
- Correspondence:
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Zhai Q, Wang J, Cen S, Zhao J, Zhang H, Tian F, Chen W. Modulation of the gut microbiota by a galactooligosaccharide protects against heavy metal lead accumulation in mice. Food Funct 2019; 10:3768-3781. [PMID: 31180403 DOI: 10.1039/c9fo00587k] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The heavy metal lead (Pb) is a toxic contaminant that induces a range of adverse effects in humans. The present study demonstrated for the first time that dietary supplementation with a galactooligosaccharide (GOS) promotes fecal Pb excretion and reduces Pb accumulation in the blood and tissues of mice. The effects against Pb exposure were also observed in mice that received the fecal microbiota from donors treated with GOS, but were diminished in gut microbiota-depleted mice that received antibiotic pre-treatment, indicating that the protection by GOS administration was dependent on the modulation of the gut microbiota. We also provide evidence that the protective mechanism of GOS supplementation was related to the enhanced abundance of intestinal bacteria with good Pb-binding ability, recovery of the gut barrier function, modulation of bile acid metabolism, and improved essential metal utilization. These results indicate that GOS can be considered a potentially protective prebiotic against Pb toxicity.
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Affiliation(s)
- Qixiao Zhai
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu 214122, China.
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Jhun MA, Hu H, Schwartz J, Weisskopf MG, Nie LH, Sparrow D, Vokonas PS, Park SK. Effect modification by vitamin D receptor genetic polymorphisms in the association between cumulative lead exposure and pulse pressure: a longitudinal study. Environ Health 2015; 14:5. [PMID: 25582168 PMCID: PMC4417283 DOI: 10.1186/1476-069x-14-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 12/27/2014] [Indexed: 05/07/2023]
Abstract
BACKGROUND Although the association between lead and cardiovascular disease is well established, potential mechanisms are still poorly understood. Calcium metabolism plays a role in lead toxicity and thus, vitamin D receptor (VDR) polymorphisms have been suggested to modulate the association between lead and health outcomes. We investigated effect modification by VDR genetic polymorphisms in the association between cumulative lead exposure and pulse pressure, a marker of arterial stiffness. METHODS We examined 727 participants (3,100 observations from follow-ups from 1991 to 2011) from the Normative Aging Study (NAS), a longitudinal study of aging. Tibia and patella bone lead levels were measured using K-x-ray fluorescence. Four single nucleotide polymorphisms (SNPs) in the VDR gene, Bsm1, Taq1, Apa1, and Fok1, were genotyped. Linear mixed effects models with random intercepts were implemented to take into account repeated measurements. RESULTS Adjusting for potential confounders, pulse pressure was 2.5 mmHg (95% CI: 0.4-4.7) and 1.9 mmHg (95% CI: 0.1-3.8) greater per interquartile range (IQR) increase in tibia lead (15 μg/g) and patella lead (20 μg/g), respectively, in those with at least one minor frequency allele in Bsm1 compared with those with major frequency allele homozygotes. The observed interaction effect between bone lead and the Bsm1 genotype persists over time during the follow-up. Similar results were observed in effect modification by Taq1. CONCLUSIONS This study suggests that subjects with the minor frequency alleles of VDR Bsm1 or Taq1 may be more susceptible to cumulative lead exposure-related elevated pulse pressure.
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Affiliation(s)
- Min A Jhun
- />Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI USA
| | - Howard Hu
- />Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Joel Schwartz
- />Department of Environmental Health, Harvard School of Public Health, Boston, MA USA
| | - Marc G Weisskopf
- />Department of Environmental Health, Harvard School of Public Health, Boston, MA USA
| | - Linda H Nie
- />School of Health Sciences, Purdue University, West Lafayette, IN USA
| | - David Sparrow
- />Veterans Affairs Boston Healthcare System and Boston University School of Medicine & Public Health, Boston, MA USA
| | - Pantel S Vokonas
- />Veterans Affairs Boston Healthcare System and Boston University School of Medicine & Public Health, Boston, MA USA
| | - Sung Kyun Park
- />Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI USA
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Integrating susceptibility into environmental policy: an analysis of the national ambient air quality standard for lead. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2012; 9:1077-96. [PMID: 22690184 PMCID: PMC3366601 DOI: 10.3390/ijerph9041077] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 03/20/2012] [Accepted: 03/21/2012] [Indexed: 11/21/2022]
Abstract
Susceptibility to chemical toxins has not been adequately addressed in risk assessment methodologies. As a result, environmental policies may fail to meet their fundamental goal of protecting the public from harm. This study examines how characterization of risk may change when susceptibility is explicitly considered in policy development; in particular we examine the process used by the U.S. Environmental Protection Agency (EPA) to set a National Ambient Air Quality Standard (NAAQS) for lead. To determine a NAAQS, EPA estimated air lead-related decreases in child neurocognitive function through a combination of multiple data elements including concentration-response (CR) functions. In this article, we present alternative scenarios for determining a lead NAAQS using CR functions developed in populations more susceptible to lead toxicity due to socioeconomic disadvantage. The use of CR functions developed in susceptible groups resulted in cognitive decrements greater than original EPA estimates. EPA’s analysis suggested that a standard level of 0.15 µg/m3 would fulfill decision criteria, but by incorporating susceptibility we found that options for the standard could reasonably be extended to lower levels. The use of data developed in susceptible populations would result in the selection of a more protective NAAQS under the same decision framework applied by EPA. Results are used to frame discussion regarding why cumulative risk assessment methodologies are needed to help inform policy development.
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Schwartz J, Bellinger D, Glass T. Exploring potential sources of differential vulnerability and susceptibility in risk from environmental hazards to expand the scope of risk assessment. Am J Public Health 2011; 101 Suppl 1:S94-101. [PMID: 22021315 DOI: 10.2105/ajph.2011.300272] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Genetic factors, other exposures, individual disease states and allostatic load, psychosocial stress, and socioeconomic position all have the potential to modify the response to environmental exposures. Moreover, many of these modifiers covary with the exposure, leading to much higher risks in some subgroups. These are not theoretical concerns; rather, all these patterns have already been demonstrated in studies of the effects of lead and air pollution. However, recent regulatory impact assessments for these exposures have generally not incorporated these findings. Therefore, differential risk and vulnerability is a critically important but neglected area within risk assessment, and should be incorporated in the future.
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Affiliation(s)
- Joel Schwartz
- Department of Environmental Health and Epidemiology, Harvard School of Public Health, and Harvard Center for Risk Analysis, Harvard University, Boston, MA 02215, USA.
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Hicken M, Gragg R, Hu H. How cumulative risks warrant a shift in our approach to racial health disparities: the case of lead, stress, and hypertension. Health Aff (Millwood) 2011; 30:1895-901. [PMID: 21976332 PMCID: PMC3915245 DOI: 10.1377/hlthaff.2010.1241] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Blacks have persistently higher rates of high blood pressure, or hypertension, compared to whites, resulting in higher health costs and mortality rates. Recent research has shown that social and environmental factors-such as high levels of stress and exposure to lead-may explain racial disparities in hypertension. Based on these findings, we recommend a fundamental shift in approaches to health disparities to focus on these sorts of cumulative risks and health effects. Federal and state agencies and research institutions should develop strategic plans to learn more about these connections and apply the broader findings to policies to reduce health disparities.
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Affiliation(s)
- Margaret Hicken
- Robert Wood Johnson Health and Society Scholar at the Center for Social Epidemiology and Population Health, University of Michigan, Ann Arbor, USA.
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Park J, Lee JS, Kim J. Relationship between dietary sodium, potassium, and calcium, anthropometric indexes, and blood pressure in young and middle aged Korean adults. Nutr Res Pract 2010; 4:155-62. [PMID: 20461205 PMCID: PMC2867227 DOI: 10.4162/nrp.2010.4.2.155] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Revised: 03/10/2010] [Accepted: 03/27/2010] [Indexed: 12/20/2022] Open
Abstract
Epidemiological evidence of the effects of dietary sodium, calcium, and potassium, and anthropometric indexes on blood pressure is still inconsistent. To investigate the relationship between dietary factors or anthropometric indexes and hypertension risk, we examined the association of systolic and diastolic blood pressure (SBP and DBP) with sodium, calcium, and potassium intakes and anthropometric indexes in 19~49-year-olds using data from Korean National Health and Nutrition Examination Survey (KNHANES) III. Total of 2,761 young and middle aged adults (574 aged 19~29 years and 2,187 aged 30~49 years) were selected from KNHANES III. General information, nutritional status, and anthropometric data were compared between two age groups (19~29 years old and 30~49 years old). The relevance of blood pressure and risk factors such as age, sex, body mass index (BMI), weight, waist circumference, and the intakes of sodium, potassium, and calcium was determined by multiple regression analysis. Multiple regression models showed that waist circumference, weight, and BMI were positively associated with SBP and DBP in both age groups. Sodium and potassium intakes were not associated with either SBP or DBP. Among 30~49-year-olds, calcium was inversely associated with both SBP and DBP (P = 0.012 and 0.010, respectively). Our findings suggest that encouraging calcium consumption and weight control may play an important role in the primary prevention and management of hypertension in early adulthood.
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Affiliation(s)
- Juyeon Park
- Cancer Epidemiology Branch, Research Institute, National Cancer Center, 111 Jungbalsanro, Ilsandong-gu, Goyang-si, Gyeonggi 410-769, Korea
| | - Jung-Sug Lee
- Cancer Epidemiology Branch, Research Institute, National Cancer Center, 111 Jungbalsanro, Ilsandong-gu, Goyang-si, Gyeonggi 410-769, Korea
| | - Jeongseon Kim
- Cancer Epidemiology Branch, Research Institute, National Cancer Center, 111 Jungbalsanro, Ilsandong-gu, Goyang-si, Gyeonggi 410-769, Korea
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Abstract
BACKGROUND Previous reviews have shown increases in blood pressure and hypertension associated with increases in lead levels in blood. We performed a meta-analysis of the association of bone lead levels with systolic blood pressure, diastolic blood pressure, and hypertension using published data. METHODS We searched Medline, Embase, and Toxline for epidemiologic studies on bone lead levels and blood pressure endpoints. We used inverse-variance weighted random-effects models to summarize the association of tibia or patella lead levels with blood pressure endpoints. RESULTS We summarized data from 3 prospective studies and 5 cross-sectional studies. All studies measured lead levels in tibia bone and 3 studies measured lead levels in patella. For a 10 microg/g increase in tibia lead, the cross-sectional summary increases in blood pressure were 0.26 mm Hg for systolic (95% confidence interval = 0.02 to 0.50) and 0.02 mm Hg for diastolic (-0.15 to 0.19). The summary odds ratio for hypertension was 1.04 (1.01 to 1.07). For a 10 microg/g increase in patella lead, the summary odds ratio for hypertension was 1.04 (0.96 to 1.12). CONCLUSION Systolic blood pressure and hypertension risk were associated with lead levels in tibia bone, but the magnitude of the summary estimates was small. These summary estimates, however, were based on published data and we could not evaluate nonlinear dose-response relationships, the relative contribution of bone and blood lead levels, or the influence of differences in study populations. A more detailed characterization of the association of bone lead levels and blood pressure endpoints would require a pooled analysis of individual participant data from existing studies.
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Peters JL, Kubzansky L, McNeely E, Schwartz J, Spiro A, Sparrow D, Wright RO, Nie H, Hu H. Stress as a potential modifier of the impact of lead levels on blood pressure: the normative aging study. ENVIRONMENTAL HEALTH PERSPECTIVES 2007; 115:1154-9. [PMID: 17687441 PMCID: PMC1940093 DOI: 10.1289/ehp.10002] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2006] [Accepted: 03/19/2007] [Indexed: 05/05/2023]
Abstract
BACKGROUND Lead exposure and psychological stress have been independently associated with hypertension in various populations, and animal studies suggest that when they co-occur, their effects may be exacerbated. OBJECTIVES We examined whether psychological stress modifies the impact of cumulative lead exposure (measured as bone lead levels) on hypertension and blood pressure in Boston-area community-exposed men participating in the Normative Aging Study. METHODS We evaluated the modifying effect of stress on lead exposure on baseline hypertension status (513 participants) and on blood pressure in those without hypertension (237 participants), cross-sectionally. In baseline nonhypertensives, we examined the same risk factors in relation to prospective risk of developing hypertension. RESULTS Cross-sectional analysis revealed a positive interaction between stress and tibia lead on systolic blood pressure, after adjusting for age, body mass index, family history of high blood pressure, education, smoking, alcohol consumption, physical activity, and nutritional factors. In prospective multivariate analyses, high stress also modified the effect of tibia lead and patella lead on the risk of developing hypertension. Those reporting high stress had 2.66 [95% confidence interval (CI), 1.43-4.95] times the risk of developing hypertension per standard deviation increase in tibia lead and had 2.64 (95% CI, 1.42-4.92) times the risk per standard deviation increase in patella lead. CONCLUSION To our knowledge, these are the first analyses to look at interactive effects of stress and lead on hypertension in humans. These results suggest that the effect of lead on hypertension is most pronounced among highly stressed individuals, independent of demographic and behavioral risk factors.
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Affiliation(s)
- Junenette L Peters
- Department of Environmental Health, Harvard Shool of Public Health, Boston, MA 02215, USA.
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