Temporal trend of cadmium exposure in the United States population suggests gender specificities

Cadmium exposure and cardiovascular disease risk: A systematic review and dose-response meta-analysis

Exposure to toxic metals is a global public health threat. Among other adverse effects, exposure to the heavy metal cadmium has been associated with greater risk of cardiovascular disease (CVD). Nonetheless, the shape of the association between cadmium exposure and CVD risk is not clear. This systematic review summarizes data on the association between cadmium exposure and risk of CVD using a dose-response approach. We carried out a literature search in PubMed, Web of Science, and Embase from inception to December 30, 2023. Inclusion criteria were: studies on adult populations, assessment of cadmium exposure, risk of overall CVD and main CVD subgroups as endpoints, and observational study design (cohort, cross-sectional, or case-control). We retrieved 26 eligible studies published during 2005-2023, measuring cadmium exposure mainly in urine and whole blood. In a dose-response meta-analysis using the one-stage method within a random-effects model, we observed a positive association between cadmium exposure and risk of overall CVD. When using whole blood cadmium as a biomarker, the association with overall CVD risk was linear, yielding a risk ratio (RR) of 2.58 (95 % confidence interval-CI 1.78-3.74) at 1 μg/L. When using urinary cadmium as a biomarker, the association was linear until 0.5 μg/g creatinine (RR = 2.79, 95 % CI 1.26-6.16), after which risk plateaued. We found similar patterns of association of cadmium exposure with overall CVD mortality and risks of heart failure, coronary heart disease, and overall stroke, whereas for ischemic stroke there was a positive association with mortality only. Overall, our results suggest that cadmium exposure, whether measured in urine or whole blood, is associated with increased CVD risk, further highlighting the importance of reducing environmental pollution from this heavy metal.

Joint association of heavy metals and polycyclic aromatic hydrocarbons exposure with depression in adults

BACKGROUND

Heavy metals (HMs) and polycyclic aromatic hydrocarbons (PAHs) represent significant components of environmental pollution, typically occurring as mixtures, raising concerns about their potential impact on human health. However, the combined effect of HMs and PAHs exposure on depression has not been explored.

METHODS

Leveraging National Health and Nutrition Examination Survey (NHANES) data spanning 2005 to 2016, we employ survey-weighted multiple logistic regression models to probe the interrelation between HMs, PAHs, and depression. This exploration is complemented by age and gender-stratified analyses, as well as a determination of the dose-response linkage via restricted cubic spline regression. Furthermore, the combined impact of HMs and PAHs on depression was evaluated through a range of statistical methodologies.

RESULTS

The study encompasses 7732 adults. Our findings unveil notable associations, indicating the significant influence of cadmium (Cd), lead (Pb), and all six PAHs metabolites on depression. Moreover, mixed exposure to HMs and PAHs emerges as a substantial contributor to an augmented depression risk, with Cd, Pb, 1-hydroxynaphthalene (1-NAP), 2-hydroxyfluorene (2-FLU), and 1-hydroxypyrene (1-PYR) likely driving this positive relationship. Intriguingly, subgroup analyses highlight greater prominence of these connections among individuals aged 20-59 and among women. Furthermore, the results tentatively suggest a potential interplay between Cd and 2-NAP in relation to depression.

CONCLUSION

This study posits that exposure to both individual and combined HMs and PAHs may be associated with an elevated risk of depression. Further prospective investigations are warranted to substantiate these findings.

The NOAEL Equivalent of Environmental Cadmium Exposure Associated with GFR Reduction and Chronic Kidney Disease

Cadmium (Cd) is a highly toxic metal pollutant present in virtually all food types. Health guidance values were established to safeguard against excessive dietary Cd exposure. The derivation of such health guidance figures has been shifted from the no-observed-adverse-effect level (NOAEL) to the lower 95% confidence bound of the benchmark dose (BMD), termed BMDL. Here, we used the PROAST software to calculate the BMDL figures for Cd excretion (E_Cd) associated with a reduction in the estimated glomerular filtration rate (eGFR), and an increased prevalence of chronic kidney disease (CKD), defined as eGFR ≤ 60 mL/min/1.73 m². Data were from 1189 Thai subjects (493 males and 696 females) mean age of 43.2 years. The overall percentages of smokers, hypertension and CKD were 33.6%, 29.4% and 6.2%, respectively. The overall mean E_Cd normalized to the excretion of creatinine (E_cr) as E_Cd/E_cr was 0.64 µg/g creatinine. E_Cd/E_cr, age and body mass index (BMI) were independently associated with increased prevalence odds ratios (POR) for CKD. BMI figures ≥24 kg/m² were associated with an increase in POR for CKD by 2.81-fold (p = 0.028). E_Cd/E_cr values of 0.38-2.49 µg/g creatinine were associated with an increase in POR for CKD risk by 6.2-fold (p = 0.001). The NOAEL equivalent figures of E_Cd/E_cr based on eGFR reduction in males, females and all subjects were 0.839, 0.849 and 0.828 µg/g creatinine, respectively. The BMDL/BMDU values of E_Cd/E_cr associated with a 10% increase in CKD prevalence were 2.77/5.06 µg/g creatinine. These data indicate that Cd-induced eGFR reduction occurs at relatively low body burdens and that the population health risk associated with E_Cd/E_cr of 2.77-5.06 µg/g creatinine was not negligible.

Cadmium and Lead Exposure, Nephrotoxicity, and Mortality

The present review aims to provide an update on health risks associated with the low-to-moderate levels of environmental cadmium (Cd) and lead (Pb) to which most populations are exposed. Epidemiological studies examining the adverse effects of coexposure to Cd and Pb have shown that Pb may enhance the nephrotoxicity of Cd and vice versa. Herein, the existing tolerable intake levels of Cd and Pb are discussed together with the conventional urinary Cd threshold limit of 5.24 μg/g creatinine. Dietary sources of Cd and Pb and the intake levels reported for average consumers in the U.S., Spain, Korea, Germany and China are summarized. The utility of urine, whole blood, plasma/serum, and erythrocytes to quantify exposure levels of Cd and Pb are discussed. Epidemiological studies that linked one of these measurements to risks of chronic kidney disease (CKD) and mortality from common ailments are reviewed. A Cd intake level of 23.2 μg/day, which is less than half the safe intake stated by the guidelines, may increase the risk of CKD by 73%, and urinary Cd levels one-tenth of the threshold limit, defined by excessive ß₂-microglobulin excretion, were associated with increased risk of CKD, mortality from heart disease, cancer of any site and Alzheimer's disease. These findings indicate that the current tolerable intake of Cd and the conventional urinary Cd threshold limit do not provide adequate health protection. Any excessive Cd excretion is probably indicative of tubular injury. In light of the evolving realization of the interaction between Cd and Pb, actions to minimize environmental exposure to these toxic metals are imperative.

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.

Maternal blood cadmium, lead and arsenic levels, nutrient combinations, and offspring birthweight

Background

Cadmium (Cd), lead (Pb) and arsenic (As) are common environmental contaminants that have been associated with lower birthweight. Although some essential metals may mitigate exposure, data are inconsistent. This study sought to evaluate the relationship between toxic metals, nutrient combinations and birthweight among 275 mother-child pairs.

Methods

Non-essential metals, Cd, Pb, As, and essential metals, iron (Fe), zinc (Zn), selenium (Se), copper (Cu), calcium (Ca), magnesium (Mg), and manganese (Mn) were measured in maternal whole blood obtained during the first trimester using inductively coupled plasma mass spectrometry. Folate concentrations were measured by microbial assay. Birthweight was obtained from medical records. We used quantile regression to evaluate the association between toxic metals and nutrients due to their underlying wedge-shaped relationship. Ordinary linear regression was used to evaluate associations between birth weight and toxic metals.

Results

After multivariate adjustment, the negative association between Pb or Cd and a combination of Fe, Se, Ca and folate was robust, persistent and dose-dependent (p < 0.05). However, a combination of Zn, Cu, Mn and Mg was positively associated with Pb and Cd levels. While prenatal blood Cd and Pb were also associated with lower birthweight. Fe, Se, Ca and folate did not modify these associations.

Conclusion

Small sample size and cross-sectional design notwithstanding, the robust and persistent negative associations between some, but not all, nutrient combinations with these ubiquitous environmental contaminants suggest that only some recommended nutrient combinations may mitigate toxic metal exposure in chronically exposed populations. Larger longitudinal studies are required to confirm these findings.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-017-4225-8) contains supplementary material, which is available to authorized users.

Cadmium and mercury exposure over time in Swedish children

PURPOSE

Knowledge about changes in exposure to toxic metals over time remains very sparse, in particular for children, the most vulnerable group. Here, we assessed whether a reduction in environmental pollution with cadmium (Cd) and mercury (Hg) caused a change in exposure over time. In total, 1257 children (age 4-9) in two towns in Sweden were sampled once in 1986-2013. Blood concentrations of Cd (b-Cd; n=1120) and Hg (b-Hg; n=560) were determined.

RESULTS

The median b-Cd was 0.10 (geometric mean 0.10; range 0.010-0.61) μg/L and b-Hg was 0.91 (geometric mean 0.83; range 0.021-8.2) μg/L. Children living close to a smelter had higher b-Cd and b-Hg than those in urban and rural areas. There was no sex difference in b-Cd or b-Hg, and b-Cd and b-Hg showed no significant accumulation by age. b-Cd decreased only slightly (0.7% per year, p<0.001) over the study period. In contrast, b-Hg did show a clear decrease over the study period (3% per year, p<0.001).

CONCLUSIONS

The exposure to Cd was very low but still might increase the risk of disease later in life. Moreover, b-Cd only showed a minor decrease, indicating that Cd pollution should be further restricted. b-Hg was relatively low and decreasing, probably because of reduced use of dental amalgam and lower Hg intake from fish. The b-Cd and b-Hg levels decreased much less than the levels of lead in the blood as previously found in the same children.

Geographic clustering of elevated blood heavy metal levels in pregnant women

Background

Cadmium (Cd), lead (Pb), mercury (Hg), and arsenic (As) exposure is ubiquitous and has been associated with higher risk of growth restriction and cardiometabolic and neurodevelopmental disorders. However, cost-efficient strategies to identify at-risk populations and potential sources of exposure to inform mitigation efforts are limited. The objective of this study was to describe the spatial distribution and identify factors associated with Cd, Pb, Hg, and As concentrations in peripheral blood of pregnant women.

Methods

Heavy metals were measured in whole peripheral blood of 310 pregnant women obtained at gestational age ~12 weeks. Prenatal residential addresses were geocoded and geospatial analysis (Getis-Ord G_i* statistics) was used to determine if elevated blood concentrations were geographically clustered. Logistic regression models were used to identify factors associated with elevated blood metal levels and cluster membership.

Results

Geospatial clusters for Cd and Pb were identified with high confidence (p-value for G_i* statistic <0.01). The Cd and Pb clusters comprised 10.5 and 9.2 % of Durham County residents, respectively. Medians and interquartile ranges of blood concentrations (μg/dL) for all participants were Cd 0.02 (0.01–0.04), Hg 0.03 (0.01–0.07), Pb 0.34 (0.16–0.83), and As 0.04 (0.04–0.05). In the Cd cluster, medians and interquartile ranges of blood concentrations (μg/dL) were Cd 0.06 (0.02–0.16), Hg 0.02 (0.00–0.05), Pb 0.54 (0.23–1.23), and As 0.05 (0.04–0.05). In the Pb cluster, medians and interquartile ranges of blood concentrations (μg/dL) were Cd 0.03 (0.02–0.15), Hg 0.01 (0.01–0.05), Pb 0.39 (0.24–0.74), and As 0.04 (0.04–0.05). Co-exposure with Pb and Cd was also clustered, the p-values for the G_i* statistic for Pb and Cd was <0.01. Cluster membership was associated with lower education levels and higher pre-pregnancy BMI.

Conclusions

Our data support that elevated blood concentrations of Cd and Pb are spatially clustered in this urban environment compared to the surrounding areas. Spatial analysis of metals concentrations in peripheral blood or urine obtained routinely during prenatal care can be useful in surveillance of heavy metal exposure.

Blood cadmium burden and the risk of nasopharyngeal carcinoma: a case-control study in Chinese Chaoshan population

Cadmium is a ubiquitous carcinogenic pollutant with multiple biological effects. Both observational and experimental studies have suggested associations between cadmium and the rates of many types of cancers. The aim of the present study was to evaluate whether cadmium exposure is associated with nasopharyngeal carcinoma (NPC) in a population with a relatively high prevalence in southeast China. Hospital-based 134 NPC cases and 132 cancer-free controls were recruited from a cancer hospital in Chaoshan area, southeast of China. Basic clinical data and information of lifetime styles, smoking, and drinking as well as other demographic characteristics were also collected from medical records. Blood cadmium levels (BCLs) were detected by graphite-furnace atomizer absorption spectrophotometer (GFAAS). BCLs and over-limit ratios between cases and controls were compared. The relationships between BCLs and NPC were explored by comparing BCLs differences between/among different characteristics of related factors and logistic regression analysis. In addition, BCLs within cases were also compared in relation to the disease clinical stages, pathological types, and metastasis. The median concentration of blood cadmium in cases (3.84, interquartile range 2.21-6.10) was significantly higher than that of controls (2.28, interquartile range 1.79-3.45). The over-limit ratio (≥5 μg/L) in cases was also higher than that in controls (35.1 vs. 13.6%, χ(2) = 16.55, p < 0.001). Smokers tended to have high levels of cadmium burden, and smokers with longer smoking pack-years in cases had relatively higher BCLs (p = 0.001). NPC patients with diseases history presented lower cadmium burden (p = 0.020). In the NPC cases, BCLs were positively associated with clinical stages and N classification (r = 0.193, 0.187, respectively, p < 0.05). Cadmium seems to be a risk factor of NPC, and high cadmium exposure may promote the occurrence and development of NPC.

The association between cigarette rod length, slim design, and blood cadmium levels among U.S. smokers: NHANES 1999-2010

BACKGROUND

Previous research has shown that long or slim cigarette design can mitigate perception of harmfulness. Cadmium (Cd) is a toxicant in cigarettes and is associated with adverse outcomes. We assessed the relationship between cigarette rod length/circumference and blood Cd levels among U.S. smokers using data from the 1999-2010 National Health and Nutrition Examination Survey.

METHODS

The analyses were performed on 4486 current cigarette smokers aged ≥20years old. Cigarette rod length included regular (68-72mm), king (79-88mm), long (94-101mm), and ultra-long (110-121mm) cigarettes currently smoked. Overall and gender stratified multivariate linear regression analyses were performed, adjusting for other influential covariates.

RESULTS

Gender stratified analysis indicated that female smokers of long and ultra-long cigarette had 20% and 27% higher mean Cd levels compared to smokers of regular sized cigarettes respectively, despite the fact that all the ultra-long cigarettes were slim cigarettes. Furthermore, among females, slim cigarette users did not reduce blood cadmium levels compared to non-slim users.

CONCLUSIONS

Female smokers of long or ultra-long cigarettes had higher mean blood Cd levels compared to smokers of regular cigarettes independent of slim design. Further research into this association is warranted.

Cadmium exposure and clinical cardiovascular disease: a systematic review

Mounting evidence supports that cadmium, a toxic metal found in tobacco, air and food, is a cardiovascular risk factor. Our objective was to conduct a systematic review of epidemiologic studies evaluating the association between cadmium exposure and cardiovascular disease. Twelve studies were identified. Overall, the pooled relative risks (95% confidence interval) for cardiovascular disease, coronary heart disease, stroke, and peripheral arterial disease were: 1.36 (95% CI: 1.11, 1.66), 1.30 (95% CI: 1.12, 1.52), 1.18 (95% CI: 0.86, 1.59), and 1.49 (95% CI: 1.15, 1.92), respectively. The pooled relative risks for cardiovascular disease in men, women and never smokers were 1.29 (1.12, 1.48), 1.20 (0.92, 1.56) and 1.27 (0.97, 1.67), respectively. Together with experimental evidence, our review supports the association between cadmium exposure and cardiovascular disease, especially for coronary heart disease. The number of studies with stroke, heart failure (HF) and peripheral arterial disease (PAD) endpoints was small. More studies, especially studies evaluating incident endpoints, are needed.

Effect of pregnancy on the levels of urinary metals for females aged 17-39 years old: data from National Health and Nutrition Examination Survey 2003-2010

Data from National Health and Nutrition Examination survey for the years 2003-2010 were used (n = 1565) to evaluate the effect of age, parity, body mass index (BMI), race/ethnicity, pregnancy, iron (Fe) storage status, smoking status, and fish/shellfish consumption on the levels of urine barium (Ba), cadmium (Cd), cesium (Cs), cobalt (Co), molybdenum (Mo), lead (Pb), antimony (Sb), thallium (TI), tungsten (W), uranium (U), and mercury (Hg) for females aged 17-39 yr old. Regression analysis was used to fit models for each of the 11 metals. For Cd, Cs, TI, and Hg, age was positively associated with levels of these metals. Body mass index was negatively associated with levels of Cs, Co, and TI. Levels of Co, Mo, and W increased over the period 2003-2010. Over the same period, levels of Pb, Sb, and Hg declined. Non-Hispanic blacks showed lower levels of almost all metals compared to either Mexican American or other unclassified race/ethnicities. Non-Hispanic whites displayed higher levels than non-Hispanic blacks for 9 of 11 metals. Smokers displayed significantly higher levels of Pb, Sb, W, and U than nonsmokers but significantly lower levels of Cd and Mo than nonsmokers. Pregnancy was found to be associated with higher levels of Ba, Cs, Co, Mo, Pb, W, and Hg compared to nonpregnant females. Levels of Mo, Cs, and Cd declined significantly during the pregnancy period but levels of Co rose during the same period.

Effect of pregnancy on the levels of blood cadmium, lead, and mercury for females aged 17-39 years old: data from National Health and Nutrition Examination Survey 2003-2010

Data from the National Health and Nutrition Examination survey for the years 2003-2010 were used (n = 4700) to evaluate the effect of age, parity, body mass index (BMI), race/ethnicity, pregnancy, iron (Fe) storage status, smoking status, and fish/shellfish consumption on the levels of blood cadmium (Cd), lead (Pb), and total mercury (Hg)for females aged 17-39 years old. Regression analysis was used to fit models for each of the three metals. For all three metals, age was positively and BMI was negatively associated with levels of these metals in blood. Smokers had statistically significantly higher levels of Cd and Pb irrespective of race/ethnicity and Fe storage status as compared to nonsmokers. Novel to this study, pregnancy was found to be associated with significantly lower levels of Cd, Pb, and Hg irrespective of race/ethnicity and Fe storage status as compared to nonpregnant females. It is conceivable that pregnancy may thus accelerate clearance of these metals from blood. Fish/shellfish consumption was associated with higher levels of Hg but not with Cd levels.

Should autism be considered a canary bird telling that Homo sapiens may be on its way to extinction?

There has been a dramatic enhancement of the reported incidence of autism in different parts of the world over the last 30 years. This can apparently not be explained only as a result of improved diagnosis and reporting, but may also reflect a real change. The causes of this change are unknown, but if we shall follow T.C. Chamberlin's principle of multiple working hypotheses, we need to take into consideration the possibility that it partly may reflect an enhancement of the average frequency of responsible alleles in large populations. If this hypothesis is correct, it means that the average germline mutation rate must now be much higher in the populations concerned, compared with the natural mutation rate in hominid ancestors before the agricultural and industrial revolutions. This is compatible with the high prevalence of impaired human semen quality in several countries and also with what is known about high levels of total exposure to several different unnatural chemical mutagens, plus some natural ones at unnaturally high levels. Moreover, dietary deficiency conditions that may lead to enhancement of mutation rates are also very widespread, affecting billions of people. However, the natural mutation rate in hominids has been found to be so high that there is apparently no tolerance for further enhancement of the germline mutation rate before the Eigen error threshold will be exceeded and our species will go extinct because of mutational meltdown. This threat, if real, should be considered far more serious than any disease causing the death only of individual patients. It should therefore be considered the first and highest priority of the best biomedical scientists in the world, of research-funding agencies and of all medical doctors to try to stop the express train carrying all humankind as passengers on board before it arrives at the end station of our civilization.