The trend of lead poisoning rate in Chinese population aged 0-18 years old: a meta-analysis

Source apportionment based on lead isotope ratios: Could domestic dog's blood lead be used to identify the level and sources of lead pollution in children?

Domestic dogs have been proved to be used as "sentinel organisms" to monitor human lead exposure. However, whether dogs' blood can be used to identify the levels and pollution source of children's lead exposure still needs evidence. To evaluate the potential use of domestic dogs' blood lead as an indicator of lead exposure levels and pollution source of children, accompanying with potential environmental media samples, lead concentrations and isotope ratios (expressed as ²⁰⁷Pb/²⁰⁶Pb, ²⁰⁸Pb/²⁰⁶Pb) in blood were investigated and compared between children and dogs, who came from a Pb-Zn smelter area, a coal fired area and a control area without industrial activity. The results showed that there were significant correlations in blood lead levels (BLLs) between children and dogs in the study areas (p < 0.01). The lead isotope ratios (LIRs) in blood of children and dogs were disparate among the three areas, however, the LIRs of dogs were quite correlated with those of children in each area (p < 0.01). With the comparison of LIRs between potential pollution sources (slag, ore, coal, paint) and blood samples, the identified lead sources based on dogs' blood were found to be coincident with those based on children's blood. Ore smelting and coal combustion were the main sources of lead exposure for the dogs and children in the smelting area, and coal combustion was the predominant source for the children and dogs living in the coal burning area and control area. The results showed that dogs' BLLs might be used to estimate children's BLLs, and blood LIRs measurements of dogs' could be used as an alternative for identifying the sources of children's lead exposure. This study further provided relevant evidence for dogs to be sentinels exposed to human lead exposure and an alternative method for source apportionment of children's lead exposure.

The Performance Comparison of Socioeconomic and Behavioural Factors as Predictors of Higher Blood Lead Levels of 0–6-Year-Old Chinese Children between 2004 and 2014

Childhood lead exposure is a commonly known risk factor affecting children’s health, and 10 governments have taken actions to reduce children’s lead exposure sources. Because lab testing for children’s blood lead levels (BLLs) was not popularized easily, socioeconomic and behavioural factors have been usually used as predictors of screening methods. Along with the overall decreasing trend of children’s BLLs, the lead-exposure-potential-predicting ability of such factors might be limited or changed over time. Our study aims to compare the predicting ability of multiple factors, including the living environment, economic disparity and personal behaviour differences between 2004 and 2014. With potential predicting factors identified, it could provide direction in identifying individual children facing high-risk lead exposure in the unit of clinics or communities of China. The study was first conducted in 12 cities in China in 2004 and then repeated in 2014 in the same 12 cities with the same method. In total, 27,972 children aged under 7 years were included in this study. With confounding factors adjusted, the child’s age, the family’s socioeconomic status and the child’s personal hygiene habit, especially biting toys, continued to be important predictors of higher blood lead levels among Chinese children. The sex of the child was no longer a predictor. Factors such as the father’s occupational contact with lead, residence near the main road and taking traditional Chinese medicine had the potential to be new predictors.

Ultra-deep removal of Pb by functionality tuned UiO-66 framework: A combined experimental, theoretical and HSAB approach

A specific functionality in the adsorbent materials plays a significant role for the selective capture of heavy metals based on Pearson's Hard-Soft-Acid-Base (HSAB) concept. Herein, we introduced single and double amino- and thiol-functionalities into the UiO-66 framework, which acted as hard and soft base sites for heavy metal adsorption, respectively. The synthesized adsorbents (labelled as NH₂-UiO-66, (NH₂)₂-UiO-66, SH-UiO-66 and (SH)₂-UiO-66) were applied for the selective removal of lead (Pb) ions from contaminated water. The removal efficiency of Pb was about 64, 85, 75 and 99% (pH = 6, T = 30 °C, sample dosage = 10 mg, Pb concentration = 100 mg L^-1), respectively, based on available number of interacting sites in the respective adsorbent. To elaborate HSAB concept, the interacting sites of these functional groups towards Pb were explored by identifying their possible types of interactions in terms of soft acid-base affinity, coordinate and covalent bonding, chelation, π-π interactions and synergetic effect of bonding. Density functional theory (DFT) simulation was used to confirm these interactions and to help the better understanding of adsorption mechanism. Model fitting and characterization of Pb-sorbed adsorbents were also performed to reveal kinetics, order of adsorptive reaction, thermodynamics and adsorption mechanism. Moreover, the optimization of adsorptive removal was performed by controlled parameters including time, initial concentration, pH and temperature. The reusability and selectivity of these adsorbents along with recovery of Pb(II) were also assessed. This study presents the conceptual framework for the design of functional adsorbents in the removal of heavy metals using the HSAB principle as an intended guideline.

Blood lead levels among Chinese children: The shifting influence of industry, traffic, and e-waste over three decades

In China, data relating to the historic prevalence of childhood lead poisoning suggest its pervasiveness. This review analysed published epidemiological data on blood lead levels (BLLs) of 735,271 Chinese children aged 0-6 between 1987 and 2017. Among these children, the geometric mean (GM) BLL was 95.1 μg/L (geometric SD = 1.62), and 24.1% suffered lead poisoning (BLL ≥ 100 μg/L). Importantly, there was a temporal decrease in the GM BLL value, from 182.9 μg/L in 1987-1991 to 42.4 μg/L in 2012-2017. However, a rebound was seen in the most recent two years (2016 and 2017). Moreover, the GM BLL among Chinese children has not fallen as low as U.S. children. This indicates that either (1) leaded petrol or lead based-paint exposure sources have not been adequately controlled in China, or (2) other pollution sources, such as industry, traffic, and e-waste, are impacting Chinese children. Drivers behind spatio-temporal variations were explored to provide scientific evidence regarding the prevention of childhood lead poisoning. We found that BLLs among children in the central and eastern areas of China have dropped lower than those in the western area, and that the GM BLL of children living in rural areas now exceeds children in urban areas. These reversals may be associated with the industrial decentralization policy of the late 1980s, when many heavily polluting industries and manufacturers moved away from cities on the east coast. It was discovered that the BLLs of children living in areas associated with mining have remained high (GM BLL = 155.0 μg/L for 2007-2017), and that the lead poisoning rate (LPR) has become exceptionally high in areas associated with e-waste. Finally, the review offers a data comparison with other countries, an overview of potentially influencing factors and sources, as well as some suggested prevention strategies to reduce childhood lead exposure.

Childhood lead poisoning from domestic products in China: A case study with implications for practice, education, and policy

OBJECTIVE

This study aimed to report three representative childhood lead poisoning cases in China from domestic products exposure and to highlight their critical implications for practice, education, and policy in prevention and treatment of childhood lead poisoning by health care providers, especially public health nurses.

DESIGN AND SAMPLE

Three representative childhood lead poisoning cases occurring in 2017 were collected and analyzed.

RESULTS

The lead exposure sources of three cases were evaluated by experts in the field and determined to be tin pots, home factories for tinfoil, and contamination of folk medicine, respectively. These cases demonstrated that the lack of lead exposure risk assessment, insufficient knowledge of potential lead exposure sources, underdeveloped policy, and regulations were areas for improvement.

CONCLUSIONS

The best strategies for preventing lead poisoning include an appropriate risk assessment of lead exposure, implementation of comprehensive parental health education, conduction of further research by public health providers, and the application of policy strategies by the government. It was determined that public health nurses are at the frontline of prevention of lead poisoning in children.

Potential dietary factors for reducing lead burden of Chinese preschool children

Dietary approaches to treat children's low lead exposure are implemented routinely in China, while evidence for the effect could not be provided until now. The aim of this study was to examine the relationship between diets including nutrition supplementation and blood lead level of preschool children of China. In total, 17,859 preschool children from 14 cities were recruited, and their social-demography, living environment, and dietary intakes were collected, and capillary blood sample was tested for lead concentration. The average blood lead concentration was 34.5 μg/L, and after adjusting children's social-demography factors, the consumption of milk or dairy production, fruits, and calcium supplementation had negative dose-response relationships with blood lead level. Conversely, intake of iron-rich food and supplementation was not associated. Further studies are needed to prove the causal relationships.

Effects of lead, mercury, aluminium and manganese co-exposure on the serum BDNF concentration of pre-school children in Taizhou, China

Previous studies have shown that toxic metal exposure can have adverse effects on the nervous system of children, but the toxicology of metal co-exposure on neurodevelopment remains to be clarified. Brain derived neurotrophic factor (BDNF) plays an important role in nervous system development, but the possible effects of metal co-exposure on the serum BDNF concentrations of children remain unknown. A total of 561 children living in Taizhou City, China were recruited to participate in our cross-sectional multicenter survey. We measured their blood Pb, Hg, Al and Mn levels and serum BDNF concentrations as well as determined their associations in the total and within sex subgroups. The geometric means of the blood Pb, Hg, Al and Mn levels in all the participants were 67.18 μg/L, 1.01 μg/L, 52.03 μg/L and 18.26 μg/L, respectively. The serum BDNF concentration in children was 19.45 ng/mL. After adjusting for confounders, the blood Pb levels were significantly negatively associated with the serum BDNF concentrations in all the subjects and boys but not in girls. In addition, a significantly negative interaction between blood Pb and blood Hg and a positive interaction between blood Pb and blood Al on serum BDNF concentrations were also observed in boys but not in girls. Our findings highlight the toxic effects of metal co-exposure on serum BDNF levels in pre-school children and indicate that these effects might differ by gender, which suggest that special attention should be paid to the sex-specific effects of metal exposure.

Environmental metals and cardiovascular disease

Metals are an important but neglected source of CV risk

Family environmental and dietary implications for low-level prenatal lead exposure in Wujiang City, China

To explore the potential environmental and dietary factors during pregnancy affecting low-level prenatal lead exposure, we conducted a longitudinal study in Wujiang City, China. A total of 1976 mother-infant pairs were included from 2009 to 2010. An interviewed questionnaire was conducted and cord blood samples were collected. The geometric means of cord blood lead level was 30.3 μg/L (95% CI, 29.8-30.8) with 99.24% below 100 μg/L. Maternal age, passive smoking, and living in the countryside were significantly associated with cord blood lead concentrations. Multiple logistic models showed that some family environmental factors including using firewood and electricity as kitchen fuel were positively correlated with increased cord blood lead levels. Among dietary sources recorded in this study, meat consumption (> 3 times/week), fish consumption (1-3 times/week), vegetables consumption (> 1 times/day), and fruit intake (> 1 times/day) had inverse relationship with cord blood lead levels. In general, our findings may have important implications for family environmental and dietary direction during pregnancy to decrease prenatal lead exposure.

Surface display of PbrR on Escherichia coli and evaluation of the bioavailability of lead associated with engineered cells in mice

Human exposure to lead mainly occurs by ingestion of contaminated food, water and soil. Blocking lead uptake in the gastrointestinal tract is a novel prevention strategy. Whole-cell biosorbent for lead was constructed with PbrR genetically engineered on the cell surface of Escherichia coli (E. coli), a predominant strain among intestinal microflora, using lipoprotein (Lpp)-OmpA as the anchoring protein. In vitro, the PbrR displayed cells had an enhanced ability for immobilizing toxic lead(II) ions from the external media at both acidic and neutral pH, and exhibited a higher specific adsorption for lead compared to other physiological two valence metal ions. In vivo, the persistence of recombinant E. coli in the murine intestinal tract and the integrity of surface displayed PbrR were confirmed. In addition, oral administration of surface-engineered E. coli was safe in mice, in which the concentrations of physiological metal ions in blood were not affected. More importantly, lead associated with PbrR-displayed E. coli was demonstrated to be less bioavailable in the experimental mouse model with exposure to oral lead. This is reflected by significantly lower blood and femur lead concentrations in PbrR-displayed E. coli groups compared to the control. These results open up the possibility for the removal of toxic metal ions in vivo using engineered microorganisms as adsorbents.

"What do you know?"--knowledge among village doctors of lead poisoning in children in rural China

BACKGROUND

This study evaluates the extent of village doctors' knowledge of lead poisoning in children in rural China and assesses the characteristics associated with possessing accurate knowledge.

METHODS

A cross-sectional, questionnaire-based survey of 297 village doctors in Fenghuang County, Hunan Province, China was conducted. All village doctors were interviewed face-to-face using a "What do you know" test questionnaire focusing on prevention strategies and lead sources in rural children.

RESULTS

A total of 287 (96.6%) village doctors completed the survey in full. Most village doctors had an appropriate degree of general knowledge of lead poisoning; however, they had relatively poor knowledge of lead sources and prevention measures. Village doctors with an undergraduate level education scored an average of 2.7 points higher than those who had a junior college level education (p = 0.033). Village doctors with an annual income ≤ 10,000 RMB yuan scored 1.03 points lower than those whose income was >10,001 RMB yuan. Ethnic Han village doctors scored 1.12 points higher, on average, than ethnic Tujia village doctors (p = 0.027).

CONCLUSIONS

This study identified important gaps in knowledge concerning lead poisoning in children among a rural population of village doctors. There is a clear need for multifaceted interventions that target village doctors to improve their knowledge regarding lead poisoning in children. The "What do you know" questionnaire is a new tool to evaluate lead poisoning knowledge and education projects.

Sources, symptoms and characteristics of childhood lead poisoning: experience from a lead specialty clinic in China

OBJECTIVES

This study explored the sources of lead exposure, identified patients' geographic distribution and evaluated the symptoms of children with elevated blood lead levels (BLLs) referred to a pediatric lead specialty clinic in China.

MATERIAL AND METHODS

Data were collected from 515 consecutive outpatients attending the Pediatric Lead Poisoning Clinic in Xinhua Hospital, Shanghai, China, between 2011 and 2016, referred for BLLs ≥5 μg/dL. Atomic absorption spectrometry was used to measure venous BLLs.

RESULTS

The mean ± standard deviation age of the patients was 4.1 ± 3.2 years. Their BLLs ranged from 5 to 126 μg/dL. The geometric mean and median BLLs were 24 and 26 μg/dL, respectively. Two hundred and twenty-two children (43.1%) were exposed to industrial lead pollution-mainly from Zhejiang, Jiangsu, Hunan, Henan and Anhui provinces; whereas, 41.4% (213 cases) were induced by folk medicines used widely throughout China. Other nonindustrial sources of lead exposure included lead-containing tinfoil and tin pots. Household lead paint was a rare source. Most patients exhibited nonspecific symptoms, such as hyperactivity, attention difficulty, aggressiveness, constipation and anorexia.

CONCLUSIONS

Industrial pollution and folk medicines are important sources of lead exposure in China. Childhood lead poisoning may be difficult to diagnose clinically as symptoms are nonspecific. Thus, blood lead screening may be necessary to identify children at high risk of exposure. Education to raise the awareness of potential sources of exposure resulting in their elimination would be expected to decrease the incidence of children with elevated BLLs.

Blood Lead Levels and Risk Factors among Preschool Children in a Lead Polluted Area in Taizhou, China

Objective. To determine the blood lead levels and identify related risk factors among preschool children in a lead polluted area (Taizhou, China) and provide theoretical support for prevention of lead pollution. Methods. A stratified-clustered-random sampling method was used to determine the survey sample. Blood lead levels were determined by the tungsten atomizer absorption spectrophotometer. Results. A total of 2,018 subjects (average age of 59 months; 1,087 boys and 931 girls) were included. The arithmetic mean, geometric mean, and median blood lead levels of the preschool children were 56.4 μg/L, 48.9 μg/L, and 46 μg/L. A total of 8.8% children had blood lead levels >100 μg/L and 43.9% had blood lead levels >50 μg/L. Mother's education level, father's occupation, decorative tableware, exposure to makeup, and the residential floor were all risk factors for elevated blood lead levels (odds ratios of 1.42, 1.21, 1.11, 1.19, and 1.27, resp.), while hand washing before eating food was a protective factor (odds ratio of 0.88). Conclusions. The blood lead levels of preschool children in Taizhou were higher than in other areas in China and in developed countries. Therefore, policies ensuring lead-based industries are not placed in close proximity to residential areas are required.

Blood Pressure Decreases Following Lead Treatment Cessation: Highest NO Bioavailability Involved

Although lead is known to induce arterial hypertension and vascular damage, it is not clear if after cessation of lead treatment, the increase of blood pressure is sustained and the vascular function is different from untreated rats. Therefore, we aimed to evaluate the systolic blood pressure during and following lead-treatment discontinuance and the possible vascular alterations involved with it. Rats received lead acetate (100 mg/L) in the drinking water or distilled water for 14 days. After 14 days, lead acetate solution was substituted by water distilled for more 28 days, as control group. Systolic blood pressure (SBP) was measured weekly by tail plethysmography, and the vascular reactivity to phenylephrine in isolated aortic rings was evaluated at end of treatment time. The increase in SBP induced by lead was reversed after stopping exposure, and it was accompanied by a reduction on vasoconstrictor response to phenylephrine. L-NAME treatment increased the phenylephrine response in both groups, but its effect was greater in lead group. Our findings provide evidence that the increased modulation by NO on contractile response to phenylephrine could be a compensatory mechanism that might contribute to decrease blood pressure after lead treatment cessation.