Blood lead levels of children with pica and surma use

Research on feeding and eating disorders in India: A narrative review

Despite growing evidence of their prevalence, research on feeding and eating disorders (FEDs) in India has been sporadic. This narrative review aimed to summarize the research on FED in India and set priorities for future research and translation of evidence. An electronic search was conducted in the MEDLINE, PsycINFO, and Google Scholar databases to identify relevant English peer-reviewed articles from April 1967 to July 2023. The extracted data from these studies included author names, publication year, research location, type of intervention (for interventional studies), nature of comparator treatments, and main outcomes or findings. We found a rising trend in the prevalence of EDs in India. Adolescent age group, female sex, higher socioeconomic status, family history of mental illness or disordered eating, and borderline personality pattern were risk factors for EDs. For feeding disorders (FDs), childhood age group, malnutrition, pregnancy, psychosis, intellectual disability (ID), and obsessive-compulsive disorder (OCD) were putative risk factors. Both physical and psychiatric comorbidities were common in FEDs. Culture appears to exert a pathoplastic effect on symptom presentation in FEDs; an illustrative example is the documented nonfat phobic variant of anorexia nervosa (AN) in India. Research on management has focused on using assessment tools, investigations to rule out medical comorbidities, psychosocial and family-based psychotherapies, nutritional rehabilitation, pharmacotherapy, and neuromodulation approaches. Whereas the publication output on FEDs in India has increased over the last decade, it remains an under-researched area, with a striking paucity of original research. Future research priorities in FEDs include conducting country-wide registry-based studies to offer real-world insights, longitudinal research to identify culturally relevant risk factors, and developing brief, culturally sensitive diagnostic instruments for FEDs in the Indian context. This will help generate locally relevant epidemiological data on FEDs and inform treatment and prevention strategies.

Association of blood lead levels with neurobehavior and BDNF expression in school going children

BACKGROUND

Childhood Lead (Pb) toxicity has been an ongoing concern for decades; however, its underlying pathogenesis remains unclear. Although its prevalence has come down in developed countries (USA, Europe); it is relatively high in low to middle-income countries of South-East Asia. The current study aimed to evaluate the association of blood lead levels (BLLs) with neurobehavioral alterations and changes in Brain-Derived Neurotropic Factor (BDNF) expression in Indian school children.

METHODOLOGY

School going children in age group of 9-15 years (N = 72) were included in the study. Neurobehavioral changes were assessed using Childhood Psychopathological Measurement Schedule (CPMS) and BLL were measured by Graphite Furnace Atomic Absorption Spectrophotometry (GFAAS). BDNF mRNA expression and serum BDNF levels were assessed by Real-Time PCR and ELISA, respectively.

RESULTS

Median BLL was 4.95 μg/dL (IQR = 4.47), very close to the recommended toxic cut off levels (<5 μg/dL). BLLs had a direct correlation with both CPMS scores and BDNF expression. Depression was found to be significantly higher in boys than in girls with high BLLs. BDNF mRNA expression and serum BDNF levels were higher among children with high BLL, although not to significant levels.

CONCLUSION

We report a significant association of neurobehavioral changes with the prevalence of high Pb levels in Indian children. Additionally significant correlation of BDNF with BLL in these children suggests a causal role of BDNF in Pb induced neurological damage.

Association of blood lead level with neurobehavior and neurotransmitter expressions in Indian children

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BLL had a significant direct correlation with abnormal neurobehavior.

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Serum serotonin levels were significantly lower in children with high blood lead levels (BLL).

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Serum serotonin and dopamine receptor expression were upregulated in children with high BLL.

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Serum serotonin levels had significant negative association with adverse neurobehavior.

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Dopamine receptor expression had significant positive association with adverse neurobehavior.

Present study aimed to assess the alterations in neurotransmitter expression and its association with Blood Lead Level (BLL) and neurobehavioral pattern in children. 72 school going children were recruited. Blood lead levels were determined by Atomic Absorption Spectrophotometer. Neurobehavioral state was assessed by means of population specific scale i.e. CPMS (Childhood Psychopathological measurement Schedule). Serum serotonin and dopamine were estimated by ELISA, receptor and transporter gene expressions were assessed by quantitative real time PCR. Significant positive correlation was observed between Total CPMS score (i.e. adverse neurobehaviour) and BLL. Further, serum serotonin levels and dopamine receptor expression showed a negative and positive association with BLL, respectively. In similarity, serum serotonin levels showed a negative correlation and dopamine receptor expression had a significant positive correlation with total CPMS score. Environmental exposure to Lead (Pb) may result in significant alterations in the neurotransmitter levels which may be associated with neurobehavioral changes in the children exposed to Pb.

A meta-analysis of blood lead levels in India and the attributable burden of disease

Multiple studies in India have found elevated blood lead levels (BLLs) in target populations. However the data have not yet been evaluated to understand population-wide exposure levels. We used arithmetic mean blood lead data published from 2010 to 2018 on Indian populations to calculate the average BLLs for multiple subgroups. We then calculated the attributable disease burden in IQ decrement and Disability Adjusted Life Years (DALYs). Our Pubmed search yielded 1066 articles. Of these, 31 studies representing the BLLs of 5472 people in 9 states met our study criteria. Evaluating these, we found a mean BLL of 6.86 μg/dL (95% CI: 4.38-9.35) in children and 7.52 μg/dL (95% CI: 5.28-9.76) in non-occupationally exposed adults. We calculated that these exposures resulted in 4.9 million DALYs (95% CI: 3.9-5.6) in the states we evaluated. Population-wide BLLs in India remain elevated despite regulatory action to eliminate leaded petrol, the most significant historical source. The estimated attributable disease burden is larger than previously calculated, particularly with regard to associated intellectual disability outcomes in children. Larger population-wide BLL studies are required to inform future calculations. Policy responses need to be developed to mitigate the worst exposures.

Factors Associated With Elevated Blood Lead Levels in Children

Objectives

To determine the prevalence and correlates of elevated blood lead level in children (6-144 months) of Aligarh.

Methods

A hospital-based cross-sectional study was conducted. Venous blood was obtained for lead estimation and a structured questionnaire was filled.

Results

A total of 260 children were enrolled. The prevalence of elevated blood lead level was 44.2%, seen mostly in children below 5 years of age. Old and deteriorating wall paints at home was found to be significantly associated with elevated levels.

Conclusions

Lead-based house paints are potential source of lead exposure. Meticulous renovation and painting of the walls with safe paints is desirable.

Diagnosis, evaluation, and treatment of lead poisoning in general population

Among the heavy metals, lead still remains the major toxic pollutant of the environment. Human exposure to lead can occur through numerous pathways including air, food, dust, soil, and water. In the present study 14 lead poisoned patients with non-occupational lead exposure were evaluated. They were followed up and compared against the controls with no history of lead exposure. The patients had high blood lead levels and symptoms of weakness, dizziness, abdominal pain, generalized body ache, loss of appetite, and anxiety. Repeated course of chelation therapy helped to bring down their body burden of lead. Alternative sources for lead exposure can cause severe lead poisoning in general population. Screening and medical management of such individuals is very important to identify and eliminate sources of lead. The treatment and management requires a thorough medical evaluation and environmental intervention.

Global Public Health and the United Arab Emirates

The United Arab Emirates (UAE), as a rapidly developing country in the Middle East, is in a good position to contribute to global health. It can share its experience of dealing with public health problems characteristic of a desert environment, and it can learn from the experience of other nations in tackling challenges posed by globalization. The health issues particular to the region include heat stress, the effects of consanguineous marriages on families and society, and exposure to occupational and environmental hazards. As in many other developed countries, the UAE also has public health problems associated with smoking, road traffic accidents, and obesity. The experience of other countries in dealing with infectious diseases has helped the UAE implement preventive measures to cope with infections such as the recent H1N1 pandemic. International collaboration has advantages to the UAE in managing problems pertaining to global public health.

[Lead poisoning caused by prolonged use of kohl, an underestimated cause in French-speaking countries]

Use of kohl (called surma in India and Pakistan) as an eye cosmetic is very common, especially among women, children, and babies, not only in North Africa (Morocco, Algeria, Egypt), but also in the Near East and the Middle East, as well in India and Pakistan. This practice has now become widespread in European countries and North America. The cultural custom is very old and has been in use in Egypt since the Ancient Empire. In a great number of kohls available on the free market, lead sulfide is the main component and the very high lead concentration is a risk, particularly for women and children. We report the observation of a case of lead poisoning in a young Moroccan woman caused by prolonged use of a kohl and provide a review of the published literature. This case study should draw the attention of ophthalmologists in French-speaking areas to a public health problem, largely ignored, although real, considering the high lead concentrations found in the majority of kohls. Actions such as prohibition (importation and sale of eye cosmetics made of lead sulfide) have proved to be inadequate. Appropriate educational campaigns directed toward populations using eye cosmetics will be more effective over the long term.

Childhood correlates of blood lead levels in Mumbai and Delhi

BACKGROUND

Lead exposure has previously been associated with intellectual impairment in children in a number of international studies. In India, it has been reported that nearly half of the children have elevated blood lead levels (BLLs). However, little is known about risk factors for these elevated BLLs.

METHODS

We conducted a retrospective cross-sectional analysis of data from the Indian National Family Health Survey, a population-based study conducted in 1998-1999. We assessed potential correlates of BLLs in 1,081 children who were < 3 years of age and living in Mumbai or Delhi, India. We examined factors such as age, sex, religion, caste, mother's education, standard of living, breast-feeding, and weight/height percentile.

RESULTS

Most children (76%) had BLLs between 5 and 20 microg/dL. Age, standard of living, weight/height percentile, and total number of children ever born to the mother were significantly associated with BLLs (log transformed) in multivariate regression models. Compared with children < or = 3 months of age, children 4-11 and 12-23 month of age had 84 and 146% higher BLLs, respectively (p < 0.001). A low standard of living correlated with a 32.3% increase in BLLs (p = 0.02). Children greater than the 95th percentile for their weight/height had 31% (p = 0.03) higher BLLs compared with those who were below the 5th percentile for their weight/height.

CONCLUSIONS

Our study found various factors correlated with elevated BLLs in children. The correlation between greater than the 95th percentile weight/height and higher BLL may reflect an impact of lead exposure on body habitus. Our study may help in targeting susceptible populations and identifying correctable factors for elevated BLLs in Mumbai and Delhi.

A pilot study of blood lead levels and neurobehavioral function in children living in Chennai, India

The relationship between blood lead level and neurodevelopment was assessed in a pilot cross-sectional study of 74 4-14-year-old children in Chennai, India. Mean blood lead level was 11.1 microg/dL (2.5-38.3). The Binet-Kamath IQ test and the Wide Range Assessment of Visual Motor Activity (WRAVMA) were administered to 58 children. Teachers completed the Connor's Behavioral Rating Scale. Excluding two outliers, IQ and WRAVMA composite scores were inversely related to blood lead level, with an effect size of approximately 6 points decline for a 10-microg/dL increase in blood lead. Children in the highest and lowest blood lead quartiles had mean IQs of 95.6+/-13.3 and 102.0+/-22.5, respectively. Behavior ratings were not associated with blood lead level. Lead exposure is a significant problem among Indian children, with many having blood lead levels associated with increased neurodevelopmental risk.

Estimating the global burden of disease of mild mental retardation and cardiovascular diseases from environmental lead exposure

The disease burden from exposure to lead resulting in mild mental retardation (due to IQ point decreases) and cardiovascular outcomes (due to increases in blood pressure) was estimated at a global level. Blood lead levels were compiled from the literature for 14 geographical regions defined by the World Health Organization according to location and adult and child mortality rates. Adjustments were applied to these levels, where appropriate, to account for recent changes relating to the implementation of lead-reduction programs and the lower levels seen in rural populations. It is estimated that mild mental retardation and cardiovascular outcomes resulting from exposure to lead amount to almost 1% of the global burden of disease, with the highest burden in developing regions. This estimate can be used to assess the magnitude of the benefits that could be accrued by increasing the global coverage of lead-reduction programs.

Low-level lead exposure and blood lead levels in children: a cross-sectional survey

The authors studied 53 girls (44.5%) and 66 (55.5%) boys in Karachi, Pakistan, to determine their blood lead levels. The association between blood lead levels/water lead levels and the possible risk factors and symptoms associated with lead toxicity was explored. The mean lead level for the entire group was 7.9 microg/dl (standard deviation = 4.5 microg/dl). Thirty (25.2%) of the children had lead levels that exceeded 10 microg/dl; 12 (10.0%) of these had lead levels that exceeded 15 microg/dl. Thirteen (20.9%) of the children under the age of 6 yr (n = 62) had lead levels greater than 10 microg/dl, and 6 (9.6%) had levels in excess of 15 microg/dl. The authors found no association (p > .05) between high lead levels in water and blood lead levels in children. Mean blood lead levels were highest in the group of children exposed to various risk factors for lead absorption (e.g., exposure to paint, remodeling, and renovation; use of lead utensils; pica). There was a significant association between a history of exposure to paint/renovation activities and a history of pica. High blood lead levels in the children in Karachi stress the urgency for actions that control lead pollution. Screening programs should be instituted by the state. Individuals must become aware of lead's toxicity, and they must avoid substances that contain lead.

Atmospheric and children's blood lead as indicators of vehicular traffic and other emission sources in Mumbai, India

Average concentration of Pb in atmospheric air particulates in different suburbs of Mumbai was studied for almost a decade and its spatial and temporal profiles are discussed in relation to emission sources. In general the concentration of Pb in all the residential suburban atmosphere is well below the Central Pollution Control Board (CPCB, 1994) prescribed limit of 1.5 microg m(-3) barring a few exceptions for some residential/industrial sites, such as those of Thane and Kurla scrap yards. The correlation between blood lead of children and air lead reveals that the blood Pb level in children could increase by 3.6 microg dl(-1) for an incremental rise of 1.0 microg Pb m(-3) of air. The temporal profile of air Pb values indicates a decreasing trend in residential suburbs (Khar: 1984, 0.39 microg m(-3); 1996, 0.17 microg m(-3)) as well as in suburban residential areas with low traffic (Goregaon: 1984, 0.53 microg m(-3); 1996, 0.30 microg m(-3)).

Plumbism--a mimicker of common childhood symptoms

Lead poisoning is a preventable entity that can affect almost every system of the body. Its toxic effects range from subtle common childhood symptoms to even death. In a prospective study forty six children with at least one symptom compatible with plumbism were enrolled after screening patients attending medical services at AIIMS. The work-up included a detailed clinical history and examination including intelligence quotient (IQ) and behaviour. Blood lead levels were estimated in all with due precautions. Their ages ranged from 2.5 to 18 years and M:F ratio was 2:1. The common symptoms included unexplained recurrent colic (39), anorexia (21), sporadic vomiting and constipation (13), pigmented gum lines (11), growth failure (11), history of pica (9) etc. None of the children had acceptable blood lead levels (< 10 micrograms/dl). Ninety three per cent children had levels > 20 micrograms/dl and 47.8% had > 45 micrograms/dl. Statistically significant correlation with blood lead levels was seen with most symptoms. Plumbism can mimic common childhood illnesses and should be investigated in children with a clinically compatible profile. Community awareness with regard to pica reduction may be an important preventive measure. This silent epidemic needs to be aggressively tackled by a multipronged approach.

Assessment of Pb, Cd, Cu, and Zn exposures of 6- to 10-year-old children in Mumbai

Population exposures to toxic trace metals are of great concern due to their nonbiodegradable nature and long biological half-lives for elimination from the body. Response to a toxic metal varies with age group; children are more sensitive and hence more at risk than others. The present study was therefore undertaken on 6- to 10-year-old children residing in various localities of Greater Mumbai and Thane. Blood samples from 566 children residing in 13 locations in Mumbai along with 410 air particulate samples and 64 "duplicate diet" samples were collected for this study. Levels of Pb, Cd, Cu, and Zn in these samples were estimated by differential pulse anodic stripping voltammetric technique. Intake of Pb, Cd, Cu, and Zn for 6- to 10-year-old children through ingestion and inhalation pathways have also been assessed. A correlation coefficient of 0.88 is observed between air lead and blood lead. It is also seen that every microgram increase in the Pb concentration in air (m-3) results in 3.56 microg increase in the blood Pb concentration (dl-1) in children. Similar correlation, however, was not observed in cases of Cd, Cu, and Zn.

Composition of eye cosmetics (kohls) used in Oman

A total of 47 kohl samples, primarily used as traditional eye cosmetics, were analyzed using X-ray powder diffraction (XRPD) and scanning electron microscopy (SEM). It was found that, of the 18 Omani-made kohls, the main component of five was galena (PbS). Of the other 13, 12 were based on amorphous carbon and one on hematite (Fe2O3). The remaining samples were made in other countries and were found to contain one of the following as the main component: galena, minium (Pb3O4), amorphous carbon, magnetite (Fe3O4), zincite (ZnO), calcite (CaCO3) or sassolite (H3BO3).

Blood lead in pregnant women in the urban slums of Lucknow, India

OBJECTIVES

To determine the concentrations of blood lead (PbB) in pregnant women in the slums of Lucknow, north India.

METHODS

Of the 203 designated municipal slums in Lucknow, 70 were randomly selected for study and a cohort of 500 pregnant women was enrolled. Each participant was interviewed with questions on possible sources of exposure to lead, surrogates of nutritional status were measured, and PbB was measured.

RESULTS

The mean PbB was 14.3 micrograms/dl and 19.2% of women had PbB > or = 20 micrograms/dl. PbB was not associated with age, height, weight, gestation, or history of abortions, although higher PbB was associated with higher parity. Women living inner city neighbourhoods near heavy vehicular traffic had PbB 2.2 micrograms/dl higher (95% confidence interval (95% CI) 0.8 to 3.6) than those living in other neighbourhoods. The PbB was not associated with reported use of piped water or the presence of paint in homes, and increasing PbB was unexpectedly associated with decreasing use of eye cosmetic "surma" and the duration of gestation.

CONCLUSIONS

The high PbB found in this population raises concern about fetal development and points to the urgent need to reduce exposure to lead.

The displacement of calcium from osteocalcin at submicromolar concentrations of free lead

Lead, an environmental toxin, is known to impair some of the functional properties of osteocalcin, a small protein (MW, 5700) active in bone mineralization and resorption. To investigate a possible mechanism of lead toxicity at the molecular level, we have studied the interaction of lead with osteocalcin using 43Ca and 1H NMR. The measured 43Ca NMR linewidth as well as longitudinal relaxation rate (1/T1) of 43CaCl2 progressively increased with increasing amounts of added osteocalcin. A titration measuring 43Ca linewidth as a function of [Ca2+]/[Osteocalcin] ratio could be fitted to a single metal binding site with a dissociation constant of 7 microM. The 43Ca 1/T1 of Ca-osteocalcin decreased in the presence of Pb2+ due to competitive displacement of Ca2+ by Pb2+. The magnitude of decrease in the effect of osteocalcin on 43Ca 1/T1 in the presence of Pb2+ was consistent with the existence of only one tight divalent cation binding site. An analysis of the NMR T1 data in osteocalcin solutions containing both Pb2+ and Ca2+ yielded a Pb-osteocalcin dissociation constant of about 2 nM. The 1H NMR spectra showed Pb-induced changes in the same aliphatic and aromatic resonances of osteocalcin that are also affected by Ca(2+)-binding, supporting interaction of Pb2+ at the Ca2+ site. However, the existence of significant differences between the Pb-osteocalcin and Ca-osteocalcin NMR spectra indicates some differences in the structures of the two complexes. Since Pb2+ inhibits the binding of osteocalcin to hydroxyapatite, the high affinity of Pb2+ for osteocalcin would indicate significant inactivation of osteocalcin even at submicromolar free lead levels. Pb(2+)-induced inactivation of osteocalcin could affect bone mineral dynamics and may be related to the observed inverse correlation between blood Pb(2+)-levels and stature and chest circumference observed in growing children.