Inverse association between intelligence quotient and urinary retinol binding protein in Chinese school-age children with low blood lead levels: results from a cross-sectional investigation

The Impact of Exposure to Iodine and Fluorine in Drinking Water on Thyroid Health and Intelligence in School-Age Children: A Cross-Sectional Investigation

Iodine and fluorine, as halogen elements, are often coexisting in water environments, with nearly 200 million people suffering from fluorosis globally, and, in 11 countries and territories, adolescents have iodine intakes higher than that required for the prevention of iodine deficiency disorders. It has been suggested that excess iodine and/or fluorine can affect thyroid health and intellectual development, especially in children, but their combined effect has been less studied in this population. This study investigated 399 school-age children in Tianjin, China, collected drinking water samples from areas where the school-age children lived, and grouped the respondents according to iodine and fluorine levels. Thyroid health was measured using thyroid hormone levels, thyroid volume, and the presence of thyroid nodules; intelligence quotient (IQ) was assessed using the Raven's Progressive Matrices (CRT) test; and monoamine neurotransmitter levels were used to explore the potential relationship between thyroid health and intelligence. Multiple linear regression and restricted cubic spline (RCS) analyses showed that iodine and fluorine were positively correlated with thyroid volume and the incidence of thyroid nodules in school-age children, and negatively correlated with IQ; similar results were obtained in the secondary subgroups based on urinary iodine and urinary fluoride levels. Interaction analyses revealed a synergistic effect of iodine and fluorine. A pathway analysis showed that iodine and fluorine were negatively associated with the secretion of free triiodothyronine (FT3) and free tetraiodothyronine (FT4), which in turn were negatively associated with the secretion of thyroid-stimulating hormone (TSH). Iodine and fluorine may affect IQ in school-aged children through the above pathways that affect thyroid hormone secretion; of these, FT3 and TSH were negatively correlated with IQ, whereas FT4 was positively correlated with IQ. The relationship between thyroid hormones and monoamine neurotransmitters may involve the hypothalamic-pituitary-thyroid axis, with FT4 hormone concentrations positively correlating with dopamine (DA), norepinephrine (NE), and 5-hydroxytryptophan (5-HT) concentrations, and FT3 hormone concentrations positively correlating with DA concentrations. Monoamine neurotransmitters may play a mediating role in the effects of iodine and fluoride on intelligence in schoolchildren. However, this study has some limitations, as the data were derived from a cross-sectional study in Tianjin, China, and no attention was paid to the reciprocal effects of iodine and fluorine at different doses on thyroid health and intelligence in schoolchildren in other regions.

Ribosomal DNA copy number associated with blood metal levels in school-age children: A follow-up study on a municipal waste incinerator in Zhejiang, China

To evaluate the body burdens of heavy metals and explore the impact of environmental metal exposure on ribosomal DNA (rDNA) or mitochondrial DNA (mtDNA) copy number (CN) variation in school-age children living near a municipal waste incinerator (MWI), we conducted a follow-up study in 2019. A total of 146 sixth-grade children from a primary school located 1.2 km away from the MWI were recruited for our study. Metals, including vanadium (V), chromium (Cr), manganese (Mn), cobalt (Co), nickel (Ni), copper (Cu), zinc (Zn), arsenic (As), selenium (Se), cadmium (Cd), stannum (Sn), stibium (Sb), thallium (Tl), and lead (Pb), were determined by an inductively coupled plasma mass spectrometer method. Real-time qPCR was used to measure the rDNA and mtDNA CN. The blood metal levels followed this order: Zn > Cu > Se > Pb > Mn > Sb > As > Ni > Cd > Co > Cr > Sn > V > Tl. Blood Cr level was significantly correlated with 18 S, 2.5 S, and 45 S CN (β = -0.25, -0.22, -0.26, p < 0.05); Ni was correlated with 5 S (β = -0.36, p < 0.01); Cu was correlated with 28 S, 18 S, and 5.8 S (β = -0.24, -0.24, -0.23, p < 0.05); while Zn was correlated with 18 S, 5.8 S, and 45 S (β = -0.28, -0.32, -0.26, p < 0.05). In conclusion, school-age children living near the MWI had lower blood metal levels compared to children recruited in 2013, while rDNA CN loss was found to be correlated to several heavy metals in these children.

IQ alteration induced by lead in developed and underdeveloped/developing countries: A systematic review and a meta-analysis

The aim of this study was to evaluate the effects of Pb exposure on full-scale IQ score in pediatric subjects. Following PRISMA guidelines, the data from January 2010 to April 2020 were systematically searched and collected on electronic databases (PubMed, Scopus, and Embase). The eligibility criteria included cross-sectional, cohort, and case-control studies that were published in English, from 2010 to 2020, that analyzed the blood Pb levels of pediatric subjects (0-19 years) and possible changes in the full-scale IQ score. In this study, 2174 scientific papers were collected from three electronic databases. From those, 726 were duplicates and 1421 were excluded because they did not meet the eligibility criteria, resulting in a total of 27 papers, from which, seven were used to perform the meta-analysis. The 27 scientific papers systematically selected for this study were separated by the country where the study was realized in developed and underdeveloped/developing countries. In the underdeveloped/developing countries the blood Pb levels are higher and showed a greater variation (1.30-11.66 μgPb/dL of blood) than in countries with higher development index (0.57-4.80 μgPb/dL of blood). The full-scale IQ score are inversely proportional to the blood Pb values, and it is possible to see that in the underdeveloped/developing countries the full-scale IQ score showed lower values and greater variation (59.2-111) compared to the individuals from developed countries (91.9-114.5). In conclusion, it was observed that blood Pb levels alter the full-scale IQ score. Thus, policies for the prevention of environmental contamination and the reduction of Pb exposure must be taken, mainly, in underdeveloped/developing countries.

Correlation between lead exposure and cognitive function in 12-year-old children: a systematic review and meta-analysis

Lead exposure as a toxic material especially in children can be recognized as a harmful factor for cognitive function system. This meta-analysis was conducted to estimate the lead exposure effect on cognitive function among 6979 children less than 12 years. The 16 studies were divided into two clusters according to "duration of exposure" and "dose" using k-means partitioning clustering algorithm. Then, subgroup analysis has been performed based on the clustered studies. According to the results of the k-means clustering, dose and duration of exposure were significant factors between all considered variables. A stronger negative significant pooled correlation was observed in higher dose and duration cluster in comparison with another cluster including lower dose and duration (r = - 0.29, P-value < 0.001 vs. r = - 0.08, P-value < 0.001). Overall, a negative significant correlation was observed between lead exposure and cognitive function test score (r = - 0.22, P-value < 0.001). This study confirms the negative effect of lead on cognitive function in children, but needed further investigations to achieve the safe dose and duration of the lead exposure.

Fluoride exposure, dopamine relative gene polymorphism and intelligence: A cross-sectional study in China

BACKGROUND

Excessive fluoride exposure is related to adverse health outcomes, but whether dopamine (DA) relative genes are involved in the health effect of low-moderate fluoride exposure on children's intelligence remain unclear.

OBJECTIVES

We conducted a cross-sectional study to explore the role of DA relative genes in the health effect of low-moderate fluoride exposure in drinking water.

METHODS

We recruited 567 resident children, aged 6-11 years old, randomly from endemic and non-endemic fluorosis areas in Tianjin, China. Spot urine samples were tested for urinary fluoride concentration, combined Raven`s test was used for intelligence quotient test. Fasting venous blood were collected to analyze ANKK1 Taq1A (rs1800497), COMT Val158Met (rs4680), DAT1 40 bp VNTR and MAOA uVNTR. Multivariable linear regression models were used to assess associations between fluoride exposure and IQ scores. We applied multiplicative and additive models to appraise single gene-environment interaction. Generalized multifactor dimensionality reduction (GMDR) was used to evaluate high-dimensional interactions of gene-gene and gene-environment.

RESULTS

In adjusted model, fluoride exposure was inversely associated with IQ scores (β = -5.957, 95% CI: -9.712, -2.202). The mean IQ scores of children with high-activity MAOA genotype was significantly lower than IQ scores of those with low-activity (P = 0.006) or female heterozygote (P = 0.016) genotype. We detected effect modification by four DA relative genes (ANKK1, COMT, DAT1 and MAOA) on the association between UF and IQ scores. We also found a high-dimensional gene-environment interaction among UF, ANKK1, COMT and MAOA on the effect of IQ (testing balanced accuracy = 0.5302, CV consistency: 10/10, P = 0.0107).

CONCLUSIONS

Our study suggests DA relative genes may modify the association between fluoride and intelligence, and a potential interaction among fluoride exposure and DA relative genes on IQ.

Impact of low-level mercury exposure on intelligence quotient in children via rice consumption

Wanshan is a city in southwest China that has several inactive mercury (Hg) mines. The local population are exposed to methylmercury (MeHg) due to the consumption of Hg contaminated rice. The relationship between Hg exposure and the cognitive functions of local children is unknown. This study investigated the relationship between hair Hg concentrations and the intelligence quotient (IQ) of 314 children aged 8-10 years, recruited from three local primary schools in Wanshan area in 2018 and 2019. IQ was evaluated using Wechsler Intelligence Scale for Children - Fourth Edition (WISC-IV). The average THg concentration in children's hair samples was 1.53 μg g^-1 (range: 0.21-12.6 μg g^-1), and 65.6% exceeded the United States Environment Protection Agency (USEPA) recommended value of 1 μg g^-1. Results of logistic regression analysis showed that children with hair Hg ≥ 1 μg g^-1 were 1.58 times more likely to have an IQ score <80, which is the clinical cut-off for borderline intellectual disability (R² = 0.20, p = 0.03). Increasing of 1 μg g^-1 hair Hg resulted in 1 point of IQ loss in Wanshan children, which was.much higher than that via fish consumption. The economical cost due to Hg exposure was estimated to be $69.8 million (9.43% of total GDP) in the Wanshan area in 2018.

Chronic exposure to heavy metals from informal e-waste recycling plants and children's attention, executive function and academic performance

E-waste contains valuable metals that require appropriate waste management plans. However, rudimentary e-waste processing methods are a source of heavy metals environmental pollution. This study has characterised concentrations of heavy metals in soil (n = 10), water (n = 10) and hair (n = 44) of children in areas surrounding Jakarta (Indonesia), where e-waste is being or has been conducted in the past, and in a reference unexposed site. Chronic exposure to Mn, Pb, Hg, As and Cd and its associations with attention and executive function, characterised with the Trail Making Test (TMT), along with academic performance scores was conducted using multivariate regression analysis. Models were adjusted for age, gender, parental education, environmental tobacco smoke and residential traffic. Lead (3653 ± 3355 mg/kg), cadmium (3.4 ± 0.9 mg/kg) and mercury (15.2 ± 28.5 mg/kg) concentrations from soil and manganese concentrations in water (1.43 ± 0.64 mg/L) in the exposed sites were higher than current regulations. Heavy metal concentrations in hair of children living near e-waste facilities was higher than for children living in non-exposed areas (Pb: 0.155 ± 0.187 vs 0.0729 ± 0.08 mg/g; Mn: 0.130 ± 0.212 vs 0.018 ± 0.045 mg/g; Hg: 0.008 ± 0.0042 vs 0.002 ± 0.0011 mg/g) suggesting chronic exposure to heavy metals. Manganese exposure was associated with worse cognitive performance in the domains of attention (TMT-A score: 66 s, 95% CI 0.09, 132), executive function (TMT-B score: 105 s, 95% CI 11.5, 198) and social sciences (-29%, 95% CI -54, -4.7) (per unit of Mn in hair mg/g). These results suggest that informal e-waste activities contribute to local heavy metal soil contamination, and could be an important source of metal exposure to children living in the vicinity of these facilities with putative impacts on their cognitive performance. E-waste management regulation and remediation programmes should be implemented to reduce environmental pollution and associated health effects.

Thyroid function, intelligence, and low-moderate fluoride exposure among Chinese school-age children

BACKGROUND

Thyroid hormones (THs) are critical for brain development. Whether low-moderate fluoride exposure affects thyroid function and what the impact is on children's intelligence remain elusive.

OBJECTIVES

We conducted a cross-sectional study to examine the associations between low-moderate fluoride exposure and thyroid function in relation to children's intelligence.

METHODS

We recruited 571 resident children, aged 7-13 years, randomly from endemic and non-endemic fluorosis areas in Tianjin, China. We measured fluoride concentrations in drinking water and urine using the national standardized ion selective electrode method. Thyroid function was evaluated through the measurements of basal THs [(total triiodothyronine (TT₃), total thyronine (TT₄), free triiodothyronine (FT₃), free thyronine (FT₄)] and thyroid-stimulating hormone (TSH) levels in serum. Multivariable linear and logistical regression models were used to assess associations among fluoride exposure, thyroid function and IQ scores.

RESULTS

In adjusted models, every 1 mg/L increment of water fluoride was associated with 0.13 uIU/mL increase in TSH. Every 1 mg/L increment of urinary fluoride was associated with 0.09 ug/dL decrease in TT₄, 0.009 ng/dL decrease in FT₄ and 0.11 uIU/mL increase in TSH. Fluoride exposure was inversely related to IQ scores (B = -1.587; 95% CI: -2.607, -0.568 for water fluoride and B = -1.214; 95% CI: -1.987, -0.442 for urinary fluoride). Higher TT₃, FT₃ were related to the increased odds of children having high normal intelligence (OR = 3.407, 95% CI: 1.044, 11.120 for TT₃; OR = 3.277, 95% CI: 1.621, 6.623 for FT₃). We detected a significant modification effect by TSH on the association between urinary fluoride and IQ scores, without mediation by THs.

CONCLUSIONS

Our study suggests low-moderate fluoride exposure is associated with alterations in childhood thyroid function that may modify the association between fluoride and intelligence.

Threshold effects of moderately excessive fluoride exposure on children's health: A potential association between dental fluorosis and loss of excellent intelligence

BACKGROUND

Excessive fluoride exposure is associated with adverse health outcomes, but little is known of the effects of moderately chronic fluoride exposure on children's health.

OBJECTIVES

We conducted a cross-sectional study to explore the health impact of moderately excessive fluoride in drinking water.

METHODS

We recruited 2886 resident children, aged 7 to 13 years, randomly from endemic and non-endemic fluorosis areas in Tianjin, China. The fluoride levels in drinking water and urine were measured using the national standardized ion selective electrode method. We examined the dose-response effects of low-to-moderate fluoride exposure on dental fluorosis (DF) and intelligence quotient (IQ), and evaluated the potential relationships between DF grades and intelligence levels using piecewise linear regression and multiple logistic regression, respectively.

RESULTS

The adjusted odds ratios (ORs) of DF were 2.24 (95% confidence interval [CI]: 2.02 to 2.48) for every 0.1 mg/L increment in the water fluoride concentration in the range of 0.80 to 1.50 mg/L, and 2.61 (95% CI: 2.32 to 2.93) for every 0.5 mg/L increment in the urinary fluoride level up to 1.80 mg/L. Every 0.5 mg/L increment in the water fluoride level was associated with a reduction of 4.29 in the IQ score (95% CI: -8.09 to -0.48) in the range of 3.40 to 3.90 mg/L, and a decreased probability of developing excellent intelligence (IQ ≥ 130, OR = 0.60, 95% CI: 0.47 to 0.77) in the range of 0.20-1.40 mg/L, respectively. Every 0.5 mg/L increment in the urinary fluoride level was related to a decrease of 2.67 in the IQ scores (95% CI: -4.67 to -0.68) between 1.60 mg/L to 2.50 mg/L. Excellent intelligence decreased by 51% in children with higher urinary fluoride, and by 30% with each degree increment of DF.

CONCLUSIONS

Our study suggests threshold and saturation effects of moderately excessive fluoride exposure on DF and intelligence loss in children, and a potential association between DF and the loss of excellent intelligence.

Effects of lead, cadmium, arsenic, and mercury co-exposure on children's intelligence quotient in an industrialized area of southern China

Exposure to metal(loid)s can lead to adverse effects on nervous system in children. However, little is known about the possible interaction effects of simultaneous exposure to multiple metal(loid)s on children's intelligence. In addition, relationship between blood lead concentrations (<100 μg/L) and the intelligence of children over 5 years needs further epidemiological evidence. We recruited 530 children aged 9-11 years, including 266 living in a town near an industrialized area and 264 from another town in the same city in South China as a reference. The levels of lead (Pb), cadmium (Cd), arsenic (As) and mercury (Hg) in blood (BPb, BCd, BAs, BHg) and urine (UPb, UCd, UAs, UHg) were assessed, as well as children's intelligence quotient (IQ). A significant decrease in IQ scores was identified in children from the industrialized town (p < .05), who had statistically higher geometric mean concentrations of BPb, BCd, UPb, UCd and UHg (65.89, 1.93, 4.04, 1.43 and 0.37 μg/L, respectively) compared with children from the reference town (37.21, 1.07, 2.14, 1.02 and 0.30 μg/L, respectively, p < .05). After adjusting confounders, only BPb had a significant negative association with IQ (B = -0.10, 95% confidence interval: -0.15 to -0.05, p < .001), which indicated that IQ decreased 0.10 points when BPb increased 1 μg/L. Significant negative interactions between BAs and BHg, positive interaction between UPb and UCd on IQ were observed (p < .10), and BPb <100 μg/L still negatively affected IQ (p < .05). Our findings suggest that although only BPb causes a decline in children's IQ when simultaneously exposed to these four metal(loid)s at relatively low levels, interactions between metal(loid)s on children's IQ should be paid special attention, and the reference standard in China of 100 μg/L BPb for children above 5 years old should be revised.

Relationship Between Neonatal Vitamin D at Birth and Risk of Autism Spectrum Disorders: the NBSIB Study

Previous studies suggested that lower vitamin D might be a risk factor for autism spectrum disorders (ASDs). The aim of this study was to estimate the prevalence of ASDs in 3-year-old Chinese children and to examine the association between neonatal vitamin D status and risk of ASDs. We conducted a study of live births who had taken part in expanded newborn screening (NBS), with outpatient follow-up when the children 3-year old. The children were confirmed for ASDs in outpatient by the Autism Diagnostic Interview-Revised and Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 criteria. Intellectual disability (ID) status was defined by the intelligence quotient (IQ < 80) for all the participants. The study design included a 1:4 case to control design. The concentration of 25-hydroxyvitamin D3 [25(OH)D3] in children with ASD and controls were assessed from neonatal dried blood samples. A total of 310 children were diagnosed as having ASDs; thus, the prevalence was 1.11% (95% CI, 0.99% to 1.23%). The concentration of 25(OH)D3 in 310 ASD and 1240 controls were assessed. The median 25(OH)D3 level was significantly lower in children with ASD as compared to controls (p < 0.0001). Compared with the fourth quartiles, the relative risk (RR) of ASDs was significantly increased for neonates in each of the three lower quartiles of the distribution of 25(OH)D3, and increased risk of ASDs by 260% (RR for lowest quartile: 3.6; 95% CI, 1.8 to 7.2; p < 0.001), 150% (RR for second quartile: 2.5; 95% CI, 1.4 to 3.5; p = 0.024), and 90% (RR for third quartile: 1.9; 95% CI, 1.1 to 3.3; p = 0.08), respectively. Furthermore, the nonlinear nature of the ID-risk relationship was more prominent when the data were assessed in deciles. This model predicted the lowest relative risk of ID in the 72rd percentile (corresponding to 48.1 nmol/L of 25(OH)D3). Neonatal vitamin D status was significantly associated with the risk of ASDs and intellectual disability. The nature of those relationships was nonlinear. © 2017 American Society for Bone and Mineral Research.

Measuring the impact of manganese exposure on children's neurodevelopment: advances and research gaps in biomarker-based approaches

BACKGROUND

Children's exposure to manganese (Mn) is a public health concern and consistent policy guidelines for safe levels of Mn exposure is lacking. The complexity of establishing exposure thresholds for Mn partially relates to its dual role as an essential micronutrient with low levels required for good health, but also as a neurotoxin at high levels. Questions exist about the age-related susceptibility to excess Mn, particularly for children, and how best to measure chronic exposures. To address this concern we conducted a systematic review of studies examining children's exposure to Mn and neurodevelopmental outcomes focused on selection of biomarker-based and environmental measurements of Mn exposure to identify the scientific advances and research gaps.

METHODS

PubMed and EMBASE databases were searched through March 2016 for studies that were published in English, used a biomarker-based or environmental measurement of Mn exposure, and measured at least one neurological outcome for children aged 0-18 years. Ultimately, thirty-six papers from 13 countries were selected. Study designs were cross-sectional (24), prospective cohorts (9), and case control (3). Neurodevelopmental outcomes were first assessed for Mn exposure in infants (6 papers), toddlers or preschoolers (3 papers) and school-age children (27 papers).

RESULTS

Studies of school-aged children most frequently measured Intelligence Quotient (IQ) scores using Mn biomarkers of hair or blood. Higher hair concentrations of Mn were consistently associated with lower IQ scores while studies of blood biomarkers and IQ scores had inconsistent findings. Studies of infants and toddlers most frequently measured mental and psychomotor development; findings were inconsistent across biomarkers of Mn (hair, cord blood, tooth enamel, maternal or child blood and dentin). Although few studies measured environmental sources of Mn, hair biomarkers were associated with Mn in drinking water and infant formula. Only one paper quantified the associations between environmental sources of Mn and blood concentrations.

CONCLUSION

Hair-Mn was the more consistent and valid biomarker of Mn exposure in school-aged children. Accurate measurement of children's exposure to Mn is crucial for addressing these knowledge gaps in future studies. However, research on biomarkers feasible for fetuses and infants is urgently needed given their unique vulnerability to excessive Mn.