Home environment and prenatal exposure to lead, arsenic and zinc on the neurodevelopment of six-month-old infants living in Chitwan Valley, Nepal

Risk factors for Ascaris lumbricoides infection and its association with nutritional status and IQ in 14-Year old adolescents in Chitwan, Nepal

Inconsistent results have been obtained from studies investigating the association between soil-transmitted helminths (STHs) and nutritional status and cognitive outcomes. This study aimed to investigate the influence of STHs and nutritional status on the intelligence quotient (IQ) of adolescents in the Chitwan Valley, Nepal. In this birth cohort study from the Chitwan district of Nepal, 74 cohort participants were followed up after 14 years. The presence and egg density of the STHs were investigated following the Kato-Katz method. Full-scale IQ was evaluated using the Wechsler Abbreviated Scale of Intelligence-II (WASI-II). Multivariate regression analysis was also conducted to examine the associations of STHs and nutritional status with IQ scores, adjusting for adverse childhood experiences (ACE) and demographic and socioeconomic factors. The only STHs detected was for Ascaris lumbricoides, which was detected in 16% (12/74) of the study participants. Similarly, 16% (12/73) of participants reported undernutrition (body mass index (BMI) Z score<-2SD), and 33% (25/74) of participants had a developmental deficit (WASI II FSIQ < 69). There were no significant associations between the presence of A. lumbricoides or egg density and IQ scores. However, undernutrition (BMIZ<-2SD) increased the odds of a developmental deficit according to both univariate and adjusted multivariate models [i.e., adjusted odds ratio (aOR) 9.41; 95% CI (2.23 to 39.80)]. While the study primarily examines the association of STHs and nutritional status with IQ, it is important to note that adolescents with educated mothers or higher incomes also showed better cognitive development. The prevalence of undernutrition and associated developmental deficits characterized by an IQ < 69 was alarmingly high in this cohort of adolescents from Chitwan, Nepal. Despite the high prevalence of A. lumbricoides, its infection was not identified as significantly associated with cognition. However, it is noteworthy that a consistent favorable impact of an enriching postnatal environment, approximated by maternal education and family income, may improve neurodevelopmental indicators.

Update of the risk assessment of inorganic arsenic in food

The European Commission asked EFSA to update its 2009 risk assessment on arsenic in food carrying out a hazard assessment of inorganic arsenic (iAs) and using the revised exposure assessment issued by EFSA in 2021. Epidemiological studies show that the chronic intake of iAs via diet and/or drinking water is associated with increased risk of several adverse outcomes including cancers of the skin, bladder and lung. The CONTAM Panel used the benchmark dose lower confidence limit based on a benchmark response (BMR) of 5% (relative increase of the background incidence after adjustment for confounders, BMDL05) of 0.06 μg iAs/kg bw per day obtained from a study on skin cancer as a Reference Point (RP). Inorganic As is a genotoxic carcinogen with additional epigenetic effects and the CONTAM Panel applied a margin of exposure (MOE) approach for the risk characterisation. In adults, the MOEs are low (range between 2 and 0.4 for mean consumers and between 0.9 and 0.2 at the 95th percentile exposure, respectively) and as such raise a health concern despite the uncertainties.

Genetic Susceptibility to Neurotoxicity Related to Prenatal Inorganic Arsenic Exposure in Young Spanish Children

We explored the influence of child and maternal single nucleotide polymorphisms (SNPs) in genes related to neurological function and arsenic metabolism (i.e., ABCA1, ABCB1, PON1, CYP3A, BDNF, GSTP1, MT2A, and APOE as well as AS3MT) on the association between prenatal arsenic (As) exposure and methylation efficiency and neuropsychological development in 4-5-year-old children. Participants were 549 mother-child pairs from the INMA (Environment and Childhood) Spanish Project. We measured inorganic arsenic (iAs) and the metabolites monomethylarsonic acid (MMA) and dimethylarsinic acid (DMA) in urine samples collected during pregnancy. Neuropsychological development was assessed at the age of 4-5 years using the McCarthy Scales of Children's Abilities (MSCA). Several SNPs were determined in maternal and child DNA; AS3MT and APOE haplotypes were inferred. The median ∑As (sum of iAs, DMA, and MMA) was 7.08 μg/g creatinine. Statistically significant interactions for children's APOE haplotype were observed. Specifically, ε4-carrier children had consistently lower MSCA scores in several scales with increasing ∑As and MMA concentrations. These results provide evidence regarding the neurotoxic effects of early life exposure to As, observing that the APOE ε4 allele could make children more vulnerable to this exposure.

Maternal Folate Status and the Relation between Gestational Arsenic Exposure and Child Health Outcomes

Gestational arsenic exposure adversely impacts child health. Folate-mediated 1-carbon metabolism facilitates urinary excretion of arsenic and may prevent arsenic-related adverse health outcomes. We investigated the potential for maternal folate status to modify associations between gestational arsenic exposure and child health. We used data from 364 mother-child pairs in the MIREC study, a prospective pan-Canadian cohort. During pregnancy, we measured first trimester urinary arsenic concentrations, plasma folate biomarkers, and folic acid supplementation intake. At age 3 years, we evaluated twelve neurodevelopmental and anthropometric features. Using latent profile analysis and multinomial regression, we developed phenotypic profiles of child health, estimated covariate-adjusted associations between arsenic and these phenotypic profiles, and evaluated whether folate status modified these associations. We identified three phenotypic profiles of neurodevelopment and three of anthropometry, ranging from less to more optimal child health. Gestational arsenic was associated with decreased odds of optimal neurodevelopment. Maternal folate status did not modify associations of arsenic with neurodevelopmental phenotypic profiles, but gestational arsenic was associated with increased odds of excess adiposity among those who exceed recommendations for folic acid (>1000 μg/day). However, arsenic exposure was low and folate status was high. Gestational arsenic exposure may adversely impact child neurodevelopment and anthropometry, and maternal folate status may not modify these associations; however, future work should examine these associations in more arsenic-exposed or lower folate-status populations.

Associations of maternal urinary arsenic concentrations during pregnancy with childhood cognitive abilities: The HOME study

Arsenic exposure during pregnancy may increase the risk for intellectual deficits in children, but limited data exist from prospective epidemiologic studies, particularly at low arsenic exposure levels. We investigated the association between prenatal maternal urinary arsenic concentrations and childhood cognitive abilities in the Health Outcomes and Measures of the Environment (HOME) Study. We used anion exchange chromatography coupled with inductively coupled plasma mass spectrometry detection to measure arsenic species content in pregnant women's urine. The summation of inorganic arsenic (iAs), monomethylarsonic acid (MMA), and dimethylarsinic acid (DMA) refers to ∑As. We assessed children's cognitive function (n = 260) longitudinally at 1-, 2-, and 3-years using Bayley Scales of Infant and Toddler Development, at 5 years using Wechsler Preschool and Primary Scale of Intelligence, and at 8 years using Wechsler Intelligence Scale for Children. We observed a modest decrease in mental development index and full-scale intelligence quotient at ages 3 and 5 years with each doubling of ∑As with estimated score (ß) differences and 95% confidence interval (CI) of -1.8 from -4.1 to 0.5 and -2.5 from -5.1 to 0.0, respectively. This trend was stronger and reached statistical significance among children whose mothers had lower iAs methylation capacity and low urinary arsenobetaine concentrations. Our findings suggest that arsenic exposure levels relevant to the general US population may affect children's cognitive abilities.

Prenatal arsenic exposure, arsenic methylation efficiency, and neuropsychological development among preschool children in a Spanish birth cohort

BACKGROUND

Prenatal arsenic (As) exposure could negatively affect child neuropsychological development, but the current evidence is inconclusive.

OBJECTIVES

To explore the relationship between prenatal urinary total As (TAs) concentrations, the As species and the methylation efficiency, and child neuropsychological development in a Spanish birth cohort. We also studied the effect modification produced by sex and several nutrients and elements.

MATERIALS AND METHODS

Study subjects were 807 mother-child pairs participating in the INMA (Childhood and Environment) Project. Urinary TAs and its metabolites, monomethylarsonic acid (MMA), dimethylarsinic acid (DMA), inorganic As (iAs) and arsenobetaine were measured in the first trimester of pregnancy. Methylation efficiency was determined through the percentages of the metabolites and using principal component analysis. Children's neuropsychological development was assessed at the age of 4-5 years using the McCarthy Scales of Children's Abilities (MSCA). Multivariable linear regression models were built to assess the association between TAs, the As species and the maternal methylation efficiency, and the neuropsychological scores. We explored effect modification by sex, iron status, maternal nutrients status (serum manganese and selenium, and urinary zinc), and maternal vitamins intake (folate, and vitamins B₁₂ and B₆).

RESULTS

The geometric mean (95%CI) of ∑As (sum of DMA, MMA and iAs) was 7.78 (7.41, 8.17) μg/g creatinine. MMA concentrations were inversely associated with the scores for the general, verbal, quantitative, memory, executive function and working memory scales (i.e. β [CI95%] = -1.37 [-2.33, -0.41] for the general scale). An inverse association between %MMA and the memory scores was found. Children whose mothers had lower manganese, zinc and ferritin concentrations obtained lower scores on several MSCA scales with decreasing As methylation efficiency.

DISCUSSION

An inverse association was observed between MMA concentrations and children's neuropsychological development. Maternal levels of manganese, zinc and ferritin affected the association between As methylation efficiency and MSCA scores.

Association of newborn blood lead concentration with neurodevelopment outcome in early infancy

BACKGROUND

In utero exposure to toxic metal substances can cause severe neurodevelopmental deficits in developing fetus and infant.

METHODS

We evaluated the association of newborn umbilical cord blood lead concentration with early neurodevelopmental performance (cognitive, receptive language, expressive language, fine motor, gross motor and social-emotional development). The Bayley Scale of Infants Developments-III (BSID-III) was used to perform neurodevelopment outcomes at an average age of 6.5 months. In this prospective study, total of 167 mother-child pairs were enrolled from Western Rajasthan, India. Association between risk factors of lead contamination and newborn umbilical cord blood lead levels was observed. Multivariate regression was performed to see the association of cord blood lead level with infant neurodevelopment outcome.

RESULTS

The obtained newborn umbilical cord blood lead concentration 5.0-10.5 μg/dL was negatively associated with the sub-scale score of gross motor development (β-coefficient with 95 % CI; -0.29 (-5.0-0.11), p = 0.04). However, no associations were found with the score of cognitive, language, gross motor, and social-emotional development. The umbilical cord blood lead concentration <5.0 μg/dL was also not associated with the BSID-III scores. The mother's regular intake of calcium supplements during the antenatal period was significantly associated with a lower umbilical cord blood lead level (p-value 0.031).

CONCLUSION

The data suggest that newborn umbilical cord blood lead concentration 0.5-10.5 μg/dL has a negative association with early gross motor development during infancy.

A systems toxicology approach to compare the heavy metal mixtures (Pb, As, MeHg) impact in neurodegenerative diseases

Conventional toxicological risk assessment methods mainly working on single chemicals that fail to adequately address the simultaneous exposure and their potential toxicity in humans. We herein investigated the toxic heavy metals lead (Pb), arsenic (As), and methylmercury (MeHg) and their binary mixtures role in neurodegenerative diseases. To characterize the toxicity of metal mixtures at the molecular level, we established a non-animal omics-based organ relevant cell model system. The obtained experimental data was refined by using the statistical and downstream functional analysis. The protein expression information substantiates the previous findings of single metal (Pb, As, and MeHg) induced alterations to mitochondrial dysfunction, oxidative stress, mRNA splicing, and ubiquitin system dysfunction relation to neurodegenerative diseases. The functional downstream analysis of single and binary mixtures protein data is presented in a comparative manner. The heavy metals mixtures' outcome showed significant differences in the protein expression compared to single metals that indicate metal mixtures exposure is more hazardous than single metal exposure. These results suggest that more comprehensive strategies are needed to improve the mixtures risk assessment in the future.

Environmental exposure to low-level lead (Pb) co-occurring with other neurotoxicants in early life and neurodevelopment of children

Lead (Pb) is a worldwide environmental contaminant that even at low levels influences brain development and affects neurobehavior later in life; nevertheless it is only a small fraction of the neurotoxicant (NT) exposome. Exposure to environmental Pb concurrent with other NT substances is often the norm, but their joint effects are challenging to study during early life. The aim of this review is to integrate studies of Pb-containing NT mixtures during the early life and neurodevelopment outcomes of children. The Pb-containing NT mixtures that have been most studied involve other metals (Mn, Al, Hg, Cd), metalloids (As), halogen (F), and organo-halogen pollutants. Co-occurring Pb-associated exposures during pregnancy and lactation depend on the environmental sources and the metabolism and half-life of the specific NT contaminant; but offspring neurobehavioral outcomes are also influenced by social stressors. Nevertheless, Pb-associated effects from prenatal exposure portend a continued burden on measurable neurodevelopment; they thus favor increased neurological health issues, decrements in neurobehavioral tests and reductions in the quality of life. Neurobehavioral test outcomes measured in the first 1000 days showed Pb-associated negative outcomes were frequently noticed in infants (<6 months). In older (preschool and school) children studies showed more variations in NT mixtures, children's age, and sensitivity and/or specificity of neurobehavioral tests; these variations and choice of statistical model (individual NT stressor or collective effect of mixture) may explain inconsistencies. Multiple exposures to NT mixtures in children diagnosed with 'autism spectrum disorders' (ASD) and 'attention deficit and hyperactivity disorders' (ADHD), strongly suggest a Pb-associated effect. Mixture potency (number or associated NT components and respective concentrations) and time (duration and developmental stage) of exposure often showed a measurable impact on neurodevelopment; however, net effects, reversibility and/or predictability of delays are insufficiently studied and need urgent attention. Nevertheless, neurodevelopment delays can be prevented and/or attenuated if public health policies are implemented to protect the unborn and the young child.

Low-level arsenic exposure and developmental neurotoxicity in children: A systematic review and risk assessment

Risk assessments of arsenic have focused on skin, bladder, and lung cancers and skin lesions as the sensitive cancer and non-cancer health endpoints, respectively; however, an increasing number of epidemiologic studies that can inform risk assessment have examined neurodevelopmental effects in children. We conducted a systematic review and risk assessment based on the epidemiologic literature on possible neurodevelopmental effects at lower arsenic exposures. Twenty-four cross-sectional, case-control, and cohort studies were identified that report on the association between low-level arsenic exposure (i.e., largely <100 μg/L of arsenic in drinking water) and neurological outcomes in children. Although the overall evidence does not consistently show a causal dose-response relationship at low doses, the most rigorously conducted studies from Bangladesh indicate possible inverse associations with cognitive function, predominantly involving concurrent arsenic exposure as measured by biomarkers (i.e., arsenic in urine or blood) and raw verbal test scores at ages 5-11 years. Issues such as non-comparability of outcome measures across studies; inaccuracies of biomarkers and other measures of inorganic arsenic exposure; potential effect modification by cultural practices; insufficient adjustment for nutritional deficiencies, maternal IQ, and other important confounders; and presence of other neurotoxicants in foreign populations limit generalizability to U.S.

POPULATIONS

Of the few U.S. studies available, the most rigorously conducted study did not find a consistent dose-response relationship between arsenic concentrations in tap water or toenails and decrements in IQ scores. Assuming that the strongest dose-response relationship from the most rigorous evidence from Bangladesh is generalizable to U.S. populations, possible reference doses were estimated in the range of 0.0004-0.001 mg/kg-day. These doses are higher than the U.S. Environmental Protection Agency reference dose for chronic lifetime exposure, thus indicating protectiveness of the existing value for potential neurotoxicity in children. This reference dose is undergoing revision as EPA considers various health endpoints in the reassessment of inorganic arsenic health risks.

Association of cord blood levels of lead, arsenic, and zinc and home environment with children neurodevelopment at 36 months living in Chitwan Valley, Nepal

Background

Inconsistent results continue to be reported from studies linking low-level prenatal lead exposure and child development. Because of limited earlier epidemiological studies with birth cohort follow up design, it still remains inconclusive that either the associations of cord blood level of toxic, and essential elements, and postnatal raising environment on neurodevelopment of children remains constant throughout childhood or change over time.

Aims

This study aims to investigate the influence of in utero toxic [lead (Pb) and arsenic (As)] and essential elements [zinc (Zn)] levels on neurodevelopment of 36 months children in Chitwan valley, Nepal taking the postnatal environment into account.

Study Designs and Subjects

In this birth cohort study, participants (N=100 mother-infants’ pairs) were recruited in Chitwan district, Nepal. We measured Pb, As and Zn concentrations in cord blood. Postnatal raising environment (i.e., Home score or home environment hereafter) was evaluated using Home Observation for Measurement of Environment (HOME) scale. Neurodevelopment of children at 36 months of age (n=70) were assessed using Bayley Scale of Infant Development, Second Edition (BSID II). Multivariate regression was performed (n=70) to see the association of in utero toxic and essential elements level and home environment with neurodevelopment score adjusted for covariates.

Results

Cord blood levels of Pb, As and Zn were not associated with any BSID II cluster scores of 36 months children. The children with relatively superior HOME score and concurrent nutritional status (weight at 36 months) showed better cognitive development (i.e., MDI scores) and motor functions than their counterparts, respectively.

Conclusion

In this general population in Nepal, prenatal Pb, As and Zn levels are not important determinants of the neurodevelopment of 36- month-old children while a consistent beneficial effect of a stimulating home environment on neurodevelopmental indicators is continued.

Neurobehavioral effects of arsenic exposure among secondary school children in the Kandal Province, Cambodia

The research was carried out at 3 study sites with varying groundwater arsenic (As) levels in the Kandal Province of Cambodia. Kampong Kong Commune was chosen as a highly contaminated site (300-500μg/L), Svay Romiet Commune was chosen as a moderately contaminated site (50-300μg/L) and Anlong Romiet Commune was chosen as a control site. Neurobehavioral tests on the 3 exposure groups were conducted using a modified WHO neurobehavioral core test battery. Seven neurobehavioral tests including digit symbol, digit span, Santa Ana manual dexterity, Benton visual retention, pursuit aiming, trail making and simple reaction time were applied. Children's hair samples were also collected to investigate the influence of hair As levels on the neurobehavioral test scores. The results from the inductively coupled plasma-mass spectrometry (ICP-MS) analyses of hair samples showed that hair As levels at the 3 study sites were significantly different (p<0.001), whereby hair samples from the highly contaminated site (n=157) had a median hair As level of 0.93μg/g, while the moderately contaminated site (n=151) had a median hair As level of 0.22μg/g, and the control site (n=214) had a median hair As level of 0.08μg/g. There were significant differences among the 3 study sites for all the neurobehavioral tests scores, except for digit span (backward) test. Multiple linear regression clearly shows a positive significant influence of hair As levels on all the neurobehavioral test scores, except for digit span (backward) test, after controlling for hair lead (Pb), manganese (Mn) and cadmium (Cd). Children with high hair As levels experienced 1.57-4.67 times greater risk of having lower neurobehavioral test scores compared to those with low hair As levels, after adjusting for hair Pb, Mn and Cd levels and BMI status. In conclusion, arsenic-exposed school children from the Kandal Province of Cambodia with a median hair As level of 0.93µg/g among those from the highly contaminated study site, showed clear evidence of neurobehavioral effects.