Estimated IQ points and lifetime earnings lost to early childhood blood lead levels in the United States

Pan-European atmospheric lead pollution, enhanced blood lead levels, and cognitive decline from Roman-era mining and smelting

Ancient texts and archaeological evidence indicate substantial lead exposure during antiquity that potentially impacted human health. Although lead exposure routes were many and included the use of glazed tablewares, paints, cosmetics, and even intentional ingestion, the most significant for the nonelite, rural majority of the population may have been through background air pollution from mining and smelting of silver and lead ores that underpinned the Roman economy. Here, we determined potential health effects of this air pollution using Arctic ice core measurements of Roman-era lead pollution, atmospheric modeling, and modern epidemiology-based relationships between air concentrations, blood lead levels (BLLs), and cognitive decline. Findings suggest air lead concentrations exceeded 150 ng/m3 near metallurgical emission sources, with average enhancements of >1.0 ng/m3 over Europe during the Pax Romana apogee of the Roman Empire. The result was blood lead enhancements in young children of about 2.4 µg/dl above an estimated Neolithic background of 1.0 µg/dl, leading to widespread cognitive decline including a 2.5-to-3 point reduction in intelligence quotient throughout the Roman Empire.

Content of Toxic Elements (Arsenic, Cadmium, Mercury, Lead) in Eggs from an Ethically Managed Laying Hen Farm

Domestic chicken farming has been promoted and spread in several Italian municipalities and worldwide as an aid to the self-consumption of domestically produced food. This study investigated the levels of four toxic elements (As, Cd, Hg, and Pb) in eggs from an ethical laying hen farm, comparing the element concentrations with those possibly present in supermarket eggs. A total of 201 eggs, 141 from the farm and produced by different hen genotypes, and 60 from the supermarket, were collected. The levels of the toxic elements were evaluated in the yolk, albumen, and eggshells of all eggs. The results show that the supermarket eggs' yolk and albumen were more contaminated with lead, compared to the rural eggs. Contrarily, the mean content of arsenic was higher in the albumen and eggshells of the rural eggs, compared to the supermarket eggs. The cadmium content was below the LOQ (0.005 mg/kg) in all samples. The mercury content was below or around the LOQ in all rural eggs. Overall, the supermarket egg albumens were significantly more contaminated than the rural ones. No significant differences were found in quality parameters for both types of eggs. The toxic element values that were detected were in line with other studies in the literature. However, despite the concentrations found not representing a risk to the consumers' health, the results of this study raise a potential food safety issue, and it would be desirable to set specific MRLs for eggs for consumers' protection.

Modulation of gut microbiota with probiotics as a strategy to counteract endogenous and exogenous neurotoxicity

The existing data demonstrate that probiotic supplementation affords protective effects against neurotoxicity of exogenous (e.g., metals, ethanol, propionic acid, aflatoxin B1, organic pollutants) and endogenous (e.g., LPS, glucose, Aβ, phospho-tau, α-synuclein) agents. Although the protective mechanisms of probiotic treatments differ between various neurotoxic agents, several key mechanisms at both the intestinal and brain levels seem inherent to all of them. Specifically, probiotic-induced improvement in gut microbiota diversity and taxonomic characteristics results in modulation of gut-derived metabolite production with increased secretion of SFCA. Moreover, modulation of gut microbiota results in inhibition of intestinal absorption of neurotoxic agents and their deposition in brain. Probiotics also maintain gut wall integrity and inhibit intestinal inflammation, thus reducing systemic levels of LPS. Centrally, probiotics ameliorate neurotoxin-induced neuroinflammation by decreasing LPS-induced TLR4/MyD88/NF-κB signaling and prevention of microglia activation. Neuroprotective mechanisms of probiotics also include inhibition of apoptosis and oxidative stress, at least partially by up-regulation of SIRT1 signaling. Moreover, probiotics reduce inhibitory effect of neurotoxic agents on BDNF expression, on neurogenesis, and on synaptic function. They can also reverse altered neurotransmitter metabolism and exert an antiamyloidogenic effect. The latter may be due to up-regulation of ADAM10 activity and down-regulation of presenilin 1 expression. Therefore, in view of the multiple mechanisms invoked for the neuroprotective effect of probiotics, as well as their high tolerance and safety, the use of probiotics should be considered as a therapeutic strategy for ameliorating adverse brain effects of various endogenous and exogenous agents.

[Allergies in the light of global environmental changes]

BACKGROUND

The increase in allergies began worldwide with the onset of the Great Acceleration. Environmental pollution and climate change now threaten to cancel out decades of success in health research.

OBJECTIVE

A summary of environmental influences is provided, which not only shows the significant increase in the prevalence of allergies worldwide but also that of noncommunicable diseases. The effects of the climate crisis on allergies and the multifactorial and interfunctional relationships with other environmental changes are described in detail.

MATERIAL AND METHODS

In order to obtain an overview of the possible effects of global environmental changes on allergies, a wide range of literature was evaluated and the study results were prepared and summarized.

RESULTS

A large number of allergens are influencing the human exposome on a daily basis. These allergens are triggered by environmental changes, such as air pollution in the ambient air and indoors, chemicals in everyday objects or residues in food. People are sensitized by the interaction of allergens and pollutants.

CONCLUSION

The prevalence of allergies is stagnating in industrialized countries. This is probably just the calm before the storm. The accelerating effects of global warming could make pollen and air pollutants even more aggressive in the future. Urgent action is therefore needed to minimize environmental pollution and mitigate climate change.

Maternal prenatal paracetamol ingestion and scholastic attainments of the offspring

Background: Fetal exposure to paracetamol (acetaminophen) has been shown to be associated with asthma and other atopic disorders, as well as behavioural problems including hyperactivity, in childhood. However, there is little information on scholastic abilities among children exposed to paracetamol in pregnancy. Objectives: To determine whether there are any differences in scholastic abilities among the offspring of women who ingested paracetamol during pregnancy compared with non-exposed children. Methods: Mothers enrolled in the Avon Longitudinal Study of Parents and Children (ALSPAC) had recorded the frequency with which they had taken the medication over two time periods during pregnancy: i) the first 18 weeks and ii) 18-32 weeks. The offspring have been followed up ever since. For this study we use as outcomes: a) 14 tests of ability at reading and 2 of spelling using the study's tests and the national education system test results; b) 6 of mathematical abilities including tests of arithmetic and mathematical reasoning, and c) 1 of scientific understanding. Multiple regression was used, adjusting for 15 different exposures including reasons for taking the medication as well as demographic features. Results: Almost all unadjusted and adjusted mean differences were negative (i.e., those exposed to maternal intake of paracetamol did less well), but negative associations for exposures between 18 and 32 weeks of gestation were much more evident than for exposures earlier in pregnancy. Of the later exposures, after adjustment, 12 of the 23 scholastic tests were associated with prenatal exposure to paracetamol at p < 0.05. These negative effects were found in the girls (12 tests at p < 0.05) but not boys (0 tests at p < 0.05). Conclusion: Evidence from this longitudinal study suggests that maternal exposure to paracetamol is associated with disadvantages to the offspring in scholastic abilities such as mathematics and reading at secondary school ages. This raises the question as to whether there are longer-lasting effects on educational attainment from age 15 years onwards, including at university level. Clearly these results should be tested in other settings, but meanwhile they add to a growing accumulation of known adverse effects of exposure to paracetamol in pregnancy.

Maternal Iron Deficiency and Environmental Lead (Pb) Exposure Alter the Predictive Value of Blood Pb Levels on Brain Pb Burden in the Offspring in a Dietary Mouse Model: An Important Consideration for Cumulative Risk in Development

Maternal iron deficiency (ID) and environmental lead (Pb) exposure are co-occurring insults that both affect the neurodevelopment of offspring. Few studies have investigated how ID affects brain-region-specific Pb accumulations using human-relevant Pb concentrations. Furthermore, how these Pb exposures impact blood and brain Fe levels remains unclear. Importantly, we also wanted to determine whether the use of blood Pb levels as a surrogate for the brain Pb burden is affected by underlying iron status. We exposed virgin Swiss Webster female mice to one of six conditions differing by iron diet and Pb water concentration (0 ppm, 19 ppm, or 50 ppm lead acetate) and used Inductively Coupled Plasma Mass Spectrometry to measure the maternal and offspring circulating, stored, and brain Pb levels. We found that maternal ID rendered the offspring iron-deficient anemic and led to a region-specific depletion of brain Fe that was exacerbated by Pb in a dose-specific manner. The postnatal iron deficiency anemia also exacerbated cortical and hippocampal Pb accumulation. Interestingly, BPb levels only correlated with the brain Pb burden in ID pups but not in IN offspring. We conclude that ID significantly increases the brain Pb burden and that BPb levels alone are insufficient as a clinical surrogate to make extrapolations on the brain Pb burden.

Achieving Child Health Equity: Policy Solutions

Policy solutions to address child health equity, with evidence to support the policies, are presented. Policies address health care, direct financial support to families, nutrition, support for early childhood and brain development, ending family homelessness, making housing and neighborhoods environmentally safe, gun violence prevention, LGBTQ + health equity, and protecting immigrant children and families. Federal, state, and local policies are addressed. Recommendations of the National Academy of Science, Engineering, and Medicine and the American Academy of Pediatrics are highlighted when appropriate.

Lead pollution-related health of children in China: Disparity, challenge, and policy

Lead (Pb) is a neurotoxic metal, and no level of lead exposure is safe for children. China has still experienced problems on child lead poisoning even though the Chinese government has phased out leaded gasoline since 2000. The underlying problem affecting the lead pollution-related health of children in China remains to be comprehensively investigated. It is found that although the significant decline of BLLs, as the Geometric Mean (GM), from 91.40 μg/L^GM in 2001 to 37.52 μg/L^GM in 2018 is observed, the average BLLs of children are still above 50 μg/L or more [average 59.70 (60.50-65.02, 95 % CI) μg/L^GM] after phasing out leaded gasoline since 2000 in China. Lead exposure causes 29.67 MID per 1000 children with a loss of 98.23 (59.40-146.21, 95 % CI) DALYs per 1000 in China, which is greater than the levels reported from the Western Pacific Region and other low- and middle-income countries. A significant correlation is observed between the number of child crimes (NoCCs) and the outcomes of long-term lead exposure for children in China. Although the disparities in BLLs in China are strongly influenced by unequal distributions of potential multi-lead related sources (soil lead, PM2.5 lead, dust lead), unbalance development of local industrialization and economies, as well as incorrect health care for younger children, the notable emissions from coal combustion (CC) and non-ferrous metals (NMS) exploitation dominate the crucial sources of low-level lead exposure to children after phasing out leaded gasoline in China currently. Faced with the unequal and disparate distribution of BLLs in China, the big bottleneck is to decrease the BLLs exertions of 36-45 μg/L in the next few decades. The Chinese government needs to make more efforts on developing more strict guidelines, implementing more policy strategies on prevention and management of blood Pb poisoning, and monitoring the nationwide changes in children's BLLs continuously.

Predictive modeling of indoor dust lead concentrations: Sources, risks, and benefits of intervention

Lead (Pb) contamination continues to contribute to world-wide morbidity in all countries, particularly low- and middle-income countries. Despite its continued widespread adverse effects on global populations, particularly children, accurate prediction of elevated household dust Pb and the potential implications of simple, low-cost household interventions at national and global scales have been lacking. A global dataset (∼40 countries, n = 1951) of community sourced household dust samples were used to predict whether indoor dust was elevated in Pb, expanding on recent work in the United States (U.S.). Binned housing age category alone was a significant (p < 0.01) predictor of elevated dust Pb, but only generated effective predictive accuracy for England and Australia (sensitivity of ∼80%), similar to previous results in the U.S. This likely reflects comparable Pb pollution legacies between these three countries, particularly with residential Pb paint. The heterogeneity associated with Pb pollution at a global scale complicates the predictive accuracy of our model, which is lower for countries outside England, the U.S., and Australia. This is likely due to differing environmental Pb regulations, sources, and the paucity of dust samples available outside of these three countries. In England, the U.S., and Australia, simple, low-cost household intervention strategies such as vacuuming and wet mopping could conservatively save 70 billion USD within a four-year period based on our model. Globally, up to 1.68 trillion USD could be saved with improved predictive modeling and primary intervention to reduce harmful exposure to Pb dust sources.

A Participatory-Based Research Approach for Assessing Exposure to Lead-Contaminated Drinking Water in the Houston Neighborhood of the Greater Fifth Ward

To address community-driven concerns about lead-contaminated drinking water in residential homes in the Greater Fifth Ward neighborhood in Northeast Houston, Texas utilizing participatory-based research. The study collected survey data and performed lead analysis on drinking water from residents’ homes. The Greater Fifth Ward is characterized as a majority-minority environmental justice community and is located within two confirmed cancer clusters. The residents of 172 homes completed a survey and had detectable lead levels in their water samples. Survey results indicated that more than half of the residents (58.2%) were concerned with the water quality and 42.9% rated the drinking water as poor. Water lead levels detected ranged from 0.01 to 22 µg/L. 10.9% of homes exceeding 1 µg/L, and one located exceeded the USEPA’s action limit of 15 µg/L. Homes built prior to 1978 without major renovation had significantly higher levels of lead in their drinking water compared to homes built after 1978 (p-value < 0.05). These findings demonstrate the need for lead testing of residential water in low socioeconomic-status communities, as well as demonstrating the benefits of community engagement and participatory research to address environmental health concerns.

The Association between Lead Exposure and Bone Mineral Density in Childhood and Adolescence: Results from NHANES 1999-2006 and 2011-2018

There are few studies on lead's effect on bone mineral density (BMD) in childhood. In this study, we examined the association between lead exposure and BMD among 13,951 children and adolescents aged 8-19 years from NHANES 1999-2006 and 2011-2018. The whole blood lead levels (BLLs) were used as lead exposure biomarkers, and total BMD, subtotal BMD, lumbar spine BMD and limb BMD were used as outcome variables. The survey weighted multivariable generalized additive models (GAMs) with smoothing terms were used to explore the association between blood lead levels and BMDs, adjusted for age, sex, race/ethnicity, height, weight, family-income-to-poverty ratio and blood cadmium. Subgroup analyses stratified by sex and bony sites were further performed. We found an N-shaped curve association between BLLs and total BMD, subtotal BMD and limb BMD for males and females, whereas the association between BLLs and lumbar spine BMD was only significantly negative for females. The findings suggested that lead exposure had different effects on BMD of different bony sites (highly cortical or trabecular regions) in childhood and adolescence and had different effects on the same bone among different ages population and/or at different levels.

Global DNA Methylation in Cord Blood as a Biomarker for Prenatal Lead and Antimony Exposures

DNA methylation is an epigenetic mechanism for gene expression modulation and can be used as a predictor of future disease risks. A prospective birth cohort study was performed to clarify the effects of neurotoxicants on child development, namely, the Tohoku Study of Child Development, in Japan. This study aimed to evaluate the association of prenatal exposure to five toxic metals—arsenic, cadmium, mercury, lead (Pb), antimony (Sb), and polychlorinated biphenyls (PCBs, N = 166)—with global DNA methylation in umbilical cord blood DNA. DNA methylation markers, 5-methyl-2′-deoxycytidine (mC) and 5-hydroxymethyl-2′-deoxycytidine (hmC), were determined using liquid chromatography-tandem mass spectrometry. The mC content in cord blood DNA was positively correlated with Pb and Sb levels (r = 0.435 and 0.288, respectively) but not with cord blood PCBs. We also observed significant positive correlations among Pb levels, maternal age, and hmC content (r = 0.155 and 0.243, respectively). The multiple regression analysis among the potential predictors demonstrated consistent positive associations between Pb and Sb levels and mC and hmC content. Our results suggest that global DNA methylation is a promising biomarker for prenatal exposure to Pb and Sb.

Half of US population exposed to adverse lead levels in early childhood

Considerable effort is expended to protect today’s children from lead exposure, but there is little evidence on the harms past lead exposures continue to hold for yesterday’s children, who are victims of what we term legacy lead exposures. We estimate that over 170 million Americans alive today were exposed to high-lead levels in early childhood, several million of whom were exposed to five-plus times the current reference level. Our estimates allow future work to plan for the health needs of these Americans and to inform estimation of the true contributions of lead exposure to population health. We estimate population-level effects on IQ loss and find that lead is responsible for the loss of 824,097,690 IQ points as of 2015.

Lead is a developmental neurotoxicant in wide industrial use that was once broadly distributed in the environment. The extent of the US population exposed in early life to high levels of lead is unknown, as are the consequences for population IQ. Serial, cross-sectional blood–lead level (BLL) data from National Health and Nutrition Examination Survey (NHANES), a nationally representative sample of US children aged 1 to 5 (n = 11,616) from 1976 to 1980 to 2015 to 2016 was combined with population estimates from the US Census, the Human Mortality Database, and the United Nations. NHANES and leaded gasoline consumption data were used to estimate BLLs from 1940 to 1975. We estimated the number and proportion of people that fall within seven BLL categories (<4.99; 5 to 0.9.99; 10 to 14.9: 15 to 19.9; 20.24.9; 25 to 29.9; and ≥30 µg/dL), by year and birth cohort, and calculated IQ points lost because of lead exposure. In 2015, over 170 million people (>53%) had BLLs above 5 µg/dL in early life (±2.84 million [80% CI]), over 54 million (>17%) above 15 µg/dL, and over 4.5 million (>1%) above 30 µg/dL (±0.28 million [80% CI]). BLLs greater than 5 µg/dL were nearly universal (>90%) among those born 1951 to 1980, while BLLs were considerably lower than 5 µg/dL among those born since 2001. The average lead-linked loss in cognitive ability was 2.6 IQ points per person as of 2015. This amounted to a total loss of 824,097,690 IQ points, disproportionately endured by those born between 1951 and 1980.

Children and adults are exposed to dual risks from ingestion of water and inhalation of ultrasonic humidifier particles from Pb-containing water

Room-sized ultrasonic humidifiers are exposure pathways to aerosolized metals, with dose positively associated with increased concentrations of metals in fill water. This study innovatively quantifies water ingestion along with inhalation doses from humidifiers for 10-1000 μg/L dissolved lead (Pb) in tap water. The subsequent indoor air Pb concentrations, average daily doses, and inhalation deposited respiratory fractions were predicted under four room scenarios for 3-mo, 12-mo, 28-mo, and 6-yr children and adults. Elevated blood Pb levels (BLLs) in children were modeled using USEPA's Integrated Exposure Uptake Biokinetic (IEUBK) model. Indoor air Pb exceeds the USEPA ambient air standard of 0.15 μg/m³ when humidifier fill water contains 33 μg/L Pb in the small room of 33.5 m³ and 0.2 h^-1 air exchange rate (AER). For this room, ~40-46% inhaled Pb-containing humidifier particles deposit in children's respiratory tracts; inhaling humidifier particles from ≥500 μg/L Pb water results in >1 μg/dL BLL in 2-7 yr children. For adults, ~23% of particles deposit in the respiratory tract; 8-h inhalation exposure with ≥17 μg/L Pb water exceeds the California EPA reproductive toxicity guideline of 0.5 μg/day. Larger rooms and higher AER decrease Pb inhalation exposure under the same water Pb concentration.

Monetary Valuation of Children's Cognitive Outcomes in Economic Evaluations from a Societal Perspective: A Review

Cognitive ability in childhood is positively associated with economic productivity in adulthood. Expected gains in economic output from interventions that protect cognitive function can be incorporated in benefit-cost and cost-effectiveness analyses conducted from a societal perspective. This review summarizes estimates from high-income countries of the association of general cognitive ability, standardized as intelligence quotient (IQ), with annual and lifetime earnings among adults. Estimates of the association of adult earnings with cognitive ability assessed in childhood or adolescence vary from 0.5% to 2.5% per IQ point. That range reflects differences in data sources and analytic methods. We take a conservative published estimate of a 1.4% difference in market productivity per IQ point in the United States from a recent study that controlled for confounding by family background and behavioral attributes. Using that estimate and the present value of lifetime earnings calculated using a 3% discount rate, the implied lifetime monetary valuation of an IQ point in the United States is USD 10,600-13,100. Despite uncertainty and the exclusion of non-market productivity, incorporation of such estimates could lead to a fuller assessment of the benefits of public health and clinical interventions that protect the developing brains of fetuses, infants, and young children.