Lead consumption of 18- to 36-month-old children as determined from duplicate diet collections: nutrient intakes, blood lead levels, and effects on growth

Toxic metal exposures from infant diets: Risk prevention strategies for caregivers and health care professionals

Concerns are growing regarding the presence of toxic elements such as arsenic (As), cadmium (Cd), mercury (Hg), and lead (Pb) in the ingredients and prepared foods for infants and young children. There are few clear, evidence-based, guidelines on the maximum tolerable limits of toxicants in foods and little understanding of toxicant exposure or adverse health effects attributable to dietary exposure. Caregivers are faced with the burden of making decisions about which foods to select, how often to feed them to their children, and what foods to limit. This article reviews the current literature and existing recommendations on dietary exposure to toxic elements in children under 2 years of age, and their health effects in early childhood-focusing on growth, neurodevelopment, and immune function. The article also outlines best practices for healthcare providers to address the concerns of toxic element exposure through the diet in young children. Several foods consistently appear in the literature as potential sources of toxic element exposure. Contaminated drinking and cooking water, including water used to prepare infant formula, could also be a major exposure source. In the absence of stronger evidence on effects of dietary modification, exclusive breastfeeding until six months of age, followed by a diverse diet are some strategies to reduce dietary toxic element exposure while ensuring an adequate and balanced nutrient intake. Healthcare providers can support families by sharing information and encouraging blood Pb testing, the only element for which such testing is currently recommended.

Contribution of household drinking water intake to arsenic and lead exposure among Uruguayan schoolchildren

BACKGROUND

Food and water are common exposure sources of arsenic and lead among children. Whereas dietary sources of these toxicants are fairly well-studied, the contribution of drinking water to toxicant exposures is not well characterized in many populations, particularly in the Global South.

OBJECTIVE

To assess the extent to which consumption of household drinking water contributes to arsenic and lead exposure among Uruguayan schoolchildren with low-level exposure.

METHODS

Children, aged 5-8 years, were enrolled into the Salud Ambiental Montevideo study during 2009-2013 from schools in Montevideo, Uruguay. Participants reported water intake as part of two 24-h dietary recalls. Concentrations of arsenic were measured in first morning void urine samples, and adjusted for urinary specific gravity. Lead concentrations were measured in venous blood samples. Drinking water samples were collected from participants' homes and toxicant concentrations measured. Data analyses involved a triangulation approach. First, multivariable linear regressions estimated the associations between toxicant exposure through drinking water, calculated for each child as the product of water intake and water toxicant concentration, and the respective toxicant biomarker concentrations among children with complete data on all variables (Sample A; n = 40). Second, regressions were repeated for participants with complete data on all variables except water intakes (Sample B; n = 195), after water intakes were imputed. Finally, models were constructed for participants of Sample B (n = 195) based on drinking water intakes assumed to be fixed at 25th, 50th, 75th percentile intakes of participants in sample A.

RESULTS

Toxicant exposure via drinking water intake was low. The triangulation approach revealed no associations between toxicant exposure through household water intake and the respective toxicant biomarker concentrations.

CONCLUSION

Studies with larger samples and repeated measures are needed to confirm these findings. Nevertheless, it appears that at low water toxicant concentrations, typical water consumption is not a major contributor to children's exposure.

Issues and Challenges in the Application of the IEUBK Model in the Health Risk Assessment of Lead: A Case Study from Blantyre Malawi

The risk assessment of lead (Pb) requires the use of biokinetic models to translate measured concentrations of Pb in food and environmental media into blood lead (BPb). The aim of this study was to assess the applicability of the Integrated Exposure Uptake Biokinetic (IEUBK) model in the health risk assessment of Pb among children in Blantyre. Children (152) aged 1–6 years were recruited into this cross-sectional study, and foods, house dust, playground soil, water, and venous blood (1 mL) were collected and analyzed for Pb. A seven-day food frequency questionnaire (FFQ) was used to collect food consumption data. The concentrations of Pb ranged from 0.01 to 3.3 mg/kg in food, 2.3 to 265 mg/kg and 1.5 to 482 mg/kg in house dust and playground soil, respectively, as well as 2.0 µg/dL to 50.4 µg/dL and 6.8 to 39.2 µg/dL for measured and predicted BPb, respectively. Various statistical tests indicated less than satisfactory agreement between measured and predicted BPb values. Despite the lack of reliable food consumption data and other limitations, both the predicted and measured BPb values indicate that children in Blantyre are exposed to high levels of Pb, largely through food and soil as a minor source.

Dietary zinc, calcium and nickel are associated with lower childhood blood lead levels

The potential mitigation of elevated blood lead (PbB) levels with nutrient intake remains debatable. A comprehensive review by Kordas (2017) concluded that careful examination of the links between nutrition (nutritional status, nutrients, diet) and lead (Pb) exposure revealed limited and tenuous evidence. We have measured 20 elements including calcium (Ca), chromium (Cr), copper (Cu), iron (Fe), magnesium (Mg), manganese (Mn), nickel (Ni), zinc (Zn), and Pb from 6-day duplicate diets of 108 young children over a 5-year period and expressed these as intakes per body weight. Bivariate analyses showed a weak positive association between the Pb content in the diets of the participants and the level of Pb in their blood, as might be expected. Weak, but negative, associations occurred between the other elements in the diet and PbB. The associations for Ca, Mg, Ni and Zn were statistically significant for both subject-based (between subjects) and within-subject effects: that is, as the levels of elements in diet increased, the PbB level decreased. The largest percentage of variance of PbB in the context of the bivariate model accounted for was 4.23% for Zn, followed by Ca (3.91%) and Fe (2.20%). Supplementary analyses indicated that the between- and within-subject effects did not vary with the age at which participants entered the study, or with the levels of elements at their first measurement. A multivariable analysis using Weighted Quantile Sum Regressions showed that a weighted composite comprised of all the dietary elements had a significant association with PbB when adjusted for Pb in the diet and other covariates and also when adjusted for Pb in house dust; the latter was found to have the strongest association with PbB in earlier analyses. The highest weights were for Ca (0.29), Ni (0.27) and Zn (0.22); these results are generally consistent with those from the mixed model analyses.

Neurotoxicants, Micronutrients, and Social Environments

SUMMARY—Systematic research evaluating the separate and interacting impacts of neurotoxicants, micronutrients, and social environments on children's cognition and behavior has only recently been initiated. Years of extensive human epidemiologic and animal experimental research document the deleterious impact of lead and other metals on the nervous system. However, discrepancies among human studies and between animal and human studies underscore the importance of variations in child nutrition as well as social and behavioral aspects of children's environments that mitigate or exacerbate the effects of neurotoxicants.

In this monograph, we review existing research on the impact of neurotoxic metals, nutrients, and social environments and interactions across the three domains. We examine the literature on lead, mercury, manganese, and cadmium in terms of dispersal, epidemiology, experimental animal studies, effects of social environments, and effects of nutrition.

Research documenting the negative impact of lead on cognition and behavior influenced reductions by the Center for Disease Control in child lead-screening guidelines from 30 micrograms per deciliter (μg/dL) in 1975 to 25 μg/dL in 1985 and to 10 μg/dL in 1991. A further reduction is currently being considered. Experimental animal research documents lead's alteration of glutamate-neurotransmitter (particularly N-methyl-D-aspartate) activity vital to learning and memory. In addition, lead induces changes in cholinergic and dopaminergic activity. Elevated lead concentrations in the blood are more common among children living in poverty and there is some evidence that socioeconomic status influences associations between lead and child outcomes. Micronutrients that influence the effects of lead include iron and zinc.

Research documenting the negative impact of mercury on children (as well as adults) has resulted in a reference dose (RfD) of 0.1 microgram per kilogram of body weight per day (μg/kg/day). In animal studies, mercury interferes with glutamatergic, cholinergic, and dopaminergic activity. Although evidence for interactions of mercury with children's social contexts is minimal, researchers are examining interactions of mercury with several nutrients.

Research on the effects of cadmium and manganese on child cognition and behavior is just beginning. Experimental animal research links cadmium to learning deficits, manganese to behaviors characteristic of Parkinson's disease, and both to altered dopaminergic functioning.

We close our review with a discussion of policy implications, and we recommend interdisciplinary research that will enable us to bridge gaps within and across domains.

Methodological evaluation of method for dietary heavy metal intake

Exposure to environmental pollutants is an important problem of environmental toxicology. Heavy metals are regarded as toxic to living organisms because of their tendency to accumulate in selected tissues. Moreover, their presence is a causative agent of various sorts of disorders, including neuro-, nephro-, carcino-, terato-, and immunological. Exposures of human to environmental chemicals can occur simultaneously from various sources. One exposure route is ingestion of hazardous chemicals through contaminated food and beverages. Considering the above-mentioned menace, efforts should be focused on the estimation of dietary intakes of potential toxic agents by consumers. Dietary exposure assessment to nonnutrients is usually performed by combining 2 sets of data-the concentration of elemental contaminants in various food products and the consumption data of these food items. A variety of approaches exist for evaluating exposure to food chemicals, and the method chosen is influenced, among others, by the intended goal, the availability of data, cost, and time frame. Moreover, it is also important to note how accurate and detailed the information concerning toxic elements intake needs to be. There are a number of sources of food consumption data currently used in exposure assessments, which range from 1 d to habitual intake. Frequently, the heavy metals for which dietary exposure is of interest are present in trace and ultra-trace quantities. Hence, an analytical technique with sufficient sensitivity is required for the accurate determination of these chemicals in food samples. It is important to remember that the accuracy of quantitative analysis is strongly dependent on the sampling and preparation steps.

Growth and Visual Information Processing in Infants in Southern Ethiopia

Speed of information processing and recognition memory can be assessed in infants using a visual information processing (VIP) paradigm. In a sample of 100 infants 6-8 months of age from Southern Ethiopia, we assessed relations between growth and VIP. The 69 infants who completed the VIP protocol had a mean weight z score of -1.12 ± 1.19 SD, and length z score of -1.05 ± 1.31. The age-appropriate novelty preference was shown by only 12 infants. When age was controlled, longest look duration during familiarization was predicted by weight (sr(2) = .16, p = .001) and length (sr(2) = .05, p =.058), and mean look duration during test phases was predicted by head circumference (sr(2) = .08, p = .018) implying that growth is associated with development of VIP. These data support the validity of VIP as a measure of infant cognitive development that is sensitive to nutritional factors and flexible enough to be adapted to individual cultures.

Origin of lead in the United States diet

We report 208Pb/207Pb and 206Pb/207Pb ratios for 1001 duplicate diets collected from mothers and children, 1304 samples of house dust and hand wipes, and 64 samples of aerosols that were taken in Omaha, Nebraska, during the period from 1990 to 1997. A plot of 208Pb/207Pb versus 206Pb/ 207Pb for the dust and hand wipes indicates that they contain lead from ores mined in Idaho, Missouri, and Mexico. The absence of lead from Utah suggests that this mixture is not representative of the whole country. The lead in the aerosols has a narrower range of isotope ratios and resembles aerosols collected elsewhere in the United States. Most dietary collections contain a large component of house dust. Some, especially those from infants, are dominated by uranogenic lead with high 206Pb/207Pb ratios. Its source is taken to be calcium-supplemented food where the calcium is derived from limestone. Another source of lead is thorogenic and is ascribed to lead in tin coatings. Agricultural lead, whether from soil (estimated from recently published analyses of sedimentary materials), fertilizer, or agricultural lime, could not be unambiguously identified in the diets. Lead derived from aerosols, if present at all, is insignificant.

Dietary intake of lead by children and adults from Germany measured by the duplicate method

The dietary lead intake was studied among children and adults from Germany. Two different age groups of children (A: 1.8, 1.3-3.0 years, B: 3.8, 1.8-5.2 years) and one group of adults (D: 40.9, 24-64 years) were from the highly industrialized Ruhr district and one group of children from the North Sea island Amrum (C: 3.9, 1.5-5.3 years). A total of 229 duplicate food portions were collected from 49 individuals between December 1994 and May 1995. Sampling period for each participant was either 3 (groups B and D) or 7 days (groups A and C). Lead levels in duplicate samples were measured by electrothermal atomic absorption spectrometry. The lead intakes (median, range) for the different groups were as follows: Group A: 0.21 (0.05-1.5) microgram/(kg bw.day), group B: 0.68 (0.06-1.6) microgram/(kg bw.day), group C: 0.29 (0.04-1.6) microgram/(kg bw.day) and group D: 0.26 (0.07-0.83) microgram/(kg bw.day). No value exceeded the provisional tolerable weekly intake (PTWI) of 25 micrograms/(kg bw.week) proposed by the WHO. The median and maximum of the different groups amounted to 7.2-16% and 16-36% of the PTWI, respectively. It is concluded that health risks due to dietary lead intake seem to be low in Germany.

Hydrophobic interaction chromatographic separation of proteins in human blood fractions hyphenated to atomic spectrometry as detector of essential elements

The binding of metals to proteins in blood fractions was investigated applying hydrophobic interaction chromatography (HIC) for protein separation and graphite furnace atomic absorption spectrometry (GFAAS) as the element specific detector. For the semi-preparative separation of metalloproteins in erythrocytes and blood plasma, a HIC column (Fractogel EMD Phenyl I (S) 150 mm x 10 mm I.D.) was adapted. The separation column was calibrated with the same four standard proteins as used in Pomazal et al. [Analyst 124 (1999) 657]. The sample injection volume and the ammonium sulphate gradient set-up were optimized: 20 or 200 microl, respectively, of blood plasma and of lysed erythrocytes were injected. The separated proteins were collected in 4-ml fractions and analyzed by GFAAS off-line. An optimization of the GFAAS measuring parameters for Cu, Mn, Fe, Zn, Co, Ni, and Cr was performed. For each element, a specific temperature program was optimized with respect to the matrix of the HIC eluate (0.02 M NaH2PO4, 1.8 M (NH4)2SO4). The obtained metal profiles of the eluate were compared with the HIC chromatograms. The limits of detection (LOD) for the elements by GFAAS were: 0.5 ng Cu/ml; 0.2 ng Mn/ml; 1 ng Fe/ml; 0.2 ng Zn/ml; 0.12 ng Co/ml; 0.2 ng Ni/ml; 0.16 ng Cr/ml. The GFAAS method enabled the detection of the proteins of interest via the metals.

Alimentary lead intake of adults in Thuringia/Germany determined with the duplicate portion technique

The daily lead intake in Germany in 1996 was studied using the duplicate portion technique. The study was carried out in four towns in Thuringia (Jena, Ronneburg, Rositz, Steudnitz), in which volunteers collected all foods and beverages over 7 consecutive days. The mean lead content of consumed food and beverages was 66 and 55 microg/kg dry matter for women and men, respectively; the average lead intake was 19 microg/day for both, women and men. In relation to body weight (b.w.) the intake for women was 283 ng/kg and for men 242 ng/kg b.w. These values are well below the WHO limit. An oral lead exposure of the adult population of Thuringia/Germany can be excluded.

Acquisition and retention of lead by young children

The concentrations and isotope ratios of lead in blood and urine, on the hands, and in duplicate diet samples were measured for children living in Omaha, Nebraska. One group consisted of 22 children followed from birth to between 1 and 2 years of age and another group was 20 2- to 4-year-old children followed for 1 year, although some in each group were followed for periods between 3 and 4 years. At no time in life was a component of dietary lead identified in blood by isotope ratios, and blood lead appears dominated by lead derived from the hands, which in turn appears derived from the floors. For some homes floor lead appeared to be a mixture of lead from window sills and from the exterior. Only 2 of the children appear to have ingested lead directly from window sills. Several who lived in homes being remodeled were exposed to lead before the age of 2 years. For those who had been briefly exposed during professional remodeling the blood lead fell with a half-life of 10 months but for those who had suffered prolonged exposure during remodeling by parents the apparent half-life was longer, between 20 and 38 months.