Environmental exposure to lead in a population of adults living in northern France: lead burden levels and their determinants

The contribution of secondhand tobacco smoke to blood lead levels in US children and adolescents: a cross-sectional analysis of NHANES 2015-2018

BACKGROUND

Lead is a major developmental neurotoxicant in children, and tobacco smoke has been suggested as a source of lead exposure in vulnerable populations. This study evaluates the contribution of secondhand tobacco smoke (SHS) to blood lead levels (BLLs) in children and adolescents.

METHODS

We analyze data from 2,815 participants aged 6-19 years who participated in the National Health and Nutrition Examination Survey (2015-2018) to investigate the association between serum cotinine levels and BLLs. A multivariate linear regression was conducted to estimate geometric means (GMs) and the ratios of GMs after adjusting for all covariates.

RESULTS

The geometric means of BLLs in study participants aged 6 - 19 years were 0.46 µg/dl (95% CI 0.44, 0.49). After adjusting for relevant participant characteristics, the geometric means of BLLs were 18% (BLL 0.48 µg/dl, 95% CI 0.45, 0.51) and 29% (BLL 0.52 µg/dl, 95% CI 0.46, 0.59) higher in participants who had intermediate serum cotinine levels (0.03 - 3 ng/mL) and those who had high serum cotinine levels (> 3 ng/mL) respectively, compared to participants who had low serum cotinine levels (BLL 0.41 µg/dl, 95% CI 0.38, 0.43).

CONCLUSIONS

SHS exposure may be a source of BLLs in US children and adolescents. Efforts to reduce lead exposure in children and adolescents should include strategies to reduce SHS exposure.

Sentinel animals for monitoring the environmental lead exposure: combination of traditional review and visualization analysis

In nature, certain animals share a common living environment with humans, thus these animals have become biomonitors of health effects related to various environmental exposures. As one of the most toxic environmental chemicals, lead (Pb) can cause detriment health effects to animals, plants, and even humans through different exposure pathways such as atmosphere, soil, food, water, and dust, etc. Sentinel animals played an "indicative" role in the researches of environmental pollution monitoring and human health. In order to comprehend the usage of sentinel animals in the indication of environmental Pb pollution and human Pb exposure completely, a combination of traditional review and visualization analysis based on CiteSpace literature was used to review earlier researches in this study. In the first instance, present researches on exposure sources and exposure pathways of Pb were summarized briefly, and then the studies using sentinel animals to monitor environmental heavy metal pollution and human health were combed. Finally, visualization software CiteSpace 5.8.R3 was used to explore and analyze the hotspots and frontiers of lead exposure and sentinel animals researches at home and abroad. The results showed that certain mammals were good indicators for human lead exposure. Sentinel animals had been widely used to monitor the ecological environment and human lead exposure. Among them, the blood lead levels of small mammals, particularly for domestic dogs and cats, had a significant correlation with the blood lead levels of human living in the same environment. It indicated that certain biological indicators in animals can be used as surrogates to monitor human body exposure to heavy metals. This study also explored the challenges and perspectives that may be faced in sentinel animal research, in order to provide a certain theoretical basis and train of thought guidance for future research.

Adult Lead Poisoning Caused by Contaminated Opium: A Two-Year Longitudinal Follow-Up Study

Background:

A major episode of lead poisoning caused by lead-adulterated opium occurred in Iran in 2016. Patients were removed from exposure and treated with chelating agents. A subset of those patients was evaluated in this follow-up study to evaluate treatment efficacy in relation to patient outcome.

Methods:

Between March 2016 and December 2017, thirty-five male cases of lead poisoning due to ingestion of lead-adulterated opium were followed for two years. There are three patient groups: 1) those who abstained from opium use; 2) those who continued to use potentially contaminated opium; and 3) those who abstained from opium and were placed on maintenance therapy. Maintenance therapy included: methadone and opium tincture, offered by the Opioid Maintenance Therapy (OMT) clinics. Amongst the three patient groups Blood Lead Levels (BLL), complete blood count, and kidney and liver function tests were compared.

Findings:

The results of BLL, hemoglobin, hematocrit, and aspartate aminotransferase were significantly different between the admission time and follow-up. Of the three patient groups, no difference was detected in these measures.

Conclusions:

Treatment of lead poisoning combined with OMT proved an effective method to prevent recurrent lead poisoning.

Blood lead levels in indigenous peoples living close to oil extraction areas in the Peruvian Amazon

BACKGROUND

High blood lead levels (BLLs) have been previously reported in indigenous people living in communities in the northern Peruvian Amazon. Oil extraction activities have been conducted in the area since the 1970s and have been identified as a source of lead exposure.

OBJECTIVE

Measure BLL and assess risk factors associated with BLL among indigenous populations from four river basins of the northern Peruvian Amazon.

METHODS

Participants from 39 communities were selected using a two-stage stratified random selection strategy and were visited between May and June 2016. Information on risk factors was collected using structured questionnaires and blood samples were taken. Overall, complete information was available from 1047 individuals (309 < 12 years old, 738 ≥ 12 years). BLL was determined using atomic absorption spectrophotometry in a graphite chamber. Weighted linear logistic regression models were used to study the association between socio-demographic variables, self-reported life-style factors, environmental, geographical and occupational exposures and BLLs.

RESULTS

Geometric mean (95% CI) BLL was 4.9 (4.5, 5.4) µg/dL in participants <12 years and 5.7 (5.4, 6.0) µg/dL in older participants. There were marked differences in BLL between river basins with the highest levels observed in the Corrientes river basin [8.1 (7.2, 9.1) µg/dL <12 years and 8.8 (8.0, 9.6) µg/dL older participants]. High BLL was associated with older age, being male, living in the Pastaza, Tigre or Corrientes river basins and consumption of fish offal in children and adults. Increased Euclidean distance between residence and oil production facilities was associated with a small reduction in BLL.

CONCLUSION

BLLs that pose a health risk were detected in the study population of a non-industrialized and remote area of the Amazon. The highest BLLs were observed in those river basins where relative oil extraction activity and environmental levels of contaminants have been reported to be greatest.

Blood lead concentration and exposure related factors in Korea from the National Environmental Health Survey (KoNEHS) II (2012-2014)

This study evaluated lead concentrations in blood and related factors among the South Korean population based on data from the Korea National Environmental Health Survey (KoNEHS) II (2012-2014) conducted by the National Institute of Environmental Research and the Ministry of Environment. Personal data were obtained from non-institutionalized civilian Korean individuals in an interview with trained community surveyors using a structured questionnaire (n = 6,455, aged 19 or older, mean age 49.7 years). The lead concentrations in whole blood were analyzed by atomic absorption spectrophotometry (AAS) with a Zeeman-effect-based background corrector. The precision and accuracy of the analytical methods were verified by internal and external quality controls (G-EQUAS, Germany). Statistical analysis was performed using weighted KoNEHS II data separated by sex, and the lead concentration was expressed as a geometric mean (GM). Multiple linear regression was performed using the SPSS 23.0 software package (SPSS Inc., Chicago, IL, USA). The total GM of lead concentrations was 19.5 µg/L. Lead concentrations increased with age and were higher in males (22.8 µg/L) than in females (16.6 µg/L). Smokers and drinkers had higher concentrations than non-smokers and non-drinkers of both sexes. People who used herbal medications had higher concentrations than those who did not among females. People of both sexes living in rural areas had higher lead concentrations than those in urban areas. Lead concentrations also varied with educational level, total family income, the type of water regularly consumed, and occupation. The average lead concentration of the general adult population in Korea has rapidly decreased over time from 45.8 µg/L (1999) to 19.45 µg/L (2012-2014); however, it remains higher than that of the United States, Germany, and Canada. The factors significantly related to lead concentration in South Korea were age, sex, smoking and alcohol drinking status, herbal medication usage by females, residential area, drinking water at home, and occupation. These factors could be used to improve occupational and environmental hygiene among the Korean population.

Lead poisoning due to ingestion of lead-contaminated opium: A diagnostic study on patients' imaging findings

OBJECTIVES

Our study attempts to determine if for patients following ingestion of lead-contaminated opium, radiographs [plain X-ray (KUB)] or unenhanced computed tomography (CT scan) of the abdomen may be predictive of lead poisoning.

METHODS

Our study is concerned with patients of >21 years with elevated lead concentrations, who had undergone KUB or CT. Patients with other toxicities who had undergone similar imaging profiles but who had low blood lead level (BLL) were enrolled as controls.

RESULTS

We evaluated a total of 79 cases and 79 controls with median [IQR] BLLs of 126 [97.4, 160] μg/dL and 8.7 [5.5, 15] μg/dL. All cases and eleven controls (13.9%) were addicted to oral opium, and of these cases, anemia (94.9%) and abdominal pain (92.4%) were the two most common clinical manifestations. Two radiologists reviewed the X-ray and non-contrast CTs. Fifty (63.3%) and 53 (67.1%) cases and controls underwent CT scanning with 34 (68%) vs. 6 (11.3%) positive CTs (P < 0.001) while 43 (54.4%) and 39 (43.3%) underwent X-rays with 21 (48.8%) vs. 4 (11.8%) positive X-rays, respectively (P < 0.001). Positive CT is associated with BLL between 10 and 45 μg/dL with a specificity of 96.9%, 88.7% and positive predictive value of 97.5% and 85% respectively.

CONCLUSIONS

In suspected cases of lead exposure due to ingested opium, and if BLL is not readily available, a positive imaging result may guide radiologists and physicians to consider lead poisoning.

Sources of lead exposure in various countries

This review evaluates the sources of lead exposure worldwide. Studies from searches relating to sources of lead exposure in various countries within different regional zones were reviewed. Results indicated that in Nigeria, exposure sources include electronic waste, paint and batteries. In Mexico exposure sources include glazed ceramics, lead contaminated utensils and lead contaminated water, for India lead sources include cosmetics and traditional medicines. Sources of lead exposure in China include e-waste, traditional medicines and industrial emissions. In France, exposure sources included lead paint from older homes, imported ceramics and cosmetics and industrial emissions. Australia's exposure sources include paint, dust, imported toys and traditional medicines. Finally, in the United States exposure sources included paint, the industrial legacy of lead exposure and batteries. In high-income countries (HICs) the legacy of lead exposure keeps populations continuously exposed. In lower- and middle-income countries (LMICs), in addition to the legacy of lead exposure, lack of regulations or the inability to enforce regulations keeps populations exposed. In all, evidence suggests that lead exposure remains an issue of public health significance in both HIC and LMIC.

Current sources of lead exposure and their relative contributions to the blood lead levels in the general adult population of Northern France: The IMEPOGE Study, 2008-2010

There is justification for limiting lead (Pb) exposure as much as possible, given its impact on health at low concentrations. Consequently, the aim of this study was to measure blood lead levels (BLL) and examine exposure factors related to BLL variations in the general adult population of northern France, a current and past industrial area. Two thousand inhabitants of northern France, aged between 20 and 59 years, were recruited using the quota method with caution. Blood lead levels were quantified by inductively coupled plasma-mass spectroscopy (ICP-MS), and variation factors were studied separately in men and women using multivariate stepwise linear and logistic regression models. The geometric mean of the BLL was 18.8 μg/L (95% confidence interval [CI]: 18.3-19.3). Occupational factors affected BLL only in men and represented 14% of total explained variance of BLL. External occupational factors significantly increasing mean levels of BLL were tobacco, consumption of some beverages (wine, coffee, tea, and/or tap water), raw vegetables, housing characteristics (built prior to 1948, Pb piping in the home) and do-it-yourself or leisure activities (paint stripping or rifle shooting). Consumption habits accounted together for 25% and 18% of the total explained variance, respectively, in men and women. Industrial environment did not significantly contribute to BLL variations. Blood lead levels observed in the general population of this industrial part of France did not appear to be excessively elevated compared to values found internationally. Nonetheless, these BLL remain a public health issue in regard to nonthreshold toxicity attributed to Pb.

Association between secondhand smoke exposure and blood lead and cadmium concentration in community dwelling women: the fifth Korea National Health and Nutrition Examination Survey (2010-2012)

OBJECTIVES

To assess the association between secondhand smoke exposure and blood lead and cadmium concentration in women in South Korea.

DESIGN

Population-based cross-sectional study.

SETTING

South Korea (Korea National Health and Nutrition Examination Survey V).

PARTICIPANTS

1490 non-smoking women who took part in the fifth Korea National Health and Nutrition Examination Survey (2010-2012), in which blood levels of lead and cadmium were measured.

PRIMARY OUTCOME MEASURES

The primary outcome was blood levels of lead and cadmium in accordance with the duration of secondhand smoke exposure.

RESULTS

The adjusted mean level of blood cadmium in women who were never exposed to secondhand smoke was 1.21 (0.02) µg/L. Among women who were exposed less than 1 h/day, the mean cadmium level was 1.13 (0.03) µg/L, and for those exposed for more than 1 h, the mean level was 1.46 (0.06) µg/L. In particular, there was a significant association between duration of secondhand smoke exposure at the workplace and blood cadmium concentration. The adjusted mean level of blood cadmium concentration in the never exposed women's group was less than that in the 1 h and more exposed group, and the 1 h and more at workplace exposed group: 1.20, 1.24 and 1.50 µg/L, respectively. We could not find any association between lead concentration in the blood and secondhand smoke exposure status.

CONCLUSIONS

This study showed that exposure to secondhand smoke and blood cadmium levels are associated. Especially, there was a significant association at the workplace. Therefore, social and political efforts for reducing the exposure to secondhand smoke at the workplace are needed in order to promote a healthier working environment for women.

High Prevalence of Pneumonia in Children of a Smelter Town

Since German reunification in 1990, most heavy industries in Eastern Germany have been shut down. Although air quality has improved in terms of sulfur dioxide and particulate matter (PM), the content of certain metals in PM in industrial areas is persistently high. Lifetime pneumonia prevalence in schoolchildren born after unification in the heavy-metal industrial area Hettstedt remain elevated. One difference between low and high pneumonia-prevalence areas seems to be the residual concentrations of heavy metals in respirable air. Toxicological and human exposure studies of Hettstedt particles have shown metal-rich PM from Hettstedt to have greater toxicity and inflammatory properties than the PM of the control region. Past industrial emissions might still play a decisive role decades after the closing of sources, and pneumonia should be considered a possible acute health burden caused by metal-rich air pollution.

Biomarkers of lead exposure among a population under environmental stress

This study aimed to evaluate the relationship between blood lead and serum creatinine and blood lead and serum urea nitrogen levels as biomarkers of lead exposure from subjects living in a historic polymetallic mining area in China. Elevated levels were found for blood lead, serum creatinine, and serum urea nitrogen in the mining area with mean values at 245.65 μg/l, 74.16 μmol/l, and 12.79 mmol/l, which were significantly higher than those in the control area, respectively. Moreover, the coefficients between paired results for blood lead and serum creatinine and blood lead and serum urea nitrogen were positively statistically significant (serum creatinine vs. blood lead, r = 0.35, p < 0.05; serum urea nitrogen vs. blood lead, r = 0.48, p < 0.05). With respect to the effects of sex and age on the blood lead, serum creatinine, and serum urea nitrogen levels, data analysis revealed there was a tendency for higher blood lead, serum creatinine, and serum urea nitrogen levels in females than in males, and the levels of blood lead, serum creatinine, and serum urea nitrogen increased among older residents. We conclude that females and the older population in the mining area are more susceptible to lead exposure. Blood lead, serum creatinine, and serum urea nitrogen can be useful biomarkers of lead exposure among populations under environmental stress.

Human biomonitoring on heavy metals in Ath: methodological aspects

The municipality of Ath is characterised by the presence, in its center, of two non-ferrous metal industries whose emissions make local residents concerned for their health. Therefore, authorities of the Walloon Region and the municipality of Ath undertook biomonitoring to assess the impact of those industrial emissions on heavy metal body burden in humans.

This paper describes the study design and methodology used to carry out this human biomonitoring.

A random sampling was done in the general population, in two areas of Ath: an area centered around the industries and a peripheral area. The target population was children (2.5-11 years) and adults (40-60 years) without occupational exposure. The three-stage sampling procedure consisted of a mixture of both mail and telephone recruitment. Firstly, 3259 eligible people, identified from a population register, were mailed an introductory letter. In a second stage, eligible individuals were contacted by phone to propose them to participate in the study. They were randomly contacted until the required sample size was obtained. In the third stage, a second mail was sent to those who agreed to participate with a questionnaire to be filled out. Finally, biological samples (blood and urine) from 278 persons were collected. The final participation rate of this study was 24%.

This sampling procedure, especially designed for the purpose of this biomonitoring study in Ath, allowed us to recruit a sample representative of the population of children and adults of Ath, reaching the expected sample size in a short period of time.

Lead exposure in female workers who are pregnant or of childbearing age

In adults, high-level lead exposure often occurs in the lead-related industries. Acute lead poisoning has become rare, but chronic exposure to low-level lead remains a public health issue. With recent advances in our understanding of lead toxicity at low-levels, researchers have shifted their focus to studying lead at concentrations below those currently recommended as 'acceptable' in worker protection. As gender plays an important role in the storage, biokinetics, and toxicity of lead, it seems inappropriate to extrapolate findings of lead exposure in men to women. Women's bones release lead more slowly to the bloodstream, so blood levels remain increased for a long time after cessation of high exposure, reflecting the endogenous source of the lead. Particularly in pregnant women, bone lead release could influence health in pregnancy and be extremely harmful to the rapidly growing and developing fetus. Accordingly, female workers of childbearing age should avoid excessive lead exposure. However, because studies of pregnant workers encounter many difficulties and inconveniences, sufficient research has not been conducted in this area. As an alternative, a group of non-occupationally exposed women, matched as well as possible for anthropometric and reproductive variables and with almost the same levels of blood lead, could be recruited for survey.

Screening for Blood Lead Levels in Basrah, Southern Iraq

A prospective study over six months (from 1 July to 31 December 2002) measured the level of blood lead in individuals attending Primary Health Centers in the center District of Basrah Governorate. Six hundred and two individuals were selected randomly from those attending seventeen Primary Health Centers in the center of Basrah. Their ages ranged from 9-79 years. Of 602, Twenty six, 15 years of age or younger had mean blood lead levels (BLL) of 12.62+3.85 ug/ dl, those older than 15 years had levels of 11.20+3.4 ug /dl (p < 0.05). Males of different age groups showed a statistically significantly higher BLL compared to females (13.25+3.25 and 10.10+2.96 ug/ dl respectively), p <  0.0001. The center of Basrah was divided into 11 main areas; there was a statistically significant difference in BLL among individuals living in different areas, ranging from 7.26+2.81 |jg/ dl to 12.76+3.63 ug/dl. Individuals with higher education and smokers showed higher BLL (12.10+3.54 ug/dl, 13.81+3.57 ug/dl respectively) compared to those of lower education and non-smokers (11.11+3.23 ug/ dl, 10.93+3.26 ug/dl respectively), the differences were statistically significant. The sources of drinking water and frequency and amount of milk consumed/ week did not show a significant correlation with BLL. History of lead exposure (occupational) was statistically significantly associated with BLL (15.3+4.85 ug/ dl) for those exposed to higher concentration of lead compared to others (11.1 2+3.3 ug/dl), p < 0.0001. Amongst females using kohl (25.6%), the mean BLL was significantly higher (13.91+4.42 ug/dl), compared to non-users (9.88+2.68 ug/dl), p < 0.0001. No significant difference was observed among those exposed to paints. As adequate data on BLL in our country do not exist, especially for children, and as the number of children in this study was small, further studies are warranted to recognize the extent and risk factors for lead poisoning in children.

Interaction between anemia and blood levels of iron, zinc, copper, cadmium and lead in children

OBJECTIVE

Anemia is a widespread problem among infants and children in many parts of the world, and it is often associated with some trace elements (iron, zinc, copper) and heavy metals (cadmium and lead). Aim of this study was to investigate the relationship between anemia and these elements.

METHODS

This research was performed on 256 children (mean age 6.8 +/- 0.2) living in Denizli city center. We observed iron deficiency anemia (IDA) in 23 children, iron deficiency without anemia (ID) in 36 children and only anemia (ferritin level normal) (OA) in 18 children, and 179 children were found healthy and they were regarded as controls (C). Blood samples were taken from subjects and the concentrations of zinc, copper, iron, cadmium and lead in serum were measured with atomic absorption spectrophotometer.

RESULTS

The levels of copper, cadmium and lead in serum were significantly higher in children with IDA than those of controls (p<0.05, p<0.05, p<0.01, respectively). The other elements in the serum of ID were not different from controls.

CONCLUSION

High copper, cadmium and lead decreased iron absorption and negatively affected hematological parameters.

Reducing the risks of children living near the site of a former lead smeltery

The sources of lead exposure, soil, household dust, diet and ambient air near a former lead smeltery were studied. The blood lead level of small children was also determined. The aim of the study was to define, based primarily on blood lead measurements, whether children living in the contaminated area may be at risk. Within 500 m from the site of the smeltery, there were several areas where the Finnish limit value for soil Pb, i.e. 300 mg/kg, was exceeded. In the recently built areas, the surface soil has been replaced and soil remediation has taken place in schoolyards and the playgrounds of children's day-care centres. Lead content in household dust was clearly elevated in the contaminated areas. In approximately 20 years, after the smeltery was closed in 1984, the lead concentrations of the fruits and berries in local gardens have decreased to one-tenth. In some samples, the limit values are still exceeded. The lead concentration in ambient air is now 50 times lower than in the 1970s. The blood lead level of the children living in the area is slightly but statistically significantly higher than that of the children in the control areas. The critical blood lead level, i.e. 10 microg/100 ml, was not exceeded in any of the children examined. The average and maximum lead concentrations of 63 analysed blood samples were 2.2 and 5 microg/100 ml, respectively. In contrast, the average and maximum blood lead levels of school children in 1981 were 6.7 and 13.0 microg/100 ml, respectively. The risk reduction measures undertaken during the past 20 years are described.

Biomarkers of renal effects in children and adults with low environmental exposure to heavy metals

The health effects of chronic exposure to heavy metals such as lead, cadmium, and mercury are widely documented, yet few data exist about the renal impact of low environmental exposure to these metals, particularly in children. The aim of this study was to assess renal parameters in children and adults living in an environment known for its past heavy metal contamination around two nonferrous smelters in northern France (Noyelles-Godault and Auby) and to compare their results with age and gender-matched controls living in neighboring municipalities with unpolluted soil (total: 400 children, 600 adults, sex ratio = 1). The integrity of renal function was assessed by measuring the urinary excretion levels of total protein, albumin, transferrin, beta(2)-microglobulin, retinol-binding protein, brush border antigen, and the enzyme N-acetyl-beta-D-glucosaminidase (NAG). The mean blood concentrations of lead (Pb-B, children </=42.2 micro/L, adults </=71.3. micro/L) and of cadmium (Cd-B, children </=0.52 microg/L, adults 0.86 microg/L) were all relatively low, indicating a low uptake of these heavy metals from the environment despite relatively high levels in soil (between 100 and 1700 ppm for lead and 0.7 to 233 ppm for cadmium). Pb-B levels were, however, significantly increased in boys, girls, and women--but not men--living in the polluted area. Boys, men, and women living in the polluted area had also on average higher Cd-B levels. The concentrations of mercury in urine (Hg-U) were by contrast similar in control and exposed groups. None of the renal parameters studied showed a significant difference between control and exposed groups. The influence of heavy metals on renal parameters was further assessed by stepwise multiple regression, testing Pb-B, Cd-B, Hg-U, age, gender, body mass index (BMI), urinary creatinine levels, and area of residence as predictors in both children and adults, including first-order metal interaction terms, smoking habits, and alcohol consumption in adults. The only positive correlation was found between the urinary excretion of NAG activity (standardized for BMI and urinary creatinine) and Cd-B levels when taking the whole children population, indicating that even low cadmium burdens may produce subtle effects on the proximal tubule in children, although deleterious consequences are unlikely should exposure not increase. However, in the absence of other positive findings even after studying the smaller subgroups with higher levels of heavy metals, these results are clearly indicative of the minimal renal impact of living around nonferrous smelters that are currently complying with pollution regulations, even when soil contamination is still high.