Risk factors for high blood lead levels among the general population in Taiwan

Trend in blood lead levels in Taiwanese adults 2005-2017

This study examined the trend of blood lead levels (BLLs) in Taiwanese adults and analyzed the variations in the BLL between Linkou (northern) and Kaohsiung (southern) hospital branches. Between 2005 and 2017, 3,804 adult participants received blood lead tests at the Linkou (n = 2,674) and Kaohsiung (n = 1,130) branches of Chang Gung Memorial Hospital. The geometric mean of BLL was 2.77 μg/dL. The adult participants from the Kaohsiung branch were not only age older (49.8±14.1 versus 39.4±14.2 years; P<0.001) and male predominant (65.8 versus 41.7%; P<0.001) but also showed a higher BLL (4.45±3.93 versus 2.82±2.42 μg/dL; P<0.001) and lower estimated glomerular filtration rate (87.62±25.94 versus 93.67±23.88; P<0.001) than those from the Linkou branch. Multivariable logistic regression analysis revealed that the Kaohsiung branch [odds ratio (OR): 7.143; 95% confident interval (CI): 5.682–8.929; P<0.001], older age (OR: 1.008; 95% CI: 1.000–1.015; P = 0.043) and reduced estimated glomerular filtration rate (OR: 1.009; 95% CI: 1.004–1.014; P = 0.001) were significant predictors for BLL > 5 μg/dL. Therefore, this study confirmed a continuous decreasing trend in the BLL in Taiwan after banning leaded petrol in 2000.

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.

The International Growth Standard for Children and Adolescents Project: Environmental Influences on Preadolescent and Adolescent Growth in Weight and Height

This review has two aims. The first is to identify important environmental influences on the growth of children aged 1 to 9 years and of adolescents, defined as those aged 10 to 19 years. The second is to identify possible environmentally based criteria for the selection of individuals and populations for data collection in the development of an international growth reference for these age ranges. There are many common environmental influences on the growth of children between the ages of 1 and 19 years; the examination and description of these forms the main body of this review. Subsequently, environmental factors influencing adolescent growth only are considered. In both cases, possible selection criteria are put forward. The most important inclusion criteria for both preadolescence and adolescence are good nutrition, lack of infection, and socioeconomic status that does not constrain growth. Additionally, low birthweight, catch-up growth, breastfeeding, and early adiposity rebound have impacts on growth and/or body composition into puberty. Exclusion of children born at low birth and/or experiencing catch-up growth could be most realistically operationalized if populations in which secular trends in growth were either completed or minimal were selected. Although an effect of hypoxia on child and adolescent growth, independent of nutrition, is small at most, many high-altitude populations have high prevalances of low birthweight and should be excluded on this basis. Since all populations are exposed to pollutants, contaminants, and toxicants in varying degrees, they cannot be realistically excluded from the sample frame. However, it may be desirable to exclude populations that are habitually exposed to extremely high levels of environmental pollution, including air pollution, and those living in close proximity to toxic waste. It is impossible to exclude populations and individuals on the basis of their exposure to aflatoxin contamination of food. However, exclusion on the basis of low socioeconomic status or poverty may well act as a proxy for this. There are a small number of populations that show extreme patterns of growth in body size and proportion in preadolescence and adolescence, and these should be excluded from the sample frame.

Blood lead concentration and related factors in Korea from the 2008 National Survey for Environmental Pollutants in the Human Body

This study evaluated blood lead concentrations in the Korean general population and the correlation between various exposure sources using data from the 2008 Korea National Survey for Environmental Pollutants in the Human Body (National Institute of Environmental Research, Korea). The general and occupational characteristics were gathered from 5136 participants who were 20 years of age and older using a structured questionnaire. Blood lead concentrations were analyzed using an atomic absorption spectrophotometer. Statistical analysis was performed using multiple linear regressions of the log lead concentrations to the independent variables such as age, gender, smoke, herbal medication and drug consumption, drinking water, and living area. Geometric mean (GM) blood lead concentrations in Korean adults were 19.7 μg/l. The blood lead concentrations increased with age; the highest concentrations were found in the 50-69-year age group (p<0.001). Males were higher than in females (p<0.001). Current smokers and drinkers had higher concentrations than nonsmokers (p<0.001) and nondrinkers (p<0.001), respectively. People who took herbal medication and drug consumption were higher than those who did not (p<0.001). Education level was negatively associated with blood lead concentration (p<0.001). People living in or around industrial areas had elevated blood lead concentration (p<0.001). Family income was also negatively associated with lead concentration, but not significantly. For drinking water, the underground water (spring or well water) drinking group had higher concentrations than other types of water drinking groups, but not significantly (p=0.063). The blood lead concentrations by occupation were significant (p<0.034): the highest was in laborer and Agricultural-Fishery-Forestry and the lowest in office workers. In women, blood lead concentrations tended to decrease with increasing delivery times, but not significantly. The blood lead concentration (GM) of the general adult population in Korea has decreased over time from 45.8 μg/l (1999) to 19.7 μg/l (2008). Although it is still higher than in other countries such as the United States and Canada, it is rapidly decreasing. Gender, age, smoking and alcohol drinking status, herbal medication and drug consumption, education level, living area and occupation were significantly related to the blood lead concentrations in Korea.

Metals and disease: a global primary health care perspective

Metals are an important and essential part of our daily lives. Their ubiquitous presence and use has not been without significant consequences. Both industrial and nonindustrial exposures to metals are characterized by a variety of acute and chronic ailments. Underreporting of illnesses related to occupational and environmental exposures to chemicals including metals is of concern and presents a serious challenge. Many primary care workers rarely consider occupational and environmental exposures to chemicals in their clinical evaluation. Their knowledge and training in the evaluation of health problems related to such exposures is inadequate. This paper presents documented research findings from various studies that have examined the relationship between metal exposures and their adverse health effects both in developing and developed countries. Further, it provides some guidance on essential elements of a basic occupational and environmental evaluation to health care workers in primary care situations.

Herbal supplement use and blood lead levels of United States adults

BACKGROUND

Some herbal supplements may contain lead.

OBJECTIVE

To examine whether use of specific herbal dietary supplements during the last 30 days is associated with blood lead levels in US men and women.

DESIGN

Cross-sectional analysis.

STUDY POPULATION

NHANES participants from 1999-2004, a representative sample of the civilian non-institutionalized US population.

MEASUREMENTS

Lead was measured in blood. Associations between lead and self-reported supplement use were estimated using multivariable regression weighted to account for NHANES sampling. Herbal supplements investigated were those previously reported to contain high heavy metal content: Ayurvedic or traditional Chinese medicine herbs, echinacea, ginkgo, ginseng, St. John's wort, and "other" herbs (specifically, kava, valerian, black cohosh, bee pollen, and nettle).

MAIN RESULTS

Among 6,712 women > or =20 years, those using herbal supplements had lead levels that were 10% higher than non-users (95% CI 3%-17%, p = 0.005). Women using Ayurvedic or traditional Chinese medicine herbs, St. John's wort, and "other" herbs had lead levels 24% (95% CI 5%-45%, p = 0.01), 23% (95% CI 4%-46%), p = 0.02), and 21% (95% CI 2%-44%, p = 0.03) higher, respectively, than non-users. No significant associations were observed between herb use and lead levels among men (n = 6,095). Among reproductive-aged women (16-45 years), herbal supplement users had lead levels 20% higher than non-users (95% CI 5%-34%, p = 0.008). In contrast, garlic and other dietary supplements were not associated with higher lead levels.

CONCLUSION

Use of specific herbal supplements is associated with higher blood lead levels among women. Our data suggest testing guidelines for herbal supplements and regulations limiting lead in supplements are needed.

Herbal Therapy Is Associated With the Risk of CKD in Adults Not Using Analgesics in Taiwan

BACKGROUND

Taiwan has the greatest incidence rate of end-stage renal disease in the world. Several cases of Chinese herb nephropathy were reported in Taiwan. Therefore, we studied the association between herbal therapy and chronic kidney disease (CKD) in Taiwan.

STUDY DESIGN

Cross-sectional survey.

SETTING & PARTICIPANTS

1,740 adults in the Nutrition and Health Survey in Taiwan (1993 to 1996).

PREDICTOR

Herbal and analgesic therapy.

OUTCOMES & MEASUREMENTS

CKD after adjustment for potential confounding variables.

RESULTS

Among medication users, prevalences of herbal therapy and analgesic use were 21.6% and 13.2%, respectively. The prevalence of CKD was 9.9%. Participants with CKD were older and had more analgesic use, diabetes, hypertension, and cardiovascular disease. Analgesic use was associated independently and positively with CKD (odds ratio, 2.2; 95% confidence interval, 1.4 to 3.5; P = 0.003) and CKD stage (odds ratio, 2.3; 95% confidence interval, 1.4 to 3.6; P = 0.003). Conversely, herbal therapy was associated independently and positively with CKD (odds ratio, 1.39; 95% confidence interval, 1.2 to 1.7; P = 0.002) and CKD stage (odds ratio, 1.38; 95% confidence interval, 1.1 to 1.7; P = 0.004) only in participants who did not use analgesics.

LIMITATIONS

Because this was a cross-sectional study, cause and effect could not be ascertained.

CONCLUSIONS

Herbal therapy was associated with CKD in adults in Taiwan who did not use analgesics.

Concentrations of lead and mercury in multimedia samples from homes near the former Clark Air Base, Philippines

We measured lead and mercury in samples collected from 31 homes in communities near the former Clark Air Base, Philippines during May and October 2002. Sample media included water used for drinking and cooking, house dust and entryway soil. Composite samples of 15 food items purchased at local markets were also collected. Samples were analyzed for total lead (Pb) and total mercury (Hg) to evaluate the relative importance of each media to residential exposure concentrations in the community adjacent to Clark (Community A) versus a control community 5 km away (Community B). In general, we measured low (e.g. background) to undetectable levels of the target analytes in all media sampled with two important exceptions. First, the Hg concentrations we measured in canned mackerel composites, which were within the range reported for mackerel from other locations worldwide, may pose a risk to pregnant women who are frequent consumers (e.g. one or more cans per day). Second, we measured Pb above the USEPA residential screening concentration (400 mug/g) in dust and soil from two homes, illustrating the need for periodic residential lead monitoring in these and other communities in the Philippines. We found no significant difference between Communities A and B with respect to Pb and Hg concentrations in water or food, although we were not able to detect very low levels of Pb in most of the foods we sampled because of trace Pb contamination added during sample homogenization. Although the Pb levels we measured in dust and soil from Community A homes were higher on average than Community B homes, the levels in both communities were low (e.g. background) thus we did not investigate the difference further. To our knowledge, these are the first reported measurements of Pb in house dust in the Philippines. The concentrations of Pb we measured in house dust were significantly higher than those in entryway soil from both communities, adding empirical support to the assertion that yard soil should not be considered a proxy for house dust in exposure studies in the Philippines or elsewhere.

Risks of herbal medicinal products

PURPOSE

Herbal medicinal products (HMPs) are again highly popular. Their current popularity renders the assessment of their safety an urgent necessity.

METHOD

Narrative review using examples only.

RESULTS

Constituents of HMPs can be toxic and numerous examples of liver, kidney or other organ damage are on record. All HMPs contain a range of pharmacologically active constituents, and users of HMPs often combine HMPs with prescribed drugs. Thus herb-drug interactions are a real possibility. In most countries, HMPs are not submitted to stringent regulation and control. Thus unreliable quality can be a problem. In particular, this poses a risk when HMPs are contaminated (e.g. with heavy metals) or adulterated (e.g. with prescription drugs). The medical literature holds numerous examples for all of these scenarios and some are used in this article to illustrate the above points. As this area is grossly under-researched, it is rarely possible to define the size of the problem.

CONCLUSIONS

It is concluded that the widespread notion of HMPs being inherently safe is naive at best and dangerous at worst. More research is required to minimise the risk HMPs may pose to consumers' health.

Predicted intake of trace elements and minerals via household drinking water by 6-year-old children from Kraków (Poland). Part 1: lead (year 2000)

A population of 232 children living in urban, peripheral and rural areas of southern Poland was included in the study. Household drinking water was collected twice a day, early in the morning and in the evening. The lead (Pb) concentration was estimated by a graphite furnace-atomic absorption spectroscopy (GF-AAS) method. The geometric mean of Pb concentration in drinking water in 2000 for evening samples was 0.68, 1.24 and 2.28 microg x l(-1) for urban, peripheral and rural areas, respectively, while for morning samples it was 1.42, 2.16 and 2.97 microg x l(-1). These areas differed significantly (p < 0.05) and odds ratio for peripheral versus urban areas was 1.6. The difference of Pb concentrations in the morning and evening water was significant (p < 0.001). The mean ratio was 1.8 and the median difference 0.8 microg x l(-1). The predicted contribution of drinking water to the Pb intake by 6-year-old children living in urban, peripheral and rural areas was 1.2, 2.0 and 5.6% of the provisional tolerable weekly intake (PTWI) respectively. For the 4.3-11.1% of children, the Pb concentration in water > 10 microg x l(-1) and in these cases the predicted Pb intake with drinking water contributed to PTWI by 22.3-30.0%. The simple test introduced in this study, the analysis of morning and evening water samples, proved that contamination of water in the plumbing is significant and common. The above parameters can be applied to routine quality control of drinking water performed in the households. The in-house water contamination should be considered as a factor in public health protection programmes with special attention to children.

Relationship between blood lead concentrations and learning achievement among primary school children in Taiwan

Over the past 20 years lead has been proven to exert an influence on the intelligence of children. Especially for children exposed to environmental lead, average blood lead was often lower than the officially recognized intoxication level. Because Kaohsiung is an industrial area in Taiwan and lead exposure is an important environmental issue, we attempted to ascertain the extent to which environmental lead influences the achievement of primary school children. We randomly selected 934 children from 32 primary schools in 11 districts of Kaohsiung City. Blood lead levels of the children were checked, and they were administered a questionnaire about their family information. Scores of several courses were used in this study on the relationship between a child's blood lead and his or her academic performance (Ranking with his or her classmates), including Chinese (reading and writing short Chinese articles), Mathematics, History and Society, and Natural Science. Multiple regression models were done with adjustments for the confounding effects of their parents' socioeconomic levels. The mean (SD) of 934 blood lead level was 5.50 (1.86) microg/dL. Spearman's coefficient showed that class rankings in Chinese, Mathematics, Natural Science, and History and Society were all strongly associated with blood lead levels (P<0.01). The multiple regression models revealed that blood lead level exerts a stronger influence on children's language ability (Chinese) than on their ability to calculate (Mathematics). Our results suggest that environmental lead exposure adversely affects a child's academic achievement, making a direct link between exposure to lead and academic attainment.

Herbal medicine

Generalized statements about herbal medicines are nonsensical, and each remedy has to be evaluated on its own merits. Some herbal treatments can be shown to have a favorable risk-benefit profile, but for most herbal medicines the data are insufficient to determine whether they do more good than harm. The research required to fill the gaps in present knowledge should have a high priority.