Assessment of blood levels of heavy metals including lead and manganese in healthy children living in the Katanga settlement of Kampala, Uganda

Update of the risk assessment of inorganic arsenic in food

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

Blood Levels of Environmental Heavy Metals are Associated with Poorer Iron Status in Ugandan Children: A Cross-Sectional Study

BACKGROUND

Iron deficiency (ID) and environmental exposure to metals frequently co-occur among Ugandan children, but little is known about their associations, although iron and other divalent metals share the same intestinal absorption transporter, divalent metal transporter 1 (DMT1).

OBJECTIVES

We examined associations between iron status and blood concentrations of lead, manganese (Mn), cobalt (Co), and cadmium, both singly and as a mixture.

METHODS

We used data on sociodemographic status, iron biomarkers, and blood concentrations of heavy metals collected from a cross-sectional survey of 100 children aged 6-59 mo in Kampala, Uganda. We compared blood concentrations of metals in ID with iron-sufficient children. We examined associations between a metal mixture and iron biomarkers using multiple linear regression and weighted quintile sum regression.

RESULTS

The median (interquartile range) blood Mn (μg/L) was higher in ID children defined by soluble transferrin receptor (sTfR) and ferritin (ID compared with iron-sufficient children): (sTfR [21.3 {15.1, 28.8}, 11.2 {8.6, 18.5}], ferritin [19.5 {15.0, 27.2}, 11.2 {8.8, 19.6}]; P < 0.001 for both). Similarly, the median (interquartile range) blood Co (μg/L) was higher in ID children by ferritin ([0.5 {0.4, 0.9}, 0.4 {0.3, 0.5}], P = 0.05). Based on the multiple linear regression results, higher blood Co and Mn were associated with poorer iron status (defined by all 4 iron indicators for Co and by sTfR for Mn). The weighted quintile sum regression result showed that higher blood concentrations of a metal mixture were associated with poorer iron status represented by sTfR, ferritin, and hepcidin, mainly driven by Co and Mn.

CONCLUSIONS

Our study findings suggest that poorer iron status is associated with overall heavy metal burden, predominantly Co and Mn, among Ugandan children. Further prospective studies should confirm our primary findings and investigate the combined effects of coexposures to neurotoxicants on the neurodevelopment of young children.

Heavy metal contamination in river water, sediment, groundwater and human blood, from Kanpur, Uttar Pradesh, India

Exponential industrialization and anthropogenic activities have resulted in water contamination by various heavy metals in Kanpur city, India. Heavy metal pollution, an issue of great concern, is not only affecting river water, but contamination of groundwater is creating health issues and worries. In the present investigation, blood samples were collected from selected volunteers, water and sediment samples from four sites of river Ganga and drinking groundwater samples from 23 locations of Kanpur city. Heavy metals analysis in river water, sediment, and human blood, was done by inductively coupled plasma optical emission spectroscopy (ICP-OES) and atomic absorption spectroscopy (AAS) was used for groundwater samples. Human blood showed a high concentration of arsenic (As) (66.6 ± 0.00 and 76.9 ± 0.01 μg L^-1 in males and female subjects, respectively) and thallium (Tl) (13.4 ± 0.004 and 16.6 ± 0.005 μg L^-1 in males and female subjects, respectively) with higher concentrations in females than males. Other heavy metals (Nickle, Beryllium, Cadmium, Cobalt, Chromium, Lithium, Molybdenum, Lead) were not observed in any of the tested human blood samples. However, in groundwater sampling, iron (Fe), copper (Cu), and arsenic (As) were detected, one sample had the presence of chromium (Cr), and two samples showed lead (Pb) contamination. River water [Cu (32-125 μg L^-1), Cr (19-725 μg L^-1), Cd (1-59 μg L^-1), Pb (37-163 μg L^-1), As (32-153 μg L^-1), Th (26.75 μg L^-1)] showed a high level of the heavy metals, as compared to reference values of BIS, CPCB (2016a), WHO, EPA and USEPA. River sediment [Cu (4168-34,470 μg Kg^-1), Cr (4040-145,650 μg Kg^-1), Cd (326-5340 μg Kg^-1), Pb (1840-19,350 μg Kg^-1), As (103-188 μg Kg^-1)] also showed high concentration when compared to reference values of USEPA and PASS. River site 4, with high Cr (725 μg L^-1), also showed Cr levels (19.8 μg L^-1) in the groundwater samples, indicating Cr contamination in groundwater while Pb was observed at groundwater samples close to two industrial sites. Drinking water might be the primary exposure pathway for As and Tl to enter the human body. The study recommends periodic monitoring of river water, sediment, groundwater, and human blood samples for contamination of heavy metals.

Metal exposures from source materials for artisanal aluminum cookware

Artisanal aluminum cookware releases lead and other metals that pose significant health risk for people in low and middle-income countries. Cookware is made from recycled engine and electronic appliance parts, cans, and other materials. We obtained fourteen custom-made pots from Ghana, produced from seven different scrap aluminum sources. We sought to determine whether avoiding certain source materials could reduce leaching of metals. Cooking was simulated using dilute acetic acid and palm oil. Aluminum released from all pots exceeded recommended guidelines. Variable amounts of lead, cadmium, chromium, nickel and other metals were leached, with the most lead coming from auto radiators and mixed metals. Pots made from engine blocks did not yield detectable amounts of lead. All pots released potentially harmful concentrations of two or more metals. Selective scrap aluminum sourcing for recycled cookware does not avoid metal contamination of food, although some sources may release lower concentrations of certain metals.

Ribosomal DNA copy number associated with blood metal levels in school-age children: A follow-up study on a municipal waste incinerator in Zhejiang, China

To evaluate the body burdens of heavy metals and explore the impact of environmental metal exposure on ribosomal DNA (rDNA) or mitochondrial DNA (mtDNA) copy number (CN) variation in school-age children living near a municipal waste incinerator (MWI), we conducted a follow-up study in 2019. A total of 146 sixth-grade children from a primary school located 1.2 km away from the MWI were recruited for our study. Metals, including vanadium (V), chromium (Cr), manganese (Mn), cobalt (Co), nickel (Ni), copper (Cu), zinc (Zn), arsenic (As), selenium (Se), cadmium (Cd), stannum (Sn), stibium (Sb), thallium (Tl), and lead (Pb), were determined by an inductively coupled plasma mass spectrometer method. Real-time qPCR was used to measure the rDNA and mtDNA CN. The blood metal levels followed this order: Zn > Cu > Se > Pb > Mn > Sb > As > Ni > Cd > Co > Cr > Sn > V > Tl. Blood Cr level was significantly correlated with 18 S, 2.5 S, and 45 S CN (β = -0.25, -0.22, -0.26, p < 0.05); Ni was correlated with 5 S (β = -0.36, p < 0.01); Cu was correlated with 28 S, 18 S, and 5.8 S (β = -0.24, -0.24, -0.23, p < 0.05); while Zn was correlated with 18 S, 5.8 S, and 45 S (β = -0.28, -0.32, -0.26, p < 0.05). In conclusion, school-age children living near the MWI had lower blood metal levels compared to children recruited in 2013, while rDNA CN loss was found to be correlated to several heavy metals in these children.

Early-life chemical exposome and gut microbiome development: African research perspectives within a global environmental health context

The gut microbiome of neonates, infants, and toddlers (NITs) is very dynamic, and only begins to stabilize towards the third year of life. Within this period, exposure to xenobiotics may perturb the gut environment, thereby driving or contributing to microbial dysbiosis, which may negatively impact health into adulthood. Despite exposure of NITs globally, but especially in Africa, to copious amounts and types of xenobiotics - such as mycotoxins, pesticide residues, and heavy metals - little is known about their influence on the early-life microbiome or their effects on acute or long-term health. Within the African context, the influence of fermented foods, herbal mixtures, and the delivery environment on the early-life microbiome are often neglected, despite being potentially important factors that influence the microbiome. Consequently, data on in-depth understanding of the microbiome-exposome interactions is lacking in African cohorts. Collecting and evaluating such data is important because exposome-induced gut dysbiosis could potentially favor disease progression.

Occurrence and health implications of heavy metals in preschool children's clothing manufactured in four Asian regions

Clothing may be a potential contributor to body metal burden in children. However, available information on heavy metals in children's clothing is extremely limited and the associated health risks remain poorly understood. This study investigated the concentrations of Pb, Cd, Co, Zn, Cr, As, Cu and Ni in new preschool children's clothing manufactured in four Asian regions. The children's clothing had higher levels of Ni and Cr but lower levels of Pb and Cd in comparison to the concentrations reported in other textile products. The concentrations of Cd were higher in the black clothing than those in the white and color samples. The non-cotton samples contained higher Co concentrations. The Pb concentrations in the samples manufactured in China were significantly higher than those in the other three regions. We estimated the dermal exposure doses for these metals and calculated the associated risks. The results indicated that the health risks from exposure to these metals in the children's clothing were acceptable. However, more research is required to investigate heavy metals and the associated risks in child clothing due to the increasing complexity of their materials and manufacturing processes.

Harmonization of Epidemiologic Research Methods to Address the Environmental and Social Determinants of Urban Slum Health Challenges in Sub-Saharan Africa

Sub-Saharan Africa (SSA) has a significant proportion of populations living in urban slum conditions, where exposure to multiple environmental stressors and social inequalities is ubiquitous. This commentary synthesizes commonalities in recent environmental health studies from urban cities in East and West Africa, presented during a symposium sponsored by the Africa Chapter of the International Society of Environmental Epidemiology (ISEE) in August 2020. A key takeaway from this symposium is the need for harmonization of epidemiologic and exposure data collection in three domains tailored to the SSA context: (1) improvements in socioeconomic status (SES) measurement through harmonization in the conceptualization and operationalization of SES indicators; (2) improvements in air pollution exposure assessment in resource-constrained contexts by better integration, validation, and harmonization of exposure data of air pollution and mitigating factors; and (3) harmonization in the assessment of health outcomes and biomonitoring of contaminants. Focusing on these three domains would galvanize environmental epidemiologists in SSA around shared data collection instruments and shared data platforms and facilitate the pooling of data across the continent. Fostering this collaborative research will enable researchers and decision-makers to glean new insights and develop robust environmental health interventions and policies for SSA urban slums and for improved population health.

Modified filters with Penicillium chrysogenum culture enhance removal of copper and iron contaminants in water

Development of a cost-effective and broad-based practical approach to wastewater treatment is of utmost importance, especially in developing countries. In this study, we investigated the efficacy of using Penicillium chrysogenum cells with sand filters for removal of heavy metals from contaminated water. This was done by designing three fungal-based sand filters (FSF) containing 30, 40, 50 spores/mL and sand filter (SF) without the fungus. These preparations were used to treat deionized water simulated with two concentrations of copper and iron (5 and 10 mg L^-1 respectively). These simulations were prepared to create commonly observed contamination levels in many water sources. Effluent reductions relative to treatments effects were analysed using the standard protocol for eight days under aseptic conditions. On the eighth day, it was observed that the copper concentration (10 mg L^-1) was reduced to 0.106 mg L^-1 in the 30 spores/mL treatment as compared to 0.198 mg L^-1 observed in SF. It was also observed that copper concentrations were significantly reduced (p  ≤ 0.05) between FSF and the SF. There was also a significant reduction while comparing the metal removal in treatments after the second and eighth days. The general affinity range for iron in the four treatments was 30 > 40 > SF > 50, in that order has 94.26, 91.66, 87.98 and 85.48 as removal efficiency for iron (5 mg L^-1) on the eighth day. P. chrysogenum is therefore a valuable biosorbent that can help improve the quality of wastewater by biosand filter treatment.

Umbilical cord serum elementomics of 52 trace elements and early childhood neurodevelopment: Evidence from a prospective birth cohort in rural Bangladesh

BACKGROUND

Prenatal exposures to neurotoxic metals and trace elements are associated with early childhood neurodevelopmental outcomes. However, consequences of simultaneous exposure to mixtures of elements remain unclear.

OBJECTIVE

To examine individual and joint effects of prenatal trace element exposure on early childhood neurodevelopment.

METHODS

Using a well-established Bangladesh prospective birth cohort (2008-2011), we measured concentrations of 52 trace elements in umbilical cord serum of 569 mother-infant pairs using inductively coupled plasma mass spectrometry. Neurodevelopment was evaluated at 20-40 months of age using Bayley Scales of Infant and Toddler Development, Third Edition. Stability elastic net (ENET) was used to screen elements individually associated with the outcome; candidate exposures were combined by weighted linear combination to form a risk score representing their mixture effect on early childhood neurodevelopment.

RESULTS

Stability ENET identified 15 trace elements associated with cognitive composite score and 14 associated with motor composite score, which were linearly combined to form the element risk score (ERS). Children with higher ERScognitive had lower probability of cognitive developmental delay (ORhighest vs lowest: 0.21; 95 %CI: 0.10, 0.40; P < 0.001; Ptrend < 0.001). Children with ERSmotor in the top quintile had a significantly lower risk of motor developmental delay (OR: 0.16; 95 %CI: 0.09, 0.31; P < 0.001; Ptrend < 0.001) versus the lowest quintile. In Bayesian kernel machine regression analyses, lithium [conditional posterior inclusion probability (cPIP) = 0.68], aluminum (cPIP = 0.83) and iron (cPIP = 1.00) contributed most to the lower cognitive composite score; zinc (cPIP = 1.00), silver (cPIP = 0.81), and antimony (cPIP = 0.65) mainly contributed to the change of motor composite score.

CONCLUSION

Co-exposure to lithium/aluminum/iron or zinc/silver/antimony appears to impact children's neurodevelopment. ERS score reflecting maternal exposure could indicate children's risk of neurodevelopmental delay, warranting further studies to explore the underlying mechanism.

Are Serum Ion Levels Elevated in Pediatric Patients With Metal Implants?

BACKGROUND

Previous studies report elevated serum titanium (Ti) levels in children with spinal implants. To provide additional data on this topic, we sought to assess serum ion levels at multiple timepoints in pediatric patients with growing spine devices, spinal fusion instrumentation, and extremity implants placed for fracture treatment. We hypothesized that serum Ti, cobalt (Co), and chromium (Cr) levels would be elevated in pediatric patients with growing spine devices compared with patients with extremity implants.

METHODS

Pediatric patients undergoing any primary spine implant placement, those with spine implant revision or removal surgery and patients with other appendicular implant removal had serum Ti, Co, and Cr ion levels drawn at the time of surgery. Fifty-one patients (12 growing spine devices, 13 fusions, and 26 extremity implants) had one set of labs, 31 of whom had labs drawn both preoperatively and postoperatively. Biopsies obtained from tissue specimens at the time of implant revision were analyzed histologically for the presence of metal debris and macrophage activity.

RESULTS

Patients with growing spine implants had elevated serum Ti (3.3 vs. 1.9 ng/mL, P=0.01) and Cr levels (1.2 vs. 0.27 ng/mL, P=0.01) in comparison to patients with fusion rods or extremity implants. With respect to patients with extremity implants, patients with growing spine devices had elevated serum Ti (3.3 vs. 0.98 ng/mL, P=0.013), Co (0.63 vs. 0.26 ng/mL, P=0.017), and Cr levels (1.18 vs. 0.26 ng/mL, P=0.005). On matched pairs analysis, patients who had labs drawn before and after spine implantation had significant increase in serum Ti levels (0.57 vs. 3.3 ng/mL, P=0.02). Histology of tissue biopsies adjacent to growing spine implants showed presence of metal debris and increased macrophage activity compared with patients with extremity implants.

CONCLUSION

Serum Ti, Co, and Cr levels are elevated in children with spinal implants compared with those with extremity implants, particularly in those with growing spine devices. However, the clinical significance of these findings remains to be determined.

LEVEL OF EVIDENCE

Level II-prospective comparative study.

Blood lead level and nutritional status indicators in preadolescent Polish schoolchildren

BACKGROUND

Environmental pollutions with heavy metals may have toxic effects on human health and development. One of the most detrimental is lead exposure, which may disturb neurodevelopment and linear growth in children. However, data on the effect of lead exposure on nutritional and weight status in children are limited, thus this study aimed to assess the effect of blood lead (Pb) level on nutritional and weight status in preadolescent schoolchildren from the industrialized, mining region in southwestern Poland.

METHODS

Our study sample involved N = 709 schoolchildren (402 boys and 307 girls) in the preadolescent developmental period (7-11 years of age for boys and 7-10 years of age for girls). Anthropometric measurements were used to assess nutritional and weight status: body mass index (BMI), mid-upper arm circumference (MUAC) and skinfolds thicknesses (triceps, subscapular, abdominal and the sum of skinfolds). Blood Pb level was evaluated and divided into two groups: above (>3.7 μg/dL) and below median value (≤3.7 μg/dL).

RESULTS

Analysis of covariance (with children's age controlled as a covariate) revealed that children with blood Pb level above median value had significantly lower values of BMI, MUAC and all skinfolds (at least p < 0.01). However, this effect was significant only in boys, whereas in girls differences were non-significant (p > 0.05). The highest effect size of blood Pb level was noted for skinfolds thicknesses (partial η²: 0.015 for the sum of skinfolds).

CONCLUSIONS

Nutritional status in children with higher blood Pb level is significantly impaired in preadolescent boys, who appear to be more sensitive to this environmental factor. Our findings indicate a particular need for nutritional and environmental interventions among preadolescent children in regions with higher lead exposure.

Metal(loid) exposure on children from a historical metallurgical site

The data obtained in this study represent a comprehensive assessment of human exposure to metal(loids) enriched in the environment, derived from metallurgical activities in Cedral, a town in North-Central Mexico. A multi-elemental analysis (As, Cd, Cr, Cu, Fe, Mn and Sb) shows high metal(loid) content in environmental media (tailings samples, dust samples and particulate matter < 2.5 µm collected in the urban area). Blood samples from school-age children were collected and analyzed to determine exposure levels. The assessment of the data obtained from this study shows that Sb and Cd are highly enriched elements in the environment of Cedral; their respective levels in the blood samples analyzed are 10.9 and 11.3 times higher than their pediatric reference levels. The statistical analysis indicates a strong relationship between metal(loid)s in blood samples and both dust and PM_2.5 samples, which reveal that ingestion and inhalation could represent important exposure routes for metal(loid) intake. Continuous monitoring in the area is paramount to assess the health impact posed by the different routes of exposure. It is also important to implement health education programs to decrease the population's exposure to metal(loid)s and to design urgent remediation measures, to be implemented as soon as possible.

The Association Between Trace Elements Exposure and the Cognition in the Elderly in China

This study aimed to evaluate the association between aluminum (Al), arsenic (As), barium (Ba), cobalt (Co), manganese (Mn), selenium (Se), strontium (Sr), thallium (Tl), and vanadium (V) levels in whole blood and the cognitive ability of people over 60 years old. A total of 1217 eligible participants were enrolled in our study in Lu'an city, Anhui province, China. The inductively coupled plasma mass spectrometry (ICP-MS) was used to determine the concentration of nine trace elements in the whole blood, which reflect their exposure levels. Mini-mental State Examination (MMSE) scale was employed to screen the cognitive function of the elderly. Logistic regression was applied to assess the associations of nine whole blood trace elements with cognition. In the work, it has found that high levels of whole blood As and Se are risk factors for cognitive dysfunction. As and Se quartile were correlated with increased risk of cognitive dysfunction, and with the odds ratio (OR) of 2.06 (95% CI 1.30-3.25; p-trend = 0.002), 1.947 (95% CI 1.20-3.17; p-trend = 0.007) in the highest quartile. However, high concentration of Al, V, and Ba in whole blood were protective factors for cognitive function [OR = 0.63 (95% CI 0.40-0.98; p-trend = 0.040), 0.549 (95% CI 0.36-0.85; p-trend = 0.007), 0.460 (95% CI 0.28-0.75; p-trend = 0.002) respectively]. The study suggested that the exposure of some trace elements (As, Se) were associated with the increased risk of cognitive dysfunction; on the contrary, other elements (Al, V, Ba) could be protective factor for cognitive function. These findings need to be confirmed in additional research of a large elderly population.

Effects of the occupational exposure on health status among petroleum station workers, Khartoum State, Sudan

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Mean blood lead level for exposed group of non-smokers was 0.58 mg/l.

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Mean blood lead level for exposed group of smokers was 1.49 mg/l.

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Mean value of lead in urine of smokers were 1.59 mg/L & 1.16 mg/L in both groups.

Objective

The hazards of petroleum station activities are greatly emphasized due to their negative impact on workers’ health and safety concerns. This study aims to assess the effect of occupational exposure among the workers in various petroleum station at the Khartoum State, Sudan.

Methods

An analytical and experimental study design is followed where 60 participants were selected through purposive sampling technique. The participants were recruited from the petroleum workstation and were considered as the lead exposed group whereas the participants who lived faraway from the petroleum station and had no exposure to lead were considered as un-exposed group. To avoid the effects of smoking on lead concentration we further divided these groups into smokers and non-smokers. IBM, SPSS was used for the statistical analysis of the collected data.

Results

The results show that there is no significant difference in white blood cells (WBCs) count between exposed and unexposed lead group. We also did not find significant difference in Red blood cells (RBCs) count. Participant from both groups had normal range of haemoglobin (Hb). However, haematocrit (Hct) levels were elevated in both of these groups. We also tested the platelet count in these groups and found that platelet count was slightly lower in lead exposed group as compared to the unexposed group but average count was found within the normal range. Finally, the lead concentration in serum and urine was detected of the participants. Results reveal that the serum lead concentration of non-smokers (0.58 mg/l) in the exposed group was higher than in non-smokers of unexposed group (0.49 mg/l). The lead concentration in serum of smokers in exposed group was also high (1.49 mg/l) than the lead concentration detected in serum of smokers in unexposed group (1.14 mg/l). Urine lead levels of exposed group was also high than the unexposed group in smokers and non-smokers. Mean value of lead in urine among non-smokers of the exposed and unexposed group were 0.76 mg/L and 0.19 mg/L respectively. In the case of smokers, 1.59 mg/L and 1.16 mg/L were the mean value of lead in urine for both exposed and unexposed groups respectively.

Conclusion

From the given results it can be concluded that health safety measures for workers must be implemented to maintain good health status of workers at petroleum stations.

Relationship between blood Lead status and anemia in Ugandan children with malaria infection

BACKGROUND

In Uganda, childhood anemia remains a health challenge and is associated with malaria infection as well as iron deficiency. Iron deficiency is intertwined with nutritional status, age and other comorbidities including helminths and Lead toxicity. Environmental Lead levels accounts for one's blood Lead (BL) levels. Blood Lead competitively blocks iron absorption, inhibits hemoglobin (Hb) biosynthesis and elevates free erythrocyte protoporphyrin (FEP) levels. Lead toxicity's contribution towards anemia pathogenesis, especially during malaria infection has not been studied. Concomitant exposure to both malaria infection and Lead pollution, exacerbates the anemia status. This study therefore aimed at expounding the anemia status of these Ugandan children aged under 5years who are exposed to both malaria infection and environmental Lead pollution.

METHODS

Briefly, venous blood samples from 198 children were microscopically assayed for malaria parasite density (PD), and hemoglobin (Hb) concentrations using the cyanmethemoglobin method, while BL and FEP levels were determined by the standard atomic absorption spectrophotometric and fluorometric methods respectively.

RESULTS

One hundred and fifty-one (76.3%) of the children analyzed had moderate anemia (Hb <10>5 g/dL) with Means of BLL=8.6 µg/dL, Hb =7.5 g/dL, FEP/Hb =8.3 µg/g and PD =3.21×10³ parasites / µL, while eight (4%) were severely anemic (<5 g/dL). Regression analysis and statistical correlation between PD and Hb (r = -0.231, R²= 0.15 P-value < 0.001) was negative and weak as compared to that between FEP/Hb and Hb (r = -0.6, R²=0.572 P-value=0.001).

CONCLUSION

Based on the study's findings, we conclude that BL significantly contributes to the pathogenesis of anemia and therefore its co-existence with malaria infection in the host exacerbates the anemia status.

Environmental exposure to metal mixtures and linear growth in healthy Ugandan children

BACKGROUND

Stunting is an indicator of poor linear growth in children and is an important public health problem in many countries. Both nutritional deficits and toxic exposures can contribute to lower height-for-age Z-score (HAZ) and stunting (HAZ < -2).

OBJECTIVES

In a community-based cross-sectional sample of 97 healthy children ages 6-59 months in Kampala, Uganda, we examined whether exposure to Pb, As, Cd, Se, or Zn were associated with HAZ individually or as a mixture.

METHODS

Blood samples were analyzed for a mixture of metals, which represent both toxins and essential nutrients. The association between HAZ and metal exposure was tested using multivariable linear regression and Weighted Quantile Sum (WQS) regression, which uses mixtures of correlated exposures as a predictor.

RESULTS

There were 22 stunted children in the sample, mean HAZ was -0.74 (SD = 1.84). Linear regression showed that Pb (β = -0.80, p = 0.021) and Se (β = 1.92, p = 0.005) were significantly associated with HAZ. The WQS models separated toxic elements with a presumed negative effect on HAZ (Pb, As, Cd) from essential nutrients with presumed positive effect on HAZ (Se and Zn). The toxic mixture was significantly associated with lower HAZ (β = -0.47, p = 0.03), with 62% of the effect from Pb. The nutrient WQS index did not reach statistical significance (β = -0.47, p = 0.16).

DISCUSSION

Higher blood lead and lower blood selenium level were both associated with lower HAZ. The significant associations by linear regression were reinforced by the WQS models, although not all associations reached statistical significance. These findings suggest that healthy children in this neighborhood of Kampala, Uganda, who have a high burden of toxic exposures, may experience detrimental health effects associated with these exposures in an environment where exposure sources are not well characterized.

Time-varying associations between prenatal metal mixtures and rapid visual processing in children

BACKGROUND

Humans are exposed to mixtures of chemicals across their lifetimes, a concept sometimes called the "exposome." Mixtures likely have temporal "critical windows" of susceptibility like single agents and measuring them repeatedly might help to define such windows. Common approaches to evaluate the effects of chemical mixtures have focused on their effects at a single time point. Our goal is to expand upon these previous techniques and examine the time-varying critical windows for metal mixtures on subsequent neurobehavior in children.

METHODS

We propose two methods, joint weighted quantile sum regression (JWQS) and meta-weighted quantile sum regression (MWQS), to estimate the effects of chemical mixtures measured across multiple time points, while providing data on their critical windows of exposure. We compare the performance of both methods using simulations. We also applied both techniques to assess second and third trimester metal mixture effects in predicting performance in the Rapid Visual Processing (RVP) task from the Cambridge Neuropsychological Test Automated Battery (CANTAB) assessed at 6-9 years in children who are part of the PROGRESS (Programming Research in Obesity, GRowth, Environment and Social Stressors) longitudinal cohort study. The metals, arsenic, cadmium (Cd), cesium, chromium, lead (Pb) and antimony (Sb) were selected based on their toxicological profile.

RESULTS

In simulations, JWQS and MWQS had over 80% accuracy in classifying exposures as either strongly or weakly contributing to an association. In real data, both JWQS and MWQS consistently found that Pb and Cd exposure jointly predicted longer latency in the RVP and that second trimester exposure better predicted the results than the third trimester. Additionally, both JWQS and MWQS highlighted the strong association Cd and Sb had with lower accuracy in the RVP and that third trimester exposure was a better predictor than second trimester exposure.

CONCLUSIONS

Our results indicate that metal mixtures effects vary across time, have distinct critical windows and that both JWQS and MWQS can determine longitudinal mixture effects including the cumulative contribution of each exposure and critical windows of effect.

Effects of ALAD genotype on the relationship between lead exposure and anthropometry in a Cohort of Mexican children

OBJECTIVES

Lead exposure is associated with children's growth, but this relationship may depend on the presence of susceptibility factors, including genetic variation. Blood lead levels (BLL) differ by ALAD (aminolevulinic acid dehydratase) genotype. We investigated the association between BLL and growth in Mexican first-graders with different ALAD genotypes.

METHODS

Children between the ages of 6-8 years (n = 602) attending first grade in schools within the vicinity of a metal foundry in Torreón, Mexico were enrolled into a randomized controlled trial (RCT) testing the efficacy of iron and/or zinc supplementation on blood lead levels (BLL) and cognition. BLL and anthropometry were assessed at baseline (height, height-for-age z-score (HAZ), knee height, head circumference), after 6 (head circumference) and 12 months (height, HAZ, knee height). Children with ALAD_1-1 and ALAD_1-2/2-2 were compared. The study sample included 538 and 470 participants who had complete data at baseline and follow-up, respectively. Separate multivariable linear regression models adjusted for covariates were used to test the association between BLL at baseline and each anthropometric measure. Covariates included age, sex, hemoglobin, crowding, and maternal education. BLL x ALAD genotype interaction term was tested.

RESULTS

Median BLL (10.1 μg/dL) did not differ by ALAD genotype. After covariate adjustment, baseline BLL was inversely associated with baseline height, HAZ, and knee height. The association (β [95% CI]) between BLL and baseline height (-0.38[-0.68, -0.09]), HAZ (-0.07[-0.12, -0.02]) and knee height (-0.14[-0.25, -0.02]), was somewhat stronger in children with ALAD_1-2/2-2 than ALAD_1-1 (-0.09[-0.16, -0.02], -0.02[-0.03, -0.004] and -0.04[-0.06, -0.01], respectively). No associations between BLL and growth at 6 or 12 months were detected irrespective of ALAD genotype.

CONCLUSIONS

BLL was adversely associated with anthropometric measures among Mexican children. ALAD genotype may be a susceptibility factor for the effects of lead on child growth.

Lead Exposure in Low and Middle-Income Countries: Perspectives and Lessons on Patterns, Injustices, Economics, and Politics

Lead exposure is a legacy issue that continues to affect vulnerable population groups globally, but particularly in low and middle-income countries (LMICS). We take a multi-disciplinary approach to examine the patterns of lead exposure in these countries, discuss the underlying injustices and socio-political causes, and the economic costs that are associated with exposure. We conclude with some lessons we drew from our discussion of lead across the disciplines and advocate for a number of approaches to solving this ongoing issue. These include (i) biomonitoring that could be integrated into existing health surveys or public health programs targeting young children; (ii) greater civic engagement to push for solutions; and, (iii) environmental control policies that represent a continuum of local, context-specific to broad, national-level, and even global approaches.

Piloting a Developmental Screening Tool Adapted for East African Children

There is a need for developmental screening that is easily administered in resource-poor settings. We hypothesized that known risk factors would predict failed developmental screening on an adapted screening tool in East African children living in poverty. The sample included 100 healthy Ugandan children aged 6–59 months. We adapted a parent-reported developmental screener based on the Child Development Review chart. The primary outcome was failure to meet age-appropriate milestones for any developmental domain. Venous blood was analyzed for lead, and caregivers completed a demographics questionnaire. We used multivariate logistic regression models to determine if elevated blood lead and stunting predicted failure on the screener, controlling for maternal education level, age in months past the lower bound of the child’s developmental age group, and absence of home electricity. In the sample, 14% (n = 14) of children failed one or more milestones on the screener. Lead levels or stunting did not predict failing the screener after controlling for covariates. Though this tool was feasibly administered, it did not demonstrate preliminary construct validity and is not yet recommended for screening in high-risk populations. Future research should include a larger sample size and cognitive interviews to ensure it is contextually relevant.