Characteristics of Anemia and Iron Status and Their Associations With Blood Manganese and Lead Among Children Aged From 3 to 19 Years Old From Four Northern First Nation Communities in Quebec

Abstract

BACKGROUND Prevalence of anemia and iron deficiency (ID) are higher among indigenous children in Canada, although few data are available in Quebec. Iron is metal that interact with the absorption of manganese (Mn) and Lead (Pb) cobalt (Co). ID is known to upregulate these metals, thereby increasing their absorption, concentration inside the body and their toxicity. OBJECTIVES The objectives of the present study are to: (i) Characterize ID and anemia prevalence and their protective/risk factors; and (ii) Study associations between blood Mn, Pb and iron status biomarkers. DESIGN/METHODS Data from The 2015 First Nation Youth Health and Environment Pilot Study was conducted among children (3 to 19 y, n = 198) from four First Nations communities in Quebec will be used in these study where, blood samples and anthropometric measures were collected, hemoglobin was measured on site using an Hemocue analyser. Protective/risk factors including education, food security, housing conditions and lifestyle and dietary habits were documented using interview-administered questionnaire to children’ parents. Serum ferritin and blood Pb, Mn, Co, Zn and Ca were measured by Modular P analyser and ICPMS. Descriptive and multiple regression statistical analyses adjusting for relevant co-variables were used. RESULTS Results showed ID and anemia prevalence of 20.7% and 17.6% respectively, among which 8.8% presented iron deficiency anemia. Moreover, up to 11.9% had elevated blood Mn (median = 15.9 µg/L, range 7.1 to 31.9 µg/L) of which 27.5% presented ID. However, blood Pb was low (median = 5.4 µg/L, range 1.8 to 50.8 µg/L). Multiple logistic regression analysis showed that crystal juice intake was associated with lower ID and anemia (OR (95%): 0.50 (0.30 - 0.82) and 0.47 (0.26 - 0.87) respectively) in girls. Likewise, the presence of hunter in the household was associated with lower anemia in girls (0.09 (0.02 - 0.53)). No factors were associated with ID in boys, and for anemia, lower serum ferritin and older age was associated with higher prevalence of anemia (1.08 (1.01 - 1.14) and 1.23 (1.02 - 1.48) respectively). In adjusted models, blood Mn was negatively associated with serum ferritin concentrations (ß = -0.05; p < 0.02) in girls and positively associated with blood Co (ß = 8.50; p < 0.01) in boys. CONCLUSION Findings on high prevalence of ID, anemia and elevated blood Mn among children form these First Nation communities support that, community and family activities increasing traditional foods consumption improve nutritional status and suggest that foods and beverages naturally rich in vitamin C - but lower in added sugar than crystal juice - would improve iron intake in girls, which would contribute to improve their iron status, decrease anemia and restore normal Mn blood levels.

Associations of a metal mixture with iron status in U.S. adolescents: Evidence from the National Health and Nutrition Examination Survey

“…Though we are not aware of any prior epidemiological study assessing associations of metal mixtures with Fe status, our findings for individuals metals, especially for Mn and Cd, are generally consistent with prior studies (Bradman et al., 2001; Choi & Kim, 2003, 2005; de Carvalho Rondó et al., 2006; Hammad et al., 1996; Henríquez‐Hernández et al., 2017; Jain et al., 2005; Kutllovci‐Zogaj et al., 2014; Park et al., 2013; Silver et al., 2013; Tahir, 2018; H. Wang et al., 2012). These studies consistently found associations between increasing exposure to metals with worse Fe status among adolescents and pre‐adolescents.…”

“…These studies consistently found associations between increasing exposure to metals with worse Fe status among adolescents and pre‐adolescents. Four of these studies were conducted in populations that included adolescents (ages 10–19 years), and each of them observed associations between higher biomarker Mn, Pb or Cd concentrations and worse Fe status (serum Fe, serum ferritin or Fe deficiency) (J. Choi & Kim, 2005; J. W. Choi & Kim, 2003; Silver et al., 2013; Tahir, 2018).…”

“…We considered five metals measured in NHANES in whole blood: Mn, Pb, Se, Cd, and total Hg. These metals were chosen for analysis based on their prior associations with Fe status in children (Bradman et al, 2001;Choi & Kim, 2003, 2005de Carvalho Rondó et al, 2006;Hammad et al, 1996;Henríquez-Hernández et al, 2017;Houghton et al, 2016;Jain et al, 2005;Kutllovci-Zogaj et al, 2014;Park et al, 2013;Rashid & Ghaznavi, 2015;Silver et al, 2013;Tahir, 2018;Wang et al, 2012;Weinhouse et al, 2017). Further, blood was selected as the primary biomarker to maximize the sample size, where all NHANES participants aged 1-year or older were eligible for measurement of blood metals (only one-third of participants aged 6-years or older were eligible for urinary metal measurement).…”

“…Emerging evidence indicates that exposure to metals may lead to altered Fe status in children across all ages. Prior epidemiologic studies have reported associations between increased lead (Pb), cadmium (Cd), manganese (Mn) and mercury (Hg) and poorer Fe status (e.g., decreased hemoglobin, serum Fe, or ferritin) in children (ages ranging from infancy to 15 years) when the metals were considered individually (Bradman et al, 2001;Choi & Kim, 2003, 2005de Carvalho Rondó et al, 2006;Hammad et al, 1996;Henríquez-Hernández et al, 2017;Jain et al, 2005;Kutllovci-Zogaj et al, 2014;Park et al, 2013;Silver et al, 2013;Tahir, 2018;Wang et al, 2012;Weinhouse et al, 2017). Mechanistically, metals compete with Fe for uptake and transport (Brain et al, 2006;Erikson et al, 2002;Kordas, 2010;Peraza et al, 1998); alter Fe metabolism (Molina et al, 2011;Shokooh Saljooghi & Delavar-Mendi, 2013); and disrupt expression of proteins (e.g., transferrin) (Kordas, 2010), erythrocyte membrane function (Adams et al, 1979;Ahyayauch et al, 2013;Demchenkov et al, 2021), and heme synthesis (Jan et al, 2015;Jang et al, 2011;Kordas, 2010).…”