The Association between Lead Exposure and Bone Mineral Density in Childhood and Adolescence: Results from NHANES 1999–2006 and 2011–2018

Li, Tao; Xie, Yixuan; Wang, Liang; Huang, Guimin; Cheng, Yijing; Hou, Dongqing; Liu, Wenqian; Zhang, Tong; Liu, Junting

doi:10.3390/nu14071523

Cited by 17 publications

(14 citation statements)

References 21 publications

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“…Meanwhile, Cho et al found that children with a mean blood lead level of 1.9 μg/dl had symptoms of attention deficit hyperactivity disorder (ADHD) ( 35 ). An N-shaped curve was found between BLL and total BMD(bone mineral density), subtotal BMD and limb BMD for males and females at low-dose lead exposure (0.84 ug/dl) ( 36 ). In addition, when studying the relationship between blood lead and cardiovascular risk factors, Xu ( 24 ) found a positive correlation between BLL (geometric mean of 1.17 ug/dl) and serum LDL-C (low-density lipoprotein cholesterol, a biomarker associated with cardiovascular disease) in American adolescents.…”

Section: Discussionmentioning

confidence: 99%

Association between serum folate concentrations and blood lead levels in adolescents: A cross-sectional study

Zhang²,

Li³

2022

Front. Pediatr.

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As a heavy metal, lead is a common toxic agent. Its accumulation in the body is harmful to physical health, particularly in children and adolescents. Studies have reported that folate may play a protective role in lead exposure. An association between serum folate concentrations (SFC) and blood lead levels (BLL) has been documented in adults, but studies in adolescents are limited. This study investigated the relationship between SFC and BLL in American adolescents. This cross-sectional study collected relevant data on both SFC and BLL of 5,195 adolescents in the NHANES database from 2007 to 2018. Multivariable linear regressions and smooth curve fittings were adopted to evaluate the correlation between BLL and SFC. After adjusting potential confounders, we found negative relationships between BLL and SFC [β = −0.0041 (−0.0063, −0.0019)], and the associations were significant in non-Hispanic Whites, Mexican Americans, and other races but not significant in non-Hispanic blacks (P = 0.139). Furthermore, the negative trends were significant in adolescents aged 16–19 years and females aged 12–15 years but insignificant in males aged 12–15 years (P = 0.172). Therefore, these findings provide a basis for future research on the mechanism of folate in regulating blood lead levels.

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Section: Discussionmentioning

confidence: 99%

Association between serum folate concentrations and blood lead levels in adolescents: A cross-sectional study

Zhang²,

Li³

2022

Front. Pediatr.

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“…Other covariates. Other covariates were chosen based on the published studies [8,24,25]. The variance inflation factor (VIF) was used to detect co-linearity between multiple variables.…”

Section: Plos Onementioning

confidence: 99%

Associations between vitamin E status and bone mineral density in children and adolescents aged 8–19 years: Evidence based on NHANES 2005–2006, 2017–2018

et al. 2023

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Introduction Bone mineral density (BMD) in adolescence is a crucial determinant in osteoporosis and fragility fractures in older age. Vitamin E is the most abundant lipid-soluble antioxidant present in the blood. However, the association of vitamin E status with BMD in children and adolescents remains unclear. Methods We first measured the association of vitamin E status (serum α- and γ tocopherol) with BMD in children and adolescents with the National Health and Nutrition Examination Survey (NHANES). Multiple linear regression models were performed to evaluate their relationship after adjusting for a large range of covariates. Stratified analyses and interaction tests were used to explore their effects on different genders, ages, and races/ethnicities. Results 13,606 children and adolescents from NHANES (2005–2006, 2017–2018) were included in our analysis. Compared with the lowest α-tocopherol quartile, individuals in the highest α-tocopherol quartile are likelier to be Non-Hispanic White and have a higher value of poverty income ratio (PIR). They have a lower value of serum phosphorus and lumbar spine BMD. Every 1umol/L increase in serum α- and γ- tocopherol, the lumbar spine BMD decreased by -0.0016 and -0.0068 g/cm2. Compared with the lowest quartile serum α- and γ- tocopherol concentration, individuals in the highest quartile have a -0.0223 and -0.0329 g/cm2 lower mean BMD, respectively. Interaction effects suggest that the negative effect is more prominent among female youth, individuals aged 8–13 years, non-Hispanic whites, Mexican Americans, and non-Hispanic blacks. Conclusions Our study indicates serum α- and γ-tocopherol are negatively correlated with lumbar BMD. Age, gender, and race may have a modifying effect on this relationship. Our study has an important clinical implication. A higher vitamin E status for children and adolescents could not improve BMD, even decrease BMD. More prospective research with stronger evidence is needed to verify our findings and their underlying mechanisms.

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“…Based on previous studies (18,(22)(23)(24), confounders that may influence BMD were chosen to eliminate potential effects on the results. We also performed a multicollinearity analysis of these covariates and did not find the presence of multicollinearity.…”

Section: Variablesmentioning

confidence: 99%

“…However, it recruited smaller samples, which may result in an unreliable conclusion (17). A recent study conducted by Li et al (18) showed an N-shaped curve association between BLL and BMD in children and adolescents.…”

Section: Introductionmentioning

confidence: 99%

Blood Lead Level Is Negatively Associated With Bone Mineral Density in U.S. Children and Adolescents Aged 8-19 Years

Cui

Xiao

et al. 2022

Front. Endocrinol.

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ContextThe relationship of lead (Pb) exposure with bone health in children and adolescents remains controversial.ObjectionWe aimed to investigate the association of blood lead levels (BLL) with bone mineral density (BMD) in American children and adolescents using data from the National Health and Nutrition Examination Survey (NHANES), 2005-2010.MethodsWe analyzed 5,583 subjects aged 8-19 years (mean age, 13.49 ± 3.35 years) from the NHANES 2005-2010. BLL was tested using inductively coupled plasma mass spectrometry. BMD was measured by dual-energy X-ray absorptiometry (DXA) at the lumbar spine, total femur, and femur neck. Multivariate linear regression models were used to explore the association between BLL and BMD, adjusting for age, gender, race/ethnicity, poverty income ratio (PIR), body mass index (BMI), serum calcium, and serum phosphorus.ResultsBLL was negatively correlated with BMD at different sites of interest in children and adolescents. For every 1mg/dl increase in BLL, the BMD of the total spine, total hip, and femoral neck decreased by 0.011 g/cm2, 0.008 g/cm2, and 0.006 g/cm2. In addition, Pb affected the lumbar spine more than the femur. The effect estimates were stronger in girls than boys at the lumbar spine (P for interaction= 0.006). This negative association remained significant in American children and adolescents after excluding individuals with BLL more than 3.5 ug/dl.ConclusionOur study indicates that BLL is negatively correlated with BMD at different sites of interest in children and adolescents aged 8-19 years, even in the reference range. More research is needed to elucidate the relationships between Pb and bone health in children and adolescents, including specific mechanisms and confounding factors like race/ethnicity, gender, and age.

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The Association between Lead Exposure and Bone Mineral Density in Childhood and Adolescence: Results from NHANES 1999–2006 and 2011–2018

Cited by 17 publications

References 21 publications

Association between serum folate concentrations and blood lead levels in adolescents: A cross-sectional study

Association between serum folate concentrations and blood lead levels in adolescents: A cross-sectional study

Associations between vitamin E status and bone mineral density in children and adolescents aged 8–19 years: Evidence based on NHANES 2005–2006, 2017–2018

Blood Lead Level Is Negatively Associated With Bone Mineral Density in U.S. Children and Adolescents Aged 8-19 Years

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