Abstract
Cadmium (Cd) is a toxic heavy metal associated with increased mortality, but the effect of zinc (Zn) intake on the association between Cd and mortality is unknown. The objective of this study was to examine the association of urinary Cd to Zn intake ratio (Cd/Zn ratio) and mortality risk. In total, 15642 US adults in NHANES 1988–1994 and 1999–2004 were followed until 2011 (15-year mean follow-up). Of the 5367 total deaths, 1194 were attributed to cancer and 1677 were attributed to CVD. After adjustment for potential confounders, positive associations were observed between urinary Cd and all-cause mortality (HR for highest vs. lowest quartile: 1.38; 95% CI: 1.14–1.68) and cancer mortality (HR: 1.54; CI: 1.05–2.27). Urinary Cd was positively associated with cancer mortality among the lowest Zn consumers, and the association diminished among the highest Zn consumers. Positive relationships were observed between the Cd/Zn ratio and all-cause mortality (HR: 1.54; CI: 1.23–1.93), cancer mortality (HR: 1.65; CI: 1.11–2.47) and CVD mortality (HR: 1.49; CI: 1.18–1.88). In conclusion, these findings indicate that Zn intake may modify the association between Cd and mortality. Furthermore, the Cd/Zn ratio, which was positively associated with mortality from all causes, cancer, and CVD, may be an important predictor of mortality.
Highlights
During certain industrial processes, cadmium (Cd), a highly toxic and carcinogenic metal, is produced as a byproduct
Our findings are in agreement with studies showing that urinary Cd was negatively associated with body mass index (BMI) in NHANES
The current study found that higher urinary Cd was associated with cardiovascular disease (CVD) risk factors such as hypertension, aspirin use, and history of coronary heart disease (CHD) or stroke, consistently with a previous report linking urinary Cd to CVD [44]
Summary
Cadmium (Cd), a highly toxic and carcinogenic metal, is produced as a byproduct. Cd can leach into soil and water which are used in agricultural processes, causing Cd to appear in the food supply [1]. Due to its long half-life, Cd may be accumulated in multiple tissue types in the human body, thereby leading to many diseases such as kidney dysfunction [3], reproductive dysfunction [4], cardiovascular disease [5], diabetes [6], osteoporosis [7], cancer [8], and increased mortality [9]. Higher Cd exposure has been linked to increased cardiovascular disease (CVD) risk in a Swedish cohort study [10] and linked to heart failure and mortality in elderly Australian women [11]. Cd exposure has been associated with mortality from total, lung and pancreatic cancers in the Strong Heart
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