Abstract
Background: Environmental lead and cadmium exposure is associated with higher risk of several age-related chronic diseases, including cardiovascular disease, chronic kidney disease and osteoporosis. Moreover, these diseases may also lead to the frailty syndrome. However, no previous study has evaluated the association between lead or cadmium exposure with frailty in older adults. Methods: Cross-sectional study among individuals aged ≥60 years who participated in the third U.S. National Health and Nutrition Examination Survey (NHANES III) and had either blood lead (N=5,272) or urine cadmium (N=4,887) determinations. Frailty was ascertained based on a slight modification of the Fried criteria. The association between lead and cadmium with frailty was evaluated using logistic regression with adjustment for relevant confounders. Results: Median (intertertile range) concentrations of blood lead and urine cadmium were 3.9 µg/dl (2.9-4.9) and 0.69 µg/g (0.52-0.98), respectively. The prevalence of frailty was 7.1%. The adjusted odds ratio (95% confidence interval) of frailty comparing the second and third to the lowest tertile of blood lead were, respectively, 1.40 (0.96-2.04) and 1.75 (1.33-2.31); p value for linear trend <0.01. Lead concentrations were also associated with the frequency of exhaustion, weakness and slowness. The corresponding odds ratios (95% confidence interval) for cadmium were, respectively, 0.70 (0.45-1.09) and 1.67 (1.05-2.66); p value for trend 0.03, but this association did not hold after excluding participants with reduced glomerular filtration rate: 1.12 (0.67-1.86) and 1.12 (0.82-1.53). Conclusions: In the US older adult population, blood lead concentrations showed a direct dose-response relationship with frailty; by contrast, the results did not support an association between cadmium and frailty.
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