Current Blood Lead Concentration Research Articles

Association of Tobacco and Lead Exposures With Attention-Deficit/Hyperactivity Disorder

The study objective was to determine the independent and joint associations of prenatal tobacco and childhood lead exposures with attention-deficit/hyperactivity disorder (ADHD), as defined by current diagnostic criteria, in a national sample of US children. Data are from the 2001-2004 National Health and Nutrition Examination Survey, a cross-sectional, nationally representative sample of the US population. Participants were 8 to 15 years of age (N = 2588). Prenatal tobacco exposure was measured by report of maternal cigarette use during pregnancy. Lead exposure was assessed by using current blood lead levels. The Diagnostic Interview Schedule for Children was used to ascertain the presence of ADHD in the past year, on the basis of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. A total of 8.7% (95% confidence interval [CI]: 7.3%-10.1%) of children met criteria for ADHD. Prenatal tobacco exposure (adjusted odds ratio [aOR]: 2.4 [95% CI: 1.5-3.7]) and higher current blood lead concentrations (aOR for third versus first tertile: 2.3 [95% CI: 1.5-3.8]) were independently associated with ADHD. Compared with children with neither exposure, children with both exposures (prenatal tobacco exposure and third-tertile lead levels) had an even greater risk of ADHD (aOR: 8.1 [95% CI: 3.5-18.7]) than would be expected if the independent risks were multiplied (tobacco-lead exposure interaction term, P < .001). Prenatal tobacco and childhood lead exposures are associated with ADHD in US children, especially among those with both exposures. Reduction of these common toxicant exposures may be an important avenue for ADHD prevention.

Association of Environmental Toxicants and Conduct Disorder in U.S. Children: NHANES 2001–2004

ObjectiveThe purpose of this study was to examine the association of tobacco smoke and environmental lead exposure with conduct disorder (CD).MethodsThe National Health and Nutrition Examination Survey (NHANES) 2001–2004 is a nationally representative cross-sectional sample of the noninstitutionalized U.S. population. We examined the association of prenatal tobacco, postnatal tobacco, and environmental lead exposure with CD in children 8–15 years of age (n = 3,081). We measured prenatal tobacco exposure by parent report of cigarette use during pregnancy, and postnatal tobacco using serum cotinine levels. We assessed lead exposure using current blood lead concentration. Parents completed the Diagnostic Interview Schedule for Children to determine whether their children met criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV ) for CD.ResultsOverall, 2.06% of children met DSM-IV criteria for CD in the past year, equivalent to 560,000 U.S. children 8–15 years of age. After adjustment, prenatal tobacco exposure was associated with increased odds for CD [odds ratio (OR) = 3.00; 95% confidence interval (CI), 1.36–6.63]. Increased blood lead levels (fourth vs. first quartile) and serum cotinine levels (fifth vs. first quintile) were associated with an 8.64-fold (95% CI, 1.87–40.04) and 9.15-fold (95% CI, 1.47–6.90) increased odds of meeting DSM-IV CD criteria. Increasing serum cotinine levels and blood lead levels were also associated with increased prevalence of CD symptoms (symptom count ratio, lead: 1.73; 95% CI, 1.23–2.43; symptom count ratio, cotinine: 1.97; 95% CI, 1.15–3.40).ConclusionsThese results suggest that prenatal tobacco exposure and environmental lead exposure contribute substantially to CD in U.S. children.

Present and Long Term Effect of Environmental Lead Exposure Over Intellectual Impairment in Children

ISEE-632 Objective: To determine if there is an association between early blood lead concentration and present intellectual ability in exposed schoolchildren, despite lead abatement in the area. Materials and Methods: 442 exposed children had blood lead evaluation in 1998. Of those, 47.5% had lead levels >10 μg/dL. After 7 years a cross-sectional study was conducted in 188 children between 7 and 16 years old, representing 43% of the group studied originally. We used past (1998) and current (2005) blood lead concentration as explanatory variables for intellectual ability (IQ) measured by the WISC-r test. Multiple regression models were used to evaluate the relationship between IQ and blood lead concentration, adjusting by maternal intelligence (WAIS scale), home stimulus (HOME questionnaire), sex, and SES. Results: Blood lead concentration was 3.6±2.3 μg/dL (range 0.5–14) in 2005 and 10.6 + 6.9 μg/dL (range 1–33) in 1998 with a correlation of 0.44 (P = 0.0001). Adjusting for the covariates, we found a significant inverse association between IQ and blood lead in 2005; however, we could not demonstrate a similar association with blood lead in 1998. An increase in the current blood lead concentration of 1 μg/dL was associated with a decrease of 1.03 IQ points (P = 0.012). The deleterious effect is greater the higher the blood lead level as shown through 4 categories of exposure: reference (1.4±0.41 μg/dL); low (2.6±0.37); medium (3.6±0.29) and high (6.5±2.5). Respectively the IQ deficits were: 1.9, 4.3, and 5.1 compared to the reference. Conclusions: Our findings provide additional evidence for deleterious effect of environmental lead on intellectual impairment at blood lead concentrations below 10 μg/dL. Recent blood lead seems more important than past blood lead. Policy efforts should target to prevent lead exposure to optimize children's intellectual potential.

Association between bone lead concentration and blood pressure among young adults.

Occupational and environmental exposure to lead has been examined for its effect on blood pressure (BP) in adults with varying results. The present analyses assessed the association between bone lead concentration and BP in early adult life in persons exposed during childhood. Study participants included young adult members of two cohorts with different past histories of lead exposure. Lead exposure was assessed using noninvasive K-X-ray fluorescence spectroscopy to quantify bone lead concentration, an index of long-term lead exposure superior to current blood lead concentration. Systolic and diastolic BP measurements were obtained using conventional clinical methods. Multiple linear regression models were constructed to allow for control of covariates of BP identified a priori. Analyses were performed on 508 participants. While controlling for potential confounders, systolic BP was 4.3 mm Hg greater among members of the highest of four bone lead concentration groups (> 10 microg Pb/g bone) when compared with the lowest bone lead concentration group (< 1 microg Pb/g bone; P = 0.004), and diastolic BP was 2.8 mm Hg greater among members of the highest bone lead concentration group when compared with the lowest bone lead concentration group (P = 0.03). These results suggest that substantial lead exposure during childhood can increase BP during young adulthood.

Vibration perception thresholds in workers with long term exposure to lead

OBJECTIVESTo evaluate the impact of long term occupational exposure to lead on function of the peripheral nervous system as reflected by vibration perception threshold (VPT), measured with a portable vibrameter.METHODS217...

109Cd K x ray fluorescence measurements of tibial lead content in young adults exposed to lead in early childhood

OBJECTIVESTibia lead measurements were performed in a population of 19–29 year old people who had been highly exposed to lead in childhood to find whether lead had persisted in the...

Relation of cumulative exposure to inorganic lead and neuropsychological test performance.

To determine if measures reflecting chronic occupational lead exposure are associated with performance on neuropsychological tests. 467 Canadian male lead smelter workers (mean (SD) age 43.4 (11.00) years, education 9.8 (3.18) years, years of employment 17.7 (7.43), and current blood lead concentration (B-Pb) 27.5 (8.4) micrograms dl-1) were given a neuropsychological screening battery. Time weighted average (TWA) and time integrated blood levels (IBL) were developed from B-Pb records obtained through regular medical monitoring (mean (range) TWA 40.1 (4.0-66.4) micrograms dl-1, mean IBL 765.2 (0.6-1625.7) micrograms-y dl-1). 14 neuropsychological variables were included in three multivariate analyses of covariance, with each exposure variable as the grouping variable (high, medium, and low) and age, education, score on a measure of depressive symptoms, and self reported alcohol use as the covariates. Groups did not differ in history of neurological conditions. Neither the B-Pb, TWA, nor IBL was significant by multivariate analyses of covariance (MANCOVA). When years of employment, a suppressor variable, was included as a covariate, IBL exposure groups differed significantly on digit symbol, logical memory, Purdue dominant hand, and trails A and B. A dose-effect relation was found between cumulative exposure (IBL) and neuropsychological performance at a time when current B-Pb concentrations were low and showed no association with performance.

Semen quality of men employed at a lead smelter.

To evaluate the effects of recent and long term occupational lead exposure on indicators of male reproductive health. In a cross sectional study of male employees of a lead smelter (n = 2469), blood samples were obtained from 152 workers including 119 who also provided semen samples. Semen analysis and serum concentrations of testosterone, follicle stimulating hormone, and luteinising hormone were used as indicators of reproductive health. Semen and hormone variables were examined in relation to measures of current and long term body lead burden estimated from current blood lead concentrations and historical blood lead monitoring data. For current blood lead concentration groups of < 15, 15-24, 25-39, > 40 micrograms/dl, the geometric mean sperm concentrations were, respectively, 79.1, 56.5, 62.7, and 44.4 million cells/ml and geometric mean total sperm counts were 186, 153, 137, and 89 million cells (P for trend 0.04). Compared with workers with blood lead concentrations less than 15 micrograms/dl, workers with current blood lead concentrations of 40 micrograms/dl or more had an increased risk of below normal sperm concentration (odds ratio (OR) 8.2, 95% confidence interval (95% CI) 1.2-57.9) and total sperm count (OR 2.6, 95% CI 0.4-15.7), based on World Health Organisation standards. Independent of current lead exposure, sperm concentration, total sperm count, and total motile sperm count were inversely related to measures of long term lead exposure. No association was found between lead exposure and measures of sperm motility, sperm morphology, or serum concentrations of reproductive hormones. Blood lead concentrations below the currently accepted worker protection criteria seem to adversely affect spermatogenesis.

Cumulative exposure to inorganic lead and neurobehavioural test performance in adults: an epidemiological review.

To evaluate the current evidence that cumulative exposure to inorganic lead is associated with decreased performance in neurobehavioural tests in adults. 21 unique studies were reviewed from 28 published manuscripts. An algorithm was developed to determine the usefulness of each study on the basis of exposure assessment, control of confounding variables, methods of subject selection, test conditions, and data analysis. Highest emphasis was placed on the use of cumulative measures of exposure or absorption. Only three studies used a measure of cumulative exposure to or absorption of lead, and two others used duration of exposure as a surrogate for cumulative exposure. All other studies used a measure that did not adequately estimate cumulative exposure to lead, most often current blood lead concentration. 20 of the studies controlled for age as a confounding variable, although in several studies the possibility for residual confounding by age remained. 16 studies controlled for intellectual ability before exposure; all of them used educational level for this purpose. Of the five studies that used direct or surrogate measures of cumulative exposure to or absorption of lead, two were thought to be of low usefulness because of inadequate duration of exposure. The three remaining studies found stronger associations of neurobehavioural performance with recent exposure measures than with those of cumulative exposure. The current scientific literature provides inadequate evidence to conclude whether or not cumulative exposure to or absorption of lead adversely affects performance in neurobehavioural tests in adults. The current evidence is flawed because of inadequate estimation of cumulative exposure to or absorption of lead and inadequate control for age and intellectual ability before exposure.

Postural stability of workers exposed to lead.

To detect, with a computerised postural sway measurement system, any significant deviation of postural sway parameters among lead workers compared with a control group. Postural stability was investigated with a computerised postural sway measurement system in 60 workers exposed to lead with a duration of exposure of 84 (range 3-366) months and 60 controls. Sway parameter data were collected with an Advanced Mechanical Technology computerised biomechanics platform system. The mean current blood lead concentration was 36.0 (range 6.4 to 64.5) micrograms/dl for the exposed workers and 6.3 (range 3.1 to 10.9) micrograms/dl for the 14 controls. There was no significant difference between the groups for the postural sway parameters obtained when the eyes were open. Significant differences were found for Xs, Ys (SDs of the coordinates of the centre of pressure); Xm, Ym (mean deviation of the coordinates of the centre of pressure); Rm (average displacement of Xi, Yi, from Xo, Yo); L (length of sway path); Vel (mean velocity of the centre of pressure along its path); Ao (area included within the path of the centre of pressure); Ae (95% confidence elliptical area). The Romberg ratios (the relation between eyes closed and open) for the Vel, L, Ao and Ae of the exposed workers were also significantly different from the controls. The study showed that workers exposed to lead had significantly poorer postural stability than the controls. Lead may affect certain parts of the whole sensory neural axis resulting in postural instability when the visual input is cut off. Based on current blood lead concentrations, we were not able to obtain any significant association with the postural sway parameters.

Male endocrine functions in workers with moderate exposure to lead.

Evidence for the effect of occupational exposure to lead on the male endocrine system is conflicting. This study evaluated the primary (testicular) and secondary (hypothalamo pituitary testicular) effects of exposure to lead in 122 current lead workers and 49 non-exposed workers. The mean current blood lead concentration was 35.2 (range 9.6-77.4) micrograms/dl in the exposed workers, and 8.3 (range 2.6-14.8) micrograms/dl in the non-exposed workers. Concentrations of plasma luteinising hormone (LH) and follicle stimulating hormone (FSH) were both significantly higher in the exposed workers, but testosterone (T) was not significantly different between the two groups. In older exposed workers, however (greater than or equal to 40 years), plasma T concentrations were significantly lower, but LH and FSH concentrations were not significantly different. Compared with non-exposed workers, those exposed for less than 10 years had significantly raised LH and FSH and normal T concentrations whereas those exposed for 10 or more years had significantly lower T, and normal LH and FSH concentrations. The concentrations of LH and FSH showed a moderate increase in relation to blood lead concentrations in the range of 10 micrograms/dl to 40 micrograms/dl and thereafter reached a plateau or declined. No apparent trend for plasma T concentrations occurred. No significant difference in prolactin (PRL) concentration was noted. It is concluded that moderate exposure to lead was associated in dose related fashion with small but measurable changes in male endocrine functions that reflected both primary and secondary effects of lead on the testes and the hypothalamo pituitary testicular axis.

Toxocara canis infection of children: epidemiologic and neuropsychologic findings.

Sera from 4,652 children whose blood was submitted to the New York City Department of Health for lead analysis were tested for antibodies to Toxocara canis using an enzyme-linked immunosorbent assay (ELISA). Standardized to the age distribution of the study population, T. canis seropositivity (inverse titers greater than or equal to 16) was 5.7 per cent in males and 5.1 per cent in females. T. canis antibody titers and lead exposures as measured by Centers for Disease Control lead classes were positively correlated. Children who were seropositive to T. canis (cases) were compared to seronegatives (controls) matched on age (+/- 6 months), sex, time-of-screening (+/- 3 months) and CDC lead class. Logistic regression analysis of 155 case-control pairs demonstrated elevated relative risks (RRs) for geophagia (RR = 3.14; 95% CI = 1.75, 5.64) and having had a litter of puppies in the home (RR = 5.22; 95% CI = 1.63, 16.71). Compared to controls, cases had increased eosinophil counts, serum immunoglobulin E concentrations, and anti-hemagglutinin-A titers. Small deficits in cases compared to controls were found in performance on several neuropsychological tests after adjustment for potential confounders including case-control differences in race, socioeconomic status, and current blood lead concentrations. The study thus confirmed that T. canis infection is common in urban children and suggested that infection may be associated with adverse neuropsychological effects.