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Environmental exposure to metals and children's growth to age 5 years: a prospective cohort study.

Gardner RM, Kippler M, Tofail F, Bottai M, Hamadani J, Grandér M, Nermell B, Palm B, Rasmussen KM, Vahter M - Am. J. Epidemiol. (2013)

Bottom Line: An inverse association was found between children's weight and height, age-adjusted z scores, and growth velocity at age 5 years and concurrent exposure to cadmium and arsenic.The associations were apparent primarily among girls.The negative effects on children's growth at age 5 years attributable to arsenic and cadmium were of similar magnitude to the difference between girls and boys in terms of weight (-0.67 kg, 95% CI: -0.82, -0.53) and height (-1.3 cm, 95% CI: -1.7, -0.89).

View Article: PubMed Central - PubMed

Affiliation: Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.

ABSTRACT
In this prospective cohort study, based on 1,505 mother-infant pairs in rural Bangladesh, we evaluated the associations between early-life exposure to arsenic, cadmium, and lead, assessed via concentrations in maternal and child urine, and children's weights and heights up to age 5 years, during the period 2001-2009. Concurrent and prenatal exposures were evaluated using linear regression analysis, while longitudinal exposure was assessed using mixed-effects linear regression. An inverse association was found between children's weight and height, age-adjusted z scores, and growth velocity at age 5 years and concurrent exposure to cadmium and arsenic. In the longitudinal analysis, multivariable-adjusted attributable differences in children's weight at age 5 years were -0.33 kg (95% confidence interval (CI): -0.60, -0.06) for high (≥95th percentile) arsenic exposure and -0.57 kg (95% CI: -0.88, -0.26) for high cadmium exposure, in comparison with children with the lowest exposure (≤5th percentile). Multivariable-adjusted attributable differences in height were -0.50 cm (95% CI: -1.20, 0.21) for high arsenic exposure and -1.6 cm (95% CI: -2.4, -0.77) for high cadmium exposure. The associations were apparent primarily among girls. The negative effects on children's growth at age 5 years attributable to arsenic and cadmium were of similar magnitude to the difference between girls and boys in terms of weight (-0.67 kg, 95% CI: -0.82, -0.53) and height (-1.3 cm, 95% CI: -1.7, -0.89).

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Relationship between children's log2-transformed urinary arsenic (As), urinary cadmium (Cd), and urinary lead (Pb) concentrations and anthropometric outcomes at age 5 years (linear regression analysis) in Matlab, Bangladesh, 2007–2009. Weight (A), height (B), weight-for-age z score (WAZ) (C), height-for-age z score (HAZ) (D), peak weight velocity (E), and peak height velocity (F) were considered as outcomes. Crude (unadjusted) associations, as described for model 1 in the Materials and Methods section, are shown as diamonds. Estimates adjusted for child's sex, family socioeconomic status, season of birth, gestational age at birth, maternal education, maternal height or body mass index (weight (kg)/height (m)2) (as appropriate), maternal tobacco-chewing, indoor cooking without ventilation, and birth order (model 2) are shown as squares. Estimates additionally adjusted for log2-transformed maternal urinary As, Cd, or Pb as appropriate (model 3) are shown as triangles. Results from a model jointly estimating the combined effects of urinary As, Cd, and Pb (model 4) are shown as circles. Δ indicates “change.” Vertical lines represent 95% confidence intervals.
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KWS437F4: Relationship between children's log2-transformed urinary arsenic (As), urinary cadmium (Cd), and urinary lead (Pb) concentrations and anthropometric outcomes at age 5 years (linear regression analysis) in Matlab, Bangladesh, 2007–2009. Weight (A), height (B), weight-for-age z score (WAZ) (C), height-for-age z score (HAZ) (D), peak weight velocity (E), and peak height velocity (F) were considered as outcomes. Crude (unadjusted) associations, as described for model 1 in the Materials and Methods section, are shown as diamonds. Estimates adjusted for child's sex, family socioeconomic status, season of birth, gestational age at birth, maternal education, maternal height or body mass index (weight (kg)/height (m)2) (as appropriate), maternal tobacco-chewing, indoor cooking without ventilation, and birth order (model 2) are shown as squares. Estimates additionally adjusted for log2-transformed maternal urinary As, Cd, or Pb as appropriate (model 3) are shown as triangles. Results from a model jointly estimating the combined effects of urinary As, Cd, and Pb (model 4) are shown as circles. Δ indicates “change.” Vertical lines represent 95% confidence intervals.

Mentions: In an analysis using log2-transformed data (Figure 4), urinary arsenic was inversely associated with weight, height, weight-for-age z score, height-for-age z score, and weight velocity at age 5 years, although these associations were no longer apparent after adjustment. When the percentage of MMA was included in model 2, we found that the percentage of MMA was positively associated with the anthropometric outcomes (Web Table 2). Urinary cadmium was consistently inversely associated with all anthropometric outcomes. The association was attenuated, though still statistically significant, after adjustment. The association strengthened slightly with the addition of prenatal urinary cadmium to the model (model 3). Urinary lead level was not associated with any of the anthropometric outcomes. In a model accounting for all 3 environmental exposures, urinary cadmium was the only biomarker to remain associated with the anthropometric outcomes.Figure 4.


Environmental exposure to metals and children's growth to age 5 years: a prospective cohort study.

Gardner RM, Kippler M, Tofail F, Bottai M, Hamadani J, Grandér M, Nermell B, Palm B, Rasmussen KM, Vahter M - Am. J. Epidemiol. (2013)

Relationship between children's log2-transformed urinary arsenic (As), urinary cadmium (Cd), and urinary lead (Pb) concentrations and anthropometric outcomes at age 5 years (linear regression analysis) in Matlab, Bangladesh, 2007–2009. Weight (A), height (B), weight-for-age z score (WAZ) (C), height-for-age z score (HAZ) (D), peak weight velocity (E), and peak height velocity (F) were considered as outcomes. Crude (unadjusted) associations, as described for model 1 in the Materials and Methods section, are shown as diamonds. Estimates adjusted for child's sex, family socioeconomic status, season of birth, gestational age at birth, maternal education, maternal height or body mass index (weight (kg)/height (m)2) (as appropriate), maternal tobacco-chewing, indoor cooking without ventilation, and birth order (model 2) are shown as squares. Estimates additionally adjusted for log2-transformed maternal urinary As, Cd, or Pb as appropriate (model 3) are shown as triangles. Results from a model jointly estimating the combined effects of urinary As, Cd, and Pb (model 4) are shown as circles. Δ indicates “change.” Vertical lines represent 95% confidence intervals.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3676155&req=5

KWS437F4: Relationship between children's log2-transformed urinary arsenic (As), urinary cadmium (Cd), and urinary lead (Pb) concentrations and anthropometric outcomes at age 5 years (linear regression analysis) in Matlab, Bangladesh, 2007–2009. Weight (A), height (B), weight-for-age z score (WAZ) (C), height-for-age z score (HAZ) (D), peak weight velocity (E), and peak height velocity (F) were considered as outcomes. Crude (unadjusted) associations, as described for model 1 in the Materials and Methods section, are shown as diamonds. Estimates adjusted for child's sex, family socioeconomic status, season of birth, gestational age at birth, maternal education, maternal height or body mass index (weight (kg)/height (m)2) (as appropriate), maternal tobacco-chewing, indoor cooking without ventilation, and birth order (model 2) are shown as squares. Estimates additionally adjusted for log2-transformed maternal urinary As, Cd, or Pb as appropriate (model 3) are shown as triangles. Results from a model jointly estimating the combined effects of urinary As, Cd, and Pb (model 4) are shown as circles. Δ indicates “change.” Vertical lines represent 95% confidence intervals.
Mentions: In an analysis using log2-transformed data (Figure 4), urinary arsenic was inversely associated with weight, height, weight-for-age z score, height-for-age z score, and weight velocity at age 5 years, although these associations were no longer apparent after adjustment. When the percentage of MMA was included in model 2, we found that the percentage of MMA was positively associated with the anthropometric outcomes (Web Table 2). Urinary cadmium was consistently inversely associated with all anthropometric outcomes. The association was attenuated, though still statistically significant, after adjustment. The association strengthened slightly with the addition of prenatal urinary cadmium to the model (model 3). Urinary lead level was not associated with any of the anthropometric outcomes. In a model accounting for all 3 environmental exposures, urinary cadmium was the only biomarker to remain associated with the anthropometric outcomes.Figure 4.

Bottom Line: An inverse association was found between children's weight and height, age-adjusted z scores, and growth velocity at age 5 years and concurrent exposure to cadmium and arsenic.The associations were apparent primarily among girls.The negative effects on children's growth at age 5 years attributable to arsenic and cadmium were of similar magnitude to the difference between girls and boys in terms of weight (-0.67 kg, 95% CI: -0.82, -0.53) and height (-1.3 cm, 95% CI: -1.7, -0.89).

View Article: PubMed Central - PubMed

Affiliation: Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.

ABSTRACT
In this prospective cohort study, based on 1,505 mother-infant pairs in rural Bangladesh, we evaluated the associations between early-life exposure to arsenic, cadmium, and lead, assessed via concentrations in maternal and child urine, and children's weights and heights up to age 5 years, during the period 2001-2009. Concurrent and prenatal exposures were evaluated using linear regression analysis, while longitudinal exposure was assessed using mixed-effects linear regression. An inverse association was found between children's weight and height, age-adjusted z scores, and growth velocity at age 5 years and concurrent exposure to cadmium and arsenic. In the longitudinal analysis, multivariable-adjusted attributable differences in children's weight at age 5 years were -0.33 kg (95% confidence interval (CI): -0.60, -0.06) for high (≥95th percentile) arsenic exposure and -0.57 kg (95% CI: -0.88, -0.26) for high cadmium exposure, in comparison with children with the lowest exposure (≤5th percentile). Multivariable-adjusted attributable differences in height were -0.50 cm (95% CI: -1.20, 0.21) for high arsenic exposure and -1.6 cm (95% CI: -2.4, -0.77) for high cadmium exposure. The associations were apparent primarily among girls. The negative effects on children's growth at age 5 years attributable to arsenic and cadmium were of similar magnitude to the difference between girls and boys in terms of weight (-0.67 kg, 95% CI: -0.82, -0.53) and height (-1.3 cm, 95% CI: -1.7, -0.89).

Show MeSH
Related in: MedlinePlus