Unit of Metals and Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Environ Res. 2016 May;147:1-7. doi: 10.1016/j.envres.2016.01.031. Epub 2016 Jan 30.
There is increasing evidence of adverse health effects due to elevated lithium exposure through drinking water but the impact on calcium homeostasis is unknown. This study aimed at elucidating if lithium exposure through drinking water during pregnancy may impair the maternal calcium homeostasis. In a population-based mother-child cohort in the Argentinean Andes (n=178), with elevated lithium concentrations in the drinking water (5-1660μg/L), blood lithium concentrations (correlating significantly with lithium in water, urine and plasma) were measured repeatedly during pregnancy by inductively coupled plasma mass spectrometry and used as exposure biomarker. Markers of calcium homeostasis included: plasma 25-hydroxyvitamin D3, serum parathyroid hormone (PTH), and calcium, phosphorus and magnesium concentrations in serum and urine. The median maternal blood lithium concentration was 25μg/L (range 1.9-145). In multivariable-adjusted mixed-effects linear regression models, blood lithium was inversely associated with 25-hydroxyvitamin D3 (-6.1nmol/L [95%CI -9.5; -2.6] for a 25μg/L increment in blood lithium). The estimate increased markedly with increasing percentiles of 25-hydroxyvitamin D3. In multivariable-adjusted mixed-effects logistic regression models, the odds ratio of having 25-hydroxyvitamin D3<30nmol/L (19% of the women) was 4.6 (95%CI 1.1; 19.3) for a 25μg/L increment in blood lithium. Blood lithium was also positively associated with serum magnesium, but not with serum calcium and PTH, and inversely associated with urinary calcium and magnesium. In conclusion, our study suggests that lithium exposure through drinking water during pregnancy may impair the calcium homeostasis, particularly vitamin D. The results reinforce the need for better control of lithium in drinking water, including bottled water.
越来越多的证据表明，饮用水中锂含量升高会对健康产生不良影响，但钙稳态的影响尚不清楚。本研究旨在阐明孕妇通过饮用水摄入锂是否会损害母体钙稳态。在阿根廷安第斯地区进行的一项基于人群的母婴队列研究中（n=178），饮用水中锂浓度升高（5-1660μg/L），通过电感耦合等离子体质谱法在怀孕期间多次测量血液锂浓度（与水中、尿液和血浆中的锂显著相关），并用作暴露生物标志物。钙稳态标志物包括：血浆 25-羟维生素 D3、血清甲状旁腺激素（PTH）以及血清和尿液中的钙、磷和镁浓度。孕妇血液锂的中位数浓度为 25μg/L（范围 1.9-145）。在多变量调整的混合效应线性回归模型中，血液锂与 25-羟维生素 D3 呈负相关（血液锂增加 25μg/L 时，-6.1nmol/L[95%CI-9.5；-2.6]）。随着 25-羟维生素 D3 百分位数的增加，估计值显著增加。在多变量调整的混合效应逻辑回归模型中，血液锂增加 25μg/L 时，25-羟维生素 D3<30nmol/L（19%的女性）的比值比为 4.6（95%CI 1.1；19.3）。血液锂还与血清镁呈正相关，但与血清钙和 PTH 无关，与尿钙和镁呈负相关。总之，我们的研究表明，孕妇通过饮用水摄入锂可能会损害钙稳态，尤其是维生素 D。这些结果强化了需要更好地控制饮用水中的锂，包括瓶装水。
