Department of Environmental Health, Harvard School of Public Health, Boston, MA 02115, United States of America.
Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, United States of America.
Environ Int. 2018 Dec;121(Pt 1):349-356. doi: 10.1016/j.envint.2018.08.029. Epub 2018 Sep 20.
Low to moderate acute cadmium exposure has been associated with increased risk of chronic diseases, such as cardiovascular and kidney disease. Little is known about the association between urinary cadmium levels-an indicator of longer-term exposure-and metabolic syndrome (MetS).
We analysed data from 3982 participants aged 20-<80 years of the National Health and Nutrition Examination Survey 2001-2014. Urinary cadmium levels were measured and adjusted for creatinine using spot urine samples. Cadmium levels were evaluated in quintiles (Q). MetS was defined by National Cholesterol Education Program's Adult Treatment Panel III report criteria. Prevalence odds ratios (OR) and 95% confidence intervals (CI) were calculated using multivariable logistic regression accounting for complex survey design, while adjusting for potential confounders and stratifying by sex and smoking status.
In the overall study population, there was a marginal inverse association between urinary cadmium and MetS (adj. OR for Q5 versus Q1: 0.7; 95% CI: 0.5-1.0). Sex stratified models were similar. When examining individual components of MetS, participants with higher levels of urinary cadmium had decreased odds of abdominal obesity (adj. OR for Q5 versus Q1 0.4; 95% CI: 0.3-0.6), but increased odds for low HDL (adj. OR for Q5 versus Q1 2.1; 95% CI: 1.4-3.1). Among current smokers, higher urinary cadmium was associated with increased odds of MetS, hypertension, and low HDL even after accounting for serum cotinine-a marker of smoking intensity.
Higher levels of urinary cadmium, a marker of long term exposure, were not associated with an increased risk of MetS in the overall study population. However, higher urine cadmium was associated with altered MetS components. Current smokers were the most vulnerable group, with higher long-term cadmium exposure being associated with increased risk of MetS, low HDL, and hypertension.
低至中度急性镉暴露与心血管和肾脏疾病等慢性疾病的风险增加有关。人们对尿液中镉水平（反映长期暴露的指标）与代谢综合征（MetS）之间的关系知之甚少。
我们分析了 2001-2014 年国家健康和营养调查（NHANES）中 3982 名年龄在 20-<80 岁的参与者的数据。使用即时尿液样本测量尿液中的镉水平，并根据肌酐进行调整。镉水平在五分位数（Q）中进行评估。MetS 根据国家胆固醇教育计划成人治疗小组 III 报告标准定义。使用多变量逻辑回归计算多变量逻辑回归，考虑到复杂的调查设计，并调整潜在的混杂因素和性别及吸烟状况分层，计算患病率比值比（OR）和 95%置信区间（CI）。
在整个研究人群中，尿液镉与 MetS 呈边际负相关（Q5 与 Q1 的调整后 OR：0.7；95%CI：0.5-1.0）。按性别分层的模型相似。在检查 MetS 的各个组成部分时，尿液镉水平较高的参与者患腹部肥胖的几率降低（Q5 与 Q1 的调整后 OR：0.4；95%CI：0.3-0.6），但患低 HDL 的几率增加（Q5 与 Q1 的调整后 OR：2.1；95%CI：1.4-3.1）。在当前吸烟者中，即使考虑到吸烟强度的标志物血清可替宁，尿液中镉含量较高与 MetS、高血压和低 HDL 的患病几率增加相关。
尿液中镉水平较高，表明长期暴露，与整个研究人群的 MetS 风险增加无关。然而，较高的尿镉与改变的 MetS 成分有关。当前吸烟者是最脆弱的群体，长期镉暴露增加与 MetS、低 HDL 和高血压的患病风险增加有关。
