Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Legal Medicine, School of Pharmacy, Universitat de Valencia. Avenida Vicente Andres Estellés s/n, Burjassot, 46100 Valencia, Spain.
Department of Biology, University of Pisa, Via Luca Ghini, 13-56126 Pisa, Italy.
Int J Environ Res Public Health. 2019 Jan 29;16(3):382. doi: 10.3390/ijerph16030382.
The etiology of Attention-Deficit/Hyperactivity Disorder (ADHD) is complex and multifactorial. Although the development of ADHD symptoms remains to be elucidated, in recent years, epigenetic processes have emerged as candidate mechanisms. Lead is one of the most dangerous environmental pollutants, and it is suspected to be associated with ADHD. The aim of the present study was to review the epidemiological literature currently available on the relation between lead exposure and the diagnosis of ADHD. The PubMed and EMBASE databases were searched from 1 July 2018 up to 31 July 2018. The authors included observational studies (cohort, case⁻control and cross-sectional studies) published in English carried out on children within the last 5 years, measuring lead exposure and health outcomes related to ADHD. Seventeen studies met the inclusion criteria: 5 of these studies found no association between lead exposure and ADHD whereas the remaining 12 studies showed positive associations, even though not all of them were homogeneous in terms of exposure periods considered or ADHD diagnosis. To conclude, the evidence from the studies allowed us to establish that there is an association between lead and ADHD and that even low levels of lead raise the risk. However, there is still a lack of longitudinal studies about the relationship between lead exposure and the development of ADHD. Given the potential importance for public health, further research that includes the entire potential risk factors for ADHD in children must be encouraged.
注意缺陷多动障碍(ADHD)的病因复杂且具有多因素性。虽然 ADHD 症状的发展仍有待阐明,但近年来,表观遗传过程已成为候选机制。铅是最危险的环境污染物之一,据怀疑与 ADHD 有关。本研究旨在综述目前关于铅暴露与 ADHD 诊断之间关系的流行病学文献。从 2018 年 7 月 1 日至 2018 年 7 月 31 日,对 PubMed 和 EMBASE 数据库进行了检索。作者纳入了在过去 5 年内发表的关于儿童的观察性研究(队列、病例对照和横断面研究),这些研究测量了铅暴露与 ADHD 相关的健康结果。有 17 项研究符合纳入标准:其中 5 项研究发现铅暴露与 ADHD 之间无关联,而其余 12 项研究显示出阳性关联,尽管它们在考虑的暴露期或 ADHD 诊断方面并非全部一致。总之,这些研究的证据表明,铅与 ADHD 之间存在关联,即使是低水平的铅也会增加风险。然而,关于铅暴露与 ADHD 发展之间关系的纵向研究仍然缺乏。鉴于其对公共卫生的潜在重要性,必须鼓励开展进一步的研究,将儿童 ADHD 的所有潜在风险因素都纳入其中。