Xu Ping, Liu Aiping, Li Fengna, Tinkov Alexey A, Liu Longjian, Zhou Ji-Chang
School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, 518100, China.
Yaroslavl State University, 150003, Yaroslavl, Russia; IM Sechenov First Moscow State Medical University (Sechenov University), 119146, Moscow, Russia.
Environ Pollut. 2021 Jan 15;273:116480. doi: 10.1016/j.envpol.2021.116480.
Four most concerned heavy metal pollutants, arsenic, cadmium, lead, and mercury may share common mechanisms to induce metabolic syndrome (MetS). However, recent studies exploring the relationships between MetS and metal exposure presented inconsistent findings. We aimed to clarify the relationship between heavy metal exposure biomarkers and MetS using a meta-analysis and systematic review approach. Literature search was conducted in international and the Chinese national databases up to June 2020. Of selected studies, we extracted the relevant data and evaluated the quality of each study's methodology. We then calculated the pooled effect sizes (ESs), standardized mean differences (SMDs), and their 95% confidence intervals (CIs) using a random-effect meta-analysis approach followed by stratification analyses for control of potential confounders. Involving 55,536 participants, the included 22 articles covered 52 observational studies reporting ESs and/or metal concentrations on specific metal and gender. Our results show that participants with MetS had significantly higher levels of heavy metal exposure [pooled ES = 1.16, 95% CI: 1.09, 1.23; n = 42, heterogeneity I = 75.6%; and SMD = 0.22, 95% CI: 0.15, 0.29; n = 32, I = 94.2%] than those without MetS. Pooled ESs in the subgroups stratified by arsenic, cadmium, lead, and mercury were 1.04 (95% CI: 0.97, 1.10; n = 8, I = 61.0%), 1.10 (0.95, 1.27; 11, 45.0%), 1.21 (1.00, 1.48; 12, 82.9%), and 1.26 (1.06, 1.48; 11, 67.7%), respectively. Pooled ESs in the subgroups stratified by blood, urine, and the other specimen were 1.22 (95% CI: 1.08, 1.38; n = 26, I = 75.8%), 1.06 (1.00, 1.13; 14, 58.1%), and 2.41 (1.30, 4.43; 2, 0.0%), respectively. In conclusion, heavy metal exposure was positively associated with MetS. Further studies are warranted to examine the effects of individual metals and their interaction on the relationship between MetS and heavy metals.
四种最受关注的重金属污染物，即砷、镉、铅和汞，可能具有共同的机制来诱发代谢综合征（MetS）。然而，最近探索MetS与金属暴露之间关系的研究结果并不一致。我们旨在通过荟萃分析和系统评价方法来阐明重金属暴露生物标志物与MetS之间的关系。截至2020年6月，我们在国际和中国国家数据库中进行了文献检索。在选定的研究中，我们提取了相关数据并评估了每项研究方法的质量。然后，我们采用随机效应荟萃分析方法计算合并效应量（ESs）、标准化均值差（SMDs）及其95%置信区间（CIs），随后进行分层分析以控制潜在的混杂因素。纳入的22篇文章涉及55536名参与者，涵盖了52项观察性研究，报告了特定金属和性别的ESs和/或金属浓度。我们的结果表明，患有MetS的参与者的重金属暴露水平显著高于未患MetS的参与者[合并ES = 1.16，95% CI：1.09，1.23；n = 42，异质性I = 75.6%；SMD = 0.22，95% CI：0.15，0.29；n = 32，I = 94.2%]。按砷、镉、铅和汞分层的亚组中的合并ESs分别为1.04（95% CI：0.97，1.10；n = 8，I = 61.0%）、1.10（0.95，1.27；11，45.0%）、1.21（1.00，1.48；12，82.9%）和1.26（1.06，1.48；11，67.7%）。按血液、尿液和其他标本分层的亚组中的合并ESs分别为1.22（95% CI：1.08，1.38；n = 26，I = 75.8%）、1.06（1.00，1.13；14，58.1%）和2.41（1.30，4.43；2，0.0%）。总之，重金属暴露与MetS呈正相关。有必要进一步研究以检查单个金属及其相互作用对MetS与重金属之间关系的影响。
