Muciño-Sandoval Karla, Ariza Ana Carolina, Ortiz-Panozo Eduardo, Pizano-Zárate María Luisa, Mercado-García Adriana, Wright Robert, Maria Téllez-Rojo Martha, Sanders Alison P, Tamayo-Ortiz Marcela
Research Center for Health and Nutrition, National Institute of Public Health, Cuernavaca, Mexico.
Research Center for Population Health, National Institute of Public Health, Cuernavaca, Mexico.
Front Pediatr. 2021 Oct 29;9:750316. doi: 10.3389/fped.2021.750316. eCollection 2021.
Exposure to lead (Pb) during the early life stages has been associated with the development of metabolic syndrome (MetS). Longitudinal studies of Pb exposure in critical developmental windows in children are limited. Our study included 601 mother-child dyads from the PROGRESS (Programming Research in Obesity, Growth, Environment and Social Stressors) birth cohort. Blood lead levels (BLLs) were assessed during the second and third gestational trimesters, in cord blood at delivery, and at ages 1, 2, and 4 years. Bone lead levels in the patella and tibia were assessed at 1 month postpartum and evaluated in separate models. To account for cumulative exposure (prenatal, postnatal, and cumulative), we dichotomized the BLLs at each stage visit and determined the following: "higher" if a BLL was at least once above the median (HPb) and "lower" if all BLLs were below the median (LPb). We analyzed fasting glucose, HbA1c, triglycerides (TGs), total cholesterol (TC), high-density lipoprotein cholesterol (cHDL), low-density lipoprotein cholesterol (cLDL), body mass index, waist circumference (WC), body fat percentage, and systolic (SBP) and diastolic blood pressure (DBP) at two study visits between 6 and 12 years of age and created cutoff points based on the clinical guidelines for each indicator. Mixed effects models were used to analyze each outcome longitudinally for each BLL score, adjusting for child's sex, size for gestational age, child's age, maternal parity, mother's age, and socioeconomic status. We observed associations for HPb exposure and TC in all stages (OR = 0.53, 95%CI = 0.32-0.86) and postnatally (OR = 0.59, 95%CI = 0.36-0.94) and for prenatal HPb and TGs (OR = 0.65, 95%CI = 0.44-0.95). HPb at all stages was associated with WC (OR = 0.27, 95%CI = 0.08-0.86), BMI (OR = 0.33, 95%CI = 0.11-0.99), SBP (OR = 0.53, 95%CI = 0.32-0.85), and DBP (OR = 0.57, 95%CI = 0.34-0.95). Pb levels in the patella were associated with cHDL (OR = 1.03, 95%CI = 1.00-1.07) and those in the tibia with TGs (OR = 0.95, 95%CI = 0.91-0.99). Early life exposure to Pb may alter early indicators of MetS. A follow-up of these children will allow for more definition on the impact of longer-term exposures.
生命早期阶段接触铅(Pb)与代谢综合征(MetS)的发生有关。关于儿童关键发育窗口期铅暴露的纵向研究有限。我们的研究纳入了来自PROGRESS(肥胖、生长、环境和社会应激源编程研究)出生队列的601对母婴。在妊娠中期的第二个和第三个月、分娩时的脐带血以及1岁、2岁和4岁时评估血铅水平(BLLs)。产后1个月评估髌骨和胫骨的骨铅水平,并在单独的模型中进行评估。为了考虑累积暴露(产前、产后和累积暴露),我们在每个阶段访视时将BLLs进行二分法划分,并确定如下:如果BLL至少有一次高于中位数,则为“较高”(HPb);如果所有BLL均低于中位数,则为“较低”(LPb)。我们在6至12岁之间的两次研究访视中分析了空腹血糖、糖化血红蛋白(HbA1c)、甘油三酯(TGs)、总胆固醇(TC)、高密度脂蛋白胆固醇(cHDL)、低密度脂蛋白胆固醇(cLDL)、体重指数、腰围(WC)、体脂百分比以及收缩压(SBP)和舒张压(DBP),并根据每个指标的临床指南设定了临界点。使用混合效应模型对每个BLL分数的每个结局进行纵向分析,同时对儿童性别、胎龄大小、儿童年龄、母亲生育次数、母亲年龄和社会经济地位进行了调整。我们观察到,在所有阶段(OR = 0.53,95%CI = 0.32 - 0.86)以及产后(OR = 0.59,95%CI = 0.36 - 0.94),HPb暴露与TC相关,产前HPb与TGs相关(OR = 0.65,95%CI = 0.44 - 0.95)。所有阶段的HPb与WC(OR = 0.27,95%CI = 0.08 - 0.86)、BMI(OR = 0.33,95%CI = 0.11 - 0.99)、SBP(OR = 0.53,95%CI = 0.32 - 0.85)和DBP(OR = 0.57,95%CI = 0.34 - 0.95)相关。髌骨中的铅水平与cHDL相关(OR = 1.03,95%CI = 1.00 - 1.07),胫骨中的铅水平与TGs相关(OR = 0.95,95%CI = 0.91 - 0.99)。生命早期接触铅可能会改变MetS的早期指标。对这些儿童进行随访将有助于更明确长期暴露的影响。