宫内暴露于有毒金属和微量营养素与儿童超重或肥胖的风险：微量营养素对抗有毒金属的新见解。
In-utero co-exposure to toxic metals and micronutrients on childhood risk of overweight or obesity: new insight on micronutrients counteracting toxic metals.
机构信息
Department of Civil and Systems Engineering, Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA.
Department of Applied Mathematics and Statistics, Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA.
出版信息
Int J Obes (Lond). 2022 Aug;46(8):1435-1445. doi: 10.1038/s41366-022-01127-x. Epub 2022 May 19.
BACKGROUND/OBJECTIVES: Low-level, in-utero exposure to toxic metals such as lead (Pb) and mercury (Hg) is widespread in the US and worldwide; and, individually, was found to be obesogenic in children. To address the literature gaps on the health effects of co-exposure to low-level toxic metals and the lack of intervention strategy, we aimed to investigate the association between in-utero co-exposure to Hg, Pb, cadmium (Cd) and childhood overweight or obesity (OWO) and whether adequate maternal micronutrients (selenium (Se) and folate) can be protective.
SUBJECTS/METHODS: This study included 1442 mother-child pairs from the Boston Birth Cohort, a predominantly urban, low-income, Black, and Hispanic population, who were enrolled at birth and followed prospectively up to age 15 years. Bayesian kernel machine regression (BKMR) was applied to estimate individual and joint effects of exposures to metals and micronutrients on childhood OWO while adjusting for pertinent covariables. Stratified analyses by maternal OWO and micronutrient status were performed to identify sensitive subgroups.
RESULTS
In this sample of understudied US children, low-level in-utero co-exposure to Hg, Pb, and Cd was widespread. Besides individual positive associations of maternal Hg and Pb exposure with offspring OWO, BKMR clearly indicated a positive dose-response association between in-utero co-exposure to the three toxic metals and childhood OWO. Notably, the metal mixture-OWO association was more pronounced in children born to mothers with OWO; and in such a setting, the association was greatly attenuated if mothers had higher Se and folate levels.
CONCLUSIONS
In this prospective cohort of US children at high-risk of toxic metal exposure and OWO, we demonstrated that among children born to mothers with OWO, low-level in-utero co-exposure to Hg, Pb, and Cd increased the risk of childhood OWO; and that adequate maternal Se and folate levels mitigated the risk of childhood OWO.
CLINICAL TRIAL REGISTRY NUMBER AND WEBSITE WHERE IT WAS OBTAINED
NCT03228875.
背景/目的：在美国和全球范围内，低水平的宫内暴露于有毒金属（如铅[Pb]和汞[Hg]）非常普遍；并且，单独来看，这些金属会导致儿童肥胖。为了解决关于低水平有毒金属共同暴露对健康影响的文献空白以及缺乏干预策略的问题，我们旨在研究宫内共同暴露于汞、铅、镉（Cd）与儿童超重或肥胖（OWO）之间的关联，以及母体充足的微量营养素（硒[Se]和叶酸）是否具有保护作用。
研究对象/方法：这项研究包括来自波士顿出生队列的 1442 对母婴对，这些母婴主要来自城市、低收入、黑人和西班牙裔人群，他们在出生时就被纳入研究，并在 15 岁之前进行了前瞻性随访。贝叶斯核机器回归（BKMR）被应用于估计金属和微量营养素暴露对儿童 OWO 的个体和联合效应，同时调整了相关的协变量。对母体 OWO 和微量营养素状况进行分层分析，以确定敏感亚组。
结果
在这个未被充分研究的美国儿童样本中，低水平的宫内共同暴露于 Hg、Pb 和 Cd 非常普遍。除了母体 Hg 和 Pb 暴露与后代 OWO 的个体正相关外，BKMR 还明确表明宫内共同暴露于这三种有毒金属与儿童 OWO 之间存在正剂量反应关系。值得注意的是，在母亲肥胖的儿童中，金属混合物与 OWO 的关联更为明显；而在这种情况下，如果母亲的 Se 和叶酸水平较高，则该关联会大大减弱。
结论
在这个高风险的美国儿童有毒金属暴露和 OWO 的前瞻性队列中，我们证明了在母亲肥胖的儿童中，低水平的宫内共同暴露于 Hg、Pb 和 Cd 增加了儿童 OWO 的风险；而母体充足的 Se 和叶酸水平则降低了儿童 OWO 的风险。
临床试验注册号及获取网站
NCT03228875。
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