Dirección de Salud Ambiental, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca 62100, Morelos, Mexico.
Dirección de Salud Reproductiva, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Ciudad de México 14080, Morelos, Mexico.
Int J Environ Res Public Health. 2023 Mar 15;20(6):5174. doi: 10.3390/ijerph20065174.
Lead can affect early childhood development (ECD) differentially due to nutritional deficiencies that lead to stunted growth, defined as being at least two standard deviations below the average height-for-age. These deficiencies are more frequent among children living in rural locations or with lower socioeconomic status (SES); however, studies at a population level are scarce worldwide. Early childhood development plays a crucial role in influencing a child's health and wellbeing throughout life. Therefore, the aim of this study was to analyze how stunted growth can modify the association between lead exposure and ECD in children from disadvantaged communities.
Data were analyzed from the 2018 National Health and Nutrition Survey in localities with fewer than 100,000 inhabitants in Mexico (ENSANUT-100K). Capillary blood lead (BPb) levels were measured using a LeadCare II device and dichotomized as detectable (cutoff point ≥ 3.3 µg/dL) and non-detectable. As a measure of ECD, language development was assessed in = 1394 children, representing 2,415,000 children aged 12-59 months. To assess the association between lead exposure and language z-scores, a linear model was generated adjusted by age, sex, stunted growth, maternal education, socioeconomic status, area, region (north, center, south), and family care characteristics; afterwards, the model was stratified by stunted growth.
Fifty percent of children had detectable BPb and 15.3% had stunted growth. BPb showed a marginal inverse association with language z-scores (β: -0.08, 95% CI: -0.53, 0.36). Children with detectable BPb and stunted growth had significantly lower language z-scores (β: -0.40, 95% CI: -0.71, -0.10) than those without stunted growth (β: -0.15, 95% CI: -0.36, 0.06).
Children with stunted growth are more vulnerable to the adverse effects of lead exposure. These results add to previous research calling for action to reduce lead exposure, particularly in children with chronic undernutrition.
由于营养缺乏导致生长迟缓，铅可能会对儿童早期发展（ECD）产生不同的影响，生长迟缓的定义是身高至少比年龄平均身高低两个标准差。这些缺陷在生活在农村地区或社会经济地位较低的儿童中更为常见；然而，全球范围内在人群层面上的研究仍然很少。儿童早期发展在影响儿童一生的健康和福祉方面起着至关重要的作用。因此，本研究旨在分析生长迟缓如何改变铅暴露与贫困社区儿童 ECD 之间的关系。
本研究对墨西哥少于 10 万居民的地区 2018 年国家健康和营养调查（ENSANUT-100K）的数据进行了分析。使用 LeadCare II 设备测量毛细血管血铅（BPb）水平，并将其分为可检测（截断值≥3.3μg/dL）和不可检测。作为 ECD 的衡量标准，对 1394 名儿童（代表 2415000 名 12-59 个月大的儿童）的语言发展进行了评估。为了评估铅暴露与语言 z 分数之间的关系，生成了一个调整了年龄、性别、生长迟缓、母亲教育、社会经济地位、地区、区域（北部、中部、南部）和家庭护理特征的线性模型；随后，根据生长迟缓对模型进行分层。
50%的儿童 BPb 可检测，15.3%的儿童生长迟缓。BPb 与语言 z 分数呈边际负相关（β：-0.08，95%CI：-0.53，0.36）。与无生长迟缓的儿童相比，BPb 可检测且生长迟缓的儿童的语言 z 分数显著较低（β：-0.40，95%CI：-0.71，-0.10）（β：-0.15，95%CI：-0.36，0.06）。
生长迟缓的儿童更容易受到铅暴露的不良影响。这些结果增加了先前呼吁采取行动减少铅暴露的研究，特别是在慢性营养不良的儿童中。
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