Gu Qianfei, Liu Jiayu, Zhang Xuanzhi, Huang Anyan, Yu Xinle, Wu Kusheng, Huang Yanhong
School of Public Health, Shantou University, Shantou, Guangdong Province, China.
Mental Health Center of Shantou University, Shantou, Guangdong Province, China.
Eur Child Adolesc Psychiatry. 2025 Mar;34(3):921-941. doi: 10.1007/s00787-024-02546-z. Epub 2024 Aug 10.
Heavy metals can negatively affect children's neurodevelopment, yet the relationship between heavy metals exposure and attention deficit hyperactivity disorder (ADHD) in children remains unclear. We aimed to examine associations between exposure to five common heavy metals (lead, arsenic, mercury, cadmium, and manganese) with neurodevelopmental toxicity and the risk of ADHD in children. Online databases of PubMed, Web of Science, and Embase were searched before February 29, 2024. A total of 31 studies involving 25,258 children were included in the final analysis. Our findings revealed that lead exposure was positively associated with ADHD risk in children (OR = 1.95, 95% CI: 1.57-2.41) overall, while the associations varied among different WHO regions, with the strongest in the Americas. Sensitivity analyses revealed significant associations between arsenic (OR = 1.53, 95% CI: 1.01-2.32) and manganese (OR = 1.79, 95% CI: 1.28-2.49) exposure and ADHD risk after omitting one study. Arsenic exposure was positively associated with ADHD risk in studies conducted in the Americas and adjusted for environmental smoke exposure. Positive associations between manganese exposure and ADHD risk were also found in several subgroup analyses. No significant associations were found for mercury and cadmium exposure. Dose-response meta-analysis suggested that children with higher blood lead levels exhibited a higher probability of ADHD diagnosis. Lead exposure consistently increases the risk of ADHD in children, while arsenic and manganese exposure may be associated with ADHD under different occasions. More research is required to understand heavy metals' impact on ADHD across varying exposure levels, particularly in less contaminated regions.
重金属会对儿童的神经发育产生负面影响，但儿童重金属暴露与注意力缺陷多动障碍（ADHD）之间的关系仍不明确。我们旨在研究五种常见重金属（铅、砷、汞、镉和锰）的暴露与儿童神经发育毒性及ADHD风险之间的关联。在2024年2月29日前检索了PubMed、Web of Science和Embase在线数据库。最终分析纳入了31项研究，涉及25258名儿童。我们的研究结果显示，总体而言，铅暴露与儿童ADHD风险呈正相关（OR = 1.95，95%CI：1.57 - 2.41），而不同世界卫生组织区域之间的关联有所不同，在美洲最为显著。敏感性分析显示，在剔除一项研究后，砷（OR = 1.53，95%CI：1.01 - 2.32）和锰（OR = 1.79，95%CI：1.28 - 2.49）暴露与ADHD风险之间存在显著关联。在美洲进行的、针对环境烟雾暴露进行校正的研究中，砷暴露与ADHD风险呈正相关。在多项亚组分析中也发现了锰暴露与ADHD风险之间的正相关。未发现汞和镉暴露与ADHD有显著关联。剂量反应荟萃分析表明，血铅水平较高的儿童被诊断为ADHD的可能性更高。铅暴露持续增加儿童患ADHD的风险，而砷和锰暴露在不同情况下可能与ADHD有关。需要更多研究来了解不同暴露水平下重金属对ADHD的影响，特别是在污染较轻的地区。
