Shin Jiyoung, Luo Yuan
Department of Health Care Policy Research, Korea Institute for Health and Social Affairs, Sejong, Republic of Korea.
Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Heliyon. 2024 Nov 7;10(23):e40221. doi: 10.1016/j.heliyon.2024.e40221. eCollection 2024 Dec 15.
BACKGROUND/AIM: Although some heavy metals and alcohol consumption are known to have adverse effects on neurobehavioral symptoms, studies on the relationship between exposure to multiple metals and interaction between these factors are limited. In this study, we aimed to explore how multiple exposure to heavy metals with drinking habit in affecting depression using the National Health and Nutrition Examination Survey (NHANES) data.
Data from the U.S. NHANES between 2007 and 2014 were used to examine the cross-sectional relationships between heavy metal exposure and depression in adult over 20 years. After applying the exclusion criteria, 6021 subjects were included in the final analysis. We used four urinary metals, including mercury (Hg), cadmium (Cd), lead (Pb), and arsenic (As), as exposure variables. The Patient Health Questionnaire (PHQ-9) was used to assess the depression symptoms of the participants. Multivariate linear regression (MLR) and quantile g-computation models were applied to investigate the effects of individual and multiple heavy metal exposures on depression, respectively. We also performed stratified analysis according to the alcohol habit of the participants.
The MLR models revealed that urinary Cd was positively associated with a continuous depression score ( = 0.39, 95 % confidence interval (CI): 0.24-0.53). Meanwhile, other urinary metals showed an insignificant positive relationship with depression. In quantile g-computation model, statistically significant positive relationship was observed between urinary heavy metal mixture and depression score (difference in PHQ-9 score increase = 0.32, 95 % CI: 0.14-0.50). When the model was stratified by drinking habit, a stronger relationship was observed in the heavy drinker group.
Comparing the results from different models, both individual urinary Cd and all the heavy metal mixtures were positively associated with depression. This association was stronger among those with heavy drinking habits. Future cohort studies are needed to confirm these associations and to clarify the causal relationship.
背景/目的：尽管已知某些重金属和饮酒会对神经行为症状产生不利影响，但关于多种金属暴露之间的关系以及这些因素之间相互作用的研究仍然有限。在本研究中，我们旨在利用美国国家健康与营养检查调查（NHANES）数据，探讨具有饮酒习惯的人群多重重金属暴露对抑郁症的影响。
使用2007年至2014年美国NHANES的数据，研究20岁以上成年人重金属暴露与抑郁症之间的横断面关系。应用排除标准后，最终纳入6021名受试者进行分析。我们将四种尿金属，包括汞（Hg）、镉（Cd）、铅（Pb）和砷（As），作为暴露变量。采用患者健康问卷（PHQ-9）评估参与者的抑郁症状。分别应用多元线性回归（MLR）和分位数g计算模型，研究个体和多种重金属暴露对抑郁症的影响。我们还根据参与者的饮酒习惯进行了分层分析。
MLR模型显示，尿镉与连续抑郁评分呈正相关（β = 0.39，95%置信区间（CI）：0.24 - 0.53）。同时，其他尿金属与抑郁症呈不显著的正相关。在分位数g计算模型中，观察到尿重金属混合物与抑郁评分之间存在统计学显著的正相关（PHQ-9评分增加差异 = 0.32，95% CI：0.14 - 0.50）。当按饮酒习惯对模型进行分层时，在重度饮酒者组中观察到更强的相关性。
比较不同模型的结果，个体尿镉和所有重金属混合物均与抑郁症呈正相关。这种关联在重度饮酒者中更强。未来需要进行队列研究以证实这些关联并阐明因果关系。
