Xu Wenzhuo, Wang Sainan, Ruan Wenhua, Hao Mingyue, Jiang Kele, Guo Hao, Geng Anyi, Man Mengting, Hu Zheng, Liu Yun, Jin Guifang, Shi Haiyan, Du Jun, Ge Keyang, Zhang Zhihua
Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China.
Department of the Second Clinical School of Medicine, Anhui Medical University, Hefei, 230032, Anhui, China.
Environ Res. 2025 Jul 1;276:121547. doi: 10.1016/j.envres.2025.121547. Epub 2025 Apr 4.
This umbrella review synthesizes evidence from meta-analyses to assess the health outcomes associated with cadmium (Cd) exposure.
Literature search was conducted in four Databases: PubMed, Embase, APA PsycNe, and the Cochrane Databases. Evaluating evidence strength via Assess Systematic Reviews 2 (AMSTAR 2), umbrella review methodology and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE).
Our review encompassed 79 non-overlapping studies, investigating 48 unique health outcomes through 113 independent effect sizes. Using the AMSTAR 2 tool, we found that 2 (3 %) meta-analyses were rated as high quality, 6 (8 %) as moderate quality, 38 as low quality, and 33 as very low quality. Applying the GRADE criteria, we observed that 1 (1 %) effect size was rated A (male fertility), 8 (7 %) were rated B (breast cancer, prostate cancer, hypertension, stroke, urolithiasis), 30 were rated C, and 74 were rated D. According to the umbrella review methodology, 5 (4 %) outcomes provided highly suggestive evidence, 13 (12 %) provided suggestive evidence, 51 provided weak evidence (class IV), and 44 had insufficient evidence for statistically significant results (class V). Meta-analyses on circulatory diseases, pregnancy outcomes, perinatal outcomes, skeletal and connective tissue diseases, neurological disorders, urinary system diseases, and male fertility had >80 % statistically significant results, while endocrine system diseases and mental and behavioral disorders had <33 %.
Cd exposure is significantly linked to various health outcomes, with implications for clinical practice and public health recommendations.
本伞状综述综合荟萃分析的证据，以评估与镉（Cd）暴露相关的健康结局。
在四个数据库中进行文献检索：PubMed、Embase、APA PsycNe和Cochrane数据库。通过评估系统评价2（AMSTAR 2）、伞状综述方法以及推荐分级、评估、制定和评价（GRADE）来评估证据强度。
我们的综述涵盖了79项非重叠研究，通过113个独立效应量研究了48种独特的健康结局。使用AMSTAR 2工具，我们发现2项（3%）荟萃分析被评为高质量，6项（8%）为中等质量，38项为低质量，33项为极低质量。应用GRADE标准，我们观察到1个（1%）效应量被评为A（男性生育能力），8个（7%）被评为B（乳腺癌、前列腺癌、高血压、中风、尿路结石），30个被评为C，74个被评为D。根据伞状综述方法，5个（4%）结局提供了高度提示性证据，13个（12%）提供了提示性证据，51个提供了弱证据（IV级），44个没有足够证据得出具有统计学意义的结果（V级）。关于循环系统疾病、妊娠结局、围产期结局、骨骼和结缔组织疾病、神经系统疾病、泌尿系统疾病和男性生育能力的荟萃分析有>80%具有统计学意义的结果，而内分泌系统疾病以及精神和行为障碍的这一比例<33%。
镉暴露与多种健康结局显著相关，对临床实践和公共卫生建议具有重要意义。
