Yang Tingting, Zhang Yuxin, Zhong Jianqin, Zhang Renhua, Xu Zixuan, Xiao Fei, Huang Jing, Hong Feng
School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang 561113, China.
School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang 561113, China.
Ecotoxicol Environ Saf. 2025 May;296:118212. doi: 10.1016/j.ecoenv.2025.118212. Epub 2025 Apr 19.
Comorbidity represents an increasingly significant public health challenge. While numerous studies have confirmed the association between metals and both hypertension and osteopenia, the relationship between the multi-faceted effects of mixed metal exposure and the comorbidity of hypertension with abnormal bone mass, as well as age-specific associations, remains unclear. This study utilized baseline data from the China Multi-Ethnic Cohort Study, investigating 9870 Chinese ethnic minorities (Dong and Miao) aged 30-79 years. We measured 17 urinary metal levels using inductively coupled plasma mass spectrometry. The study employed Least Absolute Shrinkage and Selection Operator (LASSO) penalized regression and Bayesian Kernel Machine Regression (BKMR) models to explore the association between urinary metals and comorbidity of hypertension and abnormal bone mass risk. In single-metal models, urinary nickel and zinc levels showed positive correlations with hypertension-related bone mass reduction risk, with ORs and 95 % CIs of 1.23 (1.01, 1.50) and 1.56 (1.27, 1.90), respectively. LASSO regression identified 11 urinary metals (aluminum, cobalt, chromium, copper, iron, manganese, lithium, lead, strontium, vanadium, and zinc) associated with hypertension and abnormal bone mass comorbidity. These selected metals were incorporated into subsequent analyses. BKMR analysis revealed an overall negative effect of metal mixtures on hypertension and abnormal bone mass comorbidity when all metals were fixed at their 50th percentiles. Vanadium and lithium showed negative correlations with the comorbidity. In subgroup analyses, age-stratified groups demonstrated consistent overall negative effects of metal mixtures on the comorbidity. Notably, in individuals over 60 years old, aluminum additionally exhibited a negative association alongside vanadium. Interactions were observed among metals in mixed exposures. Increasing urinary aluminum concentrations attenuated the negative correlation between manganese and hypertension-bone mass abnormality comorbidity. Similarly, increasing manganese concentrations weakened the positive association between urinary zinc and the comorbidity. In individuals under 60 years old, consistent with the general population, increasing urinary aluminum concentrations at P levels of other metals diminished the protective effect of manganese against hypertension-bone mass abnormality comorbidity. Interactions were identified between aluminum and lithium, and between manganese and zinc. This study provides substantial evidence linking mixed urinary metal exposure to hypertension and bone mass comorbidity, exploring the multifaceted effects of mixed metal exposure. These findings contribute to a deeper understanding of the role of metal exposure in chronic disease comorbidity, offering a scientific foundation and new directions for preventing and controlling hypertension and bone mass comorbidity, as well as informing public health policy formulation from an environmental metal perspective.
共病是一个日益严峻的公共卫生挑战。尽管众多研究已证实金属与高血压和骨质减少之间存在关联,但混合金属暴露的多方面影响与高血压合并骨量异常之间的关系,以及特定年龄组的关联仍不明确。本研究利用了中国多民族队列研究的基线数据,调查了9870名年龄在30 - 79岁的中国少数民族(侗族和苗族)。我们使用电感耦合等离子体质谱法测量了17种尿金属水平。该研究采用最小绝对收缩和选择算子(LASSO)惩罚回归和贝叶斯核机器回归(BKMR)模型,以探讨尿金属与高血压合并骨量异常风险之间的关联。在单金属模型中,尿镍和锌水平与高血压相关的骨量减少风险呈正相关,其比值比(OR)和95%置信区间(CI)分别为1.23(1.01, 1.50)和1.56(1.27, 1.90)。LASSO回归确定了11种与高血压和骨量异常共病相关的尿金属(铝、钴、铬、铜、铁、锰、锂、铅、锶、钒和锌)。这些选定的金属被纳入后续分析。BKMR分析显示,当所有金属固定在其第50百分位数时,金属混合物对高血压和骨量异常共病具有总体负面影响。钒和锂与共病呈负相关。在亚组分析中,按年龄分层的组显示金属混合物对共病具有一致的总体负面影响。值得注意的是,在60岁以上的个体中,除钒外,铝也表现出负相关。在混合暴露中观察到金属之间的相互作用。尿铝浓度的增加减弱了锰与高血压 - 骨量异常共病之间的负相关。同样,锰浓度的增加削弱了尿锌与共病之间的正相关。在60岁以下的个体中,与总体人群一致,在其他金属的P水平下尿铝浓度的增加减弱了锰对高血压 - 骨量异常共病的保护作用。确定了铝与锂之间以及锰与锌之间的相互作用。本研究提供了大量证据,将混合尿金属暴露与高血压和骨量共病联系起来,探讨了混合金属暴露的多方面影响。这些发现有助于更深入地理解金属暴露在慢性病共病中的作用,为预防和控制高血压和骨量共病提供科学依据和新方向,并从环境金属角度为公共卫生政策制定提供参考。