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Title: Association of lead and cadmium exposure with frailty in US older adults

Abstract

Background: Environmental lead and cadmium exposure is associated with higher risk of several age-related chronic diseases, including cardiovascular disease, chronic kidney disease and osteoporosis. These diseases may lead to frailty, a geriatric syndrome characterized by diminished physiologic reserve in multiple systems with decreased ability to cope with acute stressors. However, no previous study has evaluated the association between lead or cadmium exposure and frailty. Methods: Cross-sectional study among individuals aged ≥60 years who participated in the third U.S. National Health and Nutrition Examination Survey and had either blood lead (N=5272) or urine cadmium (N=4887) determinations. Frailty was ascertained with a slight modification of the Fried criteria, so that individuals meeting ≥3 of 5 pre-defined criteria (exhaustion, low body weight, low physical activity, weakness and slow walking speed), were considered as frail. The association between lead and cadmium with frailty was evaluated using logistic regression with adjustment for relevant confounders. Results: Median (intertertile range) concentrations of blood lead and urine cadmium were 3.9 µg/dl (2.9–4.9) and 0.62 µg/l (0.41–0.91), respectively. The prevalence of frailty was 7.1%. The adjusted odds ratios (95% confidence interval) of frailty comparing the second and third to the lowest tertile of blood lead were, respectively, 1.40 (0.96–2.04)more » and 1.75 (1.33–2.31). Lead concentrations were also associated with the frequency of exhaustion, weakness and slowness. The corresponding odds ratios (95% confidence interval) for cadmium were, respectively, 0.97 (0.68–1.39) and 1.55 (1.03–2.32), but this association did not hold after excluding participants with reduced glomerular filtration rate: 0.70 (0.43–1.14) and 1.09 (0.56–2.11), respectively. Conclusions: In the US older adult population, blood lead but not urine cadmium concentrations showed a direct dose–response relationship with frailty. These findings support that lead exposure increases frailty in older adults. - Highlights: • No previous study has evaluated the association between lead, cadmium and frailty. • In NHANES III, blood lead levels showed a dose–response relationship with frailty. • Lead was also associated with higher frequency of exhaustion, weakness and slowness. • For cadmium, the results did not support an overall association with frailty.« less

Authors:
 [1];  [2];  [3];  [4];  [3];  [3];  [5];  [6];  [1];  [2]
  1. Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/ IdiPAZ, Madrid (Spain)
  2. (CIBERESP), Madrid (Spain)
  3. (United States)
  4. Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (United States)
  5. CIBER of Epidemiology and Public Health (CIBERESP), Madrid (Spain)
  6. (Spain)
Publication Date:
OSTI Identifier:
22483283
Resource Type:
Journal Article
Resource Relation:
Journal Name: Environmental Research; Journal Volume: 137; Other Information: Copyright (c) 2015 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
54 ENVIRONMENTAL SCIENCES; ABUNDANCE; BLOOD; CADMIUM; CARDIOVASCULAR DISEASES; CONCENTRATION RATIO; ECOLOGICAL CONCENTRATION; ELDERLY PEOPLE; KIDNEYS; LEAD; NUTRITION; OSTEOPOROSIS; URINE; WEIGHT

Citation Formats

García-Esquinas, Esther, E-mail: esthergge@gmail.com, CIBER of Epidemiology and Public Health, Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, Navas-Acien, Ana, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, Pérez-Gómez, Beatriz, Environmental Epidemiology and Cancer Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Artalejo, Fernando Rodríguez, and CIBER of Epidemiology and Public Health. Association of lead and cadmium exposure with frailty in US older adults. United States: N. p., 2015. Web. doi:10.1016/J.ENVRES.2015.01.013.
García-Esquinas, Esther, E-mail: esthergge@gmail.com, CIBER of Epidemiology and Public Health, Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, Navas-Acien, Ana, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, Pérez-Gómez, Beatriz, Environmental Epidemiology and Cancer Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Artalejo, Fernando Rodríguez, & CIBER of Epidemiology and Public Health. Association of lead and cadmium exposure with frailty in US older adults. United States. doi:10.1016/J.ENVRES.2015.01.013.
García-Esquinas, Esther, E-mail: esthergge@gmail.com, CIBER of Epidemiology and Public Health, Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, Navas-Acien, Ana, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, Pérez-Gómez, Beatriz, Environmental Epidemiology and Cancer Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Artalejo, Fernando Rodríguez, and CIBER of Epidemiology and Public Health. Sun . "Association of lead and cadmium exposure with frailty in US older adults". United States. doi:10.1016/J.ENVRES.2015.01.013.
@article{osti_22483283,
title = {Association of lead and cadmium exposure with frailty in US older adults},
author = {García-Esquinas, Esther, E-mail: esthergge@gmail.com and CIBER of Epidemiology and Public Health and Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD and Navas-Acien, Ana and Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD and Pérez-Gómez, Beatriz and Environmental Epidemiology and Cancer Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid and Artalejo, Fernando Rodríguez and CIBER of Epidemiology and Public Health},
abstractNote = {Background: Environmental lead and cadmium exposure is associated with higher risk of several age-related chronic diseases, including cardiovascular disease, chronic kidney disease and osteoporosis. These diseases may lead to frailty, a geriatric syndrome characterized by diminished physiologic reserve in multiple systems with decreased ability to cope with acute stressors. However, no previous study has evaluated the association between lead or cadmium exposure and frailty. Methods: Cross-sectional study among individuals aged ≥60 years who participated in the third U.S. National Health and Nutrition Examination Survey and had either blood lead (N=5272) or urine cadmium (N=4887) determinations. Frailty was ascertained with a slight modification of the Fried criteria, so that individuals meeting ≥3 of 5 pre-defined criteria (exhaustion, low body weight, low physical activity, weakness and slow walking speed), were considered as frail. The association between lead and cadmium with frailty was evaluated using logistic regression with adjustment for relevant confounders. Results: Median (intertertile range) concentrations of blood lead and urine cadmium were 3.9 µg/dl (2.9–4.9) and 0.62 µg/l (0.41–0.91), respectively. The prevalence of frailty was 7.1%. The adjusted odds ratios (95% confidence interval) of frailty comparing the second and third to the lowest tertile of blood lead were, respectively, 1.40 (0.96–2.04) and 1.75 (1.33–2.31). Lead concentrations were also associated with the frequency of exhaustion, weakness and slowness. The corresponding odds ratios (95% confidence interval) for cadmium were, respectively, 0.97 (0.68–1.39) and 1.55 (1.03–2.32), but this association did not hold after excluding participants with reduced glomerular filtration rate: 0.70 (0.43–1.14) and 1.09 (0.56–2.11), respectively. Conclusions: In the US older adult population, blood lead but not urine cadmium concentrations showed a direct dose–response relationship with frailty. These findings support that lead exposure increases frailty in older adults. - Highlights: • No previous study has evaluated the association between lead, cadmium and frailty. • In NHANES III, blood lead levels showed a dose–response relationship with frailty. • Lead was also associated with higher frequency of exhaustion, weakness and slowness. • For cadmium, the results did not support an overall association with frailty.},
doi = {10.1016/J.ENVRES.2015.01.013},
journal = {Environmental Research},
number = ,
volume = 137,
place = {United States},
year = {Sun Feb 15 00:00:00 EST 2015},
month = {Sun Feb 15 00:00:00 EST 2015}
}