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

Esther García-Esquinas, Ana Navas Acien, Beatriz Pérez-Gómez, Fernando Rodríguez Artalejo

Research output: Contribution to journalArticle

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) 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.

Original languageEnglish (US)
Pages (from-to)424-431
Number of pages8
JournalEnvironmental Research
Volume137
DOIs
StatePublished - Feb 1 2015

Fingerprint

Cadmium
cadmium
Blood
blood
urine
Urine
confidence interval
Geriatrics
Odds Ratio
Confidence Intervals
health and nutrition
physical activity
Lead
exposure
Nutrition Surveys
dose-response relationship
cardiovascular disease
Nutrition
walking
Glomerular Filtration Rate

Keywords

  • Cadmium
  • Frailty
  • Lead
  • Muscle strength

ASJC Scopus subject areas

  • Environmental Science(all)
  • Biochemistry
  • Medicine(all)

Cite this

García-Esquinas, E., Navas Acien, A., Pérez-Gómez, B., & Artalejo, F. R. (2015). Association of lead and cadmium exposure with frailty in US older adults. Environmental Research, 137, 424-431. https://doi.org/10.1016/j.envres.2015.01.013

Association of lead and cadmium exposure with frailty in US older adults. / García-Esquinas, Esther; Navas Acien, Ana; Pérez-Gómez, Beatriz; Artalejo, Fernando Rodríguez.

In: Environmental Research, Vol. 137, 01.02.2015, p. 424-431.

Research output: Contribution to journalArticle

García-Esquinas, E, Navas Acien, A, Pérez-Gómez, B & Artalejo, FR 2015, 'Association of lead and cadmium exposure with frailty in US older adults', Environmental Research, vol. 137, pp. 424-431. https://doi.org/10.1016/j.envres.2015.01.013
García-Esquinas E, Navas Acien A, Pérez-Gómez B, Artalejo FR. Association of lead and cadmium exposure with frailty in US older adults. Environmental Research. 2015 Feb 1;137:424-431. https://doi.org/10.1016/j.envres.2015.01.013
García-Esquinas, Esther ; Navas Acien, Ana ; Pérez-Gómez, Beatriz ; Artalejo, Fernando Rodríguez. / Association of lead and cadmium exposure with frailty in US older adults. In: Environmental Research. 2015 ; Vol. 137. pp. 424-431.
@article{e2a9e2165cac4cf89d69bb7c052cac59,
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) 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.",
keywords = "Cadmium, Frailty, Lead, Muscle strength",
author = "Esther Garc{\'i}a-Esquinas and {Navas Acien}, Ana and Beatriz P{\'e}rez-G{\'o}mez and Artalejo, {Fernando Rodr{\'i}guez}",
year = "2015",
month = "2",
day = "1",
doi = "10.1016/j.envres.2015.01.013",
language = "English (US)",
volume = "137",
pages = "424--431",
journal = "Environmental Research",
issn = "0013-9351",
publisher = "Academic Press Inc.",

}

TY - JOUR

T1 - Association of lead and cadmium exposure with frailty in US older adults

AU - García-Esquinas, Esther

AU - Navas Acien, Ana

AU - Pérez-Gómez, Beatriz

AU - Artalejo, Fernando Rodríguez

PY - 2015/2/1

Y1 - 2015/2/1

N2 - 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.

AB - 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.

KW - Cadmium

KW - Frailty

KW - Lead

KW - Muscle strength

UR - http://www.scopus.com/inward/record.url?scp=84921961418&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84921961418&partnerID=8YFLogxK

U2 - 10.1016/j.envres.2015.01.013

DO - 10.1016/j.envres.2015.01.013

M3 - Article

C2 - 25622281

AN - SCOPUS:84921961418

VL - 137

SP - 424

EP - 431

JO - Environmental Research

JF - Environmental Research

SN - 0013-9351

ER -