Effects of lead exposure before pregnancy and dietary calcium during pregnancy on fetal development and lead accumulation

Millions of women of child-bearing age have substantial bone lead stores due to lead exposure as children. Dietary calcium ingested simultaneously with lead exposure can reduce lead absorption and accumulation. However, the effects of dietary calcium on previously accumulated maternal lead stores and transfer to the fetus have not been investigated. We studied the effects of lead exposure of female rats at an early age on fetal development during a subsequent pregnancy. We gave 5-week-old female Sprague-Dawley rats lead as the acetate in their drinking water for 5 weeks; controls received equimolar sodium acetate. This was followed by a 1-month period without lead exposure before mating. We randomly assigned pregnant rats (n = 39) to diets with a deficient (0.1%) or normal (0.5%) calcium content during pregnancy. A total of 345 pups were delivered alive. Lead-exposed dams and their pups had significantly higher blood lead concentrations than controls, but the concentrations were in the range of those found in many pregnant women. Pups born to dams fed the calcium-deficient diet during pregnancy had higher blood and organ lead concentrations than pups born to dams fed the 0. 5% calcium diet. Pups born to lead-exposed dams had significantly (p<0.0001) lower mean birth weights and birth lengths than controls. There were significant inverse univariate associations between dam or pup organ lead concentrations and birth weight or length. The 0.5% calcium diet did not increase in utero growth. Stepwise regression analysis demonstrated that greater litter size and female sex were significantly associated with reduced pup birth weight and length. However, lead exposure that ended well before pregnancy was significantly (p<0.0001) associated with reduced birth weight and length, even after litter size, pup sex, and dam weight gain during pregnancy were included in the regression analysis. The data demonstrate that an increase in dietary calcium during pregnancy can reduce fetal lead accumulation but cannot prevent lead-induced decreases in birth weight and length. The results provide evidence that dietary nutrients can influence the transfer of toxins to the fetus during pregnancy. If these results are applicable to women, an increase in diet calcium during pregnancy could reduce the transfer of lead from prepregnancy maternal exposures to the fetus.     

Lead exposure at an early age substantially increases lead retention in the rat.

It has been hypothesized that the high rate of bone remodeling during childhood and the consequent high calcium and lead turnover result in a substantial reduction in bone lead stores so that much of the lead incorporated in bone during childhood does not persist into adulthood. We studied the effect of age at lead exposure on blood and organ concentrations of lead, calcium, and zinc 1-5 months after termination of lead ingestion. Blood and organ lead concentrations and contents 4 weeks after lead exposure ceased were significantly higher in the rats exposed beginning at 5 weeks of age than in those exposed beginning at 10 or 15 weeks old. Bone lead declined as the time since exposure increased. Despite this trend, the rats exposed when youngest had bone lead concentrations at 20 weeks after the termination of lead exposure that were higher than those of the other rats only 4 weeks after cessation of lead ingestion. Multiple regression analysis demonstrated that age at lead exposure remained a significant predictor of blood and organ lead concentrations and contents even after the inclusion of total lead consumed, body weight, and age at organ harvesting in the regression analysis. There were only small differences in organ calcium and zinc concentrations among treatment groups except for kidney calcium. The results do not support the hypothesis of rapid depletion of bone lead stores in young animals, but rather suggest that younger age at lead exposure is associated with greater lead retention and toxicity even in the absence of continued lead exposure.     

Effects of weight loss and exercise on the distribution of lead and essential trace elements in rats with prior lead exposure.

We studied the effects of weight loss and non-weight-bearing exercise (swimming) on blood and organ lead and essential metal concentrations in rats with prior lead exposure. Nine-week-old female Sprague-Dawley rats (n = 37) received lead acetate in their drinking water for 2 weeks, followed by a 4-day latency period without lead exposure. Rats were then randomly assigned to one of six treatment groups: weight maintenance with ad libitum feeding, moderate weight loss with 20% food restriction, and substantial weight loss with 40% food restriction, either with or without swimming. Blood lead concentrations were measured weekly. The rats were euthanized after a 4-week period of food restriction, and the brain, liver, kidneys, quadriceps muscle, lumbar spinal column bones, and femur were harvested for analysis for lead, calcium, copper, iron, magnesium, and zinc using atomic absorption spectrophotometry. Both swimming and nonswimming rats fed restricted diets had consistently higher blood lead concentrations than the ad libitum controls. Rats in the substantial weight loss group had higher organ lead concentrations than rats in the weight maintenance group. Rats in the moderate weight loss group had intermediate values. There were no significant differences in blood and organ lead concentrations between the swimming and nonswimming groups. Organ iron concentrations increased with weight loss, but those of the other metals studied did not. Weight loss also increased hematocrits and decreased bone density of the nonswimming rats. The response of lead stores to weight loss was similar to that of iron stores because both were conserved during food restriction in contrast to decreased stores of the other metals studied. It is possible that weight loss, especially rapid weight loss, could result in lead toxicity in people with a history of prior excessive lead exposure.     

A noninvasive isotopic approach to estimate the bone lead contribution to blood in children: implications for assessing the efficacy of lead abatement

Lead hazard control measures to reduce children's exposure to household lead sources often result in only limited reductions in blood lead levels. This may be due to incomplete remediation of lead sources and/or to the remobilization of lead stores from bone, which may act as an endogenous lead source that buffers reductions in blood lead levels. Here we present a noninvasive isotopic approach to estimate the magnitude of the bone lead contribution to blood in children following household lead remediation. In this approach, lead isotopic ratios of a child's blood and 5-day fecal samples are determined before and after a household intervention aimed at reducing the child's lead intake. The bone lead contribution to blood is estimated from a system of mass balance equations of lead concentrations and isotopic compositions in blood at the different times of sample collection. The utility of this method is illustrated with three cases of children with blood lead levels in the range of 18-29 microg/dL. In all three cases, the release of lead from bone supported a substantial fraction of the measured blood lead level postintervention, up to 96% in one case. In general, the lead isotopic compositions of feces matched or were within the range of the lead isotopic compositions of the household dusts with lead loadings exceeding U.S. Environmental Protection Agency action levels. This isotopic agreement underscores the utility of lead isotopic measurements of feces to identify household sources of lead exposure. Results from this limited number of cases support the hypothesis that the release of bone lead into blood may substantially buffer the decrease in blood lead levels expected from the reduction in lead intake.     

Dietary and environmental determinants of blood and bone lead levels in lactating postpartum women living in Mexico City.

Despite the recent declines in environmental lead exposure in the United States and Mexico, the potential for delayed toxicity from bone lead stores remains a significant public health concern. Some evidence indicates that mobilization of lead from bone may be markedly enhanced during the increased bone turnover of pregnancy and lactation, resulting in lead exposure to the fetus and the breast-fed infant. We conducted a cross-sectional investigation of the interrelationships between environmental, dietary, and lifestyle histories, blood lead levels, and bone lead levels among 98 recently postpartum women living in Mexico City. Lead levels in the patella (representing trabecular bone) and tibia (representing cortical bone) were measured by K X-ray fluorescence (KXRF). Multivariate linear regression models showed that significant predictors of higher blood lead included a history of preparing or storing food in lead-glazed ceramic ware, lower milk consumption, and higher levels of lead in patella bone. A 34 micrograms/g increase in patella lead (from the medians of the lowest to the highest quartiles) was associated with an increase in blood lead of 2.4 micrograms/dl. Given the measurement error associated with KXRF and the extrapolation of lead burden from a single bone site, this contribution probably represents an underestimate of the influence of trabecular bone on blood lead. Significant predictors of bone lead in multivariate models included years living in Mexico City, lower consumption of high calcium content foods, and nonuse of calcium supplements for the patella and years living in Mexico City, older age, and lower calcium intake for tibia bone. Low consumption of milk and cheese, as compared to the highest consumption category (every day), was associated with an increase in tibia bone lead of 9.7 micrograms Pb/g bone mineral. The findings of this cross-sectional study suggest that patella bone is a significant contributor to blood lead during lactation and that consumption of high calcium content foods may protect against the accumulation of lead in bone.     

Influence of bone-lead stores on the observed effectiveness of lead hazard intervention

Lead hazard interventions have reduced children's blood-lead concentrations, but do not eliminate lead altogether from the bloodstream. Several studies suggest that blood-lead concentrations, measured 6 to 12 months after such interventions, decline by approximately 25%. The Environmental Protection Agency is preparing to promulgate a rule prescribing residential lead levels in paint, dust, and soil that constitute a lead-based paint hazard. Such a rule will prompt interventions of primary prevention character (i.e., precluding exposure before it occurs) rather than the secondary prevention character interventions (i.e., alleviating exposure after it has adversely affected the resident child) documented in the literature. It is important to attempt to estimate the efficacy achieved from the primary prevention interventions prompted by the rule's promulgation. As bone-lead stores represent the principal confounding factor to relating secondary prevention results to primary prevention, this paper addresses the impact of lead stored in bone, which may later be released to the blood and other parts of the child's body. A simple, but thoroughly documented, modeling exercise is presented to estimate the maximum length of time for which bone-lead stores alone could account for continuing elevated blood-lead levels observed in children following an intervention. The approach is based on a two-compartment model for the transfer of lead between blood and bone tissues within the body and the elimination of lead from the body. Modeling results suggest that bone-lead mobilization can impact blood-lead levels of young children for considerably long periods following an intervention. These results may explain the seemingly contradictory fact that low declines in blood-lead concentrations are observed despite the significant reduction in residential dust-, paint-, and soil-lead levels observed following lead hazard interventions. An intervention which reduces a 5-year-old child's total lead exposure by 50% might, due to mobilized bone-lead stores, produce only a 25% decline in the child's blood-lead concentrations measured 12 months following the intervention. The results also suggest, however, that those intervention strategies for which less than 25% declines were observed 12 months following the intervention likely eliminated less than 50% of the children's total lead exposure.     

Recommendations for medical management of adult lead exposure

Research conducted in recent years has increased public health concern about the toxicity of lead at low dose and has supported a reappraisal of the levels of lead exposure that may be safely tolerated in the workplace. In this article, which appears as part of a mini-monograph on adult lead exposure, we summarize a body of published literature that establishes the potential for hypertension, effects on renal function, cognitive dysfunction, and adverse female reproductive outcome in adults with whole-blood lead concentrations < 40 microg/dL. Based on this literature, and our collective experience in evaluating lead-exposed adults, we recommend that individuals be removed from occupational lead exposure if a single blood lead concentration exceeds 30 microg/dL or if two successive blood lead concentrations measured over a 4-week interval are > or = 20 microg/dL. Removal of individuals from lead exposure should be considered to avoid long-term risk to health if exposure control measures over an extended period do not decrease blood lead concentrations to < 10 microg/dL or if selected medical conditions exist that would increase the risk of continued exposure. Recommended medical surveillance for all lead-exposed workers should include quarterly blood lead measurements for individuals with blood lead concentrations between 10 and 19 microg/dL, and semiannual blood lead measurements when sustained blood lead concentrations are < 10 microg/dL. It is advisable for pregnant women to avoid occupational or avocational lead exposure that would result in blood lead concentrations > 5 microg/dL. Chelation may have an adjunctive role in the medical management of highly exposed adults with symptomatic lead intoxication but is not recommended for asymptomatic individuals with low blood lead concentrations.     

The interaction of lead exposure and pregnancy.

The toxic effects of low-level lead exposure have been the subject of a good deal of research and media attention in recent times. In most countries, the acceptable occupational exposure limit for lead is being progressively decreased as the adverse health effects of lead are being identified at levels approaching those found in non-occupational environments. Due to the sensitive nature of the fetus to hazardous substances, the exposure to lead of the unborn child via maternal sources is of critical concern. Preterm delivery, congenital abnormalities and decreases in growth stature have all been associated with prenatal lead exposure at "acceptable" levels. There is an accumulation of evidence which indicates that maternal exposures prior to conception can play an important role in determining blood lead levels during pregnancy. In light of these observations the practice of removing the pregnant woman from lead sources may be of questionable value with regards to providing sufficient protection for the fetus. This article reviews the relevant literature pertaining to the mobilization of lead from bone during pregnancy and the toxicity of low-level lead exposure to the fetus, and briefly discusses some factors which may affect this toxicity.     

Lead exposure, interactions and toxicity: food for thought

The recognition that nutritional status plays a role in altering susceptibility to lead absorption and toxicity has triggered the development of this review. There has been a significant increase worldwide in awareness and concern about the effects of lead on human health and the environment over the last two decades. Both occupational and environmental exposures to lead remain a serious problem in many developing and industrialising countries, as well as in some developed countries. Port Pirie (South Australia) has the world's largest lead smelter and the surrounding population continues to be exposed to environmental lead. The increased awareness of the detrimental impacts of 100 years of smelting at Port Pirie led in 1984 to the development of the Lead Implementation Program, run by the Environmental Health Centre (EHC), Department of Human Services (DHS). The major focus of the program is to reduce household lead exposure for pregnant women and children below the age of five years. Despite intervention efforts by all stakeholders in Port Pirie, 55% of children less than 4 years old have blood lead levels above the National Health and Medical Research Council (NH&MRC) goal of 10 microg/dl. The Port Pirie Lead Implementation Program includes components on nutrition education aimed at reducing lead absorption and toxicity. However, nutritional intake and nutritional status of Port Pirie residents, in particular children under five years, has not been evaluated. This review focuses on nutrition as a component of intervention in lead toxicity and it discusses the nutritional concerns in relation to lead exposure. Fortunately most food patterns that reduce susceptibility to lead toxicity are consistent with recommendations for a healthy diet. The relationship between nutritional status and lead uptake and toxicity is most clearly established for irregular food intake (i.e. periods of fasting), marginal calcium ingestion and (subtle) iron deficiency.     

儿童铅暴露临床资料分析及疗效观察

目的:观察铅暴露儿童主要症状、年龄特点、环境铅来源及锌钙制剂治疗前后血铅水平变化。方法:对2003年～2004年首都医科大学附属北京儿童医院就诊的43名铅暴露儿童诊治资料进行分析。铅暴露诊断参考指标为血铅大于5μg/dL,同时伴有症状者。资料分析包括:主要症状、血铅水平、环境铅源、年龄性别特点等。同时,对驱铅治疗前后血铅与血矿物元素等的变化进行评估。结果:血铅值在5～10μg/dl伴有临床症状的患儿占30.2%(13/43),男女儿童均在8～9岁时就诊率最高。膨化食品、玩具、碳酸饮料、房屋装修和咬铅笔是导致儿童铅暴露的高危因素,注意力涣散、易激惹和多动为最常见症状。用葡萄糖酸钙锌口服溶液躯铅治疗后,血铅值显示有意义下降(P<0.001),同时可防止血矿物元素的下滑。结论:神经症状出现在血铅水平<10μg/dl,说明铅损害可以发生在目前的诊断标准以下。铅损害的主要症状表现在神经系统。锌钙合剂治疗对降低血铅和恢复血钙、锌水平有较好效果。     

Effects of tap water lead, water hardness, alcohol, and cigarettes on blood lead concentrations.

A survey of middle-aged men in 24 British towns has found pronounced geographical variation in blood lead concentrations. Towns with the highest mean blood lead concentrations have soft water supplies and have the highest water lead concentrations. Individual blood lead can be considerably increased by raised household tap water lead concentrations. Mean blood lead is estimated to be 43% higher for men when the concentration of lead in first-draw domestic tap water is 100 micrograms/l compared with a zero concentration. Individual blood lead is also affected by alcohol consumption and cigarette smoking, such that on average these two life-style habits together contribute an estimated 17% to the blood concentration of lead in middle-aged men. Lead in water should be given greater priority in any national campaign to reduce lead exposure.     

Season modifies the relationship between bone and blood lead levels: the Normative Aging Study

Bone serves as a repository for 75% and 90-95% of lead in children and adults, respectively. Bone lead mobilization heightens during times of increased bone turnover, such as pregnancy, lactation, hyperthyroidism, and the rapid growth of childhood. Blood lead levels show seasonal periodicity. Children demonstrate peak blood lead levels in mid-summer and a secondary peak in late winter. Pregnant women demonstrate the highest mean blood lead levels in winter (January-March) and the lowest in summer (July-September). This fluctuation in blood lead levels may be related to seasonal patterns of environmental exposures, but it may also be partially related to the increased mobilization of bone lead stores during the winter months. We performed bone lead measurements using a K-x-ray fluorescent instrument to determine micrograms of lead per gram of bone mineral (parts per million) in middle-aged and elderly men who participated in the Normative Aging Study. We obtained measurements of blood and bone lead during the high sun exposure months of May-August (summer; n = 290); the intermediate sun exposure months of March, April, September, and October (spring/fall; n = 283); and the low sun exposure months of November-February (winter; n = 191). Mean blood lead concentrations were 5.8 microg/dl, 6.1 microg/dl, and 6.6 microg/dl for the summer, spring/fall, and winter, respectively. Mean patella (trabecular bone) lead concentrations were 34.3 microg/gm, 29.7 microg/gm, and 29.0 microg/gm for the summer, spring/fall, and winter time periods, respectively. In multivariate regression models, adjusted for age, smoking, alcohol ingestion, and dietary intake of iron and vitamin C, the authors found a strong interaction between season and bone lead level--with bone lead levels exerting an almost 2-fold greater influence on blood levels during the winter months than the summer months. The authors concluded that elevated blood lead levels in winter may be related to increased mobilization of endogenous bone lead stores, potentially from decreased exposure to sunlight, lower levels of activated vitamin D, and enhanced bone resorption.     

An analysis of occupational blood lead trends in Manitoba, 1979 through 1987.

BACKGROUND: While regulations for workplace lead exposure become more strict, their effectiveness in decreasing blood lead concentrations and the method by which this is attained have not been evaluated. METHODS: An analysis was conducted of 10,190 blood lead samples from employees of 10 high-risk workplaces collected in Manitoba, 1979-87, as part of regulated occupational surveillance. RESULTS: A significant decrease in blood lead concentrations was observed overall as well as for each individual company. A 1979 government regulation to reduce blood lead to below 3.38 mumol/L (70 micrograms/dl) was followed by a drop in blood lead concentrations; a 1983 order to reduce blood leads to below 2.90 mumol/L (60 micrograms/dl) was not followed by such a drop. Longitudinal analysis by individual workers suggested that companies were complying by use of administrative control, i.e., removing workers to lower lead areas until blood lead levels had fallen, then returning them to high lead areas. CONCLUSION: Focusing upon blood lead as the sole criterion for compliance is not effective; regulations must specifically require environmental monitoring and controls. Biological surveillance serves as "back-up" to environmental surveillance and this database illustrates the usefulness of a comprehensive centralized surveillance system.     

Lead in the Japanese living environment

Lead has long been known to be a neurotoxic heavy metal, particularly in the context of occupational health. However, its adverse effect on the cognitive development of children at lower exposure levels has only recently received attention. Although the exposure level of contemporary Japanese children is among the lowest in the world, it is desirable to reduce exposure as much as reasonably possible due to the absence of a threshold of exposure for adverse effects. In this review, information on lead levels in milieus of our proximate environment, such as the atmosphere, drinking water, soil, house dust, diet and others, of contemporary Japan was compiled with the aim of updating our knowledge on lead distribution. Monitoring data demonstrates that lead concentrations in the atmosphere and lead intake from food consumption have decreased substantially from the 1970s. Lead was hardly detectable in tap water in a recent nation-wide monitoring survey. To the contrary, elevated lead concentrations were detected in surface soil and house dust in one of the studies on daily exposure to lead from all potential sources, and both of these sources were regarded by the authors as significant contributors of lead exposure to general Japanese children. A similar study indicated that diet is the sole major source of lead for Japanese children. A significant difference was present in the estimated dietary lead intake levels in different studies, resulting in significant discrepancies in the current knowledge on lead in our environment. Further studies are warranted to identify the major source(s) of lead exposure in Japanese children in order to establish an effective countermeasure to reduce lead exposure to children.     

Season Modifies the Relationship between Bone and Blood Lead Levels: The Normative Aging Study

Bone serves as a repository for 75% and 90–95% of lead in children and adults, respectively. Bone lead mobilization heightens during times of increased bone turnover, such as pregnancy, lactation, hyperthyroidism, and the rapid growth of childhood. Blood lead levels show seasonal periodicity. Children demonstrate peak blood lead levels in midsummer and a secondary peak in late winter. Pregnant women demonstrate the highest mean blood lead levels in winter (January-March) and the lowest in summer (July-September). This fluctuation in blood lead levels may be related to seasonal patterns of environmental exposures, but it may also be partially related to the increased mobilization of bone lead stores during the winter months. We performed bone lead measurements using a K-x-ray fluorescent instrument to determine micrograms of lead per gram of bone mineral (parts per million) in middle-aged and elderly men who participated in the Normative Aging Study. We obtained measurements of blood and bone lead during the high sun exposure months of May-August (summer; n = 290); the intermediate sun exposure months of March, April, September, and October (spring/fall; n = 283); and the low sun exposure months of November-February (winter; n = 191). Mean blood lead concentrations were 5.8 μg/dl, 6.1 μg/dl, and 6.6 μg/dl for the summer, spring/fall, and winter, respectively. Mean patella (trabecular bone) lead concentrations were 34.3 μg/gm, 29.7 μ/gm, and 29.0 μg/gm for the summer, spring/fall, and winter time periods, respectively. In multivariate regression models, adjusted for age, smoking, alcohol ingestion, and dietary intake of iron and vitamin C, the authors found a strong interaction between season and bone lead level—with bone lead levels exerting an almost 2-fold greater influence on blood levels during the winter months than the summer months. The authors concluded that elevated blood lead levels in winter may be related to increased mobilization of endogenous bone lead stores, potentially from decreased exposure to sunlight, lower levels of activated vitamin D, and enhanced bone resorption.     

Impact of bone lead and bone resorption on plasma and whole blood lead levels during pregnancy

The authors tested the hypotheses that maternal bone lead burden is associated with increasing maternal whole blood and plasma lead levels over the course of pregnancy and that this association is modified by rates of maternal bone resorption. A total of 193 Mexican women were evaluated (1997-1999) in the first, second, and third trimesters of pregnancy. Whole blood lead and plasma lead levels were measured in each trimester. Urine was analyzed for cross-linked N-telopeptides (NTx) of type I collagen, a biomarker of bone resorption. Patella and tibia lead levels were measured at 4 weeks postpartum. The relation between whole blood, plasma, and bone lead and NTx was assessed using mixed models. Plasma lead concentrations followed a U-shape, while NTx levels increased significantly during pregnancy. In a multivariate model, the authors observed a significant and positive interaction between NTx and bone lead when plasma lead was used as the outcome variable. Dietary calcium intake was inversely associated with plasma lead. Results for whole blood lead were similar but less pronounced. These results confirm previous evidence that bone resorption increases during pregnancy, with a consequential significant release of lead from bone, constituting an endogenous source of prenatal exposure. They also provide a rationale for testing strategies (e.g., nutritional supplementation with calcium) aimed at decreasing prenatal lead exposure.     

四乙基铅接触者血中铅铜锌含量的测定

本文调查了158名职业四乙基铅接触者,并对相应作业点测定四乙基铅浓度。汽车驾驶室0.003～0.O24 mg/m~3,汽车修理间0.045～0.081 mg/m~3,另选102名无四乙基铅接触史的健康者为对照,对其血中铅、铜、锌分别进行测定。结果表明各项指标接触组高于对照组,且血铅、血锌含量与对照组相比有显著性差异(P<0.05)。本文认为接触四乙基铅的汽车驾驶员及修理工不会导致体内铅、锌的缺乏。     

Relationship of blood lead levels to personal hygiene habits in lead battery workers: Taiwan, 1991-1997.

BACKGROUND: The blood lead concentrations of workers in lead battery factories are more than 4 times higher than those of the general population in Taiwan. Therefore, efforts are needed to reduce lead exposure in this high-risk population. A health promotion program on personal habits that reduce lead exposure has been carried out in a lead battery factory since 1991. This study investigated the longitudinal relationship of workers' blood lead concentrations and personal hygiene habits from 1991 through 1997. METHODS: In each of the 7 years of the study, occupational physicians questioned workers regarding nine personal hygiene items, personal information, and medical history before their annual health examination. The relationship between blood lead concentrations and personal hygiene habits was analyzed by longitudinal multiple regression in a mixed effect model with adjustment for potential confounders. In addition, the risk ratio of a blood lead concentration exceeding 40 micrograms/dL in men and 30 micrograms/dL in women (the action levels set by the Department of Health, Taiwan) was estimated by generalized estimating equations. RESULTS: Blood lead levels decreased significantly in the first 5 years of the study. The personal habits most closely related to blood lead concentrations were smoking at work sites (estimated coefficient = 3.13, P < 0.001), and eating at work sites (estimated coefficient = 1.38, P = 0.069). The risk ratio for workers with both these habits exceeding the action level of blood lead was 2.93 (95% CI 1.27-6.77). Difference in job titles, however, accounted for a major portion of the variance in blood lead. For example, working in "pasting" and "plate-cutting" was associated with blood lead elevations > 20 micrograms/dL in comparison to the "low- or no-exposure jobs." CONCLUSIONS: Health promotion programs can decrease exposure of lead workers; reducing the practices of smoking and eating at work sites should be the core of such programs. However, a major reduction in lead exposure for some jobs (e.g., "pasting" and "plate cutting") in lead battery factories in Taiwan is unlikely to occur without major engineering changes.     

Coupling contaminants with demography: effects of lead and selenium in Pacific common eiders

We coupled intensive population monitoring with collection of blood samples from 383 nesting Pacific common eiders (Somateria mollisima v-nigrum) at two locations in Alaska (USA) from 2002 to 2004. We investigated annual, geographic, and within-season variation in blood concentrations of lead and selenium; compared exposure patterns with sympatrically nesting spectacled eiders (Somateria fischeri); and examined relationships with clutch size, egg viability, probability of hatching, and apparent survival of adult females. Lead concentrations were elevated in 3.6% of females, and all individuals exhibited elevated selenium, most (81%) at concentrations associated with death in captive waterfowl. Blood lead and selenium concentrations varied both within and among site-years and were lower than those of spectacled eiders. During incubation, blood lead concentrations in females increased significantly (possibly via re-release of stored lead from bone), whereas selenium concentrations decreased (likely because of natural excretion). Probability of a nest containing at least one nonviable egg was positively related to blood selenium in hens, but adverse effects in other life-history variables were not supported. Although reproduction appeared to be sensitive to selenium toxicity, our data suggest that high rates of nonviability are unlikely in this population and that selenium-related reductions to clutch size would be inconsequential at the scale of overall population dynamics. We conclude that Pacific common eiders and other wild marine birds likely have higher selenium tolerances than freshwater species and that interspecific differences in exposure levels may reflect differences in reproductive strategies.     

Adult blood lead epidemiology and surveillance--United States, 2008-2009

Lead exposure can result in acute or chronic adverse effects in multiple organ systems, ranging from subclinical changes in function to symptomatic, life-threatening toxicity. Despite improvements in public health policies and substantial reductions in blood lead levels (BLLs) in adults, lead exposure remains an important health problem worldwide. Approximately 95% of all elevated BLLs reported among adults in the United States are work-related, and recent research has raised concerns regarding the toxicity of BLLs as low as 5 μg/dL. CDC's state-based Adult Blood Lead Epidemiology and Surveillance (ABLES) program tracks laboratory-reported elevated BLLs. To update rate trends and identify industry subsectors and nonoccupational activities with high lead exposures, CDC collected and analyzed 2008--2009 data from 40 state ABLES programs. The results of that analysis indicated that a decline in the prevalence of elevated BLLs (≥25 μg/dL) was extended, from 14.0 per 100,000 employed adults in 1994 to 6.3 in 2009. Industry subsectors with the highest numbers of lead-exposed workers were battery manufacturing, secondary smelting and refining of nonferrous metals, and painting and paper hanging. The most common nonoccupational exposures to lead were shooting firearms; remodeling, renovating, or painting; retained bullets (gunshot wounds); and lead casting. The findings underscore the need for government agencies, employers, public health professionals, health-care providers, and worker-affiliated organizations to increase interventions to prevent workplace lead exposure, and the importance of conducting lead exposure surveillance to assess the effectiveness of these interventions.