TY - JOUR
T1 - Increased erythrocyte lead levels correlate with decreased hemoglobin levels in the Korean general population
T2 - Analysis of 2008-2010 Korean National Health and Nutrition Examination Survey data
AU - Kim, Yangho
AU - Lee, Byung Kook
N1 - Funding Information:
For an internal quality assurance and control program, commercial reference materials were used (Lyphochek Whole Blood Metals Control; Bio-Rad Laboratories, Hercules, CA, USA). The coefficients of variation for blood lead were within 2.65–6.50 % of four reference samples. As part of external quality assurance and control, the institute passed both the German External Quality Assessment Scheme, performed by Friedrich-Alexander University, and the Quality Assurance Program, performed by the Korea Occupational Safety and Health Agency. The institute was also certified by the Ministry of Employment and Labor as a designated laboratory for the analysis of specific chemicals, including heavy metals and certain organic chemicals. The method detection limit for blood lead in the present study was 0.12 µg/dL. No sample was below the detection limit.
PY - 2013/10
Y1 - 2013/10
N2 - Introduction: We present data from the Korean National Health and Nutrition Examination Survey 2008-2010 on the association between blood lead and hemoglobin levels in a representative sample of the adult South Korean population. Methods: The analysis was restricted to participants ≥20 years of age who completed the health examination survey, including blood lead measurements (n = 5,951). Multivariate linear regression analyses were performed to estimate adjusted mean differences in hemoglobin level associated with doubling of whole blood and erythrocyte lead or quartiles of the metal after covariate adjustment. Odds ratios (ORs) for having borderline anemia or clinical anemia were calculated for log-transformed whole blood and erythrocyte lead or quartiles of the metal after covariate adjustment. Results: A twofold increase in whole blood lead or erythrocyte lead was associated with a 0.285 g/dL increase or 0.088 g/dL decrease in hemoglobin level, respectively. There was a 0.416 g/dL increase or 0.143 g/dL decrease in hemoglobin, respectively, in the highest, compared with the lowest tertile of whole blood lead and erythrocyte lead, respectively. Based on ORs, doubling of whole blood lead or erythrocyte lead resulted in a 36.3 % decrease or 36.2 % increase, respectively, in the risk of borderline anemia. Conclusion: The association of whole blood lead versus erythrocyte lead with hemoglobin level was opposite. In the case of anemia, which is frequently caused by iron deficiency, the effect on the whole blood lead concentration may be very significant, leading to a considerable underestimation of the person's lead status. Therefore, hematocrit-adjusted blood lead level (i.e., erythrocyte lead) should be applied to the general population. To our knowledge, this is the first study to show that erythrocyte lead levels showed a significant inverse relationship with hemoglobin level at lead levels <10 μg/dL in the general Korean population. In conclusion, increased erythrocyte lead levels may be associated with mildly decreased hemoglobin levels, after adjusting for covariates, in a representative sample of the adult Korean population.
AB - Introduction: We present data from the Korean National Health and Nutrition Examination Survey 2008-2010 on the association between blood lead and hemoglobin levels in a representative sample of the adult South Korean population. Methods: The analysis was restricted to participants ≥20 years of age who completed the health examination survey, including blood lead measurements (n = 5,951). Multivariate linear regression analyses were performed to estimate adjusted mean differences in hemoglobin level associated with doubling of whole blood and erythrocyte lead or quartiles of the metal after covariate adjustment. Odds ratios (ORs) for having borderline anemia or clinical anemia were calculated for log-transformed whole blood and erythrocyte lead or quartiles of the metal after covariate adjustment. Results: A twofold increase in whole blood lead or erythrocyte lead was associated with a 0.285 g/dL increase or 0.088 g/dL decrease in hemoglobin level, respectively. There was a 0.416 g/dL increase or 0.143 g/dL decrease in hemoglobin, respectively, in the highest, compared with the lowest tertile of whole blood lead and erythrocyte lead, respectively. Based on ORs, doubling of whole blood lead or erythrocyte lead resulted in a 36.3 % decrease or 36.2 % increase, respectively, in the risk of borderline anemia. Conclusion: The association of whole blood lead versus erythrocyte lead with hemoglobin level was opposite. In the case of anemia, which is frequently caused by iron deficiency, the effect on the whole blood lead concentration may be very significant, leading to a considerable underestimation of the person's lead status. Therefore, hematocrit-adjusted blood lead level (i.e., erythrocyte lead) should be applied to the general population. To our knowledge, this is the first study to show that erythrocyte lead levels showed a significant inverse relationship with hemoglobin level at lead levels <10 μg/dL in the general Korean population. In conclusion, increased erythrocyte lead levels may be associated with mildly decreased hemoglobin levels, after adjusting for covariates, in a representative sample of the adult Korean population.
KW - Anemia
KW - Erythrocyte
KW - Hemoglobin
KW - Lead
KW - Serum
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U2 - 10.1007/s00420-012-0811-3
DO - 10.1007/s00420-012-0811-3
M3 - Review article
C2 - 22915145
AN - SCOPUS:84884977917
SN - 0340-0131
VL - 86
SP - 741
EP - 748
JO - International Archives of Occupational and Environmental Health
JF - International Archives of Occupational and Environmental Health
IS - 7
ER -