Abstract
Manganese (Mn) exposure may reduce bone mineral density (BMD); however, studies investigating its effects on BMD are limited, especially among adolescents. Therefore, the present study is aimed at investigating the association between blood Mn levels and BMD in adolescents. This cross-sectional study included participants aged 12–19 years with National Health and Nutrition Examination Survey data collected between 2011 and 2018. Total, trunk bone, lumbar spine, and pelvic BMDs were used as outcome variables. Multivariate linear regression models were used to investigate the association between blood Mn levels and BMD. The relationship between blood Mn level and BMD was assessed using smooth curve fitting. In total, 1,703 participants (mean age 15.62 ± 2.31 years) were considered. Multivariable linear regression models demonstrated that BMD decreased as blood Mn level increased, especially among girls aged 12–15 years. This relationship was also observable in non-Hispanic whites and other races according to subgroup analyses stratified by race. Smooth curve fitting indicated the existence of a non-linear relationship between blood Mn and BMD after confounding variable adjustment. The present study indicated that blood Mn levels were negatively associated with BMD in adolescents, especially in girls aged 12–15 years. Therefore, clinicians should be aware of the potential risk of low bone mass among adolescents with high blood Mn levels.
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Data availability
All data were extracted from National Health and Nutrition Examination Survey (NHANES) 2017–2018 database. The detailed information was provided on the NHANES website.
Code availability
All analyses were performed with R software, V.4.1.3 (R: a language and statistical computing environment (program), Vienna, Austria: R Foundation for Statistical Computing, 2016), and EmpowerStats (http://www.empowerstats. com).
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Acknowledgements
We would like to express our gratitude to American Journal Experts (https://www.aje.com/) for the language editing services provided.
Funding
This study was supported by the National Natural Science Foundation of China (81874017, 81960403, and 82060405) and Cuiying Scientific and Technological Innovation Program of Lanzhou University Second Hospital (CY2017-ZD02, CY2021-MS-A07).
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JL and YT contributed equally to this work, contributed the central idea, and analyzed most of the data. JL wrote the initial draft of the paper. The remaining authors contributed to refining the ideas, carrying out additional analyses, and finalizing this paper.
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The ethics review board of the National Center for Health Statistics approved the study. The detailed information was provided on the NHANES website.
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Informed consent was obtained from all study participants. The detailed information was provided on the NHANES website.
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![](http://media.springernature.com/lw120/springer-static/esm/art%3A10.1007%2Fs11356-022-24314-9/MediaObjects/11356_2022_24314_Fig4_ESM.png)
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The relationship between blood manganese concentration and BMD stratified by age. Sex, race, poverty income ratio, BMI status, ALT, AST, total serum calcium, phosphorus, creatinine, blood lead, blood cadmium, use of glucocorticoid, milk intake, and physical activity level were adjusted. (A) Lumbar spine BMD; (B) Pelvis BMD; (C) Total BMD; (D) Trunk bone BMD. BMD, bone mineral density; BMI, body mass index; ALT, alanine aminotransferase; AST, aspartate aminotransferase. High resolution image (TIF 9724 kb)
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11356_2022_24314_MOESM5_ESM.tif
The relationship between blood manganese concentration and BMD stratified by race. Age, sex, poverty income ratio, BMI status, ALT, AST, total serum calcium, phosphorus, creatinine, blood lead, blood cadmium, use of glucocorticoid, milk intake, and physical activity level were adjusted. (A) Lumbar spine BMD; (B) Pelvis BMD; (C) Total BMD; (D) Trunk bone BMD. BMD, bone mineral density; BMI, body mass index; ALT, alanine aminotransferase; AST, aspartate aminotransferase. High resolution image (TIF 9872 kb)
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The relationship between blood manganese concentration and BMD stratified in male participants stratified by age. Race, poverty income ratio, BMI status, ALT, AST, total serum calcium, phosphorus, creatinine, blood lead, blood cadmium, use of glucocorticoid, milk intake, and physical activity level were adjusted. (A) Lumbar spine BMD; (B) Pelvis BMD; (C) Total BMD; (D) Trunk bone BMD. BMD, bone mineral density; BMI, body mass index; ALT, alanine aminotransferase; AST, aspartate aminotransferase. High resolution image (TIF 9706 kb)
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11356_2022_24314_MOESM7_ESM.tif
The relationship between blood manganese concentration and BMD stratified in female participants stratified by age. Race, poverty income ratio, BMI status, ALT, AST, total serum calcium, phosphorus, creatinine, blood lead, blood cadmium, use of glucocorticoid, milk intake, and physical activity level were adjusted. (A) Lumbar spine BMD; (B) Pelvis BMD; (C) Total BMD; (D) Trunk bone BMD. BMD, bone mineral density; BMI, body mass index; ALT, alanine aminotransferase; AST, aspartate aminotransferase. High resolution image (TIF 9670 kb)
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Liu, J., Tang, Y., Chen, Y. et al. Association between blood manganese and bone mineral density in US adolescents. Environ Sci Pollut Res 30, 29743–29754 (2023). https://doi.org/10.1007/s11356-022-24314-9
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DOI: https://doi.org/10.1007/s11356-022-24314-9