Skip to main content
Log in

Synergistic effects of iron deficiency and lead exposure on blood lead levels in children

  • Original Article
  • Published:
World Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Background

Lead poisoning is a well recognized environmental health problem in children. Independent association of iron deficiency and lead exposure with elevated blood lead level (BLL) has been reported. Whether iron deficiency in combination with chronic lead exposure increases BLL and susceptibility to its harmful effects in children needs to be elucidated.

Methods

In this case-control study, 246 children were randomly recruited. They comprised 123 children of lead smelters/battery recycle plant workers living close to the industries at Wah/Gujranwala, Pakistan (lead exposed group) and 123 children living 30 km away from the industrial area (controls). Blood lead analysis was carried out on the anodic stripping voltammeter lead analyzer 3010B. Blood counting was done on a Sysmex hematological analyzer and serum ferritin was determined by kit method on Immulite-1000.

Results

Of the 123 children in each group, 42 (34%) were iron deficient in the exposed group while 35 (28%) in the controls. The children’s median age was 4 years (69 males and 54 females in each group). Lead exposed iron deficient children had significantly higher BLL median (quartile) 13.1 μg/dL (10.1–16.8) as compared with 9.6 μg/dL (7.6–10.3) in the iron deficient controls (P<0.05). Elevated BLL level was found in 31% of the lead exposed children and in 11% of the controls. Lead exposed children revealed a stronger negative correlation (r= −0.54; P=0.001) between BLL and serum ferritin than the controls (r=−0.36; P=0.01).

Conclusion

Iron deficiency in combination with lead exposure synergistically elevates blood lead levels and susceptibility to its harmful effects in children.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Gao W, Li Z, Kaufmann RB, Jones RL, Wang Z, Chen Y, et al. Blood lead levels among children aged 1 to 5 years in Wuxi City, China. Environ Res 2001;87:11–19.

    Article  PubMed  CAS  Google Scholar 

  2. Kadir MM, Janjua NZ, Kristensen S, Fatmi Z, Sathiakumar N. Status of children’s blood lead levels in Pakistan: implications for research and policy. Public Health 2008;122:708–715.

    Article  PubMed  Google Scholar 

  3. Gökçay G. Strategies for the prevention of iron deficiency anemia in children. J Trop Pediatr 2006;52:75–77.

    Article  PubMed  Google Scholar 

  4. WHO. Iron Deficiency Anemia: Assessment, Prevention and Control. A guide for programme managers. Geneva: World Health Organization, 2001. www.nlm.nih.gov/medlineplus/ency/article/007134.htm (accessed June 12, 2010).

    Google Scholar 

  5. Marcus S. Toxicity, Lead. e-medicine, 2009. http://emedicine.medscape.com/article/815399-overview (accessed June 12, 2010).

  6. Khan DA, Qayyum S, Saleem S, Ansari WM, Khan FA. Lead exposure and its effects among occupational workers’ children. Toxicol Ind Health 2010;26:497–504.

    Article  PubMed  CAS  Google Scholar 

  7. Wright RO, Shannon MW, Wright RJ, Hu H. Association between iron deficiency and low level lead poisoning in an urban primary care clinic. Am J Public Health 1999;89:1049–1053.

    Article  PubMed  CAS  Google Scholar 

  8. Bradman A, Eskenazi B, Sutton P, Athanasoulis M, Goldman LR. Iron deficiency associated with higher blood lead in children living in contaminated environments. Environ Health Perspect 2001;109:1079–1084.

    Article  PubMed  CAS  Google Scholar 

  9. Wright RO, Tsiah SW, Schwartz J, Wright RJ, Hu H. Association between iron deficiency and blood lead level in a longitudinal analysis of children followed in an urban primary care clinic. J Pediatr 2003;142:9–14.

    Article  PubMed  CAS  Google Scholar 

  10. Schell LM, Denham M, Stark AD, Ravenscroft J, Parsons P, Schulte E. Relationship between blood lead concentration and dietary intakes of infants from 3 to 12 months of age. Environ Res 2004;96:264–273.

    Article  PubMed  CAS  Google Scholar 

  11. Muwakkit S, Nuwayhid I, Nabulsi M, al Hajj R, Khoury R, Mikati M, et al. Iron deficiency in young Lebanese children: association with elevated blood lead levels. J Pediatr Hematol Oncol 2008;30:382–386.

    Article  PubMed  Google Scholar 

  12. Hammad TA, Sexton M, Langenberg P. Relationship between blood lead and dietary iron intake in preschool children: a cross-sectional study. Ann Epidemiol 1996;6:30–33.

    Article  PubMed  CAS  Google Scholar 

  13. Bannon DI, Chisolm JJ Jr. Anodic stripping voltammetry compared with graphite furnace atomic absorption spectrophotometry for blood lead analysis. Clin Chem 2001;47:1703–1704.

    PubMed  CAS  Google Scholar 

  14. Centers for disease Control and Prevention. Preventing lead poisoning in children. August, 2005. http://www.cdc.gov/nceh/lead/publications/prevleadpoisoning.pdf (accessed June 12, 2010).

  15. Reynolds SJ, Etre L, Thorne PS, Whitten P, Selim M, Popendorf WJ. Laboratory comparison of vacuum, OSHA, and HUD sampling methods for lead in household dust. Am Ind Hyg Assoc J 1997;58:439–446.

    PubMed  CAS  Google Scholar 

  16. Yip R, Dallman PR. Developmental changes in erythrocyte protoporphyrin: the roles of iron deficiency and lead toxicity. J Pediatr 1984;104:710–713.

    Article  PubMed  CAS  Google Scholar 

  17. Kwong WT, Friello P, Semba RD. Interactions between iron deficiency and lead poisoning: epidemiology and pathogenesis. Sci Total Environ 2004;330:21–37.

    Article  PubMed  CAS  Google Scholar 

  18. Riddell TJ, Solon O, Quimbo SA, Tan CM, Butrick E, Peabody JW. Elevated blood-lead levels among children living in the rural Philippines. Bull World Health Organ 2007;85:674–680.

    Article  PubMed  Google Scholar 

  19. Turgut S, Polat A, Inan M, Turgut G, Emmungil G, Bican M, et al. Interaction between anemia and blood levels of iron, zinc, copper, cadmium and lead in children. Indian J Pediatr 2007;74:827–830.

    Article  PubMed  Google Scholar 

  20. Raymond JS, Anderson R, Feingold M, Homa D, Brown MJ. Risk for elevated blood lead levels in 3- and 4-year-old children. Matern Child Health J 2009;13:40–47.

    Article  PubMed  Google Scholar 

  21. Rondó PH, Carvalho MF, Souza MC, Moraes F. Lead, hemoglobin, zinc protoporphyrin and ferritin concentrations in children. Rev Saúde Pública 2006;40:71–76.

    Article  PubMed  Google Scholar 

  22. Serwint JR, Damokosh AI, Berger OG, Chisolm JJ, Gunter EW, Jones RL, et al. No difference in iron status between children with low and moderate lead exposure. J Pediatr 1999;135:108–110.

    Article  PubMed  CAS  Google Scholar 

  23. Rosado JL, López P, Kordas K, García-Vargas G, Ronquillo D, Alatorre J, et al. Iron and/or zinc supplementation did not reduce blood lead concentrations in children in a randomized, placebo-controlled trial. J Nutr 2006;136:2378–2383.

    PubMed  CAS  Google Scholar 

  24. Watson WS, Morrison J, Bethel MI, Baldwin NM, Lyon DT, Dobson H, et al. Food iron and lead absorption in humans. Am J Clin Nutr 1986;44:248–256.

    PubMed  CAS  Google Scholar 

  25. Molla A, Khurshid M, Molla AM. Prevalence of iron deficiency anaemia in children of the urban slums of Karachi. J Pak Med Assoc 1992;42:118–121.

    PubMed  CAS  Google Scholar 

  26. Paracha PI, Hameed A, Simon J, Jamil A, Nawab G. Prevalence of anaemia in semi-urban areas of Peshawar, Pakistan: a challenge for health professionals and policy makers. J Pak Med Assoc 1997;47:49–53.

    PubMed  CAS  Google Scholar 

  27. American Academy of Pediatrics. Lead exposure in children: prevention, detection and management. Pediatrics 2005;116:1036–1046.

    Article  Google Scholar 

  28. Vishwanath P, Prashant A, Devanand, Nayak N, D’souza V, Venkatesh T. Screening of school children for blood lead levels and attempts to reduce them by nonpharmacological means in a coastal city of India. Indian J Med Sci 2008;62:185–192.

    Article  PubMed  Google Scholar 

  29. Zimmermann MB, Muthayya S, Moretti D, Kurpad A, Hurrell RF. Iron fortification reduces blood lead levels in children in Bangalore, India. Pediatrics 2006;117:2014–2021.

    Article  PubMed  Google Scholar 

  30. Gulson BL, Mizon KJ, Korsch MJ, Taylor AJ. Low blood lead levels do not appear to be further reduced by dietary supplements. Environ Health Perspect 2006;114:1186–1192.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Dilshad Ahmed Khan.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Khan, D.A., Ansari, W.M. & Khan, F.A. Synergistic effects of iron deficiency and lead exposure on blood lead levels in children. World J Pediatr 7, 150–154 (2011). https://doi.org/10.1007/s12519-011-0257-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12519-011-0257-9

Key words

Navigation