title: Blood cadmium is elevated in iron deficient U.S. children: a cross-sectional study.
abstract: BACKGROUND
  Cadmium (Cd), a widespread environmental contaminant, and iron deficiency (ID), the most common nutrient deficiency in the world, are known risk factors for neurodevelopmental delays, as well as other disorders, in infants and children. Studies assessing the cumulative effects of these factors are lacking in children, despite concerns of increased uptake of metals in the presence of ID. Here we sought to determine if blood and urine Cd levels were elevated in ID children compared to non-ID children.
  
  
  METHODS
  Data for 5224 children, aged 3-19 years, were obtained from the 1999-2002 NHANES. ID was defined as ≥2 of 3 abnormal iron indicators (low serum ferritin [SF], high free erythrocyte protoporphyrin [FEP], low % transferrin saturation [TSAT]); ID anemia (IDA) was defined as ID plus low hemoglobin (Hgb). Logistic regression was used to evaluate associations between ID, IDA, and abnormal iron indicators and categories of blood and urine Cd.
  
  
  RESULTS
  Adjusted odds of ID, IDA, low SF, and low TSAT were associated with increasing category of blood Cd but not urine Cd. Adjusted ORs (95% CI) for blood Cd ≥0.5 μg/L versus < LOD were = 1.74 (1.30-2.34), 4.02 (1.92-8.41), 4.08 (2.36-5.89) and 1.78 (1.32-2.39), for ID, IDA, low SF, and low TSAT, respectively. Age and sex specific analyses of blood Cd and ID/abnormal iron indicators revealed that the observed associations were strongest in females aged 16-19 years.
  
  
  CONCLUSIONS
  Given their shared neurotoxic effects in children, and that many people live in areas with high burdens of both ID and Cd, more research into the complex relationships between nutrient deficiencies and environmental toxicants is vital.
authors.forename: Monica K
authors.initials: MK
authors.lastname: Silver
authors.forename: Betsy
authors.initials: B
authors.lastname: Lozoff
authors.affiliation: Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA. meekerj@umich.edu.
authors.forename: John D
authors.initials: JD
authors.lastname: Meeker
mesh_terms: D000293:Adolescent; D018798:Anemia, Iron-Deficiency / Q000097:blood* / Q000453:epidemiology* / Q000209:etiology; D002104:Cadmium / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D009749:Nutrition Surveys; D013050:Spectrometry, Fluorescence; D013054:Spectrophotometry, Atomic; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D002104:Cadmium