A summary of two meta-analyses on neurobehavioural effects due to occupational lead exposure

The conclusions from published results about neurotoxic effects of inorganic lead exposures <700 microg lead/l blood are contradictory at present. Effects measured by neurobehavioural methods are evaluated differently as far as recommendations for a Biological Exposure Index (BEI) of occupational lead exposure are concerned. Arguments against the German BEI of 400 microg/l were put forward in new publications, and discussion of the issues is the aim of this article. It summarizes two different meta-analytical reviews on neurobehavioural effects in order to show the main tendencies of 24 selected publications on the matter. Calculations on effect sizes are compiled for 12 tests analysed in two meta-analyses and of ten tests analysed in one of the meta-analyses. The survey of six tests of learning and memory gives hints on impairments measured with two tests, covering Logical Memory and Visual Reproduction. The survey of seven tests of attention and visuospatial information processing describes impairments in four tests, namely Simple Reaction, Attention Test d2, Block Design, and Picture Completion. The survey of four tests for psychomotor functions shows impairments for three tests, namely Santa Ana, Grooved Pegboard, and Eye-hand Coordination. These test results provide evidence for subtle deficits being associated with average blood lead levels between 370 and 520 microg/l. In evaluating the adversity of such effects it is concluded that the results of both meta-analytical reviews support the recommendation for the German BEI.