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A randomized trial of calcium supplementation for childhood lead poisoning
Morri E Markowitz1, Mark Sinnett, John F Rosen
1Children's Hospital at Montefiore, Bronx, New York 10467, USA. markowit@aecom.yu.edu
Insights
Calcium supplementation did not lower blood lead levels in children with mild to moderate lead poisoning. This suggests that routine calcium supplementation is not beneficial for children already meeting their dietary calcium needs.
Area of Science:
- Pediatric toxicology
- Nutritional science
- Environmental health
Background:
- Lead (Pb) poisoning is a significant public health concern in children, with limited treatment options for mild to moderate cases (blood Pb levels [BPbs] <45 micro g/dL).
- Calcium (Ca) and Pb interactions are known, with potential competition for absorption pathways.
- Understanding Ca's role in Pb poisoning is crucial for developing effective interventions.
Purpose of the Study:
- To investigate the efficacy of supplemental calcium in reducing blood lead levels in children with mild to moderate lead poisoning.
- To determine if calcium supplementation impacts lead absorption or toxicity in this pediatric population.
Main Methods:
- A double-blinded, placebo-controlled trial involving children aged 1 to 6 years with BPbs of 10 to 45 micro g/dL.
- Participants received either a Ca-containing liquid or a placebo, with Ca dosage adjusted to 1800 mg/day for the supplemented group.
- Blood Pb levels, hematologic, and biochemical measures were assessed at baseline, 3 months, and 6 months.
Main Results:
- No statistically significant differences in blood lead levels or safety measures were observed between the Ca-supplemented and placebo groups.
- Average compliance with supplementation was approximately 80% in both groups.
- Children in both groups showed a decline in blood lead levels over the 3-month supplementation period.
Conclusions:
- Supplemental calcium, at a target of 1800 mg/day, did not reduce blood lead levels in children with mild to moderate lead poisoning.
- Dietary calcium intake was adequate or high in the study population at enrollment.
- Routine calcium supplementation is not recommended for children with mild to moderate lead poisoning who have sufficient dietary calcium intake.
Objective:
Lead (Pb) poisoning remains a common disease among children despite successful public health efforts that have reduced its prevalence. Treatment options for children with blood Pb levels (BPbs) <45 micro g/dL are limited because chelation therapy is generally not indicated. Calcium (Ca) and Pb interactions are well documented. Competition for binding to Ca-binding proteins may underlie a mechanism for Pb absorption. The purpose of this study was to determine the role, if any, of supplemental Ca at reducing BPbs in moderately poisoned children.
Methods:
Children aged 1 to 6 years with BPbs 10 to 45 micro g/dL were enrolled in a double-blinded, placebo-controlled trial of the effects of Ca supplementation on BPbs. Children received either a Ca-containing liquid or an indistinguishable placebo. Dosage was adjusted biweekly on the basis of responses to a dietary Ca intake questionnaire to reach 1800 mg in the Ca-supplemented group. Samples for BPbs and measures to assess safety were collected before and after 3 months of supplementation and after an additional 3 months of follow-up. Bivariate and multiple regression analyses were performed.
Results:
A total of 67 of 88 enrolled children with a mean age of 3.6 years completed 3 months of supplementation. There were no statistically significant differences between groups on hematologic and biochemical measures, including serum and urinary Ca, at any time points. The average compliance rate was estimated to be 80% for each group during the 3-month supplementation period.
Conclusions:
At enrollment, the average daily Ca intake in this group of inner-city children was greater than the recommended daily intake for age. Although BPbs declined during a 3-month period in both groups, Ca supplementation aimed at providing 1800 mg of Ca/day had no effect on the change in BPbs. Ca supplementation should not be routinely prescribed for mild to moderately Pb-poisoned children who are dietarily Ca sufficient.
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