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Blood micronutrients modified associations between blood heavy metals and cognitive decline in a nationally
Chunliang Liu1, Tianchen Sheng2, Hao Fan3
1Department of Epidemiology, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, United States; Department of Gastroenterology, The Second Hospital of Shanxi Medical University, Taiyuan, People's Republic of China.
Background:
Although previous studies have shown that heavy metal exposure and antioxidant micronutrient insufficiency are associated with cognitive impairment, their combined influence on cognitive function remains unclear.
Objectives:
This study investigated the associations between blood concentrations of lead, cadmium, selenium, erythrocyte folate, and serum 25-hydroxyvitamin D [25(OH)D] and cognitive performance and the interactions between heavy metals and micronutrients in a United States cross-sectional study.
Methods:
Data from 2858 participants aged ≥60 y in the National Health and Nutrition Examination Survey 2011-2014 were analyzed. Multivariable linear and logistic regression models were constructed to evaluate the main effects of heavy metals and micronutrients and their additive and multiplicative interactions on cognitive function.
Results:
After adjustment for confounders, blood lead (β: -1.67; 95% CI: -3.32, -0.03) and cadmium (β: -2.02; 95% CI: -3.19, -0.85) were inversely associated and serum 25(OH)D (β: 2.23; 95% CI: 0.88, 3.59) was positively associated with the Digit Symbol Substitution Test (DSST) score (a higher score indicating better cognitive function). Significant additive and multiplicative interactions between blood lead and erythrocyte folate, between blood lead and serum 25(OH)D, and between blood cadmium and erythrocyte folate and low DSST score were detected. Compared with individuals in the first quartile of a weighted composite score of risk factors (defined as greater than or equal to the median for 2 metals or less than the median for 3 micronutrients), those in the quartiles 2 through 4 demonstrated a progressively higher risk of low cognitive function assessed by the DSST score (OR: 1.58; 95% CI: 0.95, 2.61; OR: 2.00; 95% CI: 1.18, 3.39; and OR: 2.45; 95% CI: 1.44, 4.17, respectively; P-trend: 0.00083).
Conclusions:
This study revealed that the neurodegenerative influence of heavy metals is more pronounced in individuals with lower micronutrient status. If the results of the present study are confirmed by future studies, reducing heavy metal exposure and improving micronutrient status may offer a novel and practical strategy for preventing cognitive decline and dementia.
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