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Environmental Exposure to Metals and Children's Growth to Age 5 Years: A Prospective Cohort Study

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      Abstract

      In this prospective cohort study, based on 1,505 mother-infant pairs in rural Bangladesh, we evaluated the associations between early-life exposure to arsenic, cadmium, and lead, assessed via concentrations in maternal and child urine, and children's weights and heights up to age 5 years, during the period 2001–2009. Concurrent and prenatal exposures were evaluated using linear regression analysis, while longitudinal exposure was assessed using mixed-effects linear regression. An inverse association was found between children's weight and height, age-adjusted z scores, and growth velocity at age 5 years and concurrent exposure to cadmium and arsenic. In the longitudinal analysis, multivariable-adjusted attributable differences in children's weight at age 5 years were −0.33 kg (95% confidence interval (CI): −0.60, −0.06) for high (≥95th percentile) arsenic exposure and −0.57 kg (95% CI: −0.88, −0.26) for high cadmium exposure, in comparison with children with the lowest exposure (≤5th percentile). Multivariable-adjusted attributable differences in height were −0.50 cm (95% CI: −1.20, 0.21) for high arsenic exposure and −1.6 cm (95% CI: −2.4, −0.77) for high cadmium exposure. The associations were apparent primarily among girls. The negative effects on children's growth at age 5 years attributable to arsenic and cadmium were of similar magnitude to the difference between girls and boys in terms of weight (−0.67 kg, 95% CI: −0.82, −0.53) and height (−1.3 cm, 95% CI: −1.7, −0.89).

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          Inequality between and within populations has origins in adverse early experiences. Developmental neuroscience shows how early biological and psychosocial experiences affect brain development. We previously identified inadequate cognitive stimulation, stunting, iodine deficiency, and iron-deficiency anaemia as key risks that prevent millions of young children from attaining their developmental potential. Recent research emphasises the importance of these risks, strengthens the evidence for other risk factors including intrauterine growth restriction, malaria, lead exposure, HIV infection, maternal depression, institutionalisation, and exposure to societal violence, and identifies protective factors such as breastfeeding and maternal education. Evidence on risks resulting from prenatal maternal nutrition, maternal stress, and families affected with HIV is emerging. Interventions are urgently needed to reduce children's risk exposure and to promote development in affected children. Our goal is to provide information to help the setting of priorities for early child development programmes and policies to benefit the world's poorest children and reduce persistent inequalities. Copyright © 2011 Elsevier Ltd. All rights reserved.
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            Author and article information

            Author notes
            [* ]Correspondence to Dr. Marie Vahter, Institute of Environmental Medicine, Karolinska Institutet, Box 210, 171 77 Stockholm, Sweden (e-mail: marie.vahter@ 123456ki.se ).

            Abbreviations: CI, confidence interval; DMA, dimethylarsinic acid; MINIMat, Maternal and Infant Nutrition Interventions in Matlab; MMA, monomethylarsonic acid; SES, socioeconomic status.

            Journal
            Am J Epidemiol
            Am. J. Epidemiol
            aje
            amjepid
            American Journal of Epidemiology
            Oxford University Press
            0002-9262
            1476-6256
            15 June 2013
            14 May 2013
            14 May 2013
            : 177
            : 12
            : 1356-1367
            23676282
            3676155
            10.1093/aje/kws437
            kws437
            © The Author 2012. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health

            This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

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