重金属暴露与儿童青少年肥胖关联的系统评价与Meta分析

吴梦; 罗律儿; 王静涵; 刘琴

doi:10.16835/j.cnki.1000-9817.2025214

重金属暴露与儿童青少年肥胖关联的系统评价与Meta分析

doi: 10.16835/j.cnki.1000-9817.2025214

重庆医科大学公共卫生学院/环境与人群健康研究中心/医学与社会发展研究中心, 重庆 400016

基金项目:

国家自然科学基金面上项目 81973067

重庆医科大学未来医学青年创新团队发展支持计划项目 W0054

详细信息

作者简介:
吴梦(2001-)，女，河南许昌人，在读硕士，主要研究方向为儿童青少年健康

通讯作者:
刘琴，E-mail：liuqin@cqmu.edu.cn

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R179 R723.14 O614
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- 被引次数: 0
出版历程
- 收稿日期: 2024-12-20
- 修回日期: 2025-05-06
- 网络出版日期: 2025-08-02
- 刊出日期: 2025-07-25

Systematic review and Meta-analysis of the association between heavy metal exposure and obesity in children and adolescents

School of Public Health, Chongqing Medical University/Research Center for Environment and Human Health/Research Center for Medicine and Social Development, Chongqing 400016, China

摘要

摘要: 目的系统评价铅、砷、镉、汞、铝5种重金属暴露与儿童青少年肥胖之间的关系，为后续开展相关研究提供科学依据。方法检索中国生物医学文献数据库、维普、中国知网、万方4个中文数据库和OVID、PubMed、Web of Science、EBSCO 4个外文数据库搜集相关研究，检索时间为建库至2024年5月5日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后，对结果进行定量分析和定性归纳总结。结果共纳入5项有关铅暴露的队列研究、17项涉及铅(13项)、镉(8项)、汞(8项)、砷(4项)、铝(1项)暴露的横断面研究。2项队列研究的Meta分析结果显示铅暴露与儿童超重肥胖风险相关性无统计学意义(RR=0.76，95%CI=0.50~1.16，P＞0.05)；而横断面研究Meta分析结果显示铅暴露与儿童超重(OR=0.70，95%CI=0.59~0.84，2项研究)、肥胖(OR=0.71，95%CI=0.58~0.87，3项研究)风险均呈负相关，镉暴露与儿童超重(OR=0.83，95%CI=0.73~0.95，2项研究)、肥胖(OR=0.70，95%CI=0.63~0.78，3项研究)风险均呈负相关，汞暴露会增加儿童超重/肥胖(OR=1.42，95%CI=1.14~1.76，2项研究)、腹型肥胖(OR=1.99，95%CI=1.45~2.73，2项研究)的风险，尿液中砷质量体积浓度最高组与浓度最低组相比发生肥胖的风险更低(OR=0.39，95%CI=0.23~0.65，1项研究)，尿液中铝质量体积浓度最高组与浓度最低组相比发生肥胖的风险更低(OR=0.52，95%CI=0.31~0.86，1项研究)(P值均＜0.05)。结论重金属暴露可能是儿童青少年发生超重肥胖的风险因素，但结论尚不统一，还需进一步开展高质量前瞻性队列研究予以验证。
- 金属 /
- 肥胖症 /
- Meta分析 /
- 儿童 /
- 青少年
Abstract: Objective To systematically evaluate the relationship of exposure to five heavy metals, namely lead, arsenic, cadmium, mercury and aluminum with obesity in children and adolescents, so as to provide a scientific basis for subsequent research in the area. Methods Four Chinese databasesc (CBM, VIP, CNKI and Wanfang) and four foreign databases (OVID, PubMed, Web of Science and EBSCO), were searched to collect relevant studies, and the search period was from the establishment of the database to May 5, 2024. After 2 investigators independently screened the literature, extracted the data and evaluated the risk of bias of the included studies, the results were analyzed quantitatively and summarized qualitatively. Results A total of 5 cohort studies on lead exposure and 17 cross-sectional studies involving exposure to lead (n=13), cadmium (n=8), mercury (n=8), arsenic (n=4), and aluminum (n=1) were included. Meta analysis of the 2 cohort studies showed that lead exposure was not associated with the risk of overweight and obesity in children (RR=0.76, 95%CI=0.50-1.16, P > 0.05). The cross-sectional study Meta-analysis results showed that lead exposure was negatively associated with the risk of childhood overweight (OR=0.70, 95%CI=0.59-0.84, 2 studies) and obesity (OR=0.71, 95%CI=0.58-0.87, 3 studies); cadmium exposure was negatively associated with the risk of childhood overweight (OR=0.83, 95%CI=0.73-0.95, 2 studies) and obesity risk(OR=0.70, 95%CI=0.63-0.78, 3 studies); mercury exposure increased the risk of overweight/obesity (OR=1.42, 95%CI=1.14-1.76, 2 studies) and abdominal obesity (OR=1.99, 95%CI=1.45-2.73, 2 studies) in children; the group with the highest concentration of arsenic in urine had a lower risk of developing obesity compared to the group with the lowest concentration (OR=0.39, 95%CI=0.23-0.65, 1 study), and the group with the highest concentration of aluminum in urine had a lower risk of obesity compared with the group with the lowest concentration (OR=0.52, 95%CI=0.31-0.86, 1 study)(all P < 0.05). Conclusion Heavy metal exposure may be a risk factor for overweight and obesity in children and adolescents, but the conclusions are inconsistent and need to be validated in further high-quality prospective cohort studies.
- Metals /
- Obesity /
- Meta-analysis /
- Child /
- Adolescent
注释:

1) 利益冲突声明 所有作者声明无利益冲突。

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图 1 重金属暴露与儿童青少年肥胖关联的研究文献筛选流程

Figure 1. Flow chart of literature screening on the association between heavy metal exposure and obesity in children and adolescents

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图 2 儿童青少年铅暴露与肥胖风险的横断面研究Meta分析

Figure 2. Cross-sectional studies Meta-analysis for children and adolescents lead exposure and risk of obesity

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图 3 儿童青少年镉暴露与肥胖风险的横断面研究Meta分析

Figure 3. Cross-sectional studies Meta-analysis for children and adolescents cadmium exposure and risk of obesity

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图 4 儿童青少年汞暴露与超重肥胖风险的横断面研究Meta分析

Figure 4. Cross-sectional studies Meta-analysis for children and adolescents mercury exposure and risk of overweight/obesity

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图 5 儿童青少年汞暴露与腹型肥胖风险的横断面研究Meta分析

Figure 5. Cross-sectional studies Meta-analysis for children and adolescents mercury exposure and risk of abdominal obesity

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表 1 纳入的铅暴露与儿童青少年肥胖关联队列研究文献的基本特征

Table 1. Basic characteristics of cohort studies on the association of lead exposure and obesity in children and adolescents

第一作者及年份	国家	样本来源	样本量(男/女)	基线年龄/岁	随访次数/随访间隔	生物样本	暴露水平	结局指标	肥胖指标测量年龄/岁
Ahmadi(2022)^[17]	贝宁	保健中心	659(333/326)	1.1	2/2年	血液	59.3 μg/L^a	BMI Z分	4(随访1)，6(随访2)
Cassidy-Bushrow(2016)^[18]	美国	医院	299(159/140)	1.3	1/11个月	血液	2.45 μg/dL	BMI Z分、超重、肥胖	2.2
Deierlein(2019)^[19]	美国	学校和医院	683(女)	7.8	7/1年	血液	1.16 μg/dL	BMI、腰围、体脂百分比、超重、肥胖	7~14
Kim(1995)^[20]	美国	学校	58(27/31)	7.4	1/12年	牙本质	14.9 ppm	BMI	20.5
Liu(2019)^[21]	墨西哥	医院	248(125/123)	1~4	1/—	血液	19.6 μg/dL	BMI Z分、腰围、体脂百分比	8~16
注：—表示未报告；^a为几何平均数，其余均为算术平均数。

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表 2 纳入的重金属暴露与儿童青少年肥胖关联横断面研究的基本特征

Table 2. Basic characteristics of cross-sectional studies on the association between heavy metal exposure and obesity in children and adolescents

第一作者及年份	国家	样本来源	样本量	年龄/岁	生物样本	重金属种类及暴露水平	结局指标
Zhou(2020)^[22]	中国	医院	1 678	4.7	血液	铅：56.84 μg/L^a	BMI Z分
Cho(2021)^[23]	韩国	国民健康营养调查	1 327	10~18	血液	汞：2.16 μg/L^a	BMI、腰高比、超重、腹型肥胖
Shan(2022)^[24]	美国	国家健康与营养检查调查	27 946	6~19	尿液	铅：38.46 μg/L；镉：7.6 μg/L^c	超重、肥胖
Little(2009)^[25]	美国	社区	360	2~12	血液	铅：1.8 μg/L^b	BMI
Donangelo(2021)^[26]	乌拉圭	社区	259	6.7	血液	铅：4.2 μg/dL^b	年龄别BMI Z分
Fábelová(2018)^[27]	法国	无住房儿童和家庭	324	2.7	头发	铅：2.43 μg/g；镉：0.05 μg/g；汞：0.42 μg/g；砷：0.08 μg/g^b	BMI Z分
Gao(2018)^[28]	中国	社区	14 202	0~6	血液	汞：1.39 μg/L^b	BMI、BMI Z分
Kuang(2020)^[29]	中国	学校	395	7~11	血液	铅：30.4 μg/L^b	标化BMI、腰围
Kyoung-Bok(2008)^[30]	韩国	社区	108	5~13	血液	铅：2.4 μg/dL^b	BMI
张乔柔(2022)^[31]	中国	山东莱州湾出生队列^*	318	7.8	尿液	铅：1.13 μg/g；镉：0.41 μg/g；汞：2.66 μg/g；砷：80.01 μg/g^a	BMI、腰围、体脂率
朱美琴(2021)^[12]	中国	学校	1 471	2~6	尿液	铅：4.55 μg/g；镉：0.79 μg/g；砷：108.83μg/g；铝：127.21 μg/g^a	肥胖
Pastor(2021)^[32]	美国	国家健康与营养检查调查	1 634	6~11	血液	铅：0.5 μg/dL；汞：0.3 μg/L^c	BMI、腰围
Shao(2017)^[33]	美国	国家健康与营养检查调查	6 602	6~19	尿液	铅：0.90 ng/mL；镉：0.14 ng/mL^b	超重、肥胖
Shin(2024)^[13]	韩国	国民健康营养调查	1 458	3~11	尿液	镉：0.11 μg/L；汞：0.47 μg/L^a	BMI Z分、超重/肥胖
Shin(2018)^[34]	韩国	国民健康营养调查	1 567	10~19	血液	汞：1.93 μg/L^a	超重/肥胖、腹部肥胖
García-Villarino(2022)^[35]	西班牙	阿斯图里亚斯出生队列研究^*	328	4~5	尿液	铅：1.9 μg/g；镉：0.3 μg/g^c	BMI、腰围
Jillian(2019)^[36]	加拿大	母婴环境化学品研究	449	2~5	血液	铅：0.66 μg/dL；镉：0.089 μg/L；汞：0.22 μg/L；砷：0.46 μg/L^c	BMI Z分
注：^*为队列研究中一次横断面调查；^a为几何平均数；^b为算术平均数；^c为中位数。

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