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

WU Meng; LUO Lüer; WANG Jinghan; LIU Qin

doi:10.16835/j.cnki.1000-9817.2025214

Volume 46 Issue 7

Jul. 2025

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WU Meng, LUO Lüer, WANG Jinghan, LIU Qin. Systematic review and Meta-analysis of the association between heavy metal exposure and obesity in children and adolescents[J]. CHINESE JOURNAL OF SCHOOL HEALTH, 2025, 46(7): 926-931. doi: 10.16835/j.cnki.1000-9817.2025214

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WU Meng, LUO Lüer, WANG Jinghan, LIU Qin. Systematic review and Meta-analysis of the association between heavy metal exposure and obesity in children and adolescents[J]. CHINESE JOURNAL OF SCHOOL HEALTH, 2025, 46(7): 926-931. doi: 10.16835/j.cnki.1000-9817.2025214

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

doi: 10.16835/j.cnki.1000-9817.2025214

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

Received Date: 2024-12-20
Rev Recd Date: 2025-05-06

Available Online: 2025-08-02

Publish Date: 2025-07-25

Abstract

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

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References(39)

References

[1]	中华人民共和国国务院新闻办就《中国居民营养与慢性病状况报告(2020年)》有关情况举行发布会[EB/OL]. (2020-12-24)[2024-08-09]. http://www.gov.cn/xinwen/2020-12/24/content_5572983.htm.
[2]	REINEHR T. Long-term effects of adolescent obesity: time to act[J]. Nat Rev Endocrinol, 2018, 14(3): 183-188.
[3]	NICOLAIDIS S. Environment and obesity[J]. Metabolism, 2019, 100s: 153942.
[4]	SALCEDO-BELLIDO I, BUENO H C, OLMEDO P, et al. Metal (loid) exposure and overweight and obesity in 6-12-year-old Spanish children[J]. Expos Health, 2024, 16(6): 1471-1483.
[5]	NASAB H, RAJABI S, EGHBALIAN M, et al. Association of As, Pb, Cr, and Zn urinary heavy metals levels with predictive indicators of cardiovascular disease and obesity in children and adolescents[J]. Chemosphere, 2022, 294: 133664. http://www.sciencedirect.com/science/article/pii/S0045653522001576
[6]	YILMAZ B, TEREKECI H, SANDAL S, et al. Endocrine disrupting chemicals: exposure, effects on human health, mechanism of action, models for testing and strategies for prevention[J]. Rev Endocr Metab Disord, 2020, 21(1): 127-147.
[7]	ZOELLER R T, BROWN T R, DOAN L L, et al. Endocrine-disrupting chemicals and public health protection: a statement of principles from the endocrine society[J]. Endocrinology, 2012, 153(9): 4097-4110.
[8]	BRAUN J M. Early-life exposure to EDCs: role in childhood obesity and neurodevelopment[J]. Nat Rev Endocrinol, 2017, 13(3): 161-173.
[9]	WHO. 10 chemicals of public health concern[EB/OL]. (2020-06-01)[2024-08-07]. https://www.who.int/news-room/photo-story/photo-story-detail/10-chemicals-of-public-health-concern.
[10]	国家食品安全风险评估专家委员会. 中国居民膳食铝暴露的风险评估[R]. 北京: 国家食品安全风险评估中心, 2012: 3-5. China National Expert Committee of Food Safety Risk Assessment. Risk assessment of dietary exposure to aluminum in Chinese population[R]. Beijing: China National Center for Food Safety Risk Assessment, 2012: 3-5. (in Chinese)
[11]	SHAO W, LIU Q, HE X, et al. Association between level of urinary trace heavy metals and obesity among children aged 6-19 years: NHANES 1999-2011[J]. Environ Sci Pollut Res Int, 2017, 24(12): 11573-11581.
[12]	朱美琴, 纪宏先, 余丽丽, 等. 湖北省十堰市城区学龄前儿童尿金属水平与肥胖的关系[J]. 环境与职业医学, 2021, 38(9): 986-993. ZHU M Q, JI H X, YU L L, et al. Association of urinary metals levels with obesity in urban preschoolers in Shiyan of Hubei Province[J]. J Environ Occup Med, 2021, 38(9): 986-993. (in Chinese)
[13]	SHIN M W, KIM H B, KWON A, et al. Associations between urinary mercury/cadmium concentrations and anthropometric features in Korean children[J]. Toxics, 2024, 12(3): 175.
[14]	STANG A. Critical evaluation of the Newcastle-Ottawa Scale for the assessment of the quality of nonrandomized studies in Meta-analyses[J]. Eur J Epidemiol, 2010, 25(9): 603-605.
[15]	FAHMY O, FAHMY U A, ALHAKAMY N A, et al. Single-port versus multiple-port robot-assisted radical prostatectomy: a systematic review and Meta-analysis[J]. J Clin Med, 2021, 10(24): 5723.
[16]	曾宪涛, 刘慧, 陈曦, 等. Meta分析系列之四: 观察性研究的质量评价工具[J]. 中国循证心血管医学杂志, 2012, 4(4): 297-299. ZENG X T, LIU H, CHEN X, et al. Meta-analysis series Ⅳ: a quality assessment tool for observational studies[J]. Chin J Evid Based Cardiovasc Med, 2012, 4(4): 297-299. (in Chinese)
[17]	AHMADI S, BOTTON J, ZOUMENOU R, et al. Lead exposure in infancy and subsequent growth in Beninese children[J]. Toxics, 2022, 10(10): 595.
[18]	CASSIDY-BUSHROW A E, HAVSTAD S, BASU N, et al. Detectable blood lead level and body size in early childhood[J]. Biol Trace Elem Res, 2016, 171(1): 41-47.
[19]	DEIERLEIN A L, TEITELBAUM S L, WINDHAM G C, et al. Lead exposure during childhood and subsequent anthropometry through adolescence in girls[J]. Environ Int, 2019, 122: 310-315.
[20]	KIM R, HU H, ROTNITZKY A, et al. A longitudinal study of chronic lead exposure and physical growth in Boston children[J]. Environ Health Perspect, 1995, 103(10): 952-957.
[21]	LIU Y, PETERSON K E, MONTGOMERY K, et al. Early lead exposure and childhood adiposity in Mexico City[J]. Int J Hyg Environ Health, 2019, 222(6): 965-970.
[22]	ZHOU C C, HE Y Q, GAO Z Y, et al. Sex differences in the effects of lead exposure on growth and development in young children[J]. Chemosphere, 2020, 250: 126294.
[23]	CHO K Y. Association of blood mercury levels with the risks of overweight and high waist-to-height ratio in children and adolescents: data from the Korean national health and nutrition examination survey[J]. Children (Basel), 2021, 8(12): 1087.
[24]	SHAN Q. Trend analysis of the association of urinary metals and obesity in children and adolescents[J]. Chemosphere, 2022, 307(Pt 1): 135617.
[25]	LITTLE B B, SPALDING S, WALSH B, et al. Blood lead levels and growth status among African-American and Hispanic children in Dallas, Texas-1980 and 2002: Dallas Lead Project Ⅱ[J]. Ann Hum Biol, 2009, 36(3): 331-341.
[26]	DONANGELO C M, KERR B T, QUEIROLO E I, et al. Lead exposure and indices of height and weight in Uruguayan urban school children, considering co-exposure to cadmium and arsenic, sex, iron status and dairy intake[J]. Environ Res, 2021, 195: 110799.
[27]	FÁBELOVÁ L, VANDENTORREN S, VUILLERMOZ C, et al. Hair concentration of trace elements and growth in homeless children aged < 6 years: results from the ENFAMS study[J]. Environ Int, 2018, 114: 318-325.
[28]	GAO Z Y, LI M M, WANG J, et al. Blood mercury concentration, fish consumption and anthropometry in Chinese children: a national study[J]. Environ Int, 2018, 110: 14-21.
[29]	KUANG W, CHEN Z, SHI K, et al. Adverse health effects of lead exposure on physical growth, erythrocyte parameters and school performances for school-aged children in eastern China[J]. Environ Int, 2020, 145: 106130.
[30]	KYOUNG-BOK M. Relationship between low blood lead levels and growth in children of white-collar civil servants in Korea[J]. Int J Hygiene Environ Health, 2008, 211(1/2): 82-87.
[31]	张乔柔, 曹云, 田英, 等. 学龄期儿童重金属暴露水平与其体格发育相关指标的关联性研究[J]. 环境与职业医学, 2022, 39(2): 127-132, 140. ZHANG Q R, CAO Y, TIAN Y, et al. Correlation between heavy metal exposure levels in school-age children and their physical development-related indicators[J]. J Environ Occup Med, 2022, 39(2): 127-132, 140. (in Chinese)
[32]	PASTOR A J S, DESAI G, GARCÍA-VILLARINO M, et al. Exposure to a mixture of metals and growth indicators in 6-11-year-old children from the 2013-2016 NHANES[J]. Expos Health, 2021, 13(2): 173-184.
[33]	SHAO W, LIU Q, HE X, et al. Association between level of urinary trace heavy metals and obesity among children aged 6-19 years: NHANES 1999-2011. Environmental science and pollution research international[M]. Germany: Springer, 2017: 11573-11581.
[34]	SHIN Y Y, RYU I K, PARK M J, et al. The association of total blood mercury levels and overweight among Korean adolescents: analysis of the Korean National Health and Nutrition Examination Survey (KNHANES) 2010-2013[J]. Korean J Pediatr, 2018, 61(4): 121-128.
[35]	GARCÍA-VILLARINO M, SIGNES-PASTOR A J, KARAGAS M R, et al. Exposure to metal mixture and growth indicators at 4-5 years. A study in the INMA-Asturias Cohort[J]. Environ Res, 2022, 204(Pt D): 112375.
[36]	JILLIAN A M. Blood metal levels and early childhood anthropometric measures in a cohort of Canadian children[J]. Environ Res, 2019, 179(Pt A): 108736.
[37]	MOON M K, LEE I, LEE A, et al. Lead, mercury, and cadmium exposures are associated with obesity but not with diabetes mellitus: Korean National Environmental Health Survey (KoNEHS) 2015-2017[J]. Environ Res, 2022, 204(Pt A): 111888.
[38]	IAVICOLI I, FONTANA L, BERGAMASCHI A. The effects of metals as endocrine disruptors[J]. J Toxicol Environ Health B Crit Rev, 2009, 12(3): 206-223.
[39]	FARKHONDEH T, SAMARGHANDIAN S, AZIMI-NEZHAD M. The role of arsenic in obesity and diabetes[J]. J Cell Physiol, 2019, 234(8): 12516-12529.