Lead, cadmium and mercury in cerebrospinal fluid and risk of amyotrophic lateral sclerosis: A case-control study

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Published on Tuesday, 03 January 2017 12:00

Vinceti M, Filippini T, Mandrioli J, Violi F, Bargellini A, Weuwe J, Fini N, Grill P, Michalke B.

J Trace Elem Med Biol 2017 Jan 3

Abstract

Exposure to neurotoxic chemicals such as pesticides, selenium, and heavy metals have been suggested to play a role in the etiology of amyotrophic lateral sclerosis (ALS). We assessed exposure to lead, cadmium, and mercury in 38 ALS patients (16 men and 22 females) and 38 hospital-admitted controls by using their cerebrospinal fluid (CSF) content as biomarker. We determined CSF heavy metal levels with inductively coupled plasma sector field mass spectrometry, according to a methodology specifically developed for this biological matrix. ALS patients had higher median values for Pb (155 vs. 132ng/L) but lower levels for Cd (36 vs. 72ng/L) and Hg (196 vs. 217ng/L). In the highest tertile of exposure, ALS odds ratio was 1.39 (95% CI 0.48-4.25) for Pb, 0.29 (0.08-1.04) for Cd and 3.03 (0.52-17.55) for Hg; however, no dose-response relation emerged. Results were substantially confirmed after conducting various sensitivity analyses, and after stratification for age and sex. Though interpretation of these results is limited by the statistical imprecision of the estimates, and by the possibility that CSF heavy metal content may not reflect long-term antecedent exposure, they do not lend support to a role of the heavy metals cadmium, lead and mercury in ALS etiology.

The effect of potassium supplementation on blood pressure in hypertensive subjects: A systematic review and meta-analysis.

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Published on Wednesday, 21 December 2016 12:00

Filippini T, Violi F, D'Amico R, Vinceti M

Int J Cardiol. 2016 Dec 21

Abstract

BACKGROUND: Several intervention studies have investigated the relation between potassium intake and blood-pressure, particularly in hypertensive subjects. However, uncertainties still exist about the existence and the amount of such an effect, and about the role of some potential effect-modifiers, including the baseline potassium intake and geographical area.

METHODS: We carried out a systematic review of the evidence concerning such relation in hypertensive subjects, performing a meta-analysis and a meta-regression of RCT with selective and validated long-term (≥4weeks) potassium supplementation. We also implemented 'unconventional' search strategies in order to identify all potentially interesting studies.

RESULTS: Overall, potassium supplementation decreased systolic blood pressure of 4.48mmHg (95% CI 3.07-5.90) and diastolic blood pressure of 2.96mmHg (1.10-4.82). There was little evidence of dose-response relation between blood-pressure decrease and potassium supplementation, as assessed through total achieved potassium intake in the intervention groups, difference in achieved potassium intake, and study duration. However, lower (<90mmol/day) potassium intake at baseline was associated with a higher blood-pressure lowering effect, as were higher sodium intake (particularly ≥4g/day), higher sodium-to-potassium ratio and the absence of any anti-hypertensive drug treatment. Trials conducted in Southern Europe showed the highest blood-pressure lowering effect compared with the remaining regions.

CONCLUSIONS: Potassium supplementation in hypertensives was generally associated with decreased blood pressure, particularly in high sodium consumers, subjects not on hypertensive drug treatment, and those in the lowest category of potassium intake. An adequate dietary intake of potassium, in the order of 90mmol/day, should be achieved for blood pressure control.

Environmental metal contamination and health impact assessment in two industrial regions of Romania

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Published on Friday, 16 December 2016 12:00

Nedelescu M, Baconi D, Neagoe A, Iordache V, Stan M, Costantinescu P, Ciobanu AM, Vardavas AI, Vinceti M, Tsatsakis AM

Sci Tot Environ 2016 Dec 16. pii: S0048-9697(16)32740-1

Abstract

We investigated two Romanian industrial regions- Copşa Mică and Zlatna, to assess the current situation of soil pollution and bioaccumulation of Pb, Cd, Cu and Zn in different vegetable species and possible risks to consumers. Both total and mobile forms of the metals were determined in soil samples, and metal content in the edible parts of root vegetable samples was also assessed. The concentrations of Pb and Zn in soil were higher in Copşa Mică than in Zlatna (566mg/kg vs 271mg/kg for Pb and 1143mg/kg vs 368mg/kg for Zn)·The metal mobility in soil from Copsa Mica decreases in the order Zn>Cu>Cd>Pb (1.88mg/kg, 0.40mg/kg, 0.22mg/kg, 0.16mg/kg, respectively), while in Zlatna, the order was Cu>Zn>Pb>Cd (0.88mg/kg, 0.29mg/kg, 0.04mg/kg, 0.01mg/kg, respectively), apparently depending on metal and soil conditions. In Copsa Mica, the amount of Pb and Cd in vegetable samples exceeded the maximum permissible limits in carrots (median concentration 0.32mg/kg for Pb and Cd) and in yellow onions (median concentration 0.24mg/kg for Cd). In Zlatna region, the content of Cd exceeded the maximum limits in yellow onions (median concentration 0.11mg/kg). The amount of Pb was higher than the maximum acceptable level in carrots from the Zlatna region (median concentration 0.12mg/kg). Cu and Zn levels were within the normal range in all vegetable samples. In the Zlatna region, the transfer factors for Pb and Cd were higher in carrots (median values of 9.9 for Pb and 21.0 for Cd) compared to carrots harvested in Copsa Mica (median values of 4.0 for Pb and 2.0 for Cd). Daily intake rates of metals through local vegetable consumption exceeded the limit values established by the European Food Safety Authority for Pb (1.2 to 2.4 times) and Cd (5.5 to 9.1 times) in both regions, with potential adverse health effects for the local population. The results highlight the need for total soil remediation action before fruit and vegetables produced in these polluted areas can be safely consumed.

Validity of hospital discharge records to identify pregestational diabetes in an Italian population

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Published on Monday, 05 December 2016 12:00

Borsari L, Malagoli C, Ballottari P, De Girolamo G, Bonora K, Violi F, Capelli O, Rodolfi R, Nicolini F, Vinceti M

Diabetes Res Clin Pract. 2016 Dec 5;123:106-111

Abstract

AIMS: In recent years, the prevalence of pregestational diabetes (PGDM) and the concern about the possibility of adverse pregnancy outcomes in affected women have been increasing. Routinely collected health data represent a timely and cost-efficient approach in PGDM epidemiological research. This study aims to evaluate the reliability of hospital discharge (HD) coding to identify a population-based cohort of pregnant women with PGDM and to assess trends in prevalence in two provinces of Northern Italy.

METHODS: We selected all deliveries occurred in the period 1997-2010 with ICD-9-CM codes for PGDM in HD record and we matched up to 5 controls from mothers without diabetes. We used Diabetes Registers (DRs) as the gold standard for validation analysis.

RESULTS: We selected 3800 women, 653 with diabetes and 3147 without diabetes. The agreement between HD records and DRs was 90.7%, with K=0.58. We detected 350 false positives and only 1 false negative. Sensitivity was 99.3%, specificity 90.0%, positive predictive value 46.4% and negative predictive value 99.9%. Of the false positives, 48.6% had gestational diabetes and 2.3% impaired glucose tolerance. After the validation process, PGDM prevalence decreased from 4.4 to 2.0 per 1000 deliveries.

CONCLUSIONS: Our results show that HD facilitate detection of almost all PGDM cases, but they also include a large number of false positives, mainly due to gestational diabetes. This misclassification causes a large overestimation of PGMD prevalence. Our findings require accuracy evaluation of ICD-9-CM codes, before they can be widely applied to epidemiological research and public health surveillance related to PGDM.

Dietary reference values for potassium

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Published on Tuesday, 25 October 2016 12:00

EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA), Dominique Turck, Jean-Louis Bresson, Barbara Burlingame, Tara Dean, Susan Fairweather-Tait, Marina Heinonen, Karen Ildico Hirsch-Ernst, Inge Mangelsdorf, Harry McArdle, Monika Neuhauser-Berthold, Gra_zyna Nowicka, Kristina Pentieva, Yolanda Sanz, Alfonso Siani, Anders Sjodin, Martin Stern, Daniel Tome, Henk Van Loveren, Marco Vinceti, Peter Willatts, Peter Aggett, Ambroise Martin, Hildegard Przyrembel, Anja Bronstrup, Janusz Ciok, Jose Angel Gomez Ruiz, Agnes de Sesmaisons-Lecarre and Androniki Naska

EFSA Journal 2016;14(10):4592

Abstract

Following a request from the European Commission, the EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA) derives dietary reference values (DRVs) for potassium. The Panel decides to set DRVs on the basis of the relationships between potassium intake and blood pressure and stroke. The Panel considers that randomised controlled trials and an observational cohort study carried out in a European adult population provide evidence that a potassium intake of 3,500 mg (90 mmol)/day has beneficial effects on blood pressure in adults. Furthermore, there is consistent evidence from observational cohort studies that potassium intakes below 3,500 mg/day are associated with a higher risk of stroke. Available data cannot be used to determine the average requirement of potassium but can be used as a basis for deriving an adequate intake (AI). A potassium intake of 3,500 mg/day is considered adequate for the adult population and an AI of 3,500 mg/day for adult men and women is proposed. For infants and children, the AIs are extrapolated from the AI for adults by isometric scaling and including a growth factor. An AI of 750 mg (19 mmol)/day is set for infants aged 7–11 months. For children, AIs from 800 mg (20 mmol)/day (1–3 years old) to 3,500 mg/day (15–17 years old) are set. Considering that the daily accretion rate of potassium in fetal and maternal tissues can be met by the adaptive changes which maintain potassium homeostasis during pregnancy, the AI set for adults applies to pregnant women. For lactating women, the amount of potassium needed to compensate for the losses of potassium through breast milk is estimated and an AI of 4,000 mg (102 mmol)/day is proposed.

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