LEAD IN FOOD AND ITS CORRELATION WITH BLOOD LEAD LEVELS AMONG PREGNANT WOMEN OF SINDH, PAKISTAN

Authors

  • Shahla Naeem CMH Institute of Medical Scienes, Bahawalpur
  • Ayesha Zahid Khan Human Development Programme, Aga Khan University, Karachi, Pakistan
  • Ambreen Sahito Department of Community Medicine, Peoples University of Medical and Health Sciences for women, Nawabshah, Pakistan
  • Abdul Ghani Department of Health, Chagai
  • Ghazala Rafique Human Development Programme, Aga Khan University, Karachi, Pakistan
  • Fujio Kayama Department of Environmental and Preventive Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
  • Zafar Fatmi Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan

Abstract

Background: With increasing control of lead (Pb) in gasoline, food has emerged as an important secondary pathway for Pb exposure globally. This study assessed Pb levels in food duplicates and blood. Furthermore, it assessed the correlation of Pb in food duplicates and blood Pb levels with common food items taken by pregnant women of Sindh, Pakistan. Methods: A cross-sectional study was conducted from August 2014 to November 2015, in urban (Karachi) and rural (Gambat, Khairpur) area of Sindh-Pakistan. A total of 103 venous blood samples (Karachi = 63 and Gambat = 40) of pregnant women were measured for blood Pb levels at the time of delivery. One month post-delivery, food frequency questionnaire (FFQ) was administered and three-day food duplicates (same number of cooked portions of food eaten by women) were collected. Food duplicates were analysed for Pb levels. Multivariable linear regression was conducted to identify the frequency of food items which contribute to blood and food Pb levels of pregnant women, separately. Results: With 90% confidence interval, chapati (local flat bread) (β=0.20, p<0.001), boiled rice (β=0.35, p<0.001), cooked root vegetables (β= 0.16, p=0.03), fried savory items (β=0.15, p=0.03), sweet snacks (β=0.13, p=0.08) were positively associated with elevated mother blood Pb levels. While cream biscuits (β =-0.14, p=0.04), lassi (blend of yogurt, water and spices) (β= -0.31, p<0.01), market milk desserts (β=-0.22, p<0.001), fish (β= -0.16, p=0.02), soft drinks (β= -0.19, p=0.01) and supari/gutka (betel-nut) (β=-0.13, p= 0.06) were negatively associated with mother Pb levels. Tetra-pak market juices (β= 0.30, p<0.001) and cooked root vegetables (β=0.19, p= 0.05) were positively associated with mother food Pb levels, at 90% CI. Conclusion: Bread, boiled rice, fried savoury items, sweet snacks and cooked root vegetables were contributing to blood Pb levels of pregnant women in Pakistan. These food items may be contaminated with Pb during processing, packaging and storage. Inverse relation of Supari/gutka and soft drinks with blood Pb levels may be due its overall reduction in absorption capacity of the gut for nutrients. Objective individual food item analysis for Pb is warranted for further intervention. Background: With increasing control of lead (Pb) in gasoline, food has emerged as an important secondary pathway for Pb exposure globally. This study assessed Pb levels in food duplicates and blood. Furthermore, it assessed the correlation of Pb in food duplicates and blood Pb levels with common food items taken by pregnant women of Sindh, Pakistan. Methods: A cross-sectional study was conducted from August 2014 to November 2015, in urban (Karachi) and rural (Gambat, Khairpur) area of Sindh-Pakistan. A total of 103 venous blood samples (Karachi = 63 and Gambat = 40) of pregnant women were measured for blood Pb levels at the time of delivery. One month post-delivery, food frequency questionnaire (FFQ) was administered and three-day food duplicates (same number of cooked portions of food eaten by women) were collected. Food duplicates were analysed for Pb levels. Multivariable linear regression was conducted to identify the frequency of food items which contribute to blood and food Pb levels of pregnant women, separately. Results: With 90% confidence interval, chapati (local flat bread) (β=0.20, p<0.001), boiled rice (β=0.35, p<0.001), cooked root vegetables (β= 0.16, p=0.03), fried savory items (β=0.15, p=0.03), sweet snacks (β=0.13, p=0.08) were positively associated with elevated mother blood Pb levels. While cream biscuits (β =-0.14, p=0.04), lassi (blend of yogurt, water and spices) (β= -0.31, p<0.01), market milk desserts (β=-0.22, p<0.001), fish (β= -0.16, p=0.02), soft drinks (β= -0.19, p=0.01) and supari/gutka (betel-nut) (β=-0.13, p= 0.06) were negatively associated with mother Pb levels. Tetra-pak market juices (β= 0.30, p<0.001) and cooked root vegetables (β=0.19, p= 0.05) were positively associated with mother food Pb levels, at 90% CI. Conclusion: Bread, boiled rice, fried savoury items, sweet snacks and cooked root vegetables were contributing to blood Pb levels of pregnant women in Pakistan. These food items may be contaminated with Pb during processing, packaging and storage. Inverse relation of Supari/gutka and soft drinks with blood Pb levels may be due its overall reduction in absorption capacity of the gut for nutrients. Objective individual food item analysis for Pb is warranted for further intervention.

References

Shih RA, Hu H, Weisskopf MG, Schwartz BS. Cumulative lead dose and cognitive function in adults: a review of studies that measured both blood lead and bone lead. Environ Health Perspect 2007;115(3):483–92.

Lead poisoning and health [Internet]. World Health Organization. 2018 [cited 2018 Aug 13]. Available from: http://www.who.int/mediacentre/factsheets/fs379/en/

Rahman A, Al-Rashidi HA, Khan AR. Association of maternal blood lead level during pregnancy with child blood lead level and pregnancy outcome in Kuwait. Ecol Food Nutr 2012;51(1):40–57.

Kim JH, Lee SJ, Kim SY, Choi G, Lee JJ, Kim HJ, et al. Association of food consumption during pregnancy with mercury and lead levels in cord blood. Sci Total Environ 2016;563:118–24.

Tarragó O, Brown M. Lead (Pb) Toxicity: What Are the U.S. Standards for Lead Levels? ATSDR - Environmental Medicine & Environmental Health Education - CSEM [Internet]. Atsdr.cdc.gov. 2018 [cited 2018 Aug 13]. Available from: https://www.atsdr.cdc.gov/csem/csem.asp?csem=34&po=8

Preventing disease through healthy environments. Exposure to lead: A major public health concern. [Internet]. World Health Organization; 2010. [cited 2017 Sep 9] Available from: http://www.who.int/ipcs/features/lead.pdf

Paul R, White F, Luby S. Trends in lead content of petrol in Pakistan. Bull World Health Organ 2003;81(6):468.

Tiffany-Castiglioni E, Barhoumi R, Mouneimne Y. Kohl and surma eye cosmetics as significant sources of lead (Pb) exposure. J Local Glob Health Sci 2012;2012(1):1.

Mathee A, Naicker N, Kootbodien T, Mahuma T, Nkomo P, Naik I, et al. A cross-sectional analytical study of geophagia practices and blood metal concentrations in pregnant women in Johannesburg, South Africa. S Afr Med J 2014;104(8):568–73.

Bakhireva LN, Rowland AS, Young BN, Cano S, Phelan ST, Artyushkova K, et al. Sources of potential lead exposure among pregnant women in New Mexico. Matern Child Health J 2013;17(1):172–9.

Ayub R, Tariq N, Adil MM, Iqbal M, Jaferry T, Rais SR. Low haemoglobin levels, its determinants and associated features among pregnant women in Islamabad and surrounding region. J Pak Med Assoc 2009;59(2):86–9.

Hozhabri S, White F, Rahbar MH, Agboatwalla M, Luby S. Elevated blood lead levels among children living in a fishing community, Karachi, Pakistan. Arch Environ Health 2004;59(1):37–41.

Rahbar MH, White F, Agboatwalla M, Hozhabri S, Luby S. Factors associated with elevated blood lead concentrations in children in Karachi, Pakistan. Bull World Health Organ 2002;80(10):769–75.

Fatmi Z, Sahito A, Ikegami A, Mizuno A, Cui X, Mise N, et al. Lead Exposure Assessment among Pregnant Women, Newborns, and Children: Case Study from Karachi, Pakistan. Int J Environ Res Public Health 2017;14(4):413.

Iqbal R, Haroon MA, Dar FJ, Bilgirami M, Bano G, Habib A. Validation of a food frequency questionnaire for assessing macronutrient and calcium intake in adult Pakistani population. J Coll Physicians Surg Pak 2014;24(4):224–7.

Bibi M, Hashmi M, Malik R. The level and distribution of heavy metals and changes in oxidative stress indices in humans from Lahore district, Pakistan. Hum Exp Toxicol 2016;35(1):78–90.

Kazi TG, Shah F, Shaikh HR, Afridi HI, Shah A, Arain SS, et al. Exposure of lead to mothers and their new born infants, residents of industrial and domestic areas of Pakistan. Environ Sci Pollut Res 2014;21(4):3021–30.

Marzec Z, Koch W, Marzec A, Zukiewicz-Sobczak A. Dietary exposure to cadmium, lead and nickel among students from south-east Poland. Ann Agric Environ Med 2014;21(4):825–8.

Matsuda-Inoguchi N, Shimbo S, Zhang ZW, Srianujata S, Banjong O, Chitchumroonchokchai C, et al. Nutrient intake of working women in Bangkok, Thailand, as studied by total food duplicate method. Eur J Clin Nutr 2000;54(3):187–94.

Taylor BR, Roberts A, Sweeny C. Nutrients that reduce lead poisoning. The LEAD Group Inc., Australia. 2010.

Massaquoi LD, Ma H, Liu XH, Han PY, Zuo SM, Hua ZX, et al. Heavy metal accumulation in soils, plants, and hair samples: an assessment of heavy metal exposure risks from the consumption of vegetables grown on soils previously irrigated with wastewater. Environ Sci Pollut Res 2015;22(23):18456–68.

Hezbullah M, Sultana S, Chakraborty S, Patwary M. Heavy metal contamination of food in a developing country like Bangladesh: An emerging threat to food safety. J Toxicol Environ Health Sci 2016;8(1):1–5.

Khan MU, Malik RN, Muhammad S. Human health risk from Heavy metal via food crops consumption with wastewater irrigation practices in Pakistan. Chemosphere 2013;93(10):2230–8.

Alam N, Ahmad SR, Qadir A, Ashraf MI, Lakhan C, Lakhan VC. Use of statistical and GIS techniques to assess and predict concentrations of heavy metals in soils of Lahore City, Pakistan. Environ Monit Assess 2015;187(10):636.

Bi C, Zhou Y, Chen Z, Jia J, Bao X. Heavy metals and lead isotopes in soils, road dust and leafy vegetables and health risks via vegetable consumption in the industrial areas of Shanghai, China. Sci Total Environ 2018;619:1349–57.

Verrill L, Lando AM, O'Connell KM. Consumer vegetable and fruit washing practices in the United States, 2006 and 2010. Food Prot Trends 2012;32(4):164–72.

Roya AQ, Ali MS. Heavy metals in rice samples on the Torbat-Heidarieh market, Iran. Food Addit Contam Part B Surveill 2017;10(1):59–63.

Al-Saleh I, Abduljabbar M. Heavy metals (lead, cadmium, methylmercury, arsenic) in commonly imported rice grains (Oryza sativa) sold in Saudi Arabia and their potential health risk. Int J Hyg Environ Health 2017;220(7):1168–78.

Anwar A, Mahmood T, Khan MZ, Kiswar F, Perveen R, Ikram S. Heavy metals in fruit juices in different packing material. FUUAST J Biol 2014;4(2):191–4.

Yasmeen K, Mirza MA, Khan NA, Kausar N, Rehman AU, Hanif M. Trace metals health risk appraisal in fish species of Arabian Sea. Springerplus 2016;5(1):859.

Vartanian LR, Schwartz MB, Brownell KD. Effects of soft drink consumption on nutrition and health: a systematic review and meta-analysis. Am J Public Health 2007;97(4):667–75.

Garg A, Chaturvedi P, Gupta PC. A review of the systemic adverse effects of areca nut or betel nut. Indian J Med Paediatr Oncol 2014;35(1):3–9.

Shim JS, Oh K, Kim HC. Dietary assessment methods in epidemiologic studies. Epidemiol Health 2014;36:e2014009.

Published

2021-10-25

Issue

Vol. 33 No. 4 (2021): Journal of Ayub Medical College Abbottabad

Section

ORIGINAL ARTICLE

License

Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License  CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.

USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.

AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.