背景:人体内镉(Cd)的吸收和积累可能受到某些微量营养素状态的影响,尽管有关微量营养素暴露与Cd身体负担之间关联的现有证据仍然支离破碎且不一致。为了解决这个问题,本文回顾并综合了流行病学研究,这些研究检查了微量营养素暴露与人类Cd负担之间的关系,阐明微量营养素暴露与Cd身体负担之间的潜在关联。
方法:我们对流行病学研究进行了系统评价,这些研究报告了人群中微量营养素状态与Cd身体负担之间的关联。相关文章是根据PubMed的预定标准选择的,WebofScience,以及2000年至2021年发布的Scopus数据库。评估的暴露包括微量营养素(锌,硒,铁,钙,和维生素)状态或摄入量。感兴趣的结果是血液Cd或尿Cd水平所指示的Cd身体负担。使用JoannaBriggs研究所关键评估工具评估纳入研究的质量。我们从每篇文章中提取数据,包括研究设计,研究地点,研究人群,微量营养素状况,Cd身体负担,以及微量营养素状态与Cd身体负担之间的相关性。
结果:我们的系统搜索产生了1660篇文章。其中,根据预设的标准选择了44例纳入.这些精选的文章评估了Cd身体负担与七种不同微量营养素之间的关系,即,硒(Se),锌(Zn),钙(Ca),铁(Fe),维生素A,维生素B12和维生素D。大多数研究(n=41)是观察性的,而只有三项是随机对照试验。在评估锌状态的17项研究中,10人报告血清锌水平或摄入量与尿和血液镉水平之间呈负相关。在检验硒水平与镉体负荷之间关系的十项研究中,结果不一致。六项研究表明,血液和尿液中的Cd与血清铁蛋白(SF)呈负相关,身体铁状态的生物标志物。两项研究报道了Ca与血液Cd之间的负相关。
结论:现有证据的综合表明,某些微量营养素,特别是锌和铁,可能在减轻人群中Cd身体负担方面发挥作用。证据强烈支持锌之间的负相关,Fe,和Cd身体负担,而Se的证据,钙和维生素不足以就它们与Cd身体负担的关系得出明确的结论。此外,观察性研究限制了推断微量营养素与Cd身体负担之间因果关系的能力,强调需要额外的干预研究。我们的审查可能会为营养补充提供指导,控制Cd身体负担,以及未来在全球Cd污染背景下减轻Cd对健康不利影响的研究。
BACKGROUND: The absorption and accumulation of cadmium (Cd) within the human body can be influenced by the status of certain micronutrients, while available evidence for the association between micronutrient exposure and Cd body burden remains fragmented and inconsistent. To address this issue, this article reviews and synthesizes epidemiological studies that examine the association between micronutrient exposure and Cd burden in humans, to elucidate the potential association between micronutrient exposure and Cd body burden.
METHODS: We conducted a systematic review of epidemiologic studies reporting the association between micronutrient status and Cd body burden among the population. Relevant articles were selected based on predetermined criteria from PubMed, Web of Science, and Scopus databases published from 2000 to 2021. The exposures that were evaluated included micronutrients (zinc, selenium, iron, calcium, and vitamins) status or intakes of them. The outcome of interest was the Cd body burden as indicated by blood Cd or urinary Cd levels. The quality of included studies was assessed using The Joanna Briggs Institute critical appraisal tool. We extracted data from each article, including study design, study site, study population, micronutrient status, Cd body burden, and the correlations between micronutrient status and Cd body burden.
RESULTS: Our systematic search yielded 1660 articles. Of these, forty-four were selected for inclusion based on prespecified criteria. These selected articles evaluated the relationship between Cd body burden and seven different micronutrients, namely, selenium (Se), zinc (Zn), calcium (Ca), iron (Fe), vitamin A, vitamin B12, and vitamin D. The majority of studies (n = 41) were observational, while only three were randomized controlled trials. Among the seventeen studies assessing Zn status, ten reported a negative association between serum Zn levels or intake and urinary and blood Cd levels. Results were inconsistent among the ten studies examining the association between Se levels and Cd body burden. Six studies showed that Cd in blood and urine was negatively correlated with serum ferritin (SF), a biomarker of body Fe status. Two studies reported a negative correlation between Ca and blood Cd.
CONCLUSIONS: This synthesis of available evidence suggests that certain micronutrients, especially Zn and Fe, may play a role in reducing the Cd body burden among populations. The evidence strongly supports a negative association between Zn, Fe, and Cd body burden, whereas evidence for Se, Ca and vitamins is insufficient to draw definitive conclusions regarding their relationship with Cd body burden. In addition, observational studies limit the ability to infer a causal relationship between micronutrients and Cd body burden, highlighting the need for additional intervention studies. Our review may inform nutrient supplementation guidance, control of Cd body burden, and future research to mitigate the adverse health effects of Cd in the context of global Cd pollution.