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EndNote
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Hair Mercury Level is Associated with Anemia and Micronutrient Status in Children Living Near Artisanal and Small-Scale Gold Mining in the Peruvian Amazon
Caren Weinhouse
Caren Weinhouse
Duke Global Health Institute, Duke University, Durham, North Carolina;
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Ernesto J. Ortiz
Ernesto J. Ortiz
Duke Global Health Institute, Duke University, Durham, North Carolina;
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Axel J. Berky
Axel J. Berky
Duke Global Health Institute, Duke University, Durham, North Carolina;
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Paige Bullins
Paige Bullins
Duke Global Health Institute, Duke University, Durham, North Carolina;
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John Hare-Grogg
John Hare-Grogg
Civil and Environmental Engineering, Duke University, Durham, North Carolina;
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Laura Rogers
Laura Rogers
Civil and Environmental Engineering, Duke University, Durham, North Carolina;
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Ana-Maria Morales
Ana-Maria Morales
Centro de Estudios, Investigación y Servicios en Salud Publica, Lima, Peru;
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Heileen Hsu-Kim
Heileen Hsu-Kim
Civil and Environmental Engineering, Duke University, Durham, North Carolina;
Nicholas School of the Environment, Duke University, Durham, North Carolina
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Nicholas School of the Environment, Duke University, Durham, North Carolina
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William K. Pan
William K. Pan
Duke Global Health Institute, Duke University, Durham, North Carolina;
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Nicholas School of the Environment, Duke University, Durham, North Carolina
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Anemia has been widely studied in global health contexts because of severe nutritional deficiency, and more recently, inflammatory status, but chemical exposures are rarely considered. Until recently, “anemia” was used synonymously with “iron deficiency anemia (IDA)” in global health settings. However, only 50% of anemia cases worldwide are IDA. Environmental toxicology studies of anemia risk have generally focused on populations in developed countries, albeit with high exposure to environmental toxicants, such as lead or cadmium. In the developing world, toxicant exposures commonly coexist with other risk factors for anemia. In particular, artisanal and small-scale gold mining (ASGM) communities are at risk for dietary methylmercury exposure through contaminated fish consumption, and for anemia due to food insecurity and infectious and chronic diseases. Here, we report analysis of total hair mercury content, hemoglobin, and serum micronutrient levels in children < 12 years of age (N = 83) near ASGM in the Peruvian Amazon. Forty-nine percent (N = 29/59) of those aged < 5 years were anemic (< 11 g/dL) and 52% (N = 12/23) of those aged 5–11 years (< 11.5 g/dL). Few children were stunted, wasted, or micronutrient deficient. Median total hair mercury was 1.18 μg/g (range: 0.06–9.70 μg/g). We found an inverse association between total mercury and hemoglobin (β = −0.12 g/dL, P = 0.06) that persisted (β = −0.14 g/dL, P = 0.04) after adjusting for age, sex, anthropometrics, and vitamin B12 in multivariate regression. This study provides preliminary evidence that methylmercury exposure is associated with anemia, which is especially relevant to children living near ASGM.
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Author Notes
Financial support: This work was supported by a grant from Hunt Peru LLC. Support for C. W. was provided by the Inter-American Institute for Global Change Research (CRN #3036) and a Duke Global Health Institute postdoctoral fellowship.
Authors’ addresses: Caren Weinhouse, Ernesto J. Ortiz, and Paige Bullins, Duke University, Duke Global Health Institute, Durham, NC, E-mails: caren.weinhouse@duke.edu, ernesto.ortiz@duke.edu, and paige.meier@duke.edu. Axel J. Berky, Duke University, Nicholas School of the Environment, Durham, NC, E-mail: axel.berky@duke.edu. John Hare-Grogg and Laura Rogers, Duke University, Civil and Environmental Engineering, Durham, NC, E-mails: jwhg94@gmail.com and laura.rogers@duke.edu. Ana-Maria Morales, Centro de Estudios, Investigación y Servicios en Salud Publica, Centro de Estudios, Investigación y Servicios en Salud Publica, Lima, Peru, E-mail: anamorales30@hotmail.com. Heileen Hsu-Kim, Duke University, Civil and Environmental Engineering, Duke Global Health Institute, Durham, NC, E-mail: hsukim@duke.edu. William K. Pan, Duke University, Nicholas School of the Environment, Duke Global Health Institute, Durham, NC, E-mail: william.pan@duke.edu.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
BM P, 2004. The nutrition transition: an overview of world patterns of change. Nutr Rev 62: S140–S143.
-
2.
Popkin B, 2002. An overview on the nutrition transition and its health implications: the Bellagio meeting. Public Health Nutr 5: 93–103.
-
3.
Laborde A et al. 2015. Children’s health in Latin America: the influence of environmental exposures. Environ Health Perspect 123: 201–209.
-
4.
Lopez A, Cacoub P, Macdougall IC, Peyrin-Biroulet L, 2015. Iron deficiency anemia. Lancet 387: 907–916.
-
5.
Oppenheimer SJ, 2001. Iron and its relation to immunity and infectious disease. J Nutr 131: 616S–633S; discussion 633S–635S.
-
6.
Atkinson SH, Armitage AE, Khandwala S, Mwangi TW, Uyoga S, Bejon PA, Williams TN, Prentice AM, Drakesmith H, 2014. Combinatorial effects of malaria season, iron deficiency, and inflammation determine plasma hepcidin concentration in African children. Blood 123: 3221–3229.
-
7.
WHO, 2008. Worldwide Prevalence of Anemia 1993–2005: WHO Global Database on Anemia. Geneva, Switzerland: World Health Organization.
-
8.
Brito A, Mujica-Coopman MF, López de Romaña D, Cori H, Allen LH, 2015. Folate and vitamin B12 status in Latin America and the Caribbean: an update. Food Nutr Bull 36: S109–S118.
-
9.
Duong MC, Mora-Plazas M, Marin C, Villamor E, 2015. Vitamin B-12 deficiency in children is associated with grade repetition and school absenteeism, independent of folate, iron, zinc, or vitamin A status biomarkers. J Nutr 145: 1541–1548.
-
10.
Raiten DJ, Sakr Ashour FA, Ross AC, Meydani SN, Dawson HD, Stephensen CB, Brabin BJ, Suchdev PS, van Ommen B, Group IC, 2015. Inflammation and nutritional science for programs/policies and interpretation of research evidence (INSPIRE). J Nutr 145: 1039S–1108S.
-
11.
Zlotkin S, Newton S, Aimone AM, Azindow I, Amenga-Etego S, Tchum K, Mahama E, Thorpe KE, Owusu-Agyei S, 2013. Effect of iron fortification on malaria incidence in infants and young children in Ghana: a randomized trial. JAMA 310: 938–947.
-
12.
Hurrell R, 2010. Iron and malaria: absorption, efficacy and safety. Int J Vitam Nutr Res 80: 279–292.
-
13.
Raiten DJ, Ashour FA, 2015. Iron: current landscape and efforts to address a complex issue in a complex world. J Pediatr 167: S3–S7.
-
14.
Burke RM, Leon JS, Suchdev PS, 2014. Identification, prevention and treatment of iron deficiency during the first 1000 days. Nutrients 6: 4093–4114.
-
15.
WHO, 2006. Iron supplementation of young children in regions where malaria transmission is intense and infectious disease highly prevalent. World Health Organization Statement. Available at: http://www.who.int/maternal_child_adolescent/documents/pdfs/who_statement_iron.pdf. Accessed.
-
16.
Clark MA, Goheen MM, Fulford A, Prentice AM, Elnagheeb MA, Patel J, Fisher N, Taylor SM, Kasthuri RS, Cerami C, 2014. Host iron status and iron supplementation mediate susceptibility to erythrocytic stage Plasmodium falciparum. Nat Commun 5: 4446.
-
17.
United Nations, 2015. Transforming our world: the 2030 agenda for sustainable development. Available at: https://sustainabledevelopment.un.org/content/documents/21252030%20Agenda%20for%20Sustainable%20Development%20web.pdf. Accessed.
-
18.
Diringer SE, Feingold BJ, Ortiz EJ, Gallis JA, Araujo-Flores JM, Berky A, Pan WK, Hsu-Kim H, 2015. River transport of mercury from artisanal and small-scale gold mining and risks for dietary mercury exposure in Madre de Dios, Peru. Environ Sci Process Impacts 17: 478–487.
-
19.
Seriani R, Franca JG, Lombardi JV, Brito JM, Ranzani-Paiva MJ, 2015. Hematological changes and cytogenotoxicity in the tilapia Oreochromis niloticus caused by sub-chronic exposures to mercury and selenium. Fish Physiol Biochem 41: 311–322.
-
20.
AfTSaDR (ATSDR), 1999. Toxicological Profile for Mercury. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.
-
21.
Ryrie DR, Toghill PJ, Tanna MK, Galan GN, 1970. Marrow suppression from mercury poisoning? BMJ 1: 499.
-
22.
Priya N, Nagaprabhu VN, Kurian G, Seethalakshmi N, Rao GG, Unni VN, 2012. Aplastic anemia and membranous nephropathy induced by intravenous mercury. Indian J Nephrol 22: 451–454.
-
23.
Maramba NP et al. 2006. Environmental and human exposure assessment monitoring of communities near an abandoned mercury mine in the Philippines: a toxic legacy. J Environ Manage 81: 135–145.
-
24.
Slee PH, den Ottolander GJ, de Wolff FA, 1979. A case of merbromin (Mercurochrome) intoxication possibly resulting in aplastic anemia. Acta Med Scand 205: 463–466.
-
25.
Lang F, Lang KS, Lang PA, Huber SM, Wieder T, 2006. Mechanisms and significance of eryptosis. Antioxid Redox Signal 8: 1183–1192.
-
26.
Foller M, Huber SM, Lang F, 2008. Erythrocyte programmed cell death. IUBMB Life 60: 661–668.
-
27.
Monlezun DJ, Camargo CA Jr, Mullen JT, Quraishi SA, 2015. Vitamin D status and the risk of anemia in community-dwelling adults: results from the national health and nutrition examination survey 2001–2006. Medicine (Baltimore) 94: e1799.
-
28.
Qian Y, Zhang S, Guo W, Ma J, Chen Y, Wang L, Zhao M, Liu S, 2015. Polychlorinated biphenyls (PCBs) inhibit hepcidin expression through an estrogen-like effect associated with disordered systemic iron homeostasis. Chem Res Toxicol 28: 629–640.
-
29.
Gibb H, O’Leary KG, 2014. Mercury exposure and health impacts among individuals in the artisanal and small-scale gold mining community: a comprehensive review. Environ Health Perspect 122: 667–672.
-
30.
UNEP, 2013. UNEP Global Mercury Assessment 2013: Sources, Emissions, Releases and Environmental Transport. Geneva, Switzerland: UNEP Chemical Branch.
-
31.
Hsu-Kim H, Kucharzyk K, Deshusses MA, 2013. Mechanisms regulating mercury bioavailability for methylating microorganisms in the aquatic environment: a critical review. Environ Sci Technol 47: 2441–2456.
-
32.
Weihe P, Grandjean P, Jorgensen PJ, 2005. Application of hair-mercury analysis to determine the imapct of a seafood advisory. Environ Res 97: 200–207.
-
33.
van Wijngaarden E, Beck C, Shamlaye CF, Cernichiari E, Davidson PW, Myers GJ, Clarkson TW, 2006. Benchmark concentrations for methyl mercury obtained from the 9-year follow-up of the Seychelles Child Development Study. Neurotoxicology 27: 702–709.
-
34.
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-
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