The Effects of Calcium Supplementation on Blood Lead Levels and Short-term Memory of Chronically Exposed Children: A Clinical Trial Study

Sri Sofyani Syofyan; Arlinda Sari Wahyuni; Kusnandi  Rusmil; Aznan Lelo

doi:10.3889/oamjms.2020.3285

Authors

Sri Sofyani Syofyan Department of Child Health, Medical School, Haji Adam Malik Hospital, Universitas Sumatera Utara, Medan, Indonesia
Arlinda Sari Wahyuni Department of Community Medicine, Medical School, Universitas Sumatera Utara, Medan, Indonesia
Kusnandi Rusmil Department of Child Health, Medical School, Hasan Sadikin Hospital, Universitas Padjadjaran, Bandung, Indonesia
Aznan Lelo Departement of Pharmacology Medical School, Universitas Sumatera Utara, Medan, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2020.3285

Keywords:

Lead, Calcium, Short-term memory

Abstract

AIM: The purpose of this study is to determine the effects of calcium supplementation to decrease blood lead levels (BLLs) of children at high risk for chronic lead poisoning and to determine its effects on short-term memory.

MATERIALS AND METHODS: Children aged 8–12 years lived in the highest traffic density in Medan randomly included in this quasi-experimental study, divided into two groups (control and supplementation group received tablet contain four hundred milligrams oral calcium twice daily for 3 months). Samples for BLLs were collected before and after 3 months of supplementation, and short-term memory measurements are carried out by picture and forward digital span test. Descriptive statistics were calculated at baseline and 3 months; comparison between before and after treatment was assessed with t-tests, p < 0.05 considered statistically significant.

RESULTS: BLLs samples, who are exposed to lead for >6 months were ranging between 0.4–12 μg/dL. Median BLLs in supplementation group before treatment was 2.1 μg/dL and after treatment was 0.01 μg/dL (p < 0.01); difference between median in BLLs after treatment in supplementation group was 2.090 μg/dL (p = 0.004). Score memory picture in the supplementation group before treatment was 61.4 ± 24.83 and after treatment was 76.21 ± 15.97 (p<0.01). Score memory digital span in the supplementation group before treatment was 5 (3–7) and after treatment was 7 (5–7) (p < 0.01).

CONCLUSION: Three months of oral calcium supplementation 400 mg twice daily for high-risk chronic lead poisoning children reduced BLLs significantly and improved their short-term memory.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Papanikolaou NC, Hatzidaki EG, Belivanis S, Tzanakakis GN, Tsatsakis AM. Lead toxicity update. A brief review. Med Sci Monit. 2005;11(10):RA329-36. PMid:16192916

World Health Organization. Childhood Lead Poisoning. WHP Press; 2010.

Committee on Measuring Lead in Critical Population. Measuring Lead Exposure in Infant, Children and other Sensitive Populations. Washington, DC: United States National Academy Press; 1993. https://doi.org/10.17226/2232 DOI: https://doi.org/10.17226/2232

Lanphear BP, Hornung R, Ho M, Howard CR, Eberly S, Knauf K. Environmental lead exposure during early childhood. J Pediatr. 2002;140(1):40-7. https://doi.org/10.1067/mpd.2002.120513 PMid:11815762 DOI: https://doi.org/10.1067/mpd.2002.120513

Sauk JJ, Somerman MJ. Physiology of bone: Mineral compartment proteins as candidates for environmental perturbation by lead. Environ Health Perspect. 1991;91:9-16. https://doi.org/10.1289/ehp.91919 PMid:2040255 DOI: https://doi.org/10.1289/ehp.91919

Audesirk, G. Effects of lead exposure on the physiology of neurons. Prog Neurobiol. 1985;24(3):199-231. DOI: https://doi.org/10.1016/0301-0082(85)90006-1

Bughurst PA, McMchael AJ, Wigg NR, Vimpani GV, Robertson EF, Roberts RJ, et al. Environmental exposure to lead and children’s intelligence at the age of seven years. The port pirie cohort study. N Engl J Med. 1992;327(18):1279-84. https://doi.org/10.1056/nejm199210293271805 PMid:1383818 DOI: https://doi.org/10.1056/NEJM199210293271805

Hornung RW, Lanphear BP, Dietrich KN. Age of greatest susceptibility to childhood lead exposure: A new statistical approach. Environ Health Perspect. 2009;117(8):1309-12. https://doi.org/10.1289/ehp.0800426 PMid:19672413 DOI: https://doi.org/10.1289/ehp.0800426

Bijoor AR, Sudha S, Venkatesh T. Neurochemical and neurobehavioral effects of low lead exposure on the developing brain. Ind J Clin Biochem. 2012;27(2):147-51. https://doi.org/10.1007/s12291-012-0190-2 PMid:23543765 DOI: https://doi.org/10.1007/s12291-012-0190-2

Mahaffey KR. Nutritional factors and susceptibility to lead toxicity. Environ Health Perspect. 1974;7:107. PMid:4831135 DOI: https://doi.org/10.1289/ehp.747107

Ahamed M, Siddiqui MK. Environmental lead toxicity and nutritional factors. Clin Nutr. 2007;26(4):400-8. PMid:17499891 DOI: https://doi.org/10.1016/j.clnu.2007.03.010

Mahaffey KR, Gartside PS, Glueck CJ. Blood lead levels and dietary calcium intake in 1-to 11-year-old children: The second national health and nutrition examination survey. Pediatrics. 1986;78(2):257-62. PMid:3488536 DOI: https://doi.org/10.1542/peds.78.2.257

Roy A, Bellinger D, Hu H, Schwart J, Ettinger AS, Wright RO, et al. Lead exposure and behavior among children in Chennai, India. Environ Health Perspect. 2009;117(10):1607-11. https://doi.org/10.1289/ehp.0900625 PMid:20019913 DOI: https://doi.org/10.1289/ehp.0900625

Grandjean P. Even low-dose lead exposure is hazardous. Lancet. 2010;376(9744):855-6. https://doi.org/10.1016/s0140-6736(10)60745-3 PMid:20833288 DOI: https://doi.org/10.1016/S0140-6736(10)60745-3

Bellinger DC. A strategy for comparing the contributions of environmental chemicals and other risk factors to neurodevelopment of children. Environ Health Perspect. 2012;120(4):501-7. https://doi.org/10.1289/ehp.1104170 PMid:22182676 DOI: https://doi.org/10.1289/ehp.1104170

Grandjean P, Landrigan PJ. Neurobehavioral effects of developmental toxicity. Lancet Neurol. 2014;13(3):330-8. PMid:24556010 DOI: https://doi.org/10.1016/S1474-4422(13)70278-3

Lubis NM, Sofyani S, Lubis B. Association between blood lead levels with behavior disorders in elementary school age children. Paediatr Indones. 2016;56(Supp):11.

Albalak R, Noonan G, Buchana S, Flanders WD, Crawford CG, Kim D, et al. Blood lead levels and risk factors for lead poisoning among children in Jakarta, Indonesia. Science Total Environ. 2003;301(1-3):75-85. https://doi.org/10.1016/s0048-9697(02)00297-8 PMid:12493187 DOI: https://doi.org/10.1016/S0048-9697(02)00297-8

Gusnita, D. Pencemaran logam berat timbal (Pb) di udara dan upaya penghapusan bensin bertimbal. Ber Dirgantara. 2012;13(3).

Heinze. Assessment of Lead Exposure in School Children from Jakarta; 1998. Available from: http://www.ehp.niehs,nih. gov.members/1998/106p499-501heinze/heize-full.html. [Last accessed on 2020 Feb 10]. DOI: https://doi.org/10.1289/ehp.98106499

Amin B. Akumulasi dan Distribusi Logam Berat Pb dan Cu Pada Mangrove (Avicennia marina) di Perairan Pantai Dumai, Riau [Translation: Accumulation and Distribution of Heavy Metal Pb dan Cu on Mangrove (Avicenna marina) in Coastal Dumai, Riau] IN INDONESIAN] University of Riau Indonesia; 2001. https://doi.org/10.13170/depik.7.3.11020 DOI: https://doi.org/10.13170/depik.7.3.11020

Anggarini D. Analysis of heavy Metal Pb, Cd, Cu and Zn in a Seawater Sedimen and Gelainacoaxans in Coastal Dumai, Riau; 2007. Available from: http://www.images.cientherell4. multiply.multiplycontent.com.journal/item/1. [Last accessed on 2020 Feb 10].

Edward L. Dampak pencemaran logam berat terhadap kualitas air laut dan sumber daya perikanan (Studi kasus kematian massal ikan-ikan di Teluk. Makara Sains. 2004;8(2):52-8. https://doi.org/10.7454/mss.v8i2.414 DOI: https://doi.org/10.7454/mss.v8i2.414

Hasan W. Pencegahan Keracunan Timbal Kronis Pada Pekerja Dewasa Dengan Suplemen Kalsium. Vol. 16. Makara, Kesehatan; 2012.

Suyitno M, Vistha FM, Khasanah F, Murtinah S. Absorpsi Timbal (Pb) Dalam gas Buang Kendaraan Bermotor Bensin Dengan Karbon Aktif. Yogyakarta: Universitas Negeri Yogyakarta; 2006.

Sitohang R. Pengaruh Intensitas Kendaraan Bermotor Terhadap Emisi Logam Timbal ke Dalam Udara Ambien di Kota Medan [Thesis] Indonesia. Utara: Universitas Sumatera Utara; 2001.

Girsang, E. Hubungan Kadar Timbal di Udara Ambien Dengan Timbal Dalam Darah pada Pegawai Dinas Perhubungan Terminal Antar Kota Medan (Master’s Thesis). Utara: Postgraduate thesis Universitas Sumatera Utara; 2008. p. 36-52. https://doi.org/10.14238/sp8.3.2006.238-43 DOI: https://doi.org/10.14238/sp8.3.2006.238-43

Needleman H. Lead poisoning. Annu Rev Med. 2004;55:209-22. PMid:14746518 DOI: https://doi.org/10.1146/annurev.med.55.091902.103653

Nawrot TS, Staessen J. A Low-level environmental exposure to lead unmasked as a silent killer. Circulation. 2006;114(13):1347- 9. https://doi.org/10.1161/circulationaha.106.650440 PMid:17000919 DOI: https://doi.org/10.1161/CIRCULATIONAHA.106.650440

Nevin, R. Understanding international crime trends: The legacy of preschool lead exposure. Environ Res. 2007;104(3):315-36. https://doi.org/10.1016/j.envres.2007.02.008 PMid:17451672 DOI: https://doi.org/10.1016/j.envres.2007.02.008

World Health Organization. Brief Guide to Analytical Methods for Measuring Lead in Blood. Geneva: World Health Organization; 2011.

Flegal A, Smith DR. Lead levels in preindustrial human. N Engl J Med. 1992;326(19):1293-4. PMid:1560812 DOI: https://doi.org/10.1056/NEJM199205073261916

Sargent JD, Dalton MA, O’Connor GT, Olmstead EM, Klein RZ. Randomized trial of calcium glycerophosphate–supplemented infant formula to prevent lead absorption. Am J Clin Nutr. 1999;69(6):1224-30. https://doi.org/10.1093/ajcn/69.6.1224 DOI: https://doi.org/10.1093/ajcn/69.6.1224

Fullmer CS. Intestinal calcium and lead absorption: Effect of dietary lead and calcium. Environ Res. 1991;54(2):159-69. https://doi.org/10.1016/s0013-9351(05)80098-2 PMid:2029877 DOI: https://doi.org/10.1016/S0013-9351(05)80098-2

Suherni. Lead Poisoning in Indonesia. The LEAD Group Inc.; 2010. p. 1-16.

Santi DN. Pencemaran Udara Oleh Timbal (Pb) Serta Penanggulangannya. Utara: Fakultas Kedokteran Universitas Sumatera Utara; 2001.

Keller B, Faciano A, Tsega A, Ehrlich J. Epidemiologic characteristics of children with blood lead levels≥45 μg/dL. J Pediatr. 2017;180:229-34. https://doi.org/10.1016/j.jpeds.2016.09.017 PMid:27771006 DOI: https://doi.org/10.1016/j.jpeds.2016.09.017

Markowitz ME, Sinnet M, Rosen JF. Randomized trial of calcium supplementation for childhood lead poisoning. Pediatrics. 2004;113(1 Pt 1):e34-9. https://doi.org/10.1542/peds.113.1.e34 PMid:14702492 DOI: https://doi.org/10.1542/peds.113.1.e34

Haryanto B. Pengaruh Suplemen Kalsium Terhadap Penurunan Kadar Timah Hitam Dalam Darah (Studi Komunitas Siswa Sekolah Dasar di Kota Timah Bandung). Disertasi Program Doktor, Program Pascasarjana Fakultas Kesehatan Masyarakat, Universitas Indonesia; 2008. p. 90-1. https://doi.org/10.29408/geodika.v4i1.1891 DOI: https://doi.org/10.29408/geodika.v4i1.1891

Ballew C, Bowman B. Recommending calcium to reduce lead toxicity in children: A critical review. Nutr Rev. 2001;59(3):71-9. https://doi.org/10.1111/j.1753-4887.2001.tb06991.x PMid:11330624 DOI: https://doi.org/10.1111/j.1753-4887.2001.tb06991.x

Angleton JP, Friedman DP, Mishkin M. A comparison between the connections of the amygdala and hippocampus with the basal forebrain in the macaque. Exp Brain Res. 1987;67(3):556- 68. https://doi.org/10.1007/bf00247288 PMid:2820778 DOI: https://doi.org/10.1007/BF00247288

Baier B, Karnath HO, Dieterich M, Birklein F, Heinze C, Müller NG. Keeping memory clear and stable the contribution of human basal ganglia and prefrontal cortex to working memory. J Neurosci. 2010;30(29):9788-92. https://doi.org/10.1523/jneurosci.1513-10.2010 PMid:20660261 DOI: https://doi.org/10.1523/JNEUROSCI.1513-10.2010

Cohen RL, Sandberg T. The relation between intelligence and short-term memory. Cogn Psychol.1977;9(4):534-54. https://doi.org/10.1016/0010-0285(77)90019-6 DOI: https://doi.org/10.1016/0010-0285(77)90019-6

Salmaso D. Memory and aging: Components and processes. Funct Neurol. 1993;8(3):165-82. PMid:8406135

Squire LR, Knowlton BJ. In: Memory WL, Saunders RC, editor. Memory, Hippocampus and Brain Systems. 1989. p. 825-37.

Heard MJ, Chamberlain AC. Effect of minerals and food on uptake of lead from the gastrointestinal tract in humans. Hum Toxicol. 1982;1(4):411-5. https://doi.org/10.1177/096032718200100407 PMid:7173926 DOI: https://doi.org/10.1177/096032718200100407

Simon TJ. Cellular interactions between lead and calcium. Br Med Bull. 1986;42:431-4. PMid:3308000 DOI: https://doi.org/10.1093/oxfordjournals.bmb.a072162

Han S, Pfizenmaier DH, Garcia E, Eguez ML, Ling M, Kemp FW, et al. Effects of lead exposure before pregnancy and dietary calcium during pregnancy on fetal development and lead accumulation. Environ Health Perspect. 2000;108(6):527-31. https://doi.org/10.1289/ehp.00108527 PMid:10856026 DOI: https://doi.org/10.1289/ehp.00108527

Black KC, Barbezat GO, Mann M. Effect of dietary constituents on the gastrointestinal absorption of 203 Pb in Man. Environ Res. 1983;30:182-7. DOI: https://doi.org/10.1016/0013-9351(83)90178-0

Ziegler EE, Edward BB, Jensen RL, Mahaffey KR, Formon SJ. Absorption and relation of lead by infants. Pediatr Res. 1978;12(1):29-34. PMid:643372 DOI: https://doi.org/10.1203/00006450-197801000-00008

Lederer LG, Bing FC. Effect of calcium and phosphorus on retention of lead by the Growing organism. JAMA. 1940;114(25):2457-61. https://doi.org/10.1001/jama.1940.62810250009009 52. Bogden JD, Gertner SB, Christakos S, Kemp FW, Yang Z, Katz SR, et al. Dietary calcium modifies concentrations of lead and other metals and renal calbindin in rats. J Nutr. 1992;122(7):1351-60. https://doi.org/10.1093/jn/122.7.1351 PMid:1619463 DOI: https://doi.org/10.1093/jn/122.7.1351

Quarterman J, Morrison JN, Humphries WR. The influence of high dietary calcium and phosphate on lead uptake and release. Environ Res. 1978;17(1):60-7. https://doi.org/10.1016/0013-9351(78)90061-0 DOI: https://doi.org/10.1016/0013-9351(78)90061-0

Rosen JF, Chesney RW, Hamstra A, Mahaffey KR. Reduction in 1,25-dihydroxy vitamin D in children with increased lead absorption. N Engl J Med. 1980;302(20):1128-31. https://doi.org/10.1056/nejm198005153022006 PMid:7366636 DOI: https://doi.org/10.1056/NEJM198005153022006

Shen XM, Guo D, Zhou J, Chonghuai Y. Intervening role of calcium on lead toxicity in children: experimental study and clinical verification. Chin J Child Health. 1993;1:157.

Li K, Wang XF, Li DY, Chen YC, Zhao LJ, Liu XG, et al. The good, the bad, and the ugly of calcium supplementation: A review of calcium intake on human health. Clin Interv Aging. 2018;13:2443-52. https://doi.org/10.2147/cia.s157523 PMid:30568435 DOI: https://doi.org/10.2147/CIA.S157523

Granner DK. Hormon yang mengatur metabolisme kalsium. In: Murray RK, Granner DK, Rodwell VW, editor. Biokimia Harper. 25th ed. Jakarta: EGC; 2003. p. 253.

Groleau V, Herold RA, Schall JI, Wagner JL, Dougherty KA, Zemel BS, et al. A. Blood lead concentration is not altered by high dose Vitamin D supplementation in children and young adults with HIV. J Pediatr Gastroenterol Nutr. 2013;56(3):316-9. https://doi.org/10.1097/mpg.0b013e3182758c4a PMid:23059649 DOI: https://doi.org/10.1097/MPG.0b013e3182758c4a

Gould E. Childhood lead poisoning: Conservative estimates of the social and economic benefits of lead hazard control. Environ Health Perspect. 2009;117(7):1162-7. https://doi.org/10.1289/ehp.0800408 PMid:19654928 DOI: https://doi.org/10.1289/ehp.0800408

Pirkle JL, Brody DJ, Gunter EW, Kramer RA, Paschal DC, Flegal KM, et al. The decline in blood lead levels in the United States: The national health and nutrition examination surveys (NHANES). JAMA. 1994;272(4):284-91. https://doi.org/10.1001/jama.1994.03520040046039 PMid:8028141 DOI: https://doi.org/10.1001/jama.272.4.284