Jiyoung Kim; Minseo Shin; Sunghee Kim; Jihyun Seo; Hyesun Ma; Yoon Jung Yang

doi:10.4163/jnh.2017.50.4.350

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Kim, Shin, Kim, Seo, Ma, and Yang: Association of iron status and food intake with blood heavy metal concentrations in Korean adolescent girls and women: Based on the 2010∼2011 Korea National Health and Nutrition Examination Survey∗

Research Article

J Nutr Health 2017;50(4):350-360.

Published online: 20 January 2017

DOI: https://doi.org/10.4163/jnh.2017.50.4.350

Association of iron status and food intake with blood heavy metal concentrations in Korean adolescent girls and women: Based on the 2010∼2011 Korea National Health and Nutrition Examination Survey^∗

Jiyoung Kim^1,^∗∗, Minseo Shin^1,^∗∗, Sunghee Kim², Jihyun Seo¹, Hyesun Ma¹, Yoon Jung Yang^1,^†

¹Department of Food and Nutrition, Dongduk Women's University, Seoul 02748, Korea

²Department of Clinical Nutrition, Dongduk Women's University, Seoul 02748, Korea

^†To whom correspondence should be addressed. tel: +82-2-940-4465, E-mail: yjyang@dongduk.ac.kr

^∗ This study was supported by the Dongduk Women's University Grant.

^∗∗ These two authors equally contributed to this work.

Received 30 March 2017 Revised 21 April 2017 Accepted 31 July 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study examined and compared the associations of the iron status and food intake with the blood lead, mercury, and cadmium concentrations among Korean adolescent girls, premenopausal women, and postmenopausal women. Methods: The data from the 2010∼2011 Korea National Health and Nutrition Examination Survey (KNHANES) was used. The subjects were classified into three groups: adolescent girls (n = 268), premenopausal women (n = 1,157), and postmenopausal women (n = 446). The iron status was assessed by hemoglobin, hematocrit, serum ferritin, and iron concentrations, as well as the total iron binding capacity (TIBC). The food intake was estimated by a food frequency questionnaire. Results: The blood heavy metal concentrations and poisoning rate in postmenopausal women were higher than in the other groups. The iron status in the adolescent girls and postmenopausal women was higher than that in the premenopausal women. In the adolescent girls, the iron status was inversely associated with the blood cadmium concentration. The dairy food intake was inversely related to the blood lead and cadmium concentrations. In premenopausal women, the iron status was inversely associated with the cadmium concentrations. The fish and shellfish food intakes were positively associated with the mercury concentrations. In postmenopausal women, the iron status was positively associated with the mercury and cadmium concentrations. Fast foods and fried foods were inversely associated with the lead concentration. Conclusion: The premenopausal women showed a lower iron status than the adolescent girls and postmenopausal women. The associations of the iron status with the blood heavy metal concentrations were different among the adolescent girls, premenopausal women, and postmenopausal women. In addition, the relationships of the food intakes with the blood heavy metal concentrations differed among adolescent girls, premenopausal women, and postmenopausal women. Further studies will be needed to confirm these findings.

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Table 1.

General characteristics of the subjects

Characteristic	Adolescent girls (n = 268)	Premenopausal women (n = 1,157)	Postmenopausal women (n = 446)	p¹⁾
Age (year)	15.3 ± 0.1^2)a	34.1 ± 0.3^b	56.3 ± 0.2^c	< 0.0001
Anthropometric measurement
Height (cm)	159.9 ± 0.4^b	159.6 ± 0.2^b	155.0 ± 0.3^a	< 0.0001
Weight (kg)	54.33 ± 0.7^a	57.2 ± 0.3^b	58.2 ± 0.4^c	< 0.0001
BMI (kg/m²)	21.2 ± 0.3^a	22.5 ± 0.1^b	24.3 ± 0.2^c	< 0.0001
Education status				< 0.0001
Below elementary	134 (43.3)³⁾	42 (4.2)	203 (44.6)
Middle school	118 (50.4)	61 (5.2)	92 (23.6)
High school	15 (5.9)	495 (45.1)	121 (24.9)
College or higher	1 (0.3)	556 (45.5)	28 (6.8)
Residence area				0.0002
Urban	229 (82.8)	995 (85.2)	341 (76.3)
Rural	39 (17.2)	162 (14.8)	105 (23.7)
Alcohol intake				NA⁴⁾
None	210 (74.7)	288 (20.0)	195 (41.5)
≤ 4times/month	55 (23.8)	784 (68.1)	225 (51.3)
2∼3times/week	2 (1.4)	114 (9.5)	16 (4.3)
≥ 4times/week	0 (0.0)	25 (2.4)	9 (2.9)
Smoking status				NA
Current Smoker	0 (0.0)	85 (8.3)	15 (4.0)
Exercise				0.002
None	156 (59.6)	732 (64.1)	318 (70.9)
1∼2day/week	69 (25.8)	197 (17.5)	46 (11.5)
3∼4day/week	25 (7.9)	122 (9.9)	36 (6.8)
5∼7day/week	18 (6.8)	106 (8.6)	46 (10.8)
Nutrients
Total energy intake (kcal/day)	1,916.9 ± 60.0^b	1,774.7 ± 26.8^a	1,731.0 ± 40.6^a	0.033
Carbohydrate (g)	290.1 ± 8.4^a	280.1 ± 4.1^a	314.3 ± 7.7^b	0.003
Protein (g)	68.7 ± 2.6^b	66.4 ± 1.3^b	59.4 ± 1.8^a	< 0.0001
Fat (g)	52.9 ± 2.9^c	42.3 ± 1.1^b	28.8 ± 1.4^a	0.0005
Dietary fiber (g)	5.0 ± 0.3^a	6.4 ± 0.2^b	8.0 ± 0.4^c	< 0.0001
Calcium (mg)	460.5 ± 24.0	462.4 ± 10.5	472.9 ± 18.8	0.877
Phosphorous (mg)	1,046.3 ± 34.0	1,054.3 ± 17.1	1,062.2 ± 28.1	0.940
Iron (mg)	11.3 ± 0.6^a	13.1 ± 0.5^b	15.0 ± 0.7^c	0.0003
Sodium (mg)	3,664.2 ± 176.6 ^a	4,398.9 ± 100.6^b	4,237.5 ± 177.1^b	0.0002
Potassium (mg)	2,358.8 ± 90.8^a	2,718.2 ± 52.0^b	2,998.7 ± 100.0^c	< 0.0001
Supplement use				< 0.0001
Yes	53 (18.6)	402 (37.0)	219 (53.2)

Abbreviations: BMI, body mass index 1) P-value was analyzed by ANOVA test for continuous variables and chi-square test for categorical variables. 2) Mean ± SE (Mean values with unlike superscript letters within a row were significantly different among the three groups by Tukey's test.) 3) N (%) 4) None applicable

Table 2.

Pearson's correlation coefficients among blood heavy metal concentrations, age and body mass index

	Adolescent girls (n = 268)	Premenopausal women (n = 1,157)	Postmenopausal women (n = 446)
Age (year)
Lead (μg/dL)	0.0592 (0.3346)¹⁾	0.3307 (< 0.0001)	–0.0779 (0.1004)
Mercury (μg/L)	–0.0538 (0.3800)	0.2401 (< 0.0001)	–0.0739 (0.1190)
Cadmium (μg/L)	0.1381 (0.0237)	0.5608 (< 0.0001)	0.0194 (0.6826)
BMI (kg/m²)
Lead (μg/dL)	–0.0573 (0.3499)	0.1096 (0.0002)	–0.0002 (0.9964)
Mercury (μg/L)	0.1510 (0.0133)	0.1506 (< 0.0001)	0.2049 (< 0.0001)
Cadmium (μg/L)	–0.0022 (0.9716)	0.1538 (< 0.0001)	0.0885 (0.0617)

¹⁾ Pearson's correlation coefficient (p-value)

Table 3.

Blood heavy metal concentrations and poisoning rate of lead, mercury and cadmium

	Adolescent girls	Premenopausal	Postmenopausal	p¹⁾
	(n = 268)	women (n = 1,157)	women (n = 446)
	Geo mean (95% CI)²⁾	Geo mean (95% CI)	Geo mean (95% CI)
Blood heavy metal
Lead (μg/dL)	1.08 (1.04–1.13)^3)a	1.65 (1.62–1.69)^b	2.26 (2.19–2.33)^c	< 0.0001
Mercury (μg/L)	1.95 (1.85–2.06))^a	2.97 (2.89–3.06)^b	3.45 (3.27–3.64)^c	< 0.0001
Cadmium (μg/L)	0.35 (0.33–0.38)^a	0.92 (0.89–0.96)^b	1.41 (1.35–1.47)^c	< 0.0001
	N (%)	N (%)	N (%)
Blood heavy metal poisoning rate⁴⁾
Lead (μg/dL)	0 (0.0)	0 (0.0)	0 (0.0)	NA⁵⁾
Mercury (μg/L)	10 (3.9)	167 (14.8)	111 (24.6)	< 0.0001
Cadmium (μg/L)	0 (0.0)	0 (0.0)	1 (0.008)	NA

¹⁾ Blood heavy metal was analyzed by geometric mean (95% confidence interval). 2) P-value was analyzed by ANOVA test for continuous variables. 3) Mean values with unlike superscript letters within a row were significantly different among the three groups by Tukey's test. 4) Lead: Blood heavy metal poisoning (> 10 μg/dL), Mercury: Blood heavy metal poisoning (> 5 μg/L), Cadmium: Blood heavy metal poisoning (> 5 μg/L) 5) None applicable

Table 4.

Iron status and deficiency rate based on hemoglobin, hematocrit, ferritin, iron, and total iron binding capacity

	Adolescent girls	Premenopausal	Postmenopausal	p¹⁾
	(n = 268)	women (n = 1,157)	women (n = 446)
	Mean ± SE	Mean ± SE	Mean ± SE
Iron status
Hb (g/dL)	13.2 ± 0.07^2)b	12.9 ± 0.04^a	13.3 ± 0.1^b	< 0.0001
Hct (%)	39.7 ± 0.2^b	38.8 ± 0.1^a	39.9 ± 0.2^b	< 0.0001
Frtn (ng/mL)	28.8 ± 1.6^a	30.7 ± 0.9^a	67.4 ± 3.3^b	< 0.0001
Fe (μg/dL)	98.8 ± 2.9	98.9 ± 1.6	104.5 ± 2.0	0.055
TIBC (μg/dL)	344.3 ± 3.6^c	333.2 ± 1.8^b	314.2 ± 2.3^a	< 0.0001
	N (%)	N (%)	N (%)
Iron deficiency rate³⁾
Hb (g/dL)	22 (8.1)	185 (15.5)	319 (6.3)	< 0.0001
Hct (%)	17 (7.0)	166 (13.5)	29 (6.5)	0.001
Frtn (ng/mL)	80 (31.7)	370 (32.7)	26 (5.4)	< 0.0001
Fe (μg/dL)	18 (8.3)	114 (9.8)	9 (1.4)	< 0.0001
TIBC (μg/dL)	25 (9.0)	79 (7.9)	6 (0.7)	< 0.0001

Abbreviations: HB, hemoglobin; HCT, hematocrit; Frtn, ferritin; Fe, iron; TIBC, total iron-binding capacity

¹⁾ P-value was analyzed by ANOVA test for continuous variables.

²⁾ Mean ± SE (Mean values with unlike superscript letters within a row were significantly different among the three groups by Tukey's test.)

³⁾ Hemoglobin: Iron deficiency (< 12 g/dL), Hematocrit: Iron deficiency (< 36%), Ferritin: Iron deficiency (< 15 ng/mL), Iron: Iron deficiency (< 40 μg/dL) and Total iron-binding capacity: Iron deficiency (> 410 μg/dL)

Table 5.

Associations between blood heavy metal concentrations and iron status of the subjects

	Adolescent girls (n = 268)		Premenopausal women (n = 1,157)		Postmenopausal women (n = 446)
	β¹⁾	p²⁾	β	p	β	p
Lead (μg/dL)
Hb (g/dL)	0.035	0.138	0.043	0.0003	0.033	0.162
Hct (%)	0.011	0.173	0.020	< 0.0001	0.014	0.072
Frtn (ng/mL)	–0.0002	0.806	–0.0006	0.240	–0.00005	0.863
Fe (μg/dL)	0.0006	0.435	–0.00003	0.924	–0.001	0.031
TIBC (μg/dL)	0.0002	0.724	0.0005	0.073	–0.0004	0.349
Mercury (μg/L)
Hb (g/dL)	0.051	0.087	0.072	< 0.0001	0.064	0.049
Hct (%)	0.015	0.191	0.028	< 0.0001	0.024	0.048
Frtn (ng/mL)	0.002	0.087	0.003	0.0002	0.0004	0.612
Fe (μg/dL)	–0.0007	0.402	0.001	0.012	0.001	0.144
TIBC (μg/dL)	–0.0001	0.823	–0.0004	0.166	0.0003	0.664
Cadmium (μg/L)
Hb (g/dL)	–0.061	0.047	–0.049	0.002	0.066	0.006
Hct (%)	–0.019	0.146	–0.013	0.036	0.025	0.003
Frtn (ng/mL)	–0.006	0.0005	–0.006	< 0.0001	0.0006	0.136
Fe (μg/dL)	–0.001	0.186	–0.002	< 0.0001	0.0002	0.753
TIBC (μg/dL)	0.003	0.0001	0.003	< 0.0001	0.0007	0.162

Abbreviations: HB, hemoglobin; HCT, hematocrit; Frtn, ferritin; Fe, iron; TIBC, total iron-binding capacity; 1) Multiple linear regression analysis

²⁾ Adolescent girls: Adjusting for age, BMI, residence area, and drinking status. Premenopausa women and postmenopausal women: Adjusting for age, BMI, residence area, drinking status and smoking status

Table 6.

Associations between blood heavy metal concentrations and food consumption frequency (servings/day)

	Adolescent girls (n = 268)		Premenopausal women (n = 1,157)		Postmenopausal women (n = 446)
	β¹⁾	p²⁾	β	p	β	p
Lead (μg/dL)
Grains	0.009	0.651	–0.012	0.202	–0.006	0.633
Soy and soybean products	–0.050	0.108	–0.011	0.387	0.011	0.461
Potatoes	–0.050	0.423	–0.149	0.004	–0.060	0.456
Meat and eggs	–0.034	0.183	–0.057	0.016	–0.037	0.443
Fish and shellfish	0.011	0.701	–0.012	0.605	–0.035	0.245
Vegetables	0.005	0.728	0.0005	0.937	0.012	0.168
Seaweeds	–0.049	0.308	–0.013	0.608	–0.011	0.750
Fruits	–0.011	0.659	–0.047	0.001	–0.023	0.396
Milk and dairy products	–0.114	0.001	–0.023	0.291	–0.062	0.161
Beverages	0.062	0.136	0.011	0.313	–0.009	0.585
Alcoholic beverages	0.277	0.157	0.070	0.359	0.057	0.433
Fast foods and fried foods	0.015	0.876	–0.096	0.260	–0.048	0.049
Mercury (μg/dL)
Grains	–0.009	0.788	–0.025	0.045	0.004	0.846
Soy and soybean products	0.084	0.132	–0.028	0.156	–0.005	0.792
Potatoes	0.055	0.740	–0.219	0.0004	–0.264	0.037
Meat and eggs	0.071	0.146	–0.054	0.123	–0.002	0.978
Fish and shellfish	0.178	0.001	0.056	0.041	0.073	0.054
Vegetables	0.004	0.850	0.006	0.583	–0.019	0.285
Seaweeds	0.092	0.254	–0.031	0.408	0.029	0.633
Fruits	–0.008	0.878	–0.024	0.231	0.098	0.016
Milk and dairy products	0.005	0.917	–0.029	0.367	–0.034	0.486
Beverages	–0.046	0.408	–0.010	0.555	–0.009	0.765
Alcoholic beverages	–0.278	0.167	–0.009	0.930	0.140	0.307
Fast foods and fried foods	–0.018	0.343	–0.097	0.318	–0.371	0.386
Cadmium (μg/dL)
Grains	–0.073	0.007	0.004	0.769	–0.003	0.875
Soy and soybean products	–0.035	0.525	–0.017	0.374	–0.020	0.314
Potatoes	–0.104	0.439	–0.147	0.026	–0.213	0.062
Meat and eggs	–0.062	0.200	–0.063	0.032	–0.092	0.119
Fish and shellfish	–0.016	0.755	0.034	0.194	–0.029	0.463
Vegetables	–0.013	0.481	0.007	0.459	–0.008	0.496
Seaweeds	–0.121	0.089	0.036	0.355	0.050	0.287
Fruits	–0.049	0.270	–0.026	0.272	–0.025	0.370
Milk and dairy products	–0.092	0.048	–0.040	0.165	–0.064	0.117
Beverages	–0.008	0.914	–0.018	0.221	0.013	0.543
Alcoholic beverages	1.523	< 0.0001	0.127	0.186	0.018	0.850
Fast foods and fried foods	–0.124	0.542	–0.166	0.088	–0.508	0.088

¹⁾ Multiple linear regression analysis 2) Adolescent girls: Adjusting for age, BMI, residence area, and drinking status. Premenopausa women and postmenopausal women: Adjusting for age, BMI, residence area, drinking status and smoking status

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