[논문]The Effect of Prenatal Cadmium Exposure on Attention-deficit/Hyperactivity Disorder in 6-Year-old Children in Korea

Kim, Woosung; Jang, Yoonyoung; Lim, Youn-Hee; Kim, Bung-Nyun; Shin, Choong Ho; Lee, Young Ah; Kim, Johanna Inhyang; Hong, Yun-Chul

doi:10.3961/jpmph.19.175

The Effect of Prenatal Cadmium Exposure on Attention-deficit/Hyperactivity Disorder in 6-Year-old Children in Korea 원문보기

Journal of preventive medicine and public health = 예방의학회지, v.53 no.1, 2020년, pp.29 - 36

Kim, Woosung (Department of Preventive Medicine, Seoul National University College of Medicine) , Jang, Yoonyoung (Department of Preventive Medicine, Seoul National University College of Medicine) , Lim, Youn-Hee (Institute of Environmental Medicine, Seoul National University Medical Research Center) , Kim, Bung-Nyun (Division of Children and Adolescent Psychiatry, Department of Psychiatry, Seoul National University Hospital) , Shin, Choong Ho (Department of Pediatrics, Seoul National University Children's Hospital) , Lee, Young Ah (Department of Pediatrics, Seoul National University Children's Hospital) , Kim, Johanna Inhyang (Division of Children and Adolescent Psychiatry, Department of Psychiatry, Seoul National University Hospital) , Hong, Yun-Chul (Department of Preventive Medicine, Seoul National University College of Medicine)

Abstract ▼ AI-Helper

Objectives: Prenatal cadmium (Cd) exposure may be associated with attention-deficit/hyperactivity disorder (ADHD) in children. Therefore, the objective of this study was to examine the relationship between Cd exposure during gestation and ADHD at 6 years of age. Methods: As part of an ongoing cohort study (the Environment and Development of Children study), 479 mother-child pairs from Seoul, Korea were included for analysis between 2008 and 2011. The whole blood concentration of Cd was analyzed using atomic absorption spectrophotometry. The parents were surveyed about ADHD behaviors in their children at age 6. Multivariable linear regression models were used to investigate the relationship between prenatal exposure to Cd and ADHD at 6 years of age. Results: Increased prenatal Cd concentrations were associated with increased scores for ADHD for girls, but not for boys, at age 6. A 2-fold increase in the prenatal Cd level was significantly associated with a 22.3% (95% confidence interval, 11.6 to 34.1) increase in ADHD in girls at 6 years of age, as indicated by the linear regression model. Conclusions: Our results identified significant associations between prenatal Cd exposure and ADHD scores in 6-year-old girls.

주제어

AI 본문요약
AI-Helper

* AI 자동 식별 결과로 적합하지 않은 문장이 있을 수 있으니, 이용에 유의하시기 바랍니다.

문제 정의

In this study, we investigated the relationship between prenatal blood Cd exposure and ADHD symptoms in 6-year-old children. We observed that higher maternal blood Cd concentrations during pregnancy were significantly associated with higher ADHD scores, as measured by the K-ARS questionnaire, in girls.

제안 방법

All models controlled for potential covariates including sex (male or female), parity, birth weight(kg), mother’s body mass index (BMI, kg/m2), mother’s education level, mother’s age, and mother’s smoking status.
The model was adjusted for sex (male or female), parity, birth weight (kg), mother’s body mass index, mother's education level, mother's age, and mother's passive smoking status.
The parents completed a questionnaire about demographic data and related factors, including socioeconomic status, secondhand smoking exposure, parental age, parental education level, and medical and obstetric histories of themselves and their children. Parental education level was classified as high school graduate or less (≤12 years of education) or university or above (more education than a high school graduate).
In the examination of the regression curve for the generalized additive model, we assumed a linear relationship. We constructed a regression model for Cd exposure and ADHD scores to estimate the overall linear effects of Cd exposure on ADHD scores.

대상 데이터

Supplemental materials are available at https://doi.org/10.3961/jpmph.19.175.
We conducted follow-up assessments when the children were approximately 6 years of age, between March 2015 and December 2017. The children underwent health examinations at the Seoul National University Hospital in Jongno-gu, Seoul, Korea. The mothers’ depressive symptoms and the children’s dietary habits were assessed using the Center for Epidemiologic Studies Depression Scale and food frequency questionnaires, respectively.
In the CAS cohort study, pregnant women from the metropolitan areas of Seoul and Incheon, Korea, who received prenatal care at local hospitals were recruited. The total number of enrolled pregnant females was 13 484, and subjects were recruited during the second trimester of pregnancy. Of these females, 11 085 remained in the study and were followed up until childbirth,between August 2008 and July 2011.

이론/모형

The mothers’ depressive symptoms and the children’s dietary habits were assessed using the Center for Epidemiologic Studies Depression Scale and food frequency questionnaires, respectively.
Before analysis, the blood samples were brought to room temperature and pretreated using a Vortex Genie 2 mixer (Scientific Industries, Bohemia, NY, USA) and an ES 220A balance (Precisa Gravimetrics AG, Dietikon, Switzerland). The samples were diluted with a matrix modifier reagent (Triton X-100 and ammonium hydrogen phosphate monobasic), then assayed using the matrix-matched calibration curve method (the standard addition method). The method detection limit (MDL) was calculated according to the following formula:

성능/효과

A worldwide meta-regression analysis of 11 studies of adults with ADHD found that although the ratio of males to females with ADHD decreased with increasing age, a sex-based difference was still present in adults aged 19 years and over [22]. A pooled analysis of studies of ADHD outcomes estimated the rate of persistence of ADHD into adulthood as approximately 15% when limited to those who meet the full criteria for ADHD. However, when cases consistent with the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) definition of ADHD in partial remission were included, the persistence into adulthood was estimated to be as high as about 60% [23].
1) in girls only. When investigated separately by symptom type, again in girls only, each doubling of prenatal Cd exposure showed a 21.2% (95% CI, 7.4 to 36.8) increase in the score related to attention-deficit symptoms and a 23.5% (95% CI, 7.1 to 42.3) increase in the score for the hyperactivity symptoms. These associations were not observed for boys.

후속연구

However, given the nature of parent-reported K-ARS scores, the results of this study should be interpreted cautiously. Additional prospective epidemiological studies should be performed to further replicate and clarify the possible association observed in this study.
Consequently, there is potential for misclassification resulting from parents over-reporting or under-reporting their children’s symptoms. Given this limitation, we attempted to show the associations between increased maternal levels of Cd and symptom-related scores of ADHD at 6 years of age, although the clinical significance of our findings needs further investigation. Additionally, no children in this cohort were clinically diagnosed with ADHD.

참고문헌 (36)

1 Agency for Toxic Substances and Disease Registry Toxicological profile for cadmium 2012 [cited 2019 Jun 1]. Available from: https://www.atsdr.cdc.gov/ToxProfiles/tp5.pdf
2 Jarup L Akesson A Current status of cadmium as an environmental health problem Toxicol Appl Pharmacol 2009 238 3 201 208 19409405

상세보기
3 European Food Safety Authority (EFSA) Cadmium in foodscientific opinion of the Panel on Contaminants in the Food Chain EFSA J 2009 7 3 980
4 Ali MM Murthy RC Chandra SV Developmental and longterm neurobehavioral toxicity of low level in-utero cadmium exposure in rats Neurobehav Toxicol Teratol 1986 8 5 463 468 3785508
5 Desi I Nagymajtenyi L Schulz H Behavioural and neurotoxicological changes caused by cadmium treatment of rats during development J Appl Toxicol 1998 18 1 63 70 9526836

상세보기
6 Lehotzky K Ungvary G Polinak D Kiss A Behavioral deficits due to prenatal exposure to cadmium chloride in CFY rat pups Neurotoxicol Teratol 1990 12 2 169 172 2333070

상세보기
7 Nagymajtenyi L Schulz H Desi I Behavioural and functional neurotoxicological changes caused by cadmium in a three-generational study in rats Hum Exp Toxicol 1997 16 12 691 699 9429082

상세보기
8 Nation JR Bourgeois AE Clark DE Baker DM Hare MF The effects of oral cadmium exposure on passive avoidance performance in the adult rat Toxicol Lett 1984 20 1 41 47 6695395

상세보기
9 Jiang HM Han GA He ZL Clinical significance of hair cadmium content in the diagnosis of mental retardation of children Chin Med J (Engl) 1990 103 4 331 334 2118045
10 Marlowe M Errera J Jacobs J Increased lead and cadmium burdens among mentally retarded children and children with borderline intelligence Am J Ment Defic 1983 87 5 477 483 6837639
11 Thatcher RW Lester ML McAlaster R Horst R Effects of low levels of cadmium and lead on cognitive functioning in children Arch Environ Health 1982 37 3 159 166 7092333

상세보기
12 Capel ID Pinnock MH Dorrell HM Williams DC Grant EC Comparison of concentrations of some trace, bulk, and toxic metals in the hair of normal and dyslexic children Clin Chem 1981 27 6 879 881 7237768

상세보기
13 Ely DL Mostardi RA Woebkenberg N Worstell D Aerometric and hair trace metal content in learning-disabled children Environ Res 1981 25 2 325 339 7023938

상세보기
14 Pihl RO Parkes M Hair element content in learning disabled children Science 1977 198 4313 204 206 905825

상세보기
15 Thatcher RW McAlaster R Lester ML Cantor DS Comparisons among EEG, hair minerals and diet predictions of reading performance in children Ann N Y Acad Sci 1984 433 87 96 6597699
16 Marlowe M Cossairt A Moon C Errera J MacNeel A Peak R Main and interaction effects of metallic toxins on classroom behavior J Abnorm Child Psychol 1985 13 2 185 198 4008752

상세보기
17 Cao Y Chen A Radcliffe J Dietrich KN Jones RL Caldwell K Postnatal cadmium exposure, neurodevelopment, and blood pressure in children at 2, 5, and 7 years of age Environ Health Perspect 2009 117 10 1580 1586 20019909

상세보기
18 Gillberg C Noren JG Wahlstrom J Rasmussen P Heavy metals and neuropsychiatric disorders in six-year-old children. Aspects of dental lead and cadmium Acta Paedopsychiatr 1982 48 5 253 263 6184942

상세보기
19 Lee DH Jacobs DR Porta M Association of serum concentrations of persistent organic pollutants with the prevalence of learning disability and attention deficit disorder J Epidemiol Community Health 2007 61 7 591 596 17568050

상세보기
20 Willcutt EG The prevalence of DSM-IV attention-deficit/hyperactivity disorder: a meta-analytic review Neurotherapeutics 2012 9 3 490 499 22976615

상세보기
21 Faraone SV Biederman J Mick E The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies Psychol Med 2006 36 2 159 165 16420712

상세보기
22 Fayyad J Sampson NA Hwang I Adamowski T Aguilar-Gaxiola S Al-Hamzawi A The descriptive epidemiology of DSM-IV adult ADHD in the World Health Organization World Mental Health Surveys Atten Defic Hyperact Disord 2017 9 1 47 65 27866355
23 Faraone SV Biederman J Mick E The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies Psychol Med 2006 36 2 159 165 16420712

상세보기
24 Biederman J Petty CR Clarke A Lomedico A Faraone SV Predictors of persistent ADHD: an 11-year follow-up study J Psychiatr Res 2011 45 2 150 155 20656298

상세보기
25 Biederman J Petty CR O’Connor KB Hyder LL Faraone SV Predictors of persistence in girls with attention deficit hyperactivity disorder: results from an 11-year controlled follow-up study Acta Psychiatr Scand 2012 125 2 147 156 22097933

상세보기
26 DuPaul GJ Reid R Anastopoulos AD Lambert MC Watkins MW Power TJ Parent and teacher ratings of attention-deficit/hyperactivity disorder symptoms: factor structure and normative data Psychol Assess 2016 28 2 214 225 26011476

상세보기
27 Bao QS Lu CY Song H Wang M Ling W Chen WQ Behavioural development of school-aged children who live around a multi-metal sulphide mine in Guangdong province, China: a cross-sectional study BMC Public Health 2009 9 217 19573251

상세보기
28 Ciesielski T Weuve J Bellinger DC Schwartz J Lanphear B Wright RO Cadmium exposure and neurodevelopmental outcomes in U.S. children Environ Health Perspect 2012 120 5 758 763 22289429

상세보기
29 Sioen I Den Hond E Nelen V Van de Mieroop E Croes K Van Larebeke N Prenatal exposure to environmental contaminants and behavioural problems at age 7-8 years Environ Int 2013 59 225 231 23845936

상세보기
30 Singhal RL Merali Z Hrdina PD Aspects of the biochemical toxicology of cadmium Fed Proc 1976 35 1 75 80 173584

상세보기
31 Stowe HD Wilson M Goyer RA Clinical and morphologic effects of oral cadmium toxicity in rabbits Arch Pathol 1972 94 5 389 405 4263468

상세보기
32 Faraone SV Perlis RH Doyle AE Smoller JW Goralnick JJ Holmgren MA Molecular genetics of attention-deficit/hyperactivity disorder Biol Psychiatry 2005 57 11 1313 1323 15950004

상세보기
33 Andersson H Petersson-Grawe K Lindqvist E Luthman J Oskarsson A Olson L Low-level cadmium exposure of lactating rats causes alterations in brain serotonin levels in the offspring Neurotoxicol Teratol 1997 19 2 105 115 9136127

상세보기
34 Provias JP Ackerley CA Smith C Becker LE Cadmium encephalopathy: a report with elemental analysis and pathological findings Acta Neuropathol 1994 88 6 583 586 7879607

상세보기
35 Goodlad JK Marcus DK Fulton JJ Lead and attention-deficit/hyperactivity disorder (ADHD) symptoms: a meta-analysis Clin Psychol Rev 2013 33 3 417 425 23419800

상세보기
36 Park JI Shim SH Lee M Jung YE Park TW Park SH The validities and efficiencies of Korean ADHD rating scale and Korean child behavior checklist for screening children with ADHD in the community Psychiatry Investig 2014 11 3 258 265

표제어: PCR

동의어: Packet Collision Rate

용어 설명 출처 목록 (6)

용어 설명: PCR은 세균 특이성이 있는 primer를 이용하여 적은 수의 세균이 있을지라도 쉽게 검출할 수 있는 유용한 방법이며, 이를 이용하여 구강 내 치면세균막이나 타액에서 직접 세균을 검출할 수 있게 되었다[8].

내보내기 구분	파일저장 인쇄 메일전송
구성항목	기본정보 상세정보 관리번호, 논문명, 저널/프로시딩명, 저자 , 발행년, 권, 호, 시작페이지, 끝페이지, 발행기관 관리번호, 논문명, 대등논문명, 저자 , 저널/프로시딩명, 발행기관, 발행년, 발행언어, 권, 호, 시작페이지, 끝페이지, ISBN, ISSN, 주제분야, 키워드, 초록(한글), 초록(영문), 저자(소속기관)
저장형식	Text(ASCII format) Excel format RefWorks Direct Export RIS format (for Reference Manager, ProCite, EndNote), Scholar's Aids, Mendeley
메일정보	받는사람 (필수) @ 보내는사람 (선택) @ 제목 내용 KISTI 검색결과 이메일 서비스
안내	총 건의 자료가 검색되었습니다. 다운받으실 자료의 인덱스를 입력하세요. (1-10,000) 검색결과의 순서대로 최대 10,000건 까지 다운로드가 가능합니다. 데이타가 많을 경우 속도가 느려질 수 있습니다.(최대 2~3분 소요) 다운로드 파일은 UTF-8 형태로 저장됩니다. 파일의 내용이 제대로 보이지 않을실 때는 웹브라우저 상단의 보기 -> 인코딩 -> 자동선택 여부를 확인하십시오. ~ Text(ASCII format) Excel format

연합인증