Abstract
Objectives. This study aimed to assess blood and hair lead levels (BLL and HLL) in children with chronic constipation and compare them to healthy children; and investigated lead exposure’s role in the etiology of constipation. It also explored the correlation between BLL and HLL.
Study Design. The study included 84 constipated children aged 3-18 years as the case group and an equal number of constipation-free children as controls. Organic diseases were ruled out through history-taking, physical exams and laboratory tests. Blood and hair samples were collected and analyzed for lead levels using standardized methods.
Results. The constipated children group had significantly higher BLL (3.66 µg/dL) compared to the control group (1.61 µg/dL) with no significant HLL difference. Additionally, 48.8% of constipated children exceeded the reference value of 3.5 μg/dL, in contrast to 4.8% of the control group. BLL was unaffected by gender and age, while HLL were higher in girls and low ages. No significant correlation existed between BLL and HLL. The age of the housing showed a positive correlation with higher BLL and HLL. Lead exposure sources like drinking water, home renovation history, parental smoking, or nearby industrial facilities showed no significant relationships with lead levels.
Conclusions. Understanding the constipation-lead exposure link is crucial for prevention and intervention. HLL may vary with gender and age due to external lead particles, which is why BLL continues to be a more reliable measure. Healthcare providers should remember to investigate lead exposure risk factors in constipation patients and test BLL when necessary.
Keywords: constipation, lead, blood lead level, hair lead level
Copyright and license
Copyright © 2024 The Author(s). This is an open access article distributed under the Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.
How to cite
References
- Aziz I, Whitehead WE, Palsson OS, Törnblom H, Simrén M. An approach to the diagnosis and management of Rome IV functional disorders of chronic constipation. Expert Rev Gastroenterol Hepatol 2020; 14: 39-46. https://doi.org/10.1080/17474124.2020.1708718
- Benninga M, Candy DC, Catto-Smith AG, et al. The Paris Consensus on Childhood Constipation Terminology (PACCT) Group. J Pediatr Gastroenterol Nutr 2005; 40: 273-275. https://doi.org/10.1097/01.mpg.0000158071.24327.88
- Inan M, Aydiner CY, Tokuc B, et al. Factors associated with childhood constipation. J Paediatr Child Health 2007; 43: 700-706. https://doi.org/10.1111/j.1440-1754.2007.01165.x
- Tabbers MM, Boluyt N, Berger MY, Benninga MA. Clinical practice: diagnosis and treatment of functional constipation. Eur J Pediatr 2011; 170: 955-963. https://doi.org/10.1007/s00431-011-1515-5
- Nurko S, Zimmerman LA. Evaluation and treatment of constipation in children and adolescents. Am Fam Physician 2014; 90: 82-90.
- Bushnell PJ, Jaeger RJ. Hazards to health from environmental lead exposure: a review of recent literature. Vet Hum Toxicol 1986; 28: 255-261.
- World Health Organization Regional Office for Europe European Environment and Health Information System (ENHIS). Exposure of children to chemical hazards in food. 2007. Available at: https://iris.who.int/bitstream/handle/10665/370951/WHO-EURO-2007-6412-46178-66793-eng.pdf?sequence=1 (Accessed on January 1, 2024).
- National Geographic. Finally, the end of leaded gas. 2021. Available at: https://www.nationalgeographic.com/environment/article/finally-the-end-of-leaded-gas (Accessed on January 1, 2024).
- Centers for Disease Control and Prevention (CDC). Childhood lead poisoning prevention. Sources of lead exposure. 2023. Available at: https://www.cdc.gov/lead-prevention/prevention/index.html (Accessed on January 1, 2024).
- Surkan PJ, Zhang A, Trachtenberg F, Daniel DB, McKinlay S, Bellinger DC. Neuropsychological function in children with blood lead levels <10 microg/dL. Neurotoxicology 2007; 28: 1170-1177. https://doi.org/10.1016/j.neuro.2007.07.007
- Dietrich KN, Krafft KM, Bornschein RL, et al. Low-level fetal lead exposure effect on neurobehavioral development in early infancy. Pediatrics 1987; 80: 721-730. https://doi.org/10.1542/peds.80.5.721
- Zamani N, Hosseini A, Farnaghi F, et al. Blood lead level evaluation in children presenting with chronic constipation in Tehran-Iran: a cross-sectional study. Sci Rep 2023; 13: 2301. https://doi.org/10.1038/s41598-023-29487-y
- Shabani M, Hadeiy SK, Parhizgar P, et al. Lead poisoning; a neglected potential diagnosis in abdominal pain [published correction appears in BMC Gastroenterol 2021; 21: 411.]. BMC Gastroenterol 2020; 20: 134. https://doi.org/10.1186/s12876-020-01284-1
- Ruckart PZ, Jones RL, Courtney JG, et al. Update of the blood lead reference value - United States, 2021. MMWR Morb Mortal Wkly Rep 2021; 70: 1509-1512. https://doi.org/10.15585/mmwr.mm7043a4
- Barbosa F Jr, Tanus-Santos JE, Gerlach RF, Parsons PJ. A critical review of biomarkers used for monitoring human exposure to lead: advantages, limitations, and future needs. Environ Health Perspect 2005; 113: 1669-1674. https://doi.org/10.1289/ehp.7917
- Rabinowitz M, Leviton A, Needleman H. Lead in milk and infant blood: a dose-response model. Arch Environ Health 1985; 40: 283-286. https://doi.org/10.1080/00039896.1985.10545933
- Omokhodion FO, Crockford GW. Lead in sweat and its relationship to salivary and urinary levels in normal healthy subjects. Sci Total Environ 1991; 103: 113-122. https://doi.org/10.1016/0048-9697(91)90137-4
- World Health Organization (WHO). Legally-binding controls on lead paint. 2023. Available at: https://www.who.int/data/gho/data/themes/topics/indicator-groups/legally-binding-controls-on-lead-paint (Accessed on January 10, 2024).
- Dikme G, Arvas A, Gur E. The relation between blood lead and mercury levels and chronic neurological diseases in children. Turk Ach Pediatr 2013; 48: 221-225. https://doi.org/10.4274/tpa.296
- Sevinc N, Bilici N, Sevinc E, Dogan E. Blood and faecal lead levels in children with various functional gastrointestinal disorders. An Pediatr (Engl Ed) 2022; 96: 35-42. https://doi.org/10.1016/j.anpede.2021.02.001
- Adams JB, Holloway CE, George F, Quig D. Analyses of toxic metals and essential minerals in the hair of Arizona children with autism and associated conditions, and their mothers. Biol Trace Elem Res 2006; 110: 193-209. https://doi.org/10.1385/BTER:110:3:193
- Guo BQ, Li HB, Liu YY. Association between hair lead levels and autism spectrum disorder in children: a systematic review and meta-analysis. Psychiatry Res 2019; 276: 239-249. https://doi.org/10.1016/j.psychres.2019.05.022
- Iaquinta F, Machado I. Biomonitoring of arsenic, lead, manganese and mercury in hair from a presumably exposed Uruguayan child population. Bioanalysis 2024; 16: 107-116. https://doi.org/10.4155/bio-2023-0157
- Agency for Toxic Substances and Disease Registry. Toxicological profile for lead. 2020. Available at: https://www.atsdr.cdc.gov/toxprofiles/tp13.pdf
- Morton J, Carolan VA, Gardiner PHE. Removal of exogenously bound elements from human hair by various washing procedures and determination by inductively coupled plasma mass spectrometry. Anal Chim Acta 2002; 455: 23-34. https://doi.org/10.1016/S0003-2670(01)01578-1
- Renshaw GD, Pounds CA, Pearson EF. Variation in lead concentration along single hairs as measured by non-flame atomic absorption spectrophotometry. Nature 1972; 238: 162-163. https://doi.org/10.1038/238162a0
- Schuhmacher M, Domingo JL, Llobet JM, Corbella J. Lead in children’s hair, as related to exposure in Tarragona province, Spain. Sci Total Environ 1991; 104: 167-173. https://doi.org/10.1016/0048-9697(91)90070-u
- Vigeh M, Yokoyama K, Matsukawa T, Shinohara A, Ohtani K, Shariat M. Hair metal levels and childhood weight gain. Iran J Public Health 2020; 49: 1510-1519. https://doi.org/10.18502/ijph.v49i8.3895
- Tippairote T, Temviriyanukul P, Benjapong W, Trachootham D. Prevalence and factors associated with high levels of aluminum, arsenic, cadmium, lead, and mercury in hair samples of well-nourished Thai children in Bangkok and perimeters. Biol Trace Elem Res 2019; 188: 334-343. https://doi.org/10.1007/s12011-018-1435-6
- Wolfsperger M, Hauser G, Gössler W, Schlagenhaufen C. Heavy metals in human hair samples from Austria and Italy: influence of sex and smoking habits. Sci Total Environ 1994; 156: 235-242. https://doi.org/10.1016/0048-9697(94)90190-2