ArticleEnvironment international2018
Associations of cumulative exposure to heavy metal mixtures with obesity and its comorbidities among U.S. adults in NHANES 2003-2014.
Article in Environment international, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 145 papers, 1 of them a synthesis that pooled it.
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Who cites it
145 citing papers in PubMed, 1 synthesis or guideline pooled it, 317 citations in OpenAlex.
- An updated systematic review on the association between Cd exposure, blood pressure and hypertension.Ecotoxicology and environmental safety · 2021Pooled it
- Exposure to metals and morbidity at eight years follow-up in women of childbearing age.Scientific reports · 2021Trial
- Combined Effects and Potential Mechanisms of Multiple Metals Exposure on Coronary Artery Disease in the US Population: An Integrated Epidemiological and Network Toxicology Study.Biological trace element research · 2026Article
- Glycemic Regulation and Renal Function by Heavy Metal Exposure: A Cross-Sectional Analysis on Cement Plant Workers.Journal of applied toxicology : JAT · 2026Article
- Associations of blood and urinary heavy metals with obesity risk among children: NHANES 2015-2020.Pediatric research · 2026Article
- Prenatal and early postnatal lead exposure and later adulthood BMI: The Saint Louis baby tooth - Later life health study.Environmental research · 2026Article
- Combined Effects of Metals and PFAS Exposure on Prevalent Diabetes.Journal of xenobiotics · 2026Article
- In Silico ApoE Isoform Interactions with Methylmercury (MeHg) and In Vivo MeHg Intoxication Effects on Epididymal White Fat Tissue and Liver Function in Young ApoE Knockout Mice.Chemical research in toxicology · 2026Article
- Antimony: a cryptic metabolism disruptor ubiquitous in food contact materials.Journal of the Endocrine Society · 2026Review
- A comparison and evaluation of statistical methods for mediation analysis with mixtures of environmental exposures.BMC medical research methodology · 2026Article
- Sustained cadmium exposure and hyperglycemia additively drives mitochondrial dysfunction in hepatic cells: Implications for MASLD etiopathogenesis.Toxicology and applied pharmacology · 2026Article
- Cobalt mediates stage-specific toxicity of metal mixtures in cardiovascular-kidney-metabolic syndrome.Toxicological sciences : an official journal of the Society of Toxicology · 2026Article
- A correlation analysis between TyG-derived indices and diabetes mellitus: based on the NHANES database.Endocrine journal · 2026Article
- Association between multiple urinary trace metal elements and lumbar bone mineral density in adults.Nagoya journal of medical science · 2026Article
- Environmental pollutants associated with blood glucose levels in healthy individuals.Scientific reports · 2026Article
- Metal Mixture Inflammatory Index and diabetes risk in US adults: a cross-sectional analysis of NHANES 1999-2020 and development of a LASSO-based prediction model.BMJ open diabetes research & care · 2025Article
- Effects of Micronutrients and Heavy Metals on Endothelial Function and Cardiovascular Risk in the Face of Environmental Changes.Current issues in molecular biology · 2025Review
- Association of metal and metalloid exposure with cardiovascular-kidney-metabolic syndrome: mediation by inflammation, oxidative stress, and aging.BMC public health · 2025Article
- Exposure to Cadmium and Cerebrovascular Mortality in the United States.Hygiene and environmental health advances · 2025Article
- Endocrine-disrupting chemicals exposure: cardiometabolic health risk in humans.Cardiovascular diabetology · 2025Review
85 more citing papers are in PubMed but not listed here.
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3 authors at 1 institution in 1 country.
Funding
Abstract
backgroundSome heavy metals (e.g., arsenic, cadmium, lead, mercury) have been associated with obesity and obesity comorbidities. The analytical approach for those associations has typically focused on individual metals. There is a growing interest in evaluating the health effects of cumulative exposure to metal mixtures.
objectivesWe utilized our Environmental Risk Score (ERS), a summary measure to examine the risk of exposure to multi-pollutants in epidemiologic research, to evaluate the associations of cumulative exposure to a mixture of correlated heavy metals with obesity and its comorbidities including hypertension, and type-2 diabetes mellitus (T2DM) while accounting for high degree correlations and interactions among metal mixtures components.
methodsWe examined blood and urinary markers of 18 heavy metals among 9537 adults in NHANES 2003-2014. We randomly split data into a training set for the construction of ERS (n = 6675) and a testing set for the evaluation of its statistical performance (n = 2862). ERS of heavy metal mixtures was computed for waist circumference using adaptive elastic-net (AENET) with 189 predictors including 18 main effects, 18 squared terms, and 153 pairwise interactions of heavy metals. Regression analyses with complex survey designs were performed to assess the associations of ERS with other obesity measures, hypertension and T2DM.
results7 main effects (blood lead, blood cadmium, blood mercury, and urinary markers of monomethylarsonic acid (MMA), barium, mercury and thallium), 4 squared terms (blood cadmium, urinary cadmium, urinary antimony and urinary tungsten), and 7 pairwise interactions (blood lead & urinary cadmium, blood lead & urinary MMA, blood lead & urinary uranium, urinary cadmium & urinary MMA, urinary dimethylarsinic acid (DMA) & urinary tungsten, urinary MMA & urinary cobalt, and urinary lead & urinary antimony) were selected by AENET for construction of ERS of waist circumference-related metal mixtures. An increase in ERS from 10th percentile to 90th percentile in the overall study population was significantly associated with 4.50 kg/m
conclusionsOur study suggests that cumulative exposure to heavy metals as mixtures is associated with obesity and its related chronic conditions such as hypertension and T2DM. Additional research is needed to confirm these findings in longitudinal settings.
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