Evidence map›Paper›PMID 42616299›Full record

ArticleBiometals : an international journal on the role of metal ions in biology, biochemistry, and medicine2026

Associations between metals and anemia indicator: mixed exposure effects and mediation analysis.

Chenxu Dai, Xiangbin Zheng, Kaihui Li, Ziyi Qian, Linjie Yang, Hongfei Hu, Xijin Xu, Lei Tan, Xia Huo

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Article in Biometals : an international journal on the role of metal ions in biology, biochemistry, and medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

9 authors.

Chenxu DaiLaboratory of Environmental Medicine and Developmental Toxicology, Guangdong Key Laboratory of Environmental Pollution and Health, College of Environment and Climate, Jinan University, Guangzhou, 511443, Guangdong, China.
Xiangbin ZhengCenter for Reproductive Medicine, Clinical Research Center, Shantou Central Hospital, Shantou, 515041, Guangdong, China.
Kaihui LiLaboratory of Environmental Medicine and Developmental Toxicology, Guangdong Key Laboratory of Environmental Pollution and Health, College of Environment and Climate, Jinan University, Guangzhou, 511443, Guangdong, China.
Ziyi QianLaboratory of Environmental Medicine and Developmental Toxicology, Guangdong Key Laboratory of Environmental Pollution and Health, College of Environment and Climate, Jinan University, Guangzhou, 511443, Guangdong, China.
Linjie YangLaboratory of Environmental Medicine and Developmental Toxicology, Guangdong Key Laboratory of Environmental Pollution and Health, College of Environment and Climate, Jinan University, Guangzhou, 511443, Guangdong, China.
Hongfei HuLaboratory of Environmental Medicine and Developmental Toxicology, Guangdong Key Laboratory of Environmental Pollution and Health, College of Environment and Climate, Jinan University, Guangzhou, 511443, Guangdong, China.
Xijin XuLaboratory of Environmental Medicine and Developmental Toxicology, Shantou University Medical College, Shantou, 515041, Guangdong, China.
Lei TanGuangzhou Center for Disease Control and Prevention, Guangzhou, 510440, Guangdong, China.
Xia HuoLaboratory of Environmental Medicine and Developmental Toxicology, Guangdong Key Laboratory of Environmental Pollution and Health, College of Environment and Climate, Jinan University, Guangzhou, 511443, Guangdong, China. xhuo@jnu.edu.cn.

Funding

the Guangdong Natural Science Foundation of China 2024A1515013294
6 · The paper itself

Abstract

Exposure to metals is an important cause of anemia. The effects of mixed metal exposure on hemoglobin have been less studied, and the existing research conclusions are inconsistent. Body mass index (BMI) is associated with both metal levels and hemoglobin and may play a mediating role in the association between metals and hemoglobin. This study selected 832 children from the National Health and Nutrition Examination Survey database and further analyzed the association between metals and hemoglobin, an indicator of anemia. We found that zinc (Zn), selenium (Se) and thallium (Tl) were associated with increased hemoglobin levels in children. Copper (Cu), cobalt (Co), and lead (Pb) were associated with decreased hemoglobin levels. Both Bayesian kernel machine regression (BKMR) and Quantile g-computation (Qgcomp) analysis showed that mixed metal exposure levels were positively correlated with hemoglobin levels, and both found that Zn played a major role in this relationship. Stratified analysis showed that mixed metal exposure had a more significant effect on older children and boys. Our analysis suggested BMI as an intermediary in the associations of Pb, Mn, and Tl with hemoglobin, with mediating proportions being 100, 12.6, and 14%, respectively. The mediation analysis also suggested that the relationship between metals and hemoglobin could be explained, in part, by their correlations with other metals. In this study, the impact of mixed metal exposure on hemoglobin, as well as the possible biological mediating pathways involved, was further clarified.

Indexed as

AnemiaChildrenHemoglobinMetalsMixed exposure

Identifiers

PMID42616299

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.