Association between iron deficiency and blood lead level in a longitudinal analysis of children followed in an urban primary care clinic

  • Robert O. Wright
    Affiliations
    Department of Pediatrics, Children's Hospital, the Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, and the Occupational Health Program and Division of Environmental Epidemiology, Department of Environmental Health Sciences, Harvard School of Public Health, Boston, Massachusetts
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  • Shirng-Wern Tsaih
    Affiliations
    Department of Pediatrics, Children's Hospital, the Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, and the Occupational Health Program and Division of Environmental Epidemiology, Department of Environmental Health Sciences, Harvard School of Public Health, Boston, Massachusetts
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  • Joel Schwartz
    Affiliations
    Department of Pediatrics, Children's Hospital, the Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, and the Occupational Health Program and Division of Environmental Epidemiology, Department of Environmental Health Sciences, Harvard School of Public Health, Boston, Massachusetts
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  • Rosalind J. Wright
    Affiliations
    Department of Pediatrics, Children's Hospital, the Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, and the Occupational Health Program and Division of Environmental Epidemiology, Department of Environmental Health Sciences, Harvard School of Public Health, Boston, Massachusetts
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  • Howard Hu
    Affiliations
    Department of Pediatrics, Children's Hospital, the Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, and the Occupational Health Program and Division of Environmental Epidemiology, Department of Environmental Health Sciences, Harvard School of Public Health, Boston, Massachusetts
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      Abstract

      Objective To determine if iron deficiency (ID) is longitudinally associated with lead poisoning. Study design Blood lead levels, hemoglobin, mean corpuscular volume (MCV), red cell distribution width (RDW), insurance status, and age were determined for 1275 children. ID was defined as MCV <70 fl and RDW >14.5 if age was <2 years and MCV <73 fl and RDW >14.5 if age was ≥2 years. Logistic regression models were constructed by using the second-visit blood lead levels dichotomized at ≥0.48 μm/L (10 μg/dL) as the outcome. Results The odds ratio (OR) for baseline ID predicting lead poisoning at the second visit was 4.12 (95% CI, 1.96-8.65). In the second model, using children who were iron-replete at both visits as the referent group, for children with ID at both visits, the OR for predicting lead poisoning at the second visit was 5.54 (95% CI, 2.25-13.62). For children with ID at the first visit and iron-replete at the second visit, the OR was 2.73 (95% CI, 0.90-8.27), and for children iron-replete at the first visit and ID at the second visit, the OR was 0.81 (95% CI, 0.10-6.30). Conclusions ID is associated with subsequent lead poisoning. These data are consistent with a biological mechanism of increased lead absorption among iron deficient children. (J Pediatr 2003;142:9-14)

      Abbreviations:

      CBC ( Complete blood cell count), CDC ( Centers for Disease Control), ID ( Iron deficiency), MCV ( Mean corpuscular volume), OR ( Odds ratio), RDW ( Red cell distribution width)
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