Associations between co-exposure to multiple heavy metals and age-related macular degeneration: A cross-sectional study

Mu-Hong Wei; Ju-Xiao Li; Jing Mi; Qing Wang; Feng Xu; Che Xu

doi:10.1016/j.jtemb.2024.127573

Associations between co-exposure to multiple heavy metals and age-related macular degeneration: A cross-sectional study

J Trace Elem Med Biol. 2024 Nov 28:87:127573. doi: 10.1016/j.jtemb.2024.127573. Online ahead of print.

Authors

Mu-Hong Wei¹, Ju-Xiao Li², Jing Mi¹, Qing Wang³, Feng Xu⁴, Che Xu⁵

Affiliations

¹ Department of Epidemiology and Statistics, School of Public Health, Bengbu Medical University, No. 2600 Donghai Avenue, Bengbu 233000, China.
² Dongguan Key Laboratory of Environmental Medicine, School of Public Health, Guangdong Medical University, Dongguan, Guangdong Province 523808, China.
³ The First People's Hospital of Guiyang City, No.97 Boai Road, Nanming District, Guiyang City, China.
⁴ Biomedical Research Core Facilities, Westlake University, Hangzhou 310027, China.
⁵ Department of ophthalmology, the First Affiliated Hospital of Bengbu Medical University, No.287 Changhuai Road, Bengbu 233000, China. Electronic address: doctorxc@126.com.

PMID: 39643952
DOI: 10.1016/j.jtemb.2024.127573

Abstract

Background & aims: Accumulating evidence suggests that exposure to single heavy metal can facilitate the progression of age-related macular degeneration (AMD). However, the effects of exposure to mixtures of heavy metals on AMD remain largely unexplored. This study aims to investigate both the joint and individual impacts of arsenic (As), mercury (Hg), cadmium (Cd), and lead (Pb) on AMD within a co-exposure framework.

Methods: Data from subjects participating the US National Health and Nutrition Examination Survey (NHANES, 2005-2008) were analyzed. Concentrations of As, Hg, Cd, and Pb were determined in urine by inductively coupled plasma dynamic reaction cell mass spectrometry (ICP-DRC-MS) for As and Hg, and inductively coupled plasma mass spectrometry (ICP-MS) for Cd and Pb. The weighted quantile sum (WQS) and Bayesian kernel machine regression (BKMR) models were employed to assess the effects of heavy metal mixtures on AMD risk.

Results: Both WQS and BKMR analyses consistently revealed a significant overall association between heavy metal mixtures and the risk of all types of AMD. The combined effect was more evident among patients with early AMD compared to those with late AMD. Cd and Hg were the main contributors driving these combined effects within the context of metal mixtures. Elevated urinary levels of Cd were positively correlated with an increased risk for all types as well as early AMD. Higher exposure to Hg corresponded with an elevated risk for early AMD. Furthermore, BKMR analysis indicated that the influence of Cd on early AMD exhibited a non-linear pattern.

Conclusions: Our findings suggest that co-exposure to As, Hg, Cd, and Pb is associated with an elevated risk for developing AMD, particularly in its early stages. Furthermore, excessive exposure to Cd and Hg has been identified as key contributing factors in this process.

Keywords: Age-related macular degeneration; Co-exposure; Heavy metals; NHANES.