{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T07:19:53Z","timestamp":1790839193308,"version":"4.1.0"},"reference-count":72,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2021,1,11]],"date-time":"2021-01-11T00:00:00Z","timestamp":1610323200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000867","name":"Robert Wood Johnson Foundation","doi-asserted-by":"publisher","award":["Harvard University Robert Wood Johnson Health and Society Seed Grant"],"award-info":[{"award-number":["Harvard University Robert Wood Johnson Health and Society Seed Grant"]}],"id":[{"id":"10.13039\/100000867","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000066","name":"National Institute of Environmental Health Sciences","doi-asserted-by":"publisher","award":["P30ES023515"],"award-info":[{"award-number":["P30ES023515"]}],"id":[{"id":"10.13039\/100000066","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Elevated red blood cell distribution width (RDW), traditionally an indicator of anemia, has now been recognized as a risk marker for cardiovascular disease incidence and mortality. Experimental and acute exposure studies suggest that cadmium and lead individually affect red blood cell production; however, associations between environmental exposures and RDW have not been explored. We evaluated relationships of environmental cadmium and lead exposures to RDW. We used data from 24,607 participants aged \u226520 years in the National Health and Nutrition Examination Survey (2003\u20132016) with information on blood concentrations of cadmium and lead, RDW and socio-demographic factors. In models adjusted for age, sex, race\/ethnicity, education, poverty income ratio, BMI, alcohol consumption, smoking status and serum cotinine, RDW was increasingly elevated across progressively higher quartiles of blood cadmium concentration. A doubling of cadmium concentration was associated with 0.16 higher RDW (95% CI: 0.14, 0.18) and a doubling of lead concentration with 0.04 higher RDW (95% CI: 0.01, 0.06). Also, higher cadmium and lead concentrations were associated with increased odds of high RDW (RDW&gt;14.8%). The associations were more pronounced in women and those with low-to-normal mean corpuscular volume (MCV) and held even after controlling for iron, folate or vitamin B12 deficiencies. In analysis including both metals, cadmium remained associated with RDW, whereas the corresponding association for lead was substantially attenuated. In this general population sample, blood cadmium and lead exposures were positively associated with RDW. The associations may indicate hemolytic or erythropoietic mechanisms by which exposure increases mortality risk.<\/jats:p>","DOI":"10.1371\/journal.pone.0245173","type":"journal-article","created":{"date-parts":[[2021,1,12]],"date-time":"2021-01-12T22:45:39Z","timestamp":1610491539000},"page":"e0245173","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":35,"title":["The association of cadmium and lead exposures with red cell distribution width"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4542-4563","authenticated-orcid":true,"given":"Junenette L.","family":"Peters","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa J.","family":"Perry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eileen","family":"McNeely","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert O.","family":"Wright","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendy","family":"Heiger-Bernays","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Weuve","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,1,11]]},"reference":[{"issue":"11","key":"pone.0245173.ref001","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph17113782","article-title":"The effects of cadmium toxicity","volume":"17","author":"G Genchi","year":"2020","journal-title":"Int J Environ Res Public Health"},{"issue":"4","key":"pone.0245173.ref002","first-page":"15","article-title":"Uptake of lead by human red blood cells and intracellular distribution","volume":"63","author":"E Sugawara","year":"1990","journal-title":"Kitasato Arch Exp Med"},{"issue":"1\u20133","key":"pone.0245173.ref003","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/0378-4274(89)90124-0","article-title":"Mechanisms of lead and cadmium nephrotoxicity","volume":"46","author":"RA Goyer","year":"1989","journal-title":"Toxicol Lett"},{"issue":"4","key":"pone.0245173.ref004","first-page":"14","article-title":"Erythropoietin\u2014sites of synthesis and regulation of secretion","volume":"18","author":"C Lacombe","year":"1991","journal-title":"Am J Kidney Dis"},{"key":"pone.0245173.ref005","article-title":"Toxicological profile for lead. 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