{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T19:18:31Z","timestamp":1789759111674,"version":"4.0.1"},"reference-count":69,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2023,3,15]],"date-time":"2023-03-15T00:00:00Z","timestamp":1678838400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Mexican Health Ministry","award":["D43TW011403"],"award-info":[{"award-number":["D43TW011403"]}]},{"DOI":"10.13039\/100007277","name":"International Training Program in Environmental Health over the Lifespan","doi-asserted-by":"publisher","award":["D43TW011403"],"award-info":[{"award-number":["D43TW011403"]}],"id":[{"id":"10.13039\/100007277","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Fogarty International Center to the Icahn School of Medicine at Mount Sinai and the Universidad Nacional, Costa Rica","award":["D43TW011403"],"award-info":[{"award-number":["D43TW011403"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Lead can affect early childhood development (ECD) differentially due to nutritional deficiencies that lead to stunted growth, defined as being at least two standard deviations below the average height-for-age. These deficiencies are more frequent among children living in rural locations or with lower socioeconomic status (SES); however, studies at a population level are scarce worldwide. Early childhood development plays a crucial role in influencing a child\u2019s health and wellbeing throughout life. Therefore, the aim of this study was to analyze how stunted growth can modify the association between lead exposure and ECD in children from disadvantaged communities. Methods: Data were analyzed from the 2018 National Health and Nutrition Survey in localities with fewer than 100,000 inhabitants in Mexico (ENSANUT-100K). Capillary blood lead (BPb) levels were measured using a LeadCare II device and dichotomized as detectable (cutoff point \u2265 3.3 \u00b5g\/dL) and non-detectable. As a measure of ECD, language development was assessed in n = 1394 children, representing 2,415,000 children aged 12\u201359 months. To assess the association between lead exposure and language z-scores, a linear model was generated adjusted by age, sex, stunted growth, maternal education, socioeconomic status, area, region (north, center, south), and family care characteristics; afterwards, the model was stratified by stunted growth. Results: Fifty percent of children had detectable BPb and 15.3% had stunted growth. BPb showed a marginal inverse association with language z-scores (\u03b2: \u22120.08, 95% CI: \u22120.53, 0.36). Children with detectable BPb and stunted growth had significantly lower language z-scores (\u03b2: \u22120.40, 95% CI: \u22120.71, \u22120.10) than those without stunted growth (\u03b2: \u22120.15, 95% CI: \u22120.36, 0.06). Conclusions: Children with stunted growth are more vulnerable to the adverse effects of lead exposure. These results add to previous research calling for action to reduce lead exposure, particularly in children with chronic undernutrition.<\/jats:p>","DOI":"10.3390\/ijerph20065174","type":"journal-article","created":{"date-parts":[[2023,3,15]],"date-time":"2023-03-15T06:36:36Z","timestamp":1678862196000},"page":"5174","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Lead Exposure Can Affect Early Childhood Development and Could Be Aggravated by Stunted Growth: Perspectives from Mexico"],"prefix":"10.3390","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8766-881X","authenticated-orcid":false,"given":"Leonel","family":"C\u00f3rdoba-Gamboa","sequence":"first","affiliation":[{"name":"Direcci\u00f3n de Salud Ambiental, Centro de Investigaci\u00f3n en Salud Poblacional, Instituto Nacional de Salud P\u00fablica, Cuernavaca 62100, Morelos, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth Argelia","family":"V\u00e1zquez-Salas","sequence":"additional","affiliation":[{"name":"Direcci\u00f3n de Salud Reproductiva, Centro de Investigaci\u00f3n en Salud Poblacional, Instituto Nacional de Salud P\u00fablica, Ciudad de M\u00e9xico 14080, Morelos, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Romero-Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n en Evaluaci\u00f3n y Encuestas, Instituto Nacional de Salud P\u00fablica, Cuernavaca 62100, Morelos, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1397-8476","authenticated-orcid":false,"given":"Alejandra","family":"Cantoral","sequence":"additional","affiliation":[{"name":"Departamento de Salud, Universidad Iberoamericana, Ciudad de Mexico 01219, Morelos, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Horacio","family":"Riojas-Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Direcci\u00f3n de Salud Ambiental, Centro de Investigaci\u00f3n en Salud Poblacional, Instituto Nacional de Salud P\u00fablica, Cuernavaca 62100, Morelos, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8910-3011","authenticated-orcid":false,"given":"Sergio","family":"Bautista-Arredondo","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n en Sistemas de Salud, Instituto Nacional de Salud P\u00fablica, Cuernavaca 62100, Morelos, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis F.","family":"Bautista-Arredondo","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n en Nutrici\u00f3n y Salud, Instituto Nacional de Salud P\u00fablica, Cuernavaca 62100, Morelos, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filipa","family":"de Castro","sequence":"additional","affiliation":[{"name":"Research, Evidence, and Learning, Department of Education and Child Population, Save the Children, 501 Kings Highway East, Suite 400, Fairfield, CT 06825, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7018-3602","authenticated-orcid":false,"given":"Marcela","family":"Tamayo-Ortiz","sequence":"additional","affiliation":[{"name":"Unidad de Investigaci\u00f3n de Salud en el Trabajo, Instituto Mexicano del Seguro Social, Ciudad de M\u00e9xico 6720, Morelos, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3322-3334","authenticated-orcid":false,"given":"Martha Mar\u00eda","family":"T\u00e9llez-Rojo","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n en Nutrici\u00f3n y Salud, Instituto Nacional de Salud P\u00fablica, Cuernavaca 62100, Morelos, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,15]]},"reference":[{"key":"ref_1","unstructured":"Shonkoff, J., and Phillips, D. (2000). From Neurons to Neighborhoods: The Science of Early Childhood Development, National Academy Press."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1097\/FCH.0000000000000106","article-title":"Inequitable chronic lead exposure: A dual legacy of social and environmental injustice","volume":"39","author":"Leech","year":"2016","journal-title":"Fam. Community Health"},{"key":"ref_3","unstructured":"Rees, N., and Fuller, R. (2021, January 01). The Toxic Truth: Children\u2019 s Exposure to Lead Pollution Undermines a Generation of Future Potential. Available online: https:\/\/www.unicef.org\/reports\/toxic-truth-childrens-exposure-to-lead-pollution-2020."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Erdenebayar, E., Santos, K.D., Edwards, A., Dugersuren, N.O., Ochir, C., and Nriagu, J. (2019). Environmental injustice and childhood lead exposure in peri-urban (ger) areas of Darkhan and Erdenet, Mongolia. BMC Public Health, 19.","DOI":"10.1186\/s12889-019-6486-x"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1111\/j.1467-8624.2011.01671.x","article-title":"Child Development in Developing Countries: Introduction and Methods","volume":"83","author":"Bornstein","year":"2012","journal-title":"Child Dev."},{"key":"ref_6","unstructured":"Siddiqi, A., Irwin, L.G., and Hertzman, C. (2007). Early Child Development: A Powerful Equalizer: Final Report for the World Health Organization\u2019s Commission on the Social Determinants of Health, Human Early Learning Partnership."},{"key":"ref_7","unstructured":"Organizaci\u00f3n Mundial de la Salud (OMS) (2019, March 01). Intoxicaci\u00f3n por plomo y salud (Lead Poisoning). Available online: https:\/\/www.who.int\/es\/news-room\/fact-sheets\/detail\/lead-poisoning-and-health."},{"key":"ref_8","unstructured":"World Health Organization (2002). The World Health Report 2002: Reducing Risks, Promoting Healthy Life, World Health Organization."},{"key":"ref_9","unstructured":"World Health Organization (2020). UNICEF\/WHO\/The World Bank Group Joint Child Malnutrition Estimates: Levels and Trends in Child Malnutrition: Key Findings of the 2020 Edition, World Health Organization."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"646S","DOI":"10.1093\/ajcn\/61.3.646S","article-title":"Nutrition and metal toxicity","volume":"61","author":"Goyer","year":"1995","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1016\/j.clnu.2007.03.010","article-title":"Environmental lead toxicity and nutritional factors","volume":"26","author":"Ahamed","year":"2007","journal-title":"Clin. Nutr."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Rubio-Codina, M., Araujo, M.C., Attanasio, O., Mu\u00f1oz, P., and Grantham-McGregor, S. (2016). Concurrent validity and feasibility of short tests currently used to measure early childhood development in large scale studies. PLoS ONE, 11.","DOI":"10.18235\/0000508"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1177\/15648265100312S212","article-title":"Validity and reliability of mothers\u2019 reports of language development in 1-year-old children in a large-scale survey in Bangladesh","volume":"31","author":"Hamadani","year":"2010","journal-title":"Food Nutr. Bull."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1142","DOI":"10.1044\/1092-4388(2002\/093)","article-title":"A longitudinal investigation of with language impairments","volume":"45","author":"Catts","year":"2002","journal-title":"J. Speech Lang. Hear. Res."},{"key":"ref_15","first-page":"215","article-title":"Behaviour Problems and Language Abilities at Three","volume":"26","author":"Stevenson","year":"1985","journal-title":"Psychology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.jcomdis.2018.01.001","article-title":"Blood lead levels and longitudinal language outcomes in children from 4 to 12 years","volume":"71","author":"Lewis","year":"2018","journal-title":"J. Commun. Disord."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1542\/peds.2006-0467","article-title":"The impact of early childhood lead exposure on brain organization: A functional magnetic resonance imaging study of language function","volume":"118","author":"Yuan","year":"2006","journal-title":"Pediatrics"},{"key":"ref_18","first-page":"86","article-title":"Avances en el desarrollo infantil temprano: Desde neuronas hasta programas a gran escala (Advances in early childhood development: From neurons to large-scale programs)","volume":"74","year":"2017","journal-title":"Bol. Med. Hosp. Infant. Mex."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e323","DOI":"10.1542\/peds.2005-3123","article-title":"Longitudinal Associations Between Blood Lead Concentrations Lower Than 10 g\/dL and Neurobehavioral Development in Environmentally Exposed Children in Mexico City","volume":"118","author":"Bellinger","year":"2006","journal-title":"Pediatrics"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1040","DOI":"10.1016\/j.neuro.2012.04.022","article-title":"Assessing windows of susceptibility to lead-induced cognitive deficits in Mexican children","volume":"33","author":"Braun","year":"2012","journal-title":"Neurotoxicology"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1590\/S0036-36342000000400002","article-title":"Niveles de plomo en sangre en ni\u00f1os de 8 a 10 a\u00f1os y su relaci\u00f3n con la alteraci\u00f3n en el sistema visomotor y del equilibrio (Blood lead levels in children from 8 to to 10 years of age and their relationship with alterations in the visuomotor and balance syst","volume":"42","author":"Rothenberg","year":"2000","journal-title":"Salud Publica Mex."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1289\/ehp.1003300","article-title":"Associations of early childhood manganese and lead coexposure with neurodevelopment","volume":"120","author":"Schnaas","year":"2012","journal-title":"Environ. Health Perspect."},{"key":"ref_23","first-page":"292","article-title":"P\u00e9rdida de coeficiente intelectual en hijos de alfareros mexicanos (Loss of intelligence quotient in children of Mexican potters)","volume":"55","author":"Ericson","year":"2017","journal-title":"Rev. Med. Inst. Mex. Seguro Soc."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"226","DOI":"10.3945\/ajcn.2009.28839","article-title":"Maternal MTHFR genotype and haplotype predict deficits in early cognitive development in a lead-exposed birth cohort in Mexico","volume":"92","author":"Pilsner","year":"2010","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1080\/1028415X.2016.1193967","article-title":"Glazed clay pottery and lead exposure in Mexico: Current experimental evidence","volume":"20","author":"Montes","year":"2017","journal-title":"Nutr. Neurosci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1007\/s11356-012-0933-x","article-title":"Exposure to chemical mixtures in Mexican children: High-risk scenarios","volume":"20","year":"2013","journal-title":"Environ. Sci. Pollut. Res."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"105","DOI":"10.3200\/AEOH.62.2.105-112","article-title":"The association between lead and micronutrient status, and children\u2019s sleep, classroom behavior, and activity","volume":"62","author":"Kordas","year":"2007","journal-title":"Arch. Environ. Occup. Health"},{"key":"ref_28","first-page":"260","article-title":"Uso de cer\u00e1mica vidriada como fuente de exposici\u00f3n a plomo en ni\u00f1os ind\u00edgenas de zonas marginadas de Oaxaca, M\u00e9xico (Use of glazed ceramics as a source of lead exposure in indigenous children from marginalized areas of Oaxaca, Mexico)","volume":"57","year":"2017","journal-title":"Salud Publica Mex."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1016\/j.envres.2005.07.007","article-title":"Deficits in cognitive function and achievement in Mexican first-graders with low blood lead concentrations","volume":"100","author":"Kordas","year":"2006","journal-title":"Environ. Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/j.envint.2016.11.005","article-title":"Maternal stress modifies the effect of exposure to lead during pregnancy and 24-month old children\u2019s neurodevelopment","volume":"98","author":"Schnaas","year":"2017","journal-title":"Environ. Int."},{"key":"ref_31","unstructured":"Secretar\u00eda de Gobernaci\u00f3n (2020, October 01). Modificaci\u00f3n de la Norma Oficial Mexicana NOM-199-SSA1-2000. Niveles de Plomo en Sangre y Acciones Como Criterios para Proteger la Salud de la Poblaci\u00f3n (Norm Modification: Blood Lead Levels and Actions as Criteria to Protect the Health of the Population). Available online: http:\/\/dof.gob.mx\/nota_detalle.php?codigo=5495551&fec%0Aha=30\/08\/2017."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"833","DOI":"10.21149\/10642","article-title":"Desnutrici\u00f3n cr\u00f3nica en poblaci\u00f3n infantil de localidades con menos de 100,000 habitantes en M\u00e9xico (Chronic malnutrition in child population of localities with less than 100,000 inhabitants in Mexico)","volume":"61","year":"2019","journal-title":"Salud Publica Mex."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"678","DOI":"10.21149\/10539","article-title":"Metodolog\u00eda de la Encuesta Nacional de Salud y Nutrici\u00f3n (ENSANUT- 100K), para localidades con menos de 100 mil habitantes (Methodology of the National Health and Nutrition Survey (ENSANUT-100K), for localities with less than 100,000 inhabitants)","volume":"61","author":"Rivera","year":"2019","journal-title":"Salud Publica Mex."},{"key":"ref_34","first-page":"787","article-title":"National report of blood lead levels and lead-glazed ceramics use in vulnerable children","volume":"61","author":"Cantoral","year":"2019","journal-title":"Salud P\u00fablica M\u00e9xico"},{"key":"ref_35","unstructured":"Center for Disease Control and Prevention (CDC) (2021, July 01). Childhood Lead Poisoning Prevention, Available online: https:\/\/www.cdc.gov\/nceh\/lead\/data\/blood-lead-reference-value.htm."},{"key":"ref_36","unstructured":"Instituto Nacional de Salud P\u00fablica (INSP), and Instituto Nacional de Estad\u00edstica y Geograf\u00eda (INEGI) (2019). Encuesta Nacional de Salud y Nutrici\u00f3n Dise\u00f1o Conceptual (National Health and Nutrition Survey Conceptual Design), Instituto Nacional de Estad\u00edstica y Geograf\u00eda (INEGI)."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/S0140-6736(16)31659-2","article-title":"Early childhood development: The foundation of sustainable development","volume":"389","author":"Daelmans","year":"2016","journal-title":"Lancet"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1111\/jeea.12159","article-title":"The determinants of human capital formation during the early years of life: Theory, measurement, and policies","volume":"13","author":"Attanasio","year":"2015","journal-title":"J. Eur. Econ. Assoc."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2052","DOI":"10.1257\/aer.103.6.2052","article-title":"Understanding the Mechanisms Through Which an Influential Early Childhood Program Boosted Adult Outcomes","volume":"103","author":"Heckman","year":"2013","journal-title":"Am. Econ. Rev."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"775","DOI":"10.21149\/10560","article-title":"Contexto y resultados del desarrollo infantil temprano en ni\u00f1os y ni\u00f1as de 12 a 59 meses en M\u00e9xico (Context and results of early childhood development in boys and girls from 12 to 59 months in Mexico)","volume":"61","author":"Villalobos","year":"2019","journal-title":"Salud Publica Mex."},{"key":"ref_41","unstructured":"Dunn, L., Dunn, L., and Arribas, D. (2010). PPVT-III PEABODY: Test de Vocabulario en Im\u00e1genes. (Image Language Test), Tea Ediciones. [2nd ed.]."},{"key":"ref_42","unstructured":"Fenson, L., Marchman, V.A., Thal, D., Dale, P., Reznick, J., and Bates, E. (1993). The MacArthur Communicative Development Inventories: User\u2019s Guide and Technical Manual, Singular Publishing Group."},{"key":"ref_43","first-page":"1","article-title":"Bases metodol\u00f3gicas de la medici\u00f3n de desarrollo infantil temprano en la Ensanut 100k (Methodological bases of the measurement of early childhood development in the Ensanut 100k)","volume":"62","author":"Villalobos","year":"2020","journal-title":"Salud Publica Mex."},{"key":"ref_44","unstructured":"UNICEF (2020, July 01). Development of The Early Childhood Development Index In MICS Surveys Division of Data, Research and Policy. Available online: https:\/\/scholar.google.com\/scholar?hl=id&as_sdt=0%2C5&q=Development+of+The+Early+Childhood+Development+Index+In+MICS+Surveys+Division+of+Data%2C+Research+and+Policy&btnG=."},{"key":"ref_45","unstructured":"Instituto Nacional de Salud P\u00fablica (INSP), and Fondo de las Naciones Unidas para la Infancia (UNICEF) (2016). Encuesta Nacional de Ni\u00f1os, Ni\u00f1as y Mujeres 2015\u2014Encuesta de Indicadores M\u00faltiples por Conglomerados 2015, Informe Final (National Survey of Boys, Girls and Women 2015\u2014Multiple Indicator Cluster Survey 2015, Final Report), Instituto Nacional de Salud P\u00fablica y UNICEF Mexico."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1309\/AJCP5RKWF3IZTCTO","article-title":"Decreasing the cutoff for elevated blood lead (ebl) can decrease the screening sensitivity for EBL","volume":"139","author":"McCloskey","year":"2013","journal-title":"Am. J. Clin. Pathol."},{"key":"ref_47","unstructured":"Center for Disease Control and Prevention (CDC) (2021, July 01). Childhood Lead Poisoning Prevention. Laboratory Considerations, Available online: https:\/\/www.cdc.gov\/nceh\/lead\/lab\/default.htm?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fnceh%2Flead%2Ftraining%2Fblood_lead_samples.htm."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1007\/s13181-010-0113-7","article-title":"A Bland\u2014Altman Comparison of the Lead Care \u00ae System and Inductively Coupled Plasma Mass Spectrometry for Detecting Low-Level Lead in Child Whole Blood Samples","volume":"7","author":"Sobin","year":"2011","journal-title":"J. Med. Toxicol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"660","DOI":"10.2471\/BLT.07.043497","article-title":"Development of a WHO growth reference for school-aged children and adolescents","volume":"85","author":"Onyango","year":"2007","journal-title":"Bull. World Health Organ."},{"key":"ref_50","unstructured":"StataCorp (2017). Stata Statistical Software: Release 15.0, StataCorp."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1186\/s11689-020-09346-x","article-title":"Stunting and lead: Using causal mediation analysis to better understand how environmental lead exposure affects cognitive outcomes in children","volume":"12","author":"Gleason","year":"2020","journal-title":"J. Neurodev. Disord."},{"key":"ref_52","unstructured":"Lutter, C., and Chaparro, C. (2008). Malnutrition in Infants and Young Children in Latin America and the Caribbean: Achieving the Millennium Development Goals, Pan American Health Organization."},{"key":"ref_53","first-page":"95","article-title":"Differential association of lead on length by zinc status in two-year old Mexican children","volume":"14","author":"Cantoral","year":"2015","journal-title":"Environ. Health A Glob. Access Sci. Source"},{"key":"ref_54","first-page":"103","article-title":"Stunting is associated with blood lead concentration among Bangladeshi children aged 2\u20133 years","volume":"15","author":"Gleason","year":"2016","journal-title":"Environ. Health A Glob. Access Sci. Source"},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Raihan, M.J., Briskin, E., Mahfuz, M., Islam, M.M., Mondal, D., Hossain, M.I., Ahmed, A.M.S., Haque, R., and Ahmed, T. (2018). Examining the relationship between blood lead level and stunting, wasting and underweight\u2014A cross-sectional study of children under 2 years-of-age in a Bangladeshi slum. PLoS ONE, 13, Available online: https:\/\/pubmed.ncbi.nlm.nih.gov\/29795643\/.","DOI":"10.1371\/journal.pone.0197856"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1297\/cpe.15.123","article-title":"Lead and growth","volume":"15","author":"Kaji","year":"2006","journal-title":"Clin. Pediatr. Endocrinol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"2794","DOI":"10.1093\/jn\/137.12.2794","article-title":"Interactions between nutrition and environmental exposures: Effects on health outcomes in women and children","volume":"137","author":"Kordas","year":"2007","journal-title":"J. Nutr."},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Dzwilewski, K., and Schantz, S. (2015). Prenatal Chemical Exposures and Child Language Development. J. Commun. Disord., 41\u201365.","DOI":"10.1016\/j.jcomdis.2015.07.002"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1038\/s41370-020-0224-4","article-title":"Solid fuel use and early child development disparities in Ghana: Analyses by gender and urbanicity","volume":"30","author":"Spengler","year":"2020","journal-title":"J. Expo. Sci. Environ. Epidemiol."},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Allel, K., Jaoude, G.A., Poupakis, S., Batura, N., Skordis, J., and Haghparast-Bidgoli, H. (2021). Exploring the associations between early childhood development outcomes and ecological country-level factors across low-and middle-income countries. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18073340"},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Gao, Y., Zhang, L., Kc, A., Wang, Y., Zou, S., Chen, C., Huang, Y., Mi, X., and Zhou, H. (2021). Housing environment and early childhood development in sub-Saharan Africa: A cross-sectional analysis. PLoS Med., 18.","DOI":"10.1371\/journal.pmed.1003578"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"e20161357","DOI":"10.1542\/peds.2016-1357","article-title":"Paternal stimulation and early child development in low-and middle-income countries","volume":"138","author":"Jeong","year":"2016","journal-title":"Pediatrics"},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Miller, A.C., Garchitorena, A., Rabemananjara, F., Cordier, L., Randriamanambintsoa, M., Rabeza, V., Razanadrakoto, H.T.R., Rakoto Ramakasoa, R., Ramahefarisontiana, O., and Ratsimbazafy, B.N. (2020). Factors associated with risk of developmental delay in preschool children in a setting with high rates of malnutrition: A cross-sectional analysis of data from the IHOPE study, Madagascar. BMC Pediatr., 20.","DOI":"10.1186\/s12887-020-1985-6"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"714","DOI":"10.21149\/11869","article-title":"Caracter\u00edsticas infantiles y contextuales asociadas con el desarrollo infantil temprano en la ni\u00f1ez mexicana (Infant and contextual characteristics associated with early childhood development in Mexican childhood)","volume":"62","author":"Hubert","year":"2020","journal-title":"Salud Publica Mex."},{"key":"ref_65","first-page":"283","article-title":"Tendencias de la mala nutrici\u00f3n en menores de cinco a\u00f1os en M\u00e9xico, 1988\u20132016: An\u00e1lisis de cinco encuestas nacionales (Malnutrition trends in children under five years of age in Mexico, 1988\u20132016: Analysis of five national surveys)","volume":"60","year":"2018","journal-title":"Salud Publica Mex."},{"key":"ref_66","unstructured":"SCNM, and INEGI (2022, May 09). Producto Interno Bruto por Entidad Federativa 2006\u20132010. A\u00f1o Base 2003 (Gross Domestic Product by State 2006\u20132010. Base Year 2003). Available online: https:\/\/www.inegi.org.mx\/app\/tabulados\/default.aspx?pr=17&vr=6&in=2&tp=20&wr=1."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"129832","DOI":"10.1016\/j.chemosphere.2021.129832","article-title":"Chemosphere Assessment of LeadCare\u00ae II analysis for testing of a wide range of blood lead levels in comparison with ICP e MS analysis","volume":"271","author":"Nakata","year":"2021","journal-title":"Chemosphere"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1016\/j.envres.2017.06.033","article-title":"Background lead and mercury exposures: Psychological and behavioral problems in children","volume":"158","author":"Gump","year":"2017","journal-title":"Environ. Res."},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Geier, D.A., Kern, J.K., and Geier, M.R. (2017). Blood lead levels and learning disabilities: A cross-sectional study of the 2003-2004 national health and nutrition examination survey (NHANES). Int. J. Environ. Res. Public Health, 14.","DOI":"10.3390\/ijerph14101202"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/6\/5174\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:55:42Z","timestamp":1760122542000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/6\/5174"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,15]]},"references-count":69,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2023,3]]}},"alternative-id":["ijerph20065174"],"URL":"https:\/\/doi.org\/10.3390\/ijerph20065174","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,15]]}}}