{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:39:42Z","timestamp":1760146782393,"version":"build-2065373602"},"reference-count":30,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2024,12,17]],"date-time":"2024-12-17T00:00:00Z","timestamp":1734393600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>The objective of this study is to evaluate the impact of low blood lead levels (BLLs) on the red blood cell folate concentrations in U.S. children aged 2\u201317 years. All data were obtained from the National Health and Nutrition Examination Survey (NHANES) over six consecutive cycles from 2007\u20132008 to 2017\u20132018. A total of 12,739 children with BLLs lower than 10 \u00b5g\/dL (geometric mean: 0.66 \u00b5g\/dL) were included in the dataset. BLLs were categorized into three tertiles (tertile 1: &lt;0.55 \u00b5g\/dL; tertile 2: 0.55\u20130.95 \u00b5g\/dL; and tertile 3: \u22650.95 \u00b5g\/dL). The multivariate linear regression model analysis indicates a negative relationship between BLLs and red blood cell folate concentrations. After adjusting for potential confounding factors, red blood cell folate concentrations were lower in children in the BLL tertile 2 (\u03b2-coefficient = \u22120.0450; 95% CI: \u22120.0676, \u22120.0224) and BLL tertile 3 groups (\u03b2-coefficient = \u22120.0775; 95% CI: \u22120.1032, \u22120.0517) compared to children in the BLL tertile 1 group. When stratified by age, gender, and race\/Hispanic origin, the subgroup analysis consistently revealed a negative relationship between BLLs and red blood cell folate concentrations, with red blood cell folate concentrations being lower (p &lt; 0.05) in children in the BLL tertile 3 group compared to children in the tertile 1 group. Further investigation is needed to explore the mechanism underlying the potential relationship between BLLs and red blood cell folate concentrations and determine whether folate plays an active role beneficial for preventing the harmful effects of lead on children.<\/jats:p>","DOI":"10.3390\/ijerph21121676","type":"journal-article","created":{"date-parts":[[2024,12,17]],"date-time":"2024-12-17T03:46:02Z","timestamp":1734407162000},"page":"1676","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Association Between Lead Exposure and Red Blood Cell Folate Concentrations in U.S. Children Aged 2\u201317 Years: An Analysis of Data from NHANES 2007\u20132018"],"prefix":"10.3390","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3704-3069","authenticated-orcid":false,"given":"Wenping","family":"Hu","sequence":"first","affiliation":[{"name":"National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tanya Telfair","family":"LeBlanc","sequence":"additional","affiliation":[{"name":"National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2938-619X","authenticated-orcid":false,"given":"Perri Zeitz","family":"Ruckart","sequence":"additional","affiliation":[{"name":"National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Quanza Shavonne","family":"Brooks-Griffin","sequence":"additional","affiliation":[{"name":"National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Allwood","sequence":"additional","affiliation":[{"name":"National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,12,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"S628","DOI":"10.2105\/AJPH.2022.306980","article-title":"Ubiquitous lead\u2014A challenge for the future of public health","volume":"112","author":"LeBlanc","year":"2022","journal-title":"Am. J. Public Health"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e466","DOI":"10.3928\/19382359-20171116-01","article-title":"Childhood ingestions of environmental toxins: What are the risks?","volume":"46","author":"Hauptman","year":"2017","journal-title":"Pediatr. Ann."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.pediatrneurol.2020.08.005","article-title":"Lead toxicity in children: An unremitting public health problem","volume":"113","author":"Naranjo","year":"2020","journal-title":"Pediatr. Neurol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"S13","DOI":"10.1097\/PHH.0000000000000889","article-title":"Control of lead sources in the United States, 1970\u20132017: Public health progress and current challenges to eliminating lead exposure","volume":"25","author":"Dignam","year":"2019","journal-title":"J. Public Health Manag. Pract."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e145","DOI":"10.1016\/S2542-5196(20)30278-3","article-title":"Blood lead levels in low-income and middle-income countries: A systematic review","volume":"5","author":"Ericson","year":"2021","journal-title":"Lancet Planet Health"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1146\/annurev-nutr-043020-091647","article-title":"Folic acid and the prevention of birth defects: 30 years of opportunity and controversies","volume":"42","author":"Crider","year":"2022","journal-title":"Annu. Rev. Nutr."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1636S","DOI":"10.3945\/jn.114.206599","article-title":"Biomarkers of nutrition for development\u2014Folate review","volume":"145","author":"Bailey","year":"2015","journal-title":"J. Nutr."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"He, H., Zhang, Z., and Li, M. (2022). Association between serum folate concentrations and blood lead levels in adolescents: A cross-sectional study. Front. Pediatr., 10.","DOI":"10.3389\/fped.2022.941651"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"3565","DOI":"10.1007\/s11356-021-15767-5","article-title":"Association between serum folate levels and blood concentrations of cadmium and lead in US adults","volume":"29","author":"Wu","year":"2022","journal-title":"Environ. Sci. Pollut. Res. Int."},{"key":"ref_10","first-page":"294","article-title":"Evaluation of folate and vitamin B12 levels in lead exposed workers","volume":"42","author":"Bal","year":"2015","journal-title":"Dicle Med. J."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Wang, B.-K., and Chen, W.-L. (2022). Detrimental health relationship between blood lead and cadmium and the red blood cell folate level. Sci. Rep., 12.","DOI":"10.1038\/s41598-022-10562-9"},{"key":"ref_12","unstructured":"Centers for Disease Control and Prevention (2024, August 16). National Health and Nutrition Examination Survey (2007\u20132018). National Center for Health Statistics, Available online: https:\/\/www.cdc.gov\/nchs\/nhanes."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1016\/j.talanta.2016.09.060","article-title":"Analysis of whole human blood for Pb, Cd, Hg, Se, and Mn by ICP-DRC-MS for biomonitoring and acute exposures","volume":"162","author":"Jones","year":"2017","journal-title":"Talanta"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1093\/jn\/nxy030","article-title":"Harmonizing the calibrator and microorganism used in the folate microbiological assay increases the comparability of serum and whole-blood folate results in a CDC round-robin study","volume":"148","author":"Zhang","year":"2018","journal-title":"J. Nutr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1373\/clinchem.2006.078451","article-title":"Comparison of serum folate species analyzed by LC-MS\/MS with total folate measured by microbiologic assay and Bio-Rad Radioassay","volume":"53","author":"Fazili","year":"2007","journal-title":"Clin. Chem."},{"key":"ref_16","unstructured":"Centers for Disease Control and Prevention (2024, August 16). About Body Mass Index (BMI), Available online: https:\/\/www.cdc.gov\/bmi\/about\/index.html."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1515\/intox-2015-0009","article-title":"Lead toxicity: A review","volume":"8","author":"Wani","year":"2015","journal-title":"Interdiscip. Toxicol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1111\/ajpy.12096","article-title":"Low-level environmental lead exposure still negatively associated with children\u2019s cognitive abilities","volume":"68","author":"Earl","year":"2016","journal-title":"Aust. J. Psychol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1186\/s12940-015-0008-9","article-title":"The impact of low-level lead toxicity on school performance among children in the Chicago Public Schools: A population-based retrospective cohort study","volume":"14","author":"Evens","year":"2015","journal-title":"Environ. Health"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.neuro.2016.02.004","article-title":"Low-level lead exposure and autistic behaviors in school-age children","volume":"53","author":"Kim","year":"2016","journal-title":"Neurotoxicology"},{"key":"ref_21","unstructured":"World Health Organization (2024, August 16). Serum and Red Blood Cell Folate Concentrations for Assessing Folate Status in Populations, Available online: https:\/\/iris.who.int\/handle\/10665\/162114."},{"key":"ref_22","first-page":"239","article-title":"Folate","volume":"Volume 1","author":"Marriott","year":"2020","journal-title":"Present Knowledge in Nutrition"},{"key":"ref_23","first-page":"555","article-title":"Red cell or serum folate: What to do in clinical practice? Clin","volume":"51","author":"Farrell","year":"2013","journal-title":"Chem. Lab. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.cca.2007.04.024","article-title":"Low level lead exposure and oxidative stress: Current opinions","volume":"383","author":"Ahamed","year":"2007","journal-title":"Clin. Chim. Acta."},{"key":"ref_25","first-page":"193","article-title":"Lead exposure and oxidative stress: A systematic review","volume":"236","author":"Lopes","year":"2016","journal-title":"Rev. Environ. Contam. Toxicol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"S3","DOI":"10.1111\/j.1753-4887.2004.tb00070.x","article-title":"Physiology of folate and vitamin B12 in health and disease","volume":"62","author":"Stover","year":"2004","journal-title":"Nutr. Rev."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Lai, K.G., Chen, C.F., Ho, C.T., Liu, J.J., Liu, T.Z., and Chern, C.L. (2017). Novel roles of folic acid as redox regulator: Modulation of reactive oxygen species sinker protein expression and maintenance of mitochondrial redox homeostasis on hepatocellular carcinoma. Tumour Biol., 39.","DOI":"10.1177\/1010428317702649"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1390","DOI":"10.1016\/S0891-5849(01)00543-3","article-title":"Free radical scavenging behavior of folic acid: Evidence for possible antioxidant activity","volume":"30","author":"Joshi","year":"2001","journal-title":"Free Radic. Biol. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.1093\/ajcn\/nqz184","article-title":"Folate status in the US population 20 y after the introduction of folic acid fortification","volume":"110","author":"Pfeiffer","year":"2019","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"102366","DOI":"10.1016\/j.eclinm.2023.102366","article-title":"Global heterogeneity in folic acid fortification policies and implications for prevention of neural tube defects and stroke: A systematic review","volume":"67","author":"Quinn","year":"2023","journal-title":"EClinicalMedicine"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/21\/12\/1676\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:53:28Z","timestamp":1760115208000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/21\/12\/1676"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,17]]},"references-count":30,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["ijerph21121676"],"URL":"https:\/\/doi.org\/10.3390\/ijerph21121676","relation":{},"ISSN":["1660-4601"],"issn-type":[{"type":"electronic","value":"1660-4601"}],"subject":[],"published":{"date-parts":[[2024,12,17]]}}}