Association of blood lead level with vitamin D binding protein, total and free 25-hydroxyvitamin D levels in middle-school children

A negative association between blood Pb level (BPbL) and vitamin D metabolites in occupationally exposed populations has been reported, but data from the general population are scarce. Furthermore, the association between BPbL and vitamin D binding protein (DBP) and free 25-hydroxyvitamin D (25(OH)D) has not been reported. We investigated the association of BPbL with DBP, total and free 25(OH)D in healthy adolescents (n 1347; age range 11-16 years) cross-sectionally selected from all Governorates of Kuwait, utilising multi-stage cluster random sampling. Pb in whole blood was analysed by inductively coupled plasma MS, and DBP with ELISA. Plasma 25(OH)D was analysed by LC-MS/MS, and free 25(OH)D was calculated utilising the levels and binding affinities of DBP and albumin for 25(OH)D. DBP was positively associated with BPbL (beta = 0 center dot 81; 95 % CI 0 center dot 14, 0 center dot 22; P < 0 center dot 001). A negative association between BPbL and total 25(OH)D was non-significant (P = 0 center dot 24) when BPbL was used as a continuous variable but was significant when used as quartiles (P = 0 center dot 02). The negative association between BPbL and free 25(OH)D was significant whether BPbL was used as continuous, as quartiles or as cut-off point of <5 mu g/dl (0 center dot 24 mu mol/l). In multinomial logistic regression, the odds of vitamin D insufficiency and deficiency were more than two-fold higher in the upper quartiles of BPbL compared with the lowest quartile. The negative correlation of BPbL with free 25(OH)D was more robust than its correlation with total 25(OH)D. Future studies must consider the levels of DBP when assessing the association between Pb and vitamin D metabolites.

Automated summary

The study found a positive association between blood lead levels and vitamin D binding protein, a non-significant negative association with total 25-hydroxyvitamin D when continuous and significant when quartiles were used, and a significant negative association with free 25-hydroxyvitamin D. Higher lead levels were associated with an increased risk of vitamin D insufficiency and deficiency. Future studies should consider the levels of vitamin D binding protein when assessing the association between lead and vitamin D metabolites.