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Article(id=1325521210381042214, tenantId=1146029695717560320, journalId=1256213402557890569, issueId=1325521023759691810, articleNumber=null, orderNo=null, doi=10.16835/j.cnki.1000-9817.2025214, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1734624000000, receivedDateStr=2024-12-20, revisedDate=1746460800000, revisedDateStr=2025-05-06, acceptedDate=null, acceptedDateStr=null, onlineDate=1793958483548, onlineDateStr=2026-11-06, pubDate=1753372800000, pubDateStr=2025-07-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793958483548, onlineIssueDateStr=2026-11-06, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793958483548, creator=13701087609, updateTime=1793958483548, updator=13701087609, issue=Issue{id=1325521023759691810, tenantId=1146029695717560320, journalId=1256213402557890569, year='2025', volume='46', issue='7', pageStart='913', pageEnd='1064', issueExtLink='null', onlineDate='null', pubDate='1753372800000', pubDateStr='2025-07-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793958439054, creator='13701087609', updateTime=1793958439054, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=926, endPage=931, ext={EN=ArticleExt(id=1325521212864070184, articleId=1325521210381042214, tenantId=1146029695717560320, journalId=1256213402557890569, language=EN, title=Systematic review and Meta-analysis of the association between heavy metal exposure and obesity in children and adolescents, columnId=1325521116441215415, journalTitle=Chinese Journal of School Health, columnName=Environmental Exposure and Child & Adolescent Health Series, runingTitle=null, highlight=null, articleAbstract=
Objective

To systematically evaluate the relationship of exposure to five heavy metals, namely lead, arsenic, cadmium, mercury and aluminum with obesity in children and adolescents, so as to provide a scientific basis for subsequent research in the area.

Methods

Four Chinese databasesc (CBM, VIP, CNKI and Wanfang) and four foreign databases (OVID, PubMed, Web of Science and EBSCO), were searched to collect relevant studies, and the search period was from the establishment of the database to May 5, 2024. After 2 investigators independently screened the literature, extracted the data and evaluated the risk of bias of the included studies, the results were analyzed quantitatively and summarized qualitatively.

Results

A total of 5 cohort studies on lead exposure and 17 cross-sectional studies involving exposure to lead (n=13), cadmium (n=8), mercury (n=8), arsenic (n=4), and aluminum (n=1) were included. Meta analysis of the 2 cohort studies showed that lead exposure was not associated with the risk of overweight and obesity in children (RR=0.76, 95%CI=0.50-1.16, P > 0.05). The cross-sectional study Meta-analysis results showed that lead exposure was negatively associated with the risk of childhood overweight (OR=0.70, 95%CI=0.59-0.84, 2 studies) and obesity (OR=0.71, 95%CI=0.58-0.87, 3 studies); cadmium exposure was negatively associated with the risk of childhood overweight (OR=0.83, 95%CI=0.73-0.95, 2 studies) and obesity risk(OR=0.70, 95%CI=0.63-0.78, 3 studies); mercury exposure increased the risk of overweight/obesity (OR=1.42, 95%CI=1.14-1.76, 2 studies) and abdominal obesity (OR=1.99, 95%CI=1.45-2.73, 2 studies) in children; the group with the highest concentration of arsenic in urine had a lower risk of developing obesity compared to the group with the lowest concentration (OR=0.39, 95%CI=0.23-0.65, 1 study), and the group with the highest concentration of aluminum in urine had a lower risk of obesity compared with the group with the lowest concentration (OR=0.52, 95%CI=0.31-0.86, 1 study)(all P < 0.05).

Conclusion

Heavy metal exposure may be a risk factor for overweight and obesity in children and adolescents, but the conclusions are inconsistent and need to be validated in further high-quality prospective cohort studies.

, authors=Meng WU, Lüer LUO, Jinghan WANG, Qin LIU*, authorsList=Meng WU, Lüer LUO, Jinghan WANG, Qin LIU, authorCompany=null, correspAuthors=Qin LIU, authorNote=null, correspAuthorsNote=null, copyrightStatement=Copyright ©2025 Chinese Journal of School Health. All rights reserved., copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1325521221256872508, articleId=1325521210381042214, tenantId=1146029695717560320, journalId=1256213402557890569, language=CN, title=重金属暴露与儿童青少年肥胖关联的系统评价与Meta分析, columnId=1325521118253154745, journalTitle=中国学校卫生, columnName=环境暴露与儿童青少年健康专栏, runingTitle=null, highlight=null, articleAbstract=
目的

系统评价铅、砷、镉、汞、铝5种重金属暴露与儿童青少年肥胖之间的关系，为后续开展相关研究提供科学依据。

方法

检索中国生物医学文献数据库、维普、中国知网、万方4个中文数据库和OVID、PubMed、Web of Science、EBSCO 4个外文数据库搜集相关研究，检索时间为建库至2024年5月5日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后，对结果进行定量分析和定性归纳总结。

结果

共纳入5项有关铅暴露的队列研究、17项涉及铅(13项)、镉(8项)、汞(8项)、砷(4项)、铝(1项)暴露的横断面研究。2项队列研究的Meta分析结果显示铅暴露与儿童超重肥胖风险相关性无统计学意义(RR=0.76，95%CI=0.50~1.16，P＞0.05)；而横断面研究Meta分析结果显示铅暴露与儿童超重(OR=0.70，95%CI=0.59~0.84，2项研究)、肥胖(OR=0.71，95%CI=0.58~0.87，3项研究)风险均呈负相关，镉暴露与儿童超重(OR=0.83，95%CI=0.73~0.95，2项研究)、肥胖(OR=0.70，95%CI=0.63~0.78，3项研究)风险均呈负相关，汞暴露会增加儿童超重/肥胖(OR=1.42，95%CI=1.14~1.76，2项研究)、腹型肥胖(OR=1.99，95%CI=1.45~2.73，2项研究)的风险，尿液中砷质量体积浓度最高组与浓度最低组相比发生肥胖的风险更低(OR=0.39，95%CI=0.23~0.65，1项研究)，尿液中铝质量体积浓度最高组与浓度最低组相比发生肥胖的风险更低(OR=0.52，95%CI=0.31~0.86，1项研究)(P值均＜0.05)。

结论

重金属暴露可能是儿童青少年发生超重肥胖的风险因素，但结论尚不统一，还需进一步开展高质量前瞻性队列研究予以验证。

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吴梦(2001-)，女，河南许昌人，在读硕士，主要研究方向为儿童青少年健康

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刘琴，E-mail：
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J Toxicol Environ Health B Crit Rev, 2009, 12(3): 206-223., articleTitle=null, refAbstract=null), Reference(id=1325521255272678076, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325521210381042214, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=39, rfOrder=42, authorNames=null, journalName=null, refType=null, unstructuredReference=FARKHONDEH T, SAMARGHANDIAN S, AZIMI-NEZHAD M. The role of arsenic in obesity and diabetes[J]. 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Basic characteristics of cohort studies on the association of lead exposure and obesity in children and adolescents

, figureFileSmall=null, figureFileBig=null, tableContent=
第一作者及年份国家样本来源样本量(男/女)基线年龄/岁随访次数/随访间隔生物样本暴露水平结局指标肥胖指标测量年龄/岁
Ahmadi(2022)[17]贝宁保健中心659(333/326)1.12/2年血液59.3 μg/LaBMI Z分4(随访1)，6(随访2)
Cassidy-Bushrow(2016)[18]美国医院299(159/140)1.31/11个月血液2.45 μg/dLBMI Z分、超重、肥胖2.2
Deierlein(2019)[19]美国学校和医院683(女)7.87/1年血液1.16 μg/dLBMI、腰围、体脂百分比、超重、肥胖7~14
Kim(1995)[20]美国学校58(27/31)7.41/12年牙本质14.9 ppmBMI20.5
Liu(2019)[21]墨西哥医院248(125/123)1~41/—血液19.6 μg/dLBMI Z分、腰围、体脂百分比8~16
), ArticleFig(id=1325521244044526209, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325521210381042214, language=CN, label=表1, caption=

纳入的铅暴露与儿童青少年肥胖关联队列研究文献的基本特征

, figureFileSmall=null, figureFileBig=null, tableContent=
第一作者及年份国家样本来源样本量(男/女)基线年龄/岁随访次数/随访间隔生物样本暴露水平结局指标肥胖指标测量年龄/岁
Ahmadi(2022)[17]贝宁保健中心659(333/326)1.12/2年血液59.3 μg/LaBMI Z分4(随访1)，6(随访2)
Cassidy-Bushrow(2016)[18]美国医院299(159/140)1.31/11个月血液2.45 μg/dLBMI Z分、超重、肥胖2.2
Deierlein(2019)[19]美国学校和医院683(女)7.87/1年血液1.16 μg/dLBMI、腰围、体脂百分比、超重、肥胖7~14
Kim(1995)[20]美国学校58(27/31)7.41/12年牙本质14.9 ppmBMI20.5
Liu(2019)[21]墨西哥医院248(125/123)1~41/—血液19.6 μg/dLBMI Z分、腰围、体脂百分比8~16
), ArticleFig(id=1325521244111635074, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325521210381042214, language=EN, label=Tab.2, caption=

Basic characteristics of cross-sectional studies on the association between heavy metal exposure and obesity in children and adolescents

, figureFileSmall=null, figureFileBig=null, tableContent=
第一作者及年份国家样本来源样本量年龄/岁生物样本重金属种类及暴露水平结局指标
Zhou(2020)[22]中国医院1 6784.7血液铅：56.84 μg/LaBMI Z分
Cho(2021)[23]韩国国民健康营养调查1 32710~18血液汞：2.16 μg/LaBMI、腰高比、超重、腹型肥胖
Shan(2022)[24]美国国家健康与营养检查调查27 9466~19尿液铅：38.46 μg/L；镉：7.6 μg/Lc超重、肥胖
Little(2009)[25]美国社区3602~12血液铅：1.8 μg/LbBMI
Donangelo(2021)[26]乌拉圭社区2596.7血液铅：4.2 μg/dLb年龄别BMI Z分
Fábelová(2018)[27]法国无住房儿童和家庭3242.7头发铅：2.43 μg/g；镉：0.05 μg/g；汞：0.42 μg/g；砷：0.08 μg/gbBMI Z分
Gao(2018)[28]中国社区14 2020~6血液汞：1.39 μg/LbBMI、BMI Z分
Kuang(2020)[29]中国学校3957~11血液铅：30.4 μg/Lb标化BMI、腰围
Kyoung-Bok(2008)[30]韩国社区1085~13血液铅：2.4 μg/dLbBMI
张乔柔(2022)[31]中国山东莱州湾出生队列*3187.8尿液铅：1.13 μg/g；镉：0.41 μg/g；汞：2.66 μg/g；砷：80.01 μg/gaBMI、腰围、体脂率
朱美琴(2021)[12]中国学校1 4712~6尿液铅：4.55 μg/g；镉：0.79 μg/g；砷：108.83μg/g；铝：127.21 μg/ga肥胖
Pastor(2021)[32]美国国家健康与营养检查调查1 6346~11血液铅：0.5 μg/dL；汞：0.3 μg/LcBMI、腰围
Shao(2017)[33]美国国家健康与营养检查调查6 6026~19尿液铅：0.90 ng/mL；镉：0.14 ng/mLb超重、肥胖
Shin(2024)[13]韩国国民健康营养调查1 4583~11尿液镉：0.11 μg/L；汞：0.47 μg/LaBMI Z分、超重/肥胖
Shin(2018)[34]韩国国民健康营养调查1 56710~19血液汞：1.93 μg/La超重/肥胖、腹部肥胖
García-Villarino(2022)[35]西班牙阿斯图里亚斯出生队列研究*3284~5尿液铅：1.9 μg/g；镉：0.3 μg/gcBMI、腰围
Jillian(2019)[36]加拿大母婴环境化学品研究4492~5血液铅：0.66 μg/dL；镉：0.089 μg/L；汞：0.22 μg/L；砷：0.46 μg/LcBMI Z分
), ArticleFig(id=1325521244191326851, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325521210381042214, language=CN, label=表2, caption=

纳入的重金属暴露与儿童青少年肥胖关联横断面研究的基本特征

, figureFileSmall=null, figureFileBig=null, tableContent=
第一作者及年份国家样本来源样本量年龄/岁生物样本重金属种类及暴露水平结局指标
Zhou(2020)[22]中国医院1 6784.7血液铅：56.84 μg/LaBMI Z分
Cho(2021)[23]韩国国民健康营养调查1 32710~18血液汞：2.16 μg/LaBMI、腰高比、超重、腹型肥胖
Shan(2022)[24]美国国家健康与营养检查调查27 9466~19尿液铅：38.46 μg/L；镉：7.6 μg/Lc超重、肥胖
Little(2009)[25]美国社区3602~12血液铅：1.8 μg/LbBMI
Donangelo(2021)[26]乌拉圭社区2596.7血液铅：4.2 μg/dLb年龄别BMI Z分
Fábelová(2018)[27]法国无住房儿童和家庭3242.7头发铅：2.43 μg/g；镉：0.05 μg/g；汞：0.42 μg/g；砷：0.08 μg/gbBMI Z分
Gao(2018)[28]中国社区14 2020~6血液汞：1.39 μg/LbBMI、BMI Z分
Kuang(2020)[29]中国学校3957~11血液铅：30.4 μg/Lb标化BMI、腰围
Kyoung-Bok(2008)[30]韩国社区1085~13血液铅：2.4 μg/dLbBMI
张乔柔(2022)[31]中国山东莱州湾出生队列*3187.8尿液铅：1.13 μg/g；镉：0.41 μg/g；汞：2.66 μg/g；砷：80.01 μg/gaBMI、腰围、体脂率
朱美琴(2021)[12]中国学校1 4712~6尿液铅：4.55 μg/g；镉：0.79 μg/g；砷：108.83μg/g；铝：127.21 μg/ga肥胖
Pastor(2021)[32]美国国家健康与营养检查调查1 6346~11血液铅：0.5 μg/dL；汞：0.3 μg/LcBMI、腰围
Shao(2017)[33]美国国家健康与营养检查调查6 6026~19尿液铅：0.90 ng/mL；镉：0.14 ng/mLb超重、肥胖
Shin(2024)[13]韩国国民健康营养调查1 4583~11尿液镉：0.11 μg/L；汞：0.47 μg/LaBMI Z分、超重/肥胖
Shin(2018)[34]韩国国民健康营养调查1 56710~19血液汞：1.93 μg/La超重/肥胖、腹部肥胖
García-Villarino(2022)[35]西班牙阿斯图里亚斯出生队列研究*3284~5尿液铅：1.9 μg/g；镉：0.3 μg/gcBMI、腰围
Jillian(2019)[36]加拿大母婴环境化学品研究4492~5血液铅：0.66 μg/dL；镉：0.089 μg/L；汞：0.22 μg/L；砷：0.46 μg/LcBMI Z分
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重金属暴露与儿童青少年肥胖关联的系统评价与Meta分析
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吴梦 , 罗律儿 , 王静涵 , 刘琴 *
中国学校卫生 | 环境暴露与儿童青少年健康专栏 2025,46(7): 926-931
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中国学校卫生 |环境暴露与儿童青少年健康专栏 2025 , 46 (7) : 926 -931
重金属暴露与儿童青少年肥胖关联的系统评价与Meta分析
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吴梦, 罗律儿, 王静涵, 刘琴*
作者信息
  • 重庆医科大学公共卫生学院/环境与人群健康研究中心/医学与社会发展研究中心, 重庆 400016
通讯作者:
刘琴，E-mail：
作者简介:

吴梦(2001-)，女，河南许昌人，在读硕士，主要研究方向为儿童青少年健康

Systematic review and Meta-analysis of the association between heavy metal exposure and obesity in children and adolescents
Meng WU, Lüer LUO, Jinghan WANG, Qin LIU*
Affiliations
  • School of Public Health, Chongqing Medical University/Research Center for Environment and Human Health/Research Center for Medicine and Social Development, Chongqing 400016, China
出版时间: 2025-07-25 doi: 10.16835/j.cnki.1000-9817.2025214
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摘要
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目的

系统评价铅、砷、镉、汞、铝5种重金属暴露与儿童青少年肥胖之间的关系，为后续开展相关研究提供科学依据。

方法

检索中国生物医学文献数据库、维普、中国知网、万方4个中文数据库和OVID、PubMed、Web of Science、EBSCO 4个外文数据库搜集相关研究，检索时间为建库至2024年5月5日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后，对结果进行定量分析和定性归纳总结。

结果

共纳入5项有关铅暴露的队列研究、17项涉及铅(13项)、镉(8项)、汞(8项)、砷(4项)、铝(1项)暴露的横断面研究。2项队列研究的Meta分析结果显示铅暴露与儿童超重肥胖风险相关性无统计学意义(RR=0.76，95%CI=0.50~1.16，P＞0.05)；而横断面研究Meta分析结果显示铅暴露与儿童超重(OR=0.70，95%CI=0.59~0.84，2项研究)、肥胖(OR=0.71，95%CI=0.58~0.87，3项研究)风险均呈负相关，镉暴露与儿童超重(OR=0.83，95%CI=0.73~0.95，2项研究)、肥胖(OR=0.70，95%CI=0.63~0.78，3项研究)风险均呈负相关，汞暴露会增加儿童超重/肥胖(OR=1.42，95%CI=1.14~1.76，2项研究)、腹型肥胖(OR=1.99，95%CI=1.45~2.73，2项研究)的风险，尿液中砷质量体积浓度最高组与浓度最低组相比发生肥胖的风险更低(OR=0.39，95%CI=0.23~0.65，1项研究)，尿液中铝质量体积浓度最高组与浓度最低组相比发生肥胖的风险更低(OR=0.52，95%CI=0.31~0.86，1项研究)(P值均＜0.05)。

结论

重金属暴露可能是儿童青少年发生超重肥胖的风险因素，但结论尚不统一，还需进一步开展高质量前瞻性队列研究予以验证。

金属  /  肥胖症  /  Meta分析  /  儿童  /  青少年
Objective

To systematically evaluate the relationship of exposure to five heavy metals, namely lead, arsenic, cadmium, mercury and aluminum with obesity in children and adolescents, so as to provide a scientific basis for subsequent research in the area.

Methods

Four Chinese databasesc (CBM, VIP, CNKI and Wanfang) and four foreign databases (OVID, PubMed, Web of Science and EBSCO), were searched to collect relevant studies, and the search period was from the establishment of the database to May 5, 2024. After 2 investigators independently screened the literature, extracted the data and evaluated the risk of bias of the included studies, the results were analyzed quantitatively and summarized qualitatively.

Results

A total of 5 cohort studies on lead exposure and 17 cross-sectional studies involving exposure to lead (n=13), cadmium (n=8), mercury (n=8), arsenic (n=4), and aluminum (n=1) were included. Meta analysis of the 2 cohort studies showed that lead exposure was not associated with the risk of overweight and obesity in children (RR=0.76, 95%CI=0.50-1.16, P > 0.05). The cross-sectional study Meta-analysis results showed that lead exposure was negatively associated with the risk of childhood overweight (OR=0.70, 95%CI=0.59-0.84, 2 studies) and obesity (OR=0.71, 95%CI=0.58-0.87, 3 studies); cadmium exposure was negatively associated with the risk of childhood overweight (OR=0.83, 95%CI=0.73-0.95, 2 studies) and obesity risk(OR=0.70, 95%CI=0.63-0.78, 3 studies); mercury exposure increased the risk of overweight/obesity (OR=1.42, 95%CI=1.14-1.76, 2 studies) and abdominal obesity (OR=1.99, 95%CI=1.45-2.73, 2 studies) in children; the group with the highest concentration of arsenic in urine had a lower risk of developing obesity compared to the group with the lowest concentration (OR=0.39, 95%CI=0.23-0.65, 1 study), and the group with the highest concentration of aluminum in urine had a lower risk of obesity compared with the group with the lowest concentration (OR=0.52, 95%CI=0.31-0.86, 1 study)(all P < 0.05).

Conclusion

Heavy metal exposure may be a risk factor for overweight and obesity in children and adolescents, but the conclusions are inconsistent and need to be validated in further high-quality prospective cohort studies.

Metals  /  Obesity  /  Meta-analysis  /  Child  /  Adolescent
吴梦, 罗律儿, 王静涵, 刘琴. 重金属暴露与儿童青少年肥胖关联的系统评价与Meta分析. 中国学校卫生, 2025 , 46 (7) : 926 -931 . DOI: 10.16835/j.cnki.1000-9817.2025214
Meng WU, Lüer LUO, Jinghan WANG, Qin LIU. Systematic review and Meta-analysis of the association between heavy metal exposure and obesity in children and adolescents[J]. Chinese Journal of School Health, 2025 , 46 (7) : 926 -931 . DOI: 10.16835/j.cnki.1000-9817.2025214
正文
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《中国居民营养与慢性病状况报告(2020年)》显示，6~17岁儿童青少年超重肥胖率已经达到19%[1]。超重肥胖会导致代谢综合征、早期动脉粥样硬化、血脂异常、高血压和2型糖尿病等临床疾病[2]。肥胖的发病机制非常复杂，除传统的饮食、运动等因素外，环境因素也会影响肥胖的发生[3]，越来越多研究关注环境中的金属暴露与肥胖之间的关系[4-5]。重金属具有内分泌干扰作用[6]，可以通过改变内源性激素的产生、释放、运输、代谢、结合来扰乱人体内分泌系统的内环境平衡，从而影响生长和发育，增加个体代谢性疾病的患病风险[7-8]。铅、砷、汞和镉等重金属在2020年已被世界卫生组织列为对全球公众健康影响较大的化学污染物[9]，2012年我国2~14岁儿童摄入含铝添加剂食品的铝已超过每周可耐受摄入量(provisional tolerable weekly intake, PTWI)，存在较高的健康风险[10]。现有研究已经发现儿童出生后铅、砷、镉、汞、铝暴露与其肥胖的关联[5, 11-13]，但结果并不一致。基于此，本研究旨在通过全面检索和严格评价相关研究文献，系统总结并探究重金属暴露与儿童肥胖的关系，为后续开展相关研究提供科学依据。
1　资料来源与方法
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1.1　纳入与排除标准
1.1.1　纳入标准
(1) 研究类型：横断面研究、队列研究；(2)研究对象：年龄0~19岁的儿童青少年，不限性别、种族；(3)暴露因素：出生后铅、砷、镉、汞、铝5种重金属的内暴露情况；(4)结局指标：肥胖相关指标，连续性变量包括体质量指数(body mass index, BMI)、腰围、腰臀比、腰高比、体脂率等，分类变量包括超重、肥胖、腹型肥胖等。
1.1.2　排除标准
(1) 研究设计不符，如动物实验、病例对照研究、评论、社论、综述、书信、会议摘要等；(2)非中英文文献；(3)重复研究。
1.2　文献检索策略
计算机检索PubMed、EBSCO、Web of Science、OVID、中国生物医学文献数据库、维普、万方和中国知网数据库，搜集铅、砷、镉、汞、铝暴露与儿童青少年肥胖关系的研究，检索时限均从建库至2024年5月5日。中文检索词包括：(1)婴幼儿、儿童、男童、女童、学生、青少年、未成年；(2)重金属、铅、砷、镉、汞、铝；(3)肥胖、BMI、腰围、腰臀比、腰高比、体脂。英文检索词为：①Infant, Child, Children, Boy, Girl, Student, Pupil, Adolescent, Teen, Teenager, Youth, Juvenile, Underage；②Heavy Metal, Lead, Arsenic, Cadmium, Mercury, Aluminum；③Obesity, BMI, Waist Circumference, Waist-to-hip Ratio, Waist-to-height Ratio, Body Fat, Fat Mass。
1.3　文献筛选及资料提取
由2名研究者独立筛选文献、提取资料并交叉核对，如遇分歧，则通过讨论或与第三人协商解决。资料提取内容包括研究地区、年份、样本来源、研究设计类型、研究对象的年龄、性别、样本量、重金属暴露的测量情况、肥胖相关指标信息、重金属暴露与肥胖的关联指标。
1.4　纳入研究的偏倚风险评价
每项纳入研究均由2名研究者独立评价偏倚风险，并交叉核对结果。队列研究采用纽卡斯尔-渥太华量表(Newcastle-Ottawa Scale, NOS)[14]进行评价，总分≥7分为高质量研究，4~6分为中等质量研究，＜4分为低质量研究[15]。横断面研究采用美国卫生保健和质量管理局(Agency for Healthcare Research and Quality, AHRQ)推荐的11项清单[16]进行评估，分别采用“是”(计1分)、“否”及“不清楚”(计0分)作答，得分≥8分为高质量研究。
1.5　统计学分析
采用Stata 13.0软件对肥胖指标进行Meta分析，队列研究合并的效应统计量为RR值及其95%CI，横断面研究合并的效应统计量为β值、OR值及其95%CI。各研究间的异质性采用χ2检验，若P＞0.1，I2≤50%，表示各研究间异质性小，采用固定效应模型进行Meta分析；若P≤0.1，I2＞50%，表示各研究间异质性大，采用随机效应模型进行Meta分析。对于其他不满足Meta分析条件无法进行数据合并的研究，则按照不同肥胖指标分别进行定性归纳总结。检验水准α=0.05。
2　结果
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2.1　文献筛选流程及结果
通过数据库检索获得相关文献6 589篇，经筛选后，最终纳入22项研究，包括5项队列研究[17-21]与17项横断面研究[12-13, 22-36]，文献筛选流程及结果见图1。
2.2　纳入研究的基本特征
纳入研究中，涉及铅暴露与儿童青少年肥胖关联的共5项队列研究、13项横断面研究，涉及镉、汞、砷、铝暴露与儿童青少年肥胖关联的研究数分别为8，8，4和1项，均为横断面研究。5项队列研究涉及3个不同国家的1 947名儿童青少年，17项横断面研究涉及7个国家的60 426名儿童青少年。纳入队列研究、横断面研究的基本特征见表1~2。
2.3　偏倚风险评价结果
所纳入的5项队列研究NOS评分为6~8分，17项横断面研究AHRQ评分为5~9分。
2.4　重金属暴露与儿童青少年各肥胖指标的关系
2.4.1　重金属暴露与儿童青少年超重肥胖
2项队列研究[18-19]、3项横断面研究[12, 24, 33]涉及铅暴露与儿童超重肥胖风险的关系。按照重金属浓度的四分位数将参与者分为4组(Q1~Q4)，通常以最低四分位数组(Q1)作为参照组。队列研究中，Cassidy-Bushrow等[18]研究中血铅水平与儿童超重肥胖风险有统计学意义(RR=0.58，P＜0.05)，Deierlein等[19]血铅水平与儿童超重肥胖风险无统计学意义(RR=0.90，P＞0.05)；Meta分析结果显示，不同血铅水平与儿童超重肥胖风险之间关联无统计学意义(RR=0.76，P＞0.05)。儿童铅暴露与超重风险关联的横断面研究中，仅Shan等[24]和Shao等[33]研究发现与Q1组相比，儿童尿液中铅质量体积浓度Q4组发生超重的风险更低(OR值分别为0.67，0.73，P值均＜0.05)；Meta分析结果显示，儿童尿液中铅质量体积浓度最高组Q4与浓度最低组Q1相比发生超重的风险更低(OR=0.70，P＜0.05)。儿童铅暴露与肥胖风险的横断面研究中，仅Shan等[24]和Shao等[33]研究发现与Q1组相比，儿童尿液中铅质量体积浓度Q4组发生肥胖的风险更低(OR值分别为0.38，0.57，P值均＜0.05)；Meta分析结果显示，高尿铅水平(Q3、Q4)儿童相较于低尿铅水平儿童肥胖风险更低(OR值分别为0.72，0.53，95%CI分别为0.59~0.86，0.38~0.75，P值均＜0.05)。见图2。
4项横断面研究[12-13, 24, 33]涉及镉暴露与儿童超重肥胖风险的关系，其中仅Shao等[33]研究发现尿镉质量体积浓度水平与儿童超重风险呈负相关(OR=0.56，P＜0.05)；Meta分析结果显示，尿镉水平总体上与儿童超重风险呈负相关(OR=0.83，P＜0.05)。Shao等[33]和朱美琴等[12]均发现，与尿液中镉质量分数最低组相比，最高组发生肥胖的风险更低(OR值分别为0.46，0.50，P值均＜0.05)；Meta分析结果显示，尿镉水平与儿童肥胖风险呈负相关(OR=0.70，95%CI=0.63~0.78，P＜0.05)，亚组分析结果见图3。而Shin等[13]发现6~11岁的男童尿镉质量体积浓度与其超重/肥胖呈正相关(OR=2.44，95%CI=1.19~5.00，P＜0.05)。
3项横断面研究[13, 23-34]涉及汞暴露与儿童超重肥胖、腹型肥胖的关系，对其中2项进行Meta分析结果显示，血汞高质量体积浓度组儿童比低浓度组的超重肥胖风险更高(OR=1.42，95%CI=1.14~1.76，P＜0.05)。见图4。Shin等[13]发现儿童血汞质量体积浓度最高组与最低组相比发生腹型肥胖的风险更高(OR=3.00)，Shin等[34]仅发现男孩的血汞质量体积浓度与腹型肥胖风险呈正相关(OR=2.35)；Meta分析显示，相较于低汞暴露，高汞暴露儿童的腹型肥胖风险更高(OR=1.99，95%CI=1.45~2.73)(P值均＜0.05)。见图5。
仅1项横断面研究[12]分析了砷、铝与儿童肥胖的关系，发现尿液中砷质量体积浓度与儿童肥胖风险呈负相关(OR=0.39，95%CI=0.23~0.65)，尿铝质量体积浓度最高组与最低组相比发生肥胖的风险更低(OR=0.52，95%CI=0.31~0.86)(P值均＜0.05)。
2.4.2　重金属暴露与儿童青少年BMI/BMI Z分
5项队列研究[17-21]、10项横断面研究[22, 25-27, 29-32, 35-36]涉及铅暴露与儿童青少年BMI/BMI Z分的关联。对于BMI，在队列研究中，Deierlein等[19]发现儿童7.8岁的血铅水平与7~14岁的BMI呈负相关；Kim等[20]研究发现儿童7.4岁牙本质铅水平与20岁的BMI呈正相关。在横断面研究中，Little等[25]和Pastor等[32]发现血铅水平与BMI之间呈负相关。对于BMI Z分，在队列研究中，只有Cassidy-Bushrow等[18]发现儿童1岁时的铅暴露与2岁BMI Z分之间呈负相关。在横断面研究中，Zhou等[22]发现儿童血铅质量体积浓度最高组与浓度最低组相比具有较低的BMI Z分。
5项横断面研究[13, 27, 31, 35-36]涉及镉暴露与儿童BMI/BMI Z分的关系。对于BMI，张乔柔等[31]发现尿镉水平与BMI呈正向关联，而García-Villarino等[35]发现尿镉水平与BMI呈负相关。对于BMI Z分，仅Shin等[13]在3~5岁的女童、6~11岁男童中发现尿镉浓度与BMI Z分呈正相关。
7项横断面研究[13, 23, 27-28, 31-32, 36]涉及汞暴露与儿童BMI/BMI Z分的关系。对于BMI，Cho等[23]和Gao等[28]发现血汞水平与BMI呈正相关(β值分别为0.24，0.21，95%CI分别为0.01~0.48，0.10~0.31，P值均＜0.05)，张乔柔等[31]和Pastor等[32]未发现两者间存在关联，对其中2项[23, 28]进行Meta分析结果显示，血镉浓度与BMI之间存在正相关(β=0.21，95%CI=0.12~0.31，P＜0.05)。对于BMI Z分，Gao等[28]和Shin等[13]均发现汞与BMI Z分呈正相关，而其余2项研究[27, 36]未发现两者间存在统计学关联。3项横断面研究[27, 31, 36]分析了砷暴露与儿童BMI/BMI Z分的关系，均未发现其存在统计学关联。
2.4.3　重金属暴露与儿童青少年腰围
2项队列研究[19, 21]、4项横断面研究[29, 31-32, 35]涉及铅暴露与儿童腰围的关联。在队列研究中，Deierlein等[19]发现儿童7.8岁血铅暴露与7~14岁腰围呈负相关，而Liu等[21]未发现二者存在关联。在横断面研究中，Kuang等[29]和Pastor等[32]发现血铅水平与儿童腰围之间呈负相关，其余2项研究[31, 35]也未发现其关联有统计学意义。2项横断面研究[31, 35]涉及镉暴露与儿童腰围的关联，张乔柔等[31]发现尿镉水平与腰围呈正向关联，而García-Villarino等[35]发现尿镉水平与腰围呈负相关。2项横断面研究[31-32]涉及汞暴露与儿童腰围的关联，均未发现汞与儿童腰围存在关联。仅张乔柔等[31]分析了尿砷水平与儿童腰围的关系，未发现两者存在统计学关联。
2.4.4　重金属暴露与儿童青少年体脂率
2项队列研究[19, 21]、1项横断面研究[31]涉及铅暴露与儿童体脂率的关联，这项横断面研究同时还分析了镉、汞、砷暴露与体脂率的关联。在队列研究中，Deierlein等[19]发现儿童7.8岁血铅暴露与7~14岁体脂率呈负相关，Liu等[21]未发现铅与体脂率存在关联。在横断面研究中，张乔柔等[31]发现尿铅、镉、汞、砷与儿童体脂率无相关性。
2.4.5　汞暴露与儿童青少年腰高比
1项横断面研究[23]涉及汞暴露与儿童腰高比的关联，发现血汞水平与腰高比呈正向关联。
3　讨论
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本系统评价结果表明，队列研究提示铅暴露与儿童超重、肥胖间关联无统计学意义，对儿童肥胖相关指标的影响不一致。如Deierlein等[19]和Kim等[20]的结果不一致，可能意味着铅暴露对儿童BMI影响的短期效应和长期效应不同，也可能是由于两项研究不同的随访时间、生物样本和暴露测量方法不同，从而导致相反的结果。另外，Deierlein等[19]和Liu等[21]的结论也不同，可能与不同地区铅暴露水平的差异及不同年龄段儿童对铅暴露的敏感性和反应机制不同有关。横断面研究提示铅暴露与儿童超重无关，但与肥胖呈负相关，与肥胖相关指标的关联仍不一致，为负相关或无关联，但由于横断面无法确定时序性，这种关联可能反映反向因果关系或者是由混杂因素的干扰所致。铅具有内分泌干扰特性，动物研究发现铅可以通过下调食物饱腹感信号来减少食物的消耗，从而诱发体重下降[21]；还有研究发现，铅会通过降低瘦素和脂联素的分泌以及DNA甲基化等表观遗传变化影响身体的新陈代谢系统[37]。因此，铅暴露与儿童青少年肥胖之间的关联及生物学机制尚无定论，两者是否相关还需要进一步高质量队列验证。
横断面研究提示，镉暴露与儿童超重、肥胖呈负相关，但与肥胖指标的关联不一致，可能与暴露评估方法不同、混杂因素调整不同以及人群异质性等有关。镉的异种雌激素活性会使镉激活雌激素受体，进而增加脂质动员和脂肪分解[38]。汞暴露会增加儿童超重/肥胖、腹型肥胖风险，也有研究表明汞与BMI、腰围、体脂率等无关[31-32]，可能与样本量较小有关，两者关系应结合置信区间、Meta分析结果和生物学机制综合评估。汞影响儿童肥胖的潜在机制尚未完全阐明，可能是由于激素紊乱、氧化应激、肾功能损害等因素的相互作用[13]。有研究发现砷能提高血清瘦素的水平从而抑制脂肪细胞的合成[39]，但纳入研究中只有1项来自中国的横断面研究表明砷暴露与儿童肥胖呈负相关，其他研究均显示二者关联无统计学意义。关于铝暴露对儿童肥胖影响的研究很少，在仅发现的1项横断面研究中，朱美琴等[12]结果显示，高尿铝水平的儿童肥胖风险更低，但仅以此结果作为证据还不够充分，其潜在的生物学机制也并未阐明，不能认为铝暴露对儿童肥胖具有“保护作用”。
目前，该领域的前瞻性队列研究较为缺乏，横断面研究结果差异较大且无法确定两者因果关联，故尚不能确定重金属暴露与儿童肥胖之间的关系，未来应开展更多涉及多种重金属的大样本前瞻性队列研究进一步验证上述结果；纳入研究大多来自国外，研究样本的地域局限性可能导致结果的外推性不足，建议开展更多跨地域、多中心的队列研究；纳入研究中重金属暴露大部分为单次测量，难以反映长期暴露的真实模式，未来研究可以增加暴露评估次数，探索重金属暴露与儿童青少年肥胖的动态变化关系，进一步探讨真实世界中重金属暴露与儿童青少年肥胖之间的关系，并通过实验研究探索相关生物学机制，为防治儿童肥胖和制定有针对性的公共卫生干预措施提供参考依据。
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  • 国家自然科学基金面上项目(81973067);重庆医科大学未来医学青年创新团队发展支持计划项目(W0054)
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2025年第46卷第7期
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doi: 10.16835/j.cnki.1000-9817.2025214
  • 接收时间：2024-12-20
  • 首发时间：2026-11-06
  • 出版时间：2025-07-25
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  • 收稿日期：2024-12-20
  • 修回日期：2025-05-06
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国家自然科学基金面上项目(81973067);重庆医科大学未来医学青年创新团队发展支持计划项目(W0054)
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    重庆医科大学公共卫生学院/环境与人群健康研究中心/医学与社会发展研究中心, 重庆 400016

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2种不同金属材料的力学参数
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Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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