Environmental exposure to metal mixtures and linear growth in healthy Ugandan children

Emily C. Moody, Elena Colicino, Robert O. Wright, Ezekiel Mupere, Ericka G. Jaramillo, Chitra Amarasiriwardena, Sarah E. Cusick

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


BACKGROUND: Stunting is an indicator of poor linear growth in children and is an important public health problem in many countries. Both nutritional deficits and toxic exposures can contribute to lower height-for-age Z-score (HAZ) and stunting (HAZ < -2).

OBJECTIVES: In a community-based cross-sectional sample of 97 healthy children ages 6-59 months in Kampala, Uganda, we examined whether exposure to Pb, As, Cd, Se, or Zn were associated with HAZ individually or as a mixture.

METHODS: Blood samples were analyzed for a mixture of metals, which represent both toxins and essential nutrients. The association between HAZ and metal exposure was tested using multivariable linear regression and Weighted Quantile Sum (WQS) regression, which uses mixtures of correlated exposures as a predictor.

RESULTS: There were 22 stunted children in the sample, mean HAZ was -0.74 (SD = 1.84). Linear regression showed that Pb (β = -0.80, p = 0.021) and Se (β = 1.92, p = 0.005) were significantly associated with HAZ. The WQS models separated toxic elements with a presumed negative effect on HAZ (Pb, As, Cd) from essential nutrients with presumed positive effect on HAZ (Se and Zn). The toxic mixture was significantly associated with lower HAZ (β = -0.47, p = 0.03), with 62% of the effect from Pb. The nutrient WQS index did not reach statistical significance (β = -0.47, p = 0.16).

DISCUSSION: Higher blood lead and lower blood selenium level were both associated with lower HAZ. The significant associations by linear regression were reinforced by the WQS models, although not all associations reached statistical significance. These findings suggest that healthy children in this neighborhood of Kampala, Uganda, who have a high burden of toxic exposures, may experience detrimental health effects associated with these exposures in an environment where exposure sources are not well characterized.

Original languageEnglish (US)
Article numbere0233108
JournalPloS one
Issue number5
StatePublished - May 2020

Bibliographical note

Funding Information:
This work was made possible through NIEHS grants T32HD049311 (ECM) and P30ES023515 (ROW), a University of Minnesota School of Medicine Innovation Award (SEC and ECM) and a Doris Duke International Clinical Research Fellowship scholarship (EGJ). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Publisher Copyright:
© 2020 Moody et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


  • Body Height
  • Body Weight
  • Cadmium/blood
  • Child, Preschool
  • Cross-Sectional Studies
  • Environmental Exposure
  • Female
  • Growth Disorders/blood
  • Humans
  • Infant
  • Lead/blood
  • Linear Models
  • Male
  • Metals/blood
  • Nutritional Status
  • Selenium/blood
  • Uganda
  • Zinc/blood

PubMed: MeSH publication types

  • Research Support, Non-U.S. Gov't
  • Journal Article
  • Research Support, N.I.H., Extramural


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