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This study investigates the combined effects of environmental pollutants (lead, cadmium, total mercury) and behavioral factors (alcohol consumption, smoking) on depressive symptoms in women. Data from the National Health and Nutrition Examination Survey (NHANES) 2017–2018 cycle, specifically exposure levels of heavy metals in blood samples, were used in this study. The analysis of these data included the application of descriptive statistics, linear regression, and Bayesian Kernel Machine Regression (BKMR) to explore associations between environmental exposures, behavioral factors, and depression. The PHQ-9, a well-validated tool that assesses nine items for depressive symptoms, was used to evaluate depression severity over the prior two weeks on a 0–3 scale, with total scores ranging from 0 to 27. Exposure levels of heavy metals were measured in blood samples. BKMR was used to estimate the exposure–response relationship, while posterior inclusion probability (PIP) in BKMR was used to quantify the likelihood that a given exposure was included in the model, reflecting its relative importance in explaining the outcome (depression) within the context of other predictors in the mixture. A descriptive analysis showed mean total levels of lead, cadmium, and total mercury at 1.21 µg/dL, 1.47 µg/L, and 0.80 µg/L, respectively, with a mean PHQ-9 score of 5.94, which corresponds to mild depressive symptoms based on the PHQ-9 scoring. Linear regression indicated positive associations between depression and lead as well as cadmium, while total mercury had a negative association. Alcohol and smoking were also positively associated with depression. These findings were not significant, but limitations in linear regression prompted a BKMR analysis. BKMR posterior inclusion probability (PIP) analysis revealed alcohol and cadmium as significant contributors to depressive symptoms, with cadmium (PIP = 0.447) and alcohol (PIP = 0.565) showing notable effects. Univariate and bivariate analyses revealed lead and total mercury’s strong relationship with depression, with cadmium showing a complex pattern in the bivariate analysis. A cumulative exposure analysis of all metals and behavioral factors concurrently demonstrated that higher quantile levels of combined exposures were associated with an increased risk of depression. Finally, a single variable-effects analysis in BKMR revealed lead, cadmium, and alcohol had a stronger impact on depression. Overall, the study findings suggest that from exposure to lead, cadmium, mercury, alcohol, and smoking, cadmium and alcohol consumption emerge as key contributors to depressive symptoms. These results highlight the need to address both environmental and lifestyle choices in efforts to mitigate depression.
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This content will become publicly available on December 1, 2025
The Effect of Physical Activity on Combined Cadmium, Lead, and Mercury Exposure
Background/Objective: Environmental exposures, such as heavy metals, can significantly affect physical activity, an important determinant of health. This study explores the effect of physical activity on combined exposure to cadmium, lead, and mercury (metals), using data from the 2013–2014 National Health and Nutrition Examination Survey (NHANES). Methods: Physical activity was measured with ActiGraph GT3X+ devices worn continuously for 7 days, while blood samples were analyzed for metal content using inductively coupled plasma mass spectrometry. Descriptive statistics and multivariable linear regression were used to assess the impact of multi-metal exposure on physical activity. Additionally, Bayesian Kernel Machine Regression (BKMR) was applied to explore nonlinear and interactive effects of metal exposures on physical activity. Using a Gaussian process with a radial basis function kernel, BKMR estimates posterior distributions via Markov Chain Monte Carlo (MCMC) sampling, allowing for robust evaluation of individual and combined exposure-response relationships. Posterior Inclusion Probabilities (PIPs) were calculated to quantify the relative importance of each metal. Results: The linear regression analysis revealed positive associations between cadmium and lead exposure and physical activity. BKMR analysis, particularly the PIP, identified lead as the most influential metal in predicting physical activity, followed by cadmium and mercury. These PIP values provide a probabilistic measure of each metal’s importance, offering deeper insights into their relative contributions to the overall exposure effect. The study also uncovered complex relationships between metal exposures and physical activity. In univariate BKMR exposure-response analysis, lead and cadmium generally showed positive associations with physical activity, while mercury exhibited a slightly negative relationship. Bivariate exposure-response analysis further illustrated how the impact of one metal could be influenced by the presence and levels of another, confirming the trends observed in univariate analyses while also demonstrating the complexity varying doses of two metals can have on either increased or decreased physical activity. Additionally, the overall exposure effect analysis across different quantiles revealed that higher levels of combined metal exposures were associated with increased physical activity, though there was greater uncertainty at higher exposure levels as the 95% credible intervals were wider. Conclusions: Overall, this study fills a critical gap by investigating the interactive and combined effects of multiple metals on physical activity. The findings underscore the necessity of using advanced methods such as BKMR to capture the complex dynamics of environmental exposures and their impact on human behavior and health outcomes.
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- Award ID(s):
- 2401878
- PAR ID:
- 10572778
- Publisher / Repository:
- MDPI
- Date Published:
- Journal Name:
- Medical Sciences
- Volume:
- 12
- Issue:
- 4
- ISSN:
- 2076-3271
- Page Range / eLocation ID:
- 71
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
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