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<p>Heavy metals are known to exert neurotoxic effects on neurodevelopment in children; however, the effects of exposure to metal mixtures remain unclear. We investigated the individual and joint associations of heavy metal exposure with Stroop test performance in children and explored the potential role of dietary nutritional adequacy in these associations. We included 483 pregnant women and their children from the Environment and Development Cohort study. Blood concentrations of lead, mercury, and cadmium were measured during pregnancy and at ages 6 and 8 years. Stroop test performance at age 8 was assessed using the Stroop Color and Word Test. Dietary intake was evaluated using a semi-quantified food frequency questionnaire, and nutritional adequacy was assessed using the mean adequacy ratio (MAR). Multivariable linear regression examined individual metal effects across all exposure periods, while quantile g-computation models assessed the joint effects of concurrent exposures at age 8 years. A doubling of lead levels at age 8 was associated with lower Stroop scores (β = – 2.00, 95% confidence interval [CI] = – 3.62, – 0.38 for word; β = – 2.58, 95% CI = – 4.26, – 0.91 for color; β = – 2.82, 95% CI = – 4.74, – 0.90 for color-word). A one-quartile increase in the heavy metal mixture at age 8 years was associated with lower Stroop scores (β = – 1.66, 95% CI = – 2.96, – 0.36 for word; β = – 1.85, 95% CI = – 3.28, – 0.41 for color; β = – 1.58, 95% CI = – 3.16, – 0.01 for color-word), with Pb contributing the largest weight in the mixture model. Stratified analyses suggested stronger inverse associations among children with MAR &lt; 1.0; however, interaction tests were not statistically significant. Our findings suggest that concurrent exposure to heavy metals at age 8 years, particularly Pb exposure, was associated with lower Stroop test performance in children. Although inverse associations were more apparent among children with inadequate nutritional adequacy, the evidence for effect modification was limited and warrants further investigation.</p>

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Prenatal and Postnatal Exposure to Heavy Metals and Stroop Test Performance in 8-Year-Old Children: The Potential Role of Nutritional Adequacy

  • 期刊论文

  • 发表日期：

    2026年7月8日

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  • Heeseon Jang,
  • Choong Ho Shin,
  • Young Ah Lee,
  • Yun Jeong Lee,
  • Youn-Hee Lim,
  • Yun-Chul Hong,
  • Bung-Nyun Kim,
  • Dong-Wook Lee,
  • Johanna Inhyang Kim,
  • Kyoung-Nam Kim

摘要

Heavy metals are known to exert neurotoxic effects on neurodevelopment in children; however, the effects of exposure to metal mixtures remain unclear. We investigated the individual and joint associations of heavy metal exposure with Stroop test performance in children and explored the potential role of dietary nutritional adequacy in these associations. We included 483 pregnant women and their children from the Environment and Development Cohort study. Blood concentrations of lead, mercury, and cadmium were measured during pregnancy and at ages 6 and 8 years. Stroop test performance at age 8 was assessed using the Stroop Color and Word Test. Dietary intake was evaluated using a semi-quantified food frequency questionnaire, and nutritional adequacy was assessed using the mean adequacy ratio (MAR). Multivariable linear regression examined individual metal effects across all exposure periods, while quantile g-computation models assessed the joint effects of concurrent exposures at age 8 years. A doubling of lead levels at age 8 was associated with lower Stroop scores (β = – 2.00, 95% confidence interval [CI] = – 3.62, – 0.38 for word; β = – 2.58, 95% CI = – 4.26, – 0.91 for color; β = – 2.82, 95% CI = – 4.74, – 0.90 for color-word). A one-quartile increase in the heavy metal mixture at age 8 years was associated with lower Stroop scores (β = – 1.66, 95% CI = – 2.96, – 0.36 for word; β = – 1.85, 95% CI = – 3.28, – 0.41 for color; β = – 1.58, 95% CI = – 3.16, – 0.01 for color-word), with Pb contributing the largest weight in the mixture model. Stratified analyses suggested stronger inverse associations among children with MAR < 1.0; however, interaction tests were not statistically significant. Our findings suggest that concurrent exposure to heavy metals at age 8 years, particularly Pb exposure, was associated with lower Stroop test performance in children. Although inverse associations were more apparent among children with inadequate nutritional adequacy, the evidence for effect modification was limited and warrants further investigation.