Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2013

Open Access 01-12-2013 | Research article

Lead, mercury and cadmium in umbilical cord blood and its association with parental epidemiological variables and birth factors

Authors: Esther García-Esquinas, Beatriz Pérez-Gómez, Pablo Fernández-Navarro, Mario Antonio Fernández, Concha de Paz, Ana María Pérez-Meixeira, Elisa Gil, Andrés Iriso, Juan Carlos Sanz, Jenaro Astray, Margot Cisneros, Amparo de Santos, Ángel Asensio, José Miguel García-Sagredo, José Frutos García, Jesús Vioque, Gonzalo López-Abente, Marina Pollán, María José González, Mercedes Martínez, Nuria Aragonés

Published in: BMC Public Health | Issue 1/2013

Login to get access

Abstract

Background

In Spain, few studies have evaluated prenatal exposure to heavy metals. The objective of this study was to describe lead, mercury and cadmium concentrations in blood from a sample of newborn–mother-father trios, as well as to investigate the association between metals in cord blood and parental variables. We also explored the relationship between cord blood metal concentrations and child characteristics at birth.

Methods

Metal correlations among family members were assessed using Spearman Rank Correlation Coefficient. Linear regression was used to explore the association between parental variables and log-transformed cord blood lead and cord blood mercury concentrations. In the case of cadmium, tobit regression was used due to the existence of samples below the detection limit. The association between cord blood metal concentrations and child characteristics at birth was evaluated using linear regression.

Results

Geometric means for lead, mercury and cadmium were 14.09 μg/L, 6.72 μg/L and 0.27 μg/L in newborns; 19.80 μg/L, 3.90 μg/L and 0.53 μg/L in pregnant women; and 33.00 μg/L, 5.38 μg/L and 0.49 μg/L in men. Positive correlations were found between metal concentrations among members of the trio. Lead and cadmium concentrations were 15% and 22% higher in newborns from mothers who smoked during pregnancy, while mercury concentrations were 25% higher in newborns from mothers with greater fish intake. Cord-blood lead levels showed seasonal periodicity, with lower concentrations observed in winter. Cord blood cadmium concentrations over 0.29 μg/L were associated with lower 1-minute and 5-minute Apgar scores.

Conclusions

These results reinforce the need to establish biomonitoring programs in Spain, and provide support for tobacco smoke and fish consumption as important preventable sources of heavy metal exposure in newborns. Additionally, our findings support the hypothesis that cadmium exposure might be deleterious to fetal development.
Appendix
Available only for authorised users
Literature
1.
Cohen JT, Bellinger DC, Shaywitz BA: A quantitative analysis of prenatal methyl mercury exposure and cognitive development. Am J Prev Med. 2005, 29: 353-365. 10.1016/j.amepre.2005.06.007.CrossRefPubMed
2.
3.
Roosli M: Non-cancer effects of chemical agents on children’s health. Prog Biophys Mol Biol. 2011, 107: 315-322. 10.1016/j.pbiomolbio.2011.08.006.CrossRefPubMed
4.
Julvez J, Grandjean P: Neurodevelopmental toxicity risks due to occupational exposure to industrial chemicals during pregnancy. Ind Health. 2009, 47: 459-468. 10.2486/indhealth.47.459.CrossRefPubMed
5.
Pan J, Song H, Pan XC: Reproductive effects of occupational exposure to mercury on female workers in China: a meta-analysis. Zhonghua Liu Xing Bing Xue Za Zhi. 2007, 28: 1215-1218.PubMed
6.
Borja-Aburto VH, Hertz-Picciotto I, Rojas LM, Farias P, Rios C, Blanco J: Blood lead levels measured prospectively and risk of spontaneous abortion. Am J Epidemiol. 1999, 150: 590-597. 10.1093/oxfordjournals.aje.a010057.CrossRefPubMed
7.
Needleman HL, Rabinowitz M, Leviton A, Linn S, Schoenbaum S: The relationship between prenatal exposure to lead and congenital anomalies. JAMA. 1984, 251: 2956-2959. 10.1001/jama.1984.03340460034021.CrossRefPubMed
8.
Bellinger DC: Teratogen update: lead and pregnancy. Birth Defects Res A Clin Mol Teratol. 2005, 73: 409-420. 10.1002/bdra.20127.CrossRefPubMed
9.
Hernandez-Avila M, Peterson KE, Gonzalez-Cossio T, Sanin LH, Aro A, Schnaas L, Hu H: Effect of maternal bone lead on length and head circumference of newborns and 1-month-old infants. Arch Environ Health. 2002, 57: 482-488. 10.1080/00039890209601441.CrossRefPubMed
10.
Kennedy DA, Woodland C, Koren G: Lead exposure, gestational hypertension and pre-eclampsia: a systematic review of cause and effect. J Obstet Gynaecol. 2012, 32: 512-517. 10.3109/01443615.2012.693987.CrossRefPubMed
11.
Bellinger D, Leviton A, Needleman HL, Waternaux C, Rabinowitz M: Low-level lead exposure and infant development in the first year. Neurobehav Toxicol Teratol. 1986, 8: 151-161.PubMed
12.
Ramon R, Ballester F, Aguinagalde X, Amurrio A, Vioque J, Lacasana M, Rebagliato M, Murcia M, Iniguez C: Fish consumption during pregnancy, prenatal mercury exposure, and anthropometric measures at birth in a prospective mother-infant cohort study in Spain. Am J Clin Nutr. 2009, 90: 1047-1055. 10.3945/ajcn.2009.27944.CrossRefPubMed
13.
Jin L, Zhang L, Li Z, Liu JM, Ye R, Ren A: Placental concentrations of mercury, lead, cadmium, and arsenic and the risk of neural tube defects in a Chinese population. Reprod Toxicol. 2013, 35: 25-31.CrossRefPubMed
14.
McAleer MF, Tuan RS: Metallothionein overexpression in human trophoblastic cells protects against cadmium-induced apoptosis. In Vitr Mol Toxicol. 2001, 14: 25-42. 10.1089/109793301316882522.CrossRefPubMed
15.
Zhang YL, Zhao YC, Wang JX, Zhu HD, Liu QF, Fan YG, Wang NF, Zhao JH, Liu HS, Ou-Yang L, et al: Effect of environmental exposure to cadmium on pregnancy outcome and fetal growth: a study on healthy pregnant women in China. J Environ Sci Health Part A Toxic/hazardous Substances Environ Eng. 2004, 39: 2507-2515. 10.1081/ESE-200026331.CrossRef
16.
Nishijo M, Nakagawa H, Honda R, Tanebe K, Saito S, Teranishi H, Tawara K: Effects of maternal exposure to cadmium on pregnancy outcome and breast milk. Occup Environ Med. 2002, 59: 394-396. 10.1136/oem.59.6.394.CrossRefPubMedPubMedCentral
17.
Iijima K, Otake T, Yoshinaga J, Ikegami M, Suzuki E, Naruse H, Yamanaka T, Shibuya N, Yasumizu T, Kato N: Cadmium, lead, and selenium in cord blood and thyroid hormone status of newborns. Biol Trace Elem Res. 2007, 119: 10-18. 10.1007/s12011-007-0057-1.CrossRefPubMed
18.
Bjornberg KA, Vahter M, Petersson-Grawe K, Glynn A, Cnattingius S, Darnerud PO, Atuma S, Aune M, Becker W, Berglund M: Methyl mercury and inorganic mercury in Swedish pregnant women and in cord blood: influence of fish consumption. Environ Health Perspect. 2003, 111: 637-641. 10.1289/ehp.5618.CrossRefPubMedPubMedCentral
19.
Dorea JG, Barbosa AC: Maternal mercury transfer. Environ Res. 2003, 93: 113-114. 10.1016/S0013-9351(02)00095-6.CrossRefPubMed
20.
Tong S, Von Schirnding YE, Prapamontol T: Environmental lead exposure: a public health problem of global dimensions. Bull World Health Organ. 2000, 78: 1068-1077.PubMedPubMedCentral
21.
Tellez-Rojo MM, Hernandez-Avila M, Lamadrid-Figueroa H, Smith D, Hernandez-Cadena L, Mercado A, Aro A, Schwartz J, Hu H: Impact of bone lead and bone resorption on plasma and whole blood lead levels during pregnancy. Am J Epidemiol. 2004, 160: 668-678. 10.1093/aje/kwh271.CrossRefPubMed
22.
23.
Pan J, Plant JA, Voulvoulis N, Oates CJ, Ihlenfeld C: Cadmium levels in Europe: implications for human health. Environ Geochem Health. 2010, 32: 1-12. 10.1007/s10653-009-9273-2.CrossRefPubMed
24.
Sanchez-Martin MJ, Sanchez-Camazano M, Lorenzo LF: Cadmium and lead contents in suburban and urban soils from two medium-sized cities of Spain: influence of traffic intensity. Bull Environ Contam Toxicol. 2000, 64: 250-257. 10.1007/s001289910037.CrossRefPubMed
25.
Satarug S, Garrett SH, Sens MA, Sens DA: Cadmium, environmental exposure, and health outcomes. Environ Health Perspect. 2010, 118: 182-190.CrossRefPubMed
26.
Aragones N, Perez-Gomez B, Astray J, Gil E, Perez-Meixeira AM, de Paz C, Iriso A, Cisneros M, de Santos A, Arias P, et al: Biomonitoring of exposure to environmental pollutants in newborns and their parents in Madrid, Spain (BioMadrid): study design and field work results. Gac Sanit. 2008, 22: 483-491. 10.1157/13126931.CrossRefPubMed
27.
Vioque J: Nutrición y Salud Pública. Edited by: Serra LL, Aranceta J. 2006, Barcelona: Masson, 199-207. Validez de la evaluación de la ingesta dietética, Métodos, bases científicas y aplicaciones.
28.
Mahaffey KR, Clickner RP, Bodurow CC: Blood organic mercury and dietary mercury intake: National Health and Nutrition Examination Survey, 1999 and 2000. Environ Health Perspect. 2004, 112: 562-570.CrossRefPubMedPubMedCentral
29.
Hewett P, Ganser GH: A comparison of several methods for analyzing censored data. Ann Occup Hyg. 2007, 51: 611-632. 10.1093/annhyg/mem045.CrossRefPubMed
30.
Bleda Hernandez MJ, Tobias Garces A: Application of tobit regression models in modelling censored epidemiological variables. Gac Sanit. 2002, 16: 195-10.1016/S0213-9111(02)71652-X.CrossRef
31.
Koppen G, Den HE, Nelen V, Van de Mieroop E, Bruckers L, Bilau M, Keune H, Van LN, Covaci A, Van De Weghe H, et al: Organochlorine and heavy metals in newborns: results from the flemish environment and health survey (FLEHS 2002-2006). Environ Int. 2009, 35: 1015-1022. 10.1016/j.envint.2009.05.002.CrossRefPubMed
32.
Yazbeck C, Cheymol J, Dandres AM, Barbery-Courcoux AL: Lead exposure in pregnant women and newborns: a screening update. Arch Pediatr. 2007, 14: 15-19. 10.1016/j.arcped.2006.09.016.CrossRefPubMed
33.
Torra M, Rodamilans M, Montero F, Farre C, Corbella J: Exposure to lead among the population of Barcelona: chronologic trends from 1984 to 1995. Med Clin (Barc ). 1997, 108: 601-603.
34.
Llop S, Aguinagalde X, Vioque J, Ibarluzea J, Guxens M, Casas M, Murcia M, Ruiz M, Amurrio A, Rebagliato M, et al: Prenatal exposure to lead in Spain: cord blood levels and associated factors. Sci Total Environ. 2011, 409: 2298-2305. 10.1016/j.scitotenv.2011.02.004.CrossRefPubMed
35.
36.
Ramon R, Murcia M, Aguinagalde X, Amurrio A, Llop S, Ibarluzea J, Lertxundi A, Alvarez-Pedrerol M, Casas M, Vioque J, et al: Prenatal mercury exposure in a multicenter cohort study in Spain. Environ Int. 2011, 37: 597-604. 10.1016/j.envint.2010.12.004.CrossRefPubMed
37.
Durska G: Levels of lead and cadmium in pregnant women and newborns and evaluation of their impact on child development. Ann Acad Med Stetin. 2001, 47: 49-60.PubMed
38.
Salpietro CD, Gangemi S, Minciullo PL, Briuglia S, Merlino MV, Stelitano A, Cristani M, Trombetta D, Saija A: Cadmium concentration in maternal and cord blood and infant birth weight: a study on healthy non-smoking women. J Perinatal Med. 2002, 30: 395-399.CrossRef
39.
Wilhelm M, Schulz C, Schwenk M: Revised and new reference values for arsenic, cadmium, lead, and mercury in blood or urine of children: basis for validation of human biomonitoring data in environmental medicine. Int J Hyg Environ Health. 2006, 209: 301-305.CrossRefPubMed
40.
Schulz C, Conrad A, Becker K, Kolossa-Gehring M, Seiwert M, Seifert B: Twenty years of the German environmental survey (GerES): human biomonitoring–temporal and spatial (West Germany/East Germany) differences in population exposure. Int J Hyg Environ Health. 2007, 210: 271-297. 10.1016/j.ijheh.2007.01.034.CrossRefPubMed
41.
Falq G, Zeghnoun A, Pascal M, Vernay M, Le SY, Garnier R, Olichon D, Bretin P, Castetbon K, Frery N: Blood lead levels in the adult population living in France the French Nutrition and Health Survey (ENNS 2006-2007). Environ Int. 2011, 37: 565-571. 10.1016/j.envint.2010.11.012.CrossRefPubMed
42.
OSHA: Occupational safety and health administration. occupational safety and health standards: toxic substances: cadmium. Code Fed Regul. 2003, 29: 135-229.
43.
Batariova A, Spevackova V, Benes B, Cejchanova M, Smid J, Cerna M: Blood and urine levels of Pb, Cd and Hg in the general population of the Czech Republic and proposed reference values. Int J Hyg Environ Health. 2006, 209: 359-366. 10.1016/j.ijheh.2006.02.005.CrossRefPubMed
44.
Butler WJ, Houseman J, Seddon L, McMullen E, Tofflemire K, Mills C, Corriveau A, Weber JP, LeBlanc A, Walker M, et al: Maternal and umbilical cord blood levels of mercury, lead, cadmium, and essential trace elements in Arctic Canada. Environ Res. 2006, 100: 295-318. 10.1016/j.envres.2005.05.006.CrossRef
45.
Gundacker C, Frohlich S, Graf-Rohrmeister K, Eibenberger B, Jessenig V, Gicic D, Prinz S, Wittmann KJ, Zeisler H, Vallant B, et al: Perinatal lead and mercury exposure in Austria. Sci Total Environ. 2010, 408: 5744-5749. 10.1016/j.scitotenv.2010.07.079.CrossRefPubMed
46.
Hu H, Tellez-Rojo MM, Bellinger D, Smith D, Ettinger AS, Lamadrid-Figueroa H, Schwartz J, Schnaas L, Mercado-Garcia A, Hernandez-Avila M: Fetal lead exposure at each stage of pregnancy as a predictor of infant mental development. Environ Health Perspect. 2006, 114: 1730-1735.PubMedPubMedCentral
47.
Stern AH, Smith AE: An assessment of the cord blood:maternal blood methylmercury ratio: implications for risk assessment. Environ Health Perspect. 2003, 111: 1465-1470. 10.1289/ehp.6187.CrossRefPubMedPubMedCentral
48.
Vahter M, Akesson A, Lind B, Bjors U, Schutz A, Berglund M: Longitudinal study of methylmercury and inorganic mercury in blood and urine of pregnant and lactating women, as well as in umbilical cord blood. Environ Res. 2000, 84: 186-194. 10.1006/enrs.2000.4098.CrossRefPubMed
49.
Doi R, Kasamo M, Ishikawa M, Shimizu T: Factors influencing placental transfer of methylmercury in man. Bull Environ Contam Toxicol. 1984, 33: 69-77. 10.1007/BF01625513.CrossRefPubMed
50.
Chelchowska M, Jablonka-Salach K, Ambroszkiewicz J, Maciejewski T, Gajewska J, Bulska E, Laskowska-Klita T, Leibschang J, Barciszewski J: Effect of cigarette smoking on blood lead levels in pregnant women. Med Wieku Rozwoj. 2012, 16: 196-204.PubMed
51.
Sikorski R, Radomanski T, Paszkowski T, Skoda J: Smoking during pregnancy and the perinatal cadmium burden. J Perinat Med. 1988, 16: 225-231. 10.1515/jpme.1988.16.3.225.CrossRefPubMed
52.
Apostolou A, Garcia-Esquinas E, Fadrowski JJ, McLain P, Weaver VM, Navas-Acien A: Secondhand tobacco smoke: a source of lead exposure in US children and adolescents. Am J Publ Health. 2012, 102: 714-722. 10.2105/AJPH.2011.300161.CrossRef
53.
Xie X, Ding G, Cui C, Chen L, Gao Y, Zhou Y, Shi R, Tian Y: The effects of low-level prenatal lead exposure on birth outcomes. Environ Pollut. 2013, 175: 30-34.CrossRefPubMed
54.
Valent F, Horvat M, Sofianou-Katsoulis A, Spiric Z, Mazej D, Little D, Prasouli A, Mariuz M, Tamburlini G, Nakou S, et al: Neurodevelopmental effects of low-level prenatal mercury exposure from maternal fish consumption in a Mediterranean cohort: study rationale and design. J Epidemiol. 2013, 23 (2): 146-152. 10.2188/jea.JE20120030.CrossRefPubMedPubMedCentral
55.
Irgens A, Kruger K, Skorve AH, Irgens LM: Reproductive outcome in offspring of parents occupationally exposed to lead in Norway. Am J Ind Med. 1998, 34: 431-437. 10.1002/(SICI)1097-0274(199811)34:5<431::AID-AJIM3>3.0.CO;2-T.CrossRefPubMed
56.
Gonzalez-Cossio T, Peterson KE, Sanin LH, Fishbein E, Palazuelos E, Aro A, Hernandez-Avila M, Hu H: Decrease in birth weight in relation to maternal bone-lead burden. Pediatrics. 1997, 100: 856-862. 10.1542/peds.100.5.856.CrossRefPubMed
57.
58.
Bellinger D, Leviton A, Rabinowitz M, Allred E, Needleman H, Schoenbaum S: Weight gain and maturity in fetuses exposed to low levels of lead. Environ Res. 1991, 54: 151-158. 10.1016/S0013-9351(05)80097-0.CrossRefPubMed
59.
Satin KP, Neutra RR, Guirguis G, Flessel P: Umbilical cord blood lead levels in California. Arch Environ Health. 1991, 46: 167-173. 10.1080/00039896.1991.9937445.CrossRefPubMed
60.
Al-Saleh I, Shinwari N, Mashhour A, Rabah A: Birth outcome measures and maternal exposure to heavy metals (lead, cadmium and mercury) in Saudi Arabian population. Int J Hyg Environ Health. 2013, doi: 10.1016/j.ijheh.2013.04.009
61.
Cantonwine D, Hu H, Sanchez BN, Lamadrid-Figueroa H, Smith D, Ettinger AS, Mercado-Garcia A, Hernandez-Avila M, Wright RO, Tellez-Rojo MM: Critical windows of fetal lead exposure: adverse impacts on length of gestation and risk of premature delivery. J Occup Environ Med. 2010, 52: 1106-1111. 10.1097/JOM.0b013e3181f86fee.CrossRefPubMedPubMedCentral
62.
King E, Shih G, Ratnapradipa D, Quilliam DN, Morton J, Magee SR: Mercury, lead, and cadmium in umbilical cord blood. J Environ Health. 2013, 75: 38-43.PubMed
63.
Oken E, Kleinman KP, Olsen SF, Rich-Edwards JW, Gillman MW: Associations of seafood and elongated n-3 fatty acid intake with fetal growth and length of gestation: results from a US pregnancy cohort. Am J Epidemiol. 2004, 160: 774-783. 10.1093/aje/kwh282.CrossRefPubMedPubMedCentral
64.
Rogers I, Emmett P, Ness A, Golding J: Maternal fish intake in late pregnancy and the frequency of low birth weight and intrauterine growth retardation in a cohort of British infants. J Epidemiol Community Health. 2004, 58: 486-492. 10.1136/jech.2003.013565.CrossRefPubMedPubMedCentral
65.
Halldorsson TI, Meltzer HM, Thorsdottir I, Knudsen V, Olsen SF: Is high consumption of fatty fish during pregnancy a risk factor for fetal growth retardation? A study of 44,824 Danish pregnant women. Am J Epidemiol. 2007, 166: 687-696. 10.1093/aje/kwm133.CrossRefPubMed
66.
Lin CM, Doyle P, Wang D, Hwang YH, Chen PC: Does prenatal cadmium exposure affect fetal and child growth?. Occup Environ Med. 2011, 68: 641-646. 10.1136/oem.2010.059758.CrossRefPubMed
67.
Ronco AM, Arguello G, Suazo M, Llanos MN: Increased levels of metallothionein in placenta of smokers. Toxicology. 2005, 208: 133-139. 10.1016/j.tox.2004.11.016.CrossRefPubMed
68.
Kippler M, Hoque AM, Raqib R, Ohrvik H, Ekstrom EC, Vahter M: Accumulation of cadmium in human placenta interacts with the transport of micronutrients to the fetus. Toxicol Lett. 2010, 192: 162-168. 10.1016/j.toxlet.2009.10.018.CrossRefPubMed
69.
Stasenko S, Bradford EM, Piasek M, Henson MC, Varnai VM, Jurasovic J, Kusec V: Metals in human placenta: focus on the effects of cadmium on steroid hormones and leptin. J Appl Toxicol. 2010, 30: 242-253. 10.1002/jat.1490.CrossRefPubMed
70.
Rubarth L: The apgar score: simple yet complex. Neonatal Netw. 2012, 31: 169-177. 10.1891/0730-0832.31.3.169.CrossRefPubMed
71.
Juretschke LJ: Apgar scoring: its use and meaning for today’s newborn. Neonatal Netw. 2000, 19: 17-19.CrossRefPubMed
72.
Odd DE, Rasmussen F, Gunnell D, Lewis G, Whitelaw A: A cohort study of low Apgar scores and cognitive outcomes. Arch Dis Child Fetal Neonatal Ed. 2008, 93: F115-F120.CrossRefPubMed
73.
Stuart A, Otterblad OP, Kallen K: Apgar scores at 5 minutes after birth in relation to school performance at 16 years of age. Obstet Gynecol. 2011, 118: 201-208. 10.1097/AOG.0b013e31822200eb.CrossRefPubMed
74.
Mokhtar G, Hossny E, el-Awady M, Zekry M: In utero exposure to cadmium pollution in Cairo and Giza governorates of Egypt. East Mediterr Health J. 2002, 8: 254-260.PubMed
75.
76.
Lubin JH, Colt JS, Camann D, Davis S, Cerhan JR, Severson RK, Bernstein L, Hartge P: Epidemiologic evaluation of measurement data in the presence of detection limits. Environ Health Perspect. 2004, 112: 1691-1696. 10.1289/ehp.7199.CrossRefPubMedPubMedCentral
Metadata
Title
Lead, mercury and cadmium in umbilical cord blood and its association with parental epidemiological variables and birth factors
Authors
Esther García-Esquinas
Beatriz Pérez-Gómez
Pablo Fernández-Navarro
Mario Antonio Fernández
Concha de Paz
Ana María Pérez-Meixeira
Elisa Gil
Andrés Iriso
Juan Carlos Sanz
Jenaro Astray
Margot Cisneros
Amparo de Santos
Ángel Asensio
José Miguel García-Sagredo
José Frutos García
Jesús Vioque
Gonzalo López-Abente
Marina Pollán
María José González
Mercedes Martínez
Nuria Aragonés
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2013
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-13-841

Other articles of this Issue 1/2013

BMC Public Health 1/2013 Go to the issue

Research article

How do couples influence each other’s physical activity behaviours in retirement? An exploratory qualitative study

Research article

Association between erythrocyte parameters and metabolic syndrome in urban Han Chinese: a longitudinal cohort study

Research article

Seasonal variation in the prevalence of acute undernutrition among children under five years of age in east rural Ethiopia: a longitudinal study

Research article

Peer clustering of exercise and eating behaviours among young adults in Sweden: a cross-sectional study of egocentric network data

Research article

A lesson in business: cost-effectiveness analysis of a novel financial incentive intervention for increasing physical activity in the workplace

Study protocol

Study protocol: the effect of vitamin D supplements on cardiometabolic risk factors among urban premenopausal women in a tropical country - a randomized controlled trial