Impact of Lead Exposure on Health, Nutritional Status, and Behavioral Problems among Children: A Comprehensive Review of Global Evidence

Shweta Naik; Komala M

doi:10.61994/jpss.v4i3.2147

Authors

Shweta Naik Government Home Science College for Women, Karnataka, India
Komala M University of Mysore, Mysuru, Karnataka, India

DOI:

https://doi.org/10.61994/jpss.v4i3.2147

Keywords:

Behavioural disorders, Blood lead levels, Child health, Growth, Public health, Neurodevelopment, Nutritional status, Lead exposure

Abstract

Lead (Pb) exposure remains a major environmental health threat affecting children worldwide. Although lead has been removed from gasoline, paints, and many industrial products, environmental contamination continues to expose millions of children. Due to their developing nervous systems and higher gastrointestinal absorption, children are especially vulnerable, and no safe level of lead exposure has been identified. This review synthesizes evidence published between 2000 and 2025 from PubMed, Scopus, Web of Science, ScienceDirect, Google Scholar, WHO, UNICEF, and government health reports. The findings indicate that lead exposure is strongly associated with impaired physical growth, nutritional deficiencies, reduced intelligence quotient (IQ), delayed neurodevelopment, poor academic performance, attention-deficit/hyperactivity disorder (ADHD), behavioural disorders, anaemia, stunting, and weakened immune function. Iron and calcium deficiencies further increase lead absorption and toxicity, while long-term exposure may contribute to mental health disorders and reduced productivity in adulthood. These findings highlight the need for integrated public health strategies, including environmental regulation, nutritional interventions, routine screening, community education, and stronger policy implementation to prevent childhood lead exposure and promote lifelong health.

References

Abotnes, E. K., Mumbere, P. P., Mishika, J. M., Ndjukendi, A. O., Mpaka, D. B., Bumoko, M. G., Kayembe, T. K., Tshala-Katumbay, D., Kazadi, T. K., & Okitundu, D. L. E. A. (2016). Lead exposure and early child neurodevelopment among children 12–24 months in Kinshasa, Democratic Republic of Congo. European Child & Adolescent Psychiatry, 25(12), 1361–1367. https://doi.org/10.1007/s00787-016-0856-9

Afeiche, M., Peterson, K. E., Sánchez, B. N., Cantonwine, D., Lamadrid-Figueroa, H., Schnaas, L., Ettinger, A. S., Hernández-Avila, M., Hu, H., & Téllez-Rojo, M. M. (2012). Windows of lead exposure sensitivity attained height, and body mass index at 48 months. The Journal of Pediatrics, 160(6), 1044–1049. https://doi.org/10.1016/j.jpeds.2011.12.022

Agency for Toxic Substances and Disease Registry. (2000). Case studies in environmental medicine: Lead toxicity. U.S. Department of Health and Human Services.

Agency for Toxic Substances and Disease Registry. (2017). Lead toxicity. U.S. Department of Health and Human Services. https://www.atsdr.cdc.gov

Agency for Toxic Substances and Disease Registry. (2020). Toxicological profile for lead. U.S. Department of Health and Human Services. https://www.atsdr.cdc.gov

Anticona, C., & San Sebastian, M. (2014). Anaemia and malnutrition in indigenous children and adolescents of the Peruvian Amazon in a context of lead exposure: A cross-sectional study. Global Health Action, 7(1), 22888. https://doi.org/10.3402/gha.v7.22888

Bellinger, D. C. (2016). Lead contamination and children’s health. New England Journal of Medicine, 374(12), 1101–1103. https://doi.org/10.1056/NEJMp1600978

Bellinger, D. C., Leviton, A., Waternaux, C., Needleman, H. L., & Rabinowitz, M. (1987). Longitudinal analyses of prenatal and postnatal lead exposure and early cognitive development. New England Journal of Medicine, 316(17), 1037–1043.

Boucher, O., Jacobson, S. W., Plusquellec, P., Dewailly, É., Ayotte, P., Forget-Dubois, N., Jacobson, J. L., & Muckle, G. (2012). Prenatal methylmercury, postnatal lead exposure, and evidence of attention deficit/hyperactivity disorder among Inuit children in Arctic Québec. Environmental Health Perspectives, 120(10), 1456–1461. https://doi.org/10.1289/ehp.1204976

Braun, J. M., Froehlich, T., Daniels, J. L., Dietrich, K. N., Hornung, R., Auinger, P., & Lanphear, B. P. (2008). Association of environmental toxicants and conduct disorder in U.S. children. Environmental Health Perspectives, 116(7), 956–962.

Canfield, R. L., Henderson, C. R., Cory-Slechta, D. A., Cox, C., Jusko, T. A., & Lanphear, B. P. (2003). Intellectual impairment in children with blood lead concentrations below 10 μg per deciliter. New England Journal of Medicine, 348(16), 1517–1526. https://doi.org/10.1056/NEJMoa022848

Centers for Disease Control and Prevention. (2021). Blood led reference value. U.S. Department of Health and Human Services. https://www.cdc.gov/nceh/lead

Centers for Disease Control and Prevention. (2022). Childhood lead poisoning prevention. U.S. Department of Health and Human Services. https://www.cdc.gov/nceh/lead

Chandramouli, K., Steer, C. D., Ellis, M., & Emond, A. M. (2009). Effects of early childhood lead exposure on academic performance and behaviour of school-age children. Archives of Disease in Childhood, 94(11), 844–848. https://doi.org/10.1136/adc.2008.149955

Cleveland, L. M., Minter, M. L., Cobb, K. A., Scott, A. A., & German, V. F. (2008). Lead hazards for pregnant women and children. American Journal of Nursing, 108(10), 40–49.

Córdoba-Gamboa, L., Vázquez-Salas, R. A., Romero-Martínez, M., Cantoral, A., Riojas-Rodríguez, H., Bautista-Arredondo, S., de Castro, F., Tamayo-Ortiz, M., & Téllez-Rojo, M. M. (2023). Lead exposure can affect early childhood development and could be aggravated by stunted growth: Perspectives from Mexico. International Journal of Environmental Research and Public Health, 20(6), 5174. https://doi.org/10.3390/ijerph20065174

Couture, M. D., Courtemanche, Y., Forget-Dubois, N., Bélanger, R. E., Boucher, O., Ayotte, P., Cordier, S., Jacobson, J. L., Jacobson, S. W., & Muckle, G. (2019). Association between early lead exposure and externalizing behaviors in adolescence: A developmental cascade. Environmental Research, 178, 108679. https://doi.org/10.1016/j.envres.2019.108679

D’Souza, H. S., Menezes, G., & Venkatesh, T. (2002). Screening for lead poisoning in urban school children of southern India using capillary and venous blood samples. Indian Journal of Clinical Biochemistry, 17(1), 1–4.

Donangelo, C. M., Kerr, B. T., Queirolo, E. I., Vahter, M., Peregalli, F., Mañay, N., & Kordas, K. (2021). Lead exposure and indices of height and weight in Uruguayan urban school children. Environmental Research, 195, 110799. https://doi.org/10.1016/j.envres.2021.110799

Evens, A., Hryhorczuk, D., Lanphear, B. P., Rankin, K. M., Lewis, D. A., Forst, L., & Rosenberg, D. (2015). The impact of low-level lead toxicity on school performance among children in Chicago Public Schools. Environmental Health, 14(1), 21. https://doi.org/10.1186/1476-069X-14-21

Flora, G., Gupta, D., & Tiwari, A. (2012). Toxicity of lead: A review with recent updates. Interdisciplinary Toxicology, 5(2), 47–58. https://doi.org/10.2478/v10102-012-0009-2

Gleason, K. M., Valeri, L., Shankar, A. H., Hasan, M. O. S. I., Quamruzzaman, Q., Rodrigues, E. G., Christiani, D. C., Wright, R. O., Bellinger, D. C., & Mazumdar, M. (2016). Stunting is associated with blood lead concentration among Bangladeshi children aged 2–3 years. Environmental Health, 15(1), 103. https://doi.org/10.1186/s12940-016-0180-5

Graber, L. K., Asher, D., Anandaraja, N., Bopp, R. F., Merrill, K., Cullen, M. R., Luboga, S., & Trasande, L. (2010). Childhood lead exposure after the phase-out of leaded gasoline: An ecological study of school-age children in Kampala, Uganda. Environmental Health Perspectives, 118(6), 884–889. https://doi.org/10.1289/ehp.0901239

Hai, D. N., Tung, L. V., Van, D. K., Binh, T. T., Phuong, H. L., Trung, N. D., Son, N. D., Giang, H. T., Hung, N. M., & Khue, P. M. (2018). Lead environmental pollution and childhood lead poisoning at Ban Thi Commune, Bac Kan Province, Vietnam. BioMed Research International, 2018, 5156812. https://doi.org/10.1155/2018/5156812

Hou, S., Yuan, L., Jin, P., Ding, B., Qin, N., Li, L., Liu, X., Wu, Z., Zhao, G., & Deng, Y. (2013). A clinical study of the effects of lead poisoning on the intelligence and neurobehavioral abilities of children. Theoretical Biology and Medical Modelling, 10(13). https://doi.org/10.1186/1742-4682-10-13

Irawati, Y., Kusnoputranto, H., Achmadi, U. F., Safrudin, A., Sitorus, A., Risandi, R., et al. (2022). Blood led levels and lead toxicity in children aged 1–5 years of Cinangka Village, Bogor Regency. PLoS ONE, 17(2), e0264209. https://doi.org/10.1371/journal.pone.0264209

Iriani, D. U., Matsukawa, T., Tadjudin, M. K., et al. (2012). The effects of socioeconomic factors on lead exposure in children by gender in Serpong, Indonesia. International Journal of Environmental Research and Public Health, 9, 4135–4149.

Jain, N. B., & Hu, H. (2006). Childhood correlates of blood lead levels in Mumbai and Delhi. Environmental Health Perspectives, 114(3), 466–470.

Jordan, C. M., Yust, B. L., Robison, L. L., Hannan, P., & Deinard, A. S. (2003). A randomized trial of education to prevent lead burden in children at high risk for lead exposure. Environmental Health Perspectives, 111(16), 1947–1951.

Kuang, W., Chen, Z., Shi, K., Sun, H., Li, H., Huang, L., & Bi, J. (2020). Adverse health effects of lead exposure on physical growth, erythrocyte parameters and school performances for school-aged children in eastern China. Environment International, 145, 106130. https://doi.org/10.1016/j.envint.2020.106130

Lanphear, B. P., Hornung, R., Khoury, J., Yolton, K., Baghurst, P., Bellinger, D. C., et al. (2005). Low-level environmental lead exposure and children’s intellectual function: An international pooled analysis. Environmental Health Perspectives, 113(7), 894–899. https://doi.org/10.1289/ehp.7688

Liu, J., Liu, X., Wang, W., McCauley, L., Pinto-Martin, J., Wang, Y., Li, L., Yan, C., & Rogan, W. J. (2014). Blood led concentrations and children’s behavioural and emotional problems. JAMA Pediatrics, 168(8), 737–745. https://doi.org/10.1001/jamapediatrics.2014.332

Naicker, N., Norris, S. A., Mathee, A., von Schirnding, Y. E., & Richter, L. (2010). Prenatal and adolescent blood lead levels in South Africa: Child, maternal and household risk factors in the Birth to Twenty cohort. Environmental Research, 110(4), 355–362.

Parween, S., et al. (2018). Prevalence of elevated blood lead level in children of India: A review. Indian Journal of Pediatrics.

Renzetti, S., Just, A. C., Burris, H. H., Oken, E., Amarasiriwardena, C., Svensson, K., Mercado-García, A., Cantoral, A., Schnaas, L., Baccarelli, A. A., Wright, R. O., & Téllez-Rojo, M. M. (2017). The association of lead exposure during pregnancy and childhood anthropometry in the Mexican PROGRESS cohort. Environmental Research, 152, 226–232. https://doi.org/10.1016/j.envres.2016.10.024

Reuben, A., Schaefer, J. D., Moffitt, T. E., Broadbent, J., Harrington, H., Houts, R. M., Ramrakha, S., Poulton, R., & Caspi, A. (2019). Association of childhood lead exposure with adult personality traits and lifelong mental health. JAMA Psychiatry, 76(4), 418–425. https://doi.org/10.1001/jamapsychiatry.2018.4192

Roy, A., Bellinger, D., Hu, H., Schwartz, J., Ettinger, A. S., Wright, R. O., Bouchard, M., Palaniappan, K., & Balakrishnan, K. (2009). Lead exposure and behaviour among young children in Chennai, India. Environmental Health Perspectives, 117(10), 1607–1611. https://doi.org/10.1289/ehp.0900625

Sandoval, M., et al. (2021). Prenatal and early childhood exposure to lead and repeated measures of metabolic syndrome risk indicators from childhood to preadolescence. Frontiers in Pediatrics, 9, 649865.

Skroder, H., Hawkesworth, S., Moore, S. E., Wagatsuma, Y., Kippler, M., & Vahter, M. (2016). Prenatal lead exposure and childhood blood pressure and kidney function. Environmental Research, 151, 628–634. https://doi.org/10.1016/j.envres.2016.08.032

UNICEF & Pure Earth. (2020). The toxic truth: Children’s exposure to lead pollution undermines a generation of future potential. UNICEF. https://www.unicef.org

Winter, A. S., & Sampson, R. J. (2017). From lead exposure in early childhood to adolescent health: A Chicago birth cohort. American Journal of Public Health, 107(9), 1496–1501. https://doi.org/10.2105/AJPH.2017.303903

World Health Organization. (2023). Lead poisoning and health. https://www.who.int/news-room/fact-sheets/detail/lead-poisoning-and-health