The Modifying Effects of Lifestyle Behaviors on the Association Between Drinking Water Micronutrients and BMI Status Among Children and Adolescents Aged 7~17: A Population-Based Regional Surveillance in 2022

Overview

Journal Nutrients

Date 2024 Nov 27

PMID 39599717

Authors

Manman Chen

Xiuhong Zhang

Jianuo Jiang

Tian Yang

Li Chen

Jieyu Liu

Xinli Song

Yi Zhang

Ruolin Wang

Yang Qin

Ziqi Dong

Wen Yuan

Tongjun Guo

Zhiying Song

Jun Ma

Yanhui Dong

Yi Song

Yuhan Qin

Affiliations

Soon will be listed here.

Abstract

Background: This study aims to investigate the potential modifying effects of lifestyle behavior on the association between drinking water micronutrients and body mass index (BMI) in a large population of children and adolescents.

Methods: Data of the present analysis came from a comprehensive regional large-scale surveillance study in 2022, involving 172,880 children and adolescents (50.71% boys vs. 49.29% girls) aged seven to seventeen. A restricted cubic spline (RCS) analysis was utilized to examine the exposure-response association of regular drinking water indices (including fluoride, nitrate nitrogen, pH, chloride, sulfates, and total dissolved solids (TDS), total hardness (TH), and chemical oxygen demand (COD)) with BMI. Generalized linear model and logistic regression were conducted to relate BMI and quartiles of drinking water micronutrients.

Results: Our findings reveal a nonlinear association between nitrate nitrogen (P for nonlinear < 0.001) and pH (P for nonlinear < 0.001) with BMI. High TH and COD levels significantly increase BMI. Notably, fluoride and chloride were associated with BMI Z-scores but not with overweight and obesity (OB). The BMI Z-score showed a more pronounced association with low and high pH levels in girls. For urban participants, increased TH levels were associated with a higher risk of OB. This study also found that adopting healthy lifestyles could mitigate the negative effects of fluoride, chloride, and sulfate on BMI Z-scores.

Conclusions: This large surveillance study provides new insights into the complex interplay between drinking water micronutrients and BMI in children and adolescents. The association of various drinking water parameters on BMI varies, necessitating ongoing focus on their effects, particularly among girls and urban individuals. Healthy lifestyle behavior could mitigate the effects of fluoride, chloride, and sulfate on BMI Z-score.

References

Khan M, Nafees M, Muhammad N, Ullah U, Hussain R, Bilal M . Assessment of Drinking Water Sources for Water Quality, Human Health Risks, and Pollution Sources: A Case Study of the District Bajaur, Pakistan. Arch Environ Contam Toxicol. 2021; 80(1):41-54. DOI: 10.1007/s00244-020-00801-3. View

Zhou S, Su M, Shen P, Yang Z, Chai P, Sun S . Association between drinking water quality and mental health and the modifying role of diet: a prospective cohort study. BMC Med. 2024; 22(1):53. PMC: 10835879. DOI: 10.1186/s12916-024-03269-3. View

Hahn D, Vogel N, Hora C, Kampfe A, Schmied-Tobies M, Goen T . The role of dietary factors on blood lead concentration in children and adolescents - Results from the nationally representative German Environmental Survey 2014-2017 (GerES V). Environ Pollut. 2021; 299:118699. DOI: 10.1016/j.envpol.2021.118699. View

Chen Y, Zhang H, Lu S, Ge Y, Ji J, Chen T . Serum levels of perchlorate and chlorate in pregnant women from south China and the related health risk with thyroid function. Food Chem Toxicol. 2024; 193:114982. DOI: 10.1016/j.fct.2024.114982. View

Gunnarsdottir M, Gardarsson S, Figueras M, Puigdomenech C, Juarez R, Saucedo G . Water safety plan enhancements with improved drinking water quality detection techniques. Sci Total Environ. 2019; 698:134185. DOI: 10.1016/j.scitotenv.2019.134185. View

Farzan S, Eunus H, Haque S, Sarwar G, Hasan A, Wu F . Arsenic exposure from drinking water and endothelial dysfunction in Bangladeshi adolescents. Environ Res. 2022; 208:112697. PMC: 8917065. DOI: 10.1016/j.envres.2022.112697. View

Weyer P, Cerhan J, Kross B, Hallberg G, Kantamneni J, Breuer G . Municipal drinking water nitrate level and cancer risk in older women: the Iowa Women's Health Study. Epidemiology. 2001; 12(3):327-38. DOI: 10.1097/00001648-200105000-00013. View

Essien E, Said Abasse K, Cote A, Mohamed K, Ashraf Baig M, Habib M . Drinking-water nitrate and cancer risk: A systematic review and meta-analysis. Arch Environ Occup Health. 2020; 77(1):51-67. DOI: 10.1080/19338244.2020.1842313. View

de Onis M, Onyango A, Borghi E, Siyam A, Nishida C, Siekmann J . Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ. 2007; 85(9):660-7. PMC: 2636412. DOI: 10.2471/blt.07.043497. View

10.

Majumdar K, Guha Mazumder D . Effect of drinking arsenic-contaminated water in children. Indian J Public Health. 2012; 56(3):223-6. DOI: 10.4103/0019-557X.104250. View

11.

Fojo C, Figueira M, Almeida C . Fluoride content of soft drinks, nectars, juices, juice drinks, concentrates, teas and infusions marketed in Portugal. Food Addit Contam Part A Chem Anal Control Expo Risk Assess. 2013; 30(4):705-12. DOI: 10.1080/19440049.2013.785636. View

12.

Webber L, Srinivasan S, Wattigney W, Berenson G . Tracking of serum lipids and lipoproteins from childhood to adulthood. The Bogalusa Heart Study. Am J Epidemiol. 1991; 133(9):884-99. DOI: 10.1093/oxfordjournals.aje.a115968. View

13.

Nerbrand C, Agreus L, Lenner R, Nyberg P, Svardsudd K . The influence of calcium and magnesium in drinking water and diet on cardiovascular risk factors in individuals living in hard and soft water areas with differences in cardiovascular mortality. BMC Public Health. 2003; 3:21. PMC: 198279. DOI: 10.1186/1471-2458-3-21. View

14.

Komarulzaman A, de Jong E, Smits J . Effects of water and health on primary school enrolment and absenteeism in Indonesia. J Water Health. 2019; 17(4):633-646. DOI: 10.2166/wh.2019.044. View

15.

Gunnarsdottir M, Gardarsson S, Jonsson G, Bartram J . Chemical quality and regulatory compliance of drinking water in Iceland. Int J Hyg Environ Health. 2016; 219(8):724-733. DOI: 10.1016/j.ijheh.2016.09.011. View

16.

Serrano-Nascimento C, Nunes M . Perchlorate, nitrate, and thiocyanate: Environmental relevant NIS-inhibitors pollutants and their impact on thyroid function and human health. Front Endocrinol (Lausanne). 2022; 13:995503. PMC: 9633673. DOI: 10.3389/fendo.2022.995503. View

17.

Schullehner J, Hansen B, Thygesen M, Pedersen C, Sigsgaard T . Nitrate in drinking water and colorectal cancer risk: A nationwide population-based cohort study. Int J Cancer. 2018; 143(1):73-79. DOI: 10.1002/ijc.31306. View

18.

Muramoto T, Kurabe S, Suzuki Y, Kinoshita K, Hirata S . Effect of immersion in low-pH solution on physicochemical properties of high-pH venison. Anim Sci J. 2022; 93(1):e13778. DOI: 10.1111/asj.13778. View

19.

Aadland E, Kvalheim O, Anderssen S, Resaland G, Andersen L . The Triaxial Physical Activity Signature Associated with Metabolic Health in Children. Med Sci Sports Exerc. 2019; 51(10):2173-2179. DOI: 10.1249/MSS.0000000000002021. View

20.

Monarca S, Donato F, Zerbini I, Calderon R, Craun G . Review of epidemiological studies on drinking water hardness and cardiovascular diseases. Eur J Cardiovasc Prev Rehabil. 2006; 13(4):495-506. DOI: 10.1097/01.hjr.0000214608.99113.5c. View