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Associations have been observed in populations with mean blood lead levels as low as 4.5 μg/dL (Wright et al. 2003) and mean tibia lead levels as low as 18.7 μg/g (Shih et al. 2006).
In contrast, for those in the high BMD group, mean tibia lead levels were 0.01 μg/g lower per 100 kcal/week increase in the index (p = 0.03, Table 4, model 3).
A problem with this argument is that it is prone to the ecologic fallacy of using summary data of CBLI and mean tibia lead from groups across studies to make inferences in individuals about the relation of CBLI with tibia lead.
The APOE genotype differences in adjusted mean tibia lead were different between women with high BMD and low BMD (p < 0.01).
Healey et al. posit that the relation of CBLI with tibia lead may be nonlinear by presenting summary data from eight studies; they show that the estimated slope of the CBLI and tibia lead relation is relatively low in studies with lower mean tibia lead levels, whereas the estimated slope appears to be higher in studies with higher mean tibia lead levels.
For example, in one study of approximately 1,000 subjects 50 70 years of age with mainly environmental lead exposure, the mean blood lead level was approximately 4 μg/dL and the mean tibia lead level was approximately 19 μg/g, but the Pearson's r correlation between the two was only 0.12 at a time of low ongoing environmental lead exposure (Martin et al. 2006; Schafer et al. 2005).
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In an extensively studied cohort of 272 full-term, parturient women from Mexico City with environmental lead exposure common to the region (mean maternal blood lead, 8.9 ± 4.1 μg/dL; mean tibia bone lead, 9.8 ± 8.9 μg/g; range, 12 38 μg/g), every increase of 10 μg/g in maternal tibia lead was associated with a 73-g (95% CI, 25 121) decrease in birth weight (Gonzalez-Cossio et al. 1997).
The mean concentrations of tibia lead were similar between the prior study and ours.
Overall, the mean blood lead concentration was 5.0 ± 2.7 μg/dL, and the mean tibia and patella bone lead were 21.2 ± 13.3 and 28.0 ± 18.4 μg/g, respectively.
Tibia lead content (mean +/- SD) for women on calcium only was 11.13 +/- 6.22 microgram/g bone mineral.
Mean (+/- SD) tibia lead, blood lead, and DMSA-chelatable lead levels were 37.2 +/- 40.4 microg/g bone mineral, 32.0 +/- 15.0 microg/dL, and 767.8 +/- 862.1 microg/g creatinine, respectively.
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