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Advance Publication

Environ Health Perspect; DOI:10.1289/ehp.1307110

Non-Renal Effects and the Risk Assessment of Environmental Cadmium Exposure

Agneta Åkesson,1 Lars Barregard,2 Ingvar A. Bergdahl,3, 4 Gunnar F. Nordberg,3 Monica Nordberg,1 and Staffan Skerfving
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1Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; 2Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital and Academy, Gothenburg, Sweden; 3Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, and 4Department of Biobank Research, Umeå University, Umeå, Sweden; 5Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, University Hospital, Lund, Sweden
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This EHP Advance Publication article has been peer-reviewed, revised, and accepted for publication. EHP Advance Publication articles are completely citable using the DOI number assigned to the article. This document will be replaced with the copyedited and formatted version as soon as it is available. Through the DOI number used in the citation, you will be able to access this document at each stage of the publication process.

Citation: Åkesson A, Barregard L, Bergdahl IA, Nordberg GF, Nordberg M, Skerfving S. Non-Renal Effects and the Risk Assessment of Environmental Cadmium Exposure. Environ Health Perspect; http://dx.doi.org/10.1289/ehp.1307110.

Received: 20 May 2013
Accepted: 22 February 2014
Advance Publication: 25 February 2014

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Background: Exposure to cadmium (Cd) has long been recognized as a health hazard, both in industry and in general populations with high exposure. Under the currently prevailing health risk assessment, the relationship between urinary Cd concentrations (U-Cd) and tubular proteinuria is used. However, doubts have recently been raised regarding the justification of basing the risk assessment on this relationship at very low exposure.

Objectives: The objective of this paper is to review available information on health effects of Cd exposure with respect to human health risk assessment.

Discussion: The associations between U-Cd and U-proteins at very low exposure may not be due to Cd toxicity and the clinical significance of slight proteinuria may also be limited. More importantly, other effects have been reported at very low Cd exposure. There is reason to challenge the basis of the existing health risk assessment for Cd. Our review of the literature found that exposure to low concentrations of Cd is associated with effects on bone including increased risk of osteoporosis and fractures, and that this observation has implications for the health risk assessment of Cd. Other effects associated with Cd should also be considered, in particular cancer, though the information is still too limited for appropriate use in quantitative risk assessment.

Conclusion: Non-renal effects should be considered critical effects in the health risk assessment of Cd.

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