Health Risk Assessment of Dietary Cadmium Intake: Do Current Guidelines Indicate How Much is Safe?

http://dx.doi.org/10.1289/EHP108



Table 2. Adverse outcomes associated with Cd exposure in longitudinal studies.
Outcomes/study Risk estimates
Note: CVD, cardiovascular disease; CI, confidence interval; HR, hazard ratio; RR, rate ratio; SD, standard deviation.
aLogarithmic transformation.
Breast cancer, Julin et al. (2012), Swedish postmenopausal women, 12.2-year follow-up, n = 55,987. Dietary Cd levels ≥ 16 μg/day were associated with breast cancer (RR 1.27, 95% CI: 1.07, 1.50), and estrogen receptor positive (ER+) breast cancer (RR 1.25, 95% CI: 1.03, 1.52).
Mortality from heart and vascular diseases, Tellez-Plaza et al. (2012b), NHANES 1999–2004, average 4.8-year follow-up, n = 8,989. Urinary Cd levels ≥ 0.57 μg/g creatinine were associated with death from CVD (HR 1.74, 95% CI: 1.07, 2.83), ischemic heart disease (HR 2.53, 95% CI: 1.54, 4.16), and coronary heart disease (HR 2.09, 95% CI: 1.06, 4.13), compared with urinary Cd levels ≤ 0.14 μg/g creatinine.
Lowering Cd exposure by 4 fold could have prevented 8.8% of total deaths and 9.2% of CVD deaths.
Cancer mortality, Adams et al. (2012), NHANES III (1988–1994), average 13.4-year follow-up, n = 7,455 men, n = 8,218 women. Urinary Cd levels ≥ 0.58 μg/g creatinine were associated with death from lung cancer in men (HR 3.22, 95% CI: 1.26, 8.25).
A 2-fold rise in urinary Cd was associated with death from cancer in both men and women (male HR 1.26, 95% CI: 1.07, 1.48; female HR 1.21, 95% CI: 1.04, 1.42).
Mortality from liver-related diseases, Hyder et al. (2013), NHANES III (1988–1994), median 14.6-year follow-up, n = 12,732. Female urinary Cd levels ≥ 0.83 μg/g creatinine and male urine Cd levels ≥ 0.65 μg/g creatinine were associated with death from liver-related diseases (HR 3.42, 95% CI: 1.12, 10.47).
Cancer mortality, Lin et al. (2013), NHANES III (1988–1994), 12.4-year follow-up, n = 5,204. Urinary Cd levels > 0.79 μg/g creatinine were associated with cancer death in men (HR 3.13, 95% CI: 1.88, 5.20). Urinary Cd levels > 1.05 μg/g creatinine were associated with cancer death in women (HR 1.65, 95% CI: 1.13, 2.41).
All-cause mortality, Patel et al. (2013), NHANES 1999–2004, median 2.5–5.8-year follow-up, n = 22,076. A 1-SD change in loggeda urinary Cd levels was associated with mortality (HR 1.6, 95% CI: 1.3, 2.0).
A 1-SD change in logged blood Cd levels was associated with mortality (HR 1.4, 95% CI: 1.2, 1.6).
Three other factors associated with death were low-level physical activity, smoking, and low serum lycopene (a dietary antioxidant).
Mortality from Alzheimer’s disease, Min and Min (2016), NHANES (1999–2004), followed up until 31 December 2011, n = 4,060, aged ≥ 60 years. Blood Cd levels > 0.6 μg/L were associated with death from Alzheimer’s disease (HR 3.83, 95% CI: 1.39, 10.59), compared with blood Cd levels < 0.3 μg/L.
Higher-blood Cd levels at baseline were associated with a marginal increase in death from all causes (p = 0.07).