Pediatric Lead Exposure From Imported Indian Spices and Cultural Powders

From http://pediatrics.aappublications.org/cgi/content/abstract/peds.2009-1396v1

Cristiane Gurgel Lin, MD, PhDa,b,c, Laurel Anne Schaider, PhDd, Daniel Joseph Brabander, PhDe, Alan David Woolf, MD, MPHb,f

aPediatric Residency Program, Department of Medicine, and
fPediatric Environmental Health Center, Division of General Pediatrics, Children's Hospital Boston, Boston, Massachusetts;
bDepartment of Pediatrics, Harvard Medical School, Boston, Massachusetts;
cDepartment of Neonatology, Pediatrix Medical Group, Seton Medical Center, Austin, Texas;
dDepartment of Environmental Health, Harvard School of Public Health, Boston, Massachusetts; and
eDepartment of Geosciences, Wellesley College, Wellesley, Massachusetts

Background Significant lead poisoning has been associated with imported nonpaint products.

Objectives To describe cases of pediatric lead intoxication from imported Indian spices and cultural powders, determine lead concentrations in these products, and predict effects of ingestion on pediatric blood lead levels (BLLs).

Patients and Methods Cases and case-study information were obtained from patients followed by the Pediatric Environmental Health Center (Children's Hospital Boston). Imported spices (n = 86) and cultural powders (n = 71) were analyzed for lead by using x-ray fluorescence spectroscopy. The simple bioaccessibility extraction test was used to estimate oral bioavailability. The integrated exposure uptake biokinetic model for lead in children was used to predict population-wide geometric mean BLLs and the probability of elevated BLLs (>10 µg/dL).

Results Four cases of pediatric lead poisoning from Indian spices or cultural powders are described. Twenty-two of 86 spices and foodstuff products contained >1 µg/g lead (for these 22 samples, mean: 2.6 µg/g [95% confidence interval: 1.9–3.3]; maximum: 7.6 µg/g). Forty-six of 71 cultural products contained >1 µg/g lead (for 43 of these samples, mean: 8.0 µg/g [95% confidence interval: 5.2–10.8]; maximum: 41.4 µg/g). Three sindoor products contained >47% lead. With a fixed ingestion of 5 µg/day and 50% bioavailability, predicted geometric mean BLLs for children aged 0 to 4 years increased from 3.2 to 4.1 µg/dL, and predicted prevalence of children with a BLL of >10 µg/dL increased more than threefold (0.8%–2.8%).

Conclusions Chronic exposure to spices and cultural powders may cause elevated BLLs. A majority of cultural products contained >1 µg/g lead, and some sindoor contained extremely high bioaccessible lead levels. Clinicians should routinely screen for exposure to these products.



Key Words: pediatric lead poisoning • childhood plumbism • spices • herbal products • cosmetics • religious powders • lead contamination • Indian • sindoor • culture-specific exposure


Abbreviations: CI = confidence interval