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The association between fluoride in water and blood pressure in children and adolescents.Abstract
Background
The objective of this study was to determine the association between water and plasma fluoride and blood pressure (BP) among children and adolescents.
Methods
Our study population was individuals of 8–18 years in the 2013–2016 National Health and Nutrition Examination Survey. We performed a multivariable linear and logistic regression analysis to examine the relationship between fluoride and BP.
Results
In a linear regression analysis for systolic BP (SBP) (mm Hg) adjusting for age, sex, race, and poverty, fluoride in water (mg/L) was significant with a coefficient of -0.44 (p = 0.046) among adolescents (12–18 years). Additional adjustments for race, poverty, serum levels of cotinine, and BMI remained significant. While an inverse relationship was found in children (8–11 years), none were significant. Fluoride in plasma was not significant across all ages. The odds ratio of high BP for an increase in water fluoride also was not significant.
Conclusions
Higher concentrations of fluoride in water were associated with low SBP only among adolescents. Fluoride alone cannot be responsible for BP as several biological metabolic processes may influence its physiological effects. Fluoride consumption should be considered in conjunction with these processes.
Impact
• The high fluoride in drinking water was statistically significantly associated with low systolic BP in children and adolescents.
• The odds ratio of high BP for an increase in fluoride in drinking water was not significant.
• Our study contributes to the existing literature by providing individualized data and results on an individual level.
*Original abstract online at https://www.nature.com/articles/s41390-022-01982-4
Excerpt:
References
-
Flynn, J. T. et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics 140, e20171904 (2017).
-
Ostchega, Y. et al. Trends of elevated blood pressure among children and adolescents: data from the National Health and Nutrition Examination Survey1988-2006. Am. J. Hypertens. 22, 59–67 (2009).
-
Leng, B., Jin, Y., Li, G., Chen, L. & Jin, N. Socioeconomic status and hypertension: a meta-analysis. J. Hypertens. 33, 221–229 (2015).
-
Hardy, S. T. et al. Trends in blood pressure and hypertension among US children and adolescents, 1999-2018. JAMA Netw. Open 4, e213917 (2021).
-
Fan, A. Z., Strasser, S. M., Zhang, X., Fang, J. & Crawford, C. G. State socioeconomic indicators and self-reported hypertension among US adults, 2011 behavioral risk factor surveillance system. Prev. Chron. Dis. 12, E27 (2015).
-
Arima, H., Barzi, F. & Chalmers, J. Mortality patterns in hypertension. J. Hypertens. 29, S3–S7 (2011).
-
Center for Disease Control and Prevention. My water’s fluoride. https://nccd.cdc.gov/doh_mwf/default/AboutMWF.aspx (2008).
-
Shams, M. et al. Drinking water in Gonabad, Iran: fluoride levels in bottled, distribution network, point of use desalinator, and decentralized municipal desalination plant water. Fluoride 45, 138–141 (2012).
-
Nabipour, I. & Dobaradaran, S. Fluoride concentrations of bottled drinking water available in Bushehr, Iran. Fluoride 46, 63–64 (2013).
-
Hajiouni, S. et al. Fluoride concentration in commercially available dairy milk in Iran. Fluoride 52, 527–530 (2019).
-
Nabipour, I. & Dobaradaran, S. Fluoride and chloride levels in the Bushehr Coastal Seawater of the Persian Gulf. Fluoride 46, 204–207 (2013).
-
Dobaradaran, S., Fazelinia, F., Mahvi, A. H. & Hosseini, S. S. Particulate airborne fluoride from an aluminium production plant in Arak, Iran. Fluoride 42, 228 (2009).
-
Jamali, M. et al. Assessing the non-carcinogenic risk due to the intake of fluoride from fruit juice available in the market in Bushehr. Fluoride 53, 136–153 (2020).
-
Dobaradaran, S., Abadi, D. R. V., Mahvi, A. H. & Javid, A. Fluoride in skin and muscle of two commercial species of fish harvested off the Bushehr Shores of the Persian Gulf. Fluoride 44, 143–146 (2011).
-
National Research Council. Fluoride in Drinking Water: A Scientific Review of EPA’s Standards (National Research Council, 2007).
-
Razdan, P. et al. Effect of fluoride concentration in drinking water on intelligence quotient of 12-14-year-old children in Mathura District: a cross-sectional study. J. Int Soc. Prev. Community Dent. 7, 252–258 (2017).
-
Bashash, M. et al. Prenatal fluoride exposure and cognitive outcomes in children at 4 and 6-12 years of age in Mexico. Environ. Health Perspect. 125, 097017 (2017).
-
Green, R. et al. Association between maternal fluoride exposure during pregnancy and IQ scores in offspring in Canada. JAMA Pediatr. 173, 940–948 (2019).
-
Yousefi, M. et al. Association of hypertension, body mass index, and waist circumference with fluoride intake; water drinking in residents of fluoride endemic areas, Iran. Biol. Trace Elem. Res 185, 282–288 (2018).
-
Sun, L. et al. An assessment of the relationship between excess fluoride intake from drinking water and essential hypertension in adults residing in fluoride endemic areas. Sci. Total Environ. 443, 864–869 (2013).
-
Alabdulaaly, A. I., Al-Zarah, A. I. & Khan, M. A. Occurrence of fluoride in ground waters of Saudi Arabia. Appl Water Sci. 3, 589–595 (2013).
-
Dobaradaran, S. et al. Data on fluoride contents in groundwater of Bushehr Province, Iran. Data Brief. 17, 1158–1162 (2018).
-
Ostovar, A., D, S., Ravanipour, M. & Khajeian, A. M. Water and the prevalence of hypertension: an ecological correlation study. Int. J. Occup. Environ. Med. 4, 216–217 (2013).
-
Ailani, V., Gupta, R. C., Gupta, S. K. & Gupta, K. Oxidative stress in cases of chronic fluoride intoxication. Indian J. Clin. Biochem 24, 426–429 (2009).
-
Dobaradaran, S., Mahvi, A. H., Dehdashti, S. & Abadi, D. R. V. Drinking water fluoride and child dental caries in Dashtestan, Iran. Fluoride 41, 220–226 (2008).
-
Rahmani, A. et al. Child dental caries in relation to fluoride and some inorganic constituents in drinking water in Arsanjan, Iran. Fluoride 43, 179–186 (2010).
-
Kharabadze, M., Khetsuriani, R., Betaneli, M., Kandelaki, S. & Khutsishvili, L. Blood pressure patterns in urban and rural children and adolescents of the Kakheti region (East Georgia). Georgian Med. News 79–83 (2015).
-
Freedman, D. S., Khan, L. K., Dietz, W. H., Srinivasan, S. R. & Berenson, G. S. Relationship of childhood obesity to coronary heart disease risk factors in adulthood: The Bogalusa Heart Study. Pediatrics 108, 712–718 (2001).
-
Peckham, S. & Awofeso, N. Water fluoridation: a critical review of the physiological effects of ingested fluoride as a public health intervention. ScientificWorldJournal 2014, 293019 (2014).
-
Liu, Y. et al. Association between fluoride exposure and cardiometabolic risk in peripubertal Mexican children. Environ. Int. 134, 105302 (2020).
-
Sorof, J. & Daniels, S. Obesity hypertension in children: a problem of epidemic proportions. Hypertension 40, 441–447 (2002).
-
Oruc, N. Occurrence and problems of high fluoride waters in Turkey: an overview. Environ. Geochem. Health 30, 315–323 (2008).
-
Li, M. et al. Fluoride exposure and blood pressure: a systematic review and meta-analysis. Biol. Trace Elem. Res. 199, 925–934 (2020).
-
Oyagbemi, A. A. et al. Sodium fluoride induces hypertension and cardiac complications through generation of reactive oxygen species and activation of nuclear factor kappa beta. Environ. Toxicol. 32, 1089–1101 (2017).
-
Barbier, O., Arreola-Mendoza, L. & Del Razo, L. M. Molecular mechanisms of fluoride toxicity. Chem. Biol. Interact. 188, 319–333 (2010).
-
Montezano, A. C. et al. Oxidative stress and human hypertension: vascular mechanisms, biomarkers, and novel therapies. Can. J. Cardiol. 31, 631–641 (2015).
-
Montezano, A. C. & Touyz, R. M. Oxidative stress, noxs, and hypertension: experimental evidence and clinical controversies. Ann. Med. 44, S2–S16 (2012).
-
Pietropaoli, D. et al. Poor oral health and blood pressure control among US hypertensive adults: results from the National Health and Nutrition Examination Survey 2009 to 2014. Hypertension 72, 1365–1373 (2018).
-
Cushing, D. J., Sabouni, M. H., Brown, G. L. & Mustafa, S. J. Fluoride produces endothelium-dependent relaxation and endothelium-independent contraction in coronary artery. J. Pharm. Exp. Ther. 254, 28–32 (1990).
-
Karademir, S., Akcam, M., Kuybulu, A. E., Olgar, S. & Oktem, F. Effects of fluorosis on QT dispersion, heart rate variability and echocardiographic parameters in children. Anadolu Kardiyol. Derg. 11, 150–155 (2011).
-
Takamori, T. in The Toxicology of Fluorine Symposium (T, G. ed.) 125–129 (1964).
-
Stroup-Benham, C. A., Markides, K. S., Black, S. A. & Goodwin, J. S. Relationship between low blood pressure and depressive symptomatology in older people. J. Am. Geriatr. Soc. 48, 250–255 (2000).
-
Duschek, S., Hoffmann, A., Bair, A., Reyes Del Paso, G. A. & Montoro, C. I. Cerebral blood flow modulations during proactive control in chronic hypotension. Brain Cogn. 125, 135–141 (2018).
-
Egan, B. M. et al. Low blood pressure is associated with greater risk for cardiovascular events in treated adults with and without apparent treatment-resistant hypertension. J. Clin. Hypertens. (Greenwich) 19, 241–249 (2017).
-
Levy, S. M. & Guha-Chowdhury, N. Total fluoride intake and implications for dietary fluoride supplementation. J. Public Health Dent. 59, 211–223 (1999).
-
Buzalaf, M. A. R. & Whitford, G. M. Fluoride metabolism. Monogr. Oral Sci. 22, 20–36 (2011).
-
Whitford, G. M. Intake and metabolism of fluoride. Adv. Dent. Res 8, 5–14 (1994).
-
Cardoso, V. E., Whitford, G. M. & Buzalaf, M. A. Relationship between daily fluoride intake from diet and the use of dentifrice and human plasma fluoride concentrations. Arch. Oral Biol. 51, 552–557 (2006).
-
Pereira, H. A. et al. Fluoride intensifies hypercaloric diet-induced ER oxidative stress and alters lipid metabolism. PLoS ONE 11, e0158121 (2016).
-
Ophaug, R. H. & Singer, L. Effect of fluoride on the mobilization of skeletal magnesium and soft-tissue calcinosis during acute magnesium deficiency in the rat. J. Nutr. 106, 771–777 (1976).
-
Machoy-Mokrzynska, A. Fluoride-magnesium interaction. J. Int. Soc. Fluoride Res. 28, 175–177 (1995).
-
Sontia, B. & Touyz, R. M. Role of magnesium in hypertension. Arch. Biochem. Biophys. 458, 33–39 (2007).
-
Lavalle-Carrasco, J. et al. Recent biomarkers for monitoring the systemic fluoride levels in exposed populations: a systematic review. Int. J. Environ. Res. Public Health 18, 317 (2021).