Keywords
child health
environmental health
clinical laboratory
primary prevention
How to Cite
Abstract
Introduction: Lead (Pb) is a neurotoxic heavy metal with no known biological function in humans. Despite legislative progress and the global phase-out of leaded gasoline, childhood exposure remains a critical environmental health challenge due to residual sources and obsolete infrastructure. Objective: To analyze lead toxicity in childhood, the evolution of reference values, modern laboratory analytical challenges, and current public health challenges. Approach: The article reviews the mechanisms of gastrointestinal absorption, enhanced by iron and calcium deficiencies, and neurotoxicity at low levels. The importance of pre-analytical conditions to prevent contamination is discussed, as well as the technological transition toward more sensitive analytical methods and the need to standardize measurement units (μg/L). Furthermore, the impact of new regulations on the drinking water quality is detailed. Conclusions: There is no safe exposure threshold for lead. Clinical laboratories, primary care, and environmental health must be coordinated. Public health must transition from a secondary prevention model to a total primary prevention model, focused on eliminating the source before biological contact, to protect the neurocognitive potential of future generations.
References
Lewis J. Lead poisoning: A historical perspective. U.S. Environmental Protection Agency 1985. Disponible en: https://www.epa.gov/archive/epa/aboutepa/lead-poisoninghistorical-perspective.html. [Consultado el 2 enero 2026].
EPA: Controls and prohibitions. U S. Environmental Protection Agency Code of Federal Regulations 1997;40 CFR 80.22.
Vázquez Rodríguez GA. Crónicas del Antropoceno: el siglo del tetraetilo de plomo. An Quim. 2022; 118(2):110-7.
Mielke HW, Gonzales CR, Powell ET et al. Lead in air, soil, and blood: Pb poisoning in a changing world. Int J Environ Res Public Health. 2022; 19(15):9500. Doi: https://doi.org/10.3390/ijerph19159500.
Lanphear B, Navas-Acien A, Bellinger DC. Lead poisoning. N Engl J Med. 2024; 391(17):1621-1631. Doi: https://doi.org/10.1056/NEJMra2402527.
Agency for Toxic Substances and Disease Registry (ATSDR). Toxicological profile for lead. Atlanta, GA: U.S. Department of Health and Human Services; 2020 [consultado 2 ene 2026]. Disponible en: https://www.atsdr.cdc.gov/toxprofiles/tp13.pdf.
American Academy of Pediatrics, Council on Environmental Health. Prevention of childhood lead toxicity. Pediatrics. 2016; 138(1):e20161493. Doi: https://doi.org/10.1542/peds.2016-149310.1542/peds.2016-1493. Erratum in: Pediatrics. 2017;140(2):e20171490. Doi: https://doi.org/10.1542/peds.2017-1490.
Kayaaltı Z, Akyüzlü DK, Söylemezoğlu T. Evaluation of the effect of divalent metal transporter 1 gene polymorphism on blood iron, lead and cadmium levels. Environ Res. 2015;137: 8-13. Doi: https://doi.org/10.1016/j.envres.2014.11.008.
Peraza MA, Ayala-Fierro F, Barber DS, et al. Effects of micronutrients on metal toxicity. Environ Health Perspect. 1998;106 (1): 203-16. Doi: https://doi.org/10.1289/ehp.98106s1203.
Mahaffey KR. Nutrition and lead: strategies for public health. Environ Health Perspect. 1995;103 Suppl 6:191-6. Doi: http://dx.doi.org/10.1289/ehp.95103s6191.
Wright RO, Silverman EK, Schwartz J et al. Association between hemochromatosis genotype and lead exposure among elderly men: the normative aging study. Environ Health Perspect. 2004;112:746-50. Doi: https://doi.org/10.1289/ehp.6581.
Markowitz G, Rosner D. Lead wars. The politics of science and the fate of America’s children. University of California Press. 2013.
Bellinger DC, Bellinger AM. Childhood lead poisoning: the torturous path from science to policy. J Clin Invest. 2006;116(4):853-7. Doi: https://doi.org/10.1172/JCI28232.
Ettinger AS, Ruckart PZ, Dignam T. Lead poisoning prevention: the unfinished agenda. J Public Health Manag Pract 2019;25(Suppl 1):S1-S2. Doi: https://doi.org/10.1097/PHH.0000000000000902.
Chisolm JJ. Childhood lead intoxication. Diagnosis, management, and prevention. Med Times. 1970;98(9):92-106.
Needleman ID, Sewell E, Shapiro I. Subclinical lead exposure in Philadelphia school children: identification by dentine lead analysis. N Engl J Med.1974; 290(5): 245-8. Doi: https://doi.org/10.1056/nejm197401312900504.
Centers for Disease Control and Prevention. Implementation of the Lead Contamination Control Act of 1988. MMWR Morb Mortal Wkly Rep. 1992; 41 (17): 288-90. PMID: 1314324.
Health and Human Services. Strategic Plan for the Elimination of Childhood Lead Poisoning. Washington, DC: US Department of Health and Human Services; 1991.
Centers for Disease Control and Prevention. Preventing Lead Poisoning in Young Children. Atlanta: CDC; 2005. Disponible en: https://www.cdc.gov/lead-prevention/media/pdfs/2025/03/cdc_97650_DS1.pdf [Consultado 2 Enero 2026].
Centers for Disease Control and Prevention. Third national report on human exposure to environmental chemicals. Atlanta: CDC 2z005. Disponible en https://stacks.cdc.gov/view/cdc/21809 [Consultado 2 Enero 2026].
Paulson JA, Brown MJ. The CDC blood lead reference value for children: time for a change. Environ Health. 2019;18:16. Doi: https://doi.org/10.1186/s12940-019-0457-7.
Ruckart PZ, Jones RL, Courtney JG, et al. Update of the blood lead reference value-United States, 2021. MMWR, 2021;70(43):1509-12. Doi: http://dx.doi.org/10.15585/mmwr.mm7043a4.
González Estecha MM. Exposición al plomo. Nuevos desafíos de un viejo enemigo. Ed. Academia de Farmacia Santa María de España de la Región de Murcia. MU 000-2024.
WHO. Lead poisoning. 2023. Disponible en: https://www.who.int/health-topics/lead-poisoning#tab=tab_1 [Consultado el 2 enero 2026].
Parsons P, Brown MJ, González-Estecha M et al. Analytical Procedures for the Determination of Lead in Blood; Approved Guideline. Third Edition. Clinical and Laboratory Standards Institute (CLSI). Wayne, PA 2024.
Jones RL, Strong L, Fitzpatrick S et al. Control of Preexamination Variation in Trace Element Determinations. 2nd ed. Clinical and Laboratory Standards Institute (CLSI), Wayne, PA 2024.
Arnaud J, Patriarca M, Fofou-Caillierez MB, González-Estecha M et al. External quality assessment schemes for inorganic elements in the clinical laboratory: lessons from OELM scheme. J Trace Elem Med Biol 2020 (59) Doi: https://doi.org/10.1016/j.jtemb.2019.126414.
Woolf AD, Brown MJ. Old adversary, new challenges: childhood lead exposure and testing. Pediatrics 2022;149(5):e2021055944. Doi: https://doi.org/10.1542/peds.2021-055944.
Ettinger AS, Leonard ML, Mason J. CDC’s Lead Poisoning Prevention Program: A Long-standing Responsibility and Commitment to Protect Children From Lead Exposure. J Public Health Manag Pract 2019;5 (1):S5-S12. Doi: https://doi.org/10.1097/PHH.0000000000000868.
United States Environmental Protection Agency (EPA). Lead and copper rule improvements 2024. Disponible en: https://www.epa.gov/ground-water-and-drinking-water/lead-andcopper-rule-improvements [Consultado 2 Enero 2026].
Real Decreto 3/2023, de 10 de enero, por el que se establecen los criterios técnico-sanitarios de la calidad del agua de consumo, su control y suministro. BOE Nº 9 de 11 de enero 2023.
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