Urinary cadmium concentrations and metabolic syndrome in U.S. adults: The National Health and Nutrition Examination Survey 2001-2014

Environ Int. 2018 Dec;121(Pt 1):349-356. doi: 10.1016/j.envint.2018.08.029. Epub 2018 Sep 20.


Background: Low to moderate acute cadmium exposure has been associated with increased risk of chronic diseases, such as cardiovascular and kidney disease. Little is known about the association between urinary cadmium levels-an indicator of longer-term exposure-and metabolic syndrome (MetS).

Methods: We analysed data from 3982 participants aged 20-<80 years of the National Health and Nutrition Examination Survey 2001-2014. Urinary cadmium levels were measured and adjusted for creatinine using spot urine samples. Cadmium levels were evaluated in quintiles (Q). MetS was defined by National Cholesterol Education Program's Adult Treatment Panel III report criteria. Prevalence odds ratios (OR) and 95% confidence intervals (CI) were calculated using multivariable logistic regression accounting for complex survey design, while adjusting for potential confounders and stratifying by sex and smoking status.

Results: In the overall study population, there was a marginal inverse association between urinary cadmium and MetS (adj. OR for Q5 versus Q1: 0.7; 95% CI: 0.5-1.0). Sex stratified models were similar. When examining individual components of MetS, participants with higher levels of urinary cadmium had decreased odds of abdominal obesity (adj. OR for Q5 versus Q1 0.4; 95% CI: 0.3-0.6), but increased odds for low HDL (adj. OR for Q5 versus Q1 2.1; 95% CI: 1.4-3.1). Among current smokers, higher urinary cadmium was associated with increased odds of MetS, hypertension, and low HDL even after accounting for serum cotinine-a marker of smoking intensity.

Conclusions: Higher levels of urinary cadmium, a marker of long term exposure, were not associated with an increased risk of MetS in the overall study population. However, higher urine cadmium was associated with altered MetS components. Current smokers were the most vulnerable group, with higher long-term cadmium exposure being associated with increased risk of MetS, low HDL, and hypertension.

Keywords: Cadmium; Hyperglycemia; Hypertension; Lipids; Metabolic syndrome; Obesity.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Biomarkers
  • Cadmium / toxicity
  • Cadmium / urine*
  • Cotinine / urine
  • Environmental Exposure*
  • Female
  • Humans
  • Logistic Models
  • Male
  • Metabolic Syndrome / epidemiology
  • Metabolic Syndrome / etiology
  • Metabolic Syndrome / urine*
  • Middle Aged
  • Nutrition Surveys
  • Odds Ratio
  • Prevalence
  • Smoking / epidemiology


  • Biomarkers
  • Cadmium
  • Cotinine