Relationship between plasma fluoride content, daily calcium intake and blood cell parameters in children and adolescents
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目的 探讨儿童和青少年血浆氟含量、每日钙摄入量和血细胞参数的关联。 方法 本研究基于2013 - 2016年美国国家健康和营养检查调查（The Ethics Review Board of National Center for Health Statistics，NHANES）数据库，以3 684名6 ~ 19岁儿童和青少年为研究对象，收集数据库中血浆氟含量、每日钙摄入量和血细胞参数信息。使用限制性立方样条分析血浆氟含量、每日钙摄入量与血细胞参数的非线性关系，若存在非线性关系，使用阈值/饱和效应分析法计算最佳拐点；随后利用多重线性回归模型分析三者之间的关联，并分析每日钙摄入量（二分类变量，依据每日钙摄入量的中位数分层）对血浆氟含量与血细胞参数关联的修饰作用。 结果 血浆氟含量与白细胞计数、血红蛋白含量和血小板计数均无非线性关系（均P非线性 > 0.05），而与红细胞计数、红细胞比容均存在非线性关系（均 P非线性 < 0.001），调整混杂因素后，血浆氟含量对红细胞计数和红细胞比容效应的最佳拐点分别为0.54和0.31 μmol/L；每日钙摄入量与各血细胞参数均无非线性关系（均 P非线性 > 0.05）。调整混杂因素后，血浆氟含量每升高1 μmol/L，白细胞计数升高0.49 × 10 9个/L（P = 0.009）；血浆氟含量与红细胞计数和红细胞比容的关联存在饱和效应：血浆氟含量< 0.54 μmol/L时，其含量每升高1 μmol/L，红细胞计数降低0.46 × 1012个/L（P < 0.001）；血浆氟含量< 0.31 μmol/L时，其含量每升高1 μmol/L，红细胞比容降低6.29%（ P = 0.006）；上述关联在血浆氟含量高于最佳拐点后，均无统计学意义（均P > 0.05）。依据每日钙摄入量的中位数分层后，在低钙组（每日钙摄入量< 0.87 g），血浆氟含量每升高1 μmol/L，白细胞计数升高0.77 × 10 9个/L（P = 0.001）；血浆氟含量< 0.54 μmol/L时，其含量每升高1 μmol/L，红细胞计数降低0.41 × 1012个/L（P = 0.002）；血浆氟含量≥0.54 μmol/L时，其含量每升高1 μmol/L，红细胞计数降低0.47 × 1012个/L（P < 0.001）；血浆氟含量< 0.31 μmol/L时，其含量每升高1 μmol/L，红细胞比容降低8.29%（ P = 0.011）；而上述关联在高钙组（每日钙摄入量≥0.87 g）均无统计学意义（均P > 0.05）。每日钙摄入量与血浆氟含量对血小板计数存在交互作用（ P交互 = 0.070），血浆氟含量每升高1 μmol/L，低钙组血小板计数升高12.68 × 109个/L（P = 0.013），高钙组血小板计数降低9.05 × 109个/L（P = 0.035）。 结论 儿童和青少年血细胞参数与血浆氟含量密切相关，而与每日钙摄入量无直接关联；但不同钙摄入人群中血浆氟含量与血细胞参数关联不同，且每日钙摄入量可修饰血浆氟含量与血小板计数的关联。 Objective To investigate the relationship between plasma fluoride content, daily calcium intake and blood cell parameters in children and adolescents. Methods This study was based on the National Health and Nutrition Examination Survey (NHANES) database of the United States from 2013 to 2016, with 3 684 children and adolescents aged 6 - 19 as the research subjects. Information on plasma fluoride content, daily calcium intake and blood cell parameters from the database were collected. Non-linear relationships between plasma fluoride content, daily calcium intake and blood cell parameters were analyzed using restricted cubic splines. If there was a non-linear relationship, the optimal inflection point was calculated using threshold/saturation effect analysis method. Subsequently, multiple linear regression models were used to analyze the associations among the three, and the modification effect of daily calcium intake (binary classification, stratified by median daily calcium intake) on the association between plasma fluoride content and blood cell parameters was analyzed. Results There was no non-linear relationship between plasma fluoride content and white blood cell count, hemoglobin content and platelet count (Pnon-linear > 0.05), but there was a non-linear relationship between plasma fluoride content and erythrocyte count and hematocrit ( Pnon-linear < 0.001). After adjusting for confounding factors, the optimal inflection points of the effects of plasma fluoride content on erythrocyte count and hematocrit were 0.54 and 0.31 μmol/L, respectively. There was no non-linear relationship between daily calcium intake and blood cell parameters ( Pnon-linear > 0.05). After adjusting for confounding factors, for every 1 μmol/L increase in plasma fluoride content, the white blood cell count increased by 0.49 × 10 9/L (P = 0.009). There was a saturation effect in the association between plasma fluoride content, erythrocyte count and hematocrit: when plasma fluoride content was < 0.54 μmol/L, the erythrocyte count decreased by 0.46 × 10 12/L for every 1 μmol/L increase ( P < 0.001). When plasma fluoride content was < 0.31 μmol/L, the hematocrit decreased by 6.29% for every 1 μmol/L increase ( P = 0.006). The above associations were not statistically significant when plasma fluoride content was higher than the optimal inflection points (P > 0.05). After stratification according to the median daily calcium intake, in the low-calcium group (daily calcium intake < 0.87 g), for every 1 μmol/L increase in plasma fluoride content, the white blood cell count increased by 0.77 × 10 9/L (P = 0.001). When plasma fluoride content was < 0.54 μmol/L, the erythrocyte count decreased by 0.41 × 10 12/L for every 1 μmol/L increase ( P = 0.002). When plasma fluoride content was ≥0.54 μmol/L, erythrocyte count decreased by 0.47 × 10 12/L for every 1 μmol/L increase ( P < 0.001). When the plasma fluoride content was < 0.31 μmol/L, the hematocrit decreased by 8.29% for every 1 μmol/L increase ( P = 0.011). The above associations were not statistically significant in the high-calcium group (daily calcium intake ≥0.87 g, P > 0.05). There was an interaction of daily calcium intake and plasma fluoride content on platelet count ( Pinteraction = 0.070), as demonstrated by an increase in platelet count of 12.68 × 109/L (P = 0.013) in the low-calcium group and a decrease in platelet count of 9.05 × 109/L (P = 0.035) in the high-calcium group for every 1 μmol/L increase in plasma fluoride content. Conclusions The blood cell parameters of children and adolescents are closely related to plasma fluoride content, but not directly related to daily calcium intake. However, the correlation between plasma fluoride content and blood cell parameters varies among different calcium intake populations, and daily calcium intake can modify the association between plasma fluoride content and platelet count.
Objective To investigate the relationship between plasma fluoride content, daily calcium intake and blood cell parameters in children and adolescents. Methods This study was based on the National Health and Nutrition Examination Survey (NHANES) database of the United States from 2013 to 2016, with 3 684 children and adolescents aged 6 - 19 as the research subjects. Information on plasma fluoride content, daily calcium intake and blood cell parameters from the database were collected. Non-linear relationships between plasma fluoride content, daily calcium intake and blood cell parameters were analyzed using restricted cubic splines. If there was a non-linear relationship, the optimal inflection point was calculated using threshold/saturation effect analysis method. Subsequently, multiple linear regression models were used to analyze the associations among the three, and the modification effect of daily calcium intake (binary classification, stratified by median daily calcium intake) on the association between plasma fluoride content and blood cell parameters was analyzed. Results There was no non-linear relationship between plasma fluoride content and white blood cell count, hemoglobin content and platelet count (Pnon-linear > 0.05), but there was a non-linear relationship between plasma fluoride content and erythrocyte count and hematocrit ( Pnon-linear < 0.001). After adjusting for confounding factors, the optimal inflection points of the effects of plasma fluoride content on erythrocyte count and hematocrit were 0.54 and 0.31 μmol/L, respectively. There was no non-linear relationship between daily calcium intake and blood cell parameters ( Pnon-linear > 0.05). After adjusting for confounding factors, for every 1 μmol/L increase in plasma fluoride content, the white blood cell count increased by 0.49 × 10 9/L (P = 0.009). There was a saturation effect in the association between plasma fluoride content, erythrocyte count and hematocrit: when plasma fluoride content was < 0.54 μmol/L, the erythrocyte count decreased by 0.46 × 10 12/L for every 1 μmol/L increase ( P < 0.001). When plasma fluoride content was < 0.31 μmol/L, the hematocrit decreased by 6.29% for every 1 μmol/L increase ( P = 0.006). The above associations were not statistically significant when plasma fluoride content was higher than the optimal inflection points (P > 0.05). After stratification according to the median daily calcium intake, in the low-calcium group (daily calcium intake < 0.87 g), for every 1 μmol/L increase in plasma fluoride content, the white blood cell count increased by 0.77 × 10 9/L (P = 0.001). When plasma fluoride content was < 0.54 μmol/L, the erythrocyte count decreased by 0.41 × 10 12/L for every 1 μmol/L increase ( P = 0.002). When plasma fluoride content was ≥0.54 μmol/L, erythrocyte count decreased by 0.47 × 10 12/L for every 1 μmol/L increase ( P < 0.001). When the plasma fluoride content was < 0.31 μmol/L, the hematocrit decreased by 8.29% for every 1 μmol/L increase ( P = 0.011). The above associations were not statistically significant in the high-calcium group (daily calcium intake ≥0.87 g, P > 0.05). There was an interaction of daily calcium intake and plasma fluoride content on platelet count ( Pinteraction = 0.070), as demonstrated by an increase in platelet count of 12.68 × 109/L (P = 0.013) in the low-calcium group and a decrease in platelet count of 9.05 × 109/L (P = 0.035) in the high-calcium group for every 1 μmol/L increase in plasma fluoride content. Conclusions The blood cell parameters of children and adolescents are closely related to plasma fluoride content, but not directly related to daily calcium intake. However, the correlation between plasma fluoride content and blood cell parameters varies among different calcium intake populations, and daily calcium intake can modify the association between plasma fluoride content and platelet count.
FluorinePlasmaDaily calcium intakeBlood cell parametersNational Health and Nutrition Examination Survey
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