Table 1.

Adverse outcomes associated with Cd exposure in cross sectional studies.

Outcomes/study	Risk estimates
Kidney damagea and chronic kidney disease (CKD), Ferraro et al. (2010), NHANES 1999–2006, n = 5,426, aged ≥ 20 years.	Blood (urinary) Cd levels > 1 μg/L were associated with kidney damage (OR 1.41, 95% CI: 1.10, 1.82), and CKD (OR 1.48, 95% CI: 1.01, 2.17).
Kidney damage and diminished kidney functionb (GFR), Lin et al. (2014), NHANES 2011–2012, n = 1,545, aged ≥ 20 years.	Blood Cd levels > 0.53 μg/L were associated with kidney damage (OR 2.04, 95% CI: 1.13, 3.69), and diminished kidney function (OR 2.21, 95% CI: 1.09, 4.50).
Peripheral arterial disease (PAD), Tellez-Plaza et al. (2010), NHANES 1999–2004, n = 6,456, aged ≥ 40 years, male mean urinary Cd levels of 0.31 μg/g creatinine (0.37 μg/L), and female mean urinary Cd levels of 0.44 μg/g creatinine (0.31μg/L).	Urinary Cd levels ≥ 0.69 μg/g creatinine were associated with male PAD (OR 4.90, 95% CI: 1.55, 15.54), and female PAD (OR 0.56, 95% CI: 0.18, 1.71). PAD risk in male nonsmokers increased with blood Cd levels, but PAD prevalence and blood Cd levels in female nonsmokers showed a U-shape, reflecting adverse effects at blood Cd levels < 0.3 μg/L.
Liver inflammation, NAFLD, and NASH, Hyder et al. (2013), NHANES III (1988–1994), n = 12,732, aged ≥ 20 years.	Urinary Cd levels ≥ 0.83 μg/g creatinine were associated with female liver inflammation (OR 1.26, 95% CI: 1.01, 1.57). Urine Cd levels ≥ 0.65 μg/g creatinine were associated with male liver inflammation (OR 2.21, 95% CI: 1.64, 3.00), NAFLD (OR1.30, 95% CI: 1.01, 1.68) and NASH (OR 1.95, 95% CI: 1.11, 3.41).
Neurocognitive outcomes, Ciesielski et al. (2013), NHANES III (1988–1994), n = 5,572, aged 20–59 years.	A 1 μg/L increase in urinary Cd was associated with a 1.93% (95% CI: –0.05, –3.81) reduction in a neurocognitive function test for attention/perception domain in nonsmokers.
Depression, Scinicariello and Buser (2015), NHANES 2007–2010, n = 2,892, aged 20–39 years.	Blood Cd levels ≥ 0.54 μg/L were associated with depressive symptoms in nonsmokers (OR 2.91, 95% CI: 1.12, 7.58) and in smokers (OR 2.69, 95% CI: 1.13, 6.42).
Age-related macular degeneration (AMD), Wu et al. (2014), NHANES 2005–2008, n = 5,390, aged ≥ 40 years.	Blood Cd levels ≥ 0.66 μg/L were associated with AMD (OR 1.56, 95% CI: 1.02, 2.40), compared with blood Cd 0.14–0.25 μg/L. Urine Cd levels ≥ 0.35 μg/L were associated with AMD in non-Hispanic whites (OR 3.31, 95% CI: 1.37, 8.01).
Pre-diabetes, Wallia et al. (2014), NHANES 2005–2010, n = 2,398, aged ≥ 40 years, without albuminuria, diabetes or CKD.	Urinary Cd levels > 1.4 μg/g creatinine were associated with prediabetes in nonsmokers. Urine Cd levels > 0.7–0.9 μg/g creatinine were associated with pre-diabetes in nonsmokers and smokers.
Breast cancer, Gallagher et al. (2010), Long Island, New York, n = 100 cases, n = 98 controls, NHANES 1999–2008, n = 92 cases, n = 2,884 controls.	Long Island, urinary Cd levels ≥ 0.6 μg/g creatinine were associated with breast cancer (OR 2.69, 95% CI: 1.07, 6.78). NHANES, urinary Cd levels ≥ 0.37 μg/g creatinine were associated with breast cancer (OR 2.50, 95% CI: 1.11, 5.63).
Breast cancer, Itoh et al. (2014), Japan, n = 309 cases, n = 309 matched controls, mean age 53.8 years.	Dietary Cd intake levels ≥ 31.5 μg/day were associated with estrogen receptor positive (ER+) breast cancer (OR 1.94, 95% CI: 1.04, 3.63), compared with dietary Cd 21.4 μg/day.
Note: CI, confidence interval; HR, hazard ratio; NAFLD, non-alcoholic fatty liver; NASH, non-alcoholic steatohepatitis; n, sample size; OR, odds ratio. aUrinary albumin to creatinine ratio ≥ 30 mg/g creatinine. bEstimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2.