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@ARTICLE{Peters:164045,
      author       = {S. Peters and K. Broberg and V. Gallo and M. Levi and M.
                      Kippler and P. Vineis and J. Veldink and L. van den Berg and
                      L. Middleton and R. C. Travis and M. M. Bergmann and D.
                      Palli and S. Grioni and R. Tumino and A. Elbaz and T. Vlaar
                      and F. Mancini and T. Kühn$^*$ and V. Katzke$^*$ and A.
                      Agudo and F. Goñi and J.-H. Gómez and M.
                      Rodríguez-Barranco and S. Merino and A. Barricarte and A.
                      Trichopoulou and M. Jenab and E. Weiderpass and R.
                      Vermeulen},
      title        = {{B}lood metal levels and amyotrophic lateral sclerosis
                      risk: a prospective cohort.},
      journal      = {Annals of neurology},
      volume       = {89},
      number       = {1},
      issn         = {1531-8249},
      address      = {Hoboken, NJ},
      publisher    = {Wiley-Blackwell},
      reportid     = {DKFZ-2020-02213},
      pages        = {125-133},
      year         = {2021},
      note         = {2021 Jan;89(1):125-133},
      abstract     = {Metals have been suggested as risk factor for amyotrophic
                      lateral sclerosis (ALS), but only retrospective studies are
                      available to date. We compared metal levels in prospectively
                      collected blood samples from ALS patients and controls, to
                      explore whether metals are associated with ALS mortality.A
                      nested ALS case-control study was conducted within the
                      prospective EPIC cohort. Cases were identified through death
                      certificates. We analyzed metal levels in erythrocyte
                      samples obtained at recruitment, as biomarker for metal
                      exposure from any source. Arsenic, cadmium, copper, lead,
                      manganese, mercury, selenium and zinc concentrations were
                      measured by inductively coupled plasma-mass spectrometry. To
                      estimate ALS risk, we applied conditional logistic
                      regression models.The study population comprised 107 cases
                      $(65\%$ female) and 319 controls matched for age, sex and
                      study center. Median time between blood collection and ALS
                      death was 8 years (range 1-15). Comparing the highest with
                      the lowest tertile, cadmium (odds ratio (OR) 2.04, $95\%$
                      confidence interval (CI) 1.08-3.87) and lead (OR 1.89,
                      $95\%CI$ 0.97-3.67) concentrations suggest associations with
                      increased ALS risk. Zinc was associated with a decreased
                      risk (OR 0.50, $95\%CI$ 0.27-0.94). Associations for cadmium
                      and lead remained when limiting analyses to non-current
                      smokers.This is the first study to compare metal levels
                      before disease onset, minimizing reverse causation. The
                      observed associations suggest that cadmium, lead and zinc
                      may play a role in ALS etiology. Cadmium and lead possibly
                      act as intermediates on the pathway from smoking to ALS.
                      This article is protected by copyright. All rights
                      reserved.},
      cin          = {C020},
      ddc          = {610},
      cid          = {I:(DE-He78)C020-20160331},
      pnm          = {313 - Krebsrisikofaktoren und Prävention (POF4-313)},
      pid          = {G:(DE-HGF)POF4-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:33068316},
      doi          = {10.1002/ana.25932},
      url          = {https://inrepo02.dkfz.de/record/164045},
}