Luthviatin et al (2021): Lead (Pb) Effects on Human Health Jan 2021 Vol. 24 Issue 01

The Analysis of Potential Exposure to Lead (Pb) in The Mining Areas of and Its Effects on Human Health (Literature Review)

Novia Luthviatin1*, Hertanto W Subagio2, Onny Setiani3, Bagoes Widjanarko4

1Magister of Public Health, Doctoral Program, Faculty of Public Health, Diponegoro University, Semarang, . 2Professor of medicine, Department of Nutrition, Faculty of Medicine, Diponegoro University, Semarang, Indonesia. 3Doctor of Philosophy. Department of Environmental Health, Faculty of Public Health, Diponegoro University, Semarang, Indonesia. 4Doctoral of Public Health, Department of Health Promotion, Faculty of Public Health, Diponegoro University, Semarang, Indonesia

*Corresponding author: Novia Luthviatin Pangkalpinang, Bangka Province, Indonesia Phone Numbers: +6288286018021, +6285236333360 Email: [email protected]

Abstract

Background: province is the largest industrial tin mining area. A high prevalence rate of metabolic diseases occurs in the province as Pb exposure can affect organ systems and hormones negatively and cause metabolic disease. Aims:This review aimed to analyze the distribution of lead (Pb) in the mining areas of Bangka Island, potential exposure, and its effects on human health.Settings and Design:-Methods and Material:Literature search collected articles published in Indonesian and English related to the distribution of lead (Pb) in Bangka Island with keywords, such as Pb and Bangka Belitung. The search was carried out on the Google search engine, several websites, and direct information from researchers. All articles retrieved were narratively reviewed. Statistical analysis used:- Results:Lead (Pb) was found in rivers, post-tin mining ponds, sea, and aquatic biotas such as snails, fish, shellfish, and shrimp. Post-tin mining ponds is a source of water used by the community for drinking and fulfilling all household needs, while they always consume marine products such as fish, shellfish, and shrimp daily. Discussion: Lead (Pb) is exposed to human most likely through daily consumption, such as drinking water and food. Lead (Pb) which transmits the human body at certain levels may cause metabolic disorders, including hypertension, high cholesterol, obesity, type-2 diabetes mellitus, and coronary heart disease.Conclusions:Lead

(Pb) exposure in the mining areas of Bangka Island is significantly predicted to affect public health and

Annals of Tropical Medicine & Public Health http://doi.org/10.36295/ASRO.2021.24193

Luthviatin et al (2021): Lead (Pb) Effects on Human Health Jan 2021 Vol. 24 Issue 01

lead to the increased prevalence of metabolic diseases. It is necessary to measure the levels of heavy metals in the human body to find out its effect on health. In the long run, the provincial government of Bangka Belitung should make prevention and control measures of exposure to heavy metals that is normally below the human body's threshold.

Keywords: lead (Pb), distribution, exposure, health impacts, tin mining, Bangka Island

Key Messages:

Lead (Pb) is produced from tin mining activities in Bangka Islands. Lead (Pb) was found in several area and biota. Lead (Pb) exposure is significantly predicted to affect public health.

How to cite this article: Luthviatin N, Subagio HW, et al (2021): The analysis of potential exposure to lead (Pb) in the mining areas of Bangka Island and its effect on human health (Literature review) , Ann Trop Med & Public Health; 22(S01): SP24193. DOI: http://doi.org/10.36295/ASRO.2021.24193

Introduction

Currently, there has been an increase in the prevalence of metabolic diseases worldwide,1 including in Asian countries.2 This increase also occurred in Indonesia as the 2013-2018 Basic Health Research has shown. Metabolic diseases and metabolic syndromes, such as Diabetes Mellitus (2.1%- 2.0%), central obesity (26.6%-31.0%), and hypertension (25.8%-34.11%). Several provinces with higher prevalence of such diseases include Bangka Belitung Province which the prevalence of Diabetes Mellitus (2.5%-2.5%), central obesity (31.8%-33.8%), and hypertension (30.9%-29.9%) was above the national prevalence rate.3,4

Bangka Belitung province had the highest prevalence of hypertension and became the third- highest prevalence of stroke in Indonesia in 2013.3 In 2018, the prevalence of Diabetes Mellitus was in the sixth highest, and that of stroke was in the seventh place of all Indonesia provinces. The prevalence of obesity in the province was above the national prevalence rate in each age group, such as toddlers, children, adolescents, and adults.4Although Indonesia has been known as the global tin producer for hundreds of years, with the largest producing area on the Bangka Belitung Islands, the mining activity remains to cause health risks, including metabolic diseases. This issue has not been studied further although data have reported incidents of high metabolic diseases in Bangka Belitung province.

The increase in the prevalence of metabolic diseases and syndromes over the last 3 decades cannot be examined only from traditional factors such as genetics, diet pattern, and physical activity. Additional environmental factors may be contributing to this epidemic.5,6Since 2002, studies have begun to investigate the presence of chemicals in the environment both as natural effects and

Annals of Tropical Medicine & Public Health http://doi.org/10.36295/ASRO.2021.24193

Luthviatin et al (2021): Lead (Pb) Effects on Human Health Jan 2021 Vol. 24 Issue 01

pollutants that contribute to the increased prevalence.7 These chemicals affect the endocrine system in animals and humans, thereby disrupting the function of hormones and organs. These chemicals are called endocrine disruptor chemicals that involve heavy metals, including lead (Pb).6

Heavy metal is a general term often used to describe groups of metals (metals) or semi-metals (metalloids) associated with contamination.8 Among the elements that exist in nature, sixty elements are classified as heavy metals, such as Pb, Cd, Co, Cr, Cu, Fe, Mn, Ni, Zn, Hg, and so on.9 Heavy metals, such as lead, cadmium, and mercury, are absorbed from contaminated food and water sources, as well as cigarette smoke and polluted air, especially from certain industries such as electroplating, welding, smelting, refining, and battery manufacturing10 as well as the mining industries of tin, gold, silver, and kaolinite.11,12

Indonesia is the largest tin producer (Sn) in the world after China, while the Bangka Belitung Islands province is the largest tin mining area in Indonesia.13 The mining activities result in environmental damage to the community.14 Heavy metal pollution including Pb occurs in rivers, sea, and kolong (ex-excavated tin mining ponds).11,15Lead (Pb) exposure to humans can disrupt organ systems and hormones in the body and potentially cause metabolic diseases.16,17 This study drew some conclusions of the distribution of lead (Pb) in the mining areas of Bangka Belitung Province, its exposure and its effects on human health by reviewing findings of previous studies.

Subjects and Methods

Literature search only collected articles published in Indonesian and English related to the distribution of lead (Pb) in Bangka Island with keywords, such as Pb and Bangka Belitung. Literature search was done on Google Search Engine, specific websites, and some studies reviewed were also references from other researchers. Direct information from the Indonesian public health researchers by telephone, email, and WhatsApp. The total number of studies reviewed here was 23 articles. All articles were screened with the inclusion criteria which could be determined by reading the abstracts. After the screening process, 10 articles were qualified to the full text screening. Often relevant articles, 8 articles were continued to the analysis stage, but 2 articles were not accessible. All articles retrieved were narratively reviewed. The selected articles were published in accredited journals (SINTA, Google

Scholar, and Scopus). The literature searching process is available in figure 1, and the complete list of articles is available in table 1.

Annals of Tropical Medicine & Public Health http://doi.org/10.36295/ASRO.2021.24193

Luthviatin et al (2021): Lead (Pb) Effects on Human Health Jan 2021 Vol. 24 Issue 01

Results

Distribution of Lead Metal (Pb) in Bangka Belitung Province

Pb sources exist due to natural and anthropogenic consequences. Naturally, Pb in the environment occurs as a result of geological weathering and volcanic eruptions. Anthropogenic activities that produce Pb include mining and smelting activities, and Pb also exists as a by-product of the battery, cables, pigments, and steel industries as well as from the combustion of gasoline fuel containing TEL and TML additives. It is estimated that mining and smelting activities could produce the amount of Pb emitted into the environment at around 126,000 tons/year, and other activities could result in Pb emission at around 3 million tons/year (Manahan, 1992).18

The Bangka Belitung Islands province is located at 104 ° 50 'to 109 ° 30' East Longitude and 0 ° 50 'to 4 ° 10' South Latitude, bordered with the Bangka Strait in the West, the Strait Karimata in the East, the in the North, and the in the South. The Bangka Belitung Islands province has six districts and one city; Bangka district, West Bangka district, Central Bangka district, South Bangka district, Belitung district, East Belitung district, and Pangkalpinang city. The islands are originally inhabited by sea tribesmen from various islands such as Belitung Island, Riau Island, Kalimantan Island, Sulawesi Island, Bugis Tribes, Malays from Johor and Siantan, Malay-Chinese Tribes, and China. Currently, other tribes, including the Javanese, also have occupied the islands. As a result, the people of Bangka Belitung form a new generation, so-called Bangka Belitung Malays who speak Malay, Mandarin, and Javanese daily.19 The tin sources in Bangka Island are discoverable due to its location in the Tin Islands20 and the Southeast Asian Lead Belt.21 Tin production and export activities are regulated by a Tin Mining Business Permit (IUP) which allows the mining activities on 512,369 hectares of land and offshore of the islands of Bangka, Belitung, and Kundur.22 The mining areas cover almost a third of the total areas of the Bangka Belitung Islands province.23 Tin mining involves land preparation process, overburden stripping, high-pressure water spraying, and metal ore extraction.24

Tin mining activities leave negative ecological impacts. These include environmental degradation, loss of germplasm due to loss of forest ecosystems and habitats for animals, arid soil conditions and low fertility, high acidity levels, low oxygen levels in soil and water, and low exchange capacity values. Another negative impact is heavy metal contamination. Tin mining activities do not use chemicals during the exploration and exploitation process, but elements found in nature can oxidate and experience chemical reactions due to land clearing or standing water. This chemical reaction produces heavy metals, causing changes in water quality and potential residual contaminants.18

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Luthviatin et al (2021): Lead (Pb) Effects on Human Health Jan 2021 Vol. 24 Issue 01

Tin mining harms the environment and social conditions.14 Heavy metal pollution such as As, Cr, Cu, Pb, Zn, Fe, Cd, and Sn are commonly found around rivers, kolong (ex-tin mining excavated ponds), sea, and ex-mining land. The Pb content has been measured in two (2) areas, including in public waters in illegal mining areas and Jelitik River, Bangka district. Water in the illegal mining areas contains a small concentration of Pb.11 Likewise, the Pb concentration level in Jelitik River is still below the Environmental Quality Standard (Republic of Indonesia Government Regulations No. 82 of 2001, Minister of Health Regulations No. 416 of 1990 and Minister of Environment Decree No. 4 of 2006).25

The Pb concentration level has been measured in KacangPedang, Pangkalpinang City, South

Bangka, and in the Bangka Island regions in general. The Pb concentration level in Kacang Sword was <1.0 mg/L and in sediments from upstream to downstream, starting from 54.3 ppm, 69 ppm, 63 ppm, 41 ppm, and 38 ppm. The Pb concentration in water exceeds the normal Pb threshold, while in sediment it is over the normal threshold but lower from upstream to downstream.26 The Pb concentration in South Bangka forests was at 8.0 ppm, and it was at 10.8 ppm in reclaimed post reclaimed tin mining land and 20.7 ppm in unreclaimed post mining land. The highest Pb concentration exists in unreclaimed post mining land, while the second highest Pb concentration is discovered in reclaimed post-mining land and forests according to the government regulations standard No. 85 (1999).27 In conclusion, studies investigating the Pb concentration in Bangka Island have found a dynamic correlation of Pb concentration and age of mining sites. Pb concentration decreases from Station A to Station B and then increases at Station C, which is under the oldest duration (> 15 years).15

Pb concentration in Kelabat Bay, Bangka Island were measured in 2011 and 2019, and it shows different Pb concentration levels in water and sediments, but the same results in fishery biota. In 2011, the measurement in the soil showed Pb concentration was 5.6 ± 2.5 µg/L in the western season and 3.5 ± 1.6 µg/L in the southeast monsoon, while Pb is dissolved on the outside the soil, in which each was 3.0 ± 3.9 µg/L in the west monsoon and 3.6 ± 0.9 µg/L in the southeast monsoon. The Pb concentration in the sediments was ± 11.46 mg/kg (range: 1.04–22.01 mg/kg). The Pb concentration inside the inner sediments was on average two times higher than outside sediments with a significant difference (p= 0.003). However, the Pb concentration inside the sediments did not show any significant differences between seasons. The residual Pb concentration was 5.55 ± 0.94 mg/kg in fish, 9.26 ± 0.37 mg/kg in barking snails, and 6.76 ± 0.72 mg/kg in shellfish blood. The measurement explained the Pb content in the west monsoon water (March) and southeast monsoon water (July) varied widely and was generally relatively low. The Pb concentration inside the sediments was 2 times higher than that outside the sediments which were not influenced by seasonal factors. Pb

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Luthviatin et al (2021): Lead (Pb) Effects on Human Health Jan 2021 Vol. 24 Issue 01

concentration was still within normal limits in water and sediments, but Pb residues exceeded the maximum limit in fishery biota.28

The measurement of Pb concentration in Kelabat Bay in 2019 showed an average Pb concentration in water ranged from 0.2624-0.5713 mg/L, while it ranged from 0.2783-0.9760 mg/kg sediments. The Pb concentration (Penaeus merguiensis) was at 0.1897-0.4064 mg/kg in the shrimp hepatopancreas, 0.2424-0.4770 mg/kg in the gills, and 0.1348-0.1636 mg/kg in the meat. In summary, the Pb concentration in water exceeded the threshold above 0.008 mg/L, but did not in sediments. In shrimps, hepatopancreas has the highest Pb concentration followed by the Pb concentration in gills and meat.29

Heavy metal pollutions including As, Cr, Cu, Pb, Zn, Fe, Cd, and Sn will accumulate in organisms and later food chain. A previous study shows Pb was the highest content of heavy metal in samples of water starting from 0.087 mg/L, 0.095 mg/L, and 0.052 mg/L.11 Co, Ni, Pb, Sn, and Th concentrations decreased in ponds which was <1 year old and between 5-10 years old, and they showed an increase in ponds with water level duration of >15 years.15

Table 1. Distribution of Pb in the environment in Bangka Belitung Province due to tin mining activities

No Author Sample Result/Conclusion Conclusion 1 Prianto, E. Liquid The concentration of Pb in waters in the The concentration of heavy metals in et al. waste in illegal mining area on Bangka Island is in a waters in illegal mining areas on Bangka (2009) streams small concentration Island, although in small concentrations, the impact on aquatic organisms in the long term needs to be considered, given the nature of these heavy metals which will accumulate in aquatic organisms such as fish, crustaceans and mollusks 2 Arifin, Z. Kelabat - The average dissolved Pb concentration - The Pb content in water in the west (2011) Bay on the inside is (5.6 ± 2.5 µg/L) in the monsoon (March) and southeast waters west season and (3.5 ± 1.6 µg/L) in the monsoon (July) varies widely and is southeast monsoon, while the dissolved generally relatively low. Pb on the outside is (3.0 ± 3.9 µg/L) in - The concentration of Pb in the inner the west monsoon and (3.6 ± 0.9 µg/L) in sediment is 2 times higher than that of the southeast monsoon the outside and is not influenced by - The Pb concentration in the sediment is seasonal factors ± 11.46 mg/kg (range: 1.04–22.01 - the concentration of Pb residue has mg/kg). The Pb concentration in the inner exceeded the maximum limit in fishery sediment was on average two times biota higher than that of the outer sediment, and showed a significant difference (p = 0.003). However, the Pb concentration in the sediments did not show any significant differences between seasons - Concentrations of Pb residue ± (5.55 ± 0.94) mg/kg in fish, (9.26 ± 0.37) mg/kg in barking snails, and (6.76 ± 0.72) mg/kg in blood shells

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3 Saputro, The Pb content in river water is 0.001 mg/L in Pb levels in river water are not B. et al. waters of the upstream, middle and downstream contaminated with Pb because they are (2014) the Jelitik parts still below the Environmental Quality River Standards (Republic of Indonesia Government Regulations No. 82 of 2001, Minister of Health Regulations No. 416 of 1990 and Minister of Environment Decree No. 4 of 2006) 4 Irvani. et Water The Pb content in water is <1.0 mg/L and in - Pb in water exceeds normal al. (2016) and the sediment from upstream to threshold Sediment downstream, respectively, 54.3 ppm, 69 - Pb in the sediment exceeds the in Post- ppm, 63 ppm, 41 ppm, and 38 ppm normal threshold but at a lower Tin concentration from upstream to Mining downstream Retentio

n Ponds of

KacangP edang 5 Bidayani, Coastal - The Pb content in water ranges from - The Pb content in sediments is E., et al. of South 0.02 ± 0.01 - 0.07 ± 0.01 ppm and higher than in water, and has (2017) Bangka sediment ranges from 1.55 ± 0.10 - passed the quality standard for Regency 19.58 ± 0.03 ppm heavy metal lead, namely 0.008 - The Pb content in seagrass roots mg/L. ranged from 0.34 ± 0.08 - 3.04 ± 0.11 - In the body of seagrass, the highest ppm, rhizomes ranged from 0.11 ± 0.00 absorption of Pb is in the roots, this - 3.01 ± 0.08 ppm, and leaves ranged content has passed the quality from 0 , 26 ± 0.03 - 0.94 ± 0.07 ppm. standard for heavy metal lead, namely 0.008 mg/L. 6 Sari, E., et Post-Tin The Pb content in the forest is 8.0 ppm, in - The highest lead-in land after tin al. (2017) Mining land after reclaimed tin mining is 10.8 ppm, mining has not been reclaimed - 0 Ponds in and in land after tin mining has not been years old, followed by land that is South reclaimed - 0 years old is 20.7 ppm reclaimed and forest Bangka - The Pb content in the forest, in land after tin mining reclaimed and in land after tin mining has not been reclaimed-0 years past the

government regulations standard No. 85 (1999). 7 Tawa, D. Water, - The Pb concentration in Penaeus - The highest Pb concentration in A., et al. sedimen, merguiensis was hepatopancreas with Penaeus merguiensis is (2019) and an average of 0.1897-0.4064 mg/kg, hepatopancreas> gills> meat. prawns gills 0.2424-0.4770 mg/kg, and meat - The Pb content in water has 0.1348-0.1636 mg/kg. exceeded the threshold, which is - Average Pb concentrations in water above 0.008 mg/L. ranged from 0.2624-0.5713 mg/L, while - Pb in sediment has not exceeded sediment ranged from 0.2783-0.9760 the threshold mg/kg. 8 Kurniawa, Tin - There are 16 (sixteen) heavy metals A dynamic correlation can be found, A., et al. Mining that can be detected underneath, that the Pb concentration decreases (2019) Ponds on namely: As, Co, Cu, Cr, Fe, Ga, Hf, Sn, from Station A to Station B and then Bangka Ta, Te, Th, Mn, Ni, Pb, Zn, and V. increases at Station C Island - Pb metal, at Station C shows a higher concentration compared to Station A and Station B. Station C is under the oldest age (> 15 years)

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Figure 1. Literature searching process

Article identification on Google Search Engine, selected websites, and identification refernces from other researchers (n= 23)

Titles and abstracts were screened screening (n= 10)

eligibility & Full-text articles were assessed for inclusion eligibility and inclusion (n=8)

Discussion

Potential Pb exposure to humans

The presence of heavy metals for a certain period in the environment seriously threats the environment and living organisms as they can accumulate in a food chain.30 Accumulation over the tolerance limit results in a toxic effect on organisms.31 Heavy metals can move from the environment into cells, tissue, and organs of an organism.32 Heavy metal transmission mechanism can occur directly or indirectly. Direct transmission of heavy metals from nature can occur for the first time in the cells of microorganisms before succession occurs in post-mining or polluted ecosystems. Microorganisms are the initial organisms in polluted ecosystems.33 Direct transmission of heavy metals also occurs in plants. Plants will be in direct contact with heavy metals as the soil, roots, and tissue are stations where heavy metals accumulate.34

The Pb concentration in rivers is relatively small or still within normal limits, but it will be greater due to the fact that Pb can accumulate in the organs of aquatic organisms such as fish, crustaceans, and mollusks.11 It will be harmful when people use Pb-contaminated water for various household activities, such as washing, fish farming, and recreation areas. The government has assigned a regional water company so-called PDAM to manage raw water for drinking water in several districts or cities26.

The heavy metal transmission from a polluted environment to humans and animals can occur directly and indirectly through the accumulation of heavy metals at each trophic level of organisms.35One example of direct contamination is the interaction of fish with metal residues in the

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aquatic environment. It occurs because industrialization activities produce metal residues in the environment. Metal accumulation in large fish occurs through drinking contaminated water absorbed in fish tissue. Contamination in large fish can also occur indirectly as large fish prey small fish that drink Pb-contaminated water. Water carries metals into aquatic plants eaten by small fish. Small fish eating metal-contaminated plants are then preyed by large fish, and thus the Pb concentration level accumulates more in the large fish’s body. As fish also becomes a daily consumption, people who consume Pb-contaminated fish will also have greater potential of Pb contamination despite the indirect contact with the source of the contaminants.36 Pb contamination could transmit to other animals, such as cattle, horses, and others. As Pb also can contaminate the soil, organisms which grow in the soil can explain the routes and patterns of heavy metal contamination from the environment to the final contaminated place. A food chain can describe direct or indirect interactions between organisms and their sources of contaminants.18

The effect of lead (Pb) exposure on human health

The effect of lead (Pb) exposure on human health has been widely studied. In Indonesia, Pb comes from cigarette smoke, battery manufacturing industries, paint industries, gasoline fuel burning, residual mining activities.37So far, studies have investigated the relationship or effect of Pb on various health risks such as osteoporosis,38 blood profile,39–41 anemia,42,43 hypothyroid,44 hypertension,45–49 disturbance of body balance,50 liver function,51 as well as kidneys.52

Lead (Pb) as a heavy metal can be absorbed by the body and will quickly spread from the intravascular compartment to the interstitial fluid and will penetrate cells. Lead (Pb) enters the body through the respiratory tract, gastrointestinal tract, and even dermal contact. Lead (Pb) accumulates in blood, liver, kidneys, bones, spleen, lungs, heart, brain, and muscle tissue in descending order.53,54 After exposure, metal ions redistribute and are removed from most of the tissue. Heavy metals are generally excreted through urine processed in the kidneys and through feces in the bile, and excretion rates differ according to the type of heavy metal. Lead is easily excreted through urine.54,55 In adults exposed to lead (Pb) from the environment, Pb concentration in the blood should not exceed the standard concentration of 10 µg/dl set by the Center for Disease Control and Prevention (CDC).41Prolonged exposure to Pb can result in disorders in organs such as blood, nervous system, kidneys, reproductive system, and gastrointestinal tract.56

Lead (Pb) can disrupt endocrine system and promote adipogenesis by interfering multiple endocrine axes, generally targeting nuclear receptors, and influencing adipocyte physiology and more general regulation of energy homeostasis directly or indirectly. Several factors, such as types of organs, dose-response curves, time of exposure, sex, genetic susceptibility, can prevent effects due to

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the chemical obesogen.57 "Obesogen" is a chemical that increases obesity by elevating the number of fat cells and/or fat storage in the adipocytes. Obesogen can indirectly increase obesity by changing the energy balance to support calorie storage and changing the metabolic rate, the gut microbiota to promote food storage, and the hormonal control of appetite and satiety.37 Environmental toxins such as heavy metals may promote obesity through changes in hunger hormones, changes in sensitivity to neurotransmitters, or changes in sympathetic nervous system activity. EDCs have been proven to activate the hypothalamus-pituitary-adrenal (HPA) axis that can lead to obesity although the mechanism is unknown. The sympathetic nervous system modulation by EDCs has presumably cause weight gain.5

Metabolic disease is a medical disease related to the production of energy in human (or animal) cells. Most metabolic diseases are genetic or hereditary although some of them occur due to consumption of contaminated food, toxins, infections, and so on.58 Types of metabolic diseases are type2 diabetes and cardiovascular disease. Type-2 diabetes and heart disease usually begin with a set of symptoms such as abdominal obesity, hypertension, and high cholesterol called metabolic syndrome.37

Several studies have been conducted to investigate the effect of lead (Pb) exposure either alone or together with other heavy metals on the incidence of diabetes, obesity, and other metabolic disorders (Table 4). Lead (Pb) levels in the blood were associated with obesity in boys,59 teenage girls,60 women,61, and adult women aged> 50 years.62 Levels of Lead (Pb) in the placental blood make infants at risk of obesity.63 Other studies have found Pb levels in the blood were associated with the incidence of hypertension.46,47,49 Lead (Pb) amalgamated with other heavy metals may cause type-2 diabetes, metabolic syndrome, obesity and hypertension,16 and dislipidemia.17 Long lead (Pb) exposure may affect serum uric acid levels. Uric acid concentrations may increase the prevalence of metabolic syndrome and resulting in increased risk of cerebrovascular and cardiovascular diseases. Lead (Pb) increases serum uric acid levels even at very low blood levels.64

Conclusion

Bangka Island is the largest tin producer in the world. Mining activities can emit heavy metals in the environment and potentially expose them to humans. One of the heavy metals discovered in Bangka Island is lead (Pb). Lead exposure may result in the occurrence of metabolic diseases and syndromes. The occurrence of metabolic diseases and metabolic syndromes in Bangka Belitung

Islands tend to show a high prevalence and a tendency to increase. Therefore, measuring lead (Pb) concentration in the human body, such as in the blood to discover its effects. In the long run, prevention and control measures of Pb exposure are required to protect human health.

Annals of Tropical Medicine & Public Health http://doi.org/10.36295/ASRO.2021.24193

Luthviatin et al (2021): Lead (Pb) Effects on Human Health Jan 2021 Vol. 24 Issue 01

Acknowledgement

The authors would like to thank all parties who have helped preparing and improving this article for publication.

Conflicting Interest: no conflict interest

References

1. WHO. Global Status Report on noncommunicable diseases 2014. 2014.

2. Misra A, Singhal N, Khurana L. Obesity, the metabolic syndrome, and type 2 diabetes in developing countries: Role of dietary fats and oils. J Am Coll Nutr. 2010;29(July 2013):289S– 301S.

3. Kementerian Kesehatan Republik Indonesia. Riset Kesehatan Dasar 2013. Badan Penelitian dan Pengembangan Kesehatan. 2013;78.

4. Kementerian Kesehatan Republik Indonesia. Laporan Nasional Riset Kesehatan Dasar 2018. 2018.

5. Limaye S, Salvi S. Obesity and asthma: The role of environmental pollutants. Immunol Allergy Clin North Am. 2014;34(4):839–55.

6. Willner SA, Blumberg B. Endocrine disruptors and obesity. Encycl Endocr Dis. 2018;1:776–86.

7. Bulka CM, Persky VW, Daviglus ML, Durazo-arvizu RA, Argos M. Multiple metal exposures and metabolic syndrome : A cross-sectional analysis of the National Health and Nutrition Examination Survey 2011 – 2014. Environ Res [Internet]. 2019;168(May 2018):397–405. Available from: https://doi.org/10.1016/j.envres.2018.10.022

8. Duffus JH. “heavy metals” - A meaningless term? (IUPAC technical report). Pure Appl Chem. 2002;74(5):793–807.

9. Kakimov A, Kakimova Z, Yessimbekov Z, Bepeyeva A, Zharykbasova K, Zharykbasov Y. Heavy Metals Distribution in Soil, Water, Vegetation and Meat in the Regions of East-Kazakhstan. J Environ Prot (Irvine, Calif). 2013;04(11):1292–5.

10. Madeddu R, Solinas G, Forte G, Bocca B, Asara Y, Tolu P, et al. Diet and nutrients are contributing factors that influence blood cadmium levels. Nutr Res [Internet]. 2011;31(9):691–7. Available from: http://dx.doi.org/10.1016/j.nutres.2011.09.003

11. Prianto E, Husnah H. Penambangan Timah Inkonvensional: Dampaknya Terhadap Kerusakkan Biodiversitas Perairan Umum Di Pulau Bangka. BAWAL Widya Ris Perikan Tangkap. 2009;2(5):193.

12. Miller JR, Villarroel LF. Bolivia: Mining, river contamination, and human health [Internet]. 2nd ed. Encyclopedia of Environmental Health. Elsevier Inc.; 2019. 436-455 p. Available from: http://dx.doi.org/10.1016/B978-0-12-409548-9.10943-1

Annals of Tropical Medicine & Public Health http://doi.org/10.36295/ASRO.2021.24193

Luthviatin et al (2021): Lead (Pb) Effects on Human Health Jan 2021 Vol. 24 Issue 01

13. Maia F, Veiga MM, Stocklin-Weinberg R, Marshall BG, Constanzo C, Hariojati N, et al. The need for technological improvements in Indonesia’s artisanal cassiterite mining sector. Extr Ind Soc [Internet]. 2019;6(4):1292–301. Available from: https://doi.org/10.1016/j.exis.2019.07.010

14. Erwana F, Dewi K, Rahardyan B. Kajian Dampak Penambangan Timah Inkonvensional Terhadap Lingkungan Dan Sosial Ekonomi Masyarakat (Studi Kasus: Kabupaten Bangka Barat Provinsi Kepulauan Bangka Belitung). J Tek Lingkung. 2016;22:32–41.

15. Kurniawan A, Oedjijono O, Tamad T, Sulaeman U. The pattern of heavy metals distribution in time chronosequence of ex-tin mining ponds in Bangka Regency, Indonesia. Indones J Chem. 2019;19(1):254–61.

16. Wang X, Mukherjee B, Park SK. Associations of cumulative exposure to heavy metal mixtures with obesity and its comorbidities among U.S. adults in NHANES 2003–2014. Environ Int [Internet]. 2018;121(June):683–94. Available from: https://doi.org/10.1016/j.envint.2018.09.035

17. Guo X, Yang Q, Zhang W, Chen Y, Ren J, Gao A. Associations of blood levels of trace elements and heavy metals with metabolic syndrome in Chinese male adults with microRNA as mediators involved. Environ Pollut [Internet]. 2019;248:66–73. Available from: https://doi.org/10.1016/j.envpol.2019.02.015

18. Kurniawan A, Mustikasari D. Review: Mekanisme Akumulasi Logam Berat di Ekosistem Pascatambang Timah. J Ilmu Lingkung. 2019;17(3):408.

19. Dinas Komunikasi Dan Informatika Provinsi Kepulauan Bangka Belitung. Provinsi Kepulauan Bangka Belitung | Bumi Serumpun Sebalai [Internet]. [cited 2020 Mar 5]. Available from: https://www.babelprov.go.id/content/letak-geografis

20. Barber, A.J., Crow, M.J. dan De Smet MEM. Tectonic Evolution. In: Barber, A.J., Crow, M.J., Milsom JS (Eds. ., editor. : Geology, Resources and Tectonic Evolution. 31st ed. Geological Society Memoir; 2005. p. 234–57.

21. Cobbing EJ. Granite. In: Barber, A.J.,Crow, M.J. and Milsom JS, editor. Sumatra: Geology, Resources and Tectonic Evolution. 31st ed. Geological Society Memoir; 2005.

22. Sekilas PT TIMAH. [cited 2020 May 18]; Available from: http://www.timah.com/v3/ina/tentang- kami-sekilas-pt-timah/

23. Badan Pusat Statistik Provinsi Kepulauan Bangka Belitung [Internet]. [cited 2020 May 18]. Available from: https://babel.bps.go.id/dynamictable/2017/03/29/347/luas-wilayah-provinsi- kepulauan-bangka-belitung-per-kabupaten-kota-tahun-2017-2019-km2-.html

24. Luthfi M, Sunarwan B. Analisis Sebaran Kegiatan Pertambangan Timah Menggunakan Sistem Informasi Geografi Di Daerah Bangka, Propinsi Bangka Belitung. J Teknol. 2008;I.

25. Saputro B, Santoso LW, Sigit Heru Murti. Pengaruh Aktivitas Penambangan Timah Putih (Sn) Terhadap Kerusakan Lingkungan Perairan Sungai Jelitik Kabupaten Bangka Provinsi Kepulauan Bangka Belitung. Maj Geogr Indones. 2014;28(1):1–11.

26. Irvani, Pitulima J. Study of Heavy Metals in Water and Sediment of Kacang Pedang Retention Ponds Post Tin Mining Activities. Promine J. 2016;4(1):40–5.

Annals of Tropical Medicine & Public Health http://doi.org/10.36295/ASRO.2021.24193

Luthviatin et al (2021): Lead (Pb) Effects on Human Health Jan 2021 Vol. 24 Issue 01

27. Sari E, Fiona D sandra, Hidayati N, Nurtjahya E. Analisis Kandungan Logam pada Tumbuhan Dominan di Lahan dan Kolong Pasca Penambangan Timah Bangka Selatan Bangka ). Promine J. 2017;5(December):15–29.

28. Arifin Z. Konsentrasi Logam Berat Di Air, Sedimen Dan Biota Di Teluk Kelabat, Pulau Bangka. J Ilmu dan Teknol Kelaut Trop. 2011;3(1).

29. Tawa DA, Afriyansyah B, Ihsan M, Nugraha MA. Biokonsentrasi Timbal (Pb) pada Hepatopankreas, Insang dan Daging Penaeus merguiensis di Teluk Kelabat Bagian Luar. J Kelaut Trop. 2019;22(2):109. 30. Kumar Verma D, Gupta AP. Removal of heavy metals from whole sphere by plants working as bioindicators-A review. Basic Res J Pharm Sci [Internet]. 2013;1(May):1–7. Available from: https://www.academia.edu/4806278/Removal_of_heavy_metals_from_whole_sphere_by_plants_ working_as_bioindicators-A_review?auto=download

31. Jaishankar M, Tseten T, Anbalagan N, Mathew BB, Beeregowda KN. Toxicity, mechanism and health effects of some heavy metals. Interdiscip Toxicol. 2014;7(2):60–72.

32. Al-Mahaqeri A. Human Health Risk Assessment of Heavy Metals in Fish Species Collected from Catchments of Former Tin Mining. Int J Res Stud Sci Eng Technol. 2015;2(4):9–21.

33. Lau JA, Lennon JT. Rapid responses of soil microorganisms improve plant fitness in novel environments. Proc Natl Acad Sci U S A. 2012;109(35):14058–62.

34. Rascio N, Navari-Izzo F. Heavy metal hyperaccumulating plants: How and why do they do it? And what makes them so interesting? Plant Sci [Internet]. 2011;180(2):169–81. Available from: http://dx.doi.org/10.1016/j.plantsci.2010.08.016

35. Vries W, Römkens PF a M, Schütze G. Critical Soil Concentrations of Cadmium, Lead, and Mercury in View of Health Effects on Humans and Animals\nReviews of Environmental Contamination and Toxicology. Rev Env Contam Toxicol [Internet]. 2007;191:91–130. Available from: http://dx.doi.org/10.1007/978-0-387-69163-3_4 36. Abate A. Perovskite Solar Cells Go Lead Free. Joule [Internet]. 2017;1(4):659–64. Available from: https://doi.org/10.1016/j.joule.2017.09.007

37. Heindel JJ, Blumberg B, Cave M, Machtinger R, Mantovani A, Mendez MA, et al. Metabolism disrupting chemicals and metabolic disorders. Reprod Toxicol [Internet]. 2017;68:3–33. Available from: http://dx.doi.org/10.1016/j.reprotox.2016.10.001

38. Moelyaningrum AD. Correlation Between Blood Lead Level (BLL) And Osteoporosis in Postmenopausal Women In Surabaya Indonesia Anita Dewi Moelyaningrum. 1st Int Symp Public Heal "Emerging Re-emerging Dis. 2017;190–7.

39. Gunawan L, Setiani O, Suhartono. Hubungan Kadar Timah Hitam dalam Darah dengan Jumlah Lekosit, Trombosit, dan Aktifitas Superoxide Dismutase (SOD) pada Pekerja Timah Hitam di Kabupaten Tegal. J Kesehat Lingkung Indones. 2013;12(2):106–10.

40. Purwindah RH, Sulistiyani, Budiyono. Hubungan Kadar Timah Hitam ( Pb ) Dalam Darah Dengan Profil Darah Studi Pada Petugas Pengujian Emisi Gas Buang Dinas Perhubungan Kabupaten

Annals of Tropical Medicine & Public Health http://doi.org/10.36295/ASRO.2021.24193

Luthviatin et al (2021): Lead (Pb) Effects on Human Health Jan 2021 Vol. 24 Issue 01

Purbalingga dan Banjarnegara. J Kesehat Lingkung Indones. 2012;11(1):38–42.

41. Mifbakhuddin, W. NE, Suhartono. Hubungan Kadar Pb Dalam Darah Dengan Profil Darah Pada Petugas Operator Stasiun Pengisian Bahan Bakar Umum di Kota Semarang Timur. J Kesehat Lingkung Indones. 2007;6(1):6–12.

42. Surip, Setiani O, Rahfiludin MZ. Hubungan Antara Kadar Timbal dalam Darah dengan Kadar Hemoglobin pada Wanita Usia Subur di Lingkungan Industri Peleburan Loga Kecamatan Adiwerna Kabupaten Tegal. J Kesehat Lingkung Indones. 2013;12(2):167–70. 43. Mawardi M, Setiani O, Suhartono. Hubungan Kadar Timah Hitam (Pb) dengan Kadar Albumin dalam Darah dan Kejadian Anemia (Studi pada pekerja peleburan timah di perkampungan industri kecil (PIK) Kebasen Kab. Tegal). J Kesehat Lingkung Indones. 2013;12(2):111–5.

44. Hidayati N, Suhartono, Nurjazuli. Hubungan Kadar Pb dalam Darah dengan Kejadian Hipotiroidisme pada Wanita Usia Subur di Perkampungan Usaha Kecil dan Menengah Desa Pesarean Kabupaten Tegal. J Kesehat Lingkung Indones. 2013;12(2):116–9. 45. Eka H, Mukono J. Hubungan Kadar Timbal dalam Darah dengan Hipertensi Pekerja Pengecatan Mobil di Surabaya. J Kesehat Lingkung [Internet]. 2017;9(1):66–74. Available from: http://e- journal.unair.ac.id/JKL/article/download/9175/5164

46. Mutasir, Setiani O, Sulistiyani. Hubungan Kadar Timbal Dalam Darah Dengan Tekanan Darah Pada Tenaga Kerja Di Karoseri Semarang Association Between Blood Lead Levels And Blood Pressure Workers of Carroseri. All rights Reserv JKLI [Internet]. 2016;15(1):14–21. Available from: http://ejournal.undip.ac.id/index.php/jkli

47. Ambarwanto ST, Nurjazuli, Raharjo M. Hubungan Paparan Timbal Dalam Darah dengan Kejadian Hipertensi Pada Pekerja Industri Pengecoran Logam Di Ceper Klaten Tahun 2015. J Kesehat Lingkung Indones. 2015;14(2):35.

48. Fibrianti LD, Azizah R. Karakteristik, kadar timbal (pb) dalam darah, dan hipertensi pekerja. Kesehat Lingkung. 2015;8(1):93–102.

49. Setyabudi S, Setiani O, W NE. Hubungan Kadar Pb Dalam Darah Dengan Kejadian Hipertensi Pada Pekerja Peleburan Timah Hitam di Perkampungan Industri Kecil (PIK) Kebasen Kabupaten Tegal. J Kesehat Lingkung Indones. 2014;13(1):14–9.

50. Bowo Leksono B, Setiani O, Sulistiyani. Hubungan Paparan Pb Dengan Gangguan Keseimbangan Tubuh Pada Pekerja Industri The Relationship Between Pb Exposure with The Body Balance on Workers of Lead Melting Industry in Kebasen Tegal. J Kesehat Lingkung Indones. 2014;13(2):58.

51. Setiani O. Hubungan Kadar Pb dalam Darah dengan Kejadian Gangguan Fungsi Hati pada Pekerja Peleburan Timah Hitam di Kabupaten Tegal. J Kesehat Lingkung Indones. 2013;12(2):149–53.

52. Wibowo A, Rahaju FA, Firdaus RT, Suhartono E. The Role of Urinary Cadmium and Lead Level on Pregnant Women Renal Function. J Med Bioeng. 2014;3(1):55–8.

53. Świergosz-Kowalewska R. Cadmium distribution and toxicity in tissues of small rodents. Microsc

Annals of Tropical Medicine & Public Health http://doi.org/10.36295/ASRO.2021.24193

Luthviatin et al (2021): Lead (Pb) Effects on Human Health Jan 2021 Vol. 24 Issue 01

Res Tech. 2001;55(3):208–22.

54. Boening DW. Ecological effects, transport, and fate of mercury: A general review. Chemosphere. 2000;40(12):1335–51.

55. Aaseth J, Boivin G, Andersen O. Osteoporosis and trace elements - An overview. J Trace Elem Med Biol [Internet]. 2012;26(2–3):149–52. Available from: http://dx.doi.org/10.1016/j.jtemb.2012.03.017

56. Suksmerri S. Dampak Pencemaran Logam Timah Hitam (Pb) Terhadap Kesehatan. J Kesehat Masy Andalas. 2008;2(2):200.

57. Friso S, Choi SW. Epigenetics of obesity. Adipose Tissue Adipokines Heal Dis Second Ed. 2014;140:187–98.

58. Penyakit metabolik - Wikipedia bahasa Indonesia, ensiklopedia bebas [Internet]. [cited 2020 May 15]. Available from: https://id.wikipedia.org/wiki/Penyakit_metabolik

59. Zhou CC, He YQ, Gao ZY, Wu MQ, Yan CH. Sex differences in the effects of lead exposure on growth and development in young children. Chemosphere [Internet]. 2020;250:126294. Available from: https://doi.org/10.1016/j.chemosphere.2020.126294

60. Deierlein AL, Teitelbaum SL, Windham GC, Pinney SM, Galvez MP, Caldwell KL, et al. Lead exposure during childhood and subsequent anthropometry through adolescence in girls. Environ Int. 2019;122(October 2018):310–5.

61. M. Niehoff N, P. Keil A, M. O’Brien K, P. Jacksonc B, R. Karagas M, R. Weinberg C, et al. Metals and trace elements in relation to body mass index in a prospective study of US women.

62. Wang N, Chen C, Nie X, Han B, Li Q, Chen Y, et al. Blood lead level and its association with body mass index and obesity in China - Results from SPECT-China study. Sci Rep [Internet]. 2015;5(July):1–11. Available from: http://dx.doi.org/10.1038/srep18299

63. Kim JH, Park Y, Kim SK, Moon HB, Park J, Choi K, et al. Timing of an accelerated body mass increase in children exposed to lead in early life: A longitudinal study. Sci Total Environ [Internet]. 2017;584–585:72–7. Available from: http://dx.doi.org/10.1016/j.scitotenv.2017.01.122

64. Lee D, Choi W-J, Oh J-S, Yi M-K, Han S-W, Yun J-W, et al. The Relevance of Hyperuricemia and Metabolic Syndrome and the Effect of Blood Lead Level on Uric Acid Concentration in Steelmaking Workers. Ann Occup Environ Med. 2013;25(1):27.

Annals of Tropical Medicine & Public Health http://doi.org/10.36295/ASRO.2021.24193