Childhood exposure to manganese and postural instability in children living near a ferromanganese refinery in Southeastern Ohio

• Postural balance was assessed in children exposed to ambient air manganese.
• Manganese exposure was significantly associated with poor postural balance.
• Low-level lead exposure was significantly associated with poor postural balance.
• Ambient air Mn can affect regions of the brain known to control movement.

Airborne manganese (Mn) exposure can result in neurotoxicity and postural instability in occupationally exposed workers, yet few studies have explored the association ambient exposure to Mn in children and postural stability. The goal of this study was to determine the association between Mn and lead (Pb) exposure, as measured by blood Pb, blood and hair Mn and time weighted distance (TWD) from a ferromanganese refinery, and postural stability in children. A subset of children ages 7–9 years enrolled in the Marietta Community Actively Researching Exposure Study (CARES) were invited to participate. Postural balance was conducted on 55 children residing in Marietta, Ohio and the surrounding area. Samples of blood were collected and analyzed for Mn and Pb, and samples of hair were analyzed for Mn. Neuromotor performance was assessed using postural balance testing with a computer force platform system. Pearson correlations were calculated to identify key covariates. Associations between postural balance testing conditions and Mn and Pb exposure were estimated with linear regression analyses adjusting for gender, age, parent IQ, and parent age. Mean blood Mn was 10 μg/L (SEM = 0.36), mean blood Pb was 0.85 μg/dL (SEM = 0.05), and mean hair Mn was 0.76 μg/g (SEM = 0.16). Mean residential distance from the refinery was 11.5 km (SEM = 0.46). All three measures of Mn exposure were significantly associated with poor postural balance. In addition, low-level blood Pb was also negatively associated with balance outcomes. We conclude that Mn exposure and low-level blood Pb are significantly associated with poor postural balance.