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Geographic and dietary differences of urinary uranium levels in the Strong Heart Family Study

Journal of Exposure Science & Environmental Epidemiology volume 35, pages 393–402 (2025)Cite this article

Abstract

Background

American Indian (AI) communities are affected by uranium exposure from abandoned mines and naturally contaminated drinking water. Few studies have evaluated geographical differences across AI communities and the role of dietary exposures.

Objective

We evaluated differences in urinary uranium levels by diet and geographical area among AI participants from the Northern Plains, the Southern Plains, and the Southwest enrolled in the Strong Heart Family Study (SHFS).

Methods

We used food frequency questionnaires to determine dietary sources related to urinary uranium levels for 1,682 SHFS participants in 2001–2003. We calculated adjusted geometric mean ratios (GMRs) of urinary uranium for an interquartile range (IQR) increase in self-reported food group consumption accounting for family clustering and adjusting for sociodemographic variables and other food groups. We determined the percentage of variability in urinary uranium explained by diet.

Results

Median (IQR) urinary uranium levels were 0.027 (0.012, 0.057) μg/g creatinine. Urinary uranium levels were higher in Arizona (median 0.039 μg/g) and North Dakota and South Dakota (median 0.038 μg/g) and lower in Oklahoma (median 0.019 μg/g). The adjusted percent increase (95% confidence interval) of urinary uranium levels per IQR increase in reported food intake was 20% (5%, 36%) for organ meat, 11% (1%, 23%) for cereals, and 14% (1%, 29%) for alcoholic drinks. In analyses stratified by study center, the association with organ meat was specific to North Dakota and South Dakota participants. An IQR increase in consumption of fries and chips was inversely associated with urinary uranium levels −11% (−19%, −3%). Overall, we estimated that self-reported dietary exposures explained 1.71% of variability in urine uranium levels.

Impact

Our paper provides a novel assessment of self-reported food intake and urinary uranium levels in a cohort of American Indian participants. We identify foods (organ meat, cereals, and alcohol) positively associated with urinary uranium levels, find that organ meat consumption is only associated with urine uranium in North Dakota and South Dakota, and estimate that diet explains relatively little variation in total urinary uranium concentrations. Our findings contribute meaningful data toward a more comprehensive estimation of uranium exposure among Native American communities and support the need for high-quality assessments of water and dust uranium exposures in SHFS communities.

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Fig. 1: Violin boxplots of urinary U concentration (µg/g creatinine) distributions stratified by study center.
Fig. 2: Geometric mean ratios (GMRs) and 95% confidence intervals of urinary U concentrations (µg/g creatinine) by an increase in reported food item consumption.
Fig. 3: Geometric mean ratios (GMRs) and 95% confidence intervals of urinary uranium levels (µg/g creatinine) by an increase in reported food item, stratified by study center.

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Data availability

Strong Heart Study data is owned by the participating tribes and is not available for public use. Investigators interested in accessing Strong Heart Study data can follow the procedures put in place by the Strong Heart Study Steering committee in agreement with the participating tribes (see www.strongheartstudy.org).

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Acknowledgements

We thank all the Strong Heart Study participants and Tribal Nations that make this research possible.

Funding

The Strong Heart Study was supported by grants from the National Heart, Lung, and Blood Institute contracts 75N92019D00027, 75N92019D00028, 75N92019D00029, and 75N92019D00030; previous grants R01HL090863, R01HL109315, R01HL109301, R01HL109284, R01HL109282, and R01HL109319; and cooperative agreements U01HL41642, U01HL41652, U01HL41654, U01HL65520, and U01HL65521; and by National Institute of Environmental Health Sciences grants R01ES021367, R01ES025216, R01ES032638, P42ES033719, and P30ES009089. Kevin Patterson is also supported by III.

Author information

Authors and Affiliations

  1. Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA

    Kevin P. Patterson, Anne E. Nigra & Ana Navas-Acien

  2. Department of Legal Medicine and Toxicology, School of Medicine, University of Granada, Granada, Spain

    Pablo Olmedo

  3. Area of Cardiometabolic and Renal Risk, Biomedical Research Institute Hospital Clinic of Valencia, Valencia, Spain

    Maria Grau-Perez

  4. Missouri Breaks Industries Research Inc, Eagle Butte, SD, USA

    Rae O’Leary, Marcia O’Leary & Lyle G. Best

  5. Department of Epidemiology, University of Washington, Seattle, WA, USA

    Amanda M. Fretts

  6. MedStar Health Research Institute, Washington, DC, USA

    Jason G. Umans

  7. Institute of Chemistry, University of Graz, Graz, Austria

    Walter Goessler

  8. Texas Biomedical Research Institute, Hyattsville, MD, USA

    Shelley A. Cole

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  1. Kevin P. Patterson
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  2. Anne E. Nigra
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Contributions

KP, AN, and AN-A conceived and designed the study. KP performed the statistical analysis and drafted the initial manuscript. PO and MG-P supported the statistical analysis. PO, MG-P, RO, MO, AF, JU, LB, WG, SC contributed to literature collection, manuscript writing, and editing. AN, AN-A, and SC were responsible for the project’s conceptualization, supervising the project, data interpretation, and manuscript writing and editing.

Corresponding author

Correspondence to Kevin P. Patterson.

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Competing interests

The authors declare no competing interests.

Ethical approval and consent to participate

Informed consent was obtained from all participants. Study protocol was approved by the Indian Health Service institutional review board (IRB) of each area, IRBs of participating institutions, and participating tribes.

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Patterson, K.P., Nigra, A.E., Olmedo, P. et al. Geographic and dietary differences of urinary uranium levels in the Strong Heart Family Study. J Expo Sci Environ Epidemiol 35, 393–402 (2025). https://doi.org/10.1038/s41370-024-00695-6

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