Category Archives: exposure

Community water fluoridation is a major source of fluoride exposure for pregnant women, Canada

Christine Till, Rivka Green, John G. Grundy, Richard Hornung, Raichel Neufeld, E. Angeles Martinez-Mier, Pierre Ayotte, Gina Buckle, and Bruce Lanphear.
Community Water Fluoridation and Urinary Fluoride Concentrations in a National Sample of Pregnant Women in Canada. Environmental Health Perspectives Vol. 126, No. 10. https://doi.org/10.1289/EHP3546

Background: Fluoride exposures have not been established for pregnant women who live in regions with and without community water fluoridation.
Objective: Our aim was to measure urinary fluoride levels during pregnancy. We also assessed the contribution of drinking-water and tea consumption habits to maternal urinary fluoride (MUF) concentrations and evaluated the impact of various dilution correction standards, including adjustment for urinary creatinine and specific gravity (SG).

Methods: We measured MUF concentrations in spot samples collected in each trimester of pregnancy from 1,566 pregnant women in the Maternal–Infant Research on Environmental Chemicals cohort. We calculated intraclass correlation coefficients (ICCs) to assess variability in MUF concentrations across pregnancy. We used regression analyses to estimate associations between MUF levels, tea consumption, and water fluoride concentrations as measured by water treatment plants.

Results: Creatinine-adjusted MUF values (mean±SD; milligrams per liter) were almost two times higher for pregnant women living in fluoridated regions (0.87± 0.50) compared with nonfluoridated regions (0.46±0.34; p<0.001). MUF values tended to increase over the course of pregnancy using both unadjusted values and adjusted values. Reproducibility of the unadjusted and adjusted MUF values was modest (ICC range=0.37–0.40). The municipal water fluoride level was positively associated with creatinine-adjusted MUF (B=0.52, 95% CI: 0.46, 0.57), accounting for 24% of the variance after controlling for covariates. Higher MUF concentrations correlated with numbers of cups of black (r=0.31–0.32) but not green tea (r equals 0.04 to 0.06"r=0.91) and were interchangeable in models examining predictors of MUF.

Conclusion: Community water fluoridation is a major source of fluoride exposure for pregnant women living in Canada. Urinary dilution correction with creatinine and SG were shown to be interchangeable for our sample of pregnant women.

Mexico City food and beverages contain fluoride

Cantoral A, Luna-Villa LC, Mantilla-Rodriguez AA, Mercado A, Lippert F, Liu Y, Peterson KE, Hu H, Téllez-Rojo MM, Martinez-Mier EA. Fluoride Content in Foods and Beverages From Mexico City Markets and Supermarkets. Food and nutrition bulletin. 2019 Jul 25. doi: 10.1177/0379572119858486.

BACKGROUND: Sources of fluoride exposure for Mexicans include foods, beverages, fluoridated salt, and naturally fluoridated water. There are no available data describing fluoride content of foods and beverages consumed in Mexico.

OBJECTIVE: To measure the content of fluoride in foods and beverages typically consumed and to compare their content to that of those from the United States and the United Kingdom.

METHODS: Foods and beverages reported as part of the Mexican Health and Nutrition Survey (n = 182) were purchased in the largest supermarket chains and local markets in Mexico City. Samples were analyzed for fluoride, at least in duplicate, using a modification of the hexamethyldisiloxane microdiffusion method. Value contents were compared to those from the US Department of Agriculture and UK fluoride content tables.

RESULTS: The food groups with the lowest and highest fluoride content were eggs (2.32 µg/100 g) and seafood (371 µg/100 g), respectively. When estimating the amount of fluoride per portion size, the lowest content corresponded to eggs and the highest to fast foods. Meats and sausages, cereals, fast food, sweets and cakes, fruits, dairy products, legumes, and seafood from Mexico presented higher fluoride contents than similar foods from the United States or the United Kingdom. Drinks and eggs from the United States exhibited the highest contents, while this was the case for pasta, soups, and vegetables from the United Kingdom.

CONCLUSION: The majority of items analyzed contained higher fluoride contents than their US and UK counterparts. Data generated provide the first and largest table on fluoride content, which will be useful for future comparisons and estimations.

Meta-analyses are very squishy when something is made up out of nothing

S. Stanley Young and Warren B. Kindzierski. Evaluation of a meta-analysis of air quality and heart attacks, a case studyCritical Reviews in Toxicology  https://doi.org/10.1080/10408444.2019.1576587

It is generally acknowledged that claims from observational studies often fail to replicate. An exploratory study was undertaken to assess the reliability of base studies used in meta-analysis of short-term air quality-myocardial infarction risk and to judge the reliability of statistical evidence from meta-analysis that uses data from observational studies. A highly cited meta-analysis paper examining whether short-term air quality exposure triggers myocardial infarction was evaluated as a case study. The paper considered six air quality components – carbon monoxide, nitrogen dioxide, sulphur dioxide, particulate matter 10 lm and 2.5 lm in diameter (PM10 and PM2.5), and ozone. The number of possible questions and statistical models at issue in each of 34 base papers used were estimated and p-value plots for each of the air components were constructed to evaluate the effect heterogeneity of p-values used from the base papers. Analysis search spaces (number of statistical tests possible) in the base papers were large, median 1⁄4 12,288 (interquartile range 1⁄4 2496 ” 58,368), in comparison to actual statistical test results presented. Statistical test results taken from the base papers may not provide unbiased measures of effect for meta-analysis. Shapes of p-value plots for the six air components were consistent with the possibility of analysis manipulation to obtain small p-values in several base papers. Results suggest the appearance of heterogeneous, researcher-generated p-values used in the meta-analysis rather than unbiased evidence of real effects for air quality. We conclude that this meta-analysis does not provide reliable evidence for an association of air quality components with myocardial risk.

Brewed tea a significant source of trihalomethane exposure

Fakour H, Lo SL. Formation and risk assessment of trihalomethanes through different tea brewing habits. Int J Hyg Environ Health. 2018 Sep 1. pii: S1438-4639(18)30193-7. doi: 10.1016/j.ijheh.2018.08.013.

Trihalomethanes (THMs) are suspected carcinogens and reproductive toxicants commonly found in chlorinated drinking water. This study investigates the formation of THMs and their associated risks during different tea brewing habits. Three main categories of tea (black, oolong, and green) under various brewing conditions and drinking water sources were tested. Tea samples prepared in ordinary thermos flask formed significant levels of total THM (TTHM). The highest TTHM formation came from black tea made with tap water, plausibly due to higher concentrations of reactive THM precursors. Compared with tap water, when the background solution is bottled water or distilled water, less TTHM was observed in prepared tea infusions. The results also revealed that unlike the traditional teapot-based tea serving habit, the removal of THMs is significantly reduced when tea infusion is stored in enclosed containers. Risk assessment analysis based on the survey among tea shop costumers also revealed that cancer risks induced by ingestion of THMs through drinking tea infusions prepared in thermos flask exceeded the tolerable level. Data obtained in this research demonstrated that drinking tea infusions directly from enclosed containers can be a significant source of exposure to THMs.

Exposure routes and health effects of microcystins

Massey IY, Yang F, Ding Z, Yang S, Guo J, Tezi C, Al-Osman M, Kamegni RB, Zeng W. Exposure Routes and Health Effects of Microcystins on Animals and Humans: A Mini-review. Toxicon. 2018 Jul 9. pii: S0041-0101(18)30306-4. doi: 10.1016/j.toxicon.2018.07.010.

Microcystins (MCs) pollution has quickly risen in infamy and has become a major problem to public health worldwide. MCs are a group of monocyclic hepatotoxic peptides, which are produced by some bloom-forming cyanobacteria in water. More than 100 different MCs variants posing a great threat to animals and humans due to their potential carcinogenicity have been reported. To reduce MCs risks, the World Health Organization has set a provisional guideline of 1 µg/L MCs in human’s drinking water. This paper provides an overview of exposure routes of MCs into the human system and health effects on different organs after MCs exposure including the liver, intestine, brain, kidney, lung, heart and reproductive system. In addition, some evidences on human poisoning and deaths associated with MCs exposure are presented. Finally, in order to protect human life against the health threats posed by MCs, this paper also suggests some directions for future research that can advance MCs control and minimize human exposure to MCs.

Nationwide drinking water sampling for exposure assessment, Denmark

Voutchkova DD, Hansen B, Ernstsen V, Kristiansen SM.Nationwide Drinking Water Sampling Campaign for Exposure Assessments in Denmark. International journal of environmental research and public health. 2018 Mar 7;15(3). pii: E467. doi: 10.3390/ijerph15030467.

Nationwide sampling campaign of treated drinking water of groundwater origin was designed and implemented in Denmark in 2013. The main purpose of the sampling was to obtain data on the spatial variation of iodine concentration and speciation in treated drinking water, which was supplied to the majority of the Danish population. This data was to be used in future exposure and epidemiologic studies. The water supply sector (83 companies, owning 144 waterworks throughout Denmark) was involved actively in the planning and implementation process, which reduced significantly the cost and duration of data collection. The dataset resulting from this collaboration covers not only iodine species (I, IO₃, TI), but also major elements and parameters (pH, electrical conductivity, DOC, TC, TN, F, Cl, NO₃, SO₄2-, Ca²⁺, Mg²⁺, K⁺, Na⁺) and a long list of trace elements (n = 66). The water samples represent 144 waterworks abstracting about 45% of the annual Danish groundwater abstraction for drinking water purposes, which supply about 2.5 million Danes (45% of all Danish residents). This technical note presents the design, implementation, and limitations of such a sampling design in detail in order (1) to facilitate the future use of this dataset, (2) to inform future replication studies, or (3) to provide an example for other researchers.

Urinary Arsenic Levels Decline in US Population Served by Public Water Supplies

Nigra AE, Sanchez TR, Nachman KE, Harvey D, Chillrud SN, Graziano JH, Navas-Acien A. The effect of the Environmental Protection Agency maximum contaminant level on arsenic exposure in the USA from 2003 to 2014: an analysis of the National Health and Nutrition Examination Survey (NHANES). Lancet Public Health. 2017 Nov;2(11):e513-e521. doi: 10.1016/S2468-2667(17)30195-0.

BACKGROUND: The current US Environmental Protection Agency (EPA) maximum contaminant level (MCL) for arsenic in public water systems (10 µg/L) took effect in 2006. Arsenic is not federally regulated in private wells. The impact of the 2006 MCL on arsenic exposure in the US, as confirmed through biomarkers, is presently unknown. We evaluated national trends in water arsenic exposure in the US, hypothesizing that urinary arsenic levels would decrease over time among participants using public water systems but not among those using well water. We further estimated the expected number of avoided lung, bladder, and skin cancer cases.

METHODS: We evaluated 14,127 participants in the National Health and Nutrition Examination Survey (NHANES) 2003-2014 with urinary dimethylarsinate (DMA) and total arsenic available. To isolate water exposure, we expanded a residual-based method to remove tobacco and dietary contributions of arsenic. We applied EPA risk assessment approaches to estimate the expected annual number of avoided cancer cases comparing arsenic exposure in 2013-2014 vs. 2003-2004.

FINDINGS: Among public water users, fully adjusted geometric means (GMs) of DMA decreased from 3.01 µg/L in 2003-2004 to 2.49 µg/L in 2013-2014 (17% reduction; 95% confidence interval 10%, 24%; p-trend<0.01); no change was observed among well water users (p-trend= 0.35). Assuming these estimated exposure reductions will remain similar across a lifetime, we estimate a reduction of 200 to 900 lung and bladder cancer cases per year depending on the approach used.

INTERPRETATION: The decline in urinary arsenic among public water but not private well users in NHANES 2003-2014 indicates that the implementation of the current MCL has reduced arsenic exposure in the US population. Our study supports prior work showing that well water users are inadequately protected against drinking water arsenic, and confirms the critical role of federal drinking water regulations in reducing toxic exposures and protecting human health.