Tag Archives: Taiwan

Taiwan Arsenic Study of Limited Value

The confidence intervals on the data analysis presented here are very wide. A lower confidence interval of 1 indicates no effect. Studies such as this showing no association or a weak association are of very limited usefulness.

Hsu LI, Hsieh FI, Wang YH, Lai TS, Wu MM, Chen CJ, Chiou HY, Hsu KH. Arsenic Exposure From Drinking Water and the Incidence of CKD in Low to Moderate Exposed Areas of Taiwan: A 14-Year Prospective Study. Am J Kidney Dis. 2017 Aug 23. pii: S0272-6386(17)30800-4. doi: 10.1053/j.ajkd.2017.06.012.

BACKGROUND: Arsenic exposure is associated with decreased kidney function. The association between low to moderate arsenic exposure and kidney disease has not been fully clarified.

STUDY DESIGN: The association between arsenic exposure from drinking water and chronic kidney disease (CKD) was examined in a long-term prospective observational study.

SETTING & PARTICIPANTS: 6,093 participants 40 years and older were recruited from arseniasis-endemic areas in northeastern Taiwan. Arsenic levels were 28.0, 92.8, and 295.7μg/L at the 50th, 75th, and 90th percentiles, respectively.

PREDICTOR: Well-water arsenic and urinary total arsenic (inorganic plus methylated arsenic species) concentrations, adjusted for urinary creatinine concentration.

OUTCOMES: Kidney diseases (ICD-9 codes: 250.4, 274.1, 283.11, 403.*1, 404.*2, 404.*3, 440.1, 442.1, 447.3, or 580-589) and CKD (ICD-9 code: 585) ascertained using Taiwan’s National Health Insurance database 1998 to2011.

MEASUREMENTS: HRs contrasting CKD risk across arsenic exposure levels were estimated using Cox regression. Prevalence ORs for proteinuria (protein excretion ≥ 200mg/g) comparing quartiles of total urinary arsenic concentrations were estimated using logistic regression.

RESULTS: We identified 1,104 incident kidney disease cases, including 447 CKD cases (incidence rates, 166.5 and 67.4 per 104 person-years, respectively). A dose-dependent association between well-water arsenic concentrations and kidney diseases was observed after adjusting for age, sex, education, body mass index, cigarette smoking, alcohol consumption, and analgesic use. Using arsenic concentration ≤ 10.0μg/L as reference, multivariable-adjusted HRs for incident CKD were 1.12 (95% CI, 0.88-1.42), 1.33 (95% CI, 1.03-1.72), and 1.33 (95% CI, 1.00-1.77) for arsenic concentrations of 10.1 to 49.9, 50.0 to 149.9, and ≥150.0μg/L, respectively (P for trend=0.02). The association between arsenic concentration and kidney diseases was stronger for women (P for interaction=0.06). Arsenic values in the range of 50th to 75th and 75th to 100th percentiles of total urinary arsenic concentrations were associated with 50% and 67% higher prevalences, respectively, of proteinuria.

LIMITATIONS: Kidney diseases and CKD outcomes were based on diagnostic codes. Glomerular filtration rates were not available. Other heavy metals were not measured.

CONCLUSIONS: This study describes the temporal relationship between arsenic concentrations ≥ 10μg/L in drinking water and CKD. A dose-dependent association between well-water arsenic concentration and kidney diseases was observed. Higher creatinine-adjusted urinary total arsenic concentrations were associated with a higher prevalence of proteinuria.

Health Risk of Arsenic in Groundwater, Taiwan

Liang CP, Wang SW, Kao YH, Chen JS. Health risk assessment of groundwater arsenic pollution in southern Taiwan. Environ Geochem Health. 2016 Dec;38(6):1271-1281.

Residents of the Pingtung Plain, Taiwan, use groundwater for drinking. However, monitoring results showed that a considerable portion of groundwater has an As concentration higher than the safe drinking water regulation of 10 μg/L. Considering residents of the Pingtung Plain continue to use groundwater for drinking, this study attempted to evaluate the exposure and health risk from drinking groundwater. The health risk from drinking groundwater was evaluated based on the hazard quotient (HQ) and target risk (TR) established by the US Environmental Protection Agency. The results showed that the 95th percentile of HQ exceeded 1 and TR was above the safe value of threshold value of 10-6. To illustrate significant variability of the drinking water consumption rate and body weight of each individual, health risk assessments were also performed using a spectrum of daily water intake rate and body weight to reasonably and conservatively assess the exposure and health risk for the specific subgroups of population of the Pingtung Plain. The assessment results showed that 0.01-7.50 % of the population’s HQ levels are higher than 1 and as much as 77.7-93.3 % of the population being in high cancer risk category and having a TR value >10-6. The TR estimation results implied that groundwater use for drinking purpose places people at risk of As exposure. The government must make great efforts to provide safe drinking water for residents of the Pingtung Plain.

Arsenic and Chronic Kidney Disease, Taiwan

Cheng YY, Huang NC, Chang YT, Sung JM, Shen KH, Tsai CC, Guo HR.
Associations between arsenic in drinking water and the progression of chronic kidney disease: A nationwide study in Taiwan. J Hazard Mater. 2016 Sep 14;321:432-439. doi: 10.1016/j.jhazmat.2016.09.032.

To evaluate the associations between exposure to arsenic in drinking water and the progression of chronic kidney disease (CKD), we conducted a study in Taiwan. We recruited 8854 participants from a nationwide health screening program from 2000 to 2009 who were at least 20 years old and had two checkups in a 24-month period with at least 12 months apart. We defined CKD as having an estimated glomerular filtration rate (eGFR)5ml/min/1.73m2/year. Arsenic levels were assessed on the basis of a governmental nationwide survey. Of the 8854 participants, 1341 exhibited rapid progression. Participants who lived in areas with arsenic levels≥50μg/L had a higher risk of rapid progression, with an odds ratio of 1.22 (95% confidence interval: 1.05-1.42, p<0.01) after adjusting for hypertension, diabetes mellitus, proteinuria, and anemia. The results showed that a high arsenic level in drinking water was a risk factor for rapid progression of CKD, independent of most of the documented risk factors. Screening and intervention programs should be implemented in endemic areas of exposure to reduce the risk.

Occurrence of Nonylphenol and Bisphenol A in Household Water Pipes

Cheng YC, Chen HW, Chen WL, Chen CY, Wang GS. Occurrence of nonylphenol and bisphenol A in household water pipes made of different materials. Environmental monitoring and assessment 2015 Oct;188(10):562. doi: 10.1007/s10661-016-5556-0.

We assessed the occurrence of nonylphenol (NP) and bisphenol A (BPA) in tap water supplied through polyvinyl chloride (PVC), stainless steel, and galvanized pipes. Water samples were collected from selected households in Taipei and Kaohsiung (Northern and Southern Taiwan, respectively) in different seasons to elucidate the effects of pipeline materials and ambient temperatures on NP and BPA concentrations in tap water. We detected higher concentrations of NP in tap water from households using PVC pipes (64-195 ng/L) than from those using stainless steel pipes (17-44 ng/L) and galvanized pipes (27-96 ng/L). To verify that water can absorb NP and BPA from PVC pipes, we sealed Milli-Q and tap water in PVC and stainless steel pipes to assess the potential release of NP and BPA from the pipes into the water. Both NP and BPA concentrations initially increased with contact time in the PVC pipes, and the concentration profiles during the retention appeared to be more strongly affected by ambient temperatures. Concentration variations in the stainless steel pipes were smaller than those in the PVC pipes.

Prechlorination Increases Nitrosamines and Formation Potentials

Chen WH, Wang CY, Huang TH. Formation and fates of nitrosamines and their formation potentials from a surface water source to drinking water treatment plants in Southern Taiwan. Chemosphere. 2016 Jul 29;161:546-554. doi: 10.1016/j.chemosphere.2016.07.027.

Nitrosamines are toxic and emerging disinfection byproducts. In this study, three drinking water treatment plants (DWTPs) in southern Taiwan treating the same source water in Gaoping River with comparable technologies were selected. The objective was to evaluate the formation and fates of six nitrosamines and their formation potentials (FPs) from a surface water source to drinking water. Albeit decreased further downstream in the river, four nitrosamine-FPs were observed in the source water due to anthropogenic pollution in the upstream areas. In the DWTPs, nitrosamines were formed and NDMA was the main species. While high organic carbon concentrations indicated elevated nitrosamine-FPs in the source water, NDMA formation in the DWTPs was more positively associated with reductions of water parameters that quantify organic matters with double bonded ring structures. Although precursor removal via pre-oxidation is a viable approach to limit nitrosamine formation during post-disinfection, this study clearly indicates that a great portion of NDMA in treated water has been formed in the 1st oxidation step of drinking water treatment. The pre-oxidation simulations in the lab demonstrated the impact of pre-chlorination on nitrosamine formation. Given the limited removal in conventional treatment processes, avoiding nitrosamine-FPs in sources and/or nitrosamine formation during pre-oxidation become important issues to control the threats of nitrosamines in drinking water. Under current circumstance in which pre-oxidation is widely used to optimize the treatment effectiveness in many DWTPs, its adverse effect by forming nitrosamines needs to be carefully minimized and using technologies other than pre-chlorination (e.g., pre-ozonation) may be considered.

Colonial Microcystis Cells Resistant to Chlorine Oxidation

Fan J, Rao, Chiu YT, Lin TF. Impact of chlorine on the cell integrity and toxin release and degradation of colonial Microcystis. Water Research. 2016 Jun 29;102:394-404. doi: 10.1016/j.watres.2016.06.053.

The occurrence of toxic cyanobacteria in drinking water sources is problematic for water authorities as they can impair drinking water quality. Chlorine as a commonly used oxidant in water treatment plants has shown the potential to lyse cyanobacterial cells, resulting in the release of secondary metabolites which are hard to be removed during conventional water treatment processes. The majority of cyanobacterial species such as Microcystis, often occur in colonial forms under natural conditions. However, previous studies have mainly focused on the influence of chlorination on individual cyanobacterial cells due to technique limitations. A syringe dispersion method combined with a fluorescence technique (SYTOX Green stain with flow cytometry), was successfully developed for the evaluation of cell integrity of colonial Microcystis. Chlorination of Microcystis-laden water was conducted at different chlorine dosages for different colonial sizes (<37, 37-270 and 270-550 μm). The results indicated that colonial Microcystis cells were more resistant to chlorine oxidation than individual cells, which may be attributed to protection from the cell-bound mucilage. There was a lag phase before cell rupture occurred and a Delayed Chick Watson Model describes the experimental data very well for the kinetics of cyanobacterial cell rupture. The growing colonial size caused increases in the lag phases but decreases in the cell lysis rates. Chlorination also induced the release of microcystins (MCs) from colonial Microcystis cells. In particular, increased levels of dissolved MCs were observed in Cheng Kung Lake (CKL) water. In summary, the reaction of chlorine with colonial cyanobacteria is more complicated than with individual cells. The efficiency of chlorine oxidation could be reduced by the cell-bound mucilage and natural water matrix. These observations may provide insights for water authorities to assess the risk to drinking water quality posed by chlorination under natural conditions.

Risk Assessment of Arsenic in Groundwater, Southern Taiwan

Liang CP, Wang SW, Kao YH, Chen JS. Health risk assessment of groundwater arsenic pollution in southern Taiwan. Environmental Geochemistry and Health. 2016 Jan 27.

Residents of the Pingtung Plain, Taiwan, use groundwater for drinking. However, monitoring results showed that a considerable portion of groundwater has an As concentration higher than the safe drinking water regulation of 10 μg/L. Considering residents of the Pingtung Plain continue to use groundwater for drinking, this study attempted to evaluate the exposure and health risk from drinking groundwater. The health risk from drinking groundwater was evaluated based on the hazard quotient (HQ) and target risk (TR) established by the US Environmental Protection Agency. The results showed that the 95th percentile of HQ exceeded 1 and TR was above the safe value of threshold value of 10-6. To illustrate significant variability of the drinking water consumption rate and body weight of each individual, health risk assessments were also performed using a spectrum of daily water intake rate and body weight to reasonably and conservatively assess the exposure and health risk for the specific subgroups of population of the Pingtung Plain. The assessment results showed that 0.01-7.50 % of the population’s HQ levels are higher than 1 and as much as 77.7-93.3 % of the population being in high cancer risk category and having a TR value >10-6. The TR estimation results implied that groundwater use for drinking purpose places people at risk of As exposure. The government must make great efforts to provide safe drinking water for residents of the Pingtung Plain.