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Botton J, Kogevinas M, Gracia-Lavedan E, Patelarou E, Roumeliotaki T, Iñiguez C, Santa Marina L, Ibarluzea J, Ballester F, Mendez MA, Chatzi L, Sunyer J, Villanueva CM. Postnatal weight growth and trihalomethane exposure during pregnancy. Environ Res 2015; 136:280-288. [PMID: 25460647 DOI: 10.1016/j.envres.2014.09.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 09/04/2014] [Accepted: 09/16/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Impaired postnatal growth after chloroform exposure in utero has been observed in rodents without an effect on birth weight. We aimed to study the relationship between exposure to trihalomethanes (THMs) during pregnancy and postnatal weight growth during infancy. METHODS We analysed 2216 mother-child pairs recruited in Gipuzkoa, Sabadell, Valencia (Spain, INMA Project, enrollment: 2003-2008) and Crete (Greece, RHEA Study, enrollment: 2007-2008). Drinking water habits and water-related activities ascertained through personal interviews were combined with THM measurements in drinking water to estimate THM exposure through different exposure routes during pregnancy. Weight measurements during the first year of life were used to fit postnatal weight growth curves from birth to one year and to predict weight at six months. Multiple linear regression was used to evaluate the relationship between six months weight gain and interquartile range (IQR) increase in THM exposure adjusting for confounders. RESULTS Average weight gain at six months ranged from 4325 g (Gipuzkoa) to 4668 g (Crete). Median residential THM levels ranged from 1 μg/l (Crete) to 117 μg/l (Sabadell). No significant association was observed overall (-24.4 g [95% CI -78.8, 30.0] for an IQR increase in total residential uptake). A negative relationship was observed in Sabadell (-148 g [95% CI -282, -13.7]) for an IQR increase in ingestion THM uptake. CONCLUSIONS No consistent evidence of an association between THM exposure during pregnancy and postnatal growth was observed. The novelty of the hypothesis and the negative trend observed in the region with the highest levels warrants the replication in future studies.
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Affiliation(s)
- Jérémie Botton
- Inserm, UMR-S1018, CESP, Centre for Research in Epidemiology and Population Health, Epidemiology of diabetes, obesity and chronic kidney disease over the lifecourse Team, Villejuif, France; University Paris Sud, Faculty of Pharmacy, Châtenay-Malabry, France; Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; IMIM (Hospital del Mar Research Institute), Barcelona, Spain.
| | - Manolis Kogevinas
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; IMIM (Hospital del Mar Research Institute), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain; National School of Public Health, Athens, Greece
| | - Esther Gracia-Lavedan
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Evridiki Patelarou
- Department of Social Medicine, School of Medicine, University of Crete, Greece; Florence Nightingale School of Nursing and Midwifery, King's College London, London, United Kingdom
| | - Theano Roumeliotaki
- Department of Social Medicine, School of Medicine, University of Crete, Greece
| | - Carmen Iñiguez
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Centre for Public Health Research (CSISP-FISABIO), Valencia, Spain; University of Valencia, Valencia, Spain
| | - Loreto Santa Marina
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Subdirección de Salud Pública de Gipuzkoa, Spain; BIODONOSTIA Health Research Institute, San Sebastian, Spain
| | - Jesús Ibarluzea
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Subdirección de Salud Pública de Gipuzkoa, Spain; BIODONOSTIA Health Research Institute, San Sebastian, Spain
| | - Ferran Ballester
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Centre for Public Health Research (CSISP-FISABIO), Valencia, Spain; University of Valencia, Valencia, Spain
| | - Michelle A Mendez
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; IMIM (Hospital del Mar Research Institute), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Leda Chatzi
- Department of Social Medicine, School of Medicine, University of Crete, Greece
| | - Jordi Sunyer
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; IMIM (Hospital del Mar Research Institute), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Cristina M Villanueva
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; IMIM (Hospital del Mar Research Institute), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
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Dadvand P, Villanueva CM, Font-Ribera L, Martinez D, Basagaña X, Belmonte J, Vrijheid M, Gražulevičienė R, Kogevinas M, Nieuwenhuijsen MJ. Risks and benefits of green spaces for children: a cross-sectional study of associations with sedentary behavior, obesity, asthma, and allergy. Environ Health Perspect 2014; 122:1329-35. [PMID: 25157960 PMCID: PMC4256701 DOI: 10.1289/ehp.1308038] [Citation(s) in RCA: 189] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 08/25/2014] [Indexed: 05/17/2023]
Abstract
BACKGROUND Green spaces have been associated with both health benefits and risks in children; however, available evidence simultaneously investigating these conflicting influences, especially in association with different types of greenness, is scarce. OBJECTIVES We aimed to simultaneously evaluate health benefits and risks associated with different types of greenness in children, in terms of sedentary behavior (represented by excessive screen time), obesity, current asthma, and allergic rhinoconjunctivitis. METHODS We conducted a cross-sectional study of a population-based sample of 3,178 schoolchildren (9-12 years old) in Sabadell, Spain, in 2006. Information on outcomes and covariates was obtained by questionnaire. We measured residential surrounding greenness as the average of satellite-derived Normalized Difference Vegetation Index (NDVI) in buffers of 100 m, 250 m, 500 m, and 1,000 m around each home address. Residential proximity to green spaces was defined as living within 300 m of a forest or a park, as separate variables. We used logistic regression models to estimate associations separately for each exposure-outcome pair, adjusted for relevant covariates. RESULTS An interquartile range increase in residential surrounding greenness was associated with 11-19% lower relative prevalence of overweight/obesity and excessive screen time, but was not associated with current asthma and allergic rhinoconjunctivitis. Similarly, residential proximity to forests was associated with 39% and 25% lower relative prevalence of excessive screen time and overweight/obesity, respectively, but was not associated with current asthma. In contrast, living close to parks was associated with a 60% higher relative prevalence of current asthma, but had only weak negative associations with obesity/overweight or excessive screen time. CONCLUSION We observed two separable patterns of estimated health benefits and risks associated with different types of greenness.
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Affiliation(s)
- Payam Dadvand
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
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Salas LA, Gracia-Lavedan E, Goñi F, Moreno V, Villanueva CM. Use of urinary trichloroacetic acid as an exposure biomarker of disinfection by-products in cancer studies. Environ Res 2014; 135:276-284. [PMID: 25462676 DOI: 10.1016/j.envres.2014.09.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 09/19/2014] [Accepted: 09/25/2014] [Indexed: 06/04/2023]
Abstract
Urinary trichloroacetic acid (TCAA) has been proposed as a valid exposure biomarker for ingested disinfection by-products (DBP) for reproductive studies. However, it has never been used in epidemiologic studies on cancer. We investigate the performance of urinary TCAA as a biomarker of DBP exposure in the framework of an epidemiologic study on cancer. We conducted home visits to collect tap water, first morning void urine, and a 48h fluid intake diary among 120 controls from a case-control study of colorectal cancer in Barcelona, Spain. We measured urine TCAA and creatinine, and 9 haloacetic acids and 4 trihalomethanes (THM) in tap water. Lifetime THM exposure was estimated based on residential history since age 18 plus routine monitoring data. Robust linear regressions were used to estimate mean change in urinary TCAA adjusted by covariates. Among the studied group, mean age was 74 years (range 63-85) and 41 (34%) were females. Mean total tap water consumption was 2.2l/48h (standard error, 0.1l/48h). Geometric mean urine TCAA excretion rate was 17.3pmol/min [95%CI: 14.0-21.3], which increased 2% for a 10% increase in TCAA ingestion and decreased with total tap water consumption (-17%/l), water intake outside home (-32%), plasmatic volume (-64%/l), in smokers (-79%), and in users of non-steroidal anti-inflammatory drugs (-50%). Urinary TCAA levels were not associated with lifetime THM exposure. In conclusion, our findings support that urine TCAA is not a valid biomarker in case-control studies of adult cancer given that advanced age, comorbidites and medication use are prevalent and are determinants of urine TCAA levels, apart from ingested TCAA levels. In addition, low TCAA concentrations in drinking water limit the validity of urine TCAA as an exposure biomarker.
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Affiliation(s)
- Lucas A Salas
- Centre for Research in Environmental Epidemiology (CREAL), Doctor Aiguader 88, 08003 Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Esther Gracia-Lavedan
- Centre for Research in Environmental Epidemiology (CREAL), Doctor Aiguader 88, 08003 Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Fernando Goñi
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Basque Laboratory of Health, Gipuzkoa, Spain; BioDonostia Health Research Institute, Spain
| | - Victor Moreno
- Catalan Institute of Oncology (ICO), Spain; Bellvitge Biomedical Research Institute (IDIBELL), Spain; University of Barcelona (UB), Spain
| | - Cristina M Villanueva
- Centre for Research in Environmental Epidemiology (CREAL), Doctor Aiguader 88, 08003 Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Spain.
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Sazakli E, Villanueva CM, Kogevinas M, Maltezis K, Mouzaki A, Leotsinidis M. Chromium in drinking water: association with biomarkers of exposure and effect. Int J Environ Res Public Health 2014; 11:10125-45. [PMID: 25268509 PMCID: PMC4210971 DOI: 10.3390/ijerph111010125] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Revised: 09/16/2014] [Accepted: 09/16/2014] [Indexed: 11/23/2022]
Abstract
An epidemiological cross-sectional study was conducted in Greece to investigate health outcomes associated with long-term exposure to chromium via drinking water. The study population consisted of 304 participants. Socio-demographics, lifestyle, drinking water intake, dietary habits, occupational and medical history data were recorded through a personal interview. Physical examination and a motor test were carried out on the individuals. Total chromium concentrations were measured in blood and hair of the study subjects. Hematological, biochemical and inflammatory parameters were determined in blood. Chromium in drinking water ranged from <0.5 to 90 μg·L-1 in all samples but one (220 μg·L-1), with a median concentration of 21.2 μg·L-1. Chromium levels in blood (median 0.32 μg·L-1, range <0.18-0.92 μg·L-1) and hair (median 0.22 μg·g-1, range 0.03-1.26 μg·g-1) were found within "normal range" according to the literature. Personal lifetime chromium exposure dose via drinking water, calculated from the results of the water analyses and the questionnaire data, showed associations with blood and hair chromium levels and certain hematological and biochemical parameters. Groups of subjects whose hematological or biochemical parameters were outside the normal range were not correlated with chromium exposure dose, except for groups of subjects with high triglycerides or low sodium. Motor impairment score was not associated with exposure to chromium.
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Affiliation(s)
- Eleni Sazakli
- Lab of Public Health, Medical School, University of Patras, University Campus, Patras, GR 26504, Greece.
| | - Cristina M Villanueva
- Centre for Research in Environmental Epidemiology (CREAL), Doctor Aiguader 88, Barcelona 08003, Spain.
| | - Manolis Kogevinas
- Centre for Research in Environmental Epidemiology (CREAL), Doctor Aiguader 88, Barcelona 08003, Spain.
| | | | - Athanasia Mouzaki
- Division of Hematology, Department of Internal Medicine, Medical School, University of Patras, University Campus, Patras, GR 26504, Greece.
| | - Michalis Leotsinidis
- Lab of Public Health, Medical School, University of Patras, University Campus, Patras, GR 26504, Greece.
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Font-Ribera L, Villanueva CM, Gràcia-Lavedan E, Borràs-Santos A, Kogevinas M, Zock JP. Indoor swimming pool attendance and respiratory and dermal health in schoolchildren--HITEA Catalonia. Respir Med 2014; 108:1056-9. [PMID: 24835075 DOI: 10.1016/j.rmed.2014.04.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 04/11/2014] [Accepted: 04/22/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Health benefits of swimming in pools may outweigh adverse health outcomes in children, but evidence from epidemiological studies is scarce or inconclusive for different health outcomes. We evaluated the association between indoor swimming pool attendance during childhood and respiratory and dermal conditions and symptoms in Catalan schoolchildren. METHODS Cross-sectional study in 2758 children aged 6-12 years from 18 primary schools in Barcelona province. Information on regular indoor swimming pool attendance in seven age periods, history of health conditions (asthma, wheezing, eczema, dermatitis, rhinitis, allergic rhinitis) and symptoms in the last 12 months (wheezing, dermatitis, rhinitis and number of cold, tonsillitis or otitis episodes) were collected through parental self-administered questionnaires. The associations between swimming pool attendance and health outcomes were evaluated using multivariate mixed logistic and Poisson regression models. RESULTS Regular indoor swimming before 2 years of age was not related to having ever had asthma (Odds Ratio (OR) = 1.14; 95%CI = 0.73-1.77), wheezing (OR = 1.02; 95%CI = 0.82-1.28), or eczema (OR = 1.09; 95%CI = 0.87-1.36). Current indoor swimming was not associated with symptoms in the last 12 months (Incidence Rate Ratio for otitis was 0.94; 95%CI = 0.77-1.15). Stratification by eczema or maternal education gave very similar results. CONCLUSION This new large population-based study indicates that regular indoor swimming during infancy does not increase respiratory, allergic or dermal symptoms in Catalan schoolchildren aged 6-12 years.
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Affiliation(s)
- Laia Font-Ribera
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain.
| | - Cristina M Villanueva
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Esther Gràcia-Lavedan
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Alícia Borràs-Santos
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Manolis Kogevinas
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; National School of Public Health, Athens, Greece
| | - Jan-Paul Zock
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; Netherlands Institute for Health Services Research, Utrecht, The Netherlands
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Villanueva CM, Kogevinas M, Cordier S, Templeton MR, Vermeulen R, Nuckols JR, Nieuwenhuijsen MJ, Levallois P. Assessing exposure and health consequences of chemicals in drinking water: current state of knowledge and research needs. Environ Health Perspect 2014; 122:213-21. [PMID: 24380896 PMCID: PMC3948022 DOI: 10.1289/ehp.1206229] [Citation(s) in RCA: 129] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 12/24/2013] [Indexed: 05/20/2023]
Abstract
BACKGROUND Safe drinking water is essential for well-being. Although microbiological contamination remains the largest cause of water-related morbidity and mortality globally, chemicals in water supplies may also cause disease, and evidence of the human health consequences is limited or lacking for many of them. OBJECTIVES We aimed to summarize the state of knowledge, identify gaps in understanding, and provide recommendations for epidemiological research relating to chemicals occurring in drinking water. DISCUSSION Assessing exposure and the health consequences of chemicals in drinking water is challenging. Exposures are typically at low concentrations, measurements in water are frequently insufficient, chemicals are present in mixtures, exposure periods are usually long, multiple exposure routes may be involved, and valid biomarkers reflecting the relevant exposure period are scarce. In addition, the magnitude of the relative risks tends to be small. CONCLUSIONS Research should include well-designed epidemiological studies covering regions with contrasting contaminant levels and sufficient sample size; comprehensive evaluation of contaminant occurrence in combination with bioassays integrating the effect of complex mixtures; sufficient numbers of measurements in water to evaluate geographical and temporal variability; detailed information on personal habits resulting in exposure (e.g., ingestion, showering, swimming, diet); collection of biological samples to measure relevant biomarkers; and advanced statistical models to estimate exposure and relative risks, considering methods to address measurement error. Last, the incorporation of molecular markers of early biological effects and genetic susceptibility is essential to understand the mechanisms of action. There is a particular knowledge gap and need to evaluate human exposure and the risks of a wide range of emerging contaminants. CITATION Villanueva CM, Kogevinas M, Cordier S, Templeton MR, Vermeulen R, Nuckols JR, Nieuwenhuijsen MJ, Levallois P. 2014. Assessing exposure and health consequences of chemicals in drinking water: current state of knowledge and research needs. Environ Health Perspect 122:213–221; http://dx.doi.org/10.1289/ehp.1206229
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Abstract
This article is focused on the epidemiological evidence on the health impacts related to disinfection by-products (DBPs) in swimming pools, which is a chemical hazard generated as an undesired consequence to reduce the microbial pathogens. Specific DBPs are carcinogenic, fetotoxic and/or irritant to the airways according to experimental studies. Epidemiological evidence shows that swimming in pools during pregnancy is not associated with an increased risk of reproductive outcomes. An epidemiological study suggested an increased risk of bladder cancer with swimming pool attendance, although evidence is inconclusive. A higher prevalence of respiratory symptoms including asthma is found among swimming pool workers and elite swimmers, although the causality of this association is unclear. The body of evidence in children indicates that asthma is not increased by swimming pool attendance. Overall, the available knowledge suggests that the health benefits of swimming outweigh the potential health risks of chemical contamination. However, the positive effects of swimming should be enhanced by minimising potential risks.
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Salas LA, Cantor KP, Tardon A, Serra C, Carrato A, Garcia-Closas R, Rothman N, Malats N, Silverman D, Kogevinas M, Villanueva CM. Biological and statistical approaches for modeling exposure to specific trihalomethanes and bladder cancer risk. Am J Epidemiol 2013; 178:652-60. [PMID: 23648803 PMCID: PMC3736753 DOI: 10.1093/aje/kwt009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 01/15/2013] [Indexed: 11/13/2022] Open
Abstract
Lifetime exposure to trihalomethanes (THM) has been associated with increased risk of bladder cancer. We explored methods of analyzing bladder cancer risk associated with 4 THM (chloroform, bromodichloromethane, dibromochloromethane, and bromoform) as surrogates for disinfection by-product (DBP) mixtures in a case-control study in Spain (1998-2001). Lifetime average concentrations of THM in the households of 686 incident bladder cancer cases and 750 matched hospital-based controls were calculated. Several exposure metrics were modeled through conditional logistic regression, including the following analyses: total THM (μg/L), cytotoxicity-weighted sum of total THM (pmol/L), 4 THM in separate models, 4 THM in 1 model, chloroform and the sum of brominated THM in 1 model, and a principal-components analysis. THM composition, concentrations, and correlations varied between areas. The model for total THM was stable and showed increasing dose-response trends. Models for separate THM provided unstable estimates and inconsistent dose-response relationships. Risk estimation for specific THM is hampered by the varying composition of the mixture, correlation between species, and imprecision of historical estimates. Total THM (μg/L) provided a proxy measure of DBPs that yielded the strongest dose-response relationship with bladder cancer risk. A variety of metrics and statistical approaches should be used to evaluate this association in other settings.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Cristina M. Villanueva
- Correspondence to Dr. Cristina M. Villanueva, Centre for Research in Environmental Epidemiology, Barcelona Biomedical Research Park, Dr. Aiguader 88, 08003 Barcelona, Spain (e-mail: )
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Font-Ribera L, Villanueva CM, Ballester F, Santa Marina L, Tardón A, Espejo-Herrera N, Esplugues A, Rodríguez Dehli C, Basterrechea M, Sunyer J. Swimming pool attendance, respiratory symptoms and infections in the first year of life. Eur J Pediatr 2013; 172:977-85. [PMID: 23468123 DOI: 10.1007/s00431-013-1975-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 02/11/2013] [Indexed: 11/26/2022]
Abstract
UNLABELLED We evaluated the relationship between indoor and outdoor swimming pool attendance and respiratory symptoms and infections during the first year of life. A population-based mother-child cohort study was conducted in four Spanish areas (INMA project). Study subjects were recruited at pregnancy, followed to delivery and 14 months after birth. Information on swimming pool attendance and health manifestations during the first year of life was collected at 14 months: low respiratory tract infection (LRTI), persistent cough, wheezing, atopic eczema and otitis. Odds ratios and 95 % confidence interval (OR 95 %CI) were calculated by logistic regression adjusting for confounders. Among the 2,205 babies included, 37 % reported having LRTI, 37 % wheezing, 16 % persistent cough, 22 % atopic eczema, 33 % otitis and 50 % attended swimming pools during the first year of life. Around 40 % went to outdoor pools in summer with a median cumulative duration of 7.5 h/year, and 20 % attended indoor pools with a median cumulative duration of 18 h/year. Pool attendance differed by area, season of birth and sociodemographic characteristics, and was not associated with LRTI, wheezing, persistent cough, atopic eczema or otitis. Adjusted OR of wheezing and LRTI were, respectively, 1.06 (95 %CI, 0.88-1.28) and 1.09 (0.90-1.31) for babies attending vs. babies not attending pools. Stratification by type of swimming pool, cumulative duration or parental atopy did not modify the results. CONCLUSION No association was detected between pool attendance and LRTI, wheezing, persistent cough, atopic eczema or otitis during the first year of life in Spain.
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Affiliation(s)
- Laia Font-Ribera
- CREAL-Centre for Research in Environmental Epidemiology, Barcelona Biomedical Research Park, Dr. Aiguader, 88, 08003 Barcelona, Spain
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Espejo-Herrera N, Kogevinas M, Castaño-Vinyals G, Aragonés N, Boldo E, Ardanaz E, Azpiroz L, Ulibarrena E, Tardón A, Molina AJ, López-Rojo C, Jiménez-Moleón JJ, Capelo R, Gómez-Acebo I, Ripoll M, Villanueva CM. Nitrate and trace elements in municipal and bottled water in Spain. Gaceta Sanitaria 2013; 27:156-60. [DOI: 10.1016/j.gaceta.2012.02.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Revised: 02/02/2012] [Accepted: 02/07/2012] [Indexed: 10/28/2022]
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Jeong CH, Wagner ED, Siebert VR, Anduri S, Richardson SD, Daiber EJ, McKague AB, Kogevinas M, Villanueva CM, Goslan EH, Luo W, Isabelle LM, Pankow JF, Grazuleviciene R, Cordier S, Edwards SC, Righi E, Nieuwenhuijsen MJ, Plewa MJ. Occurrence and toxicity of disinfection byproducts in European drinking waters in relation with the HIWATE epidemiology study. Environ Sci Technol 2012; 46:12120-8. [PMID: 22958121 PMCID: PMC4790091 DOI: 10.1021/es3024226] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The HIWATE (Health Impacts of long-term exposure to disinfection byproducts in drinking WATEr) project was a systematic analysis that combined the epidemiology on adverse pregnancy outcomes and other health effects with long-term exposure to low levels of drinking water disinfection byproducts (DBPs) in the European Union. The present study focused on the relationship of the occurrence and concentration of DBPs with in vitro mammalian cell toxicity. Eleven drinking water samples were collected from five European countries. Each sampling location corresponded with an epidemiological study for the HIWATE program. Over 90 DBPs were identified; the range in the number of DBPs and their levels reflected the diverse collection sites, different disinfection processes, and the different characteristics of the source waters. For each sampling site, chronic mammalian cell cytotoxicity correlated highly with the numbers of DBPs identified and the levels of DBP chemical classes. Although there was a clear difference in the genotoxic responses among the drinking waters, these data did not correlate as well with the chemical analyses. Thus, the agents responsible for the genomic DNA damage observed in the HIWATE samples may be due to unresolved associations of combinations of identified DBPs, unknown emerging DBPs that were not identified, or other toxic water contaminants. This study represents the first to integrate quantitative in vitro toxicological data with analytical chemistry and human epidemiologic outcomes for drinking water DBPs.
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Affiliation(s)
- Clara H. Jeong
- University of Illinois at Urbana-Champaign, College of Agricultural, Consumer and Environmental Sciences, Urbana, IL, United States of America
| | - Elizabeth D. Wagner
- University of Illinois at Urbana-Champaign, College of Agricultural, Consumer and Environmental Sciences, Urbana, IL, United States of America
| | - Vincent R. Siebert
- University of Illinois at Urbana-Champaign, College of Agricultural, Consumer and Environmental Sciences, Urbana, IL, United States of America
| | - Sridevi Anduri
- U.S. Environmental Protection Agency, National Exposure Research Laboratory, Athens, GA, United States of America
| | - Susan D. Richardson
- U.S. Environmental Protection Agency, National Exposure Research Laboratory, Athens, GA, United States of America
| | - Eric J. Daiber
- U.S. Environmental Protection Agency, National Exposure Research Laboratory, Athens, GA, United States of America
| | | | - Manolis Kogevinas
- Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Hospital del Mar Research Institute (IMIM); CIBER Epidemiologia y Salud Publica (CIBERESP)
| | - Cristina M. Villanueva
- Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Hospital del Mar Research Institute (IMIM); CIBER Epidemiologia y Salud Publica (CIBERESP)
| | - Emma H. Goslan
- Cranfield Water Science Institute, Cranfield University, Cranfield, Bedford, United Kingdom
| | - Wentai Luo
- Portland State University, Portland, OR, United States of America
| | | | - James F. Pankow
- Portland State University, Portland, OR, United States of America
| | | | - Sylvaine Cordier
- National Institute for Health and Medical Research (INSERM), U1085-IRSET; University of Rennes I, Rennes, France
| | - Susan C. Edwards
- MRC-HPA Centre for Environment & Health, Imperial College, London, United Kingdom
| | - Elena Righi
- Department of Public Health Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Mark J. Nieuwenhuijsen
- Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Hospital del Mar Research Institute (IMIM); CIBER Epidemiologia y Salud Publica (CIBERESP)
| | - Michael J. Plewa
- University of Illinois at Urbana-Champaign, College of Agricultural, Consumer and Environmental Sciences, Urbana, IL, United States of America
- Corresponding Author, M.J. Plewa, , 217-333-3614
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Lourencetti C, Grimalt JO, Marco E, Fernandez P, Font-Ribera L, Villanueva CM, Kogevinas M. Trihalomethanes in chlorine and bromine disinfected swimming pools: air-water distributions and human exposure. Environ Int 2012; 45:59-67. [PMID: 22572118 DOI: 10.1016/j.envint.2012.03.009] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2010] [Revised: 03/20/2012] [Accepted: 03/22/2012] [Indexed: 05/31/2023]
Abstract
This first study of trihalomethanes (THMs) in swimming pools using bromine agents for water disinfection under real conditions shows that the mixtures of these compounds are largely dominated by bromoform in a similar process as chloroform becomes the dominant THM in pools disinfected with chlorine agents. Bromoform largely predominates in air and water of the pool installations whose concentration changes are linearly correlated. However, the air concentrations of bromoform account for about 6-11% of the expected concentrations according to theoretical partitioning defined by the Henry law. Bromoform in exhaled air of swimmers is correlated with the air concentrations of this disinfectant by-product in the pool building. Comparison of the THM exhaled air concentrations between swimmers and volunteers bathing in the water without swimming or standing in the building outside the water suggest that physical activity enhance exposure to these disinfectant by-products. They also indicate that in swimming pools, besides inhalation, dermal absorption is a relevant route for the incorporation of THMs, particularly those with lower degree of bromination.
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Affiliation(s)
- Carolina Lourencetti
- Department of Environmental Chemistry (I.D.Æ.A.-C.S.I.C.), Jordi Girona, 18, 08034-Barcelona, Catalonia, Spain
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Bustamante M, Danileviciute A, Espinosa A, Gonzalez JR, Subirana I, Cordier S, Chevrier C, Chatzi L, Grazuleviciene R, Sunyer J, Ibarluzea J, Ballester F, Villanueva CM, Nieuwenhuijsen M, Estivill X, Kogevinas M. Influence of fetal glutathione S-transferase copy number variants on adverse reproductive outcomes. BJOG 2012; 119:1141-6. [PMID: 22676722 DOI: 10.1111/j.1471-0528.2012.03400.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
A nested case-control association study was designed to investigate the influence of maternal and fetal copy number variants (CNVs) on reproductive outcomes. Genotypes of ten CNVs encompassing GST and CYP genes were assessed. Significant associations were only found for child CNV genotypes. In particular, the child GSTM1 insertion allele was associated with prematurity protection (odds ratio, 95% CI: 0.67, 0.51-0.89; P < 0.01), whereas the child GSTT2B insertion allele was associated with an increased risk of being small for gestational age (odds ratio, 95% CI: 1.33, 1.07-1.67; P = 0.01). The study highlights the role of the fetal genome in prenatal development and also the need to analyse CNVs in a systematic manner.
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Affiliation(s)
- M Bustamante
- Centre for Research in Environmental Epidemiology, Barcelona, Spain.
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Villanueva CM, Castaño-Vinyals G, Moreno V, Carrasco-Turigas G, Aragonés N, Boldo E, Ardanaz E, Toledo E, Altzibar JM, Zaldua I, Azpiroz L, Goñi F, Tardón A, Molina AJ, Martín V, López-Rojo C, Jiménez-Moleón JJ, Capelo R, Gómez-Acebo I, Peiró R, Ripoll M, Gracia-Lavedan E, Nieuwenhujsen MJ, Rantakokko P, Goslan EH, Pollán M, Kogevinas M. Concentrations and correlations of disinfection by-products in municipal drinking water from an exposure assessment perspective. Environ Res 2012; 114:1-11. [PMID: 22436294 DOI: 10.1016/j.envres.2012.02.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Revised: 01/31/2012] [Accepted: 02/07/2012] [Indexed: 05/31/2023]
Abstract
Although disinfection by-products (DBPs) occur in complex mixtures, studies evaluating health risks have been focused in few chemicals. In the framework of an epidemiological study on cancer in 11 Spanish provinces, we describe the concentration of four trihalomethanes (THMs), nine haloacetic acids (HAA), 3-chloro-4-(dichloromethyl)-5-hydroxy-2(5H)-furanone (MX), four haloacetonitries, two haloketones, chloropicrin and chloral hydrate and estimate correlations. A total of 233 tap water samples were collected in 2010. Principal component analyses were conducted to reduce dimensionality of DBPs. Overall median (range) level of THMs and HAAs was 26.4 (0.8-98.1) and 26.4 (0.9-86.9) μg/l, respectively (N=217). MX analysed in a subset (N=36) showed a median (range) concentration of 16.7 (0.8-54.1)ng/l. Haloacetonitries, haloketones, chloropicrin and chloral hydrate were analysed in a subset (N=16), showing levels from unquantifiable (<1 μg/l) to 5.5 μg/l (dibromoacetonitrile). Spearman rank correlation coefficients between DBPs varied between species and across areas, being highest between dibromochloromethane and dibromochloroacetic acid (r(s)=0.87). Principal component analyses of 13 DBPs (4 THMs, 9 HAAs) led 3 components explaining more than 80% of variance. In conclusion, THMs and HAAs have limited value as predictors of other DBPs on a generalised basis. Principal component analysis provides a complementary tool to address the complex nature of the mixture.
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Affiliation(s)
- Cristina M Villanueva
- Centre for Research in Environmental Epidemiology (CREAL), Doctor Aiguader 88, 08003-Barcelona, Spain.
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65
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Font-Ribera L, Villanueva CM, Nieuwenhuijsen MJ, Zock JP, Kogevinas M, Henderson J. Some Concerns Remain about the Proposed Association between Swimming and Asthma. Am J Respir Crit Care Med 2011. [DOI: 10.1164/ajrccm.184.12.1419a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Villanueva CM, Gracia-Lavedán E, Ibarluzea J, Santa Marina L, Ballester F, Llop S, Tardón A, Fernández MF, Freire C, Goñi F, Basagaña X, Kogevinas M, Grimalt JO, Sunyer J. Exposure to trihalomethanes through different water uses and birth weight, small for gestational age, and preterm delivery in Spain. Environ Health Perspect 2011; 119:1824-30. [PMID: 21810554 PMCID: PMC3261969 DOI: 10.1289/ehp.1002425] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Accepted: 08/02/2011] [Indexed: 05/18/2023]
Abstract
BACKGROUND Evidence associating exposure to water disinfection by-products with reduced birth weight and altered duration of gestation remains inconclusive. OBJECTIVE We assessed exposure to trihalomethanes (THMs) during pregnancy through different water uses and evaluated the association with birth weight, small for gestational age (SGA), low birth weight (LBW), and preterm delivery. METHODS Mother-child cohorts set up in five Spanish areas during the years 2000-2008 contributed data on water ingestion, showering, bathing, and swimming in pools. We ascertained residential THM levels during pregnancy periods through ad hoc sampling campaigns (828 measurements) and regulatory data (264 measurements), which were modeled and combined with personal water use and uptake factors to estimate personal uptake. We defined outcomes following standard definitions and included 2,158 newborns in the analysis. RESULTS Median residential THM ranged from 5.9 μg/L (Valencia) to 114.7 μg/L (Sabadell), and speciation differed across areas. We estimated that 89% of residential chloroform and 96% of brominated THM uptakes were from showering/bathing. The estimated change of birth weight for a 10% increase in residential uptake was -0.45 g (95% confidence interval: -1.36, 0.45 g) for chloroform and 0.16 g (-1.38, 1.70 g) for brominated THMs. Overall, THMs were not associated with SGA, LBW, or preterm delivery. CONCLUSIONS Despite the high THM levels in some areas and the extensive exposure assessment, results suggest that residential THM exposure during pregnancy driven by inhalation and dermal contact routes is not associated with birth weight, SGA, LBW, or preterm delivery in Spain.
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Castaño-Vinyals G, Nieuwenhuijsen MJ, Moreno V, Carrasco E, Guinó E, Kogevinas M, Villanueva CM. Participation rates in the selection of population controls in a case-control study of colorectal cancer using two recruitment methods. Gaceta Sanitaria 2011; 25:353-6. [DOI: 10.1016/j.gaceta.2010.05.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Revised: 05/06/2010] [Accepted: 05/07/2010] [Indexed: 10/18/2022]
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Abulí A, Fernández-Rozadilla C, Alonso-Espinaco V, Muñoz J, Gonzalo V, Bessa X, González D, Clofent J, Cubiella J, Morillas JD, Rigau J, Latorre M, Fernández-Bañares F, Peña E, Riestra S, Payá A, Jover R, Xicola RM, Llor X, Carvajal-Carmona L, Villanueva CM, Moreno V, Piqué JM, Carracedo A, Castells A, Andreu M, Ruiz-Ponte C, Castellví-Bel S. Case-control study for colorectal cancer genetic susceptibility in EPICOLON: previously identified variants and mucins. BMC Cancer 2011; 11:339. [PMID: 21819567 PMCID: PMC3176240 DOI: 10.1186/1471-2407-11-339] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Accepted: 08/05/2011] [Indexed: 11/10/2022] Open
Abstract
Background Colorectal cancer (CRC) is the second leading cause of cancer death in developed countries. Familial aggregation in CRC is also important outside syndromic forms and, in this case, a polygenic model with several common low-penetrance alleles contributing to CRC genetic predisposition could be hypothesized. Mucins and GALNTs (N-acetylgalactosaminyltransferase) are interesting candidates for CRC genetic susceptibility and have not been previously evaluated. We present results for ten genetic variants linked to CRC risk in previous studies (previously identified category) and 18 selected variants from the mucin gene family in a case-control association study from the Spanish EPICOLON consortium. Methods CRC cases and matched controls were from EPICOLON, a prospective, multicenter, nationwide Spanish initiative, comprised of two independent stages. Stage 1 corresponded to 515 CRC cases and 515 controls, whereas stage 2 consisted of 901 CRC cases and 909 controls. Also, an independent cohort of 549 CRC cases and 599 controls outside EPICOLON was available for additional replication. Genotyping was performed for ten previously identified SNPs in ADH1C, APC, CCDN1, IL6, IL8, IRS1, MTHFR, PPARG, VDR and ARL11, and 18 selected variants in the mucin gene family. Results None of the 28 SNPs analyzed in our study was found to be associated with CRC risk. Although four SNPs were significant with a P-value < 0.05 in EPICOLON stage 1 [rs698 in ADH1C (OR = 1.63, 95% CI = 1.06-2.50, P-value = 0.02, recessive), rs1800795 in IL6 (OR = 1.62, 95% CI = 1.10-2.37, P-value = 0.01, recessive), rs3803185 in ARL11 (OR = 1.58, 95% CI = 1.17-2.15, P-value = 0.007, codominant), and rs2102302 in GALNTL2 (OR = 1.20, 95% CI = 1.00-1.44, P-value = 0.04, log-additive 0, 1, 2 alleles], only rs3803185 achieved statistical significance in EPICOLON stage 2 (OR = 1.34, 95% CI = 1.06-1.69, P-value = 0.01, recessive). In the joint analysis for both stages, results were only significant for rs3803185 (OR = 1.12, 95% CI = 1.00-1.25, P-value = 0.04, log-additive 0, 1, 2 alleles) and borderline significant for rs698 and rs2102302. The rs3803185 variant was not significantly associated with CRC risk in an external cohort (MCC-Spain), but it still showed some borderline significance in the pooled analysis of both cohorts (OR = 1.08, 95% CI = 0.98-1.18, P-value = 0.09, log-additive 0, 1, 2 alleles). Conclusions ARL11, ADH1C, GALNTL2 and IL6 genetic variants may have an effect on CRC risk. Further validation and meta-analyses should be undertaken in larger CRC studies.
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Affiliation(s)
- Anna Abulí
- Department of Gastroenterology, IDIBAPS, Hospital Clínic, CIBERehd, University of Barcelona, Barcelona, Catalonia, Spain
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69
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Castaño-Vinyals G, Cantor KP, Villanueva CM, Tardon A, Garcia-Closas R, Serra C, Carrato A, Malats N, Rothman N, Silverman D, Kogevinas M. Socioeconomic status and exposure to disinfection by-products in drinking water in Spain. Environ Health 2011; 10:18. [PMID: 21410938 PMCID: PMC3068078 DOI: 10.1186/1476-069x-10-18] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Accepted: 03/16/2011] [Indexed: 05/24/2023]
Abstract
BACKGROUND Disinfection by-products in drinking water are chemical contaminants that have been associated with cancer and other adverse effects. Exposure occurs from consumption of tap water, inhalation and dermal absorption. METHODS We determined the relationship between socioeconomic status and exposure to disinfection by-products in 1271 controls from a multicentric bladder cancer case-control study in Spain. Information on lifetime drinking water sources, swimming pool attendance, showering-bathing practices, and socioeconomic status (education, income) was collected through personal interviews. RESULTS The most highly educated subjects consumed less tap water (57%) and more bottled water (33%) than illiterate subjects (69% and 17% respectively, p-value = 0.003). These differences became wider in recent time periods. The time spent bathing or showering was positively correlated with attained educational level (p < 0.001). Swimming pool attendance was more frequent among highly educated subjects compared to the illiterate (odds ratio = 3.4; 95% confidence interval 1.6-7.3). CONCLUSIONS The most highly educated subjects were less exposed to chlorination by-products through ingestion but more exposed through dermal contact and inhalation in pools and showers/baths. Health risk perceptions and economic capacity may affect patterns of water consumption that can result in differences in exposure to water contaminants.
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Affiliation(s)
- Gemma Castaño-Vinyals
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Municipal Institute of Medical Research (IMIM-Hospital del Mar), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Kenneth P Cantor
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Department of Health and Human Services, Bethesda, USA
| | - Cristina M Villanueva
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Municipal Institute of Medical Research (IMIM-Hospital del Mar), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Adonina Tardon
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Universidad de Oviedo, Oviedo, Spain
| | - Reina Garcia-Closas
- Unidad de Investigación, Hospital Universitario de Canarias, La Laguna, Tenerife, Spain
| | - Consol Serra
- Universitat Pompeu Fabra, Barcelona, Spain
- Consorci Hospitalari Parc Taulí, Sabadell, Spain
| | | | - Núria Malats
- Centro Nacional de Investigaciones Oncológicas (CNIO), Madrid, Spain
| | - Nathaniel Rothman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Department of Health and Human Services, Bethesda, USA
| | - Debra Silverman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Department of Health and Human Services, Bethesda, USA
| | - Manolis Kogevinas
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Municipal Institute of Medical Research (IMIM-Hospital del Mar), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Department of Social Medicine, Medical School, University of Crete, Herakleion, Crete, Greece
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Kogevinas M, Villanueva CM, Font-Ribera L, Liviac D, Bustamante M, Espinoza F, Nieuwenhuijsen MJ, Espinosa A, Fernandez P, DeMarini DM, Grimalt JO, Grummt T, Marcos R. Genotoxic effects in swimmers exposed to disinfection by-products in indoor swimming pools. Environ Health Perspect 2010; 118:1531-7. [PMID: 20833606 PMCID: PMC2974689 DOI: 10.1289/ehp.1001959] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Revised: 06/21/2010] [Accepted: 08/03/2010] [Indexed: 05/03/2023]
Abstract
BACKGROUND Exposure to disinfection by-products (DBPs) in drinking water has been associated with cancer risk. A recent study (Villanueva et al. 2007; Am J Epidemiol 165:148-156) found an increased bladder cancer risk among subjects attending swimming pools relative to those not attending. OBJECTIVES We evaluated adults who swam in chlorinated pools to determine whether exposure to DBPs in pool water is associated with biomarkers of genotoxicity. METHODS We collected blood, urine, and exhaled air samples from 49 nonsmoking adult volunteers before and after they swam for 40 min in an indoor chlorinated pool. We estimated associations between the concentrations of four trihalomethanes (THMs) in exhaled breath and changes in micronuclei (MN) and DNA damage (comet assay) in peripheral blood lymphocytes before and 1 hr after swimming; urine mutagenicity (Ames assay) before and 2 hr after swimming; and MN in exfoliated urothelial cells before and 2 weeks after swimming. We also estimated associations and interactions with polymorphisms in genes related to DNA repair or to DBP metabolism. RESULTS After swimming, the total concentration of the four THMs in exhaled breath was seven times higher than before swimming. The change in the frequency of micronucleated lymphocytes after swimming increased in association with higher exhaled concentrations of the brominated THMs (p = 0.03 for bromodichloromethane, p = 0.05 for chlorodibromomethane, p = 0.01 for bromoform) but not chloroform. Swimming was not associated with DNA damage detectable by the comet assay. Urine mutagenicity increased significantly after swimming, in association with the higher concentration of exhaled bromoform (p = 0.004). We found no significant associations with changes in micronucleated urothelial cells. CONCLUSIONS Our findings support potential genotoxic effects of exposure to DBPs from swimming pools. The positive health effects gained by swimming could be increased by reducing the potential health risks of pool water.
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Affiliation(s)
- Manolis Kogevinas
- Centre for Research in Environmental Epidemiology, Barcelona, Spain.
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Cantor KP, Villanueva CM, Silverman DT, Figueroa JD, Real FX, Garcia-Closas M, Malats N, Chanock S, Yeager M, Tardon A, Garcia-Closas R, Serra C, Carrato A, Castaño-Vinyals G, Samanic C, Rothman N, Kogevinas M. Polymorphisms in GSTT1, GSTZ1, and CYP2E1, disinfection by-products, and risk of bladder cancer in Spain. Environ Health Perspect 2010; 118:1545-50. [PMID: 20675267 PMCID: PMC2974691 DOI: 10.1289/ehp.1002206] [Citation(s) in RCA: 153] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Revised: 06/21/2010] [Accepted: 07/30/2010] [Indexed: 05/19/2023]
Abstract
BACKGROUND Bladder cancer has been linked with long-term exposure to disinfection by-products (DBPs) in drinking water. OBJECTIVES In this study we investigated the combined influence of DBP exposure and polymorphisms in glutathione S-transferase (GSTT1, GSTZ1) and cytochrome P450 (CYP2E1) genes in the metabolic pathways of selected by-products on bladder cancer in a hospital-based case-control study in Spain. METHODS Average exposures to trihalomethanes (THMs; a surrogate for DBPs) from 15 years of age were estimated for each subject based on residential history and information on municipal water sources among 680 cases and 714 controls. We estimated effects of THMs and GSTT1, GSTZ1, and CYP2E1 polymorphisms on bladder cancer using adjusted logistic regression models with and without interaction terms. RESULTS THM exposure was positively associated with bladder cancer: adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were 1.2 (0.8-1.8), 1.8 (1.1-2.9), and 1.8 (0.9-3.5) for THM quartiles 2, 3, and 4, respectively, relative to quartile 1. Associations between THMs and bladder cancer were stronger among subjects who were GSTT1 +/+ or +/- versus GSTT1 null (P(interaction) = 0.021), GSTZ1 rs1046428 CT/TT versus CC (P(interaction) = 0.018), or CYP2E1 rs2031920 CC versus CT/TT (P(interaction) = 0.035). Among the 195 cases and 192 controls with high-risk forms of GSTT1 and GSTZ1, the ORs for quartiles 2, 3, and 4 of THMs were 1.5 (0.7-3.5), 3.4 (1.4-8.2), and 5.9 (1.8-19.0), respectively. CONCLUSIONS Polymorphisms in key metabolizing enzymes modified DBP-associated bladder cancer risk. The consistency of these findings with experimental observations of GSTT1, GSTZ1, and CYP2E1 activity strengthens the hypothesis that DBPs cause bladder cancer and suggests possible mechanisms as well as the classes of compounds likely to be implicated.
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Affiliation(s)
- Kenneth P Cantor
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland 20892-7240, USA.
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Richardson SD, DeMarini DM, Kogevinas M, Fernandez P, Marco E, Lourencetti C, Ballesté C, Heederik D, Meliefste K, McKague AB, Marcos R, Font-Ribera L, Grimalt JO, Villanueva CM. What's in the pool? A comprehensive identification of disinfection by-products and assessment of mutagenicity of chlorinated and brominated swimming pool water. Environ Health Perspect 2010; 118:1523-30. [PMID: 20833605 PMCID: PMC2974688 DOI: 10.1289/ehp.1001965] [Citation(s) in RCA: 204] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Revised: 04/22/2010] [Accepted: 06/08/2010] [Indexed: 05/03/2023]
Abstract
BACKGROUND Swimming pool disinfectants and disinfection by-products (DBPs) have been linked to human health effects, including asthma and bladder cancer, but no studies have provided a comprehensive identification of DBPs in the water and related that to mutagenicity. OBJECTIVES We performed a comprehensive identification of DBPs and disinfectant species in waters from public swimming pools in Barcelona, Catalonia, Spain, that disinfect with either chlorine or bromine and we determined the mutagenicity of the waters to compare with the analytical results. METHODS We used gas chromatography/mass spectrometry (GC/MS) to measure trihalomethanes in water, GC with electron capture detection for air, low- and high-resolution GC/MS to comprehensively identify DBPs, photometry to measure disinfectant species (free chlorine, monochloroamine, dichloramine, and trichloramine) in the waters, and an ion chromatography method to measure trichloramine in air. We assessed mutagenicity with the Salmonella mutagenicity assay. RESULTS We identified > 100 DBPs, including many nitrogen-containing DBPs that were likely formed from nitrogen-containing precursors from human inputs, such as urine, sweat, and skin cells. Many DBPs were new and have not been reported previously in either swimming pool or drinking waters. Bromoform levels were greater in brominated than in chlorinated pool waters, but we also identified many brominated DBPs in the chlorinated waters. The pool waters were mutagenic at levels similar to that of drinking water (approximately 1,200 revertants/L-equivalents in strain TA100-S9 mix). CONCLUSIONS This study identified many new DBPs not identified previously in swimming pool or drinking water and found that swimming pool waters are as mutagenic as typical drinking waters.
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Affiliation(s)
- Susan D Richardson
- National Exposure Research Laboratory, U.S. Environmental Protection Agency, Athens, Georgia 30606, USA.
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Font-Ribera L, Esplugues A, Ballester F, Martínez-Argüelles B, Tardón A, Freire C, Fernández MF, Carrasco G, Cases A, Sunyer J, Villanueva CM. Trihalometanos en el agua de piscinas en cuatro zonas de España participantes en el proyecto INMA. Gaceta Sanitaria 2010; 24:483-6. [DOI: 10.1016/j.gaceta.2010.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Revised: 06/10/2010] [Accepted: 07/12/2010] [Indexed: 10/18/2022]
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Font-Ribera L, Kogevinas M, Zock JP, Gómez FP, Barreiro E, Nieuwenhuijsen MJ, Fernandez P, Lourencetti C, Pérez-Olabarría M, Bustamante M, Marcos R, Grimalt JO, Villanueva CM. Short-term changes in respiratory biomarkers after swimming in a chlorinated pool. Environ Health Perspect 2010; 118:1538-44. [PMID: 20833607 PMCID: PMC2974690 DOI: 10.1289/ehp.1001961] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Revised: 05/12/2010] [Accepted: 07/02/2010] [Indexed: 05/03/2023]
Abstract
BACKGROUND Swimming in chlorinated pools involves exposure to disinfection by-products (DBPs) and has been associated with impaired respiratory health. OBJECTIVES We evaluated short-term changes in several respiratory biomarkers to explore mechanisms of potential lung damage related to swimming pool exposure. METHODS We measured lung function and biomarkers of airway inflammation [fractional exhaled nitric oxide (FeNO), eight cytokines, and vascular endothelial growth factor (VEGF) in exhaled breath condensate], oxidative stress (8-isoprostane in exhaled breath condensate), and lung permeability [surfactant protein D (SP-D) and the Clara cell secretory protein (CC16) in serum] in 48 healthy nonsmoking adults before and after they swam for 40 min in a chlorinated indoor swimming pool. We measured trihalomethanes in exhaled breath as a marker of individual exposure to DBPs. Energy expenditure during swimming, atopy, and CC16 genotype (rs3741240) were also determined. RESULTS Median serum CC16 levels increased from 6.01 to 6.21 microg/L (average increase, 3.3%; paired Wilcoxon test p = 0.03), regardless of atopic status and CC16 genotype. This increase was explained both by energy expenditure and different markers of DBP exposure in multivariate models. FeNO was unchanged overall but tended to decrease among atopics. We found no significant changes in lung function, SP-D, 8-isoprostane, eight cytokines, or VEGF. CONCLUSIONS We detected a slight increase in serum CC16, a marker of lung epithelium permeability, in healthy adults after they swam in an indoor chlorinated pool. Exercise and DBP exposure explained this association, without involving inflammatory mechanisms. Further research is needed to confirm the results, establish the clinical relevance of short-term serum CC16 changes, and evaluate the long-term health impacts.
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Affiliation(s)
- Laia Font-Ribera
- Centre for Research in Environmental Epidemiology, Barcelona, Spain
- Municipal Institute of Medical Research, IMIM-Hospital del Mar, Barcelona, Spain
- CEXS (Ciències Experimentals i de la Salut), Universitat Pompeu Fabra, Barcelona, Spain
| | - Manolis Kogevinas
- Centre for Research in Environmental Epidemiology, Barcelona, Spain
- Municipal Institute of Medical Research, IMIM-Hospital del Mar, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Barcelona, Spain
- National School of Public Health, Athens, Greece
| | - Jan-Paul Zock
- Centre for Research in Environmental Epidemiology, Barcelona, Spain
- Municipal Institute of Medical Research, IMIM-Hospital del Mar, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | - Federico P. Gómez
- Hospital Clínic-IDIBAPS (Institut d’Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
- CIBER de Enfermedades Respiratorias, Bunyola, Mallorca, Spain
| | - Esther Barreiro
- Municipal Institute of Medical Research, IMIM-Hospital del Mar, Barcelona, Spain
- CEXS (Ciències Experimentals i de la Salut), Universitat Pompeu Fabra, Barcelona, Spain
- CIBER de Enfermedades Respiratorias, Bunyola, Mallorca, Spain
- Pulmonology Department-URMAR (Unitat de Recerca en Múscul i Aparell Respiratori), IMIM-Hospital del Mar, Barcelona, Spain
| | - Mark J. Nieuwenhuijsen
- Centre for Research in Environmental Epidemiology, Barcelona, Spain
- Municipal Institute of Medical Research, IMIM-Hospital del Mar, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | - Pilar Fernandez
- Institute of Environmental Assessment and Water Research, CSIC (Consejo Superior de Investigaciones Científicas), Barcelona, Spain
| | - Carolina Lourencetti
- Institute of Environmental Assessment and Water Research, CSIC (Consejo Superior de Investigaciones Científicas), Barcelona, Spain
| | - Maitane Pérez-Olabarría
- Municipal Institute of Medical Research, IMIM-Hospital del Mar, Barcelona, Spain
- Pulmonology Department-URMAR (Unitat de Recerca en Múscul i Aparell Respiratori), IMIM-Hospital del Mar, Barcelona, Spain
| | - Mariona Bustamante
- Centre for Research in Environmental Epidemiology, Barcelona, Spain
- Municipal Institute of Medical Research, IMIM-Hospital del Mar, Barcelona, Spain
- CEXS (Ciències Experimentals i de la Salut), Universitat Pompeu Fabra, Barcelona, Spain
| | - Ricard Marcos
- Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joan O. Grimalt
- Institute of Environmental Assessment and Water Research, CSIC (Consejo Superior de Investigaciones Científicas), Barcelona, Spain
| | - Cristina M. Villanueva
- Centre for Research in Environmental Epidemiology, Barcelona, Spain
- Municipal Institute of Medical Research, IMIM-Hospital del Mar, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Barcelona, Spain
- Address correspondence to C.M. Villanueva, Centre for Research in Environmental Epidemiology, Doctor Aiguader 88, Barcelona 08003, Spain. Telephone: 34-93-214-73-44. Fax: 34-93-214-73-02. E-mail:
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Vrijheid M, Martinez D, Aguilera I, Ballester F, Basterrechea M, Esplugues A, Guxens M, Larrañaga M, Lertxundi A, Mendez M, Murcia M, Marina LS, Villanueva CM, Sunyer J. Socioeconomic status and exposure to multiple environmental pollutants during pregnancy: evidence for environmental inequity? J Epidemiol Community Health 2010; 66:106-13. [PMID: 20974841 DOI: 10.1136/jech.2010.117408] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Inequities in the distribution of environmental exposures may add an extra burden to socially disadvantaged populations, especially when acting during vulnerable periods such as pregnancy and early life, but such inequities may be more complex and uncertain than is generally assumed. We therefore examine whether socioeconomic inequities exist in pregnancy exposures to multiple common environmental contaminants in air, water and food. METHODS A Spanish population-based birth cohort study enrolled over 2000 pregnant women between 2004 and 2008. Questionnaires assessed parental education, occupation, country of birth, diet and many other factors. Environmental pollutant assessments included nitrogen dioxide as a marker of traffic-related air pollution, trihalomethanes as a marker of tap water disinfection by-products, organochlorine biomarkers measured in maternal serum during pregnancy (polychlorinated biphenyls (PCB), dichlorodiphenyl dichloroethylene (p,p'-DDE), hexachlorobenzene and β-hexachlorocyclohexane) and mercury concentrations measured in cord blood. RESULTS Associations between socioeconomic status indicators and nitrogen dioxide and trihalomethanes were generally weak and inconsistent in direction. Concentrations of PCB, hexachlorobenzene and mercury were higher in higher social classes than lower social classes. p,p'-DDE and β-hexachlorocyclohexane were not related to social class. Social class explained between 1% and 5% of the variability in pollutant concentrations, much less than other variables such as region of residence, country of birth and maternal age. DISCUSSION This study demonstrates that the general assumption that more disadvantaged populations have higher levels of exposure to environmental pollution does not always hold and requires further elucidation in different international settings.
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Affiliation(s)
- Martine Vrijheid
- CREAL - Centre for Research in Environmental Epidemiology, Barcelona Biomedical Research Park (PRBB) (Room 187.02), Doctor Aiguader, 88; 08003 Barcelona, Spain.
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76
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Font-Ribera L, Villanueva CM, Nieuwenhuijsen MJ, Zock JP, Kogevinas M, Henderson J. Swimming pool attendance, asthma, allergies, and lung function in the Avon Longitudinal Study of Parents and Children cohort. Am J Respir Crit Care Med 2010; 183:582-8. [PMID: 20889905 DOI: 10.1164/rccm.201005-0761oc] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Cross-sectional studies have reported inconsistent findings for the association between recreational swimming pool attendance and asthma and allergic diseases in childhood. OBJECTIVES To examine whether swimming in infancy and childhood was associated with asthma and allergic symptoms at age 7 and 10 years in a UK longitudinal population-based birth cohort, the Avon Longitudinal Study of Parents and Children. METHODS Data on swimming were collected by questionnaire at 6, 18, 38, 42, 57, 65, and 81 months. Data on rhinitis, wheezing, asthma, eczema, hay fever, asthma medication, and potential confounders were collected through questionnaires at 7 and 10 years. Spirometry and skin prick testing were performed at 7 to 8 years. Data for analysis were available for 5,738 children. MEASUREMENTS AND MAIN RESULTS At age 7 years, more than 50% of the children swam once per week or more. Swimming frequency did not increase the risk of any evaluated symptom, either overall or in atopic children. Children with a high versus low cumulative swimming pool attendance from birth to 7 years had an odds ratio of 0.88 (95% confidence interval, 0.56-1.38) and 0.50 (0.28-0.87), respectively, for ever and current asthma at 7 years, and a 0.20 (0.02-0.39) standard deviation increase in the forced midexpiratory flow. Children with asthma with a high versus low cumulative swimming had an odds ratio for current asthma at 10 years of 0.34 (0.14-0.80). CONCLUSIONS This first prospective longitudinal study suggests that swimming did not increase the risk of asthma or allergic symptoms in British children. Swimming was associated with increased lung function and lower risk of asthma symptoms, especially among children with preexisting respiratory conditions.
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Affiliation(s)
- Laia Font-Ribera
- Centre for Research in Environmental Epidemiology, Barcelona, Spain
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77
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Font-Ribera L, Kogevinas M, Nieuwenhuijsen MJ, Grimalt JO, Villanueva CM. Patterns of water use and exposure to trihalomethanes among children in Spain. Environ Res 2010; 110:571-579. [PMID: 20554274 DOI: 10.1016/j.envres.2010.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Revised: 05/13/2010] [Accepted: 05/18/2010] [Indexed: 05/29/2023]
Abstract
Few studies characterizing trihalomethane (THM) exposure or examining potential health effects were conducted in children. The present study describes patterns of water use in children as a source of THM exposure, and estimates the daily THM uptake and the relative contribution of each pathway of exposure. A cross-sectional population-based study was conducted in children 9-12 years of age in Sabadell, Catalonia, Spain (N=2037). We collected individual information on ingestion, frequency and duration of showering, bathing and swimming, source of drinking water, age, sex and parental education. Chloroform, dibromochloroform, bromodichloroform and bromoform in tap, bottled and swimming pool water were measured. The daily chloroform and brominated THM uptakes were estimated combining environmental levels with individual water activities using algorithms reported in the literature. Among the studied group, 80% of children drank bottled water and 20% regularly attended swimming pools. Mean THM concentration in bottled, tap and chlorinated pool water were, respectively, 0.3, 117 and 92 microg/L. Brominated THM predominated in the tap water (84% of total THM) and chloroform predominated in the swimming pool (84% of total THM). Children attending swimming pools had four times higher THM uptake compared to non-swimmers (p-value<0.05). Showering was the main pathway of exposure for non-swimmers. Girls and children with low parental education had a higher THM uptake (p-value<0.05) as they reported taking longer showers and more frequent baths. In conclusion, total and specific THM uptake varied considerably with the personal water uses among children. As drinking water was mainly bottled and bathing was infrequent, showering and swimming in pools were the main pathways of THM exposure. Specific water uses among children slightly differed by sociodemographic characteristics.
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Affiliation(s)
- Laia Font-Ribera
- Centre for Research in Environmental Epidemiology (CREAL), Doctor Aiguader 88, 08003-Barcelona, Spain
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78
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Tomlinson IPM, Dunlop M, Campbell H, Zanke B, Gallinger S, Hudson T, Koessler T, Pharoah PD, Niittymäkix I, Tuupanenx S, Aaltonen LA, Hemminki K, Lindblom A, Försti A, Sieber O, Lipton L, van Wezel T, Morreau H, Wijnen JT, Devilee P, Matsuda K, Nakamura Y, Castellví-Bel S, Ruiz-Ponte C, Castells A, Carracedo A, Ho JWC, Sham P, Hofstra RMW, Vodicka P, Brenner H, Hampe J, Schafmayer C, Tepel J, Schreiber S, Völzke H, Lerch MM, Schmidt CA, Buch S, Moreno V, Villanueva CM, Peterlongo P, Radice P, Echeverry MM, Velez A, Carvajal-Carmona L, Scott R, Penegar S, Broderick P, Tenesa A, Houlston RS. COGENT (COlorectal cancer GENeTics): an international consortium to study the role of polymorphic variation on the risk of colorectal cancer. Br J Cancer 2010; 102:447-54. [PMID: 19920828 PMCID: PMC2816642 DOI: 10.1038/sj.bjc.6605338] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Revised: 09/03/2009] [Accepted: 09/03/2009] [Indexed: 12/24/2022] Open
Abstract
It is now recognised that a part of the inherited risk of colorectal cancer (CRC) can be explained by the co-inheritance of low-penetrance genetic variants. The accumulated experience to date in identifying these variants has served to highlight difficulties in conducting statistically and methodologically rigorous studies and follow-up analyses. The COGENT (COlorectal cancer GENeTics) consortium includes 20 research groups in Europe, Australia, the Americas, China and Japan. The overarching goal of COGENT is to identify and characterise low-penetrance susceptibility variants for CRC through association-based analyses. In this study, we review the rationale for identifying low-penetrance variants for CRC and our proposed strategy for establishing COGENT.
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Affiliation(s)
- I P M Tomlinson
- Molecular and Population Genetics, Nuffield Department of Medicine, University of Oxford, Wellcome Trust Centre for Human Genetics, Roosevelt Drive, Oxford OX3 7BN, UK
| | - M Dunlop
- Institute of Genetics and Molecular Medicine, University of Edinburgh, MRC-HGU, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
| | - H Campbell
- Public Health Sciences, University of Edinburgh, Edinburgh EH89AG, UK
| | - B Zanke
- The Ontario Institute for Cancer Research, The MaRS Center, 101 College St, Suite 800, Toronto, Ontario, Canada M5G 1L7
- The University of Ottawa Faculty of Medicine, 101 Smythe Rd, Ottawa, Ontario, Canada K1H 8L6
- Cancer Care Ontario, 620 University Ave., Toronto, Ontario, Canada M5G 2L7
| | - S Gallinger
- Cancer Care Ontario, 620 University Ave., Toronto, Ontario, Canada M5G 2L7
- Samuel Lunenfeld Research Institute, Mount Sinai Hospital and University of Toronto, 600 University Ave., Toronto, Ontario, Canada M5G 1X5
| | - T Hudson
- The Ontario Institute for Cancer Research, The MaRS Center, 101 College St, Suite 800, Toronto, Ontario, Canada M5G 1L7
| | - T Koessler
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - P D Pharoah
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - I Niittymäkix
- Department of Medical Genetics, Genome-Scale Biology Research Program, Biomedicum 9, University of Helsinki, Helsinki, Finland
| | - S Tuupanenx
- Department of Medical Genetics, Genome-Scale Biology Research Program, Biomedicum 9, University of Helsinki, Helsinki, Finland
| | - L A Aaltonen
- Department of Medical Genetics, Genome-Scale Biology Research Program, Biomedicum 9, University of Helsinki, Helsinki, Finland
| | - K Hemminki
- German Cancer Research Center, Heidelberg, Germany
| | - A Lindblom
- Department of Molecular Medicine and Surgery, Karolinska Institutet, CMM02, Stockholm S17176, Sweden
| | - A Försti
- Department of Molecular Medicine and Surgery, Karolinska Institutet, CMM02, Stockholm S17176, Sweden
| | - O Sieber
- LCCI Biomarker Laboratory, Ludwig Institute for Cancer Research, PO Box 2008, Royal Melbourne Hospital, VIC 3050, Australia
| | - L Lipton
- LCCI Biomarker Laboratory, Ludwig Institute for Cancer Research, PO Box 2008, Royal Melbourne Hospital, VIC 3050, Australia
| | - T van Wezel
- Department of Pathology, Leiden University Medical Center, ZA LEIDEN 2333, The Netherlands
| | - H Morreau
- Department of Pathology, Leiden University Medical Center, ZA LEIDEN 2333, The Netherlands
| | - J T Wijnen
- Departments of Human and Clinical Genetics, Leiden University Medical Center, ZA LEIDEN 2333, The Netherlands
| | - P Devilee
- Departments of Human and Clinical Genetics, Leiden University Medical Center, ZA LEIDEN 2333, The Netherlands
| | - K Matsuda
- Laboratory of Molecular Medicine, Human Genome Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Y Nakamura
- Laboratory of Molecular Medicine, Human Genome Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - S Castellví-Bel
- Department of Gastroenterology, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain
| | - C Ruiz-Ponte
- Fundacion Publica Galega de Medicina Xenomica (FPGMX), CIBERER, Genomic Medicine Group-University of Santiago de Compostela, Santiago de Compostela, Galicia, Spain
| | - A Castells
- Department of Gastroenterology, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain
| | - A Carracedo
- Fundacion Publica Galega de Medicina Xenomica (FPGMX), CIBERER, Genomic Medicine Group-University of Santiago de Compostela, Santiago de Compostela, Galicia, Spain
| | - J W C Ho
- The University of Hong Kong, Pokfulam Road, Hong Kong, China
| | - P Sham
- The University of Hong Kong, Pokfulam Road, Hong Kong, China
| | - R M W Hofstra
- Department of Genetics, University Medical Center Groningen, University of Groningen, P.O. Box 30.0001, Groningen 9700 RB, the Netherlands
| | - P Vodicka
- Institute of Experimental Medicine, Academy of Sciences of the Czech Republic, Videnska 1083, 14200 Prague 4, Czech Republic
| | - H Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 280, Heidelberg 69120, Germany
| | - J Hampe
- Department of General Internal Medicine, University Hospital, Schleswig-Holstein, Campus Kiel, Schittenhelmstraße 12, Kiel 24105, Germany
| | - C Schafmayer
- POPGEN Biobank, University Hospital Schleswig-Holstein, Campus Kiel, Schittenhelmstrasse 12, Kiel 24105, Germany
- Department of General and Thoracic Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 3, Kiel 24105, Germany
| | - J Tepel
- Department of General and Thoracic Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 3, Kiel 24105, Germany
| | - S Schreiber
- Department of General Internal Medicine, University Hospital, Schleswig-Holstein, Campus Kiel, Schittenhelmstraße 12, Kiel 24105, Germany
| | - H Völzke
- Institut für Community Medicine, University Hospital Greifswald, Walther-Rathenau-Strasse 48, Greifswald 17487, Germany
| | - M M Lerch
- Klinik für Innere Medizin A University Hospital Greifswald, Friedrich-Loeffler-Strasse 23a, Greifswald 17487, Germany
| | - C A Schmidt
- Klinik für Innere Medizin C, University Hospital Greifswald, Ferdinand-Sauerbruch-Strasse, Greifswald 17487, Germany
| | - S Buch
- Department of General Internal Medicine, University Hospital, Schleswig-Holstein, Campus Kiel, Schittenhelmstraße 12, Kiel 24105, Germany
| | - V Moreno
- IDIBELL-Catalan Institute of Oncology and University of Barcelona, Av Gran Via 199, L’Hospitalet, Barcelona 08907, Spain
| | - C M Villanueva
- Centre for Research in Environmental Epidemiology (CREAL), Municipal Institute of Medical Research (IMIM-Hospital del Mar) and CIBER Epidemiología y Salud Pública (CIBERESP), Doctor Aiguader, Barcelona 88 E-08003, Spain
| | - P Peterlongo
- Fondazione IRCCS Istituto Nazionale Tumori, and Fondazione IFOM, Istituto FIRC di Oncologia Molecolare, Milan, Italy
| | - P Radice
- Fondazione IRCCS Istituto Nazionale Tumori, and Fondazione IFOM, Istituto FIRC di Oncologia Molecolare, Milan, Italy
| | - M M Echeverry
- Departamento de Biología, Universidad del Tolima, Barrio Altos de Santa Helena, Ibague, Tolima, Colombia
| | - A Velez
- Departamento de Patología, Hospital Pablo Tobon Uribe, Calle 78 B No. 69-240, Medellín, Colombia
| | - L Carvajal-Carmona
- Molecular and Population Genetics, Nuffield Department of Medicine, University of Oxford, Wellcome Trust Centre for Human Genetics, Roosevelt Drive, Oxford OX3 7BN, UK
- Departamento de Biología, Universidad del Tolima, Barrio Altos de Santa Helena, Ibague, Tolima, Colombia
| | - R Scott
- Faculty of Health, School of Biomedical Sciences, University of Newcastle, NSW, Australia
| | - S Penegar
- Section of Cancer Genetics, Institute of Cancer Research, 15 Cotswold Rd, Sutton, Surrey SM2 5NG, UK
| | - P Broderick
- Section of Cancer Genetics, Institute of Cancer Research, 15 Cotswold Rd, Sutton, Surrey SM2 5NG, UK
| | - A Tenesa
- Institute of Genetics and Molecular Medicine, University of Edinburgh, MRC-HGU, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
| | - R S Houlston
- Section of Cancer Genetics, Institute of Cancer Research, 15 Cotswold Rd, Sutton, Surrey SM2 5NG, UK
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Villanueva CM, Silverman DT, Malats N, Tardon A, Garcia-Closas R, Serra C, Carrato A, Fortuny J, Rothman N, Dosemeci M, Kogevinas M. Determinants of quality of interview and impact on risk estimates in a case-control study of bladder cancer. Am J Epidemiol 2009; 170:237-43. [PMID: 19478234 DOI: 10.1093/aje/kwp136] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The authors evaluated potential determinants of the quality of the interview in a case-control study of bladder cancer and assessed the effect of the interview quality on the risk estimates. The analysis included 1,219 incident bladder cancer cases and 1,271 controls recruited in Spain in 1998-2001. Information on etiologic factors for bladder cancer was collected through personal interviews, which were scored as unsatisfactory, questionable, reliable, or high quality by the interviewers. Eight percent of the interviews were unsatisfactory or questionable. Increasing age, lower socioeconomic status, and poorer self-perceived health led to higher proportions of questionable or unreliable interviews. The odds ratio for cigarette smoking, the main risk factor for bladder cancer, was 6.18 (95% confidence interval: 4.56, 8.39) overall, 3.20 (95% confidence interval: 1.13, 9.04) among unsatisfactory or questionable interviews, 6.86 (95% confidence interval: 4.80, 9.82) among reliable interviews, and 7.70 (95% confidence interval: 3.64, 16.30) among high-quality interviews. Similar trends were observed for employment in high-risk occupations, drinking water containing elevated levels of trihalomethanes, and use of analgesics. Higher quality interviews led to stronger associations compared with risk estimation that did not take the quality of interview into account. The collection of quality of interview scores and the exclusion of unreliable interviews probably reduce misclassification of exposure in observational studies.
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Nieuwenhuijsen MJ, Smith R, Golfinopoulos S, Best N, Bennett J, Aggazzotti G, Righi E, Fantuzzi G, Bucchini L, Cordier S, Villanueva CM, Moreno V, La Vecchia C, Bosetti C, Vartiainen T, Rautiu R, Toledano M, Iszatt N, Grazuleviciene R, Kogevinas M. Health impacts of long-term exposure to disinfection by-products in drinking water in Europe: HIWATE. J Water Health 2009; 7:185-207. [PMID: 19240347 DOI: 10.2166/wh.2009.073] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
There appears to be very good epidemiological evidence for a relationship between chlorination by-products, as measured by trihalomethanes (THMs), in drinking water and bladder cancer, but the evidence for other cancers, including colorectal cancer appears to be inconclusive and inconsistent. There appears to be some evidence for a relationship between chlorination by-products, as measured by THMs, and small for gestational age (SGA)/intrauterine growth retardation (IUGR) and preterm delivery, but evidence for other outcomes such as low birth weight (LBW), stillbirth, congenital anomalies and semen quality appears to be inconclusive and inconsistent.The overall aim of the HIWATE study is to investigate potential human health risks (e.g. bladder and colorectal cancer, premature births, SGA, semen quality, stillbirth, congenital anomalies) associated with long-term exposure to low levels of disinfectants (such as chlorine) and DBPs occurring in water for human consumption and use in the food industry. The study will comprise risk-benefit analyses including quantitative assessments of risk associated with microbial contamination of drinking water versus chemical risk and will compare alternative treatment options. The outcome will be improved risk assessment and better information for risk management. The work is divided into different topics (exposure assessment, epidemiology, risk assessment and management) and studies.
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Affiliation(s)
- Mark J Nieuwenhuijsen
- Centre for research in Environmental, Epidemiology (CREAL), Parc de Recerca Biomédical de Barcelona-PRBB, Barcelona, Spain.
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Font-Ribera L, Kogevinas M, Zock JP, Nieuwenhuijsen MJ, Heederik D, Villanueva CM. Swimming pool attendance and risk of asthma and allergic symptoms in children. Eur Respir J 2009; 34:1304-10. [PMID: 19443529 DOI: 10.1183/09031936.00180608] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Increased asthma risk has been associated with pool attendance in children but evidence is inconsistent and inconclusive. A survey was conducted of 3,223 9-12-yr-old children in Sabadell (Spain) to evaluate association between swimming pool attendance and prevalence of asthma and allergic conditions and symptoms. Parents completed a questionnaire on lifetime frequency of pool attendance and symptoms in the last 12 months (wheezing, asthma medication, rhinitis and allergic rhinitis), ever having asthma and eczema, and potential confounders. Indicators of indoor and outdoor swimming pool attendance early in life, cumulatively and currently were calculated. Swimming pool attendance before the age of 2 yrs was associated with slightly lower prevalence of current asthma (OR 0.79, 95% CI 0.43-1.46), rhinitis (OR 0.86, 95% CI 0.68-1.08) and allergic rhinitis symptoms (OR 0.72, 95% CI 0.54-0.96) compared to those who started attending swimming pools after 4 yrs of age. An increased prevalence of eczema was associated with duration of lifetime pool attendance (OR 1.71, 95%CI 1.38-2.12 for >5 yrs versus 0 yrs). Swimming pool attendance in Spanish children was associated with slightly less upper and lower respiratory tract symptoms and with more eczema. Longitudinal studies are required to confirm these findings and avoid potential reverse causation.
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Affiliation(s)
- L Font-Ribera
- Centre for Research in Environmental Epidemiology, Barcelona, Spain
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Villanueva CM, Silverman DT, Murta-Nascimento C, Malats N, Garcia-Closas M, Castro F, Tardon A, Garcia-Closas R, Serra C, Carrato A, Rothman N, Real FX, Dosemeci M, Kogevinas M. Coffee consumption, genetic susceptibility and bladder cancer risk. Cancer Causes Control 2009; 20:121-7. [PMID: 18798002 PMCID: PMC2912840 DOI: 10.1007/s10552-008-9226-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Accepted: 09/02/2008] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We evaluated the bladder cancer risk associated with coffee consumption in a case-control study in Spain and examined the gene-environment interactions for genetic variants of caffeine-metabolizing enzymes. METHODS The analyses included 1,136 incident cases with urothelial carcinoma of the urinary bladder and 1,138 controls. Odds ratios (OR) and 95% confidence intervals (CI) were adjusted for area, age, gender, amount of cigarette smoking, and years since quitting among former smokers. RESULTS The OR (95% CI) for ever consumed coffee was 1.25 (0.95-1.64). For consumers of 1, 2, 3, and 4 or more cups/day relative to never drinkers, OR were, respectively, 1.24 (0.92-1.66), 1.11 (95% CI 0.82-1.51), 1.57 (1.13-2.19), and 1.27 (0.88-1.81). Coffee consumption was higher in smokers compared to never smokers. The OR for drinking at least 4 cups/day was 1.13 (0.61-2.09) in current smokers, 1.57 (0.86-2.90) in former smokers, and 1.23 (0.55-2.76) in never smokers. Gene-coffee interactions evaluated in NAT2, CYP1A2, and CYP2E1-02 and CYP1A1 were not identified after adjusting for multiple testing. CONCLUSION We observed a modest increased bladder cancer risk among coffee drinkers that may, in part, be explained by residual confounding by smoking. The findings from the gene-coffee interactions need replication in further studies.
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Affiliation(s)
- Cristina M Villanueva
- Centre for Research in Environmental Epidemiology (CREAL), PRBB Building, Doctor Aiguader, 88, 08003, Barcelona, Spain.
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Burney P, Potts J, Makowska J, Kowalski M, Phillips J, Gnatiuc L, Shaheen S, Joos G, Van Cauwenberge P, van Zele T, Verbruggen K, van Durme Y, Derudder I, Wohrl S, Godnic-Cvar J, Salameh B, Skadhauge L, Thomsen G, Zuberbier T, Bergmann KC, Heinzerling L, Renz H, Al-Fakhri N, Kosche B, Hildenberg A, Papadopoulos NG, Xepapadaki P, Zannikos K, Gjomarkaj M, Bruno A, Pace E, Bonini S, Bresciani M, Gramiccioni C, Fokkens W, Weersink EJM, Carlsen KH, Bakkeheim E, Loureiro C, Villanueva CM, Sanjuas C, Zock JP, Lundback B, Janson C. A case-control study of the relation between plasma selenium and asthma in European populations: a GAL2EN project. Allergy 2008; 63:865-71. [PMID: 18588552 DOI: 10.1111/j.1398-9995.2008.01716.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is evidence that selenium levels are relatively low in Europe and may be falling. Low levels of selenium or low activity of some of the enzymes dependent on selenium have been associated with asthma. METHODS The GA(2)LEN network has organized a multicentre case-control study in Europe to assess the relation of plasma selenium to asthma. The network compared 569 cases in 14 European centres with a diagnosis of asthma and reporting asthma symptoms in the last 12 months with 576 controls from the same centres with no diagnosis of asthma and no asthmatic symptoms in the last 12 months. RESULTS All cases and controls were selected from the same population defined by age and place of residence. Mean plasma selenium concentrations among the controls ranged from 116.3 microg/l in Palermo to 67.7 microg/l in Vienna and 56.1 microg/l among the children in Oslo. Random effects meta-analysis of the results from the centres showed no overall association between asthma and plasma selenium [odds ratio (OR)/10 microg/l increase in plasma selenium: 1.04; 95% confidence interval (CI): 0.89-1.21] though there was a significantly protective effect in Lodz (OR: 0.48; 95% CI: 0.29-0.78) and a marginally significant adverse effect in Amsterdam (OR: 1.68; 95% CI: 0.98-2.90) and Ghent (OR: 1.35; 95% CI: 1.03-1.77). CONCLUSION This study does not support a role for selenium in protection against asthma, but effect modification and confounding cannot be ruled out.
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Affiliation(s)
- P Burney
- National Heart Lung Institute, Imperial College, London, UK
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84
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Shaheen S, Potts J, Gnatiuc L, Makowska J, Kowalski ML, Joos G, van Zele T, van Durme Y, De Rudder I, Wöhrl S, Godnic-Cvar J, Skadhauge L, Thomsen G, Zuberbier T, Bergmann KC, Heinzerling L, Gjomarkaj M, Bruno A, Pace E, Bonini S, Fokkens W, Weersink EJM, Loureiro C, Todo-Bom A, Villanueva CM, Sanjuas C, Zock JP, Janson C, Burney P. The relation between paracetamol use and asthma: a GA2LEN European case-control study. Eur Respir J 2008; 32:1231-6. [PMID: 18579547 DOI: 10.1183/09031936.00039208] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Studies from the UK and USA suggest that frequent use of paracetamol (acetaminophen) may increase the risk of asthma, but data across Europe are lacking. As part of a multicentric case-control study organised by the Global Allergy and Asthma European Network (GA(2)LEN), it was examined whether or not frequent paracetamol use is associated with adult asthma across Europe. The network compared 521 cases with a diagnosis of asthma and reporting of asthma symptoms within the last 12 months with 507 controls with no diagnosis of asthma and no asthmatic symptoms within the last 12 months across 12 European centres. All cases and controls were selected from the same population, defined by age (20-45 yrs) and place of residence. In a random effects meta-analysis, weekly use of paracetamol, compared with less frequent use, was strongly positively associated with asthma after controlling for confounders. There was no evidence for heterogeneity across centres. No association was seen between use of other analgesics and asthma. These data add to the increasing and consistent epidemiological evidence implicating frequent paracetamol use in asthma in diverse populations.
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Affiliation(s)
- S Shaheen
- National Heart and Lung Institute, Imperial College London, Emmanuel Kaye Building, Manresa Road, London SW3 6LR, UK.
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85
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Shaheen S, Potts J, Gnatiuc L, Makowska J, Kowalski ML, Joos G, van Zele T, van Durme Y, De Rudder I, Wöhrl S, Godnic-Cvar J, Skadhauge L, Thomsen G, Zuberbier T, Bergmann KC, Heinzerling L, Gjomarkaj M, Bruno A, Pace E, Bonini S, Fokkens W, Weersink EJM, Loureiro C, Todo-Bom A, Villanueva CM, Sanjuas C, Zock JP, Janson C, Burney P. The relation between paracetamol use and asthma: a GA2LEN European case-control study. Eur Respir J 2008. [PMID: 18579547 DOI: 10.1183/09031936.00039208.] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Studies from the UK and USA suggest that frequent use of paracetamol (acetaminophen) may increase the risk of asthma, but data across Europe are lacking. As part of a multicentric case-control study organised by the Global Allergy and Asthma European Network (GA(2)LEN), it was examined whether or not frequent paracetamol use is associated with adult asthma across Europe. The network compared 521 cases with a diagnosis of asthma and reporting of asthma symptoms within the last 12 months with 507 controls with no diagnosis of asthma and no asthmatic symptoms within the last 12 months across 12 European centres. All cases and controls were selected from the same population, defined by age (20-45 yrs) and place of residence. In a random effects meta-analysis, weekly use of paracetamol, compared with less frequent use, was strongly positively associated with asthma after controlling for confounders. There was no evidence for heterogeneity across centres. No association was seen between use of other analgesics and asthma. These data add to the increasing and consistent epidemiological evidence implicating frequent paracetamol use in asthma in diverse populations.
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Affiliation(s)
- S Shaheen
- National Heart and Lung Institute, Imperial College London, Emmanuel Kaye Building, Manresa Road, London SW3 6LR, UK.
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86
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Karagas MR, Villanueva CM, Nieuwenhuijsen M, Weisel CP, Cantor KP, Kogevinas M. Disinfection byproducts in drinking water and skin cancer? A hypothesis. Cancer Causes Control 2008; 19:547-8. [PMID: 18219581 DOI: 10.1007/s10552-008-9116-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2007] [Accepted: 01/07/2008] [Indexed: 11/30/2022]
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87
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Michaud DS, Kogevinas M, Cantor KP, Villanueva CM, Garcia-Closas M, Rothman N, Malats N, Real FX, Serra C, Garcia-Closas R, Tardon A, Carrato A, Dosemeci M, Silverman DT. Total fluid and water consumption and the joint effect of exposure to disinfection by-products on risk of bladder cancer. Environ Health Perspect 2007; 115:1569-72. [PMID: 18007986 PMCID: PMC2072844 DOI: 10.1289/ehp.10281] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2007] [Accepted: 08/29/2007] [Indexed: 05/08/2023]
Abstract
BACKGROUND Findings on water and total fluid intake and bladder cancer are inconsistent; this may, in part, be due to different levels of carcinogens in drinking water. High levels of arsenic and chlorinated by-products in drinking water have been associated with elevated bladder cancer risk in most studies. A pooled analysis based on six case-control studies observed a positive association between tap water and bladder cancer but none for nontap fluid intake, suggesting that contaminants in tap water may be responsible for the excess risk. OBJECTIVES We examined the association between total fluid and water consumption and bladder cancer risk, as well as the interaction between water intake and trihalomethane (THM) exposure, in a large case-control study in Spain. METHODS A total of 397 bladder cancer cases and 664 matched controls were available for this analysis. Odds ratios (OR) were estimated using unconditional logistic regression, controlling for potential confounders. RESULTS Total fluid intake was associated with a decrease in bladder cancer risk [OR = 0.62; 95% confidence interval (CI), 0.40-0.95 for highest vs. lowest quintile comparison]. A significant inverse association was observed for water intake (for > 1,399 vs. < 400 mL/day, OR = 0.47; 95% CI, 0.33-0.66; p for trend < 0.0001), but not for other individual beverages. The inverse association between water intake and bladder cancer persisted within each level of THM exposure; we found no statistical interaction (p for interaction = 0.13). CONCLUSION Findings from this study suggest that water intake is inversely associated with bladder cancer risk, regardless of THM exposure level.
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Affiliation(s)
- Dominique S Michaud
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts 02115, USA.
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88
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Villanueva CM, Gagniere B, Monfort C, Nieuwenhuijsen MJ, Cordier S. Sources of variability in levels and exposure to trihalomethanes. Environ Res 2007; 103:211-20. [PMID: 17189628 DOI: 10.1016/j.envres.2006.11.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2006] [Revised: 10/17/2006] [Accepted: 11/01/2006] [Indexed: 05/13/2023]
Abstract
In the framework of a cohort study of pregnant women conducted in Brittany (France), we assessed the exposure to trihalomethanes (THM) during pregnancy in a subset by evaluating (1) potential sources of variability in household THM levels; (2) the between- and within-subject variability in THM levels; (3) THM levels in swimming pools; and (4) the role of water-related habits on total THM uptake. We visited 109 women from the ongoing cohort study at home for an interview and collection of tap water from October to December 2004. Forty-three of them were re-contacted to obtain a second tap water sample in April-May 2005. We designed a questionnaire to collect individual information on source and amount of drinking water, frequency of showering, bathing, and swimming pool attendance, and household characteristics. We obtained 282 THM measurements, 152 specifically for the study and 130 from a regulatory agency. Personal information and environmental data were combined using two methodologies (method 1 using regulatory data and method 2 using our THM measurements) with a different set of assumptions. We calculated ingestion, showering, bathing, and swimming pool THM uptakes and added up those uptakes to calculate total THM uptake. Average THM levels from our measurements in October, November-December, and April-May were 61.3, 45.1, and 54.5 microg/l, respectively. Geographical variability was low and characteristics of the household did not influence THM levels. Within-subject variability in THM levels was three times higher than between-subject variability. Average THM level in swimming pools was 80.4 microg/l. Average water consumption during pregnancy was 1.9l/day. The source of the household drinking water was 90% bottled, 8% municipal, and 2% from other sources. Forty-seven per cent attended swimming pools during pregnancy. Using method 1, the geometric mean of total THM uptake was 0.93 microg/day. Showering contributed 64%, swimming in pools 23%, bathing 12%, and drinking water 1% to the total THM uptake. In a setting with low geographical variability and limited environmental measurements, individual data is highly relevant to determine personal THM exposure and uptake. In a population that mainly drinks bottled water (e.g., pregnant women), individual THM uptakes are dominated by inhalation and dermal absorption during, showering, swimming in pools, and bathing.
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Affiliation(s)
- Cristina M Villanueva
- Centre for Research in Environmental Epidemiology (CREAL), Institut Municipal d'Investigació Mèdica (IMIM), Doctor Aiguader, 88, Barcelona 08003, Spain.
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89
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Villanueva CM, Cantor KP, Grimalt JO, Malats N, Silverman D, Tardon A, Garcia-Closas R, Serra C, Carrato A, Castaño-Vinyals G, Marcos R, Rothman N, Real FX, Dosemeci M, Kogevinas M. Bladder cancer and exposure to water disinfection by-products through ingestion, bathing, showering, and swimming in pools. Am J Epidemiol 2007; 165:148-56. [PMID: 17079692 DOI: 10.1093/aje/kwj364] [Citation(s) in RCA: 338] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Bladder cancer has been associated with exposure to chlorination by-products in drinking water, and experimental evidence suggests that exposure also occurs through inhalation and dermal absorption. The authors examined whether bladder cancer risk was associated with exposure to trihalomethanes (THMs) through ingestion of water and through inhalation and dermal absorption during showering, bathing, and swimming in pools. Lifetime personal information on water consumption and water-related habits was collected for 1,219 cases and 1,271 controls in a 1998-2001 case-control study in Spain and was linked with THM levels in geographic study areas. Long-term THM exposure was associated with a twofold bladder cancer risk, with an odds ratio of 2.10 (95% confidence interval: 1.09, 4.02) for average household THM levels of >49 versus < or =8 micro g/liter. Compared with subjects not drinking chlorinated water, subjects with THM exposure of >35 micro g/day through ingestion had an odds ratio of 1.35 (95% confidence interval: 0.92, 1.99). The odds ratio for duration of shower or bath weighted by residential THM level was 1.83 (95% confidence interval: 1.17, 2.87) for the highest compared with the lowest quartile. Swimming in pools was associated with an odds ratio of 1.57 (95% confidence interval: 1.18, 2.09). Bladder cancer risk was associated with long-term exposure to THMs in chlorinated water at levels regularly occurring in industrialized countries.
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Affiliation(s)
- Cristina M Villanueva
- Centre for Research in Environmental Epidemiology, Municipal Institute of Medical Research, Barcelona, Spain
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90
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Villanueva CM, Grimalt JO, Ballester F, Ibarluzea J, Sala M, Tardón A, Romero-Aliaga E, Fernández M, Ribas-Fitó N, Kogevinas M. Medida de contaminantes del agua y usos del agua durante el embarazo en un estudio de cohortes en España. Gaceta Sanitaria 2006; 20 Suppl 3:1-9. [PMID: 17433195 DOI: 10.1157/13101084] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Exposure to chlorination by-products during pregnancy has been associated with reproductive outcomes but the evidence remains inconclusive. Levels of trihalomethanes, the most prevalent chlorination by-products, are high in some areas of Spain. Within the framework of a follow-up study in pregnant women, we describe: 1) the personal habits of water use and consumption, and 2) trihalomethane levels in the drinking water of the study areas. METHODS We performed a follow-up cohort study in pregnant women in Valencia (n = 800), Sabadell (n = 800), the Basque Country (n = 600), Asturias (n = 500), and Granada (n = 700). Interviews were conducted in the third trimester of pregnancy to obtain individual information on the sources and amounts of drinking water, and on the frequency of showering, bathing, and swimming pool attendance. Water samples were collected to analyze trihalomethane levels. RESULTS The main source of drinking water was bottled water, both inside and outside the home (82% and 94% of the women, respectively). Drinking water for cooking was mainly municipal (91%). Women preferred to take showers (98.2%) and did so, on average, 6.8 times/week for 11.7 minutes. A total of 58.5% of the women went to swimming pools during pregnancy, on average 9.4 times/month to outdoor swimming pools in the summer and 3.1 times/month the rest of the year for 32.6 and 21.7 minutes, respectively. Average trihalomethane levels ranged from 4 microg/l in the province of Granada to 117 microg/l in Sabadell. CONCLUSION These preliminary results suggest that the main routes of trihalomethane exposure during pregnancy are dermal absorption and inhalation. Ingestion is a minor exposure route.
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Affiliation(s)
- Cristina M Villanueva
- Centre de Recerca en Epidemiologia Ambiental (CREAL), Institut Municipal d'Investigació Mèdica (IMIM), Barcelona, España.
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91
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Villanueva CM, Cantor KP, Grimalt JO, Castaño-Vinyals G, Malats N, Silverman D, Tardon A, Garcia-Closas R, Serra C, Carrato A, Rothman N, Real FX, Dosemeci M, Kogevinas M. Assessment of lifetime exposure to trihalomethanes through different routes. Occup Environ Med 2006; 63:273-7. [PMID: 16556748 PMCID: PMC2078091 DOI: 10.1136/oem.2005.023069] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2006] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate lifetime exposure to trihalomethanes (THM) through ingestion, inhalation, and dermal absorption in a hospital based case-control study of bladder cancer conducted between 1998 and 2001 in five areas of Spain. The study base was comprised of subjects living in the catchment areas of the participating hospitals. METHODS Individual information on water related habits was obtained from personal interviews of 1219 cases and 1271 controls: residential and occupational history, drinking water source at each residence and job, amount of water consumption, frequency and duration of showering, bathing, and swimming pool attendance. THM levels, water source history, and year when chlorination started in study areas were ascertained through measurements in drinking water samples and questionnaires to water companies and local authorities. Estimates of THM levels covered 79% of the subjects' person-years of exposure. RESULTS Current and historical average THM levels in water were correlated. Control subjects reported that drinking water source in the last residence was municipal for 63%, bottled for 22%, private well for 2%, and other sources for 13%. For the time window between age 15 and the time of interview, average residential THM level was 32.2 mug/l. THM exposure through ingestion was 23.7 mug/day on average, and was correlated with the ingestion THM level in the workplace. Overall, 79% usually took showers, 16% usually took baths, and 13% had ever attended a swimming pool. Between 21% and 45% of controls unexposed to THM through ingestion were evaluated as moderately or highly exposed through showering or bathing, and 5-10% were exposed through swimming in pools. CONCLUSION The importance of evaluating different routes is underscored by findings from experimental studies showing substantial differences in THM uptake and internal distribution by route.
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Affiliation(s)
- C M Villanueva
- Respiratory and Environmental Health Research Unit, Institut Municipal d'Investigació Mèdica (IMIM), Barcelona, Spain.
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92
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Villanueva CM, Cantor KP, King WD, Jaakkola JJK, Cordier S, Lynch CF, Porru S, Kogevinas M. Total and specific fluid consumption as determinants of bladder cancer risk. Int J Cancer 2005; 118:2040-7. [PMID: 16284957 DOI: 10.1002/ijc.21587] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We pooled the data from 6 case-control studies of bladder cancer with detailed information on fluid intake and water pollutants, particularly trihalomethanes (THM), and evaluated the bladder cancer risk associated with total and specific fluid consumption. The analysis included 2,729 cases and 5,150 controls. Odds ratios (OR) and 95% confidence intervals (CI) for fluid consumption were adjusted for age, gender, study, smoking status, occupation and education. Total fluid intake was associated with an increased risk of bladder cancer in men. The adjusted OR for 1 l/day increase in intake was 1.08, (95% CI 1.03-1.14, p-value for linear trend <0.001), while no trend was observed in women (OR=1.04, 0.94-1.15; p-value=0.7). OR was 1.33 (1.12-1.58) for men in the highest category of intake (>3.5 l/day) as compared to those in the lowest (<or=2 l/day). An increased risk was associated with intake of tap water. OR for >2 l/day vs. <or=0.5 l/day was 1.46 (1.20-1.78), with a higher risk among men (OR=1.50, 1.21-1.88). No increased risk was observed for the same intake groups of nontap water in men (OR=0.97, 0.77-1.22) or in women (OR=0.85, 0.50-1.42). Increased bladder cancer risks were observed for an intake of >5 cups of coffee daily vs. <5 and for THM exposure, but neither exposure confounded or modified the OR for tap water intake. The association of bladder cancer with tap water consumption, but not with nontap water fluids, suggests that carcinogenic chemicals in tap water may explain the increased risk.
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Affiliation(s)
- Cristina M Villanueva
- Respiratory and Environmental Health Research Unit, Institut Municipal d'Investigació Mèdica (IMIM), Barcelona, Spain.
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93
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Villanueva CM, Durand G, Coutté MB, Chevrier C, Cordier S. Atrazine in municipal drinking water and risk of low birth weight, preterm delivery, and small-for-gestational-age status. Occup Environ Med 2005; 62:400-5. [PMID: 15901888 PMCID: PMC1741023 DOI: 10.1136/oem.2004.016469] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Atrazine is a herbicide used extensively worldwide. Bioassays have shown that it is embryotoxic and embryolethal. Evidence of adverse reproductive outcomes from exposure in the general population is sparse. AIMS To evaluate the association between atrazine levels in municipal drinking water and the following adverse reproductive outcomes: increased risk of preterm delivery, low birth weight (LBW), and small-for-gestational-age (SGA) status. METHODS A total of 3510 births that took place from 1 October 1997, to 30 September 1998 were analysed. Atrazine measurements were available for 2661 samples from water treatment plants over the past decade. A seasonal pattern was identified, with atrazine peaking from May to September. The geometric mean of the atrazine level for this period was calculated for each water distribution unit and merged with the individual data by municipality of residence. RESULTS Atrazine levels in water were not associated with an increased risk of LBW or SGA status and were slightly associated with prematurity. There was an increased risk of SGA status in cases in which the third trimester overlapped in whole or in part with the May-September period, compared with those in which the third trimester occurred totally from October to April (OR = 1.37, 95% CI 1.04 to 1.81). If the entire third trimester took place from May to September, the OR was 1.54 (95% CI 1.11 to 2.13). CONCLUSIONS Low levels of atrazine, a narrow exposure range, and limitations in the exposure assessment partly explain the lack of associations with atrazine. Findings point to the third trimester of pregnancy as the potential vulnerable period for an increased risk of SGA birth. Exposures other than atrazine and also seasonal factors may explain the increased risk.
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Affiliation(s)
- C M Villanueva
- Respiratory and Environmental Health Research Unit, Institut Municipal d'Investigació Mèdica (IMIM), C/Doctor Aiguader, 80, 08003-Barcelona, Spain.
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94
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Abstract
BACKGROUND Exposure to disinfection byproducts in drinking water has been associated with an increased risk of bladder cancer. We pooled the primary data from 6 case-control studies of bladder cancer that used trihalomethanes as a marker of disinfection byproducts. METHODS Two studies were included from the United States and one each from Canada, France, Italy, and Finland. Inclusion criteria were availability of detailed data on trihalomethane exposure and individual water consumption. The analysis included 2806 cases and 5254 controls, all of whom had measures of known exposure for at least 70% of the exposure window of 40 years before the interview. Cumulative exposure to trihalomethanes was estimated by combining individual year-by-year average trihalomethane level and daily tap water consumption. RESULTS There was an adjusted odds ratio (OR) of 1.24 in men exposed to an average of more than 1 microg/L (ppb) trihalomethanes compared with those who had lower or no exposure (95% confidence interval [CI] = 1.09-1.41). Estimated relative risks increased with increasing exposure, with an OR of 1.44 (1.20-1.73) for exposure higher than 50 microg/L (ppb). Similar results were found with other indices of trihalomethane exposure. Among women, trihalomethane exposure was not associated with bladder cancer risk (0.95; 0.76-1.20). CONCLUSIONS These findings strengthen the hypothesis that the risk of bladder cancer is increased with long-term exposure to disinfection byproducts at levels currently observed in many industrialized countries.
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Affiliation(s)
- Cristina M Villanueva
- Respiratory and Environmental Health Research Unit, Institut Municipal d'Investigació Mèdica (IMIM), Barcelona, Spain
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Goebell PJ, Villanueva CM, Rettenmeier AW, Rübben H, Kogevinas M. Environmental exposure, chlorinated drinking water, and bladder cancer. World J Urol 2004; 21:424-32. [PMID: 14689225 DOI: 10.1007/s00345-003-0389-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2003] [Accepted: 11/05/2003] [Indexed: 10/26/2022] Open
Abstract
Environmental and/or occupational factors have been proposed to play a critical role in urological malignancies and, in particular, in bladder cancer. Epidemiological studies have demonstrated with sufficient evidence that factors such as smoking and exposure to aromatic amines, paints and solvents, leather dust, inks, some metals, polycyclic aromatic hydrocarbons, combustion products, or diesel exhaust fumes are associated with the development of bladder cancer. Candidates with an uncertain potential for inducing this type of cancer include dietary factors, specifically fats and cholesterol, and the exposure to contaminants in drinking water. This chapter will describe and discuss the respective literature on environmental and occupational factors linked to carcinogenesis in bladder cancer. For several reasons, the potential effects of tea and coffee consumption will also be considered. A solid epidemiological evaluation of environmental and occupational factors linked to carcinogenesis has to meet many challenges: the number of confounding factors is often large, exposure needs to be determined retrospectively, and elevation of the attributable risk is low in most cases. In view of the long-term exposure of the vast majority of the population to, for instance, drinking- water contaminants, however, the impact of even small elevations of risk warrants evaluation. This complex task needs comprehensive approaches on a large scale including modern analytical, molecular biological and epidemiological methods.
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Affiliation(s)
- Peter J Goebell
- Department of Urology, University Hospital Essen, Hufelandstrasse 55, 45122 Essen, Germany.
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96
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Villanueva CM, Fernández F, Malats N, Grimalt JO, Kogevinas M. Meta-analysis of studies on individual consumption of chlorinated drinking water and bladder cancer. J Epidemiol Community Health 2003; 57:166-73. [PMID: 12594192 PMCID: PMC1732410 DOI: 10.1136/jech.57.3.166] [Citation(s) in RCA: 121] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
STUDY OBJECTIVE To evaluate whether consumption of chlorinated drinking water is associated with bladder cancer. DESIGN A bibliographic search was conducted and the authors selected studies evaluating individual consumption of chlorinated drinking water and bladder cancer. The authors extracted from each study risk estimates for intermediate and long term (>40 years) consumption of chlorinated water, stratified by sex when possible, and performed meta-analysis for the two exposure levels. A meta-analysis was also performed of the dose-response regression slopes. SETTING Populations in Europe and North America. PARTICIPANTS Those included in six case-control studies (6084 incident bladder cancer cases, 10,816 controls) and two cohort studies (124 incident bladder cancer cases) fulfilling the inclusion criteria. MAIN RESULTS Ever consumption of chlorinated drinking water was associated with an increased risk of bladder cancer in men (combined OR=1.4, 95%CI 1.1 to 1.9) and women (combined OR=1.2, 95%CI 0.7 to 1.8). The combined OR for mid-term exposure in both genders was 1.1 (95% CI 1.0 to 1.2) and for long term exposure was 1.4 (95%CI 1.2 to 1.7). The combined estimate of the slope for a linear increase in risk was 1.13 (95% CI 1.08 to 1.20) for 20 years and 1.27 (95% CI 1.15 to 1.43) for 40 years of exposure in both sexes. CONCLUSIONS This meta-analysis of the best available epidemiological evidence indicates that long term consumption of chlorinated drinking water is associated with bladder cancer, particularly in men. The observed relative risk is only moderately high, but the population attributable risk could be important as the vast majority of the population of industrialised countries is potentially exposed to chlorination byproducts for long time periods.
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Affiliation(s)
- C M Villanueva
- Respiratory and Environmental Health Research Unit, Municipal Institute of Medical Research (IMIM), Barcelona, Spain
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97
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Abstract
Trihalomethanes (THM) and haloacetic acids (HAA) are the most frequent chlorination by-products (CBP) in finished drinking waters. Traditionally, THM have been used as surrogates for CBP although the quantitative association between THM and other CBP is not well established. This problem is addressed in the present study from the analysis of THM and HAA in drinking water samples from four Spanish regions, representing areas with very different CBP composition, e.g. between 86 and 8.0 microg/l of THM and 50-3.0 microg/l of HAA. The resulting dataset exhibit a statistically significant correlation between total THM and HAA (Pearson's correlation coefficient, r(p)=0.815,p<0.0005). Furthermore, specific HAA are highly correlated with specific THM or their combinations. Accordingly, multivariate linear regression analysis of the concentrations observed show that the levels in total and specific HAA can be predicted from the THM content. These results are relevant for epidemiological studies on health effects from CBP exposure since they usually involve comparison of populations consuming waters of very distinct quality.
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Affiliation(s)
- C M Villanueva
- Respiratory and Environmental Health Research Unit, Municipal Institute of Medical Research (IMIM), C/Doctor Aiguader 80, 08003-, Barcelona, Spain.
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98
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Affiliation(s)
- C M Villanueva
- Institut Municipal d'Investigació Mèdica (IMIM). Unitat de Recerca Respiratòria i Ambiental. Instituto de Investigaciones Químicas y Ambientales de Barcelona. Departamento de Química Ambiental. Barcelona.
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99
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Abstract
OBJECTIVES Drinking water chlorination generates trihalomethanes and other by-products with mutagenic and carcinogenic properties in animal experiments. Epidemiological studies have associated trihalomethanes to an increased risk of bladder cancer. We evaluate trihalomethane levels in four Spanish areas and calculate the bladder cancer risk attributable to this exposure. METHODS Trihalomethanes have been analysed in 111 drinking water samples from four Spanish areas using gas chromatography. Water utilities were contacted and information on drinking water consumption in Spain has been collected. We reviewed the epidemiological studies that assess the association between bladder cancer risk and exposure to chlorination by-products. Attributable risk was calculated on the basis of these levels, mortality data per area and risk estimates obtained from the literature. RESULTS Mediterranean areas present the highest levels of trihalomethanes with 81, 80, 61 and 52 µg/l in Sabadell, Alicante, Barcelona and Manresa respectively. Lower levels are found in Tenerife and Asturias with 7 and 20 µg/l respectively. The bladder cancer attributable risk in high trihalomethane exposure areas may be, on average, around 20%. CONCLUSIONS The trihalomethane levels found are high compared to those of other European Union countries. In the high exposure areas, drinking water chlorination may generate a considerable number of bladder cancer cases. These estimations have to be carefully interpreted and verified with more extensive studies.
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Affiliation(s)
- C M Villanueva
- Institut Municipal d'Investigació Mèdica (IMIM). Unitat de Recerca Respiratòria i Ambiental
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100
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Rico FG, Espinoza JL, Montero P, Espinoza F, Mancilla A, Sánchez A, Villanueva CM. [Treatment of bronchial asthma in winter using controlled-release salbutamol]. Rev Alerg Mex (1987) 1990; 37:165-71. [PMID: 2094946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This paper presents results about comparative study in winter season, in a statistics design AB and BA on 20 patients that were treated with salbutamol (Group B) and with salbutamol of controlled liberation (Group B) at random. Results showed that patients of Group B had improvement in symptomatology and had less exacerbations than those patients of group A with statistical significance. It was concluded that salbutamol tablets of controlled liberation is a therapeutic method adequate to control chronic phase of asthmatic patients in winter season.
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Affiliation(s)
- F G Rico
- Departamento de Neumología, Hospital General, Centro Médico, La Raza, IMSS
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