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Shawahna R, Abdi A, Bani-Odeh D, Saleh R, Owiwi L, Maqboul I, Hijaz H, Jaber M. Breastmilk calcium concentrations in Palestinian lactating women. Acta Paediatr 2024; 113:1315-1321. [PMID: 38482983 DOI: 10.1111/apa.17204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 02/28/2024] [Accepted: 03/04/2024] [Indexed: 07/11/2024]
Abstract
AIM Breastmilk calcium concentrations can vary between lactating women and over the lactation period. This study assessed breastmilk calcium concentrations among Palestinian lactating women. METHODS The demographic and dietary variables of the lactating women were collected using a questionnaire. The women provided a sample of about 5 mL of breastmilk using hand expression. Breastmilk calcium concentrations were quantified using an inductively coupled plasma-mass spectrometric method. RESULTS Breastmilk samples were taken from 240 lactating women. The mean breastmilk calcium concentration was 285.4 ± 115.1 mg/L. Lower breastmilk calcium concentrations were associated with age, lactating period, unemployment, dissatisfaction with income and insufficient consumption of vitamins and minerals. CONCLUSION Breastmilk calcium concentrations were affected by demographic variables of the lactating women and insufficient consumption of vitamins and minerals. The findings reported in this study are informative to healthcare providers and decision makers who might be interested in improving the health of lactating women and their infants.
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Affiliation(s)
- Ramzi Shawahna
- Department of Physiology, Pharmacology and Toxicology, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
- Clinical Research Center, An-Najah National University Hospital, Nablus, Palestine
| | - Aya Abdi
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Diana Bani-Odeh
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Rana Saleh
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Lina Owiwi
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Iyad Maqboul
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
- An-Najah National University Hospital, Nablus, Palestine
| | - Hatim Hijaz
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
- An-Najah National University Hospital, Nablus, Palestine
| | - Mohammad Jaber
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
- An-Najah National University Hospital, Nablus, Palestine
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Shawahna R, Jaber M, Maqboul I, Hijaz H, Alawneh A, Imwas H. Aluminum Concentrations in Breast Milk Samples Obtained from Breastfeeding Women from a Resource-Limited Country: A Study of the Predicting Factors. Biol Trace Elem Res 2024; 202:1-8. [PMID: 37268844 DOI: 10.1007/s12011-023-03714-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/21/2023] [Indexed: 06/04/2023]
Abstract
This study assessed aluminum concentrations in breast milk samples obtained from breastfeeding women in resource-limited countries, estimated daily intake of aluminum by breastfed infants, and identified predictors of higher breast milk aluminum concentrations. A descriptive analytical approach was used in this multicenter study. Breastfeeding women were recruited from different maternity health clinics in Palestine. Aluminum concentrations in 246 breast milk samples were determined using an inductively coupled plasma-mass spectrometric method. The mean breast milk aluminum concentration was 2.1 ± 1.5 mg/L. The mean estimated daily intake of aluminum by infants was 0.37 ± 0.26 mg/kg body weight/day. Multiple linear regression showed that breast milk aluminum concentrations were predicted by living in urban areas, closer to industrial areas, waste disposals, frequent use of deodorants, and less frequent use of vitamins. Breast milk aluminum levels among Palestinian breastfeeding women were comparable to those previously determined in occupationally unexposed women.
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Affiliation(s)
- Ramzi Shawahna
- Department of Physiology, Pharmacology and Toxicology, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
- Clinical Research Center, An-Najah National University Hospital, Nablus, Palestine.
| | - Mohammad Jaber
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
- An-Najah National University Hospital, Nablus, Palestine
| | - Iyad Maqboul
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
- An-Najah National University Hospital, Nablus, Palestine.
| | - Hatim Hijaz
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
- An-Najah National University Hospital, Nablus, Palestine
| | - Ala'a Alawneh
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Hanen Imwas
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
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Verscheure E, Stierum R, Schlünssen V, Lund Würtz AM, Vanneste D, Kogevinas M, Harding BN, Broberg K, Zienolddiny-Narui S, Erdem JS, Das MK, Makris KC, Konstantinou C, Andrianou X, Dekkers S, Morris L, Pronk A, Godderis L, Ghosh M. Characterization of the internal working-life exposome using minimally and non-invasive sampling methods - a narrative review. ENVIRONMENTAL RESEARCH 2023; 238:117001. [PMID: 37683788 DOI: 10.1016/j.envres.2023.117001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023]
Abstract
During recent years, we are moving away from the 'one exposure, one disease'-approach in occupational settings and towards a more comprehensive approach, taking into account the totality of exposures during a life course by using an exposome approach. Taking an exposome approach however is accompanied by many challenges, one of which, for example, relates to the collection of biological samples. Methods used for sample collection in occupational exposome studies should ideally be minimally invasive, while at the same time sensitive, and enable meaningful repeated sampling in a large population and over a longer time period. This might be hampered in specific situations e.g., people working in remote areas, during pandemics or with flexible work hours. In these situations, using self-sampling techniques might offer a solution. Therefore, our aim was to identify existing self-sampling techniques and to evaluate the applicability of these techniques in an occupational exposome context by conducting a literature review. We here present an overview of current self-sampling methodologies used to characterize the internal exposome. In addition, the use of different biological matrices was evaluated and subdivided based on their level of invasiveness and applicability in an occupational exposome context. In conclusion, this review and the overview of self-sampling techniques presented herein can serve as a guide in the design of future (occupational) exposome studies while circumventing sample collection challenges associated with exposome studies.
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Affiliation(s)
- Eline Verscheure
- Department of Public Health and Primary Care, Centre for Environment and Health, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Rob Stierum
- Netherlands Organisation for Applied Scientific Research TNO, Risk Analysis for Products in Development, Utrecht, the Netherlands
| | - Vivi Schlünssen
- Department of Public Health, Research unit for Environment, Occupation and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark
| | - Anne Mette Lund Würtz
- Department of Public Health, Research unit for Environment, Occupation and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark
| | - Dorian Vanneste
- Department of Public Health and Primary Care, Centre for Environment and Health, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Manolis Kogevinas
- Environment and Health over the Lifecourse Program, ISGlobal, Barcelona, Spain
| | - Barbara N Harding
- Environment and Health over the Lifecourse Program, ISGlobal, Barcelona, Spain
| | - Karin Broberg
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Mrinal K Das
- National Institute of Occupational Health, Oslo, Norway
| | - Konstantinos C Makris
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - Corina Konstantinou
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - Xanthi Andrianou
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - Susan Dekkers
- Netherlands Organisation for Applied Scientific Research TNO, Risk Analysis for Products in Development, Utrecht, the Netherlands
| | | | - Anjoeka Pronk
- Netherlands Organisation for Applied Scientific Research TNO, Risk Analysis for Products in Development, Utrecht, the Netherlands
| | - Lode Godderis
- Department of Public Health and Primary Care, Centre for Environment and Health, Katholieke Universiteit Leuven, Leuven, Belgium; Idewe, External Service for Prevention and Protection at work, Heverlee, Belgium.
| | - Manosij Ghosh
- Department of Public Health and Primary Care, Centre for Environment and Health, Katholieke Universiteit Leuven, Leuven, Belgium.
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Shawahna R, Saleh R, Owiwi L, Abdi A, Bani-Odeh D, Maqboul I, Hijaz H, Jaber M. Breastmilk cadmium levels and estimated infant exposure: a multicenter study of associated factors in a resource-limited country. Int Breastfeed J 2023; 18:36. [PMID: 37501132 PMCID: PMC10375743 DOI: 10.1186/s13006-023-00574-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 07/13/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Despite the undisputed benefits of breastfeeding, infants might become exposed to xenobiotics that could be excreted into breast milk following maternal exposure. This study was conducted to assess breastmilk cadmium levels among lactating women in Palestine, a resource-limited country. Estimated daily intake (EDI) of cadmium via breastmilk was also calculated and predictors of high breastmilk cadmium levels and high infant exposure via breastmilk were identified. METHODS This multicenter study was conducted using a descriptive-analytical design. The lactating women were recruited from different maternity and public health clinics in all regions of Palestine. Demographic variables and exposure to sources of cadmium were collected in an interviewer-administered questionnaire. Foremilk samples (about 5 mL) were collected in polyethylene tubes using the hand-expression technique. The breast milk samples were collected in the period between December 2020 and March 2021. A pre-validated method using inductively coupled plasma mass spectrometry (ICP-MS) was used to quantify breastmilk cadmium levels. EDI values were calculated from the quantified breastmilk cadmium levels. RESULTS Breastmilk samples were obtained from 256 lactating women. The mean breastmilk cadmium level was 0.34 (SD: 0.33) μg / L and the mean EDI of cadmium via breastmilk was 0.059 (SD: 0.058) µg / kg per body weight / day. Breastmilk cadmium levels were quantified in 92.6% of the breastmilk samples. Of the breastmilk samples, 13 (5.1%) had cadmium levels above those reported as "normal" by the World Health Organization (WHO). Multiple linear regression showed that higher breastmilk cadmium levels and higher EDI were predicted by being a smoker, living in a refugee camp, living close to an industrial area, living close to disposal of wastes, living close to paint shops, living in a house with peeling / chipping paint, frequent use of cosmetics, frequent use of hair dyes, and not using vitamins. CONCLUSION The breastmilk cadmium levels and infant exposure were predicted by maternal exposure to sources of cadmium. The findings reported in this study are valuable to antenatal and postnatal healthcare service providers. More studies are needed to plan and implement measures to reduce breastmilk cadmium levels and infants' exposure to cadmium via breastmilk.
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Affiliation(s)
- Ramzi Shawahna
- Department of Physiology, Pharmacology and Toxicology, Faculty of Medicine and Health Sciences, An-Najah National University, New Campus, Building: 19, Office: 1340, P.O. Box 7, Nablus, Palestine.
- Clinical Research Center, An-Najah National University Hospital, Nablus, 44839, Palestine.
| | - Rana Saleh
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Lina Owiwi
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Aya Abdi
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Diana Bani-Odeh
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Iyad Maqboul
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
- An-Najah National University Hospital, Nablus, 44839, Palestine
| | - Hatim Hijaz
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
- An-Najah National University Hospital, Nablus, 44839, Palestine
| | - Mohammad Jaber
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
- An-Najah National University Hospital, Nablus, 44839, Palestine
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Shawahna R. Predictors of Breast Milk Zinc Levels Among Breastfeeding Women in Palestine: a Cross-Sectional Study. Biol Trace Elem Res 2022; 200:4632-4640. [PMID: 35767207 DOI: 10.1007/s12011-022-03347-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/24/2022] [Indexed: 11/02/2022]
Abstract
Zinc is one of the most important essential micronutrients that is needed for the normal growth, development, and maintaining the health of human beings. Previous studies showed that zinc deficiency was highly prevalent among pregnant and lactating women. This cross-sectional study was conducted to determine breast milk zinc levels among breastfeeding women in Palestine and to identify the predictors of breast milk zinc levels. Breast milk samples were obtained from breastfeeding women who visited maternity and primary healthcare centers. Zinc levels were determined using inductively coupled plasma mass spectrometry. Breast milk zinc levels were determined in 390 breast milk samples. The mean breast milk zinc level in all samples was 0.15 ± 0.09 mg per 100 mL. Breast milk zinc levels declined with postpartum time from 0.22 ± 0.011 at ≤ 1 month postpartum to 0.09 ± 0.009 mg per 100 mL at > 9 months postpartum (p-value < 0.001). Multiple linear regression showed that high breast milk zinc levels were predicted by younger maternal age, postpartum time, being employed, frequent consumption of multivitamins/minerals, and practicing exclusive breastfeeding. In conclusion, the breast milk zinc levels quantified among breastfeeding women in Palestine were comparable to those previously reported among non-malnourished women elsewhere. The findings of this study are informative to pediatricians, gynecologists, nurses/midwives, breastfeeding advisors/counselors, nutritionists, and policymakers who might be interested in designing and implementing interventions to improve breast milk zinc levels.
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Affiliation(s)
- Ramzi Shawahna
- Faculty of Medicine and Health Sciences, Department of Physiology, Pharmacology and Toxicology, An-Najah National University, New Campus, Building: 19, Office: 1340, P.O. Box 7, Nablus, Palestine.
- An-Najah BioSciences Unit, Centre for Poisons Control, Chemical and Biological Analyses, An-Najah National University, Nablus, Palestine.
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Shawahna R. Breast milk to blood lead ratios among women from the West Bank of Palestine: a cross-sectional study of associated factors. Int Breastfeed J 2021; 16:61. [PMID: 34425844 PMCID: PMC8381486 DOI: 10.1186/s13006-021-00410-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 08/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background Infants fed contaminated breast milk are at an increased risk of exposure to lead. Breast milk to blood (M/B) ratios have not been investigated among women in Palestine. The aim of this study was to assess blood, breast milk, and M/B lead ratios in samples collected from Palestinian breastfeeding women. Associations between sociodemographic characteristics with breast milk lead levels and M/B lead ratios were also investigated. Methods This study was conducted in a cross-sectional design in the period between October 2017 and April 2018. Breastfeeding women visiting maternity care centers in different regions of the West Bank of Palestine were recruited to the study by the nurses in the maternity care centers. Sociodemographic characteristics, venous blood, and breast milk samples were collected from each participant. Lead concentrations were analyzed using a validated inductively coupled plasma-mass spectrometric method. Mann–Whitney U test, Pearson’s Chi-square, Fisher’s exact, and Spearman’s correlations were used to analyze the data. Odds ratios (OR) were computed using a multivariate logistic regression model. Results Matching blood and milk samples were collected from 80 women. Lead concentrations in 11 (13.8%) of the breast milk samples were above the World Health Organization’s recommended levels. Breast milk lead levels were more likely to be ≥5 μg/L in breastfeeding women who lived in urban areas (aOR 4.96; 95% CI 1.10, 22.38) compared to those who lived in rural areas. Breast milk to blood lead ratios were more likely to be ≥25% in breastfeeding women who lived in urban areas (aOR 7.06; 95% CI 1.68, 29.77), used eye kohl (aOR 14.29; 95% CI 1.32, 155.06), and used hair dye (aOR 5.33; 95% CI 1.58, 18.00) compared to those who lived in rural areas, did not use eye kohl, and did not use hair dye, respectively. Conclusions Higher M/B lead ratios were predicted by living in urban areas, using eye kohl, and using hair dye. Decision makers in health authorities should address sources of exposure to lead in urban areas. Cosmetics containing lead should be assessed and regulated for lead content. Supplementary Information The online version contains supplementary material available at 10.1186/s13006-021-00410-3.
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Affiliation(s)
- Ramzi Shawahna
- Department of Physiology, Pharmacology and Toxicology, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine. .,An-Najah BioSciences Unit, Centre for Poisons Control, Chemical and Biological Analyses, An-Najah National University, Nablus, Palestine.
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