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Horsdal HT, Pedersen MG, Schullehner J, Østergaard CS, Mcgrath JJ, Agerbo E, Timmermann A, Closter AM, Brandt J, Christensen JH, Frohn LM, Geels C, Ketzel M, Khan J, Ørby PV, Olsen Y, Levin G, Svenning JC, Engemann K, Gyldenkærne S, Hansen B, Hertel O, Sabel CE, Erikstrup C, Sigsgaard T, Pedersen CB. Perspectives on environment and health research in Denmark. Scand J Public Health 2024; 52:741-751. [PMID: 37278162 PMCID: PMC11308320 DOI: 10.1177/14034948231178076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/04/2023] [Accepted: 05/08/2023] [Indexed: 06/07/2023]
Abstract
AIMS We provide an overview of nationwide environmental data available for Denmark and its linkage potentials to individual-level records with the aim of promoting research on the potential impact of the local surrounding environment on human health. BACKGROUND Researchers in Denmark have unique opportunities for conducting large population-based studies treating the entire Danish population as one big, open and dynamic cohort based on nationally complete population and health registries. So far, most research in this area has utilised individual- and family-level information to study the clustering of disease in families, comorbidities, risk of, and prognosis after, disease onset, and social gradients in disease risk. Linking environmental data in time and space to individuals enables novel possibilities for studying the health effects of the social, built and physical environment. METHODS We describe the possible linkage between individuals and their local surrounding environment to establish the exposome - that is, the total environmental exposure of an individual over their life course. CONCLUSIONS The currently available nationwide longitudinal environmental data in Denmark constitutes a valuable and globally rare asset that can help explore the impact of the exposome on human health.
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Affiliation(s)
- Henriette T. Horsdal
- National Centre for Register-based Research, Aarhus University, Denmark
- Big Data Centre for Environment and Health, Aarhus University, Denmark
| | - Marianne G. Pedersen
- National Centre for Register-based Research, Aarhus University, Denmark
- Centre for Integrated Register-based Research, Aarhus University, Denmark
| | - Jörg Schullehner
- Big Data Centre for Environment and Health, Aarhus University, Denmark
- Department of Public Health, Aarhus University, Denmark
- Geological Survey of Denmark and Greenland, Denmark
| | - Cecilie S. Østergaard
- National Centre for Register-based Research, Aarhus University, Denmark
- Big Data Centre for Environment and Health, Aarhus University, Denmark
- Department of Public Health, Aarhus University, Denmark
| | - John J. Mcgrath
- National Centre for Register-based Research, Aarhus University, Denmark
- Queensland Brain Institute, The University of Queensland, Australia
- Queensland Centre for Mental Health Research, Australia
| | - Esben Agerbo
- National Centre for Register-based Research, Aarhus University, Denmark
- Centre for Integrated Register-based Research, Aarhus University, Denmark
| | - Allan Timmermann
- National Centre for Register-based Research, Aarhus University, Denmark
- Big Data Centre for Environment and Health, Aarhus University, Denmark
- Centre for Integrated Register-based Research, Aarhus University, Denmark
| | - Ane Marie Closter
- National Centre for Register-based Research, Aarhus University, Denmark
- Big Data Centre for Environment and Health, Aarhus University, Denmark
- Centre for Integrated Register-based Research, Aarhus University, Denmark
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Denmark
| | | | - Lise M. Frohn
- Department of Environmental Science, Aarhus University, Denmark
| | - Camilla Geels
- Department of Environmental Science, Aarhus University, Denmark
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Denmark
- Global Centre for Clean Air Research, University of Surrey, UK
| | - Jibran Khan
- Big Data Centre for Environment and Health, Aarhus University, Denmark
- Department of Environmental Science, Aarhus University, Denmark
| | - Pia V. Ørby
- Big Data Centre for Environment and Health, Aarhus University, Denmark
- Department of Environmental Science, Aarhus University, Denmark
| | - Yulia Olsen
- Big Data Centre for Environment and Health, Aarhus University, Denmark
- Department of Public Health, Aarhus University, Denmark
| | - Gregor Levin
- Department of Environmental Science, Aarhus University, Denmark
| | - Jens-Christian Svenning
- Center for Ecological Dynamics in a Novel Biosphere & Center for Biodiversity Dynamics in a Changing World, Department of Biology, Aarhus University, Denmark
| | - Kristine Engemann
- Center for Ecological Dynamics in a Novel Biosphere & Center for Biodiversity Dynamics in a Changing World, Department of Biology, Aarhus University, Denmark
| | | | | | - Ole Hertel
- Big Data Centre for Environment and Health, Aarhus University, Denmark
- Department of Ecoscience, Aarhus University, Denmark
| | - Clive E. Sabel
- Big Data Centre for Environment and Health, Aarhus University, Denmark
- Department of Public Health, Aarhus University, Denmark
| | - Christian Erikstrup
- Big Data Centre for Environment and Health, Aarhus University, Denmark
- Department of Clinical Immunology, Aarhus University Hospital, Denmark
| | - Torben Sigsgaard
- Big Data Centre for Environment and Health, Aarhus University, Denmark
- Department of Public Health, Aarhus University, Denmark
| | - Carsten B. Pedersen
- National Centre for Register-based Research, Aarhus University, Denmark
- Big Data Centre for Environment and Health, Aarhus University, Denmark
- Centre for Integrated Register-based Research, Aarhus University, Denmark
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Schraw JM, Rudolph KE, Shumate CJ, Gribble MO. Direct potable reuse and birth defects prevalence in Texas: An augmented synthetic control method analysis of data from a population-based birth defects registry. Environ Epidemiol 2024; 8:e300. [PMID: 38617421 PMCID: PMC11008670 DOI: 10.1097/ee9.0000000000000300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/12/2024] [Indexed: 04/16/2024] Open
Abstract
Background Direct potable reuse (DPR) involves adding purified wastewater that has not passed through an environmental buffer into a water distribution system. DPR may help address water shortages and is approved or is under consideration as a source of drinking water for several water-stressed population centers in the United States, however, there are no studies of health outcomes in populations who receive DPR drinking water. Our objective was to determine whether the introduction of DPR for certain public water systems in Texas was associated with changes in birth defect prevalence. Methods We obtained data on maternal characteristics for all live births and birth defects cases regardless of pregnancy outcome in Texas from 2003 to 2017 from the Texas Birth Defects Registry and birth and fetal death records. The ridge augmented synthetic control method was used to model changes in birth defect prevalence (per 10,000 live births) following the adoption of DPR by four Texas counties in mid-2013, with county-level data on maternal age, percent women without a high school diploma, percent who identified as Hispanic/Latina or non-Hispanic/Latina Black, and rural-urban continuum code as covariates. Results There were nonstatistically significant increases in prevalence of all birth defects collectively (average treatment effect in the treated = 53.6) and congenital heart disease (average treatment effect in the treated = 287.3) since June 2013. The estimated prevalence of neural tube defects was unchanged. Conclusions We estimated nonstatistically significant increases in birth defect prevalence following the implementation of DPR in four West Texas counties. Further research is warranted to inform water policy decisions.
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Affiliation(s)
- Jeremy M. Schraw
- Center for Epidemiology and Population Health, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Kara E. Rudolph
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, New York
| | - Charles J. Shumate
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas
| | - Matthew O. Gribble
- School of Medicine, University of California San Francisco, San Francisco, California
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Hadi M, Bashardoust P, Solaimany Aminabad M, Nazmara S, Rezvani Ghalhari M, Mesdaghinia A, Hemmati Borji S. Exposure assessment of nitrate and phenol derivatives in Tehran's water distribution system. JOURNAL OF WATER AND HEALTH 2024; 22:147-168. [PMID: 38295078 PMCID: wh_2023_133 DOI: 10.2166/wh.2023.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
The presence of organic and inorganic contaminants in drinking water is a global concern. Nitrate and phenol derivatives are examples of pollutants that could be of anthropogenic origin. They are associated with numerous health risks, underscoring the importance of monitoring their presence in drinking water. This study aimed to measure nitrate and phenol derivatives, including 2,4-Dichlorophenol (2,4-DCP), Pentachlorophenol (PCP), 2,4,5-Trichlorophenol (2,4,5-TCP), 2-Chlorophenol (2-CP), 4-Chlorophenol (4-CP), and phenol, in Tehran's water distribution system (WDS). The pollutants in Tehran's WDS were significantly and positively correlated with precipitation. The Hazard Quotient (HQ) and the Excess Lifetime Cancer Risk (ELCR) of the detected pollutants were estimated. The results showed that the regional mean of nitrate and PCP in Tehran's WDS were 35.58±8.71mg L-1 and 76.14±16.93 ng L-1 lower than the guideline values of 50 mg L-1 and 1000 ng L-1, respectively. Some districts exhibited nitrate concentration exceeding the allowable limit by a factor of 1.2 to 2.3. Consequently, the nitrate intake in some districts constituted approximately 50% of the reference dose. While PCP as a phenol derivative with more health concerns was identified in Tehran's WDS, the likelihood of its health effects was determined to be negligible.
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Affiliation(s)
- Mahdi Hadi
- Center for Water Quality Research (CWQR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran E-mail: ;
| | - Parnia Bashardoust
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehri Solaimany Aminabad
- Center for Water Quality Research (CWQR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Shahrokh Nazmara
- Center for Water Quality Research (CWQR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran; Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Rezvani Ghalhari
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Mesdaghinia
- Center for Water Quality Research (CWQR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran; Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeedeh Hemmati Borji
- Center for Water Quality Research (CWQR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
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Levin R, Villanueva CM, Beene D, Cradock AL, Donat-Vargas C, Lewis J, Martinez-Morata I, Minovi D, Nigra AE, Olson ED, Schaider LA, Ward MH, Deziel NC. US drinking water quality: exposure risk profiles for seven legacy and emerging contaminants. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2024; 34:3-22. [PMID: 37739995 PMCID: PMC10907308 DOI: 10.1038/s41370-023-00597-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Advances in drinking water infrastructure and treatment throughout the 20th and early 21st century dramatically improved water reliability and quality in the United States (US) and other parts of the world. However, numerous chemical contaminants from a range of anthropogenic and natural sources continue to pose chronic health concerns, even in countries with established drinking water regulations, such as the US. OBJECTIVE/METHODS In this review, we summarize exposure risk profiles and health effects for seven legacy and emerging drinking water contaminants or contaminant groups: arsenic, disinfection by-products, fracking-related substances, lead, nitrate, per- and polyfluorinated alkyl substances (PFAS) and uranium. We begin with an overview of US public water systems, and US and global drinking water regulation. We end with a summary of cross-cutting challenges that burden US drinking water systems: aging and deteriorated water infrastructure, vulnerabilities for children in school and childcare facilities, climate change, disparities in access to safe and reliable drinking water, uneven enforcement of drinking water standards, inadequate health assessments, large numbers of chemicals within a class, a preponderance of small water systems, and issues facing US Indigenous communities. RESULTS Research and data on US drinking water contamination show that exposure profiles, health risks, and water quality reliability issues vary widely across populations, geographically and by contaminant. Factors include water source, local and regional features, aging water infrastructure, industrial or commercial activities, and social determinants. Understanding the risk profiles of different drinking water contaminants is necessary for anticipating local and general problems, ascertaining the state of drinking water resources, and developing mitigation strategies. IMPACT STATEMENT Drinking water contamination is widespread, even in the US. Exposure risk profiles vary by contaminant. Understanding the risk profiles of different drinking water contaminants is necessary for anticipating local and general public health problems, ascertaining the state of drinking water resources, and developing mitigation strategies.
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Affiliation(s)
- Ronnie Levin
- Harvard TH Chan School of Public Health, Boston, MA, USA.
| | - Cristina M Villanueva
- ISGlobal, Barcelona, Spain
- CIBER epidemiología y salud pública (CIBERESP), Madrid, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Daniel Beene
- Community Environmental Health Program, College of Pharmacy, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
- University of New Mexico Department of Geography & Environmental Studies, Albuquerque, NM, USA
| | | | - Carolina Donat-Vargas
- ISGlobal, Barcelona, Spain
- CIBER epidemiología y salud pública (CIBERESP), Madrid, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Johnnye Lewis
- Community Environmental Health Program, College of Pharmacy, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Irene Martinez-Morata
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Darya Minovi
- Center for Science and Democracy, Union of Concerned Scientists, Washington, DC, USA
| | - Anne E Nigra
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Erik D Olson
- Natural Resources Defense Council, Washington, DC, USA
| | | | - Mary H Ward
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
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Schullehner J, Cserbik D, Gago-Ferrero P, Lundqvist J, Nuckols JR. Integrating different tools and technologies to advance drinking water quality exposure assessments. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2024; 34:108-114. [PMID: 37553410 DOI: 10.1038/s41370-023-00588-0] [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: 03/01/2023] [Revised: 07/20/2023] [Accepted: 07/20/2023] [Indexed: 08/10/2023]
Abstract
Contaminants in drinking water are a major contributor to the human exposome and adverse health effects. Assessing drinking water exposure accurately in health studies is challenging, as several of the following study design domains should be addressed as adequately as possible. In this paper, we identify the domains Time, Space, Data Quality, Data Accessibility, economic considerations of Study Size, and Complex Mixtures. We present case studies for three approaches or technologies that address these domains differently in the context of exposure assessment of drinking water quality: regulated contaminants in monitoring databases, high-resolution mass spectrometry (HRMS)-based wide-scope chemical analysis, and effect-based bioassay methods. While none of these approaches address all the domains sufficiently, together they have the potential to carry out exposure assessments that would complement each other and could advance the state-of-science towards more accurate risk analysis. The aim of our study is to give researchers investigating health effects of drinking water quality the impetus to consider how their exposure assessments relate to the above-mentioned domains and whether it would be worthwhile to integrate the advanced technologies presented into planned risk analyses. We highly suggest this three-pronged approach should be further evaluated in health risk analyses, especially epidemiological studies concerning contaminants in drinking water. The state of the knowledge regarding potential benefits of these technologies, especially when applied in tandem, provides more than sufficient evidence to support future research to determine the implications of combining the approaches described in our case studies in terms of protection of public health.
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Affiliation(s)
- Jörg Schullehner
- Environment, Occupation and Health, Department of Public Health, Aarhus University, Aarhus, Denmark.
- Danish Big Data Centre for Environment and Health (BERTHA), Aarhus University, Aarhus, Denmark.
| | - Dora Cserbik
- Barcelona Institute for Global Health, Barcelona, Spain
| | - Pablo Gago-Ferrero
- Institute of Environmental Assessment and Water Research-Spanish Council of Scientific Research (IDAEA-CSIC), Barcelona, Spain
| | - Johan Lundqvist
- Department of Biomedicine and Veterinary Public Health, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - John R Nuckols
- Emeritus Professor of Environmental Health Sciences, Colorado State University, Fort Collins, CO, USA
- Principal, JRN Environmental Health Sciences, Ltd, North Bethesda, MD, USA
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Cottrell EC. Should the non-canonical pathway of nitric oxide generation be targeted in hypertensive pregnancies? Br J Pharmacol 2023. [PMID: 37921362 DOI: 10.1111/bph.16276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 11/04/2023] Open
Abstract
Hypertension in pregnancy is prevalent, affecting around 10% of pregnancies worldwide, and significantly increases the risk of adverse outcomes for both mothers and their babies. Current treatment strategies for pregnant women with hypertension are limited, and new approaches for the management of hypertension in pregnancy are urgently needed. Substantial evidence from non-pregnant subjects has demonstrated the potential for dietary nitrate supplementation to increase nitric oxide (NO) bioavailability and lower blood pressure, following bioactivation via the non-canonical NO pathway. Emerging data suggest this approach may also be of benefit in pregnant women, although studies are limited. This review aims to summarise the current evidence from preclinical and clinical studies of nitrate supplementation in pregnancy, drawing on data from non-pregnant populations where appropriate and highlighting key gaps in knowledge that remain to be addressed in future trials.
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Affiliation(s)
- Elizabeth C Cottrell
- Maternal and Fetal Health Research Centre, Division of Developmental Biology & Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Clemmensen PJ, Schullehner J, Brix N, Sigsgaard T, Stayner LT, Kolstad HA, Ramlau-Hansen CH. Prenatal Exposure to Nitrate in Drinking Water and Adverse Health Outcomes in the Offspring: a Review of Current Epidemiological Research. Curr Environ Health Rep 2023; 10:250-263. [PMID: 37453984 PMCID: PMC10504112 DOI: 10.1007/s40572-023-00404-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE OF REVIEW Recently, several epidemiological studies have investigated whether prenatal exposure to nitrate from drinking water may be harmful to the fetus, even at nitrate levels below the current World Health Organization drinking water standard. The purpose of this review was to give an overview of the newest knowledge on potential health effects of prenatal exposure to nitrate. RECENT FINDINGS We included 13 epidemiological studies conducted since 2017. Nine studies investigated outcomes appearing around birth, and four studies investigated health outcomes appearing in childhood and young adulthood. The reviewed studies showed some indications of higher risk of preterm delivery, lower birth weight, birth defects, and childhood cancer related to prenatal exposure to nitrate. However, the numbers of studies for each outcome were sparse, and some of the results were conflicting. We suggest that there is a need for additional studies and particularly for studies that include information on water consumption patterns, intake of nitrate from diet, and intake of nitrosatable drugs.
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Affiliation(s)
| | - Jörg Schullehner
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Danish Big Data Centre for Environment and Health (BERTHA), Aarhus University, Aarhus, Denmark
| | - Nis Brix
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
| | - Torben Sigsgaard
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Danish Big Data Centre for Environment and Health (BERTHA), Aarhus University, Aarhus, Denmark
- Cirrau - Centre for Integrated Register-based Research at Aarhus University, Aarhus, Denmark
| | - Leslie Thomas Stayner
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago, School of Public Health, Chicago, IL, USA
| | - Henrik Albert Kolstad
- Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Jensen AS, Coffman VR, Schullehner J, Trabjerg BB, Pedersen CB, Hansen B, Olsen J, Pedersen M, Stayner LT, Sigsgaard T. Prenatal exposure to tap water containing nitrate and the risk of small-for-gestational-age: A nationwide register-based study of Danish births, 1991-2015. ENVIRONMENT INTERNATIONAL 2023; 174:107883. [PMID: 37001213 PMCID: PMC10172763 DOI: 10.1016/j.envint.2023.107883] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 03/07/2023] [Accepted: 03/14/2023] [Indexed: 05/14/2023]
Abstract
BACKGROUND Prenatal nitrate exposure from household tap water has been associated with increased risk of fetal growth restriction, preterm birth, birth defects, and childhood cancer. We aim to examine the association between maternal consumption of drinking-water nitrate during pregnancy and small-for-gestational-age (SGA) in a nationwide study of Danish-born children, as only one prior study has examined this association. METHODS We linked individual-level household estimates of nitrate in tap water and birth registry data to all live singleton Danish births during 1991-2015 from Danish-born parents where the mother resided in Denmark throughout the pregnancy. Exposure was both binned into four categories and modeled as an ln-transformed continuous variable. SGA was defined as the bottom 10% of births by birth weight per sex and gestational week. Multiple logistic regression models with generalized estimating equations were used to account for siblings born to the same mother while controlling for relevant confounders. RESULTS In the cohort of 1,078,892 births, the median pregnancy nitrate exposure was 1.9 mg/L nitrate. Compared to the reference group (≤2 mg/L), we found an increased risk of SGA in the second category (>2-5 mg/L) (OR = 1.04, 95% CI: 1.03-1.06) and third category (>5-25 mg/L) (OR = 1.02, 95% CI: 1.00-1.04) but not in the highest (>25 mg/L). There was strong (p = 0.002) evidence of an increase in SGA with nitrate in the model with continuous exposure (OR = 1.02, 95% CI: 1.01-1.04 per 10-fold increase in nitrate). Results were robust when restricting to households with nitrate levels at or below the current Danish and European Union regulatory drinking water standard (50 mg/L nitrate). CONCLUSIONS Our findings suggest that exposure from nitrate in household tap water, even below current regulatory standards, may increase risk of SGA, raising concerns of whether current allowable nitrate levels in drinking water protect children from SGA.
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Affiliation(s)
- Anja Søndergaard Jensen
- Centre for Integrated Register-based Research (CIRRAU), Aarhus University, Aarhus, Denmark; Big Data Centre for Environment and Health (BERTHA), Aarhus University, Aarhus, Denmark
| | - Vanessa R Coffman
- Division of Epidemiology and Biostatistics, University of Illinois Chicago, Chicago, IL, USA
| | - Jörg Schullehner
- Big Data Centre for Environment and Health (BERTHA), Aarhus University, Aarhus, Denmark; Department of Groundwater and Quaternary Geology Mapping, Geological Survey of Denmark and Greenland, Aarhus, Denmark; Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Betina B Trabjerg
- Centre for Integrated Register-based Research (CIRRAU), Aarhus University, Aarhus, Denmark; National Centre for Register-Based Research (NCRR), Aarhus University, Aarhus, Denmark
| | - Carsten B Pedersen
- Centre for Integrated Register-based Research (CIRRAU), Aarhus University, Aarhus, Denmark; Big Data Centre for Environment and Health (BERTHA), Aarhus University, Aarhus, Denmark; National Centre for Register-Based Research (NCRR), Aarhus University, Aarhus, Denmark
| | - Birgitte Hansen
- Department of Groundwater and Quaternary Geology Mapping, Geological Survey of Denmark and Greenland, Aarhus, Denmark
| | - Jørn Olsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Marie Pedersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Leslie T Stayner
- Division of Epidemiology and Biostatistics, University of Illinois Chicago, Chicago, IL, USA.
| | - Torben Sigsgaard
- Centre for Integrated Register-based Research (CIRRAU), Aarhus University, Aarhus, Denmark; Big Data Centre for Environment and Health (BERTHA), Aarhus University, Aarhus, Denmark; Department of Public Health, Aarhus University, Aarhus, Denmark
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9
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Grout L, Chambers T, Hales S, Prickett M, Baker MG, Wilson N. The potential human health hazard of nitrates in drinking water: a media discourse analysis in a high-income country. Environ Health 2023; 22:9. [PMID: 36658626 PMCID: PMC9851889 DOI: 10.1186/s12940-023-00960-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 01/03/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Recent studies linking low levels of nitrate in drinking water to colorectal cancer have raised public concerns over nitrate contamination. The aim of this study was to analyze the media discourse on the potential human health hazard of nitrates in drinking water in a high-income country with a large livestock industry: New Zealand (NZ). METHODS Searches of media sources ("major newspapers") held by the Factiva database for the NZ setting in the five-year period 17 December 2016 to 20 December 2021. RESULTS The largest number of media items was observed for 2017 (n = 108), the year of a NZ general election, with a notable decrease in 2020 (n = 20) that was likely due to the Covid-19 pandemic, which dominated health media. However, the percentage of these media items with a health focus steadily increased over time, from 11.1% of all articles in 2017 to 51.2% in 2021. The most commonly mentioned health hazard was colorectal cancer, followed by methemoglobinemia. The temporal pattern of media items suggests that the release of scientific studies and scholarly blogs was associated with the publication of subsequent media items. Major stakeholders involved in the discourse included representatives of local and central government, environmental and recreational interest groups, researchers, local residents, agricultural interest groups, and health organizations. Māori (Indigenous New Zealanders) values or perspectives were rarely mentioned. CONCLUSIONS Analysis of major newspapers for a five-year period indicated that a wide range of expert comment and opinions were made available to the public and policy makers on the issue of nitrates in water. While many different stakeholder views were captured in the media discourse, there is scope for the media to better report the views of Māori on this topic. There is also a need for articles detailing the health issues to also refer to the environmental, recreational, and cultural aspects of protecting water quality to ensure that the public, policy makers, and regulators are aware of co-benefits.
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Affiliation(s)
- Leah Grout
- Department of Public Health, University of Otago, Wellington, 6021, New Zealand.
- Larner College of Medicine, University of Vermont, VT, Burlington, USA.
| | - Tim Chambers
- Department of Public Health, University of Otago, Wellington, 6021, New Zealand
| | - Simon Hales
- Department of Public Health, University of Otago, Wellington, 6021, New Zealand
| | - Marnie Prickett
- Department of Public Health, University of Otago, Wellington, 6021, New Zealand
| | - Michael G Baker
- Department of Public Health, University of Otago, Wellington, 6021, New Zealand
| | - Nick Wilson
- Department of Public Health, University of Otago, Wellington, 6021, New Zealand
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Lin L, St Clair S, Gamble GD, Crowther CA, Dixon L, Bloomfield FH, Harding JE. Nitrate contamination in drinking water and adverse reproductive and birth outcomes: a systematic review and meta-analysis. Sci Rep 2023; 13:563. [PMID: 36631499 PMCID: PMC9834225 DOI: 10.1038/s41598-022-27345-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/30/2022] [Indexed: 01/13/2023] Open
Abstract
Exposure to low levels of nitrate in drinking water may have adverse reproductive effects. We reviewed evidence about the association between nitrate in drinking water and adverse reproductive outcomes published to November 2022. Randomized trials, cohort or case-control studies published in English that reported the relationship between nitrate intake from drinking water and the risk of perinatal outcomes were included. Random-effect models were used to pool data. Three cohort studies showed nitrate in drinking water is associated with an increased risk of preterm birth (odds ratio for 1 mg/L NO3-N increased (OR1) = 1.01, 95% CI 1.00, 1.01, I2 = 23.9%, 5,014,487 participants; comparing the highest versus the lowest nitrate exposure groups pooled OR (ORp) = 1.05, 95% CI 1.01, 1.10, I2 = 0%, 4,152,348 participants). Case-control studies showed nitrate in drinking water may be associated with the increased risk of neural tube defects OR1 = 1.06, 95% CI 1.02, 1.10; 2 studies, 2196 participants; I2 = 0%; and ORp = 1.51, 95% CI 1.12, 2.05; 3 studies, 1501 participants; I2 = 0%). The evidence for an association between nitrate in drinking water and risk of small for gestational age infants, any birth defects, or any congenital heart defects was inconsistent. Increased nitrate in drinking water may be associated with an increased risk of preterm birth and some specific congenital anomalies. These findings warrant regular review as new evidence becomes available.
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Affiliation(s)
- Luling Lin
- grid.9654.e0000 0004 0372 3343Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Sophie St Clair
- grid.9654.e0000 0004 0372 3343Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Greg D. Gamble
- grid.9654.e0000 0004 0372 3343Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Caroline A. Crowther
- grid.9654.e0000 0004 0372 3343Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Lesley Dixon
- New Zealand College of Midwives, 376 Manchester Street, Richmond, Christchurch, 8014 New Zealand
| | - Frank H. Bloomfield
- grid.9654.e0000 0004 0372 3343Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Jane E. Harding
- grid.9654.e0000 0004 0372 3343Liggins Institute, University of Auckland, Auckland, New Zealand
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Jul Clemmensen P, Brix N, Schullehner J, Lunddorf LLH, Ernst A, Ebdrup NH, Bjerregaard AA, Hansen B, Thomas Stayner L, Ingi Halldorsson T, Frodi Olsen S, Sigsgaard T, Kolstad HA, Ramlau-Hansen CH. Prenatal nitrate exposure from diet and drinking water and timing of puberty in sons and daughters: A nationwide cohort study. ENVIRONMENT INTERNATIONAL 2022; 170:107659. [PMID: 36651653 DOI: 10.1016/j.envint.2022.107659] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/31/2022] [Accepted: 11/23/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND In Western countries, age at pubertal development has declined during the last century in girls, and probably also in boys. No studies have investigated whether nitrate, a widespread environmental exposure with teratogenic and hormone disrupting properties, might affect timing of puberty. OBJECTIVES We investigated if prenatal exposure to nitrate from drinking water and diet was associated with timing of puberty. METHODS This cohort study included 15,819 children born from 2000 to 2003 within the Danish National Birth Cohort. Self-reported information on current status of various pubertal milestones was provided every six months by a questionnaire from 11 years of age until 18 years or full maturity, whichever came first. Maternal nitrate intake from diet (mg/day) was derived from a mid-pregnancy food frequency questionnaire and individual level nitrate exposure from drinking water (mg/L) was derived using measurements from Danish public waterworks. Adjusted average differences in months in age at attaining several pubertal milestones as well as the average age difference in age at attaining all the milestones were estimated separately for diet and water using a regression model for interval-censored data. C- and E-vitamin, red meat and processed meat intake were explored as potential effect modifiers in sub-analyses. RESULTS No strong associations were observed between prenatal exposure to nitrate and timing of puberty in children. However, sons born of mothers with a nitrate concentration in drinking water at their residential address of > 25 mg/L (half of the World Health Organisation (WHO) guideline value) compared with ≤ 1 mg/L showed a tendency towards earlier age at pubertal development with an average age difference of -1.2 months (95 % confidence interval,-3.0;0.6) for all the pubertal milestones combined. DISCUSSION Studies including more highly exposed children are needed before the current WHO drinking water guideline value for nitrate can be considered safe concerning pubertal development.
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Affiliation(s)
| | - Nis Brix
- Department of Public Health, Aarhus University, Aarhus, Denmark; Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
| | - Jörg Schullehner
- Department of Public Health, Aarhus University, Aarhus, Denmark; Geological Survey of Denmark and Greenland, Aarhus, Denmark; Danish Big Data Centre for Environment and Health (BERTHA), Aarhus University, Aarhus, Denmark
| | | | - Andreas Ernst
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Ninna Hinchely Ebdrup
- Department of Public Health, Aarhus University, Aarhus, Denmark; Fertility Clinic, Horsens Regional Hospital, Horsens, Denmark
| | - Anne Ahrendt Bjerregaard
- Department of Epidemiology Research, Center for Fetal Programming, Statens Serum Institut, Copenhagen, Denmark; Centre for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | | | - Leslie Thomas Stayner
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago, School of Public Health, Chicago, United States
| | - Thorhallur Ingi Halldorsson
- Department of Epidemiology Research, Center for Fetal Programming, Statens Serum Institut, Copenhagen, Denmark; Faculty of Food Science and Nutrition, School of Health Sciences, University of Iceland, Iceland
| | - Sjurdur Frodi Olsen
- Department of Epidemiology Research, Center for Fetal Programming, Statens Serum Institut, Copenhagen, Denmark; Section of Epidemiology, Institute of Public Health, University of Copenhagen, Denmark
| | - Torben Sigsgaard
- Department of Public Health, Aarhus University, Aarhus, Denmark; Danish Big Data Centre for Environment and Health (BERTHA), Aarhus University, Aarhus, Denmark; Cirrau -Centre for Integrated Register-based Research at Aarhus University, Aarhus, Denmark
| | - Henrik Albert Kolstad
- Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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12
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Clemmensen PJ, Brix N, Schullehner J, Gaml-Sørensen A, Toft G, Tøttenborg SS, Ebdrup NH, Hougaard KS, Hansen B, Sigsgaard T, Kolstad HA, Bonde JPE, Ramlau-Hansen CH. Nitrate in Maternal Drinking Water during Pregnancy and Measures of Male Fecundity in Adult Sons. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14428. [PMID: 36361307 PMCID: PMC9656746 DOI: 10.3390/ijerph192114428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/26/2022] [Accepted: 10/28/2022] [Indexed: 06/16/2023]
Abstract
Animal studies indicate deleterious effects of nitrate exposure on fecundity, but effects in humans are unknown, both for the prenatal and postnatal periods. We aimed to investigate if exposure to nitrate in maternal drinking water during the sensitive period of fetal life is associated with measures of fecundity in the adult sons. In a sub-analysis, the potential effects of nitrate exposure in adulthood were investigated. This cohort included 985 young adult men enrolled in The Fetal Programming of Semen Quality Cohort (FEPOS). Semen characteristics, testes volume and reproductive hormones were analyzed in relation to nitrate concentration in maternal drinking water, using a negative binomial regression model. The nitrate concentration in drinking water was obtained from monitoring data from Danish waterworks that were linked with the mothers' residential address during pregnancy. The median nitrate concentration in maternal drinking water was 2 mg/L. At these low exposure levels, which are far below the World Health Organization's (WHO) guideline value of 50 mg/L, we did not find indications of harmful effects of nitrate on the investigated measures of male fecundity.
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Affiliation(s)
| | - Nis Brix
- Department of Public Health, Aarhus University, 8000 Aarhus, Denmark
- Department of Clinical Genetics, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Jörg Schullehner
- Department of Public Health, Aarhus University, 8000 Aarhus, Denmark
- Geological Survey of Denmark and Greenland, 8000 Aarhus, Denmark
- Danish Big Data Centre for Environment and Health (BERTHA), Aarhus University, 8000 Aarhus, Denmark
| | | | - Gunnar Toft
- Steno Diabetes Center Aarhus, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Sandra Søgaard Tøttenborg
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital—Bispebjerg and Frederiksberg Hospital, 2400 Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, 1014 Copenhagen, Denmark
| | | | - Karin Sørig Hougaard
- Department of Public Health, University of Copenhagen, 1014 Copenhagen, Denmark
- National Research Centre for the Working Environment, 2100 Copenhagen, Denmark
| | - Birgitte Hansen
- Geological Survey of Denmark and Greenland, 8000 Aarhus, Denmark
| | - Torben Sigsgaard
- Department of Public Health, Aarhus University, 8000 Aarhus, Denmark
- Danish Big Data Centre for Environment and Health (BERTHA), Aarhus University, 8000 Aarhus, Denmark
- Centre for Integrated Register-Based Research, Aarhus University (CIRRAU), 8000 Aarhus, Denmark
| | - Henrik Albert Kolstad
- Department of Occupational Medicine, Aarhus University Hospital, 8200 Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
| | - Jens Peter Ellekilde Bonde
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital—Bispebjerg and Frederiksberg Hospital, 2400 Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, 1014 Copenhagen, Denmark
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13
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Prenatal exposure to nitrate from drinking water and the risk of preterm birth. Environ Epidemiol 2022; 6:e223. [PMID: 36249267 PMCID: PMC9556052 DOI: 10.1097/ee9.0000000000000223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/15/2022] [Indexed: 12/02/2022] Open
Abstract
Evidence is emerging that preterm birth (PTB, birth before 37 completed weeks of gestation), a risk factor for neonatal mortality and future morbidity, may be induced by maternal nitrate (NO3−) exposure from drinking water. The objective of this study is to assess the association between maternal exposure to nitrate and the risk of PTB in a nationwide study of liveborn singletons.
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14
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Kancherla V, Roos N, Walani SR. Relationship between achieving Sustainable Development Goals and promoting optimal care and prevention of birth defects globally. Birth Defects Res 2022; 114:773-784. [PMID: 35776686 DOI: 10.1002/bdr2.2055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 02/27/2022] [Accepted: 03/16/2022] [Indexed: 11/09/2022]
Abstract
Birth defects affect eight million newborns annually worldwide. About 8% of global under-5 mortality is attributable to birth defects. The United Nations (UN) Sustainable Development Goals (SDGs) have set 17 global goals for human growth and development to be achieved by 2030 using multi-sectorial approaches. The third goal (SDG-3) focuses on ensuring healthy lives and promoting well-being; achieving SDG-3 improves birth defects care and prevention. However, we aimed to show how achieving other SDGs also influence optimal care and prevention of birth defects. SDGs focused on poverty reduction, access to nutritious food, universal health coverage, equitable education, gender equality, environment, inclusivity through infrastructure innovation, and strengthening social justice is crucial to addressing social determinants of health for individuals and families affected by birth defects. Understanding birth defects in the context of several relevant SDGs will allow practitioners, researchers, and policymakers to leverage the momentum generated by SDGs and make a case for commitment and allocation of funding and resources for advancing birth defects surveillance, care, and prevention. SDGs are built on principles of equity and social justice and we urge policy-makers to approach birth defects using various SDGs as a catalyst. The synergy between several SDGs helps to optimize birth defect outcomes and prevention. Our effort to present a more comprehensive look at various SDGs and their relationship with birth defects is parallel to several other health advocacy groups conducting a similar mapping exercise, thus bringing to the forefront millions of lives that are impacted by birth defects worldwide.
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Affiliation(s)
- Vijaya Kancherla
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Nathalie Roos
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
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