Blood lead reference values: the results of an Italian polycentric study

Blood Lead Levels in the Population Living in Algeria: A Cross-Sectional National Study

Lead poisoning, is currently recognized as a real public health problem, The WHO classifies lead as one of 10 chemicals of serious public health concern. In Algeria and North Africa, to date, no study on the evaluation of lead impregnation has been carried out at the national level. The main objective of this work is to assess the exposure of the general Algerian population to lead. A cross-sectional study was carried out over the entire Algerian national territory, on a population aged between 3 and 74 years old. The survey lasted three years, A questionnaire, a clinical examination and a blood sample were carried out for each individual. Generalized linear regression models were used to determine the factors influencing lead levels measured in blood samples. The study population, spread over 39 wilayas and 121 districts, consists of 3674 individuals. The mean lead levels were 28.27 μg/L, the median was 22.22 μg/L, and the 95th percentile was 73.83 μg/L, Blood lead levels were influenced differently by age, gender, wilaya of residence, dietary habits such as consumption of canned food and the way in which water is conserved for daily consumption. The use of kohl has been confirmed as a potential source of lead exposure. In Algeria, a blood lead value of 75 µg/L serves as the Reference Exposure Value, guiding public health responses and risk management strategies, Recommendations have been issued to reduce the blood lead levels of the general population in Algeria in terms of limitation of lead in the sources of exposure, installation of an effective health monitoring system.

Metal concentrations in the whole blood of farmers in southeast Brazil

In this study, we measured Ni, Co, Cd, and Pb concentrations in the whole blood of farmers from southeast Brazil to address the factors influencing human exposure in this population. The factors included smoking, alcohol consumption, aging, body composition, gender, and feeding preferences, which were measured through carbon and nitrogen isotopic composition. We also calculated and compared the reference values (RVs) of the measured elements to evaluate ongoing exposure levels. We observed the influence of lifestyle habits on metal exposure; Cd levels were statistically higher in smokers, and alcohol consumption affected only Pb concentrations, with an association also observed with the frequency of alcohol ingestion. The metal levels were positively associated with both isotope values, indicating that feeding may be the dominant source of these elements in this population. We also observed the effect of endogenous sources measured through age, as increased Pb concentrations in both genders and higher Cd levels in older women, which is related to bone, kidney, and liver accumulation. The body mass index was negatively associated with Ni, Co, and Cd in women and positively in men. The negative associations may indicate that body fat may act as a reservoir for metals, reducing their availability in the blood in individuals with higher body mass and possibly influencing the assessment of exposure levels. The evaluated population presented elevated RVs for all elements: Ni 36, Co 3.3, Cd 16, and Pb 149 μg L-1. These values point to higher exposure in this population compared to other studies in Brazil and worldwide. These results emphasize an urgent need for monitoring programs for toxic substances in Brazil and evaluating possible health effects, given the ongoing environmental exposure associated with endogenous exposure and lifestyle habits that promote higher metal levels in this population.

In Situ Electroplating of Ir@Carbon Cloth as High-Performance Selective Oxygen Evolution Reaction Catalyst for Direct Electrolytic Recovery of Lead

The hydrometallurgical technology provides an efficient and sustainable green lead recovery process from lead acid batteries. Methanesulfonic acid has been widely considered as a green solvent for lead electrolytic recovery. However, the competitive precipitation of PbO2 at anode and higher overpotential for OER limit the lead recovery efficiency. In this work, an anodic oxygen evolution reaction (OER) catalyst with a low Ir mass fraction of 7.2% is obtained by electroplating iridium on carbon cloth (CC), exhibiting a lower overpotential of 256 mV, longer lifetime of 10 h, and better stability in the 0.5 M MSA solution. When CC-Ir is used as an anodic catalyst for lead recovery in the lead methanesulfonate electrolyte, only a lesser Pb precipitation product with Pb atom mass fraction of 1.42% is found after electrolysis of 10 h, demonstrating the suppression effect of CC-Ir for a PbO2 side reaction. This work proves that the anodic catalyst plays an important role in the lead electrolytic recovery process, which can inhibit the side reaction, reduce the energy consumption, and increase recovery efficiency.

The reference values in the interpretation of toxicological data

The worldwide gradual expansion of industrialization has led to a dramatic increase in the production and use of chemical substances. This has resulted in a greater dispersion of these elements in the environment and in an increased exposure of the general population and workers. In this scenario, a thorough knowledge of exposure levels is needed in order to assess chemical risks in environmental and occupational settings. Biological monitoring is among the most useful tools for assessing exposure. However, in order to provide really effective guidance in the application/implementation of risk management measures, biomonitoring results need to be compared with appropriate references. Reference values (RVs) are an excellent resource since useful information for a correct interpretation of toxicological data can be obtained by comparing them with biomonitoring results. In the field of public health, this may enable us to identify potential sources of exposure, define the principal and most frequently exploited routes of exposure, and outline chemical absorption. Similarly, in occupational medicine, RVs can be used to give meaning to biomonitoring findings, especially when a biological limit value is not available for the chemical in question. Furthermore, these values are a valid tool for assessing exposure to chemical carcinogens. Therefore, by integrating reference values in an appropriate and complete system of guide values that also includes action levels and biological limit values, we could obtain both an adequate assessment of exposure and a better understanding of toxicological data.

A comparison of blood metal levels in autism spectrum disorder and unaffected children in Shenzhen of China and factors involved in bioaccumulation of metals

The present study compared blood plasma metals in children with autism spectrum disorder (ASD) with those in unaffected children in Shenzhen (China). Factors associated with the metal bioaccumulation were further investigated. Thirty-four blood samples of children with ASD were collected in a local hospital (Shenzhen Children's Hospital), while those of 38 unaffected children were from a local large public kindergarten, during March to April in 2016. Metal analysis was carried out by inductively coupled plasma-optical emission spectrometry. The results showed that children with ASD had higher (P < 0.01, 0.05) Pb (ASD 31.9 μg/L, unaffected children 18.6 μg/L), Hg (3.83, and 1.09 μg/L), and Cd (0.70 and 0.26 μg/L) than unaffected children, while essential elements Zn (ASD 4552.0 μg/L, unaffected children 5118.6 μg/L), Se (61.7 and 90.6 μg/L), and Mn (13.5 and 21.4 μg/L) showed an opposite pattern. Moreover, the children exposed to passive smoking had higher (P < 0.05) Cd (passive smoking 1.08 μg/L; non-passive smoking 0.22 μg/L) than those without the exposure. Positive associations were found between levels of Hg or Pb and seafood consumption as well as body mass index (BMI). More future work is needed in order to clarify the association between metal exposure and ASD occurrence in China.

Evaluation of Tumor Necrosis Factor-Alpha and Granulocyte Colony-Stimulating Factor Serum Levels in Lead-Exposed Smoker Workers

Inorganic lead (Pb) is able to modulate the immune response even at low to moderate exposure levels. It inhibits in vitro and in vivo activities of neutrophil leucocytes and influences their blood count in humans. Neutrophil functions are governed by a number of cytokines. Pb has been shown to affect leukocyte production of some of these cytokines in vitro. The objective of this study is to assess serum tumor necrosis factor-alpha (TNF-α) and granulocyte colony-stimulating factor (G-CSF) levels of thirty-three male lead-exposed (E) workers at a lead recycling plant as compared with twenty-eight male non-exposed (NE) workers at a food processing plant, whose current smoking habit was known. Serum TNF-α and G-CSF levels were measured by a quantitative sandwich enzyme immunoassay. Blood lead levels (Pb-B) were significantly higher in E (geometric mean (GM) 30.7 μg/dl, GSD 1.7; min-max: 9.1–81.6 μg/dl) workers than controls (GM 3.6 μg/dl, GSD 1.7; min-max: 1.0–11.0 μg/dl). E workers had significantly higher serum TNF-α (median: 107.1; min-max: 11.1–623.0 pg/ml) and G-CSF levels (median: 53.0, min-max: 31.1–197.0 pg/ml) than NE workers (TNF-α: median: 12.0; min-max: 9.4–18.8 pg/ml; G-CSF: median: 34.3, min-max: 25.1–52.2 pg/ml). In particular, the TNF-α level was shown to be significantly influenced by lead exposure and smoking habit, as well as by interaction between these two factors. Both serum TNF-α and G-CSF levels were correlated with Pb-B and absolute neutrophil count. This study is the first to detect higher serum levels of G-CSF in E over NE workers. Our data confirm that exposure to low to medium doses of lead may interfere in the complex cytokine network involved in inflammation, especially in workers who are current smokers.

Physical Activity and Blood Lead Concentration in Korea: Study Using the Korea National Health and Nutrition Examination Survey (2008-2013)

Physical activity normally has a positive influence on health, however it can be detrimental in the presence of air pollution. Lead, a heavy metal with established adverse health effects, is a major air pollutant. We evaluated the correlation between blood lead concentration and physical activity using data collected from the Korea National Health and Nutrition Examination Survey. Multivariate logistic regression analysis was performed after dividing participants according to whether they were in the top 25% in the distribution of blood lead concentration (i.e., ≥ 2.76 µg/dL), with physical activity level as an independent variable and adjusting for factors such as age, sex, drinking, smoking, body mass index, region, and occupation. The high physical activity group had greater odds of having a blood lead concentration higher than 2.76 µg/dL (odds ratio 1.29, 95% CI 1.11-1.51) compared to the low physical activity group. Furthermore, blood lead concentration is correlated with increasing physical activity.

Current sources of lead exposure and their relative contributions to the blood lead levels in the general adult population of Northern France: The IMEPOGE Study, 2008-2010

There is justification for limiting lead (Pb) exposure as much as possible, given its impact on health at low concentrations. Consequently, the aim of this study was to measure blood lead levels (BLL) and examine exposure factors related to BLL variations in the general adult population of northern France, a current and past industrial area. Two thousand inhabitants of northern France, aged between 20 and 59 years, were recruited using the quota method with caution. Blood lead levels were quantified by inductively coupled plasma-mass spectroscopy (ICP-MS), and variation factors were studied separately in men and women using multivariate stepwise linear and logistic regression models. The geometric mean of the BLL was 18.8 μg/L (95% confidence interval [CI]: 18.3-19.3). Occupational factors affected BLL only in men and represented 14% of total explained variance of BLL. External occupational factors significantly increasing mean levels of BLL were tobacco, consumption of some beverages (wine, coffee, tea, and/or tap water), raw vegetables, housing characteristics (built prior to 1948, Pb piping in the home) and do-it-yourself or leisure activities (paint stripping or rifle shooting). Consumption habits accounted together for 25% and 18% of the total explained variance, respectively, in men and women. Industrial environment did not significantly contribute to BLL variations. Blood lead levels observed in the general population of this industrial part of France did not appear to be excessively elevated compared to values found internationally. Nonetheless, these BLL remain a public health issue in regard to nonthreshold toxicity attributed to Pb.

Effects of environmental cadmium and lead exposure on adults neighboring a discharge: Evidences of adverse health effects

The purpose of the study was to determine Pb and Cd concentrations in humans and to assess the effect of co-exposure to these metals on biomarkers of oxidative stress and nephrotoxicity. Blood and urine levels of Pb and Cd, oxidative stress and urinary renal biomarkers were measured in 77 subjects neighboring a discharge and 52 in the control site. Exposed subjects showed significantly higher levels of lead and cadmium in blood and urine than the controls. Excessive production of reactive oxygen species induced by these metals in exposed subjects conducted to a decrease in antioxidant defense system (GPx, Selenium, GSH) and an increase in lipid peroxidation (MDA). Moreover, changes in markers of nephrotoxicity (high urinary concentrations of total protein, RBP and CC16, as well as GSTα and LDH increased activities) suggested the occurrence of discrete and early signs of impaired renal function for the discharge neighboring population.

The associations between metals/metalloids concentrations in blood plasma of Hong Kong residents and their seafood diet, smoking habit, body mass index and age

The concentrations of metals/metalloids in blood plasma collected from 111 healthy residents (51 female, 60 male) in Hong Kong (obtained from the Hong Kong Red Cross Blood Transfusion Service, from March to April 2008) were quantified by means of a double-focusing sector field inductively coupled plasma optical emission spectrometer (ICP-OES). Results showed that concentrations of these toxic metals such as Hg, Cd, and Pb in Hong Kong residents were not serious when compared with other countries. Males accumulated significantly higher (p < 0.05 or 0.01) Fe (female 0.92 mg/L; male 1.28), Sn (0.44 μg/L; 0.60), Cr (0.77; 0.90), Hg (1.01; 1.73), and Pb (23.4; 31.6) than females. Smokers accumulated significantly higher (p < 0.05) Cd (smoker 0.27 μg/L; nonsmoker 0.17) and Pb (32.8; 17.6) than nonsmokers. Positive correlations were found between concentrations of As, Cd, Pb, and Hg, with respect to seafood diet habit, body mass index (BMI), and age. More intensive studies involving more samples are needed before a more definite conclusion can be drawn, especially on the causal relationships between concentrations of metals/metalloids with dietary preference and lifestyle of the general public.

Risk factors for lead exposure in adult population in southern Brazil

In Brazil there is no systematic evaluation to access blood lead levels (BLL) in the general population and few studies with adults have been published. The aim of this study was to examine the socioeconomic, environmental, and lifestyle determinants of BLL in the adult Brazilian population. In total, 959 adults, aged 40 years or more, were randomly selected in a city in southern Brazil. Information on socioeconomic, dietary, lifestyle, and occupational background was obtained by interviews. A spatial analysis was conducted to discern whether there were any identifiable sources of exposure. BLL were measured by inductively coupled plasma-mass spectrometry. There was an adjustment for gender, age, race, education, income class, smoking status, alcohol consumption, occupation, and red meat or cow milk consumption (Model 1), and for occupation and gender (Model 2). The geometric mean of BLL was 1.97 μg/dl (95% CI: 1.9-2.04 μg/dl). In Model 1, BLL were positively associated with male gender, older age, and drinking and smoking habits, and less frequently with milk consumption. In Model 2, data showed higher BLL in non-white than white participants, in former smokers and individuals with current or former employment in lead (Pb) industries. The participants living in the area with more Pb industries had higher BLL (3.3 μg/dl) compared with those residing in other areas with no or fewer Pb industries (1.95 μg/dl). Despite the low BLL found in adults living in an urban area, Pb industries need to be monitored and regulatory laws implemented to prevent metal contamination in urban settings.

Serum cadmium levels in a sample of blood donors in the Western Amazon, Brazil, 2010-2011

A cross-sectional study was conducted to determine the distribution of serum cadmium (Cd) levels in blood donors in Rio Branco, Acre State, Brazil. Blood samples were obtained from 922 volunteer blood donors from 18 to 65 years of age at the Hemoacre blood center in 2010-2011. Mean serum Cd was 0.37µg/L (95%CI: 0.33-0.41). Increased serum Cd was associated with lower schooling; individuals with less than five years of schooling showed a mean Cd of 0.61µg/L (95%CI: 0.34-0.89), compared to 0.34µg/L (95%CI: 0.28-0.40) among those with more than nine years of schooling. Mean serum Cd was three times higher among smokers. Smoking showed a positive association with Cd level, with an OR of 12.36 (95%CI: 7.70-19.84). Meanwhile, serum Cd was lower among individuals that regularly drank tea, as compared to non-tea drinkers. Serum Cd levels were mostly below the reference value (88.3% of participants). Mean serum Cd in the current study indicates that in general the population studied here is not exposed to worrisome Cd levels.

Reference values of lead in blood and related factors among blood donors in the Western Amazon, Brazil

The aim of this study was to (1) determine the reference value of blood lead levels (BLL) in a sample of blood donors of Rio Branco, the capital city of Acre, in the Western Brazilian Amazon, and (2) explore factors influencing lead (Pb) exposure levels. Between 2010 and 2011, blood samples were collected from universal blood donors attending the Central Hemotherapic Unit in Rio Branco with a total number of 1196. Information on characteristics of 1183 donors was obtained through questionnaires. Blood Pb concentrations were determined by inductively coupled plasma-mass spectrometry with detection limit of 0.003 μg/L. Association between BLL and participant characteristics was examined by linear regression analysis. Reference values of BLL were calculated as the upper limit of the 95% confidence interval of the 95th percentile. Reference values of BLL were 109.5 μg/L for men, 70.7 μg/L for women, 88.9 μg/L for younger individuals (18-29 yr), 115.3 μg/L for older ones (≥30 yr), 94.2 μg/L for nonsmokers, and 164.5 μg/L for smokers. Levels of BLL were significantly higher in males, subjects older than 29 yr, non-whites, smokers, regular consumers of manioc flour, and donors practicing any activity related to paints, ceramics, pottery, fishing, or firearms. Subjects with higher education, higher income, vitamin intake use, and drinkers of bottled water displayed lower BLL. In general, BLL in men and women from Rio Branco were higher than those described in other adult populations. Prevention of exposure of this population to local sources of Pb needs to be addressed.

High prevalence of elevated lead levels in pediatric dialysis patients

BACKGROUND

After parents raised concerns about potential lead (Pb) contamination of calcium carbonate for treatment of hyperphosphatemia in chronic kidney disease (CKD), we measured blood Pb using high-resolution sector field inductively coupled mass spectrometry in a quality-assurance investigation of ten pediatric dialysis patients (nine on hemodialysis) and six patients before dialysis.

METHODS

We assessed the kidney function as cystatin C estimated glomerular filtration rate (eGFR), blood Pb levels, calcium carbonate dose, and standard laboratory parameters, as well as Pb levels in the dialysis feed water.

RESULTS

Mean blood Pb concentration in the 16 pediatric CKD patients was 21.1 ± 15.8 µg/l with a maximum of 58 µg/l, which was significantly higher than that of 467 apparently healthy controls (median 6.35 µg/l, interquartile range 4.47, 8.71) and comparable to that of ten adult peritoneal dialysis (PD) patients. Lead levels correlated with red blood cell distribution width, eGFR, and calcium carbonate dose. Pb in dialysate feed water was always <0.00018 mg/l, which is below the accepted limit for water for dialysis of 0.005 mg/l.

CONCLUSIONS

We found a high prevalence of elevated Pb levels in pediatric CKD patients that correlated with the calcium carbonate dose and GFR. Lead levels should be monitored in these patients.

Reference values for lead, cadmium and mercury in the blood of adults from the metropolitan area of Sao Paulo, Brazil

Human biomonitoring is an important tool for the evaluation of environmental exposure to contaminants. The data that are obtained from these studies might be compared to appropriate reference values (RVs) in a specific population. The RVs were derived from the rounded values of the upper limit of the 95th confidence interval of the 95th percentile for lead (Pb), cadmium (Cd) and mercury (Hg) in blood from adults in the metropolitan area of Sao Paulo (MASP), Brazil to investigate the association between blood metals and sociodemographic and lifestyle factors. Blood samples from 653 nonsmoking blood donors without occupational exposure to the studied metals were collected in 2006. Our evaluations distinguished a younger group (18-39 years) and an older group (40-65 years). RVs in the younger group were 60 μgPb/L and 4 μgHg/L for men and 47 μgPb/L and 4 μgHg/L for women. RVs in the older group were 80 μgPb/L and 5 μgHg/L for men and 63 μgPb/L and 6 μgHg/L for women. The RV for Cd was 0.6 μg/L for adults aged 18-65 years. Pb and Cd levels demonstrated a significant association with sex and age. Male blood contained 50% more Pb, and the older group exhibited 23% more Pb. Fish consumption and amalgam fillings were primarily related to Hg levels. RVs for lead were similar to the Czech Republic and Germany but higher than the US population. The RV for Cd in Brazil was well below the RVs of these countries. The RVs for Hg in Brazil were similar to the US but higher than Germany and the Czech Republic.

Predicting blood lead levels from current and past environmental data in Europe

The present case study on lead in Europe illustrates the use of the Integrated Monitoring Framework Strategy to assess the health outcome of environmental pollution by evaluating the associations between lead in various environmental compartments (air, soil, dust, drinking water and diet) and lead concentrations in blood (B-Pb) for various age-related sub-populations. The case study was aimed to investigate whether environmental, exposure and biomonitoring data at general population level, covering all EU member states, could be integrated. Although blood lead has been monitored extensively in Europe, consistent datasets are not yet available. Data diverge with regard to objectives, regional scale, sampling years, gender, age groups and sample size. Significant correlations were found between B-Pb and the concentrations of Pb in air and diet. The significant decrease of the Pb in air over time from 0.31 μg/m(3) (P95: 0.94; n=98) prior to 1990 to 0.045 μg/m(3) (P95: 0.11; n=256) in 2007 (latest observations included) (Δ=-85%) corresponds to a decline in B-Pb by 48% and 57% in adult women and adult men, respectively. For pre-school children a more shallow decline in B-Pb of 16% was calculated over the same period. Similarly, the reduction in Pb-dietary intake from on average 68.7 μg/d (P95: 161.6; n=19) in 1978 to 35.7 μg/d (P95: 82.3; n=33) in the years post 2000 (Δ=-48%) is paralleled by a decline in B-Pb of 32, 33 and 19% in adult women, primary- and pre-school children, respectively. Insufficient data exist for other age groups to calculate statistically significant correlations. Although regression models have been derived to predict B-Pb for different sub-populations in Europe based on Pb concentrations in air and soil as well as dietary intake, it is concluded that the available data are insufficient to accurately predict actual and future simultaneous exposure to Pb from various environmental compartments, and as a consequence the health impact of Pb for various target populations at EU scale. At least due to data availability, air Pb remains the best predictor of B-Pb in the population. However, lead emission sources have largely been reduced and inhalation of lead in air is not causal to B-Pb levels. Therefore, there is a need of adequate data for Pb in soil and house dust, and in diet and drinking water as these are causal exposure sources with a longer Pb half-life than air. An extended and more harmonized surveillance system monitoring B-Pb, especially in children, is urgently required in order to identify, quantify and reduce still remaining sources of Pb exposure.

Blood lead and cadmium levels in a six hospital employee population. PESA study, 2009

INTRODUCTION

Exposure to lead and cadmium is a public health problem due to the broad exposure to these toxic substances among the general population. The objective of this study is to determine blood lead and cadmium concentrations in a working population drawn from six university hospitals in Madrid, Getafe, Cartagena, Santiago de Compostela, Santander and Palma de Mallorca (Spain) and to identify associated factors.

MATERIALS AND METHODS

951 individuals participated in the study and were administered the standardized PESA® questionnaire regarding exposure to lead and cadmium. The blood lead and cadmium concentrations were measured by electrothermal atomization atomic absorption spectrometry with Zeeman background correction in Perkin-Elmer spectrometers, guaranteeing the transferability of the results.

RESULTS

The median overall blood lead concentration was: 1.6 μg/dL (IQR: 0.9-2.7) and that of cadmium was: 0.21 μg/L (IQR: 0.10-0.50). There were significant differences in lead levels between men (2 μg/dL) and women (1.5 μg/dL), postmenopausal (2.6 μg/dL) and premenopausal women (1.1 μg/dL), and between participants who cooked in earthenware (2.1 μg/dL) and those who did not (1.5 μg/dL). The median of cadmium in women (0.24 μg/L) was higher than in men (0.11 μg/L) and was also higher in subjects who smoked (0.70 μg/L) than in non-smokers (0.13 μg/L).

CONCLUSIONS

A reduction in blood lead and cadmium levels was observed with respect to previous studies carried out in Spain. Nevertheless, the results suggest there are certain factors which increase risk such as age, gender, menopause, age of housing, cooking in lead-glazed earthenware and exposure to cigarette smoke.

Heavy metal levels (Pb, Cd, Cr and Hg) in the adult general population near an urban solid waste incinerator

In 2005 an urban solid waste incinerator (SWI) was commissioned in Bilbao (Basque Country, Spain). Serum and urine samples were collected from 95 and 107 volunteers in 2006 and 2008 respectively, of which 62 were repeats from the same individuals. Blood lead levels (BPb) were determined, as were the concentrations of cadmium (Cd), chromium (Cr) and mercury (Hg) in urine (UCd, UCr and UHg). The town of Alonsotegi and a borough of Bilbao (Altamira, Rekalde) were considered to be close, less than 2 km from the plant, and correspond to an urban environment with high traffic density. The areas of reference were a borough of Bilbao (Santutxu-Zurbaran), 5 km from the plant, also in an urban area with high traffic density, and a small town with little industrial activity and low traffic density (Balmaseda) 20 km from the plant; neither of these is downwind from the site with respect to prevailing winds. There was a significant correlation for BPb, r=0.63 (p<0.001), between the two surveys. However, there was no linear correlation for the other three metals (UCd, UCr and UHg), between the two sampling periods (p>0.05). Multiple linear regression models did not show increases over time of the levels of BPb, UCd, UCr and UHg in the areas close to the SWI compared to those of areas located further away, after adjusting for confounding variables. These results reinforce the hypothesis that populations near modern plants for solid waste incineration do not manifest increased levels of heavy metals.

Availability and comparability of human biomonitoring data across Europe: a case-study on blood-lead levels

Recently, it has become clear that the complexity of environmental health issues requires an approach that takes into account the complexities, interdependencies and uncertainties of the real world. An urgent issue that has surfaced is the need for accurate tools to better describe exposure characterization to environmental chemicals. By including human biomonitoring (HBM) data, a greater precision in exposure and associated risk estimates and more accurate dose-response relationships may be achieved. A restricting issue still is the availability of reliable and comparable HBM data. The aim of the current study was twofold: (1) to find out whether it is practically feasible to collect raw, individual HBM data across Europe; and (2) to evaluate the comparability and use of these HBM data for environmental health impact assessment at a European scale. Blood-lead (B-Pb) was selected as the chemical of choice because of its long history as an environmental pollutant in HBM programs and its known public health relevance. Through literature search and identification of HBM experts across Europe, HBM programs that measured B-Pb were identified and asked to share individual data on age, gender and B-Pb levels. Following this request, more than 20,000 individual data points from 8 European countries were collected. Analysing these data made clear that it is difficult to use disparate data collections because of the inherent variability with respect to the gender and age of participants and calendar-years sampled. When these confounders were taken however, there was no additional variability in B-Pb distributions among different countries. It was concluded that while it is possible to collect HBM data from different sources across Europe, the need to get data from comparable (sub-)populations is essential for appropriate use and interpretation of HBM data for environmental health impact assessment.

Heavy metal exposure in patients suffering from electromagnetic hypersensitivity

BACKGROUND

Risks from electromagnetic devices are of considerable concern. Electrohypersensitive (EHS) persons attribute a variety of rather unspecific symptoms to the exposure to electromagnetic fields. The pathophysiology of EHS is unknown and therapy remains a challenge.

OBJECTIVES

Heavy metal load has been discussed as a potential factor in the symptomatology of EHS patients. The main objective of the study was to test the hypothesis of a link between EHS and heavy metal exposure.

METHODS

We measured lead, mercury and cadmium concentrations in the blood of 132 patients (n=42 males and n=90 females) and 101 controls (n=34 males and n=67 females).

RESULTS

Our results show that heavy metal load is of no concern in most cases of EHS but might play a role in exceptional cases.

CONCLUSIONS

The data do not support the general advice to heavy metal detoxification in EHS.

Genetic background of lead and mercury metabolism in a group of medical students in Austria

BACKGROUND

Information on the impact of genetic predisposition on metal toxicokinetics in the human body is limited. There is increasing evidence that certain genetic polymorphisms modify lead and mercury toxicokinetics. This called for analysis of further candidate genes.

OBJECTIVES

Medical students (N=324) were examined in order to detect potential associations between lead exposure and polymorphisms in HFE, VDR, ALAD, and MT genes, as well as between mercury exposure and GSTT1, GSTM1, GSTA1, GSTP1, GCLC, and MT polymorphisms.

METHODS

The levels of lead and mercury exposure of students were determined by blood, urine, and hair analyses (ICP-MS, CV-AAS). Genotyping of common polymorphisms was examined by MALDI-TOF MS and the TaqMan methodology. Associations between lead and mercury exposures and genetic background were examined by bivariate analysis, and by categorical regression analysis (CATREG) controlled by metal- and matrix-specific variables.

RESULTS

Lead and mercury levels in urine, blood, and hair indicated low exposures. VDR polymorphism and joint presence of VDR/ALAD polymorphisms were significantly and independently associated with urine lead concentrations (CATREG P<0.05). Polymorphisms in GSTP1-114 and MT4 genes as well as dual gene combinations including GSTP1, GCLC, GSTT1, and GSTM1 polymorphisms were independent variables related to mercury body burdens (CATREG P<0.05). GSTP1-114/GSTT1 and GSTP1-105/GCLC combinations showed synergistic effects on hair mercury levels compared to single-gene variants.

CONCLUSIONS

We found evidence that certain genetic backgrounds were associated with lead and mercury metabolism, suggesting gene-environment and gene-gene-environment interactions. The modes of interaction remain to be evaluated.

Framework for gender differences in human and animal toxicology

Differences in exposure, anatomy, physiology, biochemistry, and behavior between males and females are a dominant theme in biology, transcending the plant and animal kingdoms. Yet differences due to sex and gender have not received adequate attention in human or animal toxicology nor always in epidemiology. Generalizations are often made about species' responses to xenobiotics, without data or consideration of female/male differences. Despite the leading role that pharmacology and drug development play in elucidating toxicokinetics, gender studies are relatively recent. Phenomenologic or clinical observations of sex differences often go unexplored, but pharmaceutical companies recognize the importance of enhanced understanding of toxicokinetics and toxicodynamics and emphasize the value of translational or integrational research--bringing laboratory findings to bedside applications and bedside questions to laboratory study. However, for many years Food and Drug Administration guidelines specifically precluded participation of females in many drug studies. Many occupational epidemiology studies, on which much of our understanding of toxic effects is based, begin by excluding women and minorities. Sex differentiation begins in the embryo under genetic and hormonal control. Changes affecting exposure, susceptibility, risk, and health continue throughout life. This paper provides a framework for analyzing the level(s) at which gender differences arise. The framework addresses exposure, toxicokinetics, toxicodynamics, and modulating influences. Men and women differ in many aspects of vulnerability to xenobiotics and other stressors, beginning with their opportunities for exposure. Toxicokinetic differences mainly involve metabolism, with few differences in absorption yet demonstrated. In addition, lifestyle, psychosocial, and hormonal factors modify the kinetics and responsiveness. Some phenomena fit the Classic Sex Hormone Paradigm in which castration (with and without hormone replacement) and administration of the opposite sex hormone demonstrate the primary regulatory role of sex hormones. Many phenomena, however, differ between males and females without showing a clear-cut relationship with the sex hormones. Since every cell both has a sex chromosome (X or Y) and is exposed to hormones, elegant techniques are just beginning to tease apart genetic from hormonal influences. Wherever possible, studies should use balanced gender and gender x age designs and should analyze data by sex and interactions, rather than simply adjusting for (discarding) gender. Power should be adequate, or lack of power (if inevitable) should be clearly stated.

Lead levels in blood and saliva in a low-income population of Detroit, Michigan

The relationships between blood lead (PbB) and saliva lead (PbSa) concentrations and the determinants of PbB and PbSa status in 970 low-income adults in the city of Detroit, Michigan were explored. Average PbB and PbSa values in the sample population were found to be 2.7+/-0.1 microg/dl and 2.4+/-0.13 microg/l (equivalent to 0.24+/-0.13 microg/dl), respectively, and a weak but statistically significant association was found between the lead levels in the two types of body fluid samples. The average PbB level for men (4.0+/-0.56 microg/dl) was higher than that for women (2.7+/-0.11 microg/dl); other significant predictors of PbB included age, level of education, being employed, income level, the presence of peeling paint on the wall at home and smoking. There was no gender- or age-dependent difference in blood saliva values but statistically significant correlations were found between PbSa and level of education, employment, income level and smoking. Dental caries was severe in this population. Only 0.5% of the participants had no clinical signs of caries, over 80% had cavitated carious lesions (i.e., lesions that had progressed into dentin), and the number of lost teeth and carious lesions averaged 3.4 and 30, respectively. Weak but significant associations were found between PbB as well as PbSa and measures of dental caries in the study population. The positive associations are believed to be a reflection of the fact that the risk factors for dental caries, especially in low-income populations of the US, overlap extensively with those of lead poisoning and may not have a causal significance.

Evaluation of peripheral blood neutrophil leucocytes in lead-exposed workers

BACKGROUND

Inorganic lead can interfere with humoral and especially cell-mediated immunity even at frequently occurring (<50 microg/dl) blood lead (Pb-B) levels. Occupational exposure to lead causes a primary impairment of the chemotactic and phagocytic activities of neutrophil leucocytes.

OBJECTIVE

To verify whether, after taking into account the main confounding factors, occupational lead exposure is shown to induce changes in the number of blood neutrophil leucocytes, and to assess a possible dose-response relationship between Pb-B and the circulating neutrophil count in exposed workers.

SUBJECTS AND METHODS

The study included 68 male lead-exposed (E) workers and 59 male workers in a food plant, recruited as controls (NE). A standardized questionnaire probing work, social, familial and personal medical history was administered to all the subjects. Blood and urine samples were collected to determine the dose and effect biological indices of lead and the total white blood cell and neutrophil counts.

RESULTS

Pb-B levels were significantly higher in E (geometric mean (GM): 20.5 microg/dl; 3.2-120 microg/dl) than in NE workers (GM: 3.5 microg/dl; 1-11 microg/dl). The mean absolute neutrophil count (ANC) was significantly higher in E workers with respect to NE workers. ANC correlated significantly with the biological lead dose and effect indices. Moreover, there was a dose-dependent increase of ANC with increasing Pb-B levels. The linear relationship between ANC and Pb-B was confirmed even after correction for age, body mass index and smoking habit. We also found an interaction between Pb-B level and smoking habit in increasing the number of blood neutrophils in lead-exposed workers.

CONCLUSION

Our study is the first to describe a dose-dependent effect of lead on ANC in exposed workers. Our results underline the importance of promoting a further reduction of occupational lead exposure levels, adopting adequate individual protection means, as well as conducting medical campaigns against smoking, at the workplace.

Assessment of reference values for polychlorinated biphenyl concentration in human blood

A chemical factory which produced polychlorinated biphenyls (PCBs) operated in Brescia, North Italy, (about 200000 inhabitants) from the 1930s to the 1980s. High levels of PCBs were recently found in soil, food and people living in an area close to the factory. We performed a survey among the general population living in non-polluted areas of the town in order to define the reference values (RVs) of the non-exposed population. A random sample of subjects aged 20-79 years (50% males) was selected. Participants underwent PCB determination and were interviewed on their residential and occupational history and current diet. For RV determination, subjects who had resided in the polluted area or consumed any food produced in the area in their lifetime were excluded. Eight hundred and ninety-two subjects were contacted, 579 (65%) of whom agreed to participate; 311 of them were considered for RV determination (53% male, mean age=48.7 years). Total PCB serum levels, computed as the sum of the 24 congeners determined, were: mean=5.15ng/ml (SD=8.83), median=4.11ng/ml, range=0.4-34.12ng/ml, 95th centile=14.38ng/ml. Lipid-adjusted mean and median were 897 and 705ng/g lipid, respectively. PCB values showed positive correlations with age (Spearman's r=0.76) and with serum concentration of total cholesterol (r=0.40) and triglycerides (r=0.36). No association was found with gender, cigarette smoking, alcohol or diet. Seven PCB congeners, (PCB 180, 153, 138, 170, 194, 118, and 156), including those at higher chlorination, were present in more than 30% of the subjects and contributed 99% of the total PCB levels, with a modest role of dioxin-like congeners.

Estimate of uncertainty of measurement from a single-laboratory validation study: application to the determination of lead in blood

BACKGROUND

Lead is an environmental pollutant, and human exposure is assessed by monitoring lead concentrations in blood. Because the main source of environmental exposure has been the use of leaded gasoline, its phase-out has led to decreased lead concentrations in the general population. Therefore, validated analytical methods for the determination of lower lead concentrations in blood (<150 microg/L) are needed. In addition, new ISO standards require that laboratories determine and specify the uncertainty of their results.

METHODS

We validated a method to determine lead in blood at concentrations up to 150 microg/L by electrothermal atomic absorption spectrometry with Zeeman background correction according to EURACHEM guidelines. Blood samples were diluted (1:1 by volume) with 2 mL/L Triton X-100. NH4H2PO4 (5 g/L) and Mg(NO3)2 (0.5 g/L) were used as modifiers. Matrix-matched standards were used for calibration.

RESULTS

We determined the limits of detection (3.1 microg/L) and quantification (9.4 microg/L). Repeatability and intermediate imprecision within the range 35-150 microg/L were <5.5% and <6.0%, respectively. We assessed trueness by use of certified reference materials, by recovery tests, and by comparison with target values of other reference materials (candidate external quality assessment samples). The expanded uncertainty ranged from 20% to 16% (with a confidence level of 95%) depending on concentration.

CONCLUSIONS

This study provides a working example of the estimate of uncertainty from method performance data according to the EURACHEM/CITAC guidelines. The estimated uncertainty is compatible with quality specifications for the analysis of lead in blood adopted in the US and the European Union.