Behavioral Intervention and Decreased Daily Melamine Exposure from Melamine Tableware

Benchmark Dose of Melamine Exposure for a Renal Injury Marker Mediated by Oxidative Stress: Examples in Patients with Urolithiasis and Occupational Workers

Establishing a safe exposure level from epidemiological studies while providing direct hazard characterization in humans often faces uncertainty in causality, especially cross-sectional data. With advances in molecular epidemiology, it is reasonable to integrate identified intermediate biomarkers into health risk assessment. In this study, by considering the mediation of the oxidative stress marker malondialdehyde (MDA), we explored the exposure threshold of melamine on the early renal injury marker N-acetyl-β-D glucosaminidase (NAG). The benchmark dose (BMD) was derived from model averaging of the composite direct effect of melamine exposure and the indirect effect through the mediation of MDA on NAG levels. As illustrative examples, we analyzed 309 adult patients with calcium urolithiasis and 80 occupational workers for the corresponding exposure thresholds. The derived threshold was subpopulation-dependent, with the one-sided lower bound BMDL10 for the patients with urolithiasis with (without) the mediator MDA for the patients with kidney stones and the occupational workers being 0.88 (0.96) μg/kg_bw/day and 22.82 (18.09) μg/kg_bw/day, respectively. The derived threshold levels, considering the oxidative stress marker MDA, were consistent with those without adjusting for the mediation effect. However, the study outcomes were further supported by the suggested mechanism pathway. The threshold for the patients with urolithiasis was up to two orders lower than the current tolerable daily intake level of 200 μg/kg_bw/day recommended by the WHO (EFSA).

Migration of Melamine and Its Derivatives from Melamine/Bamboo/Wheat Straw-Made Tableware Purchased from Internet Markets or Retail Shops in China

OBJECTIVES

The ecofriendly and sustainable concept of bamboo- and wheat straw-made tableware has gained attention in recent years. However, it is necessary to note that these kinds of tableware are composed of melamine (MEL)-formaldehyde resin with the addition of bamboo fibers or wheat straw. This study aims to explore the potential migration of MEL and its derivatives from the tableware and conduct a risk assessment.

METHODS

The study involved 46 bowls or cups purchased from Internet markets or retail shops in China, whose raw materials included MEL, bamboo, and wheat straw. There were four pieces of glass- or ceramic-made tableware used as the control group. Migration testing was performed according to the test conditions selected from the European Union Reference Laboratory for Food Contact Materials. Considering the realistic worst-case scenario, we measured the concentrations of MEL and its derivatives in food simulants using ultra-performance liquid chromatography-tandem mass spectrometry and estimated the exposure risks for adults and 1-year-old infants.

RESULTS

MEL and its derivatives could migrate from MEL-, bamboo-, and wheat straw-made tableware with varying concentrations. The total migration was ranked as follows: bamboo-made tableware > MEL-made tableware > wheat straw-made tableware > glass- or ceramic-made tableware (p < 0.001). The primary contributor to the total concentration for MEL- and bamboo-made tableware was MEL, whereas cyanuric acid (CYA) was the main contributor for wheat straw-made tableware. Based on the total concentration of MEL and its derivatives and the strictest TDI value, the proportions of the calculated hazard quotient ≥1 for MEL-, bamboo-, and wheat straw-made tableware in adults were 53.50%, 92.30%, and 1.90%; and the proportions in 1-year-old infants increased to 86.00%, 100.00%, and 7.40%.

CONCLUSION

The utilization of MEL-, bamboo-, and wheat straw-made tableware could be regarded as a significant source of human exposure to MEL and its derivatives. It is advisable for both adults and infants to refrain from using tableware manufactured with MEL and bamboo fiber, as it may increase the susceptibility to MEL-related diseases.

Sex-specific interactive effect of melamine and DEHP on a marker of early kidney damage in Taiwanese adults: A national population-based study from the Taiwan Biobank

Taiwan had the high incidence of chronic kidney disease (CKD) worldwide. Our objective was to examine associations between daily exposure of phthalates and melamine, two common nephrotoxins, and kidney damage risk in a well-established nationwide cohort. Study subjects were from Taiwan Biobank (TWB) with existing data of questionnaire and biochemical examinations. Average daily intake (ADI) levels of melamine and seven parental phthalates, including DEHP (di-2-ethylhexylphthalate), DiBP (Dibutyl phthalate), DnBP (Di-n-butyl phthalate), BBzP (Butyl benzyl phthalate), DEP (Diethyl phthalate), and DMP (Dimethyl phthalate) were estimated using a creatinine excretion-based model from urine melamine and 10 phthalate metabolites. Urine microalbumin to creatinine ratio (ACR) was used to represent for the outcome of kidney damage. Two statistical strategies were used: First, a weighted quantile sum (WQS) regression model to select the most important exposure variables of ADI levels of phthalates and melamine associated with ACR; Second, to examine effects of those most important exposure variables on ACR in multivariable linear regression models. In total, 1153 eligible adults were left for analyses. Of them, 591 (51.3%) and 562 (48.7%) were men and women, respectively, with a median age of 49 years old. By WQS, a significant and positive association was found between ADI of melamine and phthalates and ACR (β = 0.14, p = 0.002). ADI levels of melamine had the highest weight (0.57), followed by DEHP (0.13). Next, examining the two most important exposures in association with ACR, we found that the higher the melamine and DEHP intakes, the higher the ACR levels were found. An interaction effect was also found between melamine and DEHP intakes on urine ACR (p = 0.015). This result was more prominent in men (p = 0.008) than in women (p = 0.651). Environmental co-exposure of melamine and DEHP can potentially affect ACR in the community-dwelling Taiwanese adult population.

Exposure to nitrogenous based flame retardants in Chinese population: Evidence from a national-scale study

Extensive use of nitrogen-based flame retardants (NFRs) has resulted in their widespread environmental occurrence. To investigate human exposure to NFRs on a national scale, the abundance and spatial distribution of NFRs were assessed in urine specimens collected from 13 cities in China. Six out of eight target NFRs were detectable in more than half of the urine samples, and the total concentrations of NFRs ranged from 3.22 to 880 ng/mL with a median of 46.7 ng/mL. Cyanuric acid was the most abundant chemical, accounting for 66.2%, followed by melamine (16.3%), ammelide (10.8%), and ammeline (6.11%). Regional differences in concentrations and composition profiles of NFRs were observed within China as a result of different production and application profiles. In addition, we found that urinary NFRs levels were much higher than but statistically correlated with that of organophosphates (r² = 0.69, p < 0.05), another class of phosphorus-based flame retardant, implying similar emission sources and/or human exposure pathways. Furthermore, the estimated daily intakes and hazard quotients revealed that the Chinese population's exposure to NFRs is within safe limits. To the best of our knowledge, this is the first study to document the ubiquitous occurrence and region-specific variations of human exposure to NFRs in China.

Profiling of multiple classes of flame retardants in house dust in China: Pattern analysis and human exposure assessment

Legacy [e.g., brominated- (BFRs)] and alternative [e.g., organophosphate- (OPFRs) and nitrogenous- (NFRs)] flame retardants have a propensity to migrate out of consumer products, and thus are dispersed in indoor microenvironments. In this study, simultaneous presence of 11 BFRs, 18 OPFRs and 11 NFRs were measured in house dust collected from Tianjin, China. OPFRs were found at the highest concentrations, with a median value of 3200 ng/g, followed by NFRs (2600) and BFRs (1600). Tris(2-butoxyethyl) phosphate (median: 1800 ng/g), melamine (1100), and BDE-209 (870) were the top three most abundant chemicals in the respective groups. Location-specific patterns of flame retardant concentrations were found with 30%, 20% and 10% of samples were predominated by OPFRs, NFRs and BFRs, respectively, and the remaining samples contained by two or more of the chemical groups occurring concurrently. Network and cluster analysis results indicated the existence of multiple sources of flame retardants in the indoor microenvironment. Estimated human daily intakes via indoor dust ingestion were approximately several tens of ng/kg bw/day and were below their respective reference dose values. Our results indicate widespread occurrence of multiple flame retardant families in indoor dust and suggest need for continued monitoring and efforts to reduce exposures through dust ingestion.

Avatar-like body imaging of dermal exposure to melamine in factory workers analyzed by ambient mass spectrometry

Ambient mass spectrometry thermal desorption-electrospray ionization/mass spectrometry (TD-ESI/MS) can rapidly identify chemicals without pretreatment of biological samples. This study used a rapid semi-quantitative TD-ESI/MS screening technique for the probe skin sampling of melamine workers occupationally exposed to different ambient melamine concentrations to create avatar-like body images, which were then used to study temporal and dynamic changes in nephrotoxic melamine exposure. We enrolled four voluntary melamine workers from one factory, each from one of four worksites. Melamine exposure was highest in manufacturing and molding, followed by grinding and polishing, packing, and administration, the lowest. Skin samples were collected Friday (end-of-shift) and Monday (pre-shift). Early morning one-spot urine samples were also collected right after skin sampling. 2198 probe skin samples were collected and subjected to semi-quantitative TD-ESI/MS analyses of melamine chemical within 40 h. After normalization, converted body image scores revealed exposure to be highest in the manufacturing worker on Friday and lowest in the administrative worker on Monday. The absolute differences (Friday minus Monday) of normalized body image scores were all significantly positive in each individual worker and across all four workers (permutation test, all p-values < 0.002). The slope estimates of the linear regression line between body image scores and urinary melamine levels were 0.81 (p-value = 0.008). We concluded that this fast and non-invasive technique can potentially be used to study temporal and dynamic changes in exposure to occupational hazards. A future study of developing an automatic and reproducible TD-ESI/MS sampling platform is needed.

Exposure to melamine and its derivatives in Chinese adults: The cumulative risk assessment and the effect on routine blood parameters

Melamine (MEL) and its derivatives, ammeline (AMN), ammelide (AMD), cyanuric acid (CYA) are widely existed in environmental media. Animal studies have reported the cumulative risk assessment (CRA) of simultaneous exposure to MEL and its derivatives and explored the associations between exposure and routine blood parameters. Such information is largely unknown in human studies. In this study, we detected the urinary concentrations of MEL and its derivatives in 239 Chinese adults to conduct the CRA by evaluating their hazard quotients (HQ) and hazard Index (HI), and also explored the possible associations between exposure and measured routine blood parameters in study population. The detectable frequencies of MEL, AMN, AMD and CYA were 96.65%, 41.00%, 97.91% and 97.07%, respectively. The median values of creatinine (Cr)-adjusted MEL, AMN, AMD, CYA and the total concentrations of MEL and its derivatives (∑MEL) were 11.41 μg/g Cr, not detected (ND), 2.64 μg/g Cr, 15.30 μg/g Cr, 35.02 μg/g Cr, respectively. There were 9 (3.77%) participants with estimated daily intakes (EDIs) of CYA exceeding the tolerable daily intake (TDI) of 2500 ng/kg bw/day, and 12 (5.02%) participants with HI of ∑MEL exposure exceeding 1 based on the strictest TDI value. Urinary concentrations of MEL and its derivatives were positively associated with specific routine blood parameters, including hematocrit, hemoglobin, mean corpuscular volume, mean corpuscular hemoglobin concentration, mean corpuscular hemoglobin, white blood cell, neutrophil count (P < 0.05). Meanwhile, exposure to MEL and its derivatives increased the risk of red blood cell abnormality (P < 0.05). Our study is the first study to provide evidence-based data on the CRA of exposure to MEL and its derivatives in Chinese adults, and to propose a possible association between such exposure and routine blood parameters in human.

Urinary Excretion of Cyanuric Acid in Association with Urolithiasis: A Matched Case-Control Study in Shanghai Adults

Melamine (MEL) has raised human concern since the 2008 milk scandal. Co-exposure to MEL and one of its analogues, cyanuric acid (CYA), has been reported to have a synergistic effect on promoting urolithiasis. However, few epidemiological studies have reported urolithiasis in association with exposure to CYA based on our knowledge. We therefore conducted a case-control study to investigate whether cases of urolithiasis had higher excretion of urinary CYA than the controls. Spot urine samples from 70 adult cases and first-morning urine samples from 70 controls (matched by age and sex) were collected for the measurement of MEL, CYA, and other two analogues in urine. The case group also had 2.81-fold higher concentration of urinary CYA than the control group (34.87 versus 12.43 ng/mL, p-value < 0.001). Multivariate conditional logistic regression models adjusting potential confounders of personal characteristics identified the risk factor of urinary CYA as a continuous variable with odds ratio (OR) (95% confidence interval, 95%CI) of 1.11 (1.02−1.21) (p-value = 0.021) and having meals at restaurants with OR of 5.71 (1.01−32.31) (p-value = 0.049). Compared to the participants having the lowest quartile of CYA concentration in urine, participants at the second, third, and fourth quartile groups had ORs of 13.94, 83.69, and 118.65 with p-values of 0.004, <0.001, and <0.001, respectively. The high excretion of urinary CYA in urolithiasis cases might be the sign of stones in patients consisting of CYA, then proving the attribution of CYA exposure in the etiology of urolithiasis. These findings are important since CYA is a degraded by-product of chlorinated isocyanuric acid disinfectants, which are widely used in daily life not only in swimming pool water but also in other scenarios, such as serving as anti-pandemic disinfectants. Risk assessment of CYA serving as a by-product of disinfectants needs to be conducted in future studies.

Associations of Dietary Intake with Urinary Melamine and Derivative Concentrations among Children in the GAPPS Cohort

Melamine is a nephrotoxic industrial chemical. Diet is one source of melamine exposure, yet little work has examined the main dietary contributors, particularly among children. We evaluated associations of diet with urinary melamine and derivative concentrations among 123 children aged 4-6 years in the Global Alliance to Prevent Prematurity and Stillbirth cohort. Children's diets on the day preceding urine collection were assessed using 24-h dietary recalls. Associations of meat, fruit, and grain intakes with melamine exposure were examined using multiple linear regression. Remaining food groups were examined in secondary analyses. Mean (SD) melamine, ammelide, and cyanuric acid concentrations were 6.1 (12.4), 1.9 (2.1), and 60.6 (221.2) ng/mL, respectively. The second tertile of red meat consumers had 98% (95% CI: 15%, 241%) greater melamine exposure than non-consumers, yet the highest consumers did not have increased exposure. Greater consumption of certain fruits was associated with lower urinary ammelide. The top yogurt consumers had 112% (95% CI: 29%, 247%) greater melamine exposure than non-consumers. Consumption of starchy vegetables excluding potatoes was associated with 139% (95% CI: 6%, 437%) greater urinary ammelide. These observed associations should be confirmed in future studies using larger samples and increased monitoring of non-dietary routes of exposure.

Genetic Polymorphisms of MnSOD Modify the Impacts of Environmental Melamine on Oxidative Stress and Early Kidney Injury in Calcium Urolithiasis Patients

Environmental melamine exposure increases the risks of oxidative stress and early kidney injury. Manganese superoxide dismutase (MnSOD), glutathione peroxidase, and catalase can protect the kidneys against oxidative stress and maintain normal function. We evaluated whether their single-nucleotide polymorphisms (SNPs) could modify melamine’s effects. A total of 302 patients diagnosed with calcium urolithiasis were enrolled. All patients provided one-spot overnight urine samples to measure their melamine levels, urinary biomarkers of oxidative stress and renal tubular injury. Median values were used to dichotomize levels into high and low. Subjects carrying the T allele of rs4880 and high melamine levels had 3.60 times greater risk of high malondialdehyde levels than those carrying the C allele of rs4880 and low melamine levels after adjustment. Subjects carrying the G allele of rs5746136 and high melamine levels had 1.73 times greater risk of high N-Acetyl-β-d-glucosaminidase levels than those carrying the A allele of rs5746136 and low melamine levels. In conclusion, the SNPs of MnSOD, rs4880 and rs5746136, influence the risk of oxidative stress and renal tubular injury, respectively, in calcium urolithiasis patients. In the context of high urinary melamine levels, their effects on oxidative stress and renal tubular injury were further increased.

Melamine exposure threshold in early chronic kidney disease patients - A benchmark dose approach

Environmental melamine exposure has been associated with deteriorating kidney function in early-stage chronic kidney disease patients. In this study, a benchmark dose (BMD) approach was used to establish melamine exposure threshold in 293 patients with eGFR≥30 ml/min per 1.73 m². The patients were enrolled 2006-2010 and followed-up for a median of 7.0 years to monitor kidney outcomes. Average daily intakes (AvDI) of melamine were estimated using one-spot urine samples collected at enrollment. BMDs and corresponding one-sided 95% lower bound (BMDLs) were derived using established dose-response models relating estimated AvDIs and dichotomous kidney outcomes: doubling of serum creatine levels, eGFR decreased > 3 ml/min per 1.73 m² per year, and >30% decline in eGFR during the first 2 years. In addition, survival time to doubling of serum creatinine and eGFR decline over time were assessed as continuous endpoints. Given a benchmark response of 0.10, BMDLs ranged from 0.74 to 2.03 μg/kg_bw/day after Bayesian model averaging, a range one to two orders lower than the current WHO recommended tolerable daily intake of 200 μg/kg_bw/day and the US FDA's 63 μg/kg_bw/day. Our results suggest that early-stage CKD patients should strictly refrain from using melamine tableware and related melamine-made products.

Protective prospects of eco-friendly synthesized selenium nanoparticles using Moringa oleifera or Moringa oleifera leaf extract against melamine induced nephrotoxicity in male rats

Nanotechnology is used in a wide range of applications, including medical therapies that precisely target disease prevention and treatment. The current study aimed firstly, to synthesize selenium nanoparticles (SeNPs) in an eco-friendly manner using Moringa oleifera leaf extract (MOLE). Secondly, to compare the protective effects of green-synthesized MOLE-SeNPs conjugate and MOLE ethanolic extract as remedies for melamine (MEL) induced nephrotoxicity in male rats. One hundred and five male Sprague Dawley rats were divided into seven groups (n = 15), including 1st control, 2nd MOLE (800 mg/kg BW), 3rd SeNPs (0.5 mg/kg BW), 4th MOLE-SeNPs (200 μg/kg BW), 5th MEL (700 mg/kg BW), 6th MEL+MOLE, and 7th MEL+MOLE SeNPs. All groups were orally gavaged day after day for 28 days. SeNPs and the colloidal SeNPs were characterized by TEM, SEM, and DLS particle size. SeNPs showed an absorption peak at a wavelength of 530 nm, spherical shape, and an average size between 3.2 and 20 nm. Colloidal SeNPs absorption spectra were recorded between 400 and 700 nm with an average size of 3.3-17 nm. MEL-induced nephropathic alterations represented by a significant increase in serum creatinine, urea, blood urea nitrogen (BUN), renal TNFα, oxidative stress-related indices, and altered the relative mRNA expression of apoptosis-related genes Bax, Caspase-3, Bcl2, Fas, and FasL. MEL-induced array of nephrotoxic morphological changes, and up-regulated immune-expression of proliferating cell nuclear antigen (PCNA) and proliferation-associated nuclear antigen Ki-67. Administration of MOLE or MOLE-SeNPs significantly reversed MEL-induced renal function impairments, oxidative stress, histological alterations, modulation in the relative mRNA expression of apoptosis-related genes, and the immune-expression of renal PCNA and Ki-67. Conclusively, the green-synthesized MOLE-SeNPs and MOLE display nephron-protective properties against MEL-induced murine nephropathy. This study is the first to report these effects which were more pronounced in the MOLE group than the green biosynthesized MOLE-SeNPs conjugate group.

Association between two common environmental toxicants (phthalates and melamine) and urinary markers of renal injury in the third trimester of pregnant women: The Taiwan Maternal and Infant Cohort Study (TMICS)

BACKGROUND

Exposure to either melamine or phthalate, two common toxicants, during pregnancy may cause adverse health effects, including kidney damage.

OBJECTIVES

We investigated the independent and interactive effect of exposure to melamine and phthalates, particularly di-(2-ethylhexyl) phthalate (DEHP), on markers of early renal injury in women their third trimester of pregnancy in one nationwide birth cohort, the Taiwan Maternal and Infant Cohort Study (TMICS).

METHODS

Between October, 2012 and May, 2015, participants were administered questionnaires, physical examinations, and blood and urine tests during their third trimester. One-spot overnight urine specimens were used to simultaneously measure melamine, 11 phthalate metabolites, and two markers of renal injury, microalbumin and N-acetyl-beta-D-glucosaminidas (NAG). Estimated daily DEHP intake was calculated based on measurement of three urinary DEHP metabolites. Microalbuminuria was defined as having a urinary albumin/creatinine ratio (ACR) higher than 3.5 mg/mmol.

RESULTS

Total 1433 pregnant women were analyzed. The median value for urinary melamine was 0.63 μg/mmol Cr and estimated DEHP intake was 1.84 μg/kg/day. We found subjects in the highest quartile of estimated DEHP intake to have significantly higher urinary ACR (β = 0.095, p = 0.043) and the prevalence of microalbuminuria (adjusted OR = 1.752, 95% confidence interval = 1.118-2.746), compared to those in the lowest quartile. In addition, there was a significant interactive effect between urinary melamine and estimated DEHP intake on urinary ACR and NAG.

CONCLUSION

Our results suggest these two ubiquitous chemicals together may be associated with markers of early kidney injury in pregnant women.

A probabilistic approach for benchmark dose of melamine exposure for a marker of early renal dysfunction in patients with calcium urolithiasis

Environmental exposure to melamine has been associated with early renal injury in urolithiasis patients even when urinary concentrations of melamine are low. The aim of this study was to derive a benchmark dose (BMD) for melamine for urolithiasis patients. To do this, one-spot urine sample from 309 participants was obtained to measure urinary melamine and N-acetyl β-D-glucosaminidase (NAG), an early renal damage biomarker. The participants were then classified into four exposure groups based on the outcomes of melamine tableware usage questionnaire. A beta distribution of urinary excretion fraction for each group was assumed to estimate their average daily intakes (AvDIs) of melamine. The BMD and the corresponding one-sided 95% lower bound (BMDL) was then derived based on Bayesian model averaging of alternative regression models between the participants' NAG levels and their estimated AvDIs, adjusting for age, gender, and other covariates. Bayesian Markov chain Monte Carlo simulations were used for all the estimates. With a benchmark response of 0.10, the simulated BMDL of 4.89 μg/kg-bw/day for melamine exposure threshold was much lower than the WHO's current recommended tolerable daily intake of 200 μg/kg_bw/day and the US FDA's 63 μg/kg_bw/day. The current regulation level of melamine might not safeguard urolithiasis patients from further deterioration of renal function.

Are Melamine and Its Derivatives the Alternatives for Per- and Polyfluoroalkyl Substance (PFAS) Fabric Treatments in Infant Clothes?

Per- and polyfluoroalkyl substances (PFAS) and melamine (MEL)-based compounds are used in textile finishing as grease, stain, and water repellents. Here, we investigated the occurrence of a large suite of PFAS and MEL compounds in 86 infant clothing items. The ∑MEL concentrations ranged from below the method detection limit to 250,000 ng/g with a median concentration of 78.2 ng/g, significantly higher (p < 0.05) than the ∑PFAS levels (1.22-203 ng/g; median 3.62 ng/g). MEL and its derivatives were most abundant in nylon clothes (median 32,800 ng/g), followed by organic cotton (median 6120 ng/g). In a simulated laundering experiment, the ∑MEL concentrations in clothing decreased on an average by ∼60 and 90% when washed in cool (20 °C) and warm (50 °C) water, respectively. This removal rate increased to 97% when the samples were washed with a detergent. The estimated daily intakes of MEL and PFAS through dermal absorption from nylon clothes were three orders of magnitude higher than those from the non-nylon clothes and decreased by more than half for washed clothes. Our findings demonstrate that MEL-based compounds are abundant in infant clothing and suggest that this group of compounds could be used as potential PFAS replacements in textile finishing.

Associations of melamine and cyanuric acid exposure with markers of kidney function in adults: Results from NHANES 2003-2004

Higher melamine exposure may increase the risk of kidney stone formation and kidney injury in infants, but little is known about the potential nephrotoxic effects of environmental low-dose melamine and its derivative exposure on kidney function of adults in the general population. Our objective was to assess associations between urinary concentrations of melamine and its derivative, cyanuric acid, and kidney function through analyzing the data from the National Health and Nutrition Examination Survey (NHANES) 2003-2004. Information on 298 participants aged ≥20 years was utilized. Urinary melamine and cyanuric acid levels were measured using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (UACR) were calculated to reflect kidney function. Covariate-adjusted creatinine standardization concentrations accounting for sex, race, age, race/ethically, and body mass index, was employed to control potential confounding of kidney function. Multivariable linear regression models were conducted to estimate associations of covariate-adjusted creatinine standardization urinary melamine and cyanuric acid concentrations with eGFR and UACR. Log-binomial regression models were performed to estimate risks of impaired kidney function and hypertension associated with urinary melamine and cyanuric acid levels. The geometric mean values of urinary melamine and cyanuric acid concentrations were 1.51 μg/L [95% confidence interval (CI): 1.21 μg/L, 1.89 μg/L] and 5.86 μg/L (95% CI: 5.34 μg/L, 6.44 μg/L), respectively. The median value of estimated daily intake (EDI) for melamine was 0.06 (ranging from undetectable to 1.11) μg/kg body weight/day calculated by urinary concentration and creatinine excretion accounting for sex and body weight. Adults in the fourth quartile of melamine and cyanuric acid exposure had 0.142 mL/min/1.73 m² (95% CI: -0.271, -0.014) and 0.106 mL/min/1.73 m² (95% CI: -0.020, 0.006) lower eGFR for melamine and cyanuric acid, respectively, compared to participants in the first quartile of exposure with adjustment for potential confounders. To our best knowledge, this is the first study to report associations between melamine and its derivative and kidney function of the U.S. adults from NHANES 2003-2004. The suggestive evidence revealed that individuals with high melamine exposure had lower eGFR than those with low melamine exposure, although no significant association between melamine and cyanuric acid exposure and markers of kidney function was observed. These findings should be interpreted with caution regarding the possible reverse causality.

Development of analytical method of melamine in placenta from pregnant women by isotope-dilution liquid chromatography/tandem mass spectrometry

RATIONALE

Melamine is ubiquitously present in our daily life. It has a known effect on the kidneys, but it may also adversely affect the reproduction system. We have developed an analytical method for measuring melamine levels in maternal placenta and correlated these levels with melamine concentrations in urine, a necessary step in finding out if melamine might cross the placenta and enter the circulation of the fetus.

METHODS

We used liquid-liquid extraction, clean up by solid-phase extraction (SPE), and isotope-dilution liquid chromatography/tandem mass spectrometry (LC/MS/MS) to measure melamine in placenta specimens. The results of this method were assessed for linearity, limits of quantitation (LOQs), and intra- and inter-assay precision as well as accuracy, matrix effect, and recovery rate.

RESULTS

Calibration curves indicated good linearity (r >0.995) over concentrations ranging from 5 to 500 ng/mL in placenta specimens, intra- and inter-assay precision from 0.89% to 27.07%, and accuracy from 92.4% to123.5%. Recovery ranged from 63.9 to 83.9%, and the LOQ was 5 ng/mL in placenta (0.2 g). Placental melamine levels ranged from 7.87 to19.64 ng/mL, all detectable (n = 8). Pregnant women with higher levels of urinary melamine had higher placenta melamine levels than those with non-detectable urinary melamine, though the results were not significantly different (p = 0.149, n = 4 in each group).

CONCLUSIONS

The results of this study suggest that pregnant women were exposed to low doses of melamine in their daily lives as measured in urine samples and placenta specimens. It is unclear whether placenta melamine concentrations can better represent long-term exposure than urine or whether melamine in the uterus can enter the fetus via this route.

Melamine and cyanuric acid in foodstuffs from the United States and their implications for human exposure

We determined the concentrations of melamine, ammeline, ammelide, and cyanuric acid in meat, fish and seafood, cereal products, beverages, cooking oil, and vegetables (n = 121) collected from Albany, New York, United States. In addition, food packaging (n = 24) and animal feed (n = 12) were analyzed to determine the sources of melamine and its derivatives in foods. Among the six categories of foods analyzed, median concentrations of ∑melamine (sum of melamine and its three derivatives) in meat (23.6 ng/g fresh weight; fw) and cereal products (20.9 ng/g fw) were significantly (p < 0.05) higher than those in other food categories (<5.03 ng/g fw). Cyanuric acid and melamine were the major compounds, accounting for 51% and 26% of the total ∑melamine concentrations, respectively. ∑melamine was found ubiquitously in food packaging (median: 36.2 ng/g fw) and animal feed (56.5 ng/g fw), which are two important sources of melamine found in foodstuffs. The median estimated daily dietary intakes (including concentrations reported for dairy products in our previous study) of melamine and cyanuric acid were in the ranges of 13.4-72.7 and 75.4-347 ng/kg body weight/day, respectively, for various age groups. Dairy products, cereal products, and meat were major sources of dietary melamine (~76%) and cyanuric acid (~95%) exposure. The calculated hazard quotients for dietary exposure to melamine and cyanuric acid were well below 1.0, which suggested minimal risk from current exposures.

Spatial and temporal trends of melamine and its derivatives in sediment from Lake Shihwa, South Korea

Occurrence, spatial distribution, and temporal trends of melamine and its derivatives (ammeline, ammelide, and cyanuric acid) were investigated in surface sediment and two sediment cores collected from Lake Shihwa, South Korea. ∑Melamine (sum of melamine and its three derivatives) was found in all surface sediment samples at concentrations that ranged from 16.6 to 4390 ng/g dry weight (dw), with an average value of 202 ng/g dw. ∑Melamine concentrations exhibited a clear spatial gradient, in decreasing order, as: creeks (mean: 577 ng/g dw) > inshore locations (41.9 ng/g dw) > offshore locations (24.3 ng/g dw). ∑Melamine concentrations were notably high in sediment collected near wastewater treatment plant (WWTP) outfalls. Melamine was the most prevalent compound in sediment collected from creeks (87%) and WWTP outfall locations (48%), whereas cyanuric acid was the dominant compound in sediment from inshore (51%) and offshore (63%) locations. The historical profiles of ∑Melamine in sediment cores corresponded with coastal development and environmental changes in this region. This is the first study to document the occurrence and temporal distribution of melamine in sediment cores, and this information is useful in understanding the fate of these relatively less-studied chemicals in the environment.

Occurrence of Melamine and Its Derivatives in Breast Milk from the United States and Its Implications for Exposure in Infants

Melamine received public and regulatory attention in 2008 following a scandal that involved the adulteration of milk and infant formula in China that affected tens of thousands of infants. Little is known about human exposure and the food chain transfer of melamine and its derivatives. In this study, melamine, cyanuric acid, ammeline, and ammelide were analyzed in 100 human milk samples collected from the United States during the period of 2009-2012. ∑Melamine (sum of melamine and its three derivatives) was found in breast milk at concentrations that ranged from 0.176 to 10.0 ng/mL (median: 1.40 ng/mL). Cyanuric acid was the major derivative, accounting for 73% of the total concentrations, followed by melamine (21%). No remarkable associations were noted between melamine and cyanuric acid concentrations and maternal/infant characteristics. The cumulative daily intakes of melamine (16.9-30.6 ng/kg bw/day) and cyanuric acid (88.8-161 ng/kg bw/day) were calculated for breast-fed infants and were found to be 1-2 orders of magnitude below the current tolerable daily intake. This is the first study to report the distribution of melamine and its derivatives in breast milk from the United States.

Occurrence and Profiles of Melamine and Cyanuric Acid in Bovine Feed and Urine from China, India, and the United States

Melamine and cyanuric acid have been reported to occur in animal products. Nevertheless, information that pertains to the occurrence of melamine and cyanuric acid in cattle feed and urine is lacking. In this study, the occurrence of melamine and its three derivatives (i.e., cyanuric acid, ammeline, and ammelide) was determined in 183 bovine urine and 29 matched feed samples collected from China, India, and the United States. ∑Melamine (sum of four target compounds) was found in all urine samples at concentrations that ranged from 4.2 to 5280 ng/mL (median: 370 ng/mL); cyanuric acid was the major derivative, accounting for 97% of the total concentrations, followed by melamine (2.2%). The ubiquitous occurrence of ∑Melamine in feed (21-6230 ng/g) suggests that it is the major source of melamine and its derivatives in bovines. Urinary concentrations of melamine and cyanuric acid varied significantly among the three countries, with samples from China as having the highest concentrations, followed by the United States and India. The calculated cumulative daily intakes of melamine and cyanuric acid were at least 10-fold below the current tolerable daily intake recommended for humans. Our study provides evidence-based data on exposure patterns and sources of melamine and cyanuric acid in cattle.

Inter-day and inter-individual variability in urinary concentrations of melamine and cyanuric acid

Melamine is used extensively in household products, such as furniture, dinnerware, and food utensils. Several studies have shown that melamine adversely affects kidney function. Nevertheless, little is known about urinary melamine concentrations, and its temporal variability. In this study, 213 first-morning-void urine samples were collected from 19 volunteers for over a month to assess longitudinal variability in concentrations of melamine and its three structural analogues, i.e., cyanuric acid, ammeline, and ammelide. Target analytes were found in all urine samples at mean concentrations of 3.3, 16, 0.99, and 0.62 ng/mL, for melamine, cyanuric acid, ammelide, and ammeline, respectively. Cyanuric acid was the major compound found in all urine samples, accounting for 74-80% of the total concentrations, followed by melamine (12-20%), ammelide (4-6%), and ammeline (2-4%). Gender- and age-related differences in melamine concentrations were observed, although no such pattern was found for cyanuric acid. After adjusting for creatinine, melamine and cyanuric acid concentrations were moderately predictable with inter-day intraclass correlation coefficients (ICCs) in the range of 0.541-0.763. Nevertheless, substantial inter-individual variation in melamine levels existed even after creatinine adjustment, as evidenced by low ICCs (0.008-0.108). Cumulative daily intake of melamine and cyanuric acid was calculated on the basis of urinary concentrations and the mean values were found to be at least 10-fold below the current tolerable daily intake.

Systematic review showed that stepped-wedge cluster randomized trials often did not reach their planned sample size

OBJECTIVE

To determine how often stepped-wedge cluster randomized controlled trials reach their planned sample size, and what reasons are reported for choosing a stepped-wedge trial design.

STUDY DESIGN AND SETTING

We conducted a PubMed literature search (period 2012 to 2017) and included articles describing the results of a stepped-wedge cluster randomized trial. We calculated the percentage of studies reaching their prespecified number of participants and clusters, and we summarized the reasons for choosing the stepped-wedge trial design as well as difficulties during enrollment.

RESULTS

Forty-six individual stepped-wedge studies from a total of 53 articles were included in our review. Of the 35 studies, for which recruitment rate could be calculated, 69% recruited their planned number of participants, with 80% having recruited the planned number of clusters. Ethical reasons were the most common motivation for choosing the stepped-wedge trial design. Most important difficulties during study conduct were dropout of clusters and delayed implementation of the intervention.

CONCLUSION

About half of recently published stepped-wedge trials reached their planned sample size indicating that recruitment is also a major problem in these trials. Still, the stepped-wedge trial design can yield practical, ethical, and methodological advantages.

Melamine, beyond the kidney: A ubiquitous endocrine disruptor and neurotoxicant?

Melamine is commonly used in a variety of consumer products such as furniture, dining ware, and food utensils. The chemical infamously gained worldwide attention by its illegal addition to a variety of foodstuffs in order to falsify protein content, which led to serious, sometimes fatal, health impacts in children and pets. This resulted in a large amount of published primary studies and reviews of the impacts of melamine exposure on kidney function. However, a growing body of literature suggests that melamine may have impacts beyond renal dysfunction. We conducted a scoping review of this literature which yielded more than 40 studies with human, animal, and in vitro findings. Neurological impacts, reproductive function, and anthropometric outcomes were identified as possible candidates for systematic review based on evidence stream and replication of endpoints. The results of this analysis provide a basis for prioritizing future research on health impacts associated with melamine exposure.