Urinary arsenic profiles reveal exposures to inorganic arsenic from private drinking water supplies in Cornwall, UK

Assessing Acute and Chronic Risks of Human Exposure to Arsenic: A Cross-Sectional Study in Ethiopia Employing Body Biomarkers

Background

Arsenic, a widely recognized and highly toxic carcinogen, is regarded as one of the most hazardous metalloids globally. However, the precise assessment of acute and chronic human exposure to arsenic and its contributing factors remains unclear in Ethiopia.

Objective

The primary goal of this study was to assess the levels of acute and chronic arsenic exposure, as well as the contributing factors, using urine and nail biomarkers.

Methods

A community-based analytical cross-sectional study design was employed for this study. Agilent 7900 series inductively coupled plasma mass spectrometry was used to measure the concentrations of arsenic in urine and nail samples. We performed a multiple linear regression analysis to assess the relationships between multiple predictors and outcome variables.

Results

The concentration of arsenic in the urine samples ranged from undetectable (<0.01) to 126.13, with a mean and median concentration of 16.02 and 13.5 μg/L, respectively. However, the mean and median concentration of arsenic in the nails was 1.01, ranging from undetectable (<0.01 μg/g) to 2.54 μg/g. Furthermore, Pearson's correlation coefficient analysis showed a significant positive correlation between arsenic concentrations in urine and nail samples (r = 0.432, P < .001). Also, a positive correlation was observed between urinary (r = 0.21, P = .007) and nail (r = 0.14, P = .044) arsenic concentrations and the arsenic concentration in groundwater. Groundwater sources and smoking cigarettes were significantly associated with acute arsenic exposure. In contrast, groundwater sources, cigarette smoking, and the frequency of showers were significantly associated with chronic arsenic exposure.

Conclusions

The study's findings unveiled the widespread occurrence of both acute and chronic arsenic exposure in the study area. Consequently, it is crucial to prioritize the residents in the study area and take further measures to prevent both acute and chronic arsenic exposure.

Public health assessment of Kenyan ASGM communities using multi-element biomonitoring, dietary and environmental evaluation

The Kakamega gold belt's natural geological enrichment and artisanal and small-scale gold mining (ASGM) have resulted in food and environmental pollution, human exposure, and subsequent risks to health. This study aimed to characterise exposure pathways and risks among ASGM communities. Human hair, nails, urine, water, and staple food crops were collected and analysed from 144 ASGM miners and 25 people from the ASGM associated communities. Exposure to PHEs was predominantly via drinking water from mine shafts, springs and shallow-wells (for As>Pb>Cr>Al), with up to 366 µg L-1 arsenic measured in shaft waters consumed by miners. Additional exposure was via consumption of locally grown crops (for As>Ni>Pb>Cr>Cd>Hg>Al) besides inhalation of Hg vapour and dust, and direct dermal contact with Hg. Urinary elemental concentrations for both ASGM workers and wider ASGM communities were in nearly all cases above bioequivalents and reference upper thresholds for As, Cr, Hg, Ni, Pb and Sb, with median concentrations of 12.3, 0.4, 1.6, 5.1, 0.7 and 0.15 µg L-1, respectively. Urinary As concentrations showed a strong positive correlation (0.958) with As in drinking water. This study highlighted the importance of a multidisciplinary approach in integrating environmental, dietary, and public health investigations to better characterise the hazards and risks associated with ASGM and better understand the trade-offs associated with ASGM activities relating to public health and environmental sustainability. Further research is crucial, and study results have been shared with Public Health and Environmental authorities to inform mitigation efforts.

Update of the risk assessment of inorganic arsenic in food

The European Commission asked EFSA to update its 2009 risk assessment on arsenic in food carrying out a hazard assessment of inorganic arsenic (iAs) and using the revised exposure assessment issued by EFSA in 2021. Epidemiological studies show that the chronic intake of iAs via diet and/or drinking water is associated with increased risk of several adverse outcomes including cancers of the skin, bladder and lung. The CONTAM Panel used the benchmark dose lower confidence limit based on a benchmark response (BMR) of 5% (relative increase of the background incidence after adjustment for confounders, BMDL05) of 0.06 μg iAs/kg bw per day obtained from a study on skin cancer as a Reference Point (RP). Inorganic As is a genotoxic carcinogen with additional epigenetic effects and the CONTAM Panel applied a margin of exposure (MOE) approach for the risk characterisation. In adults, the MOEs are low (range between 2 and 0.4 for mean consumers and between 0.9 and 0.2 at the 95th percentile exposure, respectively) and as such raise a health concern despite the uncertainties.

The variability of arsenic in blood and urine of humans

BACKGROUND

Humans are exposed to inorganic and organic arsenic. The total arsenic (As) concentration in urine is a commonly used biomarker of exposure. However, little is known about variability of As in biological fluids and the diurnal variation of As excretion.

OBJECTIVES

Main objectives were to assess the variability of As in urine, plasma (P-As), whole blood (B-As), and the blood cell fraction (C-As), and to assess diurnal variation of As excretion.

METHODS

Six urine samples were collected at fixed times during 24 h on two different days around one week apart among 29 men and 31 women. Blood samples were collected when the morning urine samples were delivered. The intra-class correlation coefficient (ICC) was calculated as the ratio of the between-individuals variance to the total observed variance.

RESULTS

Geometric mean (GM) 24 h urinary excretions of As (U-As_24 h) were 41 and 39 µg/24 h on the two days of sampling. Concentrations of B-As, P-As and C-As were highly correlated with U-As_24 h and As in first void morning urine. No statistically significant differences were observed for the urinary As excretion rate between the different sampling times. A high ICC was observed for As in the cellular blood fraction (0.803), while ICC for first morning urine corrected for creatine was low (0.316).

CONCLUSIONS

The study suggests that C-As is the most reliable biomarker for use in exposure assessment of individual exposure. Morning urine samples have low reliability for such use. No apparent diurnal variation was observed in the urinary As excretion rate.

Human urinary arsenic species, associated exposure determinants and potential health risks assessed in the HBM4EU Aligned Studies

The European Joint Programme HBM4EU coordinated and advanced human biomonitoring (HBM) in Europe in order to provide science-based evidence for chemical policy development and improve chemical management. Arsenic (As) was selected as a priority substance under the HBM4EU initiative for which open, policy relevant questions like the status of exposure had to be answered. Internal exposure to inorganic arsenic (iAs), measured as Toxic Relevant Arsenic (TRA) (the sum of As(III), As(V), MMA, DMA) in urine samples of teenagers differed among the sampling sites (BEA (Spain) > Riksmaten adolescents (Sweden), ESTEBAN (France) > FLEHS IV (Belgium), SLO CRP (Slovenia)) with geometric means between 3.84 and 8.47 μg/L. The ratio TRA to TRA + arsenobetaine or the ratio TRA to total arsenic varied between 0.22 and 0.49. Main exposure determinants for TRA were the consumption of rice and seafood. When all studies were combined, Pearson correlation analysis showed significant associations between all considered As species. Higher concentrations of DMA, quantitatively a major constituent of TRA, were found with increasing arsenobetaine concentrations, a marker for organic As intake, e.g. through seafood, indicating that other sources of DMA than metabolism of inorganic As exist, e.g. direct intake of DMA or via the intake of arsenosugars or -lipids. Given the lower toxicity of DMA(V) versus iAs, estimating the amount of DMA not originating from iAs, or normalizing TRA for arsenobetaine intake could be useful for estimating iAs exposure and risk. Comparing urinary TRA concentrations with formerly derived biomonitoring equivalent (BE) for non-carcinogenic effects (6.4 μg/L) clearly shows that all 95th percentile exposure values in the different studies exceeded this BE. This together with the fact that cancer risk may not be excluded even at lower iAs levels, suggests a possible health concern for the general population of Europe.

Photometric flow injection analysis of As(III) by using a homemade, LED-based flow-cell device and methyl orange reagent

Inorganic arsenic especially As(III) is considered a carcinogenic substance and its measurement is important in water samples. In this work, an inexpensive flow injection analysis system was designed for the photometric determination of As(III) at low concentrations. For this purpose, a light-emitting diode (LED) based photometer with a miniaturized detector, was fabricated and used as a determination apparatus and methyl orange was used as a detecting reagent. The fabricated photometer employed the LEDs, as a light source and the light detector. The λ_max of emission for emitter and detector LEDs were 525 and 625 nm, respectively. Determination of As (III) was based on its inhibition effect on the redox reaction between methyl orange and X₂ (Cl₂ or Br₂). The decolorization of the reaction products in the FIA system was monitored using the homemade flow cell detector. Analytical figures of merit including linear responses ranging from 0.03 to 3.0 mg/l of As(III) (r = 0.994), detection limits of 0.007 mg/l As(III), RSD% of 1.5% (n = 7), low reagent consumption per determination, and sampling throughput of 50 determinations per hour were achieved.

Human urinary biomonitoring in Western Kenya for micronutrients and potentially harmful elements

Spot urinary elemental concentrations are presented for 357 adults from Western Kenya collected between 2016 and 2019 as part of a wider environmental geochemical survey. The aim of this study was to establish population level urinary elemental concentrations in Western Kenya for micronutrients and potentially harmful elements for inference of health status against established thresholds. For elements where thresholds inferring health status were not established in the literature using urine as a non-invasive matrix, this study generated reference values with a 95% confidence interval (RV95s) to contextualise urinary elemental data for this population group. Data are presented with outliers removed based upon creatinine measurements leaving 322 individuals, for sub-categories (e.g. age, gender) and by county public health administrative area. For Western Kenya, reference values with a 95% confidence interval (RV95s) were calculated as follows (μg/L): 717 (I), 89 (Se), 1753 (Zn), 336 (Mo), 24 (Cu), 15.6 (Ni), 22.1 (As), 0.34 (Cd), 0.47 (Sn), 0.46 (Sb), 7.0 (Cs), 13.4 (Ba and 1.9 (Pb). Urinary concentrations at the 25th/75th percentiles were as follows (μg/L): 149/368 (I), 15/42 (Se), 281/845 (Zn), 30/128 (Mo), 6/13 (Cu), 1.7/6.1 (Ni), 2.0/8.2 (As). 0.1/0.3 (Cd), 0.05/0.22 (Sn), 0.04/0.18 (Sb), 1.2/3.6 (Cs), 0.8/4.0 (Ba) and 0.2/0.9 (Pb). Urinary concentrations at a population level inferred excess intake of micronutrients I, Se, Zn and Mo in 38, 6, 57 and 14% of individuals, respectively, versus a bioequivalent (BE) upper threshold limit, whilst rates of deficiency were relatively low at 15, 15, 9 and 18%, respectively. Each of the administrative counties showed a broadly similar range of urinary elemental concentrations, with some exceptions for counties bordering Lake Victoria where food consumption habits may differ significantly to other counties e.g. I, Se, Zn. Corrections for urinary dilution using creatinine, specific gravity and osmolality provided a general reduction in RV95s for I, Mo, Se, As and Sn compared to uncorrected data, with consistency between the three correction methods.

Exposure to Environmental Arsenic and Emerging Risk of Alzheimer's Disease: Perspective Mechanisms, Management Strategy, and Future Directions

Alzheimer’s disease (AD) is one of the most prevailing neurodegenerative diseases, characterized by memory dysfunction and the presence of hyperphosphorylated tau and amyloid β (Aβ) aggregates in multiple brain regions, including the hippocampus and cortex. The exact etiology of AD has not yet been confirmed. However, epidemiological reports suggest that populations who were exposed to environmental hazards are more likely to develop AD than those who were not. Arsenic (As) is a naturally occurring environmental risk factor abundant in the Earth’s crust, and human exposure to As predominantly occurs through drinking water. Convincing evidence suggests that As causes neurotoxicity and impairs memory and cognition, although the hypothesis and molecular mechanism of As-associated pathobiology in AD are not yet clear. However, exposure to As and its metabolites leads to various pathogenic events such as oxidative stress, inflammation, mitochondrial dysfunctions, ER stress, apoptosis, impaired protein homeostasis, and abnormal calcium signaling. Evidence has indicated that As exposure induces alterations that coincide with most of the biochemical, pathological, and clinical developments of AD. Here, we overview existing literature to gain insights into the plausible mechanisms that underlie As-induced neurotoxicity and the subsequent neurological deficits in AD. Prospective strategies for the prevention and management of arsenic exposure and neurotoxicity have also been discussed.

Enhanced arsenic removal from water by mass re-equilibrium: kinetics and performance evaluation in a binary-adsorbent system

Because arsenic (As) is highly toxic and carcinogenic, its efficient removal from drinking water is essential. Considering some adsorption media may adsorb As fast but are too expensive to be applied in a household, while others could be abundantly available at low cost but with slow uptake kinetics, we explored a novel mass re-equilibrium (MRE) process between two media with different adsorption characteristics to enhance the overall As removal. We employed an adsorbent with fast adsorption kinetics to grab As from water, and then allow it to transfer to a second adsorbent with large capacity for As retention. In the system containing two adsorbents separated by a dialysis membrane, the results showed that As associated with a fast-adsorbing iron-based ordered mesoporous carbon could diffuse to a slow-adsorbing but high-capacity iron-based activated carbon. Column tests were further conducted, showing that the mixed medium, composed of the two adsorbents, could be used to adsorb As at a very short empty bed contact time (≤ 1 min) and the removal was improved by the MRE that potentially redistributed solid-phase As during pump-off periods. This study points to a new direction that by the MRE process, novel binary-adsorbent approaches may be developed for contaminant removal, if suitable media and process configuration could be identified.

Spatial analysis of urine zinc (Zn) concentration for women of reproductive age and school age children in Malawi

Zinc (Zn) is an essential micronutrient, and Zn deficiency remains a major global public health challenge. Recognised biomarkers of population Zn status include blood plasma or serum Zn concentration and proxy data such as dietary Zn intake and prevalence of stunting. Urine Zn concentration is rarely used to assess population Zn status. This study assessed the value of urine Zn concentration as a biomarker of population Zn status using a nationally representative sample of non-pregnant women of reproductive age (WRA) and school-aged children (SAC) in Malawi. Spot (casual) urine samples were collected from 741 WRA and 665 SAC. Urine Zn concentration was measured by inductively coupled plasma mass spectrometry with specific gravity adjustment for hydration status. Data were analysed using a linear mixed model with a spatially correlated random effect for between-cluster variation. The effect of time of sample collection (morning or afternoon), and gender (for SAC), on urine Zn concentration were examined. There was spatial dependence in urine Zn concentration between clusters among SAC but not WRA, which indicates that food system or environmental factors can influence urine Zn concentration. Mapping urine Zn concentration could potentially identify areas where the prevalence of Zn deficiency is greater and thus where further sampling or interventions might be targeted. There was no evidence for differences in urine Zn concentration between gender (P = 0.69) or time of sample collection (P = 0.85) in SAC. Urine Zn concentration was greater in afternoon samples for WRA (P = 0.003). Relationships between urine Zn concentration, serum Zn concentration, dietary Zn intake, and potential food systems covariates warrant further study.

Chronic dietary exposure to inorganic arsenic

Following an official request to EFSA from the European Commission, EFSA assessed the chronic dietary exposure to inorganic arsenic (iAs) in the European population. A total of 13,608 analytical results on iAs were considered in the current assessment (7,623 corresponding to drinking water and 5,985 to different types of food). Samples were collected across Europe between 2013 and 2018. The highest mean dietary exposure estimates at the lower bound (LB) were in toddlers (0.30 μg/kg body weight (bw) per day), and in both infants and toddlers (0.61 μg/kg bw per day) at the upper bound (UB). At the 95th percentile, the highest exposure estimates (LB-UB) were 0.58 and 1.20 μg/kg bw per day in toddlers and infants, respectively. In general, UB estimates were two to three times higher than LB estimates. The mean dietary exposure estimates (LB) were overall below the range of benchmark dose lower confidence limit (BMDL 01) values of 0.3-8 μg/kg bw per day established by the EFSA Panel on Contaminants in the Food Chain in 2009. However, for the 95th percentile dietary exposure (LB), the maximum estimates for infants, toddlers and other children were within this range of BMDL 01 values. Across the different age classes, the main contributors to the dietary exposure to iAs (LB) were 'Rice', 'Rice-based products', 'Grains and grain-based products (no rice)' and 'Drinking water'. Different ad hoc exposure scenarios (e.g. consumption of rice-based formulae) showed dietary exposure estimates in average and for high consumers close to or within the range of BMDL 01 values. The main uncertainties associated with the dietary exposure estimations refer to the impact of using the substitution method to treat the left-censored data (LB-UB differences), to the lack of information (consumption and occurrence) on some iAs-containing ingredients in specific food groups, and to the effect of food preparation on the iAs levels. Recommendations were addressed to improve future dietary exposure assessments to iAs.

Association of low-level inorganic arsenic exposure from rice with age-standardized mortality risk of cardiovascular disease (CVD) in England and Wales

Adverse health outcomes, including death from cardiovascular disease (CVD), arising from chronic exposure to inorganic arsenic (iAs) are well documented. Consumption of rice is a major iAs exposure route for over 3 billion people, however, there is still a lack of epidemiological evidence demonstrating the association between iAs exposure from rice intake and CVD risks. We explored this potential association through an ecological study using data at local authority level across England and Wales. Local authority level daily per capita iAs exposure from rice (E-iAs_ing,rice) was estimated using ethnicity as a proxy for class of rice consumption. A series of linear and non-linear models were applied to estimate the association between E-iAs_ing,rice and CVD age-standardized mortality rate (ASMR), using Akaike's Information Criterion as the principle model selection criterion. When adjusted for significant confounders, notably smoking prevalence, education level, employment rate, overweight percentage, PM2.5, female percentage and medical and care establishments, the preferred non-linear model indicated that CVD risks increased with iAs exposure from rice at exposures above 0.3 μg/person/day. Also, the best-fitted linear model indicated that CVD ASMR in the highest quartile of iAs exposure (0.375-2.71 μg/person/day) was 1.06 (1.02, 1.11; p-trend <0.001) times higher than that in the lowest quartile (<0.265 μg/person/day). Notwithstanding the well-known limitations of ecological studies, this study further suggests exposure to iAs, including from rice intake, as a potentially important confounder for studies of the factors controlling CVD risks.

Arsenic speciation in the bracket fungus Fomitopsis betulina from contaminated and pristine sites

Uptake, distribution and speciation of arsenic (As) were determined in the bracket fungus Fomitopsis betulina (previously Piptoporus betulinus), commonly known as the birch polypore, collected from a woodland adjacent to a highly contaminated former mine in the Southwest UK and at an uncontaminated site in Quebec, Canada, with no past or present mining activity. The fruiting body was divided into cap, centre and pores representing the top, middle and underside to identify trends in the distribution and transformation of As. Total As, determined by inductively coupled plasma-mass spectrometry (ICP-MS), was approximately tenfold higher in the mushroom from the contaminated compared to the uncontaminated site. Overall, accumulation of As was low relative to values reported for some soil-dwelling species, with maximum levels of 1.6 mg/kg at the contaminated site. Arsenic speciation was performed on aqueous extracts via both anion and cation high-performance liquid chromatography-ICP-MS (HPLC-ICP-MS) and on whole dried samples using X-ray absorption near edge structure (XANES) analysis. Seven As species were detected in F. betulina from the contaminated site by HPLC-ICP-MS: arsenite (As^III), arsenate (As^V), dimethylarsinate (DMA^V), methylarsonate (MA^V), trimethylarsine oxide (TMAO), tetramethylarsonium ion (Tetra) and trace levels of arsenobetaine (AB). The same As species were observed at the uncontaminated site with the exception of TMAO and Tetra. Arsenic species were localized throughout the fruiting body at the contaminated site, with the cap and pores containing a majority of As^V, only the cap containing TMAO, and the pores containing higher concentrations of DMA^V and MA^V as well as tetra and a trace of AB. XANES analysis demonstrated that the predominant form of As at the contaminated site was inorganic As^III coordinated with sulphur or oxygen and As^V coordinated with oxygen. This is the first account of arsenic speciation in F. betulina or any fungi of the family Fomitopsidaceae.

As3MT and GST Polymorphisms Influencing Arsenic Metabolism in Human Exposure to Drinking Groundwater

The urinary arsenic metabolites may vary among individuals and the genetic factors have been reported to explain part of the variation. We assessed the influence of polymorphic variants of Arsenic-3-methyl-transferase and Glutathione-S-transferase on urinary arsenic metabolites. Twenty-two groundwater wells for human consumption from municipalities of Colombia were analyzed for assessed the exposure by lifetime average daily dose (LADD) (µg/kg bw/day). Surveys on 151 participants aged between 18 and 81 years old were applied to collect demographic information and other factors. In addition, genetic polymorphisms (GSTO2-rs156697, GSTP1-rs1695, As3MT-rs3740400, GSTT1 and GSTM1) were evaluated by real time and/or conventional PCR. Arsenic metabolites: As^III, As^V, monomethylarsonic acid (MMA), and dimethylarsinic acid (DMA) were measured using HPLC-HG-AFS. The influence of polymorphic variants, LADD and other factors were tested using multivariate analyses. The median of total arsenic concentration in groundwater was of 33.3 μg/L and the median of LADD for the high exposure dose was 0.33 µg/kg bw/day. Univariate analyses among arsenic metabolites and genetic polymorphisms showed MMA concentrations higher in heterozygous and/or homozygous genotypes of As3MT compared to the wild-type genotype. Besides, DMA concentrations were lower in heterozygous and/or homozygous genotypes of GSTP1 compared to the wild-type genotype. Both DMA and MMA concentrations were higher in GSTM1-null genotypes compared to the active genotype. Multivariate analyses showed statistically significant association among interactions gene-gene and gene-covariates to modify the MMA and DMA excretion. Interactions between polymorphic variants As3MT*GSTM1 and GSTO2*GSTP1 could be potential modifiers of urinary excretion of arsenic and covariates as age, LADD, and alcohol consumption contribute to largely vary the arsenic individual metabolic capacity in exposed people.

Potential bio-indicators for assessment of mineral status in elephants

The aim of this study was two-fold: (1) identify suitable bio-indicators to assess elemental status in elephants using captive elephant samples, and (2) understand how geochemistry influences mineral intake. Tail hair, toenail, faeces, plasma and urine were collected quarterly from 21 elephants at five UK zoos. All elephant food, soil from enclosure(s), and drinking water were also sampled. Elemental analysis was conducted on all samples, using inductively coupled plasma mass spectrometry, focusing on biologically functional minerals (Ca, Cu, Fe, K, Mg, Mn, Na, P, Se and Zn) and trace metals (As, Cd, Pb, U and V). Linear mixed modelling was used to identify how keeper-fed diet, water and soil were reflected in sample bio-indicators. No sample matrix reflected the status of all assessed elements. Toenail was the best bio-indicator of intake for the most elements reviewed in this study, with keeper-fed diet being the strongest predictor. Calcium status was reflected in faeces, (p 0.019, R² between elephant within zoo - 0.608). In this study urine was of no value in determining mineral status here and plasma was of limited value. Results aimed to define the most suitable bio-indicators to assess captive animal health and encourage onward application to wildlife management.

Positive Association of Cardiovascular Disease (CVD) with Chronic Exposure to Drinking Water Arsenic (As) at Concentrations below the WHO Provisional Guideline Value: A Systematic Review and Meta-Analysis

To the best of our knowledge, a dose-response meta-analysis of the relationship between cardiovascular disease (CVD) and arsenic (As) exposure at drinking water As concentrations lower than the WHO provisional guideline value (10 µg/L) has not been published yet. We conducted a systematic review and meta-analyses to estimate the pooled association between the relative risk of each CVD endpoint and low-level As concentration in drinking water both linearly and non-linearly using a random effects dose-response model. In this study, a significant positive association was found between the risks of most CVD outcomes and drinking water As concentration for both linear and non-linear models (p-value for trend < 0.05). Using the preferred linear model, we found significant increased risks of coronary heart disease (CHD) mortality and CVD mortality as well as combined fatal and non-fatal CHD, CVD, carotid atherosclerosis disease and hypertension in those exposed to drinking water with an As concentration of 10 µg/L compared to the referent (drinking water As concentration of 1 µg/L) population. Notwithstanding limitations included, the observed significant increased risks of CVD endpoints arising from As concentrations in drinking water between 1 µg/L and the 10 µg/L suggests further lowering of this guideline value should be considered.

Iodine status in western Kenya: a community-based cross-sectional survey of urinary and drinking water iodine concentrations

Spot urinary iodine concentrations (UIC) are presented for 248 individuals from western Kenya with paired drinking water collected between 2016 and 2018. The median UIC was 271 µg L-1, ranging from 9 to 3146 µg L-1, unadjusted for hydration status/dilution. From these data, 12% were potentially iodine deficient (< 100 µg L-1), whilst 44% were considered to have an excess iodine intake (> 300 µg L-1). The application of hydration status/urinary dilution correction methods was evaluated for UICs, using creatinine, osmolality and specific gravity. The use of specific gravity correction for spot urine samples to account for hydration status/urinary dilution presents a practical approach for studies with limited budgets, rather than relying on unadjusted UICs, 24 h sampling, use of significantly large sample size in a cross-sectional study and other reported measures to smooth out the urinary dilution effect. Urinary corrections did influence boundary assessment for deficiency-sufficiency-excess for this group of participants, ranging from 31 to 44% having excess iodine intake, albeit for a study of this size. However, comparison of the correction methods did highlight that 22% of the variation in UICs was due to urinary dilution, highlighting the need for such correction, although creatinine performed poorly, yet specific gravity as a low-cost method was comparable to osmolality corrections as the often stated 'gold standard' metric for urinary concentration. Paired drinking water samples contained a median iodine concentration of 3.2 µg L-1 (0.2-304.1 µg L-1). A weak correlation was observed between UIC and water-I concentrations (R = 0.11).

Using human hair and nails as biomarkers to assess exposure of potentially harmful elements to populations living near mine waste dumps

Potentially harmful elements (PHEs) manganese (Mn), cobalt (Co), copper (Cu), lead (Pb), nickel (Ni) and zinc (Zn) were measured in human hair/nails, staple crops and drinking water to ascertain the level of exposure to dust transference via wind and rain erosion for members of the Mugala community living near a mine waste dump in the Zambian Copperbelt. The mean PHE concentrations of hair in decreasing order were Zn (137 ± 21 mg/kg), Cu (38 ± 7 mg/kg), Mn (16 ± 2 mg/kg), Pb (4.3 ± 1.9 mg/kg), Ni (1.3 ± 0.2 mg/kg) and Cr (1.2 ± 0.2 mg/kg), Co (0.9 ± 0.2 mg/kg) and Cd (0.30 ± 0.02 mg/kg). Whilst for toenails the decreasing order of mean concentrations was Zn (172 ± 27 mg/kg), Cu (30 ± 5 mg/kg), Mn (12 ± 2 mg/kg), Pb (4.8 ± 0.5 mg/kg), Ni (1.7 ± 0.14 mg/kg) and Co (1.0 ± 0.02 mg/kg), Cr (0.6 ± 0.1 mg/kg) and Cd (0.1 ± 0.002 mg/kg). The concentration of these potentially harmful elements (PHEs) varied greatly among different age groups. The results showed that Mn, Co, Pb, Cd and Zn were above the interval values (Biolab in Nutritional and environmental medicine, Hair Mineral Analysis, London, 2012) at 0.2-2.0 mg/kg for Mn, 0.01-0.20 mg/kg for Co, < 2.00 mg/kg for Pb, < 0.10 mg/kg for Cd and 0.2-2.00 mg/kg for Zn, whilst Ni, Cu and Cr concentrations were within the normal range concentrations of < 1.40 mg/kg, 10-100 mg/kg and 0.1-1.5 mg/kg, respectively. Dietary intake of PHEs was assessed from the ingestion of vegetables grown in Mugala village, with estimated PHE intakes expressed on a daily basis calculated for Mn (255), Pb (48), Ni (149) and Cd (33) µg/kg bw/day. For these metals, DI via vegetables was above the proposed limits of the provisional tolerable daily intakes (PTDIs) (WHO in Evaluation of certain food additive and contaminants, Seventy-third report of the Joint FAO/WHO Expert Committee on Food Additives, 2011) for Mn at 70 µg/kg bw/day, Pb at 3 µg/kg bw/day, Ni and Cd 5 µg/kg bw/day and 1 µg/kg bw/day, respectively. The rest of the PHEs listed were within the PTDIs limits. Therefore, Mugala inhabitants are at imminent health risk due to lead, nickel and cadmium ingestion of vegetables and drinking water at this location.

Environmental geochemistry and cancer: a pertinent global health problem requiring interdisciplinary collaboration

Primary prevention is a key strategy to reducing the global burden of cancer, a disease responsible for ~ 9.6 million deaths per year and predicted to top 13 million by 2030. The role of environmental geochemistry in the aetiology of many cancers-as well as other non-communicable diseases-should not be understated, particularly in low- and middle-income countries where 70% of global cancer deaths occur and reliance on local geochemistry for drinking water and subsistence crops is still widespread. This article is an expansion of a series of presentations and discussions held at the 34th International Conference of the Society for Environmental Geochemistry and Health in Livingstone, Zambia, on the value of effective collaborations between environmental geochemists and cancer epidemiologists. Key technical aspects of each field are presented, in addition to a case study of the extraordinarily high incidence rates of oesophageal cancer in the East African Rift Valley, which may have a geochemical contribution. The potential merit of veterinary studies for investigating common geochemical risk factors between human and animal disease is also highlighted.

Urine selenium concentration is a useful biomarker for assessing population level selenium status

Plasma selenium (Se) concentration is an established population level biomarker of Se status, especially in Se-deficient populations. Previously observed correlations between dietary Se intake and urinary Se excretion suggest that urine Se concentration is also a potentially viable biomarker of Se status. However, there are only limited data on urine Se concentration among Se-deficient populations. Here, we test if urine is a viable biomarker for assessing Se status among a large sample of women and children in Malawi, most of whom are likely to be Se-deficient based on plasma Se status. Casual (spot) urine samples (n = 1406) were collected from a nationally representative sample of women of reproductive age (WRA, n =741) and school aged children (SAC, n=665) across Malawi as part of the 2015/16 Demographic and Health Survey. Selenium concentration in urine was determined using inductively coupled plasma mass spectrometry (ICP-MS). Urinary dilution corrections for specific gravity, osmolality, and creatinine were applied to adjust for hydration status. Plasma Se status had been measured for the same survey participants. There was between-cluster variation in urine Se concentration that corresponded with variation in plasma Se concentration, but not between households within a cluster, or between individuals within a household. Corrected urine Se concentrations explained more of the between-cluster variation in plasma Se concentration than uncorrected data. These results provide new evidence that urine may be used in the surveillance of Se status at the population level in some groups. This could be a cost-effective option if urine samples are already being collected for other assessments, such as for iodine status analysis as in the Malawi and other national Demographic and Health Surveys.

A comparative assessment of dilution correction methods for spot urinary analyte concentrations in a UK population exposed to arsenic in drinking water

Spot urinary concentrations of environmental exposure biomarkers require correction for dilution. There is no consensus on the most appropriate method, with creatinine used by default despite lacking theoretical robustness. We comparatively assessed the efficacy of creatinine; specific gravity (SG); osmolality and modifications of all three for dilution correcting urinary arsenic. For 202 participants with urinary arsenic, creatinine, osmolality and SG measurements paired to drinking water As, we compared the performance corrections against two independent criteria: primarily, (A) correlations of corrected urinary As and the dilution measurements used to correct them - weak correlations indicating good performance and (B) correlations of corrected urinary As and drinking water As - strong correlations indicating good performance. More than a third of variation in spot urinary As concentrations was attributable to dilution. Conventional SG and osmolality correction removed significant dilution variation from As concentrations, whereas conventional creatinine over-corrected, and modifications of all three removed measurable dilution variation. Modified creatinine and both methods of SG and osmolality generated stronger correlations of urinary and drinking water As concentrations than conventional creatinine, which gave weaker correlations than uncorrected values. A disparity in optima between performance criteria was observed, with much smaller improvements possible for Criterion B relative to A. Conventional corrections - particularly creatinine - limit the utility spot urine samples, whereas a modified technique outlined here may allow substantial improvement and can be readily retrospectively applied to existing datasets. More studies are needed to optimize urinary dilution correction methods. Covariates of urinary dilution measurements still warrant consideration.

Assessment of arsenic species in human hair, toenail and urine and their association with water and staple food

Arsenic intake from household drinking/cooking water and food may represent a significant exposure pathway to induce cancer and non-cancer health effects. This study is based on the human biomonitoring of 395 volunteers from 223 households with private water sources located in rural Punjab, Pakistan. This work has shown the relative contribution of water and staple food to arsenic intake and accumulation by multiple biological matrix measurements of inorganic and organic arsenic species, while accounting for potential confounders such as age, gender, occupation, and exposure duration of the study population. Multi-variable linear regression showed a strong significant relationship between total arsenic (tAs) intake from water and concentrations of tAs, inorganic arsenic (iAs), monomethylarsonic acid (MMA), dimethylarsinic acid (DMA) in urine and toenail samples. tAs intake from staple food (rice and wheat) also showed a strong significant relationship with hair tAs and iAs. The sole impact of staple food intake on biomarkers was assessed and a significant correlation was found with all of the urinary arsenic metabolites. Toenail was found to be the most valuable biomarker of past exposure to inorganic and organic arsenic species of dietary and metabolic origin.

Intra-household agreement of urinary elemental concentrations in Tanzania and Kenya: potential surrogates in case-control studies

Element deficiencies and excesses play important roles in non-communicable disease aetiology. When investigating their roles in epidemiologic studies without prospective designs, reverse-causality limits the utility of transient biomarkers in cases. This study aimed to investigate whether surrogate participants may provide viable proxies by assessing concentration correlations within households. We obtained spot urine samples from 245 Tanzanian and Kenyan adults (including 101 household pairs) to investigate intra-household correlations of urinary elements (As, Ba, Ca, Cd, Co, Cs, Cu, Fe, Li, Mn, Mo, Ni, Pb, Rb, S, Se, Sr, Tl, V and Zn) and concentrations (also available for: Bi, Ce, Sb, Sn and U) relative to external population-levels and health-based values. Moderate-strong correlations were observed for As (r = 0.65), Cs (r = 0.67), Li (r = 0.56), Mo (r = 0.57), Se (r = 0.68) and Tl (r = 0.67). Remaining correlations were <0.41. Median Se concentrations in Tanzania (29 µg/L) and Kenya (24 µg/L) were low relative to 5738 Canadians (59 µg/L). Exceedances (of reference 95th percentiles) were observed for: Co, Mn, Mo, Ni and U. Compared to health-based values, exceedances were present for As, Co, Mo and Se but deficiencies were also present for Mo and Se. For well correlated elements, household members in East African settings provide feasible surrogate cases to investigate element deficiencies/excesses in relation to non-communicable diseases.

Remarks on the current quality of groundwater in Vietnam

This paper reviews the current quality of groundwater in Vietnam. In Vietnam, groundwater is obtained primarily from tubewells, which have high concentrations of pollutants such as As, Fe, Mn, and NH₄⁺. In the areas where groundwater tests were conducted, arsenic levels ranged from 0.1-3050 μg/L, which substantially exceed the standard of 10 μg/L which has been established by the WHO. Contamination sources are distributed over a large area from the Red River Delta in the north to the Mekong River Delta in the south, putting as many as ten million people at risk of adverse health effects. Levels of arsenic and iron in sediment are strongly correlated, which indicate that the presence of arsenic in groundwater results from the reduction of arsenic bound to iron oxyhydroxides. It is important to raise awareness of these issues among the Vietnamese public by disseminating information about the negative effects of contaminated drinking water, as well as carrying out long-term research projects to identify other sources of contamination and improving water treatment technology and water management capabilities.

Arsenic exposure, profiles of urinary arsenic species, and polymorphism effects of glutathione-s-transferase and metallothioneins

This study assessed the effects of polymorphic variants of gutathione-S-transferase and metallothioneins on profiles of urinary arsenic species. Drinking groundwater from Margarita and San Fernando, Colombia were analyzed and the lifetime average daily dose (LADD) of arsenic was determined. Specific surveys were applied to collect demographic information and other exposure factors. In addition, GSTT1-null, GSTM1-null, GSTP1-rs1695 and MT-2A-rs28366003 genetic polymorphisms were evaluated, either by direct PCR or PCR-RFLP. Urinary speciated arsenic concentrations were determined by HPLC-HG-AFS for species such as As^III, As^V, monomethylarsonic acid (MMA), dimethylarsinic acid (DMA), and total urinary As (TuAs). Primary methylation index (PMI) and secondary methylation index (SMI) were also calculated as indicators of the metabolic capacity. Polymorphisms effects were tested using multivariate analysis, adjusted by potential confounders. The As concentrations in groundwater were on average 34.6 ± 24.7 μg/L greater than the WHO guideline for As (10 μg/L). There was a correlation between As concentrations in groundwater and TuAs (r = 0.59; p = 0.000). Urinary inorganic arsenic (%InAs) was associated with GSTP1, LADD, GSTP1*Age, GSTP1*alcohol consumption (r² = 0.43; likelihood-ratio test, p = 0.000). PMI was associated with sex (r² = 0.20; likelihood-ratio test, p = 0.007). GSTP1 (AG + GG) homozygotes/heterozygotes could increase urinary %InAs and decrease the PMI ratio in people exposed to low and high As from drinking groundwater. Therefore, the explanatory models showed the participation of some covariates that could influence the effects of the polymorphisms on these exposure biomarkers to As.

Effect of supernatant water level on As removal in biological rapid sand filters

Current groundwater treatment facilities, mostly relying on aeration-filtration configurations, aim at the removal of iron (Fe), ammonia (NH₄ ⁺) and manganese (Mn). However, recently water companies expressed the ambition to also reduce arsenic (As) concentrations in these rapid sand filters. The aim of this study was to investigate the effect of the Fe oxidation state entering a biological filter bed on As removal. By varying supernatant water level, either Fe(II) or Fe(III) in the form of hydrous ferric oxides (HFO) could be stimulated to enter the filter bed at alkaline groundwater pH (7.6). The experimental pilot column filters showed that once the As(III) oxidation stabilised in the top layer of the filter sand, As removal reached its maximum (±75% at 120 cm supernatant level and 1.5 m/h filtration velocity). The increase in supernatant level from 5 to 120 cm resulted in additional HFO production prior to rapid filtration (1.5, 5 and 10 m/h), i.e. homogeneous Fe(II) oxidation and flocculation, and subsequently, HFO ending up deeper into the filter bed (120 cm filter depth). At a low supernatant water level of 5 cm, Fe(II) oxidised heterogeneously and was removed within the top 20 cm of the filter bed. Consequently, filters with high supernatant levels removed As to lower levels (by 20%) than in filters with low supernatant water levels. The benefits of Fe(II) oxidation prior to filtration for As removal was confirmed by comparing Fe(III) to Fe(II) additions in the supernatant water or in the filter bed. Overall it is concluded that in biological groundwater filters, the combination of a higher supernatant level and/or Fe(III) addition with biological As(III) oxidation in the top of the filter bed promotes As removal.

Surface wipe and bulk sampling of household dust: arsenic exposure in Cornwall, UK

Dust elemental levels can be expressed as concentrations (bulk samples) or surface loadings (wipe samples). Wipe sampling has not been widely adopted for elements other than lead (Pb). In this study, 433 wipe samples from 130 households in south west England - a region of widespread, natural and anthropogenic arsenic contamination linked with previous mining activities-were analysed to (i) quantify loadings of arsenic (As); (ii) assess the quality of wipe data using QA/QC criteria; (iii) estimate, using published ingestion rates, human exposure to As in dust using loadings and concentrations from 97 bulk samples and (iv) comparatively assess the performance of wipe and bulk sampling using associations with As biomonitoring data (urine, toenails and hair). Good QC performance was observed for wipes: strong agreement between field duplicates, non-detectable contamination of field blank wipes and good reference material recoveries. Arsenic loadings exceeded an existing urban background benchmark in 67 (52%) households. No exceedances of tolerable daily As intake were observed for adult exposure estimates but infant estimates exceeded for 1 household. Infant estimates calculated using bulk concentrations resulted in 4 (3%) exceedances. Neither wipe nor bulk As metrics were sufficiently better predictors of As in biospecimens. Sampling strategies, analytical protocols, exposure metrics and assessment criteria require refinement to validate dust sampling methodologies.

Using urine as a biomarker in human exposure risk associated with arsenic and other heavy metals contaminating drinking groundwater in intensively agricultural areas of Thailand

Urine used as a biomarker was collected and compared between two groups of participants: (1) a groundwater-drinking group and (2) a non-groundwater-drinking group in intensively agricultural areas in Ubon Ratchathani province, Thailand. The statistical relationship with the metal concentration in shallow groundwater wells was established with urine data. According to the groundwater data, the health risk assessment results for four metals appeared to be higher for participants who drank groundwater than for the other group. The carcinogenic risk and non-carcinogenic risk of arsenic (As) were found in 25.86 and 31.03% of participants, respectively. For lead (Pb), 13.79% of the participants had a non-carcinogenic risk. Moreover, 30 of the 58 participants in the groundwater-drinking group had As urine higher than the standard, and 26, 2 and 9 of the 58 participants had above-standard levels for cadmium (Cd), Pb and mercury (Hg) in urine, respectively. Both the risk assessment and biomarker level of groundwater-drinking participants were higher than in the other group. The results showed an average drinking rate of approximately 4.21 ± 2.73 L/day, which is twice as high as the standard. Interestingly, the As levels in the groundwater correlated with those in the urine of the groundwater-drinking participants, but not in the non-groundwater-drinking participants, as well as with the As-related cancer and non-carcinogenic risks. The hazard index (HI) of the 100 participants ranged from 0.00 to 25.86, with an average of 1.51 ± 3.63 higher than the acceptable level, revealing that 28 people appeared to have non-carcinogenic risk levels (24 and 4 people for groundwater-drinking participants and non-groundwater-drinking participants, respectively). Finally, the associated factors of heavy metals in urine were the drinking water source, body weight, smoking, sex and use of personal protective equipment.

Hazard Ranking Method for Populations Exposed to Arsenic in Private Water Supplies: Relation to Bedrock Geology

Approximately one million people in the UK are served by private water supplies (PWS) where main municipal water supply system connection is not practical or where PWS is the preferred option. Chronic exposure to contaminants in PWS may have adverse effects on health. South West England is an area with elevated arsenic concentrations in groundwater and over 9000 domestic dwellings here are supplied by PWS. There remains uncertainty as to the extent of the population exposed to arsenic (As), and the factors predicting such exposure. We describe a hazard assessment model based on simplified geology with the potential to predict exposure to As in PWS. Households with a recorded PWS in Cornwall were recruited to take part in a water sampling programme from 2011 to 2013. Bedrock geologies were aggregated and classified into nine Simplified Bedrock Geological Categories (SBGC), plus a cross-cutting “mineralized” area. PWS were sampled by random selection within SBGCs and some 508 households volunteered for the study. Transformations of the data were explored to estimate the distribution of As concentrations for PWS by SBGC. Using the distribution per SBGC, we predict the proportion of dwellings that would be affected by high concentrations and rank the geologies according to hazard. Within most SBGCs, As concentrations were found to have log-normal distributions. Across these areas, the proportion of dwellings predicted to have drinking water over the prescribed concentration value (PCV) for As ranged from 0% to 20%. From these results, a pilot predictive model was developed calculating the proportion of PWS above the PCV for As and hazard ranking supports local decision making and prioritization. With further development and testing, this can help local authorities predict the number of dwellings that might fail the PCV for As, based on bedrock geology. The model presented here for Cornwall could be applied in areas with similar geologies. Application of the method requires independent validation and further groundwater-derived PWS sampling on other geological formations.

Arsenic in groundwater of the Kolkata Municipal Corporation (KMC), India: Critical review and modes of mitigation

This study represents the first comprehensive report of groundwater arsenic contamination status in the Kolkata Municipal Corporation (KMC). During the past 23 years, 4210 groundwater samples were analysed from all 141 wards in the KMC: 14.2% and 5.2% samples had arsenic >10 μg/l and >50 μg/l, respectively, representing 77 and 37 wards. The study shows that the number of arsenic contaminated samples (and wards) in the southern part of the KMC exceeds that of other parts of the city. The daily intake of arsenic from drinking water was estimated as 0.95 μg per kg bw and the cancer risk was estimated as 1425/10⁶. Analyses of biological samples (hair, nail and urine) showed elevated concentrations of arsenic indicating the presence of subclinical arsenic poisoning, predicting an enhanced lifetime cancer risk for the population in southern part of the KMC. In the KMC, groundwater is not a sustainable source of freshwater due to arsenic, high iron, hardness and total dissolved solids. Its continued use is impelled by the lack of an adequate infrastructure to treat and supply surface water and in some wards the unaccounted for water (UFW) is even >45% incurred during distribution. The rare imposition of a water tax makes the water supply systems unsustainable and fosters indifference to water conservation. To mitigate the arsenic problem, continuous groundwater monitoring for pollutants, a treated surface water supply with strict policy implications, rainwater harvesting in the urban areas and introduction of water taxes seem to be long-term visible solutions.

Arsenic in residential soil and household dust in Cornwall, south west England: potential human exposure and the influence of historical mining

Exposure to arsenic (As) via residential soil and dust is a global concern, in regions affected by mining or with elevated concentrations present in underlying geology. Cornwall in south west England is one such area. Residential soil (n = 127) and household dust (n = 99) samples were collected from across Cornwall as part of a wider study assessing exposure to environmental As. Samples were analysed for total As (soil and dust samples) and human ingestion bioaccessible As (soil samples from properties with home-grown produce). Arsenic concentrations ranged from 12 to 992 mg kg^-1 in soil and 3 to 1079 mg kg^-1 in dust and were significantly higher in areas affected by metalliferous mineralisation. Sixty-nine percent of soils exceeded the 37 mg kg^-1 Category 4 Screening Level (C4SL), a generic assessment criteria for As in residential soils in England, which assumes 100% bioavailability following ingestion. The proportion of exceedance was reduced to 13% when the bioavailability parameter in the CLEA model was changed to generate household specific bioaccessibility adjusted assessment criteria (ACBIO). These criteria were derived using bioaccessibility data for a sub-set of individual household vegetable patch soils (n = 68). Proximity to former As mining locations was found to be a significant predictor of soil As concentration. This study highlights the value of bioaccessibility measurements and their potential for adjusting generic assessment criteria.

Variability in the chemistry of private drinking water supplies and the impact of domestic treatment systems on water quality

Tap water from 497 properties using private water supplies, in an area of metalliferous and arsenic mineralisation (Cornwall, UK), was measured to assess the extent of compliance with chemical drinking water quality standards, and how this is influenced by householder water treatment decisions. The proportion of analyses exceeding water quality standards were high, with 65 % of tap water samples exceeding one or more chemical standards. The highest exceedances for health-based standards were nitrate (11 %) and arsenic (5 %). Arsenic had a maximum observed concentration of 440 µg/L. Exceedances were also high for pH (47 %), manganese (12 %) and aluminium (7 %), for which standards are set primarily on aesthetic grounds. However, the highest observed concentrations of manganese and aluminium also exceeded relevant health-based guidelines. Significant reductions in concentrations of aluminium, cadmium, copper, lead and/or nickel were found in tap waters where households were successfully treating low-pH groundwaters, and similar adventitious results were found for arsenic and nickel where treatment was installed for iron and/or manganese removal, and successful treatment specifically to decrease tap water arsenic concentrations was observed at two properties where it was installed. However, 31 % of samples where pH treatment was reported had pH < 6.5 (the minimum value in the drinking water regulations), suggesting widespread problems with system maintenance. Other examples of ineffectual treatment are seen in failed responses post-treatment, including for nitrate. This demonstrates that even where the tap waters are considered to be treated, they may still fail one or more drinking water quality standards. We find that the degree of drinking water standard exceedances warrant further work to understand environmental controls and the location of high concentrations. We also found that residents were more willing to accept drinking water with high metal (iron and manganese) concentrations than international guidelines assume. These findings point to the need for regulators to reinforce the guidance on drinking water quality standards to private water supply users, and the benefits to long-term health of complying with these, even in areas where treated mains water is widely available.

Assessing urinary flow rate, creatinine, osmolality and other hydration adjustment methods for urinary biomonitoring using NHANES arsenic, iodine, lead and cadmium data

BACKGROUND

There are numerous methods for adjusting measured concentrations of urinary biomarkers for hydration variation. Few studies use objective criteria to quantify the relative performance of these methods. Our aim was to compare the performance of existing methods for adjusting urinary biomarkers for hydration variation.

METHODS

Creatinine, osmolality, excretion rate (ER), bodyweight adjusted ER (ERBW) and empirical analyte-specific urinary flow rate (UFR) adjustment methods on spot urinary concentrations of lead (Pb), cadmium (Cd), non-arsenobetaine arsenic (As(IMM)) and iodine (I) from the US National Health and Nutrition Examination Survey (NHANES) (2009-2010 and 2011-2012) were evaluated. The data were divided into a training dataset (n = 1,723) from which empirical adjustment coefficients were derived and a testing dataset (n = 428) on which quantification of the performance of the adjustment methods was done by calculating, primarily, the correlation of the adjusted parameter with UFR, with lower correlations indicating better performance and, secondarily, the correlation of the adjusted parameters with blood analyte concentrations (Pb and Cd), with higher correlations indicating better performance.

RESULTS

Overall performance across analytes was better for Osmolality and UFR based methods. Excretion rate and ERBW consistently performed worse, often no better than unadjusted concentrations.

CONCLUSIONS

Osmolality adjustment of urinary biomonitoring data provides for more robust adjustment than either creatinine based or ER or ERBW methods, the latter two of which tend to overcompensate for UFR. Modified UFR methods perform significantly better than all but osmolality in removing hydration variation, but depend on the accuracy of UFR calculations. Hydration adjustment performance is analyte-specific and further research is needed to establish a robust and consistent framework.