Exposure to multiple environmental agents and their effect

Machine learning-based health environmental-clinical risk scores in European children

BACKGROUND

Early life environmental stressors play an important role in the development of multiple chronic disorders. Previous studies that used environmental risk scores (ERS) to assess the cumulative impact of environmental exposures on health are limited by the diversity of exposures included, especially for early life determinants. We used machine learning methods to build early life exposome risk scores for three health outcomes using environmental, molecular, and clinical data.

METHODS

In this study, we analyzed data from 1622 mother-child pairs from the HELIX European birth cohorts, using over 300 environmental, 100 child peripheral, and 18 mother-child clinical markers to compute environmental-clinical risk scores (ECRS) for child behavioral difficulties, metabolic syndrome, and lung function. ECRS were computed using LASSO, Random Forest and XGBoost. XGBoost ECRS were selected to extract local feature contributions using Shapley values and derive feature importance and interactions.

RESULTS

ECRS captured 13%, 50% and 4% of the variance in mental, cardiometabolic, and respiratory health, respectively. We observed no significant differences in predictive performances between the above-mentioned methods.The most important predictive features were maternal stress, noise, and lifestyle exposures for mental health; proteome (mainly IL1B) and metabolome features for cardiometabolic health; child BMI and urine metabolites for respiratory health.

CONCLUSIONS

Besides their usefulness for epidemiological research, our risk scores show great potential to capture holistic individual level non-hereditary risk associations that can inform practitioners about actionable factors of high-risk children. As in the post-genetic era personalized prevention medicine will focus more and more on modifiable factors, we believe that such integrative approaches will be instrumental in shaping future healthcare paradigms.

Association of Combined PFOA, PFOS, Metals and Allostatic Load on Hepatic Disease Risk

This study utilizes the National Health and Nutrition Examination Survey (NHANES) 2017-2018 data to explore the relationship between exposure to perfluoroalkyl substances (specifically perfluorooctanoic acid (PFOA) and perfluorooctanesulfonic acid (PFOS), metals lead (Pb), mercury (Hg), and cadmium (Cd), allostatic load, and hepatic disease markers, including the fatty liver index a measure of the likelihood of non-alcoholic fatty liver disease, aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), and total bilirubin. The paper identified significant associations and interaction effects by employing descriptive statistics, Spearman's correlation analysis, linear regression, and Bayesian kernel machine regression (BKMR). Descriptive statistics highlight sex-specific differences in contaminant levels. Spearman's analysis underscores strong correlations among metals and per- and polyfluoroalkyl substances (PFAS). Linear regression reveals significant impacts of specific contaminants on AST, ALT, ALP, and bilirubin levels, adjusting for age and alcohol consumption. BKMR results further elucidate the complex, potentially synergistic relationships between these environmental exposures and the likelihood of non-alcoholic fatty liver disease, offering nuanced insights into their combined effects on liver health. The findings emphasize the intricate dynamics of environmental exposures on hepatic function, advocating for targeted public health interventions.

An Exploratory Analysis of Firefighter Reproduction through Survey Data and Biomonitoring

Firefighters are occupationally exposed to chemicals that may affect fertility. To investigate this effect, firefighters were recruited to contribute blood, urine, breast milk or semen samples to (1) evaluate chemical concentrations and semen parameters against fertility standards and the general population; (2) assess correlations between chemical concentrations and demographics, fire exposure and reproductive history; and (3) consider how occupational exposures may affect reproduction. A total of 774 firefighters completed the online survey, and 97 firefighters produced 125 urine samples, 113 plasma samples, 46 breast milk samples and 23 semen samples. Blood, urine and breast milk samples were analysed for chemical concentrations (semivolatile organic compounds, volatile organic compounds, metals). Semen samples were analysed for quality (volume, count, motility, morphology). Firefighter semen parameters were below WHO reference values across multiple parameters. Self-reported rates of miscarriage were higher than the general population (22% vs. 12-15%) and in line with prior firefighter studies. Estimated daily intake for infants was above reference values for multiple chemicals in breast milk. More frequent fire incident exposure (more than once per fortnight), longer duration of employment (≥15 years) or not always using a breathing apparatus demonstrated significantly higher concentrations across a range of investigated chemicals. Findings of this study warrant further research surrounding the risk occupational exposure has on reproduction.

Prenatal exposure to persistent organic pollutants and changes in infant growth and childhood growth trajectories

BACKGROUND

Children are born with a burden of persistent organic pollutants (POPs) which may have endocrine disrupting properties and have been postulated to contribute to the rise in childhood obesity. The current evidence is equivocal, which may partly because many studies investigate the effects at one time point during childhood. We assessed associations between prenatal exposure to POPs and growth during infancy and childhood.

METHODS

We used data from two Belgian cohorts with cord blood measurements of five organochlorines [(dichlorodiphenyldichloroethylene (p,p'-DDE), hexachlorobenzene (HCB), polychlorinated biphenyls (PCB-138, -150, -180)] (N = 1418) and two perfluoroalkyl substances [perfluorooctanoic acid (PFOA) and perfluorooctanesulfonic acid (PFOS)] (N = 346). We assessed infant growth, defined as body mass index (BMI) z-score change between birth and 2 years, and childhood growth, characterized as BMI trajectory from birth to 8 years. To evaluate associations between POP exposures and infant growth, we applied a multi-pollutant approach, using penalized elastic net regression with stability selection, controlling for covariates. To evaluate associations with childhood growth, we used single-pollutant linear mixed models with random effects for child individual, parametrized using a natural cubic spline formulation.

RESULTS

PCB-153 was associated with increased and p,p'-DDE with decreased infant growth, although these results were imprecise. No clear association between any of the exposures and longer-term childhood growth trajectories was observed. We did not find evidence of effect modification by child sex.

CONCLUSION

Our results suggest that prenatal exposure to PCB-153 and p,p'-DDE may affect infant growth in the first two years, with no evidence of more persistent effects.

Gene-alcohol interactions in birth defects

Most human birth defects are thought to result from complex interactions between combinations of genetic and environmental factors. This is true even for conditions that, at face value, may appear simple and straightforward, like fetal alcohol spectrum disorders (FASD). FASD describe the full range of structural and neurological disruptions that result from prenatal alcohol exposure. While FASD require alcohol exposure, evidence from human and animal model studies demonstrate that additional genetic and/or environmental factors can influence the embryo's susceptibility to alcohol. Only a limited number of alcohol interactions in birth defects have been identified, with many sensitizing genetic and environmental factors likely yet to be identified. Because of this, while unsatisfying, there is no definitively "safe" dose of alcohol for all pregnancies. Determining these other factors, as well as mechanistically characterizing known interactions, is critical for better understanding and preventing FASD and requires combined scrutiny of human and model organism studies.

Children Environmentally Exposed to Agrochemicals in Rural Areas Present Changes in Oxidative Status and DNA Damage

Rural children are exposed to several chemicals. This study evaluated the environmental co-exposure of rural children to cholinesterase inhibitor insecticides and metals/metalloids, and the resulting oxidative stress and DNA damage. Seventy-two children (5 to 16 years old) were studied at two different moments: period 1, when agrochemicals were less used, and period 2, when agrochemicals were extensively used in agriculture. Biomonitoring was performed by evaluating butyrylcholinesterase (BuChE) activity in serum; arsenic (As), chromium (Cr), lead (Pb), and nickel (Ni) levels in blood; malondialdehyde (MDA) in plasma; glutathione peroxidase (GSH-Px) and glutathione S-transferase (GST) activities in whole blood; non-protein thiol levels in erythrocytes; and micronuclei (MN) assay in exfoliated buccal cells. Cr and As levels were higher than the reference values in both periods, and Ni levels were higher than the reference values in period 2 alone. BuChE activity was inhibited in period 2 compared with period 1. In period 2, there was an increase in endogenous antioxidants and a decrease in MDA, probably demonstrating a compensatory mechanism as a response to increasing xenobiotics. Also in period 2, the MN frequency increased and BuChE and As were positively associated, suggesting co-exposure. On the other hand, in period 1, it was observed that Cr, Ni, and Pb blood levels were negatively associated with GSH-Px and GST, while MDA was positively associated with As levels. Our findings demonstrated an imbalance in endogenous antioxidants, contributing to genotoxicity and lipoperoxidation, probably in response to exposure to xenobiotics, especially carcinogenic elements (Cr, As, and Ni).

Work and Breast Cancer: Recommendations to Address Research Needs

A review of case-control, cohort, and meta-analytic studies on breast cancer, occupation, and work-related exposures from 2002 to 2017 revealed significant methodological limitations in the current literature. As part of our review, we tabulated the demographic and life history data, breast cancer risk factors, occupational history, and exposure estimates collected and analyzed in each study. Opportunities exist for future research to explore occupation and breast cancer more rigorously and with greater nuance by gathering specific data on age at diagnosis, menopausal status, tumor characteristics, demographics, breast cancer risk factors, and occupational histories, work roles and settings, and exposures. Inclusion of workers in the planning and implementation of research on their occupational risks and exposures is one effective way to refine research questions and ensure research is relevant to workers' needs and concerns.

Development of an asthma risk factors scale (ARFS) for risk assessment asthma screening in children

BACKGROUND

The study objective was to create asthma risk factors scale (ARFS) score that would be correlated with the increased risk of asthma in Lebanese children. This scale would eventually be used both to identify children at risk and assess early diagnosis of asthma.

METHODS

A case-control study (study 1) of 1276 children (976 controls and 300 cases) and a cross-sectional study (study 2) of 1000 children were conducted using a parental questionnaire. Children aged between 3 and 16 years were screened for possible enrollment. The ARFS was created by combining the following risk factors: child's exposure to pesticides, detergent mixing, alcohol, smoking and drug intake during pregnancy and breastfeeding, the actual paternal and maternal smoking status and history of asthma, and the types of food the child consumes.

RESULTS

There was a significant increase in the risk assessment screening for asthma per 15 points increments of ARFS (p < 0.001 for trend). The score category 0-14.99 best-represented control individuals (88.8% controls), while a score higher than 45 represented asthmatic children best (98.4% asthmatics). The positive predictive value (disease positive/all positive by scale) came out as 94.02%, whereas the negative predictive value (disease negative/all negative by scale) was found to be 90.47%. These results were confirmed in the second study sample.

CONCLUSION

The ARFS is a simple and easy-to-use tool, composed of 15 questions, for the clinician risk assessment of asthma in children, taking into account the environmental exposure, parental history of asthma and dietary habits of the child. Its value for asthma diagnosis remains to be confirmed in future prospective studies, especially in children with chronic respiratory symptoms.

Toxicity of diatom-derived polyunsaturated aldehyde mixtures on sea urchin Paracentrotus lividus development

Diatom-derived polyunsaturated aldehydes (PUAs), decadienal, heptadienal and octadienal, derive from the oxidation of fatty acids and have cytotoxic and anticancer effects. PUAs, tested separately, induce malformations in sea urchin Paracentrotus lividus embryos. Decadienal induces the worst malformations and lowest survival rates. Interestingly, decadienal, heptadienal and octadienal place in motion several genes to counteract their negative effects. To date, no studies are available reporting on the effects of PUA mixtures on marine invertebrates. Here we test binary and ternary mixtures on embryonic development of P. lividus. Our findings demonstrate that mixtures of PUAs act (i) at morphological level in synergistic way, being much more severe compared to individual PUAs; (ii) at molecular level also reveal an additive effect, affecting almost all fifty genes, previously tested using individual PUAs. This study is relevant from an ecological point of view since diatoms are a major food source for both pelagic and benthic organisms. This work opens new perspectives for understanding the molecular mechanisms that marine organisms use in reacting to environmental natural toxin mixtures such as diatom PUAs.

State of the art of the environmental behaviour and removal techniques of the endocrine disruptor 3,4-dichloroaniline

In recent years, the presence of Endocrine Disrupting Chemicals (EDCs) in wastewater discharges from agricultural and industrial sources, ^[1] fresh- and estuarine-waters, as well as soils, has been reported in the literature. ^[2] Studies of adverse changes in wildlife, linked to environmental exposure to these substances, and the suggestion that humans could also be at similar risk of adverse health effects, ^[3-5] have raised concern for urgent action to understand and reduce such risks. 3,4-Dichloroaniline (3,4-DCA) has been recognized as an EDC, with regards to endocrine disruption data for both wildlife populations and human health. ^[5] 3,4-DCA is present in the environment as a product of the biodegradation of phenylurea and phenylcarbamate pesticides ^[6,7] ; furthermore, it can be introduced from industrial and municipal wastewater that is insufficiently purified, or via accidental spills. ^[8-10] Increasing concentrations of 3,4-DCA in soil and water are the result of its high persistence and accumulation, as well as its low biodegradability. ^[11,12] Hence, remediation techniques require in-depth study, especially when considering the low removal achieved by traditional activated sludge treatments, and the generation of carcinogenic trihalomethanes as a consequence of the chlorine oxidation methods frequently used in drinking water plants. ^[13] Fe⁰/H₂O₂ systems, photodegradation using doped TiO₂, and the use of dielectric barrier discharge reactors, seem to be the most promising techniques for the removal of 3,4-DCA from water.

State of the evidence 2017: an update on the connection between breast cancer and the environment

BACKGROUND

In this review, we examine the continually expanding and increasingly compelling data linking radiation and various chemicals in our environment to the current high incidence of breast cancer. Singly and in combination, these toxicants may have contributed significantly to the increasing rates of breast cancer observed over the past several decades. Exposures early in development from gestation through adolescence and early adulthood are particularly of concern as they re-shape the program of genetic, epigenetic and physiological processes in the developing mammary system, leading to an increased risk for developing breast cancer. In the 8 years since we last published a comprehensive review of the relevant literature, hundreds of new papers have appeared supporting this link, and in this update, the evidence on this topic is more extensive and of better quality than that previously available.

CONCLUSION

Increasing evidence from epidemiological studies, as well as a better understanding of mechanisms linking toxicants with development of breast cancer, all reinforce the conclusion that exposures to these substances - many of which are found in common, everyday products and byproducts - may lead to increased risk of developing breast cancer. Moving forward, attention to methodological limitations, especially in relevant epidemiological and animal models, will need to be addressed to allow clearer and more direct connections to be evaluated.

Type I diabetes in paediatric age in Apulia (Italy): Incidence and associations with outdoor air pollutants

AIM

This study aimed to explore Type 1 diabetes (T1D) incidence and possible relations with specific air pollutants in a large population of children, during a wide time period.

METHODS

T1D rates and trends were examined (2001-2013, GAM and Joinpoint Regression analysis) by data on the first hospitalization in all children (0-14 years) living in Apulia (Southern Italy, average yearly population aged 0-14 years in the examined period: 631,275 subjects), and linked with levels of PM10, NOx, CO and ozone.

RESULTS

A total of 1501 children were first discharged in the selected area with a diagnosis of T1D. Incidence decreased from 48.5 (95% CI 43.3; 54.0, 2001) to 16.9 per 100,000 (95% CI 13.7; 20.6, 2013), with differences according to age at onset (constant at 0-4 years, continuously decreasing at 5-9 years, decreasing until 2003 at 10-14 years), and with a positive relation with PM10--but not ozone, NOx and CO average air levels. The OR was 1.037 (1.002; 1.074) in the high tertile of PM10 concentrations, and mean incidence was higher with PM10 levels in the highest, than in the medium/reference tertile. Mean age at T1D onset was linked with yearly PM10 and ozone air levels.

CONCLUSIONS

On a wide period, a stable or decreased incidence of T1D was evident in children with early- or later onset of disease, respectively. PM10 exposure significantly affects the incidence of T1D, which might be considered, at least in part, a preventable condition.

Increased deaths from gastric cancer in communities living close to waste landfills

BACKGROUND

Municipal waste landfills (MWLs) have been linked with some malignancies, but data about gastric cancer (GC) are still uncertain.

METHODS

Number of deaths from GC, death rates, and odds ratios (ORs) were calculated considering all residents in the 258 towns in the Apulia Region (4,099,547 subjects, years 2006-2009), living within 3 km from each of the 16 regional MWLs (n = 716,404) or in control areas (n = 3,383,143).

RESULTS

Males living close to MWLs showed a higher death rate for GC, a twofold higher mean number of GC deaths and higher adjusted ORs of GC, compared with controls areas.

CONCLUSIONS

In a large population and over a wide time period, an increased risk of death from GC has been shown in males living in communities close to MWLs. Primary prevention policies acting through more sustainable waste management might probably partially reduce deaths from GC in areas with MWLs.

Effects of PCBs and PBDEs on thyroid hormone, lymphocyte proliferation, hematology and kidney injury markers in residents of an e-waste dismantling area in Zhejiang, China

Polychlorinated biphenyls (PCBs) and polybrominated diphenyl ethers (PBDEs) are two typical categories of contaminants released from e-waste dismantling environments. In China, the body burdens of PCBs and PBDEs are associated with abnormal thyroid hormones in populations from e-waste dismantling sites, but the results are limited and contradictory. In this study, we measured the serum levels of PCBs and PBDEs and the thyroid hormone free triiodothyronine (FT3), free thyroxine (FT4) and thyroid-stimulating hormone (TSH) in 40 residents in an e-waste dismantling area and in 15 residents in a control area. Additionally, we also measured some lymphocyte proliferation indexes, hematologic parameters and kidney injury markers, including white blood cells, neutrophils, monocytes, lymphocytes, hemoglobin, platelets, serum creatinine and beta 2-microglobulin (β2-MG). The results indicated that the mean level of ΣPCBs in the exposure group was significantly higher than that in the control group (964.39 and 67.98 ng g(-1), p<0.0001), but the mean level of ΣPBDEs in the exposure group was not significantly higher than that in the controls (139.32 vs. 75.74 ng g(-1), p>0.05). We determined that serum levels of FT3, FT4, monocytes and lymphocytes were significantly lower, whereas the levels of neutrophils, hemoglobin, platelets and serum creatinine were significantly higher in the exposed group (p<0.05). The mean level of ΣPCBs was negatively correlated with levels of FT3, FT4, monocytes and lymphocytes (p<0.05) and positively correlated with levels of neutrophils, hemoglobin, serum creatinine and β2-MG (p<0.05). Additionally, the mean level of ΣPBDEs was positively correlated with levels of white blood cells, hemoglobin and platelets (p<0.05). Our data suggest that exposure to an e-waste dismantling environment may increase the body burdens of PCBs and the specific PBDEs congeners in native residents and that the contaminants released from e-waste may contribute to abnormal changes in body levels of thyroid hormone, hematology and kidney injury markers.

Relationships between mild PM10 and ozone urban air levels and spontaneous abortion: clues for primary prevention

The effects of environmental pollution on spontaneous abortion (SAB) are still unclear. Records of SAB were collected from five cities (514,996 residents) and correlated with PM10, NO(2) and ozone levels. Median pollutant concentrations were below legal limits. Monthly SABs positively correlated with PM10 and ozone levels but not with NO(2) levels. The mean monthly SAB rate increase was estimated equal to 19.7 and 33.6 % per 10 μg/m(3) increase in PM10 or ozone concentration, respectively. Higher values of PM10 and SABs were evident in cities with- than in those without pollutant industries, with a number of SABs twofolds higher in the former group. In conclusion, SAB occurrence is affected by PM10 (particularly if industrial areas are present) and ozone concentrations, also at levels below the legal limits. Thus, SAB might be considered, at least in part, a preventable condition.

A hypothesis to explain childhood cancers near nuclear power plants

Over 60 epidemiological studies world-wide have examined cancer incidences in children near nuclear power plants (NPPs): most of them indicate leukemia increases. These include the 2008 KiKK study commissioned by the German Government which found relative risks (RR) of 1.6 in total cancers and 2.2 in leukemias among infants living within 5 km of all German NPPs. The KiKK study has retriggered the debate as to the cause(s) of these increased cancers. A suggested hypothesis is that the increased cancers arise from radiation exposures to pregnant women near NPPs. However any theory has to account for the >10,000 fold discrepancy between official dose estimates from NPP emissions and observed increased risks. An explanation may be that doses from spikes in NPP radionuclide emissions are significantly larger than those estimated by official models which are diluted through the use of annual averages. In addition, risks to embryos/fetuses are greater than those to adults and haematopoietic tissues appear more radiosensitive in embryos/fetuses than in newborn babies. The product of possible increased doses and possible increased risks per dose may provide an explanation.

Exposure to mixtures of organohalogen contaminants and associative interactions with thyroid hormones in East Greenland polar bears (Ursus maritimus)

We investigated the multivariate relationships between adipose tissue residue levels of 48 individual organohalogen contaminants (OHCs) and circulating thyroid hormone (TH) levels in polar bears (Ursus maritimus) from East Greenland (1999-2001, n=62), using projection to latent structure (PLS) regression for four groupings of polar bears; subadults (SubA), adult females with cubs (AdF_N), adult females without cubs (AdF_S) and adult males (AdM). In the resulting significant PLS models for SubA, AdF_N and AdF_S, some OHCs were especially important in explaining variations in circulating TH levels: polybrominated diphenylether (PBDE)-99, PBDE-100, PBDE-153, polychlorinated biphenyl (PCB)-52, PCB-118, cis-nonachlor, trans-nonachlor, trichlorobenzene (TCB) and pentachlorobenzene (QCB), and both negative and positive relationships with THs were found. In addition, the models revealed that DDTs had a positive influence on total 3,5,3'-triiodothyronine (TT3) in AdF_S, and that a group of 17 higher chlorinated ortho-PCBs had a positive influence on total 3,5,3',5'-tetraiodothyronine (thyroxine, TT4) in AdF_N. TH levels in AdM seemed less influenced by OHCs because of non-significant PLS models. TH levels were also influenced by biological factors such as age, sex, body size, lipid content of adipose tissue and sampling date. When controlling for biological variables, the major relationships from the PLS models for SubA, AdF_N and AdF_S were found significant in partial correlations. The most important OHCs that influenced TH levels in the significant PLS models may potentially act through similar mechanisms on the hypothalamic-pituitary-thyroid (HPT) axis, suggesting that both combined effects by dose and response addition and perhaps synergistic potentiation may be a possibility in these polar bears. Statistical associations are not evidence per se of biological cause-effect relationships. Still, the results of the present study indicate that OHCs may affect circulating TH levels in East Greenland polar bears, adding to the "weight of evidence" suggesting that OHCs might interfere with thyroid homeostasis in polar bears.

Prenatal, early life, and childhood exposure to genotoxicants in the living environment

Health disorders and diseases related to environmental exposure in children such as cancer and immunologic disturbances (asthma, allergies) are on the rise. However, complex transplacental and prepubertal genotoxicology is given very limited consideration, even though intrauterine development and early childhood may be critical for elucidating the cancer aetiology. The foetus is transplacentally exposed to contaminants in food and environment such as various chemicals, drugs, radiochemically contaminated water and air. Target organs of xenobiotic action may differ between the mother and the foetus due to specific stage of developmental physiology and enzyme distribution. This in turn may lead to different levels of clastogenic and aneugenic metabolites of the same xenobiotic in the mother and the foetus. Adult's protective behaviour is not sufficient to isolate children from radioisotopes, pesticides, toxic metals and metalloids, environmental tobacco smoke, endocrine disrupting chemicals, and various food contaminants, which are just a part of the stressors present in a polluted environment. In order to improve legislation related to foetus and child exposure to genotoxic and possibly carcinogenic agents, oncologists, paediatricians, environmental health specialists, and genotoxicologists should work together much more closely to make a more effective use of accumulated scientific data, with the final aim to lower cancer incidence and mortality.

Childhood cancers near German nuclear power stations: hypothesis to explain the cancer increases

In early 2008, the very large Kinderkrebs in der Umgebung von Kernkraftwerken [Childhood Cancer near Nuclear Power Plants] (KiKK) study in Germany reported increases in leukaemias and solid cancers among children living near all German nuclear power plants (NPPs). This study, previously described in Medicine, Conflict and Survival, has triggered debates in many countries as to the cause or causes of these increased cancers. An accompanying article reports on the recent developments on the KiKK study including the responses by German radiation agencies, and the results of recent epidemiological studies near United Kingdom and French nuclear installations. This article outlines a possible explanation for the increased cancers. In essence, doses from environmental NPP emissions to embryos/foetuses in pregnant women near NPPs may be larger than suspected, and haematopoietic tissues may be considerably more radiosensitive in embryos/foetuses than in newborn babies. The article concludes with recommendations for further research.

Protocol of the baseline assessment for the Environments for Healthy Living (EHL) Wales cohort study

BACKGROUND

Health is a result of influences operating at multiple levels. For example, inadequate housing, poor educational attainment, and reduced access to health care are clustered together, and are all associated with reduced health. Policies which try to change individual people's behaviour have limited effect when people have little control over their environment. However, structural environmental change and an understanding of the way that influences interact with each other, has the potential to facilitate healthy choices irrespective of personal resources. The aim of Environments for Healthy Living (EHL) is to investigate the impact of gestational and postnatal environments on health, and to examine where structural change can be brought about to optimise health outcomes. The baseline assessment will focus on birth outcomes and maternal and infant health.

METHODS/DESIGN

EHL is a longitudinal birth cohort study. We aim to recruit 1000 pregnant women in the period April 2010 to March 2013. We will examine the impact of the gestational environment (maternal health) and the postnatal environment (housing and neighbourhood conditions) on subsequent health outcomes for the infants born to these women. Data collection will commence during the participants' pregnancy, from approximately 20 weeks gestation. Participants will complete a questionnaire, undergo anthropometric measurements, wear an accelerometer, compile a food diary, and have environmental measures taken within their home. They will also be asked to consent to having a sample of umbilical cord blood taken following delivery of their baby. These data will be complemented by routinely collected electronic data such as health records from GP surgeries, hospital admissions, and child health and development records. Thereafter, participants will be visited annually for follow-up of subsequent exposures and child health outcomes.

DISCUSSION

The baseline assessment of EHL will provide information concerning the impact of gestational and postnatal environments on birth outcomes and maternal and infant health. The findings can be used to inform the development of complex interventions targeted at structural, environmental factors, intended to reduce ill-health. Long-term follow-up of the cohort will focus on relationships between environmental exposures and the later development of adverse health outcomes, including obesity and diabetes.

Cumulative lead dose and cognitive function in older adults

BACKGROUND

The current population of older Americans has accumulated substantial lifetime lead doses, which raises concern about the possibility of adverse cognitive outcomes. We evaluated whether cumulative lead dose from environmental exposures is associated with cognitive function and decline, and whether such effects are persistent, reversible, or progressive.

METHODS

We used longitudinal linear modeling to evaluate associations of tibia lead concentration with cognitive function and decline in sociodemographically diverse, community-dwelling adults aged 50-70 years who were randomly selected from neighborhoods in Baltimore. Six summary measures of cognitive function were created from standard tests in the following domains: language, processing speed, eye-hand coordination, executive functioning, verbal memory and learning, and visual memory.

RESULTS

The mean (SD) tibia lead level was 18.8 (11.6) microg/g. In models adjusted for demographic characteristics, socioeconomic status (SES), and race/ethnicity, higher tibia lead was associated with a progressive decline in eye-hand coordination. Tibia lead was associated with persistently impaired cognitive function in all 6 domains, although these associations weakened after increasing covariate control. In fully adjusted stratified analysis among white persons, persistent effects were apparent in eye-hand coordination, executive functioning, and verbal memory and learning.

CONCLUSIONS

The study presents the strongest evidence to date of the effects of cumulative lead dose on adult cognitive function independent of SES. The study population was relatively young and the average total duration of follow-up short (<30 months); these findings may represent the lower bound of the impact of cumulative lead dose on cognitive function of older adults.

Childhood cancer near German nuclear power stations

In 2008, the Kinderkrebs in der Umgebung von Kernkraftwerken (KiKK) study in Germany reported a 60% increase in solid cancers and a 120% increase in leukemias among children living within 5 km of all German nuclear power stations. The study has triggered debates as to the cause(s) of these increased cancers. This article reports on the findings of the KiKK study; discusses past and more recent epidemiological studies of leukemias near nuclear installations around the world, and outlines a possible biological mechanism to explain the increased cancers. This suggests that the observed high rates of infant leukemias may be a teratogenic effect from radionuclides incorporated by pregnant women living near nuclear reactors. Doses and risks from environmental emissions to embryos and fetuses may be larger than suspected. Hematopoietic tissues appear to be considerably more radiosensitive in embryos/fetuses than in newborn babies. Recommendations for advice to local residents and for further research are made.

Effects of dioxins, PCBs, and PBDEs on immunology and hematology in adolescents

Dioxins and PCBs are environmental pollutants, proven to be immunotoxic. In the period 1987-1991 a cohort of mother-baby pairs was initiated to detect abnormalities in relation to dioxin levels in the mother's milk. At birth and at follow-up at 8-12 years, immunological and hematological effects were seen, prompting us to perform a new follow-up during adolescence. In addition, we assessed the immunological and hematological parameters in relation to current levels of PBDEs and PCBs. In the Netherlands, the pre- and postnatal exposure to dioxins have been studied prospectively since 1987. Venapuncture was performed to assess hematological (Hemoglobin, thrombocytes, thrombopoietin) and immunological (leukocytes, leukocyte differentiation) parameters and the current serum levels of dioxin, dioxinlike (dl)-PCBs and PBDEs. A decrease in the number of polymorphic neutrophils was found in adolescents with higher dl-PCBs in their serum (p = 0.021). No relation with total leukocytes, thrombocytes, hemoglobin, or thrombopoietin levels was seen. Similarly, we found no relation between prenatal, nor current dioxin levels and the hematological and the immunological parameters determined. The SigmaPBDEs were negatively associated with the number of lymphocytes (p = 0.01) and positively associated with the hemoglobin concentration (p = 0.003). These effects on the innate immunity by current levels of dl-PCBs and on the adaptive immunity by PBDEs are disconcerting, especially as the dl-PCB (0.04-7.8 WHOTEQ pg/g lipid, mean: 2.2 WHOTEQ pg/g lipid) and SigmaPBDE levels (mean 14.0 ng/g lipid, including one outlier with a sum of 73.6 ng/g lipid) were not high.

Commentary: childhood cancer near nuclear power stations

In 2008, the KiKK study in Germany reported a 1.6-fold increase in solid cancers and a 2.2-fold increase in leukemias among children living within 5 km of all German nuclear power stations. The study has triggered debates as to the cause(s) of these increased cancers. This article reports on the findings of the KiKK study; discusses past and more recent epidemiological studies of leukemias near nuclear installations around the world, and outlines a possible biological mechanism to explain the increased cancers. This suggests that the observed high rates of infant leukemias may be a teratogenic effect from incorporated radionuclides. Doses from environmental emissions from nuclear reactors to embryos and fetuses in pregnant women near nuclear power stations may be larger than suspected. Hematopoietic tissues appear to be considerably more radiosensitive in embryos/fetuses than in newborn babies. Recommendations for advice to local residents and for further research are made.

Intrauterine exposure to environmental pollutants and body mass index during the first 3 years of life

OBJECTIVE

We investigated the association between body mass index (BMI) standard deviation score (SDS) and prenatal exposure to hexachlorobenzene, dichlorodiphenyldichloroethylene (DDE), dioxin-like compounds, and polychlorinated biphenyls (PCBs).

METHODS

In this prospective birth cohort study, we assessed a random sample of mother-infant pairs (n = 138) living in Flanders, Belgium, with follow-up until the children were 3 years of age. We measured body mass index as standard deviation scores (BMI SDS) of children 1-3 years of age as well as pollutants measured in cord blood.

RESULTS

DDE correlated with BMI SDS, with effect modification by maternal smoking and the child's age. At 1 year, children of smoking mothers had higher BMI SDS than did children of nonsmoking mothers. At 3 years, this difference was reduced because of the faster rate of decline in BMI SDS in the former group. This relationship held except for children with high levels of DDE. DDE had a small effect on BMI SDS at 3 years of age in children of nonsmoking mothers (difference in BMI SDS for DDE concentrations between the 90th and 10th percentiles = 0.13). On the other hand, smoking enhanced the relation between DDE and BMI SDS at 3 years (difference in BMI SDS for DDE concentrations between the 90th and 10th percentiles = 0.76). Increasing concentrations of PCBs were associated with higher BMI SDS values at all ages (parameter estimate = 0.003 +/- 0.001; p = 0.03).

CONCLUSION

In this study we demonstrated that intrauterine exposure to DDE and PCBs is associated with BMI during early childhood. Future studies are warranted to confirm our findings and to assess possible mechanisms by which these pollutants could alter energy metabolism.

Calculating human exposure to endocrine disrupting pesticides via agricultural and non-agricultural exposure routes

Endocrine Disrupting Chemicals (EDCs) are of increasing concern because of their potential impacts on the environment, wildlife and human health. Pesticides and some pesticide metabolites are an important group of EDC, and exposure to them is a poorly quantified source of human and environmental exposure to such chemicals generally. Models for estimating human exposure to Endocrine Disrupting (ED) pesticides are an important risk management tool. Probabilistic models are now being used in addition to deterministic ones in all areas of risk assessment. These can provide more realistic exposure estimates, because they are better able to deal with variation and uncertainty more effectively and better inform risk management decisions. Deterministic models are still used and are of great value where exposure data are scarce. Models or groups of models that provide holistic human ED pesticide exposure estimates are required if the risk posed to humans by ED pesticides is to be better assessed. Much more research is needed to quantify different exposure routes such as exposure from agricultural spray drift and the medical use of pesticides to develop such models. Most available probabilistic models of human exposure were developed in the USA and require modification for use elsewhere. In particular, datasets equivalent to those used to create and apply the American models are required. This paper examines the known routes of human pesticide exposure with particular reference to ED pesticides and their quantification as unlike pesticides generally, many ED pesticides are harmful at very low doses, especially if exposure occurs during sensitive stages of development, producing effects that may not manifest for many years or that affect descendants via epigenetic changes. It also summarises available deterministic and probabilistic models commonly used to calculate human exposure. The main requirement if such models are to be used in the UK is more quantitative data on the sources and pathways of human ED pesticide exposure.

Relationship of thyroid hormone levels to levels of polychlorinated biphenyls, lead, p,p'- DDE, and other toxicants in Akwesasne Mohawk youth

BACKGROUND

It is well documented that acute exposure to high levels of persistent organic pollutants, such as polychlorinated biphenyls (PCBs), p,p'-dichlorophenyldichloroethylene (p,p'-DDE), and hexachlorobenzene (HCB), can affect human health including thyroid function. Chronic exposure to multiple toxicants is common but difficult to analyze, and most prior studies have focused on adults or newborns, creating a gap in our understanding of multitoxicant effects among adolescents.

OBJECTIVE

We investigated whether levels of PCBs, p,p'-DDE, HCB, mirex, lead, and mercury reflecting past chronic exposure are associated with alterations in levels of thyroid-stimulating hormone (TSH), triiodothyronine (T(3)), total thyroxine (TT(4)), and free thyroxine (FT(4)) among older children and adolescents.

METHODS

The sample consists of youth from the Akwesasne Mohawk Nation (n=232) who reside in proximity to several industries that have contaminated the local environment. We used multiple regression analysis to examine the effect of PCB groupings, p,p'-DDE, HCB, lead, and mercury on thyroid hormones after adjusting for sociodemographic covariates and controlling for all other toxicants.

RESULTS

Exposure to PCBs affects the thyroid hormone profile in adolescents. The group of persistent PCBs was positively associated with TSH but inversely related to FT(4). Nonpersistent PCBs were significantly and negatively related to FT(4) only. HCB was negatively associated with T(4), and lead was positively associated with T(3). Breast-fed adolescents had higher levels of persistent PCBs and p,p'-DDE but not of nonpersistent PCBs or any other toxicant when compared with non-breast-fed adolescents. Though having lower levels of persistent PCBs and p,p'-DDE, non-breast-fed adolescents exhibited significant relationships between persistent PCBs and TSH and FT(4), but breast-fed adolescents did not. It appears that PCBs from breast milk obscure the relationship between prenatal PCB exposure and thyroid function by adding random variation in PCB levels.

CONCLUSION

Our results demonstrate a reduction in thyroid function in adolescents in relation to their current serum levels of PCBs. These observations are consistent with the hypothesis that pre-natal exposure to PCBs alters thyroid function in a long-lasting manner but does not exclude the possibility that postnatal exposure is influential also.

In utero exposure to low doses of environmental pollutants disrupts fetal ovarian development in sheep

Epidemiological studies of the impact of environmental chemicals on reproductive health demonstrate consequences of exposure but establishing causative links requires animal models using ‘real life’ in utero exposures. We aimed to determine whether prolonged, low-dose, exposure of pregnant sheep to a mixture of environmental chemicals affects fetal ovarian development. Exposure of treated ewes (n = 7) to pollutants was maximized by surface application of processed sewage sludge to pasture. Control ewes (n = 10) were reared on pasture treated with inorganic fertilizer. Ovaries and blood were collected from fetuses (n = 15 control and n = 8 treated) on Day 110 of gestation for investigation of fetal endocrinology, ovarian follicle/oocyte numbers and ovarian proteome. Treated fetuses were 14% lighter than controls but fetal ovary weights were unchanged. Prolactin (48% lower) was the only measured hormone significantly affected by treatment. Treatment reduced numbers of growth differentiation factor (GDF9) and induced myeloid leukaemia cell differentiation protein (MCL1) positive oocytes by 25–26% and increased pro-apoptotic BAX by 65% and 42% of protein spots in the treated ovarian proteome were differently expressed compared with controls. Nineteen spots were identified and included proteins involved in gene expression/transcription, protein synthesis, phosphorylation and receptor activity. Fetal exposure to environmental chemicals, via the mother, significantly perturbs fetal ovarian development. If such effects are replicated in humans, premature menopause could be an outcome.

Children's environmental health and the precautionary principle

The concept of precaution has a long history in medicine and public health. The modern precautionary principle (PP), originating from environmental debates in Germany in the 1970s, has been included in many international agreements, such as the Treaty on European Union. PP is a public policy tool that justifies actions, which protect human health and the environment in face of uncertain risks. The outcome of the application of PP depends on the level, nature, and distribution of acceptable risks and on the availability of alternatives, and can range from taking no action to banning of substances or the activities of concern. Given the complex nature and uncertainty of environmental risks to children's health, a precautionary approach is warranted. Public health professionals and clinical practitioners could adopt such an approach within the wider context of considering the environment as a source of risks to children's health. Relevant knowledge and skills are needed to enable health care professionals to address these issues. New methodological and scientific approaches are necessary to make use of scattered, but potentially relevant clinical evidence in providing 'early warnings' of health hazards.

Flame retardants in placenta and breast milk and cryptorchidism in newborn boys

BACKGROUND

Polybrominated diphenyl ethers (PBDEs) are widely used in Western countries.

OBJECTIVES

Because the prevalence of cryptorchidism appears to be increasing, we investigated whether exposure to PBDEs was associated with testicular maldescent.

METHODS

In a prospective Danish-Finnish study, 1997-2001, all boys were examined for cryptorchidism. We analyzed whole placentas (for 95 cryptorchid/185 healthy boys) and individual breast milk samples (62/68) for 14 PBDEs and infant serum samples for gonadotropins, sex-hormone binding globulin, testosterone, and inhibin B.

RESULTS

In 86 placenta-milk pairs, placenta PBDE concentrations in fat were lower than in breast milk, and a larger number of congeners were nondetectable. There was no significant difference between boys with and without cryptorchidism for individual congeners, the sum of 5 most prevalent, or all 14 congeners. The concentration of PBDEs in breast milk was significantly higher in boys with cryptorchidism than in controls (sum of BDEs 47, 153, 99, 100, 28, 66, and 154: median, 4.16 vs. 3.16 ng/g fat; p < 0.007). There was a positive correlation between the sum of PBDEs and serum luteinizing hormone (p < 0.033). The sum of PBDEs in breast milk did not differ between Denmark and Finland (median, 3.52 vs. 3.44 ng/g fat), but significant differences in some individual congeners were found.

CONCLUSIONS

Two different proxies were used for prenatal PBDE exposure, and levels in breast milk, but not in placenta, showed an association with congenital cryptorchidism. Other environmental factors may contribute to cryptorchidism. Our observations are of concern because human exposure to PBDEs is high in some geographic areas.