The integrated exposure uptake biokinetic model for lead in children: independent validation and verification

Extending Regulatory Biokinetic Lead Models towards Food Safety: Evaluation of Consumer Baby Food Contribution to Infant Blood Lead Levels and Variability

The U.S. Food and Drug Administration released proposed lead (Pb) action levels for foods intended for babies and young children in January 2023 based on the agency's interim reference value of 2.2 µg/day for dietary Pb. Since the 1980s, biokinetic models have estimated blood lead levels (BLLs) associated with environmental contamination, but their use in food safety assessment has been limited. We compared three recent biokinetic models (IEUBK Model, ICRP Model Version 5, and AALM) to develop insights on contributors to variability in potential exposures to Pb in consumer baby food products. While modest variation was observed for babies, the predictions trended to convergence for children aged 3 and older, approaching the U.S. FDA dietary conversion factor of 0.16 µg Pb/dL blood per µg Pb intake/day. We applied the IEUBK model in a probabilistic exposure assessment framework characterizing the distribution of Pb in soil, dust, water, and food intake in the United States. Soil and dust were the primary contributors to variance in infant BLLs, while food and water contributed <15% combined. Thus, reductions in upper-bound soil and dust concentrations will be necessary before achieving appreciable reductions in the frequency of BLLs greater than the BLRV of 3.5 µg/dL.

Evaluation and updates to the Leggett model for pharmacokinetic modeling of exposure to lead in the workplace - Part II adjustments to the adult exposure model, confirmation of Leggett+, and modeling of workplace exposure

California's Office of Environmental Health Hazard Assessment has updated the comprehensive age-specific model of lead metabolism in humans published by Richard W. Leggett in 1993. The updated model, called Leggett+, was introduced in a peer-reviewed report in 2013. The Leggett + model simulates the relationship between blood lead and exposure in the workplace. Leggett + includes a workplace exposure model comprising respiratory tract intake (workplace lead inhaled by a worker) and uptake (lead absorbed into the blood from the respiratory tract plus uptake from ambient air and diet). The latter is calculated as intake times an inhalation transfer coefficient plus background uptake. An adjusted adult systemic model describes the metabolism of the absorbed lead. This paper provides details about the workplace exposure and uptake elements of Leggett+, an updated approach to calibrating an inhalation transfer coefficient, confirmation of the model's performance in predicting blood lead levels from workplace studies, and predictions of blood lead levels from simulated exposures to workplace airborne lead over a working lifetime. Blood lead relative to airborne lead concentrations in a standard workplace scenario predicted by Leggett + was similar to corresponding relationships from four published workplace studies. Leggett + predictions displayed a good fit to regression equations when other key factors were considered such as pre-employment blood lead and ongoing background intake of lead, workplace air concentration, lead aerosol characteristics, and worker activity levels. The comprehensive Leggett + model can simulate plausible workplace air-blood lead relationships from a broad range of worker exposures. The inhalation transfer coefficient of 0.30, derived from empirical data described in the 2013 report has been reexamined. The original estimate continues to represent a plausible mid-point for a coefficient derived from an expanded range of theoretical particle size distributions deposited in the upper and lower regions of the respiratory tract considering intake during sedentary and outdoor activity breathing scenarios. This coefficient is slightly lower than the value of 0.35 estimated for unknown forms of lead by Leggett in 1993.

Assessing Children's Lead Exposure in an Active Mining Community Using the Integrated Exposure Uptake Biokinetic Model

Lead exposure has been shown to be harmful to humans in various settings and there are no safe levels of blood lead in children. At an Alternative Superfund site in Hayden-Winkelman, Arizona, with an active copper smelter and concentrator, lead exceedances in air and soil have been measured in the past 20 years. In this work, the U.S. Environmental Protection Agency's Integrated Exposure Uptake Biokinetic (IEUBK) model was used to estimate Hayden-Winkelman children's (age 6 months-7 years) blood lead levels (BLLs) using site-specific lead concentrations measured in indoor and outdoor air, soil, indoor dust, and drinking water. Values used by a state agency's airborne lead risk forecast program were also evaluated to determine whether their forecasting program is useful in protecting children's public health. Using site-specific values in the model, the results demonstrated that lead ingested via indoor dust was the major contributor to children's BLLs. In addition, the output of the IEUBK model overestimated actual BLLs of children sampled in the community. The IEUBK model was particularly sensitive to high indoor dust levels, and these site-specific measures increased modeled BLL values. This finding is of significance as the IEUBK model is used worldwide in communities with industrial contamination. This study confirmed that the chief contributor to lead exposure in children is household dust. Thus, for lead exposure risk reduction, agencies working at Superfund sites should focus efforts on decontaminating outdoor soil and dust and indoor lead decontamination.

Issues and Challenges in the Application of the IEUBK Model in the Health Risk Assessment of Lead: A Case Study from Blantyre Malawi

The risk assessment of lead (Pb) requires the use of biokinetic models to translate measured concentrations of Pb in food and environmental media into blood lead (BPb). The aim of this study was to assess the applicability of the Integrated Exposure Uptake Biokinetic (IEUBK) model in the health risk assessment of Pb among children in Blantyre. Children (152) aged 1–6 years were recruited into this cross-sectional study, and foods, house dust, playground soil, water, and venous blood (1 mL) were collected and analyzed for Pb. A seven-day food frequency questionnaire (FFQ) was used to collect food consumption data. The concentrations of Pb ranged from 0.01 to 3.3 mg/kg in food, 2.3 to 265 mg/kg and 1.5 to 482 mg/kg in house dust and playground soil, respectively, as well as 2.0 µg/dL to 50.4 µg/dL and 6.8 to 39.2 µg/dL for measured and predicted BPb, respectively. Various statistical tests indicated less than satisfactory agreement between measured and predicted BPb values. Despite the lack of reliable food consumption data and other limitations, both the predicted and measured BPb values indicate that children in Blantyre are exposed to high levels of Pb, largely through food and soil as a minor source.

Using soil properties to predict in vivo bioavailability of lead in soils

Soil plays a significant role in controlling the potential bioavailability of contaminants in the environment. In this study, eleven soils were used to investigate the relationship between soil properties and relative bioavailability (RB) of lead (Pb). To minimise the effect of source of Pb on in vivo bioavailability, uncontaminated study soils were spiked with 1500 mg Pb/kg soil and aged for 10-12 months prior to investigating the relationships between soil properties and in vivo RB of Pb using swine model. The biological responses to oral administration of Pb in aqueous phase or as spiked soils were compared by applying a two-compartment pharmacokinetic model to blood Pb concentration. The study revealed that RB of Pb from aged soils ranged from 30±9% to 83±7%. The very different RB of Pb in these soils was attributed to variations in the soils' physico-chemical properties. This was established using sorption studies showing: firstly, Freundlich partition coefficients that ranged from 21 to 234; and secondly, a strongly significant (R(2)=0.94, P<0.001) exponential relationship between RB and Freundlich partition coefficient (Kd). This simple exponential model can be used to predict relative bioavailability of Pb in contaminated soils. To the best of our knowledge, this is the first such model derived using sorption partition coefficient to predict the relative bioavailability of Pb.

Reduced risk estimations after remediation of lead (Pb) in drinking water at two US school districts

The risk of students to develop elevated blood lead from drinking water consumption at schools was assessed, which is a different approach from predictions of geometric mean blood lead levels. Measured water lead levels (WLLs) from 63 elementary schools in Seattle and 601 elementary schools in Los Angeles were acquired before and after voluntary remediation of water lead contamination problems. Combined exposures to measured school WLLs (first-draw and flushed, 50% of water consumption) and home WLLs (50% of water consumption) were used as inputs to the Integrated Exposure Uptake Biokinetic (IEUBK) model for each school. In Seattle an average 11.2% of students were predicted to exceed a blood lead threshold of 5 μg/dL across 63 schools pre-remediation, but predicted risks at individual schools varied (7% risk of exceedance at a "low exposure school", 11% risk at a "typical exposure school", and 31% risk at a "high exposure school"). Addition of water filters and removal of lead plumbing lowered school WLL inputs to the model, and reduced the predicted risk output to 4.8% on average for Seattle elementary students across all 63 schools. The remnant post-remediation risk was attributable to other assumed background lead sources in the model (air, soil, dust, diet and home WLLs), with school WLLs practically eliminated as a health threat. Los Angeles schools instead instituted a flushing program which was assumed to eliminate first-draw WLLs as inputs to the model. With assumed benefits of remedial flushing, the predicted average risk of students to exceed a BLL threshold of 5 μg/dL dropped from 8.6% to 6.0% across 601 schools. In an era with increasingly stringent public health goals (e.g., reduction of blood lead safety threshold from 10 to 5 μg/dL), quantifiable health benefits to students were predicted after water lead remediation at two large US school systems.

Identifying sources of lead exposure for children, with lead concentrations and isotope ratios

Despite a dramatic decrease in children's blood lead levels (BLL), lead exposure remains a public health concern because increasing evidence shows effects at very low doses. Lowering BLL still further requires the identification of lead sources and, therefore, new tools to investigate and thus prevent exposure. We describe a procedure that uses both lead concentrations and isotope ratios (IRs) to identify sources of overexposure in homes. Water, dust, and paint chips were sampled from the homes of 21 children with elevated BLL from Aubervilliers (Paris metropolitan area). Lead concentrations of concern were calculated from reverse physiologically based pharmacokinetic modeling for water and dust. Isotope ratio matching of blood and environmental samples (with a lead content above the concentration of concern) was performed by computation of the distance between their IRs. When the IR of the source did not match that of the blood, the source was eliminated as a source of lead intoxication. The number of sources eliminated (per child) due to lead concentration ranged from 14% to 86% (mean 66%) for dust, and 100% for water samples. The number of remaining potential sources eliminated by IR interpretation varied from 0% to 100% for both dust and paint chips (mean 63% and 58%, respectively). IRs made it possible to eliminate at least one source in 20 of 21 cases and identified a single source in 11 of 21. The number of dust and paint sources not eliminated by concentration or IR varied from 8% to 45% (median 18%). The pilot study supports the usefulness of these procedures and the added value of IRs for identifying sources of lead poisoning. However, systematic use should be supported by cost-effectiveness analysis on a larger and more representative population of elevated BLL.

Pediatric lead exposure from imported Indian spices and cultural powders

BACKGROUND

Significant lead poisoning has been associated with imported nonpaint products.

OBJECTIVES

To describe cases of pediatric lead intoxication from imported Indian spices and cultural powders, determine lead concentrations in these products, and predict effects of ingestion on pediatric blood lead levels (BLLs).

PATIENTS AND METHODS

Cases and case-study information were obtained from patients followed by the Pediatric Environmental Health Center (Children's Hospital Boston). Imported spices (n = 86) and cultural powders (n = 71) were analyzed for lead by using x-ray fluorescence spectroscopy. The simple bioaccessibility extraction test was used to estimate oral bioavailability. The integrated exposure uptake biokinetic model for lead in children was used to predict population-wide geometric mean BLLs and the probability of elevated BLLs (>10 microg/dL).

RESULTS

Four cases of pediatric lead poisoning from Indian spices or cultural powders are described. Twenty-two of 86 spices and foodstuff products contained >1 microg/g lead (for these 22 samples, mean: 2.6 microg/g [95% confidence interval: 1.9-3.3]; maximum: 7.6 microg/g). Forty-six of 71 cultural products contained >1 microg/g lead (for 43 of these samples, mean: 8.0 microg/g [95% confidence interval: 5.2-10.8]; maximum: 41.4 microg/g). Three sindoor products contained >47% lead. With a fixed ingestion of 5 microg/day and 50% bioavailability, predicted geometric mean BLLs for children aged 0 to 4 years increased from 3.2 to 4.1 microg/dL, and predicted prevalence of children with a BLL of >10 microg/dL increased more than threefold (0.8%-2.8%).

CONCLUSIONS

Chronic exposure to spices and cultural powders may cause elevated BLLs. A majority of cultural products contained >1 microg/g lead, and some sindoor contained extremely high bioaccessible lead levels. Clinicians should routinely screen for exposure to these products.

Use of pharmacokinetic modeling to design studies for pathway-specific exposure model evaluation

Validating an exposure pathway model is difficult because the biomarker, which is often used to evaluate the model prediction, is an integrated measure for exposures from all the exposure routes and pathways. The purpose of this article is to demonstrate a method to use pharmacokinetic (PK) modeling and computer simulation to guide the design of field studies to validate pathway models. The children's dietary intake model is discussed in detail as an example. Three important aspects are identified for a successful design to evaluate the children's dietary intake model: a) longitudinally designed study with significant changes in the exposure for the route/pathway of interest, b) short biologic half-life of the selected chemical, and c) surface loading of the selected chemical at sufficient levels. Using PK modeling to guide a study design allowed a path-specific exposure model to be evaluated using urinary metabolite biomarkers.

Risks to children from exposure to lead in air during remedial or removal activities at Superfund sites: a case study of the RSR lead smelter Superfund site

Superfund sites that are contaminated with lead and undergoing remedial action generate lead-enriched dust that can be released into the air. Activities that can emit lead-enriched dust include demolition of lead smelter buildings, stacks, and baghouses; on-site traffic of heavy construction vehicles; and excavation of soil. Typically, air monitoring stations are placed around the perimeter of a site of an ongoing remediation to monitor air lead concentrations that might result from site emissions. The National Ambient Air Quality (NAAQ) standard, established in 1978 to be a quarterly average of 1.5 microg/m(3), is often used as a trigger level for corrective action to reduce emissions. This study explored modeling approaches for assessing potential risks to children from air lead emissions from the RSR Superfund site in West Dallas, TX, during demolition and removal of a smelter facility. The EPA Integrated Exposure Uptake Biokinetic (IEUBK) model and the International Commission of Radiologic Protection (ICRP) lead model were used to simulate blood lead concentrations in children, based on monitored air lead concentrations. Although air lead concentrations at monitoring stations located in the downwind community intermittently exceeded the NAAQ standard, both models indicated that exposures to children in the community areas did not pose a significant long-term or acute risk. Long-term risk was defined as greater than 5% probability of a child having a long-term blood lead concentration that exceeded 10 microg/dl, which is the CDC and the EPA blood lead concern level. Short-term or acute risk was defined as greater than 5% probability of a child having a blood lead concentration on any given day that exceeded 20 microg/dl, which is the CDC trigger level for medical evaluation (this is not intended to imply that 20 microg/dl is a threshold for health effects in children exposed acutely to airborne lead). The estimated potential long-term and short-term exposures at the downwind West Dallas community did not result in more than 5% of children exceeding the target blood lead levels. The models were also used to estimate air lead levels for short-term and long-term exposures that would not exceed specified levels of risk (risk-based concentrations, RBCs). RBCs were derived for various daily exposure durations (3 or 8 h/day) and frequencies (1-7 days/week). RBCs based on the ICRP model ranged from 0.3 (7 days/week, 8 h/day) to 4.4 microg/m(3) (1 day/week, 3 h/day) for long-term exposures and were lower than those based on the IEUBK model. For short-term exposures, the RBCs ranged from 3.5 to 29.0 microg/m(3). Recontamination of remediated residential yards from deposition of air lead emitted during remedial activities at the RSR Superfund site was also examined. The predicted increase in soil concentration due to lead deposition at the monitoring station, which represented the community at large, was 3.0 mg/kg. This potential increase in soil lead concentration was insignificant, less than 1% increase, when compared to the clean-up level of 500 mg/kg developed for residential yards at the site.

The conceptual structure of the integrated exposure uptake biokinetic model for lead in children

The integrated exposure uptake biokinetic model for lead in children was developed to provide plausible blood lead distributions corresponding to particular combinations of multimedia lead exposure. The model is based on a set of equations that convert lead exposure (expressed as micrograms per day) to blood lead concentration (expressed as micrograms per deciliter) by quantitatively mimicking the physiologic processes that determine blood lead concentration. The exposures from air, food, water, soil, and dust are modeled independently by several routes. Amounts of lead absorbed are modeled independently for air, food, water, and soil/dust, then combined as a single input to the blood plasma reservoir of the body. Lead in the blood plasma reservoir, which includes extracellular fluids, is mathematically allocated to all tissues of the body using age-specific biokinetic parameters. The model calculation provides the estimate for blood lead concentration for that age. This value is treated as the geometric mean of possible values for a single child, or the geometric mean of expected values for a population of children exposed to the same lead concentrations. The distribution of blood lead concentrations about this geometric mean is estimated using a geometric standard deviation, typically 1.6, derived from the analysis of well-conducted community blood studies.

Integrated exposure uptake biokinetic model for lead in children: empirical comparisons with epidemiologic data

The concept of model validation is evolving in the scientific community. This paper addresses the comparison of observed and predicted estimates as one component of model validation as applied to the integrated exposure uptake biokinetic (IEUBK) model for lead in children. The IEUBK model is an exposure (dose)-response model that uses children's environmental lead exposures to estimate risk of elevated blood lead (typically > 10 micrograms/dl) through estimation of lead body burdens in a mass balance framework. We used residence-specific environmental lead measurements from three epidemiologic datasets as inputs for the IEUBK model to predict blood lead levels, and compared these predictions with blood lead levels of children living at these residences. When the IEUBK modeling focused on children with representative exposure measurements, that is, children who spent the bulk of their time near the locations sampled, there was reasonably close agreement between observed and predicted blood lead distributions in the three studies considered. Geometric mean observed and predicted blood lead levels were within 0.7 microgram/dl, and proportions of study populations expected to be above 10 micrograms/dl were within 4% of those observed.