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Objective:To analyze the external quality control assessment results of fluoride in brick tea in the provincial, city (prefecture) and county (city, district)-level endemic fluorosis laboratories in Qinghai Province, and to evaluate the testing capabilities of laboratories at all levels.Methods:The Z-score method was used to analyze and evaluate the results of provincial, city (prefecture) and county (city, district)-level laboratories that participated in the external quality control assessment of fluoride in brick tea in Qinghai Province from 2014 to 2020, and│Z│≤2 was qualified; 2 <│Z│ < 3 was basic qualified; │Z│≥3 was unqualified.Results:From the feedback, the feedback rate of external quality control of fluoride in brick tea in provincial and city (prefecture)-level laboratories in Qinghai Province from 2014 to 2020 was 100.00%; the feedback rate of county (city, district)-level laboratories from 2014 to 2018 was 100.00%, and there were no feedback units in 2019 and 2020. From the assessment of qualification, the qualification rate of provincial, city (prefecture)-level laboratories was 100.00% in all other years except one unit failed in 2017; the qualification rate of county (city, district)-level laboratories was 100.00% in 2014, 2015, 2016 and 2019, and there were 6 unqualified units in other years.Conclusions:From 2014 to 2020, some endemic fluorosis laboratories in Qinghai Province still fail to pass the external quality control assessment of fluoride in brick tea. In the future, it will be the focus of work to strengthen personnel training and improve the detection ability.
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Drinking brick-tea type of endemic fluorosis is a kind of chronic fluorosis caused by excessive intake of fluoride into the body from long-term and high consumption of brick-tea, milk tea, butter tea, or other tea drinks with high fluoride content. It mainly distributes in seven western provinces of China, including Tibet Autonomous Region, Qinghai Province, Sichuan Province, Xinjiang Uygur Autonomous Region, Inner Mongolia Autonomous Region, Gansu Province, and Ningxia Hui Autonomous Region. In order to govern the production and sale of brick-tea and control the epidemic of drinking brick-tea type of endemic fluorosis, the former Ministry of Health of China issued the national standard "Fluoride Content of Brick-tea" (GB 19965-2005) in 2005, which stipulated that the total amount of water-soluble inorganic fluorine in brick-tea should not exceed 300 mg/kg. In the past 20 years, the prevalence of drinking brick-tea type of endemic fluorosis in China became clear gradually, and the habit of drinking brick-tea of residents in the epidemic fluorosis area also changed to some extent. In this paper, the dose-effect relationship between fluoride intake from brick-tea and skeletal fluorosis is reviewed, the brick-tea consumption of residents in the endemic fluorosis areas is analyzed, and the safety risk of brick-tea fluoride exposure is evaluated. It is suggested that the fluoride limit of brick-tea, ≤300 mg/kg, is still suitable for the prevention and control of drinking brick-tea type of endemic fluorosis in China at the present stage.
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Objective:To understand the prevalence of tea-drinking-borne fluorosis in Inner Mongolia Autonomous Region, and to provide a data basis for formulation of prevention and control measures.Methods:All administrative villages of 53 banners (counties) in 10 leagues (cities) of Inner Mongolia Autonomous Region were investigated for tea-drinking-borne fluorosis. The basic information and demographic information of each administrative village were collected, and 10 households were selected from each administrative village to investigate the basic information of family members and the drinking situation of brick tea, and collect household brick tea samples to determine the fluorine content. The prevalence of dental fluorosis in children aged 8 to 12 and skeletal fluorosis in adults over 16 years in the administrative villages were investigated.Results:There were 39 banners (counties) in Inner Mongolia Autonomous Region that had the habit of drinking brick tea, people who habitually drink brick tea a lot accounted for 70.22% of the total population (4.278 5 million/6.092 8 million). The per capita annual consumption of brick tea was 1.00 kg and the per capita daily intake of brick tea fluoride was 0.68 mg. A total of 24 282 brick tea samples were collected, and the samples with fluorine content exceeding the standard accounted for 74.77% (18 155/24 282). Except that the fluorine content of black brick tea was lower than the national health standard (300 mg/kg), other varieties of brick tea exceeded the standard. A total of 97 295 children aged 8 to 12 years were examined, and 6 558 cases of dental fluorosis were detected. The detection rate of dental fluorosis was 6.74%. Among them, 3 623 cases were very mild, 2 440 cases were mild, 489 cases were moderate and 6 cases were severe. There were significant differences in the detection rates of dental fluorosis in children of different regions and ages (χ 2 = 6 803.76, 30.82, P < 0.05). A total of 115 251 adults over 16 years old were examined, and 1 691 cases of skeletal fluorosis were detected. The detection rate of adult skeletal fluorosis was 1.47%; among them, 1 043 cases were mild, 481 cases were moderate and 167 cases were severe. There were statistically significant differences in the detection rates of skeletal fluorosis among adults of different regions and ages (χ 2 = 3 584.26, 562.67, P < 0.05). Conclusions:The fluoride content of brick tea consumed by residents in Inner Mongolia Autonomous Region seriously exceeds the standard. Moderate and severe patients with dental fluorosis in children aged 8 to 12 years and skeletal fluorosis in adults over 16 years old have been detected. The prevention and treatment of tea-drinking-borne fluorosis in Inner Mongolia Autonomous Region should be continuously strengthened.
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Objective:To find out the variety, producing area, fluorine content of brick tea in Qinghai Province, and the drinking situation of brick tea among people, so as to provide basis for preventing and curing endemic fluorosis of drinking tea type.Methods:From April to November 2019, according to historical data, in 3 066 administrative villages in 39 counties (cities, districts, hereinafter referred to as counties) in Qinghai Province that had the habit of drinking brick tea, 10 families were randomly selected from each village to investigate the demographic data of each family and the drinking situation of brick tea, to collect brick tea samples to determine the fluorine content, and to calculate the daily average brick tea fluorine intake of the population > 16 years old.Results:A total of 31 067 brick tea samples were collected. The main brick tea consumed by the residents in the whole province was Fu brick tea, accounting for 89.97% (27 952/31 067), followed by Kang brick tea [5.12% (1 592/31 067)], Green brick tea [2.29% (710/31 067)], Black brick tea [1.85% (574/31 067)], and golden tip, mosaic, black wool and other brick tea [0.77% (239/31 067)]. There were 523 brands of brick tea in circulation in the province, among which there were 410 brands produced in Hunan Province, 26 brands in Sichuan Province, 11 brands in Hubei Province, and 76 brands in Henan Province and other provinces. The average content of fluorine in brick tea was 646.1 mg/kg, which ranged from 40.0 to 2 295.0 mg/kg. Brick tea with fluorine content ≤300 mg/kg accounted for 7.80% (2 422/31 067) of all samples. The annual average consumption of brick tea by population > 16 years old was 1.09 (0.35 - 7.40) kg, and the daily average brick tea fluorine intake was 1.93 (0.39 - 18.64) mg. There were 15 counties and 486 administrative villages in which the daily average brick tea fluorine intake exceeded the national standard (3.5 mg).Conclusion:The main brick tea in circulation in Qinghai Province is Fu brick tea, which has high fluorine content and is harmful to people, and prevention and control measures should be taken as soon as possible.
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Abstract@#Tibet Plateau is one of the most prevalent areas of brick-tea type fluorosis in China. Effective management of brick-tea type fluorosis is a key point and a difficulty in endemic disease prevention and treatment in Tibet. Brick-tea type fluorosis is a human health concern that occurs under specific natural environments and social humanistic conditions in Tibet. Recently, the prevalence of brick-tea type fluorosis has been effectively reduced in the Tibet Plateau; however, there are still challenges for the overall brick-tea type fluorosis control, and the endemic status remains more severe than other regions endemic for brick-tea type fluorosis in China. Previous studies have shown that intake of high-fluoride brick-tea, dietary habits of drinking tea and specific natural environments are strongly associated with brick-tea type fluorosis in the Tibet Plateau. This review summarizes the advances in the epidemiological characteristics and influencing factors of brick-tea type fluorosis, so as to provide insights into the development of the long-term control strategy for brick-tea type fluorosis in the Tibet Plateau.
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Objective:To observe and evaluate the effect of health education on drinking brick-tea type fluorosis in Zhiduo County, Qinghai Province, so as to provide basis for further formulating health education strategies.Methods:From April 2019 to April 2020, according to the historical prevalence of drinking brick-tea type fluorosis in Zhiduo County, Qinghai Province, 3 townships (towns) were selected to carry out the health education activities on drinking brick-tea type fluorosis for students of grade 4 - 6, village doctors, adults and monks in each township (town). We carried out a one-year publicity on the prevention and treatment of drinking brick-tea type fluorosis, distributed health education materials and organized health education activities. Before and after the intervention, we conducted a questionnaire survey on health education among the target population (grade 4 - 6 students, village doctors, adults and monks), to evaluate the awareness rate and behavior formation rate of fluorosis prevention and control, and to evaluate the intervention effect.Results:A total of 86 students of grade 4 - 6, 40 village doctors, 42 adults and 20 monks were investigated, after the intervention, the awareness rates of prevention and treatment of drinking brick-tea type fluorosis in grade 4 - 6 students, village doctors, adults and monks were 87.98% (227/258), 96.67% (116/120), 81.75% (103/126), 83.33% (50/60), respectively, which were significantly higher than those before the intervention [38.38% (76/198), 83.33% (100/120), 15.45% (19/123), 28.89% (13/45), P < 0.05]. After the intervention, the behavior formation rates of prevention and treatment of the drinking brick-tea type fluorosis in grade 4 - 6 students, village doctors, adults and monks were 74.42% (128/172), 72.50% (58/80), 52.38% (44/84), 60.00% (24/40), respectively, which were significantly higher than those before the intervention [14.39% (19/132), 38.75% (31/80), 3.66% (3/82), 0(0/28), P < 0.05]. Conclusion:The comprehensive intervention measures based on health education can significantly improve the knowledge of local residents, and improve their bad drinking habits of drinking tea, which is of great significance to the prevention and treatment of drinking brick-tea type fluorosis.
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Objective:To study the epidemic status of drinking tea type endemic fluorosis in Qinghai Province.Methods:In 2019, in counties (cities, districts, referred to as counties) that had the habit of drinking brick tea in 8 cities (prefectures) of Qinghai Province, epidemiological investigation of drinking tea type endemic fluorosis was carried out in villages. Ten households were randomly selected from each village, to investigate the demographic data of each household and the drinking situation of brick tea, residents' drinking water and brick tea samples were collected to determine the fluorine content, and calculate the daily per capita tea fluorine intake. At the same time, skeletal fluorosis was examined in all adults over 25 years old, and dental fluorosis was examined in all children aged 8 to 12 years old in survey sites. The content of fluorine in tea and water was detected by ion selective electrode method; the diagnosis of skeletal fluorosis was based on "Diagnostic Criteria for Endemic Skeletal Fluorosis" (WS 192-2008), the diagnosis of dental fluorosis was based on "Diagnosis of Dental Fluorosis" (WS/T 208-2011).Results:The mean (range) of fluorine of the 3 602 water samples was 0.31 (0.20 - 1.00) mg/L. The geometric mean (range) of fluorine of the 31 067 brick tea samples was 646 (40 - 2 295) mg/kg, the fluorine content of the brick tea ≤300 mg/kg accounted for 7.80% (2 422/31 067) of the total samples. The proportion of drinking Fu brick-tea was 89.97% (27 952/31 067); and the daily per capita tea fluorine intake was 1.93 mg, the daily per capita tea fluorine intake in Guoluo, Yushu and Hainan prefectures were higher than the health standard (3.50 mg). The detection rate of skeletal fluorosis in adults was 0.16% (2 357/1 484 907), Yushu Prefecture was the highest [29.23% (592/2 025)], followed by Guoluo Prefecture, which was 8.21% (771/9 393). The detection rate of dental fluorosis in children was 4.79% (8 076/168 623), Yushu Prefecture was the highest [32.61% (1 562/4 790)].Conclusion:Drinking tea type endemic fluorosis is prevalent in Qinghai Province, with obvious regional characteristics, covering a large population. The disease is relatively popular in Yushu Prefecture and Guoluo Prefecture.
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Objective To observe the effect of fluorine (F) and aluminum (Al) on serum,bone,teeth,brain,kidney and liver tissues,contents of F and Al in different tissues of rats with combined F-Al toxicosis caused by drinking brick tea were determined.Methods Forty SPF grade Wistar rats of 4 weeks,including 24 females and 16 males,weighing between 40 and 50 g,were divided into control group,F group,Al group and brick tea group by random number table according to their weight,ten rats (6 females,4 males) in each group.The control group received daily drinking water.The F group drank a solution with an F content of 100 mg/L,and the Al group drank a solution with an Al content of 159 mg/L.According to the drinking habits and consumption of the herdsmen,the tea concentration and tea consumption of the rats were calculated for the brick tea group,and a tea soup was made according to the ratio,with the F content of (100 ± 2) mg/L and the Al content of (159.0 ± 1.5) mg/L.One year later,the rats were killed to determine the contents of F and Al in serum,bone,teeth,brain,kidney and liver.Results The contents of F in bone,teeth and liver of the brick tea group [(275.81 + 55.89),(283.32 ± 70.67),(15.52 ±7.57) μg/g] were significantly higher than those of the control group [(0.04 ± 0.01),(128.52 ± 12.81),(5.89 ±0.33) μg/g,P ＜ 0.01].The Al contents of teeth and liver in the brick tea group [(6.14 ± 1.69),(8.97 ± 0.85) μg/g]were significantly higher than those of the control group [(0.72 + 0.54),(5.47 + 0.83) μg/g,P ＜ 0.01].Conclusions F-Al combined toxicosis caused by drinking brick tea can cause the increases of F contents in bone,teeth and liver,and the increases of Al contents in teeth and liver.The main tissues damaged by F-Al combined toxicosis caused by drinking brick tea in rats are bone,teeth and liver.
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Objective To understand the status of fluoride content in brick tea (pressed tea) in China,and conduct health risk assessment according to the situation of drinking brick tea in fluorosis areas.Methods Twenty national designated brick tea manufacturers were selected to collect 1-5 varieties of brick tea samples of mainstream varieties with large production volume and large sales volume.If low-fluoride brick tea was produced,an additional sample would be collected to determine the fluoride content of tea.The retrospective analysis method was used to collect the monitoring data of brick tea-type fluorosis in the whole country in 2017,and analyze the use of brick tea in the residents of the brick tea-type fluorosis areas in six provinces (regions) of Inner Mongolia,Sichuan,Gansu,Ningxia,Xinjiang and Qinghai.According to the fluoride content of brick tea,combined with daily average consumption data of brick tea in the brick tea-type fluorosis areas,daily average brick tea intake,and hazard quotient of the daily average brick tea fluoride and the standard recommended fluoride intake were calculated.A health risk assessment was conducted based on the hazard quotient (hazard quotient ＞ 1 indicated a health risk).Through the total fluoride intake standard of the Chinese population,the safe consumption of brick tea with different fluoride content was simulated by using the value of the hazard quotient.The tea fluoride was measured by an ion selective electrode method.Results A total of 54 samples were collected,of which 49 were brick tea samples and 5 were low-fluoride brick tea samples.The geometric mean of the fluoride content of 49 brick tea samples was 460 mg/kg,the median was 430 mg/kg,and the range was 102-1 797 mg/kg.There were 14 samples with a fluoride content ＜ 300 mg/kg,accounting for 28.6％.The average fluoride content of 5 low-fluoride brick teasampleswas 193 mg/kg,ranging from 102 to 290 mg/kg.Forty-nine brick tea samples were distributed in 5 provinces,the fluoride content of brick tea was the lowest in Yunnan,128 mg/kg;the highest in Hubei,712 mg/kg.The lowest fluoride content of brick tea in different varieties was Tuo tea,130 mg/kg,and the highest was Jinjian tea,745 mg/kg.There were 1 000 households drinking brick tea in the brick tea-type fluorosis areas in 6 provinces,73.9％ (739/1 000) of households drinking the products of the national assigned brick tea manufacturers;a total of 1 000 brick tea samples were collected,and the geometric mean of brick tea fluoride content was 551 mg/kg,and only 17.5％ (175/1 000) of brick tea had a fluoride content ＜ 300 mg/kg.Compared with the national standards and the standards of World Health Organization,hazard quotient of agriculture,animal husbandry,semi-pastoral industry,urban residents through the brick tea fluoride was 0.34,1.38,0.75,and 0.21,respectively;0.29,1.21,0.66,and 0.19,respectively.Animal husbandry hada health risk through drinking brick tea among them.According to the health standard of total fluoride intake in China,when drinking brick tea with fluoride contents of 300,430,460 and 500 mg/kg,the safe consumption of brick tea for school-age children was 2.9,2.0,1.9 and 1.8 kg,respectively,and for adult was 4.3,3.0,2.8 and 2.6 kg,respectively.Conclusions Brick tea has high fluoride content,and percent of qualified brick tea is low and few of low-fluoride brick tea are consumed.There is a health risk in the animal husbandry who has a large amount of brick tea.
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Objective To explore the prevalence state of drinking brick-tea type fluorosis in children in Guoluo Prefecture,Qinghai Province.Methods According to the historical prevalence of drinking tea-type fluorosis in Guoluo Prefecture,in 2017,in 5 counties of Guoluo Prefecture,according to the pastoral area,agricultural area,semi-agricultural and semi-pastoral areas,each township (town) was selected,in each township (town) drawed a natural village in a ward as a survey point.At each survey site,drinking water samples of local residents were collected,and 10 households were selected,tea samples were collected,and dental fluorosis was investigated for children aged 8-12 years old.The mean of fluoride was determined by fluoride ion selective electrode method (GB/T 5750.5-2006,GB 19965-2005),and the dental fluorosis was diagnosed based on "Diagnosis of Dental Fluorosis" (WS/T 208-2011).Results The mean of fluoride in 85 water samples was 0.34 mg/L (0.20-0.77 mg/L),the mean of fluoride in 161 brick-tea samples was 579 mg/kg (110-1 278 mg/kg).The mean of daily fluoride intake of each person was 6.78 mg,among them,73.29％ (118/161) drank brick-tea,the detection rate of dental fluorosis of 2 083 children was 22.85％ (476/2 083),and the index of dental fluorosis was 0.42,the prevalence was weak.Conclusion The prevalence of drinking brick-tea type fluorosis of children in Guoluo Prefecture is less serious.
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Objective To grasp the prevalence of drinking brick-tea type fluorosis in Tibet,and to provide scientific basis for the development of prevention and control strategies.Methods Twelve counties were selected from 7 regions in Tibet.In accordance with the "Drinking Brick-Tea Type Endemic Fluorosis Monitoring Program",a total of 46 administrative villages were selected as survey points using the cluster stratified sampling method.Household water samples,tea-water samples and adult urine samples were collected,and household fluorine intake status and incidence of skeletal fluorosis in adults over 16 years old were investigated.In the rural grade primary school where the village children were concentrated,all children aged 8-12 were selected,urine samples were collected,and the prevalence of dental fluorosis was investigated.Fluoride contents in tea,water,and urine were detected by ion selective electrode method.The dental fluorosis and skeletal fluorosis were examined and judged according to the "Diagnosis of Dental Fluorosis" (WS/T 208-2011) and the "Diagnostic Criteria for Endemic Skeletal Fluorosis" (WS 192-2008),respectively.Results A total of 46 villages in 12 counties were investigated,1 992 of water samples,1 662 of tea samples,664 of children urine samples,3 186 of adult urine samples were detected;547 children aged 8-12 were examined dental fluorosis and 3 196 adults were examinea skeletal fluorosis,respectively.The water fluoride contents in all the investigated villages were less than 1.0 mg/L;the average fluoride content in brick-tea water was 6.12 mg/L,within the range of 0.11-84.00 mg/L,and the average daily brick tea fluorine intake of residents was 24.98 mg.The geometric mean of urine fluoride in children and adults was 0.76,2.28 mg/L,respectively.The prevalence rates of dental fluorosis in children and skeletal fluorosis in adults over 16 years old were 31.81％ (174/547) and 48.59％ (1 553/3 196),respectively.The children dental fluorosis index was 0.60.The detection rate of skeletal fluorosis in adults aged 36-45 was 13.37％ (69/516).Conclusions The prevalence of drinking brick-tea type fluorosis in Tibet is serious and widely distributed.In particular,the prevalence rate of skeletal fluorosis in adults is relatively high,while that of dental fluorosis in children is relatively mild.The prevention and control of drinking brick-tea type fluorosis in Tibet brook no delay.
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Objective To determine the contents of fluoride and tea polyphenols in brick-tea and to understand the utilization ratio of qualified brick-tea in fluorosis regions in Inner Mongolia.Methods The investigation was carried out in Chenbaerhuqi Country and Eweukeqi Country.Seventy-two households of four villages in Chenbaerhuqi and 11 households of three villages in Ewenkeqi were selected as study subjects.The brick-tea in each household was sampled.The contents of fluoride and tea polyphenols were determined by using fluoride selective electrode method and Forint-Ciocalteu oxidation method,respectively.T test and linear correlation were used to analyze the data.Results The fluoride content in qualified brick tea ranged from 114.82 mg/kg to 290.23 mg/kg with an average value of 171.78 mg/kg,while tea polyphenols content was between 56.15 g/kg and 132.18 g/kg with an average value of 95.44 g/kg.In unqualified brick-tea,the average fluoride content was 459.86 mg/kg with the range from 304.71 mg/kg to 660.76 mg/kg and the average of tea polyphenols was 67.48 g/kg with the range from 36.03 g/kg to 102.15 g/kg.The content of tea polyphenols of qualified brick tea was significantly higher than that of unqualified brick tea (P ＜ 0.05).The content of tea polyphenols was negatively correlated with fluoride content(r =-0.636,P ＜ 0.05).The content of tea polyphenols was 396 times more than that of fluoride in brick tea.The utilization ratio of qualified brick-tea in the investigation areas was 53.0％(44/83).Conclusion The fluoride content in qualified brick-tea was less than unqualified brick-tea,and the tea polyphenols of qualified brick-tea was higher than the unqualified brick-tea.The utilization rate of qualified brick tea is not high and further actions are needed to be taken to supply more qualified brick-tea for controlling of drinking brick-tea type fluorosis.
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Objective: To study the secondary metabolites of Eurotium cristatum from Fu Brick Tea and their biological activities. Methods: The compounds were isolated by various column chromatographies on normal phase silica gel, reversed silica gel, Sephadex LH-20, preparative TLC, and recrystallization. The structures were identified by the extensive analysis on their spectroscopic data. The inhibitory effects of compounds 1-9 against SF-268, MCF-7, and NCI-H460 cell lines were tested in vitro by SRB method. The inhibitory effects of compounds 2-9 on Staphyloccocus aureus, Escherichia coli, Salmonella enterica subsp. enterica, Shigella dysenteriae, and Proteus vulgaris were tested by MTT method. Results: Nine compounds were isolated from the extract of liquid fermentation broth of E. cristatum in Fu Brick Tea and identified as physcion (1), 1, 5-dihydroxy-3-methoxy-7-methyl-anthracene-9,10-dione (2), flavoglaucin (3), 2-(2', 3-epoxy-1', 3'-heptadienyl)-6-hydroxy-5-(3-methyl-2-butenyl) benzaldehyde (4), 2-(2', 3-epoxy-1', 3', 5'-heptatrienyl)-6-hydroxy-5-(3-methyl-2-butenyl) benzaldehyde (5), isodihydroauroglaucin (6), tyrosol (7), p-hydroxybenzoic acid (8), and orcinol (9). The results of the bioactivity test showed that compounds 3-6 displayed the good cytotoxic acitivities against the three tumor cell lines, and all the compounds exhibited the strong inhibitory activities against P. vulgaris except compounds 1 and 6. Besides, compound 9 also showed the significant inhibitory effects against S. aureus and E. coli. Conclusion: The benzaldehyde compounds are considered as the main metabolites of E. cristatum, compounds 7 and 9 are reported from the species of genus Eurotium Link: Fr. for the first time and compounds 2, 3, 5, 6, and 8 are firstly isolated from the fungus.