Associations of multiple exposures to persistent toxic substances with the risk of hyperuricemia and subclinical uric acid levels in BIOAMBIENT.ES study.

Hyperuricemia is becoming a serious public health issue, which is highly influenced by environmental factors, although there is still controversial information on the potential influence of the exposure to Persistent Toxic Substances (PTSs) in the general population. In this study we aimed to assess the association. PTS exposure with uric acid homeostasis in a sample of the Spanish population. Participants were recruited during 2009-2010 in all the main geographical areas of Spain. Exposure to 34 PTSs was estimated by chemical analyses of serum levels of 6 Polychlorinated Biphenyls (PCBs, n = 950), 13 Organochlorine Pesticides (OCPs, n = 453), 6 Perfluoroalkyl Substances (PFAs, n = 755), 7 Polybrominated Diphenyl Ethers (PBDEs, n = 365), urinary Cadmium (n = 926), and Lead in whole blood (n = 882). The two study outcomes were defined as the prevalence of hyperuricemia in the study population and uric acid levels, the latter only in individuals with no previous diagnosis of hyperuricemia. Statistical analyses were performed by means of binomial logistic regression and linear regression, and mixture effects were screened using Weighted Quantile Sum Regression (WQS). Serum concentrations of γ-HCH, o,p´-DDE, PCB-138, PCB-153, PFOA, and urinary Cadmium were associated with an increased risk of hyperuricemia, while PBDE-153 showed an inverse association with the effect. Furthermore, exposure to Cadmium, PCB-138, and to PCB-153 was positively associated with uric acid levels. Results were consistent after lipid adjustment or standardization. WQS analyses revealed a major contribution of PCB-153 within the PCB mixture on both the risk of hyperuricemia and uric acid levels. Sensitivity analyses were performed by adjusting for dietary habits, fasting glucose and estimated glomerular filtration rate. Overall, we found novel associations between human exposure to mixtures of PTSs and disturbances in uric acid homeostasis. However, we cannot completely rule out potential residual confounding effect or reversed-causality related to the cross-sectional design.

Perfluorinated alkyl substances in Spanish adults: Geographical distribution and determinants of exposure.

Per- and polyfluoroalkyl substances (PFAS) are widely found in humans and the environment. Their persistence, bioaccumulation and toxicity make them a source of increasing public health concern. In this study, we analyzed the concentrations and geographical distribution of six PFAS in the serum of 755 Spanish adults aged 18-65. The geometric mean concentrations (and P95 values) for PFOS (perfluoroctane sulfonate), PFOA (perfluorooctanoic acid), PFHxS (perfluorohexane sulfonate), PFNA (perfluorononanoic acid) and PFDA (perfluorodecanoic acid) were 7.67 (19.3), 1.99 (5.48), 0.91 (2.84), 0.96 (2.44) and 0.42 (0.99) µg/L, respectively. N-Methylperfluorooctane sulfonamide (N-MeFOSAA) was detected in only 3.3% of samples. Residents in northeast (Catalonia) and northwest of Spain (Galicia) were found to have the highest serum values, whereas residents in the Canary Islands had the lowest values for almost all PFAS. Men presented higher levels than women, and we confirm that lactation (breastfeeding) contributes to a reduced body burden for all PFAS in women. Our data provide new information on exposure to PFAS in a national cross section sample of Spanish adults, thus providing a proxy for reference values for the Spanish population and forming the base for following temporal trends in the future.

Organochlorinated pesticides levels in a representative sample of the Spanish adult population: The Bioambient.es project.

Organochlorinated pesticides (OCPs) were measured in a representative sample of Spanish adults within the Bioambient.es project, a nationwide human biomonitoring program promoted by Spanish Ministry of Agriculture, Food and Environment. The objective of Bioambient.es is to establish reference levels of environmental pollutants in the general population. Participants were recruited in 2009-2010 during their annual medical examination at work. Serum levels of thirteen OCPs were investigated: Aldrin, endrin, dieldrin, heptachlor, heptachlor-epoxide, dichlorodiphenyldichloroethylenes (DDEs), hexachlorobenzene (HCB), dichlorodiphenyltrichloroethanes (DDTs) and hexachlorocyclohexanes (HCHs) The highest concentrations were observed for DDE, HCB and ß-HCH. The 95th percentile, in ng/g lipids, were: 717.7 for 4,4-DDE, 160.4 for HCB and 107.2 for ß-HCH, while concentrations of aldrin, endrin, heptachlor, α-HCH, 2,4-DDT, 4,4-DDT and 2,4-DDE were markedly lower and detected in less than 10% of the samples. Significant differences (p<0.05) were found for DDE and HCB and seasonality, gender and age. Analyzing the geographical distribution, participants from the north of Spain had highest levels of HCB while those from the center of Spain had highest levels of 4,4-DDE. Comparing to earlier studies, the results indicated a sharp decline in the OCP concentrations in the Spanish population over time, and today values are in the same range or lower than those reported in similar studies worldwide, except for HCHs and HCB that presented higher levels than in other European countries and much higher than those observed in US and Canada. This study represents the first nationwide survey of exposure to OCPs in Spain and provides a background reference range for exposure to OCPs in the Spanish adult occupied population. These results will allow establishing reference values, observing temporal trends and identifying high exposure groups.

A fast method for analysing six perfluoroalkyl substances in human serum by solid-phase extraction on-line coupled to liquid chromatography tandem mass spectrometry.

We have developed and validated an on-line TurboFlow solid-phase extraction procedure coupled to high-performance liquid chromatography with tandem mass spectrometry for the analysis of six perfluoroalkyl substances (PFAS), two sulfonates (perfluorooctane sulfonate and perfluorohexane sulfonate), three carboxylates (perfluorooctanoic acid, perfluorononanoic acid and perfluorodecanoic acid), and one sulfonamide (N-methylperfluorooctane sulfonamide), in human serum samples. This method requires only 100 µL of sample and involves a short pre-treatment with acetonitrile followed by addition of a labelled internal standard for quantification and ultracentrifugation. All PFAS were detected with a run time of 8.5 min. Linearity ranges stay between 0.1 and 20 µg L(-1) (R (2) > 0.9960). Recoveries were determined by spiking blank serum samples with a mixture of six PFAS and found to be in the range 96-110 % for all compounds. Isotopic dilution was used to quantify the selected analytes. The low limits of quantification obtained, between 0.16 and 0.34 µg L(-1), small volume of sample required and short run time used (from two to three times shorter than any other described method), make this validated method highly recommended for human biomonitoring studies.

Urinary polycyclic aromatic hydrocarbon metabolites levels in a representative sample of the Spanish adult population: The BIOAMBIENT.ES project.

In 2009, the Spanish Ministry of Agriculture, Food and Environment promoted the BIOAMBIENT.ES project, a Human Biomonitoring program on the national scale to estimate reference levels of environmental pollutants on a representative sample of the Spanish adults. The present study focuses on polycyclic aromatic hydrocarbons (PAHs). The urinary metabolites 1-hydroxypyrene, 1-,2-,3-,4- and 9-hydroxyphenanthrene and 3-hydroxybenzo[a]pyrene were selected as indicators of PAH exposure. Urine samples from 957 subjects (16-65 years old) were collected during year 2009-2010. Geometric mean and 95th percentile for 1-hydroxypyrene in µg g(-1) creatinine were 0.117 (non-smoker: 0.079, smokers: 0.184) and 0.67 µg g(-1) creatinine (non-smokers: 0.31, smokers: 0.69) respectively. GM and 95th percentile for sum of hydroxyphenanthrenes in µg g(-1) creatinine were 0.130 (non-smokers: 0.089, smokers: 0.317) and 1.29 (non-smokers: 0.71, smokers: 1.51) respectively. 3-Hydroxybenzo[a]pyrene was below the limit of quantitation (0.05 µg L(-1)) in all cases. Significant differences (p<0.05) regarding smokers and non-smokers, coal and wood heating, body mass index and second hand smoke were found, while other variables like gender, age, or diet showed no significant association. The geographical distribution of the metabolites showed higher levels in people who lived in the north and northwest of Spain. The PAH metabolites levels found were in the same range or lower than those reported from other European countries and they were higher than those found in the U.S. This study represents the first nationwide survey of exposure to PAHs in Spain and provides a background reference range for exposure to PAHs in the Spanish adult occupied population.

Anti-smoking legislation and its effects on urinary cotinine and cadmium levels.

Anti-smoking legislation has been associated with an improvement in health indicators. Since the cadmium (Cd) body burden in the general population is markedly increased by smoke exposure, we analyzed the impact of the more restrictive legislation that came into force in Spain in 2011 by measuring Cd and cotinine in first morning urine samples from 83 adults in Madrid (Spain) before (2010) and after (2011) introduction of this law. Individual pair-wise comparisons showed a reduction of creatinine corrected Cotinine and Cd levels for non-active smokers, i. e. those which urinary cotinine levels are below 50 µg/L. After the application of the stricter law, cotinine levels in urine only decreased in non-active smokers who self-reported not to be exposed to second-hand smoke. The reduction in second hand smoke exposure was significantly higher in weekends (Friday to Sunday) than in working days (Monday to Thursday). The decrease in U-Cd was highly significant in non-active smokers and, in general, correlated with lower creatinine excretion. Therefore correction by creatinine could bias urinary Cd results, at least for cotinine levels higher than 500 µg/L. The biochemical/toxicological benefits detected herein support the stricter application of anti-smoking legislation and emphasize the need to raise the awareness of the population as regards exposure at home.

Communication in a Human biomonitoring study: Focus group work, public engagement and lessons learnt in 17 European countries.

A communication strategy was developed by The Consortium to Perform Human Biomonitoring on a European Scale (COPHES), as part of its objectives to develop a framework and protocols to enable the collection of comparable human biomonitoring data throughout Europe. The framework and protocols were tested in the pilot study DEMOCOPHES (Demonstration of a study to Coordinate and Perform Human biomonitoring on a European Scale). The aims of the communication strategy were to raise awareness of human biomonitoring, encourage participation in the study and to communicate the study results and their public health significance. It identified the audiences and key messages, documented the procedure for dissemination of results and was updated as the project progressed. A communication plan listed the tools and materials such as press releases, flyers, recruitment letters and information leaflets required for each audience with a time frame for releasing them. Public insight research was used to evaluate the recruitment material, and the feedback was used to improve the documents. Dissemination of results was coordinated in a step by step approach by the participating countries within DEMOCOPHES, taking into account specific national messages according to the needs of each country. Participants received individual results, unless they refused to be informed, along with guidance on what the results meant. The aggregate results and policy recommendations were then communicated to the general public and stakeholders, followed by dissemination at European level. Several lessons were learnt that may assist other future human biomonitoring studies. Recruitment took longer than anticipated and so social scientists, to help with community engagement, should be part of the research team from the start. As a European study, involving multiple countries, additional considerations were needed for the numerous organisations, different languages, cultures, policies and priorities. Therefore, communication documents should be seen as templates with essential information clearly indicated and the option for each country to tailor the material to reflect these differences. Future studies should consider setting up multidisciplinary networks of medical professionals and communication experts, and holding training workshops to discuss the interpretation of results and risk communication. Publicity and wide dissemination of the results helped to raise awareness of human biomonitoring to the general public, policy makers and other key stakeholders. Effective and timely communication, at all stages of a study, is essential if the potential of human biomonitoring research to improve public health is to be realised.

High-performance liquid chromatography with diode-array detection cotinine method adapted for the assessment of tobacco smoke exposure.

Smoking is considered to be one of the main risk factors for cancer and other diseases and is the second leading cause of death worldwide. As the anti-tobacco legislation implemented in Europe has reduced secondhand smoke exposure levels, analytical methods must be adapted to these new levels. Recent research has demonstrated that cotinine is the best overall discriminator when biomarkers are used to determine whether a person has ongoing exposure to tobacco smoke. This work proposes a sensitive, simple and low-cost method based on solid-phase extraction and liquid chromatography with diode array detection for the assessment of tobacco smoke exposure by cotinine determination in urine. The analytical procedure is simple and fast (20 min) when compared to other similar methods existing in the literature, and it is cheaper than the mass spectrometry techniques usually used to quantify levels in nonsmokers. We obtained a quantification limit of 12.30 µg/L and a recovery of over 90%. The linearity ranges used were 12-250 and 250-4000 µg/L. The method was successfully used to determine cotinine in urine samples collected from different volunteers and is clearly an alternative routine method that allows active and passive smokers to be distinguished.

The European COPHES/DEMOCOPHES project: towards transnational comparability and reliability of human biomonitoring results.

COPHES/DEMOCOPHES has its origins in the European Environment and Health Action Plan of 2004 to "develop a coherent approach on human biomonitoring (HBM) in Europe". Within this twin-project it was targeted to collect specimens from 120 mother-child-pairs in each of the 17 participating European countries. These specimens were investigated for six biomarkers (mercury in hair; creatinine, cotinine, cadmium, phthalate metabolites and bisphenol A in urine). The results for mercury in hair are described in a separate paper. Each participating member state was requested to contract laboratories, for capacity building reasons ideally within its borders, carrying out the chemical analyses. To ensure comparability of analytical data a Quality Assurance Unit (QAU) was established which provided the participating laboratories with standard operating procedures (SOP) and with control material. This material was specially prepared from native, non-spiked, pooled urine samples and was tested for homogeneity and stability. Four external quality assessment exercises were carried out. Highly esteemed laboratories from all over the world served as reference laboratories. Web conferences after each external quality assessment exercise functioned as a new and effective tool to improve analytical performance, to build capacity and to educate less experienced laboratories. Of the 38 laboratories participating in the quality assurance exercises 14 laboratories qualified for cadmium, 14 for creatinine, 9 for cotinine, 7 for phthalate metabolites and 5 for bisphenol A in urine. In the last of the four external quality assessment exercises the laboratories that qualified for DEMOCOPHES performed the determinations in urine with relative standard deviations (low/high concentration) of 18.0/2.1% for cotinine, 14.8/5.1% for cadmium, 4.7/3.4% for creatinine. Relative standard deviations for the newly emerging biomarkers were higher, with values between 13.5 and 20.5% for bisphenol A and between 18.9 and 45.3% for the phthalate metabolites. Plausibility control of the HBM results of all participating countries disclosed analytical shortcomings in the determination of Cd when using certain ICP/MS methods. Results were corrected by reanalyzes. The COPHES/DEMOCOPHES project for the first time succeeded in performing a harmonized pan-European HBM project. All data raised have to be regarded as utmost reliable according to the highest international state of the art, since highly renowned laboratories functioned as reference laboratories. The procedure described here, that has shown its success, can be used as a blueprint for future transnational, multicentre HBM projects.