Social distribution of internal exposure to environmental pollution in Flemish adolescents.

BACKGROUND: Environmental justice research suggests that inequalities in the distribution of environmental exposure to chemical pollution systematically disadvantage the lower social strata of society. The effects of these inequalities on the human exposure to pollution are however to a large extend unknown. The purpose of this study is to assess social gradients in human biomonitoring results of a representative sample of Flemish adolescents. METHODS: We investigate the associations between individual socioeconomic status (SES), measured by parental educational attainments, and internal body concentration of seven chemical compounds in biological samples of 1642 adolescents aged 14-15 in Flanders (Belgium): PCBs, HCB, DDE, lead, cadmium, benzene and PAHs. Social gradients in average and high exposure to these biomarkers were examined with geometric means and odds ratios (with 95% confidence intervals), using multiple regression models, controlling for covariates and confounders. RESULTS: Depending on the (type of) pollutant, adolescents with a lower SES either have higher or lower internal concentrations. Chlorinated compounds (PCBs and pesticides HCB and DDE) are positively associated with SES (higher exposures for higher SES), while heavy metals (lead and cadmium) are negatively associated (higher exposures for lower SES). For metabolites of organic compounds (benzene and PAHs) we find no association with SES. Socially constructed factors, such as dietary and lifestyle habits, play an important role in these relations. CONCLUSIONS: Our study suggests that the association between individual SES and the internal body concentration of exposure to environmental pollutants in Flemish adolescents is more complex than can be assumed on the basis of the environmental justice hypothesis.

Internal exposure to pollutants and sexual maturation in Flemish adolescents.

Flanders is densely populated with much industry and intensive farming. Sexual maturation of adolescents (aged 14-15 years) was studied in relation to internal exposure to pollutants. Serum levels of pollutants and sex hormones were measured in 1679 participants selected as a random sample of the adolescents residing in the study areas. Data on sexual development were obtained from the medical school examination files. Self-assessment questionnaires provided information on health, use of medication and lifestyle factors. In boys, serum levels of hexachlorobenzene (HCB), p,p'-DDE and polychlorinated biphenyls (sum of marker PCB138, 153 and 180) were significantly and positively associated with pubertal staging (pubic hair and genital development). Higher levels of serum HCB and blood lead were associated with, respectively, a lower and a higher risk of gynecomastia. In girls, significant and negative associations were detected between blood lead and pubic hair development; higher exposure to PCBs was significantly associated with a delay in timing of menarche. Environmental exposures to pollutants at levels actually present in the Flemish population are associated with measurable effects on pubertal development. However, further understanding of toxic mode of action and sensitive windows of exposure is needed to explain the current findings.

Internal exposure to pollutants and sex hormone levels in Flemish male adolescents in a cross-sectional study: associations and dose-response relationships.

Flanders is densely populated with much industry and intensive farming. Hormonal status of 14- to 15-year-old male adolescents was studied in relation to internal exposure to pollutants. A total of 887 participants were selected as a random sample of the adolescents residing in the study areas. Confounding factors and significant covariates were taken into account. Serum levels of testosterone, free testosterone and estradiol, and the aromatase index showed significant positive associations with serum levels of marker polychlorobiphenyls (sum of PCBs 138, 153, and 180) and of hexachlorobenzene (HCB) and a negative association with urinary cadmium concentration. Serum levels of estradiol also showed a positive association with serum levels of dichlorodiphenyldichloroethylene (DDE). A doubling of serum concentrations of marker PCBs and HCB and of urinary concentration of cadmium were, respectively, associated with an increase of 16.4% (P<0.00001) and 16.6% (P<0.001) and a decrease of 9.6% (P<0.001) in serum testosterone concentration. Similar findings were made after additional adjustment for concurrent exposures. Associations between biological effects and internal exposures were, in terms of the regression coefficient, often stronger at exposures below the median. Environmental exposures to pollutants resulting in "normal" levels of internal exposure were associated with quite substantial differences in hormone concentrations.

Internal exposure to pollutants and body size in Flemish adolescents and adults: associations and dose-response relationships.

Flanders is densely populated with much industry and intensive farming. Body size of 14- to 15-year old adolescents and of adults aged 50-65 was studied in relation to internal exposure to pollutants. 1679 adolescents (887 boys and 792 girls), 775 men and 808 women were selected as a random sample of the population. Concentrations of pollutants in blood or urine were measured in accordance with quality control/quality assurance procedures. Self-assessment questionnaires provided information on personal and life-style factors. Height and weight of subjects were measured. Confounding factors and significant covariates were taken into account. For boys and girls, height and body mass index (BMI) showed a negative association with urinary concentration of cadmium and BMI also with serum concentration of hexachlorobenzene (HCB) and with the sum of serum concentrations of polychlorinated biphenyls (PCBs) 138, 153, and 180 (marker PCBs), whereas BMI showed a positive association with serum concentration of PCB 118. For boys, height showed a negative association with urinary concentration of 1-hydroxypyrene (1-OHP) and positive associations with serum concentrations of HCB and PCB 118. For adults no significant associations between internal exposure and height were observed. For men, BMI showed negative associations with urinary cadmium concentration and with serum levels of marker PCBs and positive associations with serum levels of HCB, p,p'-dichlorodiphenyldichloroethylene (p,p'-DDE), PCB 118 and the dioxin fraction of dioxin-like activity. For women, BMI showed a negative association with urinary cadmium concentration, with blood lead concentration and with the concentration of marker PCBs in serum, and a positive association with serum concentrations of HCB, p,p'-DDE and PCB 118. Associations between biological effects and internal exposures were, in terms of the regression coefficient, often stronger at exposures below the median. Environmental exposures to pollutants resulting in "normal" levels of internal exposure were associated with quite substantial differences in body mass index.

Cross-language differential item functioning of the job content questionnaire among European countries: the JACE study.

BACKGROUND: Little is known about cross-language measurement equivalence of the job content questionnaire (JCQ) PURPOSE: The purposes of this study were to assess the extent of cross-language differential item functioning (DIF) of the 27 JCQ items in six languages (French, Dutch, Belgian-French, Belgian-Dutch (Flemish), Italian, and Swedish) from six European research centers and to test whether its effects on the scale-level mean comparisons among the centers were substantial or not. METHOD: A partial gamma coefficient method was used for statistical DIF analyses where the Flemish JCQ was the reference for other language versions. Additionally, equivalence between the Flemish and Dutch translations was subjected to a judgmental review. RESULTS: On average, 36% to 39% of the total tested items appeared to be cross-language DIF items in the statistical analyses. The judgmental review indicated that half of the DIF items may be associated with translation difference. The impacts of the DIF items on the mean comparisons of the JCQ scales between the centers were non-trivial: underestimated skill discretion (Milan), underestimated decision authority (Leiden), underestimated psychological demands (Milan women), and incomparable coworker support (Gothenburg 95). CONCLUSION: Cross-language DIF of the JCQ among European countries should be considered in international comparative studies on psychosocial job hazards using JCQ scales.

Organochlorine and heavy metals in newborns: results from the Flemish Environment and Health Survey (FLEHS 2002-2006).

To collect regional information on internal levels of pollutants in humans in Flanders, 1196 mother-child pairs were systematically recruited in 2002-2003 via 25 maternities across Flanders. Cd, Pb, PCB congeners 118, 170, 138, 153 and 180, p,p'-DDE - a key metabolite of DDT- and hexachlorobenzene (HCB) were measured in cord blood or plasma. Cd was detected in 64% of the samples (geometric mean 0.21 microg/L cord blood). p,p'-DDE (110 ng/g plasma lipids) and Pb (14.7 microg/L blood), were measurable in nearly all samples. The individual PCB congeners could be detected in 40 to 81% of the newborns (138+153+180=64.4 ng/g plasma lipids). HCB (18.9 ng/g plasma lipids) and dioxin-like compounds measured by DR-CALUX(R) (23 pg CALUX-TEQ/g lipids) were above detection limit in more than 75% of the samples. Age and smoking habits of the mothers, did not influence the cord blood Pb and Cd levels. The organochlorines increased 4 to 9% per year of the mother's age (partial R(2)=0.05 to 0.22). Mothers had 2.6% less PCBs in cord blood (partial R(2)=0.02) for each unit increase in pre-pregnancy BMI. Season of delivery, breastfeeding previous children or consumption of local dairy products, were minor determinants. Up to 20% of the variability in organochlorine concentrations was explained by residence area. It was concluded that the place of birth in Flanders is an important determinant of the load of pollutants measured at the start of life. This underlines the validity of human biomonitoring on (relatively) small geographical scale.

The relation between the estimated dietary intake of PCDD/Fs and levels in blood in a Flemish population (50-65 years).

Dioxin-like activity was measured in the serum of 1425 Flemish men and women via the CALUX assay. The adults, aged between 50 and 65 years, participated in a large biomonitoring program, executed by the Flemish Center of Expertise for Environment and Health between 2002 and 2006. Within the context of this biomonitoring program also dietary intake of dioxin-like contaminants was assessed through a food frequency questionnaire. The relation between the estimated dietary intake and the dioxin-like activity in serum was evaluated using multivariate analyses: a logistic model was performed on the total population, while a linear regression analysis was done on the subsample with quantifiable dioxin activity levels in serum. Region, gender, age, BMI, smoking status, as well as dietary habits were entered in the model, with dioxin level as an outcome estimate. Both the logistic and linear model confirmed the contribution of dietary intake to the dioxin activity measured in serum. Also BMI and region were found to be associated with dioxin activity levels.

Dietary exposure to total and toxic arsenic in Belgium: importance of arsenic speciation in North Sea fish.

Total and toxic (sum of As(III), As(V), monomethylarsenic (MMA), and dimethylarsenic (DMA)) As concentrations were assessed in 19 respectively 4 different fish and shellfish species from the North Sea. Following results were obtained: (i) for fish an average total As concentration of 12.8 microg/g ww and a P90 value of 30.6 microg/g ww; (ii) for shellfish an average total As concentration of 21.6 microg/g ww and a P90 value of 40.0 microg/g ww; (iii) for fish an average toxic As concentration of 0.132 microg/g ww and a P90 value of 0.232 microg/g ww; (iv) for shellfish an average toxic As concentration of 0.198 microg/g ww and a P90 value of 0.263 microg/g ww. For the Belgian consumer the average daily intake of total arsenic from fish, shellfish, fruit, and soft drinks (the main food carriers of As in Belgium) amounts to 285 microg/day with more than 95% coming from fish and shellfish, while for a high level consumer it amounts to 649 microg/day, more than twice the average value. Using the same daily consumption pattern for the selected food products as for total As, we find that the average daily intake of toxic As amounts to 5.8 microg/day, with a 50% contribution of fish and shellfish and the high level intake to 9.5 microg/day. When considering the FOA/WHO Expert Committee's recommendation for inorganic As intake of 2 microg/kg bw/day or 140 microg/day for a 70 kg person, the toxic dose in Belgium is thus an order of magnitude lower.

Reproducibility and relative validity of a semi-quantitative food frequency questionnaire designed for assessing the intake of dioxin-like contaminants.

OBJECTIVE: The aim of this study was to assess the reproducibility and relative validity of a food frequency questionnaire (FFQ) designed to estimate the intake of dioxin-like contaminants. METHOD: In total, 180 adults (50-65 years) completed the FFQ twice and 157 of them kept four times a 2-day estimated dietary record (EDR) spread over a year. RESULTS: Spearman rank correlation coefficients varied between 0.58 and 0.67 for reproducibility, versus between 0.28 and 0.46 for validity for the different food groups under study. Exact agreement within quartiles was between 34% and 39%, only between 3% and 9% was grossly misclassified. The weighed kappa statistics indicated fair agreement between the two methods (0.29 for the total diet). The correction factors used had a relevant influence on the absolute estimated intake. CONCLUSION: The FFQ presented here is a valuable tool for ranking individuals in the study population on the basis of estimated intake of dioxin-like contaminants. However, absolute intakes should be estimated without correction factors and interpreted with caution.

Pollutant effects on genotoxic parameters and tumor-associated protein levels in adults: a cross sectional study.

BACKGROUND: This study intended to investigate whether residence in areas polluted by heavy industry, waste incineration, a high density of traffic and housing or intensive use of pesticides, could contribute to the high incidence of cancer observed in Flanders. METHODS: Subjects were 1583 residents aged 50-65 from 9 areas with different types of pollution. Cadmium, lead, p,p'-DDE, hexachlorobenzene, PCBs and dioxin-like activity (Calux test) were measured in blood, and cadmium, t,t'-muconic acid and 1-hydroxypyrene in urine. Effect biomarkers were prostate specific antigen, carcinoembryonic antigen and p53 protein serum levels, number of micronuclei per 1000 binucleated peripheral blood cells, DNA damage (comet assay) in peripheral blood cells and 8-hydroxy-deoxyguanosine in urine. Confounding factors were taken into account. RESULTS: Overall significant differences between areas were found for carcinoembryonic antigen, micronuclei, 8-hydroxy-deoxyguanosine and DNA damage. Compared to a rural area with mainly fruit production, effect biomarkers were often significantly elevated around waste incinerators, in the cities of Antwerp and Ghent, in industrial areas and also in other rural areas. Within an industrial area DNA strand break levels were almost three times higher close to industrial installations than 5 kilometres upwind of the main industrial installations (p < 0.0001). Positive exposure-effect relationships were found for carcinoembryonic antigen (urinary cadmium, t,t'-muconic acid, 1-hydroxypyrene and blood lead), micronuclei (PCB118), DNA damage (PCB118) and 8-hydroxy-deoxyguanosine (t,t'-muconic acid, 1-hydroxypyrene). Also, we found significant associations between values of PSA above the p90 and higher values of urinary cadmium, between values of p53 above the p90 and higher serum levels of p,p'-DDE, hexachlorobenzene and marker PCBs (PCB 138, 153 and 180) and between serum levels of p,p'-DDE above the p90 and higher serum values of carcinoembryonic antigen. Significant associations were also found between effect biomarkers and occupational or lifestyle parameters. CONCLUSION: Levels of internal exposure, and residence near waste incinerators, in cities, or close to important industries, but not in areas with intensive use of pesticides, showed positive correlations with biomarkers associated with carcinogenesis and thus probably contribute to risk of cancer. In some rural areas, the levels of these biomarkers were not lower than in the rest of Flanders.

Probabilistic intake assessment of polybrominated diphenyl ethers and omega-3 fatty acids through fish consumption.

Food intake is one of the principal exposure routes of polybrominated diphenyl ethers (PBDEs) in humans. This study focuses on fish consumption as a PBDE exposure route. A probabilistic intake assessment of PBDEs and healthy long chain omega-3 PUFAs (LC n-3 PUFAs) was conducted for Belgian fish consumers in order to study the balance of the intake of LC n-3 PUFAs and PBDEs. Based on the observed fish consumption level in the sample, the mean intake of brominated diphenyl ether (BDE)-28, 47, 99, 100, 153, and 154 via fish was 0.85 ng/kg body weight (bw)/day and the intake of LC n-3 PUFAs was 3.45 mg/kg bw/day, being low compared to the recommendations. Scenario analyses showed that consuming 150 g salmon twice a week is advisable to achieve the recommended LC n-3 PUFA intake with a rather low PBDE intake. When replacing 150 g salmon by herring, the PBDE intake is higher without an increase in LC n-3 PUFAs. In contrast, the combination of cod and salmon leads to a similar PBDE intake compared to twice a week salmon, but to a lower LC n-3 PUFA intake. In conclusion, the methodology presented in the paper allows balancing benefits and risks related to fish consumption.

Intake assessment for benzoates in different subgroups of the Flemish population.

An exposure assessment was performed to estimate the daily intake of benzoates for the Flemish population. Three age groups were considered: preschool children (n=697; age 2-6; 3-day estimated dietary record), adolescents (n=341; age 14-18; 7-day estimated dietary record) and women (n=641; age 18-40; 2-day estimated dietary record). In a first step in the risk evaluation process as proposed by the European Union, the individual food consumption data were multiplied with the maximum permitted use levels for benzoates per food group. The median (interquartile range) estimated daily intake is, respectively, 2.0 (1.0-3.2) mg/kg bw, 1.7 (1.1-2.7) mg/kg bw and 1.92 (1.3-3.0) mg/kg bw for preschool children, adolescents and adult women. In all age groups, the greatest potential contributor to the total estimated benzoate intake was the group of non-alcoholic flavoured drinks. At respectively the 92nd percentile (children), the 97th percentile (adolescents) and the 94th percentile (women), the accepted daily intake (ADI) of 5mg/kg bw/day is exceeded slightly. However, this approach, in which the maximum permitted use levels are used is known to overestimate the intake, since not all food items in which benzoates are allowed, contain (the maximum permitted use level of) benzoates. A more precise estimation, using actual levels, is recommended.

Dietary exposure to dioxin-like compounds in three age groups: results from the Flemish environment and health study.

Lipophilic contaminants are present in the environment and bioaccumulate in the food chain. Therefore, their intake via animal fat of various sources was assessed for three age groups of the Flemish population, participating in a large biomonitoring program of the Flemish government. In total, 1636 adolescents (14-15 years), 1186 mothers (18-44 years), and 1586 adults (50-65 years) participated in the study and completed a semi quantitative food frequency questionnaire. Individual consumption data were combined, via a so-called simple distribution approach, with recent data on polychlorinated dibenzo-p-dioxins/furans and dioxin-like polychlorinated biphenyls, measured via the chemical-activated luciferase gene expression (CALUX) bio-assay in food items available on the Flemish market. The median (95th percentile) estimated intakes of dioxin-like contaminants were 2.24 (4.61), 2.09 (4.26), and 1.74 (3.53) pg CALUX-TEQ kg(-1) bw d(-1) for, respectively adolescents, mothers and adults. These data are in the same range as those found in other European studies. The CALUX-TEQ results of respectively 59.8%, 53.7% and 36.2% of the adolescent, mother and adult population exceed the tolerable weekly intake (TWI) of 14 pg WHO-TEQ kg(-1) bw w(-1), as derived by the Scientific Committee on Food [Scientific Committee on Food, 2001. Opinion of the Scientific Committee on Food on the Risk Assessment of Dioxins and Dioxin-like PCBs in Food, CS/CNTM/DIOXIN/20 final Brussels, Belgium]. The main contributors of dioxin-like substances are fish and seafood (25-43% of the total intake), added fats (22-25% of the total intake) and dairy products (17-20% of the total intake).

Exposure of maintenance workers to dioxin-like contaminants during the temporary shutdown of a municipal domestic solid waste incinerator: a case series.

To evaluate workers' exposure to dioxin-like substances (such as polychlorinated dibenzo-p-dioxins, dibenzofurans, and polychlorinated biphenyls), the authors used a chemical-activated luciferase gene expression (CALUX) assay to determine serum dioxin-like activity in five workers before and after two different cleaning-up activities inside a municipal domestic solid-waste incinerator. The workers' mean serum concentration of dioxin-like substances before the first cleaning operation, shown as a weighted value of toxic equivalents (or TEQs) according to the CALUX test, was 17.2 pg CALUX TEQ/g fat (range = 12-22), which is comparable with concentrations found in similarly aged men in a Flemish environmental health pilot study. After cleaning work, the workers' mean serum concentration was 28.5 pg CALUX TEQ/g fat (range = 18-31). At the second plant stoppage, the workers' mean dioxin-like activity was 15.4 pg CALUX TEQ/g fat (range = 12-21) before and 16.4 pg CALUX TEQ/g fat (range = < 10-32, where 10 pg is the limit of determination) after the cleaning operation. These results indicate that workers may be exposed to dioxin-like substances during their performance of cleaning operations in a municipal domestic solid-waste incinerator.