Assessment of drinking water safety in the Netherlands using nationwide exposure and mortality data.

BACKGROUND: Although drinking water in the Netherlands is generally accepted as safe, public concern about health risks of long-term intake still exist. OBJECTIVE: The aim was to explore associations between drinking water quality for nitrate, water hardness, calcium and magnesium and causes-of-death as related to cardiovascular diseases amongst which coronary heart disease and colorectal cancer. METHODS: We used national administrative databases on cause-specific mortality, personal characteristics, residential history, social economic indicators, air quality and drinking water quality for parameters specified by the EU Drinking Water Directive. We put together a cohort of 6,998,623 persons who were at least 30 years old on January 1, 2008 and lived for at least five years on the same address. The average drinking water concentration over 2000-2010 at the production stations were used as exposure indicators. We applied age stratified Cox proportional hazards models. RESULTS: Magnesium was associated with a reduced risk for mortality due to coronary heart diseases: HR of 0.95 (95% CI: 0.90, 0.99) per 10 mg/L increase. For mortality due to cardiovascular diseases, a 100 mg/L increase in calcium was associated with a HR of 1.08 (95% CI: 1.03, 1.13) and an increase of 2.5 mmol/L of water hardness with a HR of 1.06 (95% CI: 1.01, 1.10). The results show an elevated risk for coronary heart disease mortality at calcium concentrations below 30 mg/L, but over the whole exposure range no exposure response relation was observed. For other combinations of drinking water quality parameters and cause-specific mortality studied, no statistical significant associations were identified. CONCLUSION: We identified in this explorative study a protective effect of magnesium for the risk of mortality to coronary heart disease. Also we found an increased risk of mortality due to cardiovascular disease associated with the concentration of calcium and the water hardness in drinking water.

Assessment of the combined nitrate and nitrite exposure from food and drinking water: application of uncertainty around the nitrate to nitrite conversion factor.

Dietary exposure to nitrate and nitrite occurs via three main sources; occurrence in (vegetable) foods, food additives in certain processed foods and contaminants in drinking water. While nitrate can be converted to nitrite in the human body, their risk assessment is usually based on single substance exposure in different regulatory frameworks. Here, we assessed the long-term combined exposure to nitrate and nitrite from food and drinking water. Dutch monitoring data (2012-2018) and EFSA data from 2017 were used for concentration data. These were combined with data from the Dutch food consumption survey (2012-2016) to assess exposure. A conversion factor (median 0.023; range 0.008-0.07) was used to express the nitrate exposure in nitrite equivalents which was added to the nitrite exposure. The uncertainty around the conversion factor was taken into account by using conversion factors randomly sampled from the abovementioned range. The combined dietary exposure was calculated for the Dutch population (1-79 years) with different exposure scenarios to address regional differences in nitrate and nitrite concentrations in drinking water. All scenarios resulted in a combined exposure above the acceptable daily intake for nitrite ion (70 µg/kg bw), with the mean exposure varying between 95-114 µg nitrite/kg bw/day in the different scenarios. Of all ages, the combined exposure was highest in children aged 1 year with an average of 250 µg nitrite/kg bw/day. Vegetables contributed most to the combined exposure in food in all scenarios, varying from 34%-41%. Food additive use contributed 8%-9% to the exposure and drinking water contributed 3%-19%. Our study is the first to perform a combined dietary exposure assessment of nitrate and nitrite while accounting for the uncertain conversion factor. Such a combined exposure assessment overarching different regulatory frameworks and using different scenarios for drinking water is a better instrument for protecting human health than single substance exposure.

Measures to reduce pesticides leaching into groundwater-based drinking water resources: An appeal to national and local governments, water boards and farmers.

The purpose of this paper is to show that a number of pesticides is found in groundwater and drinking water resources and to define measures that should reduce the pesticide load in groundwater resources for drinking water in the future. Although the pesticide load that enters groundwater bodies in the Netherlands has gradually decreased over the past ten years, good drinking water quality in the future is not guaranteed. Currently, a number of pesticides ise found in groundwater abstracted for the production of drinking water, worldwide. The most frequently found compounds in the Netherlands are the herbicides BAM (2,6-dichlorobenzonitrile), bentazon and mecoprop. In shallow groundwater, the same compounds are generally found as in deeper groundwater that is abstracted for the production of drinking water, mainly bentazon and mecoprop. Additionally, DEET (N,N-Diethyl-meta-toluamide) is frequently found in shallower groundwater. In order to reduce the pesticide load in groundwater resources for drinking water in the future, 43 measures have been inventoried and ranked based on their scores for 'effectiveness' and for 'practicability'. This paper describes both the most effective measures, with high scores on practicability, and those with limitations regarding practicability. These measures are the most relevant with respect to the frequently found compounds that are still authorised, i.e., bentazon, mecoprop and DEET and, to a lesser extent, glyphosate (due to the presence of its metabolite AMPA (aminomethylphosphonic acid) and glyphosate itself) and isoproturon. The implementation of abstraction-specific 'Drinking Water Protection Files', including the systematic collection of data about the relevant water abstraction and the sources and activities that can negatively affect water quality, is recommended.

Risk assessment for drugs of abuse in the Dutch watercycle.

A screening campaign of drugs of abuse (DOA) and their relevant metabolites in the aqueous environment was performed in the Netherlands. The presence of DOA, together with the potential risks for the environment and the possible human exposure to these compounds through consumption of drinking water was investigated. Sewage water (influent and effluent), surface water of the rivers Rhine and Meuse, and drinking water (raw and finished) were analysed by four different laboratories using fully in-house validated methods for a total number of 34 DOA and metabolites. In this way, data reported for several compounds could also be confirmed by other laboratories, giving extra confidence to the results obtained in this study. In total 17 and 22 DOA were detected and quantified in influent and effluent sewage samples, respectively. The tranquilizers oxazepam and temazepam, and cocaine and its metabolite benzoylecgonine were found in high concentrations in sewage water. Nine compounds were possibly not efficiently removed during treatment and were detected in surface waters. The results indicated that substantial fractions of the total load of DOA and metabolites in the rivers Rhine and Meuse enter the Netherlands from abroad. For some compounds, loads appear to increase going downstream, which is caused by a contribution from Dutch sewage water effluents. As far as data are available, no environmental effects are expected of the measured DOA in surface waters. In raw water, three DOA were detected, whereas in only one finished drinking water out of the 17 tested, benzoylecgonine was identified, albeit at a concentration below the limit of quantification (<1 ng/L). Concentrations were well below the general signal value of 1 µg/L, which is specified for organic compounds of anthropogenic origin in the Dutch Drinking Water Act.

Relating environmental concentrations of pharmaceuticals to consumption: A mass balance approach for the river Rhine.

In this study, pharmaceuticals were frequently monitored in the Rhine delta between the year 2002 and 2008. Average concentrations of several X-ray contrast mediums were above 0.1 microg/L, the average concentration of carbamazepine was about 0.1 microg/L, while average concentrations of the other pharmaceuticals generally fell between 0.1 and 0.01 microg/L. Concentrations were used to calculate annual loads transported by the Rhine at Lobith. These loads were compared to the annual sales upstream of Lobith. This mass balance approach shows that substantial fractions (1.1% to 70.4%) of the 20 most frequently observed pharmaceuticals sold in the Rhine catchment area are recovered in the Rhine at Lobith. The observed annual loads were compared to loads predicted from annual sales in the catchment area, excreted fractions by humans and removal by waste water treatment. Observed and predicted annual loads were rather similar. The difference of the loads obtained from monitoring data and estimated from consumption was smaller than a factor of seven and did not exceed a factor of two for 15 out of the 20 pharmaceuticals. This illustrates the potential of using sales data for the prediction of concentrations in the aqueous environment.