Blood lead and cadmium and birth weight among sub-arctic and arctic populations of Norway and Russia

BACKGROUND

Delivering women and their newborns in the Kola Peninsula of Russia and the neighboring arctic area of Norway were studied to explore relationships between maternal cadmium and lead status and birth weight as a pregnancy outcome.

METHODS

Life-style information, maternal blood and cord blood specimens were collected from 50 consecutive mother-infant pairs from hospital delivery departments in three Russian and three Norwegian communities. Pregnancy outcomes were verified by consulting medical records. Lead and cadmium were determined in the blood samples by electrothermal atomic absorption spectrometry.

RESULTS

The median blood-cadmium concentration for the Russian mothers was 2.2 nmol/L (n = 148) versus 1.8 nmol/L in the Norwegian group (n = 114, p = 0.55). A weak association was observed between maternal cadmium and amount smoked (r = 0.30, p<0.001); no correlation was found between maternal blood cadmium and birth weight. The corresponding maternal lead values were 0.14 (Russia) and 0.06 micromol/L (Norway), p<0.001. The latter lead concentration constitutes one of the lowest adult population values reported to date. Maternal and cord blood lead levels were strongly correlated (r = 0.88, p<0.001). In a multivariate linear regression model, maternal blood lead was recognized as a negative explanatory variable (p<0.05) for birth weight and child's body mass index (BMIC), with or without adjustment for gestational age. A similar association was suggested by ANOVA-analysis of maternal blood lead by quartiles.

CONCLUSION

Maternal blood-lead level as an environmental factor is an apparent predictor of low birth weight and BMIC. It reduced substantially the contribution of a country factor in explaining the observed differences in birth weight.

A study of exposure standards in Russia and the role of occupational hygiene

This paper is the result of an investigation carried out in February 1997, which set out to learn about the development and application of occupational health standards, and in turn approaches to occupational environmental monitoring, in Russia, and to see how these were similar to, or different from, what takes place in other countries. The enquiry involved face-to-face meetings with senior Russian occupational health scientists and officials. It was confirmed that Russian occupational exposure standards are very stringent and provide a very high level of protection of workers. However, they are difficult to enforce, and it is suggested that the development of a strong and distinctive occupational hygiene discipline and profession in Russia would provide a "bridge" to enable more effective implementation and interpretation of those standards.

Application of recent advances in aerosol sampling science towards the development of improved sampling devices: the way ahead

This paper reviews the framework that underpins the development of a new generation of personal samplers capable of operating at much lower flowrates that those of the current generation and so capable of being used for exposure assessment not only for 'traditional' occupational populations (i.e., industrial workers) but also for people exposed to aerosols in the ambient atmosphere (including children). The opportunity for this new generation of samplers stems from the availability of very light and compact low-flowrate pumps. The development and deployment of such instruments presents: (a) physical challenges in terms of how to collect particle size fractions in a manner which is consistent with the new particle size-selective sampling criteria, and (b) analytical challenges in terms of how to quantitate the much smaller amounts of collected material that need to be analysed. The paper lays out the physical and analytical scenarios, and points the way forward to how such challenges can be overcome. Work is already in progress in several countries to develop prototype instruments for applications like those described.

Concentrations of essential trace elements in maternal serum and the effect on birth weight and newborn body mass index in sub-arctic and arctic populations of Norway and Russia

BACKGROUND

This project is part of an assessment of the impact of environmental factors on human health in the Kola Peninsula of Russia and the neighboring arctic area of Norway. Pregnant women and their newborns were studied to explore a relationship between maternal status of essential metals and birth weight.

METHODS

Life-style information and serum specimens were collected from at least 50 consecutive mother-infant pairs from hospital delivery departments in three Russian and three Norwegian communities (N=151 and 167, respectively). Pregnancy outcomes were verified by consulting medical records. Copper, selenium and zinc in serum were determined by atomic absorption spectrometry and ferritin by an automated analyzer method.

RESULTS

Mean birth weight and child's body mass index (BMIC) were significantly lower in the Russian group (p<0.001), with or without adjustment for gestational age. Copper, iron (as ferritin) and selenium serum concentrations were in the normal range, while zinc levels in both countries were mostly below the lower limit (10.8 micromol/L) of reported reference intervals. A positive correlation between zinc and birth weight or BMIC was only observed for concentrations exceeding 10.8 micromol/L. Analysis by quartiles showed that maternal urinary creatinine and birth weight were negatively correlated (p=0.001). The influence of the different elements on BMIC, grouped by quartiles, was significantly positive only for selenium (p=0.03) and ferritin (p=0.02), while there was no significant relationship for copper or zinc. Adjustment of birth weight and BMIC for gestational age did not alter substantially the various associations indicated.

CONCLUSIONS

With the exception of zinc, the mineral status of delivering women in arctic and sub-arctic regions of Norway and western Russia appears to be adequate. The significantly lower BMIC for the Russian group suggests the likely occurrence of nutritional deficiencies during pregnancy in Russia. However, the significant contribution of a country factor in the predictive model implies that the maternal serum trace-element concentrations explored in this study are incomplete indicators of fetal undernourishment.

Critical evaluation of medical, statistical, and occupational data sources in the Kola Peninsula of Russia pertinent to reproductive health studies

BACKGROUND

The feasibility study described herein was prompted by a report in 1992 of possible reproductive and developmental health concerns among female workers in a Russian nickel refinery.

OBJECTIVE

The primary goal was to ascertain whether medical, statistical, and occupational data bases could be accessed for information about the pregnancy histories, occupational histories, and life-style factors of the women affected.

METHODS

The project was facilitated by construction of a registry of all births in three towns with a nickel refinery and verification of its contents against patients' records obtained from hospital delivery and gynecology departments and community polyclinics. Municipal Registration Board, Regional Health Statistics Board, and nickel company records were also reviewed.

RESULTS

Reproductive/developmental outcome information and workplace histories were acceptable. Sample-size calculations indicated that a cohort or cross-sectional study would be amenable and suitable for the detection of an excess risk for spontaneous abortion with adequate statistical significance and power. Such investigations would need to be supplemented by workplace environmental/biological monitoring assessments for evaluation of exposure to occupational hazardous factors and a worker's questionnaire to obtain information about life-style factors. A case-control design is recommended for the study of congenital defects.

CONCLUSIONS

A well-designed, comprehensive epidemiology study is technically feasible because of the availability of a favorable pool of study subjects, reproductive/developmental outcome data, information to control for major confounders, and suitable occupational records.

Urinary nickel concentrations and selected pregnancy outcomes in delivering women and their newborns among arctic populations of Norway and Russia

The two objectives of this study were to compare urinary nickel excretion in pregnant women and their newborns living in the Murmansk and Arkhangelsk Counties of Russia with that in comparable Norwegian populations living in Finnmark and the city of Bergen and to assess the influence on pregnancy outcome of different risk variables, specifically urinary nickel concentrations and questionnaire-based anamnestic information. Life-style information and urine samples were collected from 50 consecutive mother-infant pairs from hospital delivery departments in three Russian and three Norwegian communities. Pregnancy outcomes were verified from medical records. Urinary nickel excretion was significantly higher in the Russian communities, independent of the presence of a nickel refinery as a local environmental source. The birth weight and mean body mass index of the newborn children (BMIC) were significantly lower (p < 0.001) in the Russian groups, with or without adjustment for gestational age. A multivariate linear regression analysis indicated that maternal urinary nickel concentration had no impact on birth weight. The maternal body mass index (BMI) and maternal height were positive explanatory variables; maternal urinary creatinine is suggested as a weak negative factor. Smoking was shown to be a strong negative predictor only in the Norwegian group among whom there was a significantly higher smoking frequency (p = 0.005). The significant contribution of a country factor in the predictive model is interpreted to indicate that a number of important risk factors for low birth weight were not identified.

Characterisation of workers' exposure in a Russian nickel refinery

In support of a feasibility study of reproductive and developmental health among females employed in the Monchegorsk (Russia) nickel refinery, personal exposure and biological monitoring assessments were conducted. The inhalable aerosol fraction was measured and characterised by chemical speciation and particle-size distribution measurements. Unexpected findings were that: (i), pyrometallurgical working environments had significant levels of water-soluble nickel; (ii), significant exposure to cobalt occurred for the nickel workers; (iii), particles of size corresponding to the thoracic and respirable fractions appeared to be virtually absent in most of the areas surveyed. The water-soluble fraction is judged to be primarily responsible for the observed urinary nickel and cobalt concentrations. It is concluded relative to current international occupational-exposure limits for nickel in air, and because of the high nickel concentrations observed in urine, that the Monchegorsk nickel workers are heavily exposed. The implication of this finding for follow-up epidemiological work is alluded to.

Self-reported ethnic status of delivering women, newborn body mass index, blood or urine concentrations of toxic metals, and essential elements in sera of Norwegian and Russian Arctic populations

As part of the Arctic Monitoring and Assessment Programme (AMAP), we assessed pregnancy outcome among Sami and Norwegian populations of Finnmark County in Norway and Russians living in the Kola Peninsula of Russia using body mass index of the newborn child (BMIC) as the main indicator; concentrations of essential and toxic elements in biological fluids of delivering women and their children served as additional sources of information. At the hospitals of Hammerfest and Kirkenes in the period November 1993-June 1994 a total of 107 consecutive women gave birth to a child, of whom 15 regarded themselves as Sami. The Russian group (N = 151) delivered their children in the same period. The Sami women were significantly older than the Russian group (28.5 versus 25.1 years, p = 0.04). The mean birth weight was significantly lower in the Sami group compared to non-Sami Norwegians (p = 0.01), but was of comparable magnitude to that recorded in Russia (p = 0.4). For BMIC, the Sami and non-Sami Norwegian results were similar (p = 0.2); both were significantly higher than in Russia (p < 0.001). The essential elements copper, zinc, selenium and iron (as ferritin) in serum showed no differences between the groups, although relatively low levels of serum zinc were documented in all populations studied. Blood cadmium concentrations were strongly related to smoking frequency. Blood lead and urinary nickel levels were significantly higher for the Russian mothers, but did not reach levels of medical concern.

CONCLUSION

No ethnic differences in concentrations of essential elements in biological fluids, nor of cadmium and mercury, were observed. However, national differences for lead and nickel were evident. Because of small sample size, these conclusions need confirmation. The similar BMIC values observed for the non-Sami Norwegian and Sami newborns, compared to the Russian group, suggest that BMIC may serve as a good indicator of the nutritional status and possibly also the general health condition of neonates.

Urinary nickel excretion in populations living in the proximity of two russian nickel refineries: a Norwegian-Russian population-based study

The Russian nickel refineries located in the cities of Nikel and Zapolyarny close to the Norwegian border are responsible for extensive sulfur dioxide and nickel pollution, as well as severe ecological damage in both countries. The aim of our study was to investigate human nickel exposure in the populations living on both sides of the Norwegian-Russian border. The design was a cross-sectional population-based study of adults aged 18-69 years residing in Sor-Varanger municipality, Norway, and Nikel and Zapolyarny, Russia, during 1994 and 1995. Individual exposure to nickel was assessed by measurements of nickel in urine using electrothermal atomic absorption spectrometry. For controls, urine was collected from adults in the Russian cities of Apatity and Umba (Kola Peninsula) and the Norwegian city of Tromso, all of which are locations without nearby point sources of nickel. Altogether 2,233 urine specimens were analysed for nickel. People living in Nikel had the highest concentrations (median 3.4 microg/l), followed by Umba (median 2.7 microg/l), Zapolyarny (median 2.0 microg/l), Apatity (median 1.9 microg/l), Tromso (median 1.2 microg/l), and Sor-Varanger (median 0.6 microg/l). Regardless of geographical location, the Russian study groups all had a higher urinary-nickel average than those in Norway (p<0.001). With the exception of Nikel, neither the Russian nor the Norwegian urinary-nickel levels were associated with residence location near a Russian nickel refinery. We concluded that industrial nickel pollution alone could not explain the observed discrepancy between Norway and Russia; we also discuss other possible nickel exposure sources that may account for the high urinary levels found in Russia.

Selenium in human male reproductive organs

The objective of the study was to obtain information on the concentration and distribution of selenium throughout the human male reproductive tract. Material was removed at autopsy from 41 men who had died suddenly and unexpectedly. Semen samples were also provided from 184 men attending an andrology clinic for fertility investigation and from 32 healthy volunteers. Significant positive correlations in the selenium concentration were demonstrated between the different reproductive organs, the testis having the highest concentrations. No correlation was found between the concentration of selenium in the genital organs and liver, kidney or blood, suggesting that its uptake and/or biochemical activity in the reproductive organs may be controlled by similar mechanisms not shared by the other organs. No significant age-dependent changes could be detected in tissue selenium concentrations. In a group of men under fertility investigation, a significant positive correlation was obtained between seminal plasma concentrations of selenium and concentrations of spermatozoa in the same ejaculate. A significant positive correlation between concentrations of zinc and selenium in the same ejaculates indicated that selenium may arise largely from the prostate gland.

[Mercury exposure from dental amalgam. Risk assessment and clinical evaluation]

Inorganic mercury is absorbed in small amounts from dental amalgam fillings. Exposure can be calculated by measuring the level of mercury in the blood or urine (u-Hg). The average u-Hg in Norwegians is approximately 2-3 micrograms/g creatinine (approximately 1-2 nmol/mmol creatinine). Classic signs of mercury poisoning occur in a fraction of long-term exposed subjects with u-Hg > 100 micrograms/g creatinine (56 nmol/mmol creatinine). Subtle effects (e.g. enzymuria, altered selenium metabolism, and changes in tremor spectra) have been reported in humans at average levels of 20-35 micrograms/g creatinine (approximately 11-20 nmol/mmol creatinine). There is widespread concern about possible adverse effects of mercury from amalgam fillings. Data on exposure-response relationships make it less likely that low-level mercury exposure from amalgam fillings should cause symptoms or physical signs. Studies of the association between symptoms and amalgam fillings have been negative. Patients with symptoms allegedly caused by mercury from amalgam should undergo thorough medical examination. Based on the patient's symptoms and physical signs adequate time should be allowed for careful recording of medical history, physical examination and relevant laboratory tests.

Human nickel exposure in an area polluted by nickel refining: the Sør-Varanger study

Sør-Varanger municipality in northern Norway is located close to two Russian nickel refineries that cause nickel and sulfur dioxide pollution. To investigate individual nickel exposure and possible health effects from the pollution, the authors invited all adults who were 18-69 y of age to a health survey in 1994. Urine samples were collected from 3671 participants (participation rate = 59.4%), and nickel concentrations were determined for 902 of them. Mean and median nickel concentrations were 0.9 microg/l and 0.6 microg/l, respectively. Individuals who lived in the rural areas closest to the refineries had lower nickel concentrations than individuals who lived in the more urban areas. Independent risk factors for nickel concentrations in urine were (a) being an urban dweller and (b) living close to areas with high-density traffic. The authors concluded that nickel exposure attributable to air pollution from Russian refineries was of minor importance for people who lived in Sør-Varanger.

Cadmium and selenium in blood and urine related to smoking habits and previous exposure to mercury vapour

The object of this work was to investigate possible interactions of mercury, cadmium and selenium in humans. Selenium and cadmium in blood and urine were determined in this cross-sectional study of 130 males, of whom 77 had been previously exposed to mercury vapour at a chloralkali plant. Of the participants, 61.5% were smokers and 16.2% were never-smokers. The concentration of selenium in blood (B-Se) was significantly lower in subjects currently smoking more than 50 g of tobacco per week compared to never-smokers, whereas the concentration of cadmium in blood (B-Cd) was significantly higher in all categories of current smokers. In the multiple linear regression analysis, B-Se as a dependent variable was negatively associated with B-Cd, whereas current smoking habits were not included in the model as a predictor variable. In contrast, B-Cd as a dependent variable was positively associated with current as well as previous smoking habits, and negatively with both B-Se and the 'cumulative dose' of previous mercury vapour exposure. The concentration of selenium in blood was also negatively associated with B-Cd in the group of never-smokers (Spearman's r = -0.80; P < 0.001). In conclusion, these results suggest a depressive effect of cadmium on the concentration of selenium in blood, while smoking alone did not operate as a true predictor for this effect. Furthermore, previous exposure to mercury apparently modifies the concentration of cadmium in blood.

Prevalence of hemochromatosis among first-time and repeat blood donors in Norway

BACKGROUND/AIMS

The observed prevalence of hemochromatosis has ranged considerably from 0.05 to 0.37% in studies requiring liver biopsy. We aimed to study the prevalence of genetic hemochromatosis among Norwegian blood donors.

METHODS

We studied 10,552 healthy blood donors (5312 women and 5240 men) using serum ferritin as a screening parameter. If serum ferritin concentration was > or = 100 micrograms/l in women and > or = 200 micrograms/l in men, serum iron and transferrin (measured as total iron binding capacity = TIBC) were measured. Blood donors who repeatedly had a transferrin saturation above 40% and a ferritin concentration above these limits were referred to a hepatologist (H.B.).

RESULTS

Serum ferritin was > or = 100 micrograms/l in 94/5312 (1.8%) women and > or = 200 microliters in 79/5240 (1.5%) men. Of these, 37 persons had a serum ferritin concentration above 100 micrograms/l (females) or above 200 micrograms/l (males) and a transferrin saturation above 40%. Nineteen of them (13 men and 6 women, median age 36 years, range 28-68) were identified as having hemochromatosis on the basis of increased hepatic iron index. Serum ferritin ranged from 111 to 1980 micrograms/l (median 357 micrograms/l and transferrin saturation from 50 to 100% (median 92%), hepatic iron from 48 to 471 mumol/g dry weight (median 118 mumol/g) and hepatic iron index from 1.5 to 12.1 (median 3.0). One person had cirrhosis and none had diabetes. The prevalence of hemochromatosis was significantly higher among first-time blood donors (12 out of 3500 [3.4/1000]) compared with repeat donors (7 out of 7052 [1/1000]), p < 0.005.

CONCLUSIONS

The observed prevalence of hemochromatosis in Norwegian first-time blood donors of 0.34% is comparable to recently observed prevalences in other studies. However, the use of serum ferritin as a first-step screening tool may have failed to detect hemochromatosis in the early stage where iron overload has not yet occurred.

Sample collection guidelines for trace elements in blood and urine. IUPAC Commission of Toxicology

This paper presents an organized system for element-specific sample collection and handling of human blood (whole blood, serum or plasma, packed cells or erythrocytes) and urine also indicating a proper definition of the subject and sample. Harmonized procedures for collection, preparation, analysis and quality control are suggested. The aim is to assist scientists worldwide to produce comparable data which will be useful on a regional, national and international scale. The guidelines are directed to the elements aluminium, arsenic, cadmium, chromium, cobalt, copper, lead, lithium, manganese, mercury, nickel, selenium and zinc. These include the most important elements measured for their occupational or clinical significance, and serve as examples of principles that will guide development of methods for other elements in the future.

A method for establishing tentative occupational exposure limits for inhalable dust

Four-fold classification tables are used on five datasets containing 112 parallel personal measurements of total dust and inhalable dust. The classification are carried out in such a way that the frequency of non-compliance is equal for total dust and inhalable dust. The results can be used as tentative occupational exposure limits (OELs) for inhalable dust, and the results range from 0.7 to 3.4 of OELs for total dust. The results depend on the industry and the content of the dust.

Hepatic retention of copper and selenium in primary sclerosing cholangitis

BACKGROUND

Previous studies have suggested abnormal copper metabolism in patients with primary sclerosing cholangitis (PSC). In the present work the trace element metabolism was studied in a group of 32 patients with PSC.

METHODS

Hepatic copper and selenium concentrations were determined with a sensitive electrothermal atomic absorption technique. Serum concentrations of copper and zinc were determined by conventional atomic absorption.

RESULTS

For the patient group serum copper values (20.3 +/- 4.5 mumol/l) were higher than those for the control group (14 +/- 3 mumol/l), and average hepatic copper concentrations were greater by a factor of four. Serum selenium values were slightly lower, although the average hepatic selenium was significantly higher than in the healthy control group. Previous studies have discussed possible toxic effects of hepatocellular copper accumulation, which may be accompanied by formation of activated oxygen species and depletion of glutathione. In the present study, however, it could not be demonstrated that the concentration of the lipoperoxidation product, malonic dialdehyde, was higher than normal in blood. Furthermore, blood concentrations of glutathione and glutathione peroxidase were not abnormal.

CONCLUSION

Although a protective effect of the raised selenium concentrations in the liver might be discussed, it is apparent that the copper accumulation in the liver cells described here did not induce detectable changes in the indices studied.

Urinary selenium excretion in workers with low exposure to mercury vapour

Urinary selenium excretion was studied in 21 mercury vapour (Hgo)-exposed workers involved in the demolition of a chloralkali plant. The subjects had no known previous occupational exposure to mercury. Their mean pre-exposure urinary mercury concentration, determined on average 1.2 days prior to the exposure, was 0.8 nmol mmol-1 creatinine (range 0.3-1.9). Their last mean urinary mercury concentration, determined on average after 51.4 days (range 19-103) of exposure, was 4.8 nmol mmol-1 creatinine (range 1.2-10.0). The exposure ceased on average 4.1 days after the last determined urinary mercury concentration. The corresponding concentrations of urinary selenium decreased from an average of 39.1 nmol mmol-1 creatinine (range 13.9-89.5) to 29.0 nmol mmol-1 creatinine (range 10.1-52.9) (P = 0.002). This finding may indicate that even a low to moderate work-related exposure to Hgo may reduce the urinary selenium concentration in humans in a manner that is not yet fully known.

Neuropsychological deficit among elderly workers in aluminum production

A cross-sectional study was conducted at a Norwegian primary aluminum plant. All workers aged 61-66 years were offered early retirement benefits. Among the workers, 47 met the study criteria and 38 (81%), comprising 14 potroom workers, 8 foundry workers, and 16 controls, volunteered to participate. They were tested with a neuropsychological test battery. Workers in potrooms with Søderberg electrolytic cells were found to show signs of impairment of the nervous system. A test for tremor discriminated significantly between the potroom group and the controls. There was a suggestion of increased risk of impaired visuospatial organization and a tendency to a decline in psychomotor tempo in the potroom workers. We suggest that the above findings may be related to long-term occupational exposure in the potroom, and further to chronic low-dose exposure to aluminum.

Seminal plasma lead, cadmium and zinc in relation to tobacco consumption

The total quantity of zinc in the ejaculates of smokers was significantly lower than in non-smokers. This was not related to a significant increase in the quantities of seminal cadmium or lead, or to a decrease in sperm quality in the smoking group. It appears that tobacco consumption may have to exceed 20 cigarettes/day before a noticeable increase in seminal cadmium can be recorded. It is suggested that this reduction in zinc secretion may jeopardize the content of chromatin zinc, and thereby the stability of the sperm chromatin. This may then contribute to reproductive failure or have consequences for fetal development.

Concentrations of lead, cadmium and zinc in the tissues of reproductive organs of men

The concentrations of lead in blood and the concentrations of lead, cadmium and zinc in tissues were determined in various reproductive organs, liver and kidney removed at necropsy from 41 men who had died suddenly. None of the reproductive organs specifically accumulated lead and no significant correlation could be demonstrated between blood and organ concentrations or between concentrations and age, occupation or urban/rural background of the subject. Unlike lead, the tissue concentrations of cadmium increased with increasing age in all of the reproductive organs examined. Of these, the epididymides and seminal vesicles contained the highest concentrations. Whereas prostatic zinc also exhibited a significant age-dependent increase, the concentrations in the testes declined with age. The age-dependent increase in testicular cadmium did not become apparent until after the fourth decade, when any potentially deleterious impact on male fertility has less relevance. It is concluded that measurable amounts of lead and cadmium are present in all of the human reproductive organs but their organ and age distribution do not offer strong support for their involvement in the aetiology of male infertility or in the genesis of glandular neoplasms.

Urinary mercury excretion in chloralkali workers after the cessation of exposure

Seventeen former chloralkali workers were followed through the regular determination of urinary mercury for nearly two years after the cessation of exposure to mercury vapor in a study of the time course of urinary mercury elimination. Their duration of exposure ranged from 3 d to 35.5 years. A one-compartment model for urinary mercury elimination was applied. The urinary mercury concentration declined at a rate indicating a half-time of 91 d. When corrected for an individual base-line level of urinary mercury resulting from sources of mercury intake not related to work, the half-time was 72.4 [95% confidence interval (95% CI) 63.2-81.7] d, with a mean elimination rate constant of 0.011 (95% CI 0.008-0.013).d-1. The day-to-day variability of the urinary mercury concentration averaged 22%, expressed as the coefficient of variation between urine samples delivered on three consecutive days.

Small airways function in aluminium and stainless steel welders

The effect of welding fumes on small airways was studied in 25 male subjects who welded in aluminium (Al) and to some extent also in stainless steel (SS). Despite a low exposure to welding fumes as compared to the permissible exposure limits, excretion of Al in urine was found to be increased in all subjects (median value: 0.29 mmol/mol creatinine on Friday afternoon, as compared to an upper reference level of 0.10 mmol/mol creatinine). In addition, the welders displayed increased prevalences of work-related eye and airways (pharyngitis and non-specific bronchial hyperreactivity) symptoms, as compared to 25 matched controls. Short-term welders (< or = 2.5 years) had more symptoms related to the upper airways than did long-term welders, which may indicate a selection. Spirometry, closing volume and volume of trapped gas (VTG) did not deviate. However, after methacholine inhalation, the long-term welders had a significantly steeper slope of the alveolar plateau on the single-breath nitrogen wash-out test, and a slight increase in VTG, as compared to the short-term welders and the controls. These findings may indicate a welding fume-induced increase in the reactivity of the small airways. Because Al welding was far more frequent than SS welding, an association with the former seems likely.