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Ahmad MF, Ahmad FA, Alsayegh AA, Zeyaullah M, AlShahrani AM, Muzammil K, Saati AA, Wahab S, Elbendary EY, Kambal N, Abdelrahman MH, Hussain S. Pesticides impacts on human health and the environment with their mechanisms of action and possible countermeasures. Heliyon 2024; 10:e29128. [PMID: 38623208 PMCID: PMC11016626 DOI: 10.1016/j.heliyon.2024.e29128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 03/29/2024] [Accepted: 04/01/2024] [Indexed: 04/17/2024] Open
Abstract
Pesticides are chemical constituents used to prevent or control pests, including insects, rodents, fungi, weeds, and other unwanted organisms. Despite their advantages in crop production and disease management, the use of pesticides poses significant hazards to the environment and public health. Pesticide elements have now perpetually entered our atmosphere and subsequently contaminated water, food, and soil, leading to health threats ranging from acute to chronic toxicities. Pesticides can cause acute toxicity if a high dose is inhaled, ingested, or comes into contact with the skin or eyes, while prolonged or recurrent exposure to pesticides leads to chronic toxicity. Pesticides produce different types of toxicity, for instance, neurotoxicity, mutagenicity, carcinogenicity, teratogenicity, and endocrine disruption. The toxicity of a pesticide formulation may depend on the specific active ingredient and the presence of synergistic or inert compounds that can enhance or modify its toxicity. Safety concerns are the need of the hour to control contemporary pesticide-induced health hazards. The effectiveness and implementation of the current legislature in providing ample protection for human health and the environment are key concerns. This review explored a comprehensive summary of pesticides regarding their updated impacts on human health and advanced safety concerns with legislation. Implementing regulations, proper training, and education can help mitigate the negative impacts of pesticide use and promote safer and more sustainable agricultural practices.
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Affiliation(s)
- Md Faruque Ahmad
- Department of Clinical Nutrition, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Fakhruddin Ali Ahmad
- Department of Basic and Applied Science, School of Engineering and Science, G.D Goenka University, Gururgram, Haryana, 122103, India
| | - Abdulrahman A. Alsayegh
- Department of Clinical Nutrition, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Md. Zeyaullah
- Department of Basic Medical Science, College of Applied Medical Sciences, Khamis Mushayt Campus, King Khalid University (KKU), Abha, Saudi Arabia
| | - Abdullah M. AlShahrani
- Department of Basic Medical Science, College of Applied Medical Sciences, Khamis Mushayt Campus, King Khalid University (KKU), Abha, Saudi Arabia
| | - Khursheed Muzammil
- Department of Public Health, College of Applied Medical Sciences, Khamis Mushayt Campus, King Khalid University (KKU), Abha, Saudi Arabia
| | - Abdullah Ali Saati
- Department of Community Medicine & Pilgrims Healthcare, Faculty of Medicine, Umm Al-Qura University, Saudi Arabia
| | - Shadma Wahab
- Department of Pharmacognosy, College of Pharmacy, King Khalid University, Abha, 62529, Saudi Arabia
| | - Ehab Y. Elbendary
- Department of Clinical Nutrition, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Nahla Kambal
- Department of Clinical Nutrition, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Mohamed H. Abdelrahman
- College of Applied Medical Sciences, Medical Laboratory Sciences, Jazan University, Jazan, 45142, Saudi Arabia
| | - Sohail Hussain
- Department of Pharmacology and Toxicology, College of Pharmacy, Jazan University, Jazan, 45142, Saudi Arabia
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Berlivet J, Payrastre L, Rebouillat P, Fougerat A, Touvier M, Hercberg S, Lairon D, Pointereau P, Guillou H, Vidal R, Baudry J, Kesse-Guyot E. Association between dietary pesticide exposure profiles and body weight change in French adults: Results from the NutriNet-Santé cohort. ENVIRONMENT INTERNATIONAL 2024; 184:108485. [PMID: 38350259 DOI: 10.1016/j.envint.2024.108485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 01/17/2024] [Accepted: 02/05/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND Pesticides cause a wide range of deleterious health effects, including metabolic disorders. Little is known about the effects of dietary pesticide exposure on body weight (BW) change in the general population. We aimed to investigate the role of dietary pesticide exposure in BW change among NutriNet-Santé participants, focusing on potential sexual dimorphism. METHODS Participants completed a Food Frequency Questionnaire (2014), assessing conventional and organic food consumption. Dietary exposure from plant foods of 25 commonly used pesticides was estimated using a residue database, accounting for agricultural practices (conventional and organic). Exposure profiles based on dietary patterns were computed using Non-negative Matrix Factorization (NMF). Mixed models were used to estimate the associations between BW change and exposure to pesticide mixtures, overall and after stratification by sex and menopausal status. RESULTS The final sample included 32,062 participants (8,211 men, 10,637 premenopausal, and 13,214 postmenopausal women). The median (IQR) follow-up was 7.0 (4.4; 8.0) years. Four pesticides profiles were inferred. Overall, men and postmenopausal women lost BW during follow-up, whereas premenopausal women gained BW. Higher exposure to NMF3, reflecting a lower exposure to synthetic pesticides, was associated with a lower BW gain, especially in premenopausal women (β(95 %CI) = -0.04 (-0.07; 0) kg/year, p = 0.04). Higher exposure to NMF2, highly positively correlated with a mixture of synthetic pesticides (azoxystrobin, boscalid, chlorpropham, cyprodinil, difenoconazole, fenhexamid, iprodione, tebuconazole, and lamda-cyhalothrin), was associated with a higher BW loss in men (β(95 %CI) = -0.05 (-0.08; -0.03) kg/year, p < 0.0001). No associations were observed for NMF1 and 4. CONCLUSIONS This study suggests a role of pesticide exposure, inferred from dietary patterns, on BW change, with sexually dimorphic actions, including a potential role of a lower exposure to synthetic pesticides on BW change in women. In men, exposure to a specific pesticide mixture was associated with higher BW loss. The underlying mechanisms need further elucidation.
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Affiliation(s)
- Justine Berlivet
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), F-93017, Bobigny, France.
| | - Laurence Payrastre
- Toxalim (Research Centre in Food Toxicology), Université de Toulouse, INRAE, ENVT, INP-Purpan, UPS, Toulouse, France.
| | - Pauline Rebouillat
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), F-93017, Bobigny, France.
| | - Anne Fougerat
- Toxalim (Research Centre in Food Toxicology), Université de Toulouse, INRAE, ENVT, INP-Purpan, UPS, Toulouse, France.
| | - Mathilde Touvier
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), F-93017, Bobigny, France.
| | - Serge Hercberg
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), F-93017, Bobigny, France; Toxalim (Research Centre in Food Toxicology), Université de Toulouse, INRAE, ENVT, INP-Purpan, UPS, Toulouse, France; Public Health Department, Groupe Hospitalier Paris-Seine-Saint-Denis, Assistance Publique-Hôpitaux de Paris (AP-HP), Bobigny, France.
| | - Denis Lairon
- Aix Marseille Université, Inserm, INRAE, C2VN, 13005, Marseille, France.
| | | | - Hervé Guillou
- Toxalim (Research Centre in Food Toxicology), Université de Toulouse, INRAE, ENVT, INP-Purpan, UPS, Toulouse, France.
| | - Rodolphe Vidal
- Institut de l'Agriculture et de l'Alimentation Biologiques (ITAB), 149 rue de Bercy 75595, Paris, France.
| | - Julia Baudry
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), F-93017, Bobigny, France
| | - Emmanuelle Kesse-Guyot
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), F-93017, Bobigny, France.
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Jin C, Wang C, Zhang C, Ye Q, Jin Y, Shi L. Imazalil resulted in glucolipid metabolism disturbance and abnormal m 6A RNA methylation in the liver of dam and offspring mice. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2024; 271:115963. [PMID: 38232526 DOI: 10.1016/j.ecoenv.2024.115963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 10/25/2023] [Accepted: 01/06/2024] [Indexed: 01/19/2024]
Abstract
As a fungicide with the characteristics of high effectiveness, internal absorption and broad spectrum, imazalil is widely used to prevent and treat in fruits and vegetables. Here, pregnant C57BL/6 mice were exposed to imazalil at dietary levels of 0, 0.025‰, and 0.25‰ through drinking water during pregnancy and lactation. We then analyzed the phenotype, metabolome, and expression of related genes and proteins in the livers of mice. There was a marked decrease in the body and liver weights of male offspring mice after maternal imazalil exposure, while this effect on the dam and female offspring was slight. Metabolomics analyses revealed that imazalil significantly altered the metabolite composition of liver samples from both dams and offspring. The preliminary results of the analysis indicated that glucolipid metabolism was the pathway most significantly affected by imazalil. We performed a coabundance association analysis of metabolites with significant changes in the pathway of glycolipid metabolism, and IMZ altered the networks of both dams and offspring compared with the network in control mice, especially in male offspring. The hepatic triglyceride, non-esterified fatty acid and glucose levels were increased significantly in the dams but decreased significantly in male offspring after maternal imazalil exposure. Furthermore, the expression levels of genes associated with glycolipid metabolism and m6A RNA methylation were significantly affected by maternal intake of imazalil. Imazalil-induced glucolipid metabolism disturbance was highly correlated with m6A RNA methylation. In conclusion, maternal imazalil exposure resulted in glucolipid metabolism disturbance and abnormal m6A RNA methylation in the livers of dams and offspring mice. We expected that the information acquired in this study will provide novel evidence for understanding the effect of maternal imazalil exposure on potential health risks.
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Affiliation(s)
- Cuiyuan Jin
- Institute of Translational Medicine, Zhejiang Shuren University, Hangzhou, Zhejiang 310015, China
| | - Caiyun Wang
- Department of Public Health and Preventive Medicine, Changzhi Medical College, Changzhi, Shanxi, 046000, China
| | - Chen Zhang
- Institute of Translational Medicine, Zhejiang Shuren University, Hangzhou, Zhejiang 310015, China
| | - Qi Ye
- Institute of Translational Medicine, Zhejiang Shuren University, Hangzhou, Zhejiang 310015, China
| | - Yuanxiang Jin
- College of Biotechnology and Bioengineering, Zhejiang University of Technology, Hangzhou, Zhejiang 310032, China.
| | - Liyun Shi
- Institute of Translational Medicine, Zhejiang Shuren University, Hangzhou, Zhejiang 310015, China.
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Baudry J, Neves F, Lairon D, Allès B, Langevin B, Brunin J, Berthy F, Danquah I, Touvier M, Hercberg S, Amiot MJ, Pointereau P, Kesse-Guyot E. Sustainability analysis of the Mediterranean diet: results from the French NutriNet-Santé study. Br J Nutr 2023; 130:2182-2197. [PMID: 37357796 DOI: 10.1017/s0007114523001411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
The Mediterranean diet is often proposed as a sustainable diet model. This study aimed to evaluate the associations between adherence to the Mediterranean diet and sustainability domains in a cohort of French adults, using multiple criteria including nutritional quality, environmental pressures, monetary cost and dietary pesticide exposure. Food intakes of 29 210 NutriNet-Santé volunteers were assessed in 2014 using a semi-quantitative FFQ. Adherence to the Mediterranean diet was evaluated using the validated literature-based adherence score (MEDI-LITE). The associations between the MEDI-LITE and various sustainability indicators were examined using ANCOVA models, adjusted for sex, age and energy intake. Higher adherence to the MEDI-LITE was associated with higher nutritional quality scores, better overall nutrient profile as well as reduced environmental impact (land occupation: Q5 v. Q1: -35 %, greenhouse gas emissions: -40 % and cumulative energy demand: -17 %). In turn, monetary cost increased with increasing adherence to the Mediterranean diet (Q5 v. Q1: +15 %), while higher adherents to the Mediterranean diet had overall higher pesticide exposure due to their high plant-based food consumption. In this large cohort of French adults, greater adherence to the Mediterranean diet was associated with nutritional and environmental benefits, but also with higher monetary cost and greater exposure to pesticides, illustrating the necessity to develop large-scale strategies for healthy, safe (pesticide- and contaminant-free) and environmentally sustainable diets for all.
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Affiliation(s)
- Julia Baudry
- Université Sorbonne Paris Nord and Université Paris Cité, Inserm, INRAE, CNAM, Centre of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), F-93017 Bobigny, France
| | - Floriane Neves
- Université Sorbonne Paris Nord and Université Paris Cité, Inserm, INRAE, CNAM, Centre of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), F-93017 Bobigny, France
| | - Denis Lairon
- Aix Marseille Université, Inserm, INRAE, C2VN, Marseille, France
| | - Benjamin Allès
- Université Sorbonne Paris Nord and Université Paris Cité, Inserm, INRAE, CNAM, Centre of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), F-93017 Bobigny, France
| | | | - Joséphine Brunin
- Université Sorbonne Paris Nord and Université Paris Cité, Inserm, INRAE, CNAM, Centre of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), F-93017 Bobigny, France
| | - Florine Berthy
- Université Sorbonne Paris Nord and Université Paris Cité, Inserm, INRAE, CNAM, Centre of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), F-93017 Bobigny, France
| | - Ina Danquah
- Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Mathilde Touvier
- Université Sorbonne Paris Nord and Université Paris Cité, Inserm, INRAE, CNAM, Centre of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), F-93017 Bobigny, France
| | - Serge Hercberg
- Université Sorbonne Paris Nord and Université Paris Cité, Inserm, INRAE, CNAM, Centre of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), F-93017 Bobigny, France
- Département de Santé Publique, Hôpital Avicenne, Bobigny, France
| | - Marie-Josèphe Amiot
- MoISA, Univ Montpellier, CIHEAM-IAMM, CIRAD, INRAE, Institut Agro, IRD, Montpellier, France
| | | | - Emmanuelle Kesse-Guyot
- Université Sorbonne Paris Nord and Université Paris Cité, Inserm, INRAE, CNAM, Centre of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), F-93017 Bobigny, France
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Åkesson A, Donat-Vargas C, Hallström E, Sonesson U, Widenfalk A, Wolk A. Associations between dietary pesticide residue mixture exposure and mortality in a population-based prospective cohort of men and women. ENVIRONMENT INTERNATIONAL 2023; 182:108346. [PMID: 38008011 DOI: 10.1016/j.envint.2023.108346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 10/31/2023] [Accepted: 11/21/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND There is a concern that pesticide residues, regularly detected in foods, might pose a health risk to the consumer, but epidemiological evidence is limited. We assessed the associations between dietary exposure to a mixture of pesticide residues and mortality. METHODS Food consumption was assessed in 68,844 participants from the Swedish Mammography Cohort and the Cohort of Swedish Men, 45-83 years at baseline (1997). Concentrations of pesticide residues detected in foods on the Swedish market (1996-1998), mainly fruits and vegetables, were obtained via monitoring programs. To assess mixture effects, we summed per food item the ratios of each single pesticide mean residue concentration divided by its acceptable daily intake to create for each participant a Dietary Pesticide Hazard Index (adjusted for energy intake and expressed per kilogram of body weight). Multivariable-adjusted Cox proportional hazards models were used to estimate hazard ratios (HR) and 95 % confidence intervals (95 %CI). RESULTS During 15 years of follow-up (1998-2014), a total of 16,527 deaths occurred, of which 6,238 were caused by cardiovascular disease (CVD) and 5,364 by cancer. Comparing extreme quintiles of Dietary Pesticide Hazard Index, the highest category was inversely associated with CVD mortality HR, 0.82 (95 % CI, 0.75-0.90) and with cancer mortality HR 0.82 (95 % CI 0.75-0.91). In analyses stratified by high/low Dietary Pesticide Hazard Index, similar inverse associations were observed by increasing fruit and vegetable consumption. CONCLUSIONS We observed no indications that dietary exposure to pesticide residue mixtures was associated with increased mortality, nor any clear indications that the benefits of fruit and vegetable consumption on mortality was compromised. Yet, our results need to be interpreted with caution.
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Affiliation(s)
- Agneta Åkesson
- Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-171 77 Stockholm, Sweden.
| | - Carolina Donat-Vargas
- Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-171 77 Stockholm, Sweden; ISGlobal, Campus Mar, Barcelona, Spain; Center for Networked Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Elinor Hallström
- RISE - Research Institutes of Sweden, Dep of Agriculture and Food, Box 5401, SE-402 29 Gothenburg, Sweden
| | - Ulf Sonesson
- RISE - Research Institutes of Sweden, Dep of Agriculture and Food, Box 5401, SE-402 29 Gothenburg, Sweden
| | | | - Alicja Wolk
- Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-171 77 Stockholm, Sweden
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Lunghi M, Arnich N, Lehuédé F, Dubuisson C, Thebault A. Consumption of Bivalve Shellfish in French Coastal Populations: Data for Acute and Chronic Exposure Assessment. J Food Prot 2023; 86:100180. [PMID: 37839552 DOI: 10.1016/j.jfp.2023.100180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/04/2023] [Accepted: 10/10/2023] [Indexed: 10/17/2023]
Abstract
Shellfish are a source of nutrients but are also a matter of concern in terms of food safety due to natural contaminants such as phycotoxins or anthropogenic contaminants including microbial agents and heavy metals. However, data related to consumption for each mollusk species are scarce and missing for appropriate exposure calculation. The objective of the study was to generate shellfish consumption data in the adult coastal population in France to assess exposure to health risks, the effects of determinants on the frequency of consumption and usual intake, and shellfish food risk perception. Our study, named the CONSOMER study, was carried out using an online survey in 2016 and 2017 and included a food frequency questionnaire. After validation, 2,479 individual questionnaires were available for statistical analysis. Our findings provide estimates of shellfish consumption frequency, portion sizes, weekly intake in g/week, and g/week/body weight that can be used for acute and chronic exposure calculations. For the acute risk, the 97.5th percentile of the portion size was found to be around 290 g for the adult coastal population. For chronic exposure, recreational shellfish harvesting activities were associated with higher weekly intakes. A non-negligible part of this subpopulation is not aware of food safety recommendations concerning harvesting areas. Results for shellfish harvester consumption in particular are consistent with other available data. Exposure calculations and safety recommendations should target shellfish harvesters.
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Affiliation(s)
- Mathias Lunghi
- Risk Assessment Department, French Agency for Food, Environmental and Occupational Health & Safety (ANSES), 14 rue Pierre et Marie Curie, 94700 Maisons-Alfort, France
| | - Nathalie Arnich
- Risk Assessment Department, French Agency for Food, Environmental and Occupational Health & Safety (ANSES), 14 rue Pierre et Marie Curie, 94700 Maisons-Alfort, France
| | - Franck Lehuédé
- Centre de Recherche pour l'Étude et l'Observation des Conditions de Vie (CREDOC), 142 rue du Chevaleret, 75013 Paris, France
| | - Carine Dubuisson
- Risk Assessment Department, French Agency for Food, Environmental and Occupational Health & Safety (ANSES), 14 rue Pierre et Marie Curie, 94700 Maisons-Alfort, France
| | - Anne Thebault
- Risk Assessment Department, French Agency for Food, Environmental and Occupational Health & Safety (ANSES), 14 rue Pierre et Marie Curie, 94700 Maisons-Alfort, France.
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Baudry J, Rebouillat P, Samieri C, Berlivet J, Kesse-Guyot E. Dietary pesticide exposure and non-communicable diseases and mortality: a systematic review of prospective studies among adults. Environ Health 2023; 22:76. [PMID: 37907942 PMCID: PMC10617043 DOI: 10.1186/s12940-023-01020-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/22/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND Research on the effect of pesticide exposure on health has been largely focused on occupational settings. Few reviews have synthesized the associations between dietary pesticide exposure and health outcomes in non-occupationally exposed adults. OBJECTIVE We aim to summarize the evidence regarding dietary pesticide exposure and non-communicable diseases (NCD) in adults, using a systematic review of prospective studies. METHODS Electronic and manual searches were performed until July 2023. The inclusion criteria were the following: 1) adults aged ≥ 18years, 2) (non)-randomized trials, prospective cohort studies, 3) dietary exposure to pesticides. A bias analysis was carried out using the Nutrition Evidence Systematic Review guidelines based on the Cochrane ROBINS-I. RESULTS A total of 52 studies were retrieved and 6 studies that met the above criteria were included. Studies were conducted either in France or in the United States. The studies investigated the risk of cancer (n = 3), diabetes (n = 1), cardiovascular diseases (n = 1), and mortality (n = 1). The quality of the studies varied with overall grades derived from the bias analysis ranging from low to moderate bias. The level of evidence was estimated as low for the risk of cancer while the grading was not assignable for other outcomes, as only one study per outcome was available. CONCLUSIONS Although further research is warranted to examine more in depth the relationships between low-dose chronic exposure to pesticides through diet and NCD outcomes in non-occupationally-exposed adults, studies suggest a possible role of exposure to dietary pesticide on health. Standardized methodological guidelines should also be proposed to allow for comparison across studies.
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Affiliation(s)
- Julia Baudry
- Université Sorbonne Paris Nord and Université Paris Cité, Inserm, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny, F-93017, France.
| | - Pauline Rebouillat
- Université Sorbonne Paris Nord and Université Paris Cité, Inserm, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny, F-93017, France
| | - Cécilia Samieri
- Univ Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
| | - Justine Berlivet
- Université Sorbonne Paris Nord and Université Paris Cité, Inserm, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny, F-93017, France
| | - Emmanuelle Kesse-Guyot
- Université Sorbonne Paris Nord and Université Paris Cité, Inserm, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Bobigny, F-93017, France
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Miret NV, Pontillo CA, Buján S, Chiappini FA, Randi AS. Mechanisms of breast cancer progression induced by environment-polluting aryl hydrocarbon receptor agonists. Biochem Pharmacol 2023; 216:115773. [PMID: 37659737 DOI: 10.1016/j.bcp.2023.115773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/23/2023] [Accepted: 08/30/2023] [Indexed: 09/04/2023]
Abstract
Breast cancer is the most common invasive malignancy among women worldwide and constitutes a complex and heterogeneous disease. Interest has recently grown in the role of the aryl hydrocarbon receptor (AhR) in breast cancer and the contribution of environment-polluting AhR agonists. Here, we present a literature review addressing AhR ligands, including pesticides hexachlorobenzene and chlorpyrifos, polycyclic aromatic hydrocarbons, polychlorinated dibenzo-p-dioxins and dibenzofurans, polychlorinated biphenyls, parabens, and phthalates. The objectives of this review are a) to summarize recent original experimental, preclinical, and clinical studies on the biological mechanisms of AhR agonists which interfere with the regulation of breast endocrine functions, and b) to examine the biological effects of AhR ligands and their impact on breast cancer development and progression. We discuss biological mechanisms of action in cell viability, cell cycle, proliferation, epigenetic changes, epithelial to mesenchymal transition, and cell migration and invasion. In addition, we examine the effects of AhR ligands on angiogenic processes, metastasis, chemoresistance, and stem cell renewal. We conclude that exposure to AhR agonists stimulates pathways that promote breast cancer development and may contribute to tumor progression. Given the massive use of industrial and agricultural chemicals, ongoing evaluation of their effects in laboratory assays and preclinical studies in breast cancer at environmentally relevant doses is deemed essential. Likewise, awareness should be raised in the population regarding the most harmful toxicants to eradicate or minimize their use.
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Affiliation(s)
- Noelia V Miret
- Universidad de Buenos Aires, Facultad de Medicina, Departamento de Bioquímica Humana, Laboratorio de Efectos Biológicos de Contaminantes Ambientales, Paraguay 2155, Piso 5, (CP 1121), Buenos Aires, Argentina; Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Departamento de Físico-Matemática, Laboratorio de Radioisótopos, Junín 954, 1er subsuelo (CP1113), Buenos Aires, Argentina.
| | - Carolina A Pontillo
- Universidad de Buenos Aires, Facultad de Medicina, Departamento de Bioquímica Humana, Laboratorio de Efectos Biológicos de Contaminantes Ambientales, Paraguay 2155, Piso 5, (CP 1121), Buenos Aires, Argentina
| | - Sol Buján
- Universidad de Buenos Aires, Facultad de Medicina, Departamento de Bioquímica Humana, Laboratorio de Efectos Biológicos de Contaminantes Ambientales, Paraguay 2155, Piso 5, (CP 1121), Buenos Aires, Argentina
| | - Florencia A Chiappini
- Universidad de Buenos Aires, Facultad de Medicina, Departamento de Bioquímica Humana, Laboratorio de Efectos Biológicos de Contaminantes Ambientales, Paraguay 2155, Piso 5, (CP 1121), Buenos Aires, Argentina
| | - Andrea S Randi
- Universidad de Buenos Aires, Facultad de Medicina, Departamento de Bioquímica Humana, Laboratorio de Efectos Biológicos de Contaminantes Ambientales, Paraguay 2155, Piso 5, (CP 1121), Buenos Aires, Argentina.
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da Silva RGS, Ferreira MO, Komori IMS, Oliveira HRM, Machado MG, Orrutea JFG, Alves FM, dos Santos Jaques H, da Silva JC, de Souza JA, Rech D, Panis C. Brief research report pesticide occupational exposure leads to significant inflammatory changes in normal mammary breast tissue. Front Public Health 2023; 11:1229422. [PMID: 37780419 PMCID: PMC10538633 DOI: 10.3389/fpubh.2023.1229422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/22/2023] [Indexed: 10/03/2023] Open
Abstract
Studies have documented the high occurrence of several tumors, including female breast cancer, in populations occupationally exposed to pesticides worldwide. It is believed that in addition to direct DNA damage, other molecular alterations that indicate genomic instability are associated, such as epigenetic modifications and the production of inflammation mediators. The present study characterized the profile of inflammatory changes in the breast tissue of women without cancer occupationally exposed to pesticides. In samples of normal breast tissue collected during biopsy and evaluated as negative for cancer by a pathologist, oxidative stress levels were assessed as inflammatory markers through measurements of lipoperoxides and total antioxidant capacity of the sample (TRAP) by high-sensitivity chemiluminescence, as well as levels of nitric oxide (NOx) metabolites. The levels of inflammation-modulating transcription factors PPAR-γ (peroxisome proliferator-activated receptor gamma) and NF-κB (nuclear factor kappa B) were also quantified, in addition to the pro-inflammatory cytokines tumor necrosis factor-alpha (TNF-α) and interleukin 12 (IL-12). The levels of lipoperoxides, TRAP, and NOx were significantly lower in the exposed group. On the other hand, PPAR-γ levels were increased in the breast tissue of exposed women, with no variation in NF-κB. There was also a rise of TNF-α in exposed women samples without significant variations in IL-12 levels. These findings suggest an inflammatory signature of the breast tissue associated with pesticide exposure, which may trigger mechanisms related to mutations and breast carcinogenesis.
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Affiliation(s)
| | - Mariane Okamoto Ferreira
- Laboratory of Tumor Biology, State University of West Paraná, Unioeste, Francisco Beltrão, Paraná, Brazil
| | - Isabella Mitsu Suo Komori
- Laboratory of Tumor Biology, State University of West Paraná, Unioeste, Francisco Beltrão, Paraná, Brazil
| | | | - Murilo Galvani Machado
- Laboratory of Tumor Biology, State University of West Paraná, Unioeste, Francisco Beltrão, Paraná, Brazil
| | | | - Fernanda Mara Alves
- Laboratory of Tumor Biology, State University of West Paraná, Unioeste, Francisco Beltrão, Paraná, Brazil
| | - Hellen dos Santos Jaques
- Laboratory of Tumor Biology, State University of West Paraná, Unioeste, Francisco Beltrão, Paraná, Brazil
| | - Janaína Carla da Silva
- Department of Biochemistry and Molecular Medicine, Université de Montreal, Montreal, Canada
| | - Janoário Athanazio de Souza
- Laboratory of Tumor Biology, State University of West Paraná, Unioeste, Francisco Beltrão, Paraná, Brazil
- Francisco Beltrão Cancer Hospital, Francisco Beltrão, Paraná, Brazil
| | - Daniel Rech
- Laboratory of Tumor Biology, State University of West Paraná, Unioeste, Francisco Beltrão, Paraná, Brazil
- Francisco Beltrão Cancer Hospital, Francisco Beltrão, Paraná, Brazil
| | - Carolina Panis
- Laboratory of Tumor Biology, State University of West Paraná, Unioeste, Francisco Beltrão, Paraná, Brazil
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Cavalier H, Trasande L, Porta M. Exposures to pesticides and risk of cancer: Evaluation of recent epidemiological evidence in humans and paths forward. Int J Cancer 2023; 152:879-912. [PMID: 36134639 PMCID: PMC9880902 DOI: 10.1002/ijc.34300] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 09/05/2022] [Accepted: 09/12/2022] [Indexed: 02/02/2023]
Abstract
Knowledge of the role in cancer etiology of environmental exposures as pesticides is a prerequisite for primary prevention. We review 63 epidemiological studies on exposure to pesticides and cancer risk in humans published from 2017 to 2021, with emphasis on new findings, methodological approaches, and gaps in the existing literature. While much of the recent evidence suggests causal relationships between pesticide exposure and cancer, the strongest evidence exists for acute myeloid leukemia (AML) and colorectal cancer (CRC), diseases in which the observed associations were consistent across several studies, including high-quality prospective studies and those using biomarkers for exposure assessment, with some observing dose-response relationships. Though high-quality studies have been published since the IARC monograph on organophosphate insecticides in 2017, there are still gaps in the literature on carcinogenic evidence in humans for a large number of pesticides. To further knowledge, we suggest leveraging new techniques and methods to increase sensitivity and precision of exposure assessment, incorporate multi-omics data, and investigate more thoroughly exposure to chemical mixtures. There is also a strong need for better and larger population-based cohort studies that include younger and nonoccupationally exposed individuals, particularly during developmental periods of susceptibility. Though the existing evidence has limitations, as always in science, there is sufficient evidence to implement policies and regulatory action that limit pesticide exposure in humans and, hence, further prevent a significant burden of cancers.
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Affiliation(s)
- Haleigh Cavalier
- Department of PediatricsNew York University (NYU) School of MedicineNew YorkNew YorkUSA
- Department of Environmental MedicineNew York University (NYU) School of MedicineNew YorkNew YorkUSA
- Department of Population HealthNew York University (NYU) School of MedicineNew YorkNew YorkUSA
| | - Leonardo Trasande
- Department of PediatricsNew York University (NYU) School of MedicineNew YorkNew YorkUSA
- Department of Environmental MedicineNew York University (NYU) School of MedicineNew YorkNew YorkUSA
- Department of Population HealthNew York University (NYU) School of MedicineNew YorkNew YorkUSA
- NYU School of Global Public HealthNew YorkNew YorkUSA
| | - Miquel Porta
- Department of PediatricsNew York University (NYU) School of MedicineNew YorkNew YorkUSA
- School of MedicineUniversitat Autònoma de BarcelonaBarcelonaSpain
- Hospital del Mar Medical Research Institute (IMIM PSMar PRBB)BarcelonaCataloniaSpain
- Department of Epidemiology, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP)MadridSpain
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11
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Bitencourt de Morais Valentim JM, Fagundes TR, Okamoto Ferreira M, Lonardoni Micheletti P, Broto Oliveira GE, Cremer Souza M, Geovana Leite Vacario B, da Silva JC, Scandolara TB, Gaboardi SC, Zanetti Pessoa Candiotto L, Mara Serpeloni J, Rodrigues Ferreira Seiva F, Panis C. Monitoring residues of pesticides in food in Brazil: A multiscale analysis of the main contaminants, dietary cancer risk estimative and mechanisms associated. Front Public Health 2023; 11:1130893. [PMID: 36908412 PMCID: PMC9992878 DOI: 10.3389/fpubh.2023.1130893] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 01/27/2023] [Indexed: 02/24/2023] Open
Abstract
Introduction Pesticides pose a risk for cancer development and progression. People are continuously exposed to such substances by several routes, including daily intake of contaminated food and water, especially in countries that are highly pesticide consumers and have very permissive legislation about pesticide contamination as Brazil. This work investigated the relationship among pesticides, food contamination, and dietary cancer risk. Methods Analyzed two social reports from the Brazilian Government: the Program for Analysis of Residues of Pesticides in Food (PARA) and The National Program for Control of Waste and Contaminants (PNCRC). Results and discussion First, we characterized the main pesticide residues detected over the maximum limits allowed by legislation or those prohibited for use in food samples analyzed across the country. Based on this list, we estimated the dietary cancer risks for some of the selected pesticides. Finally, we searched for data about dietary cancer risks and carcinogenic mechanisms of each pesticide. We also provided a critical analysis concerning the pesticide scenario in Brazil, aiming to discuss the food contamination levels observed from a geographical, political, and public health perspective. Exposures to pesticides in Brazil violate a range of human rights when food and water for human consumption are contaminated.
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Affiliation(s)
| | - Tatiane Renata Fagundes
- Department of Biological Sciences, Universidade Estadual do Norte do Paraná (UENP), Jacarezinho, Brazil
| | - Mariane Okamoto Ferreira
- Center of Health Sciences, Universidade Estadual do Oeste do Paraná (UNIOESTE), Blumenau, Brazil
| | | | | | - Milena Cremer Souza
- Department of Pathological Sciences, Universidade Estadual de Londrina (UEL), Londrina, Brazil
| | | | | | | | - Shaiane Carla Gaboardi
- Center of Health Sciences, Universidade Estadual do Oeste do Paraná (UNIOESTE), Blumenau, Brazil
- Instituto Federal Catarinense, Blumenau, Brazil
| | | | - Juliana Mara Serpeloni
- Department of Pathological Sciences, Universidade Estadual de Londrina (UEL), Londrina, Brazil
| | - Fábio Rodrigues Ferreira Seiva
- Department of Pathological Sciences, Universidade Estadual de Londrina (UEL), Londrina, Brazil
- Department of Biological Sciences, Universidade Estadual do Norte do Paraná (UENP), Jacarezinho, Brazil
| | - Carolina Panis
- Department of Pathological Sciences, Universidade Estadual de Londrina (UEL), Londrina, Brazil
- Center of Health Sciences, Universidade Estadual do Oeste do Paraná (UNIOESTE), Blumenau, Brazil
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12
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Ioannou E, Oikonomou S, Efthymiou N, Constantinou A, Delplancke T, Charisiadis P, Makris KC. A time differentiated dietary intervention effect on the biomarkers of exposure to pyrethroids and neonicotinoids pesticides. iScience 2022; 26:105847. [PMID: 36711241 PMCID: PMC9874006 DOI: 10.1016/j.isci.2022.105847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/08/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Tailoring medical models to the right person or risk subgroups delivered at the right time is important in personalized medicine/prevention initiatives. The CIRCA-CHEM randomized 2x2 crossover pilot trial investigated whether the consumption of fruits/vegetables within a time-restricted daily window would affect urinary biomarkers of exposure to neonicotinoids (6-chloronicotinic acid, 6-CN) and pyrethroids (3-phenoxybenzoic acid, 3-PBA) pesticides, a biomarker of oxidative damage (4-hydroxynonenal, 4-HNE) and the associated urinary NMR metabolome. A statistically significant difference (p < 0.001) in both creatinine-adjusted 6-CN and 3-PBA levels was observed between the two-time dietary intervention windows (morning vs. evening). In the evening intervention period, pesticides biomarker levels were higher compared to the baseline, whereas in the morning period, pesticide levels remained unchanged. Positive associations were observed between pesticides and 4-HNE suggesting a diurnal chrono-window of pesticide toxicity. The discovery of a chronotoxicity window associated with chrono-disrupted metabolism of food contaminants may find use in personalized medicine initiatives.
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Affiliation(s)
- Elina Ioannou
- Cyprus International Institute of Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus,Nutrition & Dietetics Department, Limassol General Hospital, State Health Services Organization, Limassol, Cyprus
| | - Stavros Oikonomou
- Cyprus International Institute of Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - Nikolaos Efthymiou
- Cyprus International Institute of Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - Andria Constantinou
- Cyprus International Institute of Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - Thibaut Delplancke
- Cyprus International Institute of Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - Pantelis Charisiadis
- Cyprus International Institute of Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - Konstantinos C. Makris
- Cyprus International Institute of Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus,Corresponding author
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13
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Touvier M, Srour B, Hercberg S, Galan P, Kesse-Guyot E, Julia C. Health impact of foods: Time to switch to a 3D-vision. Front Nutr 2022; 9:966310. [PMID: 35923202 PMCID: PMC9340250 DOI: 10.3389/fnut.2022.966310] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mathilde Touvier
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center–Université Paris Cité (CRESS), Bobigny, France
| | - Bernard Srour
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center–Université Paris Cité (CRESS), Bobigny, France
- *Correspondence: Bernard Srour
| | - Serge Hercberg
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center–Université Paris Cité (CRESS), Bobigny, France
- Public Health Department, Avicenne Hospital, AP-HP, Bobigny, France
| | - Pilar Galan
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center–Université Paris Cité (CRESS), Bobigny, France
| | - Emmanuelle Kesse-Guyot
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center–Université Paris Cité (CRESS), Bobigny, France
| | - Chantal Julia
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center–Université Paris Cité (CRESS), Bobigny, France
- Public Health Department, Avicenne Hospital, AP-HP, Bobigny, France
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14
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Cote DJ, Bever AM, Chiu YH, Sandoval-Insausti H, Smith-Warner SA, Chavarro JE, Stampfer MJ. Pesticide Residue Intake From Fruit and Vegetable Consumption and Risk of Glioma. Am J Epidemiol 2022; 191:825-833. [PMID: 35029641 PMCID: PMC9430420 DOI: 10.1093/aje/kwac007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 12/27/2021] [Accepted: 01/11/2022] [Indexed: 11/13/2022] Open
Abstract
We aimed to determine whether intake of pesticide residues from fruits and vegetables was associated with glioma. Within 3 prospective cohorts from 1998-2016-the Nurses' Health Study (NHS), Nurses' Health Study II (NHSII), and Health Professionals Follow-up Study-we computed multivariable-adjusted hazard ratios (MVHRs) and 95% confidence intervals (CI) for glioma by quintiles of intake of low- and high-pesticide-residue fruits and vegetables using Cox proportional hazards regression. Fruits and vegetables were categorized as high or low residue using a validated method based on pesticide surveillance data. We confirmed 275 glioma cases across 2,745,862 person-years. A significant association was observed between intake of high-residue fruits and vegetables and glioma in NHS (MVHR = 2.99, 95% CI: 1.38, 6.44 comparing highest with lowest quintile, P for trend = 0.02). This was not identified in NHSII (MVHR = 0.52, 95% CI: 0.19, 1.45, P for trend = 0.20) or Health Professionals Follow-up Study (MVHR = 1.01, 95% CI: 0.42, 2.45, P for trend = 0.39). No significant associations were observed by intake of low-residue fruits and vegetables; overall intake was not significantly associated with glioma in any cohort. We found no evidence for an inverse relationship of fruit and vegetable intake with glioma. Although limited in power, this study suggests a possible association between fruit-and-vegetable pesticide residue intake and risk of glioma that merits further study.
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Affiliation(s)
- David J Cote
- Correspondence to Dr. David J. Cote, 1200 N. State Street, Suite 3300, Los Angeles, CA 90033 (e-mail: )
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Sustainable Diets and Cancer: a Systematic Review. Curr Nutr Rep 2022; 11:742-752. [PMID: 36409441 PMCID: PMC9750932 DOI: 10.1007/s13668-022-00442-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE OF REVIEW This review aimed to investigate the association of sustainable diets in relation to cancer risk, cancer recurrence, and cancer-specific mortality in adults. RECENT FINDINGS More than 500 articles were initially identified. Nine articles were eligible for inclusion, presenting data from 8 prospective cohort studies, conducted in Europe and the USA. The sustainability indicators investigated were greenhouse gas emissions, food biodiversity, land use, exposure to pesticides or organic food consumption, and the EAT-Lancet diet. One study reported a sustainability index that combined multiple sustainability indicators. A modest inverse association between higher adherence to sustainable diets and cancer incidence or cancer mortality was observed in most studies. While sustainable diets may decrease cancer risk or mortality, the reviewed studies were heterogeneous regarding sustainability indicators and cancer outcomes. A common definition of dietary sustainability would facilitate better generalization of future research findings. Also, studies among non-western populations are needed.
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