Effects of tap water lead, water hardness, alcohol, and cigarettes on blood lead concentrations

Analyzing and Optimizing the Distribution of Blood Lead Level Testing for Children in New York City: A Data-Driven Approach

This study investigates blood lead level (BLL) rates and testing among children under 6 years of age across the 42 neighborhoods in New York City from 2005 to 2021. Despite a citywide general decline in BLL rates, disparities at the neighborhood level persist and are not addressed in the official reports, highlighting the need for this comprehensive analysis. In this paper, we analyze the current BLL testing distribution and cluster the neighborhoods using a k-medoids clustering algorithm. We propose an optimized approach that improves resource allocation efficiency by accounting for case incidences and neighborhood risk profiles using a grid search algorithm. Our findings demonstrate statistically significant improvements in case detection and enhanced fairness by focusing on under-served and high-risk groups. Additionally, we propose actionable recommendations to raise awareness among parents, including outreach at local daycare centers and kindergartens, among other venues.

Exploring specific biomarkers regarding neurobehavioral toxicity of lead dioxide nanoparticles in medaka fish in different water matrices

Nano-scale lead dioxide (nPbO₂) is an industrial metal oxide nanoparticle that can be also formed as a corrosion by-product from chlorination of Pb-containing plumbing materials. nPbO₂ governs release of toxic lead ion in drinking water and receiving organisms; however, its modes of toxic action regarding neurobehavioral toxicity remain unclear. This study evaluated the toxicity mechanism of nPbO₂ (10 and 20 mg/L) versus its released Pb(II)_aq (100 μg/L) in terms of aqueous chemistry, bioavailability and neurobehavioral toxicity to medaka fish in different water matrices. In very hard water (VHW), dissolved salts enhanced the aggregation and sedimentation of nPbO₂, resulting in higher bioavailability and altered locomotion of treated fish than those fish exposed to nPbO₂ in soft water with humic acid (SW + HA). Transcriptomic results identified six differentially expressed genes with greater altered expression with nPbO₂ than the control or Pb(II)_aq exposure. With VHW exposure, nPbO₂ caused greater altered expression of genes involved in cell adhesion (nlgn1 and epd), cell cytoskeleton (α1-tubulin), and relevant apoptosis (c-fos, birc5.1-a and casp3), as compared with SW + HA or Pb(II)_aq exposure. This study provides novel molecular mechanistic insights into the neurobehavioral nanotoxicity using nPbO₂ and medaka fish as surrogates, suggesting nPbO₂ promotes neurobehavioral dysfunction, leading to adverse outcomes from gene alteration to the organismal level. The identified biomarkers responded specifically to the nPbO₂-induced neurotoxicity in different water matrices can be used for evaluating toxicity risks of small metal oxide particulates on human or aquatic life under environmentally relevant exposures.

Oxidative stress, metallomics and blood toxicity after subacute low-level lead exposure in Wistar rats: Benchmark dose analyses

Exposure to lead (Pb) is still rising concern worldwide, having in mind that even low-dose exposure can induce various harmful effects. Thus, in-depth knowledge of the targets of Pb toxicity and corresponding mechanisms is essential. In the presented study, the six groups (male Wistar rats, n = 6) received 0.1; 0.5; 1; 3; 7; 15 mg Pb/kg body weight/day for 28 days, each day by oral gavage, while the control group received distilled water only. All animals were sacrificed 24 h after the treatment, and blood was collected for the analysis of hematological, biochemical, oxidative status and essential elements levels. An external and internal dose-response relationship was performed using PROASTweb 70.1 software. The results showed that low doses of Pb affect hematological parameters and lipid profile after 28 days. The possible mechanisms at examined Pb dose levels were a decrease in SOD, O₂^•- and Cu and an increase in Zn levels. The dose-dependent nature of changes in cholesterol, HDL cholesterol, O₂^.-, SOD, AOPP in serum and hemoglobin, Fe, Zn, Cu in blood were obtained in this study. The most sensitive parameters that were alerted are Cu blood levels (BMDL₅: 1.4 ng/kg b.w./day) and SOD activity (BMDL₅: 0.5 μg/kg b.w./day). The presented results provide information that may be useful in further assessing the health risks of low-level Pb exposure.

Assessment of Lead and Mercury Exposure Levels in the General Population of Korea Using Integrated National Biomonitoring Data

In Korea, the estimated values of blood lead (Pb) and mercury (Hg) levels differ between two national-level biomonitors, namely the Korean National Environmental Health Survey and the Korea National Health and Nutrition Examination Survey. The present study used integrated data from these surveys to estimate the representative values of the change in concentration and recent distribution characteristics. The yearly trend of age-standardized exposure levels in regular adults was identified, and the geometric mean (GM) adjusted according to demographic characteristics was presented. Age-standardized GM for blood Pb and Hg in the integrated data was 2.06 and 3.64 μg/L in 2008, respectively, which decreased to 1.55 and 2.92 μg/L, respectively, by 2017. Adjusted GMs from most recently conducted surveys (2015-2017) were 1.61 and 2.98 μg/L for blood Pb and Hg, respectively. In particular, the adjusted percentage of blood Hg exceeding the reference value of 5 μg/L was 20.79%. While the blood Pb and Hg exposure levels are decreasing in Korea, the levels remain high relative to those in other countries. The Hg levels exceeded the reference value in many individuals. Therefore, continued biomonitoring must be conducted, and a reduction plan and exposure management are needed for harmful metals, including Hg.

Variability and sampling of lead (Pb) in drinking water: Assessing potential human exposure depends on the sampling protocol

Lead (Pb) in drinking water has re-emerged as a modern public health threat which can vary widely in space and in time (i.e., between homes, within homes and even at the same tap over time). Spatial and temporal water Pb variability in buildings is the combined result of water chemistry, hydraulics, Pb plumbing materials and water use patterns. This makes it challenging to obtain meaningful water Pb data with which to estimate potential exposure to residents. The objectives of this review paper are to describe the root causes of intrinsic Pb variability in drinking water, which in turn impacts the numerous existing water sampling protocols for Pb. Such knowledge can assist the public health community, the drinking water industry, and other interested groups to interpret/compare existing drinking water Pb data, develop appropriate sampling protocols to answer specific questions relating to Pb in water, and understand potential exposure to Pb-contaminated water. Overall, review of the literature indicated that drinking water sampling for Pb assessment can serve many purposes. Regulatory compliance sampling protocols are useful in assessing community-wide compliance with a water Pb regulatory standard by typically employing practical single samples. More complex multi-sample protocols are useful for comprehensive Pb plumbing source determination (e.g., Pb service line, Pb brass faucet, Pb solder joint) or Pb form identification (i.e., particulate Pb release) in buildings. Exposure assessment sampling can employ cumulative water samples that directly capture an approximate average water Pb concentration over a prolonged period of normal household water use. Exposure assessment may conceivably also employ frequent random single samples, but this approach warrants further investigation. Each protocol has a specific use answering one or more questions relevant to Pb in water. In order to establish statistical correlations to blood Pb measurements or to predict blood Pb levels from existing datasets, the suitability of available drinking water Pb datasets in representing water Pb exposure needs to be understood and the uncertainties need to be characterized.

Probabilistic estimates of prenatal lead exposure at 195 toxic hotspots in low- and middle-income countries

BACKGROUND

Prior estimates of pediatric lead-related disease burden in low- and middle-income countries (LMICs) used population estimates of maternal blood lead levels (BLLs). This approach may underestimate fetal BLLs by not considering potentially high prenatal lead exposure from toxic hotspots. OBJECTIVES: We developed a probabilistic approach to using the Adult Lead Methodology (ALM) to estimate fetal BLLs from prenatal exposure to lead-contaminated soil at hotspots in the Toxic Site Identification Program (TSIP).

METHODS

We created distributions for each ALM parameter using published literature and extracted soil lead measurements from the TSIP database. Each iteration of the probabilistic ALM randomly selected values from the input distributions to generate a site-specific fetal BLL estimate. For each site, we ran 5000 model iterations, producing a site-specific fetal BLL distribution.

RESULTS

195 TSIP sites, in 33 LMICs, met our study inclusion criteria; an estimated 820,000 women of childbearing age are at risk for lead exposure at these sites. The predicted geometric means (GM) for site-specific fetal BLLs ranged from 3.3 μg/dL to 534 μg/dL, and 98% of sites had estimated GM fetal BLLs >5 μg/dL, the current reference level of the United States Centers for Disease Control and Prevention (CDC), while 11 sites had estimated GM fetal BLLs above the CDC chelation threshold of 45 μg/dL.

DISCUSSION

The TSIP soil lead data and this probabilistic approach to the ALM show that pregnant women living near TSIP sites may have BLLs that put their fetus at risk for neurologic damage and other sequelae, underscoring the need for interventions to reduce lead exposure at toxic hotspots.

A pharmacokinetic model of lead absorption and calcium competitive dynamics

Lead is a naturally-occurring element. It has been known to man for a long time, and it is one of the longest established poisons. The current consensus is that no level of lead exposure should be deemed "safe". New evidence regarding the blood levels at which morbidities occur has prompted the CDC to reduce the screening guideline of 10 μg/dl to 2 μg/dl. Measurable cognitive decline (reduced IQ, academic deficits) have been found to occur at levels below 10 μg/dl, especially in children. Knowledge of lead pharmacology allows us to better understand its absorption and metabolization, mechanisms that produce its medical consequences. Based upon an original and very simplified compartmental model of Rabinowitz (1973) with only three major compartments (blood, bone and soft tissue), extensive biophysical models sprouted over the following two decades. However, none of these models have been specifically designed to use new knowledge of lead molecular dynamics to understand its deleterious effects on the brain. We build and analyze a compartmental model of lead pharmacokinetics, focused specifically on addressing neurotoxicity. We use traditional phase space methods, parameter sensitivity analysis and bifurcation theory to study the transitions in the system's behavior in response to various physiological parameters. We conclude that modeling the complex interaction of lead and calcium along their dynamic trajectory may successfully explain counter-intuitive effects on systemic function and neural behavior which could not be addressed by existing linear models. Our results encourage further efforts towards using nonlinear phenomenology in conjunction with empirically driven system parameters, to obtain a biophysical model able to provide clinical assessments and predictions.

High-field modulated ion-selective field-effect-transistor (FET) sensors with sensitivity higher than the ideal Nernst sensitivity

Lead ion selective membrane (Pb-ISM) coated AlGaN/GaN high electron mobility transistors (HEMT) was used to demonstrate a whole new methodology for ion-selective FET sensors, which can create ultra-high sensitivity (−36 mV/log [Pb²⁺]) surpassing the limit of ideal sensitivity (−29.58 mV/log [Pb²⁺]) in a typical Nernst equation for lead ion. The largely improved sensitivity has tremendously reduced the detection limit (10⁻¹⁰ M) for several orders of magnitude of lead ion concentration compared to typical ion-selective electrode (ISE) (10⁻⁷ M). The high sensitivity was obtained by creating a strong filed between the gate electrode and the HEMT channel. Systematical investigation was done by measuring different design of the sensor and gate bias, indicating ultra-high sensitivity and ultra-low detection limit obtained only in sufficiently strong field. Theoretical study in the sensitivity consistently agrees with the experimental finding and predicts the maximum and minimum sensitivity. The detection limit of our sensor is comparable to that of Inductively-Coupled-Plasma Mass Spectrum (ICP-MS), which also has detection limit near 10⁻¹⁰ M.

A discussion about public health, lead and Legionella pneumophila in drinking water supplies in the United States

Lead (Pb) in public drinking water supplies has garnered much attention since the outset of the Flint water crisis. Pb is a known hazard in multiple environmental matrices, exposure from which results in long-term deleterious health effects in humans. This discussion paper aims to provide a succinct account of environmental Pb exposures with a focus on water Pb levels (WLLs) in the United States. It is understood that there is a strong correlation between WLLs and blood Pb levels (BLLs), and the associated health effects. However, within the Flint water crisis, more than water chemistry and Pb exposure occurred. A cascade of regulatory and bureaucratic failures culminated in the Flint water crisis. This paper will discuss pertinent regulations and responses including their limitations after an overview of the public health effects from Pb exposure as well as discussion on our limitations on monitoring and mitigating Pb in tap water. As the Flint water crisis also included increased Legionnares' disease, caused by Legionella pneumophila, this paper will discuss factors influencing L. pneumophila growth. This will highlight the systemic nature of changes to water chemistry and public health impacts. As we critically analyze these important aspects of water research, we offer discussions to stimulate future water quality research from a new and systemic perspective to inform and guide public health decision-making.

Elevation of Lead in Human Blood from its Controlled Ingestion in Beer

1 Nine volunteers ingested high levels of lead in beer over a 28-d period. The increase in blood lead varied by a factor of about two. There was a similar two-fold variability in the whole-body uptake (mean 14%) of a single oral dose of the short-lived tracer 203Pb.

2 The average elevations led to estimates of the potential increment from consumption of alcoholic beverages which accord broadly with epidemiological observation and which, if relevant to intakes of lead in table wine, raise the possibility of considerably elevated levels in the blood of avid consumers.

3 Rate constants inferred for removal of stable lead from blood were lower than reported following intake of the tracer, reflecting feedback of lead from other compartments.

Elevated blood lead levels among unskilled construction workers in Jimma, Ethiopia

Background

No study has been carried out to assess the blood lead levels of workers or the contribution of common workplace practices to lead exposure in Ethiopia. This study was carried out to assess the blood lead levels of female and male laborers in the construction sector in Jimma town, Ethiopia.

Method

A cross-sectional study on the blood lead levels of 45 construction workers was carried out in the town of Jimma. The t-test, analysis of variance, the Kruskal-Wallis, Mann–Whitney and odds ratio tests were used to compare mean blood lead levels and to investigate the associations between specific job type, use of self-protection device, sex, service years and occurrence of non-specific symptoms with BLLs.

Results

The mean blood lead level of the exposed group (40.03 ± 10.41 μg/dL) was found to be significantly greater than that of the unexposed group (29.81 ± 10.21 μg/dL), p = 0.05. Among the exposed group female workers were found to have higher mean blood lead level (42.04 ± 4.11 μg/dL) than their male colleagues (33.99 ± 3.28 μg/dL). Laborers who were regularly using self-protection devices were found to have significantly lower blood lead levels than those who were not using.

Conclusion

The blood lead levels of construction workers in Jimma town are considerably high with a range of 20.46 – 70.46 μg/dL and the workers are in danger of imminent lead toxicity. More endangered are female construction workers who are bearers of the future children of the country and the issue requires urgent attention.

Elevated blood lead levels and sources of exposure in the population of Kinshasa, the capital of the Democratic Republic of Congo

The objective of this study was to determine blood lead levels (BLLs) and the possible sources of exposure in the population of Kinshasa, the capital of the Democratic Republic of Congo. A cross-sectional survey was carried out from January to May 2008 in a representative sample of the Kinshasan population. BLL was measured in 275 individuals (53.4% women) aged 1-70 years in the urban area of Kinshasa and from 60 additional subjects in the rural area. Pb was also determined in environmental specimens (air and soil, indoor and outdoor). BLL in the study population ranged from 2.9 to 49.3 μg/dl (median, 9.9 μg/dl). The median BLL among children aged <6 years was 11.5 μg/dl (range: 3.0-37.8 μg/dl). Of these children, 71% had elevated BLL (≥10 μg/dl) and 22% had BLL ≥20 μg/dl. The proportion of elevated BLL (≥10 μg/dl) was higher for children aged <3 years than for children aged 3 to 5 years (97% vs 56%). A higher prevalence of elevated BLL was observed in urban compared with rural children (71% vs 20%). Significantly higher BLLs were also found in children whose mother consumed fired clay during pregnancy. Residential informal activities in the recycling of car batteries also contributed to elevated BLL in children. The elevated background of Pb exposure in the Kinshasan population indicates a public health issue that requires corrective actions. Pb-contaminated dust and air in children's home is an issue of public health concern. The use of leaded gasoline and the activities of car battery recycling in certain residences appear to constitute the main sources of exposure in the city of Kinshasa. The traditional use of fired clay for the treatment of gastritis by pregnant women is another significant contributor for elevated BLL in children.

Amending soils with phosphate as means to mitigate soil lead hazard: a critical review of the state of the science

Ingested soil and surface dust may be important contributors to elevated blood lead (Pb) levels in children exposed to Pb contaminated environments. Mitigation strategies have typically focused on excavation and removal of the contaminated soil. However, this is not always feasible for addressing widely disseminated contamination in populated areas often encountered in urban environments. The rationale for amending soils with phosphate is that phosphate will promote formation of highly insoluble Pb species (e.g., pyromorphite minerals) in soil, which will remain insoluble after ingestion and, therefore, inaccessible to absorption mechanisms in the gastrointestinal tract (GIT). Amending soil with phosphate might potentially be used in combination with other methods that reduce contact with or migration of contaminated soils, such as covering the soil with a green cap such as sod, clean soil with mulch, raised garden beds, or gravel. These remediation strategies may be less expensive and far less disruptive than excavation and removal of soil. This review evaluates evidence for efficacy of phosphate amendments for decreasing soil Pb bioavailability. Evidence is reviewed for (1) physical and chemical interactions of Pb and phosphate that would be expected to influence bioavailability, (2) effects of phosphate amendments on soil Pb bioaccessibility (i.e., predicted solubility of Pb in the GIT), and (3) results of bioavailability bioassays of amended soils conducted in humans and animal models. Practical implementation issues, such as criteria and methods for evaluating efficacy, and potential effects of phosphate on mobility and bioavailability of co-contaminants in soil are also discussed.

Effects of sub-chronic low-level lead exposure on the homeostasis of copper and zinc in rat tissues

Information about the health risks or the subtle adverse health effects that might be associated with low-level lead exposure on micronutrient metabolism are scarce in the literature. The present work investigated the subtle adverse health effects of exposure to progressively low levels of lead on the metabolism of two micronutrients, copper and zinc in different tissues of the rat. Rats were exposed to 200, 300 and 400 ppm lead in their drinking water for 12 weeks. Lead, copper and zinc concentrations were determined in blood, liver, kidney, heart, spleen and brain of the animals. While the imbalance in zinc metabolism was characterized by a deposition of zinc in the kidney and to a lesser extent in the heart of the animals, imbalance in copper metabolism was characterized by a depletion of blood and splenic copper concentrations as well as renal and cardiac accumulation of copper. Hepatic and brain copper and zinc contents, together with blood zinc were not affected by the 12-week lead exposure. A linear relationship was observed between lead dose and lead accumulation in the spleen, whereas a non-linear relationship was observed between lead dose and lead accumulation in blood, liver, kidney and heart. Our findings indicate that exposure to progressively low-level lead concentrations results in imbalance in copper and zinc in the organism and this might be a factor in propensity toward behavioral disorders observed in lead exposure.

Childhood lead exposure after the phaseout of leaded gasoline: an ecological study of school-age children in Kampala, Uganda

BACKGROUND

Tetraethyl lead was phased out of gasoline in Uganda in 2005. Recent mitigation of an important source of lead exposure suggests examination and re-evaluation of the prevalence of childhood lead poisoning in this country. Ongoing concerns persist about exposure from the Kiteezi landfill in Kampala, the country's capital.

OBJECTIVES

We determined blood lead distributions among Kampala schoolchildren and identified risk factors for elevated blood lead levels (EBLLs; >or= 10 microg/dL). Analytical approach: Using a stratified, cross-sectional design, we obtained blood samples, questionnaire data, and soil and dust samples from the homes and schools of 163 4- to 8-year-old children representing communities with different risks of exposure.

RESULTS

The mean blood lead level (BLL) was 7.15 microg/dL; 20.5% of the children were found to have EBLL. Multivariable analysis found participants whose families owned fewer household items, ate canned food, or used the community water supply as their primary water source to have higher BLLs and likelihood of EBLLs. Distance < 0.5 mi from the landfill was the factor most strongly associated with increments in BLL (5.51 microg/dL, p < 0.0001) and likelihood of EBLL (OR = 4.71, p = 0.0093). Dust/soil lead was not significantly predictive of BLL/EBLL.

CONCLUSIONS

Lead poisoning remains highly prevalent among school-age children in Kampala. Confirmatory studies are needed, but further efforts are indicated to limit lead exposure from the landfill, whether through water contamination or through another mechanism. Although African nations are to be lauded for the removal of lead from gasoline, this study serves as a reminder that other sources of exposure to this potent neurotoxicant merit ongoing attention.

Relationship of lead in drinking water to bone lead levels twenty years later in Boston men: the Normative Aging Study

Tap water in a city like Boston, which has old houses containing lead plumbing, is known to be a significant source of potential lead exposure. Bone lead levels integrate exposure over many years, and in vivo bone lead measurements have recently become possible with the advent of K x-ray fluorescence instruments. Thus we examined the relationship between first morning tap-water lead levels measured in homes in the 1970s and levels of lead in bone measured in the 1990s among middle-aged to elderly men who lived in those homes. We studied 129 participants in the Normative Aging Study who had lead measured in their homes' tap water in 1976 and 1977 by graphite furnace-atomic absorption spectrophotometry. From 1991 to 1995, the same subjects had blood lead levels measured by graphite furnace-atomic absorption spectroscopy and tibia and patella bone lead levels measured by K x-ray fluorescence. We ran multivariate linear regression models predicting bone lead levels that adjusted for factors which had previously been linked with this outcome in the Normative Aging Study (age, pack-years of smoking, and educational level). Among subjects who lived in houses with > or = 50 micrograms lead/liter of first morning tap water representing water that had been standing overnight in the plumbing in 1976 and 1977, those who reported medium or high levels of tap-water ingestion (> or = 1 glass/day) had progressively higher patella lead levels than did those with low levels of ingestion (< 1 glass/day). No such relationship was found among subjects who lived in houses with < 50 micrograms lead/liter of first morning tap water in 1976 and 1977. We conclude that ingestion of lead-contaminated tap water is an important predictor of elevated bone lead levels later in life.

Blood lead slope factor models for adults: comparisons of observations and predictions

Here we explore the appropriateness of various parameter values for the Bowers et al. model [Risk Anal 14:183-189, 1994] in the context of predicting the influence of site-related exposure to lead in soil on the blood lead (PbB) levels of women of childbearing age. We outline the parameters prescribed by Bowers et al. as well as those prescribed by the U.S. Environmental Protection Agency (U.S. EPA). Comparison of the PbB levels predicted by the Bowers et al. model to those predicted by the validated O'Flaherty pharmacokinetic model indicates that the Bowers et al. model performs favorably when parameter values prescribed here are used. Use of the U.S. EPA-prescribed parameters yields predicted PbB levels that substantially exceed the validated O'Flaherty model predictions. Finally, both the U.S. EPA-prescribed parameter values and the parameter values recommended herein are used to predict PbB levels among adults living in four Superfund communities. Comparison of predicted PbB levels for these communities indicates that the U.S. EPA parameters overstate the incremental influence of lead in soil on PbB levels. Differences between the parameter values prescribed here and the U.S. EPA-prescribed parameters yield substantially different cleanup criteria for lead in soil, although conservative parameter values may still be appropriate for screening purposes.

Gastrointestinal absorption of metals

Estimating gastrointestinal absorption remains a significant challenge in the risk assessment of metals. This presentation reviews our current understanding of the gastrointestinal absorption of lead (Pb) to illustrate physiological mechanisms involved in metal absorption, new approaches that are being applied to the problem of estimating metal absorption in humans, and issues related to integrating this information into risk assessment. Absorption of metals can be highly variable in human populations because it is influenced by a variety of factors that include the chemical form of the metal, environmental matrix in which the ingested metal is contained, gastrointestinal tract contents, diet, nutritional status, age, and, in some cases, genotype. Thus, in risk assessment models, gastrointestinal absorption is best described as a variable whose distribution is determined in part by the above multiple influences. Although we cannot expect to evaluate empirically each of the above factors in human populations, we can expect to achieve a sufficiently detailed understanding of absorption mechanisms to develop conceptual and, eventually, quantitative models of absorption that account for some aspects of individual variability. A conceptual model is presented of the physiological processes involved in the transfer of ingested metals from the lumen of the gastrointestinal tract to the blood circulation. Components of the model include delivery to the site(s) of absorption; distribution among intracellular and extracellular ligands and transcellular and paracellular pathways of transfer across the gastrointestinal tract epithelium. The gastrointestinal absorption of Pb is discussed in the context of this model.

Gastrointestinal absorption of metals

Estimating gastrointestinal absorption remains a significant challenge in the risk assessment of metals. This presentation reviews our current understanding of the gastrointestinal absorption of lead (Pb) to illustrate physiological mechanisms involved in metal absorption, new approaches that are being applied to the problem of estimating metal absorption in humans, and issues related to integrating this information into risk assessment. Absorption of metals can be highly variable in human populations because it is influenced by a variety of factors that include the chemical form of the metal, environmental matrix in which the ingested metal is contained, gastrointestinal tract contents, diet, nutritional status, age, and, in some cases, genotype. Thus, in risk assessment models, gastrointestinal absorption is best described as a variable whose distribution is determined in part by the above multiple influences. Although we cannot expect to evaluate empirically each of the above factors in human populations, we can expect to achieve a sufficiently detailed understanding of absorption mechanisms to develop conceptual and, eventually, quantitative models of absorption that account for some aspects of individual variability. A conceptual model is presented of the physiological processes involved in the transfer of ingested metals from the lumen of the gastrointestinal tract to the blood circulation. Components of the model include delivery of the metal to the site(s) of absorption; distribution of metal among intracellular and extracellular ligands and transcellular and paracellular pathways of transfer across the gastrointestinal tract epithelium. The gastrointestinal absorption of Pb is discussed in the context of this model.

Alcohol consumption and smoking habits as determinants of blood lead levels in a national population sample from Germany

We investigated the influence of various lifestyle factors on blood lead levels in a representative sample from the general adult population (i.e., > or = 18 y of age) of West Germany in 1987-1988. The overall mean blood lead level was 73 microg/l (standard deviation = 41.4 microg/l) in 834 men and 54 microg/l (standard deviation = 26.8 microg/l) in 1,065 women. In a multiple linear regression analysis, alcohol consumption accounted for the largest proportion of variability in blood lead levels, followed by both age and smoking. Other significant contributing factors were gender, hematocrit, calcium intake, and consumption of milk and milk products. Wine had a greater effect on blood lead levels than beer (i.e., per g of alcohol consumed). With respect to cigarette smoking (i.e., no. of cigarettes smoked/d), filterless cigarettes were associated with higher blood lead levels than filter-tipped cigarettes. In addition, smoking cigars, cigarillos, or a pipe resulted in higher blood lead levels than smoking only cigarettes. Alcohol consumption and smoking were independent contributors to blood lead levels in both men and women, but effects of alcohol consumption were stronger in women than in men. We concluded that consumption of alcohol and tobacco represent major avoidable sources of lead exposure.

Derivation of a target concentration of Pb in soil based on elevation of adult blood pressure

The increase in systolic blood pressure in males appears to be the most sensitive adult endpoint appropriate for deriving a health risk-based target level of lead (Pb) in soil. Because the response of blood pressure to blood Pb concentration (PbB) has no apparent threshold, traditional approaches based on the application of a Reference Dose (RfD) are not applicable. An alternative approach is presented based on a model which predicts the population shift in systolic blood pressure from ingestion of Pb contaminated soil as a simultaneous function of exposure to Pb in soil, the baseline distribution of blood Pb concentration in the population and baseline distribution of systolic pressure in the population. This model is analyzed using Monte Carlo analysis to predict the population distribution of systolic pressure resulting from Pb exposure. Based on this analysis, it is predicted that for adult males 18-65 years old, exposure to 1000 ppm Pb in soil will result in an increase of approximately 1 mm Hg systolic pressure, an increase in the incidence of systolic hypertension (i.e., systolic pressure > 140 mm Hg) of approximately 1% and an increase in PbB of 1-3 micrograms/dl. Based on the proposition that these adverse effects can be considered de minimis, 1000 ppm Pb in soil is proposed as a target soil concentration for adult exposure. Available data do not appear to be adequate to predict the newborn PbB level which would result from exposure to this soil level during pregnancy.

Lead exposure in Saudi Arabia and its relationship to smoking

Lead was determined in whole blood samples obtained from 202 Saudi male volunteers. The influence of smoking on lead exposure was investigated. Blood lead was significantly higher in current smokers than in non-smokers and previous smokers (P < 0.05). The distribution of blood lead data in the screened subjects suggested the existence of two mixed populations and a cut-off of 12 micrograms dl-1 was found where the two populations separate. Of the exposed population, 80% with blood lead concentrations above 12 micrograms dl-1 were smokers.

Blood lead levels in children aged 24 to 36 months in Vancouver

OBJECTIVES

To determine the blood lead levels in children and to identify risk factors for elevated levels.

DESIGN

Cross-sectional study.

SETTING

Vancouver.

PARTICIPANTS

Random sample of children aged 24 to 36 months, born and still resident in Vancouver. The sample was stratified proportionally by the median annual family income in the census tract where each family resided.

OUTCOME MEASURES

Blood lead levels and risk factors for elevated blood lead levels, determined from a questionnaire administered to parents.

RESULTS

Of the children in the sample, 42% (178/422) were ineligible or could not be located. Of the remaining children, 73% (177/244) participated and adequate blood specimens were obtained from 172. The mean blood lead level was 0.29 mumol/L (standard deviation 0.13 mumol/L). (A blood lead level of 1 mumol/L is equivalent to 20.7 micrograms/dL.) The lowest level was 0.06 mumol/L, and the highest was 0.85 mumol/L. Of children with adequate samples, 8.1% (14/172) had blood lead levels of 0.48 mumol/L or higher, and 0.6% (1/172) had a level higher than 0.72 mumol/L. The logarithms of the levels were normally distributed, with a geometric mean (GM) of 0.26 mumol/L (geometric standard deviation 1.56). Of approximately 70 possible predictors of blood lead levels analysed, those that showed a statistically significant association (p < 0.05) with increased blood lead levels were soldering performed in the home as part of an electronics hobby (GM blood lead level 0.34 mumol/L, 95% confidence interval [CI] 0.27 to 0.39 mumol/L), aboriginal heritage (GM blood lead level 0.33 mumol/L, 95% CI 0.28 to 0.39 mumol/L), dwelling built before 1921 (GM blood lead level 0.32 mumol/L, 95% CI 0.28 to 0.37 mumol/L), age of water service connection to dwelling (predicted blood lead level 0.00087 mumol/L [95% CI 0.00005 to 0.00169 mumol/L] higher per year since service connection) and decreased stature (predicted blood lead level 0.018 mumol/L [95% CI 0.0353 to 0.0015 mumol/L] higher for every standard deviation below the age-specific mean height).

CONCLUSIONS

This study found much lower blood lead levels in children than those found in previous Canadian studies. The authors believe that this result is not an artefact due to differences in population sampling or methods of collection of blood specimens. The study showed no clear risk factors for elevated blood lead levels: although a few factors had a statistically significant association with increased blood lead levels, the differences in levels were small and unimportant.

Assessing the relationship between environmental lead concentrations and adult blood lead levels

This paper presents a model for predicting blood lead levels in adults who are exposed to elevated environmental levels of lead. The model assumes a baseline blood lead level based on average blood lead levels for adults described in two recent U.S. studies. The baseline blood level in adults arises primarily from exposure to lead in diet. Media-specific ingestion and absorption parameters are assessed for the adult population, and a biokinetic slope factor that relates uptake of lead into the body to blood lead levels is estimated. These parameters are applied to predict blood lead levels for adults exposed to a hypothetical site with elevated lead levels in soil, dust and air. Blood lead levels ranging from approximately 3-57 micrograms/dl are predicted, depending on the exposure scenarios and assumptions.

Effectiveness of flushing on reducing lead and copper levels in school drinking water

Samples from drinking water fountains in 50 schools in New Jersey were collected at specific times during a typical school day and analyzed for lead, copper, pH, alkalinity, and hardness. First-draw lead and copper levels (medians 0.010 mg/l and 0.26 mg/l, respectively) decreased significantly after 10 min of flushing in the morning (medians 0.005 mg/l lead and 0.068 mg/l copper), but levels increased significantly by lunchtime (medians 0.007 mg/l lead and 0.12 mg/l copper) after normal use of fountains in the morning by students. Corrosive water, as defined by the aggressive index, contained significantly higher levels of lead and copper (medians 0.012 mg/l and 0.605 mg/l, respectively) than noncorrosive water (medians 0.005 mg/l and 0.03 mg/l, respectively).

Alcohol consumption and other lifestyle factors: avoidable sources of excess lead exposure

Lead concentration in whole blood of a representative sample of 471 subjects aged 20 to 74 years and living in Basle was determined in 1989/90 by flame atomic absorption spectrophotometry. The participants in the cross-sectional study filled in a questionnaire on demographic factors, nutrition and drinking habits. The age-adjusted geometrical mean blood lead level was 0.38 +/- 0.19 mumol/litre of whole blood for males, and 0.29 +/- 0.17 mumol/litre for females. The average lead burden was about 30% below the mean concentration found in a comparable population in Western Switzerland five years earlier. Lead emissions in Switzerland decreased by about 40% from 1984 to 1990 through restriction of lead in petrol. This offers the most plausible explanation for the low blood lead levels found in Basle. Sex, age, occupation (employment in painting or printing, construction or the metal processing industry), smoking and alcohol intake (especially wine consumption) were identified as independent blood lead predictors in a multiple linear regression analysis. Participants who consumed alcohol daily had blood lead concentrations on average 12% higher than those of abstinent subjects. Regular smokers had an unconfounded average blood lead level 8% above that of people who never smoked. Place of residence and hourly frequency of cars in that area were not identified as independent predictors in the model. The analysis of 99 different wines on the market in Basle showed an average lead concentration of 50 +/- 17 micrograms/litre wine. Compared to an estimated 25 micrograms daily nutritional intake of lead in Switzerland the value appeared to be high.(ABSTRACT TRUNCATED AT 250 WORDS)

An integrated exposure/pharmacokinetic based approach to the assessment of complex exposures. Lead: a case study

A problem in evaluating the hazard represented by an environmental toxicant is that exposures can occur via multiple media such as water, land, and air. Lead is one of the toxicants of concern that has been associated with adverse effects on heme metabolism, serum vitamin D levels, and the mental and physical development of infants and children exposed at very low environmental levels. Effects of lead on development are particularly disturbing in that the consequences of early delays or deficits in physical or mental development may have long-term consequences over the lifetime of affected individuals. Experimental and epidemiologic studies have indicated that blood lead levels in the range of 10-15 micrograms/dl, or possibly lower, are likely to produce subclinical toxicity. Since a discernible threshold has not been demonstrated, it is prudent to preclude development of a Reference Dose (RfD) for lead. As an alternate, the U.S. Environmental Protection Agency (U.S. EPA) has developed the uptake/biokinetic lead model that provides a means for evaluating the relative contribution of various media to establishing blood lead levels in children. This approach will allow for the identification of site- and situation-specific abatement strategies based on projected blood lead levels in vulnerable human populations exposed to lead in air, diet, water, soil/dust, and paint; thus making it possible to evaluate regulatory decisions concerning each medium on blood levels and potential health effects.

The correspondence between U.K. 'action levels' for lead in blood and in water

This paper considers whether the Department of the Environment's water lead concentration criterion for lead pipe replacement and action in individual cases, i.e. 50 micrograms/l in any sample, is too high when set against the Department of Health's advisory action limit for blood lead concentration of 25 micrograms/100 ml. The relationships between blood lead and water lead concentrations found in the Glasgow and Ayr duplicate diet studies, together with unpublished data from Glasgow and Liverpool, indicate that over 10% of people exposed to an average water lead concentration of 100 micrograms/l (the earlier action level) would have blood lead concentrations above 25 micrograms/100 ml, as would about 4% of those exposed to 50 micrograms/l (the Maximum Admissible Concentration in an EEC Directive). For adults, average water lead concentrations should not exceed 30 micrograms/l to ensure compliance with the limit for blood lead, i.e. so that not more than 2% exceed 25 micrograms/100 ml. However, for one of the critical groups, bottle-fed infants (whose diet is 90% water), average water lead concentrations should not exceed 10-15 micrograms/l. The WHO's Provisional Tolerable Weekly Intake (PTWI) for children (25 micrograms/kg body weight) also implies that their water lead concentrations should not exceed 10-15 micrograms/l.

Lack of lead effects on fetal development and offspring learning when combined with alcohol in the Long-Evans rat

Two studies were conducted to evaluate the interactive effects of alcohol and lead during pregnancy in rats. Our purpose was to see if lead, as lead acetate, would influence the alcohol effect already known to exist. In the first study, pregnant Long-Evans rats received lead (as lead acetate), alcohol (20% w/v), or lead plus alcohol once a day on gestation days (GD) 10-20. On GD 20, when animals were sacrificed, mean blood alcohol levels were consistently higher for the lead-plus-alcohol-dosed groups compared to alcohol alone, but these two groups did not differ in maternal weight gain, percent resorptions, litter size, or fetal weight. Mean blood lead levels were not consistently higher in the lead-plus-alcohol groups compared to lead only, but the lead-plus-alcohol groups differed significantly from the lead-only groups at higher doses in the previously mentioned parameters. The lead-only groups did not differ from vehicle controls in any parameter in spite of blood lead levels as high as 300 micrograms/dl. In the second experiment, animals given a combination of alcohol and lead did not differ in activity, passive avoidance, or active avoidance learning compared to animals given alcohol or lead alone. Animals given lead only or the combination of lead plus alcohol had longer first trial latencies in the passive avoidance test. The data indicate that neither lead nor alcohol attenuates or potentiates each other's effects on reproduction or learning behavior in the Long-Evans rat even at high blood lead levels.

Application of clearance concepts to the assessment of exposure to lead in drinking water

This paper explores the application of clearance concepts to environmental toxicology. Lead, for which a clearance of about 0.5 ml/min is estimated from published data, is chosen as an example. An index for the contribution of drinking water to total exposure is developed using these concepts. For lead, this index is shown to increase with the concentration of the metal in water; it is higher for children than for adults. At the maximum contaminant level (MCL) of 10 micrograms/L proposed by the US Environmental Protection Agency (EPA), the average contribution from lead in drinking water is estimated to be 7 percent. The contribution in children is about twice as great. At and above the current MCL of 50 micrograms/L, drinking water becomes a major source of lead exposure.

The relationship between blood lead, blood pressure, stroke, and heart attacks in middle-aged British men

The relationship between blood lead concentration and blood pressure is examined in a survey of 7371 men aged 40 to 59 from 24 British towns. After allowance for relevant confounding variables, including town of residence and alcohol consumption, there exists a very weak but statistically significant positive association between blood lead and both systolic and diastolic blood pressure. These cross-sectional data indicate that an estimated mean increase of 1.45 mm Hg in systolic blood pressure occurs for every doubling of blood lead concentration with a 95% confidence interval of 0.47 to 2.43 mm Hg. After 6 years of follow-up, 316 of these men had major ischemic heart disease, and 66 had a stroke. After allowance for the confounding effects of cigarette smoking and town of residence there is no evidence that blood lead is a risk factor for these cardiovascular events. However, as the blood lead-blood pressure association is so weak, it is unlikely that any consequent association between lead and cardiovascular disease could be demonstrated from prospective epidemiological studies. An overview of data from this and other large epidemiological surveys provides reasonably consistent evidence on lead and blood pressure. While NHANES II data on 2254 U.S. men indicate a slightly stronger association between blood lead and systolic blood pressure, data from two Welsh studies on over 2000 men did not show a statistically significant association. However, the overlapping confidence limits for all these studies suggest that there may be a weak positive statistical association whereby systolic blood pressure is increased by about 1 mm Hg for every doubling of blood lead concentration.(ABSTRACT TRUNCATED AT 250 WORDS)

The relationship between blood lead, blood pressure, stroke, and heart attacks in middle-aged British men

The relationship between blood lead concentration and blood pressure is examined in a survey of 7371 men aged 40 to 59 from 24 British towns. After allowance for relevant confounding variables, including town of residence and alcohol consumption, there exists a very weak but statistically significant positive association between blood lead and both systolic and diastolic blood pressure. These cross-sectional data indicate that an estimated mean increase of 1.45 mm Hg in systolic blood pressure occurs for every doubling of blood lead concentration with a 95% confidence interval of 0.47 to 2.43 mm Hg. After 6 years of follow-up, 316 of these men had major ischemic heart disease, and 66 had a stroke. After allowance for the confounding effects of cigarette smoking and town of residence there is no evidence that blood lead is a risk factor for these cardiovascular events. However, as the blood lead-blood pressure association is so weak, it is unlikely that any consequent association between lead and cardiovascular disease could be demonstrated from prospective epidemiological studies. An overview of data from this and other large epidemiological surveys provides reasonably consistent evidence on lead and blood pressure. While NHANES II data on 2254 U.S. men indicate a slightly stronger association between blood lead and systolic blood pressure, data from two Welsh studies on over 2000 men did not show a statistically significant association. However, the overlapping confidence limits for all these studies suggest that there may be a weak positive statistical association whereby systolic blood pressure is increased by about 1 mm Hg for every doubling of blood lead concentration.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood cadmium concentrations in the general population of British middle-aged men

Blood cadmium concentrations were determined for 6919 men aged 40-59 randomly selected from general practice registers in 24 British towns. The mean and median blood cadmium were 1.9 and 1.4 micrograms/1 respectively and the distribution was highly skewed. The mean levels in non-smokers was 1.0 micrograms/l and current smokers showed a marked gradient with the daily amount smoked, with a mean of 3.9 micrograms/l in men smoking 40 or more cigarettes per day. Whereas 95% of men who never smoked had blood cadmium less than 2.0 micrograms/l, 80% of men smoking 20 or more cigarettes a day exceeded this figure. 1% of the men had blood cadmium concentrations greater than or equal to 7 micrograms/l virtually all of whom currently smoked cigarettes. Blood cadmium levels in ex-smokers were much lower than in current smokers even for those who had stopped within the past year. However, the mean levels in ex-smokers remained higher than the 'never smoked' for several years after stopping. There was little evidence that age, social class, or alcohol consumption were associated with blood cadmium levels after allowance for cigarette smoking. There is substantial geographic variation in mean blood cadmium for middle-aged men which could not be completely accounted for by smoking differences. Towns in the south and east of England all had mean levels under 2.0 micrograms/l whereas the majority of towns in other parts of Britain had mean levels greater than 2.0 micrograms/l. Possible reasons for this geographic pattern (e.g. geochemistry, industrial exposure, dietary differences) need further exploration.

Lead from dust and water as exposure sources for children

Data from the Edinburgh Lead Study are used to estimate the respective contributions of water and dust lead to blood lead in 6-9 year old children. Both sources are significantly related to blood lead. An exposure of 100 μg/l in kitchen cold water is estimated to be equivalent to 2700 μg/g of lead in dust. In this population water is a more important source of lead than dust for the bulk of the population.

Epidemiology and trace elements

Basically, epidemiology is the making of measurements of known reproducibility, in a bias-free manner, on representative samples of subjects drawn from defined communities. Epidemiology has become a relatively precise science and its value in medicine is widely appreciated. So too are its limitations: the difficulties in achieving a high response rate, in identifying and controlling confounding factors in the examination of an association, and the ultimate difficulties in distinguishing causation from association. While the value of community-based studies seems to be recognized by those interested in man and his environment, the need for the strict application of epidemiological procedures, and the limitations imposed on conclusions drawn from studies in which these procedures have been compromised, does not seem to be adequately understood. There are certain known links between trace elements in the environment and disease: for example the level of iodine in soil and water and the prevalence of goitre; the level of fluoride in water and the prevalence of dental caries. The investigation of other possible associations is difficult for a number of reasons, including interrelationships between trace elements, confounding of trace element levels (and disease) with social and dietary factors, and the probability that relationships are generally weak. Two conditions in which associations are likely are cardiovascular disease and cancer. Despite research along a number of lines, the relevance of trace elements to cardiovascular disease is not clear, and certainly the apparent association with hardness of domestic water supply seems unlikely to be causal. The same general conclusion seems reasonable for cancer, and although there are a very few well established associations which are likely to be causal, such as exposure to arsenic and skin cancer, the role of trace elements is obscure, and likely to be very small.

Heavy metals in human and animal bones from ancient and contemporary France

The concentrations of Cd, Pb, Zn, Ba, Mg and Ca have been determined in 180 human bones from the last five millenia, and in 22 contemporary and 20000-50000-year-old animal bones. The original concentrations of Cd and Zn in the ancient human bones were not changed by fossilization processes, whereas Pb and Mg tended to migrate out of the bones, and Ba and Ca concentrations increased with the age of the bones. The distribution of metals in the structure of both the ancient and contemporary bones is not uniform, and neglecting this may render it difficult to compare results obtained from different studies. In Europe and Peru in the late Middle Ages the concentration of Pb in human bones increased by one order of magnitude. The high level of Pb persisted in Europe for several centuries and only recently decreased by an order of magnitude. The concentration of Cd has increased in human bones in the 20th century, to about ten times above the pre-industrial level. The concentration of Pb in contemporary cow bones from France is below analytical detection limits, probably due to competition of Pb with Ca and P which are added to cow fodder as mineral additives.

Baseline level of blood lead concentration among Japanese farmers

Lead concentrations were determined for more than 2500 blood samples (more than 2000 winter samples and approximately 500 summer samples) collected from farmers in various parts of Japan to establish reliable baselines for blood lead levels; the analysis was conducted in a single laboratory to avoid any inter-laboratory errors. Blood lead levels distributed log-normally with a geometric mean (i.e., a geometric standard deviation) of 48.6 micrograms/L (1.51) for males and 32.1 micrograms/L (1.50) for females. The levels observed were among the lowest in the industrialized countries of the world. The sex difference was significant (P less than .01) while the difference in Pb-B between winter and summer was essentially insignificant. Both drinking and smoking habits were associated with a dose-dependent increase in blood lead levels, especially in males; the increment was additive when the examinee was a drinker-smoker. The geographical difference in blood lead levels remained inconclusive.

The relationship between air lead and blood lead in children: a critical review

A review is given of community studies from which the relationship between air lead and blood lead in children of varying ages can be estimated. The review covers nineteen different studies which were carried out in ten different countries. The blood lead/air lead relationship is denoted with the symbol "alpha'. It is concluded that for children, a wide range of alpha-values can be estimated from the data in the different studies. Most values center on 3-5 rather than the 1-2 which is usually reported from adults. However, adjustment for confounders has been absent or incomplete in most, if not all studies. Most alpha-estimates thus have to be viewed with caution.

Hardness of domestic water and blood lead levels

The effect on the blood lead levels of residents in an area in which a soft plumbo-solvent water was hardened is examined. Water lead levels fell after hardening was introduced whereas there was a small rise in water lead levels in a control area monitored over the same time. The blood lead levels of residents fell after hardening and the fall was slightly greater than would have been predicted on the basis of the change in water lead levels. This suggests that lead is less well absorbed from hard water than from soft water. Following hardening there was a significant fall in mean blood lead level of subjects living in houses which had initially had negligible amounts of lead in the water. This suggests that hard water may interfere with the absorption of lead from sources other than water.