Exposição ao mercúrio e ao arsênio em Estados da Amazônia: síntese dos estudos do Instituto Evandro Chagas/FUNASA

Exposição ao mercúrio e anemia em crianças e adolescentes de seis comunidades da Amazônia Brasileira

Resumo O mercúrio (Hg) é uma substância tóxica, sendo o consumo de pescados uma das principais fontes de exposição da população. Este artigo visa avaliar a associação entre anemia e exposição ao Hg na população infanto-juvenil de seis comunidades ribeirinhas da Amazônia Brasileira. Realizou-se a análise secundária de dados de estudos seccionais, incluindo 1.318 indivíduos, divididos em dois grupos segundo a influência do garimpo (grupo A sob influência, e grupo B sem influência). Métodos de análise multivariada foram realizados para verificar a associação entre variável de exposição (Hg no cabelo) e anemia, estratificando pelos grupos. Foram observados 348 casos de anemia (27,1%), sendo 206 entre o grupo B e 142 no grupo A. Houve diferença na mediana dos níveis de Hg entre os grupos (A = 12,8µg/g e B = 4,3µg/g, p = 0,01). Foi observada associação entre Hg no cabelo ≥ 6,0µg/g e anemia (OR = 1,38; IC95% = 1,02-1,87), fato que foi magnificado para o grupo A quando realizada estratificação (OR = 2,23; IC95% = 1,28-3,90). O estudo mostrou elevados níveis de Hg, principalmente no grupo A, e que essa substância pode ser um possível fator de risco para anemia. Além disso, as áreas geográficas pareceram modificar esse efeito, apontando para influência de outros fatores, fato que deve ser melhor avaliado.

Seven potential sources of arsenic pollution in Latin America and their environmental and health impacts

This review presents a holistic overview of the occurrence, mobilization, and pathways of arsenic (As) from predominantly geogenic sources into different near-surface environmental compartments, together with the respective reported or potential impacts on human health in Latin America. The main sources and pathways of As pollution in this region include: (i) volcanism and geothermalism: (a) volcanic rocks, fluids (e.g., gases) and ash, including large-scale transport of the latter through different mechanisms, (b) geothermal fluids and their exploitation; (ii) natural lixiviation and accelerated mobilization from (mostly sulfidic) metal ore deposits by mining and related activities; (iii) coal deposits and their exploitation; (iv) hydrocarbon reservoirs and co-produced water during exploitation; (v) solute and sediment transport through rivers to the sea; (vi) atmospheric As (dust and aerosol); and (vii) As exposure through geophagy and involuntary ingestion. The two most important and well-recognized sources and mechanisms for As release into the Latin American population's environments are: (i) volcanism and geothermalism, and (ii) strongly accelerated As release from geogenic sources by mining and related activities. Several new analyses from As-endemic areas of Latin America emphasize that As-related mortality and morbidity continue to rise even after decadal efforts towards lowering As exposure. Several public health regulatory institutions have classified As and its compounds as carcinogenic chemicals, as As uptake can affect several organ systems, viz. dermal, gastrointestinal, peptic, neurological, respiratory, reproductive, following exposure. Accordingly, ingesting large amounts of As can damage the stomach, kidneys, liver, heart, and nervous system; and, in severe cases, may cause death. Moreover, breathing air with high As levels can cause lung damage, shortness of breath, chest pain, and cough. Further, As compounds, being corrosive, can also cause skin lesions or damage eyes, and long-term exposure to As can lead to cancer development in several organs.

Toxic and essential trace element concentrations in fish species in the Lower Amazon, Brazil

The Lower Amazon region (Western Pará, northern Brazil) is greatly affected by mining exploitations (particularly artisanal gold mines) and other industrial and intensive agricultural activities with potentially strong impacts on aquatic ecosystems. Although such impacts include contamination with various toxic elements, to date only the effects of Hg have been considered. In this study, toxic and trace element concentrations were determined in the flesh of 351 fish specimens, including detritivores (Acarí, Pterygoplichthys pardalis), omnivores (Piranha, Pygocentrus nattereri; Pirarucu, Arapaima sp.) and carnivores (Caparari, Pseudoplatystoma fasciatum; Tucunaré, Cichla ocellaris), during the dry and wet seasons in 2015 and 2016. The range of concentrations of toxic element residues were 2-238 μg/kg fresh weight for As, 1-77 μg/kg for Cd, 4-1922 μg/kg for Hg and 1-30 μg/kg for Pb. Only the maximum concentrations of Hg established in the Brazilian legislation for fish destined for human consumption (0.5 mg/kg) were exceeded (in 16% of carnivorous species). The large between-species and seasonal differences observed for all these toxic elements are probably related to the seasonal behaviour and dietary habits of the different fish species. By contrast, essential trace element concentrations were low and not related to seasonal or dietary factors, and the observed differences may be at least partly related to the metabolism of each species. The associations between Hg and the essential trace elements Se, Fe, Co and Mn deserve special attention, as these trace elements may play a role in Hg cycling and methylation and merit further evaluation with the aim of reducing Hg toxicity in aquatic environments.

Arsenic contamination assessment in Brazil - Past, present and future concerns: A historical and critical review

This paper presents a summary of some relevant documents published during the last decades regarding arsenic contamination in Brazil until December 2018, including scientific papers, reports and regulatory documents. Natural and anthropogenic arsenic sources were covered, excluding those related to agriculture. International "key" documents related to arsenic contamination were used to support the discussion and comparative analysis. This paper aims: (a) to summarize and discuss some available data (including Portuguese written documents) concerning arsenic contamination in Brazil, mainly geographical, geological, geochemical, environmental and health studies; (b) to critically review the published studies comparing their main findings; (c) to describe and compare ancient and recent contamination events; and (d) to highlight key knowledge gaps, and identify promising areas for future researches. The arsenic contamination scenario in Brazil results not only from mining. Natural or anthropogenic emissions caused by great magnitude phenomena as flooding, erosion, landslide and, water scarcity equally impact arsenic mobilization/immobilization equilibria. Our literature review demonstrates that arsenic contamination of soils, sediments and water sources is observed at least at three of the five geographically defined Brazilian regions (Northern, Southern and, Southeastern regions). Arsenic enriched soils, and waters naturally occur all around the country and anthropogenic activities have been the main contributory factor to the environmental contamination since the 18th Century. Geogenic materials (topsoil and mining tailings), and water samples could contain extremely high arsenic concentrations, i.e. 21,000 mg kg^-1 or 1,700,000 μg L^-1, respectively, have been found mainly at the "Iron Quadrangle". Moreover, if we consider both the Brazilian and international parameters, the health risks associated with the human exposition to arsenic are of significant concern. For those reasons, constant monitoring of As contaminated areas in Brazil is mandatory. Furthermore, it is necessary to learn from the mistakes made in the past in order to prevent or minimize future problems.

Arsenic Exposure and Effects in Humans: A Mini-Review in Brazil

Arsenic (As) is widely studied in several countries due to its toxicity to biota in the environment. Arsenic sources may be natural or anthropogenic, and the mobility of the element is ruled by physicochemical conditions that also define the dominant As species in the environment. Arsenic levels are evaluated in various abiotic and biotic environmental samples. The highest As levels are observed in sediment, from where it may be mobilized into the aquifers. This article reviews studies about As in the world but with emphasis on studies performed in Brazil, a country where continental water bodies are a common geographic feature. We reviewed 64 studies published between 1985 and 2016. The results indicate that in recent years more studies have been conducted to determine As levels in foods and human samples as a tool to evaluate the exposure of populations and identify potential sources. In Brazil, the main problems associated with contamination with As are the use of wood preservatives and herbicides as well as the impact caused by mining. Also, the precarious character of sewage treatment systems contributes to the contamination of water bodies.

Assessment of Mercury Concentration in Turtles (Podocnemis unifilis) in the Xingu River Basin, Brazil

Many studies on mercury contamination in aquatic biota deal with the effect of consuming metal-contaminated organisms on human health. In this study, we examined the factors that cause mercury contamination in Podocnemis unifilis in the Xingu River Basin of Mato Grosso and Pará States, Brazil. We quantified by atomic absorption spectroscopy with cold vapor the total mercury (THg) content in the liver and muscle samples of 50 Podocnemis unifilis specimens collected from the basin. The liver and muscle samples contained 134.20 ± 119.30 ng g−1 THg and 24.86 ± 26.36 ng g−1 THg, respectively. Each chelonian or meal has, on average, 5.34× more Hg than the highest level established as acceptable. From the results it can be inferred that, given the weekly consumption of chelonians, the riverine and indigenous communities in the Xingu River Basin are at risk of chronic consumption of Hg in amounts beyond the acceptable limit. The potential high risk to the health of this population is evident; however, the risk classification needs to be further studied.

Contribution to the understanding of biologic concentrations of arsenic in children living in an urban area from Rio de Janeiro, Brazil

There are few studies about children's environmental exposure to arsenic (As) in Brazil, most of them being in mining regions. The objective of this study was to contribute to the understanding of biologic concentrations of arsenic in children living in an urban area, in Brazil. A study of arsenic concentrations in capillary blood (n = 270), nail (n = 261), and urine (n = 99) samples, in male and female children, 8 to 10 years old, from two public schools in Rio de Janeiro, was conducted. Socio-economic and health data were obtained through questionnaires. The nail and capillary blood analysis were performed by inductively coupled plasma mass spectrometry (ICP-MS), while urine samples were analyzed using hydride generation atomic absorption spectrometry (HG-AAS). The median, geometric mean, and 95th percentiles of total arsenic concentrations were, respectively, 2.53, 2.40, and 3.58 μg/L in capillary blood; 0.09, 0.10, and 0.24 μg/g in nails; and 12.50, 10.97, and 39.45 μg/L in urine. The geometric mean of urinary arsenic level was above the values reported by international surveys for non-exposed populations. The arsenic concentrations in nails were compatible with the values found in national studies. These outcomes can contribute to the increase of knowledge on biologic concentrations of arsenic in children living in urban areas, in Brazil.

Vulnerability associated with "symptoms similar to those of mercury poisoning" in communities from Xingu River, Amazon basin

The Brazilian Amazon is known to be a region with high levels of mercury (Hg) in the environment and studies point to an association between high levels of natural mercury in the mother rock and the vast number of clandestine gold mines. Other studies already report the contamination of fish in this region, as well as high levels of Hg in biological material from environmentally exposed populations. On the other hand, this is one of the least developed regions of the planet and it is necessary to understand the vulnerability factors in these populations that may be intoxicated by this element. The purpose of the present study was to investigate the vulnerability factors in communities from Xingu River-Amazon basin probably exposed to Hg. A cross-selection study in two cities localized in Xingu River was conducted, and the sample contained was 268 individuals. sociodemographic questions, lifestyle, diet habits and health conditions were collated. The majority of the sample was female, between 30 and 59 years old, had less than 3 years of educational level and lived in the local of study more than 240 months. There was regular fish consumption (95.9%), principally carnivorous species (80.5%). The visual problem has a highest prevalence (43.3%) between the health problems and about the symptoms of Hg intoxication, memory loss (42.9%), weakness (35.1%), fatigue (34.3%), mood changes (28.7%) and difficulties in concentration (27.2%) was most reported. The female sex, age over 60, educational level below 3 years of study, did not had flush toilet, smoke and least one chronic non-communicable disease represent higher probability to had symptoms of Hg intoxication. Lack of access to health services, low education level and income evidence the susceptibility of this community to diseases and injuries. The vulnerable groups identified in this study should be a priority in public health and environmental health policies.

Hair as a Biomarker of Long Term Mercury Exposure in Brazilian Amazon: A Systematic Review

Many studies have assessed mercury (Hg) exposure in the Amazonian population. This article performs a literature search of the studies that used hair as a biomarker of Hg exposure in the Brazilian Amazonian population. The search covered the period from 1996 to 2016 and included articles which matched the following criteria: (1) articles related to Hg exposure into Brazilian Amazon; (2) articles that used hair as a biomarker of Hg exposure; (3) articles that used analytical tools to measure the Hg content on hair and (4) articles that presented arithmetic mean and/or minimum and maximum values of Hg. 36 studies were selected. The findings show that most of the studies were performed along margins of important rivers, such as Negro, Tapajós and Madeira. All the population presented mean levels of Hg on hair above 6 µg g^-1 and general population, adults, not determined and men presented levels of Hg on hair above 10 µg g^-1. The results show that most of the studies were performed by Brazilian institutions/researchers and the majority was performed in the State of Pará. The present study identified that Amazonian population has long-term been exposed to Hg. In terms of future perspectives, this study suggests the implementation of a strategic plan for environmental health surveillance in the region in order to promote health and benefit Amazonian population.

Medical geology in the framework of the sustainable development goals

Exposure to geogenic contaminants (GCs) such as metal(loid)s, radioactive metals and isotopes as well as transuraniums occurring naturally in geogenic sources (rocks, minerals) can negatively impact on environmental and human health. The GCs are released into the environment by natural biogeochemical processes within the near-surface environments and/or by anthropogenic activities such as mining and hydrocarbon exploitation as well as exploitation of geothermal resources. They can contaminate soil, water, air and biota and subsequently enter the food chain with often serious health impacts which are mostly underestimated and poorly recognized. Global population explosion and economic growth and the associated increase in demand for water, energy, food, and mineral resources result in accelerated release of GCs globally. The emerging science of "medical geology" assesses the complex relationships between geo-environmental factors and their impacts on humans and environments and is related to the majority of the 17 Sustainable Development Goals in the 2030 Agenda of the United Nations for Sustainable Development. In this paper, we identify multiple lines of evidence for the role of GCs in the incidence of diseases with as yet unknown etiology (causation). Integrated medical geology promises a more holistic understanding of the occurrence, mobility, bioavailability, bio-accessibility, exposure and transfer mechanisms of GCs to the food-chain and humans, and the related ecotoxicological impacts and health effects. Scientific evidence based on this approach will support adaptive solutions for prevention, preparedness and response regarding human and environmental health impacts originating from exposure to GCs.

Biomarkers of mercury exposure in the Amazon

Mercury exposure in the Amazon has been studied since the 1980s decade and the assessment of human mercury exposure in the Amazon is difficult given that the natural occurrence of this metal is high and the concentration of mercury in biological samples of this population exceeds the standardized value of normality established by WHO. Few studies have focused on the discovery of mercury biomarkers in the region's population. In this way, some studies have used genetics as well as immunological and cytogenetic tools in order to find a molecular biomarker for assessing the toxicological effect of mercury in the Amazonian population. Most of those studies focused attention on the relation between mercury exposure and autoimmunity and, because of that, they will be discussed in more detail. Here we introduce the general aspects involved with each biomarker that was studied in the region in order to contextualize the reader and add information about the Amazonian life style and health that may be considered for future studies. We hope that, in the future, the toxicological studies in this field use high technological tools, such as the next generation sequencing and proteomics skills, in order to comprehend basic questions regarding the metabolic route of mercury in populations that are under constant exposure, such as in the Amazon.

Meio ambiente e enfermagem: suas interfaces e inserção no ensino de graduação

A degradação ambiental vem modificando nosso cenário de forma acelerada e interferindo negativamente no processo saúde-doença de toda a comunidade. No entanto, o meio ambiente vem sendo concebido como um simples cenário, algo externo ao ser humano, não onde estamos inseridos e no qual acontecem suas interações e inter-relações. A complexidade dos problemas ambientais clama pela adoção de medidas que superem práticas assistencialistas, levando à adoção de práticas transdisciplinares que avancem na promoção da saúde. Neste artigo procura-se discutir, nesta perspectiva, a necessidade de inserção nos cursos de graduação em saúde a temática saúde e meio ambiente, adotando como exemplo um curso de enfermagem do interior paulista que inseriu uma disciplina relacionada ao tema. Analisa também o papel do enfermeiro na relação com o meio ambiente segundo a representação social dos alunos, trabalhada a partir do Discurso do Sujeito Coletivo. Nota-se que é fundamental discutir essa temática ambiental entre os profissionais da saúde, a fim de que eles se empoderem desse conhecimento e consigam identificar problemas relacionados à questão ambiental, propondo ações resolutivas e preventivas, juntamente com a comunidade, procurando amenizar os riscos ambientais a que todos estão expostos. Reforça-se a profundidade do papel dos profissionais de saúde diante dos problemas ambientais, buscando a saúde em uma perspectiva ampliada de promoção da saúde.

Arsenic exposure assessment of children living in a lead mining area in Southeastern Brazil

Environmental contamination by arsenic compounds in the Ribeira River Valley, São Paulo, Brazil has already been observed. Lead mining and refining activities had been carried on since late colonial times and finished recently, at the end of 1995. The source of As in the region is known to be mainly from arsenopirite geological presence in the lead ore. Chronic exposure to arsenic compounds may cause peripheral vascular disorders, hyperpigmentation, hiperkeratosis and cancer of the skin, bladder, lung, liver and other internal organs. The purpose of this study was to assess children exposure to arsenic from environmental sources in the region. Urine samples from children between 7 to 14 years old were collected at the following localities: Cerro Azul (Paraná); urban areas of Ribeira (São Paulo) and Adrianópolis (Paraná); Vila Mota neighborhood (rural area of Adrianópolis) and Serra neighborhood (Iporanga, São Paulo), identified as groups 1, 2, 3 and 4, respectively. Group 1 was considered as non-exposed control group. Toxicologically relevant forms of As were determined by atomic absorption spectrometry with hydride generation system. The median values of urine arsenic levels obtained in groups 1, 2, 3 and 4 were respectively: 3.60, 6.30, 6.41 e 8.94μg/L.

Daily mercury intake in fish-eating populations in the Brazilian Amazon

Although high levels of fish consumption and bioindicators of mercury exposure have been reported for traditional populations in the Amazon, little is known about their actual daily intake of Hg. Using an ecosystem approach, calculate daily mercury intake in adult fish-eaters, examine the relations between mercury intake and bioindicators of exposure and the factors that influence these relations. A cross-sectional dietary survey on fish and fruit consumption frequency was carried out with 256 persons from six villages of the Tapajós River. Fish portion per meal was determined. Mercury concentration was determined for 1123 local fish specimens. Daily mercury intake (microg/kg/day) was determined for men and women from each village using the average fish-mercury concentration for the fish caught in their fishing zone, the average quantity of fish per meal, fish-species frequency consumption and participants' body weight. Fish-mercury averaged 0.33 microg/g+/-0.33. Daily mercury intake varied between 0 and 11.8 microg/kg/day (mean 0.92 microg/kg/day+/-0.89) and varied by gender and village. Mean blood- and hair-mercury were 58.7+/-36.1 microg/l and 17.9+/-11.5 microg/g, respectively. There was a strong and positive relation between blood-mercury and daily mercury intake, with an inverse relation for fruit intake and schooling; significant variations were observed with immigrant status, and among villages. Hair-mercury was directly associated with daily mercury intake and inversely related to schooling and fruit consumption. Fruit consumption modified the relation between daily mercury intake and blood-mercury levels: for the same daily mercury intake, persons eating more fruit had lower blood-mercury concentrations (ANCOVA Interaction term: F=10.9, P<0.0001). The median difference of the ratio of blood-mercury to daily mercury intake between low and high fruit consumers was 26, representing a 26.3% reduction. These findings reveal high levels of daily mercury intake. Rigorous studies for developing risk-based reference doses in the Amazon should be undertaken to orient viable risk-management strategies to reduce exposure, while maintaining fish diet.

Arsenic occurrence in Brazil and human exposure

Environmental exposure to arsenic (As) in terms of public health is receiving increasing attention worldwide following cases of mass contamination in different parts of the world. However, there is a scarcity of data available on As geochemistry in Brazilian territory, despite the known occurrence of As in some of the more severely polluted areas of Brazil. The purpose of this paper is to discuss existing data on As distribution in Brazil based on recent investigations in three contaminated areas as well as results from the literature. To date, integrated studies on environmental and anthropogenic sources of As contamination have been carried out only in three areas in Brazil: (1) the Southeastern region, known as the Iron Quadrangle, where As was released into the drainage systems, soils and atmosphere as a result of gold mining; (2) the Ribeira Valley, where As occurs in Pb-Zn mine wastes and naturally in As-rich rocks and soils; (3) the Amazon region, including the Santana area, where As is associated with manganese ores mined over the last 50 years. Toxicological studies revealed that the populations were not exposed to elevated levels of As, with the As concentrations in surface water in these areas rarely exceeding 10 microg/L. Deep weathering of bedrocks along with formation of Fe/Al-enriched soils and sediments function as a chemical barrier that prevents the release of As into the water. In addition, the tropical climate results in high rates of precipitation in the northern and southeastern regions and, hence, the As contents of drinking water is diluted. Severe cases of human As exposure related to non-point pollution sources have not been reported in Brazil. However, increasing awareness of the adverse health effects of As will eventually lead to a more complete picture of the distribution of As in Brazil.

Fish consumption and bioindicators of inorganic mercury exposure

BACKGROUND

The direct and close relationship between fish consumption and blood and hair mercury (Hg) levels is well known, but the influence of fish consumption on inorganic mercury in blood (B-IHg) and in urine (U-Hg) is unclear.

OBJECTIVE

Examine the relationship between fish consumption, total, inorganic and organic blood Hg levels and urinary Hg concentration.

METHODS

A cross-sectional study was carried out on 171 persons from 7 riparian communities on the Tapajós River (Brazilian Amazon), with no history of inorganic Hg exposure from occupation or dental amalgams. During the rising water season in 2004, participants responded to a dietary survey, based on a seven-day recall of fish and fruit consumption frequency, and socio-demographic information was recorded. Blood and urine samples were collected. Total, organic and inorganic Hg in blood as well as U-Hg were determined by Atomic Absorption Spectrometry.

RESULTS

On average, participants consumed 7.4 fish meals/week and 8.8 fruits/week. Blood total Hg averaged 38.6+/-21.7 microg/L, and the average percentage of B-IHg was 13.8%. Average organic Hg (MeHg) was 33.6+/-19.4 microg/L, B-IHg was 5.0+/-2.6 microg/L, while average U-Hg was 7.5+/-6.9 microg/L, with 19.9% of participants presenting U-Hg levels above 10 microg/L. B-IHg was highly significantly related to the number of meals of carnivorous fish, but no relation was observed with non-carnivorous fish; it was negatively related to fruit consumption, increased with age, was higher among those who were born in the Tapajós region, and varied with community. U-Hg was also significantly related to carnivorous but not non-carnivorous fish consumption, showed a tendency towards a negative relation with fruit consumption, was higher among men compared to women and higher among those born in the region. U-Hg was strongly related to I-Hg, blood methyl Hg (B-MeHg) and blood total Hg (B-THg). The Odds Ratio (OR) for U-Hg above 10 microg/L for those who ate >4 carnivorous fish meals/week was 4.00 [1.83-9.20].

CONCLUSION

This study adds further evidence to a positive relation between fish consumption and IHg in both blood and urine, which may result from absorption of IHg from fish or from demethylation of MeHg. The findings support the importance of assessing IHg exposure in fish-eating communities. Further studies should examine the potential toxicity of IHg in heavy fish consumers.