Effects of a Plastic-Free Lifestyle on Urinary Bisphenol A Levels in School-Aged Children of Southern Italy: A Pilot Study

Effects of Behavioral, Clinical, and Policy Interventions in Reducing Human Exposure to Bisphenols and Phthalates: A Scoping Review

BACKGROUND

There is growing interest in evidence-based interventions, programs, and policies to mitigate exposures to bisphenols and phthalates and in using implementation science frameworks to evaluate hypotheses regarding the importance of specific approaches to individual or household behavior change or institutions adopting interventions.

OBJECTIVES

This scoping review aimed to identify, categorize, and summarize the effects of behavioral, clinical, and policy interventions focused on exposure to the most widely used and studied bisphenols [bisphenol A (BPA), bisphenol S (BPS), and bisphenol F (BPF)] and phthalates with an implementation science lens.

METHODS

A comprehensive search of all individual behavior, clinical, and policy interventions to reduce exposure to bisphenols and phthalates was conducted using PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Google Scholar. We included studies published between January 2000 and November 2022. Two reviewers screened references in CADIMA, then extracted data (population characteristics, intervention design, chemicals assessed, and outcomes) for studies meeting inclusion criteria for the present review.

RESULTS

A total of 58 interventions met the inclusion criteria. We classified interventions as dietary (n = 27 ), clinical (n = 13 ), policy (n = 14 ), and those falling outside of these three categories as "other" (n = 4 ). Most interventions (81%, 47/58) demonstrated a decrease in exposure to bisphenols and/or phthalates, with policy level interventions having the largest magnitude of effect.

DISCUSSION

Studies evaluating policy interventions that targeted the reduction of phthalates and BPA in goods and packaging showed widespread, long-term impact on decreasing exposure to bisphenols and phthalates. Clinical interventions removing bisphenol and phthalate materials from medical devices and equipment showed overall reductions in exposure biomarkers. Dietary interventions tended to lower exposure with the greatest magnitude of effect in trials where fresh foods were provided to participants. The lower exposure reductions observed in pragmatic nutrition education trials and the lack of diversity (sociodemographic backgrounds) present limitations for generalizability to all populations. https://doi.org/10.1289/EHP11760.

Exposure assessment to bisphenol A (BPA) and its analogues bisphenol S (BPS) and bisphenol F (BPF) in wild boars by hair analysis

Bisphenols are widely used in various branches of industry for the production of plastics. They penetrate to the natural environment and thus living organisms. As endocrine disruptors, bisphenols have adverse effects on various internal organs and systems. Contrary to humans, the knowledge of the exposure of wild terrestrial mammals to bisphenols is extremely limited. Therefore, this study for the first time assessed the exposure level of wild boars to three bisphenols commonly used in industry (i.e. bisphenol A - BPA, bisphenol S - BPS and bisphenol F - BPF) using hair sample analysis in liquid chromatography-mass spectrometry (LC-MS). The presence of BPA and/or BPS has been noted in the samples collected from >80 % of animals included in the study (n = 54), while the presence of BPF was not found in any sample. At least one of the bisphenols was present in every sample tested. Mean concentrations of BPA and BPS in the hair of wild boars were 151.40 ± 135.10 pg/mg dry weight (dw.) and 29.40 ± 36.97 pg./mg dw, respectively. Concentrations of BPA and BPS in females were statistically higher than in males (p < 0.05). Moreover, statistically significantly higher concentration levels of BPA (and not BPS) in the areas with higher degree of industrialization and higher human population density were also found. This is the first study concerning the use of hair samples to assess the exposure of wild terrestrial mammals to bisphenols. The obtained results show that an analysis of the hair may be a useful tool of biomonitoring bisphenols in wild animals. The presence of BPA and BPS in wild boar hair in relatively high concentration also suggests that these substances may have an influence on the health status not only in humans and aquatic animals, but also in wild terrestrial mammals. However, many aspects connected with this issue are not clear and require further study.

Environment-wide association study to identify exposure pathways of bisphenol A in Korean children and adolescents: Korean National Environmental Health Survey (KoNEHS) 2018-2020

Bisphenol A (BPA) is an endocrine-disrupting chemical commonly used in manufacturing plastic products. Despite ongoing efforts and regulatory measures, BPA exposure among children persists. This study aimed to identify the modifiable factors associated with urinary BPA levels in Korean children and adolescents. We conducted an environment-wide association study (EWAS) using data from the Korean National Environmental Health Survey (KoNEHS) Cycle 4. This study included 578 preschoolers, 736 school-aged children, and 828 adolescents. A total of 117, 103, and 102 modifiable factors were selected from KoNEHS Cycle 4. Each modifiable factor associated with urinary BPA levels was tested using a multivariable linear regression model. Subsequently, multiple testing corrections were performed using false discovery rate (FDR) estimation. For the validation phase, we used the iteration of the least absolute shrinkage and selection operator (LASSO), a machine learning-based regression analysis. After the validation phase of the LASSO regression, two modifiable factors were identified as being significantly related to urinary BPA levels in preschoolers. Urinary cotinine levels and the use of slime or clay toys were positively associated with urinary BPA levels in preschoolers. However, no significant associations were observed between school-aged children and adolescents. Our results suggest novel exposure pathways to BPA in recent lifestyles and contribute to the development of effective prevention strategies. These modifiable factors provide valuable targets for interventions aimed at reducing BPA exposure in children. Further research is needed to explore additional modifiable factors and confirm our results in larger and more diverse populations.

Does the environment affect menopause? A review of the effects of endocrine disrupting chemicals on menopause

Endocrine disrupting chemicals are widely distributed in our environment. Humans are exposed to these compounds not only through their occupations, but also through dietary consumption and exposure to contaminated water, personal care products and textiles. Chemicals that are persistent in the body and in our environment include dioxins and polychlorinated biphenyls. Non-persistent chemicals including bisphenol A, phthalates and parabens are equally as important because they are ubiquitous in our environment. Heavy metals, including lead and cadmium, can also have endocrine disrupting properties. Although difficult to study due to their variety of sources of exposures and mechanisms of action, these chemicals have been associated with early menopause, increased frequency of vasomotor symptoms, altered steroid hormone levels and markers of diminished ovarian reserve. Understanding the impacts of these exposures is important given the potential for epigenetic modification, which can alter gene function and result in multi-generational effects. This review summarizes findings in humans and animals or cell-based models from the past decade of research. Continued research is needed to assess the effects of mixtures of chemicals, chronic exposures and new compounds that are continuously being developed as replacements for toxic chemicals that are being phased out.

Perceptions and experiences of environmental health and risks among Latina mothers in urban Los Angeles, California, USA

BACKGROUND

Environmental exposures during pregnancy and early childhood can have acute and chronic adverse health impacts. As minoritized populations are more likely to reside in areas with greater pollution, it is important to understand their views and lived experiences to inform action. The purpose of this community-driven qualitative research study was to understand how urban Latina mothers in Los Angeles County, California perceived environmental health and risks.

METHODS

We conducted semi-structured individual interviews with Latina pregnant women and mothers of young children, recruited through existing collaborations with community organizations. Interviews conducted in either English or Spanish and were coded inductively according to a modified grounded theory approach.

RESULTS

Thirty-six Latina mothers completed interviews between August-October 2016. Participants lived primarily in low-income communities of South-Central Los Angeles and East Los Angeles. We identified three major themes based on the participants' responses during interviews: Defining the Environment, Environment & Health Risks, and Social & Political Responsibility. Women defined their environment in terms of both "nature" and "hazards." They consistently identified foul odors, dirtiness, noise, trash, bugs, smoke, and other visible blights as indicators of household and neighborhood environmental hazards. They expressed fear and uncertainty about how their environment could affect their health and that of their children, as well as specific concerns about respiratory health, asthma, allergies, cancer, and adverse pregnancy outcomes. Mothers often changed individual behaviors around diet and cleaning during pregnancy but were frustrated by power imbalances that left them unable to change their home or neighborhood environments, despite their desire to do so.

DISCUSSION

Our study is among the first to describe how urban Latina mothers perceive and experience environmental health risks during pregnancy and early childhood. Our research suggests additional attention is needed by public health professionals and researchers to address the environmental health risks that matter most to urban Latina mothers. They also highlight the tension that many urban Latina mothers feel between wanting to protect their families' health and well-being and feeling powerless to change their environment. Broad policy changes, rather than additional individual recommendations, are needed to address the concerns of this vulnerable population.

An overview of the occurrence, fate, and human risks of the bisphenol-A present in plastic materials, components, and products

With over 95% of bisphenol-A (BPA) used in the production of polycarbonate (PC) and epoxy resins, termed here as BPA-based plastic materials, components, and products (MCPs), an investigation of human exposure to BPA over the whole lifecycle of BPA-based plastic MCPs is necessary. This mini-review unpacks the implications arising from the long-term human exposure to BPA and its potential accumulation across the lifecycle of BPA-based plastics (production, use, and management). This investigation is timely and necessary in promoting a sustainable circular economy model. Restrictions of BPA in the form of bans and safety standards are often specific to products, while safety limits rely on traditional toxicological and biomonitoring methods that may underestimate human health implications and therefore the "safety" of BPA exposure. Controversies in regards to the: (a) dose-response curves; (b) the complexity of sources, release mechanisms, and pathways of exposure; and/or (c) the quality and reliability of toxicological studies, appear to currently stifle progress toward the regulation of BPA-based plastic MCPs. Due to the abundance of BPA in our MCPs production, consumption, and management systems, there is partial and inadequate evidence on the contribution of BPA-based plastic MCPs to human exposure to BPA. Yet, the production, use, and end-of-life management of plastic MCPs constitute the most critical BPA source and potential exposure pathways that require further investigation. Active collaboration among risk assessors, government, policy-makers, and researchers is needed to explore the impacts of BPA in the long term and introduce restrictions to BPA-based MCPs. Integr Environ Assess Manag 2023;19:45-62. © 2022 SETAC.

Low Doses of Bisphenol A Disrupt Neuronal Differentiation of Human Neuronal Stem/Progenitor Cells

Bisphenol A (BPA) is an endocrine disrupting chemical. Human epidemiological studies have suggested that adverse neurobehavioral outcomes are induced by fetal exposure to BPA. The remarkable differences in the corticogenesis between human and agyrencephalic mammals are an increase in the intermediate progenitor cells (IPCs) and a following increase in the subplate thickness. It is uncertain whether low doses of BPA (low-BPA) affect human early corticogenesis when basal progenitor cells (BPs) produce IPCs resulting in amplified neurogenesis. In this study, human-derived neuronal stem/progenitor cells were exposed to low-BPA or the vehicle only, and the resultant cell type-specific molecular changes and morphology were analyzed. We focused on stem cells immunoreactive for SOX2, BPs for NHLH1, and immature neurons for DCX. SOX2-positive cells significantly decreased at day in vitro (DIV) 4 and 7, whereas NHLH1-positive cells tended to be higher, while DCX-positive cells significantly increased at DIV7 when exposed to 100 nM of BPA compared with the vehicle. Morphologically DCX-positive cells showed a decrease in unipolar cells and an increase in multipolar cells when exposed to 100 nM of BPA compared with the vehicle. These results provide insights into the in vivo effect of low-BPA on neuronal differentiation in the human fetal corticogenesis.

Bisphenol S Alters the Steroidome in the Preovulatory Follicle, Oviduct Fluid and Plasma in Ewes With Contrasted Metabolic Status

Bisphenol A (BPA), a plasticizer and endocrine disruptor, has been substituted by bisphenol S (BPS), a structural analogue that had already shown adverse effects on granulosa cell steroidogenesis. The objective of this study was to assess the effect of chronic exposure to BPS, a possible endocrine disruptor, on steroid hormones in the ovary, oviduct and plasma using the ewe as a model. Given the interaction between steroidogenesis and the metabolic status, the BPS effect was tested according to two diet groups. Eighty adult ewes were allotted to restricted (R) and well-fed (WF) groups, that were further subdivided into two subgroups. Ewes were exposed to 50 µg BPS/kg/day in their diet (R50 and WF50 groups) or were unexposed controls (R0 and WF0 groups). After at least 3 months of BPS exposure, preovulatory follicular fluid, oviduct fluid and plasma were collected and steroid hormones were analyzed by gas chromatography coupled with tandem mass spectrometry (GC-MS/MS). A deleterious effect of restricted diet on the volume of oviduct fluid and numbers of pre-ovulatory follicles was observed. Exposure to BPS impaired estradiol concentrations in both follicular and oviduct fluids of well-fed ewes and progesterone, estradiol and estrone concentrations in plasma of restricted ewes. In addition, a significant interaction between metabolic status and BPS exposure was observed for seven steroids, including estradiol. In conclusion, BPS acts in ewes as an endocrine disruptor with differential actions according to metabolic status.

Interventions on Reducing Exposure to Endocrine Disrupting Chemicals in Human Health Care Context: A Scoping Review

Purpose

Inevitability of exposure to endocrine disrupting chemicals (EDCs) in daily lives of modern society is increasing interests in developing and implementing interventions to prevent or reduce harmful health effects of EDCs in various academic areas. This is a scoping review of intervention studies aimed at reducing exposure to EDCs in the text of human health care.

Methods

Scoping review methodology was used to explore the extent, range, and nature of current literature. A comprehensive systematic search of PubMed, CINAHL, Cochrane, PcycINFO, EMBASE, and RISS was performed for studies published to date. The authors followed Arksey and O'Malley's stages; 1) identification of research questions; 2) identification of relevant studies using a total of six electronic databases; 3) study selection; 4) charting the data; and 5) collation, summarization and reporting of the data.

Results

A total of 2114 articles were retrieved, from which 13 articles were included in the final review. Among the 13 studies, 12 conducted interventions regarding dietary modification or replacement of household or personal goods. The duration of interventions ranged from at least three days to a maximum of six months, including six studies with a period of less than ten days. The participants were all healthy populations, eight of which were for adults, three for children or adolescents, and two for families. Outcome of the interventions were measured through concentration of EDCs in urine or/and house air. The effects of the interventions were inconsistent, with 11 studies showing significant changes of EDC concentration while no significant change was found in two studies.

Conclusion

The results indicate a need for randomized controlled trials, participant-centered studies promoting active participation and practices of subjects, studies specifying subgroups of participants, and studies including families as units in interventions.

Cardiometabolic risk profile in non-obese children with obstructive sleep apnea syndrome

Obstructive sleep apnea syndrome (OSAS) in childhood is a complex disease primarily due both to adenotonsillar hypertrophy and pediatric obesity. Notably, inflammation has been recognized as one of the most important shared pathogenic factor between obesity and OSAS resulting in an increased cardiometabolic risk for these patients. To date, evidence is still limited in non-obese population with OSAS. We aimed to evaluate the cardiometabolic risk profile of a pediatric population of non-obese subjects affected by OSAS. A total of 128 school-aged children (mean age 9.70 ± 3.43) diagnosed with OSAS and 213 non-OSAS children (mean age 9.52 ± 3.35) as control group were enrolled. All subjects underwent a complete clinical and biochemical assessment (including white blood cell count (WBC), platelet count (PLT), mean platelet volume (MPV), % of neutrophils (NEU%), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), serum glucose, aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transpeptidase (GGT), uric acid, fasting insulin, iron, ferritin, and transferrin levels). A significant association between inflammation markers (including WBC, PLT, MPV, NEU%, ferritin, CPR, and ESR) and OSAS was found (all p < 0.001). Children with OSAS also showed increased transaminase, glucose, uric acid, and insulin levels (all p < 0.001) compared to healthy controls.

CONCLUSION

Taken together, these findings suggested a worse cardiometabolic profile in non-obese children with OSAS. Given the pivotal pathogenic role of inflammation both for hypoxiemia and metabolic derangements, therapeutic strategies for OSAS might also counteract the increased cardiometabolic risk of these patients, by improving their long-term quality of life.

WHAT IS KNOWN

• Pediatric OSAS has shown a close relationship with obesity and its cardiometabolic comorbidities. • Inflammation represents the hallmark of both obesity and OSAS.

WHAT IS NEW

• Non obese children with OSAS presented with a worse cardiometabolic risk profile. • OSAS treatment might serve as an effective approach also for the increased cardiometabolic risk of these children.

Nutritional interventions to ameliorate the effect of endocrine disruptors on human reproductive health: A semi-structured review from FIGO

Background

Endocrine disrupting chemicals have harmful effects on reproductive, perinatal, and obstetric outcomes.

Objective

To analyze the evidence on nutritional interventions to reduce the negative effects of endocrine disruptors on reproductive, perinatal, and obstetric outcomes.

Search strategy

A search of MEDLINE (PubMed), Allied Health Literature (CINAHL), EMBASE, Web of Science, and the Cochrane Database was conducted from inception to May 2021.

Selection criteria

Experimental studies on human populations.

Data collection and analysis

Data were collected from eligible studies. Risk of bias assessment was completed using the Cochrane risk of bias tool and the ROBINS‐I Tool.

Results

Database searches yielded 15 362 articles. Removing 11 181 duplicates, 4181 articles underwent abstract screening, 26 articles were eligible for full manuscript review, and 16 met full inclusion criteria. Several interventions were found to be effective in reducing exposure to endocrine disruptors: avoidance of plastic containers, bottles, and packaging; avoidance of canned food/beverages; consumption of fresh and organic food; avoidance of fast/processed foods; and supplementation with vitamin C, iodine, and folic acid. There were some interventional studies examining therapies to improve clinical outcomes related to endocrine disruptors.

Conclusion

Dietary alterations can reduce exposure to endocrine disruptors, with limited data on interventions to improve endocrine‐disruptor–related clinical outcomes. This review provides useful instruction to women, their families, healthcare providers, and regulatory bodies.

Nutritional interventions shown to reduce exposure to endocrine disruptors include avoidance of canned/processed or plastic‐packaged foods. Consumption of fresh/organic foods and vitamin C, iodine, and folic acid also reduce exposure.

Clinical and school-based intervention strategies for youth obesity prevention: A systematic review

Introduction

In the last couple of decades, numerous intervention strategies (ISs) have been formulated in school/community or clinical sectors using physical activity (PA) in order to prevent youth obesity because they have been highly effective in addressing this issue. These two sectors have revealed some interesting information in terms of efficient results and best practice mechanisms, but comparisons between them to learn about their functioning have been rare.

Methods

Therefore, the aim of this systematic review was to analyze and synthesize PA ISs from school/community or clinical domains for the period 2013-2017, in French or English, targeting youths aged 5-19 years old through primary, secondary, and tertiary prevention.

Results

In total, 68 full articles were reserved for data extraction and synthesis and 617 were excluded because they did not meet eligibility criteria (61 of 68 were kept for the final analysis). The results identified a number of differences between the studies of the various IS sectors and also a third type of IS, mixed sector. Mixed ISs (clinical and school-community) have a special advantage because they can benefit from the strengths of both school/community-based and clinical-based ISs. Mixed ISs showed the most promising results. This review also highlighted the differences between sectors and their ISs in terms of intervention teams, prevention objectives, duration, materials, and efficiency.

Conclusion

Future studies should focus on establishing a prevention program in a given geographical area involving all stakeholders with their respective skills/knowledge, in the area of decision-making and in the development of ISs, to ensure that the program is the most efficient and best adapted to its environment.

A Children's Health Perspective on Nano- and Microplastics

BACKGROUND

Pregnancy, infancy, and childhood are sensitive windows for environmental exposures. Yet the health effects of exposure to nano- and microplastics (NMPs) remain largely uninvestigated or unknown. Although plastic chemicals are a well-established research topic, the impacts of plastic particles are unexplored, especially with regard to early life exposures.

OBJECTIVES

This commentary aims to summarize the knowns and unknowns around child- and pregnancy-relevant exposures to NMPs via inhalation, placental transfer, ingestion and breastmilk, and dermal absorption.

METHODS

A comprehensive literature search to map the state of the science on NMPs found 37 primary research articles on the health relevance of NMPs during early life and revealed major knowledge gaps in the field. We discuss opportunities and challenges for quantifying child-specific exposures (e.g., NMPs in breastmilk or infant formula) and health effects, in light of global inequalities in baby bottle use, consumption of packaged foods, air pollution, hazardous plastic disposal, and regulatory safeguards. We also summarize research needs for linking child health and NMP exposures and address the unknowns in the context of public health action.

DISCUSSION

Few studies have addressed child-specific sources of exposure, and exposure estimates currently rely on generic assumptions rather than empirical measurements. Furthermore, toxicological research on NMPs has not specifically focused on child health, yet children's immature defense mechanisms make them particularly vulnerable. Apart from few studies investigating the placental transfer of NMPs, the physicochemical properties (e.g., polymer, size, shape, charge) driving the absorption, biodistribution, and elimination in early life have yet to be benchmarked. Accordingly, the evidence base regarding the potential health impacts of NMPs in early life remains sparse. Based on the evidence to date, we provide recommendations to fill research gaps, stimulate policymakers and industry to address the safety of NMPs, and point to opportunities for families to reduce early life exposures to plastic. https://doi.org/10.1289/EHP9086.

Pharmacogenetics and Forensic Toxicology: A New Step towards a Multidisciplinary Approach

Pharmacogenetics analyzes the individual behavior of DNA genes after the administration of a drug. Pharmacogenetic research has been implemented in recent years thanks to the improvement in genome sequencing techniques and molecular genetics. In addition to medical purposes, pharmacogenetics can constitute an important tool for clarifying the interpretation of toxicological data in post-mortem examinations, sometimes crucial for determining the cause and modality of death. The purpose of this systematic literature review is not only to raise awareness among the forensic community concerning pharmacogenetics, but also to provide a workflow for forensic toxicologists to follow in cases of unknown causes of death related to drug use/abuse. The scientific community is called on to work hard in order to supply evidence in forensic practice, demonstrating that this investigation could become an essential tool both in civil and forensic contexts. The following keywords were used for the search engine: (pharmacogenetics) AND (forensic toxicology); (pharmacogenetics) AND (post-mortem); (pharmacogenetics) AND (forensic science); and (pharmacogenetics) AND (autopsy). A total of 125 articles were collected. Of these, 29 articles were included in this systematic review. A total of 75% of the included studies were original articles (n = 21) and 25% were case reports (n = 7). A total of 78% (n = 22) of the studies involved deceased people for whom a complete autopsy was performed, while 22% (n = 6) involved people in good health who were given a drug with a subsequent pharmacogenetic study. The most studied drugs were opioids (codeine, morphine, and methadone), followed by antidepressants (tricyclic antidepressants and venlafaxine). Furthermore, all studies highlighted the importance of a pharmacogenetics study in drug-related deaths, especially in cases of non-overdose of drugs of abuse. This study highlights the importance of forensic pharmacogenetics, a field of toxicology still not fully understood, which is of great help in cases of sudden death, deaths from overdose, deaths after the administration of a drug, and also in cases of complaint of medical malpractice.