1
|
Pineda S, Lignell S, Gyllenhammar I, Lampa E, Benskin JP, Lundh T, Lindh C, Kiviranta H, Glynn A. Socio-demographic inequalities influence differences in the chemical exposome among Swedish adolescents. Environ Int 2024; 186:108618. [PMID: 38593688 DOI: 10.1016/j.envint.2024.108618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/05/2024] [Accepted: 03/29/2024] [Indexed: 04/11/2024]
Abstract
Relatively little is known about the relationship between socio-demographic factors and the chemical exposome in adolescent populations. This knowledge gap hampers global efforts to meet certain UN sustainability goals. The present work addresses this problem in Swedish adolescents by discerning patterns within the chemical exposome and identify demographic groups susceptible to heightened exposures. Enlisting the Riksmaten Adolescents 2016-17 (RMA) study population (N = 1082) in human-biomonitoring, and using proportional odds ordinal logistic regression models, we examined the associations between concentrations of a diverse array of substances (N = 63) with the determinants: gender, age, participant/maternal birth country income per capita level, parental education levels, and geographic place of living (longitude/latitude). Participant/maternal birth country exhibited a significant association with the concentrations of 46 substances, followed by gender (N = 41), and longitude (N = 37). Notably, individuals born in high-income countries by high-income country mothers demonstrated substantially higher estimated adjusted means (EAM) concentrations of polychlorinated biphenyls (PCBs), brominated flame retardants (BFRs) and per- and polyfluoroalkyl substances (PFASs) compared to those born in low-income countries by low-income country mothers. A reverse trend was observed for cobalt (Co), cadmium (Cd), lead (Pb), aluminium (Al), chlorinated pesticides, and phthalate metabolites. Males exhibited higher EAM concentrations of chromium (Cr), mercury (Hg), Pb, PCBs, chlorinated pesticides, BFRs and PFASs than females. In contrast, females displayed higher EAM concentrations of Mn, Co, Cd and metabolites of phthalates and phosphorous flame retardants, and phenolic substances. Geographical disparities, indicative of north-to-south or west-to-east substance concentrations gradients, were identified in Sweden. Only a limited number of lifestyle, physiological and dietary factors were identified as possible drivers of demographic inequalities for specific substances. This research underscores birth country, gender, and geographical disparities as contributors to exposure differences among Swedish adolescents. Identifying underlying drivers is crucial to addressing societal inequalities associated with chemical exposure and aligning with UN sustainability goals.
Collapse
Affiliation(s)
- Sebastian Pineda
- Department of Animal Biosciences, Swedish University of Agricultural Sciences, Uppsala, Sweden.
| | - Sanna Lignell
- Division of Risk and Benefit Assessment, Swedish Food Agency, Uppsala, Sweden
| | - Irina Gyllenhammar
- Department of Animal Biosciences, Swedish University of Agricultural Sciences, Uppsala, Sweden; Division of Risk and Benefit Assessment, Swedish Food Agency, Uppsala, Sweden
| | - Erik Lampa
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Jonathan P Benskin
- Department of Environmental Science, Stockholm University, Stockholm, Sweden
| | - Thomas Lundh
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Christian Lindh
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Hannu Kiviranta
- Environmental Health Unit, Finnish Institute for Health and Welfare, Kuopio, Finland
| | - Anders Glynn
- Department of Animal Biosciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| |
Collapse
|
2
|
Guldbrand C, Barregard L, Sallsten G, Forsgard N, Lundh T, Borné Y, Fagerberg B, Engström G, Bergström G, Harari F. Low-level exposure to lead and atherosclerosis in the carotid arteries: Results from the Swedish population-based cohort SCAPIS. Environ Res 2024; 244:117900. [PMID: 38092241 DOI: 10.1016/j.envres.2023.117900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/20/2023] [Accepted: 12/07/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Lead exposure is associated with cardiovascular disease. Atherosclerosis has been hypothesized to be one of the underlying mechanisms behind this association. AIM To investigate whether lead exposure is associated with an increased risk of atherosclerosis in the carotid arteries in a large Swedish population-based cohort. METHODS We performed a cross-sectional study using data from the population-based Swedish CardioPulmonary bioImage Study (SCAPIS), including 5622 middle-aged men and women, enrolled 2013-2018. Blood lead (B-Pb), measured by inductively coupled plasma mass spectrometry, was used as exposure biomarker. The presence of atherosclerotic plaque in the carotid arteries (yes/no), total plaque area (mm2) and the presence of large plaques (>25 mm2) were determined by ultrasonography. Associations between B-Pb and the different outcomes were analysed using Poisson and linear regression models, adjusted for potential confounders. RESULTS Atherosclerotic plaque was present in 57% of the individuals, for whom the median total plaque area was 16 mm2 (range: 0.2-222). The median B-Pb concentration was 14 μg/L (range: 0.75-203). After adjusting for potential confounders, individuals in the fourth quartile of B-Pb (Q4) had a prevalence ratio (PR) for plaque of 1.08 (95% CI: 1.01, 1.16) when compared with the first quartile (Q1). A 10 μg/L increase in B-Pb concentrations was associated with an increase of 0.92 mm2 (95% CI: 0.14, 1.71) in total plaque area. The PR for large plaque was 1.09 (95% CI: 0.84, 1.42 for Q4 vs Q1). CONCLUSIONS This study shows an association between B-Pb and atherosclerosis in the carotid arteries providing some support for the hypothesis that atherosclerosis is one of the mechanisms underlying the association between lead exposure and cardiovascular disease.
Collapse
Affiliation(s)
- Carl Guldbrand
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, Gothenburg, Sweden
| | - Lars Barregard
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, Gothenburg, Sweden
| | - Gerd Sallsten
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, Gothenburg, Sweden
| | - Niklas Forsgard
- Department of Clinical Chemistry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Thomas Lundh
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Sweden
| | - Yan Borné
- Department of Clinical Sciences in Malmö, Lund University, Sweden
| | - Björn Fagerberg
- Department of Molecular and Clinical Medicine, Wallenberg Laboratory for Cardiovascular and Metabolic Research, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences in Malmö, Lund University, Sweden
| | - Göran Bergström
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Florencia Harari
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, Gothenburg, Sweden.
| |
Collapse
|
3
|
Jiang Z, Schenk L, Assarsson E, Albin M, Bertilsson H, Dock E, Hagberg J, Karlsson LE, Kines P, Krais AM, Ljunggren S, Lundh T, Modig L, Möller R, Pineda D, Ricklund N, Saber AT, Storsjö T, Amir ET, Tinnerberg H, Tondel M, Vogel U, Wiebert P, Broberg K, Engfeldt M. Hexavalent chromium still a concern in Sweden - Evidence from a cross-sectional study within the SafeChrom project. Int J Hyg Environ Health 2024; 256:114298. [PMID: 38056371 DOI: 10.1016/j.ijheh.2023.114298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/24/2023] [Accepted: 11/24/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVES Hexavalent chromium (Cr(VI)) is classified as a human carcinogen. Occupational Cr(VI) exposure can occur during different work processes, but the current exposure to Cr(VI) at Swedish workplaces is unknown. METHODS This cross-sectional study (SafeChrom) recruited non-smoking men and women from 14 companies with potential Cr(VI) exposure (n = 113) and controls from 6 companies without Cr(VI) exposure (n = 72). Inhalable Cr(VI) was measured by personal air sampling (outside of respiratory protection) in exposed workers. Total Cr was measured in urine (pre- and post-shift, density-adjusted) and red blood cells (RBC) (reflecting Cr(VI)) in exposed workers and controls. The Bayesian tool Expostats was used to assess risk and evaluate occupational exposure limit (OEL) compliance. RESULTS The exposed workers performed processing of metal products, steel production, welding, plating, and various chemical processes. The geometric mean concentration of inhalable Cr(VI) in exposed workers was 0.15 μg/m3 (95% confidence interval: 0.11-0.21). Eight of the 113 exposed workers (7%) exceeded the Swedish OEL of 5 μg/m3, and the Bayesian analysis estimated the share of OEL exceedances up to 19.6% for stainless steel welders. Median post-shift urinary (0.60 μg/L, 5th-95th percentile 0.10-3.20) and RBC concentrations (0.73 μg/L, 0.51-2.33) of Cr were significantly higher in the exposed group compared with the controls (urinary 0.10 μg/L, 0.06-0.56 and RBC 0.53 μg/L, 0.42-0.72). Inhalable Cr(VI) correlated with urinary Cr (rS = 0.64) and RBC-Cr (rS = 0.53). Workers within steel production showed the highest concentrations of inhalable, urinary and RBC Cr. Workers with inferred non-acceptable local exhaustion ventilation showed significantly higher inhalable Cr(VI), urinary and RBC Cr concentrations compared with those with inferred acceptable ventilation. Furthermore, workers with inferred correct use of respiratory protection were exposed to significantly higher concentrations of Cr(VI) in air and had higher levels of Cr in urine and RBC than those assessed with incorrect or no use. Based on the Swedish job-exposure-matrix, approximately 17 900 workers were estimated to be occupationally exposed to Cr(VI) today. CONCLUSIONS Our study demonstrates that some workers in Sweden are exposed to high levels of the non-threshold carcinogen Cr(VI). Employers and workers seem aware of Cr(VI) exposure, but more efficient exposure control strategies are required. National strategies aligned with the European strategies are needed in order to eliminate this cause of occupational cancer.
Collapse
Affiliation(s)
- Zheshun Jiang
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Linda Schenk
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Eva Assarsson
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Maria Albin
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Helen Bertilsson
- Department of Public Health and Clinical Medicine, Sustainable Health, Umeå University, Umeå, Sweden
| | - Eva Dock
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden; Occupational and Environmental Medicine, Region Skåne, Lund, Sweden
| | - Jessika Hagberg
- Department of Occupational and Environmental Health, Faculty of Business, Science and Engineering, Örebro University, Örebro, Sweden
| | - Lovisa E Karlsson
- Department of Occupational and Environmental Medicine, Örebro University Hospital, Region Örebro County, Sweden
| | - Pete Kines
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Annette M Krais
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Stefan Ljunggren
- Occupational and Environmental Medicine Center in Linköping, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Thomas Lundh
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Lars Modig
- Department of Public Health and Clinical Medicine, Sustainable Health, Umeå University, Umeå, Sweden
| | - Rickie Möller
- Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Daniela Pineda
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Niklas Ricklund
- Department of Occupational and Environmental Medicine, Örebro University Hospital, Region Örebro County, Sweden
| | - Anne T Saber
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Tobias Storsjö
- Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Evana Taher Amir
- Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Håkan Tinnerberg
- Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden; Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Martin Tondel
- Occupational and Environmental Medicine, Department of Medical Sciences, Uppsala University, Uppsala, Sweden; Occupational and Environmental Medicine, Uppsala University Hospital, Uppsala, Sweden
| | - Ulla Vogel
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Pernilla Wiebert
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Karin Broberg
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; National Research Centre for the Working Environment, Copenhagen, Denmark.
| | - Malin Engfeldt
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden; Occupational and Environmental Medicine, Region Skåne, Lund, Sweden
| |
Collapse
|
4
|
Moradnia M, Attar HM, Hajizadeh Y, Lundh T, Salari M, Darvishmotevalli M. Assessing the carcinogenic and non-carcinogenic health risks of metals in the drinking water of Isfahan, Iran. Sci Rep 2024; 14:5029. [PMID: 38424133 PMCID: PMC10904872 DOI: 10.1038/s41598-024-55615-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 02/26/2024] [Indexed: 03/02/2024] Open
Abstract
Metals are significant contributors to water pollution, posing serious threats to human health. This study aims to assess the carcinogenic and non-carcinogenic health risks associated with metals in Isfahan drinking water. Eighty water samples were randomly collected from the city's distribution network between January and March 2020-2021. Inductively coupled plasma Optical Emission Spectrometry was used to measure toxic metals, namely Pb, Cr, Cd, Ni, and As concentrations. Results revealed that the mean concentration of Ni (70.03 µg/L) exceeded the WHO reference value (70 µg/L), while the other metals were below the standard values. The average chronic daily intake order of toxic metals was Ni > Cr > Pb > As > Cd. Non-carcinogenic risk assessment through hazard quotient (HQ) and hazard index (HI) demonstrated that both THI for adults (HQingestion + HQdermal = 4.02E-03) and THI for children (HIingestion + HIdermal = 3.83E-03) were below the acceptable limit (less than 1). This indicated no non-carcinogenic risk to residents through water ingestion or dermal exposure. However, findings indicated that the ingestion route was the primary exposure pathway, with HQ values for ingestion exceeding HQ values for dermal adsorption. Carcinogenic risk assessment showed that the risk associated with As metal exceeded the acceptable limit (1 × 10-6). Therefore, implementing treatment improvement programs and appropriate control measures is essential to safeguard the health of Isfahan City residents.
Collapse
Affiliation(s)
- Maryam Moradnia
- Department of Environmental Health Engineering, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Hossein Movahedian Attar
- Department of Environmental Health Engineering, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Yaghoub Hajizadeh
- Department of Environmental Health Engineering, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
- Environment Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, University of Medical Sciences, Isfahan, Iran
| | - Thomas Lundh
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Mehdi Salari
- Department of Environmental Health Engineering, School of Health, Sabzevar University of Medical Sciences, Sabzevar, Iran
- Leishmaniasis Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Mohammad Darvishmotevalli
- Research Center for Health, Safety, and Environment (RCHSE), Alborz University of Medical Sciences, Karaj, Iran.
- Department of Environmental Health Engineering, Faculty of Health, Alborz University of Medical Sciences, Karaj, Iran.
| |
Collapse
|
5
|
Stajnko A, Lundh T, Assarson E, Åkerberg Krook E, Broberg K. Lead, cadmium, and mercury blood levels in schoolchildren in southern Sweden: Time trends over the last decades. Chemosphere 2024; 346:140562. [PMID: 38303383 DOI: 10.1016/j.chemosphere.2023.140562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 02/03/2024]
Abstract
To prevent diseases arising from exposure to toxic metals, more knowledge about their temporal changes is needed, especially in children, the most vulnerable group. This study follows temporal changes in blood lead (BPb), mercury (BHg) and cadmium (BCd) levels in schoolchildren (8-11 years old) from two cities in southern Sweden. One blood sample per 773 children was used for time trend analyses between 2007 and 2022. One further blood sample re-sampled after 2 years, were used to assess intra-individual time trends of BPb (n = 377), BCd (n = 102) and BHg (n = 53) between 1979 and 2019. Geometric mean (range) of BPb, BCd and BHg concentrations during 2007-2022 was 9.9 (2.3-59), 0.09 (0.03-0.34) and 0.73 (0.02-8.2) μg/L, respectively. Living close to a Pb smelter resulted in higher levels of all three metals compared with living in the city or rural area. Annually, the concentrations clearly decreased for BPb (-4.9%, p < 0.001) and weakly for BCd (-0.6%, p = 0.013), while BHg slightly increased (+1.4%, p = 0.029). When stratified by residential area, the decrease of BCd and increase of BHg were significant only in the urban area (-1.8% and +2.8%, respectively; p < 0.01). The BPb decrease rate was the highest in the urban area followed by the rural and Pb smelter areas (-5.8% > -4.5% > -3.9%; p < 0.001). For children re-analysed during 1979-2019, a significant decrease was observed only for BPb (-6.8%; p < 0.001), with a 2% higher decrease rate in the period before than after the Pb-gasoline ban in 1994. The preventive measures against Pb pollution are reflected in the constant decrease of BPb levels over time. However, the area close to a Pb smelter, as indicated by a slower Pb decrease rate, might need further and stricter preventive measures. Exposure to Hg and Cd was low, however, the slight increase in BHg and only a minor decrease in BCd, indicate the need for continuous biomonitoring of children.
Collapse
Affiliation(s)
- Anja Stajnko
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden.
| | - Thomas Lundh
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Eva Assarson
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Else Åkerberg Krook
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Karin Broberg
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
6
|
Hrubá F, černá M, Chen C, Harari F, Horvat M, Koppová K, Krsková A, Laamech J, Li YF, Lina L, Lundh T, Lyoussi B, Mazej D, Osredkar J, Pawlas K, Pawlas N, Prokopowicz A, Rentschler G, Tratnik JS, Sommar J, Spěváčková V, Špirić Z, Skerfving S, Bergdahl IA. A regional comparison of children's blood cadmium, lead, and mercury in rural, urban and industrial areas of six European countries, and China, Ecuador, and Morocco. Int J Occup Med Environ Health 2023; 36:349-364. [PMID: 37681424 PMCID: PMC10663995 DOI: 10.13075/ijomeh.1896.02139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 05/30/2023] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVES The authors aimed to evaluate whether blood cadmium (B-Cd), lead (B-Pb) and mercury (B-Hg) in children differ regionally in 9 countries, and to identify factors correlating with exposure. MATERIAL AND METHODS The authors performed a cross-sectional study of children aged 7-14 years, living in 2007-2008 in urban, rural, or potentially polluted ("hot spot") areas (ca. 50 children from each area, in total 1363 children) in 6 European and 3 non-European countries. The authors analyzed Cd, Pb, and total Hg in blood and collected information on potential determinants of exposure through questionnaires. Regional differences in exposure levels were assessed within each country. RESULTS Children living near industrial "hot-spots" had B-Cd 1.6 (95% CI: 1.4-1.9) times higher in the Czech Republic and 2.1 (95% CI:1.6-2.8) times higher in Poland, as compared to urban children in the same countries (geometric means [GM]: 0.13 μg/l and 0.15 μg/l, respectively). Correspondingly, B-Pb in the "hot spot" areas was 1.8 (95% CI: 1.6-2.1) times higher than in urban areas in Slovakia and 2.3 (95% CI: 1.9-2.7) times higher in Poland (urban GM: 19.4 μg/l and 16.3 μg/l, respectively). In China and Morocco, rural children had significantly lower B-Pb than urban ones (urban GM: 64 μg/l and 71 μg/l, respectively), suggesting urban exposure from leaded petrol, water pipes and/or coal-burning. Hg "hot spot" areas in China had B-Hg 3.1 (95% CI: 2.7-3.5) times higher, and Ecuador 1.5 (95% CI: 1.2-1.9) times higher, as compared to urban areas (urban GM: 2.45 μg/l and 3.23 μg/l, respectively). Besides industrial exposure, traffic correlated with B-Cd; male sex, environmental tobacco smoke, and offal consumption with B-Pb; and fish consumption and amalgam fillings with B-Hg. However, these correlations could only marginally explain regional differences. CONCLUSIONS These mainly European results indicate that some children experience about doubled exposures to toxic elements just because of where they live. These exposures are unsafe, identifiable, and preventable and therefore call for preventive actions. Int J Occup Med Environ Health. 2023;36(3):349-64.
Collapse
Affiliation(s)
- Františka Hrubá
- Regional Authority of Public Health, Banská Bystrica, Slovakia
| | - Milena černá
- Charles University, Third Faculty of Medicine, Prague, Czech Republic
| | - Chunying Chen
- Chinese Academy of Sciences, Institute of High Energy Physics and National Center for Nanoscience and Technology, Beijing, China
| | - Florencia Harari
- Institute for Development of Production and Work Environment (IFA), Quito, Ecuador
| | - Milena Horvat
- Institut Jožef Stefan, Department of Environmental Sciences, Ljubljana, Slovenia
| | - Kvetoslava Koppová
- Slovak Medical University Bratislava, Faculty of Health, Banská Bystrica, Slovakia
| | - Andrea Krsková
- National Institute of Public Health, Prague, Czech Republic
| | - Jawhar Laamech
- Abdelmalek Essaadi University, Laboratory of Chemistry and Biochemistry, Faculty of Medicine and Pharmacy, Tangier, Morocco
| | - Yu-Feng Li
- Chinese Academy of Sciences, Institute of High Energy Physics, Beijing, China
| | - Löfmark Lina
- Lund University, Division of Occupational and Environmental Medicine, Lund, Sweden
| | - Thomas Lundh
- Lund University, Division of Occupational and Environmental Medicine, Lund, Sweden
| | - Badiaa Lyoussi
- University Sidi Mohamed Ben Abdellah, Laboratory of Natural Substances, Pharmacology, Environment, Modelling, Health and Quality of Life, Fez, Morocco
| | - Darja Mazej
- Institut Jožef Stefan, Department of Environmental Sciences, Ljubljana, Slovenia
| | - Joško Osredkar
- University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Krystyna Pawlas
- Wroclaw Medical University, Department of Hygiene, Wrocław, Poland
| | - Natalia Pawlas
- Medical University of Silesia, Department of Pharmacology, Faculty of Medical Sciences in Zabrze, Zabrze, Poland
| | | | - Gerda Rentschler
- Lund University, Division of Occupational and Environmental Medicine, Lund, Sweden
| | - Janja Snoj Tratnik
- Institut Jožef Stefan, Department of Environmental Sciences, Ljubljana, Slovenia
| | - Johan Sommar
- Umeå University, Department of Public Health and Clinical Medicine, Division of Sustainable Health, Umeå, Sweden
| | | | | | - Staffan Skerfving
- Lund University, Division of Occupational and Environmental Medicine, Lund, Sweden
| | - Ingvar A. Bergdahl
- Umeå University, Department of Public Health and Clinical Medicine, Division of Sustainable Health, Umeå, Sweden
| |
Collapse
|
7
|
Pineda S, Lignell S, Gyllenhammar I, Lampa E, Benskin JP, Lundh T, Lindh C, Kiviranta H, Glynn A. Exposure of Swedish adolescents to elements, persistent organic pollutants (POPs), and rapidly excreted substances - The Riksmaten adolescents 2016-17 national survey. Int J Hyg Environ Health 2023; 251:114196. [PMID: 37279611 DOI: 10.1016/j.ijheh.2023.114196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/24/2023] [Accepted: 05/26/2023] [Indexed: 06/08/2023]
Abstract
Adolescence is a period of significant physiological changes, and likely a sensitive window to chemical exposure. Few nation-wide population-based studies of chemical body burdens in adolescents have been published. In the national dietary survey Riksmaten Adolescents (RMA) 2016-17, over 13 chemical substance groups, including elements, chlorinated/brominated/fluorinated persistent organic pollutants (POPs) were analysed in blood, and in urine metabolites of phthalates/phthalate alternatives, phosphorous flame retardants, polycyclic aromatic hydrocarbons (PAHs), and pesticides, along with bisphenols and biocide/preservative/antioxidant/UV filter substances (N = 1082, ages 11-21). The aim was to characterize the body burdens in a representative population of adolescents in Sweden, and to compare results with human biomonitoring guidance values (HBM-GVs). Cluster analyses and Spearman's rank order correlations suggested that concentrations of substances with known common exposure sources and similar toxicokinetics formed obvious clusters and showed moderate to very strong correlations (r ≥ 0.4). No clusters were formed between substances from different matrices. Geometric mean (GM) concentrations of the substances were generally less than 3-fold different from those observed among adolescents in NHANES (USA 2015-16) and GerES V (Germany 2014-17). Notable exceptions were brominated diphenyl ethers (PBDEs) with >20-fold lower GM concentrations, and the biocide triclosan and ultraviolet (UV) filter benzophenone-3 with >15-fold lower mean concentrations in RMA compared to NHANES. Exceedance of the most conservative HBM-GVs were observed for aluminium (Al, 26% of subjects), perfluorooctanesulfonic acid (PFOS, 19%), perfluorooctanoic acid (PFOA, 12%), lead (Pb, 12%), MBP (dibutyl phthalate metabolite, 4.8%), hexachlorobenzene (HCB, 3.1%) and 3-phenoxybenzoic acid (PBA, pyrethroid metabolite, 2.2%). Males showed a higher proportion of exceedances than females for Pb, HCB and PFOS; otherwise no gender-related differences in exceedances were observed. A higher proportion of males than females had a Hazard Index (HI) of substances with liver and kidney toxicity and neurotoxicity >1. Industrialized countries with similarly high standards of living, with some exceptions, show comparable average body burdens of a variety of toxic chemicals among adolescents from the general population. The exceedances of HBM-GVs and HIs strongly suggests that further efforts to limit chemical exposure are warranted.
Collapse
Affiliation(s)
- Sebastian Pineda
- Department of Biomedicine and Veterinary Public Health Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden.
| | - Sanna Lignell
- Department of Risk and Benefit Assessment, Swedish National Food Agency, Uppsala, Sweden
| | - Irina Gyllenhammar
- Department of Risk and Benefit Assessment, Swedish National Food Agency, Uppsala, Sweden
| | - Erik Lampa
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Jonathan P Benskin
- Department of Environmental Science, Stockholm University, Stockholm, Sweden
| | - Thomas Lundh
- Department of Laboratory Medicine, Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Christian Lindh
- Department of Laboratory Medicine, Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Hannu Kiviranta
- Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Anders Glynn
- Department of Biomedicine and Veterinary Public Health Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| |
Collapse
|
8
|
Wen Q, Verheijen M, Wittens MMJ, Czuryło J, Engelborghs S, Hauser D, van Herwijnen MHM, Lundh T, Bergdahl IA, Kyrtopoulos SA, de Kok TM, Smeets HJM, Briedé JJ, Krauskopf J. Lead-exposure associated miRNAs in humans and Alzheimer’s disease as potential biomarkers of the disease and disease processes. Sci Rep 2022; 12:15966. [PMID: 36153426 PMCID: PMC9509380 DOI: 10.1038/s41598-022-20305-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 09/12/2022] [Indexed: 11/23/2022] Open
Abstract
Alzheimer’s disease (AD) is a neurodegenerative disease that eventually affects memory and behavior. The identification of biomarkers based on risk factors for AD provides insight into the disease since the exact cause of AD remains unknown. Several studies have proposed microRNAs (miRNAs) in blood as potential biomarkers for AD. Exposure to heavy metals is a potential risk factor for onset and development of AD. Blood cells of subjects that are exposed to lead detected in the circulatory system, potentially reflect molecular responses to this exposure that are similar to the response of neurons. In this study we analyzed blood cell-derived miRNAs derived from a general population as proxies of potentially AD-related mechanisms triggered by lead exposure. Subsequently, we analyzed these mechanisms in the brain tissue of AD subjects and controls. A total of four miRNAs were identified as lead exposure-associated with hsa-miR-3651, hsa-miR-150-5p and hsa-miR-664b-3p being negatively and hsa-miR-627 positively associated. In human brain derived from AD and AD control subjects all four miRNAs were detected. Moreover, two miRNAs (miR-3651, miR-664b-3p) showed significant differential expression in AD brains versus controls, in accordance with the change direction of lead exposure. The miRNAs’ gene targets were validated for expression in the human brain and were found enriched in AD-relevant pathways such as axon guidance. Moreover, we identified several AD relevant transcription factors such as CREB1 associated with the identified miRNAs. These findings suggest that the identified miRNAs are involved in the development of AD and might be useful in the development of new, less invasive biomarkers for monitoring of novel therapies or of processes involved in AD development.
Collapse
|
9
|
Barregard L, Sallsten G, Lundh T, Mölne J. Low-level exposure to lead, cadmium and mercury, and histopathological findings in kidney biopsies. Environ Res 2022; 211:113119. [PMID: 35288159 DOI: 10.1016/j.envres.2022.113119] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 05/22/2023]
Abstract
BACKGROUND Lead (Pb), cadmium (Cd) and mercury (Hg) are all nephrotoxic metals, and a large part of the body burden of Cd and Hg is found in the kidneys. There are, however, few studies on associations between exposure to these toxic metals and renal biopsy findings, and none at low-level exposure. AIM To examine the hypothesis that low-level concentration of Pb, Cd or Hg in the kidneys is associated with histopathological changes in the kidneys. METHODS We determined concentrations of Pb, Cd and Hg in kidney, blood and urine in 109 healthy kidney donors, aged 24-70 years. The renal biopsies were scored according to the Banff classification regarding tubular atrophy, interstitial fibrosis, glomerulosclerosis, arteriosclerosis, and arteriolohyalinosis. Kidney function was assessed based on glomerular filtration rate (GFR) as well as urinary excretion of albumin, low molecular weight proteins, kidney injury molecule 1 and N-acetylglucose aminidase. Associations between metal concentrations and histopathological changes, were assessed in models also including age, sex and smoking. RESULTS The median kidney concentrations of Pb, Cd and Hg were 0.08, 13 and 0.21 μg/g, respectively. There were signs of tubular atrophy in 63%, interstitial fibrosis in 21%, glomerulosclerosis in 71%, arteriosclerosis in 47%, and arteriolohyalinosis in 36% of the donors, but, as could be expected, the histopathological findings were limited, mostly Banff grade 1. In models adjusted for age, sex and smoking, kidney Cd was positively associated with tubular atrophy (p = 0.03) and possibly with arteriolohyalinosis (p = 0.06). Kidney Hg was associated with arteriosclerosis (p = 0.004). DISCUSSION AND CONCLUSIONS The results suggest that even low levels of Cd in the kidney can induce a mild degree of tubular atrophy. This is in line with previous findings at high-level Cd exposure. The association between kidney Hg and renal arteriosclerosis was unexpected, and may be a chance finding.
Collapse
Affiliation(s)
- Lars Barregard
- Occupational and Environmental Medicine, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Gerd Sallsten
- Occupational and Environmental Medicine, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Thomas Lundh
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University and Skane University Hospital, Lund, Sweden
| | - Johan Mölne
- Department of Clinical Pathology, Sahlgrenska University Hospital and Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
10
|
Almerud P, Zamaratskaia G, Lindroos AK, Bjermo H, Andersson EM, Lundh T, Ankarberg EH, Lignell S. Cadmium, total mercury, and lead in blood and associations with diet, sociodemographic factors, and smoking in Swedish adolescents. Environ Res 2021; 197:110991. [PMID: 33705767 DOI: 10.1016/j.envres.2021.110991] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/10/2021] [Accepted: 03/03/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Despite their vulnerability to the toxic effects of certain metals, biomonitoring data on adolescents are limited. In the present study, we assessed blood concentrations of toxic metals (cadmium [Cd], total mercury [Hg], and lead [Pb] in a national representative sample of Swedish adolescents. We also examined the associations of Cd, total Hg and Pb with habitual intakes of major energy-providing food groups and other possible determinants such as age, sex, household education, Nordic or non-Nordic origin, and smoking. METHODS We analysed blood concentrations of Cd, total Hg, and Pb in a sample of 1099 adolescents from the Riksmaten Adolescents 2016-17 study in three age groups (mean age of 12, 15, and 18 years) using inductively coupled plasma mass spectrometry. The participants completed web-based questionnaires on food consumption frequency, sociodemographic factors and health status. Dietary data from two web-based 24-h dietary recalls were used to estimate the habitual intake of 10 major food groups. RESULTS Almost all participants had detectable concentrations of Cd, total Hg, and Pb in whole blood. The median blood concentrations were 0.12 μg/L for Cd, 0.72 μg/L for total Hg, and 7.1 μg/L for Pb. Higher blood concentrations of Cd were observed in girls than in boys, whereas concentrations of total Hg and Pb were higher in boys. We observed an inverse association between Cd and meat intake. Total Hg concentrations were positively associated with intakes of fish, eggs, meat, and vegetables, and Pb concentrations were inversely associated with intakes of dairy products. Furthermore, smokers had higher concentrations of Cd and Pb. CONCLUSIONS We found that fish was a potentially important source of exposure to total Hg in Swedish adolescents. No other food group was identified to have a strong impact on the blood levels of Cd, total Hg and Pb. Thirteen per cent of the adolescents had blood Pb concentrations above 12 μg/L, the reference point used in the risk assessment of Pb by the European Food Safety Authority (EFSA).
Collapse
Affiliation(s)
- Pernilla Almerud
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Galia Zamaratskaia
- Department of Risk and Benefit Assessment, Swedish Food Agency, Uppsala, Sweden
| | - Anna Karin Lindroos
- Department of Risk and Benefit Assessment, Swedish Food Agency, Uppsala, Sweden; Department of Internal Medicine and Clinical Nutrition, The Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Helena Bjermo
- Department of Risk and Benefit Assessment, Swedish Food Agency, Uppsala, Sweden
| | - Eva M Andersson
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Thomas Lundh
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | | | - Sanna Lignell
- Department of Risk and Benefit Assessment, Swedish Food Agency, Uppsala, Sweden.
| |
Collapse
|
11
|
Barregard L, Sallsten G, Harari F, Andersson EM, Forsgard N, Hjelmgren O, Angerås O, Fagman E, Persson M, Lundh T, Borné Y, Fagerberg B, Engström G, Bergström G. Cadmium Exposure and Coronary Artery Atherosclerosis: A Cross-Sectional Population-Based Study of Swedish Middle-Aged Adults. Environ Health Perspect 2021; 129:67007. [PMID: 34160297 PMCID: PMC8221368 DOI: 10.1289/ehp8523] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND The general population is ubiquitously exposed to the toxic metal cadmium through the diet and smoking. Cadmium exposure is associated with increased morbidity and mortality in myocardial infarction and stroke. Atherosclerosis is the main underlying mechanism of myocardial infarction. However, associations between cadmium and coronary artery atherosclerosis have not been examined. OBJECTIVES Our study sought to examine the hypothesis that blood cadmium (B-Cd) is positively associated with coronary artery calcification, as a measure of coronary artery atherosclerosis in the population-based Swedish SCAPIS study. METHODS Our analysis included 5,627 individuals (51% women), age 50-64 y, enrolled from 2013 to 2018. The coronary artery calcium score (CACS) was obtained from computed tomography. Blood cadmium was determined by inductively coupled plasma mass spectrometry (ICP-MS). Associations between B-Cd and coronary artery calcium score (CACS Agatston score) were evaluated using prevalence ratios (PRs) in models adjusted for sex, age, smoking, hypertension, diabetes, low-density cholesterol/high-density cholesterol ratio, and family history. RESULTS The median B-Cd concentration was 0.24μg/L. The prevalence of positive coronary artery calcium (CACS>0) was 41% and the prevalence of CACS≥100 was 13%. Relative to the lowest quartile (Q) of B-Cd (<0.16μg/L), the highest quartile (median 0.63μg/L) was associated with a small but significant increase in CACS>0 (PR 1.1; 95% CI: 1.0, 1.3), and a greater relative increase in CACS≥100 (PR 1.6; 95% CI: 1.3, 2.0). When restricted to 2,446 never-smokers, corresponding PRs were 1.1 (95% CI 0.9, 1.3) for CACS>0 (63 cases in Q4) and 1.7 (95% CI 1.1, 2.7) for CACS≥100 (17 cases in Q4). DISCUSSION Blood cadmium in the highest quartile was associated with CACS in a general population sample with low to moderate cadmium exposure. This supports the hypothesis that atherosclerosis is an important mechanism underlying the associations between cadmium and incident cardiovascular disease. The findings suggest that public health measures to reduce cadmium exposure are warranted. https://doi.org/10.1289/EHP8523.
Collapse
Affiliation(s)
- Lars Barregard
- Occupational and Environmental Medicine, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gerd Sallsten
- Occupational and Environmental Medicine, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Florencia Harari
- Occupational and Environmental Medicine, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Eva M. Andersson
- Occupational and Environmental Medicine, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Niklas Forsgard
- Department of Clinical Chemistry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ola Hjelmgren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Oskar Angerås
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Erika Fagman
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Margaretha Persson
- Department of Clinical Sciences in Malmö, CRC, Lund University and Skåne University Hospital, Malmö, Sweden
| | - Thomas Lundh
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University and Skåne University Hospital, Lund, Sweden
| | - Yan Borné
- Department of Clinical Sciences in Malmö, CRC, Lund University and Skåne University Hospital, Malmö, Sweden
| | - Björn Fagerberg
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences in Malmö, CRC, Lund University and Skåne University Hospital, Malmö, Sweden
| | - Göran Bergström
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
12
|
Wallin M, Barregard L, Sallsten G, Lundh T, Sundh D, Lorentzon M, Ohlsson C, Mellström D. Low-level cadmium exposure is associated with decreased cortical thickness, cortical area and trabecular bone volume fraction in elderly men: The MrOS Sweden study. Bone 2021; 143:115768. [PMID: 33232837 DOI: 10.1016/j.bone.2020.115768] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 11/02/2020] [Accepted: 11/19/2020] [Indexed: 12/17/2022]
Abstract
It is well known that high-level exposure to cadmium can cause bone disease such as osteoporosis, osteomalacia and fractures. However, the effect of low-level exposure, as found in the general population (mainly derived from diet and smoking), has only been assessed recently. The aim of this study was to examine if cadmium exposure in the general Swedish population causes other bone changes than decreased areal bone mineral density as measured by traditional DXA technology, e.g. changes in microstructure and geometry, such as cortical thickness or area, cortical porosity and trabecular bone volume. The study population consisted of 444 men, aged 70-81 years at inclusion year 2002-2004, from the Swedish cohort of the Osteoporotic Fractures in Men Study (MrOS). Cadmium was analyzed in baseline urine samples (U-Cd). Different parameters of bone geometry and microstructure were measured at the distal tibia at follow-up in 2009, including examination with high-resolution peripheral quantitative computed tomography (HR-pQCT). Associations between bone parameters and U-Cd in tertiles were estimated in multivariable analyses, including potential confounding factors (age, smoking, BMI, and physical activity). We found significant associations between U-Cd and several bone geometry or microstructure parameters, with 9% lower cortical thickness (p = 0.03), 7% lower cortical area (p = 0.04), and 5% lower trabecular bone volume fraction (p = 0.02) in the third tertile of U-Cd, using the first tertile as the reference. Furthermore, significant negative associations were found between log-transformed U-Cd and cortical thickness, cortical area, trabecular number and trabecular bone volume fraction, and a significant positive association with trabecular separation. The results indicate that low-level Cd exposure in the general population has negative effects on both cortical and trabecular bone.
Collapse
Affiliation(s)
- Maria Wallin
- Department of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Lars Barregard
- Department of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gerd Sallsten
- Department of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Thomas Lundh
- Department of Occupational and Environmental Medicine, Skåne University Hospital, Lund, Sweden
| | - Daniel Sundh
- Department of Geriatric Medicine, Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Centre for Bone and Arthritis Research (CBAR), Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mattias Lorentzon
- Department of Geriatric Medicine, Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Centre for Bone and Arthritis Research (CBAR), Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Geriatric Medicine Clinic, Sahlgrenska University Hospital Mölndal, Sweden
| | - Claes Ohlsson
- Department of Geriatric Medicine, Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Dan Mellström
- Department of Geriatric Medicine, Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Centre for Bone and Arthritis Research (CBAR), Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
13
|
Taj T, Gliga AR, Hedmer M, Wahlberg K, Assarsson E, Lundh T, Tinnerberg H, Albin M, Broberg K. Effect of welding fumes on the cardiovascular system: a six-year longitudinal study. Scand J Work Environ Health 2021; 47:52-61. [PMID: 32725248 PMCID: PMC7801138 DOI: 10.5271/sjweh.3908] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Objective This study investigated whether low-to-moderate exposure to welding fumes is associated with adverse effects on the cardiovascular system. Methods To test this, we performed a longitudinal analysis of 78 mild steel welders and 96 controls; these subjects were examined twice, six years apart (ie, timepoints 1 and 2). All subjects (male and non-smoking at recruitment) completed questionnaires describing their health, work history, and lifestyle. We measured their blood pressure, endothelial function (by EndoPAT), and risk markers for cardiovascular disease [low-density lioprotein (LDL), homocysteine, C-reactive protein]. Exposure to welding fumes was assessed from the responses to questionnaires and measurements of respirable dust in their breathing zones adjusted for use of respiratory protection equipment. Linear mixed-effect regression models were used for the longitudinal analysis. Results Median respirable dust concentrations, adjusted for respirable protection, of the welders were 0.7 (5-95 percentile range 0.2-4.2) and 0.5 (0.1-1.9) mg/m 3at timepoints 1 and 2, respectively. Over the six-year period, welders showed a statistically significant increase in systolic [5.11 mm Hg, 95% confidence interval (CI) 1.92-8.31] and diastolic (3.12 mm Hg, 95% CI 0.74-5.5) blood pressure compared with controls (multi-variable adjusted mixed effect models). Diastolic blood pressure increased non-significantly by 0.22 mm Hg (95% CI -0.02-0.45) with every additional year of welding work. No consistent significant associations were found between exposure and endothelial function, LDL, homocysteine, or C-reactive protein. Conclusion Exposure to welding fumes at low-to-moderate levels is associated with increased blood pressure, suggesting that reducing the occupational exposure limit (2.5 mg/m 3for inorganic respirable dust in Sweden) is needed to protect cardiovascular health of workers.
Collapse
Affiliation(s)
- Tahir Taj
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Solé-Navais P, Brantsæter AL, Caspersen IH, Lundh T, Muglia LJ, Meltzer HM, Zhang G, Jacobsson B, Sengpiel V, Barman M. Maternal Dietary Selenium Intake during Pregnancy Is Associated with Higher Birth Weight and Lower Risk of Small for Gestational Age Births in the Norwegian Mother, Father and Child Cohort Study. Nutrients 2020; 13:nu13010023. [PMID: 33374667 PMCID: PMC7822440 DOI: 10.3390/nu13010023] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/16/2020] [Accepted: 12/19/2020] [Indexed: 12/20/2022] Open
Abstract
Selenium is an essential trace element involved in the body’s redox reactions. Low selenium intake during pregnancy has been associated with low birth weight and an increased risk of children being born small for gestational age (SGA). Based on data from the Norwegian Mother, Father and Child Cohort Study (MoBa) and the Medical Birth Registry of Norway (MBRN), we studied the association of maternal selenium intake from diet and supplements during the first half of pregnancy (n = 71,728 women) and selenium status in mid-pregnancy (n = 2628 women) with birth weight and SGA status, according to population-based, ultrasound-based and customized growth standards. An increase of one standard deviation of maternal dietary selenium intake was associated with increased birth weight z-scores (ß = 0.027, 95% CI: 0.007, 0.041) and lower SGA risk (OR = 0.91, 95% CI 0.86, 0.97) after adjusting for confounders. Maternal organic and inorganic selenium intake from supplements as well as whole blood selenium concentration were not associated with birth weight or SGA. Our results suggest that a maternal diet rich in selenium during pregnancy may be beneficial for foetal growth. However, the effect estimates were small and further studies are needed to elucidate the potential impact of selenium on foetal growth.
Collapse
Affiliation(s)
- Pol Solé-Navais
- Department of Obstetrics and Gynaecology, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden; (P.S.-N.); (B.J.); (V.S.)
| | - Anne Lise Brantsæter
- Division of Infection Control, Environment and Health, Norwegian Institute of Public Health, 0213 Oslo, Norway; (A.L.B.); (H.M.M.)
| | | | - Thomas Lundh
- Department of Laboratory Medicine, Division of Occupational and Environmental Medicine, Lund University, 221 85 Lund, Sweden;
| | - Louis J. Muglia
- Cincinnati Children’s Hospital Medical Center, Division of Human Genetics and Perinatal Institute, Cincinnati, OH 45229, USA; (L.J.M.); (G.Z.)
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
- Office of the President, Burroughs Wellcome Fund, Research Triangle Park, Durham, NC 27709, USA
| | - Helle Margrete Meltzer
- Division of Infection Control, Environment and Health, Norwegian Institute of Public Health, 0213 Oslo, Norway; (A.L.B.); (H.M.M.)
| | - Ge Zhang
- Cincinnati Children’s Hospital Medical Center, Division of Human Genetics and Perinatal Institute, Cincinnati, OH 45229, USA; (L.J.M.); (G.Z.)
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Bo Jacobsson
- Department of Obstetrics and Gynaecology, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden; (P.S.-N.); (B.J.); (V.S.)
- Department of Genetics and Bioinformatics, Domain of Health Data and Digitalisation, Institute of Public Health, 0456 Oslo, Norway
- Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital/Östra, 405 30 Gothenburg, Sweden
| | - Verena Sengpiel
- Department of Obstetrics and Gynaecology, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden; (P.S.-N.); (B.J.); (V.S.)
- Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital/Östra, 405 30 Gothenburg, Sweden
| | - Malin Barman
- Department of Biology and Biological Engineering, Chalmers University of Technology, 412 96 Gothenburg, Sweden
- Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
- Correspondence:
| |
Collapse
|
15
|
Krauskopf J, Bergdahl IA, Johansson A, Palli D, Lundh T, Kyrtopoulos SA, de Kok TM, Kleinjans JC. Blood Transcriptome Response to Environmental Metal Exposure Reveals Potential Biological Processes Related to Alzheimer's Disease. Front Public Health 2020; 8:557587. [PMID: 33194959 PMCID: PMC7609776 DOI: 10.3389/fpubh.2020.557587] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 09/16/2020] [Indexed: 01/09/2023] Open
Abstract
Alzheimer's disease (AD) is a neurodegenerative disease which is manifested by a progressive and irreversible decline of cognition, memory loss, a shortened attention span, and changes in personality. Aging and genetic pre-dispositions, particularly the presence of a specific form of apolipoprotein E (APOE), are main risk factors of sporadic AD; however, a large body of evidence has shown that multiple environmental factors, including exposure to toxic metals, increase the risk for late onset AD. Lead (Pb) and cadmium (Cd) are ubiquitous toxic metals with a wide range of applications resulting in global distribution in the environment and exposure of all living organisms on earth. In addition to being classified as carcinogenic (Cd) and possibly carcinogenic (Pb) to humans by the International Agency for Research on Cancer, both compounds disrupt metal homeostasis and can cause toxic responses at the cellular and organismal levels. Pb toxicity targets the central nervous system and evidence for that has emerged also for Cd. Recent epidemiological studies show that both metals possibly are etiological factors of multiple neurodegenerative diseases, including Alzheimer's disease (AD). To further explore the association between metal exposure and AD risk we applied whole transcriptome gene expression analysis in peripheral blood leukocytes (PBLs) from 632 subjects of the general population, taken from the EnviroGenomarkers project. We used linear mixed effect models to associate metal exposure to gene expression after adjustment for gender, age, BMI, smoking, and alcohol consumption. For Pb exposure only few associations were identified, including a downregulation of the human eukaryotic translation initiation factor 5 (eIF5). In contrast, Cd exposure, particularly in males, revealed a much stronger transcriptomic response, featuring multiple pathways related to pathomolecular mechanisms of AD, such as endocytosis, neutrophil degranulation, and Interleukin−7 signaling. A gender stratified analysis revealed that the Cd responses were male-specific and included a downregulation of the APOE gene in men. This exploratory study revealed novel hypothetical findings which might contribute to the understanding of the neurotoxic effects of chronic Pb and Cd exposure and possibly improve our knowledge on the molecular mechanisms linking metal exposure to AD risk.
Collapse
Affiliation(s)
- Julian Krauskopf
- Department of Toxicogenomics, Maastricht University, Maastricht, Netherlands
| | - Ingvar A Bergdahl
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | - Domenico Palli
- Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network - ISPRO, Florence, Italy
| | - Thomas Lundh
- Division of Occupational and Environmental Medicine, Lund University Hospital, Lund, Sweden
| | | | - Theo M de Kok
- Department of Toxicogenomics, Maastricht University, Maastricht, Netherlands
| | - Jos C Kleinjans
- Department of Toxicogenomics, Maastricht University, Maastricht, Netherlands
| |
Collapse
|
16
|
Mattisson K, Tekavec E, Lundh T, Stroh E. Cadmium and Lead Levels in Blood and Arsenic Levels in Urine among Schoolchildren Living in Contaminated Glassworks Areas, Sweden. Int J Environ Res Public Health 2020; 17:E7382. [PMID: 33050429 PMCID: PMC7600003 DOI: 10.3390/ijerph17207382] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 12/11/2022]
Abstract
The Kingdom of Crystal, an area in southern Sweden famous for its many glassworks, is historically heavily burdened by pollution from this industry. Glass crust containing cadmium (Cd), lead (Pb), and arsenic (As) has been deposited around the area and used as filling. The purpose of this study was to monitor whether the high levels of metals in the contaminated soil were reflected in blood and urine among school children in this area. Blood and urine samples were collected from 87 children in 2017. The levels of cadmium (Cd-B) and lead (Pb-B) found in blood were determined by inductively coupled plasma mass spectrometry (ICP-MS). The speciation of As in urine (As-U) was performed by ion chromatography. The geometric mean of Cd-B and Pb-B among the children were 0.09 μg/L and 9.9 μg/L respectively. The geometric mean of inorganic As (AsIII and AsV) with metabolites in urine was 6.1 μg/L and 6.94 μg/g creatinine. Children in the study area had blood levels of Pb and Cd that correspond to levels generally found in Swedish children. The levels of inorganic As and its metabolites in urine were low and in the same magnitude as other children in Europe and the U.S.
Collapse
Affiliation(s)
- Kristoffer Mattisson
- Division of Occupational and Environmental Medicine, Lund University, 22362 Lund, Sweden; (E.T.); (T.L.); (E.S.)
| | | | | | | |
Collapse
|
17
|
Gliga AR, Taj T, Wahlberg K, Lundh T, Assarsson E, Hedmer M, Albin M, Broberg K. Exposure to Mild Steel Welding and Changes in Serum Proteins With Putative Neurological Function-A Longitudinal Study. Front Public Health 2020; 8:422. [PMID: 32984236 PMCID: PMC7485227 DOI: 10.3389/fpubh.2020.00422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/13/2020] [Indexed: 12/20/2022] Open
Abstract
Welders are exposed to high levels of metal particles, consisting mainly of iron and manganese (Mn) oxide. Metal particles, especially those containing Mn can be neurotoxic. In this exploratory study, we evaluated associations between welding and expression of 87 putative neurology-related proteins in serum in a longitudinal approach. The study cohort from southern Sweden included welders working with mild steel (n = 56) and controls (n = 67), all male and non-smoking, which were sampled at two timepoints (T1, T2) 6-year apart. Observed associations in the longitudinal analysis (linear mixed models) were further evaluated (linear regression models) in another cross-sectional sample which included welders (n = 102) and controls (n = 89) who were sampled only once (T1 or T2). The median respirable dust levels for welders after adjusting for respiratory protection was at T1 0.6 (5–95 percentile: 0.2–4.2) and at T2 0.5 (0.1–1.8) mg/m3. The adjusted median respirable Mn concentration was at T2 0.049 mg/m3 (0.003–0.314) with a Spearman correlation between adjusted respirable dust and respirable Mn of rS = 0.88. We identified five neurology-related proteins that were differentially expressed in welders vs. controls in the longitudinal sample, of which one (nicotinamide/nicotinic acid mononucleotide adenylyltransferase 1; NMNAT1) was also differentially expressed in the cross-sectional sample. NMNAT1, an axon-protective protein linked to Alzheimers disease, was upregulated in welders compared with controls but no associations were discerned with degree of exposure (welders only: years welding, respirable dust, cumulative exposure). However, we identified five additional proteins that were associated with years welding (GCSF, EFNA4, CTSS, CLM6, VWC2; welders only) both in the longitudinal and in the cross-sectional samples. We also observed several neurology-related proteins that were associated with age and BMI. Our study indicates that low-to-moderate exposure to welding fumes is associated with changes in circulating levels of neurology-related proteins.
Collapse
Affiliation(s)
- Anda R Gliga
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Tahir Taj
- Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Karin Wahlberg
- Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Thomas Lundh
- Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Eva Assarsson
- Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Maria Hedmer
- Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Maria Albin
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Karin Broberg
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| |
Collapse
|
18
|
Erlandsson L, Lindgren R, Nääv Å, Krais AM, Strandberg B, Lundh T, Boman C, Isaxon C, Hansson SR, Malmqvist E. Exposure to wood smoke particles leads to inflammation, disrupted proliferation and damage to cellular structures in a human first trimester trophoblast cell line. Environ Pollut 2020; 264:114790. [PMID: 32417587 DOI: 10.1016/j.envpol.2020.114790] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/08/2020] [Accepted: 05/09/2020] [Indexed: 06/11/2023]
Abstract
The ongoing transition to renewable fuel sources has led to increased use of wood and other biomass fuels. The physiochemical characteristics of biomass combustion derived aerosols depends on appliances, fuel and operation procedures, and particles generated during incomplete combustion are linked to toxicity. Frequent indoor wood burning is related to severe health problems such as negative effects on airways and inflammation, as well as chronic hypoxia and pathological changes in placentas, adverse pregnancy outcome, preterm delivery and increased risk of preeclampsia. The presence of combustion-derived black carbon particles at both the maternal and fetal side of placentas suggests that particles can reach the fetus. Air pollution particles have also been shown to inhibit trophoblast migration and invasion, which are vital functions for the development of the placenta during the first trimester. In this study we exposed a placental first trimester trophoblast cell line to wood smoke particles emitted under Nominal Burn rate (NB) or High Burn rate (HB). The particles were visible inside exposed cells and localized to the mitochondria, causing ultrastructural changes in mitochondria and endoplasmic reticulum. Exposed cells showed decreased secretion of the pregnancy marker human chorionic gonadotropin, increased secretion of IL-6, disrupted membrane integrity, disrupted proliferation and contained specific polycyclic aromatic hydrocarbons (PAHs) from the particles. Taken together, these results suggest that wood smoke particles can enter trophoblasts and have detrimental effects early in pregnancy by disrupting critical trophoblast functions needed for normal placenta development and function. This could contribute to the underlying mechanisms leading to pregnancy complications such as miscarriage, premature birth, preeclampsia and/or fetal growth restriction. This study support the general recommendation that more efficient combustion technologies and burning practices should be adopted to reduce some of the toxicity generated during wood burning.
Collapse
Affiliation(s)
- Lena Erlandsson
- Division of Obstetrics and Gynecology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
| | - Robert Lindgren
- Thermochemical Energy Conversion Laboratory, Department of Applied Physics and Electronics, Umeå University, Umeå, Sweden.
| | - Åsa Nääv
- Division of Obstetrics and Gynecology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
| | - Annette M Krais
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden.
| | - Bo Strandberg
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden.
| | - Thomas Lundh
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden.
| | - Christoffer Boman
- Thermochemical Energy Conversion Laboratory, Department of Applied Physics and Electronics, Umeå University, Umeå, Sweden.
| | - Christina Isaxon
- Department of Ergonomics and Aerosol Technology, Lund University, Lund, Sweden.
| | - Stefan R Hansson
- Division of Obstetrics and Gynecology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
| | - Ebba Malmqvist
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden.
| |
Collapse
|
19
|
Li H, Wallin M, Barregard L, Sallsten G, Lundh T, Ohlsson C, Mellström D, Andersson EM. Smoking-Induced Risk of Osteoporosis Is Partly Mediated by Cadmium From Tobacco Smoke: The MrOS Sweden Study. J Bone Miner Res 2020; 35:1424-1429. [PMID: 32191351 DOI: 10.1002/jbmr.4014] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 02/19/2020] [Accepted: 03/15/2020] [Indexed: 11/09/2022]
Abstract
Cigarette smoking is a risk factor for osteoporosis and bone fracture. Moreover, smoking causes exposure to cadmium, which is a known risk factor for osteoporosis. It is hypothesized that part of smoking-induced osteoporosis may be mediated via cadmium from tobacco smoke. We investigated this hypothesis using mediation analysis in a Swedish cohort of elderly men. This study was performed in 886 elderly men from the Swedish cohort of the Osteoporotic Fractures in Men (MrOS) study. Urinary samples, bone mineral density (BMD), smoking data, and other background information were obtained at baseline in 2002-2004. Urinary cadmium was analyzed in baseline samples and adjusted for creatinine. The cohort was followed until August 2018 for fracture incidence, based on the X-ray register. Mediation analysis was conducted to evaluate the indirect effect (via cadmium) of smoking on both BMD and fractures. Time to first fracture was analyzed using the accelerated failure time (AFT) model and Aalen's additive hazard model. The mean level of urinary cadmium was 0.25 μg/g creatinine. There were significant inverse associations between smoking and total body, total hip, and trochanter BMD. The indirect effects via cadmium were estimated to be 43% of the total effects of smoking for whole-body BMD, and even more for total hip and trochanter BMD. Smoking was also associated with higher risk of all fractures and major osteoporosis fractures. The indirect effects via cadmium were largest in nonvertebral osteoporosis fractures and hip fractures, constituting at least one-half of the total effects, in both the AFT and Aalen's model. The findings in this study provide evidence that cadmium exposure from tobacco smoke plays an important role in smoking-induced osteoporosis © 2020 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.
Collapse
Affiliation(s)
- Huiqi Li
- Department of Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Maria Wallin
- Department of Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Lars Barregard
- Department of Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Gerd Sallsten
- Department of Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Thomas Lundh
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Claes Ohlsson
- Center for Bone and Arthritis Research (CBAR), Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Dan Mellström
- Center for Bone and Arthritis Research (CBAR), Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eva M Andersson
- Department of Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
20
|
Abstract
The growth of snail shells can be described by simple mathematical rules. Variation in a few parameters can explain much of the diversity of shell shapes seen in nature. However, empirical studies of gastropod shell shape variation typically use geometric morphometric approaches, which do not capture this growth pattern. We have developed a way to infer a set of developmentally descriptive shape parameters based on three-dimensional logarithmic helicospiral growth and using landmarks from two-dimensional shell images as input. We demonstrate the utility of this approach, and compare it to the geometric morphometric approach, using a large set of Littorina saxatilis shells in which locally adapted populations differ in shape. Our method can be modified easily to make it applicable to a wide range of shell forms, which would allow for investigations of the similarities and differences between and within many different species of gastropods.
Collapse
Affiliation(s)
- J. Larsson
- Department of Animal and Plant Sciences, University of Sheffield, Sheffield, UK
| | | | - S. Bengmark
- Mathematical Sciences, Chalmers University of Technology and University of Gothenburg, Gothenburg, Sweden
| | - T. Lundh
- Mathematical Sciences, Chalmers University of Technology and University of Gothenburg, Gothenburg, Sweden
| | - R. K. Butlin
- Department of Animal and Plant Sciences, University of Sheffield, Sheffield, UK
- Department of Marine Sciences, University of Gothenburg, Stömstad, Sweden
| |
Collapse
|
21
|
Nääv Å, Erlandsson L, Isaxon C, Åsander Frostner E, Ehinger J, Sporre MK, Krais AM, Strandberg B, Lundh T, Elmér E, Malmqvist E, Hansson SR. Urban PM2.5 Induces Cellular Toxicity, Hormone Dysregulation, Oxidative Damage, Inflammation, and Mitochondrial Interference in the HRT8 Trophoblast Cell Line. Front Endocrinol (Lausanne) 2020; 11:75. [PMID: 32226408 PMCID: PMC7080655 DOI: 10.3389/fendo.2020.00075] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 02/04/2020] [Indexed: 12/13/2022] Open
Abstract
Objective: Epidemiological studies have found air pollution to be a driver of adverse pregnancy outcomes, including gestational diabetes, low term birth weight and preeclampsia. It is unknown what biological mechanisms are involved in this process. A first trimester trophoblast cell line (HTR-8/SVneo) was exposed to various concentrations of PM2.5 (PM2.5) in order to elucidate the effect of urban particulate matter (PM) of size <2.5 μm on placental function. Methods: PM2.5 were collected at a site representative of urban traffic and dispersed in cell media by indirect and direct sonication. The HTR-8 cells were grown under standard conditions. Cellular uptake was studied after 24 and 48 h of exposure by transmission electron microscopy (TEM). The secretion of human chorionic gonadotropin (hCG), progesterone, and Interleukin-6 (IL-6) was measured by ELISA. Changes in membrane integrity and H2O2 production were analyzed using the CellToxTM Green Cytotoxicity and ROSGloTM assays. Protease activity was evaluated by MitoToxTM assay. Mitochondrial function was assessed through high resolution respirometry in an Oroboros O2k-FluoRespirometer, and mitochondrial content was quantified by citrate synthase activity. Results: TEM analysis depicted PM2.5 cellular uptake and localization of the PM2.5 to the mitochondria after 24 h. The cells showed aggregated cytoskeleton and generalized necrotic appearance, such as chromatin condensation, organelle swelling and signs of lost membrane integrity. The mitochondria displayed vacuolization and disruption of cristae morphology. At 48 h exposure, a significant drop in hCG secretion and a significant increase in progesterone secretion and IL-6 production occurred. At 48 h exposure, a five-fold increase in protease activity and a significant alteration of H2O2 production was observed. The HTR-8 cells exhibited evidence of increased cytotoxicity with increasing exposure time and dose of PM2.5. No significant difference in mitochondrial respiration or mitochondrial mass could be demonstrated. Conclusion: Following exposure to air pollution, intracellular accumulation of PM may contribute to the placental dysfunction associated with pregnancy outcomes, such as preeclampsia and intrauterine growth restriction, through their direct and indirect effects on trophoblast protein secretion, hormone regulation, inflammatory response, and mitochondrial interference.
Collapse
Affiliation(s)
- Åsa Nääv
- Obstetrics and Gynecology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- *Correspondence: Åsa Nääv
| | - Lena Erlandsson
- Obstetrics and Gynecology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Christina Isaxon
- Department of Ergonomics and Aerosol Technology, Lund University, Lund, Sweden
| | | | - Johannes Ehinger
- Mitochondrial Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Moa K. Sporre
- Department of Physics, Lund University, Lund, Sweden
| | - Annette M. Krais
- Division of Occupational and Environmental Medicine, Institution of Laboratory Medicine, Lund University, Lund, Sweden
| | - Bo Strandberg
- Division of Occupational and Environmental Medicine, Institution of Laboratory Medicine, Lund University, Lund, Sweden
| | - Thomas Lundh
- Division of Occupational and Environmental Medicine, Institution of Laboratory Medicine, Lund University, Lund, Sweden
| | - Eskil Elmér
- Mitochondrial Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | | | - Stefan R. Hansson
- Obstetrics and Gynecology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| |
Collapse
|
22
|
Caspersen IH, Thomsen C, Haug LS, Knutsen HK, Brantsæter AL, Papadopoulou E, Erlund I, Lundh T, Alexander J, Meltzer HM. Patterns and dietary determinants of essential and toxic elements in blood measured in mid-pregnancy: The Norwegian Environmental Biobank. Sci Total Environ 2019; 671:299-308. [PMID: 30928759 DOI: 10.1016/j.scitotenv.2019.03.291] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/13/2019] [Accepted: 03/19/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Inadequate stores or intakes of essential minerals in pregnancy, or too high exposure to both toxic and essential elements, can have adverse effects on mother and child. The main aims of this study were to 1) describe the concentrations and patterns of essential and toxic elements measured in maternal whole blood during pregnancy; 2) identify dietary, lifestyle and sociodemographic determinants of element status; and 3) explore the impact of iron deficiency on blood element concentrations. METHODS This study is based on blood samples collected from 2982 women in gestational week 18 in The Norwegian Mother and Child Cohort study (MoBa) which were analyzed as part of the Norwegian Environmental Biobank. We derived blood element patterns by exploratory factor analysis, and associations between blood element patterns and diet were explored using sparse partial least squares (sPLS) regression. RESULTS Blood concentrations were determined for the essential elements (in the order of most abundant) Zn > Cu > Se > Mn > Mo > Co, and the toxic metals Pb > As > Hg > Cd > Tl. The concentrations were in ranges that were similar to or sometimes more favorable than in other pregnant and non-pregnant European women. We identified two blood element patterns; one including Zn, Se and Mn and another including Hg and As. For the Zn-Se-Mn pattern, use of multimineral supplements was the most important dietary determinant, while a high score in the Hg-As pattern was mainly determined by seafood consumption. Concentrations of Mn, Cd and Co were significantly higher in women with iron deficiency (plasma ferritin < 12 μg/L) than in women with plasma ferritin ≥ 12 μg/L. CONCLUSION Our study illustrates complex relationships and coexistence of essential and toxic elements. Their potential interplay adds to the challenges of studies investigating health effects related to either diet or toxicants.
Collapse
Affiliation(s)
- Ida Henriette Caspersen
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway.
| | - Cathrine Thomsen
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Line Småstuen Haug
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Helle K Knutsen
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Anne Lise Brantsæter
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Eleni Papadopoulou
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Iris Erlund
- Genomics and Biomarkers Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Thomas Lundh
- Division of Occupational and Environmental Medicine, Institution of Laboratory Medicine, Lund University, Lund, Sweden
| | - Jan Alexander
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Helle Margrete Meltzer
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| |
Collapse
|
23
|
Caini S, Bendinelli B, Masala G, Saieva C, Assedi M, Querci A, Lundh T, Kyrtopoulos SA, Palli D. Determinants of Erythrocyte Lead Levels in 454 Adults in Florence, Italy. Int J Environ Res Public Health 2019; 16:E425. [PMID: 30717230 PMCID: PMC6388176 DOI: 10.3390/ijerph16030425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/10/2019] [Accepted: 01/31/2019] [Indexed: 01/01/2023]
Abstract
Background: Lead exposure, even at low levels, is associated with adverse health effects in humans. We investigated the determinants of individual lead levels in a general population-based sample of adults from Florence, Italy. Methods: Erythrocyte lead levels were measured (using inductively coupled plasma-mass spectrometry) in 454 subjects enrolled in the Florence cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC) study in 1992⁻1998. Multiple linear regression models were used to study the association between demographics, education and working history, lifestyle, dietary habits, anthropometry, residential history, and (among women) menstrual and reproductive history and use of exogenous sex hormones, and erythrocyte lead levels. Results: Median lead levels were 86.1 μg/L (inter-quartile range 65.5⁻111.9 μg/L). Male gender, older age, cigarette smoking and number of pack-years, alcohol intake, and residing in urban areas were positively associated with higher erythrocyte lead levels, while performing professional/managerial or administrative work or being retired was inversely associated with lead levels. Among women, lead levels were higher for those already in menopause, and lower among those who ever used hormone replacement therapy. Conclusions: Avoidable risk factors contribute to the lead body burden among adults, which could therefore be lowered through targeted public health measures.
Collapse
Affiliation(s)
- Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50139 Florence, Italy.
| | - Benedetta Bendinelli
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50139 Florence, Italy.
| | - Giovanna Masala
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50139 Florence, Italy.
| | - Calogero Saieva
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50139 Florence, Italy.
| | - Melania Assedi
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50139 Florence, Italy.
| | - Andrea Querci
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50139 Florence, Italy.
| | - Thomas Lundh
- Division of Occupational and Environmental Medicine, Lund University Hospital, 22363 Lund, Sweden.
| | - Soterios A Kyrtopoulos
- National Hellenic Research Foundation, Institute of Biology, Pharmaceutical Chemistry and Biotechnology, 11635 Athens, Greece.
| | - Domenico Palli
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50139 Florence, Italy.
| |
Collapse
|
24
|
Caini S, Bendinelli B, Masala G, Saieva C, Lundh T, Kyrtopoulos SA, Palli D. Predictors of erythrocyte cadmium levels in 454 adults in Florence, Italy. Sci Total Environ 2018; 644:37-44. [PMID: 29980083 DOI: 10.1016/j.scitotenv.2018.06.347] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 06/27/2018] [Accepted: 06/27/2018] [Indexed: 05/24/2023]
Abstract
BACKGROUND Cadmium bioaccumulates in the body and causes several adverse health effects. Understanding the primary sources of exposure is critical in order to implement effective prevention measures. METHODS We included 454 adults enrolled in the Florence cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC) during 1992-98. At enrolment, information was collected on demographics, lifestyle and dietary habits using validated questionnaires; anthropometric measures were taken; and a blood sample was collected from each study participant. Information on the residential and occupational history prior to enrolment was reconstructed by phone interviews. Cadmium levels were measured in erythrocytes using inductively coupled plasma-mass spectrometry. We used multiple linear regression models to investigate the main determinants of cadmium levels. RESULTS Median erythrocyte cadmium levels were 0.66 μg/L (inter-quartile range 0.43-1.07 μg/L). Cadmium levels were lowest in never smokers (0.50 μg/L) and highest in current smokers (1.38 μg/L). Smoking status and the number of pack-years were the strongest predictors of cadmium levels in multivariable analysis, together with erythrocyte levels of lead, and biking to work, while an inverse association emerged with consumption of red meat and dairy products and physical activity levels. Cadmium levels were higher among women than men (0.66 vs. 0.58 μg/L), and, among the former, positively associated with late menopause, nulliparity, and use of hormones for menopause. The predictors included in the multivariable model explained >40% of the variability in erythrocyte cadmium levels. CONCLUSIONS Smoking was the most important determinant of erythrocyte cadmium levels, which were also affected by dietary habits, physical activity levels, biking, and (among women) hormone-related variables. Our results are important to inform public health actions aimed at reducing the impact of potentially modifiable sources of exposure to cadmium.
Collapse
Affiliation(s)
- Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy.
| | - Benedetta Bendinelli
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Giovanna Masala
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Calogero Saieva
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Thomas Lundh
- Division of Occupational and Environmental Medicine, Lund University Hospital, Lund, Sweden
| | - Soterios A Kyrtopoulos
- National Hellenic Research Foundation, Institute of Biology, Pharmaceutical Chemistry and Biotechnology, Athens, Greece
| | - Domenico Palli
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| |
Collapse
|
25
|
Gaudet MM, Deubler EL, Kelly RS, Ryan Diver W, Teras LR, Hodge JM, Levine KE, Haines LG, Lundh T, Lenner P, Palli D, Vineis P, Bergdahl IA, Gapstur SM, Kyrtopoulos SA. Blood levels of cadmium and lead in relation to breast cancer risk in three prospective cohorts. Int J Cancer 2018; 144:1010-1016. [PMID: 30117163 DOI: 10.1002/ijc.31805] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 07/10/2018] [Accepted: 07/26/2018] [Indexed: 01/05/2023]
Abstract
Cadmium and lead have been classified as carcinogens by the International Agency for Research on Cancer. However, their associations with breast cancer risk are unknown despite their persistence in the environment and ubiquitous human exposure. We examined associations of circulating levels of cadmium and lead with breast cancer risk in three case-control studies nested within the Cancer Prevention Study-II (CPS-II) LifeLink Cohort, European Prospective Investigation into Cancer and Nutrition - Italy (EPIC-Italy) and the Northern Sweden Health and Disease Study (NSHDS) cohorts. Metal levels were measured in stored erythrocytes from 1,435 cases and 1,433 controls using inductively coupled plasma-mass spectrometry. Summary relative risks (RR) and 95% confidence intervals (CI) were calculated using random-effects models with each study result weighted by the within- and between-study variances. I2 values were calculated to estimate proportion of between study variation. Using common cut-points, cadmium levels were not associated with breast cancer risk in the CPS-II cohort (continuous RR = 1.01, 95% CI 0.76-1.34), but were inversely associated with risk in the EPIC- Italy (continuous RR = 0.80, 95% CI 0.61-1.03) and NSHDS cohorts (continuous RR = 0.73, 95% CI 0.54-0.97). The inverse association was also evident in the meta-analysis (continuous RR = 0.84, 95% CI 0.69-1.01) with low between-study heterogeneity. Large differences in lead level distributions precluded a meta-analysis of their association with breast cancer risk; no associations were found in the three studies. Adult cadmium and lead levels were not associated with higher risk of breast cancer in our large meta-analysis.
Collapse
Affiliation(s)
- Mia M Gaudet
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, GA
| | - Emily L Deubler
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, GA
| | - Rachel S Kelly
- Channing Division of Network Medicine, Brigham and Women's Hospital Harvard Medical School, Boston, MA
| | - W Ryan Diver
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, GA
| | - Lauren R Teras
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, GA
| | - James M Hodge
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, GA
| | | | | | - Thomas Lundh
- Division of Occupational and Environmental MedicineLund University, Lund, Sweden
| | - Per Lenner
- Department of Radiation Science, Umeå University, Umeå, Sweden
| | - Domenico Palli
- Molecular and Nutritional Epidemiology Unit, ISPO, Cancer Prevention and Research Institute, Florence, Italy
| | - Paolo Vineis
- Grantham Institute, Imperial College, London, United Kingdom
| | - Ingvar A Bergdahl
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden.,Department of Biobank Research, Umeå University, Umeå, Sweden
| | - Susan M Gapstur
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, GA
| | - Soterios A Kyrtopoulos
- National Hellenic Research Foundation, Institute of Biology, Medicinal Chemistry and Biotechnology, Athens, Greece
| |
Collapse
|
26
|
Vermeulen R, Saberi Hosnijeh F, Bodinier B, Portengen L, Liquet B, Garrido-Manriquez J, Lokhorst H, Bergdahl IA, Kyrtopoulos SA, Johansson AS, Georgiadis P, Melin B, Palli D, Krogh V, Panico S, Sacerdote C, Tumino R, Vineis P, Castagné R, Chadeau-Hyam M, Botsivali M, Chatziioannou A, Valavanis I, Kleinjans JCS, de Kok TMCM, Keun HC, Athersuch TJ, Kelly R, Lenner P, Hallmans G, Stephanou EG, Myridakis A, Kogevinas M, Fazzo L, De Santis M, Comba P, Bendinelli B, Kiviranta H, Rantakokko P, Airaksinen R, Ruokojarvi P, Gilthorpe M, Fleming S, Fleming T, Tu YK, Lundh T, Chien KL, Chen WJ, Lee WC, Kate Hsiao C, Kuo PH, Hung H, Liao SF. Pre-diagnostic blood immune markers, incidence and progression of B-cell lymphoma and multiple myeloma: Univariate and functionally informed multivariate analyses. Int J Cancer 2018; 143:1335-1347. [PMID: 29667176 PMCID: PMC6100111 DOI: 10.1002/ijc.31536] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 03/15/2018] [Accepted: 03/19/2018] [Indexed: 12/13/2022]
Abstract
Recent prospective studies have shown that dysregulation of the immune system may precede the development of B‐cell lymphomas (BCL) in immunocompetent individuals. However, to date, the studies were restricted to a few immune markers, which were considered separately. Using a nested case–control study within two European prospective cohorts, we measured plasma levels of 28 immune markers in samples collected a median of 6 years before diagnosis (range 2.01–15.97) in 268 incident cases of BCL (including multiple myeloma [MM]) and matched controls. Linear mixed models and partial least square analyses were used to analyze the association between levels of immune marker and the incidence of BCL and its main histological subtypes and to investigate potential biomarkers predictive of the time to diagnosis. Linear mixed model analyses identified associations linking lower levels of fibroblast growth factor‐2 (FGF‐2 p = 7.2 × 10−4) and transforming growth factor alpha (TGF‐α, p = 6.5 × 10−5) and BCL incidence. Analyses stratified by histological subtypes identified inverse associations for MM subtype including FGF‐2 (p = 7.8 × 10−7), TGF‐α (p = 4.08 × 10−5), fractalkine (p = 1.12 × 10−3), monocyte chemotactic protein‐3 (p = 1.36 × 10−4), macrophage inflammatory protein 1‐alpha (p = 4.6 × 10−4) and vascular endothelial growth factor (p = 4.23 × 10−5). Our results also provided marginal support for already reported associations between chemokines and diffuse large BCL (DLBCL) and cytokines and chronic lymphocytic leukemia (CLL). Case‐only analyses showed that Granulocyte‐macrophage colony stimulating factor levels were consistently higher closer to diagnosis, which provides further evidence of its role in tumor progression. In conclusion, our study suggests a role of growth‐factors in the incidence of MM and of chemokine and cytokine regulation in DLBCL and CLL. What's new? B‐cell lymphomas (BCL) are frequent in immunocompromised individuals, but most BCL cases are thought to occur as a consequence of minor immune perturbations in otherwise immunocompetent individuals. Here the authors prospectively examined a panel of immune markers in the blood from 268 patients afflicted with BCL and paired controls. The data uncover a functional role for growth factors (i.e. FGF‐2, TGF‐alpha) in the incidence and progression of multiple myeloma, a BCL subtype, and underscore the importance of chemokine and cytokine regulation in diffuse large B‐cell lymphoma and chronic lymphocytic leukemia.
Collapse
Affiliation(s)
- Roel Vermeulen
- Division of Environmental Epidemiology, Utrecht University, Institute for Risk Assessment Sciences, Utrecht, The Netherlands.,MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - Fatemeh Saberi Hosnijeh
- Division of Environmental Epidemiology, Utrecht University, Institute for Risk Assessment Sciences, Utrecht, The Netherlands.,Immunology Department, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Barbara Bodinier
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - Lützen Portengen
- Division of Environmental Epidemiology, Utrecht University, Institute for Risk Assessment Sciences, Utrecht, The Netherlands
| | - Benoît Liquet
- Laboratoire de Mathématiques et de leurs Applications, Université de Pau et des Pays de l'Adour, UMR CNRS, Pau, France.,ARC Centre of Excellence for Mathematical and Statistical Frontiers, Queensland University of Technology (QUT), Brisbane, Australia
| | - Javiera Garrido-Manriquez
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - Henk Lokhorst
- Department of Hematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ingvar A Bergdahl
- Department of Public Health and Clinical Medicine, and Department of Biobank Research, Umeå University, Umeå, Sweden
| | - Soterios A Kyrtopoulos
- National Hellenic Research Foundation, Institute of Biology, Medicinal Chemistry and Biotechnology, Athens, Greece
| | | | - Panagiotis Georgiadis
- National Hellenic Research Foundation, Institute of Biology, Medicinal Chemistry and Biotechnology, Athens, Greece
| | - Beatrice Melin
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Domenico Palli
- The Institute for Cancer Research and Prevention, Florence, Italy
| | - Vittorio Krogh
- Fondazione IRCCS-Instituto Nazionale dei Tumori, Milan, Italy
| | - Salvatore Panico
- Department of Clinical Medicine and Surgery, University of Naples Frederico II, Naples, Italy
| | - Carlotta Sacerdote
- Piedmont Reference Centre for Epidemiology and Cancer Prevention (CPO Piemonte), Turin, Italy
| | - Rosario Tumino
- Cancer registry and Histopathology Unit, Azienda Ospedaliera 'Civile-M.P.Arezzo', Ragusa, Italy
| | - Paolo Vineis
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom.,HuGeF Foundation, Torino, Italy
| | - Raphaële Castagné
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom.,INSERM, UMR1027, Université Toulouse III-Paul Sabatier, Toulouse, France
| | - Marc Chadeau-Hyam
- Division of Environmental Epidemiology, Utrecht University, Institute for Risk Assessment Sciences, Utrecht, The Netherlands.,MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | | | - Maria Botsivali
- Institute of Biology, Medicinal Chemistry and Biotechnology, National Hellenic Research Foundation, Athens, Greece
| | - Aristotelis Chatziioannou
- Institute of Biology, Medicinal Chemistry and Biotechnology, National Hellenic Research Foundation, Athens, Greece
| | - Ioannis Valavanis
- Institute of Biology, Medicinal Chemistry and Biotechnology, National Hellenic Research Foundation, Athens, Greece
| | - Jos C S Kleinjans
- Department of Toxicogenomics, Maastricht University, Maastricht, The Netherlands
| | - Theo M C M de Kok
- Department of Toxicogenomics, Maastricht University, Maastricht, The Netherlands
| | - Hector C Keun
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, Institute of Reproductive and Developmental Biology (IRDB), Hammersmith Hospital, London, United Kingdom
| | - Toby J Athersuch
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom.,Division of Computational and Systems Medicine, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Rachel Kelly
- Immunology Department, Erasmus University Medical Center, Rotterdam, The Netherlands.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | - Per Lenner
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Goran Hallmans
- Nutrition Research, Department of Public Health and Clinical Medicine, and Department of Biobank Research, Umeå University, Umeå, Sweden
| | | | - Antonis Myridakis
- Environmental Chemical Processes Laboratory, University of Crete, Heraklion, Greece
| | - Manolis Kogevinas
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | | | | | - Yu-Kang Tu
- University of Leeds, Leeds, United Kingdom
| | | | | | - Wei J Chen
- National Taiwan University, Taipei, Taiwan
| | | | | | | | - Hung Hung
- National Taiwan University, Taipei, Taiwan
| | | |
Collapse
|
27
|
Huyben D, Sun L, Moccia R, Kiessling A, Dicksved J, Lundh T. Dietary live yeast and increased water temperature influence the gut microbiota of rainbow trout. J Appl Microbiol 2018; 124:1377-1392. [PMID: 29464844 DOI: 10.1111/jam.13738] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 01/29/2018] [Accepted: 02/12/2018] [Indexed: 12/28/2022]
Abstract
AIMS The objective was to determine the effects of dietary substitution of fishmeal (FM) with live yeast and increasing water temperature on the diversity and composition of gut microbiota in rainbow trout. METHODS AND RESULTS Fish were fed either FM or yeast (Saccharomyces cerevisiae) and reared in water temperatures of either 11°C (cold) or 18°C (warm) for 6 weeks. Luminal content and mucosa were collected from the distal gut and the load, diversity and species abundance of yeast and bacteria were analysed using agar plating, MALDI-TOF and rRNA gene amplicon sequencing. Yeast in the gut of fish fed FM were represented by S. cerevisiae, Rhodotorula spp. and Debaryomyces hansenii, while fish fed yeast contained 4-5 log higher CFU per g of yeast that were entirely represented by S. cerevisiae. For gut bacteria, sequencing of 16S rRNA gene amplicons using Illumina MiSeq showed lower bacterial diversity and abundance of lactic acid bacteria, especially Lactobacillus, in fish reared in warm rather than cold water. Fish fed yeast had similar bacterial diversity and lower abundance of Leuconostocaceae and Photobacterium compared with fish fed FM. CONCLUSIONS Feeding live yeast mainly increased yeast load in the gut, while increased water temperature significantly altered the gut microbiota of rainbow trout in terms of bacterial diversity and abundance. SIGNIFICANCE AND IMPACT OF THE STUDY Live yeast can replace 40% of FM without disrupting bacteria communities in the gut of rainbow trout, while increased water temperature due to seasonal fluctuations and/or climate change may result in a gut dysbiosis that may jeopardize the health of farmed fish.
Collapse
Affiliation(s)
- D Huyben
- Department of Animal Nutrition and Management, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - L Sun
- Department of Molecular Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - R Moccia
- Department of Animal Biosciences, Aquaculture Centre, University of Guelph, Guelph, ON, Canada
| | - A Kiessling
- Department of Animal Nutrition and Management, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - J Dicksved
- Department of Animal Nutrition and Management, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - T Lundh
- Department of Animal Nutrition and Management, Swedish University of Agricultural Sciences, Uppsala, Sweden
| |
Collapse
|
28
|
Rentschler G, Rodushkin I, Cerna M, Chen C, Harari F, Harari R, Horvat M, Hruba F, Kasparova L, Koppova K, Krskova A, Krsnik M, Laamech J, Li YF, Löfmark L, Lundh T, Lundström NG, Lyoussi B, Mazej D, Osredkar J, Pawlas K, Pawlas N, Prokopowicz A, Skerfving S, Snoj Tratnik J, Spevackova V, Spiric Z, Sundkvist A, Strömberg U, Vadla D, Wranova K, Zizi S, Bergdahl IA. Platinum, palladium, rhodium, molybdenum and strontium in blood of urban women in nine countries. Int J Hyg Environ Health 2018; 221:223-230. [DOI: 10.1016/j.ijheh.2017.10.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 10/26/2017] [Accepted: 10/26/2017] [Indexed: 10/18/2022]
|
29
|
Gustafsson Å, Krais AM, Gorzsás A, Lundh T, Gerde P. Isolation and characterization of a respirable particle fraction from residential house-dust. Environ Res 2018; 161:284-290. [PMID: 29172162 DOI: 10.1016/j.envres.2017.10.049] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 10/27/2017] [Accepted: 10/28/2017] [Indexed: 05/12/2023]
Abstract
Indoor air pollution has caused increasing concern in recent years. As we spend most of our lives indoors, it is crucial to understand the health effects caused by indoor air pollution. Household dust serve as good proxy for accessing indoor air pollution, especially smaller dust particles that can pass into the lungs are of interest. In this study we present an efficient method for the isolation of dust particles in the respirable size range. The respirable fraction was recovered from vacuum cleaner bags, separated by stepwise sieving, followed by characterization for size, morphology, surface area, organic content and elemental composition. The respirable fraction was obtained in a yield of 0.6% with a specific surface area of 2.5m2/g and a Mass Median Aerodynamic Diameter of 3.73 ± 0.15µm. Aluminum and zink were the dominating metals measured in the dust, whereas the major mineral components were found to be silicon dioxide and calcium carbonate. The fraction of organic matter in the dust was measured to be 69 ± 1%. The organic matrix contained bacterial and fungi and a presence of skin fragments. We present here an efficient and fast method for the isolation of dust particles in the respirable size range. That is of considerable value due to the need for large quantities of respirable particle fractions to conduct toxicological studies and risk assessment work.
Collapse
Affiliation(s)
- Åsa Gustafsson
- Swetox, Karolinska Institutet, Unit of Toxicology Sciences, Forskargatan 20, SE-151 36 Södertälje, Sweden; Department of Chemistry, Umeå University, Linnaeus väg 6, SE-901 87 Umeå, Sweden.
| | - Annette M Krais
- Swetox, Karolinska Institutet, Unit of Toxicology Sciences, Forskargatan 20, SE-151 36 Södertälje, Sweden; Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, SE-221 85 Lund, Sweden
| | - András Gorzsás
- Department of Chemistry, Umeå University, Linnaeus väg 6, SE-901 87 Umeå, Sweden
| | - Thomas Lundh
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, SE-221 85 Lund, Sweden
| | - Per Gerde
- Swetox, Karolinska Institutet, Unit of Toxicology Sciences, Forskargatan 20, SE-151 36 Södertälje, Sweden; Institute of Environmental Medicine (IMM), Karolinska Institutet, Box 287, SE-17177 Stockholm, Sweden
| |
Collapse
|
30
|
Vejrup K, Brandlistuen RE, Brantsæter AL, Knutsen HK, Caspersen IH, Alexander J, Lundh T, Meltzer HM, Magnus P, Haugen M. Prenatal mercury exposure, maternal seafood consumption and associations with child language at five years. Environ Int 2018; 110:71-79. [PMID: 29089166 DOI: 10.1016/j.envint.2017.10.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 10/17/2017] [Accepted: 10/17/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Methyl mercury (MeHg) is a well-known neurotoxin and evidence suggests that also low level exposure may affect prenatal neurodevelopment. Uncertainty exists as to whether the maternal MeHg burden in Norway might affect child neurodevelopment. OBJECTIVE To evaluate the association between prenatal mercury exposure, maternal seafood consumption and child language and communication skills at age five. METHODS The study sample comprised 38,581 mother-child pairs in the Norwegian Mother and Child Cohort Study. Maternal mercury blood concentration in gestational week 17 was analysed in a sub-sample of 2239 women. Prenatal mercury exposure from maternal diet was calculated from a validated FFQ answered in mid-pregnancy. Mothers reported children's language and communications skills at age five by a questionnaire including questions from the Ages and Stages Questionnaire (ASQ), the Speech and Language Assessment Scale (SLAS) and the Twenty Statements about Language-Related Difficulties (language 20). We performed linear regression analyses adjusting for maternal characteristics, nutritional status and socioeconomic factors. RESULTS Median maternal blood mercury concentration was 1.03μg/L, dietary mercury exposure was 0.15μg/kgbw/wk, and seafood intake was 217g/wk. Blood mercury concentrations were not associated with any language and communication scales. Increased dietary mercury exposure was significantly associated with improved SLAS scores when mothers had a seafood intake below 400g/wk in the adjusted analysis. Sibling matched analysis showed a small significant adverse association between those above the 90th percentile dietary mercury exposure and the SLAS scores. Maternal seafood intake during pregnancy was positively associated with the language and communication scales. CONCLUSION Low levels of prenatal mercury exposure were positively associated with language and communication skills at five years. However, the matched sibling analyses suggested an adverse association between mercury and child language skills in the highest exposure group. This indicates that prenatal low level mercury exposure still needs our attention.
Collapse
Affiliation(s)
- Kristine Vejrup
- Norwegian Institute of Public Health, Postbox 4404, Nydalen, NO 0403 Oslo, Norway.
| | | | - Anne Lise Brantsæter
- Norwegian Institute of Public Health, Postbox 4404, Nydalen, NO 0403 Oslo, Norway
| | | | | | - Jan Alexander
- Norwegian Institute of Public Health, Postbox 4404, Nydalen, NO 0403 Oslo, Norway
| | - Thomas Lundh
- Division of Occupational and Environmental Medicine, Lund University, SE, 221 85 Lund, Sweden
| | | | - Per Magnus
- Norwegian Institute of Public Health, Postbox 4404, Nydalen, NO 0403 Oslo, Norway
| | - Margaretha Haugen
- Norwegian Institute of Public Health, Postbox 4404, Nydalen, NO 0403 Oslo, Norway
| |
Collapse
|
31
|
Abstract
Many animals, including humans, have predictive capabilities and, presumably, base their behavioral decisions-at least partially-upon an anticipated state of their environment. We explore a minimal version of this idea in the context of particles that interact according to a pairwise potential. Anticipation enters the picture by calculating the interparticle forces from linear extrapolations of the particle positions some time τ in the future. Simulations show that for intermediate values of τ, compared to a transient time scale defined by the potential and the initial conditions, the particles form rotating clusters in which the particles are arranged in a hexagonal pattern. Analysis of the system shows that anticipation induces energy dissipation and we show that the kinetic energy asymptotically decays as 1/t. Furthermore, we show that the angular momentum is not necessarily conserved for τ>0, and that asymmetries in the initial condition therefore can cause rotational movement. These results suggest that anticipation could play an important role in collective behavior, since it may induce pattern formation and stabilizes the dynamics of the system.
Collapse
Affiliation(s)
- P Gerlee
- Mathematical Sciences, Chalmers University of Technology and University of Gothenburg, 412 96 Göteborg, Sweden
| | - K Tunstrøm
- Department of Physics, Chalmers University of Technology, 412 96 Göteborg, Sweden
| | - T Lundh
- Mathematical Sciences, Chalmers University of Technology and University of Gothenburg, 412 96 Göteborg, Sweden
| | - B Wennberg
- Mathematical Sciences, Chalmers University of Technology and University of Gothenburg, 412 96 Göteborg, Sweden
| |
Collapse
|
32
|
Wennberg M, Lundh T, Sommar JN, Bergdahl IA. Time trends and exposure determinants of lead and cadmium in the adult population of northern Sweden 1990-2014. Environ Res 2017; 159:111-117. [PMID: 28787621 DOI: 10.1016/j.envres.2017.07.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 07/12/2017] [Accepted: 07/13/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION This study follows cadmium and lead concentrations in blood in the adult population in northern Sweden over 24 years. MATERIAL AND METHODS Concentrations of lead and cadmium were measured in single whole blood samples (B-Pb and B-Cd) from 619 men and 926 women participating in the Northern Sweden WHO MONICA Study on one occasion 1990-2014. Associations with smoking and dietary factors were investigated. Consumption of moose meat was asked for in 2014. RESULTS In the adult population in northern Sweden, the median B-Pb in 2014 was 11.0µg/L in young (25-35 years) men and 9.69µg/L in young women. In an older age-group (50-60 years), the median B-Pb was 15.1µg/L in men and 13.1µg/L in women. B-Pb decreased from 1990 to 2009, after which time no further decrease was observed. B-Pb was higher in smokers than in non-smokers. In never-smokers, positive associations were found between B-Pb and consumption of wine and brewed coffee (women only) in 2004-2014. Higher B-Pb with consumption of moose meat was demonstrated in men, but not in women. B-Cd was essentially stable over the whole period, but an increase in B-Cd, of 3% per year, was detected in never-smoking women between 2009 and 2014. In 2014, median B-Cd in never-smokers in the four groups was; 0.11µg/L in younger men, 0.15µg/L in younger women, 0.14µg/L in older men, and 0.21µg/L in older women. B-Cd was higher in smokers than in non-smokers. The only positive association between B-Cd and food items in 2004-2014 was with consumption of brewed coffee (men only). CONCLUSIONS The lack of a decrease in B-Cd from 1990 to 2014 and the absence of a further decrease in B-Pb after 2009 are unsatisfactory considering the health risks these metals pose in the general population at current concentrations.
Collapse
Affiliation(s)
- Maria Wennberg
- Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, Sweden.
| | - Thomas Lundh
- Department of Occupational and Environmental Medicine, Lund University, Lund, Sweden.
| | - Johan Nilsson Sommar
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden.
| | - Ingvar A Bergdahl
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden; Department of Biobank Research, Umeå University, Umeå, Sweden.
| |
Collapse
|
33
|
Pawlas N, Olewińska E, Markiewicz-Górka I, Kozłowska A, Januszewska L, Lundh T, Januszewska E, Pawlas K. Oxidative damage of DNA in subjects occupationally exposed to lead. ADV CLIN EXP MED 2017; 26:939-945. [PMID: 29068594 DOI: 10.17219/acem/64682] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Exposure to lead (Pb) in environmental and occupational settings continues to be a serious public health problem and may pose an elevated risk of genetic damage. OBJECTIVES The aim of this study was to assess the level of oxidative stress and DNA damage in subjects occupationally exposed to lead. MATERIAL AND METHODS We studied a population of 78 male workers exposed to lead in a lead and zinc smelter and battery recycling plant and 38 men from a control group. Blood lead levels were detected by graphite furnace atomic absorption spectrophotometry and plasma lead levels by inductively coupled plasma-mass spectrometry. The following assays were performed to assess the DNA damage and oxidative stress: comet assay, determination of 8-hydroxy-2'-deoxyguanosine (8-OHdG), lipid peroxidation and total antioxidant status (TAS). RESULTS The mean concentration of lead in the blood of the exposed group was 392 ± 103 μg/L and was significantly higher than in the control group (30.3 ± 29.4 μg/L, p < 0.0001). Oxidative DNA damages measured by comet assay showed no significant differences between populations. The concentration of 8-OHdG was about twice as high as in the control group. We found a significant positive correlation between the level of biomarkers of lead exposure [lead in blood, lead in plasma, zinc protoporphyrin (ZPP)] and urine concentration of 8-OHdG. The level of oxidative damage of DNA was positively correlated with the level of lipid peroxidation (TBARS) and negatively with total anti-oxidative status (TAS). CONCLUSIONS Our study suggests that occupational exposure causes an increase in oxidative damage to DNA, even in subjects with relatively short length of service (average length of about 10 years). 8-OHdG concentration in the urine proved to be a sensitive and non-invasive marker of lead induced genotoxic damage.
Collapse
Affiliation(s)
- Natalia Pawlas
- Institute of Occupational Medicine and Enviromental Health, Sosnowiec, Poland
- Department of Pharmacology, Medical University of Silesia, School of Medicine with the Division of Dentistry, Zabrze, Poland
| | - Elżbieta Olewińska
- Institute of Occupational Medicine and Enviromental Health, Sosnowiec, Poland
| | | | - Agnieszka Kozłowska
- Institute of Occupational Medicine and Enviromental Health, Sosnowiec, Poland
| | | | - Thomas Lundh
- Division of Occupational and Environmental Medicine, University Hospital, Lund, Sweden
| | - Ewa Januszewska
- Cantonal Hospital Bruderholz, University of Basle, Switzerland
| | - Krystyna Pawlas
- Institute of Occupational Medicine and Enviromental Health, Sosnowiec, Poland
- Department of Hygiene, Wroclaw Medical University, Poland
| |
Collapse
|
34
|
Akerstrom M, Barregard L, Lundh T, Sallsten G. Relationship between mercury in kidney, blood, and urine in environmentally exposed individuals, and implications for biomonitoring. Toxicol Appl Pharmacol 2017; 320:17-25. [DOI: 10.1016/j.taap.2017.02.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 01/28/2017] [Accepted: 02/07/2017] [Indexed: 11/25/2022]
|
35
|
Wallin M, Barregard L, Sallsten G, Lundh T, Karlsson MK, Lorentzon M, Ohlsson C, Mellström D. Response to "Low-Level Cadmium Exposure and Bone Health". J Bone Miner Res 2017; 32:420-421. [PMID: 27925285 DOI: 10.1002/jbmr.3050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 11/30/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Maria Wallin
- Department of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars Barregard
- Department of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gerd Sallsten
- Department of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Thomas Lundh
- Department of Occupational and Environmental Medicine, Skåne University Hospital, Lund, Sweden
| | - Magnus K Karlsson
- Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Mattias Lorentzon
- Centre for Bone and Arthritis Research (CBAR), Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Geriatric Medicine, Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Claes Ohlsson
- Centre for Bone and Arthritis Research (CBAR), Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Dan Mellström
- Centre for Bone and Arthritis Research (CBAR), Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Geriatric Medicine, Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
36
|
Lundh T, Axmon A, Skerfving S, Broberg K. Cadmium and mercury exposure over time in Swedish children. Environ Res 2016; 150:600-605. [PMID: 26922260 DOI: 10.1016/j.envres.2016.02.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 02/11/2016] [Accepted: 02/12/2016] [Indexed: 06/05/2023]
Abstract
PURPOSE Knowledge about changes in exposure to toxic metals over time remains very sparse, in particular for children, the most vulnerable group. Here, we assessed whether a reduction in environmental pollution with cadmium (Cd) and mercury (Hg) caused a change in exposure over time. In total, 1257 children (age 4-9) in two towns in Sweden were sampled once in 1986-2013. Blood concentrations of Cd (b-Cd; n=1120) and Hg (b-Hg; n=560) were determined. RESULTS The median b-Cd was 0.10 (geometric mean 0.10; range 0.010-0.61) μg/L and b-Hg was 0.91 (geometric mean 0.83; range 0.021-8.2) μg/L. Children living close to a smelter had higher b-Cd and b-Hg than those in urban and rural areas. There was no sex difference in b-Cd or b-Hg, and b-Cd and b-Hg showed no significant accumulation by age. b-Cd decreased only slightly (0.7% per year, p<0.001) over the study period. In contrast, b-Hg did show a clear decrease over the study period (3% per year, p<0.001). CONCLUSIONS The exposure to Cd was very low but still might increase the risk of disease later in life. Moreover, b-Cd only showed a minor decrease, indicating that Cd pollution should be further restricted. b-Hg was relatively low and decreasing, probably because of reduced use of dental amalgam and lower Hg intake from fish. The b-Cd and b-Hg levels decreased much less than the levels of lead in the blood as previously found in the same children.
Collapse
Affiliation(s)
- T Lundh
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, SE-22185 Lund, Sweden.
| | - A Axmon
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, SE-22185 Lund, Sweden.
| | - S Skerfving
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, SE-22185 Lund, Sweden.
| | - K Broberg
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, SE-22185 Lund, Sweden; Unit of Metals and Health, Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, SE-171 77 Stockholm, Sweden.
| |
Collapse
|
37
|
van Wendel de Joode B, Barbeau B, Bouchard MF, Mora AM, Skytt Å, Córdoba L, Quesada R, Lundh T, Lindh CH, Mergler D. Manganese concentrations in drinking water from villages near banana plantations with aerial mancozeb spraying in Costa Rica: Results from the Infants' Environmental Health Study (ISA). Environ Pollut 2016; 215:247-257. [PMID: 27208757 DOI: 10.1016/j.envpol.2016.04.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 04/04/2016] [Accepted: 04/04/2016] [Indexed: 05/27/2023]
Abstract
Elevated manganese (Mn) in drinking water has been reported worldwide. While, naturally occurring Mn in groundwater is generally the major source, anthropogenic contamination by Mn-containing fungicides such as mancozeb may also occur. The main objective of this study was to examine factors associated with Mn and ethylenethiourea (ETU), a degradation product of mancozeb, in drinking water samples from villages situated near banana plantations with aerial spraying of mancozeb. Drinking water samples (n = 126) were obtained from 124 homes of women participating in the Infants' Environmental Health Study (ISA, for its acronym in Spanish), living nearby large-scale banana plantations. Concentrations of Mn, iron (Fe), arsenic (As), lead (Pb), cadmium (Cd) and ethylenethiourea (ETU), a degradation product of mancozeb, were measured in water samples. Only six percent of samples had detectable ETU concentrations (limit of detection (LOD) = 0.15 μg/L), whereas 94% of the samples had detectable Mn (LOD = 0.05 μg/L). Mn concentrations were higher than 100 and 500 μg/L in 22% and 7% of the samples, respectively. Mn was highest in samples from private and banana farm wells. Distance from a banana plantation was inversely associated with Mn concentrations, with a 61.5% decrease (95% CI: -97.0, -26.0) in Mn concentrations for each km increase in distance. Mn concentrations in water transported with trucks from one village to another were almost 1000 times higher than Mn in water obtained from taps in houses supplied by the same well but not transported, indicating environmental Mn contamination. Elevated Mn in drinking water may be partly explained by aerial spraying of mancozeb; however, naturally occurring Mn in groundwater, and intensive agriculture may also contribute. Drinking water risk assessment for mancozeb should consider Mn as a health hazard. The findings of this study evidence the need for health-based World Health Organization (WHO) guidelines on Mn in drinking water.
Collapse
Affiliation(s)
- Berna van Wendel de Joode
- Infants' Environmental Health Program (ISA), Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional, P.O. Box 86-3000, Heredia, Costa Rica.
| | - Benoit Barbeau
- Ecole Polytechnique de Montréal, NSERC-Industrial Chair in Drinking Water, Department of Civil, Mining and Geological Engineering, Montréal, Quebec, Canada
| | - Maryse F Bouchard
- Department of Environmental and Occupational Health, University of Montreal, CHUSJ Research Center, Canada
| | - Ana María Mora
- Infants' Environmental Health Program (ISA), Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional, P.O. Box 86-3000, Heredia, Costa Rica
| | - Åsa Skytt
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Leonel Córdoba
- Infants' Environmental Health Program (ISA), Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional, P.O. Box 86-3000, Heredia, Costa Rica
| | - Rosario Quesada
- Infants' Environmental Health Program (ISA), Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional, P.O. Box 86-3000, Heredia, Costa Rica
| | - Thomas Lundh
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Christian H Lindh
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Donna Mergler
- Centre de Recherche Interdisciplinaire sur la Biologie, la Santé, la Société et l' Environnement (CINBIOSE), Université du Québec à Montréal, Pavillon des Sciences, 141, Avenue du Président Kennedy, H2× 1Y4, Montréal, Québec, Canada
| |
Collapse
|
38
|
Wallin M, Barregard L, Sallsten G, Lundh T, Karlsson MK, Lorentzon M, Ohlsson C, Mellström D. Low-Level Cadmium Exposure Is Associated With Decreased Bone Mineral Density and Increased Risk of Incident Fractures in Elderly Men: The MrOS Sweden Study. J Bone Miner Res 2016; 31:732-41. [PMID: 26572678 PMCID: PMC4832374 DOI: 10.1002/jbmr.2743] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 11/11/2015] [Accepted: 11/11/2015] [Indexed: 11/24/2022]
Abstract
One risk factor for osteoporosis that has attracted increasing attention in recent years is exposure to cadmium. The aim of this study was to examine the associations between low-level cadmium exposure, from diet and smoking, and bone mineral density (BMD) and incident fractures in elderly men. The study population consisted of 936 men from the Swedish cohort of the Osteoporotic Fractures in Men (MrOS) study, aged 70 to 81 years at inclusion (years 2002 to 2004), with reliable data on cadmium in urine (U-Cd) analyzed using inductively coupled plasma mass spectrometry in baseline samples. The participants also answered a questionnaire on lifestyle factors and medical history. BMD was measured at baseline using dual-energy X-ray absorptiometry (DXA) in the total body, hip, and lumbar spine. During the follow-up period (until 2013), all new fractures were registered by date and type. Associations between BMD and U-Cd were assessed using multiple linear regression, and associations between incident fractures and baseline U-Cd were analyzed using Cox regression. In both cases, a number of potential confounders and other risk factors (eg, age, smoking, body mass index [BMI], and physical activity) were included in the models. We found significant negative associations between U-Cd and BMD, with lower BMD (4% to 8%) for all sites in the fourth quartile of U-Cd, using the first quartile as the reference. In addition, we found positive associations between U-Cd and incident fractures, especially nonvertebral osteoporosis fractures in the fourth quartile of U-Cd, with hazard ratios of 1.8 to 3.3 in the various models. U-Cd as a continuous variable was significantly associated with nonvertebral osteoporosis fractures (adjusted hazard ratio 1.3 to 1.4 per μg Cd/g creatinine), also in never-smokers, but not with the other fracture groups (all fractures, hip fractures, vertebral fractures, and other fractures). Our results indicate that even relatively low cadmium exposure through diet and smoking increases the risk of low BMD and osteoporosis-related fractures in elderly men.
Collapse
Affiliation(s)
- Maria Wallin
- Department of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars Barregard
- Department of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gerd Sallsten
- Department of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Thomas Lundh
- Department of Occupational and Environmental Medicine, Skåne University Hospital, Lund, Sweden
| | - Magnus K Karlsson
- Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Mattias Lorentzon
- Centre for Bone and Arthritis Research (CBAR), Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Geriatric Medicine, Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Claes Ohlsson
- Centre for Bone and Arthritis Research (CBAR), Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Dan Mellström
- Centre for Bone and Arthritis Research (CBAR), Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Geriatric Medicine, Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
39
|
Skerfving S, Löfmark L, Lundh T, Mikoczy Z, Strömberg U. Late effects of low blood lead concentrations in children on school performance and cognitive functions. Neurotoxicology 2015; 49:114-20. [DOI: 10.1016/j.neuro.2015.05.009] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 05/22/2015] [Accepted: 05/23/2015] [Indexed: 12/01/2022]
|
40
|
Bergström G, Fagerberg B, Sallsten G, Lundh T, Barregard L. Is cadmium exposure associated with the burden, vulnerability and rupture of human atherosclerotic plaques? PLoS One 2015; 10:e0121240. [PMID: 25816093 PMCID: PMC4376860 DOI: 10.1371/journal.pone.0121240] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 01/29/2015] [Indexed: 11/23/2022] Open
Abstract
The general population is exposed to cadmium from food and smoking. Cadmium is a widely spread toxic pollutant that seems to be associated with cardiovascular diseases, although little is known if it contributes to the occurrence of atherosclerotic plaques and the process whereby plaques become vulnerable and are prone to rupture. We tested the hypotheses that cadmium exposure is associated not only with an increased subclinical burden of atherosclerotic plaques in different vascular territories and early signs of plaque vulnerability, but also with cadmium content and plaque-rupture in the clinical phase of the disease. Ultrasound technique was used to measure plaque prevalence and echogenicity in the carotid and femoral arteries in a population sample of women (n = 599) in whom blood cadmium was measured. In addition cadmium was measured in snap-frozen endarterectomies and whole blood obtained from patients who were referred to surgery because of symptomatic carotid plaques (n = 37). Sixteen endarterectomies were divided into three parts corresponding to different flow conditions and plaque vulnerability. In the population sample blood cadmium was associated with the number of vascular territories with plaques (p = 0.003 after adjustment for potential confounders). The cadmium concentrations in symptomatic plaques were 50-fold higher in plaque tissue than in blood. Cadmium levels in blood and plaque correlated, also after adjustment for smoking and other cardiovascular risk factors (p<0.001). Compared with the other parts of the plaque, the cadmium content was double as high in the part where plaque rupture usually occurs. In conclusion, the results show that cadmium exposure is associated with the burden of subclinical atherosclerosis in middle-aged women with different degrees of glucose tolerance, and that the content of cadmium in symptomatic plaques in patients is related to that in blood, but much higher, and preferentially located in the part of plaque where rupture often occurs.
Collapse
Affiliation(s)
- Göran Bergström
- Wallenberg Laboratory, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska University Hospital and University of Gothenburg, Gothenburg, Sweden
| | - Björn Fagerberg
- Wallenberg Laboratory, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska University Hospital and University of Gothenburg, Gothenburg, Sweden
- * E-mail:
| | - Gerd Sallsten
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, Gothenburg, Sweden
| | - Thomas Lundh
- Department of Occupational and Environmental Medicine, Lund University Hospital, Lund, Sweden
| | - Lars Barregard
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
41
|
Andreucci A, Mocevic E, Jönsson BAG, Giwercman A, Giwercman YL, Toft G, Lundh T, Bizzaro D, Specht IO, Bonde JP. Cadmium may impair prostate function as measured by prostate specific antigen in semen: A cross-sectional study among European and Inuit men. Reprod Toxicol 2015; 53:33-8. [PMID: 25660730 DOI: 10.1016/j.reprotox.2015.01.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 12/25/2014] [Accepted: 01/26/2015] [Indexed: 11/29/2022]
Abstract
We investigated the association between cadmium in blood and the concentration of the prostate specific antigen (PSA) in semen, including the modifying effects of zinc or the CAG polymorphism in the androgen receptor (AR). Blood and semen samples were collected from 504 partners of pregnant women in Greenland, Poland and Ukraine. We found an inverse trend between cadmium and PSA (log(β) = -0.121, 95% confidence interval (CI): -0.213; -0.029, P = 0.0103) in Greenlandic men. Similar results were observed in men with a high number of CAG repeats (CAG 24) (log(β) = -0.231, 95% CI: -0.363; -0.098, P = 0.0009). Inverse trends between cadmium and PSA were found when semen zinc concentrations were below the median value for men from Ukraine and Greenland. These outcomes suggest that cadmium may impair prostate function, as measured by PSA in semen, while high zinc levels and a low number of CAG repeats protects against this action.
Collapse
Affiliation(s)
- Alessandro Andreucci
- Dipartimento di Scienze della Vita e dell'Ambiente, Università Politecnica delle Marche, Via Brecce Bianche, 60131 Ancona, Italy.
| | - Emina Mocevic
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital, 2400 København NV, Denmark
| | - Bo A G Jönsson
- Department of Laboratory Medicine, Lund University Hospital, SE-221 85 Lund, Sweden
| | - Aleksander Giwercman
- Reproductive Medicine Centre, Malmö University Hospital, SE 205 02 Malmö, Sweden
| | | | - Gunnar Toft
- Department of Occupational Medicine, Aarhus University, Aarhus C, 8000 Aarhus, Denmark
| | - Thomas Lundh
- Department of Laboratory Medicine, Lund University Hospital, SE-221 85 Lund, Sweden
| | - Davide Bizzaro
- Dipartimento di Scienze della Vita e dell'Ambiente, Università Politecnica delle Marche, Via Brecce Bianche, 60131 Ancona, Italy
| | - Ina Olmer Specht
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital, 2400 København NV, Denmark
| | - Jens Peter Bonde
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital, 2400 København NV, Denmark
| |
Collapse
|
42
|
Ode A, Rylander L, Gustafsson P, Lundh T, Källén K, Olofsson P, Ivarsson SA, Rignell-Hydbom A. Manganese and selenium concentrations in umbilical cord serum and attention deficit hyperactivity disorder in childhood. Environ Res 2015; 137:373-381. [PMID: 25601741 DOI: 10.1016/j.envres.2015.01.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 01/02/2015] [Accepted: 01/03/2015] [Indexed: 06/04/2023]
Abstract
Existing evidence on the effects of manganese and selenium during fetal life on neurodevelopmental disorders is inadequate. This study aims to investigate the hypothesized relationship between fetal exposure to manganese and selenium and attention deficit hyperactivity disorder (ADHD) diagnosis in childhood. Children born between 1978 and 2000 with ADHD (n=166) were identified at the Department of Child and Adolescent Psychiatry in Malmö, Sweden. Controls from the same region (n=166) were selected from the Medical Birth Register and were matched for year of birth and maternal country of birth. Manganese and selenium were measured in umbilical cord serum. The median cord serum concentrations of manganese were 4.3μg/L in the cases and 4.1μg/L in the controls. The corresponding concentrations of selenium were 47 and 48μg/L. When the exposures were analyzed as continuous variables no associations between cord manganese or selenium concentration and ADHD were observed. However, children with selenium concentrations above the 90th percentile had 2.5 times higher odds (95% confidence interval 1.3-5.1) of having ADHD compared to those with concentrations between the 10th and 90th percentiles. There was no significant interaction between manganese and selenium exposure (p=0.08). This study showed no association between manganese concentrations in umbilical cord serum and ADHD. The association between ADHD diagnoses in children with relatively high cord selenium was unexpected and should be interpreted with caution.
Collapse
Affiliation(s)
- Amanda Ode
- Institute of Laboratory Medicine, Division of Occupational and Environmental Medicine, Lund University, SE-22185 Lund, Sweden.
| | - Lars Rylander
- Institute of Laboratory Medicine, Division of Occupational and Environmental Medicine, Lund University, SE-22185 Lund, Sweden
| | - Peik Gustafsson
- Institute of Clinical Sciences, Department of Child and Adolescent Psychiatry, Lund University, Lund, Sweden
| | - Thomas Lundh
- Institute of Laboratory Medicine, Division of Occupational and Environmental Medicine, Lund University, SE-22185 Lund, Sweden
| | - Karin Källén
- Institute of Laboratory Medicine, Division of Occupational and Environmental Medicine, Lund University, SE-22185 Lund, Sweden
| | - Per Olofsson
- Department of Obstetrics and Gynecology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Sten A Ivarsson
- Pediatric Endocrinology Unit, Clinical Research Center, Lund University, Malmö, Sweden
| | - Anna Rignell-Hydbom
- Institute of Laboratory Medicine, Division of Occupational and Environmental Medicine, Lund University, SE-22185 Lund, Sweden
| |
Collapse
|
43
|
Wallin M, Sallsten G, Lundh T, Barregard L. Low-level cadmium exposure and effects on kidney function. Occup Environ Med 2014; 71:848-54. [PMID: 25286916 PMCID: PMC4251161 DOI: 10.1136/oemed-2014-102279] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 09/09/2014] [Accepted: 09/17/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The nephrotoxicity of cadmium at low levels of exposure, measured by urinary cadmium, has recently been questioned since co-excretion of cadmium and proteins may have causes other than cadmium toxicity. The aim of this study was to explore the relation between kidney function and low or moderate cadmium levels, measured directly in kidney biopsies. METHODS We analysed cadmium in kidney biopsies (K-Cd), blood (B-Cd) and urine (U-Cd) from 109 living kidney donors in a cross-sectional study. We measured glomerular filtration rate (GFR), cystatin C in serum, albumin, β-2-microglobulin (B2M), retinol-binding protein (RBP), α-1-microglobulin (A1M), N-acetyl-β-d-glucosaminidase and kidney injury molecule 1 (KIM-1) in 24 h and overnight urine. RESULTS We found significant positive associations between A1M excretion and K-Cd in multiple regression models including age, sex, weight, smoking and urinary flow rate. This association was also present in never-smokers. A1M was also positively associated with B-Cd and U-Cd. GFR and the other biomarkers of kidney function were not associated with K-Cd. GFR estimated from serum cystatin C showed a very poor correlation with measured GFR. KIM-1, RBP and possibly albumin were positively associated with U-Cd, but only in overnight urine. No associations were found with B2M. CONCLUSIONS Our results suggest that A1M in urine is a sensitive biomarker for effects of low-level cadmium exposure. A few associations between other renal biomarkers and U-Cd, but not K-Cd, were probably caused by physiological co-excretion or chance.
Collapse
Affiliation(s)
- Maria Wallin
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital and Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gerd Sallsten
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital and Academy, University of Gothenburg, Gothenburg, Sweden
| | - Thomas Lundh
- Department of Occupational and Environmental Medicine, Lund University Hospital, Lund, Sweden
| | - Lars Barregard
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital and Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
44
|
Ali I, Engström A, Vahter M, Skerfving S, Lundh T, Lidfeldt J, Samsioe G, Halldin K, Åkesson A. Associations between cadmium exposure and circulating levels of sex hormones in postmenopausal women. Environ Res 2014; 134:265-269. [PMID: 25173093 DOI: 10.1016/j.envres.2014.08.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 08/06/2014] [Accepted: 08/09/2014] [Indexed: 06/03/2023]
Abstract
Recent epidemiological as well as in vivo and in vitro studies collectively suggest that the metalloestrogen cadmium (Cd) could be a potential risk factor for hormone-related cancers in particularly breast cancer. Assessment of the association between Cd exposure and levels of endogenous sex hormones is of pivotal importance, as increased levels of such have been associated with a higher risk of breast cancer in postmenopausal women. The present study investigated the perceived relationship (multivariable-adjusted linear regression analyses) between Cd exposure [blood Cd (B-Cd) and urinary Cd (U-Cd)], and serum levels of androstenedione, testosterone, estradiol, and sex-hormone binding globulin (SHBG), in 438 postmenopausal Swedish women without hormone replacement therapy (HRT). A significant positive association between B-Cd (median 3.4 nmol/L) and serum testosterone levels, as well as a significant inverse association between B-Cd and serum estradiol levels and with the estradiol/testosterone ratio were encountered. However, U-Cd (median 0.69 nmol/mmol creatinine) was inversely associated with serum estradiol levels only. Our data may suggest that Cd interferes with the levels of testosterone and estradiol in postmenopausal women, which might have implications for breast cancer risk.
Collapse
Affiliation(s)
- Imran Ali
- Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Annette Engström
- Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Marie Vahter
- Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Staffan Skerfving
- Division of Occupational and Environmental Medicine, University Hospital, Lund, Sweden
| | - Thomas Lundh
- Division of Occupational and Environmental Medicine, University Hospital, Lund, Sweden
| | - Jonas Lidfeldt
- Department of Community Health, Malmö University Hospital, Malmö, Sweden
| | - Göran Samsioe
- Department of Gynecology and Obstetrics, University Hospital, Lund, Sweden
| | - Krister Halldin
- Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Agneta Åkesson
- Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden.
| |
Collapse
|
45
|
Blanco-Penedo I, Lundh T, Holtenius K, Fall N, Emanuelson U. The status of essential elements and associations with milk yield and the occurrence of mastitis in organic and conventional dairy herds. Livest Sci 2014. [DOI: 10.1016/j.livsci.2014.07.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
46
|
Mora AM, van Wendel
de Joode B, Mergler D, Córdoba L, Cano C, Quesada R, Smith DR, Menezes-Filho JA, Lundh T, Lindh C, Bradman A, Eskenazi B. Blood and hair manganese concentrations in pregnant women from the infants' environmental health study (ISA) in Costa Rica. Environ Sci Technol 2014; 48:3467-76. [PMID: 24601641 PMCID: PMC3983325 DOI: 10.1021/es404279r] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 12/26/2013] [Accepted: 02/21/2014] [Indexed: 05/20/2023]
Abstract
Manganese (Mn), an essential nutrient, is a neurotoxicant at high concentrations. We measured Mn concentrations in repeated blood and hair samples collected from 449 pregnant women living near banana plantations with extensive aerial spraying of Mn-containing fungicide mancozeb in Costa Rica, and examined environmental and lifestyle factors associated with these biomarkers. Mean blood Mn and geometric mean hair Mn concentrations were 24.4 μg/L (8.9-56.3) and 1.8 μg/g (0.05-53.3), respectively. Blood Mn concentrations were positively associated with gestational age at sampling (β = 0.2; 95% CI: 0.1 to 0.2), number of household members (β = 0.4; 95% CI: 0.1 to 0.6), and living in a house made of permeable and difficult-to-clean materials (β = 2.6; 95% CI: 1.3 to 4.0); and inversely related to smoking (β = -3.1; 95% CI: -5.8 to -0.3). Hair Mn concentrations were inversely associated with gestational age at sampling (% change = 0.8; 95% CI: -1.6 to 0.0); and positively associated with living within 50 m of a plantation (% change = 42.1; 95% CI: 14.2 to 76.9) and Mn concentrations in drinking water (% change = 17.5; 95% CI: 12.2 to 22.8). Our findings suggest that pregnant women living near banana plantations aerially sprayed with mancozeb may be environmentally exposed to Mn.
Collapse
Affiliation(s)
- Ana M. Mora
- Central
American Institute for Studies on Toxic Substances (IRET), Universidad Nacional,
P.O. Box 86-3000 Heredia, Costa Rica
- Center
for Environmental Research and Children’s Health (CERCH), School of Public Health, University of California,
Berkeley, 1995 University
Ave, Suite 265, Berkeley, California 94704, United States
- Phone/fax: +506 2263-6375; e-mail:
| | - Berna van Wendel
de Joode
- Central
American Institute for Studies on Toxic Substances (IRET), Universidad Nacional,
P.O. Box 86-3000 Heredia, Costa Rica
| | - Donna Mergler
- Centre
de Recherche Interdisciplinaire sur la Biologie, la Santé,
la Société et l′Environnement (CINBIOSE), Université du Québec à Montréal, Pavillon des sciences, 141, Avenue
du Président Kennedy, H2X 1Y4 Montréal, Québec, Canada
| | - Leonel Córdoba
- Central
American Institute for Studies on Toxic Substances (IRET), Universidad Nacional,
P.O. Box 86-3000 Heredia, Costa Rica
| | - Camilo Cano
- Central
American Institute for Studies on Toxic Substances (IRET), Universidad Nacional,
P.O. Box 86-3000 Heredia, Costa Rica
| | - Rosario Quesada
- Central
American Institute for Studies on Toxic Substances (IRET), Universidad Nacional,
P.O. Box 86-3000 Heredia, Costa Rica
| | - Donald R. Smith
- Microbiology
and Environmental Toxicology, University
of California, Santa Cruz, 1156 High Street, Santa Cruz, California 95064, United States
| | - José A. Menezes-Filho
- Laboratory
of Toxicology, College of Pharmacy, Federal
University of Bahia, Av. Barão de Jeremoabo s/n Campus Universitário de
Ondina, 40170-115 Salvador, Bahia, Brazil
| | - Thomas Lundh
- Division
of Occupational and Environmental Medicine, Institute of Laboratory
Medicine, Lund University, SE-221 85 Lund, Sweden
| | - Christian
H. Lindh
- Division
of Occupational and Environmental Medicine, Institute of Laboratory
Medicine, Lund University, SE-221 85 Lund, Sweden
| | - Asa Bradman
- Center
for Environmental Research and Children’s Health (CERCH), School of Public Health, University of California,
Berkeley, 1995 University
Ave, Suite 265, Berkeley, California 94704, United States
| | - Brenda Eskenazi
- Center
for Environmental Research and Children’s Health (CERCH), School of Public Health, University of California,
Berkeley, 1995 University
Ave, Suite 265, Berkeley, California 94704, United States
| |
Collapse
|
47
|
Akerstrom M, Barregard L, Lundh T, Sallsten G. Variability of urinary cadmium excretion in spot urine samples, first morning voids, and 24 h urine in a healthy non-smoking population: implications for study design. J Expo Sci Environ Epidemiol 2014; 24:171-9. [PMID: 24022669 DOI: 10.1038/jes.2013.58] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 07/13/2013] [Accepted: 07/13/2013] [Indexed: 05/25/2023]
Abstract
When selecting the least biased exposure surrogate, for example, the concentration of a biomarker in a urine sample, information on variability must be taken into consideration. We used mixed-effects models to estimate the variability and determinants of urinary cadmium (U-Cd) excretion using spot urine samples collected at six fixed times during 2 days about 1 week apart, from 24 healthy non-smokers. The urine samples were analysed for U-Cd, the concentrations were adjusted for dilution, and the excretion rates were calculated. Between-individual variability dominated the total variability for most measures of U-Cd excretion, especially for 24 h urine and first morning samples. The U-Cd excretion showed a circadian rhythm during the day, and time point of sampling was a significant factor in the mixed-effects models, thus a standardised sampling time, such as first morning urine samples, needs to be applied. Gender, urinary flow rate, age, and urinary protein excretions were also significant determinants for U-Cd excretion. The choice of biomarker for U-Cd excretion was found to be more important in individually-based studies of exposure-response relationships than in studies of comparing Cd levels of groups. When planning a study, this variability of U-Cd in spot samples must be acknowledged.
Collapse
Affiliation(s)
- Magnus Akerstrom
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital and Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lars Barregard
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital and Academy, University of Gothenburg, Gothenburg, Sweden
| | - Thomas Lundh
- Department of Occupational and Environmental Medicine, Lund University Hospital, Lund, Sweden
| | - Gerd Sallsten
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital and Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
48
|
Sommar JN, Pettersson-Kymmer U, Lundh T, Svensson O, Hallmans G, Bergdahl IA. Hip fracture risk and cadmium in erythrocytes: a nested case-control study with prospectively collected samples. Calcif Tissue Int 2014; 94:183-90. [PMID: 24101229 DOI: 10.1007/s00223-013-9796-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 08/29/2013] [Indexed: 10/26/2022]
Abstract
Several studies have investigated the relation between bone mass density and cadmium exposure, but only few studies have been performed on fractures and biomarkers of cadmium. This study analyzed the association between hip fracture risk and cadmium in erythrocytes (Ery-Cd). Prospective samples from the Northern Sweden Health and Disease Study's biobank were used for 109 individuals who later in life had sustained a low-trauma hip fracture, matched with two controls of the same age and gender. The mean concentration of Ery-Cd (±SD) in case samples was 1.3 ± 1.4 versus 0.9 ± 1.0 μg/L in controls. The odds ratio (OR) was 1.63 [95% confidence interval (CI) 1.10-2.42] for suffering a hip fracture for each microgram per liter increase in Ery-Cd. However, when taking smoking into consideration (never, former, or current), neither Ery-Cd nor smoking showed a statistically significant increase in fracture risk. Using multiple conditional logistic regression with BMI, height, and smoking, the estimated OR for a 1-μg/L increase in Ery-Cd was 1.52 (95% CI 0.77-2.97). Subgroup analysis showed an increased fracture risk among women (OR = 1.94, 95% CI 1.18-3.20, for a 1 μg/L increase), which also remained in the multiple analysis (OR = 3.33, 95% CI 1.29-8.56). This study shows that fracture risk is associated with Ery-Cd. It is, however, not possible to draw firm conclusions on whether cadmium is the causal factor or whether other smoking-related factors cause this association. Subgroup analysis shows that cadmium is a risk factor for hip fracture among women.
Collapse
Affiliation(s)
- Johan Nilsson Sommar
- Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden,
| | | | | | | | | | | |
Collapse
|
49
|
Sommar JN, Hedmer M, Lundh T, Nilsson L, Skerfving S, Bergdahl IA. Investigation of lead concentrations in whole blood, plasma and urine as biomarkers for biological monitoring of lead exposure. J Expo Sci Environ Epidemiol 2014; 24:51-7. [PMID: 23443239 DOI: 10.1038/jes.2013.4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Accepted: 12/10/2012] [Indexed: 05/20/2023]
Abstract
Lead in blood is a major concept in biomonitoring of exposure but investigations of its alternatives are scarce. The aim of the study was to describe different lead biomarkers' variances, day-to-day and between individuals, estimating their fraction of the total variance. Repeated sampling of whole blood, plasma and urine were conducted for 48 lead-exposed men and 20 individuals under normal environmental lead exposure, in total 603 measurements. For lead workers, the fraction of the total variance attributed to differences between individuals was 91% for whole-blood lead (geometric mean 227 μg/l; geometric standard deviation (GSD): 1.55 μg/l); plasma 78% (0.57 μg/l; GSD: 1.84 μg/l); density-adjusted urine 82%; and unadjusted urine 75% (23.7 μg/l; GSD: 2.48 μg/l). For the individuals under normal lead exposure, the corresponding fractions were 95% of the total variance for whole blood (20.7 μg/l; GSD: 8.6 μg/l), 15% for plasma (0.09 μg/l; GSD: 0.04 μg/l), 87% for creatinine-adjusted urine and 34% for unadjusted (10.8 μg/l; GSD: 6.7 μg/l). Lead concentration in whole blood is the biomarker with the best ability to discriminate between individuals with different mean concentration. Urinary and plasma lead also performed acceptably in lead workers, but at low exposures plasma lead was too imprecise. Urinary adjustments appear not to increase the between-individual fraction of the total variance among lead workers but among those with normal lead exposure.
Collapse
Affiliation(s)
- Johan Nilsson Sommar
- Occupational Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Maria Hedmer
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Thomas Lundh
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Leif Nilsson
- Department of Mathematics and Mathematical Statistics, Umeå University, Umeå, Sweden
| | - Staffan Skerfving
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Ingvar A Bergdahl
- Occupational Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| |
Collapse
|
50
|
Kelly RS, Lundh T, Porta M, Bergdahl IA, Palli D, Johansson AS, Botsivali M, Vineis P, Vermeulen R, Kyrtopoulos SA, Chadeau-Hyam M. Blood erythrocyte concentrations of cadmium and lead and the risk of B-cell non-Hodgkin's lymphoma and multiple myeloma: a nested case-control study. PLoS One 2013; 8:e81892. [PMID: 24312375 PMCID: PMC3842971 DOI: 10.1371/journal.pone.0081892] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 10/17/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cadmium (Cd) and lead (Pb) are hypothesised to be risk factors for non-Hodgkin's lymphoma (NHL), a group of haematological malignancies with a suspected environmental aetiology. Within the EnviroGenoMarkers study we utilised pre-diagnostic erythrocyte concentrations of Cd and Pb to determine whether exposure was associated with risk of B-cell NHL and multiple myeloma. METHODS 194 incident cases of B-cell NHL and 76 cases of multiple myeloma diagnosed between 1990 and 2006 were identified from two existing cohorts; EPIC-Italy and the Northern Sweden Health and Disease Study. Cases were matched to healthy controls by centre, age, gender and date of blood collection. Cd and Pb were measured in blood samples provided at recruitment using inductively coupled plasma-mass spectrometry. Logistic regression was applied to assess the association with risk. Analyses were stratified by cohort and gender and by subtype where possible. RESULTS There was little evidence of an increased risk of B-cell NHL or multiple myeloma with exposure to Cd (B-cell NHL: OR 1.09 95%CI 0.61, 1.93, MM: OR 1.16 95% CI: 0.40, 3.40 ) or Pb (B-cell NHL: 0.93 95% CI 0.43, 2.02, multiple myeloma: OR 1.63 95%CI 0.45, 5.94) in the total population when comparing the highest to the lowest quartile of exposure. However, gender and cohort specific differences in results were observed. In females the risk of B-cell NHL was more than doubled in those with a body burden of Cd >1 µg/L (OR 2.20 95%CI; 1.04, 4.65). CONCLUSIONS This nested case-control study does not support a consistent positive association between Cd or Pb and NHL, but there is some indication of a gender specific effect suggesting further research is warranted.
Collapse
Affiliation(s)
- Rachel S. Kelly
- Medical Research Council-Health Protection Agency Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - Thomas Lundh
- Department of Occupational and Environmental Medicine, Lund University Hospital, Lund, Sweden
| | - Miquel Porta
- Hospital del Mar Research Institute - IMIM, CIBER Epidemiología y Salud Pública (CIBERESP) and Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Ingvar A. Bergdahl
- Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Domenico Palli
- Molecular and Nutritional Epidemiology Unit, Cancer Prevention and Research Institute (ISPO), Florence, Italy
| | | | - Maria Botsivali
- National Hellenic Research Foundation, Institute of Biology, Pharmaceutical Chemistry and Biotechnology, Athens, Greece
| | - Paolo Vineis
- Medical Research Council-Health Protection Agency Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
- HuGeF Foundation, Turin, Italy
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Division of Environmental Epidemiology, Utrecht University, Utrecht, The Netherlands
| | - Soterios A. Kyrtopoulos
- National Hellenic Research Foundation, Institute of Biology, Pharmaceutical Chemistry and Biotechnology, Athens, Greece
| | - Marc Chadeau-Hyam
- Medical Research Council-Health Protection Agency Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | | |
Collapse
|