Bottled water quality assessment through entropy-weighted water quality index (EWQI) and pollution index of groundwater (PIG): a case study in a fast-growing metropolitan area in Türkiye

The aim of the study is to evaluate the quality of water collected during wet and dry seasons of Şanlıurfa and to expand and improve understanding of the pollution status and drinking quality of bottled water used for drinking purposes. To do so, an entropy-weighted water quality index (EWQI) and a groundwater pollution index (PIG) were used to evaluate data on physicochemical parameters related to drinking water quality standards. The parameters related to bottled water quality were evaluated with Piper and Ternary diagrams. The calculated EWQI values ranged from 7.78 to 29.74 in wet season whereas 11.63 to 32.20 in dry season. Overall, EWQI data showed that all of water samples were suitable for drinking. Similarly, the values of PIG varied from 0.09 to 0.3 in wet season but 0.1 to 0.26 in dry season, which also showed that all water samples from the study area were suitable.

Insights into Anthropogenic Micro- and Nanoplastic Accumulation in Drinking Water Sources and Their Potential Effects on Human Health

Anthropogenic microplastics (MPs) and nanoplastics (NPs) are ubiquitous pollutants found in aquatic, food, soil and air environments. Recently, drinking water for human consumption has been considered a significant pathway for ingestion of such plastic pollutants. Most of the analytical methods developed for detection and identification of MPs have been established for particles with sizes > 10 μm, but new analytical approaches are required to identify NPs below 1 μm. This review aims to evaluate the most recent information on the release of MPs and NPs in water sources intended for human consumption, specifically tap water and commercial bottled water. The potential effects on human health of dermal exposure, inhalation, and ingestion of these particles were examined. Emerging technologies used to remove MPs and/or NPs from drinking water sources and their advantages and limitations were also assessed. The main findings showed that the MPs with sizes > 10 μm were completely removed from drinking water treatment plants (DWTPs). The smallest NP identified using pyrolysis-gas chromatography-mass spectrometry (Pyr-GC/MS) had a diameter of 58 nm. Contamination with MPs/NPs can occur during the distribution of tap water to consumers, as well as when opening and closing screw caps of bottled water or when using recycled plastic or glass bottles for drinking water. In conclusion, this comprehensive study emphasizes the importance of a unified approach to detect MPs and NPs in drinking water, as well as raising the awareness of regulators, policymakers and the public about the impact of these pollutants, which pose a human health risk.

Calculation of the contribution of water to calcium intake in low- and middle-income countries

Dietary calcium intake is low in many countries, particularly in low- and middle-income countries (LMICs). Water is often overlooked as a source of dietary calcium despite it being universally consumed and providing good calcium bioavailability. Our objective was to assess water distribution systems in LMICs and to develop a formula to simulate the contribution of different water sources to calcium availability. We calculated the contribution of drinking water considering different calcium concentration levels to estimate total calcium availability. We consider a country's households' access to drinking water sources and the distribution of the country's population by age and gender. Calcium availability could be increased by an average of 49 mg of calcium per person per day in the 62 countries assessed if calcium in drinking water was considered. In 22 (31%) of the countries studied, 80% of households are supplied by water sources that could increase calcium availability. Improving calcium concentration in water could be considered as a strategy in LMICs to slightly improve calcium availability.

Physico-Chemical and Microbiological Differences between Mains and Bottled Water, in an Area in the Central Area of Romania

The human body is mostly made up of water. The largest proportion of the human body is water, hence the growing interest of specialists in defining the importance of water in the body and the risks of dehydration. This study determined the physico-chemical and microbiological parameters of the drinking water distributed in the public network in the area of operation of Water Distribution Operator in Mureș County and samples of bottled water existing on the market in Mureş County (mineral, spring or table). The water supplied to the network can be safely consumed. This is demonstrated both by the results of the analyses of the physico-chemical and microbiological parameters related to the legislative standards and by the values of the similar parameters analyzed for the bottled water.

Perceptions of Water Safety and Tap Water Taste and Their Associations With Beverage Intake Among U.S. Adults

OBJECTIVES

Examine differences in perceptions of tap water (TW) and bottled water (BW) safety and TW taste and their associations with plain water (PW) and sugar-sweetened beverage (SSB) intake.

DESIGN

Quantitative, cross-sectional study.

SETTING

United States.

SUBJECTS

4,041 U.S. adults (≥18 years) in the 2018 SummerStyles survey data.

MEASURES

Outcomes were intake of TW, BW, PW (tap and bottled water), and SSB. Exposures were perceptions of TW and BW safety and TW taste (disagree, neutral, or agree). Covariates included sociodemographics.

ANALYSIS

We used chi-square analysis to examine sociodemographic differences in perceptions and multivariable logistic regressions to estimate adjusted odds ratios (AOR) for consuming TW ≤ 1 cup/day, BW > 1 cup/day, PW ≤ 3 cups/day, and SSB ≥ 1 time/day by water perceptions.

RESULTS

One in 7 (15.1%) of adults did not think their home TW was safe to drink, 39.0% thought BW was safer than TW, and 25.9% did not think their local TW tasted good. Adults who did not think local TW was safe to drink had higher odds of drinking TW ≤ 1 cup/day (AOR = 3.12) and BW >1 cup/day (AOR = 2.69). Adults who thought BW was safer than TW had higher odds of drinking TW ≤1 cup/day (AOR = 2.38), BW > 1 cup/day (AOR = 5.80), and SSB ≥ 1 time/day (AOR = 1.39). Adults who did not think TW tasted good had higher odds of drinking TW ≤ 1 cup/day (AOR = 4.39) and BW > 1 cup/day (AOR = 2.91).

CONCLUSIONS

Negative perceptions of TW safety and taste and a belief BW is safer than TW were common and associated with low TW intake. Perceiving BW is safer than TW increased the likelihood of daily SSB intake. These findings can guide programs and services to support water quality to improve perceptions of TW safety and taste, which might increase TW intake and decrease SSB intake.

Health Risk Assessment of Trace Metals in Bottled Water Purchased from Various Retail Stores in Pretoria, South Africa

Bottled water is one of the fastest growing commercial products in both developing and developed countries owing to the believe that it is safe and pure. In South Africa, over the years, there has been an increase in the sale of bottled water due to the perceived notion that water supplied by the government may not be safe for human consumption. This study investigated the concentrations of trace metals and the physicochemical properties of bottled water purchased from various supermarkets (registered and unregistered) in Pretoria with a view to determining the health risk that may be associated with the levels of trace metals resulting from the consumption of the bottled water. Twelve commonly available different brands of bottled water were purchased and analysed for trace-metal content using inductively coupled plasma mass spectrometry (ICP-MS). The water samples were also analysed for various physicochemical parameters. The health risk was assessed using the target hazard quotient (THQ). For all the bottled water, the highest concentration of all the elements was recorded for Fe. The values reported for Cr, Ni and Pb were above the limit recommended by World Health Organization. The pH values ranged from 4.67 to 7.26. Three of the samples had pH values in the acidic region below the permissible standard of 6.8-8.0 set by the International Bottled Water Association (IBWA). The target hazard quotient calculated for the water samples showed a minimum risk for Pb, Cr and Ni. The study showed the need to adhere to a strict compliance standard considering the fact that South Africa has rich natural mineral elements, which may have played a role in the high levels of trace metals reported from some of the water samples.

Quantitative Assessment of Full Size Microplastics in Bottled and Tap Water Samples in Hong Kong

Human exposure to microplastics (MPs) through drinking water has drawn serious concern recently because of the potential adverse health effects. Although there are reports on the occurrence of MPs in bottled water, little is known about the abundance of a whole spectrum of MPs with sizes ranging from 1 µm to 5 mm due to the restrictions of conventional MPs detection methods. Some studies using micro-Raman spectroscopy can achieve MPs with a size of <10 µm, however, quantitation of all MPs was extremely time consuming and only a small portion (<10%) of MPs would be analyzed. The present study quantified MPs from nine brands of bottled water using fluorescence microscopy and flow cytometry for MPs with a size of ≥50 µm and a size of <50 µm, respectively. The average abundance of MPs with a size of ≥50 µm in bottled water samples was found ranging from 8-50 particles L^-1, while MPs with a size of <50 µm were found to be 1570-17,817 particles L^-1, where the MPs abundance from mineral water samples were significantly more than distilled and spring water samples. The modal size and shape of MPs were found at 1 µm and fragments, respectively. Besides, three tap water samples obtained locally were analyzed and compared with the bottled water samples, where less MPs were found in tap water samples. In addition, contamination of MPs from bottle and cap and interference by addition of mineral salts were studied, where no significant difference from all these processes to the control sample was found, suggesting the major contamination of MPs was from other manufacturing processes. Estimated daily intake (EDI) of MPs increased substantially when data of small MPs are included, suggesting that previously reports on exposure of MPs from drinking water might be underestimated, as only large MPs were considered.

Mineral content variations between Australian tap and bottled water in the context of urolithiasis

Objectives

The objective of this study is to investigate the variations in mineral content of tap drinking water across major Australian cities, compared with bottled still and sparkling water, and discuss the possible implications on kidney stone disease (KSD).

Materials and Methods

The mineral composition of public tap water from 10 metropolitan and regional Australian cities was compared using the drinking water quality reports published from 2019 to 2021 by the respective water service utilities providers. Specifically, average levels of calcium, bicarbonate, magnesium, sodium, potassium, and sulphates were compared with published mineral content data from bottled still and sparkling drinking water in Australia.

Results

The median or mean (depending on report output) mineral composition was highly variable for calcium (range 1.3 to 20.33 mg/L), magnesium (range 1.1 to 11.2 mg/L), bicarbonate (range 12 to 79 mg/L), sodium (range 3 to 47.1 mg/L), potassium (range 0.4 to 3.23 mg/L) and (sulphates range <1 to 37.4 mg/L). Calcium, magnesium and bicarbonate levels in tap water were lower than in bottled sparkling water. Consumption of 3 L/day of the most calcium rich tap water would fulfil 4.7% of the RDI, compared with 8.7% with bottled sparkling water. Consumption of 3 L of the most magnesium rich tap water would fulfil 8% of the RDI, compared with 13.6% with bottled sparkling water.

Conclusion

The mineral content of tap drinking water varied substantially across major Australian city centres. Bottled sparkling water on average provided higher levels of calcium, bicarbonate and magnesium and may be preferred for prevention of calcium oxalate stones. These findings may assist counselling of patients with KSD depending on geographic location in the context of other modifiable risk factors and 24‐h urine analysis results.

Bottled and Well Water Quality in a Small Central Appalachian Community: Household-Level Analysis of Enteric Pathogens, Inorganic Chemicals, and Health Outcomes in Rural Southwest Virginia

Consumption of unsafe drinking water is associated with a substantial burden of disease globally. In the US, ~1.8 million people in rural areas lack reliable access to safe drinking water. Our objective was to characterize and assess household-level water sources, water quality, and associated health outcomes in Central Appalachia. We collected survey data and water samples (tap, source, and bottled water) from consenting households in a small rural community without utility-supplied water in southwest Virginia. Water samples were analyzed for physicochemical parameters, total coliforms, E. coli, nitrate, sulfate, metals (e.g., arsenic, cadmium, lead), and 30+ enteric pathogens. Among the 69% (n = 9) of households that participated, all had piped well water, though 67% (n = 6) used bottled water as their primary drinking water source. Total coliforms were detected in water samples from 44.4% (n = 4) of homes, E. coli in one home, and enteric pathogens (Aeromonas, Campylobacter, Enterobacter) in 33% (n = 3) of homes. Tap water samples from 11% (n = 1) of homes exceeded the EPA MCL for nitrate, and 33% (n = 3) exceeded the EPA SMCL for iron. Among the 19 individuals residing in study households, reported diarrhea was 25% more likely in homes with measured E. coli and/or specific pathogens (risk ratio = 1.25, cluster-robust standard error = 1.64, p = 0.865). Although our sample size was small, our findings suggest that a considerable number of lower-income residents without utility-supplied water in rural areas of southwest Virginia may be exposed to microbiological and/or chemical contaminants in their water, and many, if not most, rely on bottled water as their primary source of drinking water.

Occurrence of Potentially Toxic Elements in Bottled Drinking Water-Carcinogenic and Non-Carcinogenic Risks Assessment in Adults via Ingestion

The presence of potentially toxic elements in drinking water can be dangerous for human health because of their bioaccumulation and toxicity, which is a huge concern for many researchers. In the case of bottled water, the exposure to toxic elements is achieved, especially by ingestion, leading to disorders of important functions of the human body. The aim of this study was the detection of some potentially toxic elements, from 50 samples of bottled drinking water, available on the Romanian market. Based on obtained concentrations, an assessment of the carcinogenic and non-carcinogenic health risk was performed. The concentrations of potentially toxic elements analyzed were below the maximum allowable limits, for all contaminants, excluding Pb and Fe. Moreover, the results of total risk via ingestion, showed that 30% of samples had an Hazard Quotient (HQ) < 1, and 70% had an HQ > 1; which implies a potential risk following the consumption of those samples. Concerning total cancer risk, 28% of the samples are in the acceptable level, while 72% of the samples are considered harmful and can lead to a type of cancer after repeated exposure. The study concluded that long term use of bottled water of poor quality may pose a hazard to human health; it is helpful for inhabitants to avoid ingestion of contaminated water.

Influence of Temperature on the Quantity of Bisphenol A in Bottled Drinking Water

Bisphenol A (BPA) is a component used in the production of polycarbonate plastics (PC) and epoxy resins, which are currently widely used in food and beverage packaging. Although BPA is not used in polyethylene terephthalate (PET) manufacturing, a recent study reported its presence in PET water bottles. This study was conducted to investigate the effects of storage conditions on the release of BPA from PET bottles as well as to assess health risks associated with the consumption of bottled water. Using high-performance liquid chromatography (HPLC), we measured the content of BPA in local brands of plastic bottled water sold in the Polish market. It has been established that temperature is one of the main factors that influences the migration of bisphenol A to products, as was confirmed by determination of the amount of bisphenol A in water, which was carried out without exposing the bottles to different temperatures. Despite the fact that the individual concentrations of BPA in bottled water were low (ng/L) at 0.6 mg/kg (body weight), the cumulative daily dose in the body may be much higher than the quoted concentrations due to the number of products containing BPA. Thus, prolonged usage of bottled water and beverages should be avoided to reduce the risk of human exposure to BPA through leaching. Additionally, it was found that high temperatures resulted in increased BPA leaching.

Occurrence of Microplastics in Tap and Bottled Water: Current Knowledge

A narrative review was carried out to describe the current knowledge related to the occurrence of MPs in drinking water. The reviewed studies (n = 21) showed the presence of microplastics (MPs) in tap (TW) and bottled (BW) water, increasing concerns for public health due to the possible toxicity associated with their polymeric composition, additives, and other compounds or microorganism adsorbed on their surface. The MP concentration increase by decreasing particles size and was higher in BW than in TW. Among BW, reusable PET and glass bottles showed a higher MP contamination than other packages. The lower MP abundance in TW than in natural sources indicates a high removal rate of MPs in drinking water treatment plants. This evidence should encourage the consumers to drink TW instead of BW, in order to limit their exposure to MPS and produce less plastic waste. The high variability in the results makes it difficult to compare the findings of different studies and build up a general hypothesis on human health risk. A globally shared protocol is needed to harmonize results also in view of the monitoring plans for the emerging contaminants, including MPs, introduced by the new European regulation.

Using Water Intake Dietary Recall Data to Provide a Window into US Water Insecurity

BACKGROUND

In the United States, problems with the provision of safe, affordable water have resulted in an increasing number of adults who avoid their tap water, which could indicate underlying water insecurity. Dietary recalls provide critical nutritional surveillance data, yet have been underexplored as a water insecurity monitoring tool.

OBJECTIVES

This article aims to demonstrate how water intake variables from dietary recall data relate to and predict a key water insecurity proxy, that is, tap water avoidance.

METHODS

Using 2005-2018 NHANES data from 32,329 adults, I examine distributions and trends of mean intakes of total, plain (sum of tap and bottled water), tap, and bottled water, and percentage consuming no tap and exclusive bottled water. Second, I use multiple linear and logistic regressions to test how tap water avoidance relates to plain water intake and sugar-sweetened beverage (SSB) consumption. Next, I use receiver operating characteristics (ROC) curves to test the predictive accuracy of no plain water, no tap, and exclusive bottled water intake, and varying percentages of plain water consumed from tap water compared with tap water avoidance.

RESULTS

Trends indicate increasing plain water intake between 2005 and 2018, driven by increasing bottled water intake. In 2017-18, 51.4% of adults did not drink tap water on a given day, whereas 35.8% exclusively consumed bottled water. Adults who avoided their tap water consumed less tap and plain water, and significantly more bottled water and SSBs on a given day. No tap intake and categories of tap water intake produced 77% and 78% areas under the ROC curve in predicting tap water avoidance.

CONCLUSIONS

This study demonstrates that water intake variables from dietary recalls can be used to accurately predict tap water avoidance and provide a window into water insecurity. Growing reliance on bottled water could indicate increasing concerns about tap water.

Quantifying the nitrate levels in bottled water in New Zealand

OBJECTIVE

There is growing epidemiological evidence linking nitrate contamination to adverse health outcomes. Health concerns may drive consumers towards bottled water, however, nitrate levels in bottled water are not readily available.

METHODS

We tested water samples from the 10 most popular brands using a TriOS OPUS UV optical nitrate sensor.

RESULTS

Overall, all bottled water brands tested returned nitrate levels below 4.4 mg/L NO3.

CONCLUSIONS

The growing health concerns associated with nitrate contamination suggest that increased reporting of water quality is required. Implications for public health: Mandatory reporting of water quality laboratory reports by bottled water producers would improve transparency to consumers and help public health researchers track potential threats to water quality as new evidence emerges.

Tap Water Consumption and Perceptions in United States Latinx Adults

Insufficient water intake is associated with adverse health outcomes, including chronic disease prevalence and mortality. Adherence to Institute of Medicine total water intake (TWI) recommendations has been low in recent decades, and TWI has been consistently lower in Latinx adults compared with non-Hispanic (NH) white adults. While overall plain water intake is similar between Latinx and NH white adults, Latinx adults consistently consume significantly more bottled water and less tap water. The purpose of this review is to identify factors that may contribute to low water intake and low tap water intake, particularly in Latinx adults. The decision to drink water is complex and is influenced by a myriad of factors including context, environment, eating behaviors, geography, and beverage attributes. Plain water preferences appear to be related, in part, to perceptions of tap water safety as Latinx adults are significantly more likely to perceive their tap water as unsafe compared to NH white adults. Although recent investigations have not consistently or comprehensively evaluated the same factors, we have compiled their findings to describe the complex, interrelated determinants of tap water safety perceptions in Latinx adults. The present review proposes that perceptions are influenced by water insecurity, demographics, prior experiences, organoleptic (sensory) perceptions and availability and sources of information. Existing interventions designed to improve TWI primarily focus on improving access to water and/or educating individuals on the importance of hydration. However, this may not be sufficient in Latinx populations where water is not trusted. Future work should comprehensively assess these factors in Latinx samples and include validated plain water intake, TWI, and hydration status measures. A greater understanding of these relationships could inform interventions to improve TWI and hydration status in Latinx adults.

Nitrite and Nitrate Levels in Groundwater, Water Distribution Network, Bottled Water and Juices in Iran: A Systematic Review

BACKGROUND

Nitrate and nitrite can get into the body through the consumption of contaminated water either directly or indirectly. The accumulation of these compounds in the body, in the long run, leads to health problems, for example, digestive disorders, cancers, and even death threats in children. The aim of this review was to investigate nitrate and nitrite pollution levels in drinking water and fruit juices in Iran.

METHODS

In this review, data were collected through searching the Scientific Information Database, Science-Direct, Scopus, PubMed, Google Scholar, and Magiran databases using the keywords Nitrate, Nitrite, Drinking water, Drinking Water Resources, Juice and Iran. Finally, the location of the studies was geocoded through the Google My Maps (https://www.google.com/mymaps) software.

RESULTS

Studies clearly indicated that the juices are safe in terms of nitrate. Nitrate and nitrite values were less than the national and international standards in all samples of bottled drinking water except for a few of the studies. The results of the reviewed studies also indicated that the nitrate content was higher than that written on the label in 96% of the samples, and nitrite was not labeled in 80% of them. The nitrate quantity was higher than the permissible limit in the water distribution network of Bushehr, Gilan and Mazandaran Provinces. Talesh, Ardabil, Hashtgerd, Divandareh, and Kerman cities had high nitrate levels in more than 50% of wells.

CONCLUSION

Using nitrogen fertilizers and the lack of a wastewater treatment system were the main reasons for the presence of nitrate and nitrite.

Microbiological quality assessment (including antibiogram and threat assessment) of bottled water

Water pollution is a major global problem that has been the leading cause of morbidity and mortality. This study was carried out to assess the microbiological quality of popular domestic brands of bottled water available in the Kathmandu Valley in Nepal. For the study of bottled water, a total of 50 samples each of different volumes (20 and 1 L) were selected. The samples were processed at the Microbiology laboratory at St. Xavier's College, Maitighar, Kathmandu. The microbiological assessments were performed as per the methods described in the American Public Health Association, 2005. Out of 100 samples, 48% of samples were found to be contaminated with total coliform. Escherichia coli was the predominant strain among the coliforms. Multidrug-resistant E. coli, Enterobacter aerogenes, and Pseudomonas aeruginosa were isolated from the 48 bottled water. Treat assessment test revealed that 88.23% of the isolated E. coli produced β hemolytic colonies, while 11.77% did not show hemolytic colonies, 100% E. aerogenes colonies were not able to develop hemolytic colonies and 100%, P. aeruginosa colonies gave β hemolytic colonies, respectively. Chi-square test shows that there is a significant association (p ≤ .05) between fecal coliform and volume of the vessel (i.e., 20 and 1 L), bottle type (i.e., unscratched and undented and scratched and/or dented), season (i.e., monsoon and postmonsoon), and total coliform. Chi-square test shows that there is no significant (p > .05) association between Pseudomonas spp and season (i.e., monsoon and postmonsoon). Out of 100 samples, 48% of samples were found to be contaminated with total coliform. Microorganisms survive in bottled water as they have many nutrients required for the microorganism in ionic form. Surveillance is lacking by the license-providing organizations followed by governmental organizations.

Medicaid expansion and non-alcoholic beverage choices by low-income households

This article investigates the impact of the 2010 Patient Protection and Affordable Care Act (ACA) on the healthfulness of non-alcoholic beverage (NAB) choices of low-income households. A theoretical analysis proposes an income effect that increases unhealthy beverage purchases after Medicaid expansion and a nutrition education effect that decreases them. To empirically test these effects, we utilize household-level data for NAB purchases in 52 U.S. metropolitan areas. Our identification strategy is based on eligible households following the 2012 Supreme Court ruling that allowed states to opt out of Medicaid expansion. We examine changes in purchases across NAB categories and in purchases at the product-brand level. Empirical results indicate that Medicaid expansion resulted in eligible households buying more diet carbonated soft drinks (CSDs) and bottled water, with no effect on regular CSDs, fruit juice, fruit drinks, milk, or tea. Moreover, the expansion led to decreases in sugar purchases and increases in purchases of NAB products with lower sugar content, highlighting the benefits of supplementing the medical benefits of Medicaid with diet quality programs, such as nutrition education.

Assessment of Radiation Dose from the Consumption of Bottled Drinking Water in Japan

Activity concentrations of ²³⁴U, ²³⁵U, ²³⁸U, ²²⁶Ra, ²²⁸Ra, ²²²Rn, ²¹⁰Po, ²¹⁰Pb, ⁴⁰K, ³H, ¹⁴C, ¹³⁴Cs and ¹³⁷Cs were determined in 20 different Japanese bottled drinking water commercially available in Japan. The origins of the mineral water samples were geographically distributed across different regions of Japan. Activity concentrations above detection limits were measured for the radionuclides ²³⁴U, ²³⁵U, ²³⁸U, ²²⁶Ra, ²²⁸Ra and ²¹⁰Po. An average total annual effective dose due to ingestion was estimated for adults, based on the average annual volume of bottled water consumed in Japan in 2019, reported to be 31.7 L/y per capita. The estimated dose was found to be below the recommended World Health Organisation (WHO) guidance level of 0.1 mSv/y for drinking water quality. The most significant contributor to the estimated dose was ²²⁸Ra.

Effect of Fluoride Concentration in Drinking Water on Dental Fluorosis in Southwest Saudi Arabia

This study was intended to evaluate the fluoride concentration in drinking water and its effect on dental fluorosis in Southwest Saudi Arabia. Water samples were gathered rom wells, filtration plants and commercial brands (bottled water) in distinct urban and rural areas of Asir region of the Kingdom of Saudi Arabia (KSA). Overall, 63 water samples were collected from 12 locations and 9 brands of bottled water. ExStik^® FL700Fluoridemeter was used in the analysis of water samples for fluoride levels. The total number of screened patients for dental fluorosis, aged between 9 and 50 years, was 1150; among them, 609 were males and 541 were females. Dean's index criteria were used to examine the patients for dental fluorosis. The results revealed that fluoride levels varied between 0.03 and 3.8 ppm. People who drank well water displayed increased fluoride levels (>0.81 ppm). The prevalence of dental fluorosis was established to be 20.43% among the total number of examined patients. The findings of this study show very mild to moderate dental fluorosis prevail among the patients who consume well water in the Asir region.

Assessment of ISO Method 15216 to Quantify Hepatitis E Virus in Bottled Water

Hepatitis E virus (HEV) is one of the causative agents of water-borne human viral hepatitis and considered in Europe an emerging zoonotic pathogen. Analysis of bottled water through a standard method validated for HEV can contribute towards the risk management of this hazard. Putting some recent reports by the European Food Safety Authority in place, this study aimed to assess the performance of the concentration and extraction procedures described in ISO 15216-1:2017 for norovirus and hepatitis A virus on HEV detection. Following the ISO recommendation, the bottled water samples were spiked using serially diluted HEV fecal suspensions together with mengovirus as process control and concentrated by filtration via positively charged nylon membranes. In order to extract viral RNA from the resulting concentrates, two different methods were compared in this study: The one recommended in the ISO norm, NucliSens® MiniMag® system (NS), and an alternative commercially available kit NucleoSpin®RNA virus kit (MN). Finally, three reverse transcription quantitative PCR (RT-qPCR) assays were used to quantify HEV titers. The evaluated procedures resulted in average HEV recoveries of 14.08 ± 4.90% and 3.58 ± 0.30% for the MN and NS methods, respectively. The limit of detection (LoD95%) was 1.25 × 104 IU/L for both extraction methods combined with the three RT-qPCR assays tested, with the exception of NS extraction coupled with RT-qPCR1 that showed a LoD95% of 4.26 × 103 IU/L. The method characteristics generated in this study support the limited suitability of the ISO 15216-1:2017 concentration procedure coupled with the evaluated RT-qPCR assays for detecting HEV in bottled water.

Trends and determinants of drinking water practices among North Carolina children

OBJECTIVES

To identify trends and determinants of drinking water practices [bottled (BW) versus community water (CW) consumption] among families of pediatric patients presenting to an academic dental institution over 15 years.

METHODS

Electronic health record data were obtained for all first-time routine-care patients ages 0-16 presenting to UNC-Chapel Hill's Pediatric Dentistry Clinics from 2002 to 2016, including families' primary drinking water source and patient demographics (e.g., age, gender, residence, insurance status). Data analyses included descriptive and bivariate methods and multivariable modeling using a P < 0.05 statistical significance criterion.

RESULTS

BW consumption has increased over time, from 17 percent in 2004 to 42 percent in 2016 (n = 2,920; P < 0.05). Medicaid-enrolled children [prevalence ratio (PR) = 2.1; 95% confidence interval (CI) = 1.8-2.4] and residents of rural counties (PR = 1.3, 95% CI = 1.1-1.5) were significantly more likely to consume BW versus CW.

CONCLUSIONS

BW consumption among NC children has been increasing and is most prevalent among low-income families and in rural areas.

(Ab)use of Health Claims in Websites: The Case of Italian Bottled Waters

The massive use of web marketing makes the monitoring of nutrition and health claims used in advertising campaigns much more difficult. The present study aimed at reviewing the website content for bottled waters produced in Italy to assess (i) if nutrition and health claims are reported, (ii) what types of nutrition and health claims are reported most frequently, and (iii) if the nutrition and health claims could be considered appropriate according to the current regulation in the field. A review of the website content of the 253 bottled waters produced in Italy and reported in the annual report of Bevitalia 2016–2017 was conducted. For each brand, indications related to the preventive, curative or therapeutic properties of the water reported were examined. Bottled waters that included potentially misleading information apparently not consistent with the European Directive on the exploitation and marketing of natural mineral waters were identified. Forty bottled waters with uncertain website content were identified. The information reported in the websites referred most often to beneficial effects for urinary tract and cardiovascular systems. Present results highlight, using the bottled water case study, that website content sometimes happens to deliver misleading information to consumers, also thanks to uncertain regulation in this sensitive field.

Reasons why low-income people in urban areas do not drink tap water

BACKGROUND

Despite its higher cost and potential environmental effect compared with those of tap water, bottled water consumption has been increasing over the past decade, especially in low-income communities in which children are at a higher risk of developing caries.

METHODS

The authors used a systematic sequential sampling design for the Water Consumption Survey to collect information about water consumption beliefs and practices from clients attending 4 public health centers in Los Angeles County (LAC). The authors used health belief model constructs to examine why some low-income residents in LAC do not drink tap water.

RESULTS

From October through December 2013, 1,230 participants completed the Water Consumption Survey (86% response rate); the authors included 1,171 participants in the final analysis. Hispanic and African-American participants accounted for the largest proportions (38% and 37%, respectively). Overall, 48% of participants reported drinking tap water daily compared with 58% who reported drinking bottled water daily. The health belief model construct of perceived health risks (that is, perceived threats) significantly predicted why survey participants did not drink tap water. Other results revealed several misconceptions about tap water fluoridation and differences in beliefs about tap water safety according to income level.

CONCLUSIONS

Fluoridated tap water is a low-cost, ecologically friendly resource that provides health benefits seldom found in bottled water. However, mistrust about the quality and safety of tap water may make those in low-income communities more vulnerable to the effects of not receiving adequate fluoride and thus at higher risk of developing caries.

PRACTICAL IMPLICATIONS

Future interventions should encourage tap water use by dispelling misconceptions and educating low-income people in urban areas of LAC about the health benefits of fluoridated tap water and the safety of its sources. In addition, patient encounters could be an opportunity for pediatric dentists, general dentists, and other health care providers to reinforce the health benefits of tap water fluoridation and its use.

PCR detection of Vibrio cholerae, Escherichia coli, and Salmonella sp. from bottled drinking water in Iran

INTRODUCTION

The quality of drinking water has an important role in human health. This study was aimed to detect Escherichia. coli, Salmonella sp. and Vibrio cholerae from bottled drinking waters produced in Iran.

METHODOLOGY

A total of 240 samples of bottled water of different brands were collected for testing between March 2015 to December 2015 in Shahrekord-Iran. Samples were examined by polymerase chain reaction (PCR) combined with culture methods for the detection of E. coli, Salmonella sp., and V. cholerae.

RESULTS

The results of PCR revealed that the uidA gene from E. coli, IpaB gene from Salmonella sp, and epsM gene from V. cholerae were detected in 6 (2.5%), 1 (0.4 %), 0 (0%) of the samples, respectively. But in culture methods, only E. coli 5 (2.1%) were isolated from the samples. The contamination with E. coli was significantly higher (P < 0.05) in water produced during the hot seasons than the cold seasons.

CONCLUSIONS

This study confirmed the presence of Escherichia coli as the main microorganism in bottle drinking water in Iran. Also, our study showed that PCR can be used as a screening method for monitoring the enteric pathogens in drinking water.

Norovirus in Bottled Water Associated with Gastroenteritis Outbreak, Spain, 2016

In April 2016, an outbreak of gastrointestinal illness (4,136 cases) occurred in Catalonia, Spain. We detected high levels of norovirus genotypes I and II in office water coolers associated with the outbreak. Infectious viral titer estimates were 33–49 genome copies/L for genotype I and 327–660 genome copies/L for genotype II.

After Mexico Implemented a Tax, Purchases of Sugar-Sweetened Beverages Decreased and Water Increased: Difference by Place of Residence, Household Composition, and Income Level

Background: In January 2014, Mexico implemented a tax on sugar-sweetened beverage (SSB) purchases of 1 peso/L.Objective: We examined the heterogeneity of changes in nonalcoholic beverage (SSB and bottled water) purchases after the tax was implemented by household income, urban and rural strata, and household composition.Methods: We used 4 rounds of the National Income and Expenditure Surveys: 2008, 2010, 2012, and 2014. Changes in purchases in per capita liters per week were estimated with the use of 2-part models to adjust for nonpurchases. We compared absolute and relative differences between adjusted changes in observed purchases in 2014 with expected purchases in 2014 based on prior trends (2008-2012). The models were adjusted for sociodemographic characteristics of the households, place of residence, and lagged gross domestic product per capita.Results: We found a 6.3% reduction in the observed purchases of SSBs in 2014 compared with the expected purchases in that same year based on trends from 2008 to 2012. These reductions were higher among lower-income households, residents living in urban areas, and households with children. We also found a 16.2% increase in water purchases that was higher in low- and middle-income households, in urban areas, and among households with adults only.Conclusions: SSB purchases decreased and water purchases increased after an SSB tax was imposed in Mexico. The magnitude of these changes was greater in lower-income and urban households.

Comparison of Fluoride Levels in Tap and Bottled Water and Reported Use of Fluoride Supplementation in a United States-Mexico Border Community

BACKGROUND

Compared to the general United States (U.S.) population, Arizona counties along the U.S.-Mexico border have a higher prevalence of dental caries, which can be reduced with adequate fluoride exposure. Because of concern regarding local tap water quality, fluoride-free bottled water consumption is common in this region, raising concern that families are not receiving adequate fluoride to promote dental health.

OBJECTIVE

To evaluate the levels of fluoride in tap and bottled water as well as the use of fluoride supplements in an Arizona border community.

METHODS

Low-income Latino households (n = 90) who report use of bottled water as their primary source of water intake were recruited. Participants completed a questionnaire about their and their children's dental histories and use of fluoride supplements. Water samples (bottled and tap) were collected from a subset of households (n = 30) for analysis of fluoride.

RESULTS

Fluoride detection levels were significantly greater (p = 0.02, Fisher's exact test) in tap water (average = 0.49 mg/dL) than in bottled water, yet, the majority (22/30) were below the range for optimal dental health (0.7-1.2 mg/L). Concentration of fluoride in the majority (29/30) of bottled water samples was below the quantitative detection limit of 0.4 mg/L. Children were significantly less likely to have dental caries if they received fluoride varnishing treatments (p = 0.01, Fisher's exact test), lived in households that reported using fluoridated mouthwash (p < 0.001, Fisher's exact test), their parents received fluoride education (p = 0.01, Fisher's exact test), and their parents reported visiting a dentist yearly (p < 0.001, Fisher's exact test). Furthermore, none of the participants reported receiving recommendations from health-care providers about fluoride supplementation or variance in content by the type of water consumed.

CONCLUSION

Although fluoride was significantly more likely to be detected in tap than bottled water, neither water source in this border community is likely to provide enough fluoride for optimal dental health. Low-income children in this region may benefit from regular access to fluoride varnishing treatments and/or use of fluoridated mouthwash, interventions that could be tested in future well-designed trials.

Natural mineral waters: chemical characteristics and health effects

Water contributes significantly to health and a daily intake of 1.5 to 2 liters of water should be guaranteed, because a good hydration is essential to maintain the body water equilibrium, although needs may vary among people. However, worldwide population is far from the Recommended Allowance for water intake. Among the waters for human uses, there are 'waters (treated or not), intended for drinking, used for the food and beverages preparation or for other domestic purposes' and natural mineral waters, that are 'originated from an aquifer or underground reservoir, spring from one or more natural or bore sources and have specific hygienic features and, eventually, healthy properties'. According to the European Legislation (2009/54/EC Directive), physical and chemical characterization is used to make a classification of the different mineral waters, basing on the analysis of main parameters. Mineral composition enables to classify natural mineral waters as bicarbonate mineral waters, sulphate mineral waters, chloride mineral waters, calcic mineral waters, magnesiac mineral waters, fluorurate mineral waters, ferrous mineral waters and sodium-rich mineral waters. Although the concerns about bottled mineral waters (due to plasticizers and endocrine disruptors), many are the health effects of natural mineral waters and several studies explored their properties and their role in different physiological and pathological conditions.

Fluoride Content of Bottled Waters in Hong Kong and Qatar

OBJECTIVES

To determine the F concentration of bottled waters that was available in Hong Kong and Qatar.

STUDY DESIGN

The F concentrations of bottled waters collected from Hong Kong (n=81) and Qatar (n=32) were analysed. The F ion selective electrode method was used to measure the F concentration in the samples. Three measurements were obtained for every sample to ensure reproducibility and appropriate statistical analyses were employed.

RESULTS

Qatar group: F concentrations ranged from 0.06 ppm to 3.0 ppm with a mean value of 0.8 ppm. The F concentrations displayed on the labels of the samples (60%) were significantly lower than the measured F concentration (p < 0.0001). Hong Kong group: F concentrations ranged from 0.04 ppm to 2.52 ppm with a mean value of 0.44 ppm. The F concentrations displayed on the samples (16%) were significantly lower than the measured F concentration (p< 0.0001).

CONCLUSION

Wide variations exist in the F concentration among the different brands of bottled water available in Hong Kong and Qatar. The F concentrations displayed on the labels were not consistent with the measured F concentrations.

Packaging waste prevention activities: A life cycle assessment of the effects on a regional waste management system

A life cycle assessment was carried out to evaluate the effects of two packaging waste prevention activities on the overall environmental performance of the integrated municipal waste management system of Lombardia region, Italy. The activities are the use of refined tap water instead of bottled water for household consumption and the substitution of liquid detergents packaged in single-use containers by those distributed 'loose' through self-dispensing systems and refillable containers. A 2020 baseline scenario without waste prevention is compared with different waste prevention scenarios, where the two activities are either separately or contemporaneously implemented, by assuming a complete substitution of the traditional product(s). The results show that, when the prevention activities are carried out effectively, a reduction in total waste generation ranging from 0.14% to 0.66% is achieved, corresponding to a 1-4% reduction of the affected packaging waste fractions (plastics and glass). However, the improvements in the overall environmental performance of the waste management system can be far higher, especially when bottled water is substituted. In this case, a nearly 0.5% reduction of the total waste involves improvements ranging mostly between 5 and 23%. Conversely, for the substitution of single-use packaged liquid detergents (0.14% reduction of the total waste), the achieved improvements do not exceed 3% for nearly all impact categories.

Water Quality Evaluation of PET Bottled Water by Mineral Balance in the Northeast Asian Region: A Case Study of South Korea

BACKGROUND

The past few years have seen a demand for drinking water in contemporary society with a focus on safety and taste. Mineral water is now marketed as a popular commercial product and, partly due to health concerns, the production.

METHODS

For the study, a comparison was carried out of water samples from 9 types of polyethylene terephthalate (PET) bottled water sold in South Korea as well as from tap water in the cities of Seoul and Chuncheon. These were compared with samples of Japanese PET bottled water in order to determine shared commonalities and identify individual characteristics. To evaluate water quality objectively, we quantified the elements contained in the water samples. Samples were assessed not with the usual sensory evaluation but with the evaluation approach advocated by Hashimoto et al. which employs the Water Index of Taste and the Water Index of Health. The levels of water quality obtained were compared with the "Prerequisites for Tasty Water" and the "Standards for Tasty Water" devised for city water.

RESULTS

The PET Bottled water varieties analyzed in this study-Seoksu, Icis, Bong Pyong, Soon Soo 100, Dong Won Saem Mul, GI JANG SOO and DIAMOND-showed the Water Index of Taste ≥ 2.0 and the Water Index of Health ≥ 5.2, which we classified as tasty/healthy water. SamDaSoo and NamiNeral can be classified as tasty water due to their values of the Water Index of Taste ≥ 2.0 and the Water Index of Health < 5.2.

CONCLUSION

The South Korean PET bottled water studied here fulfills the "Water Index of Taste," "Water Index of Health," "Standard for Tasty Water" and "Prerequisites for Tasty Water" that Japanese people value for city water. We can conclude that bottled water which meets water quality requirements will be considered good-tasting by a majority of people.

Effective Dose of Radon 222 Bottled Water in Different Age Groups Humans: Bandar Abbas City, Iran

Radon 222 is a natural radioactive element with a half-life of 3.8 days. It is odorless and colorless as well as water-soluble. Consuming waters which contain high concentration of 222Rn would increase the effective dose received by different age groups. It would also be followed by an increased prevalence of cancer. In this research, 72 samples of the most commonly used bottled water in Bandar Abbas were collected in 3 consecutive months, May, June and July of 2013. Concentration 222Rn of was measured by radon-meter model RTM166-2. The effective dose received by the 4 age groups, male and female adults as well as children and infants was estimated using the equation proposed by UNSCEAR. The results revealed that the mean and range concentration of 222Rn in bottled waters were 641±9 Bq/m3 and 0-901 Bq/m3, respectively. The mean concentration of 222Rn in the well-known Marks followed this Zam Zam>Bishe>Koohrng>Dassani>Christal>Polour>Damavand>Sivan. Infants were observed to receive a higher effective dose than children. The highest and lowest effective dose received was found to belong to male adults and children, respectively.

Survey of bisphenol A in bottled water products in Canada

A method based on isotope dilution headspace solid-phase microextraction and gas chromatography/mass spectrometry was used to assess levels of bisphenol A (BPA) in 56 samples of bottled water products sold in Canada. Levels of BPA in samples of all 51 non-polycarbonate (PC) bottled water products were lower than the method detection limit (0.50 µg l(-1)). Levels of BPA in most bottled water products in PC carboys were low, ranging from <0.50 to 1.4 µg l(-1) with an average of 0.75 µg l(-1). However, BPA was detected at levels of 8.8 and 6.5 µg l(-1) in two bottles of the bottled water products in PC carboys from the same product analysed over a 5-week period, likely due to accidental or careless exposure of the products to heat (e.g. under the sun) during storage and/or transportation for extended periods of time.

Assessing bottled water nitrate concentrations to evaluate total drinking water nitrate exposure and risk of birth defects

Previous epidemiologic studies of maternal exposure to drinking water nitrate did not account for bottled water consumption. The objective of this National Birth Defects Prevention Study (NBDPS) (USA) analysis was to assess the impact of bottled water use on the relation between maternal exposure to drinking water nitrate and selected birth defects in infants born during 1997-2005. Prenatal residences of 1,410 mothers reporting exclusive bottled water use were geocoded and mapped; 326 bottled water samples were collected and analyzed using Environmental Protection Agency Method 300.0. Median bottled water nitrate concentrations were assigned by community; mothers' overall intake of nitrate in mg/day from drinking water was calculated. Odds ratios for neural tube defects, limb deficiencies, oral cleft defects, and heart defects were estimated using mixed-effects models for logistic regression. Odds ratios (95% CIs) for the highest exposure group in offspring of mothers reporting exclusive use of bottled water were: neural tube defects [1.42 (0.51, 3.99)], limb deficiencies [1.86 (0.51, 6.80)], oral clefts [1.43 (0.61, 3.31)], and heart defects [2.13, (0.87, 5.17)]. Bottled water nitrate had no appreciable impact on risk for birth defects in the NBDPS.

Public understanding of participation in regulatory decision-making: The case of bottled water quality standards in India

"Science-based" standards are an integral part of modern regulatory systems. Studies on "public understanding of science" mostly focus on high technology areas in advanced economies. In contrast, the present study analyses the public understanding of regulation in the context of standard-setting for bottled water quality in India. Using primary data, the econometric models of this paper show that public understanding of participation in regulation depends on awareness of, and trust in, existing regulatory practices in a complex, non-linear manner. In this light, the paper argues that "deficit model" and "dialogue model" frameworks cannot be seen as two mutually exclusive frameworks of analyses.

Drinking water intake and source patterns within a US-Mexico border population

This study was undertaken to identify water intake and source patterns among a population that resides in a hot, arid region on the US-Mexico border. A cross-sectional community-based survey was conducted among households in the neighbouring cities of El Paso, TX, USA and Ciudad Juárez, Chihuahua, Mexico to obtain data on the quantity and source of water consumed. The study was also designed to identify factors that impact water consumption patterns, including gender, demographics, socio-economic status, cultural characteristics, health status, types of occupations and residences, available water sources and outdoor temperature, among many others. Of all factors studied, outdoor air temperature was found to have the strongest impact upon water intake quantity. Specifically, among the survey participants, when the outdoor air temperature exceeded 90 °F, water consumption increased by 28 %. Additionally, it was found that participants in this region consumed approximately 50 % more water than the values reported in previous studies.

Fecal indicators and bacterial pathogens in bottled water from Dhaka, Bangladesh

Forty-six bottled water samples representing 16 brands from Dhaka, Bangladesh were tested for the numbers of total coliforms, fecal indicator bacteria (i.e., thermotolerant Escherichia coli and Enterococcus spp.) and potential bacterial pathogens (i.e., Aeromonas hydrophila, Pseudomonas aeruginosa, Salmonella spp., and Shigella spp.). Among the 16 brands tested, 14 (86%), ten (63%) and seven (44%) were positive for total coliforms, E. coil and Enterococcus spp., respectively. Additionally, a further nine (56%), eight (50%), six (37%), and four (25%) brands were PCR positive for A. hydrophila lip, P. aeruginosa ETA, Salmonella spp. invA, and Shigella spp. ipaH genes, respectively. The numbers of bacterial pathogens in bottled water samples ranged from 28 ± 12 to 600 ± 45 (A. hydrophila lip gene), 180 ± 40 to 900 ± 200 (Salmonella spp. invA gene), 180 ± 40 to 1,300 ± 400 (P. aeruginosa ETA gene) genomic units per L of water. Shigella spp. ipaH gene was not quantifiable. Discrepancies were observed in terms of the occurrence of fecal indicators and bacterial pathogens. No correlations were observed between fecal indicators numbers and presence/absence of A. hydrophila lip (p = 0.245), Salmonella spp. invA (p = 0.433), Shigella spp. ipaH gene (p = 0.078), and P. aeruginosa ETA (p = 0.059) genes. Our results suggest that microbiological quality of bottled waters sold in Dhaka, Bangladesh is highly variable. To protect public health, stringent quality control is recommended for the bottled water industry in Bangladesh.

Fluoride content of commercially-available bottled water in Bangkok, Thailand

AIM

To determine the fluoride content of commercially-available bottled water in Bangkok.

METHODS

 Thirty brands of bottled water (17 bottled plain water and 13 bottled mineral water) were obtained from supermarkets in Bangkok. Two randomly-selected samples of each brand were purchased 6 months apart. A 5-mL sample was mixed with 5 mL of total ionic-strength adjusting buffer III. The fluoride content of each sample was determined in triplicate by a fluoride ion-selective electrode. Fluoride standards ranging in concentration from 0.01 to 1.00 ppm were used to calibrate the measurements. Data were analyzed by Statistical Package for the Social Sciences software, version 13.0.

RESULTS

The fluoride content of bottled water in Bangkok ranged from 0.03 to 0.72 ppm, with a mean ± standard deviation of 0.17 ± 0.16 ppm. The mean fluoride content of bottled mineral water was slightly higher than that of bottled plain water, but the difference was not statistically significant.

CONCLUSIONS

Most commercially-available bottled water in Bangkok contains negligible amounts of fluoride. This serves as baseline data for dentists prescribing a fluoride supplement to make the utmost use of the fluoride caries preventive effect, while avoiding adverse effects, such as dental fluorosis.

Bottled water: United States consumers and their perceptions of water quality

Consumption of bottled water is increasing worldwide. Prior research shows many consumers believe bottled water is convenient and has better taste than tap water, despite reports of a number of water quality incidents with bottled water. The authors explore the demographic and social factors associated with bottled water users in the U.S. and the relationship between bottled water use and perceptions of the quality of local water supply. They find that U.S. consumers are more likely to report bottled water as their primary drinking water source when they perceive that drinking water is not safe. Furthermore, those who give lower ratings to the quality of their ground water are more likely to regularly purchase bottle water for drinking and use bottle water as their primary drinking water source.

Polyethylene terephthalate may yield endocrine disruptors

BACKGROUND

Recent reports suggest that endocrine disruptors may leach into the contents of bottles made from polyethylene terephthalate (PET). PET is the main ingredient in most clear plastic containers used for beverages and condiments worldwide and has previously been generally assumed not to be a source of endocrine disruptors.

OBJECTIVE

I begin by considering evidence that bottles made from PET may leach various phthalates that have been putatively identified as endocrine disruptors. I also consider evidence that leaching of antimony from PET containers may lead to endocrine-disrupting effects.

DISCUSSION

The contents of the PET bottle, and the temperature at which it is stored, both appear to influence the rate and magnitude of leaching. Endocrine disruptors other than phthalates, specifically antimony, may also contribute to the endocrine-disrupting effect of water from PET containers.

CONCLUSIONS

More research is needed in order to clarify the mechanisms whereby beverages and condiments in PET containers may be contaminated by endocrine-disrupting chemicals.

Reduction in urinary arsenic with bottled-water intervention

The study was conducted to measure the effectiveness of providing bottled water in reducing arsenic exposure. Urine, tap-water and toenail samples were collected from non-smoking adults residing in Ajo (n=40) and Tucson (n=33), Arizona, USA. The Ajo subjects were provided bottled water for 12 months prior to re-sampling. The mean total arsenic (microg/L) in tap-water was 20.3+/-3.7 in Ajo and 4.0+/-2.3 in Tucson. Baseline urinary total inorganic arsenic (microg/L) was significantly higher among the Ajo subjects (n=40, 29.1+/-20.4) than among the Tucson subjects (n=32, 11.0+/-12.0, p<0.001), as was creatinine-adjusted urinary total inorganic arsenic (microg/g) (35.5+/-25.2 vs 13.2+/-9.3, p<0.001). Baseline concentrations of arsenic (microg/g) in toenails were also higher among the Ajo subjects (0.51+/-0.72) than among the Tucson subjects (0.17+/-0.21) (p<0.001). After the intervention, the mean urinary total inorganic arsenic in Ajo (n=36) dropped by 21%, from 29.4+/-21.1 to 23.2+/-23.2 (p=0.026). The creatinine-adjusted urinary total inorganic arsenic and toenail arsenic levels did not differ significantly with the intervention. Provision of arsenic-free bottled water resulted in a modest reduction in urinary total inorganic arsenic.

Comparison of the mineral content of tap water and bottled waters

OBJECTIVES

Because of growing concern that constituents of drinking water may have adverse health effects, consumption of tap water in North America has decreased and consumption of bottled water has increased. Our objectives were to 1) determine whether North American tap water contains clinically important levels of calcium (Ca2+), magnesium (Mg2+), and sodium (Na+) and 2) determine whether differences in mineral content of tap water and commercially available bottled waters are clinically important.

DESIGN

We obtained mineral analysis reports from municipal water authorities of 21 major North American cities. Mineral content of tap water was compared with published data regarding commercially available bottled waters and with dietary reference intakes (DRIs).

MEASUREMENTS AND MAIN RESULTS

Mineral levels varied among tap water sources in North America and among bottled waters. European bottled waters generally contained higher mineral levels than North American tap water sources and North American bottled waters. For half of the tap water sources we examined, adults may fulfill between 8% and 16% of their Ca2+ DRI and between 6% and 31% of their Mg2+ DRI by drinking 2 liters per day. One liter of most moderate mineralization European bottled waters contained between 20% and 58% of the Ca2+ DRI and between 16% and 41% of the Mg2+ DRI in adults. High mineralization bottled waters often contained up to half of the maximum recommended daily intake of Na+.

CONCLUSION

Drinking water sources available to North Americans may contain high levels of Ca2+, Mg2+, and Na+ and may provide clinically important portions of the recommended dietary intake of these minerals. Physicians should encourage patients to check the mineral content of their drinking water, whether tap or bottled, and choose water most appropriate for their needs.

Examination of Bottled Water for Nontuberculous Mycobacteria

The objective of this study was to examine bottled water for the presence of nontuberculous mycobacteria as a potential source of infection in AIDS patients. Twenty brands of bottled water commonly used in the Los Angeles area were tested for the presence of nontuberculous mycobacteria. The three brands most commonly used in the Los Angeles area were tested most frequently. Sixty-nine samples were filtered and the filters were treated using cetylpyridinium chloride, sodium hydroxide, or oxalic acid (or a combination of these) as decontaminants to remove background flora. An aliquot of each sample was untreated. The filters were placed on selective Middlebrook 7H10 agar plates containing 500 μg of cycloheximide per ml. Plates were examined at 3 and 8 weeks. No acid-fast organisms were found. Although no nontuberculous mycobacteria were observed in any samples tested, before recommending the use of bottled water as an alternative to tap water by high-risk patients, the possible presence of other contaminants must be considered.