Risk-benefit assessment of methylmercury and n-3 polyunsaturated fatty acids through fish intake by pregnant women in Shanghai, China: Findings from the Shanghai Diet and Health Survey.

BACKGROUND: Fish and shellfish contain nutrients essential for fetal health, especially docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). The concern of mercury (Hg) pollution limits fish consumption among women in pregnancy, which could adversely affect child development. This study aimed to conduct risk-benefit assessment and provide recommendations for fish intake by pregnant women in Shanghai, China. METHODS: Secondary analysis was conducted using cross-sectional data from a representative sample of the Shanghai Diet and Health Survey (SDHS) (2016-2017), China. Dietary intakes of Hg and DHA + EPA were calculated from the food frequency questionnaire (FFQ) on fish items and 24hr recall record. Raw fish samples (59 common species of fish in Shanghai) were purchased in local markets and their concentrations of DHA, EPA and Hg were measured. Net IQ points gain was used to evaluate the health risk and benefit at a population level by FAO/WHO model. Recommended fish (i.e., high- DHA + EPA and low-level MeHg) were defined, and then the proportion of those hit 5.8 IQ points were simulated with their consumption frequency for 1, 2 and 3 times per week. RESULTS: The average consumption of fish and shellfish was 66.24 g/d among pregnant women in Shanghai. The mean concentrations of Hg and EPA + DHA in fish species most commonly consumed in Shanghai were 0.179 mg/kg and 0.374 g/100 g, respectively. Only 1.4% of the population exceeded the MeHg reference dose of 0.1 µg/kg·bw/d, whereas 81.3% of those who did not meet the recommended daily intakes of 250 mg EPA + DHA. In FAO/WHO model, the proportion of 28.4% reached the maximum IQ points gain. Along with the increase of "recommended fish" consumed, the simulated values of the proportion raised to 74.5, 87.3 and 91.9%, respectively. CONCLUSION: The pregnant women in Shanghai, China had an adequate fish consumption with low-level Hg exposure, but balancing the benefits of fish intake and risk of potential Hg exposure was still a challenge. It is necessary to define a local level of "recommended fish" consumption for developing dietary recommendations for pregnant women.

Physiologically-based toxicokinetic modeling of human dermal exposure to diethyl phthalate: Application to health risk assessment.

Diethyl phthalate (DEP) has been most frequently detected in personal care products (PCPs) as a solvent followed by indoor air as one of the semi-volatile organic compounds (SVOCs). Human exposure to DEP predominantly occurs via dermal uptake. However, the available physiologically based toxicokinetics (PBTK) models are developed in rats for risk assessment of DEP exposure resulting from the oral than dermal pathway. To address this issue, DEP in simulated PCPs was dermally administrated to five adult volunteers at real population levels. Following the construction of a dermal absorption model for DEP, the dermal PBTK modeling of DEP involving PCPs and air-to-skin exposure routes in humans was developed for the first time. The data of monoethyl phthalate (MEP) in serum or urine obtained from published human studies and this study were applied to calibrate and validate the developed dermal PBTK model. Monte Carlo simulation was used to evaluate model uncertainty. The dermal absorption fraction of DEP was obtained to be 56.2% for PCPs exposure and 100% for air-to-skin exposure, respectively. Approximate 24.9% of DEP in exposed skin became absorbed into systemic circulation. Model predictions were generally within 2-fold of the observed MEP levels in human serum or urine. Uncertainty analysis showed 90% of the predicted variability (P95/P5) fell within less than one order of magnitude. Assuming human intake of 5 mg/kg bw per day, the predicted serum area under the curve at steady state of DEP from the dermal route was 1.7 (PCPs) and 2.4 (air) times of those from the peroral route, respectively. It suggested that dermal exposure to DEP would pose greater risk to human health compared with oral exposure. The application of the developed dermal PBTK model provides a valuable insight into health risk assessment of DEP in humans.

Exposure to melamine and its derivatives in Chinese adults: The cumulative risk assessment and the effect on routine blood parameters.

Melamine (MEL) and its derivatives, ammeline (AMN), ammelide (AMD), cyanuric acid (CYA) are widely existed in environmental media. Animal studies have reported the cumulative risk assessment (CRA) of simultaneous exposure to MEL and its derivatives and explored the associations between exposure and routine blood parameters. Such information is largely unknown in human studies. In this study, we detected the urinary concentrations of MEL and its derivatives in 239 Chinese adults to conduct the CRA by evaluating their hazard quotients (HQ) and hazard Index (HI), and also explored the possible associations between exposure and measured routine blood parameters in study population. The detectable frequencies of MEL, AMN, AMD and CYA were 96.65%, 41.00%, 97.91% and 97.07%, respectively. The median values of creatinine (Cr)-adjusted MEL, AMN, AMD, CYA and the total concentrations of MEL and its derivatives (∑MEL) were 11.41 µg/g Cr, not detected (ND), 2.64 µg/g Cr, 15.30 µg/g Cr, 35.02 µg/g Cr, respectively. There were 9 (3.77%) participants with estimated daily intakes (EDIs) of CYA exceeding the tolerable daily intake (TDI) of 2500 ng/kg bw/day, and 12 (5.02%) participants with HI of ∑MEL exposure exceeding 1 based on the strictest TDI value. Urinary concentrations of MEL and its derivatives were positively associated with specific routine blood parameters, including hematocrit, hemoglobin, mean corpuscular volume, mean corpuscular hemoglobin concentration, mean corpuscular hemoglobin, white blood cell, neutrophil count (P < 0.05). Meanwhile, exposure to MEL and its derivatives increased the risk of red blood cell abnormality (P < 0.05). Our study is the first study to provide evidence-based data on the CRA of exposure to MEL and its derivatives in Chinese adults, and to propose a possible association between such exposure and routine blood parameters in human.

Bayesian toxicokinetic modeling of cadmium exposure in Chinese population.

Cadmium (Cd) is a toxic heavy metal widely present in the environment. Estimating its internal levels for a given external exposure using toxicokinetic (TK) models is key to the human health risk assessment of Cd. In this study, existing Cd TK models were adapted to develop a one-compartment TK model and a multi-compartment physiologically based toxicokinetic (PBTK) model by estimating the characteristics of Cd kinetics based on Cd exposure data from 814 Chinese residents. Both models not only considered the effect of gender difference on Cd kinetics, but also described the model parameters in terms of distributions to reflect individual variability. For both models, the posterior distributions of sensitive parameters were estimated using the Markov chain-Monte Carlo method (MCMC) and the approximate Bayesian computation-MCMC algorithm (ABC-MCMC). Validation with the test dataset showed 1.4-22.5% improvement in the root mean square error (RMSE) over the original models. After a systematic literature search, the optimized models showed acceptable prediction on other Chinese datasets. The study provides a method for parameter optimization of TK models under different exposure environment, and the validated models can serve as new quantitative assessment tools for the risk assessment of Cd in the Chinese population.

The development of a Chinese Healthy Eating Index for School-age Children and its Application in children from China Health and Nutrition Survey.

This study aimed to develop a Chinese Healthy Eating Index for School-age Children (CHEI-SC), apply it in the 2011 China Health and Nutrition Survey (CHNS) to assess dietary quality, and compared it with our former developed index named CHEI. Data of 3-day 24-hour diet recalls and household food inventory survey from 1600 school-age children in CHNS-2011 were used to develop the CHEI-SC, using the methods of standard portion size, energy-density-based approach, and least restrictive approach. The CHEI-SC included 19 components with a total score (T-score) ranging from 0 to 100. The investigated children had a median score of 49.6. Children with a higher T-score were more likely to have higher social economic status (SES), higher level of urbanisation, fewer family size, and regularly attending school. The CHEI-SC was able to assess dietary quality of Chinese school-age children, was sensitive to demographics, and more comprehensive and accurate than the CHEI.

Factors associated with exposure of pregnant women to perfluoroalkyl acids in North China and health risk assessment.

Perfluoroalkyl acids (PFAAs) have been frequently found in blood of pregnant women, but the predictors and potential health risk have not been well studied in China. We recruited 534 pregnant women in Tangshan City of Hebei Province in North China between 2013 and 2014 and measured five PFAAs in serum during their early term of pregnancy, including perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), perfluorohexane sulfonic acid (PFHxS), perfluoro­n­undecanoic acid (PFUdA), and perfluorononanoic acid (PFNA). We explored the factors associated with the levels of serum PFAAs and assessed associated health risks. Food consumption information was obtained by food frequency questionnaire covering 100 items. Multiple linear regression model was used to determine the associations of sociodemographic, anthropometric, and food factors with the concentrations of serum PFAAs. Some PFAAs in serum were positively associated with age and body mass index (BMI). Consumption of beans, aquatic products, and eggs was positively associated with the concentrations of several PFAAs after adjusting for important covariates. Pregnant women who ate more cereal, vegetables, mushrooms and alga tended to have lower levels of serum PFOA, PFOS and PFNA. The Hazard index (HI) for reproductive toxicity and developmental toxicity was below 0.8, and the HI for hepatotoxicity beyond 1 was found in 0.37% of pregnant women. These results suggested that age, BMI, and some food consumption were predictors for the exposure to PFAAs in Chinese pregnant women. More attention should be paid to the hepatotoxicity for these exposures.

Exposure of Adults to Antibiotics in a Shanghai Suburban Area and Health Risk Assessment: A Biomonitoring-Based Study.

An extensive exposure to antibiotics has been demonstrated in children and pregnant women by biomonitoring, but data from general adults remain limited. In the current study, we studied 822 adults aged 21-75 years in Shanghai in 2017 and analyzed 18 common antibiotics (five veterinary antibiotics (VAs), four human antibiotics (HAs), and nine human/veterinary antibiotics (H/VAs)) in spot urine by liquid chromatography coupled to high-resolution mass spectrometry. All 18 antibiotics were detected in urine with an overall detection frequency of 45.9% and the detection frequency for each ranged from 0.1% to 15.2%. HAs, VAs, H/VAs, and VAs+H/VAs were detected in 4.4%, 11.6%, 38.0, and 44.5% of urine samples, respectively. Adults with the sum of estimated daily exposure dose of all the antibiotics below 1.55 µg/kg/day accounted for 89.1% of adults tested positive. A hazard index value beyond one was seen in 7.2% of adults based on microbiological effect. Ciprofloxacin was the biggest contributor to HI and its hazard quotient value more than one was seen in 5.6% of adults. These findings indicated an extensive exposure to low-dose multiple antibiotics in adults in Shanghai and some adults were at health risk related to the disturbance of gut microbiota.

Predictors of urinary antibiotics in children of Shanghai and health risk assessment.

BACKGROUND: An extensive exposure to antibiotics has been confirmed in children, but the predictors and potential health risk remain unclear. OBJECTIVE: To investigate the predictors of antibiotics in urine and potential health risk in children of Shanghai. METHODS: We selected 284 school children aged 8-11 years from a central area of Shanghai, China, in 2017. Ultra-performance liquid chromatography coupled with high-resolution mass spectrometry was used to measure 20 antibiotics, including four human antibiotics (HAs), six veterinary antibiotics (VAs), 10 human/veterinary antibiotics (H/VAs), and three metabolites in first morning urine. Logistic regression model was used to examine the associations of 17 variables related to demographic and socioeconomic factors, recent antibiotic use, drinking water intake, food consumption, and anthropometric measurements with the detection frequency of HAs, VAs, or H/VAs in urine. After daily intake was estimated, health risk was assessed for VAs and H/VAs by using hazard quotient (HQ) and hazard index (HI) based on microbiological or toxicological effects. RESULTS: The detection frequencies of 20 antibiotics and three metabolites ranged from 0 to 27.8% with an overall detection frequency being 56.0%. The detection frequency of HAs increased with age and screen time at weekend. Sex, age, family income and screen time were positively associated with the detection frequencies of VAs and H/VAs. Children reporting antibiotic use in the past three months had a higher detection frequency of HAs. Children with a higher consumption frequency of dairy products had a higher detection frequency of VAs + H/VAs, but a lower detection frequency of HAs. An increased overall detection frequency of all antibiotics was seen in children with higher consumption frequencies of aquatic products, livestock and poultry meat, or milk and dairy products. HQ >1 was only found for ciprofloxacin (5.6%) and ofloxacin (0.4%) based on microbiological effect. HI >1 was found in 6.0% of children for microbiological effect and none was found for toxicological effect. CONCLUSIONS: Predictors for antibiotics in urine for children included sex, age, family income, screen time, clinical use, and animal-derived food consumption. There was potential health risk for children with exposure to antibiotics.

Evaluation of the Validity and Reliability of the Chinese Healthy Eating Index.

The Chinese Healthy Eating Index (CHEI) is a measuring instrument of diet quality in accordance with the Dietary Guidelines for Chinese (DGC)-2016. The objective of the study was to evaluate the validity and reliability of the CHEI. Data from 12,473 adults from the China Health and Nutrition Survey (CHNS)-2011, including 3-day-24-h dietary recalls were used in this study. The CHEI was assessed by four exemplary menus developed by the DGC-2016, the general linear models, the independent t-test and the Mann-Whitney U-test, the Spearman's correlation analysis, the principal components analysis (PCA), the Cronbach's coefficient, and the Pearson correlation with nutrient intakes. A higher CHEI score was linked with lower exposure to known risk factors of Chinese diets. The CHEI scored nearly perfect for exemplary menus for adult men (99.8), adult women (99.7), and the healthy elderly (99.1), but not for young children (91.2). The CHEI was able to distinguish the difference in diet quality between smokers and non-smokers (P < 0.0001), people with higher and lower education levels (P < 0.0001), and people living in urban and rural areas (P < 0.0001). Low correlations with energy intake for the CHEI total and component scores (|r| < 0.34, P < 0.01) supported the index assessed diet quality independently of diet quantity. The PCA indicated that underlying multiple dimensions compose the CHEI, and Cronbach's coefficient α was 0.22. Components of dairy, fruits and cooking oils had the greatest impact on the total score. People with a higher CHEI score had not only a higher absolute intake of nutrients (P < 0.001), but also a more nutrient-dense diet (P < 0.001). Our findings support the validity and reliability of the CHEI when using the 3-day-24-h recalls.

The Development of a Chinese Healthy Eating Index and Its Application in the General Population.

The objective of this study was to develop a Chinese Healthy Eating Index (CHEI) based on the updated Dietary Guidelines for Chinese (DGC-2016) and to apply it in the 2011 China Health and Nutrition Survey (CHNS-2011) to assess diet quality and its association with typical sociodemographic/economic factors. Data from 14,584 participants (≥2 years) from the CHNS-2011, including three 24-h dietary recalls and additional variables, were used to develop the CHEI. The standard portion size was applied to quantify food consumption. The CHEI was designed as a continuous scoring system, comprising 17 components; the maximum total score is 100. The mean, 1st and 99th percentiles of the CHEI score were 52.4, 27.6 and 78.3, respectively. Young and middle-aged adults scored better than the elderly. Diet insufficiency was chiefly manifested in fruits, dairy, whole grains and poultry; diet excess was mainly reflected in red meat, cooking oils and sodium. The CHEI was positively associated with education and urbanization levels; current smokers and unmarried people obtained relative low CHEI scores. Occupation and body mass index (BMI) were also related to the CHEI. Our findings indicate that the CHEI is capable of recognizing differences in diet quality among the Chinese, and it is sensitive to typical sociodemographic/economic factors.

Urinary Antibiotics of Pregnant Women in Eastern China and Cumulative Health Risk Assessment.

Exposure to antibiotics during pregnancy can pose a systematic effect on human health. A few biomonitoring studies have demonstrated an extensive exposure of children to antibiotics, but there is still a lack of data for pregnant women. To assess the exposure of pregnant women to antibiotics and potential health risk, we investigated 536 pregnant women aged 16-42 years from two geographically different study sites in Eastern China in 2015. We measured 21 antibiotics of five categories (seven fluoroquinolones, three phenicols, four tetracyclines, three macrolides, and four sulfonamides) in urine using the isotope dilution ultraperformance liquid chromatography coupled to quadrupole time-of-flight mass spectrometry. The hazard index (HI) was calculated on the basis of estimated daily exposure dose and acceptable daily intakes. A total of 16 antibiotics were found in urine, with detection frequencies between 0.2 and 16.0%. Antibiotics were overall detected in 41.6% of urine, and two or more antibiotics were detected in 13.1% of urine. Ciprofloxacin, ofloxacin, and trimethoprim were most frequently detected in urine, with detection frequencies between 10 and 20%. The majority of the antibiotics tested had an estimated daily exposure dose less than 1 µg/kg/day, and 4.3% of pregnant women had a HI value of more than 1. These findings indicated that pregnant women were frequently exposed to antibiotics and some individuals were in the potential risk of adverse microbiological effects induced by antibiotics.

[Dietary exposure assessment of deoxynivalenol and its acetylate & derivatives in wheat flour in Shanghai].

OBJECTIVE: To assess the dietary exposure of Shanghai residents to a compound of deoxynivalenol (DON) and its acetylated derivatives, 3-acetyl-deoxynivalenol (3-Ac-DON) and 15-acetyl-deoxynivalenol (15-Ac-DON) through wheat flour. METHODS: DON, 3-Ac-DON and 15-Ac-DON in wheat flour collected from 2011 to 2013 were respectively analyzed by high performance liquid chromatography tandem mass spectrometry. (HPLC-MS/MS) method and the total content of the compound was calculated. Dietary intake assessments of the compound through wheat flour were carried out in combination of wheat flour consumption data of Shanghai residents with the compound content data using both the point estimate method and the probabilistic assessment method. Group provisional maximum tolerable daily intake(PMTDI, 1 jg/(kg BW- d) )of the compound was used to assess the risk of the exposure. RESULTS: (1) At the mean and 50th percentile consumption level of wheat flour, the dietary exposure of people to the compound accounted for 18%-83% of PMTDI based on different content levels (mean and the 50th, 75th, 90th and 95th percentiles) of the compound. At the 95th percentile consumption level of wheat flour, the exposure was 1.08-2.55 times higher than PMTDI based on different toxin levels (mean and the 50th, 75th, 90th and 95th percentiles). (2) 89.99% of total Shanghai residents, 87.00% of Shanghai wheat flour consumers, and 76.55% of Shanghai residents under 15 years old had a daily exposure to the compound lower than PMTDI. CONCLUSION: The dietary exposure of Shanghai residents to the compound of DON, 3-Ac-DON and 15-Ac-DON increased along with the increase of wheat flour consumption. Most of the residents were safe through wheat flour consumption, but still 10.01% of the population was at risk, and residents under 15 years old were a high-risk group for the compound exposure.

Exposure assessment of dietary cadmium: findings from Shanghainese over 40 years, China.

BACKGROUND: Environmental exposure to cadmium causes renal dysfunction and bone damage. Cadmium contamination in food is regarded as the main environmental source of non-occupational exposure. The aim of this study was to assess the contribution of dietary cadmium exposure in environmental cadmium exposure and its health risk among adults in Shanghai, China. METHODS: A cross-sectional survey about food consumption was conducted in 2008 among 207 citizens aged over 40 years in Shanghai, China. The food frequency questionnaire was combined with food, tobacco and water cadmium exposure to estimate the daily environmental cadmium exposure in both point and probabilistic estimations. Urine and blood samples of the participants were analyzed for internal exposure to total cadmium. Correlation analysis was conducted between the internal cadmium exposure and environmental cadmium exposure. RESULTS: According to the point estimation, average daily environmental cadmium exposure of the participants was 16.7 µg/day and approached 33.8% of the provisional tolerable daily intake (PTDI). Dietary and tobacco cadmium exposure approached 25.8% and 7.9% of the PTDI, respectively. Males had higher levels of dietary cadmium exposure than females (p?=?0.002). The probabilistic model showed that 93.4% of the population did not have any health risks from dietary cadmium exposure. By sensitivity analysis, tobacco consumption, tobacco cadmium level, cadmium in vegetables and cadmium in rice accounted for 27.5%, 24.9%, 20.2% and 14.6% of the total cadmium exposure, respectively. The mean values of urinary and blood cadmium among the study population were 0.5 µg/L and 1.9 µg/L, respectively. Positive correlations were observed between environmental cadmium exposure and blood cadmium (R?=?0.52, P<0.01), tobacco cadmium intake and blood cadmium excluding non-smokers (R?=?0.26, P?=?0.049<0.05), and urine cadmium and age (R?=?0.15, P?=?0.037). CONCLUSIONS: It has been suggested that there is no increased health risk among adult residents in Shanghai, China because of recent total cadmium exposure. Vegetables and rice were the main sources of dietary cadmium intake. Tobacco cadmium exposure, which accounted for approximately 25% of the total dietary cadmium exposure, was another important source of non-occupational cadmium exposure.

Occurrence of regulated and emerging iodinated DBPs in the Shanghai drinking water.

Drinking water chlorination plays a pivotal role in preventing pathogen contamination against water-borne disease. However, chemical disinfection leads to the formation of halogenated disinfection by products (DBPs). Many DBPs are highly toxic and are of health concern. In this study, we conducted a comprehensive measurements of DBPs, including iodoacetic acid (IAA), iodoform (IF), nine haloacetic acids and four trihalomethanes in drinking waters from 13 water plants in Shanghai, China. The results suggested that IAA and IF were found in all the water treatment plants, with maximum levels of 1.66 µg/L and 1.25 µg/L for IAA and IF, respectively. Owing to deterioration of water quality, the Huangpu River has higher IAA and IF than the Yangtze River. Our results also demonstrated that low pH, high natural organic matter, ammonia nitrogen, and iodide in source waters increased IAA and IF formation. Compared to chlorine, chloramines resulted in higher concentration of iodinated DBP, but reduced the levels of trihalomethanes. This is the first study to reveal the widespread occurrence of IAA and IF in drinking water in China. The data provide a better understanding on the formation of iodinated disinfection byproducts and the findings should be useful for treatment process improvement and disinfection byproducts controls.

Change of water consumption and its potential influential factors in Shanghai: a cross-sectional study.

BACKGROUND: Different water choices affect access to drinking water with different quality. Previous studies suggested social-economic status may affect the choice of domestic drinking water. The aim of this study is to investigate whether recent social economic changes in China affect residents' drinking water choices. METHODS: We conducted a cross-sectional survey to investigate residents' water consumption behaviour in 2011. Gender, age, education, personal income, housing condition, risk perception and personal preference of a certain type of water were selected as potential influential factors. Univariate and backward stepwise logistic regression analyses were performed to analyse the relation between these factors and different drinking water choices. Basic information was compared with that of a historical survey in the same place in 2001. Self-reported drinking-water-related diarrhoea was found correlated with different water choices and water hygiene treatment using chi-square test. RESULTS: The percentage of tap water consumption remained relatively stable and a preferred choice, with 58.99% in 2001 and 58.25% in 2011. The percentage of bottled/barrelled water consumption was 36.86% in 2001 and decreased to 25.75% in 2011. That of household filtrated water was 4.15% in 2001 and increased to 16.00% in 2011. Logistic regression model showed strong correlation between one's health belief and drinking water choices (P < 0.001). Age, personal income, education, housing condition, risk perception also played important roles (P < 0.05) in the models. Drinking-water-related diarrhoea was found in all types of water and improper water hygiene behaviours still existed among residents. CONCLUSIONS: Personal health belief, housing condition, age, personal income, education, taste and if worm ever founded in tap water affected domestic drinking water choices in Shanghai.

[Risk assessment of fluoride exposure to pork and offal products of pigs in Shanghai City].

OBJECTIVE: To estimate the exposure of fluoride to pork and offal products of pigs and assess their health risks in Shanghai residents. METHODS: Conducting a dietary survey in 1630 residents cluster sampled from four districts in Shanghai. Detecting fluoride in 872 pork and offal samples, and using Monte Carlo method to estimate the chronic daily intake (CDI) and hazard quotient (HQ) of fluoride in Shanghai residents caused by eating pork and offal products of pigs. RESULT: The CDI of fluoride is less than the tolerable daily intake (TDI), and the HQ is less than 1. The intake of pork and offal product is less in elder people than young people (P < 0.05), and that is less in female than male (P < 0.05). The fluoride content in offal is higher than that in pork (P < 0.05), the fluoride in kidney (P < 0.05) and liver (P < 0.05) is higher than that in other viscera. CONCLUSION: The intake of fluoride from pork and offal products in Shanghai residents is lower than the TDI of fluoride and not reaching the risk level of fluoride causing dental fluorosis, unhealthy of bone and osteofluorosis.