Intelligence gain and social cost savings attributable to environmental lead exposure reduction strategies since the year 2000 in Flanders, Belgium.

BACKGROUND: Recent lead (Pb) exposure reduction strategies enabled to lower children's blood lead levels (B-Pb) worldwide. This study reports the estimated intelligence gain and social cost savings attributable to recent exposure reduction based on reported B-Pb levels observed in adolescents sampled within the framework of the Flemish Environment and Health Studies (FLEHS, Belgium), i.e. in 2003-2004 (FLEHSI), in 2008-2009 (FLEHSII), and in 2013-2014 (FLEHSIII). METHODS: Intelligence Quotient (IQ) loss per 100,000 individuals - attributable to B-Pb above 20 µg/L - was estimated based on widely accepted dose response functions between children's B-Pb and IQ (- 1.88 IQ points for a duplication in B-Pb from 20 µg/L onwards; 95% Confidence Interval (CI): - 1.16;-2.59) and B-Pb exposure distribution parameters of FLEHS studies. The results were translated to the Flemish population of 15-year-olds. Given a 3-year time gap between subsequent sampling periods, the exposure distribution of each study was assumed 3 years prior to the study as well. Economic impact was estimated based on expected decrease in lifetime earnings (€ 19,464 per decreasing IQ point in 2018). RESULTS: The percentage of the adolescent population exceeding a B-Pb of 20 µg/L decreased from 57% (FLEHSI) to 23% (FLEHSII), and even further to 2.5% (FLEHSIII). The estimated IQ loss per 100,000 individuals was 94,280 (95% CI: 58,427-130,138) in FLEHSI, 14,993 (95% CI: 9289-20,695) in FLEHSII, and 976 (95% CI: 604-1347) in FLEHSIII. This translates into a total loss of 378,962 (95%CI: 234,840-523,091) IQ points within the Flemish population of 15-year-olds between 2000 and 2014. Assuming that current exposure levels do not reincrease, the expected IQ loss during the subsequent period of 15 years is estimated to be maximally 10,275 (95%CI: 6363-14,182) points. CONCLUSIONS: 7176 (95%CI: 4447-9905) million € of social cost savings were achieved by Pb reduction strategies in Flanders over 15 years. If current exposure levels further reduce to B-Pb below 20 µg/L for the whole population, social cost savings may increase up to 7376 (95%CI: 4571-10,181) million €. Given the relatively low lead contamination in Flanders, the global impact of ongoing reduction strategies is expected to be tremendous.

Socio-Economic Status and Health: Evaluation of Human Biomonitored Chemical Exposure to Per- and Polyfluorinated Substances across Status.

Research on the environment, health, and well-being nexus (EHWB) is shifting from a silo toward a systemic approach that includes the socio-economic context. To disentangle further the complex interplay between the socio-exposome and internal chemical exposure, we performed a meta-analysis of human biomonitoring (HBM) studies with internal exposure data on per-and polyfluoroalkyl substances (PFASs) and detailed information on risk factors, including descriptors of socio-economic status (SES) of the study population. PFASs are persistent in nature, and some have endocrine-disrupting properties. Individual studies have shown that HBM biomarker concentrations of PFASs generally increase with SES indicators, e.g., for income. Based on a meta-analysis (five studies) of the associations between PFASs and SES indicators, the magnitude of the association could be estimated. For the SES indicator income, changes in income were expressed by a factor change, which was corrected by the Gini coefficient to take into account the differences in income categories between studies, and the income range between countries. For the SES indicator education, we had to conclude that descriptors (

Assessing multimedia/multipathway exposures to inorganic arsenic at population and individual level using MERLIN-Expo.

In this study, we report on model simulations performed using the newly developed exposure tool, MERLIN-Expo, in order to assess inorganic arsenic (iAs) exposure to adults resulting from past emissions by non-ferrous smelters in Belgium (Northern Campine area). Exposure scenarios were constructed to estimate external iAs exposure as well as the toxicologically relevant As (tAs, i.e., iAs, MMA and DMA) body burden in adults living in the vicinity of the former industrial sites as compared to adults living in adjacent areas and a reference area. Two scenarios are discussed: a first scenario studying exposure to iAs at the aggregated population level and a second scenario studying exposure at the individual level for a random sub-sample of subjects in each of the three different study areas. These two scenarios only differ in the type of human related input data (i.e., time-activity data, ingestion rates and consumption patterns) that were used, namely averages (incl. probability density functions, PDFs) in the simulation at population level and subject-specific values in the simulation at individual level. The model predictions are shown to be lower than the corresponding biomonitoring data from the monitoring campaign. Urinary tAs levels in adults, irrespective of the area they lived in, were under-predicted by MERLIN-Expo by 40% on average. The model predictions for individual adults, by contrast, under-predict the biomonitoring data by 7% on average, but with more important under-predictions for subjects at the upper end of exposure. Still, average predicted urinary tAs levels from the simulations at population level and at individual level overlap, and, at least for the current case, lead to similar conclusions. These results constitute a first and partial verification of the model performance of MERLIN-Expo when dealing with iAs in a complex site-specific exposure scenario, and demonstrate the robustness of the modelling tool for these situations.

Multimedia & PBPK modelling with MERLIN-Expo versus biomonitoring for assessing Pb exposure of pre-school children in a residential setting.

This paper reports on a case study - conducted within the European FP7 project "4FUN" - focusing on exposure of pre-school children to lead resulting from past emissions by non-ferrous smelters in Belgium (Northern Campine area). Exposure scenarios were constructed and simulated with the MERLIN-Expo tool to estimate external Pb exposure as well as the Pb body burden in children living in the vicinity of the former industrial sites as compared to children living in adjacent areas and a reference area. Simulations were run for several scenarios ranging from very simple to rather complex in order to study the effect of different simulation approaches (e.g., deterministic vs. probabilistic, individual vs. aggregated population exposure) and different exposure scenarios (e.g., with vs. without considering local food consumption or time activity patterns) on the model outcomes (predicted concentrations of Pb in environmental and human matrices). This paper discusses the two most complex scenarios, namely exposure at the aggregated population level and at the individual level for a random sub-sample of subjects, respectively. In the final and most realistic exposure scenario, simulating individual lead exposure, model predictions were shown to be higher than the biomonitoring data. Blood Pb levels in children, irrespective of the area they lived in, were overpredicted by MERLIN-Expo with a factor of about 2 on average. The model predictions for individual children overlap with the prediction interval calculated by MERLIN-Expo based on population averages, demonstrating the use of probabilistic approaches in risk assessment. While these results constitute a first verification of the model performance of MERLIN-Expo dealing with inorganic pollutants in a complex real-world exposure scenario and a demonstration of the robustness of the modelling tool, further validation and benchmarking efforts are required for a larger number of inorganic pollutants and different exposure settings.

Key aspects of a Flemish system to safeguard public health interests in case of chemical release incidents.

Although well-established protocols are available for emergency services and first-responders in case of chemical release incidents, a well-developed system to monitor and safeguard public health was, until recently, lacking in Flanders. We therefore developed a decision support system (DSS) to aid public health officials in identifying the appropriate actions in case of incidents. Although the DSS includes human biomonitoring as one of its key instruments, it also goes well beyond this instrument alone. Also other, complementary, approaches that focus more on effect assessment using in vitro toxicity testing, indirect exposures through the food chain, and parallel means of data collection (e.g. through ecosurveillance or public consultation), are integrated in the Flemish approach. Even though the DSS is set up to provide a flexible and structured decision tree, the value of expert opinion is deemed essential to account for the many uncertainties associated with the early phases of technological incidents. When the DSS and the associated instruments will be fully operational, it will provide a valuable addition to the already available protocols, and will specifically safeguard public health interests.

Application of the maximum cumulative ratio (MCR) as a screening tool for the evaluation of mixtures in residential indoor air.

The maximum cumulative ratio (MCR) method allows the categorisation of mixtures according to whether the mixture is of concern for toxicity and if so whether this is driven by one substance or multiple substances. The aim of the present study was to explore, by application of the MCR approach, whether health risks due to indoor air pollution are dominated by one substance or are due to concurrent exposure to various substances. Analysis was undertaken on monitoring data of four European indoor studies (giving five datasets), involving 1800 records of indoor air or personal exposure. Application of the MCR methodology requires knowledge of the concentrations of chemicals in a mixture together with health-based reference values for those chemicals. For this evaluation, single substance health-based reference values (RVs) were selected through a structured review process. The MCR analysis found high variability in the proportion of samples of concern for mixture toxicity. The fraction of samples in these groups of concern varied from 2% (Flemish schools) to 77% (EXPOLIS, Basel, indoor), the variation being due not only to the variation in indoor air contaminant levels across the studies but also to other factors such as differences in number and type of substances monitored, analytical performance, and choice of RVs. However, in 4 out of the 5 datasets, a considerable proportion of cases were found where a chemical-by-chemical approach failed to identify the need for the investigation of combined risk assessment. Although the MCR methodology applied in the current study provides no consideration of commonality of endpoints, it provides a tool for discrimination between those mixtures requiring further combined risk assessment and those for which a single-substance assessment is sufficient.

Assessment of indirect human exposure to environmental sources of nickel: oral exposure and risk characterization for systemic effects.

This paper describes the indirect human exposure to Ni via the oral route for the regional scale in the EU, together with a method to assess additional local exposure from industrial emissions. The approach fills a gap in the generic REACH guidance which is inadequate for assessing indirect environmental exposure of metals. Estimates of regional scale Ni dietary intake were derived from Ni dietary studies performed in the EU. Typical and Reasonable Worst Case dietary Ni intakes for the general population in the EU were below the oral Derived No Effect Level (DNEL) of Ni sulfate for systemic effects. Estimates for the Ni dietary intake at the local scale take into account the influence of aerial Ni deposition and transfer from soil to crops grown near industrial plants emitting Ni. The additional dietary exposure via this local contribution was small. Despite the use of conservative parameters for these processes, this method may underestimate dietary exposure around older industrial sites because REACH guidance does not account for historical soil contamination. Nevertheless, the method developed here can also be used as a screening tool for community-based risk assessment, as it accounts for historical soil pollution. Nickel exposure via drinking water was derived from databases on Ni tap water quality. A small proportion of the EU population (<5%) is likely to be exposed to tap water exceeding the EU standard (20 µg Ni/l). Taking into account the relative gastrointestinal absorption of Ni from water (30%) versus from solid matrices (5%), water intake constitutes, after dietary intake, the second most important pathway for oral Ni intake. Incidental ingestion of Ni from soil/dust at the regional scale, and also at the local scale, was low in comparison with dietary intake.

Brominated flame retardants and perfluorinated compounds in indoor dust from homes and offices in Flanders, Belgium.

The increasing time spent indoors combined with the abundant usage of diverse indoor chemicals led to concerns involving the impact of these compounds on human health. The current study focused on two groups of important indoor contaminants i.e. Brominated flame retardants (BFRs) and Perfluorinated compounds (PFCs). Concentrations of both compound classes have been measured in Flemish indoor dust samples from homes and offices. ΣPolybrominated diphenyl ethers (PBDEs) (BDE 47, 99, 100, 154, 153, 197, 196 and 203) and BDE 209 in homes ranged between 4-1214 ng g(-1)dw (median 35) and <5-5295 ng g(-1)dw (median 313), respectively. Hexabromocyclododecane (ΣHBCD) levels ranged from 5 to 4,2692 ng g(-1)dw (median 130), with α-HBCD being the major isomer (mean 59%). In addition, tetrabromobisphenol A (TBBPA) ranged between <3 and 419 ng g(-1)dw (median 12). For all BFRs, median levels in office dust were up to an order of magnitude higher than in home dust. ΣPFCs (sum of perfluorobutane sulfonate (PFBS), perfluorohexane sulfonate (PFHxS), perfluorooctane sulfonic acid (PFOS), perfluorobutanoic acid (PFBA), perfluorohexanoic acid (PFHxA), perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA) and perfluorodecanoic acid (PFDA)) concentrations in homes ranged from 0.2 to 336 ng g(-1) (median 3.0 ng g(-1)). Levels in office dust were higher (p<0.01) than in house dust with ΣPFCs ranging between 2.2 and 647 ng g(-1) (median 10 ng g(-1)) and median (PFOA) and perfluorooctane sulfonate values of 2.9 and 2.2 ng g(-1), respectively. The congener pattern was dominated by PFOA, followed by PFOS. Calculated human exposure was below the reference dose values set by the US-EPA for BDE 209, HBCD and below the provisional tolerable daily intakes proposed by European Food Safety Authority for PFOS and PFOA.

Brominated flame retardants and perfluorinated chemicals, two groups of persistent contaminants in Belgian human blood and milk.

We assessed the exposure of the Flemish population to brominated flame retardants (BFRs) and perfluorinated compounds (PFCs) by analysis of pooled cord blood, adolescent and adult serum, and human milk. Levels of polybrominated diphenyl ethers (PBDEs) in blood (range 1.6-6.5 ng/g lipid weight, lw) and milk (range 2.0-6.4 ng/g lw) agreed with European data. Hexabromocyclododecane ranged between <2.1-5.7 ng/g lw in milk. Perfluorooctane sulfonic acid (PFOS) and perfluorooctanoic acid (PFOA) dominated in blood and ranged between 1 and 171 ng/mL and <0.9-9.5 ng/mL, respectively. Total PFC levels in milk ranged between <0.5-29 ng/mL. A significant increase in PBDE concentrations was detected from newborns (median 2.1) to the adolescents and adults (medians 3.8 and 4.6 ng/g lw, respectively). An identical trend was observed for PFOS, but not for PFOA. We estimated that newborn exposure to BFRs and PFCs occurs predominantly post-natally, whereas placental transfer has a minor impact on the body burden.

Exposure of the Flemish population to brominated flame retardants: model and risk assessment.

Human exposure to brominated flame retardants (BFRs) varies widely throughout the world as it depends on country-related usage, production and legislation of these chemicals. US and UK exposure assessments show very diverse levels and patterns which in turn, are likely to differ from those in background exposed countries such as Belgium, where levels tend to be about an order of magnitude lower. The current study assessed human exposure to BFRs through the indoor and outdoor environment (e.g. dust, soil, and air) and food for all age groups in Flanders, Belgium. Most relevant food groups were identified based on a national food consumption survey and food items with Flemish origin were collected. Dust samples were collected using a standardized protocol in 43 homes and 10 offices throughout Flanders. Food, human milk and dust samples were analysed for their polybrominated diphenylethers (PBDE) and hexabromocyclodecane (HBCD) content using GC/MS and LC/MS-MS. An exposure model was developed including all analysed data, complemented with literature data. The model covered human exposure of infants, children and adults through human milk, food, dust/soil ingestion and air inhalation. Total human exposure was compared to the existing toxicological criteria and previous exposure estimates. In general, the exposure levels through human milk are consistent with those of a background exposed European population, whereas dust and food intake are at the low end of what has been reported in previous European intake assessments. Total average intake of SigmaHBCD and SigmaBDE(5) at 50th percentile (P50) levels by newborns equals 3.1 and 12.0ng/kg body weight (bw) day, respectively. This intake increases to 15.2 and 20.9ng/kgbwday for SigmaHBCD and SigmaBDE(5), for higher exposed newborns (95th percentile=P95 levels). Due to the limited database on health-based limit values for PBDEs and HBCD, it is difficult to assess the immediate health concern for any of the age groups, although the higher intake of newborns indicates the need for ongoing monitoring. For median exposed individuals, the average SigmaHBCD intake peaked at the age 3 to 6years with an intake of 6.59ng/kgbwday and declines to approximately 1ng/kgbwday at later age. SigmaBDE(5) intake exhibited a different profile compared to SigmaHBCD with maximal levels for newborns and a decline to approximately 0.7ng/kgbwday at adulthood.

Development of a GIS-based indicator for environmental pesticide exposure and its application to a Belgian case-control study on bladder cancer.

We developed two indicators to assess the exposure of residents to agricultural pesticide use and applied it in a case-control study on bladder cancer in the province of Limburg, Belgium. The first indicator used a distance-weighted measure of crop area for specified crops (fruit trees, fruit bushes and vegetables). The second indicator used a distance-weighted measure of pesticide use. We used information at three scale levels: (a) information at individual's level, such as distance to crop fields; (b) information at the level of the municipality, such as time-series of crop area; and (c) regional information, such as pesticide use. Pesticide use data were available per group of pesticides (fungicides, herbicides, insecticides, growth regulators and group of other pesticides). Indicators were calculated for each individual in the case-control study. The indicators were calculated per year for a period of 20 years, taking into account address history. Variation of pesticide use and toxicity with time was addressed by a relative risk factor. A very strong correlation was found between the area of fruit trees and bushes and the use of fungicides as well as the use of "other pesticides", indicating that these groups of pesticides are predominantly used in fruit production. The indicator for fruit trees is highly skewed to the right, indicating a high number of subjects with low potential exposure to fruit trees. Pesticide pressure indicators are less skewed as they combine application to multiple crops; the highest skewness is found for fungicides corresponding with the distribution for fruit trees. Statistical analysis revealed no association between the indicators and the incidence of bladder cancer. The results show that, using GIS, it is possible to reconstruct potential environmental pesticide exposure accounting for changes in pesticide use, crop area and residence history. Validation of the method with measured exposure is considered essential in view of its future application in other studies.

Comparison of five in vitro digestion models to in vivo experimental results: lead bioaccessibility in the human gastrointestinal tract.

This paper presents a multi-laboratory comparison study of in vitro models assessing bioaccessibility of soil-bound lead in the human gastrointestinal tract under simulated fasted and fed conditions. Oral bioavailability data from a previous human in vivo study on the same soil served as a reference point. In general, the bioaccessible lead fraction was significantly (P<0.05) different between the in vitro methods and ranged for the fasted models from 2% to 33% and for the fed models from 7% to 29%. The in vivo bioavailability data from literature were 26.2+/-8.1% for fasted conditions, compared to 2.5+/-1.7% for fed conditions. Under fed conditions, all models returned higher bioaccessibility values than the in vivo bioavailability; whereas three models returned a lower bioaccessibility than bioavailability under fasted conditions. These differences are often due to the method's digestion parameters that need further optimization. An important outcome of this study was the determination that the method for separating the bioaccessible lead from the non-bioaccessible fraction (centrifugation, filtration, ultrafiltration) is crucial for the interpretation of the results. Bioaccessibility values from models that use more stringent separation methods better approximate in vivo bioavailability results, yet at the expense of the level of conservancy. We conclude from this study that more optimization of in vitro digestion models is needed for use in risk assessment. Moreover, attention should be paid to the laboratory separation method since it largely influences what fraction of the contaminant is considered bioaccessible.

Comparison of five in vitro digestion models to study the bioaccessibility of soil contaminants.

Soil ingestion can be a major exposure route for humans to many immobile soil contaminants. Exposure to soil contaminants can be overestimated if oral bioavailability is not taken into account. Several in vitro digestion models simulating the human gastrointestinal tract have been developed to assess mobilization of contaminants from soil during digestion, i.e., bioaccessibility. Bioaccessibility is a crucial step in controlling the oral bioavailability for soil contaminants. To what extent in vitro determination of bioaccessibility is method dependent has, until now, not been studied. This paper describes a multi-laboratory comparison and evaluation of five in vitro digestion models. Their experimental design and the results of a round robin evaluation of three soils, each contaminated with arsenic, cadmium, and lead, are presented and discussed. A wide range of bioaccessibility values were found for the three soils: for As 6-95%, 1-19%, and 10-59%; for Cd 7-92%, 5-92%, and 6-99%; and for Pb 4-91%, 1-56%, and 3-90%. Bioaccessibility in many cases is less than 50%, indicating that a reduction of bioavailability can have implications for health risk assessment. Although the experimental designs of the different digestion systems are distinct, the main differences in test results of bioaccessibility can be explained on the basis of the applied gastric pH. High values are typically observed for a simple gastric method, which measures bioaccessibility in the gastric compartment at low pHs of 1.5. Other methods that also apply a low gastric pH, and include intestinal conditions, produce lower bioaccessibility values. The lowest bioaccessibility values are observed for a gastrointestinal method which employs a high gastric pH of 4.0.