Bisphenol A and Organophosphate Exposure in the Israeli Population: Sources and Risk Factors Judith Spungen, Tamar Berman, Rebecca Goldsmith, Thomas Göen, Lena Novack, Hagai Levine, Yona Amitai, Tami Shohat, Itamar Grotto The 9th International Symposium on Biological Monitoring in Occupational and Environmental Health 1
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Bisphenol A and Organophosphate Exposure in the Israeli Population:
Sources and Risk Factors
Judith Spungen, Tamar Berman, Rebecca Goldsmith, Thomas Göen, Lena Novack, Hagai Levine, Yona Amitai, Tami Shohat, Itamar Grotto
The 9th International Symposium on Biological Monitoring in Occupational and Environmental Health
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Israel Human Biomonitoring StudyObjectives
Measure urinary levels of several environmental contaminants in the Israeli population, compare with other populations
Cotinine (environmental tobacco smoke - ETS)Bisphenol A (BPA) PhthalatesOrganophosphate pesticides (OPs)Polycyclic aromatic hydrocarbonsGenistein and daidzein (phytoestrogens)
Identify demographic, behavioral, and dietary predictors of exposure to these contaminants
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Israel Human Biomonitoring StudyMethods and Study Population
Methods: Participants recruited in February – June 2011
250 participants from 5 regions in Israel, ages 20 – 74
Spot urine sample and in depth interview
Urine samples analyzed at University of Erlangen –Nuremberg in Germany
Study Population: Study Population (N=249)N/ %
Age Range
20-44 164 65.9%
45-74 85 34.1 %
Gender
Male 132 53 %
Female 117 47 %
Ethnicity
Jewish 184 73.9 %
Arab and other 65 26.1 %
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Israel Human Biomonitoring StudyMethods: Questions Related to Potential Exposure Sources- (1)
Demographics (age, sex, region, urban/rural residence, ethnicity, income, education)Job characteristicsSmoking historyPesticide use in home/garden/pet care products Personal care products use (deodorant, perfume)Weight and height Health and disease status Whether on dialysis/had an infusion in last week
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Israel Human Biomonitoring StudyMethods: Questions Related to Potential Exposure Sources- (2) Food Intake and preparation
24-hour dietary recall, including food consumption locationsFood frequency questionnaire - modified to enable capture of potential exposure sourcesQuestions related to intake of soy productsPolycarbonate water bottle/sports bottle useMicrowave useConsumption of smoked and/or grilled foods
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Israel Human Biomonitoring StudyThe Food Frequency Questionnaire- the format
A. The food B. Defined portion
C. No. of portions per day
D. No. of portions per week
E. No. of portions per month
F. Less than once a month or never
1 Milk 0-1% fat (including in coffee), excluding soy
1 cup
2 Milk, more than 1% fat (including in coffee), excluding soy
1 cup
3 Chocolate milk or any other type of milk-drink,
1 cup
4 Soy drink / soy milk 1 cup5 Soft white cheese or cream
cheese or cottage cheese, more than 5% fat, excluding soy
1 spoon
6 Soft white cheese or cream cheese or cottage cheese, 5% fat, excluding soy
1 spoon
7 Soy based cheese 1 spoon
Israel Human Biomonitoring StudyThe 24 hour recall questionnaire; the format
Item Letter
Hour Where did you eat/drink this item?
Which meal was it?
Item name
Food/drink description What quantity did you eat/drink?
1 2 3 4 5 6 7
1
2
3
4
7
The multiple pass method, validated and used in NHANES and other major surveys, was used.Specially trained interviewers, using the Israel Food and Food Quantities Guide, probe for details, including quantities ,of all foods and beverages consumed in the preceding 24 hours.
Israel Human Biomonitoring StudyMethods: Estimating Intakes of Canned Fish, Fruits, Vegetables
Food mixtures reported by study respondents were disaggregated to allow estimation of canned fish, fruit, and vegetable intakes from 24-hour recall data.Food labels, data from manufactures, and recipes were used to aid disaggregation.
Examples:Food Ingredient %
Eggplant with mayonnaise saladeggplant 70other ingredients 30
Results: Urinary BPA Concentrations Compared with other International Populations
Country Median creatinineadjusted urinaryconcentration(µg/g)
Age ofStudyPopulation
Year Reference
US 1.8 20 + 2009-2010 CDC, 2012
Canada 1.5 20-39 2007-2009 Health Canada, 2010
Belgium 2.25 1-75 2011 Pirard et al 2012 Korea 2.09 18 -69 2009 Kim et al 2011Germany 1.62 20 -30 2009 Koch et al 2012Israel 2.3 20 - 73 2011
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Results: Demographic Factors Related to Urinary BPA Concentrations - Ethnicity
In a multivariate analysis: urinary concentrations were 2.34 times higher in Jews compared to other ethnicities (p < 0.001)
Possible explanations:Differences in consumption of meals outside the homeDifferences in place of residence – urban/ rural living
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Results:Behavioral Factors Related to Urinary BPA Concentrations - Active Smoking
P=0.045
1.65
2.38
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Results: Behavioral Factors Related to Urinary BPA Concentrations -Exposure to Environmental Tobacco Smoke
Urinary BPA concentrations were 1.40 times higher in non-smoking study participants with urinary cotinine concentrations above 4 μg/L compared to those with urinary cotinine concentrations below 4 μg/L (p=0.06).
Possible explanations
Inhaled and exhaled tobacco smoke may be a source of BPA because BPA comprises 25% of the weight of some cigarette filters.
It is possible that smoking is a surrogate for another behavior correlated with BPA exposure.
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Results: Dietary Factors Related to Urinary BPA Concentrations - Heating Food in Microwave
Individuals who reported using a microwave to heat food at least once a week to several times a day had significantly higher urinary BPA concentrations (GM above 2.11µg/g) compared to those who reported using a microwave to heat food less than once a month or not at all (GM = 1.10, p < 0.01). This effect had borderline significance in the multivariate model, but was not included in the final model because of small sample size. Possible explanation: BPA is used in the manufacture of polycarbonate containers for microwave heating and polysulfone microwave cookware
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Consumption of water in polycarbonate water orsports bottles did not significantly affect urinaryBPA concentrations. Only about 20% reportedregularly drinking from these sports bottles.
Individuals who consumed canned fish had higherurinary BPA concentrations (GM = 2.36 μg/g)compared to those who don’t consume canned fish (GM= 1.87 μg/g) but the difference was notsignificant (p=0.478).
Results:Dietary Factors NOT Significantly Related to Urinary BPA Concentrations
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Results: Urinary Concentrations of Organophosphate Pesticide Metabolites
OP metabolites detected in all urine samples
Urinary concentrations of DMP, DMTP, and DEP were above the limit of quantification (0.3 µg/L) in over 98% of the samples
Urinary concentrations of DETP and DMDTP were above the limit of quantification in ~ 75% of the samples
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Median creatinine adjusted dialkyl phosphate urinary concentrations (ug/g)
* Median urinary concentrations of DMP, DEP, and DETP were below the LOD in the US general population (NHANES)
Results: Urinary Organophosphate Metabolite Concentrations Compared with other International Populations
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Results: Fruit and vegetable intake in study population, by demographic characteristics (1)
Females tended to consume more fruit than men – median intakes of 1.70 and 0.90 gm/kg body weight respectively (difference not significant, p= 0.38) Females tended to consume more vegetables than men – median intakes of 3.30 and 2.70 gm/kg body weight respectively (difference not significant, p= 0.16) Jewish participants tended to consume more fruits than Arabs –median intakes of 1.73 and 1.21 gm/kg body weight respectively (difference not significant, p= 0.67) Jewish participants tended to consume more vegetables than Arabs – median intakes of 3.05 and 2.46 gm/kg body weight respectively (difference not significant, p= 0.16)
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Results: Fruit and vegetable intake in study population, by demographic characteristics (cont.)
Higher income participants tended to consume more fruits; median intakes of 2.38 and 1.14 gm/kg body weight respectively, (difference not significant, p= 0.55) Higher income participants tended to consume more vegetables; median intakes of 3.98 and 3.00 gm/kg body weight respectively, (difference not significant, p= 0.77) Higher education participants tended to consume more fruits; median intakes of 2.37 and 0.90 gm/kg body weight respectively, (difference not significant, p= 0.35) Higher education participants tended to consume lessvegetables; median intakes of 2.38 and 2.84 gm/kg body weight respectively, (difference not significant, p= 0.57)
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Possible Explanations for Relatively High Urinary OP Metabolite Levels in Israeli Adults
High intake of fruits and vegetables in study population (per kg body weight), relative to general US population
Differences in agricultural use of OP pesticides (regulatory status and usage patterns)
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Results: Demographic and Dietary Predictors of OP Exposure (Univariate Analysis)
Total unadjusted dialkyl phosphates significantly associated with high household income (0.231 micromoles/L compared to 0.147, p=0.036)
Total dialkyl phosphates higher in individuals with fruit consumption above the 75th percentile (0.263 micromoles/L compared to 0.20, p=0.063)
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Results: Demographic and Dietary Predictors of OP Exposure (Multivariate Analysis)
Factor Effect p-value
Total molar quantityAge, yearsIncome
<NIS 5,000NIS 5,000-10,000≥NIS10,000
1.01
11.401.59
0.040
---0.1040.025
Dimethyl total quantityAge, yearsIncome
<NIS 5,000NIS 5,000-10,000≥NIS10,000
1.01
11.451.57
0.020
---0.0960.043
Diethyl total quantityFemales vs. malesConsumption of Fruits above 75th percentile
1.261.27
0.0430.073
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Regulatory Status of Selected OP Pesticides (Agricultural Use) in Israel, US, and Europe, 2011*
a Based on data from Israel Ministry of Health, 2012 b Out of a total of 5558 food samples
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Ministry of Health Pesticide Residue Data (2006 - 2010) Support Hypothesis that Fruits and Vegetables are Source of OP Exposure
% Residues above the Maximum Residue Level (MRL)*
OP pesticide
18%Chlorpyrifos
100 %Fenamiphos
22%Malathion
52%Methamidiphos
6%Dimethoate
57%Dichlorvos
55% Diazinon
* Number of results exceeding MRL/number of results in which OP was detected
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Conclusions
The general population in Israel is widely exposed to BisphenolA and Organophosphate pesticides
Predictors of BPA exposure include Jewish ethnicity, active smoking, exposure to environmental tobacco smoke, frequent microwave use
Intake of fruits (but not vegetables) is an important source of exposure to organophosphate pesticides
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Strengths and Limitations of the Study
Limitations
• Convenience non-random sampling technique • Exposure estimates based on a single spot urine sample
Strengths
• Individuals recruited from different ethnic groups within Israel, with wide geographical distribution. • Very detailed data on dietary habits collected, including consumption of specific fruits and vegetables in the 24 hours prior to the urine sample • Laboratory methods were of high validity and sensitivity
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Policy changes and Implications
Since conducting the study, ten of the 19 OP’s registered in Israel are being phased out, with final cancellation expected in 2014.The data collected can provide baseline information on exposure to OP’s and other contaminants, which can be used to track exposure changes, resulting from policy changes. The study also collected cotinine data, and further monitoring will enable assessment of the impact of anti-smoking legislation.
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Plans for Further Biomonitoring in the General Population in Israel
Ministry of Health RAV MABAT (Health and Nutrition Survey) in 2014-5, will include collection of urine samples
Study sample will include children ages 2 and up
We plan to analyze urinary levels of cotinine (biomarker of environmental tobacco smoke) and OP metabolites in urine samples from 300 participants, including children
We plan to store urine for future analysis of additional contaminants such as BPA and phthalates
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THANK YOU
Environment and Health Fund for generous support of the study
Advisory Committee: Dr. Lital Keinan-Boker, Dr. Shlomo Almog, Dr. Orna Matzner, Prof. Jeremy Kark, Dr. Eric Amster, Dr. John Young