Impact des concentrations de plomb dans l'eau de robinet sur la plombémie des enfants âgés de 1 à 5 ans, et estimation du rôle modifiant des facteurs nutritionnels, et sociodémographiques

Objectifs : Le but de l’étude était d’estimer l’influence des saisons de l’année sur la concentration de plomb dans l’eau de robinet et sur la plombémie (PbS) des enfants de 1 à 5 ans (1), de déterminer l’association entre l’exposition cumulée au plomb de l’eau et la PbS (2), et d’évaluer si l’âge, le sexe, la race de l’enfant, la consommation de fer, de calcium, modifient l’association entre l’exposition cumulée au plomb de l’eau et la PbS. Méthodes : Une revue systématique des études prospectives a permis d’estimer l’amplitude des variations saisonnières de la PbS. Une étude à devis transversal, avec une composante longitudinale a été conduite à Montréal, incluant les enfants âgés de 1 à 5 ans. Les données sociodémographiques et les habitudes alimentaires ont été recueillies à l’aide d’un questionnaire. Les modèles linéaires ont permis d’estimer l’influence des saisons de l’année sur les concentrations de plomb dans l’eau de robinet, de déterminer l’association entre la PbE et la PbS, et d’évaluer l’effet modifiant des facteurs sociodémographiques et nutritionnels. Le modèle d’exposition et d’absorption biocinétique intégré (IEUBK) a permis d’évaluer l’impact prédit des variations saisonnières des concentrations de plomb dans l’eau de robinet sur la PbS. Résultats : De la revue systématique de la littérature, il semble ressortir que l’augmentation de la PbS durant les mois chauds semble être inversement associée à la PbS observée durant les mois froids. Dans la région de Montréal (Canada), la concentration de plomb dans l’eau de robinet varie significativement avec les saisons. L’augmentation observée de l’hiver à l’été est d’environ 6 µg/L, voire 10 µg/L dans l’eau ayant stagné au moins 30 minutes dans les conduits. La proportion d’enfants censés excéder le seuil de PbS 5 µg/dL suite à une telle augmentation est d’au moins 12%. Par ailleurs, après 150 jours d’exposition à une concentration de plomb dans l’eau de robinet de 0,20 µg/L et plus, la PbS augmente d’au moins 19%. L’association entre la concentration de plomb dans l’eau de robinet et la PbS est plus forte chez les enfants ayant une ingestion inadéquate en fer, le sexe masculin et moins de 3 ans. Conclusion : L’association entre la concentration de plomb dans l’eau de robinet et la PbS est positive et statistiquement significative. Le fait de laisser couler l’eau 5 minutes avant consommation permettrait de réduire d’environ 40% la proportion des enfants censés avoir une PbS ≥ 5 µg/L pendant les mois chauds. L’effet conjoint de PbE et d’une consommation inadéquate de fer (idem pour le sexe masculin et le fait d’avoir moins de 3 ans) est plus fort que ce qui serait attendu sous l’hypothèse d’additivité.Objectives: This study aimed to estimate the influence of seasonality on water lead levels (WLL) and blood lead concentrations (PbS) in children aged 1 to 5 years (1), to assess the relationship between cumulative water lead exposure and PbS (2) and to assess whether children’s age, gender, and race, iron and calcium intake modify the association between cumulative exposure to water lead and PbS (3). Methods: A systematic review of prospective studies was made in order to estimate the magnitude of the seasonal changes in PbS. A cross-sectional study including a follow-up component was conducted in the Montreal area. Sociodemographic data and eating habits were collected using a questionnaire. We used linear models to determine the magnitude of seasonal changes in water lead concentrations, to estimate the association between cumulative water lead exposure and children’s PbS, and to evaluate the modifying effect of sociodemographic and nutritional factors. The integrated exposure uptake biokinetic model (IEUBK) was used to assess the impact of seasonal changes in WLL on PBS. Results: From the systematic literature review, the increase in children’s PbS during the warmer months tends to be inversely associated with PbS during the cold months. In the Montreal area (Canada), WLLs showed marked seasonal variations. We observed a colder-to-warmer increase of about 6 µg/L and 10 µg/L in flushed water and after a stagnation of 30 minutes, respectively. The proportion of children exceeding the PbS of 5 µg/dL due to this increase is at least of 12%. Furthermore, after 150 days of exposure at 0.20 µg of Pb/L and above, the PbS is expected to increase by at least 19%. Separate analyses showed a positive synergism between water lead exposure and three factors (being aged below 3 years, being a boys and having inadequate daily intake of iron). Conclusion: The association between WLL and PbS is positive and statistically significant. During warmer months, flushing the water for at least 5 minutes before consumption would reduce the proportion of children with PbS ≥ 5 µg/dL by about 40%. The joint effect of WLL and inadequate iron intake (same for being a boy and being aged below 3 years) is stronger than what would be expected in case of additivity

Exposure of young children to household water lead in the Montreal area (Canada): the potential influence of winter-to-summer changes in water lead levels on children's blood lead concentration

Drinking water represents a potential source of lead exposure. The purpose of the present study was to estimate the magnitude of winter-to-summer changes in household water lead levels (WLLs), and to predict the impact of these variations on BLLs in young children. A study was conducted from September, 2009 to March, 2010 in 305 homes, with a follow-up survey carried out from June to September 2011 in a subsample of 100 homes randomly selected. The first 1-L sample was drawn after 5 min of flushing, followed by a further 4 consecutive 1-L samples after 30 min of stagnation. Non-linear regression and general linear mixed models were used for modelling seasonal effects on WLL. The batchrun mode of Integrated Exposure Uptake Biokinetic (IEUBK) model was used to predict the impact of changes in WLL on children's blood lead levels (BLLs). The magnitude of winter-to-summer changes in average concentrations of lead corresponded to 6.55 mug/L in homes served by lead service lines (LSL+ homes) and merely 0.30 mug/L in homes without lead service lines. For stagnant samples, the value reached 10.55 mug/L in 'LSL+ homes' and remained very low (0.36 mug/L) in 'LSL- homes'. The change in the probability of BLLs >/=5 mug/dL due to winter-to-summer changes in WLL was increased from /=5 mug/dL in young children during warm months was reduced by at least 40% by flushing tap-water

Elevated blood lead levels are associated with reduced risk of malaria in Beninese infants

Introduction Elevated blood lead levels (BLL) and malaria carry an important burden of disease in West Africa. Both diseases might cause anemia and they might entail long-term consequences for the development and the health status of the child. Albeit the significant impact of malaria on lead levels described in Nigeria, no evaluation of the effect of elevated BLL on malaria risk has been investigated so far. Materials and Methods Between 2010 and 2012, blood lead levels of 203 Beninese infants from Allada, a semi-rural area 50km North from Cotonou, were assessed at 12 months of age. To assess lead levels, blood samples were analyzed by mass spectrometry. In parallel, clinical, microbiological and hematological data were collected. More precisely, hemoglobin, serum ferritin, CRP, vitamin B12, folate levels, and Plasmodium falciparum parasitemia were assessed and stool samples were also analyzed. Results At 12 months, the mean BLL of infants was 7.41 μg/dL (CI: 65.2; 83), and 128 infants (63%) had elevated blood lead levels, defined by the CDC as BLL>5 μg/dL. Lead poisoning, defined as BLL>10 μg/dL, was found in 39 infants (19%). Twenty-five infants (12.5%) had a positive blood smear at 12 months and 144 infants were anemic (71%, hemoglobin<110 g/L). Elevated blood lead levels were significantly associated with reduced risk of a positive blood smear (AOR = 0.38, P-value = 0.048) and P. falciparum parasite density (beta-estimate = -1.42, P-value = 0.03) in logistic and negative binomial regression multivariate models, respectively, adjusted on clinical and environmental indicators. Conclusion Our study shows for the first time that BLL are negatively associated with malarial risk considering other risk factors. Malaria is one of the main causes of morbidity and mortality in infants under 5 years worldwide, and lead poisoning is the 6th most important contributor to the global burden of diseases measured in disability adjusted life years (DALYs) according to the Institute of Health Metrics. In conclusion, due to the high prevalence of elevated BLL, health interventions should look forward to minimize the exposure to lead to better protect the population in West Africa

Body shape and size in 6-year old children: assessment by three-dimensional photonic scanning.

BACKGROUND: Body shape and size are typically described using measures such as body mass index (BMI) and waist circumference, which predict disease risks in adults. However, this approach may underestimate the true variability in childhood body shape and size. OBJECTIVE: To use a comprehensive three-dimensional photonic scan approach to describe variation in childhood body shape and size. SUBJECTS/METHODS: At age 6 years, 3350 children from the population-based 2004 Pelotas birth cohort study were assessed by three-dimensional photonic scanner, traditional anthropometry and dual X-ray absorptiometry. Principal component analysis (PCA) was performed on height and 24 photonic scan variables (circumferences, lengths/widths, volumes and surface areas). RESULTS: PCA identified four independent components of children's body shape and size, which we termed: Corpulence, Central:peripheral ratio, Height and arm lengths, and Shoulder diameter. Corpulence showed strong correlations with traditional anthropometric and body composition measures (r>0.90 with weight, BMI, waist circumference and fat mass; r>0.70 with height, lean mass and bone mass); in contrast, the other three components showed weak or moderate correlations with those measures (all r<0.45). There was no sex difference in Corpulence, but boys had higher Central:peripheral ratio, Height and arm lengths and Shoulder diameter values than girls. Furthermore, children with low birth weight had lower Corpulence and Height and arm lengths but higher Central:peripheral ratio and Shoulder diameter than other children. Children from high socio-economic position (SEP) families had higher Corpulence and Height and arm lengths than other children. Finally, white children had higher Corpulence and Central:peripheral ratio than mixed or black children. CONCLUSIONS: Comprehensive assessment by three-dimensional photonic scanning identified components of childhood body shape and size not captured by traditional anthropometry or body composition measures. Differences in these novel components by sex, birth weight, SEP and skin colour may indicate their potential relevance to disease risks.This article is based on data from the study ‘Pelotas Birth Cohort, 2004’ conducted by the Postgraduate Program in Epidemiology at Federal University of Pelotas, in collaboration with Brazilian Public Health Association (ABRASCO). The 2004 birth cohort study is supported by the Wellcome Trust through the scheme called ‘Major Awards for Latin America on Health Consequences of Population Change’. The World Health Organization, Brazilian National research Council (CNPq) and Brazilian Ministry of Health have supported previous phase of the study. LPS is supported by ‘Science without Borders’ Brazilian scheme under protocol number 201801/2014-0.This is the final version of the article. It first appeared from Nature Publishing Group via http://dx.doi.org/10.1038/ijo.2016.3

Net contribution and predictive ability of the CUN-BAE body fatness index in relation to cardiometabolic conditions

BACKGROUND: The CUN-BAE (Clínica Universidad de Navarra-Body adiposity estimator) index is an anthropometric index based on age, sex and body mass index (BMI) for a refined prediction of body fatness in adults. CUN-BAE may help detect metabolically unhealthy individuals with otherwise normal weight according to BMI or waist circumference (WC). The aim of this study was to evaluate whether CUN-BAE, independent of its components (BMI, age and sex), was associated with cardiometabolic conditions including arterial hypertension, diabetes mellitus and metabolic syndrome (MetS). METHODS: The ENRICA study was based on a cross-sectional sample of non-institutionalized men and women representative of the adult Spanish population. Body weight, height, and WC were measured in all participants. The residual of CUN-BAE (rCUN-BAE), i.e. the part of the index not explained by its components, was calculated. The associations of CUN-BAE, rCUN-BAE, BMI and WC with hypertension, diabetes and MetS were analysed by multivariate logistic regression, and the Akaike information criterion (AIC) was calculated. RESULTS: The sample included 12,122 individuals. rCUN-BAE was associated with hypertension (OR 1.14, 95% CI 1.07-1.21) and MetS (OR 1.48, 1.37-1.60), but not with diabetes (OR 1.05, 0.94-1.16). In subjects with a BMI?<?25 kg/m2, CUN-BAE was significantly associated with all three outcome variables. CUN-BAE was more strongly associated with the cardiometabolic conditions than BMI and WC and fit similar AICs. CONCLUSIONS: The CUN-BAE index for body fatness was positively associated with hypertension, diabetes and MetS in adults independent of BMI or WC. CUN-BAE may help to identify individuals with cardiometabolic conditions beyond BMI, but this needs to be confirmed in prospective settings.Funding: The ENRICA study was funded and financed by Sanofi-Aventis. Specific funding for this analysis came from the governmental Spain FIS PI12/1166 and PI11/01379 projects and from the “UAM Chair in Epidemiology and Control of Cardiovascular Risk”

Chemical Synthesis and Biological Evaluation of 3-Substituted Estrone/Estradiol Derivatives as 17β-Hydroxysteroid Dehydrogenase Type 1 Inhibitors Acting via a Reverse Orientation of the Natural Substrate Estrone

Estradiol (E2) plays an important role in the progression of diseases such as breast cancer and endometriosis. Inhibition of 17β-hydroxysteroid dehydrogenase type 1 (17β-HSD1), the enzyme that catalyzes the last step in the biosynthesis of the estrogenic hormone E2, therefore constitutes an interesting approach for the treatment of these two estrogen-dependent diseases. In order to obtain new inhibitors of 17β-HSD1, the impact of a m-carbamoylphenyloxy group at position three of an estrane nucleus was evaluated by preparing three derivatives of estrone (E1) and E2 using a microwave-assisted synthesis of diaryl ethers. Their inhibitory activity was addressed on two cell lines (T-47D and Z-12) representative of breast cancer and endometriosis, respectively, but unlike T-47D cells, Z-12 cells were not found suitable for testing potential 17β-HSD1 inhibitors. Thus, the addition of the m-carbamoylphenyl group at C3 of E1 (compound 5) did not increase the inhibition of E1 to E2 transformation by 17β-HSD1 present in T-47D cells (IC50 = 0.31 and 0.21 μM for 5 and E1, respectively), and this negative effect was more obvious for E2 derivatives 6 and 10 (IC50 = 1.2 and 1.3 μM, respectively). Molecular docking allowed us to identify key interactions with 17β-HSD1 and to highlight these new inhibitors’ actions through an opposite orientation than natural enzyme substrate E1′s classical one. Furthermore, molecular modeling experiments explain the better inhibitory activity of E1-ether derivative 5, as opposed to the E2-ether derivatives 6 and 10. Finally, when tested on T-47D and Z-12 cells, compounds 5, 6 and 10 did not stimulate the proliferation of these two estrogen-dependent cell lines. In fact, they reduced it

Failure to Return for Posttest Counseling and HIV Test Results at the Prevention and Voluntary Testing and Counseling Centers of Douala, Cameroon: An Evaluation of a Routine Five-Year Program

This study examined the magnitude and time trends in failure to return (FTR) rates and the relation between FTR and individual characteristics, tests procedures, waiting period for the results, and HIV test results among people who were screened for HIV in the prevention and voluntary testing and counseling centers (PVTCCs) of six district hospitals of the city of Douala in Cameroon, between January 2009 and December 2013. It was a retrospective analysis of medical records. Among the 32,020 analyzed records, the failure to return (FTR) rate was 14.3%. Overall, people aged 50 years and over, those tested between 2011 and 2012, and those tested in the PVTCC of Bonassama were less likely to return for their results. Significant factors associated with FTR included being a housewife, having a positive/undetermined/requiring confirmation result, and provider-initiated testing and counseling (PITC). There was an increasing trend for FTR in the PVTCCs of Bonassama, New-Bell, Nylon, and Cité des Palmiers. HIV testing and counseling services in Douala district hospitals must be reorganized such that individuals tested for HIV receive their results on the same day of the test. Also counselors need to better alert clients concerning the importance of returning for their test results

Synthèse bibliographique des études de biosurveillance des populations vivant en zones minières ou à proximité d’industries émettrices de métaux

- Ce rapport bibliographique constitue un préalable au programme « Niveaux d’imprégnation et déterminants de l’exposition humaine aux métaux en Nouvelle Calédonie » (Métexpo), étude de biosurveillance sur l’exposition au nickel, au cobalt, au chrome, et au manganèse en Nouvelle Calédonie. En effet, la nappe de péridotites qui recouvre un tiers du bâti calédonien est constituée de roches ultrabasiques (essentiellement des hazburgites), pauvres en silice et généralement riches en magnésium et en fer. Aux côtés de ces éléments, divers métaux traces dont le nickel (Ni), le cobalt (Co), le chrome (Cr) et le manganèse (Mn), présentent des concentrations relativement importantes. De fait une partie de la population de l’archipel de Nouvelle-Calédonie pourrait se révéler particulièrement exposée à ces métaux. D’autant que certains de ces métaux (Ni, Cr et Co), font l’objet d’une importante exploitation minière depuis le milieu du XIXème siècle.- Ce rapport vise principalement à faire une synthèse bibliographique des études nationales et internationales ayant porté sur la biosurveillance du nickel, cobalt, chrome et manganèse dans des populations vivant en zone minière ou à proximité d’industries émettrices de ces métaux.- Après un bref rappel sur la toxicité chronique de chaque métal, les études publiées s’étant penché sur le lien potentiel avec une source d’exposition minière et/ou industrielle seront décrites

Canadians Adults Fail Their Dietary Quality Examination Twice

For many years, dietary quality among Canadians has been assessed using an index that gives criticized scores and does not allow for comparison with Americans. In Canadians aged &ge;19 years, we aimed to (1) determine the dietary quality by using a more widely used evidence-based index that has shown associations with health outcomes, the alternative Healthy Eating Index (aHEI-2010); (2) assess changes in aHEI-2010 score and its components between 2004 and 2015; and (3) identify factors associated with aHEI-2010 score. We relied on the Canadian Community Health Survey 2004 (n = 35,107) and 2015 (n = 20,487). We used adjusted linear models with a time effect to compare the total aHEI-2010 score and its components. The overall aHEI-2010 score increased from 36.5 (95%CI: 36.2&ndash;36.8) in 2004 to 39.0 (95%CI: 38.5&ndash;39.4) in 2015 (p &lt; 0.0001). Participants with less than a high school diploma showed the lowest score and no improvement from 2004 to 2015 (34.8 vs. 35.3, p = 0.4864). In each period, higher scores were noted among immigrants than non-immigrants (38.3 vs. 35.9 in 2004, p &lt; 0.0001; 40.5 vs. 38.5 in 2015 p &lt; 0.0001), and lower scores were observed in current smokers (33.4 vs. 37.1 in 2004, p &lt; 0.0001; 34.5 vs. 39.9 in 2015, p &lt; 0.0001). The use of the aHEI-2010 tool suggests a lower score among Canadians than the previous index, more comparable to the score among Americans