The use of chemicals in a broad range of products, including medicinal and veterinary products, as well as in agriculture and pest control, provides benefits to society. At the same time, human and environmental exposure to hazardous chemicals represents a cost in terms of impacts on human health and reduced environmental quality. Recognizing this, the European Union’s 7th Environmental Action Programme sets the goal of assessing and minimizing risks to the environment and health associated with the use of hazardous substances by 2020.
A major hurdle to the reliable risk assessment and management of chemicals is the lack of harmonized information at European level concerning the exposure of citizens, including workers, to chemicals and their interplay with other concurrent environmental exposures and impact on health. Individuals are exposed to a complex mixture of chemicals in their daily lives through the environment, products, food and drinking water and at work. For many chemicals, the health impacts over a lifetime associated with exposure remain unknown. In addition, understanding of the health impacts of exposure to mixtures of chemicals is limited.
Human biomonitoring allows estimation of exposure to chemicals by measuring the substances themselves, their metabolites or markers of subsequent health effects in body fluids or tissues. Information on human exposure can then be linked to data on sources and epidemiological surveys, in order to inform research on the exposure-response relationships in humans.
With the aim of addressing knowledge gaps and promoting innovative approaches, the European Commission launched a call for a European Human Biomonitoring Initiative, under Horizon 2020’s Societal Challenge on health, demographic change and wellbeing. The objective is to create a European joint program for monitoring and scientific assessment of human exposures to chemicals and potential health impacts in Europe, building on previous activities undertaken at EU and national levels.
The consortium formed after successful application is led by the German Environment Agency (UBA) and brings together leading European expertise on human biomonitoring (HBM) from 24 EU Member States, as well as Norway, Iceland, North Macedonia, the UK, Israel and Switzerland in the project HBM4EU. Key objectives include:
In order to achieve these objectives, the consortium plans to harmonize human biomonitoring initiatives in the participating countries, by drawing on existing expertise and building new capacities. National Hubs are established in each country to coordinate activities, creating a robust Human Biomonitoring Platform at pan-European level.
This initiative contributes directly to the improvement of health and well-being for all citizens, by investigating how exposure to chemicals affects the health of different groups, such as children, adolescents, adults, and workers. Research will investigate how factors such as behavior, lifestyle and socio-economic status influence internal exposure to chemicals across the EU population. This knowledge will be fed directly into policy making to reduce chemical exposure and protect human health.
HBM4EU will run for five years, from 2017 to 2021, with the long-term objective of establishing a sustained programme. In developing priorities for HBM4EU under the first annual work plan, the consortium conducted a prioritisation exercise to identify those substances to be the focus of activities. Additional rounds of prioritisation have been carried out during the project lifespan in order to respond dynamically to policy needs. The most recent third round of prioritisation will feed into a successor activity PARC.
As HBM4EU will run for five years, from 2017 to 2021, negotiations of a successor project were initiated with the involved partners. PARC is an EU-wide research and innovation programme to support EU and national chemical risk assessment and risk management bodies with new data, knowledge, methods, networks and skills to address current, emerging and novel chemical safety challenges. It will facilitate the transition to next generation risk assessment to better protect human health and the environment, in line with the Green Deal’s zero-pollution ambition for a toxic free environment, and will be an enabler for the EU Chemicals Strategy for sustainability.
The Partnership will sustain the endeavour of further developing a European human biomonitoring platform started by HBM4EU. No legal mandates are yet in place for human biomonitoring and therefore this activity still depends on research funding to deliver exposure information. The Partnership is also an opportunity to further improve and reinforce the specific European collaboration on occupational monitoring and risk assessment established under HBM4EU.
Moreover, research and innovation to develop tools, methods and models to track the source of chemical exposure, the route of exposures as well as combined and aggregated exposures are still needed and will be undertaken by the Partnership. To identify emerging and new exposures non-targeted and suspect screening methods for environmental and human matrices will be developed, to support also the monitoring of real-world mixtures.
In certain cases, the Partnership will also investigate how different parameters (e.g. the move to a circular economy, occupation, lifestyle and the physical environment) act as determinants of exposure and identify subgroups of the population that are particularly at risk.
To assess health impacts of exposures, models establishing the link between external exposure and internal exposure will be developed and the causal relations between exposure biomarkers measured in human biomonitoring studies and effect biomarkers and health outcomes studied. Occupational cohorts represent an added value in this context. Last but not least the analysis and interpretation of exposure data also requires research on how to define limit values to be used in regulatory contexts.
The new Partnership will build on lessons learned and knowledge acquired not only in HBM4EU, but also in other large scale projects or project clusters funded or co-funded under Horizon 2020 or previous research framework programmes.
HBM4EU has shown that cooperation between national agencies, research organisations, the services of the European Commission (EC) and EU agencies can work well and foster mutual understanding and joint knowledge. Key experiences and results from HBM4EU which this Partnership will build on and further develop are:
Nordic collaboration related to Human Biomonitoring has been discussed at the workshops in 2014 and 2017 to strengthen the networking, collaboration, capacity building and sustainability of HBM in these countries, to exchange experiences within HBM4EU and to assemble information on their significant contributions to HBM4EU.
This Nordic Workshop in 2021 brought together scientists and regulatory specialist from the Nordic countries to discuss and reflect on:
This information will be a valuable contribution to feed in to the national advisory groups in the national hubs related to PARC and subsequently be used as input for applications for EU funding.
A detailed agenda from the workshop is attached in Annex I.
The list of participants is in Annex II.
Participants were invited to share short presentations on specific cases or issues that they find relevant to the HBM4EU in each country. Annex III lists the Nordic projects contributing to HBM4EU. The national hubs are mentioned in Annex IV. Abstracts of the presentations are attached in Annex IV. These presentations as PDF documents are available upon request. https://drive.google.com/file/d/1c7w89Wm4HLfj3gKmeaoAYLsLlQZ1vH39/view?usp=sharing is the link to the video recorded meeting.
The workshop had 57 participants from the different Nordic countries (see list of participants in Annex V). In addition, two invited presentations were given by Marika Kolossa Gehring (UBA, Germany), the HBM4EU coordinator, and Valeria Dulio (INERIS, France), the coordinator of the NORMAN networkhttps://www.norman-network.net/?q=Home, a network for reference laboratories and research centres in the field of monitoring of emerging compounds
Table 1 Summary of workshop participants.
|Institutions represented at the workshop (by country)|
|Finnish Institute for Health and Welfare (THL)|
|Ministry of Social Affairs and Health|
|Finnish Institute of Occupational Health|
|University of Iceland|
|Norwegian Institute of Public Health|
|Norwegian Environment Agency|
|National Food Agency|
|Environment Protection Agency|
|Swedish Chemicals Agency|
|Dept. of Growth and Reproduction, Region H|
|National Research Centre for the Working Environment|
|University of Southern Denmark|
|University of Copenhagen|
|Danish Veterinary and Food Administration|
|Danish Environmental Protection Agency|
|National Food Institute, Technical University of Denmark|
Table 2 Summary of Institutions represented at the workshop.
The health of European citizens is an EC priority. In this context, the science-policy interface of HBM4EU is particularly important, ensuring up-to-date and coordinated science-based information for policy makers. HBM in research in all Nordic countries has substantially benefited from HBM4EU participation – time trends, aligned studies, mechanistic studies, and method development/improvement are examples of HBM4EU activities in Nordic countries. And also vice versa, as- high quality, structured, reliable, well planned and effectively conducted HBM studies in Nordic countries have contributed significantly to HBM4EU.
The chromate study conducted in HBM4EU can be considered exemplary, in terms of providing a science-based answer to a policy question. Occupational studies in HBM4EU were conducted in Finland, but a comparable study design has been applied in a study in Denmark.
HBM in surveys was established by agencies in Sweden as part of Riksmaten, in Finland as part of health surveys, in Iceland as addition to the national nutrition survey and in Norway adhered to MoBa. The laboratory network established in HBM4EU has strong Nordic participation. Regulatory application of HBM in risk assessment has been established and bridging to source identification (environmental monitoring etc.) is requested.
Phthalates, Bisphenol A, PFAS, acrylamide, mycotoxins, metals, PAHs, flame retardants, UV filters, and pesticides are mentioned as priority substances by the workshop participants.
Although a common Nordic strategy was not discussed, much input is by Nordic countries provided to all planned activities in PARC. Agency involvement in the Nordic countries in PARC is shown below. Many research institutions, incl. universities, are participating.
After the workshop we have received positive feedback from many of the participants. Mostly the feedback has been that the Nordic collaboration has been improved, and that the participants have been inspired by other participants from the other Nordic countries. Also the participants believe that the Nordic expertise can ensure a Nordic influence on the outcome of the PARC project as a whole and how all can benefit from the shared actions. There was a proposal to arrange a new Nordic workshop/meeting in 2–3 years.
This workshop was made possible by grants from Nordic Council of Ministers. The assistance of E-moderator Omer Babiker Badreldin, Centre for Online and Blended Learning, is highly appreciated.
The proof reading and support from Katrin Vorkamp and Parvaneh Hajeb, Aarhus University is highly appreciated.
The editorial contributions from advisor in publications Ida-Lina Nyholm in Nordic Council are acknowledged very much.
24th March 2021 9-12.30
Welcome and introduction, format and expectations to the workshop Lisbeth E. Knudsen, University of Copenhagen, Denmark
9.15-12.30 Status of HBM4EU in each country including other ongoing HBM activities
A Danish alignment study in adults – Anna-Maria Andersson, Region H
The Danish time trend study – Hanne Frederiksen, Region H
Presentation of the Danish Chromium (VI) study and other ongoing NRCWE activities related to HBM4EU– Anne T. Saber, National Research Center for the Work Environment
PFAS – biomarkers of effects in human samples – Maria Wielsøe & Eva Bonefeld-Jørgensen, Aarhus University
Exposure to perfluoroalkyl substances during fetal life and hospitalization for infectious disease in childhood: A study among 1,503 children from the Odense Child Cohort – Tina Kold Jensen, University of Southern Denmark
In-utero and childhood chemical exposome in six European mother-child Cohorts – Biomonitoring in the HELIX Study – Line S. Haug, Norwegian Institute of Public Health
The Norwegian contribution to the alignment study – Cathrine Thomsen, Norwegian Institute of Public Health
Comparison of aggregated exposure to di(2-ethylhexyl) phthalate from diet and personal care products with urinary concentrations of metabolites using a PBPK model – Results from the Norwegian biomonitoring study in EuroMix – Hubert Dirven, Norwegian Institute of Public Health
Presentation of ongoing activities – Kristín Ólafsdóttir and Thorhallur Halldorsson, University of Iceland
Occupational Biomonitoring activities in Finland – Tiina Santonen (FIOH)
Human biomonitoring studies conducted at THL – Panu Rantakokko (THL)
Swedish HBM: Health related environmental monitoring – Siiri Latvala, Swedish EPA
Swedish Food Agency – ongoing activities within Riksmaten adolescents 2016-17 – Sanna Lignell, Swedish Food Agency
Are biobanked samples stable? – Christian Lindh, Lund University
Persistent chlorinated and fluorinated compounds and hypertension, cholesterol, incident type 2 diabetes and mortality – Agneta Åkeson, Karolinska Institute
Dietary exposure to acrylamide and risk of specific subtypes of cancer: a dose-response meta-analysis of observational studies – Federica Laguzzi, Karolinska Institute
25 March 2021 9-12 Lessons learned and prospects for the PARC continuation
PFAS-pollution in Ronneby – Christel Nielsen, Lund University
HBM4EU – main outcomes – Marike Kollosa-Gehring, UBA, Germany
The NORMAN network – Valeria Dulio, INERIS, France
Feasibility study in Finland – Exposure and health – Hanna Elonheimo and Elsi Haverinen, THL
Towards a network of analytical laboratories in HBM4EU – Katrin Vorkamp, Aarhus University, Denmark
Chemical analyses in the frame of HBM4EU, with particular focus on the role of the Nordic countries – Parvaneh Hajeb, Aarhus University, Denmark
Focusgroups and survey in Denmark related to HBM4EU – Lisbeth E. Knudsen, University of Copenhagen
Nordic inputs for PARC: Katrine Bom from Denmark, Hubert Dirven from Norway, Tiina Santonen from Finland, Linda Linderholm from Sweden.
|DBCODE||Country||Institution acronym||Study acronym + LINK IPCHEM||Study Description|
|BIOBRANDPART1||Denmark||NRCWE||BIOBRAND - part 1||A Biomonitoring Study of Recruits Under Education as Smoke Divers|
|BIOBRANDPART2||Denmark||NRCWE||BIOBRAND_part2||A Biomonitoring Study of firefighters|
|BIOTRACK||Denmark||NRCWE||BIOTRACK||Health effects of occupational exposure to combustion particles. A study on volunteers performing as train conductors|
|ACRIGSHOSPITALET||Denmark||RegionH||AC_Rigshospitalet||Amniocentesis Cohort at dept. of Growth and Reproduction, RegionH|
|CPHMC||Denmark||RegionH||CPH_MC||COPENHAGEN Mother Child Cohort - a longitudinel study|
|CPHKGC||Denmark||RegionH||CPH-KGC||COPENHAGEN-Kindergarten children study|
|CPHPUB129SUB||Denmark||RegionH||CPHPUB_129sub||COPENHAGEN Puberty Study - 129 children substudy|
|CPHPUBCROSS||Denmark||RegionH||CPHPUB_cross||COPENHAGEN Puberty Study - cross sectional study|
|CPHPUBLONGI||Denmark||RegionH||CPHPUB_Longi||COPENHAGEN Puberty Study - longitudinal study|
|DYMS||Denmark||RegionH||DYMS||Danish Young Men Study - cross sectional study|
|CpHMiniPUB||Denmark||RegionH||CPHPUB_minipub_parents||COPENHAGEN Mini-puberty Study – a study of infant minipuberty – for HBM4EU parent samples were used|
|Denmark||SDU||Greenhouse children-Dk||Greenhouse children|
|OCC||Denmark||SDU||OCC||Odense Child Cohort|
|DKDEMOCOPHES||Denmark||UCPH||DK-DEMOCOPHES||Denmark-DEMOnstration of a study to COordinate and Perform Human biomonitoring on a European Scale|
|OCCUPANILINES||Finland||FIOH||OCCUP_Anilines||LimsBio_database of occupational exposure to Aniline, 4,4'-MDA and MOCA|
|OCCUPBCD||Finland||FIOH||OCCUP_B-Cd||LimsBio_database of occupational exposure to cadmium and cadmium compounds (Blood)|
|OCCUPBPA||Finland||FIOH||OCCUP_BPA||Occupational exposure to bisphenol A in Finland|
|OCCUPCADMIUMIN|POWERPLANTS||Finland||FIOH||OCCUP_cadmium in power plants||Maintenance workers' exposure to cadmium in power plants in Finland|
|OCCUPPFAS||Finland||FIOH||OCCUP_PFAS||Firefighters' exposure to Firefighting foams in Finland|
|OCCUPPHTHALATES||Finland||FIOH||OCCUP_PHTHALATES||Occupational exposure to DEHP, DINP and DPHP in Finland|
|OCCUPUCD||Finland||FIOH||OCCUP_U-Cd||LimsBio_database of occupational exposure to cadmium and cadmium compounds (urine)|
|OCCUPUCR||Finland||FIOH||OCCUP_U-Cr||LimsBio_database of occupational exposure to chromium and chromium compounds|
|OCCUPUPAH||Finland||FIOH||OCCUP_U-PAH||FIOH biomonitoring database on exposure to PAHs|
|OCCUPPAH1ELOVAARA||Finland||FIOH||PAH_1_(Elovaara)||LimsBio_database of occupational exposure to polycyclic aromatic hydrocarboms|
|OCCUPPAH2VAANANEN||Finland||FIOH||PAH_2_Vaananen||LimsBio_database of occupational exposure to polycyclic aromatic hydrocarboms|
|OCCUPPYRENOLAND|NAFTOL||Finland||FIOH||Pyrenol and naftol||Firefighters' exposure to polycyclic aromatic hydrocarbons in Finland|
|REFLIM2011||Finland||FIOH||RefLim2011||Update of the Reference Limits for the Non-Occupationally Exposed Population in Finland|
|FINRISK2012||Finland||THL||FINRISK2012||FINRISK 2012 survey|
|NFBC1966||Finland||University of Oulu||NFBC1966||Northern Finland Birth Cohort 1966|
|Diet HBM||Iceland||University of Iceland||Icelandic National Dietary Survey 2019 - Human Biomonitoring Substudy|
|Mercury||Iceland||University of Iceland||HBM-MOM Iceland|
|IES||Norway||NIPH||IES||Human Exposure to Toxicants Through the Indoor Environment|
|MOBA and NEBII||Norway||NIPH||MoBa||HBM Within the Norwegian Mother and Child Cohort Study|
|CSCB||Sweden||KI||CSC&B||Central Sweden Cohort & Biobank|
|DEMOCOPHESSE||Sweden||KI||DEMOCOPHES-SE||DEMOnstration of a study to COordinate and Perform Human biomonitoring on a European Scale_Sweden|
|Riksmaten||Sweden||NFA||Riksmaten adolescents 2016-17.|
|Finnish National Hub Contact Point.|
|Name of the organisation in your language:||In your language: Terveyden ja hyvinvoinnin laitos (THL)|
|In English: National Institute for Health and Welfare|
|Contact name:||Hanna Tolonen|
|Work packages and tasks that the organisation is directly involved in: |
|HBM4EU partners in Finland.|
|Name of the organisation:||In your language: Terveyden ja hyvinvoinnin laitos (THL)|
|In English: National Institute for Health and Welfare|
|Work packages and tasks that the organisation is directly involved in: |
WP1 (Tasks 1.1, 1.2, 1.4, 1.5),
WP2 (Tasks 2.2, 2.5),
WP7 (Tasks 7.1, 7.3),
WP8 (Task 8.3),
WP10 (Tasks 10.4, 10.5),
WP11 (WP leader, all tasks),
WP15 (Tasks 15.1, 15.3)
|Name of the organisation:||In your language: Työterveyslaitos|
|In English: Finnish Institute of Occupational Health|
|Work packages and tasks that the organisation is directly involved in: |
WP2 (Task 2.5),
WP4 (Task 4.2),
WP5 (Task 5.3),
WP7 (Task 7.1, 7.3),
WP8 (Task 8.5),
WP10 (Task 10.4, 10.5),
WP11 (Task 11.1),
WP12 (Task 12.1, 12.2, 12.3),
WP13 (Task 13.2),
WP15 (Task 15.3),
WP16 (Task 16.1, 16.2, 16.3)
|Key stakeholders that work on chemical issues in Finland|
|Name of the organisation:||In your language: Turvallisuus- ja kemikaalivirasto (Tukes)|
|In English: Finnish Safety and Chemical Agency|
|Icelandic National Hub Contact Point.|
|Name of the organisation in your language:||In your language: Háskóli Íslands|
|In English: University of Iceland|
|Contact name:||Thorhallur Ingi Halldorsson|
|Work packages and tasks that the organisation is directly involved in: University of Iceland coordinates the National Hub and is directly involved the WP 13, task 13.2 and WP 10 task 10.2.|
|HBM4EU partners in Iceland.|
|Name of the organisation:||In your language: Landlæknir|
|In English: Directorate of Health|
|Work packages and tasks that the organisation is directly involved in: |
The Directorate of Health is one of the partners of the Icelandic National Hub
|Name of the organisation:||In your language: Matvælastofnun|
|In English: Icelandic Food and Veterinary Authority|
|Work packages and tasks that the organisation is directly involved in: |
The Icelandic Food and Veterinary Authority is one of the partners of the Icelandic National Hub
|Name of the organisation:||In your language: Umhverfisstofnun|
|In English: The Environment Agency of Iceland|
|Work packages and tasks that the organisation is directly involved in: |
The Environment Agency of Iceland is one of the partners of the Icelandic National Hub
|Name of the organisation:||In your language: Matís|
|In English: Matís ltd. - Icelandic Food and Biotech R&D|
|Please add more as required||Matis is one of the partners of the Icelandic National Hub|
|In Iceland, human biomonitoring falls both directly and indirectly under the remit of three different governmental agencies: The Directorate of Health (under the Minister of Welfare), The Icelandic Food and Veterinary Authority (under the Ministry of Industries and Innovation) and The Environment Agency of Iceland (under the Ministry for the Environment). When it comes to human biomonitoring these agencies usually work closely with researcher at the University of Iceland and Matis both in terms of sharing of expertise and data. As a result the National Hub consists of these key partners.|
|Norwegian National Hub Contact Point.|
|Name of the organisation in your language:||In your language: Folkehelseinstituttet|
|In English: Norwegian Institute of Public Health|
|Contact name:||Cathrine Thomsen|
|Work packages and tasks that the organisation is directly involved in: |
WP6 task 6.3,
WP8 task 8.1 and 8.4,
WP9 task 9.1,
WP10 task 10.4 and 10.5,
WP11 task 11.5,
WP13 task 13.1 and 13.2 and
WP14 task 14.2 and 14.3.
|HBM4EU partners in Norway|
|Name of the organisation:||In your language: Helse- og omsorgsdepartementet (PO)|
|In English: Ministry of Health and Care Services|
|Work packages and tasks that the organisation is directly involved in:|
|The Norwegian Institute of Public Health (NIPH) is a governmental institution placed directly under the Ministry of Health and Care Services (PO). The institute is a national centre in the areas of epidemiology, mental health, infectious diseases control, environmental medicine and drug abuse. The NIPH is PM in HBM4EU and the National Hub Contact Point in Norway. |
NIPH will be involved in all Pillars of HBM4EU where we will act as advisors and co-workers as to the handling, evaluation and interpretation of all biomonitoring data. In addition we foresee to be contributing to the chemical analyses to be undertaken in the course of the project, and furthermore, with samples and data from the Norwegian Environmental Biobank. NIPH will also contribute with toxicological expertise covering toxico-kinetics, adverse outcomes, mode of action, adverse outcome pathways and biomarker of effects development. NIPH’s toxicology-, analyses- and nutrition experts have longstanding experience with all aspects of biomonitoring; from planning and implementing studies to clinical investigations, data handling, statistics and writing up and communicating results.
|Please identify the key stakeholders that work on chemical issues in Norway.|
|Name of the organisation:||In your language: Framtiden i våre hender|
|Name of the organisation:||In your language: Miljøstiftelsen Bellona|
|In English: Bellona|
|Name of the organisation:||In your language: Greenpeace Norge|
|In English: Greenpeace Norway|
|Name of the organisation:||In your language: Miljødirektoratet|
|In English: Norwegian Environment Agency|
|Name of the organisation:||In your language: Helsedirektoratet|
|In English: Norwegian Directorate of Health|
|Name of the organisation:||In your language: Statens Arbeidsmiljøinstitutt|
|In English: STAMI – The National Institute of Occupational Health|
|Name of the organisation:||In your language: Mattilsynet|
|In English: Norwegian Food Safety Authority|
|Name of the organisation:||In your language: Vitenskapskomiteen for mattrygghet|
|In English: Norwegian Scientific Committee for Food and Environment|
|Swedish National Hub Contact Point.|
|Name of the organisation:||In your language: Naturvårdsverket|
|In English: Swedish Environmental Protection Agency|
|Contact name:||Siiri Latvala, Karin Norström|
|Website address:||www.naturvardsverket.se (in Swedish) |
http://www.swedishepa.se/ (in English)
|Work packages and tasks that the organisation is directly involved in: As a National Hub Contact Point we are involved in WP 1-2, WP 4-7, WP 9-11, WP 15|
|Please provide us with details of all HBM4EU partners in Sweden.|
|Name of the organisation:||In your language: Kemikalieinspektionen|
|In English: Swedish Chemicals Agency|
|Website address:||http://www.kemi.se (in Swedish) |
http://www.kemi.se/en (in English)
|Work packages and tasks that the organisation is directly involved in: |
Member of the National Hub
|Name of the organisation:||In your language: Forskningsrådet Formas|
|In English: The Swedish Research Council Formas|
|Website address:||http://www.formas.se (in Swedish)|
http://www.formas.se/en (in English)
|Work packages and tasks that the organisation is directly involved in: Member of the National Hub|
|Name of the organisation:||In your language: Arbetsmiljöverket|
|In English: Swedish Work Environment Authority|
|Website address:||http://www.av.se (in Swedish)|
http://www.av.se/en (in English)
|Work packages and tasks that the organisation is directly involved in: Member of the National Hub|
|Name of the organisation:||In your language: Folkhälsomyndigheten|
|In English: The Public Health Agency of Sweden|
|Website address:||http://www.folkhalsomyndigheten.se (in Swedish)|
https://www.folkhalsomyndigheten.se/the-public-health-agency-of-sweden/ (in English)
|Work packages and tasks that the organisation is directly involved in: Member of the National Hub|
|Name of the organisation:||In your language: Boverket|
|In English: National Board of Housing, Building and Planning|
|Work packages and tasks that the organisation is directly involved in: Member of the National Hub|
|HBM4EU linked third parties in Sweden.|
|Name of the organisation:||In your language: Karolinska Institutet|
|In English: Karolinska Institute|
|Website address:||http://ki.se (in Swedish)|
http://ki.se/en/startpage (in English)
Links to the departments involved:
Institute for Environmental medicine:
http://ki.se/imm/start (in Swedish)
http://ki.se/en/imm/startpage (in English)
http://swetox.se (in Swedish)
http://swetox.se/en/ (in English)
|Work packages and tasks that the organisation is directly involved in: WP 7-11, WP 13, WP 15|
|Name of the organisation:||In your language: Umeå Universitet|
|In English: Umeå University|
|Website address:||http://www.umu.se (in Swedish) |
http://www.umu.se/english/?languageId=1 (in English)
Link to the department involved:
https://www.umu.se/institutionen-for-folkhalsa-och-klinisk-medicin/ (in Swedish)
https://www.umu.se/en/department-of-public-health-and-clinical-medicine/ (in English)
|Work packages and tasks that the organisation is directly involved in: WP 11|
|Name of the organisation:||In your language: Lunds Universitet|
|In English: Lund University|
|Website address:||http://www.lu.se (in Swedish)|
http://www.lunduniversity.lu.se/ (in English)
Link to the department involved:
http://ammlund.se/ (in Swedish)
http://ammlund.se/uk.html (in English)
|Work packages and tasks that the organisation is directly involved in: WP 9|
|Name of the organisation:||In your language: Livsmedelsverket|
|In English: National Food Agency|
|Website address:||http://www.livsmedelsverket.se (in Swedish)|
http://www.livsmedelsverket.se/en/ (in English)
|Work packages and tasks that the organisation is directly involved in: WP 8 and WP 10; Member of the National Hub|
|Key stakeholders that work on chemical issues in Sweden.|
|Name of the organisation:||In your language: Naturskyddsföreningen|
|In English: Swedish Society for Nature Conservation (SSNC)|
|Website address:||http://www.naturskyddsforeningen.se (in Swedish) |
http://www.naturskyddsforeningen.se/in-english (in English)
|Name of the organisation:||In your language: CHEMSEC|
|In English: CHEMSEC - THE INTERNATIONAL CHEMICAL SECRETARIAT|
|Website address:||http://chemsec.org (in English)|
|Name of the organisation:||In your language: IKEM Innovations- och kemiindustrierna I Sverige|
|In English: Innovation and Chemical Industries in Sweden|
|Website address:||http://www.ikem.se (in Swedish) |
http://www.ikem.se/in_english (in English)
|Name of the organisation:||In your language: Kosmetik- och Hygienföretagen|
|In English: The Swedish Cosmetics, Detergents and Toiletries Association|
|Website address:||http://www.kohf.se (in Swedish) |
https://www.kohf.se/om-kohf/kohf-in-english/ (in English)
|Trade union organisation:|
|Name of the organisation:||In your language: Landsorganisationen i Sverige|
|In English: The Swedish Trade Union Confederation|
|Website address:||http://www.lo.se (in Swedish) |
http://www.lo.se/english/startpage (in English)
|Danish National Hub Contact Point.|
|Name of the organisation in your language:||In your language: Københavns Universitet|
|In English: University of Copenhagen|
|Contact name:||Lisbeth E. Knudsen|
|Work packages and tasks that the organisation is directly involved in: |
WP1 Task 1.6
WP2 Task 2.8
WP8 Task 8.2
|HBM4EU partners in Denmark.|
|Name of the organisation:||In your language: Region Hovedstaden (Region H)|
|In English: Capital Region of Copenhagen|
|Work packages and tasks that the organisation is directly involved in: WP 8-13|
|Name of the organisation:||In your language: Det Nationale Forskningscenter for arbejdsmiljø|
|In English: National Research Centre for the Working Environment|
|Work packages and tasks that the organisation is directly involved in: WP14|
|Name of the organisation:||In your language: DTU Fødevareinstituttet|
|In English: National Food Institute|
|Work packages and tasks that the organisation is directly involved in: |
|Please provide us with details of all HBM4EU linked third parties in your country.|
|Name of the organisation:||In your language: Københavns Universitet|
|In English: University of Copenhagen|
|Work packages and tasks that the organisation is directly involved in: WP1, WP2Task 1.6, task 2.8|
|Name of the organisation:||In your language: Syddansk Universitet (SDU)|
|In English: University of Southern Denmark|
|Work packages and tasks that the organisation is directly involved in: WP10,11,13|
|Name of the organisation:||In your language: Århus Universitet|
|In English: Aarhus University|
|Work packages and tasks that the organisation is directly involved in: WP9 (Laboratory analyses and quality ass.) and WP14 (Effect Biomarkers)|
|Key stakeholders that work on chemical issues in Denmark.|
|Name of the organisation:||In your language: Miljøstyrelsen|
|In English: Environmental Protection Agency|
|Name of the organisation:||In your language: Fødevarestyrelsen|
|In English: Danish Veterinary and Food Administration|
|Name of the organisation:||In your language: Arbejdstilsynet|
|In English: Danish Working Environment Authority|
|Name of the organisation:||In your language: Sundhedsstyrelsen|
|In English: Danish Health Authority|
|Name of the organisation:||Styrelsen for Forskning og Uddannelse (Observer)|
|Danish Agency for Science and Higher Education (Observer)|
|Website address:||http://ufm.dk/en/the-minister-and-the-ministry/organisation/danish-agency-for-science-and-higher-education?set_language=en&cl=en ( page in English)|
Hanne Frederiksen, Anna-Maria Andersson, and Anders Juul Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet
At Dept. of Growth and Reproduction, Rigshospitalet, we in 2018 had two ongoing populations studies with collection of biological samples, which potentially also could be used for chemical analyses. In the first study “Minipuberty: a study of early markers for lifelong reproductive health and association with early exposures - CPHMinipub” it was planned to examine >200 infants with urine samples collected every second month during the first year of life. Sample collection was initiated in 2017 and finalized at the end of 2019. Medio 2018 we decided to expand the main study by also collecting urine samples from the infant’s parents in order to investigate exposure patterns within and between families. Additional ethical approval for collection of samples from parents and for chemical analysis in these were obtained. At the same time this opportunity made it possible for us to contribute with a Danish alignment study in adults under the HBM4EU frame as the majority of the funding for recruitment and sampling was secured from other sources and could contributed to our 50% co-funding of the alignment study. The parents in CPHMinipub represent healthy (fertile) couples from the general population of the Greater Copenhagen area. However, by the finalization of the study in 2019 it became apparent that we were slightly short of adult samples to reach the goal of 300 samples for an alignment study. The other ongoing study at the department was a study of reproductive health in Danish Young Men from the general population - DYMS, in which urine samples were also collected. Ethical permission to measure environmental chemicals with endocrine disrupting potential was already available in this study. Thus, we were able to obtain supplementary samples from this cohort for the alignment study.
Hanne Frederiksen and Anna-Maria Andersson, Dept. of Growth and Reproduction, Rigshospitalet
Due to endocrine disrupting effects of bisphenol A (BPA) and phthalates such as di-iso-butyl phthalate (DiBP), di-n-butyl phthalate (DnBP), butylbenzyl phthalate (BBzP) and di-(2-ethyl-hexyl) phthalate (DEHP), these chemicals have gradually been restricted and phased out through national and European legislation. However, humans are still exposed to a wide range of other less studied phthalates, phthalate substitutes and BPA analogues as well as other polychlorinated and phenolic substances.
In this study, human exposure to a wide range of potential endocrine disrupting non-persistent chemicals were investigated over the past decade. The urinary concentration of metabolites of 15 phthalate diesters and two phthalate substitutes (DEHTP and DINCH), seven bisphenols including BPA, as well as triclosan, triclocarban, benzophenone-3, three chlorophenols and two phenylphenols were analyzed in 300 urine samples collected in the years; 2009, 2013 and 2017 (100 samples each year) from young Danish men of the general population (DYMS), participating in a large on-going cross-sectional study.
Median concentrations of the phthalate metabolites of DiBP, DnBP, BBzP and DEHP and the phenols BPA, triclosan and the chloro- and phenylphenols significantly decreased in the period from 2009 to 2017. In contrast, metabolites of the two phthalate substitutes DEHTP and DINCH increased more than 20 and 2 times, respectively. The BPA substitutes; BPS and BPF also increased, but only slightly. Despite these new exposure patterns, the exposure to the old well-known chemicals, such as DiBP, DnBP, BBzP, DEHP and BPA were still higher in 2017 compared to the exposure level of the new substitutes such as DEHTP, DINCH, BPS and BPF. A significant decrease in internal exposure to most of the common phthalates and BPA over the past reflects market changes and regulatory measures implemented in EU.
Frederiksen H., Nielsen O., Koch H.M., Skakkebaek N.E., Juul A., Jørgensen N., Andersson A.M. Changes in urinary excretion of phthalates, phthalate substitutes, bisphenols and other polychlorinated and phenolic substances in young Danish men; 2009-2017. Int J Hyg Environ Health, 2020, 223, 93-105.
Anne Thoustrup Saber, Maria Helena Guerra Andersen, Marie Frederiksen, Karin Sørig Hougaard, Ulla Vogel, The National Research Centre for the Working Environment, Copenhagen
The aim of this presentation is to present the NRCWE contributions to HBM4EU WP8, WP10 and WP14.
WP8: Hexavalent chromium (Cr(VI) is classified as carcinogenic to humans (IARC group 1). NRCWE is involved in an ongoing national chromium (VI) study. The study is not part of the HBM4EU chromium study but follows to a large extent HBM4EU WP8 chromium (VI) methodology. In the Danish studyCOWI is project leader. NRCWE is leading the biomonitoring part of the study, while Force and DTU Food are responsible for the measurements of Cr exposure in air and biological matrices, respectively., markers of short-term and long-term Cr(VI) exposure, i.e. Cr(VI) and total Cr in air (inhalable fraction) and Cr(IV) in red blood cells in 100 participants in total, will be measured. Two thirds of the participants will be potentially exposed workers at workplaces in Denmark while one third will be matched controls. Micronuclei in reticulocytes will be measured in blood by FIOH as a biological effect biomarker of chromosome damage. Data will be compared both with the HBM4EU data and with data from a Swedish Cr(VI) exposed cohort (N=150).
WP10: NRCWE contributed with data for upload in IPCHEM from two biomonitoring studies. The studies investigated different occupational settings with exposure to polycyclic aromatic hydrocarbons (PAH) and combustion particles: firefighters and train conductors. BIOBRAND, a study on conscripts performing firefighting activities and BIOTRACK, a study on volunteers being inside a diesel train. The BIOBRAND study demonstrated that PAH exposure during firefighting activity, in terms of 1-OHP in urine and dermal exposure to pyrene and ƩPAHs, was associated with genotoxicity in peripheral blood mononuclear cells (PNBMCs). The BIOTRACK study demonstrated that exposure to black carbon from diesel exhaust inside diesel-powered trains for 3 days was associated with increased levels of DNA strand breaks in PBMCs, compared with electric trains.
WP14: NRCWE have contributed to the elaboration of two drafted reviews based on systematic literature searches addressing 1) Occupational exposure to PAHs: a systematic review of the literatureThe review is performed in collaboration with Istituto Superiore di Sanità (ISS, Italy), German Federal Institute for Risk Assessment, INSA (Portugal), HSL, Health and Safety Laboratory (United Kingdom), Biosanitary Research Institute of Granada (Spain), KU Leuven, Centre for Environment and Health (Belgium), Universidade NOVA de Lisboa (Portugal), IPASUM (Germany), Finnish Institute of Occupational Health (Finland) (WP8/WP14 collaboration), and 2) Pb exposure and neurodevelopmental toxicityThe review is performed in collaboration with Medical University of Vienna (Austria), National Public Health Center, (Budapest, Hungary), University of Granada (CIBM, Spain).
Maria Wielsøe and Eva Cecilie Bonefeld-Jørgensen, Centre for Arctic Health and Molecular Epidemiology, Department of Public Health, Aarhus University
Perfluorinated substances (PFASs) are among the prioritized substances in the HBM4EU project. PFASs have been used since the 1950s because of their water and fat repellent properties. The substances are found in food (especially meat), food packaging, clothing, shoes, furniture textiles, cosmetic, impregnating agents, paints, frying pans etc. The PFASs are environmentally widespread, persistent, and accumulative in nature, animals and humans.
Aarhus University / Eva C. Bonefeld-Jørgensen has coordinated a literature review on effect biomarkers related to PFAS exposure in collaboration with the National Institute of Public Health and Environment (RIVM, the Netherlands), the Flemish Institute for Technological Research (VITO, Belgium) and the Technical University of Denmark (DTU, Denmark). The review include effect biomarkers for the following systems: neurology, cancer, endocrine, immune system, metabolism, cardiovascular, and reproduction.
This literature review has resulted in a review summarizing the epidemiological evidence for an association between exposure to PFAS and disruption of thyroid homeostasis in pregnant women and newborns. In pregnant women, this review indicates a positive association between PFAS exposure and thyrotropin (TSH) level, but a negative association with Thyroxine (T4) and Triiodthyronine (T3). For the newborn, the results were less consistent, but a negative association between PFAS exposure and TSH is possibleSophie A. H. Boesen, Manhai Long, Maria Wielsøe, Vicente Mustieles, Mariana F. Fernandez, and Eva C. Bonefeld-Jørgensen. Exposure to Perflouroalkyl acids and foetal and maternal thyroid status: a review. Environ Health, (2020) 19:107, https://doi.org/10.1186/s12940-020-00647-1.
We have previously shown that the estrogenic activity of the PFAS mixture extracted from pregnant women's serum, free of endogenous hormones, was negatively associated with birth weight and length in newbornsBjerregaard-Olesen C, Bach CC, Long M, Wielsoe M, Bech BH, Henriksen TB, et al. Associations of Fetal Growth Outcomes with Measures of the Combined Xenoestrogenic Activity of Maternal Serum Perfluorinated Alkyl Acids in Danish Pregnant Women. Environmental health perspectives. 2019;127(1):17006.. In the HBM4EU project, we contributed to a study of hormone activities of lipophilic-organochlorine contaminates from 24 placentas. We received 24 placental extracts (from University of Granada) for measuring the estrogenic activity. The study found that most placentas induced estrogen-receptor-mediated transactivation and estrogen-receptor-dependent cell proliferation, together with a strong inhibition of thyroid hormone signaling and androgen receptor transactivity; while the induction of the aryl-hydro-carbon receptor was found in only one placental extractRodríguez-Carrillo A, Rosenmai AK, Mustieles V, Couderq S, Fini JB, Vela-Soria F, Molina-Molina JM, Ferrando-Marco P, Wielsøe M, Long M, Bonefeld-Jorgensen EC, Olea N, Vinggaard AM, Fernández MF. Assessment of chemical mixtures using biomarkers of combined biological activity: A screening study in human placentas. Reprod Toxicol. 2021 Jan 11:S0890-6238(21)00002-2. doi: 10.1016/j.reprotox.2021.01.002.. Furthermore, we received placenta homogenates for extraction of the PFAS mixture and analyzes of the xeno-estrogen transactivity. About half of the samples (52%) significantly activated the estrogen receptor, while 68% of the samples could further enhance the effect of the natural estrogen. Further PFAS extractions from placental homogenates are under analyses by the HBM4EU collaborate at University of Granada for estrogen activity by the E-screen method. In addition, we are working on further developing the method to analyze the androgenic activity of serum and placenta PFAS mixtures without interference from endogenous hormones.
Sophie A. H. Boesen, Manhai Long, Maria Wielsøe, Vicente Mustieles, Mariana F. Fernandez, and Eva C. Bonefeld-Jørgensen. Exposure to Perflouroalkyl acids and foetal and maternal thyroid status: a review. Environ Health, (2020) 19:107, https://doi.org/10.1186/s12940-020-00647-1
Bjerregaard-Olesen C, Bach CC, Long M, Wielsoe M, Bech BH, Henriksen TB, et al. Associations of Fetal Growth Outcomes with Measures of the Combined Xenoestrogenic Activity of Maternal Serum Perfluorinated Alkyl Acids in Danish Pregnant Women. Environmental health perspectives. 2019;127(1):17006.
Rodríguez-Carrillo A, Rosenmai AK, Mustieles V, Couderq S, Fini JB, Vela-Soria F, Molina-Molina JM, Ferrando-Marco P, Wielsøe M, Long M, Bonefeld-Jorgensen EC, Olea N, Vinggaard AM, Fernández MF. Assessment of chemical mixtures using biomarkers of combined biological activity: A screening study in human placentas. Reprod Toxicol. 2021 Jan 11:S0890-6238(21)00002-2. doi: 10.1016/j.reprotox.2021.01.002.
Tina Kold Jensen, Louise Dalsager, Helle Raun Andersen, Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, Odense, Denmark
Objectives: To investigate the association between maternal serum concentrations of five PFASs during pregnancy and the child’s rate of hospitalization due to common infectious diseases between birth and 4 years of age. Methods: Serum samples from first trimester pregnant women from the Odense Child Cohort (OCC) collected in 2010–2012 were analyzed for concentrations of five PFASs. Data on child hospitalizations with an ICD-10 code for infectious disease was obtained from the Danish National Patient Register. The following were identified: upper respiratory tract infections (URTI), lower respiratory tract infections (LRTI), gastrointestinal infections (GI), and other infections. The Andersen-Gill Cox proportional hazard model for recurrent events was used to investigate the association between PFAS exposure and hospitalizations. The resulting estimates were hazard ratios (HRs), which express the relative change in the instantaneous risk of hospitalization with a doubling in maternal PFAS concentration.
Results: A total of 1,503 mother–child pairs were included, and 26% of the children were hospitalized at least once for infectious disease. A doubling in maternal PFOS concentration was associated with a 23% increase in the risk of hospitalization due to any infection (HR: 1.23 (95% CI: 1.05, 1.44). There was indication of an interaction between child sex and PFOS (p = 0.07) and PFDA (p = 0.06), although in opposite directions. Further, every doubling of PFOA or PFOS increased the risk of LRTI by 27% (HR: 1.27 (1.01, 1.59)) and 54% (HR: 1.54 (1.11, 2.15)), respectively. Similar tendencies were seen for URTI and the group of other infections. For GIs, the opposite pattern of association was seen as HR’s were consistently below 1 (PFOA, HR: 0.55 (0.32, 0.95)).
Discussion: We found an association between PFOS and the overall risk of infectious disease, and between PFOS and PFOA exposures and the risk of LRTI’s. These results are in agreement with previous findings from the OCC, in which maternal PFOS and PFOA concentrations were positively associated with the number of days that the children experienced fever, thereby suggesting that PFOS and PFOA may affect the prevalence of both mild and more severe infectious diseases even in a rather low-exposed population.
Line Småstuen Haug, Norwegian Institute of Public Health
Currently the amount of harmonized data describing simultaneous exposure to a large number of environmental contaminants in-utero and during childhood is very limited. Thus, this study aimed to characterize concentrations of a large number of environmental contaminants in biological samples from European pregnant women and their children. The present study is part pf the Early-Life Exposome project, HELIX, a collaborative project across six established population-based birth cohort studies in Europe. biomarkers of exposure to 45 contaminants (i.e. organochlorine compounds, polybrominated diphenyl ethers, per- and polyfluoroalkyl substances, toxic and essential elements, phthalate metabolites, environmental phenols, organophosphate pesticide metabolites and cotinine) were measured in biological samples from 1301 children (6–12 years) and their mothers during pregnancy, using highly sensitive biomonitoring methods.
High detection frequencies in mothers (35 out of 45 biomarkers with>90% detected) and children (33 out of 45 biomarkers with>90% detected) were obtained for most of the exposure biomarkers. Significantly different concentrations were observed between cohorts for all compounds, and the concentrations were generally higher in maternal compared to children samples. In general, the correlations between maternal and child concentrations for the persistent compounds were moderate to high (Spearman Rho > 0.35), while for most non-persistent compounds correlations were considerably lower (Spearman Rho < 0.15). A considerable proportion of the samples of both mothers and their children exceeded the HBM I value established by The Human Biomonitoring Commission of the German Federal Environment Agency for mercury, PFOS and PFOA.
The present study suggests that children across Europe are exposed to a wide range of environmental contaminants in fetal life and childhood. A high variability in this “chemical exposome” was seen between cohorts, showing that place of residence is a strong determinant of one's personal exposome. This large dataset of more than 100,000 concentrations of environmental contaminants forms a unique possibility for conducting epidemiological studies using an exposome approach.
Cathrine Thomsen, Norwegian Institute of Public Health
One of the duties of the Norwegian Institute of Public Health (NIPH) is to have an overview of the health status of the Norwegian population and factors influencing public health. This includes the surveillance of the intake of nutrients and environmental contaminants and their possible effects on health. A Human Environmental Biomonitoring program that use the Norwegian Mother, Father and Child Cohort Study (MoBa) as a basis for recruitment, has been established. The MoBa cohort is an ongoing prospective study which includes 114,500 children, 95,200 mothers and 75,200 fathers. Part 1 of our biomonitoring program includes analyses of 11 elements (including heavy metals) in 3,000 stored blood samples collected from women during mid-pregnancy. In addition, iodine, sodium and potassium are determined in urine and several nutrients and hormones in plasma. In Part 2 of the program, new biological samples (blood and urine) from a subset of both children and their parents from Part 1 of the study were collected in 2016/17. This collection is referred to as the Norwegian Environmental Biobank (NEB). Norway contributes with samples from children (n=300) and teenagers (n=184) in NEB to the aligned study in HBM4EU. The biomonitoring laboratory at NIPH has qualified for the analyses of the first set of priority substances to be assessed in children and teenagers. Determination of the substances on the second priority list is also planned for the same individuals. In addition, NIPH will measure other substances of interest. Some of the biomarkers of effects under scrutiny of WP14 are to be assessed in NEB as well. The bulk of the samples in NEB will be stored in the biobank for future studies, both to allow for analyses of hitherto not studied contaminants and for the purpose of studying trends in exposure. An advantage of using the MoBa cohort as basis for the environmental biobank is that extensive health information is already available. This opens for a number of studies on possible health effects of both nutrients and environmental contaminants.
Hubert Dirven1, Martínez MA2, Sharma RP2, Kumar V2,3, Andreassen M, Sakhi AK1, Thomsen C1, Trine Husøy1.
1The Norwegian Institute of Public Health, Department of Environmental Health, 0403 Oslo, Norway.
2Environmental Engineering Laboratory, Departament d′Enginyeria Quimica, Universitat Rovira i Virgili, Av. Països Catalans 26, 43007 Tarragona, Catalonia, Spain.
3IISPV, Hospital Universitari Sant Joan de Reus, Universitat Rovira I Virgili, Reus, Spain.
The Horizon 2020 EuroMix project studied exposure and hazard assessment of mixtures in food, notably pesticides and food additives. As part of the EuroMix project a biomonitoring study was performed in Norway with 144 volunteers who kept for the 24h study period detailed weighed food diaries, recorded the use of personal care products (PCPs) and collected all urine voids in individual containers. A blood sample was collected at the end of the 24h study period (Day 1). Two to three weeks after the initial study day, all the procedures were repeated for an additional 24h study period (Day 2). A number of exposure markers have been measured including phthalates, bisphenols, parabens, PFAS, PAH, acrylamide and pesticides. A number of biomarkers of effects like microRNA, cholesterol, immunotoxicity parameters have been measured as well.
Individual probabilistic external exposure to di(2-ethylhexyl) phthalate (DEHP) was estimated, aggregating dietary with non-dietary exposure from PCPs. The results show that diet is the major contributor to DEHP exposure for both males and females, with an external exposure approximately 10 times higher than for the exposure from personal care products (PCPs). The main contributors to the dietary DEHP exposure are dairy products, with a percentage contribution of 69.3% and 62.8% of the total exposure for males and females, respectively. Additional food groups contributing to DEHP exposure were grain products, fruits and vegetables, meat and fish. For both males and females, deodorants contribute most to the exposure of DEHP from PCPs. External exposure estimates from the diet were used for internal dosimetry simulations using physiologically based pharmacokinetic (PBK/PBPK) models. Simulated 24 hours urinary concentrations were compared with measured urinary metabolites of DEHP, mono-2-ethylhexyl phthalate (MEHP), mono-2-ethyl-5-hydroxyhexyl phthalate (MEHHP), mono-2-ethyl-5-oxohexyl phthalate (MEOHP) and mono-2-ethyl 5-carboxypentyl phthalate (MECCP). Verification of the exposure data using forward-dosimetry PBK/PBPK model give good convergence with 24 hours urinary concentrations of simulated and measured BM data. The measured concentration of the MECCP metabolite seems to correlate well with the simulated high exposure, while the measured concentrations of MEHP, MEHHP and MEOHP were more dispersed and partly overlapped with both simulated low, medium and high metabolite exposure.
Trine Husøy, Maria A Martínez, Raju P Sharma, Vikas Kumar, Monica Andreassen, Amrit K Sakhi, Cathrine Thomsen, Hubert Dirven. Comparison of aggregated exposure to di(2-ethylhexyl) phthalate from diet and personal care products with urinary concentrations of metabolites using a PBPK model - Results from the Norwegian biomonitoring study in EuroMix. Food and Chemical Toxicology; 2020, 143, 111510. https://doi.org/10.1016/j.fct.2020.111510
T. Husøy, M. Andreassen, H. Hjertholm, NH Carlsen, N Norberg, C. Sprong, E. Papadopoulou, AK Sakhi, A Sabaredzovic and HAAM Dirven. The Norwegian biomonitoring study from the EU project EuroMix : levels of phenols and phthalates in 24-hour urine samples and exposure sources from food and personal care products. Environment international 2019, Environ Int. 2019 Nov;132:10510
Thorhallur I Halldorsson, professor, Dept. Food and Nutrition, firstname.lastname@example.org
Kristin Olafsdottir, Dept. Head, Dept. Pharmacology and Toxicology, University of Iceland
Prior to HBM4EU, there was no human biomonitoring program in Iceland. This European initiative has, therefore, been an important catalyst for starting such a program. Domestic stakeholders all acknowledge the need for data, but due to lack of expertise and limited resources, only sporadic surveillance has taken place, mainly at the initiative of academic research. Now, we are well on our way to the first exposure assessment and are hopeful that this will lead to the establishment of a sustainable program of HBM.
The HBM4EU funds will cover bisphenols, PAH, Cd and acrylamide in urine in 200 randomly selected participants from the 20-39 y age group. Further, we have secured funding for quntifaying PFAS, Hg, and mycotoxins for these same participants. Our biomonitoring program is aligned with the 2019-2020 Icelandic National Nutrition Survey which is funded by the government. This will enable linking levels of contaminants with diet and benefit the nutrition survey with the ability to measure nutrition instead of only estimating it. In addition, questions on health-related parameters are included for the first time with the help of a HBM4EU developed questionnaire. We have permission for biobanking the collected samples and for repeated contact with participants in the future.
However, alignment with another study means compromises. We learned during this process that better prioritisation of which questions to include to minimize burden of participation and use of more modern ways to approach participants will be needed next time. This is particularly important to increase participation among younger people that are reluctant to answer phonecalls of unknown origin. With the added frustration of covid19, collection of samples was not finished until end of 2020.
The first results of PFAS showed similar levels in Icelanders as in many European nations, with 2% exceedance of the EFSA critical value in serum for the sum of PFOS, PFOA, PFNA and PFHxS. Concentrations of acrylamide adducts in urine were similar in both sexes and about 2 x higher in smokers. Analyses of the associations between diet and acrylamide concentrations in urine are pending.
Results on bisphenols, Cd and PAHs and mycotoxins are expected within few weeks and more detailed analyses of the data is scheduled in the spring.
Kiviranta, H., Tolonen, H., Rantakokko, P., Korkalainen, M., Ruokojärvi, P., Koponen, J., Haverinen, E. & Elonheimo, H. Finnish Institute for Health and Welfare (THL)
In HBM4EU WP11 – Linking HBM, health surveys and registers, one of the tasks was to conduct feasibility studies to evaluate possibilities to combine HBM and health surveys in different countries and settings. Two such feasibility studies were selected to be conducted, one in Germany among adult population and one in Finland among school age children. UK/England planned to conduct a feasibility study but was not able to fit it to the schedule of their national health examination survey. Finnish feasibility study, Koululaisten biomonitorointi – Kuopio (KouBio-Kuopio) in English Biomonitoring of schools students (https://thl.fi/koubio) aimed to assess children’s phthalate and bisphenol exposures among 5th and 6th graders living in the Kuopio area.
Study was conducted in Kuopio, a city of 120,000 inhabitants located in the central part of Finland. Selected target group consisted of 5th and 6th grade students (10–12 year olds) from the primary schools. From 18 schools invited, seven schools agreed to participate. During the fieldwork, two more schools were contacted to obtain more participants, i.e. total of 1200 students were included to the sample.
From each participant the following information was collected: personal details, such as name, address, social security number, one spot urine sample and online/pen-and-paper questionnaire. The questionnaire mapped information on dietary habits, living environment, lifestyle, health and socio-demographic information. Additional information, such as anthropometrics, medical history, medical prescriptions and entitlement to reimbursement of drug expenses were obtained from administrative registers.
Several challenges occurred during the feasibility study. The original schedule to finish the fieldwork by the end of 2019 was not possible due to several time constraints. At first, obtaining the approvals from the health and school boards of the city of Kuopio and the ethical approval of the Ethical Board of Kuopio University Hospital took almost eight months with two revision rounds in the ethics committee. Requirements of the ethics committee also resulted in substantial changes in the study protocol. The initial plan was to link the feasibility study to the regular school health check-ups however this was not approved by the ethics committee. Therefore, the sample collection package was distributed at schools by the THL researcher, together with a presentation of the study. The students were requested to send the urine samples via mail.
Unfortunately, Finnish mail service went on strike when planning to start the school visits and caused more delay in the study. Due to the COVID-19 pandemic escalation in March 2020, five out of the originally planned seven schools were visited, and visits to the remaining two schools could not be organised due to the visiting restrictions. Materials were provided to the schools and teachers, who distributed the materials to the students.
Total number of 70 students of 1200 participated in the feasibility study, concluding in a participation rate of 6%. Currently, the analysis process of the results is ongoing. For future, combining HBM studies to already existing health examination surveys might be more feasible and cost-effective way to conduct biomonitoring studies.
Tiina Santonen, Finnish Institute of Occupational Health
Occupational exposures to specific chemicals may, in many instances, be several times higher than environmental exposures experienced by the general population. However, a typical challenge in occupational studies is the low number of workers that can be recruited in national studies. Like in the case of environmental studies, the studies performed by different researchers in individual countries are usually not aligned with respect to sampling, analytical methodologies or data collection, which complicates the comparison of the findings and the use of the data e.g. in regulatory risk assessment at European level. Therefore, combining national surveys using harmonized study designs and methodologies can potentially greatly improve the information collected from occupational studies and bring EU-added value for the data collected.
Within HBM4EU, we have planned altogether three targeted occupational studies focusing on different priority substances. The first occupational study on Cr(VI) exposure began in 2018, and the analysis of the results is currently ongoing. Hexavalent chromium (Cr(VI)) is an important occupational carcinogen at workplaces. Although Cr(VI) compounds are authorized under the European regulation (EC 1907/2006) concerning the Registration, Evaluation, Authorization and Restriction of Chemicals (REACH), these compounds are still widely used in different applications. There is also a recent binding occupational limit value (BOELV) set under EU Directive 2004/37/EC on the protection of workers from the risks related to exposure to carcinogens or mutagens at work (CMD, EC, 2017) for Cr(VI). The data collected in this study will support the implementation of these regulatory measures at EU level. In addition, because of the lowering exposure levels, there is a need to evaluate the capability and validity of new, more sensitive and specific HBM parameters for the assessment of Cr(VI) exposure. These include Cr-RBC and Cr-EBC, which have been analysed as part of the study. Biomarkers of early biological effects, ranging from the classic micronucleus assay to epigenetics markers have been also collected and will provide relevant information on exposure-response relationships. In addition to Cr(VI), exposure of welders to Ni and Mn, and of chrome platers to mist suppressants containing PFAS have been assessed. The combined results from all countries will be available by summer 2020.
Study on Cr(VI) provides a good model for use in other multi-national European occupational studies. Under HBM4EU, the second occupational study with two focuses, exposure to diisocyanates and exposures in E-waste handling, is planned to be conducted in 2020-2021. Study on diisocyanate exposure will focus in the manufacturing and repair of large vehicles, the use of diisocyanate based hot-melt glues in different sectors, and construction sector, which includes different sources of diisocyanates exposure. Its main aims are to provide new data on the exposure to diisocyanates in specific sectors, test the usability of different biomarkers in the assessment of exposure to diisocyanates, use the collected data to validate the PBPK model developed in HBM4EU WP12, and to provide background data for the setting of EU wide limit value for diisocyanates and for the follow-up of the effectiveness of diisocyanate REACH restriction in different countries. The study will be conducted in five countries; UK, Finland, Belgium, France and The Netherlands.
The study on E-waste handling will be conducted in Portugal, Poland, Germany, Latvia, the Netherlands and Luxembourg with possible contribution of Belgium, Finland and UK. The main aim is to support the sustainable processing of e-waste in Europe by creating new data on the exposure of workers to several HBM4EU priority compounds, including metals (lead, inorganic mercury, cadmium, chromium), phthalates, and flame retardants. In both studies the analysis of relevant effect markers is also included; in the case of diisocyanates the focus will be in inflammatory markers, whereas in the E-waste study we will analyse a set of inflammatory, genotoxicity and epigenetic markers.
Siiri Latvala Swedish Environmental Protection Agency
The Swedish EPA is a governmental agency with a vision of achieving “A good environment for people and all living things, now and for future generations”. We have the overall responsibility for coordinating the national and regional environmental monitoring which includes ten program areas. One of these is the Swedish human biomonitoring program, HÄMI.
The focus of HÄMI is on long-term monitoring of human exposure to environmental factors that can affect the human health. Children, adolescents and women are regularly studied and for which time trends exists. The Swedish EPA collaborates with different actors performing the monitoring.
Sanna Lignell, Helena Bjermo & Anna Karin Lindroos, Swedish Food Agency
Riksmaten adolescents 2016-17
The national representative, cross-sectional dietary survey Riksmaten adolescents 2016–17 (RMA) was performed by the Swedish Food Agency (Livsmedelsverket) during the school year of 2016–17. Details of the study design and sampling procedures are described elsewhereMoraeus L et al. 2018. Riksmaten Adolescents 2016–17: A national dietary survey in Sweden – design, methods, and participation. Food & Nutrition Research 2018, 62:1381. http://dx.doi.org/10.29219/fnr.v62.1381. Livsmedelsverket & Naturvårdsverket. Contaminants in blood and urine from adolescents in Sweden – Results from the national dietary survey Riksmaten Adolescents 2016–2017. S 2020 nr 01. https://www.livsmedelsverket.se/globalassets/publikationsdatabas/rapporter/2020/s-2020-nr-01-contaminants-in-blood-and-urine-from-adolescents-in-sweden.pdf.. Briefly, students in the age groups 12, 15 and 18 years were recruited from representative Swedish schools. Information on diet and background information was collected with questionnaires and with a web-based method where participants retrospectively registered 3 days of food consumption. The dietary survey was supplemented with a biomonitoring part where a sub-group of the participants was asked to provide blood and urine samples. Complete dietary information and valid blood and urine samples were available from 1,105 students.
Markers for nutritional status (iodine, 25-hydroxy vitamin D, ferritin, folate), HDL and LDL- cholesterol and wide range of contaminants were analysed in the blood and urine samples. The analysed contaminant groups include mycotoxins, chlorinated and brominated persistent organic pollutants (e.g. PCBs, DDE, PBDEs), per- and polyfluoroalkyl substances (PFAS), metals (e.g. Cd, Hg, Pb), phthalate- and DiNCH-metabolites and phenolic substances (e.g. bisphenols and triclosan)Livsmedelsverket & Naturvårdsverket. Contaminants in blood and urine from adolescents in Sweden – Results from the national dietary survey Riksmaten Adolescents 2016–2017. S 2020 nr 01. https://www.livsmedelsverket.se/globalassets/publikationsdatabas/rapporter/2020/s-2020-nr-01-contaminants-in-blood-and-urine-from-adolescents-in-sweden.pdf.. The analyses of contaminants were performed in collaboration with the Swedish Environmental Protection Agency and is part of the national health-related environmental monitoring programme.
Data on nutritional biomarkers are presented in a Swedish reportLivsmedelsverket. 2018. Riksmaten ungdom 2016-17. Näringsintag och näringsstatus bland ungdomar i Sverige. Livsmedelsverkets rapportserie nr 23 2018. https://www.livsmedelsverket.se/bestall-ladda-ner-material/sok-publikationer/artiklar/2018/2018-nr-23-riksmaten-ungdom-del-2-naringsintag-och-naringsstatus. Results from the analyses of contaminants have been compiled in a report that also investigates possible differences in contaminant concentrations between age groups, geographical regions and gendersLivsmedelsverket & Naturvårdsverket. Contaminants in blood and urine from adolescents in Sweden – Results from the national dietary survey Riksmaten Adolescents 2016–2017. S 2020 nr 01. https://www.livsmedelsverket.se/globalassets/publikationsdatabas/rapporter/2020/s-2020-nr-01-contaminants-in-blood-and-urine-from-adolescents-in-sweden.pdf.. The concentrations of contaminants in Swedish adolescents were generally comparable to levels found in other studies and within the expected ranges. Some participants exhibited exposure to PFOS or lead that was above the reference points used in risk assessments performed by EFSA.
In-depth analyses of mycotoxin and metal data have been published in peer-reviewed papersWarensjö Lemming E et al. 2019. Mycotoxins in blood and urine of Swedish adolescents - possible associations to food intake and other background characteristics. Mycotoxin Research 2019. https://doi.org/10.1007/s12550-019-00381-9 Almerud P et al. 2021. Cadmium, total mercury, and lead in blood and associations with diet, sociodemographic factors, and smoking in Swedish adolescents. Environmental Research, in press. https://doi.org/10.1016/j.envres.2021.110991.. The Swedish Food Agency will, in collaboration with researchers, continue to evaluate data from RMA. An evaluation of PFAS in relation to consumption of food and drinking water is in progressGlynn A et al. (Swedish University of Agricultural Sciences). 2020. Koppling mellan halter av per- och polyfluorerade alkylsubstanser i dricksvatten och blodserum bland deltagarna i Riksmaten ungdom 2016-17. Report to the Swedish EPA (the Health-Related Environmental Monitoring Program). http://naturvardsverket.diva-portal.org/smash/record.jsf?pid=diva2:1395588 and RMA is also part of a research project on chemical mixtures.
RMA is one of the aligned studies on teenagers within HBM4EU. Data on PFAS and phthalate/DiNCH-metabolites have been reported to HBM4EU, and samples from the study are currently analysed for arsenic and UV-filters within the project. Data from RMA has also been reported to the Arctic Monitoring and Assessment Programme (AMAP).
Altogether, biomonitoring data from RMA provide unique information that is important for risk assessment and risk management at the Swedish Food Agency as well as for monitoring of contaminant exposure on national and international level.
Riksmaten young children
The Swedish Food Agency is currently planning for the next national representative dietary survey. Young children at the ages 9 months, 18 months and 4 years, will be included. The study will start in September 2021 but a small pilot study started in March 2020. In the main study, the goal is to collect urine and blood samples from 300 children in the age groups 18 months and 4 years,
resp.. The samples will be used for analyses of markers for nutritional status and contaminants.
Moraeus L et al. 2018. Riksmaten Adolescents 2016–17: A national dietary survey in Sweden – design, methods, and participation. Food & Nutrition Research 2018, 62:1381. http://dx.doi.org/10.29219/fnr.v62.1381.
Livsmedelsverket & Naturvårdsverket. Contaminants in blood and urine from adolescents in Sweden – Results from the national dietary survey Riksmaten Adolescents 2016–2017. S 2020 nr 01. https://www.livsmedelsverket.se/globalassets/publikationsdatabas/rapporter/2020/s-2020-nr-01-contaminants-in-blood-and-urine-from-adolescents-in-sweden.pdf.
Livsmedelsverket. 2018. Riksmaten ungdom 2016-17. Näringsintag och näringsstatus bland ungdomar i Sverige. Livsmedelsverkets rapportserie nr 23 2018. https://www.livsmedelsverket.se/bestall-ladda-ner-material/sok-publikationer/artiklar/2018/2018-nr-23-riksmaten-ungdom-del-2-naringsintag-och-naringsstatus
Warensjö Lemming E et al. 2019. Mycotoxins in blood and urine of Swedish adolescents - possible associations to food intake and other background characteristics. Mycotoxin Research 2019. https://doi.org/10.1007/s12550-019-00381-9
Almerud P et al. 2021. Cadmium, total mercury, and lead in blood and associations with diet, sociodemographic factors, and smoking in Swedish adolescents. Environmental Research, in press. https://doi.org/10.1016/j.envres.2021.110991.
Glynn A et al. (Swedish University of Agricultural Sciences). 2020. Koppling mellan halter av per- och polyfluorerade alkylsubstanser i dricksvatten och blodserum bland deltagarna i Riksmaten ungdom 2016-17. Report to the Swedish EPA (the Health-Related Environmental Monitoring Program). http://naturvardsverket.diva-portal.org/smash/record.jsf?pid=diva2:1395588
Lindh CH, Norén E, Bjermo H, Gyllenhammar I, Lignell S Lund University
Introduction: A prerequisite to conduct epidemiological or time trend studies using biobanked samples is that the sample integrity remains unimpaired and the compounds remain stable. Major problems could be sample degradation and evaporation. However, to determine the long-term stability is difficult.
One difficulty is to have analytical methods that is reproducible over a long time period. Analytical technologies change over time, both regarding instrumentation and consumables, making longitudinal studies difficult to perform.
In this study both serum and urine samples were reanalysed after 4-6 years of storage. Biobanked serum samples (n=288) were from young adults collected in year 2013 and 2017 and stored at -80°C. The samples were analysed 2014 and 2020. The biobanked urine samples (n=179) were from randomly recruited first-time mothers who were recruited every year between 2009 and 2018 and stored at –20°C. The samples were analysed 2016 and 2019.
The samples were analysed at the laboratory at Occupational and Environmental Medicine, Lund University, Sweden using liquid chromatography connected to hybrid triple quadrupole linear ion trap mass spectrometers (QTRAP 5500 or 6500+, AB Sciex; LC-MS/MS). Serum samples were analysed for 8 perfluorinated alkyl acids (PFAAs (Noren et al submitted). Urine samples were analysed for metabolites from phthalates, DINCH, alkyl phenols, selected pesticides, and PAH according to Gyllenhammar et al 2017. The laboratory participates in the HBM4EU QA/QC programme and has qualified as HBM4EU laboratory for several of these analytes.
The comparisons of PFAA concentrations in the re-analyses performed in 2014 and 2020 of the same samples collected in 2013 showed that concentrations of six of the analyzed PFAAs remained stable in serum samples after storage at –80°C for up to 6 years, and that the samples did not appear to have evaporated. This was expected based on the stability of the compounds, but this finding also confirms that the analytical method was robust and well validated, yielding very similar results despite being performed by different technicians and on different occasions. Results for the stability of the other compounds will be presented.
Norén E, Lindh C, Glynn A, Rylander L, Pineda D, and Nielsen C. Temporal Trends, 2000–2017, of Perfluoroalkyl Acid (PFAA) Concentrations in Serum of Swedish Adolescents (Submitted)
Gyllenhammar I, Glynn A, Jönsson BA, Lindh CH, Darnerud PO, Svensson K, Lignell S. Diverging temporal trends of human exposure to bisphenols and plastizisers, such as phthalates, caused by substitution of legacy EDCs? Environ Res. 2017;153:48-54.
Agneta Åkesson, Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
Bioaccumulating persistent contaminants suspected to induce endocrine-disrupting effects may be involved in metabolic and atherosclerotic processes and mitigate the beneficial effects of fish consumption. This presentation will summarize the findings from four studies encompassing population-based cohort data in Swedish women and men. Specifically we explored i) the independent associations of dietary exposure to polychlorinated biphenyls (PCBs) and long-chain omega-3 fish fatty acids intake with cardiovascular and cancer mortality; ii) the longitudinal associations of plasma concentrations of different POPs with blood pressure and risk of hypertension iii) the associations between repeated measurements of the main perfluoroalkyl substances (PFAS) in plasma and total cholesterol, triglycerides and hypertension and insulin resistance and iv) whether PFAS were prospectively associated with clinical type 2 diabetes (T2D) risk.
Findings: The beneficial effect of fish consumption on the cardiovascular system seemed compromised by co-exposure to PCBs. This could be a likely explanation for the inconsistent associations observed globally between fish consumption and mortality. Based on repeated measurements, the accumulated exposure to dioxin-like PCBs and DDE, although less clear for the latter, may disrupt the normal blood pressure levels and increase the odds of hypertension. Moreover, individuals experiencing early-life POP exposure may be at elevated risk of vascular POP effects. We observed inverse associations between PFAS and triglycerides, but no support of any link with either cholesterol or hypertension. In the prospective nested case-control study, we observed overall inverse associations between individual PFAS and risk of T2D, although mostly non-significant. Among participants without T2D, long-term PFAS exposure was prospectively associated with lower insulin resistance.
Donat-Vargas, C., et al., Cardiovascular and cancer mortality in relation to dietary polychlorinated biphenyls and marine polyunsaturated fatty acids: a nutritional-toxicological aspect of fish consumption. J Intern Med, 2020. 287(2): p. 197-209.
Donat-Vargas, C., et al., Perfluoroalkyl substances and risk of type II diabetes: A prospective nested case-control study. Environ Int, 2019. 123: p. 390-398.
Donat-Vargas, C., et al., Associations between repeated measure of plasma perfluoroalkyl substances and cardiometabolic risk factors. Environ Int, 2019. 124: p. 58-65.
Donat-Vargas, C., et al., Persistent Organochlorine Pollutants in Plasma, Blood Pressure, and Hypertension in a Longitudinal Study. Hypertension, 2018. 71(6): p. 1258-1268.
Tommaso Filippinia, Thorhallur I. Halldorssonb,c, Carolina Capitãod, Raquel Martinsd, Marco Vincetia,e, Osvaldo Santosd,f, Ana Virgolinod, Federica Laguzzig
a Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy;
b Centre for Fetal Programming, Department of Epidemiology Research, Copenhagen, Denmark
c Unit for Nutrition Research, Faculty of Food Science and Nutrition, University of Iceland, Reykjavík, Iceland
d EnviHeB Lab, Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
e Department of Epidemiology, Boston University School of Public Health, Boston, MA, US
f Unbreakable Idea Research, Cadaval, Portugal
g Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
Background/Aim: Acrylamide is a probable carcinogen in humans. The main source of exposure to acrylamide in the general population is through diet. We performed a dose-response meta-analysis of epidemiological studies evaluating the associations between dietary intake and specific subtypes of cancers.
Method: A systematic literature search, following PRISMA guidelines, was conducted using Pubmed, Scopus and Web of Science until October 2020. Eligible studies included adults, assessment of dietary acrylamide (μg/day) and cancer incidence, reporting of risk estimates for increasing exposure to acrylamide. Quality of papers was assessed using the NIH’s Quality Assessment Tool for Observational Cohort and Cross-sectional Studies. We employed random-effects models either comparing the highest versus the lowest intake of acrylamide and using the one-stage approach for dose-response meta-analysis.
Results: Out of 835 studies screened, 26 studies were eligible for this meta-analysis. A total of 526,151 (mean age 60 years, range 50-70 years) participants were included, of which 13,629 developed cancer. The mean follow-up period was 15.1 years. Mean dose of acrylamide intake across studies was 22.6 µg/day. Pooled HR showed that high intake of acrylamide (35 µg/day) vs low intake (10 µg/day) was associated with increased risk of hematological malignances (summary HR: 1.4 95%CI:1.03-1.23). Dose-response meta-analysis showed evidence of linear association (p for non-linearity: 0.56). No clear associations were noted between high intake of acrylamide compared to low exposure and esophageal, stomach, pancreatic, lung, renal, bladder-urothelial, and prostate cancers. Similar results were observed in the smoking stratification analysis.
Conclusions: In this dose-response meta-analysis of epidemiological studies investigating the association between dietary intake of acrylamide and specific subtypes of cancer, higher intake of acrylamide was associated with increased risk of hematological malignancies. Further new studies based on human biomonitoring data are needed to clarify the relationship of dietary acrylamide and cancers in humans.
Funding: The HBM4EU project has received funding from the European Union’s Horizon 2020 research and innovation program under grant agreement No 733032.
Christel Nielsen1, Ying Li2, Magdalena Lewandowski1, Tony Fletcher3 and Kristina Jakobsson2,4
1 Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University
2 School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg
3 London School of Hygiene and Tropical Medicine, UK
4 Occupational and Environmental Medicine, Sahlgrenska University Hospital
Background: The drinking water in parts of Ronneby municipality was heavily contaminated with primarily PFHxS and PFOS for decades. Although PFAS has endocrine-disrupting properties and may interfere with breastfeeding, the supporting epidemiologic literature is conflicting and based on populations with only background levels of exposure. The effects on breastfeeding in populations with a point source of high exposure are unknown.
Objectives: To investigate the potential associations between high PFAS exposure and 1) initiation and 2) duration of breastfeeding in a population-based cohort.
Methods: We retrieved data on infant feeding practices for 2,374 children born between 1999 and 2009 from Child Health Care centers in Ronneby and Karlshamn, a nearby municipality with background levels of exposure. Maternal residential address before delivery was used as a proxy for exposure, and confounder data were obtained from charts and national registers. We used modified Poisson regressions to estimate the risk of not initiating breastfeeding and, among initiators, the risks of not breastfeeding exclusively after 3 months and not breastfeeding at all at 6 months.
Results: Mothers who had received the contaminated water at their residential address had a 2.4 times (95% CI: 0.8, 6.7) higher risk of not initiating breastfeeding. Among initiators, primiparous mothers from the exposed area were at a 1.2 times increased risk (95% CI: 0.9, 1.6) of not exclusively breastfeeding at 3 months and a 1.6 times increased risk (95% CI: 1.2, 2.1) of not breastfeeding at all at 6 months. Multiparous women seemed less vulnerable to these effects, although we observed slightly increased risk estimates towards the end of the study period.
Discussion: Exposure to high levels of PFAS was associated with increased risks of not initiating breastfeeding as well as with shorter breastfeeding duration. Initiation among primiparous mothers was the most critical outcome, and targeted intervention might be warranted.
Marike Kolossa-Gehring, German Environment Agency (UBA), Dessau-Roßlau/ Berlin, Germany
People in Europe are still substantially exposed to various chemicals from different sources and via different exposure pathways. Some of these chemicals have already been restricted, cannot be reasonably further regulated, are of emerging concern or not even known as pollutants relevant for human health. Targeted and non-targeted human biomonitoring (HBM) analyses provide information on the aggregate internal exposure from all sources and via all pathways (1). They help in combination with other data to identify sources and derive effective measures. HBM is therefore an excellent basis to identify the real exposure of European citizens, to improve risk assessment procedures for chemicals, and thus to protect people’s health.
117 partners from 30 countries cooperate in the European Joint Programme HBM4EU to generate the knowledge decision makers need to improve Europe’s environment and health policy (2, 3). HBM4EU was designed after consultation with European and national policy makers to identify policy needs and priority chemicals. Inclusion of stakeholders aims at facilitating the use of scientific results by different target groups, including the general public.
HBM data have in the past been and are in many cases still today fragmented in Europe. Therefore, HBM4EU develops a network of analytical laboratories that are qualified to deliver high quality and comparable exposure biomarker results for 18 priority substances. Up to now, first important sources for reduced comparability have been identified, which will be tackled by tailored training activities developed by HBM4EU. Study centers in 21 countries collect and analyze new samples in a harmonized way. Data for three age groups will jointly be analyzed and deliver comparable HBM data. An occupational study on exposure to chromium is conducted in 8 countries. 5 countries investigate internal exposure of mothers and their children to pesticides. Interpretation of HBM data is supported by derivation of HBM Health Based Guidance Values (HBM GV), exposure modelling and physiologically based pharmacokinetic modelling, mechanistic studies, identification of appropriate effect markers, and improving novel analytical techniques to screen for emerging chemicals and their metabolites in human samples.
The Scandinavian partners in HBM4EU contribute outstandingly to the success of HBM4EU by taking over central responsibilities like inter alia responsibility for the compliance of ethical requirements in the whole 117 partner consortium and ethical study conduct, an active role in the Management Board, the lead in combining health and human biomonitoring studies or as Chemical Substance Group Leader for scoping the HBM4EU activities in the challenging field of pesticide research. The prominent experience of the Scandinavian partners in the fields of exposure and effects research and risks assessments contribute to nearly every key task and activity of HBM4EU.
The new Risk Assessment Partnership (PARC) currently prepared by the EU-Commission in cooperation with many of the HBM4EU partners will include a continuation of HBM4EU activities and shall be co-funded under Horizon Europe. Like in HBM4EU and hopefully to an even larger extent a pronounced contribution from the Scandinavia countries is important to support a development of the European chemicals policy into a preventive and precautionary direction.
The project has received funding from the European Unions’ Horizon 2020 research and innovation Programme under grant agreement No 733032 HBM4EU (www.hbm4eu.eu).
Bopp, S.K., Barouki, R., Brack, W., Dalla Costa, S., J.C.M. Dorne, P.E. Drakvik, M. Faust, T.K. Karjalainen, S. Kephalopoulos, J. van Klaveren, M. Kolossa-Gehring, A. Kortenkamp, E. Lebret, T. Lettieri, S. Norager, J. Ruegg, J.V. Tarazona, X. Trier, B. van de Water, J. van Gils, A. Bergman (2018) Current EU research activities on combined exposure to multiple chemicals, Environ. Int., 120 (2018), pp. 544-562
Ganzleben C, Antignac J-P, Barouki R, Castaño A, Fiddicke U, Klánová J, Lebret E, Olea N, Sarigiannis D, Schoeters GR, Sepai O, Tolonen H, Kolossa-Gehring M (2017) Human biomonitoring as a tool to support chemicals regulation in the European Union. International Journal of Hygiene and Environmental Health 220 (2, Part A), 94-97.
Buekers, J., David, M., Koppen, G., Bessems, J., Scheringer, M., Lebret, E., . . . Trier, X. (2018). Development of Policy Relevant Human Biomonitoring Indicators for Chemical Exposure in the European Population. International Journal of Environmental Research and Public Health, 15(10), 2085.
Valeria Dulio, INERIS, France
Created in 2005 following a call by the EU Commission (DG Research) NORMAN is an independent, self-funded, not-for-profit, multidisciplinary and multinational organisation in the field of contaminants of emerging contaminants (CECs) in the environment, which brings together more than 80 organisations representing various stakeholders such as competent authorities, national reference laboratories, research centres, academia and industry – mostly in Europe, but also in North America and AsiaDulio V, Bavel B, Brorström-Lundén E, Harmsen J, Hollender J, Schlabach M, Slobodnik J, Thomas K, Koschorreck J: Emerging pollutants in the EU: 10 years of NORMAN in support of environmental policies and regulations. Environ Sci Eur 2018, 30.
The missions of NORMAN are to: (i) facilitate a more rapid and wider exchange of data on the occurrence and effects of CECs in water, biota, air and soil compartments; (ii) improve data quality and comparability via validation and harmonisation of common sampling and measurement methods (chemical and biological), and (iii) promote synergies between research teams from different countries, with the final goal of improving the transfer of scientific finding into policy.
All the activities of the network (workshop, interlaboratory studies, databases, etc.) are organised through its annual Joint Programme of Activities (https://www.normandata.eu/?q=node/135) as a result of a consultation process in which all NORMAN members are invited to participate.
The activities are organised in eight working groups dealing with different CECs aspects, i.e. prioritisation, effect-based tools, effect-directed analysis, nanomaterials and microplastics, water reuse, indoor environment as well as two cross-working group activities on passive sampling and non-target screening and more recently two new working groups one on soil and terrestrial environment and the second on marine environment.
Over the past 15 years, NORMAN has actively contributed to the development of state-of-the-art methods for investigation of the occurrence of large number of chemicals in the environment and associated mixture effects via the application of effect-based methods (bioassays, etc.).
As regards the development and harmonisation of methods, since 2006 NORMAN has organised more than 15 Collaborative Trials in key priority fields, including on non-target screening, in vitro and in vivo bioassays, and passive sampling.
To support the robust application of non-target screening techniques, NORMAN has developed a set of key toolsHollender J, van Bavel B, Dulio V, Farmen E, Furtmann K, Koschorreck J, Kunkel U, Krauss M, Munthe J, Schlabach M, Slobodnik J, Stroomberg G, Ternes T, Thomaidis NS, Togola A, Tornero V (2019) High resolution mass spectrometry-based non-target screening can support regulatory environmental monitoring and chemicals management. Environmental Sciences Europe 31 (1). doi:10.1186/s12302-019-0225-x , all integrated in the NORMAN Database System (NDS)NORMAN (2020) Database system (Available at https://www.norman-network.com/nds/susdat/susdatSearchShow.php; Last accessed 15 March 2021). which is a platform of twelve interconnected databases able to assist effective and rapid screening of contaminants in the environment. Among the twelve NDS modules, it is worth mentioning the NORMAN SusDat database, which is a highly-curated compound database of environmentally relevant contaminants (approx. 100,000 compounds as of February 2021), NORMAN Ecotoxicology Database, which contains ecotoxicological thresholds indicating whether the occurrence levels of contaminants can potentially cause harm to the ecosystems and NORMAN Digital Sample Freezing Platform (DSFP)Alygizakis NA, Oswald P, Thomaidis NS, Schymanski EL, Aalizadeh R, Schulze T, Oswaldova M, Slobodnik J (2019) NORMAN digital sample freezing platform: A European virtual platform to exchange liquid chromatography high resolution-mass spectrometry data and screen suspects in “digitally frozen” environmental samples. TrAC Trends in Analytical Chemistry 115:129-137. doi:10.1016/j.trac.2019.04.008Samanipour S, Baz-Lomba JA, Alygizakis NA, Reid MJ, Thomaidis NS, Thomas KV (2017) Two stage algorithm vs commonly used approaches for the suspect screening of complex environmental samples analyzed via liquid chromatography high resolution time of flight mass spectroscopy: A test study. J Chromatogr A 1501:68-78. doi:10.1016/j.chroma.2017.04.040 . The latter is a digital archive of non-target screening HRMS data from environmental samples. Thanks to this platform it is possible to search retrospectively a large number of compounds (search by batch) in all the environmental samples digitally stored in the database and check whether they are present (plus semi-quantified data) or absent in the samples of interest.
We believe that the networking infrastructure that NORMAN has developed a in the field of CECs in the environment fits well with the aims and structure of the PARC Partnership for Chemicals Risk Assessment and the HBM4EU long-term vision. The multidisciplinary membership of NORMAN has proven to be a strong point as it helps to pull knowledge of CECs together and pushes the latest scientific findings towards policy-making.
Dulio V, Bavel B, Brorström-Lundén E, Harmsen J, Hollender J, Schlabach M, Slobodnik J, Thomas K, Koschorreck J: Emerging pollutants in the EU: 10 years of NORMAN in support of environmental policies and regulations. Environ Sci Eur 2018, 30.
Hollender J, van Bavel B, Dulio V, Farmen E, Furtmann K, Koschorreck J, Kunkel U, Krauss M, Munthe J, Schlabach M, Slobodnik J, Stroomberg G, Ternes T, Thomaidis NS, Togola A, Tornero V (2019) High resolution mass spectrometry-based non-target screening can support regulatory environmental monitoring and chemicals management. Environmental Sciences Europe 31 (1). doi:10.1186/s12302-019-0225-x
NORMAN (2020) Database system (Available at https://www.norman-network.com/nds/susdat/susdatSearchShow.php; Last accessed 15 March 2021).
Alygizakis NA, Oswald P, Thomaidis NS, Schymanski EL, Aalizadeh R, Schulze T, Oswaldova M, Slobodnik J (2019) NORMAN digital sample freezing platform: A European virtual platform to exchange liquid chromatography high resolution-mass spectrometry data and screen suspects in “digitally frozen” environmental samples. TrAC Trends in Analytical Chemistry 115:129-137. doi:10.1016/j.trac.2019.04.008
Samanipour S, Baz-Lomba JA, Alygizakis NA, Reid MJ, Thomaidis NS, Thomas KV (2017) Two stage algorithm vs commonly used approaches for the suspect screening of complex environmental samples analyzed via liquid chromatography high resolution time of flight mass spectroscopy: A test study. J Chromatogr A 1501:68-78. doi:10.1016/j.chroma.2017.04.040
Katrin Vorkamp1, Marta Esteban Lopéz2, Thomas Göen3, Cathrine Thomsen4, Marike Kolossa-Gehring5, Argelia Castaño2
2Instituto de Salud Carlos III, National Centre for Environmental Health, Madrid, Spain
3Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine,
Friedrich-Alexander Universität Erlangen-Nürnberg, Germany
4Norwegian Institute of Public Health, Department of Environmental Exposure and Epidemiology, Oslo, Norway
5German Environment Agency, Berlin, Germany
The EU Horizon 2020 project HBM4EU has prioritized two sets of chemicals, to which the European population may be exposed from environmental and/or occupational sources. The first set includes phthalates and 1,2-cyclohexane dicarboxylic acid diisononyl ester (DINCH), bisphenols, flame retardants (organophosphate esters (OPEs) and brominated flame retardants (BFRs)), perfluorinated alkylated substances (PFASs), polycyclic aromatic hydrocarbons (PAHs), aromatic amines, cadmium and chromium. The second set includes pesticides, acrylamides, UV filters, mycotoxins, diisocyanates, aprotic solvents, arsenic, lead and mercury. A work package in HBM4EU is dedicated to laboratory analysis and quality assurance/quality control (QA/QC). It is led by the Instituto de Salud Carlos III in Spain and consists of six tasks, of which two are led by Nordic partners, i.e. the Norwegian Institute of Public Health (NIPH) and Aarhus University (AU).
Based on a set of general criteria and a literature review, specific biomarkers and preferred matrices for human biomonitoring were identified for the prioritized compoundsVorkamp, K.; Castaño, A.; Antignac, J.-P.; Boada, L.D.; Cequier, E.; Covaci, A.; Esteban López, M.; Haug, L.S.; Kasper-Sonnenberg, M.; Koch, H.M.; Luzardo, O.P.; Osīte, A.; Rambaud, L.; Pinorini, M.-T.; Sabbioni, G.; Thomsen, C. (2021) Biomarkers, matrices and analytical methods targeting human exposure to chemicals selected for a European human biomonitoring initiative. Environ. Int. 146, 106082.. Further narrowing down the lists of biomarkers, but keeping analytical methods open, interlaboratory comparison investigations (ICIs) and/or external quality assurance schemes (EQUAS) were organized, with the purpose to ensure comparable data of high quality across biomonitoring studies in HBM4EUEsteban López, M.; Göen, T.; Mol, H.; Nübler, S.; Haji-Abbas-Zarrabi, K.; Koch, H.M.; Kasper-Sonnenberg, M.; Dvorakova, D.; Hajslova, J.; Antignac, J.-P.; Vaccher, V.; Elbers, I.; Thomsen, C.; Vorkamp, K.; Pedraza-Díaz, S.; Kolossa-Gehring, M.; Castaño, A. (2021) The European Human Biomonitoring platform – design and implementation of a QA/QC programme for selected priority chemicals. Int. J. Hyg. Environ. Health, in press. Nübler, S.; Esteban López, E.; Castaño, A.; Mol, H.; Schäfer, M.; Haji-Abbas-Zarrabi, K.; Bury, D.; Koch, H.M.; Vaccher, V.; Antignac, J.-P.; Dvorakova, D.; Hajslova, J.; Thomsen, C.; Vorkamp, K.; Göen, T. (2021) Interlaboratory Comparison Investigations (ICIs) and External Quality Assurance Schemes (EQUAS) for cadmium in urine and blood: results from the HBM4EU project. Int. J. Hyg. Environ. Health 234, 113711.. All interested laboratories in Europe were invited to participate for the first group of prioritized compounds, via a previously established wide-scope list of candidate laboratories. The laboratory performance for the second group of prioritized compounds was assessed via an EQUAS for selected expert laboratories. Laboratories were considered qualified for chemical analyses of specific biomarkers in HBM4EU after satisfactory results in two rounds of the ICI/EQUAS. All QA/QC related activities in HBM4EU were designed and accompanied by a Quality Assurance Unit (QAU) consisting of experts in analytical chemistry.
A total of 84 laboratories qualified in this process for the first set of prioritized compounds, of which ten institutions were from the Nordic countries: Norwegian Institute for Public Health (BFRs, PFASs, bisphenols, phthalates, DINCH, OPEs), University of Lund, Sweden (PFASs, bisphenols, Cd, Cr, PAHs, phthalates), Karolinska Institute, Sweden (Cd), Finnish Institute of Occupational Health (Cd, Cr, PAHs), National Institute for Health and Welfare, Finland (BFRs, PFASs, bisphenols, phthalates), University of Southern Denmark (PFASs), University Hospital Copenhagen/Department of Growth and Reproduction, Denmark (Bisphenols, phthalates, DINCH), University of Copenhagen, Denmark (PAHs) and Aarhus University/Department of Environmental Science/Department of Bioscience, Denmark (BFRs, PFASs, Cd). In the EQUAS process for the second set of prioritized substances, 15 expert laboratories qualified, amongst these the University Hospital Copenhagen/Department of Growth and Reproduction, Denmark (UV-filters).
The qualified laboratories have analyzed the prioritized biomarkers in urine and serum samples from three age groups of the general population of Europe (“aligned studies”), in existing samples from the DEMOCOPHES project and in newly conducted occupational studies, with the main purpose of generating data for risk assessment purposes. The network of laboratories established in HBM4EU will be carried over into the planned Partnership for the Assessment of Risks from Chemicals (PARC) where it is expected to be consolidated and expanded. Following the HBM4EU model, similar networks are planned in PARC for laboratories with expertise in other fields.
Acknowledgements: We would like to acknowledge all partners in the HBM4EU WP9 for their contributions. The HBM4EU project received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 733032.
Vorkamp, K.; Castaño, A.; Antignac, J.-P.; Boada, L.D.; Cequier, E.; Covaci, A.; Esteban López, M.; Haug, L.S.; Kasper-Sonnenberg, M.; Koch, H.M.; Luzardo, O.P.; Osīte, A.; Rambaud, L.; Pinorini, M.-T.; Sabbioni, G.; Thomsen, C. (2021) Biomarkers, matrices and analytical methods targeting human exposure to chemicals selected for a European human biomonitoring initiative. Environ. Int. 146, 106082.
Esteban López, M.; Göen, T.; Mol, H.; Nübler, S.; Haji-Abbas-Zarrabi, K.; Koch, H.M.; Kasper-Sonnenberg, M.; Dvorakova, D.; Hajslova, J.; Antignac, J.-P.; Vaccher, V.; Elbers, I.; Thomsen, C.; Vorkamp, K.; Pedraza-Díaz, S.; Kolossa-Gehring, M.; Castaño, A. (2021) The European Human Biomonitoring platform – design and implementation of a QA/QC programme for selected priority chemicals. Int. J. Hyg. Environ. Health, in press.
Nübler, S.; Esteban López, E.; Castaño, A.; Mol, H.; Schäfer, M.; Haji-Abbas-Zarrabi, K.; Bury, D.; Koch, H.M.; Vaccher, V.; Antignac, J.-P.; Dvorakova, D.; Hajslova, J.; Thomsen, C.; Vorkamp, K.; Göen, T. (2021) Interlaboratory Comparison Investigations (ICIs) and External Quality Assurance Schemes (EQUAS) for cadmium in urine and blood: results from the HBM4EU project. Int. J. Hyg. Environ. Health 234, 113711.
Parvaneh Hajeb1, Marta Esteban López2, Katrin Vorkamp1, Argelia Castaño2
1Aarhus University (AU), Denmark; email@example.com
2Instituto de Salud Carlos III, National Centre for Environmental Health, Spain; firstname.lastname@example.org
HBM4EU includes chemical analyses of two sets of prioritized compounds in human samples from human biomonitoring studies focus on different target populations. An overview of the chemical analyses for the 1st and 2nd set of prioritized compounds, which is currently in progress, is given in the table below.
Overview of chemical analyses in the human biomonitoring studies HBM4EU
|8.1||Alignment of national studies||Partners representing Northern, Southern, Western and Eastern Europe |
3 age groups (children, teenagers, adults)
~ 150/300 samples per partner and compound group, urine and/or serum
1st group of priority substances: Phthalates, DINCH, OPFRs, HFRs, PFAS, bisphenols, PAHs, cadmium
2nd group of priority substances: Acrylamide, arsenic, mycotoxins, pesticides, UV-filters
|8.2||Use of existing samples from biobanks to determine exposure time-trends||Three time points |
10 partners, representing North, South, West and East
Mother-child pairs, urine samples
Phthalates, DINCH, OPFRs, PAHs, cadmium, bisphenols
|8.5||Targeted occupational studies||1st occupational study: |
8 partners from different European countries
Chromate in urine, plasma, red blood cells, exhaled breath condensate (EBC), air and hand wipes
Additional analyses of PFAS in plasma
2nd occupational studies:
1) Exposure to diisocyanates:
5 European countries
Workers in manufacturing and repair of large vehicles
Exposure biomarkers and effect biomarkers in blood, urine, buccal cell
2) Exposures in e-waste management
9 European countries – FI, UK and BE on own initiative
Metals (Pb, Hg, Cd, Cr), phthalates, and flame retardants in blood, urine, buccal cell and hair
|8.7A||Mercury studies||5 coastal European countries |
Two samplings: in the 1st trimester and after birth
Mercury in hair
AU and partners coordinate the chemical analyses in HBM4EU. This includes, among others, that AU conducted surveys on the status of sampling campaigns, ethical approval and laboratory selection among the sample owners, with the support of the respective tasks leads in HBM4EU. Laboratories qualified for analyses in HBM4EU were asked for information on price, capacity, time frames and technical details of the analyses. This information was then made available to interested sample owners, looking for qualified laboratories for the chemical analyses. Analyses have been completed for 67% of studies for the 1st set of prioritized compounds. On the other hand, very few analyses (< 10%) have been completed to date for the 2nd set of prioritized compounds. Delays occurred due to covid-19 shout downs.
Nordic partners actively contribute to HBM4EU, both as sample owners and qualified laboratories. Six partners from the five Nordic countries participate in Task 8.1. A total of 30 studies from Nordic partners include the analysis of phthalates, DINCH, OPFRs, HFRs, and acrylamide (in 600 children), phthalates, DINCH, PFAS, arsenic, and UV-filters (in 484 teenagers) and bisphenols, PAHs, cadmium, acrylamide, mycotoxins, UV-filters (in 814 adults). Two Nordic partners (UCPH/Denmark and SEPA/Sweden) participate in Task 8.2 with DEMOCOPHES samples analyzed for phthalates, DINCH, OPFRs, PAHs, cadmium, bisphenols (in 219 children and 94 women). FIOH/Finland is the only Nordic partner participating in Task 8.5. FIOH planned six studies (> 444 samples) in the 1st occupational study including the analysis of chromium and PFAS as described in the table. In the 2nd occupational studies, FIOH planned four studies (> 210 samples) with regard to diisocyanate exposure including analysis of diisocyanate Hb and lysine adducts, diamines and inflammatory markers, and eight studies (> 625 samples) regarding e-waste management. A new study was initiated in October 2020, focusing on prenatal exposure to mercury and related dietary advice with regard to fish consumption during pregnancy. UI/Iceland is the only Nordic country participating in this study.
The current status of the chemical analyses shows that analyses have been completed for most of the Nordic partners contributing with samples. In total, eleven Nordic laboratories (from ten institutions) are qualified according to the HBM4EU scheme for quality assurance/quality control. Of these seven qualified laboratories have been selected by the sample owners for analysis of different biomarkers of interest in HBM4EU.
Acknowledgments: This work is funding by the European Union`s Horizon 2020 program, grant agreement No. 733032 HBM4EU
Lisbeth E. Knudsen, University of Copenhagen, Denmark
Focus groups are considered valuable sources of information as the group interviews are expected to motivate and inspire discussions. The HBM4EU team at UCPH did not have access to list of potential participants for focus groups and outsourced the recruitment to Norstat. Norstat offers recruitment for qualitative surveys, including focus groups and in-depth interviews. Both parts are offered settled with physical attendance with or online. Norstat can provide premises and online platforms and also offers to handle incentives for respondents.
The first focus group was on site in Copenhagen the 3rd November 2020 at Norstats premises with 6 participants arriving well in advance and being situated in a room with sufficient space to meet the Covid-19 recommendations.
The second focus group was virtual the 11th November 2020 hosted by Norstat with 7 participants.
One moderator guided the discussions from the script adapted from the previous focus groups and two colleagues followed from remote but did not intervene.
The survey was compiled in all countries within HBM4EU. In Denmark a representative sample of 1000 persons was drawn by Norstat and replies were sent anonymised to the central distributor in Austria who analysed the results.
In Denmark a total of 363 participants completed the online questionnaire in the citizen survey.
|personal care products||35.3|
|non-food consumer products||21.8|
|the home environment||12.1|
Areas of chemical exposure should be a priority of human biomonitoring studies (n = 363)
HBM4EU – The European Human Biomonitoring Initiative; and its continuation in PARC
Lisbeth E. Knudsen
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