Environmental Chemicals in People: Challenges in Interpreting Biomonitoring Information

By LaKind, Judy S.; Barraj, Leila et al. | Journal of Environmental Health, May 2008 | Go to article overview

Environmental Chemicals in People: Challenges in Interpreting Biomonitoring Information


LaKind, Judy S., Barraj, Leila, Tran, Nga, Aylward, Lesa L., Journal of Environmental Health


Introduction

The risk assessment paradigm, which serves as the basis for public health evaluations and actions with respect to environmental chemicals, requires not only an assessment of the potential toxicity of a chemical but also an estimate of human exposure. Biomonitoring, the direct measurement of chemicals or their metabolites in blood, urine, or other bodily fluids or tissues, is becoming an increasingly common exposure assessment tool. As noted in the recent National Research Council review of the use of biomonitoring data in health risk assessment, "The ultimate objective of the biomonitoring research is to link biomarkers of exposure to biomarkers of effect and susceptibility to understand the public health implications of exposure to environmental chemicals" (National Research Council [NRC], 2006, page 23).

Advances in analytical methods, an increase in the number of available data sets including biomonitoring and health data, and improved computational capability have resulted in a greater number of studies examining associations between biomonitoring data and health endpoints. Reported associations between measured levels of chemicals in human blood or urine and health outcomes may be interpreted readily by the press and public as demonstrating cause and effect. In turn, health care providers or public health officials may be queried on relationships between biomonitored chemicals and illness as reported in the press. Most health care providers, however, do not have extensive experience or training in this area (NRC, 2006). Thus, we seek here to highlight key issues affecting the interpretation of studies on associations between biomonitoring data and human health.

In the United States, the most comprehensive biomonitoring effort has been conducted by the Centers for Disease Control and Prevention (CDC) as part of the National Health and Nutrition Examination Survey (NHANES). The main focus of the NHANES program has been to provide data on health and nutrition in the United States by compiling detailed health questionnaire and physical-examination data (including clinical-chemistry endpoints) on a statistically representative sample of the U.S. population. Measurement of a limited number of environmental chemicals (e.g., lead) has been part of NHANES since the 1970s. These data have yielded information on levels and trends in general U.S. population exposure to environmental chemicals (including some exposure information specific to race, gender, and ethnicity) and information on the success of regulatory efforts to limit exposures to specific environmental chemicals (Thomas, Socolow, Fanelli, & Spiro, 1999).

Recently, the number of chemicals measured in blood or urine as part of NHANES has increased dramatically (in 2001, data on 27 chemicals were released; approximately 300 chemicals are being measured in blood and urine samples collected as part of the 2003-2004 NHANES effort), and these data are publicly available in CDC's National Exposure Reports (CDC, 2005) and on the Internet (http://www.cdc.gov/nchs/nhanes.htm). The collection of large data sets on both environmental chemical exposure and health-related parameters has made it possible to evaluate these databases for statistical associations between levels of a chemical in blood or urine and aspects of participants' health. Several recent publications have used the NHANES data to explore such possible associations (Elliott, Longnecker, Kissling, & London, 2006; Lee et al., 2006; Lee, Lee, Steffes, & Jacobs, 2007; Saraiva et al., 2007).

Criteria for assessing whether reported associations may represent causal relationships between exposures and health effects are a fundamental bedrock of epidemiology and public health (Kundi, 2006). Interpretation of associations between measured levels of chemicals and health endpoints drawn from studies such as NHANES, however, poses specific challenges that have not been fully explored. …

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