PMID- 11140442
OWN - NLM
STAT- MEDLINE
DCOM- 20010301
LR  - 20240109
IS  - 1053-4245 (Print)
IS  - 1053-4245 (Linking)
VI  - 10
IP  - 6 Pt 1
DP  - 2000 Nov-Dec
TI  - Uptake of chlorination disinfection by-products; a review and a discussion of its 
      implications for exposure assessment in epidemiological studies.
PG  - 586-99
AB  - We have reviewed the relevant issues in the exposure assessment of disinfection 
      by-products (DBPs) of chlorination for epidemiological and health risk 
      assessment. Various DBPs can be detected in drinking water and swimming pools, 
      and the reported levels show a considerable range, but were generally below the 
      current health standard for total trihalomethanes (TTHMs) (100 microg/l). 
      Relatively little information is available on the correlation between the various 
      DBPs in drinking water and in swimming pools. Chloroform was generally, but not 
      always, the most predominant DBP. In epidemiological studies, TTHM levels have 
      been used as an indicator for total DBP load, even though TTHM levels do not 
      always correlate well with individual DPBs. Factors such as residence time, 
      temperature, pH, organic content, including humic and fulvic acid and bromide 
      levels affect the composition and levels of DBPs. Although there are biomarkers 
      of DBPs, mainly for chloroform and more recently for the other volatile 
      trihalomethanes (THMs) and the nonvolatile haloacetic acids (HAAs) such as 
      trichloroacetic acid (TCAA) and dichloroacetic acid (DCAA), they have not been 
      used in epidemiological studies. The THMs have been measured in exhaled breath 
      and serum, while the HAAs have been measured in urine. These biomarkers have been 
      useful to estimate the actual uptake of the DBPs and the relative contribution of 
      various exposure routes. Physiologically based pharmacokinetic (PBPK) models 
      exist for, e.g. chloroform, but their main target organs are the kidney and liver 
      and they have not been used in epidemiological studies. Tap water ingestion, 
      showering, bathing, swimming, boiling water and dishwashing are all activities 
      that have been associated with the uptake of DBPs, and considerable variation in 
      these activities has been observed between people. No studies have reported on 
      the correlation between human uptake of DBPs and water-zone mean estimates, but 
      various studies found a good correlation between THM concentrations in exhaled 
      breath and THM concentrations in water during showering and swimming. In general 
      exposure assessment in epidemiological studies has been limited which complicates 
      the interpretation. These findings have implications for epidemiological studies, 
      particularly with reference to Berkson and classical error type models, study 
      power, attenuation and precision of health-risk estimates and study efficiency. 
      Recommendations are made for further areas of study.
FAU - Nieuwenhuijsen, M J
AU  - Nieuwenhuijsen MJ
AD  - The TH Huxley School of Environmental, Earth Sciences and Engineering, Imperial 
      College School of Science, Technology and Medicine, London, UK. 
      m.nieuwenhuijsen@ic.ac.uk
FAU - Toledano, M B
AU  - Toledano MB
FAU - Elliott, P
AU  - Elliott P
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PL  - England
TA  - J Expo Anal Environ Epidemiol
JT  - Journal of exposure analysis and environmental epidemiology
JID - 9111438
RN  - 0 (Chlorine Compounds)
RN  - 0 (Disinfectants)
SB  - IM
MH  - Chlorine Compounds/adverse effects/*pharmacokinetics
MH  - Disinfectants/adverse effects/*pharmacokinetics
MH  - Epidemiologic Studies
MH  - Humans
MH  - Models, Theoretical
MH  - Public Health
MH  - Risk Assessment
MH  - Swimming Pools
MH  - Tissue Distribution
MH  - *Water Supply
RF  - 84
EDAT- 2001/01/05 11:00
MHDA- 2001/03/07 10:01
CRDT- 2001/01/05 11:00
PHST- 2001/01/05 11:00 [pubmed]
PHST- 2001/03/07 10:01 [medline]
PHST- 2001/01/05 11:00 [entrez]
AID - 10.1038/sj.jea.7500139 [doi]
PST - ppublish
SO  - J Expo Anal Environ Epidemiol. 2000 Nov-Dec;10(6 Pt 1):586-99. doi: 
      10.1038/sj.jea.7500139.