Nitrat og Folkesundhed

Transkript

1 Nitrat og Folkesundhed Jörg Schullehner miljøingeniør, ph.d. i medicin Geological Survey of Denmark and Greenland National Centre for Register-Based Research EnviNa Temadage om indsatsplaner for grundvandsbeskyttelse

2 Program Nitrateksponering Akutte sundhedseffekter Kroniske sundhedseffekter Et dansk studie 2

3 Introduktion Modellerede andelen af befolkningen >25 mg/l Tarmkræftsrelaterede samfundsomkostninger 260 millioner DKK pr år i DK 3

4 Nitrat i drikkevandet Daglig nitratindtag 60 mg grønsager, frugt, drikkevand Petersen & Stolze (1999) Hansen et al. (2012) 4

5 S U N D H E D S E F F E K T E R 5

6 Akutte sundhedseffekter Grænseværdi i drikkevandet: 50 mg/l baseret på kliniske epidemiologiske studier beskytter spædbørn: blå børn syge meget sjældent i DK i dag Schullehner (2016) 6

7 Formodede kroniske sundhedseffekter Kræft mave, tarm, endetarm, spiserør, bugspytkirtel, blære, æggestokke, non-hodgkins lymfom, hjerne Andre Medfødte defekter, stofstifte (hypertrofi), type I diabetes, forhøjet blodtryk, akut åndedrætsbesvær hos børn Positive effekter Antibakterielle egenskaber, beskyttende mod hjerteanfald (myokardieinfarkt), slagtilfælde, forhøjet blodtryk, mavesår Ward et al. (2005), Espejo-Herrera et al. (2015,2016), Lundberg et al. (2008) 7

8 Kroniske sundhedseffekter Omdannelsen af nitrat i kroppen er årsagen til 40-75% af vores eksponering til nitrosaminer, nitrosamider (NOC er) Nitrat indtag forhøjer NOC er i urin IARC gruppe 2A probably carcinogenic to humans under conditions that result in endogenous nitrosation VITAMIN C VITAMIN E Schullehner (2016) 8

9 Tarmkræft Tyktarm Endetarm Bugspytkirtel Spiserør Etablerede risiko faktorer rød/forarbejdet kød rygning alkohol fysisk inaktivitet fedme Mave Tyndtarm NORDCAN (2016), Giovannucci (2001) Giovannucci et al. (1995), Larsson & Wolk (2007) Cho et al. (2004), Aune et al. (2013) 9

10 Epidemiologi tarmkræft Slovakiet/USA: forhøjet risiko >20 mg/l nitrat Spanien/Italien: forhøjet risiko >5 mg/l nitrat En del undersøgelser, der ikke viser (statistisk signifikant) sammenhæng 10

11 E T D A N S K S T U D I E 11

12 Register-baseret kohortestudie Bopæl Det Centrale Personregister Historiske bopælsoplysninger Eksponering Jupiter-database Nitratkoncentrationer Sundhedseffekt Cancerregisteret Diagnoser Kovariater Sundheds-/administrative registre alder, køn, uddannelse, rygning, kost 12

13 Nitrat i almene vandværker For hver person: Bopæl mellem kendt eksponering til nitrat 13

14 Nitrat i dansk drikkevand Almene vandværker Enkeltindvindere 14

15 Enkeltindvindere 15

16 Nitrat i dansk drikkevand Andel befolkningen, der får drikkevand med forhøjet nitratindhold >25 mg/l 16

17 K O N K L U S I O N E R 17

18 Hvad betyder det? Teorien Biologisk forklaring: omdannelse i kroppen til NOC Gamle epi-studier pegede i den retning at der er en kronisk effekt, men med statistisk usikkerhed, tvetydige resultater Nyeste studier Længere tidsserier, bedre eksponeringsberegninger USA: forhøjet risiko for blærekræft fra ca. 20 mg/l Spanien/Italien: forhøjet risiko for tarmkræft fra ca. 5 mg/l Kroniske effekter kan ikke udelukkes grænseværdi? 18

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