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Abstract Background Air pollution is a growing health problem for urban populations in emerging economies. The present study examines the (cross-sectional) relation between blood pressure and particulate air pollution in schoolchildren of Lahore (Pakistan). Methods We recruited a sample of 8–12 year-old children (mean age 9.9 years; 45% girls) from two schools in Lahore situated in areas with low (n = 79) and high (n = 100) air pollution, respectively. During the study period (January-April 2009) particulate pollution [PM10 and PM2.5i.e. particles with aerodynamic diameters below 10 μm or 2.5 μm, respectively] was measured at the school sites with a laser operated device (Metone Aerocet 531). Blood pressure was measured, after 5 minutes of sitting rest, using an automated device (average of 5 consecutive measurements). Spot urine samples were also collected and concentrations of Na and K were measured. Results Mean daily values of PM2.5 were 28.5 μg/m3 (SD: 10.3) and 183 μg/m3 (SD: 30.2), in the low and high pollution areas, respectively. Systolic and diastolic blood pressure were significantly higher in children living in the high pollution area (115.9/70.9 mm Hg) than in the low pollution area (108.3/66.4 mm Hg), independently of age, gender, height, weight, socio-economic status, passive smoking and the urinary concentrations of Na, K, and creatinine. Conclusions In 8–12 year-old children, exposure to (traffic-related) air pollution was associated with higher systolic and diastolic blood pressure. These findings, if they persist, might have clinical relevance at older age.

Abstract Background Exposure to cadmium has been associated with osteoporosis and fracture risk in women and elderly, but studies in children are lacking. In the present study we investigate the association between markers of bone demineralization [urinary calcium (Ca) and deoxypyridinoline (DPD) excretion] and urinary cadmium (Cd) excretion (as an index of lifetime body burden). Methods 155 schoolchildren from 2 elementary schools in Lahore, Pakistan were included. Urinary Cd was measured as an index of lifetime exposure. We assessed the multivariate-adjusted association of exposure with markers of bone resorption, urinary DPD as well as with Ca excretion. Results Urinary Cd averaged 0.50 nmol/mmol creatinine and was not influenced by age, height, weight and socio-economic status (SES). Independent of gender, age, height, weight and SES a doubling of urinary Cd was associated with a 1.72 times (p < 0.0001) increase in urinary DPD and, a 1.21 times (p = 0.02) increase in urinary Ca. Additional adjustment for urinary Ca revealed still significant associations between urinary Cd and urinary DPD. The shape of the association was linear without evidence of a threshold. Conclusions Even in young children, low-level environmental exposure to cadmium is associated with evidence of bone resorption, suggesting a direct osteotoxic effect with increased calciuria. These findings might have clinical relevance at older age.

Abstract Background Numerous epidemiological studies have demonstrated adverse health effects of a sedentary life style, on the one hand, and of acute and chronic exposure to traffic-related air pollution, on the other. Because physical exercise augments the amount of inhaled pollutants, it is not clear whether cycling to work in a polluted urban environment should be encouraged or not. To address this conundrum we investigated if a bicycle journey along a busy commuting road would induce changes in biomarkers of pulmonary and systematic inflammation in a group of healthy subjects. Methods 38 volunteers (mean age: 43 ± 8.6 years, 26% women) cycled for about 20 minutes in real traffic near a major bypass road (road test; mean UFP exposure: 28,867 particles per cm3) in Antwerp and in a laboratory with filtered air (clean room; mean UFP exposure: 496 particles per cm3). The exercise intensity (heart rate) and duration of cycling were similar for each volunteer in both experiments. Exhaled nitric oxide (NO), plasma interleukin-6 (IL-6), platelet function, Clara cell protein in serum and blood cell counts were measured before and 30 minutes after exercise. Results Percentage of blood neutrophils increased significantly more (p = 0.004) after exercise in the road test (3.9%; 95% CI: 1.5 to 6.2%; p = 0.003) than after exercise in the clean room (0.2%; 95% CI: -1.8 to 2.2%, p = 0.83). The pre/post-cycling changes in exhaled NO, plasma IL-6, platelet function, serum levels of Clara cell protein and number of total blood leukocytes did not differ significantly between the two scenarios. Conclusions Traffic-related exposure to particles during exercise caused a small increase in the distribution of inflammatory blood cells in healthy subjects. The health significance of this isolated change is unclear.

In order to document the exposure to trace metals among urban schoolchildren and rural working children, we measured the urinary concentrations of metals in schoolchildren from two areas of differing traffic intensity in Lahore, and in children working in carpet weaving or the brick industry outside Lahore. In a cross-sectional design, we recruited a convenience sample of 339 children aged 8-12 years (mean age 9.9 y, SD 1.4; 47% girls) from two elementary schools in Lahore - one situated in a high air pollution area (n=100) and one situated in an area with lower air pollution (n=79) - and from the carpet weaving industry (n=80) and brick industry (n=80). A spot urine sample was collected and concentrations of 20 metals and metalloids were measured by inductively coupled plasma-mass spectrometry (ICP-MS). Samples of drinking water were similarly analyzed. In general, the urinary concentrations of several toxic metals (including Cr, Mn, As, Mo, Cd, Pb, U) were higher than international reference values. Concentrations of As were especially elevated in children working in the brick making industry [geometric mean (GM) 118 μg/L], but they were also high among urban schoolchildren (GM 68 μg/L and 56 μg/L). Lead (Pb) was higher in urine from schoolchildren in the high air pollution area (GM 11 μg/L) than in those from the lower pollution area (GM 5.3 μg/L). Uranium (U) was high in both carpet weavers (GM 0.28 μg/L) and brick kiln workers (GM 0.45 μg/L). Concentrations of As, Pb, and U in drinking water corresponded well with urinary concentrations of metals. This descriptive study provides evidence for a high exposure to several toxic metals in this area of Pakistan. The concentrations of urinary As are in the order of those found in other regions of the world with high environmental exposure to As. The sources and pathways of exposure and the health significance of these findings need to be further investigated., (Copyright © 2014 Elsevier GmbH. All rights reserved.)

Background: A considerable part of the worldwide production of surgical instruments takes place in Sialkot, Pakistan. Many children work in hazardous conditions in this industry., Objective: We investigated exposure to metals and possible health effects among children working in surgical instruments manufacturing units compared with schoolchildren from the same city., Methods: In a cross-sectional study we studied a convenience sample of 104 male children (10-14 years of age) working in surgical instruments manufacturing units and 75 male children of similar age from a school in Sialkot, Pakistan. A respiratory questionnaire was administered, spirometry was performed, and blood pressure was measured. In a spot urine sample, concentrations of metals were measured by inductively coupled plasma mass spectrometry and 8-hydroxydeoxyguanosine (8OHdG, reflecting oxidative DNA damage) by ELISA., Results: The working children reported more asthma (10% vs. 0%; p = 0.005) and dry cough at night (36% vs. 20%; p = 0.02) than did the schoolchildren, but there were no significant differences in pulmonary function or blood pressure. The urinary concentration of chromium was 35 times higher in working children [geometric mean, 23.0 µg/L; 25th-75th percentile, 8.38-58.6] than in schoolchildren [0.66 µg/L; 0.38-1.09)], and largely in excess of the occupational Biological Exposure Index for adult workers (25 µg/L). Urinary 8-OHdG concentrations were not significantly higher in working children than in schoolchildren (19.3 vs. 17.6 µg/g creatinine, p = 0.4), but were significantly correlated with urinary nickel (r = 0.41; p < 0.0001) and with a composite index of metal exposure (r = 0.46; p < 0.0001)., Conclusions: Children working in the surgical instruments manufacturing industry had substantial exposure to several metals, especially chromium and nickel, which are established carcinogens. Exposure to nickel was associated with evidence of increased oxidative DNA damage.