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Intra-household agreement of urinary elemental concentrations in Tanzania and Kenya: potential surrogates in case–control studies

Journal of Exposure Science & Environmental Epidemiology volume 29, pages 335–343 (2019)Cite this article

Abstract

Element deficiencies and excesses play important roles in non-communicable disease aetiology. When investigating their roles in epidemiologic studies without prospective designs, reverse-causality limits the utility of transient biomarkers in cases. This study aimed to investigate whether surrogate participants may provide viable proxies by assessing concentration correlations within households. We obtained spot urine samples from 245 Tanzanian and Kenyan adults (including 101 household pairs) to investigate intra-household correlations of urinary elements (As, Ba, Ca, Cd, Co, Cs, Cu, Fe, Li, Mn, Mo, Ni, Pb, Rb, S, Se, Sr, Tl, V and Zn) and concentrations (also available for: Bi, Ce, Sb, Sn and U) relative to external population-levels and health-based values. Moderate-strong correlations were observed for As (r = 0.65), Cs (r = 0.67), Li (r = 0.56), Mo (r = 0.57), Se (r = 0.68) and Tl (r = 0.67). Remaining correlations were <0.41. Median Se concentrations in Tanzania (29 µg/L) and Kenya (24 µg/L) were low relative to 5738 Canadians (59 µg/L). Exceedances (of reference 95th percentiles) were observed for: Co, Mn, Mo, Ni and U. Compared to health-based values, exceedances were present for As, Co, Mo and Se but deficiencies were also present for Mo and Se. For well correlated elements, household members in East African settings provide feasible surrogate cases to investigate element deficiencies/excesses in relation to non-communicable diseases.

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Acknowledgements

The authors thank Dr. Graham Byrnes and Liacine Bouaoun for statistical discussions and advice.

Funding

Funding was received from an NIH grant (R21CA191965) with support from BGS Global and the Centre for Environmental Geochemistry. The work reported was undertaken during the tenure of a Postdoctoral Fellowship from the International agency for Research on cancer, partially supported by the European Commission FP7 Marie Curie Actions—People—Co-funding of regional, national and international programmes (COFUND) and a UICC IARC Development Fellowship.

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Authors and Affiliations

  1. Section of Environment and Radiation, International Agency for Research on Cancer (IARC), Lyon, France

    Daniel R. S. Middleton, Valerie A. McCormack & Joachim Schüz

  2. Kilimanjaro Christian Medical Centre, Moshi, Tanzania

    Michael O. Munishi, Amos O. Mwasamwaja & Blandina T. Mmbaga

  3. School of Public Health, Moi University, Eldoret, Kenya

    Diana Menya

  4. University of Eldoret, Eldoret, Kenya

    Diana Menya, David Samoei & Odipo Osano

  5. Inorganic Geochemistry, Centre for Environmental Geochemistry, British Geological Survey, Keyworth, Nottingham, UK

    Andrew L. Marriott, Elliott M. Hamilton & Michael J. Watts

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  1. Daniel R. S. Middleton
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Correspondence to Daniel R. S. Middleton.

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Ethical approval was granted at IARC (IEC 14–15), in Tanzania (NIMR/HQ/R.8a) and Moi University in Kenya (IREC 000921). Informed consent was obtained from all participants.

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Middleton, D.R.S., McCormack, V.A., Munishi, M.O. et al. Intra-household agreement of urinary elemental concentrations in Tanzania and Kenya: potential surrogates in case–control studies. J Expo Sci Environ Epidemiol 29, 335–343 (2019). https://doi.org/10.1038/s41370-018-0071-8

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