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Tuakuila et at. Archives of Public Health 2013, 71:14
http://www.archpublichealth.conn/content/71 /I /1 4



ARCHIVES OF PUBLIC HEALTH



RESEARCH Open Access



High human exposure to pyrene (polycyclic
aromatic hydrocarbon) in Kinshasa, a capital of
the Democratic Republic of Congo

Joel Tuakuila^'^^ Martin Kabamba^ and Honore Mata^



Abstract

Background: Data on human exposure to chemicals in Africa are scarce. A biomonitoring study was conducted in
a representative sample of the population in Kinshasa (Democratic Republic of Congo) to document exposure to
polycyclic aromatics hydrocarbons.

Methods: 1-hydroxypyrene (1-OHP) was measured by HPLC fluorescence in spot urine samples from 220
individuals (50.5% women), aged 6-70 years living in the urban area and from 50 additional subjects from the
sub-rural area of Kinshasa. Data were compiled as geometric means and selected percentiles, expressed without
([jg/L) or with creatinine adjustment [\iq/q cr). Multiple regression analyses were applied to factors (creatinine,
grilled meat habits and smoking habits) influencing 1-OHP (stepwise procedure, criteria: probability F to enter
< 0.05 and probability F to remove > 0.10).

Results: According to the regression models, creatinine, grilled meat habits and smoking habits contribute to
explain 45% of the variation in population's urinary 1-OHP by the environmental exposure. Overall, living in urban
area of Kinshasa was associated with increased levels of 1-OHP in urine as compared to a population living in the
sub-rural area [GM: 1.8 |jg/L (n = 220) versus 1.4 |jg/L (n = 50), p < 0.01] as well as compared to the reference values
from databases involving American or German populations.

Conclusion: This study reveals the high pyrene (PAH) exposure of the Kinshasa population. However, more work,
with a rigorous design in the exposed population (monitoring of air concentrations and identifying other sources of
pyrene -PAH exposure), is needed to establish further documentation.

Keywords: Biomonitoring, Environmental pollution. Organic compounds. Public health, Polycyclic aromatic
hydrocarbons



Background

Polycyclic aromatic hydrocarbons (PAH) are produced
when organic materials undergo incomplete combustion.
They are composed of two or more benzene rings and
occur, depending on the type of pyrolytic process and of
source material, in various compounds, but always in the
form of a mixture. Because so many incomplete combus-
tion processes occur, PAH are ubiquitous environmental
contaminants. Exposure to PAH is associated with lung.



^ Correspondence: joeltuakuila@yahoo.fr

^Medical and Environmental Chemistry, Faculty of Sciences, University of
Kinshasa, Kinshasa, Democratic Republic of Congo

^Louvain Center for Toxicology and Applied Pharmacology (LTAP), Universite
catholique de Louvain, Avenue E. Mounier 53, box 52.02.12, 1200 Brussels,
Belgium



esophageal, gastric, colorectal, bladder, skin, prostate, and
cervical cancers in human and animal models [1].

Pyrene is present in almost all PAH mixture in relatively
high concentrations and there is a good correlation between
pyrene and other components in PAH mixture [2]. 1-OHP
(1-hydroxypyrene), a major metabolite of pyrene, has been
widely used as an indicator of internal exposure to PAH [3,4].

The main source of PAH intake is food, on the one hand
as a result of airborne PAH precipitating onto cereals, fruit
and vegetables, and on the other hand as a result of PAH
generated during the preparation of food. For example,
smoked food and food grilled on open flames display sub-
stantial levels of PAH content [5].



O© 2013 Tuakuila et a!.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
BIoIVIGCI CGntrsI commons Attribution License (http://creativecommons.Org/licenses/by/2.0), which permits unrestricted use, distribution, and
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A very important source of PAH exposure among the
general population is tobacco smoke [6]. Smokers' intake
of pyrene in cigarette smoke is of the same order of
magnitude as intake from average food consumption [7].

It has been shown that domestic wood burning, resi-
dential charcoal burning stoves and barbecue charcoal
combustion turn out to be important sources of pollu-
tant exposure to humans [8,9].

In DRC (Democratic Republic of Congo), only 5% of the
population has access to electricity. As a result, wood en-
ergy production accounts for 85% of total energy con-
sumption and fuel wood and charcoal are by far the most
heavily consumed energy sources in DRC [10,11], used
primarily for household heating and cooking.

In this study, we provide the first data for biomonitoring
PAH in a representative sample of the Kinshasa population.
The values were compared to those reported by the refer-
ence values from American [12] or German databases [13].

Methods

Study design

In the absence of reliable population registers and in
view of the practical difficulties of conducting a truly
random sampling in the population of Kinshasa, we ap-
plied a two-stage systematic sampling approach [14]. In
the first stage, the 22 administrative entities of Kinshasa
were listed in alphabetical order and 11 out of them
were selected as follows: a first entity was drawn ran-
domly from the list and every other subsequent entity
was then included, thus ensuring a comprehensive
coverage of the entire urban area of Kinshasa. In the sec-
ond stage, we aimed to recruit about 25 healthy male
and female subjects between 6 and 70 years from each
of the 11 entities. In a mobilization campaign (mainly by
word of mouth), healthy subjects were invited to come
to the local health center to provide a urine sample.
After exclusion of 13 individuals because of possible dir-
ect occupational exposure to PAH (asphalt application,
waste incineration, aluminum smelting), 220 individuals
provided a urine sample and were included in the
present study (80% of the target number was reached).
Informed consent was obtained from each subject and
information on age, gender, place of residence and
smoking habits were recorded. With the same methods
of mobilization campaign, fifty additional subjects living
in the sub-rural area of Kinshasa were also included.
The characteristics of two areas (urban/sub-rural) se-
lected: urban area had high percentage of population
density; motorization, old second hand vehicles and car
traffic whereas sub-rural had high percentage of green
area [15]. This study was approved by the Congolese
committee of medical ethics and the study results will
be informed back to individuals sample donors with
proper explanations.



Laboratory methods

Great care was taken to avoid contamination during all
the steps of collection, transport and analysis. Spot urine
specimens were collected in metal-free polystyrene con-
tainers and stored at -20°C. The samples were then kept
frozen and transported in a cool box to be analyzed by the
Louvain centre for Toxicology and Applied Pharmacology
(Brussels, Belgium). We determined urinary 1-OHP by
HPLC (High Performance Liquid Chromatography) as de-
scribed previously [16,17] with some modifications [18].
Briefly, 2.0 mL urine was used for each sample, and the
identification and quantification of 1-OHP were based on
retention time and peak area measured using a linear re-
gression curve obtained from internal standard solutions.
The limit of quantification (LOQ) was 0.20 (ig/L. The valid
urine 1-OHP concentrations were expressed as (ig/L or
(ig/g of creatinine. The determinations of urinary cotinine
(LOQ = 50 (ig/L) were done by HPLC according to the
methods previously described [19]. Creatinine was deter-
mined (LOQ = 0.1 g/L) on a Beckman Synchron LX 20
analyser (Beckman Coulter GmbH, Krefeld, Germany) by
the Jaffe method [20]. For quality control, internal controls
and reference materials were run together with the sam-
ples on a daily basis.

Statistical analyses

Concentrations were log transformed for data analysis.
Geometric means (GM), ninety-five percent confidence
intervals (CI) and percentiles were calculated using NCSS
version 2004 (NCSS Institute Inc. 2004). The limit of
quantification (LOQ) divided by 2 was used for imput-
ation of values lower than the LOQ [21]. Differences be-
tween samples with normal distribution were examined by
the T-test and Chi-square test. Stepwise multiple linear re-
gression analyses of log-transformed data were used to es-
timate the influence independent variables (creatinine,
grilled meat habits and smoking habits) on the 1-OHP
(stepwise procedure, criteria: probability F to enter < 0.05
and probability F to remove > 0.10). A p-value lower than
0.05 was considered as statistically significant for all tests.

Results

Age of these 220 urban subjects was between 6 and
70 years and 31 years on average (standard deviation:
18). Most participants were adults (74.5%) and nearly
half (50.5%) were female. Among adults, thirty-six per-
cent were current smokers. The characteristics of sub-
rural subjects are also presented in Table 1.

Geometric mean (GM) urinary 1-OHP was 1.8 (ig/L
(95% CI: 1.6, 2.0) (Table 2). Three (1.4%) 1-OHP measure-
ments were less than the LOQ. As expected, smokers had
higher cotinine urinary levels (Cot-U) than non-smokers
[GM (95% CI): 137.3 (ig/L (115.5, 163.2) versus GM (95%
CI): 87.7 (ig/L (70.4, 104.3)].



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Table 1 Demographic characteristics of the participants





Urban


Sub-rural


P


Number of subjects


220


50




Age, years^


31 ±18 [6-70]


36 ±15 [6-60]


0.55


6-14, n (%)


56 (25.4%)


12 (24.0%)


0.83


>14, n (%)


164 (74.5%)


38 (76.0%)




Sex:








Male, n (%)


109 (49.5%)


21 (42.0%)


0.93


Female, n (%)


1 1 1 (50.5%)


29 (58.0%)




Current Smokers, n (%)


79 (35.9%)


6 (12.0%)


<0.01



'Arithmetic mean ± SD [Range].



There was a statistically significant difference (p-value <
0.01) with smoking habits (0 for no/1 for yes) for 1-OHP,
Age (0 for 6-14 years/ 1 for > 14 years) and sex (0 for
female/ 1 for male) were not shown a significant difference
(Table 2),

In multivariable analyses, creatinine (continuous log-
variable), grilled meat habits (0 for non-consumers/ 1 for
consumers) and smoking habits (cotinine as continuous
log-variable) were the parameters significantly associated
with urinary excretion of 1-OHP with 0.449 as a value of
(Table 3).



Discussion

None of the measured values of Urinary 1-OHP was sig-
nificantly different among the 11 urban entities investi-
gated; indicating that our sampling strategy "unweigted
clusters" did probably not introduce a strong bias in the
representativeness of our population sample.

Urinary 1-OHP, a metabolite of PAH, has been shown to
be an indicator of both uptake of pyrene from foods and
exposure to exogenous PAH [22]. However, an important
limitation of this biomarker is that it only reflects recent ex-
posure and tends to vary widely within individuals [23-26].

The distribution of urinary 1-OHP levels of the reference
population are not Gaussian. Normalization can be
obtained when expressing experimental data as a base 10
logarithm. Our results (Table 2) showed a significant differ-
ence in 1-OHP levels between current smokers and non-
smokers (GM: 2.3 (ig/L versus 1.3 (ig/L, p < 0.01), which
may be due to the fact that tobacco smoking may influence
levels of urinary of 1-OHP [7,18,27-29].

In agreement with other studies, we found higher 1-OHP
levels in consumers of grilled meat than in non-consumers
(0 for non-consumers GM: 1.2 (ig/L versus 1 for consumers
GM: 4.0 (ig/L, p < 0.01) (Figure 1; Table 2), which is not sur-
prising since grilled meat represents an important source of
PAH exposure [7,30-32].



Table 2 Urinary concentrations of 1-OHP in the Kinshasa population (n = 220; 6-70 years)

N Urinary concentrations of 1-OHP









Min


P50


P95


Max


GM (CI 95%)




Total


Mg/L


220


0.1


1.6


6.6


26.8


1.8 (1.6-2.0)






jjg/g cr




0.1


1.2


5.8


14.8


1.3 (1.1 - 1.4)




Sex Men


Mg/L


109


0.2


1.6


6.5


26.8


1.6 (1.4- 1.9)


0.19




Mg/g cr




0.2


0.9


4.7


14.8


1 .0 (0.9 - 1 .2)




Women


Mg/L


111


0.1


1.8


7.6


16.4


1.9 (1.6-2.2)






Mg/g cr




0.1


1.3


6.5


12.1


1.5 (1.2 - 1.7)




Age 6-14 years


Mg/L


56


0.4


2.1


7.6


14.7


2.1 (1.6-2.6)


0.10




Mg/g cr




0.3


1.7


8.9


14.8


1.9 (1.4-2.5)




> 14 years


Mg/L


164


0.1


1.5


5.9


26.8


1.7 (1.5 - 1.9)






Mg/g cr




0.1


1.0


4.7


12.9


1.1 (0.9- 1.2)




Smoking habits Current smol<ers


Mg/L


79


0.1


2.0


8.2


26.8


2.3 (1.9-2.7)


<0.01




Mg/g cr




0.1


1.2


6.3


12.9


1.3 (1.0- 1.5)




Non-smol<ers


Mg/L


141


0.2


1.6


5.2


16.4


1.5 (1.3 - 1.7)






Mg/g cr




0.2


1.1


5.8


14.8


1.2 (1.0 - 1.4)




Grilled meat habits Consumers


Mg/L


65


0.5


4.1


14.1


26.8


4.0 (3.4 - 4.7)


<0.01




Mg/g cr




0.5


2.3


12.3


14.8


2.5 (2.1 - 3.1)




Non-consumers


Mg/L


155


0.1


1.3


2.8


6.5


1.2 (1.1 - 1.4)






Mg/g cr




0.1


0.8


3.2


5.5


0.9 (0.8 - 1 .0)





N sample size; P50, P95 = percentiles; Min minimum value, Max maximum value;

GM geometric mean (CI = 95% confidence Interval); ^p-value (f-test on log-transformed values).

N < Limit of quantification (0.20 \xq/l) = 3 (1.4%).



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Table 3 Multiple regression analysis models of 1-OHP
levels



Independent variable


Coefficient P (95% CI)


Adjusted


Intercept


0.415 (0.253 to 0.579)


0.449


Creatinine^


0.193 (0.035 to 0.349)




Grilled meat habits^


0.505 (0.426 to 0.584)




Smoking habits ^


0.081 (0.003 to 0.157)





^Creatinine represented as continuous log-variable, '^Grilled meat represented
as 0 for Non-consumers and 1 for consumers; ^ Smoking habits: cotinine
represented as continuous log- variable, R^: explained variance (i.e. the square
of the correlation coefficient). Results are given for those variables that
correlated, and only when the regression was significant (p < 0.05).



As reported in the literature [12,33], investigations
have not shown significant differences neither for sex
groups nor for age groups (Table 2).

In Stepwise multivariable analyses, creatinine (continuous
log- variable), grilled meat habits (yes/no) and smoking
habits (continuous log-variable) were the independent pa-
rameters significantly associated with urinary unadjusted
values of 1-OHP (depend parameter) with 0.45 as a value of
(Table 3),

As in other surveys, increased 1-OHP levels were measured
in residents of urban areas compared to sub-rural settings
[GM: 1.8 (ig/L (n = 220) versus 1.4 (ig/L (n = 50), p<0.01].
The high percentage of smokers (Table 1) in the urban popu-
lation could, at least partly, explain this difference.



The mean 1- OHP level in the sub-rural and the urban
populations (smokers and non-smokers combined) ex-
ceeded the American and German levels (smokers and
non-smokers combined) [12,13]. Children from Kinshasa
were found to have much higher levels (GM [95%CI]:
2.1 (ig/L [1.6-2.6] for children 6-14 years) than American
children (GM [95%CI]: 0.09 (ig/L [0.07-0.11] for children
6-11 years; GM [95%CI]: 0.10 (ig/L [0.085-0.129] for
children 12-19 years) [34]. Inhalation of emissions from
charcoal burning or from cooking on open fires or trad-
itional stoves fueled with biomass (wood, charcoal, crop
and waste residues, ...) either outdoor or in poorly venti-
lated spaces, and consumption of this broiled, smoked,
fried or grilled food (Figure 1) are likely to contribute to
the high levels of urinary 1-OHP in Kinshasa subjects.

The present study has several limitations. First, with regard
to sample collection, selection of urinary sample donors did
not follow rigid sampling strategy (such as random sampling)
but by chance, which was practically inevitable under present
survey conditions. Second, low number of subjects and char-
acteristics selected. Third, passive smoking exposure is a
factor affecting PAH exposure; this factor did not evaluate.

Despite such limitations, however, it is prudent to conclude
that data from the present study constitutes levels generally
exceeded in the Kinshasa population. Living in urban area of
Kinshasa is associated with increased levels of 1-OHP in
urine as compared to a reference population living in a sub-
rural area of the same region. Increased levels were also




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found by comparison with the reference values from data-
bases involving American or German populations.

Conclusion

This study reveals the high pyrene (PAH) exposure of
the Kinshasa population requiring the determination of
PAH concentrations in ambient air of Kinshasa and
limits values for the protection of human health.

Competing interests

The authors declare that they have no competing interests.
Authors' contributions

JT drafted the manuscript. All authors commented the draft versions. All
authors read and approved the final manuscript.

Acknowledgments

We are highly indebted to the study participants and to the staff of investigators,
as well as all the local health services and health centers of the Kinshasa Public
Health System that supported the field work. We also thank Pr Lison, Pr Hoet, Pr
Haufroid, Mr Boesmans and Mrs Lissenko for their collaboration. The financial
support of the Belgian Technical Cooperation (Cooperation Technique Belge-CTB
/Belgische Technische Cooperatie-BTC) was gratefully acknowledged.

Received: 4 April 2013 Accepted: 18 June 2013
Published: 19 June 2013

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Cite this article as: Tuakuila et al.: High human exposure to pyrene
(polycyclic aromatic hydrocarbon) in Kinshasa, a capital of the
Democratic Republic of Congo. Archives of Public Health 2013 71:14.




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