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Variability of blood lead levels in an urban population in relation to drinking and smoking habits
The Science of the Total Environment, 138 (1993) 23-29 Elsevier Science Publishers B.V., Amsterdam
23
Variability of blood lead levels in an urban population in relation to drinking and smoking habits M. Schuhmacher a, J.L. Domingo a, J.M. Llobet a and J. Corbella b
aLaboratory of Toxicology and Biochemistry, School of Medicine, University of Barcelona, 43201 Reus, Spoln hDepartment of Toxicology, School of Medicine, University of Barcelona, 08036 Barcelona, Spain (Received April 27th, 1992; accepted June 10th, 1992)
ABSTRACT The influence of drinking and smoking habits on blood lead levels of an urban population was assessed in this study. Lead concentrations were determined in 287 blood samples collected from non-occupationally lead exposed men living in Barcelona, Spain. Blood lead levels significantly increased with the consumption of wine. Although not statistically significant, a similar tendency was also observed for beer drinkers, but not for the consumers of spirits. Slight increases in the blood lead concentrations of smokers were also found. However, because of the significant correlation between heavy smoking and drinking observed in this study, alcohol consumption would probably be responsible for these increases. Wine consumption was the most influential variable (7.72%, P < 0.001) on the blood lead levels of the population examined.
Key words: lead in blood; alcohol; smoking; urban men
INTRODUCTION Over many years, lead exposure has been associated with human disease. The reports of lead toxicity have been related primarily to relatively high burdens of this metal from occupational exposure [ I - 3 ] or environmental pollution [4-6]. F o r non-occupationally exposed people, two main sources of lead exposure have been proposed: contamination of air with fumes from leaded gasoline and soft water in contact with piping containing lead [7]. The concentration of lead in blood has become a widely used index of body or target organ burden of lead, which may be useful to diagnose lead intoxication or to evaluate exposure in epidemiological studies of lead [8]. 0048-9697/93/$06.00 © 1993 Elsevier Science Publishers B.V. All rights reserved
24
M. SCHUHMACHER El" AL.
However, the blood lead concentrations are also depending on a series of factors such as age, sex, certain habits (drinking and smoking), etc. [9-11]. With regard to the drinking habits, it has been established that the blood lead coTcentrations are positively associated with alcohol consumption [11-14]. On the other hand, although there is a lack of consensus on the influence of tobacco on the levels of lead in blood, smoking has also been shown to represent a source of exposure to lead. Nevertheless, in contrast to drinking, smoking was reported to make a small contribution to the total lead intake [9,15]. It was found that smokers with occupational lead exposure may have higher blood lead levels than non-smokers, but this difference was not found in individuals without occupational lead exposure [16]. The purpose of this study was to evaluate the influence of the drinking and smoking habits on the blood lead levels in an adult ~Jon-occupationally exposed population. The blood lead concentrations were assessed according to the wine, beer, or spirits intake as well as according to the consumption of cigarettes and the age as smoker. EXPERIMENTAL
Population Two-hundred eighty seven men, age 42.2 ~ 8.2 years, who were subjected to a general check-up in the National Institute of Hygiene and Occupational Safety from Barcelona (Catalonia, Spain) participated in this study. The subjects were randomly selected and people who had been, or still were, occupationally exposed to lead were excluded from the study. Each participant was asked to complete an extensive standard questionnaire that included questions on occupational history, the health status, alcohol consumption and smoking habits. With regard to alcohol consumption, subjects were classified according to the type of alcoholic beverages (wine, beer, or spirits) into four subgroups for each group: non-drinkers, men drinking < 100 g ethanol per week, men drinking between 100 and 200 g ethanol per week and men drinking > 200 g ethanol per week. Ethanol intake was quantified in accordance with the following conversion factors: a glass of wine, 16 g ethanol; a glass of beer, 6 g ethanol; and a tot of spirits, 15 g ethanol. With regard to the smoking habits, individuals were classified into four categories according to the daily consumption of cigarettes: non-smokers, men smoking < 10 cigarettes per day, men smoking between l0 and 20 cigarettes per day and men smoking > 20 cigarettes per day. Subjects were also classified according to the age as smoker: 0, < 5, 5-10 and > 10 years.
BLOOD LEAD LEVELS IN RELA'ilON TO DRINKING AND SMOKING HABITS
25
Analytical methods Blood samples were obtained by venipuncture in the morning of the examination day, after 12 h of fasting and abstinence of smoking. Blood lead levels were measured by atomic absorption spectrophotometry using a PerkinElmer 5100 Zeeman spectrophotometer and Spectra A-30 graphite furnace. Details of the analytical procedure were recently reported [11]. All analyses were carried out under strict quality control conditions. The mean recovery rate obtained lbr lead was 95.2%.
Statistics The distribution of lead concentrations was found to be log normal. Consequently, the results were expressed as geometric means ~- geometric S.D. Statistical differences were evaluated by one-way analysis of variance (ANOVA). The method of Scheff6 was subsequently used to differentiate between subgroups. Stepwise multiple regression analysis was carried out using the logarithms of blood lead concentrations as the dependent variable. NS (not significant) denotes P > 0.05. RESULTS AND DISCUSSION
Table 1 summarizes the blood lead levels of a general population from the city of Barcelona with regard to the d~rinking habits. Since most of the alcohol drinkers were regular consumers of wine, beer and spirits, each alcoholic drink was studied independently of the others. About 57% of the studied population drank wine regularly, whereas 63% were consumers of beer and about 37% of spirits. Blood lead concentrations increased with the consumption of wine. The differences reached the level of significance in the groups ingesting between 100 and 200 g of ethanol, or > 200 g of ethanol per week. Although not statistically significant, a similar tendency was observed for the drinkers of beer. In contrast, this tendency was not noted for the consumers of spirits although again the blood lead levels were higher for alcohol drinkers. These results are in agreement with those of previous studies which found a significant correlation between alcohol consumption and an increase in the blood lead concentrations [10,12,17]. It was suggested that because of the evidence from animal studies that lead is also excreted in the liver (in addition to the kidney), mainly in the bile, moderate to heavy alcohol intake on a daily basis may affect hepatic ability to excrete lead, resulting in increased blood lead levels [10,13]. However, in the present study the hepatic and renal blood indicators of functional alterations showed normal values. Thus, the increases in the blood lead concentrations should be attributed to the content of lead in the beverages.
26
M. SCHUHMACHER ET AL,
TABLE 1
Blood lead levels in relation to drinking habits in urban men Drink
Alcohol consumption per week
n
Lead a concentrations
P-value b
<0.001 b
Wine 0 (Non-drinkers) < 100 g 100-200 g >200 g
118 85 48 36
8.72 9.83 10.87 12.98
4. 4. 4. 4.
1.59 1.48 1.49 !.47
0 (Non-drinkers) < 100 g 100-200 g >200 g
102 144 29 12
9,63 9.70 10.26 12.76
~ 4. 4. 4.
159 1.51 1.64 1.39
0 (Non-drinkers) < 100 g 100-200 g >200 g
174 66 37 10
9.39.4. 10.25.4. 11.26 4. 10.20 4.
!.56 1.54 1.51 1.54
Beer
Spirits
NS <0.01 <0.001 NS b NS NS NS NS b NS NS NS
'Geometric mean in/~g dl -~ of blood .4. geometric S.D. bANOVA P-value. To differentiate between non-drinkers and the other subgroups for each group of drinks, the contrast method of Scheff6 was used; the indicated P-values correspond to these comparisons.
On the other hand, it was reported that wine drinkers had higher blood lead levels than beer or spirit drinkers [14]. It is probably due to a higher lead content in wine as compared to other beverages. With regard to it, it was recently reported that the average lead concentration in Spanish wines is about 100-200 ~g l -~ [18]. The average blood lead levels according to smoking habits are summarized in Table 2. Although slight increases in the blood lead concentrations of smokers (depending on the daily consumption of cigarettes and the age as smoker) could be observed, these difl'erences were not statistically significant. The increases were probably due to that in this study a significant correlation (r---0.22, P < 0.001) between heavy smoking and heavy drinking was found. Thus, alcohol consumption would be the responsible for the increases of blood lead levels in smokers. The average lead content in Spanish cigarettes was reported to be 1.07 :t: 0.72 ~g per cigarette [19]. A high percentage of lead found in cigarettes remains in the ash and butt, while only a small portion, approximately 5%, is transferred to the smoke [20]. Consequently, a daily consumption of 20 cigarettes would imply a daily lead con-
27
BLOOD LEAD LEVELS IN RELATION TO DRINKING AND SMOKING HABITS
TABLE 2 Blood lead levels in relation to smoking habits in urban men Groups
Subgroups
Cigarettes consumption (day-') 0 (Non-smokers) < 10 10-20 >20 Age as smokers (years) 0 (Non-smokers) <5 5-10 > 10
n
Lead concentrations ~
143 40 61 43
9.50 9.53 10.46 10.14
444. 4-
1.54 1.45 1.49 1.67
114 36 59 78
9.22 9. ! I 9.82 I 1.01
4. 4. i 4.
!.53 i.63 1.52 !.51
P-value b
NS b NS NS NS NS b NS NS NS
~Geometric mean in ~tg d l " of blood 4. geometric S.D. bANOVA P-value. The differences between non-smokers and the subgroups of smokers were not statistically significant (NS).
tribution for the participants in our study of approximately 1.07 pg, with only a small amount being absorbed into the body [20]. However, there is a controversy in literature on the effects of smoking on blood lead levels. Although this study confirms the results of previous investigations, which showed that smokers have higher levels of lead in blood than non-smokers [9,12,15,21], other investigators did not find significant differences in the blood lead concentrations of smokers and non-smokers [20,22]. As previously reported, although the increase in the level of lead in the blood of smokers can be attributed to a direct effect of smoking, such a phenomenon seems to be inconsistent with the absence of a dose-effect relationship between the number of cigarettes smoked daily and the level of lead in blood [10,20]. Using stepwise multiple regression analysis, we found that wine consumption was the most influential variable on the blood lead levels (7.72%, P < 0.001), whereas the contribution of the other beverages as well as that of the smoking habits did not show statistically significant differences on the concentration of lead in blood. According to a previous study, the mean lead intake (not including beverages) by an adult man in Catalonia is 114.8 ttg day "l [23]. The consumption of a daily glass of wine would imply an increase in the dietary lead of approximately 40 ~tg, which would mean about 25% of the total daily in-
28
M. SCHUHMACHER ET AL.
take of lead (including drinks). This amount would involve an increase in the blood lead concentrations of 2.18/~g 1-m. ACKNOWLEDGEMENTS
This work was supported by REPSOL PETROLEO S.A., Tarragona, Spain. The authors thank the Servei d'Espectroscopia, University of Barcelona for excellent technical assistance. REFERENCES 1 P.J. Landrigan, Occupational and community exposures to toxic metals: lead, cadmium, mercury and arsenic. West. J. Med., 137 (1982) 531-539. 2 W.C. Cooper, O. Wong and L. Kheifets, Mortality among employees of lead battery plants and lead producing plants, 1947-1980. Scand. J. Work Environ. Health, I I (1985) 331-345. 3 A.J. McMichael and H.M. Johnson, Long-term mortality profile of heavily-exposed lead smelter workers. J. Occup. Med., 24 (1982) 375-378. 4 P.J. Landrigan and E.L. Baker, Exposure of children to heavy metals from smelters: epidemiology and toxic consequences. Environ. Res., 25 (1981) 204-224. 5 R.N. Khandekar, R. Raghunath and U.C. Mishra, Levels of lead, cadmium, zinc and copper in the blood of an urban population. Sci. Total Environ., 66 (1987) 185-191. 6 M.J. Quinn and H.T. Delves, UK blood lead monitoring programme 1984-1987: results for 1985. Hum. Toxicoi., 7 (1988) 105-123. 7 W.R. Harlan, The relationship of blood lead levels to blood pressure in the U.S. population. Environ. Health Perspect., 78 (1988) 9-13. 8 M. Rabinowitz, A. Leviton and H. Needleman, Variability of blood lead concentrations during infancy. Arch. Environ. Health, 39 (1984) 74-77. 9 A. Brockhaus, I. Freier, U. Ewers, E. Jermann and R. Dolgner, Levels of cadmium and lead in blood in relation to smoking, sex, occupation and other factors in an adult population of the FRO. Int. Arch. Occup. Environ. Health, 52 (1983) 167-175. 10 C. Grasmiok, G. Huel, T. Moreau and H. Sarmini, The combined effect of tobacco and alcohol consumption on the level of lead and cadmium in blood. Sci. Total Environ., 41 (1985) 207-217. II M. Schuhmacher, J.L. Doming<),J.M. Llobet and J. Corbella, Lead concentration and delta-aminolevulinic acid dehydratase activity in the blood of the general population of Tarragona Province, Spain. Sci. Total Environ., 116 (1992) 253-259. 12 P. Grandjean, N.B. Olsen and H. Hollnagel, Influence of smoking and alcohol consumption on blood lead levels. Int. Arch. Occup. Environ. Health, 48 (1981) 391-397. 13 A.G. Shaper, S.J. Pocock, M. Walker, C.J. Wale, B. Clayton, H.T. Delves and L. Hinks, Effect of alcohol and smoking on blood lead in middle-aged British men. Br. Med. J, 284 (1982) 299-302. 14 S. Dally, C. Girre, E. Hispard, G. Thomas and L. Fournier, High blood lead level in alcoholics: wine versus beer. Drug Alcohol Depend., 23 (1989) 45-48. 15 R.L. Zielhuis, E.J. Stuik, R.F.M. Herber, H.J.A. Sail~, M.M. Verberk, F.D. Posma and J.H. Jager, Smoking habits and levels of lead and cadmium in blood in urban women. Int. Arch. Occup. Environ. Health, 39 (1977) 53-58.
BLOOD LEAD LEVELS IN RELATION TO DRINKING AND SMOKING HABITS
29
16 S. Tola and C.H. Nordman, Smoking and blood lead concentrations in lead-exposed workers and an unexposed population. Environ. Res., 13 (1977) 250-255. 17 S.J. Pocock, A.G. Shaper, M. Walker, C.J. Wale, B. Clayton, H.T. Delves and R.F. Lacey, Effects of tap-water lead, water hardness alcohol and cigarettes on blood lead concentration. J. Epidemiol., 37 (1983) 1-7. 18 M. L6pez-Artiguez, A. Grilo, M.L. Sofia, M. Castro and M. Repetto, Levels of zinc, copper and lead in wines from the area south of Seville. Bull. Environ. Contam. Toxicol., 45 (1990) 711-717. 19 T. Watanabe, M. Kasahara, H. Nakatsuka and M. lkeda, Cadmium and lead contents ofcigarettes produced in various areas of the world. Sci. Total Environ., 66 (1987) 29-37. 20 M. McLaughlin and G.J. Stopps, Smoking and lead. Arch. Environ. Health, 26 (1973) 131-136. 21 M.J. Quinn, Factors affecting blood lead concentrations in the UK: results of the EEC blood lead surveys, 1979-198 !. Int. J. Epidemiol., 14 (1985) 420-43 i. 22 J.P. Buchet, H. Roels, G. Hubermont and R. Lauwerys, Placental transfer of lead, cadmium and carbon monoxide in women. Environ. Res., 15 (1978) 494-503. 23 M. Schuhmacher, M.A. Bosque, J.L. Domingo and J. Corbella, Dietary intake of lead and cadmium from foods in Tarragona Province, Spain. Bull. Environ. Contain. Toxicol., 46 (1991) 320-328.
23
Variability of blood lead levels in an urban population in relation to drinking and smoking habits M. Schuhmacher a, J.L. Domingo a, J.M. Llobet a and J. Corbella b
aLaboratory of Toxicology and Biochemistry, School of Medicine, University of Barcelona, 43201 Reus, Spoln hDepartment of Toxicology, School of Medicine, University of Barcelona, 08036 Barcelona, Spain (Received April 27th, 1992; accepted June 10th, 1992)
ABSTRACT The influence of drinking and smoking habits on blood lead levels of an urban population was assessed in this study. Lead concentrations were determined in 287 blood samples collected from non-occupationally lead exposed men living in Barcelona, Spain. Blood lead levels significantly increased with the consumption of wine. Although not statistically significant, a similar tendency was also observed for beer drinkers, but not for the consumers of spirits. Slight increases in the blood lead concentrations of smokers were also found. However, because of the significant correlation between heavy smoking and drinking observed in this study, alcohol consumption would probably be responsible for these increases. Wine consumption was the most influential variable (7.72%, P < 0.001) on the blood lead levels of the population examined.
Key words: lead in blood; alcohol; smoking; urban men
INTRODUCTION Over many years, lead exposure has been associated with human disease. The reports of lead toxicity have been related primarily to relatively high burdens of this metal from occupational exposure [ I - 3 ] or environmental pollution [4-6]. F o r non-occupationally exposed people, two main sources of lead exposure have been proposed: contamination of air with fumes from leaded gasoline and soft water in contact with piping containing lead [7]. The concentration of lead in blood has become a widely used index of body or target organ burden of lead, which may be useful to diagnose lead intoxication or to evaluate exposure in epidemiological studies of lead [8]. 0048-9697/93/$06.00 © 1993 Elsevier Science Publishers B.V. All rights reserved
24
M. SCHUHMACHER El" AL.
However, the blood lead concentrations are also depending on a series of factors such as age, sex, certain habits (drinking and smoking), etc. [9-11]. With regard to the drinking habits, it has been established that the blood lead coTcentrations are positively associated with alcohol consumption [11-14]. On the other hand, although there is a lack of consensus on the influence of tobacco on the levels of lead in blood, smoking has also been shown to represent a source of exposure to lead. Nevertheless, in contrast to drinking, smoking was reported to make a small contribution to the total lead intake [9,15]. It was found that smokers with occupational lead exposure may have higher blood lead levels than non-smokers, but this difference was not found in individuals without occupational lead exposure [16]. The purpose of this study was to evaluate the influence of the drinking and smoking habits on the blood lead levels in an adult ~Jon-occupationally exposed population. The blood lead concentrations were assessed according to the wine, beer, or spirits intake as well as according to the consumption of cigarettes and the age as smoker. EXPERIMENTAL
Population Two-hundred eighty seven men, age 42.2 ~ 8.2 years, who were subjected to a general check-up in the National Institute of Hygiene and Occupational Safety from Barcelona (Catalonia, Spain) participated in this study. The subjects were randomly selected and people who had been, or still were, occupationally exposed to lead were excluded from the study. Each participant was asked to complete an extensive standard questionnaire that included questions on occupational history, the health status, alcohol consumption and smoking habits. With regard to alcohol consumption, subjects were classified according to the type of alcoholic beverages (wine, beer, or spirits) into four subgroups for each group: non-drinkers, men drinking < 100 g ethanol per week, men drinking between 100 and 200 g ethanol per week and men drinking > 200 g ethanol per week. Ethanol intake was quantified in accordance with the following conversion factors: a glass of wine, 16 g ethanol; a glass of beer, 6 g ethanol; and a tot of spirits, 15 g ethanol. With regard to the smoking habits, individuals were classified into four categories according to the daily consumption of cigarettes: non-smokers, men smoking < 10 cigarettes per day, men smoking between l0 and 20 cigarettes per day and men smoking > 20 cigarettes per day. Subjects were also classified according to the age as smoker: 0, < 5, 5-10 and > 10 years.
BLOOD LEAD LEVELS IN RELA'ilON TO DRINKING AND SMOKING HABITS
25
Analytical methods Blood samples were obtained by venipuncture in the morning of the examination day, after 12 h of fasting and abstinence of smoking. Blood lead levels were measured by atomic absorption spectrophotometry using a PerkinElmer 5100 Zeeman spectrophotometer and Spectra A-30 graphite furnace. Details of the analytical procedure were recently reported [11]. All analyses were carried out under strict quality control conditions. The mean recovery rate obtained lbr lead was 95.2%.
Statistics The distribution of lead concentrations was found to be log normal. Consequently, the results were expressed as geometric means ~- geometric S.D. Statistical differences were evaluated by one-way analysis of variance (ANOVA). The method of Scheff6 was subsequently used to differentiate between subgroups. Stepwise multiple regression analysis was carried out using the logarithms of blood lead concentrations as the dependent variable. NS (not significant) denotes P > 0.05. RESULTS AND DISCUSSION
Table 1 summarizes the blood lead levels of a general population from the city of Barcelona with regard to the d~rinking habits. Since most of the alcohol drinkers were regular consumers of wine, beer and spirits, each alcoholic drink was studied independently of the others. About 57% of the studied population drank wine regularly, whereas 63% were consumers of beer and about 37% of spirits. Blood lead concentrations increased with the consumption of wine. The differences reached the level of significance in the groups ingesting between 100 and 200 g of ethanol, or > 200 g of ethanol per week. Although not statistically significant, a similar tendency was observed for the drinkers of beer. In contrast, this tendency was not noted for the consumers of spirits although again the blood lead levels were higher for alcohol drinkers. These results are in agreement with those of previous studies which found a significant correlation between alcohol consumption and an increase in the blood lead concentrations [10,12,17]. It was suggested that because of the evidence from animal studies that lead is also excreted in the liver (in addition to the kidney), mainly in the bile, moderate to heavy alcohol intake on a daily basis may affect hepatic ability to excrete lead, resulting in increased blood lead levels [10,13]. However, in the present study the hepatic and renal blood indicators of functional alterations showed normal values. Thus, the increases in the blood lead concentrations should be attributed to the content of lead in the beverages.
26
M. SCHUHMACHER ET AL,
TABLE 1
Blood lead levels in relation to drinking habits in urban men Drink
Alcohol consumption per week
n
Lead a concentrations
P-value b
<0.001 b
Wine 0 (Non-drinkers) < 100 g 100-200 g >200 g
118 85 48 36
8.72 9.83 10.87 12.98
4. 4. 4. 4.
1.59 1.48 1.49 !.47
0 (Non-drinkers) < 100 g 100-200 g >200 g
102 144 29 12
9,63 9.70 10.26 12.76
~ 4. 4. 4.
159 1.51 1.64 1.39
0 (Non-drinkers) < 100 g 100-200 g >200 g
174 66 37 10
9.39.4. 10.25.4. 11.26 4. 10.20 4.
!.56 1.54 1.51 1.54
Beer
Spirits
NS <0.01 <0.001 NS b NS NS NS NS b NS NS NS
'Geometric mean in/~g dl -~ of blood .4. geometric S.D. bANOVA P-value. To differentiate between non-drinkers and the other subgroups for each group of drinks, the contrast method of Scheff6 was used; the indicated P-values correspond to these comparisons.
On the other hand, it was reported that wine drinkers had higher blood lead levels than beer or spirit drinkers [14]. It is probably due to a higher lead content in wine as compared to other beverages. With regard to it, it was recently reported that the average lead concentration in Spanish wines is about 100-200 ~g l -~ [18]. The average blood lead levels according to smoking habits are summarized in Table 2. Although slight increases in the blood lead concentrations of smokers (depending on the daily consumption of cigarettes and the age as smoker) could be observed, these difl'erences were not statistically significant. The increases were probably due to that in this study a significant correlation (r---0.22, P < 0.001) between heavy smoking and heavy drinking was found. Thus, alcohol consumption would be the responsible for the increases of blood lead levels in smokers. The average lead content in Spanish cigarettes was reported to be 1.07 :t: 0.72 ~g per cigarette [19]. A high percentage of lead found in cigarettes remains in the ash and butt, while only a small portion, approximately 5%, is transferred to the smoke [20]. Consequently, a daily consumption of 20 cigarettes would imply a daily lead con-
27
BLOOD LEAD LEVELS IN RELATION TO DRINKING AND SMOKING HABITS
TABLE 2 Blood lead levels in relation to smoking habits in urban men Groups
Subgroups
Cigarettes consumption (day-') 0 (Non-smokers) < 10 10-20 >20 Age as smokers (years) 0 (Non-smokers) <5 5-10 > 10
n
Lead concentrations ~
143 40 61 43
9.50 9.53 10.46 10.14
444. 4-
1.54 1.45 1.49 1.67
114 36 59 78
9.22 9. ! I 9.82 I 1.01
4. 4. i 4.
!.53 i.63 1.52 !.51
P-value b
NS b NS NS NS NS b NS NS NS
~Geometric mean in ~tg d l " of blood 4. geometric S.D. bANOVA P-value. The differences between non-smokers and the subgroups of smokers were not statistically significant (NS).
tribution for the participants in our study of approximately 1.07 pg, with only a small amount being absorbed into the body [20]. However, there is a controversy in literature on the effects of smoking on blood lead levels. Although this study confirms the results of previous investigations, which showed that smokers have higher levels of lead in blood than non-smokers [9,12,15,21], other investigators did not find significant differences in the blood lead concentrations of smokers and non-smokers [20,22]. As previously reported, although the increase in the level of lead in the blood of smokers can be attributed to a direct effect of smoking, such a phenomenon seems to be inconsistent with the absence of a dose-effect relationship between the number of cigarettes smoked daily and the level of lead in blood [10,20]. Using stepwise multiple regression analysis, we found that wine consumption was the most influential variable on the blood lead levels (7.72%, P < 0.001), whereas the contribution of the other beverages as well as that of the smoking habits did not show statistically significant differences on the concentration of lead in blood. According to a previous study, the mean lead intake (not including beverages) by an adult man in Catalonia is 114.8 ttg day "l [23]. The consumption of a daily glass of wine would imply an increase in the dietary lead of approximately 40 ~tg, which would mean about 25% of the total daily in-
28
M. SCHUHMACHER ET AL.
take of lead (including drinks). This amount would involve an increase in the blood lead concentrations of 2.18/~g 1-m. ACKNOWLEDGEMENTS
This work was supported by REPSOL PETROLEO S.A., Tarragona, Spain. The authors thank the Servei d'Espectroscopia, University of Barcelona for excellent technical assistance. REFERENCES 1 P.J. Landrigan, Occupational and community exposures to toxic metals: lead, cadmium, mercury and arsenic. West. J. Med., 137 (1982) 531-539. 2 W.C. Cooper, O. Wong and L. Kheifets, Mortality among employees of lead battery plants and lead producing plants, 1947-1980. Scand. J. Work Environ. Health, I I (1985) 331-345. 3 A.J. McMichael and H.M. Johnson, Long-term mortality profile of heavily-exposed lead smelter workers. J. Occup. Med., 24 (1982) 375-378. 4 P.J. Landrigan and E.L. Baker, Exposure of children to heavy metals from smelters: epidemiology and toxic consequences. Environ. Res., 25 (1981) 204-224. 5 R.N. Khandekar, R. Raghunath and U.C. Mishra, Levels of lead, cadmium, zinc and copper in the blood of an urban population. Sci. Total Environ., 66 (1987) 185-191. 6 M.J. Quinn and H.T. Delves, UK blood lead monitoring programme 1984-1987: results for 1985. Hum. Toxicoi., 7 (1988) 105-123. 7 W.R. Harlan, The relationship of blood lead levels to blood pressure in the U.S. population. Environ. Health Perspect., 78 (1988) 9-13. 8 M. Rabinowitz, A. Leviton and H. Needleman, Variability of blood lead concentrations during infancy. Arch. Environ. Health, 39 (1984) 74-77. 9 A. Brockhaus, I. Freier, U. Ewers, E. Jermann and R. Dolgner, Levels of cadmium and lead in blood in relation to smoking, sex, occupation and other factors in an adult population of the FRO. Int. Arch. Occup. Environ. Health, 52 (1983) 167-175. 10 C. Grasmiok, G. Huel, T. Moreau and H. Sarmini, The combined effect of tobacco and alcohol consumption on the level of lead and cadmium in blood. Sci. Total Environ., 41 (1985) 207-217. II M. Schuhmacher, J.L. Doming<),J.M. Llobet and J. Corbella, Lead concentration and delta-aminolevulinic acid dehydratase activity in the blood of the general population of Tarragona Province, Spain. Sci. Total Environ., 116 (1992) 253-259. 12 P. Grandjean, N.B. Olsen and H. Hollnagel, Influence of smoking and alcohol consumption on blood lead levels. Int. Arch. Occup. Environ. Health, 48 (1981) 391-397. 13 A.G. Shaper, S.J. Pocock, M. Walker, C.J. Wale, B. Clayton, H.T. Delves and L. Hinks, Effect of alcohol and smoking on blood lead in middle-aged British men. Br. Med. J, 284 (1982) 299-302. 14 S. Dally, C. Girre, E. Hispard, G. Thomas and L. Fournier, High blood lead level in alcoholics: wine versus beer. Drug Alcohol Depend., 23 (1989) 45-48. 15 R.L. Zielhuis, E.J. Stuik, R.F.M. Herber, H.J.A. Sail~, M.M. Verberk, F.D. Posma and J.H. Jager, Smoking habits and levels of lead and cadmium in blood in urban women. Int. Arch. Occup. Environ. Health, 39 (1977) 53-58.
BLOOD LEAD LEVELS IN RELATION TO DRINKING AND SMOKING HABITS
29
16 S. Tola and C.H. Nordman, Smoking and blood lead concentrations in lead-exposed workers and an unexposed population. Environ. Res., 13 (1977) 250-255. 17 S.J. Pocock, A.G. Shaper, M. Walker, C.J. Wale, B. Clayton, H.T. Delves and R.F. Lacey, Effects of tap-water lead, water hardness alcohol and cigarettes on blood lead concentration. J. Epidemiol., 37 (1983) 1-7. 18 M. L6pez-Artiguez, A. Grilo, M.L. Sofia, M. Castro and M. Repetto, Levels of zinc, copper and lead in wines from the area south of Seville. Bull. Environ. Contam. Toxicol., 45 (1990) 711-717. 19 T. Watanabe, M. Kasahara, H. Nakatsuka and M. lkeda, Cadmium and lead contents ofcigarettes produced in various areas of the world. Sci. Total Environ., 66 (1987) 29-37. 20 M. McLaughlin and G.J. Stopps, Smoking and lead. Arch. Environ. Health, 26 (1973) 131-136. 21 M.J. Quinn, Factors affecting blood lead concentrations in the UK: results of the EEC blood lead surveys, 1979-198 !. Int. J. Epidemiol., 14 (1985) 420-43 i. 22 J.P. Buchet, H. Roels, G. Hubermont and R. Lauwerys, Placental transfer of lead, cadmium and carbon monoxide in women. Environ. Res., 15 (1978) 494-503. 23 M. Schuhmacher, M.A. Bosque, J.L. Domingo and J. Corbella, Dietary intake of lead and cadmium from foods in Tarragona Province, Spain. Bull. Environ. Contain. Toxicol., 46 (1991) 320-328.