Re: Discussion, high H1N1 CFR and elevated arsenic
Re: Discussion, high H1N1 CFR and elevated arsenic
Interesting, many Inuit mothers have very high levels of contamination.
http://www.sciencedirect.com/scienc...serid=10&md5=0f11866494ac3a354c2f6653b7fe1c4a
doi:10.1016/j.scitotenv.2005.03.034
Crown copyright © 2005 Published by Elsevier B.V.
Review
Human health implications of environmental contaminants in Arctic Canada: A review
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J. Van Oostdam<sup>a</sup><sup>, </sup><sup>
</sup><sup>, </sup><sup>
</sup>, S.G. Donaldson<sup>a</sup><sup>, </sup><sup>b</sup>, M. Feeley<sup>c</sup>, D. Arnold<sup>c</sup>, P. Ayotte<sup>d</sup>, G. Bondy<sup>c</sup>, L. Chan<sup>e</sup>, É. Dewaily<sup>d</sup>, C.M. Furgal<sup>f</sup>, H. Kuhnlein<sup>e</sup>, E. Loring<sup>g</sup>, G. Muckle<sup>h</sup>, E. Myles<sup>i</sup>, O. Receveur<sup>j</sup>, B. Tracy<sup>k</sup>, U. Gill<sup>l</sup> and S. Kalhok<sup>m</sup>
<!-- authorsNoEnt --><sup>a</sup>Environmental Contaminants Bureau, Safe Environments Program, Health Canada, Rm 4-046, BMO Building, 269 Laurier Avenue W., AL4904B, Ottawa, ON, Canada K1A 0K9
<sup>b</sup>Carleton University, 1125 Coloney By Drive, Ottawa, ON, Canada K1S 5B6
<sup>c</sup>Health Canada, Food Directorate, Bureau of Chemical Safety, Banting Research Center, Tunney's Pasture, Ottawa, ON, Canada K1A 0L2
<sup>d</sup>Unité de recherche en santé publique (Centre hospitalier universitaire de Québec - Centre hospitalier de l'Université Laval), Université Laval, 945 Ave Wolfe, Ste. Foy, Québec, Canada G1V 5B3
<sup>e</sup>Centre for Indigenous Peoples' Nutrition and Environment, Macdonald Campus of McGill University, 21,111 Lakeshore Road, Ste.-Anne-de-Bellevue, Quebec, Canada H9X 3V9
<sup>f</sup>Départment Science Politique et Unité de recherche en santé publique (Centre hospitalier universitaire de Québec - Centre hospitalier de l'Université Laval), Université Laval, 945 Ave Wolfe, Ste. Foy, Québec, Canada G1V 5B3
<sup>g</sup>Environmental Contaminants Research Division, Inuit Tapiriit Kanatami, 170 Laurier Avenue West, 12th Floor, Ottawa, ON, Canada, K1P 5V5
<sup>h</sup>École de psychologie et Unité de recherche en santé publique (Centre hospitalier universitaire de Québec - Centre hospitalier de l'Université Laval), Université Laval, Ste Foy, Québec, Canada G1K 7P4
<sup>i</sup>AXYS Environmental Consulting Ltd., Suite 300, 805 8th Ave SW, Calgary, Alberta, Canada T2P 1H7
<sup>j</sup>Faculté de Medicin, Nutrition, Université de Montreal, CP6128, Succursale Centre Ville Montreal, QC, Canada H3C 3J7
<sup>k</sup>Health Canada, Environmental Health Directorate, Radiation Protection Bureau, 775 Brookfield Road, AL 6302D1, Ottawa, ON, Canada K1A 0L2
<sup>l</sup>Health Canada, Health Products and Food Branch, 2nd Floor, Qualicum Twr A, 2936 Baseline, AL 3302C Nepean, ON, Canada K1A 0K9
<sup>m</sup>Indian and Northern Affairs, Northern Science and Contaminants Research Directorate, 10 Wellington Street, Gatineau, Quebec, Canada K1A 0H4
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Accepted 30 March 2005.
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Abstract
The objectives of this paper are to: assess the impact of exposure to current levels of environmental contaminants in the Canadian Arctic on human health; identify the data and knowledge gaps that need to be filled by future human health research and monitoring; examine how these issues have changed since our first assessment [Van Oostdam, J., Gilman, A., Dewailly, É., Usher, P., Wheatley, B., Kuhnlein, H. et al., 1999. Human health implications of environmental contaminants in Arctic Canada: a review. Sci Total Environ 230, 1–82]. The primary exposure pathway for contaminants for various organochlorines (OCs) and toxic metals is through the traditional northern diet. Exposures tend to be higher in the eastern than the western Canadian Arctic. In recent dietary surveys among five Inuit regions, mean intakes by 20- to 40-year-old adults in Baffin, Kivalliq and Inuvialuit communities exceeded the provisional tolerable daily intakes (pTDIs) for the OCs, chlordane and toxaphene. The most recent findings in NWT and Nunavut indicate that almost half of the blood samples from Inuit mothers exceeded the level of concern value of 5 μg/L for PCBs, but none exceeded the action level of 100 μg/L. For Dene/Métis and Caucasians of the Northwest Territories exposure to OCs are mostly below this level of concern. Based on the exceedances of the pTDI and of various blood guidelines, mercury and to a lesser extent lead (from the use of lead shot in hunting game) are also concerns among Arctic peoples. The developing foetus is likely to be more sensitive to the effects of OCs and metals than adults, and is the age groups of greatest risk in the Arctic. Studies of infant development in Nunavik have linked deficits in immune function, an increase in childhood respiratory infections and birth weight to prenatal exposure to OCs. Balancing the risks and benefits of a diet of country foods is very difficult. The nutritional benefits of country food and its contribution to the total diet are substantial. Country food contributes significantly more protein, iron and zinc to the diets of consumers than southern/market foods. The increase in obesity, diabetes and cardiovascular disease has been linked to a shift away from a country food diet and a less active lifestyle. These foods are an integral component of good health among Aboriginal peoples. The social, cultural, spiritual, nutritional and economic benefits of these foods must be considered in concert with the risks of exposure to environmental contaminants through their exposure. Consequently, the contamination of country food raises problems which go far beyond the usual confines of public health and cannot be resolved simply by risk-based health advisories or food substitutions alone. All decisions should involve the community and consider many aspects of socio-cultural stability to arrive at a decision that will be the most protective and least detrimental to the communities.
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Keywords: Arctic regions; Environmental monitoring; PCBs; Organochlorines; Mercury; Maternal; Infant; Monitoring environmental pollution; Northern populations; Public health; Risk factors; Risk-benefit management
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Article Outline
<dl><dt>1.
Introduction </dt><dl><dt>1.1.
Aboriginal peoples of Canada </dt><dt>1.2.
Aboriginal perspectives on food and health </dt><dt>1.3.
Factors that contribute to Aboriginal Northerners' exposure to country food contamination </dt><dt>1.4.
Evaluation of research in CACAR and application to benefit and risk assessment/management </dt><dt>1.5.
Research ethics</dt></dl><dt>2.
Exposure assessment </dt><dl><dt>2.1.
Country food consumption in the Arctic </dt><dt>2.2.
Contaminant levels in people and their relationship to traditional food diets </dt><dl><dt>2.2.1.
Tissue levels of contaminant results </dt><dt>2.2.2.
Levels of mercury in hair and blood </dt><dt>2.2.3.
Population groups and studies </dt><dt>2.2.4.
Maternal hair </dt><dt>2.2.5.
Maternal/cord blood </dt><dt>2.2.6.
Levels of selenium in maternal blood </dt><dt>2.2.7.
Levels of lead in maternal blood </dt><dt>2.2.8.
Levels of cadmium in maternal blood </dt><dt>2.2.9.
Radionuclide exposure </dt><dl><dt>2.2.9.1.
Radiocesium </dt><dt>2.2.9.2.
Lead-210 and polonium-210 </dt><dt>2.2.9.3.
Summary of radionuclide exposures</dt></dl></dl><dt>2.3.
Trends in traditional/country food dietary intakes and contaminant exposures</dt></dl><dt>3.
Toxicology </dt><dl><dt>3.1.
Priority contaminants </dt><dl><dt>3.1.1.
Toxaphene </dt><dl><dt>3.1.1.1.
Discussion</dt></dl><dt>3.1.2.
Chlordane </dt><dl><dt>3.1.2.1.
Discussion</dt></dl></dl><dt>3.2.
Toxicological effects induced by exposure to food-chain contaminant mixtures </dt><dl><dt>3.2.1.
Discussion</dt></dl><dt>3.3.
Contaminant and dietary nutrient interactions </dt><dl><dt>3.3.1.
Discussion</dt></dl></dl><dt>4.
Epidemiology and human biomarkers </dt><dl><dt>4.1.
Immune system function </dt><dl><dt>4.1.1.
Clinical outcomes </dt><dt>4.1.2.
Biomarkers </dt><dl><dt>4.1.2.1.
Lymphocyte subsets and immunoglobulins </dt><dt>4.1.2.2.
Antibody response following vaccination </dt><dt>4.1.2.3.
Complement system </dt><dt>4.1.2.4.
Cytokine production by Th1/Th2 Cells </dt><dt>4.1.2.5.
Vitamin A status</dt></dl></dl><dt>4.2.
Neurodevelopment </dt><dl><dt>4.2.1.
Clinical outcomes </dt><dl><dt>4.2.1.1.
Polychlorinated biphenyls (PCBs) </dt><dt>4.2.1.2.
Methylmercury</dt></dl><dt>4.2.2.
Biomarkers of developmental effects </dt><dl><dt>4.2.2.1.
Cytochrome P4501A1 induction and DNA adduct formation </dt><dt>4.2.2.2.
Thyroid hormones</dt></dl></dl><dt>4.3.
Sex hormone disruption </dt><dl><dt>4.3.1.
Clinical outcomes </dt><dl><dt>4.3.1.1.
Sexual maturation of newborn males </dt><dt>4.3.1.2.
Environmental risk factors for osteoporosis</dt></dl><dt>4.3.2.
Hormonal biomarkers </dt><dl><dt>4.3.2.1.
Hormone profiles</dt></dl></dl><dt>4.4.
Oxidative stress</dt></dl><dt>5.
Risk-benefit characterization, assessment and advice </dt><dl><dt>5.1.
Contaminant exposure risks </dt><dl><dt>5.1.1.
Contaminant intakes </dt><dl><dt>5.1.1.1.
Persistent organic pollutants </dt><dt>5.1.1.2.
Metals—mercury, cadmium, and lead </dt><dt>5.1.1.3.
Contaminant tissue levels and guidelines</dt></dl></dl><dt>5.2.
Special considerations for risk management in Arctic communities </dt><dl><dt>5.2.1.
Nutritional benefits</dt></dl><dt>5.3.
Social, cultural, spiritual and economic benefits of country food </dt><dt>5.4.
Assessment of perceptions of risks, benefits and safety of country foods </dt><dl><dt>5.4.1.
Perceptions of risks in the north </dt><dt>5.4.2.
Research on the perceptions of food-chain contamination in the north </dt><dt>5.4.3.
Impacts of these perceptions</dt></dl><dt>5.5.
Risk-benefit characterization </dt><dl><dt>5.5.1.
Risk management frameworks </dt><dt>5.5.2.
Problem identification and context </dt><dt>5.5.3.
Risk and benefit assessment </dt><dl><dt>5.5.3.1.
Risk assessment </dt><dt>5.5.3.2.
Benefit assessment</dt></dl><dt>5.5.4.
Risk characterization </dt><dt>5.5.5.
Assumptions/uncertainties of concern </dt><dt>5.5.6.
Weighing benefits and risks—challenges in practice </dt><dt>5.5.7.
Option analysis/evaluation </dt><dt>5.5.8.
Selecting a risk management option </dt><dt>5.5.9.
Implementation </dt><dt>5.5.10.
Monitoring and evaluating the decision</dt></dl><dt>5.6.
Risk and benefit communication</dt></dl><dt>6.
Conclusions </dt><dl><dt>6.1.
Aboriginal perspectives on food and health and interpretation of research results </dt><dt>6.2.
Exposure assessment </dt><dt>6.3.
Toxicology </dt><dt>6.4.
Epidemiology and biomarkers </dt><dt>6.5.
Risk and benefit characterization, assessment and advice</dt></dl><dt>7.
Knowledge gaps </dt><dl><dt>7.1.
Exposure assessment </dt><dt>7.2.
Toxicology </dt><dt>7.3.
Epidemiology </dt><dt>7.4.
Risk and benefit characterization, assessment and advice</dt></dl><dt>
Acknowledgements </dt><dt>
References</dt></dl>
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<table><tbody><tr><td width="10%">
</td></tr></tbody></table>Fig. 1.1.1. General locations of Arctic cultural groups (adapted from
Van Oostdam et al., 1999).
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</td></tr></tbody></table>Fig. 1.1.2. Age distribution of Canadian Arctic population by ethnicity.
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</td></tr></tbody></table>Fig. 2.1.1. Communities participating in CINE dietary assessments.
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</td></tr></tbody></table>Fig. 2.1.2. Percentage of energy from traditional/country foods in the Yukon, Dene and Métis, and Inuit communities.
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</td></tr></tbody></table>Fig. 2.2.1. Contaminant studies in the Northwest Territories, Nunavut, and Nunavik.
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</td></tr></tbody></table>Fig. 2.2.2. Maternal contaminant levels in Arctic Canada: oxychlordane (μg/L plasma).
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</td></tr></tbody></table>Fig. 2.2.3. Maternal contaminant levels in Arctic Canada: hexachlorobenzene (μg/L plasma).
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</td></tr></tbody></table>Fig. 2.2.4. Maternal contaminant levels in Arctic Canada: total toxaphene (μg/L plasma).
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</td></tr></tbody></table>Fig. 2.2.5. Maternal contaminant levels in Arctic Canada: β-hexachlorocyclohexane (μg/L plasma).
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</td></tr></tbody></table>Fig. 2.2.6. Maternal contaminant levels in Arctic Canada:
p,
p′-DDE (μg/L plasma).
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</td></tr></tbody></table>Fig. 2.2.7. Maternal contaminant levels in Arctic Canada: PCBs (as Aroclor 1260) (μg/L plasma).
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<table><tbody><tr><td width="10%">
</td></tr></tbody></table>Fig. 2.2.8. Adjusted mean organochlorine (OC) concentrations according of the year of birth: (a) PCBs; (b) DDE; (c) HCB; (d) oxychlordane (
Dallaire et al., 2003a).
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<table><tbody><tr><td width="10%">
</td></tr></tbody></table>Fig. 2.2.9. Maternal contaminant levels in Arctic Canada: total mercury (μg/L plasma).
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</td></tr></tbody></table>Fig. 2.2.10. Adjusted mean metal concentrations according to the year of birth for (a) lead and (b) mercury (
Dallaire et al., 2003a).
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<table><tbody><tr><td width="10%">
</td></tr></tbody></table>Fig. 4.1.1. Distribution of PCB 153 concentration in cord serum or plasma, 10 studies (
Longnecker et al., 2003).
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</td></tr></tbody></table>Fig. 5.1.1. Mean intakes of chlordane, toxaphene, and mercury in northern Canada (μg/kg/day) (
Kuhnlein et al., 2001b).
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<table><tbody><tr><td width="10%">
</td></tr></tbody></table>Fig. 5.1.2. Mean intakes of toxaphene and chlordane in different regions (ages 20–40 years) (
Chan et al., in preparation(a)).
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<table><tbody><tr><td width="10%">
</td></tr></tbody></table>Fig. 5.1.3. Mean intakes of toxaphene and chlordane among different age groups in Baffin (
Chan et al., in preparation(a)).
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<table><tbody><tr><td width="10%">
</td></tr></tbody></table>Fig. 5.1.4. Maternal blood guideline exceedances for PCBs as Aroclor 1260 in Arctic Canada, by region and ethnicity (
Van Oostdam, 2001).
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<table><tbody><tr><td width="10%">
</td></tr></tbody></table>Fig. 5.1.5. Mean intake of total mercury in different regions (μg/kg/day) (
Chan et al., in preparation(b)).
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</td></tr></tbody></table>Fig. 5.1.6. Maternal blood guideline exceedances for organic mercury in Arctic Canada, by region and ethnicity (
Van Oostdam, 2001).
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</td></tr></tbody></table>Fig. 5.5.1. Framework for environmental health risk management (
Presidential/Congressional Commission on Risk Assessment and Risk Management, 1997a and
Presidential/Congressional Commission on Risk Assessment and Risk Management, 1997b).
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Table 1.1.1 Aboriginal peoples: population size and proportion of the total population in each region of Arctic Canada, 1996
Source: Statistics Canada (2001).
<sup>a</sup> Data presented in this table are for those who identify with one or more Aboriginal groups (Metis, Inuit, or North American Indian).
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Table 2.1.1 Five country/traditional food items most often consumed (yearly average of days per week)
Source: Kuhnlein (2002).
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Table 2.2.1 Mean levels of organochlorine pesticides in maternal blood, by region and ethnic group (geometric means, range, μg/L plasma)
NA = Not available; nd = not detected.
<sup>a</sup>
Source: Butler Walker et al. (2003).
<sup>b</sup>
Source: Muckle, 2000 and
Muckle et al., 2001b.
<sup>c</sup>
N = 25.
<sup>d</sup>
N = 42.
<sup>e</sup> Four composites (
n = 12, 12, 12 and 14;
Seddon, 1996).
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Table 2.2.2 Mean levels of PCBs in maternal blood, by region and ethnic group (geometric means, range, μg/L plasma)
NA = Not available; nd = not detected.
<sup>a</sup>
Source: Butler Walker et al. (2003).
<sup>b</sup>
Source: Muckle (2000) and
Muckle et al., 2001a and
Muckle et al., 2001b.
<sup>c</sup> Aroclor 1260 = 5.2 (PCB 153 + 138) (
Weber, 2002).
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Table 2.2.3 Dioxins and furans and PCBs in maternal blood
<sup>a</sup> TEQs = toxic equivalents.
<sup>b</sup> D + F = dioxins and furans.
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Table 2.2.4 Cord and maternal contaminants (lipid weight basis)
Source: Van Oostdam (2001).
Abbreviations: B-HCH, beta-hexachlorocyclohexane; PCBs, polychlorinated biphenyls.
<sup>a</sup> Sample size: cord–maternal pairs.
<sup>b</sup> Concentration (μg/kg lipid, arithmetic mean).
<sup>c</sup> Cord/maternal blood (paired data only).
<sup>d</sup> Pearson's correlations.
<sup>e</sup> Statistical significance of cord/maternal Pearson's correlations.
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Table 2.2.5 Worldwide comparisons of maternal blood levels of PCBs (Aroclor 1260) and β-HCH (geometric means, μg/L plasma)
<sup>a</sup>
Source: Butler Walker et al. (2003).
<sup>b</sup>
Source: Muckle (2000) and
Muckle et al., 2001a and
Muckle et al., 2001b.
<sup>c</sup>
Source: Deutch (2001).
<sup>d</sup>
Source: Deutch and Hansen (2000).
<sup>e</sup>
Source: Klopov et al. (1998).
<sup>f</sup>
Source: Klopov (2000),
Klopov and Shepovalnikov (2000), and
Klopov and Tchachchine (2001).
<sup>g</sup>
Source: Odland (2001).
<sup>h</sup>
Source: Sharma and Bhatnagar (1996).
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Table 2.2.6 Current and historic levels
<sup>a</sup> of mercury in maternal hair (μg/g)
Source: Snider and Gill (2001).
LOD: below analytical method detection limits (0.4 μg/g).
<sup>a</sup> Peak exposure levels reported as parts per million (ppm) in hair.
<sup>b</sup> GSD: Geometric mean standard deviation.
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Table 2.2.7 Mean concentrations of metals in maternal blood, by ethnicity and region (geometric mean (range), μg/L whole blood)
NA = Not available; nd = not detected.
<sup>a</sup>
Source: Butler Walker et al. (2005).
<sup>b</sup>
Source: Muckle et al., 2001a and
Muckle et al., 2001b.
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Table 2.2.8 Worldwide comparisons of maternal blood mercury levels (μg/L whole blood) for women living in arctic regions
<sup>a</sup> GM: geometric mean.
<sup>b</sup> GSD: geometric standard deviation.
<sup>c</sup>
Source: Bjerregaard and Hansen (2000).
<sup>d</sup>
Source: AMAP (1998).
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Table 2.2.9 Radionuclide levels in caribou meat and people in the Canadian Arctic, and resulting radiation doses to people
Source: Tracy and Kramer (2000).
<sup>a</sup> Doses based on measured whole-body concentrations of <sup>137</sup>Cs (
Tracy et al., 1997).
<sup>b</sup> Doses based on estimated caribou consumption in a typical northern diet and on human metabolic parameters. The higher <sup>210</sup>Po doses in the 1960s is not based on any changes in environmental levels of <sup>210</sup>Po but on an estimated higher consumption of caribou meat at that time (
Tracy and Kramer, 2000).
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Table 3.1.1 Relative percent contribution to chlordane total
<sup>a</sup>
Buchert et al. (1989).
<sup>b</sup> Marine mammal blubber average, 1993–1994.
<sup>c</sup> As heptachlor epoxide.
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Table 3.1.2 Chlordane-induced mortality in sub-acute studies
Bondy et al., 2000 and
Bondy et al., 2003.
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Table 3.2.1 Composition of the organochlorine mixture
Source: Ayotte (2001).
<sup>a</sup> Mixture containing 2,4,4′-trichlorobiphenyl (320 mg), 2,2′,4,4′-tetrachlorobiphenyl (256 mg), 3,3′,4,4′-tetrachlorobiphenyl (1.4 mg), 3,3′,4,4′,5-pentachlorobiphenyl (6.7 mg), Aroclor 1254 (12.8 g), and Aroclor 1260 (19.2 g).
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Table 3.2.2 Composition of complex mixture based on human blood residues
Source: Bowers et al. (2003).
<sup>a</sup> Containing PCBs 28, 52, 99, 101, 105, 118, 128, 138, 153, 156, 170, 180, 183, 187.
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Table 3.2.3 Comparison of PBTK-derived TDIs to estimated contaminant intakes
Source: Chan et al., 1997 and
Chan et al., 2000. ND—not determined.
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Table 4.2.1 Comparison of mercury (total) concentrations in Nunavik with those observed in other cohorts
Source: Muckle et al. (2001b).
<sup>a</sup> The average Hg concentration was reported in nmol/L, this concentrations was divided by 5 to transform to μg/L.
<sup>b</sup> 95% confidence interval.
<sup>c</sup> Women aged between 15 and 39 years old.
<sup>d</sup> Arithmetic mean.
<sup>e</sup> Standard deviation.
<sup>f</sup> Among seafood consumers.
<sup>g</sup> Among non-seafood consumers.
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Table 5.1.1 Sources of organochlorines in the Baffin Region (percent contribution)
Source: Kuhnlein and Receveur (2001).
<sup>a</sup> Percent by weight of each species contributing to the traditional diet.
<sup>b</sup> Percent of each contaminant contributed by each food.
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Table 5.1.2 Proportionate contributions of three main food sources of chlordane and toxaphene, in five Inuit regions, by food item
Source: Kuhnlein and Receveur (2001).
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Table 5.1.3 Population distribution of organochlorine intake in Qikiqtarjuaq (μg/kg bw/day)
Source: Kuhnlein and Receveur (2001).
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Table 5.1.4 Comparison of daily intake of selected contaminants in Qikiqtarjuaq in 1987–1988 and 1998–1999
<sup>a</sup>
Source: Kuhnlein et al. (1995a) and
Chan et al. (1997).
<sup>b</sup>
Source: Kuhnlein et al. (2000).
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Table 5.1.5 Proportionate contributions of three main food sources of total mercury, and total mercury concentrations by food item in five Inuit regions
Source: Kuhnlein and Receveur (2001).
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Table 5.1.6 Population distribution of heavy metal intake in Qikiqtarjuaq (μg/kg bw/day)
Source: Kuhnlein and Receveur (2001).
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Table 5.1.7 Blood guideline exceedances for methyl mercury, lead, and cadmium in Arctic Canada, by region and ethnicity
NA = Not available.
<sup>a</sup> Based on US EPA 1999 re-evaluation of methyl mercury.
<sup>b</sup> Increasing risk range is 20–100 μg/L, Health Canada.
<sup>c</sup> Guideline value of 5 μg/L is for occupational exposure.
<sup>d</sup>
Source: Butler Walker et al. (2005).
<sup>e</sup>
Source: Ayotte (2001).
<sup>f</sup> ≥ 5.8 μg/L value.
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Table 5.2.1 Percent energy from macronutrients on days with or without traditional/country food (least square means ± S.E.M.)
Source: Kuhnlein et al. (2004).
<sup>
</sup> Different from with TF,
p < 0.01.
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Table 5.2.2 Top three sources of selected nutrients from 24-h recalls (fall and late winter combined) in five Inuit regions
Source: Kuhnlein and Receveur (2001).
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Table 5.2.3 Reported daily fish consumption by gender and age group in three recent dietary surveys among Canadian Arctic indigenous peoples
<sup>a</sup>
Data adapted from
Receveur et al., 1996 and
Receveur et al., 1998a and
Kuhnlein et al. (2000).
<sup>a</sup> Estimates obtained by averaging food intake over all 24-h recalls collected in two seasons (Sep–Nov and Feb–Apr).
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<sup>
</sup>Corresponding author. Tel.: +1 613 941 3570.