Cohort profile: China National Human Biomonitoring (CNHBM)—A nationally representative, prospective cohort in Chinese population

Abstract

Objective: Globally, developed countries such as the United States, Canada, Germany, Korea, have carried out long-term and systematic biomonitoring programs for environmental chemicals in their populations. The China National Human Biomonitoring (CNHBM) was to document the extent of human exposure to a wide array of environmental chemicals, to understand exposure profiles, magnitude and ongoing trends in exposure in the general Chinese population, and to establish a national biorepository. Methods: CNHBM adopted three-stage sampling method to obtain a nationally representative sample of the population. A total of 21,888 participants who were permanent residents in 31 provinces were designed to interviewed in this national biomonitoring (152 monitoring sites × 3 survey units × 2 sexes × 6 age groups × 4 persons = 21,888 persons) in 2017–2018. Unlike the US National Health and Nutrition Examination Survey, the CNHBM will follow the same participants in subsequent cycles allowing for dynamic, longitudinal data sets for epidemiologic follow-up. Each survey cycle of CNHBM will last 2 years and each subsequent cycle will occur 3 years after the prior cycle’s completion. Results: In 2017–2018, the CNHBM created a large cohort of Chinese citizens that included districts/counties questionnaire, community questionnaire collecting information on villages/communities, individual questionnaire, household questionnaire, comprehensive medical examination, and collection of blood and urine samples for measurement of clinical and exposure biomarkers. A total of 21,746 participants were finally included in CNHBM, accounting for 99.4% of the designed sample size; and 152 PSUs questionnaires, 454 community questionnaires, 21,619 family questionnaires, 21,712 cases of medical examinations, 21,700 individual questionnaires, 21,701 blood samples and 21,704 urine samples were collected, respectively. Planned analyses of blood and urine samples were to measure both inorganic and organic chemicals, including 13 heavy metals and metalloids, 18 poly- and per-fluorinated alkyl substances, 12 phthalate metabolites, 9 polycyclic aromatic hydrocarbons metabolites, 4 environmental alkylated phenols, and 2 benzene metabolites. Conclusions: CNHBM established the first nationally representative, prospective cohort in the Chinese population to understand the baseline and trend of internal exposure of environmental chemicals in general population, and to understand environmental toxicity.

Spatiotemporal trends in human semen quality

“…The main challenges are to include large samples with harmonized data, reach high participation rates for appropriate representativeness, cover long periods to investigate temporal trends and obtain substantial funding. For example, coupling semen data collection to national biomonitoring surveillance cohorts 195 – 198 , which already exist in numerous countries, would be an ideal approach. On a smaller scale, well-controlled study designs are needed to investigate temporal trends, to minimize the influence of known factors of bias through precise methodological and high-quality statistical planning.…”

Harmonization of Human Biomonitoring Studies in Europe: Characteristics of the HBM4EU-Aligned Studies Participants

“…To assess the potential health risks, a good understanding of the extent of human exposure is needed, together with the toxic potency of the chemicals. It is often difficult to predict individual exposure based on environmental exposure measurements (e.g., water, food, soil), given that they are usually multi-pathway in nature [ 2 ]. Human biomonitoring (HBM) is an important tool to measure the concentration of chemicals present in the human body.…”

“…Also in Korea in 2005, the first National Survey for Environmental Pollutants in the Human Body (KorSEP) was conducted followed by the Korean National Environmental Health Survey (KoNEHS) [ 3 ] which was implemented in 2009 as a recurrent program with a 3-year interval period. More recently, in 2017, also China initiated an HBM program called CHBM (China National Human Biomonitoring) [ 2 ]. In Europe, a coherent European recurrent HBM surveillance program is lacking.…”

“…The resulting HBM data indicate the present chemical exposure of European citizens (spatial trends). It can be used to identify (sub)populations at risk and highlight inequalities, to compare with exposure levels measured in internationally established HBM campaigns such as NHANES [ 15 ], CHMS [ 16 ], KNHANES [ 17 ], JECS [ 18 ], CNHBM [ 2 ] or previous European HBM projects such as COPHES/DEMOCOPHES [ 19 ] and to identify variables that may influence internal exposure levels. The HBM data can also be input into models to estimate external intakes or the dose to target organs.…”

Life-Time Environmental Chemical Exposure and Obesity: Review of Epidemiological Studies Using Human Biomonitoring Methods

“…Humans are exposed to these ECs through environmental media by ingestion, inhalation, absorption, and even through transplacental transfer and breast milk (34)(35)(36)(37)(38)(39)(40)(41)(42). The human exposure levels of these ECs are generally estimated by biomonitoring of their metabolites or parent compounds in human urine or blood (cord blood or peripheral blood) as exposure biomarkers worldwide (43)(44)(45)(46)(47).…”