Evaluation of pulmonary function within a cohort of flavorings workers

Ronk, Christopher J.; Hollins, Dana M.; Jacobsen, Megan J; Galbraith, David A.; Paustenbach, Dennis J.

doi:10.3109/08958378.2012.760691

Cited by 11 publications

(12 citation statements)

References 27 publications

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“…Although hand‐popping was popular until the mid‐20th century, the advent of MWs necessitated development of MW popcorn. To obtain the pleasing buttery aroma and flavor expected of “home‐made” buttered popcorn, MW popcorn manufacturers have used a variety of flavorings, including acetaldehyde, acetic acid, acetoin, butyric acid, and diacetyl (FEMA ; NTP ; Ronk and others ).…”

Section: Diacetyl Health Effectsmentioning

confidence: 99%

“…In a Letter to the Editor regarding Kreiss and others (), Taubert and others () brought into question whether diacetyl alone can be singled out as a causative agent in lung ailments. Since then, numerous investigators, including those associated with the initial research, have questioned diacetyl as a single causative agent (Kreiss and others ; Morgan and others ,b; Finley and others ; Galbraith and Weill ; Lockey and others ; Ronk and others ). Even contrasting views by single researchers have been unearthed.…”

Section: Diacetyl Health Effectsmentioning

confidence: 99%

“…More recently, a re‐analysis was conducted on the Health Hazard Evaluation that was performed by NIOSH (Kreiss and others ; same spirometry results and employment histories) regarding the pulmonary status of workers at the flavorings manufacturing factory, to account for inherent bias (the fact that pulmonary health data are inherently correlated as a result of the longitudinal nature of spirometry testing) (Ronk and others ). The investigators concluded that exposures to flavoring chemicals in the workplace, including diacetyl, did not produce an increased risk of abnormal spirometric findings (Ronk and others ).…”

Section: Diacetyl Health Effectsmentioning

confidence: 99%

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Diacetyl in Foods: A Review of Safety and Sensory Characteristics

Clark

Winter

2015

Comp Rev Food Sci Food Safe

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Diacetyl, noted for its appealing butter-like aroma, is present naturally in many foods, and humans have been exposed to it since the beginning of civilization. The advent of microwave (MW) cooking technology has led to the development of a significant market for MW popcorn, to which diacetyl and other flavoring compounds have been frequently added. Based upon reported associations between diacetyl inhalation and lung disease in employees of MW popcorn processing facilities, a very conservative safe level of occupational exposure to diacetyl has been proposed by the American Conference of Governmental Industrial Hygienists. Yet there is conflicting evidence that diacetyl causes lung disease in workers, and no evidence to condemn diacetyl as the cause of lung problems in MW popcorn consumers. Consumer dietary exposure to diacetyl in foods is below levels of health concern while common airborne levels of diacetyl from MW popcorn are far below the conservatively established limit to protect workers.

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Section: Diacetyl Health Effectsmentioning

confidence: 99%

Section: Diacetyl Health Effectsmentioning

confidence: 99%

Section: Diacetyl Health Effectsmentioning

confidence: 99%

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Diacetyl in Foods: A Review of Safety and Sensory Characteristics

Clark

Winter

2015

Comp Rev Food Sci Food Safe

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“…Ronk et al 59 reanalyzed pulmonary function data from a NIOSH HHE at a facility manufacturing flavorings, including diacetyl, 60 and found no decrease in lung function in these workers. However, as with typical cross-sectional studies, there is evidence of survivor bias in their analysis.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Impairment and Risk Assessment in a Diacetyl-Exposed Population

Park

Gilbert

2018

Journal of Occupational &Amp; Environmental Medicine

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Objectives: The butter flavoring additive, diacetyl (DA), can cause bronchiolitis obliterans (BO) by inhalation. A risk assessment was performed using data from a microwave popcorn manufacturing plant. Methods: Current employees’ medical history and pulmonary function tests together with air sampling over a 2.7-year period were used to analyze forced expiratory volume in 1 second (FEV1) and FEV1/forced vital capacity (FVC). The exposure responses for declining pulmonary function and for possible early onset of BO were estimated using multiple regression methods. Several exposure metrics were investigated; benchmark dose and excess lifetime risk of impairment were calculated. Results: Forty-six percent of the population had less than 6 months exposure to DA. Percent-of-predicted FEV1 declined with cumulative exposure (0.40 per ppm-yr, P < 10−7) as did percent FEV1/FVC (0.13 per ppm-yr, P = 0.0004). Lifetime respiratory impairment prevalence of one per thousand resulted from 0.005 ppm DA and one per thousand lifetime incidence of impairment was predicted for 0.002 ppm DA. Conclusion: DA exposures, often exceeding 1 ppm in the past, place workers at high risk of pulmonary impairment.

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“…The group with higher potential flavoring chemical exposure had 5.8-fold risk of excessive decline of lung function during employment, compared to the group with lower potential for exposure. A contradictory industry-sponsored re-analysis of the same company data (Ronk et al, 2013) incorrectly described the lower exposure group as unexposed and omitted evidence of mean excessive decline in presentation of statistical models.…”

Section: Flavor Manufacturing Risk In Californiamentioning

confidence: 99%

Recognizing occupational effects of diacetyl: What can we learn from this history?

Kreiss

2017

Toxicology

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For half of the 30-odd years that diacetyl-exposed workers have developed disabling lung disease, obliterative bronchiolitis was unrecognized as an occupational risk. Delays in its recognition as an occupational lung disease are attributable to the absence of a work-related temporal pattern of symptoms; failure to recognize clusters of cases; complexity of exposure environments; and absence of epidemiologic characterization of workforces giving rise to case clusters. Few physicians are familiar with this rare disease, and motivation to investigate the unknown requires familiarity with what is known and what is anomalous. In pursuit of the previously undescribed risk, investigators benefited greatly from multi-disciplinary collaboration, in this case including physicians, epidemiologists, environmental scientists, toxicologists, industry representatives, and worker advocates. In the 15 years since obliterative bronchiolitis was described in microwave popcorn workers, α-dicarbonyl-related lung disease has been found in flavoring manufacturing workers, other food production workers, diacetyl manufacturing workers, and coffee production workers, alongside case reports in other industries. Within the field of occupational health, impacts include new ventures in public health surveillance, attention to spirometry quality for serial measurements, identifying other indolent causes of obliterative bronchiolitis apart from accidental over-exposures, and broadening the spectrum of diagnostic abnormalities in the disease. Within toxicology, impacts include new attention to appropriate animal models of obliterative bronchiolitis, pertinence of computational fluid dynamic-physiologically based pharmacokinetic modeling, and contributions to mechanistic understanding of respiratory epithelial necrosis, airway fibrosis, and central nervous system effects. In these continuing efforts, collaboration between laboratory scientists, clinicians, occupational public health practitioners in government and industry, and employers remains critical for improving the health of workers inhaling volatile α-dicarbonyl compounds.

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Evaluation of pulmonary function within a cohort of flavorings workers

Abstract: Many years of exposures to flavoring chemicals in this workplace, including diacetyl, were not found to produce an increased risk of abnormal spirometric findings.

Cited by 11 publications

References 27 publications

Diacetyl in Foods: A Review of Safety and Sensory Characteristics

Diacetyl in Foods: A Review of Safety and Sensory Characteristics

Pulmonary Impairment and Risk Assessment in a Diacetyl-Exposed Population

Recognizing occupational effects of diacetyl: What can we learn from this history?

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