Potential impact of the sewer system on the applicability of alcohol and tobacco biomarkers in wastewater‐based epidemiology

Abstract

Understanding the actual consumption of alcohol and tobacco in the population is important for forming public health policy. For this purpose, wastewater-based epidemiology has been applied as a complementary method to estimate the overall alcohol and tobacco consumption in different communities. However, the stability of their consumption biomarkers - ethyl sulfate, ethyl glucuronide, cotinine, and trans-3'-hydroxycotinine - in the sewer system has not yet been assessed. This study aimed to conduct such assessment using sewer reactors mimicking conditions of rising main, gravity sewer, and wastewater alone, over a 12-hour period. The results show that cotinine and trans-3'-hydroxycotinine are relatively stable under all sewer conditions while ethyl sulfate was only stable in wastewater alone and gradually degraded in rising main and gravity sewer conditions. Ethyl glucuronide quickly degraded in all reactors. These findings suggest that cotinine and trans-3'-hydroxycotinine are good biomarkers to estimate tobacco consumption; ethyl sulfate may be used as a biomarker to estimate alcohol consumption, but its in-sewer loss should be accounted for in the calculation of consumption estimates. Ethyl glucuronide, and probably most of glucuronide compounds, are not suitable biomarkers to be used in wastewater-based epidemiology due to their in-sewer instability.

Assessing alcohol consumption through wastewater-based epidemiology: Spain as a case study

“…Although, good correlation has been mostly obtained between WBE-derived data and those obtained with established indicators, the estimates of alcohol consumption by means of WBE have associated other uncertainties that should be taken into consideration. On the one hand, it has been shown that EtS is stable in wastewater (one week at room temperature and more than 1 month at -20ºC) (Rodríguez-Álvarez et al, 2014), however, in sewage systems EtS could be degraded to some extent (Banks et al, 2018;Gao et al, 2018). This could lead to an underestimation of the real alcohol consumption, which could (partially) explain the lower consumption estimates obtained by means of WBE compared to those reported by the WHO.…”

Preparing for COVID-2x: Urban Planning Needs to Regard Urological Wastewater as an Invaluable Communal Public Health Asset and Not as a Burden

“…In addition, sewage testing allows us to estimate uses of other detectable substances/their metabolites for general public health assessments. Urological waste water testing has been used to assess the use of depressants as well as antidepressants [33], nicotine (as a proxy for smoking) [34,35], alcohol [35], and select diseases such as gout [36]. It has been used to determine the usage of a range of medication [37], such as antibiotics [38], and decongestants [38], as well medication for other disorders such as ADHD (e.g., Ritalin) [39], Urological waste water testing allowed health authorities to assess the uptake of antiviral treatments (e.g., Tamilflu) during H1N1 influenza pandemics [38,40].…”

Monitoring wastewater for assessing community health: Sewage Chemical-Information Mining (SCIM)

“…Examples of candidate markers for consumption of potentially harmful foods include: metabolites of ethyl alcohol [ethyl glucuronide (EtG), ethyl sulfate (EtS), phosphatidyl ethanol (PEth)] and 5-hydroxytryptophol (HTOL) ( Maenhout et al, 2013 ; Reid et al, 2011 ) (note that since PEth is synthesized via phospholipase D, it serves as a definitive metabolite, but one for which sewage has apparently not yet been monitored); DON-15-GlcA, which is the most important glucuronic acid (GlcA) conjugate of deoxynivalenol (DON; also known as vomitoxin)—one of the most prevalent Fusarium mycotoxins (common contaminant of grains worldwide, especially wheat, barley, maize, and oats) ( Gruber-Dorninger et al, 2017 ; Huybrechts et al, 2015 ); and 1-methyl-histidine (a marker for meat consumption), but not 3-methyl-histidine, which can be formed via muscle catabolism ( Fraser et al, 2016 ; Lindsay and Costello, 2017 ). Note, however, that although conjugates provide an assurance that they originate from metabolism and therefore reflect exposure, their inherent chemical instability introduces added challenges in performing back-calculations to quantify exposure (e.g., Banks et al, 2017 ).…”