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Background and aims: Prenatal chemical exposure has frequently been associated with reduced fetal growth although results have been inconsistent. Most studies associate single pollutant exposure to this health outcome, even though this does not reflect real life situations as humans are exposed to many pollutants during their life time. The objective of this study is to investigate the association between prenatal exposure to a mixture of persistent environmental chemicals and birth weight using multipollutant models. Methods: We combined exposure biomarker data measured in cord blood samples of 1579 women from four Flemish birth cohorts collected over a 10 years' time period. The common set of available and detectable exposure measures in these cohorts are three polychlorinated biphenyls (PCB) congeners (138, 153 and 180), hexachlorobenzene (HCB), dichlorodiphenyldichloroethylene (p,p'-DDE) and the metals cadmium and lead. Multiple linear regression (MLR), Bayesian Information Criterion (BIC), penalized regression using minimax concave penalty (MCP) and Bayesian Adaptive Sampling (BAS) were applied to assess the influence of multiple pollutants in a single analysis on birth weight, adjusted for a priori selected covariates. Results: In the pooled dataset, a median (P25-P75) birth weight and gestational age of 3420 (3140-3700) grams and 39 (39-40) weeks was observed respectively. The median contaminant levels in cord blood were: 15.8, 26.5, 18.0, 16.9 and 91.5 ng/g lipid for PCB 138, PCB 153, PCB 180, HCB and p,p'-DDE, respectively, 0.075 mu g/L for cadmium and 9.7 mu g/L for lead. According to the applied statistical methods for multipollutant assessment, p,p'-DDE and PCB 180 were most consistently associated with birth weight. In addition, PCB 153 was selected when applying MCP and BAS. An inverse association with birth weight was found for the PCB congeners, while an increased birth weight was observed for elevated levels of p,p'-DDE. Conclusions: Assessing the health risk of combinations of exposure biomarkers reflects better real-world situations and thereby allows more effective risk assessment. Our results add to the existing evidence based on detrimental effects of PCBs on birth weight and indicate a possible increase in birth weight due to p,p'-DDE (while correcting for PCBs). The FLEHS studies were carried out by the Flemish Center of Expertise on Environment and Health. The studies of the Center were commissioned, financed and steered by the Ministry of the Flemish Community. NIRAS/ONDRAF (Belgian National Agency for Radioactive Waste and enriched Fissile Material), STORA (Study and Consultation Radioactive Waste Dessel) and MONA (Mols Overleg Nucleair Afval) financed the 3xG study. Govarts, E (corresponding author), Flemish Inst Technol Res VITO, Hlth, Boeretang 200, B-2400 Mol, Belgium. eva.govarts@vito.be

Aims: Decisive evidence on the optimal diuretic agent, dosing schedule, and administration route is lacking in acute heart failure (AHF) with congestion. The Acetazolamide in Decompensated heart failure with Volume OveRload (ADVOR) trial is designed to test the hypothesis that the carbonic anhydrase inhibitor acetazolamide, a potent inhibitor of proximal tubular sodium reabsorption, improves decongestion when combined with loop diuretic therapy in AHF, potentially leading to better clinical outcomes. Methods: The ADVOR trial is set up as a multicentre, randomized, double-blind, placebo-controlled study, aiming to recruit 519 patients with AHF and clinically evident volume overload. All study participants receive high-dose intravenous loop diuretics as background therapy and are randomized towards intravenous acetazolamide at a dose of 500 mg once daily vs. placebo, stratified according to including study centre and ejection fraction (< 40% vs. ≥ 40%). The primary endpoint is successful decongestion with no more than trace oedema assessed on the third morning after hospital admission, with good diuretic efficacy defined as a urine output > 3.5 L during the first 30–48 h of decongestive treatment. Secondary endpoints include all-cause mortality or heart failure readmission after 3 months, length of hospital stay for the index admission, and longitudinal changes in the EuroQol-5 dimensions questionnaire. Conclusion: ADVOR will investigate if acetazolamide combined with loop diuretic therapy improves decongestion in AHF with volume overload. © 2018 The Authors. European Journal of Heart Failure © 2018 European Society of Cardiology

epub ahead of print ispartof: Wiley Interdisciplinary Reviews: Nanomedicine and Nanobiotechnology pages:1-14 status: Published online

In this paper, we propose a method to cluster multivariate functional data with missing observations. Analysis of functional data often encompasses dimension reduction techniques such as principal component analysis (PCA). These techniques require complete data matrices. In this paper, the data are completed by means of multiple imputation, and subsequently each imputed data set is submitted to a cluster procedure. The final partition of the data, summarizing the partitions obtained for the imputed data sets, is obtained by means of ensemble clustering. The uncertainty in cluster membership, due to missing data, is characterized by means of the agreement between the members of the ensemble and fuzziness of the consensus clustering. The potential of the method was brought out on the heart failure (HF) data. Daily measurement for four biomarkers (heart rate, diastolic, and systolic blood pressure, weight) were used to cluster the patients. To normalize the distributions of the longitudinal outcomes, the data were transformed with a natural logarithm function. A cubic spline base with 69 basis functions was employed to smooth the profiles. The proposed algorithm indicates the existence of a latent structure and divides the HF patients into two clusters, showing a different evolution in blood pressure values and weight. In general, cluster results are sensitive to choices made. Likewise for the proposed approach, alternative choices for the distance measure, procedure to optimize the objective function, choice of the scree-test threshold, or the number of principal components, to be used in the approximation of the surrogate density, could all influence the final partition. For the HF data set, the final partition depends on the number of principal components used in the procedure. The authors gratefully acknowledge support from IAP research Network P7/06 of the Belgian government (Belgian Science Policy).

No data have been reported yet on treatment outcome in persons who inject drugs (PWID) infected with hepatitis C virus treated with boceprevir or telaprevir in combination with peginterferon (Peg IFN) and ribavirin (RBV). Additionally, there are concerns about the safety of boceprevir and telaprevir in some subgroups of patients with hepatitis C (HCV). In a cohort of HCV patients infected with genotype 1 in Belgium, treatment outcome of patients infected due to IV drug use was analyzed and compared with patients who have no history of substance use. The study population consisted of 179 patients: 78 PWID and 101 controls treated with boceprevir (n=79) or telaprevir (n=100) additional to Peg IFN and RBV; 53 (30%) had advanced disease (F3, F4) and 79 (44%) had an antiviral therapy previously. There were no significant differences in the baseline characteristics between both groups, except that PWID patients were more frequently infected with genotype 1a (67% vs 21%), were younger and were predominantly male. Psychiatric complaints during follow-up occurred more frequently in the PWID patients: 24% versus 11% (P=.02). Treatment failure for other reasons than absence of viral response was 70% and 64% in PWID and non-PWID respectively. The sustained viral response (SVR) rates were similar in both groups (71% in PWID vs 72% in non-PWID); with a non-inferiority test with -5% margin there is a difference of -1% (95% CI [-15%, 13%]) and P=0.30. There are no reasons to exclude PWID from treatment with boceprevir, telaprevir and novel antiviral therapies. J. Med. Virol. 88:94-99, 2016. (c) 2015 Wiley Periodicals, Inc.

Background and aims: One of the goals of human biomonitoring by the Flemish Centre of Environment and Health was to investigate exposure-response associations for various biomarkers of exposure and effect. The aim of this study is to describe the results of the exposure-effect associations involving exposure to metals and metalloids. Methods: Participants donated blood and/or urine for determination of concentrations of metals and metalloids (by ICP-MS) and biomarkers of effect (by various analytical methods). All subjects filled in a questionnaire to provide information on health, life-style and personal factors. The age groups sampled were mother-newborn pairs (maternal and cord blood), 14-15 year old adolescents (blood and urine) and 20-40 year old adults (urine). Regression models were fitted to determine associations between effect- and exposure markers, adjusted for relevant confounders and covariates (e.g. smoking, age, gender). Results: Many significant associations were in line with previously reported findings, while some were not published before. The size of newborns was negatively correlated with cord blood As, and positively with Cu. For adolescent girls, blood and urinary Tl were negatively correlated with development of pubic hair and breasts. In boys negative correlations were found between urinary Tl and pubic hair development, and between both urinary Tl and blood Pb and genital development. In adolescents, urinary Cd showed a negative correlation with the T4 thyroid hormone and a positive correlation with an indicator of DNA damage, while urinary Cd and urinary Cr showed positive correlation with indicators of kidney damage. Various correlations were found between metals and sex hormones (aromatase, SHBG, testosterone, estradiol) in boys. In adults, there was only a significant negative association between urinary As and blood platelet aggregation. Conclusions: Many exposure-effect associations were supported by the literature, some were reported earlier in a previous cycle of the Flemish human biomonitoring.

In 2002, the Centre for Environment and Health in Flanders, Belgium started a human biomonitoring program (FLEHS I). For 1679 adolescents, residing in nine study areas with differing pollution pressure, exposure to the pesticides p,p'-DDE and HCB, hormone levels and the degree of sexual maturation were measured. Possible confounding effects of lifestyle and personal characteristics were taken into account. In 2007, a second cycle of the Flemish human biomonitoring program (FLEHS II) started. The main purpose was generating reference values for several biomarkers, both of exposure and of effect, and establishing dose-effect relationships. In this survey, not only the pesticides p,p'-DDE and HCB were measured, but also metabolites from organophosphate pesticides and para-dichlorophenol (2,5-DCP), a metabolite of para-dichlorobenzene. Data on internal exposure of the pesticides p,p'-DDE and HCB showed a positive correlation with sexual maturation and the aromatase index for boys and with free T4 (both boys andgirls), while a negative association with sexual development in girls was found. For HCB also a positive correlation was found with testosterone (boys) and TSH levels in the blood (boys and girls). The organophosphate pesticide metabolites were negatively associated with sex hormone levels in the blood of the boys and with sexual maturation (both boys and girls). The pesticide metabolite 2,5-DCP was negatively correlated with free T4, while a positive association with TSH was reported (boys and girls). These results show that even relatively low concentrations of pesticides can have significant influences on hormone levels and the degree of sexual maturation in 14-15 year-old adolescents.

Environmental justice research suggests that inequalities in the distribution of environmental quality systematically disadvantage the lower social strata of society. The effects of these inequalities on the human exposure to specific chemical pollution remain, however, to a large extend unknown, especially in hotspot areas where surrounding neighbourhoods are exposed to a mixture of diverse pollution. In Flanders, the northern part of Belgium, a community-based participatory approach was set up between 2009-2010 to collect blood, urine and hair samples of 197 socially and ethnically diverse adolescents (14-15 years of age) living in the close proximity of a non-ferro industrial area. We conduct a socio- stratification of human biomonitoring results by associating the internal body concentration of three types of chemical pollution (heavy metals, POPs and volatile compounds) with individual socioeconomic status (SES) and ethnic background. Social gradients in exposure to these chemicals are assessed with geometric means, using multiple regression models, controlling for covariates and confounders. Our results show that, depending on the (type of) pollutant, adolescents with a lower SES can either have higher or lower internal concentrations. Socially constructed factors, such as dietary and lifestyle habits, play an important role in these relations. We conclude that when assessing the human exposure concentrations of pollutants, more complex patterns of social stratification emerge than can be assumed on the basis of the environmental justice hypothesis. It therefore remains important to consider the chemical environment in relation to the social environment when monitoring environmental health risks. By emphasising on transparent communication and relevant interaction between residents, local stakeholders and scientists, monitoring environmental health could enhance the empowerment of socioeconomically disadvantaged communities.

To collect information on the concentration levels of Persistent Organic Pollutants (POPs) in the rural areas in Flanders (Belgium), 84 breastfeeding mothers were recruited in rural communities in East and West Flanders and Flemish Brabant in 2009-2010. Polychlorinated biphenyl (PCB) congeners, organochlorine pesticides, brominated flame retardants, perfluorinated compounds, polychlorinated dibenzodioxines and dibenzofurans, and dioxin-like PCBs were measured in individual milk samples and in a pooled milk sample, while some additional pollutants were only measured in the pooled sample. For most pollutants, the concentration levels in this study were lower or comparable to the levels measured in the pooled Belgian sample of the WHO human milk study of 2006, except for the pesticides dichlorodiphenyltrichloroethane DDT (+25% for ?DDT and metabolites) and trans-nonachlor (+94%), and for the brominated flame retardant hexachlorocyclododecane HBCD (+153%). Perfluorinated compounds were for the first time determined in human milk samples from Belgium and the levels were comparable to those from other European countries. Also, interesting associations were found between the levels of POPs measured in human milk and personal characteristics as well as dietary habits of the study population. PFOS en PFOA concentrations were significantly higher in milk of primiparous participants compared to mothers who gave birth to their second child. Lower brominated PBDE congeners increased with increasing BMI of the mothers (p=0.01 for BDE 47, p=0.02 for BDE 99 and p=0.02 for BDE 100). Participants consuming milk or dairy products daily had significant higher levels of sumDDTs (p=0.03) and oxychlordane (p=0.047) in their human milk samples.

Since 2002 a human biomonitoring network has been established in Flanders (Belgium) as part of a programme on environmental health surveillance. The human biomonitoring network should support environmental health policy by identifying priorities for further action. The first cycle of the programme (2002-2006) confirmed the hypotheses that living in areas with different environmental pressure is reflected in different loads of environmental chemicals in the residents. In the second cycle of the programme(2007-2011) the number of environmental chemicals for which human biomonitoring data were obtained was expanded substantially. The goal of the Flemish programme is to use and translate the scientific results into policy actions. Its further orientation in the second cycle to human biomonitoring in hot spots and sensitive age groups or susceptible persons with underlying complications (e.g.persons with diabetes) are linked to these goals. Interaction with stakeholders is embedded in the programmeemphasizing transparency of the choices that are made and direct communication. The Flemish human biomonitoring programme is organized centrally with major involvement of research partners from different disciplines which allows engrafting environmental health research on the programme. One of the major focuses is the question whether combinations of pollutants in the general population are associated with biological effects. The objective of this paper is to review and discuss the options that were taken in the human biomonitoring programme in order to achieve its goals.

Although emissions of PCDD/Fs and PCBs have decreased during recent years, these compounds are still environmental pollutants of concern: 1) since PCDD/Fs and dioxin-like PCBs (dl-PCBs) are persistent in the environment, accumulate in fat tissue and have hormone disrupting properties and 2) because emissions in certain locations in Flanders are still high. Therefore, it is important to include these compounds as biomarkers of exposure in human biomonitoring programs. In 2007, a second cycle of the Flemish Human Biomonitoring program (FLEHS II) started. More than 40 biomarkers of exposure and 10 effect markers were measured in 650 samples, recruited from 14-15 year-old adolescents (n=200), 20-40 year old-adults (n=200) and mother-newborn pairs (n=250). Since only a small amount of serum was available for the PCDD/F and dl-PCB determination, GC-HRMS analysis was not possible. The CALUX bioassay provided a good alternative, since it requires only 5 mL of serum. This publication presents an optimized method for the separate analysis of PCDD/Fs and dl-PCBs in human serum with the newly developed and more sensitive third generation CALUX (H1L7.5c1) cell line.

In juli 2002 werden de resultaten van de "Women's Health Initiative"(WHI)-studie bekendgemaakt, waaruit bleek dat gecombineerde hormonale substitutietherapie (HST) positief geassocieerd was met het ontstaan van borstkanker. Deze informatie sijpelde langzaam door naar het Belgische publiek, met een daling van het HST-gebruik vanaf het 4e trimester van 2002 en een verdere scherpe daling in de volgende 3 jaar tot gevolg. Vanaf 2006 stabiliseerde het gebruik op ongeveer de helft van dit in 2001. Uit de registratie van borstkanker in de provincie Limburg (LIKAR) tussen 1996 en 2005 blijkt dat de borstkankerincidentie bij vrouwen tussen 50 en 69 jaar stijgt tot en met 2002, en dan scherp daalt in 2003 en 2004. In 2005 is er een niet te verklaren stijging van het aantal borstkankers. De incidentie blijft evenwel significant lager dan in 2002. Deze trend wordt alleen vastgesteld bij de vrouwen die veruit het vaakst HST gebruiken, nl. vrouwen tussen 50 en 69 jaar, maar niet in andere leeftijdscategorieën. De WHI-studie heeft dus een aardverschuiving teweeggebracht in het HST-gebruik. De daling van HST-gebruik wordt, zoals in alle landen waar er een hoog gebruik van HST bestond, vrij snel gevolgd door een daling van het aantal borstkankers.

In juli 2002 werden de resultaten van de „Women’s Health Initiative”(WHI)-studie bekendgemaakt, waaruit bleek dat gecombineerde hormonale substitutietherapie (HST) positief geassocieerd was met het ontstaan van borstkanker. Deze informatie sijpelde langzaam door naar het Belgische publiek, met een daling van het HST-gebruik vanaf het 4e trimester van 2002 en een verdere scherpe daling in de volgende 3 jaar tot gevolg. Vanaf 2006 stabiliseerde het gebruik op ongeveer de helft van dit in 2001. Uit de registratie van borstkanker in de provincie Limburg (LIKAR) tussen 1996 en 2005 blijkt dat de borstkankerincidentie bij vrouwen tussen 50 en 69 jaar stijgt tot en met 2002, en dan scherp daalt in 2003 en 2004. In 2005 is er een niet te verklaren stijging van het aantal borstkankers. De incidentie blijft evenwel significant lager dan in 2002. Deze trend wordt alleen vastgesteld bij de vrouwen die veruit het vaakst HST gebruiken, nl. vrouwen tussen 50 en 69 jaar, maar niet in andere leeftijdscategorieën. De WHI-studie heeft dus een aardverschuiving teweeggebracht in het HST-gebruik. De daling van HSTgebruik wordt, zoals in alle landen waar er een hoog gebruik van HST bestond, vrij snel gevolgd door een daling van het aantal borstkankers. ispartof: Tijdschrift voor Geneeskunde vol:66 issue:1 pages:25-30 status: published

To collect regional information on internal levels of pollutants in humans in Flanders, 1196 mother–child pairs were systematically recruited in 2002–2003 via 25 maternities across Flanders. Cd, Pb, PCB congeners 118, 170, 138, 153 and 180, p,p′-DDE — a key metabolite of DDT- and hexachlorobenzene (HCB) were measured in cord blood or plasma. Cd was detected in 64% of the samples (geometric mean 0.21 µg/L cord blood). p,p′-DDE (110 ng/g plasma lipids) and Pb (14.7 µg/L blood), were measurable in nearly all samples. The individual PCB congeners could be detected in 40 to 81% of the newborns (138 + 153 + 180 = 64.4 ng/g plasma lipids). HCB (18.9 ng/g plasma lipids) and dioxin-like compounds measured by DR-CALUX® (23 pg CALUX-TEQ/g lipids) were above detection limit in more than 75% of the samples. Age and smoking habits of the mothers, did not influence the cord blood Pb and Cd levels. The organochlorines increased 4 to 9% per year of the mother's age (partial R2 = 0.05 to 0.22). Mothers had 2.6% less PCBs in cord blood (partial R2 = 0.02) for each unit increase in pre-pregnancy BMI. Season of delivery, breastfeeding previous children or consumption of local dairy products, were minor determinants. Up to 20% of the variability in organochlorine concentrations was explained by residence area. It was concluded that the place of birth in Flanders is an important determinant of the load of pollutants measured at the start of life. This underlines the validity of human biomonitoring on (relatively) small geographical scale.

Background and study aims : The combination of Pegylated (PEG)interferon a-2b and ribavirin is considered to be the standard treatment for naïve chronic hepatitis C patients. Study aims are to evaluate the differences between standard interferon and PEG-interferon by conducting a multi-centre, controlled randomized trial comparing 3 groups. Group A : daily interferon alfa-2b at a dose of 4 MIU + ribavirin, Group B : PEG-interferon alfa-2b at a dose of 100 mcg/week + ribavirin ; Group C : interferon alfa-2b at a dose of 3 MIU TIW + ribavirin Patients and methods : Multicentrer, open label study including naïve chronic Hepatitis C Virus patients randomised in three groups with a ratio of 2:2:1. Group A : daily interferon a-2b (4 MIU s.c. for patients > 65 kg or 0.06 MIU/kg 65 kg or 1.5 μg/kg weekly for patients < 65 kg) and ribavirin and group C (reference arm) : interferon a-2b (3MIU s.c. TWI) and ribavirin. The duration of the treatment was 48 weeks for all 3 groups, with a 6 month follow-up period. 336 patients were enrolled in the study and included in the intention-to-treat analysis ; 78 never started treatment (35 in group A, 28 in group B and 15 in group C) : 101 in group A, 98 in group B and 59 in group C. Results : Demographic data, PCR results and reasons for early withdrawal have been statistically analysed. At baseline, the 3 groups did not show any statistical difference regarding age, gender, race, genotypes and METAVIR score. At week 24 on treatment, HCV ribonucleic acid RNA was undetectable in 87% in group A, in 79% in group B and in 69% in group C. At the end of treatment, 73% 74% and 58% respectively, had a negative PCR result. At week 24 of follow-up, these results were 71%, 64% and 48%, respectively. When comparing the efficacy of the daily interferon (+ ribavirin) and the PEG-interferon (+ ribavirin) regimen, no statistical difference was found (p = 0.32). In group A, 38% of drop-outs were due to adverse events compared to 37% in group B and 58% in group C. No statistical differences were observed regarding safety. Conclusion : Daily weight based interferon a-2b dosing and PEG interferon a-2b weighed based dosing once weekly both in combination with Ribavirin offer the same efficacy and safety rates. (Acta gastro enterol. belg., 2008, 71, 293-297). Key words : chronic hepatitis C, interferon, daily administration, pegylated interferon.

Objectives: To outline an evidence-based health policy, one is often interested in the profiles of persons who are at risk to obtain certain diseases or who do not respond to prevention programs as e.g. cervix cancer screening via smears. Methods: Statistical modelling can provide a tool to discover such profiles. In this paper the method of classification trees is described. The use of classification trees has advantages but also limitations with respect to their application in the survey domain. A closer look on the handling of missing data and weighting in this context will be given. Material: The Belgian Health Interview Survey (HIS) was conducted in 1997. The Belgian communities are responsible for cervix cancer screening as a part of the preventional health care. Om een gefundeerd gezondheidsbeleid uit te zetten, is men geïnteresseerd in de profielen van subgroepen van personen, bijvoorbeeld zij die vatbaar zijn voor bepaalde ziektes of diegenen die niet reageren op preventie-programma’s zoals baarmoederhalskanker-onderzoek via uitstrijkjes. Statistisch modelleren kan een oplossing bieden om zulke persoonsprofielen te zoeken. In deze tekst wordt de methode van classificatiebomen toegepast. Deze methode heeft vele voordelen in vergelijking met logistische regressie. Er zijn echter ook enkele beperkingen tot het gebruik in het survey domein. Hoe deze methode omgaat met missing data en gewichten wordt van naderbij bekeken. De eerste Belgische Gezondheidsenquête (HIS) werd uitgevoerd in 1997. De Belgische gemeenschappen zijn verantwoordelijk voor het onderzoek naar baarmoederhalskanker als onderdeel van de preventieve gezondheidszorg. De HIS laat ons toe om profielen van personen te onderzoeken die aan zo’n onderzoek deelnemen. Mensen die niet voldoen aan dit patroon zouden aangemoedigd moeten worden om toch aan deze onderzoeken deel te nemen.

Objective: The relationship between body weight and alcohol, particularly beer, consumption was studied in a representative sample of the Belgian population using a quantity frequency (QF)index, which measures the units of alcohol weekly consumed. The data of the health questionnaires 1997 were used. Design: A total of 10000 individuals were interviewed, after ommission of individuals younger than 15 years of age, the questionnaires of 7809 subjects were used for analysis. The most important confounding factors reported in the literature, i.e. smoking behaviour, concern for weight, sugared drinks, snacks, milk products, fish, type of bread, use of fats, lack of physical activity, age, educational level and income, were corrected for in the analysis. We distinguished between beer, wine and strong alcoholic drinks. Results: results show that contribution of alcohol to the body mass index of the population is minor. For males the body mass index (BMI) and the risk for obesity increase slightly by increasing QF index. Women show a negative relation because BMI and the risk for obesity decrease with increasing QF index. In women, the relative risk for obesity decreases with increasing beer intake and the BMI decreases with increasing wine intake. Conclusion: Moderate consuption of alcohol increases slightly the BMI and risk for obesity in women. Beer seems not to confer an increased risk for obesity and overweight. Complex gender specific effects on BMI and risk to obesity were observed and demand further exploration. De relatie tussen lichaamsgewicht en alcohol, voornamelijk bier, consumptie werd bestudeerd in een representatief staal van de Belgische bevolking door middel van een kwantitatieve frequentie (QF) index, waardoor de wekelijks alcohol inname in eenheden wordt weergegeven. Een totaal van 10000 personen werden ondervraagd en, na exclusie van personen jonger dan 15 jaar, 7809 vragenlijsten werden onderzocht. De meest bekende covariabelen uit de literatuur zoals rookgedrag, bezorgdheid omtrent gewicht, frisdranken, snacks, zuivelprodukten, vis, type van brood, vetinname, fysieke activiteit, leeftijd en socioeconomische factoren, werden in de studie opgenomen. We maakten onderscheid tussen bier, wijn en sterke alcoholische dranken. Alcoholische dranken hebben weinig invloed op de lichaamsmassa index (BMI). Voor mannen is de toename in BMI en het risico voor obesitas proportioneel aan een stijgende QF index. Vrouwen vertonen een negatieve relatie doordat de BMI en het risico voor obesitas dalen naargelang de QF toeneemt. Voor vrouwen daalt het risico voor obesitas met stijgend bierverbruik en daalt de BMI bij toenemende consumptie van wijn. Een matige alcoholconsumptie laat de BMI en het risico voor obesitas toenemen bij de man en afnemen bij de vrouw. Bier lijkt geen invloed te hebben op het risico voor obesitas noch op overgewicht. Het complexe verschil tussen beide geslachten nodigt uit tot verder onderzoek. La relation entre la consommation d’alcool, en articulier la bière, et l’obésité a été examinée dans un échantillon représentatif de la population belge en utilisant un index de Quantité-Fréquence (QF) comme mesure de la quantité hebdomadaire de boissons alcoolisées consommées. Au total, 10000 individus ont pris part à l’étude, mais les analyses ne portent que sur les personnes de 15 ans et plus, soit 7809 personnes. Les facteurs confondants les plus souvent rapportés dans la littérature, comme le tabagisme, la préoccupation pour son poids, les boissons sucrées, les snacks, les produits laitiers, le poisson, le type de pain, les graisses alimentaires, l’activité physique, l’âge et les facteurs socio-économiques, ont été introduits dans les analyses. Nous faisons une distinction entre la bière, le vin et les alcools forts. Les résultats montrent que la contribution des boissons alcoolisées à l’indice de masse corporelle (BMI) de la population est mineure. Chez les hommes, le BMI et le risque d’obésité augmentent avec l’index QF global. Chez les femmes, la relation est négative, à savoir le BMI et le risque d’obésité diminuent lorsque l’index QF global augmente. Chez les femmes, on note aussi que le risque d’obésité tend à diminuer avec une consommation plus importante de bière (mais pas avec le vin ou les alcools forts), et que le BMI décroît avec une consommation croissante de vin. En conclusion, une consommation modérée d’alcool est liée à une augmentation du BMI et du risque d’obésité chez les hommes, alors qu’elle est liée à une diminution du BMI et du risque d’obésité chez les femmes. Cet effet spécifique du sexe sur la relation entre la consommation d’alcool et le poids (BMI et obésité) doit faire l’objet d’une investigation scientifique plus approfondie.

ispartof: Archives of Public Health vol:59 issue:5-6 pages:223-238 status: published

In the first Flemish Environment and Health survey run by the Flemish Centre of Expertise on Environment and Health (FLEHS I 2002-2006) increased concentrations of PCBs, dioxin-like substances and chlorinated pesticides (a metabolite of DDT and hexachlorobenzene) were observed in cord blood of newborns and in blood of 14-15 year-old adolescents and 50-65 year-old adults living in low populated rural communities of East and West Flanders and Flemish Brabant compared to other Flemish regions. Due to the health concern associated with chlorinated compounds follow-up of pollutant levels in this area is of importance. Therefore, human breast milk from mothers living in these regions was collected (2009-2010) for analysis of different POPs. For the quantification of PCDD/Fs and/or dioxin-like PCBs in (human) milk samples both GC-HRMS and the CALUX bioassay are used in routine analysis. However, most CALUX methods use high amounts of milk (varying between 10 and 60 mL)1, 2. Since for the Flemish human breast milk survey in the rural areas not only PCDD/F and dioxin-like PCBs were analyzed, but also other POPs like DDE, PBDEs, marker PCBs, HCB, HCH, perfluorinated compounds, etc., the amount of milk available for the CALUX bioassay was limited. Therefore, a new method was developed for the analysis of PCDD/Fs and dioxin-like PCBs in only 5 mL milk.