Maurizio Bonati

Dipartimento di Salute Pubblica

Laboratorio per la Salute Materno Infantile

XXXIX CONGRESSO AIE

ALLATTAMENTO E

AMBIENTE

Milano, 27 ottobre 2015

Nome: Maurizio Bonati

Ente di appartenenza: IRCCS Istituto di Ricerche Farmacologiche “Mario Negri”,

Milano

Impiego nell’industria farmaceutica o di altro settore nel corso degli ultimi cinque

anni;

appartenenza al personale;

attività varie (consulenza, etc.);

interessi finanziari nel capitale;

benefici diretti o indiretti;

altri interessi o fatti a beneficio del proprio nucleo familiare: NESSUNO

In fede:

Maurizio Bonati Milano, 27 ottobre 2015

Dichiarazione pubblica sul conflitto di interessi

Acknowledgemnts

Maria Malgorzata Ulaszewska

Roberto Fanelli

Ettore Zuccato

Enrico Davoli

Elena Fattore

Dipartimento Salute e Ambiente

IRCCS Istituto di Ricerche Farmacologiche

Mario Negri, Milano

Mariapina Gallo

USSD Tossicologia

Centro Antiveleni Teratology Information Service (TIS)

AO Papa Giovanni XXIII, Bergamo

Ciclo alimentare umano (inquinamento degli alimenti)

Fonti di DIOXINA de

po

sizi

on

e

Accumulo nel tessuto adiposi

95%

cibo

aria

suolo e sedimenti

fiumi e oceani

Safe Food: Crucial for Child Development

http://www.who.int/ceh/publications/en/15food.pdf

Safe Food: Crucial for Child Development

US National Breastfeeding Rates (Exclusive Breastfeeding)

Mean concentrations of PFOS in

food products milk samples

Guerranti C, et al. Food Chemistry 2013;140:197–203

Bre

ast

milk

ho

ney

bev

erag

es

oil

an

d f

ats

fru

it a

nd

ve

geta

ble

s

milk

an

d d

airy

p

rod

uct

s eggs

mea

t

fish

an

d s

eaf

oo

d

Ce

real

bas

ed

p

rod

uct

s

ng/

g 30

25

20

15

10

5

0

Activity concentration of Cs in breast milk in the first week

after delivery as a function of month of parturition

Giussani A, et al. Environ Int. 2012 Feb;39(1):122-7

Effect of diet and age on levels of PCDDs/Fs

and PCBs in breast milk

Older mothers (30-40 years old)

had higher level of dioxins than younger

mothers (20-30 years old) Ulaszewska MM, et al. Chemosphere 2011;83(6):774-82

Postnatal exposure levels, median (range),

from breast milk and formula milk

Boersma ER. APMIS 2001;109(Suppl. 103):S243-53

δ ΣPCBmilk, sum of Polychlorinated biphenyl (PCB) congeners IUPAC Nos 118, 138, 153 and 180 in breast milk.

Adverse health outcomes linked with preconception

and prenatal exposure to environmental chemicals

Di Renzo GC, et al. Gin Obst in press 2015

Fertility and pregnancy Decreased semen quality with PCBs

Spontaneous abortion and fetal loss with solvents

Impaired fetal growth with pesticides

Fetal loss, low birth weight, and preterm delivery

with air pollutants

Decreased fetal and birth weight, and congenital

malformations with toluene

Shortened gestational age with phthalates

Low birth weight with PCBs

Reduced birth weight and fetal growth with

perfluorinated compounds

Neurodevelopment Impaired cognitive and neurodevelopment, increase in

attention problems and attention deficit hyperactivity

disorder behaviors at age 5 years, and reduction in

working memory capabilities at age 7 years with

pesticides

Impaired neurodevelopment in girls and reduction in

executive function at age 4–9 yearswith phthalates

Intellectual impairment with lead

Reduced cognitive performance, impaired

neurodevelopment, and reduced psychomotor outcomes

with methyl mercury

Decreased placental expression of genes implicated in

normal neurodevelopmental trajectories with increasing

in utero exposure to fine particle air pollution

Reduced intelligence quotient score and a wide range of

attention and executive function deficits with PCBs

Impaired neurodevelopment and reduction in sustained

attention with polybrominated diphenol ethers

Attention problems at age 6–7 years with polycyclic

aromatic hydrocarbons

Aggression and hyperactivity in girls, and reduction in

executive functioning skills in girls aged 3 years with

bisphenol A

Cancer Maternal breast cancer risk with PCBs

Increased childhood cancers and susceptibility to

testicular cancer with pesticides

Modificata da Thompson RA e Nelson CA. Am Psychol 2001; 56: 5-15

Sviluppo del cervello umano

Correlation between cortisol (A) and cortisone (B) levels in serum and

dioxin concentrations in breast milk of women from the dioxin hot spot

and nonexposed area

Teruhiko Kido et al. Eur J Endocrinol 2014;170:131-139

Mean PCDD/F levels (pg WHO-TEQ /g fat) in breast milk

samples collected in different years (from 1992 to 2008)

and locations

Ulaszewska MM, et al. Chemosphere 2011;83(6):774-82

Mean PCB levels (pg WHO-TEQ /g fat) in breast milk samples

collected in different years (from 1992 to 2008) and locations

Ulaszewska MM, et al. Chemosphere 2011;83(6):774-82

Time-related changes of PCDD/F and DL-PCB levels in breast

milk samples from various Italian cities in 1987–2009

Ulaszewska MM, et al. Chemosphere 2011;83(6):774–782

PCDDs & PCDFs (pg/g of fat)

1) Congener profiles are

similar for all locations

except for 12378-PeCDF

(p=0.02)

Piacenza: 57.02 pg/g of fat

(p=0.05)

Milano: 51.04 pg/g of at

Giugliano: 46.64 pg/g of fat

Ulaszewska MM, et al. Chemosphere 2011;83(6):774-82

PCDDs & PCDFs (WHO-TEQ pg/g of fat )

Slight difference

was observed for

TCDD, but did not

reach a level of

statistic

significance

Ulaszewska MM, et al. Chemosphere 2011;83(6):774-82

PCBs and residential area of mothers

Ulaszewska MM, et al. Chemosphere2011;82(1):1-8

PCBs

MILANO 6,28 WHO-TCDD

Equivalenti 2006 pg/f fat

GIUGLIANO 4,8 WHO-TCDD

Equivalenti 2006 pg/f fat

PIACENZA 5,27 WHO-TCDD

Equivalenti 2006 pg/f fat

NESSUNA SIGNIFICATIVITÀ

STATISTICA

Ulaszewska MM, et al. Chemosphere2011;82(1):1-8

Level of dioxins in human milk from Italy

Ulaszewska MM, et al. Chemosphere 2011;83(6):774-82

1. There in no direct correlation between level of dioxins in human milk collected

in Giugliano and potential emission from open-air wastes combustion.

2. Background levels of PCBs measured in breast milk were result of typical

dietary intake of general, non-occupationally exposed population.

3. Older mothers pass higher amount of dioxins to their breastfeed infants.

4. Statistically significant differences were observed for samples from Piacenza

and Giugliano (dioxins in pg/g of fat p=0,05; PCBs ng/g of fat p=0,05), and we

are looking for explanation.

Then …

Ulaszewska MM, et al. Chemosphere 2011;83(6):774-82

Multimedia fate model which predict

the partition and reactions of

chemical substances in the

environmental systems such as air,

soil, surface water, groundwater,

plant, and animal compartments

Physiologically Based Pharmacokinetic

(PBPK) model dealing with physiological

changes of substances in humans by the

absorption, distribution, metabolism and

excretion

Model

Esposizione a fumo passivo

Llaquet H, et al. Annal Bioanal Chem. 2010;396(1):379-99

I livelli di nicotina nel latte materno è di 2,9 volte maggiore di quello riscontrato

nel plasma materno.

I livelli di cotinina, il maggiore metabolita della nicotina, presenti nelle urine dei

neonati allattati da madri fumatrici sono in media 10 volte superiori di quelli

ritrovati nei neonati con madri fumatrici ma allattati artificialmente.

I levelli urinari di cotinina nei neonati allattati da madri fumatrici sono simili a quelli

ritrovati nei fumatori adulti.

nicotina e cotinina sono escreti nel latte materno in quantità proporzionali al

numero di sigarette fumate durante il giorno

Esposizione al THC

Il THC è altamente liposolubile e passa nel latte materno dove tende ad

accumularsi

La concentrazione nel latte materno in utilizzatrici croniche è di circa 8 volte più

elevata che nel plasma materno

La quantità nel latte materno è stimata in circa lo 0.8% della dose materna/Kg (Bennet PN, 1997)

In lattanti esposti è stata messa in evidenza l’eliminazione di THC nelle urine fino

a 2-3 settimane.

Sono stati riportati: sedazione, scarsa crescita, ridotto tono muscolare, ridotta

capacità di suzione. (D’ Apolito K, 2013)

Scarsi e contrastanti sono i dati sullo sviluppo psicomotorio a lungo termine nei

lattanti di madri che utilizzano cannabis.

Neonati esposti con l’allattamento, soprattutto durante primo mese di vita,

mostravano un punteggio medio significativamente inferiore nel Bayley

Psychomotor Development Index ad un anno di vita. (Tennes K, et al, 1985; Astley S, et

al, 1990)

Gallo MP, 2015 (personal communication)

breastfeed

avoid smoking cigarettes and drinking alcohol

avoid pesticides and lead-based paints

reduce intake of animal fats

increase intake of grains, fruits and vegetables

wash and peel fruits and vegetables to help eliminate

pesticide residues

avoid swordfish and shark or freshwater fish from waters

reported by local health agencies as contaminated

limit exposure to common chemicals (eg solvents found in

paints, non-water based glues, furniture strippers, nail polish

and gasoline fumes)

limit exposure to dry-cleaned garments. Remove the plastic

cover of dry-cleaned clothing, and air out the garments in a

room with open windows for 12–24 hours

avoid contact with smoke and ash, preserved wood, or

produce grown near incinerators

avoid occupational exposure to chemical contaminants

avoid bringing contaminant residue into the home.

How to limit exposure to environmental pollutants

https://www.breastfeeding.asn.au/bfinfo/breastfeeding-and-environmental-pollutants

“…human breast milk offers the optimal nutrition for infants

and provides immunological, developmental, psychological,

economic, and practical advantages when compared to

artificial feeding. For proper growth, development, and health,

infants should be exclusively breastfed with no other food or

drink-not even water-for their first 6 months of life…”.

Conclusioni