Second phase of the general population exposure study

The biomonitoring component of the ESTEBAN study (Health Study on the Environment, Biomonitoring, Physical Activity, and Nutrition) enables the description and monitoring of exposure levels in the French population to approximately 100 substances selected based on their presumed and/or observed impact on health. The results published today regarding exposure to metals such as cadmium, copper, nickel, and mercury constitute the second phase of this major biomonitoring study conducted by Santé publique France. These data supplement the results published in September 2019 concerning substances from everyday products and those published in March 2020 concerning lead.

The study was conducted on a representative sample of the general population consisting of 1,104 children and 2,503 adults aged 6 to 74. This study includes biological samples (urine, blood, and hair) and the administration of a questionnaire on lifestyle habits, dietary intake, and participant characteristics. Cross-analysis of the results from the samples and questionnaires makes it possible to quantify the presence of these metals in the population and better understand the sources of exposure.

Metals detected in the general French population

Naturally present in the environment, metals can cause chronic diseases, immune deficiency, or even cancer. Measuring the population’s exposure to these substances, combined with collecting information on their behaviors and dietary habits, helps identify sources of exposure that can be addressed to prevent the onset of such conditions.

This is why Santé publique France has chosen to measure the population’s exposure to these substances present in our environment.

The main results show that:

• population exposure to these metals affects all adult and child participants (detection rates ranging from over 97% to 100%);

• the levels measured in adults were similar for mercury in hair and nickel in urine compared to those measured in the ENNS (National Nutrition and Health Study) in 2006–2007;

• the levels measured in adults were higher for arsenic, cadmium, and chromium than those measured in the ENNS study in 2006–2007. This trend was consistent for cadmium and chromium with that observed in the ANSES total diet studies (EAT1 and EAT2);

• Furthermore, the levels measured for both children and adults in France were higher than those found in most other countries (Europe and North America), except for nickel and copper.

Different sources of exposure depending on the metal

The measured determinants of exposure, primarily dietary, were similar to those observed in the literature:

• consumption of fish and seafood influenced concentrations of arsenic, chromium, cadmium, and mercury;

• consumption of grains influenced cadmium levels, and when these grains were organically grown, they influenced copper levels;

• consumption of organically grown vegetables influenced copper levels.

Other known determinants were also observed:

• tobacco use increased cadmium and copper concentrations;

• medical implants increased chromium levels;

• dental fillings, urinary mercury levels.

Reference values for improved monitoring of the French population and regulatory compliance

Exceedances of health guideline values were observed in the population according to the Esteban study for arsenic, mercury, lead, and particularly cadmium, with just under half of the French adult population having cadmium levels exceeding the value recommended by ANSES. Furthermore, Santé Publique France has initiated collaborative work with various partners—ANSES, the Food Chain Surveillance Platform (SCA), and INRAE—to explore hypotheses regarding the rise in cadmium concentrations in the French population, which could be attributable to the food chain, from farm to table.

Given the adverse health effects of metals and the increase in exposure levels to arsenic, cadmium, and chromium between the ENNS and Esteban surveys, it remains necessary today to continue measures aimed at reducing the general population’s exposure to these substances, particularly by addressing the sources of exposure.