• 24-uurs urine-excretie van natrium. Voedingsstatusonderzoek bij volwassen Nederlanders

      van den Hooven C; Fransen H; Jansen E; Ocke M; CVG; GBO (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2007-07-09)
      De zoutinneming van volwassenen uit Doetinchem is gemiddeld bijna 9 gram per dag. Dit is 50% boven de aanbeveling van maximaal 6 gram per dag. Deze bevinding maakt het aannemelijk dat de zoutinneming voor de algemene Nederlandse bevolking ook ruim boven de aanbeveling ligt. Bij mannen en jongvolwassenen is de zoutconsumptie gemiddeld hoger dan bij vrouwen en personen van 50-70 jaar. Bij mannen is de zoutinneming gemiddeld 10,1 gram onder 19-49 jarigen en 9,7 gram onder 50-70 jarigen. Bij vrouwen is dit respectievelijk 8,6 en 7,5 gram. Bovengenoemde schattingen zijn gebaseerd op een onderzoek waarin 333 personen van 19-70 jaar in November 2006 24-uur hun urine verzamelden. Aan de hand van de natriumexcretie in de urines is de zoutinneming geschat. De deelnemers waren afkomstig uit Doetinchem of nabije omgeving. Door het reduceren van de huidige te hoge zoutinneming van de Nederlandse bevolking naar de aanbevolen hoeveelheid kan aanzienlijke gezondheidswinst behaald worden. Maatregelen worden dan ook geadviseerd.
    • Allergens in consumer products

      Wijnhoven SWP; Ezendam J; Schuur AG; van Loveren H; van Engelen JGM; SIR; GBO (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2008-10-10)
      Many consumer products contain substances that can cause an allergic reaction, such as contact dermatitis or contact eczema. A reaction can also occur due to allergen exposure through the airways. However, little is known about this type of reaction. The main causes of contact dermatitis are nickel contained in jewellery and fragrances in cosmetics. Products containing preservatives and some types of wax can also be the cause of an allergic reaction. Both the degree to which the user is exposed to the substance and its concentration are important factors in determining how the reaction will develop. The Food and Consumer Product Safety Authority (VWA) commissioned the RIVM to make an inventory on the degree to which people suffer discomfort from skin and other allergies due to substances in consumer products. Contact dermatitis is relatively common in the Netherlands compared to other conditions such as asthma, hay fever and food allergies. Allergic conditions belong to the most common chronic conditions occurring in Europe. Limit values have been set by law for a number of allergenic substances contained in products, but these have not yet been based on a quantitative risk assessment. A quantitative approach determines which dosage level can induce a reaction. Knowledge of this critical dosage level is essential in order to set safe limit values of allergens in a particular product. Two quantitative methods are currently under development, but these are not yet ready to be used in daily practice. It is particularly important that exposure to more than one product (aggregated exposure) is included in this methodology to a satisfactory extent.
    • Alternative methods in reproductive toxicity testing: state of the art

      Luijten M; de Vries A; Opperhuizen A; Piersma AH; GBO (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2008-01-08)
      This report overviews the currently existing in vitro models for reproductive toxicity and describes their potential use in reproductive toxicity testing, as well as the modular approach of validating these alternative test systems. Here, it is also indicated why these tests have not been implemented yet in any of the guidelines. A limited number of alternative tests for embryotoxicity, which can be applied after optimisation, has been validated. Although none of the in vitro methods represents a replacement for current animal tests, these methods can function as a pre-screen in a tiered approach. In this way, the industry can set priorities for in vivo testing and thus reduce animal use in reproductive toxicology. Development of in vitro methods for reproductive toxicity testing is essential, since testing according to the present guidelines requires a high number of test animals. The numbers of test animals needed range from 560 - 6,000 animals per chemical, dependent on the production volume. Moreover, increased animal use is envisaged as a result of the implementation of REACH, the new European legislation for manufacturers and users of chemicals. REACH requires toxicological information to be submitted for about 30,000 existing chemicals, which will require millions of test animals. Many alternative test methods have already been developed for reproductive toxicity testing, and several of them are in a (pre-)validation process. However, none of these methods offers enough reliability to replace in vivo assays currently used. Testing toxic effects on the reproductive cycle is complex, since reproduction is characterised by many different processes and sensitive periods. Due to its complexity, the whole cycle cannot be modelled in one in vitro system. Parts of the system need to be studied individually and then integrated into testing strategies.
    • Are common intervention strategies to prevent a range of allergic conditions feasible?

      Janssen CM; Wijga A; van Loveren H; Ezendam J; GBO; vgc (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2012-01-30)
      Allergic conditions comprise food allergy, rhinitis, atopic dermatitis and asthma. These allergic conditions present at various stages in life and may influence each other. Different allergens are involved at different stages in life. It is still unclear if the different allergic conditions have a common or distinct etiology. If food allergy and respiratory allergy have a common aetiology or if risk factors are overlapping, common intervention strategies may be possible. In a previous study (putative) risk factors for food allergy were identified. In the current literature study breast-feeding, allergen avoidance, introduction of solid foods, pre-and probiotics intake, and (poly unsaturated fatty acid (PUFA) intake were studied in relation to development of respiratory allergy. These factors were selected based on their (possible) effect on development of food allergy. In addition, the impact of currently promoted intervention strategies was discussed. The main conclusions are that: - Breast feeding is a protective factor in the development of respiratory allergy. For food allergy data are conflicting; - There is limited evidence to suggest that intake of PUFA is associated with development of respiratory allergy. There is also limited evidence that PUFA intake is associated with development of food allergy; - Other studied risk factors for food allergy did not affect development of respiratory allergy; - One of the strategies to prevent development of allergy is allergen avoidance or delayed introduction of solid foods. Data described in the literature indicate that this does not prevent allergy and may even be a risk factor. Promising areas of research that will help develop intervention strategies in the future are: vitamin D- , PUFA and antioxidant-intake, modulation of intestinal flora, and developmental programming of food allergy. In addition, ongoing studies on possible detrimental effects of delayed introduction of solid foods, need to be monitored closely.
    • Het belang van een goed herstel

      van Amsterdam J; GBO (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2012-09-20)
      The importance of a good recovery after work Shifts workers have an increased risk of poor concentration if they take insufficient rest after work. This allows them to make mistakes in the workplace resulting in unsafe situations. There is also the chance that employees who take too little rest between their services, become chronically physically disrupted, what increases the risk of 'chronic' diseases and syndromes such as 'burnout', cancer, cardiovascular and psychiatric conditions. This is evidenced by the literature review of the RIVM about the required rest periods for shift workers. In the Netherlands, 1.1 million people work at night and about 3 million people work in the evening, such as nurses and truck drivers. Factors leading to insufficient recovery after work The Working Hours Act (ATW) prescribes amongst others per type of work schedule the minimum number of hours employees must get rest. Shift workers deserve extra attention because they regularly work in evening and night shifts. This disturbs their sleep patterns or creates a sleep deficiency because they have to perform other tasks at home or sleep bad on during daytime due to noise, light and their children. Sleep deprivation is a major risk factor for physiological disruption and work-related disease burden. In addition, shift workers have a greater disease burden if their shifts are longer than twelve hours. Except specifically for shift work, RIVM has identified other risk factors for insufficient recovery. That is a higher age, working late, work hard, (such as police officers, physicians and nurses), informal care, "on call' services and an unfavorable home-work balance. New working forms Most workers experience new working forms, such as self-scheduling, telecommuting and 'The New Working' (HNW) as positive, partly because of the flexible working hours and the ability to work from home. These new working forms, however, blurs the boundary between 'work time' and 'private time', such as working on the computer in private time. The long-term health effects of these working forms are not known. Finally, the need to recover may increase if the workplace conditions at home are not optimal.
    • Current innovations in regulatory reproductive toxicity assessment

      Piersma AH; Hakkert B; Muller JJA; GBO; SEC; SIR (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2008-03-13)
      Chemicals must be tested for adverse effects on human reproduction. Thanks to innovations, testing will become more efficient, thereby reducing the use of experimental animals. The main developments have been signalled in an overview of current developments in the testing of reproductive toxicity (the adverse effects of chemicals of reproduction) documented in this RIVM report. Chemicals can adversely affect reproduction, which may manifest itself as reduced fertility or maldevelopment of the fetus. Manufacturers of chemicals are required to assess these adverse effects, for example, in the framework of the European programme for chemical safety called REACH. Current methods for reproductive toxicity assessment, which rely mainly on experimental animal studies, stem from the early eighties. The high animal use in the testing of reproductive toxicicity is primarily due to the need to study more than one generation. Reductions of animal use are, however, imminent, with developments in the endocrine disruption, animal welfare and REACH having stimulated innovations in this area. Standard protocols are in the process of being amended and there are proposals for novel test systems. These developments also influence testing strategies, which combine individual tests in a tiered approach. These are innovations then that should lead to increased efficiency and reduced animal use.
    • Detection of sensitization to low molecular weight chemicals. Inventory and evaluation of ex vivo methods

      Ezendam J; van Loveren H; GBO (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2010-01-28)
    • Development and implementation of alternative methods in reproductive toxicology

      Piersma AH; GBO; vgc (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2012-05-02)
      RIVM is improving alternative test methods in the area of reproductive toxicology, to make them ready for regulatory application. This will reduce experimental animal use. Reproductive toxicology pertains to adverse effects on fertility and reproduction and on prenatal development of the unborn child. In this report, the state of the art of alternatives in this area is reviewed. Research into alternative methods: RIVM develops alternative tests and testing strategies expected to be able to predict reproductive toxicity. During the last five years advances have been achieved with the embryonic stem cell test, the rat embryo culture and the zebra fish embryo test. These embryos are highly premature and not considered as experimental animals under European law. In these tests effects are studied on the level of gene expression. Effects on gene expression may give more detailed information on compound effects. Moreover, such effects may allow easier translation to effects in man. Current effect assessment is done in experimental animals. Innovation of regulatory toxicology: In addition, RIVM is active in the international arena to innovate regulations concerning experimental animals and alternative test systems. This research provides important support for these activities.
    • Development of an experimental model for assessing adverse effects of juvenile chemical exposures

      Piersma AH; Tonk ECM; van Loveren H; GBO (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2012-05-02)
      Exposures to chemicals may have larger risks in children than in adults. Test methods for chemical hazards do not take sufficient account of these differences. Therefore, RIVM has carried out several animal studies to design an optimal protocol for the assessment of hazards of chemicals for children. The preliminary conclusion indicates that exposure between postnatal days 10 and 50 in the rat is most relevant for hazard assessment. Effects on physical and immune system development are most prominent in this period. The protocol was designed by order of the ministry of health, welfare and sports. Neurologic diseases and immune system malfunction, ranging from ADHD to allergies and diabetes, may or may not be caused by chemical exposures early in life. Physical and behavioural differences: Variability in risks can be explained by physical and behavioural differences between children and adults. Children will more often put objects in their mouth (toys, sand), which may result in possible exposures to hazardous chemicals. Incomplete organ development in children may reduce excretion of chemicals from the body. In addition, incomplete development of the brain and immune system may render these tissues more susceptible to adverse effects of chemicals. Continued studies are needed for a final judgment. It is important to also consider the neural system in this research. International perspective: Internationally, the results of this research have been discussed in the test guidelines programme of OECD (Organisation for Economic Cooperation and Development). This programme provides worldwide consensus of test guidelines. In addition, a scientific symposium was organised on the subject.
    • The effect of REACH implementation on genotoxicity and carcinogenicity testing

      van Benthem J; GBO (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2008-02-01)
      Results of an RIVM investigation documented in this report on the effect of REACH, the new European policy on chemicals, show that it is possible to test chemicals for carcinogenicity in an efficient manner without endangering the safety of the product use. REACH, the Registration, Evaluation and Authorization of Chemicals, is a new EU policy aimed at charting the risks of chemicals to which people are exposed to on a daily basis. We are concerned here not only with the approximately 100,000 existing chemicals, but also with new chemicals on the market which are up for testing. The objective of REACH is to realize a more rapid and less expensive method to identify risks, while sparing laboratory animals from tests. RIVM's aim was to investigate the possibility of scrapping the test for carcinogenity by employing a more efficient means of testing. This is possible if other tests provide the same data. Examples are (sub)-chronic toxicity or genotoxicity tests measuring DNA damage. Another approach is the Toxicological Threshold Concept (TTC), which yields a fixed value for maximum permissible dose, where the risk is less than one in a million (given as negligible risk). Exclusive use of in vitro (use of cultured cells) tests does not adequately guarantee that DNA damage will not occur. Therefore it is recommended to compare in vitro results with results from in vivo (use of living organism) experiments. Test animals will still be necessary for measuring DNA damage, but their use will be kept to a minimum through careful choice of testing methods.
    • Het effect van rookverboden op de incidentie van hart- en vaatziekten

      Talhout R; Opperhuizen A; GBO (2009-07-20)
      Abstract not available
    • Effects of prolonged exposure to skin sensitizers in concentrations below the EC3 value : Implications for quantitative risk assessment

      Ezendam J; Vermeulen J; van Loveren H; GBO; vgc (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2010-11-04)
    • Exposure to nanomaterials in consumer products

      Wijnhoven SWP; Dekkers S; Hagens WI; de Jong WH; GBO (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2009-09-04)
    • Fragrance allergens in scented consumer products on the Dutch market : Assessment of exposure levels and immune effects

      Ezendam J; ter Burg W; Vermeulen JP; Wijnhoven SWP; van Engelen J; GBO; vgc (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2012-06-04)
      The National Institute for Public Health and the Environment (RIVM) has been asked to investigate if consumers who use scented products, such as air fresheners are at risk for respiratory allergies. There are currently no validated methods available to assess these risks. In order to gain an indication of the possible risks, the fragrance exposure levels were calculated for consumers using air fresheners. Subsequently, possible effects on immune system of mice were assessed. This research has been conducted by order and for the account of the Netherlands Food and Consumer Product Safety Authority (NVWA). Scented products often contain fragrance allergens: Twenty-six fragrances are known to be a cause of skin allergy, but it is not known whether or not they can cause respiratory allergy. For this reason, the NVWA sampled 109 scented products to determine which fragrance allergens they contained. Twenty of the 26 fragrance allergens were found in these products, especially the substances limonene and linalool. Subsequently, the RIVM calculated exposure levels for these fragrances when scented products are used. It was shown that trigger sprays and evaporators produce higher levels of exposure than air fresheners and scented blocks. In inhalation studies in mice, it was demonstrated that short-term inhalation of limonene and linalool did not activate the immune system; the fragrance allergen isoeugenol was, however, shown to do so. The risk for respiratory allergy is small due to low exposure: Exposure to isoeugenol is considerably lower compared to limonene and linalool. This exposure is also lower than exposure to chemicals known to cause respiratory allergies, for example, the diisocyanates that can cause occupational asthma. Based on this comparison, it is not likely that limonene, linalool and isoeugenol will cause respiratory allergies, but due to the lack of a valid test method, this conclusion has been made with reservations. Furthermore, it cannot be excluded that long-term exposure to fragrance allergens in occupational settings might cause respiratory allergy.
    • Genetic contribution to obesity: a literature review

      van den Berg SW; Dolle MET; Boer JMA; CVG; GBO (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2008-03-27)
      The risk of obesity is for a considerable part genetically determined. Which specific genetic factors are involved is yet unknown. Therefore, the use of genetic information for obesity prevention or treatment is currently unjustifiable. This is the conclusion of a literature review on the genetics of obesity conducted by the National Institute for Public Health and the Environment (RIVM) in order of the Dutch Ministry of Public Health, Welfare and Sports. This study showed that about 40% of the total variation in body weight between individuals (expressed as the body mass index, BMI: weight / height-2) can be explained by genetic differences. Moreover, due to their genetic profile, individuals react differently on changes in energy intake and expenditure. For one out of ten cases with severe early onset obesity a rare mutation in a single gene is known. This is the case for at most 2.5% of the less extreme forms of obesity. A lot of research has been carried out on gene variants that occur frequently in the population. For five of these gene variants there is convincing evidence supporting their involvement in determining BMI or obesity risk. They may explain 10% of the cases with overweight and 20% of the cases with obesity. However, genetic variation between individuals is more complex than previously thought. Therefore, the contribution of genetic factors to the onset of obesity is expected to be larger than currently known. This justifies current and future research in this area.
    • De genetica van overgewicht: stap naar beleid en maatschappij. Resultaten van een expertmeeting

      van den Berg SW; Dolle MET; Tijhuis MJ; van der A DL; Boer JMA; CVG; GBO (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2009-05-14)
      The amount of concrete data on heritable factors contributing to overweight is inadequate and, as such, there is currently no solid basis for (changes in) government policies. This is the consensus conclusion of experts in several associated disciplines who participated in an expert meeting organized by the National Institute for Public Health and the Environment (RIVM). To obtain more insight into the genetics of overweight, it will be necessary to carry out large-scale studies in which the diet and physical activity of thousands of participants are accurately measured. The amount of body fat and its distribution throughout the body should also be determined. According to the participants of the expert meeting, the insights gained from such studies will facilitate the development of new medicines that will be able to prevent and treat overweight. The acquired knowledge will also enable for example healthcare providers to identify overweight individuals with a high risk of complications, such as cardiovascular diseases and diabetes mellitus, at an early stage based on their genetic background. It would then be possible to treat this group of people with medicines and dietary and physical activity recommendations that have been determined on the basis of their genetic profile. Whether these expectations will ever become a reality - and if so, when - is unknown. However, in anticipation that such future developments are put into practice, the government can take steps now to improve the level of general knowledge of genetics among the general public and medical professionals. The general public will require this knowledge to be able to deal appropriately with the choices that will emerge from the application of these medical developments. Medical professionals will also be better able to answer questions from their patients. The government could also start internal discussions on the possible consequences of such developments on their policies as well as their own responsibility in this area.
    • Handhaving van een rookvrij binnenmilieu

      Talhout R; Sleijffers A; Opperhuizen A; GBO (2009-07-20)
      Abstract not available
    • Herziening EU-Tabaksproductrichtlijn 2001/37/EG

      Talhout R; Opperhuizen A; GBO (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2012-04-13)
      Public consultation: The EU Tobacco Products Directive 2001/37/EC containing rules on the production, presentation and sale of tobacco products, may be revised. This involves an update on products which should be included, consumer information on packaging, reporting, registration and regulation of additives, and consumers' access to tobacco products. RIVM has assessed whether the proposed revisions can be scientifically substantiated. Information on tobacco product packaging: This research shows, amongst others, that the levels of tar, nicotine and carbon monoxide (TNCO) on cigarette packs are generally lower than the actual exposure of the smoker, especially for light cigarettes. Information on these levels is therefore misleading for the consumer. For example, they can be replaced by information on the harmful, addiction- and attractiveness-enhancing effects of substances in smoke and tobacco. In addition, the design of tobacco product packages can be standardized. A generic design may make buying and consuming tobacco products less attractive. The same applies to the use of large picture warnings. In new nicotine and tobacco products, such as electronic cigarettes and hookah, tobacco warnings and product information are also important. Additives: Existing regulations for tobacco additives, such as flavors, appear to be based on criteria for safe use of food additives. This means that for example combustion products are not considered. For a proper risk assessment of tobacco products these effects also need to be taken into account. In addition, it is important whether an additive makes a tobacco product more attractive for consumption. Regulation to limit the use of additives that make cigarettes more attractive has been introduced in several countries in recent years. For a proper risk assessment, information on other ingredients is necessary including tobacco species, design features such as the type of filter, and information about other substances present in smoke. In all cases, policy makers can analyze and disclose information more easily if tobacco manufacturers provide this information electronically and uniformly. Revision Directive 2001/37/EC tobacco products ingredients regulation
    • Immune effects of inhalation exposure to fragrance allergens

      Ezendam J; de Klerk A; Vermeulen J; Fokkens PHB; van Loveren H; GBO; MGO (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2010-04-01)
    • Immune effects of probiotics in humans. Evaluation of efficacy and safety

      Ezendam J; van Loveren H; GBO (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2008-05-30)
      There is currently insufficient scientific evidence demonstrating that probiotics can have beneficial effects on the immune system. The safety of these products also has not been demonstrated scientifically. The number of commercially available products that contain probiotics, such as food supplements, dairy products and infant formulas, is steadily increasing. Although probiotics are claimed to have positive effects on gut microflora and immune resistance and to prevent allergies, most of these effects are not based on scientific evidence. The National Institute for Public Health and the Environment (RIVM) conducted a literature study aimed at assessing the efficacy and safety of probiotics. The effects of probiotics, for example, on constipation or diarrhea, are currently subjects of extensive investigation. This literature study focuses on the effects of probiotics on the immune system, as determined from human clinical trials. No or insufficient evidence was found for supporting the claims that probiotics are effective in treating hay fever, rheumatoid arthritis or Crohn's disease. In contrast, data are available on the beneficial effects of certain probiotics on immune resistance, atopic eczema and the chronic inflammatory bowel disease, ulcerative colitis. However, more research is needed to substantiate these effects scientifically. The best substantiated evidence for positive effects of probiotics is currently available for two intestinal disorders, diarrhea caused by antibiotics and 'pouchitis' (a complication that can occur after surgery of colitis patients). Little information is available on the possible adverse effects that can occur when people consume these products. A recent publication reported that probiotics induced an unwanted stimulation of the immune system in infants. It is recommended that both the safety and efficacy of these products should be closely investigated.