The Association of Urinary Polycyclic Aromatic Hydrocarbon Metabolites and C-Reactive Protein Levels in the HAPIN Trial Open Access

Jones, John (Spring 2021)

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Solid fuel sources are used by upwards of 3 billion people worldwide for cooking and heating homes, primarily in low- and middle-income countries. The resulting household air pollution accounted for an estimated 2.6 million deaths in 2016. The aim of the Household Air Pollution Intervention Network Trial is to conduct a large-scale, randomized control trial using a clean source of fuel (Liquid Petroleum Gas) for stoves as an intervention. PAHs are a group of chemicals that occur naturally in coal, crude oil, and gasoline, and are also byproducts of combustion and are formed when coal, oil, gas, wood, garbage, and tobacco are burned as a fuel source or heating source or when foods are grilled. Inhalation and ingestion of PAHs has been linked to blood and liver abnormalities, as well as inflammation of the respiratory system (CDC). Urinary PAHs were found to have a positive association with elevated baseline serum C-Reactive Protein levels, which are a biomarker for inflammation (Alshaarawy Et al). For the purpose of this study, we are only analyzing baseline data on the “other older adult woman” living in the household alongside the pregnant study participants. The analysis involved the creation of eight different multiple linear regression models with a PAH metabolite (PAHm) as the dependent variable and CRP as an independent predictor variable alongside demographic data, backwards elimination was performed until all variables were significant at p-value<0.05. Significant predictor variables included CRP, Specific Gravity, Charred Food, Stove Fuel, and IRC. All PAHm were significantly associated with Specific Gravity (p<0.0001), 2-Naphthol was associated with Charred Food and IRC (p<0.05), 1-Naphthol was associated with Stove Fuel and IRC, Fluorene and 1-Hydroxypyrene were both associated with Charred Food, Stove Fuel, and IRC (p<0.05), 1-Hydroxyphenanthrene and 2-Hydroxyphenanthrene were both associated with CRP, Charred Food, and Stove Fuel (p<0.05 for all, except charred was nominally significant at p<0.1 for OHPHE2), 4-Hydroxyphenanthrene was associated with Charred Food (p<0.05), and sumPAH was associated with Stove Fuel and IRC (p<0.05). The analysis highlights the need for further research after intervention to better understand the association of the predictor variables, particularly CRP. 

Table of Contents

Purpose. 1

Background. 1

Household air pollution and health. 1

Polycyclic Aromatic Hydrocarbons (PAHs) 2

C-Reactive Protein (CRP) 3

Methods. 3

PAH’s Extraction. 3

CRP. 4

Data Analysis. 5

Results. 6

CRP. 6

PAH.. 6

Demographic Data. 7

Model Results. 8

Model 1: sumPAH.. 8

Model 2: _2N.. 9

Model 3: _1N.. 9

Model 4: FLU.. 9

Model 5: OHPHE2. 10

Model 6: OHPHE1. 10

Model 7: OHPHE4. 11

Model 8: OHP. 11

Discussion. 12

CRP. 12

Specific Gravity. 12

Charred Food Ingestion. 13

Stove Fuel Type. 14

IRC. 15

Limitations and Next Steps 15

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