Child Skeletal Fluorosis from Indoor Burning of Coal in Southwestern China

Abstract

Objectives. We assess the prevalence and pathogenic stage of skeletal fluorosis among children and adolescents residing in a severe coal-burning endemic fluorosis area of southwest China. Methods. We used a cross-sectional design. A total of 1,616 students aged between 7 and 16 years in Zhijin County, Guizhou, China in late 2004 were selected via a cluster sampling of all 9-year compulsory education schools to complete the study questionnaire. Any student lived in a household that burned coal, used an open-burning stove, or baked foodstuffs over a coal stove was deemed high-risk for skeletal fluorosis. About 23% (370) of students (188 boys, 182 girls) were identified as high-risk and further examined by X-ray. Results. One-third of the 370 high-risk participants were diagnosed with skeletal fluorosis. Overall prevalence of child skeletal fluorosis due to indoor burning of coal was 7.5%. Children aged 12–16 years were significantly more likely to be diagnosed with skeletal fluorosis than children aged 7–11 years (OR = 1.84, 95% CI: 1.17–2.90; P = .0082). Four types of skeletal fluorosis were identified: constrictive (60.7%), raritas (15.6%), mixed (16.4%), and soft (7.4%). Most diagnosed cases (91%) were mild or moderate in severity. In addition, about 97% of 370 high-risk children were identified with dental fluorosis. Dental fluorosis was highly correlated with skeletal fluorosis in this study. Conclusions. Skeletal fluorosis among children may contribute to poor health and reduced productivity when they reach adulthood. Further efforts to reduce fluoride exposure among children in southwestern of China where coal is burned indoors are desperately needed.

Dental fluorosis, fluoride in urine, and nutritional status in adolescent students living in the rural areas of Guanajuato, Mexico

“…High concentrations of fluoride can also produce long-term bone damage in children and adults such as skeletal fluorosis. [1] Even intelligence quotient (IQ) has been associated with fluoride exposure. [2]…”

Association Between Dietary Patterns and Fluorosis in Guizhou, China

“…Previous studies reported fluoride contents of roasted chili, corn, squash, potatoes and cured meat reached 419.8 mg/kg (33), 39.5 mg/kg (33), 121.8 mg/kg (34), 134.6 mg/kg (35), and 182.2 mg/kg (36), respectively. Corn and potatoes are the primary foods consumed by residents of Zhijin and daily mean fluoride intake (per person) from corn was 37.6 and 3.5 mg from potatoes (37). Previous studies demonstrated that particular roasted foods, such as corn, chilli, and potatoes, were the primary pathological cause of coal-burning fluorosis, because of the fluorine pollution coming from the coal briquettes and binder clay (6,37,38).…”

“…Corn and potatoes are the primary foods consumed by residents of Zhijin and daily mean fluoride intake (per person) from corn was 37.6 and 3.5 mg from potatoes (37). Previous studies demonstrated that particular roasted foods, such as corn, chilli, and potatoes, were the primary pathological cause of coal-burning fluorosis, because of the fluorine pollution coming from the coal briquettes and binder clay (6,37,38). Therefore, the present study suggests that the easy-to-roast dietary pattern in our study was positively associated with a risk of fluorosis not because the foods themselves were a source of fluorine, but rather roasting food over coal stoves caused the fluorine pollution.…”

Progressive Research in the Molecular Mechanisms of Chronic Fluorosis

“…Most cases of fluorosis were caused by drinking fluorous water. In China, fluorosis is caused by drinking water as well as inhaling combustion fumes of coal being used as an indoor fuel source [28][29][30][31]. Guizhou is one of the most severely afflicted areas of endemic fluorosis in China and this occurrence is due to indoor coal burning [30].…”