Urinary levels of selected metals and associated individual-level characteristics in Tuscany, Italy: The EPIMETAL study.

Several metallic elements pose a significant threat to health, as they are causally linked to numerous diseases. Within the EPIMETAL project, we conducted a cross-sectional investigation in Tuscany, Italy, aiming at quantifying urinary levels of selected metals among 300 older individuals from the EPIC-Florence cohort and identifying associated individual-level characteristics. Urinary metals levels were also compared with those of two surveys previously conducted in areas of Tuscany with known environmental contamination. Urine samples were collected in 2021-2022, and inductively coupled plasma-mass spectrometry was used for metals quantification. Extensive information was collected on multiple potential sources and routes of exposure to metals. The statistical analysis was conducted by fitting regression models adjusted by sex, age, and urinary creatinine. The geometric mean of urinary metals levels in the EPIMETAL study was lower than both the reference values for the Italian population, and the levels recorded in the other areas of Tuscany. Factors associated with higher urinary levels included female sex (Cd, Hg); cigarette smoking (Cd, Pb); consumption of seafood (As, Hg, Tl), plant-based foods (As, Ni, Tl), and wine (Pb); dental fillings and wearing jewelry (Hg); and regular use of various medications (As, Cd, Cr, Hg, Ni, Tl). Our study provides a broad picture of the degree of contamination to multiple metallic elements in Tuscany, while also identifying the main sources and routes of exposure. These findings are instrumental in setting public health priorities and devising interventions aiming at reducing exposure to toxic metals in Tuscany.