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Andjelkovic et al. J Environ Expo Assess 2024;3:23 https://dx.doi.org/10.20517/jeea.2024.22 Page 15 of 20

Netherlands, Czechia, Slovakia, Austria, and Lithuania, among WEOG countries, achieved reductions in the
range of 85% to 95% between the late 1980s/early 1990s and the period from 2012 to 2019. For example,
DDT concentrations, with levels ranging from 29 μg DDT complex/kg lipid in Finland (2007) to 615 μg
DDT complex/kg lipid in Australia (2010), followed by a threefold decrease in Australia in subsequent
surveys. DDT concentrations in Belgium during the 2014 survey fell on the lower end of the spectrum. The
relatively low DDT levels across WEOG countries are likely attributed to the early adoption of bans on its
agricultural use.

Exposure assessment for nursing infants
The exposure of nursing infants to the POPs measured in national human milk samples ranged between
-3
3.5 × 10 µg/kg bw/day (BDE-99) and 1.7 µg/kg bw/day (∑DDTs). In Tables 4 and 5, the estimated dietary
exposure to various POPs via human milk is shown and compared with their respective reference values.

Out of ten PBDE congeners, the highest dietary exposure was for BDE-47 and BDE-153 (the most
predominant PBDE congeners). The average dietary exposure of an infant to total HBCDs via human milk
was estimated at 23 ng/kg bw/day, which was comparable to or lower than some previously reported
[29]
levels . The reference values in Table 4 are HBGV and in Table 5 are reference points in case data from
toxicological studies were lacking or were insufficient to establish a HBGV. Furthermore, some HBGV, like
TWI and TDI, could not be directly used to evaluate the exposure of breastfed infants. In the assessed
scenario involving one-month-old breastfed infants, it was assumed that their diets were specialized,
primarily consisting of human milk or formula, along with tap or mineral water. The possible gradual
introduction of small amounts of a limited number of foods that may be specifically designed for infants
was not considered for this age.

The estimated exposure to PFOS/PFOA was higher than the established TWI . As said previously, this is a
[66]
protective value for children at later ages, describing that the risk of adverse effects increases if TWI and
TDI are exceeded. Moreover, the concentration of PFOS/PFAS was comparable across various European
countries.

The current TWI for the PCB+PCDD/F TEQ was 2 pg total WHO2005-TEQ/kg bw/week . Since this
[67]
study assessed exposure solely in infants through breastfeeding, without accounting for maternal exposure
via diet or other sources, the TWI can only serve as an indicator. The infants were exposed to 60 pg total
WHO2005-TEQ/kg bw per week, suggesting a potential risk over their lifetime; however, exposure levels
throughout their lives may change. Additionally, PCDD/F concentrations showed a downward trend over
time. In 2004, Belgium had some of the highest PCDD/F levels among participating countries, but by 2014,
these levels had become comparable to those in other industrialized nations.

Finally, regarding BDE congeners, no health risk concern was estimated for BDE-47, but for the congeners
BDE-99 and BDE-153 at their 50th and 95th percentile concentration (worst case scenario) for both
individual samples, as well as for pooled samples, MOE was below 2.5, indicating a health concern. In
addition, the derived MOET value for the three BDE congeners was below 25, indicating a possible health
concern. Although this approach slightly deviates from the EFSA’s recommended PBDE mixture
approach , which also includes BDE-209, the derived values may still imply a health concern.
[28]