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Page 12 of 20 Andjelkovic et al. J Environ Expo Assess 2024;3:23 https://dx.doi.org/10.20517/jeea.2024.22

evaluated HBCD presence, particularly suggesting that the elevated values in eels from Flemish rivers could
be linked to the textile industry present in this region [21,41,49] . Supplementary Table 5 highlights the variation
in HBCD concentration across the provinces, with the highest concentration measured in East Flanders,
confirming regional differences in Belgium. Additionally, Goscinny et al. detected HBCDs in 80% of
analyzed foods, with only 8 out of 43 samples showing levels below the LOD . They found the highest
[50]
concentration of ∑HBCD in fish and fishery products, followed by meat and meat products and dairy
products. This indicated that dietary sources might have partially contributed to external exposure metrics.

Levels of POPs in the Belgian national pooled sample and time trends
Trend analysis of POP concentrations
Belgium participated in six surveys. While the first three campaigns included limited geographical coverage
and fewer individual samples, the fourth and sixth surveys incorporated a greater number of samples from
all three regions. The fourth survey in 2006 featured a single pooled Belgian sample comprising 178
[15]
individual samples, with sizes proportional to each province’s population . A similar method was applied
in this study (see section “Preparation of the individual and pooled milk samples”). Figure 3 shows a
downward trend in the concentration of most POPs between 2006 and 2014.

A substantial decrease was observed for p,p’-DDE from 132 to 74 ng/g lw, for HCB from 15 to 10.8 ng/g lw
and for β-HCH from 12 to 4.3 ng/g lw. The main reason for this decrease is probably linked to the reduced
use of these POPs and the time-related reduction of their environmental levels. More than 10 years passed
since the last Belgian WHO-coordinated survey on POPs in human milk . As the first human
[15]
biomonitoring survey in Flanders (2002-2006) demonstrated an increased exposure to p,p’-DDE in some
parts of Flanders, the Flemish government took several policy actions to limit the exposure to DDT. The
results of the different surveys in Flanders indicated that consumption of locally-produced vegetables and
home-produced eggs was associated with a higher body burden of p,p’-DDE . Measurements in eggs
[51]
confirmed the elevated p,p’-DDE levels in home-produced eggs compared to levels in eggs from retail
shops [52-54] . The Flemish government issued guidelines for healthy gardening and safe consumption of locally
grown food. In addition, an action was organized whereby individuals could return residues of banned
pesticides such as DDT to container parks . The presence of DDT in human milk is a worldwide
[55]
phenomenon, with higher levels in milk from countries where DDT use is still allowed for some
applications . During the survey in 2014, a reduction of half of the burden of p,p’-DDE was observed over
[56]
a 10-year period. In Flanders, the human biomonitoring surveys also demonstrated a significant decrease in
p,p’-DDE levels in cord blood samples. Both results indicate that the measures taken by the government to
reduce the presence of POPs had a positive impact. The concentrations of PCDD/Fs have decreased
substantially since the first survey in which Belgium participated. In the initial four WHO milk surveys,
PCDD/F levels in Belgian samples ranged from the highest among participating countries to those
comparable to other industrialized nations. Importantly, PCDD/F concentrations in human milk collected
in Belgium reflected the international downward trend. In the first four WHO milk surveys, Belgium had
PCDD/F levels ranging from the highest level of all participating countries to levels comparable with other
industrialized countries. The PCDD/F concentrations in Belgian human milk followed the international
downward trend. The concentrations decreased from 37.5 pg TEQ/g lw (1988-1989) to 24.8 pg TEQ/g lw
(1991-1992) and further to 10 pg WHO TEQ/g lw (2006) with a substantial decrease to 4 pg TEQ/g lw
(current study). The concentration for the sum of 6 marker PCBs decreased from around 200 ng/g lw in
2001 (for 2 samples from Liège) to 80 ng/g lw (in the pooled Belgian sample from 2006) and 37.5 ng/g lw in
the present study. The concentrations for dioxin-like PCBs have been determined only since 1991. In 2006,
similar levels as in the years ’90 were found. However, in the present study, a decrease from 7 to 2.5 pg
WHO TEQ/g lw was observed, marking a threefold decrease between 2006 and 2014. These results are not
unexpected, as many European countries have reported a general decrease in dietary exposure to dioxins