|Year : 2022 | Volume
| Issue : 1 | Page : 47-53
Effect of duration of exposure on health complaints, systemic inflammatory responses, immunological markers, and pulmonary function tests among workers working at the vegetable market
Kalahasthi Ravibabu, Vinay Kumar Adepu, Jamalpur Ravi Prakash, Raju Nagaraju, Jakkam Surendar
Department of Biochemistry, Regional Occupational Health Centre (Southern), Indian Council of Medical Research, Bengaluru, Karnataka, India
|Date of Submission||23-Jul-2020|
|Date of Acceptance||04-May-2022|
|Date of Web Publication||16-Feb-2023|
Dr. Kalahasthi Ravibabu
Regional Occupational Health Centre (Southern), Indian Council of Medical Research, ICMR Complex, Kannamangala Post, Poojanahalli Road Devanahalli Taluk, Bengaluru - 562 110, Karnataka
Source of Support: None, Conflict of Interest: None
BACKGROUND: The vegetable markets are a rich source of organic dust and bioaerosol exposure. The effect of duration of exposure on health complaints, systemic inflammatory responses (SIR), immunological markers, and pulmonary function tests (PFT) among loading and unloading workers at the vegetable market was not explored.
OBJECTIVE: The current study was undertaken to assess the effect of duration of exposure on health complaints, SIR, immunological markers, and PFT among workers working at the vegetable market.
MATERIALS AND METHODS: The study design is descriptive, 45 male participants with no smoking habit and having more than 3 years of experience were enrolled in the study. The study participants were categorized into low (n = 23) and high (n = 22) exposure groups based on the median duration of exposure, which is the multiplication of years of exposure and working hours per day. The demographic details, health complaints, SIR, immunological, and PFT parameters were investigated and compared between low and high exposure groups.
RESULTS: Workers with a prolonged duration of exposure have reported a considerable increase in musculoskeletal disorders, eye irritation, and skin allergies. SIR such as serum albumin, high sensitivity C-reactive protein, lymphocytes, white blood cell count, and immunological markers (immunoglobulin E and immunoglobulin A) were considerably increased, and PFT were significantly decreased in the high exposure group as compared to the low-exposure group.
CONCLUSIONS: Contemporary study revealed that high duration of exposure contributes to augmented health complaints, SIR, immunological markers, and reduced competence of PFT among loading and unloading workers at vegetable markets. Therefore, this study suggests workplace hygiene practices with the use of personal protective equipment might lower the health effects and inflammation markers.
Keywords: Health complaints, immunological markers, loading and unloading workers, pulmonary function tests, systemic inflammatory responses
|How to cite this article:|
Ravibabu K, Adepu VK, Prakash JR, Nagaraju R, Surendar J. Effect of duration of exposure on health complaints, systemic inflammatory responses, immunological markers, and pulmonary function tests among workers working at the vegetable market. Indian J Allergy Asthma Immunol 2022;36:47-53
|How to cite this URL:|
Ravibabu K, Adepu VK, Prakash JR, Nagaraju R, Surendar J. Effect of duration of exposure on health complaints, systemic inflammatory responses, immunological markers, and pulmonary function tests among workers working at the vegetable market. Indian J Allergy Asthma Immunol [serial online] 2022 [cited 2023 Mar 29];36:47-53. Available from: https://www.ijaai.in/text.asp?2022/36/1/47/369808
| Introduction|| |
Vegetable market habitation is the key source of organic dust such as vegetable debris and aerosolized micro-organism components, i.e., bacteria, fungi, endotoxin, and 1–3 β-D-glucan. These hazards are emitted into the environment due to improper handling and storage of fruits and vegetables. The loading and unloading workers at the vegetable market were exposed to organic dust and aerosolized microbial components through inhalation. Recent studies have reported a higher count of airborne bacteria, fungi, and 1–3 β-D-glucan with diminished lung function tests in farmworkers., Organic dust toxic syndrome was noted in occupational settings such as farmers, industries, animal husbandry, and municipal sewage waste management. Similarly, a higher prevalence of respiratory symptoms with decreased spirometry values was reported in workers from the vegetable market. As per the review of literature, it is evidenced that the higher exposure to bacteria and fungi in the marketplaces causes high incidences of respiratory symptoms with declining pulmonary function tests (PFT). Organic dust exposure in occupational settings has been reported to cause increased respiratory disorders, inflammatory, immunological markers, and diminished PFT.,
The process of loading and unloading work represents the carrying of heavyweights on the head, back (spinal loading), pulling, and pushing tasks. The workers involved in those tasks complain of musculoskeletal disorders (MSDs) such as low back, shoulder pain, and knee pain., From the review of literature, the vegetable market habitation was found to have a high concentration of organic dust with aerosolized microbial components, which were associated with inflammation and respiratory disorders. The loading and unloading workers working at the vegetable markets, their health complaints, systemic inflammatory responses (SIR), immunological markers, and PFT were not explored. Therefore, the present study was undertaken to assess the health complaints, SIR, immunological markers, and PFT among the loading and unloading workers working at the vegetable market.
| Materials and Methods|| |
A descriptive study was carried out on 45 male participants with no history of smoking habit and having more than 3 years of exposure. These participants were involved in the loading and unloading of the vegetable market located in Bangalore, Karnataka, India. Study participants were categorized into two groups based on the median value of exposure, which is the multiplication of years of exposure and working hours per day. The first group consists of 23 workers whose median duration of exposure is 228 and is considered a low-exposure group. The second group consists of 22 workers having a median duration of exposure is > 228 and enrolled them as a high exposure group. The data of health complaints, SIR, immunological markers, and PFT were compared between low and high exposure groups. This study was approved by the institutional ethical committee and informed consent was obtained from the participants after explaining the study objective. The details of demographic, occupational history, and health complaints were obtained using pre-validated questionnaires. Body mass index (BMI) was calculated using the subject's height (meter2) and weight (kilograms).
The venous blood sample was collected by venipuncture (5 ml) from each worker. Around 2 ml of whole blood was transferred into a tri-potassium ethylenediaminetetraacetate (K3-EDTA) tube (Vacuurate easy, Lab tech disposables, India) and used for the assessment of hematological parameters. About 3 ml of the whole blood sample was collected into a clot activator tube (Vacuurate easy, Lab tech disposables, India). The blood was centrifuged (4000 RPM for 10 min) at 4°C and the serum was separated and used for the analysis of SIR and immunological markers.
The white blood count (WBC), platelets, lymphocytes, and neutrophils count were analyzed using a fully automated three-part hematology analyzer (Fx-19E, Unitron biomedical, and India).
Serum high-sensitivity C-reactive protein
The serum concentration of high-sensitive C-reactive protein (Hs-CRP) was analyzed using a commercial ELISA kit as per manufacturer protocol (Catalog no. K250, CRP Ultra EIA, XEMA Co., Ltd., Russia). The sensitivity of the method is < 0.05 mg/L and the detection range is 0–25 mg/L. The results were expressed as mg/L.
The serum albumin concentration was measured by using the Bromocresol green method using a semi-automated analyzer (Robonik India Pvt Ltd., India).
Systematic inflammatory responses
The derived parameters, namely neutrophils: lymphocytes ratio, platelet: lymphocytes ratio (PLR), systemic inflammatory index, prognostic nutrition index (PNI), and C-reactive protein: albumin ratio (CAR) were calculated.
The serum immunoglobulin A (IgA) (Catalog no. K275) and immunoglobulin E (IgE) (Catalog no. K200) levels were analyzed using the ELISA method as per the manufacturer's protocol (XEMA Co., Ltd., Russia).
Pulmonary function test
The PFT was performed using spirometry (Medispiror, USA). The test was conducted in a standing posture by using a nose clip three times after adequate rest for 5 min to avoid exertion. The best attempt has been taken into consideration. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1 s), FEF 25%–75% (forced expiratory flow 25%–75%), and FEV1/FVC were included in the study.
The Statistical Package for the Social Sciences (SPSS) version 23 software was used for data analysis (IBM Corp, Armonk, Newyork, USA). The results were expressed as mean ± standard deviation and frequency distribution. The mean variables of age, BMI, SIR, immunological markers, and PFT were compared between low and high groups using a Student's t-test. The proportion of educational status, blood pressure, tobacco chewers, alcohol consumption, and health complaints among low- and high-exposure groups were analyzed using a Chi-square test. The association between duration of exposure and findings of the SIR, immunological markers, and PFT among the subjects was done using the Spearman correlation coefficient test. Probability < 0.05 is considered significant.
| Results|| |
The demographic details of low- and high-exposure groups working in the vegetable market are depicted in [Table 1]. The variables of BMI, educational status, blood pressure, and habits of alcohol consumption, and tobacco chewing among high-exposure groups were suitably matched with the low-exposure group. The mean age of the high-exposure group was found to be significantly higher in comparison with the low-exposure group (P = 0.001).
|Table 1: Demographic characteristics of low and high exposure workers of vegetable market|
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The health complaints among low- and high-exposure groups are reported in [Table 2]. The health complaints of MSDs such as joint pain (P = 0.002), muscle pain (P = 0.001), muscle rigidity (P = 0.003), and muscle weakness (P = 0.017). The ophthalmological complaints such as tears in the eye (P = 0.033) and irritation of the eye (P = 0.007) and allergic complaints like skin allergy (P = 0.023), were considerably amplified in the high-exposure group in comparison with the low-exposure group.
|Table 2: Health complaints in of low- and high-exposure workers of vegetable market|
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[Table 3] represents the SIR and immunological markers of low- and high-exposure groups. The SIR markers, namely serum albumin (P = 0.009), Hs-CRP (P = 0.005), WBC count (P = 0.001), lymphocytes (P = 0.020), and PNI (P = 0.007) levels were considerably higher in the high-exposure group in comparison with the low-exposure group. In contrast, the serum immunoglobulin such as IgA and IgE levels were increased by 2-fold and 0.75-fold, respectively, in the high-exposure group.
|Table 3: Inflammatory responses and immunological markers among of low- and high-exposure workers of vegetable market|
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The PFT between low- and high-exposure groups are tabulated in [Table 4]. The lung capacity and volumes (FVC, P = 0.001), (FEV1, P = 0.001), (FEF 25%–75%, P = 0.042), and (FEV1/FVC, P = 0.002) were significantly reduced in the high exposure group in comparison with the low-exposure group.
|Table 4: Pulmonary function test in of low- and high-exposure workers of vegetable markets|
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The correlation between respiratory complaints and PFTs among workers is presented in [Table 5]. The PFTs were reduced in workers with respiratory symptoms. The parameters such as FVC, FEV1, and FEF 25%–75% were significantly reduced in workers having symptoms of allergic retinitis. Wheezing and coughing with sputum were noted to reduce the FEF 25%–75%.
|Table 5: Correlation between respiratory symptoms and pulmonary function test among workers of vegetable markets|
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The results of the spearmen correlation coefficient (r) between duration of exposure and variables such as SIR, immunoglobulin levels, and PFT among the participants are tabulated in [Table 6]. A positive and significant association was observed between duration of exposure and SIR such as Hs-CRP (r = 0.422, P = 0.004), CAR (r = 0.344, P = 0.021), WBC (r = 0.669, P = 0.001), lymphocytes (r = 0.333, P = 0.025), neutrophils (r = 0.319, P = 0.033), PNI (r = 0.408, P = 0.005), and immunological IgA (r = 0.624, P = 0.001), and IgE (r = 0.652, P = 0.001). A negative and significant association was noted between duration of exposure and PLR (r = −0.304, P = 0.042), and PFT like FVC (r = −0.486, P = 0.001), FEV1 (r = −0.597, P = 0.001), FEF 25%–75% (r = −0.474, P = 0.001), and FEV1/FEV (r =−0.567, P = 0.001).
|Table 6: Spearman's correlation for duration of experience and findings reported in of low- and high-exposure workers|
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| Discussion|| |
The current study assessed the effect of the duration of exposure on health complaints, SIR, immunological markers, and PFT among the loading and unloading workers working at the vegetable market. Repetitive exposure to organic dust was linked to harmful health effects. In the present study, the study participants were categorized into two groups: high- and low-exposure based on the median duration of exposure, which is a multiplication of years of exposure and working hours per day.
MSDs such as joint pain, muscle pain, muscle rigidity, and muscle weakness were significantly increased in the high-exposure group as compared to the low-exposure group. Similar findings were noted in drivers who were involved in load and unloading work, physical loaders, and fruit and vegetable market workers. The possible reasons for these work-related MSDs are heavy physical activity, pushing, and pulling of loads.
Recent studies have also demonstrated a high prevalence of dermatological and ocular symptoms in workers exposed to bioaerosols, organic dust, and sawdust. In the current study, we observed significantly higher health complaints of skin allergy and ophthalmological problems like tears in the eyes, and eye irritation in the high-exposure group.
Inflammation of the lungs depends on B-cells and organic dust indices. Chronic inflammation is a risk factor for damaging cells, tissues, and organs. In the current study, we monitored the SIR in workers working at the vegetable market. In the high-exposure group, we noted significantly augmented levels of serum albumin, Hs-CRP, total WBC count, and PNI. Similar findings were also noted in workers from farms, photocopiers, and municipal solid wastes management. The possible reason for the increase in SIR among the high exposure group was due to the exposure to organic dust and bioaerosols in the workplace.
The immunological consequences are microbial motifs in organic dust, which can be caused by innate immune receptor signaling pathways. In this study, we assessed the serum immunoglobulin (IgE and IgA) levels in high- and low-exposure groups. Serum IgE and IgA levels were considerably increased in workers with a high duration of exposure. The findings of this study were comparable with other studies reported on agricultural exposure, cement dust, bio-waste collectors, and waste management. Higher immunoglobulin levels might be attributed to prolonged environmental inhalant organic dust exposure.
Studies have reported the high prevalence of respiratory symptoms and reduced lung function tests in workers from the fruit and vegetable market, flour mill factory, wood dust,, compost workers, potato processing workers, cotton fabric swing workers, flour mill, and sawdust exposure. Further, we also assessed the PFT between high- and low-exposure groups and noted significantly diminished PFT findings in high exposure groups as compared to low exposure.
Our study limitation is that healthy individuals as control of the same age group were not included. We recommend that future studies include controls and comparisons with exposed workers.
| Conclusions|| |
Contemporary study results revealed that the high duration of exposure contributes to augmented health complaints, SIR, immunological markers, and reduced competence of PFT among loading and unloading workers at vegetable markets. Therefore, this study suggests workplace hygiene practices with personal protective equipment usage might minimize the health effects and inflammation markers.
We are very much grateful to the Director, NIOH for his support. We acknowledge the substantial contribution of Mrs. N. Thara, Mr. Rajeev kumar Yadav, Mr. J Prakash Nayak for the technical support, and Mr. Aneesh Ahmed (Driver) in the study.
Financial support and sponsorship
National Institute of Occupational Health, Ahmedabad.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]