PDF(Pubmed)
Abstract：
METHODS: Human, animal, and in vitro studies. Extensive literature search of multiple bibliographic databases, trial registries, major grey literature sources and bibliographies of identified studies.
METHODS: The authors aimed to identify studies which could be used to determine the maximum safe level for fluoride in drinking water. To identify new studies published since a 2016 Australian review, the search period was 2016 to July 2021. Studies which evaluated the association between either naturally or artificially fluoridated water (any concentration) and any health outcomes were included. No restrictions on study design or publication status. Articles published in a \'non-Latin language\' were excluded. Screening of abstracts and full texts was in duplicate. For IQ and dental fluorosis, a top-up search was conducted between 2021 and Feb 2023.
METHODS: Extensive data extraction. Risk of bias assessment using the OHAT tool. A narrative synthesis of the results was carried out.
RESULTS: The review included 89 studies in humans, 199 in animals and 10 reviews of in vitro studies. Where there was consistent evidence of a positive association, in relation to a water fluoride concentration of <20 ppm (mg F/L), and where studies were judged to be acceptable or high quality, health effects were taken forwards for further examination of causality using Bradford Hill\'s 9 criteria. Of the 39 health outcomes reviewed, 4 were further assessed for causality. The authors reported \'strong\' evidence of causality for dental fluorosis and reductions in children\'s IQ scores, \'moderate\' strength evidence for thyroid dysfunction, \'weak\' for kidney dysfunction, and \'limited\' evidence for sex hormone disruption.
CONCLUSIONS: The authors conclude that moderate dental fluorosis and reductions in children\'s IQ scores are the most appropriate health outcomes to use when setting an upper safe level of fluoride in drinking water. For reductions in children\'s IQ, the authors acknowledge a biological mechanism of action has not been elucidated, and the dose response curve is not clear at lower concentrations, limiting the ability to set an upper safe threshold.
METHODS: The authors aimed to identify studies which could be used to determine the maximum safe level for fluoride in drinking water. To identify new studies published since a 2016 Australian review, the search period was 2016 to July 2021. Studies which evaluated the association between either naturally or artificially fluoridated water (any concentration) and any health outcomes were included. No restrictions on study design or publication status. Articles published in a \'non-Latin language\' were excluded. Screening of abstracts and full texts was in duplicate. For IQ and dental fluorosis, a top-up search was conducted between 2021 and Feb 2023.
METHODS: Extensive data extraction. Risk of bias assessment using the OHAT tool. A narrative synthesis of the results was carried out.
RESULTS: The review included 89 studies in humans, 199 in animals and 10 reviews of in vitro studies. Where there was consistent evidence of a positive association, in relation to a water fluoride concentration of <20 ppm (mg F/L), and where studies were judged to be acceptable or high quality, health effects were taken forwards for further examination of causality using Bradford Hill\'s 9 criteria. Of the 39 health outcomes reviewed, 4 were further assessed for causality. The authors reported \'strong\' evidence of causality for dental fluorosis and reductions in children\'s IQ scores, \'moderate\' strength evidence for thyroid dysfunction, \'weak\' for kidney dysfunction, and \'limited\' evidence for sex hormone disruption.
CONCLUSIONS: The authors conclude that moderate dental fluorosis and reductions in children\'s IQ scores are the most appropriate health outcomes to use when setting an upper safe level of fluoride in drinking water. For reductions in children\'s IQ, the authors acknowledge a biological mechanism of action has not been elucidated, and the dose response curve is not clear at lower concentrations, limiting the ability to set an upper safe threshold.
摘要：
方法：人类，动物,和体外研究。对多个书目数据库进行广泛的文献检索，审判登记处，已确定研究的主要灰色文献来源和参考书目。
方法：作者旨在确定可用于确定饮用水中氟化物的最大安全水平的研究。为了确定自2016年澳大利亚审查以来发表的新研究，搜索期为2016年至2021年7月。包括评估天然或人工氟化水（任何浓度）与任何健康结果之间关联的研究。对研究设计或发表状态没有限制。不包括以“非拉丁语”发布的文章。摘要和全文的筛选一式两份。对于智商和氟斑牙，在2021年至2023年2月之间进行了一次充值搜索。
方法：广泛的数据提取。使用OHAT工具进行偏差评估的风险。对结果进行了叙述性综合。
结果：该综述包括89项人类研究，199个动物和10个体外研究综述。如果有一致的证据表明存在正相关，与水氟化物浓度<20ppm（mgF/L）有关，如果研究被认为是可接受的或高质量的，使用布拉德福德·希尔的9项标准，对健康的影响进行了进一步的因果关系检查。在审查的39项健康结果中，4进一步评估了因果关系。作者报告了氟中毒和儿童智商得分降低的因果关系的强有力证据，甲状腺功能障碍的“中等强度”证据，肾功能不全的“弱”，和“有限的”性激素破坏的证据。
结论：作者得出的结论是，在设定饮用水中氟化物的较高安全水平时，中度氟斑牙和儿童智商评分降低是最合适的健康结果。为了降低儿童的智商，作者承认尚未阐明生物学作用机制，在较低浓度下剂量反应曲线不清晰，限制设置安全上限阈值的能力。
方法：作者旨在确定可用于确定饮用水中氟化物的最大安全水平的研究。为了确定自2016年澳大利亚审查以来发表的新研究，搜索期为2016年至2021年7月。包括评估天然或人工氟化水（任何浓度）与任何健康结果之间关联的研究。对研究设计或发表状态没有限制。不包括以“非拉丁语”发布的文章。摘要和全文的筛选一式两份。对于智商和氟斑牙，在2021年至2023年2月之间进行了一次充值搜索。
方法：广泛的数据提取。使用OHAT工具进行偏差评估的风险。对结果进行了叙述性综合。
结果：该综述包括89项人类研究，199个动物和10个体外研究综述。如果有一致的证据表明存在正相关，与水氟化物浓度<20ppm（mgF/L）有关，如果研究被认为是可接受的或高质量的，使用布拉德福德·希尔的9项标准，对健康的影响进行了进一步的因果关系检查。在审查的39项健康结果中，4进一步评估了因果关系。作者报告了氟中毒和儿童智商得分降低的因果关系的强有力证据，甲状腺功能障碍的“中等强度”证据，肾功能不全的“弱”，和“有限的”性激素破坏的证据。
结论：作者得出的结论是，在设定饮用水中氟化物的较高安全水平时，中度氟斑牙和儿童智商评分降低是最合适的健康结果。为了降低儿童的智商，作者承认尚未阐明生物学作用机制，在较低浓度下剂量反应曲线不清晰，限制设置安全上限阈值的能力。
