Carla Teles Martins

• Doctor of Public Health
• Researcher at Universidade NOVA de Lisboa

Aim We estimated the average direct cost per Acute Coronary Syndromes (ACS) in-patient episodes by diagnosis, namely ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), unstable angina (UA), and undetermined AMI (Acute Myocardial Infarction). We also analyzed the changes in direct costs over time between 200...

Introduction Waste management represents an occupational setting where fungi are significant contaminants. This study aimed to assess the exposure of waste workers to mycotoxins through a human biomonitoring study. Methods A total of 33 workers and 19 controls provided spot urine samples to determine 10 mycotoxins’ urinary biomarkers using liquid...

Clean air is a requirement for life, and the quality of indoor air is a health determinant since people spend most of their daily time indoors. The aim of this study was to systematically review the available evidence regarding the sources, determinants and concentrations of indoor air pollutants in a set of scenarios under study in K-HEALTHinAIR p...

In the scope of the European Union (EU) human biomonitoring initiative, a multicentric study on different occupational settings from several European countries was performed, to provide information on occupational exposure to hexavalent chromium [Cr(VI)], a known lung carcinogen. Biomonitoring approaches were used to obtain exposure data to support...

Background Air pollution is an important contributing factor for many pathologies, including stroke. Nitrogen dioxide (NO2), an air pollutant, has been associated in multiple studies with strokes’ mortality. Aim This study aims, for the first time, to estimate the number of deaths by stroke due to long-term, ambient exposure to nitrogen dioxide in...

Background Indoor Air Quality (IAQ) is an important determinant of health. This study aimed to review the available scientific evidence about indoor pollutants and determinants of exposure in several settings, in the scope of the K-HEALTHinAIR project. Methods The systematic review was performed for the sources, concentrations, and determinants of...

Background Ambient air pollution, particularly surface ozone, is a significant global health concern, with 9 out of 10 people exposed to levels exceeding WHO guidelines. This exposure is linked to approximately 7 million premature deaths annually, a number expected to double by 2050. While the effects of short-term exposure to ozone on exacerbation...

Background Lung cancer is recognized as one of the most common causes of cancer morbidity and mortality worldwide and is the second cause of death with highest years of life lost in highly developed regions. Ambient exposure to particulate matter (PM2.5) is the leading global environmental risk factor. Long-term exposure to PM2.5 is associated with...

Background Arsenic (As) exposure poses significant health risks to exposed populations, with exposure occurring predominantly via diet for the general population as recently referred by the European Food Safety Authority. This study assesses the environmental burden of disease (EBD) for three cancer types related to arsenic, across Europe. Methods...

The quantification of the burden associated with chemicals is essential for comprehending their impact on public health and implementing effective risk management strategies. This presentation underscores the significance of conducting such assessments at both national and local levels, taking into account the exposures and vulnerabilities of those...

Background Air pollution, specifically particulate matter with a diameter of 2.5 micrometers (PM2.5), is the primary environmental health risk in Europe. Exposure to PM2.5 increases the risk of cardiovascular diseases, including AMI, resulting in high direct costs associated with in-patient treatment. This study aims to estimate the avoidable and a...

Background Air pollution is a major environmental risk to human health, contributing to premature death and disease. Nitrogen dioxide (NO2) is a pollutant of significant public health concern, associated with increased risks of all-cause mortality, particularly in cardiovascular and respiratory deaths. In 2021, NO2 exposure exceeding the World Heal...

Background Mercury (Hg), a global pollutant, poses risks to both human and environmental health. The management and recycling of electrical and electronic waste (e-waste) is recognized as having the potential to promote workers’ exposure to this pollutant. Human biomonitoring (HBM) is a tool that can be used to evaluate exposure and monitor the hea...

The pressure global food systems exert on the environment has amplified over time, following the growth of the human population, changes in the food consumption patterns and intensification of the production systems. Without changes in food systems, an overpressure on agriculture and food production will be unavoidable, with inevitable consequences...

The European Food Safety Authority (EFSA) has a goal to efficiently conduct aggregate exposure assessments (AEAs) for chemicals using both exposure models and human biomonitoring (HBM) data by 2030. To achieve EFSA's vision, a roadmap for action for advancing aggregate exposure (AE) in the EU was developed. This roadmap was created by performing a...

Background Exposure to high levels of environmental air pollution causes several health outcomes and has been associated with increased mortality, premature mortality, and morbidity. Ambient exposure to PM2.5 is currently considered the leading environmental risk factor globally. A causal relationship between exposure to PM2.5 and the contribution...

Workers involved in the processing of electronic waste (e-waste) are potentially exposed to toxic chemicals, including phthalates and alternative plasticizers (APs). Dismantling and shredding of e-waste may lead to the production of dust that contains these plasticizers. The aim of this study, which was part of the European Human Biomonitoring Init...

Retrospective observational study that included all reported cases of human brucellosis in Portugal, between 1998 and 2018 (last official public data available). Data was collected from reports made available by the Directorate-General for Health (DGS). Descriptive statistics (frequencies mean, median, proportions) by sex, age and geographic locati...

Background Exposure to air pollution has been associated with increased mortality, premature mortality, and morbidity. A causal relationship between fine particulate matter (PM2.5) exposure and cardiovascular morbidity and mortality was demonstrated by the American Heart Association. In 2020, exposure to PM2.5 concentrations above limits defined by...

Background The proliferation of mycotoxin-producing fungi in agricultural settings poses a challenge for human health and nutrition around the world. Mycotoxins contaminate food sources and their negative health outcomes include carcinogenic, nephrotoxic and teratogenic effects. Potential risks are still poorly characterized and few studies assess...

Background Particulate matter with or less 2.5 diameters (PM2.5) has deleterious health effects on humans. In 2020, exposure to levels of PM2.5 above World Health Organization Air Quality Guidelines (WHO AQG) caused 238,000 and 2,600 premature deaths in the European Union and Portugal, respectively. During the lockdowns and restrictions periods due...

Background The impact of the COVID-19 pandemic on the Portuguese population is still underexplored. Therefore, the characterization of years of life lost (YLL) due to this epidemic may provide relevant data for establishing effective strategies in future epidemics. The aim of this study was to calculate YLL associated with COVID-19 deaths in Portug...

One of the aims of the European Human Biomonitoring Initiative, HBM4EU, was to provide examples of and good practices for the effective use of human biomonitoring (HBM) data in human health risk assessment (RA). The need for such information is pressing, as previous research has indicated that regulatory risk assessors generally lack knowledge and...

Mycotoxins are natural metabolites produced by fungi that contaminate food and feed worldwide. They can pose a threat to human and animal health, mainly causing chronic effects, e.g., immunotoxic and carcinogenic. Due to climate change, an increase in European population exposure to mycotoxins is expected to occur, raising public health concerns. T...

Particulate matter with a diameter of 2.5 μm or less (PM2.5) are one of the air pollutants more detrimental to human health, being responsible for around 400 000 premature deaths in Europe every year. The cardiovascular diseases (CVD) and air pollution are linked, with existing evidence of a causal relationship between exposure to particulate matte...

Pollution is the worldwide largest environmental cause of disease and premature death, being also considered a risk for planetary health, a cause of ecosystems destruction and intimately linked to global climate change. Pollution is considered costly, with attributable diseases resulting in health-care costs that are responsible for 1.7% of annual...

Titanium dioxide nanoparticles (TiO2-NPs) are widely used, and humans are exposed through food (E171), cosmetics (e.g., toothpaste), and pharmaceuticals. The oral and gastrointestinal (GIT) tract are the first contact sites, but it may be systemically distributed. However, a robust adverse outcome pathway (AOP) has not been developed upon GIT expos...

The occupational exposure to chemicals usually occurs in higher levels than for the general population, usually by inhalation and dermal absorption but inadvertent ingestion may also occur. Biomonitoring is a powerful tool to assess exposure at the individual level, thus providing additional and valuable information in comparison with air monitorin...

There is a strong demand for plant-based milk substitutes, often low in protein content (<1.5% w/v). Protein-rich pulse seeds and the right processing technologies make it possible to make relevant choices. The major objective of this study was to assess the impact of processing on the nutritional characteristics of beverages with a high impact on...

Early-life exposure occurs during gestation through transfer to the fetus and later, during lactation. Recent monitoring data revealed that the Portuguese population is exposed to mycotoxins, including young children. This study aimed to develop a pilot study to assess the early-life exposure to mycotoxins through a mother-child cohort, and to iden...

The use of nanoparticles (e.g. titanium dioxide) in commercial food products to modify some properties, such as brightness and whiteness, increased in the last years and is nowadays widespread. Despite the inhalation of nanoparticles is already a topic of concern, the potential adverse health effects due to ingestion still present gaps of knowledge...

Work-related exposures in industrial processing of chromate (chrome plating, surface treatment and welding) raise concern regarding the health risk of hexavalent chromium (Cr(VI)). In this study, performed under the HBM4EU project, we focused on better understanding the determinants of exposure and recognising how risk management measures (RMMs) co...

Aflatoxins (AFTs) are genotoxic and carcinogenic food contaminants causing hepatocellular carcinoma, the third leading cause of cancer deaths worldwide. In 2015, WHO estimated the burden of disease associated with exposure to AFTs and concluded that this exposure corresponds to 636,869 Disability-adjusted Life Years (DALYs) at global level. Particu...

Cereal-based foods, including breakfast (BC) and infant cereals (IC), are among the first solid foods introduced to infants. BC and IC are sources of macro and micronutrients that have beneficial effects on health, but can also be sources of harmful chemical and microbiological contaminants and nutrients that may lead to adverse health effects at h...

Cadmium (Cd) is a toxic heavy metal widespread in the environment leading to human exposure in particular through diet (when smoking is excluded), as documented by recent human biomonitoring (HBM) surveys. Exposure to Cd at environmental low-exposure levels has been associated with adverse effects such as renal toxicity and more recently bone effec...

Deoxynivalenol (DON), an enteropathogenic mycotoxin produced by Fusarium species, is usually associated with adverse health outcomes such as gastrointestinal diseases and immunotoxicity. To estimate DON exposure of the Portuguese population at national level, a modelling approach, based on data from 94 Portuguese volunteers, was developed consideri...

Several metallic nanomaterials (NMs), such as titanium dioxide nanomaterials (TiO2), present beneficial properties with a broad range of innovative applications. The human population is exposed to TiO2, particularly by ingestion, due to its increasing use as a food additive and inclusion in dietary supplements and food packaging materials. Whether...

In occupational settings where exposure to organic dust occurs (e.g., intensive animal production, waste management, farming and many others) workers can also be exposed to mycotoxins. However, recognizing exposure to mycotoxins in workplace environments does not happen commonly and, consequently, remains as a not identified occupational risk facto...

Introduction: Mycotoxins are food contaminants with several health outcomes such as carcinogenic, estrogenic, immunotoxic, nephrotoxic and teratogenic effects. The present thesis aimed to assess the exposure of the Portuguese population to mycotoxins through a human biomonitoring approach. Materials and Methods: Under the scope of the National Food...

Human biomonitoring is an important tool to assess human exposure to chemicals, contributing to describe trends of exposure over time and to identify population groups that could be under risk. Aflatoxins are genotoxic and carcinogenic food contaminants causing hepatocellular carcinoma, the third leading cause of cancer deaths worldwide. In Portuga...

Zearalenone and alternariol are mycotoxins produced by Fusarium and Alternaria species, respectively, that present estrogenic activity and consequently are classified as endocrine disruptors. To estimate the exposure of the Portuguese population to these two mycotoxins at a national level, a modelling approach, based on data from 94 Portuguese volu...

Mycotoxins are natural chemical contaminants of foods, posing several health risks to humans. Biomarkers-driven research has been used as a tool for a more accurate characterization of the internal exposure. Whether certain food items are predictors of exposure to mycotoxins constitutes an important aspect for the risk assessment of mycotoxins. Com...

Human Biomonitoring (HBM) has been identified as a promising tool to assess the exposure to contaminants from different origins, providing information of aggregated exposures from different routes and contributing to the establishment of the total body burden of an individual. Mycotoxins are fungi metabolites produced by specific fungal genera that...

Zearalenone and alternariol are mycotoxins produced by Fusarium and Alternaria species, respectively, that present estrogenic activity and are considered endocrine disruptors. These mycotoxins are present in a variety of food commodities and the human exposure could be of concern due to the associated health effects. This article intends to gather...

Climate change constitutes an important driver affecting food sector, and consequently represents a public health issue that deserves particular attention. Under this context, mycotoxins emerge as a particular concern since their prevalence and concentrations in food and feed may vary due to climatic conditions. Aflatoxins, the most toxic mycotoxin...

Climate change constitutes an important driver affecting food sector, and consequently represents a public health issue that deserves particular attention. Under this context, mycotoxins emerge as a particular concern since their prevalence and concentrations in food and feed may vary due to climatic conditions. Aflatoxins, the most toxic mycotoxin...

“RiskBenefit4EU ‐ Partnering to strengthen the risk‐benefit assessment within EU using a holistic approach” was a knowledge transfer project funded by the European Food Safety Authority (EFSA) that integrated a multidisciplinary team from Portugal, Denmark and France. This project aimed to strengthen the EU capacity to assess risks and benefits ass...

Mycotoxins constitute a relevant group of food contaminants with several associated health outcomes such as estrogenic, immunotoxic, nephrotoxic and teratogenic effects. Although scarce data are available in Portugal, human biomonitoring studies have been globally developed to assess the exposure to mycotoxins at individual level. The present study...

Human biomonitoring (HBM) is recognized as an important tool to assess the Human exposure to chemicals, contributing to describe trends and patterns of exposure over time and to identify population groups that could be under risk. Natural chemicals as mycotoxins, fungi metabolites that produce toxic effects in humans, are important compounds that c...

Biomarker-driven research has been proposed as a successful method to assess the exposure of individuals to xenobiotics, including mycotoxins, through estimation of their metabolites in biological fluids. A methodology to determine patulin (PAT) and citrinin (CIT) in human urine and plasma using liquid chromatography coupled to tandem mass spectrom...

Objectives: There is an epidemic of Mesoamerican nephropathy (MeN) in Central America, where sugarcane production is prominent. Numerous causes are proposed, but to date limited evidence supports any one hypothesis. A nested case-control study using biosamples from a rural, community-based follow-up study of 350 young adults from Northwest Nicarag...

Background: Breast milk is considered an essential food segment for children up to 6 months; however, it can be contaminated with some mycotoxins, such as aflatoxin M1 (AFM1) and ochratoxin A (OTA) as a consequence of ingestion of dietary mycotoxins by lactating mothers. Moreover, the health of infants can be threatened due to simultaneous exposure...

Background: Human diet may present both risks and benefits to consumers’ health. Risk-benefit assessment of foods (RBA) intends to estimate the overall health impact associated with exposure (or lack of exposure) to a particular food or food component. Scope and approach: “RiskBenefit4EU – Partnering to strengthen the risk-benefit assessment within...

Human biomonitoring (HBM) is an important tool to survey the internal exposure of humans which represents the real life chemical body burden to chemicals and/or their metabolites. It results from total exposure to chemical substances from different sources and via different routes. These substances may be regulated under different legislative frame...

Mycotoxins constitute a relevant group of food contaminants with several associated health outcomes such as estrogenic, immunotoxic, nephrotoxic and teratogenic effects. Although scarce data are available in Portugal, human biomonitoring studies have been globally developed to assess the exposure to mycotoxins at individual level. In order to overc...

Developing a mechanistic understanding of the impact of food structure and composition on human health has increasingly involved simulating digestion in the upper gastrointestinal tract. These simulations have used a wide range of different conditions that often have very little physiological relevance, and this impedes the meaningful comparison of...

Swine production workers are exposed simultaneously to multiple contaminants. Occupational exposure to aflatoxin B1 (AFB1) in Portuguese swine production farms has already been reported. However, besides AFB1, data regarding fungal contamination showed that exposure to other mycotoxins could be expected in this setting. The present study aimed to c...

Zinc (Zn) is an essential dietary mineral which has been reported to also affect the metabolism of water‐soluble vitamins. Intestinal folate conjugase enzyme is zinc‐dependent, such that Zn deficiency tends to reduce absorption of polyglutamylfolates. Hence, it is important to investigate the co‐occurrence and bioaccessibility of Zn and folates in...

Zearalenone (ZEN) is a mycotoxin that occurs widely in food commodities with particular incidence in cereals. Due to chemical structures similar to the endogenous estrogen 17-β-estradiol, ZEN and its metabolites exert estrogenic toxicity. Therefore, it is crucial to assess ZEN exposure among the population. Biomarker-driven research appeared as a p...

Mycotoxins are secondary fungi metabolites that induce acute and chronic toxic effects in humans and animals. Simultaneous contamination of cereal-based products by multiple mycotoxins has been increasingly reported, including in food products usually consumed by children. Although some previous authors assessed the health risk of children exposed...

Climate change has been indicated as a driver for food safety issues worldwide, mainly due to the impact on the occurrence of food safety hazards at various stages of food chain. Mycotoxins, natural contaminants produced by fungi, are among the most important of such hazards. Aflatoxins, which have the highest acute and chronic toxicity of all myco...

Mycotoxins are contaminants usually found in foodstuffs including fruit and products thereof. These secondary metabolites produced by fungi can cause serious human and animal health problems. Patulin is a mycotoxin that occurs primarily in apples and products thereof, including those consumed by children, such as apple purées or fruit juices. The i...

This paper reports the first study of patulin occurrence in fruit juices and risk assessment related to patulin intake by children, adolescents and adults in Serbia. During three consecutive years (2013-2015), 142 fruit (apple or multi-fruit) juices were collected from the market and analysed using HPLC-UV. Patulin was found in 51.4% of juices with...

Mycotoxins are secondary metabolites of fungi that cause toxic and carcinogenic effects. Human exposure to multiple mycotoxins constitutes an increasing health concern due to potential mycotoxins combined effects. The presence of mycotoxins mixtures in foodstuffs as cereals has been reported over the last years, but few studies are available concer...

Background. In vitro digestion models show great promise in facilitating the rationale design of foods. This paper provides a look into the current state of the art and outlines possible future paths for developments of digestion models recreating the diverse physiological conditions of specific groups of the human population. Scope and Approach....

Patulin (PAT) and ochratoxin A (OTA) are well known enteropathogenic mycotoxins that are present in several foodstuffs. Processed cereal-based foods are among the first solid foods eaten by children, a particularly vulnerable population group. There is a lack of knowledge related to the co-occurrence of PAT and OTA in food intended for children con...

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Historically, the health risk of mycotoxins have been evaluated on the basis of single-chemical and single-exposure pathway scenarios. However, the co-contamination of foodstuffs with these compounds is being reported at an increasing rate and a multiple-exposure scenario for humans and vulnerable population groups as children is urgently needed. C...

As micotoxinas são metabolitos secundários produzidos por várias espécies de fungos, e que podem contaminar os alimentos nas diferentes fases de produção, colheita, armazenagem ou processamento. Além de constituir um problema económico e de segurança alimentar, a contaminação de alimentos com micotoxinas é essencialmente um problema de saúde públic...

The intestinal mucosa is the first biological barrier encountered by mycotoxins potentially present in foods. Patulin, a mycotoxin produced by fungi of genera Penicillium, constitutes an especial concern considering the immunological, neurological and gastrointestinal effects resulting from human exposure. The present work aims to evaluate the inte...

Patulin is a mycotoxin produced by fungi of the genera Aspergillus and Penicillium. This toxin can contaminate several fruits, including apples and by-products, and may be associated with the occurrence of mutagenic, genotoxic, immunosuppressant, immunotoxic, neurotoxic, and possibly carcinogenic effects. Thus, it is fundamental to monitor the occu...

Within the active field of in vitro digestion in food research, the COST Action INFOGEST aimed to harmonize in vitro protocols simulating human digestion on the basis of physiologically inferred conditions. A harmonized static in vitro digestion (IVD) method was recently published as a primary output from this network. To validate this protocol, in...

There is a growing concern within public health about mycotoxin involvement in human diseases, namely those related to children. Scarce data are available in the literature concerning the occurrence of multiple mycotoxins in infant food and their combined toxicity, and no data exists in Portugal concerning this issue. In order to contribute to fill...

This research was performed under the MycoMix project “Exploring the toxic effects of mixtures of mycotoxins in infant food and potential health impact” (PTDC/DTPFTO/0417/2012) funded by the Fundac¸ ao para a Ciencia e Tecnologia (FCT), Portugal.

Risk analysis, is a powerful tool for including science-based knowledge in a systematic approach to food safety problems. The use of risk analysis can promote ongoing improvements in public health and provide a basis for expanding international trade in foods. Within risk analysis, the risk assessment results are quantitative or qualitative express...

In human health risk assessment, ingestion of food is considered a major route of exposure to mycotoxins, metabolites that cause toxic outcomes in humans and infants are a particularly vulnerable population group. This study aims to characterize the risk associated with the consumption of breakfast cereals (BC) concerning the exposure of Portuguese...

Food products provide essential nutrients, but also contaminants that affect human health. Mycotoxins are fungal natural contaminants commonly found in a great variety of foods including baby foods. Patulin (PAT) is a mycotoxin found in fruits and fruit based products1 and aflatoxin M1 (AFM1), the hydroxilated metabolite of AFB1, is a potent carcin...

Mycotoxins are natural contaminants produced by fungi and its common occurrence in food poses a threat to human health, mainly to vulnerable population groups as children. The MycoMix Project (2013-15) aims to study the occurrence of multiple mycotoxins and toxicity interactions in infant foods and cereals consumed by Portuguese children and try to...

In human health risk assessment, ingestion of food is considered a major route of exposure to mycotoxins, metabolites that cause toxic outcomes in humans and infants are a particularly vulnerable population group. This study aims to characterize the risk associated with the consumption of breakfast cereals (BC) concerning the exposure of Portuguese...

In human health risk assessment, ingestion of food is considered a major route of exposure to many contaminants, although the total amount of an ingested contaminant (external dose) does not always reflect the quantity available for the body (internal dose). In this study, two in vitro methods were applied to study bioaccessibility and intestinal m...

A ocorrência de micotoxinas constitui uma preocupação crescente em saúde pública, particularmente os síndromes associados à exposição das crianças a estas toxinas através da alimentação. A ocorrência simultânea de micotoxinas poderá constituir uma preocupação adicional dado que podem provocar maior toxicidade e carcinogenicidade do que individualme...