Pulmonary Function Among Flour Mill Workers: a Systematic Review and Meta-analysis

Overview

Journal BMC Public Health

Publisher Biomed Central

Specialty Public Health

Date 2025 Jan 8

PMID 39773483

Authors

Kuldip Upadhyay

Bhavani Shankara Bagepally

Rakesh Balachandar

Ankit Sheth

Ankit Viramgami

Affiliations

Soon will be listed here.

Abstract

Background: Flour dust, with an inherent allergic nature, increases vulnerability to various respiratory ailments. We systemically reviewed and compared literature-reported pulmonary function parameters to quantify pulmonary dysfunction among individuals with high flour dust exposure (among flour mill workers) and relatively un-exposed groups.

Methods: Studies that compared pulmonary function parameters for flour dust exposed and unexposed control groups were systemically searched in PubMed, Scopus and Embase from inception to June 2024. The Newcastle Ottawa scale was used to assess the risk of bias among included studies. With the random effect model, we pooled (along with 95% CI) the mean difference for forced expiratory volume in the first second (FEV), forced vital capacity (FVC), the ratio of FEV & FVC, mid-expiratory flow (FEF25-75%), peak expiratory flow rate (PEFR) and other pulmonary function parameters. Cochran-Q test and I statistics were applied to determine heterogeneity.

Results: This quantitative synthesis included twenty-two studies involving 2,482 flour dust exposed and 1,925 control participants. The pooled mean difference for FEV, FVC, FEV/FVC, PEFR and FEF were - 0.43 L (-0.57, -0.29; I = 88.7), -0.49 L (-0.64, -0.33; I = 89.3), -3.5% (-6.49, -0.5; I = 89.7), -1.36 L/s (-1.70, -1.03; I = 90.4) and - 0.34 L/s (-0.63, -0.06; I = 77.3). The pooled odds ratio for obstructive [12.9 (3.41, 49.2); I = 82.4)] and restrictive changes [5.11 (0.55, 47.4); I = 81.6] were significantly higher among the exposed than controls. As per the bias assessment majority of studies rated with moderate to severe risk of bias.

Conclusion: Study observed pulmonary function deficits associated with exposure to flour dust. However, considering the quality of primary studies and higher heterogeneity, high-quality larger studies with longitudinal design are required to affirm the effects of flour dust on lung function.

References

DerSimonian R, Laird N . Meta-analysis in clinical trials. Control Clin Trials. 1986; 7(3):177-88. DOI: 10.1016/0197-2456(86)90046-2. View

Fonn S, Groeneveld H, deBeer M, BECKLAKE M . An environmental and respiratory health survey of workers in a grain mill in the Johannesburg area, South Africa. Am J Ind Med. 1993; 24(4):387-400. DOI: 10.1002/ajim.4700240405. View

Prakash S, Manjunatha S, Shashikala C . Morbidity patterns among rice mill workers: A cross sectional study. Indian J Occup Environ Med. 2011; 14(3):91-3. PMC: 3062021. DOI: 10.4103/0019-5278.75696. View

Ijadunola K, Erhabor G, Onayade A, Ijadunola M, Fatusi A, Asuzu M . Pulmonary functions of wheat flour mill workers and controls in Ibadan, Nigeria. Am J Ind Med. 2005; 48(4):308-17. DOI: 10.1002/ajim.20219. View

Meo S . Dose responses of years of exposure on lung functions in flour mill workers. J Occup Health. 2004; 46(3):187-91. DOI: 10.1539/joh.46.187. View

Bulat P, Myny K, Braeckman L, Van Sprundel M, Kusters E, Doekes G . Exposure to inhalable dust, wheat flour and alpha-amylase allergens in industrial and traditional bakeries. Ann Occup Hyg. 2004; 48(1):57-63. DOI: 10.1093/annhyg/meg075. View

Iyogun K, Lateef S, Ana G . Lung Function of Grain Millers Exposed to Grain Dust and Diesel Exhaust in Two Food Markets in Ibadan Metropolis, Nigeria. Saf Health Work. 2019; 10(1):47-53. PMC: 6428965. DOI: 10.1016/j.shaw.2018.01.002. View

Awad el Karim M, Gad El Rab M, Omer A, el Haimi Y . Respiratory and allergic disorders in workers exposed to grain and flour dusts. Arch Environ Health. 1986; 41(5):297-301. DOI: 10.1080/00039896.1986.9936700. View

Sundaram P, Kamat R, Joshi J . Flour mill lung: a pneumoconiosis of mixed aetiology. Indian J Chest Dis Allied Sci. 2002; 44(3):199-201. View

10.

Cohen R, Go L, Rose C . Global Trends in Occupational Lung Disease. Semin Respir Crit Care Med. 2023; 44(3):317-326. DOI: 10.1055/s-0043-1766117. View

11.

Athavale A, Iyer A, Sahoo D, Salgia K, Raut A, Kanodra N . Incidence of silicosis in flourmill workers. Indian J Occup Environ Med. 2012; 15(3):104-8. PMC: 3299093. DOI: 10.4103/0019-5278.93199. View

12.

Demeke D, Haile D . Assessment of Respiratory Symptoms and Pulmonary Function Status among Workers of Flour Mills in Addis Ababa, Ethiopia: Comparative Cross-Sectional Study. Pulm Med. 2018; 2018:9521297. PMC: 6220375. DOI: 10.1155/2018/9521297. View

13.

Yach D, Myers J, Bradshaw D, Benatar S . A respiratory epidemiologic survey of grain mill workers in Cape Town, South Africa. Am Rev Respir Dis. 1985; 131(4):505-10. DOI: 10.1164/arrd.1985.131.4.505. View

14.

Kapoor R, Mahajan K, Marya R . Ventilatory and diffusion studies in smoker and non smoker flour-mill workers. Indian J Physiol Pharmacol. 1989; 33(4):211-5. View

15.

Ibekwe R, Okojie O . Lung function indices of flour millworkers in Edo and Delta States. Niger Postgrad Med J. 2014; 21(1):5-10. View

16.

Tatham A, Shewry P . Allergens to wheat and related cereals. Clin Exp Allergy. 2008; 38(11):1712-26. DOI: 10.1111/j.1365-2222.2008.03101.x. View

17.

Luo D, Wan X, Liu J, Tong T . Optimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range. Stat Methods Med Res. 2016; 27(6):1785-1805. DOI: 10.1177/0962280216669183. View

18.

Karpinski E . Exposure to inhalable flour dust in Canadian flour mills. Appl Occup Environ Hyg. 2003; 18(12):1022-30. DOI: 10.1080/714044192. View

19.

Subbarao P, Becker A, Brook J, Daley D, Mandhane P, Miller G . Epidemiology of asthma: risk factors for development. Expert Rev Clin Immunol. 2010; 5(1):77-95. DOI: 10.1586/1744666X.5.1.77. View

20.

Hozo S, Djulbegovic B, Hozo I . Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 2005; 5:13. PMC: 1097734. DOI: 10.1186/1471-2288-5-13. View