{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T15:59:46Z","timestamp":1792166386722,"version":"4.4.0"},"reference-count":40,"publisher":"BMJ","issue":"10","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Occup Environ Med"],"published-print":{"date-parts":[[2018,10]]},"abstract":"\n Objectives<\/jats:title>\n Diacetyl, a butter flavour compound used in food and flavouring production, is a respiratory toxin. We characterised the burden of respiratory abnormalities in workers at popcorn and flavouring manufacturing facilities that used diacetyl as evaluated through US National Institute for Occupational Safety and Health (NIOSH) health hazard evaluations.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n We performed analyses describing the number and percentage of current and former workers from popcorn and flavouring manufacturing facilities where NIOSH administered a respiratory health questionnaire and spirometry testing who met case definitions of suspected flavouring-related lung disease. Case definitions were pathologist reported: lung biopsy pathology report stating supportive of\/consistent with constrictive bronchiolitis or bronchiolitis obliterans; probable: obstructive\/mixed spirometric pattern with forced expiratory volume in 1\u2009s (FEV\n 1<\/jats:sub>\n ) <60% predicted; possible: obstructive\/mixed spirometric pattern with FEV\n 1<\/jats:sub>\n \u226560%\u2009or any spirometric restriction; symptoms only: normal spirometry plus exertional dyspnoea or usual cough.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n During 2000\u20132012, NIOSH collected questionnaire and spirometry data on 1407 workers (87.0% current, 13.0% former) at nine facilities in eight states. After applying case definitions, 4 (0.3%) were classified as pathologist reported, 48 (3.4%) as probable, 234 (16.6%) as possible and 404 (28.7%) as symptoms only. The remaining 717 (51.0%) workers had normal spirometry without exertional dyspnoea or usual cough. Seven of 11 workers with biopsies did not meet the pathologist-reported case definition, although four met probable and three met possible.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n This approach demonstrates the substantial burden of respiratory abnormalities in these workers. A similar approach could quantify the burden of respiratory abnormalities in other industries that use diacetyl.<\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/oemed-2018-105150","type":"journal-article","created":{"date-parts":[[2018,7,25]],"date-time":"2018-07-25T12:15:22Z","timestamp":1532520922000},"page":"709-715","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":16,"title":["Burden of respiratory abnormalities in microwave popcorn and flavouring manufacturing workers"],"prefix":"10.1136","volume":"75","author":[{"given":"Ethan D","family":"Fechter-Leggett","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra K","family":"White","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen B","family":"Fedan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean M","family":"Cox-Ganser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristin J","family":"Cummings","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,7,25]]},"reference":[{"key":"2020050722594222000_75.10.709.1","unstructured":"National Toxicology Program (NTP). Chemical information review document for artificial butter flavoring and constituents diacetyl [CAS no. 431-03-8] and acetoin [CAS no. 513-86-0]: Research Triangle Park, NC Integrated Laboratory Systems, Inc, 2007."},{"key":"2020050722594222000_75.10.709.2","doi-asserted-by":"publisher","DOI":"10.1080\/15459620802368463"},{"key":"2020050722594222000_75.10.709.3","unstructured":"NIOSH. Hazard evaluation and technical assistance report: American Pop Corn Company, Sioux City, IA. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, NIOSH HETA Report No. 2001\u20130474\u20132943, 2004. https:\/\/www.cdc.gov\/niosh\/hhe\/reports\/pdfs\/2001-0474-2943.pdf."},{"key":"2020050722594222000_75.10.709.4","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.04.00013903"},{"key":"2020050722594222000_75.10.709.5","unstructured":"NIOSH. Hazard evaluation and technical assistance report: Gilster-Mary Lee Corporation, Jasper, MO. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, NIOSH HETA Report No. 2000\u20130401\u20132991, 2006. https:\/\/www.cdc.gov\/niosh\/hhe\/reports\/pdfs\/2000-0401-2991.pdf."},{"key":"2020050722594222000_75.10.709.6","doi-asserted-by":"publisher","DOI":"10.1006\/taap.2002.9525"},{"key":"2020050722594222000_75.10.709.7","doi-asserted-by":"publisher","DOI":"10.1177\/0192623307312694"},{"key":"2020050722594222000_75.10.709.8","doi-asserted-by":"publisher","DOI":"10.1093\/toxsci\/kfn016"},{"key":"2020050722594222000_75.10.709.9","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.165.2.ats01"},{"key":"2020050722594222000_75.10.709.10","unstructured":"Epler GR . Grippi MA , Fishman\u2019s pulmonary diseases and disorders, 2015:778\u201387."},{"key":"2020050722594222000_75.10.709.11","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1204664"},{"key":"2020050722594222000_75.10.709.12","unstructured":"NIOSH. Hazard evaluation and technical assistance report: Agrilink Foods Popcorn Plant, Ridgway, IL. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, NIOSH HETA Report No. 2002\u20130408\u20132915, 2003. https:\/\/www.cdc.gov\/niosh\/hhe\/reports\/pdfs\/2002-0408-2915.pdf."},{"key":"2020050722594222000_75.10.709.13","unstructured":"NIOSH. Hazard evaluation and technical assistance report: Nebraska Popcorn, Clearwater, NE. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, NIOSH HETA Report No. 2002\u20130089, 2003. https:\/\/www.cdc.gov\/niosh\/hhe\/reports\/pdfs\/2002-0089-letter.pdf."},{"key":"2020050722594222000_75.10.709.14","unstructured":"NIOSH. Hazard evaluation and technical assistance report: ConAgra Snack Foods, Marion, OH. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, NIOSH HETA Report No. 2003\u20130112\u20132949, 2004. https:\/\/www.cdc.gov\/niosh\/hhe\/reports\/pdfs\/2003-0112-2949.pdf."},{"key":"2020050722594222000_75.10.709.15","unstructured":"NIOSH. Hazard evaluation and technical assistance report: Carmi Flavor and Fragrance Company, Inc., Commerce, CA. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, NIOSH HETA Report No. 2006\u20130303\u20133043, 2007. https:\/\/www.cdc.gov\/niosh\/hhe\/reports\/pdfs\/2006-0303-3043.pdf."},{"key":"2020050722594222000_75.10.709.16","unstructured":"NIOSH. Hazard evaluation and technical assistance report: Gold Coast Ingredients, Inc., Commerce, CA. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, NIOSH HETA Report No. 2007\u20130033\u20133074, 2008. https:\/\/www.cdc.gov\/niosh\/hhe\/reports\/pdfs\/2007-0033-3074.pdf."},{"key":"2020050722594222000_75.10.709.17","unstructured":"NIOSH. Hazard evaluation and technical assistance report: Chr. Hansen, Inc., New Berlin, WI. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, NIOSH HETA Report No. 2007\u20130327\u20133083, 2009. https:\/\/www.cdc.gov\/niosh\/hhe\/reports\/pdfs\/2007-0327-3083.pdf."},{"key":"2020050722594222000_75.10.709.18","unstructured":"NIOSH. Hazard evaluation and technical assistance report: an evaluation of respiratory health at a flavoring manufacturing facility\u2014Kentucky. Morgantown, WV: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, NIOSH HETA Report No. 2012\u20130012\u20133192, 2013. https:\/\/www.cdc.gov\/niosh\/hhe\/reports\/pdfs\/2012-0012-3192.pdf."},{"key":"2020050722594222000_75.10.709.19","doi-asserted-by":"publisher","DOI":"10.1097\/MCP.0b013e3282f52478"},{"key":"2020050722594222000_75.10.709.20","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa020300"},{"key":"2020050722594222000_75.10.709.21","first-page":"389","article-title":"Fixed obstructive lung disease among workers in the flavor-manufacturing industry--California, 2004-2007","volume":"56","author":"Centers for Disease Control and Prevention (CDC)","year":"2007","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2020050722594222000_75.10.709.22","doi-asserted-by":"publisher","DOI":"10.1097\/01.jom.0000194152.48728.fb"},{"key":"2020050722594222000_75.10.709.23","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1002\/ajim.20858","article-title":"Industry-wide medical surveillance of California flavor manufacturing workers: Cross-sectional results","volume":"53","author":"Kim","year":"2010","journal-title":"Am J Ind Med"},{"key":"2020050722594222000_75.10.709.24","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2008.01.016"},{"key":"2020050722594222000_75.10.709.25","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1101388"},{"key":"2020050722594222000_75.10.709.26","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.02.00282001"},{"key":"2020050722594222000_75.10.709.27","doi-asserted-by":"publisher","DOI":"10.1136\/oemed-2013-101927"},{"key":"2020050722594222000_75.10.709.28","unstructured":"CFR. Code of Federal Regulations. Washington, DC: US Government Printing Office, Office of the Federal Register."},{"key":"2020050722594222000_75.10.709.29","first-page":"1","article-title":"Epidemiology Standardization Project (American Thoracic Society)","volume":"118","author":"Ferris","year":"1978","journal-title":"Am Rev Respir Dis"},{"key":"2020050722594222000_75.10.709.30","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1097\/CPM.0b013e31825d5b57","article-title":"Respiratory disease among flavoring-exposed workers in food and flavoring manufacture","volume":"19","author":"Kreiss","year":"2012","journal-title":"Clin Pulm Med"},{"key":"2020050722594222000_75.10.709.31","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.152.3.7663792"},{"key":"2020050722594222000_75.10.709.32","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.05.00034805"},{"key":"2020050722594222000_75.10.709.33","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.05.00035205"},{"key":"2020050722594222000_75.10.709.34","unstructured":"Centers for Disease Control and Prevention (CDC). About adult BMI. 2017 https:\/\/www.cdc.gov\/healthyweight\/assessing\/bmi\/adult_bmi\/ (accessed Oct 2017)."},{"key":"2020050722594222000_75.10.709.35","doi-asserted-by":"publisher","DOI":"10.1002\/ajim.22282"},{"key":"2020050722594222000_75.10.709.36","doi-asserted-by":"publisher","DOI":"10.1378\/chest.12-1411"},{"key":"2020050722594222000_75.10.709.37","unstructured":"NIOSH. Criteria for a recommended standard: occupational exposure to diacetyl and 2,3-pentanedione. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 2016\u2013111, 2016. https:\/\/www.cdc.gov\/niosh\/docs\/2016-111\/pdfs\/2016-111-all.pdf?id=10.26616\/NIOSHPUB2016111."},{"key":"2020050722594222000_75.10.709.38","unstructured":"Centers for Disease Control and Prevention (CDC). Vital and health statistics series reports, Series 10: data from the National Health Interview Survey. 2015 https:\/\/www.cdc.gov\/nchs\/products\/series\/series10.htm (accessed Oct 2017)."},{"key":"2020050722594222000_75.10.709.39","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.tox.2017.03.019","article-title":"Early detection, clinical diagnosis, and management of lung disease from exposure to diacetyl","volume":"388","author":"Rose","year":"2017","journal-title":"Toxicology"},{"key":"2020050722594222000_75.10.709.40","doi-asserted-by":"publisher","DOI":"10.1186\/s13023-014-0106-8"}],"container-title":["Occupational and Environmental Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/oemed-2018-105150","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,8]],"date-time":"2024-07-08T12:52:27Z","timestamp":1720443147000},"score":1,"resource":{"primary":{"URL":"https:\/\/oem.bmj.com\/lookup\/doi\/10.1136\/oemed-2018-105150"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,7,25]]},"references-count":40,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2018,9,13]]},"published-print":{"date-parts":[[2018,10]]}},"alternative-id":["10.1136\/oemed-2018-105150"],"URL":"https:\/\/doi.org\/10.1136\/oemed-2018-105150","relation":{"has-review":[{"id-type":"doi","id":"10.3410\/f.733700061.793549460","asserted-by":"object"}]},"ISSN":["1351-0711","1470-7926"],"issn-type":[{"value":"1351-0711","type":"print"},{"value":"1470-7926","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,7,25]]}}}