1 Meta-Analysis Showing Heterogeneity oOf Human Exposure tTo Microplastics

2 tThrough Drinking Water

3

4 AbstractABSTRACT
5 : Growing concerns about health risks caused by microplastics are rapidly increasing.

6 Drinking water is one of the primary pathways of microplastics ingested by humans.

7 However, the contribution of microplastic exposure through drinking water is still unclear.

8 Here, we conducted a systematic meta-analysis of microplastics in drinking water and found

9 significant heterogeneity among the studies. Small-size microplastics (<50 μm) accounted for

10 more than 71% and 49% of the total microplastics found in plastic bottled water and tap

11 water, respectively. The most frequently detected polymer types were PET, PP, and PE in

12 drinking water. Furthermore, microplastic abundance in tap water was significantly correlated

13 with the volume of sampling samples and the minimum size of microplastics detected in

14 samples. The average intake rate of microplastics estimated is 139.49 particles/capita/day, in

15 which primary microplastics are ingested by bottled water consuming more tiny particles (1-

16 10 μm). Most importantly, an irreversible accumulation of 1-10 μm particles in body tissue

17 reaches 8.02 × 102 particles/capita until 18 years old and 3.12 × 10 3 particles/capita until 70.

18 Thus, more attention should focus on the potential health risk caused by microplastics from

19 the consumption of bottled water in the future, especially these tiny microparticles less than

20 10 μm in size.

21 1. IntroductionINTRODUCTION

22 Microplastics, defined as tiny plastic particles less than 5 mm in size, are emerging

23 anthropogenic pollutants in the environment due to the rapid increase in plastic production

24 and usage worldwide. These tiny particles are ubiquitously detected in various foods (Kim et

25 al., 2018; Liebezeit and Liebezeit, 2013; Smith et al., 2018), drinking water (Kosuth et al.,

26 2018), and air (Christian et al., 2019), resulting in microplastics frequently found in human

27 tissue and stool (Ibrahim et al., 2021; Ragusa et al., 2021; Zhang et al., 2021a). Generally,

28 ingestion is one of the primary pathways through which humans are exposed to microplastic

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29 pollution. It is concluded that an average of 0.10−5.0 g of microplastics would be ingested

30 weekly per person (Senathirajah et al., 2021). Moreover, it is estimated that the annual intake

31 of microplastics through different foods is as follows; 11,000 particles from seafood (Cho et

32 al., 2019; Van Cauwenberghe and Janssen, 2014), 0−73,000 particles from salt (Zhang et al.,

33 2020), 90,000 particles from bottled water (Cox et al., 2019), and 114,000 particles from tap

34 water (Cox et al., 2019). From the above statements, it looked like microplastics in drinking

35 water contributes to the main proportions of total microplastics ingested through foods. Due

36 to the lack of standardization in the analysis of microplastics, however, the information is still

37 unclear on human exposure to microplastic ingestion through drinking water (Zhang et al.,

38 2020).
39 Studies reported that microplastics hopelessly polluted 93% of the total 259 tested bottles

40 with an average of 10.4 particles/L (> 100 μm) (Mason et al., 2018). Moreover, 81% of the

41 global sources of tap waters were also contaminated with anthropogenic plastic particulates,

42 of which the contamination rates in developed countries are significantly higher than that in

43 developing countries (Kosuth et al., 2018). Recently, World Health Organization (WHO)

44 released a report related to microplastic contamination in drinking water (WHO, 2019),

45 pointing out that it is urgent to implement a more accurate assessment of exposure to

46 microplastics and their potential impacts on human health. This is due to the rising concerns

47 about the health risks of microplastics in drinking water. Danopoulos et al. (2020b) conducted

48 a systematic review of microplastic contamination in drinking water. They estimated that the

49 microplastic abundance in bottled water (4889 particles/L) was significantly higher than that

50 ofin tap water (628 particles/L). Surprisingly, it is estimated that drinking water, including

51 both tap water and bottled water, was the largest source of microplastic particles ingested per

52 person, per year (Senathirajah et al., 2021). All of these implied that more microplastics

53 would be ingested through the consumption of bottled water. However, the minimum size of

54 microplastics detected in drinking water varied greatly because different analytical

55 technologies and methods were employed extensively, resulting in a significant variation of

56 microplastic abundance in samples. For example, the minimum size of microplastics detected

57 in tap water was often more than 10 μm (Mintenig et al., 2019; Zhang et al., 2019) as detected

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58 by Fourier transform-infrared (FTIR), while one study lowed the detection limit to 1 μm by

59 combination with FTIR and Raman (Pivokonsky et al., 2018). Consequently, Danopoulos et

60 al. (Danopoulos et al., 2020a) also wondered why their conclusion was controversial due to

61 the limited available data. Furthermore, Mohamed et al. (2021) developed a probabilistic

62 lifetime exposure model to account for the variability of microplastic exposure through

63 different intake pathways. They concluded that all ingestion pathways were the highest level

64 among all ingestion pathways, with 1.96 × 10−2 mg/capita/day. However, the microplastic

65 data in bottled and tap water from nine studies only were roughly analyzed in their research.

66 Meanwhile, limited data quality also affected the results derived from the present data. As far

67 as we know, quality assurance not only ensures the high quality of individual studies but also

68 allows reproducibility and comparability of results obtained from different studies, and

69 further promotes the availability of data for risk assessment. For example, Koelmans et al.

70 (2019) proposed that quality assurance is crucial to prevent quality failure for further analysis.

71 Based on the principles of environmental scientific evidence (Higgins et al., 2011), risk of

72 bias (RoB) has been established in recent years as a promising assessment tool to screen and

73 filter the data quality for accurate microplastic analysis (Page et al., 2018).
74 The literature about microplastic abundance in drinking water has been expanding

75 promptly in recent years because of growing public and scientific interest moving forward

76 with the potential health risk related to microplastics. Also, the data about microplastic

77 abundance was significantly improved with the development of advanced analytical

78 technologies and methods. It would promote filling in the knowledge gap of the microplastic

79 exposure risk through drinking water. Here, our primary aim was to learn the microplastic

80 ingestion through drinking water based on the latest data on microplastics in drinking water.

81 This result emphasized the potential health risk of microplastic contamination in drinking

82 water, especially bottled water. As expected, it would provide scientific evidence to

83 implement health risk assessment caused by microplastics in drinking water.

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 84 2. Materials and MethodsMATERALS AND METHODS

85 2.1. Data processing

86 A literature search was conducted to focus on microplastics in drinking water. The

87 deadline for these available studies was November 31, 2021. Peer-reviewed scientific

88 literature in the Web of Science (WoS) database was retrieved and screened using a series of

89 search strings: TS = ((microplastic* OR micro-plastic) AND (drink* OR tap OR mineral OR

90 bottle* OR potable)). The type of literature was limited to only “article”, but non-English

91 records were also excluded. The same retrieval strategy was implemented in Scopus and

92 Google Scholar databases to avoid incomplete searches. After that, all unreliable results were

93 phased out according to the following criteria: (1) only drinking water was the topic,

94 including plastic bottled water, glass bottled water, and tap water, and (2) control groups and

95 experimental groups were carried out throughout test, (3) microplastic abundance and

96 morphological characteristic were available simultaneously, and (4) sampling, processing,

97 and identification methods for microplastics were reported clearly. Finally, articles that met

98 the above criteria were retained. Then, the name of the first author, year of publication,

99 countries, methods of sampling and processing, the mean and standard error value of

100 microplastic abundance, number of samples, and microplastic characteristics were extracted

101 from the retained literature (Supplementary Materials).

102 2.2. Filtering Ddata Uusing the RoB Aassessment Ttool

103 To improve the data quality for further analysis, these remaining studies were filtered by

104 ulterior means ulteriorly filtered using an RoB assessment tool (Higgins et al., 2011) with

105 four domains (Danopoulos et al., 2020a): study design, sampling, analysis, and reporting

106 (Supplementary Materials), and finally gave an overall assessment. For each entry, a

107 question was answered (No, Yes, or Indetermination) referring to the prompt message. The

108 accumulation of all entries constitutes an overall rating of every study. The overall rating of

109 each study could be classified into three groups: high risk, low risk, or uncertainty. All studies

110 in the group with high RoB were phased out firstly, and the remaining were subjected to

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111 further analysis at the next step. The visualization analysis of RoB was conducted using

112 software Review Manager 5.4 (the Cochrane Collaboration).

113 2.3. Data Aanalysis

114 The random and fixed-effect models in the R package (version 4.1.3) were employed to

115 implement a meta-analysis for data obtained from the outputs after the RoB assessment. As a

116 result, an average microplastic abundance was expressed as particles per liter. The statistical

117 significance among studies was defined by a 95% confidence interval (CI) with a p-value <

118 0.05. After that, Spearman’s correlation was applied to check the relationships between

119 microplastic abundance and multiple factors. These factors were the sampling volume, the

120 number of samples, the processing method, the minimum size, polymer identification

121 technology, measured contamination, and the recovery rate. Subsequently, the multiple linear

122 regression and generalized linear models were used to fit these correlation factors and confirm

123 which factors were remarkably related to microplastic abundance.

124 3. ResultsRESULTS

125 3.1. Studies Ccharacteristics

126 After the preliminary screening, 318 studies were obtained from the WoS, Scopus, and

127 Google Scholar databases. Based on their titles and abstracts, 250 publications were phased

128 out, and finally, 68 articles were filtered from the 318 studies. The remaining were further

129 evaluated, and a total of 29 studies that met the criteria set for the following RoB analysis

130 were extracted that met the criteria set for the following RoB analysis. Subsequently, studies

131 related to bottled water had higher RoB than those for tap water (Fig. 1 and Fig. S1), which

132 was contributed mainly by the domains of analysis and reporting. Specifically, a failure to

133 adopt neither of the four validated identification methods resulted in high RoB of the

134 reporting domains, including FTIR, Raman, pyrolysis gas chromatography/ mass

135 spectrometry (Pyr-GC-MS), and scanning electron microscopy plus (SEM) (Supplementary

136 Materials). According to the overall rating for individual studies across four domains, three

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137 studies scored with high RoB were eliminated (Fig. S1), and 26 articles were kept for further

138 meta-analysis.
139 Among these 26 studies, 16 detected microplastics in tap water, and 10 articles tested

140 bottled water. Moreover, 9 studies investigated microplastics in plastic bottled water, 4 studies

141 detected microplastics in glass bottled water, in which 3 studies simultaneously detected

142 microplastics in plastic bottled water and glass bottled water. The studies from Europe

143 contributed to the majority, including 5 articles for bottled water and 9 articles for tap water,

144 followed by Asia with 4 studies for bottled water and 7 for tap water, both North America and

145 South Americas with 2 for bottled water and 3 for tap water, and Africa with 1 for bottled

146 water. Of course, 2 studies detected microplastics in drinking water synchronously sampled

147 from Europe, Asia, and boththe Americas. Additionally, more than half of the studies (53.8%)

148 employed wet peroxide oxidation to digest organic matter and isolated particles based on the

149 principle of density separation. Among these studies, FTIR (53.8%), Raman (42.3%), Pyr-

150 GC-MS (7.7%), and SEM (19.2%) are often used to identify and confirm polymer types of

151 microplastics. However, a few studies (11.5%) simply observed microplastics by visual

152 inspection and staining.

153 3.2. Meta-analysis of Mmicroplastics in Bbottled Wwater

154 Microplastic abundance in plastic bottled water varied significantly among nine studies,

155 ranging from 2.93 particles/L to 2649 particles/L with an average of 52.98 particles/L (I2 =

156 91%, p < 0.05) (Fig. 2a). Given the microplastic abundance depending on the minimum size

157 of particles detected, a subgroup meta-analysis for 7 studies was conducted with the lowest

158 detection limits of 1-5 μm. As expected, an average of 104.58 particles/L of microplastics

159 were extracted, ranging from 8.5 particles/L to 2649 particles/L (I2 = 86%, p < 0.05) (Fig. 2b),

160 which was nearly double the microplastic abundance in 9 studies. It implied that microplastics

161 with small sizes dominated the total microplastics in samples. Although it looked like the

162 microplastic abundance was related to the lowest detection limits in samples, Spearman’s

163 correlation analysis showed microplastic abundance was independent of the lowest detection

164 limit and even the other five factors. This might be related to the present limited data, which

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165 were insufficient to infer a solid conclusion.
166 After phasing out 1 study without the exact size information, the remaining eight studies

167 were classified into four groups according to these sizes of microplastics: 1-50 μm, 50-100

168 μm, 100-500 μm, and >500 μm. Interestingly, 1-50 μm of microplastics in size were the main

169 components, accounting for 71% of the total microplastics detected in all samples. It should

170 point out that the lowest detection limits in 6 studies were more than 1 μm in the 1-50 μm

171 group (66.7%), which depended on the limitation of the pore size of the filter membrane. The

172 polymer types of microplastics also showed significant variations in nine studies. Among the

173 total 11 polymers detected in drinking waters, polyethylene terephthalate (PET),

174 polypropylene (PP), and polyethylene (PE) were the most popular types, corresponding to

175 more than 40%, 20%, and 10%, respectively. And the highest percentage of these three

176 microplastic polymers reached 78%, 54%, and 24.8% (Ossmann et al., 2018). Of course, a

177 few polymers might be the dominant components of microplastics in individual studies. For

178 instance, Schymanski et al. (2018) showed that the polymer blend of a polyester polymer with

179 PET accounted for 54%, which was the primary polymer in all polymers identified. Besides

180 PP, Mason et al. (2018) found nylon (16%) was the most dominant polymer among

181 microplastics, while Ibeto et al. (2021) reported that polydimethyl siloxane (PDMS)

182 accounted for 17.9% as the main component of the total polymers in their study.
183 Additionally, four studies investigated the microplastic profiles in glass bottled water

184 which also showed notable variations. An average microplastic abundance of 93.69

185 particles/L (p < 0.05) (Fig. 3) was reported, which was close to that in plastic bottled water.

186 Moreover, the lowest detection limits in three studies were set to 1-5 μm, while only one

187 study detected microplastics more than 10 μm in size.

188 3.3. Meta-Aanalysis of Mmicroplastics in Ttap Wwater

189 Sixteen studies detected microplastics in tap water. Their results showed that an average

190 abundance of microplastics was 2.05 particles/L in tap water, ranging from 0.0007 particles/L

191 to 469.89 particles/L (I2 = 99%, p < 0.05) (Fig. 4(a)). However, the microplastic abundance

192 was lower significantly lower than that detected in bottled water (p < 0.05). Subsequently, the

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193 Spearman's Rank Correlation analysis showed that four factors significantly influenced

194 microplastic abundance in tap water, including the sampling volume (p=0.000), the minimum

195 size of particles (p=0.005), recovery rate reported, or not (p=0.012), and background

196 contamination (p=0.019). After fitting the four factors, the Multiple Linear Regression further

197 showed that microplastic abundance was only related to the minimum size of particles (p <

198 0.05). However, these studies showed that the microplastic abundance decreased with the

199 increase of sampling volume, implying that the sampling volume is also an influencing factor

200 in microplastic abundance (Fig. S2). The outputs have also demonstrated this from the

201 generalized linear model. That is, both the sampling volume and the minimum size of

202 particles were positively correlated with microplastic abundance (p = 0.000 < 0.05) (Table 1).

203 Furthermore, fifty liters samples might be an inflection point for sampling because

204 microplastic concentration (0.0007-0.38 particles/L) was nearly kept constant when more than

205 50 L were sampled (p > 0.05) (Table 2). Consequently, a sampling volume of at least 50 L

206 should be required for microplastic analysis in tap water. At the same time, the Random Effect

207 Model (REM) was used to perform subgroup analysis for 9 studies with the lowest detection

208 limits of 1-5 μm. The result showed that the average abundance of microplastics (23.57

209 particles/L) was higher, 11-fold than those in 16 studies, ranging from 0.04 to 469.89

210 particles/L (Fig. 4b). It suggested that small-size microplastics in samples, particularly 1-5

211 μm particles, contributed to the dominant composition of microplastics. It was also found in

212 plastic bottled water.

213 After removing 2 studies without size information, the remaining 14 studies were

214 grouped according to the size of microplastics: 1-50 μm, 50-100 μm, 100-500 μm, and >500

215 μm, corresponding to 49%-62%, 8%-31%, 37.12%-44.33%, 26.09%-28.74%, respectively. It

216 indicated that 1-50 μm of microplastics were more abundant than large microplastics.

217 Furthermore, a total of 12 types of polymers were identified and confirmed in 12 studies after

218 removing 4 studies without polymer information. The dominant polymer types in all

219 microplastics consisted of polyethylene (PE), polypropylene (PP), polystyrene (PS), and

220 polyethylene terephthalate (PET), with an average percentage of 22.8%, 16.5-18.1%, 7.3%,

221 and 25.6%, respectively. Furthermore, the highest proportions of these four polymers each

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222 reached 73%, 50%, 30.5%, and 56.9%, with notable variation among studies (Feld et al.,

223 2021; Johnson et al., 2020; Mukotaka et al., 2021; Pittroff et al., 2021). PVC and PEST were

224 occasionally found to be the dominant polymers in two studies (Kankanige and Babel, 2020a;

225 Mintenig et al., 2019). Additionally, PA, PEST, nylon, polyvinyl chloride (PVC), styrene-

226 ethylene butylene copolymer (SEBS), and polyphenylene sulfide (PPS) were also reported in

227 a few studies as the main compositions of microplastics. For instance, Mukotaka et al. (2021)

228 identified six polymer types in tap water sampled from five countries and reported that SEBS

229 and polyester (PES) accounted for 17.3% and 12.2% respectively of all microplastics with

230 relatively high proportions.

231 3.4. Exposure Aassessment of Mmicroplastics in Ddrinking Wwater

232 Based on the latest available information about microplastic abundances, sizes, and

233 polymers in plastic bottled water and tap water by meta-analysis, a probabilistic exposure

234 model (Mohamed et al., 2021) predicted that an adult could ingest 139.49 particles/capita/day

235 of microplastic (1-5000 μm) through the drinking water pathway (Text S2). Furthermore, the

236 median abundance of microplastics in tissues would reach 8.02 × 102 (1.97 × 102 – 2.10 × 103)

237 particles/capita until 18-year-old and 3.12 × 103 (7.67 × 102 - 8.18 × 103) particles/capita until

238 70-year-old if 1-10 μm microplastics is accumulate throughout the whole lifetime. Taking into

239 account the personal habits of drinking water for humans, the ingestion rate of microplastics

240 is dramatically different if only drinking either bottled water or tap water. An average of

241 209.16 microplastics per day would be ingested through plastic bottled water, while a few

242 47.14 particles per day would be consumed if drinking tap water only. It showed that the daily

243 intake of microplastics through bottled water is more than 4 times higher than the intake that

244 through tap water. This is due to more microplastics being detected in bottled water,

245 according to the results of a meta-analysis. Our investigation also verified this result. We

246 detected microplastics in 5 common brands of plastic bottled water and tap water in Beijing,

247 and the microplastic abundance was used as the input of the probabilistic exposure model.

248 The results showed that 118.14 microplastics per day would be ingested through plastic

249 bottled water, while 85.42 microplastics ingestion per day through tap water. However, little

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250 difference in the daily ingestion of microplastics between plastic bottled water and tap water

251 was shown in our investigation. This might be related to the lowest detection limits, which

252 were 10 μm in our study while 1-5 μm in the literature. Thus, more concerns should focus on

253 small-size microplastics (1-10 μm) to estimate microplastic abundance and further assess

254 human health risks.

255 4. DiscussionDISCUSSION

256 4.1. Microplastics in Ddrinking Wwater

257 Microplastic abundance in plastic bottled water was 52.98 particles/L, ranging from 2.93

258 particles/L to 2649.00 particles/L, and 2.05 particles/L in tap water, ranging from 0.0007

259 particles/L to 469.89 particles/L. Interestingly, there was only a little difference in

260 microplastic abundance between plastic bottled water and glass bottled water. Nevertheless,

261 more microplastics were detected in plastic bottled water than in tap water, implying more

262 microplastics would be ingested through bottled water than in tap water. Presently, some

263 countries and regions consume bottled water as a daily drinking water source because their

264 piped water supplies are contaminated and unsafe for consumption (Mohamed et al., 2021).

265 Of course, some consumers with certain habits, especially young people, only drink bottled

266 water for convenience. Based on our investigation, for example, we found that 27.45% of

267 young people only drink only plastic bottled water a per day in Beijing. Consequently, they

268 might ingest more microplastics than those who take tap water as a primary drinking water

269 source. Compared to plastic bottled water, polymer types in tap water showed more abundant

270 diversities, suggesting the microplastics in tap water are derived from more sources than

271 bottled water. As the dominant kinds of polymers in drinking water, PE, PP, and PET are the

272 most popular plastics due to the rapid increase of demand worldwide, which has led to

273 comprehensive detection with relatively high abundance. Regarding the source of

274 microplastics in drinking water, the packaging material of bottles might be the major

275 contributor. The bottles made of PET and the bottle-caps made of HDPE generate

276 microplastics due to the physical abrasion during transport, storage, shaking, opening, and/or

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277 injection of water into the plastic bottle with high pressure (Kankanige and Babel, 2020b).

278 This was also verified that microplastic abundance was higher in water from the reusable

279 glass and PET bottles than in disposable plastic bottles owing to constant abrasion

280 (Schymanski et al., 2018). Of course, it cannot be ruled out that parts of microplastics might

281 result from the treatment process of drinking water despite the sources of water also

282 containing microplastics. In contrast, nearly no physical abrasion occurs in tap water from the

283 source to drinking, so microplastics in tap water might be mainly derived from PVC, PE, or

284 PP pipes in drinking water distribution systems or households (Mintenig et al., 2019).

285 Therefore, it is recommended to conduct further studies on the production, cleaning, and

286 refilling processes for bottled water to eliminate microplastic contamination from sources.

287 4.2. Potential Ffactors for Ddistribution Hheterogeneity

288 Due to distribution heterogeneity, microplastic abundances in bottled water and tap water

289 range from 3 to 6 orders of magnitude. Among the four factors related to microplastic

290 abundance in tap water, the minimum size and sampling volume showed tighter effects than

291 the other two factors. Studies also found that microplastics less than 50 μm dominated total

292 microplastics detected in samples., Eespecially microplastics with size < 5 μm were higher

293 abundance than others (Pivokonsky et al., 2018; Shen et al., 2021; Tong et al., 2020).

294 Generally, the sizes of particles detected in samples depended on the pore size of filter

295 membranes (Zhang et al., 2020) and the resolution of spectroscopy identification. Smaller-

296 sized microplastics are escaped easily from a filter membrane with a large pore size during

297 filtration, resulting in that microplastic abundance being seriously underestimated (Karami et

298 al., 2017). For example, microplastic abundance treated with 0.45 μm pore size of filters (96

299 particles/L) (Kankanige and Babel, 2020a) was significantly higher than those treated with 50

300 μm pore size of filters (0.62-0.68 particles/L) (Chanpiwat and Damrongsiri, 2021). Different

301 detection techniques also resulted in the variation of particle sizes, and further influenced

302 microplastic abundance. Frond et al. (2022) employed various techniques to identify

303 microplastics in drinking water, and they showed that optical microscopy was appropriate for

304 identifying plastic particles more than 50 μm in size. Alternatively, FTIR identification is non-

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305 effective for particles less than 20 μm, and Raman effectively identifies 3-20 μm plastic

306 particles with 94% accuracy.

307 Sufficient sampling volume is also vital to determine all particle sizes in samples, and

308 further accurately quantify microplastic abundance. For example, Weber et al. (2021) and

309 Mukotaka et al. (2021) filtered tap water samples with a 10 μm filter membrane for

310 microplastic analysis. As a result, the smallest particle of 10 μm in size was detected by

311 Weber et al. (2021) who employed a bulk water sampling method (250-1300 L), while the

312 smallest particle of 19.2 μm in size was detected by Mukotaka et al. (2021) who treated 0.5 L

313 water sample only. Thus, bulk sampling is an admirable method to capture

314 more microplastics within the smaller size range in samples, improving the data quality than a

315 method with a small volume of sampling (Guo et al., 2021). It is a pity that, however,

316 presently, no specific factor has been identified to affect the abundance of microplastics in

317 bottled water due to limited data and tiny plastic particles that are often too small to observe.

318 4.3. Human Eexposure to Microplastics

319 Recent studies reported that humans constantly inhale and ingest microplastics. It is

320 estimated that microplastic median intake rates were 883 particles/capita/day through both

321 ingestion and inhalation for adults. The present study predicted that microplastic ingestion

322 through the drinking water contributed to nearly 20% of the total microplastic intake daily,

323 indicating drinking water would contribute to microplastic ingestion as the primary exposure

324 pathway. Moreover, small-size particles were the dominant composition among microplastics

325 in drinking water, especially 1-5 μm microplastics in size. Generally, microplastics are

326 smaller in size and; microplasticsics are more easily absorbed by humans and pose adverse

327 impacts on health (WHO, 2019). Thus, it is reasonable to assume that the health effects have

328 already occurred owing to the general population's constant exposure to microplastics through

329 drinking water.

330 This assumption has been demonstrated by existing evidence despite the limited studies,

331 including various microplastics detected in colectomy specimens (Ibrahim et al., 2021) and

332 stool (Schwabl et al., 2019; Zhang et al., 2021b). Additionally, 12 microplastics were detected

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333 in placentas’ samples (Ragusa et al., 2021). Most importantly, a recent study first reported

334 microplastics’ occurrence in the blood (Leslie et al., 2022). It implied that microplastics could

335 circulate from the gut into the blood, and then into internal organs which cause adverse health

336 effects in many ways, such as inflammatory responses, oxidative stress, and gut microbiome

337 dysbiosis. For example, Yan et al. (2021) found that microplastic abundance in the fecal of

338 inflammatory bowel disease patients (41.8 particles/g) was significantly higher than that in

339 healthy people (28.0 particles/g dm), suggesting that microplastics in the body might pose

340 adverse impacts on human health. This was confirmed by microplastics absorbed after

341 drinking water and other pathways ingestion. In theory, microplastics of sizes smaller than

342 150 μm could translocate to the lymph and circulatory system (Barboza et al., 2018). Still, no

343 more than 0.3% of these ingested particles could be further up-taken through pinocytosis and

344 vesicular phagocytic processes (Galloway, 2015). Moreover, only microplastics < 10 μm in

345 size might penetrate specific organs, and particles < 1.5 μm could access all organs smoothly

346 and circulate to other organs (EFSA, 2016). For example, it has also been reported that

347 microplastics can enter the circulation system and reach human tissues through cellular

348 internalization (Browne et al., 2008; Deng et al., 2021; Ramsperger et al., 2020). Without

349 hesitation, the harmful effects of microplastics on human health are size-dependent,

350 suggesting that small-size microplastics in drinking water might pose more severe outcomes.
351 It is also not enough to compile the particle size and abundance to assess the health risk

352 caused by microplastics through drinking water; other vital factors also need to be considered,

353 such as polymer type. It is reported that PVC is more hazardous than common polymers after

354 continuous accumulation (Zhu et al., 2018), which is in line with the PVC having a relatively

355 higher potential level of risk to human health than PP, PS, PET, LDPE, and HDPE (Yuan et

356 al., 2022). Similarly, Machado et al. (2018) also reported that microplastic risks are a

357 combination of physical and chemical effects. That is, the toxic effects of microplastics on

358 human health are highly complicated. They are not only related to particle size and

359 abundance, but also, the plastic additives leaching out, or hydrophobic pollutants adsorption

360 on the surface. Of course, these harmful parameters are only the first step to understanding the

361 impacts of microplastics on human health, and more definitive evidence linking microplastic

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362 ingestion to human health is urgent to be provided, including drinking water. As a result, the

363 accurate exposure assessment needs sufficient and high-quality data, including abundance,

364 size, polymer, shape, chemical toxicity, and even microbial toxicity (Koelmans et al., 2019).

365 5. Conclusion

366 The present study showed highly significant heterogeneity of microplastic abundance in

367 drinking water after screening and filtering the available data based on a standard RoB

368 assessment tool. Microplastic abundance was also significantly correlated with the minimum

369 size and sampling volume in tap water, particularly 50 L as the turn-point for sampling

370 microplastics in tap water and 1-5 μm as the minimum size of microplastics detected . It is

371 estimated that an average abundance of 139.49 particles/capita/day of microplastic was

372 ingested through drinking water, in which plastic bottled water contributed more particles

373 than tap water. Significantly, 1-10 μm of microplastics could accumulate to 8.02 × 102

374 particles/capita until 18-year-old and 3.12 × 103 particles/capita until 70-year-old, accounting

375 for 20% of total intake daily according to the previous estimation of eight foods and air. The

376 information is expected to update the existing knowledge about human health risks exposure

377 to microplastics through drinking water.

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