Monitoring-Based Assessment of Fluoride Exposure and Health Risks via Drinking Water in the Taruo Lake Region, Tibetan Plateau

Excessive fluoride intake from drinking water remains a public health concern in geogenic high-fluoride regions, yet direct evidence linking environmental fluoride levels to internal exposure in remote high-altitude areas is limited. This study integrated environmental monitoring with human biomonitoring to assess fluoride exposure and health risks in the Taruo Lake region of the Tibetan Plateau. Surface water (n = 45 for Taruo Lake; n = 8 for its tributaries) and groundwater samples (n = 4) were collected and analyzed for fluoride concentrations, and blood ionic fluoride (BIF) levels were measured in 122 local residents (47 adults, 75 children). The results showed that fluoride concentrations in most surface water tributaries of Taruo Lake and groundwater sources were below China’s drinking water standard, whereas those in Taruo Lake exceeded this limit (routine monitoring mean 2.54 mg/L; multi-site mean 2.79 mg/L). BIF levels were significantly higher in adults (0.126 ± 0.041 mg/L) than in children (0.075 ± 0.032 mg/L) and showed a positive correlation with age (r = 0.533, p < 0.001). Notably, 23.4% of adults and 1.3% of children exceeded 0.15 mg/L, an empirical threshold typical for healthy populations in non-endemic areas. Based on the hazard quotient (HQ) model recommended by the US EPA, most drinking water sources posed acceptable non-carcinogenic risks (HQ < 1). In contrast, Taruo Lake water presented an elevated risk (HQ > 1) in 2024 primarily due to the regional geological background, and although not used for daily drinking, this finding offers an indicative reference for local water management and risk prevention. This preliminary monitoring and biomonitoring assessment provides baseline data for future studies and underscores the necessity of continuous surveillance and evaluation of total dietary fluoride intake to protect the health of this vulnerable high-altitude population.