Fish Intake During Pregnancy and Early Cognitive Development of Offspring

Varying coefficient function models to explore interactions between maternal nutritional status and prenatal methylmercury toxicity in the Seychelles Child Development Nutrition Study

Maternal consumption of fish during the gestational period exposes the fetus to both nutrients, especially the long-chain polyunsaturated fatty acids (LCPUFAs), believed to be beneficial for fetal brain development, as well as to the neurotoxicant methylmercury (MeHg). We recently reported that nutrients present in fish may modify MeHg neurotoxicity. Understanding the apparent interaction of MeHg exposure and nutrients present in fish is complicated by the limitations of modeling methods. In this study we fit varying coefficient function models to data from the Seychelles Child Development Nutrition Study (SCDNS) cohort to assess the association of dietary nutrients and children's development. This cohort of mother-child pairs in the Republic of Seychelles had fish consumption averaging 9 meals per week. Maternal nutritional status was assessed for five different nutritional components known to be present in fish (n-3 LCPUFA, n-6 LCPUFA, iron status, iodine status, and choline) and associated with children's neurological development. We also included prenatal MeHg exposure (measured in maternal hair). We examined two child neurodevelopmental outcomes (Bayley Scales Infant Development-II (BSID-II) Mental Developmental Index (MDI) and Psychomotor Developmental Index (PDI)), each administered at 9 and at 30 months. The varying coefficient models allow the possible interactions between each nutritional component and MeHg to be modeled as a smoothly varying function of MeHg as an effect modifier. Iron, iodine, choline, and n-6 LCPUFA had little or no observable modulation at different MeHg exposures. In contrast the n-3 LCPUFA docosahexaenoic acid (DHA) had beneficial effects on the BSID-II PDI that were reduced or absent at higher MeHg exposures. This study presents a useful modeling method that can be brought to bear on questions involving interactions between covariates, and illustrates the continuing importance of viewing fish consumption during pregnancy as a case of multiple exposures to nutrients and to MeHg. The results encourage more emphasis on a holistic view of the risks and benefits of fish consumption as it relates to infant development.

Partial linear inference for a 2-stage outcome-dependent sampling design with a continuous outcome

The outcome-dependent sampling (ODS) design, which allows observation of exposure variable to depend on the outcome, has been shown to be cost efficient. In this article, we propose a new statistical inference method, an estimated penalized likelihood method, for a partial linear model in the setting of a 2-stage ODS with a continuous outcome. We develop the asymptotic properties and conduct simulation studies to demonstrate the performance of the proposed estimator. A real environmental study data set is used to illustrate the proposed method.

Neurobehavioral effects of prenatal exposure to methylmercury and PCBs, and seafood intake: neonatal behavioral assessment scale results of Tohoku study of child development

As factors affecting neonatal neurodevelopment, methylmercury, polychlorinated biphenyls (PCBs), and maternal seafood intake reflecting n-3 polyunsaturated fatty acids (PUFAs) are believed to have adverse or beneficial effects, but there are a few reports addressing such factors simultaneously. We carried out a birth cohort study to clarify the effects of these three factors on the Neonatal Behavioral Assessment Scale (NBAS), administered 3 days after birth. In a total of 498 mother-neonate pairs, the total mercury level (median, 1.96microg/g) in maternal hair at parturition and the summation operatorPCB level (45.5ng/g-lipid) in cord blood were analyzed, and maternal seafood intake was estimated using a semi-quantitative food frequency questionnaire. A negative relationship between the hair mercury level and the motor cluster of NBAS was observed, even after adjusting for PCBs, maternal seafood intake, and possible confounders such as maternal age, birth weight, and parity. The summation operatorPCB level was negatively correlated with the motor cluster, but this association was attenuated after adjusting for mercury and the confounders. There was seen to be a positive association between maternal seafood intake and the motor cluster when considering the effects of mercury and PCBs. In conclusion, our data suggest that prenatal exposure to methylmercury adversely affects neonatal neurobehavioral function; in contrast, maternal seafood intake appears to be beneficial. The neurobehavioral effect of prenatal exposure to PCBs remains unclear in our study. Further research is necessary to elucidate interactive effects of methylmercury, PCBs, and n-3 PUFAs, originating from fish, on child neurodevelopment.

A risk-benefit analysis of wild fish consumption for various species in Alaska reveals shortcomings in data and monitoring needs

Northern peoples face a difficult decision of whether or not to consume wild fish, which may contain dangerous levels of contaminants such as methylmercury (MeHg), but which also offer a number of positive health benefits, and play an important role in rural household economies. Here, new methods for developing consumption advice are applied to an existing data-set for methylmercury (MeHg) levels in Alaskan fish. We apply a quantitative risk-benefit analysis for eight freshwater, saltwater and anadromous fish species, using dose-response relationships to weigh the risks of MeHg bioaccumulation against the benefits of omega-3 fatty acids (EPA and DHA) toward cardiovascular and neurodevelopmental health endpoints. Findings suggests that consumption of many of the fish species reviewed here, including northern pike, Pacific Halibut, and arctic grayling, may lead to increased risk of coronary heart disease and declines in infant visual recognition memory. However, we also identify significant variation among regions, among studies within the same region, and also within studies, which make it difficult to craft consistent consumption advice. Whereas salmon consistently shows a net-benefit, for instance, data for arctic grayling, pike, sablefish, and some halibut are all too imprecise to provide consistent recommendations. We argue for more detailed local-scale monitoring, and identification of possible thresholds for increased risk in the future. We caution that MeHg and omega-3 FA are just two variables in a complicated calculus for weighing the risks and benefits of locally-available and culturally-significant foods, and argue for future work that takes both a place-based and plate-based approach to diet and contamination.

Hair mercury levels in pregnant women in Mahshahr, Iran: fish consumption as a determinant of exposure

MeHg is a well-documented neurotoxicant even at low levels of exposure. Developing brain, in particular, is vulnerable to that. Through bioaccumulating to differing degrees in various fish species, it can have serious adverse effects on the development and functioning of the human central nervous system, especially during prenatal exposure. Therefore, the purpose of this study was to investigate mercury concentration in hair samples of pregnant women living in Mahshahr located in Khuzestan province, Iran. It assessed the association between fish consumption and specific characteristics that can influence exposure. From April to June 2008, 149 pregnant women were invited to participate in this study. An interview administered questionnaire was used to collect information about age, body weight, height, fish (fresh, canned and shrimp) consumption, pregnancy stage, residence duration, education level, family income and number of dental amalgam fillings. The obtained results showed that the geometric mean and range for hair total Hg concentration was 3.52 microg/g (0.44-53.56 microg/g). About 5.4% of mothers had hair total Hg levels in excess of 10 microg/g. Maternal hair mercury level was less than threshold level of WHO (5 microg/g). As expected, there was a clear increase in hair Hg with reported fresh marine fish consumption (p=0.04). The highest mean for hair mercury level in a group who consumed fish several times per week, was 4.93 microg/g. Moreover, a significant effect of age and residential time on Hg concentration in the hair of the women was found. Pregnant women in Mahshahr consumed large amounts of fish; consequently, most of their offspring were prenatally exposed to moderately high levels of mercury. The results found suggest that pregnant women should decrease their fish consumption.

Fish consumption, mercury exposure, and their associations with scholastic achievement in the Seychelles Child Development Study

Studies of neurodevelopmental outcomes in offspring exposed to MeHg from maternal consumption of fish have primarily measured cognitive abilities. Reported associations have been subtle and in both adverse and beneficial directions. Changes in functional outcomes such as school achievement and behavior in exposed children and adolescents have not been examined. We undertook an assessment of school success of children in the Seychelles Child Development Study (SCDS) main cohort to determine if there were any associations with either prenatal or recent postnatal MeHg exposure. The primary endpoints were Seychelles nationally standardized end-of-year examinations given when the cohort children were 9 and 17 years of age. A subgroup (n=215) from the main cohort was also examined at 9 years of age using a regional achievement test called SACMEQ. Prenatal MeHg exposure was 6.8 ppm in maternal hair; recent postnatal exposure was 6.09 ppm at 9 years and 8.0 ppm at 17 years, measured in child hair. Multiple linear regression analyses showed no pattern of associations between prenatal or postnatal exposure, and either the 9- or 17-year end-of-year examination scores. For the subgroup of 215 subjects who participated in the SACMEQ test, there were significant adverse associations between examination scores and postnatal exposure, but only for males. The average postnatal exposure level in child hair for this subgroup was significantly higher than for the overall cohort. These results are consistent with our earlier studies and support the interpretation that prenatal MeHg exposure at dosages achieved by mothers consuming a diet high in fish are not associated with adverse educational measures of scholastic achievement. The adverse association of educational measures with postnatal exposure in males is intriguing, but will need to be confirmed by further studies examining factors that influence scholastic achievement.

Hair mercury levels of women of reproductive age in Ontario, Canada: implications to fetal safety and fish consumption

OBJECTIVE

To study hair mercury concentrations among women of reproductive age in relation to fish intake in Ontario, Canada.

STUDY DESIGN

Three groups were studied: 22 women who had called the Motherisk Program for information on the reproductive safety of consuming fish during pregnancy, a group of Japanese residing in Toronto (n=23) consuming much larger amounts of fish, and a group of Canadian women of reproductive age (n=20) not seeking advice, were studied. Mercury concentrations in hair samples were measured using inductively coupled plasma mass spectrometry. Seafood consumption habits were recorded for each participant. Based on the types of fish consumed and consumption frequencies, the estimated monthly intake of mercury was calculated. Hair mercury concentrations were correlated to both the number of monthly seafood servings and the estimated ingested mercury dose.

RESULTS

There were significant correlations between fish servings and hair mercury (Spearman r=0.73, P<.0001) and between amounts of consumed mercury and hair mercury concentrations (Spearman r=0.81, P<.0001). Nearly two thirds of the Motherisk callers, all of the Japanese women, and 15% of the Canadian women of reproductive age had hair mercury above 0.3 microg/g, which was shown recently to be the lowest observable adverse effect level in a large systematic review of all perinatal studies.

CONCLUSIONS

Because of very wide variability, general recommendations for a safe number of fish servings may not be sufficient to protect the fetus. Analysis of hair mercury may be warranted before pregnancy in selected groups of women consuming more than 12 ounces of fish per week, as dietary modification can decrease body burden and ensure fetal safety.

Metabolic imprinting, programming and epigenetics – a review of present priorities and future opportunities

Metabolic programming and metabolic imprinting describe early life events, which impact upon on later physiological outcomes. Despite the increasing numbers of papers and studies, the distinction between metabolic programming and metabolic imprinting remains confusing. The former can be defined as a dynamic process whose effects are dependent upon a critical window(s) while the latter can be more strictly associated with imprinting at the genomic level. The clinical end points associated with these phenomena can sometimes be mechanistically explicable in terms of gene expression mediated by epigenetics. The predictivity of outcomes depends on determining if there is causality or association in the context of both early dietary exposure and future health parameters. The use of biomarkers is a key aspect of determining the predictability of later outcome, and the strengths of particular types of biomarkers need to be determined. It has become clear that several important health endpoints are impacted upon by metabolic programming/imprinting. These include the link between perinatal nutrition, nutritional epigenetics and programming at an early developmental stage and its link to a range of future health risks such as CVD and diabetes. In some cases, the evidence base remains patchy and associative, while in others, a more direct causality between early nutrition and later health is clear. In addition, it is also essential to acknowledge the communication to consumers, industry, health care providers, policy-making bodies as well as to the scientific community. In this way, both programming and, eventually, reprogramming can become effective tools to improve health through dietary intervention at specific developmental points.

Methylmercury exposure and health effects from rice and fish consumption: a review

Methylmercury (MeHg) is highly toxic, and its principal target tissue in humans is the nervous system, which has made MeHg intoxication a public health concern for many decades. The general population is primarily exposed to MeHg through consumption of contaminated fish and marine mammals, but recent studies have reported high levels of MeHg in rice and confirmed that in China the main human exposure to MeHg is related to frequent rice consumption in mercury (Hg) polluted areas. This article reviews the progress in the research on MeHg accumulation in rice, human exposure and health effects, and nutrient and co-contaminant interactions. Compared with fish, rice is of poor nutritional quality and lacks specific micronutrients identified as having health benefits (e.g., n-3 long chain polyunsaturated fatty acid, selenium, essential amino acids). The effects of these nutrients on the toxicity of MeHg should be better addressed in future epidemiologic and clinical studies. More emphasis should be given to assessing the health effects of low level MeHg exposure in the long term, with appropriate recommendations, as needed, to reduce MeHg exposure in the rice-eating population.

Ranking the contributions of commercial fish and shellfish varieties to mercury exposure in the United States: implications for risk communication

Fish and shellfish have important nutritional benefits, and US per capita seafood consumption has increased substantially since 2002. Recent research has reinforced concerns about adverse effects of methylmercury exposure, suggesting that methylmercury doses associated with typical US rates of fish consumption may pose measurable risks, with no threshold. These converging trends create a need to improve risk communication about fish consumption and mercury. The analysis performed here identifies the relative importance of different fish and shellfish as sources of mercury in the US seafood supply and proposes improved consumer advice, so that the public can benefit from fish consumption while minimizing mercury exposure. I have quantified contributions to total mercury in the US seafood supply by 51 different varieties of fish and shellfish, then ranked and sorted the 51 varieties in terms of relative impact. Except for swordfish, most fish with the highest mercury levels are relatively minor contributors to total inputs. Tuna (canned light, canned albacore and fresh/frozen varieties) accounts for 37.4 percent of total mercury inputs, while two-thirds of the seafood supply and nine of the 11 most heavily consumed fish and shellfish are low or very low in mercury. Substantial improvement in risk communication about mercury in fish and seafood is needed; in particular, several population subsets need better guidance to base their seafood choices more explicitly on mercury content. I have sorted the 51 seafood varieties into six categories based on mercury levels, as a framework for improving risk communication in this regard.

Epidemiology of seafood-associated infections in the United States

Seafood is part of a healthful diet, but seafood consumption is not risk-free. Seafood is responsible for an important proportion of food-borne illnesses and outbreaks in the United States. Seafood-associated infections are caused by a variety of bacteria, viruses, and parasites; this diverse group of pathogens results in a wide variety of clinical syndromes, each with its own epidemiology. Some seafood commodities are inherently more risky than others, owing to many factors, including the nature of the environment from which they come, their mode of feeding, the season during which they are harvested, and how they are prepared and served. Prevention of seafood-associated infections requires an understanding not only of the etiologic agents and seafood commodities associated with illness but also of the mechanisms of contamination that are amenable to control. Defining these problem areas, which relies on surveillance of seafood-associated infections through outbreak and case reporting, can lead to targeted research and help to guide control efforts. Coordinated efforts are necessary to further reduce the risk of seafood-associated illnesses. Continued surveillance will be important to assess the effectiveness of current and future prevention strategies.

Fish consumption and school grades in Swedish adolescents: a study of the large general population

AIM

To study the associations between fish intake and academic achievement as cognitive parameter among Swedish adolescents.

METHODS

In 2000, a questionnaire including respiratory items, socioeconomic conditions and dietary information was mailed to all schoolchildren (n = 18 158), aged 15 and living in Västra Götaland region of Sweden. The questionnaire was returned by 10 837 subjects. One year later, the total school grades for each subject who had completed the questionnaire and who included their full personal identification number were obtained from the national registers. Multiple linear regression models were applied to evaluate the association between fish intake and academic grades among 9448 schoolchildren, while adjusting for potential confounders, e.g. parents' education.

RESULTS

Grades were higher in subjects with fish consumption once a week compared with subjects with fish consumption of less than once a week (reference group) [increment in estimate 14.5, 95% confidence interval (CI) 11.8-17.1]. Grades were even higher in subjects with fish consumption of more than once a week compared with the reference group (increment in estimate 19.9, 95% CI 16.5-23.3). In the model stratified for parents' education, there were still higher grades among subjects with frequent fish intake in all educational strata (p < 0.01).

CONCLUSION

Frequent fish intake among schoolchildren may provide benefits in terms of academic achievement.

Reproducibility of reported nutrient intake and supplement use during a past pregnancy: a report from the Children's Oncology Group

Maternal diet and nutrition have been thought to play a role in many childhood conditions. Studies using food frequency questionnaires (FFQ) have reported associations with maternal diet, but these findings are difficult to interpret because the reliability and validity of the FFQs for diet during a past pregnancy are not known. We determined the reproducibility of reported diet and supplement use during a past pregnancy in a subset of mothers interviewed for a case-control study of maternal diet in relation to the risk of childhood brain tumours. Cases were Children's Oncology Group patients, diagnosed at age <6 with medulloblastoma or primitive neuroectodermal tumour from 1991 to 1997. Area code, race/ethnicity, and birth date matched controls were selected by random-digit-dialling. Case and control mothers completed a modified Willett FFQ a mean of 5 years after the index child's birth. A mean of 3.6 months later, a subset of mothers consisting of 52 case and 51 control mothers repeated the interview; these comprise the reproducibility study population. The mean intra-class correlation was 0.59 (range 0.41, 0.69) for energy-adjusted nutrients from dietary sources only; it was 0.41 (range 0.06, 0.70) when supplements were included. Agreement for reporting multivitamin use during pregnancy by time period and pattern was good to very good (kappa = 0.66-0.85). Overall, the reproducibility of nutrient estimates and supplement use in pregnancy was good and similar to that reported for adult diet.

Hair mercury levels, fish consumption, and cognitive development in preschool children from Granada, Spain

The main source of human exposure to mercury is the consumption of fish contaminated with methylmercury, which may adversely affect early neurodevelopment. This study assessed mercury levels in hair of preschoolers in Spain, where fish consumption is elevated, with the aim of investigating the influence of their fish intake and other factors on mercury exposure, and evaluating their association with cognitive development. A population-based birth cohort from Granada (Spain) was studied at the age of 4yr. Total mercury (T-Hg) levels were determined in children's hair, and daily fish intake was assessed by a food frequency questionnaire. The McCarthy Scales of Children's Abilities (MSCA) were used to assess children's motor and cognitive abilities. Complete data were gathered on 72 children, and multivariate analyses were performed to evaluate the influence of mercury exposure and fish intake on MSCA outcomes. Mean concentration of T-Hg in hair was 0.96 microg/g (95% confidence interval=0.76; 1.20 microg/g). T-Hg levels were associated with higher frequency of oily fish consumption, place of residence, maternal age, and passive smoking. After adjustment for fish intake, T-Hg levels > or =1microg/g were associated with decrements in the general cognitive (-6.6 points), memory (-8.4 points), and verbal (-7.5 points) MSCA scores. Higher mercury exposure in children from this Mediterranean area was associated with cognitive development delay. Studies on the putative benefits of fish intake during early development should consider mercury exposure from different fish species.

Undernutrition, fatty acid and micronutrient status in relation to cognitive performance in Indian school children: a cross-sectional study

While undernutrition and anaemia have previously been linked to poor development of children, relatively little is known about the role of B-vitamins and fatty acids on cognition. The present study aims to explore the associations between indicators of body size, fatty acid and micronutrient status on cognitive performance in 598 Indian school children aged 6-10 years. Baseline data of a clinical study were used to assess these associations by analyses of variance adjusting for age, sex, school, maternal education and cognitive tester. The Kaufman Assessment Battery for Children II was used to measure four cognitive domains, including fluid reasoning, short-term memory, retrieval ability and cognitive speediness. Scores were combined into an overall measure, named mental processing index (MPI). Body size indicators and Hb concentrations were significantly positively related to cognitive domains and MPI, such that increases of 1 sd in height-for-age and weight-for-age z-scores would each translate into a 0.09 sd increase in MPI, P = 0.0006 and 0.002, respectively. A 10 g/l increase in Hb concentrations would translate into a 0.08 sd increase in MPI, P = 0.0008. Log-transformed vitamin B12 concentrations were significantly inversely associated with short-term memory, retrieval ability and MPI (beta (95 % CI) = - 0.124 (- 0.224, - 0.023), P = 0.02). Other indicators of Fe, iodine, folate and fatty acid status were not significantly related to cognition. Our findings for body size, fatty acids and micronutrients were in agreement with previous observational studies. The inverse association of vitamin B12 with mental development was unexpected and needed further study.

Bayesian models for multiple outcomes nested in domains

We consider the problem of estimating the effect of exposure on multiple continuous outcomes, when the outcomes are measured on different scales and are nested within multiple outcome classes, or "domains." Our Bayesian model extends the linear mixed models approach to allow the exposure effect to differ across domains and across outcomes within domains. Our model can be parameterized to allow shrinkage of the effects within the different levels of nesting, or to allow fixed domain-specific effects with no shrinkage. Our model also allows covariate effects to differ across outcomes and domains. Our methodology is applied to data on prenatal methylmercury exposure and multiple outcomes in four domains measured at 9 years of age on children enrolled in the Seychelles Child Development Study. We use three different priors and found that our main conclusions were not sensitive to the choice of prior. Simulation studies examine the model performance under alternative scenarios. Our results demonstrate that a sizeable increase in power is possible.

Elevating optimal human nutrition to a central goal of plant breeding and production of plant-based foods

High-yielding cereals and other staples have produced adequate calories to ward off starvation for much of the world over several decades. However, deficiencies in certain amino acids, minerals, vitamins and fatty acids in staple crops, and animal diets derived from them, have aggravated the problem of malnutrition and the increasing incidence of certain chronic diseases in nominally well-nourished people (the so-called diseases of civilization). Enhanced global nutrition has great potential to reduce acute and chronic disease, the need for health care, the cost of health care, and to increase educational attainment, economic productivity and the quality of life. However, nutrition is currently not an important driver of most plant breeding efforts, and there are only a few well-known efforts to breed crops that are adapted to the needs of optimal human nutrition. Technological tools are available to greatly enhance the nutritional value of our staple crops. However, enhanced nutrition in major crops might only be achieved if nutritional traits are introduced in tandem with important agronomic yield drivers, such as resistance to emerging pests or diseases, to drought and salinity, to herbicides, parasitic plants, frost or heat. In this way we might circumvent a natural tendency for high yield and low production cost to effectively select against the best human nutrition. Here we discuss the need and means for agriculture, food processing, food transport, sociology, nutrition and medicine to be integrated into new approaches to food production with optimal human nutrition as a principle goal.

High levels of depressive symptoms in pregnancy with low omega-3 fatty acid intake from fish

BACKGROUND

Depression during pregnancy has adverse consequences for both mother and child. Although common in western countries, depression appears to be virtually absent in countries with high seafood intake. We test the hypothesis that low seafood intake during pregnancy is associated with increased prevalence of depressive symptoms.

METHODS

This study used data prospectively collected from women participating in the Avon Longitudinal Study of Parents and Children in the period 1991-1992. At 32 weeks' gestation, the mother completed a questionnaire that included symptoms of depression and a food frequency questionnaire from which the amount of omega-3 fatty acids from fish was calculated. Statistical analysis took social and lifestyle factors into account.

RESULTS

Unadjusted and adjusted analyses showed lower maternal intake of omega-3 from seafood was associated with high levels of depressive symptoms. Compared with women consuming more than 1.5 g omega-3 from seafood per week, those consuming none were more likely to have high levels of depressive symptoms at 32 weeks' gestation (adjusted odds ratios = 1.54; 95% confidence interval = 1.25-1.89).

CONCLUSIONS

These observational data support an association between low omega-3 intake from seafood and increased risk of high levels of depressive symptoms during pregnancy. Eating seafood during pregnancy may have beneficial effects on mental well-being.

Measuring outcomes in a longitudinal birth cohort

Longitudinal studies are often focussed on specific outcomes to address predetermined hypotheses. Nevertheless, many discoveries have been made with data collected that were not part of the original design. Measurement of a broad range of outcomes is therefore important. Here we describe examples of the types of outcome that a birth cohort should collect, with emphasis on accuracy. We emphasise the use of continuous traits as well as of dichotomous outcomes, using a variety of examples.

Choosing the types of biological sample to collect in longitudinal birth cohort studies

There are a variety of biological samples that can be collected from participants in longitudinal studies. Here we outline those that are particularly useful in longitudinal birth cohort studies starting in pregnancy, and discuss their advantages and disadvantages.

Assessing diet in longitudinal birth cohort studies

Diet is an important component of a person's environment. It is important for adults and particularly for mothers during pregnancy and while breast feeding, and for children in utero and during later growth and development. Measurement of the type and amount of foods consumed is complex. Here we describe the different methods that can be used, when and when not to use each one, and the importance of validation studies.

Marine fish food in the United States and methylmercury risk

This paper takes a market-oriented approach to study potential exposure of methylmercury (MeHg) risk to human health from US domestic commercial ocean fish landings (consumption). Information is assembled on MeHg concentration levels of marine species. Landings were examined for 1995-2005. Confined to this seafood source, trends of landings indicating high concentration species (above 0.7 ppm, tilefish, shark, king mackerel and swordfish) were significantly decreased. People bought stable amount of medium MeHg level species (0.3-0.7 ppm, grouper, Spanish mackerel) but less amount of low concentration level species (below 0.3 ppm, catfish, tuna and southern flounder). Based on estimated prices of species and quantities taken it is found that consumers, one crucial link of the entire MeHg risk assessment process, had exhibited awareness of potential MeHg risk in fish and demonstrated in household fish consumption. Information assembled in this paper is insufficient to draw further inference on specific population cohorts more susceptible to potential exposure of MeHg risk. This inquiry may be extended to imported fish in the US for comparison.

Fish intake of Swedish male adolescents is a predictor of cognitive performance

AIM

Fish intake is reported to positively influence cognitive performance in infants and the elderly. In a longitudinal cohort study, we evaluated how fish consumption related to later cognitive performance in healthy young male adolescents.

METHODS

In 2000, all 15-year-olds (n = 18 158; 9260 males) in the western region of Sweden were requested to complete an extensive questionnaire with items on diseases, fish consumption and socioeconomic status. Questionnaire data from the male responders (n = 4792, response rate 52%) were linked with records on subsequent intelligence test performance at age 18 from the Swedish Military Conscription Register (n = 3972). Multivariate linear models were used to estimate associations between fish intake and cognitive performance, adjusting for potential confounders.

RESULTS

There was a positive association between the number of times having fish meals per week at age 15 and cognitive performance measured 3 years later. Fish consumption of more than once per week compared to less than once per week was associated with higher stanine scores in combined intelligence (0.58 units; 95% confidence interval 0.39, 0.76), in verbal performance (0.45; 0.27, 0.63) and in visuospatial performance (0.50; 0.31, 0.69). The association between fish consumption and the 3 intelligence scores was the same in lowly and highly educated groups. This indicates that education did not influence the association between the frequency of fish meals consumed and cognitive performance.

CONCLUSION

Frequent fish intake at age 15 was associated with significantly higher cognitive performance 3 years later.

Quantitative approach for incorporating methylmercury risks and omega-3 fatty acid benefits in developing species-specific fish consumption advice

BACKGROUND

Despite general agreement about the toxicity of methylmercury (MeHg), fish consumption advice remains controversial. Concerns have been raised that negative messages will steer people away from fish and omega-3 fatty acid (FA) benefits. One approach is to provide advice for individual species that highlights beneficial fish while cautioning against riskier fish.

OBJECTIVES

Our goal in this study was to develop a method to quantitatively analyze the net risk/benefit of individual fish species based on their MeHg and omega-3 FA content.

METHODS

We identified dose-response relationships for MeHg and omega-3 FA effects on coronary heart disease (CHD) and neurodevelopment. We used the MeHg and omega-3 FA content of 16 commonly consumed species to calculate the net risk/benefit for each species.

RESULTS

Estimated omega-3 FA benefits outweigh MeHg risks for some species (e.g., farmed salmon, herring, trout); however, the opposite was true for others (swordfish, shark). Other species were associated with a small net benefit (e.g., flounder, canned light tuna) or a small net risk (e.g., canned white tuna, halibut). These results were used to place fish into one of four meal frequency categories, with the advice tentative because of limitations in the underlying dose-response information. Separate advice appears warranted for the neurodevelopmental risk group versus the cardiovascular risk group because we found a greater net benefit from fish consumption for the cardiovascular risk group.

CONCLUSIONS

This research illustrates a framework for risk/benefit analysis that can be used to develop categories of consumption advice ranging from "do not eat" to "unlimited," with the caveat that unlimited may need to be tempered for certain fish (e.g., farm-raised salmon) because of other contaminants and end points (e.g., cancer risk). Uncertainties exist in the underlying dose-response relationships, pointing in particular to the need for more research on the adverse effects of MeHg on cardiovascular end points.

Human health effects of methylmercury exposure

Mercury (Hg), and the organometallic compounds formed from it, are among the most toxic of substances to the global environment. Mercury is environmentally ubiquitous, and both wildlife and humans are exposed to the toxic effects of its environmental residues, primarily elemental mercury (Hg0), divalent mercury (Hg2+) and methylmercury (MeHg). Humans are exposed to different forms of Hg, and potential health risks have been reported from such exposures; examples of Hg exposure include mercury vapor from dental amalgams, occupational exposures and exposures during artisan and small-scale gold mining operations. Despite the significance of those foregoing Hg exposures, of particular concern is human and wildlife exposure to MeHg, a potent neurotoxicant. Once incorporated into the body, MeHg easily penetrates the blood-brain barrier and causes damage to the central nervous system, particularly in fetuses. It bioaacumulates and biomagnifies in the aquatic food chain; consequently, fish and seafood consumption is the major pathway by which humans are exposed to MeHg. MeHg is the focus of this review. It adversely affects humans and is currently the subject of intense public health interest and worldwide concern. In this review, I summarize the sources and cycling of global mercury in the environment, pathways of exposure, toxicity and exposure evaluation, toxicokinetics, the common biomarkers to evaluate exposure and effects in populations, and finally review the nutritional risks and benefits from fish consumption.

Maternal fish and other seafood intakes during pregnancy and child neurodevelopment at age 4 years

OBJECTIVE

To analyse the relationship between maternal intakes of fish and other seafood during pregnancy and child neurodevelopment at age 4 years. Although pregnant women are advised to limit seafood intakes because of possible neurotoxin contamination, several studies suggest that overall maternal seafood intakes are associated with improved child neurodevelopment, perhaps because of higher DHA intakes.

DESIGN

The study uses data from a prospective birth cohort study. Maternal seafood intakes were assessed using a semi-quantitative FFQ administered shortly after delivery. Multivariate linear regression was used to estimate associations between seafood consumption and scores on the McCarthy Scales of Children's Abilities (MCSA). Analyses were stratified by breast-feeding duration as breast milk is a source of DHA during the postnatal phase of the brain growth spurt.

SETTING

Menorca, Spain, 1997-2001.

SUBJECTS

Full-term children (n 392) with data on maternal diet in pregnancy, breast-feeding duration and neurodevelopment at age 4 years.

RESULTS

Among children breast-fed for <6 months, maternal fish intakes of >2-3 times/week were associated with significantly higher scores on several MCSA subscales compared with intakes < or =1 time/week. There was no association among children breast-fed for longer periods. Maternal intakes of other seafood (shellfish/squid) were, however, inversely associated with scores on several subscales, regardless of breast-feeding duration.

CONCLUSIONS

The study suggests that moderately high intakes of fish, but not other seafood, during pregnancy may be beneficial for neurodevelopment among children breast-fed for <6 months. Further research in other populations with high seafood intakes and data on additional potential confounders are needed to confirm this finding.

Associations of maternal long-chain polyunsaturated fatty acids, methyl mercury, and infant development in the Seychelles Child Development Nutrition Study

Fish consumption during gestation can provide the fetus with long-chain polyunsaturated fatty acids (LCPUFA) and other nutrients essential for growth and development of the brain. However, fish consumption also exposes the fetus to the neurotoxicant, methyl mercury (MeHg). We studied the association between these fetal exposures and early child development in the Seychelles Child Development Nutrition Study (SCDNS). Specifically, we examined a priori models of Omega-3 and Omega-6 LCPUFA measures in maternal serum to test the hypothesis that these LCPUFA families before or after adjusting for prenatal MeHg exposure would reveal associations with child development assessed by the BSID-II at ages 9 and 30 months. There were 229 children with complete outcome and covariate data available for analysis. At 9 months, the PDI was positively associated with total Omega-3 LCPUFA and negatively associated with the ratio of Omega-6/Omega-3 LCPUFA. These associations were stronger in models adjusted for prenatal MeHg exposure. Secondary models suggested that the MeHg effect at 9 months varied by the ratio of Omega-6/Omega-3 LCPUFA. There were no significant associations between LCPUFA measures and the PDI at 30 months. There were significant adverse associations, however, between prenatal MeHg and the 30-month PDI when the LCPUFA measures were included in the regression analysis. The BSID-II mental developmental index (MDI) was not associated with any exposure variable. These data support the potential importance to child development of prenatal availability of Omega-3 LCPUFA present in fish and of LCPUFA in the overall diet. Furthermore, they indicate that the beneficial effects of LCPUFA can obscure the determination of adverse effects of prenatal MeHg exposure in longitudinal observational studies.

Neurodevelopmental effects of maternal nutritional status and exposure to methylmercury from eating fish during pregnancy

Fish contain nutrients that promote optimal brain growth and development but also contain methylmercury (MeHg) that can have toxic effects. The present study tested the hypothesis that the intake of selected nutrients in fish or measures of maternal nutritional status may represent important confounders when estimating the effects of prenatal methylmercury exposure on child development. The study took place in the Republic of Seychelles, an Indian Ocean archipelago where fish consumption is high. A longitudinal cohort study design was used. A total of 300 mothers were enrolled early in pregnancy. Nutrients considered to be important for brain development were measured during pregnancy along with prenatal MeHg exposure. The children were evaluated periodically to age 30 months. There were 229 children with complete outcome and covariate data for analysis. The primary endpoint was the Bayley Scales of Infant Development-II (BSID-II), administered at 9 and 30 months of age. Combinations of four secondary measures of infant cognition and memory were also given at 5, 9 and 25 months. Cohort mothers consumed an average of 537 g of fish (nine meals containing fish) per week. The average prenatal MeHg exposure was 5.9 ppm in maternal hair. The primary analysis examined the associations between MeHg, maternal nutritional measures and children's scores on the BSID-II and showed an adverse association between MeHg and the mean Psychomotor Developmental Index (PDI) score at 30 months. Secondary analyses of the association between the PDI and only MeHg alone or nutritional factors alone showed only a borderline significant association between MeHg and the PDI at 30 months and no associations with nutritional factors. One experimental measure at 5 months of age was positively associated with iodine status, but not prenatal MeHg exposure. These findings suggest a possible confounding role of maternal nutrition in studies examining associations between prenatal MeHg exposures and developmental outcomes in children.

Overview of modifiers of methylmercury neurotoxicity: chemicals, nutrients, and the social environment

It has been known for decades that methylmercury is a potent neurotoxicant, and that the developing brain is more susceptible to impairment as a result of methylmercury exposure than is the adult. Exposure to methylmercury is exclusively through consumption of fish and marine mammals. In recent years, the potential for protection against methylmercury toxicity by nutrients present in fish, particularly omega-3 fatty acids and selenium, has been explored in both epidemiological and experimental studies. There is evidence from several studies that fish consumption per se and methylmercury body burden act in opposition with regard to neuropsychological outcomes, whereas the evidence for a protective effect of specific nutrients is contradictory in both epidemiological and experimental studies published to date. The potential for methylmercury to interact with other chemicals present in marine food, particularly PCBs, has been explored in both animal models and human studies. Results may be both exposure- and endpoint-dependent. The Seychelles Islands study has explored the potential for the social environment to modify the effects of developmental methylmercury exposure. An understanding of the interactions of the multiple factors that determine the final behavioral outcome of exposure to methylmercury is crucial to risk assessment and risk management decisions.

High dietary omega-6 fatty acids contribute to reduced docosahexaenoic acid in the developing brain and inhibit secondary neurite growth

Docosahexaenoic acid (DHA, 22:6omega-3) is a major polyunsaturated fatty acid in the brain and is required in large amounts during development. Low levels of DHA in the brain are associated with functional deficits. The omega-3 fatty acids are essential nutrients and their metabolism and incorporation in developing brain depends on the composition of dietary fat. We assessed the importance of the intake of the omega-3 fatty acid, 18:3omega-3 and the balance with the omega-6 fatty acid, 18:2omega-6, and the effects of dietary arachidonic acid (20:4omega-6) and DHA in milk diets using the piglet as a model of early infant nutrition. Piglets were fed (% energy) 1.2% 18:2omega-6 and 0.05% 18:3omega-3 (deficient), 10.7% 18:2omega-6 and 1.1% 18:3omega-3 (contemporary), 1.2% 18:2omega-6 and 1.1% 18:3omega-3 (evolutionary), or the contemporary diet with 0.3% 20:4omega-6 and 0.3% DHA (supplemented) from birth to 30 days of age. Our results show that a contemporary diet, high in 18:2omega-6 compromises DHA accretion and leads to increased 22:4omega-6 and 22:5omega-6 in the brain. However, an evolutionary diet, low in 18:2omega-6, supports high brain DHA. DHA supplementation effectively increased DHA, but not the intermediate omega-3 fatty acids, 20:5omega-3 and 22:5omega-3. Using primary cultures of cortical neurons, we show that 22:5omega-6 is efficiently acylated and preferentially taken up over DHA. However, DHA, but not 22:5omega-6 supports growth of secondary neurites. Our results suggest the need to consider whether current high dietary omega-6 fatty acid intakes compromise brain DHA accretion and contribute to poor neurodevelopment.

Relation between cord blood mercury levels and early child development in a World Trade Center cohort

OBJECTIVE

This study was designed to determine whether prenatal mercury exposure, including potential releases from the World Trade Center (WTC) disaster, adversely affects fetal growth and child development.

METHODS

We determined maternal and umbilical cord blood total mercury of nonsmoking women who delivered at term in lower Manhattan after 11 September 2001, and measured birth outcomes and child development.

RESULTS

Levels of total mercury in cord and maternal blood were not significantly higher for women who resided or worked within 1 or 2 miles of the WTC in the month after 11 September, compared with women who lived and worked farther away. Average cord mercury levels were more than twice maternal levels, and both were elevated in women who reported eating fish/seafood during pregnancy. Regression analyses showed no significant association between (ln) cord or maternal blood total mercury and birth outcomes. Log cord mercury was inversely associated with the Bayley Scales of Infant Development psychomotor score [Psychomotor Development Index (PDI)] at 36 months (b = -4.2, p = 0.007) and with Performance (b = -3.4, p = 0.023), Verbal (b = -2.9, p = 0.023), and Full IQ scores (b = -3.8, p = 0.002) on the Wechsler Preschool and Primary Scale of Intelligence, Revised (WPPSI-R), at 48 months, after controlling for fish/seafood consumption and other confounders. Fish/seafood consumption during pregnancy was significantly associated with a 5.6- to 9.9-point increase in 36-month PDI, and 48-month Verbal and Full IQ scores.

CONCLUSIONS

Blood mercury was not significantly raised in women living or working close to the WTC site in the weeks after 11 September 2001. Higher cord blood mercury was associated with reductions in developmental scores at 36 and 48 months, after adjusting for the positive effects of fish/seafood consumption during pregnancy.

Persistent, bioaccumulative and toxic substances in fish: human health considerations

Fish are important dietary items that provide essential nutrients. Fish however, bioaccumulate monomethyl mercury (MMHg) and organo-halogenated pollutants (OHP) that are persistent bioaccumulative and toxic substances (PBTS). Unlike man-made OHP, MMHg is mainly of natural origin but background concentrations of aquatic systems are determined by the environmental Hg-methylating potential. Industrial activities can modulate environmental discharges and fish bioaccumulation of PBTS. Fish and seafood consumption are associated with human body load of PBTS, but farming practices that utilize fishmeal increase the terrestrial food chain resulting in farm-animal accumulation of PBTS. These substances are neurotoxic and endocrine active that can impact humans and wild life, but chemical characteristics of MMHg and OHP modulate interactions with animal tissues. MMHg is protein reactive with a faster metabolism (months) than OHP that are stored and slowly (years) metabolized in fat tissues. Except for brain-Hg, neither Hg nor OHP in tissues are markers of toxic effects; however, deficits in neurobehavioral test-scores of children have been shown in some fish-eating populations. These deficits are transient and within normal range, and are not prodromes of neurological diseases. Although population studies show that consumption of fish at current levels of contamination do not explain neurological disorders, endocrine activity remains controversial. Understanding risk of hazard caused by fish-PBTS consumption requires a wide range of expertise. We discuss chemical, toxic, metabolic, and ecological characteristics associated with PBTS in fish. There are proven health outcome derived from fish consumption, while risk of exposure to avoidable PBTS is a chance that can be minimized by societal actions.

Maternal fish intake during pregnancy, blood mercury levels, and child cognition at age 3 years in a US cohort

The balance of contaminant risk and nutritional benefit from maternal prenatal fish consumption for child cognitive development is not known. Using data from a prospective cohort study of 341 mother-child pairs in Massachusetts enrolled in 1999-2002, the authors studied associations of maternal second-trimester fish intake and erythrocyte mercury levels with children's scores on the Peabody Picture Vocabulary Test (PPVT) and Wide Range Assessment of Visual Motor Abilities (WRAVMA) at age 3 years. Mean maternal total fish intake was 1.5 (standard deviation, 1.4) servings/week, and 40 (12%) mothers consumed >2 servings/week. Mean maternal mercury level was 3.8 (standard deviation, 3.8) ng/g. After adjustment using multivariable linear regression, higher fish intake was associated with better child cognitive test performance, and higher mercury levels with poorer test scores. Associations strengthened with inclusion of both fish and mercury: effect estimates for fish intake of >2 servings/week versus never were 2.2 (95% confidence interval (CI): -2.6, 7.0) for the PPVT and 6.4 (95% CI: 2.0, 10.8) for the WRAVMA; for mercury in the top decile, they were -4.5 (95% CI: -8.5, -0.4) for the PPVT and -4.6 (95% CI: -8.3, -0.9) for the WRAVMA. Fish consumption of < or =2 servings/week was not associated with a benefit. Dietary recommendations for pregnant women should incorporate the nutritional benefits as well as the risks of fish intake.

Epidemiologic evidence of relationships between reproductive and child health outcomes and environmental chemical contaminants

This review summarizes the level of epidemiologic evidence for relationships between prenatal and/or early life exposure to environmental chemical contaminants and fetal, child, and adult health. Discussion focuses on fetal loss, intrauterine growth restriction, preterm birth, birth defects, respiratory and other childhood diseases, neuropsychological deficits, premature or delayed sexual maturation, and certain adult cancers linked to fetal or childhood exposures. Environmental exposures considered here include chemical toxicants in air, water, soil/house dust and foods (including human breast milk), and consumer products. Reports reviewed here included original epidemiologic studies (with at least basic descriptions of methods and results), literature reviews, expert group reports, meta-analyses, and pooled analyses. Levels of evidence for causal relationships were categorized as sufficient, limited, or inadequate according to predefined criteria. There was sufficient epidemiological evidence for causal relationships between several adverse pregnancy or child health outcomes and prenatal or childhood exposure to environmental chemical contaminants. These included prenatal high-level methylmercury (CH(3)Hg) exposure (delayed developmental milestones and cognitive, motor, auditory, and visual deficits), high-level prenatal exposure to polychlorinated biphenyls (PCBs), polychlorinated dibenzofurans (PCDFs), and related toxicants (neonatal tooth abnormalities, cognitive and motor deficits), maternal active smoking (delayed conception, preterm birth, fetal growth deficit [FGD] and sudden infant death syndrome [SIDS]) and prenatal environmental tobacco smoke (ETS) exposure (preterm birth), low-level childhood lead exposure (cognitive deficits and renal tubular damage), high-level childhood CH(3)Hg exposure (visual deficits), high-level childhood exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) (chloracne), childhood ETS exposure (SIDS, new-onset asthma, increased asthma severity, lung and middle ear infections, and adult breast and lung cancer), childhood exposure to biomass smoke (lung infections), and childhood exposure to outdoor air pollutants (increased asthma severity). Evidence for some proven relationships came from investigation of relatively small numbers of children with high-dose prenatal or early childhood exposures, e.g., CH(3)Hg poisoning episodes in Japan and Iraq. In contrast, consensus on a causal relationship between incident asthma and ETS exposure came only recently after many studies and prolonged debate. There were many relationships supported by limited epidemiologic evidence, ranging from several studies with fairly consistent findings and evidence of dose-response relationships to those where 20 or more studies provided inconsistent or otherwise less than convincing evidence of an association. The latter included childhood cancer and parental or childhood exposures to pesticides. In most cases, relationships supported by inadequate epidemiologic evidence reflect scarcity of evidence as opposed to strong evidence of no effect. This summary points to three main needs: (1) Where relationships between child health and environmental exposures are supported by sufficient evidence of causal relationships, there is a need for (a) policies and programs to minimize population exposures and (b) population-based biomonitoring to track exposure levels, i.e., through ongoing or periodic surveys with measurements of contaminant levels in blood, urine and other samples. (2) For relationships supported by limited evidence, there is a need for targeted research and policy options ranging from ongoing evaluation of evidence to proactive actions. (3) There is a great need for population-based, multidisciplinary and collaborative research on the many relationships supported by inadequate evidence, as these represent major knowledge gaps. Expert groups faced with evaluating epidemiologic evidence of potential causal relationships repeatedly encounter problems in summarizing the available data. A major driver for undertaking such summaries is the need to compensate for the limited sample sizes of individual epidemiologic studies. Sample size limitations are major obstacles to exploration of prenatal, paternal, and childhood exposures during specific time windows, exposure intensity, exposure-exposure or exposure-gene interactions, and relatively rare health outcomes such as childhood cancer. Such research needs call for investments in research infrastructure, including human resources and methods development (standardized protocols, biomarker research, validated exposure metrics, reference analytic laboratories). These are needed to generate research findings that can be compared and subjected to pooled analyses aimed at knowledge synthesis.

Human and crab exposure to mercury in the Caribbean coastal shoreline of Colombia: impact from an abandoned chlor-alkali plant

Human hair samples from male and female people aged 6-85 years, as well as muscle of crabs (Callinectes sapidus and Callinectes bocourti) were collected from different fishing places along the Caribbean coastal shoreline of Colombia and analyzed for total mercury (T-Hg) in order to establish the impact of mercury-polluted sediments in Cartagena bay on the ecosystem. Hair T-Hg in inhabitants varied between 0.1 and 21.8 microg/g, with average and median of 1.52 microg/g and 1.1 microg/g, respectively. Differences between sampling locations were significant (P<0.01) and median values decreased in the order: Caño del Oro (1.5 microg/g)<Bocachica (1.4 microg/g) (both located in Cartagena Bay)<Coveñas (1.2 microg/g)<Lomarena (0.7 microg/g)=Tasajera (0.7 microg/g). A similar trend was observed for T-Hg in muscle of crabs, however, along Cartagena bay, T-Hg distribution in these organisms varied widely, with highest values detected in samples collected in front of the extinct chlor-alkali plant. Although the T-Hg median for these people is equal to the threshold risk level recommended by U.S. EPA, this study highlights the fact that contaminated sediments are still driving the distribution of mercury through the food chain, allowing its accumulation in fishermen whose diet includes marine products as sources of protein.

Association between prenatal exposure to methylmercury and visuospatial ability at 10.7 years in the seychelles child development study

The Seychelles Child Development Study was designed to test the hypothesis that prenatal exposure to MeHg from maternal consumption of a diet high in fish is detrimental to child neurodevelopment. To date, no consistent pattern of adverse associations between prenatal exposure and children's development has appeared. In a comprehensive review of developmental studies involving MeHg, a panel of experts recommended a more consistent use of the same endpoints across studies to facilitate comparisons. Both the SCDS and the Faeroe Islands studies administered the Bender Visual Motor Gestalt Test. However, the method of test administration and scoring used was different. We repeated the test on the SCDS Main Study children (mean age 10.7 years) using the same testing and scoring procedure reported by the Faeroe studies to obtain Copying Task and Reproduction Task scores. We found no association between prenatal MeHg exposure and Copying Task scores which was reported from the Faeroese study. However, our analysis did show a significant adverse association between MeHg and Reproduction Task scores with all the data (p=0.04), but not when the single outlier was removed (p=0.07). In a population whose exposure to MeHg is from fish consumption, we continue to find no consistent adverse association between MeHg and visual motor coordination.

Prenatal exposure to mercury in a prospective mother-infant cohort study in a Mediterranean area, Valencia, Spain

BACKGROUND

Mercury (Hg) is a ubiquitous pollutant that negatively affects fetal and child neurodevelopment at accidental high-dose exposure. Some studies indicate that Mediterranean populations could be at risk of prenatal exposure to mercury through fish consumption.

OBJECTIVES

To assess the prenatal exposure to total mercury (T-Hg), both inorganic and organic, in newborns by analyzing the T-Hg concentration in cord blood, and to evaluate the role of maternal fish consumption in this exposure.

METHODS

In the context of a multi-center project (INMA project), a prospective birth cohort was set up in Valencia, Spain, from 2005 to 2006. A total of 253 newborns were included in this study. We compared cord blood T-Hg concentration by levels of fish intake assessed by a food frequency questionnaire completed at 28-32 weeks of gestation. Maternal covariates were obtained through a questionnaire.

RESULTS

The geometric mean of T-Hg at birth was 9.9 microg/L (95% CI: 9.0, 10.8). Seventy five percent of cord blood samples were above the estimated level assumed to be without appreciable harm (5.8 microg/L). Women who consumed a portion of large oily fish, lean fish, or mixed fried fish two or more times per week had mean cord blood levels 1.6, 1.4 and 1.3 times higher, respectively, than those who rarely or never consumed fish. Other factors such as the mother's age, country of origin, smoking and season of delivery were also significantly and independently associated with cord blood T-Hg concentrations.

CONCLUSIONS

Newborns from a Mediterranean area presented elevated levels of T-Hg in cord blood. Higher concentrations of T-Hg were related to maternal fish intake, particularly in the case of large oily fish species.

Contaminants in fish: risk-benefit considerations

Fish provide a healthful source of dietary protein and are high in nutrients such as omega-3 fatty acids. There is evidence of beneficial effects of fish consumption in coronary heart disease, stroke, age-related macular degeneration, and growth and development. Yet, benefits may be offset by the presence of contaminants, such as methylmercury (MeHg), dioxins, polychlorinated biphenyls (PCBs) and several other halogenated persistent organic pollutants. MeHg is a known developmental neurotoxicant, as evidenced by several animal studies and episodes of human intoxication in Japan and Iraq. Fish represent the main source of exposure to MeHg for the general population, and large predatory fish (swordfish, tuna) have the highest levels of MeHg contamination. Provisional tolerable weekly intakes of 0.7 microg kg(-1) to 1.6 microg kg(-1) have been set by regulatory agencies. Concern for contamination of fish with dioxins and dioxin-like PCBs stems from their reported carcinogenicity, immunotoxicity, and reproductive and developmental toxicities. Farmed and wild-caught fish appear to have similar levels of contaminants. Advisories are in place that recommend limited consumption of certain fish in children, pregnant women and women of childbearing age. Careful risk-benefit considerations should foster fish consumption while minimizing exposure to toxic contaminants.

Human developmental neurotoxicity of methylmercury: impact of variables and risk modifiers

Methylmercury (MeHg) is a widespread environmental and food toxicant which has long been known to affect neurodevelopment in both humans and experimental animals. Risk assessment for MeHg is mainly based on human data coming from the massive episodes of poisoning in Japan and Iraq, as well as from large scale epidemiological studies concerning childhood development and neurotoxicity in relation to in utero exposure in various fish eating communities around the world. Despite the extensive literature and research, the threshold dose for MeHg neurotoxic effects is still unclear, in particular when it comes to subtle effects on neurobehaviour. In this article clinical and epidemiological findings concerning the neurodevelopmental toxicity of MeHg are reviewed. Much attention is focussed on the potential impact of factors, such as diet and nutrition, gender, pattern of exposure and co-exposure to other neurotoxic pollutants, which may modulate MeHg toxic effects. These factors, together with the notion that some symptoms may ensue or exacerbate with aging, contribute to the difficulties in the definition of safe levels for developmental exposure.

Assessment of intrauterine methylmercury exposure affecting child development: messages from the newborn

In evaluating the health effects in the offspring born to the mothers exposed to methylmercury (MeHg) during pregnancy, biomarkers obtained from maternal blood and hair, and umbilical cord have been employed for the exposure assessment. However, which biomarker is employed may affect the study conclusion. In this sense, umbilical cord mercury concentration appears to be a direct exposure biomarker of the fetus. We present an overview of the studies addressing umbilical cord and mercury and scrutinize the usefulness of umbilical cord samples for intrauterine exposure assessment of MeHg. The mean total mercury concentration in cord blood ranged from 0.5 to 35.6 microg/L among the studies reviewed. In Japanese populations, MeHg concentrations in dry cord tissue did not exceed 0.4 microg/g. Also, dry cord tissue would be preferable to wet tissue because the definition of wet weight of the umbilical cord is ambiguous. The cord blood-to-maternal blood ratio of mercury concentrations differed considerably among mother-child pairs despite the significant positive correlation between the cord and maternal mercury concentrations. Moreover, the increased cord mercury concentration was associated with some neurobehavioral and neurophysiological deficits in child. Therefore, mercury concentrations in cord blood and tissue can be accepted as more useful and valid biomarkers of fetal exposure to MeHg, for assessing a dose-response relationship in children at the developmental stage, than maternal mercury concentrations at parturition. Because umbilical cord blood has been used for cord-blood stem cell transplants, dry umbilical cord tissue should be effectively utilized for the advancement of medical sciences.