Blood levels of total and organic mercury in residents of the upper St. Lawrence River basin, Québec: association with age, gender, and fish consumption

Environment-wide association study of elevated liver enzymes: results from the Korean National Environmental Health Survey 2018-2022

Background

Environmental exposure is characterized by low concentration, chronic, and complex exposure. Traditional epidemiological studies show limitations in reflecting these characteristics since they usually focus on a single or very limited number of exposure factors at a time. In this study, we adopted the methodology of environment-wide association study (EWAS) to figure out the association of human liver function with various environmentally hazardous substances.

Methods

We analyzed 2,961 participants from the Korean National Environmental Health Survey Cycle 4 (2018-2020). Using generalized linear model (GLM) analysis, we analyzed the association of 72 variables with 3 liver function indices (aspartate aminotransferase [AST], alanine aminotransferase [ALT], and gamma glutamyl transferase [GGT]). Finally, we visualized our results with Manhattan plot.

Results

In GLM analysis, perfluorooctanesulfonate were positively associated with ALT (odds ratio [OR]: 2.2; 95% confidence interval [CI]: 1.39-3.46; p adjusted = 0.0147) and perfluorodecanoic acid showed positive association with GGT (OR: 2.73; 95% CI: 1.36-5.5; p adjusted = 0.0256). Plasma mercury showed positive association with GGT (OR: 1.45; 95% CI: 1.14-1.84; p adjusted = 0.0315). Using a plastic container while keeping food in the refrigerator was associated with elevated GGT compared to using a glass container (OR: 1.51; 95% CI: 1.16-1.95; p adjusted = 0.0153). 2-ethyl-5-oxohexyl phthalate, showed a negative trend with all 3 indices, with AST (OR: 0.54; 95% CI: 0.39-0.73; p adjusted = 0.00357), ALT (OR: 0.5; 95% CI: 0.34-0.75; p adjusted = 0.036), GGT (OR: 0.55; 95% CI: 0.4-0.76; p adjusted = 0.00697). Bisphenol S and frequent use of sunblock cream showed negative association with ALT (OR: 0.77; 95% CI: 0.66-0.89), and GGT (OR: 0.25; 95% CI: 0.11-0.55), respectively.

Conclusions

We conducted an exploratory study on environmental exposure and human liver function. By using EWAS methodology, we identified 7 factors that could have potential association with liver function.

A descriptive analysis of blood mercury test results in British Columbia to identify excessive exposures

OBJECTIVE

The objective of this study was to describe who in British Columbia (BC) is tested for blood mercury, the distribution of their results, and the adequacy of follow-up testing.

METHODS

The BC Centre for Disease Control (BCCDC) obtained records of clinician-ordered analyses of blood mercury conducted by BC laboratories during 2009 and 2010. We conducted a descriptive analysis with statistical testing of who was tested, the distribution of their blood mercury concentrations, whose results exceeded Health Canada's proposed guidance values (8 μg/L (40 nmol/L) for children/adolescents ≤ 18 years and women 19-49 years, and 20 μg/L (100 nmol/L) for other adults), and patterns of repeat testing.

RESULTS

Mercury test results for 6487 individuals were reviewed. Adults ≥ 50 years had the highest testing rates. The median blood mercury concentration for all tested persons was 1.8 μg/L. Nine percent of women aged 19-49 years had results exceeding Health Canada's provisional guidance value of 8 μg/L. Data from one of BC's two biomarker laboratories indicated that some residents of Vancouver and nearby suburbs have higher exposure to mercury than other BC residents. Of 127 individuals who had results in 2009 exceeding provisional guidance values, only 45% were tested again within 12 months.

CONCLUSION

Collating and analyzing all clinical biomarker testing such as blood mercury at a provincial population level allows for assessment of the adequacy and appropriateness of follow-up testing and suggests which regional and demographic strata are at higher levels of exposure.

The Relationship between Mercury Exposure Indices and Dietary Intake of Fish and Shellfish in Women of Childbearing Age

Women of childbearing age who are susceptible to mercury exposure were studied to understand the relation between mercury intake through fish and shellfish consumption and mercury exposure indices from blood, hair, and urine samples. A total of 711 women of childbearing age from coastal areas with a high concentration of mercury exposure in Korea were studied. Data were collected on demographic characteristics, dietary intake of fish and shellfish using the simple Food Frequency Questionnaire. Mercury concentration was estimated from the collected samples of blood, hair, and urine. The geometric mean of blood methyl mercury concentration of mercury exposure through seafood was 3.06 μg/L for the low tertile, 3.12 μg/L for the middle tertile, and 3.60 μg/L for the high tertile, indicating a clear tendency of blood methyl mercury to increase as the mercury exposure by fish and shellfish intake ascended. For total blood mercury and hair mercury, the middle and high tertiles had higher values than the low. Mercury exposure through fish and shellfish intake is a main factor for an increase of blood methyl mercury concentration in women of childbearing age. More attention needs to be paid to mercury exposure through seafood intake, considering the serious effect mercury concentration has on women of childbearing age.

Heavy-Metals-Mediated Phospholipids Scrambling by Human Phospholipid Scramblase 3: A Probable Role in Mitochondrial Apoptosis

Human phospholipid scramblases are a family of four homologous transmembrane proteins (hPLSCR1-4) mediating phospholipids (PLs) translocation in plasma membrane upon Ca²⁺ activation. hPLSCR3, the only homologue localized to mitochondria, plays a vital role in mitochondrial structure, function, maintenance, and apoptosis. Upon Ca²⁺ activation, hPLSCR3 mediates PL translocation at the mitochondrial membrane enhancing t-bid-induced cytochrome c release and apoptosis. Mitochondria are important target organelles for heavy-metals-induced apoptotic signaling cascade and are the central executioner of apoptosis to trigger. Pb²⁺ and Hg²⁺ toxicity mediates apoptosis by increased reactive oxygen species (ROS) and cytochrome c release from mitochondria. To discover the role of hPLSCR3 in heavy metal toxicity, hPLSCR3 was overexpressed as a recombinant protein in Escherichia coli Rosetta (DE3) and purified by affinity chromatography. The biochemical assay using synthetic proteoliposomes demonstrated that hPLSCR3 translocated aminophospholipids in the presence of micromolar concentrations of Pb²⁺ and Hg²⁺. A point mutation in the Ca²⁺-binding motif (F258V) led to a ∼60% loss in the functional activity and decreased binding affinities for Pb²⁺ and Hg²⁺ implying that the divalent heavy metal ions bind to the Ca²⁺-binding motif. This was further affirmed by the characteristic spectra observed with stains-all dye. The conformational changes upon heavy metal binding were monitored by circular dichroism, intrinsic tryptophan fluorescence, and light-scattering studies. Our results revealed that Pb²⁺ and Hg²⁺ bind to hPLSCR3 with higher affinity than Ca²⁺ thus mediating scramblase activity. To summarize, this is the first biochemical evidence for heavy metals binding to the mitochondrial membrane protein leading to bidirectional translocation of PLs specifically toward phosphatidylethanolamine.

Estimated exposure to mercury from fish consumption among women anglers of childbearing age in the Great Lakes region

Women of childbearing age (WCBA) are advised by state, tribal, and federal agencies to limit their consumption of certain fish, in part, because of concerns about the ingestion of methylmercury and its impact on the development of fetuses. We studied the fish-eating habits of WCBA who had a fishing license and lived near the Great Lakes, where mercury in locally-caught fish is a concern, as these women were likely at greater risk of elevated mercury exposure than the general population. We used a web-based diary method to gather fish consumption data from WCBA anglers over a 4-month period in the summer of 2014. We estimated mercury intake based on reported mercury content of species consumed, frequency of consumption, and meal portion size, and calculated percent exceeding the USEPA reference dose (RfD). Based on these calculations, we estimated that study participants (n = 1395) ingested 0.031 ± 0.002 (95% CI) ug/kg/d of methylmercury (arithmetic mean). We also found that 3.4% of study participants exceeded the RfD when we averaged estimated intake over the 4-month study period. While most (82%) of the fish meals WCBA anglers ate were purchased fish meals generally low in mercury, study participants ingested a disproportionate amount of mercury from locally-caught fish meals (18% of meals contributed 37% of mercury intake). We estimated 11% of WCBA anglers who did not follow state and federal guidelines in effect at the time of our study exceeded the mercury RfD, whereas fewer than 1% of WCBA anglers who followed the guidelines exceeded the RfD. These findings highlight the importance of encouraging WCBA to follow guidelines from agencies for locally-caught fish, in combination with guidelines for purchased fish.

Cooking and co-ingested polyphenols reduce in vitro methylmercury bioaccessibility from fish and may alter exposure in humans

Fish consumption is a major pathway for mercury exposure in humans. Current guidelines and risk assessments assume that 100% of methylmercury (MeHg) in fish is absorbed by the human body after ingestion. However, a growing body of literature suggests that this absorption rate may be overestimated. We used an in vitro digestion method to measure MeHg bioaccessibility in commercially-purchased fish, and investigated the effects of dietary practices on MeHg bioaccessibility. Cooking had the greatest effect, decreasing bioaccessibility on average to 12.5±5.6%. Polyphenol-rich beverages also significantly reduced bioaccessibility to 22.7±3.8% and 28.6±13.9%, for green and black tea respectively. We confirmed the suspected role of polyphenols in tea as being a driver of MeHg's reduced bioaccessibility, and found that epicatechin, epigallocatechin gallate, rutin and cafeic acid could individually decrease MeHg bioaccessibility by up to 55%. When both cooking and polyphenol-rich beverage treatments were combined, only 1% of MeHg remained bioaccessible. These results call for in vivo validation, and suggest that dietary practices should be considered when setting consumer guidelines for MeHg. More realistic risk assessments could promote consumption of fish as a source of fatty acids, which can play a protective role against cardiovascular disease.

An analysis of factors affecting the mercury content in the human femoral bone

The study was carried out to determine the content of mercury in bone tissue of the proximal femur (head and neck bone) of 95 patients undergoing total hip replacement due to osteoarthritis, using CF-AFS analytical technique. Furthermore, the investigations were aimed at assessing the impact of selected factors, such as age, gender, tobacco smoking, alcohol consumption, exposure to chemical substance at work, type of degenerative changes, clinical evaluation and radiological parameters, type of medications, on the concentration of mercury in the head and neck of the femur, resected in situ. Mercury was obtained in all samples of the head and neck of the femur (n = 190) in patients aged 25-91 years. The mean content of mercury for the whole group of patients was as follows: 37.1 ± 35.0 ng/g for the femoral neck and 24.2 ± 19.5 ng/g for the femoral head. The highest Hg contents were found in femoral neck samples, both in women and men, and they amounted to 169.6 and 176.5 ng/g, respectively. The research showed that the mercury content of bones can be associated with body mass index, differences in body anatomy, and gender. The uses of statistical analysis gave the possibility to define the influence of factors on mercury content in human femoral bones.

Fishing for Identity: Mercury Contamination and Fish Consumption Among Indigenous Groups in the United States

Mercury contamination of local fish stocks has become an escalating problem in the United States. Federal and state governments increasingly have issued fish consumption advisories to warn individuals of the risks of eating specific species of fish in particular quantities from individual bodies of water. Some indigenous groups in the United States who rely on these fisheries for subsistence and ritual cultural reasons have become disproportionately impacted by the risks of mercury contamination of their food source. Some of these groups are forced to make a decision whether to continue their cultural life ways and become exposed to mercury or to stop eating fish and witness the degradation of their identity. This article explores the unique conditions of cultural fishing practices among Native American groups in the United States and their disproportionate risk to mercury contamination. Spatial analysis using the geographical information systems software is accompanied by two case studies to explore the risks faced by indigenous communities.

Modeling tribal exposures to methyl mercury from fish consumption

Exposure assessment and risk management considerations for tribal fish consumption are different than for the general U.S. population because of higher fish intake from subsistence fishing and/or from unique cultural practices. This research summarizes analyses of available data and methodologies for estimating tribal fish consumption exposures to methyl mercury (MeHg). Large MeHg fish tissue data sets from the Environmental Protections Agency's (EPA's) Office of Water, USGS's EMMMA program, and other data sources, were integrated, analyzed, and combined with fish intake (consumption) data for exposure analyses using EPA's SHEDS-Dietary model. Results were mapped with GIS tools to depict spatial distributions of the MeHg in fish tissues and fish consumption exposure patterns. Contribution analyses indicates the major sources for those exposures, such as type and length of fish, geographical distribution (water bodies), and dietary exposure patterns. Sensitivity analyses identify the key variables and exposure pathways. Our results show that MeHg exposure of tribal populations from fish are about 3 to 10 times higher than the US general population and that exposure poses potential health risks. The estimated risks would be reduced as much as 50%, especially for high percentiles, just by avoiding consumption of fish species with higher MeHg concentrations such as walleye and bowfin, even without changing total fish intake. These exposure assessment methods and tools can help inform decisions regarding meal sizes and frequency, types of fish and water bodies to avoid, and other factors to minimize exposures and potential health risks from contaminated fish on tribal lands.

Total and methyl mercury in whole blood measured for the first time in the U.S. population: NHANES 2011-2012

BACKGROUND

Despite the public health and toxicologic interest in methyl mercury (MeHg) and ethyl mercury (EHg), these mercury species have been technically difficult to measure in large population studies.

METHODS

Using NHANES 2011-2012 data, we calculated reference ranges and examined demographic factors associated with specific mercury species concentrations and the ratio of MeHg to THg. We conducted several multiple regression analyses to examine factors associated with MeHg concentrations and also with the ratio of MeHg to THg.

RESULTS

Asians had the highest geometric mean concentrations for MeHg, 1.58 µg/L (95% CI 1.29, 1.93) and THg, 1.86 µg/L (1.58, 2.19), followed by non-Hispanic blacks with MeHg, 0.52 µg/L (0.39, 0.68) and THg, 0.68 µg/L (0.54, 0.85). Greater education attainment in adults and male sex were associated with higher MeHg and THg concentrations. Race/ethnicity, age, and sex were significant predictors of MeHg concentrations, which increased with age and were highest in Asians in all age categories, followed by non-Hispanic blacks. Mexican Americans had the lowest adjusted MeHg concentrations. The ratio of MeHg to THg was highest in Asians, varied by racial/ethnic group, and increased with age in a non-linear fashion. The amount of increase in the MeHg to THg ratio with age depended on the initial ratio, with a greater increase as age increased. Of the overall population, 3.05% (95% CI 1.77, 4.87) had MeHg concentrations >5.8 µg/L (a value that corresponds to the U.S. EPA reference dose). The prevalence was highest in Asians at 15.85% (95% CI 11.85, 20.56), increased with age, reaching a maximum of 9.26% (3.03, 20.42) at ages 60-69 years. Females 16-44 years old had a 1.76% (0.82-3.28) prevalence of MeHg concentrations >5.8 µg/L.

CONCLUSIONS

Asians, males, older individuals, and adults with greater educational attainment had higher MeHg concentrations. The ratio of MeHg to THg varied with racial/ethnic group, increased with age, and was nonlinear. U.S. population reference values for MeHg and the ratio of MeHg to THg can assist in more precise assessment of public health risk from MeHg consumed in seafood.

Concentrations of selected heavy metals in maternal blood and associated factors in rural areas in Shanxi Province, China

BACKGROUND

Animal experiments indicate that prenatal exposure to mercury (Hg), lead (Pb), cadmium (Cd) and arsenic (As) can induce fetal neural tube defects (NTDs). The objectives of this study were to determine the levels of maternal exposure to Hg, Pb, Cd and As during early pregnancy in rural areas of Shanxi Province, China, in order to explore factors that were associated with the concentrations of these metals in blood.

METHODS

In 2010, we studied 215 pregnant women during their first and second trimesters in two counties with different prevalence levels of NTDs in Shanxi Province, China. Demographic and exposure data were collected from questionnaires. Blood concentrations of Hg, Pb and Cd were measured with ICP-MS; the As concentration was measured using atomic fluorescence spectrophotometry (AFS) in whole-blood specimens.

RESULTS

The median concentrations of Hg, Pb, Cd and As in maternal blood were 0.26 μg/L (interquartile range [IQR]: 0.16-0.45), 24.48 μg/L (IQR: 18.72-32.31), 0.47 μg/L (IQR: 0.33-0.67) and 0.52 μg/L (IQR: 0.32-0.71), respectively. The maternal blood level of Cd was higher in Yushe county (median: 0.54 μg/L) than in Daixian county (0.39 μg/L). Women who lived near a coal combustion factory, used coal as cooking fuel, consumed fish, shrimp or shellfish, and consumed pork, beef or mutton during the week before the investigation had higher blood concentrations of Hg and As than their counterparts (P<0.05) after controlling for confounding variables, including the county of residence, in the logistic regression models.

CONCLUSIONS

Blood levels of Cd were higher in Yushe county, which has a higher prevalence of neural tube defects. Higher maternal blood levels of Hg in pregnant women were associated with coal combustion. Higher maternal blood levels of Hg and As were associated with fish, shrimp or shellfish consumption, as well as pork, beef or mutton consumption.

Global methylmercury exposure from seafood consumption and risk of developmental neurotoxicity: a systematic review

OBJECTIVE

To examine biomarkers of methylmercury (MeHg) intake in women and infants from seafood-consuming populations globally and characterize the comparative risk of fetal developmental neurotoxicity.

METHODS

A search was conducted of the published literature reporting total mercury (Hg) in hair and blood in women and infants. These biomarkers are validated proxy measures of MeHg, a neurotoxin found primarily in seafood. Average and high-end biomarkers were extracted, stratified by seafood consumption context, and pooled by category. Medians for average and high-end pooled distributions were compared with the reference level established by a joint expert committee of the Food and Agriculture Organization (FAO) and the World Health Organization (WHO).

FINDINGS

Selection criteria were met by 164 studies of women and infants from 43 countries. Pooled average biomarkers suggest an intake of MeHg several times over the FAO/WHO reference in fish-consuming riparians living near small-scale gold mining and well over the reference in consumers of marine mammals in Arctic regions. In coastal regions of south-eastern Asia, the western Pacific and the Mediterranean, average biomarkers approach the reference. Although the two former groups have a higher risk of neurotoxicity than the latter, coastal regions are home to the largest number at risk. High-end biomarkers across all categories indicate MeHg intake is in excess of the reference value.

CONCLUSION

There is a need for policies to reduce Hg exposure among women and infants and for surveillance in high-risk populations, the majority of which live in low-and middle-income countries.

Blood mercury concentrations in pregnant and nonpregnant women in the United States: National Health and Nutrition Examination Survey 1999-2006

BACKGROUND

Prenatal exposure to methylmercury is associated with adverse neurologic development in children. We examined total blood mercury concentrations and predictors of higher blood mercury concentrations in pregnant and nonpregnant women.

METHODS

We analyzed data from 1183 pregnant and 5587 nonpregnant women aged 16-49 years from the 1999-2006 National Health and Nutrition Examination Survey (NHANES). We estimated geometric mean blood mercury concentrations and characteristics associated with higher mercury concentrations (≥3.5 μg/L) in crude and adjusted linear and logistic regression models.

RESULTS

After adjusting for age and race/ethnicity, geometric mean blood mercury concentrations were clinically similar but significantly lower for pregnant (0.81 μg/L; 95% confidence interval [CI], 0.71-0.91) and nonpregnant women of childbearing age (0.93 μg/L; 95% CI, 0.87-0.99); 94% of pregnant and 89% of nonpregnant women had blood mercury concentrations below 3.5 μg/L. The most significant predictor of higher blood mercury concentrations for both pregnant and nonpregnant women was any seafood consumption vs no consumption in the last 30 days (odds ratio, 18.7; 95% CI, 4.9-71.1; odds ratio, 15.5; 95% CI, 7.5-32.1, respectively). Other characteristics associated with ≥3.5 μg/L blood mercury concentrations were older age (≥35 years), higher education (greater than high school), and higher family income to poverty ratio (3.501+) for both pregnant and nonpregnant women.

CONCLUSION

Pregnancy status was not strongly associated with blood mercury concentrations in women of childbearing age and blood mercury concentrations above the 3.5 μg/L cut were uncommon.

Plasma mercury levels in Hong Kong residents: in relation to fish consumption

Mercury exposure is of particular concern since mercury is a neurotoxin and the developing fetus is most sensitive to its adverse effect. Human blood is routinely used as an indicator for the evaluation of human exposure to Hg. To investigate Hg species in human plasma for Hong Kong residents and the relationship between fish consumption and Hg species in plasma, 151 plasma samples were analyzed for Hg species. The mean values of total Hg (THg) and methyl-mercury (MeHg) concentration in plasma were 0.62 and 0.28 μg/L, respectively. No significant differences were observed between females and males as well as among age groups. Fish consumption rate was significantly positively correlated with MeHg concentrations in plasma, which demonstrated that plasma could be a biomarker for human MeHg exposure. Two methods were used to estimate human MeHg exposure. One was based on fish MeHg content and fish consumption rate (EDI(Fish)), another was employed by converting MeHg concentration in blood to MeHg exposure amount (EDI(Blood)). A significant positive correlation was observed between EDI(Blood) and EDI(Fish), and no significant difference was found between EDI(Blood) and EDI(Fish). These results demonstrated that fish consumption was the major source of MeHg for humans.

Biochemical evidence for lead and mercury induced transbilayer movement of phospholipids mediated by human phospholipid scramblase 1

Human phospholipid scramblase 1(hPLSCR1) is a transmembrane protein involved in bidirectional scrambling of plasma membrane phospholipids during cell activation, blood coagulation, and apoptosis in response to elevated intracellular Ca(2+) levels. Pb(2+) and Hg(2+) are known to cause procoagulant activation via phosphatidylserine exposure to the external surface in erythrocytes, resulting in blood coagulation. To explore its role in lead and mercury poisoning, hPLSCR1 was overexpressed in Escherichia coli BL21 (DE3) and purified using affinity chromatography. The biochemical assay showed rapid scrambling of phospholipids in the presence of Hg(2+) and Pb(2+). The binding constant (Ka) was calculated and found to be 250 nM(-1) and 170 nM(-1) for Hg(2+) and Pb(2+), respectively. The intrinsic tryptophan fluorescence and far ultraviolet circular dichroism studies revealed that Hg(2+) and Pb(2+) bind to hPLSCR1 and induce conformational changes. hPLSCR1 treated with protein modifying reagent N-ethylmaleimide before functional reconstitution showed 40% and 24% inhibition in the presence of Hg(2+) and Pb(2+), respectively. This is the first biochemical evidence to prove the above hypothesis that hPLSCR1 is activated in heavy metal poisoning, which leads to bidirectional transbilayer movement of phospholipids.

Temporal evolution of exposure to mercury in riverside communities in the Tapajós basin, from 1994 to 2010

Our objective was to evaluate the temporal evolution of mercury exposure in two riverside communities, Barreiras and São Luiz do Tapajós, downstream of gold mining areas in the Tapajós basin, Brazilian Amazon. The quantification of mercury in hair sample was made by atomic absorption spectrophotometry in the period between 1994 and 2010. In São Luiz do Tapajós the mercury exposure varied, in log units, from the peak of 1.21 ± 0.03 μg/g in 1996 to 1.16 ± 0.07 μg/g in 2007. Mercury exposure in Barreiras varied, in log units, from 1.25 ± 0.04 μg/g in 1994 to 1 ± 0.03 μg/g in 2010, peaking in 1995 at 1.25 ± 0.06 μg/g. Total mercury concentration found in both communities had no statistical differences across the years (p > 0.05) and they were higher than non-mercury exposed communities in Brazil and in South America. We concluded that the mercury exposure in the Tapajós basin is more than regulatory levels or higher than the general population.

The relationship between the fish consumption and blood total/methyl-mercury concentration of costal area in Korea

The purpose of this study was to evaluate the relationship between fish consumption and blood THg/MeHg concentration in Korean adults by measuring MeHg concentration in blood directly. The study subjects consisted of 400 adults aged 20 or older from 30 subareas in Busan, Ulsan and Gyeongsangnam-do province in Korea from August to October, 2010. We tried to recruit the same number of male and female participants in different age groups (20s, 30s, 40s, 50s and 60s) and allocated 13-16 subjects by district to represent Hg concentration in the research areas. The geometric means of THg and MeHg concentration in blood were 5.27 μg/L (5.00-5.57) and 4.05 μg/L (3.81-4.32), respectively. The proportion of MeHg/THg concentration was 78.53% (77.09-79.97). MeHg concentration was higher in coastal areas (4.26 μg/L) than in inland areas (3.52 μg/L) and was higher in men (4.68 μg/L) than in women (3.52 μg/L). In male participants, blood MeHg concentration increased with increasing annual fish consumption, and the proportion of MeHg/THg concentration showed an upward trend as THg concentration increased. However, none of the measures of the proportion of MeHg/THg showed significant differences. This is the first report in Korea about the relationship between blood MeHg concentration and related factors. Our findings suggest that MeHg concentration is affected by fish consumption as well as by gender difference and drinking status. Since the pathological mechanism has not been clarified, additional studies are needed for explaining the biological and lifestyle differences in the risk of adverse health effects by Hg exposure.

Biomarkers of methylmercury exposure immunotoxicity among fish consumers in Amazonian Brazil

BACKGROUND

Mercury (Hg) is a ubiquitous environmental contaminant with neurodevelopmental and immune system effects. An informative biomarker of Hg-induced immunotoxicity could aid studies on the potential contribution to immune-related health effects.

OBJECTIVES

Our objectives were to test the hypothesis that methylmercury (MeHg) exposures affect levels of serum biomarkers and to examine interactions between Hg and selenium (Se) in terms of these responses.

METHODS

This cross-sectional epidemiological study assessed adults living along the Tapajós River, a system long affected by MeHg. We measured antinuclear (ANA) and antinucleolar (ANoA) autoantibody levels and eight cytokines in serum samples (n = 232). Total Hg (including MeHg) and Se were measured in blood, plasma, hair, and urine.

RESULTS

The median (range) total Hg concentrations were 14.1 μg/g (1.1-62.4), 53.5 μg/L (4.3-288.9), 8.8 μg/L (0.2-40), and 3.0 μg/L (0.2-16.1) for hair, blood, plasma, and urine, respectively. Elevated titers of ANA (but not ANoA) were positively associated with MeHg exposure (log-transformed, for blood and plasma), unadjusted [odds ratio (OR) = 2.6; 95% confidence interval (CI): 1.1, 6.2] and adjusted for sex and age (OR = 2.9; 95% CI: 1.1, 7.5). Proinflammatory [interleukin (IL)-6 and interferon (IFN)-γ], anti-inflammatory (IL-4), and IL-17 cytokine levels were increased with MeHg exposure; however, in the subset of the population with elevated ANA, proinflammatory IL-1β, IL-6, IFN-γ, and tumor necrosis factor (TNF)-α and anti-inflammatory (IL-4) cytokine levels were decreased with MeHg exposure. Although Se status was associated with MeHg level (correlation coefficient = 0.86; 95% CI: 0.29, 1.43), Se status was not associated with any changes in ANA and did not modify associations between Hg and ANA titers.

CONCLUSIONS

MeHg exposure was associated with an increased ANA and changes in serum cytokine profile. Moreover, alterations in serum cytokine profiles differed based on ANA response, suggesting a specific phenotype of MeHg susceptibility. Further research on the potential health implications of these observed immunological changes is warranted.

Fetal and maternal immune responses to methylmercury exposure: a cross-sectional study

Methylmercury (MeHg) is a ubiquitous environmental contaminant with known neurodevelopmental effects. In humans, prenatal exposures primarily occur through maternal consumption of contaminated fish. In this study, we evaluated the association between prenatal exposure to MeHg and titers of total immunoglobulins (Ig) and specific autoantibodies in both mothers and fetuses by analyzing maternal and cord blood serum samples. We examined multiple immunoglobulin isotypes to determine if these biomarkers could inform as to fetal or maternal responses since IgG but not IgM can cross the placenta. Finally, we evaluated serum cytokine levels to further characterize the immune response to mercury exposure. The study was conducted using a subset of serum samples (N=61 pairs) collected from individuals enrolled in a population surveillance of MeHg exposures in the Brazilian Amazon during 2000/2001. Serum titers of antinuclear and antinucleolar autoantibodies were measured by indirect immunofluorescence. Serum immunoglobulins were measured by enzyme-linked immunosorbent assay (ELISA) and BioPlex multiplex assay. Serum cytokines were measured by BioPlex multiplex assay. In this population, the geometric mean mercury level was within the 95th percentile for US populations of women of childbearing age but the upper level of the range was significantly higher. Fetal blood mercury levels were higher (1.35 times) than those in their mothers, but highly correlated (correlation coefficient [r]=0.71; 95% CI: 0.54, 0.89). Total IgG (r=0.40; 95% CI: 0.19, 0.62) and antinuclear autoantibody (odds ratio [OR]=1.05; 95% CI: 1.02, 1.08) levels in paired maternal and fetal samples were also associated; in contrast, other immunoglobulin (IgM, IgE, and IgA) levels were not associated between pairs. Total IgG levels were significantly correlated with both maternal (r=0.60; 95% CI: 0.25, 0.96) and cord blood mercury levels (r=0.61; 95% CI: 0.25, 0.97), but individual isotypes were not. Serum cytokines, interleukin-1β (r=0.37; 95% CI: 0.01, 0.73), interleukin-6 (r=0.34; 95% CI: 0.03, 0.65), and tumor necrosis factor-α (r=0.24; 95% CI: 0.015, 0.47), were positively correlated between maternal and fetal samples. Antinuclear and antinucleolar autoantibody titer and serum cytokine levels, in either maternal or cord blood, were not significantly associated with either maternal or cord blood mercury levels. These data provide further evidence that there are likely IgG biomarkers of mercury-induced immunotoxicity in this population since IgG levels were elevated with increased, and associated with, mercury exposure. However, unlike previous data from adult males and non-pregnant females, we found no evidence that antinuclear and antinucleolar autoantibody titer is a reliable biomarker of mercury immunotoxicity in this population.

Blood mercury concentration and related factors in an urban coastal area in Korea

OBJECTIVES

This study was carried out for the purpose of evaluating the blood mercury concentration of the residents of Busan, Korea, as well as the relationship between the mercury concentration and the pattern of fish consumption along with other epidemiological factors.

METHODS

Two hundred ninety-three subjects (147 men and 146 women), who were aged 40 years or more, were recruited into this study between June and October 2009. The mean age of the subjects was 54.3 years (with a range of 40-70 years). Mercury concentrations in blood samples were measured using a gold-amalgam collection method.

RESULTS

The geometric mean concentration of mercury in the total subjects was 8.63 µg/L [range: 1.48~45.71 µg/L]. The blood mercury concentration of the men (9.55 µg/L) was significantly higher than that of the women (7.76 µg/L). The blood mercury concentration of those who eat fish more than 4 times per week was higher than others, and was statistically significant (male p = 0.0019, female p = 0.0002). According to the multiple analysis, the blood mercury concentration was significantly affected by the consumed fish but other epidemiological factors were not related.

CONCLUSIONS

It was found that the subjects who have consumed a large amount of fish may have high blood mercury concentration. It appears that fish consumption can influence blood mercury concentration. Therefore, guidelines for fish consumption that will decrease blood mercury concentration might be necessary in Korea.

Blood total mercury and fish consumption in the Korean general population in KNHANES III, 2005

OBJECTIVES

The objective of this study was to assess the association between the blood total mercury concentration and fish consumption in the Korean general adult population using a representative sample.

METHODS

We studied the blood mercury concentration in a representative sample of 1,749 Koreans who were included in the Third Korean National Health and Nutritional Examination Survey (KNHANES III) performed in 2005, and compared it with the frequency of fish consumption collected during the nutrition survey of KNHANES III.

RESULTS

The geometric means of the blood mercury levels in female subjects (n=890), male subjects (n=859), and all participants (n=1,749) representing adult Koreans aged > or =20 years were 3.70 microg/L [95% confidence interval (CI), 3.46-3.94 microg/L], 4.70 microg/L (95% CI, 4.38-5.02 microg/L), and 4.15 microg/L (95% CI, 3.93-4.38 microg/L), respectively. The geometric mean of the blood mercury level was significantly higher in the high-fish-consumption group (4.38 microg/L; more than once a week) than in the low-consumption group (3.71 microg/L: less than once a week), but the intergroup difference of 18% was less than that in Western countries. Among the nine listed individual types of fish and shellfish, there was a general trend for the blood mercury level to increase with the consumption frequency of squid, clam, salted seafood, and mackerel. The proportion of Korean women aged 20-49 years having blood mercury levels of at least 5.8 microg/L was 27.7% (150/542) in our study.

CONCLUSIONS

The blood mercury level in a representative sample of the Korean adult population was found to be associated with fish consumption in both men and women. However, a high consumption of fish increased the blood mercury level by only 18%.

Low-level mercury can enhance procoagulant activity of erythrocytes: a new contributing factor for mercury-related thrombotic disease

BACKGROUND

Associations between cardiovascular diseases and mercury have been frequently described, but underlying mechanisms are poorly understood.

OBJECTIVES

We investigate the procoagulant activation of erythrocytes, an important contributor to thrombosis, by low-level mercury to explore the roles of erythrocytes in mercury-related cardiovascular diseases.

METHODS

We used freshly isolated human erythrocytes and ex vivo and in vivo thrombosis models in rats to investigate mercury-induced procoagulant activity.

RESULTS

Prolonged exposure to low-dose mercuric ion (Hg(2+); 0.25-5 microM for 1-48 hr) induced erythrocyte shape changes from discocytes to echinocytes to spherocytes, accompanied by microvesicle (MV) generation. These MVs and remnant erythrocytes expressed phosphatidylserine (PS), an important mediator of procoagulant activation. Hg(2+) inhibited flippase, an enzyme that recovers PS into the inner leaflet of the cell membrane, and activated scramblase, an enzyme that alters lipid asymmetry in the cell membrane. Consistent with these activity changes, Hg(2+) increased intracellular calcium and depleted ATP and protein thiol. A thiol supplement reversed Hg(2+)-induced MV generation and PS exposure and inhibited the increase in calcium ion (Ca(2+)) and depletion of ATP, indicating that free-thiol depletion was critical to Hg(2+)-mediated procoagulant activity. The procoagulant activity of Hg(2+)-treated erythrocytes was demonstrated by increased thrombin generation and endothelial cell adhesion. We further confirmed Hg(2+)-mediated procoagulant activation of erythrocytes in ex vivo and in vivo rat thrombosis models, where Hg(2+) treatment (0.5-2.5 mg/kg) increased PS exposure and thrombus formation significantly.

CONCLUSION

This study demonstrated that mercury could provoke procoagulant activity in erythrocytes through protein-thiol depletion-mediated PS exposure and MV generation, ultimately leading to enhanced thrombosis.

Urine mercury excretion following meso-dimercaptosuccinic acid challenge in fish eaters

CONTEXT

Public awareness of methylmercury in fish has caused patients to seek testing for mercury poisoning. In some patients, the diagnosis of mercury poisoning has been made based on urine mercury excretions following oral dosing of meso-dimercaptosuccinic acid (DMSA), a metal chelator. However, studies comparing urine mercury excretion following DMSA in healthy non-fish eaters with healthy fish eaters could not be located.

OBJECTIVES

To describe urinary mercury excretion before and after DMSA in healthy fish eaters and non-fish eaters, and to determine whether urine mercury excretion after DMSA would rise above baseline levels to a greater extent in fish eaters.

DESIGN

A total of 24 healthy physicians were assigned to 1 of 3 groups based on fish consumption: non-fish eaters; 1 to 2 fish servings per week; and 3 or more servings per week. Blood mercury concentrations and 12-hour urine mercury and creatinine excretions were measured before and after oral ingestion of 30 mg of DMSA per kilogram of body weight.

RESULTS

A total of 24 subjects completed the study, and 2 subsequently were excluded. No difference in baseline urinary mercury excretion was detected between groups. All groups demonstrated an increase in urinary mercury excretion following DMSA, which was higher in fish eaters (P = .04). Multiple linear regression found that the best predictor of a rise in urine mercury excretion following DMSA challenge was the prechelation blood mercury concentration.

CONCLUSIONS

In this study of healthy physicians, oral DMSA produced a rise in urine mercury excretion both in non-fish eaters and fish eaters. The increase in chelated mercury excretion was higher in fish eaters. A simple rise in chelated mercury excretion over baseline excretion is not a reliable diagnostic indicator of mercury poisoning.

Meeting report: Methylmercury in marine ecosystems--from sources to seafood consumers

Mercury and other contaminants in coastal and open-ocean ecosystems are an issue of great concern globally and in the United States, where consumption of marine fish and shellfish is a major route of human exposure to methylmercury (MeHg). A recent National Institute of Environmental Health Sciences-Superfund Basic Research Program workshop titled "Fate and Bioavailability of Mercury in Aquatic Ecosystems and Effects on Human Exposure," convened by the Dartmouth Toxic Metals Research Program on 15-16 November 2006 in Durham, New Hampshire, brought together human health experts, marine scientists, and ecotoxicologists to encourage cross-disciplinary discussion between ecosystem and human health scientists and to articulate research and monitoring priorities to better understand how marine food webs have become contaminated with MeHg. Although human health effects of Hg contamination were a major theme, the workshop also explored effects on marine biota. The workgroup focused on three major topics: a) the biogeochemical cycling of Hg in marine ecosystems, b) the trophic transfer and bioaccumulation of MeHg in marine food webs, and c) human exposure to Hg from marine fish and shellfish consumption. The group concluded that current understanding of Hg in marine ecosystems across a range of habitats, chemical conditions, and ocean basins is severely data limited. An integrated research and monitoring program is needed to link the processes and mechanisms of MeHg production, bioaccumulation, and transfer with MeHg exposure in humans.

Cognitive function and blood methylmercury in adults living near a deserted chloralkali factory

We assessed the association between blood methylmercury (MeHg) and cognitive function in 240 adult residents living near a deserted chloralkali plant. Total mercury (T-Hg) in the blood, MeHg, and health and dietary related questionnaire were examined for all participants. The Cognitive Abilities Screening Instrument (CASI C-2.0) and Mini-Mental State Examination (MMSE) were used to assess the participants' cognitive functions. We found a significantly high correlation (r=0.979; p<0.001) between blood T-Hg (17.3+/-10.9 microg/L) and MeHg (15.3+/-9.2 microg/L). We also found significantly higher blood MeHg levels in participants with high local fish and seafood consumption, which revealed that dietary intake was the major exposure route of MeHg. All the participants were assigned to the high-MeHg (H-MeHg, 27.0+/-10.4 microg/L) or low-MeHg (L-MeHg, 11.6+/-4.7 microg/L) groups based on the 75th percentile of their blood MeHg (19.2 microg/L), and then matched for cognitive function confounders: age, gender, and education levels. Higher abnormality rates for remote memory (p=0.036), mental manipulation (p=0.013), and orientation (p=0.005) were found in the H-MeHg group than in the L-MeHg group. Long-term consumption of MeHg-contaminated fish and seafood by residents living near this contaminated area may have persistent effects on their cognitive function. We suggest a follow-up study to monitor the long-term health effects on the residents living near this deserted plant.

Gender differences in the effects of organochlorines, mercury, and lead on thyroid hormone levels in lakeside communities of Quebec (Canada)

Environmental chemicals can disrupt endocrine balance and in particular thyroid hormone (TH) homeostasis. However, studies differ with respect to thyroid profile changes and gender differences are rarely examined. This study investigated the THs, triodothyronine (T3), thyroxine (T4), and thyroid stimulating hormone (TSH), in relation to serum organochlorines (OCs), bioindicators of mercury (Hg) and blood lead (Pb) in 211 freshwater fish consumers (124 men and 87 women) from two communities in Canada. Thyroid hormones were within the normal range and the bioindicators of exposure were low compared to other reports on fish consumers. Stratified analysis showed that for women, serum T3 concentrations were negatively related to serum concentrations of PCB 138, PCB 153, the non-coplanar congeners, Arochlor 1260, and SigmaPCB, as well as p,p'-DDE. No relations were observed between T4 and any of the chemicals measured, but TSH was negatively related to blood Pb. For men, serum T4 was inversely related to PCB 138, non-ortho-substituted (dioxin-like) PCBs and SigmaPCB. A significant positive relationship was observed between serum TSH and different PCB congeners (PCB 138, PCB 180, non-coplanar congeners, mono-ortho coplanar congeners, dioxin-like PCBs), as well as SigmaPCB. Serum TSH increased with hair and blood Hg concentrations and was highest among those in the highest 50th percentile for both Hg and dioxin-like PCB congeners compared to the others. No associations were observed for T3 in men. These findings suggest that even at low concentrations, these environmental contaminants can interfere with thyroid status and effects may differ by gender.

Managing mercury in the great lakes: an analytical review of abatement policies

Mercury, a toxic metal known to have several deleterious affects on human health, has been one of the principal contaminants of concern in the Great Lakes basin. There are numerous anthropogenic sources of mercury to the Great Lakes area. Combustion of coal, smelting of non ferrous metals, and incineration of municipal and medical waste are major sources of mercury emissions in the region. In addition to North American anthropogenic emissions, global atmospheric emissions also significantly contribute to the deposition of mercury in the Great Lakes basin. Both the USA and Canada have agreed to reduce human exposure to mercury in the Great Lakes basin and have significantly curtailed mercury load to this region through individual and joint efforts. However, many important mercury sources, such as coal-fired power plants, still exist in the vicinity of the Great Lakes. More serious actions to drastically reduce mercury sources by employing alternative energy sources, restricting mercury trade and banning various mercury containing consumer products, such as dental amalgam are as essential as cleaning up the historical deposits of mercury in the basin. A strong political will and mass momentum are crucial for efficient mercury management. International cooperation is equally important. In the present paper, we have analyzed existing policies in respective jurisdictions to reduce mercury concentration in the Great Lakes environment. A brief review of the sources, occurrence in the Great Lakes, and the health effects of mercury is also included.

Maternal fish consumption, mercury levels, and risk of preterm delivery

BACKGROUND

Pregnant women receive mixed messages about fish consumption in pregnancy because unsaturated fatty acids and protein in fish are thought to be beneficial, but contaminants such as methylmercury may pose a hazard.

METHODS

In the Pregnancy Outcomes and Community Health (POUCH) study, women were enrolled in the 15th to 27th week of pregnancy from 52 prenatal clinics in five Michigan communities. At enrollment, information was gathered on amount and category of fish consumed during the current pregnancy, and a hair sample was obtained. A segment of hair closest to the scalp, approximating exposure during pregnancy, was assessed for total mercury levels (70-90% methylmercury) in 1,024 POUCH cohort women.

RESULTS

Mercury levels ranged from 0.01 to 2.50 pg/g (mean = 0.29 microg/g; median = 0.23 microg/g). Total fish consumption and consumption of canned fish, bought fish, and sport-caught fish were positively associated with mercury levels in hair. The greatest fish source for mercury exposure appeared to be canned fish. Compared with women delivering at term, women who delivered before 35 weeks' gestation were more likely to have hair mercury levels at or above the 90th percentile (> or = 0.55 microg/g), even after adjusting for maternal characteristics and fish consumption (adjusted odds ratio = 3.0; 95% confidence interval, 1.3-6.7).

CONCLUSION

This is the first large, community-based study to examine risk of very preterm birth in relation to mercury levels among women with low to moderate exposure. Additional studies are needed to see whether these findings will be replicated in other settings.

Whole blood mercury and selenium concentrations in a selected Austrian population: does gender matter?

BACKGROUND

Data on mercury exposure of the Austrian population were inadequate. This study was performed to determine the causal factors underlying mercury exposure and selenium concentrations, and to estimate the gender-related health impacts.

METHODOLOGY

Venous blood samples of 78 women and 81 men were drawn at the Austrian Red Cross, Vienna. Mercury contents in acid-digested whole blood samples were measured after amalgam enrichment by CV-AAS, and selenium by AAS (heated quartz-cell) after hydrid formation.

RESULTS

The average total mercury blood content of Austrians was low (2.38+/-1.55 microgL(-1); N=152). Mercury and selenium concentrations were not different between the genders (P>0.05) but we observed discrepancies regarding the causal factors. Mercury levels in men were influenced not only by fish consumption but also by age, education level, and amalgam fillings, whereas in women, only the diet (fish/seafood, red wine consumption) determined blood mercury (P<0.05). Moreover, only the males indicated a depressive effect of dental amalgam on hematocrit (P<0.05). Regarding selenium, age and alcohol consumption led to lower concentrations in men, whereas a high-level education had the opposite effect; no determinant was found for women. For the whole study group, a significant effect of chronic disease on selenium levels could be detected (P<0.05). 18% of women and 13% of men showed marginal selenium deficiency (blood selenium<65 microgL(-1)). Selenium and mercury concentrations were not correlated.

CONCLUSIONS

Our results indicate the need to evaluate and integrate gender-related findings in metal toxicology and trace element research, because different causal factors require different preventive measures to reduce mercury exposure and the risk of low selenium concentrations. Future research is needed on the gender- and age-related differences in fish/seafood consumption habits, the modifications of mercury toxicokinetics through sex hormones, the selenium supply in Austria, and the clinical relevance of a low selenium status.

Relationship between platelet monoamine oxidase-B (MAO-B) activity and mercury exposure in fish consumers from the Lake St. Pierre region of Que., Canada

Mercury (Hg) is a widespread neurotoxic compound that bio-accumulates in fish and marine mammals. Monoamine oxidase (MAO; EC 1.4.3.4) regulates biogenic amine concentration in the brain and peripheral tissue and has been shown to be a molecular target of Hg compounds in animal models. Blood platelet monoamine oxidase-B (MAO-B) activity may reflect MAO function in the central nervous tissue. Therefore, the objective of this study was to evaluate the relationship between platelet MAO-B and Hg exposure in fish-eating adults (n=127) living along the St. Lawrence River (Lake St. Pierre, Que., Canada). Hg concentrations were determined in blood and hair samples. A significant negative association was observed between platelet MAO-B activity and blood-Hg (r=-0.193, p=0.029) but not with hair-Hg levels (r=-0.125, p=0.169). Multiple linear regression analysis demonstrated that blood-Hg (beta=-4.6, p=0.011) and heavy smoking (beta=-8.5, p=0.001) were associated with reduced platelet MAO activity in the total population. In addition, this reduction in MAO-B activity appeared to be associated with blood-Hg concentrations above 3.4 microg/L (75th percentile). Possible gender related differences were also observed and are discussed. Our results suggest that MAO-B activity in blood platelets may be a useful tool to assess biochemical effects of Hg exposure in human populations. These changes in platelet MAO-B may reflect enzymatic changes in nervous tissue and should be further investigated as a surrogate marker of neurotoxicity.

Inter-individual variations of human mercury exposure biomarkers: a cross-sectional assessment

BACKGROUND

Biomarkers for mercury (Hg) exposure have frequently been used to assess exposure and risk in various groups of the general population. We have evaluated the most frequently used biomarkers and the physiology on which they are based, to explore the inter-individual variations and their suitability for exposure assessment.

METHODS

Concentrations of total Hg (THg), inorganic Hg (IHg) and organic Hg (OHg, assumed to be methylmercury; MeHg) were determined in whole blood, red blood cells, plasma, hair and urine from Swedish men and women. An automated multiple injection cold vapour atomic fluorescence spectrophotometry analytical system for Hg analysis was developed, which provided high sensitivity, accuracy, and precision. The distribution of the various mercury forms in the different biological media was explored.

RESULTS

About 90% of the mercury found in the red blood cells was in the form of MeHg with small inter-individual variations, and part of the IHg found in the red blood cells could be attributed to demethylated MeHg. THg in plasma was associated with both IHg and MeHg, with large inter-individual variations in the distribution between red blood cells and plasma. THg in hair reflects MeHg exposure at all exposure levels, and not IHg exposure. The small fraction of IHg in hair is most probably emanating from demethylated MeHg. The inter-individual variation in the blood to hair ratio was very large. The variability seemed to decrease with increasing OHg in blood, most probably due to more frequent fish consumption and thereby blood concentrations approaching steady state. THg in urine reflected IHg exposure, also at very low IHg exposure levels.

CONCLUSION

The use of THg concentration in whole blood as a proxy for MeHg exposure will give rise to an overestimation of the MeHg exposure depending on the degree of IHg exposure, why speciation of mercury forms is needed. THg in RBC and hair are suitable proxies for MeHg exposure. Using THg concentration in plasma as a measure of IHg exposure can lead to significant exposure misclassification. THg in urine is a suitable proxy for IHg exposure.

Impact of consumption of freshwater fish on mercury levels in hair, blood, urine, and alveolar air

Human exposure to methylmercury occurs mainly via consumption of fish. The aim of the study was to investigate the influence of freshwater fish consumption on mercury levels in hair, blood, urine, and end-exhaled air. Twenty subjects without dental amalgam fillings were recruited from sport-fishing societies. They ranged in age from 61 to 87 yr. Six individuals ate freshwater fish at least once a week and were categorized as high consumers. Eight individuals were classified as medium consumers and ate freshwater fish at least once a month but less than once a week. Six individuals were categorized as low consumers and had not eaten freshwater fish in the past 3 mo. Among the high consumers, median concentrations of mercury were 8.6 microg/L in blood, 2.4 microg/g in hair, 10 pg/L in end-exhaled air, and 1.1 microg/g creatinine in urine. The relationship between freshwater fish consumption and mercury was significant in all biological media. The high-consumption group had much higher mercury levels in blood (9-fold), hair (7-fold), alveolar air (3-fold), and urine (15-fold) than the low-consumption group. The latter finding may be explained by demethylation of methylmercury in the body. The ratio between mercury concentration in blood and hair was 1:270. This implies that the typical blood-hair ratio of 1:250, specified by the World Health Organization (WHO) in 1990, is valid also for exposure to low amounts of methylmercury.

Omega 3 fatty acids for prevention and treatment of cardiovascular disease

BACKGROUND

It has been suggested that omega 3 (W3, n-3 or omega-3) fats from oily fish and plants are beneficial to health.

OBJECTIVES

To assess whether dietary or supplemental omega 3 fatty acids alter total mortality, cardiovascular events or cancers using both RCT and cohort studies.

SEARCH STRATEGY

Five databases including CENTRAL, MEDLINE and EMBASE were searched to February 2002. No language restrictions were applied. Bibliographies were checked and authors contacted.

SELECTION CRITERIA

RCTs were included where omega 3 intake or advice was randomly allocated and unconfounded, and study duration was at least six months. Cohorts were included where a cohort was followed up for at least six months and omega 3 intake estimated.

DATA COLLECTION AND ANALYSIS

Studies were assessed for inclusion, data extracted and quality assessed independently in duplicate. Random effects meta-analysis was performed separately for RCT and cohort data.

MAIN RESULTS

Forty eight randomised controlled trials (36,913 participants) and 41 cohort analyses were included. Pooled trial results did not show a reduction in the risk of total mortality or combined cardiovascular events in those taking additional omega 3 fats (with significant statistical heterogeneity). Sensitivity analysis, retaining only studies at low risk of bias, reduced heterogeneity and again suggested no significant effect of omega 3 fats. Restricting analysis to trials increasing fish-based omega 3 fats, or those increasing short chain omega 3s, did not suggest significant effects on mortality or cardiovascular events in either group. Subgroup analysis by dietary advice or supplementation, baseline risk of CVD or omega 3 dose suggested no clear effects of these factors on primary outcomes. Neither RCTs nor cohorts suggested increased relative risk of cancers with higher omega 3 intake but estimates were imprecise so a clinically important effect could not be excluded.

REVIEWERS' CONCLUSIONS

It is not clear that dietary or supplemental omega 3 fats alter total mortality, combined cardiovascular events or cancers in people with, or at high risk of, cardiovascular disease or in the general population. There is no evidence we should advise people to stop taking rich sources of omega 3 fats, but further high quality trials are needed to confirm suggestions of a protective effect of omega 3 fats on cardiovascular health. There is no clear evidence that omega 3 fats differ in effectiveness according to fish or plant sources, dietary or supplemental sources, dose or presence of placebo.

Temporal variation of blood and hair mercury levels in pregnancy in relation to fish consumption history in a population living along the St. Lawrence River

Fish consumption from the Great Lakes and the St. Lawrence River has been decreasing over the last years due to advisories and increased awareness of the presence of several contaminants. Methylmercury (MeHg), a well-established neurotoxicant even at low levels of exposure, bioaccumulates to differing degrees in various fish species and can have serious adverse effects on the development and functioning of the human central nervous system, especially during prenatal exposure. Most studies on MeHg exposure have focussed on high-level consumers from local fish sources, although mercury (Hg) is also present in fresh, frozen, and canned market fish. Moreover, little information exists on the temporal variation of blood and hair Hg in pregnant women, particularly in populations with low levels of Hg. The aim of the present study was to characterize the temporal variation of Hg during pregnancy and to investigate the relation between fish consumption from various sources prior to and during pregnancy and maternal cord blood and mother's hair Hg levels. We recruited 159 pregnant women from Southwest Quebec through two prenatal clinics of the Quebec Public Health System. All women completed two detailed questionnaires concerning their fish consumption (species and frequency) prior to and during pregnancy. The women also provided blood samples for all three trimesters of pregnancy and hair samples after delivery of up to 9 cm in length. Blood and hair Hg levels were analyzed by cold-vapor atomic-absorption and -fluorescence spectrometry methods, respectively. Results showed that maternal blood and hair Hg levels decreased significantly between the second and third trimesters of pregnancy. However, cord blood Hg was significantly higher than maternal blood at birth. Maternal hair was correlated with Hg blood concentration and was highly predictive of the organic fraction in cord blood. A strong dose relation was observed between the frequency of fish consumption before and during pregnancy and Hg exposure in mothers and newborns. Fish consumption prior to and during pregnancy explained 26% and 20% of cord blood Hg variance, respectively. For this population, detailed multivariate analyses showed that during pregnancy market fish (fresh, canned, and frozen) were more important sources of Hg exposure than were fish from the St. Lawrence River. These results should be taken into account for future advisories and intervention strategies, which should consider Hg levels in different species from all sources in order to maximize the nutritional input from fish and minimize the toxic risk.

Blood mercury levels among Ontario anglers and sport-fish eaters

We conducted two surveys of Ontario (Canada) fishers: a stratified sample of licensed anglers in two Lake Ontario communities (anglers, n=232) and a shore and community-based sample in five Great Lakes' Areas of Concern (AOC eaters, n=86). Among the 176 anglers consuming their catch, the median number of sport-fish meals/year was 34.2 meals and 10.9, respectively, in two communities, with a mean blood total mercury level among these sport-fish consumers of 2.8 microg/L. The vast majority of fish eaten by AOC eaters was from Ontario waters (74%). For AOC eaters, two broad country-of-origin groups were assembled: Euro-Canadians (EC) and Asian-Canadians (AC). EC consumed a median of 174 total fish meals/year and had a geometric mean total mercury level of 2.0 microg/L. Corresponding AC figures were 325 total fish meals/year and 7.9 microg/L. Overall, mercury levels among AOC eaters were higher than in many other Great Lakes populations but lower than in populations frequently consuming seafood. In multivariate models, mercury levels were significantly associated with levels of fish consumption among both anglers and EC AOC eaters. Given the nutritional and social benefits of fish consumption, prudent species and location choices should continue.

Four years of clinical experience with an adverse reaction unit for dental biomaterials

OBJECTIVES

We describe the function of, and results from, the Norwegian National Dental Biomaterials Adverse Reaction Unit after 4 years of activity from 1993 to 1997.

METHODS

During this period of time, 296 patients were examined at the unit, which is located at the Dental School, University of Bergen. The most prevalent age group was 40-49 years, and 70% were women. Dental amalgam was the primary reason for referral to the unit for nearly 85% of the patients, followed by metals in crowns and bridges (11%). Materials in removable dentures, resin-based filling materials and cements, endodontic materials, and others, including temporary materials, were also involved. Nearly all (96%) patients reported general subjective symptoms, such as muscle and joint pain, fatigue, and memory problems. Complaints involving the orofacial region (lips, face, temporomandibular joint) and intraoral subjective symptoms were also common.

RESULTS

Of the patients who were patch tested with substances in dental materials, 23% were positive to gold, 28% to nickel, 14% to cobalt, 9% to palladium, 6% to mercury, and 8% to one or more components of resin-based materials. Mercury concentrations in blood and urine were statistically higher in the patients with amalgam fillings compared with those without.

CONCLUSIONS

Generally, we could not establish a straightforward cause-and-effect relationship between the presence of dental biomaterials and general symptoms. Twenty patients were advised to replace restorative materials because of contact lesions. Another 20 patients were recommended replacement of materials because of allergy verified with positive patch tests. The complex nature of most of the reactions requires a multidisciplinary approach to the care taking of patients who are concerned about reactions from dental materials, particularly amalgam.

Mercury and selenium in whole blood and serum in relation to fish consumption and amalgam fillings in adolescents

Mercury and selenium in whole blood and serum of 245 17-year old Swedish adolescents were analysed. The relationships between these elements' concentrations and the consumption of fish as well as the number of dental amalgam fillings were studied. The geometric means (GM) of the mercury concentrations were 1.1 microg/L in blood and 0.43 microg/L in serum. The mean selenium concentration in blood was 110 microg/L and the GM of the serum selenium concentration 110 microg/L. Fish species with dietary restrictions due to elevated mercury Levels (i.e. pike, perch, pikeperch, burbot, eel and halibut) were consumed on average 0.7 times/month and fish species without such restrictions 4.1 times/month. Despite this comparatively low fish consumption, the adolescents' blood mercury concentrations were positively correlated with fish consumption. Of the adolescents, 39% had amalgam fillings (mean 2 +/- 1.5). Serum mercury was influenced by the number of amalgam fillings, by fish consumption, blood and serum levels of selenium and the residential area. Blood and serum selenium concentrations were not influenced by fish consumption, but were positively associated with the serum mercury concentration.

Reference intervals of cadmium, lead, and mercury in blood, urine, hair, and nails among residents in Mansoura city, Nile delta, Egypt

A random sample of 68 males and 25 females who reside in Mansoura city, Egypt, was examined for concentrations of cadmium, lead, and mercury in blood, urine, hair, and nails. The effect of gender and smoking on such levels was studied. The influence of dental amalgam on the levels of mercury in these biological samples was also examined. The results obtained show that only blood lead, which increased among males, was affected by gender. Blood levels of cadmium and lead as well as hair lead appeared to increase with smoking habit. Mercury levels in blood and urine were related to the presence of dental amalgam fillings. International comparisons between our results and the corresponding levels in other localities in the world showed that there were environmentally related variations in terms of cadmium levels in hair, lead levels in blood, urine, hair, and nails, and mercury levels in blood, hair, and nails. In conclusion, reference intervals of cadmium, lead, and mercury in the biological samples are environmentally related parameters. Some factors, such as gender, smoking habit, and the presence of dental amalgam fillings, may affect such levels and therefore should be considered.

Contaminant exposure among women of childbearing age who eat St. Lawrence River sport fish

Little information is available concerning the level of consumption and degree of contaminant exposure for North American women of childbearing age who eat sport fish. The authors reanalyzed a 1995-1996 study of Montreal-area (Canada) sport fishers. The authors focused on women sport fishers of childbearing age and male sport fishers who had spouses of childbearing age. The primary research involved an on-site questionnaire about fish consumption, with follow-up assessment of sport fishers estimated to have either the highest or lowest levels of fish-based contaminant exposure. Among the 1,654 interviewees were 100 women less than 45 yr of age who had eaten sport fish for an average of 11 yr; 45% ate fish less than once a month. From the follow-up subsample of high- and low-level consumers, the authors identified 17 women less than 45 yr of age and 25 males whose spouses who were less than 45 yr of age and who consumed similar quantities of sport fish. Among this group of 42, the high-exposure women differed from the low-exposure women with respect to their yearly consumption of freshwater fish, blood mercury levels (median = 6.4 vs. 1.4 microgram/l), and plasma polychlorinated biphenyl congener 99 (median = 10.5 vs. 5.9 microgram/kg plasma lipids). Few Montreal-area women of childbearing age consume local sport fish frequently or for extended periods. However, among the small proportion that consumes sport fish frequently or for extended periods, blood mercury concentrations approach levels of concern for fetal protection.

Review of neurobehavioral deficits and river fish consumption from the Tapajós (Brazil) and St. Lawrence (Canada)

Our research group is carrying out studies on neurobehavioral changes associated with eating fish from the Upper St. Lawrence River (Québec, Canada) and the Lower Tapajós River (Brazilian Amazon). Here, these studies are reviewed with respect to exposure, effects and intervention. Although mercury (Hg) levels in piscivorous fish are similar in both regions, in the Amazon, fish constitutes the dietary mainstay, while in Quebec, fish consumption is primarily occasional. Mercury exposure of Amazonian fish-eaters was considerably higher than Québec (median blood total Hg: 28 and 1 μg/l, respectively), but fish from the St. Lawrence contain multiple contaminants. For the Tapajós River, increasing hair Hg was associated with reduced motor and visual functions. Comparison of neurobehavioral performance of Québec fish-eaters and non fish-eaters showed a consistent pattern of information processing slowing among the former; these deficits were not related to blood methyl Hg levels. Early changes associated with exposure can be used to trigger intervention. Since fish provide important essential nutrients, mitigation must balance the beneficial and harmful effects. In Canada, advisories from environmental and health agencies consider both these aspects. In the Amazon, we are currently involved in a participatory research whose goal is to reduce Hg absorption, while maintaining fish consumption.

Mercury exposure and malaria prevalence among gold miners in Pará, Brazil

Economic development, including resource extraction, can cause toxic exposures that interact with endemic infectious diseases. Mercury is an immunotoxic metal used in the amalgamation of gold, resulting in both occupational exposures and environmental pollution. A cross-sectional medical survey was conducted in 1997 on 135 garimpeiros in Para, Brazil, because of their risks of both mercury exposure and malaria transmission. Mean levels of blood and urine mercury were well above non-exposed background levels. Twenty-six subjects had malaria parasitemia: Health symptoms consistent with mercury exposure were reported, but neither symptoms nor signs correlated with mercury levels in blood or urine. We did not find a dose response relationship between mercury exposure and likelihood of prevalent malaria infection, but there was a possible reduction in acquisition of immunity that may be associated with conditions in gold mining, including mercury exposure.

Recent advances in recognition of low-level methylmercury poisoning

Clinically evident neurologic damage from methylmercury exposure was well described following poisoning episodes in Japan and Iraq several decades ago. Paresthesias have been considered to be an early effect; however, additional data raise questions about whether this is the most sensitive adverse effect among adults. Fetuses are considered the most sensitive subpopulation because of the vulnerability of the developing nervous system. Over the past 5 years questions have been raised about what is an appropriate level of exposure for sensitive groups. A recent evaluation by a committee for the US National Research Council found that 0.1 microg/kg body weight per day is a scientifically justified level of methylmercury exposure for maternal-fetal pairs. The conclusions of this report and other issues are discussed in the present review. Because of anthropogenic release of mercury into the environment, methylmercury exposure from fish consumption is a pathway that is of increasing concern.

Mercury exposure in Montrealers who eat St. Lawrence River sportfish

We assessed levels and determinants of mercury biomarkers among residents of Montreal and surroundings who eat sportfish from the nearby St. Lawrence River. Participants were selected from 1118 adult fishers responding to a 1996 screening questionnaire; the study sample (n=132) overrepresented respondents expected to have the greatest and the least exposure to mercury. Tissue mercury concentrations were associated with sportfish consumption: among participants who ate sportfish at least once weekly, hair geometric mean (GM)=0.82+/-2.54 microg/g and blood mercury GM=3.03+/-2.43 microg/L, compared to hair GM=0.38+/-2.28 microg/g and blood mercury GM=1.44+/-2.23 microg/L for those who ate sportfish less than once weekly. While these levels are somewhat higher than those shown for other Greater Lakes and St. Lawrence River fishers, only one participant surpassed the Canadian recommended population mercury limit of 6 microg/g for hair and 20 microg/L for blood. Consumption of several sportfish species independently explained much of the variation in measured blood mercury; the predatory species pike was the most important in multivariable regression. Coincident consumption of waterfowl, fishing during the longer summer/fall rather than the brief winter season, and fishers' age were independently associated with blood mercury. Serum selenium related neither to the level of fish consumption nor to the participants' blood mercury.

An observation on the mercury contents of scalp hair in the urban residents of South Korea

The average value of total mercury (THg) in scalp hair of male residents in Seoul city was 1.7+/-0.18 ppm (mean+/-S.E.) and that of methylmercury (MeHg), 1.0+/-0.12 ppm (58.8% THg). In female, level of THg was 1.1+/-0.15 ppm and MeHg was 0.5+/-0.14 ppm (45.5%). Mercury was found more in the scalp hair of male than female (P<0.01). THg/MeHg increased with age of subjects in male (P<0.01), but not female. Coefficients of correlation (r) between THg and MeHg contents in scalp hair of male was +0.877 (P<0.01) and that of female was +0.508 (P<0.01), respectively.