Monitoring of essential and toxic elements in multi-ingredient food supplements produced in European Union

Monitoring of Essential and Toxic Elements in Multivitamin/Mineral Effervescent Tablet Supplements and Safety Assessment

Multivitamin/mineral (MVM) supplements are the most commonly utilized dietary supplements by many populations. However, there is a severe concern about their adverse effects due to elemental impurities. In the present study, it was aimed to determine the levels of 11 elemental impurities (Cd, Pb, As, Hg, Co, V, Ni, Se, Mo, Cu, and Cr) by inductively coupled plasma-mass spectrometry (ICP-MS) and evaluate the human health risk associated with the consumption of 33 MVM effervescent tablet supplements available in Turkey. The precision of the method in terms of relative standard deviation (RSD) was less than 4.6%. The accuracy of the method was tested with recovery experiments, and the results ranged between 86 and 107%. The impurity levels for Cd, Pb, As, Co, V, Ni, Se, Mo, Cu, and Cr were found between 0.011-0.050, 0.025-0.098, 0.018-0.056, 0.010-0.626, 0.027-0.290, 0.026-1.65, 1.92-21.83, 0.034-34.09, 0.140-183.9, and 0.033-13.10 µg/g, respectively, and Hg was not detected in any sample. The calculated concentrations for elemental impurities complied with EMA and USP guidelines, except one supplement for Se (21.83 µg/g) with a permitted limit of 15 µg/g. The hazard quotient (HQ) and hazard index (HI) levels were below 1 for all samples within the ranges of 3.4 × 10-1-1.4 × 10-6 for HQ and 7.8 × 10-1-1.4 × 10-6 for HI indicating that there is no risk for consumption. The carcinogenic risk (CR) of As was between 1.7 × 10-6 and 5.9 × 10-6, below the threshold value of 1 × 10-4. The results showed that there is no risk to human health.

Safety Assessment of Herbal Food Supplements: Elemental Profiling and Associated Risk

Increased usage of herbal food supplements by both the paediatric and adult populations prompted a health risk assessment study. The elemental profiles of 52 supplements collected in Serbia were obtained using ICP-MS. The calculated contribution to permitted daily exposure was in compliance with the guidelines for elemental impurities: up to 46.8% for Pb (infants), 67.2% for Cu (toddlers), 6.8% for As (preschool children), and 8.0% for Hg (adolescents). Hazard quotients indicated high exposure of toddlers to Cu (100.9%) and Zn (112.7%), although by only one supplement, for which hazard indices ranged from 229 to 105% (aligning from toddlers to adolescents). Based on the margin of exposure, As and Pb were not of safety concern. Conversely, the proportion of supplements exceeding the acceptable level of lifetime cancer risk due to As exposure varied from 41.9% in adolescents to 54.3% in adults. Simultaneous use of multiple supplements over a prolonged period of time could further deepen health concerns.

Toxic elements in children's multivitamin-multimineral supplements and the health risks they pose

This work aimed to determine the levels of toxic elements (As, Cd, Hg, and Pb) and their risks in children's multivitamin-multimineral (CMVM) supplements. An inductively coupled plasma-mass spectrometer (ICP-MS) was used to quantify the studied elements. The mean concentrations and ranges (μg/kg) of the toxic elements in the CMVM products were as follows: As (32.4, 5.3-90); Cd (58.2, 6-129); Hg (42.2, 6-108); and Pb (231,8.6-541). The estimated oral daily intakes (EODI) were determined to be in the range of 0.01-0.31 g/day, 0.01-0.64 g/day, 0.02-0.53 g/day, and 0.01-2.36 g/day for As, Cd, Hg, and Pb, respectively. All the EODI values were below the tolerable intake limits set for each element. The chronic non-cancer risks associated with oral exposure to studied elements were evaluated using the target hazard quotient (THQ) and the hazard index (HI). The THQ and HI values were below 1, indicating that these products were safe for consumption by children. The potential cancer risks associated with exposure to As and Pb through the consumption of CMVM products were determined using the Incremental Lifetime Cancer Risk (ILCR) and the total cancer risks (TCR). The ILCR and TCR values were below the threshold value of 1 × 10-4, indicating that the risk of developing cancer was very low and ignorable.

Long-term dietary exposure to copper in the population in Germany – Results from the BfR MEAL study

The German Total Diet Study (BfR MEAL Study) measured copper in 356 foods. In 105 of these foods copper was determined separately for conventionally and organically pooled samples. Mammalian liver, nuts, oilseeds, cocoa powder and chia seeds contained the highest copper levels. Organically produced foods tended to have higher levels compared to conventionally produced foods. Children's copper exposure was between 0.04 mg/kg body weight per day (mg/kg bw/day) and 0.07 mg/kg bw/day (median). High exposure (95th percentile) ranged between 0.07 mg/kg bw/day and 0.11 mg/kg bw/day. Adult's exposure ranged between 0.02 mg/kg bw/day (median) and 0.04 mg/kg bw/day (95th percentile). Grains and grain-based products were main contributors for all age groups. Copper intake was about 10% higher in a scenario where consumers select the organically produced variants. Children's median and high exposure was above the acceptable daily intake (ADI) of 0.07 mg/kg bw/day set by the European Food Safety Authority (EFSA). However, according to EFSA's evaluation this is not of concern due to higher requirement related to growth. For adults, frequent consumers of mammalian liver exceeded the ADI in median and 95th percentile. Intake of copper-containing dietary supplements may also lead to exceedance of the ADI in all age groups.

Application of Liquid Chromatography Coupled to Mass Spectrometry in Quality Assessment of Dietary Supplements—A Case Study of Tryptophan Supplements: Release Assay, Targeted and Untargeted Studies

Dietary supplements are widely consumed in the EU and the USA. Based on their similarity to pharmaceuticals, consumers mistakenly believe that dietary supplements have also been approved for safety and efficacy. However, in the absence of mandatory testing, data on supplement quality is scarce. Thus, we applied liquid chromatography coupled with tandem mass spectrometry to analyse the quality of dietary supplements containing tryptophan (Trp). We examined 22 supplements in tablets or capsules, produced in the USA, Great Britain, Germany, France, Czech Republic, and Poland. Trp release, crucial for bioavailability and efficiency, was assessed. Additionally, we performed a qualitative analysis of the main ingredient and screened for contaminants. Among the contaminants, we detected Trp’s metabolites, condensation products of Trp and carbonyl compounds, Trp degradation products, degradation products of kynurenine, and other contaminants such as glucosamine and melatonin. The main ingredient content was in the range of 55–100% in capsules and 69–87% in tablets. Surprisingly, almost no Trp release was noted from some supplements. Our study confirms the need to advance research on supplements. We believe that the high-quality analysis of supplements based on reliable analytical techniques will be an important contribution to the discussion on the regulatory framework of these products.

Quality Control of Protein Supplements: A Review

The growing consumer awareness regarding health and fitness has been leading to a huge rise in the consumption of nutritional supplements and, consequently, to an increase in concerns about their quality. In this sense, one of the most consumed products is protein supplements and, despite being safer than other types of supplements, there are several studies showing incompatibilities between what is present on the labels and their actual content. Therefore, this review is focused on gathering information about the problems arising from poor manufacturing practices and inadequate quality control of sport protein supplements. These issues are mainly related to three aspects: reduction of the supplements’ nutritional value, the presence of pharmacological substances, and contamination with microorganisms or toxic metals. Regarding the first aspect, reports about the “classic” addition of nitrogen-rich compounds to mask the protein content measured by the Kjeldahl method were discussed, as well as recent topics such as the addition of cheaper proteins to produce an “undetectable” adulteration in whey protein supplements. With respect to the presence of pharmacological compounds, it is a finding that is not very common in protein supplements; however, even trace amounts of foreign substances in this type of product may cause adverse effects to consumers, and, in the case of an elite athlete, may result in doping. Finally, we discuss about the contamination with microorganisms and toxic metals, this latter being a subject that should be further explored due to few studies in the literature.

Trace and major elements in food supplements of different origin: Implications for daily intake levels and health risks

As the use of food supplements increases, voices are being raised questioning the safety of these products. As a contribution to understanding the trace and major elemental composition of food supplements and their potential health risks, this study presents concentrations of 71 elements in 138 supplements, categorised into synthetic products and three groups of products with natural ingredients. Concentrations were converted into average daily doses (ADDs) and compared to tolerable daily intakes (TDIs). For elements where we found significant ADDs relative to the TDI a comparison was also made to the normal dietary intake. Our main findings are that: 1) Most elements display highly variable concentrations in food supplements; more so than in normal foodstuff; 2) For ten of the analysed elements some products rendered ADDs > 50 % of the TDI. Half of the elements were essential (Fe, Mn, Se, Mo, Zn), and as such motivated in food supplements. The other half (As, Pb, Cd, Al, Ni) represent non-essential and highly toxic elements, where the occurrence in food supplements ought to be viewed as contamination. Although none of these toxic metals were declared on any product's table of content, several products gave high ADDs - in several cases even exceeding the TDIs; 3) The risk of reaching high ADDs for the toxic elements is strongly associated with products that contain marine ingredients (e.g. algae, mussels etc), and to some degree products of terrestrial plant-based origin. The health of consumers would benefit if food regulatory frameworks were updated to better address the risks of food supplements occasionally being contaminated with different toxic metals, for example by setting maximum permissible concentrations for a longer list of elements.

An Approach to Investigate Content-Related Quality of Nutraceuticals Used by Slovenian Consumers: A Case Study with Folate and Vitamin D Supplements

A predisposition for the efficiency of nutraceuticals is that the product contains a sufficient quantity of a vitamin. Several studies have highlighted different quality issues. Our objective was to investigate whether the contents of the vitamins in selected types of food supplements were in accordance with labeling. We focused on two types of food supplements where content-related quality issues could result in public health risks: food supplements for supplementation with (a) folic acid (as 5-methyltetrahydrofolate (5-MTHF)) in pregnancy and (b) with vitamin D in the general population. The study was done on supplements from the global supply that are typically used by Slovenian consumers. We sampled one production batch of 30 different food supplements-six and 24 samples with 5-MTHF and cholecalciferol, respectively. We found samples with vitamin contents outside the 80-150% tolerance interval in both sets. Particularly, 5-MTHF was found to be more problematic, probably due to its lower stability. This study shows the need for better quality control. Quality control is needed during both the manufacturing process and product shelf lifetimes. Content quality should be also subject to external controls by authorities. Voluntarily quality control schemes would also enable consumers to identify products of sufficient quality.

Suplementos alimentares: uma fonte de doping não intencional?

Resumo O excessivo consumo de suplementos alimentares, aliado a uma legislação inespecífica e a um controle de qualidade ineficiente, faz com que a saúde dos consumidores seja colocada em risco devido à possível existência de contaminantes, em especial pró-hormônios, esteroides anabolizantes e estimulantes. Estes compostos podem proporcionar um aumento do desempenho esportivo e acarretar uma série de efeitos adversos, sendo assim proibidos pela Agência Mundial Antidopagem. A contaminação de suplementos pode ocorrer de maneira deliberada ou através de más práticas de produção, em que são encontrados traços dessas substâncias. Todavia, ambos os casos exigem atenção, já que uma contaminação de apenas 0,00005% em massa pode levar ao doping. Neste sentido, estima-se que de 6,4% a 8,8% dos casos estejam relacionados ao consumo de suplementos contaminados. Perante estes fatos, os objetivos principais do trabalho foram: fazer uma revisão da literatura tanto em trabalhos nacionais quanto internacionais, no que concerne à contaminação de suplementos alimentares e sua relação com a dopagem não intencional, bem como orientar os consumidores a escolherem produtos mais seguros. Neste sentido, foi possível observar que os suplementos nacionais são, geralmente, mais seguros quanto à presença de substâncias proibidas, principalmente em relação à contaminação por agentes anabolizantes. Contudo, ainda é preciso um melhor controle de qualidade perante a contaminação/adulteração por estimulantes.

Metals and Metalloids Release from Orthodontic Elastomeric and Stainless Steel Ligatures: In Vitro Risk Assessment of Human Exposure

Elastomeric ligatures are increasingly used as a part of esthetic orthodontic treatment, particularly in children. The aim of the present study was to experimentally test whether these appliances may contribute to exposure to toxic elements. In the present study, elastomeric ligatures (ELs) were incubated in artificial human saliva for 1 month (a typical period of their use) and the release of 21 metals (Ba, Cd, Co, Cr, Cu, Fe, Li, Mn, Mg, Mo, Ni, Pb, Rb, Tl, Ti, Sb, Sr, Sn, Zn, U, V) and 2 metalloids (As and Ge) was studied using inductively coupled plasma-mass spectrometry. For comparison, stainless steel ligatures (SLs) were incubated for 1, 3, and 6 months (since sometimes their use is prolonged) under similar conditions. The determined metal levels were compared to the corresponding safety limits for human exposure. During 1 month, the ELs released Cd, Co, Cr, Mn, Ni, and Sn at total mean ± SD level of 0.31 ± 0.09, 0.98 ± 0.30, 3.96 ± 1.31, 14.7 ± 8.5, 13.8 ± 4.8, and 49.5 ± 27.7 μg, respectively. Other elements were always below the detection limits. In case of SL, the release of Co, Cr, Fe, Ni, Mn, and Sn was observed, and the determined values increased over the studied period. After 6 months, their total mean ± SD levels amounted to 28.6 ± 0.2, 21.7 ± 0.2, 623.5 ± 3.0, 1152.7 ± 1.8, 5.5 ± 0.3, and 22.6 ± 0.2 μg, respectively. The released metal levels from both ligature types were always below safety limits. The release of Ni from SL during 6 months would constitute 5.0 and 11.5% of tolerable intake in adults and children, respectively. The results of this in vitro study highlight that the use of ligatures in orthodontic treatment can be considered safe in terms of metal exposure although elastic ligatures replaced on a monthly basis appear to be advantageous in comparison to the prolonged use of stainless steel appliances.

Contaminants: a dark side of food supplements?

Food supplements (FS) are often consumed as one of the strategies to fight ageing-associated pathologies, especially in the case of oxidative stress-related diseases. Despite the popularity of FS, some concerns about their quality and safety have been raised, especially regarding the presence of contaminants. This paper reviews and discusses the occurrence of contaminants in marketed samples of FS in the last two decades, considering both scientific literature and notifications registered on RASFF portal. The most relevant classes of contaminants were included namely metals, toxins, pesticides, dioxins and PCBs, as well as pharmacologically active ingredients. Variable amounts of contaminants were reported in a significant number of commercially available FS. Although the presence of contaminants does not necessarily mean that their levels exceed the regulatory limits or that the FS intake constitutes a risk to human health, it alerts for the need to further monitor FS safety. The evaluation of the risk associated to the consumption of FS, especially in the elderly population, is particularly challenging due to the frequent exposure to multiple toxicants and to different exposure sources, as well as due to possible pre-existing diseases and respective therapeutics. Therefore, improved quality control procedures and monitoring programs should be pursued in order to avoid undesirable products and assure the safety of FS.

Is Lithium a Micronutrient? From Biological Activity and Epidemiological Observation to Food Fortification

Lithium compounds have been widely used in psychopharmacology, particularly in the treatment of bipolar disorder. Their normothymic and neuroprotective properties when used at high doses have been well established. However, a number of observations suggest that environmentally relevant lithium doses may also exert beneficial health effects, leading to a decrease in the rate of suicides and levels of violence. Despite the fact that this element is not officially considered to be a micronutrient, some authors have suggested provisional recommended intakes set at 1000 μg/day for a 70-kg adult (14.3 μg/kg body weight). The present paper reviews the biological action of lithium, its bioavailability and metabolism, and content in different foodstuffs and water. It also assesses epidemiological data on potential correlations between lithium intake and suicide rate as well as examines the concept of fortifying food with this element as a strategy in the primary prevention of mood disorders and pre-suicidal syndrome.