French infant total diet study: Exposure to selected trace elements and associated health risks

Experimental design optimisation and validation by accuracy profile of a novel method for Hg speciation analysis by HPLC-ICP-MS and application to Total Diet Studies

This study addresses the development and validation of an analytical method for speciation analysis of mercury (inorganic/Hg2+ and methylmercury/CH3Hg+) in fishery products. The Hg species are separated by reversed-phase (RP) high-performance liquid chromatography (HPLC) coupled to inductively coupled plasma mass spectrometry (ICP-MS). The effective separation of Hg2+ and CH3Hg+ was achieved in <8 min using a peptide mapping RP column and a mobile phase containing 2-mercaptoethanol at 0.25% (v/v) and methanol at 1% (v/v). The optimization was carried out using an experimental design through response surface methodology (RSM) with central composite design (CCD), addressing both the HPLC separation and the sample extraction. The method validation was carried out based on the accuracy profile approach. For this purpose, six series of measurements were carried out in duplicate over a time span of 2 months. The limits of quantification (LOQ) were 2.5 µg/kg (wet weight, ww) for CH3Hg+ and 1.2 µg/kg (ww) for Hg2+. The intermediate reproducibility in terms of coefficient of variation (CVR) was <6%. The bias (%) obtained for the analysis of four certified reference materials (CRMs), namely TORT-3 (lobster hepatopancreas), SRM 1566-b (oyster tissue), SQID-1 (cuttlefish) and NMIJ CRM 7402-a (cod fish tissue) was <7%. This demonstrates the method robustness and suitability for routine speciation analysis of CH3Hg+ and Hg2+ in fishery products. The method is intended to be applied for the analysis of the panel of fishery products and fish-based foods in the framework of the (ongoing) third French Total Diet Study.

Homemade weaning foods as a source of lead and mercury exposure in Korean infants - A dietary risk assessment study

Lead (Pb) and mercury (Hg) are neurodevelopmental toxicants that pose risks to cognitive and behavioral health. Given early childhood's vulnerability to these metals, understanding their sources and pathways of exposure during infancy is crucial for public health. During the weaning process, infants may be exposed to metals through the baby food they consume. We aimed to assess metal exposure through homemade weaning foods by analyzing 288 samples consumed by 157 Korean infants aged 6-, 9-, 12-, 15-, and 24-27 months. Pb was detected in 65 % of samples, with levels reaching up to 169 ng/g. Notably, 58 % exceeded the Maximum Level (ML) of 10 ng/g, with a median concentration of 14.7 ng/g fresh weight. Total Hg was found in 88 % of samples, with a median concentration of 4.56 ng/g fresh weight. Estimated median daily intakes of Pb and Hg were 0.29 and 0.09 μg/kg/d, respectively. Considering a benchmark dose for Pb (0.5 μg/kg/d by EFSA), 94 % (the margin of exposure <10) of all age groups was estimated to have a potential health concern associated with homemade baby food consumption. For Hg, only 6 % exceeded a hazard quotients of 1 compared to a provisional tolerable weekly intake for Hg (4 μg/kg/week by WHO). This study marks the first direct assessment of daily Pb and Hg intake through homemade baby food among Korean infants. Our findings underscore the urgent need for heightened awareness regarding metal exposure through homemade baby food.

Bioaccessibility data of potentially toxic elements in complementary foods for infants: A review

The introduction of complementary foods (CFs) is a critical step in an infant's transition to solid foods, providing essential nutrients beyond breast milk. However, CFs may contain potentially toxic elements (PTEs), such as arsenic and cadmium that pose health risks to infants. In this context, understanding the bioaccessibility of PTEs is vital as it determines the fraction of a contaminant released from the food matrix and available for absorption in the gastrointestinal tract. Efforts have been made to standardize the assessment methodology for bioaccessibility, ensuring consistent and reliable data. Moreover, regulatory agencies have established guidelines for PTEs levels in food. However, important gaps still exist, which motivates many research opportunities on this topic.

A survey of toxic elements in ready to eat baby foods in the US market 2021

A non-targeted convenience survey was conducted in 2021 to estimate the range of total arsenic (As), cadmium (Cd), total mercury (Hg) and lead (Pb) concentrations in ready-to-eat baby foods. Four hundred samples were purchased both online and in brick-and-mortar retail. Samples included both organic and non-organic products, packaged in glass or plastic jars and foil or plastic pouches. Samples were analysed by acid assisted microwave digestion and ICP-MS with an emphasis on ultra-low detection limits. Limits of quantification were 2.26, 1.31, 0.72, and 3.14 µg/kg (ppb) for As, Cd, Hg and Pb, respectively. The median concentrations of As, Cd, Hg, and Pb in tested products were 2.60, 1.81, 0.09, and 1.38 µg/kg, respectively. Foods containing rice were more likely to contain arsenic. Foods with leafy greens, such as spinach and kale, were more likely to contain cadmium and foods with root vegetables had the highest concentrations of lead.

Characterization of childhood exposure to environmental contaminants using stool in a semi-urban middle-class cohort from eastern Canada

Children are exposed to various environmental organic and inorganic contaminants with effects on health outcomes still largely unknown. Many matrices (e.g., blood, urine, nail, hair) have been used to characterize exposure to organic and inorganic contaminants. The sampling of feces presents several advantages; it is non-invasive and provides a direct evaluation of the gut microbiome exposure to contaminants. The gut microbiome is a key factor in neurological development through the brain-gut axis. Its composition and disturbances can affect the neurodevelopment of children. Characterization of children exposure to contaminants is often performed on vulnerable populations (e.g., from developing countries, low-income neighborhoods, and large urban centers). Data on the exposure of children from middle-class, semi-urban, and mid-size populations to contaminants is scarce despite representing a significant fraction of the population in North America. In this study, 73 organics compounds from different chemical classes and 22 elements were analyzed in 6 years old (n = 84) and 10 years old (n = 119) children's feces from a middle-class, semi-urban, mid-size population cohort from Eastern Canada. Results show that 67 out of 73 targeted organics compounds and all elements were at least detected in one child's feces. Only caffeine (97% & 80%) and acetaminophen (28% & 48%) were detected in more than 25% of the children's feces, whereas all elements besides titanium were detected in more than 50% of the children.

Gene/environment interaction in the susceptibility of Crohn's disease patients to aluminum

BACKGROUND & AIM

The key role of environmental factors in the pathogenesis of Inflammatory Bowel Diseases (IBD) is recognized. Aluminum is suspected to be a risk factor for IBD. However, mechanisms linking aluminum exposure to disease development are unknown. We examined the role of aluminum transport and subcellular localisation on human colon susceptibility to aluminum-induced inflammation.

METHODS

Human colon biopsies isolated from Crohn's disease (CD) or control patients and Caco-2 cells were incubated with aluminum. The effects of aluminum were evaluated on cytokine secretion and transporter expression. The role of aluminum kinetics parameters was studied in Caco-2 using transport inhibitors and in human colon biopsies by assessing genetic polymorphisms of transporters.

RESULTS

Aluminum exposure was shown to induce cytokine secretion in colon of CD but not healthy patients. In Caco-2 cells, aluminum internalisation was correlated with inflammatory status. In human colon, analysis of genetic polymorphisms and expression of ABCB1 and SLC26A3 transporters showed that their decreased activity was involved in aluminum-induced inflammation.

CONCLUSIONS

We hypothesize that alteration in detoxifying response would lead to a deregulation of intestinal homeostasis and to the expression of IBD. Our study emphasizes the complexity of gene/environment interaction for aluminum adverse health effect, highlighting at risk populations or subtypes of patients. A better understanding of correlations between gene expression or SNP and xenobiotic kinetics parameters would shift the medical paradigm to more personalized disease management and treatment.

Infant exposure to trace elements in breast milk, infant formulas and complementary foods from southern China

Excessive intake of essential trace elements or exposure to potentially toxic elements above certain thresholds may cause adverse health effects in humans. To date, there is scarce evidence concerning Chinese infant exposure to trace elements and the associated risks. In this study, we collected 61 breast milk, 54 infant formula and 90 complementary food samples from southern China to investigate the levels of cobalt (Co), chromium (Cr), copper (Cu), selenium (Se), zinc (Zn), arsenic (As), cadmium (Cd), nickel (Ni) and lead (Pb). The concentrations of these elements in the breast milk samples ranged from under the limit of detection (<LOD)-0.65, <LOD-65.5, 107-1040, 6.17-27.9, 820-10,160, <LOD-2.96, <LOD-0.52, <LOD-230, and <LOD-19.1 μg/L, respectively. In infant formula samples, the concentrations of these elements ranged from 2.77 to 7.56, 27.5-205, 188-4321, 69.7-322, 40,793-84,405, 2.47-12.2, 0.15-3.57, <LOD-505 and 2.19-26.5 μg/kg, respectively, while the concentrations detected in complementary food samples ranged from <LOD-23.7, <LOD-224, <LOD-3705, <LOD-219, 15,335-100,905, <LOD-159, <LOD-66.6, <LOD-502 and <LOD-25.6 μg/kg, respectively. The results showed that the levels of Cr, Cu and Se in 14.8-55.6 % of the infant formula and complementary food samples were lower than the reference values set by Codex Alimentarius or Chinese National Standards, while the levels of Zn in commercial food samples exceeded the corresponding reference values in 9.3-27.8 % of cases; these results suggest a potential risk via the consumption of commercial infant foods. To the best of our knowledge, this is the first study that has comprehensively assessed whether exposure to trace elements via food intake poses potential health risks to Chinese infants.

Pediatric Health Risk Assessment for Exposure to Aluminum from Infant Formulas and Children under the Age of Five's Food Products among Arab Infants: Experience from Lebanon

Chronic dietary aluminum (Al) exposure can have various negative effects on health. The aim of our study is to (1) assess the contamination level of Al in infant formulas (n = 41) and baby food products (n = 76) available in the Lebanese market, and to (2) evaluate the margin of exposure of Al through the consumption of these foods among children under the age of five in Lebanon. Flame atomic absorption spectrometry (FAAS) was used to evaluate all of the samples. Al levels in all tested children’s food items were below the limit of detection. The highest Al level was detected in cornflakes (0.361 ± 0.049 mg/kg) and pureed foods (0.362 ± 0.079 mg/kg). Among infants aged 0−23 months, the average Al exposure due to the daily intake of infant formulas and baby foods was 0.01 and 0.0104 mg/kg BW/day for males and females, respectively. Babies aged 8−10 and 3−5 months had the highest and lowest levels of Al exposure, respectively. Additionally, the toxicological contribution of Al exposure determined for several age groups to a provisional tolerated weekly intake (PTWI) set by JECFA was  <6% and  <7% for males and females, respectively. The total Al exposure through the consumption of infant formulas and complementary foods among all ages in both males and females was below the values of weekly tolerable intakes (2 mg/kg/BW/W) set by JECFA. However, the values of hazard quotient (HQ) exceeded 1 in both male and female Lebanese infants. As a result, the risk of infants being exposed to Al in baby foods needs to be continuously considered.

Assessment of Aluminum via Baby Foods Consumption in Turkey: Estimated Early-Life Dietary Exposure and Target Hazard Quotient

This study focuses on infant formulas and baby biscuits, which have an important place in the nutrition of the most vulnerable individuals, namely babies. In this sense, the aluminum levels of 64 different baby foods, retrospectively consumed by 348 babies for dietary recall 24 h, were determined by ICP-MS. Then, the exposure resulting from the consumption of these foods was calculated via a deterministic model, and a risk assessment was made. Aluminum levels of infant formulas and baby biscuits that are of higher values compared to other studies were found in the range of 718-6987 and 1803-15,479 μg/kg, respectively. Aluminum exposure was calculated as 8.02, 7.28, 4.03, and 4.08 μg/kg bw/day in babies aged 0-6, 7-12, 13-24, and 25-36 months, respectively. There is no statistically significant difference between different age groups according to the total aluminum exposure levels. The toxicological contribution of aluminum exposure is quite limited (< 6.0% of PTWI). THQ values were calculated as 10-20 for babies aged 0-36 months. Therefore, THQ values indicate a potential health problem.

Pollution and health: a progress update

The Lancet Commission on pollution and health reported that pollution was responsible for 9 million premature deaths in 2015, making it the world's largest environmental risk factor for disease and premature death. We have now updated this estimate using data from the Global Burden of Diseases, Injuriaes, and Risk Factors Study 2019. We find that pollution remains responsible for approximately 9 million deaths per year, corresponding to one in six deaths worldwide. Reductions have occurred in the number of deaths attributable to the types of pollution associated with extreme poverty. However, these reductions in deaths from household air pollution and water pollution are offset by increased deaths attributable to ambient air pollution and toxic chemical pollution (ie, lead). Deaths from these modern pollution risk factors, which are the unintended consequence of industrialisation and urbanisation, have risen by 7% since 2015 and by over 66% since 2000. Despite ongoing efforts by UN agencies, committed groups, committed individuals, and some national governments (mostly in high-income countries), little real progress against pollution can be identified overall, particularly in the low-income and middle-income countries, where pollution is most severe. Urgent attention is needed to control pollution and prevent pollution-related disease, with an emphasis on air pollution and lead poisoning, and a stronger focus on hazardous chemical pollution. Pollution, climate change, and biodiversity loss are closely linked. Successful control of these conjoined threats requires a globally supported, formal science-policy interface to inform intervention, influence research, and guide funding. Pollution has typically been viewed as a local issue to be addressed through subnational and national regulation or, occasionally, using regional policy in higher-income countries. Now, however, it is increasingly clear that pollution is a planetary threat, and that its drivers, its dispersion, and its effects on health transcend local boundaries and demand a global response. Global action on all major modern pollutants is needed. Global efforts can synergise with other global environmental policy programmes, especially as a large-scale, rapid transition away from all fossil fuels to clean, renewable energy is an effective strategy for preventing pollution while also slowing down climate change, and thus achieves a double benefit for planetary health.

Cereal and Juice, Lead and Arsenic, Our Children at Risk: A Call for the FDA to Re-Evaluate the Allowable Limits of Lead and Arsenic That Children May Ingest

Eliminating heavy metal contamination of foods is a goal yet to be achieved in the U.S. In recent months, efforts have been underway to have the Food and Drug Administration (FDA) re-evaluate the permissible limits of lead (Pb) and arsenic (As) allowable in cereals and juices aimed for consumption by children. This report discusses the recent scientific literature that support proposed revisions in these limits. It presents proactive suggestions for the FDA to consider in its response to concerns of ongoing Pb and As exposures in food and drinks. While more scientific studies are needed to better define ‘safe’ levels of Pb and As exposures and ingestion of these elements in general are neurotoxic, the higher sensitivity of children to these toxic elements makes it imperative that the FDA adjust standards to be most protective of infants, toddlers, and children.

Dietary intake and risk assessment of elements for 1- and 2-year-old children in the Netherlands

In 2017, a total diet study (TDS) was conducted in the Netherlands to determine the intake of elements by 1- and 2-year-old children. Concentrations of 47 elements were analysed and long-term dietary intake was calculated for 24 elements. The 95th percentile (P95) intake estimates were compared with a tolerable daily or weekly intake (TDI or TWI) or tolerable upper intake level (UL), or a margin of exposure (MOE) was calculated. The P95 intake of cadmium and zinc exceeded the TWI or UL, respectively, and the P95 intake of inorganic arsenic and lead resulted in low MOEs. Food subgroups contributing most to the intake were "potatoes" for cadmium, "milk and milk-based beverages" for zinc, "concentrated fruit juices" and "rice" for inorganic arsenic, and "candies" for lead. For inorganic mercury, it could not be established if the intake was (too) high. P95 intake estimates of the other elements for which a risk characterisation could be performed were below the health-based guidance values. It was noted that the P50 intake estimate of manganese was a factor of 3 higher than the adequate intake level. Due to the absence of a UL, it is not clear if this intake is of concern.

Health Risk Assessment of Exposure to 15 Essential and Toxic Elements in Spanish Women of Reproductive Age: A Case Study

This case study investigates the exposure of 119 Spanish women of reproductive age to 5 essential (Co, Cu, Mn, V, Zn) and 10 toxic (Ba, Be, Cs, Ni, Pb, Pt, Sb, Th, Al, U) elements and assesses their risk. The essential elements (Co, Cu, Mn, V, and Zn) showed average concentrations (GM: geometric mean) of 0.8, 35, 0.5, 0.2, and 347 μg/L, respectively. Five of the toxic elements (Ba, Cs, Ni, Al, U) exhibited detection frequencies of 100%. The GM concentrations of the novel toxic elements were 12 μg/L (Al), 0.01 μg/L (Pt), 0.02 μg/L (U), 0.12 μg/L (Th), 0.009 μg/L (Be) and 4 μg/L (Cs). The urine analysis was combined with a survey to assess any variations between subgroups and potential predictors of exposure to elements in the female population. Significant differences were obtained between the rural and urban areas studied for the toxic element Cs, with higher levels found in mothers living in urban areas. In relation to diet, statistically significantly higher levels of essential (Cu) and toxic (Ba) elements were detected in women with a high consumption of fish, while mothers who consumed a large quantity of legumes presented higher levels of the toxic element Ni (p = 0.0134). In a risk-assessment context, hazard quotients (HQs) greater than 1 were only observed for the essential elements Zn and Cu in P95. No deficiency was found regarding the only essential element for which a biomonitoring equivalent for nutritional deficit is available (Zn). For the less-studied toxic elements (Al, Pt, U, Th, Be, and Cs), HQs were lower than 1, and thus, the health risk due to exposure to these elements is expected to be low for the female population under study.

Provision of folic acid for reducing arsenic toxicity in arsenic-exposed children and adults

BACKGROUND

Arsenic is a common environmental toxin. Exposure to arsenic (particularly its inorganic form) through contaminated food and drinking water is an important public health burden worldwide, and is associated with increased risk of neurotoxicity, congenital anomalies, cancer, and adverse neurodevelopment in children. Arsenic is excreted following methylation reactions, which are mediated by folate. Provision of folate through folic acid supplements could facilitate arsenic methylation and excretion, thereby reducing arsenic toxicity.

OBJECTIVES

To assess the effects of provision of folic acid (through fortified foods or supplements), alone or in combination with other nutrients, in lessening the burden of arsenic-related health outcomes and reducing arsenic toxicity in arsenic-exposed populations.

SEARCH METHODS

In September 2020, we searched CENTRAL, MEDLINE, Embase, 10 other international databases, nine regional databases, and two trials registers.

SELECTION CRITERIA

Randomised controlled trials (RCTs) and quasi-RCTs comparing the provision of folic acid (at any dose or duration), alone or in combination with other nutrients or nutrient supplements, with no intervention, placebo, unfortified food, or the same nutrient or supplements without folic acid, in arsenic-exposed populations of all ages and genders.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane.

MAIN RESULTS

We included two RCTs with 822 adults exposed to arsenic-contaminated drinking water in Bangladesh. The RCTs compared 400 µg/d (FA400) or 800 µg/d (FA800) folic acid supplements, given for 12 or 24 weeks, with placebo. One RCT, a multi-armed trial, compared FA400 plus creatine (3 g/d) to creatine alone. We judged both RCTs at low risk of bias in all domains. Due to differences in co-intervention, arsenic exposure, and participants' nutritional status, we could not conduct meta-analyses, and therefore, provide a narrative description of the data. Neither RCT reported on cancer, all-cause mortality, neurocognitive function, or congenital anomalies. Folic acid supplements alone versus placebo Blood arsenic. In arsenic-exposed individuals, FA likely reduces blood arsenic concentrations compared to placebo (2 studies, 536 participants; moderate-certainty evidence). For folate-deficient and folate-replete participants who received arsenic-removal water filters as a co-intervention, FA800 reduced blood arsenic levels more than placebo (percentage change (%change) in geometric mean (GM) FA800 -17.8%, 95% confidence intervals (CI) -25.0 to -9.8; placebo GM -9.5%, 95% CI -16.5 to -1.8; 1 study, 406 participants). In one study with 130 participants with low baseline plasma folate, FA400 reduced total blood arsenic (%change FA400 mean (M) -13.62%, standard error (SE) ± 2.87; placebo M -2.49%, SE ± 3.25), and monomethylarsonic acid (MMA) concentrations (%change FA400 M -22.24%, SE ± 2.86; placebo M -1.24%, SE ± 3.59) more than placebo. Inorganic arsenic (InAs) concentrations reduced in both groups (%change FA400 M -18.54%, SE ± 3.60; placebo M -10.61%, SE ± 3.38). There was little to no change in dimethylarsinic acid (DMA) in either group. Urinary arsenic. In arsenic-exposed individuals, FA likely reduces the proportion of total urinary arsenic excreted as InAs (%InAs) and MMA (%MMA) and increases the proportion excreted as DMA (%DMA) to a greater extent than placebo (2 studies, 546 participants; moderate-certainty evidence), suggesting that FA enhances arsenic methylation. In a mixed folate-deficient and folate-replete population (1 study, 352 participants) receiving arsenic-removal water filters as a co-intervention, groups receiving FA had a greater decrease in %InAs (within-person change FA400 M -0.09%, 95% CI -0.17 to -0.01; FA800 M -0.14%, 95% CI -0.21 to -0.06; placebo M 0.05%, 95% CI 0.00 to 0.10), a greater decrease in %MMA (within-person change FA400 M -1.80%, 95% CI -2.53 to -1.07; FA800 M -2.60%, 95% CI -3.35 to -1.85; placebo M 0.15%, 95% CI -0.37 to 0.68), and a greater increase in %DMA (within-person change FA400 M 3.25%, 95% CI 1.81 to 4.68; FA800 M 4.57%, 95% CI 3.20 to 5.95; placebo M -1.17%, 95% CI -2.18 to -0.17), compared to placebo. In 194 participants with low baseline plasma folate, FA reduced %InAs (%change FA400 M -0.31%, SE ± 0.04; placebo M -0.13%, SE ± 0.04) and %MMA (%change FA400 M -2.6%, SE ± 0.37; placebo M -0.71%, SE ± 0.43), and increased %DMA (%change FA400 M 5.9%, SE ± 0.82; placebo M 2.14%, SE ± 0.71), more than placebo. Plasma homocysteine: In arsenic-exposed individuals, FA400 likely reduces homocysteine concentrations to a greater extent than placebo (2 studies, 448 participants; moderate-certainty evidence), in the mixed folate-deficient and folate-replete population receiving arsenic-removal water filters as a co-intervention (%change in GM FA400 -23.4%, 95% CI -27.1 to -19.5; placebo -1.3%, 95% CI -5.3 to 3.1; 1 study, 254 participants), and participants with low baseline plasma folate (within-person change FA400 M -3.06 µmol/L, SE ± 3.51; placebo M -0.05 µmol/L, SE ± 4.31; 1 study, 194 participants). FA supplements plus other nutrient supplements versus nutrient supplements alone In arsenic-exposed individuals who received arsenic-removal water filters as a co-intervention, FA400 plus creatine may reduce blood arsenic concentrations more than creatine alone (%change in GM FA400 + creatine -14%, 95% CI -22.2 to -5.0; creatine -7.0%, 95% CI -14.8 to 1.5; 1 study, 204 participants; low-certainty evidence); may not change urinary arsenic methylation indices (FA400 + creatine: %InAs M 13.2%, SE ± 7.0; %MMA M 10.8, SE ± 4.1; %DMA M 76, SE ± 7.8; creatine: %InAs M 14.8, SE ± 5.5; %MMA M 12.8, SE ± 4.0; %DMA M 72.4, SE ±7.6; 1 study, 190 participants; low-certainty evidence); and may reduce homocysteine concentrations to a greater extent (%change in GM FA400 + creatinine -21%, 95% CI -25.2 to -16.4; creatine -4.3%, 95% CI -9.0 to 0.7; 1 study, 204 participants; low-certainty evidence) than creatine alone.

AUTHORS' CONCLUSIONS

There is moderate-certainty evidence that FA supplements may benefit blood arsenic concentration, urinary arsenic methylation profiles, and plasma homocysteine concentration versus placebo. There is low-certainty evidence that FA supplements plus other nutrients may benefit blood arsenic and plasma homocysteine concentrations versus nutrients alone. No studies reported on cancer, all-cause mortality, neurocognitive function, or congenital anomalies. Given the limited number of RCTs, more studies conducted in diverse settings are needed to assess the effects of FA on arsenic-related health outcomes and arsenic toxicity in arsenic-exposed adults and children.

Risk-Benefit Assessment of Cereal-Based Foods Consumed by Portuguese Children Aged 6 to 36 Months-A Case Study under the RiskBenefit4EU Project

Cereal-based foods, including breakfast (BC) and infant cereals (IC), are among the first solid foods introduced to infants. BC and IC are sources of macro and micronutrients that have beneficial effects on health, but can also be sources of harmful chemical and microbiological contaminants and nutrients that may lead to adverse health effects at high consumption levels. This study was performed under the RiskBenefit4EU project with the aim of assessing the health impact associated with consumption of BC and IC by Portuguese children under 35 months. Adverse effects associated with the presence of aflatoxins, Bacillus cereus, sodium and free sugars were assessed against the benefits of fiber intake. We applied a risk–benefit assessment approach, and quantified the health impact of changes in consumption of BC and IC from current to various alternative consumption scenarios. Health impact was assessed in terms of disability-adjusted life years. Results showed that moving from the current consumption scenario to considered alternative scenarios results in a gain of healthy life years. Portuguese children can benefit from exchanging intake of IC to BC, if the BC consumed has an adequate nutritional profile in terms of fiber, sodium and free sugars, with levels of aflatoxins reduced as much as possible.

Temporal trend of the dietary exposure to metals/metalloids: A case study in Tarragona County, Spain

In 2018, samples of various food groups were randomly purchased in different establishments of Tarragona County (Catalonia, Spain). The levels of As, Be, Cd, Cr, Hg, Mn, Ni, Pb, Sn, Tl and V were determined in the analyzed foodstuffs and their dietary intakes were estimated. Manganese was the element showing the highest concentration, while Be, Cr and Tl were not detected in any of the samples. Fish and shellfish was the only food group with detectable traces of all the remaining elements. The current levels were compared with the results of two previous surveys conducted in 1998 and 2013 in the same area. Although the levels of the analyzed elements in foodstuffs increased during the period 2013-2018, their intakes decreased by an average of 60%, due to consumption patterns changes by the population. Children and adolescents exceeded the maximum recommended intake of Ni set by the EFSA, while the dietary exposure to Pb for children was also above safety values. Compared with the concentrations found in 2013, Ni was the only element showing an increase, as well as an increase of human dietary intake. Meat, vegetables and milk were identified as the main contributors to Ni exposure. This trend was also correlated with changes in the biological burden of the same elements previously reported for the population of the area, for whom an increase of Ni in lungs was reported. Based on these results, Ni should be included as a target metal by food safety authorities, being suggested its inclusion in future Total Diet Studies.

Exposure assessment of methylmercury in samples of the BfR MEAL Study

The BfR MEAL Study is the first German total diet study and will establish a representative and comprehensive database for dietary exposure assessment in Germany. The present study reports first results of the BfR MEAL Study regarding methylmercury in fish, seafood and mushrooms. In total, 34 MEAL foods were purchased nationally or regionally according to a defined sampling plan, prepared in a representative way for German households, pooled into 49 samples, homogenized and subjected to ICP-MS analysis. Dogfish, tuna, ocean perch, halibut and eel were the fish species with highest MeHg concentrations, while levels in mushrooms and mushroom products had markedly lower MeHg levels. Exposure was estimated by matching the present results with consumption data at appropriate levels of food group aggregation. MeHg exposure for adult high consumers (P 95) exceeded the tolerable weekly intake recommended by the European Food Safety Authority in two age groups (14-17 and 18-24 years). In children, no age group exceeded the recommended tolerable weekly intake. Regional samples differed only slightly in MeHg levels. The differences in exposure found in four regions of Germany were influenced by consumption habits rather than MeHg level in the investigated food.

Serum concentration of toxic metals and rare earth elements in children and adolescent

Biomonitoring studies are important for quantifying the body burden of pollutants and their possible effects on health. Serum concentration of 42 elements was assessed by ICP-MS in 89 children (7.2 ± 3.4 years old) from Bucharest (Romania). Levels of pollutants were compared with the clinical data obtained from routine blood tests. Clinical parameters were in the physiological range. Deficiencies of manganese, selenium, and zinc were discovered. Blood levels of elements were low. The highest levels were observed among children younger than six years. The sum of iron, selenium, barium, nickel, antimony, and cerium was positively associated with hemoglobin (Spearman rho = 0.217, P-value = 0.041), while the sum of copper, thallium, niobium, and tantalum was negatively associated (Spearman rho = -0.228, P-value = 0.032). Given the inherent sensitivity of the child population, additional studies are needed to assess the effects of these elements on their health.

Update of the risk assessment of nickel in food and drinking water

The European Commission asked EFSA to update its previous Opinion on nickel in food and drinking water, taking into account new occurrence data, the updated benchmark dose (BMD) Guidance and newly available scientific information. More than 47,000 analytical results on the occurrence of nickel were used for calculating chronic and acute dietary exposure. An increased incidence of post-implantation loss in rats was identified as the critical effect for the risk characterisation of chronic oral exposure and a BMDL 10 of 1.3 mg Ni/kg body weight (bw) per day was selected as the reference point for the establishment of a tolerable daily intake (TDI) of 13 μg/kg bw. Eczematous flare-up reactions in the skin elicited in nickel-sensitised humans, a condition known as systemic contact dermatitis, was identified as the critical effect for the risk characterisation of acute oral exposure. A BMDL could not be derived, and therefore, the lowest-observed-adverse-effect-level of 4.3 μg Ni/kg bw was selected as the reference point. The margin of exposure (MOE) approach was applied and an MOE of 30 or higher was considered as being indicative of a low health concern. The mean lower bound (LB)/upper bound (UB) chronic dietary exposure was below or at the level of the TDI. The 95th percentile LB/UB chronic dietary exposure was below the TDI in adolescents and in all adult age groups, but generally exceeded the TDI in toddlers and in other children, as well as in infants in some surveys. This may raise a health concern in these young age groups. The MOE values for the mean UB acute dietary exposure and for the 95th percentile UB raises a health concern for nickel-sensitised individuals. The MOE values for an acute scenario regarding consumption of a glass of water on an empty stomach do not raise a health concern.

Dietary exposure to pesticide residues and associated health risks in infants and young children - Results of the French infant total diet study

A total diet study (TDS) was undertaken to estimate the chronic dietary exposure to pesticide residues and health risks for the French infants and young children below 3 years old. As a whole, 516 pesticides and metabolites were analysed in 309 food composite samples including 219 manufactured baby foods and 90 common foods, which cover 97% of infants and young children's diet. These composite samples were prepared using 5,484 food products purchased during all seasons from 2011 to 2012 and processed as consumed. Pesticide residues were detected in 67% of the samples and quantified in 27% of the baby food samples and in 60% of the common foods. Seventy-eight different pesticides were detected and 37 of these quantified at levels ranging from 0.02 to 594 µg/kg. The most frequently detected pesticides (greater than 5% samples) were (1) the fungicides 2-phenylphenol, azoxystrobin, boscalid, captan and its metabolite tetrahydrophthalimide, carbendazim, cyprodinil, difenoconazole, dodine, imazalil, metalaxyl, tebuconazole, thiabendazole, (2) the insecticides acetamiprid, pirimiphos-methyl and thiacloprid, (3) the herbicide metribuzin and (4) the synergist piperonyl butoxide. Dietary intakes were estimated for each of the 705 individuals studied and for 431 pesticides incl. 281 with a toxicological reference value (TRV). In the lower-bound scenario, which tends to underestimate the exposure, the TRV were never exceeded. In the upper-bound scenario that overestimates exposure, the estimated intakes exceeded the TRV for dieldrin and lindane (two persistent organic pollutants) and propylene thiourea, a metabolite of propineb. For these three substances, more sensitive analyses are needed to refine the assessment. For 17 other detected and/or prioritised pesticides, the risk could not be characterised due to the lack of a valid TRV, of certain food analyses or the absence of analytical standards for their metabolites.

Biomonitoring of Trace Elements in Subjects Living Near a Hazardous Waste Incinerator: Concentrations in Autopsy Tissues

The only hazardous waste incinerator (HWI) in Spain started to operate in 1999. Twenty years later, the levels of 11 trace elements (As, Be, Cd, Cr, Hg, Mn, Ni, Pb, Sn, Tl and V) were analyzed in five different autopsy tissues (kidney, liver, brain, bone and lung) from 20 individuals who had been living near the facility. In 2019, As, Be, Tl and V were not detected in any of the analyzed tissues, while Hg could be only quantified in very few samples. The highest levels of Cd and Pb were found in kidney and bone, respectively, while those of Mn were observed in liver and kidney. In turn, the mean concentrations of Cr and Sn were very similar in all tissues. A consistent temporal trend (1998-2019) was only found for Cr and Pb. On the one hand, the mean Cr concentrations in kidney and bone have increased progressively since 1998. In contrast, the mean levels of Pb decreased significantly over time, probably due to ban of Pb as gasoline additive. The data global analysis indicates that the emissions of trace elements by the HWI have not increased the exposure and/or accumulation of these elements in individuals living near the facility.

Aggregated aluminium exposure: risk assessment for the general population

Aluminium is one of the most abundant elements in earth's crust and its manifold uses result in an exposure of the population from many sources. Developmental toxicity, effects on the urinary tract and neurotoxicity are known effects of aluminium and its compounds. Here, we assessed the health risks resulting from total consumer exposure towards aluminium and various aluminium compounds, including contributions from foodstuffs, food additives, food contact materials (FCM), and cosmetic products. For the estimation of aluminium contents in foodstuff, data from the German "Pilot-Total-Diet-Study" were used, which was conducted as part of the European TDS-Exposure project. These were combined with consumption data from the German National Consumption Survey II to yield aluminium exposure via food for adults. It was found that the average weekly aluminium exposure resulting from food intake amounts to approx. 50% of the tolerable weekly intake (TWI) of 1 mg/kg body weight (bw)/week, derived by the European Food Safety Authority (EFSA). For children, data from the French "Infant Total Diet Study" and the "Second French Total Diet Study" were used to estimate aluminium exposure via food. As a result, the TWI can be exhausted or slightly exceeded-particularly for infants who are not exclusively breastfed and young children relying on specially adapted diets (e.g. soy-based, lactose free, hypoallergenic). When taking into account the overall aluminium exposure from foods, cosmetic products (cosmetics), pharmaceuticals and FCM from uncoated aluminium, a significant exceedance of the EFSA-derived TWI and even the PTWI of 2 mg/kg bw/week, derived by the Joint FAO/WHO Expert Committee on Food Additives, may occur. Specifically, high exposure levels were found for adolescents aged 11-14 years. Although exposure data were collected with special regard to the German population, it is also representative for European and comparable to international consumers. From a toxicological point of view, regular exceedance of the lifetime tolerable aluminium intake (TWI/PTWI) is undesirable, since this results in an increased risk for health impairments. Consequently, recommendations on how to reduce overall aluminium exposure are given.

Metals in biological tissues of the population living near a hazardous waste incinerator in Catalonia, Spain: Two decades of follow-up

During the period 1996-1998, a hazardous waste incinerator (HWI) was built in Constantí (Tarragona County, Catalonia, Spain). Because of the potential adverse effects of toxic emissions, mainly metals and dioxins and furans, waste incinerators in general have been an important cause of concern for the public opinion. For that reason, to assess its environmental impact on the surroundings, as well as the potential human health risks of the HWI, environmental and biological monitoring studies have been carried out since 1996-1998, when the baseline concentrations were established. This article summarizes all the results corresponding to metals in biological tissues of the population living near the HWI, two decades after the construction of the facility. In 1996-1998, the baseline concentrations of a number of elements (As, Be, Cd, Cr, Hg, Mn, Ni, Pb, Sn, Tl and V) were determined in samples of hair, blood and autopsy tissues (bone, brain, liver, lung and kidney) of subjects living in the area. In successive 5-year periods, new surveys were conducted to periodically measure the levels of metals in the same biological tissues. The daily dietary intake of these metals was also estimated for the population of the area. The results of this surveillance program do no suggest additional adverse health risks of metals for the population living near the HWI. However, special attention should be paid to Cr, due not only to the increases of this element observed in most analyzed biological tissues, but also in its dietary intake.

Lead and cadmium in foods/drinking water from Slovenian market/taps: Estimation of overall chronic dietary exposure and health risks

Approximately 3000 food samples from the Slovenian market and 2500 drinking (tap) water samples in the period 2011 - 2016 were evaluated for the presence of toxic elements lead (Pb) and cadmium (Cd) and the overall chronic dietary exposure was assessed for each element. The highest mean concentrations were found for Pb in products for special nutritional use - dietary supplements (0.383 mg/kg) and for Cd in fish and seafood (0.117 mg/kg). The consumption data were obtained from the national study of the household budget and from the European Food Safety Authority (EFSA) summary statistics. Chronic dietary exposure was estimated deterministically. The average Pb and Cd intakes from food and drinking (tap) water ranged for children from 0.90 to 1.021 µg/kg bw/day and 4.65 to 5.65 µg/kg bw/week, respectively, and for adults, including adolescents, from 0.40 to 0.53 µg/kg bw/day and 1.98 to 2.82 µg/kg bw/week, respectively. The high consumption of cereal-based foods and vegetables contributed most to overall Pb and Cd intake in the majority of the age groups. The exposure to Pb was generally lower and that to Cd was higher compared to the average EU values. The most exposed were children, as the health-based guidance values were exceeded for both elements, which indicates a health concern. An important contribution to Cd exposure can be attributed to grains and potatoes grown in Slovenia, where the soil contains more Cd than that in other EU countries. Further efforts to reduce Pb and Cd intake are required to minimize potential health risks.

Lead and cadmium contamination in a large sample of United States infant formulas and baby foods

Data is limited on lead and cadmium contamination in baby food, a population uniquely susceptible to the toxic effects of heavy metals. The goal of this study was to examine lead and cadmium concentrations in a large convenience sample of US baby foods. We identified the number of baby food product samples that exceeded US FDA and California Proposition 65 limits for daily lead consumption across a range of servings/calories, and the number of samples that exceeded World Health Organization and California Proposition 65 limits for daily cadmium consumption across a range of servings/calories. In total, 564 baby foods were tested across infant and toddler formula, cereals, meals, juices/drinks, jars, pouches, snacks, and electrolyte water. ICP-MS analysis of lead and cadmium was completed using a modified version of EPA method 6020A. Samples were analyzed using kinetic energy distribution mode. Lead was detected in 37% of samples (median = non-detect, 75% = 5.6, maximum = 183.6 μg/kg), and cadmium in 57% (25% = non-detect, median = 2.8, 75% = 9.5, maximum = 103.90 μg/kg). Of 91 infant formula samples, none exceeded FDA lead consumption guidelines in 31 oz, but 22% exceeded the Proposition 65 lead guidelines, 23% exceeded the Proposition 65 cadmium guidelines, and 14% exceeded the WHO tolerable cadmium intake levels for a four-month-old baby. In the solid baby food samples, 1% exceeded FDA lead guidelines in two servings (26% exceeded CA Proposition 65 limits), 3% in 300 cal (34% exceeded CA Proposition 65 limits). For cadmium, 6% exceeded Proposition 65 guidelines in two servings, 8% in 300 cal. There was no association between whether the product was certified organic and its heavy metal concentration. Products containing rice were higher in both lead and cadmium concentrations. Further research is needed to understand the long-term health effects of this chronic daily low level heavy metal exposure in babies.