Use of advanced cluster analysis to characterize fish consumption patterns and methylmercury dietary exposures from fish and other sea foods among pregnant women

Human health risk-benefit assessment of fish and other seafood: a scoping review

Fish and other seafood are important sources of nutrients, but they are also sources of chemical contaminants that may cause adverse health effects. This article aimed to identify existing risk-benefit assessments (RBA) of fish, shellfish, and other seafood, compare methodologies, discuss differences and commonalities in findings, and identify limitations and ways forward for future studies. We conducted a scoping review of the scientific literature of studies in all languages published from 2000 through April 2019. We identified 106 RBA of fish and other seafood across Europe, Asia, North America, Africa, and at the global level. Studies were heterogeneous in terms of types of fish and other seafood considered, beneficial and adverse compounds assessed, and overall methodology. Collected data showed that a diet consisting of a variety of lean and fatty fish and other seafood is recommended for the overall population and that women of childbearing age and children should limit the consumption of fish and other seafood types that have a high likelihood of contamination. Our review emphasizes the need for evidence-based, up-to-date, and harmonized approaches in RBA in general.

Food Safety Implications of Transitions Toward Sustainable Healthy Diets

Despite increased political attention, foodborne diseases still cause a substantial public health, economic, and social burden worldwide. Children younger than 5 years, people living in developing regions, and in the poorest areas of the world are disproportionally affected, bearing a large proportion of the global burden of foodborne disease. Yet, food safety is a prerequisite to ensuring food security globally: Foods that are responsible for important food safety problems are also crucial to ensure food security in some regions and are essential sources of nutrition. Moreover, together with calls for action to meeting international sustainable development goals, global efforts to promote food security and healthy diets have now highlighted the need to modify food systems globally. This article therefore explores the food safety dimensions of transitions toward food systems that promote sustainable healthy diets. The current body of evidence points to the combined health and environmental benefits of shifting toward a more plant-based diet, including vegetables and fruits, nuts, pulses, and whole grains. As a shift toward more plant-based diets may also lead to higher exposures to chemicals or pathogens present in these foods, an evaluation of food safety implications of such transitions is now imperative. We conclude that several synergies between public health, environmental, and food safety strategies can be identified to support dietary transitions.

Public health benefits of hair-mercury analysis and dietary advice in lowering methylmercury exposure in pregnant women

AIMS

To evaluate whether a public health intervention using focused dietary advice combined with a hair-mercury analysis can lower neurotoxic methylmercury exposure among pregnant women without decreasing their overall intake of seafood.

METHODS

A total of 146 pregnant women were consecutively recruited from the antenatal clinic at a Danish university hospital at their initial ultrasound scan. Dietary advice was provided on avoiding methylmercury exposure from large predatory fish and a hair sample from each participant was analysed for mercury, with the results being communicated shortly thereafter to the women. A dietary questionnaire was filled in. Follow-up three months later included a dietary questionnaire and a repeat hair-mercury analysis.

RESULTS

In the follow-up group, 22% of the women had hair-mercury concentrations above a safe limit of 0.58 µg/g at enrolment, decreasing to 8% three months later. Average hair-mercury concentrations decreased by 21%. However, the total seafood intake remained at the same level after three months.

CONCLUSIONS

Increased exposure to methylmercury among pregnant women is an important public health concern in Denmark. The observed lowering of hair-mercury concentrations associated with dietary advice corresponds to a substantial public health benefit that probably makes such an intervention highly profitable.

More surprises in the global greenhouse: Human health impacts from recent toxic marine aerosol formations, due to centennial alterations of world-wide coastal food webs

Reductions of zooplankton biomasses and grazing pressures were observed during overfishing-induced trophic cascades and concurrent oil spills at global scales. Recent phytoplankton increments followed, once Fe-, P-, and N-nutrient limitations of commensal diazotrophs and dinoflagellates were also eliminated by respective human desertification, deforestation, and eutrophication during climate changes. Si-limitation of diatoms instead ensued during these last anthropogenic perturbations of agricultural effluents and sewage loadings. Consequently, ~15% of total world-wide annual asthma trigger responses, i.e. amounting to ~45 million adjacent humans during 2004, resulted from brevetoxin and palytoxin poisons in aerosol forms of western boundary current origins. They were denoted by greater global harmful algal bloom [HAB] abundances and breathing attacks among sea-side children during prior decadal surveys of asthma prevalence, compiled here in ten paired shelf ecosystems of western and eutrophied boundary currents. Since 1965, such inferred onshore fluxes of aerosolized DOC poisons of HABs may have served as additional wind-borne organic carriers of toxic marine MeHg, phthalate, and DDT/DDE vectors, traced by radio-iodine isotopes to potentially elicit carcinomas. During these exchanges, as much as 40% of mercury poisonings may instead have been effected by inhalation of collateral HAB-carried marine neurotoxic aerosols of MeHg, not just from eating marine fish. Health impacts in some areas were additional asthma and pneumonia episodes, as well as endocrine disruptions among the same adjacent humans, with known large local rates of thyroid cancers, physician-diagnosed pulmonary problems, and ubiquitous high indices of mercury in hair, pesticides in breast milk, and phthalates in urine.

Biomarkers of exposure to environmental contaminants in French pregnant women from the Elfe cohort in 2011

BACKGROUND

As part of the perinatal component of the French Human Biomonitoring (HBM) program, biomarkers levels of various chemicals have been described among pregnant women having given birth in continental France in 2011 and who have been enrolled in the Elfe cohort (French Longitudinal Study since Childhood). This paper describes the design of the study and provides main descriptive results regarding exposure biomarkers levels.

METHODS

Exposure biomarkers were measured in biological samples collected at delivery from pregnant women randomly selected among the participants in the clinical and biological component of the Elfe cohort (n=4145). The geometric mean and percentiles of the levels distribution were estimated for each biomarker. The sampling design was taken into account in order to obtain estimates representative of the French pregnant women in 2011.

RESULTS

Results provide a nation-wide representative description of biomarker levels for important environmental contaminants among pregnant women who gave birth in France in 2011. Bisphenol A (BPA), and some metabolites of phthalates, pesticides (mainly pyrethroids), dioxins, furans, polychlorobiphenyls (PCBs), brominated flame retardants (BFRs), perfluorinated compounds (PFCs) and metals (except uranium) were quantified in almost 100% of the pregnant women. Some compounds showed a downward trend compared to previous studies (lead, mercury), but others did not (pyrethroids) and should be further monitored.

CONCLUSION AND PERSPECTIVES

The present results show that French pregnant women are exposed to a wide variety of pollutants, including some that have been banned or restricted in France.

Relationship between self-reported fish and shellfish consumption, carbon and nitrogen stable isotope values and total mercury concentrations in pregnant women (II) from Baja California Sur, Mexico

•

[THg], δ¹³C, and δ¹⁵N were measured in hair segments of pregnant women from Mexico.

•

Higher δ¹⁵N was related to [THg] and frequency of fish and shellfish consumption.

•

THg exposure and assimilation are more complex in higher fish consumption categories.

•

At high fish consumption, trophic level remains elevated while [THg] is lower.

Seafood is a valuable source of nutrients important for fetal development. However, seafood consumption is the main route of exposure to monomethyl mercury (MeHg⁺) for humans. MeHg⁺ is highly bioavailable and potentially adversely affects fetal neurodevelopment. MeHg⁺ exposure from fish consumption varies significantly by age and trophic level of fish consumed as well as the frequency and amount of fish consumed. This study investigates total Hg concentrations ([THg]) in hair segments of pregnant Mexican women in relation to (1) self-reported frequency of fish and shellfish consumption, (2) maternal trophic level and marine diet contributions, determined using hair carbon (C) and nitrogen (N) stable isotopes, and (3) relates [THg] to various hair advisory thresholds. We also examined whether variation in C and N isotope values is explained by self-reported frequency of fish and shellfish consumption. A significant proportion of hair samples had [THg] higher than suggested agency thresholds and, for women within the range of the various advisory thresholds (1–20 μg g⁻¹), the specific statistic used and threshold applied are important considerations for assessing and communicating risk. Individuals enriched in ¹⁵N (δ¹⁵N values) had higher [THg] as did individuals that reported consuming fish and shellfish more frequently, suggesting that variation in [THg] can be explained by both consumer reported diet and diet as determined by C and N stable isotope assessment. However, at higher reported fish consumption levels the trophic level is maintained while [THg] is paradoxically lower. This suggests that THg exposure and assimilation are more complicated in higher fish frequency consumption categories. [THg] is more variable at the higher concentrations, possibly indicating some exposure to non-dietary Hg, heritable variations affecting Hg toxicodynamics, and BMI and tobacco exposure factors as outlined in our companion paper.

Human mercury exposure and effects in Europe

The effects of human exposure to mercury (Hg) and its compounds in Europe have been the focus of numerous studies that differed in their design, including recruiting different population groups at different levels of exposure and using different protocols and recruitment strategies. The objective of the present study was to review current studies of Hg exposure in Europe, taking into account the potential routes of Hg exposure, actual Hg exposure levels assessed by different biomarkers, and the effects of Hg to Europeans. All published studies from 2000 onward were reviewed, and exposure and effects studies were compared with known Hg levels in environmental compartments by mapping the various population groups studied and taking into account known sources of Hg. A study of the spatial distribution trends confirmed that the highest exposure levels to Hg, mostly as methylmercury (MeHg), are found in coastal populations, which consume more fish than inland populations. Fewer studies addressed exposure to elemental Hg through inhalation of Hg in air and inorganic Hg in food, particularly in highly contaminated areas. Overall, at the currently low exposure levels of Hg prevalently found in Europe, further studies are needed to confirm the risk to European populations, taking into consideration exposure to various Hg compounds and mixtures of stressors with similar end-points, nutritional status, and a detailed understanding of Hg in fish present in European markets.

Exposure to food contaminants during pregnancy

During pregnancy, the fetus is exposed to contaminants from its mother's diet. This work provides an assessment of the dietary exposure of pregnant women to inorganic contaminants (aluminum, mercury, lead, inorganic arsenic, cobalt), polychlorodibenzodioxins, polychlorodibenzofurans, dioxin-like and non-dioxin-like polychlorobiphenyls (DL-PCBs, NDL-PCBs), polybromodiphenyl ethers (PBDEs), perfluoroalkyl acids, mycotoxins (zearalenone, patulin, trichothecenes), and heat-generated compounds (acrylamide and polycyclic aromatic hydrocarbons). Consumption data of 2002 pregnant women aged 18 to 45 from the EDEN cohort study were combined with contamination data from the second French total diet study to assess the exposure before pregnancy (n=1861) and during the third trimester of pregnancy (n=1775). Exposure was also assessed considering the season during which the third trimester of pregnancy occurred. Significant changes in consumptions during pregnancy and between seasons were associated with differences in exposures for some substances. Some contaminant exposures appeared to be of health concern. Margins of exposure to acrylamide (635 to 1094 for mean), inorganic arsenic, lead, and BDE-99 (≤100) were too low to exclude all risks. For NDL-PCBs, T-2 and HT-2 toxins, and deoxynivalenol, significant exceedings of toxicological reference values were found before pregnancy, but there was no significant exceeding in the third trimester.

Economic benefits of methylmercury exposure control in Europe: monetary value of neurotoxicity prevention

BACKGROUND

Due to global mercury pollution and the adverse health effects of prenatal exposure to methylmercury (MeHg), an assessment of the economic benefits of prevented developmental neurotoxicity is necessary for any cost-benefit analysis.

METHODS

Distributions of hair-Hg concentrations among women of reproductive age were obtained from the DEMOCOPHES project (1,875 subjects in 17 countries) and literature data (6,820 subjects from 8 countries). The exposures were assumed to comply with log-normal distributions. Neurotoxicity effects were estimated from a linear dose-response function with a slope of 0.465 Intelligence Quotient (IQ) point reduction per μg/g increase in the maternal hair-Hg concentration during pregnancy, assuming no deficits below a hair-Hg limit of 0.58 μg/g thought to be safe. A logarithmic IQ response was used in sensitivity analyses. The estimated IQ benefit cost was based on lifetime income, adjusted for purchasing power parity.

RESULTS

The hair-mercury concentrations were the highest in Southern Europe and lowest in Eastern Europe. The results suggest that, within the EU, more than 1.8 million children are born every year with MeHg exposures above the limit of 0.58 μg/g, and about 200,000 births exceed a higher limit of 2.5 μg/g proposed by the World Health Organization (WHO). The total annual benefits of exposure prevention within the EU were estimated at more than 600,000 IQ points per year, corresponding to a total economic benefit between €8,000 million and €9,000 million per year. About four-fold higher values were obtained when using the logarithmic response function, while adjustment for productivity resulted in slightly lower total benefits. These calculations do not include the less tangible advantages of protecting brain development against neurotoxicity or any other adverse effects.

CONCLUSIONS

These estimates document that efforts to combat mercury pollution and to reduce MeHg exposures will have very substantial economic benefits in Europe, mainly in southern countries. Some data may not be entirely representative, some countries were not covered, and anticipated changes in mercury pollution all suggest a need for extended biomonitoring of human MeHg exposure.

Economic evaluation of health consequences of prenatal methylmercury exposure in France

BACKGROUND

Evidence of a dose-response relationship between prenatal exposure to methylmercury (MeHg) and neurodevelopmental consequences in terms of IQ reduction, makes it possible to evaluate the economic consequences of MeHg exposures.

OBJECTIVE

To perform an economic evaluation of annual national benefits of reduction of the prenatal MeHg exposure in France.

METHODS

We used data on hair-Hg concentrations in French women of childbearing age (18-45 years) from a national sample of 126 women and from two studies conducted in coastal regions (n = 161and n = 503). A linear dose response function with a slope of 0.465 IQ point reduction per μg/g increase in hair-Hg concentration was used, along with a log transformation of the exposure scale, where a doubling of exposure was associated with a loss of 1.5 IQ points. The costs calculations utilized an updated estimate of €2008 17,363 per IQ point decrement, with three hypothetical exposure cut-off points (hair-Hg of 0.58, 1.0, and 2.5 μg/g).

RESULTS

Because of higher exposure levels of women in coastal communities, the annual economic impacts based on these data were greater than those using the national data, i.e., € 1.62 billion (national), and € 3.02 billion and € 2.51 billion (regional), respectively, with the linear model, and € 5.46 billion (national), and € 9.13 billion and € 8.17 billion (regional), with the log model, for exposures above 0.58 μg/g.

CONCLUSIONS

These results emphasize that efforts to reduce MeHg exposures would have high social benefits by preventing the serious and lifelong consequences of neurodevelopmental deficits in children.

A risk–benefit analysis approach to seafood intake to determine optimal consumption

Seafood provides n-3 long-chain PUFA (n-3 LC-PUFA), vitamins and minerals, which are essential to maintain good health. Moreover, seafood is a source of contaminants such as methylmercury, arsenic and persistent organic pollutants that may affect health. The aim of the present study was to determine in what quantities seafood consumption would provide nutritional benefits, while minimising the risks linked to food contaminants. Seafood was grouped into clusters using a hierarchical cluster analysis. Those nutrients and contaminants were selected for which it is known that seafood is a major source. The risk–benefit analysis consisted in using an optimisation model with constraints to calculate optimum seafood cluster consumption levels. The goal was to optimise nutrient intakes as well as to limit contaminant exposure with the condition being to attain recommended nutritional intakes without exceeding tolerable upper intakes for contaminants and nutrients, while taking into account background intakes. An optimum consumption level was calculated for adults that minimises inorganic arsenic exposure and increases vitamin D intake in the general population. This consumption level guarantees that the consumer reaches the recommended intake for n-3 LC-PUFA, Se and I, while remaining below the tolerable upper intakes for methylmercury, Cd, dioxins, polychlorobiphenyls, Zn, Ca and Cu. This consumption level, which is approximately 200 g/week of certain fatty fish species and approximately 50 g/week of lean fish, molluscs and crustaceans, has to be considered in order to determine food consumption recommendations in a public health perspective.

Integrating variability in half-lives and dietary intakes to predict mercury concentration in hair

Methylmercury (MeHg) is a bioaccumulative environmental toxin that exerts its effect on fetal and infant neurodevelopment. Mercury concentration in hair is a good biomarker of MeHg accumulation in the body, with seafood being the main source of MeHg in humans. Therefore, modeling the link between food intake and mercury concentration in hair is a key step in assessing the risk of MeHg exposure. Using repeated measurements of diet and mercury concentration in hair, we studied 125 French pregnant women who consumed seafood (e.g., fish, mollusks and crustaceans) and compared their individual estimated dietary MeHg intakes with their hair mercury concentrations. We used a one-compartment toxicokinetic model for these comparisons. We integrated and estimated the between-person variability in MeHg half-life into the model. In a second model, we took into account an intra-individual MeHg intake variability to improve the performance of the toxicokinetic model.