Potential exposure and risk of fluoride intakes from tea drinks produced in Taiwan

Intake of fluoride and other Hofmeister ions from black tea consumption in CKDu prevalent areas, Sri Lanka

Dietary exposure of selected Hofmeister ions-fluoride, chloride, sulfate, phosphate, sodium, potassium, magnesium, and calcium from black tea consumption in chronic kidney disease of unknown etiology (CKDu) prevalent areas in Sri Lanka-were assessed in order to understand exposure and risk. Black tea samples (n = 25) were collected from CKDu prevalent areas and control areas (n = 15). Total fluoride content in alkali fused digested black tea samples was determined. The available Hofmeister ions in tea infusions prepared using deionized water and the groundwater collected by CKDu endemic areas were compared. Dietary exposure was calculated by chronic daily intake data. Total fluoride concentrations ranged from 80 to 269 mg/kg in tea collected from the CKDu endemic regions and 62.5-123.5 mg/kg in non-endemic regions. The fluoride content in infusions ranged from 1.45 to 2.04 mg/L in CKDu endemic areas and 1.11-1.38 mg/L in control samples. The infusions prepared with local groundwater from the CKDu endemic areas showed an elevated level of fluoride 95% than that of the infusion prepared using same tea with deionized water. Aggregated chronic daily intake value from tea and groundwater exceeds the estimated adequate daily intake value of fluoride. The hazard quotient (HQ) values of fluoride in 5 min and 120 min tea infusions were 1.60 and 2.20, respectively, and indicate an adverse health risk. Potassium content in tea infusions collected from CKDu endemic areas is higher than in the control. Even though these values are less than the adequate intake, it may pose an impairment on a weak kidney. Chronic daily intake of Hofmeister ions, i.e., fluoride and potassium from black tea consumed in CKDu endemic areas may induce a risk for CKDu.

Brick tea consumption and its relationship with fluorosis in Tibetan areas

Brick tea-type fluorosis (BTF) due to a high intake of brick tea is possible in Tibetan populations, and dental fluorosis (DF) and skeletal fluorosis (SF) are its primary manifestations. To determine the prevalence of DF and SF and their relationships with brick tea intake in Tibetan populations, a literature review was conducted for studies published between 1994 and 2021. The available evidence revealed that brick tea may be produced from older stems and leaves of the tea plant and that the fluoride content of brick tea exceeds the national standard. The harsh environment of the plateau has led to limited food sources for the local Tibetan people who form the habit of drinking tea leaves as a satiation solution to digest greasy food and replenish vitamins, and regular consumption of brick tea leads to excessive exposure of Tibetan residents to fluoride. Studies in Tibet showed that the prevalence of DF in children was 14.06-75.93% in different districts, and the overall pooled prevalence of DF was 26.08%. The prevalence of SF in adults was 19.90-74.77% in different Tibetan districts, and the overall pooled prevalence of SF was 33.84%. The analysis of risk factors showed that the prevalence of BTF may be related to high-altitude and different working and living conditions, and BTF in children may be associated with fluoride intake during mothers' pregnancy and lactation. With the development of bioinformatics research, gene polymorphisms were suspected to be related to susceptibility to fluorosis in Tibetan populations. The study of BTF in Tibetan people needs to be further investigated and standardized, and additional studies evaluating the pathogenesis and preventive measures of BTF are warranted.

Fluoride concentration in teas derived from Camellia Sinensis produced in Argentina

To evaluate the fluoride concentration and pH of tea derived from Camellia sinensis produced and commercialized in Argentina. Forty-eight varieties of tea (black (n = 16), green (n = 21), red (n = 7), and white (n = 4)) commercialized in the form of leaves or tea bags were acquired. One bag or 2.0 ± 0.05 g of each product was infused for 5 min in 200 mL of distilled boiled water. The F^- concentration was determined using an ion-selective electrode and pH was measured using a pH meter. The found fluoride concentrations ranged from 0.1 to 9.7 µg/mL and the pH ranged from 2.7 to 5.1. A higher fluoride concentration was observed in the leaves group (2.75 ± 2.65 µg/mL) compared to tea bags (1.10 ± 0.82 µg/mL) (p < 0.05). Regarding the type of tea, green and black tea were richer in F^- than red and white tea. Fluoride and pH appeared not to be correlated (Pearson test). All the studied tea samples presented fluoride concentrations greater than the threshold recommended for drinking water. The pH proved to be low, which could be a risk for erosive tooth wear.

Concentrations, leachability, and health risks of mercury in green tea from major production areas in China

Green tea has many health benefits and is the most consumed type in China. However, the heavy metals and contaminants in tea can also pose a great risk to human health. In this study, mercury (Hg) concentration in green tea collected from 11 provinces in China was examined. The leaching characteristics of Hg during brewing and the associated exposure to drinkers were also evaluated. Results indicated a low potential of Hg accumulation in green tea. The Hg content of green tea from Wanshan District, Guizhou Province-which has the largest Hg mine in China and is severely contaminated by Hg-could be limited by controlling the harvest time of tea leaves. The average Hg content of green tea from 43 tea production sites in China was only 6.3 ± 6.4 µg/kg dry weight. The brewing experiments of green tea showed that the leaching ratio of Hg was 22.61 ± 7.58% for 40 min of a single brew, and increased to 32.83 ± 12.37% after four rounds (3 min/ round) of brewing. The leaching of Hg from tea leaves was significantly affected by leaching time, temperature, and solid-liquid ratio but not by water hardness. The risk of Hg exposure from green tea intake was found to be very low, with an average hazard quotient (HQ) value of only 1.82 ± 1.85% for a single brew in 40 min and 2.64 ± 2.68% after four rounds of brewing. However, in some highly contaminated areas, with HQ values as high as 43.12 ± 2.41%, green tea intake may still pose a high risk of Hg exposure, and this risk should not be ignored.

A combined analytical-chemometric approach for the in vitro determination of polyphenol bioaccessibility by simulated gastrointestinal digestion

In this study, an integrated characterisation through polyphenol and caffeine content and antioxidant activity was combined with chemometric analysis to assess the effects of simulated in vitro gastrointestinal digestion on the bioaccessibility of these bioactive compounds from nine different tea infusions. Tea infusions were characterised based on total flavonoids, total polyphenols and antioxidant activity, together with the determination of individual polyphenol content. Fourteen phenolic compounds, including phenolic acids, stilbenes and flavonoids, were selected based on their reported bioactivity and high accessibility, attributed to their low molecular weight. Both polyphenols and caffeine were initially monitored in raw tea infusions and through the different digestion stages (salivary, gastric and duodenal) by capillary high performance liquid chromatography coupled to diode array detection (cHPLC-DAD) and/or HPLC coupled to a triple quadrupole mass analyser (HPLC–MS/MS). Multivariate analysis of the studied bioactives, using principal component analysis and cluster analysis, revealed that the decaffeination process seems to increase the stability and concentration of the compounds evaluated during digestion. The greatest transformations occurred mainly in the gastric and duodenal stages, where low bioactivity indices (IVBA) were shown for resveratrol and caffeic acid (IVBA = 0%). In contrast, the polyphenols gallic acid, chlorogenic acid and quercetin gave rise to their availability in white, green and oolong infusion teas (IVBA > 90%). Furthermore, highly fermented black and pu-erh varieties could be designated as less bioaccessible environments in the duodenum with respect to the tested compounds.

Effects of brewing conditions on infusible fluoride levels in tea and herbal products and probabilistic health risk assessment

Excessive ingestion of fluorides might adversely affect the health of humans. Hence, this study aimed to investigate the concentrations of infusible fluoride in five different types of tea and herbal products; additionally, the probabilistic health risks associated with the ingestion of fluoride in drinking tea and herbal products were estimated. The highest and lowest concentrations of infusible fluoride were detected in black and white tea, respectively. On average, the highest amount of infusible fluoride was extracted following a short brewing time of 5 min in the case of black tea (2.54 mg/L), herbal tea (0.40 mg/L), and white tea (0.21 mg/L). The level of infusible fluoride during brewing was inversely associated with the leaf size of the tea and herbal products. Furthermore, the type of water used influenced the release of infusible fluoride; purified water yielded lower amounts of infused fluoride. The findings of the probabilistic health risk assessment indicated that the consumption of black tea can increase the fluoride intake leading to chronic exposure. Thus, the health risk posed by fluoride intake from drinking tea needs to be evaluated in more details in the future. Appropriate measures for health risk mitigation need to be implemented to minimize the total body burden of fluorides in humans.

Fluoride absorption, transportation and tolerance mechanism in Camellia sinensis, and its bioavailability and health risk assessment: a systematic review

Tea is the one of the most popular non-alcoholic caffeinated beverages in the world. Tea is produced from the tea plant (Camellia sinensis (L.) O. Kuntze), which is known to accumulate fluoride. This article systematically analyzes the literature concerning fluoride absorption, transportation and fluoride tolerance mechanisms in tea plants. Fluoride bioavailability and exposure levels in tea infusions are also reviewed. The circulation of fluoride within the tea plantation ecosystems is in a positive equilibrium, with greater amounts of fluoride introduced to tea orchards than removed. Water extractable fluoride and magnesium chloride (MgCl₂ ) extractable fluoride in plantation soil are the main sources of absorption by tea plant root via active trans-membrane transport and anion channels. Most fluoride is readily transported through the xylem as F^- /F-Al complexes to leaf cell walls and vacuole. The findings indicate that tea plants employ cell wall accumulation, vacuole compartmentalization, and F-Al complexes to co-detoxify fluoride and aluminum, a possible tolerance mechanism through which tea tolerates higher levels of fluoride than most plants. Furthermore, dietary and endogenous factors influence fluoride bioavailability and should be considered when exposure levels of fluoride in commercially available dried tea leaves are interpreted. The relevant current challenges and future perspectives are also discussed. © 2020 Society of Chemical Industry.

sKlotho is associated with the severity of brick tea-type skeletal fluorosis in China

The change of serum soluble Klotho (sKlotho) content is related to a variety of osteoarthropathy. However, its association with the severity of skeletal fluorosis (SF) is not clear. Here, the association of tea fluoride exposure with serum sKlotho levels and the severity of SF were investigated and further verified in a rat model of fluorosis. A cross sectional case control study was conducted in residents over 50 years old from brick-tea drinking areas in Qinghai and Xinjiang Provinces, China. Concentrations of fluoride in brick tea water and urine were determined by ion selective electrode method, and the levels of serum sKlotho were determined by ELISA method. Linear regression and ordered logistic regression models were constructed to examine the relationship among fluoride exposure, serum sKlotho levels and the severity of SF. The kidney and small intestine of Wistar rats were isolated for detection of Klotho by immunohistochemistry (IHC), and femoral artery blood was sampled to measure the serum levels of sKlotho. An increase of 1 mg/day in tea fluoride intake (TFI) was associated with a 12.070 pg/mL (95% CI: 0.452-23.689) increase in serum sKlotho levels and a 1.163-fold (95% CI: 1.007-1.342) increase in the severity of SF after adjusting for age, gender, and ethnicity. Serum sKlotho levels were also positively associated with the severity of SF (P < 0.05). The mediation analysis showed that serum sKlotho levels mediated 17.76% of the increase in the severity of SF caused by an increase of 1 mg/day of TFI. Moreover, a significant increase of serum sKlotho levels in fluoride-exposed groups was also seen in the rat model. The present study suggests that serum sKlotho may be a potential mediator of SF in brick tea-type fluorosis endemic areas.

Does fluoride cause the mysterious chronic kidney disease of multifactorial origin?

A chronic kidney disease of multifactorial origin (CKDmfo), also known as CKD of unknown origin, started to manifest during the past four decades in certain economically poor, peri-equatorial agricultural countries. CKDmfo is an environmentally induced, occupationally-mediated, chronic tubulointerstitial disease. Prolonged exposure to environmental nephrotoxic agents and extenuating conditions are prerequisites for its manifestation. More than 30 causative factors have been postulated, but none one has been properly scientifically tested, to be able to include or exclude. In recent years, fluoride has come to be considered a key contender as a causative agent of CKDmfo. Therefore, this review examines the pros and cons of that theory and the potential plausibility that fluoride causes CKDmfo. It also examines the potential interactions and additive or synergistic effects of certain geogenic factors, especially, the plausibility of CaPO₄^-3 apatite and fluorapatite crystals and nanotube formation in concentrated tubular filtrate and within tubular cells, in renal tubules. The information presented is based on published work and data collected over the past two decades in Sri Lanka. However, the evidence and concepts are applicable to all CKDmfo-affected countries. Thus, the presented content might facilitate scientists to narrowed down causative factors to just a few and government departments to implement effective programs for preventing this disease. The findings suggest that in addition to the geogenic components, disease manifestation requires (A) prolonged exposure to environmental nephrotoxins and factors, (B) interactions among elements (Ca²⁺, PO₄^-3 , F^-, and Mg²⁺), and (C) vulnerability of the person, such as chronic dehydration, and antioxidant and micronutrient deficiencies. In vivo precipitation of nanominerals in renal tubular tissues that arising over several years causes tubulointerstitial disease-CKDmfo. Inherent vulnerabilities and conditions, together with nanomineral precipitation, trigger renal tubular cell oxidative stresses, inflammation, and fibrosis, and eventually causing tubulointerstitial chronic renal failure-CKDmfo.

Total reflection X-ray fluorescence analysis of elemental composition of herbal infusions and teas

BACKGROUND

The elemental composition of herbal infusions and teas has not been sufficiently investigated. It could potentially be used for defining fingerprints for individual herbal / tea infusions, differentiation of botanical families, detecting the influence of packaging, and other purposes. The objective of this study was to determine the elemental composition, including the trace element content, of various herbal infusions and teas by means of total reflection X-ray fluorescence analysis (TXRF), with a chemometrics approach using principal component analysis (PCA).

RESULTS

This study determined the elemental composition of various herbal infusions and teas, including trace elements, using total reflection X-ray fluorescence (TXRF). The methodology for the sample preparation was established, including the multiple-steepings procedure for the two tea samples (Oolong and Pu-erh). Data from 29 samples were collected. We hypothesized that the elemental content of infusions could reflect certain features, such as the influence of processing and the type of tea.

CONCLUSION

A chemometric approach (PCA) was applied, and differences between teas and herbal infusions were found. This was further corroborated by explicit differentiation of one botanical family, Theaceae. The influence of packaging (tea bags) on herbal material was identified. The three types of tea (Camellia sinensis) appeared to be separated with PCA, and elemental concentrations in Pu-erh changed with multiple steepings.

Systematic probabilistic risk assessment of pesticide residues in tea leaves

Multiple pesticide residues are frequently present in tea leaves and while the majority of residues satisfy Taiwan's current health regulations, there are potential health effects from pesticide exposure that are of great concern for tea drinkers. We undertook a systematic probabilistic risk assessment of 59 pesticides in tea leaves from 1629 tea leaf samples obtained by Taiwan's Food and Drug Administration in two monitoring surveys in 2015. Bayesian statistics used a Markov Chain Monte Carlo approach to estimate posterior distributions of pesticide residues in tea leaves, lifetime average daily doses and hazard quotients (HQs) of evaluated pesticides. We classified 95th percentile values of HQs into three categories: 0 < HQ < 0.5, 0.5 ≤ HQ ≤ 1 and 1 < HQ. The 95th percentiles of HQs for triazophos (3.39), carbofuran (2.04) and endosulfan (1.80) exceeded 1 in the adult population; the HQ for 3-OH carbofuran was 0.97 and was less than 0.5 for the remaining 55 pesticides. The health risk posed by pesticide residues for tea drinkers is negligible, if triazophos, carbofuran, endosulfan, and 3-OH carbofuran residues satisfy regulatory standards. However, five legacy pesticides, DDT, methomyl, carbofuran, dicofol and endosulfan, were identified. To reduce uncertainties, this study combined Bayesian statistics with a mode of action approach for systematic risk assessment of co-exposure to multiple pesticide residues in tea leaf samples. Measuring pesticide transfer rates will improve the quality of future risk assessments concerning residues in tea leaves. Appropriate management of pesticides in Taiwanese tea farms and monitoring of pesticide residues in imported tea is warranted to protect Taiwan's tea drinkers.

FRZB1 rs2242070 polymorphisms is associated with brick tea type skeletal fluorosis in Kazakhs, but not in Tibetans, China

Skeletal fluorosis is a metabolic bone and joint disease caused by excessive accumulation of fluoride in the bones. Compared with Kazakhs, Tibetans are more likely to develop moderate and severe brick tea type skeletal fluorosis, although they have similar fluoride exposure. Single nucleotide polymorphisms (SNPs) in frizzled-related protein (FRZB) have been associated with osteoarthritis, but their association with the risk of skeletal fluorosis has not been reported. In this paper, we investigated the association of three SNPs (rs7775, rs2242070 and rs9288087) in FRZB1with brick tea type skeletal fluorosis risk in a cross-sectional case-control study conducted in Sinkiang and Qinghai, China. A total of 598 individuals, including 308 Tibetans and 290 Kazakhs, were enrolled in this study, in which cases and controls were 221 and 377, respectively. The skeletal fluorosis was diagnosed according to the Chinese diagnostic criteria of endemic skeletal fluorosis (WS192-2008). The fluoride content in tea water or urine was detected using the fluoride ion electrode. SNPs were assessed using the Sequenom MassARRAY system. Binary logistic regressions found evidence of association with rs2242070 AA genotype in only Kazakh participants [odds ratio (OR) 0.417, 95% CI 0.216-0.807, p = 0.009], but not in Tibetans. When stratified by age, this protective effect of AA genotype in rs2242070 was pronounced in Kazakh participants aged 46-65 (OR 0.321, 95% CI 0.135-0.764, p = 0.010). This protective association with AA genotype in rs2242070 in Kazakhs also appeared to be stronger with tea fluoride intake > 3.5 mg/day (OR 0.396, 95% CI 0.182-0.864, p = 0.020). Our data suggest there might be differential genetic influence on skeletal fluorosis risk in Kazakh and Tibetan participants and that this difference might be modified by tea fluoride intake.

Black Tea Source, Production, and Consumption: Assessment of Health Risks of Fluoride Intake in New Zealand

In countries with fluoridation of public water, it is imperative to determine other dietary sources of fluoride intake to reduce the public health risk of chronic exposure. New Zealand has one of the highest per capita consumption rates of black tea internationally and is one of the few countries to artificially fluoridate public water; yet no information is available to consumers on the fluoride levels in tea products. In this study, we determined the contribution of black tea as a source of dietary fluoride intake by measuring the fluoride content in 18 brands of commercially available products in New Zealand. Fluoride concentrations were measured by potentiometric method with a fluoride ion-selective electrode and the contribution of black tea to Adequate Intake (AI) and Tolerable Upper Intake Level (UL) was calculated for a range of consumption scenarios. We examined factors that influence the fluoride content in manufactured tea and tea infusions, as well as temporal changes in fluoride exposure from black tea. We review the international evidence regarding chronic fluoride intake and its association with chronic pain, arthritic disease, and musculoskeletal disorders and provide insights into possible association between fluoride intake and the high prevalence of these disorders in New Zealand.

Probable benefits of green tea with genetic implications

Tea is produced from the Camellia sinensis plant and can generally be divided into categories based on how they are processed. In general, green tea that is unfermented C. sinensis has been considered superior to black tea in health benefits. It contains a unique set of catechins that possess biological activity as antioxidant, anti-inflammatory and antiproliferative, which is potentially significant to the prevention and treatment of various forms of diseases. Oral cavity oxidative stress and inflammation, consequent cigarettes due to nicotine and acrolein, may be reduced in the presence of green tea polyphenols. In addition, green tea polyphenols can close down halitosis through modification of odorant sulfur components. Usually, green tea defends healthy cells from malignant transformation and locally has the ability to induce apoptosis in oral cancer cells. In unison, there is an increasing implication in the health benefits of green tea in the field of oral health. This review will cover recent findings on the therapeutic properties and anticancer health benefits of green tea.

Critical factors determining fluoride concentration in tea leaves produced from Anhui province, China

This study investigated the fluoride present in tea plants (Camellia sinensis (L.) O. Kuntze) and its relationship to soils, varieties, seasons and tea leaf maturity. The study also explored how different manufacturing processes affect the leaching of fluoride into tea beverages. The fluoride concentration in the tea leaves was significantly correlate to the concentration of water-soluble fluoride in the soil. Different tea varieties accumulated different levels of fluoride, with varieties, Anji baicha having the highest and Nongkang zao having the lowest fluoride concentration. In eight different varieties of tea plant harvested over three tea seasons, fluoride concentration were highest in the summer and lowest in the spring in china. The fluoride concentration in tea leaves was directly related to the maturity of the tea leaves at harvest. Importantly, the tea manufacturing process did not introduced fluoride contamination. The leaching of fluoride was 6.8% and 14.1% higher in black and white tea, respectively, than in fresh tea leaves. The manufacturing step most affecting the leaching of fluoride into tea beverage was withering used in white, black and oolong tea rather than rolling or fermentation. The exposure and associated health risks for fluoride concentration in infusions of 115 commercially available teas from Chinese tea markets was determined. The fluoride concentration ranged from 5.0 to 306.0mgkg(-1), with an average of 81.7mgkg(-1). The hazard quotient (HQ) of these teas indicated that there was no risk of fluorosis from drinking tea, based on statistical analysis by Monte Carlo simulation.

Fluoride Content in Alcoholic Drinks

The aim of the study was to determine the role of alcoholic drinks as a potential source of dietary fluoride by means of measuring fluoride levels in selected alcoholic drinks available on the Polish market that are also diverse in terms of the percentage content of ethanol. The study was conducted on 48 types of drinks with low, medium, and high alcohol content available on the Polish market and offered by various manufacturers, both Polish and foreign. Fluoride concentrations in individual samples were measured by potentiometric method with a fluoride ion-selective electrode. The highest fluoride levels were determined in the lowest percentage drinks (less than 10 % v/v ethanol), with the lowest fluoride levels observed in the highest percentage drinks (above 40 % v/v ethanol). In terms of types of alcoholic drinks, the highest fluoride levels were determined in beers and wines, while the lowest levels were observed in vodkas. These data confirm the fact that alcoholic beverages need to be considered as a significant source of fluoride delivered into the body.

Risk Assessment of Fluoride Intake from Tea in the Republic of Ireland and its Implications for Public Health and Water Fluoridation

The Republic of Ireland (RoI) is the only European Country with a mandatory national legislation requiring artificial fluoridation of drinking water and has the highest per capita consumption of black tea in the world. Tea is a hyperaccumulator of fluoride and chronic fluoride intake is associated with multiple negative health outcomes. In this study, fifty four brands of the commercially available black tea bag products were purchased and the fluoride level in tea infusions tested by an ion-selective electrode method. The fluoride content in all brands tested ranged from 1.6 to 6.1 mg/L, with a mean value of 3.3 mg/L. According to our risk assessment it is evident that the general population in the RoI is at a high risk of chronic fluoride exposure and associated adverse health effects based on established reference values. We conclude that the culture of habitual tea drinking in the RoI indicates that the total cumulative dietary fluoride intake in the general population could readily exceed the levels known to cause chronic fluoride intoxication. Evidence suggests that excessive fluoride intake may be contributing to a wide range of adverse health effects. Therefore from a public health perspective, it would seem prudent and sensible that risk reduction measures be implemented to reduce the total body burden of fluoride in the population.

Modifying Role of GSTP1 Polymorphism on the Association between Tea Fluoride Exposure and the Brick-Tea Type Fluorosis

Background

Brick tea type fluorosis is a public health concern in the north-west area of China. The association between SNPs of genes influencing bone mass and fluorosis has attracted attention, but the association of SNPs with the risk of brick-tea type of fluorosis has not been reported.

Objective

To investigate the modifying roles of GSTP1 rs1695 polymorphisms on this association.

Methods

A cross-sectional study was conducted. Brick-tea water was tested by the standard of GB1996-2005 (China). Urinary fluoride was tested by the standard of WS/T 89-2006 (China). Skeletal fluorosis was diagnosed by X-ray, the part we scheduled was forearm, shank, and pelvic, then diagnosed the skeletal fluorosis by the standard of WS/192-2008 (China). Gene polymorphism was tested by Sequenom MassARRAY system.

Result

The prevalence rate in different ethnical participants was different: Tibetan individuals had the highest prevalence rate of skeletal fluorosis. There were significant differences in genotype frequencies of GSTP1 Rs1695 among different ethnical participants (p<0.001): Tibetan, Mongolian and Han subjects with homozygous wild type (GSTP1-AA) genotype were numerically higher than Kazakh and Russian subjects (p<0.001). Compared to Tibetan participants who carried homozygous A allele of GSTP1 Rs1695, Tibetan participants who carried G allele had a significantly decreased risk of skeletal fluorosis (OR = 0.558 [95% CI, 0.326-0.955]). For Kazakh participants, a decreased risk of skeletal fluorosis among carriers of the G allele was limited to non high-loaded fluoride status (OR = 0. 166 [95% CI, 0.035–0.780] vs. OR = 1.478 [95% CI, 0.866–2.552] in participants with high-loaded fluoride status). Neither SNP-IF nor SNP-age for GSTP1 Rs1695 was observed.

Conclusion

The prevalence rate of the brick tea type fluorosis might have ethnic difference. For Tibetan individuals, who had the highest prevalence rate, G allele of GSTP1 Rs1695 might be a protective factor for brick tea type skeletal fluorosis.

The benefits and risks of consuming brewed tea: beware of toxic element contamination

Background. Increasing concern is evident about contamination of foodstuffs and natural health products. Methods. Common off-the-shelf varieties of black, green, white, and oolong teas sold in tea bags were used for analysis in this study. Toxic element testing was performed on 30 different teas by analyzing (i) tea leaves, (ii) tea steeped for 3-4 minutes, and (iii) tea steeped for 15-17 minutes. Results were compared to existing preferred endpoints. Results. All brewed teas contained lead with 73% of teas brewed for 3 minutes and 83% brewed for 15 minutes having lead levels considered unsafe for consumption during pregnancy and lactation. Aluminum levels were above recommended guidelines in 20% of brewed teas. No mercury was found at detectable levels in any brewed tea samples. Teas contained several beneficial elements such as magnesium, calcium, potassium, and phosphorus. Of trace minerals, only manganese levels were found to be excessive in some black teas. Conclusions. Toxic contamination by heavy metals was found in most of the teas sampled. Some tea samples are considered unsafe. There are no existing guidelines for routine testing or reporting of toxicant levels in "naturally" occurring products. Public health warnings or industry regulation might be indicated to protect consumer safety.

Variation of photosynthesis, fatty acid composition, ATPase and acid phosphatase activities, and anatomical structure of two tea (Camellia sinensis (L.) O. Kuntze) cultivars in response to fluoride

The changes of photosynthetic parameters, water use efficiency (WUE), fatty acid composition, chlorophyll (Chl) content, malondialdehyde (MDA) content, ATPase and acid phosphatase activities, fluoride (F) content, and leaf anatomical structure of two tea cultivars, “Pingyangtezao” (PY) and “Fudingdabai” (FD), after F treatments were investigated. The results show that net photosynthetic rate (P_n), stomatal conductance (g_s), and transpiration rate (E) significantly decreased in both cultivars after 0.3 mM F treatment, but FD had higher P_n, g_s, and WUE and lower E than PY. Chl content in PY significantly decreased after 0.2 and 0.3 mM F treatments, while no significant changes were observed in FD. The proportions of shorter chain and saturated fatty acids increased and those of longer chain and unsaturated fatty acids decreased in both cultivars under F treatments. The contents of MDA increased after F treatments but were higher in PY than in FD. In addition, F treatments decreased the activities of ATPase and acid phosphatase and increased F content in both cultivars; however, compared with PY, FD showed higher enzymatic activities and lower F content in roots and leaves. Leaf anatomical structure in FD indicated that cells in leaf midrib region were less injured by F than in PY.

Periostitis secondary to prolonged voriconazole therapy in a lung transplant recipient

This article reports a case of perostitis deformans in a lung transplantation patient taking the fluoride-containing medication voriconazole, a relatively new and potent anti-fungal. The patient had a normal range of motion in all joints and a normal gait. On radiographs at presentation, multifocal areas of periostitis were visualized involving the left-hand first, second, and third proximal phalanx shafts. Similar periostitis was present on the left-hand third, fourth, and fifth middle phalanx shafts. Plain radiographs of the right hand also demonstrated multifocal periostitis of the third and fourth proximal and middle phalanges. Aggressive periostitis at the level of the right fourth proximal and middle phalanges was also present. Given her long-term treatment with voriconazole and a presentation consistent with periostitis deformans, voriconazole was presumed to be the offending agent and was replaced with itraconazole. The patient's symptoms resolved shortly after withdrawal of voriconazole.Voriconazole-associated periostitis has only recently been reported in the literature. Food and Drug Administration-approved in 2002, voriconazole is efficacious in treating serious, invasive fungal infections that are generally seen in immunocompromised patients. Due to the novel nature of voriconazole and the uncommon indications for its long-term use, the periostitis deformans described in this article may be unfamiliar to the orthopedic surgeon. Consequently, a patient presenting with bone pain and periosteal involvement on plain radiographs may provoke a broad, expensive, and ultimately unnecessary diagnostic evaluation. The clinical case and imaging findings presented here can help to promote understanding of this benign condition and its simple cure: voriconazole discontinuation.