Levels of infants' urinary arsenic metabolites related to formula feeding and weaning with rice products exceeding the EU inorganic arsenic standard

Urinary concentrations of non-essential and essential elements during weaning in infants from the NELA cohort in Spain

Infancy is a period of continuous growth and development, where inadequate intake of essential elements and exposure to non-essential elements may have lifelong health consequences. Thus, the aim of this study is to evaluate the urine concentration of essential and non-essential elements as a proxy for internal exposure during the weaning period, from 3 to 18 months of age. The Nutrition in Early Life and Asthma (NELA) birth cohort generated the data for this study. Sociodemographic, dietary, and urine concentration of essential (Co, Cu, Mo, I, Fe, Mn, Se, Zn, and Ni) and non-essential elements (Al, V, As, Cd, Sb, Tl, and Pb) data were available for 490 participants at 3 months of age and 216 participants at 18 months of age. Paired urine samples at both time periods were available for 175 infants. At 3 months of age, exclusively breastfed infants had lower urine concentrations of Al, V, Fe, Co, Se, Sb, and Tl. Notably, the concentration of Mo had a median (IQR) of 0.60 (0.40-2.10) μg/L compared to a median (IQR) of 39.80 (25.00-56.40) μg/L observed in infants exclusively fed with formula. When we analyzed the change in urine elements concentrations between 3 and 18 months of age, we observed increased As (0.75 vs. 18.60 μg/L), Co (0.05 vs. 0.24 μg/L), Mo (1.98 vs. 50.0 μg/L), Pb (0.15 vs. 0.69 μg/L), Se (11.3 vs. 23.1 μg/L), Tl (0.02 vs. 0.11 μg/L), and V (0.05 vs. 0.11 μg/L). For Cu, lower urine concentrations were observed at 18 months of age in comparison with concentrations at 3 months (5.77 vs. 4.41 μg/L). Among the main food items identified as driving the changes in urine concentration between 3 and 18 months of age were white fish, rice and pasta, potato chips, custard, small blue fish, and legumes. Exclusively breastfed infants showed lower exposure to non-essential elements compared to those who were fed with a mixture or formula. With the introduction of solid foods, the exposure to some non-essential elements increased drastically, as in the case of As and Pb. In addition, exposure to the essential metal Mo also increased substantially with the introduction of solid food.

Toxic Metals and Metalloids in Food: Current Status, Health Risks, and Mitigation Strategies

PURPOSE OF REVIEW

Exposure to toxic metals/metalloids, such as arsenic (As), cadmium (Cd), and lead (Pb), through food consumption is a global public health concern. This review examines the contamination status of these metals/metalloids in food, assesses dietary intake across different populations, and proposes strategies to reduce metal/metalloid exposures throughout the food chain.

RECENT FINDINGS

For the general population, dietary intake of metals/metalloids is generally lower than health-based guidance values. However, for vulnerable populations, such as infants, children, and pregnant women, their dietary intake levels are close to or even higher than the guidance values. Among different food categories, seafood shows higher total As, but largely present as organic species. Rice accumulates higher As concentration than other cereals, with inorganic As (iAs) and dimethylarsinic acid (DMA) being the main As species. Methylated thioarsenate species, such as dimethylmonothioarsenate, have also been detected in rice. The distribution of iAs and DMA in rice shows geographical variation. Additionally, seafood and cocoa products generally contain more Cd than other food, but seafood consumption does not significantly increase in adverse health effects due to its high zinc and iron content. Compared to As and Cd, Pb concentrations in food are generally lower. To minimize the health risks of metal/metalloid exposure, several strategies are proposed. Food contamination with toxic metals/metalloids poses significant concerns for human health, particularly for vulnerable populations. This review provides scientific evidence and suggestions for policy makers to reduce human exposure of metals/metalloids via dietary intake.

Quantified retrospective biomonitoring of fetal and infant elemental exposure using LA-ICP-MS analysis of deciduous dentin in three contrasting human cohorts

BACKGROUND

Spatial elemental analysis of deciduous tooth dentin combined with odontochronological estimates can provide an early life (in utero to ~2 years of age) history of inorganic element exposure and status.

OBJECTIVE

To demonstrate the importance of data normalization to a certified reference material to enable between-study comparisons, using populations with assumed contrasting elemental exposures.

METHODS

We used laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS) of dentin to derive a history of elemental composition from three distinct cohort studies: a present day rural cohort, (the New Hampshire Birth Cohort Study (NHBCS; N = 154)), an historical cohort from an urban area (1958-1970), (the St. Louis Baby Tooth Study (SLBT; N = 78)), and a present-day Nigerian cohort established to study maternal HIV transmission (Dental caries and its association with Oral Microbiomes and HIV in young children-Nigeria (DOMHaIN; N = 31)).

RESULTS

We report Li, Al, Mn, Cu, Zn, Sr, Ba and Pb concentrations (µg/g) and qualitatively examine As, Cd and Hg across all three cohorts. Rates of detection were highest, both overall and for each cohort individually, for Zn, Sr, Ba and Li. Zinc was detected in 100% of samples and was stably present in teeth at a concentration range of 64 - 86 µg/g. Mercury, As and Cd detection rates were the lowest, and had high variability within individual ablated spots. We found the highest concentrations of Pb in the pre- and postnatal dentin of the SLBT cohort, consistent with the prevalent use of Pb as an additive to gasoline prior to 1975. The characteristic decline in Mn after the second trimester was observed in all cohorts.

IMPACT

Spatially resolved elemental analysis of deciduous teeth combined with methods for estimating crown formation times can be used to reconstruct an early-life history of elemental exposure inaccessible via other biomarkers. Quantification of data into absolute values using an external standard reference material has not been conducted since 2012, preventing comparison between studies, a common and highly informative component of epidemiology. We demonstrate, with three contrasting populations, that absolute quantification produces data with the lowest variability, compares well with available data and recommends that future tooth biomarker studies report data in this way.

Deciduous teeth from the New Hampshire birth cohort study: Early life environmental and dietary predictors of dentin elements

BACKGROUND

Sparse research exists on predictors of element concentrations measured in deciduous teeth.

OBJECTIVE

To estimate associations between maternal/child characteristics, elements measured in home tap water during pregnancy and element concentrations in the dentin of shed deciduous teeth.

METHODS

Our analysis included 152 pregnant person-infant dyads followed from the second trimester through the end of the first postnatal year from the New Hampshire Birth Cohort Study. During pregnancy and early infancy, we collected dietary and sociodemographic information via surveys, measured elements in home tap water, and later collected naturally exfoliated teeth from child participants. We measured longitudinal deposition of elements in dentin using LA-ICP-MS. Multivariable linear mixed models were used to estimate associations between predictors and dentin element concentrations.

RESULTS

We measured 12 elements in dentin including those previously reported (Ba, Mn, Pb, Sr, Zn) and less frequently reported (Al, As, Cd, Cu, Hg, Li, and W). A doubling of Pb or Sr concentrations in water was associated with higher dentin Pb or Sr respectively in prenatally formed [9% (95%CI: 3%, 15%); 3% (1%, 6%)] and postnatally formed [10% (2%, 19%); 6% (2%, 10%)] dentin. Formula feeding from birth to 6 weeks or 6 weeks to 4 months was associated with higher element concentrations in postnatal dentin within the given time period as compared to exclusive human milk feeding: Sr: 6 weeks: 61% (36%, 90%) and 4 months: 85% (54%, 121%); Ba: 6 weeks: 35% (3.3%, 77%) and 4 months: 42% (10%, 83%); and Li: 6 weeks: 61% (33%, 95%) and 4 months: 58% (31%, 90%).

SIGNIFICANCE

These findings offer insights into predictors of dentin elements and potential confounders in exposure-health outcome relationships during critical developmental periods.

Elemental composition of toxic and essential elements in rice-based baby foods from the United States and other countries: A probabilistic risk analysis

Consumption of rice-based foods provides essential nutrients required for infants and toddlers' growth. However, they could contain toxic and excess essential elements that may affect human health. The study aims to determine the composition of rice-based baby foods in the USA and outside and conduct a multiple-life stages probabilistic exposure and risk assessment of toxic and essential elements in children. Elemental concentrations were measured using Inductively Coupled Plasma Mass Spectrometry (ICP-MS) in thirty-three rice-based baby foods. This includes 2 infant formulas, 11 rice baby cereals, and 20 rice snacks produced primarily in the United States, China, and other countries. A probabilistic risk assessment was conducted to assess risks of adverse health effects. Results showed that infant formula had higher median concentrations of selenium (Se), copper (Cu), zinc (Zn), sodium (Na), magnesium (Mg), calcium (Ca), and potassium (K) compared to rice baby cereal and rice snacks. On the contrary, rice snacks had the highest median concentration of Arsenic (As) (127 μg/kg) while rice baby cereals showed the highest median concentration of Cd (7 μg/kg). A higher lifetime estimated daily intake was observed for samples manufactured in the USA compared to those from China and other countries. Hazard quotient (HQ < 1) values were suggestive of minimal adverse health effects. However, lifetime carcinogenic risk analysis based on total As indicated an unacceptable cancer risk (>1E-04). These findings show a need for ongoing monitoring of rice-based foods consumed by infants and toddlers as supplementary and substitutes for breast milk or weaning food options. This can be useful in risk reduction and mitigation of early life exposure to improve health outcomes.

Effects of dietary arsenic exposure on liver metabolism in mice

Arsenic, a ubiquitous environmental toxicant with various forms and complex food matrix interactions, can reportedly exert differential effects on the liver compared to drinking water exposure. To examine its specific liver-related harms, we targeted the liver in C57BL/6 J mice (n=48, 8-week-old) fed with arsenic-contaminated food (30 mg/kg) for 60 days, mimicking the rice arsenic composition observed in real-world scenarios (iAsV: 7.3%, iAsIII: 72.7%, MMA: 1.0%, DMA: 19.0%). We then comprehensively evaluated liver histopathology, metabolic changes, and the potential role of the gut-liver axis using human hepatocellular carcinoma cells (HepG2) and microbiota/metabolite analyses. Rice arsenic exposure significantly altered hepatic lipid (fatty acids, glycerol lipids, phospholipids, sphingolipids) and metabolite (glutathione, thioneine, spermidine, inosine, indole-derivatives, etc.) profiles, disrupting 33 metabolic pathways (bile secretion, unsaturated fatty acid biosynthesis, glutathione metabolism, ferroptosis, etc.). Pathological examination revealed liver cell necrosis/apoptosis, further confirmed by ferroptosis induction in HepG2 cells. Gut microbiome analysis showed enrichment of pathogenic bacteria linked to liver diseases and depletion of beneficial strains. Fecal primary and secondary bile acids, short-chain fatty acids, and branched-chain amino acids were also elevated. Importantly, mediation analysis revealed significant correlations between gut microbiota, fecal metabolites, and liver metabolic alterations, suggesting fecal metabolites may mediate the impact of gut microbiota and liver metabolic disorders. Gut microbiota and its metabolites may play significant roles in arsenic-induced gut-liver injuries. Overall, our findings demonstrate that rice arsenic exposure triggers oxidative stress, disrupts liver metabolism, and induces ferroptosis.

A critical analysis of various post-harvest arsenic removal treatments of rice and their impact on public health due to nutrient loss

Rice (Oryza sativa L.) is particularly susceptible to arsenic (As) accumulation. Currently, to decrease the level of As accumulated in rice, various post-harvest methods, i.e., polishing, parboiling, pH-dependent soaking, washing, and cooking at different rice-to-water ratios (r/w), are being focused, because it removes significant amount of As from rice grain. Depending upon the rice variety and type, i.e., rough (with husk), husked (without husk/brown), or polished rice, these methods can remove 39-54% As by parboiling, 38-55% by polishing, 37-63% by soaking, and 6-80% by washing and cooking. Infants are highly vulnerable to As exposure; thus, these methods can be helpful for the production of rice-based infant foods. Although concern arises during the use of these methods that apart from decreasing the level of As in rice grain, they also lead to a significant loss of nutrients, such as macro- and micro-elements present in rice. Among these discussed methods, parboiling curtails 5-59%, polishing curtails 6-96%, soaking curtails 33-83%, and washing and cooking in different r/w reduce 8-81% of essential nutrients resulting in 2-90% reduction in contribution to the RDI of these nutrients through rice-based diet. Thus, these post-harvest arsenic removal methods, although reduce arsenic induced health hazard, but may also lead to malnutrition and compromised health in the population based on rice diet. There is a need to explore another way to reduce As from rice without compromising the nutrient availability or to supplement these nutrients through grain enrichment or by introducing additional dietary sources by changing eating habits; however, this may impose an extra economic burden on people.

Safety of African grown rice: Comparative review of As, Cd, and Pb contamination in African rice and paddy fields

This review aimed to investigate the reported concentrations of arsenic (As), cadmium (Cd), and lead (Pb) in rice cultivated in Africa and African rice paddies compared to other regions. It also aimed to explore the factors influencing these concentrations and evaluate the associated health risks of elevated As, Cd, and Pb exposure. Relevant data were obtained from electronic databases such as PubMed, Scopus, and Google Scholar using specific keywords related to arsenic, cadmium, lead, rice, Africa, paddy, and grain. While the number of studies reporting the concentrations of As, Cd, and Pb in rice and rice paddies in Africa is relatively low compared to other regions, this review revealed that most of the African rice and paddy soils have low concentrations of these metals. However, some studies have reported elevated concentrations of As, Cd, and Pb in paddy fields, which is concerning due to the increased use of agrochemicals containing heavy metals in rice production. Nonetheless, agronomical interventions such as implementing alternate wetting and drying water management, cultivating cultivars with low accumulation of As, Cd, and Pb, amending rice fields with sorbents, and screening irrigation water can limit the bioaccumulation of these carcinogens in paddy fields using phytoremediation techniques. Therefore, we strongly urge African governments and organizations operating in Africa to enhance the capacity of rice farmers and extension officers in adopting approaches and practices that reduce the accumulation of these carcinogenic metals in rice. This is essential to achieve the sustainable development goal of providing safe food for all.

Dietary Exposure to Toxic Elements and the Health of Young Children: Methodological Considerations and Data Needs

Concerns have been raised regarding toxic-element (arsenic, cadmium, lead, and mercury) contamination of commercially available infant foods around the world. Young children are vulnerable to the effects of toxic elements, based on higher absorption levels and potentially poorer detoxification capacities. Toxic-element exposures in early life exact high societal costs, but it is unclear how much dietary exposure to these elements contributes to adverse health outcomes. Well-designed epidemiological studies conducted in different geographical and socioeconomic contexts need to estimate dietary toxicant exposure in young children and to determine whether causal links exist between toxicants in children's diets and health outcomes. This commentary outlines the methodological considerations and data needs to advance such research.

Diagnosis and management of food allergy-associated gastroesophageal reflux disease in young children-EAACI position paper

Gastro-oesophageal reflux (GOR) and food allergy (FA) are common conditions, especially during the first 12 months of life. When GOR leads to troublesome symptoms, that affect the daily functioning of the infant and family, it is referred to as GOR disease (GORD). The role of food allergens as a cause of GORD remains controversial. This European Academy of Allergy and Clinical Immunology (EAACI) position paper aims to review the evidence for FA-associated GORD in young children and translate this into clinical practice that guides healthcare professionals through the diagnosis of suspected FA-associated GORD and medical and dietary management. The task force (TF) on non-IgE mediated allergy consists of EAACI experts in paediatric gastroenterology, allergy, dietetics and psychology from Europe, United Kingdom, United States, Turkey and Brazil. Six clinical questions were formulated, amended and approved by the TF to guide this publication. A systematic literature search using PubMed, Cochrane and EMBASE databases (until June 2021) using predefined inclusion criteria based on the 6 questions was used. The TF also gained access to the database from the European Society of Paediatric Gastroenterology and Hepatology working group, who published guidelines on GORD and ensured that all publications used within that position paper were included. For each of the 6 questions, practice points were formulated, followed by a modified Delphi method consisting of anonymous web-based voting that was repeated with modified practice points where required, until at least 80% consensus for each practice point was achieved. This TF position paper shares the process, the discussion and consensus on all practice points on FA-associated GORD.

Toxic metal exposures from infant diets: Risk prevention strategies for caregivers and health care professionals

Concerns are growing regarding the presence of toxic elements such as arsenic (As), cadmium (Cd), mercury (Hg), and lead (Pb) in the ingredients and prepared foods for infants and young children. There are few clear, evidence-based, guidelines on the maximum tolerable limits of toxicants in foods and little understanding of toxicant exposure or adverse health effects attributable to dietary exposure. Caregivers are faced with the burden of making decisions about which foods to select, how often to feed them to their children, and what foods to limit. This article reviews the current literature and existing recommendations on dietary exposure to toxic elements in children under 2 years of age, and their health effects in early childhood-focusing on growth, neurodevelopment, and immune function. The article also outlines best practices for healthcare providers to address the concerns of toxic element exposure through the diet in young children. Several foods consistently appear in the literature as potential sources of toxic element exposure. Contaminated drinking and cooking water, including water used to prepare infant formula, could also be a major exposure source. In the absence of stronger evidence on effects of dietary modification, exclusive breastfeeding until six months of age, followed by a diverse diet are some strategies to reduce dietary toxic element exposure while ensuring an adequate and balanced nutrient intake. Healthcare providers can support families by sharing information and encouraging blood Pb testing, the only element for which such testing is currently recommended.

A Narrative Review of Toxic Heavy Metal Content of Infant and Toddler Foods and Evaluation of United States Policy

Excessive exposure to inorganic contaminants through ingestion of foods, such as those commonly referred to as heavy metals may cause cancer and other non-cancerous adverse effects. Infants and young children are especially vulnerable to these toxic effects due to their immature development and high ’food intake/ body weight' ratio. Concerns have been raised by multiple independent studies that heavy metals have been found to be present in many foods in the infant and child food sector. Most recently, reports from the U.S. House of Representatives Subcommittee on Economic and Consumer Policy suggest subpar testing practices, lenient or absent standards, and limited oversight of food manufacturers perpetuate the presence of these contaminants in infant and toddler foods. The aim of this narrative review is to evaluate the current state of policies in the United States designed to safe-guard against excessive heavy metal exposure and to discuss what is presently known about the presence of the so-called heavy metals; arsenic, lead, mercury and cadmium found in infant and toddler foods. PubMed was used to search for studies published between 1999 and 2022 using a combination of search terms including: “heavy metal,” “contamination,” “infant,” “toddler,” and “complementary food”.

Dietary Exposure to Essential and Non-essential Elements During Infants' First Year of Life in the New Hampshire Birth Cohort Study

Even the low levels of non-essential elements exposure common in the US may have health consequences especially early in life. However, little is known about the infant's dynamic exposure to essential and non-essential elements. This study aims to evaluate exposure to essential and non-essential elements during infants' first year of life and to explore the association between the exposure and rice consumption. Paired urine samples from infants enrolled in the New Hampshire Birth Cohort Study (NHBCS) were collected at approximately 6 weeks (exclusively breastfed) and at 1 year of age after weaning (n = 187). A further independent subgroup of NHBCS infants with details about rice consumption at 1 year of age also was included (n = 147). Urinary concentrations of 8 essential (Co, Cr, Cu, Fe, Mn, Mo, Ni, and Se) and 9 non-essential (Al, As, Cd, Hg, Pb, Sb, Sn, V, and U) elements were determined as a measure of exposure. Several essential (Co, Fe, Mo, Ni, and Se) and non-essential (Al, As, Cd, Hg, Pb, Sb, Sn, and V) elements had higher concentrations at 1 year than at 6 weeks of age. The highest increases were for urinary As and Mo with median concentrations of 0.20 and 1.02 µg/L at 6 weeks and 2.31 and 45.36 µg/L at 1 year of age, respectively. At 1 year of age, As and Mo urine concentrations were related to rice consumption. Further efforts are necessary to minimize exposure to non-essential elements while retaining essential elements to protect and promote children's health.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12403-022-00489-x.

Arsenic Exposure through Dietary Intake and Associated Health Hazards in the Middle East

Dietary arsenic (As) contamination is a major public health issue. In the Middle East, the food supply relies primarily on the import of food commodities. Among different age groups the main source of As exposure is grains and grain-based food products, particularly rice and rice-based dietary products. Rice and rice products are a rich source of core macronutrients and act as a chief energy source across the world. The rate of rice consumption ranges from 250 to 650 g per day per person in South East Asian countries. The source of carbohydrates through rice is one of the leading causes of human As exposure. The Gulf population consumes primarily rice and ready-to-eat cereals as a large proportion of their meals. Exposure to arsenic leads to an increased risk of non-communicable diseases such as dysbiosis, obesity, metabolic syndrome, diabetes, chronic kidney disease, chronic heart disease, cancer, and maternal and fetal complications. The impact of arsenic-containing food items and their exposure on health outcomes are different among different age groups. In the Middle East countries, neurological deficit disorder (NDD) and autism spectrum disorder (ASD) cases are alarming issues. Arsenic exposure might be a causative factor that should be assessed by screening the population and regulatory bodies rechecking the limits of As among all age groups. Our goals for this review are to outline the source and distribution of arsenic in various foods and water and summarize the health complications linked with arsenic toxicity along with identified modifiers that add heterogeneity in biological responses and suggest improvements for multi-disciplinary interventions to minimize the global influence of arsenic. The development and validation of diverse analytical techniques to evaluate the toxic levels of different As contaminants in our food products is the need of the hour. Furthermore, standard parameters and guidelines for As-containing foods should be developed and implemented.

Infant infections, respiratory symptoms, and allergy in relation to timing of rice cereal introduction in a United States cohort

Rice products marketed in the USA, including baby rice cereal, contain inorganic arsenic, a putative immunotoxin. We sought to determine whether the timing of introduction of rice cereal in the first year of life influences occurrence of infections, respiratory symptoms, and allergy. Among 572 infants from the New Hampshire Birth Cohort Study, we used generalized estimating equation, adjusted for maternal smoking during pregnancy, marital status, education attainment, pre-pregnancy body mass index, maternal age at enrollment, infant birth weight, and breastfeeding history. Among 572 infants, each month earlier of introduction to rice cereal was associated with increased risks of subsequent upper respiratory tract infections (relative risk, RR = 1.04; 95% CI: 1.00-1.09); lower respiratory tract infections (RR = 1.19; 95% CI: 1.02-1.39); acute respiratory symptoms including wheeze, difficulty breathing, and cough (RR = 1.10; 95% CI: 1.00-1.22); fever requiring a prescription medicine (RR = 1.22; 95% CI: 1.02-1.45) and allergy diagnosed by a physician (RR = 1.20; 95% CI: 1.06-1.36). No clear associations were observed with gastrointestinal symptoms. Our findings suggest that introduction of rice cereal earlier may influence infants' susceptibility to respiratory infections and allergy.

CRM rapid response approach for the certification of arsenic species and toxic trace elements in baby cereal coarse rice flour certified reference material BARI-1

With recently legislated maximum levels of inorganic arsenic (iAs) in white and brown rice in Canada, the regulatory bodies are evaluating the need for regulation of As levels in infant food products. Rice is a major part of infants' diet, and therefore, the presence of As in this staple food causes concerns. So far, the scientific community was lacking suitable certified reference material (CRM) which could be used to assess the accuracy of developed analytical methods for As speciation in infants' food products. As a result, we have developed BARI-1, a baby cereal coarse rice flour reference material which was certified for total arsenic (0.248 ± 0.018 mg kg^-1), cadmium (0.0134 ± 0.0014 mg kg^-1), mercury (0.0026 ± 0.0003 mg kg^-1), lead (0.0064 ± 0.0016 mg kg^-1), inorganic As (0.113 ± 0.016 mg kg^-1) and dimethylarsinic acid (DMA) (0.115 ± 0.010 mg kg^-1), and reference value for monomethylarsonic acid (MMA) (0.0045 ± 0.0008 mg kg^-1) was reported. We also observed trace amounts of an unknown As compound, with chromatographic retention time close to DMA. Participating laboratories were allowed to use their in-house-validated extraction and/or digestion methods, and the detection of total metals was done by ICP-MS whereas HPLC-ICP-MS was used for As speciation. Despite the diversity in sample preparation and quantitation methods, reported values were in good agreement. For iAs measurement, the comparison between hydride generation ICP-MS and HPLC-ICP-MS found iAs overestimation with the former method, possibly due to interference from DMA. The certification was accomplished with a CRM rapid response approach in collaborative, focused effort completing the CRM development in few months instead of the typical multiyear project. This approach allowed to respond to measurement needs in a timely fashion. Graphical abstract.

Selenium intake from tuna in Galicia (Spain): Health risk assessment and protective role against exposure to mercury and inorganic arsenic

This study aims to quantify the selenium contribution from tuna to the Spanish diet and evidence the Se protective role against mercury and inorganic arsenic toxicity. Selenium concentrations in tuna were determined by ICP-MS spectrometry (expressed as mg kg^-1), and the risk assessment was evaluated joined to Hg and iAs contrasting criteria of regulatory agencies with those that consider the Se protective role. Differences between Se average concentrations in fresh (1.24) and preserved (1.17) tuna were not statistically significant. In canned tuna species, Se presented higher mean levels in Thunnus albacares (1.28) than Thunnus alalunga (1.01) with statistically significant differences (p = 0.002), and among canned preparations a decreasing sequence was observed in different preparation-packaging media: oil (1.42) > natural (1.01) > pickled (0.92). Statistical study showed Hg-iAs as the only pair significantly correlated in all samples. The HI (sum of individual target hazard quotients -THQs-) on the consumption of tuna in Spain, due to exposure to Se, Hg and iAs, revealed the possibility of risk of adverse chronic effects in the six-year-old children group (1.09). According to the maximum allowable tuna consumption rate in meals/week (CR_mw) and the THQs obtained, tuna intake, especially in children, should be moderated. The health benefit values (HBV_Se) were positive in all samples, 14.53 and 15.65 in fresh and preserved tuna, respectively, which allows tuna to be considered safe. The benefit-risk value (BRV) evidenced the Se molar excess with respect to Hg that reached a surplus of 14.32% on Se AI in adults. Since iAs reduces the Se bioavailability, applying a new BRV criterion, the aforementioned percentage decreased to 13.49% of Se AI. In conclusion, tuna offers high levels of selenium to counteract adverse effects by the presence of Hg and iAs, and to provide consumers an important source of this essential element safely.

Genetic loci regulating arsenic content in rice grains when grown flooded or under alternative wetting and drying irrigation

BACKGROUND

Rice is a global staple crop, being the main calorific component of many people living subsistence livelihoods. Rice can accumulate toxic elements such as arsenic, with the crop water management strongly affecting uptake. This study utilises the Bengal and Assam Aus Panel to conduct genome wide association (GWA) mapping for arsenic in shoots and grains of rice grown over 2 years under continually flooded (CF) and alternate wetting and drying (AWD). The aim was to assess genotype by water management interaction, identify quantitative trait loci (QTL) for arsenic accumulation, and propose candidate genes for lowering grain arsenic.

RESULTS

AWD significantly reduced grain arsenic across all cultivars on average by 15.7 and 15.1% in year 1 and 2 respectively and shoot arsenic by 27.0% compared to the plants grown under CF. There was a weak cultivar by treatment interaction for grain for arsenic. All traits were strongly influenced by cultivar. GWA mapping identified a large number of 74 individual QTLs for arsenic, with six QTLs showing stability across years and/or water treatments. Three of the loci (one on chromosome 3, one on chromosome 4, and one on chromosome 5) were investigated in detail using an approach of clustering cultivars that had similar haplotypes for the QTL regions and then looking at the phenotypic values across the clusters. Two of the identified QTLs co-localised with known genes involved in arsenic accumulation, including Lsi2 which has not previously been reported to underlie a grain arsenic QTL.

CONCLUSIONS

This study has identified a number of novel QTLs for arsenic accumulation, as well as cultivars that consistently accumulate less arsenic over multiple field traits. The use of a haplotype clustering approach after GWA mapping has allowed for the effect, in terms of arsenic accumulation, to be determined for cultivars that share similar genomic sequence. Allocating nine high yielding Bangladeshi cultivars to these clusters has identified the potential of utilising these QTLs in breeding programmes; for example, incorporation of the QTL on chromosome 5 should decrease grain arsenic in elite high yielding Bangladeshi cultivars by 10% in all high yielding cultivars studied.

Clinical Aspects of Thickeners for Pediatric Gastroesophageal Reflux and Oropharyngeal Dysphagia

PURPOSE OF REVIEW

The purpose of this review is to discuss current knowledge and recent findings regarding clinical aspects of thickeners for pediatric gastroesophageal reflux and oropharyngeal dysphagia. We review evidence for thickener efficacy, discuss types of thickeners, practical considerations when using various thickeners, and risks and benefits of thickener use in pediatrics.

RECENT FINDINGS

Thickeners are effective in decreasing regurgitation and improving swallowing mechanics and can often be used empirically for the treatment of infants and young children. Adverse effects have been reported, but with careful consideration of appropriate thickener types, desired thickening consistency, and follow-up in collaboration with feeding specialists, most patients have symptomatic improvements. Thickeners are typically well tolerated and with few side effects, but close follow-up is needed to make sure patients tolerate thickeners and have adequate symptom improvement.

Arsenic and cadmium contents in Brazilian rice from different origins can vary more than two orders of magnitude

Brazil is a major producer of rice, but there is not enough information about As and Cd in rice grown under different conditions in this country. Here, As and Cd were determined by ICP-MS and species of As by HPLC-ICP-MS in Brazilian husked rice, covering diverse cultivars and regions, as well as upland and flooded production systems. Significant differences were observed for contents of both elements according to the origin of rice. All samples were below the maximum limit for Cd (400 µg/kg) set by national legislation, while nine samples presented total As above the legislation limit (300 µg/kg). From 24 samples analyzed for As species, 42% showed iAs above the European limit for production of food to infants (100 µg/kg). The total As content in samples from Mato Grosso state presented a maximum value of 6 µg/kg, which combined with low Cd content make interesting further studies.

Opportunities and Challenges for Dietary Arsenic Intervention

The diet is emerging as the dominant source of arsenic exposure for most of the U.S. population. Despite this, limited regulatory efforts have been aimed at mitigating exposure, and the role of diet in arsenic exposure and disease processes remains understudied. In this brief, we discuss the evidence linking dietary arsenic intake to human disease and discuss challenges associated with exposure characterization and efforts to quantify risks. In light of these challenges, and in recognition of the potential longer-term process of establishing regulation, we introduce a framework for shorter-term interventions that employs a field-to-plate food supply chain model to identify monitoring, intervention, and communication opportunities as part of a multisector, multiagency, science-informed, public health systems approach to mitigation of dietary arsenic exposure. Such an approach is dependent on coordination across commodity producers, the food industry, nongovernmental organizations, health professionals, researchers, and the regulatory community. https://doi.org/10.1289/EHP3997.

Infants' dietary arsenic exposure during transition to solid food

Early-life exposure to inorganic arsenic (i-As) may cause long-lasting health effects, but as yet, little is known about exposure among weaning infants. We assessed exposure before and during weaning and investigated the association between solid food intake and infants' urinary arsenic species concentrations. Following the recording of a comprehensive 3 day food diary, paired urine samples (pre- and post-weaning) were collected and analyzed for arsenic speciation from 15 infants participating in the New Hampshire Birth Cohort Study. Infants had higher urinary i-As (p-value = 0.04), monomethylarsonic acid (MMA) (p-value = 0.002), dimethylarsinic acid (DMA) (p-value = 0.01), and sum of arsenic species (i-As + MMA + DMA, p-value = 0.01) during weaning than while exclusively fed on a liquid diet (i.e., breast milk, formula, or a mixture of both). Among weaning infants, increased sum of urinary arsenic species was pairwise-associated with intake of rice cereal (Spearman's ρ = 0.90, p-value = 0.03), fruit (ρ = 0.70, p-value = 0.03), and vegetables (ρ = 0.86, p-value = 0.01). Our observed increases in urinary arsenic concentrations likely indicate increased exposure to i-As during the transition to solid foods, suggests the need to minimize exposure during this critical period of development.

Dilution of rice with other gluten free grains to lower inorganic arsenic in foods for young children in response to European Union regulations provides impetus to setting stricter standards

There has been an increasing realisation that young infants are exposed to elevated concentrations of the carcinogen inorganic arsenic, relative to adults. This is because many infant food products are rice based, and rice is ~10-fold elevated in inorganic arsenic compared to most other foods. The European Commission (EC) has acted on this concern setting stricter standards for infants, 100 μg of inorganic arsenic per kg of food (100 μg/kg), as compared to adults (200 μg/kg), for rice based foods, a law that was brought into place in 1^st January 2016. Here we investigate how this law has impacted on inorganic arsenic in baby food products in the UK market, and compare the findings to previous baby food surveys taken before and just after the law came into place. We find that for a wide range of UK infant products that the new regulations are being adhered to, with all samples surveyed, being under 100 μg/kg inorganic arsenic. The prevalence of pure rice products had decreased in the UK, and there appears to be careful sourcing of the rice used in these products to ensure conformity with regulations. There has been an increased presence of mixed cereal products, with rice and maize as the main ingredient, appearing on the UK market, with varying rice contents for infant porridges, cakes and mueslis, with the latter being a relatively innovative product for infant foods. There was a highly significant correlation (P<0.0001) between rice content and inorganic arsenic concentration across all infant foods. When UK infant rice cakes, breakfast cereals and porridges were compare to their general, i.e. not labelled specifically for being for infant consumption, equivalent it was found that the adult foods generally exceeded the 100 μg/kg inorganic arsenic standard for infant foods. Thus, infants should not be given rice products not specifically labelled as being for them if a lower inorganic arsenic diet is to be maintained.

Arsenic exposure and risk of nonalcoholic fatty liver disease (NAFLD) among U.S. adolescents and adults: an association modified by race/ethnicity, NHANES 2005-2014

BACKGROUND

While associated with obesity, the cause of the rapid rise in prevalence of nonalcoholic fatty liver disease (NAFLD) in children, which is highest among Hispanics, is not well understood. Animal experiments have demonstrated that arsenic exposure contributes to liver injury. Our objective was to examine the association between arsenic exposure and NAFLD in humans and to determine if race/ethnicity modifies the association.

METHODS

Urinary inorganic arsenic concentrations among those ≥12 years in the National Health and Nutrition Examination Survey, 2005-2014 were used to assess the cross-sectional association with serum alanine aminotransferase (ALT) levels, a marker of liver dysfunction. We excluded high alcohol consumers (>4-5 drinks/day; n = 939), positive hepatitis B or C (n = 2330), those missing body mass index (n = 100) and pregnant women (n = 629) for a final sample of 8518. Arsenic was measured using liquid chromatography coupled with mass spectrometry and ALT was measured using standard methods. Sampling weights were used to obtain national estimates. Due to lack of normality, estimates were log transformed and are presented as geometric means. Logistic regression models controlling for age, sex, income, and weight category estimate adjusted odd ratios (aOR) of elevated ALT by quartile of arsenic and tested for effect modification by race/ethnicity and weight. Elevated ALT was defined as >25 IU/L and >22 IU/L for boys and girls ≤17 years, respectively and >30 IU/L and >19 IU/L for men and women, respectively.

RESULTS

Among all, aOR of elevated ALT were higher among those in the highest vs. lowest arsenic quartile (referent), 1.4 (95% confidence interval [CI]: 1.1, 1.7) with a borderline significant interaction (p = 0.07) by race/ethnicity but not weight (p = 0.4). In analysis stratified by race/ethnicity, aOR of elevated ALT among those in the 4th quartile were higher among Mexican Americans, 2.0 (CI: 1.3, 3.1) and non-Hispanic whites only, aOR 1.4 (CI: 1.1, 1.8) despite the fact that obesity prevalence was highest among non-Hispanic blacks.

CONCLUSIONS

Our findings demonstrate a positive association between urinary arsenic exposure and risk of NAFLD among U.S. adolescents and adults that is highest among Mexican Americans and among those obese, regardless of race/ethnicity.