Scientific opinion on the tolerable upper intake level for vitamin B6

Following a request from the European Commission, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) was asked to deliver a scientific opinion on the tolerable upper intake level (UL) for vitamin B6. Systematic reviews of the literature were conducted by a contractor. The relationship between excess vitamin B6 intakes and the development of peripheral neuropathy is well established and is the critical effect on which the UL is based. A lowest-observed-effect-level (LOAEL) could not be established based on human data. A reference point (RP) of 50 mg/day is identified by the Panel from a case-control study, supported by data from case reports and vigilance data. An uncertainty factor (UF) of 4 is applied to the RP to account for the inverse relationship between dose and time to onset of symptoms and the limited data available. The latter covers uncertainties as to the level of intake that would represent a LOAEL. This leads to a UL of 12.5 mg/day. From a subchronic study in Beagle dogs, a LOAEL of 50 mg/kg body weight (bw) per day can be identified. Using an UF of 300, and a default bw of 70 kg, a UL of 11.7 mg/day can be calculated. From the midpoint of the range of these two ULs and rounding down, a UL of 12 mg/day is established by the Panel for vitamin B6 for adults (including pregnant and lactating women). ULs for infants and children are derived from the UL for adults using allometric scaling: 2.2-2.5 mg/day (4-11 months), 3.2-4.5 mg/day (1-6 years), 6.1-10.7 mg/day (7-17 years). Based on available intake data, EU populations are unlikely to exceed ULs, except for regular users of food supplements containing high doses of vitamin B6.

Scientific opinion on the tolerable upper intake level for selenium

Following a request from the European Commission, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) was asked to deliver a scientific opinion on the tolerable upper intake level (UL) for selenium. Systematic reviews of the literature were conducted to identify evidence regarding excess selenium intake and clinical effects and potential biomarkers of effect, risk of chronic diseases and impaired neuropsychological development in humans. Alopecia, as an early observable feature and a well-established adverse effect of excess selenium exposure, is selected as the critical endpoint on which to base a UL for selenium. A lowest-observed-adverse-effect-level (LOAEL) of 330 μg/day is identified from a large randomised controlled trial in humans (the Selenium and Vitamin E Cancer Prevention Trial (SELECT)), to which an uncertainty factor of 1.3 is applied. A UL of 255 μg/day is established for adult men and women (including pregnant and lactating women). ULs for children are derived from the UL for adults using allometric scaling (body weight0.75). Based on available intake data, adult consumers are unlikely to exceed the UL, except for regular users of food supplements containing high daily doses of selenium or regular consumers of Brazil nuts. No risk has been reported with the current levels of selenium intake in European countries from food (excluding food supplements) in toddlers and children, and selenium intake arising from the natural content of foods does not raise reasons for concern. Selenium-containing supplements in toddlers and children should be used with caution, based on individual needs.

Guidance for establishing and applying tolerable upper intake levels for vitamins and essential minerals: Draft for internal testing

Vitamins and essential minerals are micronutrients that are essential for the normal functioning of the human body. However, they may lead to adverse health effects if consumed in excess. The concept of a tolerable upper intake level (UL) is a science-based reference value, which was introduced to support policy-makers and other relevant actors in managing the risks of excess nutrient intake. EFSA's principles for establishing ULs for vitamins and minerals were originally developed by the Scientific Committee on Food in 2000. Since then, experience has been gained and the scientific field developed. This guidance from the EFSA Panel on Nutrition, Novel Foods and Food Allergens provides an updated framework to support EFSA's UL assessments. It covers aspects related to the planning of the risk assessment (problem formulation and definition of methods) and its implementation (evidence retrieval, appraisal, synthesis, integration, uncertainty analysis). As in the previous framework, the general principles developed for the risk assessment of chemicals in food are applied (hazard identification, hazard characterisation, intake assessment, risk characterisation). Peculiar to nutrients are their biochemical and physiological roles and the specific and selective mechanisms that maintain the systemic homoeostasis and body burden of the nutrient. These must be considered when conducting a risk assessment of nutrients. This document constitutes a draft guidance that will be applied in EFSA's assessments during a 1-year pilot phase and be revised and complemented as necessary. Before finalisation of the guidance, a public consultation will be launched.

Update of the tolerable upper intake level for vitamin D for infants

Following a request from the European Commission, the Panel on Dietetic Products, Nutrition and Allergies (NDA) was asked to revise the tolerable upper intake level (UL) for vitamin D for infants (≤ 1 year) set in 2012. From its literature review, the Panel concluded that the available evidence on daily vitamin D intake and the risk of adverse health outcomes (hypercalciuria, hypercalcaemia, nephrocalcinosis and abnormal growth patterns) cannot be used alone for deriving the UL for infants. The Panel conducted a meta-regression analysis of collected data, to derive a dose-response relationship between daily supplemental intake of vitamin D and mean achieved serum 25(OH)D concentrations. Considering that a serum 25(OH)D concentration of 200 nmol/L or below is unlikely to pose a risk of adverse health outcomes in infants, the Panel estimated the percentage of infants reaching a concentration above this value at different intakes of vitamin D. Based on the overall evidence, the Panel kept the UL of 25 μg/day for infants aged up to 6 months and set a UL of 35 μg/day for infants 6-12 months. The Panel was also asked to advise on the safety of the consumption of infant formulae with an increased maximum vitamin D content of 3 μg/100 kcal (Commission Delegated Regulation (EU) 2016/127 repealing Directive 2006/141/EC in 2020). For infants aged up to 4 months, the intake assessment showed that the use of infant formulae containing vitamin D at 3 μg/100 kcal may lead some infants to receive an intake above the UL of 25 μg/day from formulae alone without considering vitamin D supplemental intake. For infants aged 4-12 months, the 95th percentile of vitamin D intake (high consumers) estimated from formulae and foods fortified or not with vitamin D does not exceed the ULs, without considering vitamin D supplemental intake.

Estimation of the Prevalence of Inadequate and Excessive Iodine Intakes in School-Age Children from the Adjusted Distribution of Urinary Iodine Concentrations from Population Surveys

BACKGROUND

The urinary iodine concentration (UIC), a biomarker of iodine intake, is used to assess population iodine status by deriving the median UIC, but this does not quantify the percentage of individuals with habitually deficient or excess iodine intakes. Individuals with a UIC <100 μg/L or ≥300 μg/L are often incorrectly classified as having deficient or excess intakes, but this likely overestimates the true prevalence.

OBJECTIVE

Our aim was to estimate the prevalence of inadequate and excess iodine intake in children (aged 4-14 y) with the distribution of spot UIC from iodine surveys.

METHODS

With the use of data from national iodine studies (Kuwait, Oman, Thailand, and Qatar) and a regional study (China) in children (n = 6117) in which a repeat UIC was obtained in a subsample (n = 1060), we calculated daily iodine intake from spot UICs from the relation between body weight and 24-h urine volume and within-person variation by using the repeat UIC. We also estimated pooled external within-person proportion of total variances by region. We used within-person variance proportions to obtain the prevalence of inadequate or excess usual iodine intake by using the Estimated Average Requirement (EAR)/Tolerable Upper Intake Level (UL) cutoff method.

RESULTS

Median UICs in Kuwait, Oman, China, Thailand, and Qatar were 132, 192, 199, 262, and 333 μg/L, respectively. Internal within-person variance proportions ranged from 25.0% to 80.0%, and pooled regional external estimates ranged from 40.4% to 77.5%. The prevalence of inadequate and excess intakes as defined by the adjusted EAR/UL cutoff method was ∼45-99% lower than those defined by a spot UIC <100 μg/L or ≥300 μg/L (P < 0.01).

CONCLUSIONS

Applying the EAR/UL cutoff method to iodine intakes from adjusted UIC distributions is a promising approach to estimate the number of individuals with deficient or excess iodine intakes.

The impact of surface loading and dosing scheme on the skin uptake of fragrances

This study compared the skin uptake of γ-undecalactone, decanol, and dodecyl acetate in an in vitro, un-occluded penetration assay in which they were applied to porcine skin at different finite loadings and application schemes. The pattern of fractional uptake differed between the chemicals and did not show the often assumed inverse correlation with surface loading. Furthermore, the mass uptake of identical cumulative amounts of the chemicals was not always additive. These results show that the uptake of fragrances in absence of occlusion and at finite loadings is chemical-specific and depends on the surface loading, the application scheme, and most probably, on the effects of the chemicals on the skin barrier efficiency. The observed lack of additivity might explain some of the differences in the responses observed in patch and repeated open application tests, and the boosting of the allergic state in sensitized individuals by sub-clinical exposures.

Spatial and temporal RF electromagnetic field exposure of children and adults in indoor micro environments in Belgium and Greece

Personal radio frequency electromagnetic field (RF-EMF) exposure, or exposimetry, is gaining importance in the bioelectromagnetics community but only limited data on personal exposure is available in indoor areas, namely schools, crèches, homes, and offices. Most studies are focused on adult exposure, whereas indoor microenvironments, where children are exposed, are usually not considered. A method to assess spatial and temporal indoor exposure of children and adults is proposed without involving the subjects themselves. Moreover, maximal possible daily exposure is estimated by combining instantaneous spatial and temporal exposure. In Belgium and Greece, the exposure is measured at 153 positions spread over 55 indoor microenvironments with spectral equipment. In addition, personal exposimeters (measuring EMFs of people during their daily activities) captured the temporal exposure variations during several days up to one week at 98 positions. The data were analyzed using the robust regression on order statistics (ROS) method to account for data below the detection limit. All instantaneous and maximal exposures satisfied international exposure limits and were of the same order of magnitude in Greece and Belgium. Mobile telecommunications and radio broadcasting (FM) were most present. In Belgium, digital cordless phone (DECT) exposure was present for at least 75% in the indoor microenvironments except for schools. Temporal variations of the exposure were mainly due to variations of mobile telecommunication signals. The exposure was higher during daytime than at night due to the increased voice and data traffic on the networks. Total exposure varied the most in Belgian crèches (39.3%) and Greek homes (58.2%).

Motor recovery of the ipsilesional upper limb in subacute stroke

OBJECTIVE

To investigate the time-related changes in motor performance of the ipsilesional upper limb in subacute poststroke patients by using clinical and kinematic assessments.

DESIGN

Observational, longitudinal, prospective, monocentric study.

SETTING

Physical medicine and rehabilitation department.

PARTICIPANTS

Stroke patients (n=19; mean age, 62.9y) were included less than 30 days after a first unilateral ischemic/hemorrhagic stroke. The control group was composed of age-matched, healthy volunteers (n=9; mean age, 63.1y).

INTERVENTIONS

Clinical and kinematic assessments were conducted once a week during 6 weeks and 3 months after inclusion. Clinical measures consisted of Fugl-Meyer Assessment, Box and Block Test (BBT), Nine-Hole Peg Test (9HPT), and Barthel Index. We used a 3-dimensional motion recording system during a reach-to-grasp task to analyze movement smoothness, movement time, and peak velocity of the hand. Healthy controls performed both clinical (BBT and 9HPT) and kinematic evaluation within a single session.

MAIN OUTCOME MEASURES

BBT and 9HPT.

RESULTS

Recovery of ipsilesional upper arm capacities increased over time and leveled off after a 6-week period of rehabilitation, corresponding to 9 weeks poststroke. At study discharge, patients demonstrated similar ipsilesional clinical scores to controls but exhibited less smooth reaching movements. We found no effect of the hemispheric side of the lesion on ipsilesional motor deficits.

CONCLUSIONS

Our findings provide evidence that ipsilesional motor capacities remain impaired at least 3 months after stroke, even if clinical tests fail to detect the impairment. Focusing on this lasting ipsilesional impairment through a more detailed kinematic analysis could be of interest to understand the specific neural network underlying ipsilesional upper-limb impairment.

Epidemiological and phylogenetic analysis of institutional mouse parvoviruses

Mouse parvoviruses (MPVs) are small, single-stranded, 5 kb DNA viruses that are subclinical and endemic in many laboratory mouse colonies. MPVs cause more distinctive deleterious effects in immune-compromised or genetically-engineered mice than immuno-competent mice. At the University of Louisville (U of L), there was an unexpected increase of MPV sero-positivity for MPV infections in mouse colonies between January 2006 and February 2007, resulting in strategic husbandry changes aimed at controlling MPV spread throughout the animal facility. To investigate these MPVs, VP2 genes of seven MPVs were cloned and sequenced from eight documented incidences by PCR technology. The mutations in these VP2 genes were compared to those found at the Genbank database (NCBI; http://www.ncbi.nlm.nih.gov) and an intra-institutional phylogenetic tree for MPV infections at U of L was constructed. We discovered that the seven MPV isolates were different from those in Genbank and were not identical to each other. These MPVs were designated MPV-UL1 to 7; none of them were minute virus of mice (MVMs). Four isolates could be classified as MPV1, one was classified as MPV2, and two were defined as novel types with less than 96% and 94% homology with existing MPV types. Considering that all seven isolates had mutations in their VP2 genes and no mutations were observed in VP2 genes of MPV during a four-month time period of incubation, we concluded that all seven MPVs isolated at U of L between 2006 and 2007 probably originated from different sources. Serological survey for MPV infections verified that each MPV outbreak was controlled without further contamination within the institution.

Individualized vitamin A supplementation for patients with cystic fibrosis

BACKGROUND & AIMS

To determine the vitamin A status and appropriate supplementation dosage of cystic fibrosis (CF) patients who received vitamin A supplementation based on annual serum retinol measurements.

METHODS

Vitamin A food intake, supplementation dosage, and serum retinol levels were obtained for 32 CF patients >4 years of age (4.3-27.3 years old) who had pancreatic insufficiency and mild-to-moderate lung disease (percent predicted of forced expiratory volume in 1 s > 40%). These measurements were compared with the dietary reference intake for healthy children and adults (D-A-CH dietary recommendations), US and German CF recommendations, and serum retinol concentrations from National Health and Nutrition Examination Survey (NHANES) data.

RESULTS

Total vitamin A intake from food and supplementation was 315% ± 182% of D-A-CH recommendations, with 65% from supplements. The range of the prescribed vitamin A supplementation dosage was 0-20,000 IU/day (median 5500 IU), and it was consistent with CF recommendations in 28% of participants. A quarter of all patients did not need any vitamin A supplementation. The total vitamin A intake exceeded the recommended upper limit of intake in 69% of subjects. The mean (range) serum retinol was 38.6 μg/dl (22.1-59.1 μg/dl). All subjects had serum retinol levels above 20 μg/dl and below 72 μg/dl (95th percentile of NHANES reference range).

CONCLUSION

Individualized vitamin A supplementation of 0-20,000 IU/day based on annual serum retinol measurements may prevent deficiency and high serum retinol levels, but it may lead to vitamin A intake above the tolerable upper intake level.