Biomonitoring of mercury and selenium in commercially important shellfish: Distribution pattern, health benefit assessment and consumption advisories

This study aims to explore the concentrations of Se and Hg in shellfish along the Gulf of Mannar (GoM) coast (Southeast India) and to estimate related risks and risk-based consumption limits for children, pregnant women, and adults. Se concentrations in shrimp, crab, and cephalopods ranged from 0.256 to 0.275 mg kg-1, 0.182 to 0.553 mg kg-1, and 0.176 to 0.255 mg kg-1, respectively, whereas Hg concentrations differed from 0.009 to 0.014 mg kg-1, 0.022 to 0.042 mg kg-1 and 0.011 to 0.024 mg kg-1, respectively. Se and Hg content in bamboo shark (C. griseum) was 0.242 mg kg-1 and 0.082 mg kg-1, respectively. The lowest and highest Se concentrations were found in C. indicus (0.176 mg kg-1) and C. natator (0.553 mg kg-1), while Hg was found high in C. griseum (0.082 mg kg-1) and low in P. vannamei (0.009 mg kg-1). Se shellfishes were found in the following order: crabs > shrimp > shark > cephalopods, while that of Hg were shark > crabs > cephalopods > shrimp. Se in shellfish was negatively correlated with trophic level (TL) and size (length and weight), whereas Hg was positively correlated with TL and size. Hg concentrations in shellfish were below the maximum residual limits (MRL) of 0.5 mg kg-1 for crustaceans and cephalopods set by FSSAI, 0.5 mg kg-1 for crustaceans and 1.0 mg kg-1 for cephalopods and sharks prescribed by the European Commission (EC/1881/2006). Se risk-benefit analysis, the AI (actual intake):RDI (recommended daily intake) ratio was > 100%, and the AI:UL (upper limit) ratio was < 100%, indicating that all shellfish have sufficient level of Se to meet daily requirements without exceeding the upper limit (UL). The target hazard quotient (THQ < 1) and hazard index (HI < 1) imply that the consumption of shellfish has no non-carcinogenic health impacts for all age groups. However, despite variations among the examined shellfish, it was consistently observed that they all exhibited a Se:Hg molar ratio > 1. This finding implies that the consumption of shellfish is generally safe in terms of Hg content. The health benefit indexes, Se-HBV and HBVse, consistently showed high positive values across all shellfish, further supporting the protective influence of Se against Hg toxicity and reinforcing the overall safety of shellfish consumption. Enhancing comprehension of food safety analysis, it is crucial to recognize that the elevated Se:Hg ratio in shellfish may be attributed to regular selenoprotein synthesis and the mitigation of Hg toxicity by substituting Se bound to Hg.

Risk assessment of nutrients: There must be a threshold for their effects

Nutrients serve physiological functions in a dose-dependent manner and that needs to be recognized in risk assessment. An example of the consequences of not properly considering this can be seen in a recent assessment by the European Food Safety Authority (EFSA). EFSA concluded in 2022 that the intake of added and free sugars should be "as low as possible in the context of a nutritionally adequate diet". That conclusion of EFSA is based on the effects on two surrogate endpoints for an adverse effect found in randomized controlled trials with high sugars intake levels: fasting glucose and fasting triglycerides. The lowest intake levels in these trials were around 10 energy% and at this intake level there were no adverse effects on the two outcomes. This indicates that the adverse effects of sugars have an observable threshold value for these two endpoints. The most appropriate interpretation from the vast amount of data is that currently no definitive conclusion can be drawn on the tolerable upper intake level for dietary sugars. Therefore, EFSA's own guidance would lead to the conclusion that the available data do not allow the setting of an upper limit for added sugars and hence, that more robust data are required to identify the threshold value for intake of sugars.

Cannabidiol safety considerations: Development of a potential acceptable daily intake value and recommended upper intake limits for dietary supplement use

Consumer use of hemp-derived products continues to rise, underscoring the need to establish evidence-based safety guidance. The present study sought to develop recommendations for oral upper intake limits of cannabidiol (CBD) isolate. Sufficiently robust and reliable data for this purpose were identified from published human clinical trials and guideline-compliant toxicity studies in animal models. Based on the metrics used in this assessment, a potential Acceptable Daily Intake (ADI) value of 0.43 mg/kg-bw/d (e.g., 30 mg/d for 70-kg adult) was determined for the general population based on liver effects in human studies. This value applies to the most sensitive subpopulations, including children, over a lifetime of exposure and from all sources, including food. For dietary supplements with adequate product labeling intended for use by healthy adults only, a potential Upper Intake Limit (UL) of 70 mg/d was determined based on reproductive effects in animals. For healthy adults, except those trying to conceive, or currently pregnant or lactating, a conservative dietary supplement UL of 100 mg/d was identified based on liver effects; however, as the target population excludes individuals at risk for liver injury, an alternative dietary supplement UL of 160 mg/d for this population can also be considered.

Clinical relevance of joint line obliquity after high tibial osteotomy for medial knee osteoarthritis remains controversial: a systematic review

PURPOSE

To systematically review the literature on the association between knee joint line obliquity (KJLO) and clinical outcome after high tibial osteotomy (HTO) for medial knee osteoarthritis and summarize the KJLO cut-off value used when studying this association.

METHODS

A systematic search was conducted in three databases (PubMed, Embase, and Web of Science) on September 2022, updated on February 2023. Eligible studies describing postoperative KJLO in relation to clinical outcome after HTO for medial knee osteoarthritis were included. Nonpatient studies and conference abstracts without full-text were excluded. Two independent reviewers assessed title, abstract and full-text based on the inclusion and exclusion criteria. The modified Downs and Black checklist was used to assess the methodological quality of each included study.

RESULTS

Of the seventeen studies included, three had good methodological quality, thirteen fair quality, and one had poor quality. Conflicting findings were shown on the associations between postoperative KJLO and patient-reported outcome, medial knee cartilage regeneration, and 10-year surgical survival in sixteen studies. Three good-quality studies found no significant differences in lateral knee cartilage degeneration between postoperative medial proximal tibial angle > 95° and < 95°. Joint line orientation angles by the tibial plateau of 4° and 6°, joint line orientation angle by the middle knee joint space of 5°, medial proximal tibial angles of 95° and 98°, and Mikulicz joint line angle of 94° were KJLO cut-off values used in the included studies.

CONCLUSION

Based on current evidence, the actual association between postoperative KJLO and clinical consequences after HTO for medial knee osteoarthritis cannot be ascertained. The clinical relevance of KJLO after HTO remains controversial.

LEVEL OF EVIDENCE

IV.