Dietary exposure to lead, cadmium, mercury and radionuclides of an adult urban population in Lebanon: a total diet study approach

Detection and measurement of radioactive substances in water and food: a narrative review

Contamination of food and water with radioactive substances is a serious health problem. There are several methods to detect and measure radioactive materials, some of which have been developed in recent years. This paper aims to discuss the methods of detecting and measuring radioactive substances in food and water. The principles and the advantages and disadvantages of each method have been discussed. The results showed that some of these methods, such as spectrometry γ-ray high-purity germanium, portable radon gas surveyor SILENA, RAD7, and inductively coupled plasma mass spectrometry, have a higher sensitivity for detection and measurement. The spectrometry γ-ray high-purity germanium method has attracted more attention than other methods because it can measure a wide range of radionuclides with high resolution.

Multi-matrix biomonitoring approach to assess exposure to metals and trace elements in the Lebanese population and associations with drinking water consumption

This study is the first attempt to assess exposure to metals and trace elements in subgroups of the Lebanese population using a multi-matrix biomonitoring approach. Concentrations of 11 metals and trace elements (aluminum (Al), arsenic (As), cadmium (Cd), chromium (Cr), copper (Cu), iron (Fe), lead (Pb), manganese (Mn), selenium (Se), uranium (U), zinc (Zn)) were measured in urine, hair and toenails. Biological levels were compared according to age, sex, smoking status, socioeconomic status, geographical area and drinking water source. While most urinary and toenail concentrations of metals and trace elements were not different between males and females, measured concentrations of several elements in hair were higher in females compared to males. Urinary concentrations of some metals (Al, Cu, Se and Zn) were higher in children compared to teenagers and adults. Hair and toenail concentrations of several elements (As, Cd, Pb, Mn, Se in hair and toenails plus Al, Fe in toenails) were also significantly higher in children compared to teenagers and/or adults. Smoking status had no influence on metal and trace element concentrations. Levels of Cd, Pb and Mn were also higher in samples from subgroups with lower economic status (Cd and Pb in the three matrices and Mn in hair and toenails). Very few correlations were identified between sources of drinking water and urine, hair, and toenail concentrations of metals and trace elements. However, a correlation was observed between hair and toenails levels of As, Cd and Pb. Overall, results highlight that a special attention should be given to metal and trace element exposure in this population (including Pb, As, Cd, Mn, and Se). It could be relevant to scale up this kind of investigation with a large human biomonitoring initiative in the Lebanese population in order to generalize results, and assess trends over time.

History of injury in a developing country: a scoping review of injury literature in Lebanon

BACKGROUND

Lebanon, an Eastern Mediterranean country, suffers a large burden of injury as a consequence of conflict and war, political instability, and the lack of policies and safety regulations. This article aims to systematically map and comprehensively describe the injury research literature in Lebanon and, to identify gaps for future research.

METHODS

MEDLINE, Embase, Eric and SafetyLit, and the grey literature, including conference proceedings, theses and dissertations, government and media reports, were searched without any date or language limits. Data were extracted from 467 documents using REDCap.

RESULTS

War-related injuries were the most prevalent type of injury in Lebanon, followed by homicide and other forms of violence. While existing literature targeted vulnerable and at-risk populations, the vast majority focused solely on reporting the prevalence of injuries and associated risk factors. There are considerable gaps in the literature dealing with the integration of preventive programs and interventions across all populations.

CONCLUSIONS

Lebanon, historically and currently, experiences a high number of injuries from many different external causes. To date, efforts have focused on reporting the prevalence of injuries and making recommendations, rather than implementing and evaluating interventions and programs to inform policies. Future injury related work should prioritize interventions and prevention programs.

Lead in Brazilian food: Exposure assessment and risk characterization

A risk assessment was performed to estimate the lead (Pb) dietary intake in the Brazilian population. Data on Pb concentration in food were obtained through a systematic review with meta-analyses and from the GEMS/Food database, both involving data through 2018. Food consumption data were obtained from a Brazilian official dietary survey. Pb dietary intakes were estimated by a deterministic approach. Risk characterisation was conducted using the margin of exposure approach (MOE). The total Pb intake in the Brazilian population ranged from 1.53 to 2.01 μg/kg bw/day. Major contributors to Pb dietary exposure were the vegetable and vegetable products and beverage categories. From the results obtained, a risk of increased systolic pressure, nephrotoxicity and decrease of 0.5 point intelligence quotient can be expected, MOE<1, with greater magnitudes of risk observed for men in rural areas and in the Midwest, Southeast and South Brazilian regions. The dietary risk assessment indicates a health concern for the Brazilian population associated with Pb dietary intake.

Total Diet Study to Assess Radioactive Cs and 40K Levels in the Japanese Population before and after the Fukushima Daiichi Nuclear Power Plant Accident

We conducted a total diet study (TDS) of ¹³⁷Cs, ¹³⁴Cs, and ⁴⁰K to assess their average dietary exposure levels in a Japanese adult population before and after the Fukushima Daiichi nuclear power plant (FDNPP) accident. Nineteen market baskets were evaluated in 2006–2011. In each basket, a TDS sample comprising tap water and 160–170 food items, which were combined into 13 groups, were collected for analysis by gamma-ray spectrometry. From 2006 to 2010, the ¹³⁷Cs activity concentration in the “fish and shellfish” group was 0.099 Bq/kg, representing the highest value obtained, whereas the total committed effective dose (CED) of radiocesium isotopes (¹³⁷Cs + ¹³⁴Cs) was 0.69 μSv. In 2011, “milk and dairy products” from Sendai City had a Cs activity concentration of 12 Bq/kg, representing the highest values among all food groups studied. However, the annual CED of radioactive Cs in Fukushima City was 17 μSv after the FDNPP accident, which is 60-fold lower than the maximum permissible dose of 1 mSv/year. The mean CED obtained for ⁴⁰K was 180 μSv, which is comparable to the global average. Our results reveal the average dietary exposure of ¹³⁷Cs, ¹³⁴Cs, and ⁴⁰K, which can aid in estimating the radiological safety of foods.

Dietary Intakes of Zinc, Copper, Magnesium, Calcium, Phosphorus, and Sodium by the General Adult Population Aged 20-50 Years in Shiraz, Iran: A Total Diet Study Approach

In the present total diet study, the dietary intake of zinc (Zn), copper (Cu), magnesium (Mg), calcium (Ca), phosphorus (P), and sodium (Na) by healthy adults in Shiraz, Iran, was estimated from the foods as consumed. A total of 580 individual food items were collected, prepared, and pooled into 129 composite samples. The metal concentration was then evaluated using inductively coupled plasma–optical emission spectrometry. The mean intakes of Zn (12.92 mg/d), Cu (3.80 mg/d), and Mg (412.68 mg/d) exceeded the estimated average requirements (EARs), but they were well below the upper limits. A high prevalence of inadequate intake was observed for Ca (91.6%) and P (89.7%), which was mainly due to nutritionally imbalanced diets. Sodium intake for average and high consumers (97.5th percentile) was 123.6% and 237.8% of the tolerable upper intake level of 2300 mg/d, respectively, with 70% of the participants having intakes higher than this threshold value. Nutrition education, nutritional rehabilitation, Ca supplementation, food fortification, mandatory reduction of salt content in processed foods, and discretionary salt use (in home cooking or at the table) are among the possible strategies that can be adopted to combat the health problems.

Lead exposure in an Italian population: Food content, dietary intake and risk assessment

BACKGROUND AND AIM

Lead is a highly toxic heavy metal released into the environment after natural and anthropogenic activities. Excluding populations in occupations where there is possible lead contamination, food is the major source of human exposure. In this study, we determined lead contamination in food and beverages consumed in a Northern Italy community and performed a health risk assessment.

METHODS

We collected a total of 908 food samples and measured lead levels using inductively coupled plasma mass spectrometry. Using a validated food frequency questionnaire, we assessed the dietary habits and estimated daily lead dietary intakes in a sample of 719 adult individuals. We performed risk assessment using a benchmark dose and margin of exposure approach, based on exposure levels for both adverse effect of systolic blood pressure and chronic kidney disease.

RESULTS

Foods with the highest lead levels include non-chocolate confectionery (48.7 µg/kg), leafy (39.0 µg/kg) and other vegetables (42.2 µg/kg), and crustaceans and molluscs (39.0 µg/kg). The estimated mean lead intake was 0.155 µg/kg bw-day in all subjects, with little lower intakes in men (0.151 µg/kg bw-day) compared to women (0.157 µg/kg bw-day). Top food contributors were vegetables, cereals, and beverages, particularly wine. In relation to risk assessment, the estimated dietary intake was lower than levels associated with cardiovascular risk and nephrotoxicity.

CONCLUSIONS

Our study provides an updated assessment of lead food contamination and dietary exposure in a Northern Italian community. The margin of exposure risk assessment approach suggests that risk of detrimental effects due to dietary lead intake is low in the investigated population. Nonetheless, these exposure levels for adverse effects are not reference health standards, and no safety threshold value can be established for lead. As a consequence, other and more subtle adverse effects may still occur in vulnerable and occupationally exposed individuals, particularly in relation to the nervous system.

Global burden of intellectual disability resulting from dietary exposure to lead, 2015

Lead is a ubiquitous dietary contaminant that occurs in food because of natural and anthropogenic sources and pathways of exposure. Lead adversely affects a number of tissues and organ systems and the severity of effect on each is dependent on the level and duration of exposure. The most sensitive and notable effects are those that occur on the nervous system. This is particularly the case in the exposure to the fetus, infant and child. Infants and children generally have higher lead exposures on a body weight basis. While lead exposure can come from many sources, a major source of exposure for at least some individuals comes from food. Estimates for the impact of dietary lead on IQ were developed from published total diet studies. While most of these were designed to characterize intake of chemical contaminants on a national basis, some sampled market baskets from a single city. To develop global estimates, default ranges were created for countries with no data which encompassed the values encountered elsewhere. Blood lead levels and IQ decrements were estimated using functions previously developed by the WHO Joint Expert Committee for Food Additives. Since both the exposure and dose response components were variable and uncertain, a two dimensional Monte-Carlo simulation was used to develop the estimates for the impact of dietary lead on IQ. In addition to estimating blood lead and IQ decrements attributable to dietary lead from those countries with published market basket data, simulations were also run for WHO regions that sampled in the variability dimension based on the population size of the individual countries in each region. Dietary exposure to lead occurs throughout the world. The global average IQ decrement attributable to dietary lead was 1.1. The total number of Disability-Adjusted Life Years (DALYs) arising from those IQ decrements were estimated to be 5.2 million DALYs, with an uncertainty range of 0-31 million DALYs. Significant uncertainties regarding exposure and dose-response relationships, however, warrant continued investigation.

Cobalt toxicity in humans-A review of the potential sources and systemic health effects

Cobalt (Co) and its compounds are widely distributed in nature and are part of numerous anthropogenic activities. Although cobalt has a biologically necessary role as metal constituent of vitamin B₁₂, excessive exposure has been shown to induce various adverse health effects. This review provides an extended overview of the possible Co sources and related intake routes, the detection and quantification methods for Co intake and the interpretation thereof, and the reported health effects. The Co sources were allocated to four exposure settings: occupational, environmental, dietary and medical exposure. Oral intake of Co supplements and internal exposure through metal-on-metal (MoM) hip implants deliver the highest systemic Co concentrations. The systemic health effects are characterized by a complex clinical syndrome, mainly including neurological (e.g. hearing and visual impairment), cardiovascular and endocrine deficits. Recently, a biokinetic model has been proposed to characterize the dose-response relationship and effects of chronic exposure. According to the model, health effects are unlikely to occur at blood Co concentrations under 300μg/l (100μg/l respecting a safety factor of 3) in healthy individuals, hematological and endocrine dysfunctions are the primary health endpoints, and chronic exposure to acceptable doses is not expected to pose considerable health hazards. However, toxic reactions at lower doses have been described in several cases of malfunctioning MoM hip implants, which may be explained by certain underlying pathologies that increase the individual susceptibility for Co-induced systemic toxicity. This may be associated with a decrease in Co bound to serum proteins and an increase in free ionic Co²⁺. As the latter is believed to be the primary toxic form, monitoring of the free fraction of Co²⁺ might be advisable for future risk assessment. Furthermore, future research should focus on longitudinal studies in the clinical setting of MoM hip implant patients to further elucidate the dose-response discrepancies.

Determination of mycotoxins in biscuits, dried fruits and fruit jams: an assessment of human exposure

A reliable, fast and simple method using UHPLC-MS/MS was developed for the determination of aflatoxins B₁ (AFB1), G₁ (AFG1), B₂ (AFB2) and G₂ (AFG2), ochratoxin A (OTA), deoxynivalenol (DON), zearalenone (ZEA), HT-2 toxin and T-2 toxin in crude extracts of biscuits with fruit filling, cookies, dried fruits and fruit jams. The method was successfully demonstrated on 39 samples of biscuits with fruit filling, 34 cookies, 14 dried fruits and 10 fruit jams. The mycotoxins detected in biscuits samples were ZEA, OTA, T-2 and AFB1 with an average concentrations of positive samples of 2.64, 4.10, 8.13 and 1.32 µg kg^-1, respectively; while the mycotoxins detected in jam samples were AFB1, OTA, T-2 and AFB2 with an average concentrations of positive samples of 2.00, 17.7, 4.37 and 1.15 µg kg^-1, respectively. The results showed that the majority of samples were in compliance with relevant regulations. However in eight samples of biscuits and three samples of fig jam the contents of OTA were higher than the existing OTA limits. The combined dietary exposure of selected mycotoxins was estimated for the first time for children, adolescents and adults. The estimated combined dietary exposures were all lower than the proposed value assumed to predict a possible risk scenario.

Dietary exposure to pesticide residues from foods of plant origin and drinks in Lebanon

This study assesses the dietary exposure of Lebanese adults to 47 pesticide residues from both foods of plant origin and drinks. The study was conducted using the Total Diet Study protocol in two different areas of Lebanon: Greater Beirut (urban) and Keserwan (semi-rural). A total of 1860 individual foods were collected, prepared, and cooked prior to analysis. Composite samples of similar foods were analyzed, following the QuEChERS Multiresidue method. Eighteen residues were detected/quantified on at least one composite sample, with 66.7 % of the results being quantifiable and 33.3 % detectable. Quantifiable levels ranged between 10.3 and 208 μg/kg. For the composite samples where residues were detected, 55 % had one residue, while 45 % had 2-4 residues. The most frequently detected/quantified pesticide residues included Chlorpyrifos, Procymidone, Primiphos methyl, Dimethoate, and Dieldrin. The dietary exposure assessment was conducted using the deterministic approach with two scenarios: (1) the lower bound (LB) approach and (2) the upper bound (UB) approach. Using the LB approach, mean estimated daily exposures were far below the acceptable daily intakes (ADIs) for all investigated residues. Using the UB approach, which tends to overestimate exposure, mean estimated daily exposures were below the ADIs for all residues except for Dieldrin (semi-rural: 128.7 % ADI; urban: 100.7 % ADI). Estimates of mean exposure to Diazinon reached 50.3 % of ADI in the urban diet and 61.9 % in the semi-rural diet. Findings of this study identify specific pesticide residues as monitoring priorities for which more comprehensive and sensitive analyses are needed in order to refine exposure assessment.

Daily dietary intakes of zinc, copper, lead, and cadmium as determined by duplicate portion sampling combined with either instrumental analysis or the use of food composition tables, Shiraz, Iran

Estimation of essential and toxic element intakes is crucial to evaluate the risks of deficiency or toxicity. The purpose of this study was to investigate and also to compare the dietary intakes of zinc (Zn) and copper (Cu) by adults living in Shiraz, Iran, determined by two procedures: duplicate portion sampling of 21 hospital meals combined with either instrumental analysis (voltammetric measurement) or the use of food composition tables (FCTs). The level of exposure to lead (Pb) and cadmium (Cd) was evaluated as well. The daily Zn intakes of both methods were not significantly different and were higher than the RDA values except the value measured by the instrumental analysis which was lower than the RDA established for a male adult. Daily intake of Cu determined by instrumental analysis was significantly lower and closer to RDA for adults compared with the value estimated by FCTs. The dietary intakes of Pb and Cd were 313 and 61% of the respective provisional tolerable weekly intakes (PTWIs), respectively. The accuracy of two methods used for estimation of Zn intake was similar. In the case of Cu, the use of FCTs, in which the influence of environmental conditions and dietary habits of meal preparation is not taken into account, overestimated dietary intake. The risk of zinc deficiency was found in adult males. Moreover, the estimated intake of Pb, but not Cd, could be a cause of concern for Shiraz population. Thus, conducting regular periodic studies to assess the dietary intake of mentioned elements are recommended.

Dietary exposure and health risk assessment for 14 toxic and essential trace elements in Yaoundé: the Cameroonian total diet study

Dietary exposure to trace elements (aluminium, antimony, barium, cadmium, lead, nickel, vanadium, copper, manganese, molybdenum, germanium, lithium, strontium and tellurium) was assessed by the total diet study (TDS) method. Sixty-four pooled samples representing 96.5% of the diet in Yaoundé, Cameroon, were prepared "as consumed" before analysis. Consumption data were sourced from a households' budget survey. Dietary exposures were compared with health-based guidance or nutritional values and to worldwide TDS results. The health-based guidance value was exceeded by ≤ 0.2% of the study population for aluminium, antimony, barium, cadmium, nickel and vanadium. For lead, the observed 95th percentile of exposure (3.05 µg kg(-1) body weight day(-1)) equals the critical value considered by JECFA for cardiovascular effects; therefore, risk to health cannot be excluded for certain consumer groups. The population at risk of excess intake for manganese, copper, molybdenum and nickel was considered to be low (≤ 0.3%). The prevalence of inadequate intake was estimated at 5.9% for copper and was nil for molybdenum. Due to the lack of toxicological and/or nutritional consistent data to perform a risk assessment, dietary exposures to germanium, lithium, strontium and tellurium were provided as supplementary data. The food groups highest contributors to exposure were "tubers and starches" for aluminium (27%), lead (39%) and copper (26%), "cereals and cereal products" for cadmium (54%) and manganese (35%), "fruits, vegetables and oilseeds" for barium (34%), molybdenum (49%) and nickel (31%), "beverages" for antimony (27%) and "fish" for vanadium (43% - lower bound). Measures should be recommended to maintain low levels of exposure before the problem could become an important health or trade issue.

Dietary exposure estimates of twenty-one trace elements from a Total Diet Study carried out in Pavia, Northern Italy

The significant role of trace elements in human health is well documented. Trace elements are those compounds that need to be present in the human diet to maintain normal physiological functions. However, some microelements may become harmful at high levels of exposure, or, on the other hand, may give rise to malnutrition, when their exposure is too low. The aim of the present study was to provide a reliable estimate of the dietary exposure of twenty-one trace elements in a Northern Italian area. For this purpose, trace element analyses were undertaken on total diet samples collected from a university cafeteria in Pavia, Northern Italy. The average daily exposure for the adult people was calculated on the basis of food consumption frequency, portion size and trace element levels in foodstuffs. The mean exposure values satisfy the Italian RDA for all the essential trace elements, except for Fe exposure in females, and are well below the Provisional Tolerable Daily Intake for all the toxic compounds, showing that the probability of dietary exposure to health risks is overall small. As far as Fe exposure is concerned, a potential risk of anaemia in the female adult population should be considered, then studies aimed at evaluating the Fe nutritional status of adult Italian women should be addressed. In conclusion, while not excluding the possibility that the daily exposure determined in the present study may not be representative of the population as a whole, this study provides a good estimate of the Italian adult consumer exposure to twenty-one trace elements.

Dietary exposure to pesticide residues in Yaoundé: the Cameroonian total diet study

Dietary exposure to pesticide residues was assessed in Yaoundé, Cameroon, using the total diet study (TDS) method. Sixty-three composite samples, representative of the foods as consumed in Yaoundé, were collected, prepared, and analysed for residues of pesticides including organochlorine, organophosphorous, and pyrethroids. A multi-residue method was used with a limit of detection (LOD) of 0.005 mg kg(-1). Additional analyses were performed for dithiocarbamates (LOD=0.050 mg kg(-1)), glyphosate (LOD=0.005 mg kg(-1)) and chlordecone (LOD=0.0008 mg kg(-1)) on certain composites samples. The overall contamination was low with 37 out of 46 pesticides below the LOD in all samples. The estimated upper bound (for values less than the LOD equal the LOD; and values less than the LOQ equal the LOQ) of the mean dietary exposures ranged from 0.24% (cypermethrin) to 3.03% (pirimiphos-methyl) of the acceptable daily intakes (ADIs) for pesticides for which at least one analysis was greater than the LOD. This study suggests a low dietary exposure to pesticide residues in Yaoundé.

Are more restrictive food cadmium standards justifiable health safety measures or opportunistic barriers to trade? An answer from economics and public health

In the past, Cd regulations have imposed trade restrictions on foodstuffs from some developing countries seeking to access markets in the developed world and in recent years, there has been a trend towards imposing more rigorous standards. This trend seems to respond more to public and private sectors strategies in some developed countries to create disguised barriers to trade and to improve market competitiveness for their industries, than to scientifically justified health precautions (sanitary and phytosanitary measures) and/or technical barriers to trade acceptable under the Uruguay Round Agreement of the WTO. Applying more rigorous Cd standards in some developed countries will not only increase production costs in developing countries but it will also have a large impact on their economies highly dependent on international agricultural markets. In the current literature there are large uncertainties in the cause-effect relationship between current levels of Cd intakes and eventual health effects in human beings; even the risk of Cd to kidney function is under considerable debate. Recent works on the importance of zinc:Cd ratio rather than Cd levels alone to determine Cd risk factors, on the one hand, and on the declining trends of Cd level in foods and soils, on the other, also indicate a lack of scientific evidence justifying more restrictive cadmium standards. This shows that developing countries should fight for changing and making more transparent the current international structures and procedures for setting sanitary and phytosanitary measures and technical barriers to trade.