Critical comparison of BMD and TD50 methods for the calculation of acceptable intakes for N-nitroso compounds

The tumorigenic dose 50 (TD50) is a widely used measure of carcinogenic potency which has historically been used to determine acceptable intake limits for carcinogenic compounds. Although broadly used, the TD50 model was not designed to account for important biological factors such as DNA repair and cell compensatory mechanisms, changes in absorption, etc., leading to the development of benchmark dose (BMD) approaches, which use more flexible dose-response models that are better able to account for these processes. Using a nitrosamine dataset as a case study, we compare the impact of moving to a BMD-based limit as opposed to a TD50-based limit. Although there are differences in individual potency estimates between the two approaches for some compounds, we show that the key metrics such as the 5th percentile of the respective potency distributions, used when calculating class-specific default acceptable intakes, are not greatly affected. Furthermore, potency estimates for nitrosamine compounds relevant to read-across do not vary by more than a factor of 3, which is little in the context of the inherent variability in a biological response, in an overall landscape wherein potencies can vary by four orders of magnitude. This suggests a move to BMD-based limits is achievable without significant disruption to existing limits while utilising a more robust methodology.

Dietary intake and risk assessment of nitrosamine in processed meat products among medical staff during their night shift

The study aims to evaluate the levels of nitrosamine, a known carcinogenic compound, in processed meat products and to assess its dietary intake and margin of exposure among medical staff, including physicians, pharmacists, and nurses working night shifts at Alexandria University Hospitals. Additionally, the study seeks to evaluate the participants' knowledge of dietary sources and regulatory limits of carcinogens. A cross-sectional study was conducted with 420 participants. Results showed that hotdogs contained the highest nitrosamine levels (159.24 ± 87.99 µg/g) with a consumption pattern of 0.02126 µg/kg BW/day. In contrast, sausages and burgers had the lowest nitrosamine content (2.36 µg/g and 2.37 µg/g, respectively). Luncheon meat also exhibited low nitrosamine levels and consumption patterns, at 18.53 µg/g and 0.00141 µg/kg BW/day, respectively. The Margin of Exposure (MOE) was calculated to assess risk, with a Benchmark Dose Lower Confidence Limit (BMDL)10 value of 29 µg/kg BW/day as the reference point. MOE values ≥ 17,000, derived for nitrosamine exposure in this study, indicate a low level of concern for carcinogenic risk. A statistically significant difference in dietary nitrosamine intake was observed across different professions among the medical staff (p < 0.001).

Volatile N-nitrosamines in processed meat products: An approach for monitoring dietary exposure, assessing human risk, and evaluating variable correlations by principal component analysis and heat map

Several epidemiological studies have reported a positive association between the consumption of processed meats containing N-nitrosamines (NAs) and the incidence of hepatocellular and colon cancer. The health risk assessment in this investigation was based on the concentration of six volatile N-nitrosamines (VNAs) (N-nitrosodimethylamine, N-nitrosodiethylamine, N-nitrosomethylethylamine, N-nitrosopiperidine, N-nitrosodibutylamine, and N-nitrosodi-n-propylamine) found in processed meat products (sausage and kielbasa) in the Iranian market. Direct supported liquid membrane two-phase hollow fiber electromembrane extraction coupled to gas chromatography/mass spectrometry was used to analyse six VNAs. The mean concentration of the six VNAs in sausages and kielbasa was 38.677 ± 27.56 and 48.383 ± 35.76 μg/kg, respectively. The 95th percentile for the chronic daily intake of total VNAs for children (3-14 years) and adults (15-70 years) were calculated to be 5.06 × 10-4 and 1.09 × 10-4 mg/kg bw/day, respectively. The cancer risk assessment showed that the risk associated with NDEA was the highest among the other VNAs studied in Iranian processed meat, with a 95th percentile for the child and adult groups. Based on an incremental lifetime cancer risk (ILCR) value of ≤10-4 for the carcinogenic effects of exposure to a total of six VNAs, it indicates low concern for all age groups.

Risk characterization of N-nitrosodimethylamine in pharmaceuticals

Since 2018, N-nitrosodimethylamine (NDMA) has been a reported contaminant in numerous pharmaceutical products. To guide the pharmaceutical industry, FDA identified an acceptable intake (AI) of 96 ng/day NDMA. The approach assumed a linear extrapolation from the Carcinogenic Potency Database (CPDB) harmonic-mean TD50 identified in chronic studies in rats. Although NDMA has been thought to act as a mutagenic carcinogen in experimental animals, it has not been classified as a known human carcinogen by any regulatory agency. Humans are exposed to high daily exogenous and endogenous doses of NDMA. Due to the likelihood of a threshold dose for NDMA-related tumors in animals, we believe that there is ample scientific basis to utilize the threshold-based benchmark dose or point-of-departure (POD) approach when estimating a Permissible Daily Exposure limit (PDE) for NDMA. We estimated that 29,000 ng/kg/day was an appropriate POD for calculating a PDE. Assuming an average bodyweight of 50 kg, we expect that human exposures to NDMA at doses below 5800 ng/day in pharmaceuticals would not result in an increased risk of liver cancer, and that there is little, if any, risk for any other type of cancer, when accounting for the mode-of-action in humans.

Association of N-nitrosodimethylamine exposure with cognitive impairment based on the clues of mice and humans

N-nitrosodimethylamine (NDMA) is an environmental and food contaminant, but limited data to concern whether NDMA has adverse effects on the brain. This study first determined the concentration of NDMA in foods from aquaculture markets in Shenzhen, then analyzed the effects on C57BL/6 mice and further evaluated on the urine samples of elderly Chinese residents with normal cognition (NC, n = 144), cognitive decline (CD, n = 116) and mild cognitive impairment (MCI, n = 123). The excessive rate of NDMA in foods was 3.32% (27/813), with a exceeding range of 4.78-131.00 μg/kg. Behavioral tests showed that 60 days treatment of mice with 3 mg/kg NDMA reduced cognitive performance. Cognitive impairment in human was significantly associated with sex, educational levels, length of residence in Shenzhen, household registration, passive smoking, rice, fresh vegetables, bacon products. NDMA was detected in 55.4% (212/383) of urine samples, with a median concentration of 0.23 μg/L (1.20 × 10 ^-7-157.39 μg/L). The median concentration for NC, CD and MCI were 0.32, 0.27, and 0 μg/L, respectively. The urinary NDMA concentration had a strong negative correlation with cognitive impairment (Kendall's Tau-b = -0.89, P = 0.024). The median estimated daily intake (EDI) of NDMA was determined to be 6.63 ng/kg-bw/day. Taken together, there appears to be an association between NDMA and human and murine cognition, which provides a new clue to Alzheimer's disease (AD).

Levels of nitrate, nitrite and nitrosamines in model sausages during heat treatment and in vitro digestion - The impact of adding nitrite and spinach (Spinacia oleracea L.)

Nitrite derivatives react with endogenous precursors forming N-nitrosamines associated with development of colorectal cancer. The present study aims to investigate the formation of N-nitrosamines in sausage during processing and in vitro gastrointestinal digestion after adding sodium nitrite and/or spinach emulsion. The INFOGEST digestion protocol was used to simulate the oral, gastric, and small intestinal phases of digestion, and sodium nitrite was added in the oral phase to mimic the input of nitrite from saliva as it has shown to affect the endogenous formation of N-nitrosamines. The results show that the addition of spinach emulsion, in spite of it being a source of nitrate, did not affect the nitrite content in either batter, sausage, or roasted sausage. The levels of N-nitrosamines increased with the added amount of sodium nitrite, and further formation of some volatile N-nitrosamines was observed during roasting and in vitro digestion. In general, N-nitrosamine levels in the intestinal phase followed the same trend as in the undigested products. The results further indicate that nitrite present in saliva may cause a significant increase in N-nitrosamine levels in the gastrointestinal tract and that bioactive components in spinach may protect against the formation of volatile N-nitrosamines both during roasting and digestion.

Margin of Exposure Analyses and Overall Toxic Effects of Alcohol with Special Consideration of Carcinogenicity

Quantitative assessments of the health risk of the constituents of alcoholic beverages including ethanol are reported in the literature, generally with hepatotoxic effects considered as the endpoint. Risk assessment studies on minor compounds such as mycotoxins, metals, and other contaminants are also available on carcinogenicity as the endpoint. This review seeks to highlight population cancer risks due to alcohol consumption using the margin of exposure methodology. The individual and cumulative health risk contribution of each component in alcoholic beverages is highlighted. Overall, the results obtained consistently show that the ethanol contributes the bulk of harmful effects of alcoholic beverages, while all other compounds only contribute in a minor fashion (less than 1% compared to ethanol). Our data provide compelling evidence that policy should be focused on reducing total alcohol intake (recorded and unrecorded), while measures on other compounds should be only secondary to this goal.

Permitted daily exposure limits for noteworthy N-nitrosamines

A genotoxic carcinogen, N-nitrosodimethylamine (NDMA), was detected as a synthesis impurity in some valsartan drugs in 2018, and other N-nitrosamines, such as N-nitrosodiethylamine (NDEA), were later detected in other sartan products. N-nitrosamines are pro-mutagens that can react with DNA following metabolism to produce DNA adducts, such as O⁶ -alkyl-guanine. The adducts can result in DNA replication miscoding errors leading to GC>AT mutations and increased risk of genomic instability and carcinogenesis. Both NDMA and NDEA are known rodent carcinogens in male and female rats. The DNA repair enzyme, methylguanine DNA-methyltransferase can restore DNA integrity via the removal of alkyl groups from guanine in an error-free fashion and this can result in nonlinear dose responses and a point of departure or "practical threshold" for mutation at low doses of exposure. Following International recommendations (ICHM7; ICHQ3C and ICHQ3D), we calculated permissible daily exposures (PDE) for NDMA and NDEA using published rodent cancer bioassay and in vivo mutagenicity data to determine benchmark dose values and define points of departure and adjusted with appropriate uncertainty factors (UFs). PDEs for NDMA were 6.2 and 0.6 μg/person/day for cancer and mutation, respectively, and for NDEA, 2.2 and 0.04 μg/person/day. Both PDEs are higher than the acceptable daily intake values (96 ng for NDMA and 26.5 ng for NDEA) calculated by regulatory authorities using simple linear extrapolation from carcinogenicity data. These PDE calculations using a bench-mark approach provide a more robust assessment of exposure limits compared with simple linear extrapolations and can better inform risk to patients exposed to the contaminated sartans.

Use of less-than-lifetime (LTL) durational limits for nitrosamines: Case study of N-Nitrosodiethylamine (NDEA)

The ICH M7(R1) guideline describes a framework to assess the carcinogenic risk of mutagenic and carcinogenic pharmaceutical impurities following less-than-lifetime (LTL) exposures. This LTL framework is important as many pharmaceuticals are not administered for a patient's lifetime and as clinical trials typically involve LTL exposures. While there has been regulatory caution about applying LTL concepts to cohort of concern (COC) impurities such as N-nitrosamines, ICH M7 does not preclude this and indeed literature data suggests that the LTL framework will be protective of patient safety for N-nitrosamines. The goal was to investigate if applying the LTL framework in ICH M7 would control exposure to an acceptable excess cancer risk in humans. Using N-nitrosodiethylamine as a case study, empirical data correlating exposure duration (as a percentage of lifespan) and cancer incidence in rodent bioassays indicate that the LTL acceptable intake (AI) as derived using the ICH M7 framework would not exceed a negligible additional risk of cancer. Therefore, controlling N-nitrosamines to an LTL AI based on the ICH M7 framework is thus demonstrated to be protective for potential carcinogenic risk to patients over the exposure durations typical of clinical trials and many prescribed medicines.

Tolerability of risk: A commentary on the nitrosamine contamination issue

For decades, regulators have grappled with different approaches to address the issue of control of impurities. Safety-based limits, such as permissible daily exposure (PDE), acceptable intake (AI), threshold of toxicological concern (TTC) and less than lifetime limits (LTL) have all been used. For many years these safety-based limits have been recognized as virtually safe doses (VSDs). Recently, however, many regulatory agencies are seeking to impose limits for N-nitrosamine impurities, which are significantly below the VSD. This commentary will discuss the evolution of safety-based limits for impurities, provide an overview of the valsartan N-nitrosamine contamination issue and review the toxicology of N-nitrosamines. The outcome of a lessons-learned exercise on sartan medications undertaken by the European Medicines Agency (EMA) will also be discussed. The review will also highlight the many analytical challenges inherent with controlling impurities to ppb-based limits. The use of highly sensitive, low ppb limits, methods may lead to future issues of batch rejection, based on false positives. Regulators initially viewed the N-nitrosamine risk as being insufficient to prompt immediate product discontinuation and patients were specifically advised to continue using their affected medication. Patients were also informed that exposure to N-nitrosamines is extremely common via food and drinking water.

Regulatory Updates and Analytical Methodologies for Nitrosamine Impurities Detection in Sartans, Ranitidine, Nizatidine, and Metformin along with Sample Preparation Techniques

Nitrosamine impurities have been detected in various pharmaceutical products in recent days. Various sartans, ranitidine, nizatidine, and metformin have been recalled from the markets due to the high limit of nitrosamine impurities. This review aims to provide a brief overview of nitrosamine impurities, detection methods in detail, mechanism of action of nitrosamine impurities, sample preparation techniques, and regulatory limits. Numerous reported nitrosamine impurities also have been discussed with chemical structure. Various detection methods including LC-MS/MS, GC-MS-HS, and HPLC for nitrosamine impurities along with sartans, ranitidine, nizatidine, and metformin are being discussed in this review article. Various sample preparation techniques such as solid-phase extraction, liquid-liquid extraction, and rapid-fire techniques have also been discussed. This review will provide the detail information to the analytical manpower working in various quality control laboratories as well as in research organizations. HighlightsDetection of nitrosamine (NA) impurities in drug substances as well as finished products.HPLC, LC-MS/MS, and GC-MS/HS/AS discussed for the quantificationSolid-phase extraction, liquid-liquid extraction, and rapid-fire method for NA sample preparationMechanistic approach for nitrosamine formation and its removal strategiesRegulatory limits for NA impurities incorporated.

Incorporating Exogenous and Endogenous Exposures into Dietary Risk Assessment of Nitrates and Nitrites in Vegetables: A Probabilistic Integrated Toxicokinetic Modeling Approach

This study aimed to estimate the dietary risk of nitrates and nitrites in vegetables based on internal dose in a probabilistic manner by integrating exogenous exposure based on measured concentrations in vegetables with endogenous exposure using a toxicokinetic (TK) model. We optimized and validated a previous TK model and incorporated Monte Carlo simulations to account for variability across different age populations for predicting internal dose. High levels of nitrates were detected in leafy vegetables (from 545 ± 274 to 1641 ± 873 mg/kg). Nitrite contents of vegetables were generally low (from 1.26 ± 1.40 to 8.20 ± 14.1 mg/kg). The dietary risk was found to be different based on internal versus external dose, suggesting that it is critical to include endogenous nitrite formation into risk assessment. Nitrate and nitrite exposure from vegetables is unlikely to result in appreciable risks for most populations but may be a potential risk for preschoolers.

Assessment of the combined nitrate and nitrite exposure from food and drinking water: application of uncertainty around the nitrate to nitrite conversion factor

Dietary exposure to nitrate and nitrite occurs via three main sources; occurrence in (vegetable) foods, food additives in certain processed foods and contaminants in drinking water. While nitrate can be converted to nitrite in the human body, their risk assessment is usually based on single substance exposure in different regulatory frameworks. Here, we assessed the long-term combined exposure to nitrate and nitrite from food and drinking water. Dutch monitoring data (2012-2018) and EFSA data from 2017 were used for concentration data. These were combined with data from the Dutch food consumption survey (2012-2016) to assess exposure. A conversion factor (median 0.023; range 0.008-0.07) was used to express the nitrate exposure in nitrite equivalents which was added to the nitrite exposure. The uncertainty around the conversion factor was taken into account by using conversion factors randomly sampled from the abovementioned range. The combined dietary exposure was calculated for the Dutch population (1-79 years) with different exposure scenarios to address regional differences in nitrate and nitrite concentrations in drinking water. All scenarios resulted in a combined exposure above the acceptable daily intake for nitrite ion (70 µg/kg bw), with the mean exposure varying between 95-114 µg nitrite/kg bw/day in the different scenarios. Of all ages, the combined exposure was highest in children aged 1 year with an average of 250 µg nitrite/kg bw/day. Vegetables contributed most to the combined exposure in food in all scenarios, varying from 34%-41%. Food additive use contributed 8%-9% to the exposure and drinking water contributed 3%-19%. Our study is the first to perform a combined dietary exposure assessment of nitrate and nitrite while accounting for the uncertain conversion factor. Such a combined exposure assessment overarching different regulatory frameworks and using different scenarios for drinking water is a better instrument for protecting human health than single substance exposure.

Health risk assessment on N-nitrosodimethylamine in drinking water and food in major cities of China with disability-adjusted life years (DALYs)

In this study, a health risk assessment of N-nitrosodimethylamine (NDMA) in drinking water and food was conducted using disability-adjusted life years (DALYs) in major cities of China. Considering the numerous non-detected values found in drinking water samples, a zero-inflated model was employed to obtain a more precise NDMA concentration distribution function in drinking water. With exogenous chronic daily intake of 1.20 × 10^-6 mg/(kg*d), the lifetime cancer risk and disability-adjusted life years of NDMA are 4.01 × 10^-5 and 5.52 × 10^-6 per person-year (ppy). The disease burden attributable to water sources accounts for nearly 9.94% of total exogenous intake. The contribution rate of vegetables is the largest, followed by cereals, milk products, fish and shrimp, and meat. Taking endogenous sources into consideration, the contribution rates of drinking water and food sources decrease to 0.08% and 0.69%. This study provides a scientific basis for making policy decisions on NDMA pollution management.

The Signaling Pathways in Nitric Oxide Production by Neutrophils Exposed to N-nitrosodimethylamine

Background:

Polymorphonuclear neutrophils (PMNs) play a crucial role in the innate immune system’s response to microbial pathogens through the release of reactive nitrogen species, including Nitric Oxide (NO). </P><P> Methods: In neutrophils, NO is produced by the inducible Nitric Oxide Synthase (iNOS), which is regulated by various signaling pathways and transcription factors. N-nitrosodimethylamine (NDMA), a potential human carcinogen, affects immune cells. NDMA plays a major part in the growing incidence of cancers. Thanks to the increasing knowledge on the toxicological role of NDMA, the environmental factors that condition the exposure to this compound, especially its precursors- nitrates arouse wide concern.

Results:

In this article, we present a detailed summary of the molecular mechanisms of NDMA’s effect on the iNOS-dependent NO production in human neutrophils.

Conclusion:

This research contributes to a more complete understanding of the mechanisms that explain the changes that occur during nonspecific cellular responses to NDMA toxicity.

Drinking Water Nitrate and Human Health: An Updated Review

Nitrate levels in our water resources have increased in many areas of the world largely due to applications of inorganic fertilizer and animal manure in agricultural areas. The regulatory limit for nitrate in public drinking water supplies was set to protect against infant methemoglobinemia, but other health effects were not considered. Risk of specific cancers and birth defects may be increased when nitrate is ingested under conditions that increase formation of N-nitroso compounds. We previously reviewed epidemiologic studies before 2005 of nitrate intake from drinking water and cancer, adverse reproductive outcomes and other health effects. Since that review, more than 30 epidemiologic studies have evaluated drinking water nitrate and these outcomes. The most common endpoints studied were colorectal cancer, bladder, and breast cancer (three studies each), and thyroid disease (four studies). Considering all studies, the strongest evidence for a relationship between drinking water nitrate ingestion and adverse health outcomes (besides methemoglobinemia) is for colorectal cancer, thyroid disease, and neural tube defects. Many studies observed increased risk with ingestion of water nitrate levels that were below regulatory limits. Future studies of these and other health outcomes should include improved exposure assessment and accurate characterization of individual factors that affect endogenous nitrosation.

Re-evaluation of sodium nitrate (E 251) and potassium nitrate (E 252) as food additives

The Panel on Food Additives and Nutrient Sources added to Food (ANS) provided a scientific opinion re-evaluating the safety of sodium nitrate (E 251) and potassium nitrate (E 252) when used as food additives. The current acceptable daily intakes (ADIs) for nitrate of 3.7 mg/kg body weight (bw) per day were established by the SCF (1997) and JECFA (2002). The available data did not indicate genotoxic potential for sodium and potassium nitrate. The carcinogenicity studies in mice and rats were negative. The Panel considered the derivation of an ADI for nitrate based on the formation of methaemoglobin, following the conversion of nitrate, excreted in the saliva, to nitrite. However, there were large variations in the data on the nitrate-to-nitrite conversion in the saliva in humans. Therefore, the Panel considered that it was not possible to derive a single value of the ADI from the available data. The Panel noticed that even using the highest nitrate-to-nitrite conversion factor the methaemoglobin levels produced due to nitrite obtained from this conversion would not be clinically significant and would result to a theoretically estimated endogenous N-nitroso compounds (ENOC) production at levels which would be of low concern. Hence, and despite the uncertainty associated with the ADI established by the SCF, the Panel concluded that currently there was insufficient evidence to withdraw this ADI. The exposure to nitrate solely from its use as a food additive was estimated to be less than 5% of the overall exposure to nitrate in food based on a refined estimated exposure scenario. This exposure did not exceed the current ADI (SCF, 1997). However, if all sources of exposure to dietary nitrate are considered (food additive, natural presence and contamination), the ADI would be exceeded for all age groups at the mean and the highest exposure.

Re-evaluation of potassium nitrite (E 249) and sodium nitrite (E 250) as food additives

The Panel on Food Additives and Nutrient Sources added to Food (ANS) provided a scientific opinion re-evaluating the safety of potassium nitrite (E 249) and sodium nitrite (E 250) when used as food additives. The ADIs established by the SCF (1997) and by JECFA (2002) for nitrite were 0-0.06 and 0-0.07 mg/kg bw per day, respectively. The available information did not indicate in vivo genotoxic potential for sodium and potassium nitrite. Overall, an ADI for nitrite per se could be derived from the available repeated dose toxicity studies in animals, also considering the negative carcinogenicity results. The Panel concluded that an increased methaemoglobin level, observed in human and animals, was a relevant effect for the derivation of the ADI. The Panel, using a BMD approach, derived an ADI of 0.07 mg nitrite ion/kg bw per day. The exposure to nitrite resulting from its use as food additive did not exceed this ADI for the general population, except for a slight exceedance in children at the highest percentile. The Panel assessed the endogenous formation of nitrosamines from nitrites based on the theoretical calculation of the NDMA produced upon ingestion of nitrites at the ADI and estimated a MoE > 10,000. The Panel estimated the MoE to exogenous nitrosamines in meat products to be < 10,000 in all age groups at high level exposure. Based on the results of a systematic review, it was not possible to clearly discern nitrosamines produced from the nitrite added at the authorised levels, from those found in the food matrix without addition of external nitrite. In epidemiological studies there was some evidence to link (i) dietary nitrite and gastric cancers and (ii) the combination of nitrite plus nitrate from processed meat and colorectal cancers. There was evidence to link preformed NDMA and colorectal cancers.

C3H/He Mice as an Incompatible Cholangiocarcinoma Model by Clonorchis sinensis, Dicyclanil and N-Nitrosodimethylamine

Clonorchis sinensis is a Group-I bio-carcinogen, associated with cholangiocarcinoma (CCA). The hamster is the only experimental model of C. sinensis-mediated CCA, but we oblige another animal model. The present study intended to develop a C. sinensis (Cs) mediated CCA model using C3H/He mice, co-stimulated with N-nitrosodimethyl-amine (NDMA) and dicyclanil (DC). The mice were divided into 8 groups with different combinations of Cs, NDMA, and DC. Six months later the mice were sacrificed and subjected to gross and histopathological examination. The body weights were significantly reduced among the groups treated with 2 or more agents (eg. Cs+NDMA, Cs+DC, NDMA+DC, and Cs+NDMA+DC). In contrast, liver weight percentages to body weight were increased in above groups by 4.1% to 4.7%. A Change of the spleen weight was observed only in Cs+NDMA group. Though C. sinensis infection is evident from hyperplastic changes, only 1 worm was recovered. T wo mice, 1 from Cs and the other from Cs+DC group, showed mass forming lesions; 1 (281.2 mm³) from the Cs group was a hepatocellular adenoma and the other (280.6 mm³) from the Cs+DC group was a cystic mass (peliosis). Higher prevalence of gray-white nodules was observed in Cs group (42.9%) followed by Cs+NDMA+DC group (21.4%). The mice of the Cs+NDMA+DC group showed hyper-proliferation of the bile duct with fibrotic changes. No characteristic change for CCA was recognized in any of the groups. In conclusion, C3H/He mice produce no CCA but extensive fibrosis when they are challenged by Cs, NDMA, and DC together.

Carcinogenic compounds in alcoholic beverages: an update

The consumption of alcoholic beverages has been classified as carcinogenic to humans by the International Agency for Research on Cancer (IARC) since 1988. More recently, in 2010, ethanol as the major constituent of alcoholic beverages and its metabolite acetaldehyde were also classified as carcinogenic to humans. Alcoholic beverages as multi-component mixtures may additionally contain further known or suspected human carcinogens as constituent or contaminant. This review will discuss the occurrence and toxicology of eighteen carcinogenic compounds (acetaldehyde, acrylamide, aflatoxins, arsenic, benzene, cadmium, ethanol, ethyl carbamate, formaldehyde, furan, glyphosate, lead, 3-MCPD, 4-methylimidazole, N-nitrosodimethylamine, pulegone, ochratoxin A, safrole) occurring in alcoholic beverages as identified based on monograph reviews by the IARC. For most of the compounds of alcoholic beverages, quantitative risk assessment provided evidence for only a very low risk (such as margins of exposure above 10,000). The highest risk was found for ethanol, which may reach exposures in ranges known to increase the cancer risk even at moderate drinking (margin of exposure around 1). Other constituents that could pose a risk to the drinker were inorganic lead, arsenic, acetaldehyde, cadmium and ethyl carbamate, for most of which mitigation by good manufacturing practices is possible. Nevertheless, due to the major effect of ethanol, the cancer burden due to alcohol consumption can only be reduced by reducing alcohol consumption in general or by lowering the alcoholic strength of beverages.

Effects of heavy metal ions on N-nitrosodimethylamine (NDMA) formation

The mechanism of NDMA formation as affected by heavy metal complexes [MONO]⁺ (M = Cd, Pb, Hg) was investigated using density functional theory (DFT). Three possible NDMA formation pathways are discussed.

Growing patterns to produce 'nitrate-free' lettuce (Lactuca sativa)

Vegetables can contain significant amounts of nitrate and, therefore, may pose health hazards to consumers by exceeding the accepted daily intake for nitrate. Different hydroponic growing patterns were examined in this work in order to obtain 'nitrate-free lettuces'. Growing lettuces on low nitrate content nutrient solution resulted in a significant decrease in lettuces' nitrate concentrations (1741 versus 39 mg kg(-1)), however the beneficial effect was cancelled out by an increase in the ambient temperature. Nitrate replacement with ammonium was associated with an important decrease of the lettuces' nitrate concentration (from 1896 to 14 mg kg(-1)) and survival rate. An economically feasible method to reduce nitrate concentrations was the removal of all inorganic nitrogen from the nutrient solution before the exponential growth phase. This method led to lettuces almost devoid of nitrate (10 mg kg(-1)). The dried mass and calcinated mass of lettuces, used as markers of lettuces' quality, were not influenced by this treatment, but a small reduction (18%, p < 0.05) in the fresh mass was recorded. The concentrations of nitrite in the lettuces and their modifications are also discussed in the paper. It is possible to obtain 'nitrate-free' lettuces in an economically feasible way.

Nitrate and nitrite in the diet: how to assess their benefit and risk for human health

Nitrate is a natural constituent of the human diet and an approved food additive. It can be partially converted to nitrogen monoxide, which induces vasodilation and thereby decreases blood pressure. This effect is associated with a reduced risk regarding cardiovascular disease, myocardial infarction, and stroke. Moreover, dietary nitrate has been associated with beneficial effects in patients with gastric ulcer, renal failure, or metabolic syndrome. Recent studies indicate that such beneficial health effects due to dietary nitrate may be achievable at intake levels resulting from the daily consumption of nitrate-rich vegetables. N-nitroso compounds are endogenously formed in humans. However, their relevance for human health has not been adequately explored up to now. Nitrate and nitrite are per se not carcinogenic, but under conditions that result in endogenous nitrosation, it cannot be excluded that ingested nitrate and nitrite may lead to an increased cancer risk and may probably be carcinogenic to humans. In this review, the known beneficial and detrimental health effects related to dietary nitrate/nitrite intake are described and the identified gaps in knowledge as well as the research needs required to perform a reliable benefit/risk assessment in terms of long-term human health consequences due to dietary nitrate/nitrite intake are presented.

Exploring the uncertainties in cancer risk assessment using the integrated probabilistic risk assessment (IPRA) approach

Current methods for cancer risk assessment result in single values, without any quantitative information on the uncertainties in these values. Therefore, single risk values could easily be overinterpreted. In this study, we discuss a full probabilistic cancer risk assessment approach in which all the generally recognized uncertainties in both exposure and hazard assessment are quantitatively characterized and probabilistically evaluated, resulting in a confidence interval for the final risk estimate. The methodology is applied to three example chemicals (aflatoxin, N-nitrosodimethylamine, and methyleugenol). These examples illustrate that the uncertainty in a cancer risk estimate may be huge, making single value estimates of cancer risk meaningless. Further, a risk based on linear extrapolation tends to be lower than the upper 95% confidence limit of a probabilistic risk estimate, and in that sense it is not conservative. Our conceptual analysis showed that there are two possible basic approaches for cancer risk assessment, depending on the interpretation of the dose-incidence data measured in animals. However, it remains unclear which of the two interpretations is the more adequate one, adding an additional uncertainty to the already huge confidence intervals for cancer risk estimates.

Effects of nitrite on development of embryos and early larval stages of the zebrafish (Danio rerio)

Epidemiological studies suggest that high nitrate levels in food and water may cause birth defects or spontaneous abortions in humans. Experimental mammalian studies show that high nitrite levels adversely affect reproductive outcomes, but have not shown congenital malformations. Consequently, the teratogenic potential of nitrite is unclear. In this study, the effects of nitrite on development of zebrafish embryos and early larval stages were investigated. Eggs were exposed to ethanol (a known teratogen), nitrite, or nitrate for 24 or 96 hours, and larvae examined at 120 hours. Sublethal exposure to 300 mM ethanol for 24 hours caused severe pericardial and yolk sac edema, craniofacial and axial malformations, and swim bladder noninflation. The 96 hour LC(50) for nitrite was 411 mg/L. Less severe edema, craniofacial (but not axial) malformations, swim bladder noninflation, and immobility were observed after sublethal exposure to nitrite between 10 and 300 mg/L for 96 hours. Exposure to nitrite for 24 hours at concentrations as high as 2000 mg/L was not lethal. Only axial malformations and swim bladder noninflation were observed at 1500 mg/L. The results demonstrate that sublethal nitrite concentrations cause developmental defects. The type and magnitude of these defects differed after 24 and 96 hours of exposure.

Comparative risk assessment of carcinogens in alcoholic beverages using the margin of exposure approach

Alcoholic beverages have been classified as carcinogenic to humans. As alcoholic beverages are multicomponent mixtures containing several carcinogenic compounds, a quantitative approach is necessary to compare the risks. Fifteen known and suspected human carcinogens (acetaldehyde, acrylamide, aflatoxins, arsenic, benzene, cadmium, ethanol, ethyl carbamate, formaldehyde, furan, lead, 4-methylimidazole, N-nitrosodimethylamine, ochratoxin A and safrole) occurring in alcoholic beverages were identified based on monograph reviews by the International Agency for Research on Cancer. The margin of exposure (MOE) approach was used for comparative risk assessment. MOE compares a toxicological threshold with the exposure. MOEs above 10,000 are judged as low priority for risk management action. MOEs were calculated for different drinking scenarios (low risk and heavy drinking) and different levels of contamination for four beverage groups (beer, wine, spirits and unrecorded alcohol). The lowest MOEs were found for ethanol (3.1 for low risk and 0.8 for heavy drinking). Inorganic lead and arsenic have average MOEs between 10 and 300, followed by acetaldehyde, cadmium and ethyl carbamate between 1,000 and 10,000. All other compounds had average MOEs above 10,000 independent of beverage type. Ethanol was identified as the most important carcinogen in alcoholic beverages, with clear dose response. Some other compounds (lead, arsenic, ethyl carbamate, acetaldehyde) may pose risks below thresholds normally tolerated for food contaminants, but from a cost-effectiveness point of view, the focus should be on reducing alcohol consumption in general rather than on mitigative measures for some contaminants that contribute only to a limited extent (if at all) to the total health risk.