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减轻饮食砷暴露:美国的现状及改善前进道路的建议。

Mitigating dietary arsenic exposure: Current status in the United States and recommendations for an improved path forward.

机构信息

Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Johns Hopkins Center for a Livable Future, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Johns Hopkins Risk Sciences and Public Policy Institute, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.

Connecticut Department of Public Health, Hartford, CT, USA.

出版信息

Sci Total Environ. 2017 Mar 1;581-582:221-236. doi: 10.1016/j.scitotenv.2016.12.112. Epub 2017 Jan 5.

Abstract

Inorganic arsenic (iAs) is a well-characterized carcinogen, and recent epidemiologic studies have linked chronic exposures to non-cancer health outcomes, including cardiovascular disease, diabetes, skin lesions and respiratory disorders. Greater vulnerability has been demonstrated with early life exposure for health effects including lung and bladder cancer, immunotoxicity and neurodevelopment. Despite its well-known toxicity, there are important gaps in the regulatory oversight of iAs in food and in risk communication. This paper focuses on the US regulatory framework in relation to iAs in food and beverages. The state of existing regulatory agency toxicological assessments, monitoring efforts, standard setting, intervention policies and risk communication are explored. Regarding the approach for standard setting, risk-based evaluations of iAs in particular foods can be informative but are insufficient to create a numeric criterion, given current uncertainties in iAs toxicology and the degree to which traditional risk targets can be exceeded by dietary exposures. We describe a process for prioritizing dietary exposures for different lifestages and recommend a relative source contribution-based approach to setting criteria for arsenic in prioritized foods. Intervention strategies begin with an appropriately set criterion and a monitoring program that documents the degree to which this target is met for a particular food. This approach will promote improvements in food production to lower iAs contamination for those foods which initially do not meet the criterion. Risk communication improvements are recommended to ensure that the public has reliable information regarding sources and alternative dietary choices. A key recommendation is the consideration of meal frequency advice similar to what is currently done for contaminants in fish. Recent action level determinations by FDA for apple juice and infant rice cereal are evaluated and used as illustrations of how our recommended approach can further the goal of exposure mitigation from key sources of dietary iAs in the US.

摘要

无机砷(iAs)是一种特征明确的致癌物质,最近的流行病学研究将慢性暴露与非癌症健康结果联系起来,包括心血管疾病、糖尿病、皮肤损伤和呼吸道疾病。生命早期接触会导致更大的脆弱性,包括肺癌和膀胱癌、免疫毒性和神经发育。尽管其毒性众所周知,但在食品中的 iAs 监管监督和风险沟通方面仍存在重要差距。本文重点关注美国食品和饮料中 iAs 的监管框架。探讨了现有的监管机构毒理学评估、监测工作、标准制定、干预政策和风险沟通的状态。关于标准制定方法,对特定食品中 iAs 的基于风险的评估可以提供信息,但由于 iAs 毒理学的当前不确定性以及传统风险目标在多大程度上可以被饮食暴露所超越,因此不足以制定数值标准。我们描述了一种针对不同生命阶段的饮食暴露进行优先排序的方法,并建议基于相对来源贡献的方法来为优先食品中的砷制定标准。干预策略从适当设定的标准和监测计划开始,该计划记录特定食品达到该目标的程度。这种方法将促进食品生产的改进,以降低最初不符合标准的食品中的 iAs 污染。建议改进风险沟通,以确保公众获得有关来源和替代饮食选择的可靠信息。一个关键建议是考虑类似目前针对鱼类污染物所做的餐次频率建议。本文还评估了 FDA 最近对苹果汁和婴儿米粉的行动水平确定,并将其用作说明,说明我们建议的方法如何进一步实现减轻美国饮食中 iAs 的主要来源的暴露目标。

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