Occurrence of heavy metals coupled with elevated levels of essential elements in chocolates: Health risk assessment.

The presence of contaminants in cacao-derived products, especially in chocolates, has raised concerns regarding food safety and human health. The study assessed the concentration variation of 16 elements in 155 chocolate samples from the US market by cacao content and country of geographic origin. The study further examined the potential health risks posed by toxic metals and determined the contribution of essential elements to the Daily Recommended Intake (DRI), estimated based on an ounce (∼28.4 g) of daily chocolate consumption. Dark chocolates with ≥50 % cacao exhibited consecutively increasing mean levels from 1.2 to 391 µg/kg for U, Tl, Th, As, Pb, Se, Cd, and Co. Similarly, Ni, Sr, Cu, Mn, Zn, Fe, Ca, and Mg had mean concentrations from 4.0 to 1890 mg/kg. Dark chocolates sourced from Central and South America exhibited the highest mean levels of Cd, and South America samples also contained elevated Pb, whereas those from West Africa and Asia had low Cd and Pb, respectively. Cacao contents showed increasingly strong association with Cd, Co, Mn, Sr, Ni, Cu, Zn, and Mg (r = 0.60-0.84), and moderately with Se, Fe, As, and Tl (r = 0.35-0.49), indicating these elements are primarily derived from cacao beans. Weak association of cacao contents with Pb, Th, and U levels (r < 0.25), indicates post-harvest contaminations. Hazard Quotient (HQ) > 1 was found only for Cd in 4 dark chocolates, and Hazard Index (HI) > 1 for cumulative risk of Cd, Pb, Ni, As, and U was found in 33 dark chocolates, indicating potential non-carcinogenic risks for 15 kg children but none for 70 kg adults. Dark chocolate also substantially contributed to 47-95 % of the DRI of Cu for children and 50 % for adults. Dark chocolates also provided notable Fe, Mn, Mg, and Zn contributions to the DRI. These essential elements are recognized to reduce the bioavailability of toxic metals such as Cd, Pb, or Ni, thereby potentially lowering associated health risks. This study informs consumers, food industries, and regulatory agencies to target cacao origins or chocolate brands with lower toxic metal contents for food safety and minimizing adverse health effects.

Elemental composition of toxic and essential elements in rice-based baby foods from the United States and other countries: A probabilistic risk analysis.

Consumption of rice-based foods provides essential nutrients required for infants and toddlers' growth. However, they could contain toxic and excess essential elements that may affect human health. The study aims to determine the composition of rice-based baby foods in the USA and outside and conduct a multiple-life stages probabilistic exposure and risk assessment of toxic and essential elements in children. Elemental concentrations were measured using Inductively Coupled Plasma Mass Spectrometry (ICP-MS) in thirty-three rice-based baby foods. This includes 2 infant formulas, 11 rice baby cereals, and 20 rice snacks produced primarily in the United States, China, and other countries. A probabilistic risk assessment was conducted to assess risks of adverse health effects. Results showed that infant formula had higher median concentrations of selenium (Se), copper (Cu), zinc (Zn), sodium (Na), magnesium (Mg), calcium (Ca), and potassium (K) compared to rice baby cereal and rice snacks. On the contrary, rice snacks had the highest median concentration of Arsenic (As) (127 µg/kg) while rice baby cereals showed the highest median concentration of Cd (7 µg/kg). A higher lifetime estimated daily intake was observed for samples manufactured in the USA compared to those from China and other countries. Hazard quotient (HQ < 1) values were suggestive of minimal adverse health effects. However, lifetime carcinogenic risk analysis based on total As indicated an unacceptable cancer risk (>1E-04). These findings show a need for ongoing monitoring of rice-based foods consumed by infants and toddlers as supplementary and substitutes for breast milk or weaning food options. This can be useful in risk reduction and mitigation of early life exposure to improve health outcomes.

Association between fluoride exposure in drinking water and cognitive deficits in children: A pilot study.

Fluoride (F) exposure in drinking water may lead to reduced cognitive function among children; however, findings largely remain inconclusive. In this pilot study, we examined associations between a range of chronic F exposures (low to high: 0.4 to 15.5 mg/L) in drinking water and cognition in school-aged children (5-14 years, n = 74) in rural Ethiopia. Fluoride exposure was determined from samples of community-based drinking water wells and urine. Cognitive performance was measured using: 1) assessments of ability to draw familiar objects (donkey, house, and person), and 2) a validated Cambridge Neuropsychological Test Automated Battery's (CANTAB) Paired Associate Learning (PAL), which examines memory and new learning and is closely associated with hippocampus function of the brain. Associations between F and cognitive outcomes were evaluated using regression analysis, adjusting for demographic, health status, and other covariates. The median (range) of water and urine F levels was 7.6 (0.4-15.5 mg/L) and 6.3 (0.5-15.7 mg/L), respectively; these measures were strongly correlated (r = 0.74), indicating that water is the primary source of F exposure. Fluoride in drinking water was negatively associated with cognitive function, measured by both drawing and CANTAB test performance. Inverse relationships were also found between F and drawing objects task scores, after adjusting for covariates (p < 0.05). Further analysis using CANTAB PAL tasks in the children confirmed that F level in drinking water was positively associated with the number of errors made by children (p < 0.01), also after adjusting for covariates (p < 0.05). This association between water F and total errors made became markedly stronger as PAL task difficulty increased. Fluoride exposure was also inversely associated with other PAL tasksthe number of patterns reached, first attempt memory score and mean errors to success. These findings provide supportive evidence that high F exposures may be associated with cognitive deficits in children. Additional well-designed studies are critically needed to establish the neurotoxicity of F in children and adults exposed to both low levels known to protect dental caries, as well as excess F levels in drinking water.

Selenium in drinking water and cereal grains, and biomarkers of Se status in urine and fingernails of the Main Ethiopian Rift Valley population.

BACKGROUND: Selenium (Se) plays an important role in human health, yet Se overexposure or deficiency can lead to deleterious health effects. This study aims to determine the concentration of Se in drinking water and staple cereal grain (maize, wheat, and teff) samples from the Main Ethiopian Rift (MER) Valley, and correspondingly, assesses Se biomarkers and their status as measured in the urine and fingernails of 230 individuals living in 25 MER communities. METHOD: The concentration of Se in drinking water and cereal grain (maize, wheat, and teff) samples, and urine and fingernail samples were measured using Inductively Coupled Plasma Mass Spectrometry (ICP-MS). Demographic, anthropometric, and elemental concentrations were described by their quartiles and mean ± standard deviations. The 5th and 95th percentiles were used to describe the concentrations Se biomarkers ranges. The Se biomarker distributions in different study communities were further characterized according to Se levels found in drinking water, sex, and age using ANOVA, and multivariate regression. We conducted a correlation analysis (with Pearson correlation coefficient) and fitted a regression to evaluate the associations between these variables. RESULTS: The mean concentration of Se in the drinking water samples was 0.66 (range: 0.015-2.64 µg/L; n = 25), and all samples were below the threshold value of 10 µg/L for Se in drinking water set by the World Health Organiation (WHO). In Ethiopia, most rural communities rely on locally produced cereal grains. We found mean Se concentrations (µg/kg) of 357 ± 190 (n = 14), 289 ± 123 (n = 14), and 145 ± 100 (n = 14) in wheat, teff, and maize, respectively. Furthermore, Se concentrations in drinking water showed no significant correlation with biomarker measures, indicating that the primary source of dietary Se is likely from local foods including staple grains. The mean±SD (5th-95th percentiles) of Se concentrations in fingernails and urine among study subjects were 1022 ± 320 (624-1551 µg/kg), and 38 ± 30 (1.9-100 µg/L), respectively. CONCLUSION: A sizeable share of study participants (31%) fell below the lower limits of what is considered the currently accepted Se range of 20-90 µg/L in urine, though relatively few (only 4%) had similarly low fingernail levels. On the other hand, none of the samples reached Se toxicity levels, and the biomarker levels in this study are comparable to results from other studies that find adequate Se. Our results show that Se toxicity or deficiency is unlikely in the study population.

Disparities in Underlying Health Conditions and COVID-19 Infection and Mortality in Louisiana, USA.

BACKGROUND: Louisiana is ranked among the top 10 states with the highest COVID-19 death rate in the USA, and African Americans (AA) that account 32.2% (1.5 million) of the state's population have been impacted differentially with higher rates of chronic health conditions such as hypertension, obesity, and diabetes. These conditions can compromise immune systems and increase susceptibility to COVID-19. Prior health disparity and COVID-19 studies in Louisiana are limited to comprehensively evaluate the risk of underlying health conditions on COVID-19 incidence and death in minority communities and thus the study aims to address this research gap. METHODS: Negative binomial regression analyses were used to correlate risk factors with COVID-19 incidence and death rates using SAS software. Spatial distribution and burden of COVID-19 incidence and mortality rates were mapped using ArcGIS Pro. RESULTS: We found that AA COVID-19 death was three times higher than other races, and mortality rate was ten times higher in counties with more than 40% AA. Highest AA case and death counts were found in Orleans County; mortality rate in Bienville; and incidence rate in East Feliciana. Hypertension, diabetes, and obesity were significantly correlated with both COVID-19 incidence and mortality rates in AA. Greater odds of incidence and death rates also found in counties with higher AA population density with higher burden of underlying health conditions. Furthermore, living in poverty, being 65 years and older significantly influenced COVID-19 cases and deaths in the state. CONCLUSIONS: The study highlights the need to reduce the burden of health disparities in underserved communities, and help to inform the public, scientific communities, and policy makers to plan effective responses to reduce the risks of COVID-19 infection, death, and other potential infectious diseases at the state.

Neuro-medical manifestations of fluorosis in populations living in the Main Ethiopian Rift Valley.

Prolonged exposure to higher concentrations of fluoride (> 1.5 mg/L) is associated with dental and skeletal fluorosis. The effects of fluoride on dental and skeletal system have been studied extensively; however, the neurological consequences of fluoride in population-based studies are limited. The study aims to assess the epidemiology of neurological and other manifestations of fluorosis among rural populations living in the Main Ethiopian Rift valley. In this cross-sectional study, we enrolled 316 individuals from 23 rural communities in the Main Ethiopian Rift valley. Fluoride concentration was measured in drinking water samples collected from 23 community wells. Association between fluoride concentrations and clinical features of fluorosis was assessed using student t test, chi square, multivariable regression using adjusted odds ratio (OR). The mean fluoride concentration in the drinking water was 6.8 ± 4.3 mg/L (range: 0.3-15.5 mg/L). At least one clinical sign of skeletal fluorosis was observed in 54.4% (n = 175) of the study participants. Headache and joint pain reported by 67.1% and 56.3% of the participants as the most common neurological manifestation, and skeletal fluorosis symptom, respectively. The mean fluoride level was higher for those individuals who reported paresthesia compared to those with no-paresthesia. Loss of appetite, constipation, and fatigue were reported by 48.0%, 45.6%, and 56.6% of the participants, respectively. Signs of crippling fluorosis were observed in small proportion (1.6%) of the participants. Individuals who reported headache are most likely exposed to higher fluoride concentrations in drinking water compared to those reported no-headache (p < 0.001). The study demonstrates high prevalence of neuro-medical manifestations of fluorosis in population living in the Main Ethiopian Rift valley. Fluoride concentration in drinking water and joint pain were independent predictors of fluorosis.

Elemental composition of teff (a gluten-free grain), maize and wheat: Staple crops in the Main Ethiopian Rift Valley.

Teff, maize, and wheat are the major cereals grown in volcanic ash-rich soils of the Main Ethiopian Rift (MER) Valley. Teff is a gluten-free cereal native to Ethiopia, used for making a local flat bread called injera, and is getting popularity globally due to its nutritional value (gluten-free and high fiber content). Teff can thus be an alternative diet for the treatment of celiac disease, a lifelong intolerance to gluten. This study aims to assess the distribution of toxic and essential elements in these staple cereals using Inductively Coupled Plasma Mass Spectrometry (ICP-MS) and compare with mineral composition of wheat, and maize consumed in the Main Ethiopian Rift Valley. We found significantly higher mean concentrations (in mg/kg) of Mg (1400), Ca (1210), Na (33), Fe (159), Mn (71), Sr (5.6), and Cu (4.8) in teff compared to wheat and maize. Maize had the lowest concentrations of these essential elements. Mean concentrations (in µg/kg) of As (24.7) and Pb (70) in teff were relatively higher compared to wheat and maize, which had similar values of As (4.5) and Pb (8.9). Teff and wheat had similar Cd concentrations (in µg/kg) of 4.8 and 5.4 respectively compared to maize (1.5). Cadmium concentrations were below the Codex standard established for Cd in cereal grains (100 µg/kg). Only one teff sample exceeded the Codex standard set for Pb (200 µg/kg) in cereal grains. This study provides information on nutritional values and food safety of maize, wheat, and teff; the latter is becoming an alternative gluten-free diet for celiac patients in countries where wheat is commonly a staple food.

Bone quality in fluoride-exposed populations: A novel application of the ultrasonic method.

BACKGROUND: Various studies, mostly with animals, have provided evidence of adverse impacts of fluoride (F-) on bone density, collagen and microstructure, yet its effects on overall bone quality (strength) has not been clearly or extensively characterized in human populations. OBJECTIVE: In this observational study, we assessed variation in an integrated measures of bone quality in a population exposed to wide-ranging F- levels (0.3 to 15.5 mg/L) in drinking water, using a novel application of non-ionizing ultrasonic method. METHOD: We collected 871 speed of sound (SOS) measurements from 341 subjects residing in 25 communities, aged 10-70 years (188 males and 153 females). All subjects received scans of the cortical radius and tibia, and adults over the age of 19 received an additional scan of the phalanx. Associations between F- in drinking water and 24-h urine samples, and SOS as a measure of bone quality, were evaluated in bivariate and multivariable regressions adjusting for age, sex, BMI, smoking, and toothpaste use. RESULTS: We found negative associations between F- exposure and bone quality at all three bones. Adult tibial SOS showed the strongest inverse association with F- exposure, which accounted for 20% of the variance in SOS measures (r = 0.45; n = 199; p < 0.0001). In adjusted analysis, a 1 mg/L increase in F- in drinking water was related to a reduction of 15.8 m/s (95% CI: -21.3 to -10.3), whereas a 1 mg/L increase in 24-h urinary F- (range: 0.04-39.5 mg/L) was linked to a reduction of 8.4 m/s (95% CI: -12.7, -4.12) of adult tibial SOS. Among adolescents, in contrast, weaker and non-significant inverse associations between F- exposure and SOS were found, while age, gender, and BMI were more significant predictors than in adults. CONCLUSIONS: These results are indicative of a fluoride-induced deterioration of bone quality in humans, likely reflecting a combination of factors related to SOS: net bone loss, abnormal mineralization and collagen formation, or altered microarchitecture. The portable and low-cost ultrasound technique appears potentially useful for assessment of bone quality, and should be tested in other locations and for other bone-related disorders, to assess the feasibility of its more extensive diagnostic use in hard-to-reach rural regions.

Biomonitoring of metals and trace elements in urine of central Ethiopian populations.

Biomonitoring of chemical concentrations in humans is important for detecting, monitoring, and addressing a wide range of health threats. However, it is virtually absent across many African nations, including Ethiopia. This study aims to determine urinary concentrations for metals and trace elements in populations living in the central Ethiopian Rift Valley. The region is unindustralized, rural, and characterized by unique geologic rifting and volcanic activities that have produced vast pyroclastic materials, forming its aquifer and fertile agricultural soils. Millions of people in the region rely on wells for drinking water and are engaged in cereal-based subsistence agriculture. We enrolled a total of 386 residents aged 10-50 years old (201 females and 185 males). The levels of 23 elements except F─ were quantified in water and urine samples by ICP-MS. Mean concentrations of B, F─, Ca, and Mg were measured in mg/L levels, while concentrations of Mo, Zn, Sr, Rb, and Li ranged between 100 and 700 µg/L. Mean concentrations between 5 and 15 µg/L were found for Ni, Cu, and Mn, while Ag, Be, Cd, Co, Pb, Sb, Th, TI, and U were all below 5 µg/L. Arsenic and Al had mean concentrations between 30 and 50 µg/L. Mean urinary concentrations of Ca, Cu, Mg, Pb, Sr, and Zn were significantly higher in males than females, whereas Co and Mn were higher in females. Finally, younger individuals (10-30 years) had significantly higher mean concentrations of B, Cd, Co, Mg, Mo, and Pb than those between 31 and 50 years, whereas only Ca was higher in the older age group. The concentration ranges of B, Mo, Mn, TI, Li, Zn, and in particular F─ (0.44-44.6 mg/L) and As (2.2-164 µg/L) in urine were higher than the reference ranges reported in healthy unexposed North American and European populations, while those for the remaining 16 elements were comparable to published reference ranges from such settings. The established concentration ranges are important to monitor future changes in exposure, and risk factors for disease, that might stem from the economic growth and industrialization that is currently underway in the region.