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

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.

Human exposure to dietary inorganic arsenic and other arsenic species: State of knowledge, gaps and uncertainties

“…Therefore, iAs exposure clearly represents a food safety priority worldwide. How to mitigate iAs dietary exposure is the subject of another paper in this issue (Nachman et al, this issue). …”

Exposure to Arsenite in CD-1 Mice during Juvenile and Adult Stages: Effects on Intestinal Microbiota and Gut-Associated Immune Status

“…The U.S. Environmental Protection Agency (EPA) has set regulatory standards for the arsenic level in drinking water at 0.01 mg/liter or 10 ppb (4). In 2016, FDA proposed an action level of 100 ppb for iAs (inorganic arsenic) in infant rice products (5). Larger amounts of arsenic are known to be associated with gastrointestinal disturbance and other adverse effects (6)(7)(8).…”

“…Larger amounts of arsenic are known to be associated with gastrointestinal disturbance and other adverse effects (6)(7)(8). These adverse health hazards could include cancer or other health disorders (5,7,(9)(10)(11)(12). Specifically, exposure to arsenic by ingestion is known to be associated with liver, lung, kidney, and bladder cancer (see reference 13).…”

Environmental Exposure of Arsenic in Groundwater Associated to Carcinogenic Risk in Underweight Children Exposed to Fluorides

“…Therefore, interventions to reduce environmental exposure are justified [29]. In terms of costs, in populations in India, China and Bangladesh, greater severity has been reported for As exposure than for diseases such as cancer, as these are populations with nutritional deficiencies [32]. Other studies in populations in the United States where As concentrations in drinking water are the same present no evidence of arsenism; it is likely that these populations are well nourished and have a high socioeconomic status and, thus, a higher level of protection, unlike populations living in developing countries [33].…”