Arsenic and Rice: Translating Research to Address Health Care Providers' Needs
2015; Elsevier BV; Volume: 167; Issue: 4 Linguagem: Inglês
10.1016/j.jpeds.2015.07.003
ISSN1097-6833
AutoresPui Y. Lai, Kathryn L. Cottingham, Craig Steinmaus, Margaret R. Karagas, Mark Miller,
Tópico(s)Environmental Justice and Health Disparities
ResumoArsenic is a naturally occurring element and anthropogenic contaminant present in 2 general forms: inorganic and organic. Inorganic arsenic is considered highly toxic to humans.1American Academy of PediatricsPediatric Environmental Health.in: Etzel R.A. Balk S.J. 3rd ed. AAP, Elk Grove Village, IL2011Google Scholar The International Agency for Research on Cancer, Agency for Toxic Substances and Disease Registry, and the US Environmental Protection Agency (EPA) all classify inorganic arsenic as a human carcinogen.2IARC Working Group on the Evaluation of Carcinogenic Risks to HumansArsenic, metals, fibres, and dusts.IARC Monogr Eval Carcinog Risks Hum. 2012; 100: 11-465PubMed Google Scholar, 3ATSDR Toxicological profile for arsenic. Agency for Toxic Substances and Disease Registry, Division of Toxicology, Atlanta, GA2007Google Scholar, 4Arsenic compounds. United States Environmental Protection Agency, Washington, DC2012http://www.epa.gov/ttnatw01/hlthef/arsenic.htmlGoogle Scholar The health effects of organic forms are not fully understood; however, some of the organic forms also may have toxic and potentially carcinogenic properties.5European Food Safety AuthorityPanel on contaminants in the food chain (CONTAM); scientific opinion on arsenic in food.EFSA J. 2009; (7; 67-72; 84-5; 89; 132-42)Google Scholar Children can be exposed to arsenic in multiple ways.1American Academy of PediatricsPediatric Environmental Health.in: Etzel R.A. Balk S.J. 3rd ed. AAP, Elk Grove Village, IL2011Google Scholar, 3ATSDR Toxicological profile for arsenic. Agency for Toxic Substances and Disease Registry, Division of Toxicology, Atlanta, GA2007Google Scholar An important source of chronic exposure to inorganic arsenic worldwide is contaminated drinking water. However, because municipal water systems in the US are regulated to meet federal standards, the primary exposure to arsenic for most people in the US is food.3ATSDR Toxicological profile for arsenic. Agency for Toxic Substances and Disease Registry, Division of Toxicology, Atlanta, GA2007Google Scholar One food known to be particularly high in arsenic is rice, a staple for much of the world's population.6Meharg A.A. Williams P.N. Adomako E. Lawgali Y.Y. Deacon C. Villada A. et al.Geographical variation in total and inorganic arsenic content of polished (white) rice.Environ Sci Technol. 2009; 43: 1612-1617Crossref PubMed Scopus (563) Google Scholar Rice grown throughout the world contains arsenic, particularly US-grown rice.7Meharg A.A. Zhao F. Arsenic & Rice. Springer, New York2012Crossref Scopus (63) Google Scholar Though the amount and forms of arsenic found in different rice cultivars vary, the average levels of inorganic arsenic detected in rice are high enough to raise questions about potential health impacts, including for children.8Arsenic in your food: our findings show a real need for federal standards for this toxin.Consum Rep. 2012; 77: 22Google Scholar, 9Hite A.H. Arsenic and rice: a call for regulation.Nutrition. 2013; 29: 353-354Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar, 10Navas-Acien A. Nachman K.E. Public health responses to arsenic in rice and other foods.JAMA Int Med. 2013; 173: 1395-1396Crossref PubMed Scopus (32) Google Scholar, 11Zhu Y. Williams P.N. Meharg A.A. Exposure to inorganic arsenic from rice: a global health issue?.Environ Pollut. 2008; 154: 169-171Crossref PubMed Scopus (316) Google Scholar Dietary exposure to arsenic is of particular concern for children for several reasons.5European Food Safety AuthorityPanel on contaminants in the food chain (CONTAM); scientific opinion on arsenic in food.EFSA J. 2009; (7; 67-72; 84-5; 89; 132-42)Google Scholar, 12Authority E.F.S. Dietary exposure to inorganic arsenic in the European population.EFSA J. 2014; (8; 28; 36-7; 42-5; 53-8)Google Scholar First, exposure to arsenic and other chemicals during critical windows of vulnerability in early childhood may result in greater health risks.12Authority E.F.S. Dietary exposure to inorganic arsenic in the European population.EFSA J. 2014; (8; 28; 36-7; 42-5; 53-8)Google Scholar, 13Meharg A.A. Sun G. Williams P.N. Adomako E. Deacon C. Zhu Y. et al.Inorganic arsenic levels in baby rice are of concern.Environ Pollut. 2008; 152: 746-749Crossref PubMed Scopus (151) Google Scholar Second, children typically have greater exposure to contaminants per unit body weight than adults14US Environmental Protection AgencyChild-Specific Exposure Factors Handbook. U.S. Environmental Protection Agency, Washington, DC2008Google Scholar in part because of their greater consumption rates and high caloric needs.15Jackson B.P. Taylor V.F. Punshon T. Cottingham K.L. Arsenic concentration and speciation in infant formulas and first foods.Pure Appl Chem. 2012; 84: 215-223Crossref PubMed Scopus (64) Google Scholar, 16Miller M.D. Marty M.A. Arcus A. Brown J. Morry D. Sandy M. Differences between children and adults: implications for risk assessment at California EPA.Int J Toxicol. 2002; 21: 403-418Crossref PubMed Scopus (103) Google Scholar Finally, children may also be more exposed to contaminants unique to certain foods because of their selective eating patterns and limited dietary choices.16Miller M.D. Marty M.A. Arcus A. Brown J. Morry D. Sandy M. Differences between children and adults: implications for risk assessment at California EPA.Int J Toxicol. 2002; 21: 403-418Crossref PubMed Scopus (103) Google Scholar For example, rice is used in many first foods15Jackson B.P. Taylor V.F. Punshon T. Cottingham K.L. Arsenic concentration and speciation in infant formulas and first foods.Pure Appl Chem. 2012; 84: 215-223Crossref PubMed Scopus (64) Google Scholar and is a key component of numerous processed foods marketed specifically to children.17Jackson B.P. Taylor V.F. Karagas M.R. Punshon T. Cottingham K.L. Arsenic, organic foods, and brown rice syrup.Environ Health Perspect. 2012; 120: 623-626Crossref PubMed Scopus (124) Google Scholar Thus, it is important for clinicians to become familiar with childhood arsenic exposure, potential health effects, and strategies to reduce exposure. Given the concern about children's consumption of arsenic in rice, the US Food and Drug Administration (FDA) has published brief statements on this topic to encourage families to eat a "well-balanced diet,"18FDA explores impact of arsenic in rice. US Food and Drug Administration, Silver Spring, MD2013http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm352569.htmGoogle Scholar and the American Academy of Pediatrics (AAP) suggests that cereals from other grains, finely chopped meats, and vegetable purees are equally acceptable as rice cereal for introduction as first foods,19AAP offers advice for parents concerned about arsenic in food. American Academy of Pediatrics, 2013https://www.aap.org/en-us/about-the-aap/aap-press-room/pages/AAP-Offers-Advice-For-Parents-Concerned-About-Arsenic-in-Food.aspxGoogle Scholar and to consider the use of alternatives, like oats and cornstarch, instead of rice, to thicken first foods.20AAP Arsenic in Rice Expert Work GroupAAP group offers advice to reduce infants' exposure to arsenic in rice.AAP News. 2014; 35: 13Google Scholar Both organizations, however, have not offered more specific guidance on this issue to the public. This Commentary aims to provide key information for health care providers faced with providing guidance on arsenic exposure from rice consumption for the children before more definitive guidance is issued. Health studies of ingested arsenic exposure are limited primarily to exposure from water. Worldwide, over 100 million people are exposed via contaminated drinking water,7Meharg A.A. Zhao F. Arsenic & Rice. Springer, New York2012Crossref Scopus (63) Google Scholar, 21Brammer H. Ravenscroft P. Arsenic in groundwater: a threat to sustainable agriculture in South and Southeast Asia.Environ Int. 2009; 35: 647-654Crossref PubMed Scopus (381) Google Scholar including more than 2 million Americans drinking water from private wells containing arsenic at concentrations above the current World Health Organization and US EPA maximum contaminant level (MCL) of 10 μg As/L.22Naujokas M.F. Anderson B. Ahsan H. Aposhian H.V. Graziano J.H. Thompson C. et al.The broad scope of health effects from chronic arsenic exposure: update on a worldwide public health problem.Environ Health Perspect. 2013; 121: 295-302Crossref PubMed Scopus (789) Google Scholar, 23George C.M. Smith A.H. Kalman D.A. Steinmaus C.M. Reverse osmosis filter use and high arsenic levels in private well water.Arch Environ Occupational Health. 2006; 61: 171-175Crossref PubMed Scopus (38) Google Scholar Nearly all of the arsenic in groundwater is in inorganic form, known to be toxic.24National Research Council (US)Subcommittee on arsenic in drinking water. National Academies Press, Washington, DC1999Google Scholar Numerous studies have linked chronic exposure to high levels of arsenic to adverse health effects in multiple organ systems including keratosis; skin, bladder and lung cancers; impaired intellectual function; bronchiectasis; coronary heart disease; and diabetes.2IARC Working Group on the Evaluation of Carcinogenic Risks to HumansArsenic, metals, fibres, and dusts.IARC Monogr Eval Carcinog Risks Hum. 2012; 100: 11-465PubMed Google Scholar, 3ATSDR Toxicological profile for arsenic. Agency for Toxic Substances and Disease Registry, Division of Toxicology, Atlanta, GA2007Google Scholar, 22Naujokas M.F. Anderson B. Ahsan H. Aposhian H.V. Graziano J.H. Thompson C. et al.The broad scope of health effects from chronic arsenic exposure: update on a worldwide public health problem.Environ Health Perspect. 2013; 121: 295-302Crossref PubMed Scopus (789) Google Scholar, 24National Research Council (US)Subcommittee on arsenic in drinking water. National Academies Press, Washington, DC1999Google Scholar According to the National Research Council, the current US EPA drinking water standard of 10 μg/L may be associated with an estimated lifetime excess cancer risk as high as 1 case in 300 people,24National Research Council (US)Subcommittee on arsenic in drinking water. National Academies Press, Washington, DC1999Google Scholar where a lifetime is considered to be 70 years of exposure. This is 3000 times higher than a commonly accepted cancer risk for an environmental carcinogen of 1 case in 1 000 000 people. Effects of prenatal and early childhood exposure to high levels of arsenic can be substantial.25Quansah R. Armah F.A. Essumang D.K. Luginaah I. Clarke E. Marfo K. et al.Association of arsenic with adverse pregnancy outcomes-infant mortality: a systematic review and meta-analysis.Environ Health Perspect. 2015; 123: 412-421PubMed Google Scholar, 26Laine J.E. Bailey K.A. Rubio-Andrade M. Olshan A.F. Smeester L. Drobna Z. et al.Maternal arsenic exposure, arsenic methylation efficiency, and birth outcomes in the biomarkers of exposure to ARsenic (BEAR) pregnancy cohort in Mexico.Environ Health Perspect. 2015; 123: 186-192Crossref PubMed Scopus (2) Google Scholar Arsenic readily passes through the placenta,1American Academy of PediatricsPediatric Environmental Health.in: Etzel R.A. Balk S.J. 3rd ed. AAP, Elk Grove Village, IL2011Google Scholar, 27Concha G. Vogler G. Lezcano D. Nermell B. Vahter M. Exposure to inorganic arsenic metabolites during early human development.Toxicol Sci. 1998; 44: 185-190Crossref PubMed Google Scholar and epidemiologic studies in Bangladesh, Chile, and Taiwan have linked in utero exposure to low birth weight,28Rahman A. Vahter M. Smith A.H. Nermell B. Yunus M. El Arifeen S. et al.Arsenic exposure during pregnancy and size at birth: a prospective cohort study in Bangladesh.Am J Epidemiol. 2009; 169: 304-312Crossref PubMed Scopus (205) Google Scholar spontaneous abortions, infant mortality,29Hopenhayn-Rich C. Browning S.R. Hertz-Picciotto I. Ferreccio C. Peralta C. Gibb H. Chronic arsenic exposure and risk of infant mortality in two areas of Chile.Environ Health Perspect. 2000; 108: 667-673Crossref PubMed Scopus (202) Google Scholar, 30Milton A.H. Smith W. Rahman B. Hasan Z. Kulsum U. Dear K. et al.Chronic arsenic exposure and adverse pregnancy outcomes in Bangladesh.Epidemiology. 2005; 16: 82-86Crossref PubMed Scopus (216) Google Scholar, 31Rahman A. Persson L.A. Nermell B. El Arifeen S. Ekstrom E.C. Smith A.H. et al.Arsenic exposure and risk of spontaneous abortion, stillbirth, and infant mortality.Epidemiology. 2010; 21: 797-804Crossref PubMed Scopus (147) Google Scholar, 32Rahman A. Vahter M. Ekstrom E.C. Rahman M. Golam Mustafa A.H. Wahed M.A. et al.Association of arsenic exposure during pregnancy with fetal loss and infant death: a cohort study in Bangladesh.Am J Epidemiol. 2007; 165: 1389-1396Crossref PubMed Scopus (178) Google Scholar and increased risk of lung cancer later in life.33Steinmaus C. Ferreccio C. Acevedo J. Yuan Y. Liaw J. Duran V. et al.Increased lung and bladder cancer incidence in adults after in utero and early-life arsenic exposure.Cancer Epidemiol Biomarkers Prev. 2014; 23: 1529-1538Crossref PubMed Scopus (121) Google Scholar Moreover, emerging evidence links maternal exposure to low doses of arsenic in drinking water (∼5-10 μg/L) during pregnancy to increased infections during infancy.34Farzan S.F. Karagas M.R. Chen Y. In utero and early life arsenic exposure in relation to long-term health and disease.Toxicol Appl Pharmacol. 2013; 272: 384-390Crossref PubMed Scopus (135) Google Scholar In contrast, there appears to be limited transfer of arsenic into breast milk in both highly exposed populations27Concha G. Vogler G. Lezcano D. Nermell B. Vahter M. Exposure to inorganic arsenic metabolites during early human development.Toxicol Sci. 1998; 44: 185-190Crossref PubMed Google Scholar, 35Fangstrom B. Moore S. Nermell B. Kuenstl L. Goessler W. Grandér M. et al.Breast-feeding protects against arsenic exposure in Bangladeshi infants.Environ Health Perspect. 2008; 116: 963-969Crossref PubMed Scopus (110) Google Scholar, 36Samanta G. Das D. Mandal B.K. Chowdhury T.R. Chakraborti D. Pal A. et al.Arsenic in the breast milk of lactating women in arsenic-affected areas of West Bengal, India and its effect on infants.J Environ Sci Health A Tox Hazard Subst Environ Eng. 2007; 42: 1815-1825Crossref PubMed Scopus (33) Google Scholar and less exposed populations,37Carignan C. Cottingham K. Jackson B. Farzan S. Gandolfi A. Punshon T. et al.Estimated exposure to arsenic in breastfed and formula-fed infants in a United States cohort.Environ Health Perspect. 2015; 123: 500-506PubMed Google Scholar, 38Björklund K.L. Vahter M. Palm B. Grandér M. Lignell S. Berglund M. Metals and trace element concentrations in breast milk of first time healthy mothers: a biological monitoring study.Environ Health. 2012; 11: 92-99Crossref PubMed Scopus (98) Google Scholar suggesting that breastfeeding may reduce exposure. Exposure may occur in formula-fed babies through both the formula powder and drinking water.15Jackson B.P. Taylor V.F. Punshon T. Cottingham K.L. Arsenic concentration and speciation in infant formulas and first foods.Pure Appl Chem. 2012; 84: 215-223Crossref PubMed Scopus (64) Google Scholar, 37Carignan C. Cottingham K. Jackson B. Farzan S. Gandolfi A. Punshon T. et al.Estimated exposure to arsenic in breastfed and formula-fed infants in a United States cohort.Environ Health Perspect. 2015; 123: 500-506PubMed Google Scholar Developing fetuses and children have both enhanced vulnerability and a longer post-exposure lifespan than adults. Effects with long latency periods, such as carcinogenic action, have a greater opportunity to manifest after early life exposure.16Miller M.D. Marty M.A. Arcus A. Brown J. Morry D. Sandy M. Differences between children and adults: implications for risk assessment at California EPA.Int J Toxicol. 2002; 21: 403-418Crossref PubMed Scopus (103) Google Scholar, 34Farzan S.F. Karagas M.R. Chen Y. In utero and early life arsenic exposure in relation to long-term health and disease.Toxicol Appl Pharmacol. 2013; 272: 384-390Crossref PubMed Scopus (135) Google Scholar Enhanced vulnerability was identified in research of heavily exposed populations in northern Chile that indicates in utero or early life exposures to ingested arsenic are associated with high mortality rates of bronchiectasis, acute myocardial infarction, and bladder, laryngeal, and lung cancers.39Smith A.H. Marshall G. Liaw J. Yuan Y. Ferreccio C. Steinmaus C. Mortality in young adults following in utero and childhood exposure to arsenic in drinking water.Environ Health Perspect. 2012; 120: 1527-1531Crossref PubMed Scopus (134) Google Scholar Recent data also suggest that in utero or early life exposure is associated with decreased lung function as adults40Dauphiné D.C. Ferreccio C. Guntur S. Yuan Y. Hammond S.K. Balmes J. et al.Lung function in adults following in utero and childhood exposure to arsenic in drinking water: Preliminary findings.Int Arch Occup Environ Health. 2011; 84: 591-600Crossref PubMed Scopus (95) Google Scholar and excess relative risks of lung cancer and bladder cancer, which are 2 to 4 times higher than those who were exposed later in life.33Steinmaus C. Ferreccio C. Acevedo J. Yuan Y. Liaw J. Duran V. et al.Increased lung and bladder cancer incidence in adults after in utero and early-life arsenic exposure.Cancer Epidemiol Biomarkers Prev. 2014; 23: 1529-1538Crossref PubMed Scopus (121) Google Scholar Early life exposure has also been associated with neurocognitive and motor impairment,41Hamadani J.D. Tofail F. Nermell B. Gardner R. Shiraji S. Bottai M. et al.Critical windows of exposure for arsenic-associated impairment of cognitive function in preschool girls and boys: A population-based cohort study.Int J Epidemiol. 2011; 40: 1593-1604Crossref PubMed Scopus (192) Google Scholar, 42Parvez F. Wasserman G.A. Factor-Litvak P. Liu X. Slavkovich V. Siddique A.B. et al.Arsenic exposure and motor function among children in Bangladesh.Environ Health Perspect. 2011; 119: 1665Crossref PubMed Scopus (126) Google Scholar, 43Wasserman G.A. Liu X. Parvez F. Ahsan H. Factor-Litvak P. van Geen A. et al.Water arsenic exposure and children's intellectual function in Araihazar, Bangladesh.Environ Health Perspect. 2004; 112: 1329-1333Crossref PubMed Scopus (536) Google Scholar, 44Wasserman G.A. Liu X. Parvez F. Ahsan H. Factor-Litvak P. Kline J. et al.Water arsenic exposure and intellectual function in 6-year-old children in Araihazar, Bangladesh.Environ Health Perspect. 2007; 115: 285-289Crossref PubMed Scopus (260) Google Scholar as well as decreased IQ.45Wasserman G.A. Liu X. Loiacono N.J. Kline J. Factor-Litvak P. van Geen A. et al.A cross-sectional study of well water arsenic and child IQ in Maine schoolchildren.Environ Health. 2014; 13: 23Crossref PubMed Scopus (118) Google Scholar Literature regarding the presence of arsenic in rice prompted the US FDA to extensively test different brands of rice grains and rice products sold in the US for inorganic arsenic.46Arsenic in rice and rice products. United States Food and Drug Administration, Silver Spring, MD2014http://www.fda.gov/food/foodborneillnesscontaminants/metals/ucm319870.htmGoogle Scholar Based on data published in 2013, all of the 1343 samples contained inorganic arsenic. Though there is a variable amount of arsenic in the products sampled, nearly one-third (30%) contained high levels of inorganic arsenic (>4 μg per serving), which at a consumption rate of 2.5 servings a day could pose an estimated lifetime excess cancer risk at or above 1 case in 300 people, by comparison with the current water MCL. One of the hot rice bran cereals sampled, though an outlier, contained as much as 30 μg of inorganic arsenic per serving.46Arsenic in rice and rice products. United States Food and Drug Administration, Silver Spring, MD2014http://www.fda.gov/food/foodborneillnesscontaminants/metals/ucm319870.htmGoogle Scholar Moreover, many of the products containing high levels of arsenic may be consumed by children, including rice cakes and bakery mixes/pudding.46Arsenic in rice and rice products. United States Food and Drug Administration, Silver Spring, MD2014http://www.fda.gov/food/foodborneillnesscontaminants/metals/ucm319870.htmGoogle Scholar Rice generally contains more arsenic than other grains because of its anaerobic growing environment and unique physiology. In flooded rice paddies, arsenic is brought into the plant by its silicon transporters, and then used in place of silicon to strengthen the plant stem and husks, including the part of the plant we eat.7Meharg A.A. Zhao F. Arsenic & Rice. Springer, New York2012Crossref Scopus (63) Google Scholar There is wide variation in total and inorganic arsenic concentrations across different types of rice and growing locations. Limited sampling indicates that in general, rice grown in the South Central US (Arkansas, Missouri, Louisiana, and Texas) contains more arsenic than rice grown in California.7Meharg A.A. Zhao F. Arsenic & Rice. Springer, New York2012Crossref Scopus (63) Google Scholar, 47Williams P. Raab A. Feldmann J. Meharg A. Market basket survey shows elevated levels of as in south central US processed rice compared to California: consequences for human dietary exposure.Environ Sci Technol. 2007; 41: 2178-2183Crossref PubMed Scopus (228) Google Scholar This may in part be a result of the historical application of arsenic-containing pesticides from the legacy of cotton production in the region, which has since been converted to rice production.7Meharg A.A. Zhao F. Arsenic & Rice. Springer, New York2012Crossref Scopus (63) Google Scholar, 47Williams P. Raab A. Feldmann J. Meharg A. Market basket survey shows elevated levels of as in south central US processed rice compared to California: consequences for human dietary exposure.Environ Sci Technol. 2007; 41: 2178-2183Crossref PubMed Scopus (228) Google Scholar In comparing across types and locations, inorganic arsenic concentrations appear to be lowest in sushi rice from the US and Basmati rice from California, India, or Pakistan.48Report: Analysis of arsenic in rice and other grains. Consumer Reports, 2014http://www.greenerchoices.org/pdf/CR_FSASC_Arsenic_Analysis_Nov2014.pdfGoogle Scholar Within any one type of rice, brown rice contains more arsenic than white rice because arsenic accumulates in the bran, which is the hard outer layer of the grain seen in brown rice.7Meharg A.A. Zhao F. Arsenic & Rice. Springer, New York2012Crossref Scopus (63) Google Scholar, 8Arsenic in your food: our findings show a real need for federal standards for this toxin.Consum Rep. 2012; 77: 22Google Scholar Removal of this layer produces white rice, thereby eliminating a portion of the arsenic. However, the bran also contains nutritious fiber and vitamins,7Meharg A.A. Zhao F. Arsenic & Rice. Springer, New York2012Crossref Scopus (63) Google Scholar so even though brown rice on average contains more inorganic arsenic, it also provides more nutrition. Studies conducted in the US have shown a positive relationship between rice consumption and urinary arsenic excretion, which is directly related to overall arsenic exposure.49Orloff K. Mistry K. Metcalf S. Biomonitoring for environmental exposures to arsenic.J Toxicol Environ Health B Crit Rev. 2009; 12: 509-524Crossref PubMed Scopus (100) Google Scholar Cleland et al found a statistically significant association between rice consumption and urinary arsenic excretion in 67 women of childbearing age of Korean descent from Washington State.50Cleland B. Tsuchiya A. Kalman D.A. Dills R. Burbacher T.M. White J.W. et al.Arsenic exposure within the Korean community (United States) based on dietary behavior and arsenic levels in hair, urine, air, and water.Environ Health Perspect. 2009; 117: 632-638Crossref PubMed Scopus (42) Google Scholar Rice was a major source of inorganic arsenic exposure for this population, with an estimated average intake of 16.3 μg of inorganic arsenic from rice per day,50Cleland B. Tsuchiya A. Kalman D.A. Dills R. Burbacher T.M. White J.W. et al.Arsenic exposure within the Korean community (United States) based on dietary behavior and arsenic levels in hair, urine, air, and water.Environ Health Perspect. 2009; 117: 632-638Crossref PubMed Scopus (42) Google Scholar comparable with drinking 1.6 L of water at the current US EPA MCL. Another study analyzed 229 pregnant women in New Hampshire who drank private, unregulated well water and found an association between rice consumption and urinary arsenic excretion after correcting for water exposure.51Gilbert-Diamond D. Cottingham K.L. Gruber J.F. Punshon T. Sayarath V. Gandolfi A.J. et al.Rice consumption contributes to arsenic exposure in US women.Proc Natl Acad Sci U S A. 2011; 108: 20656-20660Crossref PubMed Scopus (261) Google Scholar Each 1 g increase in rice intake was associated with a 1% increase in urinary total arsenic, such that eating 0.56 cups of cooked rice was considered comparable with drinking 1 L/d of water at the current US EPA MCL.51Gilbert-Diamond D. Cottingham K.L. Gruber J.F. Punshon T. Sayarath V. Gandolfi A.J. et al.Rice consumption contributes to arsenic exposure in US women.Proc Natl Acad Sci U S A. 2011; 108: 20656-20660Crossref PubMed Scopus (261) Google Scholar The European Food Safety Authority has reported that dietary exposure to inorganic arsenic for children under 3 years old is about 3 times higher than that of adults based on kilogram body weight,5European Food Safety AuthorityPanel on contaminants in the food chain (CONTAM); scientific opinion on arsenic in food.EFSA J. 2009; (7; 67-72; 84-5; 89; 132-42)Google Scholar, 12Authority E.F.S. Dietary exposure to inorganic arsenic in the European population.EFSA J. 2014; (8; 28; 36-7; 42-5; 53-8)Google Scholar due in part to the types of foods infants and young children consume. Elevated levels of inorganic arsenic have been found in foods commonly eaten by infants and toddlers, including rice cereals (a common first food), pureed foods, and products sweetened with brown rice syrup.13Meharg A.A. Sun G. Williams P.N. Adomako E. Deacon C. Zhu Y. et al.Inorganic arsenic levels in baby rice are of concern.Environ Pollut. 2008; 152: 746-749Crossref PubMed Scopus (151) Google Scholar, 15Jackson B.P. Taylor V.F. Punshon T. Cottingham K.L. Arsenic concentration and speciation in infant formulas and first foods.Pure Appl Chem. 2012; 84: 215-223Crossref PubMed Scopus (64) Google Scholar, 17Jackson B.P. Taylor V.F. Karagas M.R. Punshon T. Cottingham K.L. Arsenic, organic foods, and brown rice syrup.Environ Health Perspect. 2012; 120: 623-626Crossref PubMed Scopus (124) Google Scholar, 52Carbonell-Barrachina Á.A. Wu X. Ramírez-Gandolfo A. Norton G.J. Burló F. Deacon C. et al.Inorganic arsenic contents in rice-based infant foods from Spain, UK, China, and USA.Environ Pollut. 2012; 163: 77-83Crossref PubMed Scopus (105) Google Scholar, 53Yost L. Tao S. Egan S. Barraj L. Smith K. Tsuji J. et al.Estimation of dietary intake of inorganic arsenic in US children.Hum Ecol Risk Assess. 2004; 10: 473-483Crossref Scopus (69) Google Scholar Based on measurements of arsenic concentrations by the US FDA, exposure to inorganic arsenic via just one 17-g serving of infant rice cereal per day is estimated to be 0.22-0.60 μg kg−1 d−1 in 6 to 12-month-old infants (Carignan et al, unpublished data)—an intake well above the 0.17 μg kg−1 d−1 calculated by Meharg et al13Meharg A.A. Sun G. Williams P.N. Adomako E. Deacon C. Zhu Y. et al.Inorganic arsenic levels in baby rice are of concern.Environ Pollut. 2008; 152: 746-749Crossref PubMed Scopus (151) Google Scholar to be equivalent in dose to the water MCL threshold established by the US EPA. During the toddler years, lactose-intolerant children may be offered rice milk, which has an average inorganic arsenic concentration of 11.7 μg/L,12Authority E.F.S. Dietary exposure to inorganic arsenic in the European population.EFSA J. 2014; (8; 28; 36-7; 42-5; 53-8)Google Scholar higher than the water standard.54Survey of total and inorganic arsenic in rice drinks. Food Standards Agency, London2009http://tna.europarchive.org/20140306205048/http://www.food.gov.uk/science/research/surveillance/fsisbranch2009/survey0209Google Scholar For this reason, the United Kingdom Food Standards Agency recommends that children under 4.5 years of age not use rice milk as a milk substitute.54Survey of total and inorganic arsenic in rice drinks. Food Standards Agency, London2009http://tna.europarchive.org/20140306205048/http://www.food.gov.uk/science/research/surveillance/fsisbranch2009/survey0209Google Scholar Thus, infants or toddlers consuming rice-containing products may regularly be exposed to unacceptably high levels of arsenic. Of American children between 1 and 6 years old who have the highest dietary exposure to arsenic (ie, 95th percentile), rice and rice products contribute about 50% of their exposure.53Yost L. Tao S. Egan S. Barraj L. Smith K. Tsuji J. et al.Estimation of dietary intake of inorganic arsenic in US children.Hum Ecol Risk Assess. 2004; 10: 473-483Crossref Scopus (69) Google Scholar Twenty percent of the 2323 children between ages 6 and 17 years sampled in the National Health and Nutrition Examination Survey between 2003 and 2008 reported eating the equivalent of at least one-quarter cup of cooked rice per day.56Davis M.A. Mackenzie T.A. Cottingham K.L. Gilbert-Diamond D. Punshon T. Karagas M.R. Rice consumption and urinary arsenic concentrations in US children.Environ Health Perspect. 2012; 120: 1418-1424Crossref PubMed Scopus (125) Google Scholar Mean urinary arsenic concentratio
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