Risk of Ill-Informed Decision-Making When Choosing ...

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Risk of Ill-Informed Decision-Making When Choosing Your Favorite Fish a

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Darren G. Rumbold , Marc Engel & Donald M. Axelrad a

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Florida Gulf Coast University, Ft. Myers, FL, USA

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Florida Department of Agriculture and Consumer Services, Chemical Residue Laboratory, Tallahassee, FL, USA c

Florida Department of Environmental Protection, Tallahassee, FL, USA Available online: 20 Sep 2011

To cite this article: Darren G. Rumbold, Marc Engel & Donald M. Axelrad (2011): Risk of Ill-Informed Decision-Making When Choosing Your Favorite Fish, Human and Ecological Risk Assessment: An International Journal, 17:5, 1156-1169 To link to this article: http://dx.doi.org/10.1080/10807039.2011.605729

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Risk of Ill-Informed Decision-Making When Choosing Your Favorite Fish Darren G. Rumbold,1 Marc Engel,2 and Donald M. Axelrad3 Florida Gulf Coast University, Ft. Myers, FL, USA; 2Florida Department of Agriculture and Consumer Services, Chemical Residue Laboratory, Tallahassee, FL, USA; 3Florida Department of Environmental Protection, Tallahassee, FL, USA

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ABSTRACT Risk to children of women who choose a favorite fish without regard to its methylmercury or omega-3 content was estimated under three consumption scenarios: (1) current fish consumption rate by U.S. women if limited to orange roughy (Hoplostethus atlanticus), (2) 12 oz of roughy per week, and (3) roughy consumption to meet docosahexaenoic acid (DHA) requirements. Risks were similarly assessed if king mackerel (Scomberomorus cavalla) were eaten. Based on mercury concentrations in fillets purchased from 2004–2007 (0.73 ± 0.29 mg Hg/kg; n = 45), women would have an 85% probability of exceeding USEPA’s reference dose (RfD) if they ate only roughy. Based on literature-derived concentrations, they would have a 91% probability of exceeding the RfD if they ate only mackerel. Increasing consumption of either fish to 12 oz per week would increase their probability of exceeding the RfD to 100%. Attempting to meet DHA requirements through eating these fish also results in a 100% probability of exceeding the RfD; however, owing to its very low DHA content, roughy consumption would result in exceedance by 100-fold. These results highlight recommendations of others that benefits and risks of fish consumption should be presented together to enable consumers to make informed decisions. Key Words:

orange roughy, king mackerel, mercury, methylmercury, Docosahexaenoic acid, DHA, probabilistic.

INTRODUCTION The neurotoxic effects of methylmercury are well documented for both children and adults (for review, see NRC 2000). Yet, dietary guidance on exposures to methylmercury (MeHg) through fish consumption is one of the most widely discussed and controversial topics in food safety today. To increase consistency in Received 21 March 2010; revised manuscript accepted 5 August 2010. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors; there are no conflicts of interest. Address correspondence to Dr. Darren Rumbold, Florida Gulf Coast University, 10501 FGCU Blvd. South, Ft. Myers, FL 33965, USA. E-mail: [email protected] 1156


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pubic health guidance at the federal level, the U.S. Environmental Protection Agency (USEPA) and the U.S. Food and Drug Administration (USFDA) issued a joint fish consumption advisory in 2004 for women who might become pregnant, women who are pregnant, nursing mothers, and young children. The advisory recommended these groups: (1) avoid eating four kinds of fish (e.g., shark, swordfish, king mackerel, and tilefish), (2) eat up to 12 ounces a week of a variety of fish and shellfish that are lower in mercury, and (3) check local advisories about the safety of fish caught by family and friends in local lakes, rivers, and coastal areas (USEPA/USFDA 2004). The two agencies arrived at this point taking very different paths in terms of both exposure assessment and dose–response assessment. This is not surprising given their different statutory mandates (for review, see NRC 2000). USEPA had published three separate dose–response assessments and reference doses (RfDs) for methylmercury since 1985 (USEPA 2001). Similarly, USFDA’s mercury action level—the regulatory guideline for seafood sold in interstate commerce—has been re-evaluated several times since it was established (United States v. Anderson Seafoods, Inc. 1978; USFDA 2000; Carrington et al. 2004). Yet, the 2004 joint fish consumption advisory did little to end the controversy or to stop the criticism in the press directed primarily at the USFDA (Roe and Hawthorne 2005; Waldman 2005). More recently, USFDA released a draft risk and benefit assessment report of consumption of commercial fish (USFDA 2009) that immediately prompted more criticism (Hawthorne 2008; Houlihan and Lunder 2009), even from the USEPA (Keehner 2009). One of the main criticisms of USFDA’s draft report was that by relying on average fish methylmercury concentrations, average bodyweight, and national average composite diets and fish consumption rates, USFDA’s models focused on the average consumer rather than on highly exposed individuals or sensitive populations (Houlihan and Lunder 2009; Keehner 2009). Central to USFDA’s argument for basing their model on averages is the assumption that if women randomly select fish repeatedly over time, their exposure over time will be equivalent to eating a fish with the mean concentration. This argument also extends to fish consumption patterns (e.g., fish meal frequency, portion size, and fish species selected). Results from several studies, however, indicate fish consumption patterns of sub-populations may differ due to ethnicity, region of the county (e.g., coastal areas versus other areas, by state), and income (Degner et al. 1994; Burger et al. 2001; Sechena et al. 2003; Karouna-Renier et al. 2008; Moya et al. 2008; Tsuchiya et al. 2009; Mahaffey et al. 2009; for review, see IOM 2007). Further, there may also be subgroups that, for health reasons, preferentially choose fish as their primary protein source. Moreover, most people do not select their fish dishes at random. Instead they preferentially select certain favorite species to recreationally fish for, or to purchase; sometimes to surprising extremes. There have been numerous reports of individuals consuming multiple meals of canned tuna per week, even by woman during pregnancy (Björnberg et al. 2003), with some individuals consuming one tuna meal every day (Kales and Goldman 2002; Knobeloch et al. 2006; Ho et al. 2009) or more (Golding and Fenton 2010). Besides tuna, there have been reported cases where: an individual consumed 14 meals of swordfish per month (Hightower and Moore 2003), a family consumed Chilean sea bass twice a week for 9 months (Knobeloch et al. 2006), a Hum. Ecol. Risk Assess. Vol. 17, No. 5, 2011

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individual ate king mackerel twice a week for 6 months (Hightower and Moore 2003), and where another individual ate northern pike two or three times a week for more than 30 years (Knobeloch et al. 2006). Not surprisingly, all of these individuals had elevated mercury. A further criticism of USFDA involved the way they composite samples in surveys of mercury levels in fish, especially tuna (USFDA 2003a; Roe and Hawthorne 2006). There was a concern that compositing would, by physical averaging, mask any extreme levels of mercury in the samples. USFDA (2003a) responded that the distributions used in modeling concentrations could be widened to correct for the effect of compositing; however, “since high mercury exposures do not occur as the result of the consumption of a single fish” they did not expect this would significantly affect the exposures. Controversy remains, however, regarding bolus dose exposures as it relates to both potential effects to the individual (Ginsberg and Toal 2000; Castoldi et al. 2008a) and exposures to populations, which may account for differences in results seen in the Faroe Islands and Seychelles studies (Castoldi et al. 2008b; for review, see Stern et al. 2004). There was confusion also regarding the bolus dose issue as it might relate to the “do not eat” grouping and to USFDA’s action level. A recent report (Great Lakes Consortium 2007) surmised that eliminating the option of six meals per year advice for fish with very high mercury content, which had been included in previous advisories, “makes the ‘do not’ eat cut-off equal to the USFDA action level and addresses the issue of bolus doses.” A lack of transparency, including how canned white tuna was placed in the low-mercury group, is another criticism leveled at USFDA (Waldman 2005). The continued lack of transparency is somewhat surprising given that USFDA had recognized the need for objective criteria to define high-, mid-, and low-mercury fish and a protocol for adding and deleting fish from the “do not eat” list in 2003 (USFDA 2003b). Public health recommendations regarding the benefits of fish consumption that ignore the risks of mercury exposure add to the confusion (IOM 2007; for review, see Santerre 2008). Fish are clearly an important source of protein and essential micronutrients, especially long-chain n-3 polyunsaturated (omega-3) fatty acids including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Several recent works (Cohen et al. 2005; Mozaffarian and Rimm 2006; Innis 2007; IOM 2007) have reviewed the available literature and found DHA intake by pregnant woman and infants to be associated with clear benefits in a range of developmental outcomes. The conflicting messages in fish consumption advisories was recently illustrated by a statement released by National Healthy Mothers, Healthy Babies Coalition that advised pregnant woman to eat “at least” 12 ounces of fish each week (Couzin 2007). In this article, the risk of developmental toxicity due to mercury exposure is examined under three different consumption scenarios involving a single fish species, the orange roughy (Hoplostethus atlanticus), which is not on the USEPA/USFDA “do not eat” list but that is relatively high in methylmercury and very low in DHA content. For comparative purposes, we examined the risk from these consumption scenarios where women of childbearing age consumed only king mackerel (Scomberomorus cavalla), a fish that is on the “do not eat” list and has moderate DHA content. Given the case histories reported above, it is easily conceivable that a small number of women 1158

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might select one of these species as their favorite fish and consume it multiple times a week during their pregnancy. The simplified consumption scenarios used here provide extreme (but not 0% probability) examples of fish consumption patterns to highlight information that should be taken into account by expert panels when developing consumption advisories, and by women when choosing a favorite fish.

METHODS Daily estimates of mercury intake were calculated using a simplified dietary exposure model (USEPA 2001; Health Canada 2007a) that incorporated fish mercury concentrations, daily fish consumption, and bodyweight of the population of concern. To capture combinations of factors that might lead to the maximum exposure under these scenarios, a probabilistic approach was employed through the use of Monte Carlo sampling with each iteration randomly selecting one value from Hg concentration, fish consumption, and bodyweight distributions to estimate a possible daily exposure (Johnston and Snow 2007; Hsiao et al. 2010). Each Monte Carlo simulation went through 2000 iterations using a Latin hypercube sampling routine in the Crystal Ball software (Oracle, Denver, CO). The distribution of bodyweights for U.S. woman of childbearing age (Table 1) was based on data from the 2003–2004 and 2005–2006 National Health and Nutrition Examination Survey (NHANES; National Center for Health Statistics 2008). NHANES is a program of the National Center for Health Statistics within the Centers Table 1.

Scenario 1

2 3

Fish consumption scenarios, parameter values, and distributions used to estimate mercury exposure to U.S. women of childbearing age (15–44 years old; bodyweight geometric mean ± GSD: 69.6 ± 1.3 kg∗ ). Daily fish consumption Current uncooked fish consumption rate: Mean = 236.56 mg/kg bw/day, 95th% = 1,361.81 mg/kg bw/day (USEPA 2002) modeled as normal distribution, lower tail truncated at 0 mg/kg bw/day. USEPA/USFDA recommendation of 12 oz cooked fish per week or 453.6 g uncooked (USEPA/USFDA 2004) modeled as a point estimate. Daily consumption of fish necessary to ensure a DHA intake of 300 mg/d† modeled as a point estimate; DHA concentration for a given species† modeled either as a normal distribution or point estimate depending on available data.

∗

Based on pooled data from 2003–2004 and 2005–2006 National Health and Nutrition Examination Survey (National Center for Health Statistics 2008; n for age range = 3679). Bodyweight was modeled using a lognormal distribution (cf. Portier et al. 2007) truncated at ±2 SD to avoid the simulation of implausibly low or high values. † Based on recommendation for pregnant and lactating woman (Simopoulos et al. 1999). † Raw orange roughy reported to contain 15 ± 12 mg of DHA/100 g fish (USDA 2008; n = 3); modeled as a normal distribution truncated at ±2 SD; raw king mackerel reported to contain on average 177 mg DHA/100 g fish (USDA 2008; n = 2); modeled as a point estimate. Hum. Ecol. Risk Assess. Vol. 17, No. 5, 2011

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for Disease Control and Prevention. It combines interviews and physical examination of a nationally representative sample of about 5000 persons each year (for more information, see http://www.cdc.gov/nchs/nhanes/about nhanes.htm). Simulations involved three different daily fish consumption rates, of either only orange roughy or only king mackerel: (1) current uncooked fish consumption rate by U.S. woman of childbearing age (age 15–44), 2) the USEPA/USFDA recommendation of 12 oz of fish per week (USEPA/USFDA 2004) and, 3) daily consumption of fish necessary to meet the recommend DHA intake for pregnant and lactating women (Simopoulos et al. 1999; Table 1). The current uncooked fish consumption rate by U.S. women of childbearing age was based on the U.S. Department of Agriculture’s (USDA’s) 1994–1996 and 1998 Continuing Survey of Food Intakes by Individuals (CSFII; USEPA 2002). The USDA’s CSFII is a national survey conducted according to a stratified, multi–area probability sample organized using estimates of the 1990 U.S. population (USEPA 2002). Survey participants provided two non–consecutive, 24-h days of dietary data (sample size for women in this age group was 2275). Both days’ dietary recall information, on meals consumed at and away from home, was collected by an in-home interviewer. The Day 2 interview occurred three to ten days after the Day 1 interview but not on the same day of the week (USEPA 2002). Because virtually all of the mercury in muscle tissue of fish is present in the methylated form (Bloom 1992), fish tissues are typically analyzed for total mercury, which is a more straightforward and less costly procedure than for methylmercury, and interpreted as being equivalent to the analysis of methylmercury. Mercury concentration in orange roughy was modeled as a log-normal distribution with an arithmetic average of 0.73 mg Hg/kg (geometric mean of 0.68 mg Hg/kg) and a standard deviation of 0.29 mg/kg (maximum concentration was 1.66 mg Hg/kg), without truncation. This distribution was generated from analyses of 45 orange roughy samples haphazardly purchased from retail outlets throughout the state of Florida (USA) from July 2004–October 2007 by the Food Laboratory of the Florida Department of Agriculture and Consumer Services (Tallahassee, FL). Total mercury concentration was determined in representative portions of fillets by microwave (CEM MARSX, Matthews, NC) digestion in 5 ml of Optima grade HNO3 followed by inductivelycoupled plasma mass spectrometry (ICP-MS; Perkin Elmer Sciex Elan 6100). A rinse solution of 200 ppb Au and 5% HNO3 was used between each sample analysis to help ensure that carryover did not occur. Quality control check samples included, among others: laboratory reagent blanks after every 10 fish samples, internal standards, a previously analyzed proficiency sample, and analyses of standard reference materials, SRM 1641d (NIST, Gaithersburg, MD), following each set of ten samples and at the end of the analytical run. A method quantification level of 25 ppb has been established by an in-house method validation. All samples were analyzed in duplicate. Mercury concentration in king mackerel was modeled as log-normal distribution with an arithmetic average of 1.55 mg Hg/kg (geometric mean of 1.26 mg Hg/kg) and a standard deviation of 1.05 mg Hg/kg, without truncation. This was based on data on 135 fish (>610 mm in fork length, that is, administrative censoring at legal size in state and federal waters) collected from 1994 to 2002 from nearshore and offshore waters of Florida’s gulf coast (Adams and McMichael 2007; dataset provided by D. Adams, Florida Fish and Wildlife Conservation Commission). 1160




Effects assessment was based on USEPA’s methylmercury reference dose (RfD) of 0.1 µg/kg bw/day (USEPA 2001). The RfD is defined as the “estimate (with uncertainty spanning perhaps an order of magnitude) of a daily exposure to the human population (including sensitive subgroups) that is likely to be without an appreciable risk of deleterious health effects during a lifetime” (USEPA 2001). The health endpoint was developmental neurotoxicity. It should be noted, however, that even then USEPA recognized that evidence was emerging that suggested cardiovascular toxicity could occur from low-dose methylmercury exposure (USEPA 2001). More recent data suggests the assumption that developmental toxicity was more sensitive than cardiovascular effects in adults may not hold (Rice 2004).

RESULTS AND DISCUSSION Results of simulations indicated that, if women were to choose to eat only orange roughy or only king mackerel as their favorite fish at the current (all species) fish consumption rate by U.S. women (age 15–44 years; USEPA 2002), they would have an 85% and 91% probability of exceeding the RfD, respectively (Figures 1 and 2). If women increased their fish consumption of one or the other of these fish to the recommended 12 oz per week (USEPA/USFDA 2004), the likelihood of exceeding the RfD would be 100% for both species. The markedly higher daily methylmercury intake simulated if king mackerel were the favorite species, under both the current and recommended consumption rates (Figures 1 and 2), was directly due to higher mercury concentrations in king mackerel as compared to orange roughy. Although the power of the probabilistic approach was underutilized in the present study due to the simplified consumption scenarios, these results nonetheless demonstrate its advantages over a deterministic approach where a single value is used for each of the input variables that generate in a single exposure forecast. The many advantages of probabilistic techniques (e.g., allows maximal use of all available data, allows for separation of natural variability from incertitude, and it reveals compounded conservatisms) have long been recognized (Burmaster 1996). As argued by Johnston and Snow (2007), basing fish advisories on average fish methylmercury concentrations, average consumption rates, and average bodyweights may not provide protection for the entire population, as subpopulations may have characteristics that differ significantly from mean population values. The most important advantage of a probabilistic approach is that it allows examination of the entire distribution of possible exposures (Burmaster 1996, see also Hsiao et al. 2010), especially its right tail, and investigation of the underlying factors responsible for the distribution. Monte Carlo simulations in the present assessment resulted in daily methylmercury intakes higher than would have occurred if fish methylmercury concentrations were based on values published in USFDA’s database, even if USFDA’s exposure model had been used. The distribution of tissue mercury concentrations reported here for orange roughy were significantly higher (ln transformed, F = 13.054; df = 1, 92; p < .001) than values in the USFDA database (USFDA 2006); mean = 0.554 mg/kg, maximum = 0.855 mg Hg/kg, n = 49 total Hg values). Similarly, tissue mercury concentrations used here for king mackerel were markedly higher than the values published in USFDA’s database (USFDA 2006), which was based on Hum. Ecol. Risk Assess. Vol. 17, No. 5, 2011

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Figure 1.

Comparison of reverse cumulative distribution of simulated daily mercury dose from a diet of orange roughy based on: (a) current (all species) fish consumption rate by U.S. women of childbearing age or, (b) 12 ounces cooked fish per week, relative to the RfD (0.1 µg/kg BW/d). The ordinate value (y) represents the probability of exceeding the daily Hg dose on the abscissa.

grand mean of site means, some of which represented up to 26 fish, reported in Ache et al. (2000). In concurrence with these results, Burger et al. (2005) also found higher mean mercury levels in fillets of a number of fishes purchased in stores in New Jersey as compared to data for those species in the database maintained by USFDA (2006). Further, although average concentrations were similar, Burger and Gochfeld (2006) found several orange roughy fillets purchased from stores in Chicago in 2005 exceeded the maximal values reported in USFDA’s database with 5% of values exceeding the USFDA action level. In the present study, 15% of the orange roughy exceeded the 1 mg/kg USFDA action level. Burger et al. (2005) suggested the disagreement between datasets could be a result of differences in source (i.e., population fished or harvest area), year of collection, differences in fish sizes, use of composite samples or all of the above. In a recent market analysis, orange roughy were found to be imported into the United States from New Zealand, Australia, China, Chile, and Namibia (Seafood Market Analyst 2005). It is highly likely that Hg concentrations differ among different fish populations due to regional differences in methylmercury availability. Mercury concentrations are known to differ, for example, between Atlantic and 1162




Figure 2.

Comparison of reverse cumulative distributions of simulated daily mercury dose from a diet of king mackerel based on: (a) current (all species) fish consumption rate by U.S. women of childbearing age or, (b) 12 ounces cooked fish, relative to the RfD (0.1 µg/kg BW/d).

Gulf of Mexico populations of king mackerel (Adams and McMichael 2007). Of the orange roughy purchased for the present study where nation of origin was available, most came from China but a few were from Australia and New Zealand. The origin of the orange roughy in the USFDA or Burger and Gochfeld (2006) datasets is unknown. The orange roughy data published in the USFDA database were for fish collected from 1990–2004, whereas the orange roughy for this assessment were purchased from 2004–2007. Consequently, a temporal change in mercury concentrations in the fish or a change in regional wholesale seafood distributions cannot be ruled out. Recommendations have previously been made that USFDA continuously monitor mercury concentrations in fish and update its database to account for possible changes in mercury levels over time or due to changes in seafood source (Burger and Gochfeld 2006; IOM 2007). Alternatively, the observed differences between the tissue mercury concentration distributions, particularly the truncation of the right tail (which, if considerable, could skew the average), may be a result of composite sampling by the USFDA. Unquestionably, composite sampling is a cost-effective method for analyzing a large number of samples and may be satisfactory for estimating the mean of a distribution. Hum. Ecol. Risk Assess. Vol. 17, No. 5, 2011

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Figure 3.

Comparison of reverse cumulative distributions of simulated daily mercury dose from consuming: (a) orange roughy or, (b) king mackerel sufficient to satisfy a DHA intake of 300 mg/d.

Composite sampling is recommended by USEPA in their guidance for assessing chemical contaminant data for use in fish advisories; however, they do recognize its limitations, that is, information on extreme levels in individual sample units is lost (USEPA 2000). They also acknowledge that there are some situations in which individual fish analysis can be more appropriate from a risk assessment perspective (USEPA 2000). Much of the debate on composite sampling centers on whether the toxicant is chronic or acute. As discussed previously, uncertainty remains regarding the importance of a bolus dose (Ginsberg and Toal 2000; Castoldi et al. 2008a). In Figure 3 are presented the reverse cumulative distribution functions of simulated daily fish consumption if pregnant or nursing women tried to achieve the recommended DHA intake of 300 mg/day (Simopoulos et al. 1999) by consuming only orange roughy or only king mackerel. Owing to its very low DHA content, an implausibly high amount of orange roughy would need to be eaten per day (about 2 kg) to satisfy this nutritional recommendation. At this level of orange roughy consumption, there would be a 100% probability of not only exceeding the RfD but of exceeding it by 100-fold (11.41 µg/kg bw/d; Figure 3a). The daily recommended level of DHA could more reasonably be achieved by eating king mackerel because it contains a 12-fold higher concentration of DHA as compared to orange roughy (i.e., only 0.169 kg of king mackerel would have to be eaten). This rate of consumption of 1164




mackerel also ensures a 100% probability of exceeding the RfD, but the magnitude of exceedance (i.e., dose) is much smaller. Clearly, the point to be made from these simulations is that women should not try to meet their DHA needs with orange roughy or king mackerel. Consumers may also preferentially choose fish high in DHA for other potential benefits, including cardiovascular health (for review, see IOM 2007 or Santerre 2008). It is interesting to note that despite its recognized low DHA content and relatively high mercury concentrations (see American Heart Association webpage; http://www.americanheart.org/presenter.jhtml?identifier=3013797 [accessed July 30, 2010]) that the American Heart Association webpage includes a recipe for “Broiled Orange Roughy Parmesan” and identifies it as “heart healthy” (http://www.americanheart.org/presenter.jhtml?identifier=3064528 [accessed July 30, 2010]). The results of this assessment serve to highlight recommendations of others (Joint FAO/WHO Expert Committee on Food Additives 2003; Levenson and Axelrad 2006; Ginsberg and Toal 2009) that benefits and risks of fish consumption should be presented together to enable consumers to make informed decisions. Together this information should serve also as criteria for establishing simplified groupings for public health advisories (Santerre 2008). Results presented here indicate that the Joint FAO/WHO Expert Committee on Food Additives (JECFA), USEPA, USFDA and other groups issuing consumption advisories should also revisit the classification of orange roughy and determine if it should no longer be categorized in the medium-Hg level group but instead be placed in the high-mercury group. More importantly, based on a qualitative analysis of benefit–risk tradeoffs, these groups should consider advising consumers not to choose orange roughy to meet their DHA needs. A similar conclusion is advanced if orange roughy is subjected to a more quantitative analysis developed by Ginsberg and Toal (2009) that integrates omega-3 benefits and MeHg risks. Using their model, the net effect of MeHg and fish oils from eating two 6-oz orange roughy meals per week (based on average values) would be highly negative on infant neurodevelopment (i.e., visual recognition memory). Health Canada (2007b) and a number of states already recommend avoiding orange roughy (Florida Department of Health 2009; North Carolina Division of Public Health 2009). Interestingly, it is also noteworthy that the mean mercury concentration reported here for orange roughy (i.e., 0.73 mg/kg) is identical to the mean concentration value published in the USFDA database for king mackerel (USFDA 2006), which presumably was the basis for its inclusion in the “do not eat” grouping by USFDA. Fortunately, as pointed out by numerous other researchers (Gochfeld and Burger 2005; Levenson and Axelrad 2006; Mahaffey et al. 2008), many fish species have high levels of beneficial fatty acids and at the same time are low in mercury. A recent assessment of blood mercury concentrations in U.S. women suggests they are making better-informed choices of what type of fish to eat. Mahaffey et al. (2009) reported a decline in women’s blood-mercury levels from 1999 to 2004 from the NHANES dataset, but found no consistent decline in fish consumption rates over that period. Based on this, they concluded the lower blood-mercury was suggestive of a shift in consumption to seafood containing less mercury. While this is cause for Hum. Ecol. Risk Assess. Vol. 17, No. 5, 2011

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optimism, there is a continued need for clear guidance on the benefit–risk tradeoffs of eating different types of fish.


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