Dietary heavy metal(loid)s exposure and prevalence of chronic kidney disease of unknown aetiology (CKDu) in Sri Lanka

Intake of heavy metals and metalloids through the diet is posing a big research challenge in Sri Lanka due to the increasing occurrence of chronic kidney disease of unknown aetiology (CKDu) among the farming communities pursuing their livelihoods in the North Central Province (NCP). Duplicated diet studies were conducted on a sample of 62 individuals comprising adult males, adult females, boys, and girls who were selected following a demographic survey in an area of the NCP where there was a high incidence of CKDu. A health risk assessment was made by analysing the heavy metal(loid)s content in the diet samples, by means of inductively coupled plasma mass spectrometry. Rice and vegetables constituted the main diet in the CKDu prevalent areas, with all gender and age categories adhering to similar daily diet patterns. Results of the heavy metal(loid) analysis of duplicated food intake samples indicated that the amounts of Pb in rice, As and Pb in vegetables, and Cd in fish exceeded the recommended daily limits. Because consumption of rice was much higher than the other food items, the estimated daily intake of Pb exceeded the permissible daily intake of 3.5 mu g/kg(BW)/day. There were no significant differences between the age and gender categories in respect of estimated daily intake of Pb, which suggested that the entire population of the study area faced the risk of a high level of Pb exposure. Further, the hazard quotient of Pb was greater than 1. Influence of heavy metal(loid)s on the prevalence of CKDu cannot be understated, and as such interventions are required as a matter of urgency to reduce the local population's dietary exposure to heavy metal(loid)s.

Automated summary

Research in Sri Lanka has shown that intake of heavy metals and metalloids through diet, particularly from rice, vegetables, and fish, exceeds recommended daily limits in areas with high prevalence of CKDu. The entire population in the study area faces a risk of high exposure to lead, with no significant difference in estimated daily intake between different age and gender categories. Immediate interventions are needed to reduce dietary exposure to heavy metals and metalloids.