Risk assessment for nutrients assumes a single population with a normal distribution of indexes of requirements and excess. Toxic levels are by definition intakes above the upper level; for copper, however, because we lack noninvasive, sensitive biomarkers of storage or early damage from excess, excess is based on the infrequent occurrence of clinical disease, such as unexplained liver cirrhosis. We examine the limitations of this approach for copper given the very low prevalence of clinical and subclinical disease and suggest that the population risk for copper excess be based on hepatic copper loading as a potentially quantifiable measurement. The challenge ahead is to develop biomarkers that predict the population risk of elevated hepatic copper stores and thus the possibility of disease in a population.

译文

营养素的风险评估假设单个人群的需求和过量指数呈正态分布。根据定义,毒性水平高于较高水平; 然而,对于铜,由于我们缺乏非侵入性、敏感的生物标志物储存或过量的早期损害,过量是基于临床疾病的罕见发生,如不明原因的肝硬化。鉴于临床和亚临床疾病的患病率非常低,我们研究了这种方法对铜的局限性,并建议铜过量的人群风险基于肝铜负荷作为潜在的可量化度量。未来的挑战是开发生物标志物,以预测肝铜存储升高的人群风险,从而预测人群中疾病的可能性。

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