Staple food is a crucial exposure route for the human intake of potentially toxic elements (PTEs), but it has been neglected in previous human health risk (HHR) studies. Lack of attention to this issue will lead to an underestimation of HHR caused by PTEs. This study establishes a comprehensive regional identification method for health risk assessment (HRA), namely, soil-maize health risk assessment (SMHRA) and applies it to Ziyang, Shaanxi, which is a typical agricultural county. SMHRA considered the exposure pathway of staple food and utilized Monte Carlo simulation to enhance the accuracy of HRA for PTEs. Results indicated the PTE spatial heterogeneity in a soil-maize system. Introducing staple food exposure pathway would increase HHR values and probabilities 1.57-2.80 and 1.53-5.63 times than that when food route was not considered. Overall, the HHR caused by a single PTE was low, which relatively safe. The introduction of food pathway contributed to accurate estimate the HHR of As and Ni, and the risk probabilities ranged from 0.04% to 12.46%. Few areas had high levels of Ni, which pose health risks: approximately 1.8% for children and higher than 0.5% for adults. Both As and Ni had the highest contribution to HHR among all PTEs, with 33.84%-41.56% TNCR caused by As, and 54.73%-56.90% TCR created by Ni, respectively. For human health risk routes, the staple food exhibited the highest contribution to HHR among all exposure routes, with TNCR of 36.15%-56.73% and the TCR of 44.96%-64.28%. Our research imply that dietary intake of PETs must be considered in the human health risk assessment in agricultural environment, which offers the foundation for subsequent environmental risk prevention and control.
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