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BACKGROUND: Pregnant women need fish consumption advice that increases seafood intake and simultaneously reduces methylmercury (MeHg) exposure. Two disciplines, epidemiology and benefit-risk modeling, can support such advice. Some current models suggest that fish consumption during pregnancy has only net beneficial effects. In contrast, many recent epidemiological studies have associated adverse effects on cognitive development with ordinary fish intake and MeHg doses routinely encountered by up to one in six US women of childbearing age. Proposed federal fish-consumption advice is based solely on a benefit-risk model. A more complete assessment integrating both types of evidence is needed. OBJECTIVES AND METHODS: The goal of this paper is to use a model to rank seafood items by their relative benefits and risks, producing consumer seafood choice recommendations that are also consistent with epidemiological observations. Recent epidemiological studies and benefit-risk models are reviewed, and model results are compared with one another and with epidemiological observations to identify commonalities that support inter-calibration. RESULTS AND CONCLUSIONS: Both approaches quantify MeHg doses at which harm slightly exceeds benefit. A model from the US Food and Drug Administration (FDA) predicts adverse effects at fish intakes containing, on average, more than 16 times the the US Reference Dose (RfD) for MeHg. Epidemiological results indicate that the RfD itself approximates a minimal adverse dose. This conceptual similarity allows FDA's model to be calibrated with the epidemiological results to generate fish intake recommendations that both the model and the epidemiology suggest should have substantially positive public health impacts.

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More than a decade in the making, a new, legally binding treaty on mercury will be adopted by governments in the fall of 2013. The treaty's objective is to protect human health and the environment from anthropogenic mercury emissions through a range of provisions - including an article devoted to reducing exposure to mercury. Global emissions have increased since 2005, with the environmental health burden increasingly shifting to developing countries. Time is of the essence to reduce pollution because (i) exposure risk to mercury is much greater than previously thought and (ii) mercury already in the environment can be re-emitted via processes in the natural cycle, resulting in a longer lag time before pollution reduction can have a demonstrable effect on the food chain. Health professionals can assist in reducing exposure, choosing mercury-free products and urging governments to ratify the treaty as quickly as possible so that it can take effect.

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Fish is a valuable source of nutrition, and many people would benefit from eating fish regularly. But some people eat a lot of fish, every day or several meals per week, and thus can run a significant risk of overexposure to methylmercury. Current advice regarding methylmercury from fish consumption is targeted to protect the developing brain and nervous system but adverse health effects are increasingly associated with adult chronic low-level methylmercury exposure. Manifestations of methylmercury poisoning are variable and may be difficult to detect unless one considers this specific diagnosis and does an appropriate test (blood or hair analysis). We provide information to physicians to recognize and prevent overexposure to methylmercury from fish and seafood consumption. Physicians are urged to ask patients if they eat fish: how often, how much, and what kinds. People who eat fish frequently (once a week or more often) and pregnant women are advised to choose low mercury fish.

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Fish and shellfish have important nutritional benefits, and US per capita seafood consumption has increased substantially since 2002. Recent research has reinforced concerns about adverse effects of methylmercury exposure, suggesting that methylmercury doses associated with typical US rates of fish consumption may pose measurable risks, with no threshold. These converging trends create a need to improve risk communication about fish consumption and mercury. The analysis performed here identifies the relative importance of different fish and shellfish as sources of mercury in the US seafood supply and proposes improved consumer advice, so that the public can benefit from fish consumption while minimizing mercury exposure. I have quantified contributions to total mercury in the US seafood supply by 51 different varieties of fish and shellfish, then ranked and sorted the 51 varieties in terms of relative impact. Except for swordfish, most fish with the highest mercury levels are relatively minor contributors to total inputs. Tuna (canned light, canned albacore and fresh/frozen varieties) accounts for 37.4 percent of total mercury inputs, while two-thirds of the seafood supply and nine of the 11 most heavily consumed fish and shellfish are low or very low in mercury. Substantial improvement in risk communication about mercury in fish and seafood is needed; in particular, several population subsets need better guidance to base their seafood choices more explicitly on mercury content. I have sorted the 51 seafood varieties into six categories based on mercury levels, as a framework for improving risk communication in this regard.

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