{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T11:38:19Z","timestamp":1791027499983,"version":"4.1.0"},"reference-count":36,"publisher":"American Chemical Society (ACS)","issue":"3","license":[{"start":{"date-parts":[[2017,12,29]],"date-time":"2017-12-29T00:00:00Z","timestamp":1514505600000},"content-version":"vor","delay-in-days":4033,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2007,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Fish and seafood provide important nutrients but may also contain toxic contaminants, such as methylmercury. Advisories against pollutants may therefore conflict with dietary recommendations. In resolving this conundrum, most epidemiologic studies provide little guidance because they address either nutrient benefits or mercury toxicity, not both.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Impact on the same health outcomes by two exposures originating from the same food source provides a classical example of confounding. To explore the extent of this bias, we applied structural equation modeling to data from a prospective study of developmental methylmercury neurotoxicity in the Faroe Islands.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Adjustment for the benefits conferred by maternal fish intake during pregnancy resulted in an increased effect of the prenatal methylmercury exposure, as compared with the unadjusted results. The dietary questionnaire response is likely to be an imprecise proxy for the transfer of seafood nutrients to the fetus, and this imprecision may bias the confounder-adjusted mercury effect estimate. We explored the magnitude of this bias in sensitivity analysis assuming a range of error variances. At realistic imprecision levels, mercury-associated deficits increased by up to 2-fold when compared with the unadjusted effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These results suggest that uncontrolled confounding from a beneficial parameter, and imprecision of this confounder, may cause substantial underestimation of the effects of a toxic exposure. The adverse effects of methylmercury exposure from fish and seafood are therefore likely to be underestimated by unadjusted results from observational studies, and the extent of this bias will be study dependent.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1289\/ehp.9738","type":"journal-article","created":{"date-parts":[[2006,12,14]],"date-time":"2006-12-14T12:29:03Z","timestamp":1166099343000},"page":"323-327","source":"Crossref","is-referenced-by-count":198,"title":["Separation of Risks and Benefits of Seafood Intake"],"prefix":"10.1021","volume":"115","author":[{"given":"Esben","family":"Budtz-J\u00f8rgensen","sequence":"first","affiliation":[{"name":"Department of Biostatistics, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippe","family":"Grandjean","sequence":"additional","affiliation":[{"name":"Institute of Public Health, University of Southern Denmark, Odense, Denmark"},{"name":"Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pal","family":"Weihe","sequence":"additional","affiliation":[{"name":"Institute of Public Health, University of Southern Denmark, Odense, Denmark"},{"name":"Faroese Hospital System, T\u00f3rshavn, Faroe Islands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"316","published-online":{"date-parts":[[2006,12,14]]},"reference":[{"key":"2026080503064463700_micit1","doi-asserted-by":"crossref","first-page":"1689","DOI":"10.1111\/j.0272-4332.2004.00560.x","article-title":"Effects of exposure imprecision on estimation of the benchmark dose","volume":"24","author":"Budtz-J\u00f8rgensen","year":"2004","journal-title":"Risk Anal"},{"key":"2026080503064463700_micit2","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1186\/1476-069X-1-2","article-title":"Estimation of health effects of prenatal mercury exposure using structural equation models","volume":"1","author":"Budtz-J\u00f8rgensen","year":"2002","journal-title":"Environ Health"},{"key":"2026080503064463700_micit3","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.annepidem.2006.05.007","article-title":"Confounder selection in environmental epidemiology: Assessment of health effects of prenatal mercury exposure","volume":"17","author":"Budtz-J\u00f8rgensen","year":"2007","journal-title":"Ann Epidemiol"},{"key":"2026080503064463700_micit4","doi-asserted-by":"crossref","first-page":"3089","DOI":"10.1002\/sim.1541","article-title":"Consequences of exposure measurement error for confounder identification in environmental epidemiology","volume":"22","author":"Budtz-J\u00f8rgensen","year":"2003","journal-title":"Stat Med"},{"key":"2026080503064463700_micit5","doi-asserted-by":"crossref","first-page":"1731","DOI":"10.1056\/NEJMra022471","article-title":"The toxicology of mercury\u2014current exposures and clinical manifestations","volume":"349","author":"Clarkson","year":"2003","journal-title":"N Engl J Med"},{"key":"2026080503064463700_micit6","doi-asserted-by":"crossref","first-page":"1539S","DOI":"10.1093\/jn\/133.5.1539S","article-title":"Nutritional factors may modify the toxic action of methyl mercury in fish-eating populations","volume":"133","author":"Clarkson","year":"2003","journal-title":"J Nutr"},{"key":"2026080503064463700_micit7","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1097\/01.ede.0000129514.46451.ce","article-title":"Fish intake during pregnancy and early cognitive development of offspring","volume":"15","author":"Daniels","year":"2004","journal-title":"Epidemiology"},{"key":"2026080503064463700_micit8","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1001\/jama.280.8.701","article-title":"Effects of prenatal and postnatal methylmercury exposure from fish consumption on neurodevelopment: outcomes at 66 months of age in the Seychelles Child Development Study","volume":"280","author":"Davidson","year":"1998","journal-title":"JAMA"},{"key":"2026080503064463700_micit9","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1016\/j.ntt.2006.02.004","article-title":"Impact of prenatal methylmercury toxicity on neurobehavioral function at age 14 years","volume":"28","author":"Debes","year":"2006","journal-title":"Neurotoxicol Teratol"},{"key":"2026080503064463700_micit10","author":"European Food Safety Authority"},{"key":"2026080503064463700_micit11","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1016\/j.neuro.2004.12.010","article-title":"Good fish\/bad fish: a composite benefit-risk by dose curve","volume":"26","author":"Gochfeld","year":"2005","journal-title":"Neurotoxicology"},{"key":"2026080503064463700_micit12","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1289\/ehp.7842","article-title":"Umbilical cord mercury concentration as biomarker of prenatal exposure to methylmercury","volume":"113","author":"Grandjean","year":"2005","journal-title":"Environ Health Perspect"},{"key":"2026080503064463700_micit13","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1093\/oxfordjournals.aje.a010002","article-title":"Methylmercury exposure biomarkers as indicators of neurotoxicity in children aged 7 years","volume":"150","author":"Grandjean","year":"1999","journal-title":"Am J Epidemiol"},{"key":"2026080503064463700_micit14","author":"Grandjean"},{"key":"2026080503064463700_micit15","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1016\/S0892-0362(01)00155-6","article-title":"Neurobehavioral deficits associated with PCB in 7-year-old children prenatally exposed to seafood neurotoxicants","volume":"23","author":"Grandjean","year":"2001","journal-title":"Neurotoxicol Teratol"},{"key":"2026080503064463700_micit16","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1080\/00039896.1992.9938348","article-title":"Impact of maternal seafood diet on fetal exposure to mercury, selenium, and lead","volume":"47","author":"Grandjean","year":"1992","journal-title":"Arch Environ Health"},{"key":"2026080503064463700_micit17","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1016\/S0892-0362(97)00097-4","article-title":"Cognitive deficit in 7-year-old children with prenatal exposure to methylmercury","volume":"19","author":"Grandjean","year":"1997","journal-title":"Neurotoxicol Teratol"},{"key":"2026080503064463700_micit18","doi-asserted-by":"crossref","first-page":"1747","DOI":"10.1056\/NEJMoa020157","article-title":"Mercury, fish oils, and the risk of myocardial infarction","volume":"347","author":"Guallar","year":"2002","journal-title":"N Engl J Med"},{"key":"2026080503064463700_micit19","author":"Joint Expert Committee on Food Additives"},{"key":"2026080503064463700_micit20","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1016\/S0140-6736(03)14166-9","article-title":"Prenatal methylmercury exposure in the Seychelles [Letter]","volume":"362","author":"Keiding","year":"2003","journal-title":"Lancet"},{"key":"2026080503064463700_micit21","author":"Kjellstr\u00f6m"},{"key":"2026080503064463700_micit22","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1111\/j.1753-4887.2006.tb00197.x","article-title":"Too much of a good thing? Update on fish consumption and mercury exposure","volume":"64","author":"Levenson","year":"2006","journal-title":"Nutr Rev"},{"key":"2026080503064463700_micit23","author":"Little"},{"key":"2026080503064463700_micit24","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1016\/j.envres.2004.02.006","article-title":"Fish and shellfish as dietary sources of methylmercury and the omega-3 fatty acids, eicosa-hexaenoic acid and docosahexaenoic acid: risks and benefits","volume":"95","author":"Mahaffey","year":"2004","journal-title":"Environ Res"},{"key":"2026080503064463700_micit25","author":"National Toxicology Program"},{"key":"2026080503064463700_micit26","author":"NRC (National Research Council)"},{"key":"2026080503064463700_micit27","doi-asserted-by":"crossref","first-page":"1376","DOI":"10.1289\/ehp.8041","article-title":"Maternal fish consumption, hair mercury, and infant cognition in a U.S. cohort","volume":"113","author":"Oken","year":"2005","journal-title":"Environ Health Perspect"},{"key":"2026080503064463700_micit28","doi-asserted-by":"crossref","first-page":"3860","DOI":"10.1021\/es034983m","article-title":"Maternal and fetal mercury and n-3 polyunsaturated fatty acids as a risk and benefit of fish consumption to fetus","volume":"38","author":"Sakamoto","year":"2004","journal-title":"Environ Sci Technol"},{"key":"2026080503064463700_micit29","first-page":"597","article-title":"The Seychelles child development study on neurodevelopmental outcomes in children following in utero exposure to methylmercury from a maternal fish diet: background and demographics","volume":"16","author":"Shamlaye","year":"1995","journal-title":"Neurotoxicology"},{"key":"2026080503064463700_micit30","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1111\/j.1753-4887.2005.tb00120.x","article-title":"Fish consumption: recommendations versus advisories, can they be reconciled?","volume":"63","author":"Smith","year":"2005","journal-title":"Nutr Rev"},{"key":"2026080503064463700_micit31","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1067\/mpd.2000.102774","article-title":"Maternal seafood diet, methylmercury exposure, and neonatal neurological function","volume":"136","author":"Steuerwald","year":"2000","journal-title":"J Pediatr"},{"key":"2026080503064463700_micit32","author":"U.S. EPA (U.S. Environmental Protection Agency). 2004"},{"key":"2026080503064463700_micit33","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1161\/01.ATV.0000150040.20950.61","article-title":"Mercury, fish oils, and risk of acute coronary events and cardiovascular disease, coronary heart disease, and all-cause mortality in men in eastern Finland","volume":"25","author":"Virtanen","year":"2005","journal-title":"Arterioscler Thromb Vasc Biol"},{"key":"2026080503064463700_micit34","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/j.envres.2004.01.006","article-title":"Application of hair-mercury analysis to determine the impact of a seafood advisory","volume":"97","author":"Weihe","year":"2005","journal-title":"Environ Res"},{"key":"2026080503064463700_micit35","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1054\/plef.2000.0198","article-title":"The role of long-chain polyunsaturated fatty acids in infant cognitive development","volume":"63","author":"Willatts","year":"2000","journal-title":"Prostaglandins Leukot Essent Fatty Acids"},{"key":"2026080503064463700_micit36","doi-asserted-by":"crossref","first-page":"1755","DOI":"10.1056\/NEJMoa021437","article-title":"Mercury and the risk of coronary heart disease in men","volume":"347","author":"Yoshizawa","year":"2002","journal-title":"N Engl J Med"}],"container-title":["Environmental Health Perspectives"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/pubs.acs.org\/evhpaz\/article-pdf\/115\/3\/323\/66397098\/ehp.9738.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/pubs.acs.org\/evhpaz\/article-pdf\/115\/3\/323\/66397098\/ehp.9738.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T13:45:19Z","timestamp":1786628719000},"score":1,"resource":{"primary":{"URL":"https:\/\/pubs.acs.org\/evhpaz\/article-lookup\/doi\/10.1289\/ehp.9738"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2006,12,14]]},"references-count":36,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2006,12,14]]},"published-print":{"date-parts":[[2007,3,1]]}},"URL":"https:\/\/doi.org\/10.1289\/ehp.9738","relation":{},"ISSN":["0091-6765","1552-9924"],"issn-type":[{"value":"0091-6765","type":"print"},{"value":"1552-9924","type":"electronic"}],"subject":[],"published":{"date-parts":[[2006,12,14]]}}}