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The objective of this study was to investigate the potential effects from exposure to multiple metals, including cadmium (Cd), chromium (Cr), arsenic (As), mercury (Hg), nickel (Ni) and lead (Pb) that exist in shellfish in Chinese populations, and evaluate the impacts of cumulative exposures among individuals. A total 15,469 individual shellfish samples were analyzed following a protocol for elemental analysis. A total of 25,669 respondents were selected through stratified multi-stage cluster sampling from  31 survey sites in China. Individual shellfish consumption data and body weight were collected and analyzed with a 24-hour dietary recall method on three non-consecutive days. The consumers were divided into two groups: aged 2–12 years group and aged ≥13 years. Exposure levels were estimated based using a semi-probabilistic risk assessment method and cumulative exposures among individual persons using the maximum cumulative ratio (MCR) method. The mean, median and 95th percentile of all metals exposure for age 2–12 years group were higher than age ≥13 years group, but none exceeded the respective reference doses of the metals. The mean hazard indices (HI) of each metal in shellfish for both age groups were less than 1. The MCR values calculated among 1283 consumers ranged from 1.28 to 3.25 with the average MCR value was 2.22. There were 51 (3.98%) consumers in group I, 1186 (92.44%) consumers in group II, 26(2.03%) consumers in group III A, and 20 (1.56%) consumers in group III B. And cadmium (Cd) and lead (Pb) produced the HQ Max  that trigged cumulative exposures. It was concluded that heavy metals did not present a potential health risk to people solely through shellfish. The cumulative risks indicated that 7.56% of the surveyed consumers were of concern because of high HI of metals exposure, and Cd, Pb, and Ni made significant contributions to the potential risk.

Application of the maximum cumulative ratio (MCR) as a screening tool for the evaluation of multiple metal mixtures in shellfish in Chinese population