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Background  Evidence of chronic low levels of exposure to heavy metals in Sri Lanka has emerged in a number of studies carried out in the recent past. The source and magnitude of such exposures have to be understood in order to assess the risk of adverse health effects of this exposure and to propose suitable public health interventions.    Methods  An assessment was carried out to quantify chronic exposure to cadmium, lead and arsenic through food in people living in an area in Sri Lanka, where prevalence of Chronic Kidney Disease of unknown origin (CKDu) is highest. First a dietary survey was carried out in the subjects to estimate the type and quantity of typical food items in order to estimate an average consumption. A model diet was formulated using this dietary consumption data; and this was thereafter used for estimation of chronic dietary exposure of selected contaminants. In parallel, the levels of contaminants of interest in the various identified food items: cadmium, lead and arsenic, were determined.    Results  Assuming the major route of intake is food, and based on the quantity and type of food items consumed, a 60 kg man is exposed to average doses of 83.7 μg cadmium, 924.1 μg lead, and 180.3 μg arsenic per week. The impact of chronic lead exposure was affirmed by a mean blood lead level of 3.0 μg/dL, with a maximum level of 8.8 μg/dL being observed in some cases.    Conclusions  Chronic low dose exposure of lead from food appears to be a public health concern in the studied population. Cadmium exposure through food appears to be of concern also. However, arsenic exposure through food appears to be within safe limits. As there are numbers of possible adverse health outcomes that can be associated with such estimated exposures of heavy metals, public health interventions are warranted to limit the described harmful exposures. Advocacy on dietary patterns and agronomic practices to lower the contaminants identified are the two broad strategies suggested.

A quantitative analysis of chronic exposure of selected heavy metals in a model diet in a CKD hotspot in Sri Lanka