International Journal of Environmental Analytical

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The concentration of potentially toxic elements

(PTEs) in fruit juices: a global systematic review,
meta-analysis and probabilistic health risk
assessment

Salman Khazaei , Elaheh Talebi Ghane , Saeid Bashirian & Fereshteh Mehri

To cite this article: Salman Khazaei , Elaheh Talebi Ghane , Saeid Bashirian & Fereshteh
Mehri (2021): The concentration of potentially toxic elements (PTEs) in fruit juices: a global
systematic review, meta-analysis and probabilistic health risk assessment, International Journal of
Environmental Analytical Chemistry, DOI: 10.1080/03067319.2021.1873309

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INTERNATIONAL JOURNAL OF ENVIRONMENTAL ANALYTICAL CHEMISTRY
https://doi.org/10.1080/03067319.2021.1873309

The concentration of potentially toxic elements (PTEs) in fruit

juices: a global systematic review, meta-analysis and
probabilistic health risk assessment
Salman Khazaeia, Elaheh Talebi Ghaneb, Saeid Bashirianc and Fereshteh Mehrid
a
Department of Epidemiology, Research Center for Health Sciences, Hamadan University of Medical
Sciences, Hamadan, Iran; bDepartment of Biostatistics, Hamadan University of Medical Sciences Hamadan,
Hamadan, Iran; cDepartment of Health Education, Social Determinants of Health Research Center, Hamadan
University of Medical Sciences, Hamadan, Iran; dDepartment of Toxicology, Nutrition Health Research
Center, Hamadan University of Medical Sciences, Hamadan, Iran

ABSTRACT ARTICLE HISTORY

This study was conducted to estimate the contamination of potentially Received 29 October 2020
toxic elements (PTEs) in fruit juice, e.g. apple, grape, mango, orange, Accepted 30 December 2020
peach, and pineapple. The related studies regarding the concentration KEYWORDS
of PTEs in fruit juice which have been published in recommended Potentially toxic elements
databases including PubMed, Embase, Web of Science and Scopus (PTEs); fruit juice; meta-
from 7 January 1969 to 20 February 2020 were analysed. Also, the analysis; systematic review;
health risk assessment for consumers due to PTEs ingestion via con­ risk assessment
suming various fruit juices was evaluated using target hazard quotient
(THQ). Among 701 retrieved citations in the identification step, 44
articles were included in this conducted meta-analysis. In this context,
the overall rank order of PTEs mean concentrations in the fruit juices
were as follows: iron (Fe) >zinc (Zn)> copper (Cu)> lead (Pb) >nickel
(Ni)> cadmium (Cd)> in apple and orange, Cu> Zn> Pb in grape, Fe>
Zn>Cu>Ni>Cd>Pb in mango, Fe>Zn>Cu>Ni >Pb>Cd in peach and
Cu>Zn>Cd>Ni>As in pineapple. Our results showed that the highest
concentration of Pb and Cd were 0.075 and 0.204 mg/kg in orange and
pineapple, respectively. The concentration of As in apple and orange
juices was similar (0.003 mg/kg). Regarding Ni, Cu, Zn and Fe, the
highest concentrations were 0.188, 0.508, 0.562 and 16.712 mg/kg in
peach, mango and pineapple, respectively. The assessment of non-
carcinogenic risk indicated that risk pattern was different in various
countries. In addition, fruit juice consumers did not have a significant
risk because of the ingestion of PTEs.

1. Introduction
Fruits are the main part of the human’s food basket, which are mainly cultivated differently
in different regions of the world; the processes of production of the fruits are dependent to
a number of parameters like the cultivable conditions of crops and the environmental
properties of each region [1]. In this study, in addition to the fruits, their products like
different juices have popularity in many countries, and the tendency to consume these
products is growing different compounds such as fibre, trace elements, vitamin C, minerals,

CONTACT Fereshteh Mehri freshteh_mehri@yahoo.com

© 2021 Informa UK Limited, trading as Taylor & Francis Group
2 S. KHAZAEI ET AL.

and various noticeably [2]. The statistics show that the worldwide consumption of fruit
juices and fruit nectars by region in 2017 and 2018 was 35 billion litres, almost 9.1 billion
litres of which were consumed in EU countries [3].The recorded per capita consumption of
fruit products including fruit juices has increased by about 56.1% since the late 1960s, and
71.5% since the late 1930s, so that 95.5% of the children of 2–4 years and 92% of the
children of 5–12 years consume the minimum recommended intake of fruit juice in each day
[4]. These drinks commonly have kinds of antioxidants which are essential for human health
and reducing disease risk as cancer and cardiovascular diseases [5]. In spite of the important
role of these compounds in the humans’ diet, one of the biggest concerns is the contam­
ination of fruit juices with impurities and farming-related substances such as metals and
pesticides. Potentially toxic elements (PTEs) including heavy metals and trace elements are
substances which naturally present in the environment and human activities can change
their concentrations and lead to harmful effects on the health of both humans and animals
[6]. According to former studies, more than 90% of the human’s exposure to PTEs is related
to the consumption of contaminated foods [7]. PTEs’ toxicity can be diverse based on the
type and other criteria including duration, intensity, frequency of their exposure, and
exposure routes of metals. To date, different kinds of guidelines have been set by a huge
number of countries for monitoring the levels of toxic metals in food products, confirming
their safety for human’s consumption [8]. Owing to the accumulation of toxic metals in food
crops in high concentrations, fruits contamination is considered as an important problem
for humans’ health [9]. Metals are categorised into essential and non-essential classes.
Essential metals such as Cu, Ni and Zn are considered vital for humans’ health, because
these metals are of important coenzymes in body and play an important role in growth and
respiration. In contrast, other metals like As, Pb and Cd have been identified as toxic or non-
essential metals which have not biological activity and resulting in nutritional problems and
serious risk for human’s health [10]. Based on previous studies, Pb can occupy the Zn site in
erythrocytes and bind to δ-aminolevulinic acid dehydratase and leads to inhibition of its
function in the body [11]. Cd is considered as a carcinogenic metal which can induce
diseases such as thyroid and pancreatic cancer in the body [12]. Exposure to As via
contaminated crops can result in diabetes, neurologic and neurobehavioral disorders,
hearing loss, and haematologic disorders [13]. There are several sources of contaminating
metals which can be derived from nature and influence the quality of fruits. In another
words, contamination of agricultural soil [14] and water for irrigation with these metals [15],
the amount and type of pesticides and chemical fertilisers during fruit planting, the
contamination of water source that applied during the fruit juices production [16], as well
as the contamination during packaging and processing technologies can be factors which
cause toxicity in fruit juices. The contamination of heavy metals in different fruit juices such
as apple, grape, mango, orange, peach, and pineapple has been widely studied in a number
of countries like Poland [8, Romania [17], Ghana [18] and Nigeria [19]. Meta-analysis is
defined as an approach to integrate data from individual studies, which can be highly
advantageous and may allow new conclusions to be made [20,21]. Given that no systematic
review has been done in the field of concentration of PTEs in the fruit juices, and because of
increasing trends of fruit juice consumption in all around the world and their adverse effects
on human’s health as a result of contamination with PTEs [22], we conducted the current
research, for the first time, in order to estimate the concentration of PTEs (Pb, Cd, As, Fe, Zn,
Ni and Cu) in different fruit juices including apple, grape, mango, orange, peach, and
 INTERNATIONAL JOURNAL OF ENVIRONMENTAL ANALYTICAL CHEMISTRY 3

pineapple using a systematic review and meta-analyse according to specified subgroups.

Furthermore, the probabilistic human health risks for consumers due to in taking PTEs in the
fruit juices were estimated by using a Monte Carlo Simulated (MCS) method.

1. Experimental
1.1. Study protocol
The present systematic review focussed on estimating the concentration of PTEs in fruit
juices according to the PRISMA guidelines for systematic review and meta-analysis [23].

1.2. Search strategy

In the present study, all published papers in the English language since the database
inception up to 20 February 2020 from all countries and were selected through searching
in the international databases including Web of Science, PubMed, Medline, Scopus, Embase
and Google Scholar search engine. In order to access to more related papers, the references
of the selected papers were also screened manually. In some cases, we contacted their
authors for additional references. The following keywords were used for screening database:
Scopus: ((ti/ab (‘metals’) OR ti/ab (‘heavy metals’))) OR ti/ab (‘metal(oid)s’)AND ((ti/ab
(‘fruit juices’) ((ti/ab (‘juices’) OR ((ti/ab (‘fruit’) OR ((ti/ab (‘plant’).
Medline: Search(((‘Metals’[Mesh]) OR (((heavy metals [Ti/Ab]) OR metals [Ti/Ab]) OR metal­
(oid)s [Tit_Abs]))) AND (((((((Plant [Ti/Ab]) OR fruit juices [Ti/Ab]) juices [Ti/Ab]) fruit [Ti/Ab]).
Embase: (‘metals’:abt OR ‘heavy metals’:abt OR’ metal(oid)s: abt) AND ‘fruit juices:abt
OR plants’.

1.3. Eligibility criteria

In this systematic review, all original descriptive studies in the English language, which
had investigated the concentration of PTEs in fruit juices, were included. In this regard,
duplicates, qualitative studies, clinical trials, case reports, review articles and letter to
editors were excluded.

1.4. Screening and data extraction

All records were evaluated by title and abstract by two researchers: FM, and SK, indepen­
dently according to inclusion and exclusion criteria. The Kappa index showed an agree­
ment of 93% between the findings of two researchers. Finally, the difference between
records among the researchers was corrected by re-examining the articles. The agree­
ment was reached by group discussion by the third researcher.

1.5. Extraction of data and inclusion/exclusion criteria

In the present study, the inclusion criteria were assessing to the full-text of the published
papers, English language, cross-sectional study, and reporting of mean and/or range con­
centration of toxic metals in fruit juices [24]. Various data were extracted from the collected
4 S. KHAZAEI ET AL.

papers including year, country, type of fruit juices, average concentration, standard deviation
of measurements, sample size and concentration range of toxic metals. In order to unify the
units in the studied papers, all units of concentration such as μg/kg, ppb and ng/g, which have
been for the heavy metals, were changed to mg/kg-dry-weight.

1.6. Risk assessment

In order to calculate the non-carcinogenic risk of ingestion of the studied metals through
consumption of the fruit juices, the following equation was used:
EDI ¼ C � IR � EF � ED=BW � ATn Eq(1)
where C shows the mean concentration of the studied metals in fruit juices (mg/kg), IR
represents the ingestion rate of fruit juices (kg/n-day), EF indicates exposure frequency
(350 days/year), ED is exposure duration (children = 6 years and adults = 30 years), BW is
body weight (children = 15 kg and adults = 70 kg), ATn (EF×ED) is average time exposure
(children = 2190 days and adults = 10,950 days). The average world ingestion rate of fruit
juices is 0.045 kg/n d.
Moreover, Eq. 2 was utilised to estimate the Target hazard quotient (THQ) due to intake
metals in fruit juices [25]:
THQ ¼ EDI=RfD Eq(2)
where EDI indicates the estimated daily intake and RfD is an oral reference dose. In this
Eq., Rfds of Pb, Cd, As, Zn, Cu, Fe, Ni were considered to be 0.003, 0.001, 0.003, 0.3,0.04, 0.7
and 0.02 mg/kg/day, respectively [26].
Xn
TTHQ ¼ i¼1
THQi Eq(3)

Where TTHQ indicates the sum of each THQ for the whole metal analysed in the fruit juice
samples [26,27]. TTHQ values lower than 1 indicate acceptable health hazard for health
human [28].

1.7. Uncertainty analysis

A Monte Carlo Simulated (MCS) approach was applied to increase the precise of risk
assessment through considering uncertainties. MCS as a precise and accurate approach
incorporates the variability of risk assessment and considers the parameters affecting
uncertainties. In this study, the Oracle Crystal Ball software (version 11.1.2.4.600) applied
to analyse the data. In this method, various parameters such as metal concentration (C),
ingestion rate (IR) and body weight (BW) were considered as a lognormal distribution [29].
Moreover, the number of repetitions was at 10,000 and percentile 95% of THQ and TTHQ
was considered a cut point of human health risk [25,30].

1.8. Data analysis

The meta-analysis method was adopted to assess the pooled concentration of metals in fruit
juices using the random effect model. The subgroup analysis was separately conducted
 INTERNATIONAL JOURNAL OF ENVIRONMENTAL ANALYTICAL CHEMISTRY 5

based on metal type. Heterogeneity was calculated among the studies by Q and I2 tests.
Cochran Q test (Q statistic, p < 0.10) shows statistically significant heterogeneity and I2
statistic (I2 > 50%) indicates a large heterogeneity. Statistical analysis and data analysis were
performed using the second version of the comprehensive meta-analysis software. The
significance level was considered to be less than 0.05. The data were analysed by the Stata
software, version 14 (StataCorp, College Station, TX, USA) at a significance level of 0.05.

2. Results and discussion

2.1. Retrieve studies process
A comprehensive literature search was performed using Scopus, Embase, Web of Science and
PubMed international databases for obtaining researches conducted on the concentration of
PTEs in fruit juices from 7 January 1969 to 20 February 2020. Seven hundred and one
published articles were retrieved. In the first step, 224 articles were excluded via EndNote
citation manager (vX7.4, Thomas Reuters, New York, USA) due to repetition. Based on the titles
of retrieved articles, 477 articles were considered suitable for this study. Afterwards, due to the
irrelevant title, 258 articles were excluded. Based on the abstract, 219 articles were reviewed,
and then 169 articles were excluded. Full texts of 50 retrieved articles were downloaded and
reviewed, and finally, 44 articles were included (Figure 1).

2.2. Study Characteristics

The study characteristics and results have been shown in Table 1–7 S. The included
studies were published between 2000 and 2018 for As, between 1997 and 2018 for Cd,
between 1997 and 2019 for Cu, between 1969 and 2019 for Fe, between 1997 and 2019
for Ni, between 1997 and 2018 for Pb, and between 1996 and 2018 for Zn. Moreover, the
sample size of included articles varied from 6 to 50 with a total of 244 samples for As, from
6 to 42 with a total of 317 samples for Cd, from 5 to 60 with a total of 573 samples for Cu,
from 5 to 45 with a total of 391 samples for Fe, from 5 to 31 with a total of 346 samples for
Ni, from 4 to 50 with a total of 405 samples for Pb, and from 5 to 60 with a total of 555
samples for Zn. The ranking of countries based on number of study was Nigeria (39
studies) > Brazil (19 studies) > Romania (12 studies) ~ Turkey (12 studies) ~ USA (12
studies)> Egypt (11 studies) ~ Pakistan (11 studies) > Turkey (9 studies) > Saudi Arabia (9
studies) ~ Iran (9 studies) > Northern Jorden (6 studies)> Serbia (5 studies) > Latvia (4
studies)> India (3 studies) ~ Iraq (3 studies) ~ Spain (3 studies)> Australia (2 studies)~
Bangladesh (2 studies) ~ Ghana (2 studies) ~ Poland (2 studies) ~ Venezuela (2 studies) >
Tanzania (1 study) (Table 1).

2.3. PTEs level in fruit juices based on fruit types and continents
Our Meta-analysis regarding the concentration of PTEs in fruit juices based on fruit types
and continents have been presented in Tables 1 and Tables 2. The ranking of metals
concentration was Fe> Zn> Cu> Pb > Ni> Cd> As in apple and orange, Cu> Zn> Pb in
grape, Fe> Zn> Cu> Ni> Cd> Pb in mango, Fe> Zn> Cu> Ni > Pb> Cd in peach and Cu> Zn>
Cd> Ni> As in pineapple.
6 S. KHAZAEI ET AL.

Idenficaon
Records idenfied through
database searching
(n = 701)

Duplicates removed
(n = 244)
Screening

Titles reviewed Titles removed based on tle

(n =477) (n = 285)

Abstracts reviewed Abstracts removed based

(n =219) on abstract
Eligibility

(n = 169)

Full -text reviewed

Full -text removed based
(n =50) on full -text (n = 6)
Included

Studies included in (meta-

analysis)
(n = 44)

Figure 1. Selection process evidence searches and inclusion.

According to the results, the concentration of PTEs in the investigated fruit juices was
greatly diverse which can be related to the several factors such as the characteristics of
metals, nature of the fruit, composition of the irrigation water and soil, the weather
conditions, agricultural activities such as the types and amounts of fertilisers used, as
well as, storage condition and processing technologies [31].
It is clearly seen that the higher concentration of Fe Zn, Cu and Ni as compared with
other investigated elements such as Pb, Cd and As in most examples can be related to this
fact that essential elements have higher transfer factors than toxic metals leading to
higher accumulation of them in fruits [32]. We observed that the concentrations of Pb and
Cd were in the lowest level in peach (0.016 mg/kg and 0.011 mg/kg) and in level in orange
and pineapple, respectively (0.075 mg/kg and 0.204 mg/kg). The concentration of As in
 INTERNATIONAL JOURNAL OF ENVIRONMENTAL ANALYTICAL CHEMISTRY 7

Table 1. Meta-analysis of concentration of toxic metal (PTEs) (mg/kg) in juice based on fruit juice.
Heterogeneity
Metal Fruit juice N of studies ES (95% CI) weight Statistics df P.Value I2 (%)
Pb Apple 15 0.076 (0.067, 0.085) 24.38 11,732.04 14 <0.001 99.9
Grape 5 0.071 (0.049, 0.093) 7.23 289.20 4 <0.001 98.6
Mango 6 0.050 (0.040, 0.060) 11.57 2227.95 5 <0.001 99.8
Orange 18 0.076 (0.058, 0.094) 28.68 61,265.85 17 <0.001 100.0
Peach 7 0.016 (0.010, 0.021) 11.55 587.15 6 <0.001 99.0
Pineapple 11 0.035 (0.029, 0.040) 16.58 1306.59 10 <0.001 99.2
Cd Apple 11 0.041 (0.039, 0.043) 21.35 19,765.50 10 <0.001 99.9
Mango 6 0.068 (0.040, 0.096) 15.19 4956.97 5 <0.001 99.9
Orange 12 0.015 (0.011, 0.020) 32.38 3329.34 11 <0.001 99.7
Peach 6 0.011 (−0.001, 0.022) 18.20 5130.04 5 <0.001 99.9
Pineapple 7 0.204 (0.117, 0.291) 12.88 17,697.26 6 <0.001 100.0
As Apple 6 0.003 (0.001, 0.004) 65.73 163.41 5 <0.001 96.9
Orange 4 0.003 (0, 0.007) 34.27 66.5 3 <0.001 95.5
Fe Apple 14 1.794 (1.452, 2.137) 28.90 4.3E+05 13 <0.001 100.0
Mango 13 3.216 (1.535, 4.897) 24.57 3.6E+05 12 <0.001 100.0
Orange 15 2.083 (1.777, 2.390) 30.01 4228.01 14 <0.001 99.7
Peach 7 2.45 (0.82, 4.08) 14.52 14,175.8 6 <0.001 100.0
Pineapple 5 16.712 (14.906, 18.518) 2.00 5.12 4 0.275 21.9
Zn Apple 16 0.431 (0.318, 0.543) 23.12 3.5E+05 15 <0.001 100.0
Grape 5 0.447 (0.358, 0.537) 7.11 484.44 4 <0.001 99.2
Mango 11 0.562 (0.403, 0.721) 14.92 1.6E+05 10 <0.001 100.0
Orange 21 0.466 (0.371, 0.562) 27.30 52,046.47 20 <0.001 100.0
Peach 11 0.561 (0.403, 0.718) 14.82 1.9E+05 10 <0.001 100.0
Pineapple 9 0.256 (0.139, 0.372) 12.74 69,226.38 8 <0.001 100.0
Cu Apple 17 0.272 (0.230, 0.313) 22.63 9457.18 16 <0.001 99.8
Grape 6 0.458 (0.313, 0.603) 8.10 11,870.11 5 <0.001 100.0
Mango 9 0.206 (0.174, 0.238) 12.16 9681.99 8 <0.001 99.9
Orange 23 0.379 (0.240, 0.518) 30.60 2.1E+05 22 <0.001 100.0
Peach 10 0.508 (0.303, 0.713) 13.15 27,792.34 9 <0.001 100.0
Pineapple 10 0.282 (0.194, 0.371) 13.37 15,471.46 9 <0.001 99.9
Ni Apple 14 0.047 (0.034, 0.059) 25.11 2987.28 13 <0.001 99.6
Mango 10 0.164 (0.116, 0.213) 19.45 3358.75 9 <0.001 99.7
Orange 15 0.046 (0.035, 0.058) 26.61 3206.66 14 <0.001 99.6
Peach 6 0.188 (0.100, 0.276) 11.79 6354.39 5 <0.001 99.6
Pineapple 9 0.178(0.122, 0.235) 17.04 3360.87 8 <0.001 99.8

apple and orange juices was similar (0.003 mg/kg). Moreover, the lowest and the highest
concentrations of Fe were found in apple juice and pineapple juice (1.794 mg/kg and
16.712 mg/kg). For Cu, Ni and Zn, the highest concentration belonged to peach and
mango (0.508 mg/kg, 0.188 mg/kg and 0.562 mg/kg) and the lowest one belonged to
mango, orange and pineapple (0.206 mg/kg, 0.046 mg/kg and 0.256 mg/kg), respectively.
It should bear in mind that the difference that was observed in kind and content of
metals between different fruit juices can be related to physicochemical characteristics as
the bioavailability of metals and plant species [33]. Metals like Fe and Cu have high-
mobility and quickly move from soil into an aerial plant, while other metals such as Pb
have low-mobility accumulating with a high concentration in plant’s root [34]. Although
metals have similar bioavailability, other sources of contamination in fruit juices are
probably included among these differences [35]. According to the study conducted by
Mahugija et al., (2018) the mean concentrations of Cu in the pineapple juices were greater
than those of mango juices. They explained that various concentrations in these two
plants may be related to properties of them. Since the mango tree has the taller size than
the pineapple tree, thus, the location of it, than to the soil, is higher compared to
pineapple tree therefore the uptake of Cu metals from the soil is slower [36]. In the meta-
8 S. KHAZAEI ET AL.

analysis conducted separately based on the subgroup of continents, as seen in Table 2,

the concentrations of As, Cd and Pb were in the lowest level in the Euroregion (0.002,
0.013 and 0.010 mg/kg) and in highest level in PAHO, AFRO and EMRO (0.008, 0.128 and
0.206 mg/kg), respectively. In regard to essential elements, it was observed that the
highest concentration of Fe, Ni, Zn, and Cu belonged to AFRO and WPRO regions
(4.903, 0.168, 0.820 and 700 mg/kg) and the lowest concentration in SEARO, PAHO, and
Euroregions (0.500, 0.071, 0.319, and 0.260 mg/kg), respectively.
According to these results, the much difference was seen in the concentration of
metals in studied fruit juices among different continents. In addition, the type of metals
and species of plants, physicochemical characteristics of water and soil which are used for
cultivation of plant have a significant impact on these differences. Generally speaking, soil
can be affected by industrial and urban activities [32] near to heavy-traffic roads, factories,
mines, highways, usage of chemicals as fertilisers or fungicides, as well as atmospheric
conditions and agricultural practices [37].
According to the results of Finster et al., (2005), Pb pollution in the soils of areas near to
the roads, due to tetraethyl emissions resulting from exhausted vehicles, was higher than
the soil of other areas [38]. As mentioned in previous studies, parameters such as organic
matters, pH of the soil, and the concentration of phosphate have a critical role in the stability
of metals [39]. In this regard, an increase in pH significantly reduces the metal’s mobility; this

Table 2. Meta-analysis of concentration of toxic metal (PTEs) (mg/kg) in juice based on WHO regions.
WHO Heterogeneity
Metal Region N of studies ES (95% CI) weight Statistics df P.Value I2 (%)
Pb AFRO 22 0.048 (0.042, 0.054) 31.61 8332.56 21 <0.001 99.7
EMRO 16 0.206 (0.179, 0.234) 23.75 42,207.71 15 <0.001 100.0
PAHO 10 0.006 (0.004, 0.008) 19.95 327.04 9 <0.001 97.2
EURO 14 0.010 (0.008, 0.012) 24.7 803.13 13 <0.001 98.4
Cd AFRO 13 0.128 (0.101, 0.156) 25.79 15,766.07 12 <0.001 99.9
EMRO 11 0.075 (0.059, 0.090) 25.86 9471.43 10 <0.001 99.9
PAHO 6 0.017 (0.006, 0.029) 20.67 5225.93 5 <0.001 99.9
EURO 13 0.013 (0.012, 0.014) 27.69 14,639.44 12 <0.001 99.9
As EMRO 4 0.003 (−0.001, 0.007) 33.57 68.28 3 <0.001 95.6
PAHO 1 0.008 (0.006, 0.010) 13.24 – 0 – –
EURO 5 0.002 (0, 0.003) 53.19 106.86 4 <0.001 96.7
Fe AFRO 19 4.903 (3.693, 6.113) 29.78 4.3E+05 18 <0.001 100.0
EMRO 15 1.771 (1.559, 1.982) 30.44 8220.94 14 <0.001 99.8
PAHO 11 1.565 (1.376, 1.754) 21.24 14,511.79 10 <0.001 99.9
EURO 8 2.714 (1.021, 4.406) 16.43 15,629.12 7 <0.001 100.0
SEARO 1 0.500 (0.412, 0.588) 2.11 – 0 – –
Zn AFRO 23 0.351 (0.270, 0.431) 32.43 2.1E+05 22 <0.001 100.0
EMRO 15 0.687 (0.446, 0.927) 20.16 66,717.44 14 <0.001 100.0
PAHO 20 0.455 (0.380, 0.529) 26.44 1.7E+05 19 <0.001 100.0
EURO 15 0.319 (0.251, 0.386) 19.52 63,706.44 14 <0.001 100.0
WPRO 1 0.820 (0.786, 0.854) 1.44 – 0 – –
Cu AFRO 23 0.320 (0.247, 0.393) 30.26 40,582.84 22 <0.001 99.9
EMRO 16 0.539 (0.362, 0.716) 21.31 1.8E+05 15 <0.001 100.0
PAHO 18 0.260 (0.210, 0.311) 24.27 81,000.48 17 <0.001 100.0
EURO 15 0.268 (0.144, 0.391) 20.12 31,460.19 14 <0.001 100.0
SERO 2 0.310 (−0.158, 0.779) 2.69 361.24 1 <0.001 99.7
WPRO 1 0.700 (0.666, 0.734) 1.34 – 0 <0.001 –
Ni AFRO 18 0.168 (0.135, 0.201) 30.48 3711.96 17 <0.001 99.5
EMRO 14 0.158 (0.128, 0.187) 26.23 10,735.65 13 <0.001 99.9
PAHO 12 0.071 (0.055, 0.088) 23.65 2209.17 11 <0.001 99.5
EURO 10 0.098 (−0.005, 0.201) 19.63 330,000 9 <0.001 100.0
 INTERNATIONAL JOURNAL OF ENVIRONMENTAL ANALYTICAL CHEMISTRY 9

change can occur via irrigation of soil with wastewater and cultivation of plants with
different species. Therefore, this issue can lead to forming carbonates and hydroxides and
increased organic matter of soil [7]. Yaylali-Abanuz and Tuysuz in their study indicated that
there was a significant negative relation between soil pH and uptake of metals by tea plants
[40]. Al-Busaidi et al. (2005), reported that the soil which was irrigated by wastewater had
higher pH and metal concentration as compared with the soil which was irrigated by
ground water [41]. In two separate studies conducted in India and China, the results showed
irrigation by wastewater compared to clean water and groundwater led to a significant
increase in metal content into the soil and the following various crops [42]. Clearly, long and
frequent irrigation with wastewater has incremental effects on organic total content,
bioavailability and concentration of metals in irrigated crops [43]. Moreover, domestic and
industrial sewages can directly affect the transfer rate (bioavailability) and subsequently
accumulation of metals in crops [44]. Using modern and high-efficiency technologies in
irrigating by wastewater can result in removing large amounts of harmful metals [45].
According to the research conducted by Al-Busaidi et al, in 2015, those fruits irrigated by
groundwater had lower concentrations of Fe, Cu, Cd and Ni (0.017, 0.008, 0.142 and
0.001 mg/L), respectively [46] in comparison with other ones irrigated by wastewater
(0.018, 0.024, 0.431, and 0.039 mg/L), respectively.
Likewise, in another similar study, it was indicated that the concentrations of Pb, Zn,
Cu, Co, Cr, As, Cd, Fe, Mn and Ni in sewage effluents were higher than those in clean water,
which, in turn, were found in irrigated crops by these two water resources [47].

2.4. Processes of fruit juice production

The wide variation range of reported data, in different studies and also our study, may
probably be due to the following factors such as using different techniques, stage of
storage, transport and packaging processes in fruit juice production [48]. Three different
types of fruit juices prepared and consumed in different countries included freshly, mar­
keted and commercial juices [49]. In many studies, these three different forms of produced
fruit juice have been compared to each other regarding the level of contamination with
different metals. According to the results, commercial juice products had higher concentra­
tions of contamination than other juices, because of absorption of heavy metals from the
metallic packaging material into the products [50]. Also, it is clear that using suitable
techniques can affect metal content in the production process of fruit juices. In 2017,
Wang et al. indicated that As concentration in apple and grape juices which had been
processed with filter aids was lower than those processed without filters [51]. Based on the
findings obtained by Artes et al., (2005), the tap water than to chlorinate washing can
effectively remove sand, soil and other contaminations from fresh fruits, without causing
toxicity or damaging fruits in washing stage [52]. In the previous investigation conducted by
Stilwell et al. regarding grapefruit juice packaged in glass containers or tin-coated metal,
they found that Pb levels were lower in grapefruit juice packaged in glass containers
compared with tin-coated metal [53].
10 S. KHAZAEI ET AL.

Table 3. Uncertainty analysis for TTHQ of metals in an adult due to consumption of fruit juice in
various countries.
Percentile 95%
Country AS Cd Cu Fe Ni Pb Zn TTHQ
Australia – – 0.0146 – – – 0.0023 0.013
Bangladesh – – 0.0015 – – – – 0.001
Brazil – 0.0120 0.0045 0.0166 0.0051 0.0014 0.0042 0.025
Egypt – 0.0179 0.0119 0.0132 0.0079 0.0250 0.0029 0.062
Ghana – 0.0364 – – – 0.0107 – 0.031
India – – 0.0119 0.0007 – – – 0.009
Iran 0.0004 0.0128 0.0146 – 0.0024 0.0347 – 0.059
Iraq – 0.0204 0.0011 0.0050 – – – 0.021
Latvia – – 0.0030 0.0011 0.0020 – 0.0006 0.004
Nigeria – 0.1328 0.0074 0.0194 0.0081 0.0168 0.0017 0.140
Northern Jordan – 0.1249 0.0186 – 0.0273 0.0004 0.0018 0.137
Pakistan 0.1943 0.0150 0.0042 0.0008 0.0140 – 0.0010 0.098
Poland – 0.0558 – – – 0.0042 – 0.048
Romania 0.0004 0.0241 0.0032 – 0.0028 0.0014 0.0009 0.025
Saudi Arabia – – 0.0144 0.0010 0.0009 0.0557 0.0018 0.070
Serbia – 0.0573 0.0139 0.0088 0.0085 – 0.0011 0.072
Spain – 0.0092 – – – – 0.0027 0.008
Tanzania – – 0.0022 – – – 0.002
Turkey 0.0041 0.0021 0.0028 0.0014 0.0032 0.0093 0.0008 0.020
USA 0.0034 0.0281 0.0054 0.0016 0.0016 0.0111 0.0011 0.052
Venezuela – – – 0.0009 – – 0.0010 0.001

2.5. Health risk assessment

The non-carcinogenic risk assessment of toxic metals by the consumption of fruit juices in
different countries has been presented in Table 3. The ranking of countries according to
THQ in the adult consumers was as follows: Nigeria> Northern Jordan> Pakistan> Serbia>
Saudi Arabia> Egypt> Iran> USA>Poland> Ghana> Brazil> Romania> Iraq> Turkey>
Australia> India> Spain> Latvia> Tanzania> Bangladesh> Venezuela. It was observed that,
among all countries, Nigeria and Venezuela had, respectively, the highest and lowest non-
carcinogenic risk assessment of toxic metals by consuming fruit juices. In general, the
dietary pattern of fruit juice consumption, per capita consumption of fruit juice, the con­
centration of PTEs in soil and wastewater used for cultivation of fruit are of important
parameters affect the health risk assessment, due to ingestion of PTEs via fruit juice
consumption [21]. In our study, the TTHQ amounts accounted for adult groups in all
investigated countries, were lower than 1. Therefore, there was not an acceptable health
risk for consumers of fruit juices.

3. Conclusion
In the current study, the concentrations of PTEs in the fruit juices such as apple, grape, mango,
orange, peach and pineapple were meta-analysed, and non-carcinogenic health risk in the
adults was evaluated. According to the results, the pattern of PTEs contamination was
different among fruit juices among countries. It was clear that the concentration of Fe Zn,
Cu and Ni were higher compared to other investigated elements such as Pb, Cd and As in
most fruit juices. Among heavy metals, Cd and essential elements, Fe had a higher concentra­
tion of contamination (0.204 and 16.712 mg/kg), respectively, which was related to pineapple
 INTERNATIONAL JOURNAL OF ENVIRONMENTAL ANALYTICAL CHEMISTRY 11

juice. The health risk assessment indicated that the amount of TTHQ of PTEs in fruit juices was
lower. Therefore, consumers at different ages were not at considerable non-carcinogenic risk
due to consuming fruit juices. Several factors such as physicochemical characteristics of PTEs,
the type and species of plant, as well as characteristics of soil and water used for cultivation,
various processes involved in fruit juice production play a basic role in the uptake of PTEs by
fruits. Therefore, in order to reduce the concentration of PTEs in fruit juices, there are some
preventive approaches including monitoring of soil and water used during fruit cultivation like
irrigation with clean water and appropriate techniques, which should be considered by
governments as well as farmers.

Acknowledgments
The authors would appreciate the Deputy of Research and Technology, Hamadan University of
Medical Sciences, for financial support of the study.

Disclosure statement
No potential conflict of interest was reported by the author(s).

Conflict interest
All authors express that they have any conflict of interest.

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