Supplementary Material

Potential Adverse Public Health Effects Afforded by

the Ingestion of Dietary Lipid Oxidation Product
Toxins: Significance of Fried Food Sources
Martin Grootveld 1,*, Benita C. Percival 1, Justine Leenders 1 and Philippe B. Wilson 1
1 Leicester School of Pharmacy, De Montfort University, The Gateway, Leicester LE1 9BH, UK;
[email protected](B.C.P.); [email protected](J.L.); [email protected](P.B.W.)
* Correspondence: [email protected];Tel.: +44-(0)116-250-6443

S1. Epoxy-fatty acid (epoxy-FA) LOPs: In vivo absorption and toxicities

Epoxy-FAs, i.e. FA acyl chains with epoxide rings, are generated from the direct attack of reactive
LOO• radicals on olefinic carbon sites in both MUFAs and PUFAs, a mechanism giving rise to the
generation of oxirane functions and alkoxyl radicals (LO•) [S1]; this process readily occurs during the
exposure of UFA-rich edible oils to common frying episode temperatures [9,14]. Major epoxy-FAs are
leukotoxin (9,10-epoxy-12-octadecenoate) and its diol derivatives from linoleic acid oxidation, which
promote the degeneration and necrosis of leukocytes. Moreover, these toxins have been implicated in
the pathogenesis of breast cancer, multiple organ failure, and impairments to the reproductive
functions of rats [S2]. Leukotoxins also have the ability to disturb cell proliferation and the respiratory
burst of neutrophils in vitro [S3]. Additionally, epoxy-stearate arising from the thermally-induced
oxidation of oleoylglycerol FA chains [9,14] was found to give rise to cytotoxicity, and stimulate
oxidative stress and apoptosis in HepG2 cells [S4], and a further study revealed that oxylipin epoxy-
FAs may be involved in soybean-induced obesity in mice [S5]. Notably, high-resolution 1H NMR
analysis is a highly valuable technique for the detection and quantification of epoxy-FAs and their
derivatives in thermally-stressed COs, including trans-9,10-epoxystearate, 9,10-epoxy-octadecanoate,
9,10-epoxy-12-octadecenoate (leukotoxin), 12,13-epoxy-9-octadecenoate (isoleukotoxin), cis-9,10-
epoxystearate and 9,10-12,13-diepoxyoctadecanoate, along with primary alcohol LOPs [9,14].
Further studies have confirmed that these epoxy-FAs are also absorbed into the systemic
circulation in humans [S6], and this consideration has major implications regarding the monitoring of
oxidative stress in humans, just as it does for the absorption of dietary-available aldehydes [93].
In assessments of the ability of soluble epoxide hydrolase (sHE) to modify the mode of action and
enhance the cytotoxicity of such FA epoxides, Greene et al. [S7] classified three groups of these
compounds with respect to this determinant, and from their results suggested that long-chain
derivatives of these oxidation products (as methyl esters) act as pro-toxins which are metabolised by
sHE to their corresponding diols, which exert a higher level of toxicity. Furthermore, both leukotoxin
and isoleukotoxin appear to be structurally optimised to serve this purpose. FAs and esters without
epoxide, nor vicinal diol functions, were found to not exert any toxic effects. Recently, Wagner et al.
reviewed the involvement of long-chain FA epoxides in nociceptive signalling processes [S8].

S2. Overview of Dietary Sources of LOPs

S2.1 Red meat, chicken and poultry

Lipid peroxidation represents the major reason for the deterioration of red meats and red meat
products, including rancidity, undesirable odours, loss of essential UFAs and consequently toxic
secondary LOP development, together with associated changes in meat textural qualities [S9-S11]. Of
course, secondary aldehydic LOPs are chemically reactive towards a range of meat muscle
biomolecules, particularly proteins, a process which leads to adverse sensory changes and nutritional
quality loss [S12]. However, the peroxidative stability of such meat products is dependent on the
balance of pro- and antioxidants present, and the composition of oxidizable lipidic substrates therein,
particularly PUFAs, cholesterol, proteins and selected pigments. Following slaughter, animal muscle
cells become overloaded with reactive oxygen species (ROS), a process also occurring during
refrigerator storage at 2–4 °C.
The secondary phase of lipid peroxidation involving the conversion of lipid hydroperoxides to
secondary LOP fragments (Figure 1) occurs during the early post-slaughter stage, with biochemical
modifications limited to the transformation of muscle to meat giving rise to optimal conditions for
oxidation of the highly-unsaturated phospholipid (PL) fraction of sub-cellular membranes, since this
process is no longer tightly regulated [S13,S14].
LOPs detectable in chicken meat may arise from inadvertently-peroxidised chicken feed (albeit
very unlikely for hydroperoxides in view of their high reactivities and metabolic transformations),
processing and packaging methods, and even heat exposure in chicken coops. Indeed, the presence of
peroxidised oils in chicken feed [S15], or metal ions such as catalytic, pro-oxidant Cu(II) [S16] has been
found to give rise to an enhancement of lipid peroxidation in the blood serum and liver of these animals
[S17].
It also appears that ‘warmed-over’ flavour (WOF) represents a sensory attribute of LOPs detectable
in meat products [S18]. The meat and poultry industries have, for many years, provided pre-cooked
meats for the foodservice industry, i.e. airline, restaurant, institutional and military services. Indeed, in
recent times severe outbreaks of food-borne diseases, predominantly those caused by undercooked
beef, have led to a great deal of interest in the pre-cooking of most, if not all, meats sold to consumers.
Implementation of this process effectively pasteurises or sterilises such meat products, thereby offering
protection against such diseases. Unfortunately, the pre-cooking of uncured meats (e.g., beef patties)
initiates a particular type of iron ion-catalysed lipid peroxidation which primarily involves the highly
polyunsaturated muscle membrane phospholipids, a phenomenon giving rise to the rapid
development of an off-flavour. Currently, there is no completely reliable method for the suppression
of post-cooking lipid oxidation in meat. Moreover, some consumers are completely unable to detect
WOF, whereas others exhibit varying degrees of sensitivity. Indeed, WOF is so common that the
majority of consumers tend to accept meats with this flavour. Although much research work has been
previously conducted in this area, little has been accomplished on the precise molecular nature and
concentrations of toxic LOPs such as CHPDs and aldehydes, together with any further secondary LOPs
generated. Therefore, it appears that further research work to determine the precise molecular nature
and levels of these toxic LOPs in meat samples is required, both prior and subsequent to the
development of WOF.
Developments in some modern technologies for the preservation of meat products, and the
maximisation of their impacts on lipid stability, include high-pressure processing (HPP) treatments,
limited microwave cooking durations, non-ionising UC-C radiation, infra-red heating, and the addition
of antioxidant and transition metal ion chelators, etc., are discussed in detail in [S19].

S2.2 Fish products

Fish products are generally more susceptible to lipid peroxidation than meat ones in view of the
high levels of peroxidatively-vulnerable ω-3 PUFAs present, particularly DHA and EPA. Although not
a major focus of this commentary paper, the generation of cholesterol oxides in fish products are also
notable, and also of at least some public health concern [S20].
Stress levels experienced by fish just prior to or at slaughter appears to represent one of the major
explanations for deteriorations in flesh tissue, and this process engenders the activation of metabolic
pathways which feature the generation of ROS, including lipid hydroperoxides [S21,S22]. Such primary
LOPs may represent the main cause of increased peroxidation cascades experienced following death,
and also during storage episodes. However, fortuitously these adverse effects may be successfully
suppressed via the performance of bleeding episodes, which are able to diminish ROS concentrations
and, of course, those of catalytic haemoglobin and related Fe(II)/Fe(III) haem pigment pro-oxidants
[S23]. Similarly, the frozen storage of fish products at –30 to –40 °C also hinders the peroxidation
process. Indeed, freezing in this manner appears to retard peroxidative damage to the greatest extent
[S24].
Additionally, these studies are also of some relevance to the direct shallow frying of ω-3 FA-laden
fish such as tuna, which displays major losses of O-3 FAs, particularly EPA and DHA, when exposed
to such high temperatures [S25]. Results obtained concerning the 1H-NMR monitoring of the toxic
aldehydic LOP dataset acquired on the CLO products when heated according to laboratory-based
thermal stressing episodes at 180oC are also of a more generic significance to the food science and
nutrition areas in view of their generation during the shallow frying of fish. Indeed, in one relevant
study [S25], it was found that the shallow frying of Skipjack tuna portions of 74 cm length in double-
refined sunflower oil for periods of up to 10.0 min. gave rise to losses of 69 and 84% (w/w) EPA and
DHA contents respectively. Although a significant level of FA exchange between the oil medium and
fried fish may partially account for these observations, this is, of course, also fully consistent with the
thermally-induced peroxidation of tuna O-3 FAs as noted here. In general, the shallow frying period
employed for fish is dependent upon the mass/thickness of the food product utilised, e.g. 10–12 min.
for whole fish, and 3–6 min. for finfish fillets at temperatures ranging from 177–191 °C.

S2.3 Dairy products

PUFAs present in milk and milk products are susceptible to peroxidation, especially during
pasteurisation processes (72 °C) ultra-heat treatment (UHT) and homogenisation practices employed
by the dairy industry to circumvent spoilage and retain taste. Interestingly, a hedonic sensory analysis
revealed that pasteurised milk products from grain-fed cows, which had higher LOP values, were
preferred over that from cows fed a mixed ration [S26]. However, results from investigations involving
analytical LOP and sensory testings, along with sensory characteristics of ω-3 FA-supplemented dairy
products, were mixed [S27,S28]. Moreover, ultra-high pressure treatment (UHPT) appears to limit
oxidation and hence influence product safety [S29]. Pereda et al. [S30] found that such treatment of milk
at 300 MPa and a temperature of 30–40 °C gave rise to significantly lower hexanal and malondialdehyde
(MDA) levels when compared to that treated at only 200 MPa, or when exposed to a high pasteurization
temperature (90oC for a period of 15 s). Acrolein is detectable in some types of cheese, particularly the
Egyptian Domiati type, which contains levels as high as 290–1024 µg/g [S31].

S2.4 Grain products

The manufacture of grain-based food products induces the peroxidation of PUFAs therein,
although this phenomenon is critically dependent on food water content. For example, superheated
steaming processes, which represent techniques for the roasting of rice, has been shown to give rise to
significant rises in peroxide value and thiobarbituric acid-reactive substance (TBARS) indices in this
food when water activity was not moderated [S32].
Low moisture foods appear to be more resistant to lipid peroxidation, and this observation is best
rationalised by the emulsification of lipidic sources therein, a process which enhances the surface area
of peroxidizable PUFAs and hence their level of exposure to the essential O2 reactant. Moreover, food
processing water sources may carry significant levels of catalytic transition metal ions (particularly
those of iron and copper), which may promote peroxidation processes, along with the decomposition
of lipid hydroperoxides to secondary LOPs such as aldehydes. On example involved the manufacture
of crackers, in which such hydroperoxides were more stable in low moisture products than they were
in bulk oils, meats and emulsions [S33]. Since this delayed the production of the secondary LOP
hexanal, either of the above explanations are plausible (Equations S1 and S2, where L represents a metal
ion-complexing ligand, and n the number of these complexed to the metal ion centre):
LOOH + Fe(II)Ln → LO● + OH- + Fe(III)Ln (S1)

LOOH + Fe(III)Ln → LOO● + H+ + Fe(II)Ln (S2)

 Occurrence of the lipid peroxidation cycle during non-thermal high pressure processing methods
is pressure-dependent, and to date results acquired indicate that the application of lowered pressures
of 200-350 MPa offer a higher level of resistance of food lipids against oxidation [S34]. As expected,
replacement of PUFAs by SFAs provides grain-rich shelf foods with extended shelf-lives in view of a
diminished level of lipid peroxidation therein. Notwithstanding, newer strategies for the protection of
PUFAs against peroxidation involve microencapsulation techniques, in which particles or droplets are
encapsulated in carbohydrates, polymers or even protein coatings.

S2.5 Fruits and vegetables

The natural function of trans-2-hexenal offers protection to plants against bacteria and fungi [S35].
Indeed, it has the ability to act in this capacity in view of its powerful mutagenic [S36-S38] and genotoxic
[S39-S41] actions. Since humans have a permanent intake of this a,b-unsaturated aldehyde from
vegetable and fruit products, with an estimated mean intake of 60 mg/kg BW (equivalent to 4.2 mg for
a 70 kg average mass human) per day from a ‘normal’ diet, and of 0.6–2.1 mg/kg BW per day from
foods rich in 2-hexenal such as bananas [125], there remains some concern that this genotoxin may play
a significant role in human carcinogenicity.
Interestingly, acrolein may be formed during fruit-ripening episodes [S42,S43]. In 1991, Feron et
al. [113] determined acrolein levels of <0.01 to 0.05 mg/kg in fruit; however, concentrations of up to 0.59
mg/kg were found in vegetables. Notwithstanding, unfortunately this study lacked information
regarding sample collection location(s) and date(s), and also the numbers of such samples analysed.
Serrano et al. [S44] developed a new static headspace-gas chromatographic-mass spectrometric
(SHS-GC-MS) technique to successfully monitor 15 different aldehydes in canned vegetable products,
which arise as natural constituents or are present as disinection by-products. These aldehydes were
detectable in both the solid and liquid phases of these products, and 13 of these carbonyl compounds
were present at mean levels ranging from 2.2–39 µg/kg and 0.25–71 µg/L, respectively. Additionally,
glyoxal and methylglyoxal found predominantly in the liquid phase at concentrations of 1.4–4.1 µg/L
were attributable to their employment in treated water used for manufacturing purposes.

S2.6 Alcoholic beverages

Acrolein can also arise as an undesirable by-product of alcoholic beverage fermentation, and also
from the storage and maturation of alcoholic drinks [113]. Although data available are very limited, a
maximal concentration of 3.8 mg/kg acrolein has been documented for red wine [113], and mean levels
in samples of United Kingdom lager beer were found to be 1.6 µg/L and 5.0 µg/L for fresh and aged
samples respectively [S45]. Such trace concentrations (<10 µg/L) were also measured in a Canadian
apple wine product [S46]. This secondary LOP has also been found in a range of non-alcoholic
beverages such as tea and coffee, although no concentration information was provided [113].
Astonishingly, the extremely high level of acroleinfound in red wine [113], which is very nearly
equivalent to 70 mmol/kg (Table 1, [19]), is greater than the total aldehyde concentration of a very
highly thermally-stressed or reused PUFA-rich culinary frying medium such as sunflower or corn oils
[14]. Therefore it appears that this commonly consumed beverage presents a number of serious health
risks, which will clearly markedly negate any positive health benefits offered by the rich plethora of
antioxidants, phenolic or otherwise, contained therein, and which continue to be reported in many
scientific publications.
Alcoholic beverages in general serve as major sources of acetaldehyde, which amounts to an
estimated 7.8 mg/day for a human of mean BW 70 kg. Full details of dietary sources of this staurated
aldehyde are provided in section S3.

S2.7 Aldehydes as food flavouring agents

trans-2-Hexenal, a known secondary LOP, is something of an exception since it is widely used in
the food industry as a flavouring agent. and humans have a permanent, and what might be now
considered a very frequent intake of it from vegetable and fruit sources [section S2.5]. Hence, its
carcinogenic potential in humans remains a health concern. The 2.4 mg estimate for total trans-2-
alkenals for a typical single 154 g fried food portion [14] is similar to that estimated for the mean daily
human intake of 2-hexenal from such ‘normal’ diet food sources.
In 2004, a report from the sixty-first meeting of the Joint FAO/World Health Organisation (WHO)
Expert Committee on Food Additives (JECFA) [S47] stated that ‘α,β-Unsaturated aldehydes are formed
endogenously by lipid peroxidation of PUFAs (Frankel et al., [S48]) or can be consumed as naturally-
occurring constituents of food (Stofberg and Grundschober, [S49]; Maarse et al., [S50]), and are only
consumed to a minor extent as added flavouring agents.’ However, at that point in time, this report
was limited by the unavailability of reliable research data, and information regarding the
preponderance of proportionately much higher levels of such aldehydic toxins in dietary fried and
other food/environmental sources available for human consumption [3,14].
trans,trans-2,4-Decadienal (t,t-DDE) represents 50–60% of the total production of linear aliphatic
alkadienal flavouring agents in both Europe and the USA [S47], and Section S11 of the Supplementary
Materials section provides estimates of its daily human intake as a flavourant. Notably, the potential
role of this a,b-unsaturated aldehyde as an indoor air pollutant toxin present in cooking oil fumes has
been implicated in the development of lung cancer in restaurant workers, and this is also discussed in
Section S11.
Further aldehydes which are added as flavouring agents to a wide range of frequently consumed
foods include aromatic classes of these compounds, for example benzaldehyde, phenyl-acetaldehyde,
and vanillin and its ethyl ester derivative. An example of the routine 1H-NMR screening of food
products for aldehydes is shown in Figure 4, which reveals that high levels of vanillin (3-methoxy-4-
hydroxybenzaldehyde), and tentatively also one of its oxidation products, were present in a chocolate-
hazelnut spread product, along with much smaller amounts of secondary trans,trans-2,4-alkadienal and
n-alkanal LOPs. Similarly, furfuraldehyde (furfural) is also employed as a food flavourant, and also
occurs naturally in a range of agricultural by-products such as wheat bran, oats and corncobs.
Interestingly, cocoa and coffee contain as much as 55–250 ppm of this agent [S51], and there is evidence
available that this aldehyde exerts genotoxic and carcinogenic actions, especially in the liver [S52].
Further aldehydic food flavouring agents are citral, methional and methylglyoxal [S53].

S2.8 Thermoplastic food packaging materials

Residual solvents derived from the coating, printing and lamination manfacturing practices
represent the major sources of undesirable packaging odours, which may also arise from degradation
of the polymeric packaging material itself, along with that of any adhesives, coatings and inks
employed. Such adverse odours may result from the thermally-induced deterioration of processed
packaging matrices, resin oxidation and/or the corona discharge-mediated oxidation of films and/or
their additives. In view of these problems, researchers have targeted odour-scavening as a major
developmental research area for extending the shelf-life of pre-packaged food products, and a series of
anti-oxidant and aldehyde-scavenging agents have been refined and advanced for this purpose, the
latter predominantly focused on hexanal. Alternative strategies have involved the development of
oxygen-scavenging agents, activated carbon and molecular sieves.
Acrolein is also produced as a thermal degradation product of cellophane and polystyrene
thermoplastics used to package foods [S54,S55]; however, to date there are no reports available which
suggest its possible transfer to packaged food products.

S3. Food sources and Cancer Risks of Acetaldehyde and Formaldehyde

For acetaldehyde and formaldehyde, estimated mean daily dietary exposure quantities are 93 and
11 g/kg respectively (equivalent to 5.6 and 0.66 mg, respectively, for a mean 60 kg body weight) in
Korea [S56]. In that country, the major contributors towards these values are napa cabbage kimchi
(15%), rice wine (11%), and beer (7%) for acetaldehyde (this aldehyde is a very common trace
contaminant in alcoholic beverages), and white rice (11%), napa cabbage kimchi (4%) and
ramveon/instant noodles (4%) for formaldehyde. Additionally, for foods and their associated
cooking/frying methods, acetaldehyde was found to be most prevalent in macerated dried shiitake,
boiled garlic, cheonggukjang/rich soybean paste, and pan-fried yeast. For formaldehyde, however,
cooked/prepared foods containing the highest levels of this toxin were dried Alaskan pollack, > dried
shiitake boiled following maceration, > broiled dried Alaskan pollack > myeongran jeot/ cooked salted
pollack roe > yeast > dried Alaskan pollack.
In 2009, Lachenmeier et al. [S57] conducted a highly detailed and prolific investigation of the mean
exposure of human populations to acetaldehyde from alcoholic beverage sources alone, and this was
estimated as 0.112 mg/kg BW/day (corresponding to 7.8 mg/day for a human of average BW 70 kg).
The margin of exposure (MOE) value (defined as the ratio of its no-observed-adverse-effect (NOAEL)
value to its theoretical, predicted, or estimated dose/concentration of human intake) was computed to
be 498, and the life-time cancer risk was found to be 7.6 in 10,000. However, greater risks may be
considered for those exposed to high levels of acetaldehyde contaminations, as noted for unrecorded
alcoholic beverage consumption in Guatemala and Russia, and for which possible exposure risks are
within the 1 in 1,000 range [S57]. However, both these life-time cancer risk values greatly exceed those
of well-known established ones from environmental factors, which generally lie between 10-4 and 10-6
[S57].
Acetaldehyde is a quite common flavouring additive for many food products, e.g., those of milk
(fruit yoghurts), fruit juices, sweets, desserts, margarine and soft drinks, for example [113], and the
FEMA has provided consumption level data for this toxin of 0.16 mg/kg BW/day from such flavouring
applications alone [S58]. Corresponding estimates from JECFA were 0.16 and 0.18 mg/kg BW/day for
the USA and Europe respectively [S59]. Exposures to this aldehyde arising from cosmetic use appear
to be virtually negligible [S57]. However, the life-time cancer risk from ethanolic sources, which is
metabolised to acetaldehyde in vivo, remains much greater than that of alcoholic beverage sources of
this aldehyde, specifically 10-3 to 10-2 [S60].

S4. Comparisons of the Dietary Availability and Ingestion of Aldehydic LOPs to those of trans-Fatty
Acids, Acrylamide and Monochloro-Propanediol (MCPD) CO/Fried Food/Lipid Product Toxins
Adverse health risks associated with human ingestion of the neuro- and reproductive system
toxin, and potential carcinogen acrylamide (ca. 0.6 ppm only for potato chip products [S61]) are here
considered almost negligible when compared to the estimated levels of cytotoxic and genotoxic
aldehydes available for human consumption in fried foods [3,14]. Similarly, potato chip levels of
established monochloro-propanediol (MCPD)/MCPD glycidyl ester adduct carcinogens are also very
low (0.10–0.26 ppm [S62]). Estimated mean potato chip ppm levels of the most prevalent aldehydes
arising from the peroxidation of linoleoylglycerol sources alone are 15, 24 and 13 ppm for trans-2-
octenal, trans,trans-deca-2,4-dienal and n-hexenal respectively, whereas those from oleoylglycerol
hydroperoxide substrates are 19 and 18 ppm for trans-2-decenal and n-nonanal respectively [14].
Moreover, the adverse health effects potentially exerted by a variety of aldehydic LOPs have a
much broader span than those provoked by the dietary ingestion of trans-FAs, which are generally
limited to their long-term effects on the development of coronary heart diseases [S63,S64], but not
cancer. Additionally, on a mole-for-mole (molar) equivalence scale, the severity of the cytotoxic and
genotoxic actions of such LOPs are much more substantial than any deleterious health effects exerted
long-term by trans-FAs. However, it is important to note that despite this, from 1999 to 2002 the
estimated mean US daily intake of trans-FAs (6.1 g, equivalent to 2.5% of energy) [S65] was, of course,
substantially greater than that of dietary aldehydes; the trans-FA intake range within the fifth
distributional quintiles was very broad, and ranged from 8.8 to 92.4 g. The major dietary sources of
trans-FAs were reported to be cakes, biscuits, pies and pastries in this communication.

S5. In vivo Absorption, Metabolic Fate, Toxicology, and Adverse Health Effects of HNE and HHE
Animal model system-based investigations have demonstrated that chronic consumption of high
levels of toxic aldehydic LOPs such as 4-hydroxy-trans-2-nonenal (HNE), a fragmentation product of
linoleoylglycerol hydroperoxides, and also generated in thermally-stressed culinary frying oils
containing these precursors (albeit at significantly lower levels than those of trans-2-alkenals,
trans,trans-2,4-alkadienals and n-alkanals [14]), amplifies tumour frequencies [13,S66], and significantly
contributes towards the metabolic syndrome [S66]. It is also associated with the development and
perpetuation of vascular and neurodegenerative diseases, the former including atherosclerotic lesion
development [13,S67]. Many of these adverse effects have been observed at concentrations similar to
those available in vivo (sub-micromolar for HNE). Intriguingly, early studies revealed that HNE has the
ability to engender genotoxic events in lymphocytes and hepatocytes [13,128,S68,S69], and also modify
cell-cell adhesion, induce reactive oxygen species (ROS) production, and diminish intracellular
glutathione stores in lung microvascular endothelial cells [S70].
Awada et al. [76] explored the intestinal absorption of both HHE and HNE, and for this purpose
they fed diets containing either unoxidized (control) or moderately-oxidised -3 FAs (with -6 to -3
% content ratios of 5–8) to mice, the latter diet containing much higher levels of both aldehydes than
the unoxidized one. Other model rats featured in the study received orally-administered HHE against
baseline control animals (mice were postprandially euthanized). Further experiments involved the in
vitro equilibration of human Caco-2/TC7 cells with added HHE and HNE. Intestinal absorption of HHE
was indeed observed, and this uptake was found to be related to the formation of its protein adducts
(presumably via Michael addition and Schiff-base reactions), and an enhanced expression of
glutathione peroxidase 2 (GPx2) and glucose-regulated protein 78, both in vitro and in vivo. Moreover,
the oxidised -3 FA diets administered elevated the inflammatory biomarkers interleukin-6 (IL-6) and
monocyte chemoattractant protein (MCP-1) in blood plasma, and also activated nuclear factor kappaB
(NF-B).
Therefore, this pioneering work provided powerful evidence for the in vivo absorption of 4-HHE
and perhaps also 4-HNE; although blood plasma concentrations of both these reactive -unsaturated
aldehydes were elevated following oral administration of the oxidised lipid dietary regimen
(substantially so for 4-HHE), that observed for 4-HNE was only minor (from 6 to 9 nmol/L), and this
increase was found not to be statistically significant.
A summary of key studies focused on the metabolic fate of HNE in cells, organs and experimental
animals are provided below:
(1) In packed erythrocytes, metabolic routes found featured a GSH conjugate and 4-
hydroxynonenate (70 and 25% of total metabolites respectively) – the glutathione conjugate
was subsequently resolved into 2 distinct species, i.e. glutathionyl-HNE and glutathionyl-1,4-
dihydroxynonene [78].
(2) A differential but limited capacity to metabolise HNE in the lung and the brain, information
supporting the propensity for trace amounts of this toxin to give rise to tissue injury within
these organs during episodes of in vivo oxidative stress [S71]. However, in this investigation,
metabolism to GSH conjugates by glutathione-S-transfer was observed, with the highest
concentrations being observed in the lungs of rats and the livers of mice; protein-HNE
adducts were found in all tissues evaluated, and NAD(P)+ and NAD(P)H were found to
substantially promote HNE’s metabolism in the liver only.
(3) Siems et al. [S72] conducted a highly-intensive study investigating intracellular metabolism
of HNE in a very wide range of mammalian cells and organs at added levels of either 1 or
100 mol/L and a temperature of 37 °C, the former concentration corresponding to that found
physiologically. At this lower level, typical blood serum levels of 0.1 to 0.2 mol/L were
found to be restored within 10–30 s, and most of the 100 mol/L dose was metabolised within
a 3 min. period. In hepatocytes and further cell types, the 1:1 GSH-HNE conjugate, along
with the corresponding alcohol and carboxylic acid adducts of the added substrate, i.e. 1,4-
dihydroxynonene, and hydroxynonenate respectively, were the primary products generated.
-Oxidation of the latter carboxylic acid metabolite was also shown. Chemical reactions of
HNE with protein functional groups were observed, but only to a low extent (≤ 8%) of the
total consumption level. However, generation of the mercapturate, cysteine-HNE and
 glycine-cysteine-HNE Michael addition adducts was limited to only neutrophils and kidney
cells. The involvement of such pathways provided evidence for antioxidant defence
mechanisms in place to alleviate the potentially adverse chemical modification of proteins in
vivo, i.e. those involving the generation of protein-carbonyl and alternative aldehyde-
damaged species.
(4) Protein-HNE adducts predominantly involve cysteinyl, histidyl and lysyl residues as the
major targets of electrophilic addition at the C-3 position of HNE to form Michael addition
products (reviewed in [77]). Such adducts can give rise to major impairments in the normal
biochemical functioning of a range of proteins, as documented in [S73]. HNE also has the
ability to cross-link these biomacromolecules in view of its capacity to engage in both Michael
addition and Schiff base reaction processes. Although Michael addition products are
relatively stable, Schiff base reactions are physiologically slow and reversible [S74].

S6. Further Limitations of the Mak et al. Study (Ref. [79]).

Further potential limitations noted for the study reported in [79] were the possible impacts of
therapeutic agents that both groups of patients were receiving. For example, inhibition of vasculature
ROS generation in CHF group participants by ACE inhibitor therapies (n = 7 out of 8 patients), which
conceivably could have underestimated the elevations observed in their plasma aldehydic LOP
concentrations, if indeed they arose from in vivo lipid peroxidation. Notwithstanding, CHF-mediated
upregulations of these secondary LOPs were perceived not to arise solely from the presence of coronary
artery disease or its risk factors, the prevalence of which were found to be equivalent in the two groups
compared.

S7. Blood Plasma Aldehyde Concentrations in Infants with Chronic Lung Disease
Ogihara et al. in 1999 [87] determined the blood plasma levels of aldehydic LOPs in premature
infants with and without chronic lung disease (CLD), i.e. those of 3 long-chain n-alkanals, 4 trans-2-
alkenalsand HNE only. In contrast to aldehydic LOP data available in [79], the age-matched non-CLD
infants were found to have much higher levels of total n-alkanals (predominantly n-hexenal and -
heptenal) than those of total -unsaturated aldehydes (i.e. molar ratios of > 5), with HNE representing
approximately 30% of the latter, more chemically-reactive classification. The relative abundances of
these saturated and unsaturated aldehydes were in the order n-hexanal >> -heptanal >>> -pentanal, and
HNE > trans-2-heptenal > -nonenal > -hexenal > -octenal, respectively. Notwithstanding, these
researchers found that plasma levels of heptanal, 2-nonenal, and HNE were significantly elevated in
CLD infants on the day of birth over those of non-CLD controls, but this was not the case at 4–6 days
of age, and such results indicated that in vivo lipid peroxidation may be pathologically featured in
neonatal CLD.

S8. DNA Adduct Formation with and Detoxification of trans-2-Hexenal

trans-2-Hexenal detoxification and DNA adduct generation in humans was tested in
physiologically-based in silico models by Kiwamoto et al. [124]. In these experiments, trans-2-hexenal
exposure gave rise to 0.039 adducts/108 nucleotides (nt) at its questionable quoted estimated mean
dietary intake of only 40 µg/kg BW, and 0.18 adducts/108 nt at the corresponding 95th percentile of this
estimated daily intake dataset (178 µg/kg BW, equivalent to 12.5 mg for a 70 kg human). However,
these 108 nt-normalised levels were found to be up to 1,000-fold lower than the natural background
DNA adduct values documented for disease-free humans (6.8–110 adducts/108 nt), and therefore it was
concluded that the genotoxicity risk for trans-2-hexenal in humans was negligible. Notwithstanding, it
is of much importance to note that the above estimated mean and 95th percentile values for the dietary
intake of this aldehyde are only focused on a single trans-2-alkenal, and no allowance whatsoever has
been made for the accumulative effects of a range of further aldehydes carried as toxicological hazards
by fried food products, i.e. trans-2-octenal, -pentenal and -decenal, which represent the predominant
secondary trans-2-alkenal LOPs derived from the peroxidation of linoleoyl-, linolenoyl- and
oleoylglycerols respectively [14].

S9. Cytotoxic and Mutagenic Potential of the Natural Product 2-Cyclohexene-1-one Evaluated
against a Range of Dietary Aldehydes
Glaab et al. [S75] tested the cytotoxic and genotoxic potential of 2-cyclohexene-1-one, a natural
product present in some tropical fruits and a soft drink contaminant, against those exhibited by the 2-
alkenals trans-2-hexenal, trans-2-octenal, trans-2-nonenal, trans,cis-hexa-2,4-dienal, trans,cis-nona-2,6-
dienal and cinnamaldehyde in V79 and Caco-2 cell lines. With the exception of trans-2-hexenal and
cinnamaldehyde, all these -unsaturated aldehydes displayed a much higher level of cytotoxicity
than 2-cyclohexene-1-one following a 1.0 hr. incubation period. All aldehydes evaluated gave rise to
higher levels of DNA damage than that exerted by 2-cyclohexene-1-one, apart from cinnamaldehyde.
Intracellular glutathione levels also diminished following treatment with all these carbonyl
compounds, as might be expected.

S10. Acrolein as an Inhaled or Ingested Toxin of Carcinogenic Potential: a Special Case for
Consideration
In addition to its generation from the fragmentation of CHPDs arising from the peroxidation of -
3 FAs (including -linolenic acid, and fish oil-specific EPA and DHA) during high-temperature
frying/cooking episodes, acrolein represents a special case for consideration since many recent
intensive investigations have been focused on the adverse health effects of both dietary and/or
environmental sources of it. This highly-reactive aldehyde is also liberated from the combustion of
fuels, petroleum biodiesel, wood, paper and plastic sources, and is also a major toxin/carcinogen
present in inhaled tobacco smoke [134].
One major, valuable consideration is the high level of diversity of tissues and organs in which
acrolein has the ability to exert its damaging actions. In each case, there may be mechanisms which are
either organ- or disease-explicit, in addition to more common non-specific ones, which may facilitate
the design of targeted and non-targeted approaches, respectively, for the therapy and management of
acrolein toxicity. However, in the case of orally-ingested exogenous acrolein, the GI system is the most
important, primary site of acrolein attack and inducible damage.
Acrolein’s ability to cause DNA damage (via chemical modification of its base moieties) and
suppression of DNA repair pathways are features which engender its carcinogenicity.
Notwithstanding, such actions remain a subject of considerable debate [S76]. When administered via
the i.p. route, this reactive aldehyde, i.e. 75 and 150 nmol. per animal, elevated the frequency of DNA
damage adducts, but not the incidence of tumours in both male and female B6C3F1 mice, an
observation indicating that such DNA modifications did not correlate with cancer development [S77].
However, it should be noted that such doses are extremely small, and assuming a mean animal mass
of 15 g, these values equate to only 1.87 and 3.75 mol./kg, which is extremely low when compared to
typical dietary aldehydic intake assaults, which in one study was reported as 5 mg/kg for the total
unsaturated aldehyde intake value in humans [19], of which the proportion of dietary acrolein will vary
according to variations in dietary patterns and frying oil use, including the oils and frying methods
used, etc. For example, populations with high intakes of marine oils, which contain high contents of
acrolein-generating -3 FAs, particularly those exposed to high temperature frying episodes which
substantially promote their peroxidation. Similarly, Western diets using relatively high levels of
soybean, canola or rapeseed oils as frying media, with low but nevertheless significant -3 FA contents
(ca. 7–12% (w/w)), will also produce much higher levels of this potential aldehydic carcinogen.
An epidemiological study performed in 2002 [156] explored relationships between lung cancer risk
in Chinese women and the use of locally-manufactured rapeseed and linseed oils for stir-frying
practices, and these researchers found that for women who frequently performed stir-fry cooking
methods, there was a significantly enhanced risk of lung cancer, especially when using rapeseed oil. As
might be expected, this risk increased with the total number of years that they had been exposed to
cooking oil fumes. Moreover, some evidence for a contribution towards this risk value from exposure
to linseed oil cooking fumes was also obtained. Incidences of eye and throat irritations arising from the
employment of these oils for frying purposes also bestowed a significantly increased lung cancer risk.
This investigation is of much interest and value, since both these oils contain relatively high levels of
linolenoylglycerols, linseed oil exceedingly so: ca. 8% (w/w) for rapeseed, and as much as ca. 55% (w/w)
for linseed oils. Both acrolein and MDA are liberated from the degradation of hydroperoxides
generated from this and other -3 PUFAs, and do not arise from the fragmentation of -6 PUFAs such
as vegetable oil-prevalent linoleoylglycerols, although acrolein can also potentially be formed from free
glycerol oxidation. Therefore, it is conceivable that these specific aldehydes play a major contributory
role towards the development of lung cancer (notably adenocarcinoma) in Chinese women exposed to
wok cooking fumes, especially acrolein.
Acrolein also acts as a respiratory and pulmonary toxin, and hence has been implicated in a range
of pulmonary conditions, e.g. pulmonary oedema, amplification of bronchial responsiveness [S78], and
also chronic obstructive pulmonary disease (COPD) [28], the latter inducible and exacerbated by the
inhalation of acrolein-and crotonaldehyde-rich tobacco smoke (estimated contents of these aldehydes
in a daily 25-cigarette allocation of them are 0.62-3.5 [S79] and 1.8-5.7 mg [137] respectively).
Feroe et al. [S80] also investigated the influence of ingested acrolein intake on diabetes and insulin
resistance, and for this purpose they explored associations between its urinary creatinine-normalised
metabolites, specifically (N-acetyl-S-(3-hydroxypropyl)-L-cysteine and N-acetyl-S-(carboxyethyl)-L-
cysteine, and their molar sum, in a very large number of participants with these disorders, who were
recruited to the 2005-2006 National Health and Nutrition Examination Survey (NAHANES). This study
demonstrated that both these conditions were positively associated with the excretion of both urinary
metabolites, along with their summed total values. Some evidence for a dose-response relationship was
also obtained.

S11. Dietary Sources, Inhalation/Ingestion, Cytotoxicity and Genotoxicity of t,t-DDE

Available reports [S81-S83] have estimated that the combined daily human intake of a total of 12
of these flavour enhancers was ca. 40 µg in Europe and ca. 120 µg in the USA, and that for trans,trans-
deca-2,4-dienal alone was ca. 20 µg in Europe and ca. 70 µg in the USA (the estimated value for all the
remaining flavouring agents in this group was stated as being within the 0.007–24 µg/day range).
However, such estimates are unfortunately solely and loosely based on the intake of these agents,
predominantly t,t-DDE, as added flavour-enhancing agents. Indeed, our estimate of 3.8 mg of total
trans,trans-2,4-alkadienals (predominantly t,t-DDE) alone in a single 154 g portion of fried potato chips
for human consumption is substantially greater than the above flavouring agent-based one, and
therefore conceivable public health threats presented by its non-flavouring dietary intake are certainly
worthy of consideration. Our mean±SEM estimate of 157 ± 43 µmol./kg for total trans,trans-alka-2,4-
deienals [14] is not dissimilar to the maximal deep-frying value of ca. 65 µmol.kg-1 (10–11 ppm) for
trans,trans-deca-2,4-dienal alone in French fries estimated by Boskou et al. [S84]. However, our higher
determined mean value [14] will also include contributions from all other trans,trans-alka-2,4-dienals
present.
t,t-DDE, which arises from the thermolytic β-scission fragmentation of linoleoylglycerol
hydroperoxides, exerts a high level of cellular toxicity in the liver and kidney [S85], along with its ability
to induce the proliferation of GI epithelial cells [S86]. In view of its high reactivity towards DNA base
adducts [S87], currently there are numerous concerns regarding strong linkages between its inhalation
and/or ingestion and cancer development in humans. Since this class of aldehydes (trans,trans-2,4-
alkadienals) are readily generated from the thermally-induced peroxidation of PUFAs within COs and
foods, and also have an extensive incidence, albeit at much lower contents, as flavouring agents in food
products [S47], t,t-DDE is considered by the National Cancer Institute (NCI) and National Toxicology
Program (NTP) at the National Institutes of Environmental Health Sciences (NIEHS) as a major priority.
Indeed, strong supporting evidence for a very disturbing increase in the incidence of lung
adenocarcinoma in non-smoking women based in China, Hong Kong, Taiwan and Singapore has been
provided by a series of epidemiological studies [S88–S91], and this rise has been ascribed to their rather
excessive exposure to cooking oil fumes [S88,S90–S92]. Although these fumes are, of course, highly
complex, multicomponent human toxin admixtures [S93], and their compositions vary with their frying
oil sources and frying conditions such as temperature, aldehydic LOPs such as t,t-DDE represent major
constituents. Indeed, t,t-DDE is one of the most predominant -unsaturated aldehydes detectable
therein, along with acrolein [188].
The toxicological effects exerted by this reactive aldehyde towards a non-cancerous human
bronchial epithelial cells (BEAS-2B) have been previously investigated [S86], and this study reported a
significant boost to their ROS production capacity, and also changes to their GSH/glutathione
disulphide ([GSH]:[GSSG]) balance, the latter of which is presumably ROS-mediated; significant
decreases in [GSH]:[GSSG] ratios were observed when this cell line was exposed to 1–5 M t,t-DDE
short-term (48 hr.), and likewise only 0.10-1.00 M long-term (up to 30 days). Furthermore, an increased
cellular proliferation was observed when these cell lines were incubated with 1.0 µmol/L t,t-DDE for a
45 day period. The expression and release of the pro-inflammatory cytokines TNF and interleukin 1B
(IL-1B) was also observed. Since these cytokines are associated with the augmentation of tumours, t,t-
DDE (and likewise other members of this class of aldehydes), may promote the development of lung
epithelial cell tumours. Furthermore, t,t-DDE was found to give rise to oxidative stress, and exerted
genotoxic actions towards human lung carcinoma A549 cells [S94].

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