was completed in the USA. There was no effect of
daily supplementation with 200 mg of selenium on the
primary endpoint skin cancer, but there was a statis-
tically significant reduction in several additional end-
points such as total cancer mortality (50%), and
incidence of cancer of the prostate (63%), lung
(46%), colorectal (58%), and total cancer. Further
studies are needed to confirm these observations.
Selenium and Cardiovascular Disease
0040 Similarly, dietary deficiency of selenium has been
implicated in the etiology of cardiovascular diseases,
but the evidence at present is less convincing than for
cancer. Although a large case-control study in Finland
suggested that selenium was an independent risk
factor for myocardial infarction in a low-selenium
population, evaluation of prospective epidemio-
logical studies has failed to provide sufficient evi-
dence to implicate selenium deficiency in most
aspects of cardiovascular disease. While some investi-
gations have observed a relationship between low
serum-selenium levels and risk of coronary disease,
others have not. However, selenium may have some
role in protection against thrombosis and low-density
lipoprotein oxidation, in particular in individuals
such as smokers at risk from increased oxidant stress.
Further evidence must come from controlled inter-
vention trials to clarify any possible role for selenium
in atherosclerotic disease.
Toxicity
0041 The margin between an adequate and toxic intake of
selenium is quite narrow. Overexposure or selenosis
may occur from consuming high-selenium foods
grown in seleniferous areas in Venezuela and some
areas of China. People following long-term liberal
megadosing can also attain an undesirably high sel-
enium status. The most common sign of poisoning is
loss of hair and nails, but lesions of the skin, nervous
system, and teeth may also be involved. Garlic odor
on the breath is an indication of excessive selenium
exposure resulting from expiration of dimethylsele-
nide. Sensitive biochemical techniques are lacking for
selenium toxicity, which is at present diagnosed from
hair loss and nail changes. Some effects of selenium
toxicity are seen in individuals with dietary intakes as
low as 900 mg, and the maximum safe dietary intake
has been suggested as 400 mg per day.
Assessment of Selenium Status
0042 Blood selenium concentration is generally considered
a useful measure of both selenium status and intake,
but other tissues are often assessed as well. Plasma
selenium reflects short-term status and erythrocyte
selenium long-term status, but blood selenium con-
centrations are influenced by the chemical form of
selenium ingested as a result of the different patterns
of absorption and retention outlined previously. Toe-
nails are often used, but selenium-containing sham-
poos restrict the use of hair. Urinary excretion can
also be used to assess selenium status, and total
dietary intake is estimated as twice the daily urinary
excretion.
0043The close relationship between blood or red-cell
glutathione peroxidase activity and selenium con-
centrations (Figure 3) is useful for assessment in
people with a relatively low status, but not once
the saturating activity of the enzyme is reached at
blood selenium concentrations above 100 mgl
1
(1.27 mmol l
1
). More recently, mesurement of sele-
noprotein P has been used to assess selenium status,
and there is the potential for measurement of other
enzymes as functional markers. However, their use is
limited at present by the lack of simple assay tech-
niques. Furthermore, the conclusions drawn from
measurement of one selenoprotein may not apply to
all biological functions of selenium because of the
differences in responses of tissues and these proteins
to deficient, adequate, or high levels of selenium in
terms of their ‘hierarchy’ of importance. Therefore,
there may be no single indicator of functional selen-
ium status, but rather a series of markers that apply to
specific problems associated with suboptimal selen-
ium status. The situation is further complicated by the
large number of interacting factors, including, pro-
tein, methionine, polyunsaturated fatty acids and
other oxidant stressors, vitamin E, other trace elem-
ents, and heavy metals such as mercury, cadmium,
and lead.
Dietary Intake
0044Food is the major source of selenium; drinking water
contributes little. Dietary intake varies with the
geographic source of foods and eating habits of the
people. Plant food concentrations reflect selenium
content of soils and its availability for uptake, as
plants do not require selenium for growth; cereals
and grains grown in soils poor or rich in selenium
may vary over 100-fold in selenium content. Animal
foods vary less. Fish and organ meats are the richest
sources followed by muscle meats, cereals, grains,
and dairy products, with fruits and vegetables mostly
poor sources. Average daily dietary intakes vary con-
siderably, depending on the levels of selenium in soils
(Table 1), ranging from 10–20 mg of selenium in low
soil-selenium areas of China where Keshan disease is
endemic, 30–60 mg in New Zealand, and up to 200 mg
5122 SELENIUM/Physiology