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Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc
On the basis of considerations of causality, relevance, and the quality and completeness of the database, liver damage was selected as the critical endpoint on which to base a UL. The selection of gastrointestinal effects as a critical endpoint was considered because of the data involving acute ingestion of soluble (highly ionized) copper salts in drinking water. However, in the United States and Canada, liver damage is a much more relevant endpoint because of the potential for excess intake from food and supplements. Furthermore, extensive evidence from studies in humans and experimental animals indicates that liver damage is the critical endpoint resulting from daily intake of high levels of copper salts (IPCS, 1998).
Data Selection. The human data evaluating liver effects after chronic consumption of copper gluconate appear most relevant to setting a UL. The UL derived below does not apply to individuals at increased risk of adverse effects from excess intake of copper. These subgroups are identified under “Special Considerations.”
Identification of a No-Observed-Adverse-Effect Level (NOAEL) and a Lowest-Observed-Adverse-Effect Level (LOAEL). A NOAEL of 10 mg/day of copper was identified on the basis of the results of Pratt and coworkers (1985). In a 12-week, double-blind study, 10 mg of copper as copper gluconate capsules was consumed daily by seven adults. Liver function tests were normal. From a case report, consumption of 30 mg/day as copper tablets for 2 years, followed by 60 mg/day for an additional period of time, resulted in acute liver failure (O’Donohue et al., 1993).
Uncertainty Assessment. The NOAEL of 10 mg/day was considered to be protective of the general population. Therefore, an uncertainty factor (UF) of 1.0 was selected. A larger UF was considered unnecessary in view of the large international database in humans indicating no adverse effects from daily consumption of 10 to 12 mg/day of copper in foods and the rarity of observed liver damage from copper exposures in human populations with normal copper homeostasis.