Internal Dose Benchmarking of Acrylamide Exposure and Peripheral Neuropathy Risk: A National Population-Based Validation Study

Abstract Background. Acrylamide, a neurotoxicant in heated foods and smoke, is linked to occupational neuropathy, but evidence regarding chronic, low-level population exposure remains limited. We evaluated the association between acrylamide exposure biomarkers and peripheral neuropathy among U.S. adults. Methods. A total of 2,266 NHANES 2003-2004 participants (age >40) were analyzed. Exposure was assessed via hemoglobin adducts (HbAA/HbGA); neuropathy via monofilament testing >1 site). Survey-weighted logistic regression models adjusted for confounders. Sensitivity analyses included cubic splines, diabetes stratification, and multiple imputation. Results. Neuropathy prevalence was 15.5%. In adjusted models, neither adduct was associated with neuropathy (HbAA OR: 0.98, 95% CI: 0.82-1.17; HbGA OR: 0.91, 95% CI: 0.77-1.08). No dose-response gradient was observed. Expected risk factors (age, diabetes) showed strong associations, validating model sensitivity. The null result remained robust across sensitivity analyses, including a stricter outcome definition and multiple imputation (pooled OR: 0.97, 95% CI: 0.83-1.14). Conclusions. Acrylamide adducts were not associated with peripheral neuropathy in this national sample. General population levels (~55-70 pmol/g) lie well below established occupational no-observed-adverse-effect levels (~510 pmol/g) and clinical neuropathy thresholds (~6,000 pmol/g), providing a mechanistically coherent explanation for this null result.