Determination of 10 nitrosamines in stinky mandarin fish and cumulative health risk assessment across four dietary patterns

In this study, a health risk assessment of 10 N-nitrosamines (NAs) in stinky mandarin fish under four dietary patterns and different exposure frequencies was conducted using disability-adjusted life years (DALYs). Considering the numerous non-detected values found in samples, Quantile–Quantile (Q–Q) plot model was employed to obtain more precise NAs concentration distribution functions in stinky mandarin fish. Results show that 2.97% of stinky mandarin fish samples exceeded the Chinese standard threshold of 4 µg/kg for NDMA. The cumulative disease burdens of 9 NAs across four dietary patterns and four exposure frequencies ranged from 4.52 × 10 −9 to 1.09 × 10 −5 ppy. Liver cancer emerged as the primary health concern associated with NAs exposure, followed by lung and bladder cancers. The dietary patterns risk stratification based on their median risk estimates was as follows: Ketogenic > Mediterranean > Chinese Food Guide Pagoda > DASH diets. Conversely, within the framework of the four dietary patterns defined in this study, and accounting solely for NAs exposure derived from stinky mandarin fish, monthly intake of the fish was found to be safe. This study provides scientific evidence and valuable insights for optimizing dietary patterns and mitigating NAs-associated cancer risks.