WHO Consultation on Global Burden of Foodborne Diseases,25-27 September 2006, Geneva
Health impact of chemicals in food
F.X. Rolaf van LeeuwenNational Institute for Public Health and the Environment
BIlthoven, The Netherlands
WHO Consultation on Global Burden of Foodborne Diseases,25-27 September 2006, Geneva
- How healthy is the Dutch diet? - How safe is Dutch food? - What health gains can be achieved through better diet, better
eating habits and by reducing overweight? - What is the appropriate balance between the desire for a
healthy diet and the need to ensure safe food? - How will this affect the various parties involved in food
production, distribution and consumption?
QUESTIONS ADDRESSED
WHO Consultation on Global Burden of Foodborne Diseases,25-27 September 2006, Geneva
- DALY’s for persons of >20 year and life expectancy for persons >40 year- Maximum scenario: everyone meets the recommendations - Middle scenario: realistic, feasible interventions
Estimated health gain through healthy diet and appropriate body weight
Our food, our health; Table 2.7
WHO Consultation on Global Burden of Foodborne Diseases,25-27 September 2006, Geneva
To compare the potential health threats caused by an unhealthy diet and by microbiological and chemical contamination of food the DALY was chosen as integrated measure of health impact.
DALY (Disability Adjusted Life Years) = YLL + YLD
YLL = number of life years lost (deaths)
YLD = number of years with illness or disability, corrected for the seriousness of the effect with a weighing factorvarying between 0 (totally healthy) and 1 (as serious asdeath)
(Murray & Lopez, 1996; WHO, 2002)
WHO Consultation on Global Burden of Foodborne Diseases,25-27 September 2006, Geneva
Estimated incidence of foodborne infections in the Netherlands
Our food, our health; Fig 4.2
WHO Consultation on Global Burden of Foodborne Diseases,25-27 September 2006, Geneva
Incidence of food-related gastroenteritis caused by known pathogens in the Netherlands
Our food, our health; Table 4.2
WHO Consultation on Global Burden of Foodborne Diseases,25-27 September 2006, Geneva
Burden of disease due to various infectious diseases
Our food, our health; Table 4.5
WHO Consultation on Global Burden of Foodborne Diseases,25-27 September 2006, Geneva
WHO Consultation on Global Burden of Foodborne Diseases,25-27 September 2006, Geneva
Information needed to assess the health impact of chemicals in food
• Data on the intake of chemicals- consumption data (total diet, different food items)- occurrence of chemicals in food commodities
Resulting in point estimates or distributions (probabilistic estimates)
• Effect data- human data (epidemiological data: case control, cohort) - animal data- dose response
Chemical food constituents which are potentially harmful
WHO Consultation on Global Burden of Foodborne Diseases,25-27 September 2006, Geneva
Naturally occurring chemical compoundsNaturally occurring chemical compounds•• allergensallergens•• mycotoxinen, fycotoxinen, fytotoxinen mycotoxinen, fycotoxinen, fytotoxinen •• nitratenitrate
NonNon--naturally occuring chemical compoundsnaturally occuring chemical compounds•• deliberately added (e.g. additives, flavourings)deliberately added (e.g. additives, flavourings)•• result of deliberate handling (result of deliberate handling (e.g. e.g. veterinary drugs, pesticides, veterinary drugs, pesticides,
food contact materials) food contact materials) •• unintentionally present (environmental or processunintentionally present (environmental or process contaminants)contaminants)
• Of the (adult) Dutch population 2% suffer from some form of food allergy.
• Assume that 10% are unaware of the cause, and therefore cannot avoidit and have more or less permanent symptoms of illness.
• This gives the total of 32,000 disability years (0.2% of 16 million).
• The weighing factor is 0.03 (comparable with light-to-moderate asthma).
The health loss is therefore 0.03 x 32,000 = approx. 1,000 DALYs.
ALLERGENIC SUBSTANCES
WHO Consultation on Global Burden of Foodborne Diseases,25-27 September 2006, Geneva
• Consumption of vegetables which are rich in nitrates combinedwith fish can result in the formation of nitrosamines.
• Nitrosamines are carcinogenic.
NITRATE/NITROSAMINES
WHO Consultation on Global Burden of Foodborne Diseases,25-27 September 2006, Geneva
Liver tumours in rats caused by NDMA
WHO Consultation on Global Burden of Foodborne Diseases,25-27 September 2006, Geneva
-4 -3 -2 -1 0
log10-dose_mg.kg
0.0
0.2
0.4
0.6
0.8
1.0
tum
ors
NDMA log-logistic model, pi = a+(1-a)/(1+exp(c.log10(b/x)))
version: 09.tmp model : A 5 a- : 0.074 b-liver_all : 0.1097 c : 5.3561 lik : -797.77 conv : TRUE sf.x : 1 selected : tumor.type liver_al fact2: tumor.type
Liver tumours in rats caused by NDMA
WHO Consultation on Global Burden of Foodborne Diseases,25-27 September 2006, Geneva
-4 -3 -2 -1 0
log10-dose_mg.kg
0.0
0.2
0.4
0.6
0.8
1.0
tum
ors
NDMA log-logistic model, pi = a+(1-a)/(1+exp(c.log10(b/x)))
version: 09.tmp model : A 5 a- : 0.074 b-liver_all : 0.1097 c : 5.3561 lik : -797.77 conv : TRUE sf.x : 1 selected : tumor.type liver_al fact2: tumor.type
• Consumption of vegetables which are rich in nitrates combinedwith fish can result in the formation of nitrosamines.
• Based on conservative estimates this can result in approximately20 -100 additional cancer cases per year.
• It’s assumed that premature death represents an average loss of 5 life-years.
The resultant health loss is approximately 100 to 500 DALYs.
NITRATE/NITROSAMINES
WHO Consultation on Global Burden of Foodborne Diseases,25-27 September 2006, Geneva
• The ASP incident in Canada has been taken as the reference.
• There were three deaths representing, an average loss of twentylife years = 60 DALYs.
• There were 105 acute intoxications giving serious but temporary effects (comparable to a transitory disease such as pneumonia).
• A weighing factor of 0.1 was applied resulting in 10.5 DALYs.
The resultant health loss is approximately 70 DALYs.
PHYCOTOXINS
WHO Consultation on Global Burden of Foodborne Diseases,25-27 September 2006, Geneva
Acrylamide (I)
WHO Consultation on Global Burden of Foodborne Diseases,25-27 September 2006, Geneva
Toxicity of acrylamide:- neurotoxic- reproductive - genotoxic - carcinogenic (tumours in mammary gland, thyroid, testes)
Excess lifetime cancer risk 1:104
US EPA, 1993 0.02 µg/kg bw per dayWHO, 1996 0.14 µg/kg bw per dayNFCA, 2002 0.08 µg/kg bw per day
ACRYLAMIDE (II)
WHO Consultation on Global Burden of Foodborne Diseases,25-27 September 2006, Geneva
0.1 1 10 100 1000 10000 100000
Intake (ng/kg bw/day)
16%
21%
31%
5% 4%
13%
10%
biscuits
bread
coffee
spiced cake
chips
crisps
others
Food groups contributing to acrylamide exposure
Exposure of general population to acrylamide
• Based on extrapolations from animal carcinogenicity studies the current exposure level in the Netherlands may lead to an additional 75-130 cancer cases each year.
• It’s assumed that each case will result in premature death and an average loss of five life-years,
The resultant health loss can be calculated as 375 - 650 DALYs.
ACRYLAMIDE (III)
WHO Consultation on Global Burden of Foodborne Diseases,25-27 September 2006, Geneva
Chemical substances in food in the Netherlands, with health risks and the possible health gains if exposure is avoided
Our food, our health; Table 4.8
WHO Consultation on Global Burden of Foodborne Diseases,25-27 September 2006, Geneva
Unfavourable diet 130,000 - 250,000 DALYs
Foodborne infections 1000 - 4000 DALYs
Chemical contamination 1500 - 2000 DALYs
Estimated health loss or potential health gain following improved diet and avoidance of exposure
WHO Consultation on Global Burden of Foodborne Diseases,25-27 September 2006, Geneva
Due to an unhealthy diet Dutch people are less healthy than they could be.
Dietary interventions can reverse a substantial proportion of the estimated health loss.
Much greater health gains are to be made through encouraging a healthy diet than through improving food safety.
www.rivm.nl
Key messages
WHO Consultation on Global Burden of Foodborne Diseases,25-27 September 2006, Geneva
Editors in chief:C.F. van Kreijl, A.G.A.C. Knaap and J.M.A. van Raaij
Editors:M.C.M. Busch, A.H. Havelaar, P.G.N. Kramers, D. Kromhout, F.X.R. van Leeuwen, H.M.J.A. van Leent-Loenen, M.C. Ocké, and H. Verkleij
Contributors;Drs. E. Anten-Kools, Dr. A.J. Baars, Dr. M.I. Bakker, Dr. ir. R.A. Bausch-Goldbohm, Ir. W. Bosman, Drs. M.C.M. Busch, E.J.M. Buurma-Rethans, Dr. Y.T.H.P. van Duijnhoven, Dr. E. Duizer, Ir. H.P. van Egmond, Dr. ir. E.J.M. Feskens, Dr.ir. A.W. van de Giessen, Dr. J.W.B. van der Giessen, Dr. L.A. van Ginkel, Dr.ir. C.P.G.M. de Groot, Dr.ir. A.H. Havelaar, Ir. R.T. Hoogenveen, Dr. K.F.A.M. Hulshof, Dr.ir. E.H.J.M. Jansen, Dr.ir. M.C.J.F. Jansen, Dr..ir. N. de Jong, Drs. A.G.A.C. Knaap, Prof.dr. F. van Knapen, Dr. M.A. Koelen, Dr.. M.P.G. Koopmans, Drs. L.M. Kortbeek, Dr. P.G.N. Kramers, Dr. C.F. van Kreijl, Prof.dr.ir. D. Kromhout, Ir. H.M.J.A. van Leent-Loenen, Dr. F.X.R. van Leeuwen, Mr.F.M. van Leusden, Prof.dr. H. van Loveren, Dr. S. Lijklema, Dr.ir. M.C. Ocké, Dr. W. van Pelt, Dr.ir. M.N. Pieters, Dr. W.H.M. van der Poel, Dr.ir. J.M.A. van Raaij, Ing. J.H.J. Reimerink, Prof.dr. S.A. Reijneveld, Dr. C.J.M. Rompelberg, Dr.ir. C.T.M. van Rossum, Prof.dr.ir. J. Seidell, Prof.dr. W.A. van Staveren, Dr. C. Thijs, Dr.ir. W.M.M. Verschuren, Dr. H. Verkleij, Dr. T.L.S. Visscher.
ACKNOWLEDGEMENT
WHO Consultation on Global Burden of Foodborne Diseases,25-27 September 2006, Geneva
Top Related