Application of the BRAFO-tiered approach for benefit-risk assessment to case studies on natural foods

Relationship between oily fish intake and breast cancer based on estrogen receptor status: a Mendelian randomization study

OBJECTIVE

We used a Mendelian randomization (MR) method in our research to examine the relationship between genetically determined oily fish intake and breast cancer (BC) incidence.

METHODS

The summary data pertaining to the oily fish intake were acquired from the UK Biobank, which consisted of a sample size of 460,443 people. Information on BC was received from the Breast Cancer Association Consortium (BCAC). We analyzed the causal connection between oily fish intake and BC incidence using various methods, including inverse variance weighting (IVW). Heterogeneity was investigated using Cochran's Q test. IVW, MR-Egger, and MR-PRESSO methods were used for sensitivity analysis. In addition, a multivariate MR adjusted for body mass index (BMI) and weight was used for further research.

RESULTS

Two-sample MR results showed that oily fish intake was negatively associated with total breast cancer (odds ratio (OR) 0.58, 95% confidence interval (CI) 0.39-0.87, IVW method), estrogen receptor-positive (ER +) breast cancer (OR 0.44, 95% CI 0.21-0.93, IVW method), and estrogen receptor-negative (ER-) breast cancer (OR 0.53, 95% CI 0.30-0.93, IVW method). The sensitivity analysis did not observe the presence of heterogeneity and horizontal pleiotropy. In multivariate MR analysis, the negative association between oily fish intake and total breast cancer (P = 0.03) and ER- breast cancer (P = 0.04) risk persisted after adjusting for BMI and body weight. However, no correlation was found in ER + breast cancer (P = 0.30).

CONCLUSION

The oily fish intake has a negatively correlated with the incidence of total breast cancer, particularly in the cases of ER- breast cancer. There is a lack of substantial evidence supporting a link between the oily fish intake and the incidence of ER + breast cancer.

Probabilistic benefit-risk analysis of fish: Nutritional benefit versus methylmercury-contaminated risk

This paper carries out probabilistic approach to quantify the benefit-risk analysis for foods (BRAFO) of omega-3 polyunsaturated fatty acid and methylmercury (MeHg) for the people who eat the mercury-contaminated fish in Taiwan. We applied the hazard quotient (HQ) model to assess the risk of developmental neuropsychological impairment effect and the desirable dose index (DI) model to quantify the health benefits. Besides, we also applied the disability adjusted life years (DALY) model to assess the number of years lost by incidence of affected infants' intelligence quotient (IQ) and coronary heart disease (CHD) or Stroke for adult. The results of this study show that although the risk of cod and scad are higher, Taiwan residents do not need to reduce intake rate based on benefit considerations. Furthermore, according to the benefits of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), this study suggests that more intake of saury and salmon.

Dietary Exposure of the Taiwan Population to Mercury Content in Various Seafood Assessed by a Total Diet Study

This paper examines the health risks of exposure to methylmercury (MeHg) through the consumption of mercury-contaminated seafood in Taiwan, based on the total diet study (TDS) method. Samples of seafood (n = 140) were purchased at fishing harbors or supermarkets and classified into seven categories (pelagic fish, inshore fish, farmed fish, shellfish, cephalopods, crustaceans, and algae). For each sample, we analyzed raw and cooked versions and compared the concentration difference. Total mercury (THg) was detected at the highest rate and in the highest concentrations in pelagic fish, followed by inshore fish and other farmed fish. The average concentration of THg was higher after cooking. In a 75th percentile scenario, the hazard indices for children aged 1 to 3 years and children aged 4 to 6 years were higher than 100% of the provisional tolerable weekly intake. Taking into consideration the risk assessment results, MeHg concentrations, and the nutritional composition of fish, we have provided weekly consumption advisories for children aged 1 to 3 years, children aged 4 to 6 years, and childbearing women aged 19 to 49 years. The weekly consumption advisories for childbearing women are 35 g/week of pelagic fish and 245 g/week of inshore fish based on the risk results from MeHg and the potential benefits from eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) intake.

Application of BRAFO-tiered approach for health benefit-risk assessment of dark tea consumption in China

Dark tea, a unique tea fermented primarily in China, has numerous potential beneficial effects. However, harmful substances present in dark tea have provoked significant concern. To conduct a quantitative benefit-risk assessment of dark tea for Chinese residents and provide guidance on rational consumption, a framework of Benefit-Risk Analysis for Foods (BRAFO) and meta-analysis was applied to construct a disability-adjusted life year (DALY). Based on the BRAFO-tiered approach, a reference scenario (no intake) and an alternative scenario (intake of 3 cups/day) were determined. The overall health impacts of dark tea were simulated by comparing the risks of fluoride and AF with benefits of reduced-risk to coronary heart disease (CHD) and diabetes in different scenarios. Three cups of fermented tea consumed per day decreased risks of CHD and diabetes by 8.16% and 12.77% respectively. After quantitative integration of information, the ultimate net health effect was found to be -1958.827 illustrating that the benefits of drinking three cups of dark tea per day outweigh the risks. However, considering the uncertainties in the process, decision-makers should proceed with caution, consulting additional well-conducted studies and further managing harmful substances in dark tea.

Human health risk-benefit assessment of fish and other seafood: a scoping review

Fish and other seafood are important sources of nutrients, but they are also sources of chemical contaminants that may cause adverse health effects. This article aimed to identify existing risk-benefit assessments (RBA) of fish, shellfish, and other seafood, compare methodologies, discuss differences and commonalities in findings, and identify limitations and ways forward for future studies. We conducted a scoping review of the scientific literature of studies in all languages published from 2000 through April 2019. We identified 106 RBA of fish and other seafood across Europe, Asia, North America, Africa, and at the global level. Studies were heterogeneous in terms of types of fish and other seafood considered, beneficial and adverse compounds assessed, and overall methodology. Collected data showed that a diet consisting of a variety of lean and fatty fish and other seafood is recommended for the overall population and that women of childbearing age and children should limit the consumption of fish and other seafood types that have a high likelihood of contamination. Our review emphasizes the need for evidence-based, up-to-date, and harmonized approaches in RBA in general.

Effects of Speciation, Cooking and Changes in Bioaccessibility on Methylmercury Exposure Assessment for Contrasting Diets of Fish and Marine Mammals

Uptake of the neurotoxicant monomethylmercury (MeHg) from fish and marine mammals continues to present a public health concern in Canada and elsewhere. However, fish and marine mammals are key diet items contributing to food security for some Indigenous populations in Canada. Mercury (Hg) exposure is estimated assuming that 100% of Hg is methylated, that 100% will be absorbed by the consumer and that cooking does not affect MeHg concentrations. Some of these assumptions do not correspond to our current state of knowledge. The aim of this study was to assess the impact of additional variables on Hg exposure equation using probabilistic risk analysis. New variables tested were (1) the proportion of methylated Hg compared to total Hg (pMeHg, %), (2) the relative absorption factor (RAF, %) expressed as bioaccessibility and (3) the mass loss factor (MLF, unitless) that represents the loss of moisture during cooking, known to increase MeHg concentration in fish and mammals. For the new variables, data from literature were used in order to set point estimate values that were further used in the probabilistic risk analysis. Modelling results for both fish and marine mammals indicate that adding these new variables significantly influenced estimates of MeHg exposure (Mood's median test, p < 0.05). This study highlights that the evaluation of exposure to MeHg is sensitive to pMeHg, RAF and MLF, and the inclusion of these variables in risk assessment should be considered with care. Further research is needed to provide better food-dependent, population-specific estimates of RAF and MLF before formal inclusion in exposure estimates.

Risk and benefit assessment of potential neurodevelopmental effect resulting from consumption of marine fish from a coastal archipelago in China

The aim of this study was to assess net neurodevelopmental effect via maternal consumption of marine fish. A total of thirty-one species were collected from Zhoushan, China. The net IQ point gain was assessed by FAO/WHO deterministic approach and probabilistic computation (if necessary). Results of the deterministic assessment of two samples belonging to Scoliodon sorrakowah showed negative IQ point gain in both common and extreme consumption scenarios (175 and 450 g/week, respectively); the net IQ gain caused by both consumption scenarios of other species were positive. Both consumption scenarios of Scoliodon sorrakowah showed beneficial neurodevelopmental effect according to probabilistic computation (95% CI for mean of net IQ gain: 0.0536-0.0554 and 0.1377-0.1425, respectively). Except for Scoliodon sorrakowah, this study indicates that both consumption scenarios of other studied species would be recommended according to the FAO/WHO approach. There would be no recommendation of consumption scenarios of Scoliodon sorrakowah for the reason for carefulness.

Critical appraisal of the assessment of benefits and risks for foods, 'BRAFO Consensus Working Group'

BRAFO, Benefit-Risk Analysis for Foods, was a European Commission project funded within Framework Six as a Specific Support Action and coordinated by ILSI Europe. BRAFO developed a tiered methodology for assessing the benefits and risks of foods and food components, utilising a quantitative, common scale for health assessment in higher tiers. This manuscript reports on the implications of the experience gained during the development of the project for the further improvement of benefit-risk assessment methodology. It was concluded that the methodology proposed is applicable to a range of situations and that it does help in optimising resource utilisation through early identification of those benefit-risk questions where benefit clearly outweighs risk or vice versa. However, higher tier assessments are complex and demanding of time and resources, emphasising the need for prioritisation. Areas identified as requiring further development to improve the utility of benefit-risk assessment include health weights for different populations and endpoints where they do not currently exist, extrapolation of effects from studies in animals to humans, use of in vitro data in benefit-risk assessments, and biomarkers of early effect and how these would be used in a quantitative assessment.

Fish, contaminants and human health: quantifying and weighing benefits and risks

This paper describes a quantitative risk-benefit assessment of fish consumption. We compare the net health effect expressed in DALYs of two scenarios. The reference scenario is the current fish intake of the Dutch population, which is less than what is recommended by the health authorities. The alternative scenario describes the health effects if the population consumes 200g of fish per week, which is close to the recommendation. All health effects due to fish consumption for which there is convincing evidence are incorporated in the assessment. The QALIBRA software (www.qalibra.eu) is used to simulate the two scenarios. The results show there is a net benefit for the population if it consumes 200g of fish each week.