Meeting the challenges in the development of risk-benefit assessment of foods

Substituting red meat with insects in burgers: Estimating the public health impact using risk-benefit assessment

In Western societies, reducing red meat consumption gained prominence due to health, environmental, and animal welfare considerations. We estimated the public health impact of substituting beef with house cricket (Acheta domesticus) in European diets (Denmark, France, and Greece) using the risk-benefit assessment (RBA) methodology, building upon the EFSA-funded NovRBA project. The overall health impact of substituting beef patties with insect powder-containing patties was found to be impacted by the amount of cricket powder incorporated in the patties. While using high amounts of cricket powder in meat substitutes may be safe, it does not inherently offer a healthier dietary option compared to beef. Adjustment of cricket powder levels is needed to yield a positive overall health impact. The main driver of the outcome is sodium, naturally present in substantial amounts in crickets. Moreover, the way that cricket powder is hydrated before being used for the production of patties (ratio of powder to water), influences the results. Our study highlighted that any consideration for dietary substitution should be multidimensional, considering nutritional, microbiological and toxicological aspects, and that the design of new food products in the framework of dietary shifts should consider both health risks and benefits associated with the food.

Guidance on risk-benefit assessment of foods

The EFSA Scientific Committee has updated its 2010 Guidance on risk-benefit assessment (RBA) of foods. The update addresses methodological developments and regulatory needs. While it retains the stepwise RBA approach, it provides additional methods for complex assessments, such as multiple chemical hazards and all relevant health effects impacting different population subgroups. The updated guidance includes approaches for systematic identification, prioritisation and selection of hazardous and beneficial food components. It also offers updates relevant to characterising adverse and beneficial effects, such as measures of effect size and dose-response modelling. The guidance expands options for characterising risks and benefits, incorporating variability, uncertainty, severity categorisation and ranking of different (beneficial or adverse) effects. The impact of different types of health effects is assessed qualitatively or quantitatively, depending on the problem formulation, scope of the RBA question and data availability. The integration of risks and benefits often involves value-based judgements and should ideally be performed with the risk-benefit manager. Metrics such as Disability-Adjusted Life Years (DALYs) and Quality-Adjusted Life Years (QALYs) can be used. Additional approaches are presented, such as probability of all relevant effects and/or effects of given severities and their integration using severity weight functions. The update includes practical guidance on reporting results, interpreting outcomes and communicating the outcome of an RBA, considering consumer perspectives and responses to advice.

Risk-benefit assessment of shifting from traditional meat-based diets to alternative dietary patterns

The consumption of plant-based meat alternatives has recently transitioned from the niche market to the mainstream. However, changing the dietary patterns may lead to new health challenges referred to possible higher exposure to natural toxins found in plant-based food. The present project aimed to train the fellow in the field of chemical risk assessment and provide a comprehensive overview on how a change towards plant-based meat alternatives may represent a driver for emerging risks. Thus, within the EU-FORA programme the fellow engaged in the following activities: (i) perform a systematic review to analyse the distribution of natural toxins in the most common plant-based meat alternatives in Europe, (ii) risk-benefit assessment of shifting from meat-based diets to soy-based meat alternatives by modelling the substitution of meat with soy, and (iii) determine the occurrence of mycotoxins in plant-based meat alternatives from local markets in Parma, Italy. The fellow learnt the chemical risk assessment procedures applied by the researchers from the Department of Food and Drug of Parma University, thus gaining an in-depth expertise in all the steps. A risk-benefit assessment was performed modelling the intake of aflatoxin B1-contaminated soy-based meat analogues. The health impact due to intake of soy and exposure to aflatoxin B1 was estimated. Within the research group, the fellow also worked on developing a multi-mycotoxin determination method for plant-based meat alternatives matrices. The results of the project provide a picture reflecting the occurrence of natural toxins in plant-based meat alternatives and the need of upgraded regulation frameworks that take into account new products and dietary patterns. The EU-FORA fellowship was a great opportunity for the fellow to expand his professional network and increase his expertise in food safety by gaining new skills in chemical risk assessment, risk-benefit assessment and analytical chemistry.

Risk–benefit assessment of seaweed Allergenicity risk assessment of novel protein

As the world population rapidly grows, there is a clear need for alternative food sources, particularly for the provision of protein. Seaweed is one such alternative source of protein that requires greater investigation. In this context, a working programme within the European Food Risk Assessment (EU‐FORA) Fellowship Programme framework was developed at National Food Institute – Technical University of Denmark. This Programme is an initiative of the EFSA with the aim to build a European risk assessment community. The purpose of this technical report is to describe the activities in which the fellow was involved. As part of the Research Group for Risk–Benefit, the fellow performed a risk–benefit assessment of seaweed Palmaria palmata gaining an in‐depth expertise in all the steps. The health impact of Palmaria palmata consumption was estimated, considering its high nutritional value but also highlighting concerns towards some components. Simultaneous to the work on the risk–benefit, the fellow also worked within the Research Group for Food Allergy, specifically on the allergenicity risk assessment of a plant‐based novel protein (seaweed protein) using different laboratory assays. Seaweed protein digestibility was assessed, and its digestion products were characterised and assessed for immunogenicity. Finally, the fellow collaborated with the Research Group for Microbial Biotechnology and Biorefining in the development of a novel food (alfalfa protein) application dossier to be submitted to EFSA, gaining expertise in the risk assessment of a novel food. In conclusion, the present working programme, together with additional activities and training provided by different institutions, enabled the fellow to gain a broader perspective in food safety, particularly concerning seaweed, novel foods and the safety assessment of novel proteins.

Communicating Food Risk-Benefit Assessments: Edible Insects as Red Meat Replacers

Risk-benefit Assessment (RBA) is an emerging methodology in the area of Food and Nutrition that offers a simultaneous evaluation of both risks and benefits linked to dietary choices. Communication of such research to consumers may present a challenge due to the dual nature of RBA. We present a case study of a communication strategy developed for the NovRBA-project. The NovRBA-project (Novel foods as red meat replacers—an insight using Risk Benefit Assessment methods) performed a risk-benefit assessment to evaluate the overall health impact of substituting red meat (beef) by a novel food (house cricket), considering the microbial, toxicological and nutritional characteristics of the respective dietary choices. A literature review of risk perceptions and acceptance of beef and insects as food formed the basis of the communication strategy for the study's results, drawing on environmental and emotional as well as health-related motivations to consume or avoid either food and considering the sociodemographic characteristics of likely consumers. Challenges and future directions for consumer protection organizations communicating findings of risk-benefit analyses on food safety are discussed.

Nourishing the Human Holobiont to Reduce the Risk of Non-Communicable Diseases: A Cow’s Milk Evidence Map Example

The microbiome revolution brought the realization that diet, health, and safety for humans in reality means diet, health, and safety for the human holobiont/superorganism. Eating healthier means much more than just feeding human cells. Our diet must also nourish the combination of our microbiome and our connected physiological systems (e.g., the microimmunosome). For this reason, there has been an interest in returning to ancestral “complete” unprocessed foods enriched in microbes, including raw milks. To contribute to this inevitable “nourishing the holobiont” trend, we introduce a systematic risk–benefit analysis tool (evidence mapping), which facilitates transdisciplinary state-of-the-science decisions that transcend single scientific disciplines. Our prior paper developed an evidence map (a type of risk–benefit mind map) for raw vs. processed/pasteurized human breast milk. In the present paper, we follow with a comprehensive evidence map and narrative for raw/natural vs. processed/pasteurized cow’s milk. Importantly, the evidence maps incorporate clinical data for both infectious and non-communicable diseases and allow the impact of modern agricultural, food management, and medical and veterinary monitoring outcomes to be captured. Additionally, we focus on the impact of raw milks (as “complete” foods) on the microimmunosome, the microbiome-systems biology unit that significantly determines risk of the world’s number one cause of human death, non-communicable diseases.

Examining Evidence of Benefits and Risks for Pasteurizing Donor Breastmilk

An evidence map is visualized as a starting point for deliberations by trans-disciplinary stakeholders, including microbiologists with interests in the evidence and its influence on health and safety. Available evidence for microbial benefits and risks of the breastmilk ecosystem was structured as an evidence map using established risk analysis methodology. The evidence map based on the published literature and reports included the evidence basis, pro- and contra-arguments with supporting and attenuating evidence, supplemental studies on mechanisms, overall conclusions, and remaining uncertainties. The evidence basis for raw breastmilk included one benefit–risk assessment, systematic review, and systematic review/meta-analysis, and two cohort studies. The evidence basis for benefits was clear, convincing, and conclusive, with supplemental studies on plausible mechanisms attributable to biologically active raw breastmilk. Limited evidence was available to assess microbial risks associated with raw breastmilk and pasteurized donor milk. The evidence map provides transparent communication of the ‘state-of-the-science’ and uncertainties for microbial benefits and risks associated with the breastmilk microbiota to assist in deeper deliberations of the evidence with decision makers and stakeholders. The long-term aims of the evidence map are to foster deliberation, motivate additional research and analysis, and inform future evidence-based policies about pasteurizing donor breastmilk.

Risk-Benefit Assessment of Cereal-Based Foods Consumed by Portuguese Children Aged 6 to 36 Months-A Case Study under the RiskBenefit4EU Project

Cereal-based foods, including breakfast (BC) and infant cereals (IC), are among the first solid foods introduced to infants. BC and IC are sources of macro and micronutrients that have beneficial effects on health, but can also be sources of harmful chemical and microbiological contaminants and nutrients that may lead to adverse health effects at high consumption levels. This study was performed under the RiskBenefit4EU project with the aim of assessing the health impact associated with consumption of BC and IC by Portuguese children under 35 months. Adverse effects associated with the presence of aflatoxins, Bacillus cereus, sodium and free sugars were assessed against the benefits of fiber intake. We applied a risk-benefit assessment approach, and quantified the health impact of changes in consumption of BC and IC from current to various alternative consumption scenarios. Health impact was assessed in terms of disability-adjusted life years. Results showed that moving from the current consumption scenario to considered alternative scenarios results in a gain of healthy life years. Portuguese children can benefit from exchanging intake of IC to BC, if the BC consumed has an adequate nutritional profile in terms of fiber, sodium and free sugars, with levels of aflatoxins reduced as much as possible.

Approaches for Health Effect Characterization in Risk-Benefit Assessment of Foods: A Comparative Case Study

One of the challenges in quantitative risk-benefit assessment (RBA) of foods is the choice of approach for health effect characterization to estimate the health impact of dietary changes. The purpose of health effect characterization is to describe an association between intake of a food or food component and a health effect in terms of a dose-response relationship. We assessed the impact of the choice of approach for health effect characterization in RBA in two case studies based on substitution of (i) white rice by brown rice and (ii) unprocessed red meat by vegetables. We explored this by comparing the dose-response relations linking a health effect with (i) a food component present in the food, (ii) a food based on non-specified substitution analyses, and (iii) a food based on specified substitution analyses. We found that the choice of approach for health effect characterization in RBA may largely impact the results of the health impact estimates. Conducting the calculations only for a food component may neglect potential effects of the food matrix and of the whole food on the diet-disease association. Furthermore, calculations based on associations for non-specified substitutions include underlying food substitutions without specifying these. Data on relevant specified substitutions, which could reduce this type of bias, are unfortunately rarely available. Assumptions and limitations of the health effect characterization approaches taken in RBA should be documented and discussed, and scenario analysis is encouraged when multiple options are available.

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.

Drinking Green Tea: Despite the Risks Due to Mycotoxins, Is It Possible to Increase the Associated Health Benefits?

Tea has been consumed for thousands of years. Despite the different varieties, particular emphasis has been placed on green tea (GT), considering the associated health benefits following its regular consumption, some of which are due to its polyphenol constituents, such as epigallocatechin-3-gallate (EGCG). Tea is not prone to the growth of microorganisms, except fungus, when proper storage, handling, and packing conditions are compromised. Consequently, mycotoxins, secondary metabolites of fungi, could contaminate tea samples, affecting human health. In the present study, we aimed to assess the balance between risks (due to mycotoxins and high levels of EGCG) and benefits (due to moderate intake of EGCG) associated with the consumption of GT. For this, 20 GT samples (10 in bulk and 10 in bags) available in different markets in Lisbon were analyzed through a LC-MS/MS method, evaluating 38 different mycotoxins. Six samples revealed detectable values of the considered toxins. Current levels of mycotoxins and EGCG intake were not associated with health concerns. Scenarios considering an increasing consumption of GT in Portugal showed that drinking up to seven cups of GT per day should maximize the associated health benefits. The present study contributes to the future establishment of GT consumption recommendations in Portugal.

The health impact of substituting unprocessed red meat by pulses in the Danish diet

BACKGROUND

Diets consisting of high amounts of animal-based protein have been associated with adverse public health effects and are often deemed environmentally unsustainable. Therefore, replacing red meat by pulses has been proposed to reduce the adverse impact on human health and environment. However, unprocessed red meat is an important source of nutrients, such as vitamin B₁₂, iron, zinc and selenium, and the substitution may have negative impact on nutrient adequacy.

METHOD

Using a risk-benefit assessment (RBA) approach, we, therefore, estimated the health impact of substituting unprocessed red meat by pulses on the burden of non-communicable diseases in Denmark, using Disability-Adjusted Life Years (DALY). Furthermore, we assessed the impact of the substitution on nutrient adequacy.

RESULTS

We found that 187 (95% UI: 209; 168) healthy years of life could be gained per 100,000 individuals per year by substituting 100% of unprocessed red meat by pulses in the Danish diet. We found a decrease in the intake of vitamin B₁₂, zinc and selenium due to the substitution. An additional 10% of the Danish population will become at risk of vitamin B₁₂ and selenium inadequacy, and an additional 20% will be at risk of zinc inadequacy due to the substitution. For iron, a small decrease in the proportion at risk of inadequacy was found.

CONCLUSION

Substitution of unprocessed red meat by pulses was estimated to provide a beneficial health impact on the burden of non-communicable disease, expressed in DALY. Additionally, it was found that the complete substitution will lead to a higher risk of nutrient inadequacies.

Public health risk-benefit assessment of red meat in France: Current consumption and alternative scenarios

Consumption of red meat has been associated with the risks of colorectal cancer (CRC), cardiovascular disease (CVD), foodborne-pathogen related diseases and with the potential benefit obtained by reduction of iron deficiency anemia (IDA). Based on probabilistic models, current risks and benefit for the French population were aggregated into a single metric, the disability adjusted life years (DALY). In France, per 100,000 people, current red meat consumption was responsible for a mean of 19 DALYs due to CRC, 21 DALYs to CVD and 7 DALYs to foodborne diseases. Current consumption of iron throughout the diet led to a mean of 15 DALYs due to IDA. To mitigate the risks, scenarios were built per sub-population of age and gender. Among adult and elderly population, the big meat eaters would benefit to adhere to the current recommendation (less than 500 g/w): the risks of CRC and CVD would decrease. Regarding IDA (scenario built with fixed ground beef amount), for young population, a consumption of 375g/w would be sufficient to eliminate the burden while for 25-44 years-old females, 455g/w would reduce IDA, but not entirely. This study highlighted the importance of assessing health risk-benefit per sub-populations and the necessity of communicating the results accordingly.

Risk-benefit in food safety and nutrition - Outcome of the 2019 Parma Summer School

Risk-benefit assessment is the comparison of the risk of a situation to its related benefits, i.e. a comparison of scenarios estimating the overall health impact. The risk-benefit analysis paradigm mirrors the classical risk analysis one: risk-benefit assessment goes hand-in-hand with risk-benefit management and risk-benefit communication. The various health effects associated with food consumption, together with the increasing demand for advice on healthy and safe diets, have led to the development of different research disciplines in food safety and nutrition. In this sense, there is a clear need for a holistic approach, including and comparing all of the relevant health risks and benefits. The risk-benefit assessment of foods is a valuable approach to estimate the overall impact of food on health. It aims to assess together the negative and positive health effects associated with food intake by integrating chemical and microbiological risk assessment with risk and benefit assessment in food safety and nutrition. The 2019 Parma Summer School on risk-benefit in food safety and nutrition had the objective was to provide an opportunity to learn from experts in the field of risk-benefit approach in food safety and nutrition, including theory, case studies, and communication of risk-benefit assessments plus identify challenges for the future. It was evident that whereas tools and approaches have been developed, more and more case studies have been performed which can form an inherent validation of the risk-benefit approach. Executed risk-benefit assessment case studies apply the steps and characteristics developed: a problem formulation (with at least 2 scenarios), a tiered approach until a decision can be made, one common currency to describe both beneficial and adverse effects (DALYs in most instances). It was concluded that risk-benefit assessment in food safety and nutrition is gaining more and more momentum, while also many challenges remain for the future. Risk-benefit is on the verge of really enrolling into the risk assessment and risk analysis paradigm. The interaction between risk-benefit assessors and risk-benefit managers is pivotal in this, as is the interaction with risk-benefit communicators.

Food Safety Implications of Transitions Toward Sustainable Healthy Diets

Despite increased political attention, foodborne diseases still cause a substantial public health, economic, and social burden worldwide. Children younger than 5 years, people living in developing regions, and in the poorest areas of the world are disproportionally affected, bearing a large proportion of the global burden of foodborne disease. Yet, food safety is a prerequisite to ensuring food security globally: Foods that are responsible for important food safety problems are also crucial to ensure food security in some regions and are essential sources of nutrition. Moreover, together with calls for action to meeting international sustainable development goals, global efforts to promote food security and healthy diets have now highlighted the need to modify food systems globally. This article therefore explores the food safety dimensions of transitions toward food systems that promote sustainable healthy diets. The current body of evidence points to the combined health and environmental benefits of shifting toward a more plant-based diet, including vegetables and fruits, nuts, pulses, and whole grains. As a shift toward more plant-based diets may also lead to higher exposures to chemicals or pathogens present in these foods, an evaluation of food safety implications of such transitions is now imperative. We conclude that several synergies between public health, environmental, and food safety strategies can be identified to support dietary transitions.

Identification of Precursors and Formation Pathway for the Heterocyclic Aromatic Amine 2-Amino-3-methylimidazo(4,5-f)quinoline (IQ)

Food processing is responsible for the destruction of some health hazards, but it is responsible for the formation of new ones. Among them, the formation of heterocyclic aromatic amines (HAAs) has received a considerable attention because of their carcinogenicity. In spite of this, HAA formation is still poorly understood. This study was undertaken to identify precursors and formation pathways for 2-amino-3-methylimidazo(4,5-f)quinoline (IQ). IQ was produced by reaction of acrolein, crotonaldehyde, creatinine, and ammonia. Reaction conditions were studied, and its activation energy (E_a) was determined to be 77.0 ± 1.3 kJ/mol. IQ formation was always accompanied by the formation of the HAA 2-amino-3,4-dimethylimidazo(4,5-f)quinoline (MeIQ), which was produced with an E_a of 72.2 ± 0.4 kJ/mol. A reaction pathway for the competitive formation of IQ and MeIQ is proposed. Obtained results demonstrate the significant role of reactive carbonyls (the food carbonylome) in HAA formation and provide evidences for designing HAA mitigation strategies.

Risk-Benefit Assessment of Foods

Food is an elementary requirement for human life, providing nutrients and essential energy needed for optimal health. But at the same time, food can also be a vehicle of hazardous substances or pathogens that could affect human health negatively. Risk‐benefit assessment (RBA) of foods, a relatively new methodology for decision support, integrates nutrition, toxicology, microbiology, chemistry and human epidemiology for a comprehensive health impact assessment. By integrating health risks and benefits related to food consumption, RBA facilitates science‐based decision‐making in food‐related areas and the development of policies and consumer advice. The present work programme aimed to allow the fellow to become acquainted with the process of RBA and the associated tools needed to assess quantitatively the risks and the benefits through three main activities (i) to learn the different methodologies used for RBA; (ii) to apply these methodologies to a specific case‐study – RBA of raw milk consumption; and (iii) to participate in the main activities of the Risk‐Benefit research group at DTU Food regarding risk‐benefit issues. For the RBA of raw milk consumption, microbiological pathogens (Listeria monocytogenes, Salmonella spp., Campylobacter jejuni and Shiga toxin‐producing Escherichia coli), probiotic bacteria and nutritional components (vitamins B2 and A) were considered, as well as the potential impact of raw milk consumption in the reduction of the allergies’ prevalence. Two major approaches were applied: the bottom‐up (estimating the disease incidence due to the exposure) and the top‐down (using epidemiological and incidence data to the estimate the number of cases attributable to a certain exposure). Through all the training and hands‐on activities performed, the present work programme enabled the fellow to extend the knowledge on the quantitative RBA, specifically in the context of raw milk consumption. EU‐FORA programme also provided an exceptional opportunity of networking and establishment of future research lines of collaboration.

Simultaneous exploration of nutrients and pollutants in human milk and their impact on preterm infant growth: An integrative cross-platform approach

Early nutritional management including fortified human breastmilk is currently recommended to fulfil the energy demands and counterbalance risks associated to preterm birth. However, little is known about the potential adverse effects of exposure to persistent organic pollutants (POPs) carried in human milk on preterm infant growth. We conducted a pilot study proving the application of an integrative analytical approach based on mass spectrometry (MS) coupled to advanced statistical models, favouring the comprehensive molecular profiling to support the identification of multiple biomarkers. We applied this workflow in the frame of a preterm infants' cohort to explore environmental determinants of growth. The combination of high resolution gas and liquid chromatography MS platforms generated a large molecular profile, including 102 pollutants and nutrients (targeted analysis) and 784 metabolites (non-targeted analysis). Data analysis consisted in a preliminary examination of associations between the signatures of POPs and the normalised growth of preterm infants, using multivariate linear regression adjusting for known confounding variables. A second analysis aimed to identify multidimensional biomarkers using a multiblock algorithm allowing the integration of multiple datasets in the growth model of preterm infants. The preliminary results did not suggest an impairment of preterm growth associated to the milk concentrations of POPs. The multiblock approach however revealed complex interrelated molecular networks of POPs, lipids, metabolites and amino acids in breastmilk associated to preterm infant growth, supporting the high potential of biomarkers exploration of this proposed workflow. Whereas the present study intended to identify simultaneously pollutant and nutrient exposure profiles associated to early preterm infant growth, this workflow may be easily adapted and applied to other matrices (e.g. serum) and research settings, favouring the functional exploration of environmental determinants of complex and multifactorial diseases.

Estimation of the Burden of Iron Deficiency Anemia in France from Iron Intake: Methodological Approach

: Dietary iron deficiency (ID) is the first nutritional deficiency in the world, in terms of disability adjusted life years (DALY). This nutritional deficiency may lead to anemia, especially among children, adolescents, and adult women. The aim of this study was to build an original probabilistic model to quantitatively assess the ID, the iron deficiency anemia (IDA) and the subsequent health burden in France expressed in DALY, per age class and gender. The model considered the distribution of absorbed iron intake, the iron requirement distribution established by the European Food Safety Authority and the iron status in France. Uncertainty due to lack of data and variability due to biological diversity were taken into account and separated using a second-order Monte Carlo procedure. A total of 1290 (95% CI = 1230-1350) IDA cases corresponding to 16 (95% CI = 11-20) DALY were estimated per 100,000 individuals per year. The major contributors to IDA burden were menstruating females aged from 25 to 44 years old. Then, a consumption scenario was built with ground beef as intake, an increase in red meat consumption to 100 g/d would not eliminate entirely the IDA burden. The quantitative methodology applied here for France could be reused for other populations.

Scientific assessments in European food law: Making it future-proof

European food laws increasingly use scientific evidence to protect consumers from hazards and to prevent the use of misleading information. In this article, the use of risk assessment in European food law is analysed and the implications of the recently adopted adjustments to the EU's General Food Law are reviewed. The risk analysis cycle that has been implemented in many authorisation decisions of the European Commission has resulted in the increased level of public health protection since 2002. The food law evaluation under REFIT however identified various shortcomings, including the civil societies' perception that various elements of EFSA's work lacked transparency and independence. To deal with these identified issues, the newly adopted regulation will bring about specific adjustments to the General Food Law and sectorial legislation. Although these adjustments are expected to improve European food policies, today's EU food laws should be further enhanced by improving the use of nutritional sciences in food law. Such joint efforts can result in a higher level of consumer protection and further advance the internal European market. Only through improving the systematic way to conduct scientific analyses into and by enhancing their use in risk management, European food law will become more future-proof.

Estimation of the burden of disease attributable to red meat consumption in France: Influence on colorectal cancer and cardiovascular diseases

The consumption of red meat has been associated with colorectal cancer (CRC) and cardiovascular disease (CVD) worldwide. The objective of this study was to assess quantitatively the burden of disease of CRC and CVD due to the consumption of red meat in France. A probabilistic risk assessment model quantifying the risk, deaths and disability adjusted life years (DALY) of both outcomes was built. In the model, uncertainty and variability were propagated separately. The model used data on current CRC and CVD incidence and red meat consumption in France, as well as dose-response from epidemiological studies. Results were given by age class and gender. A total of 19 [95% CI = 8-33] DALY per 100,000 people per year for CRC associated with red meat consumption was estimated. For CVD, 21 [95% CI = 12-32] DALY per 100,000 people per year was estimated. The uncertainty was mainly due to the dose-response, as revealed by a sensitivity analysis. A scenario analysis, performed on red meat intake, highlighted that consumption of less than 65 g per day could limit the risk of CRC and CVD in the most affected sub-populations.

A probabilistic approach for risk-benefit assessment of food substitutions: A case study on substituting meat by fish

Accounting for substitution of foods is inevitable when evaluating health impact of dietary changes. But substitution behavior and the associated health impact may vary between individuals. We therefore propose the use of probabilistic methods to model substitution and assess health impact distributions in risk-benefit assessment (RBA) of foods. We investigated the health impact of substituting red and processed meat with fish in the Danish adult population and the variability in health impact. We applied probabilistic approaches in modeling the substitution to reflect variability between individual substitution behaviors. Furthermore, when multiple intake scenarios are compared, we propose a method for adjusting intake differences for individual day-to-day variability. We estimated that 134 (95% UI: 102; 169) Disability-Adjusted Life Years/100,000 were averted per year by the substitution. The health impact varied considerably by age and sex, with the largest health benefit of the substitution observed for young women in the child-bearing age and for the older generation, mainly men. This study provides further insight in how the health impact of substituting meat by fish varies between individuals and suggests a framework to be applied in RBAs of other food substitutions. Our results are relevant for policy makers in defining targeted public health strategies.

Risk Benefit Assessment of foods: Key findings from an international workshop

Whilst risk management measures, including food policy, are developed for the protection of public health and the environment, they may also lead to a reduction in health benefits. Policy decisions require then consideration of these necessary trade-offs, which leads to an increasing need to apply formal risk-benefit assessment (RBA) of foods. In this context, the European Food Safety Authority sponsored a Risk-Benefit Assessment Workshop on "past, current and future developments within the risk-benefit assessment of foods (RBA)" held in May 2017. The overall aims of the RBA Workshop were to discuss existing methods, challenges and needs within RBA, and to draft a roadmap for future development of RBA. The specific objectives were to i) identify RBA activities in Europe and globally; ii) discuss how to further develop and optimize RBA methodology; iii) identify challenges and opportunities within RBA; and iv) increase collaboration internationally. The two-day workshop gathered 28 participants from 16 institutions in 11 countries. It included technical presentations of RBA methods and case studies, and two break-out sessions for group discussions. All participants agreed that RBA has substantial potential to inform risk-management decisions in the areas of food safety, nutrition and public health. Several activities to optimize further developments within RBA were suggested. This paper provides a summary of workshop presentations, a discussion of challenges that limit progress in this area, and suggestions of next steps for this promising approach supporting a science-based decision process in the area of risk-benefit management of foods.