World Health Organization estimates of the global and regional disease burden of four foodborne chemical toxins, 2010: a data synthesis

Quantifying national burdens of foodborne disease-Four imperatives for global impact

Estimates of national burdens of the foodborne disease (FBD) inform country-level food safety policies, ranking infectious and non-infectious FBD hazards in terms of health and socioeconomic impact to mitigate FBD burdens. Using relevant publications on FBD burdens from scientific literature, this review contends that four major imperatives (health, economic, planetary boundaries, governance) argue for a sustainable programme to quantify national FBD burdens. FBD disproportionately affects children under five years of age, and low- and middle-income countries. The economic costs are significant and include medical care, child development, lost productivity and international trade losses. Climatic changes and environmental contamination cause socio-ecological disruptions, increasing risk factors for FBD. Good governance promotes food safety initiatives, addressing in part under-diagnosis and underreporting. Strengthening national policies on FBD surveillance and burden estimation can promote food safety policies and address the global and national imperatives for FBD control. Evidence-based educational and regulatory interventions for FBD can promote improvements in the health and socioeconomic circumstances of the most vulnerable.

Implantation of Aspergillus Section Flavi in French Maize and Consequences on Aflatoxin Contamination of Maize at Harvest: Three-Year Survey

The worldwide distribution of aflatoxin B1, a carcinogenic mycotoxin, is changing due to climate change. This frequent contaminant of crops in tropical and subtropical regions is an emerging threat in Europe. Its first appearance in French maize was reported in 2015, a year with exceptional climatic conditions. But, from this year, such conditions (drought during spring and hot summers) occurred regularly, raising the question of a possible durable implantation of aflatoxigenic fungal species in French maize fields. To answer this question, 554 maize samples were collected during three consecutive years (2018-2020) throughout the French territory. They were subjected to mycological analysis and strains belonging to the Flavi section of the Aspergillus genus were identified, and their toxigenic potential was determined. This survey demonstrates that Aspergillus section Flavi are now frequent contaminants of maize since they were observed in more than 50% of samples in 2018 and 2019. This prevalence sharply increased in 2020 to reach 80% contamination. In parallel, the frequency of contamination with aflatoxins also increased. While it was very limited during the first two years of the study, despite favorable climatic conditions, contamination with aflatoxins was present in 16% of samples analyzed in 2020, exceeding E.U. regulation by 5%. Even if Aspergillus flavus is the dominant species, representing more than 90% of isolated strains, Aspergillus parasiticus seems to play a major role in grain contamination, as demonstrated by the presence of AFG in 50% of contaminated samples. These findings highlight the need to rethink the monitoring and management of aflatoxin risk in France for the future.

Echinococcus granulosus sensu lato control measures: a specific focus on vaccines for both definitive and intermediate hosts

Echinococcosis, a neglected zoonotic disease caused by Echinococcus tapeworms, presents significant public health challenges worldwide. Cystic and alveolar echinococcosis has substantial health and economic impacts, necessitating effective prevention and control strategies. The present review provides a framework to expand our knowledge regarding key components of echinococcosis prevention and control, including phases, options, targets and available tools as well as current gaps and challenges in the field. Furthermore, we discuss the progress made in developing vaccines for the intermediate and definitive hosts and review the limitations and obstacles in vaccine development for definitive hosts. Abundant information is available on various aspects of the Echinococcus vaccine in sheep. Livestock vaccination effectively reduces Echinococcus transmission to sheep, offering a feasible control measure in intermediate hosts. However, vaccine development for the definitive host, i.e. dogs, exhibits significant challenges. Information gaps regarding the immune-mediated protective responses in dogs, repeatability of results, factors influencing the immune response, reinfection resistance, potential age-related decreases in worm burden and factors associated with the antifecundity effect are key challenges that should be addressed in canine vaccine development, and research collaboration, innovative technologies, and a deeper understanding of transmission dynamics are crucial. Multisectoral coordination under the One Health framework, with long-term political commitment and national and international cooperation, is critical for effective control in endemic areas.

The burden of cancer attributable to dietary dioxins and dioxin-like compounds exposure in China, 2000-2020

Dioxin is a typical class of persistent organic pollutants (POPs) that could cause cancer. In China, the contribution of dietary dioxins to the cancer burden remains underexplored. This study evaluates the cancer risk and burden due to dietary dioxins and dioxin-like compounds among Chinese residents from 2000 to 2020. Based on adjustments in China's dioxin policies, the study period was divided into three stages with split years of 2007 and 2014 to estimate the toxic equivalent (TEQ) of dioxins. Participants in dietary surveys conducted in 31 provinces were included. Dietary exposure to dioxins was estimated in a probability model and compared with the provisional tolerable monthly intake (PTMI). The risk was assessed using carcinogenic slope factors and expressed as the incremental lifetime cancer risk (ILCR). A two-stage model evaluated the burden of cancer attributable to dietary dioxins and dioxin-like compounds. Among all food categories, the highest concentration of dioxins and dioxin-like compounds was observed in aquatic foods at 0.15 pg TEQ/kg. Median dietary exposure to dioxins among Chinese residents decreased from 12.39 pg TEQ/kg/month to 8.72 pg TEQ/kg/month between 2000 and 2020. Consequently, the ILCR due to dietary dioxins declined from 6.44 × 10-5 to 4.53 × 10-5. The health risks were higher in younger groups and among residents of coastal areas (P < 0.001). The burden of cancer attributable to dietary intake of dioxins and dioxin-like compounds in the Chinese population in 2000-2007, 2008-2014, and 2015-2020 was 2.25 (2.09-2.42) per 100,000, 2.20 (2.06-2.35) per 100,000, and 1.68 (1.60-1.77) per 100,000, respectively. Furthermore, the disease burden was highest for prostate cancer in men and for breast cancer in women. The dioxin management policies has reduced the burden of cancer attributable to dietary exposure to dioxins and dioxin-like compounds in China. However, excess exposure in coastal areas and children remains a priority for attention.

When less is more: The association between the expression of polymorphic CYPs and AFB1-induced HCC

BACKGROUND

An individual's genetic fingerprint is emerging as a pivotal predictor of numerous disease- and treatment-related factors. Single nucleotide polymorphisms (SNPs) in drug-metabolizing enzymes play key roles in an individual's exposure to a malignancy-associated risk, such as Aflatoxin B1 (AFB1)-induced hepatocellular carcinoma (HCC).

AIM

This study aimed at reviewing literature on the polymorphisms that exist in CYP enzymes and their possible link with susceptibility to AFB1-induced HCC.

MATERIALS & METHODS

A set of keywords associated with the study subject of interest was used to search the Google Scholar and the PubMed database. The last ten years' worth of research projects were included in the results filter. The research involved HCC patients and any connection between polymorphic forms of CYP enzymes and their susceptibility to AFB1-induced HCC, including older but significant data.

RESULTS

Variations in CYP1A2 and CYP3A4 were reported to impact the rate and magnitude of AFB1 bio-activation, thus influencing an individual's vulnerability to develop HCC. In HCC patients, the activity of CYP isoforms varies, where increased activity has been reported with CYP2C9, CYP2D6, and CYP2E1, while CYP1A2, CYP2C8, and CYP2C19 exhibit decreased activity. CYP2D6*10 frequency has been discovered to differ considerably in HCC patients. Rs2740574 (an upstream polymorphism in CYP3A4 as detected in CYP3A4*1B) and rs776746 (which affects CYP3A5 RNA splicing), both of which influence CYP3A expression, thus impacting the variability of AFB1-epoxide adducts in HCC patients.

DISCUSSION

CYP1A2 is the primary enzyme accountable for the formation of harmful AFBO globally. CYP3A4, CYP3A5, CYP3A7, CYP2B7, and CYP3A3 are also implicated in the bio-activation of AFB1 to mutagenic metabolites. It is thought that CYP3A4 is the protein that interacts with AFB1 metabolism the most.

CONCLUSION

Polymorphic variants of CYP enzymes have a functional impact on the susceptibility to AFB1-induced HCC. Outlining such variation and their implications may provide deeper insights into approaching HCC in a more personalized manner for guiding future risk-assessment, diagnosis, and treatment.

Rapid Detection of Aflatoxins in Ground Maize Using Near Infrared Spectroscopy

Aflatoxins are carcinogenic mycotoxins that may contaminate many crops and more especially maize. To protect consumers from these contaminants, many countries set up low regulatory thresholds of few µg/kg. The control of food requires time-consuming analysis for which sampling is a key step. It would therefore of key sanitary and economic relevance to develop rapid, sensitive and accurate methods that could even be applied on line at harvest, to identify batches to be excluded as soon as possible. In this study, we analyzed more than 500 maize samples taken at harvest during 3 years for their aflatoxin contamination using HPLC-MS. Among them, only 7% were contaminated but sometimes at levels largely exceeding European regulations. We demonstrate that Near InfraRed Spectroscopy (NIRS) could be of great help to classify cereal samples according to their level of aflatoxin contamination (below or higher than E.U. regulation). To build the model, all AF contaminated samples as well as an equivalent number of AF free samples were used. NIRS performance was not sufficient to quantify the toxins with adequate precision. However, its ability to discriminate naturally contaminated maize samples according to their level of contamination with aflatoxins in relation to European regulations using a quadratic PCA-DA model was excellent. Accuracy of the model was 97.4% for aflatoxin B1 and 100% for total aflatoxins.

Aptamer Based Nanoprobes for Detection of Foodborne Virus in Food and Environment Samples: Recent Progress and Challenges

Accepting the fact that there is a huge number of virus particles in food that lead to several infectious diseases, eliminating of the foodborne virus from food is tangible. In 2020, the appearance of new SARS-CoV-2 variants had remarked the importance of food safety in our lives. Detection virus is a dynamic domain. Recently, many papers have tried to detect several foodborne viruses by using conventional sensing platforms including ELISA (enzyme-linked immunosorbent assay), PCR (polymerase chain reaction-based methods) and NASBA (nucleic acid sequence-based amplification). However, small sizes, low infective doses and discrete distribution of the foodborne virus have converted these microorganisms into the most challengeable pathogen in the food samples matrix. Foodborne virus detection exploiting aptamer-based biosensors has attracted considerable attention toward the numerous benefits of sourcing from aptamers in which a variety of viruses could be detected by conjugation of aptamer-virus. The development of multiple sensing methodologies and platforms in terms of aptasensor application in real food and environment samples has demonstrated promising results. In this review, we present the latest developments in myriad types of aptasensors (including electrochemical, optical and piezoelectric aptasensor) for the quantification of foodborne viruses. Working strategies, benefits and disadvantages of these platforms are argued.

Quantitative risk ranking of mycotoxins in milk under climate change scenarios

Mycotoxins are toxic fungal metabolites that may occur in crops. Mycotoxins may carry-over into bovine milk if bovines ingest mycotoxin-contaminated feed. Due to climate change, there may be a potential increase in the prevalence and concentration of mycotoxins in crops. However, the toxicity to humans and the carry-over rate of mycotoxins from feed to milk from bovines varies considerably. This research aimed to rank emerging and existing mycotoxins under different climate change scenarios based on their occurrence in milk and their toxicity to humans. The quantitative risk ranking took a probabilistic approach, using Monte-Carlo simulation to take account of input uncertainties and variabilities. Mycotoxins were ranked based on their hazard quotient, calculated using estimated daily intake and tolerable daily intake values. Four climate change scenarios were assessed, including an Irish baseline model in addition to best-case, worst-case, and most likely scenarios, corresponding to equivalent Intergovernmental Panel on Climate Change (IPCC) scenarios. This research prioritised aflatoxin B1, zearalenone, and T-2 and HT-2 toxin as potential human health hazards for adults and children compared to other mycotoxins under all scenarios. Relatively lower risks were found to be associated with mycophenolic acid, enniatins, and deoxynivalenol. Overall, the carry-over rate of mycotoxins, the milk consumption, and the concentration of mycotoxins in silage, maize, and wheat were found to be the most sensitive parameters (positively correlated) of this probabilistic model. Though climate change may impact mycotoxin prevalence and concentration in crops, the carry-over rate notably affects the final concentration of mycotoxin in milk to a greater extent. The results obtained in this study facilitate the identification of risk reduction measures to limit mycotoxin contamination of dairy products, considering potential climate change influences.

Children's cognitive impairment associated with cassava cyanide in Democratic Republic of the Congo: Burden of disease

Worldwide, tens of millions of children rely on cassava as a dietary staple throughout their formative years of brain and behavioral development. Recently, it was discovered that cassava cyanide can impair children's neurocognitive development at relatively low exposures. We revisited the World Health Organization's foodborne disease burden estimate of cassava cyanide, focusing on the new health endpoint of children's cognitive impairment in Democratic Republic of the Congo (DRC). The loss of Intelligence Quotient (IQ) scores was used to measure the endpoint of cognitive impairment caused by cassava cyanide exposure, which was estimated based on the concentration-effect relationship between children's IQ scores and cyanide concentrations in flour. We estimated the burden of intellectual disability (ID) associated with cassava cyanide exposure in terms of disability-adjusted life years (DALYs). The median content of cyanide in cassava samples collected from DRC was 12.5 mg/kg, causing a median decrement to children's IQ of 2.37 points. The estimated number of children with ID associated with cassava cyanide exposure was 1,643 cases, although 1,567 of these cases (95%) were mild ID. The burden of cognitive impairment attributable to cassava cyanide in DRC alone was 13,862 DALYs per 100,000 children, or 3.01 million for all children under age 5. The results of the study, showing a significant burden of cassava cyanide-related cognitive impairment in children even at relatively low doses, can contribute to the implementation of cost-effective interventions to make cassava consumption safer for children in high-risk rural areas of DRC.

Assessment of the Adverse Health Effects of Aflatoxin Exposure from Unpackaged Peanut Oil in Guangdong, China

Aflatoxins are liver carcinogens and are common contaminants in unpackaged peanut (UPP) oil. However, the health risks associated with consuming aflatoxins in UPP oil remain unclear. In this study, aflatoxin contamination in 143 UPP oil samples from Guangdong Province were assessed via liquid chromatography-tandem mass spectrometry (LC-MS). We also recruited 168 human subjects, who consumed this oil, to measure their liver functions and lipid metabolism status. Aflatoxin B1 (AFB1) was detected in 79.72% of the UPP oil samples, with levels ranging from 0.02 to 174.13 μg/kg. The average daily human intake of AFB1 from UPP oil was 3.14 ng/kg·bw/day; therefore, the incidence of liver cancer, caused by intake of 1 ng/kg·bw/day AFB1, was estimated to be 5.32 cases out of every 100,000 persons per year. Meanwhile, Hepatitis B virus (HBV) infection and AFB1 exposure exerted a synergistic effect to cause liver dysfunction. In addition, the triglycerides (TG) abnormal rate was statistically significant when using AFB1 to estimate daily intake (EDI) quartile spacing grouping (p = 0.011). In conclusion, high aflatoxin exposure may exacerbate the harmful effects of HBV infection on liver function. Contamination of UPP oil with aflatoxins in Guangdong urgently requires more attention, and public health management of the consumer population is urgently required.

Food processing contaminants: Dietary exposure to 3-MCPD and glycidol and associated burden of disease for Italian consumers

In this study we assessed Italian consumers' dietary exposure to 3-MCPD and glycidol followed by risk characterization, potential cancer risk and the associated burden of disease. Consumption data was retrieved from the most recent Italian Food Consumption Survey (2017-2020), while contamination data was obtained from the European Food Safety Authority. The level of risk due to exposure to 3-MCPD was negligible, below the tolerable daily intake (TDI), except for high consumption of infant formulas. For infants, the intake level was higher than the TDI (139-141% of TDI), indicating a potential health risk. Exposure to glycidol indicated a health concern for infants, toddlers, other children, and adolescents consuming infant formulas, plain cakes, chocolate spreads, processed cereals, biscuits, rusks, and cookies (margin of exposure (MOE) < 25,000). The risk of cancer due to exposure to glycidol was estimated and the overall health impact was quantified in Disability-Adjusted Life Years (DALYs). The risk of cancer due to chronic dietary exposure to glycidol was estimated at 0.08-0.52 cancer cases/year/100,000 individuals depending on the life stage and dietary habits in Italy. The burden of disease quantified in DALYs varied from 0.7 to 5.37 DALYs/year/100,000 individuals. It is crucial to continuously gather consumption and occurrence data for glycidol over time to track patterns, assess potential health risks, identify exposure sources, and develop effective countermeasures, as long-term exposure to chemical contaminants can lead to an increased risk for human health. This data is critical for protecting public health and reducing the likelihood of cancer and other health issues related to glycidol exposure.

Disease burden contributed by dietary exposure to aflatoxins in a mountainous city in Southwest China

Introduction

Aflatoxins (AFT) identified as a Group 1 human carcinogen naturally contaminate various types of food and could increase the risk of hepatocellular carcinoma (HCC) through dietary intake. Chongqing municipality is located in Southwest China with subtropical monsoon climate which is conducive to AFT contamination in crops. However, the burden of HCC caused by the dietary exposure of the population in Chongqing to AFT has not been quantified.

Methods

The burden of HCC was estimated in terms of Disability Adjusted Life Year (DALY) using FDA-iRISK software. Dietary exposure to AFT in three food categories including grain and its products, nuts and seeds, and spices was assessed.

Results

The lifetime average daily dose (LADD) of AFT exposure for the population ranged from 2.40 to 8.25 ng/kg bw/day and 9.51 to 15.10 ng/kg bw/day at the mean and heavy (P95) AFT contamination levels, respectively. Among the three food categories, grain and its products contributed most to AFT exposure of the population. The estimated DALYs related to HCC induced by AFT were 162,000-556,000 and 641,000-1,020,000; the DALY rates were 6.47-22.20 and 25.59-40.72 per 100,000 persons per year; and the population attribution fractions (PAF) were 1.68-5.78% and 6.66-10.60%.

Discussion

Although the burden of HCC caused by dietary AFT was estimated to be relatively low among the population, the overall health burden might be underestimated owing to the uncertainties of this dataset. Thus, the overall health burden associated with AFT intake should still be of concern in further studies.

Designing optimal food safety monitoring schemes using Bayesian network and integer programming: The case of monitoring dioxins and DL-PCBs

Efficient food safety monitoring should achieve optimal resource allocation. In this article, a methodology is presented to optimize the use of resources for food safety monitoring aimed at identifying noncompliant samples and estimating background level of hazards in food products. A Bayesian network (BN) model and an optimization model were combined in a single framework. The framework was applied to monitoring dioxins and dioxin-like polychlorinated biphenyls (DL-PCBs) in primary animal-derived food products in the Netherlands. The BN model was built using a national dataset with monitoring results of dioxins and DL-PCBs in animal-derived food products over a 10-year period (2008-2017). These data were used to estimate the probability of detecting suspect samples with dioxins and DL-PCBs levels above preset thresholds, given certain sample conditions. The results of the BN model were then inserted into the optimization model to compute an optimal monitoring scheme. Model estimates showed that the probability of dioxins and DL-PCBs exceeding threshold limits was higher in laying hen eggs and sheep meat than in other animal-derived food (except deer meat). Compared with the monitoring scheme used in the Netherlands in 2018, the optimal monitoring scheme would save around 10,000 EUR per year. This could be obtained by reallocating monitoring resources from products with lower probability of dioxin and DL-PCBs exceeding threshold limits (e.g., pig meat) to products with higher probability (e.g., bovine animal meat), and by shifting sample collection from the last quarter of the year toward the first three quarters of the year.

Role of Polyphenols from the Aqueous Extract of Aloysia citrodora in the Inhibition of Aflatoxin B1 Synthesis in Aspergillus flavus

Aflatoxin B1 (AFB1) is a mycotoxin considered a potent carcinogen for humans that contaminates a wide range of crops. Various strategies have been established to reduce or block the synthesis of AFB1 in food and feed. The use of aqueous extracts derived from plants with high antioxidant activity has been a subject of study in recent years due to their efficacy in inhibiting AFB1. In this study, we assessed the effect of Aloysia citrodora aqueous extract on Aspergillus flavus growth and on AFB1 production. A bio-guided fractionation followed by High Performance Liquid Chromatography (HPLC) and Mass spectrometry analysis of the active fraction were applied to identify the candidate molecules responsible for the dose-effect inhibition of AFB1 synthesis. Our results revealed that polyphenols are the molecules implicated in AFB1 inhibition, achieving almost a total inhibition of the toxin production (99%). We identified luteolin-7-diglucuronide as one of the main constituents in A. citrodora extract, and demonstrated that it is able to inhibit, by itself, AFB1 production by 57%. This is the first study demonstrating the anti-Aflatoxin B1 effect of this molecule, while other polyphenols surely intervene in A. citrodora anti-AFB1 activity.

DNA methylation patterns associated with konzo in Sub-Saharan Africa

Konzo, a disease characterized by sudden, irreversible spastic paraparesis, affecting up to 10% of the population in some regions of Sub-Saharan Africa during outbreaks, is strongly associated with dietary exposure to cyanogenic bitter cassava. The molecular mechanisms underlying the development of konzo remain largely unknown. Here, through an analysis of 16 individuals with konzo and matched healthy controls from the same outbreak zones, we identified 117 differentially methylated loci involved in numerous biological processes that may identify cyanogenic-sensitive regions of the genome, providing the first study of epigenomic alterations associated with a clinical phenotype of konzo.

Possible Mechanisms of the Interplay between Drugs and Mycotoxins-Is There a Possible Impact?

Mycotoxin contamination is a global food safety issue leading to major public health concerns. Repeated exposure to multiple mycotoxins not only has repercussions on human health but could theoretically also lead to interactions with other xenobiotic substances-such as drugs-in the body by altering their pharmacokinetics and/or pharmacodynamics. The combined effects of chronic drug use and mycotoxin exposure need to be well understood in order to draw valid conclusions and, in due course, to develop guidelines. The aim of this review is to focus on food contaminants, more precisely on mycotoxins, and drugs. First, a description of relevant mycotoxins and their effects on human health and metabolism is presented. The potential for interactions of mycotoxins with drugs using in vitro and in vivo animal experiments is summarized. Predictive software tools for unraveling mycotoxin-drug interactions are proposed and future perspectives on this emerging topic are highlighted with a view to evaluate associated risks and to focus on precision medicine. In vitro and in vivo animal studies have shown that mycotoxins affect CYP450 enzyme activity. An impact from drugs on mycotoxins mediated via CYP450-enzymes is plausible; however, an impact of mycotoxins on drugs is less likely considering the much smaller dose exposure to mycotoxins. Drugs that are CYP450 perpetrators and/or substrates potentially influence the metabolism of mycotoxins, metabolized via these CYP450 enzymes. To date, very little research has been conducted on this matter. The only statistically sound reports describe mycotoxins as victims and drugs as perpetrators in interactions; however, more analysis on mycotoxin-drug interactions needs to be performed.

Multiple Mycotoxin Contamination in Medicinal Plants Frequently Sold in the Free State Province, South Africa Detected Using UPLC-ESI-MS/MS

Medicinal plants are important in the South African traditional healthcare system, the growth in the consumption has led to increase in trade through muthi shops and street vendors. Medicinal plants are prone to contamination with fungi and their mycotoxins. The study investigated multiple mycotoxin contamination using Ultra High Pressure Liquid Chromatography-Tandem Mass Spectrometry (UPLC-ESI-MS/MS) for the simultaneous detection of Aflatoxin B1 (AFB1), Deoxynivalenol (DON), Fumonisins (FB1, FB2, FB3), Nivalenol (NIV), Ochratoxin A (OTA) and Zearalenone (ZEN) in frequently sold medicinal plants. Medicinal plant samples (n = 34) were purchased and analyzed for the presence of eight mycotoxins. DON and NIV were not detected in all samples analyzed. Ten out of thirty-four samples tested positive for mycotoxins -AFB1 (10.0%); OTA (10.0%); FB1 (30.0%); FB2 (50.0%); FB3 (20.0%); and ZEN (30.0%). Mean concentration levels ranged from AFB1 (15 µg/kg), OTA (4 µg/kg), FB1 (7-12 µg/kg), FB2 (1-18 µg/kg), FB3 (1-15 µg/kg) and ZEN (7-183 µg/kg). Multiple mycotoxin contamination was observed in 30% of the positive samples with fumonisins. The concentration of AFB1 reported in this study is above the permissible limit for AFB1 (5 µg/kg). Fumonisin concentration did not exceed the limits set for raw maize grain (4000 µg/kg of FB1 and FB2). ZEN and OTA are not regulated in South Africa. The findings indicate the prevalence of mycotoxin contamination in frequently traded medicinal plants that poses a health risk to consumers. There is therefore a need for routine monitoring of multiple mycotoxin contamination, human exposure assessments using biomarker analysis and establishment of regulations and standards.

Toxic Metals and Metalloids in Hassawi Brown Rice: Fate during Cooking and Associated Health Risks

Rice has been a dietary staple for centuries, providing vital nutrients to the human body. Brown rice is well known for its nutrient-dense food profile. However, owing to multiple causes (anthropogenic and non-anthropogenic), it can also be a potential source of toxic heavy metals in the diet. Brown Hassawi rice samples were collected from the Al-Ahsa region and analyzed for its content of toxic metals. The results reveal that all the tested metals varied significantly in the brown rice samples, while As and Pb in all three samples exceeded their respective maximum allowable limits (MALs), followed by Cd, which nearly approached the MAL in two samples out of three. Brown rice samples were cooked in rice:water systems, viz., low rice:water ratios (1:2.5, 1:3.5) and high rice:water ratios (1:5, 1:6), along with soaking as a pre-treatment. Soaking was unproductive in removing the heavy metals from the rice, whereas cooking dissipated all metals from the rice, except for Cd, which was statistically non-significant. The high-water cooking of the rice was more effective in the dissipation of metals from the rice as compared to low-water cooking conditions. Through the consumption of rice, the estimated daily intake (EDI) of heavy metals is 162 g per person per day for As, which is above the provisional maximum tolerable daily intake (PMTDI) regardless of cooking circumstances. The hazard risk index (HRI) also highlighted the fact that As can be a potential health hazard to rice consumers in the Al-Ahsa region of Saudi Arabia. These results indicate the potential health risks caused by the consumption of this rice by humans. Regular monitoring is recommended to manage and control elevated concentrations and related health hazards as a result of the use of Hassawi rice contaminated by the accumulation of metals and metalloids.

Burden of cardiovascular disease attributable to dietary lead exposure in adolescents and adults in China

Lead is a naturally occurring metal with a range of industrial applications; however, it can cause adverse health effects upon human exposure. Even if blood lead levels (BLLs) in the human body are in the acceptable range, it is independently associated with cardiovascular disease (CVD), which is the leading cause of death in China. However, the role of lead exposure in CVD outcomes has not been quantified well. A top-down approach was adopted in this study to calculate the population attribution fraction (PAF) by combining pooled BLLs in the Chinese population reported between 2001 and 2022 with the relative risk (RR) of lead-induced CVD. Subsequently, the disease burden (DB) of lead-induced CVD was estimated and expressed in disability-adjusted life years (DALYs), and the attribution analysis about various sources of lead exposure was performed. Among Chinese adolescents and adults, BLLs of 5.50 ± 2.45 μg/dL resulted in an estimated total DB (×10⁶ DALYs) of 2.21 (2.07-2.32) for CVD, including 1.18 (1.12-1.25), 0.71 (0.69-0.74), 0.23 (0.15-0.26), and 0.02 (0.02-0.02) for stroke, and ischemic, hypertensive, and rheumatic heart diseases, respectively. Dietary lead intake was a major contributor to the DB (68.1%), and lead ingested through food was responsible for 15.1 × 10⁵ DALYs of the CVD burden. Guangxi, Hunan, and Yunnan regions in China reported higher BLLs in adolescents and adults, and the DB of lead-induced CVD was higher in Hunan, Henan, and Sichuan. Lead is a risk factor for CVD that can cause significant DB. Further practical and cost-effective efforts to reduce lead exposure are urgently needed.

Availability of Antidotes for Management of Acute Toxicity Cases at Emergency Departments in Qassim Hospitals: A Retrospective Study

Background: Drug overdose is a medico-social issue worldwide that may occur intentionally or unintentionally. It is one of the most common reasons for emergency department visits, and it is also a frequent cause of morbidity and mortality globally. This study aims to determine the occurrence of acute toxicity cases and their management outcomes at the emergency departments in Qassim Province hospitals in Saudi Arabia. In addition, the study aims to investigate the antidote availabilities at those medical centers.

Methods: A retrospective hospital record-based study of acute toxicity cases admitted to the emergency department in hospitals in Qassim during the period from January 1, 2020, to December 31, 2020, was conducted. Data were collected based on hospital resources such as gastrointestinal decontamination, stabilization, elimination enhancement resources, and antidotes from Qassim hospitals, and the availability of antidotes as well as the clinical data of the patients with the management outcome.

Results: A total of 264 patients with acute toxicity were admitted to the emergency departments of 14 hospitals in Qassim Province in 2020. Of the 264 cases, 179 (68%) were males, and 85 (32%) cases were females. Ninety-five percent of the cases were admitted to public hospitals, whereas 5% were admitted to private hospitals. The largest group by age of admitted cases were aged 11-20 years (19.3%). This study showed that 99% received appropriate treatment for their cause of toxicity, whereas 1% did not. The most common causes of toxicity in Qassim were found to be food poisoning (20.5%), followed by intentional suicide attempts with warfarin/enoxaparin/aspirin overdoses (15.9%) and acetaminophen (paracetamol) overdosage seen in 15.5% of admitted cases. Flagyl, in addition to fluids, was used in the management of 16.7% of cases, N-acetyl cysteine was used for 16.3%, and vitamins K and B6 were used for 14.0% of cases. Activated charcoal, atropine, calcium chloride, calcium gluconate, flumazenil, insulin, magnesium, sodium bicarbonate, and vitamin K were available at all the studied hospitals. However, all the hospitals lacked both ethylenediaminetetraacetic acid (EDTA) and a cyanide kit. Methylene blue and leucovorin were available in only one of the studied hospitals.

Attribution of country level foodborne disease to food group and food types in three African countries: Conclusions from a structured expert judgment study

BACKGROUND

According to the World Health Organization, 600 million cases of foodborne disease occurred in 2010. To inform risk management strategies aimed at reducing this burden, attribution to specific foods is necessary.

OBJECTIVE

We present attribution estimates for foodborne pathogens (Campylobacter spp., enterotoxigenic Escherichia coli (ETEC), Shiga-toxin producing E. coli, nontyphoidal Salmonella enterica, Cryptosporidium spp., Brucella spp., and Mycobacterium bovis) in three African countries (Burkina Faso, Ethiopia, Rwanda) to support risk assessment and cost-benefit analysis in three projects aimed at increasing safety of beef, dairy, poultry meat and vegetables in these countries.

METHODS

We used the same methodology as the World Health Organization, i.e., Structured Expert Judgment according to Cooke's Classical Model, using three different panels for the three countries. Experts were interviewed remotely and completed calibration questions during the interview without access to any resources. They then completed target questions after the interview, using resources as considered necessary. Expert data were validated using two objective measures, calibration score or statistical accuracy, and information score. Performance-based weights were derived from the two measures to aggregate experts' distributions into a so-called decision maker. The analysis was made using Excalibur software, and resulting distributions were normalized using Monte Carlo simulation.

RESULTS

Individual experts' uncertainty assessments resulted in modest statistical accuracy and high information scores, suggesting overconfident assessments. Nevertheless, the optimized item-weighted decision maker was statistically accurate and informative. While there is no evidence that animal pathogenic ETEC strains are infectious to humans, a sizeable proportion of ETEC illness was attributed to animal source foods as experts considered contamination of food products by infected food handlers can occur at any step in the food chain. For all pathogens, a major share of the burden was attributed to food groups of interest. Within food groups, the highest attribution was to products consumed raw, but processed products were also considered important sources of infection.

CONCLUSIONS

Cooke's Classical Model with performance-based weighting provided robust uncertainty estimates of the attribution of foodborne disease in three African countries. Attribution estimates will be combined with country-level estimates of the burden of foodborne disease to inform decision making by national authorities.

Spatial-temporal distribution, cancer risk, and disease burden attributed to the dietary dioxins exposure of Chinese residents

This study analyzed the characteristics of dioxins represented by polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) as well as dioxin-like polychlorinated biphenyls (dl-PCBs) in food from China. The spatial-temporal distribution characteristics of dioxins dietary intake, cancer risk, and disease burden were evaluated among the Chinese population. In the temporal dimension, descending trends in animal-origin-food were found both in dietary intake PCDD/Fs and dl-PCBs, with the reverse for plant-origin-food. The probability assessments of dietary intakes showed that after 2007, the exposure level of PCDD/Fs through diets of urban and rural residents in China was significantly lower than that before 2007 (p < 0.05). The spatial distribution results showed that the southern coastal regions were high exposure regions of dietary intakes of PCDD/Fs and dl-PCBs. Cancer risk and disease burden of dietary dioxins showed downward trends after 2007 both under an average exposure scenario and an extreme exposure scenario. After 2007, the disease burden resulting from exposure to dl-PCBs became higher and approached the median of values reported by the WHO, while the disease burden resulting from exposure to PCDD/Fs approached the lower level of 95% CI reported by the WHO. The results indicate that accompanying the National Implementation Plan and a series of subsequent scientific guidance documents launched for reducing dioxins pollution in 2007, the health benefits and the health risks caused by dl-PCBs should be given further attention and evaluation in future studies.

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.

Burden of Disease Associated with Dietary Exposure to Aflatoxins in China in 2020

Aflatoxins (AFTs), as a group 1 carcinogen, could lead to hepatocellular carcinoma (HCC). Dietary intake is the primary way of AFT exposure in humans. However, the contribution of foodborne AFT intake to the HCC burden remains unknown in recent years in China. Hence, the present study was conducted to estimate the burden of HCC attributed to foodborne AFT exposure by using disability-adjusted life years (DALYs). The risk assessment was used to estimate the incidence of HCC related to AFT exposure. Concentrations of AFTs in peanuts, peanut oil, corn, and corn products were retrieved from literature published between 2010 and 2020 in China. Corresponding daily food consumption data were obtained from two nationwide Chinese surveys. A direct approach was used to calculate DALY and DALY rates to quantify the HCC burden attributed to dietary AFT exposure. The total amount of AFT intake through peanut, peanut oil, corn, and corn products was 4.018 ng/kg bw/day resulting in 0.125 extra HCC cases per year/100,000 persons, corresponding to a DALY number and DALY rate of 21,625.08 and 1.53 per 100,000 population, respectively. Regionally, DALYs were high in Guangxi and Guangdong provinces, corresponding to 5948 and 5595 DALYs. A total of 1.5 DALYs/100,000 were lost due to the AFT exposure. DALYs per 100,000 population were higher in several coastal areas. Though the disease burden of HCC caused by dietary AFTs was low in the Chinese population, a high health risk was found in the residents of some areas with high AFT exposure. AFTs are still a health challenge for the Chinese people.

Preservation of Mimosa tenuiflora Antiaflatoxigenic Activity Using Microencapsulation by Spray-Drying

Mimosa tenuiflora aqueous extract (MAE) is rich in phenolic compounds. Among them, condensed tannins have been demonstrated to exhibit a strong antioxidant and antiaflatoxin B1 activities in Aspergillus flavus. Since antioxidant capacity can change with time due to environmental interactions, this study aimed to evaluate the ability of encapsulation by spray-drying of Mimosa tenuiflora aqueous extract to preserve their biological activities through storage. A dry formulation may also facilitate transportation and uses. For that, three different wall materials were used and compared for their efficiency. Total phenolic content, antioxidant activity, antifungal and antiaflatoxin activities were measured after the production of the microparticles and after one year of storage at room temperature. These results confirmed that encapsulation by spray-drying using polysaccharide wall materials is able to preserve antiaflatoxin activity of Mimosa tenuiflora extract better than freezing.

Aflatoxin Biosynthesis, Genetic Regulation, Toxicity, and Control Strategies: A Review

Aflatoxins (AFs) are highly toxic and cancer-causing compounds, predominantly synthesized by the Aspergillus species. AFs biosynthesis is a lengthy process that requires as minimum as 30 genes grouped inside 75 kilobytes (kB) of gene clusters, which are regulated by specific transcription factors, including aflR, aflS, and some general transcription factors. This paper summarizes the status of research on characterizing structural and regulatory genes associated with AF production and their roles in aflatoxigenic fungi, particularly Aspergillus flavus and A. parasiticus, and enhances the current understanding of AFs that adversely affect humans and animals with a great emphasis on toxicity and preventive methods.

Identification of chemical mixtures to which women are exposed through the diet: Results from the French E3N cohort

Due to the large number of chemical food contaminants, consumers are exposed simultaneously to a wide range of chemicals which can interact and have a negative impact on health. Nevertheless, due to the multitude of possible chemical combinations it is unrealistic to test all combined toxicological effects. It is therefore essential to identify the most relevant mixtures to which the population is exposed through the diet and investigate their impact on heath. The present study aims to identify and describe the main chemical mixtures to which women enrolled in the E3N study, a large French prospective cohort, are chronically exposed through the diet. 74522 women who had answered a validated semi-quantitative food frequency questionnaire in 1993, were included in the present study. Dietary exposure to chemical contaminates was estimated based on the food contamination measured in 186 core food in France collected between 2007 and 2009 by the French agency for food, environment and occupational health, and safety (ANSES) in the framework of the second French total diet study (2TDS). The sparse non-negative matrix under-approximation (SNMU) was used to identify mixtures of chemical substances. A k-means clustering classification of the whole study population was then performed to define clusters with similar co-exposure profiles. Overall, 8 mixtures which explained 83% of the total variance, were retained. The first mixture, entitled "Minerals, inorganic contaminants, and furans", explained the highest proportion of the total variance (38%), and was correlated in particular with the consumption of "Offal" (rho = 0.22), "Vegetables except roots" (rho = 0.20), and "Eggs" (rho = 0.19). The other seven mixtures explained between 17% and 1% of the variance. Finally, 5 clusters were identified based on the adherence to the 8 mixtures. This study, being the largest ever conducted to identify dietary exposure to chemical mixtures, represents a concrete attempt to prioritize mixtures for which it is essential to investigate combined health effects based on exposure.

Biocontrol of Aflatoxins Using Non-Aflatoxigenic Aspergillus flavus: A Literature Review

Aflatoxins (AFs) are mycotoxins, predominantly produced by Aspergillus flavus, A. parasiticus, A. nomius, and A. pseudotamarii. AFs are carcinogenic compounds causing liver cancer in humans and animals. Physical and biological factors significantly affect AF production during the pre-and post-harvest time. Several methodologies have been developed to control AF contamination, yet; they are usually expensive and unfriendly to the environment. Consequently, interest in using biocontrol agents has increased, as they are convenient, advanced, and friendly to the environment. Using non-aflatoxigenic strains of A. flavus (AF⁻) as biocontrol agents is the most promising method to control AFs’ contamination in cereal crops. AF⁻ strains cannot produce AFs due to the absence of polyketide synthase genes or genetic mutation. AF⁻ strains competitively exclude the AF⁺ strains in the field, giving an extra advantage to the stored grains. Several microbiological, molecular, and field-based approaches have been used to select a suitable biocontrol agent. The effectiveness of biocontrol agents in controlling AF contamination could reach up to 99.3%. Optimal inoculum rate and a perfect time of application are critical factors influencing the efficacy of biocontrol agents.

The aflatoxin situation in Africa: Systematic literature review

Contamination of African staple foods is a major issue for human and animal health, nutrition, and trade. This review aimed to collect and synthesize the available evidence on geographical spread, scale of contamination, disease burden, economic impact, and mitigation measures for aflatoxins in Africa by way of a systematic literature review. This knowledge can enhance management strategies for the major challenges to combat aflatoxins. The search was conducted by applying a predefined search strategy, using bibliographic databases and websites, covering the period 2010 to 2018. Results showed that maize, peanuts, and animal feeds were the most studied commodities. For maize, all studies indicated mean AFB₁ to exceed the European Union legal limit. From studies on contamination levels and biomarkers, it is clear that overall exposure is high, leading to a substantial increase in long-term disease burden. In addition, concentrations in food occasionally can reach very high levels, causing acute aflatoxicoses. The trade-related impact of aflatoxin contamination was mainly evaluated from the standpoint of aflatoxin regulation affecting products imported from Africa. There was a limited number of studies on health-related economic impacts, pointing out a gap in peer-reviewed literature. A number of mitigation measures have been developed, but proof of cost-effectiveness or even costs alone of the practices is often lacking. We recommend more emphasis to be put in peer-reviewed studies on evidence-based cost-effective mitigation strategies for aflatoxins, on the scale and spread of the problem and its impacts on public health and economics for use in evidence-based policies.

The burden of disease of three food-associated heavy metals in clusters in the Danish population - Towards targeted public health strategies

Lifestyle and sociodemographics are likely to influence dietary patterns, and, as a result, human exposure to chemical contaminants in foods and their associated health impact. We aimed to characterize subgroups of the Danish population based on diet and sociodemographic indicators, and identify those bearing a higher disease burden due to exposure to methylmercury (MeHg), cadmium (Cd) and inorganic arsenic (i-As). We collected dietary, lifestyle, and sociodemographic data on the occurrence of chemical contaminants in foods from Danish surveys. We grouped participants according to similarities in diet, lifestyle, and sociodemographics using Self-Organizing Maps (SOM), and estimated disease burden in disability-adjusted life years (DALY). SOM clustering resulted in 12 population groups with distinct characteristics. Exposure to contaminants varied between clusters and was largely driven by intake of fish, seafood and cereal products. Five clusters had an estimated annual burden >20 DALY/100,000. The cluster with the highest burden had a high proportion of women of childbearing age, with most of the burden attributed to MeHg. Individuals belonging to the top three clusters had higher education and physical activity, were mainly non-smokers and lived in urban areas. Our findings may facilitate the development of preventive strategies targeted to the most affected subgroups.

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.

Optimization of Sampling for Monitoring Chemicals in the Food Supply Chain Using a Risk-Based Approach: The Case of Aflatoxins and Dioxins in the Dutch Dairy Chain

Food safety monitoring faces the challenge of tackling multiple chemicals along the various stages of the food supply chain. Our study developed a methodology for optimizing sampling for monitoring multiple chemicals along the dairy supply chain. We used a mixed integer nonlinear programming approach to maximize the performance of the sampling in terms of reducing the risk of the potential disability adjusted life years (DALYs) in the population. Decision variables are the number of samples collected and analyzed at each stage of the food chain (feed mills, dairy farms, milk trucks, and dairy processing plants) for each chemical, given a predefined budget. The model was applied to the case of monitoring for aflatoxin B₁ /M₁ (AFB₁ /M₁ ) and dioxins in a hypothetical Dutch dairy supply chain, and results were calculated for various contamination scenarios defined in terms of contamination fraction and concentrations. Considering various monitoring budgets for both chemicals, monitoring for AFB₁ /M₁ showed to be more effective than for dioxins in most of the considered scenarios, because AFB₁ /M₁ could result into more DALYs than dioxins when both chemicals are in same contamination fraction, and costs for analyzing one AFB₁ /M₁ sample are lower than for one dioxins sample. The results suggest that relatively more resources be spent on monitoring AFB₁ /M₁ when both chemicals' contamination fractions are low; when both contamination fractions are higher, relatively more budget should be addressed to monitoring dioxins.

Forty Years of Food Safety Risk Assessment: A History and Analysis

Before the founding of the Society for Risk Analysis (SRA) in 1980, food safety in the United States had long been a concern, but there was a lack of systematic methods to assess food-related risks. In 1906, the U.S. Congress passed, and President Roosevelt signed, the Pure Food and Drug Act and the Meat Inspection Act to regulate food safety at the federal level. This Act followed the publication of multiple reports of food contamination, culminating in Upton Sinclair's novel The Jungle, which highlighted food and worker abuses in the meatpacking industry. Later in the 20th century, important developments in agricultural and food technology greatly increased food production. But chemical exposures from agricultural and other practices resulted in major amendments to federal food laws, including the Delaney Clause, aimed specifically at cancer-causing chemicals. Later in the 20th century, when quantitative risk assessment methods were given greater scientific status in a seminal National Research Council report, food safety risk assessment became more systematized. Additionally, in these last 40 years, food safety research has resulted in increased understanding of a range of health effects from foodborne chemicals, and technological developments have improved U.S. food safety from farm to fork by offering new ways to manage risks. We discuss the history of food safety and the role risk analysis has played in its evolution, starting from over a century ago, but focusing on the last 40 years. While we focus on chemical risk assessment in the U.S., we also discuss microbial risk assessment and international food safety.

Indoxyl sulfate promotes the atherosclerosis through up-regulating the miR-34a expression in endothelial cells and vascular smooth muscle cells in vitro

Atherosclerosis (AS) is one of the most common cardiovascular events in patients with chronic renal insufficiency (CRI). During the development of CRI, uremic toxins, including indoxyl sulfate (IS), are pivotal risk factors for AS. However, the underlying mechanism between AS and IS has not been fully elucidated. The present study was designed to test our hypothesis that IS promotes the AS by regulating viability, proliferation, migration and apoptosis of endothelial cells and vascular smooth muscle cells. In this present study, our date showed that IS inhibited the cell viability of human umbilical vein endothelial cells (HUVECs) and human aortic vascular smooth muscle cells (HA-VSMCs) in a dose-dependent manner (P < .05). Moreover, IS inhibited the proliferation, migration and induced apoptosis of HUVECs and HA-VSMCs significantly (P < .05). However, inhibition of the miR-34a abolished these effects of IS in vitro, indicating that miR-34a is involved in the development of AS induced by IS. In addition, the luciferase reporter gene assay showed that up-regulating of miR-34a inhibited the Notch1 transcriptional activity remarkably (P < .05). The expression of Notch1 decreased after IS treatment, while miR-34a inhibitor attenuated this effect. Moreover, the expression of miR-34a-related proteins Wnt-1, Jag1, E2F1 and SIRT1 decreased, while the expression of p53 increased in HUVECs and HA-VSMCs after IS treatment. Consistently, blockage of miR-34a abolished the remarkable effects on protein expressions induced by IS. Taken together, this study showed that IS can inhibit the proliferation, migration and promote apoptosis of HUVECs and HA-VSMCs through the Notch1 signal and miR-34a-related proteins by up-regulating miR-34a. These findings may provide new insights into the underlying mechanism of AS in CRI.

Estimating the national burden of mild intellectual disability in children exposed to dietary lead in China

The effects of lead as a dietary pollutant remain a global public health concern that needs urgent resolution. Children are highly susceptible to the adverse outcomes of lead pollution, as even low levels of lead may cause irreversible damage to intellectual development. Since several sources of lead exposure are present in the environment, it is necessary to identify the attributable burden of lead-related diseases arising from different exposure sources. In the present study, we used epidemiological data from studies around the nation to estimate the burden of mild intellectual disability (MID) attributed to lead exposure sources by using disability-adjusted life years (DALYs). To this end, a dose-response approach was used and a model comprising three components was established: exposure, dose-response, and DALYs module. In Chinese children aged 0-6 years, blood lead levels (BLLs) of 5.34 ± 3.09 μg/dL resulted in a MID incidence rate of 12.84 cases per 1000 children, with an estimated burden of disease (BoD) of 42.23 DALYs per 1000 children. Owing to dietary lead exposure, 36.64 healthy life years per 1000 children were lost, which was notably higher than the outcomes associated with exposure from other sources. This was consistent with the result that dietary exposure was the main contributor to children's lead exposure, accounting for 86.76%. According to the regional distribution based on the existing literature, the areas in China with higher BLLs were Heilongjiang, Shanxi, and Jiangxi. Our findings provided the information for lead risk management decisions and policies making.

Chronic and Acute Toxicities of Aflatoxins: Mechanisms of Action

There are presently more than 18 known aflatoxins most of which have been insufficiently studied for their incidence, health-risk, and mechanisms of toxicity to allow effective intervention and control means that would significantly and sustainably reduce their incidence and adverse effects on health and economy. Among these, aflatoxin B1 (AFB1) has been by far the most studied; yet, many aspects of the range and mechanisms of the diseases it causes remain to be elucidated. Its mutagenicity, tumorigenicity, and carcinogenicity-which are the best known-still suffer from limitations regarding the relative contribution of the oxidative stress and the reactive epoxide derivative (Aflatoxin-exo 8,9-epoxide) in the induction of the diseases, as well as its metabolic and synthesis pathways. Additionally, despite the well-established additive effects for carcinogenicity between AFB1 and other risk factors, e.g., hepatitis viruses B and C, and the hepatotoxic algal microcystins, the mechanisms of this synergy remain unclear. This study reviews the most recent advances in the field of the mechanisms of toxicity of aflatoxins and the adverse health effects that they cause in humans and animals.

Using disease-burden method to evaluate the strategies for reduction of aflatoxin exposure in peanuts

Aflatoxin is a fungal secondary metabolite with high toxicity that is capable of contaminating various types of food crops. It has been identified as a Group 1 human carcinogen by the International Agency for Research on Cancer. Chronic aflatoxin exposure has caused worldwide concern as a matter of public food safety. Peanuts and peanut products are the major sources of aflatoxin exposure. Therefore, some reduction interventions have been developed to minimize contamination throughout the peanut production chain. The purpose of this study is to estimate the efficacy of interventions in reducing the health impact of hepatocellular carcinoma caused by aflatoxin contamination in peanuts. The estimated total Disability-Adjusted Life Years (DALYs) were calculated using FDA-iRISK software. Six aflatoxin reduction strategies were evaluated, including good agricultural practice (GAP), biocontrol, Purdue Improved Crop Storage packaging, basic processing, ozonolysis, and ultraviolet irradiation. The results indicated that basic processing could prevent huge public health loss of 4,079.7-21,833 total DALYs per year. In addition, GAP and biocontrol were both found to be effective strategies in the farm field. Meanwhile, the other three interventions had limited effectiveness in reducing total DALYs. In conclusion, this study could help farmers, processing plants, and government policy makers to alleviate aflatoxin contamination issues in the peanut production chain.

Food-borne and water-borne diseases under climate change in low- and middle-income countries: Further efforts needed for reducing environmental health exposure risks

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Food- and water-borne diseases (FWBD) are a major cause of mortality and morbidity.

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Africa counts 91 million people falling ill and 137,000 dying per year by FWBD.

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Climate change could increase FWBD through bad water, sanitation and hygiene (WASH).

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Floods’ vulnerability maps of drinking water systems are important for prevention.

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Appropriate WASH interventions can significantly contribute in reducing FWBD under climate change.

This paper provides a view of the major facts and figures related to infectious diseases with a focus on food-borne and water-borne diseases and their link with environmental factors and climate change. The global burden of food-borne diseases for 31 selected hazards was estimated by the World Health Organization at 33 million disability-adjusted life years (DALYs) in 2010 with 40% of this burden concentrated among children under 5 years of age. The highest burden per population of food-borne diseases is found in Africa, followed by Southeast Asia and the Eastern Mediterranean sub-regions. Unsafe water used for the cleaning and processing of food is a key risk factors contributing to food-borne diseases. The role of quality and quantity of water to the general burden of infectious diseases deserves attention, particularly in low- and middle-income countries, as its effects go beyond the food chain. Water-related infectious diseases are a major cause of mortality and morbidity worldwide, and climate change effects will exacerbate the challenges for the public health sector for both food-borne and water-borne diseases. Selected case studies from Africa and Asia show that (i) climate change extreme events, such as floods, may exacerbate the risks for infectious diseases spreading through water systems, and (ii) improvements related to drinking water, sanitation and hygiene could result in a significant reduction of intestinal parasitic infections among school-aged children. There is a need to better anticipate the impacts of climate change on infectious diseases and fostering multi-stakeholder engagement and multi-sectoral collaborations for integrated interventions at schools, community and household levels. The paper calls for giving priority to improving the environmental conditions affecting food-borne and water-borne infectious diseases under climate change.

Global burden of intellectual disability resulting from dietary exposure to lead, 2015

Lead is a ubiquitous dietary contaminant that occurs in food because of natural and anthropogenic sources and pathways of exposure. Lead adversely affects a number of tissues and organ systems and the severity of effect on each is dependent on the level and duration of exposure. The most sensitive and notable effects are those that occur on the nervous system. This is particularly the case in the exposure to the fetus, infant and child. Infants and children generally have higher lead exposures on a body weight basis. While lead exposure can come from many sources, a major source of exposure for at least some individuals comes from food. Estimates for the impact of dietary lead on IQ were developed from published total diet studies. While most of these were designed to characterize intake of chemical contaminants on a national basis, some sampled market baskets from a single city. To develop global estimates, default ranges were created for countries with no data which encompassed the values encountered elsewhere. Blood lead levels and IQ decrements were estimated using functions previously developed by the WHO Joint Expert Committee for Food Additives. Since both the exposure and dose response components were variable and uncertain, a two dimensional Monte-Carlo simulation was used to develop the estimates for the impact of dietary lead on IQ. In addition to estimating blood lead and IQ decrements attributable to dietary lead from those countries with published market basket data, simulations were also run for WHO regions that sampled in the variability dimension based on the population size of the individual countries in each region. Dietary exposure to lead occurs throughout the world. The global average IQ decrement attributable to dietary lead was 1.1. The total number of Disability-Adjusted Life Years (DALYs) arising from those IQ decrements were estimated to be 5.2 million DALYs, with an uncertainty range of 0-31 million DALYs. Significant uncertainties regarding exposure and dose-response relationships, however, warrant continued investigation.

Exposure Assessment and Risk Characterization of Aflatoxin M1 Intake through Consumption of Milk and Yoghurt by Student Population in Serbia and Greece

The objective of this research was to perform an exposure assessment of aflatoxin M1 (AFM1) intake through the consumption of milk and yoghurt by the student population in Serbia and Greece. A food consumption survey of milk and yoghurt was performed during the first half of 2018 in the two countries with at least 500 interviewees (aged between 18 and 27 years) per country, covering their dietary habits and body weight based on one-day and seven-day recall methods. Values for the concentration of AFM1 were extracted from published research. Finally, a Monte Carlo analysis of 100,000 iterations was performed to estimate the intake of AFM1 from the consumption of the two dairy products. Results revealed that the estimated average exposure of students to AFM1 was in the range of 1.238⁻2.674 ng kg^-1 bw day^-1 for Serbia, and 0.350⁻0.499 ng kg^-1 bw day^-1 for Greece, depending on the dietary recall method employed. High estimations for hepatocellular carcinoma (HCC) cases/year/10⁵ individuals, depending on the prevalence of Hepatitis B virus surface antigen positive individuals (HBsAg+), were 0.0036⁻0.0047 and 0.0007⁻0.0009 for Serbia and Greece, respectively. Presented Margin of Exposure (MOE) and Hazard Index (HI) values indicate increased risk from exposure to AFM1, particularly in Serbia.

Risk associated with the intake of aflatoxin M1 from milk in Iran

Aflatoxin M1 is an oxidative metabolite of aflatoxin B1 formed in liver and excreted into milk, urine and faeces of dairy cattle and other mammalian species. The International Agency for Research on Cancer classified aflatoxin M1 in Group 2B because of its potential to get bioactivated to a mutagen analogous to aflatoxin B1. Risk assessments are undertaken to guide food regulators and scientists in risk management processes, such as the legislative levels or guideline targets for mycotoxins in food supplies. Using existing international resources for hazard data and local exposure data, and based on cancer potency as the endpoint, the risk of exposure to aflatoxin M1 in milk for the Iranian population was calculated considering various scenarios. During 2014-2015, 518 samples were collected from the market and tested for aflatoxin M1 contamination by HPLC-FLD. The most probable scenarios calculated as mean occurrence multiplied by the mean consumption in consumers of milk, and for maximum level allowed for aflatoxin M1 in milk with 99 percentiles of milk consumption showed the risk of 0.08 and 0.72 additional liver cancer cases per year for the Iranian population, respectively. Thus, our study reveals a low risk and that the current maximum limit of 100 ng/l for aflatoxin M1 in milk, heat treated milk and flavoured milk is sustainable.

[Research in Motor Neuron Diseases Caused by Natural Substances: Focus on Pathological Mechanisms of Neurolathyrism]

Diseases of the motor-conducting system that cause moving disability affect socio-economic activity as well as human dignity. Neurolathyrism, konzo, and amyotrophic lateral sclerosis-parkinsonism-dementia complex (ALS-PDC) have attracted researchers to study the pathology of motor neuron (MN) diseases such as ALS. I have been studying neurolathyrism, which is caused by overconsumption of a legume grass pea (Lathyrys sativus L.). Among people who consume the legume as a food staple, many developed life-long paraparesis in their legs. β-N-oxalyl-l-α,β- diaminopropionic (l-β-ODAP; BOAA), contained in this plant, is a neurotoxic analog of l-glutamic acid. We have clarified that in addition to the causal involvement of α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) type glutamatergic receptor in MN death, a toxic role of group I metabotropic glutamate receptors as well as transient receptor potential channels were involved in the MN insult by l-β-ODAP using primary MN culture. We have also established a neurolathyrism rat model by repeated, peripheral l-β-ODAP treatment to newborn rats under mild stress. Rats showing hind-leg paraparesis with an incidence rate of around 25% were useful to study the in vivo pathology of MN disease. MNs of these rats were greatly decreased at their lumbo/sacral segments at various ages. Intra-parenchymal hemorrhage was consistently observed in paraparetic rats but not in cripple-free, treated rats. MN were depleted even at an acute period around bleeding spots, suggesting catastrophic neuro-vascular-glial interaction in this MN disease. Summaries of konzo and ALS-PDCs studies are also introduced.