Risk-Benefit Assessment of Cereal-Based Foods Consumed by Portuguese Children Aged 6 to 36 Months—A Case Study under the RiskBenefit4EU Project
Abstract
:1. Introduction
2. Materials and Methods
2.1. Selection of Relevant Components and Health Effects
2.2. Investigated Consumption Scenarios
- 100% BC scenario, simulating that all infants consume only BC;
- 100% IC scenario, simulating that all infants consume only IC;
- Optimal BC scenario, simulating that all infants consume only BC at an optimal composition; and
- Worst IC, simulating that all infants consume only IC with the worst composition.
2.3. Data Used in the Model
2.4. Exposure Assessment, DALY Calculation and Integration of Risks and Benefits
2.4.1. Total Fiber, Sodium and Free Sugars
2.4.2. Aflatoxins
2.4.3. Bacillus Cereus
2.4.4. Integration of DALY
3. Results
3.1. Intake and Exposure Assessment
3.2. Incidence and DALYs
3.3. Comparison to DRVs
4. Discussion
4.1. Consumption of Breakfast Cereals Instead of Infant Cereals Could Result in a Gain of Healthy-Life Years
4.2. Sources of Uncertainty
- Selection of relevant food components and associated health effects: Despite an extensive literature search being performed to support decisions in the selection of food components and associated health effects, other beneficial (e.g., micronutrients used for fortification or saturated fats) or hazardous (e.g., other mycotoxins such as deoxynivalenol and zearalenone, heavy metals, furans, acrylamide) components could be present in BC and IC; also, food allergies are relevant health outcomes when investigating the health impact of infant and toddler foods, but have been disregarded in this assessment.
- Data used in the exposure assessment: Concentration of B. cereus and aflatoxins in BC and IC were based on reported levels of analyzed samples or extracted from the Portuguese Food Composition Table (sodium, free sugars and fiber). These data are necessarily affected by uncertainty that impacted (over and/or underestimated) the exposure assessment.
- Risk of CVD and T2D later in life based on exposure that occurred in the first years of life: Due to the restrictions of the data, CVD and T2D cases were estimated, taking into account the available dose–response data. However, it was assumed that exposure occurring in the first years of life will contribute to and determine cases later in life.
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A. Search Strategy
Appendix B. Fiber Intake and Risk Ratio Estimates
References
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Food Components | Health Effects | Type of Analysis | |
---|---|---|---|
Nutrition | Total fiber | Type 2 Diabetes mellitus Cardiovascular diseases | Quantitative a |
Sodium | Type 2 diabetes | Semi-quantitative b | |
Free sugars | Cardiovascular disease Cancer (different organs) | ||
Toxicology | Aflatoxins (AFB1) c | Hepatocellular carcinoma | Quantitative a |
Microbiology | Bacillus cereus | Gastrointestinal disease | Quantitative a |
Fiber (g/100 kcal) | Sodium (mg/100 kcal) | Free Sugar (g/100 kcal) | |
---|---|---|---|
Best BC | 3.9 | 1.4 | 0 |
Worst IC | 0.2 | 51.4 | 4.2 |
Dose–Response (Cases/100,000/year/ng/kg AFT bw/day) | Incidence 2 (Cases/100 k) (Mean, 95% CI) | Risk Ratios (Mean, 95% CI) | DALY Rate 2 (DALY/100 k) (Mean, 95% CI) | |
---|---|---|---|---|
Hepatocellular carcinoma (HCC) | 0.01 3 | NA | NA | 9.96 |
(7.77–12.61) | ||||
Cardiovascular disease (CVD) | NA | 25.07 | 0.78 1 | 60.78 |
(21.36–29.12) | (0.68–0.90) | (49.67–73.44) | ||
Diabetes mellitus 2 (DM2) | NA | 168.07 | 0.85 1 | 22.4 |
(125.70–215.47) | (0.82–0.89) | (12.71–34.47) |
Reference | 100% BC | 100% IC | Best BC | Worst IC | |
---|---|---|---|---|---|
BC (g/day) | 0.0 (0.0–20.8) | 13.4 (0.0–51.1) | - | 14.5 (0.0–55.5) | - |
IC (g/day) | 8.7 (0.0–42.7) | - | 12.5 (0.0–50.1) | - | 13.7 (0.0–52.3) |
Reference | 100% BC | 100% IC | Best BC | Worst IC | ||
---|---|---|---|---|---|---|
Fiber (g/day) | Mean | 9.3 | 9.5 | 9.2 | 11.3 | 8.9 |
Median | 9.0 | 9.2 | 9.0 | 11.0 | 8.7 | |
(P25–P75) | (7.2–11.1) | (7.3–11.4) | (7.1–11.0) | (8.8–13.5) | (6.8–10.7) | |
Sodium (g/day) | Mean | 1.17 | 1.18 | 1.16 | 1.15 | 1.18 |
Median | 1.15 | 1.17 | 1.14 | 1.13 | 1.16 | |
(P25–P75) | (0.79–1.50) | (0.80–1.51) | (0.79–1.49) | (0.77–1.47) | (0.80–1.51) | |
Free sugars (g/day) | Mean | 19.5 | 20.0 | 19.4 | 16.3 | 19.0 |
Median | 17.8 | 18.4 | 17.7 | 14.2 | 17.4 | |
(P25–P75) | (11.8–25.2) | (12.4–25.8) | (11.8–25.1) | (8.8–21.5) | (11.6–24.6) | |
Aflatoxins (ng/kg bw/day) | Mean | 0.065 | 0.073 | 0.065 | 0.052 | 0.090 |
Median | 0.049 | 0.054 | 0.047 | 0.038 | 0.066 | |
(P25–P75) | (0.0–0.95) | (0.0–0.109) | (0.0–0.094) | (0.0–0.078) | (0.0–0.136) | |
Bacillus cereus (log CFU/day) | 2.5 | 2.1 | 2.6 | <0 * | 3.3 |
100% BC | 100% IC | Best BC | Worst IC | |
---|---|---|---|---|
DM2 (fiber) | ||||
Number of cases/100,000/year * (95% CI) | −0.714 | 0.211 | −6.618 | 1.272 |
(−0.998; −0.482) | (0.143; 0.295) | (−9.229; −4.489) | (0.858; 1.782) | |
CVD (fiber) | ||||
Number of cases/100,000/year * (95% CI) | −0.160 | 0.047 | −1.469 | 0.288 |
(−0.253; −0.072) | (0.021; 0.074) | (−2.288; −0.668) | (0.127; 0.458) | |
HCC (AFB1) | ||||
Number of cases/100 k/year ** (95% CI) | 0.00073 | 0.00065 | 0.00077 | 0.00090 |
(0; 0.0027) | (0; 0.0023) | (0; 0.0028) | (0; 0.0033) | |
Number of Gastrointestinal disease (Bacillus cereus) | 0 | 0 | 0 | 0 |
100% BC | 100% IC | Best BC | Worst IC | |
---|---|---|---|---|
Sum of ΔDALY (per 100 k individuals) (95% CI) | −0.486 | 0.143 | −4.473 | 0.877 |
(−0.727;−0.262) | (0.078;0.213) | (−6.614;−2.449) | (0.471;1.317) |
DRV | Reference | 100% BC | 100% IC | Best BC | Worst IC |
---|---|---|---|---|---|
Sodium (UL) | |||||
1500 mg/day | 24.8% | 25.7% | 24.3% | 23.4% | 25.4% |
Free sugars (RI) | |||||
5% TEI | 80.0% | 81.9% | 79.8% | 69.7% | 79.0% |
10% TEI | 29.4% | 31.6% | 29.2% | 16.0% | 27.7% |
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Assunção, R.; Boué, G.; Alvito, P.; Brazão, R.; Carmona, P.; Carvalho, C.; Correia, D.; Fernandes, P.; Lopes, C.; Martins, C.; et al. Risk-Benefit Assessment of Cereal-Based Foods Consumed by Portuguese Children Aged 6 to 36 Months—A Case Study under the RiskBenefit4EU Project. Nutrients 2021, 13, 3127. https://doi.org/10.3390/nu13093127
Assunção R, Boué G, Alvito P, Brazão R, Carmona P, Carvalho C, Correia D, Fernandes P, Lopes C, Martins C, et al. Risk-Benefit Assessment of Cereal-Based Foods Consumed by Portuguese Children Aged 6 to 36 Months—A Case Study under the RiskBenefit4EU Project. Nutrients. 2021; 13(9):3127. https://doi.org/10.3390/nu13093127
Chicago/Turabian StyleAssunção, Ricardo, Géraldine Boué, Paula Alvito, Roberto Brazão, Paulo Carmona, Catarina Carvalho, Daniela Correia, Paulo Fernandes, Carla Lopes, Carla Martins, and et al. 2021. "Risk-Benefit Assessment of Cereal-Based Foods Consumed by Portuguese Children Aged 6 to 36 Months—A Case Study under the RiskBenefit4EU Project" Nutrients 13, no. 9: 3127. https://doi.org/10.3390/nu13093127