Burden of Disease of Dietary Exposure to Four Chemical Contaminants in Denmark, 2019

Sofie Theresa Thomsen,Malene Outzen,Freja A Fabricius,Sisse Fagt,Brecht Devleesschauwer,Sara M Pires,Hernan G Redondo,Max Hansen,Lea S Jakobsen

doi:10.1007/s12403-022-00461-9

Sofie Theresa Thomsen, Malene Outzen + Show 7 more

Open Access

https://doi.org/10.1007/s12403-022-00461-9

Copy DOI

Abstract

Exposure to chemical contaminants found in foods has been associated with diverse adverse health effects. The aim of this study was to estimate the burden of disease associated with dietary exposure to four chemicals in Denmark in 2019: lead (Pb), cadmium (Cd), methylmercury (MeHg), and inorganic arsenic (i-As). We collected national food consumption and chemical food monitoring data from Danish databases, dose-response and severity data from the scientific literature, and disease incidence and population numbers from national statistics. We adopted a risk assessment approach to estimate disease burden, quantifying incidence, mortality, and Disability-Adjusted Life Years (DALYs) attributable to dietary exposure to the chemicals. In all models, we propagated uncertainty around the input parameters through the calculations using Monte Carlo simulation. We estimated that, among these chemicals, Pb and MeHg were responsible for the highest disease burden. MeHg led to the loss of nearly 600 healthy life years, or approximately 10 DALYs per 100,000 inhabitants. Dietary exposure to Pb was estimated to cause 383 to 1,261 DALYs, corresponding to 6.6 (lower bound) to 22 (upper bound) DALYs/100,000 per year. The foods contributing most to disease burden were fish (MeHg) and sweets, fruit, and bread and cereals (Pb). The burden attributed to dietary exposure to i-As (5 DALYs) and Cd (0.04 DALY) was substantially lower. Interpretation of estimates needs to consider all underlying uncertainties, linked with data and knowledge gaps. These estimates are useful supplements to traditional risk assessment to guide food safety interventions and inform dietary guidelines for different population groups.

Highlights

Foods may be contaminated with chemicals of natural origin, or resulting from primary production, processing, packaging, or environmental contamination
The uncertainty intervals of the disease burden attributed to exposure to Pb and MeHg overlapped, and interpretations of the ranking of these two chemicals on the basis of estimated Disability-Adjusted Life Years (DALYs) should be made with care
Since Cd and I-As combined led to approximately 6 DALY, our results suggest that interventions in the foods contributing to the dietary exposure to Pb and MeHg are of higher priority to reduce disease burden

Summary

Introduction

Foods may be contaminated with chemicals of natural origin, or resulting from primary production, processing, packaging, or environmental contamination. For many food-associated chemicals, thresholds of maximum exposure levels are established and enforced based on available evidence, data and risk assessments to control the exposure in populations (European Commission 2006). Estimates of the actual public health impact of dietary exposure to chemicals in the population are lacking, as are rankings of the chemical hazards causing the highest burden of disease and of the foods contributing most to this burden. These are useful to inform national-level public health strategies to prevent foodborne exposure and disease

Objectives

Methods

Results

Discussion

Conclusion