Ensuring Safe Food for Infants: The Importance of an Integrated Approach to Monitor and Reduce the Risks of Biological, Chemical, and Physical Hazards

Abstract

Despite a decrease in biological, chemical, and physical hazards in infant food owing to national and international control programs, the risks of hazards in infant food remain a global concern.1Rather I.A. Koh W.Y. Paek W.K. Lim J. The sources of chemical contaminants in food and their health implications.Front Pharmacol. 2017; 8: 830Crossref PubMed Scopus (99) Google Scholar Raising consumer awareness on the consequences of unhealthy food consumption, and a growth of consciousness by the food industry of the importance of ensuring protection against contaminants in commercially available products, have limited the risk of food contaminants.2Pettoello-Mantovani M. Ehrich J. Sacco M. Ferrara P. Giardino I. Pop T.L. Food insecurity and children's rights to adequate nutrition in Europe.J Pediatr. 2018; 198: 329-330.e1Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar,3European CommissionFood safety: overview.https://ec.europa.eu/food/overview_enDate accessed: October 27, 2020Google Scholar However, interventions applied across the food supply chain to inspect the presence of food contaminants and help to ensure a sustainable supply of nutritious safe food, are insufficient to provide an extensive and comprehensive protection.3European CommissionFood safety: overview.https://ec.europa.eu/food/overview_enDate accessed: October 27, 2020Google Scholar Infant food safety in the economically advanced Western world is currently monitored by increasingly strict legal regulations; however, some countries still use banned substances in industrial food production owing to their poor economy and insufficient regulation.4European UnionEUR-Lex.Food safety.https://eur-lex.europa.eu/summary/chapter/food_safety.html?root_default=SUM_1_CODED%3D30&locale=enDate accessed: October 27, 2020Google Scholar The export and import exchange of commercial, often low-cost, infant food products, may raise serious risks for children's health despite the presence of standard control procedures and techniques, which may be insufficient or inadequate to detect a large variety of contaminants in food products.3European CommissionFood safety: overview.https://ec.europa.eu/food/overview_enDate accessed: October 27, 2020Google Scholar,4European UnionEUR-Lex.Food safety.https://eur-lex.europa.eu/summary/chapter/food_safety.html?root_default=SUM_1_CODED%3D30&locale=enDate accessed: October 27, 2020Google Scholar This commentary aims to increase awareness of the necessity to further decrease the risks of hazards of different nature in infants and children's food and to emphasize the importance of developing and constantly update integrated and effective systems for monitoring the presence of contaminants in infant food.5Ehrich J.H. Kerbl R. Pettoello-Mantovani M. Lenton S. Opening the debate on pediatric subspecialties and specialist centers: opportunities for better care or risks of care fragmentation?.J Pediatr. 2015; 167: 1177-1178.e2Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar Food safety and protection of consumer's health are a major concern for many governments. Policies aim to prevent, mitigate, or eliminate risks at different stages of the food chain, while maintaining, providing, and supplying high-quality food to meet consumer demands.2Pettoello-Mantovani M. Ehrich J. Sacco M. Ferrara P. Giardino I. Pop T.L. Food insecurity and children's rights to adequate nutrition in Europe.J Pediatr. 2018; 198: 329-330.e1Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar,4European UnionEUR-Lex.Food safety.https://eur-lex.europa.eu/summary/chapter/food_safety.html?root_default=SUM_1_CODED%3D30&locale=enDate accessed: October 27, 2020Google Scholar Globalization involves trade liberalization, integration of production, and consumption and lifestyle patterns; this implies a widespread import, export, and distribution of a great variety of foodstuffs, including food for infants and children. Owing to increasing consumer demand for quality and transparency, larger scale food production, intensive food trade, and growing urbanization influencing production patterns of food, food safety has become a major priority in public health. Food safety and quality assurance involve trust, transparency, and harmonization of practices, which is a prerequisite for the development of efficient and reliable domestic and international trade. However, implementing efficient food safety control is a complex task owing to several factors, including the variety of products resulting from the diversity of raw materials, processing, packaging, and storage and to the different regulatory contexts and health surveillance systems between countries. Furthermore, the diversity and changes in consumer practices favor a constant evolution of products facilitated by agri-food innovations and advances in human health knowledge, which also contribute to the regulatory changes.6McIntosh E.D. Janda J. Ehrich J.H. Pettoello-Mantovani M. Somekh E. Vaccine hesitancy and refusal.J Pediatr. 2016; 175: 248-249.e1Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar Biological, chemical, or physical hazards may be introduced into the food supply at any time during harvesting, processing, transporting, preparing, storing, and serving food. Understanding the risks associated with each of these steps can significantly decrease the potential of foodborne illnesses. All can be avoided through an effective food safety management system. Biological hazard occurs when food becomes contaminated by micro-organisms. Many micro-organisms are beneficial; however, in the right conditions, some may cause a foodborne illness.7Hojsak I. Fabiano V. Pop T.L. Goulet O. Zuccotti G.V. Çokuğraş F.C. et al.Guidance on the use of probiotics in clinical practice in children with selected clinical conditions and in specific vulnerable groups.Acta Paediatr. 2018; 107: 927-937Crossref PubMed Scopus (46) Google Scholar Foodborne diseases can be caused by consuming food or water contaminated by pathogenic micro-organisms, which include bacteria and their toxins, fungi, viruses, and parasites.8Pettoello-Mantovani M. Nocerino A. Polonelli L. Morace G. Conti S. Di Martino L. et al.Hansenula anomala killer toxin induces secretion and severe acute injury in the rat intestine.Gastroenterology. 1995; 109: 1900-1906Abstract Full Text PDF PubMed Scopus (34) Google Scholar,9Pettoello Mantovani M. Guandalini S. Ecuba P. Corvino C. di Martino L. Lactose malabsorption in children with symptomatic Giardia lamblia infection: feasibility of yogurt supplementation.J Pediatr Gastroenterol Nutr. 1989; 9: 295-300Crossref PubMed Scopus (32) Google Scholar Food can be contaminated both at the source as raw material and during food processing, storage, and distribution. Infected individuals or carriers of pathogens and the environment, through food contact surfaces and facilities, can spread micro-organisms to raw or processed food. Food contaminants include environmental contaminants, food processing contaminants, unapproved adulterants, food additives, and migrants from packaging materials.10Silano M. Vincentini O. Luciani A. Felli C. Caserta S. Esposito S. et al.Early tissue transglutaminase-mediated response underlies K562(S)-cell gliadin-dependent agglutination.Pediatr Res. 2012; 71: 532-538Crossref PubMed Scopus (28) Google Scholar Typically, chemicals used for pest control or for cleaning and sanitizing food contact surfaces and food preparation equipment may contaminate food. Persistent organic pollutants are a common and dangerous group of chemical contaminants that persist in the environment, bioaccumulate through the food web, and pose a risk of causing adverse effects to human health and the environment (Table I; available at www.jpeds.com).1Rather I.A. Koh W.Y. Paek W.K. Lim J. The sources of chemical contaminants in food and their health implications.Front Pharmacol. 2017; 8: 830Crossref PubMed Scopus (99) Google Scholar A variety of extraneous materials in foodstuffs are hazardous to individuals, causing illness or injury. Foreign items can be unintentionally introduced to food products, or naturally occurring objects may fail to be separated along a food processing line and excluded from consumption (Table II; available at www.jpeds.com). Materials normally absent in food products include metal fragments in ground meat, bone chips, pieces of product packaging, stones, glass or wood fragments, insects or other filth, and personal items.11Raia P.K. Leeb S.S. Zhangc M. Tsangd Y.F. Kime K.H. Heavy metals in food crops: health risks, fate, mechanisms, and management.Environ Int. 2019; 125: 365-385Crossref PubMed Scopus (479) Google Scholar Furthermore, individuals may be exposed to metals and metal compounds as environmental pollutants from industrial or other human activities.11Raia P.K. Leeb S.S. Zhangc M. Tsangd Y.F. Kime K.H. Heavy metals in food crops: health risks, fate, mechanisms, and management.Environ Int. 2019; 125: 365-385Crossref PubMed Scopus (479) Google Scholar Heavy metals such as lead, arsenic, mercury, or cadmium, may be considered a potential contaminant. These substances are of concern owing to their toxicity, particularly in the case of a long-term intake, because they may accumulate in the body and cause organ damage, especially in susceptible groups, including young children.11Raia P.K. Leeb S.S. Zhangc M. Tsangd Y.F. Kime K.H. Heavy metals in food crops: health risks, fate, mechanisms, and management.Environ Int. 2019; 125: 365-385Crossref PubMed Scopus (479) Google Scholar Improving risk assessment and monitoring of food safety, including the use of big data, is important. Effective control programs are required to plan integrated approaches along the entire food chain for detecting, assessing, and mitigating relevant pathogens and other contaminant hazards.12Motarjemi Y. Lelieveld H. Food safety management. A practical guide for the food industry. Academic Press, New York (NY)2014Google Scholar That implies the development of efficient food safety control systems, supported by reliable authentication and traceability approaches. Effective control systems should be implemented across the entire food chain, focusing on the combination of hazard monitoring and control options. To overcome the complexity and the diversity of food chains, tools, databases, procedures, and operating models, need to be integrated in a user-friendly and upgradable decision support system for identification, detection, ranking, and control of hazards and risk assessment. A reliable and effective integrated approach is based on the involvement and contribution of different disciplines competent but not limited to risk assessment, food technology, predictive toxicology, residue chemistry, predictive microbiology, child health, data science, and knowledge engineering. The integrated approaches should collect and combine pertinent knowledge and data from the entire food chain, taking into account the diversity of biological, chemical, and physical hazards. Finally, the different criteria contributing to risk ranking should consider and include the public health impact, community perception of the risks, diversity of local cultures, and a rigorous selection of the different sources of information.12Motarjemi Y. Lelieveld H. Food safety management. A practical guide for the food industry. Academic Press, New York (NY)2014Google Scholar In 2020, the European Paediatric Association, Union of National European Paediatric Societies and Associations working group on nutrition joined forces with a consortium of 19 European research centers, coordinated by the French National Research Institute for Agriculture, Food and the Environment, to develop a research program called safe food for infants, supported by the European Union (EU).13Republique FrancaiseINRAE, Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Evironnement. Paris, France.https://www.inrae.fr/Date accessed: October 23, 2020Google Scholar,14European CommissionEU Research results. Taking microbial and chemical hazards off your baby’s menu.https://cordis.europa.eu/programme/id/H2020_SFS-37-2019Date accessed: October 23, 2020Google Scholar This EU-funded project aims to improve risk-based food safety management of biohazards. To achieve these goals, the consortium is developing procedures to enhance top-down and bottom-up hazard control by combining management options within the frame of the EU Horizon 2020 research and innovation program.14European CommissionEU Research results. Taking microbial and chemical hazards off your baby’s menu.https://cordis.europa.eu/programme/id/H2020_SFS-37-2019Date accessed: October 23, 2020Google Scholar In view of the food safety challenges in the monitoring and detecting of contamination in food supplies, whether by accident or fraud, the consortium is developing decision support systems to enhance safety controls along the food chain. Focusing on the potential risks raised by the major international channels of infant food trade, the program is also establishing educational and knowledge transfer activities to foster harmonization of good practices. Global collaboration in the area of food safety and control is of great strategic importance, and the EU program includes cooperation with public health authorities of governments around the world.15Corsello G. Ferrara P. Chiamenti G. Nigri L. Campanozzi A. Pettoello-Mantovani M. The child health care system in Italy.J Pediatr. 2016; 177S: S116-S126Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar Owing to increasing populations and global threats, the integrity and safety of global food chains are at risk. In many countries, simply getting enough to eat can be an issue, with poor quality food often contaminated with hazardous agents, whereas in developed countries the pressure to deliver cheap, affordable food may affect quality and safety.16Morano M. Rutigliano I. Rago A. Pettoello-Mantovani M. Campanozzi A. A multicomponent, school-initiated obesity intervention to promote healthy lifestyles in children.Nutrition. 2016; 32: 1075-1080Crossref PubMed Scopus (27) Google Scholar