Society For Risk Analysis Annual Meeting 2013

Session Schedule & Abstracts


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Common abbreviations

M2-E
Symposium: World cafe, Literally: Global Burden of Disease Caused by Foodborne Toxins

Room: Key Ballroom 5   10:30 AM- 12:00 PM

Chair(s): Felicia Wu   fwu@msu.edu



M2-E.1  10:30  Foodborne epidemiology reference group: Chemical and toxins task force. Gibb HJ*; Tetra Tech Sciences   herman.gibb@tetratech.com

Abstract: In 2006, the World Health Organization (WHO) launched the Foodborne Epidemiology Reference Group (FERG). The purpose of the FERG is to provide an estimate of the global burden of disease from foodborne viruses, bacteria, parasites, chemicals and toxins. To accomplish this work, the FERG was divided into several task forces. These task forces initially included the Enteric Task Force (viruses and bacteria), the Parasitic Task Force, and the Chemicals and Toxins Task Force. The Source Attribution, Country Studies, and Computational Task Forces were subsequently added. The presentations at this symposium relate to the work of the Chemicals and Toxins Task Force (CTTF). The work of the CTTF has been a combination of contracted efforts by WHO to international experts and of in-kind contributions. The Chemicals and Toxins Task Force at its initial meeting discussed and evaluated criteria to prioritize the chemicals and toxins on which to base its global estimates. The chemicals and toxins that were eventually selected are aflatoxin, peanut allergen, dioxin, cyanide in cassava, methyl mercury, arsenic, lead, and cadmium. Age-specific estimates of disease incidence resulting from exposure to these foodborne chemicals or toxins have been developed or are being developed. These estimates of incidence and case-fatality rates for the disease will be used by WHO to make estimates of the Disability Adjusted Life Years (DALYs). The DALY estimates are expected to be published by WHO in 2014.

M2-E.2  10:50  Lead: Global burden of disease. Carrington C*; U.S. Food and Drug Administration   Clark.Carrington@fda.hhs.gov

Abstract: At higher doses, lead has been known to result in many toxic effects, including hemolytic anemia, peripheral and central nervous system toxicity, renal failure from impaired proximal tubule function, and reproductive toxicity. At lower doses, the effects of greatest concern are impaired neurobehavioral development in children and elevated hypertension and associated cardiovascular diseases in adults. Dose-response relationships for the effects of lead are typically characterized using blood lead as a biomarker. While the diet may be an important source of exposure to lead, sources such soil, dust, and drinking water are important as well. Dietary surveys designed to provide statistically representative estimates of dietary lead exposure in adults and/or children have been conducted in many countries, outside of the Europe, North America and the Pacific Rim, information on dietary exposure to lead is very limited. Based on the data compiled from the available literature, national mean population average daily dietary intakes of lead in children in different countries range from about 5 to 50 µg per person. Adult lead intakes are approximately 50% higher. Based on dose-response analyses that integrated results from multiple epidemiological studies, IQ decrements attributable to lead were estimated for children, while increments in systolic blood pressure (SBP) attributable to lead were estimated for adults. Globally, a modest decrement of about 1.3 IQ points may be attributed to dietary exposure to lead. However, lower and higher average decrements were estimated for some countries (range 0.13 to 2.7 IQ points), and effects in individuals within a region may encompass an even larger range. Projected impacts on SBP were generally very small, which maximum estimated increments of less than 0.2 mm Hg. Estimated increments in relative risk attributable to dietary lead exposure in cardiovascular diseases ranged from about 0.01 to 0.1%.

M2-E.3  11:10  Cadmium: Parameters for the Estimation of Global Burden of Disease. Zang Y*, Carrington CD; US FDA-CFSAN   Janet.Zang@fda.hhs.gov

Abstract: Cadmium is a toxic element widely distributed in foods. World Health Organization (WHO)’s Foodborne Disease Epidemiology Reference Group (FERG) has listed cadmium as one of the priority chemical hazards. To calculate cadmium-attributable disability-adjusted life year (DALY), it is essential to estimate the incidence of cadmium-related diseases around the world. Based on a thorough weight of evidence analysis and the disability weight information from the WHO Global Burden of Disease report (GBD 2010), two cadmium-associated disease endpoints were selected: 1) stage 4-5 chronic renal disease (CKD), caused by the reduction of glomerular filtration rate (GFR); and 2) fracture, caused by the reduction of bone-mass density (BMD). Since cadmium-attributable disease rates are not available, an exposure-based method was used to indirectly estimate the incidence rates. First, cadmium exposures in different global regions were collected from the published urinary cadmium (U-Cd) levels as well as from the WHO GEMS/Food database. Based on the dose-response relationships between cadmium exposure and GFR or BMD, the magnitude of reduction in GFR or BMD were calculated for different global regions based on their exposure data. Next, the incidence rate of cadmium-attributable CKD stage 4-5 can be derived by calculating the distributional shift of GFR into <30 mL/min/1.73 m2 due to cadmium-related GFR reduction. The incidence rate of cadmium-attributable fracture can be derived by calculating the extra risk of fracture due to cadmium-related BMD reduction. The resulting region-specific incidence rates will be incorporated into a WHO/FERG disease model to calculate the global burden of disease caused by cadmium exposure.

M2-E.4  11:30  Aflatoxin and cyanide: Global burden of disease. Wu F*, Liu Y; Michigan State University   fwu@msu.edu

Abstract: Aflatoxin is a toxin produced by certain Aspergillus fungi that infect food crops, particularly corn, peanuts, and tree nuts (pistachios, hazelnuts, almonds, walnuts, etc.). It is the most potent naturally occurring human liver carcinogen known, and is particularly a danger in the parts of the world where corn and peanuts are dietary staples. We present our estimates of the global burden of human liver cancer caused by aflatoxin, and discuss the potential role of aflatoxin exposure in causing childhood stunting. Finally, we give a brief discussion of cyanide in cassava, its adverse effects, and the populations most at risk worldwide.

M2-E.5  11:50  Peanut allergen: Global Burden of Disease. Bolger PM*, Ezendam J; Exponent, Washington DC; National Institute for Public Health and the Environment, Bilthoven, The Netherlands   pmbolger33@gmail.com

Abstract: A systematic literature review of peanut allergy was performed within the framework of the Foodborne Epidemiology Reference Group (FERG) of the World Health Organization (WHO) that is tasked with estimating the global burden of disease (BOD) for food borne diseases. The symptoms of peanut allergy vary from mild to severe, from swollen lips, shortness of breath to anaphylactic shock, which is potentially fatal. The most important parameters were found to be the number of people who suffer from a peanut allergy and the impact it has on their quality of life. BOD is a measure that quantifies the consequences of a disease by combining the loss of health from impaired quality of life and premature mortality. The prevalence of peanut allergy in Western countries is 0.5 to 1.5 percent of the population; however, there is a lack of prevalence data from developing countries. Geographical differences in prevalence appear to exist, since peanut allergy is uncommon in Turkey and Israel. Symptoms of the allergy are induced when individuals with a peanut allergy eat products that contain peanuts. Although they can be severe, the symptoms are usually short-lasting. Consequently, they will not have a large impact on BOD. The number of people who die due to a peanut allergy is low which also has a limited impact on BOD. The quality of life of people with a peanut allergy can be significantly impaired, primarily because they are anxious about accidentally eating products that contain peanut. This impairment of quality of life is important in deriving an estimate of the BOD.



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