Prenatal dietary exposure to mixtures of chemicals is associated with allergy or respiratory diseases in children in the ELFE nationwide cohort.

INTRODUCTION: Prenatal exposure to environmental chemicals may be associated with allergies later in life. We aimed to examine the association between prenatal dietary exposure to mixtures of chemicals and allergic or respiratory diseases up to age 5.5 y. METHODS: We included 11,638 mother-child pairs from the French "Étude Longitudinale Française depuis l'Enfance" (ELFE) cohort. Maternal dietary exposure during pregnancy to eight mixtures of chemicals was previously assessed. Allergic and respiratory diseases (eczema, food allergy, wheezing and asthma) were reported by parents between birth and age 5.5 years. Associations were evaluated with adjusted logistic regressions. Results are expressed as odds ratio (OR[95%CI]) for a variation of one SD increase in mixture pattern. RESULTS: Maternal dietary exposure to a mixture composed mainly of trace elements, furans and polycyclic aromatic hydrocarbons (PAHs) was positively associated with the risk of eczema (1.10 [1.05; 1.15]), this association was consistent across sensitivity analyses. Dietary exposure to one mixture of pesticides was positively associated with the risk of food allergy (1.10 [1.02; 1.18]), whereas the exposure to another mixture of pesticides was positively but slightly related to the risk of wheezing (1.05 [1.01; 1.08]). This last association was not found in all sensitivity analyses. Dietary exposure to a mixture composed by perfluoroalkyl acids, PAHs and trace elements was negatively associated with the risk of asthma (0.89 [0.80; 0.99]), this association was consistent across sensitivity analyses, except the complete-case analysis. CONCLUSION: Whereas few individual chemicals were related to the risk of allergic and respiratory diseases, some consistent associations were found between prenatal dietary exposure to some mixtures of chemicals and the risk of allergic or respiratory diseases. The positive association between trace elements, furans and PAHs and the risk of eczema, and that between pesticides mixtures and food allergy need to be confirmed in other studies. Conversely, the negative association between perfluoroalkyl acids, PAHs and trace elements and the risk of asthma need to be further explored.

Impact of a modification of food regulation on cadmium exposure.

The 2nd French Total Diet Study demonstrated that 0.6% of adults and 14.9% of children exceeded the tolerable weekly intake set by EFSA. The overexposure of several consumers (adults and children) can be partially due to the high consumption of bread and dried bread products, of bivalve mollusks and of potatoes. Except for mollusks, these foods are the main contributors identified for the general population. On this basis, the French agency for food, environmental and occupational health and safety (ANSES) assessed whether a decrease of the European maximum limits in foodstuffs could significantly reduce the level of exposure of French consumers. Applying ML set at P90 of the main contributors would neither significantly reduce exposure levels to cadmium for the general population, nor the percentage of subjects exceeding the TWI. To reduce background consumer exposure to cadmium, actions to be taken include efforts on sources that are at the origin of the soil contamination and the efficacy of consumption recommendations.

Prenatal dietary exposure to chemicals and allergy or respiratory diseases in children in the EDEN mother-child cohort.

INTRODUCTION: Maternal exposure to food chemicals may increase the risk of allergy and respiratory disorders in offspring. We aimed to assess the association of prenatal dietary exposure to single chemicals and chemical mixtures with allergy or respiratory events reported before age 8 y in children. METHODS: We included 1428 mother-child pairs enrolled in the EDEN mother-child cohort. Maternal dietary exposure to 209 chemicals and eight associated mixtures was investigated. Allergic and respiratory diseases (wheezing, asthma, allergic rhinitis, eczema and food allergy) were reported by parents between birth and age 8 y. Associations with the studied outcomes were evaluated with three approaches based on adjusted logistic regression, estimating odds ratios (ORs) and 95 % confidence intervals (CIs). First, food chemicals were considered individually, with correction for multiple testing. Second, chemicals selected by elastic net regression were considered simultaneously in a multiple exposure model. Third, predefined mixtures were introduced in the same adjusted logistic regression. Results are expressed as odds ratio (OR[95 % CI]). RESULTS: Prenatal single exposure to 74 food chemicals was associated with higher risk of allergic rhinitis. Prenatal single exposure to 11 chemicals was associated with higher risk of wheezing. In the multi-exposure approach, risk of wheezing was associated with the pesticides diazinon and triadimenol, and polycyclic aromatic hydrocarbon 5-methylchrysene. Phytoestrogen resveratrol was negatively associated with lower risk of both wheezing and allergic rhinitis, and mycotoxin monoacetoxyscirpenol was negatively associated with risk of eczema. Finally, a chemical mixture composed mainly of trace elements, furans and polycyclic aromatic hydrocarbons, was associated with higher risk of allergic rhinitis (1.33 [1.02;1.73]). CONCLUSION: Prenatal dietary exposure to chemicals was associated with risk of allergic rhinitis or wheezing up to age 8 y. A few chemicals were associated with other allergic and respiratory diseases. Larger prospective studies are needed to confirm these findings.

A risk-benefit analysis approach to seafood intake to determine optimal consumption.

Seafood provides n-3 long-chain PUFA (n-3 LC-PUFA), vitamins and minerals, which are essential to maintain good health. Moreover, seafood is a source of contaminants such as methylmercury, arsenic and persistent organic pollutants that may affect health. The aim of the present study was to determine in what quantities seafood consumption would provide nutritional benefits, while minimising the risks linked to food contaminants. Seafood was grouped into clusters using a hierarchical cluster analysis. Those nutrients and contaminants were selected for which it is known that seafood is a major source. The risk-benefit analysis consisted in using an optimisation model with constraints to calculate optimum seafood cluster consumption levels. The goal was to optimise nutrient intakes as well as to limit contaminant exposure with the condition being to attain recommended nutritional intakes without exceeding tolerable upper intakes for contaminants and nutrients, while taking into account background intakes. An optimum consumption level was calculated for adults that minimises inorganic arsenic exposure and increases vitamin D intake in the general population. This consumption level guarantees that the consumer reaches the recommended intake for n-3 LC-PUFA, Se and I, while remaining below the tolerable upper intakes for methylmercury, Cd, dioxins, polychlorobiphenyls, Zn, Ca and Cu. This consumption level, which is approximately 200 g/week of certain fatty fish species and approximately 50 g/week of lean fish, molluscs and crustaceans, has to be considered in order to determine food consumption recommendations in a public health perspective.

Food and nutrient intakes of French frequent seafood consumers with regard to fish consumption recommendations: results from the CALIPSO study.

Besides providing n-3 fatty acids with nutritional and health benefits, seafood consumption may contribute to the reduction of nutrient prevalences of inadequacy. To evaluate the contributions of seafood and other food groups to nutrient intakes of frequent seafood consumers, food consumption was evaluated through an FFQ on 991 French men and women (18-81 years) consuming seafood at least twice a week. Intakes, prevalence of inadequacies, risks of upper limit excess and food contributions to intakes were assessed for thirty-three nutrients. Mean fat contributions to total energy intakes (38·3 and 39·0 % for men and women, respectively) met French recommendations, but mean carbohydrate intakes (40·9 and 39·7 %, respectively) were insufficient. Micronutrient inadequacies were lower than in the French general population, the highest being for vitamin C (41·3 and 40·1 % for men and women, respectively), vitamin E (35·0 and 35·3 % for men and women, respectively) and Mg (37·5 and 25·5 % for men and women, respectively). Upper safety limits (USL) were exceeded mostly for Zn (6·2 %), Ca (3·7 %), retinol (2·0 %) and Cu (0·9 %). Mean contributions of seafood to vitamin D, B12, I and Se intakes ranged 40-65 %. Molluscs and crustaceans significantly contributed to vitamin B12 (13·7 %), Cu (11·4 %), Fe (11·5 %), Zn (8·4 %) and I (6·1 %) intakes, and canned fish contributed to vitamin D intake (13·4 %). Besides fish, contributions of mollusc and crustacean consumption to nutrient intakes should be considered from a public health viewpoint. Consuming seafood at least twice a week induces moderate inadequacies and risks of exceeding USL for some micronutrients, whereas macronutrient intakes remained imbalanced.

Pb, Hg, Cd, As, Sb and Al levels in foodstuffs from the 2nd French total diet study.

In 2006, the French Food Safety Agency (AFSSA) conducted the second French total diet study (TDS) to estimate dietary exposures of main minerals and trace elements from 1319 samples of foods habitually consumed by the French population. The foodstuffs were analysed by ICP-MS after microwave-assisted digestion. Contamination data for lead, mercury, cadmium, arsenic, antimony and aluminium were reported and compared with results from the previous French total diet study. The results are comparable with those from the rest of Europe. "Fish and fish products" and "sweeteners, honey and confectionery" were the food groups showing the highest cumulated contents in Pb, Hg, Cd, As, Al and Sb. However, observed levels remained low and were generally well below the maximum levels set by the current European regulation for lead, cadmium and mercury.

Determination of 20 trace elements in fish and other seafood from the French market.

The levels of 20 essential or toxic trace elements in 159 fish, other seafood and seafood products on the French coastal market collected between January and April 2005 were measured by ICP-MS. The concentration ranges (mg/kg of fresh mass) for the elements determined were compared with previous studies. The contents of Co, Cu, Fe, Li, Mn, Se, Zn and Pb found in fish are close to or often lower than previous studies. For other seafood, comparison is difficult due to the lack of data on a more global scale. However, it should be noted that the contents of Ag were found considerably higher in this study.

Perspective: Modeling Healthy Eating Patterns for Food-Based Dietary Guidelines-Scientific Concepts, Methodological Processes, Limitations, and Lessons.

The relations between dietary features and human health are varied and complex. Health-related variables are many and they have intricate relations at different and interrelated nutritional levels: nutrients, food groups, and the complex overall pattern. Food-based dietary guidelines (FBDGs) are principally designed to synthesize this information to make it available to the public. Here, we describe the method used to establish healthy eating patterns (HEPs) for the latest French FBDGs, which consists of in-depth food pattern modeling using an enhanced optimization method that gathered all aspects of HEPs. We present the novelty of this food modeling approach for FBDGs, which aims to gather information related to nutrients, food contaminants, and epidemiological relations with long-term health, and to be combined with the objective of realistic dietary patterns that deviate minimally from the prevailing diet. We draw lessons from stepwise implementation of the method and discuss its strengths, limitations, and perspectives. In light of the modeled HEPs, we discuss the importance of food grouping; of accounting for dietary habits while not precluding modeled diets that can be realistic/acceptable; and of taking into account the exposure to food contaminants. We discuss the tolerance and flexibility to be applied to certain dietary reference values for nutrients and health-based guidance values for contaminants so that HEPs can ultimately be identified, and how account can be taken of varied health-related outcomes applied to food groups. Although the approach involves all the peculiar uncertainties of numerous optimization model parameters and input data, its merit is that it offers a rationalized approach to establishing HEPs with multiple constraints and competing objectives. It is also versatile because it is possible to operationalize further dimensions of dietary patterns to favor human and planetary health.

Infant total diet study in France: Exposure to substances migrating from food contact materials.

A total diet study (TDS) was conducted in France to assess the health risks related to the chemicals in food of non-breastfed children under three years of age (Infant TDS). For the first time, substances coming from food contact materials, such as bisphenol A (BPA), bisphenol A diglycidyl ether (BADGE) and its derivatives, some phthalates, and some ink photoinitiators, were targeted because of growing interest in these substances. Food samples were collected to be representative of the whole diet of non-breastfed children aged 1-36 months, and prepared as consumed prior to analysis. Dietary exposure was assessed for 705 representative children under three years of age. Generally, the substances from food contact materials were detected in few samples: 38% for BPA, 0% for BADGE and its derivatives, 0-35% for phthalates, 1.9% for benzophenone, and 0% for the other ink photoinitiators. Regarding exposure levels, the situation was deemed tolerable for BADGE and its hydrolysis products, di-isodecyl phthalate, dibutyl phthalate, butyl benzyl phthalate, bis(2-ethylhexyl) phthalate, and di-isononyl phthalate, benzophenone, and 4-methylbenzophenone. Only for BPA, the exposure levels of some children exceeded the lowest toxicological value established by the French Agency for Food, Environmental and Occupational Health & Safety at 0.083 µg.kg bw-1.d-1. The temporary tolerable daily intake of the European Food Safety Authority (EFSA), set at 4 µg.kg bw-1.d-1, was never exceeded. However, actual exposure to BPA was probably overestimated, as well as the associated risk, because the foods were sampled prior to the recent regulations banning BPA in food packaging. This study is the first worldwide to provide an estimate of infant food contamination levels and exposures of children under 3 years of age, based on a TDS approach. It therefore provides key data on the exposure of this particularly sensitive population to substances released from food contact materials, and presents useful data for studies evaluating exposure to mixtures or aggregated exposure.

Risk-benefit in food safety and nutrition - Outcome of the 2019 Parma Summer School.

Risk-benefit assessment is the comparison of the risk of a situation to its related benefits, i.e. a comparison of scenarios estimating the overall health impact. The risk-benefit analysis paradigm mirrors the classical risk analysis one: risk-benefit assessment goes hand-in-hand with risk-benefit management and risk-benefit communication. The various health effects associated with food consumption, together with the increasing demand for advice on healthy and safe diets, have led to the development of different research disciplines in food safety and nutrition. In this sense, there is a clear need for a holistic approach, including and comparing all of the relevant health risks and benefits. The risk-benefit assessment of foods is a valuable approach to estimate the overall impact of food on health. It aims to assess together the negative and positive health effects associated with food intake by integrating chemical and microbiological risk assessment with risk and benefit assessment in food safety and nutrition. The 2019 Parma Summer School on risk-benefit in food safety and nutrition had the objective was to provide an opportunity to learn from experts in the field of risk-benefit approach in food safety and nutrition, including theory, case studies, and communication of risk-benefit assessments plus identify challenges for the future. It was evident that whereas tools and approaches have been developed, more and more case studies have been performed which can form an inherent validation of the risk-benefit approach. Executed risk-benefit assessment case studies apply the steps and characteristics developed: a problem formulation (with at least 2 scenarios), a tiered approach until a decision can be made, one common currency to describe both beneficial and adverse effects (DALYs in most instances). It was concluded that risk-benefit assessment in food safety and nutrition is gaining more and more momentum, while also many challenges remain for the future. Risk-benefit is on the verge of really enrolling into the risk assessment and risk analysis paradigm. The interaction between risk-benefit assessors and risk-benefit managers is pivotal in this, as is the interaction with risk-benefit communicators.

Health risk assessment to dioxins, furans and PCBs in young children: The first French evaluation.

A total diet study (TDS) was conducted between 2010 and 2016 to characterize the health risk related to chemical residues in food of French not breastfed children under three years of age (infant TDS). Among the targeted substances, polychlorinated dibenzo-p-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs) and polychlorinated biphenyls (PCBs) have been characterized as they accumulate through the food chain, especially in lipid-rich food items, and because they have been associated with a number of adverse effects in humans. Food samples (n = 180) were collected to be representative of the dioxins and PCB exposure through the whole diet of non-breastfed children from 1 to 36 months old and prepared as consumed (including cooking) prior to analysis. Dietary exposure was then assessed for 705 representative children under 3 years of age based on their food consumptions recorded through a 3-consecutive-days record. Levels of PCDD/Fs and PCBs in infant food were lower than those observed in common food, leading to significant differences in exposure according to age groups. Mean exposures to PCDD/Fs ranged from 0.22 to 0.44 pg TEQWHO05.kg bw-1.d-1 (0.40-0.65 at the 90th percentile), depending on the age group and the hypothesis considered to manage left-censored data. Mean exposure to non-dioxin-like PCBs ranged from 0.87 ng kg bw-1.d-1 (1.55 at the 90th percentile) in the 1-4 months old children to 3.53 ng kg bw-1.d-1 (5.44 at the 90th percentile) in the 13-36 months old children. For dioxins and NDL-PCBs, the tolerable daily intake (TDI) was exceeded for some age groups, in particular for older ones. Therefore, appropriate management measures must continue for reducing exposure; it concerns mainly common milk in youngest children, ultra-fresh dairy products and fish. For PCBs, recommendations on fish consumption should be reminded. Moreover, toxicity studies focusing on mixtures of dioxin-like compounds should be encouraged in order to take into account effect of mixtures.

Dietary exposure to mycotoxins in the French infant total diet study.

The present study evaluated the exposure of children aged from one to 36 months to seven groups of mycotoxins, in the context of the infant French Total Diet Study (iTDS). Exposure was then compared to the health-based guidance values (HBGVs) for each mycotoxin. The value of the 90th percentile of exposure to nivalenol, patulin, fumonisins and zearalenone was less than 40% of the HBGV considered relevant for children. On the other hand, a risk could not be excluded for ochratoxin A and aflatoxins as exposure was close to the HBGV for ochratoxin A and the margin of exposure was much lower than the critical margin of 10,000 for aflatoxins. The HBGVs for toxins T2 and HT2, and for deoxynivalenol (DON) and its acetylated compounds were exceeded. Five percent to 10% of the children aged 5-12 months exceeded the HBGV considering the lower bound hypothesis for toxins T2 and HT2 and 7.5%-27% of the children aged 5 months and above exceeded the HBGV for DON. Consequently, the exposure of young children raises safety concerns for T2/HT2 and DON. Efforts should therefore be pursued to decrease their exposure to these molecules.

Dietary exposure to pesticide residues and associated health risks in infants and young children - Results of the French infant total diet study.

A total diet study (TDS) was undertaken to estimate the chronic dietary exposure to pesticide residues and health risks for the French infants and young children below 3 years old. As a whole, 516 pesticides and metabolites were analysed in 309 food composite samples including 219 manufactured baby foods and 90 common foods, which cover 97% of infants and young children's diet. These composite samples were prepared using 5,484 food products purchased during all seasons from 2011 to 2012 and processed as consumed. Pesticide residues were detected in 67% of the samples and quantified in 27% of the baby food samples and in 60% of the common foods. Seventy-eight different pesticides were detected and 37 of these quantified at levels ranging from 0.02 to 594 µg/kg. The most frequently detected pesticides (greater than 5% samples) were (1) the fungicides 2-phenylphenol, azoxystrobin, boscalid, captan and its metabolite tetrahydrophthalimide, carbendazim, cyprodinil, difenoconazole, dodine, imazalil, metalaxyl, tebuconazole, thiabendazole, (2) the insecticides acetamiprid, pirimiphos-methyl and thiacloprid, (3) the herbicide metribuzin and (4) the synergist piperonyl butoxide. Dietary intakes were estimated for each of the 705 individuals studied and for 431 pesticides incl. 281 with a toxicological reference value (TRV). In the lower-bound scenario, which tends to underestimate the exposure, the TRV were never exceeded. In the upper-bound scenario that overestimates exposure, the estimated intakes exceeded the TRV for dieldrin and lindane (two persistent organic pollutants) and propylene thiourea, a metabolite of propineb. For these three substances, more sensitive analyses are needed to refine the assessment. For 17 other detected and/or prioritised pesticides, the risk could not be characterised due to the lack of a valid TRV, of certain food analyses or the absence of analytical standards for their metabolites.

Dietary exposure to perfluoroalkyl acids, brominated flame retardants and health risk assessment in the French infant total diet study.

Perfluoroalkyl acids (PFAAs) and brominated flame retardants (BFRs) are widely used and present in human food. Due to the increased susceptibility to pollutants of the young children, we conducted a total diet study focusing on this population. Around 200 baby and common food composite samples, prepared "as consumed", have been analysed for PFAAS, hexabromocyclododecanes, polybrominated biphenyls, polybrominated diphenyl ethers and tetrabromobisphenol A. The dietary exposure of 705 children aged 1-36 months was assessed. PFAAS were detected only in one fish sample. Detection rates varied from 4 to 93% for BFRs, depending on the congeners. Regarding the provisional health-based guidance values set by EFSA in 2018 for PFOA and PFOS at 0.8 and 1.8 ng kg bw-1.d-1, respectively, 20-100% of children exceeded them, depending on the age. Efforts should be made to decrease the PFAAs contamination of common foods. This study also highlighted that for other PFAAs, toxicological studies are needed to set dietary health-based guidance values, to assess their related health risk. Conversely, dietary exposures to BRFs were much lower than the respective health based guidance values or margins of safety were high enough, and consequently not considered at-risk due to very low contamination of the infant specific foods.

French infant total diet study: Dietary exposure to heat-induced compounds (acrylamide, furan and polycyclic aromatic hydrocarbons) and associated health risks.

A total diet study (TDS) was conducted between 2010 and 2016 to assess the risk associated with chemicals in food of non-breast-fed children from 1 to 36 months living in France. Food samples were collected, prepared "as consumed", and analyzed for chemicals of public health interest. Acrylamide, furan and polycyclic aromatic hydrocarbons (PAHs) were analyzed as heat-induced compounds produced mainly during thermal processing of foods. Dietary exposure was assessed for 705 representative children using food consumptions recorded through a 3-consecutive-days record. As all calculated margins of exposure (MOE) for PAHs exceeded 10 000, dietary exposure of the infant and toddler population was deemed tolerable with regard to the carcinogenic risk. Conversely, the exposure levels to acrylamide and furan were considered as of concern, requiring management measures to reduce the exposure essentially by reducing the formation of heat-induced compounds during food production or preparation processes. Efforts should mainly focus on major contributors to the exposure, i.e. sweet and savoury biscuits and bars, and potatoes and potato products for acrylamide, baby jars of vegetables, with or without meat or fish for acrylamide and furan.

A risk-benefit analysis of French high fish consumption: a QALY approach.

The health risk and the nutritional benefit of a food are usually assessed separately. Toxicologists recommend limiting the consumption of certain fish because of methylmercury; while nutritionists recommend eating more oily fish because of omega 3. A common evaluation is imperative to provide coherent recommendations. In order to evaluate the risks along with the benefits related to fish consumption, a common metric based on the quality-adjusted life year (QALY) method has been used. The impact of a theoretical change from a medium n-3 PUFAs intake to a high intake is studied, in terms of the cardiovascular system (CHD mortality, stroke mortality and morbidity) and on fetal neuronal development (IQ loss or gain). This application can be considered as a sensitive analysis of the model used and looks at the impact of changing the dose-response relationships between cardiovascular diseases and n-3 PUFAs intakes. Results show that increasing fish consumption may have a beneficial impact on health. However, the confidence interval of the overall estimation has a negative lower bound, which means that this increase in fish consumption may have a negative impact due to MeHg contamination. Some limits of the QALY approach are identified. The first concerns determination of the dose-response relationships. The second concerns the economic origins of the approach and of individual preferences. Finally, since only one beneficial aspect and one risk element were studied, consideration should be given to how other beneficial and risk components may be integrated in the model.

Levels of furan in foods from the first French Total Diet Study on infants and toddlers.

This study describes an optimisation and validation process on a method using gas chromatography coupled with mass spectrometry to quantify furan in foods consumed mainly by infants and toddlers. The method that we developed allowed for low limits of quantification for liquid (1 µg kg-1) and solid (2 µg kg-1) samples. Our method was then applied to 134 food samples from the first French Total Diet Study on infants and toddlers. Furan was detected in 84% and quantified in 61% of the samples, at average lower and upper bound (LB/UB) concentrations ranging from 0 to 44 µg kg-1. The sugar and sugar derivatives, milk, growth milk, infant formulae and "other hot beverages categories contained the lowest average content (LB/UB ≤ 1 µg kg-1) and breakfast cereals contained the highest (LB/UB = 44 µg kg-1).

French infant total diet study: Exposure to selected trace elements and associated health risks.

A total diet study (TDS) was conducted between 2010 and 2016 to assess the risk associated with chemicals in food of non-breast-fed children under three living in France. 291 composite food samples were prepared "as consumed" and analyzed for 16 trace elements: aluminium (Al), antimony (Sb), arsenic (As), barium (Ba), cobalt (Co), chromium (Cr), gallium (Ga), germanium (Ge), lead (Pb), mercury (Hg), nickel (Ni), silver (Ag), strontium (Sr), tellurium (Te), tin (Sn), vanadium (V). Dietary exposure was assessed for 705 representative children using food consumptions recorded through a 3-consecutive-days record. For inorganic mercury, chromium III, and antimony, the exposure levels were lower than the health-based guidance values and the risk was considered tolerable. Conversely, the exposure levels to inorganic arsenic, lead and nickel were higher than the health-based guidance values for a part of children and were considered as a concern, requiring management measures to reduce the exposure. For aluminium, methylmercury, strontium, chromium VI, cobalt, and barium, a risk could not be ruled out because of uncertainty sources. As a precautionary measure, reducing the exposure is recommended. For chemicals without robust health-based guidance value (organic arsenic, gallium, germanium, silver, tin, tellurium and vanadium), additional data are needed for risk assessment.

Quality Management Framework for Total Diet Study centres in Europe.

A Quality Management Framework to improve quality and harmonization of Total Diet Study practices in Europe was developed within the TDS-Exposure Project. Seventeen processes were identified and hazards, Critical Control Points and associated preventive and corrective measures described. The Total Diet Study process was summarized in a flowchart divided into planning and practical (sample collection, preparation and analysis; risk assessment analysis and publication) phases. Standard Operating Procedures were developed and implemented in pilot studies in five organizations. The flowchart was used to develop a quality framework for Total Diet Studies that could be included in formal quality management systems. Pilot studies operated by four project partners were visited by project assessors who reviewed implementation of the proposed framework and identified areas that could be improved. The quality framework developed can be the starting point for any Total Diet Study centre and can be used within existing formal quality management approaches.

Dietary exposure to cadmium and health risk assessment in children - Results of the French infant total diet study.

Besides specific occupational activities or smoking, food is the main route of cadmium exposure for the general population. In France a total diet study previously conducted for adults and children over 3 years old revealed that health concerns due to Cd dietary exposure existed for both adults and children. This study showed that the Cd tolerable weekly intake, based on potential nephrotoxicity effects, is exceeded by a high proportion of children under 3 years old. Nephrotoxicity results from the accumulation of cadmium in the kidney and appears typically after long-term exposure (40-50 years). Despite the exceeding of the tolerable weekly intake observed during the first three years of childhood, due to low body weights compared to adults, the accumulation rate of cadmium is much lower during the whole childhood period (from 0 to 17 years of age) than during adulthood. These data suggest that dietary exposure to cadmium should be reduced for both children and adults to prevent health concerns associated with nephrotoxicity in later life. Moreover, recent literature suggests that Cd can induce other adverse health effects (especially endocrine disruption or neurotoxicity) that could be triggered at even lower doses than those triggering nephrotoxicity.