Estimated PCDD/F TEQ and total TEQ concentrations in the serum of 7-10 year old Finnish children.

Polychlorinated dibenzo-p-dioxins and furans (PCDD/Fs) and polychlorinated biphenyls (PCBs) are persistent organic pollutants that have detrimental health effects. As people are exposed to them mainly through the diet, EU has set maximum food dioxin and PCBs levels. EFSA CONTAM Panel made new risk assessment in 2018 that lowered the tolerable weekly intake (TWI) from 14 pg-TEQ/kg bw/week to 2 pg-TEQ/kg bw/week. Critical effect was decreased semen count at the age of 18-19 years if serum total TEQ at the age of 9 years exceeded the No Observed Adverse Effect Level (NOAEL) of 7 pg/g lipid. However, it is largely unknown to what extent NOAEL is exceed in European boys currently. We thus measured PCBs from small volume of serum in 184 Finnish children 7-10 years of age. To estimate the TEQ levels of children from measured PCB levels, we used our existing human milk PCDD/F and PCB concentrations to create a hierarchical Bayesian regression model that was used to estimate TEQs from measured PCBs. For quality control (QC), three pooled blood samples from 18 to 20 year old males were measured for PCDD/Fs and PCBs, and estimated for TEQs. In QC samples measured and estimated TEQs agreed within 84%-106%. In our estimate for 7-10 year old children, PCDD/F TEQ exceeded NOAEL only in 0.5% and total TEQ in 2.7% of subjects. Risk management following the decreased TWI proposed by the CONTAM Panel should be carefully considered if total TEQ in children is already largely below the NOAEL.

From insight network to open policy practice: practical experiences.

BACKGROUND: Evidence-informed decision-making and better use of scientific information in societal decisions has been an area of development for decades but is still topical. Decision support work can be viewed from the perspective of information collection, synthesis and flow between decision-makers, experts and stakeholders. Open policy practice is a coherent set of methods for such work. It has been developed and utilised mostly in Finnish and European contexts. METHODS: An overview of open policy practice is given, and theoretical and practical properties are evaluated based on properties of good policy support. The evaluation is based on information from several assessments and research projects developing and applying open policy practice and the authors' practical experiences. The methods are evaluated against their capability of producing quality of content, applicability and efficiency in policy support as well as how well they support close interaction among participants and understanding of each other's views. RESULTS: The evaluation revealed that methods and online tools work as expected, as demonstrated by the assessments and policy support processes conducted. The approach improves the availability of information and especially of relevant details. Experts are ambivalent about the acceptability of openness - it is an important scientific principle, but it goes against many current research and decision-making practices. However, co-creation and openness are megatrends that are changing science, decision-making and the society at large. Against many experts' fears, open participation has not caused problems in performing high-quality assessments. On the contrary, a key challenge is to motivate and help more experts, decision-makers and citizens to participate and share their views. Many methods within open policy practice have also been widely used in other contexts. CONCLUSIONS: Open policy practice proved to be a useful and coherent set of methods. It guided policy processes toward a more collaborative approach, whose purpose was wider understanding rather than winning a debate. There is potential for merging open policy practice with other open science and open decision process tools. Active facilitation, community building and improving the user-friendliness of the tools were identified as key solutions for improving the usability of the method in the future.

Correction to: Health effects of nutrients and environmental pollutants in Baltic herring and salmon: a quantitative benefit-risk assessment.

It was highlighted that the original article [1] contained a formatting error in the equations.

Health effects of nutrients and environmental pollutants in Baltic herring and salmon: a quantitative benefit-risk assessment.

BACKGROUND: Health risks linked with dioxin in fish remain a complex policy issue. Fatty Baltic fish contain persistent pollutants, but they are otherwise healthy food. We studied the health benefits and risks associated with Baltic herring and salmon in four countries to identify critical uncertainties and to facilitate an evidence-based discussion. METHODS: We performed an online survey investigating consumers' fish consumption and its motivation in Denmark, Estonia, Finland, and Sweden. Dioxin and methylmercury concentrations were estimated based on Finnish studies. Exposure-response functions for several health endpoints were evaluated and quantified based on the scientific literature. We also quantified the infertility risk of men based on a recent European risk assessment estimating childhood dioxin exposure and its effect on sperm concentration later in life. RESULTS: Baltic herring and salmon contain omega-3 fatty acids and vitamin D, and the beneficial impact of these fishes on cardiovascular diseases, mortality, and the risk of depression and cancer clearly outweighs risks of dioxins and methylmercury in people older than 45 years of age and in young men. Young women may expose their children to pollutants during pregnancy and breast feeding. This study suggests that even in this critical subgroup, the risks are small and the health benefits are greater than or at least similar to the health risks. Value of information analysis demonstrated that the remaining scientific uncertainties are not large. In contrast, there are several critical uncertainties that are inherently value judgements, such as whether exceeding the tolerable weekly intake is an adverse outcome as such; and whether or not subgroup-specific restrictions are problematic. CONCLUSIONS: The potential health risks attributable to dioxins in Baltic fish have more than halved in the past 10 years. The new risk assessment issued by the European Food Safety Authority clearly increases the fraction of the population exceeding the tolerable dioxin intake, but nonetheless, quantitative estimates of net health impacts change only marginally. Increased use of small herring (which have less pollutants) is a no-regret option. A more relevant value-based policy discussion rather than research is needed to clarify official recommendations related to dioxins in fish.

Premature Deaths, Statistical Lives, and Years of Life Lost: Identification, Quantification, and Valuation of Mortality Risks.

Mortality effects of exposure to air pollution and other environmental hazards are often described by the estimated number of "premature" or "attributable" deaths and the economic value of a reduction in exposure as the product of an estimate of "statistical lives saved" and a "value per statistical life." These terms can be misleading because the number of deaths advanced by exposure cannot be determined from mortality data alone, whether from epidemiology or randomized trials (it is not statistically identified). The fraction of deaths "attributed" to exposure is conventionally derived as the hazard fraction (R - 1)/R, where R is the relative risk of mortality between high and low exposure levels. The fraction of deaths advanced by exposure (the "etiologic" fraction) can be substantially larger or smaller: it can be as large as one and as small as 1/e (≈0.37) times the hazard fraction (if the association is causal and zero otherwise). Recent literature reveals misunderstanding about these concepts. Total life years lost in a population due to exposure can be estimated but cannot be disaggregated by age or cause of death. Economic valuation of a change in exposure-related mortality risk to a population is not affected by inability to know the fraction of deaths that are etiologic. When individuals facing larger or smaller changes in mortality risk cannot be identified, the mean change in population hazard is sufficient for valuation; otherwise, the economic value can depend on the distribution of risk reductions.

How scientists perceive the evolutionary origin of human traits: Results of a survey study.

Various hypotheses have been proposed for why the traits distinguishing humans from other primates originally evolved, and any given trait may have been explained both as an adaptation to different environments and as a result of demands from social organization or sexual selection. To find out how popular the different explanations are among scientists, we carried out an online survey among authors of recent scientific papers in journals covering relevant fields of science (paleoanthropology, paleontology, ecology, evolution, human biology). Some of the hypotheses were clearly more popular among the 1,266 respondents than others, but none was universally accepted or rejected. Even the most popular of the hypotheses were assessed "very likely" by <50% of the respondents, but many traits had 1-3 hypotheses that were found at least moderately likely by >70% of the respondents. An ordination of the hypotheses identified two strong gradients. Along one gradient, the hypotheses were sorted by their popularity, measured by the average credibility score given by the respondents. The second gradient separated all hypotheses postulating adaptation to swimming or diving into their own group. The average credibility scores given for different subgroups of the hypotheses were not related to respondent's age or number of publications authored. However, (paleo)anthropologists were more critical of all hypotheses, and much more critical of the water-related ones, than were respondents representing other fields of expertise. Although most respondents did not find the water-related hypotheses likely, only a small minority found them unscientific. The most popular hypotheses were based on inherent drivers; that is, they assumed the evolution of a trait to have been triggered by the prior emergence of another human-specific behavioral or morphological trait, but opinions differed as to which of the traits came first.

Comparison of questionnaire data and analyzed dioxin concentrations as a measure of exposure in soft-tissue sarcoma studies.

Soft-tissue sarcoma is one of the few specific tumors thought to be caused by polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) and specifically TCDD. Evidence is, however, based on questionnaire-based case-control studies, and on very few cancer cases in cohort studies at high occupational exposures to chlorophenols or chlorophenoxy acid herbicides with dioxin impurities. Recall bias has been suspected to influence the reporting of exposure, but this possibility has never been adequately put to test. In the present study 87 cancer patients and 308 controls answered a questionnaire asking their exposure to wood preservatives, fungicides and herbicides, and insecticides, and their PCDD/F concentrations were also measured. After matching for age and area 67-69 sarcoma patients and 153-156 controls were available for the study depending on the chemical group, 1-3 controls for each sarcoma patient. Sarcoma patients reported exposure to these chemicals significantly more often than controls did, odds ratios were 6.7 for wood preservatives (p=0.02), 16 for fungicides and herbicides (p=0.01), and 4.9 for insecticides (p=0.06). There was no association, when the analysis was based on measured PCDD/F concentrations (odds ratios close to 1). Although it is not possible to exclude the role of the main chemical as the cause with certainty, the results indicate that recall bias is very likely in previous studies. Thus the causality between contaminant PCDD/Fs and soft tissue sarcoma cannot be considered proven.

A pharmacokinetic analysis and dietary information are necessary to confirm or reject the hypothesis on persistent organic pollutants causing type 2 diabetes.

A number of studies have found an association between the concentrations of persistent organic pollutants (POP) and type 2 diabetes. Causality has remained uncertain. This study describes the pharmacokinetic behavior of PCDD/Fs (polychlorinated dibenzo-p-dioxins and dibenzofurans) both in a theoretical model based on elimination rate constants, and in a group of 409 adult surgical patients with known PCDD/F concentrations and dietary information. A model assuming 10% annual decrease in past PCDD/F intake, predicted the measured profile of TEQ (toxic equivalents) in the patient population fairly well. The dominant determinant of PCDD/F level was age, and the level in patients was also associated with consumption of animal source products. Predicted daily intakes correlated with diet, but also with body mass index (BMI), indicating that high BMI was preceded by high consumption of foods containing PCDD/Fs. The results suggest that a third factor, e.g. high intake of animal source foods, could explain both higher levels of POPs in the body and higher incidence of type 2 diabetes, and BMI is not sufficient in describing the confounding caused by diet. Thus, to fully address the causality between POPs and type 2 diabetes, careful studies considering the pharmacokinetics of the studied compounds, and including the analysis of food consumption, are needed.

Building-related health impacts in European and Chinese cities: a scalable assessment method.

BACKGROUND: Public health is often affected by societal decisions that are not primarily about health. Climate change mitigation requires intensive actions to minimise greenhouse gas emissions in the future. Many of these actions take place in cities due to their traffic, buildings, and energy consumption. Active climate mitigation policies will also, aside of their long term global impacts, have short term local impacts, both positive and negative, on public health. Our main objective was to develop a generic open impact model to estimate health impacts of emissions due to heat and power consumption of buildings. In addition, the model should be usable for policy comparisons by non-health experts on city level with city-specific data, it should give guidance on the particular climate mitigation questions but at the same time increase understanding on the related health impacts and the model should follow the building stock in time, make comparisons between scenarios, propagate uncertainties, and scale to different levels of detail. We tested The functionalities of the model in two case cities, namely Kuopio and Basel. We estimated the health and climate impacts of two actual policies planned or implemented in the cities. The assessed policies were replacement of peat with wood chips in co-generation of district heat and power, and improved energy efficiency of buildings achieved by renovations. RESULTS: Health impacts were not large in the two cities, but also clear differences in implementation and predictability between the two tested policies were seen. Renovation policies can improve the energy efficiency of buildings and reduce greenhouse gas emissions significantly, but this requires systematic policy sustained for decades. In contrast, fuel changes in large district heating facilities may have rapid and large impacts on emissions. However, the life cycle impacts of different fuels is somewhat an open question. CONCLUSIONS: In conclusion, we were able to develop a practical model for city-level assessments promoting evidence-based policy in general and health aspects in particular. Although all data and code is freely available, implementation of the current model version in a new city requires some modelling skills.

[Big data in the promotion of public health]. / Massadata kansanterveyden edistämisessä.

Big data (very large data sets) are increasing in an accelerating speed. More and more data is also becoming freely available. This article is an overview of this progress and data sources related to molecular biology and public health especially from the Finnish perspective. Finland has several excellent data sources that are currently not used effectively. Big data has already produced major benefits especially in molecular biology, but benefits in public health and individual choice are only now being materialised. The paradigm in research may change dramatically, if the effort switches from article production to the production of knowledge crystals, i.e. collaborative data-based answers to research questions. Also the role of a clinician is becoming more like that of a coach.

2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) increases bilirubin formation but hampers quantitative hepatic conversion of biliverdin to bilirubin in rats with wild-type AH receptor.

In haem degradation, haem oxygenase-1 (HO-1) first cleaves haem to biliverdin, which is reduced to bilirubin by biliverdin IXα reductase (BVR-A). The environmental pollutant 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) causes hepatic accumulation of biliverdin in moderately TCDD-resistant line B (Kuopio) rats. Using line B and two TCDD-sensitive rat strains, the present study set out to probe the dose-response and biochemical mechanisms of this accumulation. At 28 days after exposure to 3-300 µg/kg TCDD in line B rats, already the lowest dose of TCDD tested, 3 µg/kg, affected serum bilirubin conjugates, and after doses ≥100 µg/kg, the liver content of bilirubin, biliverdin and their conjugates (collectively 'bile pigments') as well as HO-1 was elevated. BVR-A activity and serum bile acids were increased only by the doses of 100 and 300 µg/kg TCDD, respectively. Biliverdin conjugates correlated best with biliverdin suggesting it to be their immediate precursor. TCDD (100 µg/kg, 10 days) increased hepatic bilirubin and biliverdin levels also in TCDD-sensitive Long-Evans (Turku/AB; L-E) rats. Hepatic bilirubin and bile acids, but not biliverdin, were increased in feed-restricted L-E control rats. In TCDD-sensitive line C (Kuopio) rats, 10 µg/kg of TCDD increased the body-weight-normalized biliary excretion of bilirubin. Altogether, the results suggest that at acutely toxic doses, TCDD induces the formation of bilirubin in rats. However, concurrently, TCDD seems to hamper the quantitative conversion of biliverdin to bilirubin in line B and L-E rats' liver. Biliverdin conjugates are most likely formed as secondary products of biliverdin.

Perspectives to performance of environment and health assessments and models--from outputs to outcomes?

The calls for knowledge-based policy and policy-relevant research invoke a need to evaluate and manage environment and health assessments and models according to their societal outcomes. This review explores how well the existing approaches to assessment and model performance serve this need. The perspectives to assessment and model performance in the scientific literature can be called: (1) quality assurance/control, (2) uncertainty analysis, (3) technical assessment of models, (4) effectiveness and (5) other perspectives, according to what is primarily seen to constitute the goodness of assessments and models. The categorization is not strict and methods, tools and frameworks in different perspectives may overlap. However, altogether it seems that most approaches to assessment and model performance are relatively narrow in their scope. The focus in most approaches is on the outputs and making of assessments and models. Practical application of the outputs and the consequential outcomes are often left unaddressed. It appears that more comprehensive approaches that combine the essential characteristics of different perspectives are needed. This necessitates a better account of the mechanisms of collective knowledge creation and the relations between knowledge and practical action. Some new approaches to assessment, modeling and their evaluation and management span the chain from knowledge creation to societal outcomes, but the complexity of evaluating societal outcomes remains a challenge.

Estimated intake levels for Finnish children of methylmercury from fish.

Methylmercury (MeHg) is a well-known neurotoxic agent, and consumption of contaminated fish is the principal environmental source of MeHg exposure in humans. Children are more susceptible to adverse effects than adults. No previous specific data exist for intake by Finnish children of methylmercury from fish. We estimated fish consumption and MeHg intakes from species most commonly consumed by Finnish children aged 1-6 years. The total mercury concentrations were determined in fish species consumed, and age-specific methylmercury intakes were derived. We also examined safety margins and the proportion of children exceeding the tolerable daily intakes set by international expert bodies. The daily intake of MeHg ranged from 0 to 0.33 µg/kg bw. The strictest reference value 0.1 µg/kg bw/day for MeHg, proposed by USEPA, was exceeded by 1-15% of the study population, and FAO/WHO JECFA provisional tolerable weekly intake of 1.6 µg/kg bw was exceeded by 1% of boys and 2.5% of girls aged 6 years. Intakes of 1-year old girls were higher than of boys, whereas for 3-year olds they were the opposite. The highest intakes were observed for 6-year-old boys and girls. There was great variation in the estimated MeHg intakes among Finnish children.

Long-term daily intake estimates of polychlorinated dibenzo-p-dioxins and furans, polychlorinated biphenyls and polybrominated diphenylethers from food in Finnish children: risk assessment implications.

Food is contaminated by polychlorinated dibenzo-p-dioxins and furans (PCDD/F), polychlorinated biphenyls (PCB) and polybrominated diphenylethers (PBDE) worldwide. Previous data show elevated intakes in children. We determined intakes of POPs in Finnish children. Because no children-specific safe limit values exist, we used tolerable daily intakes (TDIs) set for adults by international expert bodies to examine the proportion of the study population that exceed those limits. We utilised dietary monitoring data with food consumption of Finnish boys and girls aged 1-6 years, measured the contaminant concentrations in all the main food items and calculated age-specific contaminant sum and congener-specific long-term daily intake levels. Our food intake and contaminant data correspond to years 2002-2005. The long-term upper-bound dioxin intakes ranged between 0.1 and 12.8 pg WHO(PCDD/F-PCB)-TEQ/kg bw/d (min and max). An immediate TDI for WHO(PCDD/F-PCB)-TEQs of 4.0 pg/kg bw/d were exceeded by 2.5%-7.5% of the children. PBDE long-term upper-bound intake was between 0.1 and 5.8 ng/kg bw/d (min and max). Congener-specific analyses indicated a typical Finnish adult exposure pattern of the children to PCDD/Fs, PCBs and PBDEs. The highest POP intakes were observed in children aged 3 years. Long-term daily PCDD/F, PCB and PBDE intakes among Finnish children varied greatly between individuals and ages. In each age group of the study population, there was a proportion of children with their WHO(PCDD/F-PCB)-TEQ intake exceeding considered safe limits set for adults. Based on the exposure profile reported herein, children should be clearly considered as a specific sub-population in food-mediated contaminant risk assessment.

Is the fear of dioxin cancer more harmful than dioxin?

2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) is a proven animal carcinogen. Occupational cohorts with the highest exposures imply that there is a small risk of all cancers combined, but it is difficult to pinpoint the confounding effect of the main chemicals. Studies after major accidents do not unequivocally confirm this risk. The risks to populations at the current dioxin levels seem trivial if present at all. There is increasing evidence that the aryl hydrocarbon receptor (AhR), i.e. the so called "dioxin receptor", is a physiological transcription factor exerting important functions in the body. Consequently a certain level of AhR activation may be beneficial rather than harmful. This challenges the wisdom of excessive regulation of dioxin levels in certain foods and nutrients. This could pose indirect nutritional risks, in fact being more harmful than even the worst case predictions of the putative cancer risks attributable to dioxins.

Openness in participation, assessment, and policy making upon issues of environment and environmental health: a review of literature and recent project results.

Issues of environment and environmental health involve multiple interests regarding e.g. political, societal, economical, and public concerns represented by different kinds of organizations and individuals. Not surprisingly, stakeholder and public participation has become a major issue in environmental and environmental health policy and assessment. The need for participation has been discussed and reasoned by many, including environmental legislators around the world. In principle, participation is generally considered as desirable and the focus of most scholars and practitioners is on carrying out participation, and making participation more effective. In practice also doubts regarding the effectiveness and importance of participation exist among policy makers, assessors, and public, leading even to undermining participatory practices in policy making and assessment.There are many possible purposes for participation, and different possible models of interaction between assessment and policy. A solid conceptual understanding of the interrelations between participation, assessment, and policy making is necessary in order to design and implement effective participatory practices. In this paper we ask, do current common conceptions of assessment, policy making and participation provide a sufficient framework for achieving effective participation? This question is addresses by reviewing the range of approaches to participation in assessment and policy making upon issues of environment and environmental health and some related insights from recent research projects, INTARESE and BENERIS.Openness, considered e.g. in terms of a) scope of participation, b) access to information, c) scope of contribution, d) timing of openness, and e) impact of contribution, provides a new perspective to the relationships between participation, assessment and policy making. Participation, assessment, and policy making form an inherently intertwined complex with interrelated objectives and outcomes. Based on experiences from implementing openness, we suggest complete openness as the new default, deviation from which should be explicitly argued, in assessment and policy making upon issues of environment and environmental health. Openness does not undermine the existing participatory models and techniques, but provides conceptual means for their more effective application, and opens up avenues for developing new kinds of effective participatory practices that aim for societal development through collaborative creation of knowledge.

Immediate and highly sensitive aversion response to a novel food item linked to AH receptor stimulation.

Aversion to novel food items was studied in male rats and mice after 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) exposure using chocolate consumption as an indicator. The correlation of this phenomenon with susceptibility to acute toxicity and CYP1A1 induction was examined by determining the dose-response of chocolate aversion in differently dioxin-sensitive rat lines after TCDD (0.01-10 µg/kg). Furthermore, the dependence of this behavioral alteration on the AH receptor (AHR) was studied employing AHR-deficient and wild-type mice. We offered chocolate for both species as a novel food item immediately after the exposure, and it was available with standard rodent chow for 3 days. The ED50 value for the extremely resistant rat line A (LD50) value > 10,000 µg/kg) was 0.36 µg/kg, for the semi-resistant line B (LD50) value 830 µg/kg) 1.07 µg/kg and for the TCDD-sensitive line C (LD50 value 40 µg/kg) 0.34 µg/kg. Interestingly, the ED50 values for chocolate aversion were very similar to those for CYP1A1 induction in these rat lines. Findings on AHR-deficient and wild-type mice implied the involvement of the AHR in this intriguing response, which may thus represent a mechanism to restrict exposure to potentially toxic dietary substances causing hepatic induction of drug-metabolizing enzymes.

Characterization of the 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD)-provoked strong and rapid aversion to unfamiliar foodstuffs in rats.

A conspicuous but scantly studied feature of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) toxicity is avoidance of unfamiliar foodstuffs, which seems to be one of the very few exquisitely sensitive behavioural effects in adult laboratory animals. Here we characterized this peculiar response further after low doses of TCDD. The time-course of the novelty avoidance, the role of nutriment form and dependence of the aversion on the time lag between TCDD exposure and the presentation of a novel food item was determined using rats with different sensitivities to lethality of TCDD. Rats were offered chocolate, liquid nutriment or familiar feed with an unfamiliar texture and the consumptions were measured for varying periods. Aversion to a novel food item (chocolate) emerged within 5.5h after TCDD exposure. A lag of a week or more between TCDD exposure and the presentation of chocolate abolished the avoidance whereas simultaneous presentation of chocolate with TCDD treatment rendered the rats oblivious to the chocolate's presence for over 40 days. Rats avoided also liquid nutriments when these were coupled with TCDD administration but this faded much sooner than chocolate aversion. Even a change in feed texture at the exposure was able to elicit the response. However, habituation was found to interfere with the aversion. These findings indicate that temporal proximity to TCDD exposure is a requisite for the avoidance response which emerges rapidly and may linger on for extended periods, but is not strictly confined to any specific food type. The molecular mechanisms of this tantalizing behavioural alteration remain to be determined.

Modelling the intake of polychlorinated dibenzo-p-dioxins and dibenzofurans: impact of energy under-reporting and number of reporting days in dietary surveys.

A probabilistic long-term intake estimation of dioxins was carried out using food consumption data obtained from the National FINDIET 2007 Survey (Paturi et al. 2008). The study population consisted of 606 participants who were first interviewed with a 48-h recall and then filled in a 3-day food record twice. The concentrations of dioxins were obtained from previously published studies. The intake was estimated using a semi-parametric Monte Carlo simulation. The analyses were done separately for the whole study population and for the population excluding energy under-reporters. To diminish the impact of intra-individual variation and nuisance effects, adjustment with software (C-SIDE) was also done after Monte Carlo simulation. It was found that when C-SIDE was used, the 95th percentile of intake and its confidence limit was higher with 2 reporting days than with a higher number of days. However, with a crude intake estimation (no adjustment), the confidence intervals of the 95th percentile were also smaller with a higher number of days, but the 95th percentiles were higher with a higher number of reporting days. When under-reporters were excluded the intakes increased, but the impact of energy under-reporting was smaller with 8 reporting days than with 2 days and smaller using C-SIDE than with a crude estimation. To conclude, adjustment for intra-individual variation and taking energy under-reporting into account are essential for intake estimation of dioxins with food consumption data of a limited number of reporting days.