Risk-Benefit Assessment: Science to empower the consumer Maarten Nauta Risk-Benefit Research group Risk-Benefit Assessment: Science to empower the consumer

What should I eat? IS ALL FOOD DANGEROUS?

Risk-Benefit Assessment of foods Usually our research focus is on only risks or benefits one contaminant or one nutrient one food one health effect Food is associated with benefits and risks This requires an integrated approach Multidisciplinary

Risk-Benefit Assessment at DTU in Denmark Risk-Benefit research group established 2015 Expertises available at DTU Toxicology Nutrition Microbiology Food Safety Risk assessment Epidemiology (Burden of foodborne diseases) MetriX project

International Activities Past European projects BRAFO (2010) EFSA opinion with guidelines (2010) Workshop Nordic countries (2016) EFSA sponsored workshop in Copenhagen (2017) International Risk Benefit Network established Summer school in Parma (11-13 June 2019) PhD course at DTU (8 days, november 2019)

What can we do? Dietary advices for the population on health risks and benefits Is it healthy to eat more fish? Should we fortify food with folic acid or vitamin D? Estimate expected health impact What difference does it actually make for my health? Personalised advices Based on personal traits and preferences

Our focus: Quantitative health impact assessment Not just assess whether there is a risk or a benefit Is it healthy to eat more fish? Should we fortify food with folic acid or vitamin D? But also How large is the estimated population health impact? Population incidence of disease Mortality Disease burden (healthy life years lost; DALY) How does my probability of illness change if I change my diet? Personalised recommendations

Three examples of our research Barbecuing and the risk of cancer 2. Health impact of following the Danish fish intake recommendations 3. Develop personalised recommendations for fish intake

1. Barbecuing and the risk of cancer Carcinogenic compounds (benzo[a]pyrene) may be formed with barbecuing There IS a risk, but does that mean we should not do it? How large is the risk? How is the risk associated with sex and body weight?

Mean extra lifetime risk of cancer is 7 in 100.000 mean population risk Mean extra lifetime risk of cancer is 7 in 100.000 (95% CI: 3 in 10.000.000 ; 7 in 10.000) How often can I BBQ before I exceed that? Mean extra lifetime risk of cancer Median of the mean risk is 7 x 10^-5

2. Impact of following the Danish fish intake recommendations Risk-benefit question: What is the overall health impact of increasing fish consumption to the recommended 350 g/week in the Danish adult diet while substituting red and processed meat? Eat more fish 350 g/week – minimum 200 g of fatty fish Eat lean meat and lean processed meat Maximum 500 g/week

Gain in healthy life years for adults in Denmark Mix Fatty fish Lean fish Bad  Disability adjusted life years (DALY) Each bar represents the different health outcomes considered Health impact mainly driven by the effects of increased fish consumption – beneficial effects of DHA+EPA but also the effects on neurodevelopment In the fourth scenario, we found that the picture was turned upside down due to in particular a lower intake of DHA+EPA but also due to an increased exposure of women in the childbearing age to MeHg Impact of decreased meat consumption was minor and the changes in exposure to dioxin + dl-PCBs were negligible Good  7000 7200 3700

3. Develop personalised recommendations for fish intake using mathematical optimization Current fish intake in the Danish population Does it meet safety levels and recommended intakes ? Danish guidelines

3. Develop personalised recommendations for fish intake using mathematical optimization Current fish intake in the Danish population Does it meet safety levels and recommended intakes ? Find minimal changes needed in current diet On an individual basis

Personalised recommendations for fish intake Current Individual Advice

What quantitative Risk Benefit assessment adds Not just say what is healthy and not but How healthy is it? Can be personalised Age, sex, life style factors, personal traits Preferences Do you want to give up health for food you like? Empowers consumers to manage their own health

Future perspectives Challenges Methods need further development Data needs Dose response Diet and substitution effects Evidence synthesis and uncertainty More case studies should be done There is more than health Sustainability Economic impact Communication Collaboration!

Acknowledgements Risk Benefit Research group, DTU Special thanks to: Lea Jakobsen Maria Persson Sofie Thomsen You!