World Health Organization Estimates of the Global and Regional Disease Burden of Four Foodborne Chemical Toxins, 2010

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Gibb, Herman; Devleesschauwer, Brecht; Bolger, P. Michael; Wu, Felicia; Ezendam, Janine; Pitt, John


2015-12-31


Journal Article


PLoS Medicine


4


1393-1407


Background Chemical exposures have been associated with a variety of health effects; however, little is known about the global disease burden from foodborne chemicals. Food can be a major pathway for the general population’s exposure to chemicals, and for some chemicals, it accounts for almost 100% of exposure. Methods and Findings Groups of foodborne chemicals, both natural and anthropogenic, were evaluated for their ability to contribute to the burden of disease. The results of the analyses on four chemicals are presented here - cyanide in cassava, peanut allergen, aflatoxin, and dioxin. Systematic reviews of the literature were conducted to develop age- and sex-specific disease incidence and mortality estimates due to these chemicals. From these estimates, the numbers of cases, deaths and Disability Adjusted Life Years (DALYs) were calculated. For these four chemicals combined, the total number of illnesses, deaths, and DALYs in 2010 is estimated to be 339,000 (95% Uncertainty Interval [UI]: 186,000-1,239,000); 20,000 (95%UI: 8,000-52,000); and 1,012,000 (95%UI: 562,000-2,822,000), respectively. Both cyanide in cassava and aflatoxin are associated with diseases with high case-fatality ratios. Virtually all human exposure to these four chemicals is through the food supply. Due to data limitations, burden estimates for peanut allergen were made only for three of the six WHO regions. We assumed that konzo, a neurologic disease caused by cyanide in cassava only occurs in six countries in sub-Saharan Africa because cases have been reported only in those countries. For other countries we assumed the burden due to konzo was zero. Other effects, such as acute intoxication have also been associated with cyanide in cassava, but data were insufficient to estimate burden. By the same token, burdens could not be estimatedfor other effects that have been associated with chemicals (e.g., childhood stunting and aflatoxin intake) because of insufficient data. Given the above and the fact that our estimates are limited to four chemicals, the total burden estimate for chemicals can be assumed to be much larger. Conclusion Chemicals in the food supply, as evidenced by the results for four chemicals, contribute significantly to the global burden of disease. The burden of disease from foodborne chemical toxins is marked by large uncertainties and data gaps, highlighting the need for further baseline epidemiological, clinical, and biomonitoring research.


Public Library of Science


F1000Research


Mycology


EP156179


Journal article - Refereed


English


Gibb, Herman; Devleesschauwer, Brecht; Bolger, P. Michael; Wu, Felicia; Ezendam, Janine; Pitt, John. World Health Organization Estimates of the Global and Regional Disease Burden of Four Foodborne Chemical Toxins, 2010. PLoS Medicine. 2015; 4:1393-1407.



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