Open Access Grey Literature

Benefit-risk Assessment of Fish and Fish Products in the Norwegian Diet – An Update

Janneche Utne Skåre, Anne Lise Brantsæter, Livar Frøyland, Gro-Ingunn Hemre, Helle Katrine Knutsen, Inger Therese L. Lillegaard, Bente Torstensen

European Journal of Nutrition & Food Safety, Page 260-266
DOI: 10.9734/EJNFS/2015/18605

Request from the Norwegian Food Safety Authority (NFSA)

In September 2013, the Norwegian Food Safety Authority requested VKM to update relevant parts of the benefit-risk assessment of fish in the Norwegian diet published by VKM in 2006. The background for the request was new knowledge and data on the content of some nutrients and contaminants both for wild and farmed fish since 2006. The proportion of vegetable ingredients used in farmed fish feed has in recent years increased, and new national dietary surveys for adults and children have been conducted.

The Norwegian Food Safety Authority referred to VKM’s report from 2006, which pointed out that the positive impact of fish consumption on public health was especially due to the content of polyunsaturated fatty acids and vitamin D in fish. Further, VKM concluded that the contaminants that could pose a potential risk to public health through fish consumption mainly were methylmercury, dioxins and dioxin-like PCBs (dl-PCBs).

The request included a reassessment of fish consumption in Norway with focus on specific nutrients; n-3 fatty acids (eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA), docosahexaenoic acid (DHA), vitamin D, and the minerals iodine and selenium, and on specific contaminants; mercury, dioxins and dl-PCBs. VKM was asked to address the main changes in the use of raw materials in farmed fish feed and how these affect the levels of nutrients, mercury, dioxins and dl-PCBs and in fish feed. Further, VKM was asked to address to what extent levels of nutrients and contaminants in fish have changed since 2006, to describe these changes and estimate the human intake of the substances in question on the basis of recent dietary data. VKM was also requested to consider the benefits of eating fish with regard to the intake of nutrients and the risks associated with the intake of mercury, dioxins and dl-PCBs and comment on whether this change the conclusions from the report in 2006. Additionally, on the basis of updated knowledge, VKM was asked to comment whether other substances, like pesticide and residues of veterinary medicinal products, could affect the conclusions with regard to the impact on public health.

The Norwegian Food Safety Authority and the Directorate of Health will use the updated assessment as a basis for public recommendations concerning the consumption of fish and fish products.

How VKM has Addressed the Request

The VKM appointed a working group consisting of VKM members and external experts to answer the request. Several of the scientific panels of VKM reviewed the report during its preparation. The Scientific Steering Committee of VKM has given their final assessment and approval of the current report.

In the current report, VKM has mainly used data from national surveillance and monitoring programs for nutrient and contaminant concentrations in fish feed, farmed fish and wild caught fish, but occurrence data have also been derived from peer reviewed articles.

VKM has estimated fish consumption in three population groups (2-year-olds, adults and pregnant women). The estimated fish consumption was compared to national dietary guidelines.

To assess health effects of fish consumption, the current estimated fish intakes were also compared with assessments done by recognised international bodies and results from epidemiological studies addressing possible associations between fish consumption and specific health outcomes. Literature searches were done to identify relevant epidemiological studies. VKM has not systematically assessed reviews or meta-analyses nor individual studies for weight of evidence, but merely summarised the studies retrieved from the literature search. It was considered being beyond the scope of this assessment to review individual studies included in reviews or meta-analyses.

Furthermore, based on current fish consumption in the various population groups, intake of nutrients and exposure to contaminants from fish were estimated. For benefit characterisation of the specific nutrients the estimated nutrient intake was compared with national recommendations of nutrients intake and for EPA and DHA a comparison was also done with European recommendations. For risk characterization of contaminant exposure from fish, VKM used health based guidance values set by international risk assessment bodies (WHO, EFSA).

VKM noted that the request from NFSA was restricted to fish, whereas the VKM report in 2006 included both fish and other seafood.

VKM focused on specific nutrients and contaminants as requested by the NFSA. In addition, VKM also commented on other substances that could affect the risk assessment, such as residues of veterinary medicinal products including residues of antibiotics, new contaminants from fish feed like the pesticide endosulfan, polycyclic aromatic hydrocarbons (PAHs), mycotoxins, the synthetic antioxidants ethoxyquin, butylhydroxyanisole (BHA) and butylhydroxytoluene (BHT), as well as environmental contaminants like brominated flame retardants and perfluorated organic compounds.

In the Norwegian diet fish is important source of well-balanced proteins, and important nutrients such as EPA and DHA, vitamin D, iodine and selenium. On the other hand, fish is also a source of exposure to chemical contaminants like dioxins, PCBs and mercury.

Over the last 10 years there has been a great change in raw materials used in fish feeds, and in 2013 terrestrial plant proteins and vegetable oils accounted for 70% of the feed. The changes in concentrations of nutrients and contaminants in fish feed for farmed Atlantic salmon and trout are reflected in changed concentrations and compositions of the same nutrients and contaminants in the farmed fish fillet.

The current national dietary guideline is to eat fish as dinner meals 2-3 times per week for all age groups, representing 300-450 g fish per week for adults, including at least 200 g fatty fish, such as salmon, trout, mackerel and herring. Fish is also recommended as bread spread. Further, a daily supplement of vitamin D to infants from 4 weeks of age is recommended, and if this supplement is taken as cod liver oil it will in addition ensure an adequate supply of EPA and DHA.

The present benefit-risk assessment is comprised of three elements, i.e. benefit assessment, risk assessment and benefit-risk comparison. This methodology is in accordance with the guidance given by EFSA in 2010.

Fish Consumption in Norway and Comparison with National Dietary Guidelines

VKM has used information about fish consumption from more recent national dietary surveys among 2-year-olds (Småbarnskost 2007) and adults at 18-70 years of age (Norkost 3, 2010/2011), as well as information for pregnant women who answered the Norwegian Mother and Child Cohort Study (MoBa2, 2002-2008) food frequency questionnaire. The national food consumption survey Ungkost 2000, which covers the age groups 4-, 9-, and 13-year-old children, was considered too old to be used and it is therefore not known if their fish consumption patterns have changed, neither in amount consumed nor type of fish consumed.

Even though there are methodological differences between the dietary surveys used in 2006 and 2014, the amount of fish consumed appears to be unchanged for all population groups. Furthermore, in 2014, lean fish and fatty fish contribute with about 60 and 40 percent, respectively, of the total fish consumption, which is similar to 2006.

Given a portion size of 150 g fish, the average adult eats fish equivalent to 2-3 dinner servings per week and the average pregnant woman eats fish equivalent to 1-2 dinner servings per week, while the average two-year-old eats fish equivalent to 1-2 dinner servings per week given a portion size of 75 g. The table below describes fish intake in the selected populations.

Fish consumption (expressed as raw fish), mean grams (g) per week in 2-year-olds (Småbarnskost 2007, n=1674), adults (Norkost 3, n=1787) and pregnant women (MoBa, n=86277)


VKM concludes that of the different population groups, only adults (18-70 years of age) with an average or higher fish consumption reach the national food based dietary guidelines for total fish consumption. Mean total fish consumption and fatty fish consumption in children (2-year-olds) and pregnant women, as well as the mean fatty fish consumption in adults are lower than recommended. In pregnant women and 2-year-olds, fish consumption is too low to meet the food based dietary guidelines.

Health Effects of Fish Consumption

VKM is of the opinion that according to epidemiological studies, the net effects of the present average fish consumption in Norway for adults including pregnant women is beneficial for specific cardiovascular diseases (particularly cardiac mortality, but also with regard to ischaemic stroke, non-fatal coronary heart disease events, congestive heart failure and atrial fibrillation), as well as for optimal neurodevelopment of foetus and infants. Furthermore, VKM is of the opinion that those with fish consumption less than one dinner serving per week may miss these beneficial effects.

The health benefit of fish consumption is reported from 1-2 dinner servings per week and up to 3-4 dinner servings per week. For higher fish intake per week, the limited number of consumers in epidemiological studies does not allow for drawing firm conclusions about the actual balance of risk and benefit. More knowledge is needed to reveal the beneficial mechanisms of fish consumption.

Benefit Characterisation of Nutrients in Fish

VKM is of the opinion that there has been minor or no changes of the composition and concentrations of nutrients in wild caught fish since 2006.

Due to replacement of fish oil and fish protein with plant proteins and vegetable oils in feed for farmed fish, the concentrations in farmed Atlantic salmon with regard to EPA, DPA and DHA, and selenium are about 50 and 40% respectively, of the corresponding levels in 2006, while the concentration of vitamin D appears unchanged. The level of iodine in farmed Atlantic salmon was low in 2006, and is still low compared to lean fish. The level of n-6 fatty acids is about 4-fold higher than in 2006.

VKM has estimated the contribution from fish to the recommended daily intakes of certain nutrients. Fish is the major source of EPA+DPA+DHA, but for vitamin D, iodine and selenium, other sources in addition to fish are needed in order to meet the recommendation. Fish is not a major dietary source of n-6 fatty acids. The contribution of dietary n-6 fatty acids from farmed salmon compared to the overall dietary intake of n-6 fatty acids is low (less than 3%).

VKM concludes that with current average consumption of fish, the contribution of EPA and DHA from fish will reach the European recommended intake of EPA+DHA for adults and 2-year-olds. For pregnant women the average EPA+DHA intake is insufficient to meet the European recommendation for this group. However, the average intake of DHA is sufficient to meet the national intake recommendation for pregnant women.

For vitamin D, current average fish consumption contributes approximately 20% of the national recommended intakes for adults but less for pregnant women and 2-year-olds.

Furthermore, with current average fish consumption, low intakes of selenium and iodine from fish relative to the national recommended values may be complemented by intake from other dietary sources.

VKM has made various scenarios to foresee how possible changes in fish consumption pattern and amounts will affect the contribution from fish to recommended intakes of specific important nutrients. According to the scenarios, increasing the consumption of fatty fish will increase the intakes particularly of vitamin D, EPA+DPA+DHA, while increasing consumption of lean fish will increase the intakes particularly of iodine. Furthermore, VKM notes that the choice of fatty fish species, e.g. farmed Atlantic salmon, mackerel and herring is also of importance for nutrient intake due to differences in nutrient content.

Risk Characterisation of Undesirable Substances in Fish

The available concentration data of contaminants in wild fish is not suitable for time-trend analyses. A rough comparison of contaminant concentrations between 2006 and 2014 indicates minor or no changes in concentrations of mercury, dioxins and dl-PCBs in wild fish species. However, for dioxins and dl-PCBs, a decreasing environmental time-trend is expected to be reflected also in wild fish species.

Due to replacement of fish oil and fish protein with plant proteins and vegetable oils in farmed fish feed, the concentrations of dioxins and dioxin-like PCBs, and mercury have changed in farmed Atlantic salmon. VKM concludes that the current concentrations of dioxins and dl-PCBs, and mercury in farmed Atlantic salmon are reduced to about 30 and 50%, respectively, of the corresponding levels in 2006.

VKM has estimated the dietary exposure to contaminants from fish based on mean levels in different fish species and compared the exposure levels with the relevant health based guidance levels, tolerable weekly intakes (TWIs). A tolerable intake is the amount of a substance, or substance group, which can be consumed safely throughout a person's lifetime without appreciable risk of adverse health effects. Tolerable intakes incorporate safety margins, in order to protect all parts of the population.

VKM concludes that with the present mean concentration of mercury in fish on the Norwegian market and the present fish consumption in Norway, the methylmercury exposure from fish is below the tolerable weekly intake (TWI) of 1.3 µg/kg bw/ week for more than 95% of the population of 2-year-olds, adults and pregnant women. This exposure represents a negligible risk and is of no concern.

With the present mean level of dioxins and dl-PCBs in fish on the Norwegian market and the present fish consumption in Norway, high fish consumption (the 95th percentile) contributes with up to 50%, 19%, 67% of the TWI of 14 pg TEQ/kg bw/ week for adults, pregnant women and 2-year-olds respectively. Daily consumption of cod liver oil or fish oil (which is common in all population groups) in amounts as suggested on the product will in addition contribute with 0.8 to 16% of the TWI, depending on the body weight. With the present TWI and taking into consideration that fish and fish products are significant sources to dioxins and dl-PCBs in the Norwegian diet, VKM concludes that the exposure from fish to dioxins and dl-PCBs represents negligible risk and is of no concern.

VKM is of the opinion that the present exposure to residues of veterinary medicinal products including residues of antibiotics in farmed fish in the Norwegian diet is of no concern since the levels are very low and often not detectable even with sensitive analytical methods.

For new contaminants in fish feed like the pesticide endosulfan, polyaromatic hydrocarbon (PAHs) and mycotoxins, VKM is of the opinion that the concentrations in farmed fish in the Norwegian diet are likely not a food safety issue since the concentrations are very low and often not detectable even with sensitive analytical methods.

Regarding the environmental contaminants brominated flame retardants; VKM refers to the conclusions in a risk assessment from EFSA in 2011 that the health risk associated with the current exposure to these compounds is low. The amount of fluorinated compounds such as PFOS and PFOA in the Norwegian diet is much lower than what is tolerable according to an EFSA assessment in 2008.

VKM has made various scenarios to foresee how possible changes in fish consumption pattern and amounts will affect the exposure from fish to TWIs of methylmercury, and dioxins and dl-PCBs. Fish is the only source for methylmercury exposure from foods, whereas exposure to dioxins and dl-PCBs also comes from other foods than fish. Based on these scenarios, where only exposure to dioxins and dl-PCBs from fish were taken into consideration, VKM is of the opinion that fish consumption in line with the food-based dietary guideline of 300-450 g fish, hereof 200 g fatty fish per week, does not lead to exposures to dioxins and dl-PCBs or methylmercury from either fatty or lean fish exceeding the respective TWIs, and is therefore, from a contaminant exposure perspective, of no concern.
However, since there are other food sources in the Norwegian diet that contribute to exposure to these contaminants, VKM performed a simple model estimate of weekly intake of dioxins and dl-PCBs in adults from various amounts of farmed salmon and other foods. Based on this scenario, VKM is of the opinion that there is negligible risk associated with eating farmed Atlantic salmon with the present mean concentrations of dioxins and dl-PCBs. The TWI is not exceeded when consuming amounts equivalent to 1400 g farmed salmon weekly for adults (representing 9 weekly dinner servings). Neither is the TWI exceeded when exposures to dioxins and dl-PCBs from other foods and cod liver oil are taken into consideration. In comparison, an adult can consume about 800 g mackerel weekly (representing 5 weekly dinner servings) with current mean concentration of dioxins and dl-PCBs without exceeding TWI. From a contaminant exposure perspective consumption of farmed salmon is of no concern. This also applies for commercially available wild caught fish like mackerel.

Benefit – Risk Comparison

Following a comprehensive assessment of the scientific literature on the positive health effects of fish consumption and the contribution from fish to intake of beneficial compounds as well as exposure to hazardous contaminants in Norway, VKM concludes that the benefits clearly outweighs the negligible risk presented by current levels of contaminants and other known undesirable substances in fish. Furthermore, adults including pregnant women with fish consumption less than one serving per week may miss the beneficial effects on cardiovascular diseases and optimal neurodevelopment in the foetuses and infants. In contrast to the conclusion in 2006, VKM concludes that there is no reason for specific dietary limitations on fatty fish consumption for pregnant women.


This benefit-risk assessment is composed of several different parts. Various databases are used, including data on levels of nutrients and contaminants in fish feed and fish which may all contain uncertainties which in turn may influence the overall assessment. Furthermore, there may be uncertainties in the estimated fish consumption data retrieved from the dietary food surveys and there may be weaknesses in the epidemiological studies about health effects of fish consumption. Despite some limitations in assessing the fish consumption and the uncertainties related to the estimated intakes of nutrients and exposures to contaminants from fish and fish products, VKM concludes that the intake and exposure estimates presented in this opinion are within realistic ranges for each study population. VKM compared intakes of nutrients with national recommended intake values and exposures to contaminants with internationally recognised health based guidance values (tolerable intakes). Likewise, the benefits for health associated with fish consumption were also evaluated by international bodies, and the uncertainties in these assessments were not evaluated by VKM. VKM considers the overall uncertainty in the outcome of the present assessment on benefit and risk of fish consumption in Norway to be low.

Open Access Grey Literature

Risk Assessment of Folic Acid in Food Supplements

Margaretha Haugen, Wenche Frølich, Tor A. Strand, Grethe S. Tell

European Journal of Nutrition & Food Safety, Page 305-307
DOI: 10.9734/EJNFS/2015/19619

The Norwegian Scientific Committee for Food Safety (VKM) received a request from the Norwegian Food Safety Authority to assess whether the Tolerable Upper Intake Level (UL) of folic acid should be amended in light of new scientific evidence suggesting a possible link between high intake levels of folic acid and risk of cancer. Folic acid obtained from both food supplements and fortified foods should be assessed. Folic acid is a synthetic form of folate and is commonly used in food supplements and in food fortification because of its stability and bioavailability. Folic acid is reduced, methylated and released into the circulation. Natural folates occur in reduced forms, e.g. as tetrahydrofolate (THF), which are unstable and may thus loose biochemical activity during harvesting, storage, processing, and preparation.


Folate is cofactor for enzymes in one-carbon metabolism where it provides one-carbon units for the formation of RNA and DNA. Folate is also essential for the normal functioning of the methionine cycle, which is responsible for both the conversion of homocysteine to methionine and the production of the universal methyl donor S-adenosylmethionine (SAM). SAM donates its methyl group to more than 100 methyltransferases for a wide range of substrates such as DNA, hormones, proteins, neurotransmitters and membrane phospholipids.


While no Tolerable Upper Intake Level (UL) has been derived for natural dietary folates, the Scientific Committee on Food (SCF, 2000) set an UL of 1000 µg folic acid per day in 2000. The UL was set because it was found that high intakes of folic acid could correct megaloblastic anemia, which is the hallmark manifestation of vitamin B12 deficiency. In this way folic acid may mask vitamin B12 deficiency which again may cause irreversible neurological damage. The ULs for children and adolescents (1-17 years) were adjusted on the basis of body weight and range from 200 to 800 μg/day. The UL for folic acid has been reassessed by other authorities, most recently in 2009 by EFSA (EFSA, 2009), who upheld an UL of 1000 μg/day.


In 2009, Ebbing et al. published results from combined analyses of two randomised, placebo-controlled trials with B-vitamin supplementation in patients with ischemic heart disease. They found an increased risk of cancer in those who were randomised to receive folic acid in combination with vitamin B12 (Ebbing et al. 2009). Folates are important for cell division. It is therefore possible that tumor growth or growth of premalignant cells may be stimulated by high concentrations of folate in the blood. Another concern with use of folic acid is circulating unmetabolised folic acid (UMFA) which is often found at intakes of more than 200 µg per day (Kelly et al. 1997). It has been argued that UMFA could affect homeostatic regulation of folate (Smith et al. 2008), and that it may reduce natural-killer cell cytotoxicity (Troen et al. 2006). In vitro studies have also demonstrated that folic acid can down-regulate tumor suppressor genes (Lubecka-Pietruszewska et al. 2013).


This opinion addresses the question whether the current UL for folic acid should be amended based on new scientific evidence. Furthermore, VKM has been requested to estimate folic acid intake from food supplements and from foods that are fortified with folic acid, in all age groups in the population above 1 year. In addition, possible consequences of amending the maximum limit for folic acid in food supplements should be discussed.


In the literature search for this opinion (articles published from 2009 to 15 October 2014 were obtained), we found eight meta-analyses and five single studies where the aims were to study the relation between folic acid supplementation and incidence of cancer. Meta-analyses including studies in which folic acid was used in combination with other supplements were not included in the final evaluation, as the effect of folic acid could not be distinguished from the effect of the other substances. Only one meta-analysis was therefore considered relevant for the evaluation of UL for folic acid; a meta-analysis of patients with colorectal adenomas who received 1 mg folic acid per day for 3-6 years (Figueiredo et al. 2011). No increased risk of colorectal adenomas or cancer was found in this meta-analysis. Nor did the included single studies report increased risk of colorectal cancer following folic acid supplementation (Gao et al. 2013; Wu et al. 2009).


Brain tumor and childhood leukemia were investigated in two case-control studies in offspring of women using folic acid supplementation during pregnancy (Amigou et al. 2012; Milne et al. 2012). Both studies indicated no negative effects of folic acid supplementation during pregnancy.


A secondary analysis of one of the single studies on colorectal adenomas found a statistically significant increased risk of prostate cancer following folic acid supplementation (Figueiredo et al. 2009). However, the small number of prostate cancer cases in this single study does not make this result robust.


In six studies circulating UMFA was reported among subjects who used folic acid supplements or who were subjected to folic acid food fortification. Whether UMFA contributes to the development of cancer or other undesirable health effects is not known. These studies do not provide new evidence for amending the existing UL for folic acid.


About 26% of women and 18% of men aged 18-70 years participating in the nationwide dietary survey Norkost 3, reported to take folic acid supplements. The mean intake of folic acid among users was149 µg/day among women and 172 µg/day among men. Among pregnant women participating in The Norwegian Mother and Child Cohort Study, 62% reported use of folic acid supplements in 2008. Mean folic acid intake was 388 µg/day, and the 95th percentile was 800 µg/day. Information on intake of folic acid from supplements for other age groups is not available.


Intake of folic acid from fortified foods is not available in the national food consumption surveys for any age groups. However, according to a Norwegian model for food fortification from 2006 and later updates (last update in 2013), 53 µg folic acid per 100 kcal can be added to food and drinks without exceeding the UL for folic acid in any age groups. With the current levels of folic acid in food supplements and current levels in fortified products, the UL for folic acid will not be exceeded.


VKM was also requested to assess the impact of any increase of the current maximum limit of 200 µg for folic acid in supplements. Increasing the maximum limits in food supplements to 400 µg will imply exceedance of UL for children younger than 6 years and an intake close to UL in children 7-10 years. An increase in the maximum limits in food supplements to 600 µg will imply exceedance of UL for children younger than 10 years and an intake close to UL in children 11-14 years. Increasing the maximum limits in food supplements to 400 µg or 600 µg will not imply exceedance of UL among adults as evaluated in the Norwegian food fortification model (VKM, 2013).


No new evidence for increased risk of cancer related to folic acid was found in the reviewed literature. Studies in subjects who had a history of colorectal adenomas, a group considered particularly vulnerable to develop cancer, reported no increased risk of colon cancer or adenomas after 3-5 years of treatment with 1000 µg of folic acid per day. VKM therefore concludes that studies published after 2009 and until 15 October 2014 examining cancer do not provide support to alter the existing UL for folic acid.

Open Access Short Research Article

Dietary Patterns and Metabolic Syndrome in Adults

Maria Stella R. de Oliveira, Natielen J. Schuch, Vivian C. Garcia, Lígia A. Martini

European Journal of Nutrition & Food Safety, Page 297-304
DOI: 10.9734/EJNFS/2015/14973

Aims: Considering that diet is a potential factor contributing to the development of Metabolic Syndrome (MetS) and it is increasingly prevalent among population worldwide, the aim of the present study was to correlate dietary patterns with MetS and its main risk factors in adults.

Study Design: Cross-sectional.

Place and Duration of Study: School of Public Health, University of São Paulo, between August 2007 and January 2010.

Methodology: This study was conducted with 267 adults (189 women and 78 men) submitted to evaluation procedures which included body composition (waist circumference (WC), height and weight) and blood pressure measurements, biochemical analysis from a single blood sample after a 12-h fasting (serum triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c) and fasting glucose) and assessment of dietary intake using a 24-hour recall. Dietary patterns (DPs) were identified using principal components factor analysis with varimax orthogonal rotation.

Results: Three distinct DPs were identified from the principal component factor analysis: “Traditional”, “Healthy” and “Western”. Among individuals with MetS, there was a positive correlation between Healthy pattern and HDL-c (P = .03), as well as between Western pattern and WC, TG and LDL-c (P = .001, P = .04 and P = .047). In people without MetS, the negative correlation was observed between Traditional pattern and LDL-c (P = .049), and positive correlation between Healthy pattern and age, TC and, LDL-c (P = .01, P = .03 and P = .03).

Conclusion: Our assessment offers information concerning food combinations that may increase the risk and prevalence of MetS. However, more studies are required to confirm these findings and to assist in the prevention and development of specific nutritional recommendations for this syndrome.

Open Access Opinion Article

From Dietary Guidelines to Dietary Guidance?

Egbert Clevers, Miriam Urlings

European Journal of Nutrition & Food Safety, Page 250-259
DOI: 10.9734/EJNFS/2015/17435

One challenge is to make food consumption healthful and sustainable. Tools to achieve this include science-based documented dietary advice (here: 'dietary guidelines'), and policy-based initiatives and legislation (here: 'dietary guidance'). These two scientific and political tools operate independently, which may be counterproductive, especially if the future gives rise to high-impact scenarios of food crisis. This paper analyses, based on empirical trend data, the potential of dietary guidelines and guidance, and provides suggestions for these to align.
Trend-analyses and empirical data point out that dietary guidelines, although relevant, achieve limited uptake by the consumer. Scientists apparently lack the management tools and communication channels to effectively reach the consumer, and thus major changes are not expected. By contrast, emerging issues such as the obesogenic environment and climate change are likely to call for greater involvement of policy-makers.
This paper therefore advocates alignment of science and food policy. First, dietary guidelines, used for individual health promoting purposes, should be calibrated on global considerations. Guidelines on red meat consumption are recommended, as red meat consumption is a burden on both health and sustainability. Second, dietary guidance, used for global health and sustainability promoting purposes, should be calibrated on empowering the individual. Guidance in creating self-sufficient local food networks is recommended, as self-sufficient local food networks address both health and sustainability.

Open Access Policy Article

Developing the Right Public Health Strategies for Folic Acid and Reduction of Risk of Neural Tube Defects (NTDs) in the United Kingdom

David P. Richardson

European Journal of Nutrition & Food Safety, Page 242-249
DOI: 10.9734/EJNFS/2015/18093

The UK urgently needs a public health strategy for NTD reduction, which could include the use of food supplements, food fortification or a combination of both. An updated nutritional benefit-risk analysis is needed to inform population-based and/or targeted public health policies for folic acid intake and reduction of risk of neural tube defects. Policymakers should be cautious about the long-term exposure of the population as a whole to additional folic acid, especially potential adverse effects on the nervous system and brain function in older people, and higher levels of intake during infancy and childhood. The European-wide authorised health claim for folic acid food supplements and reduced risk of NTDs could transform the communication of the health benefits for women of childbearing age. Vitamin B12 deficiency may be an independent risk factor for NTDs, in which case dietary interventions with folic acid combined with vitamin B12 need to be considered.

Open Access Original Research Article

Association of Supplemental Nutrition Assistance Program (SNAP) with Food Security and Nutrition Status among Persons Living with HIV

Irene Hatsu, Fatma Huffman, Paulette Johnson, Marianna Baum, Barbara Thomlison, Adriana Campa

European Journal of Nutrition & Food Safety, Page 229-241
DOI: 10.9734/EJNFS/2015/10876

Aims: Nutritional status can be compromised by food insecurity which is common among HIV infected persons. Providing food assistance is expected to improve food insecurity and nutritional status among persons infected with HIV. This study aimed at examining the relationship of participating in the Supplemental Nutrition Assistance Program (SNAP), the largest food assistance program in the United States, with food security and nutritional status among HIV infected adults. 
Study Design: A cross-sectional study design was used in this study.
Place and Duration of Study: This study was conducted in Miami, FL, USA, between April 2011 and August 2012. 
Methodology: We included 159 HIV infected individuals in this study, 113 participants were SNAP recipients while 46 were not. All study participants were, however, eligible to participate in SNAP. Each participant completed demographic and food security surveys as well as dietary and nutrition status assessment. Statistical analyses were conducted using univariate and multivariate analyses.
Results: More than half (56%) of the sample experienced food insecurity and had inadequate intakes of several nutrients. There were no significant differences in food security level and nutritional status between SNAP participants and eligible non-participants, even after controlling for demographic and health characteristics. Individuals with very low food security had 4.7 times increased odds (95% CI: 1.29-17.38) of illicit drugs use, which was prevalent (38%) among HIV+ SNAP participants in Miami. Drug users were more than twice likely to have inadequate intakes of vitamins B1, B2, B6, and zinc, compared to non-drug users.
Conclusion: Our results do not support an association between SNAP participation and food security or nutritional status in this cohort of HIV infected individuals with prevalent substance abuse. However, it demonstrates that food insecurity and inadequate nutrient intake continues to be prevalent among HIV infected adults and it is related to drug abuse. Resources need to be identified and targeted at addressing both food insecurity and poor nutritional outcomes among populations of HIV infected adults.

Open Access Original Research Article

Prevalence and Characterization of Salmonella Isolated from Beef in Namibia

Renatus P. Shilangale, Godwin P. Kaaya, Percy M. Chimwamurombe

European Journal of Nutrition & Food Safety, Page 267-274
DOI: 10.9734/EJNFS/2015/17276

Aim: The purpose of this research was to determine the prevalence of Salmonella in raw beef produced from selected commercial abbatoirs in Namibia.

Methodology: A total of 9508 of beef samples from three different types of samples; meat cuts, carcass swabs and meat fluid were collected from the three local abattoirs over a period of two years starting from January 2008 to December 2009. Pre-enrichment for isolation of Salmonella was done in Buffered peptone water followed by enrichment in the Rappaport-Vassiliadis and selenite cystine broth. The isolation of Salmonella was done on Xylose Lysine Desoxycholate and Brilliant Green agar followed by biochemical confirmation and serotyping according to Kauffman-White scheme.

Results: The overall prevalence of Salmonella was 0.85% for beef samples derived from meat cuts, meat fluid and carcass swabs. The prevalence of Salmonella in carcass swabs (2.67%) was significantly different (P= 0.05) from that of meat cuts (0.50%) and meat fluid (0.43%). No significant difference (= 0.05) on the prevalence of Salmonella existed between the meat cuts and meat fluid. A total of 34 different types of Salmonella serovars were identified with S. Chester being the most frequently isolated serovars (n = 12), followed by S. Reading and S. Bredeney (n = 6) and S. Typhimurium (n = 5).

Conclusions: The prevalence of Salmonella in raw beef found in this survey was lower than those observed in Sub Sahara Africa with S. Chester being the most prevalent serovar.

Open Access Original Research Article

Health Risks Associated with Freshwater Fish Consumption

Angelika A. Linowska, Ewa Sobecka

European Journal of Nutrition & Food Safety, Page 275-280
DOI: 10.9734/EJNFS/2015/17597

Aims: To determine the prevalence and density of the larval digenean trematode Paracoenogonimus ovatus in fish muscle tissue. To determine larval survival under selected thermal conditions.

Place and Duration of Study: Division of Hydrobiology, Ichthyology and Biotechnology of Breeding, West Pomeranian University of Technology, Szczecin, October 2009 and 2014.

Methodology: Twelve fish species from Lake Dąbie (Poland) that are exploited by both commercial and recreational fisheries were selected. Samples of muscle tissue were weighed and then viewed under a trichinoscope where encysted P. ovatus larvae (metacercariae) could be counted. Then, they were subjected to artificial digestive juice (0.1% activated pepsin and 5% citric acid) to facilitate isolating the cysts from the muscle tissues. The parasites that were isolated were removed from their shells, and the species was identified. Further, ten freshwater bream fillets with encysted larvae were placed under refrigeration (4ºC) and frozen (-18ºC); larval viability was checked after 24, 48, and 78 h.

Results: The prevalence of P. ovatus larvae increases (76.5% in 2009 and 80.5% in 2014). The highest density was noted in roach (Rutilus rutilus), freshwater bream (Abramis brama), and white bream (Blicca bjoerkna). It was confirmed that metacercariae are resistant to decreases in temperature to 4ºC, but that further reducing the temperature to -18ºC results in larval death in 24 h.

Conclusion: Many species of freshwater fishes are infected by P. ovatus metacercariae. Eating improperly prepared fish and fisheries products may provide serious health problems. Further studies are needed to neutralize the living metacercariae in raw materials and food products.

Open Access Original Research Article

Nutritional Risk Assessment of Eleven Minerals and Trace Elements: Prevalence of Inadequate and Excessive Intakes from the Second French Total Diet Study

Esther Kalonji, Véronique Sirot, Laurent Noel, Thierry Guerin, Irène Margaritis, Jean-Charles Leblanc

European Journal of Nutrition & Food Safety, Page 281-296
DOI: 10.9734/EJNFS/2015/18193

Aims: Adequate coverage of nutrient requirements is a real health concern and surveillance of the nutritional status of a population is a key element for public policies. This study aimed at providing a reliable nutritional risk assessment of the French population based on prevalences of inadequate and excessive intakes of eleven minerals and trace elements.

Methodology: Intakes from foods (dietary supplements excluded) were estimated by combining composition data from the second national Total Diet Study (TDS2/2007-2009) and consumption data from the Individual and National Study on Food Consumption.  Results were compared with those from other TDSs.

Results: Sodium intakes exceeded World Health Organization (WHO) guidance values, respectively for 74% of adults, and for 76% of children. For calcium and magnesium, the prevalence of inadequate intakes in adults and children ranged from approximately 50 to 70% to over 80% in teenagers. Prevalences of inadequacy were 13% in adults and 18% in children for selenium, and 40% in children and 74% in 16-17 year-old girls for iron.

Conclusion: These substantial risks of inadequate intakes should be considered in the light of nutritional status biomarkers. Furthermore, effort to reduce excessive intakes of sodium in the French population should be maintained.

Open Access Review Article

Symposium Report: Effective and Safe Micronutrient Interventions, Weighing the Risks against the Benefits

Ingrid Bielderman, Maaike J. Bruins, Reina Engle-Stone, Noel W. Solomons, Hans Verhagen, Lindsay H. Allen, Lynnette M. Neufeld, Klaus Kraemer, Jane Badham

European Journal of Nutrition & Food Safety, Page 202-228
DOI: 10.9734/EJNFS/2015/17357

Micronutrient fortification of staple foods can be an effective strategy to combat micronutrient malnutrition. When planning on fortification, challenges faced include the collection of essential information on population food and nutrient intake patterns, as well as the use of this information in a method to select appropriate fortification levels. A symposium was organized aimed at discussing the existing approaches to set effective and safe micronutrient fortification levels and to outline the challenges and needs in this area. Two different approaches to establish effective and safe fortification levels for food fortification were presented. In the first approach, the Estimated Average Requirement (EAR) and Tolerable Upper Intake Level (UL) are used as cut-points in the micronutrient intake distribution to evaluate and simulate effective and safe micronutrient intakes. This was exemplified by challenges encountered in Guatemala and Cameroon towards unequal vitamin A intake distribution and the impact of the food vehicle choice. Secondly, the risk-benefit approach was presented as an approach in which risks and benefits of micronutrient intakes can be quantified and balanced in order to optimize fortification benefits with the least risks and to allow decision making. This was illustrated by a case on folic acid fortification in The Netherlands.
Irrespective of the approach, food and nutrient intake data are required to identify potential vehicles for fortification, quantify the nutrient gap to be addressed, and set the appropriate level of fortification based on consumption pattern. Such information is rarely available to the quality and extent ideal to set fortification levels and requires regular updating, as exemplified in the case of sugar fortification in Guatemala. While the EAR cut-point method can be used to determine the proportion of the population meeting their required and safe nutrient intakes and set goals, risk-benefit assessment may offer an answer to commonly-asked questions as to whether, and at which levels, the benefits of increasing micronutrient intakes outweigh the risks.