Browsing by Author "Pires, Sara"
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- Avaliação de risco-benefício associado à alimentação: um instrumento para uma melhor política alimentar e de saúde na EuropaPublication . Brazão, Roberto; Fernandes, Paulo; Martins, Carla; Nabais, Pedro; Torres, Duarte; Pires, Sara; Thomsen, S.; Jakobsen, L.; Géraldine, B.; Membré, J.; Assunção, Ricardo; Alvito, PaulaO RiskBenefit4EU (GP/EFSA/AFSCO/2017/01 - GA02) é um projeto europeu, financiado pela EFSA, que visa fortalecer a capacidade de avaliação de risco-benefício associado à alimentação na União Europeia (UE), aplicando uma abordagem holística. Este projeto resulta de uma parceria entre instituições de investigação & desenvolvimento e académicas, das áreas da saúde, alimentação e nutrição, e autoridades nacionais de segurança alimentar, de Portugal (país coordenador), Dinamarca e França.
- Building capacity in risk-benefit assessment of foods: lessons learned from the RB4EU projectPublication . Assunção, Ricardo; Alvito, Paula; Brazão, Roberto; Carmona, Paulo; Fernandes, Paulo; Jakobsen, Lea S.; Lopes, Carla; Martins, Carla; Membré, Jeanne-Marie; Monteiro, Sarogini; Nabais, Pedro; Thomsen, Sofie T.; Torres, Duarte; Viegas, Silvia; Pires, Sara; Boué, GeraldineBackground: Human diet may present both risks and benefits to consumers’ health. Risk-benefit assessment of foods (RBA) intends to estimate the overall health impact associated with exposure (or lack of exposure) to a particular food or food component. Scope and approach: “RiskBenefit4EU – Partnering to strengthen the risk-benefit assessment within EU using a holistic approach” (RB4EU) is a project funded by the European Food Safety Authority (EFSA) that integrates a multidisciplinary team from Portugal, Denmark and France. This project aims to strengthen the EU capacity to assess and integrate food risks and benefits regarding toxicology, microbiology and nutrition. One of the specific objectives of RB4EU was to build capacity in RBA among the recipient partners from Portugal. In order to achieve this objective, a capacity building strategy including theoretical and hands-on training and the development of a case-study were established. This paper aims to present the strategy used in the RB4EU project to build capacity within RBA, including the main training approaches and the lessons learned. Key findings and conclusions: The capacity-building program included three main activities: theoretical training, focusing on RBA concepts; hands-on training, applying the acquired concepts to a concrete case-study, using the methods and tools displayed; and scientific missions, intending to provide advanced training in specific domains of RBA. The developed strategy can be used in the future to build capacity within RBA.
- Building capacity in risk-benefit assessment of foods: lessons learned from the RB4EU ProjectPublication . Boué, Géraldine; Assunção, Ricardo; Alvito, Paula; Brazão, R.; Carmona, Paulo; Carvalho, Catarina; Correia, D.; Fernandes, Paulo; Jakobsen, Lea; Lopes, Carla; Martins, Carla; Membré, Jeanne-Marie; Monteiro, Sarogini; Nabais, Pedro; Thomsen, Sofie; Torres, Duarte; Pires, SaraRisk-Benefit Assessment (RBA) of food, food ingredients and diets, has recently emerged to address multidisciplinary public health issues. RBA aims to assess in a global perspective potential risks and benefits related to microbiology, toxicology and nutrition; in order to evaluate different options and to support decision-making process. At this time, significant methodological progress have been made but only few research groups have experience in RBA. To promote knowledge transfer, the RiskBenefit4EU project was funded by the European Food Safety Authority (EFSA). The objective of the presentation will be to introduce the strategy developed to capacitate a new team in RBA and to give an overview on lessons learned from this experience. The new team was comprised of experts in risk assessment in toxicology, microbiology or nutrition, epidemiology, dietary assessment or data analysis to answer to a specific multidisciplinary public health issue on cereal-based foods consumed by young children considering breakfast and infant cereals. Activities of the capacity building experience were designed by experienced researchers in RBA to transfer a harmonized methodology. Two weeks of face-to-face training were organized, one on theoretical concepts used in RBA and one on their application to the cereal case study. This experience has highlighted the necessity to build a common language within the team by harmonizing important concepts including hazard, health effect, adverse health effect, beneficial health effect, risk, benefit, health and health impact. It was also important that all participant learn basis of all area of expertise used in RBA. A harmonized RBA stepwise approach was introduced with key steps illustrated with examples of previous RBA performed. Finally, the RBA case study was initiated to design a shared protocol. The learning by doing process experienced under the RB4EU project enabled to create the first training in RBA. The strategy developed, with materials and method used, can now be re-used to capacitate other new teams in RBA and can be considered as a robust basis to build on.
- Burden of Disease Methods: a Guide to Calculate COVID-19 Disability-Adjusted Life YearsPublication . Wyper, Grant; Assunção, Ricardo; Colzani, Edoardo; Grant, Ian; Haagsma, Juanita A; Lagerweij, Giske; Von der Lippe, Elena; McDonald, Scott A.; Pires, Sara; Porst, Michael; Speybroeck, Niko; Devleesschauwer, BrechtBackground: To date, most efforts to understand the comparative population health impact of COVID-19 have been made using mortality-based metrics. This has intensified discussion over methodological choices; in particular, how we value the life-years prematurely lost due to COVID-19. So far, the direct impact of COVID-19 on population health has varied across countries, with wide variation in incidence and infection fatality rates. Understanding and quantifying the combined impact of morbidity and mortality is a key step to standardizing comparisons across countries, and to quantify the within-country impact of COVID-19 relative to other causes of disease and injury, sub-national areas or demographics. This can be achieved by estimating summary measures of population health like disability-adjusted life years (DALYs). The estimation of DALYs is useful to provide comprehensive and comparative public health intelligence to inform decision-making for the management of the COVID-19 pandemic, particularly around the extent of direct and indirect consequences. At present, the Global Burden of Disease (GBD) study has not integrated COVID-19. Some studies have already estimated DALYs due to COVID-19. The first published assessment was performed for Korea, up until the end of April 2020. An assessment, using a similar time frame, followed for Italy. To date, published studies have only included one COVID-19 related health state, or disability weights were country-specific. Aim: Our paper provides a step-by-step guide to define COVID-19 as a cause of disease burden, which can be used to calculate DALYs. Additionally, we suggest pragmatic data inputs, reflecting that availability and quality of data inputs will vary by country. This paper builds on previous DALY calculation guides. As our paper provides suggestions for different solutions, we recommend that users should be clear about their methodological choices to aid comparisons and knowledge translation.
- Climate change and the health impact of aflatoxins exposure in Portugal – an overviewPublication . Assunção, Ricardo; Martins, Carla; Viegas, Susana; Viegas, Carla; Jakobsen, Lea S; Pires, Sara; Alvito, PaulaClimate change has been indicated as a driver for food safety issues worldwide, mainly due to the impact on the occurrence of food safety hazards at various stages of food chain. Mycotoxins, natural contaminants produced by fungi, are among the most important of such hazards. Aflatoxins, which have the highest acute and chronic toxicity of all mycotoxins, assume particular importance. A recent study predicted aflatoxin contamination in maize and wheat crops in Europe within the next 100 years and aflatoxin B1 is predicted to become a food safety issue in Europe, especially in the most probable scenario of climate change (+2°C). This review discusses the potential influence of climate change on the health risk associated to aflatoxins dietary exposure of Portuguese population. We estimated the burden of disease associated to the current aflatoxin exposure for Portuguese population in terms of Disability Adjusted Life Years (DALYs). It is expected that in the future the number of DALYs and the associated cases of hepatocellular carcinoma due to aflatoxins exposure will increase due to climate change. The topics highlighted through this review, including the potential impact on health of the Portuguese population through the dietary exposure to aflatoxins, should represent an alert for the potential consequences of an incompletely explored perspective of climate change. Politics and decision-makers should be involved and committed to implement effective measures to deal with climate change issues and to reduce its possible consequences. This review constitutes a contribution for the prioritisation of strategies to face the unequal burden of effects of weather related hazards in Portugal and across Europe.
- Escolhas alimentares sustentáveis: o contributo do projeto ALTERNATIVA enquanto ferramenta para a escolha de fontes alternativas de proteínaPublication . Serôdio, Ana; Biasini, Beatrice; Boué, Géraldine; Castanheira, Isabel; Cozzi, Elena; Federighi, Michel; Jakobsen, Lea; Martins, Carla; Menozzi, Davide; Motta, Carla; Naska, Androniki; Niforou, Katerina; Pavel, Marta; Pires, Sara; Poulsen, Morten; Assunção, RicardoO aumento da população humana e a consequente pressão exercida pelos sistemas alimentares desafiam a saúde e o meio ambiente, cujo impacto se reflete, entre outros, ao nível das alterações climáticas associadas ao aquecimento global, exploração de recursos naturais e da perda de biodiversidade. Entre os fatores que mais contribuem para esse impacto está a produção de proteínas de origem animal, como a carne vermelha e os lacticínios. Neste sentido, urge uma transformação dos sistemas alimentares, sendo que esta transformação deverá ser sustentada numa avaliação dos impactos de fontes alternativas de proteínas, quer na saúde quer na sustentabilidade. Este artigo tem como principal objetivo discutir os desafios colocados aos sistemas alimentares e a necessidade de avaliar o impacto destes, à luz do projeto ALTERNATIVA (Alternative sources of protein in European diets – integrating risk-benefit for health and sustainability) como uma ferra menta para o desenvolvimento sustentável nas diferentes vertentes – ambiental, social e económica, através de uma metodologia que reúne e combina conhecimentos em avaliação do risco-benefício (ARB) de alimentos e a avaliação da sustentabilidade. A utilização de abordagens holísticas, como a que está a ser aplicada no projeto ALTERNATIVA com o objetivo de fornecer ferramentas inovadoras para apoiar decisões sobre as futuras dietas, é fundamental para minimizar os efeitos dos desafios atuais tentando garantir alimentos seguros, economicamente justos, acessíveis, dietas nutricionalmente adequadas e saudáveis com menores impactos ambientais.
- Fontes alternativas de proteínas nas dietas europeias: a contribuição do projeto ALTERNATIVA para a perspetiva One HealthPublication . Serôdio, Ana; Biasini, Beatrice; Boué, Géraldine; Cozzi, Elena; Federighi, Michel; Jakobsen, Lea; Martins, Carla; Menozzi, Davide; Motta, Carla; Naska, Androniki; Niforou, Katerina; Pavel, Marta; Pires, Sara; Poulsen, Morten; Assunção, RicardoA abordagem como a One Health, baseada em princípios que promovem a coexistência saudável, bem-estar e sustentabilidade entre humanos, animais e ambiente, tem surgido como indispensável para fazer face aos diversos problemas globais associados às alterações climáticas e sus- tentabilidade. A mesma multidisciplinaridade do conceito One Health é, também, uma característica do conceito e aplicação da Avaliação de Risco-Benefício (ARB). Este estudo tem como objetivo demonstrar de que forma é que o projeto ALTERNATIVA – Alternative protein sources in the European diets integrating health risk-benefit and sustainability (Fontes alternativas de proteínas nas dietas europeias – integrando risco-benefício para a saúde e sustentabilidade) contribui para o desenvolvimento e aplicação do conceito One Health, tendo por base a ARB de diferentes dietas alimentares. Realizou-se uma pesquisa bibliográfica sobre o conceito “One Health” através da base de dados Pubmed/U.S. National Library of Medicine e no Google Scholar, nos quais foram efetuadas pesquisas avançadas, que in- cluíram os termos: “One health approach”, “Risk benefit food one health”, “Alternative protein”, “One health food” e “One health food assessment”. Os resultados deste estudo demonstram de que forma é que o projeto ALTERNATIVA, através das suas diferentes atividades desenvolvidas, integra os principais pilares do conceito One Health (Humano, Animal e Ambiental) em todas as suas dimensões. Conclui-se que o projeto ALTERNATIVA aliado ao conceito One Health, constitui uma ferramenta inovadora para apoiar as melhores decisões sobre as dietas do futuro, garantindo a nutrição humana e a saúde planetária, ao contribuir para a mitigação das tendências adversas que estão diretamente associadas às nossas escolhas alimentares.
- Identification of risks and benefits associated to the consumption of raw milk: the first step of a risk-benefit assessmentPublication . Assunção, Ricardo; Pires, Sara; Nauta, MartenMilk is a highly nutritious food. Due to consumers’ perception that raw milk (RM) is a better source of nutrients and other active components there is currently considerable debate on the potential health benefits of consumption of RM compared to pasteurized milk (PM). Current trends advocating for “consuming natural” and “purchasing locally” have contributed to the increased popularity of RM in some countries (e.g. Italy, Estonia and the US). Claimed health benefits are e.g. “higher nutritional value”, especially in terms of vitamins’ contents, “beneficial microflora” as probiotic bacteria, and “allergy prevention”. However, several human pathogens can be present in RM and have been identified as the cause of several foodborne outbreaks. Consequently, this new trend encourages a proper assessment of the associated risks and benefits through a quantitative risk-benefit assessment (RBA). Traditionally, RBA considers as a first step the identification of the risks and the benefits posed by the considered food product, gathering scientific evidence for the inclusion or exclusion of each food component. This study aimed to identify the risks and the benefits associated to the consumption of RM when compared to PM. Through literature search, the nutritional, toxicological and microbiological food components that could be present in RM and PM were identified. For each identified food component, scientific evidence were analysed to support the decision about the inclusion or exclusion of each food component. Microbiological pathogens (Listeria monocytogenes, Salmonella spp., Campylobacter jejuni and Shiga toxin-producing Escherichia coli), probiotic bacteria (Lactobacillus spp.) and nutritional components (vitamins B2 and A) were identified, as well as the potential impact of RM in the reduction of the allergies’ prevalence. Since it is not expected that heat-treatment could affect the occurrence of chemical toxic compounds in milk, no toxicological components were identified in the assessment. We identified the main components that should be considered in RBA of RM consumption. Such a quantitative RBA will contribute to inform the consumers about the magnitude of the risk and the expected health impact.
- Nut consumption in Portugal: the balance between the risks and the benefits regarding liver cancer and cardiovascular diseasePublication . Assunção, Ricardo; Jakobsen, Lea; Alvito, Paula; Carmona, P.; Carvalho, C.; Lopes, C.; Martins, C.; Monteiro, Sarogini; Nabais, P.; Correia, D.; Torres, D.; Viegas, Carla; Viegas, S.; Nauta, Marten; Pires, SaraNuts are rich sources of cis-unsaturated fatty acids, fibre, vitamins, minerals, and a number of bioactive substances and the regular consumption of nuts are being associated with a reduction in all-cause mortality, particularly cardiovascular disease (CVD). At the same time, the occurrence of mycotoxins in nuts, including the most potent carcinogenic aflatoxins (AFTs), has been reported by several authors worldwide. According to the National Food, Nutrition and Physical Activity Survey (IAN-AF 2015-16), the usual consumption of nuts by the Portuguese adults is 2.7 g/day. Some recent epidemiological studies (e.g. PREDIMED) suggested that a daily nuts consumption of 30 g could reduce the incidence of CVD. The present study aimed to quantify the health impact in terms of Disability-adjusted life years (DALY) of increasing nut consumption to 30 g/day by adult Portuguese population, when compared to the current intake. Regarding nut consumption, two scenarios were established: current consumption (CS) – 2.7 g/day; alternative scenario (AS) – 30 g/day. AFTs occurrence in nuts available in Portuguese market and nut consumption data were used to estimate AFTs intake. Epidemiological and National population data were used to estimate the DALYs, considering two different endpoints: the occurrence of hepatocellular carcinoma due to exposure to AFTs (IPSC/WHO) and the prevention of acute myocardial infarction due to nuts’ consumption (PREDIMED). A mean daily intake of AFTs of 0.013 (CS) and 0.142 (AS) ng/kg bw/day was predicted. This intake is estimated to cause 0.013 (CS) and 0.15 (AS) extra cases of Hepatocellular Carcinoma, corresponding to 0.2 (CS) and 2.7 (AS) annual DALYs. In contrast, the estimated number of preventable cases of myocardial infarction due to the increasing of nut consumption to 30 g/day was 1402 and the DALYs gained was 5658. Integrating risks and benefits, 5656 annual DALYs could be potentially saved. These results suggest an overall beneficial health effect of increased nut consumption in Portugal. Therefore, it seems not advisable to reduce exposure to AFTs by recommending a reduced intake of nuts.
- Raw drinking milk: when potential health benefits face the foodborne pathogens – a risk-benefit studyPublication . Assunção, Ricardo; Pires, Sara; Nauta, M.Introduction: Milk is a highly nutritious food, and currently there is a considerable debate on the potential health benefits of consumption of raw milk (RM) compared to pasteurized milk (PM). Claimed health benefits are e.g. “higher nutritional value”, especially regarding vitamins, “beneficial microflora” as probiotic bacteria, and “allergy prevention”. However, several human pathogens can be present in RM and have been identified as the cause of several foodborne outbreaks. Methodology: The objective of this study was to assess the risk-benefit balance and quantify the health impact of RM consumption in terms of Disability-adjusted life years (DALY). The microbiological hazards Listeria monocytogenes, Salmonella spp., Campylobacter jejuni and Shiga toxin-producing Escherichia coli were considered next to potentially beneficial components such as vitamins A and B2. Mathematical modeling, including predictive modeling of bacterial inactivation and growth, were used to quantify the DALYs associated to the consumption of RM directly from vending machines. Published data were used to perform exposure assessment (initial concentration and prevalence of pathogens, growth models of pathogens in milk according to different storage conditions), hazard characterization (dose-response models) and risk characterization (estimating the number of cases due to milk consumption). BCoDE was used to estimate the associated DALYs. Dutch food composition database was used to estimate the vitamins A and B2 intake through milk consumption. Modelling resources and GBD Results Tool were used to establish the associated risk prevention and to estimate the associated DALYs, respectively. Results: Despite the evidence for health benefits is limited and that the included pathogens do not reach high levels under proper storage, in extreme conditions (3 days under 8°C), 7.6 DALYs/year were estimated to be lost due to listeriosis. Still, preventable DALYs/year associated to vitamins would not exceed 1. Conclusions and Relevance: Quantification into DALYs will aid the public debate on the possible benefits and risks regarding the growing popularity of the consumption of RM. The added value of such a quantitative assessment is that consumers can be informed on the magnitude of the risk and the expected health impact. Special efforts are needed to control storage and to ensure the safety of RM.