Public health economic evaluation of different European Union–level policy options aimed at reducing population dietary trans fat intake.

Background: The adverse relation between dietary trans fatty acid (TFA) intake and coronary artery disease risk is well established. Many countries in the European Union (EU) and worldwide have implemented different policies to reduce the TFA intake of their populations. Objective: The aim of this study was to assess the added value of EU-level action by estimating the cost-effectiveness of 3 possible EU-level policy measures to reduce population dietary TFA intake. This was calculated against a reference situation of not implementing any EU-level policy (i.e., by assuming only national or selfregulatory measures).post-print582 K

Trans fatty acids in Europe: where do we stand?

Trans fatty acids (TFA) are a particular type of unsaturated fatty acid. They are naturally present in food products made from ruminant animals such as dairy and meat from cattle, sheep or goat (naturally occurring ruminant TFA or rTFA) but can also be produced industrially (TFA of industrial origin or iTFA). Consumption of TFA is associated with increased risk of coronary heart disease (CHD). The European Food Safety Authority (EFSA) states that ‘TFA intakes should be as low as is possible within the context of a nutritionally adequate diet'. Denmark was the first country to adopt legislation limiting the content of TFA in foods in 2003. Since 2003, Switzerland (2008), Austria (2009), Iceland (2011), Hungary (2013) and Norway (2014) have legislation in place and now also limit the content of TFA in foodstuffs. EU legislation does not regulate the content of TFA in foodstuffs nor does it require its labelling.The European Parliament and the Council have however requested as part of the recent Regulation (EC) No1169/11 on the provision of food information to consumers that the European Commission (EC) reports on ‘the presence of trans fats in foods and in the overall diet of the Union population’. It is expected that the results can inform further decisions on introducing, at European level, ‘appropriate means that could enable consumers to make healthier food and overall dietary choices or that could promote the provision of healthier food options to consumers, including, among others, the provision of information on trans fats to consumers or restrictions on their use’. This report is a first step in addressing this request. The analysis of the most recent publicly available data confirms reported reduction of TFA in foods but also shows that there are still a number of foods with high levels of TFA (above 2g TFA per 100g of fat) in some European food markets. Results from dietary surveys also indicate that although the overall population TFA intake is below the World Health Organization (WHO)-recommended maximum of 1 E% there are subpopulations exceeding the recommended threshold. As long as products with high TFA content remain in the food market, it is possible that individuals may consume more than the recommended maximum. As it stands, there appears to be room for improvement of the European situation as regards the presence of iTFA in foodstuffs.JRC.I.2-Public Health Policy Suppor

Public health economic evaluation of different European Union–level policy options aimed at reducing population dietary trans fat intake

Background: The adverse relation between dietary trans fatty acid (TFA) intake and coronary artery disease risk is well established. Many countries in the European Union (EU) and worldwide have implemented different policies to reduce the TFA intake of their populations. Objective: The aim of this study was to assess the added value of EU-level action by estimating the cost-effectiveness of 3 possible EU-level policy measures to reduce population dietary TFA intake. This was calculated against a reference situation of not implementing any EU-level policy (i.e., by assuming only national or self-regulatory measures). Design: We developed a mathematical model to compare different policy options at the EU level: 1) to do nothing beyond the current state (reference situation), 2) to impose mandatory TFA labeling of prepackaged foods, 3) to seek voluntary agreements toward further reducing industrially produced TFA (iTFA) content in foods, and 4) to impose a legislative limit for iTFA content in foods. Results: The model indicated that to impose an EU-level legal limit or to make voluntary agreements may, over the course of a lifetime (85 y), avoid the loss of 3.73 and 2.19 million disability-adjusted life-years (DALYs), respectively, and save >51 and 23 billion euros when compared with the reference situation. Implementing mandatory TFA labeling can also avoid the loss of 0.98 million DALYs, but this option incurs more costs than it saves compared with the reference option. Conclusions: The model indicates that there is added value of an EU-level action, either via a legal limit or through voluntary agreements, with the legal limit option producing the highest additional health benefits. Introducing mandatory TFA labeling for the EU common market may provide some additional health benefits; however, this would likely not be a cost-effective strategy.JRC.F.1-Health in Societ

OpenFoodTox: EFSA's chemical hazards database

<p><strong>Background: EFSA's remit and chemical risk assessment of regulated products and contaminants</strong></p> <p>The European Food Safety Authority (EFSA) has the remit to provide scientific advice to risk managers and decision makers through risk assessment and risk communication on issues related to “food and feed safety, animal health and welfare, plant health, nutrition, and environmental issues”. Risk assessment has been defined as "a scientifically based process consisting of four steps: hazard identification, hazard characterisation, exposure assessment and risk characterisation" (EC, 2002). </p> <p>In the food and feed safety area, hazard identification and hazard characterisation aim to determine safe levels of exposure for regulated products or contaminants as “reference values¹” to protect human health, animal health, environmental-relevant species or the whole ecosystem. Such reference values for a given species are most often derived by using a “reference point²" determined from the critical toxicological study on which an uncertainty factor³ is applied.</p> <p>Since its creation in 2002, the European Food safety Authority (EFSA) has produced risk assessments for <strong>more than 4,750 unique substances</strong> in <strong>over 1,800 Scientific Opinions, Statements and Conclusions</strong> through the work of its scientific Panels, Units and Scientific Committee. </p> <p>For regulated products, these risk assessments have been performed by five <a href="http://www.efsa.europa.eu/en/science/scientific-committee-and-panels">scientific panels</a> and four supporting units. </p> <p> </p> <p> <strong>EFSA's chemical Hazards Database : OpenFoodTox </strong></p> <p>OpenFoodTox is a structured database summarising the outcomes of hazard identification and characterisation for the human health (all regulated products and contaminants), the animal health (feed additives, pesticides and contaminants) and the environment (feed additives and pesticides). </p> <p>OpenFoodTox the substance characterisation, the links to EFSA’s related output, background European legislation, and a summary of the critical toxicological endpoints and reference values.</p> <p>For each individual substance, the data model of OpenFoodTox has been designed using OECD Harmonised Template (OHTs) as a basis to collect and structure the data in a harmonised manner. OpenFoodTox provides open source data for the substance characterisation, EFSA outputs, reference points, reference values and genotoxicity. OpenFoodTox and can be searched under the following link using a microstrategy tool: <a href="https://dwh.efsa.europa.eu/bi/asp/Main.aspx?rwtrep=400">https://dwh.efsa.europa.eu/bi/asp/Main.aspx?rwtrep=400</a></p> <p>In order to disseminate OpenFoodTox to a wider community, two sets of data can be downloaded:</p> <p><strong>1. </strong>Five individual spreadsheets extracted from the EFSA microstrategy tool providing for all compounds: a. substance characterisation, b. EFSA outputs, c. reference points, d. reference values and, e. genotoxicity.</p> <p><strong>2. </strong>The full database.</p> <p>OpenFoodTox contributes actively to EFSA’s 2020 Science Strategy (EFSA, 2016) and to the aim of widening EFSA’s evidence base and optimising access to its data as a valuable open source toxicological database that can be shared with all scientific advisory bodies and stakeholders with an interest in chemical risk assessment. In addition, OpenFoodTox has been submitted to the OECD’s Global Portal to Information on Chemical Substances (<a href="https://www.echemportal.org/">eChemPortal</a>) so that individual substances can be searched as part of the national and international databases. Further description and associated references are described in the EFSA journal editorial (Dorne et al., 2017).</p> <p> </p> <p><strong>Using OpenFoodTox to develop innovative <em>in silico</em> models</strong></p> <p>Recently, <em>in silico</em> models using OpenFoodTox have been developed for ecological risk assessment  (bees and rainbow trout) and  human risk assessment using rat toxicological data (Como et al., 2017; Benefenati et al., 2017; Toporov et al., 2017, Toporov et al., 2018). These <em>in silico </em>models provide alternative means to animal experiments for the  hazard identification and characterisation of chemicals, and are becoming of increasing interest in the risk assessment community to deliver the 3Rs (replacement, reduction, refinement) (Hartung, 2004; OECD, 2005) particularly since the banning of animal testing for the approval of cosmetics as consumer products (Regulation (EC) No. 1223/2009, Art.18(2)).</p> <p> </p> <p> </p> <p>Definitions</p> <p>¹Reference Value : The estimated maximum dose (on a body mass basis) or the concentration of an agent to which an individual may be exposed over a specified period without appreciable risk. Reference values are established by applying an uncertainty factor to the reference point. Examples of reference values in human health include acceptable daily intake (ADI) for food and feed additives, and pesticides, tolerable upper intake levels (UL) for vitamins and minerals, and tolerable daily intake (TDI) for contaminants and food contact materials. For acute effects and operators, the acute reference dose (ARfD) and the acceptable operator exposure level (AOEL). In animal health and the ecological area, these include safe feed concentrations and the Predicted no effect concentration (PNEC) respectively (EFSA Scientific Committee, 2018).</p> <p>²Reference point : Defined point on an experimental dose–response relationship for the critical effect. This term is synonymous to Point of departure (USA). Reference points include the lowest or no observed adverse effect level (LOAEL/NOAEL) or benchmark dose lower confidence limit (BDML), used to derive a reference value or Margin of Exposure in human and animal health risk assessment. In the ecological area, these include lethal dose (LD50), effect concentration (EC5/ECx), no (adverse) effect concentration/dose (NOEC/NOAEC/NOAED), no (adverse) effect level (NEL/NOAEL), hazard concentration (HC5/HCx) derived from a Species Sensitivity Distributions (SSD) for the ecosystem (EFSA Scientific Committee,2018).</p> <p>³Uncertainty factor: Reductive factor by which an observed or estimated no observed adverse effect level or other reference point, such as the benchmark dose or benchmark dose lower confidence limit, is divided to arrive at a reference dose or standard that is considered safe or without appreciable risk (WHO, 2009).</p

The effect of a kindergarten-based, family-involved intervention on objectively measured physical activity in Belgian preschool boys and girls of high and low SES: The ToyBox-study

Background: The ToyBox-study developed an evidence- and theory-based intervention to improve preschoolers' energy balance-related behaviours - including physical activity (PA) - by targeting the kindergarten environment and involving their parents/caregivers. The present study aimed to examine the effect of the ToyBox-intervention on increasing Belgian preschoolers' objectively measured PA levels.Methods: A sample of 472 preschoolers (4.43 ± 0.55 years; 55.1% boys) from 27 kindergartens (15 intervention, 12 control kindergartens) in Flanders, Belgium were included in the data analyses. Preschoolers wore an ActiGraph accelerometer for six consecutive days and were included in the data analyses if they had a minimum of two weekdays and one weekend day, both at baseline and follow-up (one year later). Preschoolers' PA outcomes were estimated for an average day, weekday, weekend day, during school hours, and during after school hours. To assess intervention effects, multilevel repeated measures analyses were conducted for the total sample, and for sub-groups (according to sex, kindergarten levels of socio-economic status (SES) and risk groups (low levels of PA at baseline)) of preschoolers.Results: Small intervention effects were found in the total sample. Most intervention effects were found in boys and in preschoolers from high SES kindergartens. Boys from the intervention group had an increase in vigorous PA (ß = 1.47, p = 0.03) and moderate-to-vigorous PA (ß = 1.27, p = 0.03) from baseline to follow-up, whereas PA levels in boys from the control group stagnated or decreased. In preschoolers from high SES kindergartens, the largest effects were found for PA outcomes during school hours and during after school hours.Conclusion: The results from the Belgian sample demonstrate that effects of the PA-component of the ToyBox-intervention on objectively measured PA were found in preschool boys and in preschoolers from high SES kindergartens, which means that the ToyBox-intervention was mainly effective in those sub-groups. Future interventions should search for alternative strategies to increase preschoolers' PA levels in preschool girls and preschoolers from low SES kindergartens, as these are the most important at-risk groups regarding PA