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Additional occurrence data are needed to better understand human exposure to per- and poly-fluoroalkyl substances (PFAS) from commercially available foods in the United States. The Food and Drug Administration’s (FDA) Total Diet Study (TDS) collects foods that are both nationally and regionally distributed. In 2018, 172 processed foods were collected from grocery stores around Lenexa, KS, as part of the TDS national collection. A previously developed method for the analysis of PFAS in foods as part of the TDS regional collection was modified and optimized for these samples. This method was single lab validated using 5 different matrices and method detection limits were calculated. During the analysis of these samples, challenges arose with method blanks and further investigation into statistical methods to distinguish between blank and sample concentrations were done. The confirmation of two short chain PFAS, perfluorobutanoic acid (PFBA) and perfluoropentanoic acid (PFPeA), was not possible using triple quadrupole mass spectrometry and a confirmation method was developed using high-resolution mass spectrometry. This technique was also used to investigate potential detections and interferents that fell within the retention time criteria for positive detections. In the national collection, positive detections of perfluorooctanesulfonic acid (PFOS) and perfluorononanoic acid (PFNA) were found in frozen fish sticks/patties, PFOS and perfluorodecanoic acid (PFDA) in canned tuna, and PFOS in protein powder. Concentrations were all below 150 ppt, and no other detects were confirmed above the method detection limits in any other foods.

Purpose This study attempted gaining insight into the intake of protein and fat of 12- to 36-month-old children in the Netherlands. Methods In 2017, a Total Diet Study (TDS) was carried out in the Netherlands including following three age groups: 12–17-, 18–23- and 24- to 36-month-old children. Protein and fat concentrations of 164 composite samples were analysed and combined with the consumption data from the Dutch National Food Consumption Survey 2012–2016 (DNFCS). Results Median protein intake of the 12- to 35-month-old Dutch children based on the TDS was 35 g/day with main contributions from the food subgroups “milk and milk-based beverages”, “beef” and “yoghurts and desserts”. Median fat intake was 34 g/day with main contributions from the food subgroups “margarines”, “cheeses” and “milk and milk-based beverages”. For the youngest age group (12- to 18-month-old children), (ready to drink) follow-on formula was one of the main contributors to the fat intake. Conclusion Compared to the EFSA reference values, protein intake of the Dutch 12- to 36-month-old children is high, whereas fat intake follows the reference intake. A TDS is a suitable instrument to estimate macronutrient intakes.

In 2017, a Total Diet Study was conducted in the Netherlands in which mycotoxins were analysed in foods and beverages consumed by 1- and 2-year-old children. These mycotoxins were aflatoxins, Alternaria toxins, citrinin, ergot alkaloids, fumonisins, ochratoxin A, patulin, sterigmatocystin, trichothecenes, and zearalenone. Long-term exposure was calculated by combining concentrations in foods and beverages with consumed amounts of these products. Analysed foods and beverages with a concentration below the detection limit that could contain the mycotoxin, were assigned a concentration equal to half this limit value. To assess if the exposure could result in a possible health risk, the high long-term exposure (95th percentile) was compared with a health-based guidance value (HBGV) or a margin of exposure (MOE) was calculated. Exposure to aflatoxins, Alternaria toxins, ochratoxin A and T-2/HT-2 sum may pose a health concern. Foods that contributed most to the exposure of these mycotoxins were bread, biscuits, breakfast cereals, chocolates, dried fruit, follow-on formula and fruit juices.

Cadmium (Cd) is a heavy metal known to be harmful to human health. The aim of this study was to analyze the regional characteristics of dietary Cd intake of adult male residents in different regions of China. The value of this research is to guide regional consumers to minimize Cd intake by adjusting diets for different food categories in various regions. Dietary Cd intake data is used from the 4th and 5th Chinese Total Diet Studies (CTDS). The 4th CTDS collected data from 12 provinces, covering about 50% of the Chinese population. The 5th CTDS collected data from 20 provinces, covering about 67% of the Chinese population. Over 200 kinds of foods were sampled and divided into 13 categories and organized by geographic information system (GIS) mapping. The results showed that firstly, the dietary Cd intake of Chinese residents has increased; secondly, the food groups with the highest Cd intake were cereals and vegetables; and thirdly, the main food group of dietary Cd intake in different regions is presented such as cereals in Sichuan, Jiangxi, Zhejiang, Guangdong, Fujian, and Guangxi and vegetables in Shanghai, Ningxia, and Heilongjiang. Lastly, the food product with the highest dietary Cd intake concentration was found to be nori in 5 provinces. The other notable foods, with Cd intake, included peanuts, rice, squid, cuttlefish, and mushrooms.

The total diet study (TDS) is a significant part of food consumption-based health risk assessment. Since 1990, China has conducted five TDSs based on its unique food culture. In the present study, the health risks of residents from 20 regions of China are assessed by comparing the estimated daily intake (EDI) with adequate intake (AI) for Cr, and the estimated dietary exposure (EDE) with the reference dose (RfD) for seven toxic heavy metals (THMs), which are Al, As, inorganic arsenic (iAs), Cd, Hg, methyl mercury (MeHg), and Pb. The original data were sourced from the 5th China TDS. The data indicated the following: (1) Cereals and vegetables were the main dietary exposure sources of Al, As, iAs, Cd, and Cr; aquatic foods were the important dietary exposure source for As, Hg, and MeHg, especially for the residents from coastal regions. (2) Compared to other elements, Pb had more dietary exposure sources, which included cereals, vegetables, meats, and beverages and water. (3) Potatoes, beverages and water, and meats were the important sources of Al, iAs, and Cr. The results showed that the average level of the dietary intake of Cr was 11 times higher than the AI, as determined from the ratio of EDI to Al. Moreover, the hazard quotients (HQs) of Al, iAs, Cd, Hg, MeHg, and Pb were1, while that of As (6.49) was1; therefore, the EDIs of As and Cr by the residents of China are worthy of attention. Additionally, the discrepancies in the dietary exposures of HMs by the residents were due to the different HM contents among different types of foods, and the different dietary structures.

Dietary exposures to lead were estimated for older children, females of childbearing age and adults based on lead concentration data from the FDA's Total Diet Study and on food consumption data from What We Eat In America (WWEIA), the food survey portion of the National Health and Nutrition Examination Survey (NHANES). Estimated mean exposures varied based on the population and on the three different substitution scenarios for lead values below the limit of detection (non-detects = 0; non-detects = limit of detection; hybrid approach). Estimated mean lead exposures range from 1.4 to 4.0 µg/day for older children (males and females 7-17 years), 1.6 to 4.6 µg/day for women of childbearing age (females 16-49 years) and 1.7 to 5.3 µg/day for adults (males and females 18 years and older). Estimated 90th percentile lead exposures range from 2.3 to 5.8 µg/day for older children, 2.8 to 6.7 µg/day for women of childbearing age and 3.2 to 7.8 µg/day for adults. Exposure estimates suggest some older children may be exposed to dietary lead above the FDA interim reference level for lead in children of 3 µg/day. The results of this study can be used by the FDA to prioritise research and regulatory efforts in the area of dietary lead exposure.

Diet has been regarded as the main exposure source of perfluoroalkyl acids (PFAAs), but the national dietary survey of PFAAs in China was limited. Here, eight typical PFAAs were detected in milk, aquatic food, meat, and eggs from the Chinese Total Diet Studies (TDSs) during 2005–2007 and 2011–2013. Aquatic food was found to be the main source of PFAAs among animal-origin foods. The estimated dietary intakes of ∑PFAAs from animal foods (EDIanimal-origin foods) in coastal areas were relatively higher than in inland areas. The highest EDIanimal-origin foods of PFOS [4.07 and 2.02 ng kg–1 of body weight (bw) day–1] and PFOA (2.19 ng kg–1 of bw day–1) found in Shanghai and perfluorononanoic acid (PFNA, 2.72 ng kg–1 of bw day–1) in Fujian approach or exceed current minimal risk levels from the Agency for Toxic Substances and Disease Registry and tolerable weekly intakes from the European Food Safety Authority, suggesting potential risk of PFAA exposure from animal-origin foods in these areas.

Children are at potential risk for adverse effects from lead and cadmium exposures due to the effects of these elements on developing brains. Children's dietary exposures to lead and cadmium were estimated based on lead and cadmium concentration data from FDA's Total Diet Study (TDS) and on food consumption data from What We Eat In America (WWEIA), the food survey portion of the National Health and Nutrition Examination Study (NHANES). Estimated mean exposures vary based on age range (1-3 y, 4-6 y, or 1-6 y) and on substitution scenarios for values below the limit of detection (non-detects = 0; non-detects = limit of detection; hybrid approach). Estimated mean lead exposures range from 1 to 3.4 µg/day, with major contributions from grains, fruit, dairy, and mixtures (e.g. hamburgers, pizza, lasagna, soups). Estimated mean cadmium exposures range from 0.38 to 0.44 µg/kg bw/day, with major contributions from grains, mixtures, and vegetables. Estimated children's lead exposures declined slightly since 2004-08, but cadmium exposures did not decline. No safe level has been identified for lead exposures, and toxicologic reference values for cadmium range from 0.1 to 0.83 µg/kg bw/day. The data on lead and cadmium exposures, and on contributors to exposures, will inform research and regulatory priorities on mitigation of exposures to lead and cadmium.

The impacts of dietary nitrates and nitrites on human health have been a controversial topic for many years. However, the risk and benefit assessment of nitrates and nitrites is complicated by the large variation in nitrate and nitrite intake among people and the endogenous nitrite formation in the body. This study conducted a probabilistic risk–benefit assessment of dietary nitrates and nitrites based on internal dose by integrating exogenous and endogenous exposures with human trial data on cardiovascular benefits. A total diet study was carried out to quantify the age-specific dietary intakes of nitrates and nitrites. A previously well-validated human toxicokinetic model was used to predict internal doses for different age groups. In addition, the integrated approach was applied to different populations from different countries/regions based on reported exposure estimates to conduct a comprehensive risk–benefit assessment of dietary nitrates and nitrites. The results demonstrated that vegetable consumption was the main contributor to the internal nitrate and nitrite levels in all age groups. Exposure to nitrates and nitrites exceeding acceptable daily intakes in a variety of foods showed cardiovascular benefits. The probabilistic risk assessment showed that the exposure to nitrates and nitrites did not pose an appreciable health and safety risk. Therefore, the present results suggest that dietary nitrates and nitrites have clear cardiovascular benefits that may outweigh potential risks. Our analysis contributes significantly to addressing the controversy regarding risks and benefits from dietary nitrates and nitrites, and our approach could be applied to other dietary constituents with the potential for both risks and benefits.

International audience; The present study evaluated the exposure of children aged from one to 36 months to seven groups of mycotoxins, in the context of the infant French Total Diet Study (iTDS). Exposure was then compared to the health-based guidance values (HBGVs) for each mycotoxin. The value of the 90th percentile of exposure to nivalenol, patulin, fumonisins and zearalenone was less than 40% of the HBGV considered relevant for children. On the other hand, a risk could not be excluded for ochratoxin A and aflatoxins as exposure was close to the HBGV for ochratoxin A and the margin of exposure was much lower than the critical margin of 10,000 for aflatoxins. The HBGVs for toxins T2 and HT2, and for deoxynivalenol (DON) and its acetylated compounds were exceeded. Five percent to 10% of the children aged 5–12 months exceeded the HBGV considering the lower bound hypothesis for toxins T2 and HT2 and 7.5%–27% of the children aged 5 months and above exceeded the HBGV for DON. Consequently, the exposure of young children raises safety concerns for T2/HT2 and DON. Efforts should therefore be pursued to decrease their exposure to these molecules.

Background: Human dietary exposure to chemicals may result in a wide spectrum of adverse health effects. Some substances may cause non-communicable diseases including cancer and coronary heart diseases, and also be nephrotoxic. Food is the main human exposure route of many chemicals. A cost effective methodological approach called Total Diet Study was for the first time used to assess human dietary exposure to a wide spectrum of food chemicals in Benin, Cameroon, Mali, and Nigeria. Methods: This Total Diet Study covered, with 4020 representative samples of foods prepared as consumed, more than 90% of the diet of 7291 households from eight study centres. By combining representative dietary surveys of countries with findings regarding concentrations of 872 chemicals in foods, human dietary exposure was characterized. Findings: Exposure to lead may result in increases in adult blood pressure up to 2·0 mm Hg while children may lose 8·8-13·3 IQ points (95 th percentile in Kano). Morbidity factors due to co-exposure to aflatoxin B1 and hepatitis B virus, as well as sterigmatocystin and fumonisins, suggest several thousands of additional liver cancer cases per year, as well as a significant contribution to the burden of child chronic malnutrition. Exposures to 13 polycyclic aromatic hydrocarbons from consumption of smoked fish and edible oils exceeded levels associated with possible carcinogenicity and genotoxicity health concern in all study centres. Exposures to aluminium, ochratoxin A and citrinin indicate a public health concern about nephropathies. Interpretation: Risks characterized by the study underscore specific priorities in terms of food safety management in Sub-Saharan Africa. The need for similar investigation specifically targeting children is critical. Funding Statement: The study was funded under grant STDF/PG/303, Standard and Trade Development Facility Declaration of Interests: The authors declare no competing interest. Ethics Approval Statement: Not required.

Previous studies have suggested that vegetarianism can result in a reduction of vitamin B12 circulating levels. The aim of the present study was to investigate the effects of a 3-month dietary intervention with a lacto-ovo-vegetarian diet (VD) on the levels of circulating vitamin B12 in a group of omnivores. We analysed fifty-four omnivorous subjects who followed a VD as a first dietary intervention within the CARDIVEG (Cardiovascular Prevention with Vegetarian Diet) study, a dietary intervention study. VD resulted in a significant reduction (P12 intake and in a significant reduction (P=0·005) of 6·2 % of the circulating levels of vitamin B12 (–24·5 pg/ml). Changes in vitamin B12 intake were significantly correlated with changes in circulating levels of vitamin B12 (R 0·61, P12 levels was more evident in participants who were younger, overweight, non-smokers and had hypercholesterolaemia. A logistic regression analysis showed that a reduction in vitamin B12 intake greater than the first quartile of the delta changes obtained in the study population (–28·5 %) conferred a significantly higher risk of experiencing a decrease in circulating vitamin B12 levels (OR 10·1; 95 % CI 1·3, 76·1). In conclusion, a 3-month VD period determined a significant reduction in circulating levels of vitamin B12, being significantly correlated with the reduction in vitamin B12 intake. Although a well-planned VD can provide adequate nutrition across all life stages, special care must be taken to ensure adequate vitamin B12 intake and to help prevent deficiency.

Aim Although there is some evidence of the relationships between sleep duration/quality and nutrient and/or food intake, the associations between sleep and dietary patterns have been poorly explored. The aim of the present study was to evaluate sleep duration and quality in relation to adherence to the Mediterranean diet (MeDi), and to investigate the sex- and age-specific associations in a population-representative cohort of older adults. Methods Participants from the Hellenic Longitudinal Investigation of Aging and Diet were included. The sample consisted of 1639 adults aged ≥65 years. Sleep duration and quality were assessed through a self-report questionnaire, whereas adherence to the MeDi was evaluated by an a priori score. Results Sleep quality was positively associated with the MeDi in the unadjusted and the adjusted model (age, sex, depression, years of education, body mass index, level of physical activity and total energy intake were added as covariates). In contrast, sleep duration was not associated with MeDi adherence either in the unadjusted or the adjusted models. In relation to the age-related associations, sleep quality was positively associated with MeDi adherence in those aged ≤75 years, and not in those aged >75 years. Associations between sleep and MeDi did not differ between men and women. Conclusions The present results suggest that sleep quality is associated with MeDi adherence in older adults; there are also age-specific associations between sleep quality and the MeDi. Although additional studies are required, improvements in diet quality should be considered in the context of sleep management interventions in older individuals. Geriatr Gerontol Int 2018; 18: 1543-1548.

The neurotoxic and carcinogenic nature of acrylamide, coupled with the recent emphasis of the “probable carcinogenic” status of acrylamide is a cause for concern requiring further studies. The objective of this study was to determine the carcinogenic and neurotoxic risks associated with the consumption of frequently consumed foods in a Total Diet Study (TDS). From a selection of 80 frequently consumed foods, the acrylamide concentrations in the foods were purified by the QuEChERS method of extraction and purification, and the concentrations of acrylamide were determined using the HPLC. Acrylamide was detected in 82% of all the foods analyzed, and the levels ranged from 1.33×10-3 ± 1.89 to 14.39×10-3 ± 6.33 mg/g. The probabilistic approach was used to model the chronic exposures using the Monte Carlo simulation of the Palisade @Risk software. The mean, 50th and 95th percentile values for acrylamide exposures were in the range of 1.56×10-3 to 1.88×10-2, 3.21×10-4 to 5.85×10-3 and 6.16×10-3 to 8.32×10-2 mg/kg bw/day respectively. The mean and 95th percentile values for the margins of exposure (MOE) for the risk of tumorigenesis and neurotoxicity were below the thresholds, hence posing significant public health concern. Generally, the lifetime cancer risks of male consumers were higher compared to that of the female consumers. The median and 95th percentile consumers presented unacceptable risk, since their lifetime cancer risks were greater than the de minimus (10-6). The elements that imparted the most on the overall lifetime cancer risk of the consumers were the exposure duration and the concentration of acrylamide in the foods. To lower these lifetime cancer risks, mitigation studies can thus, be mounted in order to help lower the concentrations of acrylamide in the foods.

Cadmium (Cd) contamination has become a public health concern in recent decades. The aim of the present study was to assess the contribution of dietary Cd exposure and its health risk among Shenzhen adult residents using the Total Diet Study (TDS) approach. Cd was determined in 13 food groups using 276 individual samples by ICP-MS. The major food contributors to Cd exposure of Shenzhen adult residents were ‘Vegetables’ (32.6% of the total exposure), ‘Rice and its products’ (19.2% of the total exposure) and ‘Fish, seafood and shellfish’ (18.5% of the total exposure). The mean and the 95th percentile dietary exposure to Cd of Shenzhen adults were 9.9 and 13 μg kg−1 bw month−1, respectively. The dietary exposures of all individual age-gender population subgroups were below the provisional tolerable monthly intake (PTMI = 25 μg kg−1 bw month−1), so the health risk of Cd dietary exposure of Shenzhen adults is considered to be low, but still, cadmium pollution should be strictly controlled and monitored...

This article discusses what we know about some of the main food safety risks in China. The focus is on role of the China Total Diet Study (TDS) as a tool for food safety risk assessment and the selection of priorities for monitoring. We compare the strengths and weaknesses of the TDS with those of two other major sources of information about food safety and nutrition: the National Food Safety Contamination Monitoring Network (FSCN) and the China Health and Nutrition Survey (CHNS), showing how the different methods they use produce different but complementary information. We then use an analysis of lead, cadmium and pesticide residues to demonstrate that, despite its shortcomings, the TDS provides the most reliable source of information about the actual dietary intake of harmful substances.

Objectives This study aimed to calculate the fluoride concentrations of commonly consumed foods and beverages for 2-years-old children utilizing market basket information for the US Midwest region. Methods Total Diet Study food lists were cross-referenced with National Health and Nutrition Examination Survey—What We Eat in America data to determine the foods and beverages to be included. Fluoride concentrations were determined using a modification of the hexamethyldisiloxane microdiffusion technique. Fluoride concentrations were summarized for each of the food categories. Daily dietary fluoride intake was estimated using a simulation analysis. Results Food and beverage fluoride concentrations varied widely, ranging from nondetectable for some oils and dairy products to more than 3.0 μgF/g food for some processed meats, fish and fruits. The estimated mean (±SD) daily dietary fluoride intake, excluding dentifrice and supplements, was 412±114 μgF/d. The estimated average ingestion for a 2-years-old weighing 12.24 kg was 0.034±0.009 mg/kg/d. A diet based on foods and beverages in the fifth percentile of fluoride intake distribution for an average child would result in 247 μgF/d or 0.020 mg/kg/d, while a diet with foods and beverages in the 95th percentile would result in a total intake of 622 μgF/d or 0.051 mg/kg/d. Conclusions The fluoride concentrations of foods and beverages vary widely, and, if items in the 95th percentile of fluoride intake distribution are ingested, children could consume more fluoride than the recommended 0.05 mg/kg/d. Fluoride intake calculated in this study was higher than historically reported dietary levels.

Dietary exposure of the German adult population to the elements aluminium, copper, mercury (and as methylmercury), manganese and lead were assessed using data from the first total diet study (TDS) in Germany. In this pilot TDS, performed 2014-2015, 246 food samples were purchased in the Berlin area, prepared 'as consumed', and subsequently analysed. Dietary exposure for the German adult population between 14 and 80 years of age was estimated by combining TDS data with individual consumption data from the German National Consumption Survey II (NVS II). Estimated mean and high-level dietary exposure values showed that none of the elements analysed exceeded toxicological reference values; neither was there an undersupply of essential elements. Assessments for methylmercury and lead in women of child-bearing age, in particular, showed no considerable elevated intake levels.

Perfluoroalkyl acids (PFAAs) and brominated flame retardants (BFRs) are widely used and present in human food. Due to the increased susceptibility to pollutants of the young children, we conducted a total diet study focusing on this population. Around 200 baby and common food composite samples, prepared “as consumed”, have been analysed for PFAAS, hexabromocyclododecanes, polybrominated biphenyls, polybrominated diphenyl ethers and tetrabromobisphenol A. The dietary exposure of 705 children aged 1–36 months was assessed. PFAAS were detected only in one fish sample. Detection rates varied from 4 to 93% for BFRs, depending on the congeners. Regarding the provisional health-based guidance values set by EFSA in 2018 for PFOA and PFOS at 0.8 and 1.8 ng kg bw−1.d−1, respectively, 20–100% of children exceeded them, depending on the age. Efforts should be made to decrease the PFAAs contamination of common foods. This study also highlighted that for other PFAAs, toxicological studies are needed to set dietary health-based guidance values, to assess their related health risk. Conversely, dietary exposures to BRFs were much lower than the respective health based guidance values or margins of safety were high enough, and consequently not considered at-risk due to very low contamination of the infant specific foods.

Due to the lack of current, large-scale studies examining their dietary intake and health, there are concerns about vegetarian (VG) and vegan (VN) diets in childhood. Therefore, the Vegetarian and Vegan Children Study (VeChi Diet Study) examined the energy and macronutrient intake as well as the anthropometrics of 430 VG, VN, and omnivorous (OM) children (1–3 years) in Germany. A 3-day weighed dietary record assessed dietary intake, and an online questionnaire assessed lifestyle, body weight (BW), and height. Average dietary intakes and anthropometrics were compared between groups using ANCOVA. There were no significant differences in energy intake or density and anthropometrics between the study groups. OM children had the highest adjusted median intakes of protein (OM: 2.7, VG: 2.3, VN: 2.4 g/kg BW, p &lt, 0.0001), fat (OM: 36.0, VG: 33.5, VN: 31.2%E, p &lt, 0.0001), and added sugars (OM: 5.3, VG: 4.5, VN: 3.8%E, p = 0.002), whereas VN children had the highest adjusted intakes of carbohydrates (OM: 50.1, VG: 54.1, VN: 56.2%E, p &lt, 0.0001) and fiber (OM: 12.2, VG: 16.5, VN: 21.8 g/1,000 kcal, p &lt, 0.0001). Therefore, a VG and VN diet in early childhood can provide the same amount of energy and macronutrients, leading to a normal growth in comparison to OM children.

Background and Study Objectives: The rising incidence of cardiovascular disease (CVD) over the last 25 years has become a public health priority, especially its prevention through lifestyle interventions. Many studies have reported that higher adherence to Mediterranean, vegan or whole-food, plant based (WFPB) diets may decrease CVD incidence and mortality. However evidence on the health effects of various diets on CVD health is equivocal. The objective of this study is to compare and assess the relative impact of four different types of diets; i.e. a) WFPB; b) Mediterranean; c) Paleolithic; and d) Dietary Approaches to Stop Hypertension (DASH) diets on CVD health. Methods: This is a 6-month prospective clinical trial examining 280 participants stratified into four nonrandomized groups over a two month intervention with a follow up at six months of encouraged diet compliance. Clinical and behavioral measures related to CVD were collected; including, HDL, LDL, Total Cholesterol and Triglycerides. 60-day difference in CVD factors were analyzed using Repeated Measures ANOVA between all diets and two-tailed t-test to compare the WFPB diet vs. all other diets. Results: Significant 60-day differences between all diets were seen for HDL (p Conclusion: Participants in the WFPB diet group demonstrated significant improvements in modifiable CVD risk factors compared to other diet categories over 60 days. Future research exploring the impact of quality of WFPB diets on long-term health outcomes is necessary

International audience; A total diet study (TDS) was conducted between 2010 and 2016 to assess the risk associated with chemicals in food of non-breast-fed children from 1 to 36 months living in France. Food samples were collected, prepared "as consumed", and analyzed for chemicals of public health interest. Acrylamide, furan and polycyclic aromatic hydrocarbons (PAHs) were analyzed as heat-induced compounds produced mainly during thermal processing of foods. Dietary exposure was assessed for 705 representative children using food consumptions recorded through a 3-consecutive-days record. As all calculated margins of exposure (MOE) for PAHs exceeded 10 000, dietary exposure of the infant and toddler population was deemed tolerable with regard to the carcinogenic risk. Conversely, the exposure levels to acrylamide and furan were considered as of concern, requiring management measures to reduce the exposure essentially by reducing the formation of heat-induced compounds during food production or preparation processes. Efforts should mainly focus on major contributors to the exposure, i.e. sweet and savoury biscuits and bars, and potatoes and potato products for acrylamide, baby jars of vegetables, with or without meat or fish for acrylamide and furan.

The current level of "discussion" on these diets by many people reminds me of elementary school children fighting on the playground during recess. Ms. Michaels efforts to bring some intelligence to this discussion is different. Despite the constant arguments about, you cannot honestly call any of this a debate or intelligent discussion, between the low carbohydrate diets and the other types of diets proposed by the diet pundits, there is little if any new or useful information. Study after study show if you change the way a person eats, they can lose weight; big deal! These same studies use changes in blood tests to support the benefit they have for reducing heart disease. These studies exclude people whose cholesterol and other blood tests for inflammation go up, thereby making the results look better, while criticizing other studies for not agreeing with them. The major problem with this approach is that I never said that reducing your cholesterol level or your insulin resistance or your CRP level would reduce your heart disease. My "inflammation and heart disease" and "angina" Theories explain why people develop heart disease and why this heart disease causes chest pain. In 2008 while developing a method to actually measure heart disease my research showed that changes in these blood tests of inflammation didn't match actual changes in heart disease; which means that measuring cholesterol and other blood tests won't tell you if your heart disease is changing. To know what's happening to your heart, you actually have to measure it. The only quantitative method for accurately, consistently and reproducibly being able to do this is FMTVDM. If the diet pundits want to know what happens to your heart when you go on their diets, they will need to measure it with FMTVDM.

The US Food and Drug Administration (FDA) and the Nutrient Data Laboratory (NDL) of the USDA Agricultural Research Service have worked independently on determining the iodine content of foods and dietary supplements and are now harmonizing their efforts. The objective of the current article is to describe the harmonization plan and the results of initial iodine analyses accomplished under that plan. For many years, the FDA’s Total Diet Study (TDS) has measured iodine concentrations in selected foods collected in 4 regions of the country each year. For more than a decade, the NDL has collected and analyzed foods as part of the National Food and Nutrient Analysis Program; iodine analysis is now being added to the program. The NDL recently qualified a commercial laboratory to conduct iodine analysis of foods by an inductively coupled plasma mass spectrometry (ICP-MS) method. Co-analysis of a set of samples by the commercial laboratory using the ICP-MS method and by the FDA laboratory using its standard colorimetric method yielded comparable results. The FDA recently reviewed historical TDS data for trends in the iodine content of selected foods, and the NDL analyzed samples of a limited subset of those foods for iodine. The FDA and the NDL are working to combine their data on iodine in foods and to produce an online database that can be used for estimating iodine intake from foods in the US population. In addition, the NDL continues to analyze dietary supplements for iodine and, in collaboration with the NIH Office of Dietary Supplements, to publish the data online in the Dietary Supplement Ingredient Database. The goal is to provide, through these 2 harmonized databases and the continuing TDS focus on iodine, improved tools for estimating iodine intake in population studies.

The levels of acrylamide in 240 food composite samples from the 5th Chinese Total Diet Study (TDS) were measured using an LC-MS/MS method and the exposure estimates for the general population were evaluated. The samples were collected from 20 provinces in China, covering about two thirds of the Chinese population. Acrylamide was detected in 40.0% of composite samples with the concentrations ranged from 0.8 to 211.8 μg/kg. The average dietary intakes from the 5th Chinese TDS were 0.319 μg kg(-1) bw day(-1) and an increase with about 70% was observed from the 3rd Chinese TDS in 2000 to the 5th Chinese TDS between 2009 and 2012. The main food group contributors to acrylamide exposure were vegetables (35.2%), cereals (34.3%) and potatoes (15.7%). Based on the benchmark dose lower confidence limit at 10% risk (BMDL10) of 0.31 mg kg(-1) bw day(-1) for the induction of mammary tumors in rats and 0.18 mg kg(-1) bw day(-1) for Harderian gland tumors in mice, the margins of exposure (MOEs) were 973 and 565 for Chinese general population, respectively. These MOEs indicate a human health concern.

Dietary exposure of the Italian population to nickel has been assessed in the national Total Diet Study (TDS). Occurrence data were combined with national individual consumption data to estimate mean and high level dietary exposure of population subgroups according to age and gender, both at the national level and for the four main geographical areas of Italy. The mean chronic dietary exposure of infants and toddlers, children, adolescents, adults, and the elderly were 4.00, 4.57, 2.57, 1.55, and 1.47 μg/kg bw per day, respectively. These intakes lie in the intermediate range of exposure estimates from TDS carried out in other countries. Main contributors to the total nickel exposure for children and adolescents were ‘sweet products’ and ‘cereals and cereal products’. In adults and the elderly nearly 30% of the exposure was associated to the consumption of ‘cereals and cereal products’. Mean and 95th percentile chronic dietary exposure was below the TDI in all age groups. For the risk characterisation of acute oral exposure, exposure data for consumers only in the adult population were compared with the reference point for systemic contact dermatitis. Consumption of ‘cocoa’, ‘chocolate’, ‘crustaceans and molluscs’, ‘pulses’ had remarkable potential to elicit adverse effects in nickel-sensitised individuals.

The rising incidence of cardiovascular disease (CVD) over the last 25 years has become a public health priority, especially its prevention through lifestyle interventions. Many studies have reported that higher adherence to Mediterranean, vegan or whole-food, plant based (WFPB) diets may decrease

Cadmium (Cd) is a toxic heavy metal that can contribute to numerous diseases as well as increased mortality. Diet is the primary source of Cd exposure for most individuals, yet little is known about the foods and food groups that contribute most substantially to dietary Cd intake in the US. Therefore, the objective of this study was to estimate dietary Cd intake and identify major food sources of Cd in the US population and among subgroups of the population. Individuals aged 2 years and older from the National Health and Nutrition Examination Survey (NHANES) 2007&ndash, 2012 were included in this study (n = 12,523). Cd intakes were estimated from two days of 24-h dietary recalls by matching intake data with the Cd database of the Food and Drug Administration (FDA)&rsquo, s Total Diet Study 2006 through 2013. The average dietary Cd consumption in the population was 4.63 &mu, g/day, or 0.54 &mu, g/kg body weight/week, which is 22% of the tolerable weekly intake (TWI) of 2.5 &mu, g/kg body weight/week. Greater daily Cd intakes were observed in older adults, males, those with higher income, higher education, or higher body mass index. The highest Cd intakes on a body weight basis were observed in children 10 years and younger (38% of TWI), underweight individuals (38% of TWI), and alcohol non-consumers (24% of TWI). The food groups that contributed most to Cd intake were cereals and bread (34%), leafy vegetables (20%), potatoes (11%), legumes and nuts (7%), and stem/root vegetables (6%). The foods that contributed most to total Cd intake were lettuce (14%), spaghetti (8%), bread (7%), and potatoes (6%). Lettuce was the major Cd source for Caucasians and Blacks, whereas tortillas were the top source for Hispanics, and rice was the top contributor among other ethnic subgroups including Asians. This study provides important information on the dietary Cd exposure of Americans, and identifies the groups with the greatest dietary Cd exposure as well as the major sources of dietary Cd among sociodemographic subgroups.

Background: Fruits and vegetables are key to a healthy diet, particularly in children; however, parents may be concerned about contaminants found in fruits and vegetables. Making informed food choices for children requires understanding and balancing the risks of contaminant exposure with the importance of providing a healthy diet. The objective of this work is to identify fruits and vegetables commonly consumed by infants and toddlers; identify potential contaminants in fruits and vegetables; and outline considerations in assessing contaminant risks in food categories with a critical role in a healthy diet. Method: Commonly consumed fruits and vegetables were obtained from the Feeding Infants & Toddlers Study (FITS 2016). The US Food and Drug Administration Total Diet Study was reviewed for contaminant occurrence, and multiple experts were consulted on considerations in assessing risk of certain contaminants. Results: FITS data show eight fruits and nine vegetables account for over 80% of consumption in infants and toddlers. Several contaminants have been detected in fruits and vegetables. Questions to be addressed prior to establishing contaminant guidance were identified. Conclusion: Contaminant guidance for fruits and vegetables consumed by infants and toddlers raises several challenges. Expertise from multiple disciplines is required to find an approach that maximizes public health benefit.

Following the core food (CF) models of the USA and France reported in the 2000s, this study presents the first oriental CF model, for total diet studies in Taiwan. First, we combined the four latest national dietary recall surveys from 2005 to 2012, data sets from the Nutrition and Health Survey in Taiwan (NAHSIT) covering all ages (1 to 65+ years old). In total, 3,098 NAHSIT food codes from 349,497 records of responses from 7,580 individuals were aggregated within a three-tiered scheme into 237 CFs in 54 subcategories and 16 categories. As with Western foods, Taiwanese foods were mainly aggregated by food type and major ingredient, processing method, cooking method or serving habit. In addition, we propose several categories typical to Taiwanese foods: (1) processed foods (e.g. rice paste, rice noodle, bean curd); (2) mixed foods (e.g. tomato fried with egg, Guangdong porridge) and stuffed staple foods (e.g. rice cake, zongzi); (3) Chinese Dim Sum (e.g. dumpling, salted bun); and (4) animal offal (e.g. pig liver, chicken kidney) and by-products (e.g. chicken head, pig foot). Systematic nomenclature and coding methods are also proposed. A computerised web model was developed using a graphical user interface (GUI) for automatic CF aggregation and inquiry of various consumption estimates according to the residing area, age group, and gender of consumers. Point estimates of weighted means were calculated for consumption rates (CR) based on the whole group (WG) or consumers only (CO). The CR and body weight (BW) of each individual were matched to calculate mean intake per unit body weight (g/kg bw/day). A general sample design procedure with the CF model is suggested for a total diet study (TDS) on target hazards. Strategies are also discussed for improving the quality of food matching in sample designs.

The usual dietary intake of vitamin D was studied in 10 subgroups of the Czech population. Food consumption data was collected using repeated 24 h recall in a national cross-sectional survey (the Study of Individual Food Consumption, SISP04), and the vitamin D content in marketed foods was quantified within the national Total Diet Study (2014&ndash, 2015). The Monte Carlo Risk Assessment computational model (version MCRA 8.2) was used to assess usual intake. The median vitamin D intakes for the Czech population (aged 4&ndash, 90 years, both genders) were within a range of 2.5&ndash, 5.1 &mu, g/day. The highest median intake, excluding dietary supplements, was observed in men aged 18&ndash, 64, and the lowest was observed in children aged 4&ndash, 6 and girls aged 11&ndash, 17. The main sources in the diet were hen eggs (21&ndash, 28% of usual dietary intake), fine bakery wares (11&ndash, 19%), cow&rsquo, s milk and dairy products (7&ndash, 23%), meat and meat products (4&ndash, 12%), fish (6&ndash, 20%), and margarines (7&ndash, 18%). The dietary intake of vitamin D for more than 95% of the Czech population was below the recommended Dietary Reference Values (DRVs). These findings should encourage public health authorities to support interventions and education and implement new regulatory measures for improving intake.

Pregnant women and their unborn child are exposed to a large number of substances during pregnancy. Some of these substances may cross the placenta, resulting in exposure of the foetus. There is growing evidence that certain substances could interact to produce a mixture effect. It is therefore essential to identify the main mixtures mothers are exposed to. This study aimed to identify the major mixtures French pregnant women included in EDEN and ELFE cohorts were exposed to, on the basis of the 441 substances analysed in the second French total diet study. Exposure systems and the composition of substances were identified from co-exposures using sparse non-negative matrix under-approximation to generate the main mixtures. Individuals were clustered to define clusters with similar co-exposure profiles. Six clusters associated with eight mixtures were identified. For example in ELFE, cluster 2 comprising 10% of the population was characterised by mixtures "Pest-1" mainly contains pesticides and "TE-F-PAH″ contains trace elements, furans and polycyclic aromatic hydrocarbons. Five other clusters were also described with their associated mixtures. Similar results were observed for EDEN. This study helps to prioritise mixtures for which it is crucial to investigate possible toxicological effects and to recommend epidemiological studies concerning health effects.

Human exposure to polychlorinated biphenyls (PCBs) from foods was investigated through a Total Diet Study (TDS) for the first time in Korea. A representative food list was developed from food intake data. Non-selected foods were also included in the TDS through the mapping process to anticipate practical risk assessment. For better representativeness, data (2008-2011) from the Korea National Health and Nutrition Examination Survey (KNHANES) were combined with the TDS data set. And also, we estimated the dietary exposure to PCBs from various food items using a 'best-fit' mapping process and assessed the differences in PCB exposures by sex and age. In this study, we examined total PCBs (62 congeners) including dioxin-like PCBs (DL-PCBs) and indicator PCBs, which are congeners that are mainly detected in various environmental matrices. The average dietary exposure (3.94 ng/kg body weight/day) that was estimated through food intake was 19.7% of the World Health Organization (WHO) recommendation.

This study aimed to analyse the concentrations of Al, Ba, Bi, Cu, Cr, Ge, Mn, Mo, Ni, Sb, Se, Sr and Zn in food samples collected in 2008 in Catalonia (Spain). The dietary intake of these 13 trace elements was subsequently estimated by different age-gender groups of the population: children, adolescents, adults and seniors. In general terms, fish and shellfish, cereals, and pulses were the food groups showing the highest levels for most elements. Higher dietary intakes were associated with male groups (adolescents, adults and seniors). However, none exceeded the tolerable levels. When exposure was estimated based on body weight, children were the group with the highest dietary intake. Notwithstanding, only the weekly intake of Al by children exceeded the recommendations of the European Food Safety Authority (EFSA). It is a consequence of the higher intake of cereals in relation to their respective body weights. In addition to the periodical food surveillance of toxic metals (As, Cd, Hg and Pb), it is also important to determine the levels of other trace elements in order to ensure that the dietary exposure by the Catalan population is under control.

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 populati on 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 (TDS2/2 007 - 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

Concentrations of bisphenol A (BPA) and nonylphenol (NP) were measured in food samples from the 2007 Chinese total diet study (TDS). BPA and NP were detected in 72 and 143 of 144 TDS samples, respectively, with concentrations ranging from 20 ng/kg to 267 μg/kg and 30 ng/kg to 1,268 μg/kg, respectively. BPA was highest in Hebei (HB) province for most food groups. NP was much higher in milk than in other foods across all the provinces. Mean exposures to BPA and NP were estimated to be 43 ng/kg bw/day and 520 ng/kg bw/day for a Chinese adult, respectively, well below the tolerable daily intake (TDI). Mean exposure to NP from formula for infants aged 0-6 years ranged from 300 ng/kg bw/day to 17 μg/kg bw/day. For infants aged 0-1 year, intakes ranged from 5 to 17 μg/kg bw/day, which is above the TDI.

Summary Rheumatoid arthritis (RA) is a painful disabling difficult to treat disease. Clinicians and guidelines invariably focus on drugs. Diet is important but lacks robust data. We carried out a comprehensive analytical study in Indian (Asian) patients. Methods 141 consenting symptomatic chronic RA patients [mean age 46 years) center and 165 unrelated healthy control subjects (mean age 36 years) completed a a-priori validated food frequency questionnaire in a cross-sectional non-random design study under the supervision of a nutritionist. All patients were under standard rheumatology care. A 3 day retrospective recall record captured dietary data for all subjects. National Indian guidelines were adopted for diet analytics. Standard statistical analysis was carried out; significant p Results Daily diet was found to be significantly deficient in calories and consumption of proteins, calcium and potassium when compared to healthy subjects. It was also inadequate for several nutrients when compacted to recommended daily allowance. The proportion of carbohydrates (65%), proteins (15%) and fat (25%) in daily diet was consistent with Indian standards (healthy). Women patients reported higher deficiency. 44% patients consumed vegetarian diet and showed lesser pain and better function compared to non-vegetarians (not significant). 44% patients reported dietary restriction; higher swollen joint counts in patients following any dietary restriction (p = 0.01) or Ayurveda (ancient Indian medicinal system) advise (p = 0.01) or consuming night shade vegetables (p = 0.002). Conclusion Dietary inadequacy and in particular for protein and potassium was identified in patients of RA. Any form of dietary restriction did not seem to improve RA. Specific dietary needs of RA patients and in particular impact of potassium deficiency needs further research.

The core-food (CF) approach, first adopted in the United States in the 1980s, has been widely used by many countries to assess the exposure to dietary hazards at a population level. However, the reliability of exposure estimates (C × CR) depends critically on sampling methods designed for the detected chemical concentrations (C) of each CF to match with the corresponding consumption rate (CR) estimated from the surveyed intake data. In order to reduce the uncertainty of food matching, this study presents a sampling design scheme, namely the subsample method, for the 2016 Taiwan total diet study (TDS) on veterinary drugs. We first combined the four sets of national dietary recall data that covered the entire age strata (1-65+ years), and aggregated them into 307 CFs by their similarity in nutritional values, manufacturing and cooking methods. The 40 CFs pertinent to veterinary drug residues were selected for this study, and 16 subsamples for each CF were designed by weighing their quantities in CR, product brands, manufacturing, processing and cooking methods. The calculated food matching rates of each CF from this study were 84.3-97.3%, which were higher than those obtained from many previous studies using the representative food (RF) method (53.1-57.8%). The subsample method not only considers the variety of food processing and cooking methods, but also it provides better food matching and reduces the uncertainty of exposure assessment.

Based on the 5th Chinese Total Diet Study (TDS) carried out in 2011, the dietary exposure of Chinese population to three currently used brominated flame retardants (BFRs), tetrabromobisphenol A (TBBPA), hexabromocyclododecane (HBCD) and decabrominated diphenyl ether (BDE-209), was estimated and the related health risks were assessed. Levels of the three BFRs were determined in 80 composite samples from four animal-origin food groups. The average levels of BFRs in various food groups ranged from 0.671 to 5.76 ng/g lipid weight (lw). The levels of TBBPA were lower than those of HBCD but higher than those of BDE-209. Moreover, average contamination levels of TBBPA and HBCD in TDS 2011 were found to be 3 to 30 times higher than those observed in TDS 2007 in the four food groups, indicating an increase in TBBPA and HBCD in the environment during 2007–2011. The average estimated daily intakes (EDIs) of TBBPA, HBCD and BDE-209 via food consumption for a “standard Chinese man” were 1.34, 1.51 and 0.96 ng/kg bw/day, respectively. Meat and meat products were found to be the major contributor to the daily dietary intake because the consumption of meat and meat products were significantly higher than that of other food groups in China. In comparison, the levels and EDIs of BFRs in this study were found to be higher than those in most studies worldwide. However, the large margin of exposure (MOE), with at least 1.1 × 10 5 calculated following the European Food Safety Authority (EFSA) approach, indicates that the estimated dietary exposure to these three BFRs is unlikely to raise significant health concerns. In addition, a comparison between the contamination levels of TBBPA, HBCD, BDE-209 and some novel BFRs in food samples from TDS 2011 indicated an obvious shift in the industrial production and usage pattern between PBDE and non-PBDE BFRs in China.

Exposure to mycotoxins may be associated with carcinogenic, immunosuppressant and estrogenic effects. In the Middle-East, studies investigating food contamination and dietary exposure to mycotoxins are particularly scarce. This study aims at evaluating the dietary exposure of an adult Lebanese urban population to four mycotoxins (AFB1, AFM1, OTA, DON) classified as priority food contaminants by the WHO. Dietary exposure assessment was performed by means of the total diet study approach. Average and excessive consumer exposure estimates (p95) were calculated and compared with appropriate toxicological reference values (TRVs). Average dietary exposure levels to OTA and DON represented 29.9% and 156.8% of the respective TRVs, with the p95 exposure estimates approaching or exceeding the TRVs for these mycotoxins (95.1% and 355.8%, respectively). Based on the mean dietary exposure level to AFB1, cancer risk was estimated at 0.0527-0.0545cases/100,000persons/year, while mean exposure to AFM1 was associated with a population risk of 0.0018-0.0027cases/100,000persons/year. The study's findings place Lebanon among countries that are highly exposed to mycotoxins through the diet and call for larger-scale studies aiming at providing a comprehensive assessment of the dietary exposure of the Lebanese population to mycotoxins as well as to other food contaminants.

The use of pesticides and other chemicals has become a common practice in modern agriculture to enhance and stabilise crop yield, protect the nutritional integrity of food, facilitate food storage to assure year-round supplies, and provide attractive and appealing food products. With the adoption of strict good agricultural practice (GAP), only minimal amounts of pesticide residues should remain on the crops or in connected foods of animal origin up the food chain. To assess their associated health risk to local people, the dietary exposure of Hong Kong adults to residues of four groups of pesticides or their metabolites - organophosphorus pesticides (OPPs), carbamates, pyrethrins and pyrethroids, and dithiocarbamate (DTC) metabolites - is estimated in the first Hong Kong Total Diet Study (TDS). A total of 150 commonly consumed food items were collected and prepared "as consumed". A total of 600 composite food samples were analysed for 85 pesticides or their metabolites by liquid chromatography-tandem mass spectrometry (LC-MS/MS). These pesticides were primarily found at low levels (highest mean = 350 μg kg⁻¹) in food samples of plant origin such as vegetables and fruits. Dietary exposures to pesticide residues were estimated based on the analytical results and the food consumption data of the local residents. The estimated dietary exposures of Hong Kong adults to all individual pesticides were well below their respective acceptable daily intakes (ADIs). The percentage contributions of the estimated mean and 95th percentile dietary exposures to the ADIs of individual pesticides were

Acrylamide is a processing contaminant in food formed during cooking at high temperature, such as frying and baking. To assess the associated health risk of the Hong Kong population, the dietary exposure of Hong Kong adults to acrylamide was estimated in the first Hong Kong Total Diet Study (TDS), where food samples were collected and prepared "as consumed". A total of 532 composite food samples were analysed for acrylamide using LC-MS/MS. Dietary exposures were estimated by combining the analytical results with the food consumption data of the Hong Kong adults. The mean and 95th percentile exposures to acrylamide of the Hong Kong population were 0.213 and 0.538 μg kg⁻¹ body weight (bw) day⁻¹, respectively, and their margins of exposure (MOEs) were all below 10,000. The main dietary source of acrylamide was "Vegetables and their products" (52.4% of the total exposure), particularly stir-fried vegetables (44.9%), followed by "Cereals and their products" (14.7%) and "Mixed dishes" (9.43%). The study findings suggest that the relatively low figures for MOE for a genotoxic carcinogen may indicate human health concern of the Hong Kong population. Efforts should continue to be made in the interest of reducing acrylamide levels in food locally.