Implementing a Framework to Evaluate the Impact of Food Intake Shifts on Risk of Illness Using a Case Study with Infant Cereal (P11-118-19)

Abstract

Objectives: We developed a framework to provide decision makers with a multi-faceted evaluation of the impact of dietary shifts on risk of illness in the U.S. population. Methods: We collected representative data on prevalence and concentration of inorganic arsenic and aflatoxin in infant rice and oat cereal. Exposure to these contaminants through consumption and risk of illness from cancer were assessed per consumer based on data from the National Health and Nutrition Examination Survey and published dose-response and related data. The expected number of additional cases of illness and disability-adjusted life years (DALYs) for the U.S. population were estimated. The public health impact of shifts in consumption from one product to the other considered marginal and joint consumption and characterized uncertainty arising from estimates of contaminant concentrations, bioavailability and dose-response models. Monte Carlo simulations were developed in R and a Shiny app was created. Results: Based on current consumption of infant rice and oat cereal, the estimated additional DALY for the total US population from inorganic arsenic and aflatoxin is 4,600 (CI 90% [370; 8,400]). If all consumers shift their consumption (maintaining equivalent servings) to only infant rice or only infant oat cereal, the estimated DALY increases to 1.4 and decreases to 0.4 relative to the baseline, respectively. Changes in contaminant concentrations or % consumers also significantly impact risk. Uncertainty in risk estimates is primarily driven by the dose-response models for this case study. The case study showcases applicability of the framework for a wide range of food safety and nutrition questions. Results support previous advice on varying grain intake in children. Conclusions: The current risk-risk framework can provide decision makers with a nuanced understanding of the impact of consumption shifts on public health and reveal parameters that drive predicted changes in public health. The Shiny app provides a real-time visualization tool to facilitate understanding and allow direct query by decision makers. Funding Sources: This work was carried out under official duties or contract with U.S. FDA.