Sodium and Saturated Fat Levels in Meat Products in the Netherlands: An Evaluation Based on Label Information

Aim: To collate and analyse label information on nutrients for meat products (used as sandwich fillings) in the Netherlands, using a standardised methodology established by the Global Food Monitoring Group. The objective was to compare levels of saturated fat (in g/100 grams) and sodium (in mg/100 grams) from 2011-2015 and to evaluate reformulation targets for sodium and saturated fat levels that were due to be met by January 1, 2015. Study Design: Data collection study. Place and Duration: Data collection in two supermarkets in the Netherlands for one month. Methodology: Data were collected by photographing the Nutrition Information Panels (NIPs), front-of-pack communications (Guideline Daily Amounts, health logos) and other back-of-pack information from product labels of processed foods in-store using smartphone technology. Photos were uploaded to a central database where data were entered and checked and cleaned manually. Levels of sodium and saturated fat were calculated and compared with data available from reformulation monitoring reports and with the reformulation targets of the meat sector. Results: Data were collected for 911 processed meat products, with data available for 863 meat products after data cleaning, and 86% (n=745) displaying a NIP. Sodium levels in 2015 were similar compared to concentrations observed in previous years for all subcategories of meat products. For saturated fat, combined heated meat products' saturated fat content was 8 g/100g (SD=3) based on label information in 2015 compared with 10 g/100g (SD=3) based on the label and chemical analyses information of 2014: P<0.001. The percentages of products (2015) which complied with the reformulation targets ranged per product category from 14%-93% for sodium levels and 25%-88% for saturated fat levels. Only a small percentage of meats displayed a health logo (2%) or Guideline Daily Amounts (15%) on the label. Conclusion: Based on the comparison we observed no progress with sodium reductions and little progress with saturated fat reductions in the Netherlands between 2011 and 2015 in processed meat products. In light of the Netherlands’ reformulation covenant of 2014, focus on nutrient levels of meat products could contribute to help meet the national commitment to reduce sodium and saturated fat levels. This method of evaluation could also be used for other product categories to monitor progress and to ultimately decrease the burden of nutrition-associated diseases in the country.

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

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

Short Review of Extracts of Rosemary as a Food Additive.

Extracts from Rosmarinus officinalis L., more commonly known as rosemary, have been approved for use in the EU as food additive E932 under Regulation 1333/2008 of the European Parliament and the Council. Rosemary extracts are currently widely used to increase shelf life of food products. Rosemary extracts are characterised by two reference antioxidant compounds, carnosol and carnosic acid. This characterization allows for differences in rosemary extracts. Four approved production methods, as described by Commission Regulation 231/2012, produce rosemary extracts with different compositions and antioxidant activity. This results in difficulties to compare scientific data and to assess the safety of approved rosemary extracts. Based on unpublished studies for each of the four approved extract types, EFSA concluded that “the proposed uses and use levels would not be of safety concern“. Yet, gaps in knowledge still exist for the approved extracts as many different rosemary extracts are used in scientific research.

Short Review of Sulphites as Food Additives.

Sulphites or sulphiting agents refer to sodium hydrogen sulphite, sodium metabisulphite, potassium metabisulphite, calcium sulphite, calcium hydrogen sulphite, and potassium hydrogen sulphite. As food additives, they are widely used by the food industry with a variety of commercial uses in food and beverages. Sulphites are effective bleaching agents, antimicrobials, oxygen scavengers, reducing agents, and enzyme inhibitors. Wine, beer, dehydrated fruits and vegetables, jam, juice, sugar, processed potatoes, seafood, meat and baked products are some of the food categories in which sulphites are added. Sulphites have been implicated in various health related issues. Asthmatic reactions and some antinutritional consequences such the degradation of thiamine (vitamin B1) are adverse reactions associated with sulphites. In many countries, sulphites have been regulated. Sulphites are generally recognized as safe in the USA with some exceptions when using in raw fruits and vegetables. In the European Union sulphites are also controlled, and the permitted amount varies according to the food product.

Perspectives on Low Calorie Intense Sweeteners with a Focus on Aspartame and Stevia.

The safety of some food additives/E-numbers, including low calorie (intense) sweeteners (LCS), is constantly the subject of dispute and controversy. However, since LCS have been assigned an acceptable daily intake (ADI) and an E-number following extensive assessment of available safety and toxicological data, consumer safety is assured. These substances have been carefully evaluated, for example by the European Food Safety Authority (EFSA), leading to the conclusion that they are essentially safe when consumption is below ADI levels. Although, intake data indicate that general consumption of LCS is relatively low, many people appear to remain concerned about their safety, particularly aspartame (E951). More recently, stevia (steviol glycosides, E960) has been marketed as a “natural” alternative to aspartame. However, it is unclear whether stevia can live up to its promises. With regards to public health, the real risk within our diet is not the safety of food additives, but rather more likely to be the potential impacts of consuming too much energy and/or an unhealthy dietary pattern.

Chemical Sensitivity in the Elderly: Lessons Learned from Micronutrient Consumption in the Dutch Elderly Population.

A food consumption survey in the Dutch elderly population (51-69 years of age) showed an increased trend in micronutrient supplement intake (36.4%; 120/347 participants). Because data on chemical sensitivity in the elderly is lacking, evaluation as to whether the current uncertainty factor (UF) of 10 is sufficient to protect the elderly was investigated using the micronutrient consumption data in the elderly Dutch population as a case study. Theories of ageing, and differences in toxicokinetic and toxicodynamics are briefly discussed in the context of chemical sensitivity in the elderly. Evidence suggests that for the healthy elderly, no additional default UFs are recommended because the present UF of 10 is probably sufficient. However, more research is needed to ensure that there is no additional risk, particularly in the not-so healthy elderly population. Although there is a trend of increased consumption of micronutrient supplements (i.e. vitamins and minerals) by the Dutch population, the existing European legislation for micronutrients in fortified foods (Regulation 1925/2006) and food supplements (Directive 2002/46) is now being translated to simultaneously set maximum levels of micronutrients in foods and in supplements. For the healthy elderly, no foreseeable risk is expected due to the consumption of micronutrients. For the unhealthy elderly, the effects of micronutrient consumption are not yet known and therefore, dietary supplement intakes need to be continuously monitored with detailed questioning on health status, supplement and prescription drug use. In addition, the generation of an international and up-todate database on the composition of available dietary supplements is needed to fill the current data gaps.

Finding the Optimum Scenario in Risk-benefit Assessment: An Example on Vitamin D.

Objectives: In risk-benefit assessment of food and nutrients, several studies so far have focused on comparison of two scenarios to weigh the health effect against each other. One obvious next step is finding the optimum scenario that provides maximum net health gains. This paper aims to show a method for finding the optimum scenario that provides maximum net health gains. Methods: A multiple scenario simulation. The method is presented using vitamin D intake in Denmark as an example. In addition to the reference scenario, several alternative scenarios are simulated to detect the scenario that provides maximum net health gains. As a common health metric, Disability Adjusted Life Years (DALY) has been used to project the net health effect by using the QALIBRA (Quality of Life for Benefit Risk Assessment) software. Results: The method used in the vitamin D example shows that it is feasible to find an optimum scenario that provides maximum net health gain in health risk-benefit assessment of dietary exposure as expressed by serum vitamin D level. With regard to the vitamin D assessment, a considerable health gain is observed due to the reduction of risk of other cause mortality, fall and hip fractures when changing from the reference to the optimum scenario. Conclusions: The method allowed us to find the optimum serum level in the vitamin D example. Additional case studies are needed to further validate the applicability of the approach to other nutrients or foods, especially with regards to the uncertainty that is usually attending the data.

A New Approach to Estimate Safe Maximum Fortification Levels for Micronutrients.

Objectives: Maximum fortification levels for voluntarily fortified foods are meant to guard against excessive micronutrient intake. Existing methods of estimating safe maximum levels take a conservative approach by considering a single point in the intake distribution of the micronutrient of interest. The free space for fortification has traditionally been estimated as the tolerable upper intake level minus an observed high intake value (e.g., 95th percentile), with or without considering the contribution of supplements. Using a single value from the distribution results in a single estimate of a safe maximum fortification level. This potentially results in unrealistically high estimates. We propose a probabilistic approach for setting safe maximum fortification levels. Methods: We build upon the estimation of i) a measure of the amount of the food supply that is potentially fortifiable with a micronutrient (i.e., the ‘fortifiable pool'), and ii) a ‘free space' available for intake from voluntarily fortified sources. As a proxy for the fortifiable pool, we utilize the fraction of energy provided by potentially fortifiable foods. The energy from the fortifiable pool and nutrient intake from food and supplemental sources are then jointly modeled. Results: Applying this probabilistic approach to the estimation of safe maximum fortification levels provides a distribution of safe maximum fortification levels from which an appropriate level can be chosen. Conclusions: This approach can estimate safe maximum fortification levels that more realistically convey the potential benefits to be achieved by increased micronutrient intake through voluntary fortified foods, as well as the risks associated with excessive intake.

Publishing Grey Literature Government Reports in the European Journal Nutrition and Food Safety.

Objectives: Governmental research institutes in Europe/world are confronted with the problem that good scientific reports are produced directly for governmental sponsors and are published on an institute's website only. However, scientists like to publish their work in the scientific arena. As reports are not disseminated into the scientific world because they are not identified by normal literature attending systems, this leads to frustration with the scientists, very good scientific work being unnoticed by a wider audience, possible re-duplication of the work in other countries, a loss of resources, and hence to a slower progression of science. Methods: The Open Access Journal "European Journal Nutrition and Food Safety" (EJNFS) publishes governmental reports in a peer-reviewed scientific journal. EJNFS publishes (extended) abstracts of governmental reports (in English language only) following a regular peer review system. Area (nutrition and food safety), scientific excellence, open access and English language are the prerequisites. Results: Upon acceptance of the work, an abstract will contain the title of the work, the authors as well as a hyperlink to the original full report, so that the reports will be opened to a worldwide scientific. Many reports have already been published in this way, including on micronutrient fortification. Conclusions: By peer review and uptake of "extended abstracts with hyperlink", scientists will inherently get knowledge of the content of many good reports being produced worldwide, thereby contributing to the positioning of their institute and their personal achievements. Information: http://www.sciencedomain.org/journal-home.php?id=30

Integrated Risk-benefit in Food and Nutrition.

Objectives: Integrated Risk-Benefit Analysis (RBA) compares the risk of a situation to its related benefits and addresses the acceptability of the risk. Over the past years RBA in relation to food and food ingredients has gained attention. Food, and even the same food ingredient, may confer both beneficial and adverse effects. Measures directed at food safety may lead to suboptimal or insufficient levels of ingredients from a benefit perspective. Methods: In RBA, benefits and risks of food (ingredients) are assessed in one go and may conditionally be expressed into one currency. This allows the comparison of adverse and beneficial effects to be qualitative and quantitative. A RBA should help policy-makers to make more informed and balanced benefit-risk management decisions. Not allowing food benefits to occur in order to guarantee food safety is a risk management decision much the same as accepting some risk in order to achieve more benefits. Results: In 2012-2013 the large EU projects in this area closed (QALIBRA: http://www.qalibra.eu/, BENERIS: http://en.opasnet.org/w/Beneris, BRAFO: http://www.ilsi.org/Europe/Pages/BRAFO.aspx, BEPRARIBEAN: http://en.opasnet.org/w/Bepraribean). Many papers have been published, thereby making significant progress in this area. There are ample examples were benefits outweigh potential risks for public health, including for micronutrient fortification (e.g. folic acid). Conclusions: The results can be used for ranking of risks and benefits, and reporting to policy makers to make effective decisions, and to convey these to a wider stakeholder audience. The improved awareness, understanding, availability and exchange of knowledge in benefit-risk analysis will be vital to implement benefit-risk assessment, ranking, management and communication.

Evolution of Foods in Europe: Novel Foods, Foods Reformulation, Food Fortification and Nutrient Profiles.

Objectives: Food development in the European Union (EU) is subject to changes, based on developments in food legislation or on changing demands in food composition for better nutrition and improved public health. Methods: The legal environment in Europe is laid down in Regulation 178/2002 (http://ec.europa.eu/food/food/foodlaw/index_en.htm) and in Regulation 1169/2011 on the provision of food information to consumers (food labeling). Results: Novel food (ingredients) have not been used for human consumption to a significant degree in the EU before 15 May 1997 (Regulation 258/97). Prior to marketing a risk assessment needs to be. Food fortification is relevant for adequate provision of micronutrients. Applicable are Regulation 1925/2006 and Directive 46/2002. Models are available for estimating maximum safe levels of micronutrients in foods and food supplements. Risk managers need to decide how to divide between food fortification and/or food supplements. Nutrient profiling is the science of categorizing foods according to their nutritional composition. Nutrient profiling in EU is relevant to identify food products eligible to bear a nutrition or health claim (article 4 of Regulation 1924/2006). Reformulation of foods is considered one of the key options to achieve population nutrient goals. The composition of foods can be modified to bring the diet more in line with dietary recommendations. Food reformulation is not subject to a particular regulation. Europe focuses on reducing levels of salt/sodium and saturated fatty acids. Conclusions: Regulation 178/2002 is the overarching Regulation in the EU. There are many Regulations and Directives for foods in EU. This is a fluid system which is updated constantly.

A Simple Visual Model to Compare Existing Front-of-pack Nutrient Profiling Schemes.

Nutrient profiling is an important tool for governments, non-governmental organizations (NGO’s) and for the food industry, to help consumers make healthier food choices. Multiple nutrient profiling systems (NPS) have been introduced worldwide. There is, however, no agreement on the use of a single NPS in leading regions like the USA and Europe. In 2008, the Arrow Model of Verhagen and van den Berg was created to illustrate and compare characteristics of existing NPS. Recent developments in nutrient profiling give rise to the need for an updated Model. The present study aims to develop a comprehensive model, which can be used to explain and compare various front-of-pack nutrient profiling systems (FOP-NPSs). An extensive literature research was conducted to obtain an overview of existing FOP-NPS worldwide. Only FOP-NPS that are currently in use, focus on health-related product aspects and target the general population (adults and children) were included. The Funnel Model was developed based on the analysis of 40 existing FOP-NPSs and expert interviews. This Model illustrates different FOP-NPS and allows comparison among them. The Funnel Model includes several new characteristics compared to the Arrow Model. Numerous ingredients and four new characteristics were added to the Funnel Model: directivity, type of institution initiating the system, purpose and utilization. Several other characteristics were expanded with new elements. The Funnel Model also has a new visual presentation which is useful to clearly explain and compare FOP-NPS.

Short Review of Calcium Disodium Ethylene Diamine Tetra Acetic Acid as a Food Additive.

Calcium disodium ethylenediaminetetraacetate (Calcium Disodium EDTA, C10H12CaN2Na2O8.2H2O) is a derivative of EthylenediamineTetraacetic Acid and is an approved food additive (E385). It is used as preservative, sequestrant, flavouring agent, and colour retention agent in foods. As a drug it is used for the reduction of blood and mobile depot lead in the treatment of acute and chronic lead poisoning. Calcium Disodium EDTA is very poorly absorbed from the gastrointestinal tract following ingestion. The compound is metabolically inert and no accumulation in the body has been found. Acute, short-term, sub chronic and chronic toxicity studies carried out with Calcium Disodium EDTA in laboratory animals found that the compound is nephrotoxic at high doses. In similar high doses, application of Calcium Disodium EDTAcan result in complexation of zinc ions, thus interfering with the zinc homeostasis and causing developmental toxicity. No evidence exists suggesting the compound exerts genotoxic or carcinogenic effects. Overall, Calcium Disodium EDTAseems to be safe for use as a food additive, as the noted toxic doses are higher than can be achieved via the addition of Calcium Disodium EDTA to food. However, human data is limited and the gross of available (human and animal) data, as well as the ADI, stems from several decades ago. Caution should also be taken when Calcium Disodium EDTA is administered as treatment for lead poisoning, as the exposure increases greatly. Until 2020, EFSA will carry out new risk assessments, and subsequently the Commission will revise the list of food additives and the conditions of use specified therein. The deadline for food additives other than colours and sweeteners is 31 December 2018, which seems appropriate regarding the non-acute need for reevaluation of Calcium Disodium EDTA as food additive.

Grey Area Novel Foods: An Investigation into Criteria with Clear Boundaries.

In the European Union novel foods are defined by the Novel Foods Regulation as food products and food ingredients that have not been consumed to a significant degree in the European Union before May 1997. However, there are new foods for some reason not considered as novel foods, although it may not be excluded that they differ from conventional foods to such an extent that an assessment of their safety prior to their entry to the market would be called for. Previously, we reported that this ‘grey area’ of novel foods exists and comprises: (1) food products or ingredients for which the current Novel Foods Regulation leaves too much space for different interpretations and (2) food products or ingredients that are not novel according to the current Novel Foods Regulation because it contains gaps. This paper focuses on how to handle these interpretation differences and gaps and provides recommendations to improve these pitfalls of the current Novel Foods Regulation. To this end, we propose criteria with clear boundaries as part of an assessment tool to reduce the uncertainties in interpretation with respect to consumption to a significant degree in the European Union, which take into account the commercial availability, length, extent and frequency of use of the particular food/ingredient. In addition, biological relevant boundaries for the criteria regarding changes in the nutritional value, metabolism (better all aspects of absorption, distribution, metabolism and excretion), and levels of undesirable substances are proposed for significant changes in the composition of foods due to changes in the production process. In addition, criteria are proposed to cover ambiguities and gaps in the Novel Foods Regulation dealing with food products and food ingredients obtained from 1) animals on a new feeding regime, 2) new varieties of organisms, 3) other growth stages of crops. Finally, a criterion that takes into account the total ingredient intake rather than single product intake is added to deal with the risk of overexposure to substances. Taken together, the proposed boundaries and criteria may contribute to diminishing the interpretation issues regarding the Novel Foods Regulation and thus to reducing the extent of the grey area of novel foods.

Benefit-Risk Analysis for Foods (BRAFO)- Executive Project Summary.

BRAFO, Benefit-Risk Analysis for Foods, was a European Commission project funded within Framework Six as a Specific Support Action and coordinated by ILSI Europe. BRAFO developed a tiered methodology for assessing the benefits and risks of foods and food components, utilising a quantitative, common scale for health assessment in higher tiers. A methodology group reviewed and assembled the methodologies available developing a guidance document that describes a tiered (‘stepwise’) approach for performing a risk and benefit assessment of foods. In parallel, three expert groups on natural foods, dietary interventions and heat processing applied the tiered approach to several case studies. Finally a consensus group reported on the implications of the experience gained during the development of the project for the further improvement.

An Assessment Framework to Delineate Between Dietary Foods for Special Medical Purposes and Normal Foods.

This paper describes an assessment framework (‘decision tree’) to delineate between ‘dietary foods for special medical purposes’ and normal ‘foods’. The Netherlands Food and Consumer Product Safety Authority commissioned this work in 2010. The background for the 2010 request was that some normal foods to which the EU Nutrition and Health Claims Regulation 1924/2006 applies [1], were presented on the market in the Netherlands as ‘dietary foods for special medical purposes’ falling under Directive 1999/21/EC [2]. In order to assist in the enforcement of the EU Nutrition and Health Claims Regulation 1924/2006 it was necessary to have an assessment framework. In 2010, the National Institute for Public Health and the Environment (RIVM) produced its final report. This report was since then used by the Netherlands Food and Consumer Product Safety Authority to enforce appropriate law in Europe/the Netherlands. Although since 2010 this decision tree has worked satisfactory, it was available only in the Dutch language on the website of the Netherlands Food and Consumer Product Safety Authority [3]. Hence, it could not be communicated internationally. However, once international experts became aware of this document existing in Dutch and indicated their active interest, it was decided to have a full translation of the original document in the public domain. This paper shortly describes the relevant definitions of “foods” in the applicable EU legislations and then the full translation (in English) of the original document (in Dutch). In an annex, the definition of ‘food’ in the applicable EU legislation is given.