Aspartame exposures in the US population: Demonstration of a novel approach for exposure estimates to food additives using NHANES data.

BACKGROUND: Exposure to food additives is widespread but up-to-date and accurate intake estimates are rarely available. The safety of the food additive aspartame is the subject of recent controversy and intake estimates for this nonnutritive sweetener are typically derived from surrogates such as diet soda consumption. OBJECTIVE: We describe an approach for developing nationally representative dietary exposure estimates for food additives that combines intake from dietary recalls and grocery purchasing information. METHODS: We combined NielsenIQ Homescan Consumer Panel purchasing data with the USDA Global Branded Food Products database and the National Health and Nutrition Examination Survey to estimate aspartame intake and prevalence of consumption for the US population. We examined points of departure for aspartame from CompTox Chemicals Dashboard to provide context for exposures and potential effects. RESULTS: Mean, 90th percentile, and 95th percentile aspartame intake estimates are below the acceptable daily intake (50 mg/kg/day) and are lower than estimates from previous decades. Groups with the highest aspartame intakes are non-Hispanic whites, 60- to 69-year-olds, and individuals on diabetic diets. Aspartame exposure is highly prevalent (62.6%) in the US including sensitive populations such as pregnant women and children. IMPACT STATEMENT: Exposure to the widely consumed food additive aspartame is not well characterized, and concerns about potential health effects remain despite assurances of safety when consumed under conditions of intended use. This work provides current intake estimates for the US population with important comparisons across demographic groups and individuals on special diets. The approach includes ingredient statement and grocery purchasing data to capture all aspartame-containing products, beyond diet soda, in intake estimates. This framework also has the potential for application to other food ingredients.

Left atrial appendage volume is an independent predictor of atrial arrhythmia recurrence following cryoballoon pulmonary vein isolation in persistent atrial fibrillation.

Purpose: Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation in persistent AF (persAF), and cryoballoon PVI emerged as an initial ablation strategy. Symptomatic atrial arrhythmia recurrence following successful PVI in persAF is observed more frequently than in paroxysmal AF. Predictors for arrhythmia recurrence following cryoballoon PVI for persAF are not well described, and the role of left atrial appendage (LAA) anatomy is uncertain. Methods: Patients with symptomatic persAF and pre-procedural cardiac computed tomography angiography (CCTA) images undergoing initial second-generation cryoballoon (CBG2) were enrolled. Left atrial (LA), pulmonary vein (PV) and LAA anatomical data were assessed. Clinical outcome and predictors for atrial arrhythmia recurrence were evaluated by univariate and multivariate regression analysis. Results: From May 2012 to September 2016, 488 consecutive persAF patients underwent CBG2-PVI. CCTA with sufficient quality for measurements was available in 196 (60.4%) patients. Mean age was 65.7 ± 9.5 years. Freedom from arrhythmia was 58.2% after a median follow-up of 19 (13; 29) months. No major complications occurred. Independent predictors for arrhythmia recurrence were LAA volume (HR 1.082; 95% CI, 1.032 to 1.134; p = 0.001) and mitral regurgitation ≥ grade 2 (HR, 2.49; 95% CI 1.207 to 5.126; p = 0.013). LA volumes ≥110.35 ml [sensitivity: 0.81, specificity: 0.40, area under the curve (AUC) = 0.62] and LAA volumes ≥9.75 ml (sensitivity: 0.56, specificity 0.70, AUC = 0.64) were associated with recurrence. LAA-morphology, classified as chicken-wing (21.9%), windsock (52.6%), cactus (10.2%) and cauliflower (15.3%), did not predict outcome (log-rank, p = 0.832). Conclusion: LAA volume and mitral regurgitation were independent predictors for arrhythmia recurrence following cryoballoon ablation in persAF. LA volume was less predictive and correlated with LAA volume. LAA morphology did not predict the clinical outcome. To improve outcomes in persAF ablation, further studies should focus on treatment strategies for persAF patients with large LAA and mitral regurgitation.

Implementation of Visual-Only Swine Inspection in the European Union: Challenges, Opportunities, and Lessons Learned.

ABSTRACT: Consumption of contaminated meat and poultry products is a major source of foodborne illness in the United States and globally. Meat inspection procedures, established more than 100 years ago to detect prevailing food safety issues of the time and largely harmonized around the world, do not effectively detect modern hazards and may inadvertently increase food safety risks by spreading contamination across carcasses. Visual-only inspection (VOI) is a significantly different, modernized meat inspection system that is data driven and minimizes physical manipulation of the carcass during inspection. It was developed based on scientific evidence and risk assessment and aims to better control current food safety hazards. In 2014, the European Union (EU) became the first supranational government in the world to require VOI for all swine herds slaughtered in member states that met certain epidemiologic and animal rearing conditions. Here, we review the implementation of this new inspection system with the goal of informing similar modernization efforts in other countries and for other commodities beyond pork. This article reports the results of a literature review and interviews conducted with nine experts in 2018 on the implementation of the EU's 2014 VOI regulation. Challenges, opportunities, and lessons learned about the implementation of the regulation are described for audiences interested in adapting inspection procedures to prevent and detect modern food safety hazards. Overall, implementation of VOI varies within and across member states, and among slaughterhouses of different sizes. This variation is due to disease risk patterns, supply chain conditions, and trade barriers. Before transitioning to a similar risk-based meat inspection system, other countries should consider the following: science-based research agendas to identify what food chain information best predicts herd health and foodborne hazards, regulatory system design that accurately reflects local hazards, and development of targeted VOI educational materials.