title: World Health Organization estimates of the global and regional disease burden of four foodborne chemical toxins, 2010: a data synthesis.
abstract: Background Chemical exposures have been associated with a variety of health effects; however, little is known about the global disease burden from foodborne chemicals. Food can be a major pathway for the general population's exposure to chemicals, and for some chemicals, it accounts for almost 100% of exposure.  Methods and Findings Groups of foodborne chemicals, both natural and anthropogenic, were evaluated for their ability to contribute to the burden of disease.  The results of the analyses on four chemicals are presented here - cyanide in cassava, peanut allergen, aflatoxin, and dioxin.  Systematic reviews of the literature were conducted to develop age- and sex-specific disease incidence and mortality estimates due to these chemicals.  From these estimates, the numbers of cases, deaths and disability adjusted life years (DALYs) were calculated.  For these four chemicals combined, the total number of illnesses, deaths, and DALYs in 2010 is estimated to be 339,000 (95% uncertainty interval [UI]: 186,000-1,239,000); 20,000 (95% UI: 8,000-52,000); and 1,012,000 (95% UI: 562,000-2,822,000), respectively.  Both cyanide in cassava and aflatoxin are associated with diseases with high case-fatality ratios.  Virtually all human exposure to these four chemicals is through the food supply.  Conclusion Chemicals in the food supply, as evidenced by the results for only four chemicals, can have a significant impact on the global burden of disease. The case-fatality rates for these four chemicals range from low (e.g., peanut allergen) to extremely high (aflatoxin and liver cancer).  The effects associated with these four chemicals are neurologic (cyanide in cassava), cancer (aflatoxin), allergic response (peanut allergen), endocrine (dioxin), and reproductive (dioxin).
authors.affiliation: Gibb Epidemiology Consulting LLC, Arlington, VA, USA.
authors.forename: Herman
authors.initials: H
authors.lastname: Gibb
authors.affiliation: Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium; Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium; Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; Emerging Pathogens Institute and Animal Sciences Department, University of Florida, Gainesville, FL, USA.
authors.forename: Brecht
authors.initials: B
authors.lastname: Devleesschauwer
authors.affiliation: Exponent, Center for Chemical Regulation and Food Safety, Washington, DC, USA.
authors.forename: P Michael
authors.initials: PM
authors.lastname: Bolger
authors.affiliation: Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI, USA; Department of Agricultural, Food, and Resource Economics, Michigan State University, East Lansing, MI, USA.
authors.forename: Felicia
authors.initials: F
authors.lastname: Wu
authors.affiliation: National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands.
authors.forename: Janine
authors.initials: J
authors.lastname: Ezendam
authors.affiliation: Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique.
authors.forename: Julie
authors.initials: J
authors.lastname: Cliff
authors.affiliation: National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands.
authors.forename: Marco
authors.initials: M
authors.lastname: Zeilmaker
authors.affiliation: Department of Food Safety and Zoonoses, World Health Organization, Geneva, Switzerland.
authors.forename: Philippe
authors.initials: P
authors.lastname: Verger
authors.affiliation: CSIRO Food and Nutrition Flagship, North Ryde, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Pitt
authors.affiliation: Food Data Analysis Section, Food Standards Australia New Zealand, Canberra, Australia.
authors.forename: Janis
authors.initials: J
authors.lastname: Baines
authors.affiliation: Department of Food Technology, University of Ibadan, Ibadan, Nigeria.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Adegoke
authors.affiliation: Environmental Health Services, British Columbia Centre for Disease Control, Vancouver, BC, Canada.
authors.forename: Reza
authors.initials: R
authors.lastname: Afshari
authors.affiliation: INTERTEK, Oak Brook, IL, USA.
authors.forename: Yan
authors.initials: Y
authors.lastname: Liu
authors.affiliation: National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands.
authors.forename: Bas
authors.initials: B
authors.lastname: Bokkers
authors.affiliation: National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands.
authors.forename: Henk
authors.initials: H
authors.lastname: van Loveren
authors.affiliation: National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands.
authors.forename: Marcel
authors.initials: M
authors.lastname: Mengelers
authors.affiliation: National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands.
authors.forename: Esther
authors.initials: E
authors.lastname: Brandon
authors.affiliation: National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands; Emerging Pathogens Institute and Animal Sciences Department, University of Florida, Gainesville, FL, USA; Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands.
authors.forename: Arie H
authors.initials: AH
authors.lastname: Havelaar
authors.affiliation: Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Bellinger
keywords: DALYs; aflatoxin; cassava; cyanide; dioxin; epidemiology; foodborne diseases; peanut allergen; public health