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OCR for page 110
Human Foods and
Food-Consumption Patterns
Food is the major route for human exposure to dioxins and dioxin-like com-
pounds (referred to collectively as DLCs). Most DLCs in foods are contained in
the lipid component of foods of animal origin. While DLC exposure through
fruits, vegetables, and grains also occurs, it is thought to result primarily from the
adhesion of soil to plant material. DLCs have relatively long half-lives in the
human body, and the rate of elimination of these compounds from the body is
inversely related to age and increased adiposity (Kreuzer et al., 1997), presum-
ably on the basis of the age-associated increase in adipose tissue depots. Thus, the
overall body burden tends to increase over time, even if exposure levels do not
change.
The ability to estimate dietary exposure and the within-population variability
in exposure to DLCs is limited by the availability of appropriate data. The most
recent National Health and Nutrition Examination Survey (NHANES) included
testing of serum dioxin levels on a subsample of individuals and dietary measures
on all participants, which should provide a clearer picture of exposures. (Dioxin
measurements were added to this survey in 1999-2000, and the first data were
released in January 2003, too late for inclusion in this report.) At this writing, the
best available approach to estimating DLC exposure through diet is to combine
information from two sources: the U.S. Department of Health and Human Ser-
vices, Food and Drug Administration's (FDA) Total Diet Study (IDS), which
has been accumulating information on the DLC content of selected commonly
consumed food items since 1999, and the national food-consumption monitoring
surveys that are conducted repeatedly by the U.S. Department of Agriculture
(USDA). The consumption data selected for this report were based on actual
110
OCR for page 111
HUMAN FOODS AND FOOD-CONSUMPTION PA'ITERNS
111
intakes rather than on disappearance data in order to obtain a more accurate
perspective when the data was applied to exposure estimates. The committee
commissioned an analysis based on these data; the analysis is discussed later in
this chapter and in Appendix B. Aspects of current dietary patterns in the United
States with regard to fat intake and to consumption of products that contribute the
largest share of exposure to DLCs (i.e., meats, poultry, dairy products, and fish)
are reviewed briefly below.
DIETARY-INTAKE PATTERNS
Overall, American adults derive about 34 percent of their dietary energy
from fat and one-fourth to one-third of that is from saturated fat, which is largely
animal fat. USDA survey data (1977-1978, 1989-1991, and 1994-1996) show
that the average adult intake of fat in total grams increased slightly (from an
average of 78.5 g/d to 83.1 g/d) between the 1989-1991 and 1994-1996 surveys
(although the percent of dietary energy derived from fat decreased from 34.9
percent to 32.9 percent, a function of an overall increase in dietary energy intake).
Saturated fat intake was more stable over the same time period at an average of
27.6 to 28.3 g/d (although again, the percent of dietary energy from saturated fat
decreased). Fat intakes were substantially higher for men than for women (Ken-
nedy et al., 1999~.
The stability of the average absolute intakes, however, masks real changes in
the food sources of fat over the same time period. A steady substitution of low-fat
and skim milk for whole milk and yogurt occurred between 1970 and 1990, but
consumption of cheese and of cream products (including sour cream, half and
half, cream-based dips, and light cream) increased (Enns et al., 1997~.
A trend toward more poultry and fish consumption and less red-meat con-
sumption occurred over the same time period. Based on national food supply data
(Putnam and Allshouse, 1993), the U.S. population per capita consumed an aver-
age of 18 lb less red meat, 26 lb more poultry, and 3 lb more fish and shellfish in
1992 than in 1970.
Adults (both men and women) consume more meat and fish than children,
but children are major consumers of dairy products. On average, children con-
sume almost twice as much milk and dairy products as do adults. Fish consump-
tion is of particular interest for several reasons. One is that fish consumption has
been increasing in the population, and this trend is generally a good one from a
health standpoint. However, the level of DLCs in fish is variable; fish from
contaminated waterways and those that receive feed that contains DLCs have
higher DLC levels. Furthermore, there are relatively small subgroups of the popu-
lation whose reliance on fish may be more important than that for the general
population. These subgroups have the potential to have substantially higher DLC
exposures than the general population.
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2
DIOXINS AND DIOXIN-LIKE COMPOUNDS IN THE FOOD SUPPLY
American Indian groups in traditional fishing cultures (primarily in the North-
east and northern Midwest) and Alaska Native and northern Canadian groups
(Northern Dwelling populations) that traditionally consume large amounts of fish
and marine mammals, and rural subsistence and sport fishers in various parts of
the country, are potentially at risk. A number of rivers and lakes that are impor-
tant for fishing, including the Great Lakes, are near or downstream from indus-
trial sources of contamination. While data on dietary exposures to DLCs in these
groups are limited, a few studies are relevant.
Outside of American Indian groups, there is a paucity of data on the intakes
of subsistence or sport fishers. Frequent consumption of game fish is of concern
because many of these fish are particularly high sources of DLCs (Anderson et
al., 1998~. Subsistence fishing is a cultural tradition in many African-American
families and in Southeast-Asian immigrants.
DLC Analyses of Foods Consumed
Due primarily to the high cost per sample to analyze DLCs, there is relatively
little information on the DLC content of the U.S. food supply. Recently however,
FDA conducted DLC analyses for selected foods collected as market basket
samples in the 1999-2000 and 2001 TDS. The TDS survey samples foods pur-
chased by FDA personnel from supermarkets or grocery stores four times per
year; one sample is collected from each of three cities from each of four geo-
graphic regions. Each market basket contains similar foods purchased in the three
cities in a given region. The market basket food samples are then prepared as for
consumption, and the three samples of a food from a region are composited into
a single sample, prepared in duplicate, and analyzed for DLCs. Representative
ranges of DLC content in foods from a portion of the 2001 analysis are presented
in Table 5-1 (the complete analysis is presented in Appendix B). The ranges on
the table reflect the estimates of the absolute DLC levels in foods not exposure
levels, which are determined by the amount of food consumed. Furthermore, the
analysis was based on whole food or wet weight rather than on a lipid basis in
order to maintain consistency with consumption data and to preserve data quality,
although inclusion of the lipid content might have been useful in comparisons
among reports.
Table 5-1 shows that DLCs may be found in all foods, with a range of
content within each food group. However, only in animal products, specifically
red meat, fish, and dairy products, do concentrations reach more than 0.10 ppt. In
general, higher DLC concentrations are associated with higher fat contents, par-
ticularly with animal fats. Foods representing the upper levels of these ranges
include high-fat cuts of beef, bacon, frankfurters, full-fat cheeses, fatty fish (e.g.,
salmon), and butter. On the other hand, within each of these categories, foods
containing relatively low levels of DLCs can be selected, including lean steak
(0.03 ppt), lean ham (0.04 ppt), cottage cheese (0.03 ppt), shrimp (0.06 ppt), and
OCR for page 113
HUMAN FOODS AND FOOD-CONSUMPTION PA'ITERNS
TABLE 5-1 Dioxin and Dioxin-like Compound (DLC) Content Per Gram in
Selected Food Groups from the 2001 Total Diet Study
113
Food Group
DLC Content (ppt toxicity equivalents)
Meat, fish, poultry, eggs
Beef, pork, lamb
Processed meats
Fish, shellfish
Poultry
Eggs
Dairy foods
Cheese
Cream/ice cream
Milk
Fats, oils, nuts
Butter
Vegetable oils
Nuts
Breads, cereals
Breads
Crackers
Pasta
Breakfast cereal
Fruits, vegetables
Fruit
Vegetables
0.005-0.46
0.01-0.21
0.01-0.33
0.004-0.06
0.01-0.05
0.002-0.24
0.0001-0.06
0.0006-0.01
0.22
0.002-0.06
0.003-0.006
0.001-0.05
0.001-0.02
0.0001-0.02
0.0007-0.01
0.0007-0.01
0.0001-0.05
NOTE: Mean toxicity equivalents at nondetects = 0.
SOURCE: Douglass and Murphy (2002).
margarine (0.03 ppt). Fruit, vegetable, and grain products have considerably
lower concentrations of DLCs, but because large volumes are consumed, these
foods also contribute to total DLC exposure (Douglass and Murphy, 2002~.
USDA's Agricultural Research Service conducts a nationally representative
survey, formerly known as the Continuing Survey of Food Intakes by Individuals
(CSFII), which has now been merged with NHANES. This survey provides im-
portant information about the types of foods Americans are consuming and the
quantities consumed (NCHS, 2003~.
The 1994-1996 CSFII was conducted between January 1994 and January
1997. In each of the three survey years, data were collected from a nationally
representative sample of noninstitutionalized individuals of all ages in the United
States. The 1998 CSFII was a survey of children ages O through 9 years. It was
conducted using the same sampling and dietary intake methodologies as the
1994-1996 CSFII so that the survey results could be merged to increase the total
sample size for children. In both surveys, dietary intakes were collected through
OCR for page 114
4
DIOXINS AND DIOXIN-LIKE COMPOUNDS IN THE FOOD SUPPLY
in-person interviews using 24-hour recalls on two nonconsecutive days, approxi-
mately one week apart. A total of 21,662 individuals provided data for the first
day; of those individuals, 20,607 provided data for the second day. Each dietary
recall included a record of all foods and beverages consumed in the previous 24
hours, including the gram weight of each food or beverage consumed.
Data obtained from the sequential CSFIIs over the past 30 years indicate a
trend in food consumption toward a lower total saturated fat intake and a lower
total fat intake as a percent of energy consumed, although with a higher total
energy intake. A summary of 1994-1996 CSFII intake data for foods that are
most likely to contain high amounts of DLCs is presented in Figures 5-1 through
5-3. The figures demonstrate that differing age and sex groups tend to be exposed
to DLCs through intakes of foods from different food groups. For example, male
adolescents and men consume considerably more beef than women, with little
consumed by children under 6 years of age. More fish is consumed by adults than
by children, and more by men than by women. On the other hand, the average
milk and dairy consumption is highest for young children; adults consume con-
siderably less.
The committee commissioned an analysis (see Appendix B) to estimate ex-
posures to DLCs from the U.S. food supply for venous age and sex groups. The
analysis utilized data from the TDS for samples collected in 2001 (which were
45
40
35
In 30
o
O 25
3 20
1 5
CD 1 0
5
o
0-5 M/F 6-11 M 6-11 F 12-19M 12-19F 20&Up 20&Up
M F
Age Range (y) by Gender
FIGURE 5-1 Beef consumption by age and sex, 1-day average intake, 1994-1996. Val-
ues represent population intake averages of absolute amounts of beef consumed per indi-
vidual for 1 day. Error bars are standard errors of the mean. M = male, F = female.
SC)IJRCE- Fond Survevs Research Group (1997~.
OCR for page 115
HUMAN FOODS AND FOOD-CONSUMPTION PA'ITERNS
500
450
is, 400
In
o
350
250
A 200
a:
150
100
50
o
115
0-5 M/F 6-11 M 6-11 F 12-19M 12-19F 20&Up 20&Up
M F
Age Range (y) by Gender
FIGURE 5-2 Fish consumption by age and sex, 1-day average intake, 1994-1996. Val-
ues represent population intake averages of absolute amounts of fish consumed per indi-
vidual for 1 day. Error bars are standard errors of the mean. M = male, F = female.
SOURCE: Food Surveys Research Group (1997~.
40 -
~, 35-
30-
(n
o
~ 20
o
15
10
25 -
o
0-5 M/F 6-11 M 6-11 F 12-19
12-19 F 20 & Up 20 & Up
M F
Age Range (y) by Gender
FIGURE 5-3 Dairy consumption by age and sex, 1-day average intake, 1994-1996.
Values represent population intake averages of absolute amounts of milk and dairy foods
consumed per individual for 1 day. Error bars are standard errors of the mean. M = male,
F = female.
SOURCE: Food Surveys Research Group (1997~.
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116
DIOXINS AND DIOXIN-LIKE COMPOUNDS IN THE FOOD SUPPLY
analyzed for 17 dioxin congeners). The TDS data were linked to intake data from
the 1994-1996 and 1998 CSFII to estimate dietary exposure to DLCs, through
foods actually consumed. The TDS weighting factors developed for use in esti-
mating exposure based on analyte concentrations in TDS foods are based on
results of the 1987-1988 USDA Nationwide Food Consumption Survey, and
therefore are not likely to reflect current patterns of intake. Therefore, the analy-
sis commissioned by the committee used results from the 1994-1996,1998 CSFII.
Because relatively few foods were sampled for the TDS relative to the thou-
sands of foods in the CSFII database, CSFII foods were grouped to estimate DLC
content from the most similar analyzed food. This method generates substantial
errors for individual intake estimates, but because FDA sampled the foods it
considered most representative of the U.S. diet, the results should provide reason-
able average DLC intake estimates. These limitations must, however, be taken
into consideration when interpreting the results.
The results of this merged analysis (presented in Figures 5-4 through 5-11)
allow a view of the relative contnbution, within the limitations of the data, to total
DLC intake from venous food groups based on actual U.S. dietary intake. The
analysis did not utilize "usual intakes" (commonly used for nutrient intake levels
from foods) because of the extensive variability of levels of contaminants (e.g.,
DLCs) in foods.
Other Foods and Mixtures
10%
Fats, Oils and Mixtures
1%
Fruits, Vegetables and Mixtures
10%
Eggs and Mixtures
4%
Fish and Mixtures
4%
Poultry and Mixtures''
Meat and Mixtures
35%
Dairy Foods and Mixtures
30%
FIGURE 5-4 Estimated percent contribution of foods to intakes of dioxins and dioxin-
like compounds (DLCs), children ages 1 through S years. Nondetects = 0. Percentages
were calculated based on mean 2-day average DLC intake/kg of body weight.
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HUMAN FOODS AND FOOD-CONSUMPTION PA'ITERNS
Other Foods and Mixtures
13%
Fats, Oils and Mixtures
1%
Fruits, Vegetables and Mixtures
9%
Eggs and Mixtures
2%
Fish and Mixtures
6%
Poultry and Mixtures'
7%
117
Dairy Foods and Mixtures
24%
Meat and Mixtures
38%
FIGURE 5-5 Estimated percent contribution of foods to intakes of dioxins and dioxin-
like compounds (DLCs), children ages 6 through 11 years. Nondetects = 0. Percentages
were calculated based on mean 2-day average DLC intake/kg of body weight.
Other Foods and Mixtures
~ 4o/^
Fats, Oils and Mixtures
Fruits, Vegetables and Mixtures
9%
Eggs and Mixtures
2%
Fish and Mixtures
5%
Poultry and Mixtures "
7%
Dairy Foods and Mixtures
16%
Meat and Mixtures
46%
FIGURE 5-6 Estimated percent contribution of foods to intakes of dioxins and dioxin-
like compounds (DLCs), boys ages 12 through 19 years. Nondetects = 0. Percentages
were calculated based on mean 2-day average DLC intake/kg of body weight.
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118
DIOXINS AND DIOXIN-LIKE COMPOUNDS IN THE FOOD SUPPLY
Other Foods and Mixtures
12%
Fats, Oils and Mixtures
2%
Fruits, Vegetables and
Mixtures 9%
Eggs and Mixtures
Fish and Mixtures
10%
Poultry and Mixtures
7%
Dairy Foods and Mixtures
1 1 %
Meat and Mixtures
46%
FIGURE 5-7 Estimated percent contribution of foods to intakes of dioxins and dioxin-
like compounds (DLCs), men ages 20 years and older. Nondetects = 0. Percentages were
calculated based on mean 2-day average DLC intake/kg of body weight.
Other Foods and Mixtures
~ Ro/O
Fats, Oils and Mixtures
1%
Fruits, Vegetables and Mixtures
8%
Eggs and Mixtures
2%
Fish and Mixtures
5%
Poultry and Mixtures
7%
Dairy Foods and
17%
ixtures
Meat and Mixtures
45%
FIGURE 5-8 Estimated percent contribution of foods to intakes of dioxins and dioxin-
like compounds (DLCs), girls ages 12 through 19 years. Nondetects = 0. Percentages
were calculated based on mean 2-day average DLC intake/kg of body weight.
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HUMAN FOODS AND FOOD-CONSUMPTION PA'ITERNS
Other Foods and Mixtures
13%
Fats, Oils and Mixtures
2%
Fruits, Vegetables and
Mixtures 1 1%
Eggs and Mixtures
3%
Fish and Mixtures
12%
Dairy Foods and Mixtures
1 polio
Poultry and Mixtures
7%
119
Meat and Mixtures
40%
FIGURE 5-9 Estimated percent contribution of foods to intakes of dioxins and dioxin-
like compounds (DLCs), women ages 20 years and older. Nondetects = 0. Percentages
were calculated based on mean 2-day average DLC intake/kg of body weight.
Other Foods and Mixtures
15%
Fats, Oils and Mixtures
1%
Fruits, Vegetables and Mixtures
12%
Eggs and Mixtures
4%
Fish and Mixtures
4%
Poultry and Mixtures
7%
Dairy Foods and Mixtures
20%
Meat and Mixtures
37%
FIGURE 5-10 Estimated percent contribution of foods to intakes of dioxins and dioxin-
like compounds (DLCs), pregnant and/or lactating females ages 12 years and older. Non-
detects = 0. Percentages were calculated based on mean 2-day average DLC intake/kg of
body weight.
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120
DIOXINS AND DIOXIN-LIKE COMPOUNDS IN THE FOOD SUPPLY
Other Foods and Mixtures
12%
Fats, Oils and Mixtures
Fruits, Vegetables and Mixtures
10%
Eggs and Mixtures
3%
Fish and Mixtures
8%
Poultry and Mixtures - .
7%
Dairy Foods and Mixtures
7o/^
Meat and Mixtures
42%
FIGURE 5-11 Estimated percent contribution of foods to intakes of dioxins and dioxin-
like compounds (DLCs), males and females ages 1 year and older. Nondetects = 0. Per-
centages were calculated based on mean 2-day average DLC intake/kg of body weight.
Because it was not possible to more closely define the food categories, the
"fruits, vegetables and mixtures" and "other foods and mixtures" categories con-
tain an array of items. Foods that fell within the general category of fruits and
vegetables included raw and cooked vegetables and fruits, along with vegetable
items prepared as mixtures that contained some milk, eggs, cheese, and meat. The
others foods and mixtures category included food combinations and mixtures,
some of which were made with animal food products. The imputation of foods in
these two groups to data from the CSFII also required making generalizations
about specific intakes.
The data in the figures are relative exposures, with DLC nondetect levels
assumed to be zero. The committee chose this reference value because it felt that,
under these circumstances, this value gave the most accurate representation of the
DLC intake. The common alternative methods (assuming nondetects = I/2 of the
limit of detection or nondetects = the limit of detection) are more conservative,
but they tend to artifactually indicate a greater contribution of substances known
to be low in DLCs (grains, fruits, and vegetables) because of their relative roles in
the total diet.
The results of the analysis, discounting the other foods and mixtures cat-
egory, suggest that DLC exposure levels to the general adult population from
animal-food products and based on estimated amounts consumed by population
groups, are greatest from meat, followed by dairy foods and fish. The estimates
for dairy foods do not take into account the consumption of low-fat and skim milk
because only whole milk was analyzed. The dairy foods estimates do, however,
OCR for page 139
HUMAN FOODS AND FOOD-CONSUMPTION PA'ITERNS
139
free and easy to implement. Selecting low-fat products; trimming and discarding
visible fat from meat, fish, and poultry; discarding skin from fish and poultry;
avoiding practices that add or retain animal fat; and washing vegetables and
peeling root and waxy-coated vegetables are recommended.
Food and Nutrition Assistance Programs
USDA administers several food assistance programs that provide a variety of
benefits to target recipients. The four primary programs are the Food Stamp
Program, the National School Lunch Program, the School Breakfast Program,
and WIC. The nationwide average monthly participation rate for the Food Stamp
Program was just over 19 million in fiscal year 2002 (FNS,2003b). More than 28
million children participated in the National School Lunch Program in fiscal year
2002, and more than 8.1 million participated in the School Breakfast Program
(FNS, 2003c, 2003d). Statistics for the WIC program show that in fiscal year
2002 nearly 7.5 million people participated in the program (FNS, 2003e). The
target recipients for the National School Lunch and School Breakfast Programs
and WIC participants are of particular interest to this report.
Although surveys of participants in the National School Lunch Program
showed that they had greater intakes of energy, protein, and several vitamins and
minerals compared with nonparticipants, they also consumed greater amounts of
total fat and saturated fat per day than nonparticipants (Devaney et al., 1993~.
Data from the School Nutrition Dietary Assessment Study-II show that in the
survey years 1998-1999, at least 70 percent of elementary school lunches served
met the program standard for calories (one-third of the Recommended Dietary
Allowance), but exceeded the program standards for levels of fat and saturated
fat. Results also showed that, on average, elementary school lunches provided 33
percent of calories from total fat and 12 percent of calories from saturated fat. At
the same time, calories provided from carbohydrate were below the recommended
55 percent (Fox et al., 2001~.
WIC providers encourage pregnant women to breastfeed their babies and the
program supplies a greater variety and quantity of foods and offers longer partici-
pation to breastfeeding participants (FNS, 2003a). Fifty-six percent of WIC par-
ticipants initiate breastfeeding in the hospital; however, only 45 percent are still
breastfeeding at discharge, and only 16 percent continue breastfeeding to 5 months
of age. WIC participants who breastfeed and are most likely to continue breast-
feeding are those who receive the special food package for breastfeeding mothers
along with information and advice on breastfeeding (IOM, 2002b).
WIC participants receive a food package that includes milk, cheese, and
eggs. The recent report, Dietary Risk Assessment in the WIC Program (IOM,
2002b), identified adherence to Food Guide Pyramid recommendations, includ-
ing consumption of fat, saturated fat, and cholesterol, as an appropriate criterion
for reducing dietary risk, recognizing that essentially low-income women and
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140
DIOXINS AND DIOXIN-LIKE COMPOUNDS IN THE FOOD SUPPLY
children will meet this criterion. However, whether WIC participants are at
risk for greater exposure to DLCs than the general population has not been
determined.
DIETARY GUIDANCE
The ultimate goal of dietary guidance and consumer education with regard to
DLC exposure is to reduce body burdens across the whole population, and par-
ticularly for women prior to pregnancy and breastfeeding. Empowering individu-
als, through information, to make dietary changes that reduce DLC exposure is
theoretically possible but requires a long-term view. The stability of these com-
pounds in the body means that reduction in risk through dietary choice is ineffec-
tive in the short run, but it is likely very important over years and decades,
particularly if begun in childhood.
There are several sources of dietary recommendations and associated educa-
tional tools for the general population that are consistent with the reduction of
DLC exposure through the reduction of animal fat intake. HHS and USDA jointly
developed the Dietary Guidelines for Americans (USDA/HHS, 2000), which
provide recommendations to the general population, based on current scientific
evidence, about the relationship between diet and risk for chronic disease, and
which serve as guides for how a healthy diet may improve nutritional status. By
statute, these guidelines now form the basis of federal food, nutrition education,
and information programs. The Food Guide Pyramid is designed as an educa-
tional tool to translate these recommendations for the public (USDA, 1996~.
The U.S. Dietary Guidelines recommend that Americans over the age of 2
years "choose a diet that is low in saturated fat and cholesterol and moderate in
total fat," and specifically that individuals should keep their "intake of saturated
fat at less than 10 percent of total calories" and should "aim for a total fat intake
of no more than 30 percent of total calories" (USDA/HHS,2000~. In this context,
the U.S. Dietary Guidelines recommend choosing "vegetable oils rather than
solid fats (meat, dairy fats, shortening)" and fat-free or low-fat milks, yogurts,
and cheeses, and limiting intakes of high-fat processed meats and organ meats
(including liver) and sauces made with cream.
Similar to the U.S. Dietary Guidelines, the American Heart Association's
(AMA) 2000 dietary guidelines "advocates a population-wide saturated fat intake
of less than 10 percent energy, which can be achieved by limiting intake of foods
rich in saturated fatty acids (e.g., full-fat dairy products and fatty meats)" (Krause
et al., 2000~. Another report, Dietary Reference Intakes for Energy, Carbohy-
drate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (IOM,
2002a), is consistent with the Dietary Guidelines and the AHA recommendations
in that it identifies the association between the excessive intake of saturated fats
with the increased incidence of heart disease and the development of certain
cancers. Further, the reports cited above all recommend that individuals strive to
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HUMAN FOODS AND FOOD-CONSUMPTION PA'ITERNS
141
achieve and maintain a healthy body weight, that is, to avoid gaining excess
weight because of the known adverse health consequences of obesity, indepen-
dent of the increased body burden of DLCs due to the accumulation of total body
fat. The committee did not, however, find evidence to support a reduction in DLC
body burden through weight loss. Thus, preventing obesity is preferred as a
means of reducing the potential for DLC accumulation.
The committee identified two areas in which changes in individual behavior
could reduce DLC exposure, but which are not advised because of countervailing
risks. These are reductions in fatty-fish consumption below current recommenda-
tions of 1 to 2 fish meals per week and in breastfeeding. Each of these are
discussed briefly below.
Fish
A recommendation that emerged very recently and does not appear specifi-
cally in the current U.S. Dietary Guidelines recognizes the potential health ben-
efits of fish consumption. Unlike the saturated fat in dairy products and meats,
the fatty acids in fish have been shown in epidemiological studies to be beneficial
to health. The strongest evidence for the importance of omega-3 fatty acids is a
reduction in risk of sudden death from cardiac arrest: epidemiological studies
show a lower risk with greater fish consumption among both men and women
(Daviglus, 1997; Guallar, 1995; Hu et al., 2002~.
Two long-chained, highly polyunsaturated fatty acids, docosahexaenoic acid
and eicosapentaenoic acid, are thought to be responsible for these health benefits
by providing strong antiarrhythmic action on the heart, by serving as precursors
to prostaglandins, and by providing anti-inflammatory and anti-thrombotic ac-
tions. There is a large body of epidemiological evidence to indicate that con-
sumption of omega-3 polyunsaturated fatty acids, which are present in fatty fish,
seafood, and certain vegetable oils, is beneficial in preventing heart disease
(Conner, 2000; Hu et al., 2002; Siscovick et al., 1995~. Potential adverse effects
on immune function and increased clotting time from high intakes of omega-3
fatty acids have also been identified, but there is a need for greater clinical
evidence to support the epidemiological findings (IOM, 2002a). Research is un-
derway and will help address these issues.
Based on current evidence in support of this decrease in risk for heart disease
associated with the consumption of omega-3 fatty acids, AHA recommends eat-
ing fish two times per week, including fatty fish such as mackerel, lake trout,
tuna, and salmon (Krause et al., 2000~. While AHA acknowledges the reported
effects of omega-3 fatty-acid supplements in patients with heart disease, it con-
cludes that "further studies are needed to establish optimal doses of omega-3 fatty
acids...for both primary and secondary prevention of coronary disease..." and
that "consumption of 1 fatty fish meal per day (or alternatively, a fish oil supple-
ment) could result in an omega-3 fatty acid intake...of approximately 900 ma/
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42
DIOXINS AND DIOXIN-LIKE COMPOUNDS IN THE FOOD SUPPLY
day, an amount shown to beneficially affect coronary heart disease mortality
rates in patients with coronary disease" (Krause et al., 2000~.
In addition to heart disease, some studies suggest that there are benefits of
omega-3 fatty acids against a variety of health conditions (Conner, 2000~. These
include inflammatory diseases such as rheumatoid arthritis (Carder et al., 2002),
epileptic seizure (Schlanger et al., 2002), endometrial cancer (Terry et al., 2002),
age-related macular degeneration (Seddon et al., 2001), prostate cancer (Terry et
al., 2001), and premature birth (Allen and Harris, 2001~.
The increasing evidence of health benefits from the consumption of fish
argues that efforts to reduce the DLC content in fish should be promoted, rather
than restricting intake in order to reduce DLC exposure. One caution regarding
fish consumption exists with regard to women who are pregnant or who may
become pregnant: some species of fish, particularly long-lived, larger predatory
fish may contain high levels of methylmercury, a developmental neurotoxin that
may harm a fetus's developing nervous system if ingested at high levels.
FDA has issued guidance to women of childbearing age, advising them to
limit their consumption of fish to an average of not more than 12 oz/wk of cooked
fish (approximately two to four servings). FDA also recommended that pregnant
or potentially pregnant women eat a variety of fish; avoid eating shark, sword-
fish, king mackerel, and tilefish; and check with their state or local health depart-
ment to see if there are special advisories on fish caught from freshwater lakes
and streams in their local area (CFSAN, 2001~.
The degree of contamination of farmed and wild-caught fish varies geo-
graphically and with changes in aquaculture practices (Gerstenberger et al., 1997;
He et al., 2001~. However, as sources of fats used in fish feeds change, so do the
levels of DLCs that are introduced through this route. Thus, accurate data on
regional sources that contribute to geographic variability are needed. Addition-
ally, the committee recognizes that there are comigrating contaminants that will
be found with DLCs in many types of fish, but an examination of these other
contaminants was beyond the committee's charge and were not considered in this
report.
In summary, fish are important sources of nutrients and potentially beneficial
omega-3 fatty acids, and they also have cultural importance in the traditional
diets of many population groups. But, unlike meats and poultry, fish cannot easily
be trimmed to reduce their fat content. Therefore, fish consumption should be
encouraged at currently recommended levels (1 to 2 fish meals per week), except
for fish caught where known DLC contamination has occurred and fish adviso-
. .
nes are In p ace.
Breastfeeding
As previously mentioned, AAP recommends exclusive breastfeeding until
the age of 6 months and continued breastfeeding with supplementary foods until
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HUMAN FOODS AND FOOD-CONSUMPTION PA'ITERNS
143
at least the age of 1 year. The benefits of breastfeeding have been clearly and
positively identified, at the level of the infant, the mother, the family, and society
(Work Group on Breastfeeding, 1997), and it would be inappropriate to interfere
with the current upward trend in breastfeeding rates in the United States because
of as yet only theoretical detrimental effects of the DLC levels currently found in
breast milk. It is important to emphasize that changing the mother's diet during
pregnancy and lactation will not have an impact on reducing DLC levels in her
breast milk, since the accumulated body burden is what determines DLC expo-
sure to the fetus in utero and to the nursing infant. Rather, the focus on reducing
DLC exposure should begin after weaning and throughout childhood, so that the
next generation of women will enter their reproductive years with lower body
burdens of DLCs. This is a long-term agenda and emphasizes the value of reduc-
ing animal-fat consumption for children, with particular benefits for girls. For
children, the general dietary guidance that applies to adults is appropriate for
children over the age of 2 years, including the use of low-fat or skim milk rather
than whole milk (AAP Committee on Nutrition, 1983; AHA, 1983~.
SUMMARY
The major sources of DLCs in the food supply are animal fats, although
small amounts appear in most foods. Exposure can be reduced through the re-
duced intake of animal fat by selecting lean cuts of meat, poultry, and fish;
trimming visible fat and removing skin, as appropriate; and by selecting low-fat
dairy products. DLCs on fruits and vegetables can be reduced through washing
and through peeling root and waxy-coated vegetables.
In general, these precautions are consistent with current dietary advice, with
two major exceptions. Although breast milk is a relatively concentrated source of
DLCs, particularly in first lactations, and contributes significantly to body bur-
dens, the evidence of the benefits of human breast milk overall outweighs the
potential risks from this source. The focus should be on reducing lifetime body
burdens through other means so that future generations of breastfeeding mothers
will increasingly transmit lower levels through this important source of infant
nutriture. The second exception is the conflict between recommendations to con-
sume more fatty fish and the fact that some of the highest concentrations of DLCs
in the food supply come from these fish, both farmed and from the sea. Some
subsets of the population are likely to be at greater than average risk from this
source and should be monitored. The accumulating evidence of health benefit
from fatty fish (e.g., mackerel and salmon) suggest that rather than avoiding this
food, the focus must again be on reducing the content of DLCs in future stocks.
OCR for page 144
44
DIOXINS AND DIOXIN-LIKE COMPOUNDS IN THE FOOD SUPPLY
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Representative terms from entire chapter:
food supply
