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Concept: Food safety

161

In order to facilitate foodborne outbreak investigations there is a need to improve the methods for identifying the food products that should be sampled for laboratory analysis. The aim of this study was to examine the applicability of a likelihood ratio approach previously developed on simulated data, to real outbreak data. We used human case and food product distribution data from the Norwegian enterohaemorrhagic Escherichia coli outbreak in 2006. The approach was adjusted to include time, space smoothing and to handle missing or misclassified information. The performance of the adjusted likelihood ratio approach on the data originating from the HUS outbreak and control data indicates that the adjusted approach is promising and indicates that the adjusted approach could be a useful tool to assist and facilitate the investigation of food borne outbreaks in the future if good traceability are available and implemented in the distribution chain. However, the approach needs to be further validated on other outbreak data and also including other food products than meat products in order to make a more general conclusion of the applicability of the developed approach.

Concepts: Bacteria, Nutrition, Escherichia coli, Food, Escherichia coli O157:H7, Foodborne illness, Food safety, Maslow's hierarchy of needs

120

Bacterial cross-contamination from surfaces to food can contribute to foodborne disease. The cross-contamination rate of Enterobacter aerogenes was evaluated on household surfaces using scenarios that differed by surface type, food type, contact time (<1, 5, 30 and 300 s), and inoculum matrix (tryptic soy broth or peptone buffer). The surfaces used were stainless steel, tile, wood and carpet. The food types were watermelon, bread, bread with butter and gummy candy. Surfaces (25 cm(2)) were spot inoculated with 1 ml of inoculum and allowed to dry for 5 h, yielding an approximate concentration of 10(7) CFU/surface. Foods (with 16 cm(2) contact area) were dropped on the surfaces from a height of 12.5 cm and left to rest as appropriate. Post transfer surfaces and foods were placed in sterile filter bags and homogenized or massaged, diluted and plated on tryptic soy agar. The transfer rate was quantified as the log % transfer from the surface to the food. Contact time, food and surface type all had a highly significant effect (P<0.000001) on log % transfer of bacteria. The inoculum matrix (TSB or peptone buffer) also had a significant effect on transfer (P = 0.013), and most interaction terms were significant. More bacteria transferred to watermelon (∼0.2-97%) relative to other foods, while fewer bacteria transferred to gummy candy (∼0.1-62%). Transfer of bacteria to bread (∼0.02-94%) and bread with butter (∼0.02-82%) were similar, and transfer rates under a given set of condition were more variable compared with watermelon and gummy candy.

Concepts: Bacteria, Food, Bread, Foodborne illness, Food safety, Enterobacter, Enterobacter aerogenes, Gummi bear

111

The U.S. wastes 31 to 40% of its post-harvest food supply, with a substantial portion of this waste occurring at the consumer level. Globally, interventions to address wasted food have proliferated, but efforts are in their infancy in the U.S. To inform these efforts and provide baseline data to track change, we performed a survey of U.S. consumer awareness, attitudes and behaviors related to wasted food. The survey was administered online to members of a nationally representative panel (N=1010), and post-survey weights were applied. The survey found widespread (self-reported) awareness of wasted food as an issue, efforts to reduce it, and knowledge about how to do so, plus moderately frequent performance of waste-reducing behaviors. Three-quarters of respondents said they discard less food than the average American. The leading motivations for waste reduction were saving money and setting an example for children, with environmental concerns ranked last. The most common reasons given for discarding food were concern about foodborne illness and a desire to eat only the freshest food. In some cases there were modest differences based on age, parental status, and income, but no differences were found by race, education, rural/urban residence or other demographic factors. Respondents recommended ways retailers and restaurants could help reduce waste. This is the first nationally representative consumer survey focused on wasted food in the U.S. It provides insight into U.S. consumers' perceptions related to wasted food, and comparisons to existing literature. The findings suggest approaches including recognizing that many consumers perceive themselves as being already-knowledgeable and engaged, framing messages to focus on budgets, and modifying existing messages about food freshness and aesthetics. This research also suggests opportunities to shift retail and restaurant practice, and identifies critical research gaps.

Concepts: Food, Recycling, Foodborne illness, Food safety, Restaurant, Consumer

75

We estimate models of consumer food waste awareness and attitudes using responses from a national survey of U.S. residents. Our models are interpreted through the lens of several theories that describe how pro-social behaviors relate to awareness, attitudes and opinions. Our analysis of patterns among respondents' food waste attitudes yields a model with three principal components: one that represents perceived practical benefits households may lose if food waste were reduced, one that represents the guilt associated with food waste, and one that represents whether households feel they could be doing more to reduce food waste. We find our respondents express significant agreement that some perceived practical benefits are ascribed to throwing away uneaten food, e.g., nearly 70% of respondents agree that throwing away food after the package date has passed reduces the odds of foodborne illness, while nearly 60% agree that some food waste is necessary to ensure meals taste fresh. We identify that these attitudinal responses significantly load onto a single principal component that may represent a key attitudinal construct useful for policy guidance. Further, multivariate regression analysis reveals a significant positive association between the strength of this component and household income, suggesting that higher income households most strongly agree with statements that link throwing away uneaten food to perceived private benefits.

Concepts: Regression analysis, Statistics, Multivariate statistics, Household, Linear discriminant analysis, Household income in the United States, Food safety, Income quintiles

34

The PulseNet surveillance system is a molecular subtyping network of public health and food regulatory agency laboratories designed to identify and facilitate investigation of foodborne illness outbreaks. This study estimates health and economic impacts associated with PulseNet. The staggered adoption of PulseNet across the states offers a natural experiment to evaluate its effectiveness, which is measured as reduction of reported illnesses due to improved information, enhanced industry accountability, and more-rapid recalls. Economic impacts attributable to PulseNet include medical costs and productivity losses averted due to reduced illness. Program costs are also reported. Better information and accountability from enhanced surveillance is associated with large reductions of reported illnesses. Data collected between 1994 and 2009 were assembled and analyzed between 2010 and 2015. Conservatively, accounting for underreporting and underdiagnosis, 266,522 illnesses from Salmonella, 9,489 illnesses from Escherichia coli (E. coli), and 56 illnesses due to Listeria monocytogenes are avoided annually. This reduces medical and productivity costs by $507 million. Additionally, direct effects from improved recalls reduce illnesses from E. coli by 2,819 and Salmonella by 16,994, leading to $37 million in costs averted. Annual costs to public health agencies are $7.3 million. The PulseNet system makes possible the identification of food safety risks by detecting widespread or non-focal outbreaks. This gives stakeholders information for informed decision making and provides a powerful incentive for industry. Furthermore, PulseNet enhances the focus of regulatory agencies and limits the impact of outbreaks. The health and economic benefits from PulseNet and the foodborne disease surveillance system are substantial.

Concepts: Epidemiology, Bacteria, Escherichia coli, Illness, Escherichia coli O157:H7, Foodborne illness, Gastroenteritis, Food safety

30

Illness and death from diseases caused by contaminated food are a constant threat to public health and a significant impediment to socio-economic development worldwide. To measure the global and regional burden of foodborne disease (FBD), the World Health Organization (WHO) established the Foodborne Disease Burden Epidemiology Reference Group (FERG), which here reports their first estimates of the incidence, mortality, and disease burden due to 31 foodborne hazards. We find that the global burden of FBD is comparable to those of the major infectious diseases, HIV/AIDS, malaria and tuberculosis. The most frequent causes of foodborne illness were diarrheal disease agents, particularly norovirus and Campylobacter spp. Diarrheal disease agents, especially non-typhoidal Salmonella enterica, were also responsible for the majority of deaths due to FBD. Other major causes of FBD deaths were Salmonella Typhi, Taenia solium and hepatitis A virus. The global burden of FBD caused by the 31 hazards in 2010 was 33 million Disability Adjusted Life Years (DALYs); children under five years old bore 40% of this burden. The 14 subregions, defined on the basis of child and adult mortality, had considerably different burdens of FBD, with the greatest falling on the subregions in Africa, followed by the subregions in South-East Asia and the Eastern Mediterranean D subregion. Some hazards, such as non-typhoidal S. enterica, were important causes of FBD in all regions of the world, whereas others, such as certain parasitic helminths, were highly localised. Thus, the burden of FBD is borne particularly by children under five years old-although they represent only 9% of the global population-and people living in low-income regions of the world. These estimates are conservative, i.e., underestimates rather than overestimates; further studies are needed to address the data gaps and limitations of the study. Nevertheless, all stakeholders can contribute to improvements in food safety throughout the food chain by incorporating these estimates into policy development at national and international levels.

Concepts: Epidemiology, Infectious disease, Microbiology, Salmonella enterica, Salmonella, Foodborne illness, Gastroenteritis, Food safety

28

Fermented foods and beverages were among the first processed food products consumed by humans. The production of foods such as yogurt and cultured milk, wine and beer, sauerkraut and kimchi, and fermented sausage were initially valued because of their improved shelf life, safety, and organoleptic properties. It is increasingly understood that fermented foods can also have enhanced nutritional and functional properties due to transformation of substrates and formation of bioactive or bioavailable end-products. Many fermented foods also contain living microorganisms of which some are genetically similar to strains used as probiotics. Although only a limited number of clinical studies on fermented foods have been performed, there is evidence that these foods provide health benefits well-beyond the starting food materials.

Concepts: Bacteria, Nutrition, Food, Fermentation, Food safety, Kefir, Pickling, Fermented foods

28

Food products can be contaminated with toxic compounds via the environment. Another possibility of food contamination is that toxicants are generated in foods or that chemicals migrate from food contact materials into foods during processing. In this study, the effect of cooking at home on the levels of phthalates - world’s most used group of plasticisers - in various food types (starchy products, vegetables and meat and fish) was examined. Eight compounds were considered, namely dimethyl phthalate (DMP), diethyl phthalate (DEP), diisobutyl phthalate (DiBP), di-n-butyl phthalate (DnBP), benzylbutyl phthalate (BBP), di(2-ethylhexyl) phthalate (DEHP), dicyclohexyl phthalate (DCHP) and di-n-octyl phthalate (DnOP). Food products were analysed before as well as after cooking (boiling, steaming, (deep-)frying or grilling). In general, phthalate concentrations in foods declined after cooking, except in vegetables, where almost no effect was seen. Several factors influenced the degree of this decline (e.g. weight difference, fat uptake, etc.). Of all phthalates, DEHP, DiBP and BBP were affected the most. In conclusion, cooking at home definitely affected phthalate concentrations in foods and thus needs to be considered in order to correctly assess humans' dietary exposure to these contaminants.

Concepts: Nutrition, Food, Phthalates, Phthalate, Food safety, Cooking, Bis(2-ethylhexyl) phthalate, Plasticizers

27

Regarding food borne intoxications, the accumulation of biogenic amines must be avoided in all kinds of food products. Moreover, biogenic amines can function as precursors for the formation of carcinogenic N-nitrosamines when nitrite is present. To estimate the food safety of the dry fermented sausages available on the Belgian market, a screening of the residual sodium nitrite and nitrate contents, biogenic amines and volatile N-nitrosamine concentrations was performed on 101 samples. The median concentrations of residual NaNO2 and NaNO3 were each individually lower than 20mg/kg. In general, the biogenic amine accumulation remained low at the end of shelf life. Only in one product the amounts of cadaverine and putrescine reached intoxicating levels. Concerning the occurrence of N-nitrosamines, only N-nitrosopiperidine and N-nitrosomorpholine were detected in a high number of samples (resp. 22% and 28%). No correlation between the presence of N-nitrosamines and the biogenic amines content was observed. Although the N-nitrosamines could not been linked to specific product categories, the occurrence of N-nitrosopiperidine could probably be attributed to the use of pepper.

Concepts: Amine, Ammonia, Food, Food safety, Biogenic amine, Nitrosamine, Garde manger, Sodium nitrite

27

Red yeast rice (RYR) is a commonly used dietary supplement for the management of dyslipidemia. In 2007, the Food and Drug Administration (FDA) issued a consumer warning to avoid RYR products because they may contain unauthorized drug (lovastatin) and also implemented Current Good Manufacturing Practices (CGMP) requiring that proper controls be in place by dietary supplement companies to ensure products are manufactured and processed in a consistent manner and produce high-quality products that are not adulterated with impurities or contaminants and are accurately labeled.

Concepts: Food and Drug Administration, Food safety, Dietary supplements, Red yeast rice, Lovastatin