Aideen McKevitt

Pattern of intake of food additives associated with hyperactivity in Irish children and teenagers.

A double-blind randomized intervention study has previously shown that a significant relationship exists between the consumption of various mixes of seven target additives by children and the onset of hyperactive behaviour. The present study set out to ascertain the pattern of intake of two mixes (A and B) of these seven target additives in Irish children and teenagers using the Irish national food consumption databases for children (n = 594) and teenagers (n = 441) and the National Food Ingredient Database. The majority of additive-containing foods consumed by both the children and teenagers contained one of the target additives. No food consumed by either the children or teenagers contained all seven of the target food additives. For each additive intake, estimates for every individual were made assuming that the additive was present at the maximum legal permitted level in those foods identified as containing it. For both groups, mean intakes of the food additives among consumers only were far below the doses used in the previous study on hyperactivity. Intakes at the 97.5th percentile of all food colours fell below the doses used in Mix B, while intakes for four of the six food colours were also below the doses used in Mix A. However, in the case of the preservative sodium benzoate, it exceeded the previously used dose in both children and teenagers. No child or teenager achieved the overall intakes used in the study linking food additives with hyperactivity.

Estimation of the dietary intake of 13 priority additives in France, Italy, the UK and Ireland as part of the FACET project

The aim of this study was to assess the dietary exposure of 13 priority additives in four European countries (France, Italy, the UK and Ireland) using the Flavourings, Additives and Contact Materials Exposure Task (FACET) software. The studied additives were benzoates (E210–213), nitrites (E249–250) and sulphites (E220–228), butylated hydroxytoluene (E321), polysorbates (E432–436), sucroses esters and sucroglycerides (E473–474), polyglycerol esters of fatty acids (E475), stearoyl-lactylates (E481–482), sorbitan esters (E493–494 and E491–495), phosphates (E338–343/E450–452), aspartame (E951) and acesulfame (E950). A conservative approach (based on individual consumption data combined with maximum permitted levels (Tier 2)) was compared with more refined estimates (using a fitted distribution of concentrations based on data provided by the food industry (Tier 3)). These calculations demonstrated that the estimated intake is below the acceptable daily intake (ADI) for nine of the studied additives. However, there was a potential theoretical exceedance of the ADI observed for four additives at Tier 3 for high consumers (97.5th percentile) among children: E220–228 in the UK and Ireland, E432–436 and E481–482 in Ireland, Italy and the UK, and E493–494 in all countries. The mean intake of E493–494 could potentially exceed the ADI for one age group of children (aged 1–4 years) in the UK. For adults, high consumers only in all countries had a potential intake higher than the ADI for E493–494 at Tier 3 (an additive mainly found in bakery wares). All other additives examined had an intake below the ADI. Further refined exposure assessments may be warranted to provide a more in-depth investigation for those additives that exceeded the ADIs in this paper. This refinement may be undertaken by the introduction of additive occurrence data, which take into account the actual presence of these additives in the different food groups. Graphical Abstract

Development and use of a serotyping scheme for Pseudomonas cepacia

Abstract A method is described for the serological typing of Pseudomonas cepacia. Mice were immunized with each of 39 P. cepacia isolates by intraperitoneal injection of whole cells. Based upon agglutination reactions with homologous and heterologous anti-sera, the P. cepacia isolates were separated into five serotypes, A-E. Large volumes of antisera were obtained by immunization of rabbits with whole cells of each of the five type strains. These antisera were used to type 137 P. cepacia isolates from five geographic locations including consecutive isolates from individual cystic fibrosis patients. Results from these studies indicate that strains related by geographic isolation site demonstrate a tendency toward serological relatedness, and that cystic fibrosis patients tend to be infected by one P. cepacia serotype and remain infected with that same serotype over time.

Probabilistic modelling to assess exposure to three artificial sweeteners of young Irish patients aged 1–3 years with PKU and CMPA

ABSTRACT The choice of suitable normal foods is limited for individuals with particular medical conditions, e.g., inborn errors of metabolism (phenylketonuria – PKU) or severe cow’s milk protein allergy (CMPA). Patients may have dietary restrictions and exclusive or partial replacement of specific food groups with specially formulated products to meet particular nutrition requirements. Artificial sweeteners are used to improve the appearance and palatability of such food products to avoid food refusal and ensure dietary adherence. Young children have a higher risk of exceeding acceptable daily intakes for additives than adults due to higher food intakes kg–1 body weight. The Budget Method and EFSA’s Food Additives Intake Model (FAIM) are not equipped to assess partial dietary replacement with special formulations as they are built on data from dietary surveys of consumers without special medical requirements impacting the diet. The aim of this study was to explore dietary exposure modelling as a means of estimating the intake of artificial sweeteners by young PKU and CMPA patients aged 1–3 years. An adapted validated probabilistic model (FACET) was used to assess patients’ exposure to artificial sweeteners. Food consumption data were derived from the food consumption survey data of healthy young children in Ireland from the National Preschool and Nutrition Survey (NPNS, 2010–11). Specially formulated foods for special medical purposes were included in the exposure model to replace restricted foods. Inclusion was based on recommendations for adequate protein intake and dietary adherence data. Exposure assessment results indicated that young children with PKU and CMPA have higher relative average intakes of artificial sweeteners than healthy young children. The reliability and robustness of the model in the estimation of patient additive exposures was further investigated and provides the first exposure estimates for these special populations.

Microbial assessment of an upward and downward dehiding technique in a commercial beef processing plant.

Preventing microbial contamination during dehiding is challenging, and skinning methods are of critical importance for the hygienic status of beef carcasses. Two skinning methods are usually employed: upward hide pulling (UHP) and downward hide pulling (DHP). This study has compared the microbiological contamination of carcasses using both systems in a beef processing plant in the process of changing its dehiding method from UHP to DHP. 100 cm(2) areas from eight carcass sites (ham, chuck, rump, bung, flank, brisket, shin and neck) were sampled on 36 skinned carcasses dehided by each technique. Total viable counts (TVCs) and Enterobacteriaceae counts for each site were determined. No significant differences were observed in total (pooled-samples) carcass contamination regardless of the method used. However, significant differences (p<0.05) in TVCs were observed at the flank, shin, brisket and neck. These differences can be attributed to possible deficiencies in the implementation of the HACCP pre-requisite programmes, and are not necessarily associated with the skinning method per se.

Longitudinal modelling of the exposure of young UK patients with PKU to acesulfame K and sucralose

ABSTRACT Artificial sweeteners are used in protein substitutes intended for the dietary management of inborn errors of metabolism (phenylketonuria, PKU) to improve the variety of medical foods available to patients and ensure dietary adherence to the prescribed course of dietary management. These patients can be exposed to artificial sweeteners from the combination of free and prescribed foods. Young children have a higher risk of exceeding acceptable daily intakes (ADI) for additives than adults, due to higher food intakes per kg body weight. Young patients with PKU aged 1–3 years can be exposed to higher levels of artificial sweeteners from these dual sources than normal healthy children and are at a higher risk of exceeding the ADI. Standard intake assessment methods are not adequate to assess the additive exposure of young patients with PKU. The aim of this study was to estimate the combination effect on the intake of artificial sweeteners and the impact of the introduction of new provisions for an artificial sweetener (sucralose, E955) on exposure of PKU patients using a validated probabilistic model. Food consumption data were derived from the food consumption survey data of healthy young children in the United Kingdom from the National Diet and Nutrition Survey (NDNS, 1992–2012). Specially formulated protein substitutes as foods for special medical purposes (FSMPs) were included in the exposure model to replace restricted foods. Inclusion of these protein substitutes is based on recommendations to ensure adequate protein intake in these patients. Exposure assessment results indicated the availability of sucralose for use in FSMPs for PKU leads to changes in intakes in young patients. These data further support the viability of probabilistic modelling as a means to estimate food additive exposure in patients consuming medical nutrition products.

Investigation of the potential for a simplified exposure tool in medical nutrition (SETIM) to minimise exposures to sweeteners in young patients aged 1–3 years with PKU and CMPA

ABSTRACT Children with phenylketonuria (PKU) and severe cow’s milk protein allergy (CMPA) consume prescribed, specially formulated, foods for special medical purposes (FSMPs) in addition to having restricted intake of normal foods. These vulnerable patients are exposed to artificial sweeteners from the consumption of a combination of both free and prescribed foods. Young patients with PKU and CMPA aged from 1 to 3 years have a higher risk of exceeding the acceptable daily intake (ADI) for sweeteners than age-matched healthy children. A probabilistic modelling approach has been adapted successfully to assess the exposure of young patients with PKU and CMPA to low-calorie sweeteners. To assist professionals in the screening and formulation of foods containing food additives for such patients, a simplified exposure method/tool has been developed. The tool is intended to ensure that total dietary exposure can be considered. The simplified tool is not intended to replace the probabilistic model but may be used as a screening tool to determine if further investigation on exposure is warranted. The aim of this study was to develop and validate this simplified exposure tool to support those currently used by healthcare professionals (HCPs) using data available from the probabilistic modelling of exposure in young children with PKU and CMPA. The probabilistic model does not allow for swift screening of exposure scenarios nor is the present EFSA Food Additive Intake Assessment Model (FAIM) fully suitable for application to medical foods. The simplified exposure tool in medical nutrition (SETIM) reported here is both reliable and consistent and provides additive usage levels which minimise regular exposure above the ADI in patients. In addition to the usefulness of SETIM for the medical nutrition industry, the tool has the potential to enhance the practice of evidence-based medical nutrition by official risk assessment bodies, registration authorities and healthcare professionals.

Predictive modelling of the exposure to steviol glycosides in Irish patients aged 1-3 years with phenylketonuria and cow’s milk protein allergy

ABSTRACT Children with Phenylketonuria (PKU) and severe cow’s milk protein allergy (CMPA) consume prescribed, specially formulated, foods for special medical purposes (FSMPs) as well as restricted amounts of normal foods. These patients are exposed to artificial sweeteners from the consumption of a combination of free and prescribed foods. Young patients with PKU and CMPA have a higher risk of exceeding acceptable daily intakes (ADI) for additives than age-matched healthy children. A predictive modelling approach has been adapted successfully to assess the additive exposure of young patients with PKU and CMPA to artificial sweeteners. Steviol glycosides (E960) are at various stages of regulatory approval for the various food categories in the EU but are not as yet permitted for use in products intended for young children. The aim of this study was to predict potential steviol glycoside exposure in young children with PKU and CMPA considering the potential for future provisions for the use of this sweetener. The recent introduction of steviol glycosides means that no exposure data are available for children with CMPA and PKU. Food consumption data were derived from the food consumption survey data of healthy young children in Ireland from the National Preschool and Nutrition Survey (NPNS, 2010–11). Specially formulated amino acid-based FSMPs are used to replace whole or milk protein foods and were included in the exposure model to replace restricted foods. The recommendations to ensure adequate protein intake in these patients were used to determine FSMP intake. Exposure assessment results indicated that the maximum permitted level (MPL) for FSMPs would warrant careful consideration to avoid exposures above the ADI. These data can be used to inform recommendations for the medical nutrition industry.

A cross-sectional observation on habitual non-alcoholic beverage consumption among adolescents from four Irish post-primary schools.

OBJECTIVE No up-to-date data on the dietary intake of Irish adolescents are available. The aim of the present pilot study was to obtain and compare cross-sectional information on habitual adolescent beverage consumption between four distinct post-primary schools in the Republic of Ireland, in 2014-2015. DESIGN A cross-sectional observation study. A beverage consumption questionnaire was used to obtain data on beverage intake and influences on consumption. SETTING Four post-primary mixed-sex schools in Ireland representing the following school classifications were selected for the study: urban fee-paying, urban disadvantaged, rural fee-paying and rural disadvantaged. SUBJECTS Students (n 761) aged 12-18 years. RESULTS Data were analysed by Kruskal-Wallis (non-parametric) ANOVA to compare the distribution of beverage consumption across the schools. Water was the most highly consumed beverage among students from all four schools (median 1425 ml/d). Students from urban and rural disadvantaged schools reported a significantly higher volume of carbonated beverage intake than students from fee-paying schools. Students from an urban disadvantaged school also reported a significantly higher volume of carbonated beverage and energy drink intake compared with the other three schools. Students from an urban fee-paying school reported the highest consumption of water, while rural disadvantaged school students were the biggest consumers of tea and milk. CONCLUSIONS Significant differences in beverage consumption (ml/d) were reported by adolescents from four schools in Ireland. Surveillance on current beverage consumption trends among adolescents is vital to guide policies and interventions, and for appropriate targeting of resources.

The pattern of usage of a selected combination of food additives in Irish children

Artificial food colours and other food additives may cause adverse behavioural effects in children (1) . A recent study has assessed the effects of two combinations of food additives on hyperactivity in children (2) . The purpose of the present research was to establish the probability of the intakes of these additives (E110, sunset yellow; E122, carmosine; E102, tartrazine; E124, Ponceau 4R; E211, sodium benzoate; E129, allura red; E104, quinoline yellow) in the diets of Irish children, using the Irish National Food Ingredient Database (INFID) and the National Children’s Food Survey (NCFS) (3) . The NCFS was a 7 d weighed dietary survey of 594 children aged 5‐12 years. Food intake was coded at brand level and information on all packaging materials, including ingredients lists, were entered into INFID. In total over the 7 d there were 19 795 eating occasions and 72 024 foods consumed, relating to 1945 unique food codes. These food codes are adapted from UK fifth edition of McCance and Widdowson’s The Composition of Foods (4) and McCance and Widdowson’s The Composition of Foods Sixth Edition (5) plus supplemental volumes. These food codes are associated with 5551 different brand codes. Results are presented for (1) brand level, (2) food eating occasions, (3) per meal and (4) per d. Of the 5551 different brand codes in the database, 5265 (94.8%) did not contain any of the seven target additives, 279 (5.0%) contained at least one of the target additives and information could not be obtained for the remaining seven brand codes (0.2%). In assessing the frequency of the seven target additives during the 72 024 eating occasions, sodium benzoate occurred most frequently (n 2183), followed by sunset yellow (n 555). Of the 72 024 food eating occasions, none involved the consumption of six or seven of the target additives. Of the 19 795 meal eating occasions, 3160 (16 %) contained at least one of the target additives. Only one meal containing all seven of the target additives (0.005%) was identified (Table).