national public health institute, finland balancing between benefits and risks. baltic fish species...

National Public Health Institute, Finlandww

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Balancing between benefits and risks. Baltic fish species as a food

resource

Jouni TuomistoNational Public Health Institute (KTL)

Kuopio, Finland


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Critical questions about benefits and risks of fish

• Fish is healthy, but how healthy is it actually?• What are the major health risks related to fish?• What are the specific issues in the Baltic region?• Should there be specific recommendations due to

health impacts?• How is health related to marine sustainability?


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Mozaffarian & Rimm, JAMA. 2006;296:1885-1899


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Hites (2004): Farmed salmon is more polluted

Hites et al., Science 2004


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Dioxin concentrations in farmed and wild salmon

0 2 4 6 8 10 12 14 16 18 20

Wild chum, Kodiak AK (lowest wild)

Wild chinook, British Columbia (highest wild)

Farmed rainbow trout, Finland

Farmed salmon, Chile (lowest farmed)

Farmed salmon, Frankfurt (highest supermarket)

Farmed salmon, Scotland (highest farmed)

Wild salmon, Southern Baltic Sea

Wild salmon, Gulf of Finland

Wild salmon, Gulf of Bothnia

TEQ (ng/kg in fat)


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Farmed salmon: Two different decisions

Pollutanthealth risk

Health effectof fish

Net healtheffect

Pollutantexposure

Fish feedLower limitsfor pollutantsin fish feed?

Exposure-response

function foromega3

Exposure-response

function forpollutant

risk

Food intake

Recommend restrictedfarmed salmonconsumption?

Omega3content in

salmon

Omega3exposure

Pollutants insalmon


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What is the right health metric?

BAU

Restrict fish use

30900

23400

-206

-154

If risk managers assume responsibility of total health effect of salmon consumption

If risk managers care only for cancer due to pollutants

30000250000

BAU

Restrict fish use

30900

23400

-206

-154

If risk managers assume responsibility of total health effect of salmon consumption

If risk managers care only for cancer due to pollutants

30000250000


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Table 3: Annual health loss (in DALYs) due to dietary factors and energy balance, against other lifestyle factors, environmental factors and disease categories in the Netherlands. (Source: RIVM 2004)

DALYs lost

DIET OTHER DISEASES

Dietary factors Microbiological contamination Chemical contamination

Other lifestyle factors Environmental factors

Selection from Puclic Health Status Forecasts report 2002

>300 000 Unhealthy diet total (1) Three lifestyle factors combined (2), smoking

Cardiovascular diseases, all cancers

100 000- 300 000

5 dietary factors together, energy balance (3)

Lack of physical activity Coronary disease, depression, lung cancer, diabetes, alcohol-dependency

30 000- 100 000

Too much trans fatty acids, too little fruit, vegetables and fish

Alcohol consumption (4) Road traffic accidents, breast cancer

10 000- 30 000

Too much saturated fatty acids Particulate matter in atmosphere

Schizophrenia, prostate cancer, influenza

3000- 10 000

Gastroenteritiscaused by microorganisms in food

Passive smoking Upper respiratory tract infections, HIV/AIDS, stomach/intestinal ulcers

1000-3000 Radon (interior) Bacterial meningitis, bacterial STDs (5), tuberculosis

300-1000 Campylobacter in food Allergens, acrylamide

<300 STEC 0157 (5) PAHs (5), other substances

Various substances


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'Evidence lost'Dariush Mozaffarian, lead author of the study said:

"Overall, for major health outcomes among adults, the benefits of eating fish greatly outweigh the risks.

"Somehow this evidence has been lost on the public." Source: BBC News, 17.10.2006By the author of a large fish health review (Mozaffarian

& Rimm, JAMA. 2006;296:1885-1899)


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Benefits and risks of eating Baltic fish• Health benefits of eating fish are clear• The average population should eat more fish, at

least twice a week• A variety of fish species should be used• Even if the Baltic Sea is polluted with dioxins and

PCBs, the health benefits are 10-100 times higher than risks

• Special groups should be aware of certain risks (pregnant and nursing women, high (local) methyl mercury levels in some species)


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Health, fish, and sustainability• Fisheries are deteriorating due to overharvesting

(Worm et al: Impacts of Biodiversity Loss on Ocean Ecosystem Services. Science Nov 3 2006: 787-790)

Why don't we simply use farmed fish?– Fish eat fish: farming is only improvement of marine

resources for human use• Lack of suitable terrestrial fish feed sources• If feed is low with omega-3, also the fish will be

• Marine food resources are NOT easily replacedThe sustainability of seas is also an important

health issue


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Table 3: Annual health loss (in DALYs) due to dietary factors and energy balance, against other lifestyle factors, environmental factors and disease categories in the Netherlands.

DALYs lost

DIET OTHER DISEASES

Dietary factors Microbiol. contaminat.

Chemical contamination

Other lifestyle factors

Environmental factors Selection from Puclic Health Status Forecasts report 2002

>300 000 Unhealthy diet total (1)

Three lifestyle factors combined (2), smoking

Cardiovascular diseases, all cancers

100 000-300 000

5 dietary factors together, energy balance (3)

Lack of physical activity

Coronary disease, depression, lung cancer, diabetes, alcohol-dependency

30 000-100 000

Too much trans fatty acids, too little fruit, vegetables and fish

Alcohol consumption (4)

Road traffic accidents, breast cancer

10 000- 30 000

Too much saturated fatty acids

Particulate matter in atmosphere

Schizophrenia, prostate cancer, influenza

3000- 10 000

Gastroenteritiscaused by microorganisms in food

Passive smoking Upper respiratory tract infections, HIV/AIDS (5), stomach/intestinal ulcers

1000-3000 Radon (interior) Bacterial meningitis, bacterial STDs (5), tuberculosis

300-1000 Campylobacter in food

Allergens, acrylamide

<300 STEC 0157 (5) PAHs (5), other substances Various substances


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Value of information for feed contaminant restrictions

Tuomisto et al., Science 2004


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Kalalaji

Keskimääräinen kulutus

Suomessa (g/viikko)

Pitkäaikaisesti voi syödä ilman

huolta ympäristömyrkyistä (g/viikko)+

Monikokertaiset terveyshyödyt

ympäristömyrkkyjen haittoihin

verrattuna vähintään

Oleellinen ympäristömyrk

ky

Kasvatettu kirjolohi 25 500 600 Dioksiini

Silakka 20 40-400 20 Dioksiini, Riippuu

silakan koosta,

Hauki 14 140 5-50 Elohopea sisävesillä

Ahven 10 300 10-100 Elohopea sisävesillä

Muikku 10 400 50-500 Elohopea sisävesillä

Siika 8 300 100 Dioksiini merialueella

Kuha 9 900 10-100 Elohopea sisävesillä

Villilohi (Itämeri ja joet)

5 50 60 Dioksiini

Kampela 0,4 200 60 Dioksiini merialueilla

Made 1 200 5-50 Elohopea sisävesillä

national public health institute, finland balancing between benefits and risks. baltic fish species...

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