Burden of disease of dietary exposure to four chemical contaminants in Denmark, 2019

Exposure to chemical contaminants found in foods has been associated with diverse adverse health effects. The aim of this study was to estimate the burden of disease associated with dietary exposure to four chemicals in Denmark in 2019: lead (Pb), cadmium (Cd), methylmercury (MeHg), and inorganic arsenic (i-As). We collected national food consumption and chemical food monitoring data from Danish databases, dose-response and severity data from the scientific literature, and disease incidence and population numbers from national statistics. We adopted a risk assessment approach to estimate disease burden, quantifying incidence, mortality, and Disability-Adjusted Life Years (DALYs) attributable to dietary exposure to the chemicals. In all models, we propagated uncertainty around the input parameters through the calculations using Monte Carlo simulation. We estimated that, among these chemicals, Pb and MeHg were responsible for the highest disease burden. MeHg led to the loss of nearly 600 healthy life years, or approximately 10 DALYs per 100,000 inhabitants. Dietary exposure to Pb was estimated to cause 383 to 1,261 DALYs, corresponding to 6.6 (lower bound) to 22 (upper bound) DALYs/100,000 per year. The foods contributing most to disease burden were fish (MeHg) and sweets, fruit, and bread and cereals (Pb). The burden attributed to dietary exposure to i-As (5 DALYs) and Cd (0.04 DALY) was substantially lower. Interpretation of estimates needs to consider all underlying uncertainties, linked with data and knowledge gaps. These estimates are useful supplements to traditional risk assessment to guide food safety interventions and inform dietary guidelines for different population groups.