A Risk‐Benefit Analysis of French High Fish Consumption: A QALY Approach

Abstract

The health risk and the nutritional benefit of a food are usually assessed separately. Toxicologists recommend limiting the consumption of certain fish because of methylmercury; while nutritionists recommend eating more oily fish because of omega 3. A common evaluation is imperative to provide coherent recommendations. In order to evaluate the risks along with the benefits related to fish consumption, a common metric based on the quality-adjusted life year (QALY) method has been used. The impact of a theoretical change from a medium n-3 PUFAs intake to a high intake is studied, in terms of the cardiovascular system (CHD mortality, stroke mortality and morbidity) and on fetal neuronal development (IQ loss or gain). This application can be considered as a sensitive analysis of the model used and looks at the impact of changing the dose-response relationships between cardiovascular diseases and n-3 PUFAs intakes. Results show that increasing fish consumption may have a beneficial impact on health. However, the confidence interval of the overall estimation has a negative lower bound, which means that this increase in fish consumption may have a negative impact due to MeHg contamination. Some limits of the QALY approach are identified. The first concerns determination of the dose-response relationships. The second concerns the economic origins of the approach and of individual preferences. Finally, since only one beneficial aspect and one risk element were studied, consideration should be given to how other beneficial and risk components may be integrated in the model.

An exploration of the role of a fish-oriented diet in cognitive decline: a systematic review of the literature

“…These analyses provided the estimates of a pooled relative risk across studies with a common comparison unit to calculate possible linear dose-response associations. For citations that described fish consumption in “servings,” one serving was assumed to be 100 g fish [45–46]. The relative risk for fish intake with an increase of 100 g/week was then estimated for each potential study and the final data synthesis were handled together.…”

Risks and Benefits of Consumption of Great Lakes Fish

“…Despite the need for such assessments, there is currently no accepted method to compare net risks with net benefits of consuming fish (Domingo et al 2007; Ginsberg and Toal 2009; Guevel et al 2008; van der Voet et al 2007). The few risk–benefit assessments for fish consumption that have been attempted have focused on methylmercury and omega-3 fatty acids in relation to cardiovascular disease and/or neurobehavioral outcomes (Guallar et al 2002; Mahaffey et al 2008).…”

Simulated Impacts of Fish Consumption on the IQ Points of Infants

“…The endpoints were manifold, e.g. three endpoints other than one were used in the studies [5,6], and the results would be changed accordingly. Although the dose-relationship between MeHg exposure and IQ point assumed to be linear was considered as a reasonable approach in this study, as same as statement as Axelrad et al [11], it is still not consistent.…”

“…Following the issued advisory, fish consumers may change their fish consumption patterns [4,5,6]. To simulate the influence of varied fish consumption patterns on MeHg exposure and DHA intake, some hypothetical scenarios are designed to represent potential consumer responses to the advisory.…”