Appraising diet–disease associations to be used in risk assessment, including an insight in nutritional epidemiology

Abstract

High consumption of red meat, in particular of its processed products, has been linked to the development of various chronic diseases, and the need to reduce consumption levels of these products has been identified as a public health priority in Europe. Among the potential alternatives, pulses have gained a prominent position in recent years. Stemming from the broader context of the substitution of red meat in the diet with alternative plant‐based protein sources, this work programme was developed to address the need of improving the current understanding on the public health impact of potential substitutes. From a training perspective, the main goal was to advance the fellow’s background knowledge in the principles of nutritional epidemiology, while contributing to the harmonisation of food risk assessment practices across Europe. The activities developed comprised a comprehensive learning experience in the different components of the risk assessment framework, giving particular focus to the appraisal of epidemiological evidence within this context (hazard identification and characterisation). The fellow had the opportunity to gain hands‐on experience with EFSA’s databases among other relevant national and international data sources. The association between the consumption of legumes and risk of cardiovascular disease in particular was extensively explored and described by summarising the available evidence through dose–response meta‐analyses. The one‐stage approach method was used to explore the shape of the associations, including studies with as few as two levels of exposure, in a weighted mixed‐effects model. The analysis was also performed taking into account the potential risk of bias of included studies, assessed using the ROBINS‐I tool. Upon the completion of the activities carried out, the fellow made significant progress towards the learning outcomes expected to be achieved throughout the duration of the EU‐FORA fellowship period.