SEAFOOD CHOICES

BALANCING BENEFITS AND RISKS

Committee on Nutrient Relationships in Seafood: Selections to Balance Benefits and Risks

Food and Nutrition Board

Malden C. Nesheim and Ann L. Yaktine, Editors

INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.
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Seafood Choices: Balancing Benefits and Risks SEAFOOD CHOICES BALANCING BENEFITS AND RISKS Committee on Nutrient Relationships in Seafood: Selections to Balance Benefits and Risks Food and Nutrition Board Malden C. Nesheim and Ann L. Yaktine, Editors INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES THE NATIONAL ACADEMIES PRESS Washington, D.C. www.nap.edu

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Seafood Choices: Balancing Benefits and Risks THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. The study was supported by Contract No. DG133R04CQ0009 TO #8 between the National Academy of Sciences and the Department of Commerce, and Contract No. 223-01-2460 TO #29 between the National Academy of Sciences and the U.S. Food and Drug Administration. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the authors and do not necessarily reflect the views of the organizations or agencies that provided support for the project. Library of Congress Cataloging-in-Publication Data Seafood choices : balancing benefits and risks/Committee on Nutrient Relationships in Seafood: Selections to Balance Benefits and Risks, Food and Nutrition Board ; Malden C. Nesheim, and Ann L. Yaktine, editors. p. ; cm. Includes bibliographical references and index. The study was supported by Contract No. DG133R04CQ0009 TO #8 between the National Academy of Sciences and the Department of Commerce, and Contract No. 223-01-2460 TO #29 between the National Academy of Sciences and the U.S. Food and Drug Administration. ISBN-13: 978-0-309-10218-6 (hardback) ISBN-10: 0-309-10218-9 (hardback) 1. Seafood—Health aspects. 2. Seafood poisoning. I. Nesheim, Malden C. II. Yaktine, Ann L. III. Institute of Medicine (U.S.). Committee on Nutrient Relationships in Seafood: Selections to Balance Benefits and Risk. [DNLM: 1. Seafood—standards. 2. Consumer Participation. 3. Food Contamination. 4. Nutritive Value. 5. Risk Assessment. WB 426 S438 2007] RA602.F5.S428 2007 363.19'29—dc22 2006035748 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2007 by the National Academy of Sciences. All rights reserved. Printed in the United States of America. The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

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Seafood Choices: Balancing Benefits and Risks “Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES Advising the Nation. Improving Health.

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Seafood Choices: Balancing Benefits and Risks THE NATIONAL ACADEMIES Advisers to the Nation on Science, Engineering, and Medicine The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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Seafood Choices: Balancing Benefits and Risks COMMITTEE ON NUTRIENT RELATIONSHIPS IN SEAFOOD: SELECTIONS TO BALANCE BENEFITS AND RISKS MALDEN C. NESHEIM (Chair), Cornell University, Ithaca, NY DAVID C. BELLINGER, Harvard School of Public Health, Harvard Medical School, Boston, MA ANN BOSTROM, School of Public Policy, Georgia Institute of Technology, Atlanta SUSAN E. CARLSON, Department of Dietetics and Nutrition, The University of Kansas Medical Center, Kansas City JULIE A. CASWELL, Department of Resource Economics, University of Massachusetts, Amherst CLAUDE EARL FOX, Department of Epidemiology, University of Miami, FL JENNIFER HILLARD, Consumer Interest Alliance, Inc., Winnipeg, Canada SUSAN M. KREBS-SMITH, Applied Research Program, National Cancer Institute, Bethesda, MD STANLEY T. OMAYE, Department of Nutrition, University of Nevada, Reno JOSE M. ORDOVAS, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA W. STEVEN OTWELL, Department of Food Science and Human Nutrition, University of Florida, Gainesville MADELEINE SIGMAN-GRANT, University of Nevada Cooperative Extension, Las Vegas NICOLAS STETTLER, The Children’s Hospital of Philadelphia, PA Food and Nutrition Board Liaison SUSAN A. FERENC, Chemical Producers and Distributors Association, Alexandria, VA Consultants JAMES T. HEIMBACH, JHeimbach LLC, Washington, DC ERIC LORING, Inuit Tapiriit Kanatami, Ottawa, Canada NICOLAAS P. PRONK, Center for Health Promotion, HealthPartners, Minneapolis, MN Staff ANN L. YAKTINE, Study Director CARA JAMES, Research Associate SANDRA AMAMOO-KAKRA, Senior Program Assistant

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Seafood Choices: Balancing Benefits and Risks FOOD AND NUTRITION BOARD* DENNIS M. BIER (Chair), Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX MICHAEL P. DOYLE (Vice Chair), Center for Food Safety, University of Georgia, Griffin DIANE BIRT, Center for Research on Dietary Botanical Supplements, Iowa State University, Ames YVONNE BRONNER, School of Public Health and Policy, Morgan State University, Baltimore, MD SUSAN FERENC, Chemical Producers and Distributors Association, Alexandria, VA NANCY F. KREBS, Department of Pediatrics, University of Colorado Health Sciences Center, Denver REYNALDO MARTORELL, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA J. GLENN MORRIS, JR., Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore SUZANNE P. MURPHY, Cancer Research Center of Hawaii, University of Hawaii, Honolulu JOSE M. ORDOVAS, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA JIM E. RIVIERE, College of Veterinary Medicine, North Carolina State University, Raleigh NICHOLAS J. SCHORK, Department of Psychiatry, Polymorphism Research Laboratory, University of California, San Diego REBECCA J. STOLTZFUS, Division of Nutritional Sciences, Cornell University, Ithaca, NY JOHN W. SUTTIE, Department of Biochemistry, University of Wisconsin, Madison WALTER C. WILLETT, Department of Nutrition, Harvard School of Public Health, Boston, MA BARRY L. ZOUMAS, Department of Agricultural Economics and Rural Sociology, The Pennsylvania State University, University Park Staff LINDA D. MEYERS, Director GERALDINE KENNEDO, Administrative Assistant ANTON L. BANDY, Financial Associate * IOM Boards do not review or approve individual reports and are not asked to endorse conclusions and recommendations. The responsibility for the content of the report rests with the authoring committee and the institution.

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Seafood Choices: Balancing Benefits and Risks Independent Report Reviewers This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: Henry B. Chin, The Coca-Cola Company, Atlanta, GA Rebecca Goldburg, Environmental Defense, New York Scott M. Grundy, The University of Texas Southwestern Medical Center at Dallas, TX Sheila M. Innis, University of British Columbia, Vancouver, Canada Lester Lave, Graduate School of Industrial Administration, Carnegie Mellon University, Pittsburgh, PA Robert S. Lawrence, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD Alice Lichtenstein, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA Barbara J. Petersen, Exponent, Inc., Washington, DC Hildegard Przyrembel, Federal Institute for Risk Assessment, Berlin, Germany

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Seafood Choices: Balancing Benefits and Risks Nadine R. Sahyoun, Center on Aging, University of Maryland, College Park, MD Sally E. Shaywitz, Yale University School of Medicine, New Haven, CT Alan Stern, Bureau of Risk Analysis, Division of Science and Research and Technology, New Jersey Department of Environmental Protection, Trenton Michael R. Taylor, University of Maryland School of Medicine, Baltimore, MD Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Johanna T. Dwyer, Tufts University School of Medicine and Friedman School of Nutrition Science & Policy and Tufts–New England Medical Center and Catherine E. Woteki, Mars, Inc. Appointed by the National Research Council and Institute of Medicine, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

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Seafood Choices: Balancing Benefits and Risks Preface When I was growing up, fish were considered “brain food.” I was told that eating fish was good for you and would make you smart. Amazingly, there now is some evidence that this old food lore may have some scientific basis, as mothers who consume seafood may provide benefits to the developing fetal nervous system from fatty acids in the seafood. It is not clear, however, whether this will make you smarter as an adult. Seafood is a good source of high-quality protein, is low in saturated fat, and is rich in many micronutrients. Seafood is also a major source of the long-chain polyunsaturated omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which are synthesized in limited amounts by the human body from alpha-linolenic acid (ALA), an omega-3 fatty acid found in several vegetable, nut, and seed oils. Though these fatty acids are found in other foods, some seafood is an unusually rich source. In the past several years, research has implicated seafood and/or EPA and DHA in an array of health benefits for the developing fetus, infants, and also for adults, especially those prone to heart disease. This has led to recommendations by several health authorities to include seafood in a healthy diet. Seafood is the only animal protein food that is still provided in significant amounts to human diets through capture of wild species. Though our oceans are being depleted of some wild species, and aquaculture has become an important source of seafood, wild capture still provides a significant portion of the seafood we consume. The pollution of our oceans both through natural processes and practices of an increasingly industrialized world raise concern about the contaminants found in our seafood supply. As aquacul-

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Seafood Choices: Balancing Benefits and Risks ture of some species also uses fish meal and fish oil produced from captured wild sources, farmed seafood is not free from potential risks of further reducing ocean stocks or from potential contaminants. As consumption of seafood rises, there has been an increasing awareness of the potential risks from seafood consumption due to the presence of microbial contaminants; persistent organic pollutants; and heavy metals, especially mercury, in our oceans and inland waters. Consumers are therefore confronted with a dilemma: they are told that seafood is good for them and should be consumed in larger amounts than current consumption, while at the same time the federal government and virtually all the state governments have issued advisories urging caution in consumption of fish of certain species or from specific waters. Clearly, it should be an environmental priority to eliminate the sources of contamination of this important component of our food supply so that such a contradiction is avoided. The National Oceanic and Atmospheric Administration (NOAA) provides federal leadership in marine science and conservation. The seafood industry contributes a large part of the nation’s economic health, and as an agency of the US Department of Commerce, NOAA works to advance fisheries management policies and programs to ensure that fishery resources are healthy and sustainable so that they will remain a safe, nutritious, and affordable component of the US food supply. In light of these considerations, NOAA recognized the need for an independent group to examine the scientific evidence on the nutritional benefits obtained from seafood balanced against potential risks from exposure to contaminants, and ways to guide US consumers to make selections appropriate to their needs. Thus, NOAA asked the Institute of Medicine (IOM) to convene a committee with a diverse background and a broad scope of expertise to address the task put before them. The committee was charged to identify and prioritize adverse health effects from both naturally occurring and introduced toxicants in seafood; assess evidence on availability of specific nutrients in seafood compared to other food sources; determine the impact of modifying food choices to reduce intake of naturally occurring and introduced toxicants on nutrient intake and nutritional status within the US population; develop a decision path for US consumers to balance their seafood choices to obtain nutritional benefits while minimizing exposure risks; and identify data gaps and recommend future research. The committee’s report recommends approaches to decision-making for selecting seafood to obtain the greatest nutritional benefits balanced against exposure to potential toxicants, and identifies data gaps and research needs. The committee concentrated on issues affecting marine species and has not dealt in detail with freshwater fisheries.

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Seafood Choices: Balancing Benefits and Risks The task has not been an easy one. The committee reviewed the existing literature on benefits of seafood consumption and has attempted to make judgments as to the strength of the evidence. In many cases, we have deemed the evidence for benefit insufficient or too preliminary. Similarly, the committee reviewed the data on contaminants and risks they imply. We were surprised at the lack of good data on the distribution of some contaminants in the seafood supply. There is likewise little available evidence as to how beneficial effects of seafood may counteract some of the risks from contaminants. The committee also considered how consumers make decisions as to what they eat and tried to advise on how to approach the task of communicating benefits and risks to consumers. We have not regarded it the committee’s task to set specific dietary standards for seafood or EPA/DHA consumption and we have considered our findings in the light of the dietary recommendations of the Dietary Guidelines Advisory Committee as well as other authoritative groups. The Committee on Nutrient Relationships in Seafood was made up of committed members with widely varied expertise who volunteered countless hours to the research, deliberations, and preparation of the report. Many other individuals volunteered significant time and effort to address and educate our committee members during the first open session, workshop, and through consultations, and we are grateful for their contributions. The report could not have been produced without the dedicated guidance and expertise of the study director, Ann Yaktine, and her colleagues; Cara James, research associate; and Sandra Amamoo-Kakra, senior program assistant. We also thank Geraldine Kennedo for administrative support, Greg Fulco for graphic design, and Hilary Ray for technical and copy editing. This project benefited from the support and wisdom of Linda Meyers, director of the Food and Nutrition Board. Malden C. Nesheim, Chair Committee on Nutrient Relationships in Seafood

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Seafood Choices: Balancing Benefits and Risks Contents     SUMMARY   1 1   INTRODUCTION   17 2   CONSUMPTION PATTERNS AND COMPOSITION OF SEAFOOD   30 3   HEALTH BENEFITS ASSOCIATED WITH NUTRIENTS IN SEAFOOD   67 4   HEALTH RISKS ASSOCIATED WITH SEAFOOD CONSUMPTION   121 5   ANALYSIS OF THE BALANCING OF BENEFITS AND RISKS OF SEAFOOD CONSUMPTION   195 6   UNDERSTANDING CONSUMER DECISION MAKING AS THE BASIS FOR THE DESIGN OF CONSUMER GUIDANCE   217 7   BALANCING CHOICES: SUPPORTING CONSUMER SEAFOOD CONSUMPTION DECISIONS   248

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Seafood Choices: Balancing Benefits and Risks     APPENDIXES     A   Glossary and Supplementary Information   275 B   Data Tables   297 C   Tables and Scenarios   683 D   Open Session and Workshop Agendas   687 E   Committee Member Biographical Sketches   691     INDEX   697