Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.
Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.
OCR for page 17
Seafood Choices: Balancing Benefits and Risks 1 Introduction Federal agencies and private organizations have recommended including seafood as part of a healthy diet because of the variety of nutrients it provides. However, contamination of seafood, whether by naturally occurring or introduced contaminants, remains a concern for US consumers because of the potential for adverse health effects. The extent to which a contaminant in a food may be considered a risk to health depends upon the nature and level of the compound present, and the sensitivity of individuals or groups in a population to potentially toxic compounds. Specific population groups have been identified as being at particular risk from exposure to contaminants in seafood. Paradoxically, these population groups may especially benefit from the nutrients in seafood. For most of the general population, optimal benefits from seafood can be obtained by making choices to maximize intake of desirable nutrients balanced against exposure to contaminants that may pose a health risk. Making such selections, however, requires that consumers are aware of the variety of seafood available and are provided information on both benefits and risks to inform their choices. For the purposes of this report, the term seafood refers to all commercially obtained fish, shellfish, and mollusks, both marine and freshwater. When marine mammals are pertinent to the discussion, they will be identified separately. The impact of seafood obtained by subsistence and recreational harvesting is considered as far as the more limited data allow.
OCR for page 18
Seafood Choices: Balancing Benefits and Risks RECOMMENDATIONS TO ENCOURAGE SEAFOOD CONSUMPTION Seafood contributes a variety of nutrients to the American diet, including protein and important micronutrients, and its eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) content distinguishes it as providing a unique nutritional benefit. EPA and DHA are abundant in some seafood types and the conversion from alpha-linolenic acid (ALA) is inefficient in humans (Burdge, 2004). Seafood is not a primary source for ALA. EPA and DHA are believed to be important in reducing the risk of cardiovascular disease, lengthening gestation, and possibly promoting fetal and infant neurological development. For these reasons, several groups have recommended inclusion of seafood, particularly those choices high in EPA/DHA, in the American diet (see Appendix Table B-3). These recommendations frequently refer to servings per week; throughout this report, unless otherwise stated, a serving of seafood is defined as 4 ounces raw, which yields 3 ounces cooked. As noted later in this chapter and throughout the report, some federal and state agencies and nonfederal organizations include larger (8 ounce) serving sizes in their recommendations and advisories. This committee has adopted the convention of the Dietary Guidelines Advisory Committee (see below) in considering a serving size from the meat, poultry, fish, and egg food group to be 4 ounces raw, or 3 ounces cooked. Dietary Guidelines Advisory Committee Every 5 years, an expert Dietary Guidelines Advisory Committee (DGAC) is appointed to make recommendations to the Secretaries of the Department of Health and Human Services (HHS) and the Department of Agriculture (USDA) concerning revision of the Dietary Guidelines for Americans (DGA). In 2005, the DGAC issued its own report, separate from the Dietary Guidelines, which reviewed the preponderance of scientific and medical knowledge and suggested a set of key messages (DGAC, 2005). One of these messages, in the section on dietary fats, was “the consumption of two servings (approximately 6–8 ounces) per week of fish high in EPA and DHA is associated with reduced risk of both sudden death and death from coronary heart disease in adults. To benefit from the potential cardioprotective effects of EPA and DHA, the weekly consumption of two servings of fish, particularly fish rich in EPA and DHA, is suggested. Other sources of EPA and DHA may provide similar benefits; however, further research is warranted.” The strength of this message was tempered somewhat by the section on food safety, which warned of the potential danger of methylmercury in fish.
OCR for page 19
Seafood Choices: Balancing Benefits and Risks Dietary Guidelines for Americans The Dietary Guidelines for Americans provide science-based advice to promote health and reduce risk for major chronic diseases through diet and physical activity. The DGA are a statement of federal nutrition policy and, as such, form the basis of all federal food assistance as well as nutrition education and information programs. For example, the DGA are used in menu planning in the National School Lunch Program; in educational materials used by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); and in setting the Healthy People objectives for the nation. In addition, the Secretaries of HHS and USDA review all federal publications related to dietary guidance to ensure consistency with the DGA. Developed for policy makers, nutrition professionals, and educators, the DGA were initially published in 1980 by HHS and USDA, and have been updated every 5 years. The most recent edition was drafted in 2005 by a committee of scientists after reviewing the recommendations of the DGAC (see above) and the associated public comments. Because of the competing benefits and risks associated with seafood consumption pointed out in the DGAC report, drafters of the DGA stopped short of making a quantified key recommendation for fish or seafood. Instead, they recommended that individuals “Keep total fat intake between 20 to 35 percent of calories, with most fats coming from sources of polyunsaturated and monounsaturated fatty acids, such as fish, nuts, and vegetable oils” (DGA, 2005). The accompanying text cites evidence for a reduced risk of cardiovascular disease among the general population associated with the consumption of certain fatty acids from seafood. MyPyramid After the release of the DGA, the USDA released the MyPyramid food guidance system along with the new MyPyramid symbol (USDA, 2005). This food guidance system was developed to help Americans make healthy food choices, given their sex, age, and activity level. Recommended quantities are provided for each food group (grains, fruits, vegetables, milk, meat and beans, oils, and discretionary calories), with fish represented in the meat and beans group. While no specific quantity of fish is recommended, “selection tips” suggest that Americans “select fish rich in omega-3 fatty acids, such as salmon, trout, and herring, more often” (Source: http://www.mypyramid.gov). American Heart Association Guidelines The American Heart Association (AHA) Dietary Guidelines are based on the findings of the nutrition committee of the AHA and were last revised
OCR for page 20
Seafood Choices: Balancing Benefits and Risks TABLE 1-1 Summary of American Heart Association Recommendations for Omega-3 Fatty Acid Intakea Population Recommendation Patients without documented coronary heart disease (CHD) Eat a variety of (preferably fatty) fish at least twice a week. Include oils and foods rich in alpha-linolenic acid (flaxseed, canola, and soybean oils; flaxseed and walnuts). Patients with documented CHD Consume about 1 g of EPA+DHA per day, preferably from fatty fish. EPA+DHA supplements could be considered in consultation with the physician. Patients who need to lower triglycerides 2 to 4 g of EPA+DHA per day provided as capsules under a physician’s care. aPatients taking more than 3 g of omega-3 fatty acids from supplements should do so only under a physician’s care. High intakes could cause excessive bleeding in some people. SOURCE: AHA, 2005. in 2000 (Krauss et al., 2000). The AHA recommendations are aimed at reducing risk for cardiovascular disease by altering dietary and lifestyle factors among the general population, although there are individualized approaches for specific subgroups with medical concerns such as lipid disorders and diabetes. The AHA dietary guidelines include a recommendation that healthy adults eat fish at least twice a week. Altogether, the AHA has three recommended intake levels for EPA and DHA, corresponding to research findings on associations between EPA/DHA intake and cardiac risk reduction. The AHA (2005) recommendations, posted on its website (Source: http://www.americanheart.org/presenter.jhtml?identifier=851), are shown in Table 1-1. The basis for the AHA recommendations is research suggesting that adopting healthy food habits that include eating two 3-ounce servings of seafood per week can help reduce three major risk factors for heart attack—high blood cholesterol, high blood pressure, and excess body weight (see Chapter 3 for discussion). Reducing blood pressure may also help reduce the major risk factors for stroke. Recognizing the importance of primary prevention, i.e., preventing the development of cardiovascular risk factors before symptoms arise, the American Heart Association also endorses the recommendation that children aged 2 years and above increase consumption of “oily” fish prepared by broiling or baking (Gidding et al., 2005). The American Dietetic Association The American Dietetic Association and the Dietitians of Canada (ADA, 2003) published a position paper on vegetarian diets that addressed inclusion of omega-3 fatty acids. Vegetarian diets, which are rich in omega-6
OCR for page 21
Seafood Choices: Balancing Benefits and Risks but poor in omega-3 fatty acids, may contribute to decreased production of EPA and DHA in vegetarians. Apart from fish and eggs, omega-3 fatty acids can be obtained from microalgae, which is now available as a dietary supplement. The Dietary Reference Intake (IOM, 2002/2005) recommendation for an adequate intake (AI) of 1.6 and 1.1 grams of ALA per day for men and women, respectively, assumes some intake of EPA and DHA to meet targeted omega-3 levels. However, since vegetarians may not consume adequate levels of preformed EPA and DHA from seafood, and ALA is not efficiently converted to EPA/DHA, this recommendation may not be adequate for their needs. The joint World Health Organization/Food and Agriculture Organization Consultation on Diet, Nutrition and the Prevention of Chronic Disease (WHO/FAO, 2003) recommendation of an intake of 5–8 percent of daily calories from omega-6 and 1–2 percent from all omega-3 (EPA, DHA, and ALA) sources also falls short of vegetarians’ needs if an algal source is not included in the diet. The position of the American Dietetic Association is that vegetarians should include good sources of ALA, such as flaxseed, flaxseed oil, soy, or walnut oil in their diets. In addition, for those with increased requirements, including pregnant and lactating females, direct sources of EPA and DHA such as microalgae should be included in the diet. ADVISORIES AND WARNINGS ABOUT SEAFOOD CONSUMPTION The levels of different toxic compounds in seafood vary within and among species due to the chemical properties of the contaminant and the characteristics of the seafood. For example, compounds such as dioxins and polychlorinated biphenyls (PCBs) accumulate in fat tissue and are found predominantly in fatty fish and fish that live in fresh or coastal waters, including striped bass, bluefish, American eel, lake trout, and farmed Atlantic salmon. Heavy metals such as methylmercury accumulate in lean tissue and are found in the muscle tissue of older, predatory fish such as shark, swordfish, king mackerel, and tilefish. Federal Advisories The Food and Drug Administration (FDA) of the US Department of Health and Human Services announced in 2001 its advice to pregnant females and those of childbearing age who may become pregnant on the hazard of consuming fish that may contain high levels of methylmercury. In 2004, the advice was jointly reissued by FDA and the US Environmental Protection Agency (US EPA), and was updated to include the message that seafood makes an important contribution to the diet (US EPA/FDA, 2004).
OCR for page 22
Seafood Choices: Balancing Benefits and Risks The FDA advice states that women should select a variety of seafood including shellfish, canned fish, smaller ocean fish or farm-raised fish, and that they could safely consume 12 ounces per week of cooked fish (four 3-ounce servings). The US EPA/FDA joint advisory also includes information on specific types of fish that are low or high in methylmercury and advice to consumers to check their local advisories about the safety of locally caught fish. The advisory further cautions pregnant women and women of childbearing age who may become pregnant, as well as women who are nursing and young children, to avoid consuming shark, swordfish, king mackerel, and tilefish. This recommendation applies to commercially obtained as well as consumer-caught fish. The US EPA national fishing advisory states that, for consumer-caught fish, consumers should first consult their local advisories, or in the case where no advisory exists, to restrict consumption of consumer-caught fish to one “8-ounce (raw; 6 ounces cooked) meal per week” (US EPA, 2004a) for an adult with a body weight of 70 kilograms (kg) (154 pounds) (see Table 1-2). State Advisories The five primary bioaccumulative pollutants for which fishing advisories have been established are mercury, PCBs, chlordane, dioxins, and DDT and its metabolites, although approximately 76 percent of all advisories issued addressed mercury contamination. States establish their own advisory criteria, which may be based on established federal advisories, and determine which water bodies to monitor; these may include coastal waters, rivers, and lakes. Across the states and territories of the United States, the number of waterbodies under advisory represents 35 percent of total lake acres (approximately 101,818 lakes), 24 percent of total river miles (approximately 846,310 river miles), and 71 percent of the contiguous coastal waters (US EPA, 2004b). The National Listing of Fish Advisories database (Source: http://www.epa.gov/waterscience/fish/advisories/index.html) listed 3,089 advisories in 48 states, the District of Columbia, and the US Territory of American Samoa in 2003 (US EPA, 2005b). In 2003, 31 states had statewide advisories in effect, including new statewide advisories for all rivers and lakes in Montana and Washington, and an advisory for marine fish in Hawaii. In addition to advisories in place in 2003, 16 states across the United States had Safe Eating Guidelines, either for specific waterbodies or inclusive of all rivers and lakes statewide. The guidelines are issued to inform and reassure the public that certain species of fish taken from these waterbodies have been tested and shown to contain very low levels of contaminants. The only state within the continental United States that did not have an advisory of any type in 2003 was Wyoming
OCR for page 23
Seafood Choices: Balancing Benefits and Risks TABLE 1-2 Federal Fish Advisories in the United States Organization Audience Reasons for Advisories/Restrictions Fish Advisories/Restrictionsa Type of Fish/Seafood Serving Size Number of Servings Environmental Protection Agency Not specified Inform the public from which specific bodies of water or which species of fish it is safe to eat Noncommercial fish (where there is no local advisory) 8 ounces raw (6 ounces cooked)b Once per week Food and Drug Administration Pregnant women and women of childbearing age Receive the benefits of eating fish and shellfish and be confident of reductions in exposure to the harmful effects of methylmercury A variety of fish includes shellfish, canned fish, smaller ocean fish, or farm-raised fish 6 ounces cooked Twice per week Environmental Protection Agency and Food and Drug Administration Pregnant women, women of childbearing age, nursing women, and children These fish contain high levels of methylmercury Shark, swordfish, king mackerel, tilefish Any Avoid Environmental Protection Agency and Food and Drug Administration Pregnant women, women of childbearing age, nursing women, and children Albacore (“white”) tuna has more methylmercury than canned light tuna Albacore (“white”) tuna and locally caught fish 6 ounces Once per weekc aWhen consuming noncommercial fish, always check for local fishing advisories. bFor an adult with an average body weight of 70 kilograms (154 pounds), based on a reference dose for methylmercury of 1×10−4 mg/kg/day. cIf consuming locally caught fish, do not consume any other fish that week. SOURCES: US EPA, 2004a; FDA, 2001; US EPA/FDA, 2004.
OCR for page 24
Seafood Choices: Balancing Benefits and Risks (Source: http://www.epa.gov/waterscience/fish/advisories/fs2004.html). The number of total state and territory advisories increased to 3,221 in 2004; however, the number of Safe Eating Guidelines issued by states increased as well to 1,213 in 2004. ADVICE ON SEAFOOD CONSUMPTION OUTSIDE THE US The United Kingdom’s Scientific Advisory Committee on Nutrition In the United Kingdom (UK), the Food Standards Agency (FSA) and the Department of Health sought advice from the Scientific Advisory Committee on Nutrition (SACN) and the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment (COT) on the benefits and risks of fish consumption, with particular reference to “oily” fish (fish high in EPA/DHA). A joint SACN/COT subgroup was convened to deliberate and produce a report. The report (SACN, 2004) assessed the risks associated with consumption of seafood, weighed the nutritional benefits against possible risks, and developed coherent dietary advice for the public on the consumption of seafood. A summary of the benefits and risks associated with seafood consumption was reviewed in the report. Among the conclusions reached by the SACN/COT regarding those benefits and risks associated with increased consumption of seafood and fish oils were that: SACN endorsed the general population recommendation to eat at least two servings of fish per week, of which one should be oily, and agreed that this recommendation should also apply to pregnant women; An increase in oily fish consumption to one serving a week, from the current levels of about a third of a serving a week, would probably confer significant public health benefits in terms of reduced risk of cardiovascular disease; There is further evidence that increased seafood consumption might have beneficial effects on fetal development; The evidence to support benefits at higher levels of consumption is insufficient to enable accurate quantification; and Exceeding designated intake guideline ranges over the short-term would not be deleterious, but long-term exceedances could have deleterious effects in sensitive individuals. In the case of pregnant and lactating women, for example, a woman who had not consistently exceeded the guideline range previously, could increase her oily fish consumption throughout pregnancy and lactation above the guideline range (e.g., to two to three servings of oily fish a week) without detrimental effects from exposure to persistent organic pollutants such as dioxins and PCBs.
OCR for page 25
Seafood Choices: Balancing Benefits and Risks The European Food Safety Authority Recognizing that fish is a source of nutritional benefit but also of contaminants of concern, particularly methylmercury, dioxins, and dioxin-like compounds (DLCs), the European Food Safety Authority (EFSA) was asked by the European Parliament to assess health risks associated with consumption of farmed and wild-caught fish, including an assessment of the safety of consuming Baltic herring (EFSA, 2005a). EFSA reviewed evidence on the benefits of nutrients, especially omega-3 fatty acids, in fish; sources of contaminants of concern in seafood; and risks to health from consuming fish and generated exposure scenarios from data on consumption of and contaminants in fish. The conclusions and recommendations of EFSA were published as an opinion on the health risks related to consumption of wild and farmed fish (Source: http://www.efsa.eu.int/science/contam/contam_opinions/1007_en.html). The report pointed out that fish obtained from the Baltic Sea are likely to contain higher levels of contaminants, particularly dioxins and PCBs, than comparable fish obtained from other sources. For some EU member countries, i.e., Sweden and Finland, there is specific national advice for consumers, particularly girls (due to childbearing potential), about consuming Baltic fish that may be contaminated with dioxins and PCBs. Apart from fish obtained from the Baltic Sea, the EFSA opinion states that there are no consistent differences between wild and farmed fish regarding either safety or nutritional value, and that consumption of fish, especially fish high in EPA/DHA, is beneficial to cardiovascular health and to fetal development. The report noted that fish is a valuable source of many nutrients, including protein, iodine, selenium, and vitamins A and D. The EFSA statement was further qualified, however, with the advice that vulnerable population groups, such as pregnant women and women of childbearing age, should consider the nutritional benefits of fish weighed against potential risks from contaminants in certain types of fish. The EFSA panel also stated that advice regarding fish consumption should take into account other comparable sources of contaminants, particularly dioxin-like compounds and PCBs, that are present in the fatty components of other animal foods. Pregnant women were advised to consume up to two servings of fish per week as long as certain types of fish, e.g., long-lived predatory fish such as swordfish and tuna, were avoided (for additional information see Cossa et al., 1989; Claisse et al., 2001). Lastly, the EFSA panel recommended development of a consistent and agreed-upon methodology for carrying out quantitative assessments of benefits and risks related to food consumption.
OCR for page 26
Seafood Choices: Balancing Benefits and Risks World Health Organization A Joint WHO/FAO Expert Consultation on Diet, Nutrition and the Prevention of Chronic Diseases met in Geneva in 2002 to evaluate evidence for the role of diet in the prevention of nutritional deficiency and chronic disease. The Joint WHO/FAO committee’s report Diet, Nutrition and the Prevention of Chronic Diseases recommends a shift in the conceptual framework for developing health care strategies that would place nutrition, together with the other principal risk factors for chronic disease, at the forefront of public health policies and programs (WHO/FAO, 2003). The report examined the role of omega-6 and omega-3 fatty acids in the prevention of chronic disease, including cancer and cardiovascular disease. Recommendations included that diets should provide a total intake of omega-6 and omega-3 fatty acids in the range of 6–10 percent of daily energy (caloric) intake, but an optimal balance would include 5–8 percent of those percent as n-6 and 1–2 percent as n-3 fatty acids. Omega-3 fatty acids include α-linolenic (ALA), eicosapentaenoic (EPA), and docosahexaenoic (DHA). Whereas certain fish are the primary source of EPA and DHA, ALA is derived primarily from plant sources, e.g., soybean, flaxseed, and walnut oils. The WHO/FAO (2003) recommendation on the consumption of fish is that “Regular fish consumption (1–2 servings per week) is protective against coronary heart disease and ischaemic stroke and is recommended. The serving should provide an equivalent of 200–500 mg of eicosapentaenoic and docosahexaenoic acid. People who are vegetarians are recommended to ensure adequate intake of plant sources of α-linolenic acid.” THE CHARGE TO THE COMMITTEE Considering the recommendations and suggestions to increase seafood intake to promote cardiovascular health, and the somewhat conflicting messages to avoid certain fish, consumers and health professionals may feel confused regarding the healthfulness of consuming seafood. For this reason, the National Marine Fisheries Service (NMFS) of the Department of Commerce, National Oceanic and Atmospheric Administration (NOAA), in particular the National Marine Fisheries Science Board, asked the Institute of Medicine to convene an ad hoc committee to (1) identify and prioritize the potential for adverse health effects from both naturally occurring and introduced toxicants in seafood, (2) assess evidence on availability of specific nutrients in seafood compared to other food sources, (3) 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, (4) develop a decision path, appropriate to the needs of US consumers, for selecting seafood to balance their choices to obtain
OCR for page 27
Seafood Choices: Balancing Benefits and Risks nutritional benefits against exposure risks, and (5) identify data gaps and recommend future research. Many of the contaminants that are present in seafood and have a role in influencing selections to balance benefits and risks are introduced, and thus may be controlled. For this reason, an examination of the sources of toxicants and the pathways by which they enter and bioaccumulate in the seafood supply is important. However, the committee was not asked to make recommendations to mitigate contaminant sources in seafood. Approach to the Task Following a request by NOAA to the National Academies, an expert committee was appointed to review evidence on ways for the US consumer to balance the benefits of seafood consumption against potential risks from exposure to contaminants they may contain, and to recommend ways to guide US consumers in making selections appropriate to their needs. The committee approached its task by gathering information from existing literature and from workshop presentations by recognized experts (see Appendix D for workshop agendas), consulting with experts in relevant fields, performing analyses on data collected in the most recent National Health and Nutrition Examination Survey (NHANES), deliberating on issues relevant to the task, and formulating an approach to address the scope of work. ORGANIZATION OF THE REPORT This report is organized into seven chapters that describe what is known about the benefits associated with nutrients in seafood, particularly omega-3 fatty acids; risks associated with contaminants found in seafood; and ways to balance benefits and risks and guide consumers in making selections appropriate to their needs. Chapter 2 provides information on seafood consumption patterns, and nutrients and contaminants in seafood. Chapter 3 provides in-depth evaluation of the literature on benefits of consuming seafood, particularly omega-3 fatty acids, and the impact of seafood consumption on health outcomes. Chapter 4 reviews risks associated with introduced and naturally occurring contaminants in seafood and potential health outcomes from exposure. Chapter 5 discusses the scientific assessment and analysis of risks and benefits from seafood consumption and ways that benefits and risks could vary depending on the type of fish consumed. Chapter 6 discusses consumer decision-making and the current consumer information environment and Chapter 7 discusses approaches to designing consumer information and supporting seafood consumption decisions.
OCR for page 28
Seafood Choices: Balancing Benefits and Risks REFERENCES ADA (American Dietetic Association). 2003. Position of the American Dietetic Association and Dietitians of Canada: Vegetarian diets. Journal of the American Dietetic Association 103(6):748–765. AHA (American Heart Association). 2005. Fish and Omega-3 Fatty Acids: AHA Recommendation. [Online]. Available: http://www.americanheart.org/presenter.jhtml?identifier=4632 [accessed December 9, 2005]. AHA. 2006. Our 2006 Diet and Lifestyle Recommendations. [Online]. Available: http://www.americanheart.org/presenter.jhtml?identifier=851 [accessed September 6, 2006]. Burdge G. 2004. Alpha-linolenic acid metabolism in men and women: Nutritional and biological implications. Current Opinion in Clinical Nutrition and Metabolic Care 7(2):137–144. Claisse D, Cossa D, Bretaudeau-Sanjuan J, Touchard G, Bombled B. 2001. Methylmercury in molluscs along the French coast. Marine Pollution Bulletin 42(4):329–332. Cossa D, Auger D, Averty B, Lucon M, Masselin P, Noel J, SanJuan J. 1989. Atlas Des Niveaux de Concentration en Metaux Metalloides et Composes Organochlores dans les Produits de la Peche Cotiere Francaise. Technical Report. Nantes, France: IFREMER. DGA (Dietary Guidelines for Americans). 2005. Washington, DC: Department of Health and Human Services and the Department of Agriculture. [Online]. Available: http://www.health.gov/dietaryguidelines/dga2005/document/ [accessed November 29, 2005]. DGAC (Dietary Guidelines Advisory Committee). 2005. Dietary Guidelines Advisory Committee Report. Washington, DC: Department of Health and Human Services and the Department of Agriculture. [Online]. Available: http://www.health.gov/dietaryguidelines/dga2005/report/ [accessed November 29, 2005]. EFSA (European Food Safety Authority). 2005a. Opinion of the CONTAM Panel Related to the Safety Assessment of Wild and Farmed Fish. [Online]. Available: http://www.efsa.eu.int/science/contam/contam_opinions/1007_en.html [accessed December 4, 2006]. EFSA. 2005b. Opinion of the scientific panel on contaminants in the food chain on a request from the European Parliament related to the safety assessment of wild and farmed fish. The EFSA Journal 236:1–118. [Online]. Available: http://www.efsa.eu.int/press_room/press_release/258_en.html [accessed October 6, 2005]. FDA (Food and Drug Administration). 2001. FDA Announces Advisory on Methyl Mercury in Fish. [Online]. Available: http://www.fda.gov/bbs/topics/ANSWERS/2001/ANS01065.html [accessed May 9, 2006]. Gidding SS, Dennison BA, Birch LL, Daniels SR, Gilman MW, Lichtenstein AH, Rattay KT, Steinberger J, Stettler N, Van Horn L. 2005. Dietary recommendations for children and adolescents: A guide for practitioners. Consensus statement from the American Heart Association. Circulation 112(13):2061–2075. IOM (Institute of Medicine). 2002/2005. Dietary Reference Intakes for Energy, Carbohydrates, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. Washington, DC: The National Academies Press. Krauss RM, Eckel RH, Howard B, Appel LJ, Daniels SR, Deckelbaum RJ, Erdman JW, Kris-Etherton P, Goldberg IJ, Kotchen, TA, Lichtenstein AH, Mitch WE, Mullis R, Robinson K, Wylie-Rosett J, St. Jeor S, Suttie J, Tribble DL, Bazzarre TL. 2000. AHA Dietary Guidelines Revision 2000: A statement for healthcare professionals from the Nutrition Committee of the American Heart Association. Circulation 102:2284–2299. SACN (Scientific Advisory Committee on Nutrition). 2004. Advice on Fish Consumption: Benefits & Risks. London, UK: TSO (The Stationery Office). [Online]. Available: http://www.sacn.gov.uk/reports/#/ [accessed September 8, 2005].
OCR for page 29
Seafood Choices: Balancing Benefits and Risks US EPA (US Environmental Protection Agency). 2004a (March 11). Origin of 1 Meal/Week Noncommerical Fish Consumption Rate in National Advisory for Mercury. Technical Memorandum. [Online]. Available: http://www.epa.gov/waterscience/fishadvice/1-meal-per-week.pdf [accessed September 8, 2005]. US EPA. 2004b. National Listing of Fish Advisories: Fact Sheet. EPA-823-F-04-016. [Online]. Available: http://www.epa.gov/waterscience/fish/advisories/factsheet.pdf [accessed September 8, 2005]. US EPA. 2005a. 2004 National Listing of Fish Advisories: Fact Sheet (September 2005). [Online]. Available: http://www.epa.gov/waterscience/fish/advisories/fs2004.html [accessed September 13, 2005]. US EPA. 2005b. The National Listing of Fish Advisories (NLFA). [Online]. Available: http://www.epa.gov/waterscience/fish/advisories/index.html [accessed September 13, 2005]. US EPA/FDA (US Environmental Protection Agency and the Food and Drug Administration). 2004. What You Need to Know About Mercury in Fish and Shellfish. EPA-823-R-04-005. [Online]. Available: http://www.epa.gov/waterscience/fishadvice/advice/html or http://www.cfsan.fda.gov/~dms/admehg3.html [accessed September 8, 2005]. USDA. 2005. My Pyramid: Steps to a Healthier You. [Online]. Available: http://www.mypyramid.gov [accessed September 27, 2005]. WHO/FAO (World Health Organization/Food and Agriculture Organization) Expert Consultation on Diet, Nutrition and the Prevention of Chronic Diseases. 2003. Diet, Nutrition and the Prevention of Chronic Diseases. Geneva, Switzerland: World Health Organization. [Online]. Available: http://www.who.int/dietphysicalactivity/publications/trs916/kit/en/ [accessed October 27, 2005].
Representative terms from entire chapter: