Sara M Pires

Technical University of Denmark | DTU · National Food Institute

Background: Campylobacteriosis is a major zoonotic and foodborne disease (FBD), posing a substantial social and health economic burden on human health. Burden of disease (BoD) studies, which increasingly use the disability-adjusted life years (DALYs) metric, provide comprehensive insights into disease effects. However, the complexity of DALY calcul...

The pressure global food systems exert on the environment has amplified over time, following the growth of the human population, changes in the food consumption patterns and intensification of the production systems. Without changes in food systems, an overpressure on agriculture and food production will be unavoidable, with inevitable consequences...

Background Diarrheal diseases substantially affect public health impact in low- and middle-income countries (LMIC), particularly in Africa, where previous studies have indicated a lack of comprehensive data. With a growing number of primary studies on enteric infections in Africa, this study aimed to estimate the incidence and mortality of diarrhea...

Acute childhood diarrhea is one of the leading causes of childhood morbidity and mortality in sub-Saharan African countries. Entamoeba histolytica and Giardia lamblia are the common cause of childhood diarrhea in the region. However, there are only few studies on protozoa causing diarrhea in sub-Saharan African countries. This study was conducted t...

Knowledge about the extent of the COVID-19 mortality burden is important to inform policy-making decisions. To gain greater insights into the population health impact of COVID-19 mortality, Years of Life Lost (YLL) can be estimated. We aimed to determine YLL linked to COVID-19 over the first two years (March 2020–March 2022) of the pandemic in Cypr...

Previous efforts to estimate the burden of fatigue-related symptoms due to long COVID have a very high threshold for inclusion of cases, relative to the proposed definition from the World Health Organization. In practice this means that milder cases, that may be occurring very frequently, are not included in estimates of the burden of long COVID wh...

Objectives: Within the framework of the burden of disease (BoD) approach, disease and injury burden estimates attributable to risk factors are a useful guide for policy formulation and priority setting in disease prevention. Considering the important differences in methods, and their impact on burden estimates, we conducted a scoping literature re...

Exposure to chemical contaminants found in foods has been associated with various adverse health effects. Burden of disease studies are increasingly used to estimate the public health impact of such exposures. The aims of this study were to estimate the burden of disease due to dietary exposure to four chemicals in France in 2019 (lead (Pb), cadmiu...

Background Public health surveillance data do not always capture all cases, due in part to test availability and health care seeking behaviour. Our study aimed to estimate under-ascertainment multipliers for each step in the reporting chain for COVID-19 in Toronto, Canada. Design and methods We applied stochastic modeling to estimate these proport...

This systematic literature review aimed to provide an overview of the characteristics and methods used in studies applying the disability-adjusted life years (DALY) concept for infectious diseases within European Union (EU)/European Economic Area (EEA)/European Free Trade Association (EFTA) countries and the United Kingdom. Electronic databases and...

This systematic literature review aimed to provide an overview of the characteristics and methods used in studies applying the disability-adjusted life years (DALY) concept for infectious diseases within European Union (EU)/European Economic Area (EEA)/European Free Trade Association (EFTA) countries and the United Kingdom. Electronic databases and...

Foods can be an important source of exposure to chemicals harmful to humans. To identify and prioritize effective food safety strategies, and allocate resources to the interventions with maximum public health benefit, policy makers need evidence on which hazards cause the highest burden of disease in the population. The Disability Adjusted Life Yea...

Previous efforts to estimate the burden of fatigue-related symptoms due to long COVID have a very high threshold for inclusion of cases, relative to the proposed definition from the World Health Organization. In practice, this means that milder cases, that may be occurring very frequently, are not included in estimates of the burden of long COVID,...

Investigating the impact of diet on public health using risk–benefit assessment (RBA) methods that simultaneously consider both beneficial and adverse health outcomes could be useful for shaping dietary policies and guidelines. In the field of food safety and nutrition, RBA is a relatively new approach facing methodological challenges and being sub...

Background Calculating the disease burden due to injury is complex, as it requires many methodological choices. Until now, an overview of the methodological design choices that have been made in burden of disease (BoD) studies in injury populations is not available. The aim of this systematic literature review was to identify existing injury BoD st...

We ranked seven foodborne pathogens in Denmark on the basis of their health and economic impact on society in 2019. We estimated burden of disease of infections with Campylobacter spp., Salmonella spp., Shiga toxin-producing Escherichia coli (STEC), Yersinia enterocolitica, Listeria monocytogenes, norovirus, and hepatitis A virus in terms of incide...

Background Burden of disease studies measure the public health impact of a disease in a society. The aim of this study was to quantify the direct burden of COVID-19 in the first 12 months of the epidemic in Denmark. Methods We collected national surveillance data on positive individuals for SARS-CoV-2 with RT-PCR, hospitalization data, and COVID-1...

Salmonella remains a major cause of foodborne outbreaks in Europe despite the implementation of harmonized control programmes. Outbreak data are observed at the public health endpoint and provide a picture of the most important sources of human salmonellosis at the level of exposure. To prioritize interventions, it is important to keep abreast of t...

Background Collaborative research is being increasingly implemented in Africa to study health-related issues, for example, the lack of evidence on disease burden, in particular for the presumptive high load of foodborne diseases. The FOCAL (Foodborne disease epidemiology, surveillance, and control in African LMIC) Project is a multi-partner study t...

Objectives Quantifying the combined impact of morbidity and mortality is a key enabler to assessing the impact of COVID-19 across countries and within countries relative to other diseases, regions, or demographics. Differences in methods, data sources, and definitions of mortality due to COVID-19 may hamper comparisons. We describe efforts to suppo...

Objectives: Burden of Disease frameworks facilitate estimation of the health impact of diseases to be translated into a single measure, such as the Disability-Adjusted-Life-Year (DALY). Methods: DALYs were calculated as the sum of Years of Life Lost (YLL) and Years Lived with Disability (YLD) directly associated with COVID-19 in the Republic of Ire...

The project entitled “Novel foods as red meat replacers – an insight using Risk Benefit Assessment methods (NovRBA)” aimed to develop and test harmonised Risk Benefit Assessment (RBA) methods to estimate the overall health impact of replacing red meat with an edible insect species (a novel food). Based on an appraisal of insect products that are mo...

Food microbiology researchers, risk assessment agencies and food business operators rely heavily on the re-use of knowledge that is available as data, models and tools. Unfortunately, such knowledge re-use remains challenging, as food safety data sets, models and tools are usually only available in platform- or software-dependent formats that rarel...

Background: The true incidence of acute gastrointestinal illness in China is underrecognized by surveillance systems. The aims of this study were to estimate the incidence and prevalence of self-reported AGI in the community of China, and to investigate sociodemographic and epidemiological determinants of AGI. Methods: We conducted a 12-months cros...

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 consumpti...

Background Assessment of disability-adjusted life years (DALYs) resulting from non-communicable diseases (NCDs) requires specific calculation methods and input data. The aims of this study were to: (i) identify existing NCD burden of disease (BoD) activities in Europe; (ii) collate information on data sources for mortality and morbidity; and (iii)...

Objectives Burden of Disease frameworks facilitate estimation of the health impact of diseases to be translated into a single measure, such as the Disability-Adjusted-Life-Year (DALY). Methods DALYs were calculated as the sum of Years of Life Lost (YLL) and Years Lived with Disability (YLD) directly associated with COVID-19 in the Republic of Irela...

The European Burden of Disease Network (burden-eu) joins 271 members from 50 countries. Upon the onset of the COVID-19 pandemic, several of these members started studies to estimate the burden of COVID-19 in their countries, and many others showed interest in taking steps to launch such studies. Capacity building is one of the key pillars of burden...

Facing the considerable variation in the computation of disability-adjusted life years (DALY) in the numerous updates of the Global Burden of Disease (GBD) study and many independent studies, the European burden of disease network (burden-eu) launched a series of systematic literature reviews (SLR) to explore the key assumptions used in the Europea...

Along with the computation of disability-adjusted life years (DALY), the Global Burden of Disease (GBD) study uses the comparative risk assessment method to estimate the burden attributable to risk factors (RF). The methodology used for GBD studies has undergone continuous improvements through the years and across many independent studies. The Euro...

Facing the considerable variation in the computation of disability-adjusted life years (DALY), the European Burden of Disease Network (burden-eu) launched a series of systematic literature reviews (SLR) to explore the key variations in the assumptions used in the European burden of disease (BoD) assessments. The studies were evaluated in terms of p...

Introduction: Foodborne diseases are a growing public health problem and have caused a large burden of disease in China. This study analyzed epidemiological characteristics of foodborne diseases in China in 2020 to provide a scientific basis for prevention and control measures. Methods: Data were collected from 30 of 31 provincial-level administ...

Cereal-based foods, including breakfast (BC) and infant cereals (IC), are among the first solid foods introduced to infants. BC and IC are sources of macro and micronutrients that have beneficial effects on health, but can also be sources of harmful chemical and microbiological contaminants and nutrients that may lead to adverse health effects at h...

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 consumptio...

Objective: To evaluate the health impact of current and alternative patterns of rice consumption in Chinese adult men (40–79 years of age). Methods: We applied a risk–benefit assessment (RBA) model that took into account the health effects of selenium (Se), cadmium (Cd), and inorganic arsenic (i-As). The health effects included the prevention of pr...

What is already known on this topic?: Vibrio parahaemolyticus (V. parahaemolyticus) is frequently resistant to common antimicrobials such as ampicillin and generally highly susceptible to most clinically used antimicrobials. What is added by this report?: V. parahaemolyticus were highly resistant to cefazolin and ampicillin: 94.4% and 37.0%, res...

Recent estimates have reiterated that non-fatal causes of disease, such as low back pain, headaches and depressive disorders, are amongst the leading causes of disability-adjusted life years (DALYs). For these causes, the contribution of years lived with disability (YLD) - put simply, ill-health - is what drives DALYs, not mortality. Being able to...

Introduction: Mushroom poisoning was the leading cause of foodborne disease outbreaks and outbreak-associated deaths in China. Mushroom poisoning outbreak surveillance can provide insight into the epidemiological characteristics of mushroom poisonings and guide policymaking and health education to reduce illnesses and deaths. Methods: Foodborne Di...

Fish and other seafood are important sources of nutrients, but they are also sources of chemical contaminants that may cause adverse health effects. This article aimed to identify existing risk-benefit assessments (RBA) of fish, shellfish, and other seafood, compare methodologies, discuss differences and commonalities in findings, and identify limi...

Background Toxoplasma gondii is a ubiquitous protozoan parasite that can infect virtually all warm-blooded animals. It is the causative agent of toxoplasmosis, a significant public health issue worldwide. Mathematical models are useful to study the transmission dynamics of T. gondii infection in different settings, and may be used to compare the ef...

National burden of foodborne disease (FBD) studies are essential to establish food safety as a public health priority, rank diseases, and inform interventions. In recent years, various countries have taken steps to implement them. Despite progress, the current burden of disease landscape remains scattered, and researchers struggle to translate find...

Lifestyle and sociodemographics are likely to influence dietary patterns, and, as a result, human exposure to chemical contaminants in foods and their associated health impact. We aimed to characterize subgroups of the Danish population based on diet and sociodemographic indicators, and identify those bearing a higher disease burden due to exposure...

Salmonella spp. remains the most significant foodborne pathogen in south Brazil, but its epidemiology tends to change over time. Using official and surrogate data, a microbial subtyping model attributed different Salmonella serovars to laying hens, pigs, broilers, and turkeys from 2005 to 2015 in Rio Grande do Sul (RS). Additional to the subtyping...

Estimates of burden of foodborne diseases are important for prioritizing food safety policy at national and international levels. Estimating burden of foodborne diseases is complex: It requires data from many sources and relies on many assumptions. In 2015, the World Health Organization Foodborne Disease Burden Epidemiology Reference group (WHO/FER...

In the past, food-based dietary guidelines (FBDGs) were derived nearly exclusively by using systematic reviews on diet-health-relationships and translating dietary reference values for nutrient intake into foods. This approach neglects many other implications that dietary recommendations have on society, the economy and environment. In view of pres...

Arsenic is a naturally occurring metalloid in soil, air, water and food in organic and inorganic forms. Several epidemiological studies have shown that inorganic arsenic (i-As) is carcinogenic to humans. Previous studies have raised concern about dietary i-As exposure from various sources, including brown rice. We estimated the burden of disease in...

Despite increased political attention, foodborne diseases still cause a substantial public health, economic, and social burden worldwide. Children younger than 5 years, people living in developing regions, and in the poorest areas of the world are disproportionally affected, bearing a large proportion of the global burden of foodborne disease. Yet,...

Our paper provides a step-by-step guide to define COVID-19 as a cause of disease burden, which can be used to calculate DALYs. Additionally, we suggest pragmatic data inputs, reflecting the availability and quality of data inputs will vary by country. As our paper provides suggestions for different solutions, we recommend that users should be clear...

The burden of disease landscape in Europe is currently scattered with experts from diverse professional backgrounds, ranging from experts in infectious diseases, non-communicable diseases, injuries and risk factors, to experts in more comprehensive national, regional and global burden of disease studies. Currently there is little interaction betwee...

An amendment to this paper has been published and can be accessed via the original article.

Background: Evidence has emerged showing that elderly people and those with pre-existing chronic health conditions may be at higher risk of developing severe health consequences from COVID-19. In Europe, this is of particular relevance with ageing populations living with non-communicable diseases, multi-morbidity and frailty. Published estimates o...

Background: Evidence has emerged showing that elderly people and those with pre-existing chronic health conditions may be at higher risk of developing severe health consequences from COVID-19. In Europe, this is of particular relevance with ageing populations living with non-communicable diseases, multi-morbidity and frailty. Published estimates of...

Foodborne disease remains a major public health problem worldwide. To understand the epidemiology and changes of foodborne disease in China, data reported to the National Foodborne Disease Outbreak Surveillance System during 2003–2017 were collected. A total of 19,517 outbreaks, which resulted in 235,754 illnesses, 107,470 hospitalizations, and 145...

Abstract The provisional molecular approach, proposed by EFSA in 2013, for the pathogenicity assessment of Shiga toxin‐producing Escherichia coli (STEC) has been reviewed. Analysis of the confirmed reported human STEC infections in the EU/EEA (2012–2017) demonstrated that isolates positive for any of the reported Shiga toxin (Stx) subtypes (and enc...

“RiskBenefit4EU ‐ Partnering to strengthen the risk‐benefit assessment within EU using a holistic approach” was a knowledge transfer project funded by the European Food Safety Authority (EFSA) that integrated a multidisciplinary team from Portugal, Denmark and France. This project aimed to strengthen the EU capacity to assess risks and benefits ass...

Burden of disease metrics is increasingly established to prioritize food safety interventions. We estimated the burden of disease caused by seven foodborne pathogens in Denmark in 2017: Campylobacter, Salmonella, Shiga toxin-producing Escherichia coli, norovirus, Yersinia enterocolitica, Listeria monocytogenes, and Toxoplasma gondii. We used public...

Background Humans are exposed to heavy metals from certain foods, thus specific dietary patterns may lead to high burden of disease (BoD). By identifying diet, lifestyle and socio-demographic characteristics of population groups with highest BoD, targeted preventive strategies can be developed. We aimed at identifying clusters and characteristics o...

Background Recent global estimates have shown that dietary exposure to chemical contaminants cause over 56,000 deaths and 9 million healthy life years lost each year. However, the contribution of causative agents varies greatly between world regions and countries due to local food consumption and contamination. To prioritize public health intervent...

Background Sufficient intake of fish and limited red meat intake is commonly encouraged by national dietary guidelines to prevent various lifestyle diseases. One way to fulfill these guidelines would be to substitute red meat by fish. However, quantitative evidence of the public health gain of such substitution is lacking. Moreover, contaminants in...

Abstract Food is an elementary requirement for human life, providing nutrients and essential energy needed for optimal health. But at the same time, food can also be a vehicle of hazardous substances or pathogens that could affect human health negatively. Risk‐benefit assessment (RBA) of foods, a relatively new methodology for decision support, int...

Shiga toxin-producing Escherichia coli (STEC) infections are a substantial health issue worldwide. Circa 2010, foodborne STEC caused > 1 million human illnesses, 128 deaths, and ~ 13,000 Disability Adjusted Life Years (DALYs). To appropriately target interventions to prevent STEC infections transmitted through food, it is important to determine th...

Background: Human diet may present both risks and benefits to consumers’ health. Risk-benefit assessment of foods (RBA) intends to estimate the overall health impact associated with exposure (or lack of exposure) to a particular food or food component. Scope and approach: “RiskBenefit4EU – Partnering to strengthen the risk-benefit assessment within...

Background: Toxoplasma gondii is an important foodborne zoonotic parasite. Meat of infected animals is presumed to constitute a major source of human infection and may be a driver of geographical variation in the prevalence of anti-T. gondii antibodies in humans, which is substantial in the Nordic-Baltic region in northern Europe. However, data on...

Accounting for substitution of foods is inevitable when evaluating health impact of dietary changes. But substitution behavior and the associated health impact may vary between individuals. We therefore propose the use of probabilistic methods to model substitution and assess health impact distributions in risk-benefit assessment (RBA) of foods. We...

Shiga toxin-producing Escherichia coli (STEC) infections pose a substantial health and economic burden worldwide. To target interventions to prevent foodborne infections, it is important to determine the types of foods leading to illness. Our objective was to determine the food sources of STEC globally and for the six World Health Organization regi...

Shiga toxin-producing Escherichia coli (STEC) infections are a significant public health issue, with foodborne transmission causing >1 million illnesses worldwide each year. We conducted a systematic review and meta-analysis (PROSPERO registry # CRD42017074239), to determine the relative association of different food types with sporadic illnesses c...

Disease burden estimates provide the foundation for evidence-informed policy making and are critical to public health priority setting around food safety. Several efforts have recently been undertaken to better quantify the burden of foodborne disease, but there is still much work to be done. While burden estimates are crucial to raising awareness...

Context and Objective Being born small or large for gestational age and intrauterine exposure to gestational diabetes (GDM) increase the risk of type 2 diabetes (T2D) in the offspring, however, the potential combined deleterious effects of size at birth and GDM exposure remains unknown. We aimed to examine the independent effect of size at birth as...