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• Published: 24 August 2024

Research on food security issues considering changes in rainfall

• SiMan Jiang 1 ,
• Shuyue Chen 2 ,
• Qiqi Xiao 2 &
• Zhong Fang 2  

Scientific Reports volume  14 , Article number:  19698 ( 2024 ) Cite this article

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• Environmental economics
• Environmental social sciences

Ensuring food security is not only vital to the adequate supply of food in the world, but also the key to the economic development and social stability of various countries. Based on the panel data of 29 provinces in China from 2016 to 2020, this paper selects the number of foodborne diseases patients and iodine deficiency disease patients as reference objects, uses stunting rate of children under 5 years old, malnutrition rate of children under 5 years old, obesity rate of children under 5 years old, and newborn visit rate to measure improving nutrition, proposes Meta Entropy Two-Stage Dynamic Direction Distance Function (DDF) Under an exogenous Data Envelopment Analysis (DEA) model to measure the efficiency of hunger eradication, food security, and improving nutrition under the influence of exogenous variable rainfall. The research results indicate that the sustainability of China’s agricultural economy is insufficient, and the focus of attention should be different in different stages. In addition, the average efficiency of the three regions generally shows a decreasing level in the eastern, western, and central regions. In order to improve China's ability to guarantee food security, we must continue to strengthen the construction of agricultural infrastructure, increase policy support for green agricultural production, promote the diversification of agricultural production, and enrich people’s agricultural product consumption varieties.

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Introduction.

The issue of food security is not only related to the livelihoods of countries but also to global development. In 2015, the United Nations General Assembly adopted the 2030 Agenda for Sustainable Development, putting forward 17 Sustainable Development Goals (SDGs), of which the second goal (SDG2) focuses on food security and commits to eradicating hunger, achieving food security, improving nutrition, and promoting sustainable agriculture by 2030, also known as the “Zero Hunger” goal. Food security is an important cornerstone and key issue for global sustainable development. Currently, Food production has made significant progress globally in eradicating hunger, food insecurity, and malnutrition. However, many people are still facing hunger and malnutrition due to the impact of various factors such as extreme weather, global COVID-19 pandemic, and geopolitical conflicts in recent years. In addition, the loss of arable land and urban expansion have adversely affected agricultural land and put enormous pressure on preventing the degradation of ecosystem service functions and adapting to climate change, which brings new uncertainties to global food security and new challenges to food security in China. To cope with the uncertainty of global food security, food security in China has become even more important.

Having entered a new stage of development, China has made significant achievements in food security. In the face of the global food crisis, China’s food production has achieved a good harvest for 19 consecutive years, the total food output has remained above 650 million tons for 8 consecutive years, the self-sufficiency rate of food rations has exceeded 100 percent and that of cereal foods has exceeded 95 percent, with the per capita food possession at approximately 480 kg, which is higher than the internationally acknowledged food security line of 400 kg, and China has achieved basic self-sufficiency in cereals and absolute security in rations. Using 9 percent of the world's arable land and 6 percent of its freshwater resources, China has been able to feed nearly 20 percent of its population, making a historic transition from hunger to subsistence to well-being. However, after a long period of sustained improvement, China's food security situation was reversed in 2015 due to multiple challenges, including agricultural environmental pollution and intensifying climate change. Climate change will have a negative impact on food production, which will increase the price of agricultural products and subsequently increase China’s food imports, which in turn will affect China’s level of food self-sufficiency. Currently, for every 0.1 °C increase in temperature, China’s yield per unit area of the three major food crops will decrease by about 2.6 per cent, and just a 1 per cent increase in precipitation will increase the yield per unit area by 0.4 per cent. In recent years, climate change has led to significant changes in China’s agroclimatic resources: From 1951 to 2021, the annual average surface temperature in China increased at a rate of 0.26 °C per decade; annual rainfall in China increased by an average of 4.9 mm per decade, showing a trend of “northern expansion of the rainfall belt”. The “double increase in water and heat” of climate change has led to significant changes in China’s agroclimatic resources, with the crop growing season lengthening by 1.8 days per decade. The impact of climate change on agricultural production is both negative and positive, but the negative impact of uneven rainfall and extreme weather on agriculture is significant and requires increased attention. The problem of uneven rainfall is reflected in the redistribution of global rainfall, with increased rainfall in some areas causing flooding and damage to crop roots and soil structure, thus reducing food production; reduced rainfall in some other areas leads to drought, which affects crop growth and development, and likewise reduces food production. Droughts used to exist in the northern regions of China, but seasonal droughts are now occurring in many southern regions, especially at critical times of crop growth, leading to significant reductions in crop yields. At present, China's food security still faces many risks and challenges, with new problems in both production and consumption, such as the contradiction between the basic balance of food supply and demand and structural scarcity, the contradiction between food production methods and the upgrading of food demand, and the contradiction between the international food market linkage and the volatility of domestic food prices, which has resulted in a potentially further deterioration of the food security situation. These food insecurity trends will ultimately increase the risk of malnutrition and further affect the quality of diets, affecting people’s health in different ways. Currently, with less than a decade to go before the achievement of the 2030 SDGs, the global food security situation is still spiraling downwards. Therefore, food security should always be a matter of crisis awareness.

Food security is affected by several factors, and rainfall is one of the major influences on food production. The regional impact of rainfall on production is complex and can have an impact on the total food production in China. Although the national rainfall has not shown a significant trend in the last 50 years, there are significant regional differences. In the scientific study of global change, there will be a long way to go to study the impact of rainfall changes on food production and food security in different regions of China and to propose effective countermeasures.

Literature review

The concept of food security was first officially introduced by the Food and Agriculture Organization of the United Nations (FAO) in 1974. It is defined as ensuring sufficient global availability of basic food supplies at all times, particularly in the case of natural disasters or other emergencies to prevent the exacerbation of food shortages, while steadily increasing food consumption in countries with low per capita intake to reduce production and price fluctuations. Make food security one of the basic rights of human life. This concept reflects people’s concerns about the occurrence of global food crisis at that time, recognizing that the decline of food supply plays a major role in promoting the expansion of hunger, while the instability of food prices caused by supply–demand imbalances exacerbates the severity of the hunger situation 1 . Although the early definition of food security primarily emphasized the quantity of food supply, namely the accessibility of food, and measures to address hunger mainly focused on expanding food production, there has been a growing recognition of the importance of food stability as a crucial aspect of food security 2 . As the world's economic situation evolves, people have gained a better understanding of food security, leading to an expanded conceptual framework. In 1982, the FAO revised the definition of food security to ensure sufficient food supply, stable food flows, and stable food sources for individuals or households. This new interpretation incorporates some micro considerations into the existing macro perspective, emphasizing the significance of balancing food supply and demand 3 . During the World Food Summit in 1996, the FAO updated the definition of food security to ensure that all individuals have physical and economic access to sufficient, nutritious and safe food at all times, and the effective utilization of these food nutrients, and defined four pillars of food security: availability, accessibility, utilization, and stability. In 2001, the FAO added the term “social” to the original definition of food security, which has become the most widely cited definition in current international food policies, that is, to ensure that all individuals at all times have physical, social and economic access to sufficient, nutritious and safe food to meet people's needs and preferences regarding food and promote people to lead positive and healthy lives.

Food security is closely related to people's lives, and it has always been the focus of academic attention. The existing research mainly analyzes the impact of resource endowment, climate change and government policy on food security, and then explores practical paths for various countries and regions to ensure food security in the future.

The literature primarily focuses on water resources, land resources, and human resources and other aspects to study the impact of resource endowment on food security. From the perspective of water resources, Kang et al. 4 summarized the evolution of irrigation water productivity in China over the past 60 years, studied the differences in food productivity under different planting patterns, fertilization levels, and irrigation water consumption, analyzed the current situation of water resources’ impact on food security and explored comprehensive measures to improve agricultural water use efficiency in the future; Chloe et al. 5 combining interviews and surveys from British farmers with the resilience theory to analyze the influencing factors of water scarcity risk and management strategies, found that farmers need to establish resilience by maintaining the buffer of water resources or increasing the availability of backup resources to minimize the negative impacts of water scarcity on food production and farmer’s economic income. From the perspective of land resources, Charoenratana and Shinohara 6 pointed out that land and its legal rights are crucial factors for farmer income and agricultural production, and sustainable food security can only be achieved if land is kept safe. Li et al. 7 indicated that while there has been a strong transition of cultivated land from non-staple food production to food production in the suburbs of Changchun after rapid urbanization, overall, the utilization diversity of suburban cultivated land in the black soil region of Northeast China has decreased, leading to a reduction in local supply of non-staple food. From the perspective of human resources, Yang et al. 8 found that the relationship between non-agricultural employment and food production presents an inverted U-shaped pattern, which means that in the case of a small supply of non-agricultural labor force, increasing non-agricultural employment will have a positive impact on food output, while in the case of a large supply of non-agricultural labor force, increasing non-agricultural employment is not conducive to food output increase. Abebaw et al. 9 investigated the impact of rural outmigration on food security in Ethiopia, and the results showed that rural outmigration significantly increased the daily calorie intake per adult by approximately 22%, reducing the gap and severity of food poverty by 7% and 4%, respectively.

Climate change. There is no consensus on the impact of climate change on food security. The majority of scholars assert that climate change will have significant negative effects on the availability, accessibility, and stability of food. Bijay et al. 10 argued that the ongoing global climate change has caused a range of issues, including increased carbon dioxide, frequent droughts, and temperature fluctuations, which pose significant obstacles to pest management, consequently impeding increased food production. Muhammad et al. 11 concluded through empirical analysis that climate change has a substantial adverse impact on irrigation water, agriculture, and rural livelihoods, and the latter three have a significant positive correlation with food security, suggesting that climate change is detrimental to food security. Atuoye et al. 12 examined the influence of gender, migration, and climate change on food security, and their findings revealed that as global climate changes, the impact of controlling carbon emissions on non-migrant food insecurity in Tanzania is reduced, while it exacerbates the impact on migrant food insecurity. However, some scholars contend that climate change can improve agricultural production conditions in certain regions, thereby facilitating increased food production and positively impacting food security 13 , 14 .

Government policy. Bizikova et al. 15 evaluated 73 intervention policies in a sample of 66 publications, of which 49 intervention policies had a positive impact on food security, 7 intervention policies had a negative impact, and 17 intervention policies had no impact. Chengyou et al. 16 used data such as mutual aid funds of impoverished villages in China to evaluate the effect of agricultural subsidies, and the empirical conclusion pointed out that agricultural subsidies can improve farmers' willingness to plant food, promote farmers in impoverished areas to increase the planting area, and help farmers improve their own food production capacity and economic income. Na et al. 17 proposed that food subsidies can increase the working time of part-time farmers in agricultural work, especially in food planting, and promote farmers to better switch between non-agricultural work and agricultural work. This subsidy effect is conducive to maintaining sufficient supply and sustainable development of food production.

The existing literature studies food security from different perspectives and draws reasonable conclusions and policy recommendations, but it fails to analyze the issue of food security under the comprehensive effect of resource endowment, climate change and government policy. Based on this, this paper proposes the Entropy Window two-stage DDF to measure the efficiency of hunger eradication, food security and improving nutrition in 29 provinces of China under the influence of exogenous variable rainfall. From the perspective of food security, the impact of resource endowment, climate change and government policy on food security is comprehensively considered. In addition, in terms of climate change, different from the existing research focusing on the negative effects of high temperature, low temperature and drought on food production, this paper focuses on the impact of extreme changes in rainfall on food security, providing a certain complement to the existing literature on food security research.

Research methods

The evolution of DEA methods has seen many discussions of the dynamic DEA model. Färe and Grosskopf 18 first established the concept of dynamic DEA, devised a form of dynamic analysis, and then proposed a delayed lag (carryover) variable for the dynamic model. Tone and Tsutsui 19 then extended it to a dynamic DEA approach based on weighted relaxation, including four types of connected activities: (1) desired (good); (2) undesired (bad); (3) discretionary (free); and (4) non-discretionary (fixed). Battese and Rao 20 and Battese et al. 21 next demonstrated that it is possible to compare the technical efficiencies of different groups using the Meta-frontier model. Portela and Thanassoulis 22 proposed a convex Meta-frontier concept that can take into account the technology of all groups, the state-of-the-art level of technological production, as well as the communication between groups and can be further extended to improve business performance. O’Donnell et al. 23 proposed a Meta-frontier model for defining technical efficiency using an output distance function, which accurately calculates group and Meta-frontier technical efficiencies and finds that the level of technology of all groups is superior to the level of technology of any one group.

In this paper, the evaluation performance based on DDF is better, which can provide more accurate estimation results. Therefore, this paper modifies the traditional DDF model, combines Dynamic DEA with Network Structure 19 , 24 and Entropy method 25 , and considers exogenous issues to construct Meta Entropy Two-Stage Dynamic DDF Under an Exogenous DEA Model in order to measure the efficiency of hunger eradication, food security, and improving nutrition in 29 provinces of China under the influence of rainfall.

The entropy method

In this model, the stage 2 (Hunger eradication and improving nutrition of sustainable stage) output item “Improving nutrition” covers four detailed indicators: (1) stunting rate of children under 5 years old; (2) malnutrition rate of children under 5 years old; (3) obesity rate of children under 5 years old; and (4) newborn visit rate. If these detailed indicators are put into DEA, then there will be problems that cannot be solved. Therefore, this model first uses the Entropy method and then finds the weights and output values of four detailed indicators of improving nutrition in stage 2. The Entropy method mainly includes the following four steps.

Step 1: Standardize the data of the four detailed indicators of improving nutrition in stage 2 in 29 provinces of China.

Here, \(r_{mn}\) is the standardized value of the \(n\) th indicator of the \(m\) th province; \(\mathop {\min }\limits_{m} x_{mn}\) is the minimum value of the \(n\) th indicator of the \(m\) th province; and \(\mathop {\max }\limits_{m} x_{mn}\) is the maximum value of the \(n\) th indicator of the \(m\) th province.

Step 2: Add up the standardized values of the four detailed indicators of improving nutrition in stage 2.

Here, \(P_{mn}\) represents the ratio of the standardized value of the \(n\) th indicator to the sum of the standardized values for the \(m\) th province.

Step 3: Calculate the entropy value ( \({\text{e}}_{{\text{n}}}\) ) for the \({\text{n}}\) th indicator.

Step 4: Calculate the weight of the \({\text{n}}\) th indicator \(\left( {{\text{w}}_{{\text{n}}} } \right)\) .

Using the above steps, we are able to find the weights and output values of the four detailed indicators of improving nutrition in stage 2.

Meta entropy two-stage dynamic DDF under an exogenous DEA model

Suppose there are two stages in each \(t \left( {t = 1, \ldots ,T} \right)\) time periods. In each time period, there are two stages, including agricultural production stage (stage 1), hunger eradication and improving nutrition of sustainable stage (stage 2).

In stage 1, there are \(b \left( {b = 1, \ldots ,B} \right)\) inputs \(x1_{bj}^{t}\) , producing \(a \left( {a = 1, \ldots , A} \right)\) desirable outputs \(y1_{aj}^{t}\) and \(o \left( {o = 1, \ldots , O} \right)\) undesirable outputs \(U1_{oj}^{t}\) . Stage 2 takes \(d \left( {d = 1, \ldots , D} \right)\) inputs \(x2_{dj}^{t}\) , creating \(s \left( {s = 1, \ldots ., S} \right)\) desirable outputs \(y2_{sj}^{t}\) and \(c \left( {c = 1, \ldots ., C} \right)\) undesirable outputs \(U2_{cj}^{t}\) ; the intermediate outputs connecting stages 1 and 2 are \(z_{hj}^{t} \left( {h = 1, \ldots ,H} \right)\) ; the carry-over variable is \(c_{lj}^{t} \left( {l = 1, \ldots ,L} \right)\) ; the exogenous variable is \(E_{vj}^{t} \left( {v = 1, \ldots ,V} \right)\) .

Figure  1 illustrates the framework diagram of the model. In stage 1, the input variables are agricultural employment, effective irrigation area and total agricultural water use, and the output variables are total agricultural output value and agricultural wastewater discharge. In stage 2, the input variable is local financial medical and health expenditure, and the output variables are the number of foodborne disease patients, the number of iodine deficiency disease patients, and improving nutrition. The link between stage 1 and stage 2 is the intermediate output: total agricultural output value. And the exogenous variable is rainfall.

Model framework.

Under the frontier, the DMU can choose the final output that is most favorable to its maximum value, so the efficiency of the decision unit under the common boundary can be solved by the following linear programming procedure.

Objective function

Efficiency of \({\text{DMUi}}\) is:

Here, \({\text{w}}_{1}^{{\text{t}}}\) and \({\text{w}}_{2}^{{\text{t}}}\) are the weights for stages 1 and stage 2, and \({ }\theta_{1}^{{\text{t}}}\) and \(\theta_{2}^{{\text{t}}}\) are the efficiency values for stages 1 and stage 2.

Subject to:

Stage 1: Agricultural production stage

Here, \({\text{q}}_{{{\text{bi}}1}}^{{\text{t}}}\) , \({\text{q}}_{{{\text{ai}}1}}^{{\text{t}}}\) , and \({\text{q}}_{{{\text{oi}}1}}^{{\text{t}}}\) denote the direction vectors associated with stage 1 inputs, desirable outputs, and undesirable outputs.

Stage 2: Hunger eradication and improving nutrition of sustainable stage

Here, \({\text{q}}_{{{\text{di}}2}}^{{\text{t}}}\) , \({\text{q}}_{{{\text{ci}}2}}^{{\text{t}}}\) , and \({\text{q}}_{{{\text{hi}}\left( {1,2} \right)}}^{{\text{t}}}\) denote the direction vectors associated with stage 2 inputs, undesirable outputs, and the intermediate outputs connecting stages 1 and 2.

The link of two periods

The exogenous variables

From the above results, the overall efficiency, the efficiency in each period, the efficiency in each stage, the efficiency in each stage in each period are obtained.

Input, desirable output, and undesirable output efficiencies

The disparity between the actual input–output indicators and the ideal input–output indicators under optimal efficiency represents the potential for efficiency improvement in terms of input and output orientation. This paper chooses the ratio of actual input–output values to the computed optimal input–output values as the efficiency measure for the input–output indicators. The relationship between the optimal value, actual value, and indicator efficiency is as follows:

If the actual input and undesirable output equals the optimal input and undesirable output, then the efficiencies of that input and undesirable output are equal to 1 and known as efficient. However, if the actual input exceeds the optimal input, then the efficiency of that input indicator is less than 1, which denotes being inefficient.

If the actual desirable output equals the optimal desirable output, then the efficiency of that desirable output is equal to 1 and is referred to as efficient. However, if the actual desirable output is less than the optimal desirable output, then the efficiency of that desirable output indicator is less than 1 and is considered inefficient. ME (Mean Efficiency) reflects the average efficiency of a certain region throughout the study period, with higher values indicating higher efficiency in that region.

Empirical study

Comparative analysis of total efficiency values considering and not considering exogenous variables.

As shown in Fig.  2 , in terms of the average total efficiency value for each region, without considering the exogenous variable rainfall, from 2016 to 2020, the average total efficiency values of the eastern, central, and western regions show a pattern of “eastern > western > central” in descending order. With the exogenous variable rainfall taken into account, the average total efficiency values for each region for each year were greater than the corresponding average total efficiency values without taking into account the exogenous variable rainfall, which may be attributed to the fact that rainfall plays a key role in irrigating the farmland and replenishing the soil moisture, which is an important factor in the process of agricultural production, and that the addition of rainfall has a more pronounced marginal effect on the increase in the total efficiency values. With the exogenous variable rainfall taken into account, the average total efficiency values for each region in each year are larger than the corresponding average total efficiency values without taking into account the exogenous variable rainfall, indicating that there is more room for improvement in the average total efficiency values without taking rainfall into account than in the efficiency values with rainfall taken into account. Except for 2016, when the average total efficiency value of the western region was greater than that of the eastern region and the central region, the average total efficiency values of the eastern, central, and western regions from 2017 to 2020 also showed a pattern of “eastern > western > central” from largest to smallest. It can be concluded that whether or not the exogenous variable rainfall is taken into account, the eastern region has a better overall efficiency in agricultural production and achieving food security than the western and central regions due to its better agricultural infrastructure, good economic base, and better educated labor force.

Average efficiency by region from 2016 to 2020.

The three regions of the East, Central and West maintain a similar fluctuating upward trend. The average efficiency in the eastern and western regions is relatively high, and the five-year fluctuation interval is small, ranging from 0.75 to 0.85. After considering the exogenous variable rainfall, the average total efficiency value in the central region increased from 0.62 to 0.66. However, compared with the eastern and western regions, the total efficiency in the central region is still at a lower level and the five-year fluctuation interval is larger, between 0.55 and 0.70, with the largest fluctuation interval in the average efficiency in 2017–2018, at − 0.11. This may be due to the downsizing of grain sowing area under the structural reform of the agricultural supply side, leading to a small decline in the total national grain output in 2018, which in turn affects the level of efficiency in eradicating hunger, guaranteeing food security and improving nutrition. From this, it can be concluded that the eastern and western regions should give full play to their original advantages and promote the modernization and sustainable development of agricultural production in order to accelerate the achievement of the three major goals of eradicating hunger, guaranteeing food security and improving nutrition, while the central region still has more room for improvement and needs to further play the role of agricultural policies to alleviate the people’s worries about food.

Table 1 Average efficiency by province and city from 2016 to 2020 demonstrates the average efficiency values for each province and city from 2016 to 2020 when rainfall is considered and not considered. From the point of view of the annual average total efficiency by province, after considering the exogenous variable rainfall, the efficiency value of most provinces has been improved. The average efficiency has also been improved from 0.6134 to 0.6189. Among them, the efficiency value of Qinghai increases from 0.8167 to 1, and the ranking also rises from 11th to 1st place. Qinghai is deep inland, with less rainfall throughout the year, and its agricultural and animal husbandry production is more sensitive to the changes of rainfall, and the addition of exogenous variable rainfall makes the average total efficiency more accurately portrayed, and achieves the DEA validity. Shandong’s ranking drops from 9 to 11th after considering the exogenous variable rainfall. As a major agricultural province, Shandong’s food production will be seriously affected by persistent heavy precipitation and other extreme weather events, which indicates that Shandong needs to take measures to strengthen the ability of its agricultural production to cope with extreme precipitation.

Two-stage average efficiency analysis

The average efficiency values of the two stages in both cases of considering exogenous variable rainfall and not considering exogenous variable rainfall are very similar, indicating that exogenous variable rainfall does not have much effect on the efficiency of stage 1 and stage 2, and therefore only the specific case with exogenous variable rainfall is discussed. Figures  3 and 4 show the efficiency values for Stage 1 and Stage 2 for each province and city for the years 2016–2020 when rainfall is considered. As shown in Fig.  3 , the difference between the efficiency values for Stage 1 and Stage 2 is still relatively significant. The efficiency of agricultural production in Stage 1 is significantly higher than that of hunger elimination, food security and nutritional improvement in Stage 2, and the fluctuation is relatively smooth, which indicates that there is still much room for improvement in China’s food production in terms of hunger elimination, food security and nutritional improvement, and that how to develop high-quality and high-efficiency agriculture and increase the output of food units is an urgent problem to be solved by each province.

Comparison of the average efficiency of the two phases by province from 2016 to 2020.

Average efficiency values for the two phases in each province from 2016 to 2020.

Specifically, there are large gaps in the efficiency of agricultural production in China's provinces, which can be roughly categorized into three types: the first type has an efficiency value of 1, realizing the DEA is effective, and is filled in green in Fig.  4 ; the second type has an efficiency value between 1 and the average, and is filled in yellow in Fig.  4 ; and the third type has an efficiency value below the average, and is filled in red in Fig.  4 .

In the first stage, the first category is Shanghai, Shandong, Tianjin, Beijing and other 15 provinces, whose agricultural production efficiency values are all 1, at the meta-frontier, and these provinces rely on a solid economic foundation and sound agricultural infrastructure to realize the optimal efficiency of effective inputs and outputs; the second category is Guangxi, Hubei, Sichuan, and Liaoning, whose agricultural production efficiencies are higher than the national average and close to the meta-frontier; the third category consists of 10 provinces such as Gansu, Inner Mongolia, Jilin, Heilongjiang, etc., whose economic development is relatively slow, meteorological conditions are poor, agricultural production is susceptible to meteorological disasters, and the efficiency of agricultural production is below the average level, among which the value of Gansu’s agricultural production efficiency is the lowest, 0.496.

In the second stage, the first category includes seven provinces, including Yunnan, Tianjin, Beijing, and Ningxia, which either have higher economic levels or better climatic conditions, and have the highest efficiency in eradicating hunger, achieving food security, and improving nutrition, with an efficiency value of 1; the second category includes eight provinces, including Shanghai, Chongqing, Jilin, and Shaanxi, which have an efficiency in eradicating hunger, achieving food security, and improving nutrition higher than the national average, and are close to the meta-frontier; the third category includes 14 provinces, including Fujian, Shanxi, Inner Mongolia, and Guangxi, which are below the national average, among which Sichuan has the lowest efficiency value of 0.1, which is evident that Sichuan, as a “Heavenly Grain Silo,” is more likely to speed up the realization of mechanization and digital development to improve comprehensive grain production capacity.

In summary, provinces with high efficiency values in agricultural production and in eradicating hunger, achieving food security and improving nutrition can be categorized into two groups, one of which is the developed and coastal provinces with good economic and climatic conditions, such as Beijing, Shanghai, Tianjin, and Hainan, can enhance agricultural sustainable efficiency and actively promote the sustainable development of the agricultural economy; the other category is the provinces with relatively backward economic development, including Yunnan, Ningxia, Qinghai, Heilongjiang and other central and western regions, although their development is relatively late and low, they have unique climatic conditions, geographic conditions, ecological conditions, and other resource advantages, which bring opportunities for sustainable agricultural development in the central and western regions. As for the provinces with lower efficiency values for agricultural production and hunger eradication, reaching food security and improving nutrition, they are not only affected by the level of economic development and ecological conditions such as climate and environment, but also by the level of urbanization, such as Fujian, Jiangsu, Zhejiang, Guangdong and other eastern coastal provinces with a high level of urbanization will also face pressure on the supply of agricultural products as the sown area of crops continues to decrease due to a combination of factors such as the occupation of arable land by construction sites as well as abandonment of land.

Comparative analysis of output indicator efficiency in the regions

Taking rainfall as an exogenous variable into account, the efficiency of the number of foodborne diseases patients and improving nutrition showed a higher pattern in the eastern and western regions and a lower pattern in the central region. Table 2 shows the efficiency values of each output indicator for 2016–2020. From 2016 to 2020, the efficiency of these two output indicators in the eastern and western regions showed an upward trend, while that in the central region showed a downward trend. It shows that the contribution of agricultural production to food security in the eastern and western regions is small, and more perfect institutional measures should be formulated to ensure food security; the contribution of agricultural production to improving nutrition in the central region is relatively small, and corresponding health expenditures need to be increased to improve people's own nutritional supplements. In terms of the efficiency of the number of iodine deficiency disease patients, the efficiency in the eastern and central regions was low and showed a downward trend from 2016 to 2020, while the efficiency in the western region was high and the fluctuation was relatively small. As people in the eastern and central regions can easily buy kelp, laver and other iodine-rich foods, local residents eat iodine-rich food at high frequency and in large amounts, while in the western region, which is far from the sea, daily eating may not meet the human body's daily demand for iodine. Therefore, in order to reduce the incidence of iodine deficiency diseases caused by geographical location and dietary habits, governments in the western region need to speed up the opening of transportation channels and purchasing channels for iodized salt and iodine-rich foods.

Conclusions and policy recommendation

The key to sustainable agricultural development lies in the organic integration of ecological sustainability, economic sustainability, and social sustainability, emphasizing the coordination between agroecological production capacity and human development. The conclusions of this paper are as follows.

First, in the total factor efficiency analysis, the average total efficiency values of the eastern, central, and western regions in each year when the exogenous variable rainfall is taken into account are higher than the corresponding average total efficiency values without considering exogenous variable rainfall. This may be due to the fact that rainfall is an important factor in the agricultural production process and the inclusion of rainfall has a more pronounced marginal effect on the increase in the total efficiency value. In addition, there is a certain difference between the average total efficiency values of the eastern and western regions regardless of whether exogenous variable rainfall is considered. Still, the difference is not very large, and all three regions maintain a similar trend of fluctuating upward. However, the average total efficiency value of the central region is still at a lower level compared to the eastern and western regions, and the fluctuations of the eastern and western regions over the 5 years are small, fluctuating between 0.75 and 0.85, while the average efficiency of the central region over the 5 years is low and fluctuates greatly, fluctuating between 0.55 and 0.70, and the fluctuations of the average efficiency in 2017–2018 are the largest, at − 0.11. Besides the average efficiency of the eastern region was slightly lower than that of the western region in 2016, the average efficiency of the three regions generally showed a decreasing hierarchy of eastern, western, and central regions one by one. In terms of the annual average total efficiency of each province, after considering the exogenous variable rainfall, the efficiency values of most provinces have improved, with Qinghai's average total efficiency rising to 1, achieving optimal input–output efficiency.. In contrast, Shandong's average efficiency ranking has declined.

Second, under the condition of considering the exogenous variable rainfall, the efficiency value in stage 1 (agricultural production stage) is significantly higher than the efficiency value in stage 2 (eliminating hunger, achieving food security and improving nutrition), and the fluctuation is relatively smooth, which suggests that China's food production still has a large room for improvement, and that the focus of attention should be different in different stages. Specifically, in stage 1, the provinces with lower agricultural production efficiency values belong to the central and western inland provinces with slower economic development and poorer meteorological conditions, while in stage 2, the provinces with lower efficiency value also include the more economically developed eastern coastal provinces, such as Fujian, Jiangsu, Zhejiang, Guangdong, etc. The rapid population growth in the developed eastern coastal areas, coupled with the impact of the construction of arable land and the impact of a combination of factors such as the abandonment of land, crop sowing area has been decreasing, resulting in per capita arable land area is lower than the national average level. This shows that although the developed eastern coastal provinces have a better foundation for agricultural development, they are also facing enormous pressure on the supply of agricultural products and increasingly fierce competition in the future industrial development.

Third, a comparative analysis of the efficiency of output indicators by region, taking into account the exogenous variable of rainfall, reveals that the efficiency of the number of foodborne diseases patients and improving nutrition are both high in the eastern and western regions and low in the central region and that the efficiency of these two output indicators shows a rising trend in the eastern and western regions and a declining trend in the central region in the period from 2016 to 2020. In terms of the efficiency of the number of iodine deficiency disease patients, the efficiency of the eastern and central regions is low and shows a similar downward trend over the five-year period, while the efficiency of the western region is high and fluctuates relatively little, with no significant trend of change.

Through the above empirical analysis, it can be seen that rainfall, an exogenous variable, has a significant impact on the average efficiency in the eastern, central and western regions. Therefore, this paper puts forward corresponding policy recommendations on hunger eradication, food security and improving nutrition. The specific recommendations are as follows:

First, continue to strengthen the construction of agricultural infrastructure and increase the per capita arable land. All regions, especially the central and western regions, need to continue to increase investment in agriculture, build agricultural infrastructure such as water conservancy facilities, transportation facilities, and electric power facilities, promote the transformation and upgrading of old agricultural infrastructure, help the rapid development of agricultural mechanization in China, further enhance the ability to resist natural disasters, and improve agricultural output and production efficiency. In this way, the contradiction between food production and the growing rigid demand for food can be alleviated.

Second, increase policy support for green agricultural production to ensure China's food security. Due to the developed industry and serious pollution, the eastern region should pay more attention to green agricultural production. Each province shall formulate corresponding subsidy plans for green agricultural production according to the specific conditions of the province, strengthen green technology to lead the green development of agriculture, increase the enthusiasm of farmers to carry out green agricultural production, promote the promotion of green agricultural production, decrease the use of harmful fertilizers, pesticides, agricultural film, etc., to reduce agricultural pollution, so as to increase the supply of green agricultural products on the market to decrease the prevalence of foodborne diseases.

Third, promote the diversification of agricultural production and enrich people's agricultural product consumption varieties. On the one hand, each province extends local agricultural production varieties according to climate conditions and resources, rationally layout the supply structure of agricultural products, and increase policies to encourage farmers to carry out diversified agricultural production. On the other hand, some regions are limited by resource endowments and cannot expand the types of agricultural production, so it is necessary to speed up the construction of infrastructure such as logistics and preservation, improve the system of connecting production and marketing of agricultural products, enrich the "vegetable basket" of people in these regions with poor agricultural resources, and meet people's diversified consumption demand for agricultural products. In addition, nutrition guidance, publicity and education should be strengthened to raise people's awareness of rational diet and nutritious diet.

Data availability

All data generated or analysed during this study are included in this published article [and its supplementary information files].

Upton, B. J., Cissé, D. J. & Barrett, B. C. Food security as resilience: Reconciling definition and measurement. Agr. Econ. 47 , 135–147 (2016).

Article   Google Scholar  

Jennifer, C. G. et al. Viewpoint: The case for a six-dimensional food security framework. Food Policy 106 , 102164 (2022).

Maxwell, S. Food security: A post-modern perspective. Food Policy 21 , 155–170 (1996).

Kang, S. et al. Improving agricultural water productivity to ensure food security in China under changing environment: From research to practice. Agr. Water Manage. 179 , 5–17 (2017).

Chloe, S., Jerry, K. & Tim, H. Managing irrigation under pressure: How supply chain demands and environmental objectives drive imbalance in agricultural resilience to water shortages. Agr. Water Manage. 243 , 106484 (2021).

Charoenratana, S. & Shinohara, C. Rural farmers in an unequal world: Land rights and food security for sustainable well-being. Land Use Policy 78 , 185–194 (2018).

Li, W. et al. Measuring urbanization-occupation and internal conversion of peri-urban cultivated land to determine changes in the peri-urban agriculture of the black soil region. Ecol. Indic. 102 , 328–337 (2019).

Yang, J., Wan, Q. & Bi, W. Off-farm employment and food production change: New evidence from China. China Econ. Rev. 63 , 135 (2020).

Abebaw, D. et al. Can rural outmigration improve household food security? Empirical evidence from Ethiopia. World Dev. 129 , 104879 (2020).

Bijay, S., Anju, P. & Samikshya, A. The impact of climate change on insect pest biology and ecology: Implications for pest management strategies, crop production, and food security. J. Agr. Food Res. 14 , 100733 (2023).

Google Scholar  

Muhammad, U. et al. Pathway analysis of food security by employing climate change, water, and agriculture nexus in Pakistan: Partial least square structural equation modeling. Environ. Sci. Pollut. Res. 30 , 88577–88597 (2023).

Atuoye, K. N. et al. Who are the losers? Gendered-migration, climate change, and the impact of large scale land acquisitions on food security in coastal Tanzania. Land Use Policy 101 , 105154 (2021).

Shi, W. et al. Has climate change driven spatio-temporal changes of cropland in northern China since the 1970s. Clim. Change 124 , 163–177 (2014).

Article   ADS   Google Scholar  

Tao, F. et al. Responses of wheat growth and yield to climate change in different climate zones of China, 1981–2009. Agr. Forest Meteorol. 189 , 91–104 (2014).

Bizikova, L., Jungcurt, S., McDougal, K. & Tyler, S. How can agricultural interventions enhance contribution to food security and SDG 2.1. Glob. Food Secur. 26 , 100450 (2020).

Chengyou, L. et al. The effectiveness assessment of agricultural subsidy policies on food security: Evidence from China’s poverty-stricken villages. Int. J. Environ. Res. Public Health 19 , 13797 (2022).

Na, X., Liqin, Z. & Xiyuan, L. Sustainable food production from a labor supply perspective: Policies and implications. Sustainability 14 , 15935 (2022).

Färe, R. & Grosskopf, S. Productivity and intermediate products: A frontier approach. Econ. Lett. 50 , 65–70 (1996).

Tone, K. & Tsutsui, M. Dynamic DEA: A slacks-based measure approach. Omega 38 , 145–156 (2010).

Battese, G. E. & Rao, D. P. Technology gap, efficiency, and a stochastic metafrontier function. Int. J. Bus. Econ. 1 (2), 87–93 (2002).

Battese, G. E., Rao, D. P. & O’Donnell, C. J. A metafrontier production function for estimation of technical efficiencies and technology gaps for firms operating under different technologies. J. Prod. Anal. 21 (1), 91–103 (2004).

Portela, M. C., Thanassoulis, E. & Simpson, G. Negative data in DEA: A directional distance approach applied to bank branches. J. Oper. Res. Soc. 55 (10), 1111–1121 (2004).

O’Donnell, C. J., Rao, D. P. & Battese, G. E. Metafrontier frameworks for the study of firm-level efficiencies and technology ratios. Empirical Econ. 34 (2), 231–255 (2008).

Charnes, A., Cooper, W. W. & Rhodes, E. Measuring the efficiency of decision making units. Eur. J. Oper. Res. 2 , 429–444 (1978).

Article   MathSciNet   Google Scholar  

Shannon, C. E. A mathematical theory of communication. Bell Syst. Tech. J. 27 , 379–423 (1948).

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Jiang, S., Chen, S., Xiao, Q. et al. Research on food security issues considering changes in rainfall. Sci Rep 14 , 19698 (2024). https://doi.org/10.1038/s41598-024-70803-x

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Probiotics: Usefulness and Safety

.header_greentext{color:green!important;font-size:24px!important;font-weight:500!important;}.header_bluetext{color:blue!important;font-size:18px!important;font-weight:500!important;}.header_redtext{color:red!important;font-size:28px!important;font-weight:500!important;}.header_darkred{color:#803d2f!important;font-size:28px!important;font-weight:500!important;}.header_purpletext{color:purple!important;font-size:31px!important;font-weight:500!important;}.header_yellowtext{color:yellow!important;font-size:20px!important;font-weight:500!important;}.header_blacktext{color:black!important;font-size:22px!important;font-weight:500!important;}.header_whitetext{color:white!important;font-size:22px!important;font-weight:500!important;}.header_darkred{color:#803d2f!important;}.Green_Header{color:green!important;font-size:24px!important;font-weight:500!important;}.Blue_Header{color:blue!important;font-size:18px!important;font-weight:500!important;}.Red_Header{color:red!important;font-size:28px!important;font-weight:500!important;}.Purple_Header{color:purple!important;font-size:31px!important;font-weight:500!important;}.Yellow_Header{color:yellow!important;font-size:20px!important;font-weight:500!important;}.Black_Header{color:black!important;font-size:22px!important;font-weight:500!important;}.White_Header{color:white!important;font-size:22px!important;font-weight:500!important;} What are probiotics?

Probiotics are live microorganisms that are intended to have health benefits when consumed or applied to the body. They can be found in yogurt and other fermented foods, dietary supplements , and beauty products. Cases of severe or fatal infections have been reported in premature infants who were given probiotics, and the U.S. Food and Drug Administration (FDA) has warned health care providers about this risk.

Although people often think of bacteria and other microorganisms as harmful “germs,” many are actually helpful. Some bacteria help digest food, destroy disease-causing cells, or produce vitamins. Many of the microorganisms in probiotic products are the same as or similar to microorganisms that naturally live in our bodies.

What types of bacteria are in probiotics?

Probiotics may contain a variety of microorganisms. The most common are bacteria that belong to groups called Lactobacillus and Bifidobacterium . Other bacteria may also be used as probiotics, and so may yeasts such as Saccharomyces boulardii .

Different types of probiotics may have different effects. For example, if a specific kind of Lactobacillus helps prevent an illness, that doesn’t necessarily mean that another kind of Lactobacillus or any of the Bifidobacterium probiotics would do the same thing.

Are prebiotics the same as probiotics?

No, prebiotics aren’t the same as probiotics. Prebiotics are nondigestible food components that selectively stimulate the growth or activity of desirable microorganisms.

What are synbiotics?

Synbiotics are products that combine probiotics and prebiotics.

How popular are probiotics?

The 2012 National Health Interview Survey (NHIS) showed that about 4 million (1.6 percent) U.S. adults had used probiotics or prebiotics in the past 30 days. Among adults, probiotics or prebiotics were the third most commonly used dietary supplement other than vitamins and minerals. The use of probiotics by adults quadrupled between 2007 and 2012. The 2012 NHIS also showed that 300,000 children age 4 to 17 (0.5 percent) had used probiotics or prebiotics in the 30 days before the survey.

How might probiotics work?

Probiotics may have a variety of effects in the body, and different probiotics may act in different ways.

Probiotics might:

• Help your body maintain a healthy community of microorganisms or help your body’s community of microorganisms return to a healthy condition after being disturbed
• Produce substances that have desirable effects
• Influence your body’s immune response.

How are probiotics regulated in the United States?

Government regulation of probiotics in the United States is complex. Depending on a probiotic product’s intended use, the FDA might regulate it as a dietary supplement, a food ingredient, or a drug.

Many probiotics are sold as dietary supplements, which don’t require FDA approval before they are marketed. Dietary supplement labels may make claims about how the product affects the structure or function of the body without FDA approval, but they aren’t allowed to make health claims, such as saying the supplement lowers your risk of getting a disease, without the FDA’s consent.

If a probiotic is going to be marketed as a drug for treatment of a disease or disorder, it has to meet stricter requirements. It must be proven safe and effective for its intended use through clinical trials and be approved by the FDA before it can be sold.

.header_greentext{color:green!important;font-size:24px!important;font-weight:500!important;}.header_bluetext{color:blue!important;font-size:18px!important;font-weight:500!important;}.header_redtext{color:red!important;font-size:28px!important;font-weight:500!important;}.header_darkred{color:#803d2f!important;font-size:28px!important;font-weight:500!important;}.header_purpletext{color:purple!important;font-size:31px!important;font-weight:500!important;}.header_yellowtext{color:yellow!important;font-size:20px!important;font-weight:500!important;}.header_blacktext{color:black!important;font-size:22px!important;font-weight:500!important;}.header_whitetext{color:white!important;font-size:22px!important;font-weight:500!important;}.header_darkred{color:#803d2f!important;}.Green_Header{color:green!important;font-size:24px!important;font-weight:500!important;}.Blue_Header{color:blue!important;font-size:18px!important;font-weight:500!important;}.Red_Header{color:red!important;font-size:28px!important;font-weight:500!important;}.Purple_Header{color:purple!important;font-size:31px!important;font-weight:500!important;}.Yellow_Header{color:yellow!important;font-size:20px!important;font-weight:500!important;}.Black_Header{color:black!important;font-size:22px!important;font-weight:500!important;}.White_Header{color:white!important;font-size:22px!important;font-weight:500!important;} Learning About the Microbiome

The community of microorganisms that lives on us and in us is called the “microbiome,” and it’s a hot topic for research. The Human Microbiome Project, supported by the National Institutes of Health (NIH) from 2007 to 2016, played a key role in this research by mapping the normal bacteria that live in and on the healthy human body. With this understanding of a normal microbiome as the basis, researchers around the world, including many supported by NIH, are now exploring the links between changes in the microbiome and various diseases. They’re also developing new therapeutic approaches designed to modify the microbiome to treat disease and support health.

The National Center for Complementary and Integrative Health (NCCIH) is among the many agencies funding research on the microbiome. Researchers supported by NCCIH are studying the interactions between components of food and microorganisms in the digestive tract. The focus is on the ways in which diet-microbiome interactions may lead to the production of substances with beneficial health effects.

.header_greentext{color:green!important;font-size:24px!important;font-weight:500!important;}.header_bluetext{color:blue!important;font-size:18px!important;font-weight:500!important;}.header_redtext{color:red!important;font-size:28px!important;font-weight:500!important;}.header_darkred{color:#803d2f!important;font-size:28px!important;font-weight:500!important;}.header_purpletext{color:purple!important;font-size:31px!important;font-weight:500!important;}.header_yellowtext{color:yellow!important;font-size:20px!important;font-weight:500!important;}.header_blacktext{color:black!important;font-size:22px!important;font-weight:500!important;}.header_whitetext{color:white!important;font-size:22px!important;font-weight:500!important;}.header_darkred{color:#803d2f!important;}.Green_Header{color:green!important;font-size:24px!important;font-weight:500!important;}.Blue_Header{color:blue!important;font-size:18px!important;font-weight:500!important;}.Red_Header{color:red!important;font-size:28px!important;font-weight:500!important;}.Purple_Header{color:purple!important;font-size:31px!important;font-weight:500!important;}.Yellow_Header{color:yellow!important;font-size:20px!important;font-weight:500!important;}.Black_Header{color:black!important;font-size:22px!important;font-weight:500!important;}.White_Header{color:white!important;font-size:22px!important;font-weight:500!important;} What has science shown about the effectiveness of probiotics for health conditions?

A great deal of research has been done on probiotics, but much remains to be learned about whether they’re helpful and safe for various health conditions.

Probiotics have shown promise for a variety of health purposes, including prevention of antibiotic-associated diarrhea (including diarrhea caused by Clostridium difficile ), prevention of necrotizing enterocolitis and sepsis in premature infants, treatment of infant colic , treatment of periodontal disease , and induction or maintenance of remission in ulcerative colitis .

However, in most instances, we still don’t know which probiotics are helpful and which are not. We also don’t know how much of the probiotic people would have to take or who would be most likely to benefit. Even for the conditions that have been studied the most, researchers are still working toward finding the answers to these questions.

The following sections summarize the research on probiotics for some of the conditions for which they’ve been studied.

Gastrointestinal Conditions

.header_greentext{color:greenimportant;font-size:24pximportant;font-weight:500important;}.header_bluetext{color:blueimportant;font-size:18pximportant;font-weight:500important;}.header_redtext{color:redimportant;font-size:28pximportant;font-weight:500important;}.header_darkred{color:#803d2fimportant;font-size:28pximportant;font-weight:500important;}.header_purpletext{color:purpleimportant;font-size:31pximportant;font-weight:500important;}.header_yellowtext{color:yellowimportant;font-size:20pximportant;font-weight:500important;}.header_blacktext{color:blackimportant;font-size:22pximportant;font-weight:500important;}.header_whitetext{color:whiteimportant;font-size:22pximportant;font-weight:500important;}.header_darkred{color:#803d2fimportant;}.green_header{color:greenimportant;font-size:24pximportant;font-weight:500important;}.blue_header{color:blueimportant;font-size:18pximportant;font-weight:500important;}.red_header{color:redimportant;font-size:28pximportant;font-weight:500important;}.purple_header{color:purpleimportant;font-size:31pximportant;font-weight:500important;}.yellow_header{color:yellowimportant;font-size:20pximportant;font-weight:500important;}.black_header{color:blackimportant;font-size:22pximportant;font-weight:500important;}.white_header{color:whiteimportant;font-size:22pximportant;font-weight:500important;} antibiotic-associated diarrhea.

• Probiotics have been studied for antibiotic-associated diarrhea in general, as well as for antibiotic-associated diarrhea caused by one specific bacterium, Clostridium difficile . This section discusses the research on antibiotic-associated diarrhea in general. C. difficile is discussed in a separate section below.
• A 2017 review of 17 studies (3,631 total participants) in people who were not hospitalized indicated that giving probiotics to patients along with antibiotics was associated with a decrease of about half in the likelihood of antibiotic-associated diarrhea. However, this conclusion was considered tentative because the quality of the studies was only moderate. Patients who were given probiotics had no more side effects than patients who didn’t receive them.
• Probiotics may be helpful for antibiotic-associated diarrhea in young and middle-aged people, but a benefit has not been demonstrated in elderly people, according to a 2016 review of 30 studies (7,260 participants), 5 of which focused on people age 65 or older. It’s uncertain whether probiotics actually don’t work in elderly people or whether no effect was seen because there were only a few studies of people in this age group.
• A review of 23 studies (with 3,938 participants) of probiotics to prevent antibiotic-associated diarrhea in children provided moderate quality evidence that probiotics had a protective effect. No serious side effects were observed in children who were otherwise healthy, except for the infection for which they were being treated.

.header_greentext{color:green!important;font-size:24px!important;font-weight:500!important;}.header_bluetext{color:blue!important;font-size:18px!important;font-weight:500!important;}.header_redtext{color:red!important;font-size:28px!important;font-weight:500!important;}.header_darkred{color:#803d2f!important;font-size:28px!important;font-weight:500!important;}.header_purpletext{color:purple!important;font-size:31px!important;font-weight:500!important;}.header_yellowtext{color:yellow!important;font-size:20px!important;font-weight:500!important;}.header_blacktext{color:black!important;font-size:22px!important;font-weight:500!important;}.header_whitetext{color:white!important;font-size:22px!important;font-weight:500!important;}.header_darkred{color:#803d2f!important;}.Green_Header{color:green!important;font-size:24px!important;font-weight:500!important;}.Blue_Header{color:blue!important;font-size:18px!important;font-weight:500!important;}.Red_Header{color:red!important;font-size:28px!important;font-weight:500!important;}.Purple_Header{color:purple!important;font-size:31px!important;font-weight:500!important;}.Yellow_Header{color:yellow!important;font-size:20px!important;font-weight:500!important;}.Black_Header{color:black!important;font-size:22px!important;font-weight:500!important;}.White_Header{color:white!important;font-size:22px!important;font-weight:500!important;} Clostridium difficile Infection

• The bacterium Clostridium difficile can infect the colon (large intestine) of patients who have received antibiotics, causing diarrhea that can range from mild to severe. C. difficile infection is difficult to treat and sometimes comes back after treatment. It’s more common in people who take antibiotics long-term and in elderly people, and it can spread in hospitals and nursing homes. C. difficile infection affects about half a million people a year in the United States and causes about 15,000 deaths.
• A 2017 analysis of 31 studies (8,672 total patients) concluded that it is moderately certain that probiotics can reduce the risk of C. difficile diarrhea in adults and children who are receiving antibiotics. Most of these studies involved hospital patients. The analysis also concluded that the use of probiotics along with antibiotics appears to be safe, except for patients who are very weak or have poorly functioning immune systems.
• The types of probiotics that would be most useful in reducing the risk of C. difficile diarrhea, the length of time for which they should be taken, and the most appropriate doses are uncertain.

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• A 2014 review of 14 studies (1,182 participants) of probiotics for constipation in adults showed some evidence of benefit, especially for Bifidobacterium lactis .
• A 2017 evaluation of 9 studies (778 participants) of probiotics for constipation in elderly people indicated that probiotics produced a small but meaningful benefit. The type of bacteria most often tested was Bifidobacterium longum . The researchers who performed the evaluation suggested that probiotics might be helpful for chronic constipation in older people as an addition to the usual forms of treatment.
• A 2017 review looked at 7 studies of probiotics for constipation in children (515 participants). The studies were hard to compare because of differences in the groups of children studied, the types of probiotics used, and other factors. The reviewers did not find evidence that any of the probiotics tested in the children were helpful. A second 2017 review, which included 4 of the same studies and 2 others (498 total participants in the 6 studies examined), took a more optimistic view of the evidence, noting that overall, probiotics did increase stool frequency, and that the effect was more noticeable in Asian than European children.

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• Diarrhea is a common side effect of chemotherapy or radiotherapy for cancer. It’s been suggested that probiotics might help prevent or treat this type of diarrhea. However, a 2018 review of 12 studies (1,554 participants) found that the evidence for a beneficial effect of probiotics was inconclusive.

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• In diverticulosis, small pouches develop at weak spots in the wall of the colon (large intestine). In most cases, this does not cause any symptoms. If symptoms (such as bloating, constipation, diarrhea, or cramping) do occur, the condition is called diverticular disease. If any of the pouches become inflamed, the condition is called diverticulitis. Patients with diverticulitis can have severe abdominal pain and may develop serious complications.
• A 2016 review of 11 studies (764 participants) of probiotics for diverticular disease was unable to reach conclusions on whether the probiotics were helpful because of the poor quality of the studies.

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• Inflammatory bowel disease is a term for a group of conditions that cause a portion of the digestive system to become inflamed; the most common types are ulcerative colitis and Crohn’s disease. Symptoms may include abdominal pain, diarrhea (which may be bloody), loss of appetite, weight loss, and fever. The symptoms can range from mild to severe, and they may come and go. Treatment includes medicines and in some cases, surgery.
• A 2014 review of 21 studies in patients with ulcerative colitis (1,700 participants) indicated that adding probiotics, prebiotics, or synbiotics to conventional treatment could be helpful in inducing or maintaining remission of the disease. The same review also looked at 14 studies (746 participants) of probiotics, prebiotics, or synbiotics for Crohn’s disease and did not find evidence that they were beneficial.

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• A 2018 review of 53 studies (5,545 total participants) of probiotics for irritable bowel syndrome (IBS) concluded that probiotics may have beneficial effects on global IBS symptoms and abdominal pain, but it was not possible to draw definite conclusions about their effectiveness or to identify which species, strains, or combinations of probiotics are most likely to be helpful.

For more information, see the NCCIH fact sheet on irritable bowel syndrome .

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• A 2018 review evaluated 11 studies (5,143 participants) of probiotics or prebiotics for prevention of traveler’s diarrhea and found evidence that they may be helpful. However, the review didn’t assess the quality of the studies and didn’t include data on side effects.
• A 2017 clinical practice guideline by the International Society of Travel Medicine stated that there’s insufficient evidence to recommend probiotics or prebiotics to prevent or treat traveler’s diarrhea. The guidelines acknowledged that there’s evidence suggesting a small benefit but pointed out that studies vary greatly in terms of factors such as the probiotic strains used, the causes of the diarrhea, and geographic locations. Also, some studies had weaknesses in their design.

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• Colic is excessive, unexplained crying in young infants. Babies with colic may cry for 3 hours a day or more, but they eat well and grow normally. The cause of colic is not well understood, but studies have shown differences in the microbial community in the digestive tract between infants who have colic and those who don’t, which suggests that microorganisms may be involved.
• A 2018 review of 7 studies (471 participants) of probiotics for colic, 5 of which involved the probiotic Lactobacillus reuteri DSM 17938, found that this probiotic was associated with successful treatment (defined as a reduction of more than half in daily crying time). However, the effect was mainly seen in exclusively breastfed infants.
• No harmful effects were seen in a review of 4 studies (345 participants) of L. reuteri DSM 17938 for colic or in a small NCCIH-funded study that included repeated physical examinations and blood tests in infants with colic who were given this probiotic, as well as parents’ reports of symptoms.

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• Necrotizing enterocolitis is a serious, sometimes fatal disease that occurs in premature infants. It involves injury or damage to the intestinal tract, causing death of intestinal tissue. Its exact cause is unknown, but an abnormal reaction to food components and the microorganisms that live in a premature baby’s digestive tract may play a role.
• A 2017 review of 23 studies (7,325 infants) showed that probiotics helped to prevent necrotizing enterocolitis in very-low-birth-weight infants. However, the results of individual studies varied; not all showed a benefit. Probiotics that included both Lactobacillus and Bifidobacterium seemed to produce the best results, but it was not possible to identify the most beneficial strains within these large groups of bacteria.
• None of the infants in the studies described above developed harmful short-term side effects from the probiotics. However, the long-term effects of receiving probiotics at such a young age are uncertain. Outside of these studies, there have been instances when probiotics did have harmful effects in newborns. In 2023, the FDA warned health care providers that premature infants who are given probiotics are at risk of severe, potentially fatal infections caused by the microorganisms in the products.

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• Sepsis is a serious illness in which the body has a harmful, overwhelming response to an infection. It can cause major organs and body systems to stop working properly and can be life threatening. The risk of sepsis is highest in infants, children, the elderly, and people with serious medical problems. One group particularly at risk for sepsis is premature infants.
• A review of 37 studies (9,416 participants) found that probiotics were helpful in reducing the risk of sepsis in premature infants.

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.header_greentext{color:greenimportant;font-size:24pximportant;font-weight:500important;}.header_bluetext{color:blueimportant;font-size:18pximportant;font-weight:500important;}.header_redtext{color:redimportant;font-size:28pximportant;font-weight:500important;}.header_darkred{color:#803d2fimportant;font-size:28pximportant;font-weight:500important;}.header_purpletext{color:purpleimportant;font-size:31pximportant;font-weight:500important;}.header_yellowtext{color:yellowimportant;font-size:20pximportant;font-weight:500important;}.header_blacktext{color:blackimportant;font-size:22pximportant;font-weight:500important;}.header_whitetext{color:whiteimportant;font-size:22pximportant;font-weight:500important;}.header_darkred{color:#803d2fimportant;}.green_header{color:greenimportant;font-size:24pximportant;font-weight:500important;}.blue_header{color:blueimportant;font-size:18pximportant;font-weight:500important;}.red_header{color:redimportant;font-size:28pximportant;font-weight:500important;}.purple_header{color:purpleimportant;font-size:31pximportant;font-weight:500important;}.yellow_header{color:yellowimportant;font-size:20pximportant;font-weight:500important;}.black_header{color:blackimportant;font-size:22pximportant;font-weight:500important;}.white_header{color:whiteimportant;font-size:22pximportant;font-weight:500important;} dental caries (tooth decay).

• A small amount of research, all in infants and young children, has examined the possibility that probiotics might be helpful in preventing dental caries (also called cavities or tooth decay). A review of 7 studies (1,715 total participants) found that the use of probiotics was associated with fewer cavities in 4 of the 7 studies, but the quality of the evidence was low, and no definite conclusions about the effectiveness of probiotics could be reached.

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• Periodontal diseases result from infections and inflammation of the gums and bone that surround and support the teeth. If the disease is severe, the gums can pull away from the teeth, bone can be lost, and teeth may loosen or fall out.
• A 2016 review of 12 studies (452 participants) that evaluated probiotics for periodontal disease found evidence that they could be a helpful addition to treatment by reducing disease-causing bacteria and improving clinical signs of the disease. However, effects may differ for different probiotics.

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.header_greentext{color:greenimportant;font-size:24pximportant;font-weight:500important;}.header_bluetext{color:blueimportant;font-size:18pximportant;font-weight:500important;}.header_redtext{color:redimportant;font-size:28pximportant;font-weight:500important;}.header_darkred{color:#803d2fimportant;font-size:28pximportant;font-weight:500important;}.header_purpletext{color:purpleimportant;font-size:31pximportant;font-weight:500important;}.header_yellowtext{color:yellowimportant;font-size:20pximportant;font-weight:500important;}.header_blacktext{color:blackimportant;font-size:22pximportant;font-weight:500important;}.header_whitetext{color:whiteimportant;font-size:22pximportant;font-weight:500important;}.header_darkred{color:#803d2fimportant;}.green_header{color:greenimportant;font-size:24pximportant;font-weight:500important;}.blue_header{color:blueimportant;font-size:18pximportant;font-weight:500important;}.red_header{color:redimportant;font-size:28pximportant;font-weight:500important;}.purple_header{color:purpleimportant;font-size:31pximportant;font-weight:500important;}.yellow_header{color:yellowimportant;font-size:20pximportant;font-weight:500important;}.black_header{color:blackimportant;font-size:22pximportant;font-weight:500important;}.white_header{color:whiteimportant;font-size:22pximportant;font-weight:500important;} allergic rhinitis (hay fever).

• A review of 23 studies (1,919 participants) in which probiotics were tested for treating allergic rhinitis found some evidence that they may be helpful for improving symptoms and quality of life. However, because the studies tested different probiotics and measured different effects, no recommendations about the use of probiotics could be made. Few side effects of probiotics were reported in these studies.

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• A review of 11 studies (910 participants) of probiotics for asthma in children had inconclusive results.

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• Atopic dermatitis is an itchy chronic skin disorder that’s associated with allergies but not caused by them. It’s most common in infants and may start as early as age 2 to 6 months. Many people outgrow it by early adulthood. Atopic dermatitis is one of several types of eczema.
• A 2017 review of 13 studies (1,271 participants) of probiotics for the treatment of atopic dermatitis in infants and children did not find consistent evidence of a beneficial effect. A review of 9 studies (269 participants) in adults provided preliminary evidence that some strains of probiotics might be beneficial for symptoms of atopic dermatitis.

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• It’s been suggested that changes in people’s lifestyles and environment may have led to reduced contact with microorganisms early in life, and that this decrease may have contributed to an increase in allergies. This is sometimes called the “hygiene hypothesis,” although factors unrelated to hygiene, such as smaller family size and the use of antibiotics, may also play a role. Studies have been done in which probiotics were given to pregnant women and/or young infants in the hope of preventing the development of allergies.
• A 2015 review of 17 studies (4,755 participants) that evaluated the use of probiotics during pregnancy or early infancy found that infants exposed to probiotics had a lower risk of developing atopic dermatitis, especially if they were exposed to a mixture of probiotics. However, probiotics did not have an effect on the risks of asthma, wheezing, or hay fever (allergic rhinitis).

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.header_greentext{color:greenimportant;font-size:24pximportant;font-weight:500important;}.header_bluetext{color:blueimportant;font-size:18pximportant;font-weight:500important;}.header_redtext{color:redimportant;font-size:28pximportant;font-weight:500important;}.header_darkred{color:#803d2fimportant;font-size:28pximportant;font-weight:500important;}.header_purpletext{color:purpleimportant;font-size:31pximportant;font-weight:500important;}.header_yellowtext{color:yellowimportant;font-size:20pximportant;font-weight:500important;}.header_blacktext{color:blackimportant;font-size:22pximportant;font-weight:500important;}.header_whitetext{color:whiteimportant;font-size:22pximportant;font-weight:500important;}.header_darkred{color:#803d2fimportant;}.green_header{color:greenimportant;font-size:24pximportant;font-weight:500important;}.blue_header{color:blueimportant;font-size:18pximportant;font-weight:500important;}.red_header{color:redimportant;font-size:28pximportant;font-weight:500important;}.purple_header{color:purpleimportant;font-size:31pximportant;font-weight:500important;}.yellow_header{color:yellowimportant;font-size:20pximportant;font-weight:500important;}.black_header{color:blackimportant;font-size:22pximportant;font-weight:500important;}.white_header{color:whiteimportant;font-size:22pximportant;font-weight:500important;} acne.

• Research has identified mechanisms by which probiotics, either taken orally or used topically (applied to the skin), might influence acne. However, there has been very little research in people on probiotics for acne, and the American Academy of Dermatology’s 2016 guidelines for managing acne state that the existing evidence isn’t strong enough to justify any recommendations about the use of probiotics.

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• When the liver is damaged and unable to remove toxic substances from the blood, the toxins can build up in the bloodstream and affect the nervous system. This may lead to impairments of brain function called hepatic encephalopathy.
• A 2017 review looked at 21 studies (1,420 participants) of probiotics for hepatic encephalopathy and concluded that they were generally of low quality. There was evidence that compared with a placebo (an inactive substance) or no treatment, probiotics probably had beneficial effects on hepatic encephalopathy, but it was uncertain whether probiotics were better than lactulose, a conventional treatment for liver disease.

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• Probiotics have been tested for their effects against upper respiratory infections (a group that includes the common cold, middle ear infections, sinusitis, and various throat infections). A 2015 evaluation of 12 studies with 3,720 total participants indicated that people taking probiotics may have fewer and shorter upper respiratory infections. However, the quality of the evidence was low because some of the studies were poorly conducted.

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• A 2015 review of 9 studies (735 participants) of probiotics for the prevention of urinary tract infection did not find evidence of a beneficial effect.

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• Probiotics have an extensive history of apparently safe use, particularly in healthy people. However, few studies have looked at the safety of probiotics in detail, so there’s a lack of solid information on the frequency and severity of side effects.
• The risk of harmful effects from probiotics is greater in people with severe illnesses or compromised immune systems. When probiotics are being considered for high-risk individuals, such as premature infants or seriously ill hospital patients, the potential risks of probiotics should be carefully weighed against their benefits. Cases of severe or fatal infections have been reported in premature infants who were given probiotics, and the U.S. Food and Drug Administration (FDA) has warned health care providers about this risk.
• Possible harmful effects of probiotics include infections, production of harmful substances by the probiotic microorganisms, and transfer of antibiotic resistance genes from probiotic microorganisms to other microorganisms in the digestive tract.
• Some probiotic products have been reported to contain microorganisms other than those listed on the label. In some instances, these contaminants may pose serious health risks.

NCCIH-Funded Research

NCCIH sponsors a variety of research projects related to probiotics or the microbiome. In addition to the previously mentioned studies on diet-microbiome interactions in the digestive tract, recent topics include:

• The mechanisms by which probiotics may help to reduce postmenopausal bone loss
• Engineering probiotics to synthesize natural substances for microbiome-brain research
• The mechanisms by which certain probiotics may relieve chronic pelvic pain
• The effects of a specific Bifidobacterium strain on changes in short-chain fatty acid production in the gut that may play a role in antibiotic-associated diarrhea.

More To Consider

• Don’t use probiotics as a reason to postpone seeing your health care provider about any health problem.
• If you’re considering a probiotic dietary supplement, consult your health care provider first. This is especially important if you have health problems. Anyone with a serious underlying health condition should be monitored closely while taking probiotics.
• Take charge of your health—talk with your health care providers about any complementary health approaches you use. Together, you can make shared, well-informed decisions.

For More Information

Nccih clearinghouse.

The NCCIH Clearinghouse provides information on NCCIH and complementary and integrative health approaches, including publications and searches of Federal databases of scientific and medical literature. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.

Toll-free in the U.S.: 1-888-644-6226

Telecommunications relay service (TRS): 7-1-1

Website: https://www.nccih.nih.gov

Email: [email protected] (link sends email)

Know the Science

NCCIH and the National Institutes of Health (NIH) provide tools to help you understand the basics and terminology of scientific research so you can make well-informed decisions about your health. Know the Science features a variety of materials, including interactive modules, quizzes, and videos, as well as links to informative content from Federal resources designed to help consumers make sense of health information.

Explaining How Research Works (NIH)

Know the Science: How To Make Sense of a Scientific Journal Article

Understanding Clinical Studies (NIH)

A service of the National Library of Medicine, PubMed® contains publication information and (in most cases) brief summaries of articles from scientific and medical journals. For guidance from NCCIH on using PubMed, see How To Find Information About Complementary Health Approaches on PubMed .

Website: https://pubmed.ncbi.nlm.nih.gov/

MedlinePlus

To provide resources that help answer health questions, MedlinePlus (a service of the National Library of Medicine) brings together authoritative information from the National Institutes of Health as well as other Government agencies and health-related organizations.

Website: https://www.medlineplus.gov

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• Bafeta A, Koh M, Riveros C, et al. Harms reporting in randomized controlled trials of interventions aimed at modifying microbiota: a systematic review. Annals of Internal Medicine . 2018;169(4):240-247.
• Blaabjerg S, Artzi DM, Aabenhus R. Probiotics for the prevention of antibiotic-associated diarrhea in outpatients—a systematic review and meta-analysis. Antibiotics . 2017;6(4).pii:E21.
• Butel M-J. Probiotics, gut microbiota and health. Médecine et Maladies Infectieuses . 2014;44(1):1-8.
• Cohen PA. Probiotic safety—no guarantees. JAMA Internal Medicine . 2018;178(12):1577-1578.
• Degnan FH. The US Food and Drug Administration and probiotics: regulatory categorization. Clinical Infectious Diseases. 2008;46(Suppl 2):S133–S136.
• Didari T, Solki S, Mozaffari S, et al. A systematic review of the safety of probiotics. Expert Opinion on Drug Safety . 2014;13(2):227–239.
• Dryl R, Szajewska H. Probiotics for management of infantile colic: a systematic review of randomized controlled trials. Archives of Medical Science. 2018;14(5):1137-1143.
• Fijan S. Microorganisms with claimed probiotic properties: an overview of recent literature. International Journal of Environmental Research and Public Health. 2014;11(5):4745-4767.
• Ford AC, Harris LA, Lacy BE, et al. Systematic review with meta-analysis: the efficacy of prebiotics, probiotics, synbiotics and antibiotics in irritable bowel syndrome. Alimentary Pharmacology & Therapeutics . 2018;48(10):1044-1060.
• Goldenberg JZ, Yap C, Lytvyn L, et al. Probiotics for the prevention of Clostridium difficile -associated diarrhea in adults and children. Cochrane Database of Systematic Reviews. 2017;(12):CD006095. Accessed at www.cochranelibrary.com on January 23, 2018.
• Guarner F, Khan AG, Garisch J, et al. World Gastroenterology Organisation Global Guidelines. Probiotics and Prebiotics. October 2011. Journal of Clinical Gastroenterology . 2012;46(6):468–481.
• Hempel S, Newberry SJ, Maher AR, et al. Probiotics for the prevention and treatment of antibiotic-associated diarrhea: a systematic review and meta-analysis. JAMA . 2012;307(18):1959–1969.
• Hempel S, Newberry S, Ruelaz A, et al. Safety of Probiotics to Reduce Risk and Prevent or Treat Disease. Evidence Report/Technology Assessment no. 200. Rockville, MD: Agency for Healthcare Research and Quality; 2011. AHRQ publication no. 11-E007.
• Rao SC, Athalye-Jape GK, Deshpande GC, et al. Probiotic supplementation and late-onset sepsis in preterm infants: a meta-analysis. Pediatrics. 2016;137(3):e20153684.
• Sanders ME, Akkermans LM, Haller D, et al. Safety assessment of probiotics for human use. Gut Microbes . 2010;1(3):164-185.
• Thomas JP, Raine T, Reddy S, et al. Probiotics for the prevention of necrotizing enterocolitis in very low-birth-weight infants: a meta-analysis and systematic review. Acta Paediatrica . 2017;106(11):1729-1741.
• U.S. Food and Drug Administration. Warning Regarding Use of Probiotics in Preterm Infants. Issued September 29, 2023. Accessed at  https://www.fda.gov/media/172606 on October 2, 2023.
• Zuccotti G, Meneghin F, Aceti A, et al. Probiotics for prevention of atopic diseases in infants: systematic review and meta-analysis. Allergy. 2015;70(11):1356-13

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• Bae J-M. Prophylactic efficacy of probiotics on travelers’ diarrhea: an adaptive meta-analysis of randomized controlled trials. Epidemiology and Health . 2018;40:e2018043.
• Black LI, Clarke TC, Barnes PM, Stussman BJ, Nahin RL. Use of complementary health approaches among children aged 4-17 years in the United States: National Health Interview Survey, 2007-2012. National health statistics reports; no 78. Hyattsville, MD: National Center for Health Statistics. 2015.
• Cao L, Wang L, Yang L, et al. Long-term effect of early-life supplementation with probiotics on preventing atopic dermatitis: a meta-analysis. Journal of Dermatological Treatment . 2015;26(6):537-540.
• Clarke TC, Black LI, Stussman BJ, Barnes PM, Nahin RL. Trends in the use of complementary health approaches among adults: United States, 2002–2012. National health statistics reports; no 79. Hyattsville, MD: National Center for Health Statistics. 2015.
• Dalal R, McGee RG, Riordan SM, et al. Probiotics for people with hepatic encephalopathy. Cochrane Database of Systematic Reviews . 2017;(2):CD008716. Accessed at www.cochranelibrary.com on November 15, 2018.
• Dimidi E, Christodoulides S, Fragkos KC, et al. The effect of probiotics on functional constipation in adults: a systematic review and meta-analysis of randomized controlled trials. American Journal of Clinical Nutrition . 2014;100(4):1075-1084.
• Doron S, Snydman DR. Risk and safety of probiotics. Clinical Infectious Diseases . 2015;60(Suppl 2):S129-S134.
• Fatheree NY, Liu Y, Taylor CM, et al. Lactobacillus reuteri for infants with colic: a double-blind, placebo-controlled, randomized clinical trial. Journal of Pediatrics . 2017;191:170-178.
• Ghouri YA, Richards DM, Rahimi EF, et al. Systematic review of randomized controlled trials of probiotics, prebiotics, and synbiotics in inflammatory bowel disease. Clinical and Experimental Gastroenterology . 2014;7:473-487.
• Gibson GR, Hutkins R, Sanders ME, et al. Expert consensus document: The International Scientific Association for Probiotics and Prebiotics (ISAPP) consensus statement on the definition and scope of prebiotics. Nature Reviews. Gastroenterology & Hepatology . 2017;14(8):491-502.
• Goldenberg JZ, Lytvyn L, Steurich J, et al. Probiotics for the prevention of pediatric antibiotic-associated diarrhea. Cochrane Database of Systematic Reviews . 2015;(12):CD004827. Accessed at www.cochranelibrary.com on November 2, 2018.
• Hao Q, Dong BR, Wu T. Probiotics for preventing acute upper respiratory tract infections. Cochrane Database of Systematic Reviews . 2015;(2):CD006895. Accessed at www.cochranelibrary.com on March 6, 2018.
• Hoffmann DE, Fraser CM, Palumbo FB, et al. Probiotics: finding the right regulatory balance. Science . 2013;342(6156):314-315.
• Huang R, Hu J. Positive effect of probiotics on constipation in children: a systematic review and meta-analysis of six randomized controlled trials. Frontiers in Cellular and Infection Microbiology. 2017;7:153.
• Huang R, Ning H, Shen M, et al. Probiotics for the treatment of atopic dermatitis in children: a systematic review and meta-analysis of randomized controlled trials. Frontiers in Cellular and Infection Microbiology. 2017;7:392.
• Jafarnejad S, Shab-Bidar S, Speakman JR, et al. Probiotics reduce the risk of antibiotic-associated diarrhea in adults (18-64 years) but not the elderly (>65 years): a meta-analysis. Nutrition in Clinical Practice . 2016;31(4):502-513.
• Jørgensen MR, Castiblanco G, Twetman S, et al. Prevention of caries with probiotic bacteria during early childhood. Promising but inconsistent findings. American Journal of Dentistry . 2016;29(3):127-131.
• Kechagia M, Basoulis D, Konstantopoulou S, et al. Health benefits of probiotics: a review. ISRN Nutrition . 2013;2013:48165.
• Kelesidis T, Pothoulakis C. Efficacy and safety of the probiotic Saccharomyces boulardii for the prevention and therapy of gastrointestinal disorders. Therapeutic Advances in Gastroenterology . 2012;5(2):111-125.
• Kober M-M, Bowe WP. The effect of probiotics on immune regulation, acne, and photoaging. International Journal of Women’s Dermatology . 2015;1(2):85-89.
• Lahner E, Bellisario C, Hassan C, et al. Probiotics in the treatment of diverticular disease. A systematic review. Journal of Gastrointestinal and Liver Diseases . 2016;25(1):79-86.
• Lin J, Zhang Y, He C, et al. Probiotics supplementation in children with asthma: a systematic review and meta-analysis. Journal of Paediatrics and Child Health. 2018;54(9):953-961.
• Marcason W. Probiotics: where do we stand? Journal of the Academy of Nutrition and Dietetics. 2013;113(10):1424.
• Martínez-Martínez MI, Calabuig-Tolsá R, Cauli O. The effect of probiotics as a treatment for constipation in elderly people: a systematic review. Archives of Gerontology and Geriatrics. 2017;71:142-149.
• Matsubara VH, Bandara HM, Ishikawa KH, et al. The role of probiotic bacteria in managing periodontal disease: a systematic review. Expert Review of Anti-infective Therapy . 2016;14(7):643-655.
• Notay M, Foolad N, Vaughn AR, et al. Probiotics, prebiotics, and synbiotics for the treatment and prevention of adult dermatological diseases. American Journal of Clinical Dermatology . 2017;18(6):721-732.
• Oelschlaeger TA. Mechanisms of probiotic actions – A review. International Journal of Medical Microbiology . 2010;300(1):57-62.
• Osborn DA, Sinn JKH. Prebiotics in infants for prevention of allergy. Cochrane Database of Systematic Reviews . 2013(3):CD006474. Accessed at www.cochranelibrary.com on March 6, 2018.
• Petschow B, Doré J, Hibberd P, et al. Probiotics, prebiotics, and the host microbiome: the science of translation. Annals of the New York Academy of Sciences . 2013;1306:1–17.
• Reid G. Probiotics: definition, scope and mechanisms of action. Best Practice & Research: Clinical Gastroenterology. 2016;30(1):17-25.
• Riddle MS, Connor BA, Beeching NJ, et al. Guidelines for the prevention and treatment of travelers’ diarrhea: a graded expert panel report. Journal of Travel Medicine . 2017;24(Suppl 1):S63-S80.
• Sanders ME, Guarner F, Guerrant R, et al. An update on the use and investigation of probiotics in health and disease. Gut. 2013;62(5):787-796.
• Schwenger EM, Tejani AM, Loewen PS. Probiotics for preventing urinary tract infections in adults and children. Cochrane Database of Systematic Reviews . 2015;(12):CD008772. Accessed at www.cochranelibrary.com on November 9, 2018.
• Shanahan F. A commentary on the safety of probiotics. Gastroenterology Clinics of North America . 2012;41(4):869–876.
• Steele SR, McCormick J, Melton GB, et al. Practice parameters for the management of Clostridium difficile infection. Diseases of the Colon and Rectum . 2015;58(1):10-24.
• Sung V, D’Amico F, Cabana MD, et al. Lactobacillus reuteri to treat infant colic: a meta-analysis. Pediatrics . 2018;141(1):e20171811.
• Vallabhaneni S, Walker TA, Lockhart SR, et al. Fatal gastrointestinal mucormycosis in a premature infant associated with a contaminated dietary supplement—Connecticut, 2014. Morbidity and Mortality Weekly Report. 2015;64(6):155-156.
• Venugopalan V, Shriner KA, Wong-Beringer A. Regulatory oversight and safety of probiotic use. Emerging Infectious Diseases. 2010;16(11):1661-1665.
• Wei D, Heus P, van de Wetering FT, et al. Probiotics for the prevention or treatment of chemotherapy- or radiotherapy-related diarrhoea in people with cancer. Cochrane Database of Systematic Reviews. 2018;(8):CD008831. Accessed at www.cochranelibrary.com on November 9, 2018.
• Wojtyniak K, Szajewska H. Systematic review: probiotics for functional constipation in children. European Journal of Pediatrics . 2017;176(9):1155-1162.
• Zaenglein AL, Pathy AL, Schlosser BJ, et al. Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology . 2016;74(5):945-973.
• Zajac AE, Adams AS, Turner JH. A systematic review and meta-analysis of probiotics for the treatment of allergic rhinitis. International Forum of Allergy and Rhinology . 2015;5(6):524-532.

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Environment and food safety: a novel integrative review

• Review Article
• Published: 25 August 2021
• Volume 28 , pages 54511–54530, ( 2021 )

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• Shanxue Jiang 1 , 2 , 3 ,
• Fang Wang 1 , 2 , 3 ,
• Qirun Li 1 ,
• Haishu Sun 4 ,
• Huijiao Wang 5 &
• Zhiliang Yao   ORCID: orcid.org/0000-0001-5125-8245 1 , 2 , 3  

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Environment protection and food safety are two critical issues in the world. In this review, a novel approach which integrates statistical study and subjective discussion was adopted to review recent advances on environment and food safety. Firstly, a scientometric-based statistical study was conducted based on 4904 publications collected from the Web of Science Core Collection database. It was found that the research on environment and food safety was growing steadily from 2001 to 2020. Interestingly, the statistical analysis of most-cited papers, titles, abstracts, keywords, and research areas revealed that the research on environment and food safety was diverse and multidisciplinary. In addition to the scientometric study, strategies to protect environment and ensure food safety were critically discussed, followed by a discussion on the emerging research topics, including emerging contaminates (e.g., microplastics), rapid detection of contaminants (e.g., biosensors), and environment friendly food packaging materials (e.g., biodegradable polymers). Finally, current challenges and future research directions were proposed.

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Introduction

Environment and food safety have been two important topics in the world (Zhang et al. 2015 ; Bilal and Iqbal 2020 ; Liu et al. 2020b ; Song et al. 2020 ; Ye et al. 2020 ; Qin et al. 2021 ). Human activities have posed great threats on environment and food safety. For example, due to the intensive use of disposable masks which are mainly made of non-biodegradable polymers, massive amount of waste is produced. In fact, environment and food safety are closely intercorrelated (He et al. 2016 ; Sagbara et al. 2020 ). As shown in Figure 1 , on the one hand, food safety is strongly affected by environment (Lu et al. 2015 ). Contaminants from polluted soil, water, and air could migrate into crops, vegetables, fish, animals, and so on (Lu et al. 2015 ; Sun et al. 2017 ; Li et al. 2020a ). On the other hand, in order to ensure food safety and quality, various processing procedures are carried out, which increase the burden on the environment and even cause environmental pollution (Yao et al. 2020 ). For example, food processing industry produces a huge amount of wastewater (Li et al. 2019 ; Ahmad et al. 2020 ; Akansha et al. 2020 ; Boguniewicz-Zablocka et al. 2020 ). If the wastewater is discharged into rivers directly, the rivers will be polluted. As food industry wastewater typically contains high concentrations of organic matters, eutrophication can easily take place (Feng et al. 2021 ; Jiang et al. 2021 ). In addition, food packaging materials are widely used as food containers and to preserve food from decay (Vitale et al. 2018 ; Wohner et al. 2020 ; Zeng et al. 2021 ). When the food is consumed, a mass of packaging waste is produced, which will cause environmental problems if not disposed properly (Poyatos-Racionero et al. 2018 ; Bala et al. 2020 ; Brennan et al. 2020 ; Liu et al. 2020a ). However, plastics, as one of the most commonly used packaging materials, cannot be disposed easily and can exist in the environment for hundreds of years (Barnes 2019 ; Chen et al. 2021b ; Mulakkal et al. 2021 ; Patrício Silva et al. 2021 ).

Illustration of the relationship between environment and food safety and their impacts on human health

Environment and food safety have strong impacts on human health (Fung et al. 2018 ; Gallo et al. 2020 ). Many studies are conducted to investigate the migration of contaminants from the environment to food, and finally to human beings. For example, it is reported that heavy metals in the aquatic environment can migrate into fishes via bioaccumulation and bioconcentration (Baki et al. 2018 ; Korkmaz et al. 2019 ; Arisekar et al. 2020 ). When these polluted fishes are consumed, the heavy metals will migrate into human bodies (Saha et al. 2016 ; Gholamhosseini et al. 2021 ). Although the concentrations of heavy metals in the fishes are usually below the maximum allowed level (Velusamy et al. 2014 ; Safiur Rahman et al. 2019 ), the fact that humans are at the top of the food chain cannot be ignored. In other words, as there are various food sources for human beings, the heavy metals in our bodies could accumulate and finally reach a level that causes serious health risks, such as cancer (Badamasi et al. 2019 ; Yu et al. 2020a ). In addition to the common types of contaminants (e.g., heavy metals, pesticides, pathogen, particulate matter), there are also some emerging types of contaminants (e.g., microplastics, personal care products, pharmaceuticals), and more efforts are needed to study their effects on human health (Aghilinasrollahabadi et al. 2020 ; Li et al. 2020b ; Zhang et al. 2020 ).

Given the importance of environment and food safety, it is not surprising that a lot of related studies have been published, including many review studies. For example, Qin et al ( 2021 ) reviewed the effects of heavy metals in soil on food safety in China and discussed the sources (e.g., pesticides, fertilizers, vehicle emissions, coal combustion, sewage irrigation, mining) and remediation strategies (e.g., soil amendments, phytoremediation, foliar sprays). Suhani et al. (Suhani et al. 2021 ) reviewed the effects of cadmium pollution on food safety and human health with a focus on the mechanisms (e.g., cellular or molecular alterations). Deshwal et al. (Deshwal and Panjagari 2020 ) reviewed the effects of metal-based packaging materials on food safety and health issues (e.g., bisphenol A migration, metal migration, dissolution, blackening, and corrosion). Sun et al. (Sun et al. 2017 ) reviewed the relationship between air pollution and food security with a focus on the food system (e.g., the effect of agricultural policy on food security). However, most of these review studies only focus on certain subfields (Ayelign and De Saeger 2020 ; Endersen and Coffey 2020 ; Imathiu 2020 ; Nelis et al. 2020 ; Singh et al. 2020a ). In addition, most of these reviews are based solely on the subjective experiences of the researchers in the related fields. In the age of big data, it is necessary to give a timely update on the research of environment and food safety through objective data analysis. The scientometric-based statistical method provides a powerful tool to disclose research trends and progress on certain research areas through data analysis of published documents. However, although there are already quite a few scientometric studies on other research areas (Jiang et al. 2018 ; Li et al. 2018 ; Kamali et al. 2020 ; Khalaj et al. 2020 ; Zakka et al. 2021 ; Zeb et al. 2021 ; Ni et al. 2021 ), the scientometric studies on environment and food safety are very limited. Therefore, the aim of this study is to provide an integrative review on environment and food safety via objective statistical analysis coupled with subjective review on strategies to protect the environment and ensure food safety, followed by a discussion on emerging research topics.

A scientometric review

As shown in Figure 2 , during the past 20 years, there were nearly 5000 publications on the topic of environment and food safety (detailed method was provided in the Supplementary Information ). From 2001 to 2020, there was a steady increase in publications every year. Meanwhile, it was indicated that the increase in research output slowed down in 2020, possibly due to the terrible coronavirus pandemic which suspended researchers’ lab work. In terms of document types, the 4904 publications were categorized into 10 types, where research article, review, and proceedings paper were the top three, accounting for 73.23%, 16.54%, and 13.09% of the total publications, respectively (Supplementary Table 1 ). In terms of languages, most of the documents were published in English, accounting for 96.76% of the total publications (Supplementary Table 2 ). The following languages were German (0.67%), Chinese (0.57%), Portuguese (0.43%), Spanish (0.41%), French (0.39%), etc. The language analysis revealed that a SCIE journal is not necessarily an English journal. For example, among the journals included in the data, the SCIE journal Berliner und Munchener Tierarztliche Wochenschrift publishes research results in German, and the SCIE journal Progress in Chemistry publishes research results in Chinese. To be available to researchers from all over the world, an English version of the titles, keywords, and abstracts of these publications are also provided. However, as the main text is not written in English, the impact of these publications is usually limited to the local research community, i.e., the papers written in German is normally only read by German researchers while the papers written in Chinese is normally only read by Chinese researchers.

Number of publications per year and cumulative number of publications from 2001 to 2020

In terms of journals, about 165 journals published at least 5 papers, and the total papers published in these journals accounted to about half of the total publications (more details are provided in supplementary data ). Furthermore, as shown in Figure 3 , the total papers published in the top 20 most publishing journals accounted to about one-fourth of the total publications. These results revealed that the research on environment and food safety is of broad interest.

Number of publications and cumulative percentage of the top 20 most publishing journals

In terms of publishing countries/regions, more than 100 countries/regions contributed to these publications (more details are provided in supplementary data ). Especially, more than 50 countries/regions contributed at least 20 publications to the research on environment and food safety during the past 20 years. These results again revealed that the research on environment and food safety is of global interest. As shown in Figure 4 , in terms of research output, the USA and China were leading the research on environment and food safety. Specifically, among the countries/regions, the USA was undoubtedly the most publishing country, which accounted for nearly one-fourth of the total publications. The runner-up was China, which contributed to around 15% of the total publications. However, it does not mean that the USA and China have contributed to around 40% of the total publications because many papers are published as a result of collaborations among several countries.

Number of publications and corresponding percentage of the top 20 most publishing countries/regions

Generally, over 400 research institutes had contributed at least 5 publications to the research on environment and food safety, and nearly 50 research institutes published at least 20 papers during the past 20 years (more details are provided in supplementary data ). The top 20 most publishing research institutes were summarized in Table 1 . Chinese Academy of Sciences (CAS), which ranked the first place based on number of publications, is the largest cluster of research institutes in China. The research conducted by CAS is quite diverse and multidisciplinary. Especially, the research on environment and food safety is loosely conducted by different CAS research institutes, including but are not limited to Research Center for Eco-Environmental Sciences (RCEES), Institute of Urban Environment, and Institute of Soil Science. For example, researchers from RCEES found that water pollution and soil pollution had serious effect on food safety and human health (Lu et al. 2015 ). The next one, USDA ARS, short for United States Department of Agriculture Agricultural Research Service, is a leading research institute in the USA focusing on food safety and human health from the aspect of agriculture. Similarly, US FDA is short for United States Food and Drug Administration and is exclusively focusing on food and drug-related research so as to protect public health. INRA, short for French National Institute of Agronomic Research, is a very famous research institute in Europe focusing on agricultural research. Similarly, Istituto Superiore di Sanità is a leading research institute in Italy focusing on public health. In addition to the above 5 research institutes, the remaining 15 research institutes are all universities, and their research on environment and food safety is mainly conducted by the related departments or research centers of the universities. For examples, the Department of Food Technology, Food Safety and Health at Ghent University (located in Belgium) is renowned for its state-of-the-art research on food technology, food microbiology, food chemistry, food safety, etc. Similarly, Wageningen University (located in Netherlands) has a research institute named Wageningen Food Safety Research. Another two European universities were both from Denmark, namely University of Copenhagen and Technical University of Denmark. The Department of Food Science at University of Copenhagen and the National Food Institute at Technical University of Denmark are mainly responsible for food-related research. Besides, there were also two universities from China (i.e., China Agricultural University and Zhejiang University) and one university from Canada (i.e., University of Guelph). The remaining 8 universities all came from the USA, accounting for over half of the universities in the top 20 most publishing research institutes, which corresponded well with the above countries/regions analysis.

Table 2 summarized the top 20 most-cited articles on environment and food safety. As revealed by Table 2 , the research on environment and food safety is diverse, and there are quite a few research directions which received a lot of attention. Generally, the research topics disclosed by the most cited papers included food inspection/detection technique, heavy metal pollution, food additives, food packaging, food allergy, food pesticide, foodborne pathogen and diseases, microplastics, food processing, and production. Various food inspection/detection techniques have been reported, including electrochemical strategies to detect gallic acid in food (Badea et al. 2019 ), thermal imaging technique coupled with chemometrics (Mohd Ali et al. 2020 ), paper-based analysis device for rapid food safety detection (Qi et al. 2020 ), line-scan spatially offset Raman spectroscopy technique for subsurface inspection of food (Qin et al. 2017 ), surface-enhanced Raman spectroscopy for detection of mycotoxins in food (Wu et al. 2021b ), chromatography, and mass spectrometry (Pauk et al. 2021 ; Suman et al. 2021 ). In addition, heavy metal pollution has posed great threats on food safety, and a lot of studies are conducted, including the soil heavy metal pollution and food safety (Qin et al. 2021 ) and the impacts of various heavy metals (e.g., cadmium, lead, arsenic) on food safety and human health (Corguinha et al. 2015 ; Suhani et al. 2021 ). Furthermore, there are a variety of food additives used in different situations. For example, feed additives such as antibiotics have been used in animal nutrition; however, the use of antibiotics can cause antimicrobial resistance which can further increase the morbidity and mortality of diseases (Silveira et al. 2021 ). Therefore, as will be discussed below, laws and regulations are needed to strictly control the use of food additives. Furthermore, foodborne pathogen also has strong impacts on food safety. As an effective way to kill or inhibit foodborne pathogen, antimicrobial food packaging is gaining growing research interest in recent years (Woraprayote et al. 2018 ; Motelica et al. 2020 ; Alizadeh-Sani et al. 2021 ).

TC , total citations; the TC data was collected based on Web of Science core collection; PY , publishing year

As shown in Supplementary Figure 1 and Supplementary Figure 2 , food, safety, and environment were the top three most common words in titles. The following ones were assessment, health, risk, and environmental. It is well known that environmental pollution can pose risks on food safety and finally threatens human health. A further analysis revealed that a lot of studies were related to risk assessment, such as risk assessment of antimicrobial resistance (Likotrafiti et al. 2018 ; Pires et al. 2018 ), risk assessment of heavy metals (Yasotha et al. 2020 ), risk assessment of pesticide (Frische et al. 2014 ), risk assessment of veterinary drugs (Tsai et al. 2019 ), environmental risk assessment (More et al. 2020 ), and health risk assessment (Akhbarizadeh et al. 2020 ). The next one was efficacy, which was usually combined together with safety, such as safety and efficacy of feed additives (Bampidis et al. 2020 ). Besides, Listeria monocytogenes was intensively studied by researchers (Anast et al. 2020 ; Kawacka et al. 2020 ; Wu et al. 2020b ). Another common word was analysis, such as analysis of herbicide (Pan et al. 2020 ), analysis of bacteria (Kang et al. 2020 ), and analysis of microplastics (Primpke et al. 2020 ). Other common research topics revealed by title analysis included but are not limited to food quality, food production, food processing, food additive, food contamination, detection of food contaminants, food microbiology, environmental impact, as well as water, soil, animal, fish, meat, and dairy.

The top 20 most used keywords were listed in Table 3 (more details are provided in supplementary data ). It could be seen that microbiology was closely related to food safety, and a lot of studies were conducted on Listeria monocytogenes, biofilm, salmonella, and antibiotic resistance. In addition, additives, such as zootechnical additives and nutritional additives, were also intensively investigated by researchers. Other topics included aquaculture, poultry, and agriculture. Another keyword worth mentioning was food security. Food security is different with food safety. Briefly, food security is a more inclusive term and focuses more on the availability of food while food safety is about the quality of food. On the other hand, food security and food safety are closely related to each other (Vipham et al. 2020 ). For instance, if food security becomes a big issue, then usually food safety is not guaranteed, and vice versa. Generally, the results revealed by keywords analysis were in consistent with the above title and keywords analysis.

The keywords network graph revealed some interesting results. As shown in Figure 5 , the network had three centers, namely the “ food safety ”-centered network, the “ safety ”-centered network and the “ efficacy ”-centered network. Interestingly, the “ safety ”-centered network and the “ efficacy ”-centered network were closely related, while they were relatively unrelated with the “ food safety ”-centered network. Furthermore, the results again uncovered that food safety involved many aspects, many of which were already discussed above.

Keywords network graph. Keywords whose cooccurrence exceeded 10 times were connected with lines

The publications in this study were divided into over 200 Web of Science categories (more details are provided in supplementary data ). The top 20 Web of Science categories were shown in Figure 6 . Undoubtedly, the Food Science & Technology category ranked the first place, followed by the Environment Sciences category. As revealed by Figure 6 , food safety was closely related to microbiology, chemistry, and agriculture. Microorganisms such as foodborne pathogens pose great threats on food safety and a lot of studies are focusing on it. For instance, Lin et al (Lin et al. 2021 ) studied the role of Salmonella Hessarek, an emerging foodborne pathogen, in egg safety. Anyogu et al. (Anyogu et al. 2021 ) reviewed the microorganisms and indigenous fermented foods with a focus on microbial food safety hazards. Van Boxstael et al. ( 2013 ) studied the impacts of bacterial pathogens and viruses on food safety in the fresh produce chain. Also, a lot of studies are focusing on food safety and chemistry, such as untargeted food chemical safety assessment (Delaporte et al. 2019 ), chemical safety of recycled food packaging (Geueke et al. 2018 ), and chemical food safety hazards of sausages (Halagarda et al. 2018 ). Furthermore, studies on food safety and agriculture include but are not limited to chemical and biological risks in urban agriculture (Buscaroli et al. 2021 ), biosensors for sustainable agriculture and food safety (Griesche and Baeumner 2020 ), agricultural soil contamination, and the impact on food safety (Wang et al. 2019b ). In addition, the Materials Science category was also on the top list, which indicated that materials are also important research directions in environment and food safety. A further analysis revealed the common materials studied by researchers, including biomaterials, food packaging materials, biodegradable materials, coating materials, sensors and biosensors for food detection, and nanoparticles. The research area analysis showed similar results with Web of Science categories (Supplementary Table 3 ).

Number of publications and corresponding percentage of the top 20 Web of Science categories

Strategies to protect environment and ensure food safety

The above scientometric analysis revealed that the studies on environment and food safety were diversified and multidisciplinary. Further analysis of the above results disclosed the challenges and strategies to protect environment and ensure food safety. As discussed earlier, environment and food safety are closely related to each other. It should be noted that the environment here is not limited to the broad environment (e.g., air, water, soil) which the public are familiar with. In other words, in addition to the broad environment, there are also food-related environments which exist in various processes, including but are not limited to food processing, food packaging, food transportation, food storage, and food consumption. In order to ensure food safety, contaminants/pollutants from the environmental side should be prevented from reaching the food side. An example of food chain pollution control is presented in Figure 7 . It can be seen that from growing wheat to making bread, there are a variety of processes which could cause pollution and control strategies are needed, which are summarized as follows. Firstly, from wheat growing to wheat harvesting: the pollutants/contaminants could be taken in or migrate into the wheat via contaminated soil, water, and air, and therefore strategies are needed to prevent soil, water, and air from being contaminated, such as reducing the use of pesticides and fertilizers. Secondly, initial processing of wheat: after the wheat is harvested, traditionally it needs to be dried by the farmers before it is sold. During this process, contamination can easily occur if the wheat is dried directly on the road which is common in rural China. In addition, the containers of the harvested wheat are also sources of pollution which should be carefully controlled. Alternatively, the pollution can be avoided if the wheat is directly sold and transported to the flour mill from the farm without being dried by the farmers. Thirdly, during the transportation processes (e.g., from farm to flour mill, from flour mill to bread bakery, from bread bakery to supermarkets), contamination can also take place and control strategies are needed. Fourthly, during the wheat processing at the mill and bread baking at the bakery, contamination can take place due to environment exposure, insufficient frequency and quality of facility washing and cleaning, use of additives, etc. Fifthly, during the bread packaging process, the workers can be an important source of bread contamination if the bread is packed manually. Finally, when the consumers buy the bread and do not consume the bread timely, the bread can decay. Based on the above discussion, the food chain pollution control can be generally categorized into the following sections: source pollution (i.e., soil, water, air) control, pollution control during food processing, pollution control during food packaging, pollution control during transportation, pollution control during storage, and pollution control during consumption.

Demonstration of the whole food chain pollution control from wheat growing to bread consuming

Especially, based on the type of chemicals, the contaminants/pollutants can be categorized into pesticides and herbicides, heavy metals, food additives, pathogens, microplastics, antibiotics, and so on (Van Boxstael et al. 2013 ; Tóth et al. 2016 ; He et al. 2019b ; Rajmohan et al. 2019 ; Bonerba et al. 2021 ). Therefore, the corresponding strategies are to control the use of chemicals and materials which can produce these contaminates. For example, as will be discussed in the following section, microplastics come from the wide use of plastics and are receiving growing concern. In order to reduce the amount of microplastics, the use of plastics should be controlled or restricted. Based on the media of migration, these contaminants can reach at the food side via air, water, and soil. Therefore, the corresponding strategies are to remove contaminants from air, water and soil. Alternatively, strategies can be deployed to prevent these contaminants from contacting the food. For example, as will be discussed later, food packaging is a common strategy to protect food from being contaminated by the environment (Risyon et al. 2020 ). To sum up, by controlling the sources and migration routes of food contaminants, food safety can be improved. Furthermore, in order to ensure food safety, whole process monitoring techniques and platforms are necessary. A lot of studied have been conducted on food safety monitoring. For example, De Oliveira et al. ( 2021 ) proposed that environmental monitoring programs (EMPs) are necessary to ensure food safety and quality. The EMPs are used to prevent environmental contamination of the finished product, via checking the cleaning-sanitation procedures, and other environmental pathogen control programs with a range of sampling analysis. Medina et al. (Medina et al. 2019 ) proposed food fingerprints as an effective tool to monitor food safety. Weng et al. (Weng and Neethirajan 2017 ) reviewed microfluidics as an effective method to realize rapid, cost-effective, and sensitive detection of food contaminants such as foodborne pathogens, heavy metals, additives, and pesticide residues. Other monitoring methods/techniques/devices include but are not limited to pH-sensitive smart packaging films (Alizadeh-Sani et al. 2020 ), point-of-care detection devices (Wu et al. 2017 ), and real-time pathogen monitoring via a nanotechnology-based method (Weidemaier et al. 2015 ). Food safety monitoring can be done by either government officials or the relative bodies (e.g., self-monitoring), or both. Furthermore, from the time the food raw materials are being cultivated in the farmland, pasture, fishing ground or other places, to the time the food is being consumed by customers, inspecting and detecting should be deployed. This can be done by the government officials and/or the stakeholders. Although the term “inspection” and “detection” are often used as the same, here, food safety inspection is regarded as an administrative strategy, which is carried out by governmental officials to check whether the relative workers/factories/bodies have followed the food safety requirements/regulations, while food safety detection is regarded as a technique-based strategy, which is used to detect food contaminants and check whether the quality of the food meets the relative standards. Meanwhile, food safety laws need to be enacted to discourage or prevent the relative workers/factories/bodies from affecting the food safety, whether purposely or not.

On the other hand, during the process of food production, the environment can be polluted as well. For example, in order to increase crop yield, a lot of fertilizers are used, which will migrate into the soil and water bodies, and cause soil and water pollution. Therefore, the use of fertilizers should be restricted, which can be realized through agricultural innovations (Liu et al. 2021 ), government policies (van Wesenbeeck et al. 2021 ), etc. Furthermore, during food processing, a large amount of solid waste or/and wastewater are produced which can cause environmental pollution. Therefore, techniques are needed to dispose the food waste properly. Especially, food waste usually contains high amount of organic compounds and therefore falls into the category of biomass, which can be used to produce useful biochemicals like biofuels (Wainaina et al. 2018 ; Chun et al. 2019 ). For example, agro-food waste is an important source of lignocellulosic biomass; the valorization of lignocellulosic biomass is regarded as a sustainable source of energy and has the potential to replace conventional fossil fuels (Ong and Wu 2020 ; Lee and Wu 2021 ; Lee et al. 2021 ; Mankar et al. 2021 ; Zhenquan et al. 2021 ). Furthermore, the concepts of recycling and sustainable development can be deployed. For example, food packaging materials can be recycled and used again. Another example is to use cloth bags to replace plastic bags when shopping. These strategies can reduce the burden on the environment as the amount of food-related waste can be reduced. In addition, novel environment-friendly materials (e.g., biodegradable polymers) can be developed and used in food industries (Stoica et al. 2020 ; Cheng et al. 2021 ). To summarize, the above strategies to protect environment and ensure food safety are presented in Figure 8 .

Emerging studies on environment and food safety

Scientometric analysis is powerful in disclosing the research trend and is relatively subjective compared to conventional type of review. However, as it is essentially a statistical study which relies on a huge amount of data, it is less effective to reveal the emerging research directions which could be ignored in the scientometric study. Therefore, it is necessary and important to carry out a subjective discussion on emerging studies on environment and food safety as an indispensable supplement (Figure 9 ).

Emerging contaminants

There are various contaminants affecting environment and food safety. Among the various types of contaminants, emerging contaminants, such as microplastics, are receiving growing concern due to their potential effects on human health (Sarker et al. 2020 ). Because of the wide application of plastics, microplastics are found almost everywhere in the environment, including soil, water, and air (Álvarez-Lopeztello et al. 2020 ; Chen et al. 2020 ; Wang et al. 2021c ). For example, microplastics are reported to exist in bottled water (Zhou et al. 2021 ) and take-out food plastic containers (Du et al. 2020 ). Furthermore, researchers have found that microplastics could serve as the carrier for many other contaminants such as heavy metals and antibiotics (Zhou et al. 2019 ; Purwiyanto et al. 2020 ; Yu et al. 2020b ). Studies reveal that the ability to absorb heavy metals increase as the microplastics age (Lang et al. 2020 ). As a result, the risks of microplastics on environment, food safety, and human health could be significantly increased. However, the research on microplastics is still at an early stage, and more efforts are needed to uncover the world of microplastics. For example, there is no standard procedures to extract, identify, and quantify microplastics so results by different methods could be different and uncomparable (Kumar et al. 2020 ; Zhou et al. 2020 ). Meanwhile, due to the various sizes, shapes, forms, sources, and types of microplastics, it is difficult and time-consuming to characterize microplastics (Wu et al. 2020a ). Therefore, it is important to develop new methods for rapid and effective detection of microplastics (Li et al. 2020c ).

In addition to microplastics, there are other emerging contaminants which can have negative effects on the environment, food safety, and human health. These emerging contaminants include but are not limited to persistent organic pollutants (Titchou et al. 2021 ), antibiotics (Koch et al. 2021 ), personal care products (Scaria et al. 2021 ), pharmaceuticals (Chaturvedi et al. 2021 ), endocrine-disrupting compounds (Kasonga et al. 2021 ), and non-nutritive artificial sweeteners (Praveena et al. 2019 ). More research efforts are needed to gain a better understanding of the migration, degradation, accumulation characteristics, as well as the potential risks of these contaminants.

Rapid detection of contaminants

Not limited to the detection of microplastics, it is also necessary to develop rapid detection methods for common contaminants. For example, due to the widespread application of pesticides in agriculture, pesticide residue is becoming a serious environment and food safety issue (Farahy et al. 2021 ). Traditionally, food contaminants are detected by instrumental analysis, such as chromatography and mass spectrometry (Ye et al. 2019 ). However, the instrumental analysis process is expensive, complicated, and time-consuming (Zhang et al. 2019 ). Furthermore, the contaminants are usually in low concentration, but can accumulate gradually in human bodies via bioconcentration. Therefore, it is important to develop rapid method to detect trace-level concentration of food contaminants. Biosensor is an emerging and promising technology in detecting food contaminants such as pesticides, and a variety of biosensors have been developed in recent years (Majdinasab et al. 2018 , 2019 ). For example, Ouyang et al. (Ouyang et al. 2021 ) developed a sensitive biosensor to detect carbendazim pesticide residues based on luminescent resonance energy transfer from aptamer-labelled upconversion nanoparticles to manganese dioxide nanosheets. Capobianco et al. (Capobianco et al. 2021 ) developed an enzyme-linked immunoelectrochemical biosensor to detect pathogenic bacteria in large volume food samples without subsampling. Wang et al. (Wang et al. 2019a ) developed a magnetic quantum dot-based lateral flow biosensor to detect protein toxins in food samples. Kaushal et al. (Kaushal et al. 2019 ) developed a novel biosensor using gold nanorods capped by glycoconjugates which demonstrated potential in optical detection and ablation of foodborne bacteria. Generally, a biosensor is mainly composed of a biological sensing element (also known as bioreceptor), a transducer, and an electrical output system (Santana Oliveira et al. 2019 ; Majdinasab et al. 2021 ). The bioreceptor will interact with the analyte, and the transducer will convert the interaction into a detectable signal, which is then processed and displayed on the output system. Common materials used in the biological element include antibodies, enzymes, nucleic acids, antigens, aptamers, whole cells, and bacteriophage (Arora et al. 2011 ; Rotariu et al. 2016 ; Griesche and Baeumner 2020 ; Singh et al. 2020b . Biosensor technology has obvious advantages compared to traditional detection technologies. It is rapid, highly sensitive and selective, accurate, relatively compact, and easy to operate (Dominguez et al. 2017 ). However, there are still some challenges to widely commercialize biosensors, such as limited lifetime of the biological sensing elements and limited range of analytes that can be detected (Di Nardo and Anfossi 2020 ). Furthermore, as a specific type of biosensor is only effective in detecting a specific type of contaminant, more efforts are needed to develop integrated biosensors which can detect different types of containments simultaneously (Majdinasab et al. 2020 ). In addition to biosensors, there are also a variety of other reported methods for rapid detection of food contaminants, such as surface-enhanced Raman scattering (SERS) (Yao et al. 2021 ), optical sensors based on nanomaterials (Chen et al. 2021a ), hyperspectral imaging technology (He and Sun 2015 ), and perfluorinated compounds (PFCs) (Cai et al. 2021 ).

Environment friendly food packaging materials

As revealed above, food packaging is closely related to food safety. Although there are different kinds of food packaging materials, the non-biodegradable plastic materials (e.g., polyethylene, polypropylene, polyvinyl chloride, polystyrene, polyethylene terephthalate) are the most common ones and are widely used in our daily life (Cazón and Vázquez 2021 ). However, the non-biodegradable plastic materials have caused serious environmental problems, commonly known as white pollution. Especially, because of the coronavirus pandemic, take-out food becomes more popular. As plastic materials are the most common packaging materials for take-out food, the demand for plastic materials increases dramatically. Meanwhile, plastic materials also have food safety issues. It is found that the monomer residues used to make plastic polymers could migrate into food, which could cause health problems (Pilevar et al. 2019 ). Especially, the migration rate is not only affected by the quality of these materials, but also affected by the food properties. In addition to monomer residues, additives in these plastic materials could also migrate into food, causing health risks (Hahladakis et al. 2018 ). For example, bisphenol A, a common additive used in plastics, can adversely affect human endocrine system, block normal cell function, affect thyroid hormone, affect testosterone levels, and could also possibly induce cancer (Huang et al. 2019 ; Vilarinho et al. 2019 ). Another very common additive in plastics is phthalates, which is used as plasticizer to soften the plastics. It is reported that phthalates in plastic bottles could migrate into water, and the amount of migration increases as the storage time increases (Luo et al. 2018 ). Similar to bisphenol A, phthalates can also disrupt human endocrine system and cause bad effects on human health (Wang et al. 2018 ). Not limited to bisphenol A and phthalates, there are many types of plastic additives which could migrate into food and cause food safety issues.

As the conventional non-biodegradable plastics can cause both environmental problems and food safety issues, a lot of studies are carried out to find alternatives to non-biodegradable plastics for food packaging. Biodegradable polymers are regarded as the one of the most promising alternatives for food packaging (Othman 2014 ). As its name indicates, biodegradable polymers can be decomposed by microorganisms. Common biodegradable polymers studied as food packaging materials include but are not limited to polylactic acid (PLA) (Swaroop and Shukla 2018 , 2019 ; Mohamad et al. 2020 ), polybutylene adipate terephthalate (PBAT) (Pattanayaiying et al. 2019 ), polysaccharides (such as starch (Osorio et al. 2019 ; Menzel 2020 ; Saraiva Rodrigues et al. 2020 ), cellulose (Balasubramaniam et al. 2020 ; Riaz et al. 2020 ), pectin (Nešić et al. 2018 ), chitosan (Haghighi et al. 2020 ; Priyadarshi and Rhim 2020 )), polyhydroxyalkanoates (PHAs) such as polyhydroxybutyrate (PHB) (Adeleye et al. 2020 ; Fernandes et al. 2020 ; Shahid et al. 2020 ), polycaprolactone (PCL) (Khalid et al. 2018 ; Mugwagwa and Chimphango 2020 ), and cellulose acetate (Xie and Hung 2018 ; Rajeswari et al. 2020 ).

However, in addition to high production cost, there are some critical technical challenges which must be solved so as to widely commercialize biodegradable polymers and replace conventional plastics (Pérez-Arauz et al. 2019 ). Generally, biodegradable polymers have low thermal stability, low mechanical stability, and poor barrier properties (Risyon et al. 2020 ). One way to improve its performance is to add additives during production. For example, Risyona et al. (Risyon et al. 2020 ) prepared PLA-based film using different concentrations of halloysite nanotubes as additives. They found that the PLA film with 3.0 wt.% of halloysite nanotubes demonstrated optimal properties. Dash et al. (Dash et al. 2019 ) prepared starch and pectin-based film using different concentrations of titanium dioxide nanoparticles. They found that addition of the nanoparticles could effectively improve the mechanical properties and moisture barrier properties of the films. However, similarly to conventional plastics, these additives might also migrate into food (He et al. 2019a ). Another strategy being intensively studied is polymer blending, which integrates the merits of different polymers (de Oliveira et al. 2020 ). For example, Rajeswari et al. (Rajeswari et al. 2020 ) blended polysaccharides and cellulose acetate together, and the resulting film showed improved thermal stability and tensile strength. The prepared films also demonstrated antimicrobial properties towards certain types of microorganisms. Sangroniz et al. (Sangroniz et al. 2018 ) blended poly(butylene adipate-co-terephthalate) with poly(hydroxi amino ether), and the resulting film showed great improvement of barrier properties. However, polymer blending could also have its drawback. For example, if the blending polymers are immiscible with each other, the mechanical strength and barrier properties of the resulting materials will be affected (Corres et al. 2020 ).

Conclusions, challenges, and future research directions

In this review, a scientometric-based statistical study was firstly conducted on the research of environment and food safety, which revealed that the research on environment and food safety was growing steadily from 2001 to 2020. Interestingly, statistical analysis of the most-cited papers, titles, abstracts, keywords, and research areas revealed that the research on environment and food safety is diverse and multidisciplinary. Furthermore, strategies to protect the environment and ensure food safety are discussed, such as controlling the use of chemicals and materials which can produce environment and food contaminates, preventing these contaminants from contacting the food, developing whole process monitoring techniques and platforms, and utilizing the food waste properly. In addition, emerging research topics are discussed, such as emerging contaminants, rapid detection of contaminants, and environment friendly food packaging materials.

Although environment and food safety are receiving growing concern, there are still some very challenging issues. These challenges can be categorized into four parts. Firstly, it is challenging to eliminate environmental pollutions (Hao et al. 2018 ; Christy et al. 2021 ). Air pollution, water pollution, and soil pollution are still serious environmental problems in many parts of the world (Wu et al. 2016 , 2021a ; Rajeswari et al. 2019 ; Shen et al. 2021b ). Although a lot of studies have been carried out, the mechanisms of some pollutions (e.g., haze weather) are still unclear (Shen et al. 2020 ; Wang et al. 2021a ). Secondly, it is challenging to dispose food waste effectively and efficiently. It is reported that a substantial amount of food waste is produced along the food supply chain (Aschemann-Witzel 2016 ; Li et al. 2019 ). Especially, food wastewater typically contains very complex components, and the treatment process is very energy intensive and costly. Thirdly, it is challenging to realize whole-process monitoring of contaminants, due to the diverse contaminants during food cultivation, processing, packaging, transportation, and retailing. Fourthly, the accurate effects of environmental pollution on human health are still unclear, and it is challenging to establish procedures to accurately assess the risks of environmental pollution on human health. For example, it is well reported that ozone pollution and PM2.5 pollution can cause negative effects on human health (Guan et al. 2021 ; Shen et al. 2021a ; Wang et al. 2021b ). However, the underlying mechanisms, accurate assessment procedures, and quantitative studies are still lacking. In order to address these challenges, more research efforts are needed to (1) uncover the underlying mechanisms of contaminant formation, migration and fate; (2) develop more cost-effective and sustainable food waste treatment and utilization technologies, targeting net zero emissions; (3) develop rapid detection methods and in situ monitoring technologies for environment and food safety; and (4) establish health risk assessment models and procedures.

Data availability

All data generated or analyzed during this study are included in this published article.

Adeleye AT, Odoh CK, Enudi OC et al (2020) Sustainable synthesis and applications of polyhydroxyalkanoates (PHAs) from biomass. Process Biochem 96:174–193

Article   CAS   Google Scholar  

Aghilinasrollahabadi K, Salehi M, Fujiwara T (2020) Investigate the influence of microplastics weathering on their heavy metals uptake in stormwater. J Hazard Mater 408:124439. https://doi.org/10.1016/j.jhazmat.2020.124439

Ahmad T, Belwal T, Li L et al (2020) Utilization of wastewater from edible oil industry, turning waste into valuable products: a review. Trends Food Sci Technol 99:21–33. https://doi.org/10.1016/j.tifs.2020.02.017

Akansha J, Nidheesh PV, Gopinath A et al (2020) Treatment of dairy industry wastewater by combined aerated electrocoagulation and phytoremediation process. Chemosphere 253:126652. https://doi.org/10.1016/j.chemosphere.2020.126652

Akhbarizadeh R, Moore F, Monteiro C et al (2020) Occurrence, trophic transfer, and health risk assessment of bisphenol analogues in seafood from the Persian Gulf. Mar Pollut Bull 154:111036. https://doi.org/10.1016/j.marpolbul.2020.111036

Alizadeh-Sani M, Moghaddas Kia E, Ghasempour Z, Ehsani A (2021) Preparation of active nanocomposite film consisting of sodium caseinate, ZnO nanoparticles and Rosemary essential oil for food packaging a0pplications. J Polym Environ 29:588–598. https://doi.org/10.1007/s10924-020-01906-5

Alizadeh-Sani M, Mohammadian E, Rhim J-W, Jafari SM (2020) pH-sensitive (halochromic) smart packaging films based on natural food colorants for the monitoring of food quality and safety. Trends Food Sci Technol 105:93–144. https://doi.org/10.1016/j.tifs.2020.08.014

Álvarez-Lopeztello J, Robles C, del Castillo RF (2020) Microplastic pollution in neotropical rainforest, savanna, pine plantations, and pasture soils in lowland areas of Oaxaca, Mexico: Preliminary results. Ecol Indic 121:107084. https://doi.org/10.1016/j.ecolind.2020.107084

Anast JM, Bobik TA, Schmitz-Esser S (2020) The cobalamin-sependent gene cluster of Listeria monocytogenes: implications for virulence, stress response, and food safety. Front Microbiol 11:60181

Article   Google Scholar  

Anyogu A, Olukorede A, Anumudu C et al (2021) Microorganisms and food safety risks associated with indigenous fermented foods from Africa. Food Control 129:108227. https://doi.org/10.1016/j.foodcont.2021.108227

Arisekar U, Shakila RJ, Shalini R, Jeyasekaran G (2020) Human health risk assessment of heavy metals in aquatic sediments and freshwater fish caught from Thamirabarani River, the Western Ghats of South Tamil Nadu. Mar Pollut Bull 159:111496. https://doi.org/10.1016/j.marpolbul.2020.111496

Arora P, Sindhu A, Dilbaghi N, Chaudhury A (2011) Biosensors as innovative tools for the detection of food borne pathogens. Biosens Bioelectron 28:1–12. https://doi.org/10.1016/j.bios.2011.06.002

Aschemann-Witzel J (2016) Waste not, want not, emit less: reducing food waste in the supply chain and at home can help to reduce carbon emissions. Science (80-) 352:408–409. https://doi.org/10.1126/science.aaf2978

Ayelign A, De Saeger S (2020) Mycotoxins in Ethiopia: current status, implications to food safety and mitigation strategies. Food Control 113:107163. https://doi.org/10.1016/j.foodcont.2020.107163

Badamasi I, Odong R, Masembe C (2019) Implications of increasing pollution levels on commercially important fishes in Lake Victoria. J Great Lakes Res 45:1274–1289. https://doi.org/10.1016/j.jglr.2019.09.024

Badea M, di Modugno F, Floroian L et al (2019) Electrochemical strategies for gallic acid detection: potential for application in clinical, food or environmental analyses. Sci Total Environ 672:129–140. https://doi.org/10.1016/j.scitotenv.2019.03.404

Baki MA, Hossain MM, Akter J et al (2018) Concentration of heavy metals in seafood (fishes, shrimp, lobster and crabs) and human health assessment in Saint Martin Island, Bangladesh. Ecotoxicol Environ Saf 159:153–163. https://doi.org/10.1016/j.ecoenv.2018.04.035

Bala A, Laso J, Abejón R et al (2020) Environmental assessment of the food packaging waste management system in Spain: understanding the present to improve the future. Sci Total Environ 702:134603. https://doi.org/10.1016/j.scitotenv.2019.134603

Balasubramaniam SPL, Patel AS, Nayak B (2020) Surface modification of cellulose nanofiber film with fatty acids for developing renewable hydrophobic food packaging. Food Packag Shelf Life 26:100587. https://doi.org/10.1016/j.fpsl.2020.100587

Bampidis V, Azimonti G, de Lourdes Bastos M et al (2020) Safety and efficacy of methyl cellulose for all animal species. EFSA J 18:e06212. https://doi.org/10.2903/j.efsa.2020.6212

Barnes SJ (2019) Understanding plastics pollution: the role of economic development and technological research. Environ Pollut 249:812–821. https://doi.org/10.1016/j.envpol.2019.03.108

Bilal M, Iqbal HMN (2020) Transportation fate and removal of microplastic pollution – a perspective on environmental pollution. Case Stud Chem Environ Eng 2:100015. https://doi.org/10.1016/j.cscee.2020.100015

Boguniewicz-Zablocka J, Klosok-Bazan I, Callegari A, Capodaglio AG (2020) Snack-food industry effluent pre-treatment for annatto dye and yeast removal: process improvement for effectiveness and sustainability. J Clean Prod 277:124117. https://doi.org/10.1016/j.jclepro.2020.124117

Bonerba E, Panseri S, Arioli F et al (2021) Determination of antibiotic residues in honey in relation to different potential sources and relevance for food inspection. Food Chem 334. https://doi.org/10.1016/j.foodchem.2020.127575

Brennan L, Langley S, Verghese K et al (2020) The role of packaging in fighting food waste: a systematised review of consumer perceptions of packaging. J Clean Prod 281:125276. https://doi.org/10.1016/j.jclepro.2020.125276

Buscaroli E, Braschi I, Cirillo C et al (2021) Reviewing chemical and biological risks in urban agriculture: a comprehensive framework for a food safety assessment of city region food systems. Food Control 126:108085. https://doi.org/10.1016/j.foodcont.2021.108085

Cai Y, Wang Q, Zhou B et al (2021) A review of responses of terrestrial organisms to perfluorinated compounds. Sci Total Environ 793:148565. https://doi.org/10.1016/j.scitotenv.2021.148565

Capobianco JA, Armstrong CM, Lee J, Gehring AG (2021) Detection of pathogenic bacteria in large volume food samples using an enzyme-linked immunoelectrochemical biosensor. Food Control 119:107456. https://doi.org/10.1016/j.foodcont.2020.107456

Cazón P, Vázquez M (2021) Bacterial cellulose as a biodegradable food packaging material: a review. Food Hydrocoll 113:106530. https://doi.org/10.1016/j.foodhyd.2020.106530

Chaturvedi P, Shukla P, Giri BS et al (2021) Prevalence and hazardous impact of pharmaceutical and personal care products and antibiotics in environment: a review on emerging contaminants. Environ Res 194:110664. https://doi.org/10.1016/j.envres.2020.110664

Chen D, Wang T, Ma Y et al (2020) Rapid characterization of heavy metals in single microplastics by laser induced breakdown spectroscopy. Sci Total Environ 743:140850. https://doi.org/10.1016/j.scitotenv.2020.140850

Chen H, Zhang L, Hu Y et al (2021a) Nanomaterials as optical sensors for application in rapid detection of food contaminants, quality and authenticity. Sensors Actuators B Chem 329:129135. https://doi.org/10.1016/j.snb.2020.129135

Chen Y, Awasthi AK, Wei F et al (2021b) Single-use plastics: production, usage, disposal, and adverse impacts. Sci Total Environ 752:141772. https://doi.org/10.1016/j.scitotenv.2020.141772

Cheng H, Chen L, McClements DJ et al (2021) Starch-based biodegradable packaging materials: a review of their preparation, characterization and diverse applications in the food industry. Trends Food Sci Technol 114:70–82. https://doi.org/10.1016/j.tifs.2021.05.017

Christy EJS, Amalraj A, Rajeswari A, Pius A (2021) Enhanced photocatalytic performance of Zr(IV) doped ZnO nanocomposite for the degradation efficiency of different azo dyes. Environ Chem Ecotoxicol 3:31–41. https://doi.org/10.1016/j.enceco.2020.10.005

Chun M, Zhenquan V, Yeong T (2019) Potential use of alkaline hydrogen peroxide in lignocellulosic biomass pretreatment and valorization – a review. Renew Sust Energ Rev 112:75–86. https://doi.org/10.1016/j.rser.2019.04.082

Corguinha APB, de Souza GA, Gonçalves VC et al (2015) Assessing arsenic, cadmium, and lead contents in major crops in Brazil for food safety purposes. J Food Compos Anal 37:143–150. https://doi.org/10.1016/j.jfca.2014.08.004

Corres MÁ, Mayor Á, Sangroniz A et al (2020) Blends based on biodegradable poly(caprolactone) with outstanding barrier properties for packaging applications: the role of free volume and interactions. Eur Polym J 135:109869. https://doi.org/10.1016/j.eurpolymj.2020.109869

Damalas CA, Eleftherohorinos IG (2011) Pesticide exposure, safety issues, and risk assessment indicators. Int. J. Environ. Res. Public Health 8:1402–1419

CAS   Google Scholar  

Dash KK, Ali NA, Das D, Mohanta D (2019) Thorough evaluation of sweet potato starch and lemon-waste pectin based-edible films with nano-titania inclusions for food packaging applications. Int J Biol Macromol 139:449–458. https://doi.org/10.1016/j.ijbiomac.2019.07.193

De Oliveira MJ, Boué G, Prévost H et al (2021) Environmental monitoring program to support food microbiological safety and quality in food industries: a scoping review of the research and guidelines. Food Control 130:108283. https://doi.org/10.1016/j.foodcont.2021.108283

de Oliveira TV, de Freitas PAV, Pola CC et al (2020) Development and optimization of antimicrobial active films produced with a reinforced and compatibilized biodegradable polymers. Food Packag Shelf Life 24:100459. https://doi.org/10.1016/j.fpsl.2019.100459

Delaporte G, Cladière M, Camel V (2019) Untargeted food chemical safety assessment: a proof-of-concept on two analytical platforms and contamination scenarios of tea. Food Control 98:510–519. https://doi.org/10.1016/j.foodcont.2018.12.004

Deshwal GK, Panjagari NR (2020) Review on metal packaging: materials, forms, food applications, safety and recyclability. J Food Sci Technol 57:2377–2392. https://doi.org/10.1007/s13197-019-04172-z

Di Nardo F, Anfossi L (2020) Commercial biosensors for detection of food additives, contaminants, and pathogens. Elsevier Inc.

Dominguez RB, Hayat A, Alonso GA, et al (2017) Nanomaterial-based biosensors for food contaminant assessment. Elsevier Inc.

Du F, Cai H, Zhang Q et al (2020) Microplastics in take-out food containers. J Hazard Mater 399:122969. https://doi.org/10.1016/j.jhazmat.2020.122969

Endersen L, Coffey A (2020) The use of bacteriophages for food safety. Curr Opin Food Sci 36:1–8. https://doi.org/10.1016/j.cofs.2020.10.006

Farahy O, Laghfiri M, Bourioug M, Aleya L (2021) Overview of pesticide use in Moroccan apple orchards and its effects on the environment. Curr Opin Environ Sci Heal 19:100223. https://doi.org/10.1016/j.coesh.2020.10.011

Feng XC, Bao X, Che L, Wu QL (2021) Enhance biological nitrogen and phosphorus removal in wastewater treatment process by adding food waste fermentation liquid as external carbon source. Biochem Eng J 165:107811. https://doi.org/10.1016/j.bej.2020.107811

Fernandes M, Salvador A, Alves MM, Vicente AA (2020) Factors affecting polyhydroxyalkanoates biodegradation in soil. Polym Degrad Stab 182:109408

Frederiksen M, Vorkamp K, Thomsen M, Knudsen LE (2009) Human internal and external exposure to PBDEs - a review of levels and sources. Int J Hyg Environ Health 212:109–134

Friedman M (2003) Chemistry, biochemistry, and safety of acrylamide. A review. J Agric Food Chem 51:4504–4526

Frische T, Matezki S, Wogram J (2014) Environmental risk assessment of pesticide mixtures under regulation 1107/2009/EC: a regulatory review by the German Federal Environment Agency (UBA). J fur Verbraucherschutz und Leb 9:377–389. https://doi.org/10.1007/s00003-014-0916-6

Fung F, Wang HS, Menon S (2018) Food safety in the 21st century. Biom J 41:88–95. https://doi.org/10.1016/j.bj.2018.03.003

Gallo M, Ferrara L, Calogero A et al (2020) Relationships between food and diseases: what to know to ensure food safety. Food Res Int 137:109414. https://doi.org/10.1016/j.foodres.2020.109414

Gandhi M, Chikindas ML (2007) Listeria: a foodborne pathogen that knows how to survive. Int J Food Microbiol 113:1–15

Geueke B, Groh K, Muncke J (2018) Food packaging in the circular economy: overview of chemical safety aspects for commonly used materials. J Clean Prod 193:491–505. https://doi.org/10.1016/j.jclepro.2018.05.005

Gholamhosseini A, Shiry N, Soltanian S, Banaee M (2021) Bioaccumulation of metals in marine fish species captured from the northern shores of the Gulf of Oman, Iran. Reg Stud Mar Sci 41:101599. https://doi.org/10.1016/j.rsma.2020.101599

Griesche C, Baeumner AJ (2020) Biosensors to support sustainable agriculture and food safety. TrAC - Trends Anal Chem 128:115906. https://doi.org/10.1016/j.trac.2020.115906

Guan Y, Xiao Y, Wang F et al (2021) Health impacts attributable to ambient PM2.5 and ozone pollution in major Chinese cities at seasonal-level. J Clean. Prod 311:127510. https://doi.org/10.1016/j.jclepro.2021.127510

Haghighi H, Licciardello F, Fava P et al (2020) Recent advances on chitosan-based films for sustainable food packaging applications. Food Packag Shelf Life 26:100551

Hahladakis JN, Velis CA, Weber R et al (2018) An overview of chemical additives present in plastics: migration, release, fate and environmental impact during their use, disposal and recycling. J Hazard Mater 344:179–199

Halagarda M, Kędzior W, Pyrzyńska E (2018) Nutritional value and potential chemical food safety hazards of selected Polish sausages as influenced by their traditionality. Meat Sci 139:25–34. https://doi.org/10.1016/j.meatsci.2018.01.006

Hao X, Zhang X, Cao X et al (2018) Characterization and carcinogenic risk assessment of polycyclic aromatic and nitro-polycyclic aromatic hydrocarbons in exhaust emission from gasoline passenger cars using on-road measurements in Beijing, China. Sci Total Environ 645:347–355. https://doi.org/10.1016/j.scitotenv.2018.07.113

He H-J, Sun D-W (2015) Hyperspectral imaging technology for rapid detection of various microbial contaminants in agricultural and food products. Trends Food Sci Technol 46:99–109. https://doi.org/10.1016/j.tifs.2015.08.001

He JF, Lv XG, Lin QB et al (2019a) Migration of metal elements from polylactic acid dinner plate into acidic food simulant and its safety evaluation. Food Packag Shelf Life 22:100381. https://doi.org/10.1016/j.fpsl.2019.100381

He LY, Ying GG, Liu YS et al (2016) Discharge of swine wastes risks water quality and food safety: antibiotics and antibiotic resistance genes from swine sources to the receiving environments. Environ Int 92–93:210–219. https://doi.org/10.1016/j.envint.2016.03.023

He M, Shen H, Li Z et al (2019b) Ten-year regional monitoring of soil-rice grain contamination by heavy metals with implications for target remediation and food safety. Environ Pollut 244:431–439. https://doi.org/10.1016/j.envpol.2018.10.070

Hong HA, Le HD, Cutting SM (2005) The use of bacterial spore formers as probiotics. FEMS Microbiol Rev 29:813–835

Huang W, Zhao C, Zhong H et al (2019) Bisphenol S induced epigenetic and transcriptional changes in human breast cancer cell line MCF-7. Environ Pollut 246:697–703. https://doi.org/10.1016/j.envpol.2018.12.084

Humphrey T, O’Brien S, Madsen M (2007) Campylobacters as zoonotic pathogens: a food production perspective. Int J Food Microbiol 117:237–257

Imathiu S (2020) Benefits and food safety concerns associated with consumption of edible insects. NFS J 18:1–11. https://doi.org/10.1016/j.nfs.2019.11.002

Järup L, Åkesson A (2009) Current status of cadmium as an environmental health problem. Toxicol Appl Pharmacol 238:201–208

Jiang S, Hagesteijn KFL, Ni J, Ladewig BP (2018) A scientometric study of the research on ion exchange membranes. RSC Adv 8:24036–24048. https://doi.org/10.1039/c8ra04686g

Jiang S, Sun H, Wang H et al (2021) A comprehensive review on the synthesis and applications of ion exchange membranes. Chemosphere 282:130817. https://doi.org/10.1016/j.chemosphere.2021.130817

Kamali M, Jahaninafard D, Mostafaie A et al (2020) Scientometric analysis and scientific trends on biochar application as soil amendment. Chem Eng J 395:125128. https://doi.org/10.1016/j.cej.2020.125128

Kang S, Ravensdale JT, Coorey R et al (2020) Bacterial community analysis using 16S rRNA amplicon sequencing in the boning room of Australian beef export abattoirs. Int J Food Microbiol 332:108779. https://doi.org/10.1016/j.ijfoodmicro.2020.108779

Kasonga TK, Coetzee MAA, Kamika I et al (2021) Endocrine-disruptive chemicals as contaminants of emerging concern in wastewater and surface water: a review. J Environ Manag 277:111485. https://doi.org/10.1016/j.jenvman.2020.111485

Kathariou S (2002) Listeria monocytogenes virulence and pathogenicity, a food safety perspective. J Food Prot 65:1811–1829

Kaushal S, Priyadarshi N, Pinnaka AK et al (2019) Glycoconjugates coated gold nanorods based novel biosensor for optical detection and photothermal ablation of food borne bacteria. Sensors Actuators B Chem 289:207–215. https://doi.org/10.1016/j.snb.2019.03.096

Kawacka I, Olejnik-Schmidt A, Schmidt M, Sip A (2020) Effectiveness of phage-based inhibition of listeria monocytogenes in food products and food processing environments. Microorganisms 8:1–20

Kenawy ER, Worley SD, Broughton R (2007) The chemistry and applications of antimicrobial polymers: a state-of-the-art review. Biomacromolecules 8:1359–1384

Khalaj M, Kamali M, Costa MEV, Capela I (2020) Green synthesis of nanomaterials - a scientometric assessment. J Clean Prod 267:122036. https://doi.org/10.1016/j.jclepro.2020.122036

Khalid S, Yu L, Feng M et al (2018) Development and characterization of biodegradable antimicrobial packaging films based on polycaprolactone, starch and pomegranate rind hybrids. Food Packag Shelf Life 18:71–79. https://doi.org/10.1016/j.fpsl.2018.08.008

Koch N, Islam NF, Sonowal S et al (2021) Environmental antibiotics and resistance genes as emerging contaminants: methods of detection and bioremediation. Curr Res Microb Sci 2:100027. https://doi.org/10.1016/j.crmicr.2021.100027

Koopmans M, Duizer E (2004) Foodborne viruses: an emerging problem. Int J Food Microbiol 90:23–41. https://doi.org/10.1016/S0168-1605(03)00169-7

Korkmaz C, Ay Ö, Ersoysal Y et al (2019) Heavy metal levels in muscle tissues of some fish species caught from north-east Mediterranean: evaluation of their effects on human health. J Food Compos Anal 81:1–9. https://doi.org/10.1016/j.jfca.2019.04.005

Kumar M, Xiong X, He M et al (2020) Microplastics as pollutants in agricultural soils. Environ Pollut 265:114980. https://doi.org/10.1016/j.envpol.2020.114980

Lacey LA, Frutos R, Kaya HK, Vail P (2001) Insect pathogens as biological control agents: do they have a future? Biol Control 21:230–248. https://doi.org/10.1006/bcon.2001.0938

Lang M, Yu X, Liu J et al (2020) Fenton aging significantly affects the heavy metal adsorption capacity of polystyrene microplastics. Sci Total Environ 722:137762. https://doi.org/10.1016/j.scitotenv.2020.137762

Lee CBTL, Wu TY (2021) A review on solvent systems for furfural production from lignocellulosic biomass. Renew Sust Energ Rev 137:110172. https://doi.org/10.1016/j.rser.2020.110172

Lee CBTL, Wu TY, Cheng CK et al (2021) Nonsevere furfural production using ultrasonicated oil palm fronds and aqueous choline chloride-oxalic acid. Ind Crop Prod 166:113397. https://doi.org/10.1016/j.indcrop.2021.113397

Li J, Song Y, Cai Y (2020a) Focus topics on microplastics in soil: analytical methods, occurrence, transport, and ecological risks. Environ Pollut 257:113570. https://doi.org/10.1016/j.envpol.2019.113570

Li JF, Huang YF, Ding Y et al (2010) Shell-isolated nanoparticle-enhanced Raman spectroscopy. Nature 464:392–395. https://doi.org/10.1038/nature08907

Li S, Zhao S, Yan S et al (2019) Food processing wastewater purification by microalgae cultivation associated with high value-added compounds production —a review. Chin J Chem Eng 27:2845–2856. https://doi.org/10.1016/j.cjche.2019.03.028

Li W, Wufuer R, Duo J et al (2020b) Microplastics in agricultural soils: extraction and characterization after different periods of polythene film mulching in an arid region. Sci Total Environ 749:141420. https://doi.org/10.1016/j.scitotenv.2020.141420

Li Y, Jiang S, Wang T et al (2018) Research on biochar via a comprehensive scientometric approach. RSC Adv 8:28700–28709. https://doi.org/10.1039/c8ra05689g

Li Y, Yao J, Nie P et al (2020c) An effective method for the rapid detection of microplastics in soil. Chemosphere 276:128696. https://doi.org/10.1016/j.chemosphere.2020.128696

Likotrafiti E, Oniciuc E, Prieto M et al (2018) Risk assessment of antimicrobial resistance along the food chain through culture-independent methodologies. EFSA J 16:e160811. https://doi.org/10.2903/j.efsa.2018.e160811

Lin Q, Chousalkar KK, McWhorter AR, Khan S (2021) Salmonella Hessarek: an emerging food borne pathogen and its role in egg safety. Food Control 125:107996. https://doi.org/10.1016/j.foodcont.2021.107996

Liu G, Agostinho F, Duan H et al (2020a) Environmental impacts characterization of packaging waste generated by urban food delivery services. A big-data analysis in Jing-Jin-Ji region (China). Waste Manag 117:157–169. https://doi.org/10.1016/j.wasman.2020.07.028

Liu P, Qi S, Li D, Ravenscroft N (2021) Promoting agricultural innovation as a means of improving China’s rural environment. J Environ Manag 280:111675. https://doi.org/10.1016/j.jenvman.2020.111675

Liu X, Sun T, Feng Q, Zhang D (2020b) Dynamic environmental regulation threshold effect of technical progress on China’s environmental pollution. J Clean Prod 272:122780. https://doi.org/10.1016/j.jclepro.2020.122780

Lu Y, Song S, Wang R et al (2015) Impacts of soil and water pollution on food safety and health risks in China. Environ Int 77:5–15. https://doi.org/10.1016/j.envint.2014.12.010

Luo Q, Hua LZ, Yin H et al (2018) Migration and potential risk of trace phthalates in bottled water: a global situation. Water Res 147:362–372

Majdinasab M, Daneshi M, Louis Marty J (2021) Recent developments in non-enzymatic (bio)sensors for detection of pesticide residues: focusing on antibody, aptamer and molecularly imprinted polymer. Talanta 232:122397. https://doi.org/10.1016/j.talanta.2021.122397

Majdinasab M, Hayat A, Marty JL (2018) Aptamer-based assays and aptasensors for detection of pathogenic bacteria in food samples. TrAC Trends Anal Chem 107:60–77. https://doi.org/10.1016/j.trac.2018.07.016

Majdinasab M, Mishra RK, Tang X, Marty JL (2020) Detection of antibiotics in food: new achievements in the development of biosensors. TrAC - Trends Anal Chem 127:115883. https://doi.org/10.1016/j.trac.2020.115883

Majdinasab M, Mitsubayashi K, Marty JL (2019) Optical and electrochemical sensors and biosensors for the detection of quinolones. Trends Biotechnol 37:898–915. https://doi.org/10.1016/j.tibtech.2019.01.004

Mankar AR, Pandey A, Modak A, Pant KK (2021) Pretreatment of lignocellulosic biomass: a review on recent advances. Bioresour Technol 334:125235. https://doi.org/10.1016/j.biortech.2021.125235

Medina S, Pereira JA, Silva P et al (2019) Food fingerprints – a valuable tool to monitor food authenticity and safety. Food Chem 278:144–162. https://doi.org/10.1016/j.foodchem.2018.11.046

Menzel C (2020) Improvement of starch films for food packaging through a three-principle approach: antioxidants, cross-linking and reinforcement. Carbohydr Polym 250. https://doi.org/10.1016/j.carbpol.2020.116828

Mohamad N, Mazlan MM, Tawakkal ISMA et al (2020) Development of active agents filled polylactic acid films for food packaging application. Int J Biol Macromol 163:1451–1457. https://doi.org/10.1016/j.ijbiomac.2020.07.209

Mohd Ali M, Hashim N, Aziz SA, Lasekan O (2020) Emerging non-destructive thermal imaging technique coupled with chemometrics on quality and safety inspection in food and agriculture. Trends Food Sci Technol 105:176–185. https://doi.org/10.1016/j.tifs.2020.09.003

More S, Bampidis V, Benford D et al (2020) Evaluation of existing guidelines for their adequacy for the microbial characterisation and environmental risk assessment of microorganisms obtained through synthetic biology. EFSA J 18:e06263. https://doi.org/10.2903/j.efsa.2020.6263

Motelica L, Ficai D, Ficai A et al (2020) Innovative antimicrobial chitosan/ZnO/Ag NPs/citronella essential oil nanocomposite—potential coating for grapes. Foods 9:1801. https://doi.org/10.3390/foods9121801

Mugwagwa LR, Chimphango AFA (2020) Enhancing the functional properties of acetylated hemicellulose films for active food packaging using acetylated nanocellulose reinforcement and polycaprolactone coating. Food Packag Shelf Life 24:100481. https://doi.org/10.1016/j.fpsl.2020.100481

Mulakkal MC, Castillo Castillo A, Taylor AC et al (2021) Advancing mechanical recycling of multilayer plastics through finite element modelling and environmental policy. Resour Conserv Recycl 166:105371. https://doi.org/10.1016/j.resconrec.2020.105371

Nagajyoti PC, Lee KD, Sreekanth TVM (2010) Heavy metals, occurrence and toxicity for plants: a review. Environ Chem Lett 8:199–216

Nelis JLD, Tsagkaris AS, Dillon MJ et al (2020) Smartphone-based optical assays in the food safety field. TrAC - Trends Anal Chem 129:115934. https://doi.org/10.1016/j.trac.2020.115934

Nešić A, Gordić M, Davidović S et al (2018) Pectin-based nanocomposite aerogels for potential insulated food packaging application. Carbohydr Polym 195:128–135. https://doi.org/10.1016/j.carbpol.2018.04.076

Newell DG, Koopmans M, Verhoef L et al (2010) Food-borne diseases - the challenges of 20years ago still persist while new ones continue to emerge. Int J Food Microbiol 139:S3–S15. https://doi.org/10.1016/j.ijfoodmicro.2010.01.021

Ni J, Steinberger-Wilckens R, Jiang S et al (2021) Novel study on microbial fuel cells via a comprehensive bibliometric and dynamic approach. Rev Environ Health. https://doi.org/10.1515/reveh-2020-0123

Ong VZ, Wu TY (2020) An application of ultrasonication in lignocellulosic biomass valorisation into bio-energy and bio-based products. Renew Sust Energ Rev 132:109924. https://doi.org/10.1016/j.rser.2020.109924

Osorio J, Aznar M, Nerín C (2019) Identification of key odorant compounds in starch-based polymers intended for food contact materials. Food Chem 285:39–45. https://doi.org/10.1016/j.foodchem.2019.01.157

Othman SH (2014) Bio-nanocomposite materials for food packaging applications: types of biopolymer and nano-sized filler. Agric Agric Sci Procedia 2:296–303. https://doi.org/10.1016/j.aaspro.2014.11.042

Ouyang Q, Wang L, Ahmad W et al (2021) A highly sensitive detection of carbendazim pesticide in food based on the upconversion-MnO2 luminescent resonance energy transfer biosensor. Food Chem 349:129157. https://doi.org/10.1016/j.foodchem.2021.129157

Pan C, Chen H, Lin Q et al (2020) Evaluation of the SERS-based strategy in fast and on-site food safety inspection: qualitative and quantitative analysis of trace unexpected herbicide in complicated herbicide matrix. J Raman Spectrosc. https://doi.org/10.1002/jrs.6026

Patrício Silva AL, Prata JC, Walker TR et al (2021) Increased plastic pollution due to COVID-19 pandemic: challenges and recommendations. Chem Eng J 405:126683. https://doi.org/10.1016/j.cej.2020.126683

Pattanayaiying R, Sane A, Photjanataree P, Cutter CN (2019) Thermoplastic starch/polybutylene adipate terephthalate film coated with gelatin containing nisin Z and lauric arginate for control of foodborne pathogens associated with chilled and frozen seafood. Int J Food Microbiol 290:59–67. https://doi.org/10.1016/j.ijfoodmicro.2018.09.015

Pauk V, Krejčí M, Lemr K (2021) Unified chromatography – mass spectrometry as a versatile tool for determination of food dyes. Anal Chim Acta 1157:338401. https://doi.org/10.1016/j.aca.2021.338401

Pérez-Arauz AO, Aguilar-Rabiela AE, Vargas-Torres A et al (2019) Production and characterization of biodegradable films of a novel polyhydroxyalkanoate (PHA) synthesized from peanut oil. Food Packag Shelf Life 20:100297. https://doi.org/10.1016/j.fpsl.2019.01.001

Pilevar Z, Bahrami A, Beikzadeh S et al (2019) Migration of styrene monomer from polystyrene packaging materials into foods: characterization and safety evaluation. Trends Food Sci Technol 91:248–261

Pires SM, Duarte AS, Hald T (2018) Source attribution and risk assessment of antimicrobial resistance. Microbiol Spectr 6. https://doi.org/10.1128/microbiolspec.arba-0027-2017

Poyatos-Racionero E, Ros-Lis JV, Vivancos JL, Martínez-Máñez R (2018) Recent advances on intelligent packaging as tools to reduce food waste. J Clean Prod 172:3398–3409. https://doi.org/10.1016/j.jclepro.2017.11.075

Praveena SM, Cheema MS, Guo H-R (2019) Non-nutritive artificial sweeteners as an emerging contaminant in environment: a global review and risks perspectives. Ecotoxicol Environ Saf 170:699–707. https://doi.org/10.1016/j.ecoenv.2018.12.048

Primpke S, Christiansen SH, Cowger W et al (2020) Critical assessment of analytical methods for the harmonized and cost-efficient analysis of microplastics. Appl Spectrosc 74:1012–1047. https://doi.org/10.1177/0003702820921465

Priyadarshi R, Rhim JW (2020) Chitosan-based biodegradable functional films for food packaging applications. Innov Food Sci Emerg Technol 62:102346

Purwiyanto AIS, Suteja Y, Trisno et al (2020) Concentration and adsorption of Pb and Cu in microplastics: case study in aquatic environment. Mar Pollut Bull 158:111380. https://doi.org/10.1016/j.marpolbul.2020.111380

Qi J, Fan X-X, Deng D-M et al (2020) Progress in rapid detection techniques using paper-based platforms for food safety. Chin J Anal Chem 48:1616–1624. https://doi.org/10.1016/S1872-2040(20)60064-0

Qin G, Niu Z, Yu J et al (2021) Soil heavy metal pollution and food safety in China: effects, sources and removing technology. Chemosphere 267:129205. https://doi.org/10.1016/j.chemosphere.2020.129205

Qin J, Kim MS, Chao K et al (2017) Subsurface inspection of food safety and quality using line-scan spatially offset Raman spectroscopy technique. Food Control 75:246–254. https://doi.org/10.1016/j.foodcont.2016.12.012

Rajeswari A, Christy EJS, Swathi E, Pius A (2020) Fabrication of improved cellulose acetate-based biodegradable films for food packaging applications. Environ Chem Ecotoxicol 2:107–114. https://doi.org/10.1016/j.enceco.2020.07.003

Rajeswari A, Jackcina Stobel Christy E, Ida Celine Mary G et al (2019) Cellulose acetate based biopolymeric mixed matrix membranes with various nanoparticles for environmental remediation-a comparative study. J Environ Chem Eng 7:103278. https://doi.org/10.1016/j.jece.2019.103278

Rajmohan KVS, Ramya C, Raja Viswanathan M, Varjani S (2019) Plastic pollutants: effective waste management for pollution control and abatement. Curr Opin Environ Sci Heal 12:72–84. https://doi.org/10.1016/j.coesh.2019.08.006

Riaz A, Lagnika C, Luo H et al (2020) Effect of Chinese chives (Allium tuberosum) addition to carboxymethyl cellulose based food packaging films. Carbohydr Polym 235:115944. https://doi.org/10.1016/j.carbpol.2020.115944

Risyon NP, Othman SH, Basha RK, Talib RA (2020) Characterization of polylactic acid/halloysite nanotubes bionanocomposite films for food packaging. Food Packag Shelf Life 23:100450. https://doi.org/10.1016/j.fpsl.2019.100450

Rotariu L, Lagarde F, Jaffrezic-Renault N, Bala C (2016) Electrochemical biosensors for fast detection of food contaminants - trends and perspective. TrAC - Trends Anal Chem 79:80–87. https://doi.org/10.1016/j.trac.2015.12.017

Safiur Rahman M, Solaiman Hossain M, Ahmed MK et al (2019) Assessment of heavy metals contamination in selected tropical marine fish species in Bangladesh and their impact on human health. Environ Nanotechnol Monit Manag 11:100210. https://doi.org/10.1016/j.enmm.2019.100210

Sagbara G, Zabbey N, Sam K, Nwipie GN (2020) Heavy metal concentration in soil and maize (Zea mays L.) in partially reclaimed refuse dumpsite ‘borrow-pit’ in Port Harcourt, Nigeria. Environ Technol Innov 18:100745. https://doi.org/10.1016/j.eti.2020.100745

Saha N, Mollah MZI, Alam MF, Safiur Rahman M (2016) Seasonal investigation of heavy metals in marine fishes captured from the Bay of Bengal and the implications for human health risk assessment. Food Control 70:110–118. https://doi.org/10.1016/j.foodcont.2016.05.040

Sangroniz A, Sangroniz L, Aranburu N et al (2018) Blends of biodegradable poly(butylene adipate-co-terephthalate) with poly(hydroxi amino ether) for packaging applications: miscibility, rheology and transport properties. Eur Polym J 105:348–358. https://doi.org/10.1016/j.eurpolymj.2018.06.016

Santana Oliveira I, da Silva Junior AG, de Andrade CAS, Lima Oliveira MD (2019) Biosensors for early detection of fungi spoilage and toxigenic and mycotoxins in food. Curr Opin Food Sci 29:64–79. https://doi.org/10.1016/j.cofs.2019.08.004

Saraiva Rodrigues SC, da Silva AS, de Carvalho LH et al (2020) Morphological, structural, thermal properties of a native starch obtained from babassu mesocarp for food packaging application. J Mater Res Technol 9:15670–15678. https://doi.org/10.1016/j.jmrt.2020.11.030

Sarker A, Deepo DM, Nandi R et al (2020) A review of microplastics pollution in the soil and terrestrial ecosystems: a global and Bangladesh perspective. Sci Total Environ 733:139296. https://doi.org/10.1016/j.scitotenv.2020.139296

Scaria J, Gopinath A, Nidheesh PV (2021) A versatile strategy to eliminate emerging contaminants from the aqueous environment: heterogeneous Fenton process. J Clean Prod 278:124014. https://doi.org/10.1016/j.jclepro.2020.124014

Shahid S, Razzaq S, Farooq R, Nazli ZIH (2020) Polyhydroxyalkanoates: next generation natural biomolecules and a solution for the world’s future economy. Int J Biol Macromol 166:297–321

Shen J, Zhao Q, Cheng Z et al (2020) Insights into source origins and formation mechanisms of nitrate during winter haze episodes in the Yangtze River Delta. Sci Total Environ 741:140187. https://doi.org/10.1016/j.scitotenv.2020.140187

Shen X, Hao J, Kong L et al (2021a) Variation characteristics of fine particulate matter and its components in diesel vehicle emission plumes. J Environ Sci 107:138–149. https://doi.org/10.1016/j.jes.2021.01.034

Shen X, Shi Y, Kong L et al (2021b) Particle number emissions from light-duty gasoline vehicles in Beijing, China. Sci Total Environ 773:145663. https://doi.org/10.1016/j.scitotenv.2021.145663

Sicherer SH, Sampson HA (2014) Food allergy: epidemiology, pathogenesis, diagnosis, and treatment. J Allergy Clin Immunol 133:291–307

Silveira RF, Roque-Borda CA, Vicente EF (2021) Antimicrobial peptides as a feed additive alternative to animal production, food safety and public health implications: an overview. Anim Nutr. https://doi.org/10.1016/j.aninu.2021.01.004

Silvestre C, Duraccio D, Cimmino S (2011) Food packaging based on polymer nanomaterials. Prog Polym Sci 36:1766–1782

Singh H, Bhardwaj SK, Khatri M et al (2020a) UVC radiation for food safety: an emerging technology for the microbial disinfection of food products. Chem Eng J 417:128084. https://doi.org/10.1016/j.cej.2020.128084

Singh S, Dhanjal DS, Sonali et al (2020b) An insight in bacteriophage based biosensors with focus on their detection methods and recent advancements. Environ Technol Innov 20:101081. https://doi.org/10.1016/j.eti.2020.101081

Song Y, Yang T, Li Z et al (2020) Research on the direct and indirect effects of environmental regulation on environmental pollution: empirical evidence from 253 prefecture-level cities in China. J Clean Prod 269:122425. https://doi.org/10.1016/j.jclepro.2020.122425

Stoica M, Marian Antohi V, Laura Zlati M, Stoica D (2020) The financial impact of replacing plastic packaging by biodegradable biopolymers - a smart solution for the food industry. J Clean Prod 277:124013. https://doi.org/10.1016/j.jclepro.2020.124013

Su YC, Liu C (2007) Vibrio parahaemolyticus: a concern of seafood safety. Food Microbiol 24:549–558

Suhani I, Sahab S, Srivastava V, Singh RP (2021) Impact of cadmium pollution on food safety and human health. Curr Opin Toxicol 27:1–7. https://doi.org/10.1016/j.cotox.2021.04.004

Suman M, Cavanna D, Sammarco G et al (2021) Fighting food frauds exploiting chromatography-mass spectrometry technologies: scenario comparison between solutions in scientific literature and real approaches in place in industrial facilities. TrAC Trends Anal Chem 142:116305. https://doi.org/10.1016/j.trac.2021.116305

Sun F, DAI Y, Yu X (2017) Air pollution, food production and food security: a review from the perspective of food system. J Integr Agric 16:2945–2962

Swaroop C, Shukla M (2019) Development of blown polylactic acid-MgO nanocomposite films for food packaging. Compos Part A Appl Sci Manuf 124:105482. https://doi.org/10.1016/j.compositesa.2019.105482

Swaroop C, Shukla M (2018) Nano-magnesium oxide reinforced polylactic acid biofilms for food packaging applications. Int J Biol Macromol 113:729–736. https://doi.org/10.1016/j.ijbiomac.2018.02.156

Titchou FE, Zazou H, Afanga H et al (2021) Removal of persistent organic pollutants (POPs) from water and wastewater by adsorption and electrocoagulation process. Groundw Sustain Dev 13:100575. https://doi.org/10.1016/j.gsd.2021.100575

Tompkin RB (2002) Control of Listeria monocytogenes in the food-processing environment. J Food Prot 65:709–725

Tóth G, Hermann T, Da Silva MR, Montanarella L (2016) Heavy metals in agricultural soils of the European Union with implications for food safety. Environ Int 88:299–309. https://doi.org/10.1016/j.envint.2015.12.017

Tsai MY, Lin CF, Yang WC et al (2019) Health risk assessment of banned veterinary drugs and quinolone residues in shrimp through liquid chromatography-tandem mass spectrometry. Appl Sci 9:2463. https://doi.org/10.3390/app9122463

Van Boxstael S, Habib I, Jacxsens L et al (2013) Food safety issues in fresh produce: bacterial pathogens, viruses and pesticide residues indicated as major concerns by stakeholders in the fresh produce chain. Food Control 32:190–197. https://doi.org/10.1016/j.foodcont.2012.11.038

Van Cauwenberghe L, Janssen CR (2014) Microplastics in bivalves cultured for human consumption. Environ Pollut 193:65–70. https://doi.org/10.1016/j.envpol.2014.06.010

van Wesenbeeck CFA, Keyzer MA, van Veen WCM, Qiu H (2021) Can China’s overuse of fertilizer be reduced without threatening food security and farm incomes? Agric Syst 190:103093. https://doi.org/10.1016/j.agsy.2021.103093

Velusamy A, Satheesh Kumar P, Ram A, Chinnadurai S (2014) Bioaccumulation of heavy metals in commercially important marine fishes from Mumbai Harbor, India. Mar Pollut Bull 81:218–224. https://doi.org/10.1016/j.marpolbul.2014.01.049

Vilarinho F, Sendón R, van der Kellen A et al (2019) Bisphenol A in food as a result of its migration from food packaging. Trends Food Sci Technol 91:33–65

Vipham JL, Amenu K, Alonso S et al (2020) No food security without food safety: lessons from livestock related research. Glob Food Sec 26:100382. https://doi.org/10.1016/j.gfs.2020.100382

Vitale G, Mosna D, Bottani E et al (2018) Environmental impact of a new industrial process for the recovery and valorisation of packaging materials derived from packaged food waste. Sustain Prod Consum 14:105–121. https://doi.org/10.1016/j.spc.2018.02.001

Wainaina S, Horváth IS, Taherzadeh MJ (2018) Biochemicals from food waste and recalcitrant biomass via syngas fermentation: a review. Bioresour Technol 248:113–121. https://doi.org/10.1016/j.biortech.2017.06.075

Wang C, Xiao R, Wang S et al (2019a) Magnetic quantum dot based lateral flow assay biosensor for multiplex and sensitive detection of protein toxins in food samples. Biosens Bioelectron 146:111754. https://doi.org/10.1016/j.bios.2019.111754

Wang L, Luo D, Liu X et al (2021a) Effects of PM2.5 exposure on reproductive system and its mechanisms. Chemosphere 264:128436. https://doi.org/10.1016/j.chemosphere.2020.128436

Wang P, Chen H, Kopittke PM, Zhao F-J (2019b) Cadmium contamination in agricultural soils of China and the impact on food safety. Environ Pollut 249:1038–1048. https://doi.org/10.1016/j.envpol.2019.03.063

Wang R, Han X, Pang H et al (2021b) Illuminating a time-response mechanism in mice liver after PM2.5 exposure using metabolomics analysis. Sci Total Environ 767:144485. https://doi.org/10.1016/j.scitotenv.2020.144485

Wang W, Leung AOW, Chu LH, Wong MH (2018) Phthalates contamination in China: status, trends and human exposure-with an emphasis on oral intake. Environ Pollut 238:771–782

Wang Y, Wang X, Li Y et al (2021c) Effects of exposure of polyethylene microplastics to air, water and soil on their adsorption behaviors for copper and tetracycline. Chem Eng J 404:126412. https://doi.org/10.1016/j.cej.2020.126412

Weidemaier K, Carruthers E, Curry A et al (2015) Real-time pathogen monitoring during enrichment: a novel nanotechnology-based approach to food safety testing. Int J Food Microbiol 198:19–27. https://doi.org/10.1016/j.ijfoodmicro.2014.12.018

Weir A, Westerhoff P, Fabricius L et al (2012) Titanium dioxide nanoparticles in food and personal care products. Environ Sci Technol 46:2242–2250. https://doi.org/10.1021/es204168d

Weng X, Neethirajan S (2017) Ensuring food safety: quality monitoring using microfluidics. Trends Food Sci Technol 65:10–22. https://doi.org/10.1016/j.tifs.2017.04.015

Wohner B, Gabriel VH, Krenn B et al (2020) Environmental and economic assessment of food-packaging systems with a focus on food waste. Case study on tomato ketchup. Sci Total Environ 738:139846. https://doi.org/10.1016/j.scitotenv.2020.139846

Woraprayote W, Pumpuang L, Tosukhowong A et al (2018) Antimicrobial biodegradable food packaging impregnated with Bacteriocin 7293 for control of pathogenic bacteria in pangasius fish fillets. LWT Food Sci Technol 89:427–433. https://doi.org/10.1016/j.lwt.2017.10.026

Wu B, Shen X, Cao X et al (2016) Characterization of the chemical composition of PM2.5 emitted from on-road China III and China IV diesel trucks in Beijing, China. Sci Total Environ 551–552:579–589. https://doi.org/10.1016/j.scitotenv.2016.02.048

Wu B, Xuan K, Zhang X et al (2021a) Mass absorption cross-section of black carbon from residential biofuel stoves and diesel trucks based on real-world measurements. Sci Total Environ 784:147225. https://doi.org/10.1016/j.scitotenv.2021.147225

Wu M, Yang C, Du C, Liu H (2020a) Microplastics in waters and soils: occurrence, analytical methods and ecotoxicological effects. Ecotoxicol Environ Saf 202:110910. https://doi.org/10.1016/j.ecoenv.2020.110910

Wu MY-C, Hsu M-Y, Chen S-J et al (2017) Point-of-care detection devices for food safety monitoring: proactive disease prevention. Trends Biotechnol 35:288–300. https://doi.org/10.1016/j.tibtech.2016.12.005

Wu ST, Hammons SR, Silver R et al (2020b) Retail deli managers and associates have better food safety culture in stores with lower Listeria monocytogenes contamination. Food Control 110:106983. https://doi.org/10.1016/j.foodcont.2019.106983

Wu Z, Pu H, Sun D-W (2021b) Fingerprinting and tagging detection of mycotoxins in agri-food products by surface-enhanced Raman spectroscopy: principles and recent applications. Trends Food Sci Technol 110:393–404. https://doi.org/10.1016/j.tifs.2021.02.013

Xie J, Hung YC (2018) UV-A activated TiO2 embedded biodegradable polymer film for antimicrobial food packaging application. Lwt 96:307–314. https://doi.org/10.1016/j.lwt.2018.05.050

Yao L, Ouyang L, Lv J et al (2021) Rapid and sensitive SERS detection of food contaminants by using nano-Ag aggregates with controllable hydrophobicity. Microchem J 166:106221. https://doi.org/10.1016/j.microc.2021.106221

Yao X, Wang K, Zhang S et al (2020) Degradation of the mixture of ethyl formate, propionic aldehyde, and acetone by Aeromonas salmonicida: a novel microorganism screened from biomass generated in the citric acid fermentation industry. Chemosphere 258:127320. https://doi.org/10.1016/j.chemosphere.2020.127320

Yasotha A, Dabadé DS, Singh VP, Sivakumar T (2020) Risk assessment of heavy metals in milk from cows reared around industrial areas in India. Environ Geochem Health. https://doi.org/10.1007/s10653-020-00758-1

Ye FF, Yang LH, Wang YM, Chen L (2020) An environmental pollution management method based on extended belief rule base and data envelopment analysis under interval uncertainty. Comput Ind Eng 144:106454. https://doi.org/10.1016/j.cie.2020.106454

Ye Y, Guo H, Sun X (2019) Recent progress on cell-based biosensors for analysis of food safety and quality control. Biosens Bioelectron 126:389–404. https://doi.org/10.1016/j.bios.2018.10.039

Yu B, Wang X, Dong KF et al (2020a) Heavy metal concentrations in aquatic organisms (fishes, shrimp and crabs) and health risk assessment in China. Mar Pollut Bull 159:111505. https://doi.org/10.1016/j.marpolbul.2020.111505

Yu F, Li Y, Huang G et al (2020b) Adsorption behavior of the antibiotic levofloxacin on microplastics in the presence of different heavy metals in an aqueous solution. Chemosphere 260:127650. https://doi.org/10.1016/j.chemosphere.2020.127650

Zakka WP, Abdul Shukor Lim NH, Chau Khun M (2021) A scientometric review of geopolymer concrete. J Clean Prod 280:124353. https://doi.org/10.1016/j.jclepro.2020.124353

Zeb A, Liu W, Wu J et al (2021) Knowledge domain and emerging trends in nanoparticles and plants interaction research: a scientometric analysis. NanoImpact 21:100278. https://doi.org/10.1016/j.impact.2020.100278

Zeng T, Durif F, Robinot E (2021) Can eco-design packaging reduce consumer food waste? an experimental study. Technol Forecast Soc Change 162:120342. https://doi.org/10.1016/j.techfore.2020.120342

Zhang S, Wang J, Yan P et al (2020) Non-biodegradable microplastics in soils: a brief review and challenge. J Hazard Mater 409:124525. https://doi.org/10.1016/j.jhazmat.2020.124525

Zhang X-N, Guo Q-P, Shen X-X et al (2015) Water quality, agriculture and food safety in China: Current situation, trends, interdependencies, and management. J Integr Agric 14:2365–2379. https://doi.org/10.1016/S2095-3119(15)61128-5

Zhang X, Wu D, Zhou X et al (2019) Recent progress in the construction of nanozyme-based biosensors and their applications to food safety assay. TrAC - Trends Anal Chem 121:115668. https://doi.org/10.1016/j.trac.2019.115668

Zhenquan V, Yeong T, Kai K et al (2021) Industrial crops & products A combined pretreatment with ultrasound-assisted alkaline solution and aqueous deep eutectic solvent for enhancing delignification and enzymatic hydrolysis from oil palm fronds. Ind Crop Prod 160:112974. https://doi.org/10.1016/j.indcrop.2020.112974

Zhou X, Wang J, Li H et al (2021) Microplastic pollution of bottled water in China. J Water Process Eng 40:101884. https://doi.org/10.1016/j.jwpe.2020.101884

Zhou Y, Liu X, Wang J (2019) Characterization of microplastics and the association of heavy metals with microplastics in suburban soil of central China. Sci Total Environ 694:133798. https://doi.org/10.1016/j.scitotenv.2019.133798

Zhou Y, Wang J, Zou M et al (2020) Microplastics in soils: a review of methods, occurrence, fate, transport, ecological and environmental risks. Sci Total Environ 748:141368. https://doi.org/10.1016/j.scitotenv.2020.141368

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This work was supported by the Beijing Municipal Commission of Education (grant no. PXM2019_014213_000007) and School Level Cultivation Fund of Beijing Technology and Business University for Distinguished and Excellent Young Scholars (grant no. BTBUYP2020).

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Jiang, ., Wang, F., Li, Q. et al. Environment and food safety: a novel integrative review. Environ Sci Pollut Res 28 , 54511–54530 (2021). https://doi.org/10.1007/s11356-021-16069-6

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Food safety knowledge, attitude, and hygiene practices of street-cooked food handlers in North Dayi District, Ghana

• Lawrence Sena Tuglo 1 ,
• Percival Delali Agordoh 2 ,
• David Tekpor 3 ,
• Zhongqin Pan 1 ,
• Gabriel Agbanyo 3 &
• Minjie Chu   ORCID: orcid.org/0000-0002-7533-9119 1  

Environmental Health and Preventive Medicine volume  26 , Article number:  54 ( 2021 ) Cite this article

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Food safety and hygiene are currently a global health apprehension especially in unindustrialized countries as a result of increasing food-borne diseases (FBDs) and accompanying deaths. This study aimed at assessing knowledge, attitude, and hygiene practices (KAP) of food safety among street-cooked food handlers (SCFHs) in North Dayi District, Ghana.

This was a descriptive cross-sectional study conducted on 407 SCFHs in North Dayi District, Ghana. The World Health Organization’s Five Keys to Safer Food for food handlers and a pretested structured questionnaire were adapted for data collection among stationary SCFHs along principal streets. Significant parameters such as educational status, average monthly income, registered SCFHs, and food safety training course were used in bivariate and multivariate logistic regression models to calculate the power of the relationships observed.

The majority 84.3% of SCFHs were female and 56.0% had not attended a food safety training course. This study showed that 67.3%, 58.2%, and 62.9% of SCFHs had good levels of KAP of food safety, respectively. About 87.2% showed a good attitude of separating uncooked and prepared meal before storage. Good knowledge of food safety was 2 times higher among registered SCFHs compared to unregistered [cOR=1.64, p =0.032]. SCFHs with secondary education were 4 times good at hygiene practices of food safety likened to no education [aOR=4.06, p =0.003]. Above GHc1500 average monthly income earners were 5 times good at hygiene practices of food safety compared to below GHc500 [aOR=4.89, p =0.006]. Registered SCFHs were 8 times good at hygiene practice of food safety compared to unregistered [aOR=7.50, p <0.001]. The odd for good hygiene practice of food safety was 6 times found among SCFHs who had training on food safety courses likened to those who had not [aOR=5.97, p <0.001].

Conclusions

Over half of the SCFHs had good levels of KAP of food safety. Registering as SCFH was significantly associated with good knowledge and hygiene practices of food safety. Therefore, our results may present an imperative foundation for design to increase food safety and hygiene practice in the district, region, and beyond.

Introduction

A report by the World Health Organization (WHO) (2015) showed that about two million incurable cases of food poisoning materialize annually in unindustrialized nations. The WHO further estimates that 600 million food-borne diseases (FBDs) each year were related to poor food safety and hygiene practice with 420,000 deaths [ 1 ], the majority attributed to meat-related vulnerabilities [ 2 ]. About, 76 million FBDs caused 325,000 hospitalizations in the USA which led to 5000 deaths [ 3 ]. The source was associated with the consumption of turkey contaminated by Salmonella enterica serovar Heidelberg , responsible for salmonellosis in the USA [ 4 ]. Almost, 1.3 million FBDs resulted in 21,000 hospital stays reported in England which led to 500 deaths. The contamination was due to sprouts by Escherichia coli O104 [ 3 ]. Around 53% of the food-borne problems and 31% of its associated illness were attributed to meat consumption in the Netherlands [ 2 ]. The rate of FBDs in Malaysia was 47.8% out of 100,000 people who patronized street-cooked foods [ 5 ]. In Ghana, about 65,000 persons including 5000 kids below 5 years died yearly due to FBDs [ 6 ].

The risk factors such as inappropriate time interval, unsuitable temperature, weather condition, unhygienic activities, unacceptable handling of foods, foodstuff from insecure origins, impoverished self-cleanliness, improper cleaning of cooking materials, using untreated water, and improper food storages were attributed to the causes of FBDs [ 7 , 8 , 9 ]. Also, neglect of hygienic measures by food handlers has been implicated as enablers for the spread of pathogenic microorganisms [ 10 ] and the cause of infections among consumers [ 11 ].

Studies recount that 12 to 18% of food-borne illnesses are attributable to contaminations [ 12 , 13 ], poor food safety, and inappropriate hygiene practices which were accredited to street-cooked food handlers (SCFHs) [ 14 , 15 ]. These SCFHs are people who are wholly or partly engaged in the food preparation, processing, and production value chain and who have a direct touch on food and cooking utensils [ 9 , 16 ]. Foods prepared by food handlers under unhygienic conditions become a public health concern both in industrialized and low-income countries [ 17 ]. Food safety and hygienic practices of SCFHs are essential to ensure that food is free from any forms of contamination through preparation and processing for consumption and to prevent the spread of FBDs [ 18 , 19 ].

Food safety knowledge (FSK) is the understanding of food learned from skills or schooling, food safety attitude (FSA) refers to sensation or belief about food safety, and food safety practice refers (FSP) to the act or use of food safety [ 20 ]. Food safety knowledge, attitude, and practices (KAP) are important because inadequate knowledge, poor attitude, and poor sanitation practices by SCFHs have a severe danger to food safety applications in food companies [ 21 ]; hence, KAP of food safety contributes significantly to the occurrence of food poisoning and FBDs among consumers [ 22 ].

A study conducted in Brazil among food truck food handlers revealed poor hygiene, poor clean observes, poor environments, and higher contaminated meals [ 23 ]. The problem of FBDs was higher in Southeast Asian and African counties [ 24 ]. Ma et al. [ 25 ] study in China, among street food vendors, revealed poor behaviour practices and knowledge of food safety among the respondents. Tabit and Teffo [ 26 ] in South Africa found over 60% of the respondents keep good knowledge and acceptable hygiene performance of food safety. Lema et al. [ 27 ] in Ethiopia reported that below half of the respondents obtained good food cleanliness applications. The effects of food-related illness expenditures in hospital treatments are about US$ 110 billion annually in developing countries, which resulted in decreasing production [ 28 ].

The recurrent happenings of food-related illnesses brought in its wake concerns about the food safety knowledge and hygiene among SCFHs [ 29 ]. Maintaining food safety involves establishing global laws conferring to an agreement between institutions that actualized this agenda [ 30 , 31 ]. The Government of Ghana affirmed food safety regulations in collaboration with the Food and Drug Authority (FDA) [ 30 ]. Yet, its application is undermined due to ineffective supervision by appropriate agencies [ 32 ]. The problem was due to the broad governmental assembly in cities and communities under the local administration [ 31 ]. Some local studies conducted in the four regions of Ghana such as Greater Accra, Northern, Western, and Central have reported adequate knowledge, good attitude, and positive behavioural practices of food safety and handling practices [ 11 , 33 , 34 , 35 ]. Studies have shown that SCFHs were not knowledgeable about the WHO’s Five Keys to Safer Food for food handlers [ 33 , 36 ] which include keeping clean, separating raw and cooked food, cooking thoroughly, keeping food at safe temperatures, and using safe water and raw materials [ 37 ].

Hence, the acceptance and the use of the KAP instrument as a problem-solving approach in this study are validated from previous researches [ 23 , 38 , 39 ]. This would adequately support the policymaking development and the change of embattled intervention policies for the prevention and control of FBDs. The KAP’s tool assessment defined in this study is considered appropriate to other frameworks if the statements in the KAP’s sections are validated. To our knowledge, no research has yet been done on KAP of food safety among SCFHs selling commonly consumable foods on the street in Volta Region, Ghana. Hitherto, the high cases of FBDs such as diarrhoea, cholera, and typhoid fever outbreak occurrences in the district are presumed to be influenced by SCFHs. The KAP of SCFHs on food safety and hygiene precautions ruins uncertainty in the district, and a swift policy to mend some causes central to the occurrence of FBDs is obligatory. This would help the District Health Directorate’s regulatory agency to plan the prevention methods. Therefore, this study assessed knowledge, attitude, and hygiene practices of food safety on SCFHs in North Dayi District, Ghana.

Materials and methods

Study design and setting.

This study was a descriptive cross-sectional carried out between August and November 2020 and used a validated, pretested, and structured questionnaire to collect data from stationary SCFHs along the principal streets within North Dayi District. North Dayi District is one of the 18 administrative districts in the Volta Region, Ghana [ 40 ]. It shares boundaries with Kpando Municipal to the north, South Dayi District to the south, and Afadzato South District to the east. The entire residents of the North Dayi District are 39,913 covering 46.7% men and 53.3% women [ 40 ]. The people of the District constitute 1.9% of the total population of the Volta Region [ 40 ]. Farming is the foremost financial activity, making it one of the main sources of income in the district [ 40 ]. We carried out this study because of the recent cases of food-borne illness reported among the residents such as diarrhoea, cholera, and typhoid fever in the district [ 41 ].

Eligibility criteria

Stationary SCFHs who directly served already cooked food to customers and those who owned their outlets were included in the study. SCFHs who dissented to partake in the research were excepted including all assistants and helpers. The assistants and helpers were excluded because not all vendors had assistants or helpers and they tend to be more in numbers than the vendor-owners themselves. So for as not to allow bias in the results, we chose to sample only the vendor-owners. Moreover, vendor-owners tend to have direct responsibility for monitoring the food safety environment of their vending sites; hence, we chose to sample them as the focus of this study.

Sample size and sampling

Cochran’s formula Z 2 p  (1 −  p )/ e 2 [ 42 ] for unknown study populations was used. Since a similar study in the Volta Region of Ghana among the population subgroup is unavailable, 50% was used for response distribution, with 95% confidence level, and a margin of error of 5% for the populace, plus 10% non-response rate which gave us a sample size of 423.

Data collection tools

A structured questionnaire was designed based on different studies conducted globally [ 16 , 20 , 38 , 39 , 43 , 44 , 45 , 46 ]. Similar versions of the questionnaires were used in studies conducted in Ghana [ 47 , 48 , 49 ]. The instrument was distributed into 4 parts: socio-demographics, knowledge, attitude, and hygiene practices. The statements on KAP were adapted from the WHO’s Five Keys to Safer Food guidebook for food handlers [ 37 ]. The questionnaire was firstly designed in English, then converted to local dialects, and translated back to English to ensure reliability and simplicity of the question. Four professionals in the field of the study assessed the face and the content validity of the questionnaire. The questionnaire was pretested on 12 stationary SCFHs in Tanyigbe located 7 km from the study area. The pretesting findings were not added to the main study but were used to modify some questions to improve their clarity. The most pertinent modifications done on the study instrument were a cooked meal should stay hot more than 60°C before serving, putting uncooked and prepared meal separating prevent cross-contamination, and checking and dispose of meal that past their expiry date. The data were collected through trained research assistant-led interviews which lasted for about 25 min per respondent. The interviewer-administered questionnaire was given to the SCFHs who could read and write to answer by themselves while those SCFHs who could not read and write have been aided by the research assistants in answering the questionnaire.

Determination of knowledge, attitude, and hygiene practices on food safety

Section 2 of the questionnaire contained 10 structured questions on knowledge of food safety with 3 likely responses; “true”, “false”, and “do not know”. The questions precisely covered the respondents’ knowledge of individual cleanliness, food-borne illnesses, microbes, infection control, and sanitary practices. Each correct knowledge item reported was awarded a score of 1 point. Incorrect knowledge was awarded a 0 score (including “do not know”). In this study, if “true” is the correct answer, then “true” is score 1 point while “false” is score 0 point or otherwise reverse.

Queries relating to attitudes in the third segment of the questionnaire were designed to assess the knowledge of SCFHs on food wellbeing and hygiene. This part of the section assessed psychological state concerning views, opinion, morals, and characters to act in particular [ 21 , 48 ]. It contains 10 structured queries with 3 likely answers: “agree”, “disagree”, and “not sure”. Each correct attitude reported was awarded a score of 1 point while the other incorrect attitude option was rated a 0 score (including “not sure”). In this study, if “agree” is the correct answer, then “agree” is score 1 point while “disagree” is score 0 point or otherwise reverse.

• Hygiene practice

Section 4 of the questionnaire measured food hygiene and sanitation practices of SCFHs. It contained 10 structured queries with 2 likely answers: “yes” and “no”. Each correct hygiene practice reported was awarded a score of 1 point while incorrect hygiene practices reported were awarded a score of 0. This method of assessment was used in previous studies [ 28 ]. In this study, if “yes” is the correct answer, then “yes” is score 1 point while “no” is score 0 point or otherwise reverse.

The grouping method is appropriate and suitable for studies allied to the assessment “of food handlers” KAP of food safety and hygiene [ 27 , 28 , 34 , 46 , 47 , 50 , 51 , 52 ]. The knowledge and attitude questions with “do not know” or “not sure”, thus the third option, had been presented to enable simplicity of responding by SCFHs for fascinating for thoughts considered by an undecided or doubtfulness [ 28 ]. This third option “do not know” or “not sure” always scores a 0 point due to the cumulative percentage approach adapted which considers only the acceptable response or the correct answer [ 53 ]. The cumulative percentage scoring method of assessment considers only the acceptable answer and the total cumulative score is converted to 100% [ 53 ]. The cumulative scores below 70% of the acceptable responses on WHO’s Five Keys to Safer Food-related knowledge, attitude, and hygiene practices were considered as “poor”, and cumulative scores 70% and higher were considered as “good” [ 27 , 34 , 39 , 46 , 48 ].

Data analysis

Questionnaires were checked manually before entering into Microsoft Excel 2016 spreadsheet. Coding and analysis were done in IBM Statistical Package for Social Sciences (SPSS Inc., Chicago, USA; https://www.spss.com ) version 24.0. Categorical variables were expressed as frequency and percentage. The disparity between categorical variable groups was verified using the Fisher exact or chi-square test where appropriate. Significant parameters were used in bivariate and multivariate logistic regression models to calculate the power of the relationships observed. A p -value <0.05 was considered statistically significant.

Ethical consideration

Approval was sought from Ghana Health Service, North Dayi District Health Directorate, with the identity (NDDHD/GR/002/20) 15/07/2020. The research assistants introduced themselves and written informed permission was sought from the respondents. The research method was plainly explained to the respondents in their native dialects (English, Ewe, or Twi). Participants were identified by study numbers. The study numbers of the participants were kept in both locked files and secured computer files and accessible only to key investigators. All data were anonymized and unlinked to the respondents’ identities during the data analysis.

Demographic data

A total complete of 423 questionnaires were conveniently distributed for data collection based on the availability of SCFHs at their dedicated vending sites. Questionnaires of 407 were fully answered and collected from the respondents with a 96.2% (407/423) success rate. n = Z 2 p  (1 −  p )/ e 2   = 1.96 2 0.5 (1 − 0.5)/0.05 2 =384.16+38.416 =422.576. The majority ( n =343; 84.3%) of SCFHs were female, were between the age range of 26 and 35 years ( n =153; 37.6%), and were married ( n =311; 76.4%). Over one-third ( n =144; 35.4%) of SCFHs had attained secondary education. Most ( n =168; 41.3%) of SCFHs earned an average monthly income between GHc501 and GHc1000. Over half ( n =217; 53.3%) of SCFHs had 3–10 years of working experience. Regarding SCFH registered, n =297 (73.0%) reported that they have registered. More than half ( n =228; 56.0%) of SCFHs had not attended a food safety training course (Fig. 1 ).

Demographic data of respondents

Food safety knowledge

Almost all ( n = 381; 93.6%) of SCFHs knew about the washing of hands for 1 min using water and soap before touching food. The majority ( n =313; 76.9%) of SCFHs knew that similar chopping board should not be used for uncooked and prepared foods if it appears wash; n = 336 (82.6%) knew that cooked meal should stay hot before serving (more than 60°C); and n = 275 (67.6%) knew that excess meal should be kept at zone temperature and eat for the following mealtime. Most ( n =239; 58.7%) of SCFHs knew that uncooked meal should be kept individually from a prepared meal; n = 363 (89.2%) knew that treated water should be used for cooking; n = 363 (89.2%) knew that cockroach and house flies should not be allowed into the kitchen; and n = 274 (67.3%) knew that wiping cloths can spread microorganisms and cause disease. However, the majority ( n =235; 57.7%) of SCFHs did not know that food cooking utensils should not be cleaned using tap water only. Also, n = 202 (49.6%) of SCFHs did not know that fresh meat should not be stowed anyplace in the fridge once it is cool (Table 1 ).

Food safety attitude

The majority ( n =277; 68.1%) of SCFHs disagreed that regular hand cleaning throughout meal processing is needless; n = 323 (79.4%) agreed that cleaning kitchen shells lessen the danger of infection, and n = 355 (87.2%) agreed that putting uncooked and prepared meal separating stop infection. Below half ( n =181; 44.5%) of SCFHs agreed that they should be able to differentiate healthy diets and rotten food through eyeing; n =262 (64.4%) disagreed that using different knives and chopping materials for a fresh and prepared meal require more time; n = 366 (89.9%) agreed that they cough or sneeze inside the elbow if towel or paper not available; n = 291 (71.5%) agreed that checking meal for cleanliness and healthiness is important; and n =377 (92.6%) agreed that it is vital to dispose of meals that have gotten to expiring date. Nevertheless, n = 332 (81.6%) of SCFHs agreed that it is acceptable to use the same cloth for dusting and drying and n =217 (53.3%) disagreed that is unhealthy to allow prepared meal stay outside of the fridge for over 2 h (Table 2 ).

Food safety hygiene practice

The majority ( n =343; 84.3%) of SCFHs cleaned their fingers throughout meal cooking; n = 267 (65.6%) washed their cooking utensils used to cook a meal before using for a different meal; n =234 (57.5%) used different cooking bowls and chopping material if cooking a fresh and prepared meal; and n =359 (88.2%) dispersed uncooked and prepared meal before preservation. Also, n =278 (68.3%) keep prepared food at room temperature for 2 h when finished cooking; n =269 (66.1%) checked and disposed of meal past its expiry date; n =372 (91.4%) cleaned fresh food that needs no cooking before consumption; n =320 (78.6%) inspected if a meal is cooked by eyeing; and n =359 (88.2%) examined if a meal is grilled by touching it. Moreover, n =253 (62.2%) used similar kitchen cloth to clean shells and hands (Table 3 ).

SCFH knowledge, attitude, and hygiene practice on food safety classification

A high proportion ( n =274, 67.3%; n =237, 58.2%; and n =256, 62.9%) of SCFHs had good levels in knowledge, attitude, and hygiene practices on food safety (Fig. 2 ).

Levels of respondents’ knowledge, attitude, and hygiene practice on food safety

Association between knowledge, attitude, and hygiene practice and demographic data

Statistical significance was observed in the knowledge section among registered SCFHs ( p =0.031). None of the respondent’s socio-demographic data was statistically significant in the attitude section of food safety p < 0.05. The study found significant differences ( p <0.05) in the hygiene practice scores section with the educational status, average monthly income, registered SCFHs, and SCFHs completing food safety training course of food safety among SCFHs (Table 4 ). The odds ratio showed registered SCFHs were 1.6 times good at food safety knowledge likened to unregistered SCFHs [cOR=1.64 (95% CI 1.04–2.59), p =0.032]. The logistic regression analysis revealed that respondents who had secondary education were 4.1 times good at hygiene practice of food safety [aOR=4.06 (95% CI 1.63–10.11), p =0.003] compared to informal education. The respondents with average monthly income greater than GHc1500 were 4.9 times more likely to have good food safety and hygiene practices compared to those who earned less than Ghc500 average monthly income [aOR=4.89 (95% CI 1.56–15.34), p =0.006]. Meanwhile, registered SCFHs were 7.5 times more likely to have good food safety and hygiene practices compared to unregistered SCFHs [aOR=7.50 (95% CI 4.27–13.19), p <0.001]. The SCFHs who had completed a food safety training course were 6 times more likely to have good food safety and hygiene practices compared to those who had no such training [aOR=5.97 (95% CI 3.50–10.18), p <0.001] (Table 5 ).

Pearson correlation between knowledge, attitude, and hygiene practice toward food safety

The study revealed a positive correlation in the knowledge with the attitude outcomes sections (FSA) of food safety ( r =0.153, p =0.002) (Table 6 ).

The present study investigated knowledge, attitude, and hygiene practices of food safety on SCFHs in North Dayi District of Volta Region, Ghana. This study showed that the majority of SCFHs had good knowledge of food safety. This would help decrease the threat to contamination of foods, food poisoning, and FBDs to the consumers. Studies conducted in Saudi Arabia, Ethiopia, and Ghana have identified the importance of knowledge of food safety to SCFHs and have recommended training programmes on food safety to cultivate the knowledge into hygiene practices [ 14 , 27 , 34 ]. Our finding is inconsistent with previous studies done in Ethiopia and Jordan [ 38 , 45 ], however consistent with studies conducted in Ghana and Malaysia [ 47 , 54 ]. The possible reasons could be the type of food training courses received, the sample size, the scoring rubric applied, and understandings acquired on the subjects. This supported claims, creating an optimistic culture of food safety, inhibit food contamination if incorporated periodically [ 44 , 46 ]. This scenario affirms that the food safety training courses may remarkably enhance the knowledge of food handlers, especially concerning FBDs.

This study found that most of SCFHs knew about the washing of hands for 1 min using liquid and cleanser before touching food, which coincides with the study done in Iran [ 39 ]. The washing of hands with soap and water could reduce contamination of hands, cooking utensils, and cooking preparation surfaces leading to a substantive reduction of the risk of FBDs. Our finding does not corroborate with finding from a study done in Malaysia where a vast majority of SCFHs were knowledgeable of the 4th WHO Five Keys to Safer Food to keep the meal at healthy temperatures [ 20 ]. In our study, the SCFHs wrongly answered that fresh meat should be bestowed at any place in the fridge once it is cool. This misapplication of temperature could result in contamination and possibly proliferating of microbes in food. The reason is that appropriate temperatures can significantly lessen the risk at which foods will deteriorate, thereby preventing FBDs; hence for safety, foods must be held at an appropriate temperature sufficient to slow down the growth of microorganisms or kill microbes.

Attitude is one of the key elements that influence food safety and the practice and lessen the recurrence of food-related illnesses [ 51 ]. This study showed that most of SCFHs had a good attitude toward food safety. It means they understood their roles in food safety which was transmitted into attitude because they possibly serve as a vector for infectious pathogens which lead to food contamination. This agrees with studies conducted in Ghana and Haiti [ 48 , 55 ], but differs from a study done in Malaysia [ 36 ], where the majority of SCFHs had a poor attitude toward food safety. Possibly these could be due to the variances in socio-demographic characteristics, study population, and the study settings. These attitudinal variations could also be due to public reputation preference. Our study showed that visual checking was one of the key ways of differentiating healthy food from rotten ones, which concurs with a study conducted in Iran [ 39 ]. This finding is disturbing because the process of identifying food contamination cannot be performed by visual checking, since pathogens or toxins might be present in those foods without necessarily affecting SCFHs’ sensory aspects (smell, colour, or taste); therefore, food handlers who rely on visual checking for the identification of food contamination might expose consumers to an increased risk of contracting FBDs [ 39 , 56 ]. Therefore, the regulatory authorities must ensure that all SCFHs are trained professionally and certified.

The present study revealed a vast majority of SCFHs agreed that putting uncooked and prepared meal separating prevent cross-contamination, which corresponds to a study done in Haiti [ 55 ]. This act of putting fresh foods separating from cooked food could help prevent cross-contamination, which in turn may prevent infections from happening and halt FBDs. This is one of the highly endorsed public health measures to prevent cross-contamination [ 57 ]. This study found that almost all of SCFHs agreed that they coughed or sneezed into their elbows if a towel or paper is not available. Coughing and sneezing into the elbow or covering coughs and sneezes, and immediately washing the hands, could help to avert the spread of severe respiratory infections such as influenza and whooping cough. Our finding contradicts with other studies conducted in Malaysia and America; they reported that almost all respondents sneezed right away into their hands and never clean it [ 20 , 58 ]. This unpleasant attitude is harmful to the public since sneezing and coughing let out droplets of watery and perhaps transmittable microorganisms which can contaminate foods leading to FBDs.

Preservation of good sanitary behaviours is one of the goals for any food establishment, thereby its observance is vital to ensure safe meals for consumers [ 28 , 59 ]. The proportion of SCFHs in this current study with good hygiene practices of food safety corroborates with previous studies conducted in Saudi Arabia and Ghana [ 21 , 34 ]. This is an indication that SCFHs can be relied upon to act as the first-line responder to prevent several FBDs when they practice what they know. This would help reduce accidental contamination of foodstuffs due to improper management of cooking utensils and surroundings. Contradictory, in the present study, the scores obtained on the practices section were higher than hygiene practices of food safety reported in studies done in China and Nigeria [ 25 , 60 ]. The likely explanations of the difference reported could be as a result of the research population, the study cut-off used, the disparity in food safety courses, and differences in the law enforcement regimes. Our study revealed that the level of hygiene practices score was greater than the level of the attitude score attained by the SCFHs which corresponds to a study conducted in Malaysia [ 15 ]. The probable justification could be the SCFHs tend to provide responses they trust will create a good picture of their hygiene practices which account for the greater level score. The current study revealed that a vast majority of SCFHs washed their cooking utensils used to cook meals before using them for different meals, which is in line with a study done in Iran [ 39 ]. This act is acceptable because food handlers have been mostly identified as a significant vector for food contamination and responsible for FBDs [ 14 , 15 ]. Our study found that SCFHs practised wrongly by using similar kitchen cloth to clean shells and hands at the time which concurs with a study done in Malaysia [ 20 ]. The possible justification could be due to the non-compliance of the respondents to food safety training received. It could also be that they lack understandings of food safety education received. Hence, this displeasing practice may eventually result in contamination of hands and transfers of microorganisms to the consumers. This study showed that a vast majority of SCFHs cleaned fresh food that needs no cooking before consumption, which is in line with a study conducted in Malaysia [ 20 ]. This good hygiene practice is necessary to the elementary control of the spread of possibly FBDs.

Our study revealed a positive relationship between knowledge and the attitude of food safety which corresponds to earlier studies conducted in Malaysia, Iran, and Ghana [ 15 , 39 , 47 ]. Nevertheless, the strength of the correlation identified in the knowledge with the attitude scores of food safety was not strong, which implies that it is vital for the respective agency to monitor SCFH activities and enforce safety standards. Previous studies conducted in Malaysia and Iran found no significant relationship in the knowledge with the hygiene practices of food safety [ 20 , 39 ], which corresponds to our finding but contradicts with studies done in Malaysia and Ghana [ 15 , 47 ]. This result confirms the assertion that good knowledge does not affect the hygiene performance of food safety [ 61 ]. Hence, food handlers should be encouraged by food safety regulatory agencies to at least practise good hygiene irrespective of their levels of knowledge of food safety. In our study, no statistical association was found in the attitudes with the hygiene practice scores of food safety, which opposes earlier studies conducted in Malaysia, Iran, and Ghana [ 39 , 47 , 54 ]. These disparities could be due to their levels of knowledge of food safety and also possibly as a result of the kind of food safety training courses received. This present study found that registered SCFHs were more likely to have good food safety knowledge likened to unregistered SCFHs which is in line with earlier research in Lebanon [ 51 ] but differs in the study done in Malaysia [ 62 ]. The potential explanation is that maybe before SCFHs have been given their certification of registration, they probably have been taken through food safety training courses which provide them with adequate knowledge of food safety and offer them a good understanding of food poisoning, contamination, and hygiene. This shows the importance of registering food handlers who have successfully been through food safety training courses to acquire knowledge on food safety.

This study showed that the odds of good hygiene practices were higher among SCFHs who had secondary education likened to those with no formal education which is in line with a study conducted in Ethiopia [ 12 ]. In contrast to our findings, other studies conducted in Ethiopia and Ghana found SCFHs with primary education as more likely to have good hygiene practices of food safety likened to secondary education [ 27 , 34 ]. The possible reasons are because most food preparation skills, personal hygiene, and cleanliness are learned from friends, relatives, parents, and media but not necessarily from formal education. However, a lower level of education reduces awareness but the higher one gets educated the better the knowledge which affects their attitude and eventually may reflect into hygiene practices. It implies that food handlers should be encouraged to attain at least basic education before engaging into the cooking business, although it serves as the first sources of income for most uneducated people in the societies. Nevertheless, a study conducted in Ghana showed that regardless of educational background, the food safety actions of SCFHs remain an issue in many nations [ 48 ].

The present study showed that SCFHs who earned average monthly income above GHc1500 were more likely to have good hygiene practices compared to respondents who earned less than Ghc500. Our finding confirms a study conducted in Ethiopia and Jordan that found good hygiene practice among food handlers with higher monthly income than those with lower higher monthly income [ 27 , 63 ]. The possible justification is that SCFHs with high monthly income can afford to purchase items needed to establish themselves in hygienic environments and afford more employees to help in cleaning and waste treatment which could result in a reduction in food poisoning and cross-contamination. This means the high monthly income of food handlers determine their ways of hygiene practices, purchasing more cooking utensils for preparing different meals and managing their leftovers foods to prevent contamination.

The present study showed that registered SCFHs were in favour of good hygiene practices of food safety than the unregistered. The likely description is because of the food safety training courses they received before being registered as food handlers which provides them with an in-depth and comprehensive understanding of hygiene practices such as proper handling of food, personal cleanliness, and sanitation while preparing food. However, there is no research found relating registration of food handlers with hygiene practice scores; hence, the lack of the associated literature offers difficulties to compare our finding to collective results reasonably with concrete answered questions. Nonetheless, our finding shows the importance of registering food handlers after they have been through food safety training courses to encourage them to practise good hygiene.

This study found that SCFHs who have completed training courses on food safety were in favour of good hygiene practices of food safety likened to respondents who had not. Our finding asserts with previous studies done in Ethiopia, Malaysia, and Ghana [ 36 , 38 , 47 ]. The probable justification is that SCFHs who have completed food safety training courses had gained the talents and awareness necessary to handle food safely and sustain great ethics of self-cleanness and hygiene practices. Our finding affirms the assertion that training upsurges understanding of food safety which might reflect into hygiene practices [ 48 ]. Hence, a lack of or inadequate training of SCFHs on food safety may inadvertently result in poor hygiene practices, thereby encouraging food contamination [ 26 , 36 ]. This implies providing food safety training to food handles is important to keep consumers from food poisoning and other wellbeing dangers that could arise from eating unsafe food.

In this present study, it is significant to highpoint SCFHs’ knowledge, attitudes, and hygiene practices are unpredictable from the study conceded, though most of SCFHs properly responded by answering appropriately to related questions of WHO’s Five Keys to Safe Foods guidelines for food handlers. This theoretic-based assessment of the KAP method applied to assessed food handlers’ food safety KAP has some limitations. Firstly, the postulation that the received knowledge on food safety is translated into attitude is not entirely true. The existence of a social desirability bias could similarly have added to the discrepancy amid interview-responded KAP of SCFHs. Social desirability bias is the propensity of SCFHs to provide publically anticipated answers which will be regarded approvingly by people [ 64 ]. This proclivity has been shown by their descriptions and overrating socially anticipated KAP questions on food safety. Secondly, as we beforehand mentioned, the research assistants revealed their identities and the purpose of the study to the SCFHs; therefore, the SCFHs were mindful of the hygiene practices and the significance of observing them, but they remained keen to acknowledge their nonconformity and these could likely affect the self-reported hygiene practices. Thirdly, the unavailability of sufficient data from related studies in the district impedes an evaluative comparison of our findings to determine an improvement of food safety KAP among SCFHs; therefore, our findings ought to be interpreted with caution. However, due to the representative nature of the sample assessed, the findings of this study can be generalized to other SCFHs in the district. After all, it makes a substantial impact concerning food safety KAP in North Dayi District because it is the first study conducted in the district that presents an imperative foundation for design to increase food safety and hygiene practice in the district, region, and beyond.

Over half of the respondents had good levels of KAP of food safety. This study found a significant relationship in the knowledge and hygiene practice scores of food safety with SCFH registration. This shows the importance of strict enforcement of registration and certification of SCFHs by regulatory agencies as a means of protecting the consuming public. Therefore, the government agency through FDA should intensify the vitality of undertaking food safety training on WHO’s Five Keys to Safer Food by food handlers before being registered. Furthermore, the District Health Directorate should properly and effectively supervise food handlers engaging in cooking businesses to ensure they transmit the link between knowledge with the attitude of food safety into hygiene practice. Further studies should assess the kind of food safety training modules received and their impacts on the KAP of WHO’s Five Keys to Safer Foods as well as evaluating their hygiene practices with observational checklists.

Availability of data and materials

The datasets generated during and/or analyzed during the current study are not publicly available due to ethical consideration but are available from the corresponding author on reasonable request.

World Health Organization WHO. WHO estimates of the global burden of foodborne diseases: foodborne disease burden epidemiology reference group 2007-2015: World Health Organization; 2015.

Brandwagt D, van den Wijngaard C, Tulen AD, Mulder AC, Hofhuis A, Jacobs R, et al. Outbreak of Salmonella Bovismorbificans associated with the consumption of uncooked ham products, the Netherlands, 2016 to 2017. Eurosurveillance. 2018;23:317–35.

Google Scholar  

Navarro-Garcia F. Escherichia coli O104: H4 pathogenesis: an enteroaggregative E. coli/Shiga toxin-producing E. coli explosive cocktail of high virulence. Enterohemorrhagic Escherichia coli Other Shiga Toxin-Producing E coli. 2015;1:503–29.

Etter AJ, West AM, Burnett JL, Wu ST, Veenhuizen DR, Ogas RA, et al. Salmonella Heidelberg food isolates associated with a Salmonellosis outbreak have enhanced stress tolerance capabilities. Appl Environ Microbiol. 2019;85:1–22.

WPSE, Netty D, Sangaran G. Paper review of factors, surveillance and burden of food borne disease outbreak in Malaysia. Malaysian J public Heal Med. 2013;13:98–105.

Monney I, Agyei D, Owusu W. Hygienic practices among food vendors in educational institutions in Ghana: the case of Konongo. Foods. 2013;2(3):282–94. https://doi.org/10.3390/foods2030282 .

Fan YX, Liu XM, Bao YD. Analysis of main risk factors causing foodborne diseases in food catering business. Zhonghua Yu Fang Yi Xue Za Zhi. 2011;45:543–6.

Cheng Y, Zhang Y, Ma J, Zhan S. Food safety knowledge, attitude and self-reported practice of secondary school students in Beijing, China: a cross-sectional study. PLoS One. 2017;12:1–13.

Saad M, See TP, Adil MAM. Hygiene practices of food handlers at Malaysian government institutions training centers. Procedia-Social Behav Sci. 2013;85:118–27. https://doi.org/10.1016/j.sbspro.2013.08.344 .

Abdalla MA, Suliman SE, Bakhiet AO. Food safety knowledge and practices of street foodvendors in Atbara City (Naher Elneel State Sudan). African J Biotechnol. 2009;8:6967–71.

Ayeh-Kumi PF, Quarcoo S, Kwakye-Nuako G, Kretchy JP, Osafo-Kantanka A, Mortu S. Prevalence of intestinal parasitic infections among food vendors in Accra, Ghana. J Trop Med Parasitol. 2009;32:1–8.

Dagne H, Raju RP, Andualem Z, Hagos T, Addis K. Food safety practice and its associated factors among mothers in Debarq Town, Northwest Ethiopia: community-based cross-sectional study. Biomed Res Int. 2019;1:1–9.

Kuchenmüller T, Hird S, Stein C, Kramarz P, Nanda A, Havelaar AH. Estimating the global burden of foodborne diseases-a collaborative effort. Eurosurveillance. 2009;14:1–13.

Ayaz WO, Priyadarshini A, Jaiswal AK. Food safety knowledge and practices among Saudi mothers. Foods. 2018;7(12):193–208. https://doi.org/10.3390/foods7120193 .

Sani NA, Siow ON. Knowledge, attitudes and practices of food handlers on food safety in food service operations at the Universiti Kebangsaan Malaysia. Food Control. 2014;37:210–7. https://doi.org/10.1016/j.foodcont.2013.09.036 .

Oridota SE, Ochulo NF, Akanmu ON, Olajide TO, Soriyan OO. Food hygiene and safety practices of food handlers and its determinants in Lagos State. J Med Res Pract. 2014;3:37–41.

Chukuezi CO. Food safety and hyienic practices of street food vendors in Owerri, Nigeria. Stud Sociol Sci. 2010;1:50–7.

Dun-Dery EJ, Addo HO. Food hygiene awareness, processing and practice among street food vendors in Ghana. Food Public Heal. 2016;6:65–74.

Tefera T, Mebrie G. Prevalence and predictors of intestinal parasites among food handlers in Yebu town, southwest Ethiopia. PLoS One. 2014;9:1–13.

Soon JM, Wahab IRA, Hamdan RH, Jamaludin MH. Structural equation modelling of food safety knowledge, attitude and practices among consumers in Malaysia. PLoS One. 2020;15:1–12.

Sharif L, Al-Malki T. Knowledge, attitude and practice of Taif University students on food poisoning. Food Control. 2010;21(1):55–60. https://doi.org/10.1016/j.foodcont.2009.03.015 .

Kim J, Cho Y. Convergence evaluating food safety knowledge, attitude, and practice regarding food handler. J Korea Converg Soc. 2019;10:73–8.

Isoni Auad L, Cortez Ginani V, Stedefeldt E, Yoshio Nakano E, Costa Santos Nunes A, Puppin Zandonadi R. Food safety knowledge, attitudes, and practices of Brazilian food truck food handlers. Nutrients. 2019;11(8):1784–803. https://doi.org/10.3390/nu11081784 .

Zhao Y, Yu X, Xiao Y, Cai Z, Luo X, Zhang F. Netizens’ food safety knowledge, attitude, behaviors, and demand for science popularization by WeMedia. Int J Environ Res Public Health. 2020;17(3):730–40. https://doi.org/10.3390/ijerph17030730 .

Ma L, Chen H, Yan H, Wu L, Zhang W. Food safety knowledge, attitudes, and behavior of street food vendors and consumers in Handan, a third tier city in China. BMC Public Health. 2019;19(1):1128–39. https://doi.org/10.1186/s12889-019-7475-9 .

Tabit FT, Teffo LA. An assessment of the food safety knowledge and attitudes of food handlers in hospitals. BMC Public Health. 2020;20:311–22.

Lema K, Abuhay N, Kindie W, Dagne H, Guadu T. Food hygiene practice and its determinants among food handlers at University of Gondar, Northwest Ethiopia, 2019. Int J Gen Med. 2020;13:1129–37. https://doi.org/10.2147/IJGM.S262767 .

Yenealem DG, Yallew WW, Abdulmajid S. Food safety practice and associated factors among meat handlers in Gondar town: a cross-sectional study. J Environ Public Health. 2020;1:1–7.

Adane M, Teka B, Gismu Y, Halefom G, Ademe M. Food hygiene and safety measures among food handlers in street food shops and food establishments of Dessie town, Ethiopia: a community-based cross-sectional study. PLoS One. 2018;13:1–13.

Ababio PF, Lovatt P. A review on food safety and food hygiene studies in Ghana. Food Control. 2015;47:92–7. https://doi.org/10.1016/j.foodcont.2014.06.041 .

Yeleliere E, Cobbina SJ, Abubakari ZI. Review of microbial food contamination and food hygiene in selected capital cities of Ghana. Cogent Food Agric. 2017;3:1–12.

Ghana Standard Authority GSA. Personal communication with standard documentation department. 2013.

Sarkodie NA, Bempong EK, Tetteh ON, Saaka AC, Moses GK. Assessing the level of hygienic practices among street food vendors in Sunyani township. Pakistan J Nutr. 2014;13(10):610–5. https://doi.org/10.3923/pjn.2014.610.615 .

Odonkor ST, Kurantin N, Sallar AM. Food safety practices among postnatal mothers in Western Ghana. Int J Food Sci. 2020;1:1–10.

Monney I, Agyei D, Ewoenam BS, Priscilla C, Nyaw S. Food hygiene and safety practices among street food vendors: an assessment of compliance, institutional and legislative framework in Ghana. Food public Heal. 2014;4:306–15.

Rahman M, Arif MT, Bakar K, bt Tambi Z. Food safety knowledge, attitude and hygiene practices among the street food vendors in Northern Kuching city, Sarawak. Borneo Sci. 2012;31:95–103.

World Health Organization WHO. Five Keys to Safer Food Manual; Department of Food Safety, Zoonoses and Foodborne Disease. 2006; www.who.int/entity/foodsafety/ .

Azanaw J, Gebrehiwot M, Dagne H. Factors associated with food safety practices among food handlers: facility-based cross-sectional study. BMC Res Notes. 2019;12(1):683–9. https://doi.org/10.1186/s13104-019-4702-5 .

Fariba R, Gholamreza JK, Saharnaz N, Ehsan H, Masoud Y. Knowledge, attitude, and practice among food handlers of semi-industrial catering: a cross sectional study at one of the governmental organization in Tehran. J Environ Heal Sci Eng. 2018;16(2):249–56. https://doi.org/10.1007/s40201-018-0312-8 .

Ghana Statistical Service GSS. Population and housing census 2010 district and analytical report. 2010.

GHS GHS. Annual report, Ghana Health Service: GHS; 2020.

Cochran WG. Sampling technique. Third edit. New York: John Wiley & Sons; 1977.

Byrd-Bredbenner C, Berning J, Martin-Biggers J, Quick V. Food safety in home kitchens: a synthesis of the literature. Int J Environ Res Public Health. 2013;10(9):4060–85. https://doi.org/10.3390/ijerph10094060 .

Hashanuzzaman M, Bhowmik S, Rahman MS, Zakaria MUMA, Voumik LC, Mamun A-A. Assessment of food safety knowledge, attitudes and practices of fish farmers and restaurants food handlers in Bangladesh. Heliyon. 2020;6:1–8.

Osaili TM, Jamous DOA, Obeidat BA, Bawadi HA, Tayyem RF, Subih HS. Food safety knowledge among food workers in restaurants in Jordan. Food Control. 2013;31(1):145–50. https://doi.org/10.1016/j.foodcont.2012.09.037 .

Soares LS, Almeida RCC, Cerqueira ES, Carvalho JS, Nunes IL. Knowledge, attitudes and practices in food safety and the presence of coagulase-positive staphylococci on hands of food handlers in the schools of Camaçari, Brazil. Food Control. 2012;27(1):206–13. https://doi.org/10.1016/j.foodcont.2012.03.016 .

Amegah KE, Addo HO, Ashinyo ME, Fiagbe L, Akpanya S, Akoriyea SK, et al. Determinants of hand hygiene practice at critical times among food handlers in educational institutions of the Sagnarigu municipality of Ghana: a cross-sectional study. Environ Health Insights. 2020;14:1–10.

Akabanda F, Hlortsi EH, Owusu-Kwarteng J. Food safety knowledge, attitudes and practices of institutional food-handlers in Ghana. BMC Public Health. 2017;17(1):40–9. https://doi.org/10.1186/s12889-016-3986-9 .

Apanga S, Addah J, Sey DR. Food safety knowledge and practice of street food vendors in rural Northern Ghana. Food Public Heal. 2014;4:99–103.

Adesokan HK, Akinseye VO, Adesokan GA. Food safety training is associated with improved knowledge and behaviours among foodservice establishments’ workers. Int J Food Sci. 2015;1:1–8.

Bou-Mitri C, Mahmoud D, El Gerges N, Jaoude MA. Food safety knowledge, attitudes and practices of food handlers in Lebanese hospitals: a cross-sectional study. Food Control. 2018;94:78–84. https://doi.org/10.1016/j.foodcont.2018.06.032 .

Derso T, Tariku A, Ambaw F, Alemenhew M, Biks GA, Nega A. Socio-demographic factors and availability of piped fountains affect food hygiene practice of food handlers in Bahir Dar Town, northwest Ethiopia: a cross-sectional study. BMC Res Notes. 2017;10(1):628–35. https://doi.org/10.1186/s13104-017-2965-2 .

Al RA. On the contribution of student experience survey regarding quality management in higher education: an institutional study in Saudi Arabia. J Serv Sci Manag. 2010;3:464–9.

Siau AMF, Son R, Mohhiddin O, Toh PS, Chai LC. Food court hygiene assessment and food safety knowledge, attitudes and practices of food handlers in Putrajaya. Int Food Res J. 2015;22:1843–54.

Samapundo S, Climat R, Xhaferi R, Devlieghere F. Food safety knowledge, attitudes and practices of street food vendors and consumers in Port-au-Prince, Haiti. Food Control. 2015;50:457–66. https://doi.org/10.1016/j.foodcont.2014.09.010 .

Murray R, Glass-Kaastra S, Gardhouse C, Marshall B, Ciampa N, Franklin K, et al. Canadian consumer food safety practices and knowledge: foodbook study. J Food Prot. 2017;80(10):1711–8. https://doi.org/10.4315/0362-028X.JFP-17-108 .

Zhang H, Lu L, Liang J, Huang Q. Knowledge, attitude and practices of food safety amongst food handlers in the coastal resort of Guangdong, China. Food Control. 2015;47:457–61.

Berry TD, Fournier AK. Examining university students’ sneezing and coughing etiquette. Am J Infect Control. 2014;42(12):1317–8. https://doi.org/10.1016/j.ajic.2014.09.003 .

Khanal G, Poudel S. Factors associated with meat safety knowledge and practices among butchers of Ratnanagar municipality, Chitwan, Nepal: a cross-sectional study. Asia Pacific J Public Heal. 2017;29(8):683–91. https://doi.org/10.1177/1010539517743850 .

Faremi FA, Olatubi MI, Nnabuife GC. Food safety and hygiene practices among food vendors in a Tertiary Educational Institution in South Western Nigeria. Eur J Nutr Food Saf. 2018;8(2):59–70. https://doi.org/10.9734/EJNFS/2018/39368 .

Fadaei A. Assessment of knowledge, attitudes and practices of food workers about food hygiene in Shahrekord restaurants, Iran. World Appl Sci J. 2015;33:1113–7.

Radu S, Othman M, Toh PS, Chai LC. Assessment of knowledge, attitude and practices concerning food safety among restaurant workers in Putrajaya, Malaysia. Food Sci Qual Manag. 2014;32:20–7.

Osaili TM, Al-Nabulsi AA, Krasneh HDA. Food safety knowledge among foodservice staff at the universities in Jordan. Food Control. 2018;89:167–76. https://doi.org/10.1016/j.foodcont.2018.02.011 .

Jespersen L, MacLaurin T, Vlerick P. Development and validation of a scale to capture social desirability in food safety culture. Food Control. 2017;82:42–7. https://doi.org/10.1016/j.foodcont.2017.06.010 .

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Lawrence Sena Tuglo, Zhongqin Pan & Minjie Chu

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Tuglo, L.S., Agordoh, P.D., Tekpor, D. et al. Food safety knowledge, attitude, and hygiene practices of street-cooked food handlers in North Dayi District, Ghana. Environ Health Prev Med 26 , 54 (2021). https://doi.org/10.1186/s12199-021-00975-9

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Food safety in the 21st century

a Division of Occupational & Environmental Medicine, University of California Irvine School of Medicine, Irvine, CA, USA

b Department of Occupational Medicine, Sharp HealthCare/Sharp Rees-Stealy Medical Group, San Diego, CA, USA

Huei-Shyong Wang

c Division of Pediatric Neurology, Chang Gung Children's Hospital at Linkou, Taoyuan, Taiwan

d College of Medicine, Chang Gung University, Taoyuan, Taiwan

Suresh Menon

e Department of Research and Development, Menon Biosensors Inc., Escondido, CA, USA

Food is essential to life, hence food safety is a basic human right. Billons of people in the world are at risk of unsafe food. Many millions become sick while hundreds of thousand die yearly. The food chain starts from farm to fork/plate while challenges include microbial, chemical, personal and environmental hygiene. Historically, documented human tragedies and economic disasters due to consuming contaminated food occurred as a result of intentional or unintentional personal conduct and governmental failure to safeguard food quality and safety. While earlier incidents were mainly chemical contaminants, more recent outbreaks have been due to microbial agents. The Disability Adjusted Life Years (DALYs) attributed to these agents are most devastating to children younger than 5 years of age, the elderly and the sick. To ensure food safety and to prevent unnecessary foodborne illnesses, rapid and accurate detection of pathogenic agents is essential. Culture-based tests are being substituted by faster and sensitive culture independent diagnostics including antigen-based assays and polymerase chain reaction (PCR) panels. Innovative technology such as Nuclear Magnetic Resonance (NMR) coupled with nanoparticles can detect multiple target microbial pathogens' DNA or proteins using nucleic acids, antibodies and other biomarkers assays analysis. The food producers, distributors, handlers and vendors bear primary responsibility while consumers must remain vigilant and literate. Government agencies must enforce food safety laws to safeguard public and individual health. Medical providers must remain passionate to prevent foodborne illnesses and may consider treating diseases with safe diet therapy under proper medical supervision. The intimate collaboration between all the stakeholders will ultimately ensure food safety in the 21st century.

Introduction and historical perspective

Food safety is a basic human right.

Billions of people in the world are at risk of unsafe food. Many millions become sick while hundreds of thousands die every year because they consume unsafe food. Therefore, safe food saves lives. Safe food enhances individual and population health. Safe food improves economic growth of the region where food safety is practiced and enhanced. Safe food supply depends on both sound science and equitable law enforcement. With technological advances, new regulations must be enacted to protect a continuing supply of food products that are safe and wholesome for the health and wellness of people.

As the standard of living improves, concerns over food safety and potential contaminants will continue to be an important health issue. Consumers demand quality and safety of products they consume because food as energy and nutrient is necessary to sustain life. In general, consumers rely on government to ensure all food products not only are safe but are sold as what they claim to contain. For example, a jar of olive oil labeled as 100% virgin olive oil must contain exactly what the label says except the naturally occurring trace elements that are part of olive oil and which cannot be extracted or eliminated completely without destroying the olive oil.

Challenges and tragedies in food safety include chemical, biological, personal hygiene and environmentally related incidents. Historically, incidents of food products contaminated with industrial pollutants have been well documented. Japan, Iraq, United States and other nations experienced incidents where hundreds and thousands of people fell ill or died.

Most notorious is the Minamata disease (methylmercury poisoning) first discovered in 1956 around Minamata Bay in Kumamoto Prefecture, Japan. A second epidemic occurred in 1965 along the Agano River, in Niigata Prefecture, Japan. Symptoms of this disease included cerebellar ataxia, sensory disturbance, narrowing of the visual field, and hearing and speech disturbances. The discharged methyl mercury accumulated in fishes and shellfishes and caused poisoning on consumption [1] , [2] .

Before 1960, the local population in the Jinzu river basin of Japan suffered an endemic illness called “Itai–Itai” due to the residents in that area consumed rice contaminated with high level of cadmium. An investigation in 1961 determined that the Mitsui Mining and Smelting's Kamioka Mining Station caused the cadmium pollution and that the worst-affected areas were 30 km downstream of the mine. Not until 1968 the Ministry of Health and Welfare of Japan issued a formal statement about the symptoms of “itai–itai” disease is in fact caused by the cadmium poisoning [3] .

In 1968, a mass poisoning by polychlorinated biphenyls (PCBs) occurred in northern Kyushu, Japan where rice oil that had become contaminated by heat-degraded PCBs during processing. These patients suffered a unique skin disease called chloracne. In addition, hepatic, reproductive, endocrine, neurobehavioral and carcinogenic effects have been described. The Illness was coined “Yusho” disease (literally oil syndrome). It should be noted that Yusho was not a deliberate contamination of cooking oil [4] , [5] .

In 1971–72, a large outbreak of mercury poisoning caused by the consumption of seed dressed with organomercury compounds occurred in Iraq. The source of organomercury came from seeds are treated with fungicides before planting, mainly to control infection by seed- or soil-borne fungi. Patients who consumed these seeds suffered tremor, confusion, hallucination, delusion and seizure [6] .

Similar food contamination incidents have appeared in Taiwan around 1979. It was discovered that cooking oil contaminated with PCBs and dibenzofurans (PCDFs) was sold to the public. The volume of contaminated oil and the nature of oil processing, packaging, labeling, distribution, sales, and usage were extensive that about 2000 people consumed contaminated eating oil. A recent study concludes that exposure to PCBs and PCDFs may increase mortality pattern even 3 decades later [7] . The short and long term health consequences of people consumed contaminated oil during recent (2014–5) oil incidents in Taiwan are yet to be studied.

In 1989, the United States Food & Drug Administration (US FDA) issued a “fats and oils” injunction against brokers buying and selling non-feed oils, such as waste industrial oil, and labeled them for animal feed use. One case evolved from findings PCB residue in turkeys marketed for human food. FDA field investigators traced the PCBs to waste oils from a chemical plant's scum pond, labeled “industrial waste not for animal feed use.” Further investigation showed that merchants “buy and sell” railcars and tankers of oils and invoice the products to feed manufacturers as feed grade regardless of source. The manufacturer might have blended it with other fats and oils so its original identity and any contaminants were greatly diluted. This US incident was not widespread because of the alert FDA field investigators program and state of the art food toxicology laboratory that stopped a major crisis [8] .

In the 21st century, food safety issues have not waned. Local outbreaks can turn into international emergencies due to the speed and range of product distribution. Serious foodborne disease outbreaks have occurred on every continent. In China alone, the 2008 contamination of infant formula with melamine affected 300,000 infants and young children, 51, 900 were hospitalized and 6 of whom died. In addition to renal damages, complications such as tumorigenesis or growth retardation in the future have been raised [9] , [10] .

In 2011, the Enteropathogenic Escherichia coli ( EHE coli ) outbreak in Germany linked to contaminated fenugreek sprouts, where cases were reported in 8 countries in Europe and North America, leading to 53 deaths. The 2011 E . coli outbreak in Germany caused US$ 1.3 billion in losses for farmers and industries and US$ 236 million in emergency aid payments to 22 European Union Member States [11] .

Unsafe food poses global health threats. The young, the elderly and the sick are particularly vulnerable. If food supplies are unsecured, population shifts to less healthy diets and consume more “unsafe foods” – in which chemical, microbiological and other hazards pose health risks, that in turn costs higher healthcare expenditure and drains national wealth [12] . In light of recurrent food contamination incidents, food safety in the 21st century should expand beyond improving nutritional profile, transparency of ingredients and regulations of unhealthy foods to include regular monitoring, surveillance and enforcement of food products in furtherance of the general public well-being and prevention of foodborne illnesses [13] . For up to date information, the Center for Science in the Public Interest provides comprehensive tracking and documentation of foodborne illness outbreaks since 1997  [14] .

Major challenges of food safety

Challenges of food safety include four major areas.

• • Microbiological Safety. Food by nature is biological. It is capable of supporting the growth of microbials that are potential sources of foodborne diseases. Viruses are more responsible for the majority of foodborne illnesses but hospitalizations and deaths associated with foodborne infections are due to bacterial agents. The illnesses range from mild gastroenteritis to neurologic, hepatic, and renal syndromes caused by either toxin from the disease-causing microbe. Foodborne bacterial agents are the leading cause of severe and fatal foodborne illnesses. Over 90% of food-poisoning illnesses are caused by species of Staphylococcus , Salmonella , Clostridium , Campylobacter , Listeria , Vibrio , Bacillus , and E . coli. For instance, in the US and France, in the last decade of the 20th century, Salmonella was the most frequent cause of bacterial foodborne illness accounting for 5700 to 10,200 cases, followed by Campylobacter for 2600 to 3500 cases and Listeria for 304 cases [15] .
• • Chemical Safety. Nonfood grade chemical additives, such as colorants and preservatives, and contaminants, such as pesticide residues, have been found in foods. Some food samples had higher levels of heavy metals such as lead, cadmium, arsenic, mercury, and copper than average food samples, suggesting possible leaching from the utensils and inadequate food hygiene.
• • Personal Hygiene. Poor personal hygiene practices of food handler and preparers pose considerable risks to personal and public health. Simple activities such as thorough hand washing and adequate washing facilities can prevent many foodforne illnesses.
• • Environmental Hygiene. Inadequate recycling and waste disposal equipment and facilities lead to the accumulation of spoiled and contaminated food. This leads to an increased pest and insect population that can result in risk of food contamination and spoilage. Poor sanitary conditions in the area where foods are processed and prepared contribute to poor food storage and transport as well as selling of unhygienic food.

Why is safe food supply important?

A safe food supply is important because of significant disease burden as well as economic burden to the society and nation. In US alone, foodborne illnesses each year result in 325,000 hospitalizations and 5000 deaths [16] . Worldwide, it has been estimated that more than one billion (1,000,000,000) episodes of food poisoning-related diarrhea occur annually [16] ; these poisonings are responsible for the deaths of about 3 million children a year, mostly in underdeveloped regions.

Foodborne illnesses associated with microbial pathogens or other food contaminants pose serious health threat in developing and developed countries. WHO estimates less than 10% of foodborne illness cases are reported whereas less than 1% of cases are reported in developing nations [17] . In a recent report, WHO estimates 600 million foodborne illnesses and 420,000 deaths in 2010. The most frequent causes of foodborne illness were diarrheal disease agents, particularly norovirus and Campylobacter spp. Other major causes of foodborne deaths were Salmonella typhi , Taenia solium , hepatitis A virus, and mycotoxins especially aflatoxins [18] , [19] .

Children are disproportionately bearing this burden - accounting for an estimated half of foodborne illness cases annually. Children are also among those most at risk of associated death and serious lifelong health complications from foodborne diseases. They are at high risk for foodborne illness for a number of reasons. Children have developing immune systems that are not always well equipped to fight infection; they are often smaller in size than adults, reducing the amount of pathogen needed to make them sick; and children have limited control over their diets and lack the developmental maturity necessary to carefully judge food safety risks.

From economic perspective, access to sufficient amounts of safe and nutritious food is crucial to sustaining life, promoting good health and economic growth. According to one study, the average cost per case of foodborne illness (in US dollars) was $1626 for the enhanced cost-of-illness model and $1068 for the basic model. The resulting aggregated annual cost of illness was $77.7 billion and $51.0 billion for the enhanced and basic models, respectively. The study defines basic cost-of-illness model to include economic estimates for medical costs, productivity losses, and illness-related mortality. The enhanced cost-of-illness model replaces the productivity loss estimates with a more inclusive pain, suffering, and functional disability measure based on monetized quality-adjusted life year estimates [20] .

Major foodborne illnesses and burden

According to US Centers for Disease Control, foodborne diseases cause an estimated 48 million illnesses each year in the United States, including 9.4 million caused by known pathogens. The pathogen-commodity pairs most commonly responsible for outbreaks were scombroid toxin/histamine and fish (317 outbreaks), ciguatoxin and fish (172 outbreaks), Salmonella and poultry (145 outbreaks), and norovirus and leafy vegetables (141 outbreaks). The pathogen-commodity pairs most commonly responsible for outbreak-related illnesses were norovirus and leafy vegetables (4011 illnesses), Clostridium perfringens and poultry (3452 illnesses), Salmonella and vine-stalk vegetables (3216 illnesses), and C . perfringens and beef (2963 illnesses) [21] , [22] . Examples of unsafe food that commonly contain these hazards include uncooked foods of animal origin, fruits and vegetables contaminated with feces, raw shellfish and industrial pollution.

In a comprehensive estimation, the 2015 WHO report not only provides numbers of foodborne illnesses in terms of incidence but also number of deaths and Disability Adjusted Life Years (DALYs) as a measure of burden due to foodborne related morbidity and mortality. The DALYs data are based on the metrics established by WHO and are consistent with the Global Burden of Disease project [18] . Together, these foodborne hazards caused an enormous human burden of 33 millions DALYs with 40% among children younger than 5 year-old. With substantial global burden of foodborne diseases and deaths, the impact is most significant among young children living in low income regions where food hygiene and water sanitation are below optimal standards. Therefore, improving microbial, personal, chemical and environmental health will improve overall health of children and adults alike. It should be noted that antimicrobial overuse and misuse in veterinary and human medicine has been linked to the emergence and spread of resistant bacteria, rendering the treatment of infectious diseases ineffective in animals and humans [24] .

From a global perspective, most foodborne pathogens and toxins, along with morbidity, mortality and health burden are summarized in Table 1 . Commonly encountered microbial pathogens and toxins include the following categories. A brief description of their illnesses is provided below for a quick reference.

• • Bacteria: Salmonella , Campylobacter , and Enterohemorrhagic Escherichia coli ( EHE coli ) are among the most common foodborne pathogens. Symptoms include fever, headache, nausea, vomiting, abdominal pain and diarrhea. Sources of salmonellosis include eggs, poultry and other products of animal origin. Foodborne Campylobacter is caused by raw milk, raw or undercooked poultry and drinking water . EHE coli are associated with unpasteurized milk, undercooked meat and fresh fruits and vegetables. Listeria infection increases the risk of spontaneous abortions and stillbirths. Listeria is found in unpasteurized dairy products and various ready-to-eat foods and can grow at refrigeration temperatures. Vibrio cholerae infects people through contaminated water or food. Symptoms include abdominal pain, vomiting and profuse watery diarrhea, which may lead to severe dehydration and possibly death. Rice, vegetables, millet gruel and various types of seafood have been implicated in cholera outbreaks.
• • Viruses: Norovirus infections are characterized by nausea, explosive vomiting, watery diarrhea and abdominal pain. Food handlers infected with Hepatitis A virus are common source of contamination and spreads typically through raw or undercooked seafood or contaminated raw produce.
• • Parasites: Some parasites, such as fish-borne trematodes, are only transmitted through food. Others, for example Echinococcus spp, may infect people through food or direct contact with animals. Other parasites, such as Ascaris , Cryptosporidium , Entamoeba histolytica or Giardia , enter the food chain via water or soil and can contaminate fresh produce.
• • Worms: Cestodes, nematodes, trematodes and helminths are worms most prevalent in regions where food preparation and storage, personal hygiene, water sanitation and environmental health are not routinely practiced Even though worm related foodborne illness are not as fatal as virus and bacteria, they account for a substantial burned to foodborne disability.
• • Chemicals: Naturally occurring toxins and environmental pollutants have caused many outbreaks. In addition, chemical residues used to eradicate or control pests and worms can be an independent risk of foodborne hazard. Mycotoxins, marine biotoxins, cyanogenic glycosides and poisonous mushrooms are all natural toxins. Staple foods like corn or cereals can contain high levels of mycotoxins, such as aflatoxin and ochratoxin. A long-term exposure can affect the immune system and normal development, or cause cancer. Environmental pollutants are becoming major concerns for pediatricians and public health practitioners. Persistent organic pollutants (POPs) are compounds that accumulate in the environment and human body. Dioxins and polychlorinated biphenyls (PCBs) are byproducts of industrial processes and waste incineration. They are found in the environment and accumulate in animal food chains. Dioxins are highly toxic and can cause reproductive and developmental problems, damage the immune system, interfere with hormones and cause cancer. Finally, heavy metals such as lead, cadmium and mercury can cause neurological and kidney damage. Contamination by heavy metals in food occurs mainly through environmental pollution of air, water and soil.

Common foodborne pathogens and their medical and economic impacts.

The Uncertainty Intervals (UI) are not shown

Diagnostic advances to ensure food safety

Due to the globalization of the world's food trade, food has become a major pathway for human exposure to pathogenic microbials responsible for foodborne illness entering at many points along the value chain [23] . Thus, tracking and detecting microbials especially pathogenic bacteria in foods back to their sources pose challenges to producer, processor, distributor, and consumer of food alike. In addition, clinicians and epidemiologists are frequently confronted with diagnostic and treatment uncertainty of patients with potential foodborne infectious diseases at the point of care.

Rapid and accurate detection of foodborne pathogens is essential for public health bio-surveillance to prevent foodborne infections and ensure the safety of foods. Detection methods of microbials have improved over time [25] , [26] , [27] . Generally speaking, culture-based tests are being substituted by faster and more sensitive culture-independent diagnostic tests such as antigen-based assays and PCR panels [28] . However, these tests are used mainly in the public health laboratories not readily available for practitioners in the industry and clinical fields.

Non-culture based applications are gaining importance mainly because of their relatively quick results when compared with culture based methodologies. There are several diagnostic technologies to detecting pathogenic microbes such as Salmonella and Vibrio spp in animals and food. Ideally, microbial pathogens and contaminants can be detected at relatively low cost in the field because of assay and instrument simplicity. This will ensure higher sampling efficiency of analyte of interest as a result of higher sample measurement volume, detects with near 100% specificity and accuracy as a result of orthogonal measurement [29] of biomarkers with flexibility in sample type such as soil, feces, animal tissue, fruits, water and blood. The goals are savings in time due to higher speed of detection and savings to overhead expenses. However, Point of Need Test (PONT) devices for field diagnostics do not exist for many of the pathogens of interest in agriculture, animal farming, aquaculture, wild caught animals, and food safety in general.

• • NMR-nanotechnology

Nuclear Magnetic Resonance (NMR) nanotechnology platform detects multiple target microbials hybridizing to pathogen's DNA or protein in same the device chamber that runs assays using nucleic acid, antibodies, and other biomarkers [30] . Orthogonal confirmatory tests can be achieved via multiple biomarkers of single microbial in same detection device. This raises specificity and accuracy thus serving as both screening and confirming tool at the same time. It has a dynamic range of 8 log before saturation, more sensitive than other systems due to standard amplification process plus signal amplification through the nanoparticles. Hence, this technology increases the sensitivity and specificity of detecting target microbial. End point PCR can be applied on DNA amplification while antibody ligands method can be used for protein structure amplification. Multiplexing with large sample volume enables multiple biomarker measurements to be analyzed thus further increases specificity of the detection method.

• • PCR-based

Polymerase chain reaction (PCR) based assay enzyme linked immuno-sorbent assay (ELISA) and instruments rely on extensive enrichment (up to 24 h) to produce enough cells for detection. Following enrichment, the assay requires DNA amplification and detection. The entire process from enrichment through detection may take several hours to days. Because of sample preparation processes and ancillary lab equipment (shakers, incubators, microplate readers) such detection system may not be practical as PONT devices. Another commonly utilized technology is based on either standard or real-time PCR (qPCR) depending on the instrument and takes up to 3.5 h for detection. The system is limited to using PCR method thus unable to perform multiple biomarkers detection. Table 2 provides an example of comparing two non-culture based detection systems for Salmonella [31] , [32] . The commercial testing brand names are not mentioned in this analysis.

Provides an example of comparing two non-culture based detection systems for Salmonella .

Medical provider's role in food therapy

Most medical professionals have focused on the treatment of diseases without seeking which are caused by long-term exposure to problematic food and food products. Some dietitians tend to keep counting the calories of macronutrients without considering chemicals adding in the food and food product that have no nutrient values. The food industry for business reasons may look mainly for continuous profit over the health of general population. Many diseases could be prevented or treated with appropriate and safe food under proper medical supervision. Ketogenic diet therapy for epilepsy is a good example. This medical food therapy began at least 100 years ago, but was abandoned gradually over the next five decades because of the appearance of antiepileptic drugs [33] , [34] . This approach has been revived about 20 years ago because 40% of epileptic patients are resistant to antiepileptic medications. As a result of medically promising indications of the ketogenic diet, it is expanding its therapeutic efficacy from epilepsy to diabetes mellitus, malignancies, and many selective neurodegenerative disorders [35] , [36] , [37] . Therefore, the important role of medical providers in food therapy cannot be over emphasized. The late Professor Ja-Liang Lin, aka Lin Chieh-liang [38] , renowned toxicologist–nephrologist left behind an important legacy that serves as a role model [39] for medical professionals to exercise the duty to improve and safeguard food quality and safety of Taiwan and international community for many years to come.

Government's role to regulate and enforce food safety

Safe food supply depends on both sound science and equitable law enforcement. Periodically, new laws and regulations must be enacted to further protect a continuing supply of food products that are safe and wholesome for the health and wellness of people.

In most countries, the overarching goal of having Food and Drug Administration (FDA) or similar agency is to take responsibility for compliance of food safety law to ensure a three-fold aim in protecting public health and safety: (1) inform citizens of nutrition and components of important food products; (2) enforce existing laws and regulations on food industry to ensure supply of safe food products; and (3) investigate and eliminate potential toxic contaminants and prosecute economic fraud via regular monitoring and surveillance on chain of food supply.

Once the laws are enacted, they must be enforced to ensure compliance by the entire food industry including industries that are directly or indirectly connected with the food source, labeling, packaging, transportation, distribution down to retail sales. The FDA is given resources and authority to write rules and regulations, assemble experts both as agency employees or consultants so to fulfill the three-prong aim of informing, enforcing and eliminating any food related safety and risk.

All governmental agencies involved in potential food chain supply must be given resources and authorities to discharge the 3-fold duty of (1) inform, (2) enforce, and (3) eliminate as described above. In addition to FDA, other governmental agencies collaborations are required. For example, US Environmental Protection Agency (EPA) is in charge of safe drinking water, clean air, and nontoxic natural resources such as soil and land; the US Department of Agriculture (USDA) is in charge of ensuring animal and plant health, as well as food and nutrition services; and Immigration and Customs Enforcement of US Department of Justice are all involved in stopping illegal and contaminated toxic substances. Therefore, to enforce food safety, inter-agency sharing of information and database is necessary [40] . Some have proposed to expand FDA's discretionary authority as part of the anti-terrorism in the post-9/11 period, particularly with respect to FDA's authority to monitor and publicize potential health risks linked to food, dietary supplements, nonprescription drugs, and other consumer health products [41] .

To equitably enforce food safety laws, sound science must be the basis of setting the regulations and protocols to inform, enforce and eliminate unsafe foods. Risk assessment is a scientific process that puts the concern about food contaminations in proper perspective. As the purpose of scientific risk calculation is to get the best estimate of the true risk using available and current information.

Generally, to assure the public safety, regulatory agencies go beyond scientific risk. To calculate regulatory risk, agencies first start with the scientific risk level. Then, the maximum consumption is estimated as if that item is consumed daily for a person's entire lifetime. This risk is multiplied by a factor of 100 or 1000 [42] , [46] as additional safety factor for the vulnerable individuals. Animal toxicology studies and any available human reports and studies are extensively reviewed and analyzed for relevancy and validity. The sponsor (usually the food manufacturer) must establish scientifically that the substance is safe and free from contamination. The sponsor must also demonstrate that any residues remaining in a food product pose no threat to human health, both acutely and chronically. If toxicological studies raise the suspicion that a contaminant may cause cancer, the agency may require the sponsor to conduct chronic feeding studies in animals. If the results show that the chemical causes cancer, the FDA uses a conservative risk assessment procedure to determine how much contaminant presents the consumer with no significant risk of cancer. Under this procedure the FDA allows the upper limit of lifetime risk of cancer to be one in one million (that is, if one million consumers ingested the contaminant for their entire lifetime of 70 years, one of them might get cancer from the drug/chemical residue). Such a risk is approximately 10 times less than the risk of being struck by lightning [42] , [43] , [44] , [45] , [46] , [47] .

Programs and tools to ensure the safety of food supply

In general, periodic food monitoring provides a 95% assurance that microbial or chemical contaminant of any targeted food is detected if it occurs in more than 1% of product lots. Food surveillance is used to investigate and control the movement of potentially contaminated products. The field inspectors are granted the power of the agency vested by the executive branch of the government. Anonymous tips may trigger some food products for surveillance testing if they appear reasonably suspicious of foul play such as unclear labeling, or coming from questionable sources. Contaminants above legal limits are to be re-tested in split samples given to two separate laboratories to ensure fairness. Food safety inspector has responsibility to inspect foods during packaging, labeling, processing and distribution and storage. Similarly, inspector of different training may assume responsibility when the food products are in the grocery store or in retails.

The voluntary report of “accidental” exposure program has worked well in many countries. Food products may accidentally be exposed to contaminants without any deliberate or knowingly use contaminated products such as microbial, pesticides, industrial chemicals or natural toxicants. In such event, the merchant or manufacturer may voluntarily report such contamination to FDA. FDA may then send specially trained consultant to provide regulatory and scientific assistance to the food industry. Depending on the nature and extent of consultation, consultant or laboratory fees may be assessed to be paid by the company owner or corporation [48] .

In the US, programs such as the Food Safety and Inspection Service (FSIS) ensure safety of current and future food supply must be implemented. Regular monitoring, surveillance and voluntary report or recall are all part of risk management that will minimize mishaps and ensure safe food supply [50] . The Pathogen Reduction/Hazard Analysis & Critical Control Points System has been implemented by US FDA so that food safety risks are addressed more adequately and the allocation of inspection resources is improved further [48] , [49] , [50] .

The future food safety

Safe food provides basic human necessity. It supports national economy, trade and tourism, contributes to nutrition security, and underpins sustainable development. Globalization has triggered growing consumer demand for a wider variety of foods, resulting in an increasingly complex and longer global food chain. As the world's population grows, the intensification and industrialization of agriculture and animal production to meet increasing demand for food creates both opportunities and challenges for food safety. The food producers, distributors, handlers and vendors must bear the primary responsibility to ensure food safety. Consumers should remain vigilant and literate on food safety issues. Government agencies such as FDA and EPA are the legal enforcers to protect public health and safety. They must enforce the law equitably and with fairness.

The legal professionals appear to be more active in advocating food safety in the global market. The medical and healthcare professionals should be equally passionate to take the lead in addressing food safety. After all, safe and nutritious food implies healthier population. Regardless of who is taking the lead in food safety, in the end, a close collaboration between all the stakeholders should be the goal in achieving a meaningful food safety for every person in a global perspective [51] , [52] , [53] , [54] , [55] .

In summary, food safety and nutrition are closely connected. Unsafe food creates a vicious cycle of disease and malnutrition affecting infants, young children, elderly and the sick. Because food supply chains cross multiple national and regional borders, collaboration between governments, producers, suppliers, distributors and consumers will ultimately ensure food safety in the 21st century.

Conflicts of interest

The authors declare no conflict of interest.

Peer review under responsibility of Chang Gung University.