10th Anniversary Review: when healthy food becomes polluted—implications for public health and dietary advice

Divergent scientific and regulatory agency perspectives about contaminants in fish have lead to contradictory advice and confusing public messages about its consumption. The evidence for the protective effect of eating fish on cardiovascular outcomes is considered to be convincing. It has long been attributed to n-3 unsaturated long-chain fatty acids. Persistent organic pollutants (POPs) are compounds that are lipid soluble and accumulate in the aquatic food chain. Despite a considerable decrease in their levels in fish during the last two decades, there is still significant concern about potential negative health effects and an ongoing debate exists about what type of fish consumption advisories are most suitable. In this review our aim is twofold, namely to explore: (1) the underlying causes for the conflicting recommendations by discussing the strengths and limitations of risk assessment and epidemiological evidence; and (2), the role of risk management in formulating public dietary advisories. It is our view that the latter advice is most appropriately formulated in the context of risk management, of which both epidemiologic evidence and risk assessment are essential components.