Development and evaluation of a nutrition education program designed to increase fruit and vegetable consumption in girls, ages 9--12

The purpose of this study is to evaluate the theory-based Eat 5 nutrition badge. It is designed to increase fruit and vegetable (F&V) intake in 4th-6th grade junior Girl Scouts. Twenty-two troops were recruited and randomized by grade level (4th, 5th, 6th, or mixed) into either the intervention or control conditions. The leaders in the intervention condition received a brief training and the materials and conducted the program with their troops during four meetings. The Girl Scouts in the intervention condition completed 1-day Food Frequency Questionnaires and Nutrition Questionnaires both before and after completing the Eat 5 badge, and a third measurement of F&V intake three months after the posttest. Girl Scouts in the control condition were only evaluated at the three time periods.^ The primary hypotheses were that the Girl Scouts in the intervention condition would increase their daily intake of fruits and vegetables at both the posttest and three months later, compared to the Girl Scouts in the control condition. Other study questions investigated the impact of the Eat 5 program on intervening variables such as knowledge, self-efficacy, barriers, norms, F&V preference, and F&V selection and preparation skills.^ A nested ANOVA, with troop as the unit of analysis nested within condition, was used to assess the effects of the program. Pretest F&V intake and grade level were used as covariates. Pretest mean F&V intake for the total sample of 210 girls was 2.50 servings per day; 3.0 for the intervention group (n = 101). Significant increases in F&V intake (to 3.4 servings per day), knowledge, and fruit and vegetable preference were found for the intervention condition troops compared to the troops in the control condition. Three months later, the mean F&V intake had returned to pretest levels.^ This study indicates that social groups such as Girl Scouts can provide a channel for nutrition education. Long term effects were not sustained by the intervention; a possible cause was the lack of change in self-efficacy. Therefore, additional interventions are recommended such as booster lessons to maintain increased F&V intake by Girl Scouts. ^

(Table 3) Liver weight, blood liver parameters, and blood plasma PCB concentrations in 14 sledge dog bitches and their 14 pups in Aasiaat, west Greenland

We assessed the relationship between exposure to organohalogen polluted minke whale (Balaenoptera acutorostrata) blubber and liver morphology and function in a generational controlled study of 28 Greenland sledge dogs (Canis familiaris). The prevalence of portal fibrosis, mild bile duct hyperplasia, and vascular leukocyte infiltrations was significantly higher in the exposed group (all Chi-square: p<0.05). In case of granulomas, the frequency was significantly highest in the bitches (P generation) while the prevalence of portal fibrosis was highest in the F generation (pups) (both Chi-square: p<0.05). No significant difference between exposed and controls was found for bile acid, ALAT, and ALKP, while ASAT and LDH were significantly highest in the control group (both ANOVA: p<0.05). We therefore suggest that a daily intake of 50-200 g environmentally organohalogen polluted minke whale blubber can cause liver lesions in Greenland sledge dogs. It is reasonable to infer that other apex predators such as polar bears (Ursus maritimus) and humans may suffer from similar impacts.

Efeito das farinhas de jatobá-do-cerrado (Hymenaea stigonocarpa Mart.) in natura e extrusada no metabolismo lipídico e parâmetros fermentativos em hamsters e resposta glicêmica em humanos após a extrusão

Introdução: A polpa farinácea do jatobá-do-cerrado (Hymenaea stigonocarpa Mart.) apresenta alto teor de fibra alimentar, em média 60 g/100 g, que são importantes para a redução do risco e controle de doenças crônicas não transmissíveis (DCNT). A extrusão termoplástica neutraliza aromas intensos, proporciona a formação de amido resistente, aumenta a fibra alimentar solúvel e melhora a textura do produto final. Objetivo: Estudar o efeito das farinhas de jatobá-do-cerrado in natura (FIN) e extrusada (FE) no metabolismo lipídico e parâmetros fermentativos em hamsters, bem como verificar a resposta glicêmica em humanos após a extrusão. Métodos: Processo de extrusão: velocidade de 200 rpm; matriz com 4 mm de diâmetro; taxa de compressão 3:1; alimentação constante de 70 gramas/minuto; temperatura de 150 °C; proporção farinha de jatobá-do-cerrado e amido de milho: 70:30 por cento e umidade a 25 por cento . Foi realizado um experimento animal com hamsters durante 21 dias, em que se analisou alguns parâmetros do metabolismo lipídico e colônico (fermentativos) dos animais, divididos em quatro grupos experimentais, se diferenciando pela dieta. As dietas controle (GC), in natura (GFI) e extrusada (GFE) eram hipercolesterolemizantes (13,5 por cento de gordura de coco e 0,1 por cento de colesterol) e a dieta referência (GR) com óleo de soja como fonte lipídica, não. Todas as dietas apresentavam 15 por cento de fibra alimentar, sendo que as dietas GR e GC tinham como fonte de fibra a celulose, e as dietas GFI e GFE tiveram as próprias fibras como fonte. A resposta glicêmica em humanos foi verificada por meio do ensaio do índice glicêmico e carga glicêmica da FE, com dez voluntários saudáveis que consumiram 25 gramas de carboidratos disponíveis do alimento teste (farinha extrusada) ou do pão branco como alimento controle. Resultados: Não foi observada diferença significativa entre o peso final, ingestão diária média e total, ganho de peso e CEA entre os animais dos quatro grupos. A concentração de triglicerídeos foi menor em 41 por cento e 38 por cento nos animais que receberam as dietas GFI e GFE, em relação aqueles que receberam a dieta GC, assim como também para o colesterol total (55 por cento e 47 por cento ), LDL-c (70 por cento e 53 por cento ) e não-HDL-c (63 por cento e 49 por cento ) séricos, lipídeos totais hepáticos (39 por cento e 45 por cento ) e o peso dos fígados dos animais também foi menor (21 por cento em ambos os grupos). Não houve diferença no colesterol hepático e excretado nas fezes dos animais dos quatro grupos. Os animais do GFE excretaram 57 por cento mais ácidos biliares nas fezes que os animais do GC. Com relação aos parâmetros fermentativos, observou-se maior excreção de fibras (1,24 ± 0,08 e 1,52 ± 0,09 gramas) nos animais dos grupos GR e GC respectivamente, em relação aos do GFI e GFE (0,50 e 0,48 gramas), porém o escore fecal (3,50 ± 0,19 e 3,38 ± 0,18) e o grau de fermentação (54 e 52 por cento ) foi maior nos animais dos grupos GFI e GFE. Houve uma maior produção de AGCC no ceco dos animais dos grupos GFI e GFE (80 e 57,5 µmol/g de ceco respectivamente) e maior diminuição do pH no conteúdo cecal nos animais do grupo GFI (7,49 ± 0,10), em relação ao GC (8,06 ± 0,13). Os ácidos acético e propiônico, estiveram presentes em maior quantidade no ceco dos animais dos grupos GFI (58,5 e 6,1 µmol/g de ceco) e GFE (42,5 e 6,6 µmol/g de ceco) e os animais do GFI produziram mais ácido butírico (15 µmol/g de ceco), em relação aos demais grupos. Quanto à resposta glicêmica da farinha pós extrusão, não houve diferença entre a área de resposta glicêmica da farinha extrusada e do pão branco, o índice glicêmico da farinha extrusada (glicose como controle) foi classificado como moderado, e a carga glicêmica (na porção de 30 gramas), baixa. Conclusão: As FIN e FE favoreceram a redução do colesterol total, LDL-c, não-HDL-c e dos triglicerídeos séricos, além da diminuição do acúmulo de lipídeos hepáticos. Foi observado também aumento expressivo na formação de AGCC e no grau de fermentação. A FE proporcionou um aumento na excreção de ácidos biliares nas fezes e apresentou índice glicêmico moderado e baixa carga glicêmica.

Toxicokinetics of domoic acid in a nonhuman primate model (Macaca fascicularis)

Thesis (Master's)--University of Washington, 2016-06

Endurance exercise, plasma oxidation and cardiovascular risk

Objective-Although physical activity is beneficial to health, people who exercise at high intensities throughout their lifetime may have increased cardiovascular risk. Aerobic exercise increases oxidative stress and may contribute to atherogenesis by augmented oxidation of plasma lipoproteins. The aim of this study was to examine the relationship between aerobic power and markers of oxidative stress, including the susceptibility of plasma to oxidation. Methods and results-Aerobic power was measured in 24 healthy men aged 29 9 years (mean +/- SD). Plasma was analysed from subjects of high aerobic power (HAP; VO(2)max, 64.6 +/- 6.1 ml/kg/min) and lower aerobic power (LAP;VO(2)max, 45.1 +/- 6.3 ml/kg/min) for total antioxidant capacity (TAC), malondialdehyde (MDA) and susceptibility to oxidation. Three measures were used to quantify plasma oxidizability: (1) lag time to conjugated diene formation (lag time); (2) change in absorbance at 234 nm and; (3) slope of the oxidation curve during propagation (slope). The HAP subjects had significantly lowerTAC (1.38 +/- 0.04 versus 1.42 +/- 0.06 TEAC units; P < 0.05), significantly higher change in absorbance (1.55 +/- 0.21 versus 1.36 +/- 0.17 arbitrary units; P < 0.05), but no difference in MDA (P = 0.6), compared to LAP subjects. There was a significant inverse association between TAC and slope (r = -0.49; P < 0.05). Lipoprotein profiles and daily intake of nutrients did not differ between the groups. Conclusions-These findings suggest that people with high aerobic power, due to extreme endurance exercise, have plasma with decreased antioxidant capacity and higher susceptibility to oxidation, which may increase their cardiovascular risk.

Kidney dysfunction and hypertension: Role for cadmium, P450 and heme oxygenases?

Cadmium (Cd) is a metal toxin of continuing worldwide concern. Daily intake of Cd, albeit in small quantities, is associated with a number of adverse health effects which are attributable to distinct pathological changes in a variety of tissues and organs. In the present review, we focus on its renal tubular effects in people who have been exposed environmentally to Cd at levels below the provisional tolerable intake level set for the toxin. We highlight the data linking such low-level Cd intake with tubular injury, altered abundance of cytochromes P450 (CYPs) in the kidney and an expression of a hypertensive phenotype. We provide updated knowledge on renal and vascular effects of the eicosanoids 20-hydroxyeicosatetraenoic acid (20-HETE) and eicosatrienoic acids (EETs), which are biologically active metabolites from arachidonate metabolism mediated by certain CYPs in the kidney. We note the ability of Cd to elicit oxidative stress and to alter metal homeostasis notably of zinc which may lead to augmentation of the defense mechanisms involving induction of the antioxidant enzyme heme oxygenase-1 (HO-1) and the metal binding protein metallothionein (MT) in the kidney. We hypothesize that renal Cd accumulation triggers the host responses mediated by HO-I and MT in an attempt to protect the kidney against injurious oxidative stress and to resist a rise in blood pressure levels. This hypothesis predicts that individuals with less active HO-1 (caused by the HO-1 genetic polymorphisms) are more likely to have renal injury and express a hypertensive phenotype following chronic ingestion of low-level Cd, compared with those having more active HO-1. Future analytical and molecular epidemiologic research should pave the way to the utility of induction of heme oxygenases together with dietary antioxidants in reducing the risk of kidney injury and hypertension in susceptible people.

Dietary habits are major determinants of the plasma antioxidant status in healthy elderly subjects

Previous studies indicate that regular consumption of a diet rich in fruits and vegetables is associated with a lower risk for age-related diseases. The aim of the present study was to evaluate whether the often-reported age-related decrease of plasma antioxidants in man depends on differences in dietary intake or on other age- and gender-related factors. In this observational case-control study, thirty-nine community-dwelling healthy subjects aged 65 years and older consuming high intakes of fruits and vegetables daily (HI) and forty-eight healthy subjects aged 65 and older consuming low intakes of fruit and vegetables daily (LI) were enrolled. Plasma levels of retinol, tocopherols, carotenoids and malondialdehyde (MDA) as well as content of protein carbonyls in Ig G were measured. Plasma levels of retinol, tocopherols and carotenoids were significantly higher in group HI than in group LI subjects independent of age and gender. MDA levels were inversely correlated with vitamin A and α-carotene. Protein carbonyls were inversely correlated with γ-tocopherol. In the elderly, a higher daily intake of fruits and vegetables is associated with an improved antioxidant status in comparison to subjects consuming diets poor in fruits and vegetables. Modification of nutritional habits among other lifestyle changes should be encouraged to lower prevalence of disease risk factors in later life. © The Authors 2005.

Aspirin and aspirin analogs on esophageal cancer

Background: Esophageal cancer is the eighth most common cancer seen worldwide and is the sixth most common cause of death from cancer. The UK alone has over 8,000 new cases of esophageal cancer every year. Epidemiological studies have shown that low-dose daily intake of aspirin can decrease the incidence of esophageal cancer. However, its use as an anti-cancer drug has been restrained because of its side effects exerted through inhibition of cyclooxygenase (COX) enzymes. In our study, we have investigated the effects of a number of novel aspirin analogs on esophageal cancer cell lines. Methods: The effects of aspirin and its analogs on the viability of esophageal cancer cell lines were tested using the MTT assay. ApoSense and flow cytometric analysis were performed to examine whether aspirin analog-mediated tumor cell death is due to apoptosis or necrosis. Colorimetric assays measuring peroxidase component of cyclooxygenases were employed to screen aspirin analogs for COX inhibition. Results: Our data suggests that the anti-proliferative property of certain aspirin analogs is greater than that of aspirin itself. Benzoylsalicylates and fumaroyl diaspirin were more effective than aspirin against the oe21 squamous cell carcinoma cells and oe33 esophageal adenocarcinoma cells. Flo-1 esophageal adenocarcinoma cells showed resistance to aspirin and most of the aspirin analogs other than the benzoylsalicylates. Both diaspirin and benzoylsalicylates inhibited metabolic activity in all these esophageal cells. However, apoptosis was induced in only a small proportion. We have also shown that these aspirin analogs do not appear to inhibit COX enzymes. Conclusion: We have synthesized and characterized a number of novel aspirin analogs that are more effective against esophageal cancer cell lines than aspirin. These compounds do not exert their anti-proliferative effect through induction of apoptosis. Moreover, these analogs inability to inhibit COX enzymes suggests that they may cause fewer or no side effects compared to aspirin.

Avaliação da efetividade do Programa de Alimentação do Trabalhador

This study analyzed the Worker’s Healthy Eating Program in Rio Grande do Norte state (RN) to assess its possible impact on the nutritional status of the workers benefitted. To that end, we conducted a cross-sectional observational prospective study based on a multistage stratified random sample comparing 26 small and medium-sized companies from the Manufacturing Sector (textiles, food and beverages, and nonmetallic minerals) of RN, divided into two equal groups (WFP and Non WFP). Interviews were conducted at each company by trained interviewers from Tuesday to Saturday between September and December 2014. Data were collected on the company (characterization and information regarding the program’s desired results) and workers (personal and professional information, anthropometrics, health, lifestyle and food consumed the previous day). Population estimates were calculated for RN on the characteristics of workers and the study variables. The main variable was BMI. The secondary variables were waist circumference (WC), nutritional diagnosis, calorie intake, blood pressure, metabolic variables and lifestyle indicators. The statistical method used was hierarchical mixed effects linear regression for interval variables and hierarchical mixed effects logistic regression for binary variables. The variables measured in ordinal scales were analyzed by ordinal logistic regression adjusted for correlated variables, adopting robust standard errors. The results for interval variables are presented as point estimates and their 95% confidence intervals; and as odds-ratios and their 95% confidence intervals for binary variables. The Fisher’s exact and Student’s t-tests were used for simple comparisons between proportions and means, respectively. Differences were considered statistically significant at p<0.05. A total of 1069 workers were interviewed, of which 541 were from the WFP group and 528 from the Non WFP group. Subjects were predominantly males and average age was 34.5 years. Significant intergroup differences were observed for schooling level, income above 1 MW (minimum wage) and specific training for their position at the company. The results indicated a significant difference between the BMI of workers benefitted, which was on average 0.989 kg/m2 higher than the BMI of workers from the Non WFP group (p=0.002); and between the WC, with the waist circumference of WFP group workers an average of 1.528 cm larger (p<0.05). Higher prevalence of overweight and obesity (p<0.001) and cardiovascular risk (p=0.038) were recorded in the WFP group. Tests on the possible effect of the WFP on health (blood pressure and metabolic indicators) and lifestyle indicators (smoking, alcohol consumption and exercise) were not significant. With respect to worker’s diets, differences were significant for consumption of saturated fat (lunch and daily intake), salt (lunch, other meals and daily intake) and proteins (other meals and daily intake), with higher consumption of these nutrients in the WFP group. The study showed a possible positive impact of the WFP on nutritional status (BMI and WC) among the workers benefitted. No possible effects of the program were observed for the lifestyle indicators studied. Workers benefitted consumed less salt, saturated fat and protein. The relevance of the WFP is recognized for this portion of society and it is understood that, if the program can reach and impact those involved, the development of educational initiatives aimed at nutritional and food safety may also exert a positive influence.

Reduction of salt in yeasted wheat bread: impact on bread quality and solutions using sourdough fermented by functional lactic acid bacteria strains

The dietary intake of sodium chloride has increased considerably over the last few decades due to changes in the human diet. This higher intake has been linked to a number of diseases including hypertension and other cardiovascular diseases. Numerous international health agencies, as well as the food industry, have now recommended a salt intake level of 5-6 g daily, approximately half of the average current daily intake level. Cereal products, and in particular bread, are a major source of salt in the Western diet. Therefore, any reduction in the level of salt in bread could have a major impact on global health. However, salt is a critical ingredient in bread production, and its reduction can have a deleterious effect on the production process as well as on the final bread quality characteristics such as shelf-life, bread volume and sensory characteristics, all deviating from the bakers’ and consumers’ expectations. This work addresses the feasibility of NaCl reduction in wheat bread focusing on options to compensate NaCl with the use of functional sourdoughs. Three strains were used for the application of low-salt bread; L. amylovorus DSM19280, W. cibaria MG1 and L. reuteri FF2hh2. The multifunctional strain L. reuteri FF2hh2 was tested the first time and its application could be demonstrated successfully. The functionalities were based on the production of exopolysaccharides as well as the production of antifungal compounds. While the exopolysaccharides, mainly high molecular dextrans, positively influenced mainly bread loaf volume, crumb structure and staling rate, the strains producing antifungal compounds prolonged the microbial shelf life significantly and compensated the lack of salt. The impact on the sensory characteristics of bread were evaluated by descriptive sensory evaluation. The increase in surface area as well as the presence of organic acids impacted significantly on the flavour profile of the sourdough bread samples. The flavour attribute “salt” could be enhanced by sourdough addition and increased the salty perception. Furthermore, a trained sensory panel evaluated for the first time the impact of yeast activity, based on different salt and yeast concentrations, on the volatile aroma profile of bread crumb samples. The analytical measurements using high resolution gas chromatography and proton-transfer-reaction mass spectrometry (PTR-MS) resulted in significantly different results based on different yeast activities. Nevertheless, the extent of the result could not be recognised by the sensory panel analysing the odour profile of the bread crumb samples. Hence, the consumer cannot recognised low-salt bread by its odour. The use of sourdough is a natural option to overcome the broad range of technological issues caused by salt reduction and also a more popular alternative compared to existing chemical salt replacers.

National Diet and Nutrition Survey: assessment of dietary sodium in adults (19 to 64 years) in England, 2014

There is an established relationship between salt intake and risk of high blood pressure (BP). High blood pressure (hypertension) is a risk factor for cardiovascular disease (CVD) and scientific evidence shows that a high salt intake can contribute to the development of elevated blood pressure. The Scientific Advisory Committee on Nutrition (SACN) recommend a target reduction in the average salt intake of the population to no more than 6g per day. This figure has been adopted by the UK government as the recommended maximum salt intake for adults and children aged 11 years and over. Following publication of the SACN report in 2003, the government began a programme of reformulation work with the food industry aimed at reducing the salt content of processed food products. Voluntary salt reduction targets were first set in 2006, and subsequently in 2009, 2011 and 2014, for a range of food categories that contribute the most to the population’s salt intakes. Population representative urinary sodium data were collected in England in 2005-06, 2008 (UK), 2011 and 2014. In the latest survey assessment, estimated salt intake of adults aged 19 to 64 years in England was assessed from 24-hour urinary sodium excretion of 689 adults, selected to be representative of this section of the population. Estimated salt intake was calculated using the equation 17.1mmol of sodium = 1g of salt and assumes all sodium was derived from salt. The data were validated as representing daily intake by checking completeness of the urine collections by the para-amino benzoic acid (PABA) method. Urine samples were collected over five months (May to September) in 2014, concurrently with a similar survey in Scotland. This report presents the results for the latest survey assessment (2014) and a new analysis of the trend in estimated salt intake over time. The trend analysis is based on data for urinary sodium excretion from this survey and previous sodium surveys (including data from the National Diet and Nutrition Survey Rolling Programme (NDNS RP) Years 1 to 5) carried out in England over the last ten years, between 2005-06 and 2014. This data has been adjusted to take account of biases resulting from differences between surveys in laboratory analytical methods used for sodium. The analysis provides a revised assessment of the trend in estimated salt intake over time. The trend analysis in this report supersedes the trend analysis published in the report of the 2011 England urinary sodium survey.

Erosão dentária

A erosão dentária é o resultado físico da perda patológica, crónica e localizada de tecidos dentários mineralizados, provocada quimicamente por ácidos e/ou quelantes, sem envolvimento bacteriano. O diagnóstico diferencial das lesões de erosão dentária deve ser feito o mais precocemente possível, sendo que as suas características clínicas dificilmente se dissociam de fenómenos de atrição e/ou de abrasão. Desta forma é importante o uso de índices de abordagem do desgaste dentário não demasiado discriminatórios, mas que possam ser válidos num âmbito clínico para monitorizar o desgaste, e avaliar a eficácia das medidas preventivas instituídas. A intervenção clínica face á perda estrutural de causa erosiva implica o controlo dos fatores etiológicos nomeadamente dietéticos, comportamentais e patológicos, associado a um aporte diário de agentes de reforço da estrutura dentária. O objectivo deste trabalho foi realizar uma pesquisa bibliográfica de forma a sistematizar os pontos importantes a ter em conta na abordagem clínica das lesões erosivas. Este tema torna-se importante e útil dado que estes conhecimentos podem ser aplicados diariamente na prática clínica.

BPA occupational exposure assessment in Europe: a scientific gap

Bisphenol A (BPA), 2,2-bis(4-hydroxyphenyl) propane one is of the greatest volume industrial chemicals utilized in the world with increased production every year. Environmental exposure to this xenoestrogen is considered a generalized phenomenon with a Tolerable Daily Intake (TDI) of4 µg/kg body weight/day established by the European Food Safety Authority. Several studies have focused in estimate human daily intake and potential associated health effects of environmental exposures, however despite of the massive BPA production and consumption in European countries, with policarbonate and epoxy resins as the major applications, occupational exposure to BPA have been overlooked and considered safe by the European authorities.

Quantificação de iodo em alimentos consumidos em Portugal: resultados preliminares

O iodo é um oligoelemento indispensável para a síntese das hormonas da tiroide. A alimentação é a maior fonte natural de iodo. Assim, o principal objetivo deste trabalho foi a determinação de iodo em alimentos como consumidos e representativos da dieta portuguesa. A metodologia escolhida para a quantificação deste nutriente foi a espectrometria de massa acoplada ao plasma indutivo (ICP-MS). Analisaram-se seis grupos de alimentos: peixes, mariscos e bivalves, leite e derivados, vegetais, fruta e refeições compostas. Os grupos do pescado (peixe, marisco e bivalves) foram os que apresentaram concentrações de iodo mais elevados, com um valor médio de 114 μg/100g. Os laticínios são também uma fonte importante para suprir o aporte diário de iodo (150 μg/dia) apresentado valores médios de 22 μg/100g. Os resultados permitem concluir que em Portugal uma alimentação rica em pescado e lacticínios supre a dose diária recomendada de iodo para um adulto saudável.

Is there a health risk concerning the children´s consumption of cereal-based products? A cumulative mycotoxin risk assessment approach

Historically, the health risk of mycotoxins had been evaluated on the basis of single-chemical and single-exposure pathway scenarios. However, the co-contamination of foodstuffs with these compounds is being reported at an increasing rate and a multiple-exposure scenario for humans and vulnerable population groups as children is urgently needed. Cereals are among the first solid foods eaten by child and thus constitute an important food group of their diet. Few data are available relatively to early stages child´s exposure to mycotoxins through consumption of cereal-based foods. The present study aims to perform the cumulative risk assessment of mycotoxins present in a set of cereal-based foods including breakfast cereals (BC), processed cereal-based foods (PCBF) and biscuits (BT), consumed by children (1 to 3 years old, n=75) from Lisbon region, Portugal. Children food consumption and occurrence of 12 mycotoxins (aflatoxins, ochratoxin A, fumonisins and trichothecenes) in cereal-based foods were combined to estimate the mycotoxin daily intake, using deterministic and probabilistic approaches. Different strategies were used to treat the left censored data. For aflatoxins, as carcinogenic compounds, the margin of exposure (MoE) was calculated as a ratio of BMDL (benchmark dose lower confidence limit) and aflatoxin daily exposure. For the remaining mycotoxins, the output of exposure was compared to the dose reference values (TDI) in order to calculate the hazard quotients (HQ, ratio between exposure and a reference dose). The concentration addition (CA) concept was used for the cumulative risk assessment of multiple mycotoxins. The combined margin of exposure (MoET) and the hazard index (HI) were calculated for aflatoxins and the remaining mycotoxins, respectively. Main results revealed a significant health concern related to aflatoxins and especially aflatoxin M1 exposure according to the MoET and MoE values (below 10000), respectively. HQ and HI values for the remaining mycotoxins were below 1, revealing a low concern from a public health point of view. These are the first results on cumulative risk assessment of multiple mycotoxins present in cereal-based foods consumed by children. Considering the present results, more research studies are needed to provide the governmental regulatory bodies with data to develop an approach that contemplate the human exposure and, particularly, children, to multiple mycotoxins in food. The last issue is particularly important considering the potential synergistic effects that could occur between mycotoxins and its potential impact on human and, mainly, children health.