Journal Articles
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Item Proposing a unified Mediterranean diet score to address the current conceptual and methodological challenges in examining adherence to the Mediterranean diet(Frontiers Media S.A., 2025-09-12) Hwalla N; Trichopoulou A; Delarue J; Adinolfi F; Brighenti F; Burlingame B; Capone R; Dernini S; El Moujabber M; González-Gross M; Vecchio Y; Massouh N; Naja F; Pederiva CA plethora of studies has documented the benefits of the Mediterranean diet (MedDiet) for both human and environmental health. At the core of these investigations lies the assessment of adherence to it. In this manuscript, we aim to examine existing original scores used to assess adherence to the MedDiet and propose a framework for a unified score to address current challenges and complement the existing scores. A literature search was conducted to identify original MED scores, excluding those derived from earlier scores. A total of nineteen original scores were identified and examined. At the conceptual level, across existing scores, the following issues were identified: inconsistencies in food items, lack of holistic lifestyle approaches with focus on food-based components, limited cultural specificity, absence of sustainability evaluations, and regional focus solely on economically developed countries. At the methodological level, the majority of scores were based on cutoffs set by the population-specific distributions of dietary intake. Such cutoffs may be in discordance with the dietary recommendations of the different food groups considered. In addition, the definition of “adherence” is inconsistent across the scores, making the interpretation and comparability of the prevalence of adherence another methodological challenge. As a result, a framework for a Unified Mediterranean diet Score (UMEDS) is proposed. This framework consists of 10 food groups (whole grains, fruits, vegetables, dairy products, fish, legumes, olive oil, nuts and seeds, poultry, and red meat). These food groups are the common denominators of a traditional Mediterranean diet. In addition to the food-related components, the UMEDS also addresses physical activity, sleep, conviviality, and culture-specific food consumption (mainly composite dishes based on olive oil). For each of these items, evidence-based cut-offs were proposed. The total score for the UMEDS ranges from 0 to 22 with higher scores indicating a higher adherence (≤12 poor adherence, 13–17 moderate adherence, ≥18 good adherence). By integrating key components of dietary intake, lifestyle habits, and cultural practices, the UMEDS provides a comprehensive unified approach that aligns with global health guidelines and reflects the true spirit of the Mediterranean diet, rooted in food, lifestyle, culture, lifestyle, and traditional knowledge and practices.Item Multi-scalar policy uptake of the six-dimensional food security framework(Elsevier Ltd, 2025-11-01) Clapp J; Moseley WG; Termine P; Burlingame BIn 2022, along with colleagues, we proposed a six-dimensional food security framework in a Food Policy viewpoint article that argued for the need to expand the commonly cited four pillar approach (availability, access, utilization and stability) by adding two additional dimensions: agency and sustainability. The proposal was not just for a new conceptual framework for scholarly analysis, but also for its application in policy settings. Over three years later, we are humbled to see widespread uptake of our call to embrace agency and sustainability as dimensions of food security in multiple tyles of policy settings at different scales. This brief policy comment outlines the growing recognition and application of the six-dimensional framework for food security in policy contexts from the global to the local level. We are hopeful that the growing application of this idea will help to make improvements in the global quest to end hunger.Item Global protein sustainability and the United Nations, through to the 2030 agenda(Frontiers Media S.A., 2024-10-15) Burlingame B; Moltedo A; Cafiero C; Hendriks WOrganizations and initiatives concerned with food security and nutrition have long positioned protein, together with dietary energy, as the keystone for life itself. Indeed, the word protein, derived from the Greek proteios, means ‘of primary importance’. There is a long history of attention to, and controversies over, proteins in UN processes, beginning in the 1930s and continuing to this day. The importance of protein for agriculture, health, food security and nutrition is reflected in the data collected and presented in the statistical databases of the Food and Agriculture Organization (FAOSTAT), available per commodity, per country and over an extensive time series. Protein features directly and indirectly in all 17 Sustainable Development Goals (SDG), which constitute the United Nations 2030 Agenda. Most directly involved is SDG 2. The short title for SDG 2 is ‘zero hunger’. The long title offers more detail: end hunger, achieve food security and improved nutrition and promote sustainable agriculture.Item Partnerships for the Sustainable Development Goals: a call for more science(Frontiers Media S.A., 2024-04-11) Berry EM; Burlingame B; le Coutre J; Nikolaou CKItem Guidance on the preparation and submission of the notification and application for authorisation of traditional foods from third countries in the context of Regulation (EU) 2015/2283 (Revision 1)(John Wiley and Sons Ltd on behalf of the European Food Safety Authority, 2021-03-26) EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA); Turck D; Bresson J-L; Burlingame B; Dean T; Fairweather-Tait S; Heinonen M; Hirsch-Ernst KI; Mangelsdorf I; McArdle HJ; Naska A; Neuhäuser-Berthold M; Nowicka G; Pentieva K; Sanz Y; Siani A; Sjödin A; Stern M; Tomé D; Vinceti M; Willatts P; Engel K-H; Marchelli R; Pöting A; Poulsen M; Schlatter J; Gelbmann W; de Sesmaisons-Lecarré A; Verhagen H; van Loveren HFollowing the adoption of Regulation (EU) 2015/2283 on Novel Foods, the European Commission requested EFSA to develop a scientific and technical guidance for the preparation and submission of notifications for traditional foods from third countries. This guidance presents a common format for the organisation of the information to be presented by applicant for the preparation of a well-structured dossier. The safety of a traditional food should be substantiated by reliable data on its composition, its experience of continued use and its proposed conditions of use. Its normal consumption should not be nutritionally disadvantageous. This guidance is also intended to support applicants in providing the type and quality of information EU Member States and EFSA need for the assessments of traditional foods from third countries. The applicant should integrate the information on the composition and the experience of continued use and provide a concise overall consideration on how this substantiates the history of safe use of the traditional food and how this relates to the proposed conditions of use for the EU. Where potential health hazards have been identified on the basis of the composition and/or data from the experience of continued use, they should be discussed. On the basis of the information provided, EFSA will assess the safety related to the consumption of the traditional food under the proposed conditions of use. This guidance was originally adopted by the NDA Panel in 2016. It has been revised in 2020 to inform applicants of the new provisions introduced by Regulation (EC) No 178/2002, as amended by Regulation (EU) 2019/1381 on the transparency and sustainability of the EU risk assessment in the food chain.It is applicable to allnotifications and applications submitted as of 27 March 2021. The 2016 version remains applicable to notifications and applications submitted before 27 March 2021.Item Guidance on the scientific requirements for health claims related to muscle function and physical performance: (Revision 1)(John Wiley and Sons Ltd on behalf of European Food Safety Authority, 2018-10-30) EFSA Panel on Nutrition, Novel Foods and Food Allergens (EFSA NDA Panel); Turck D; Castenmiller J; De Henauw S; Hirsch-Ernst KI; Kearney J; Knutsen HK; Maciuk A; Mangelsdorf I; McArdle HJ; Naska A; Pelaez C; Pentieva K; Thies F; Tsabouri S; Vinceti M; Bresson J-L; Burlingame B; Dean T; Fairweather-Tait S; Heinonen M; Neuhäuser-Berthold M; Nowicka G; Sanz Y; Sjödin A; Stern M; Tomé D; Van Loveren H; Willatts P; Martin A; Strain JJ; Heng L; Martínez SV; Siani AEFSA has asked the Panel on Nutrition, Novel Foods and Food Allergens (NDA) to update the guidance on the scientific requirements for health claims related to physical performance published in 2012. The update takes into account the experience gained by the NDA Panel with the evaluation of additional health claim applications, changes introduced to the general scientific guidance for stakeholders for health claims applications and information collected from a grant launched in 2014 which aimed at gathering information in relation to claimed effects, outcome variables and methods of measurement in the context of the scientific substantiation of health claims. The guidance is intended to assist applicants in preparing applications for the authorisation of health claims related to muscle function and physical performance. The draft guidance was subject to public consultation from 16 July to 2 September 2018. This document supersedes the guidance on the scientific requirements for health claims related to physical performance published in 2012. It is intended that the guidance will be further updated as appropriate in the light of experience gained from the evaluation of health claims.Item Black tea and improvement of attention: evaluation of a health claim pursuant to Article 13(5) of Regulation (EC) No 1924/2006(John Wiley and Sons Ltd on behalf of European Food Safety Authority, 2018-05-24) EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA); Turck D; Bresson J-L; Burlingame B; Dean T; Fairweather-Tait S; Heinonen M; Hirsch-Ernst KI; Mangelsdorf I; McArdle HJ; Naska A; Neuhäuser-Berthold M; Nowicka G; Pentieva K; Sanz Y; Sjödin A; Stern M; Tomé D; Van Loveren H; Vinceti M; Willatts P; Martin A; Strain SJJ; Siani AFollowing an application from Unilever NV, submitted for authorisation of a health claim pursuant to Article 13(5) of Regulation (EC) No 1924/2006 via the Competent Authority of Ireland, the EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA) was asked to deliver an opinion on the scientific substantiation of a health claim related to black tea and improvement of attention. The scope of the application was proposed to fall under a health claim based on newly developed scientific evidence. The food proposed by the applicant as the subject of the health claim is black tea. The Panel considers that black tea characterised by its content of tea solids, caffeine and l-theanine, which is the subject of the health claim, is sufficiently characterised in relation to the claimed effect. The claimed effect proposed by the applicant is 'improves attention'. The Panel considers that improvement of attention is a beneficial physiological effect. Three human intervention studies provided by the applicant show an effect of black tea on attention under the conditions of used proposed by the applicant. The applicant proposed that the claimed effect depends on the concerted action of two substances, caffeine and l-theanine, both of which are present in black tea. The Panel considers that the effect of black tea on attention observed in the three human intervention studies provided by the applicant can be explained by its caffeine content. The Panel concludes that a cause and effect relationship has been established between the consumption of black tea and improvement of attention. The Panel considers that the effect of black tea on attention can be explained by its caffeine content. The following wording reflects the scientific evidence: 'Owing to its caffeine content, black tea improves attention'. In order to obtain the claimed effect, 2-3 servings of black tea providing at least 75 mg of caffeine in total should be consumed within 90 min.Item Safety of xylo-oligosaccharides (XOS) as a novel food pursuant to Regulation (EU) 2015/2283(John Wiley and Sons Ltd on behalf of European Food Safety Authority, 2018-07-23) EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA); Turck D; Bresson J-L; Burlingame B; Dean T; Fairweather-Tait S; Heinonen M; Hirsch-Ernst KI; Mangelsdorf I; McArdle HJ; Naska A; Neuhäuser-Berthold M; Nowicka G; Pentieva K; Sanz Y; Siani A; Sjödin A; Stern M; Tomé D; Vinceti M; Willatts P; Engel K-H; Marchelli R; Pöting A; Poulsen M; Schlatter JR; Turla E; van Loveren HFollowing a request from the European Commission, the EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA) was asked to deliver a scientific opinion on a mixture of xylo-oligosaccharides (XOS) as a novel food (NF) pursuant to Regulation (EU) 2015/2283. The NF is obtained from corncobs (Zea mays subsp. mays) via enzyme-catalysed hydrolysis and subsequent purification. The main components of the NF, the oligosaccharides, are resistant to human digestive enzymes and are fermented by colonic bacteria. The intention is to add the NF to a variety of foods such as bakery and dairy products, fruit jelly, chocolates and soy-drinks. The information provided on composition, specifications, production process and stability of the NF, does not raise safety concerns. There were effects observed in the animal studies with the NF or with other XOS which were considered by the Panel to be expected from the intake of non-digestible carbohydrates. The Panel notes that the acute and transient gastrointestinal observed in human intervention studies with the NF or with other XOS have also been associated with the consumption of other non-digestible carbohydrates. The Panel concludes that the NF, a mixture of XOS, is safe under the proposed uses and use levels. The target population is the general population.Item Xanthohumol in XERME®, a xanthohumol-enriched roasted malt extract, and protection of DNA from oxidative damage: evaluation of a health claim pursuant to Article 13(5) of Regulation (EC) No 1924/2006(John Wiley and Sons Ltd on behalf of European Food Safety Authority, 2018-03-13) EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA); Turck D; Bresson J-L; Burlingame B; Dean T; Fairweather-Tait S; Heinonen M; Hirsch-Ernst KI; Mangelsdorf I; McArdle HJ; Naska A; Neuhäuser-Berthold M; Nowicka G; Pentieva K; Sanz Y; Sjödin A; Stern M; Tomé D; Van Loveren H; Vinceti M; Willatts P; Martin A; Strain SJJ; Siani AFollowing an application from TA-XAN AG, submitted for authorisation of a health claim pursuant to Article 13(5) of Regulation (EC) No 1924/2006 via the Competent Authority of Germany, the EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA) was asked to deliver an opinion on the scientific substantiation of a health claim related to xanthohumol in XERME ®, a xanthohumol-enriched roasted malt extract, and protection of DNA from oxidative damage. The scope of the application was proposed to fall under a health claim based on newly developed scientific evidence. The food proposed by the applicant as the subject of the health claim is xanthohumol in XERME ®, a xanthohumol-enriched roasted malt extract. The Panel considers that xanthohumol in XERME ®, a xanthohumol-enriched roasted malt extract, is sufficiently characterised. The claimed effect proposed by the applicant is 'helps to maintain the integrity of DNA and protects against oxidative damage in the cells of the body'. The Panel considers that protection of DNA from oxidative damage is a beneficial physiological effect. The only human study from which conclusions can be drawn for the scientific substantiation of the claim did not show an effect of xanthohumol in XERME ® on the protection of DNA from oxidative damage. In the absence of evidence for an effect of xanthohumol in XERME ® on the protection of DNA from oxidative damage, the studies provided by the applicant on the proposed mechanisms by which the food/constituent could exert the claimed effect were not considered by the Panel for the scientific substantiation of the claim. The Panel concludes that a cause and effect relationship has not been established between the consumption of xanthohumol in XERME ®, a xanthohumol-enriched roasted malt extract, and protection of DNA from oxidative damage.Item Symbiosal® and lowering of blood pressure and reduced risk of hypertension: evaluation of a health claim pursuant to Article 14 of Regulation (EC) No 1924/2006(John Wiley and Sons Ltd on behalf of European Food Safety Authority, 2018-07-25) EFSA Panel on Dietetic Products, Nutrition and Allergies (EFSA NDA Panel); Turck D; Bresson J-L; Burlingame B; Dean T; Fairweather-Tait S; Heinonen M; Hirsch-Ernst KI; Mangelsdorf I; McArdle HJ; Naska A; Neuhäuser-Berthold M; Nowicka G; Pentieva K; Sanz Y; Sjödin A; Stern M; Tomé D; Van Loveren H; Vinceti M; Willatts P; Martin A; Strain SJJ; Siani AFollowing an application from Han-Biotech GmbH, submitted for authorisation of a health claim pursuant to Article 14 of Regulation (EC) No 1924/2006 via the Competent Authority of Germany, the EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA) was asked to deliver an opinion on the scientific substantiation of a health claim related to Symbiosal®, lowering of blood pressure and reduced risk of hypertension. The Panel considers that the food, Symbiosal®, which is the subject of the health claim, and the food, table salt, which Symbiosal® should replace, are sufficiently characterised. Lowering of blood pressure is a beneficial physiological effect. Increased blood pressure is a risk factor for hypertension. In weighing the evidence, the Panel took into account that one human study with some methodological limitations showed an effect of Symbiosal® on blood pressure in the context of a self-selected diet with a maximum of 3 g/day added salt. The Panel also took into account that no other human studies in which these results have been replicated were provided, that the animal studies did not support the results of the human study, that no evidence was provided in support of a mechanism by which Symbiosal® could induce a decrease in blood pressure upon oral consumption as compared to table salt in vivo in humans, and the low biological plausibility of the effect observed in the human intervention study. The Panel concludes that a cause and effect relationship has not been established between the consumption of Symbiosal® and lowering of blood pressure.