In this second installment, we continue our conversation with Dr. Sandra Hoffmann about the June 4 release of the World Health Organization’s and Foodborne Disease Burden Epidemiology Reference Group’s (FERG’s) 2025 Global Burden of Foodborne Disease Estimates.
Asked what stood out in this second release, Hoffmann pointed to the addition of heavy metals. While biological hazards cause almost 99% of foodborne illness cases, she explained, chemicals account for 73% of deaths — and many of those deaths trace to heavy metals and metalloids. Capturing those hazards was critical.
For this round, more information was available on the chronic effects of heavy metals and metalloids, particularly the effects of lead and inorganic arsenic exposure on heart disease. Global burden estimates for foodborne inorganic arsenic, cadmium, lead, and methylmercury were previously published in a separate 2018 paper. The disease incidence estimates from 2018 are similar to those in 2025, but the burden for lead and arsenic is higher, reflecting recent work linking these hazards to heart disease and, in turn, to higher mortality. More epidemiological research on these effects is still needed to complete the picture of foodborne disease burden.
What is striking is how concentrated the burden is by region. Lead and inorganic arsenic rank highest among the 42 hazards in disability-adjusted life years (DALYs), and that ranking is part of why Southeast Asia sits just behind Africa in foodborne disease burden. High foodborne lead and methylmercury exposures across Southeast Asian countries are likely the product of several factors: high fish consumption, industrial and mining runoff, the legacy of leaded gasoline, and lead in spices. Because these metals contribute so much of the region's burden, identifying their exposure routes — and reducing foodborne exposure — could substantially lower national and regional DALY burden from foodborne disease.
If you'd like to read more about the burden-of-disease estimates, you can find them on the PLOS website.