Application of BRAFO-Tiered Approach for Risk–Benefit Assessment of Nut Consumption in Chinese Adults

Nuts are nutrient-rich foods that help reduce the risk of coronary heart disease (CHD), but their potential contamination with aflatoxins (AFs) may increase the risk of liver cancer. In this study, the European Benefit-Risk Analysis for Foods (BRAFO) framework was used to evaluate both the health risks and benefits of nut consumption among Chinese adults. Based on the actual consumption patterns of nuts among the Chinese population, the current consumption level was set as the reference scenario (4.66 g/day), and three alternative scenarios were simulated with a daily nut consumption of 10, 20, and 30 g, respectively. Dose-response relationships were established using a two-stage dose-response analysis for nut consumption and CHD risk, and a one-stage dose-response analysis for aflatoxin B1 (AFB1) exposure and liver cancer risk. A Monte Carlo probabilistic model quantified the CHD prevention benefits and liver cancer risks associated with AF exposure. Disability-Adjusted Life Year (DALY) analysis indicated net health benefits in all scenarios, with nut consumptions of 10, 20, and 30 g/day reducing DALYs per 100,000 population by 104.39, 143.63, and 181.47 in men, and by 58.79, 81.29, and 102.94 in women, respectively. A nut consumption of 10 g/day was recommended for Chinese adults, considering both health benefits and the risk of AF exposure. This study presents the first application of the BRAFO framework to evaluate the net health effect of nut consumption in a Chinese population, filling a critical gap in the risk-benefit assessment of nut consumption.