## 3 Results and Discussion: Environmental and Human Health Impact Assessment of Cooked Ham Production
### The Potential Impact of Nitrosamines on Human Health  
This study estimated that the exposure to exogenous nitrosamines (NDMA, NDEA, NPYR, and NPIP) by the daily consumption of cooked ham (16 g) was 0.15 \(\pm\) 0.11 ug per day [78]. The variability in the product was associated with the quantification of the various nitrite compounds. Other studies on cooked ham were limited to the estimated NDMA concentration. For example, in our estimation, the exposure was lower than what was reported in work by [PERSON] et al. [39]; the contribution of exogenous nitroso compounds was between 0 and 2.1 ug per day. In our study, this contribution ranged from 0.003 to 0.34 ug per day and corresponded only to the consumption of cooked ham. In addition to their use for preserving meat, nitrites are added to other foods to preserve them by limiting the proliferation of pathogenic microorganisms, in particular, _Clostridium botulinum_. Nitrates alone are used to prevent some cheeses from swelling during fermentation. They are also naturally present in some vegetables, with the highest concentrations occurring in leafy vegetables, such as spinach or lettuce. Moreover, these substances can enter the food chain as environmental contaminants in water due to their use in intensive agricultural practices, animal production and wastewater discharge. According to the European Food Safety Authority (EFSA) [79], based on realistic data, i.e., levels of concentration actually observed in foods, the intake of nitrates in the form of a food additive is less than 5% of the global exposure to nitrates through food. The development of gastrointestinal cancer is associated with exogenous exposure to nitroso compounds. The ingestion of exogenous nitrosamines in subjects with cancer was 0.0591 \(\pm\) 0.0485 \(\upmu\)g per day. However, this estimate corresponds to the NDMA compound in the diet [80]. [PERSON] et al. [81] also estimated dietary exposure to NDMA in a Spanish population at 0.114 \(\upmu\)g per day. The foods that contributed most to this exposure are meat products (14%), beer (11%), and refined cheese (13%). In addition, a study on a European population showed that dietary exposure to NDMA was 0.26 \(\pm\) 0.34 \(\upmu\)g per day and 0.19 \(\pm\) 0.31 \(\upmu\)g per day for subjects with gastric cancer and for healthy subjects, respectively [82]. The exposure determined for the consumption of cooked ham for our study seemed high in comparison to these evaluations. However, the quantification of a single type of nitrosamine (NDMA) causes an underestimation of the risk of exogenous nitrosamines. In our case, the exposure to nitrosamines by the consumption of cooked ham decreased drastically if NDMA was the only nitrite compound taken into account: 0.065 \(\pm\) 0.063 \(\upmu\)g per day. In France, the exposure (NDMA) due to ham was estimated to be 0.0038 \(\upmu\)g per day, with the presence of NDMA at 0.31 \(\upmu\)g per kg ham and the annual ham consumption of 4.45 kg during the period of 1987-1992. The exposure to NDMA in the diet was determined to be 0.19 \(\upmu\)g per day. Meat products contributed to 12.5% of NDMA exposure [83]. A preliminary study estimated a daily exposure of 0.25 \(\upmu\)g (NDMA) per day per person in France [84]. In general, these studies only considered NDMA in assessing nitrosamine exposure. The exposure to preformed nitrosamines was only considered for the estimation of the indicator. The severity of nitrosamines (2.2x10\({}^{-6}\) DALY.kg\({}^{-1}\)), considering the effect on an entire population and not limited to a sensitive population, was in line with a report from the International Agency for Research on Cancer (IARC) [31]. These experts recognized that there is strong evidence to support changing the recommendations for processed meat product consumption to achieve moderation or a reduction in consumption. Indeed, an increased risk of colorectal cancer is associated with higher consumption of meat products.