On February 3, 2000, the French Food Safety Agency (AFSSA) was questioned by UFC Que Choisir regarding the risks associated with the presence of aluminum in the consumer environment across all sources of exposure. In parallel with this request for a risk assessment, the French Health Products Safety Agency (Afssaps) initiated a review focusing on aluminum and health products. A joint Afssaps/Afssa meeting was therefore held in June 2000 to conduct an initial review of the available toxicological, chemical, and epidemiological data. In July 2000, INSERM Unit 330 published in the American Journal of Epidemiology the results of the 8-year follow-up of the Paquid cohort, which highlighted an increased risk of dementia, particularly Alzheimer’s-type dementia, among subjects exposed to aluminum concentrations in tap water exceeding 100 μg/L. This study reignited a debate that began in the 1970s regarding the potential role of aluminum in Alzheimer’s degenerative dementia. At the same time, the AFSSA’s Committee of Specialized Experts (CES) for the "Water" and the Higher Council of Public Health of France (CSHPF) to rule on the renewal of the quality limit value for total aluminum in water intended for human consumption, set at 200 μg/L by Decree 89-3 of January 3, 1989. It was in this context that the Directorate General of Health (DGS) referred the matter on September 12, 2000, to the Institute for Public Health Surveillance (InVS) and AFSSA. It sought a critical analysis of studies examining the relationship between aluminum and Alzheimer’s disease in order to assess the quality of the available evidence and, if warranted, issue recommendations for improving knowledge and revising regulatory provisions in the fields of water and food. The scientific literature has suggested that aluminum may be involved in the etiology of conditions other than Alzheimer’s disease (primarily neurological, skeletal, respiratory, and immuno-allergic disorders) and that sources of exposure other than water and food may contribute to the risks. Given the decision-making support provided by this study, particularly in the context of revisions to environmental quality limits, it seemed preferable to broaden the scope of the analysis: - To all possible health effects of aluminum. Indeed, Alzheimer’s disease—assuming this condition is linked to aluminum—may not be the first effect to occur at the lowest exposure levels (critical effect). However, if other adverse effects are likely to manifest at exposure levels lower than those leading to Alzheimer's disease, they should be taken into account when establishing recommendations aimed at protecting people. - All sources and routes of aluminum exposure. Indeed, sources of exposure other than water and food can contribute significantly to aluminum intake in the human body. While the toxic effects of aluminum are not specific to any single source or route of exposure, health-related recommendations cannot be made regarding water or food without understanding the attributable share or the specific role of these media in human exposure and the occurrence of adverse effects. A Steering Committee involving the three public health agencies (AFSSA, AFSSAPS, and InVS) was established to organize a national review of available data to assess the health risks associated with public exposure to aluminum in various environments, particularly in water, food, and health products. The work was divided among three expert groups: - "Exposure" Group: responsible for analyzing data to quantify aluminum intake in its various forms—via water, food, and health products—distinguishing between naturally occurring sources and those resulting from human activities. This group was divided into three subgroups: water, food, and health products. Scientific and technical coordination of the "water" and "food" groups was provided by AFSSA, while that of the "health products" group was provided by AFSSAPS. - "Toxicology" group: responsible for analyzing data to describe the kinetics and metabolism of aluminum in humans, identifying target organs and potential toxic effects, and providing evidence regarding the existence or absence of toxicological reference values applicable to the population for the relevant exposure routes. The scientific and technical coordination of this group was provided by Afssaps. - "Epidemiology" group: responsible for analyzing epidemiological studies to complement the toxicological approach regarding hazard identification and the potential determination of exposure-risk relationships. The scientific and technical coordination of this group was provided by InVS. (Background and Objectives)