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Impacts of an Industrialized Food System on Maternal and Child Health

Where in the Food System do Concerns Exist?

Production Pesticides, chemical fertilizers, antibiotic and hormone use in meat and dairy production, infectious agents, arsenic, environmental degradation

Processing Increased reliance on imported, unregulated processed foods; melamine; residual mercury; food-borne illness

Packaging / Transportation

Bisphenol A (BPA), phthalates, perfluorochemicals, air quality, food miles, widespread use of plastics leading to large volumes of waste both in landfills and incinerated, environmental degradation

Consumption Fast food, sugar-sweetened beverages, high fructose corn syrup, marketing, obesogens, nutritionally deplete foods

Chemicals in the Food System

Mercury Pesticides Bisphenol A Flame retardants Phthalates PCBs (polychlorinated biphenyls)

Our Chemical Environment

Over 85,000 synthetic chemicals in production 3,800 high production volume; used in quantities > 1 million lbs/yr ~900 active pesticide ingredients (EPA) ~ 3,000 in food processing (FDA)

Toxic Substances Control Act of 1976 (TSCA) Health data exists for < 10% of chemicals on the market 62,000 ‘grandfathered’ in Potential for endocrine disruption is not assessed

Cumulative exposures matter Risk assessment and safety standards

use a 1-chemical-at-a-time approach

Widespread exposure to chemicals with reproductive/developmental toxicity

Based on analysis of representative sample of U.S. population by NHANES 2003-2004. Note, not all women were tested for all chemicals

Critical and Sensitive Windows of Development

Periconception Prenatal Postnatal

Blastocyst EmbryoFetus

Infant ChildAdolescent

Environmental ExposuresImmediate & Long Term

Consequences

Louis GMB, Cooney MA, Lynch CD, et al. Fertility and Sterility 2008

Childhood

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Body Burden

www.ewg.org/reports/bodyburden

Umbilical Cord Blood 10 infants tested showed an

average of 200 industrial compounds and pollutants, including 21 out of 28 pesticides tested (2004).

PesticidesDetected in human urine, semen, breast milk, ovarian fluid, cord blood, and amniotic fluid

ToxicityVulnerable periods of

development

Bioconcentration

Persistence

Persistent Bioaccumulative Toxicants (PBT’s)

Neurodevelopmental Toxicants

Metals lead, mercury, manganese, arsenic

Solvents

PCBs

Dioxins

PBDEs (Polybrominated Diphenyl Ethers)

Pesticides

National Pesticide Use

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Carcinogenic Pesticides Used Annually in CA

CA Department of Pesticide Regulation Pesticide Use Reports, 2008. Mapped by CA

Environmental Health Investigations Branch.

Pesticides and Cancer

Occupational exposure and cancer Organophosphate Pesticides – NHL, Leukemia Arsenical Pesticides – Lung, Skin cancer Triazine herbicides – Ovary

Epidemiologic studies associate pesticide exposure with cancer in children

Leukemia, neuroblastoma, Wilms' tumor, soft-tissue sarcoma, Ewing's sarcoma, non-Hodgkin's lymphoma, and cancers of the brain, colorectum, and testes

Zahm et al. EHP 1998; Infante-Rivard et al. J Tox Environ Health B Crit Rev. 2007

OP Exposure in Children and ADHD:A Cross Sectional Study

1139 children ages 8 – 15 (NHANES)

Examined Urinary OP metabolites

Diagnosis of ADHD by DISC-IV or Med use

10-fold ↑ in urinary DMAP associated with an adjusted OR of 1.55 (1.14 – 2.10) for ADHD

Children with dimethyl thiophosphate > median had OR of 1.93 (1.23 - 3.02) for ADHD compared with children with ND levels

Bouchard et al. Pediatrics, 125(6), 2010

Non-Cancer Adverse Health Effects Prenatal Exposure to Organophosphate Pesticides

Decreased Bayley MDI and PDI scores at 36 months (Rauh et al Pediatrics 2006)

Greater likelihood of behavioral issues on CBCL (Rauh et al Pediatrics 2006)

Abnormal primitive newborn reflexes (Brazelton NBAS)

(Engel et al. Am J of Epid 2007)

Decreased birth weight and length (Whyatt et al. EHP 2004)

Smaller Head Circumference (Berkowitz et al. EHP 2004)

Decreased Bayley MDI at 24 mo. (Eskanazi et al, EHP 2007)

Atrazine in surface water and birth defects in the United States

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Winchester et al. Acta Paediatr. 2009 April; 98(4): 664–669

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Effects of Postnatal Female Pesticide Exposure

Women Age at puberty and

menarche

Menstrual and ovarian function

Fertility and fecundity

Menopause

Breast cancer

Mendola P, Messer LC, Rappazzo K.. Fertility and Sterility. 2008;

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Effects of Adult Male Pesticide Exposure

Men Sterility Altered semen

quality Prostate cancer

Hauser R. Seminars in ReproductiveMedicine. 2006; Swan SH. Seminars in Reproductive Medicine. 2006; Diamanti-Kandarakis E et al. Endo. Reviews

2009

Magnitude of Exposure

Prenatal OP exposure in a farm worker cohort assoc. with lower mental development index scores at 24 mo.

Median Maternal Urinary MDA level 0.82 mcg/L

(Eskenazi at al EHP 2007)

Child exposure through conventional produce dietMedian Child Urinary MDA level 1.5 mcg/L

(Lu et al EFP 2006)� -----------

� A bit of apples and oranges?� In the same ball park but different exposure windows

Pesticide Exposure Reduction

OP residues dramatically reduced (malathion, chorpyrifos)

� in elementary school children with organic diets substituted for conventional diets for 5 days in a longitudinal design

Lu et al, EHP 2006

Choosing Produce to Reduce

Pesticide Exposure

www.ewg.org/foodnews

Recombinant Bovine Growth Hormone (rBGH) in Milk Production

Animal Welfare and Human Health Concerns Average increase in milk production 11%-16%

Increases rates of udder infections in cows (25% increase), necessitating the use of antibiotics

Possible increases levels of insulin-like growth factor (IGF-1) found in milk, raising concerns about cancer risks

rBGH is banned in: Canada, Australia,

New Zealand, Japan, and all 25 nations of the

European Union

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Arsenic Use in Poultry Production

Arsenic is fed to ~70% of US broilers For growth promotion, feed efficiency and improved pigmentation

Chicken meat can carry arsenic residues

Chicken waste contains ¾ of arsenic dose 90% applied to cropland as fertilizer Fed as a protein source to beef cattle

Water Contamination 13 million Americans drink water contaminated

with arsenic beyond the safety standard of 10 ppb

Health Concerns Related to Arsenic Exposure

Cancer (even at low levels of exposure)

Neural tube defects Neurodevelopmental effects Diabetes Heart disease.

Arsenic in poultry feed is banned inall 25 countries of the European Union.

The Antibiotic Resistance Crisis: Infections with No Treatment

“Without effective action, treatments for common infections will become

increasingly limited and expensive – and,

in some cases, nonexistent.”

CDC, 2001

A Public Health Action Plan to Combat Antimicrobial Resistance

Livestock Production and Antibiotics: Use or Misuse?

80% of antibiotics in the US are used in livestock production

Of those, more than 50% are medically-important to humans

Livestock use is non-therapeutic; for growth promotion

Contributes to increasing levels of antibiotic resistant bacteria

Resistant bacteria transmitted to humans via food

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Courtesy of David Wallinga, MD IATP / KeepAntibioticsWorking.org

Antibiotic Use in the United States

Millions of pounds

Antibiotics widely used in livestock production:

Erythromycin Tetracycline Bacitracin Penicillin Sulfathiazole Sulfamethazine Tylosin (macrolide) Virginiamycin (streptogramin) Fluroquinolones (withdrawn in 2000)

Courtesy of David Wallinga, MD IATP / KeepAntibioticsWorking.org

HUMANS(General Populace)

Routes of Human Exposure to Antibiotic Resistant Bacteria

ANTIBIOTICS

via WORKERSHandling of Feed, Manure;

transfer to family, community

via FOOD Slaughter, Handling, Consumption (undercooked meat, cross-contamination)

via ENVIRONMENTContamination of ground & surface water; spraying of fields by resistant bacteria and

undigested antibiotics from manure.

BACTERIA

ANIMALS

Food Borne Illness in the United States

Over 75 million cases annually 1/3 from tainted meat

325,000 require hospital care

5,000 deaths annually

“The Isolation of Antibiotic-Resistant Salmonella from Retail Ground Meats”

20% of supermarket samples in Washington D.C. were contaminated with salmonella

84% of these isolates were resistant to at least one antibiotic

Volume 345:1147-1154 October 18, 2001

Food Borne Illness - Salmonella

a Emerging Evidence

Bisphenol A (BPA)

Widespread Human Exposure Over 90% of Americans have residues

in their urine (CDC) young adults > older adults NHB > Caucasian, Hispanic

Breast milk, amniotic fluid, cord blood

Routes of Exposure Most likely oral, although dermal and

inhalation also possible

FDA estimates major exposure is from food Infants > Adults

Bisphenol A (BPA)

Over 6 billion pounds produced each year

Developed as estrogenic drug in the 1930s

Exposure in fetuses and young children up to 2-3 yrs can affect brain development .

PCB exposure has been associated with low birth weight, hypoactivity and smaller head circumference at birth.

Alterations in thyroid hormone function linked with lower IQ, lower reading comprehension, and behavioral abnormalities in children

Endocrine Disruption – Interference with thyroid hormone action

Studies of comparison between developmental effects in animals and humans find that “there is concordance of developmental effects between animals and humans and that humans are as sensitive or more sensitive than the most sensitive animal species”.

s National Academy of Science on Animal Data

BPA Animal Studies

Carcinogen Prostate hyperplasia/cancer Mammary cancer

Developmental toxin Altered onset of puberty Chromosomal abnormalities

Neurological toxin

Obesogen/Insulin Resistance

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Food Packaging

3 day “fresh foods” intervention

Urine levels of BPA and DEHP metabolites ↓ significantly

↓ of mean concentrations of BPA by 66% and

DEHP by 53-56%

Bisphenol A and Phthalate Exposure: Findings from a Dietary Intervention

Rudel et al, EHP 2011

Obesogens

BPA, phthalates, fructose, and certain organophosphate pesticides

Chemical compounds hypothesized to disrupt normal development or homeostasis of metabolism of lipids, ultimately resulting in obesity

Interplay between genes and fetal and early postnatal exposure

What we have reviewed today

Widespread exposures throughout various points in the food system

Critical and sensitive windows of vulnerability

Health effects and exposures: Pesticides rBGH Arsenic Antibiotics Emerging threats (BPA)

Health care costs are not reflected in food prices

Acknowledgments

Thank you to the many people who contributed slides, information, and ideas for this presentation including:

Sean Palfrey, Michelle Gottlieb, Jamie Harvie, Sarah Janssen, Kendra Klein, Lucia Sayre, Patrice Sutton,, David Wallinga, Tracey Woodruff