1 d 1 impacts of an industrialized food system on maternal and child health
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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