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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
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Pesticides
Bisphenol A
Flame retardants
Phthalates
PCBs (polychlorinated biphenyls)
Our Chemical Environment
 Over 85,000 synthetic chemicals in production
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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)
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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
Blastocyst
Periconception
Embryo
Fetus
Infant
Prenatal
Postnatal
Environmental Exposures
Child
Adolescent
Childhood
Immediate & Long Term
Consequences
Louis GMB, Cooney MA, Lynch CD, et al. Fertility and Sterility 2008
Body Burden
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Umbilical Cord Blood
10 infants tested showed an
average of 200 industrial
compounds and pollutants,
including 21 out of 28 pesticides
tested (2004).
Pesticides
Detected in human urine, semen,
breast milk, ovarian fluid, cord
www.ewg.org/reports/bodyburden
blood, and amniotic fluid
Persistent Bioaccumulative Toxicants (PBT’s)
 Toxicity
Vulnerable periods of
development
 Bioconcentration
 Persistence
Neurodevelopmental Toxicants
 Metals
 lead, mercury, manganese, arsenic
 Solvents
 PCBs
 Dioxins
 PBDEs (Polybrominated Diphenyl Ethers)
 Pesticides
National Pesticide Use
Carcinogenic Pesticides Used Annually in CA
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CA Department of Pesticide Regulation
Pesticide Use Reports, 2008. Mapped by CA
Environmental Health Investigations Branch.
Pesticides and Cancer
Occupational exposure and cancer
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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
Effects of Postnatal Female Pesticide Exposure
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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;
Effects of Adult Male Pesticide Exposure
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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 diet
Median 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
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Possible increases levels of insulin-like growth factor (IGF1) 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
Arsenic Use in Poultry Production
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 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 in
all 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
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Livestock use is non-therapeutic; for
growth promotion
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Contributes to increasing levels of
antibiotic resistant bacteria
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Resistant bacteria transmitted to
humans via food
Antibiotic Use in the United States
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Antibiotics widely used in
livestock production:
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Millions of pounds
Erythromycin
Tetracycline
Bacitracin
Penicillin
Sulfathiazole
Sulfamethazine
Tylosin (macrolide)
Virginiamycin
(streptogramin)
 Fluroquinolones
(withdrawn in 2000)
Courtesy of David Wallinga, MD IATP / KeepAntibioticsWorking.org
Routes of Human Exposure to
Antibiotic Resistant Bacteria
via
ANTIBIOTICS
FOOD
Slaughter, Handling, Consumption
(undercooked meat, cross-contamination)
ANIMALS
WORKERS
HUMANS
Handling of Feed, Manure;
transfer to family, community
(General
Populace)
via
via
BACTERIA
ENVIRONMENT
Contamination of ground & surface water;
spraying of fields by resistant bacteria and
undigested antibiotics from manure.
Courtesy of David Wallinga, MD IATP / KeepAntibioticsWorking.org
Food Borne Illness in the United States

Over 75 million cases
annually
 1/3 from tainted meat
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325,000 require hospital
care

5,000 deaths annually
Food Borne Illness - Salmonella
“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
a Emerging Evidence
Bisphenol A (BPA)
Widespread Human Exposure
 Over 90% of Americans have residues
in their urine (CDC)
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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
Endocrine Disruption – Interference with thyroid
hormone action
 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
s National Academy of Science on Animal Data
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”.
BPA Animal Studies
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Carcinogen
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Prostate hyperplasia/cancer
Mammary cancer
Developmental toxin
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Altered onset of puberty
Chromosomal abnormalities
 Neurological toxin
 Obesogen/Insulin Resistance
Food
Packaging
Bisphenol A and Phthalate Exposure:
Findings from a Dietary Intervention
37
3 day “fresh foods” intervention

Urine levels of BPA and DEHP
metabolites ↓ significantly
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↓ of mean concentrations of
BPA by 66% and
DEHP by 53-56%
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:
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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