Pediatrics Group Issues Statement on Food Additives and Child Health

From NEJM Journal Watch, published July 23, 2018 Edited by Susan Sadoughi, MD, and André Sofair, MD, MPH

Numerous food additives — whether those added directly to food during processing or those used in manufacturing or packaging — may put children’s health at risk, according to a new technical report and policy statement from the American Academy of Pediatrics.

Here are some of the additives with the most evidence for concern:

Bisphenols: Used in plastic containers and the lining of metal cans, bisphenols (such as BPA) can disrupt endocrine function, potentially reducing fertility and changing the timing of puberty. Research also suggests effects on neurodevelopmental outcomes and childhood obesity.
Phthalates: Found in plastic food wrap as well as in plastic tubes used during food manufacturing, phthalates have been tied to endocrine disruption (including testicular toxicity), cardiotoxic effects, and oxidative stress.
Nitrates and nitrites: Added directly to foods (usually processed meats) as a preservative or to enhance color, these compounds have been linked to cancer and thyroid dysfunction.

To help reduce exposure, the AAP recommends that clinicians advise families to eat more fresh or frozen (rather than canned) fruits and vegetables, and to avoid processed meats. In addition, plastic shouldn’t be put in microwaves or dishwashers, as heat can cause chemicals to leak into food.

The full list of chemicals of concern — and more recommendations for clinicians — are available free of charge at the links below.

AAP technical report in Pediatrics (Free)

Abstract

Increasing scientific evidence suggests potential adverse effects on children’s health from synthetic chemicals used as food additives, both those deliberately added to food during processing (direct) and those used in materials that may contaminate food as part of packaging or manufacturing (indirect). Concern regarding food additives has increased in the past 2 decades in part because of studies that increasingly document endocrine disruption and other adverse health effects. In some cases, exposure to these chemicals is disproportionate among minority and low-income populations. This report focuses on those food additives with the strongest scientific evidence for concern. Further research is needed to study effects of exposure over various points in the life course, and toxicity testing must be advanced to be able to better identify health concerns prior to widespread population exposure. The accompanying policy statement describes approaches policy makers and pediatricians can take to prevent the disease and disability that are increasingly being identified in relation to chemicals used as food additives, among other uses.

AAP policy statement in Pediatrics (Free)

Abstract

Our purposes with this policy statement and its accompanying technical report are to review and highlight emerging child health concerns related to the use of colorings, flavorings, and chemicals deliberately added to food during processing (direct food additives) as well as substances in food contact materials, including adhesives, dyes, coatings, paper, paperboard, plastic, and other polymers, which may contaminate food as part of packaging or manufacturing equipment (indirect food additives); to make reasonable recommendations that the pediatrician might be able to adopt into the guidance provided during pediatric visits; and to propose urgently needed reforms to the current regulatory process at the US Food and Drug Administration (FDA) for food additives. Concern regarding food additives has increased in the past 2 decades, in part because of studies in which authors document endocrine disruption and other adverse health effects. In some cases, exposure to these chemicals is disproportionate among minority and low-income populations. Regulation and oversight of many food additives is inadequate because of several key problems in the Federal Food, Drug, and Cosmetic Act. Current requirements for a “generally recognized as safe” (GRAS) designation are insufficient to ensure the safety of food additives and do not contain sufficient protections against conflict of interest. Additionally, the FDA does not have adequate authority to acquire data on chemicals on the market or reassess their safety for human health. These are critical weaknesses in the current regulatory system for food additives. Data about health effects of food additives on infants and children are limited or missing; however, in general, infants and children are more vulnerable to chemical exposures. Substantial improvements to the food additives regulatory system are urgently needed, including greatly strengthening or replacing the “generally recognized as safe” (GRAS) determination process, updating the scientific foundation of the FDA’s safety assessment program, retesting all previously approved chemicals, and labeling direct additives with limited or no toxicity data.