From the Journals

AAP: Food additives inadequately regulated, pose risks to children



The regulation of food additives needs an overhaul in the United States because of the risks these compounds pose to children and infants, according to a new policy statement by the American Academy of Pediatrics.

Plastic bottles namiroz/iStock/Getty Images

Health care providers can offer the parents of patients some practical suggestions to reduce exposure to some of the greatest food additive offenders, suggested members of the AAP Council on Environmental Health.

Among the additives of greatest concern, the statement notes, are bisphenols (including bisphenol A), phthalates, certain pesticides, perfluoroalkyl chemicals, perchlorate, artificial food colors, nitrates, and nitrites. A technical report accompanying the policy statement reviewed existing evidence on these compounds.

The statement, authored by the council led by Leonardo Trasande, MD, of New York University, noted that many of the more than 10,000 chemicals added to food and food packaging were grandfathered into use prior to current regulations. Further, approximately 1,000 of these chemicals fall under the Food and Drug Administration’s designation of “generally recognized as safe,” which does not require FDA approval for use.

“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,” they wrote. “Additionally, the FDA does not have authority to obtain data on or reassess the safety of chemicals already on the market.” The FDA does not regularly consider cumulative effects of food additives or the synergistic effects of chemicals found in foods.

The authors noted that concerns about food additives have increased in the past 20 years as new research has identified adverse health effects, including endocrine disruption, associated with these chemicals.

Dr. Trasande and his associates also acknowledged the limited evidence available on food additives particularly for children and infants, but noted this population’s greater vulnerability to chemical exposures.

Compounds addressed in the statement

  • Bisphenols. Health concerns tied to these chemicals are endocrine/neurodevelopmental disruption and obesogenic activity.
  • Phthalates. Health concerns linked to these chemicals are endocrine disruption, obesogenic activity, oxidative stress, and cardiotoxicity.
  • Perfluoroalkyl chemicals. Health concerns associated with these chemicals are immunosuppression, endocrine disruption, obesogenic activity, and decreased birth weight.
  • Perchlorate. The health concern tied to this chemical is thyroid hormone disruption.
  • Nitrates and nitrites. Use of these as a preservative and color enhancer has been linked to carcinogenicity and thyroid hormone disruption.

Of these, only nitrates and nitrites are directly added to food while the other chemicals are indirect additives via their use in food packaging that directly touches the food.

How health care providers can help parents and children

“Insofar as these modifications can pose additional costs, barriers may exist for low-income families to reduce their exposure to food additives of concern,” the authors wrote. Health care providers “may wish to tailor guidance in the context of practicality, especially because food insecurity remains a substantial child health concern.”

Their recommendations on guidance for parents include:

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