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Pesticides in the Diets of Infants and Children Executive Summary PESTICIDES ARE USED WIDELY in agriculture in the United States. Their application has improved crop yields and has increased the quantity of fresh fruits and vegetables in the diet, thereby contributing to improvements in public health. But pesticides may also cause harm. Some can damage the environment and accumulate in ecosystems. And depending on dose, some pesticides can cause a range of adverse effects on human health, including cancer, acute and chronic injury to the nervous system, lung damage, reproductive dysfunction, and possibly dysfunction of the endocrine and immune systems. Diet is an important source of exposure to pesticides. The trace quantities of pesticides that are present on or in foodstuffs are termed residues. To minimize exposure of the general population to pesticide residues in food, the U.S. Government has instituted regulatory controls on pesticide use. These are intended to limit exposures to residues while ensuring an abundant and nutritious food supply. The legislative framework for these controls was established by the Congress through the Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA) and the Federal Food, Drug, and Cosmetic Act (FFDCA). Pesticides are defined broadly in this context to include insecticides, herbicides, and fungicides. Tolerances constitute the single, most important mechanism by which EPA limits levels of pesticide residues in foods. A tolerance is defined as the legal limit of a pesticide residue allowed in or on a raw agricultural commodity and, in appropriate cases, on processed foods. A tolerance must be established for any pesticide used on any food crop.
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Pesticides in the Diets of Infants and Children Tolerance concentrations are based primarily on the results of field trials conducted by pesticide manufacturers and are designed to reflect the highest residue concentrations likely under normal conditions of agricultural use. Their principal purpose is to ensure compliance with good agricultural practice. Tolerances are not based primarily on health considerations. This report addresses the question of whether current regulatory approaches for controlling pesticide residues in foods adequately protect infants and children. The exposure of infants and children and their susceptibility to harm from ingesting pesticide residues may differ from that of adults. The current regulatory system does not, however, specifically consider infants and children. It does not examine the wide range of pesticide exposure patterns that appear to exist within the U.S. population. It looks only at the average exposure of the entire population. As a consequence, variations in dietary exposure to pesticides and health risks related to age and to such other factors as geographic region and ethnicity are not addressed in current regulatory practice. Concern about the potential vulnerability of infants and children to dietary pesticides led to U.S. Congress in 1988 to request that the National Academy of Sciences (NAS) appoint a committee to study this issue through its National Research Council (NRC). In response, the NRC appointed a Committee on Pesticide Residues in the Diets of Infants and Children under the joint aegis of the Board on Agriculture and the Board on Environmental Studies and Toxicology. The committee was charged with responsibility for examining scientific and policy issues faced by government agencies, particularly EPA, in regulating pesticide residues in foods consumed by infants and children. Specifically, the committee was asked to examine the adequacy of current risk assessment policies and methods; to assess information on the dietary intakes of infants and children; to evaluate data on pesticide residues in the food supply; to identify toxicological issues of greatest concern; and to develop relevant research priorities. Expertise represented on the committee included toxicology, epidemiology, biostatistics, food science and nutrition, analytical chemistry, child growth and development, and pediatrics. The committee was not asked to consider toxicities resulting from exposures to microorganisms (bacteria and viruses) or from other naturally occurring potential toxins. It was not asked to weigh the benefits and risks to be derived from a plentiful and varied food supply against the potential risks resulting from pesticide exposure. It was not asked to assess the overall safety of the food supply. In this report, the committee considered the development of children from the beginning of the last trimester of pregnancy (26 weeks) through
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Pesticides in the Diets of Infants and Children 18 years of age, the point when all biological systems have essentially matured. CONCLUSIONS Age-Related Variation in Susceptibility and Toxicity A fundamental maxim of pediatric medicine is that children are not ''little adults." Profound differences exist between children and adults. Infants and children are growing and developing. Their metabolic rates are more rapid than those of adults. There are differences in their ability to activate, detoxify, and excrete xenobiotic compounds. All these differences can affect the toxicity of pesticides in infants and children, and for these reasons the toxicity of pesticides is frequently different in children and adults. Children may be more sensitive or less sensitive than adults, depending on the pesticide to which they are exposed. Moreover, because these processes can change rapidly and can counteract one another, there is no simple way to predict the kinetics and sensitivity to chemical compounds in infants and children from data derived entirely from adult humans or from toxicity testing in adult or adolescent animals. The committee found both quantitative and occasionally qualitative differences in toxicity of pesticides between children and adults . Qualitative differences in toxicity are the consequence of exposures during special windows of vulnerability—brief periods early in development when exposure to a toxicant can permanently alter the structure or function of an organ system. Classic examples include chloramphenicol exposure of newborns and vascular collapse (gray baby syndrome), tetracycline and dysplasia of the dental enamel, and lead and altered neurologic development. Quantitative differences in pesticide toxicity between children and adults are due in part to age-related differences in absorption, metabolism, detoxification, and excretion of xenobiotic compounds, that is, to differences in both pharmacokinetic and pharmacodynamic processes. Differences in size, immaturity of biochemical and physiological functions in major body systems, and variation in body composition (water, fat, protein, and mineral content) all can influence the extent of toxicity. Because newborns are the group most different anatomically and physiologically from adults, they may exhibit the most pronounced quantitative differences in sensitivity to pesticides. The committee found that quantitative differences in toxicity between children and adults are usually less than a factor of approximately 10-fold. The committee concluded that the mechanism of action of a toxicant—how it causes harm—is generally similar in most species and across age
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Pesticides in the Diets of Infants and Children and developmental stages within species. For example, if a substance is cytotoxic in adults, it is usually also cytotoxic in immature individuals. Lack of data on pesticide toxicity in developing organisms was a recurrent problem encountered by the committee. In particular, little work has been done to identify effects that develop after a long latent period or to investigate the effects of pesticide exposure on neurotoxic, immunotoxic, or endocrine responses in infants and children. The committee therefore had to rely mostly on incomplete information derived from studies in mature animals and on chemicals other than pesticides. The committee reviewed current EPA requirements for toxicity testing by pesticide manufacturers, as well as testing modifications proposed by the agency. In general, the committee found that current and past studies conducted by pesticide manufacturers are designed primarily to assess pesticide toxicity in sexually mature animals. Only a minority of testing protocols have supported extrapolation to infant and adolescent animals. Current testing protocols do not, for the most part, adequately address the toxicity and metabolism of pesticides in neonates and adolescent animals or the effects of exposure during early developmental stages and their sequelae in later life. Age-Related Differences in Exposure Estimation of the exposures of infants and children to pesticide residues requires information on (1) dietary composition and (2) residue concentrations in and on the food and water consumed. The committee found that infants and children differ both qualitatively and quantitatively from adults in their exposure to pesticide residues in foods. Children consume more calories of food per unit of body weight than do adults. But at the same time, infants and children consume far fewer types of foods than do adults. Thus, infants and young children may consume much more of certain foods, especially processed foods, than do adults. And water consumption, both as drinking water and as a food component, is very different between children and adults. The committee concluded that differences in diet and thus in dietary exposure to pesticide residues account for most of the differences in pesticide-related health risks that were found to exist between children and adults. Differences in exposure were generally a more important source of differences in risk than were age-related differences in toxicologic vulnerability. Data from various food consumption surveys were made available to the committee. In analyzing these data, the committee found it necessary to create its own computer programs to convert foods as consumed into their component raw agricultural commodities (RACs). This analytic approach
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Pesticides in the Diets of Infants and Children facilitated the use of data from different sources and permitted evaluation of total exposure to pesticides in different food commodities. For processed foods, the committee noted that effects of processing on residue concentrations should be considered, but that information on these effects is quite limited. Processing may decrease or increase pesticide residue concentrations. The limited data available suggest that pesticide residues are generally reduced by processing; however, more research is needed to define the direction and magnitude of the changes for specific pesticide-food combinations. The effect of processing is an important consideration in assessing the dietary exposures of infants and young children, who consume large quantities of processed foods, such as fruit juices, baby food, milk, and infant formula. Although there are several sources of data on pesticide residues in the United States, the data are of variable quality, and there are wide variations in sample selection, reflecting criteria developed for different sampling purposes, and in analytical procedures, reflecting different laboratory capabilities and different levels of quantification between and within laboratories. These differences reflect variations in precision and in the accuracy of methods used and the different approaches to analytical issues, such as variations in limit of quantification. There also are substantial differences in data reporting. These differences are due in part to different record-keeping requirements, such as whether to identify samples with multiple residues, and differences in statistical treatment of laboratory results below the limit of quantification. Both government and industry data on residue concentrations in foods reflect the current regulatory emphasis on average adult consumption patterns. The committee found that foods eaten by infants and children are underrepresented in surveys of commodity residues. Many of the available residue data were generated for targeted compliance purposes by the Food and Drug Administration (FDA) to find residue concentrations exceeding the legal tolerances established by the EPA under FFDCA. Survey data on consumption of particular foods are conventionally grouped by broad age categories. The average consumption of a hypothetical "normal" person is then used to represent the age group. However, in relying solely on the average as a measure of consumption, important information on the distribution of consumption patterns is lost. For example, the high levels of consumption within a particular age group are especially relevant when considering foods that might contain residues capable of causing acute toxic effects. Also, geographic, ethnic, and other differences may be overlooked. To overcome the problems inherent in the current reliance on "average" exposures, the committee used the technique of statistical convolution (i.e., combining various data bases) to merge distributions of food consumption
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Pesticides in the Diets of Infants and Children with distributions of residue concentrations. This approach permits examination of the full range of pesticide exposures in the U.S. pediatric population. As is described in the next section, this approach provides an improved basis over the approach now used for assessing risks for infants and children. A New Approach to Risk Assessment for Infants and Children To properly characterize risk to infants and children from pesticide residues in the diet, information is required on (1) food consumption patterns of infants and children, (2) concentrations of pesticide residues in foods consumed by infants and children, and (3) toxic effects of pesticides, especially effects that may be unique to infants and children. If suitable data on these three items are available, risk assessment methods based on the technique of statistical convolution can be used to estimate the likelihood that infants and children who experience specific exposure patterns may be at risk. To characterize potential risks to infants and children in this fashion, the committee utilized data on distributions of pesticide exposure that, in turn, were based on distributions of food consumption merged with data on the distribution of pesticide residue concentrations. The committee found that age-related differences in exposure patterns for 1– to 5-year-old children were most accurately illuminated by using 1-year age groupings of data on children's food consumption. Exposure estimates should be constructed differently depending on whether acute or chronic effects are of concern. Average daily ingestion of pesticide residues is an appropriate measure of exposure for assessing the risk of chronic toxicity. However, actual individual daily ingestion is more appropriate for assessing acute toxicity. Because chronic toxicity is often related to long-term average exposure, the average daily dietary exposure to pesticide residues may be used as the basis for risk assessment when the potential for delayed, irreversible chronic toxic effects exists. Because acute toxicity is more often mediated by peak exposures occurring within a short period (e.g., over the course of a day or even during a single eating occasion), individual daily intakes are of interest. Examining the distribution of individual daily intakes within the population of interest reflects day-to-day variation in pesticide ingestion both for specific individuals and among individuals. Children may be exposed to multiple pesticides with a common toxic effect, and estimates of exposure and of risk could therefore be improved by accounting for these simultaneous exposures. This can be accomplished by assigning toxicity equivalence factors to each of the compounds having a common mechanism of action. Total residue exposure is then estimated
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Pesticides in the Diets of Infants and Children by multiplying the actual level of each pesticide residue by its toxicity equivalence factor and summing the results. This information may be combined with data on consumption to construct a distribution of total exposure to all pesticides having a common mechanism of action. To test this multiple-residue methodology, the committee estimated children's acute health risks resulting from combined exposure to five members of the organophosphate insecticide family. This was accomplished by combining actual food consumption data with data on actual pesticide residue levels. Through this new analytical procedure, the committee estimated that for some children, total organophosphate exposures may exceed the reference dose. Furthermore, although the data were weak, the committee estimated that for some children exposures could be sufficiently high to produce symptoms of acute organophosphate pesticide poisoning. Compared to late-in-life exposures, exposures to pesticides early in life can lead to a greater risk of chronic effects that are expressed only after long latency periods have elapsed. Such effects include cancer, neurodevelopmental impairment, and immune dysfunction. The committee developed new risk assessment methods to examine this issue. Although some risk assessment methods take into account changes in exposure with age, these models are not universally applied in practice. The committee explored the use of newer risk assessment methods that allow for changes in exposure and susceptibility with age. However, the committee found that sufficient data are not currently available to permit wide application of these methods. RECOMMENDATIONS On the basis of its findings, the committee recommends that certain changes be made in current regulatory practice. Most importantly, estimates of expected total exposure to pesticide residues should reflect the unique characteristics of the diets of infants and children and should account also for all nondietary intake of pesticides. Estimates of exposure should take into account the fact that not all crops are treated with pesticides that can be legally applied to those crops, and they should consider the effects of food processing and storage. Exposure estimates should recognize that pesticide residues may be present on more than one food commodity consumed by infants and children and that more than one pesticide may be present on one food sample. Lastly, determinations of safe levels of exposure should take into consideration the physiological factors that can place infants and children at greater risk of harm than adults.
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Pesticides in the Diets of Infants and Children Tolerances. Tolerances for pesticide residues on commodities are currently established by the EPA under FIFRA and FFDCA. A tolerance concentration is defined under FFDCA as the maximum quantity of a pesticide residue allowable on a raw agricultural commodity (RAC) (FFDCA, Section 408) and in processed food when the pesticide concentrates during processing (FFDCA Section 409). Tolerance concentrations on RACs are based on the results of field trials conducted by pesticide manufacturers and are designed to reflect the highest residue concentrations likely under normal agricultural practice. More than 8,500 food tolerances for pesticides are currently listed in the Code of Federal Regulations (CFR). Approximately 8,350 of these tolerances are for residues on raw commodities (promulgated under section 408) and about 150 are for residues known to concentrate in processed foods (promulgated under section 409). The determination of what might be a safe level of residue exposure is made by considering the results of toxicological studies of the pesticide's effects on animals and, when data are available, on humans. Both acute and chronic effects, including cancer, are considered, although acute effects are treated separately. These data are used to establish human exposure guidelines (i.e., a reference dose, RfD) against which one can compare the expected exposure. Exposure is a function of the amount and kind of foods consumed and the amount and identity of the residues in the foods (i.e., Theoretical Maximum Residue Contributions, TMRCs). If the TMRCs exceed the RfD, then anticipated residues are calculated for comparison with the proposed tolerance. The percent of crop acreage treated is also considered. If the anticipated residues exceed the RfD, then the proposed tolerance is rejected, and the manufacturer may recommend a new tolerance level. Although tolerances establish enforceable legal limits for pesticide residues in food, they are not based primarily on health considerations, and they do not provide a good basis for inference about actual exposures of infants and children to pesticide residues in or on foods. Tolerances constitute the only tool that EPA has under the law for controlling pesticide residues in food. To ensure that infants and children are not exposed to unsafe levels of pesticide residues, the committee recommends that EPA modify its decision-making process for setting tolerances so that it is based more on health considerations than on agricultural practices. These changes should incorporate the use of improved estimates of exposure and more relevant toxicology, along with continued consideration of the requirements of agricultural production. As a result, human health considerations would be more fully reflected in tolerance levels. Children should be able to eat a healthful diet
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Pesticides in the Diets of Infants and Children containing legal residues without encroaching on safety margins. This goal should be kept clear. Toxicity testing. The committee believes it is essential to develop toxicity testing procedures that specifically evaluate the vulnerability of infants and children. Testing must be performed during the developmental period in appropriate animal models, and the adverse effects that may become evident must be monitored over a lifetime. Of particular importance are tests for neurotoxicity and toxicity to the developing immune and reproductive systems. Extrapolation of toxicity data from adult and adolescent laboratory animals to young humans may be inaccurate. Careful attention to interspecies differences in pharmacokinetics and metabolism of pesticides and the relative ages at which organ systems mature is essential. It is also important to enhance understanding of developmental toxicity, especially in humans, during critical periods of postnatal development, including infancy and puberty. Uncertainty factors. For toxic effects other than cancer or heritable mutation, uncertainty factors are widely used to establish guidelines for human exposure on the basis of animal testing results. This is often done by dividing the no-observed-effect level (NOEL) found in animal tests by an uncertainty factor of 100-fold. This factor comprises two separate factors of 10-fold each: one allows for uncertainty in extrapolating data from animals to humans; the other accommodates variation within the human population. Although the committee believes that the latter uncertainty factor generally provides adequate protection for infants and children, this population subgroup may be uniquely susceptible to chemical exposures at particularly sensitive stages of development. At present, to provide added protection during early development, a third uncertainty factor of 10 is applied to the NOEL to develop the RfD. This third 10-fold factor has been applied by the EPA and FDA whenever toxicity studies and metabolic/disposition studies have shown fetal developmental effects. Because there exist specific periods of vulnerability during postnatal development, the committee recommends that an uncertainty factor up to the 10-fold factor traditionally used by EPA and FDA for fetal developmental toxicity should also be considered when there is evidence of postnatal developmental toxicity and when data from toxicity testing relative to children are incomplete. The committee wishes to emphasize that this is not a new, additional uncertainty factor but, rather, an extended application of a uncertainty factor now routinely used by the agencies for a narrower purpose. In the absence of data to the contrary, there should be a presumption of greater toxicity to infants and children. To validate this presumption,
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Pesticides in the Diets of Infants and Children the sensitivity of mature and immature individuals should be studied systematically to expand the current limited data base on relative sensitivity. Food consumption data. The committee recommends that additional data on the food consumption patterns of infants and children be collected within narrow age groups. The available data indicate that infants and children consume much more of certain foods on a body weight basis than do adults. Because higher exposures can lead to higher risks, it is important to have accurate data on food consumption patterns for infants and children. At present, data are derived from relatively small samples and broad age groupings, making it difficult to draw conclusions about the food consumption patterns of infants and children. Because the composition of a child's diet changes dramatically from birth through childhood and adolescence to maturity, "market basket" food consumption surveys should include adequate samples of food consumption by children at 1-year intervals up to age 5, by children between the ages of 5 and 10 years, and by children between 11 and 18 years. Food consumption surveys should be conducted periodically to ascertain changes in consumption patterns over time. Pesticide residue data. To maximize the utility of pesticide residue data collected by various laboratories, the committee recommends the use of comparable analytical methods and standardized reporting procedures and the establishment of a computerized data base to collate data on pesticide residues generated by different laboratories. Reports on pesticide residue testing should describe the food commodity analyzed (whether processed or raw), the analytical methods used, the compounds for which tests were conducted, quality assurance and control procedures, and the limit of quantification of the tests. All findings should be reported, whether or not the residue sought is found. In its surveillance of pesticide residues, FDA should increase the frequency of sampling of the commodities most likely to be consumed by infants and children. The residue testing program should include all toxic forms of the pesticide, for example, its metabolites and degradation products. Food residue monitoring should target a special "market basket" survey focused toward the diets of infants and children. Pesticide field trials currently conducted by pesticide manufacturers in support of registration provide data on variation in residue concentrations associated with different rates and methods of application. Such data should be consulted to provide a basis for estimating potential maximum residue levels.
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Pesticides in the Diets of Infants and Children More complete information is needed on the effects of food processing on levels of pesticides—both the parent compound and its metabolites—in specific food-chemical combinations potentially present in the diets of infants and children. Risk assessment. All exposures to pesticides—dietary and nondietary—need to be considered when evaluating the potential risks to infants and children. Nondietary environmental sources of exposure include air, dirt, indoor surfaces, lawns, and pets. Estimates of total dietary exposure should be refined to consider intake of multiple pesticides with a common toxic effect. Converting residues for each pesticide with a common mechanism of action to toxicity equivalence factors for one of the compounds would provide one approach to estimating total residue levels in toxicologically equivalent units. Consumption of pesticide residues in water is an important potential route of exposure. Risk assessment should include estimates of exposure to pesticides in drinking water and in water as a component of processed foods. Given adequate data on food consumption and residues, the committee recommends the use of exposure distributions rather than single point data to characterize the likelihood of exposure to different concentrations of pesticide residues. The distribution of average daily exposure of individuals in the population of interest is most relevant for use in chronic toxicity risk assessment, and the distribution of individual daily intakes is recommended for evaluating acute toxicity. Ultimately, the collection of suitable data on the distribution of exposures to pesticides will permit an assessment of the proportion of the population that may be at risk. Although the committee considers the use of exposure distributions to be more informative than point estimates of typical exposures, the data available to the committee did not always permit the distribution of exposures to be well characterized. Existing food consumption surveys generally involve relatively small numbers of infants and children, and food consumption data are collected for only a few days for each individual surveyed. Depending on the purpose for which they were originally collected, residue data may not reflect the actual distribution of pesticide residues in the food supply. Since residue data are not developed and reported in a consistent fashion, it is generally not possible to pool data sets derived from different surveys. Consequently, the committee recommends that guidelines be developed for consumption and residue data permitting characterization of distributions of dietary exposure to pesticides. The committee identified important differences in susceptibility to the toxic effects of pesticides and exposure to pesticides in the diet with age.
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Pesticides in the Diets of Infants and Children For carcinogenic effects, the committee proposed new methods of cancer risk assessment designed to take such differences into account. Preliminary analyses conducted by the committee suggest that consideration of such differences can lead to lifetime estimates of cancer risk that can be higher or lower than estimates derived with methods based on constant exposure. However, underestimation of risk assuming constant exposure was limited to a factor of about 3- to 5-fold in all cases considered by the committee. Because these results are based on limited data and specific assumptions about the mechanisms by which carcinogenic effects are induced, the applicability of these conclusions under other conditions should be established. Currently, most long-term laboratory studies of carcinogenesis and other chronic end points are based on protocols in which the level of exposure is held constant during the course of the study. To facilitate the application of risk assessment methods that allow for changes in exposure and susceptibility with age, it would be desirable to develop bioassay protocols that provide direct information on the relative contribution of exposures at different ages to lifetime risks. Although the committee does consider it necessary to develop special bioassay protocols for mandatory application in the regulation of pesticides, it would be useful to design special studies to provide information on the relative effects of exposures at different ages on lifetime cancer and other risks with selected chemical carcinogens. In addition to pharmacodynamic models for cancer risk assessment, the committee recommends the development and application of physiologically based pharmacokinetic models that describe the unique features of infants and children. For example, differences in relative organ weights with age can be easily described in physiologic pharmacokinetic models; special compartments for the developing fetus may also be incorporated. Physiologically based pharmacokinetic models can be used to predict the dose of the proximate toxicant reaching target tissues, and may lead to more accurate estimates of risk. In summary, better data on dietary exposure to pesticide residues should be combined with improved information on the potentially harmful effects of pesticides on infants and children. Risk assessment methods that enhance the ability to estimate the magnitude of these effects should be developed, along with appropriate toxicological tests for perinatal and childhood toxicity. The committee's recommendations support the need to improve methods for estimating exposure and for setting tolerances to safeguard the health of infants and children.
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