A Review of the Effectiveness of Current US Policies on Antimicrobial Use in Meat and Poultry Production.

PURPOSE: Industrial food animal production accounts for most animal-source protein consumed in the USA. These operations rely on an array of external inputs, which can include antimicrobials of medical importance. The use of these drugs in this context has been the subject of public health debate for decades because their widespread use contributes to the selection for and proliferation of drug-resistant bacteria and their genetic determinants. Here, we describe legislative and regulatory efforts, at different levels of governance in the USA, to curtail food animal consumption of medically important antimicrobials. RECENT FINDINGS: The features and relative success of the US efforts are examined alongside those of selected member states (Denmark and the Netherlands) of the European Union. Evaluation of efforts at all levels of US governance was complicated by shortcomings in prescribed data collection; nevertheless, available information suggests deficiencies in policy implementation and enforcement compromise the effectiveness of interventions pursued to date. The political will, robust systems for collecting and integrating data on antimicrobial consumption and use, and cross-sectoral collaboration that have been integral to the success of efforts in Denmark and The Netherlands have been notably absent in the USA, especially at the federal level.

Correction to: Mercury exposure, nutritional deficiencies and metabolic disruptions may affect learning in children.

The original version of this article [1] unfortunately contained an error which has since been acknowledged in this Correction article. The URL link in the Reference 19 was broken and it needs to be replaced with the active link given below.

A Food Systems Approach To Healthy Food And Agriculture Policy.

Food has become a prominent focus of US public health policy. The emphasis has been almost exclusively on what Americans eat, not what is grown or how it is grown. A field of research, policy, and practice activities addresses the food-health-agriculture nexus, yet the work is still often considered "alternative" to the mainstream. This article outlines the diverse ways in which agriculture affects public health. It then describes three policy issues: farm-to-school programming, sustainability recommendations in the Dietary Guidelines for Americans, and antibiotic use in animal agriculture. These issues illustrate the progress, challenges, and public health benefits of taking a food systems approach that brings together the food, agriculture, and public health fields.

Evaluation of the association between maternal smoking, childhood obesity, and metabolic disorders: a national toxicology program workshop review.

BACKGROUND: An emerging literature suggests that environmental chemicals may play a role in the development of childhood obesity and metabolic disorders, especially when exposure occurs early in life. OBJECTIVE: Here we assess the association between these health outcomes and exposure to maternal smoking during pregnancy as part of a broader effort to develop a research agenda to better understand the role of environmental chemicals as potential risk factors for obesity and metabolic disorders. METHODS: PubMed was searched up to 8 March 2012 for epidemiological and experimental animal studies related to maternal smoking or nicotine exposure during pregnancy and childhood obesity or metabolic disorders at any age. A total of 101 studies-83 in humans and 18 in animals-were identified as the primary literature. DISCUSSION: Current epidemiological data support a positive association between maternal smoking and increased risk of obesity or overweight in offspring. The data strongly suggest a causal relation, although the possibility that the association is attributable to unmeasured residual confounding cannot be completely ruled out. This conclusion is supported by findings from laboratory animals exposed to nicotine during development. The existing literature on human exposures does not support an association between maternal smoking during pregnancy and type 1 diabetes in offspring. Too few human studies have assessed outcomes related to type 2 diabetes or metabolic syndrome to reach conclusions based on patterns of findings. There may be a number of mechanistic pathways important for the development of aberrant metabolic outcomes following perinatal exposure to cigarette smoke, which remain largely unexplored. CONCLUSIONS: From a toxicological perspective, the linkages between maternal smoking during pregnancy and childhood overweight/obesity provide proof-of-concept of how early-life exposure to an environmental toxicant can be a risk factor for childhood obesity.

Exporting obesity: US farm and trade policy and the transformation of the Mexican consumer food environment.

Obesity has reached epidemic proportions, in the United States as well as among its trade partners such as Mexico. It has been established that an "obesogenic" (obesity-causing) food environment is one influence on obesity prevalence. To isolate the particular role of NAFTA, the North American Free Trade Agreement, in changing Mexico's food environment, we plotted the flow of several key products between the United States and Mexico over the 14-year NAFTA period (1994-2008) and situated them in a broader historical context. Key sources of USDA data include the Foreign Agricultural Service's Global Agricultural Trade System, its official repository for current and historical data on imports, exports and re-exports, and its Production, Supply, and Distribution online database. US export data were queried for agricultural products linked to shifting diet patterns including: corn, soybeans, sugar and sweeteners, consumer-oriented products, and livestock products. The Bureau of Economic Analysis' Balance of Payments and Direct Investment Position Data in their web-based International Economic Accounts system also helped determine changes in US direct investment abroad from 1982 to 2009. Directly and indirectly, the United States has exported increasing amounts of corn, soybeans, sugar, snack foods, and meat products into Mexico over the last two decades. Facilitated by NAFTA, these exports are one important way in which US agriculture and trade policy influences Mexico's food system. Because of significant US agribusiness investment in Mexico across the full spectrum of the latter's food supply chain, from production and processing to distribution and retail, the Mexican food system increasingly looks like the industrialized food system of the United States.

A macroepigenetic approach to identify factors responsible for the autism epidemic in the United States.

The number of children ages 6 to 21 in the United States receiving special education services under the autism disability category increased 91% between 2005 to 2010 while the number of children receiving special education services overall declined by 5%. The demand for special education services continues to rise in disability categories associated with pervasive developmental disorders. Neurodevelopment can be adversely impacted when gene expression is altered by dietary transcription factors, such as zinc insufficiency or deficiency, or by exposure to toxic substances found in our environment, such as mercury or organophosphate pesticides. Gene expression patterns differ geographically between populations and within populations. Gene variants of paraoxonase-1 are associated with autism in North America, but not in Italy, indicating regional specificity in gene-environment interactions. In the current review, we utilize a novel macroepigenetic approach to compare variations in diet and toxic substance exposure between these two geographical populations to determine the likely factors responsible for the autism epidemic in the United States.

MRSA in conventional and alternative retail pork products.

In order to examine the prevalence of Staphylococcus aureus on retail pork, three hundred ninety-five pork samples were collected from a total of 36 stores in Iowa, Minnesota, and New Jersey. S. aureus was isolated from 256 samples (64.8%, 95% confidence interval [CI] 59.9%-69.5%). S. aureus was isolated from 67.3% (202/300) of conventional pork samples and from 56.8% (54/95) of alternative pork samples (labeled "raised without antibiotics" or "raised without antibiotic growth promotants"). Two hundred and thirty samples (58.2%, 95% CI 53.2%-63.1%) were found to carry methicillin-sensitive S. aureus (MSSA). MSSA was isolated from 61.0% (183/300) of conventional samples and from 49.5% (47/95) of alternative samples. Twenty-six pork samples (6.6%, 95% CI 4.3%-9.5%) carried methicillin-resistant S. aureus (MRSA). No statistically significant differences were observed for the prevalence of S. aureus in general, or MSSA or MRSA specifically, when comparing pork products from conventionally raised swine and swine raised without antibiotics, a finding that contrasts with a prior study from The Netherlands examining both conventional and "biologic" meat products. In our study spa types associated with "livestock-associated" ST398 (t034, t011) were found in 26.9% of the MRSA isolates, while 46.2% were spa types t002 and t008--common human types of MRSA that also have been found in live swine. The study represents the largest sampling of raw meat products for MRSA contamination to date in the U.S. MRSA prevalence on pork products was higher than in previous U.S.-conducted studies, although similar to that in Canadian studies.

Reproductive health and the industrialized food system: a point of intervention for health policy.

What food is produced, and how, can have a critical impact on human nutrition and the environment, which in turn are key drivers of healthy human reproduction and development. The US food production system yields a large volume of food that is relatively low in cost for consumers but is often high in calories and low in nutritional value. In this article we examine the evidence that intensive use of pesticides, chemical fertilizers, hormones, antibiotics, and fossil fuel in food production, as well as chemicals in food packaging, are potentially harmful to human reproductive and developmental health. We conclude that policies to advance a healthy food system are necessary to prevent adverse reproductive health effects and avoid associated health costs among current and future generations. These policies include changes to the Farm Bill and the Toxic Substances Control Act, and greater involvement by the health care sector in supporting and sourcing food from urban agriculture programs, farmers' markets, and local food outlets, as well as increasing understanding by clinicians of the links between reproductive health and industrialized food production.

Agricultural policy and childhood obesity: a food systems and public health commentary.

For thirty-five years, U.S. agriculture has operated under a "cheap food" policy that spurred production of a few commodity crops, not fruit or vegetables, and thus of the calories from them. A key driver of childhood obesity is the consumption of excess calories, many from inexpensive, nutrient-poor snacks, sweets, and sweetened beverages made with fats and sugars derived from these policy-supported crops. Limiting or eliminating farm subsidies to commodity farmers is wrongly perceived as a quick fix to a complex agricultural system, evolved over decades, that promotes obesity. Yet this paper does set forth a series of policy recommendations that could help, including managing commodity crop oversupply and supporting farmers who produce more fruit and vegetables to build a healthier, more balanced agricultural policy.

Mercury exposure, nutritional deficiencies and metabolic disruptions may affect learning in children.

Among dietary factors, learning and behavior are influenced not only by nutrients, but also by exposure to toxic food contaminants such as mercury that can disrupt metabolic processes and alter neuronal plasticity. Neurons lacking in plasticity are a factor in neurodevelopmental disorders such as autism and mental retardation. Essential nutrients help maintain normal neuronal plasticity. Nutritional deficiencies, including deficiencies in the long chain polyunsaturated fatty acids eicosapentaenoic acid and docosahexaenoic acid, the amino acid methionine, and the trace minerals zinc and selenium, have been shown to influence neuronal function and produce defects in neuronal plasticity, as well as impact behavior in children with attention deficit hyperactivity disorder. Nutritional deficiencies and mercury exposure have been shown to alter neuronal function and increase oxidative stress among children with autism. These dietary factors may be directly related to the development of behavior disorders and learning disabilities. Mercury, either individually or in concert with other factors, may be harmful if ingested in above average amounts or by sensitive individuals. High fructose corn syrup has been shown to contain trace amounts of mercury as a result of some manufacturing processes, and its consumption can also lead to zinc loss. Consumption of certain artificial food color additives has also been shown to lead to zinc deficiency. Dietary zinc is essential for maintaining the metabolic processes required for mercury elimination. Since high fructose corn syrup and artificial food color additives are common ingredients in many foodstuffs, their consumption should be considered in those individuals with nutritional deficits such as zinc deficiency or who are allergic or sensitive to the effects of mercury or unable to effectively metabolize and eliminate it from the body.

The $64 million question. Invest in good teaching.

University of Minnesota School of Public health, USA.

Mercury from chlor-alkali plants: measured concentrations in food product sugar.

Mercury cell chlor-alkali products are used to produce thousands of other products including food ingredients such as citric acid, sodium benzoate, and high fructose corn syrup. High fructose corn syrup is used in food products to enhance shelf life. A pilot study was conducted to determine if high fructose corn syrup contains mercury, a toxic metal historically used as an anti-microbial. High fructose corn syrup samples were collected from three different manufacturers and analyzed for total mercury. The samples were found to contain levels of mercury ranging from below a detection limit of 0.005 to 0.570 micrograms mercury per gram of high fructose corn syrup. Average daily consumption of high fructose corn syrup is about 50 grams per person in the United States. With respect to total mercury exposure, it may be necessary to account for this source of mercury in the diet of children and sensitive populations.

Food Systems and Public Health: Linkages to Achieve Healthier Diets and Healthier Communities.

The Airlie Conference on "Food Systems and Public Health: Linkages to Achieve Healthier Diets and Healthier Communities" was convened to discuss how we as a nation can shift toward promoting healthy, sustainably produced foods that are aligned with national dietary and health priorities; the most strategic changes in policy, governance and practices that can help this shift occur; and identify knowledge gaps and policy-relevant research needs. This special theme issue presents papers emanating from the conference, and policy-relevant research and action recommendations from the small group breakout sessions.

Research and Action Priorities for Linking Public Health, Food Systems, and Sustainable Agriculture: Recommendations from the Airlie Conference.

One hundred leading researchers, practitioners, and advocates in public health, health care, nutrition, obesity, economics, sustainable agriculture, and food systems met at the Airlie Conference Center in April 2009 to discuss creating linkages among food systems, public health, and sustainable agriculture in order to achieve healthier diets, healthier communities, and a healthier planet. Participants convened in small groups to explore and discuss research that is needed to create a health-based and sustainable food system. The discussion and key recommendations from the small breakout sessions are presented.

Today's Food System: How Healthy Is It?

With its focus on the quantity of production, often to the exclusion of other goals, today's food system is on an unsustainable course. The problem begins with and is driven by industrialized production of both crops and animals. Industrialization is a product of technological change, public policy, and, most recently, globalized trade. The lack of sustainability derives from reliance on the intensive use of nonrenewable and hard-to-renew resources-soil, antibiotics, fresh water, and fossil fuels, for example-but also from the waste and pollution created by the industrial model. For at least 50 years, American agriculture policies have promoted production of, and ultimately lower market prices for, commodity crops like corn, wheat, and soybeans. Over the last 3 decades in particular, these "cheap food" policies have exacerbated the negative impacts of an industrialized agriculture on the health of the agro-ecosystem, as well as on the health of the humans who must share and be sustained by it. Sustainability and health are two sides of the same food system coin. Policies that put US food production on more sustainable footing can help aid in public efforts to address the myriad crises confronting both the food and health systems.

The role of the environment in pediatric practice in Minnesota: attitudes, beliefs, and practices.

Pediatricians can help limit children's exposures to environmental hazards, but few studies have assessed their comfort with discussing and dealing with environmental health issues. We surveyed the membership of the Minnesota Chapter of the American Academy of Pediatrics to assess pediatricians' attitudes and beliefs about the effect the environment can have on children's health, and to assess their practices in regard to screening for, diagnosing, and treating illnesses related to environmental exposures. Results showed that Minnesota pediatricians agree that children are suffering from preventable illnesses of environmental origin but feel ill-equipped to educate parents about many common exposures and their consequences. Responses also indicated significant demand for education on the subject and for a referral center that can evaluate patients who may be suffering from environmental exposures.