>>WELCOME, EVERYONE.
DEPENDING WHERE YOU'RE JOINING
US FROM, GOOD MORNING, GOOD
AFTERNOON, OR GOOD EVENING.
MY NAME IS DREW BREMER, IT'S MY
HONOR AND PLEASURE TO WELCOME
YOU TO THIS TWO-DAY WORKSHOP,
BRIDGING THE BIOLOGICAL AND
COMMUNICATIONS SCIENCES ON
NUTRIENTS AND ENVIRONMENTAL
CONTAMINANTS IN FOODS.
THIS WORKSHOP CO-HOSTED BY THE
NIH AND FDA FOCUSES ON RESEARCH
AND COMMUNICATION, ENVIRONMENTAL
CONTAMINANTS IN FOOD, THE ROLE
OF NUTRITION AS THEY RELATE TO
CHILD DEVELOPMENT.
THE SESSIONS WILL FOCUS ON A
WIDE RANGE OF NUTRITION,
TOXICOLOGY, RISK COMMUNICATION
SCIENCE TOPICS, INCLUDING
CHALLENGES IN CHILDREN CONSUMING
ADEQUATE NUTRIENTS, THE ROLE OF
EXPOSURE TO CONTAMINANTS FROM
FOODS, THE IMPORTANT ROLE OF
NUTRIENTS FROM FOOD GROUPS IN
CHILD DEVELOPMENT, AND HELPING
TO PROTECT CHILDREN FROM HEALTH
EFFECTS ASSOCIATED WITH
EXPOSURE, RESEARCH OPPORTUNITIES
IN FOOD, NUTRIENTS, EFFECTS OF
ENVIRONMENTAL EXPOSURES, AND
FEDERAL AGENCY STRATEGIES.
BEFORE WE KICK THE MEETING OFF I
WANT TO PAUSE AND RECOGNIZE
KIMBERLEA GIBBS FROM THE EUNICE
KENNEDY SHRIVER CENTER AND TINA
EYRE FOR THEIR LEADERSHIP IN
ORGANIZING THIS CONFERENCE.
I WOULD LIKE TO THANK THE OTHER
MEMBERS OF THE ORGANIZING TEAM
INCLUDING ASHLEY VARGAS, KELLY
CASSAVALE, JEAN, CASEY, ROBIN,
ALL OF OUR COLLEAGUES FROM THE
OTHER FEDERAL AGENCIES IN
ADDITION TO OUR SPEAKERS AN
PANELISTS.
WE'RE GRATEFUL FOR YOUR TIME AND
EXPERTISE.
I WOULD LIKE TO THANK THE
INDIVIDUALS WHO HAVE WORKED
BEHIND THE SCENES TO COORDINATE
THIS VIRTUAL WORKSHOP.
WE'RE ALL USED TO VIRTUAL
WORKSHOPS BY NOW WE KNOW THEY
DON'T JUST HAPPEN WITHOUT A LOT
OF LOGISTICAL SUPPORT.
THANK YOU.
FOR THOSE JOINING VIA VIDEOCAST,
THANK YOU, AND FEEL FREE TO SEND
COMMENTS AND QUESTIONS TO THE
WEBSITE THAT WAS LISTED ON THE
OPENING SCREEN.
NICHDFADFEBWORKSHOP@MAIL.NIH.GOV
.
I PROMISED TO KEEP MY REMARKS
SHORT.
I WOULD LIKE TO THAN DR. DIANA
BIANCHI, DIRECTOR OF THE EUNICE
KENNEDY SHRIVER NATIONAL
INSTITUTE OF CHILD HEALTH AND
HUMAN DEVELOPMENT, AS WELL AS
DR. SUSAN MAYNESES IS FROM FDA.
I'LL PASS THE TORCH TO DR.
MAYNES.
THANK YOU.
>>THANK YOU.
I'D LIKE TO ADD A WARM WELCOME
TO EVERYBODY JOINS US TODAY.
I UNDERSTAND WE HAVE A LARGE
NUMBER AND WIDE RANGE OF FOLKS
PARTICIPATING FROM INDUSTRY,
ACADEMIA, FEDERAL, STATE, LOCAL
GOVERNMENT REPRESENTATIVES.
AND MORE.
WE AT THE FDA ARE DELIGHTED TO
BE CO-HOSTING THIS TWO-DAY
WORKSHOP ON RESEARCH AND RISK
COMMUNICATION, ENVIRONMENTAL
CONTAMINANTS IN FOODS AND ROAM
OF NUTRITION IN RELATIONSHIP TO
CHILD GROWTH AND DEVELOPMENT.
AS YOU MAY OR MAY NOT KNOW OUR
CENTER AT FDA, CENTER FOR FOOD
SAFETY AND APPLIED NUTRITION,
REGULATES SAFETY AND LABELING OF
80% OF THE FOOD SUPPLY, AND
AGENCY HAS REGULATORY TOOLS TO
HELP LOWER LEVELS OF
CONTAMINANTS IN FOODS WHEN A
CERTAIN LEVEL IS UNAVOIDABLE.
THIS WORKSHOP SUPPORTS THE FDA
CLOSER TO ZERO ACTION PLAN AND
GOAL TO REDUCE EXPOSURE TO
ARSENIC, LEAD, CADMIUM AND
MERCURY WHILE MAINTAINING ACCESS
TO FOODS PROVIDING NUTRIENTS
THAT PREVENT DISEASE.
THE CLOSER TO ZERO ACTION PLAN
IS PART OF AN EFFORT UNDERTAKEN
BY THE FEDERAL GOVERNMENT TO
REDUCE EXPOSURES TO TOXIC
ELEMENTS ACROSS THE BOARD.
AT THE CORE OF THIS EFFORT IS
THE PRESIDENT'S TASK FORCE ON
ENVIRONMENTAL HEALTH RISKS AND
SAFETY RISKS TO CHILDREN WHICH
COORDINATE THE FEDERAL
GOVERNMENT'S EFFORTS TO EXPLORE,
UNDERSTAND, AND ACT TO IMPROVE
CHILDREN'S ENVIRONMENTAL HEALTH.
AS A SCIENCE BASED PUBLIC HEALTH
AGENCY, WE WORK CLOSELY WITH OUR
COLLEAGUES ACROSS THE FEDERAL
GOVERNMENT AND HAVE AN
ESPECIALLY CLOSE WORKING
RELATIONSHIP WITH OUR NIH
COLLEAGUES, ROBUST SCIENCE IS
THE BASIS FOR OUR REGULATORY
DECISION MAKING.
EARLIER IN MY CAREER, BEFORE I
CAME TO THE FDA, I WAS A
PROFESSOR AT YALE SCHOOL OF
PUBLIC HEALTH.
AND I WAS ALSO PRINCIPAL
INVESTIGATOR ON SEVERAL RESEARCH
GRANTS AS WELL AS A MEMBER OF
THE NATIONAL CANCER INSTITUTE
BOARD OF SCIENTIFIC COUNSELORS,
I'VE HAD EXPERIENCE WORKING WITH
THE NIH AND IN MANY CAPACITIES,
AND I UNDERSTAND HOW CRITICAL
THE RELATIONSHIP IS BETWEEN THE
AGENCIES.
FROM OUR PERSPECTIVE AT CFSAN
THERE CONTINUES TO BE A STRONG
DEMAND FOR NUTRITION-RELATED
RESEARCH TO HELP INFORM
IMPORTANT SCIENTIFIC GAPS IN OUR
UNDERSTANDING.
MANY OF WHICH HAVE IMPLICATIONS
FOR OUR REGULATORY WORK AT THE
FDA.
AS EVIDENCED HERE TODAY, WE
PARTNER WITH NIH IN IDENTIFYING
RESEARCH GAPS THAT ARE
PARTICULARLY IMPORTANT FOR OUR
WORK.
AT THE FDA WE'RE WELL POSITIONED
TO ADVANCE WORK THAT PROMOTES
HEALTHY DIETARY PATTERNS AND
CONSUMPTION ESSENTIAL NUTRIENTS
IN YOUNG CHILDREN AND TO
PROTECTING NUTRITION AND HEALTH
OF THE MOST VULNERABLE AMONG US.
THIS IS ESPECIALLY IMPORTANT
GIVEN THE CURRENT EDITION OF THE
GUIDELINES FOR AMERICANS, FOR
THE FIRST TIME SINCE THE 1980s
INCLUDES DIETARY GUIDANCE FOR
CHILDREN UNDER 2 YEARS OF AGE.
WHICH IS A CRITICAL PERIOD FOR
GROWTH AND DEVELOPMENT.
I WILL NOTE THE NEWLY ANNOUNCED
DIETARY GUIDELINES ADVISORY
COMMITTEE IS ALSO CONVENING
TODAY AND TOMORROW.
THAT COMMITTEE WILL BE REVIEWING
SCIENTIFIC EVIDENCE TO HELP
INFORM THE NEXT GENERATION OF
THE DIETARY GUIDELINES FOR
AMERICANS, 2025 TO 2030.
FDA IS A VERY ENGAGED
COLLABORATOR AND WE LOOK FORWARD
TO INTEGRATING OPPORTUNITIES FOR
CROSS-COLLABORATION AND
MULTI-DISCIPLINARY RESEARCH AND
EVALUATION TO INFORM OUR WORK AT
FDA.
IN THIS WORKSHOP OVER THE NEXT
TWO DAYS SCIENTISTS WILL PROVIDE
EVIDENCE-BASED INFORMATION ON
NUTRITION AND TOXICOLOGY TOPICS
INCLUDING KEY CHALLENGES IN
ADEQUATE INTAKE AND ROLE OF
EXPOSURE.
IMPORTANT ROLE OF NUTRIENTS IN
CHILD DEVELOPMENT AND HELPING
PROTECT CHILDREN FROM HEALTH
EFFECTS ASSOCIATED WITH
COMPOSURE TO CONTAMINANTS.
RESEARCH OPPORTUNITIES IN FOOD
ON CHILD GROWTH AND DEVELOPMENT.
FEDERAL AGENCIES CURRENT AND
FUTURE RISK COMMUNICATIONS,
EMPHASIZING THAT BECAUSE
UNDERSTANDING THE RISK THAT
HARMFUL CONTAMINANTS POSE IN OUR
FOOD SUPPLY IS COMPLICATED,
WHICH COMPLICATES THE
COMMUNICATION OF THESE RISKS.
AND EXPOSURE OF THESE
CONTAMINANTS CAN COME FROM MANY
FOODS INCLUDING HIGHLY
NUTRITIOUS FOODS, MANY OF WHICH
ARE THE FOUNDATION OF HEALTHY
DIETARY PATTERNS.
IT'S ALSO CRUCIAL TO ENSURE THAT
COMMUNICATION ABOUT
ENVIRONMENTAL CONTAMINANTS IN
FOODS NOT RESULT IN UNINTENDED
CONSEQUENCES SUCH AS ELIMINATING
FOODS THAT HAVE SIGNIFICANT
NUTRITIONAL BENEFIT, OR REDUCING
ONE CONTAMINANTS IN THE DIET
WHILE INCREASING ANOTHER.
I'M PARTICULARLY PLEASED THAT
FDA IS COLLABORATING WITH NIH
AND ALSO WITH THE U.S.
DEPARTMENT OF AGRICULTURE,
ENVIRONMENTAL PROTECTION AGENCY,
AND CENTERS FOR DISEASE CONTROL
AND PREVENTION ON THIS
INITIATIVE TO HELP IDENTIFY
CRITICAL RESEARCH GAPS AND BEST
PRACTICES FOR STRENGTHENING OUR
COMMUNICATIONS AND OUTREACH
EFFORTS.
IN CLOSING, LIKE DR. BREMER
INDICATED, I WANT TO THANK ALL
THE STAFF WHO WORKED SO HARD
BEHIND THE SCENES TO BRING THIS
WORKSHOP TOGETHER, AND TO THE
SPEAKERS AND TO ALL JOINING WITH
US HERE TODAY.
I KNOW IT PROMISES TO BE AN
EXCITING AND ILLUMINATING TWO
DAYS THAT WILL HELP ADVANCE THE
SCIENCE ON THIS IMPORTANT TOPIC.
WITH THAT, I WILL NOW HAND IT
OVER TO DR. CONRAD CHOINIERE,
DIRECTOR OF OFFICE OF ANALYTICS
AND OUTREACH AND LEADS THE
CLOSER TO ZERO INITIATIVE TO SAY
A FEW WORDS.
>>THANK YOU, DR. MAYNE.
THANK YOU FOR PARTICIPATING
TODAY AND TOMORROW.
I VERY MUCH APPRECIATE THE
EFFORTS OF ALL WHO MADE THIS
EVENT POSSIBLE.
THIS OPPORTUNITY TO SHARE
KNOWLEDGE AND EXPERTISE IN WHAT
I THINK IS A CREATIVE WAY
BRINGING THE VARIOUS SCIENCES
TOGETHER TO BEAR ON AN IMPORTANT
PUBLIC HEALTH ISSUE.
THE WORKSHOP MARKS AN IMPORTANT
MILESTONE FOR OUR CLOSER TO ZERO
INITIATIVE, AS WELL AS OUR
OVERALL WORK ON REDUCING
EXPOSURES TO ENVIRONMENTAL
CONTAMINANTS FROM FOODS.
AS YOU ALL KNOW, THESE
CONTAMINANTS ARE IN THE SOIL,
WATER, AND AIR.
SOME ARE NATURALLY OCCURRING.
MANY ARE PRESENT DUE TO HUMAN
ACTIVITIES SUCH AS CURRENT OR
PAST POLLUTION.
CLOSER TO ZERO, WE STRIVE TO
REDUCE LEAD, ARSENIC, CADMIUM
AND MERCURY IN FOODS CONSUMED BY
BABIES AND YOUNG CHILDREN TO AS
LOW AS POSSIBLE.
BECAUSE OF THEIR PRESENCE IN THE
ENVIRONMENT, THE CONTAMINANTS
ENTER THE COMMODITIES WE USE TO
PRODUCE OUR FOODS, WHETHER THOSE
BE FRUITS, VEGETABLES, GRAINS,
DAIRY, OR SEAFOOD.
WHETHER THOSE FOODS ARE IN THE
JARRED BABY FOODS OR PRODUCE
SECTION OF YOUR GROCERY STORE.
ALL OF THESE FOODS FORM THE
BASIS OF A HEALTHY EATING
PATTERN.
THIS MEANS EXPOSURE TO
CONTAMINANTS IN NUTRIENTS ARE
NOT HAPPENING IN ISOLATION.
WE'RE REDUCING LEVELS TO
CONTAMINANTS FROM THOSE FOODS
REQUIRES AN ITERATIVE,
MULTI-DISCIPLINARY SCIENCE-BASED
APPROACH.
AND IT WILL TAKE TIME TO REDUCE
THOSE LEVELS.
WE'RE DRAWING UPON OUR
EXPERTISE, WHETHER NUTRITION,
TOXICOLOGY, CHEMISTRY,
EPIDEMIOLOGY, AS WELL AS SOCIAL
SCIENCE.
BUT AS DR. MAYNE INDICATED WE'RE
WORKING WITH FEDERAL PARTNERS TO
ALSO RELY ON THEIR EXPERTISE IN
THOSE DISCIPLINES AND MORE SUCH
AS WITH USDA, TO BETTER
UNDERSTAND AGRICULTURAL
SCIENCES, UNDERSTAND HOW
PRACTICES, SOIL CONDITIONS AND
PLANT VARIETY CAN INFLUENCE THE
UPTAKE OF CONTAMINANTS AND
NUTRIENTS.
AT EPA ON ISSUES RELATED TO
TOXICOLOGY BUT ALSO
ENVIRONMENTAL MITIGATION.
AND OF COURSE WITH OUR PARTNERS
HERE TODAY AT NIH ON THE
BIOLOGICAL SCIENCES TO
UNDERSTAND THE IMPACTS ON
HEALTH, AS WELL AS COMMUNICATION
AND BEHAVIORAL SCIENCES
GRAPPLING WITH ISSUES RELATED TO
ISSUES PROVIDING INFORMATION TO
CONSUMERS AND PROFESSIONALS TO
SUPPORT THEM MAKING FOOD
DECISIONS THAT WILL ULTIMATELY
SUPPORT DEVELOPMENT OF CHILDREN
AND HEALTH OF OUR COMMUNITIES.
OFTENTIMES WE HAVE FOUND
CONSUMERS OVERSTIMMATE RISKS AND
UNDERESTIMATE BENEFITS.
OUR PERSON IS PARENTS AND
CAREGIVERS MAY AVOID FOODS ON
THE BASIS OF LIMITED INFORMATION
OR OVERESTIMATE OF RISKS FROM
EXPOSURE TO CONTAMINANTS.
THIS HAS POTENTIAL TO DO MORE
HARM THAN GOOD.
I DON'T SAY THIS TO MINIMIZE THE
ISSUE.
ON THE CONTRARY, WE BELIEVE IT
IS IMPORTANT TO REDUCE THE
CONTAMINANTS IN FOODS, AND WE
HAVE MADE SIGNIFICANT PROGRESS
OVER THE YEARS IN DOING SO.
HOWEVER, REDUCING LEVELS FURTHER
IS WARRANTED BECAUSE OF IMPACTS
THAT EXPOSURE CAN HAVE ON
CHILDHOOD DEVELOPMENT.
AND NO ONE HAS IDENTIFIED A SAFE
LEVEL OF EXPOSURE FOR MANY OF
THESE CONTAMINANTS, PARTICULARLY
WHEN IT COMES TO CHILDHOOD
DEVELOPMENT.
CLOSER TO ZERO ACKNOWLEDGES THAT
IT WILL BE DIFFICULT IF NOT
IMPOSSIBLE TO GET TO ZERO
EXPOSURE.
PARTICULARLY FOR NATURALLY
OCCURRING TOXIC ELEMENTS FOR
WHICH WE DEVELOPED METHODS TO
DETECT AT INCREASINGLY LOW
LEVELS.
HOWEVER, MUCH MORE CAN BE DONE
TO GET US CLOSER TO ZERO.
BUT AS WE MOVE CLOSER TO ZERO
IT'S IMPORTANT FOR US TO BETTER
UNDERSTAND THE ROLE OF NUTRITION
IN PROTECTING CHILDREN FROM
ADVERSE IMPACTS OF EXPOSURE, SO
WE CAN BETTER COMMUNICATE ABOUT
THE ISSUES TO THE PUBLIC.
AS DR. MAYNE SAID, IT'S CRUCIAL
OUR COMMUNICATION ABOUT
CONTAMINANTS IN FOODS DOES NOT
RESULT IN UNINTENDED
CONSEQUENCES.
SUCH AS PARENTS CHOOSING NOT TO
FEED THEIR FAMILIES CERTAIN
NUTRIENT DENSE FOODS.
OR MAKING NUTRITION FOODS MORE
EXPENSIVE OR LESS AVAILABLE OR
REDUCING EXPOSURE TO ONE
CONTAMINANT WHILE INCREASING
EXPOSURE TO ANOTHER.
WE KNOW DIETS ALIGNED WITH
RECOMMENDATIONS OF THE DIETARY
GUIDELINES ARE MORE LIKELY TO
SUPPORTED A ADEQUATE INTAKE AND
STORES WITHIN THE BODY, TO HELP
SUPPORT HEALTHY CHILD
DEVELOPMENT.
AS WE WILL DISCUSS TODAY, GOOD
NUTRITION ALSO BETTER PROTECTS
CHILDREN AGAINST THE POTENTIAL
IMPACTS CONTAMINANTS MAY HAVE.
WE HAVE A RESPONSIBILITY IN OUR
MESSAGING AND THE INFORMATION WE
GIVE AND ADVICE WE PROVIDE
AROUND DIETARY INTAKE AND
ENVIRONMENTAL CONTAMINANTS IN
THE FOOD SUPPLY.
MESSAGES NEED TO BE CLEAR, BUT
THEY ALSO NEED TO HELP THE
SUPPORTED DESIRED HEALTHY
DIETARY BEHAVIORS.
WE LOOK TO SOCIAL BEHAVIORAL AND
COMMUNICATION SCIENCES TO HELP
US DEVELOP THOSE MESSAGES THAT
CAN INFLUENCE THE DIETARY
BEHAVIORS IN ORDER TO SUPPORT
HEALTHY CHILDHOOD DEVELOPMENT.
THAT'S WHY WE VALUE THIS
OPPORTUNITY TODAY AND TOMORROW.
THIS WORKSHOP IS A GREAT STEP
TOWARD BETTER UNDERSTANDING THE
BIOLOGICAL MECHANISMS RELATED TO
NUTRIENTS IN DEVELOPMENT AND
BETTER UNDERSTANDING
COMMUNICATION SCIENCE TO HELP
INFORM OUR EFFORTS AS WE MOVE
FORWARD ON ALL FRONTS.
OUR REGULATORY ACTIVITY,
SCIENTIFIC RESEARCH, AND OUR
COMMUNICATION AND OUTREACH
ISSUES.
I VERY MUCH LOOK FORWARD TO WHAT
WE WILL BE HEARING TODAY AND
TOMORROW.
SO I THANK YOU AGAIN FOR
PARTICIPATING.
WITH THAT I'D LIKE TO TURN IT
OVER TO OUR NEXT SPEAKER, DR.
DIANA BIANCHI, DIRECTOR OF THE
EUNICE KENNEDY SHRIVER NATIONAL
INSTITUTE OF CHILD HEALTH AND
HUMAN DEVELOPMENT AT NIH.
>>I'M DR. DIANA BIANCHI,
DIRECTOR OF THE EUNICE KENNEDY
SHRIVER NATIONAL INSTITUTE OF
CHILD HEALTH AND HUMAN
DEVELOPMENT.
NICHD.
I'D LIKE TO WELCOME EVERYONE TO
THIS TWO-DAY WORKSHOP, BRIDGING
THE BIOLOGICAL AND
COMMUNICATIONS SCIENCES ON
NUTRIENTS AND ENVIRONMENTAL
CONTAMINANTS IN FOODS TO SUPPORT
CHILD DEVELOPMENT THAT THE NIH
IS CO-HOSTING WITH OUR SISTER
AGENCY, THE FDA.
ALTHOUGH SCIENCE MISINFORMATION
IS NOT NEW, IT IS UNFORTUNATELY
NOW A COMMON TOPIC IN PUBLIC
FORUMS, PARTICULARLY IN CONTEXT
OF COVID-19.
HOWEVER, NUTRITION HAS LONG BEEN
THE EXEMPLAR OF HOW
COMMUNICATING SCIENTIFIC
FINDINGS TO THE PUBLIC CAN
RESULT IN CONFLICTING AND
CONFUSING ADVICE.
TO LEVERAGE THIS RENEWED
INTEREST IN IMPROVING
COMMUNICATION SCIENCE ON
IMPORTANT PUBLIC HEALTH TOPICS,
THE STAFF FROM THE PEDIATRIC
GROWTH AND NUTRITION BRANCH FROM
NICHD HAVE PARTNERED WITH OUR
COLLEAGUES AT THE FDA'S CENTER
FOR FOOD SAFETY AND APPLIED
NUTRITION TO DISCUSS, NUMBER
ONE, THE STATE OF THE SCIENTIFIC
EVIDENCE ON FOODS THAT SUPPORT
CHILD DEVELOPMENT BUT CONTAIN
BOTH NUTRIENTS AND CONTAMINANTS.
AND NUMBER TWO, HOW RESEARCH CAN
SUPPORT BETTER COMMUNICATION TO
FAMILIES ABOUT FOOD CHOICES THAT
SUPPORT HEALTH.
IMPORTANTLY BOTH DAYS OF THIS
WORKSHOP WILL HIGHLIGHT RESEARCH
SUCCESSES AND OPPORTUNITIES TO
IMPROVE THE NUTRITIONAL STATUS
OF CHILDREN AND FAMILIES.
NUTRITION CONTINUES TO BE AN
IMPORTANT CROSS-CUTTING TOPIC IN
THE NICHD STRATEGIC PLAN.
UNDERSTANDING SCIENCE HOW TO
CLEARLY COMMUNICATE THE BEST
EVIDENCE AROUND REDUCING DIETARY
EXPOSURES, ARSENIC, LEAD,
CADMIUM, MERCURY, AND OTHER
ENVIRONMENTAL CONTAMINANTS,
WHILE MAINTAINING ADEQUATE
NUTRITIONAL INTAKE FOR CHILD
GROWTH AND DEVELOPMENT IS AN
IMPORTANT PART OF OUR MISSION.
NOT ONLY IS THIS WORKSHOP A
REFLECTION OF THE COLLABORATIVE
NATURE BETWEEN THE TWO AGENCIES,
BUT IT IS ALSO A PRO-ACTIVE
APPROACH TO PILLAR 5 OF THE
WHITE HOUSE STRATEGY TO ADDRESS
HUNGER AND REDUCE DIET-RELATED
DISEASES AND DISPARITIES OVER
THE NEXT DECADE.
OUTCOMES FROM THIS WORKSHOP WILL
ALSO FACILITATE HIGH-QUALITY
NUTRITION RESEARCH TO IMPROVE
PUBLIC HEALTH OUTCOMES ACROSS
THE LIFESPAN, TO REDUCE RISK
FACTORS FOR AND INCIDENCE OF
NUTRITION-RELATED ILLNESS, AND
ALSO TO INFORM NUTRITION-RELATED
REGULATORY DECISION MAKING AND
CONSUMER OUTREACH AND EDUCATION
RELATED TO NUTRITION.
THEREFORE, WE AT NICHD ARE PROUD
TO BE PART OF THE
WHOLE-OF-GOVERNMENT AND
WHOLE-OF-SOCIETY EFFORTS TO
IMPROVE THE NATION'S HEALTH
THROUGH FOOD AND NUTRITION.
WE'RE EXTREMELY THANK FOLLOW
HAVE COLLEAGUES FROM THE CENTERS
FOR DISEASE CONTROL AND
PREVENTION, ENVIRONMENTAL
PROTECTION AGENCY, AND UNITED
STATES DEPARTMENT OF AGRICULTURE
WHO ARE JOINING US IN THIS
COLLABORATION TO SHARE EXPERT
EXPERIENCES WITH RISK
COMMUNICATION AND AGENCY
ACTIVITIES AROUND THIS IMPORTANT
TOPIC.
IN CLOSING, I'D LIKE TO THANK
BOTH THE NIH AND THE FDA STAFF
FOR ORGANIZING THIS WORKSHOP,
AND ALL OF OUR PARTICIPANTS FOR
JOINING US OVER THESE NEXT TWO
DAYS.
THANK YOU.
>>HELLO, EVERYONE.
I'M KIMBERLEA GIBBS IN THE
PEDIATRIC AND NUTRITION BRANCH
AT NICHD.
IT'S A PLEASURE TO INTRODUCE DR.
STEVE HERMANSKY, SENIOR SCIENCE
ADVISER FOR TOXICOLOGY, JOINED
US AFTER SEVERAL YEARS AT
CON-AGR BRANDS WHAT HE OVERSAW
PROGRAMS AS WELL AS HEADING THE
FOOD PROTECTION REGULATORY
AFFAIRS AND ANALYTICAL AND
APPLIED SCIENCES DEPARTMENT.
HE ALSO HAS EXPERIENCE IN
PHARMACOLOGY INDUSTRY AS A
TOXICOLOGIST WITH
RESPONSIBILITIES IN DRUG SAFETY
CLINICAL TRIALS, HE HAS A
DOCTORATE OF PHARMACY DEGREE,
MASTER'S OF SCIENCE, DOCTOR OF
PHILOSOPHY IN TOXICOLOGY FROM
UNIVERSITY OF NEBRASKA, A
DIPLOMATE OF THE AMERICAN BOARD
OF TOXICOLOGY, HAS PUBLISHED 40
TEXT BOOK CHAPTERS AND PAPERS,
AND HAS SERVED ON THE ADVISORY
AND EDITORIAL BOARDS OF SEVERAL
ORGANIZATIONS.
WELCOME.
PLEASE SHARE YOUR SLIDES WHEN
YOU'RE READY.
>>GOOD MORNING.
THANK YOU.
I WANT TO CONFIRM THAT EVERYONE
CAN HEAR ME.
I WANT TO THANK THE CONVENERS OF
THIS CONFERENCE FOR THE
OPPORTUNITY TO SHARE MY
THOUGHTS.
AS SAID, I'M STEVE HERMANSKY, I
JOINED THE FDA IN 2022, AS A
SENIOR SCIENCE ADVISER, ENJOYED
THE OPPORTUNITY TO CONTRIBUTE IN
A DIFFERENT WAY TO SOCIETY.
I'M NOT ADVANCING.
AMY, CAN YOU PROVIDE SOME HELP
HERE?
>>JUST SAY NEXT SLIDE AND I'LL
ADVANCE FOR YOU.
>>ALL RIGHT.
THANK YOU.
AND SO EVERYONE IS AWARE,
TODAY'S COMMENTS ARE THOSE OF
MINE, THEY DO NOT NECESSARILY
REPRESENT THOSE OF THE FOOD AND
DRUG ADMINISTRATION.
NEXT SLIDE.
STEPHEN HAWKING DIDN'T INVENT
THIS CONCEPT BUT SAID IN THE
RIGHT CONTEXT FOR TODAY'S WORLD
PEOPLE BELIEVE SO MANY DIFFERENT
THINGS, FROM SO MANY SOURCES.
SOME CREDIBLE, MANY NOT.
SCIENTIFIC FACTS ARE BLENDED
WITH SO MUCH MISINFORMATION, A
THREAT TO KNOWLEDGE.
NEXT SLIDE.
HERE ARE EXAMPLES OF WHAT
UNDERMINES CREDIBILITY OF OUR
KNOWLEDGE AND MESSAGING.
CONSUMERS HEAR ALL KINDS OF
MESSAGES ABOUT SO MANY THINGS.
INFLUENCEERS GAIN THEIR TRUST
THROUGH MESSAGES THAT SEEM LIKE
COMMON SENSE.
MEDIA ENHANCES THESE BY
GENERATING CLICKS THROUGH
HIGHLIGHTING CONTROVERSY.
ALL OF THIS LEADS TO A GENERAL
DISTRUST OF SCIENCE AS A WHOLE
BUT ALSO A DISTRUST OF BIG
BUSINESS AND GOVERNMENT.
NEXT SLIDE PLEASE.
SOCIAL MEDIA HAS CREATED A
PLATFORM WHERE SO MUCH
INFORMATION IS SHARED THAT
NOBODY KNOWS WHAT TO TRUST
ANYMORE.
AN EXPERT IS ANYONE, EDUCATION
AND EXPERIENCE DON'T REALLY
MATTER AS MUCH AS LIKES AND
FOLLOWERS.
DO YOU KNOW WHAT FALSE
EQUIVALENCE IS?
THE FIRST TIME I REMEMBER IT IS
WHEN MERYL STREEP WAS DEBATING
THE EPA ON "THE TODAY SHOW" IN
THE 1980s ABOUT THE SAFETY OF
ALAR, SHE HAD NO EDUCATION OR
TRAINING BUT WAS SET UP BY THE
SHOW TO HAVE GRANTED
CREDIBILITY.
THIS IS NO LONGER THE EXCEPTION.
THIS IS NOW THE RULE OF HOW WE
MUST ENGAGE.
REGULATORY COMPLIANCE IS NOW
ONLY ONE FACTOR TO CONSIDER WHEN
MARKETING A PRODUCT.
THERE ARE SO MANY OTHER
INFLUENCEERS OUT THERE.
NEXT SLIDE.
IS IT FAIR TO LIVE IN THIS WORLD
WHERE OUR EDUCATION AND
EXPERIENCE ARE NO LONGER THE
DEFINING CONTRIBUTION TO OUR
ABILITY TO CONVINCE PEOPLE IN AN
ARGUMENT?
NEXT SLIDE.
WELL, GET OVER IT.
NOBODY EVER CLAIMED LIFE IS
FAIR.
THIS IS NOW OUR WORLD.
NEXT SLIDE PLEASE.
EFFECTIVE COMMUNICATION FROM
CREDIBLE SOURCES IS MORE
IMPORTANT THAN EVER.
PEOPLE ARE CONFUSED AND ANGERED
BY SO MANY VOICES AND OPINIONS
ON THE SAME SUBJECT.
THEY DON'T SEE THE LINES AS
CLEARLY BETWEEN CREDIBLE AND NOT
AS WE DO.
PEOPLE OFTEN HEAR THE WRONG
MESSAGE OR NO MESSAGE GETS
THROUGH.
HOW DOES THAT HELP RISK
COMMUNICATION EFFORTS?
IF WE DON'T COMMUNICATE PROPERLY
AND CAREFUL WE CAN HAVE
UNINTENDED CONSEQUENCES SUCH AS
ALIENATING THE EXACT AUDIENCE WE
NEED TO REACH THE MOST.
FOR US TO BE SUCCESSFUL AT
COMMUNICATION, WE NEED TO LEARN
TO LIVE IN THIS NEW WORLD.
WE MUST ACTIVELY SEEK
UNDERSTANDING AND HAVE PATIENCE
WITH OUR AUDIENCE WHO ARE PRETTY
MUCH CONFUSED THESE DAYS.
HEARING FRUSTRATION AND ANGER
FROM US WILL ONLY PUSH THEM AWAY
FROM OUR MESSAGE EVEN MORE.
NEXT SLIDE PLEASE.
TOO MUCH COMMUNICATION AND TOO
MANY FORMS CAN LEAD TO
UNINTENDED CONSEQUENCES.
NOT ONLY THAT, BUT IF WE AREN'T
CAREFUL WE CAN CAUSE PEOPLE TO
REACT DIFFERENTLY THAN WE EXPECT
OR HOPE.
WE ALL HAVE EXAMPLES, PERSONALLY
AND PROFESSIONALLY, WHEN PEOPLE
REACTED UNEXPECTEDLY TO OUR
WELL-INTENDED COMMUNICATION.
IN TODAY'S WORLD OF E-MAIL,
TEXT, SOCIAL MEDIA, THESE
MISCUES HAPPEN MORE FREQUENTLY
AND SOMETIMES MORE SEVERELY.
NOW IS THE TIME TO ADDRESS THIS
AND PREPARE FOR A FUTURE WHERE
COMMUNICATION IS INCREASINGLY
DOMINATED BY COPIOUS AMOUNTS OF
INFORMATION INCLUDING
MISINFORMATION, THAT MAY OR MAY
NOT BE WELL INTENDED.
NEXT SLIDE PLEASE.
THE FUTURE IS COMPLEX.
WE HAVE SOME DECISIONS TO MAKE
ON OUR FUTURE AS RISK
COMMUNICATORS.
THE OLD WAY WHERE WE GOT TO SAY,
I HAVE ALL KINDS OF DEGREES, AND
30 YEARS OF EXPERIENCE SO I'M
REALLY SMART, AND YOU SHOULD
LISTEN TO ME.
THOSE DAYS ARE OVER.
DON'T WISH FOR THEM TO COME
BACK.
WE HAVE TO LEARN TO COMMUNICATE
IN THIS NEW WORLD.
DEFINITION OF EXPERT HAS
CHANGED.
IT IS ALL ABOUT WHO HAS A VOICE
OR KEYBOARD AND AN OPINION THEY
SHARE, AND SOMETIMES THEY SHARE
THEM LOUDLY AND REPEATEDLY.
WE HAVE TO LEARN TO COMMUNICATE
IN THAT WORLD BY CONVINCING THE
AUDIENCE TO LISTEN TO US.
WE CANNOT SIMPLY TELL THEM TO
LISTEN TO US.
WE ALL NEED TO EARN THAT RIGHT
TO BE A TRUSTED VOICE.
THE CONSEQUENCES OF NOT DOING
THIS RIGHT ARE GREATER THAN
EVER, AND WE RUN THE RISK OF THE
WORST POSSIBLE OUTCOME.
WE BECOME IRRELEVANT.
NEXT SLIDE PLEASE.
THEREFORE, OUR RELEVANCE TO THE
WORLD IS DEPENDENT ON HOW WE
ADAPT.
THE OLD WAYS ARE NOT COMING
BACK.
DON'T WISH FOR THEM OR PRE-TEND
THEY STILL STILL EXIST.
LEARN TO COMMUNICATE BY EARNING
TRUST.
LEARN TO EMBRACE DIFFERENT WAYS
OF THINKING, COMMUNICATING, AND
START THIS BY LISTENING AND
UNDERSTANDING FIRST.
NEXT SLIDE.
IF WE -- WE SHOULD NOT SIMPLY
IGNORE PEOPLE WHO DENY FACTS.
THEY GAIN POWER AND FOLLOWING BY
LEVERAGING OUR DIFFERENCES.
WE MUST LEARN TO COMMUNICATE IN
WAYS THAT DO NOT LEND STRENGTH
TO THEIR MESSAGES.
NEXT SLIDE.
THEY USE PHRASES SUCH AS THEY
ARE AFRAID OF US US OR THEY
DON'T WANT YOU TO KNOW THE
TRUTH.
IGNORING THEM GIVES THEM MORE
AMMUNITION.
NOBODY SAID ANY OF THIS WAS
EASY.
I CERTAINLY DON'T HAVE ALL THE
ANSWERS.
BUT TREATING THESE INFLUENCEERS
AS ON THE FRINGE OR SIMPLY WRONG
WILL ONLY LEAD TO GREATER
RESOLVE ON THEIR PART AND EVEN
LOUDER MESSAGES.
WE NEED TO SEEK UNDERSTANDING OF
WHY THEY ARE SAYING WHAT THEY
ARE SAYING, AND THAT STARTS WITH
TREATING THEM WITH RESPECT AND
COMPASSION AND WORKING TO
UNDERSTAND THEIR POINT OF VIEW.
NONE OF THIS IS GOING TO BE EASY
BUT THE OLD DAYS ARE JUST THAT,
THE OLD DAYS.
THEY ARE GONE.
WE NEED TO CHANGE.
THE WORLD ISN'T GOING TO CHANGE
TO SUIT US.
A YOUNG LADY I USED TO WORK WITH
AND ENDED PRESENTATIONS WITH
PHRASE.
I STOLE IT FROM HER AND TOLD HER
I WAS STEALING IT FROM HER.
IT IS THE RIGHT MESSAGE FOR US
TODAY.
OVER THE NEXT COUPLE DAYS, I
CHALLENGE YOU TO THINK ABOUT
WHAT COULD CHANGE IF WE CHANGE.
THANK YOU VERY MUCH.
>>THANK YOU FOR THAT WONDERFUL
PRESENTATION.
I'D LIKE TO NOW INTRODUCE OUR
MODERATOR, IT'S MY PLEASURE TO
INTRODUCE ASHLEY VARGAS,
MOLECULAR EPIDEMIOLOGIST AND
PROGRAM DIRECTOR AT NICHD'S
PEDIATRIC GROWTH AND NUTRITION
BRANCH, CLINICAL AND RESEARCH
EXPERIENCE FOCUSES ON IMPROVING
PRECISION OF NUTRITION, RISK
ASSESSMENT, AND APPLICATION OF
NUTRITION THERAPY TO INDIVIDUALS
ACROSS THE LIFESPAN.
SHE'S THE U.S. COORDINATOR FOR
HUMAN MILK COMPOSITION
INITIATIVE, DR. VARGAS I TURN
THE SESSION OVER TO YOU.
>>THANK YOU FOR THE KIND
INTRODUCTION.
WELCOME TO OUR FIRST SESSION,
SESSION 1.
I'M ASHLEY VARGAS, I WILL BE
MODERATING THIS SESSION THAT
WILL COVER NUTRIENT NEEDS, GAPS,
SUPPORTING CHILD DEVELOPMENT.
WE'LL BEGIN WITH A BRIEF
INTRODUCTION OF OUR SPEAKERS AND
PRESENTATION ORDER.
PLEASE REMEMBER WE WANT THIS TO
BE INTERACTIVE.
THROUGHOUT THE PRESENTATION,
QUESTIONS AND COMMENTS CAN BE
SUBMITTED TO THE WORKSHOP E-MAIL
THAT YOU CAN SEE ON THE SCREEN
THROUGHOUT THIS PRESENTATION.
OUR FIRST SPEAKER IS DR. ANNA
MARIA SIEGA-RID, UNIVERSITY OF
MASSACHUSETTS AMHERST.
HER RESEARCH FOCUSES ON
CONNECTION BETWEEN MATERNAL
HEALTH, PRE-CONCEPTUALLY AND
DURING PREGNANCY, AND HEALTH
OUTCOMES, AND WILL BE SPEAKING
ON PREGNANCY AND LACTATION AS
CRITICAL PERIODS OF EXPOSURE
TODAY.
SECOND SPEAKER IS DR. KATHERINE
DEWEY, DISTINGUISHED PROFESSOR
EMERITA, UNIVERSITY OF
CALIFORNIA, DAVIS, RESEARCH ON
MATERNAL AND CHILD HEALTH WITH
DOMESTIC AND GLOBAL FOCUS,
INCLUDING SERVICE ON THE 2020
U.S. DIETARY GUIDELINES ADVISORY
COMMITTEE WHICH DEVELOPED
FOOD-BASED DIETARY GUIDANCE FOR
CHILDREN UNDER 2.
FOR THE FIRST TIME AND WILL
SPEAK OF IT CRITICAL PERIODS F
EXPOSURE.
DR. SIEGA-RID, PLEASE SHARE YOUR
SLIDES.
>>THANK YOU.
LET ME SEE IF I CAN GET THIS
DONE.
GIVE ME ONE SECOND.
AS I CONVERTTY.
OKAY.
ARE YOU SEEING THE RIGHT SET OF
SLIDES, I HOPE?
PERFECT.
OKAY.
WONDERFUL.
THANK YOU VERY MUCH FOR THE
OPPORTUNITY TO BE HERE AND TO
PRESENT ON THIS TOPIC.
A TOPIC THAT I HAVE SPENT MY
CAREER ON STUDYING THE NUTRIENT
INTAKES OF PREGNANT AND
LACTATING WOMEN AND HOW IT
AFFECTS NOT ONLY THEIR OWN LIFE,
BUT THE LIFE OF THE CHILD.
SO, WHY START WITH PREGNANCY
WHEN THE TOPIC OF THE
CONVERSATION IS HOW TO MINIMIZE
TOXICANTS' IMPACTS ON COGNITIVE
DEVELOPMENT?
ONE THING FOR SURE THAT THE
FIELD HAS DONE FOR SCIENCE IS TO
MOVE FROM THIS STUDY OF SIMPLE
ASSOCIATIONS BETWEEN EARLY LIFE
EVENTS AND SUBSEQUENT PATHOLOGY
TO THE INVESTIGATION OF
UNDERLYING MECHANISMS, USING THE
LIFE COURSE APPROACH THIS FIGURE
FROM AN ARTICLE SUMMARIZES
EVIDENCE FROM EPIDEMIOLOGICAL
DATA.
LOOK AT THE RISK OF
NON-COMMUNICABLE DISEASES.
IN THIS SLIDE IT SHOWS THAT RISK
INCREASES IN A NON-LINEAR
FASHION AS RESULT OF DECLINING
PLASTICITY IN CUMULATIVE DAMAGE
FROM LIFESTYLE EXPOSURES AS WELL
AS OTHER CHALLENGES.
THE EFFECT OF THE MISMATCH
BETWEEN DEVELOPMENTALLY AND
EVOLUTIONARY INFLUENCED
PHENOTYPE IN ADULT ENVIRONMENT
INCREASES THROUGHOUT THE LIFE
COURSE.
INTERVENTION IN ADULTS
ESPECIALLY AT HIGH RISK CAN BE
BENEFICIAL BUT ONLY TO A CERTAIN
DEGREE.
SCREENING MAY BE TOO LATE TO
REDUCE RISK SUBSTANTIALLY.
SO, THE PRENATAL PERIOD
ESTABLISHES RISK THROUGH THE
INTERACTION BETWEEN GENETIC,
EPIGENETIC AND ENVIRONMENTAL
FACTORS AS SHOWN HERE IN THIS
FIGURE.
YOU CAN SEE WE HAVE
ENVIRONMENTAL CONTAMINANTS
PREVIOUSLY STATED FOUND IN OUR
SOIL, FOOD, WATER.
WE INGEST THEM OR ARE EXPOSED TO
THEM.
AND DURING SUSCEPTIBLE PHASES OF
DEVELOPMENT THESE PARTICULAR
EXPOSURES CAN HAVE EPIGENETIC
MODIFICATIONS THAT THEN
INFLUENCES HEALTH OUTCOMES IN
THE NEXT GENERATION.
FURTHERMORE, OVER THE YEARS
WE'VE BECOME WELL ACQUAINTED
WITH THE NOTION OF CRITICAL
PERIODS.
THESE ARE PERIODS IN THE LIFE
CYCLE OF GROWTH AND DEVELOPMENT
WHERE AN EXPOSURE TO A NEGATIVE
FACTOR OR LACK OF PARTICULAR
FACTOR HAS A NEGATIVE EFFECT
RESULTING IN PERMANENT AND
IRREVERSIBLE DAMAGE OR DISEASE
INCLUDING MATERNAL EXPOSURE TO
THALIDOMIDE.
NEURAL COGNITIVE OUTCOMES AS YOU
CAN SEE, THE IMPORTANCE BEGINS
AT 28 WEEKS WHEN THE BRAIN IS
GROWING RAPIDLY AND CONTINUES
THROUGHOUT THE FIRST YEAR OF
LIFE WHEN MYELINATION OF THE
BRAIN IS CRITICAL FOR OPTIMAL
NEURAL COGNITIVE DEVELOPMENT.
IN THE FIELD OF NUTRITION WE
HAVE REFERENCE INTAKES THAT
GUIDE RECOMMENDATION FOR MICRO
AND MACRONUTRIENTS IN LIFE
STAGES.
EAR IS AMOUNT OF NUTRIENT
ESTIMATED TO MEET REQUIREMENT
FOR SPECIFIC CRITERION OF HALF
OF THE INDIVIDUALS OF A SPECIFIC
AGE, SEX, LIFE STAGE GROUP.
THE RDA IS A VALUE TO MEET THE
REQUIREMENTS OF NEARLY ALL, 97
TO 98% IN A PARTICULAR SEX AND
LIFE STAGE GROUP.
A.I. IS ESTABLISHED WHEN EAR
CAN'T BE, BASED ON RECOMMENDED
AVERAGE INTAKES FROM
OBSERVATIONAL OR EXPERIMENTAL
DETERMINED APPROXIMATIONS.
WE HAVE THE UPPER LIMIT, THE
HIGHEST AVERAGE DAILY NUTRIENT
INTAKE THAT IS LIKELY TO POSE NO
RISK OF ADVERSE HEALTH EFFECTS
TO ALMOST ALL INDIVIDUALS IN THE
GENERAL POPULATION.
AS INTAKES INCREASE, POTENTIAL
RISK OF ADVERSE EFFECTS MAY
INCREASE.
LIKEWISE, AS INTAKES ARE DEEMED
TO BE LESS THAN THE EAR,
POTENTIAL RISK OF ADVERSE
EFFECTS ALSO INCREASES.
IT'S IMPORTANT TO NOTE THAT THE
DRIs DO NOT TAKE INTO ACCOUNT
NUTRIENT NEEDS TO MODULATE
EFFECTS HEAVY METALS AND
CONTAMINANTS.
ALL THE NUTRIENTS SHOWN HERE
HAVE AN ESTABLISHED RDA EAR,
WHAT WE'VE SHOWN IS IN BLUE THE
INCREASED NEEDS OF NUTRIENTS
BEYOND NON-PREGNANT
NON-LACTATION STATE IN BLUE,
LACTATION IN ORANGE.
INCREASED NEEDS DURING THE TWO
PERIODS OF THE WOMAN AS SHE IS
ABOUT TO NOURISH HER CHILD.
WE ALSO HAVE ENERGY NEEDS OF
PREGNANT WOMEN.
CONTRARY TO POPULAR BELIEF IT IS
NOT DOUBLE BUT RATHER DEPENDENT
ON THE TRIMESTER OF PREGNANCY,
THE WEIGHT, HEIGHT, AND AGE OF
PHYSICAL ACTIVITY OF THE MOTHER,
AND AMOUNT OF ENERGY DEPOSITION
RELATED TO FETAL GROWTH AND
MATERNAL TISSUE WHICH VARIES BY
WEIGHT STATUS OF THE MOTHER.
THESE NEW DRIs HAVE JUST BEEN
PUBLISHED BY THE NATIONAL
ACADEMY OF SCIENCES AND
MEDICINE.
THEY ARE DESIGNED TO BE MORE IN
LINE WITH GESTATIONAL WEIGHT
GAIN RECOMMENDATIONS.
DURING LACTATION ENERGY NEEDS
VARIES BY TIME PERIODS OF WHEN
THE CHILD IS BEING EXCLUSIVELY
BREASTFED VERSES COMPLEMENTARY
FOODS ARE BEING INTRODUCED.
BOTTOM LINE, IT DOES CAUSE
ENERGY TO PRODUCE MILK.
A WOMAN CAN MEET NEEDS BY
INCREASING ENERGY INTAKE AND/OR
MOBILIZING FAT STORES LAID DOWN
IN PREGNANCY.
WOMEN WHO ARE PREGNANT OR
LACTATING ARE ENCOURAGED TO
FOLLOW THE RECOMMENDATIONS ON
THE TYPES OF FOODS AND BEVERAGES
THAT MAKE UP THE HEALTHY PATTERN
DESCRIBED IN THE DIETARY
GUIDELINES FOR AMERICANS SHOWN
HERE.
CORE ELEMENTS DURING THESE LIFE
STAGES ARE SIMILAR TO
RECOMMENDATIONS FOR WOMEN NOT
PREGNANT.
THIS TABLE DISPLAYS HEALTHY U.S.
DIETARY PATTERN TO ILLUSTRATE
SPECIFIC AMOUNTS AND LIMITS FOR
FOOD GROUPS AND OTHER DIETARY
COMPONENTS THAT MAKE UP THE
HEALTHY DIETARY PATTERNS ACROSS
THE SIX CALORIE LEVELS RELEVANT
TO WOMEN PREGNANT OR LACTATING.
HIGHLIGHTED IN RED, THE AREA OF
INTAKE MOST COMPARABLE TO
AVERAGE INTAKES OF THE
POPULATION OF PREGNANT AND
LACTATING WOMEN.
THE INCREASED CALORIE AND
NUTRIENT NEEDS IN PREGNANCY AND
LACTATION SHOULD BE MET BY
CONSUMING NUTRIENT-DENSE FOOD
CHOICES AS PART OF A HEALTHY
DIETARY PATTERN.
FISH IS PART OF A HEALTHY EATING
PATTERN BECAUSE IT PROVIDES KEY
NUTRIENTS DURING CRITICAL
PERIODS OF DEVELOPMENT SUCH AS
THESE SHOWN HERE.
OMEGA 3 AND 6 FATTY ACIDS, IRON,
IODINE, PREGNANCY AND CHOLINE.
FISH IS ALSO A SOURCE OF
METHYLMERCURY, LIMITING THIS IS
IMPORTANT.
EPA PROVIDES GUIDELINES ON FISH
THAT ARE BEST CHOICES TO MEET
NUTRIENT NEEDS AND TYPES OF FISH
THAT SHOULD BE AVOIDED DUE TO
HIGHER LEVELS OF METHYLMERCURY
BEING PRESENT.
FOLLOWING SLIDES, I'LL BE USING
DATA FROM OUR NATIONAL
SURVEILLANCE MONITORING SYSTEMS
TO DESCRIBE WHAT ARE PREGNANT
AND LACTATING WOMEN CONSUMING IN
THE U.S.
THESE ARE DATA FROM NHANES,
SPECIFICALLY SAMPLE OF WOMEN WHO
ARE PREGNANT OR LACTATING,
BASICALLY SHOWING INTAKES OF
PREGNANT AND NON-LACTATING WOMEN
COMPARED TO NON-PREGNANT NOT
LACTATING WOMEN FOR
MACRONUTRIENTS.
KEEP IN MIND WHAT WE'VE SEEN IN
THIS DATA AND OTHER COHORT DATA
ABLE TO LOOK AT DIETARY INTAKES
OF PREGNANT AND LACTATING WOMEN
IN THESE STATES AND WHILE NOT
PREGNANT.
IN FACT, THE MACRONUTRIENT
COMPOSITION DOESN'T CHANGE VERY
MUCH.
THEY TEND TO INCREASE AMOUNT OF
CALORIES CONSUMING.
WE SEE SLIGHT REDUCTION IN
CERTAIN FOODS SUCH AS CAFFEINE
AND ALCOHOL, SLIGHT INCREASES IN
DAIRY AND PROTEIN SOURCES FOR
VEGETARIANS.
THERE ARE GREATER CHANGES FOR
WOMEN WHOSE INCOME ALLOWS FOR IT
AND WHERE THERE'S BETTER ACCESS
FOR THE FOOD SUPPLY.
THIS BAR CHART -- I'LL SHOW A
SERIES OF CHARTS USED IN
GUIDELINES, USING DATA FROM
NHANES.
I'M SHOWING YOU HOW AVERAGE
INTAKES OF FOOD GROUPS PER DAY
COMPARE WITH RECOMMENDED INTAKE
RANGES FOR WOMEN WHO ARE
PREGNANT AND LACTATING.
WHAT YOU SEE ARE THE AVERAGE
INTAKES RECOMMENDED IN BLUE, AND
THEN WHAT THE WOMEN ARE ACTUALLY
CONSUMING, PREGNANT AND
LACTATING.
SO WHAT YOU CAN SEE HERE IS THAT
TOTAL VEGETABLES ARE BELOW
RECOMMENDED INTAKES.
FRUITS ARE CLOSER.
CLEARLY WOMEN ARE CONSUMING WHAT
THEY ARE SUPPOSED TO WHEN WE
LOOK AT TOTAL GRAINS.
THEY ARE CONSUMING LESS FOR
TOTAL DAIRY.
AND PROTEIN TENDS TO BE EITHER
WITHIN OR ABOVE RECOMMENDED
INTAKES.
WHEN WE LOOK AT INDICE COMPARED
TO NOT BEING PREGNANT OR
LACTATING, IN GENERAL WOMEN WHO
ARE PREGNANT AND LACTATING TEND
TO HAVE BETTER QUALITY DIETS.
BUT NOT THAT MUCH HIGHER.
IF WE DIG DEEPER INTO THE
DIFFERENT TYPES OF VEGETABLES AS
WELL AS GRAINS AND PROTEIN
FOODS, COMPARED TO RECOMMENDED
INTAKES, WHAT YOU ACTUALLY BEGIN
TO SEE ARE SOME UNIQUE
DIFFERENCES.
PREGNANT AND LACTATING WOMEN
CONSUMING LESS RED AND ORANGE,
AS WELL AS STARCHY VEGETABLES.
TOTAL GRAINS YOU SEE LOWER
INTAKES THAN WHAT IS RECOMMENDED
FOR WHOLE GRAINS, BUT HIGHER
INTAKES OF REFINED GRAINS.
IF WE LOOK AT DIFFERENT TYPES OF
PROTEIN FOODS YOU SEE HIGHER
INTAKES THAN WHAT'S RECOMMENDED
FOR MEAT, POULTRY AND EGGS.
SEAFOODS ARE SLIGHTLY LOWER THAN
RECOMMENDED INTAKES.
THESE CIRCLE CHARTS ARE USED NOW
TO SHOW PERCENT OF THIS AGE
GROUP WHO EXCEEDS LIMITS FOR
ADDED SUGARS, SATURATED FAT,
SODIUM.
WE SEE THAT 70 AND 51% OF
PREGNANT AND LACTATING WOMEN
RESPECTIVELY EXCEED LIMIT FOR
ADDED SUGARS.
75 AND 77% EXCEED THE LIMIT FOR
SATURATED FAT.
80 AND 97% OF PREGNANT AND
LACTATING WOMEN EXCEED THE LIMIT
FOR SODIUM.
IF WE FOCUS ON NUTRIENTS THAT
FALL BELOW OR EXCEED THE DRIs,
WE CAN SEE THAT FOUR NUTRIENTS
ARE GREATER THAN 30% BELOW
RECOMMENDATIONS.
A FEW NUTRIENTS ARE ABOVE THE
UPPER LIMIT WHEN SUPPLEMENTED
ARE CONSUMED.
DIVING DEEPER INTO TWO NUTRIENTS
OF PARTICULAR INTEREST DURING
PREGNANCY WE SEE THAT WOMEN WHO
ONLY CONSUME FOODS SHOWN HERE IN
GRAY BAR HAVE A GREATER
PROPORTION TO FALL BELOW THE EAR
FOR IRON AND FOLATE
REQUIREMENTS.
WE'VE JUST SEEN DATA FROM
SELF-REPORTED INTAKE, IN ORDER
TO TRULY IDENTIFY NUTRIENTS OF
CONCERNS WE NEED TO HAVE AN
EXAMINATION OF BIOMARKER DATA.
THAT'S BECAUSE THERE'S
MEASUREMENT ERROR INHERENT IN
REPORTS OF DIETS.
SEEN HERE IS THE FRAMEWORK USED
BY THE DIETARY GUIDELINES FOR
AMERICAN FEDERAL ADVISORY
COMMITTEE TO IDENTIFY NUTRIENTS
OF CONCERN.
WHAT WE HAVE IS DOES THE
NUTRIENT ACTUALLY HAVE AN EAR OR
RDA?
IF IT DOES, AND THERE ACTUALLY
IS A BIOMARKER SPECIFIC TO THAT
NUTRIENT, AND IF THAT INDICATES
IN FACT THAT THERE IS A
DEFICIENCY, AS WELL AS WITH A
LOWER INTAKE THAN WHAT'S
RECOMMENDED, THEN THOSE TWO
FACTORS TOGETHER WILL PRODUCE A
NUTRIENT OF CONCERN.
NUTRIENTS OF PUBLIC HEALTH
CONCERN FOR PREGNANT AND
LACTATING WOMEN USING THIS
FRAMEWORK IDENTIFIED BY DIETARY
GUIDELINES COMMITTEE ARE FOLIC
ACID DURING PRE-CONCEPTION --
PERICONCEPTION PERIOD THROUGH
FIRST TRIMESTER, IRON ACROSS ALL
TRIMESTERS, AND IODINE.
IODINE IS ASTERISKED BECAUSE
THERE'S NO DIETARY DATA
AVAILABLE FOR ESTIMATING IODINE
INTAKE.
HOWEVER, THERE'S BIOMARKER DATA
THAT SUGGESTS THAT LOW DIETARY
INTAKE OF IODINE EXISTS.
AND THAT WITH INADEQUATE IODINE
INTAKES ARE ASSOCIATED WITH
IRREVERSIBLE IMPAIRED
NEUROLOGICAL AND BEHAVIORAL
DEVELOPMENT OF THE OFFSPRING
PUTS IT AT THIS SORT OF
POTENTIAL FOR BEING A PUBLIC
HEALTH CONCERN NUTRIENT.
ONE REASON WE'RE SEEING A LOWER
LEVEL OF IODINE IN THE
POPULATION IS ASSOCIATED WITH
TREND OF HIGHER USE OF SEA SALT
IN PLACE OF IODIZED SALT.
THERE'S A CLOSER TO ZERO EFFORT
TO GET TO MINIMAL EXPOSURES
INCLUDING ARSENIC, LEAD,
CADMIUM, MERCURY.
FDA CONDUCTS TOTAL DIET STUDY,
THIS IS THE WAY IN WHICH FDA
MONITORS THE U.S. FOOD SUPPLY.
LATEST REPORT SUMMARIZES ITS
FINDINGS FROM 2018 TO 2020.
THE SURVEY IS A CONTINUOUS
SURVEY THAT COLLECTS FOODS FROM
RETAIL OUTLETS AND INCLUDES
FOODS, BEVERAGES, WATER.
DURING THIS TIME PERIOD OF 2018
TO 2020, 87 FOOD COLLECTIONS
OCCURRED THAT RESULTED IN OVER
3,000 FOODS BEING ANALYZED.
THE FOODS HIGHLIGHTED IN CLOSER
TO ZERO INITIATIVE ARE INCLUDED
IN DARK BLUE ZONE.
THIS SHOWS YOU THAT THERE ARE
FOODS ANALYZED IN BOTH ANALYSIS
AND TOTAL DIET SURVEY OCCURRED
IN FOODS AND BEVERAGES, AND
WATER, ALL FOODS.
AND FOODS IN THE CLOSE TO ZERO
INITIATIVE ARE INCLUDED HERE.
THE RESULTS OF THIS CURRENT
SURVEY ARE SHOWN IN THIS
PARTICULAR TABLE.
I'VE HIGHLIGHTED THE FOUR
ELEMENTS THAT WE ARE MOST
INTERESTED IN DURING THIS
CONFERENCE RIGHT NOW.
AND WHAT THIS TABLE BASICALLY
TELLS YOU IS THE PERCENT IN
WHICH THERE WAS NO DETECTION OF
THAT PARTICULAR ELEMENT, AND
THEN THE FOODS WITH THE HIGHEST
MEAN CONCENTRATION.
SO HERE YOU CAN SEE FOR ARSENIC,
IN TERMS OF INORGANIC AND TOTAL
ARSENIC, THERE IS 57% OF FOODS
WHERE THERE WAS NO ARSENIC
DETECTED.
BUT THE HIGHEST MEAN
CONCENTRATIONS WAS FOUND IN
BAKED COD, CANNED TUNA, FISH
STICKS, BAKED SALMON, PRE-COOKED
SHRIMP.
WE CAN FOLLOW FOR EACH OF THOSE
PARTICULAR ELEMENTS.
CADMIUM, 39% NO DETECT.
HIGHEST WERE SUNFLOWER SEEDS,
SPINACH.
LEAD 86% OF FOODS HAD NO
DETECTION.
THOSE THAT HAD HIGHEST WAS BABY
FOODS SWEET POTATOES AND
TEETHING BISCUITS.
METHYLMERCURY YOU CAN SEE 93% NO
DETECTION BUT THEY WERE DETECTED
IN CANNED TUNA, BAKED COD, BAKED
SALMON, PAN COOKED CATFISH AND
PRE-COOKED SHRIMP.
LET ME ORIENT YOU TO THIS SLIDE
BECAUSE I WILL BE USING A COUPLE
VERSIONS OF THIS TO EXPLAIN
WHERE THESE FOODS ARE.
BLUE REGION IS PERCENT OF FOODS
FOR WHICH THE ELEMENT WAS
DETECTED.
AND THE NUMBER OF FOODS IN WHICH
THEY WERE DETECTED.
YOU CAN SEE ARSENIC, AMONG ALL
FRUITS, ARSENIC WAS THE ELEMENT
THAT WAS MOST DETECTED.
IT'S ABOUT 39% AS WE JUST SAW.
THERE WERE 138 FOODS FOR WHICH
IT WAS DETECTED IN.
WHEN WE LOOK AT IN GREATER
DETAIL THE SPECIFIC FRUITS FOR
WHICH HAD THE HIGHEST MEAN TOTAL
ARSENIC CONCENTRATION, YOU CAN
SEE THE MEAN AND MAXIMUM FOR
THESE FOODS, AND IF YOU LOOK AT
THE MEANS THAT TEND TO BE THE
HIGHEST, THE MAXIMUM, YOU CAN
SEE THEY ARE PRETTY COMMON FOODS
THAT ARE CONSUMED IN THE
POPULATION.
WITHIN THE VEGETABLE FOOD GROUP,
CADMIUM WAS DETECTED IN MOST
VEGETABLE SAMPLES.
HOWEVER, MANY CONCENTRATIONS
WERE LOW AS I'LL SHOW IN THE
NEXT SLIDE.
HERE WE HAVE THAT SLIDE.
SO YOU CAN SEE THE MINIMUM AND
MAXIMUM.
THESE ARE LOW LEVELS THAT WERE
DETECTED.
BUT IF YOU LOOK AT SOME FOODS
THAT TEND TO BE GOOD SOURCES OF
FOLATE, COLLARDS, KALE, LETTUCE
AND SPINACH, THEY ARE COMING IN.
HERE IS THE RESULT FOR THE DAIRY
PRODUCTS.
BASICALLY, THERE WAS VERY LITTLE
OF THESE ELEMENTS DETECTED IN
DAIRY PRODUCTS, AS YOU CAN SEE.
SO IN SUMMARY, WHAT I HOPE I
HAVE BEEN ABLE TO DESCRIBE TO
YOU IS THAT THERE ARE
NUTRITIONAL GAPS IDENTIFIED IN
PREGNANT AND LACTATION.
AND THOSE INCLUDE INADEQUATE
INTAKES OF FRUITS, VEGETABLES,
DAIRY PRODUCTS, SEAFOODS.
NUTRIENTS OF PUBLIC HEALTH
CONCERNS ARE FOLIC ACID, IRON,
IODINE.
THUS, FOODS THAT NEED TO BE
INCREASED DURING THIS TIME ARE
ALSO ONES THAT CONTAIN SOME OF
THESE CONTAMINANTS THAT WE'RE
MOST INTERESTED IN.
THAT CAN POSE A RISK TO THE
DEVELOPING FETUS AND CHILD.
THANK YOU VERY MUCH.
AND I THINK WE'RE GOING TO BE
TAKING QUESTIONS AT THE END.
>>WE'LL HOLD QUESTIONS TO THE
END.
THANK YOU, THIS IS A WONDERFUL
PRESENTATION THAT
COMPREHENSIVELY TALKED ABOUT THE
CONCERNS IN THIS SPACE FOR
LACTATING AND PREGNANT
INDIVIDUALS.
WE WILL NOW TURN OUR ATTENTION
TO DR. DEWEY.
WE'RE LOOKING FORWARD TO YOUR
PRESENTATION.
PLEASE FEEL FREE TO SHARE YOUR
SLIDES.
>>THANK YOU VERY MUCH.
IT'S AN HONOR TO BE A PART OF
THIS WORKSHOP.
AS MENTIONED, I'LL BE TALKING
ABOUT THESE TOPICS FOR THE AGE
PERIOD FROM BIRTH TO 5 YEARS OF
AGE.
I'D LIKE TO MENTION I HAVE NO
RELEVANT FINANCIAL RELATIONSHIPS
WITH ANY COMMERCIAL INTERESTS ON
THIS TOPIC.
IN THIS PRESENTATION I'LL
BRIEFLY GO OVER THE DRIs FOR
0-5 YEARS OF AGE, AND DESCRIBE
THE NUTRIENTS THAT MAY BECOME
LIMITING BEFORE 6 MONTHS OF AGE
AND NUTRIENTS OF CONCERN AT 6-12
MONTHS, 1-5 YEARS OF AGE IN THE
U.S.
I'LL MOVE TO KEY DIETARY SOURCES
TO SUPPORT CHILD DEVELOPMENT.
THEN COVER SOME DIETARY
GUIDELINES FOR THESE AGE GROUPS.
AND WRAP UP WITH SOME
CONCLUSIONS.
SO AS DESCRIBED, THE DIETARY
REFERENCE INTAKES INCLUDE RDA
VALUES FOR MANY BUT NOT ALL
NUTRIENTS.
ALTERNATIVE ESTIMATE, ADEQUATE
INTAKE, IS ESTABLISHED WHEN
THERE'S INSUFFICIENT SCIENTIFIC
EVIDENCE TO ESTABLISH AN EAR.
IT'S USUALLY DEVELOPED BASED ON
INTAKE OF HEALTHY POPULATION.
BIRTH TO 5 YEARS OF AGE, WE HAVE
LESS INFORMATION ON NUTRIENT
REQUIREMENTS THAN AT OTHER
STAGES OF THE LIFE CYCLE.
SO FOR 0-6 MONTHS, FOR EXAMPLE,
ALL OF THE DRI VALUES ARE
ADEQUATE INTAKE VALUES.
THEY ARE BASED ON ESTIMATED
INTAKE OF EXCLUSIVELY BREASTFED
INFANTS.
6-12 MONTHS RDA FOR IRON, ZINC,
PROTEIN, ALL OTHERS ARE
ESTIMATED.
1-3 AND 4-8 YEARS WE HAVE RDAs
FOR MOST NUTRIENTS.
BUT THERE ARE SOME FOR WHICH WE
ONLY HAVE ADEQUATE INTAKE
VALUES.
THOSE ARE LISTED AT THE BOTTOM
OF THE SLIDE.
LET'S START WITH THE FIRST 6
MONTHS WHEN EXCLUSIVE
BREASTFEEDING IS RECOMMENDED.
HUMAN MILK IS NORMALLY AN
ADEQUATE SOURCE OF ALL REQUIRED
NUTRIENTS, BUT THERE ARE SOME
THAT MAY BECOME LIMITING PRIOR
TO 6 MONTHS DEPENDING ON THE
SITUATION.
FIRST ONE I'D LIKE TO MENTION IS
IRON.
HUMAN MILK HAS RELATIVELY LITTLE
IRON IN IT.
THIS MAY BE FOR ADAPTIVE REASONS
THAT I WON'T HAVE TIME TO GET
INTO.
BUT INFANTS RELY ON BODY IRON
STORES AT BIRTH TO PROVIDE MOST
IRON NEEDED IN THE FIRST SIX
MONTHS.
BODY IRON AT BIRTH IS HIGHLY
VARIABLE.
THERE ARE QUESTIONS ABOUT
WHETHER ZINC MAY BECOME LIMITING
BEFORE 6 MONTHS AS WELL AS
VITAMIN D WHICH DEPENDS ON
MATERNAL VITAMIN D STATUS AND
SUN EXPOSURE OF BOTH MOTHER AND
BABY AND THERE MAY BE OTHER
VITAMINS AND POSSIBLY IODINE
THAT COULD BE LIMITS IF THE
MOTHER'S DIET IS INADEQUATE.
SO LET'S FOCUS ON IRON BECAUSE
IT'S SUCH A CRITICAL NUTRIENT
FOR CHILD DEVELOPMENT.
THIS IS A FIGURE THAT
ILLUSTRATES HOW LONG WE CAN
PREDICT BODY IRON AT BIRTH MIGHT
LAST.
THIS IS BASED ON THE BIRTH
WEIGHT OF THE CHILD AND TIMING
OF UMBILICAL CORD CLAMPING WHICH
CAN HAVE A STRONG INFLUENCE ON
THE AMOUNT OF IRON THE BABY HAS
RIGHT AFTER BIRTH.
THE RED LINE HERE IS THE
REFERENCE BODY IRON NEEDED TO
MEET DESIRABLE TISSUE AND
CIRCULATING IRON.
SO IN THE FIRST LINE THIS WILL
BE A BABY BORN AT 3.2 KILOGRAMS,
A LITTLE BIT LOW, WITH EARLY
CORD CLAMPING.
IN THAT SITUATION, THERE ARE
PREDICTED IRON STORES WILL LAST
FOR ONLY 3 MONTHS.
BUT IF YOU THEN HAVE A CHILD AT
THE SAME BIRTH WEIGHT WITH
DELAYED CLAMPING, IT IS 6
MONTHS.
LARGER BIRTH WEIGHT BABY EARLY
CLAMPING IT WOULD LAST FOR 4
MONTHS.
LAST SCENARIO OF A LARGER BABY
WITH DELAYED CORD CLAMPING IRON
STORES SHOULD LAST FOR AT LEAST
8 MONTHS.
THESE FACTORS ARE EXTREMELY
IMPORTANT IN INDICATING WHETHER
BODY IRON WILL LAST THROUGHOUT
THE FIRST 6 MONTHS.
AFTER 6 MONTHS OF AGE, THIS
SLIDE SHOWS ESTIMATED AVERAGE
REQUIREMENT AND RDA FROM TWO
SOURCES.
AND I'D LIKE TO POINT OUT THAT
FOR THE RDA, THE VALUES HAVE THE
SAME BETWEEN INSTITUTE OF
MEDICINE AND EUROPEAN AUTHORITY,
11 AT 6 TO 12, AND 7 AT 12 TO 24
MONTHS.
THE IMPORTANT TO NOTE NEEDS ARE
HIGHER IN INFANCY THAN
SUBSEQUENTLY.
THIS IS BECAUSE OF VERY RAPID
EXPANSION OF BLOOD VOLUME AND
HEMOGLOBIN NEEDS THAT REQUIRE
IRON.
NOW, THESE ESTIMATES ASSUME 10%
ABSORPTION BUT ABSORPTION FROM
PLANT-BASED FOODS IS LIKELY TO
BE LESS THAN THAT.
AND LASTLY, WE'VE LEARNED FOR
BREASTFED INFANTS ACHIEVING
ADEQUATE INTAKE AT 6 TO 12
MONTHS IS CHALLENGING.
THEY NEED TO CONSUME
COMPLEMENTARY FOODS WITH HIGH
IRON DENSITY, OR IRON FORTIFIED
FOODS.
I'LL GET INTO THAT IN DETAIL
LATER.
NOW, ANNA MARIA TALKED ABOUT
NUTRIENTS OF PUBLIC HEALTH,
RELEVANCE, DEFINED BY DIETARY
GUIDELINES ADVISORY COMMITTEE
FROM 2020.
THIS TABLE SHOWS PROPOSED
DEFINITIONS FOR FOUR CATEGORIES
OF NUTRIENTS THAT WE MIGHT BE
THINKING ABOUT.
THEY COULD BE UNDERCONSUMED,
OVERCONSUMED, COULD BE
IDENTIFIED AS NUTRIENTS OF
PUBLIC HEALTH CONCERN, WHICH
MEANS THERE'S SUPPORTING
EVIDENCE THROUGH BIOCHEMICAL
INDICES OR FUNCTIONAL STATUS
INDICATORS, THAT CONFIRM DATA.
LASTLY A CATEGORY THAT OUR
NUTRIENTS THAT POSE SPECIAL
CHALLENGES.
THESE ARE THOSE FOR WHICH IT'S
DIFFICULT TO IDENTIFY THE
AT-RISK GROUPS OR FOR WHICH
DIETARY GUIDANCE COULD MAKE
INTAKE LEVELS BUT CHALLENGING TO
DEVELOP.
I'D LIKE TO GO THROUGH THE AGE
GROUPS FROM 0-5 YEARS.
STARTING WITH 6-12 MONTHS, IN
THE CATEGORY OF NUTRIENTS OF
PUBLIC HEALTH CONCERN, THERE WAS
ONE NUTRIENT IDENTIFIED AND THAT
WAS IRON AMONG INFANTS FED HUMAN
MILK.
77% HAD INTAKES LESS THAN THE
ESTIMATED AVERAGE REQUIREMENT OF
6.9 MILLIGRAMS PER DAY.
IN ADDITION BIOMARKER DATA
INDICATED IRON DEFICIENCY IN
OLDER AGE GROUPS.
YOU CAN SEE HERE BASED ON
FERRITIN OF LESS THAN 12 THAT
13% OF TODDLERS 1 TO 2 YEARS OF
AGE WERE IRON DEFICIENT.
BY CONTRAST THE MEAN IRON INTAKE
OF FORMULA OR MIXED FED INFANTS
IS HIGH, 17 MILLIGRAMS PER DAY
ON AVERAGE, NOT MEETING
CRITERION RELATIVE TO UPPER
LEVEL BUT EXCESS IRON INTAKE IS
A CONCERN.
IT'S NOTEWORTHY THE IRON CONTENT
OF FORMULA IS MOST COMMONLY USED
IN THE U.S. IS RELATIVELY HIGH,
ABOUT 40 TIMES THE IRON CONTENT
OF HUMAN MILK.
NOW, THERE WERE SOME NUTRIENTS
ALSO IDENTIFIED AS POSING
SPECIAL CHALLENGES FROM 6 TO 12
MONTHS.
INCLUDING POTASSIUM, VITAMIN D,
CHOLINE, FOR ALL INFANTS.
TABLE SHOWS THE MEAN INTAKE FROM
ALL SOURCES BY FEEDING GROUP.
YOU CAN SEE THAT POTASSIUM, 700
WAS BELOW THE A.I.
FOR VITAMIN D HUMAN MILK FED AND
FORMULA FED INTAKES BELOW A.I.
SAME FOR CHOLINE.
IT'S IMPORTANT TO NOTE THAT WHAT
THESE NUTRIENTS THERE ARE NO
RDAs SO WE'RE NOT CERTAIN
ABOUT WHETHER THESE ARE TRULY
INADEQUATE.
WE ALSO HAVE NO CLINICAL OR
BIOCHEMICAL DATA AT THIS AGE
THAT ARE NATIONAL TO CONFIRM THE
CONCERN ABOUT THEM BEING LOW.
NOW, FROM 1 TO 5 YEARS OF AGE,
THERE WERE SEVERAL NUTRIENTS
THAT WERE IDENTIFIED AS BEING
UNDERCONSUMED, OF PUBLIC HEALTH
CONCERN.
ON THE LEFT I'M SHOWING A FIGURE
FOR D AND CALCIUM, BELOW EAR, SO
THIS WOULD BE PERCENTAGE THAT
WERE CONSIDERED DEFICIENT IN
DIETARY INTAKE.
IT'S A HIGH PERCENTAGE FOR
VITAMIN D AT ALL THREE AGE
RANGES HERE.
CALCIUM, NOT SO MUCH FOR 1 TO 2
AND 2 TO 3 YEARS, BUT BY 4 TO 6
YEARS APPROXIMATELY 30% OF
CHILDREN WITH INTAKES THAT ARE
LOW.
ON THE RIGHT ARE PERCENTAGE OF
CHILDREN WHOSE INTAKE IS AT OR
ABOVE THE ADEQUATE INTAKE LEVEL
FOR POTASSIUM AND FIBER.
FOR POTASSIUM YOU CAN SEE THAT
ABOUT 50% ARE ABOVE THE A.I. OR
ARE ADEQUATE, IN THE 1 TO 2 AND
2 TO 3 YEAR AGE GROUP.
AND IT'S A LITTLE BIT LOWER FOR
4 TO 6 YEARS.
FOR FIBER, YOU CAN SEE VIRTUALLY
NONE OF THE CHILDREN HAD INTAKES
ABOVE A.I.
VIRTUALLY EVERYONE IS LOW IN
FIBER.
THERE WERE SOME NUTRIENTS ALSO
IDENTIFIED AS BEING OVERCONSUMED
OF PUBLIC HEALTH CONCERNS,
INCLUDING SODIUM, ADDED SUGARS
ABOVE 1 YEAR OF AGE, SATURATED
FAT ABOVE 2 YEARS OF AGE.
THERE WERE SEVERAL NUTRIENTS
THAT WERE IDENTIFIED AS POSING
SPECIAL CHALLENGES FROM 1-5
YEARS.
THIS FIGURE AT THE TOP IS FOR
CHOLINE, ABOVE 1 YEAR OF AGE.
IN TERMS OF ADEQUATE INTAKE
VALUE, ONLY ABOUT 50% OF
CHILDREN AT 1-2 AND 2-3 YEARS
HAD INTAKES ABOVE THAT LEVEL.
LESS THAN 30% OF CHILDREN AT 4-6
HAD INTAKES ABOVE THE ADEQUATE
INTAKE.
LINOLEIC ACID POSED A SPECIAL
CHALLENGE, INTAKE DATA WAS NOT
AVAILABLE.
FOR BOTH OF THESE, ONLY ADEQUATE
INTAKES VALUES ARE AVAILABLE, NO
RDAs, NO CLINICAL BIOMARKER
DATA ARE AVAILABLE THAT ARE
NATIONAL IN SCOPE TO CONFIRM THE
CONCERN.
I'D LIKE TO MENTION THERE MAY BE
LOW INTAKE OF DHA ALONG THE
CHAIN OF POLY UN-- A LONG CHAIN
POLY UNSATURATED ACID IMPORTANT
FOR CHILD DEVELOPMENT.
THIS SHOWS MEDIAN 16 TO 17
MILLIGRAMS PER DAY, FAR BELOW
THE RECOMMENDED INTAKE OF 70-100
PER DAY FROM TWO SOURCES IN
EUROPE.
WE DON'T HAVE A COMPARABLE
RECOMMENDATION FOR THE U.S.
BUT IT'S SOMETHING TO MAKE NOTE
OF IN TERMS OF CONSEQUENCES FOR
CHILD DEVELOPMENT.
SO MOVING TO THE NEXT TOPIC, KEY
DIETARY SOURCES OF NUTRIENTS TO
SUPPORT CHILD DEVELOPMENT FIRST
GOAL IS TO IDENTIFY WHICH
NUTRIENTS ARE MOST CRITICAL FOR
BRAIN DEVELOPMENT.
THIS IS A TABLE ADAPTED FROM A
PAPER WE PUBLISHED A NUMBER OF
YEARS AGO, BUT I THINK IS STILL
RELEVANT, WHICH SHOWS FIVE
DIFFERENT ASPECTS OF BRAIN
DEVELOPMENT FOR WHICH SOME
NUTRIENTS ARE QUITE IMPORTANT.
IF THERE'S A CHECK MARK IT MEANS
THE NUTRIENT ON THE LEFT HAS A
ROLE TO PLAY IN THAT PROCESS.
NUTRIENTS LISTED HERE INCLUDE
FATTY ACIDS, LONG CHAIN POLY
UNSATURATED FATTY ACIDS, IRON,
IODINE, ZINC, CHOLINE, CERTAIN B
VITAMINS.
THESE ARE INVOLVED IN MULTIPLE
ASPECTS OF BRAIN DEVELOPMENT.
IT'S ALSO IMPORTANT TO NOTE THE
TIMING OF NUTRIENT DEFICIENCY IS
IMPORTANT.
THIS IS A FIGURE THAT SHOWS THAT
BRAIN DEVELOPMENT STARTS AT THE
TIME OF CONCEPTION.
THERE ARE SEVERAL THINGS GOING
ON DURING GESTATION THAT ARE
CRITICAL.
AFTER BIRTH YOU CAN SEE LINES IN
GREEN SHOWING ASPECTS OF BRAIN
DEVELOPMENT SUCH AS MYELINATION.
THESE PROCESSES THAT OCCUR IN
THE FIRST TWO YEARS OF LIFE ARE
CRITICAL FOR SEEING AND HEARING,
FOR RECEPTIVE LANGUAGE AND
SPEECH PRODUCTION, AND FOR THE
EARLY STAGES OF HIGHER COGNITIVE
FUNCTION.
IT'S ALSO IMPORTANT TO NOTE
THOUGH THAT DEVELOPMENT OF THOSE
HIGHER COGNITIVE FUNCTIONS
CONTINUES TO OCCUR WELL AFTER
THE FIRST TWO YEARS OF LIFE.
FULL FUNCTION IS NOT ACHIEVED
UNTIL CLOSER TO ADULTHOOD.
CLEARLY THE FIRST THOUSAND DAYS
AS WE CALL IT FROM CONCEPTION TO
2 YEARS OF LIFE IS ABSOLUTELY
CRITICAL.
I'D LIKE TO MENTION MORE ABOUT
IRON AND CHILD DEVELOPMENT
BECAUSE IT IS A NUTRIENT OF
PUBLIC HEALTH CONCERN, AND IT'S
STRONGLY RELATED TO CHILD
DEVELOPMENT.
I WON'T READ ALL THE TEXT TO
SAVE TIME BUT THE SLIDE SHOULD
BE AVAILABLE LATER ON.
WHAT I'D LIKE TO HIGHLIGHT IS
THAT BOTH ANIMAL MODELS AND
HUMAN STUDIES SHOW RELATIONSHIP
BETWEEN IRON DEFICIENCY IN
INFANCY AND IMPAIRED BRAIN
DEVELOPMENT AND FUNCTION.
IN HUMANS WE HAVE GOOD EVIDENCE
FOR INFANTS AND PRESCHOOLERS ON
THE CONSEQUENCES OF BOTH IRON
DEFICIENCY.
EVIDENCE FROM BOTH SOURCES
SUGGESTS THERE ARE CRITICAL
PERIODS OF DEVELOPMENT WHEREBY
NEGATIVE CONSEQUENCES OF IRON
DEFICIENCY IN EARLY LIFE SEEM TO
PERSIST DESPITE IRON REPLETION.
PRESENTING IN INFANCY SHOULD BE
A TOP PRIORITY.
IT MAY BE TOO LATE TO PROVIDE
IRON AFTER THAT PERIOD IF YOU'RE
HOPING TO RESTORE FULL
DEVELOPMENT.
I WON'T GO INTO DETAILS BUT IT
HAS TO DO WITH THE FACT THAT THE
ABSORPTION OF LEAD MAY BE
INCREASED DURING IRON
DEFICIENCY, IRON AND LEAD SHARE
A COMMON INTESTINAL TRANSPORTER
THAT IS UPREGULATED DURING IRON
DEFICIENCY.
I'D LIKE TO MENTION THAT EXCESS
IRON DURING INFANCY MAY BE
RELATED TO LOWER DEVELOP MENTAL
SCORES AT LATER AGES.
THERE'S A VERY USEFUL STUDY FROM
CHILE RANDOMIZED CONTROLLED
TRIAL THAT ILLUSTRATED THAT
INFANTS EXPOSED TO IRON
FORTIFIED FORMULA SCORED LOWER
ON SEVERAL NEURODEVELOPMENTAL
MEASURES AT 10 YEARS AND 16
YEARS OF AGE COMPARED TO THOSE
RANDOMIZED TO LOW IRON FORMULA.
I THINK WE NEED TO FOLLOW UP
WITH ADDITIONAL RESEARCH ON
POTENTIAL RISK OF EXCESS IRON AT
THIS AGE.
WHAT ARE KEY DIETARY SOURCES TO
SUPPORT DEVELOPMENT?
ITEMS ON THE LEFT ARE THOSE THAT
ARE HIGH IN IRON DENSITY.
YOU CAN SEE MANY ARE MEATS AND
SEAFOODS.
THERE ARE SOME FRUITS AND
VEGETABLES AS WELL.
IT'S ALSO I THINK IMPORTANT TO
NOTE THAT MEATS AND SEAFOODS
HERE, INFANTS TEND NOT TO BE
CONSUMERS OF ITEMS LISTED.
CHOLINE, PARTICULARLY LIVER AND
EGGS.
THERE ARE A FEW FRUITS AND
VEGETABLES ALSO RELATIVELY HIGH
IN CHOLINE.
ANIMAL SOURCES DOMINATE FOODS
HIGH IN ZINC.
AND THERE ARE SOME, AGAIN,
PLANT-BASED FOODS RELATIVELY
HIGH IN ZINC BUT WE HAVE TO
CONSIDER WHETHER BIOAVAILABILITY
MIGHT BE REDUCED BECAUSE OF
(INDISCERNIBLE) CONTENT.
ON THE RIGHT, KEY SOURCES OF
FATTY ACID.
PRECURSORS ARE ABUNDANT IN SEEDS
AND VEGETABLE OILS, CONVERTED TO
LONGER CHAIN POLY UNSATURATED
FATTY ACIDS EPA AND DHA PRESENT
IN FISH AND OTHER SEAFOODS.
I'D LIKE TO DIVE IN ON IRON AS A
CRITICAL NUTRIENT.
ONE OF THE THINGS WE LEARNED
FROM THE FOOD PATTERN MODEL,
GUIDELINES FOR AMERICANS, IRON,
WE COULD NOT MEET RDA WITHOUT
INCLUDING IRON FORTIFIED FOODS,
IMPORTANT TO EMPHASIZE IT'S BEEN
AN IMPORTANT STRATEGY FOR
REDUCING IRON DEFICIENCY IN THE
U.S. FOR SEVERAL DECADES.
HEME IRON FOUND IN MEAT IS
BETTER THAN NON-HEME FOUND IN
PLANT BASED.
IF THEY GOT THAT FROM BEEF, THEY
WOULD HAVE TO EAT A LOT, ABOUT
440 GRAMS OR 356 CALORIES, NOT
FEASIBLE FOR INFANTS.
ORGAN MEATS HAVE FAR MORE IRON,
SUCH AS LIVER.
IF THEY ATE CHICKEN LIVER COULD
MEET THE RDA FROM THAT SOURCE
BUT FEEDING LIVER TO INFANTS IS
NOT PARTICULARLY COMMON IN THE
UNITED STATES.
I'D LIKE TO MENTION A COUPLE
OTHER POINTS ABOUT KEY DIETARY
SOURCE OF NUTRIENTS, FIRST FOR
IODINE, WE DON'T HAVE ADEQUATE
INTAKE DATA.
IT'S HARD TO KNOW HOW LOW INTAKE
MIGHT BE.
IODIZED SALT IS A KEY SOURCE BUT
NOT ADDING SALT IS RECOMMENDED.
A SITUATION IN WHICH NEITHER THE
NEITHER MOTHER OR INFANT CONSUME
FROM SALT OR DAIRY PRODUCTS,
INTAKE OF INFANTS COULD BE
DEFICIENT.
WE DON'T HAVE A LOT OF
INFORMATION ON HOW MUCH IODINE
IS COMING FROM TABLE SALT BUT WE
KNOW THAT IN 2009 ONLY ABOUT
HALF OF THE TABLE SALT SOLD AT
RETAIL LEVEL WAS IODIZED, AND
THE CONTENT IN COW MILK IS
HIGHLY VARIABLE IN THE UNITED
STATES.
I'D LIKE TO BRIEFLY MENTION FOR
B VITAMINS THOSE ARE FOUND IN
MANY FOODS SUCH AS WHOLE GRAINS,
BUT VITAMIN B-12 IS FOUND ONLY
IN ANIMAL SOURCE FOODS OR
FORTIFIED PRODUCTS.
SO I'D LIKE TO FINISH UP WITH A
FEW SLIDES ON THE DIETARY
GUIDELINES FOR THESE AGE GROUPS.
AND EMPHASIZE A FEW OF THE
MESSAGES THAT I THINK ARE
RELEVANT FOR THE WORKSHOP THAT
WE'RE IN TODAY.
DURING THE INTRODUCTION OF
COMPLEMENTARY FOODS IT IS
RECOMMENDED THAT ABOUT 6 MONTHS
OF AGE BABIES SHOULD BEGIN
RECEIVING IRON-RICH FOODS, AND
ZINC-RICH FOODS.
THEY CAN BE MEATS AND SEAFOODS,
OR IRON AND ZINC FORTIFIED
CEREALS OR OTHER PRODUCTS.
THERE'S A USEFUL RESOURCE FOR
CAREGIVERS AT THE WEBSITE, LINK
BELOW, I RECOMMEND THAT YOU TAKE
A LOOK AT THAT.
THE OTHER IMPORTANT
RECOMMENDATION IS THAT FOODS
LIKE PEANUTS, EGG, COW MILK
PRODUCTS, TREE NUTS, WHEAT,
CRUSTACEAN SHELLFISH FISH AND
SOY SHOULD BE PRODUCED WHEN
OTHER COMPLEMENTARY FOODS ARE
INTRODUCED TO HELP PREVENT
ALLERGIES, FOR EXAMPLE PEANUT
ALLERGIES.
AND THEN THERE'S AN OVERRIDING
RECOMMENDATION HERE FOR ENTIRE
AGE RAGE FROM 6 TO 23 MONTHS
INCLUDING EMPHASIS ON VARIETY,
AND CERTAIN TYPES OF FOOD.
I'VE HIGHLIGHTED PROTEIN FOODS
BECAUSE SOME OF THESE CONTRIBUTE
RICHERS SOURCES OF NUTRIENTS
MOST CRITICAL FOR CHILD
DEVELOPMENT.
AND THE DIETARY GUIDELINES CALL
OUT IRON, ZINC, PROTEIN,
CHOLINE, AND LONG CHAIN POLY
UNSATURATED FATTY ACIDS FROM
THOSE SOURCES.
THERE'S A RESOURCE FOR
CAREGIVERS THAT'S USEFUL, AT THE
LINK.
I'M GOING TO SHOW THE HEALTHY
U.S. STYLE DIETARY PATTERNS
DEVELOPED FOR TODDLERS AND FOR
OTHER CHILDREN ABOVE 1 YEAR OF
AGE.
THIS IS THE ONE FOR 12-23
MONTHS.
I'LL HIGHLIGHT THAT THERE ARE
SUBSTANTIAL AMOUNTS RECOMMENDED
FOR THE CATEGORIES MEATS AND
POULTRY, EGGS, SEAFOOD, NUTS,
SOY PRODUCTS, ALL VEGETABLE
GROUPS, WHOLE GRAINS WHICH ARE
RECOMMENDED TO BE THE
PREDOMINANT TYPE OF GRAIN, AND
OIL WHICH IS A SOURCE OF
ESSENTIAL FATTY ACIDS.
ALL THESE FOODS ARE NUTRIENT
DENSE FORMS AND PREPARED WITH
MINIMAL ADDED SUGARS.
IN FACT WE FOUND NO CALORIES
LEFT OVER FOR ADDITIONAL ADDED
SUGARS AT THIS AGE.
AGES 2 THROUGH 8, AGAIN THERE
ARE SUBSTANTIAL AMOUNTS
RECOMMENDED FOR SOME KEY FOOD
GROUPS INCLUDING SEAFOOD, NUTS,
SEEDS, SOY PRODUCTS, VEGETABLES,
WHOLE GRAINS, AND OILS.
BUT AS ANNA MARIA SHOWED THE
ACTUAL INTAKES OF SEVERAL OF
THESE SUBGROUPS ARE QUITE LOW
COMPARED TO RECOMMENDED INTAKE
RANGES.
AGAIN HERE THE RECOMMENDED
RANGES ARE IN THE BLUE, AVERAGE
INTAKE IN PURPLE.
VEGETABLES, CHILDREN, TODDLERS
AT THIS AGE ARE NOT CONSUMING
ENOUGH.
PARTICULARLY THE DARK GREEN
LEAFY VEGETABLES.
THEY ARE FAR BELOW INTAKE FOR
WHOLE GRAIN, MARGINAL FOR EGG,
BELOW RECOMMENDED LEVEL FOR
SEAFOOD.
AGES 2-4 YEARS, LOW FOR ALL OF
THE VEGETABLE GROUPS, PROBABLY
DOESN'T COME AS A SURPRISE TO
YOU.
ALSO VERY LOW FOR WHOLE GRAINS,
AND FOR SEAFOODS.
SO WE KNOW WHAT WE NEED TO
EMPHASIZE.
BUT IT'S A CHALLENGE TO INCREASE
CONSUMPTION OF SOME OF THESE
FOOD GROUPS.
AGAIN, THERE ARE SOME KEY
DIETARY SOURCES THAT ARE
RELEVANT FOR THESE IMPORTANT
NUTRIENTS BUT THEY ALSO MAY BE
SOURCES OF CERTAIN CONTAMINANTS.
I WANT TO SHOW YOU THE FDA
GUIDANCE THAT I FOUND TO BE VERY
USEFUL THAT ADDRESSES THESE TWO
SIMULTANEOUS ISSUES.
ONE OF THOSE IS CONSUMPTION OF
FORTIFIED INFANT CEREALS THAT IT
IS RECOMMENDED TO INCLUDE IRON
AND ZINC FORTIFIED INFANT
CEREALS, CHOOSE WHOLE GRAIN
VERSIONS PROVIDING B VITAMINS TO
PROTECT AGAINST ARSENIC, TO KNOW
GRAINS, FEED IRON FORTIFIED
CEREALS THAT RICE CEREAL SHOULD
NOT BE THE ONLY CHOICE OR FIRST
CHOICE.
OTHERS CAN BE CHOSEN CHOSE.
TO INCLUDE ANIMAL SOURCES,
SEAFOOD HAS NUTRIENTS THAT
SUPPORT BRAIN AND IMMUNE SYSTEM
DEVELOPMENT CHOICES ARE
PARTICULARLY LOW IN MERCURY.
LASTLY TO FOCUS ON VARIETY.
USING VARIETY OF HEALTHY FOODS
HELPS THE CHILD GET ESSENTIAL
NUTRIENTS AND CAN MAKE IT LESS
LIKELY FOR THE CHILD TO BE
EXPOSED TO THE SAME CONTAMINANT
FROM THE SAME FOOD MANY TIMES.
SO IN CONCLUSION, I'VE TRIED TO
SHOW INFANTS AND YOUNG CHILDREN
NEED A NUTRIENT-DENSE DIET.
THERE ARE SOME KEY NUTRIENTS FOR
CHILD DEVELOPMENT THAT INCLUDE
FATTY ACIDS, IRON, IODINE, ZINC,
CHOLINE AND B VITAMINS.
INTAKES OF SOME ARE LOWER THAN
RECOMMENDED INCLUDING ONES SHOWN
HERE.
IMPACT OF NUTRIENT DEFICIENCY ON
DEVELOPMENT MAY DEPEND ON TIMING
OF DEFICIENCY DURING THE FIRST
FEW YEARS OF LIFE.
ANIMAL SOURCED FOODS, CERTAIN
VEGETABLES AND CERTAIN PRODUCTS
ARE KEY SOURCES, INTAKES OF
SEAFOOD, VEGETABLE AND WHOLE
GRAINS ARE BELOW RECOMMENDED
AMOUNTS.
AND KEY DIETARY SOURCES AND
NUTRIENTS MAY ALSO BE SOURCES OF
CERTAIN CONTAMINANTS.
GUIDELINES FOR AMERICANS AND FDA
RECOMMENDATIONS PROVIDE GUIDANCE
TO HELP CAREGIVERS MAKE GOOD
CHOICES WHEN NAVIGATING THIS
DOMAIN.
I'D LIKE TO THANK YOU FOR YOUR
ATTENTION.
>>THANK YOU.
I APPRECIATE THE COVERAGE YOU
PROVIDED FOR THE NUTRIENT NEEDS
OF YOUNG CHILDREN AND I THINK
IT'S AN EXCELLENT SEGUE INTO OUR
Q&A.
I'LL INVITE ANNA MARIA TO TURN
ON HER CAMERA TOO AND WE'LL
START WITH A QUESTION WE'VE
THOUGHT HARD ON AND PREPARED FOR
YOU ALL.
I WANT TO SAY THAT I THOUGHT
THIS WAS A FANTASTIC TRANSITION
FROM DR. HERMANSKY'S TALK
FOCUSED ON COMMUNICATION
CHALLENGES IN THIS SPACE, RIGHT
INTO THE HEART OF THE SCIENCE.
I'M HOPING THAT OUR
COMMUNICATION SCIENTIST
COLLEAGUES GOT A LOT OUT OF BOTH
OF YOUR PRESENTATIONS, KNOWING
MORE ABOUT THE BACKGROUND AND
HOW WE MAKE RECOMMENDATIONS, AND
I LOOK FORWARD TO LEARN FROM THE
COMMUNICATION WHERE THEIR
SCIENCE IS AT.
I'LL START WITH ANNA MARIA.
CAN YOU SPEAK TO WHETHER OR NOT
THE NUTRIENT REQUIREMENTS ARE
HIGHER IN THE PRESENCE OF
ENVIRONMENTAL CONTAMINANTS?
>>WELL, I THINK IT'S IMPORTANT
TO REALIZE AS I STATED THAT THE
CURRENT DRIs DO NOT CONSIDER
ENVIRONMENTAL CONTAMINANTS IN
ESTABLISHING WHAT THE ADEQUATE
LEVELS SHOULD BE FOR PREGNANT
AND LACTATING WOMEN.
THERE IS EVOLVING RESEARCH THAT
IS BEGINNING TO SHOW FOR CERTAIN
ELEMENTS IF YOU HAVE HIGHER
LEVELS OF OTHER NUTRIENTS THAT
IT MIGHT MITIGATE THE EFFECTS OF
THAT PARTICULAR CHEMICAL OR
ELEMENT IN THE DEVELOPMENT OF
THESE ADVERSE HEALTH OUTCOMES
THAT WE'RE INTERESTED IN.
I THINK THAT'S NEW EVOLVING
SCIENCE THAT IS TAKING PLACE
RIGHT NOW.
I THINK YOU'RE GOING TO HEAR
MORE ABOUT THAT IN THE NEXT
SESSION.
CLEARLY THAT'S WHERE WE HOPE
WE'LL GO WITH THE NEXT ROUND OF
RECOMMENDATIONS THAT WE ACTUALLY
GET.
>>SOUNDS LIKE IT'S GOING TO
CHALLENGE THE EXISTING
INFRASTRUCTURE FOR MAKING
RECOMMENDATIONS, BUT IT'S SOUND
LIKE IT'S A NECESSARY STEP
FORWARD.
I KNOW YOU HINTED AND TALKED A
BIT ABOUT SOME OF THOSE
POTENTIAL INTERACTION, IF YOU
WANT TO ADD MORE ABOUT THE YOUNG
CHILD IN THE SPACE WITH RESPECT
TO HIGHER NEED FOR NUTRIENTS IN
THE FACE OF ENVIRONMENTAL
CONTAMINANTS.
>>YEAH, I'M NOT SURE I CAN
SPEAK TO SOME OF THE
CONTAMINANTS THAT I DON'T REALLY
KNOW AS WELL BUT I DID MENTION
THE RELATIONSHIP BETWEEN IRON
AND LEAD BECAUSE I'VE ACTUALLY
LOOKED AT THAT MYSELF TO SOME
EXTENT.
AND ONE INTERESTING FINDING WE
HAD WAS IN A RANDOMIZED TRIAL OF
DELAYED CORD CLAMPING WE FOUND
THAT CHILDREN WITH DELAYED CORD
CLAMPING HAD BETTER IRON STATUS
AND LOWER BLOOD LEAD LEVELS, IN
MEXICO, IN MEXICO CITY, EXPOSED
TO QUITE A LOT OF LEAD IN THE
ENVIRONMENT.
WE SUSPECT THE REASON IS THAT
HAVING A GREATER IRON STATUS IN
THE FIRST SIX MONTHS DUE TO
DELAYED CORD CLAMPING HELPED
THEM AVOID GREATER ABSORPTION OF
LEAD FROM THE DUST.
AS I MENTIONED, IRON AND LEAD
SHARE THE SAME TRANSPORTER
ACROSS THE GUT BUT IRON HAS A
SLIGHTLY HIGHER AFFINITY FOR
THAT TRANSPORTER.
SO WHEN IRON STATUS IS ADEQUATE
LEAD HAS A HARDER TIME GETTING
ABSORBED INTO THE BODY.
IRON REPLETE STATUS, BEING
ADEQUATE, IS PROTECTIVE AGAINST
LEAD TOXICITY.
AND THAT'S WHY IT'S EVEN MORE
IMPORTANT TO MAKE SURE THAT WE
DON'T ALLOW CHILDREN TO BECOME
IRON DEFICIENT REALLY AT ANY
STAGE WHEN THEIR BRAINS ARE
DEVELOPING AND SO VULNERABLE TO
LEAD EXPOSURE.
>>THERE'S A SIMILAR SITUATION
THAT OCCURS DURING PREGNANCY.
WE KNOW ABOUT CALCIUM.
AND IF IN FACT CALCIUM LEVELS OR
INTAKE LEVELS ARE FACTOR THERE'S
LESS LIKELIHOOD YOU'LL GET
CALCIUM BEING RELEASED FROM THE
BONES.
ONCE WE START GETTING CALCIUM
RELEASE FROM BONES ALONG WITH IT
COMES LEAD, WHAT'S STORED IN
BONES.
SO THAT'S WHERE YOU END UP
GETTING SORT OF LIKE A SIMILAR
STORY BEING TOLD WHAT WE'RE
TRYING TO DO IS MAKE SURE THAT
WOMEN AND CHILDREN ARE
SUFFICIENT IN THEIR LEVELS SO
THAT YOU DON'T START GETTING
THESE EFFECTS THAT MIGHT HAPPEN
AT DEFICIENT LEVELS.
>>THANK YOU FOR THOSE
THOUGHTFUL ANSWERS.
WE HAVE BEEN GETTING SOME
QUESTIONS IN ABOUT THE
AVAILABILITY OF YOUR SLIDES
BECAUSE EVERYONE IS APPRECIATIVE
OF YOUR TALKS.
I WANT TO ADDRESS THAT.
BOTH SLIDE DECKS WILL BE
AVAILABLE, AND RECORDING WILL
EVENTUALLY BE AVAILABLE ONCE
IT'S BEEN APPROVED THROUGH THE
FEDERAL PROCESS, PUBLICLY AND
FOR FREE.
FOR THOSE THAT WANT TO GO BACK
IN, LISTEN AGAIN, OR LOOK INTO
DETAIL REFERENCES AND FANTASTIC
FIGURES THAT YOU BOTH PROVIDED,
IT WILL BE AVAILABLE FOR THE
PUBLIC.
I HAVE A QUESTION FOR YOU, KAY.
CAN YOU SPEAK MORE ABOUT WHAT
NUTRIENTS ARE OF CONCERN IN
DIFFERENT STAGES OF CHILD GROWTH
AND DEVELOPMENT?
>>YEAH, SO ACTUALLY WHEN I -- A
FEW COMMENTS, ANNA MARIA TALKING
MORE ABOUT PREGNANCY.
I TRIED TO EMPHASIZE THE ONE
MOST CRITICAL FOR THE BRAIN
DEVELOPMENT ASPECT, IRON,
IODINE, POSSIBLY CHOLINE, SOME B
VITAMINS.
AND POTENTIALLY ZINC.
SOME ARE LOW AT THIS STAGE.
SO, I THINK WE HAVE LESS
CERTAINTY ABOUT ABOUT THE ONES
FOR WHICH WE ONLY HAVE ADEQUATE
ESTIMATES.
THAT'S WHY CHOLINE IS A QUESTION
MARK.
WE KNOW IT IS VERY IMPORTANT FOR
BRAIN DEVELOPMENT BUT DON'T HAVE
AS MUCH CONFIDENCE IN THE
ADEQUATE INTAKE ESTIMATE AS WE
WOULD IF WE HAD AN ESTIMATED
AVERAGE REQUIREMENT.
WE KNOW INTAKES TEND TO BE LOW
RELATIVE TO A.I.
WE DON'T KNOW IF THAT'S LOW
ENOUGH TO REALLY COMPROMISE
BRAIN DEVELOPMENT AT THIS
CRITICAL AGE.
I THINK THAT'S AN IMPORTANT AREA
OF RESEARCH.
IN TERMS OF IMPLICATIONS FOR
DIETARY INTAKE, ONE OF THE KEY
COURSES OF CHOLINE IS EGGS.
AND THOSE ARE FREQUENTLY
CONSUMED BY INFANTS AND YOUNG
CHILDREN, THAT'S ONE THAT I LIKE
TO MENTION.
AS A WAY OF SUPPORTING THAT
PARTICULAR NEED.
>>EXCELLENT.
ANNA MARIA, DID YOU WANT TO ADD
ANYTHING?
>>IN TERMS OF CRITICAL
NUTRIENTS THAT WE KNOW ARE
RELATED TO NEURAL COGNITIVE, YOU
KNOW, CLEARLY THE CHOLINE COMES
INTO PLAY AS WELL.
WE KNOW IN FACT THAT CHOLINE
DURING PREGNANCY ALSO HAS AN
A.I., SO THERE'S NOT A DRI
ESTABLISHED AT THIS PARTICULAR
POINT IN TIME.
WE HAVE -- THERE'S BEEN
BEAUTIFUL EXPERIMENTAL STUDIES
SHOWING WOMEN WHO ARE CONSUMING
MORE CHOLINE DURING PREGNANCY
THAT YOU'RE SEEING SOME IMPROVED
PROXY DETERMINANTS OF NEURAL
COGNITIVE DEVELOPMENT IN
CHILDREN LATER ON.
THE OTHER IS ALSO OMEGA-3 FATTY
ACIDS, CLEARLY IMPORTANT.
THERE ARE CRITICAL PERIODS OF
DEVELOPMENT.
THE BRAIN IS RAPIDLY GROWING.
IN FACT, WE SEE THIS WHEN YOU'RE
ALSO THINKING ABOUT THE
DIFFERENCE BETWEEN PRE-TERM
INFANTS AND THOSE BORN AT TERM,
THAT CRITICAL PERIOD IN THE
THIRD TRIMESTER TO BE ABLE TO
ALLOW THE FETUS TO LAY DOWN ITS
FAT STORES AND ABSORB, YOU KNOW,
THE FATTY ACIDS THAT ARE
CRITICAL FOR BRAIN DEVELOPMENT
DURING THAT TIME PERIOD AS WELL
AS EARLY ON IN LIFE.
>>THANK YOU FOR THAT.
IF I CAN ASK A FOLLOW-UP
QUESTION.
I KNOW AT LEAST A LOT OF
RESEARCH I'VE READ IN THIS SPACE
LOOKING AT ADEQUACY IS FOCUSED
ON FETAL HEALTH AND CHILD
DEVELOPMENT.
I DON'T KNOW IF I WANT TO ADD
TRENDS YOU MIGHT SEE THAT FOCUS
ON OUTCOMES ON WOMEN'S HEALTH OR
LACTATING OR PREGNANT INDIVIDUAL
HEALTH WITH RESPECT TO SETTING
GUIDELINES.
>>I THINK THAT JUST DETERMINES
HOW THE NEW DRIs WILL MOVE
WHEN THEY ARE REEVALUATED FOR
THESE PARTICULAR NUTRIENTS OF
INTEREST.
I MEAN, WHEN THE DRIs WERE
DEVELOPED, EVEN THE EARLY
2000s FOR FOLATE, WE HAD
SUFFICIENT EVIDENCE ABOUT FOLIC
ACID AND IMPORTANCE OF FOLIC
ACID IN PERICONCEPTUAL PERIOD TO
PREVENT BIRTH DEFECTS.
THAT WASN'T CONSIDERED.
HOPEFULLY GIVEN EVOLUTION OF THE
FRAMEWORK USED TO DEVELOP THE
DRIs THAT WE MIGHT SEE AN
IMPROVEMENT IN THE CONSIDERATION
OF THAT EVIDENCE IN ESTABLISHING
REVISE THE DRIs FOR PREGNANT
WOMEN DURING THIS VERY IMPORTANT
PHASE WHERE FOLIC ACID AND A LOT
OF METHYL DONORS AS WELL,
BECAUSE THAT WAS THE POINT I
ALSO FORGOT TO MAKE BECAUSE IF
YOU TALK ABOUT CHOLINE, CHOLINE
SOMETIMES COMES INTO PLAY AS
WELL IF IN FACT YOU DON'T HAVE
SUFFICIENT, YOU KNOW, FOLIC ACID
INTAKE IN ORDER TO HELP OUT WITH
THE ONE CARBON METHYL TRANSFERS
OCCURRING DURING THIS PARTICULAR
POINT IN TIME WHICH LEADS TO
SOME OF THOSE EPIGENETIC CHANGES
THAT WE'RE VERY INTERESTED IN.
>>THANK YOU.
DR. DEWEY, ONE MORE QUESTION FOR
YOU.
WHICH IS, WHAT ARE SOME MAJOR
CHALLENGES IN MEETING DRIs
THAT HAVE TO BE OVERCOME IN
YOUNG CHILDREN?
WE'VE ALL HAD EXPERIENCE WITH
YOUNG CHILDREN BEING PICKY
EATERS, ONE COMES TO MIND, YOU
HAVE MORE THOUGHTS THERE.
>>YEAH, ALL HAVE HAD CHILDREN
THAT HAVE GONE THROUGH THAT.
IT'S NORMAL FOR INFANTS AND
YOUNG CHILDREN TO BE PHOBIC AND
NOT WANT TO TAKE SOMETHING
UNFAMILIAR, IT'S PROTECTIVE IN
CASE THERE'S A CHANCE OF TOXIC
SUBSTANCE.
SO ONE OF THE PRINCIPLES IS
REPEATED EXPOSURE.
THAT'S BEEN VERIFIED BY RESEARCH
THAT FOR VEGETABLES, FOR
EXAMPLE, REJECTS THEM, IF YOU
KEEP TRYING, SOMETIMES EIGHT TO
TEN TIMES, YOU EVENTUALLY WILL
FIND THE BABY IS MORE LIKELY TO
ACCEPT THEM.
I THINK THERE'S ALSO AN EFFECT
OF WHAT THE MOM IS CONSUMING, AT
LEAST DURING LACTATION, MAYBE
PREGNANCY, BECAUSE SOME FLAVORS
PRESENT IN THE MOTHER'S DIET
WILL GET TRANSMITTED THROUGH
BREAST MILK TO THE NURSING BABY,
EDUCATING THE BABY TO FIND THOSE
FLAVORS FAMILIAR AND PREFER SOME
OF THEM.
BREAK LIKE MILK WITH GARLIC
FLAVOR, IF THE MOTHER EATS
CARROTS THE BABY LIKES MILK THAT
TASTES LIKE CARROTS AND WILL
LIKE CARROTS LATER ON.
THERE'S AN ELEMENT WE COULD WORK
ON IN TERMS OF MODIFYING
MOTHER'S DIE THE SO -- DIET SO
THE BABY IS PRE-EXPOSED TO
FLAVORS.
FOR FISH AND SEAFOOD, THERE'S A
GOOD CHANCE THAT BABIES WILL
LIKE SOME OF THOSE SOURCES AS
WELL.
THEY DO LIKE EGGS, AS I
MENTIONED.
SO THERE ARE OPPORTUNITIES TO
MAKE PROGRESS ON THOSE FRONTS.
BUT TO BE TRUTHFUL I THINK
FORTIFIED PRODUCTS OR EVEN
SUPPLEMENTS CAN BE HELPFUL IN
SITUATIONS WHERE THE BABY'S DIET
IS JUST NOT WHERE IT NEEDS TO BE
AND THERE'S CONCERN ABOUT
MEETING SOME OF THOSE
RECOMMENDED INTAKE LEVELS.
ANDS THIS IS WHERE HEALTH CARE
PROVIDERS NEED TO STEP IN.
IF BABIES BECOME IRON DEFICIENT
THERE NEEDS TO BE INTERVENTION
THAT IS SUCCESSFUL.
WE HAVE LESS SCREENING FOR THE
OTHER DEFICIENCIES, SO IT'S
HARDER TO INTERWEAVE WITH THE
HEALTH CARE SYSTEM.
BUT I THINK FOR CERTAIN
CAREGIVERS, FINDING RIGHT TYPE
OF SUPPLEMENT IS SOMETHING THAT
MIGHT BE A RELIEF AND TAKE
PRESSURE OFF BECAUSE YOU DON'T
WANT TO FORCE CHILDREN TO EAT
CERTAIN FOODS.
THAT CAN BACKFIRE.
ONE HAS TO BE PATIENT AND GIVE
PLENTY OF TIME AND MODEL THE
TYPE OF FOODS IN THE HOUSEHOLD
THAT YOU WANT THE BABY TO EAT.
>>THAT'S HELPFUL.
I AM EXCITED TO HEAR MORE AS
MORE IS DEVELOPED ON THE SENSORY
SCIENCE PIECE OF THINGS THAT
LACTATION CONTENT AND CHILD
DEVELOPMENT OF LIKES AND
DISLIKES.
THE NEXT QUESTION, HOW MANY
DIFFERING GROUPS ARE
DISPROPORTIONATELY AFFECTED BY
ENVIRONMENTAL CONTAMINANTS
ISSUES RELATED TO HEALTH EQUITY
IN ENVIRONMENTAL JUSTICE?
>>THAT'S A REALLY IMPORTANT
POINT.
WE'RE TALKING HERE IN
GENERALITY, BUT IT'S VERY WELL
KNOWN THAT THESE CONTAMINANTS
ARE MORE PREVALENT IN AREAS
WHERE THERE IS LOWER INCOME,
LOWER RESOURCED COMMUNITIES.
AND IN THOSE AREAS PREGNANT AND
LACTATING WOMEN FROM THE
LIKELIHOOD OF HAVING GREATER
EXPOSURES, AND UNLESS YOU'RE
ACTUALLY STUDYING THOSE
PARTICULAR COMMUNITIES, WE HAVE
PROBABLY UNDERESTIMATED
EXPOSURES TO THESE INDIVIDUALS.
BECAUSE THEY ARE LESS LIKELY TO
PARTICIPATE IN THE NATIONAL
NUTRITION MONITORING DATASETS
AND EVEN IN MORE OF OUR
PREGNANCY COHORTS WHICH I'VE
EVEN DEVELOPED OVER THE COURSE
OF MY LIFETIME.
SO UNDERSTANDING AND FOCUSING ON
CLEANING UP COMMUNITIES AND
PROVIDING CLEAR COMMUNICATION
GUIDELINES TO THESE WOMEN WHO
MIGHT NEED IT, WHO ARE NOT
AWARE, IT'S REALLY OF CRITICAL
IMPORTANCE BECAUSE THERE IS
HEALTH INEQUITIES, AND THE
HEALTH INEQUITIES EXIST BECAUSE
THERE IS INEQUITIES IN THE
RESOURCES OF WHERE COMMUNITIES
PUT, YOU KNOW, DUMP SITES, WHERE
THEY PUT BUS STATIONS, WHERE
THEY ARE PROVIDING HEALTHIER
FOODS FOR INDIVIDUALS TO BE ABLE
TO CONSUME.
AND SO THEY ARE DEFINITELY --
IT'S A COMPLICATED SYSTEM THAT
IS AFFECTING THESE EXPOSURES TO
THE INDIVIDUALS WHO ARE MOST
LIKELY TO BE VULNERABLE TO
HAVING HARMFUL EFFECTS OCCUR,
NOT ONLY TO THEMSELVES BUT ALSO
TO THEIR CHILDREN.
BECAUSE THOSE EFFECTS CONTINUE
OVER THE LIFETIME, RIGHT?
IF YOU HAVE A PREGNANT WOMAN
CONSUMING, THE LIKELIHOOD THE
CHILD CONTINUES TO BE EXPOSED IS
INCREASED.
>>THANK YOU FOR BRINGING UP THE
LARGER CONTEXT.
TODAY AND TOMORROW CON CON TAM-
CONTAMINANTS, BUT OTHERS CAN GET
IN THE FOOD FROM SOIL IF THERE'S
LOCAL GROWING.
BACK TO DR. DEWEY.
CAN YOU SPEAK ABOUT THE
NUTRIENTS THAT ARE CRUCIAL TO
CONSIDER SUPPORTING NUTRIENT
ADEQUACY?
YOU COVERED A BIT OF THIS IN
YOUR TALK BUT COULD YOU
SUMMARIZE THE KEY FOODS THAT YOU
THINK REALLY NEED PERHAPS MORE
RESEARCH OR MORE PUBLIC HEALTH
THOUGHT FOR YOUNG CHILDREN.
>>WELL, AS I MENTIONED,
ANIMAL-SOURCE FOODS ARE THE
RICHEST SOURCES OF SOME KEY
NUTRIENTS, IRON, ZINC, CHOLINE,
AND THE LONG CHAIN POLY
UNSATURATED FATTY ACID AND
SEAFOOD AND FISH.
BABIES ESPECIALLY 6-12 MONTHS IN
MY VIEW SHOULD HAVE ACCESS TO
THOSE NUTRIENT-RICH ANIMAL
SOURCE FOODS.
ONE CONCERN IS IN FAMILIES THAT
ARE INTERESTED IN FEEDING
VEGETARIAN DIET THOSE NEED
PARTICULAR GUIDANCE IN EITHER
CHOOSING PLANT-BASED SOURCES
THAT HAVE SUBSTANTIAL AMOUNTS OF
SOME NUTRIENTS AND BYPRODUCTS.
THEY WILL NEED A SOURCE OF B-12
AND MOST LIKELY IRON AND ZINC
FORTIFIED TO REACH THOSE LEVELS.
ONE AREA WE DON'T KNOW WELL
ENOUGH IS ABILITY TO CONVERT THE
PRECURSORS TO OF THE LONG CHAIN
FATTY UNSATURATED ASSED, THE
ABILITY OF BABY TO CONVERT THOSE
TO EPA AND DHA IS PROBABLY NOT
VERY HIGH.
WE DON'T KNOW ENOUGH ABOUT THE
FACTORS THAT AFFECT HOW MUCH
WILL GET CONVERTED BUT WE KNOW
THE LONG CHAIN POLY UNSATURATED
FATTY ACIDS ARE CRITICAL FOR
BRAIN DEVELOPMENT SO WANT TO BE
SURE THERE'S ENOUGH OF THOSE
PRESENT EITHER PRE-FORMED FROM
FISH AND SEAFOOD OR CONVERSION
FROM THE PRECURSORS.
THAT'S AN AREA WHERE MORE
RESEARCH IS NEEDED I THINK.
IODINE I POINTED OUT BECAUSE WE
SIMPLY DON'T KNOW WHETHER IODINE
STATUS OF CHILDREN UNDER 5
PARTICULARLY INFANTS MIGHT BE
INADEQUATE.
IODINE IS REALLY CRITICAL FOR
DEVELOPMENT AS ANNA MARIA
POINTED OUT ESPECIALLY IN
PREGNANCY, EVEN THEREAFTER.
THERE ARE COUNTRIES IN EUROPE
WHERE IODINE STATUS IS
INADEQUATE PARTLY BECAUSE OF
SOILS IN MOUNTAIN AREAS, IT'S
NOT A FUNCTION OF INCOME LEVEL
UNLIKE MANY OTHER NUTRIENTS.
IT'S A FUNCTION OF TYPES OF
FOODS AND USE OF IODIZED SALT,
FOR EXAMPLE.
WE NEED TO KNOW MORE AND HOW TO
ACHIEVE LEVELS FOR BABIES
WITHOUT GIVING TOO MUCH SALT IS
AN INTERESTING TOPIC.
I'M NOT SURE IF I ANSWERED THE
QUESTION.
>>YOU HIT THE KEY FOODS, YES.
WE'RE AT TIME.
THIS HAS BEEN A DELIGHTFUL
DISCUSSION.
I COULD KEEP TALKING WITH YOU
BOTH ALL DAY.
THANK YOU BOTH VERY MUCH FOR
YOUR TIME AND YOUR PRESENTATION.
NOW I BELIEVE WE'LL TAKE A SHORT
BREAK BUT I CAN TURN IT OVER TO
KIMBERLY IN CASE I'M WRONG.
>>THANK YOU.
YES, WE WILL TAKE A SHORT BREAK
AND I BELIEVE THE BREAK IS FIVE
MINUTES, BUT WE'LL HAVE THE TIME
ON THE SLIDE FOR YOU FOR WHEN
IT'S TIME -- I'M SORRY.
EVERYONE, PLEASE RETURN BY
12:15.
THANK YOU.
>>GOOD AFTERNOON.
WELCOME BACK TO THE WORKSHOP.
I'M TINA IRRER, POSTDOCAL
FELLOW, AT FDA.
IT IS MY PLEASURE TO INTRODUCE
MY COLLEAGUE DR. KELLIE CASAVALE
TO MODERATE THE SECOND SESSION.
SHE'S SENIOR SCIENCE ADVISER IN
OFFICE OF ANALYTICS AND OUTREACH
AT FDA, SUPPORTS CROSS-CENTER
AND CROSS-DEPARTMENTAL
COLLABORATIONS, ESPECIALLY THOSE
RELATED TO DIETARY GUIDELINES
FOR AMERICANS, CLOSER TO ZERO, A
TERRIBLE AND CHILD POPULATIONS,
CONTRIBUTES LEADERSHIP FOR CLOSE
TO ZERO AND FDA EPA ADVICE.
IT'S MY PLEASURE TO HAND IT
OVER.
>>THANK YOU SO MUCH.
WELCOME TO SESSION 2 ON THE
PROTECTIVE ROLE OF NUTRIENTS.
I'M KELLIE CASAVALE SENIOR
SCIENCE ADVISER FOR NUTRITION AT
FDA.
I'LL KICK OFF BY INTRODUCING YOU
TO THE PANEL SPEAKERS, AND
REMINDER THAT QUESTIONS AND
COMMENTS CAN BE SUBMITTED TO THE
WORKSHOP E-MAIL ADDRESS
THROUGHOUT THE PRESENTATION THAT
YOU SEE ON THIS SLIDE.
WE'LL HAVE TIME FOR QUESTIONS TO
THE PANEL AT THE END OF THE
SESSION.
WE START WITH A BRIEF
INTRODUCTION OF EACH SPEAKER AND
GO THROUGH ALL FOUR
PRESENTATIONS BEFORE WE HAVE
PANEL DISCUSSION.
FIRST WILL BE DR. GAURI DESAI,
FROM STATE UNIVERSITY OF NEW
YORK AT BUFFALO, A CLINICAL
ASSISTANT PROFESSOR IN
DEPARTMENT OF EPIDEMIOLOGY AND
ENVIRONMENTAL HEALTH, SPEAKING
ON NUTRIENT AND TOXICANT
EXPOSURES RELATED TO FRUIT,
VEGETABLE, DAIRY.
SECOND IS DR. MARGARET KARAGAS,
DARTMOUTH, PROFESSOR OF
EPIDEMIOLOGY IN DEPARTMENT OF
EPIDEMIOLOGY, SPEAKING ON ROLE
OF GRAINS IN NUTRIENT AND
TOXICANT EXPOSURES.
THIRD IS DR. ALEJANDRA CANTORAL
FROM MEXICO CITY, THE
COORDINATOR OF THE NUTRITION
CLINIC AND PRESENTING ON THE
BENEFITS AND RISKS OF SEAFOOD
INTAKE.
FINAL SPEAKER WILL BE DR.
KATARZYNA KORDAS, STATE
UNIVERSITY OF NEW YORK AT
BUFFALO AS WELL, DIRECTOR OF THE
MPH CONCENTRATION AND ASSOCIATE
PROFESSOR IN DEPARTMENT OF
EPIDEMIOLOGY AND ENVIRONMENTAL
HEALTH.
SPEAKERRING ON DIET PATTERNS AND
QUALITY WITH TOXIC ELEMENT
EXPOSURE.
YOU CAN SHARE YOUR SLIDES AND
WE'LL GET STARTED.
>>AM I SHOWING THE CORRECT
SCREEN?
>>I DO NOT SEE YOUR SHARE.
THERE YOU ARE.
GO INTO SHOW MODE.
PERFECT.
>>THAT'S THE CORRECT ONE,
RIGHT?
>>PERFECT.
>>THANK YOU SO MUCH FOR THIS
OPPORTUNITY.
IT'S AN HONOR TO BE HERE.
I WANT TO START BY SAYING I HAVE
NO CONFLICTS OF INTEREST TO
DECLARE.
LET'S BEGIN BY REVIEWING THE
FRUIT, VEGETABLE AND DAIRY
INTAKE OF CHILDREN IN THE FIRST
2 YEARS OF LIFE.
THE FIGURE PRESENTS ESTIMATED
PRO PORTION U.S. CHILDREN 0-23
MONTHS CONSUMING DIFFERENT FOOD
GROUPS, AND THIS IS FROM THE
2019-14 CYCLES OF THE NATIONAL
HEALTH AND NUTRITION EXAMINES
SURVEY, OR NHANES.
THIS FOCUSES ON THE FIRST TWO
YEARS OF LIFE BECAUSE THAT'S
WHEN CHILDREN'S DIETS RAPIDLY
CHANGE.
THEY ARE HIGHLY VULNERABLE TO
TOXICANT EXPOSURE AND RAPIDLY
GROWING AND NEED SEVERAL
NUTRIENTS.
WE ALSO NEED TO CONSIDER
NUTRITION OF YOUNG CHILDREN
BEYOND 2 YEARS OF AGE.
COMING BACK TO THE X-AXIS, WE
HAVE THE AGE GROUP AND Y-AXIS IS
THE ESTIMATED PROPORTION OF DIET
OF EACH FOOD OR GROUP.
WE CAN SEE THAT THE INTAKE OF
FRUITS AND VEGETABLES INDICATED
BY THE BLACK LINE AND PINK LINE
IS RAPIDLY INCREASING AFTER THE
FIRST FIVE MONTHS.
AND THEN REDUCING A LITTLE BIT
LATER.
OVERALL AFTER THE INFANT IS
INTRODUCED SOLID FOODS AROUND
FIVE TO SIX MONTHS OF AGE THE
INTAKE OF FRUITS, VEGETABLES,
AND MILK LATER INCREASES.
THAT IS A GOOD THING BECAUSE
FRUITS, VEGETABLES AND DAIRY
CONTAIN SEVERAL ESSENTIAL
NUTRIENTS.
I'M GOING TO PRESENT SOME OF THE
MOST COMMON OR MOST IMPORTANT
NUTRIENTS THAT ARE PRESENT IN
FRUITS, VEGETABLES, AND DAIRY.
IRON IS A KEY NUTRIENT IN SWEET
POTATOES, PEAS, STRAWBERRIES,
WATERMELON, IN ADDITION TO
SPINACH, LEAFY GREENS, BROCCOLI
DAIRY PRODUCTS CONTAIN D.
ALSO SOURCES OF CALCIUM.
ANOTHER IS WINTER SQUASH.
BERRIES, SPINACH AND LEAFY
GREENS ARE SOURCES OF B MIGHT
VINCE, PRESENT IN AVOCADOS,
CITRUS FRUITS AND JUICES.
CITRUS FRUITS AND JUICES ARE
SOURCES OF VITAMIN C, ALSO
OBTAINED FROM BROCCOLI.
THESE ARE SOME OF THE MOST
COMMON OR MOST IMPORTANT
NUTRIENTS PRESENT IN SOME OF
THESE FRUITS, VEGETABLES, AND
DAIRY.
THIS VENN DIAGRAM IS NOT
COMPREHENSIVE OF ALL THE
NUTRIENTS PRESENT IN ALL FRUITS,
VEGETABLES AND DAIRY.
NEXT FEW SLIDES I WILL GO OVER
THE ROLES OF NUTRIENTS IN THE
BODY, AND HOW EACH OF THESE
INTERACTS WITH TOXIC ELEMENTS.
IRON IS AN ESSENTIAL COMPONENT
OF HEMOGLOBIN WHICH DELIVERS
OXYGEN TO THE CELLS, REQUIRED IN
SYNTHESIS OF NEUROTRANSMITTERS,
SIGNIFICANT IN NEUROTRANSMITTERS
WHICH MAKES IT ESSENTIAL IN THE
BRAIN DEVELOPMENT AND
FUNCTIONING.
PARTICULARLY FOR CHILDREN IRON
DEFICIENCY CAN CAUSE ANEMIA.
BLOOD LACKS RED BLOOD CELLS.
WE SAY DELAYED GROWTH AND
DEVELOPMENT, INCREASE THE
SUSCEPTIBLE TO INFECTION.
IRON AND LEAD ARE BOTH SHUTTLED
BY THE DIVALENT METAL
TRANSPORTER 1, SUFFICIENT STORES
AFFECT EXPRESSION OF DMT 1 GENE,
CONDITIONING NUMBER OF AVAILABLE
TRANSPORTERS.
SUBOPTIMAL INTAKE WILL RESULT IN
INCREASED ABSORPTION OF LEAD,
DUE TO EXISTING PATHWAYS.
THERE IS SOME EPIDEMIOLOGICAL
EVIDENCE THAT SUGGESTS
ASSOCIATION BETWEEN IRON
DEFICIENCY AND INCREASED
ABSORPTION OF LEAD.
CALCIUM IS ESSENTIAL FOR
FORMATION OF BONE, CALCIUM
DEFICIENCY RESULTS IN REDUCED
BONE STRENGTH AND SOFTENING.
ABSORPTION OCCURS BY
TRANSCELLULARLY, LIKELY ALLOWS
ENTRY AND PARACELLULARLY,
BETWEEN CELLS, ACTIVE TRANSPORT,
DEPENDENT ON VITAMIN D AND THAT
ALSO MAY ACCOMMODATE LEAD ENTRY.
CAT 1 EXHIBITS HIGH AFFINITY FR
CALCIUM AND LEAD.
COMPETITION EXISTS FOR BEING
ABSORBED IN THE GASTROINTESTINAL
TRACT AND LOW LEVELS ARE RELATED
TO GREATER LEAD ABSORPTION.
EXPRESSION OF CAT1 IS DEPENDENT
ON VITAMIN D, STATUS OF THIS
VITAMIN ALSO PLAYS A ROLE IN
ABSORPTION OF LEAD.
THAT TAKES US TO VITAMIN D WHICH
IS ESSENTIAL FOR ABSORPTION OF
CALCIUM IN THE GUT.
WE TALKED ABOUT THIS IN THE
PREVIOUS SLIDE.
VITAMIN D IS ALSO REQUIRED TO
MAINTAIN ADEQUATE SERUM LEVELS
OF CALCIUM AND PHOSPATE,
ENABLING BONE MINERALIZATION.
IN CHILDREN DEFICIENCY LEADS TO
RICKETS, ET CETERA.
VITAMIN D AND LEAD HAVE A
BIDIRECTIONAL ASSOCIATION, HIGH
LEVELS CAN REDUCE RELEASE OF
LEAD FROM THE BONE THROUGH
BLOODSTREAM AND THEREFORE OTHER
ORGANS INSIDE THE BODY.
C IS ANOTHER NUTRIENT PRESENT IN
SOME FRUITS AND VEGETABLES THAT
ARE COMMONLY CONSUMED BY YOUNG
CHILDREN.
C IS AN ANTIOXIDANT THAT CAN
NEUTRALIZE HARMFUL FREE
RADICALS, PLAYS A ROLE IN
CONTROLLING INFECTIONS AND
HEALING OF WOUNDS.
AND C IS ALSO REQUIRED IN THE
SYNTHESIS OF A CERTAIN
NEUROTRANSMITTER AND PROTEIN MET
OF METABOLISM.
ACUTE DEFICIENCY LEADS TO
DISEASE CALLED SCURVY.
C ENHANCES ABSORPTION OF
NON-HEME IRON, PLANT BASED IRON,
BECAUSE IT REDUCES NATURALLY
OCCURRING FERRIC TO FERROUS IRON
AND THIS IS A NECESSARY STEP FOR
TRANSPORT, DMT1.
EVIDENCE IT CAN INHIBIT UPTAKE
OF LEAD AND CELLULAR TOXICITY.
B VITAMINS ARE THE NEXT GROUP.
THESE ARE WATER SOLUBLE, SEVERAL
WITH REQUIRED IN ENERGY
PRODUCTION.
VITAMIN B 1 THIAMIN IS REQUIRED
FOR ENZYMES INVOLVED IN GLUCOSE,
AMINO ACID, LIPID METABOLISM,
DEFICIENCY CAUSES BERIBERI.
RIBOFLAVIN IS A COMPONENT OF
CO-ENZYMES REQUIRED IN ENERGY
PRODUCTION, METABOLISM OF FAT,
DRUGS, STEROIDS.
DEFICIENCY IS ASSOCIATED WITH
SKIN-RELATED DISORDERS.
B 3 IS A PRECURSOR FOR
CO-ENZYMES REQUIRED IN HUNDREDS
OF REACTIONS AND PLAYS A ROLE IN
MAINTAINING GENE EXPRESSION,
ALSO CELLULAR COMMUNICATION.
PELLEGRA IS RARE IN THE UNITED
STATES.
B 6 IS REQUIRED IN PRODUCTION OF
HEMOGLOBIN AND
NEUROTRANSMILTERS, ESSENTIAL FOR
BRAIN DEVELOPMENT OF CHILDREN.
DEFICIENCY ASSOCIATED WITH
ANEMIA, DEPRESSION, WEAKENED
IMMUNE FUNCTION.
FOLATE B 9 IS REQUIRED FOR
SYNTHESIS OF BOTH SYNTHESIS OF
DNA AND RNA.
B-12, PRESENCE OF MINERAL
COBALT, NEEDED FOR DEVELOPMENT,
MYELINATION, FUNCTION OF CENTRAL
NERVOUS SYSTEM, HEALTHY RED
BLOOD CELL FORMATION, ALSO DNA
SYNTHESIS.
B-12 DEFICIENCY LEADS TO MEGALO
BLASTIC ANEMIA.
B VITAMINS AID IN METHYLATION OF
INORGANIC ARSENIC, METHYLATES TO
FORM MONO METHYL MMA, WHICH
METHYLATES TO FORM DMA.
THESE ARE EXCRETED IN THE URINE.
DMA IS LESS TOXIC THAN BOTH MMA
AS WELL AS INORGANIC ARSENIC,
METHYLATION REACTIONS ARE
GENERALLY THOUGHT TO BE
DETOXIFYING REACTION.
METHYL GROUP ARE DONATED BY
DIETARY SOURCES, FOLATE IS AN
IMPORTANT SOURCE.
OTHER B VITAMINS ACT AS
CO-FACTORS IN REACTIONS.
B1 AND B 3 ARE ASSOCIATED WITH
METHYLATION IN ADULT POPULATION.
AFTER REVIEWING LITERATURE ON
INTERACTION BETWEEN NUTRIENTS
AND TOXICANTS WE REALIZE THAT
BEYOND LEAD AND TO SOME EXTENT
ARSENIC INTERACTIONS OF SEVERAL
MICRO NUTRIENTS NOT WELL STUDIED
AMONG HUMANS.
THIS PRESENTS ASSOCIATION
BETWEEN NUTRIENT STATUS OR
INTAKE AND BIOMARKERS OF
TOXICANTS IN CHILDREN.
TWO STUDIES, ONE IN THE U.S. AND
THE OTHER IN CHINA, ON SERUM
CONCENTRATIONS, A MARKER OF
VITAMIN D AND BLOOD LEAD LEVELS
SHOW CONTRASTING FINDINGS.
IN THE U.S. STUDY, SERUM 25 WAS
PARTLY ASSOCIATED, IN THE
CHINESE STUDY THERE WAS AN
INVERSE ASSOCIATION.
IN ALBANY NEW YORK, CALCIUM AND
IRON INVERSELY ASSOCIATED WITH
BLOOD LEAD LEVELS.
AND THIS WAS MODEST ASSOCIATION
WITH BETA2 COEFFICIENT ON THE
SLIDE.
WHEN YOU COMPARE THIS WITH
RANDOMIZED TRIALS, WE FIND
DIFFERENT RESULT.
NIGERIAN INFANTS NO EFFECT ON
BLOOD LEVELS.
SIMILAR AA STUDY USING NHANES
DATA SHOWED NO ASSOCIATION
BETWEEN CALCIUM INTAKE AND
URINARY CADMIUM LEVELS.
WHEN WE LOOK AT STUDIES OF IRON
INTAKE OR STATUS, IRON
SUPPLEMENTATION HAD NO EFFECTS
ON MEXICAN FOURTH GRADERS BUT
REDUCED PREVALENCE ABOVE IN A
RANDOMIZED TRIAL IN INDIA.
VITAMIN C WAS ASSOCIATED WITH
LOWER BLOOD LEAD LEVELS IN
NHANES PARTICIPANTS, RATIO 0.11,
MODEST TO SUBSTANTIAL STRENGTH
OF ASSOCIATION.
WE SEE INVERSE ASSOCIATION
BETWEEN FOLATE INTAKE AND
URINARY PERCENT OF MONO METHYL
ARSONIC ACID, POSITIVE WITH
URINARY PERCENT DNA.
TO RECAP MMA IS MORE TOXIC THAN
DNA.
THE ASSOCIATION HERE INDICATES
THAT FOLATE INTAKE IS HELPING IN
DETOXIFICATION OF ARSENIC.
FINALLY PLASMA FOLATE INVERSELY
ASSOCIATED WITH URINARY
INORGANIC PERCENT, POSITIVELY
DNA RICH INDICATES THAT FOLATE
STATUS IS HELPING IN THE
DETOXIFICATION OF ARSENIC.
THIS IS NOT A COMPREHENSIVE LIST
OF STUDIES AND FOCUSES ON
NUTRIENTS THAT ARE FOUND IN
FRUITS, VEGETABLES, DAIRY
PRODUCTS, BUT IT'S STILL
HIGHLIGHTING THE POINT THAT
ASSOCIATIONS BETWEEN NUTRIENT
INTAKE OR STATUS AND TOXICANT
BIOMARKERS ARE INCONSISTENT OR
THEY ARE UNDERSTUDIED WHICH IS
THE CASE FOR CADMIUM.
SOME STUDIES HAVE ALSO FOCUSED
ON THE ASSOCIATION BETWEEN
INTAKE OF SPECIFIC FOODS OR
GROUPS, AND BIOMARKERS OF
TOXICANT EXPOSURE.
THE PREVIOUS SLIDE FOCUSED ON
NUTRIENTS.
THIS FOCUSES ON FOODS.
FOR EXAMPLE, OUR GROUP CONDUCTED
A STUDY AMONG 12-36 MONTHS OLD
USING NHANES DATA, POSITIVE
ASSOCIATION.
FRUIT DRINK WAS ASSOCIATED WITH
BLOOD CADMIUM, MILK WITH BLOOD
LEAD LEVELS.
AMONG INFANTS IN THE NEW
HAMPSHIRE COHORT INTAKE OF
FRUITS AND VEGETABLES BOTH WAS
ASSOCIATED WITH HIGHER URINARY
ARSENIC LEVELS AS INFANTS WERE
BEGINNING TO EAT SOLID FOODS AT
SIX MONTHS OF AGE.
EXPERIMENTS CORRELATIONS
INDICATED STRONG ASSOCIATIONS IN
THIS STUDY.
AMONG 13-36 MONTHS OLD IN NEW
JERSEY INVERSE ASSOCIATION
BETWEEN YOGURT INTAKE AND BLOOD
LEAD LEVELS.
AMONG CHILDREN IN URUGUAY OUR
GROUP FOUND INVERSE ASSOCIATION
BETWEEN MILK INTAKE AND LEAD IN
URINE, WITH A MODERATE TO STRONG
ASSOCIATION.
THE EVIDENCE LINKING INTAKE OF
FRUITS, VEGETABLES, DAIRY
PRODUCTS AND BIOMARKERS OF
TOXICANTS IS SCARCE BUT IT IS
SLOWLY GROWING.
FROM THE TABLES WE SAW WE CAN
CONCLUDE THAT STUDIES ON
NUTRIENT INTAKE OR STATUS AND
TOXICANT BIOMARKER LEVELS SHOW
INCONSISTENT FINDINGS.
AND INTERESTINGLY WHEN WE LOOK
AT THE STUDIES ON FOODS RICH IN
THESE NUTRIENTS AND TOXIC
BIOMARKERS WE DON'T ALWAYS FIND
THAT NUTRIENT BASED STUDIES AND
FOOD BASED STUDIES SUPPORT EACH
OTHER.
DIFFERENCES, ET CETERA, EXPLAIN
THOSE INCONSISTENCIES TO SOME
EXTENT BUT THERE ARE OTHER
FACTORS WE NEED TO CONSIDER AS
WELL.
SOME FOOD BASED STUDIES, SOME
FRUITS, VEGETABLES AND DAIRY
CONTAIN TOXICANTS.
THIS IS FAMILIAR, WE SAW EARLIER
IN THE PRESENTATION.
STRAWBERRY PUFFS CONTAIN
ARSENIC, DAIRY PRODUCTS LIKE
MILK AND YOGURT HAVE BEEN FOUND
TO CONTAIN BOTH ARSENIC AND
LEAD.
SPINACH WHICH IS RICH IN SEVERAL
NUTRIENTS IS FOUND TO BE A
SOURCE OF CADMIUM AND LEAD
EXPOSURE.
BROCCOLI CONTAINS ARSENIC, AND
JUICE BLENDS A SOURCE OF
ARSENIC, LEAD, CADMIUM.
WE SEE THAT SOME FOODS CONTAIN
TOXICANTS IN THEIR RAW FORM
WITHOUT BEING PROCESSED AT ALL.
CERTAIN VEGETABLES ARE MORE
LIKELY TO ACCUMULATE HARMFUL
LEVELS OF HEAVY METALS THAN
OTHERS.
IN GENERAL, HEAVY METALS TEND TO
ACCUMULATE IN ROOT, LEAVES, STEM
TISSUE.
SO VEGETABLES LIKE CARROTS,
SWEET POTATOES, KALE, SPINACH,
BROCCOLI, NATURALLY CONTAIN
HIGHER AMOUNTS OF TOXICANTS
COMPARED TO VEGETABLES THAT COME
FROM FLOWERS LIKE CUCUMBERS,
TOMATOES, PEPPERS.
NOW WHERE ARE THESE TOXICANTS
COMING FROM?
CONTAMINATED SOIL IS A SOURCE
THAT WE NEED TO CONSIDER.
CROPS FROM URBAN AND PERIURBAN
HORTICULTURE HAVE HIGHER LEVELS.
THERE'S EVIDENCE THAT SHOWS THAT
SEVERAL SOURCES LIKE TRAFFIC,
STREET DUST, INCINERATION, TIE
WEAR CONTRIBUTE TO SOIL
CONTAMINATION IN URBAN
ENVIRONMENT.
WE KNOW SOME CROPS DO UPTAKE
SOME AMOUNT FROM SOIL BUT
EVIDENCE ON THE QUANTIFICATION
OF THE UPTAKE OF TOXICANTS FROM
SOIL TO INDIVIDUAL PLANTS IS NOT
VERY CLEAR.
AND TO ADDRESS THIS ISSUING
RAISED BEDS IN URBAN
ENVIRONMENT, ADDING COMPOST TO
SOIL IS RECOMMENDED.
BUT THESE MEASURES DO NOT
COMPLETELY ELIMINATE TOXICANTS
FROM THE CROP TISSUE.
OTHER FACTORS THAT IMPACT ARE
COOKING PRACTICES WHICH INCLUDES
WASHING, TAKING PEELS OFF, ET
CETERA.
FOOD SERVING PRACTICES, EATING
BEHAVIORS LIKE THE HAND TO MOUTH
BEHAVIORS IN CHILDREN, MEAL
SKIPPING AND MEAL PATTERNS AND
INTERACTIONS BETWEEN FOODS,
NUTRIENTS, TOXICANTS EXPLAIN A
SHARE OF INCONSISTENTS BETWEEN
FOOD VERSUS NUTRIENT-BASED
STUDIES.
MY COLLEAGUES WILL COVER THESE
POINTS.
FOODS ARE IMPORTANT SOURCES OF
SEVERAL NUTRIENTS THAT ARE
ESSENTIAL IN GROWTH AND
FUNCTIONING.
SOME FRUITS, VEGETABLES, DAIRY
PRODUCTS CONTAIN TOXICANTS.
THEY INTERACT AT CELLULAR
LEVELS, EVIDENCE BASE IS
LIMITED.
MORE ROBUST STUDIES FOCUSING ON
RELATIONSHIP OF INTAKES OF
FRUITS, VEGETABLES, DAIRY AND
BIOMARKERS OF TOXICANTS ARE
NEEDED TO ESTABLISH CAUSALITY.
QUANTIFYING TOXICANT EXPOSURE
OCCURRING THROUGH THE DIET
RATHER THAN INDIVIDUAL FOODS IS
ESSENTIAL BECAUSE INDIVIDUAL
FOODS MAY CONTAIN LOW AMOUNTS
OF TOXICANTS BUT ADD UP IN A
DAY.
FINALLY QUANTIFYING DISEASE
BURDEN IS SOMETHING THAT IS
REALLY NECESSARY.
AND WITH THIS I WANT TO THANK
YOU AND END MY PRESENTATION.
>>THANK YOU.
WE WILL MOVE TO THE NEXT
PRESENTATION
DR. ALEJANDRA
CANTORAL.
THANK YOU.
INCLUDING FISH, CRUSTACEANS,
CEPHALOPODS OR MOLLUSKS.
FACTORS LIKE LOCATION AND TIME
OF YEAR INFLUENCE.
WILD SPECIES, COD HAS LOWEST
OMEGA 3 AND MACKEREL THE
HIGHEST.
FARMING TECHNIQUES IMPACT THE
PROFILE.
HOWEVER, FARM RAISED FISH TEND
TO BE HIGHER IN TOTAL FAT DUE TO
FATTY ACIDS.
CERTAIN SPECIES SUCH AS TILLAPIA
CAN BE FARMED.
INFLUENCING CONCENTRATION IN
SEAFOOD.
TILAPIA AS THE LOWEST OMEGA 3
CONTENT.
NUTRITIONAL QUALITY IS ALSO
AFFECTED BY POST HARVEST
HANDLING, PROCESSES, TRANSPORT,
PACKAGING.
SEAFOOD EXPIRES FASTER THAN
OTHER FOOD GROUPS, SO CHILLING,
BIOLOGY, DRYING ARE NECESSARY
PRESERVATION METHODS BUT THESE
METHODS REDUCE SOME NUTRIENTS.
VITAMINS MAY BE LOST AFTER 90%
AFTER THESE PROCESS.
SEA HAD HAS NUTRITIONAL AND
BIOACTIVE COMPONENTS DIETARY
GUIDELINES ALL OVER THE WORLD
RECOMMEND CONSUMPTION OF SEAFOOD
AT LEAST TWICE A WEEK.
THE MOST RECOGNIZED STUDIES IS
LIPID, OMEGA 3 PRODUCED BY
CERTAIN TYPES OF ANIMALS THAT
ACCUMULATE IN TISSUES OR ORGANS.
OMEGA 3s ARE FOUND IN ALL
AQUATIC FOODS, PARTICULARLY
FATTY ISSUES OF OILY FOOD, LIKE
SALMON AND MACKEREL, IN THE
LIVER OF COD, AND THICK LAYER OF
FAT UNDER THE SKIN OF SEALS AND
WHALES.
SMALLER AMOUNTS FOUND IN
CRUSTACEANS AND CEPHALOPODS.
BENEFITS OF FISH CONSUMPTION IN
PREGNANCY STRONG AND SHOULD
INCORPORATE IN WOMEN OF THIS
BENEFIT.
INTAKE OF FISH NUTRIENTS AND
BIOACTIVE INCLUDE MEMORY,
COGNITION, INCLUDING I.Q.
DURING THE FIRST TRIMISTER AND
FIRST YEARS OF LIFE, TO OBTAIN
500 MILLIGRAMS HER DAY OF EPA
AND DHA, PREGNANT WOMEN NEED TO
CONSUME AROUND TWO SALMON, TWO
SERVINGS PER WEEK OF SALMON OR
HERRING.
INSTEAD, INTAKE LIKE 10 SERVINGS
OF CANNED LIGHT TUNE OR OR 30
SERVINGS OF TILLAPIA.
THE AMOUNT DEPENDS ON THE
SPECIES.
FOODS CONTAIN PROTEINS AND
DEPENDING ON SPECIES VARIOUS
VITAMINS AND NUTRIENT.
ESSENTIAL AMINO ACID FROM 18 TO
20%.
ALSO SEAFOOD IS A PRIMARY SOURCE
OF IODINE IN DIET CAN CONTAIN
IRON, ZINC, SELENIUM, COPPER.
CRUSTACEANS CALCIUM AND
PHOSPHORUS, BENEFITS FOR
CHILDREN IN GROWTH.
AND FATTY FISH AND MOLLUSKS A
GOOD SOURCE OF VITAMIN D, E, AND
CRUSTACEANS, FISH LIKE SALMON,
GOOD SOURCE OF CARATINOIDS.
FOOD IMPACTS GROWTH,
DEVELOPMENT, HEALTH.
FISH IS CONSIDERED A FUNCTIONAL
FOOD, INTAKE HAS A LOT OF
BENEFITS.
ANTIOXIDANT, ANTI-INFLAMMATORY,
SELENIUM HAS NEUROLOGIC
BENEFITS.
MOLLUSK AND CRUSTACEAN PROVIDE
ANTIOXIDANT PROTECTION.
FATTY ACID HAVE
ANTI-INFLAMMATORY EFFECT.
BRAIN NEURAL PROTECTION ALSO.
IN SOME SPECIES ANTIMICROBIAL
AND ANTIBACTERIAL PROPERTIES
FOUND.
PEPTIDES EFFECTIVE IN AGING
CONDITIONS.
SO GLOBAL CONSUMPTION OF FISH IS
DOUBLE IN RECENT TIMES.
IN SOME COUNTRIES FISH IS MAJOR
SOURCE OF PROTEIN AND ESSENTIAL
NUTRIENTS.
PER CAPITA INTAKE INCREASED FROM
10 KILOGRAMS IN THE '60s TO
OVER 19 19 KILOGRAMS.
FISH ACCOUNTED FOR 17 TO 20% OF
ANIMAL PROTEIN, REPRESENTING 7%
OF ALL PROTEINS GLOBALLY AND
SEAFOOD PROVIDES DAILY ANIMAL
PROTEIN INTAKE FOR MORE THAN 3
BILLION PEOPLE.
CONSUMPTION IN THE U.S., THIS IS
DATA FROM THE NHANES.
20% OF ADULTS CONSUME SEAFOOD AT
LEAST TWO TIMES A WEEK, BUT ONLY
10 TO 20% OF U.S. WOMEN EAT AS
MUCH AS 8 OUNCES OF FISH PER
WEEK.
PARTICULARLY PREGNANT WOMEN EAT
LESS THAN 2 OUNCES PER WEEK IN
AVERAGE.
LIMITING FISH CONSUMPTION DURING
PREGNANCY HAS BEEN RELATED TO
MERCURY, CAN HARM NEUROCOGNITIVE
DEVELOPMENT.
ALSO, APPROXIMATELY 6% OF YOUNG
CHILDREN CONSUME SEAFOOD AT
LEAST TWO TIMES PER WEEK, VERY
LOW.
CONSUMPTION ACCORDING TO RACE,
FOR EXAMPLE MORE THAN 40% OF
NON-HISPANIC ASIAN ADULTS
CONSUME SEAFOOD AT LEAST TWO
TIMES PER WEEK.
IN CONTRAST 14% OF HISPANIC THE
SAME AMOUNT.
IN 2013 MOST COMMONLY CONSUMED
IN THE U.S., SALMON, CANNED
TUNA, TILAPI, LOW IN OMEGA-3
FATTY ACIDS.
I TALKED ABOUT BENEFITS OF
CONSUMING SEAFOOD.
THERE ARE MANY POTENTIAL
CONTAMINANTS OF CONCERN.
MERCURY, LEAD, CADMIUM, ARSENIC,
PCBs, DIOXINS.
MERCURY IS IN THE ENVIRONMENT
NATURALLY AND AS A RESULT OF
HUMAN ACTIVITIES, AND RELEASED
BY THESE ACTIVITIES FALL OUT IN
WATER AND TRANSFORMED BY
MICROORGANISM TO METHYLMERCURY,
MORE TOXIC, ENTERS AQUATIC FOOD
CHAIN, PREDATORY FISH SUCH AS
SHARK, SWORDFISH, CERTAIN FISHES
OF TUNA, ACCUMULATE HIGHER
LEVELS.
METHYLMERCURY IS ASSOCIATED WITH
FREQUENCY OF SEAFOOD INTAKE
ESPECIALLY WITH THESE FISHES.
SWORDFISH, SHARK, TUNA,
SHELLFISH.
WE CAN SEE IN THE AREAS IN U.S.
MERCURY IN HAIR AND BLOOD HIGHER
THAN INNER AREAS OF THE U.S.
SO, THE PROBLEM IS THAT MERCURY
HAS ABILITY TO CROSS THE
PLACENTAL AND BLOOD-BRAIN
BARRIERS, DEVELOPING NERVOUS
SYSTEM IS KNOWN TO BE
PARTICULARLY VULNERABLE TO
METHYLMERCURY.
SO COHORT OF STUDIES HAS SHOWN
EXPOSURE CAN RESULT IN COGNITIVE
DEFICITS, ATTENTION DEFICITS,
DECREASE IN LEARNING CAPACITIES.
THEN IT IS IMPORTANT TO IDENTIFY
WHICH SPECIES SHOULD BE CONSUMED
TO MAXIMIZE INTAKE OF OMEGA 3
AND MINIMIZE METHYLMERCURY
EXPOSURE.
THIS IS WHAT WE'VE DONE IN
MEXICO WITH 20 MOST CONSUMED
SEAFOOD BY MEXICAN POPULATION,
ACCORDING TO METHYLMERCURY PER
GRAM OF TISSUE, ABOVE THE USA
EPA RECOMMENDATION BUT ALSO NEED
TO ENCOMPASS THOSE THAT ARE
HIGHEST IN OMEGA-3 FATTY ACIDS.
AS MY COLLEAGUES MENTIONED
BEFORE THERE ARE SOME NUTRIENT
TOXIN INTERACTIONS.
IN THE CASE OF SEAFOOD DIETARY
SELENIUM IS RELATED TO
METHYLMERCURY TOXICITY.
SO IN ONE HAND STUDIES SHOW
SELENIUM ENRICHED DIET PREVENTS
METHYLMERCURY TOXICITY, BUT IN
OTHER IT HAS HIGH AFFINITY FOR
SELENIUM AND SPECIFICALLY
METHYLMERCURY (INDISCERNIBLE)
REQUIRED TO PREVENT AND REVERSE
OXIDATIVE DAMAGE, PARTICULARLY
IN THE BRAIN AND ENDOCRINE
TISSUES.
THIS MAY EXPLAIN WHY COHORTS OF
STUDIES OF MATERNAL POPULATIONS
EXPOSED TO SEAFOOD THAT CONTAINS
MERCURY WITH LOW SELENIUM
CONTENT SUCH AS SHARK OR WHALE
MEAT, OUTCOMES RELATED TO FISH
INTAKE, SOME STUDIES INSTEAD OF
HARM.
SELENIUM CONTENT FISH DEPENDS ON
STATUS, FISH WITH HIGH
METHYLMERCURY MAY BE CAUSE FOR
CONCERN.
COOK AND BIOACCESSIBILITY,
COOKING PROCESS ARE RAW,
STEAMED, GRILLED, FRIED.
SPANISH MACKEREL, BOIL AND FREUD
FISH 40 TO 60% LOWER THAN RAW
SAMPLES.
COOKING AS WELL AS REMOVING THE
SKIN AND FAT OF FISH CAN ALSO
REDUCE PCBS AND DIOXINS.
EMPHASIZING NEURAL DEVELOPMENT
OF BENEFITS TO OFFSPRING OF
WOMEN WHO CONSUMED FISH AND
NEURAL DEVELOPMENT TO OFFSPRING
WHO DO NOT CONSUME FISH.
U.S. FDA AND EPA RECOMMEND
CONSUMING TWO TO THREE SERVES
PER WEEK OF MOST FISH AND
SEAFOOD DURING PREGNANCY.
BETWEEN 8 TO 12 OUNCES PER WEEK.
ALSO, BLUE FISH, RATES FOR
METHYLMERCURY, CERTAIN FISH NOT
RECOMMENDED TO EAT DURING
PREGNANCY AS SHARK OR SWORDFISH,
GIVEN HIGH LEVELS OF MERCURY,
AND ALSO WE HAVE TO TAKE INTO
ACCOUNT TO GET MAXIMUM BENEFIT
TO PREGNANT WOMEN AND THEIR
OFFSPRING CONSUMING TROUT OR
SALMON, CLAMS, SARDINES,
CATFISH, 10 GRAMS A WEEK.
FINAL REFLECTIONS WE HAVE TO
DEVELOP AND MAINTAIN ALL THIS
INFORMATION ABOUT NUTRIENT
CONTENT OF SEAFOOD, ALSO
CONTAMINANTS, PARTICULARLY
METHYLMERCURY AND DIOXIN,
MONITORING SEAFOOD EXPORTING TO
UNITED STATES ALSO BECAUSE WE A
LOT OF SEE FOOD CONSUMED IN THE
UNITED STATES CAME FROM OTHER
COUNTRIES.
ALSO INCLUDE ADVICE HOW TO COOK
FISH TO DECREASE TOXEN WITHOUT
LOSING NUTRIENTS.
MORE EVIDENCE IS NEEDED.
FIRST COMBINED EXPOSURE IN
PRESENCE OF MORE THAN TWO
METTLES, MERCURY YES BUT ALSO
LEAD OR CADMIUM IN THE SEAFOOD.
IN THE SAME SEAFOOD.
WE NEED TO HAVE MORE RESEARCH IN
THIS AREA, COMBINATION OF METALS
AND TOXICS.
AND WE NEED MORE AREAS OF
RESEARCH ON INTERACTIONS BETWEEN
NUTRIENTS AND TOXINS.
FOR EXAMPLE, IN THE ROLE OF
SELENIUM.
THANK YOU VERY MUCH FOR YOUR
ATTENTION.
>>THANK YOU, ALEJANDRA.
THANK YOU VERY MUCH.
WE'LL GO TO OUR LAST
PRESENTATION, DR. KORDAS.
>>THANK YOU.
HOPE YOU'RE SEEING MY SCREEN.
IT'S A PLEASURE AND PRIVILEGE TO
BE HERE AND CONTRIBUTE TO THIS
CONVERSATION.
THANK YOU FOR THE INVITATION.
I HAVE NO CONFLICTS OF INTEREST
TO DISCLOSE.
I WILL CONTINUE THE CONVERSATION
THAT WAS STARTED BY MY
COLLEAGUES WHERE WE HEARD THAT
FOODS SUPPORT OPTIMAL GROWTH AND
HEALTH OF CHILDREN, AND THEY CAN
FURTHER BE BENEFICIAL BY
BLOCKING ABSORPTION OR CONTRA
ACTING EFFECTS OF TOXIC ELEMENTS
ON DIFFERENT ASPECTS OF
CHILDREN'S HEALTH AND
DEVELOPMENT.
I WANT TO THINK ABOUT THE FACT
THAT WHEN WE PLAN OUR MEALS,
DURING A DAY OR FOR THE WEEK, WE
RARELY THINK ABOUT NUTRIENTS AND
WHAT WE MAY NEED IN TERMS OF THE
HEALTH BENEFITS OF NUTRIENTS.
WE THINK ABOUT PREFERENCE, WHAT
WE GREW UP, WHAT IS CULTURALLY
RELEVANT AND APPROPRIATE FOR US.
WHAT MAY BE AVAILABLE IN A GIVEN
SEASON AS WELL AS IN PLACE WHERE
IS WE LIVE.
HOW MUCH WHAT WE CAN AFFORD, HOW
MUCH WE CAN AFFORD TO BUY.
THOSE ARE FOREMOST RATHER THAN
NUTRIENTS.
IT TURNS OUT THAT THE WAY WE
EAT, WHAT WE CONSUME IN TERMS OF
FOODS AND BEVERAGES, HOW MUCH WE
CONSUME AND HOW FREQUENTLY, CAN
BE DESCRIBED AND QUANTIFIED.
THERE'S A PATTERN TO THE WAY WE
EAT.
I WILL DEFINE A DIET PATTERN
BECAUSE WE'LL BE USING THESE
TERMS QUITE A BIT.
IT'S THE QUANTITY, VARIETY,
COMBINATION OF FOODS AND
BEVERAGES AND FREQUENCY WITH
WHICH WE CONSUME THEM.
AND SO I WOULD LIKE TO SPEND A
LITTLE BIT OF TIME NOW TO THINK
ABOUT DIFFERENT DIET PATTERNS
AND QUALITY, AND WHY WE WANT TO
THINK ABOUT THEM IN RELATION TO
TOXICS ELEMENT EXPOSURES AND
EFFECT ON HEALTH IN CHILDREN.
FIRST, I WILL SAY THAT THERE ARE
DIFFERENT WAYS OF THINKING ABOUT
DIET PATTERNS AND DEFINING AND
MEASURING THEM.
I'LL TALK ABOUT THESE BECAUSE
I'LL BE USING THE TERMS DIET
PATTERN AND DIET QUALITY QUITE A
BIT TO DESCRIBE THE EVIDENCE
THAT WE CURRENTLY HAVE, AND SO I
WANT TO MAKE SURE THAT WE'RE ALL
ON THE SAME PAGE ABOUT WHAT IT
IS THAT I MEAN.
ONE WAY OF DESCRIBING A DIETARY
PATTERN OR MEASURING DIETARY
PATTERN IS WHAT WE CALL DATA
DRIVEN.
THIS IS WHERE THE CONSUMPTION
FREQUENCY OR AMOUNT OF FOODS OR
FOOD GROUPS ARE ANALYZED USING
STATISTICAL TOOLS, TO IDENTIFY
SOME KIND OF MEANINGFUL PATTERN.
I'LL GIVE AN EXAMPLE OF HOW THIS
IS DONE IN A SECOND.
BUT THE TIMES OF DIETARY
PATTERNS YOU MAY HAVE HEARD OF
ARE WESTERN DIETARY PATTERN OR
PASSIVE FOODS OR PRUDENT DIETARY
PATTERN.
THOSE ARE THE THINGS THAT YOU
MAY HAVE HEARD OF.
ON THE OTHER HAND, THERE IS A
WAY OF SCORING HOW WE EAT, IN
COMPARISON TO PRE-DEFINED NOTION
OR PRE-DEFINED RECOMMENDATION
FOR WHAT IS HEALTHY DIET.
SO, WE CAN MAKE COMPARISONS AND
WE CAN SCORE SOMEBODY'S DIET.
THIS SCORE, AGAIN, IS QUANTIFIED
AND THERE ARE DIFFERENT TYPES OF
APPROACHES.
I'M SORRY, DIETS THAT HAVE --
DIET QUALITY INDICES THAT HAVE
BEEN DESIGNED FOR THE UNITED
STATES, SOME THAT WE HAVE HEARD
OF ARE DIETARY APPROACH TO STOP
HYPERTENSION, DASH, OR HEALTHY
EATING INDEX SCORES, BUT THERE
ARE OTHER SCORES, BOTH IN USE IN
THE UNITED STATES AS WELL AS
AROUND OTHER PARTS OF THE WORLD
HEALTHY DIET PATTERN MAY BE --
MAY MEAN GRAINS AS WELL AS
HEALTHIER PROTEINS SUCH AS FISH.
I WANT TO GO OVER IN A LITTLE
BIT MORE DETAIL ABOUT HOW
DATA-DRIVEN DIET PATTERNS ARE
IDENTIFIED OR QUANTIFIED.
DETAILS ARE NOT SO CRITICAL, BUT
WHAT I WANT TO TELL YOU IS THAT
TO DO THIS, TYPICALLY A FOOD
FREQUENCY QUESTIONNAIRE OR MAY
BE 24-HOUR RECALL WILL BED -- L
BE ADMINISTERED.
BASED ON REPORTED FOOD,
THOSE-LISTED.
OFTEN GROUPED FURTHER INTO
SIMILAR TYPES OF FOODS.
AND THEN STATISTICAL CODES SUCH
AS PRINCIPAL COMPONENTS ANALYSIS
WILL BE APPLIED TO TRY TO
UNDERSTAND HOW THESE FOOD GROUPS
RELATE TO ONE ANOTHER AS WELL AS
UNDERLYING CONSTRUCT OF SOME
SORT.
HIGHER CORRELATION WILL MEAN
THAT THEY RELATE MORE STRONGLY
AND A LOWER CORRELATION WILL
MEAN THAT THEY DON'T RELAY AS
STRONGLY.
SOMETHING THAT CORRELATES
NEGATIVELY ACTUALLY MEANS THAT
IT'S SORT OF RELATING IN A
DIRECTION TO THIS UNDERLYING
CONSTRUCT.
SO, IN THIS EXAMPLE, FROM THE
LITERATURE, TWO TYPES OF DIET
PATTERNS HAVE BEEN IDENTIFIED.
ONE IS THE WESTERN DIET PATTERN.
THE OTHER ONE IS THE PRUDENT
DIET PATTERN.
THE WAY THESE ARE NAMED IS THAT
RESEARCHER WILL LOOK AT THE
FOODS COLLATING HIGHLY, AND SORT
OF EXAMINE WHAT THOSE ARE, AND
THEN COME UP WITH A NAME THAT IS
DESCRIPTIVE AND THAT REPRESENTS
WHAT'S HAPPENING WITH THE FOOD
THAT RELATE TO THAT PATTERN.
ON THE OTHER HAND, I MENTIONED
DIET QUALITY INDICES AND THE
SCORES THAT CAN BE CALCULATED TO
REPRESENT THE HEALTHINESS OF A
DIET.
AND HERE'S AN EXAMPLE OF HOW THE
HEALTHY EATING INDEX 2015 IS
CALCULATED.
AGAIN WE WOULD TAKE SOMEBODY'S
DIET RECALL AND LOOK AT ARE THEY
CONSUMING THE RECOMMENDED FOOD
GROUPS AS WELL AS HOW CLOSELY DO
THEY COME IN TERMS OF QUANTITY
TO THE RECOMMENDED AMOUNTS.
THE CLOSER THEY ARE, HIGHER
POINTS THEY RECEIVE.
POINTS EVENTUALLY TOTAL TO 100.
AND ALL OF US UNDERSTAND WHAT A
SCORE OF 100 MEANS.
AND HOW FAR WE ARE FROM THAT
DESIRED TOTAL.
THEY ARE INTUITIVELY
UNDERSTANDABLE.
WE CAN USE THEM TO COMPARE,
TRACK PROGRESS OVER TIME,
COMPARE DIFFERENT POPULATION
GROUPS OR AGES, AND WHAT WE'RE
LOOKING AT HERE IS OUR HEALTHY
EATING INDEX SCORES, ACROSS
CHILDHOOD AND ADOLESCENCE IN THE
UNITED STATES.
WE SEE SCORES DECREASE GRADUALLY
AS CHILDREN AGE.
THE REASON WE WANT TO THINK
ABOUT DIET PATTERNS OR DIET
QUALITY IN RELATION TO TOXIC
ELEMENTS AND EFFECTS ON HEALTH
IS THAT FOR DIETS THE WHOLE IS
GREATER THAN THE SUM OF ITS
PARTS.
SO, AS I ALREADY SAID, FOODS AND
BEVERAGES ARE CONSUMED IN
COMBINATION.
AND THE DIETARY COMPONENTS THAT
THEY PROVIDE SUCH AS MINERALS,
VITAMINS, FIBER, ET CETERA,
REALLY ACT IN SYNERGY.
SO IT'S MORE LIKELY THAT
TOGETHER THEY INFLUENCE HEALTH
TO A GREATER EXTENT THAN ANY
SINGLE FOOD ALONE.
THERE'S BEEN A NUMBER OF STUDIES
IN CHILDREN AS WELL AS ADULTS,
RELATING HOW DIET PATTERNS MAY
BE RELATED TO DIFFERENT HEALTH
OUTCOMES.
HERE I'M SHOWING YOU AN EXAMPLE
OF JUST ONE SUCH STUDY.
SO IN CHILDREN IN BRITAIN WHO
WERE GROWING UP IN THE 1990s,
DIETARY PATTERNS, DATA-DRIVEN,
WERE IDENTIFIED AT DIFFERENT
AGES.
IN EARLY CHILDHOOD, THREE
PATTERNS ARE PRESENTED HERE.
PROCESS PATTERN, TRADITIONAL
PATTERN, HEALTH CONSCIOUS
PATTERN AT 3, 4, 7, 8 1/2 AGES.
WHAT THE RESEARCHERS DID WAS
RELATE IN REGRESSION MODELS THE
SCORES ON THESE PATTERNS WITH
I.Q. IN CHILDREN AROUND 8 YEARS
OF AGE.
AND WE SEE, FOR EXAMPLE, THAT AT
AGE 3 YEARS, HIGHER SCORES ON
PROCESS PATTERN INDICATE CLOSER
ADHERENCE, RELATED WITH LOWER
I.Q. SCORES IN CHILDREN.
FLIP SLIDE, AGES 3 AND AROUND 8,
HIGHER SCORES ON HEALTH
CONSCIOUS PATTERN RELATED TO
BETTER I.Q. SCORES IN CHILDREN.
THERE'S A NUMBER OF STUDIES
RELATED DIET PATTERNS TO
CHILDREN'S HEALTH.
I HAVE POOLED EXAMPLES OF
STUDIES TO REPRESENT SEVERAL
ASPECTS OF CHILDREN'S HEALTH SO
WE HAVE BODY FATNESS, BMI,
COGNITIVE FUNCTION, MENTAL
HEALTH, AS WELL AS ORAL HEALTH,
BUT OTHER TYPES OF STUDIES HAVE
BEEN CONDUCTED.
IN SUMMARY, ALTHOUGH THERE ARE
GAPS IN THIS RESEARCH, I THINK A
COMMON THREAD THAT COMES OUT IS
DIETS BASED ON FRUITS AND
VEGETABLES AND HEALTHY PROTEINS
RELATE IN A POSITIVE WAY TO
POSITIVE OUTCOMES, COGNITION,
MENTAL HEALTH WITH LOWER
DEPRESSIVE SYMPTOMS, BETTER ORAL
HEALTH IN CHILDREN.
BUT WHILE WE KNOW THAT DIETS ARE
RELATED IN A POSITIVE WAY TO
HEALTH, WE HAVE ALSO HEARD FROM
PREVIOUS SPEAKERS THAT THEY ARE
A SOURCE OF TOXICANTS, SO THEY
HAVE THIS DUAL ROLE THAT
PRESENTS A QUANDARY TO PARENTS,
TO REGULATORS, AND REALLY THE
REASON WE'RE HERE.
THIS COUNTRY DESERVES SERIOUS
CONSIDERATION FROM US TO THINK
ABOUT WHAT MAY BE HAPPENING.
AND WHILE WE DO ULTIMATE -- THE
ULTIMATE GOAL TO HAVE DIETS AS
LOW IN THESE TOXICANTS AS
POSSIBLE, AT THE MOMENT I THINK
ONE OF THE BIG QUESTIONS IS CAN
THE BENEFITS OF NUTRIENTS AND
HEALTHY FOODS OUTWEIGH HARMS OF
EXPOSURE TO TOXICS ELEMENTS THAT
MAY ALSO BE IN THOSE FOODS.
ONE WAY OF ANSWERING THIS
QUESTION IS TO ASK, WELL, DO
DIET PATTERNS RELATE TO LEVELS
OF TOXIC ELEMENTS IN THE HUMAN
BODY?
I'M SHOWING THIS SLIDE FROM A
STUDY DR. KARAGAS MENTIONED,
EMPHASIZING THE POINT SHE'S MADE
AS INFANTS CONDITIONED TO MORE
SOLID FOODS THROUGHOUT THE FIRST
YEAR OF LIFE, THEIR LEVELS OF
ARSENIC IN URINE DO INCREASE AND
THIS IS TRUE FOR INORGANIC
ARSENIC AS WELL AS METHYLATED
ARSENIC SPECIES.
SIMILARLY IT WAS MENTIONED, THIS
STUDY OF BLOOD LEAD
CONCENTRATION IN 12 TO 24 MONTH
OLD INFANTS, WHICH WE CONDUCTED
A FEW YEARS BACK.
AND SHE DIDN'T SHOW DATA SO I
WILL ORIENT YOU TO THIS SLIDE
LOOKING FOR COMPARISON AMONG
CHILDREN WITH NO INTAKE OF
CERTAIN FOOD GROUP.
AND NO INTAKE IS SHOWN IN BLUE.
COMPARED TO INCREASING LEVELS OR
HIGHER CATEGORIES OF INTAKE OF
DIFFERENT TYPES OF FOODS SHOWN
IN ORANGE, GREEN, AND THEN RED
LINE.
THE TYPES OF FOODS WERE COMMONY
CONSUMED BY CHILDREN ON THESE
AGES.
THOSE WERE MILK, CEREALS,
SWEETS, GRAINS, VEGETABLES,
MEATS, FRUIT DRINKS, AND WHAT WE
FOUND JUST HIGHLIGHTING FOR YOU
HERE HIGHER CONSUMPTION OF MILK
ASSOCIATED WITH LOWER BLOOD LEAD
CONCENTRATION, HIGHER CEREALS
RELATED, HIGHER INTAKE OF
STARCHY VEGETABLES AND FRUIT
DRINKS RELATED TO HIGHER BLOOD
LEAD CONCENTRATION IN THESE
CHILDREN.
AS I ALREADY MADE THE POINT,
FOODS -- DIETS ARE GREATER THAN
THE SUM OF THEIR PARTS.
SO WE NOT ONLY WANT TO ASK ABOUT
FOODS AND FOOD GROUPS AND HOW
THEY RELATE TO BIOMARKERS OF
EXPOSURE, LEVELS OF TOXIC
ELEMENTS IN OUR BODIES, BUT ALSO
DO DIET PATTERNS RELATE TO THESE
BIOMARKERS.
HERE I'M SHOWING A STUDY FROM
URUGUAY, CONDUCTED AMONG 6 TO 8
YEAR OLD CHILDREN, FIRST GRADE
OF ELEMENTARY SCHOOL
ESSENTIALLY.
WE IDENTIFIED TWO DIET PATTERNS
IN THE CHILDREN.
HERE I'M SHOWING INFORMATION FOR
ONE, WHICH WAS NUTRIENT DENSE
DIET PATTERN.
AND THIS WAS CHARACTERIZED BY
HIGHER INTAKE OF DARK LEAFY
VEGETABLES, DARK ORANGE AND RED,
HIGHER SCORES INDICATE CLOSER
ADHERENCE TO THIS TYPE OF EATING
PATTERN.
WE SEE ON THE X-AXIS THESE
SCORES THAT GO FROM NEGATIVE, SO
FAR AWAY FROM THIS PATTERN, TO
MORE HIGHLY POSITIVE, SO AGAIN
CLOSER TO THE PATTERN.
ON THE Y-AXIS WE WOULD BE
LOOKING AT URINARY INORGANIC
ARSENIC CONCENTRATION AND WE SEE
THAT THERE IS AN INVERSE
ASSOCIATION.
SO CLOSER YOU ADHERE TO THIS
NUTRIENT DENSE DIET PATTERN, THE
LOWER INORGANIC ARSENIC
CONCENTRATION THE CHILD HAS.
ON THE FLIP SIDE, THE SAME DIET
PATTERN IS ASSOCIATED WITH IN A
POSITIVE WAY, WITH BLOOD LEAD
CONCENTRATIONS IN CHILDREN, I
THINK THIS IS WHERE IT'S
IMPORTANT TO PAUSE AND THINK
ABOUT THE COMPLEXITY OF THIS
ISSUE.
YOU HAVE THE SAME DIET PATTERN
THAT IS -- SEEMS TO BE
BENEFICIAL AND DOING SOMETHING
POSITIVE FOR ONE TOXICANT, BUT
MAY BE MORE NEGATIVE FOR ANOTHER
TOXICANT.
IT'S SOMETHING WE NEED TO THINK
ABOUT MORE AS WE MOVE FORWARD
WITH THIS TYPE OF RESEARCH, AND
THINKING THROUGH WHAT
RECOMMENDATIONS NEED TO BE MADE.
AS I SAID, THERE ARE TWO WAYS OF
THINKING ABOUT DIETS AND SO I
SHOWED YOU INFORMATION ON THE
DATA-DRIVEN DIET PATTERN, BUT WE
ALSO DID AN ASSESSMENT OF DIET
QUALITY IN THE SAME CHILDREN
AND, AGAIN, RELATED THEM TO
BIOMARKERS OF TOXIC ELEMENTS.
WE SCORED CHILDREN VARIETY OF
DIETS, ADEQUACY OF INTAKE OF
CERTAIN NUTRIENTS AS WELL AS
FOOD GROUPS, AND THEN MODERATION
IN THEIR INTAKE OF CERTAIN
THINGS THAT ARE CONSIDERED LESS
HEALTHY.
AGAIN, WE RAN MODELS TO TRY TO
TEST THEIR ASSOCIATION.
URINARY ARSENIC FOUND NO
SIGNIFICANT ASSOCIATION.
THIS WAS ALSO TRUE FOR LEAD.
WE DID FIND VERY MODEST BUT
NEGATIVE ASSOCIATIONS SUGGESTING
THAT BETTER VARIETY SCORES AND
BETTER SCORES ON MODERATION ARE
ACTUALLY RELATED WITH LOWER
CADMIUM CONCENTRATIONS IN
CHILDREN.
THESE NON-SIGNIFICANT RESULTS
MAY -- DON'T NECESSARILY MEAN
THAT -- WELL, THEY MEAN THAT
WHILE THESE DIET QUALITY ISN'T
NECESSARILY PROTECTIVE, IT'S NOT
ASSOCIATED IN A NEGATIVE WAY OR
IN A DETRIMENTAL WAY WITH
URINARY ARSENIC AND BLOOD LEAD
CONCENTRATION.
NOW, THIS SORT OF REPRESENTS A
MAJORITY OF INFORMATION THAT WE
HAVE ON CHILDREN.
SO I WANT TO JUST SHARE MORE
RECENT SLIDE, MORE RECENT STUDY
ON U.S. ADULTS USING NHANES
DATA, WHERE A SIMILAR ANALYSIS
WAS CONDUCTED ON INTAKES OF
DIFFERENT FOOD GROUPS AS WELL AS
ON THE VERY RIGHT HERE THE
HEALTHY EATING INDEX 2015 TOTAL
SCORE.
THESE WERE CORRELATED WITH BLOOD
LEAD, CADMIUM, TOLD BLOOD
MERCURY, CONCENTRATIONS IN THESE
ADULTS.
AND WHAT THEY FOUND WERE NO
CORRELATIONS WITH LEAD AND
CADMIUM, BUT DID FIND POSITIVE
MODEST CORRELATIONS WITH
MERCURY.
AGAIN, WE ALREADY KNOW MERCURY
IS FOUND IN MANY FOODS.
ANOTHER WAY OF THINKING ABOUT
HOW FOODS AND DIETARY PATTERNS
AFFECT -- ARE IMPORTANT IN THE
RELATIONSHIP WITH TOXIC
ELEMENTS, DO THEY -- WHAT ROLE
DO THEY PLAY BETWEEN THE
EXPOSURE TO TOXICS ELEMENTS AND
HEALTH.
UNFORTUNATELY WE DON'T HAVE VERY
MANY STUDIES IN CHILDREN THAT
CAN HELP US ANSWER THIS YET.
THERE ARE SOME REALLY
INTERESTING STUDIES COMING OUT
IN ADULTS AND WE HOPE THAT OTHER
STUDIES IN CHILDREN WILL FOLLOW
SOON.
LET ME TELL YOU ABOUT THE STUDY.
THE WAY IT WAS CONDUCTED IS THEY
ASKED A QUESTION SLIGHTLY
DIFFERENTLY WONDERING WHETHER
TOXIC ELEMENTS OFFSET BENEFITS
OF QUALITY DIETS ON BMI OF
ADULTS.
THESE ELEMENTS CANNOT BE
ATTRIBUTED TO DIET IN THE STUDY.
THEY WERE MEASURED IN BIOMARKERS
WHERE THE SOURCES CAN BE
MULTIPLE.
THIS PANEL I WILL FOCUS ON THE
LEFT-HAND SIDE FOR LEAD, SHOWS
THE QUARTILES OF HEALTHY EATING
INDEX, RIGHT HERE, FROM THE LINE
THAT INTERSECTS AND GOING DOWN
TO ABOUT 40, THESE POINTS
REPRESENT THE ODDS RATIO,
LIKELIHOOD OF OVERWEIGHT OR
OBESITY IN ADULTS, AS WE SEE
HIGHER INTAKE OF HEALTHY DIETS
LIKELIHOOD OF OVERWEIGHT AND
OBESITY IN ADULTS GOES DOWN.
AND THIS IS TRUE, THIS
RELATIONSHIP, THIS PATTERN OF
RELATIONSHIPS IS TRUE EVEN AS
BLOOD LEAD CONCENTRATIONS IN
THESE ADULTS GO UP.
THIS IS ALSO REPEATED, THE SAME
PATTERN REPEATED FOR CADMIUM AND
MERCURY SUGGESTING THAT EVEN IF
THERE IS EXPOSURE TO TOXIC
ELEMENTS, HEALTHY DIETS CONTINUE
TO HAVE BENEFIT FOR SUCH
IMPORTANT OUTCOMES AS BMI.
ANOTHER STUDY IN ADULTS ASKED
WHETHER THERE IS A RELATIONSHIP
BETWEEN METAL MIXTURES AND
MIXTURES THAT THEY LOOKED AT WAS
CADMIUM, MANAGE -- MANGANESE AD
LEAD, ADULTS OLDER THAN 60 YEARS
OF AGE.
WHAT AUTHORS FOUND WAS THAT
THERE WAS A NEGATIVE ASSOCIATION
BETWEEN THIS MIXTURE, AND
COGNITIVE PERFORMANCE.
PARTICULARLY WHEN HEALTHY EATING
INDEX SCORES WERE LOW.
SO I'M SHOWING THAT HERE IN
THESE LINES, ORANGE LINE AND
GREEN LINE, FOR WOMEN.
NEGATIVE ASSOCIATION WASN'T
THERE FOR THE WOMEN WHEN THEY
HAD HIGHER SCORES ON THE HEALTHY
EATING INDEX, AND THAT IS
APPARENT HERE IN THE PURPLE AND
PINK LINES.
AND WHILE THESE RELATIONSHIPS
WERE A LITTLE BIT MORE APPARENT
FOR THE WOMEN, THEY WERE NOT SO
APPARENT FOR THE MEN.
SO THERE MAY ALSO BE SOME
DIFFERENCES IN THE SEXES, HOW
THIS IS PLAYED OUT.
I WANT CONCLUDE BASED ON
EXISTING EVIDENCE, WE DO SEE
THAT HEALTHY DIET PATTERNS, DIET
QUALITY, IS ASSOCIATED WITH
BETTER HEALTH OUTCOMES IN
CHILDREN.
SOME DIET PATTERNS ARE RELATED
TO LOWER OR HIGHER TOXIC ELEMENT
LEVELS IN THE BLOOD MEASURED BY
BIOMARKERS OF EXPOSURE BUT AS I
MENTIONED RELATIONSHIPS CAN BE
NEGATIVE OR POSITIVE, DEPENDING
ON THE TOXICANT WE'RE TALKING
ABOUT.
IN GENERAL THERE ARE VERY FEW
STUDIES AMONG CHILDREN, TRUE NOT
ONLY FOR STUDIES ON DIET
PATTERNS AND QUALITY, AND
RELATIONSHIP TO TOXIC ELEMENT
LEVELS IN THE BODY BUT ALSO ON
THE ROLE THAT THESE DIET
PATTERNS MAY PLAY IN THE
RELATIONSHIP BETWEEN TOXIC
ELEMENT BIOMARKERS AND HEALTH
OUTCOMES.
IT'S DIFFICULT TO EXTRAPOLATE
FROM OTHER AGES BECAUSE AS WE
HEARD IN SESSION 1, DIFFERENT
AGE GROUPS HAVE DIFFERENT
NUTRIENT REQUIREMENTS.
THEY HAVE -- BODIES ARE GROWING
AT DIFFERENT SPEEDS.
AND THEREFORE IT'S DIFFICULT TO
EXTRAPOLATE FROM DIFFERENT AGES
AND LIFE STAGES.
AND WE NEED MORE STUDIES ON
CHILDREN.
THESE STUDIES HAVE SHOWN US GAPS
IN EVIDENCE.
I WANT TO GO OVER THESE REALLY
QUICKLY.
THE FIRST GAP IS RIGHT HERE.
IN TERMS OF UNDERSTANDING THE
EXTENT TO WHICH CHILDREN ARE
EXPOSED TO TOXIC ELEMENTS, FROM
THEIR DIETS AS A WHOLE, WHAT IS
THE TOTAL EXPOSURE.
THE SECOND QUESTION THAT WE
STILL VERY MUCH NEED TO GRAPPLE
WITH IS WHAT IS THE RELATIONSHIP
BETWEEN THESE EXPOSURES, DIETS
SPECIFICALLY, AND LEVELS OF
TOXIC ELEMENTS IN CHILDREN'S
BODIES AS MEASURED BY BIOMARKES
OF EXPOSURE AND DO DIETARY
NUTRIENTS MODERATE THIS
RELATIONSHIP.
OF COURSE, IN SESSION 1 WE HEARD
NUTRITIONAL STATUS AND
DEFICIENCIES ARE IMPORTANT AND
MAY PLAY A ROLE HERE AS WELL.
WE WANT TO ACCOUNT FOR THAT AS
WELL AS OTHER SOURCES OF
EXPOSURE TO TOXIC ELEMENTS.
THE FINAL THING WE WOULD WANT TO
UNDERSTAND MORE CLOSELY IS WHAT
IS THE ROLE OF DIET PATTERNS AS
WELL AS DIET QUALITY IN THIS
RELATIONSHIP BETWEEN BIOMARKERS
OF EXPOSURE AND CHILDREN'S
HEALTH, WHEN WE KNOW AGAIN THAT
OTHER SOURCES OF EXPOSURE ARE
IMPORTANT.
AND NUTRITIONAL DEFICIENCIES
ALSO PLAY A ROLE.
I WANT TO REALLY QUICKLY CLOSE
WITH MAJOR DATA GAPS THAT WE
HAVE TO ADDRESS IN ORDER TO
ANSWER THE QUESTIONS THAT I JUST
MENTIONED, TO EXPAND DIETARY
ASSESSMENT OF THE POPULATION,
ESPECIALLY AT YOUNGER AGES.
THIS ALLOWS US TO LOOK AT -- TO
ESTIMATE WHAT IS THE TOXIC
ELEMENT EXPOSURE IN THESE
GROUPS.
SO I THINK WE SHOULD INCLUDE
VULNERABLE GROUPS, CHILDREN WITH
METABOLIC DISEASES, WITH SPECIAL
DIETS, WITH FOOD ALLERGIES, AS
WELL AS DEVELOPMENTAL DISORDERS,
BECAUSE TYPES OF DIET PATTERNS
THAT THEY HAVE MAY NOT
NECESSARILY BE REPRESENTED BY
DIET PATTERNS, MEASURED IN
NHANES.
WE SHOULD BE USING VALIDATED
INSTRUMENTS TO ASSESS DIETS.
AND CONSIDER A PERIOD OF RECALL
THAT WOULD REFLECT REALISTICALLY
CHANGES IN TOXIC METAL
CONCENTRATIONS IN THE BODY.
EXPANDING BIOMARKER MEASUREMENT
TO HELP US LOOK AT SOME
RELATIONSHIPS I MENTIONED WOULD
ALSO BE IMPORTANT.
FREQUENTLY AND COMPREHENSIVELY
ASSESSING TOXICANTS IN FOODS,
INCLUDING CULTURALLY RELEVANT
AND IMPORTED FOODS, AS WAS
MENTIONED, EXPANDING THE NUMBER
OF CONTAMINANTS ASSESSED BEYOND
THE USUAL SUSPECTS OF LEAD,
CADMIUM, ARSENIC AND MERCURY TO
OTHERS.
AND WHEN WE DO THIS USING
SENSITIVE LABORATORY METHODS AND
MEASURES TO DETECT LOW LEVELS OF
CONTAMINANT.
I WILL STOP NOW AND THANK YOU.
I WANT TO ACKNOWLEDGE THE
FUNDERS OF OUR RESEARCH AS WELL
AS MY COLLABORATORS WHO HAVE
CONTRIBUTED TO THE DATA I
PRESENTED.
>>WONDERFUL, THANK YOU.
I'D LIKE TO NOW INVITE ALL FOUR
OF OUR PRESENT ERS TO TURN ON
CAMERAS.
WE HAVE A CHUNK OF TIME FOR
QUESTIONS, GOOD QUESTIONS FROM
THE PUBLIC AS WELL.
IT'S SO GOOD TO SEE YOU.
FOUR FANTASTIC PRESENTATIONS.
THANK YOU SO MUCH.
IT'S REALLY INTERESTING TO BE
ABLE TO LOOK AT THESE ISSUES
FROM THE PERSPECTIVE OF
INDIVIDUAL CONTAMINANTS,
INDIVIDUAL NUTRIENTS IN FOODS,
ALSO FROM THE FOOD PERSPECTIVES
AND BRINGING IT FULL
CIRCLE TO
DIETARY PATTERNS.
I'M GOING ASK MY FIRST QUESTION
TO DR. KARAGAS, THE PICTURE
ABOUT THE FIBER GRAIN SHOWING
WHERE ALL THE PARTS OF THE GRAIN
ARE AND -- I'M SORRY, THE GRAIN
SHOWING WHERE THE PARTS ARE
INCLUDING THE FIBER.
FIBER IS REALLY OF INTEREST TO
ME PROFESSIONALLY.
AND MAINLY BECAUSE WE DO
RECOMMEND HALF THE GRAINS BE
WHOLE GRAINS, AND A LOT OF
REASONING FOR THAT IS BECAUSE
THE NUTRIENTS IN THAT PART OF
THE GRAIN REMOVED INCLUDES
FINER.
CURIOUS IF YOU COULD EXPAND MORE
ABOUT WHETHER OR NOT THERE'S
ASSOCIATION BETWEEN WHERE FIBER
IS IN THE GRAIN AND RETENTION OF
CONTAMINANTS AS WELL AS
NUTRIENTS COMPARED TO THE OTHER
PARTS OF THE GRAIN.
>>THANK YOU FOR THE QUESTION, A
SUPER IMPORTANT ISSUE.
THERE'S A LOT WE DON'T KNOW.
WE KNOW AND I MENTIONED RICE,
WHEN WE POLISH RICE WE CAN GET
RID OF SOME INORGANIC ARSENIC ON
THE OUTSIDE OF THE GRAIN.
IT'S NOT THE SAME FOR TOXICANTS
AND NUTRIENTS.
YOU REMOVE THE FIBER, ON THE
OUTER PART OF THE GRAIN.
WE NEED TO UNDERSTAND THIS A
LITTLE BIT MORE.
FOR MERCURY, FOR EXAMPLE,
THERE'S STUDIES THAT SUGGEST
THAT IT'S THE ENDOSPERM, THE
INSIDE OF THE GRAIN THAT MIGHT
HAVE HIGHER METHYLMERCURY
CONCENTRATIONS.
THERE'S NOT A ONE-SIZE-FITS-ALL
FOR YOUR QUESTION.
IT'S NOT THAT SIMPLE.
I DON'T THINK ANYONE ANY
NUTRITIONAL SCIENCE IS THAT
SIMPLE.
WHICH IS WHY WE'RE CHALLENGED
BECAUSE WE ARE ALL SO DIFFERENT
AND GRAINS WILL DIFFER.
I DO HOPE THAT WE CAN SPEND SOME
TIME UNDERSTANDING ALL THESE
DIFFERENT PROCESSES SO WE CAN
COME UP WITH FOODS THAT ARE
HEALTHY, NUTRIENTWISE AND
FIBER-WISE, AND ALSO REDUCE
TOXICANT LEVELS.
>>THANK YOU.
I THINK THE NEXT QUESTION IS
GOING TO BE ABOUT SELENIUM AND
MERCURY INTERACTING, THINKING
ABOUT WHAT'S HAPPENING, THE
RESULT THAT SELENIUM IS NO
LONGER AVAILABLE FOR GROWTH AND
DEVELOPMENT THAT LEADS TO AN
OUTCOME, OR IS IT THAT MERCURY
IS NO LONGER AVAILABLE TO IMPAIR
DEVELOPMENT?
CAN YOU SAY MORE ABOUT WHAT WE
MAY THINK IS GOING ON THERE?
>>MAINLY WHAT EVIDENCE SAYS IS
BOTH.
BECAUSE IT DEPENDS WHAT YOU EAT.
IF YOU HAVE A SEAFOOD OR FISH
HIGH IN MERCURY, LOW SELENIUM,
DIET LOW IN SELENIUM, AFFINITY
OF MERCURY FOR SELENIUM INHIBITS
SELENIUM SO THIS IS ONE WAY WHY
MERCURY AFFECTS NEURAL
RECOGNITION AND ANOTHER ORGAN
BUT ALSO POSITIVE THING WHEN YOU
HAVE A RICH DIET RICH IN
SELENIUM OR SEAFOOD WITH HIGH
CONCENTRATION, WHAT SELENIUM
DOES IS REVERSE TOXICITY OF
MERCURY.
SO IT IS QUITE INTERESTING AND I
THINK THAT WE SHOULD FOCUS ON
MORE RESEARCH AND EVIDENCE
BETWEEN FOOD SCIENCE,
NUTRITIONAL SCIENCE, CHEMICAL
SCIENCE BECAUSE WE ALL HAVE TO
WORK TOGETHER IN ORDER TO
UNDERSTAND MORE DIFFERENT
RELATION, INVERSE RELATION
BETWEEN MERCURY AND SELENIUM,
BUT ALSO BETWEEN OTHER NUTRIENTS
AND TOXIC INTERACTIONS THAT WE
SEE EVERY DAY IN THE COMMON
DIETS.
>>IF ANY OTHER SPEAKERS HAVE
SOMETHING TO ADD TO ONE OF THE
QUESTIONS, I ASK, PLEASE FEEL
FREE TO JUMP IN BEFORE I MOVE TO
ANOTHER QUESTION.
I HAVE A LITTLE BIT OF A
FOLLOW-UP QUESTION, ALEJANDRA.
WE SEE THERE'S A RELATIONSHIP
BETWEEN SEAFOOD INTAKE AND
PREGNANCY, AND POSITIVE
COGNITIVE DEVELOPMENT IN
OFFSPRING.
AND, YOU KNOW, WHAT INTERACTION
EXAMPLES BETWEEN NUTRIENTS AND
CONTAMINANTS MIGHT HELP US
BETTER UNDERSTAND WHY WE'RE
SEEING THAT RELATIONSHIP KNOWING
THERE'S A LOT GOING ON IN
SEAFOODS?
>>WELL, OKAY.
ACTUALLY, IT IS QUITE
INTERESTING BECAUSE AS I FIRST
PRESENTED ALSO SEAFOOD IS SOURCE
OF LEAD, RIGHT?
AND CADMIUM, ARSENIC, AND PBCs
ARE ALSO BIG TOXICANTS.
IT'S INTERESTING TO SEE IF FOR
EXAMPLE IN THE CASE OF LEAD AND
CALCIUM WE HAVE ALSO SEE THIS
INTERACTION, EVEN SEAFOOD CAN BE
A SOURCE OF LEAD SPECIFICALLY IN
THE AREA WHERE OCEAN IS VERY
POLLUTED BUT WE CAN SEE MAYBE
WITH DIET HIGH IN CALCIUM LEAD
NOT ONLY BY SEAFOOD BUT OTHER
FOOD GROUPS, YES, AS THEY
PRESENT LIKE GREEN LEAVES,
MUSHROOMS, IN MUSHROOMS THEY
HAVE A LOT OF LEAD IN MEXICO,
INTERESTING NOT ONLY FOCUS IN
ONE FOOD GROUP, YES, COULD BE
THE SOURCE BUT THE WHOLE DIET
CAN IMPACT ALSO.
A DIET HIGH IN CALCIUM THAT
DECREASE AMOUNT OF METALS
ABSORBED, AND ALSO CALCIUM, FOR
EXAMPLE, WE KNOW THAT IN
VEGETABLES WE HAVE FIBER THAT
CAN ALSO INHIBIT ABSORPTION OF
ALL METAL.
>>THANK YOU.
WONDERFUL.
A QUESTION FOR KASIA, THE SLIDE
WITH A FINDING FOR CADMIUM BUT
NOT FOR THE OTHER CONTAMINANTS.
WITH THOSE FINDINGS WHERE YOU
FOUND LOWER URINARY CADMIUM WITH
HIGHER DIET QUALITY, DO HAVE YOU
THOUGHTS ON WHY THAT PARTICULAR
ASSOCIATION MAY HAVE BEEN FOUND
WHEN IT WASN'T POSSIBLE TO
IDENTIFY ASSOCIATION FOR THE
OTHERS?
>>THAT'S AN EXCELLENT QUESTION.
A LOT OF THIS I THINK WOULD
BE -- THINKING ABOUT -- I HAVE
TO THINK ABOUT THIS MORE AND
I'LL LOOK AT THAT SLIDE AND
THINK ABOUT WHAT IT IS THAT WE
ASSESS IN TERMS OF DIET QUALITY,
SO FOR VARIETY WE WERE LOOKING
AT SCORING ON INTAKE THE MEATS
AND EGGS, DAIRY AND BEANS.
SOME FRUITS AND VEGETABLES BUT
NOT SPECIFIED WHICH ONES, AND
PROTEIN COMING FROM DIFFERENT
SOURCES.
IT'S POSSIBLE THAT WHEN YOU HAVE
THAT KIND OF A SCORE, ON
VARIETY, YOU'RE ABLE TO -- THERE
ARE MANY SOURCES OF CADMIUM,
JUST BY EATING A VARIED DIET
YOU'RE ABLE TO LOWER CADMIUM
CONCENTRATIONS IN CHILDREN TO
SOME EXTENT.
I WILL SAY THESE ARE IN A LOT OF
WAYS PRELIMINARY RESULTS AND
WOULD HAVE TO BE CONFIRMED FOR
CHILDREN IN OTHER STUDIES.
URINARY CADMIUM IS A MARKER OF
LONG-TERM EXPOSURE, WE WERE
LOOKING AT DIET OVER A SHORTER
TERM, SO I THINK THERE'S A LOT
THAT STILL NEEDS TO BE WORKED
OUT THERE AND CONFIRMED BEFORE
WE CAN SAY, OKAY, WELL, THIS IS
THE TRUTH.
BUT LOOKING AT HOW THAT VARIETY
SCORE WAS DERIVED AND WHAT IT
REFLECTS, IT JUST MAY MEAN
CHILDREN WHO EAT A GREATER
VARIETY OF FOODS RATHER THAN
FOCUSING ON, YOU KNOW, ONE TYPE
OF FOOD OR ONE GROUP OF FOODS
ARE JUST -- JUST HAVE -- ARE
BETTER ABLE TO DEAL WITH CADMIUM
IN THEIR BODIES.
SO THAT'S MY PRELIMINARY ANSWER.
>>THANK YOU.
>>OTHER SHOULD FEEL FREE TO
JUMP IN.
AGAIN, I THINK IT NEEDS TO BE
CONFIRMED.
I'M KIND OF HEARTENED BY THE
FACT THAT IN THE U.S. NHANES IN
ADULTS THERE WAS ALSO -- WELL
THERE WAS NO CORRELATION WITH
HEALTHY EATING INDEX AND BLACK
CADMIUM BUT THAT NO CORRELATION
AGAIN I THINK CAN BE, YOU KNOW,
IT'S NOT A BAD RESULT.
I THINK IT COULD JUST MEAN THAT
WHEN YOU HAVE A VARIED DIET, YOU
DON'T GET ELEVATED CADMIUM
LEVELS.
THERE'S SOME CONSISTENCY THERE
BUT WITH TWO STUDIES I THINK WE
NEED TO EXPLORE THAT A LITTLE
BIT MORE.
>>THAT'S A RUNNING THEME TODAY.
WONDERFUL.
THIS QUESTION IS GOING TO BE FOR
DR. DESAI, FRUITS AND
VEGETABLES.
MY EXPERIENCE WITH THE DIETARY
GUIDELINES AND HOW CORE FRUIT
AND VEGETABLE INTAKE WITH ITS
RELATIONSHIP FOR DECREASED RISK
OF MULTIPLE DIET-RELATED CHRONIC
DISEASE OUTCOMES ESPECIALLY
CANCER, I'M THINKING ABOUT LIFE
STAGES.
AND HOW WE CONSIDER ROLE OF
NUTRIENT DENSE FOOD LIKE FRUITS
AND VEGETABLES IN HEALTH WHILE
ALSO ACCOUNTING FOR THE EFFECTS
OF ENVIRONMENTAL CONTAMINANTS
THAT THESE FOODS MAY BE A SOURCE
OF.
>>VERY GOOD QUESTION.
THANK YOU.
I THINK ONE CONSIDERATION WE
NEED TO HAVE IS THAT LIKE WE SAW
THERE ARE SEVERAL FRUITS AND
VEGETABLES THAT ARE GIVING US
THE SAME NUTRIENTS BUT THEY
CONTAIN THE SAME OR DIFFERENT
TOXICANTS.
SWEET POTATOES ARE MORE LIKELY
TO CONTAIN TOXICANTS SUCH AS
LEAD, AS COMPARED TO PEAS, BOTH
GREAT SOURCES OF IRON.
MAKING SURE THAT WE EAT A
DIVERSE DIET IS IMPORTANT SO WE
GET THE NUTRIENTS THAT WE NEED,
WITHOUT GETTING HIGHLY EXPOSED
TO SOME SPECIFIC TOXICANT.
I THINK THE BASELINE IS KIND OF
THE SAME AS WHAT THE OTHER
SPEAKERS ARE SAID THAT FOCUSES
ON DIVERSE DIET IS KEY.
>>WONDERFUL.
THANK YOU.
THESE ARE GOOD THINGS TO HEAR
OVER AND OVER AGAIN.
IT'S REALLY HELPFUL.
NOW I'M GOING TO SPEAK TO SOME
QUESTIONS THAT ARE MORE BROAD,
MAYBE THINGS THAT MANY OF YOU
WOULD LIKE TO CONTRIBUTE TO
ANSWERING.
THE FIRST QUESTION IS REALLY
ABOUT NUTRIENTSES WITH RESEARCH
GAPS.
WHICH STAND OUT AS AN AREA
RESEARCH SHOULD FOCUS MORE
INTENTRY REGARDING WHAT THEIR
ROLE MAY OR MAY NOT MODULATING
CONTAMINANTS FOR PURPOSES OF
PROMOTING CHILD DEVELOPMENT OR
HEALTH ACROSS THE LIFESPAN?
WHO WOULD LIKE TO START?
WHICH NUTRIENTS, IF YOU COULD
PROMOTE CERTAIN NUTRIENTS FOR
WHICH YOU THINK WE SHOULD STUDY
MORE DEEPLY FIRST, WHICH SHOULD
WE LEAN TOWARDS?
>>IT'S A TOUGH ONE.
I'LL GIVE IT A TRY.
IN THE FIRST SESSION WE HEARD
TWO SPEAKERS TALK QUITE A LOT
ABOUT IRON, THEY TALKED ABOUT
IODINE.
VITAMIN D AND CALCIUM.
I THINK IRON SORT OF CAME
THROUGH AS A THEME THROUGHOUT
BOTH PRESENTATIONS AND
PREGNANCY.
AND INFANCY.
IT REMAINS AN IMPORTANT NUTRIENT
TO STUDY BECAUSE IT IS SO
CRITICAL.
THEY ALSO MENTIONED A COUPLE
OTHER THINGS THAT WERE NOT WELL
STUDIED WHERE WE, FOR EXAMPLE,
HAVE INFORMATION OR WE HAVE SET
ADEQUATE INTAKE LEVEL BUT NO
RDA.
IODINE WAS MENTIONED THERE.
BUT ALSO SOME FATTY ACIDS.
AND OTHER NUTRIENTS IMPORTANT
FOR NEURAL DEVELOPMENT.
SO, I WOULD CERTAINLY CALL THOSE
OUT.
CHOLINE WAS MENTIONED BY ONE OF
THE SPEAKERS IN THE FIRST
SESSION.
SO, I THINK WE STILL HAVE MORE
TO LEARN ABOUT THE USUAL
SUSPECTS AT NUTRIENTS SUCH AS
IRON BUT DEFINITELY A LOT OF
THINGS MENTIONED IN THE FIRST
SESSION ARE NOT VERY WELL KNOWN
IN TERMS OF HOW THEY INTERACT
WITH TOXIC ELEMENTS AND WE WOULD
WANT TO KNOW THAT.
SO, THOSE ARE SOME OF THE ONES I
HIGHLIGHTED ALREADY.
>>A FOLLOW-UP QUESTION TO THAT
ONE IN A MINUTE.
LET ME SEE WHAT THE OTHER
PRESENTERS THINK AS FAR AS IF
THERE'S ANY CERTAIN NUTRIENTS
THAT STAND OUT TO YOU OF THE
ONES THAT HAVE BEEN MENTIONED.
>>I AGREE WITH WHAT KASIA AND
OTHERS SAID BUT I WOULD LIKE TO
PUT IN A PLUG FOR BEING ABLE TO
TEST MULTIPLE ELEMENTS WHICH
WERE ALSO MENTIONED, ELEMENTS
AND NUTRIENTS, AND OTHER DIETARY
COMPONENTS BECAUSE TESTING HAS
BECOME MUCH EASIER.
WE HAVE MORE UNTARGETED AND
TARGETED APPROACHES.
COSTS ARE COMING DOWN.
SOMETIMES WE'RE SURPRISED.
THAT'S WHAT I FIND BEING AN
EPIDEMIOLOGIST.
IT'S NOT ALWAYS WHAT I THINK OR
SET OUT TO DO.
AND THE REALITY IS WE MAY FIND
THAT THE PRESENCE OF CERTAIN
NUTRIENTS MAKE TOXICANTS MORE
HARMFUL.
WE DON'T WHAT DIRECTION THESE
ARE GOING IN.
TO TEASE APART ALL THE DIFFERENT
FACTORS I ENCOURAGE US TO ALSO
DO OUR TARGETED
HYPOTHESIS-DRIVEN WORK BUT ALSO
KEEP AN OPEN MIND AS WELL TO
EMERGING CONTAMINANTS SUCH AS
PFOS IN SEAFOOD, FOR EXAMPLE.
SO I'LL JUST PUT IN A PLUG FOR
THAT.
>>THANK YOU.
ALEJANDRA, ADDITIONAL THOUGHTS?
>>YES.
I WANT TO ADD THAT IT IS
IMPORTANT IN THE CASE OF SEAFOOD
WE HAVE OMEGA-3 FATTY ACIDS,
SUPER FOOD IN MANY COHORT
STUDIES, WE KNOW THAT ADVANTAGES
OF CONSUMING THEM.
BUT I THINK THE BEST THING IS
CONSUMED NOT ONLY THE OMEGA 3
SUPPLEMENT FOR EXAMPLE BUT
INSTEAD THE FOOD, THE SEAFOOD,
BECAUSE AS WE SAW IT'S ALSO
CONTAINS ANOTHER IMPORTANT
COMPONENT AND NUTRIENTS HEALTHY
CHILDREN OR PREGNANT WOMEN IN
DIFFERENT FUNCTION AND
INFLAMMATION, AND ANTIOXIDANTS,
AND NEURAL COGNITIVE PROTECTION,
ET CETERA.
IN THE OTHER PART, WE HAVE
STUDIOUS IN MEXICO, IS THAT MORE
THAN NUTRIENT WE SHOULD BE
STUDYING THOSE PREGNANT WOMEN OR
CHILDREN WITH DEFICIENT OR LOW
NUTRITIONAL STATUS, DEFICIENT -
I MEAN ANEMIA, LOW SELENIUM,
STUNTING OR UNDERNUTRITION
BECAUSE THOSE CHILDREN OF
PREGNANT WOMEN WITH CONDITIONS
LIKE ANEMIA AND DEFICIENCY ARE
THE MOST AFFECTED BY CONSUMING
TOXICANTS IN ANY FOOD BECAUSE
THEY CAN ABSORB MORE, ESPECIALY
CHILDREN.
THAT'S ANOTHER AREA WE SHOULD
KEEP LOOKING AT, NOT ONLY IN
COUNTRIES LIKE MEXICO BUT ALSO
IN U.S. BECAUSE WE HAVE SOME
DISPARITIES ALSO THERE.
>>GREAT.
THANK YOU.
>>ALONG THE LINES OF WHAT
MARGARET SAID, IN THAT STUDYING
INTERACTIONS IS SOMETHING WE
REALLY NEED BECAUSE WE EAT
MULTIPLE FOODS AND NUTRIENTS
THAT INTERACT, NUTRIENTS AND
TOXICANTS INTERACT WITHIN THE
BODY.
THAT'S WHAT WE REALLY GOING
FORWARD SHOULD LOOK AT.
>>PIGGYBACKING ON THAT, FROM
THE STUDIES THAT YOU PRESENTED
LOOKING AT DIETARY PATTERNS AND
DIET QUALITY DO YOU HAVE SOME
THOUGHTS ON WHAT THE NEXT STEPS
WOULD BE TO NOT JUST REPLICATE
THESE IN OTHER POPULATIONS AND
DIFFERENT VULNERABLE GROUPS BUT
WHAT WOULD YOU LIKE TO SEE AS
NEXT STEPS BEING ABLE TO LOOK AT
DIETARY EXPOSURES AND OUTCOMES
PARTICULARLY THOSE RELATED TO
VULNERABLE POPULATIONS LIKE
CHILD BIRTH AND DEVELOPMENT?
>>THAT'S A REALLY GOOD
QUESTION.
AND YOU STUMPED ME ON DON'T
REPLICATE.
>>WE ALWAYS WANT TO REPLICATE.
>>WELL, IT'S HARD NOT TO WANT
TO REPLICATE WHEN WE'VE HAD SO
FEW STUDIES, SO FAR.
WE'VE HAD SOME IN YOUNGER
CHILDREN, SCHOOL CHILDREN,
VULNERABILITY OCCURRING AMONG
THE EARLY LIFE CONTINUUM
INCLUDING PREGNANCY.
SO I WOULD WANT TO SEE MORE
STUDIES, OF THIS TYPE, JUST TO
UNDERSTAND IS THIS REAL, IS THAT
WHAT WE CAN BE RECOMMENDING?
BUT ALSO, SO FAR WE'VE SORT OF
SAID OKAY, THERE'S AN
ASSOCIATION BETWEEN THE TYPES F
FOODS OR PATTERNS CHILDREN,
PREGNANT WOMEN, ARE CONSUMING,
LEVELS OF LEAD OR CADMIUM OR
WHAT HAVE YOU.
SO, BUT REALLY THE QUESTION AND
THE ROLE OF DIET REMAINS
UNANSWERED.
I SHOWED TWO STUDIES, BOTH IN
ADULTS.
SO WHEN YOU HAVE DUALITY AGAIN
OF THE SAME DIET IS DELIVERING
BENEFICIAL NUTRIENTS, BUT ALSO
DELIVERING POTENTIALLY HARMFUL
EFFECTS OF TOXICANTS, WE REALLY
NEED TO UNDERSTAND WHAT ROLE
DOES THIS PLAY.
WILL THE NUTRIENTS MODERATE IN A
POSITIVE WAY?
WILL THEY BUFFER OR HELP
CHILDREN'S DEVELOPMENT?
WILL QUALITY DIETS PLAY THIS
BUFFERING OR MODERATING ROLE?
I THINK THAT'S AN IMPORTANT
QUESTION THAT NEEDS TO BE
ANSWERED.
AT THE SAME TIME THAT OTHERS ARE
WORKING ON LOWERING THESE TOXIC
ELEMENTS IN FOODS TO BEGIN WITH.
SO, I THINK THERE'S A LOT OF
WORK ON MANY FRONTS.
I DON'T KNOW IF THIS IS A
SATISFY ANSWER TO YOUR QUESTION.
SATISFACTORY ANSWER TO YOUR
QUESTION.
BUT I'M SURE OTHERS WILL HAVE
THINGS TO ADD AS WELL.
>>DO OTHERS HAVE ADDITIONAL
THINGS TO ADD THERE?
WHAT YOU WOULD LIKE TO SEE TO
REALLY BETTER LOOK AT THE
HOLISTIC PICTURE OF EXPOSURE AND
OUTCOMES?
>>RESPECT TO REPLICATION, THERE
ARE STUDIES GOING ON IN THE
UNITED STATES RIGHT NOW, THE
LARGE ECHO COHORT CONSORTIUM,
ENVIRONMENTAL INFLUENCES ON
CHILD HEALTH OUTCOMES.
THAT'S PLACE WE MAY BE ABLE TO
TAKE A NATIONAL LOOK AT
DIFFERENT VULNERABLE AND
SUSCEPTIBLE POPULATIONS.
I DON'T KNOW IF WE CAN ADDRESS
THE SUBGROUPS BUT THERE MAY BE
SOME.
IT'S OUR BEST CHANCE OR BETTER
CHANCE OF LOOKING AT CONSISTENCY
ACROSS STUDIES AND LOOKING AT
RARE EXPOSURES AND OUTCOMES.
>>ANY OTHER THOUGHTS?
ALL RIGHT.
NEXT QUESTION IS REALLY ABOUT
THE LACK OF BIOMARKER DATA IN
INFANTS.
AND I HEARD SEVERAL PRESENTERS
TODAY TALK ABOUT LACK OF
BIOMARKER DATA IN INFANTS.
WE DO HAVE A PILOT PROJECT
THAT'S BEEN FUNDED THROUGH
MULTIPLE AGENCIES IN THE FEDERAL
GOVERNMENT TO WORK WITH NHANES
TO PILOT TO SEE IF THEY CAN GET
BLOOD VALUES, BLOOD DRAW FROM
INFANTS.
THAT WAS UNFORTUNATELY
INTERRUPTED BY THE COVID
PANDEMIC WHEN IT WAS GOING IN
THE FIELD TO TEST.
WE'RE WAITING TO GET BACK IN THE
FIELD.
WHILE WE'RE WAITING TO SEE IF WE
CAN GET BLOOD VALUES FROM
INFANTS, I WANT TO ASK WHAT ELSE
IN ADDITION TO BLOOD WOULD BE
HELPFUL HERE TO HAVE BIOMARKER
DATA FOR INFANTS FOR THIS TOPIC?
>>FOR EXAMPLE IN THE CASE OF
MERCURY, IT'S EASY TO HAVE A
HAIR SAMPLE.
IT'S NOT SO INVASIVE IN SMALL
CHILDREN.
YOU CAN MEASURE THE AMOUNT OF
METHYLMERCURY OF CHILDREN AND
COMPARE WITH REFERENCE VALUES
ACCORDING TO EPA.
ALSO WHAT WE TRY TO DO FOR
EXAMPLE IN MEXICO WHERE LEAD
TOXICITY IS HIGH, WE DON'T TAKE
BLOOD SAMPLES IN NEWBORNS.
BUT WE CAN MEASURE LEAD IN THE
CORD BLOOD.
SO IT'S A PROXY OF AMOUNT OF
EXPOSURE IN NEWBORNS.
AROUND 17% OF OUR CHILDREN ARE
BORN WITH LEAD LEVELS ABOVE 5
MILLIGRAMS PER DECILITER, THE
REFERENCE VALUE.
WE CAN HAVE OTHER OPTIONS.
I KNOW THAT'S, WELL, KASIA IS
THE EXPERT.
ARSENIC CAN BE MEASURED IN
URINE.
IT'S ANOTHER WAY.
IT'S NOT INVASIVE, RIGHT?
IT'S NOT ALWAYS BLOOD, WHAT I
MEAN.
WE HAVE ANOTHER OPTION.
AND WE CAN MEASURE OTHER THINGS
THAT ARE AFFECTING CHILDREN
BECAUSE IT'S NOT ONLY METALS, IN
URINE YOU CAN MEASURE
PTHALLATES, BPA, WELL
RECOGNIZED.
>>THANK YOU.
OTHER THOUGHTS?
>>I'LL SECOND THE URINE, WHICH
IS SOME DATA I PRESENTED.
I WANTED TO MENTION THE
IMPORTANCE OF SPECIATING ARSENIC
AND WE'RE LOOKING AT SPECIATING
OTHER ELEMENTS AS WELL,
DIFFERENT FORMS THAT MAY HAVE
DIFFERENT TOXICITIES.
FOR ARSENIC THERE ARE SPECIES WE
DON'T EVEN KNOW WHAT THEIR
TOXICITY IS.
SOME OF THEM PRODUCED BY OUR
MICROBIOME INCLUDING FOUND IN
SEAWEEDS, SOME ARSENIC OR
SUGARS.
VERY BASIC LEVEL IT'S IMPORTANT
TO SPECIATE AND URINE DOES A
GOOD JOB.
WE'VE MEASURED TOENAIL
CLIPPINGS.
YOU CAN SEE TRANSFER OF SOME
NUTRIENTS AND TOXICANTS FROM
PREGNANT PERSONS TO INFANTS BY
MEASURING AND COMPARING TOENAIL
CONCENTRATIONS, EASY TO COLLECT,
USEFUL, PICK UP LEAD, MANGANESE,
SELENIUM, CADMIUM IN NAIL
TISSUE.
THEY ARE NOT EXPENSIVE TO
COLLECT EITHER.
I'M ALWAYS MINDFUL OF THAT IN
RESEARCH STUDIES.
>>NOT TIME CONSUMING TO TAKE
NAIL CLIPPING EITHER, REALLY
IMPORTANT FOR NHANES TO COLLECT
DATA.
WONDERFUL.
THE NEXT QUESTION I HAVE IS KIND
OF A DIETARY PATTERNS QUESTION
BUT ALSO REALLY SPEAKS TO GUARI
AND MARGARET'S PRESENTATION
SINCE THEY SPOKE ABOUT PLANT
FOODS.
AND I WANTED TO ASK ABOUT THE
THOUGHTS YOU MIGHT HAVE ABOUT
THE GROWING TREND AND
ENCOURAGEMENT OF PLANT-BASED
DIETS AND HOW THAT MIGHT
INTERSECT WITH POTENTIAL
INCREASES IN TOXIC ELEMENT
UPTAKE BUT ALSO SHIFT NUTRIENT
INTAKE, PARTICULARLY HOW THIS
MAY AFFECT YOUNG CHILDREN.
WHAT ARE SOME OF THE
CONSIDERATIONS RELATED TO DIETS
MORE PLANT BASED AND LESS ANIMAL
BASED, RELATED TO TOXIC ELEMENT
EXPOSURE AND NUTRIENTS?
>>WE NEED TO CONSIDER SEVERAL
OUTCOMES THINKING ABOUT PLANTS
VERSUS ANIMAL-BASED DIETS.
KASIA SHOWED DATA REGARDING
PLANT-BASED DIETS AND COMMENTED
EVEN AMONG ADULTS WE'VE SEEN
POSITIVE RELATIONSHIPS WITH
HEALTH OUTCOMES.
THAT ARE POSITIVES WE NEED TO
CONSIDER.
WHEN WE'RE TALKING ABOUT
TOXICANT EXPOSURES, FROM PLANTS
OR PLANT-BASED FOODS, I THINK
AGAIN GOING BACK TO THE DIETARY
DIVERSITY, IS KEY.
IF WE LOOK AT ANIMAL-BASED DIETS
AS WELL, WE HAVE EVIDENCE THAT
SHOWS THOSE ARE ASSOCIATED WITH
TOXICANT EXPOSURE.
IT IS THERE.
WE DO NEED TO LOOK AT THE BIG
PICTURE, DIFFERENT OUTCOMES, AND
FOCUS ON DIETARY DIVERSITY IS MY
TAKE ON THAT.
>>THOUGHTS?
>>I CAN ADD A COUPLE THOUGHTS.
SO, FROM A NUTRITIONAL
STANDPOINT, OBVIOUSLY IN SESSION
1 WE HEARD HOW IRON IS CRITICAL
FOR EARLY LIFE DEVELOPMENT.
AND PLANTS ARE MOSTLY SOURCES OF
NON-HEME IRON, WHICH IS COMPLEX
AND IS MORE DIFFICULT TO ABSORB.
SO, THAT WOULD BE SOMETHING TO
THINK ABOUT TO TAKE INTO ACCOUNT
WHEN FOCUSING ON PLANT-BASED
DIETS.
OBVIOUSLY THERE'S, YOU KNOW,
DIFFERENT TYPES OF PLANT-BASED
DIETS, FROM JUST INCLUDING MORE
FRUITS AND VEGETABLES IN A
REGULAR DIET TO BEGIN WITH,
GOING ALL THE WAY TO TO VEGETA,
PALEO, VEGAN, UNCOOKED FRUITS
AND VEGETABLES, THE RANGE IS
WIDE ENOUGH IT'S HARD TO HAVE A
SINGLE ANSWER TO THAT QUESTION.
AND AGAIN IT DEPENDS WHAT WE'RE
TALKING ABOUT.
I AGREE WITH EVERYTHING THAT
GUARI SAID, ADDING THE THOUGHT
ON IRON TO THE MIX AND THEN SORT
OF HIGHLIGHTING THE FACT THAT
THERE ARE DIFFERENT PLANT-BASED
DIETS AND MAKING DIFFERENT
THINGS.
>>ANYTHING ELSE ANYONE WANTS TO
ADD?
ONE FINAL QUESTION, AN
OPPORTUNITY FOR YOU TO ADD ANY
ADDITIONAL THOUGHTS THAT YOU
HAVE THROUGHOUT THE DAY TODAY
THAT YOU MAY NOT HAVE BEEN ABLE
TO SHARE OR EVEN AS IMPORTANT TO
REITERATE POINTS THAT YOU HAVE
HEARD THAT YOU'VE MADE TODAY
THAT YOU THINK ARE PARTICULARLY
RELEVANT AS WE MOVE FORWARD IN
THIS DISCUSSION.
IT'S REALLY ABOUT WHAT YOU SEE
AS OPPORTUNITY TO FILL GAPS IN
SCIENCE BASE TO SUPPORT MORE OF
AN INTEGRATED APPROACH TO
EFFECTS OF EXPOSURE, NUTRIENT
AND TOXICANT EXPOSURES OF FOOD
ON HEALTH.
WHO WOULD LIKE TO START?
MAYBE HIGH POINTS THAT YOU
REMEMBER FROM YOUR TALK OR FROM
THE TALK OF OTHERS, OR MAIN
TAKEAWAYS ON WHAT OPPORTUNITIES
ARE TO FILL THESE GAPS.
WHAT WOULD YOU LIKE TO SEE?
>>WELL, I WOULD LIKE TO START.
>>PLEASE DO.
>>JUST TO COMMENT ON SOMETHING,
SOMETIMES WHEN PEOPLE IN GENERAL
CARE ABOUT, OKAY, RICE HAS
ARSENIC, SEAFOOD HAS MERCURY, SO
WE DON'T KNOW, WE DON'T HAVE
GOOD ADVICE FOR THE POPULATION
OR CLEAR ADVICE FOR THE
POPULATION, WHICH TYPE OF
SEAFOOD, WHICH ONE YES, WHICH
ONE NO, BUT INSTEAD SOME PEOPLE
START TO CHANGE THESE HEALTHY
FOODS LIKE SEAFOOD OR WHOLE
GRAIN CEREALS, START CONSUMING
PRODUCTS WHICH CONTAINS A LOT OF
THINGS LOW IN SOME
MICRONUTRIENTS, ALSO PRODUCTS
CAN CONTAIN A LOT OF TOXICANTS
AS WE HAVE SEEN IN STUDIES OF
THE BABY FOODS WHICH I CONSIDER
SOME OF THEM ARE CONSIDERED
ULTRA PROCESSED PRODUCTS, AND
ALSO CONTAIN LEAD OR MAYBE
ARSENIC OR MAYBE CADMIUM SO WE
HAVE TO BE CAREFUL ON HOW TO
TRANSMIT ALL MESSAGES TO THE
POPULATION ABOUT WHAT TO EAT,
WHICH AMOUNTS, HOW TO COMBINE
FOODS.
I THINK THAT ALREADY KASIA
MENTIONED THIS.
BUT IT'S IMPORTANT TO HAVE NOT
THE SAME FOODS ALL THE DAYS BUT
INSTEAD OF MAKE THIS VARIATION
BETWEEN FRUITS, VEGETABLES,
SEAFOODS, MEATS, DAIRY PRODUCTS,
ET CETERA.
SO, TAKING THIS DIET, YOU
CANNOT -- IT'S LESS POSSIBLE TO
EXCEED THE AMOUNT OF TOXIC IN
THE DIET.
BUT ALSO TO BE VERY CAREFUL IN
THE MESSAGES THAT WE GIVE TO THE
POPULATION.
THIS IS VERY IMPORTANT BECAUSE
ALSO ULTRA PROCESSED PRODUCTS
ARE BABIES FOODS, PACKAGED, CAN
CONTAIN A LOT OF TOXINS WE START
KNOWING IN RECENT RESEARCH.
>>THANK YOU.
OTHERS?
WHAT ARE OPPORTUNITIES TO FILL
THE GAPS?
I'LL GO NEXT.
I REALLY LIKE THE KASIA'S LAST
SLIDE SUMMARIZING THE GAPS,
NICELY ARTICULATED AND
SUMMARIZED.
I DID WANT TO HIGHLIGHT ONE OF
THE FINDINGS THAT I SHOWED IN MY
PRESENTATION ON THE MICROBIOME.
PART OF THE REASON FOR THAT WAS
TO LOOK AT THOSE VERY EARLY
SIGNALS, NOT WAIT FOR COGNITIVE
DECLINE OR ADVERSE GROWTH
OUTCOME.
YOU KNOW, DOWNSTREAM CANCERS
EVEN.
BUT TO LOOK AT EARLY SIGNALS IS
AN OPPORTUNITY FOR US AND
RESEARCH TO CAPTURE AND
INTERVENE EARLY IN THE CASE OF
THE MICROBIOME, PRE OR
PROBIOTICS.
WE DO HAVE THAT OPPORTUNITY TO
LOOK EARLY ON.
AGAIN, YOU KNOW, AS TECHNOLOGIES
AND DISCOVERIES ARE BEING MADE,
THIS IS A PRIME TIME TO DO THAT
IN OUR RESEARCH.
THANKS.
>>OTHERS?
>>QUANTIFYING DISEASE BURDEN
THAT IS ATTRIBUTABLE TO DIETARY
EXPOSURES IS HARD.
BUT THAT IS SOMETHING THAT IS
NECESSARY AND DOING THAT WOULD
HELP US STRENGTHEN THE CASE FOR
REDUCING TOXICANTS AND
PREVENTING DIETARY TOXICANT
EXPOSURE.
SO I THINK THAT QUANTIFICATION
IS SOMETHING THAT WE DO NEED.
>>GREAT.
GUARI, ANY THOUGHTS?
I'M SORRY, KASIA?
WE'LL SKIP OVER.
>>I DON'T HAVE A LOT TO ADD.
I FEEL LIKE OTHERS DID A NICE
JOB SUMMARIZING OPPORTUNITIES.
WE'VE ALREADY COVERED A LOT OF
THE GAPS THAT WE FEEL ARE
IMPORTANT IN OUR PRESENTATIONS.
SO, I'LL SECOND WHAT THEY SAID.
PROBABLY DON'T HAVE ANY
ADDITIONAL POINTS TO ADD AT THIS
MOMENT.
>>ALL RIGHT.
WONDERFUL.
THANK YOU SO MUCH.
CAN'T SAY ENOUGH HOW MUCH I
ENJOYED HEARING YOUR
PRESENTATIONS.
HAVING THIS DISCUSSION WITH YOU
TODAY, AS I KNOW THE AUDIENCE
WATCHING TODAY DID.
AND ALEJANDRA'S POINT ABOUT
COMMUNICATION, I HOPE YOU'RE
ABLE TO TUNE IN TOMORROW TAKING
DISCUSSION ON THE SCIENCE OF
NUTRITION AND TOXIC ELEMENTS IN
FOOD ANOTHER STEP FORWARD TO SAY
HOW CAN WE LOOK AT BEHAVIORAL
AND COMMUNICATION SCIENCES AS A
WAY TO BRING THIS FULL CIRCLE
WHAT TO TELL PEOPLE TO EAT TO
BENEFIT HEALTH.
I'LL TURN IT OVER TO KIMBERLEA
GIBBS TO TAKE US TO BREAK BEFORE
A WRAP UP.
>>THANK YOU.
WE'LL HAVE A 15-MINUTE BREAK.
WE ASK THAT YOU WILL REJOIN US
FOR SESSION 3 AT 2:45.
>>THANK YOU FOR JOINING US FOR
SESSION 3.
MORNING, AFTERNOON OR EVENING.
IT'S MY PLEASURE TO INTRODUCE
THE MODERATOR FOR THE NEXT
SESSION, DR. JEAN HARRY, HEAD OF
NEURAL TOXICOLOGY LABORATORY,
NATIONAL INSTITUTE OF
ENVIRONMENTAL HEALTH SCIENCES AT
NIH.
RECEIVED HER Ph.D. AND
MASTER'S IN SCIENCE IN
EXPERIMENTAL PSYCHOLOGY, NEURAL
PHARMACOLOGY, FROM VIRGINIA
COMMONWEALTH UNIVERSITY,
TRAINING AT NORTH CAROLINA
CHAPEL HILL NEURAL TRAINING IN
BIOCHEMISTRY, HELD FACULTY
POSITIONS AT UNIVERSITY OF NORTH
CAROLINA AND DUKE UNIVERSITY,
EDITORIAL BOARD, ASSOCIATE
EDITOR FOR MULTIPLE NEUROSCIENCE
AND TOXICOLOGY JOURNALS,
CO-EDITED FIVE BOOKS AND
PUBLISHED OVER 130 PAPERS AND
CHAPTERS, SERVED AS EXPERT
REVIEWER FOR MULTIPLE
GOVERNMENTAL GUIDELINE DOCUMENTS
FOR HER FIELD AND HAS SERVED ON
NUMEROUS NATIONAL AND
INTERNATIONAL PANELS AS EXPERT
IN NEURAL TOXICOLOGY.
THANK YOU, DR. HARRY.
OVER TO YOU.
>>THANK YOU, KIMBERLEA.
I'M ASSUMING EVERYBODY CAN HEAR
ME.
THANK YOU FOR JOINING US TODAY.
IT'S BEEN A LONG DAY BUT A VERY
INTERESTING DAY.
I THINK WE'RE GOING TO COME INTO
THIS SESSION WHERE WE'RE GOING
TO TRY TO NOW TALK ABOUT WHAT
EXPERIMENTAL MODELS CAN PROVIDE
US IN UNDERSTANDING HUMAN
NUTRITION AND TOXICOLOGY
RESEARCH AS THEY ARE SO CRITICAL
FOR TRANSLATING INFORMATION
OVER.
I WOULD REALLY LIKE TO INTRODUCE
OUR TWO SPEAKERS FOR YOU TODAY,
FIRST IS DR. RITA STRAKOVSKY,
FROM MICHIGAN STATE UNIVERSITY,
ASSISTANT PROFESSOR IN
DEPARTMENT OF FOOD SCIENCE AND
HUMAN NUTRITION, AND WILL BE
SPEAKING ON CONSIDERATIONS FOR
INTEGRATING EXPERIMENTAL AND
EPIDEMIOLOGICAL RESEARCH
FINDINGS IN NUTRITION AND
TOXICOLOGY.
SECOND IS DR. HARRY DAWSON FROM
AGRICULTURAL RESEARCH SERVICES
AT THE USDA, A SENIOR SCIENTIST
AT THE DIET GENOMIC AND
IMMUNOLOGY LABORATORY SPEAKING
ABOUT THE GENOMIC BASED
COMPARATIVE ASSESSMENTS OF
POTENTIAL FOR MICE AND PIGS USED
AS MODELS IN RESEARCH.
FURTHER INFORMATION ON THE TWO
SPEAKERS FOUND ON THE WORKSHOP
WEBSITE.
PLEASE ALSO REMEMBER THAT THE
QUESTIONS AND COMMENTS CAN BE
SUBMITTED TO THE WORKSHOP E-MAIL
ADDRESS THROUGHOUT THE
PRESENTATION, AND WE WILL DEAL
WITH THOSE AT THE END.
PLEASE JOIN ME FOR WELCOMING OUR
FIRST SPEAKER, DR. RITA
STRAKOVSKY.
AND SHE WILL PROVIDE HER SLIDES.
THANK YOU FOR JOINING US.
>>THANK YOU, JEAN.
I'LL WAIT FOR THIS TO GO AWAY
AND THEN I THINK I CAN SHARE.
HOW ARE WE LOOKING?
GOOD?
I CAN'T TELL.
THANK YOU.
GOOD AFTERNOON.
IT'S REALLY A PLEASURE AND HONOR
TO BE HERE WITH YOU TODAY TO
SPEAK ON THIS REALLY IMPORTANT
TOPIC.
ESPECIALLY THANK THE ORGANIZERS
FOR ALLOWING ME TO SHARE USING
EXPERIMENTAL MODELS TO ADDRESS
QUESTIONS RELATED TO NUTRITION
OR TOXICOLOGY TODAY.
FIRST I'M NOT GIVING A REAL
RESEARCH TALK TODAY, I WILL
SHARE VERY LITTLE DATA ACTUAL.
WE'LL TALK ABOUT SOME CONCEPTS
INSTEAD.
I WANT TO THANK MY RESEARCH
GROUP FOR THEIR SUPPORT AND HARD
WORK, ALSO ALLOWING ME THE
OPPORTUNITY TO TALK ABOUT THESE
IMPORTANT TOPICS ON A REGULAR
BASIS WITH THEM.
TO PROVIDE CONTEXT TO YOU FOR
THIS WORKSHOP I WAS TASKED WITH
HIGHLIGHTING SOME CHALLENGES AND
OPPORTUNITIES IN USING
EXPERIMENTAL MODELS FOR RESEARCH
AND NUTRITION AND TOXICOLOGY.
CURRENTLY FOCUSING ON HUMAN
POPULATIONS, TRAINED AS BASIC
SCIENTIST, EXPERIMENTALIST, I
GUESS, AND REFLECT ON THAT
EXPERIENCE AS I DEVELOP
HYPOTHESES, INTERPRETING
FINDINGS IN STUDIES.
FOR MANY OF YOU THE INFORMATION
I WILL SHARE WILL NOT BE EARTH
SHATTERING.
IT'S A SUMMARY AND REVIEW.
I HOPE TO PROVIDE A BIT OF
PERSPECTIVE IN SOMETHING THAT
WILL LEAD TO DISCUSSION AT THE
END.
A BRIEF OVERVIEW OF THE
PRESENTATION, TWO BROAD TOPICS,
I'LL HIGHLIGHT SOME REASONS WHY
EXPERIMENTAL MODELS ARE CRITICAL
IN OUR FIELD AS WELL AS ISSUES
SURROUNDING INTERPRETATION OF
EXPERIMENTAL DATA.
I WILL PROVIDE A QUICK EXAMPLE
OF EXPERIMENTAL STUDY THAT
INCLUDES CHEMICAL EXPOSURES AND
NUTRITIONAL MODULATION, AND WILL
END BY PROVIDING SOME
RECOMMENDATIONS FOR REPORTING OF
THE RESULTING FINDINGS.
JUST TO GET STARTED, I DON'T
PLAN TO SHARE TOO MUCH DATA
SPECIFICALLY RELATED TO MY OWN
WORK BUT TO PROVIDE A BIT OF
INTRODUCTION FOR CONTEXT.
AS WAS HIGHLIGHTED TODAY, ALL
DAY, DIET IS AN IMPORTANT SOURCE
OF VARIOUS NON-NUTRITIVE
CHEMICALS.
COMPOUNDS WE STUDY TRAVEL WITH
FOOD SUPPLY IN OTHER WAYS, FOOD
PACKAGING MATERIALS, PREPARATION
METHODS, AND SOME OF THESE
INCLUDE BISPHENOLS, PTHALATES,
PARABENS AND OTHERS.
WE'RE ALSO INTERESTED IN
UNDERSTANDING DIETARY PATTERNS,
SPECIFICALLY, AS PRE-DISTRICTORS
OF CHEMICAL EXPOSURES AND
RELEVANT TO TODAYS WORKSHOP
INTERESTED IN DIETARY PATTERNS
OR QUALITY AS POTENTIAL
MITIGATORS OF EXPOSURES.
NOT NECESSARILY DIRECTLY RELATED
TO THOSE BEING DISCUSSED EARLIER
THIS MORNING, IN THE LAST
SESSION, I HOPE THAT THE
APPROACHES OR CONSIDERATIONS
WILL BE RELEVANT ACROSS VARIOUS
CHEMICAL EXPOSURES.
SPECIFICALLY, I'M INTERESTED BY
THE IDEA EXPERIMENT TO THE
RESEARCH CYCLE.
THIS IS JUST SOMETHING FOR US TO
THINK ABOUT TODAY.
WE CAN START ON THE RIGHT OR
LEFT.
YOU CAN THINK OF THE CYCLE AS
BEGINNING HERE ON THE RIGHT WITH
INTERESTING OBSERVATION,
EPIDEMIOLOGIC STUDY FOLLOWED BY
STUDIES IN ANIMAL MODELS, IF
WE'RE LUCKY IDEAL SITUATION WE
CAN GO BACK INTO THE POPULATION
STUDY TO ASK ADDITIONAL
QUESTIONS INSPIRED BY OUR
EXPERIMENTAL MODEL, PERHAPS TO
TEST A NEW BIOMARKER WE
IDENTIFIED IN EX VIVO OR ANIMAL
MODEL.
BEFORE I TALK BRIEFLY ABOUT WHAT
MAKES A GOOD EXPERIMENTAL MODEL
I WANT TO DISCUSS RELATED
CONSIDERATIONS RELATED TO THE
IMPORTANCE OF BOTH APPROACHES.
FOR MOST LEFT TO RIGHT MAKES
SENSE, USING ANIMAL MODEL IT'S
IMPORTANT TO BE DRIVEN BY HUMAN
DISEASES, OTHERWISE IT IS
IRRELEVANT IN MOST CASES WHEN IT
COMES TO HUMAN HEALTH.
THIS IS A FAMILIAR THING FOR
ANYONE WHO IS EXPERIMENT YAMIST
WHO WRITES GRANTS, YOU HAVE TO
HIGHLIGHT THESE FACTS.
NOT AS MANY OF US THINK ABOUT
GOING IN THE OPPOSITE DIRECTION,
WE'RE APPLYING WHAT WE LEARNED
FROM ANIMAL MODELS TO INSPIRE
STUDIES IN HUMAN POPULATIONS OR
TO JUSTIFY FINDINGS IN HUMAN
POPULATIONS.
WHY WOULD EPIDEMIOLOGISTS
STUDYING THE CORE PROBLEM OR
CORE SPECIES, HUMANS, RELY ON
ANIMAL MODELS?
WELL, IN REALITY, THE REASON IS
THAT OUR ABILITY TO DRAW CLOSER
TO CAUSE AND EFFECT OR WHAT WE
CALL CAUSAL INFERENCE RELIES ON
HIGH QUALITY EXPERIMENTAL DATA.
I THINK IT'S REALLY CRITICAL FOR
US TO BE ABLE TO COMMUNICATE
THAT FACT.
WE KNOW RCTs ARE THE GOLD
STANDARD, IT'S COMFORTING TO
THINK ALL POSSIBLE RISKS OR
UNCERTAINTY ARE BEING ADDRESSED
AS PART OF THE STUDY DESIGN.
AND RIGHT AROUND HALLOWEEN WAY
TO GROUP AND I SHARE THIS VERY
SPOOKY PUMPKIN.
NOTHING SCARIER THAN INFERRING
CAUSATION FROM CORRELATION,
RIGHT?
REALITY IS MOST EPIDEMIOLOGIC
STUDIES ARE NOT RCTs, AND IT
DOESN'T NECESSARILY MAKE THEM
BAD STUDIES, I HOPE WE'RE DOING
GOOD WORK.
EVEN IF WE'RE NOT DOING RCTs.
WE NEED TO UNDERSTAND HOW TO
APPROACH AND INTERPRET THEM.
FOR MANY OF US THIS IS WHERE THE
BRADFORD HILL CRITERIA COME IN,
REPRESENTING APPROACHES FOR
MOVING CLOSER TO CAUSAL
INFERENCE, AND IMPORTANTLY
SEVERAL RELY ON EXPERIMENTAL
MODELS.
FOR EXAMPLE AS WOULD MAKE SENSE
THE EXPERIMENTAL CRITERIA ASKING
DOES REMOVING CAUSE CHANGE THE
OUTCOME, CAN AND OFTEN DOES RELY
ON EXPERIMENTAL MODELS.
IN ADDITION TO OTHER POTENTIAL
EPIDEMIOLOGIC STUDIES.
AS DOES THE DOSE-RESPONSE
CRITERIA, WHICH WOULD MAKE
SENSE.
AS WELL AS SPECIFICITY CRITERIA.
IN THAT SENSE THERE'S GREAT
RESPONSIBILITY TO PROVIDE
HIGH-QUALITY DATA TO SUPPORT
POPULATION HEALTH STUDIES.
IN MY EXPERIENCE WHERE WE DO
HAVE SOME COMMUNICATION
BREAKDOWN AROUND THE VALUE OF
EXPERIMENTAL MODELS IS WHEN
EPIDEMIOLOGIC STUDIES AND
EXPERIMENTAL STUDIES DO NOT
NECESSARILY CORROBORATE ONE
ANOTHER.
WHAT HAPPENS THEN?
UNFORTUNATELY OFTEN OUR
IMMEDIATE ASSUMPTION IS THE
EXPERIMENTAL DATA ARE BAD.
BUT THAT ISN'T NECESSARILY TRUE,
OFTEN NOT TRUE.
SO, HERE'S A SIMPLE EXAMPLE
WHERE I'VE JUST PULLED APART THE
EXPERIMENTAL TO EPIDEMIOLOGIC
RESEARCH CYCLE TO ALIGN.
WE BEGIN WITH OBSERVATION AND
COHORT STUDY, THAT CHEMICAL Z
DECREASES HORMONE Y IN ADULT
MEN, HOPEFULLY THIS IS AN EASY
EXAMPLE FOR OTHERS.
THE COLLEAGUES,
EXPERIMENTALISTS, DEVELOP AN
EXCELLENT MODEL OF THE PHENOTYPE
TO INVESTIGATE VARIOUS
MECHANISMS WHICH PROVIDE
EXCELLENT INSIGHT FOR THE FIELD.
FOR EXAMPLE, THEY MIGHT STUDY
UNDERLYING EPIGENETIC BASIS FOR
OUR FINDING, OR THEY CAN PROVIDE
ADDITIONAL INFORMATION ABOUT
SPECIFIC HORMONE RECEPTORS
INVOLVED IN RESPONSE.
SO, THIS IS GREAT.
HOORAY.
AND THEN WE USING BOTH DATA WE
CAN ESTABLISH CHEMICALS Z IS
ENDOCRINE DISRUPTER.
THIS IS THE OPPOSITE OF WHAT WE
HYPOTHESIZED.
WE DO WHAT WE'RE TRAINED TO DO
AND SPEND A FEW SENTENCES OR
PARAGRAPHS DISCUSSING IN THE
DISCUSSION SECTION POLITELY
TIPTOEING AROUND THE IDEA THAT
POTENTIAL ISSUE WITH THESE
DISCREPANCIES IS EXPERIMENTAL
MODEL.
TRULY ARE THE EXPERIMENTAL DATA
BAD SCIENCE?
LIKELY NOT.
THEY ARE LIKELY GREAT SCIENCE
BUT POTENTIALLY JUST
INAPPROPRIATE FOR OUR QUESTION
TO BEGIN WITH.
NOW WE HAVE THIS LONG DISCUSSION
SECTION, VERY HIGH IMPACT PAPER,
EPIDEMIOLOGY, THAT PROVIDES
REASONS TO NOT TRUST
EXPERIMENTAL DATA.
WHAT COULD WE CONSIDER DOING
INSTEAD?
THE SOLUTION IS BETTER
COMMUNICATION TO BEGIN WITH.
SO I'M CERTAIN THERE ARE VARIOUS
APPROACHES BUT FIRST AS
EPIDEMIOLOGISTS WE COULD FIND
MORE COMPARABLE MODEL,
ADDITIONALLY USE DISCUSSION
SECTION TO HIGHLIGHT NEED FOR
APPROPRIATE MODELS.
WHETHER WE'RE SEARCHING FOR
ALTERNATIVES OR PROPOSING NEED,
HERE ARE A FEW IMPORTANT FACTORS
TO CONSIDER WHEN COMMUNICATING
FINDINGS AND COMPARING THEM TO
THE EXPERIMENTAL LITERATURE.
FIRST IS THE LIFE STAGES OF
EXPOSURE IN YELLOW.
FOR EXAMPLE, USING MY PREVIOUS
EXAMPLE, HORMONE METABOLISM IN
PREGNANT WOMEN IS ALIENATING,
USING DATA FROM CYCLING FEMALE
MICE TO MODEL CHEMICAL EXPOSURE
IN PREGNANT WOMEN IS LIKELY
INAPPROPRIATE.
AGE IS A CRITICAL CONSIDERATION
AS CHEMICAL OR NUTRIENT PATHWAYS
CHANGE, COMPARING FINDINGS IN
AGED RATS TO FINDINGS IN
CHILDREN WOULD ALSO BE
INCORRECT.
DOSE OF CHEMICAL OR NUTRIENTS
USED IN EXPERIMENTAL MODELS IS
OFTEN EASIEST TO REFLECT ON.
THIS IS MAYBE WHAT WE'RE TRAINED
TO DO INITIALLY OR AT FIRST.
MANY STUDIES ARE NOW MOVING
TOWARDS USING MORE HUMAN
RELEVANT EXPOSURES, BUT PLENTY
OF PRIOR STUDIES HAVE FOCUSED ON
PROOF OF CONCEPT EXPOSURES AND
OUTCOMES THAT OVERESTIMATE
EXPOSURES IN HUMANS.
ANOTHER IMPORTANT FACTOR TO
THINK ABOUT IS TIMING OF
EXPOSURE, CHRONIC OR ACUTE, DIET
PATTERNS, OR CHEMICAL EXPOSURES
IN HUMANS ARE QUITE CHRONIC.
SO AGAIN THIS MAY JUST NEED TO
BE REFLECTED UPON WHEN MAKING
COMPARISONS.
FINALLY WHERE WE HAVE ISSUES,
TRANSLATING TO SYSTEMIC
BIOMARKERS IN HUMANS, VERY EASY
TO MEASURE, SO FOR EXAMPLE
OBSERVING A CHEMICAL OR NUTRIENT
INDUCES OXIDATIVE STRESS OR
INFLAMMATION IN LIVER OF A
RODENT DOES NOT NECESSARILY
TRANSLATE INTO SYSTEMIC
INFLAMMATION IN HUMANS.
AND, AGAIN, IT DOESN'T MEAN
EITHER IS NOT HAPPENING OR THAT
EITHER EXPERIMENTAL OR
EPIDEMIOLOGIC STUDY ARE
INCORRECT.
IT JUST MEANS THAT COMPARISON IS
INAPPROPRIATE.
WITH THESE FACTORS IN MIND, I
DIDN'T HAVE TO MAKE A NEW
FIGURE.
THIS IS A SUMMARY FIGURE FROM A
REVIEW WE WROTE SEVERAL YEARS
AGO HIGHLIGHTING FUTURE
DIRECTIONS FOR RESEARCH RELATED
TO TRANSLATING PLACENTAL
FINDINGS ACROSS EXPERIMENTAL AND
EPIDEMIOLOGIC STUDIES,
SPECIFICALLY RELATED TO RESEARCH
IN ENDOCRINE DISRUPTING
CHEMICALS, WHAT I STUDY.
THIS IS SOMETHING I'VE BEEN
REALLY INTERESTED IN, AGAIN
MAKING THE TRANSITION FROM BEING
SOMEONE WHO DOES EXPERIMENTAL
WORK TO EPIDEMIOLOGY, AND THIS
ALLOWED US TO THINK THROUGH OUR
APPROACH.
SOME FACTORS WE PROPOSED HERE
ARE CRITICAL, SPECIFIC TO
PLACENTA, SEVERAL UNIVERSAL.
CONSIDERING EXTENSIVE RANGES OF
EXPOSURE IN LINE WITH HUMAN
EXPOSURES, I MENTIONED THAT
ALREADY.
WE RECOMMENDED ANIMAL MODELS
SHOULD FOCUS ON MODELING
OUTCOMES OBSERVED IN HUMANS AND
SURPRISINGLY THIS WASN'T THE
CASE FOR PAPERS WE REVIEWED AND
HIGHLIGHTED CONSIDERING
PLACENTAL SEX.
AS WITH ANY KIND OF ANIMAL
MODEL, OR TISSUE, THE PLACENTA
HAS A SEX.
PREGNANCY RESULTING IN A MALE
HAVE A MALE PLACENTA, FEMALE
WITH FEMALE.
UNDERSTANDING SEX DIFFERENCE IS
CRITICAL, NOT ADDRESSED IN MOST
STUDIES.
WITH THIS FIGURE, I THOUGHT THIS
WOULD BE A GOOD PLACE TO END THE
FIRST INTRODUCTORY PORTION TO
THE IMPORTANCE OF ANIMAL MODELS
AND CONSIDERING WHAT WE NEED TO
THINK ABOUT WHEN USING AND
INTERPRETING ANIMAL MODELS IN
THE CONTEXT OF EPIDEMIOLOGIC
STUDIES.
I HOPE IT PROVIDED SOME IMPETUS
FOR EVALUATING EXPERIMENTAL DATA
MORE CRITICALLY AND THOUGHTFULLY
AND THAT'S SOMETHING THAT I WILL
TALK ABOUT NEXT.
SO, SORT OF USING AN EXAMPLE,
AGAIN RATHER THAN SHOWING SCARY
AMOUNT OF REAL DATA, I CREATED A
MOCK FINDING REPRESENTING MANY
OF THE DATA WE PUBLISHED AS I
WAS TRAINING AND I'LL SHOW SOME
OF THE MANUSCRIPTS FROM THIS
WORK.
SPECIFICALLY THIS FIGURE
REPRESENTS FINDINGS FROM A
RELATIVELY SIMPLE BUT COMMON
STUDY DESIGN IN WHICH ANIMALS,
IN THIS CASE MY FAVORITE SPRIG
DAWLEY, THIS DESIGN CAN BE
APPLIED AT ANY LIFE STAGE.
THE Y-AXIS OR FINDING OF
INTEREST REPRESENTS VERY BAD
THING, IN MY CASE WE WORK IN
METABOLIC OUTCOMES, THIS COULD
BE ELEVATED GLUCOSE LEVELS OR
ADIPOSITY.
HIGHER NUMBER IS MORE
DELETERIOUS FINDING.
BARS ON THE LEFT, TWO BARS,
REPRESENTATIVE ANIMALS CONSUMING
A STANDARD GOOD DIET, WITH NO
CHEMICAL EXPOSURE ON THE LEFT,
AND CHEMICAL EXPOSURE IN BLUE
BAR TO THE RIGHT OF THAT.
BARS ON THE RIGHT REPEAT THE
PARADIGM EXCEPTION CONSUMING BAD
DIET, TYPICAL TWO BY TWO STUDY
DESIGN, TWO FACTORS, TWO LEVELS
OF EACH FACTOR.
TWO LEVELS OF DIET, TWO LEVELS
OF TOXICANT.
REALLY THE MOST INTERESTING
GROUP TO THOSE OF US WHO USE
THIS KIND OF STUDY DESIGN IS THE
ONE ALL THE WAY ON THE RIGHT.
NOW IN YELLOW.
IT REPRESENTS ANIMALS THAT HAVE
THE DOUBLE BURDEN OF CHEMICAL
EXPOSURE AND DIET.
WITH HYPOTHESIS THE TWO
EXPOSURES WOULD HAVE A
CUMULATIVE EFFECT.
IF YOU ARE LUCKY AND SAID YOUR
PRAYERS JUST RIGHT, YOU MIGHT
SEE A SYNERGISTIC EFFECT,
ESSENTIALLY TWO FACTORS COMBINE
WOULD MAYBE HAVE EVEN HIGHER
EFFECT THAN EACH INDIVIDUALLY.
SO, AS I MENTIONED, THE PREVIOUS
GRAPH REPRESENTATIVE OF THE DATA
THAT WE PUBLISHED FROM THESE
STUDIES AND SPECIFICALLY I'M
SHOWING EXAMPLES OF TWO OF THEM.
AGAIN IN OUR SPRAGUE-DAWLEY
RATS, UNDERSTANDING PRENATAL
EXPOSURE TO ONE OF THE TWO
CHEMICALS, BISPHENOL A AND
PTHALATES, WANTING TO UNDERSTAND
HOW FACTORS INTERACT WITH DIET
POSTNATAL AND POTENTIAL SEX
DIFFERENCES.
SO CHEMICAL EXPOSURE COMING BACK
TO EPIDEMIOLOGIC EXPERIMENTAL
CYCLE, EXPOSURES ARE GOOD
EXAMPLES OF ENDOCRINE
DISRUPTERS, SPECIFICALLY
METABOLIC, WHY OUR ENDPOINTS OF
INTEREST WERE METABOLIC.
CHEMICAL EXPOSURES THAT WE
MODELED RELATED TO THOSE TO
WHICH HUMANS AND PREGNANT WOMEN
WITH UBIQUITOUSLY EXPOSED FROM
THE FOOD SUPPLY INCLUDING BPA
FROM HARD PLASTICS, DEHP FROM
FLEXIBLE PLASTICS USED IN FOOD
STORAGE AND PRODUCTION.
THE DIET WAS MEANT TO ADD
ADDITIONAL LAYER BY MODELING
DIET CONSUMED IN THE U.S.
ESPECIALLY.
WE BASED OUR HIGH HIGH POTENTIL
HIGH -- HYPOTHESES
ON PREVIOUS STUDY, BOTH
COMPOUNDS WERE PROPOSED
OBESEOGENS, INTERESTED IN USING
STUDY TO UNDERSTAND UNDERLYING
MECHANISM OF THE CHEMICALS'
ACTION.
FOR BPA ON THE LEFT, WE LOOKED
AND PUBLISHED ON EPIGENETIC
MECHANISMS, FOR PTHALLATE ON THE
RIGHT EVALUATED AND PUBLISHED ON
VERY EXTENSIVE PHENOTYPING OF
ADIPOSE TISSUE IN ACROSS THE
STUDY.
BASED ON PRIOR STUDIES,
SHOWING -- BASED ON PRIOR
EPIDEMIOLOGIC STUDIES, SHOWING
THERE WERE SEXUAL MORPHISMS,
RECORDED ON SEXUALLY DIMORPHIC
EFFECTS, SIMILAR TO COMBINED
EPIDEMIOLOGIC EXPERIMENTAL CYCLE
I SHOWED A FEW SLIDES AGO.
A LOT GOES INTO DEVELOPING A
STUDY, THE STUDY AND MODEL I
JUST DESCRIBED AND THESE FACTORS
SHOULD BE THOUGHTFULLY REPORTED
AND CRITICALLY DISCUSSED IN THE
RESULTING MANUSCRIPT.
I DON'T CLAIM THAT OUR PAPERS
WERE BY ANY MEANS EXEMPLARS OF
ALL OF THIS, BUT I WANTED TO
SHARE WITH YOU SOME OF THE MOST
CRITICAL FACTORS THAT NEEDED TO
BE INCLUDED IN ORDER TO PROVIDE
THE MOST KIND OF VALUABLE DATA
TO THE READER.
SO, FIRST OF ALL, HERE I'M GOING
TO LIST A FEW OF THOSE FACTORS,
NOT OBVIOUSLY THE ENTIRE METHODS
SECTION.
AND THE OTHER THING IS THAT
BECAUSE THIS STUDY INCLUDED
TOXICOLOGY AND NUTRITIONAL
COMPONENT I WANTED TO SHARE
THOSE INDIVIDUALLY BECAUSE THERE
ARE SOME CONSIDERATIONS.
FIRST OF ALL BOTH FIELDS REQUIRE
USE OF EPIDEMIOLOGIC DATA FOR
HYPOTHESIS BUILDING.
IMPORTANTLY IF THE GOAL IS TO
UNDERSTAND UNDERLYING MECHANISM
PHENOTYPING MODELED IN
EXPERIMENTAL MODEL SHOULD MATCH
THAT REPORTED IN HUMANS IN
RESPONSE TO SAME EXPOSURES AND
HOPEFULLY THAT MAKES SENSE.
SECOND IT'S CRITERIA DUEL
CONSIDER APPROPRIATENESS.
SOME RODENT MODELS SHOULD NOT BE
USED IN METABOLIC STUDIES,
OTHERS DO A POOR JOB MODELING
HUMAN REPRODUCTIVE DEVELOPMENT.
WINDOWS OF EXPOSURE SHOULD BE
CONSIDERED, SO CAREFULLY
UNDERSTANDING ORGANOGENESIS OR
MILESTONES OCCURRING, CRITICAL
FOR CAPTURING OUTCOMES OF
INTEREST.
AS I PREVIOUSLY DISCUSSED LENGTH
OF EXPOSURE IS CRITICAL.
PREGNANCY STUDIES ARE A BIT MORE
CONTROLLED IN THAT SENSE.
THEY ARE ONLY THE -- THE
PREGNANCY IS ONLY OH LONG.
IF EXPOSURE IN HUMANS IS BEFORE,
DURING, AFTER CONCEPTION,
CRITICAL WINDOWS, THEN MODELS
SHOULD CONSIDER EXPOSURE WINDOWS
OR JUSTIFY SPECIFIC INTEREST AND
ONLY FOCUSING ON ONE, FOR
EXAMPLE, ONLY DOSING DURING
PREGNANCY.
IN THE CASE OF CHEMICAL
EXPOSURES, THE ACTUAL TOXICANT
AND MODE SHOULD BE CONSIDERED,
SUCH THAT CHEMICAL OR TOXICANT
IS OBSERVED IN SOME RELEVANT
PROPORTION OF THE HUMAN
POPULATION.
ROUTE OF EXPOSURE IS MATCHED,
FOR EXAMPLE, DERMAL VERSUS ORAL,
SO IF YOUR TOXICANT OF INTEREST
IS SPECIFICALLY COMING FROM THE
FOOD SUPPLY WE WOULDN'T WANT TO
EXPOSE OUR ANIMALS DERMALLY OR
VIA THE SKIN.
SO SIMILARLY IN NUTRITION STUDY,
THE MODULATION SHOULD ALSO BE
RELEVANT AND ALSO PREVALENT.
SO THIS SHOULD BE A DIET
COMPONENT THAT MOST PEOPLE ARE
CONSUMING REGULARLY OR DIET KIND
OF -- DIETARY PATTERN RELEVANT
TO AT LEAST SOME PROPORTION OF
THE POPULATION.
AS WE ALREADY DISCUSSED, THE
CHEMICAL OR TAX CAN'T EXPOSURE
DOSE SHOULD BE WITHIN THE
EXPECTED RANGE IN HUMANS IN CASE
OF TOXICANTS, IN TERMS OF
NUTRITIONAL MODIFICATION MACRO
OR MICRO CHANGE SHOULD BE
CONSISTENT WITH HUMANS.
THE EXAMPLE IS USE OF HIGH FAT
DIETS, IN REALITY ACCORDING TO
NHANES WHAT WE CONSIDER MAYBE A
HIGH FAT DIET WOULD BE IN THE
MID-30%, HUMAN POPULATION, 38,
39.
BUT IN RODENTS WE GO AS HIGH AS
45%.
WHICH IS A BIT HIGH BUT MAYBE
WITHIN SOME REASONABLE RANGE.
THERE ARE MANY STUDIES HIGHING
HIGH FAT DIETS AS HIGH AS 60% OF
CALORIC INTAKE.
THE ISSUE IS FIRST OF ALL
POTENTIALLY DON'T MODEL HUMAN
EXPOSURE AND YOU'RE INCREASING
PROPORTION OF OTHER
MACRONUTRIENTS CRITICAL FOR
GROWTH AND DEVELOPMENT.
NOW YOU'VE INTRODUCED A NEW
FACTOR THAT REALLY NEEDS TO BE
HIGHLIGHTED, DISCUSSED, AND
JUSTIFIED.
SO THAT THE LAY READER CAN
UNDERSTAND WHY THEIR DATA DON'T
MATCH YOUR DATA.
SO, FINALLY A POINT FOR
DISCUSSION IS THE INCLUSION OR
REALLY EXCLUSION OF THE
STRENGTHS AND LIMITATION SECTION
IN MANUSCRIPTS, REALLY A
COMMUNICATION, MAYBE FUTURE
DIRECTIONS.
FOR THOSE WORKING IN
EPIDEMIOLOGY, YOU KNOW THIS
SECTION IS A MUST.
WE CAN'T GET AWAY WITH NOT
INCLUDING A THOROUGH OFTEN PAGES
LONG STRENGTH IN LIMITATION
SECTION.
THIS IS LIKELY BECAUSE WE OFTEN
HAVE VERY LITTLE CONTROL OVER
HOW OUR DATA ARE COLLECTED,
USING DATASETS NOT NECESSARILY
IDEALLY SUITED FOR OUR STUDY.
SO WE NEED TO PROVIDE
ACKNOWLEDGMENTS OF THESE ISSUES,
AND HIGHLIGHT HOW OUR STUDY
ADDRESSED OR OVERCAME
LIMITATIONS.
I'VE OFTEN WONDERS IF THIS WOULD
BE HELPFUL FOR ANIMAL MODELS.
I UNDERSTAND HESITATION OF
ACKNOWLEDGING LIMITATIONS
AROUND, YOU KNOW, STUDY DESIGN
SPECIFICALLY.
BUT THE INCLUSIONS OF SUCH A
DISCUSSION AND INCLUSION OF
IMPORTANT STRENGTHS OF THE STUDY
WOULD REALLY ALLOW FOR EASIER
INTERPRETATION BY THOSE OF US
OUTSIDE THE EXPERIMENTAL WORLD.
SO WITH THAT, I'VE GIVEN A BRIEF
EXAMPLE OF RELEVANT ANIMAL
MODELS AND I WANTED TO FINISH BY
SHARING THAT WE TRIED TO
PRACTICE WHAT WE PREACH IN TERMS
OF TRANSLATING EXPERIMENTAL
MODELS BACK TO HUMANS.
THERE'S NO SURPRISE WHERE I'VE
RECAPITULATED THE STUDY I
SHARED, BUT THERE IS WORK IN OUR
GROUP WHERE WE'RE TRYING TO TAKE
A SIMILAR THOUGHT PROCESS IN
STUDIES IN HUMAN POPULATION.
SO IN THIS STUDY THAT I'M
SHARING HERE WE PUBLISHED THIS
LAST YEAR, TOOK A SIMILAR
APPROACH ESSENTIALLY TO THE
RODENT STUDY I DESCRIBED
EARLIER.
WITH THE SLIGHTLY DIFFERENT
PERSPECTIVE.
ON THE LEFT IS THE SAME FAMILIAR
GRAPH I SHOWED EARLIER.
THE BLUE BAR TO THE RIGHT IS THE
BAR OF INTEREST, WHERE WE'RE
THINKING ABOUT THE CUMULATIVE
EFFECT OF CHEMICAL WITH DIET.
HOWEVER, TO THINK OF DIET AS A
POSSIBLE MITIGATOR, WHICH IS
WHAT I'M REALLY INTERESTED IN AS
A DIETITIAN AND NUTRITION
PROFESSIONAL WE NEEDED TO CHANGE
OUR PERSPECTIVE SO THIS YELLOW
BAR IS OF INTEREST, POTENTIAL
IMPACT OF A BETTER DIET IN
HUMANS THIS TIME ON HEALTH OF
PREGNANT WOMEN EXPOSED TO A
CHEMICAL WHICH IS WHAT WE CAN
ESSENTIALLY MODEL.
OF COURSE, HUMAN DATA WE CAN'T
JUST TREAT OUR PARTICIPANTS WITH
CHEMICALS AND HIGH FAT DIET, SO
WE TAKE OTHER APPROACHES TO DO
THIS WORK.
IN THIS STUDY OF INTEREST OUR
CHEMICAL WAS PARABENS,
UNDERSTANDING HOW SPECIFICALLY
MATERNAL DIET QUALITY RATHER
THAN SPECIFIC NUTRIENTS
POTENTIALLY MITIGATE THE IMPACT
OF PAR ABENS WITH FOCUS ON COMMN
BIRTH OUTCOMES LIKE GESTATIONAL
AGE AT BIRTH, BIRTH WEIGHT,
BIRTH LENGTH, SO ON.
WE OBSERVED THAT THE DELETERIOUS
EFFECTS WERE ONLY OBSERVED IN
BABIES OF MOMS WHO CONSUMED A
POOR DIET.
AND THE OPPOSITE INTERACTION OR
INTERPRETATION, WE OBSERVED NO
EFFECTS OF OF PARABEN WITH BIRH
OUTCOMES OF HIGHER QUALITY
DIETS.
THIS IS SIMILAR BUT REVERSED IN
TERMS OF INTERPRETATION COMPARED
TO EXPERIMENTAL MODEL IN
RODENTS, ONLY OBSERVED IN BABY
GIRLS, AGAIN JUST TO COMPARE
THAT TO RODENT STUDIES, THAT'S
THE SEXUAL DIMORPHISM ASPECT
ALSO OBSERVED IN ESSENTIALLY ALL
OF OUR RODENT MODELS.
SOME MAIN TAKEAWAYS WITH
BEAUTIFUL FOOD TO GET THROUGH
THE AFTERNOON.
WE KNOW EPIDEMIOLOGIC STUDIES
RELY ON HIGH QUALITY
EXPERIMENTAL MODELS, THAT'S
REALLY IMPORTANT TO CARRY WITH
YOU.
HOWEVER, EXPERIMENTAL MODELS
THAT ARE REALLY GOOD SCIENCE BUT
POTENTIALLY INAPPROPRIATE TO
LEAD TO COMMUNICATION BREAKDOWN
IN THEIR VALUE TO THE
EPIDEMIOLOGIC STUDY.
HIGH QUALITY EXPERIMENTAL
STUDIES CONSIDER NUMEROUS
FACTORS IN A SHOULD BE REPORTED
AND INCLUDED IN RESULTING
MANUSCRIPTS, AND NOT SURE I CAN
CHANGE THE WORLD BUT POTENTIALLY
WE COULD CONSIDER INCLUDING
DISCUSSIONS OF STRENGTHS AND
LIMITATIONS IN EXPERIMENTAL
STUDIES TO REALLY PROVIDE
INSIGHT FOR THE INEXPERIENCED
READER.
AGAIN, A QUICK THANK YOU.
AND I KNOW WE'LL TAKE QUESTIONS
AT THE END.
THANK YOU SO MUCH.
>>THANK YOU FOR YOUR
PRESENTATION.
WHAT WE'LL DO IS GO TO THE NEXT
SPEAKER, AND WE'LL HAVE A
COORDINATED DISCUSSION AT THE
END SINCE A NUMBER OF QUESTIONS
ARE GOING TO BE APPLIED TO
SPEAKERS.
DR. DAWSON, IF YOU WOULD LIKE TO
TAKE US FORWARD AND TO MICE AND
PIGS.
>>I WAS INVITED TO RECAPITULATE
PART OF A PRESENTATION AT ODS A
COUPLE WEEKS AGO.
AND TALK ABOUT MY OWN RESEARCH
PROGRAM, THEY ALSO WANTED ME TO
FOCUS A LITTLE BIT ON
INFLAMMATION AND ON WHAT WE KNEE
ABOUT TOXICITY STUDIES.
THAT'S WHERE WE ARE TODAY.
I WANT TO THANK THE AUDIENCE FOR
STAYING UNTIL THE LAST
PRESENTATION.
ONE BY SCIENTISTS WITH POSSIBLE
EXCEPTION OF NON-HUMAN PRIMATES
IT IS APPARENT THAT THE PIG IS
THE BEST MODEL FOR STUDYING
NUTRITION IN THE OMNIVEROUS
HUMAN.
AND THAT WAS PRE-GENOMIC ERA,
I'LL BE ABLE TO UPDATE WHEN WE
PUBLISH OUR WORK IN A FEW
MONTHS.
SECOND QUOTE IS ALL MODELS ARE
WRONG, HOW WRONG TO NOT BE
USEFUL?
THERE'S A FOLLOW-UP TO THAT.
BY THE MATHEMATICIAN GEORGE BOX,
SOME MODELS ARE USEFUL.
WE'LL TAKE A LOOK HERE AT THE
SPECIES USED FOR BIOMEDICAL
RESEARCH.
THIS IS AN OLDER SLIDE.
THEY WANTED TO KNOW PROPORTION
OF SPECIES BEING USED.
YOU CAN SEE RATS AND MICE
PREDOMINATE, ALSO NON-HUMAN
PRIMATES, BUT YOU GOT TONE LARGE
IT, COME HERE TO SEE FARM
ANIMALS ARE 1%, OUT OF THAT 1% A
SMALL PERCENTAGE ARE IN FACT
PIGS.
DESPITE THE FACT THEY WOULD SEEM
TO BE THE MOST USEFUL MODEL FOR
HUMAN NUTRITION STUDIES, THEY
ARE UNDERUTILIZED.
WE DON'T HAVE DEFINITIVE DATA ON
NUTRITION RESEARCH BUT HAVE DATA
FROM LITERATURE THAT'S BEEN
PUBLISHED RECENTLY.
AGAIN, TOP TABLE IS FROM THE
U.K.
IN WHICH THEY ATTEMPTED TO TALLY
THE USE OF ALL ANIMALS, LIVE
ANIMAL RESEARCH, AND IF YOU COME
OVER AT THE END YOU CAN SEE IT
PREDOMINATES.
IN PARTICULAR, WITH IMMUNE
SYSTEM AND ENDOCRINE AND
METABOLIC SYSTEM, CLOSEST WE
COME TO IMMUNE AND NUTRITION,
THEY DOMINATE AT 95% AND 90%
LEVEL.
AND THE USE OF THESE ANIMALS IN
THE TOXICOLOGIC LITERATURE, A
STUDY WAS PUBLISHED AROUND THE
SAME TIME, 37 ORGANIZATIONS GOT
TOGETHER AND EVALUATED THE
REGULATORY PROCESS OF 172 DRUGS,
ONE STATEMENT IN THERE STOOD
OUT, MINI PIG ONLY USED TO MODEL
ONE MOLECULE, ODD FOR ITS
TESTING ACROSS THE INDUSTRY.
WE THINK THE PIG IS HIGHLY
UNDERUTILIZED.
WE USE MICE, PIGS, AND HUMAN
CELL LINES IN MY RESEARCH,
OCCASIONALLY HUMAN CLINICAL
TRIALS.
SO WE USE ALL THREE OF THOSE IN
OUR RESEARCH.
I DON'T WANT THIS TO TURN INTO A
MOUSE OR RODENT BASHING SESSION
FOR A NUMBER OF REASONS, BUT
WHEN YOU SEE THAT 95% OF SPECIES
BEING USED, YOU HAVE TO QUESTION
HOW SIMILAR ARE SPECIES TO
JUSTIFY THAT USE OF RESOURCE.
THAT BRINGS US TO TODAY'S
PRESENTATION.
WE THINK PIGS ARE SCIENTIFICALLY
INTERMEDIATE SPECIES, YOU CAN
MODEL THINGS IN RODENTS, GO TO
PIGS, AND GO INTO HUMANS WITHOUT
HAVING TO INVOLVE CANINES OR
NON-HUMAN PRIMATE.
IN ORDER TO ASSESS THIS WE USE
COMPARATIVE GENOMICS.
THIS IS A SLIDE FROM THE
NATIONAL HUMAN GENOME RESEARCH
INSTITUTE.
THIS RESEARCH HAS A BUNCH OF
DIFFERENT -- THE WIDTH OF FOCUS
AND FIRST SECTION HERE WE LOOK
AT CROSS-SPECIES COMPARING TO
SEE WHETHER THINGS ARE DIFFERENT
OR THE SAME.
YOU CAN LOOK WITHIN PRIMATES,
FOR EXAMPLE, TO FIND GENES THAT
ARE INVOLVED IN VARIOUS
PHENOMENON IN A.
THIS WORK LED TO IDENTIFICATION
OF GENES IN A WE PUTATIVELY
THINK ARE INVOLVED IN
DEVELOPMENT OF HUMAN HUMAN SPE.
THIS IS COMPARING HUMANS TO
ENTHUSIASMS, LIKE THE THOUSAND
GENOME PROJECT LOOKING AT THE
DIFFERENT TYPES OF POLYMORPHISMS
AND GENE COPY NUMBER WOULD GIVE
US THAT INFORMATION.
FOR OUR RESEARCH WE FOCUS ON
FIVE QUESTIONS.
IS THE GENE THERE OR NOT?
IS THE GENE OR PROTEIN SIMILAR?
IS IT EXPRESSED IN SIMILAR CELL
TYPES?
IS IT REGULATED IN A SIMILAR
MANNER TO STIMULUS?
AND WHAT HAPPENS WHEN A GENE IS
MISSING AND YOU INTRODUCE A GENE
FROM A FOREIGN SPECIES TO TRY TO
MAKE UP FOR THAT MISSING GENE?
WE WON'T COVER ALL THAT TODAY.
WE'LL FOCUS ON THREE OF THESE.
LET'S START OUT IS THE GENE
CONSERVED?
PART OF THE FOCUS OF THIS
MEETING IS SO SCIENCE
COMMUNICATION PROBLEMS, I'VE
CHOSEN A COUPLE SLIDES ON THE
BORDERLINE OF RIDICULOUS BUT
THEY ARE OUT THERE.
WHEN THE MOUSE GENOME WAS FIRST
FINISHED, AND THEN THE HUMAN
GENOME WAS FINISHED, THE
HEADLINES PROCLAIMED THAT MICE
AND HUMANS WERE 99% SIMILAR,
SHARE 99% OF GENES.
LATER ON I GUESS THEY TONED IT
DOWN, 2% OF DNA TURNS MICE INTO
MEN.
TAKE A BRIEF BREAK HERE.
ORTHOOLOGY IS AN INEXACT
SCIENCE.
YOU CAN FIND CRAZY STUFF ON THE
INTERNET STUFF.
LEFT SIDE IS FACEBOOK
POTENTIALLY FROM MYTH BUSTERS.
THEY PUT A STATEMENT OUT THAT
HUMANS SHARE 98% OF DNA WITH
CHIMPS.
70% SLUGS.
50% BANANAS.
IF YOU GO ON THE RIGHT-HAND SIDE
OF THE SCREEN AND LOOK AT THREE
METHODS OF DETERMINING
ORTHOOLOGY, YOU'LL FIND IT'S
ROUGHLY 20%.
IF YOU RELY ON INTERNET MEMES
YOU BELIEVE THE 50%.
BACK TO OUR SHOW, A MORE
REALISTIC ESTIMATE IS THAT MICE
SHARE PROBABLY 70% OF ORTOLOGY
WITH HUMANS.
IF YOU LOOK HERE, THEY DON'T
EVEN SHARE 100% WITH RATS.
THE REASON I'M ILLUSTRATING THIS
IS I DON'T THINK THERE'S AN
APPRECIATION IN MY EXPERIENCE
PRESENTING DATA OVER THE YEARS
HOY DIFFERENT EXPERIENCE ARE.
WE ATTEMPTED TO TRY TO FIGURE
OUT ESSENTIALLY WHERE PIGS FIT
IN WITH ALL OF THIS.
WE TOOK 36,000 GENES AT THE
MOMENT, THERE'S A LOT MORE THAN
THAT, BUT WE DETERMINED WHETHER
OR NOT IT'S THERE OR NOT BY
HAND.
THERE'S A CORE GROUP IN THE
CENTER.
THREE SPECIES SHARE 80% AT
ONE-TO-ONE LEVEL.
I CHEATED BECAUSE I GOT RID OF
OLFACTORY RECEPTORS.
PIGS HAVE ABOUT 2,000, MICE HAVE
1,000.
A LOT MORE THAN YOU AND I.
IF YOU CONSIDER PIGS ARE USED,
FOR EXAMPLE, TO FIND TRUFFLES IN
FRANCE BECAUSE VERY LARGE
PORTION OF THEIR BRAIN IS
DEVOTED TO THE SENSE OF
OLFACTION.
IF YOU TAKE THOSE OUT, COME UP
WITH THESE NUMBERS.
AND ANOTHER REASON WHY I TOOK
THEM OUT IT'S NOT EASY TO
DETERMINE THE ONE ORTHOLOGY
BECAUSE THEY HAVE BEEN REPEATED
OVER AND OVER AGAIN.
WE'VE PUBLISHED INFORMATION, 8
PAPERS ON THESE PARTICULAR
CLASSES OF GENES, FOCUSING ON
IMMUNOLOGY INFLAMMATION, OUR
DATA SHOWS THERE'S AN
OVERWHELMING SIMILARITY BETWEEN
PIGS AND HUMANS COMPARISON TO
MICE.
IT'S IN THE WORKS, TWO BE ON
THREE MANUSCRIPTS RELATED TO
GENES, NUTRITION AND METABOLISM.
AT THE BOTTOM LINE HERE WHEN THE
GENE IS MISSING FROM ONE OF THE
THREE GENOMES, PIGS ARE FIVE
TIMES MORE LIKELY TO HAVE THE
HUMAN GENE THAN MICE.
IF YOU TAKE A LOOK AT THOSE
NUTRITION AND METABOLISM-RELATED
GENES, WE DETERMINED THERE'S
1500 GENES, PIGS HAVE AROUND
FOUR-FOLD LESS UNIQUE GENES THAN
MICE OR HUMANS.
SIMILAR TO PREVIOUS SLIDE WHEN
ONE GENE IS MISSING FROM THE
GENOME, THE FREQUENCY OF GENE
PRESERVATION IS MORE THAN TEN
TIMES SIMILAR, TAKING 120 AND
DIVIDING BY 17.
THESE PARTICULAR UNIQUE CLASSES
OF GENES ARE THE AMYLASES
INVOLVED IN STARCH DIGESTION,
CYTOCHROME P450 SYSTEM WHICH
I'LL TALK IN A FEW SECONDS,
LIPASES, TASTE RECEPTORS, GENES
IN A AND C METABOLISM AND
ZINC-CONTAINING KRAB-A BOX
PROTEIN, DIFFERENT BETWEEN MICE
AND HUMANS, WE CONFIRMED THAT
TRUE IS THE PIG ALTHOUGH THERE'S
MORE SIMILARITIES.
LET'S TAKE A LOOK AT ONE SYSTEM.
THESE GENES ARE INVOLVED IN THE
ACTIVATION OR DETOXIFICATION OR
METABOLISM OF A WIDE VARIETY OF
MYCOTOXINS, CARCINOGENS,
STEROIDS, HORMONES, VITAMINS,
YOU NAME IT.
NEURAL TRANSMITTERS, DRUGS, BILE
ACIDS.
THE HUMAN GENOME HAS 59 OF THESE
GENES.
PIGS HAVE 7 4.
MICE HAVE 101.
THESE CAN BE DIVIDED INTO 47
SUBFAMILIES.
THEY ARE FOUND IN THE LIVER AND
KIDNEY AND INTESTINE, EXPRESSION
IN HEART AND BRAIN AND OTHER
TISSUES.
THERE'S CONSIDERABLE SPECIES
SPECIFICITY IN RESPONSES SO THAT
MINOR DIFFERENCES IN AMINO ACIDS
SEQUENCES AROUND THE CATALYTIC
SITE LEADS TO VERY LARGE
DIFFERENCES IN SUBSTRATE
SPECIFICITY.
THAT ALSO HOLDS THROUGH FOR
POLYMORPHISMS IN HUMANS, SO THE
OPPOSITE IS ALSO TRUE.
SOME ENZYMES THAT DON'T HAVE
VERY MUCH SEQUENCE SIMILARITY
METABOLIZE VERY SIMILAR
SUBSTRATES TO SIMILAR PRODUCTS.
LET'S TAKE A LOOK AT WHAT WE
FOUND.
HERE IS THE ANALYSIS OF THE
COMBINED 234 PROTEINS, MICE HAVE
65 UNIQUE ONES, TWO TIMES MORE
THAN HUMANS OR PIGS.
THERE'S A CORE GROUP OF 33 GENES
CONSERVED AMONG THE SPECIES.
WHAT DO THEY DO?
WE DID SOME BIOINFORMATICS
ANALYSIS, RAN THROUGH REACTOME
PIPELINE, AND THEY ARE INVOLVED
IN THESE PARTICULAR PATHWAYS.
STEROID METABOLISM, METABOLISM
OF FATTY ACIDS, ACID, BILE SALT
METABOLISM, XENOBIOTIC,
SYNTHESIS OF PROSTAGLANDIN, IT
DOESN'T TELL YOU ANYTHING, JUST
WHETHER THEY ARE PRESENT.
HERE IS A GROUP OF GENES, CYP1A
SUBFAMILY INVOLVED IN METABOLISM
OF MYCOTOXINS AND AROMATIC
AMINES.
THERE ARE DIFFERENCES IN ENZYMES
TOWARDS SUBSTRATES AMONG HUMANS
AND RATS AND MICE.
THEY CAN METABOLIZE DIOXINS.
ON THE RIGHT-HAND SLIDE I HAVE
DIFFERENT PROTEINS ANALYZED
ACCORDING TO PHYLOGENETIC
DIFFERENCES.
THINK OF THIS AS EVOLUTIONARY
TREE.
IN EACH CASE HUMAN AND PIG ARE
MORE SIMILAR TO ONE ANOTHER.
AND THESE TWO GROUPS OF GENES
ARE VERY DISTANT FROM THE SECOND
CYP1AB GENE.
TAKE DISTANCES, TO THE NODE OF
THE MOST COMMON ANCESTRAL GENE,
YOU CAN CALCULATE HOW CLOSE
THESE ARE WHICH IS GOING TO BE
INDICATOR OF THE LIKELY
SIMILARITIES OF THESE THINGS IN
ENZYMATIC ACTIVITY.
IN FACT WE'VE DONE THAT FOR THE
WHOLE CLASS OF THESE CYP 450
GENES, 33 CONSERVED, WE CAN SEE
THE AVERAGE DISTANCE OF THE
COMMON NODE IN THE MOUSE AND
PIG, THE MOUSE IS LARGER THAN
THE PIG.
YOU COMPARE TO HUMAN, IT'S
1.8-FOLD MORE THAN HUMAN,
1.3-FOLD MORE.
PIGS HAVE A GREATER SIMILARITY
TO HUMAN FOR 26 OF THESE.
MOUSE HAS A GREATER SIMILARITY
TO PIG FOR 7.
ROUGHLY A 3 TO 1 RATIO.
IF YOU TAKE A LOOK AT THE BOTTOM
YOU CAN SEE THE MOUSE AND HUMAN
IN FACT ARE STATISTICALLY
DIFFERENT FROM ONE ANOTHER.
THE PIG AND HUMAN ARE
STATISTICALLY DIFFERENT FROM ONE
ANOTHER.
MOUSE TO HUMAN AND PIG TO HUMAN
RATIO IS ROUGHLY 2 TO 1.
THAT COULD TELL US SOMETHING
ABOUT THE FUNCTIONALITY OF
THESE, IF YOU'RE DECIDING TO
STUDY THESE IN A MODEL OF
INTEREST.
LET'S TAKE A LOOK AT WHAT'S NOT
CONSERVED.
LET'S FOCUS ON THE 7 FOUND IN
THE HUMAN AND PIG AND THEN THE 1
FOUND IN THE HUMAN AND MOUSE AND
NOT PIG.
THAT'S A 7 TO 1 RATIO.
THESE ARE INVOLVED IN XENOBIOTIC
METABOLISM.
ONE IS ORPHAN ENZYME, WE DON'T
KNOW WHAT IT DOES.
SOME THESE ARE INVOLVED IN
SYNTHESIS OF THESE HYDROXY TETRA
ACID, AND ONE HUMAN AND MOUSE IS
INVOLVED IN THE SYNTHESIS OF
ALDOSTERONE.
SO, FOR THESE SPECIES-SPECIFIC
GENES IF YOU DO THIS SIMILAR
ANALYSIS YOU CAN SEE, I WON'T GO
INTO EACH, XENOBIOTIC METABOLISM
IS THE NUMBER ONE PATHWAY OF
UNIQUE GENES, ALONG WITH
AFLATOXIN ACTIVATION, SOME
PATHWAYS WILL LIKELY DIFFER.
THE PROBLEM WITH ME SAYING THE
PIG IS SIMILAR IS WE JUST DON'T
KNOW WHAT THESE UNIQUE PIG GENES
DO FOR THE MOST PART.
WE DO HAVE SOME IDEA.
THERE'S TWO CHARACTERIZED.
SO IF YOU COME HERE AND TAKE A
LOOK, FOR EXAMPLE, AT BILE ACID
METABOLISM WHICH I INDICATED WAS
SIMILAR IN THE 33 CONSERVED
GENES, IN FACT UP UNTIL A
CERTAIN POINT IT IS NOT
CONSERVED.
ON THE LEFT-HAND SIDE OF THE
SCREEN WE HAVE WHAT HAPPENS IN
HUMAN LIVER, AND DISTRIBUTION OF
MAJOR BILE ACIDS SO COALIC IN
YELLOW, SOME OTHER SPECIES ARE
INDICATED HERE.
MICE HAVE CHOLIC, INSTEAD MAKE
MURICHOLIC ACID.
PIGS MAKE HYDRO CHOLIC ACID.
YOU HAVE TO SPLIT BETWEEN THE
SPECIES.
THEY ARE COMPLETELY DIFFERENT
FROM EACH OTHER.
THERE HAVE BEEN ATTEMPTS, FOR
EXAMPLE, I'LL MENTION THIS, THEY
STRIPPED OUT HUMAN GENES, OR I'M
SORRY STRIPPED OUT THE MOUSE
GENES THAT ARE RESPONSIBLE FOR
BILE ACID SYNTHESIS AND PUT
HUMAN GENES IN TO HUMANIZE THE
MICE.
WHAT THEY FIND IS THAT IT
DOESN'T RECAPITULATE HUMAN
PHYSIOLOGY.
IN FACT SOME BILE ACIDS ARE
TOXIC.
IT'S NOT SURPRISING IF YOU
CONSIDER THESE SPECIES HAVE BEEN
AROUND FOR MILLIONS OF YEARS
SEPARATE FROM EACH OTHER, AND
THE MOUSE HAS NEVER SEEN THESE
ACIDS IN THE AMOUNTS BEING
PRODUCED.
SO, THIS IS AN EXAMPLE OF WHERE
YOU HAVE TO PICK AND CHOOSE
WHICH SYSTEM YOU WANT TO USE
BASED UPON WHAT YOU ARE
INTERESTED IN SEEING.
IF YOU'RE DOING CHENODEOYCHOLIC
ACID YOU MIGHT USE PIG AND
HUMAN.
IS THE GENE AND PROTEIN
STRUCTURAL AND FUNCTIONALLY
SIMILAR?
IS IT REGULATED IN THE SIMILAR
MANNER TO STIMULUS?
THIS IS A RATHER CONVOLUTED
DIAGRAM FROM ONE OF OUR
PUBLICATIONS.
I DO NOT WANT YOU TO FOCUS IN ON
THIS OTHER THAN THE RESPONSE TO
SOMETHING LIKE A BACTERIA IS
VERY COMPLICATED, AT THE END OF
THE DAY ALL OF THESE PATHWAYS
FEEDBACK INTO THE PRODUCTION OF
INTERLEUKIN 1, A KEY REGULATORY
CYTOKINE IN THE PROCESS OF
INFLAMMATION.
AND UP HERE IN THE LEFT HAND
CORNER WE HAVE RESPONSES TO LPS
WHICH IS LIPOPOLYSACCHARIDE,
COMPONENT OF THE OUTER WALL OF
GRAM NEGATIVE BACTERIA, A POTENT
INFLAMMATORY COMPOUND.
ALSO FEEDS IN HERE.
THE BOX THAT I HAVE INDICATED
HERE IS WHAT'S CONSIDERED TO BE
THE INFLAMMASOME.
THIS IS NOT ACTIVE, JUST
ACTIVATED IN RESPONSE TO
BACTERIAL PRODUCTS BUT ALSO IN
RESPONSE TO TOXICANTS AND HEAVY
METALS.
I'LL SHOW THAT IN A SECOND.
THERE'S A GROWING LITERATURE TO
SHOW THAT HEAVY METALS IN FACT
INTERACT WITH THESE COMPONENTS
OF THE INFLAMMASOME, SO IN THE
FIRST STUDY THESE ARE DIFFERENT
ARSENICALS, INHIBITED.
SECOND STUDY MERCURY AND ARSENIC
BUT NOT CADMIUM OR LEAD
INHIBITED THIS CANONICAL NLRP
SIGNALING IN VITRO AND IN VIVO.
AND FINALLY IN THE LAST STUDY,
SERIES OF STUDIES, CADMIUM
INDUCED INFLAMMASOME-DEPENDENT
INFLAMMATORY CELL DEATH WHICH IS
DUE TO INTERLEUKIN 1.
IN HUMAN ENDOTHELIAL CELLS IN
VITRO AND RECENTLY DEMONSTRATED
THAT IT'S HAPPENED IN THE BRAINS
OF PIGS IN VIVO.
IS THERE IS A POTENTIAL
INTERACTION OF HEAVY METALS AN
INFLAMMATION THROUGH
INFLAMMASOME ACTIVATION.
SO WHAT I SHOWED YOU WAS THE
HUMAN SITUATION, LET'S TAKE A
LOOK AT WHAT IT LOOKS LIKE
COMPARED TO THE OTHER SPECIES.
SO, FIRST OF ALL I'M NOT GOING
TO SHOW YOU THE NLRP
INFLAMMASOME BECAUSE IT'S
IDENTICAL AMONG ALL THREE
SPECIES.
I CAN'T FIND ANY DIFFERENCE
WHATSOEVER.
WHEN IT COMES TO THE NLRP,
HUMANS HAVE ONE COMPONENT.
PIGS HAVE ONE.
IT'S MISSING A DOMAIN.
I WANT TO ORIENT YOU TO THESE
GREEN REPETITIVE STRUCTURES.
THESE ARE WHAT'S KNOWN AS
LUCEINE RICH REPEATS, TYPICALLY
BIND PATHOGEN OR MOLECULE OF
INTEREST.
I THINK OF THEM AS A KEY AND
LOCK.
IF I'M USING THIS KEY TO GO IN A
LOCK, THIS IS THE PART THAT GOES
IN THE LOCK I'M GOING TO SAY
THIS IS GOING TO OPEN THAT LOCK.
BUT THE THREE MOUSE ONES ARE NOT
GOING TO OPEN THAT LOCK.
AGAIN, MICE TEND TO REPEAT GENES
AND MAKE COPIES OVER AND OVER
AGAIN.
IN CONTRAST TO THAT, IN PIGS,
THIS IS A PSEUDOGENE FOR THE
NRLC 4 INFLAMMASOME, YOU CAN
FIND PARTNER IN GENOME BUT GOING
AWAY, PIG GENE IS DEVOLVING,
THERE'S NOT MUCH DIFFERENT BUT
WHEN THE PARTNER IS LOOKED AT,
BOY, THE MOUSE HAS A LOT OF
THEM.
WE'VE WOULD SAY THE PIG WINS IN
THIS CASE.
IN THIS CASE, THE MOUSE WINS.
IF YOU COME OVER HERE AND DO
THAT FOR ALL OF THESE NLR
PROTEINS, AND ADD UP WHERE ALL
RED IS GREATER THAN THE YELLOW,
YOU CAN SEE THE CONSERVATION OF
THIS STRUCTURE OCCURS AT RATE OF
TWO TIMES THE RATE IN MICE.
SO, WE THINK THAT PUTTING SOME
SORT OF QUANTITATIVE NUMBERS TO
THIS WILL HELP PEOPLE MAKE
BETTER DECISIONS ABOUT WHICH
SYSTEM TO USE WHEN MODELING IT,
INFLAMMASOME ACTIVATION.
SO, IF YOU GO INTO THE
LITERATURE, YOU WILL SEE THAT
THERE IS A RAGING DEBATE AS FAR
AS WHAT'S APPROPRIATE FOR
INFLAMMASOME ACTIVATIONS.
SORRY, I OPENED THAT WINDOW.
NOT SURE IF YOU CAN SEE THAT OR
NOT.
THE CHAT WINDOW HAS OPENED UP.
I'M TRYING TO CLOSE IT DOWN.
ANYWAY, THESE STUDIES HAVE BEEN
GOING BACK AND FORTH, NATIONAL
ACADEMY OF SCIENCE,
COMMUNICATION IS PART OF THE
FOCUS.
NEW YORK TIMES HEADLINE SAID
MICE FAIL SHORT AS SUBJECT AS
FOR SOME OF HUMANS' DEADLY ILLS.
WE HAVE ON THE LEFT A PAPER
WHERE THIS CAME FROM, A GROUP OF
SCIENTISTS BASICALLY WERE FED UP
WITH USING RODENTS AS MODELS FOR
HUMAN SEPSIS.
AND THEY DID A FORMAL EVALUATION
AND SAID THEY ARE TERRIBLE
MODELS.
ANOTHER GROUP A YEAR LATER
WEIGHED IN AND SAID THEY ARE
GREATLY.
YOU CAN'T HAVE IT BOTH WAYS.
SO THERE'S A STUDY JUST
PUBLISHED LAST WEEK, IN WHICH
GROUP OF SCIENTISTS LOOKED AT
VARIOUS MODELS AND APPLIED SOME
MACHINE LEARNING ARTIFICIAL
INTELLIGENCE AND THE LIKE TO TRY
TO CLEAN UP THE COMPARISONS AND
CAME TO THE CONCLUSION SIX
INFLAMMATORY DISEASE, THREE
MODELED BY MICE, THREE NOT.
AND TWO THERE WASN'T ENOUGH
DATA.
HOW'S THAT FLOOR SPLITTING INTO
THIRDS?
LET'S TAKE A LOOK AT THIS, WHAT
WE KNOW AMONG THE THREE SPECIES.
AT THE TOP PART OF THE DIAGRAM
WE HAVE LPS COMING IN, ENGAGING
TOLL-LIKE RECEPTORS WHICH WE SAW
IN THE BIG DIAGRAM.
THAT TURNS ON THE SYNTHESIS OF A
CYTOCHROME P450 CYP 27B 1 THAT
CATALYZES FORMATION OF ACTIVE
VITAMIN D, GOES TO THE VITAMIN D
RECEPTOR, GOES TO THE NUCLEUS,
TURNS ON A GENE CALLED LL 37 OR
CAMP, ENTER ACTORS WITH PATHOGEN
IN THE ENDOSOME TO KILL IT.
WE KNOW THIS HAPPENS IN HUMANS.
BUT DOES IT HAPPEN IN OTHER
SPECIES?
THE ANSWER IS NO.
THESE PAPERS WERE PUT OUT BY
COLLEAGUES OF MINE.
THEY LOOKED AT HOW COMPARABLE
RESPONSES WERE OF LPS IN PIGS
AND HUMANS AND MICE.
AND ONE STUDY ONLY 30% OF GENES
OF THE SAME BETWEEN MICE AND
HUMANS.
WHEN THEY EXPANDED TO PIGS, THEY
SAID THE RESPONSE WAS
OVERWHELMING.
THIS IS A DIAGRAM FROM ONE OF
THE PAPERS.
CYP 27B 1 MOST HIGHLY INDUCED IN
HUMANS AND PIGS.
BUT WASN'T INDUCED IN MICE AT
ALL.
AT LEAST FOR CYP 27B 1, THIS
PATHWAY DOESN'T HAPPEN IN MICE.
SO WE TAKE A LOOK AT CAMP GENE,
LL 37, IT TECHNICALLY CAN'T
HAPPEN IN ANY OTHER SPECIES THAN
PRIMATES.
IN EVOLUTION ALONG THE LINE IN
CHIMPANZEES AND HUMANS AND
SEVERAL OTHER PRIMATES THERE'S A
VITAMIN D RESPONSIVE ELEMENT IN
THE PROMOTER REGION OF THE GENE.
AND PIGS ARE MISSING FROM THIS
COMPARISON.
BUT I KNOW THAT IT CAN'T HAPPEN
IN PIGS BECAUSE PIGS IN FACT
DON'T HAVE THIS CAMP GENE, SO IF
THEY DON'T HAVE THE GENE, THEY
CAN'T MAKE IT.
AND THIS IS ONE OF THE SYSTEMS
WHERE PEOPLE HAVE TAKEN THIS
CAMP GENE AND PUT IT BACK INTO
MICE
AND HAVE MODELED INDUCTION, THEY
GET MODULATION OF CAMP GENE IN
MICE BY VITAMIN D AND ACTS AS
ANTIBACTERIAL AGENT.
WE'RE THINKING ABOUT DOING THAT
IN THE PIG MODEL, ALONG WITH THE
NATURAL VITAMIN D-INDUCING
ENZYME CYP B-21.
WE SAY PIG MEETS HUMAN HALFWAY
IN THIS CASE.
MOUSE NOT AT ALL.
BUT IN MICE THEY HAVE BEEN ABLE
TO MAKE IT HALFWAY BY PUTTING
THIS GENE IN.
I SUSPECT THEY WILL PUT CYP B-21
IN THERE.
THAT LEAVES WITH MY CONCLUSION
SLIDES.
IS THE GENE CONSERVED?
THERE'S GREATER PIG-HUMAN
CONSERVATION.
IS IT SIMILAR?
GREATER PIG-HUMAN CONSERVATION.
IS IT REGULATED IN A SIMILAR
MANNER TO STIMULUS, AND I
PROVIDED EVIDENCE THAT THE
ANSWER IS THERE'S GREATER
PIG-HUMAN CONSERVATION BUT FOR
ALL OF THESE EXAMPLES THERE ARE
LOTS AND LOTS AND LOTS OF
EXAMPLES WHERE THE MICE AND PIG
WILL NOT BE USEFUL.
I WOULD ARGUE THAT PEOPLE LOOK
DEEPER INTO THE LITERATURE WHEN
MAKING EXPERIMENTAL STUDIES.
WITH THAT, I'LL RETURN TO THE
ORIGINAL HYPOTHESIS THAT PIGS
ARE A SCIENTIFICALLY AND
ETHICALLY ACCEPTABLE
INTERMEDIATE SPECIES, I WOULD
SAY A QUALIFIED YES.
AND WITH THAT I WOULD LIKE TO
THANK MY COLLABORATORS, IN
PARTICULAR DR. CHEN, MY PARTNER
IN BIOINFORMATICS EFFORT, DR.
WANG, MY RESEARCH LEADER, ALSO
EXPERT IN XENOBIOTIC METABOLISM.
AND I'D LIKE TO ACKNOWLEDGE DR.
JOAN LUNNEY, MY PARTNER IN THE
GENOME BUSINESS FOR A LONG TIME.
IF ANYBODY IS INTERESTED, SHE
WROTE A REVIEW ARTICLE ON PIGS
AS MODELS FOR HUMAN DISEASE
PROCESSES, IT WAS LAST YEAR,
EXCELLENT ARTICLE.
I ENCOURAGE YOU TO SEEK IT OUT.
I'LL LEAVE YOU WITH ONE LAST
SLIDE DATABASE WE'VE DEVELOPED,
AS OF TODAY, THERE ARE 24,000
GENES IN THERE.
ALL OF THE DATA THAT I SHOWED
YOU IS IN THERE AT SOME POINT.
IT'S A RESOURCE FOR PIGS BECAUSE
ONE OF THE GAPS IN RESEARCH IS
THAT MICE ARE SO WELL
CHARACTERIZED, SO MANY REAGENTS,
SO MANY STRAINS, PIGS THERE ARE
STRAINS IF YOU WANT TO CALL THEM
THAT, BREEDS, BUT THE TOOLKIT IS
MISSING.
WHAT WE'VE DONE FOR 17 YEARS IS
BUILT THIS INFRASTRUCTURE UP SO
PEOPLE COULD GO TO THE DATABASE
AND TAKE ADVANTAGE OF OUR
EXPERIENCES.
I'LL STOP MY SCREEN SHARING.
>>THANK YOU.
NOW WE'RE BACK TO ASKING YOU
GUYS THOSE QUESTIONS.
TO BOTH SPEAKERS, THERE'S PRETTY
MUCH A GENERAL QUESTION, EACH
ONE OF YOU WENT THROUGH THE
DETAILS OF WHAT YOU SHOULD
CONSIDER AN EXPERIMENTAL DESIGN,
CHOOSING A SPECIES THAT YOU WANT
TO LOOK AT.
WHAT TRANSLATES OVER THE
LIMITATIONS AND BENEFITS, BUT
ONE OF THE QUESTIONS THAT CAME
IN IS REALLY INTERESTING BECAUSE
IT'S TRYING TO SAY HOW OFTEN DO
YOU THINK THESE CRITICAL POINTS
THAT YOU'VE RAISED OF CHOOSING A
MODEL ARE CONSIDERED IN THE
NUTRITION/TOXICOLOGY, THOSE TWO
TOGETHER, NOT EACH INDEPENDENTLY
BUT WORKING THOSE TWO TOGETHER.
IT'S A LEADING QUESTION, I
REALIZE.
WHOEVER WANTS TO GO FIRST, BUT
IT SETS THE FRAMEWORK.
YOU LAID OUT BEAUTIFUL DATA
THERE ABOUT THINGS WE SHOULD BE
DOING.
I GUESS THE QUESTION IS WHAT ARE
WE DOING?
>>I'M UNMUTED, I WAS THE FIRST
ONE.
IT'S LEADING BECAUSE YOU'RE
THINKING IT DOESN'T HAPPEN VERY
OFTEN THESE ARE HIGHLIGHTED.
MOSTLY RIGHT.
I DON'T WANT TO SAY THAT
EVERYTHING IS TERRIBLE.
I THINK WHAT'S DONE REALLY WELL
MORE OFTEN IS THAT EXPERIMENTAL
RESEARCHERS ARE VERY GOOD AT
OFTEN JUSTIFYING THE USE OF
THEIR SPECIFIC MODEL FOR THEIR
OUTCOME.
RATHER THAN EXPOSURE.
WHAT I MEAN IS IF THEY ARE
MODELING OBESITY THEY ARE GOOD
AT SELECTING RODENT OR PRIMATE
MODEL OR A PIG.
WHATEVER IS THE MORE APPROPRIATE
MODEL FOR MODELING THE OUTCOME.
FOR NEURODEVELOPMENTAL OUTCOMES,
PIG IS EXCELLENT.
THAT'S OFTEN JUSTIFIED WELL.
FOR CERTAIN OBESITY ENDPOINTS,
STEM CELL AND OBESITY RESEARCH,
THERE ARE BENEFITS TO USING
CERTAIN MICE STRAINS OVER
OTHERS.
AND THAT'S OFTEN INCLUDED IN THE
LITERATURE.
HIGHLIGHTED TO HIGHLIGHT THE
STRENGTH OF THE STUDY.
BUT AS YOU ALLUDED TO IT'S NOT
OFTEN THEN DISCUSSED HOW
EXPOSURE OVERLAYS ON TOP OF
THAT.
SO THE NUTRIENT METABOLISM, IF
NUTRITION, BEST IN THAT ANIMAL,
OR TOXICANT METABOLISM THE BEST,
I THINK A LOT OF TOXICOLOGY
STUDIES IN OUR FIELD IN
ENDOCRINE DISRUPTERS DO HAVE
THAT KIND OF STANDARD SENTENCE
OF THIS DOSE WAS SELECTED BASED
ON PRIOR STUDIES FROM FDA
TOXICOLOGY STUDIES THAT SHOW
THIS IS IN LINE WITH HUMAN
EXPOSURES.
THEY ARE HIGHLIGHTING THAT
RODENT IN THIS PARTICULAR CASE
HAS BEEN SORT OF MODELED TO
MATCH HUMANS BUT WHETHER OR NOT
IT DOES IN TERMS OF THE
PHENOTYPE, RESULTING PHENOTYPE
IN RESPONSE IS NEVER HIGHLIGHTED
OR DISCUSSED.
YEAH, IT'S A YES AND A NO THAT
WE COULD DO BETTER BUT WE DO
WELL WITH WHAT HAS BEEN EXPECTED
OF US THAT WE SHOULD TALK ABOUT
HOW OUTCOME IS VERY WELL MODELED
USING THE MODEL, THE RODENT OR
THE EX VIVO MODEL.
HARRY, WHAT DO YOU THINK?
>>AS A GOVERNMENT EMPLOYEE I
NEED TO PROCEED IN THE NEXT
SECTION SAYING THIS IS MY
OPINION.
NOT THAT OF THE GOVERNMENT.
I'VE SAT THROUGH A COUPLE OF
PRESENTATIONS WHERE THE PERSON
IS TALKING ABOUT A PARTICULAR
PATHWAY, AND THEY ARE USING
MICE, GETTING THEIR PUBLICATIONS
IN VERY NICE JOURNALS.
AND THEY NEVER BOTHERED TO TELL
THE AUDIENCE UNTIL THEY WERE
ASKED THAT IN FACT THAT PATHWAY
DIDN'T EVEN EXIST IN HUMANS.
NOW, YOU CAN SAY THAT'S
PURPOSELY EVASIVE OR JUST
SLIPPED MY MIND.
ONE OF THE THINGS THAT I WOULD
LIKE TO JUST GO BACK TO, YOU
DON'T HAVE TO DO A LITERATURE
SEARCH IN ORDER TO START
THINKING ABOUT MODEL
APPROPRIATENESS FOR CERTAIN
THINGS.
I'LL USE TWO EXAMPLES.
ONE IS THAT JUST TAKING THE PIG
AND MOUSE, COMPARED TO A HUMAN,
HOW DO THEY LIVE?
A MOUSE SPENDS ITS TIME RUNNING
ALONG THE GROUND SNIFFING DIRT.
LOOKING FOR ALL VARIOUS THINGS,
IDENTIFYING PHEROMONES AND THE
LIKE.
IN THE PROCESS INHALING A LARGE
AMOUNT OF BACTERIA.
PIGS DO THE SAME THING.
YOU SEE THEM ROOTING AROUND ON
THE GROUND, NOSE IN THE GROUND.
SO RESPONSE, BACTERIA OR LPS HAS
TO BE DRAMATICALLY DIFFERENT
AMONG THOSE SPECIES.
WHEN WE LIVE FIVE FEET OR MORE
AWAY FROM GROUND, UNLESS YOU'RE
ROLLING AROUND ON THE GROUND,
THINK ABOUT DIFFERENCES, MAYBE
SOME REASONS WHY WE SEE
DIFFERENCES.
THE OTHER THING, PIGS ARE
OMNIVORES, MICE ARE
OPPORTUNISTIC OMNIVORES, HUMANS
ARE OMNIVORES.
IN FACT PIGS EAT THEIR OWN
FECES, SO DO MICE.
MICE IT'S OBLIGATE FOR DIETARY
CYCLES.
YOUR REACTION TO BACTERIA AND
LIPOPOLYSACCHARIDE IS GOING TO
BE DIFFERENT, FOR EXAMPLE,
DURING THE GUSH --
IN THE G.I. ROUTE.
IF YOU APPROACH DESIGN OF YOUR
STUDY JUST THINKING HOW THE
ANIMAL LIVES YOU DON'T NEED A
LITERATURE SEARCH TO KNOW THOSE
THINGS.
THAT'S WHAT I WOULD ASK
PARTICULARLY WHEN INTERPRETING
YOUR RESULTS.
REMEMBER WHERE THE ANIMALS ARE
AND WHAT THEIR LIVING CONDITIONS
ARE.
>>I'M GOING TO BUILD OFF OF
THAT AND SAY, PLEASE TAKE THIS
FOR THE COMMENT THAT IT IS, BUT
IF THERE IS MUCH MORE OF ORAL
AND NASAL CONTACT WITH THE
WORLD, THAT MIGHT ACTUALLY
SOMETIME REFLECT CHILDREN IF WE
THINK BACK TO THERE.
>>YES.
>>IN THAT SENSE, HOW YOU REALLY
COMPLICATED THAT A BIT MORE YOU
MIGHT ACTUALLY -- WELL, WITH THE
EXCEPTION OF THE NUTRIENT
DEMANDS OF TAKING IN THE FECES,
YOU KNOW, THERE'S SOME ASPECTS
THAT MIGHT MAKE THEM MORE
RELEVANT TO THAT CRITICAL TIME
FOR CHILDREN OF HAND-TO-MOUTH
THAT THEY DO.
IT HAS NOTHING TO DO WITH
NUTRITION.
YEAH, WE COME BACK TO NUTRITION.
WE GOT SORT OF THE ANSWER FROM
YOU, THAT THERE ARE LOTS OF
PEOPLE THAT DO TRY TO DO THIS.
THERE ARE LIMITATIONS WE CAN DO.
THERE'S LOTS OF RELYING ON AS
WAS MENTIONED AS RITA MENTION
MENTIONED, IT'S BEEN DONE IN
FDA, LEVELS THERE, SOMETIMES
THOSE ARE WEIGHTY CRUTCHES THAT
ARE USED IN PAPERS.
I THINK.
BUT, YOU KNOW, THERE'S AN
EMPHASIS THERE.
I HAVE ONE MORE QUESTION FOR YOU
ON THIS BECAUSE WE'RE RIGHT ON
IT, WE'RE TALKING ABOUT MODELS
AND TALKING ABOUT EXPERIMENTAL
MODELS.
AND LIMITATIONS OF THEM.
AND THERE IS, YOU KNOW, A HUGE
COHORT THAT SAYS LET'S GO TO IN
VITRO MODEL SYSTEMS.
OR, YOU KNOW, LET'S GO TO
ALTERNATIVE LIKE FISH OR THINGS
LIKE THAT.
I THINK HOW DO YOU THINK WE'RE
EVER GOING TO BE ABLE TO CAPTURE
THE NUTRITIONAL ASPECT WITH ANY
OF THOSE MODELS?
IS THERE ANYTHING THAT OFFERS
THAT?
>>WHO DO YOU WANT TO GO FIRST?
WHOEVER RAISES THEIR HAND.
>>HARRY, DO YOU HAVE THOUGHTS?
>>YES.
SO THERE'S A CONTINUUM FROM CELL
CULTURE TO DROSOPHILA,
ZEBRAFISH, RODENTS.
YOU KNOW, PIGS, NON-HUMAN
PRIMATE, AND HUMANS.
A VERY LARGE AMOUNT OF WORK
THAT'S ALREADY BEEN DONE THERE.
I'M AWARE OF THE ARGUMENTS WE
CAN GO TO IN VITRO.
AGAIN, SPEAKING AS MY OWN
PERSONAL OPINION, I DON'T THINK
WE'RE AT THE POINT WHERE WE'VE
COLLECTED ENOUGH DATA IN ALL OF
THOSE SPECIES TO SAY THAT WE
KNOW ENOUGH TO THEN MODEL
ANYTHING THAT COMES ALONG IN THE
FUTURE.
I JUST DON'T THINK WE'RE AT THAT
POINT.
>>MY SENSE IS I GUESS AS A
PHYSIOLOGIST I'M SORT OF --
THERE'S -- I MEAN THERE'S A BIG
DISCUSSION AROUND THIS, RIGHT?
WE'RE NOT REINVENTING THE WHEEL
BY DISCUSSING THIS.
THERE'S A HUGE DISCUSSION ABOUT
ELIMINATING THOSE MODELS.
I WOULD SAY FOR NUTRITION, AS
HARRY SAID, IF MORE IS KNOWN
ABOUT PHENOTYPES, EXPOSURES,
RESPONSE SYSTEMICALLY AND ALL
WE'RE INTERESTED IN IS TRYING TO
UNDERSTAND THE IMPACT ON ONE
SPECIFIC TARGET ORGAN SYSTEM OR
SOMETHING LIKE THAT, AND WE WANT
TO USE ORGAN ON A CHIP, THERE'S
PROBABLY GOING TO BE BENEFITS OF
THAT.
AND INTERPRETATION IS GOING TO
BE LIMITED, BUT NOT INACCURATE
PROBABLY IF IT'S MODELED DONE
WELL.
BUT WE HAVE TO STILL UNDERSTAND
MORE OF THE PHYSIOLOGY IN ORDER
TO MAKE THE MODEL APPROPRIATE.
AND THE -- YOU KNOW, ONCE THAT
IS DONE, THEN WE CAN BE A LITTLE
BIT MORE SURE THAT VERY SMALL
THING WE'RE ASKING OF THE MODEL
TO TELL US IS PROBABLY CORRECT.
>>I'LL JUMP IN AND JUST ADD TWO
SMALL THINGS.
ONE, PART OF THIS WORK, THIS
WORK I DO, COMPARATIVE GENOMICS,
IS NOT PART OF MY MAIN MISSION.
PART OF IT IS TO MAKE SMARTER
DECISIONS WHICH MODELS TO USE,
MAY INCLUDE WALKING AWAY WHEN
THERE ARE NO GOOD OPTIONS.
SECONDS IS WE HAVE DONE IN THE
PAST, TAKEN THINGS IN THE PIG,
MODELED BASED ON HUMAN DATA I'VE
DONE FROM CELL CULTURE WORK,
INTO THE BIG, BACK INTO CELL
CULTURE, PIG AND HUMAN CELLS
IDENTIFIED THE SAME THING IN THE
AREA OF, FOR EXAMPLE, ALLERGY
RESEARCH.
SO, YOU KNOW, I THINK YOU CAN
SUCCESSFULLY DO THAT, BUT AGAIN
AT THE END OF THE DAY I'D LIKE
TO SEE LESS ANIMALS BEING USED,
WHETHER THAT'S LESS PIGS OR LESS
MICE, BUT I DON'T THINK WE'RE AT
THE POINT WHERE WE CAN
ABSOLUTELY GET RID OF THEM.
>>OKAY.
FOLLOWING UP ON THAT, A LOT OF
EMPHASIS HAS BEEN ON NUTRITIONAL
ASPECTS IN PREGNANCY AND IN THE
YOUNG AND, YOU KNOW, I'LL PUT IN
AS SOME PEOPLE HAVE MENTIONED,
AS THAT CHANGES OVER THE COURSE
OF AGING.
IT ALSO GOES BACK TO THE
INFLAMMATION, DYNAMICS OF WHAT
ARE INFLAMMATORY FACTORS DOING
DEVELOPMENTALLY BECAUSE SOME OF
THEM ARE GROWTH FACTORS DURING
DEVELOPMENT.
AND WHAT IF THAT NLRP 3
INFLAMMASOME IS NOT FUNCTIONING
CORRECTLY LATER ON, OKAY?
THESE ARE THINGS THAT ARE
SUPPOSED TO HAPPEN.
HOW DO YOU SEE SOME OF THESE
INTEGRATING SOME QUESTIONS OF
SUSCEPTIBLABILITY, INTEGRATING
WITH DIFFERENT MODELS AND
APPROACHES THAT YOU'RE
CONSIDERING AS AN ADVICE TO
OTHER PEOPLE THAT SORT OF TAKES
YOU OFF OF A LITTLE BIT OF
PRESSURE ON YOU ARE YOUR STUFF.
IS THERE SOME SPECIAL WAY THAT
WE SHOULD THINK ABOUT THOSE
FACTORS WHEN WE'RE DESIGNING
THESE TYPES OF STUDIES?
>>I THINK SOME OF THAT, A LOT
OF INFLAMMATION THINGS HARRY
WILL ADDRESS BETTER, THAT'S NOT
WHAT I DO.
I THINK THE BENEFIT THAT I
ALWAYS -- MY TRAINEES AND I
DISCUSS WHEN WE TRY TO CITE
LITERATURE TO SUPPORT OUR
FINDINGS AND EPIDEMIOLOGIC
STUDIES, AGAIN TRYING TO
PRACTICE WHAT I PREACH, A LOT OF
THE BEST KIND OF EXPERIMENTAL
STUDY IS SORT OF THE ONE THAT
VERY NARROWLY FOCUSES ON A
PARTICULAR WINDOW, A VERY
PARTICULAR TIME POINT, A
PARTICULAR DISEASE STATE, ASKS A
SPECIFIC KIND OF QUESTION, THAT
YOU CAN BE SURE THAT IF YOU'RE
ASKING ABOUT PREGNANCY EXPOSURE
TO A NUTRIENT, SAY IN INDIA,
WHAT YOU'RE TRYING TO MODEL, I
THINK THERE'S A LOT OF VALUE IN
THOSE STUDIES.
SO PROVIDING THOSE DETAILS,
PROVIDING CONTEXT FOR EXACTLY
WHAT YOU'RE TRYING TO MODEL IS
MAYBE THE BEST KIND OF ANIMAL
MODEL BECAUSE WHEN YOU START
TRYING TO MODEL EVERYTHING, YOU
ULTIMATELY MISS A LOT.
LIKE SO YOU TRY TO BE TOO BROAD,
THERE'S NO NEED FOR THAT OFTEN.
OFTEN THE GOAL IS TO USE THE
HUMAN EPIDEMIOLOGIC DATA WHICH
IS QUITE BROAD, AND THEN TO
BRING THAT AND PROVIDE A NARROW
PERSPECTIVE ON EXPOSURE, A
PARTICULAR TIME POINT, A
PARTICULAR OUTCOME, MAYBE A CELL
OF INTEREST, AND REALLY PROVIDE
BEAUTIFUL MECHANISTIC INSIGHT.
THAT'S WHAT I'M LOOKING FOR.
I DON'T KNOW THAT I ALWAYS
PUBLISH LIKE THAT WHEN DOING
EXPERIMENTAL MODELS BUT THAT'S
WHAT -- THAT'S WHAT WE LOOK FOR
NOW, TO REALLY UNDERSTAND
UNDERLYING MECHANISM OF OUR
FINDING IN HUMANS.
>>THANK YOU.
HARRY?
TWO MINUTES.
>>THAT'S BEAUTIFUL.
I DON'T KNOW THAT I CAN ADD MUCH
TO THAT.
I'VE HEARD PART OF THE QUESTION,
YOU SAID SOMETHING ABOUT AGING.
I WANTED TO THROW IN SOME
PRACTICAL ADVICE.
MICE LIVE TWO YEARS.
PIGS LIVE TO BE 20+.
I DON'T KNOW HOW YOU WRITE A
GRANT, YOU KNOW, THAT'S GOING TO
BE 20 YEARS LONG.
ANYWAY, AGAIN, I DON'T KNOW THAT
I HAVE MUCH TO REITERATE.
YOU MENTIONED ALSO INFLAMMATORY
COMPONENTS IN DEVELOPMENT.
THAT'S RIGHT.
TOLL-LIKE RECEPTORS WERE
DISCOVERED IN DROSOPHILA BASED
ON ABILITY TO REGULATE
DEVELOPMENT.
I DON'T THINK THERE'S A VERY
STRONG SENSE ABOUT WHAT THEY
ACTUALLY DO IN HUMANS OR EVEN
MOUSE EMBRYONIC DEVELOPMENT.
LET ALONE TO THINK ABOUT
INTERACTION WITH INFLAMMATION
AND HOW THAT MIGHT BE OCCURRING
AT THE SAME TIME IN THE MOTHER.
THAT'S A VERY LARGE KNOWLEDGE
GAP.
>>WE ARE AT OUR 4:00 AND FIVE
MINUTES, THANK YOU FOR A GREAT
PRESENTATION AND A GOOD
DISCUSSION EVEN THOUGH YOU
ANSWERED MOSTLY ALL THESE
QUESTIONS THAT CAME IN ON THE
CHAT OR THAT I HAD IN MY HEAD.
AND I THINK I WILL TURN THIS
BACK OVER AND WE WILL THEN GET
READY TO CLOSE OUT THE DAY WITH
WHATEVER WE HAVE NEXT TO DO.
AND PLEASE BE THERE TOMORROW
WITH US.
>>RIGHT.
THANK YOU SO MUCH, DR. HARRY.
I'M ROBIN McKINNON.
I'M A SENIOR ADVISER FOR
NUTRITION POLICY AT FDA CENTER
FOR FOOD SAFETY.
AND I'M GOING TO CLOSE US OUT
HERE FOR THIS FASCINATING DAY
THAT WE'VE SPENT TOGETHER.
FIRST I WOULD REALLY LIKE TO
REITERATE MY APPRECIATION FOR
THE COLLABORATION WITH OUR
FEDERAL COLLEAGUES AT NIH,
CORRECT CDC, USD, EPA, BROADER
RESEARCH COMMUNITY AND BEYOND.
I'LL PROVIDE HIGH LEVEL SUMMARY
OF WHAT WE'VE HEARD, WHERE WE'RE
HEADING.
BUT IT'S BEEN A FULL DAY,
FASCINATING PRESENTATIONS AND
DISCUSSIONS.
A VERY HIGH LEVEL, AGAIN IN THIS
WORKSHOP WE'RE FOCUSING ON
INTERSECTION OF NUTRITION AND
TOXICOLOGIES TOPICS.
SO LOOKING AT THE CHALLENGES OF
ADEQUATE INTAKE, STAGES OF
GROWTH AND DEVELOPMENT, ROLE OF
EXPOSURE TO ENVIRONMENTAL
CONTAMINANTS IN FOODS, AND
IMPORTANT ROLE OF NUTRIENTS FROM
DIFFERENT FOOD GROUPS IN CHILD
DEVELOPMENT, HELPING TO PROTECT
CHILDREN FROM HEALTH EFFECTS
ASSOCIATED WITH EXPOSURE TO
CONTAMINANTS, LOOKING AT
RESEARCH OPPORTUNITIES IN FOOD
AND NUTRIENTS, EFFECTS OF
ENVIRONMENTAL EXPOSURE AND CHILD
GROWTH AND DEVELOPMENT.
AND FEDERAL AGENCIES, CURRENT
AND FUTURE, RISK COMMUNICATIONS.
AND, AGAIN, WE'RE EMPHASIZING
RISK COMMUNICATION BECAUSE
UNDERSTANDING THE RISK HARMFUL
CONTAMINANTS POSE ON THE FOOD
SUPPLY IS COMPLICATED, CAN
FURTHER COMPLICATE COMMUNICATION
OF THESE RISKS.
EXPOSURE OF CONTAMINANTS CAN
COME FROM MANY FOODS, INCLUDING
NUTRITIOUS FOODS.
IT'S CRUCIAL TO ENSURE OUR
COMMUNICATION ABOUT THESE
CONTAMINANTS IN FOODS NOT RESULT
IN UNINTENDED CONSEQUENCES, LIKE
ELIMINATING CERTAIN FOODS THAT
HAVE SIGNIFICANT NUTRITIONAL
BENEFITS OR REDUCING ONE
CONTAMINANT IN A DIET,
INCREASING ANOTHER.
STEVE HERMANSKY LED OFF IN HIS
TALK ABOUT RISK COMMUNICATION,
IN THIS NEW REALITY THAT THIS
WORLD -- THAT WE'RE IN WITH NEW
REALITY, AND POTENTIAL
UNINTENDED CONSEQUENCE CAN BE
ALIENATING KEY AUDIENCES.
SO, STEVE NOTED DEFINITION OF
EXPERT HAS CHANGED.
AND THE SCIENTIFIC COMMUNITY
MORE BROADLY MUST ADAPT TO THIS
NEW WORLD.
AND THIS NEW PARADIGM.
SO THERE'S AN EMPHASIS AND
IMPORTANCE OF EARNING TRUST
FIRST.
SO STARTING BY LISTENING AND
UNDERSTANDING FIRST BECAUSE
CHANGING MINDS REQUIRES FIRST
UNDERSTANDING, AND STEVE POSED
THE PROVOCATIVE QUESTION, WHAT
COULD CHANGE IF WE CHANGED.
WE MOVED INTO FIRST SESSION,
FOCUSING ON NUTRIENT NEEDS,
GAPS, KEY DIETARY SOURCES OF
NUTRIENTS TO SUPPORT CHILD
DEVELOPMENT.
AND HEARD JUST THE CRITICAL
PERIODS OF FETAL AND CHILD
DEVELOPMENT THAT PREGNANCY AND
LACTATION ARE.
AND ALSO IN VERY YOUNG CHILDREN
THAT INFANTS, VERY YOUNG
CHILDREN NEED NUTRIENT DENSE
DIET, KEY NUTRIENTS INCLUDE
OMEGA 3
OMEGA-3 FATTY ACID, IRON, ZINC,
CHOLINE, SOME INTAKES ARE LOWER
THAN RECOMMENDED, PARTICULARLY
IRON, CHOLINE, FATTY ACIDS.
THERE WAS ALSO NOTING TIME OF OF
THOSE ARE ALSO IMPORTANT IN
CHILD DEVELOPMENT.
ESPECIALLY IN THE FIRST THOUSAND
DAYS.
THE NUTRIENTS WERE IMPORTANT IN
THEMSELVES.
BUT THEY COULD ALSO HAVE
PROTECTIVE EFFECTS, SO THERE WAS
MENTION IN SEVERAL PRESENTATIONS
THAT THE PROTECTIVE EFFECT OF
IRON AGAINST LEAD TOXICITY, AND
POINT MADE ABOUT PREVENTING IRON
DEFICIENCY SHOULD BE A HIGH
PRIORITY.
AND THE PROTECTIVE EFFECT OF B
VITAMINS AGAINST CERTAIN EFFECTS
OF ARSENIC.
AND SOURCES, KEY SOURCES OF
NUTRIENTS INCLUDE MEATS,
SEAFOOD, FRUITS AND VEGETABLES,
BEANS, NUTS, SEEDS, EGGS, DAIRY,
GRAINS.
IN THE DIETARY GUIDELINES
PROVIDE DIETARY PATTERNS TO
CONSUME THESE HEALTHY DIETARY
PATTERNS, MANY FOOD GROUPS ARE
UNDERCONSUMED LIKE SEAFOOD,
FRUITS AND VEGETABLES, WHOLE
GRAINS.
SOME KEY SOURCES CAN ALSO BE
SOURCES OF CONTAMINANTS, SO
FOODS THAT NEED TO BE INCREASED
CAN ALSO SOMETIMES HAVE THE
PRESENCE OF CERTAIN
CONTAMINANTS, OFTEN DUE TO
PRESENCE IN SOIL AND AIR AND
WATER.
THIS IS WHY AUTHORITATIVE ADVICE
AND RECOMMENDATIONS HOW TO
CHARACTERIZE THE RISKS, TAKE
ACTION, MITIGATE EXPOSURE, WHY
THIS IS SO NECESSARY TO HELP
PARENTS AND CAREGIVERS MAKE GOOD
CHOICES.
IN SESSION 2 WE DIVED INTO
PROTECTIVE ROLE OF NUTRIENTS,
FOODS AND GROUPS ESSENTIAL FOR
CHILD GROWTH AND DEVELOPMENT.
LOOKING AT FRUITS AND
VEGETABLES, DAIRY, NUTRIENTS
PARTICULARLY OF IRON AND VITAMIN
D, CALCIUM, B VITAMINS,
CONTAINED AND VITAMIN C, WITHIN
FRUITS, VEGETABLES, DAIRY.
AND ALSO NOTING THE EFFECTS
OF -- NEGATIVE EFFECTS OF
DEFICIENCIES IN THESE NUTRIENTS
IN TERMS OF DEVELOPMENTAL
DELAYS, MANY NEGATIVE HEALTH
OUTCOMES AND PROTECTIVE EFFECTS
AGAINST CONTAMINANTS, LIKE
VITAMIN D AGAINST LEAD, CERTAIN
B VITAMINS AIDING IN METHYLATION
OF INORGANIC ARSENIC, VITAMIN C
ENHANCING NON-HEME IRON AND
INHIBITING LEAD UPTAKE.
AND THEN THERE WAS THE TALK ON
THE ROLE OF GRAINS AND HOW WHOLE
GRAINS COULD CONTAIN MANY
ESSENTIAL ELEMENTS, ALSO CAN
INCREASE EXPOSURE TO
CONTAMINANTS LIKE ARSENIC AND
MERCURY.
SEAFOOD INTAKE, SO MANY
IMPORTANT BENEFITS OF SEAFOOD
INTAKE INCLUDING OMEGA 3 FATTY
ACID, IRON, CHOLINE, WHICH VARY
BY SPECIES AND EXPOSURE TO
METHYLMERCURY AND PROTECTIVE
EFFECT OF SELENIUM AND CERTAIN
COOKING METHODS.
AND ROUNDING OUT WITH DISCUSSION
OF DIETARY PATTERNS AND DIET
QUALITY, SO QUANTITY, VARIETY,
COMBINATION OF FOODS AND
FREQUENCY OF CONSUMPTION AS A
WHOLE LOOKING AT THAT DIET AS A
WHOLE AND THE WHOLE IS GREATER
THAN THE SUM OF THE PARTS, FOODS
AND BEVERAGES CONSUMED IN
COMBINATION, AND IN THE DIETARY
GUIDELINES AND OTHER PLACES
THERE'S A WAY OF CHARACTERIZING
THAT, ATI SCORES, BEING ABLE TO
COMPARE OVERALL DIET QUALITY AND
CHARACTERIZING THE DIETARY
QUALITY ACROSS DIFFERENT DIETARY
PATTERNS.
AND THE LINK BETWEEN DIETARY
PATTERNS AND QUALITY OF DIET,
LINKING THAT TO THINGS LIKE
CHILD COGNITION, SO HIGHER DIET
QUALITY, BEING LINKED TO HIGHER
COGNITIVE FUNCTION IN CERTAIN
CASES, I.Q., ALSO MENTAL HEALTH
AND ORAL HEALTH.
SO INTERESTINGLY, CERTAIN
DIETARY PATTERNS CAN BE LINKED
TO HIGHER OR LOWER LEVELS OF
CONTAMINANT EXPOSURE AS WELL.
LASTLY WE HEARD ABOUT THE ROLES
OF EXPERIMENTAL MODELS, AND WHAT
THEY CAN PLAY IN HUMAN NUTRITION
AND TOXICOLOGY RESEARCH.
AND THIS SESSION EMPHASIZED
IMPORTANCE OF ANIMAL MODELS AND
HUMAN NUTRITION, TOXICOLOGY
RESEARCH, AND INTERPRETATION OF
THOSE RESULTS.
HIGHLIGHTING THE IMPORTANCE OF
THAT EXPERIMENTAL RESEARCH, NEED
FOR APPROPRIATE MODELS, RESEARCH
QUESTIONS, LIFE STAGE, EXPOSURE
LEVEL, TIMING, ORGAN-SPECIFIC
FINDINGS AND NOTING CYCLE
BETWEEN -- APPROPRIATE BETWEEN
EXPERIMENTAL AND EPIDEMIOLOGIC
RESEARCH, EPIDEMIOLOGIC
RESEARCH, BUT NOTING THE
INTERPLAY BETWEEN THESE.
AND THINKING AHEAD FOR CONSUMERS
OF THE RESEARCH AND APPROPRIATE
PRESENTATION OF STRENGTHS AND
LIMITATIONS IN MANUSCRIPTS,
CHARACTERIZING SOME OF THOSE
INSIGHTS AND LIMITATIONS
APPROPRIATELY AND NOTING AT THE
END THE CAREFUL CHOICE OF ANIMAL
MODEL OR SPECIES THAT MAY BE
NEEDED, SPECIFICALLY FOR THE
QUESTIONS UNDER STUDY.
AGAIN, A GREAT DEAL OF
COMPLEXITY, WHEN YOU STEP BACK
AND LISTEN TO ALL THAT WE'VE
HEARD, BUT CERTAIN THINGS REALLY
POPPED OUT FOR ME.
CRITICAL POINT THAT CERTAIN
NUTRIENTS AND FOODS PROVIDE
ESSENTIAL ROLES IN CHILD GROWTH
AND DEVELOPMENT, INFANTS AND
CHILDREN NEED NUTRIENT-DENSE
DIET, THAT THERE CAN BE
EPIGENETIC AND IMMUNE AND OTHER
POTENTIAL DEVELOPMENTAL
PERTURBATIONS RESULTING FROM
UNDERCONSUMPTION OF ESSENTIAL
NUTRIENTS.
SO THERE'S A RISK OF
UNDERCONSUMPTION OF THESE
CRITICAL NUTRIENTS.
THERE'S ALSO POTENTIAL MEDIATION
EFFECT, PROTECTIVE EFFECT OF
NUTRIENT-DENSE FOODS, AND
CERTAIN NUTRIENTS, HIGH QUALITY
DIETARY PATTERNS, AND ALSO SOME
OF THE FOODS THAT ARE IMPORTANT
SOURCES OF THESE NUTRIENTS CAN
BE SOURCED OF EXPOSURE TO
CERTAIN CONTAMINANTS.
CLEARLY THERE ARE MANY
OPPORTUNITIES FOR INVESTIGATION
WHERE THERE ARE RESEARCH GAPS,
MORE RESEARCH IS NEEDED IN A
NUMBER OF AREAS.
FOR EXAMPLE, INTERACTION BETWEEN
NUTRIENTS, BOTH FOODS AND
DIETARY PATTERNS, AND CERTAIN
CONTAMINANTS.
AND PERHAPS PARTICULARLY
PROTECTIVE ROLE OF NUTRIENTS,
FOODS, DIETARY PATTERNS,
IMPORTANCE OF TESTING AND
EXAMINING MULTIPLE CONTAMINANTS,
INCREASING COLLECTION OF
BIOMARKER DATA, NATIONAL
SURVEILLANCE SYSTEMS.
IMPORTANCE OF MORE RESEARCH ON
DIET AND DIETARY PATTERNS IN
CHILDREN, PARTICULARLY.
I WANTED TO EMPHASIZE CRITICAL
IMPORTANCE OF HEALTH INEQUITIES
FOR UNDERSERVED COMMUNITIES, AND
THAT WE MAY BE UNDERESTIMATING
EXPOSURES IN CERTAIN POPULATIONS
AND NEED TO INCREASE IMPORTANCE
OF COMMUNICATIONS AND
POTENTIALLY TAILORING FOR
CERTAIN COMMUNITIES.
FINALLY THE VERY IMPORTANT ROLE
OF EXPERIMENTAL AND ANIMAL
STUDIES.
SO TOMORROW WE'LL BE TURNING TO
THE ART AND SCIENCE OF
COMMUNICATION AND APPROPRIATELY
CONVEYING CRITICALLY IMPORTANT
BUT ALSO NUANCED INFORMATION.
SO WE'LL BE TURNING TOWARDS THE
BEHAVIORAL AND SOCIAL AND
COMMUNICATION SCIENCES, AND HOW
TO OPTIMALLY COMMUNICATE ADVICE
THAT IS DRAWN FROM THE
UNDERLYING BIOLOGICAL SCIENCE,
WHETHER ANIMAL MODELS, WHETHER
IT'S EPIDEMIOLOGICAL AND
OBSERVATIONAL STUDIES, AND USING
THOSE INSIGHTS FROM CURRENT,
FUTURE EXAMPLES OF FEDERAL
COMMUNICATIONS AND HOW TO
PROTECT AGAINST MISINFORMATION,
ANOTHER CRITICALLY IMPORTANT
TOPIC.
OVERALL, LEARNING SO THAT WE CAN
SPEAK SO THAT PEOPLE CAN HEAR
APPROPRIATELY.
WITH THAT, I WILL CLOSE OUT AND
I WILL HAND BACK TO KIM, WHO
WILL END THE DAY.
THANK YOU AGAIN.
>>THANK YOU, DR. McKINNON.
ON BEHALF OF THE PLANNING TEAM I
WOULD LIKE TO THANK OUR SPEAKERS
TODAY FOR TIME AND WONDERFUL
PRESENTATIONS.
I'D LIKE TO THANK THE
PARTICIPANTS FOR JOINING THIS
WORKSHOP.
PLEASE JOIN US FOR OUR SECOND
DAY TOMORROW.
FULL OF INFORMATIVE
PRESENTATIONS, RICH PANEL
DISCUSSIONS, FROM EXPERTS THAT
WILL EXPAND ON RISK
COMMUNICATION SCIENCE,
TOXICOLOGY, NUTRITION AND FOOD
SAFETY.
WE'LL BEGIN DAY 2 AT 10:30 A.M.
EASTERN STANDARD TIME.
REMINDER, AGENDA AND FULL
SPEAKER BIOS ARE ON THE PAGE.
HAVE A WONDERFUL DAY.
WE LOOK FORWARD TO SEEING YOU
TOMORROW.