tag:theconversation.com,2011:/es/topics/baby-food-39751/articlesbaby food – The Conversation2020-05-27T17:14:29Ztag:theconversation.com,2011:article/1380902020-05-27T17:14:29Z2020-05-27T17:14:29ZPeanuts, eggs and your baby: How to introduce food allergens during the coronavirus pandemic<figure><img src="https://images.theconversation.com/files/337093/original/file-20200522-124826-1wdo67v.jpg?ixlib=rb-1.1.0&rect=49%2C0%2C5193%2C3637&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Recommendations suggest babies be introduced to food allergens around age six months.</span> <span class="attribution"><span class="source">(Pixabay)</span></span></figcaption></figure><p>The best way to prevent food allergies is to introduce the most common allergenic foods to babies early in life, as <a href="https://www.doi.org/10.1001/jama.2016.12623">research evidence for peanut and egg has shown</a>. Even during the current COVID-19 pandemic, the benefits of allergy prevention outweigh the very small risk of a severe reaction.</p>
<p>As clinicians and researchers in the field of allergy and infant nutrition, we are worried that COVID-19 may lead parents to delay the introduction of allergens to their babies. Parents may not feel comfortable taking their baby to an emergency room because of potential exposure to COVID-19, so they don’t want to risk a severe allergic reaction requiring a hospital visit.</p>
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<img alt="" src="https://images.theconversation.com/files/335092/original/file-20200514-77243-1yqe5xr.jpg?ixlib=rb-1.1.0&rect=31%2C146%2C3463%2C2551&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/335092/original/file-20200514-77243-1yqe5xr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=463&fit=crop&dpr=1 600w, https://images.theconversation.com/files/335092/original/file-20200514-77243-1yqe5xr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=463&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/335092/original/file-20200514-77243-1yqe5xr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=463&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/335092/original/file-20200514-77243-1yqe5xr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=582&fit=crop&dpr=1 754w, https://images.theconversation.com/files/335092/original/file-20200514-77243-1yqe5xr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=582&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/335092/original/file-20200514-77243-1yqe5xr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=582&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The most common food allergens are cow’s milk, eggs, peanuts and tree nuts, sesame seeds, fish and shellfish, soy and wheat.</span>
<span class="attribution"><span class="source">(Unsplash)</span></span>
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<p>The <a href="https://doi.org/10.1093/pch/pxy195">most recent Canadian recommendations</a> continue to apply during the COVID-19 pandemic. The recommendations encourage parents to introduce allergenic foods to babies as soon as they start eating solids around six months, but not before four months of age. This applies to lower-risk infants as well, but is especially important for babies who are at higher risk of allergy due to eczema, other food allergies or an immediate family history of an allergic condition. </p>
<h2>Should I delay introduction of allergens?</h2>
<p>Many parents may be wondering if they should hold off on introducing allergens to their baby because of COVID-19. The answer is no. Despite the pandemic and some families trying to avoid the risk of an emergency room visit, introducing allergens to babies <a href="https://www.cps.ca/en/blog-blogue/can-we-continue-to-recommend-early-allergenic-food-introduction-during-a-pandemic">without delay</a> is recommended. The risk of a severe allergic reaction when eating a new food for the first time <a href="http://www.doi.org/10.1056/NEJMoa1414850">is extremely low — well below two per cent</a>. </p>
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<img alt="" src="https://images.theconversation.com/files/337095/original/file-20200522-124832-13c5g6g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/337095/original/file-20200522-124832-13c5g6g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/337095/original/file-20200522-124832-13c5g6g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/337095/original/file-20200522-124832-13c5g6g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/337095/original/file-20200522-124832-13c5g6g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/337095/original/file-20200522-124832-13c5g6g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/337095/original/file-20200522-124832-13c5g6g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The risk of a severe allergic reaction to a new food is very low.</span>
<span class="attribution"><span class="source">(Unsplash)</span></span>
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<p>Delaying the introduction might put children at higher risk of allergies. If not introduced in infancy, the risk of an allergic reaction as a child gets older is increased, so it’s better to introduce early and not delay. There is evidence that in higher-risk infants, peanut introduction during infancy <a href="http://www.doi.org/10.1056/NEJMoa1414850">reduces the risk of peanut allergy by up to 80 per cent</a>.</p>
<h2>What if my baby has an anaphylactic reaction?</h2>
<p>It’s very unlikely that infants will react so severely to a new food that they will need an emergency trip to the hospital. To put it further into perspective, <a href="https://doi.org/10.1001/jama.2010.582">food allergies affect around two per cent to 10 per cent</a> of Canadians, so even most older children will not have an allergic reaction to foods. The chance of a severe allergic reaction such as anaphylaxis is much less than two per cent, even in higher risk infants.</p>
<p>In the unlikely event that infants have a severe reaction and need to go to the emergency room, <a href="https://doi.org/10.1016/j.jiph.2020.03.019">the risk of acquiring COVID-19 is also extremely low when proper infection control measures are adhered to</a>. The risk of an infant dying from COVID-19 in the unlikely event that it is acquired while visiting the emergency room is even more remote <a href="http://www.doi.org/10.1097/INF.0000000000002700">since children have milder disease symptoms</a>.</p>
<h2>How should I introduce allergens?</h2>
<p>In Canada, the most common allergens are cow’s milk, eggs, peanuts and tree nuts, sesame seeds, fish and shellfish, soy and wheat. Puréed foods, smooth nut butters diluted with breast milk or formula, or ground nuts mixed in purées are great ways for parents to introduce allergens safely in non-choking form for babies.</p>
<p>It’s important that the allergen be introduced orally, meaning that the infant eats the food. We don’t recommend rubbing it on the skin or lips to test for an allergic reaction as that may cause irritation that could be misinterpreted as allergy.</p>
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<img alt="" src="https://images.theconversation.com/files/337150/original/file-20200523-124810-1ohh493.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/337150/original/file-20200523-124810-1ohh493.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/337150/original/file-20200523-124810-1ohh493.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/337150/original/file-20200523-124810-1ohh493.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/337150/original/file-20200523-124810-1ohh493.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/337150/original/file-20200523-124810-1ohh493.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/337150/original/file-20200523-124810-1ohh493.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Allergens can be introduced in puréed foods. Smooth peanut butter can be diluted with breast milk or formula.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>Parents can introduce these foods one at a time, always in an age-appropriate way for their baby, and without delays between the introduction of new foods. Allergic reactions usually appear very quickly, so parents can gauge reaction within a couple of hours following the meal. </p>
<p><a href="https://foodallergycanada.ca/food-allergy-basics/preventing-and-treating-allergic-reactions/reaction-signs-and-symptoms/">Allergic reactions in infants will usually affect</a> the skin (hives, itchiness, rash), gastrointestinal tract (vomiting, diarrhea) or respiratory system (wheezing). Parents should monitor the signs closely and take pictures of skin reactions as they seek advice from their family doctor. If there is a reaction, the food should be avoided until parents have consulted their health-care team, and decided on the next best steps to take. </p>
<p>Once an allergen has been introduced safely, it is very important to keep offering and serving it to the baby a few times a week to maintain tolerance. Aiming to include these allergens in the regular family diet is a practical way for parents to offer it often to baby. </p>
<p>The benefit of preventing the development of food allergy (which can affect the quality of life of the whole family for many years) is far greater in our professional opinion than the very small risk of experiencing a life-threatening allergic reaction and potentially exposing infants to COVID-19.</p><img src="https://counter.theconversation.com/content/138090/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Maude Perreault was a Vanier Scholar and received funding from the Canadian Institutes of Health Research, and the Canadian Child Health Clinician Scientist Program.</span></em></p><p class="fine-print"><em><span>Edmond S. Chan has received research support from DBV Technologies; has been a member of advisory boards for Pfizer, Pediapharm, Leo Pharma, Kaleo, DBV, AllerGenis; is a member of the healthcare advisory board for Food Allergy Canada; was an expert panel and coordinating committee member of the National Institute of Allergy and Infectious Diseases (NIAID)-sponsored Guidelines for Peanut Allergy Prevention; and was co-lead of the CSACI oral immunotherapy guidelines.</span></em></p><p class="fine-print"><em><span>Elissa Abrams is a member of theHealthcare advisory board for Food Allergy Canada. </span></em></p>Introducing food allergens early is the best way to prevent food allergies from developing. Even in a pandemic, the benefits outweigh the very small risk of a severe reaction requiring emergency care.Maude Perreault, Registered dietitian and Research Associate, McMaster UniversityEdmond S. Chan, Pediatric Allergist; Head & Clinical Associate Professor, Division of Allergy & Immunology, Department of Pediatrics, Faculty of Medicine; Investigator, BC Children's Hospital Research Institute, University of British ColumbiaElissa M. Abrams, Asssistant Professor, Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Johns Hopkins UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1170322019-05-28T14:40:02Z2019-05-28T14:40:02ZWe tested baby food sugar levels in South Africa. This is what we found<figure><img src="https://images.theconversation.com/files/274110/original/file-20190513-183096-1eu8vnq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Researchers are calling for legislation limiting the amount of sugar in baby food.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>South Africa has the highest rates of childhood obesity in the world, with an alarming figure of <a href="https://www.statssa.gov.za/publications/Report%2003-00-09/Report%2003-00-092016.pdf">13%</a>. The global average stands at <a href="https://www.gainhealth.org/wp-content/uploads/2017/11/GNR-Report_2017.pdf">6%</a>. One of the main causes of South Africa’s rate is the rapid growth of the country’s commercial food industry. This has led to increased consumption of cheap, easily accessible and ultra-processed food that is high in sugar. </p>
<p>We <a href="http://www.samj.org.za/index.php/samj/article/view/12597/8810">analysed</a> the sugar content of a variety of baby food products. The study sample included commercially available baby foods – including boxes of cereals and jars of processed food – targeted at children under 12 months and sold in supermarkets and other major retailers in South Africa. We collected data on sugar content and compared this with recommended intake guidelines. We also checked if the sugar content was added sugar or free sugar – the kind often found in processed food. </p>
<p>We also characterised the food based on back of the package information. This wasn’t easy as the facts are provided in tiny font that is difficult to read and interpret. For example the content is usually shown as grams per 100 ml or per serving, not in teaspoons. </p>
<p>Our findings showed that most baby cereals have added sugar. This is a concern because they are often the first food given to babies when they are weaned. We also found that pureed fruit and desserts had very high levels of sugar (20g or more per serving; that’s about 4 teaspoons).</p>
<p>This is bad news for the future health of South Africa’s population because it encourages a “sweet tooth” in children – in other words a preference for foods that taste sweet for the rest of their lives. </p>
<p>Sugar is a big contributor to increased tooth decay. It also results in childhood weight gain and obesity that causes preventable diseases later in life such as diabetes, high blood pressure and cancer. Although the sweet-taste preference is present <a href="https://www.ncbi.nlm.nih.gov/pubmed/23660363">at birth</a>, exposure to too much sugar early in life can affect <a href="https://academic.oup.com/ajcn/article/99/3/723S/4577491">what people eat</a>, including a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1351274/">preference</a> for sweet things. </p>
<p>What this adds up to is that, in the long term, sugar in baby products will contribute to South Africa’s rising burden of noncommunicable diseases and will affect life expectancy. </p>
<p>Global weaning guidelines recommend that babies get fed complementary foods that don’t have added sugars. The aim is to ensure that the threshold for sweet tastes is set at lower levels. In turn, this helps prevent health problems in both childhood as well as later in life. </p>
<p>We conclude that there’s an urgent need to start regulating sugar in baby foods. South Africa’s childhood obesity crisis won’t be resolved unless the baby food industry stops promoting the development of sweet preference from an early age.</p>
<h2>What we found</h2>
<p>Commercial baby foods are <a href="https://www.cambridge.org/core/journals/public-health-nutrition/article/qualitative-exploration-of-rural-feeding-and-weaning-practices-knowledge-and-attitudes-on-nutrition/6D1156ED9699CB3D90B75AD2150DABA6">often introduced as first foods</a> to infants in South Africa because they are convenient and easy to use. This makes our findings particularly alarming. </p>
<p>We collected and analysed the sugar content of 235 baby food items from 12 different manufacturers sold in major South African supermarkets. Nearly 90% were prepared baby food products, of which 35% were pureed fruit and 20% were pureed meals. </p>
<p>Only one in five of the baby foods in the study had acceptable levels as defined by the World Health Organisation (WHO) – that is, less than 20% of total calories was derived from sugar. </p>
<p>But nearly 80% of cereals and pureed desserts contained added sugar. Processed meals that contained added sugar, including honey, were a carrot blend with semolina and two types of breakfast oats.</p>
<p>The study also shed light on the fact that little information was available to consumers on the ingredients used in the baby foods. For example, it was almost impossible to identify which products had added sugar versus those that had intrinsic (natural) sugars only. Both are unhealthy in processed products. </p>
<h2>Recommendations</h2>
<p>On the basis of our study, we have a number of recommendations. The first is that the amount of sugar in baby food should be regulated as a matter of urgency. To start with, mandatory disclosure of added sugar by manufacturers and the introduction of a food labelling system is essential. </p>
<p>A promising example is <a href="https://www.ncbi.nlm.nih.gov/pubmed/24102671/">Chile’s warning octagonal logos</a> that tell consumers if a product exceeds a recommended limit of sugar. There is already <a href="http://www.dii.uchile.cl/%7Ecnoton/AENS_2018.pdf">less demand</a> for juices and cereal with high sugar content. </p>
<p>And given the importance of serving sizes in controlling obesity, information on nutrients per portion and the number of portions per package should be included. It would help if this were standardised across all related food products, which is currently not the case. </p>
<p>Consumers can’t make informed choices about what’s in the food they are feeding their infants without easily understandable labels of calorie and nutritional information. Even if they wanted to stick to the WHO’s <a href="https://www.who.int/nutrition/publications/guidelines/sugars_intake/en/">recommendation</a> that the intake of free sugars should be reduced to less than 10% of total energy intake, the public can’t do so because of a lack of clearly understandable information.</p>
<p>We also recommend limiting sweet, processed baby foods in favour of healthier alternatives. </p>
<p><em>We acknowledge the contribution of Agnes Erze in the preparation of this piece. She is a research fellow at the SAMRC/Wits Centre for Health Economics and Decision Science/PRICELESS.</em></p><img src="https://counter.theconversation.com/content/117032/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Karen Hofman currently receives research funding from the IDRC (Canada), UK Wellcome Trust, UK National Institutes for Health Research, Bloomberg Philanthropies and the South African Medical Research Council. In the past, she has also received funding from the Bill and Melinda Gates Foundation, WHO and UNFPA.</span></em></p><p class="fine-print"><em><span>Nicola Christofides does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A study showed that most baby food products have a high sugar content.Karen Hofman, Professor and Program Director, SA MRC Centre for Health Economics and Decision Science - PRICELESS SA ( Priority Cost Effective Lessons in Systems Stregthening South Africa), University of the WitwatersrandNicola Christofides, Associate Professor, School of Public Health, University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1132192019-04-01T11:20:27Z2019-04-01T11:20:27ZBaby-led weaning or spoon feeding? The difference it makes to your child’s eating habits is actually very small<figure><img src="https://images.theconversation.com/files/266555/original/file-20190329-70996-s89be1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Dinner time - but who's leading the feeding?</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/baby-early-stages-led-weaning-1072172030">R Gallianos/Shutterstock</a></span></figcaption></figure><p>When it comes to avoiding picky eating and meal time tantrums, parents are usually ready to try any method that promises their child will become a better and less fussy eater. This is in part why methods of giving solid food to infants have received a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5934812/">lot of attention</a> in the last few years. Some think that the way babies are introduced to solids can change their attitudes to food into childhood or even for life.</p>
<p>The most <a href="https://www.nhs.uk/conditions/pregnancy-and-baby/solid-foods-weaning/">common method</a> used to give babies their first solids has long been to offer a puree or mash using a spoon. This helps parents make sure their babies receive adequate energy and nutrients for their development – something many are often anxious over.</p>
<p>More recently, however, <a href="https://www.bbcgoodfood.com/howto/guide/what-baby-led-weaning">baby-led weaning</a> has gained popularity – and divided parents. This method sees babies selecting finger foods – such as carrot sticks, broccoli trees or other pieces of whole, baby-fist size pieces of food – and feeding themselves. While there have been unsubstantiated claims that this method can improve a baby’s <a href="https://www.annabelkarmel.com/baby-led-weaning-pros-and-cons/">dexterity and confidence</a>, research has associated baby-led weaning with their ability to recognise <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.2047-6310.2013.00207.x">when they are full</a> and being less fussy with their food. This makes it an appealing choice for some parents.</p>
<p>However, as with most things baby-related, the reality is that many parents don’t use just one method of feeding. It changes depending on the time, day or situation they are in. Which is why, for our <a href="https://www.sciencedirect.com/science/article/pii/S0195666318316581?dgcid=author">recently published study</a>, we wanted to compare how different styles of feeding affects a baby’s eating habits and attitudes to food.</p>
<h2>Is baby-led weaning better?</h2>
<p>We looked at four different categories of toddlers, whose parents introduced them to solids using either: solely baby-led weaning, mostly baby-led weaning with occasional spoon feeding, mostly spoon feeding with occasional finger foods, or just spoon feeding. We asked the parents questions about their feeding strategies and eating behaviours of their toddlers, like fussiness and food enjoyment. </p>
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<span class="caption">Here comes the aeroplane!</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/closeup-shot-baby-feeding-spoon-428585137">Petr Bonek/Shutterstock</a></span>
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<p>Usually, in a statistical analysis, we look at whether there is a difference between groups. But what this doesn’t tell us is how big the difference actually is. To solve this problem, we looked at the size of the difference between the groups (what we call the effect size). It helps us understand whether the difference actually matters. </p>
<p>We found that the magnitude of difference in a toddler’s fussiness and food enjoyment is minimal across the four groups. This means that baby-led weaning, spoon-feeding or anything in between might not actually be the solution to future mealtime battlegrounds some parents hope it will be. That may seem to be in contrast with what the research shows so far, but it doesn’t negate those findings. Babies will be less picky about their food if they are fed using baby-led weaning as opposed to any of the other types of feeding, it’s just not by that much.</p>
<h2>Socio-economics at play</h2>
<p>When looking at the strategies parents use to feed their children, our study did show that those who follow baby-led weaning are less likely to use food as a reward or encouragement, and have less control on eating overall. This helps their toddlers learn to make eating decisions for themselves based on whether they are hungry or full. These parents are also more likely to breastfeed for longer, introduce solids after six months and eat more frequently with their toddlers.</p>
<p>However, the key difference here is not that the children were fed using baby-led weaning but instead the type of families who usually follow it. Our findings show that these parents are usually of a higher socio-economic status and more educated, which makes them more likely to follow a distinctly different parenting style and be able to afford to spend more time and money doing so.</p>
<p>Overall, our results suggest that the way a baby is introduced to solids will make very little difference to how fussy they will become, or how much they will enjoy food. It is important to remember that how children eat depend on a lot of factors, including <a href="https://www.telegraph.co.uk/science/2016/10/13/fussy-eating-habits-of-children-are-down-to-genetics-not-bad-par/">their genetic background</a>, their past experiences with food and their <a href="https://www.livestrong.com/slideshow/13711836-12-ways-your-parents-messed-up-your-relationship-with-food/">interaction with their parents</a>.</p>
<p>Research findings are important when communicating complementary feeding advice to new parents, but headlines and quoted study results can often be misleading. So remember that when reports of research say there is a difference between one method over an other, it’s not the whole story. The size of this difference – something that is not often communicated – matters too. The most important thing that parents can do is to try their best and introduce solids in a way that is more appropriate for their family, rather than stressing about a specific method, as research suggests might make a only a very small difference.</p><img src="https://counter.theconversation.com/content/113219/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sophia Komninou does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Baby-led weaning won’t necessarily make your child a less fussy eater, new research finds.Sophia Komninou, Lecturer in Infant and Child Public Health, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/996452018-07-10T10:46:03Z2018-07-10T10:46:03ZGiving your baby solid food early won’t help them sleep better<figure><img src="https://images.theconversation.com/files/226940/original/file-20180710-70042-wmwq4j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Sleeping like a baby.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/3-months-old-baby-girl-sleeping-1102507679?src=oQVF0_4WEh552o-LfunUJw-1-75">Ekaterina Pokrovsky/Shutterstock</a></span></figcaption></figure><p><a href="https://www.theguardian.com/lifeandstyle/2018/jul/09/feeding-baby-solids-early-may-help-them-sleep-study">New research</a> claims that giving babies solid foods at just three months old will help them sleep. Though this may sound appealing to exhausted new parents, unfortunately there is a large gulf between the headlines and the data. </p>
<p>Much of the published evidence in this area actually shows the opposite, that what a baby eats has nothing to do with their sleep. In 2015 <a href="https://www.ncbi.nlm.nih.gov/pubmed/25973527">we found</a> that neither breast nor formula milk, timing of solids introduction, nor the amount of solids eaten affected how often babies woke up at six to 12 months. </p>
<p>Another study has found that the common practice of <a href="https://jamanetwork.com/journals/jamapediatrics/article-abstract/514762">adding rice cereal</a> to a bottle before bed (which should be avoided as it can cause choking) has no impact on sleep at four months old. While <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2866807/">a third</a> found that early introduction of solids was associated with <em>less</em> sleep at 12 months old. </p>
<p>The recent study is an excellent example of how statistically significant differences and real world differences can be miles apart. The <a href="https://jamanetwork.com/journals/jamapediatrics/fullarticle/2686726">authors themselves note</a> that no difference in waking was seen until five months old, despite one group having solids from three months. </p>
<p>From then, babies in the early introduction group may have technically slept more, but this amounted to an average of just seven minutes more a night. At its maximum (six months old) the difference was 16 minutes. Most babies in the study still woke up once or twice a night whatever they were fed. And given these figures are based on the self-reporting of sleep deprived parents – <a href="https://www.sciencedirect.com/science/article/pii/S1389945718303204">which often does not match up to sleep recordings</a> – this is not a basis for making major changes in infant feeding practices. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/VYGziCvEcoY?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<p>There is no physiological reason why introducing solid foods early would help a baby sleep. First, babies (after the first few weeks) <a href="https://www.huffingtonpost.co.uk/amy-brown/does-anyone-really-sleep-_b_16971544.html">do not simply wake at night</a> because they are hungry. Just like adults, <a href="https://www.isisonline.org.uk/how_babies_sleep/">they wake because they are cold, uncomfortable or simply want comfort</a>. The difference being that they cannot always soothe themselves back to sleep. </p>
<p>Second, even if it were for hunger, the most sensible solution would be to offer additional milk, as it will give <a href="https://kellymom.com/nutrition/starting-solids/babyfoodcalories/">more energy, fat and protein than any other food</a> you can give a baby. The aim of the trial from which this data came was not to increase overall energy intake, but <a href="https://www.food.gov.uk/sites/default/files/media/document/eat-study-full-report.pdf">to test how introduction of allergenic foods</a> at three versus six months affects the development of allergies (which it did not). </p>
<p>The parents were advised to give very small amounts of allergenic foods (such as one egg, 25g fish and 100g yogurt spread over a week – just a few spoonfuls a day) alongside rice, cereals, fruit and vegetables. All of these foods are lower in calories than breast or formula milk but take up more room, meaning babies might even eat a little less as they get used to weaning – a potential explanation for the larger sleep gap at six months as the standard group got used to food. </p>
<h2>Solid sleep</h2>
<p>Less than half of the parents in the early introduction group stuck to the protocol. A variety of reasons were given but a major issue with introducing solids early is that <a href="https://kellymom.com/nutrition/starting-solids/solids-when/">babies are simply not physiologically ready</a>. At three months, many may only just have good head control. They won’t be able to sit up properly. They still have a gag reflex that pushes food out of their mouth. Earlier introduction of solids can be <a href="https://www.ncbi.nlm.nih.gov/pubmed/21143584">messy, time consuming and demoralising</a>, as babies simply aren’t equipped to be eating solids so soon.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/226915/original/file-20180710-70060-fe9jjo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/226915/original/file-20180710-70060-fe9jjo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/226915/original/file-20180710-70060-fe9jjo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/226915/original/file-20180710-70060-fe9jjo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/226915/original/file-20180710-70060-fe9jjo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/226915/original/file-20180710-70060-fe9jjo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/226915/original/file-20180710-70060-fe9jjo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">At three months, most babies can’t sit up properly.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/biracial-mix-hispanic-black-african-american-39099073?src=PNXo7MeLuRpuMmASso4sCg-1-21">OLJ Studio/Shutterstock</a></span>
</figcaption>
</figure>
<p>Research shows that the earlier a baby is weaned, the longer it takes them to eat anything other than a few tastes. <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1651-2227.2001.tb00785.x">One study found</a> if babies were given solids before four months it took them six weeks on average to eat just 100ml of food per day, but it was just 12 days for those weaned at the recommended six months.</p>
<p>The <a href="https://static1.squarespace.com/static/59f75004f09ca48694070f3b/t/5a5a41479140b7e31a75ccbc/1515864404727/Eating_well_the_first_year_Sep_17_small.pdf">guidelines to introduce solid foods</a> at six months are there for good reason. There is <a href="https://www.ncbi.nlm.nih.gov/pubmed/22895934">no deficit to growth or nutrient status</a> in waiting until six months to introduce solid foods, but there is an increased risk of gastrointestinal and respiratory illnesses in infants given solid foods before then. </p>
<p>Introducing solids too early <a href="https://files.eric.ed.gov/fulltext/ED479275.pdf">can lead to</a> a reduction in breastmilk intake (and its associated antibodies), introduction of contaminants, and can cause digestive difficulties as babies do not develop all the enzymes needed to properly digest solid foods until between four and six months old. </p>
<p>It should also be noted that the babies in the study were a very specific group. Nearly all were <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1514210">breastfed until six months old</a> – 97%, compared to <a href="https://digital.nhs.uk/data-and-information/publications/statistical/infant-feeding-survey/infant-feeding-survey-uk-2010">just 34% in the UK population</a>. Research shows that <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/apt.12023">breastfeeding through introduction to solid foods</a> is important in reducing allergy development, but often early introduction of solids increases risk of <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/mcn.12166">stopping breastfeeding</a>. </p>
<p>Great care must be taken in generalising these findings. The research begs the question, does introducing solids early – with all its associated risks – really carry more weight if it comes with a few minutes of sleep every night? It seems to me that we should be asking why parents are struggling with sleep so much and <a href="https://www.ncbi.nlm.nih.gov/pubmed/28744924">seek better ways to support them</a> instead.</p><img src="https://counter.theconversation.com/content/99645/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amy Brown has previously received funding from the ESRC, NIHR and Public Health Wales. She is author of three books published by Pinter and Martin Ltd - 'Breastfeeding Uncovered: who really decides how we feed our babies', 'Why starting solids matters' and the forthcoming 'The Positive Breastfeeding Book'.</span></em></p>A new study claims that an early start on solids can help babies sleep – but established research has proven the risks outweigh any benefit.Amy Brown, Professor of Child Public Health, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/794812017-06-16T00:42:05Z2017-06-16T00:42:05ZIs lead in the US food supply decreasing our IQ?<figure><img src="https://images.theconversation.com/files/174088/original/file-20170615-24915-1i3j0lg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A baby plays with blocks spelling out one of the most famous formulas in history. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/genius-baby-high-iq-playing-cubes-461058916?src=ygHBdVvcs9OKo5WBzS4ZZg-1-16">vchal/From www.shutterstock.com</a></span></figcaption></figure><p>The environmental advocacy group Environmental Defense Fund (EDF) on June 15 released a <a href="https://www.edf.org/health/lead-food-hidden-health-threat?_ga=2.61184942.363465047.1497539228-274183335.1497539228">study</a> about dietary lead exposure, with a focus on food intended for babies and young children. </p>
<p>Using a Federal Drug Administration (FDA) database of food samples, EDF reported some pretty worrying numbers, most remarkably in fruit juice samples intended for children. For example, 89 percent of the baby food grape juice samples had detectable levels of lead in them.</p>
<p>As researchers who served as independent reviewers on the EDF report, we think it raises important concerns about the safety of our food supply. Since EDF primarily focused on exposure (whether lead was detectable or not), we were interested to see if we could get a better sense of the magnitude of risk. Specifically, we examined potential IQ loss and the percentage of samples with high lead concentrations.</p>
<h2>Why is lead in our food and beverages?</h2>
<p>Most of us are probably familiar with the dangers of chipping and peeling <a href="https://www.epa.gov/lead">lead paint</a>. And the Flint water crisis has brought <a href="https://theconversation.com/piping-as-poison-the-flint-water-crisis-and-americas-toxic-infrastructure-53473">lead pipes</a> to the forefront of our minds.</p>
<p>But food is a source of lead exposure most of us probably aren’t thinking about. <a href="https://www.fda.gov/Food/FoodborneIllnessContaminants/Metals/ucm557424.htm">Soil contamination</a> is a known source of lead in food, but the EDF report also raised the possibility of contamination occurring via the use of lead-containing materials during food processing. </p>
<p>Eating lead-contaminated food increases the level of lead in the blood. Chronic, low-level exposure to lead during childhood can harm <a href="https://www.atsdr.cdc.gov/phs/phs.asp?id=92&tid=22#bookmark06">mental and physical development</a>. For each microgram (µg) per day of dietary lead intake, blood lead levels increase by about .16 micrograms per deciliter (µg/dL), though there is individual <a href="http://onlinelibrary.wiley.com/doi/10.2903/j.efsa.2010.1570/epdf">variation in how much lead is absorbed through the gastroinestical tract</a>. A microgram is one millionth of a gram – a very small unit of measure. </p>
<p>There is <a href="http://www.who.int/mediacentre/factsheets/fs379/en/">no known level of lead exposure</a> that is considered safe. Even <a href="https://ntp.niehs.nih.gov/pubhealth/hat/noms/lead/index.html">low blood lead levels</a> can harm child development and behavior. In 2012, the Centers for Disease Control and Prevention (CDC) reduced the <a href="https://www.cdc.gov/nceh/lead/acclpp/lead_levels_in_children_fact_sheet.pdf">definition of elevated blood levels in children</a> from 10 to 5 μg/dL.</p>
<p>This revised definition reflects findings from a <a href="https://ntp.niehs.nih.gov/pubhealth/hat/noms/lead/index.html">2012 National Toxicology Program Report</a> that concluded a wide range of adverse health effects are associated with blood lead levels less than 5 μg/dL. These included “decreased academic achievement, IQ, and specific cognitive measures; increased incidence of attention-related behaviors and problem behaviors.”</p>
<p>The FDA has set <a href="https://www.fda.gov/Food/FoodborneIllnessContaminants/Metals/ucm557424.htm">limits for lead</a> in the form of maximum parts per billion (ppb) for certain foods. The FDA reports that these differences in limits are due to what is considered <a href="https://www.fda.gov/Food/FoodborneIllnessContaminants/Metals/ucm557424.htm">achievable</a> after food processing. The American Academy of Pediatrics has the lowest recommended limit at <a href="http://pediatrics.aappublications.org/content/pediatrics/early/2016/06/16/peds.2016-1493.full.pdf">1 ppb for school drinking water</a>. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/173915/original/file-20170615-26091-16ilnpm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/173915/original/file-20170615-26091-16ilnpm.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=433&fit=crop&dpr=1 600w, https://images.theconversation.com/files/173915/original/file-20170615-26091-16ilnpm.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=433&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/173915/original/file-20170615-26091-16ilnpm.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=433&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/173915/original/file-20170615-26091-16ilnpm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=545&fit=crop&dpr=1 754w, https://images.theconversation.com/files/173915/original/file-20170615-26091-16ilnpm.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=545&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/173915/original/file-20170615-26091-16ilnpm.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=545&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Lead Limits in Juice and Water.</span>
<span class="attribution"><span class="source">Environmental Defense Fund</span></span>
</figcaption>
</figure>
<h2>How many of the samples had detectable levels of lead?</h2>
<p>EDF analyzed more than 12,000 test results from the 2003-2013 FDA national composite food sample data (the <a href="https://www.fda.gov/Food/FoodScienceResearch/TotalDietStudy/ucm184232.htm">Total Diet Study</a>). The Total Diet Study is an FDA “<a href="https://www.fda.gov/Food/FoodScienceResearch/TotalDietStudy/ucm494299.htm">market-basket</a>” survey of typical foods eaten by U.S. consumers and is used to assess average nutrient intake and exposure to chemical contaminants. </p>
<p>EDF did an exposure analysis (detection/nondetection), and reported the percentage of samples within different food types that tested positive for lead. Twenty percent of the samples designated by the FDA as baby food had detectable levels of lead in them, compared to 14 percent for regular foods.</p>
<p>This type of analysis is similar to measuring accident rates in workplaces, or even visits by children to the medical staff in schools. As with the lead data, increases in these numbers alert organizations to potential problems, but they don’t give enough indication to pinpoint the exact nature of the problem. </p>
<p>Even without specifics on the magnitude of the risks involved, when a lead exposure issue is flagged, it’s good practice to reduce the exposure – as a way to guard against associated negative health impacts such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1257652/">decreased intellectual function</a>.</p>
<h2>How might this be affecting our IQ?</h2>
<p>These data alone aren’t enough to indicate what the likely health effects are. Ultimately, the risk depends on how much contaminated food a child will eat through his or her childhood, and how much neurological damage this ends up causing.</p>
<p>Based on <a href="https://www.epa.gov/sites/production/files/2017-01/documents/report_proposed_modeling_approaches_for_a_health_based_benchmark_for_lead_in_drinking_water_final_0.pdf">EPA estimates</a> of average childhood dietary lead exposure, we are roughly dealing with a less than 1-point decrease in IQ in the adult population than it might otherwise be. </p>
<p>In its analysis, EDF calculated an 0.38 average IQ loss from dietary lead based on the following assumptions: </p>
<ul>
<li><p>Average dietary lead exposure for young children is 2.9 µg/day. This calculation is based on a <a href="https://www.epa.gov/sites/production/files/2017-01/documents/report_proposed_modeling_approaches_for_a_health_based_benchmark_for_lead_in_drinking_water_final_0.pdf">2017 EPA dietary lead intake estimate</a> for children ages 1-7 years.</p></li>
<li><p>2.9 µg/day dietary exposure elevates blood lead levels by 0.46 µg/dL. This calculation is based on a <a href="http://www.sciencedirect.com/science/article/pii/027323009290008W?via%3Dihub">ratio of dietary lead intake to the increase in blood lead levels</a> (for every 1 µg/day lead consumed in the diet, lead increases in the blood by 0.16 µg/dL).</p></li>
<li><p>This 0.46 µg/dL elevation in lead in the blood decreases IQ by an estimated 0.38 IQ points. This calculation is based on a <a href="http://onlinelibrary.wiley.com/doi/10.2903/j.efsa.2010.1570/epdf">2013 European Food Safety Authority (EFSA) ratio of blood lead level increase to IQ loss</a> (1.2 µg/dL lead in blood to a 1 point IQ loss).</p></li>
</ul>
<p>Recall that the <a href="https://ntp.niehs.nih.gov/pubhealth/hat/noms/lead/index.html">2012 National Toxicology Program Report</a> cited a wide range of measurable health effects occurring with blood lead levels less than 5 μg/dL. For comparison, we are talking about an average increase of 0.46 μg/dL blood lead levels from dietary exposure alone.</p>
<p>Though the estimated reductions in IQ here may seem low, they are not insignificant – in some cases, small losses in IQ might make the difference, for example, in the type of career one leads and subsequent <a href="http://www.nber.org/papers/w22470">lifetime earnings</a>. </p>
<h2>How many of the samples tested above specific lead concentrations?</h2>
<p>We went back to the same FDA data EDF used, looked at the measured amounts of lead, and then plotted the percentage of tested baby food products with lead concentrations above certain amounts.</p>
<p>This type of plot gives a ballpark idea of the percentage of the baby food being sold in the U.S. for certain levels of lead. But the data need to be treated with caution, as many of the measurements were below the Limit of Quantification (LOQ), meaning that they may not be particularly accurate.</p>
<p>Average dietary lead exposure for young children is around <a href="https://www.epa.gov/sites/production/files/2017-01/documents/report_proposed_modeling_approaches_for_a_health_based_benchmark_for_lead_in_drinking_water_final_0.pdf">2.9 µg/day</a>, which approximately equates to daily levels in food at about 2.9 ppb (assuming <a href="https://cfpub.epa.gov/ncea/risk/recordisplay.cfm?deid=236252">average consumption of about 1 kg of food</a>). Our analysis shows the percentage of baby food samples testing at higher levels. Eighteen percent of the baby food samples tested above 5 ppb lead, which is the amount the FDA allows in drinking water. This percentage decreased in accordance with the lead concentration: 9 percent of the samples tested above 10 ppb lead; 2 percent tested above 20 ppb lead; and less than 1 percent tested above 30 ppb lead. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/173948/original/file-20170615-25014-v467x7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/173948/original/file-20170615-25014-v467x7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/173948/original/file-20170615-25014-v467x7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/173948/original/file-20170615-25014-v467x7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/173948/original/file-20170615-25014-v467x7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/173948/original/file-20170615-25014-v467x7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/173948/original/file-20170615-25014-v467x7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Percentage of baby food samples with lead concentrations greater than a given level.</span>
</figcaption>
</figure>
<h2>Where do we go from here?</h2>
<p>Even though these are not life-and-death type risks, we believe there is no room for complacency. The FDA sets limits for lead in food, but the current limits are based on levels that can be reliably measured and are considered achievable after manufacturing processes. However, a May 2017 <a href="https://www.fda.gov/Food/FoodborneIllnessContaminants/Metals/ucm557424.htm">FDA fact sheet on lead in foods</a> states that a Toxic Elements Working Group will be developing a risk-based approach. Establishing limits based on risk would help further curb the impacts of lead on society. </p>
<p>The good news is that this is possible. Many of the samples tested by FDA are already either lead-free (according to the limits of detection in the analyses used) or have low lead content. It should be possible to expand the number of products that fit into these categories, simply by understanding what some companies do right and replicating it.</p>
<p>The bottom line is that, even with relatively few products on the market with relatively high quantities of lead, the health risks from this metal are insidious, which means the more we do to eliminate it from our food supply, the better off we’ll be.</p>
<p><em>This story was updated on June 16 to correct the date of CDC recommendations and also to clarify that the 2017 EPA dietary lead exposure estimate is based on data from 2007-2013.</em></p><img src="https://counter.theconversation.com/content/79481/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Szejda's position is funded by the Center for Research on Ingredient Safety (CRIS) at Michigan State University.
She served as an independent reviewer on the EDF Lead in Food Report.</span></em></p><p class="fine-print"><em><span>Andrew Maynard receives funding support from the Center for Research on Ingredient Safety (CRIS) at Michigan State University. He is also on the Board of Trustees of the International Life Sciences Association North America. He served as an independent reviewer on the EDF Lead in Food Report.</span></em></p>A new report from the Environmental Defense Fund raises concerns about lead in our food supply. Here are some things you should consider.Keri Szejda, Postdoctoral Research Associate, Arizona State UniversityAndrew Maynard, Director, Risk Innovation Lab, Arizona State UniversityLicensed as Creative Commons – attribution, no derivatives.