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HHRA is conducting a nested case-control study similar to the PROTECT study that will measure herbicide levels in pregnant women and determine if higher exposures are correlated with preterm births or other reproductive impacts.

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  • Eaters Deserve More Complete Information About Nutrition and Health Impacts on Food Labels  

    Multiple lines of evidence point to consumer food choices as major contributors to diet-related disease, and poor health and fitness. In a peer-reviewed journal article published today, authors Chuck Benbrook and Robin Mesnage cite studies indicating that “Some 90% of the estimated USD 4.3 trillion in annual health care costs in the US is triggered or made worse by poor food quality and diet-related disease.” Benbrook is the founder and former executive director of the Heartland Health Research Alliance (HHRA). The authors recommend novel metrics on both the nutrient density of food, and how to more accurately and usefully characterize the degree of food processing and its impacts on public health. The article is open access in the journal Foods and entitled “Enhanced Labeling to Promote Consumption of Nutrient Dense Foods and Healthier Diets.” The core nutrient density metric is a ratio: the percent of daily nutrient needs satisfied by a serving of food relative to the percent of a 2000 calorie daily diet taken up by the serving of food. This single metric is unmatched in comprehensively reflecting the nutritional quality of food. A graphic option to convey the metric on packaging is presented in Figure 3 in the new paper: A novel graphic is presented in Figure 5 to which integrates both the nutrient density and food processing metrics and graphics in a single graphic, shown below. The impacts of ultra-processed food (UPF) on public health outcomes is among the hottest topics in nutrition, medical, and public health journals, and media coverage on food quality and health outcomes. At the request of the journal, the authors developed a video abstract that explains the paper’s goals, methods, and key findings and recommendations. The authors conclude their paper with these observations: Transparent and accurate food product-specific ingredient and nutrient composition data should determine the content of nutrition health labeling. Efforts to soften the message should be resisted in light of the overwhelming need for new food labels that help bring about substantial improvements in food nutritional quality and dietary choices. Benbrook and Mesnage’s paper builds on public comments HHRA submitted in response to the US Food and Drug Administration (FDA) proposed rule in 2023 to update the definition of the term “healthy” on food labels. The proposed role would require foods labeled “healthy” to contain minimum amounts of foods recommended by USDA’s Dietary Guidelines, and to limit saturated fat, sodium, added sugar and other less healthy nutrients. Entitled “Food Labeling: Nutrient Content Claims; Definition of Term `Healthy’”, the comments recommended new  nutrition/health messaging on the front of food packaging. Co-authors of comments included the chair of HHRA’s Policy Advisory committee Dr. Kathleen Merrigan, HHRA science advisors, and other experts working on how changes in farming systems and technology can increase the nutritional quality of food: Dr. Hannah Flower, Dr. Donald R. Davis, Dr. David Montgomery and Anne Biklé. In the comments, the authors introduced “NuCal” as a name for their new system. Resources HHRA February 2023 comments to the FDA. Benbrook and Mesnage (2024). Enhanced Labeling to Promote Consumption of Nutrient Dense Foods and Healthier Diets, Foods. https://doi.org/10.3390/foods13213377 Video Abstract: “Enhanced Labeling to Promote Consumption of Nutrient Dense Foods and Healthier Diets”

  • HHRA Weighs in on Key Pesticide Issues Under Review by the National Organic Standards Board

    HHRA and ORG-Tracker, represented by Dr. Chuck Benbrook and Dr. Brian Baker, submitted comments to the Agricultural Marketing Service at the USDA in advance of the National Organic Standards Board (NOSB) meeting in Portland, Oregon, from October 22nd to 24th, 2024. Drs. Benbrook and Baker will both attend the conference and deliver public comments. ORG-Tracker is a project carried out by HHRA. It aggregates pesticide residue data from inspections of organic farms carried out by certifiers. The tables generated by ORG-Tracker utilize the results of certifier testing to compare residue frequency and risk levels to food produced on conventional farms. The team is working to more effectively highlight gaps and challenges faced by certification agencies to answer questions like What crops should we be testing, and where? Is a pesticide residue found in an organic sample likely caused by accident, pesticide drift, or an intentional and illegal application? How can we modify organic programs to better mitigate risk? The comments delivered to the USDA discuss risk-based certification, pesticide residue testing, and policies impacting the incorporation of so-called inert ingredients in the biopesticides approved for use on organic farms. They argue for a more rigorous, comprehensive, and health-focused approach to risk oversight. Regarding residue testing, they advocate for more expansive and effective data aggregation to inform consumers and the organics community. Finally, for inert ingredients, they recommend further review of current policy, including increased transparency of ingredients in pesticide products. Thank you to Drs. Benbrook and Baker for your advocacy and hard work!   The three sets of comments are posted on HHRA’s website as part of our policy program: Comments to the NOSB on the Risk-Based Certification Discussion Document Under Consideration During the October 2024 Meeting in Portland, Oregon Written Comments on the NOSB Discussion Document “Residue Testing for the Global Supply Chain” Comments on the Inert Ingredients in Organic Pesticide Products Proposal dated August 13, 2024   Drs. Benbrook and Baker also submitted and presented comments at the Spring 2024 meeting of the NOSB, which are available on HHRA’s Policy and Regulatory Reform page.

  • Dr. Kimberly Yolton joins HHRA board

    Dr. Yolton is a developmental psychologist and epidemiologist serving as Professor of Pediatrics at Cincinnati Children’s Hospital Medical Center. Her interests include exposures and experiences that may alter a child’s developmental trajectory from infancy through adolescence. She collaborates on research projects on typical child development as well as those focused on the impact of exposures to environmental toxicants, opiates and stress during early development.

  • Paul Hartnett, HHRA’s Executive Director

      Paul Hartnett has served as HHRA’s CFO since our founding . With the departure of Russell King, Paul has now joined the board and Executive Director. We thank Russell for his service and wish him the best in his future endeavors.

  • Heartland Study Enrolls 1,000th Mother-Infant Pair

    July 19, 2024 – In June of this year, the Heartland Study achieved a major milestone, enrolling its 1,000th mother-infant pair. Enrollment is now at 50% of goal. The objective of the Study is to help fill major gaps in our understanding of the impacts of herbicides on maternal and infant health. Currently in Phase 1, the Study is focused on evaluating associations between herbicide concentrations in body fluids and tissue samples from pregnant women and infants, and pregnancy/childbirth outcomes. Phase 2 is designed to evaluate potential associations between herbicide biomarkers and early childhood neurological development. Much appreciation for the mothers enrolled, and the entire Heartland Study Team including scientists, support staff and clinicians for this tremendous achievement, and for our funders to making this work possible. Read more about the study including peer-reviewed studies published in Chemosphere and Agrichemicals at our publications  page. The investment required to conduct this study exceeds $1 million each year. You can support this important work by making a donation here.

Searching for an Ounce of Prevention

May 25th, 2021
May 25th, 2021
HHRA is conducting a nested case-control study similar to the PROTECT study that will measure herbicide levels in pregnant women and determine if higher exposures are correlated with preterm births or other reproductive impacts.

By: Dr. David M. Haas and Melissa Perry, ScD

Over 18% of the babies born in Puerto Rico in 2011 were preterm, increasing life-long risks for multiple adverse developmental, reproductive, and chronic disease outcomes. In that same year, an NIH-funded birth cohort study was initiated entitled the Puerto Rico Testsite for Exploring Contamination Threats (PROTECT).

The PROTECT birth cohort included 1,028 babies, 10% of whom were born preterm. Multiple papers have been published by the research team reporting on factors associated with elevated risk of preterm birth.

In a 2019 paper reporting PROTECT study results, the team identified links between socioeconomic factors and preterm births, but no other significant risk factors. The last sentence in the paper’s conclusion section reads:

“Environmental factors including chemical exposures may play an important role in the etiology of adverse birth outcomes but have yet to be explored in Puerto Rico.”

Results of a PROTECT nested case-control study were published on May 19, 2021 in Environmental Health Perspectives . Silver et al (2021) report strong associations between preterm birth and levels of glyphosate (GLY) and AMPA in the urine of pregnant women. Aminomethylphosphonic acid (AMPA) is GLY’s major metabolite and a primary source of dietary exposures following food-crop applications of glyphosate-based herbicides.

The new PROTECT study reports an unexpected finding — GLY and AMPA levels in urine late in pregnancy are more strongly associated with preterm birth than exposures earlier in pregnancy.

A woman’s first pregnancy results in about 40% of new births annually. It is widely accepted that first pregnancies tend to proceed differently than subsequent ones, but little was known previously about the reasons why. This led to the design and funding by the National Institutes of Health of a large prospective birth cohort study called the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b).

Over 10,000 pregnant women enrolled in nuMoM2b study sites across the continental US  between 2012 and 2015 (Haas et al 2015). This cohort has produced a plethora of research findings related to preterm birth, hypertensive disorders, gestational diabetes, as well as the impact of sociodemographic factors, disordered sleep, and others on disparities and pregnancy outcomes.

Like the PROTECT cohort, nuMoM2b identified several associations between socioeconomic and health status and adverse birth outcomes including preterm delivery, but environmental factors and chemical exposures had not been examined previously.

Early in 2021, the Heartland Health Research Alliance (HHRA) began a nested case-control study drawing on the nuMoM2b cohort. Our new study is similar to the nested case control study examining GLY and AMPA carried out by the PROTECT team. We too are examining associations between GLY and AMPA levels in the urine of pregnant women and adverse birth outcomes, including preterm delivery.

In our study, we are paying close attention to the timing of exposures during pregnancy to assess whether our study replicates the unexpected PROTECT finding that exposures later in pregnancy play a larger role in preterm delivery than first trimester exposures.

We have already reached out to the PROTECT team to learn more from their work and build upon the methodological advances in their GLY and AMPA study.

Nested case-control studies can produce important new insights more quickly and at lower cost than launching a new birth cohort. Finding ways to merge the results of comparably designed case-control studies enhances statistical power and can accelerate the search for answers. We hope to develop new collaborations with other study teams that have completed birth cohort studies to find more answers faster to these pressing women and infant health issues .

Ultimately, we want to highlight potential new avenues to reduce the risk of and prevent  preterm births. We are focusing our research on regions like the US Heartland where a large percentage of the landscape is sprayed multiple times every year with herbicides to control weeds in agriculture, in backyards, and public spaces.

About the Authors

Dr. David Haas is the Chair of the HHRA Board, a member of the Heartland Study Management Team, and the Director of OGBYN Research at the Indiana University School of Medicine.

Dr. Melissa Perry is a Co-PI of the Heartland Study and Chair of the Department of Environmental and Occupational Health Sciences at George Washington University.


Sources:

Ferguson, K. K., Rosario, Z., McElrath, T. F., Velez Vega, C., Cordero, J. F., Alshawabkeh, A., & Meeker, J. D.; “Demographic risk factors for adverse birth outcomes in Puerto Rico in the PROTECT cohort;” Plos One, 2019, 14(6), e0217770; DOI: 10.1371/journal.pone.0217770.

Haas, D. M., Parker, C. B., Wing, D. A., Parry, S., Grobman, W. A., Mercer, B. M., Simhan, H. N., Hoffman, M. K., Silver, R. M., Wadhwa, P., Iams, J. D., Koch, M. A., Caritis, S. N., Wapner, R. J., Esplin, M. S., Elovitz, M. A., Foroud, T., Peaceman, A. M., Saade, G. R., Willinger, M., Reddy, U. M., & NuMo, M. b study; “A description of the methods of the Nulliparous Pregnancy Outcomes Study: monitoring mothers-to-be (nuMoM2b);” American Journal of Obstetrics & Gynecology, 2015, 212(4), 539 e531-539 e524; DOI: 10.1016/j.ajog.2015.01.019.

Silver, M. K., Fernandez, J., Tang, J., McDade, A., Sabino, J., Rosario, Z., Velez Vega, C., Alshawabkeh, A., Cordero, J. F., & Meeker, J. D.; “Prenatal Exposure to Glyphosate and Its Environmental Degradate, Aminomethylphosphonic Acid (AMPA), and Preterm Birth: A Nested Case-Control Study in the PROTECT Cohort (Puerto Rico);” Environmental Health Perspectives, 2021, 129(5), 57011; DOI: 10.1289/EHP7295.

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