Infants may be exposed to contaminants from environmental and food sources, including human milk (HM) or infant formula (IF). The objective of this series of systematic reviews (PROSPERO: CRD42024530332, CRD42024530336, CRD42024530339, and CRD42024530344) was to 1) assess infant exposure to contaminants from HM and/or IF in the United States and 2) assess the bioavailability of these contaminants from HM and IF when consumed by infants. The protocol was developed with a technical expert panel (TEP). Through 2 April, 2025, CAB Abstracts, CENTRAL, CINAHL, Embase, and MEDLINE databases were searched for peer-reviewed articles published in English. Another TEP critically appraised sample collection and contaminant assessment methods for included articles. Studies needed to report contaminant concentrations of biospecimens based on infant feeding (HM only, IF only, or HM and IF). Results were narratively described. Risk of bias was assessed using ROBINS-E. From 6799 unique records, 7 articles from 4 studies were identified. The New Hampshire birth cohort reported infant urinary concentrations of arsenic (n = 4 articles), cadmium (n = 2), lead (n = 1), and mercury (n = 1) between 2009 and 2019. Three other studies reported infant blood lead concentrations between 1975 and 1994. All articles had acceptable contaminant assessment methods, and most (n = 6 articles) had low risk or some concerns of bias. Collectively, most evidence was from 1 cohort or published 30+ y ago and lacked demographic and geographic diversity. Therefore, conclusions could not be made about exposure to arsenic, cadmium, lead, or mercury from HM and/or IF for infants in the United States. No evidence was found that reported on per- and polyfluoroalkyl substances in infant biospecimens or bioavailability of any of the contaminants from HM or IF. These findings highlight the need for research about infant exposure to and bioavailability of arsenic, cadmium, lead, mercury, and per- and polyfluoroalkyl substances from HM or IF in the United States.

Agricultural production processes can affect heavy metal contaminants in foods, which impacts food safety. To inform future research on heavy metals in foods, we conducted a scoping review on agricultural production processes and arsenic, cadmium, lead, and mercury in foods for human consumption and presented results in an interactive, easy-to-use interface. We identified 76,587 peer-reviewed records from 5 databases from 2013-2023. After dual title and abstract screening, 10,884 articles met eligibility criteria and abstract-level data were extracted. We organized evidence into 3 food domains (crops, meat and poultry, seafood) and into production process categories for each domain. These articles covered 622 foods and 29 agricultural production process categories, resulting in 18,038 food and production process "pairs." Most articles assessed crops (73%), then seafood (21%), and meat and poultry (8%); and cadmium (68%), then lead (44%), arsenic (24%), and mercury (15%). We built an interactive evidence map that displays all included articles and allows users to sort and filter references by foods, production process categories, and heavy metals. This scoping review and interactive evidence map will be foundational for researchers and policymakers to identify primary research needs and areas where systematic reviews can be conducted to synthesize existing evidence to improve food safety.

BACKGROUND:Approximately 75% of the US population uses dietary supplements to boost their nutrient intake beyond what they obtain from foods and drinks. Therefore, it is crucial to clearly communicate how dietary supplements contribute to overall nutrient intake, enabling consumers to make informed health decisions. OBJECTIVE:The objective of this study was to test user comprehension of 4 aspects of nutrient intake displayed in the ASA24 Respondent Nutrition Report (Total, Target, Limit, and Warning) among adults with diverse numeracy levels. DESIGN:Two-phase qualitative study using semi-structured interviews with dietary supplement users (Phase I conducted March 1-April 31, 2021; Phase II conducted June 1-July 31, 2021). PARTICIPANTS/SETTING:A total of 50 dietary supplement users ≥19 years of age were recruited via a nationwide opt-in research panel for phases I (30 participants) and II (20 participants). Participant interviews were conducted virtually. ANALYSES PERFORMED:A deductive-to-inductive coding method was used for creation of the codebook; 20% of transcripts were double-coded with inter-rater reliability >90%. Summative content analysis assessed comprehension of reviewed concepts. RESULTS:In Phase I, participants found the graphic format easier to understand than a table. Additionally, most participants believed the graphic would be easier for the general public to understand. Using participant feedback from Phase I, the graphic was revised, which led to a better understanding of key features of the graphic for participants in Phase II, especially for nutrients that fell below the target. These updates improved understandability among both higher and lower numeracy participants. CONCLUSIONS:Content for Total Nutrient Intake from Foods, Drinks, and Supplements for the ASA24's Respondent Nutrition Report was developed, underwent usability testing, and demonstrated sufficient user comprehension. Future research can evaluate the effectiveness of the final graphic for behavior change with different populations or conduct future testing of the Respondent Nutrition Report (RNR), with a focus on individuals with lower numeracy scores.

BACKGROUND:Ultra-processed food (UPF) accounts for a majority of calories consumed in the United States, but the impact on human health remains unclear. We aimed to identify poly-metabolite scores in blood and urine that are predictive of UPF intake. METHODS AND FINDINGS:Of the 1,082 Interactive Diet and Activity Tracking in AARP (IDATA) Study (clinicaltrials.gov ID NCT03268577) participants, aged 50-74 years, who provided biospecimen consent, n = 718 with serially collected blood and urine and one to six 24-h dietary recalls (ASA-24s), collected over 12-months, met eligibility criteria and were included in the metabolomics analysis. Ultra-high performance liquid chromatography with tandem mass spectrometry was used to measure >1,000 serum and urine metabolites. Average daily UPF intake was estimated as percentage energy according to the Nova system. Partial Spearman correlations and Least Absolute Shrinkage and Selection Operator (LASSO) regression were used to estimate UPF-metabolite correlations and build poly-metabolite scores of UPF intake, respectively. Scores were tested in a post-hoc analysis of a previously conducted randomized, controlled, crossover-feeding trial (clinicaltrials.gov ID NCT03407053) of 20 subjects who were admitted to the NIH Clinical Center and randomized to consume ad libitum diets that were 80% or 0% energy from UPF for 2 weeks immediately followed by the alternate diet for 2 weeks; eligible subjects were between 18-50 years old with a body mass index of >18.5 kg/m2 and weight-stable. IDATA participants were 51% female, and 97% completed ≥4 ASA-24s. Mean intake was 50% energy from UPF. UPF intake was correlated with 191 (of 952) serum and 293 (of 1,044) 24-h urine metabolites (FDR-corrected P-value < 0.01), including lipid (n = 56 serum, n = 22 24-h urine), amino acid (n = 33, 61), carbohydrate (n = 4, 8), xenobiotic (n = 33, 70), cofactor and vitamin (n = 9, 12), peptide (n = 7, 6), and nucleotide (n = 7, 10) metabolites. Using LASSO regression, 28 serum and 33 24-h urine metabolites were selected as predictors of UPF intake; biospecimen-specific scores were calculated as a linear combination of selected metabolites. Overlapping metabolites included (S)C(S)S-S-Methylcysteine sulfoxide (rs = -0.23, -0.19), N2,N5-diacetylornithine (rs = -0.27 for serum, -0.26 for 24-h urine), pentoic acid (rs = -0.30, -0.32), and N6-carboxymethyllysine (rs = 0.15, 0.20). Within the cross-over feeding trial, the poly-metabolite scores differed, within individual, between UPF diet phases (P-value for paired t test < 0.001). IDATA Study participants were older US adults whose diets may not be reflective of other populations. CONCLUSIONS:Poly-metabolite scores, developed in IDATA participants with varying diets, are predictive of UPF intake and could advance epidemiological research on UPF and health. Poly-metabolite scores should be evaluated and iteratively improved in populations with a wide range of UPF intake.

BACKGROUND:Assessing seafood as a food group, rather than as a source of omega-3 fatty acids or contaminants, may better inform dietary guidance for pregnancy and lactation. OBJECTIVES:This study aims to assess relationships between seafood consumption during pregnancy and lactation and neurocognitive development in the child. METHODS:Three electronic databases were searched up to September 2024 to update a previous search from 2000 to 2019. Articles were included if seafood intake during pregnancy or lactation and a child outcome was assessed [neurocognitive development including cognitive, social-emotional, behavioral, movement/physical, language/communication, and aggregate scores as well as depression, anxiety, attention-deficit/hyperactivity disorder (ADHD), and autism spectrum disorder (ASD)]. Articles were screened at title, abstract, and full-text levels independently by 2 analysts. Data were extracted, quality checked, and synthesized narratively considering the direction, magnitude, and statistical significance of results. The risk of bias was assessed using study design-specific tools. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluations. RESULTS:Forty articles [1 randomized controlled trial (RCT), 24 prospective cohorts, and 1 retrospective cohort] during pregnancy were identified; none for lactation. Evidence suggested relationships between higher seafood consumption and better social-emotional and behavioral development in children and adolescents aged 0-18 y as well as better aggregate scores of development for those <4 y. The certainty of the evidence was very low to moderate due to the lack of RCTs. Evidence for overall cognitive development was inconsistent but higher seafood may be related to better attention, reasoning and problem-solving, and verbal intelligence. However, evidence was limited in the number of studies and ages assessed. Evidence was inconsistent for movement/physical and language/communication development, and a paucity of studies was found for ADHD and ASD. CONCLUSIONS:Seafood consumption within currently recommended amounts during pregnancy may be associated with better social-emotional, behavioral, and aggregate scores of development in the child, as well as potentially some aspects of cognitive development. This study was registered at PROSPERO as CRD42023432844.

Nutrition epidemiological models involve many analytic decisions, such as defining exposures, selecting which covariates to include, or configuring variables in different ways. We explored the impact of analytical decisions on conclusions in nutrition epidemiology using self-reported beef intake and incident coronary heart disease as a case study. We used REasons for Geographic and Racial Differences in Stroke (REGARDS) data, and selected covariates and their configurations from published literature to recapitulate common models used to assess associations between meat intake and health outcomes. Three model sets were designed: sets one and two used continuous and quintile-defined beef intakes, respectively, each with ∼500,000 randomly sampled specifications. Set three models directly emulated published covariate combinations. Few models (<1%) were statistically significant at p < 0.05. More hazard ratio (HR) point estimates were >1 when beef was polychotomized via quintiles (95% of models) vs. continuous intake (79% of models). Including covariates for race or multivitamin use shifted HRs toward the null with similar confidence interval widths. Models emulating existing published associations were all above HR of 1. For our case study, exposure configuration and exposure inclusion resulted in substantially different HR distributions, illustrating how analytical decisions can affect nutrition-related exposure/outcome associations. The finding of few statistically significant models does not prove, but may suggest, minimal association between beef and CHD. Singular assessments of nutritional epidemiology questions should therefore be interpreted with caution. Modeling many analytical approaches may better establish and investigate the uncertainty of nutritional epidemiology questions and provisional answers.

OBJECTIVE:The objective of this review was to summarize recent and relevant systematic reviews (SRs) that assessed relationships between mercury (Hg) exposure during pregnancy, lactation, and childhood and child outcomes. EVIDENCE REVIEW:Three electronic databases were searched for SRs published between January 2018 to December 2024 about Hg exposure (of any form or source, including seafood), during pregnancy, lactation or childhood and child outcomes including: anthropometrics, neurodevelopment, attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), exposure biomarkers, cardiometabolic health, immunity, and birth outcomes. All articles were screened at title/abstract and full-text levels by two independent reviewers. A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2 critical appraisal tool was used to assess the methodological quality of the included SRs. FINDINGS:Twenty-nine SRs of observational studies were identified that assessed Hg during pregnancy (n = 19) and/or childhood (n = 17). During pregnancy, results from the SRs suggested that higher Hg may be associated with higher risk of birth defects, pre-term birth, ADHD, ASD, and low birth weight, length, and head circumference. Results varied for neurodevelopment outcomes in the child, likely due to co-exposure with seafood during pregnancy, variation in response by sex of the child, and etiological differences among developmental domains. During childhood, SRs suggested that higher Hg may be associated with higher risk of ADHD and adverse neurodevelopment, growth, and body composition outcomes. Also, Hg concentrations were higher in children with ASD than those without in case-control studies but longitudinal data were lacking. Evidence on methylmercury exposure from seafood during pregnancy and childhood was limited and inconclusive. CONCLUSION AND RELEVANCE:Mercury exposure during pregnancy and childhood is recognized as a major public health concern. However, more research is needed that specifically examines methylmercury from seafood to better inform future dietary recommendations.

Bovine Ephemeral Fever (BEF), caused by an arthropod-borne rhabdovirus, is widespread in tropical and subtropical regions. It affects cattle with symptoms of fever, lameness, inappetence and in some situations can result in mortality. The goal of this study is to determine if accelerometer data can be used to identify the behavior patterns that occur when cattle become ill from BEF. Eight heifers in a separate experiment were monitored with 3-axis accelerometers sensors. Movement variation (MV) was calculated from accelerometer data (25 Hz) using 1-min epochs and then averaged hourly. Two different approaches, cosine similarity (CS) and deviation from previous behavioral patterns, were developed to autonomously detect patterns and recognize the onset of sickness in cattle using accelerometer data. Analyses show that one heifer had behavioral changes one day before the manager observed BEF, and another heifer had behavioral changes on the same day the manager observed BEF. The other six heifers did not display any BEF symptoms. To validate the efficacy of our analytical approaches, we employed them on a separate commercial herd of 73 cows where 4 of the 27 monitored cows were observed with BEF symptoms. Predictions were either on the day or even the day prior to the manager's observation and diagnosis. There were likely no false positives in the first or second trials using the deviation algorithm with sum_deviation formula, but there were several false positives with the other algorithms. These case studies demonstrate the potential of accelerometer data to autonomously detect disease onset, in some cases before it was apparent to the human observer. However, more research is needed to minimize false positives that may occur from other similar diseases, abnormal weather events or cyclical changes in behavior such as estrus is required.

We convened experts to discuss methods for measuring body composition and diagnosing obesity among infants, children, and adolescents aged 0-19 y. The motivation for this meeting was to inform critical decisions for a systematic review protocol to assess the diagnostic test accuracy (DTA) of body mass index (BMI)-for-age and sex for diagnosing infants, children, and adolescents with excessive adiposity that can impair health. Thirty-nine clinicians and researchers from 23 countries provided written responses and/or attended 1 of 2 virtual meetings held in January 2024. Experts were asked to share their perspectives about methods and clinical tests used to measure body composition, including thresholds and adiposity types (i.e., total or central), for diagnosing obesity for infants, children, and adolescents. Experts suggested that deuterium oxide dilution, magnetic resonance imaging, dual energy X-ray absorptiometry, air displacement plethysmography, hydrostatic weighing, and multicompartmental models were acceptable to measure body composition, with the 4-compartmental model preferred. Waist circumference and bioelectrical impedance were preferred clinical tests to use either alone or in combination with BMI for diagnosing obesity; preferential use was country specific. Most experts preferred fat mass index (fat mass/height2) to % body fat as the metric, because it is more sensitive to changes over time and depends on age and height, similar to BMI. Experts agreed that total and regional adiposity are important for determining metabolic risk related to obesity, but using central adiposity for diagnosing obesity is challenging due to variations in body type. All agreed that age, race, ethnicity, and puberty stage should be considered when defining thresholds of obesity. This input from experts informed the systematic review protocol for an assessment of the DTA of BMI to support the World Health Organization's guideline development for the integrated management of children and adolescents with obesity in all their diversity.

Background/Objectives: Breastfeeding has health benefits for infants and mothers, and hospitals play an important role in supporting breastfeeding. This analysis examines the longitudinal association of hospital maternity care practices and policies with in-hospital exclusive breastfeeding rates from 2018 to 2022. Methods: U.S. hospitals completing ≥2 surveys during 2018, 2020, and 2022 cycles of CDC’s Maternity Practices in Infant Nutrition and Care (mPINC) survey comprised a nested longitudinal cohort (n = 2109). Hospitals were given a modified mPINC score (0 to 100 points) based on self-reported adherence to maternity care practices and policies supportive of breastfeeding, including skin-to-skin contact, monitoring following birth, rooming-in, feeding counseling and education, and institutional policies. Hospitals reported their exclusive breastfeeding rates for healthy infants for the duration of hospitalization. A path analysis quantified the total effects of modified mPINC scores on in-hospital exclusive breastfeeding rates in subsequent survey cycles, controlling for annual births. Results: Among hospitals with the highest modified mPINC scores of 100 points, the mean in-hospital exclusive breastfeeding rates were 62.0% in 2018 (n = 129), 62.2% in 2020 (n = 132), and 61.7% in 2022 (n = 138). Hospitals with the lowest scores of <60 points had exclusive breastfeeding rates of 40.6% (n = 247), 41.9% (n = 173), and 37.8% (n = 127), respectively. Hospitals that increased their modified mPINC score by 10 points from 2018 to 2022, regardless of their score in 2018, had a 2.0 p.p. increase in their exclusive breastfeeding rates. In an adjusted path analysis, each 10-point higher modified mPINC score in 2018 was associated with a 4.4 (95% CI, 4.0–4.9) percentage point higher exclusive breastfeeding rate in 2022—through increasing the likelihood of higher in-hospital exclusive breastfeeding rates in 2018 and 2020 and higher modified mPINC scores in 2020 and 2022. Conclusions: Improving and sustaining maternity care practices and policies supportive of breastfeeding are associated with higher in-hospital exclusive breastfeeding over time.