More than 10,000 chemicals can be added to food in the United States, including those added deliberately during food processing and those that come into contact with food during manufacturing or packaging. Children are particularly vulnerable to the adverse health effects of these agents, and the American Academy of Pediatrics has issued a report focusing on substances that come into contact with food and are associated with adverse health effects in early life.

Bisphenols are used in metal cans and plastic containers. Bisphenol A (BPA) can bind to the estrogen receptor and is classified as an endocrine disruptor. It has been linked to endocrine-related disorders, including reduced fertility, altered timing of puberty, and neoplasias. Since the U.S. Food and Drug Administration (FDA) banned the use of BPA in infant bottles and cups, it has been replaced by bisphenol S, which may have similar adverse effects.

Phthalate esters such as DEHP are widely used in shampoos, lotions, and other personal care items, as well as food wraps and other items used in food manufacturing. Phthalates are antiandrogenic, adversely affecting male fetal genital development. In addition, phthalates may contribute to childhood obesity and insulin resistance and are linked to oxidative stress, which may promote vasoconstriction, platelet adhesion, and the release of proinflammatory cytokines. DIDP and DINP, which are used as replacements for DEHP, are associated with insulin resistance and effects on blood pressure in children.

Perfluoroalkyl chemicals (PFCs) are used in household products, such as nonstick cooking surfaces and food packaging, and nearly 100% of the U.S. population has detectable levels of these chemicals in their blood. Exposure to PFCs is associated with reduced immune response to vaccines, metabolic changes, low birth weight, reduced fertility, and thyroid changes. The FDA has banned use of long-chain PFCs in foods, but short-chain PFCs are still used. Perchlorate, another additive used in food manufacturing and packaging, disrupts the production of thyroid hormone and is particularly hazardous during pregnancy and in infants.

Direct food additives also pose risks. Evidence suggests that artificial food colors may exacerbate attention deficit-hyperactivity disorder. Consumption of nitrates and nitrites used as preservatives in cured and processed meats, fish, and cheese has been linked to gastrointestinal and neural cancers. Nitrites can also disrupt thyroid function, which is critical during pregnancy. Neither nitrates nor nitrites can be used in foods specifically manufactured for infants or young children.-KR

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