CLINICAL REPORT

Organic Foods: Health and Environmental Advantagesand Disadvantages

abstractThe US market for organic foods has grown from $3.5 billion in 1996 to$28.6 billion in 2010, according to the Organic Trade Association. Or-ganic products are now sold in specialty stores and conventionalsupermarkets. Organic products contain numerous marketing claimsand terms, only some of which are standardized and regulated.

In terms of health advantages, organic diets have been convincinglydemonstrated to expose consumers to fewer pesticides associatedwith human disease. Organic farming has been demonstrated to haveless environmental impact than conventional approaches. However,current evidence does not support any meaningful nutritional benefitsor deficits from eating organic compared with conventionally grownfoods, and there are no well-powered human studies that directly dem-onstrate health benefits or disease protection as a result of consumingan organic diet. Studies also have not demonstrated any detrimental ordisease-promoting effects from an organic diet. Although organic foodsregularly command a significant price premium, well-designed farm-ing studies demonstrate that costs can be competitive and yields com-parable to those of conventional farming techniques. Pediatriciansshould incorporate this evidence when discussing the health and en-vironmental impact of organic foods and organic farming while con-tinuing to encourage all patients and their families to attain optimalnutrition and dietary variety consistent with the US Department of Agri-culture’s MyPlate recommendations.

This clinical report reviews the health and environmental issues re-lated to organic food production and consumption. It defines the term“organic,” reviews organic food-labeling standards, describes organicand conventional farming practices, and explores the cost and envi-ronmental implications of organic production techniques. It examinesthe evidence available on nutritional quality and production contam-inants in conventionally produced and organic foods. Finally, this re-port provides guidance for pediatricians to assist them in advisingtheir patients regarding organic and conventionally produced foodchoices. Pediatrics 2012;130:e1406–e1415

Joel Forman, MD, Janet Silverstein, MD, COMMITTEE ONNUTRITION, and COUNCIL ON ENVIRONMENTAL HEALTH

KEY WORDSorganic food, produce, meat, dairy, growth hormone, antibiotic,farming, diet

ABBREVIATIONSGH—growth hormoneNOP—National Organic ProgramUSDA—US Department of Agriculture

This document is copyrighted and is property of the AmericanAcademy of Pediatrics and its Board of Directors. All authorshave filed conflict of interest statements with the AmericanAcademy of Pediatrics. Any conflicts have been resolved througha process approved by the Board of Directors. The AmericanAcademy of Pediatrics has neither solicited nor accepted anycommercial involvement in the development of the content ofthis publication.

The guidance in this report does not indicate an exclusivecourse of treatment or serve as a standard of medical care.Variations, taking into account individual circumstances, may beappropriate.

www.pediatrics.org/cgi/doi/10.1542/peds.2012-2579

doi:10.1542/peds.2012-2579

All clinical reports from the American Academy of Pediatricsautomatically expire 5 years after publication unless reaffirmed,revised, or retired at or before that time.

PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).

Copyright © 2012 by the American Academy of Pediatrics

e1406 FROM THE AMERICAN ACADEMY OF PEDIATRICS

Guidance for the Clinician inRendering Pediatric Care

by guest on January 17, 2020www.aappublications.org/newsDownloaded from

DEFINITION AND REGULATION OFORGANIC FOODS

Definition

Organic farming uses an approach togrowing crops and raising livestock thatavoids synthetic chemicals, hormones,antibiotic agents, genetic engineering,and irradiation. In the United States, theUS Department of Agriculture (USDA) hasimplemented the National Organic Pro-gram (NOP)1 in response to the OrganicFoods Production Act of 1990.2 The NOPset labeling standards that have been ineffect since October 2002. NOP stand-ards for organic food production in-clude many specific requirements forboth crops and livestock. To qualify asorganic, crops must be produced onfarms that have not used most syntheticpesticides, herbicides, and fertilizer for3 years before harvest and have a suffi-cient buffer zone to decrease contami-nation from adjacent lands. Geneticengineering, ionizing radiation, andsewage sludge is prohibited. Soil fertil-ity and nutrient content is managedprimarily with cultivation practices,crop rotations, and cover crops sup-plemented with animal and crop wastefertilizers. Pests, weeds, and diseasesare managed primarily by physical,mechanical, and biological controls in-stead of with synthetic pesticides andherbicides. Exceptions are allowed ifsubstances are on a national approvedlist. Organic livestock must be rearedwithout the routine use of antibioticagents or growth hormones (GHs) andmust be provided with access to theoutdoors. If an animal is treated fordisease with antibiotic agents, it cannotbe sold as organic. Preventive healthpractices include vaccination and vita-min and mineral supplementation. TheUSDA certifies organic products accord-ing to these guidelines. Organic farmersmust apply for certification, pass atest, and pay a fee. The NOP requiresannual inspections to ensure ongoingcompliance with these standards.

Labeling

Consumers are confronted with awide range of food product marketingterms, some regulated and some not(Table 1). The labeling requirements ofthe NOP apply to raw, fresh productsand processed products that containorganic agricultural ingredients. Theselabeling requirements are based onthe percentage of organic ingredientsin a product.3 Products labeled “100%organic” must contain only organicallyproduced ingredients and processingaids (excluding water and salt). Prod-ucts labeled “organic” must consist ofat least 95% organically processedingredients (excluding water and salt);the remaining 5% of ingredients maybe conventional or synthetic but mustbe on the USDA’s approved list. Pro-cessed products that contain at least70% organic ingredients can use thephrase “made with organic ingredients”and list up to 3 of the organic

ingredients or food groups on theprincipal display panel. For example,soup made with at least 70% organicingredients and only organic vegetablesmay be labeled either “soup made withorganic peas, potatoes, and carrots” or“soup made with organic vegetables.”

Related Terms

The NOP places no restrictions on theuse of truthful labeling claims, such as“no drugs or growth hormones used,”“free range,” or “sustainably har-vested.”3 The USDA regulates the term“free range” for poultry products; touse this term, producers must dem-onstrate that the poultry has beenallowed “access to the outside.”4

According to Consumers Union’s eval-uation, this means that a poultryproduct comes from a bird that had atleast 5 minutes of access to the out-doors each day.4,5 No standard defi-nition exists for all other products

TABLE 1 Commonly Used Food Product Marketing Terms

Term Definition

100% organic Must contain only organically produced ingredients andprocessing aids (excluding water and salt).

Organic Must consist of at least 95% organically produced ingredients(excluding water and salt). Any remaining productingredients must consist of nonagricultural substancesapproved on the National List.

Made with organic ingredients Must contain at least 70% organic ingredients.Natural A product containing no artificial ingredient or added color and

that is only minimally processed (a process that does notfundamentally alter the raw product). The label must explainthe use of the term.

Free range Producers must demonstrate to the USDA that the poultry hasbeen allowed access to the outside.

No hormones (pork or poultry) Hormones are not allowed in raising hogs or poultry. Therefore,the claim “no hormones added” cannot be used on the labelsof pork or poultry unless it is followed by a statement thatsays “Federal regulations prohibit the use of hormones.”

No hormones (beef) The term “no hormones administered” may be approved foruse on the label of beef products if sufficient documentationis provided to the USDA by the producer showing nohormones have been used in raising the animals.

No antibiotics (red meat and poultry) The terms “no antibiotics added” may be used on labels formeat or poultry products if sufficient documentation isprovided by the producer to the USDA demonstrating thatthe animals were raised without antibiotics.

Certified “Certified” implies that the USDA’s Food Safety and InspectionService and the Agriculture Marketing Service have officiallyevaluated a meat product.

Chemical free This term is not allowed to be used on a label.

There are no restrictions on use of other truthful labeling claims, such as “no drugs or growth hormones used,” or“sustainably harvested.”

PEDIATRICS Volume 130, Number 5, November 2012 e1407

FROM THE AMERICAN ACADEMY OF PEDIATRICS

by guest on January 17, 2020www.aappublications.org/newsDownloaded from

carrying the “free range” label, suchas beef, pork, or eggs; the use of theterm, however, is allowed.

The term “natural” or “all natural” isdefined by the USDA for meat andpoultry and means that the productscontain no artificial flavoring, coloringredients, chemical preservatives,or artificial or synthetic ingredientsand are “minimally processed.” Mini-mally processed means that the rawproduct was not fundamentally al-tered. Additional USDA definitions ofother labeling terms can be found inpublicly available USDA fact sheets.4

The term “raw” milk refers to un-pasteurized milk. All milk certified asorganic by the USDA is pasteurized.Raw milk can contain harmful bacteria,such as Salmonella species, Escher-ichia coli O157:H7, Listeria species,Campylobacter species, and Brucellaspecies, and has been repeatedly as-sociated with outbreaks of diseasecaused by these pathogens. The Amer-ican Academy of Pediatrics, US Foodand Drug Administration, and Centersfor Disease Control and Preventionadvise consumers not to consume rawmilk.6–8

SCOPE OF CONSUMER USE,PRICES, AND TRENDS IN ORGANICFOOD

In 2008, more than two-thirds of USconsumers bought some organic prod-ucts, and more than one-quarter boughtorganic at least weekly. The amount ofUS acreage dedicated to organic cropshas doubled since 1997.9 Consumerschoose organic food in the belief thatorganic foods are more nutritious, havefewer additives and contaminants, andare grown more sustainably.10 Somestudies11,12 suggest that families withchildren and adolescents or youngerconsumers in general are more likelyto buy organic fruits and vegetablesthan are other consumers.13 The factormost consistently associated with the

increased propensity to purchase or-ganic food is the level of consumereducation.14–21 Organic products, how-ever, cost up to 40% more.

NUTRITIONAL QUALITY OF ORGANICVERSUS CONVENTIONAL FOOD

Produce

Consumers believe that organic pro-duce is more nutritious than conven-tionally grown produce, but theresearch to support that belief is notdefinitive. Many studies have demon-strated no important differences incarbohydrate or vitamin and mineralcontent.22 Some studies have foundlower nitrate content in organic foodsversus conventionally grown foods,which is potentially desirable becauseof the association of nitrates with in-creased risk of gastrointestinal cancerand, in infants, methemoglobinemia.Higher vitamin C concentrations werefound in organic leafy vegetables,such as spinach, lettuce, and chardversus the same conventionally pro-duced vegetables in 21 of 36 (58%)studies.22 Other studies have foundhigher total phenols in organic pro-duce versus conventionally grownproduce and have postulated healthbenefits from antioxidant effects.23

Several attempts have been made toreview the relevant literature anddraw conclusions on organic versusconventional foods, but the results areconflicting.24–28 A large systematic re-view published in 2009 found thatfewer than 20% of 292 articles withpotentially relevant titles met criteriafor quality, leaving only 55 studies toassess. The authors highlighted thefact that the nutrient content of pro-duce is affected by numerous factors,including the geographic location ofthe farm, local soil characteristics,climactic conditions that can vary byseason, maturity at time of harvest,and storage and time to testingafter harvest. Because of the large

number of nutrients reported in vari-ous articles, the authors grouped thenutrients into large categories. Theyfound no significant differences inmost nutrients, with the exception ofhigher nitrogen content in conven-tional produce and higher titratableacidity and phosphorus in organicproduce.29 Better-quality research thataccounts for the many confoundingvariables is needed to elucidate po-tential differences in nutrients and theclinical importance of nutrients thatmay be different. At this time, however,there does not appear to be convincingevidence of a substantial difference innutritional quality of organic versusconventional produce.

Milk

The composition of dairy products,including milk, is affected by manyfactors, including differences causedby genetic variability and cattle breed;thus, the results of studies assessingmilk composition must be interpretedwith caution. In general, milk has thesame protein, vitamin, trace mineralcontent, and lipids from both organi-cally and conventionally reared cows.Fat-soluble antioxidants and vitaminspresent in milk come primarily fromthe natural components of the diet orfrom the synthetic compounds used tosupplement the feed ingested by lac-tating cows.30

One recent study examined antibioticand microorganism content, hormoneconcentrations, and nutritional valuesof milk in 334 samples from 48 stateslabeled as organic, not treated withbovine GH (referred to as “GH-free”), orconventional. This study found that milklabeled “conventional” had lower bac-terial counts than milk that was or-ganic or GH-free, although this was notclinically significant. Estradiol and pro-gesterone concentrations were lower inconventional milk than in organic milk,but GH-free milk had progesteroneconcentrations similar to conventional

e1408 FROM THE AMERICAN ACADEMY OF PEDIATRICS by guest on January 17, 2020www.aappublications.org/newsDownloaded from

milk and estradiol concentrations sim-ilar to organic milk. Macronutrientcomposition was similar, although or-ganic milk had 0.1% more protein thanthe other 2 milk types.31

Several studies have demonstratedthat organic milk has higher concen-trations of antioxidants and poly-unsaturated fatty acids. However, it isimportant to recognize that the com-position of milk is strongly related towhat the cows eat. This differs by timeof year (outdoors in the summer, in-door forage in the winter) and whetherthe farms are high or low input. High-input farms supplement the diets ofcattle with proprietary minerals andvitamins. Low-input farms use meth-ods similar to those used in organicfarming but do not follow all therestrictions prescribed by organicfarming standards; they use mineralfertilizers but at lower levels than usedby conventional high-input systems.One study comparing milk from all 3production systems found milk fromboth the low-input organic and low-inputnonorganic systems generally had sig-nificantly higher concentrations of nu-tritionally desirable unsaturated fattyacids (conjugated linoleic acid andomega-3 fatty acids) and fat-solubleantioxidants compared with milk fromthe high-input systems; milk derivedfrom cows in both organic certified andnonorganic low-input systems wassignificantly higher in conjugated lino-leic acid content than was milk fromconventional high-input systems.32

HORMONES

GH

Hormone supplementation of farmanimals, especially with GH, is one ofthe major reasons consumers statethey prefer to buy organic foods. Bo-vine GH (ie, recombinant bovine so-matotropin) increases milk yield by10% to 15% and is lipotropic in cows.Because GH is degraded in the acidic

stomach environment, it must be givenby injection. GH is species-specific, andbovine GH is biologically inactive inhumans. Because of this, any bovineGH in food products has no physiologiceffect on humans, even if it wereabsorbed intact from the gastroin-testinal tract. In addition, 90% of bo-vine GH in milk is destroyed during thepasteurization process. There is noevidence that the gross composition ofmilk (fat, protein, and lactose) is al-tered by treatment with bovine GH, noris there any evidence that the vitaminand mineral contents of milk arechanged by GH treatment.31

GH treatment of cowsmay actually haveenvironmental benefits. GH increasesmilk production per cow, which couldtheoretically decrease the number ofcows needed to produce a givenamount of milk, with resultant need forfewer cows and, thus, less cultivatedland needed to feed the cows. In ad-dition, fewer cows would result in theproduction of less manure with re-sultant reduced methane productionand less carbon dioxide production,with a resultant salutary effect onglobal warming.33

Sex Steroids

Treatment of cattle with sex steroidsincreases lean muscle mass, accel-erates the rate of growth, and is anefficient way to increase meat yield.Estrogens are usually given by im-plantation of estrogen pellets into theskin on the underside of the ear, andthe ear is discarded during slaughter.Unlike GH, sex steroids are not species-specific and may be given orallywithout degradation in the stomach. In1998, the Food and Agriculture Orga-nization of the United Nations andWorld Health Organization jointly con-cluded that meat from estradiol-trea-ted animals was safe on the basis ofdata obtained from residue levels inmeat from studies performed in the

1970s and 1980s using radioimmuno-assay methods. One study demon-strated concentrations of estrogensfound in meat residues were low andoverlapped with concentrations foundin untreated cows.34 Gas chromatog-raphy measurements of sex steroidsprogesterone, testosterone, 17β es-tradiol, and estrone and their metab-olites in meat products, fish, poultry,milk, and eggs revealed insignificantamounts compared with daily pro-duction of these steroids in adults andchildren.35 Furthermore, 98% to 99%of endogenous sex steroids are boundby sex-hormone-binding globulin, ren-dering them metabolically inactive asonly the unbound (free) forms of sexsteroids are metabolically active. Syn-thetic sex steroids (zeranol, melen-gestrol, and trenbolone) commonlyused in animals have lower affinitiesto sex-hormone-binding globulin and,therefore, are potentially more meta-bolically active unbound sex steroids.These hormones do not occur naturallyin humans, and although the concen-trations of these hormones are low incattle, the biological effects in humans,if any, are unknown.

Ingestion of milk from estrogen-treatedcows appears to be safe for children.Estradiol and estrone concentrations inorganic and conventional 1%, 2%, andwhole milk were the same, although theconcentrations of sex steroids werehigher as the fat content of the milkincreased and were lower than en-dogenous production rates in humans.Estradiol concentrations in milk rangedfrom 0.4 to 1.1 pg/mL, and estroneconcentrations ranged from 2.9 to 7.9pg/mL, with the lowest concentrationsin skim milk and the highest in wholemilk.36

Endogenous estradiol concentrationsare as high as 80 pg/mL in 2- to 4-month-old female infants and 40 pg/mLin 2- to 4-month-old male infants. Hu-man milk has estradiol concentrations

PEDIATRICS Volume 130, Number 5, November 2012 e1409

FROM THE AMERICAN ACADEMY OF PEDIATRICS

by guest on January 17, 2020www.aappublications.org/newsDownloaded from

as high as 39 pg/mL and estrone(which has approximately half thepotency of estradiol) concentrationsas high as 1177 pg/mL. Human co-lostrum has even higher estrogenconcentrations of 500 pg/mL and 4000to 5000 pg/mL for estradiol and es-trone, respectively. Cow milk, bycomparison, has estradiol concen-trations of 4 to 14 pg/mL and estroneconcentrations of 34 to 55 pg/mL.37,38

It has been postulated that ingestedestrogen in food derived from sex-hormone-treated animals may playa role in earlier development of pubertyand increasing risk of breast cancer.However, no studies have supportedthis hypothesis in humans. Studies inanimals demonstrating carcinogenicand teratogenic effects of estrogensused high doses of estradiol and cannotbe extrapolated to the low doses ofsex steroids found in the food supply.Estrogen concentrations in the myo-metrium, breast, and vagina of post-menopausal women, although still low,are higher than those found in serum,and additional studies are needed todetermine the significance of theselow concentrations of sex steroids inestrogen-sensitive tissues.39

An association has been found be-tween red meat consumption in highschool girls and the development ofbreast cancer later in life. A 7-yearprospective longitudinal study of 39 268premenopausal women 33 to 53 yearsof age who filled out a comprehensivediet history of foods eaten while in highschool in the 1960s and 1970s revealeda linear association between each ad-ditional 100 g of red meat consumed inhigh school per day with the risk ofdeveloping hormone-receptor-positivepremenopausal tumors (relative risk,1.36; 95% confidence interval, 1.08–1.70; P = .008). Red meat ingestion didnot increase the risk of hormone-receptor-negative tumors. Althoughthis intriguing study, which suggested

that higher red meat consumption inadolescence may increase breastcancer risk, tracked cases of cancerprospectively after the dietary historywas obtained, it was limited bya number of factors, including thedependence on subjects’ long-termmemory of amount of food eatendecades previously, the likelihood thathormone concentrations in meat werehigher in that period, and the lackof direct measurement of hormonalexposure.40 Longitudinal prospectivestudies are needed to compare therisk of breast cancer in women whoeat meat from hormone-treated ani-mals with the risk in women who eatmeat from untreated animals.

Endocrine disrupters, chemicals thatinterfere with hormone signaling sys-tems, are pervasive in our environment.Among the most commonly found en-docrine disrupters are bisphenol A,found in industrial chemicals andplastics; phthalates, found in personalcare items such as cosmetics; andlavender and tea tree oil, found in manyhair products, soaps, and lotions; allhave estrogenic properties. Endocrinedisrupters are postulated to be in-volved in the increased occurrence ofgenital abnormalities among newbornboys and precocious puberty in girls.Recent literature on sex steroid con-centrations and their physiologic rolesduring childhood indicate that con-centrations of estradiol in prepubertalchildren are lower than originallythought and that children are extremelysensitive to estradiol and may respondwith increased growth and/or breastdevelopment even at serum concen-trations below the current detectionlimits.41 No threshold has been estab-lished below which there are no hor-monal effects on exposed children.Furthermore, the daily endogenousproduction rates of sex steroids inchildren estimated by the Food andDrug Administration in 1999 and still

used in risk assessments are highlyoverestimated and should be reeval-uated by using current assays.41 It istherefore important to determine therelative importance of hormone treat-ment of animals in the context of otherenvironmental endocrine disruptersthrough long-term longitudinal studiesin children.

NONTHERAPEUTIC USE OFANTIBIOTIC AGENTS

Conventional animal husbandry fre-quently includes the administration ofantibiotic agents in nontherapeuticdoses to livestock to promote growthand increase yields. Between 40% and80% of the antimicrobial agents used inthe United States each year are used infood animals, three-quarters of whichis nontherapeutic. Many of these agentsare identical or similar to drugs used inhumans.42 Evidence is clear that suchnontherapeutic use promotes the de-velopment of drug-resistant organismsin the animals and that these organ-isms then colonize the intestines ofpeople living on farms where thispractice occurs.43 Evidence is alsoample that human disease caused byantibiotic-resistant organisms spreadthrough the food chain.44 Because or-ganic farming prohibits the non-therapeutic use of antibiotic agents, itcould contribute to a reduction in thethreat of human disease caused bydrug-resistant organisms.

SYNTHETIC CHEMICAL EXPOSURE

Pesticides

Pesticides have a host of toxic effectsthat range from acute poisonings tosubtle subclinical effects from long-term, low-dose exposure.45 Organo-phosphate pesticides are commonlyused in agriculture, and poisoning isa persistent problem in the agricul-tural setting. From 1998 to 2005, 3271cases of agricultural occupationalacute pesticide poisoning were

e1410 FROM THE AMERICAN ACADEMY OF PEDIATRICS by guest on January 17, 2020www.aappublications.org/newsDownloaded from

reported to the California Departmentof Pesticide Regulation and the Na-tional Institute of Occupational Health’sSENSOR-Pesticides program. This con-stitutes a rate of 56 cases per 100 000full-time equivalents, 38 times the rateobserved in nonagricultural occupa-tions.46 Chronic exposure among farmworkers has been associated with nu-merous adult health problems, in-cluding respiratory problems, memorydisorders, dermatologic conditions, de-pression, neurologic deficits includingParkinson disease, miscarriages, birthdefects, and cancer.47–50 Prenatal or-ganophosphate pesticide exposure hasbeen associated with adverse birthoutcomes, such as decreased birthweight and length51 and smaller headcircumference.52 A large prospectivebirth cohort study that measured pes-ticide exposure in pregnant farmworkers in California and followed theiroffspring found lower mental de-velopment index scores at 24 months ofage53 and attentional problems at 3.5and 5 years of age.54 An analysis ofcross-sectional data from the NHANEShas demonstrated that within the rangeof exposure in the general US pop-ulation, the odds of attention-deficit/hyperactivity disorder for 8- to 15-year-old children were increased 55% witha 10-fold increase in urinary concen-trations of the organophosphate me-tabolite dimethyl alkylphosphate.55

The National Research Council repor-ted in 1993 that the primary form ofexposure to pesticides in children isthrough dietary intake.56 Organic pro-duce consistently has lower levels ofpesticide residues than does conven-tionally grown produce,57 and a dietof organic produce reduces humanexposure. Several studies have clearlydemonstrated that an organic dietreduces children’s exposure to pesti-cides commonly used in conventionalagricultural production. A small longitu-dinal cohort of children who regularly

consumed conventional produce demon-strated that urinary pesticide residueswere reduced to almost nondetectablelevels (below 0.3 μg/L for malathiondicarboxylic acid, for example) whenthey were changed to an organicproduce diet for 5 days.58 In addition,residues varied with seasonal intakeof produce, suggesting that dietaryintake of organophosphate pesticidesrepresented the major source of ex-posure in these young children.59

Although a common practice, rinsingconventionally farmed produce reducessome but not all pesticide residues onproduce to varying degrees but hasnot been proven to decrease humanexposure.60

Pesticide metabolite concentrationsobserved in studies that examined ex-posure in farming communities as wellas in residential settings were in thesame range as those observed in sub-jects consuming conventional producein studies of biological exposuremeasures for organic versus conven-tional produce diets. For instance, themedian concentration observed formalathion urinary metabolites in femalefarm workers whose offspring hadsignificantly lower mental developmentindex scores at 24 months of age was0.82 μg/L,53 which is close to the me-dian concentration found in children inthe initial conventional diet phase ofthe organic diet study of 1.5 μg/L, dis-cussed previously.58 Ranges for otherpesticide metabolites were similar.

Although chronic pesticide exposureand measurable pesticide metaboliteconcentrations seem undesirable andpotentially unhealthy, no studies todate have experimentally examined thecausal relationship between exposureto pesticides directly from conven-tionally grown foods and adverseneurodevelopmental health outcomes.Most of the research implicatingpesticides in these adverse healthoutcomes is from case-control or

cross-sectional studies. These studiesare limited by a number of factors,including difficulties measuring pastexposures and the lack of a positivetemporal relationship between expo-sure and outcome. It is difficult to di-rectly extrapolate from these studiesand draw conclusions about potentialtoxicity at the levels of pesticide ex-posure documented from dietary in-take of conventional produce. Dataderived from large prospective cohortstudies may address some of theseshortcomings.

ENVIRONMENTAL IMPACT ANDPRODUCTION EFFICIENCY OFORGANIC VERSUS CONVENTIONALFARMING METHODS

Environmental Impact

A major subject in the organic debateis whether organic farming methodshave less impact on the environment,can be equally as productive, and canbe no more expensive than conven-tional approaches. A variety of surveysand studies have attempted to com-pare these issues for organic andconventional farming methods. Manybelieve that organic farming is lessdamaging to the environment becauseorganic farms do not use or releasesynthetic pesticides into the environ-ment, some of which have the potentialto harm soil, water, and local terres-trial and aquatic wildlife.61 In addition,it is thought that organic farms arebetter than conventional farms atsustaining diverse ecosystems, in-cluding populations of plants, insects,and animals, because of practicessuch as crop rotation. When calcu-lated either per unit area or perunit of yield, organic farms use lessenergy and produce less waste.62,63

Organically managed soil has beendemonstrated to be of higher qualityand have higher water retention,which may increase yields for organicfarms in drought years.64

PEDIATRICS Volume 130, Number 5, November 2012 e1411

FROM THE AMERICAN ACADEMY OF PEDIATRICS

by guest on January 17, 2020www.aappublications.org/newsDownloaded from

Production Efficiency

Critics of organic farming methodsbelieve that organic farms requiremore land to produce the sameamount of food as conventional farms.One study found a 20% smaller yieldfrom organic farms.65 Another studyfrom the Danish Environmental Pro-tection Agency found that, area forarea, organic farms of potatoes,sugar beets, and seed grass produceas little as half the output as theirconventional farm counterparts.66

It remains controversial whether or-ganic farming is able to provide ade-quate food supply to sustain the worldpopulation. Norman Borlaug, consid-ered to be the father of the “greenrevolution” and winner of the NobelPeace Prize, believes that organicfarming alone is incapable of feedingthe world population and needs to beused in conjunction with geneticallymodified food.67 On the other hand,a meta-analysis of 292 studies designedto assess the efficiency of both organicand conventional farming concludedthat organic methods could produceenough food on a global per-capitabasis to sustain the current humanpopulation and potentially an evenlarger population without increasingthe agricultural land base.68

The largest prospective farming studyto date is a comparative trial of morethan 20 years’ duration conducted byresearchers from Cornell University.This study, conducted in Pennsylvania,compared various conventional andorganic farming approaches in acontrolled prospective design inwhich confounding influences such asweather and moisture were similar inthe different systems. Over 20 years ofobservation, the organic fields hadproductivity that was generally com-parable to the conventional fields,while avoiding environmental pollutionwith herbicides and pesticides and re-ducing fossil fuel consumption by 30%.

Although costs were higher primarilybecause of increased labor costs (15%),the return for the organic plots washigher because of the higher pricescommanded at the marketplace.64

THE DIFFERENCE IN PRICE OFORGANIC VERSUS CONVENTIONALFOODS

One major concern with organic foodis its higher price to consumers. Or-ganic products typically cost 10% to40% more than similar conventionallyproduced products.69 A number offactors contribute to these highercosts, including higher-priced organicanimal feed, lower productivity, andhigher labor costs because of the in-creased reliance on hand weeding. Ofpotential concern is that the higherprice of organically produced fruitsand vegetables might lead consumersto eat less of these foods, despite thewell-established literature document-ing the health benefits of eating fruitsand vegetables, including lower ratesof obesity, cardiovascular disease,and certain types of cancer. Fifty-fivepercent of children born in the UnitedStates are eligible for food packagesunder the Special Supplemental Nu-trition Program for Women, Infants,and Children, and these food pack-ages are currently giving families ap-proximately $10 a month to spend onfruits and vegetables, so the moneymust be used wisely to maximizespending capacity for healthy foods.

SUMMARY

To demonstrate superiority of 1 foodproduction method over another, it isimportant to show an advantage interms of improved individual healthor an important societal advantage.Organic diets have been convincinglydemonstrated to expose consumersto fewer pesticides associated withhuman disease. Nontherapeutic useof antibiotic agents in livestock

contributes to the emergence of re-sistant bacteria; thus, organic animalhusbandry may reduce the risk ofhuman disease attributable to resistantorganisms. There is sound evidencethat organic foods contain more vi-tamin C (ascorbic acid) and phos-phorus than do conventional foods,but there is no direct evidence thatthis provides meaningful nutritionalbenefits to children eating organicfoods compared with those who eatconventionally grown food products.Well-designed farming studies dem-onstrate that comparable yields canbe achieved with organic farmingtechniques and that organic farminghas a lower environmental impactthan do conventional approaches.However, no well-powered humanstudies have directly demonstratedhealth benefits or disease protectionas a result of consuming an organicdiet. Such studies would be difficultto perform and require large pro-spective cohort populations or, better,randomly assigning subjects to inter-ventions that increase organic versusconventional food intakes. Additionaldata are needed to identify relation-ships between diet and pesticide ex-posure and individual health outcomes.Pediatricians should incorporate thisevidence when discussing the healthand environmental impact of organicfoods and organic farming while con-tinuing to encourage all patients andtheir families to attain optimal nutritionand dietary variety by choosing a diethigh in fresh fruits and vegetables,consistent with the USDA’s MyPlaterecommendations.

Key Points

1. Nutritional differences between organicand conventional produce appear min-imal, but studies examining this havebeen limited by inadequate controls forthe many subtle potential confounders,such as moisture, maturity of the pro-duce, and measurement techniques.

e1412 FROM THE AMERICAN ACADEMY OF PEDIATRICS by guest on January 17, 2020www.aappublications.org/newsDownloaded from

No direct evidence of a clinically rele-vant nutritional difference between or-ganic and conventional produce exists.

2. Organic produce contains fewerpesticide residues than does con-ventional produce, and consuminga diet of organic produce reduceshuman exposure to pesticides. Itremains unclear whether such a re-duction in exposure is clinically rel-evant.

3. Organic animal husbandry that pro-hibits the nontherapeutic use of an-tibiotic agents has the potential toreduce human disease caused bydrug-resistant organisms.

4. There is no evidence of clinicallyrelevant differences in organicand conventional milk.

a. There are few, if any, nutritionaldifferences between organic andconventional milk. There is no ev-idence that any differences thatmay exist are clinically relevant.

b. There is no evidence that organicmilk has clinically significanthigher bacterial contamination lev-els than does conventional milk.

c. There is no evidence that conven-tional milk contains significantlyincreased amounts of bovine GH.Any bovine GH that might remainin conventional milk is not biolog-ically active in humans because ofstructural differences and suscep-tibility to digestion in the stomach.

5. Organic farming approaches inpractice are usually more expen-sive than conventional approaches,but in carefully designed experi-mental farms, the cost differencecan be mitigated.

6. The price differential between organicand conventional food might be re-duced or eliminated as organic farm-ing techniques advance and as theprices of petroleum products, suchas pesticides and herbicides, as wellas the price of energy, increase.

7. Organic farming reduces fossil fuelconsumption and reduces environ-mental contamination with pesti-cides and herbicides.

8. Large prospective cohort studies thatrecord dietary intake accurately andmeasure environmental exposuresdirectly will likely greatly enhanceunderstanding of the relationship be-tween pesticide exposure from con-ventional foods and human diseaseand between consumption of meatfrom hormone-treated animals andthe risk of breast cancer in women.

Advice for Pediatricians

1. Encourage patients and their familiesto eat an optimally health-promotingdiet rich in fruits, vegetables, wholegrains, and low-fat or fat-free milkand dairy products.

2. When approached by families inter-ested in consuming organic foods,review key facts presented in thisreport to address the full range ofrelevant nutrition, human health,environmental, and cost issues.Be explicit about areas in whichscientific evidence is strong as wellas those in which it is uncertain.

3. When advice is sought by familiesconcerned with the potentialhealth impact of pesticide residuesin food, direct them toward reli-able resources that provide infor-mation on the relative pesticidecontent of various fruits and vege-tables. Two such examples include:

a. Consumer Reports article (Sep-tember 2008) “Fruits and Vegeta-bles, When to Buy Organic” (http://www.consumerreports.org/health/healthy-living/diet-nutrition/healthy-foods/organic-foods/overview/when-to-buy-organic.htm) and

b. Environmental Working Group’s“Shopper’s Guide to Pesticides”(http://www.foodnews.org).

LEAD AUTHORSJoel Forman, MDJanet Silverstein, MD

COMMITTEE ON NUTRITION,2011–2012Jatinder J. S. Bhatia, MD, ChairpersonSteven A. Abrams, MDMark R. Corkins, MDSarah D. de Ferranti, MDNeville Hylton Golden, MDJanet Silverstein, MD

FORMER COMMITTEE MEMBERSStephen R. Daniels, MD, PhDFrank R. Greer, MDMarcie B. Schneider, MDNicolas Stettler, MDDan W. Thomas, MD

LIAISONSLaurence Grummer-Strawn, PhD – Centers forDisease Control and PreventionVan S. Hubbard, MD, PhD – National Institutes ofHealthValérie Marchand, MD – Canadian PediatricSocietyBenson M. Silverman, MD – US Food and DrugAdministrationValery Soto, MS, RD, LD – US Department ofAgriculture

STAFFDebra L. Burrowes, MHA

COUNCIL ON ENVIRONMENTAL HEALTHEXECUTIVE COMMITTEE, 2011–2012Jerome A. Paulson, MD, ChairpersonAlice Cantwell Brock-Utne, MDHeather Lynn Brumberg, MD, MPHCarla C. Campbell, MD, MSBruce Perrin Lanphear, MD, MPHKevin C. Osterhoudt, MD, MSCEMegan T. Sandel, MDLeonardo Trasande, MD, MPPRobert O. Wright, MD, MPH

FORMER COMMITTEE MEMBERSHelen J. Binns, MD, MPHJoel Forman, MD

LIAISONSPeter C. Grevatt, PhD – US Environmental Pro-tection AgencyMary Ellen Mortensen, MD, MS – Centers forDisease Control and PreventionWalter Rogan, MD – National Institutes of HealthSharon Ann Savage, MD – National Cancer Institute

STAFFPaul Spire

PEDIATRICS Volume 130, Number 5, November 2012 e1413

FROM THE AMERICAN ACADEMY OF PEDIATRICS

by guest on January 17, 2020www.aappublications.org/newsDownloaded from

REFERENCES

1. US Department of Agriculture, AgriculturalMarketing Service. National organic pro-gram. Available at: www.ams.usda.gov/AMSv1.0/nop. Accessed May 15, 2011

2. Organic Foods Production Act of 1990.Available at: www.ams.usda.gov/AMSv1.0/getfile?dDocName=STELPRDC5060370&acct=nopgeninfo. Accessed May 15, 2011

3. US Department of Agriculture, AgricultureMarketing Services, National Organic Pro-gram. Organic labeling and marketing in-formation. October 2002; updated April 2008.Available at: www.ams.usda.gov/AMSv1.0/getfile?dDocName=STELDEV3004446. AccessedMay 15, 2011

4. US Department of Agriculture, Food Safetyand Inspection Service. Meet and poultry la-beling terms fact sheet. Available at: www.fsis.usda.gov/factsheets/meat_&_poultry_labeling_terms/index.asp#4. Accessed May 15, 2011

5. Consumers Union of United States Inc. TheConsumers Union Guide to EnvironmentalLabels. Available at: www.greenerchoices.org/eco-labels/label.cfm?LabelID=111. AccessedMay 15, 2011

6. American Academy of Pediatrics. AppendixVIII: prevention of disease from potentiallycontaminated food products. In: PickeringLK, Baker CJ, Kimberlin DW, Long SS, eds.Red Book: 2009 Report of the Committee onInfectious Diseases. 28th ed. Elk GroveVillage, IL: American Academy of Pediatrics;2009:857–859

7. US Food and Drug Administration. Thedangers of raw milk: unpasteurized milkcan pose a serious health risk. Availableat: www.fda.gov/Food/ResourcesForYou/Consumers/ucm079516.htm. Accessed August11, 2011

8. Centers for Disease Control and Pre-vention. Raw milk questions and answers.Available at: www.cdc.gov/foodsafety/rawmilk/raw-milk-questions-and-answers.html. Accessed August 11, 2011

9. US Department of Agriculture. Emergingissues in the US organic industry economicresearch service. June 2009. Available at:www.ers.usda.gov/publications/eib55/eib55.pdf. Accessed May 15, 2011

10. Shepherd R, Magnusson M, Sjödén PO.Determinants of consumer behavior re-lated to organic foods. Ambio. 2005;34(4–5):352–359

11. Thompson GD, Kidwell J. Explaining thechoice of organic produce: cosmeticdefects, prices, and consumer preferences.Am J Agric Econ. 1998;80(2):277–287

12. Loureiro LL, McCluskey JJ, MittelhammerRC. Preferences for organic, eco-labeled, or

regular apples. Am J Agric Res Econ. 2001;26(2):404–416

13. Magnusson MK, Arvola A, Hursti UK, ÅbergL, Sjödén PO. Choice of organic foods isrelated to perceived consequences forhuman health and to environmentallyfriendly behaviour. Appetite. 2003;40(2):109–117

14. Dimitri C, Oberholtzer L. Marketing U.S.Organic Foods: Recent Trends From Farmsto Consumers. Economic Information Bul-letin No. EIB-58. Washington, DC: US De-partment of Agriculture, EconomicResearch Service; 2009

15. Dettmann RL, Dimitri C. Who’s buying or-ganic vegetables? Demographic character-istics of U.S. consumers. J Food ProdMarketing. 2010;16(1):79–91

16. Zepeda L, Li J. Characteristics of organicfood shoppers. J Agric Appl Econ. 2007;39(1):17–28

17. Krystallis A, Fotopoulos C, Zotos Y. Organicconsumers’ profile and their willingness topay (WTP) for selected organic food prod-ucts in Greece. J Int Consum Marketing.2006;19(1):81–106

18. O’Donovan P, McCarthy M. Irish consumerpreference for organic meat. Br Food J.2002;104(3–5):353–370

19. Cicia G, Del Giudice T, Scarpa R. Consumers’perception of quality in organic food:a random utility model under preferenceheterogeneity and choice correlation fromrank-orderings. Br Food J. 2002;104(3):200–213

20. Fotopoulos C, Krystallis A. Purchasingmotives and profile of the Greek organicconsumer: a countrywide survey. Br Food J.2002;104(9):730–765

21. Magnusson M, Arvola A, Hursti U, Aberg L,Sjoden P. Attitudes towards organic foodsamong Swedish consumers. Br Food J.2001;103(3):209–226

22. Williams CM. Nutritional quality of organicfood: shades of grey or shades of green?Proc Nutr Soc. 2002;61(1):19–24

23. Asami DK, Hong YJ, Barrett DM, Mitchell AE.Comparison of the total phenolic andascorbic acid content of freeze-dried andair-dried marionberry, strawberry, andcorn grown using conventional, organic,and sustainable agricultural practices. JAgric Food Chem. 2003;51(5):1237–1241

24. Worthington V. Nutritional quality of or-ganic versus conventional fruits, vegeta-bles, and grains. J Altern Complement Med.2001;7(2):161–173

25. Soil Association. Organic farming, food qualityand human health: a review of the evidence.

Bristol, United Kingdom: Soil Association;2000. Available at: www.soilassociation.org/LinkClick.aspx?fileticket=cY8kfP3Q%2BgA%3D&tabid=388. Accessed May 15, 2011

26. Magkos F, Arvaniti F, Zampelas A. Organicfood: nutritious food or food for thought? Areview of the evidence. Int J Food Sci Nutr.2003;54(5):357–371

27. Bourn D, Prescott J. A comparison of thenutritional value, sensory qualities, andfood safety of organically and convention-ally produced foods. Crit Rev Food Sci Nutr.2002;42(1):1–34

28. Woese K, Lange D, Boess C, Bogl KW. Acomparison of organically and conven-tionally grown foods—results of a reviewof the relevant literature. J Sci Food Agric.1997;74(3):281–293

29. Dangour AD, Dodhia SK, Hayter A, Allen E,Lock K, Uauy R. Nutritional quality of or-ganic foods: a systematic review. Am J ClinNutr. 2009;90(3):680–685

30. Butler G, Nielsen JH, Slots T, et al. Fatty acidand fat soluble antioxidant concentrationsin milk from high- and low-input conven-tional and organic systems: seasonalvariation. J Sci Food Agric. 2008;88(8):1431–1441

31. Vicini J, Etherton T, Kris-Etherton P, et al.Survey of retail milk composition as af-fected by label claims regarding farm-management practices. J Am Diet Assoc.2008;108(7):1198–1203

32. Butler G, Coloumb M, Rehberger B,Sanderson R, Eyre M, Leifert C. Conjugatedlinoleic acid isomer concentrations in milkfrom high- and low-input managementsystems. J Sci Food Agric. 2009;89(4):697–705

33. Capper JL, Castañeda-Gutiérrez E, CadyRA, Bauman DE. The environmental im-pact of recombinant bovine somatotro-pin (rbST) use in dairy production.Proc Natl Acad Sci USA. 2008;105(28):9668–9673

34. Tsujioka T, Ito S, Ohga A. Female sex steroidresidues in the tissues of steers treatedwith progesterone and oestradiol-17 β. ResVet Sci. 1992;52(1):105–109

35. Hartmann S, Lacom M, Steinhart H. Naturaloccurrence of steroid hormones in food.Food Chem. 1998;62(1):7–20

36. Pape-Zambito DA, Roberts RF, Kensinger RS.Estrone and 17beta-estradiol concen-trations in pasteurized-homogenized milkand commercial dairy products. J DairySci. 2010;93(6):2533–2540

37. Wolford ST, Argoudelis CJ. Measurement ofestrogens in cow’s milk, human milk, and

e1414 FROM THE AMERICAN ACADEMY OF PEDIATRICS by guest on January 17, 2020www.aappublications.org/newsDownloaded from

dairy products. J Dairy Sci. 1979;62(9):1458–1463

38. Schams D, Karg H. Hormones in milk. Ann NY Acad Sci. 1986;464:75–86

39. Andersson AM, Skakkebaek NE. Exposure toexogenous estrogens in food: possible im-pact on human development and health.Eur J Endocrinol. 1999;140(6):477–485

40. Linos E, Willett WC, Cho E, Colditz G, FrazierLA. Red meat consumption during ado-lescence among premenopausal womenand risk of breast cancer. CancerEpidemiol Biomarkers Prev. 2008;17(8):2146–2151

41. Aksglaede L, Juul A, Leffers H, SkakkebaekNE, Andersson AM. The sensitivity of thechild to sex steroids: possible impact ofexogenous estrogens. Hum Reprod Update.2006;12(4):341–349

42. Shea KM; American Academy of PediatricsCommittee on Environmental Health;American Academy of Pediatrics Committeeon Infectious Diseases. Nontherapeutic useof antimicrobial agents in animal agricul-ture: implications for pediatrics. Pediatrics.2004;114(3):862–868

43. Levy SB, FitzGerald GB, Macone AB. Changesin intestinal flora of farm personnel afterintroduction of a tetracycline-supplementedfeed on a farm. N Engl J Med. 1976;295(11):583–588

44. Hamer DH, Gill CJ. From the farm to thekitchen table: the negative impact of anti-microbial use in animals on humans. NutrRev. 2002;60(8):261–264

45. American Academy of Pediatrics, Councilon Environmental Health. Pesticide expo-sure in children. Pediatrics. 2012; in press

46. Calvert GM, Karnik J, Mehler L, et al. Acutepesticide poisoning among agriculturalworkers in the United States, 1998–2005.Am J Ind Med. 2008;51(12):883–898

47. Blair A, Freeman L. Epidemiologic studies ofcancer in agricultural populations: obser-vations and future directions. J Agromed.2009;14(2):125–131

48. Daniels JL, Olshan AF, Savitz DA. Pesticidesand childhood cancers. Environ HealthPerspect. 1997;105(10):1068–1077

49. Kamel F, Tanner CM, Umbach DM, et al.Pesticide exposure and self-reportedParkinson’s disease in the agricultural

health study. Am J Epidemiol. 2007;165(4):364–374

50. Engel LS, O’Meara ES, Schwartz SM. Ma-ternal occupation in agriculture and risk oflimb defects in Washington State, 1980–1993. Scand J Work Environ Health. 2000;26(3):193–198

51. Whyatt RM, Rauh V, Barr DB, et al. Prenatalinsecticide exposures and birth weight andlength among an urban minority cohort.Environ Health Perspect. 2004;112(10):1125–1132

52. Berkowitz GS, Wetmur JG, Birman-Deych E,et al. In utero pesticide exposure, maternalparaoxonase activity, and head circumfer-ence. Environ Health Perspect. 2004;112(3):388–391

53. Eskenazi B, Marks AR, Bradman A, et al.Organophosphate pesticide exposure andneurodevelopment in young Mexican-American children. Environ Health Per-spect. 2007;115(5):792–798

54. Marks AR, Harley K, Bradman A, et al.Organophosphate pesticide exposure andattention in young Mexican-American chil-dren: the CHAMACOS study. Environ HealthPerspect. 2010;118(12):1768–1774

55. Bouchard MF, Bellinger DC, Wright RO,Weisskopf MG. Attention-deficit/hyperactivitydisorder and urinary metabolites of organ-ophosphate pesticides. Pediatrics. 2010;125(6). Available at: www.pediatrics.org/cgi/content/full/125/6/e1270

56. National Research Council. Pesticides in theDiets of Infants and Children. Washington,DC: National Academies Press; 1993

57. Baker B, Benbrook C, Groth E, III, Benbrook K.Pesticide residues in conventional, in-tegrated pest management (IPM)-grown andorganic foods: insights from three U.S. datasets. Food Addit Contam. 2002;19(5):427–446

58. Lu C, Toepel K, Irish R, Fenske RA, Barr DB,Bravo R. Organic diets significantly lowerchildren’s dietary exposure to organo-phosphorus pesticides. Environ HealthPerspect. 2006;114(2):260–263

59. Lu C, Barr DB, Pearson MA, Waller LA. Di-etary intake and its contribution to longi-tudinal organophosphorus pesticideexposure in urban/suburban children. En-viron Health Perspect. 2008;116(4):537–542

60. Krol WJ, Arsenault TL, Pylypiw HM, Jr;Incorvia Mattina MJ. Reduction of pesticideresidues on produce by rinsing. J AgricFood Chem. 2000;48(10):4666–4670

61. Oquist KA, Strock JS, Mulla DJ. Influence ofalternative and conventional farmingpractices on subsurface drainage and wa-ter quality. J Environ Qual. 2007;36(4):1194–1204

62. Stolze M, Piorr A, Haring AM, Dabbert S. En-vironmental impacts of organic farming inEurope. Organic Farming in Europe: Eco-nomics and Policy. Vol. 6. Stuttgart, Germany:University of Hohenheim; 2000. Available at:http://orgprints.org/8400/1/Organic_Farming_in_Europe_Volume06_The_Environmental_Impacts_of_Organic_Farming_in_Europe.pdf.Accessed May 15, 2011

63. Hansen B, Alroe HJ, Kristensen ES.Approaches to assess the environmentalimpact of organic farming with particularregard to Denmark. Agric Ecosyst Environ.2001;83(1–2):11–26

64. Pimentel D, Hepperly P, Hanson J, Douds D,Seidel R. Environmental, energetic, andeconomic comparisons of organic andconventional farming systems. Bioscience.2005;55(7):573–582

65. Mäder P, Fliessbach A, Dubois D, Gunst L,Fried P, Niggli U. Soil fertility and bio-diversity in organic farming. Science. 2002;296(5573):1694–1697

66. Danish Environmental Protection Agency,The Bichel Committee. Report from themain committee. Conclusions and recom-mendations of the committee. Section 8.7.1.1999. Available at: http://www2.mst.dk/common/Udgivramme/Frame.asp?http://www2.mst.dk/udgiv/Publications/1998/87-7909-445-7/html/helepubl_eng.htm. Accessed May 15,2011

67. Borlaug NE. Ending world hunger. Thepromise of biotechnology and the threat ofantiscience zealotry. Plant Physiol. 2000;124(2):487–490

68. Badgley C, Moghtader J, Quintero E, et al.Organic agriculture and the global foodsupply. Renewable Agric Food Syst. 2007;22(2):86–108

69. Winter CK, Davis SF. Organic foods. J FoodSci. 2006;71(9):R117–R124

PEDIATRICS Volume 130, Number 5, November 2012 e1415

FROM THE AMERICAN ACADEMY OF PEDIATRICS

by guest on January 17, 2020www.aappublications.org/newsDownloaded from

DOI: 10.1542/peds.2012-2579 originally published online October 22, 2012; 2012;130;e1406Pediatrics 

ENVIRONMENTAL HEALTHJoel Forman, Janet Silverstein, COMMITTEE ON NUTRITION and COUNCIL ON

Organic Foods: Health and Environmental Advantages and Disadvantages

ServicesUpdated Information &

http://pediatrics.aappublications.org/content/130/5/e1406including high resolution figures, can be found at:

Referenceshttp://pediatrics.aappublications.org/content/130/5/e1406#BIBLThis article cites 53 articles, 8 of which you can access for free at:

Subspecialty Collections

http://www.aappublications.org/cgi/collection/nutrition_subNutritionhttp://www.aappublications.org/cgi/collection/gastroenterology_subGastroenterologyental_healthhttp://www.aappublications.org/cgi/collection/council_on_environmCouncil on Environmental Healthonhttp://www.aappublications.org/cgi/collection/committee_on_nutritiCommittee on Nutritionhttp://www.aappublications.org/cgi/collection/current_policyCurrent Policyfollowing collection(s): This article, along with others on similar topics, appears in the

Permissions & Licensing

http://www.aappublications.org/site/misc/Permissions.xhtmlin its entirety can be found online at: Information about reproducing this article in parts (figures, tables) or

Reprintshttp://www.aappublications.org/site/misc/reprints.xhtmlInformation about ordering reprints can be found online:

by guest on January 17, 2020www.aappublications.org/newsDownloaded from

DOI: 10.1542/peds.2012-2579 originally published online October 22, 2012; 2012;130;e1406Pediatrics 

ENVIRONMENTAL HEALTHJoel Forman, Janet Silverstein, COMMITTEE ON NUTRITION and COUNCIL ON

Organic Foods: Health and Environmental Advantages and Disadvantages

http://pediatrics.aappublications.org/content/130/5/e1406located on the World Wide Web at:

The online version of this article, along with updated information and services, is

ISSN: 1073-0397. 60007. Copyright © 2012 by the American Academy of Pediatrics. All rights reserved. Print the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois,has been published continuously since 1948. Pediatrics is owned, published, and trademarked by Pediatrics is the official journal of the American Academy of Pediatrics. A monthly publication, it

by guest on January 17, 2020www.aappublications.org/newsDownloaded from