Food additives and preschool children

Making life look and taste better

ABSTRACTFood additives such as antioxidants and color fixatives are substances used in food intentionally for technical effect, such as decolorizing or intensifying the color of food. Based on the necessity of re-evaluating food additives for safety and to improve consumer perception, we conducted safety assessments for food additives according to the Risk Assessment Guidelines of the Korean Ministry of Food and Drug Safety. These safety assessments evaluated new risk information based on toxicology data and estimates of dietary intake exposures to food additives in comparison with the acceptable daily intake (ADI). Estimated daily intakes (EDI) of food additives were calculated using food consumption data for the Korean population derived from the Korea National Health and Nutrition Examination Survey and monitoring data based on the analysis of food additives in food products. Unlike contaminants, antioxidants and color fixatives are purposely added as food additives, and they are largely consumed in processed foods. Therefore, EDI was compared with ADI to investigate the likelihood of potentially hazardous effects in humans. The risk likelihoods of food additives, evaluated by comparing the EDI with the ADI, were less than 2% in the total population. Thus, exposure levels to antioxidants and color fixatives do not exceed the ADI. Based on the safety assessments conducted in this study, we estimate exposure to food additives to be within safe limits for all population groups.

The Scientific Panel on Food Additives and Flavouring (FAF) provides a scientific opinion on the safety evaluation of annatto E and an exposure assessment of the annatto colouring principles bixin and norbixin (E 160b) when used as a food additive, taking into account new proposed uses and use levels. In 2016, the EFSA Panel on Food Additives and Nutrient Sources added to Food (ANS) adopted a scientific opinion on the safety of annatto extracts (E 160b) as a food additive. In that opinion, the Panel concluded that the toxicological database was sufficient to derive an acceptable daily intake (ADI) of 6 mg bixin/kg body weight (bw) per day and an ADI of 0.3 mg norbixin/kg bw per day. The Panel was not able to conclude on the safety of annatto E. Dietary exposure for annatto (E 160b), bixin‐ and norbixin‐based annatto extracts was estimated taking into account the maximum permitted levels (MPLs) as set in the Annex II to Regulation (EC) No 1333/2008, the use levels provided by food industry as well as the proposed use levels from an applicant for an extension of use. Exposure estimates for bixin were below the ADI for all population groups and for all refined exposure scenarios, including the proposed extension of use. For norbixin, exceedance was observed for the extension of use at the 95th percentile for some population groups. In the 2017 EFSA statement related to the exposure assessment of colouring principles bixin and norbixin considering new proposed uses and use levels, the dietary exposure for bixin did not exceed the ADI. For norbixin, dietary exposure exceeded the ADI at the high level (95th percentile) for toddlers and children. In the current opinion, the Panel concluded that food colour annatto E does not raise concern for genotoxicity. Accordingly, the ADIs established in 2016 for the two colouring principles bixin and norbixin can be applied also to the annatto E. For bixin, none of the exposure estimates exceeded the ADI of 6 mg/kg bw per day. For norbixin, the ADI was reached at the high level (p95) for toddlers in the refined exposure assessment scenarios in one country. Considering the uncertainties and the very likely overestimation of the exposure, the Panel concluded that the level of exposure does not raise a health concern.

The results of French intake estimates for 13 food additives prioritized by the methods proposed in the 2001 Report from the European Commission on Dietary Food Additive Intake in the European Union are reported. These 13 additives were selected using the first and second tiers of the three-tier approach. The first tier was based on theoretical food consumption data and the maximum permitted level of additives. The second tier used real individual food consumption data and the maximum permitted level of additives for the substances which exceeded the acceptable daily intakes (ADI) in the first tier. In the third tier reported in this study, intake estimates were calculated for the 13 additives (colours, preservatives, antioxidants, stabilizers, emulsifiers and sweeteners) according to two modelling assumptions corresponding to two different food habit scenarios (assumption 1: consumers consume foods that may or may not contain food additives, and assumption 2: consumers always consume foods that contain additives) when possible. In this approach, real individual food consumption data and the occurrence/use-level of food additives reported by the food industry were used. Overall, the results of the intake estimates are reassuring for the majority of additives studied since the risk of exceeding the ADI was low, except for nitrites, sulfites and annatto, whose ADIs were exceeded by either children or adult consumers or by both populations under one and/or two modelling assumptions. Under the first assumption, the ADI is exceeded for high consumers among adults for nitrites and sulfites (155 and 118.4%, respectively) and among children for nitrites (275%). Under the second assumption, the average nitrites dietary exposure in children exceeds the ADI (146.7%). For high consumers, adults exceed the nitrite and sulfite ADIs (223 and 156.4%, respectively) and children exceed the nitrite, annatto and sulfite ADIs (416.7, 124.6 and 130.6%, respectively).

An exposure assessment was performed to estimate the potential intake of preservatives in the Austrian population. Food consumption data of different population groups, such as preschool children aged 3–6 years, female and male adults aged 19–65 years were used for calculation. Levels of the preservatives in food were derived from analyses conducted from January 2007 to August 2010. Dietary intakes of the preservatives were estimated and compared to the respective acceptable daily intakes (ADIs). In the average-intake scenario, assuming that consumers randomly consume food products that do or do not contain food additives, estimated dietary intakes of all studied preservatives are well below the ADI for all population groups. Sulphite exposure accounted for 34%, 84% and 89% of the ADI in preschool children, females and males, respectively. The mean estimated daily intake of benzoic acid was 32% (preschool children), 31% (males) and 36% (females) of the ADI. Sorbic acid intakes correspond to 7% of the ADI in preschool children and 6% of the ADI in adults. In the high-intake scenario assuming that consumers always consume food products that contain additives and considering a kind of brand loyalty of consumers, the ADI is exceeded for sulphites among adults (119 and 124%, respectively). Major contributors to the total intake of sulphites were wine and dried fruits for adults. Mean estimated dietary intakes of benzoic acid exceeded the ADI in all population groups, 135% in preschool children, 124% in females and 118% of the ADI in males, respectively. Dietary intakes of sorbic acid are well below the ADI, accounting for a maximum of 30% of the ADI in preschool children. The highest contributors to benzoic and sorbic acid exposure were fish and fish products mainly caused by high consumption data of this large food group, including also mayonnaise-containing fish salads. Other important sources of sorbic acid were bread, buns and toast bread and fruit and vegetable juices.

The presence of endocrine disrupting chemicals (EDCs) in the home environment is ubiquitous and is a major contributor to the exposure of young children to these chemicals. EDCs are found throughout the domestic environment, including in consumer goods, dust, air and food. Whilst the term EDCs refers to chemicals that have been demonstrated to disrupt the normal homeostasis of the endocrine system, they also affect a variety of other systems.Epidemiological evidence suggests that exposure to EDCs during the foetal period and childhood may be contributing to the increasing incidence of non-communicable diseases, such as obesity, during childhood and possibly later in life. However, to date, little research has been conducted in Australia to assess exposure of young (less than three years old) children to EDCs and associated health outcomes. The current ‘gold standard’ of assessing human exposure to these chemicals is biomonitoring. Biomonitoring in environmental epidemiology studies of children is ethically and practically challenging. There is a pressing need to develop alternative practical and accurate exposure assessment methods for use in large-scale children’s environmental epidemiology studies.The aim of this PhD was to explore the feasibility of online questionnaires as an alternative method of exposure assessment – by designing a household-level exposure-assessment questionnaire and then administering it in conjunction with human biomonitoring. The feasibility testing was conducted for two selected groups of EDCs, insecticides, with the pyrethroids and organophosphates as the chemicals of interest, and polybrominated diphenyl ether flame retardants (PBDEs). Plastics, with bisphenol A and phthalates as the focus, were included in the questionnaire design phase of this thesis, but were then excluded from the questionnaire in the human biomonitoring study to reduce its length.To identify potential determinants of exposure to be included in the exposure-assessment questionnaire extensive literature reviews were conducted. However, the information obtained from literature reviews alone was insufficient to ensure the content validity of the questionnaire, since data on EDC exposure pathways in Australian households were scarce and international data is not necessarily generalisable to the Australian context. Additional primary research was therefore undertaken in Queensland, Australia, to obtain more information on insecticide exposures. A more extensive literature review was also undertaken with a specific focus on the flame-retardant BDE-209.The questionnaire was then designed and pre-tested. After this phase, plastics were removed from the questionnaire to reduce its total length. To assess the feasibility of the approach, the questionnaire was administered in a questionnaire-biomonitoring study of 61 families with children aged <2 years (at the time of recruitment) from Brisbane and Toowoomba, QLD. Practical aspects of questionnaire administration were assessed and the content validity of the questionnaire was examined by assessing the association between questionnaire data and human biomonitoring data via linear regression modelling.The PBDE flame retardants as a group failed to meet many of the criteria important for effective exposure-assessment questionnaires during the design phase of the questionnaire. Despite the extensive literature reviews conducted in this PhD, many gaps in our knowledge of PBDE sources and exposure pathways exist for young children. Of the known possible sources, many of these cannot be confidently identified via a questionnaire. Since there are multiple sources and exposure pathways (including historical and maternal exposures) that contribute to PBDE body burdens in children, it is not feasible to measure all of these in a questionnaire. Finally, in the questionnaire-biomonitoring study, associations between questionnaire data and PBDE biomonitoring concentrations were not consistent with exposure determinants that had previously been identified. Biomonitoring therefore remains the exposure assessment method of choice for PBDEs.There was a relatively greater body of work examining young children’s exposure to insecticides and more Australian data about likely sources were identified via the literature reviews and the analysis of calls to the Queensland Poisons Information Centre. In contrast to PBDEs, the major pathways of exposure to insecticides, including diet and domestic pest-control product use, were readily assessable via the questionnaire. In the questionnaire-biomonitoring study, the associations between biomonitoring data of insecticide concentrations and questionnaire data were generally consistent with determinants that were identified in the questionnaire design phase. These findings suggest that questionnaires may be a feasible method of insecticide exposure assessment in young children. Based on this assessment, a formal validation study for the insecticide component of the questionnaire is indicated.In summary, the questionnaire-based approach to exposure assessment may be feasible when comprehensive exposure pathway data for the chemical of interest are available, when the total number and complexity of exposure pathways is limited, and when sources are readily identifiable via a questionnaire.

Recommended Dietary Allowances (RDAs) are allocated to each food article as published in the Denmark Budget Methods in the Codex Alimentalius of the WHO/FAO Joint Committee when standards of pollutants in food are needed. When daily intakes of Food Additives and Contaminants need to be calculated, the Theoretical Maximum Daily Intake. (TMDI) and the Estimated Maximum Daily Intake (EMDI) have been generally used. TMDI and EMDI are calculated using the formulae shown below: [formula: see text] i: food article (i = 1, ....., n) A: standard value for food additives and contaminants X: mean weight of food article consumed daily l: rate of residue after cooking Exposure assessment should be more exact in order to meet social health needs and to help avoid unnecessarily strict regulations. The U. S. Food and Drug Administration (FDA) is continually improving its estimates of the dietary intakes of pesticides and essential minerals, and comparing these intakes with established safe or recommended dietary intake levels. Dietary survey methods have also improved in parallel, with examples being the USDA's Household Food Consumption Survey (1955 and 1965) and National Health and Nutrition Examination Survey II (1976-1980). In Japan, TMDI and EMDI have received more attention as methods of estimating the daily intakes of food additives and contaminants than has the Total Diet Study, even though the former are not as exact as the latter. The Japanese National Nutrition Survey is one of the most respected nutrition surveys in the world, because it has continued nationwide yearly since 1946. Nevertheless, it is very unfortunate that no one utilizes the Household Food Consumption Survey data for the estimation of intakes of food additives and contaminants, because that is not the primary purpose of the Japanese National Nutrition Survey. Practically, there are neither foods which have an uniform of food additives and contaminants nor individuals who consume uniform amounts of each food item. In this report the authors propose a revised estimation method for the daily intake of food contaminants and additives, based on food consumption data of 159 female volunteers, without using the National Nutrition Survey data. The results obtained are as follows: 1) This method succeeded in making clear the intakes of food additives and contaminants. Mean, maximum and minimum values and distribution curves for the target population were obtained. 2) The suggested name for this method is "Estimated Ecological Daily Intake (EEDI)", which is processed in terms of the food consumption structure for calculation, and methodologically estimated by food ecology.

To estimate the daily intake of food additives by young children aged 1–6 years in Japan, an intake survey was conducted in 2018 using the market basket method for food additives, including twelve types of colourants, three kinds of preservatives, three kinds of sweeteners and two kinds of food manufacturing agents. A list of the daily consumption of processed foods was prepared based on a special survey (MHLW 2011) and used for the estimation. The results of the survey showed that the food additives with the highest daily intake were phosphorus compounds (phosphoric acid and its salts; 11.2 mg/kg bw/day, expressed as phosphorus), followed by propylene glycol (0.80 mg/kg bw/day). The daily intake of other food additives ranged from 0 to 0.20 mg/kg bw/day. The estimated daily intake of each food additives by young children was compared with the acceptable daily intake (ADI) or maximum tolerable daily intake (MTDI). The highest ratio of the estimated daily intake to ADI was 3.2% for propylene glycol, whereas the ratios of the estimated daily intake to ADI for colourants, preservatives and sweeteners ranged from 0 to 1.1% (benzoic acid). The ratio of the estimated daily intake to MTDI for phosphorus compounds was 16%.

Report of workshop on the significance of excursions of intake above the ADI.

Additives in Dairy Foods: Safety

From middle childhood onwards, substantial evidence points to phenotypic differentiation between anxiety diagnostic categories such as generalised anxiety, separation anxiety, specific phobia, and obsessive-compulsive disorders. However, little is known about the genetics of these categories and especially about the phenotypic and genetic structure of related behaviours in pre-school children. We examined the phenotypic differentiation and genetics of mother-reported anxiety-related behaviours in 4,564 four-year-old twin pairs, from a population-based sample. Confirmatory factor analyses provided support for five correlated factors: General Distress, Separation Anxiety, Fears, Obsessive-Compulsive Behaviours, and Shyness/Inhibition. Genetic influences were found on all five factors, but the pattern of influences differed considerably across them, with particularly high heritability estimates for Obsessive-Compulsive Behaviours and Shyness/Inhibition, and substantial shared environmental influence on Separation Anxiety. Multivariate genetic analyses revealed moderate genetic correlations between the five factors. Genetic overlap was particularly pronounced between General Distress and the other anxiety-related behaviours, accounting for about half of their covariance. Genetic variance on Obsessive-Compulsive Behaviours was the least correlated with the other scales. The shared environmental influences correlated highly across the factors, accounting for the greatest proportion of covariation between Separation Anxiety, Fears and Obsessive-Compulsive Behaviours. The non-shared environment influences were largely variable specific. These data provide evidence for phenotypic and genetic overlap as well as differentiation between aspects of anxiety-related behaviours in young children. We conclude that research with young children will benefit from more specific assessments of anxiety-related behaviours in addition to less differentiated assessments of 'internalising' symptoms.

Food additive intakes have increased with the increase in "ultra-processed" food consumption. Food additive emulsifiers have received particular research attention in recent years due to preliminary evidence of adverse gastrointestinal and metabolic health effects. In this review, the use of emulsifiers as food additives is discussed, and the current estimations of exposure to, and safety of, emulsifiers are critically assessed. Food additive emulsifier research is complicated by heterogeneity in additives considered to be emulsifiers and labelling of them on foods globally. Major limitations exist in estimating food additive emulsifier exposure, relating predominantly to a lack of available food occurrence and concentration data. Development of brand-specific food additive emulsifier databases are crucial to accurately estimating emulsifier exposure. Current research on the health effects of food additive emulsifiers are limited to in vitro and murine studies and small, acute studies in humans, and future research should focus on controlled human trials of longer duration.

Introduction. At present, the causes and methods of manifestation of aggression in children with hearing impairment are considered as an insufficiently studied problem, and the available studies are contradictory: the unified principles, methods and techniques for diagnosing and correcting aggressive behavior in children are insufficiently developed and substantiated. Severe emotional states, including aggression, are a fairly common occurrence in older preschool children with hearing impairment, when they realize their difference from their normal hearing peers. Household methods of dealing with aggression do not always help, often exacerbate the problem. Preventive and corrective work should be based on the means available for understanding by children of preschool age. Fairy tale therapy has effective methods and techniques in correctional and developmental work with children with hearing impairment in work with manifestations of aggression.Materials and Methods. Review and critical analysis of scientific literature. Empirical research methods: study of medical records, experiment. Method of mathematical processing of research results.Results. Methods for diagnosing aggressive behavior and methods for its correction in preschool children with hearing impairment are analyzed. The initial level of manifestation of aggression in children of senior preschool age with hearing impairment was revealed. A program and methodological recommendations for the correction of aggressive behavior in senior preschool children with hearing impairment by means of fairy tale therapy in the conditions of a preschool educational organization have been developed. During the analysis of the results of the study of children in the experimental and control groups, a decrease in the indicators of the manifestation of aggressive behavior was observed, which confirms the effectiveness of the developed program.Discussion and Conclusions. The implementation of the program for the correction of aggressive behavior in children of senior preschool age with hearing impairments by means of fairy tale therapy should be carried out in the conditions of a preschool educational organization and boarding schools, when methods and techniques for preventing and correcting aggressive behavior of children based on fairy tales are included in the correctional and developmental lesson. taking into account in the process of its implementation the structure of hearing impairment, the psychological characteristics of preschool children with hearing impairment.

Objectives. To determine the most effective treatments for clinically significant disruptive behaviors in children and adolescents. Data sources. Ovid® MEDLINE®, the Cochrane Library, PsycINFO®, and Embase® databases were searched from 2014 to July 22, 2024. Additionally, we reviewed all studies included in the prior 2015 Agency for Healthcare Research and Quality review. Review methods. We dual reviewed abstracts and full-text articles; data extraction was checked by a second reviewer; risk of bias and strength of evidence were assessed by two reviewers; and disagreements were resolved by consensus. Results. For this review, 168 studies in 194 publications (160 randomized controlled trials [RCTs] and 8 nonrandomized studies) met inclusion criteria. Psychosocial interventions: Multicomponent interventions (parent or teacher plus child) substantially reduced parent-reported disruptive behavior more than usual care or waitlist in preschool children (10 RCTs, N=784, standard mean difference [SMD] -0.96, 95% confidence interval [CI] -1.39 to -0.60) and moderately reduced disruptive behavior in school-age children (9 RCTs, N=524, SMD -0.61, 95% CI -1.05 to -0.20) immediately posttreatment. Similarly, interventions that involved the parent only and not the child also moderately reduced parent-reported disruptive behavior in preschool children (13 RCTs, N=1,222, SMD -0.61, 95% CI 0.99 to -0.31) and slightly reduced disruptive behavior in school-age children (11 RCTs, N=1,289, SMD 0.39, 95% CI 0.58 to 0.22). Comparisons between psychosocial interventions generally showed only minor differences in disruptive behaviors in preschool and school-age children. Findings in adolescents for multicomponent and child-only interventions versus usual care and waitlist and versus another intervention were mixed. Through pairwise, indirect, and network meta-analyses, we were not able to determine whether multicomponent, parent-only, or child-only interventions are superior overall, though there was less evidence in child-only interventions and interventions in adolescents. Pharmacologic interventions: There was limited evidence to support the use of stimulants and/or antipsychotics for disruptive behavior disorders in selected children. Treatment response was more likely with stimulant treatment alone (2 RCTs) and in pooled analysis of add-on risperidone (2 RCTs) and risperidone maintenance (1 RCT) compared with placebo. Study withdrawal due to adverse events was higher with any pharmacotherapy relative to placebo (6 RCTs, N=911, RR 3.44, 95% CI 1.35 to 8.75), although serious adverse events were rare and not different from placebo. Evidence was insufficient to determine whether psychosocial, pharmacological, or a combination of psychological and pharmacological interventions are more effective in reducing disruptive behaviors in children and adolescents. Evidence was also inconsistent or insufficient to determine if benefits and harms of treatment interventions varied based on patient, clinical, or treatment characteristics, or treatment history. Conclusions. Multicomponent psychosocial interventions (parent or teacher plus child) and parent-only psychosocial interventions were better than treatment as usual or waitlist at reducing parent report of child disruptive behaviors for preschool and school-age children immediately post-treatment. In these children, direct and indirect comparisons of multicomponent, parent-only, and child-only interventions generally found no or only minor differences in reducing disruptive behaviors, although effectiveness differed by specific psychosocial intervention. Results of multicomponent interventions and child-only interventions were mixed in adolescents and studies in adolescents were few. Pharmacotherapy may be helpful in reducing disruptive behaviors in some children who have inadequate response to psychosocial interventions. The use of medications was associated with an increased risk of experiencing any adverse event, but serious adverse events were infrequent and similar to placebo. For all age groups, evidence for some psychosocial interventions and all pharmacological interventions was limited, as was reporting of long-term outcomes. Additional research is needed to aid the clinician in selecting the intervention most likely to be effective in reducing disruptive behaviors well beyond treatment completion.

Coupled to increasing consumer demand, food manufacturers have moved towards increased usage of approved natural colours. There is a legal requirement for governments to monitor the consumption of all food additives in the European Union to ensure the acceptable daily intakes (ADIs) are not exceeded, especially by young children. Validated analytical methods are needed to fulfil this requirement. The aim of this paper is to review the available literature on methods of extraction for approved natural colours in food and drink. Available analytical methods for the determination of European Union-permitted natural food colour additives in foods and beverages have been assessed for their fitness for purpose in terms of their key extraction and analysis procedures, selectivity and sensitivity, especially with regard to maximum permitted levels, and their applicability for use in surveillance and in an enforcement role. The advantages and disadvantages of available analytical methods for each of nine designated chemical classes (groups) of natural colours in different food and beverage matrices are given. Other important factors such as technical requirements, cost, transferability and applicability are given due consideration. Gaps in the knowledge and levels of validation are identified and recommendations made on further research to develop suitable methods. The nine designated natural colour classes covered are: 1. Curcumin (E100), 2. Riboflavins (E101i–ii), 3. Cochineal (E120), 4. Chlorophylls-including chlorophyllins and copper analogues (E140–141), 5. Caramel Classes I–IV (E150a–d), 6. Carotenoids (E160a–f, E161b, E161g), 7. Beetroot red (E162), 8. Anthocyanins (E163), and 9. Other colours – Vegetable carbon (E153), Calcium carbonate (E170), Titanium dioxide (E171) and Iron oxides and hydroxides (E172).