The Role of Seafood Consumption
in Child Growth and Development
_____
Committee on the Role of Seafood Consumption
on Child Growth and Development
Food and Nutrition Board
Health and Medicine Division
Consensus Study Report
NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001
This activity was supported by a contract between the National Academy of Sciences and the U.S. Department of Health and Human Services, U.S. Food and Drug Administration Grant No. 75F40122F19001, which includes funds from the National Oceanic and Atmospheric Administration, the U.S. Department of Agriculture, and the U.S. Environmental Protection Agency. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-71698-7
International Standard Book Number-10: 0-309-71698-5
Digital Object Identifier: https://doi.org/10.17226/27623
Library of Congress Control Number: 2024937830
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2024. The role of seafood consumption in child growth and development. Washington, DC: The National Academies Press. https://doi.org/10.17226/27623.
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COMMITTEE ON THE ROLE OF SEAFOOD CONSUMPTION IN CHILD GROWTH AND DEVELOPMENT
VIRGINIA A. STALLINGS (Chair), Professor of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, The Children’s Hospital of Philadelphia, University of Pennsylvania
LAURIE HING MAN CHAN, Canada Research Chair in Toxicology and Environmental Health, Department of Biology, University of Ottawa, Canada
ELAINE M. FAUSTMAN, Professor, Department of Environmental & Occupational Health Sciences and Director, Institute of Risk Analysis and Risk Communication, School of Public Health and Community Medicine, University of Washington
CLAUDE EARL FOX, Professor Emeritus, Department of Epidemiology, School of Public Health Sciences, University of Miami Miller School of Medicine
DELBERT M. GATLIN III, Regents Professor, Texas A&M AgriLife Research Senior Faculty Fellow, Department of Ecology and Conservation Biology, Texas A&M University
JULIE HERBSTMAN, Professor, Environmental Health Sciences, Director, Columbia Center for Children’s Environmental Health, Columbia University, New York
MARGARET R. KARAGAS, James W. Squires Professor and Chair, Department of Epidemiology, Geisel School of Medicine, Dartmouth College, New Hampshire
SIBYLLE KRANZ, Associate Professor, Department of Kinesiology, Adjunct Associate Professor, Public Health Sciences, University of Virginia
MAUREEN LICHTVELD, Dean, Graduate School of Public Health, Jonas Salk Professor of Population Health, Professor of Environmental and Occupational Health, University of Pittsburgh
CHARLES A. NELSON, Professor of Pediatrics and Neuroscience, Richard David Scott Chair in Pediatric Developmental Medicine Research, Harvard Medical School, Boston Children’s Hospital
EMILY OKEN, Alice Hamilton Professor and Vice Chair, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute
IAN J. SALDANHA, Associate Professor, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore
Consultants
JULEEN LAM, Assistant Professor, Department of Public Health, California State University East Bay
ALICE H. LICHTENSTEIN, Gershoff Professor of Nutrition Science, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Massachusetts (until March 2023)
BARBARA O. SCHNEEMAN, Professor Emerita, University of California, Davis
ALICIA TIMME-LARAGY, Professor, School of Public Health & Health Sciences, University of Massachusetts Amherst
AMANDA MACFARLANE, Director, Texas A&M Agriculture, Food, and Nutrition Evidence Center
MAUREEN SPILL, Program Lead, Nutrition & Health, Texas A&M Agriculture, Food, and Nutrition Evidence Center
DAVID LOVE, Senior Scientist, Seafood, Public Health & Food Systems Project, Johns Hopkins Center for a Livable Future at the Bloomberg School of Public Health
ANDREW THORNE-LYMAN, Associate Research Professor, Department of International Health, Johns Hopkins Center for a Livable Future at the Bloomberg School of Public Health
Study Staff
ELIZABETTE ANDRADE, Study Director
KATHRYN GUYTON, Senior Program Officer (until May 2023)
ALICE VOROSMARTI, Associate Program Officer
JENNIFER STEPHENSON, Research Associate
JENNIFER MOUSER, Senior Program Assistant
THOMASINA LYLES, Senior Program Assistant (until April 2023)
REBECCA MORGAN, Senior Librarian
ANN L. YAKTINE, Director, Food and Nutrition Board
Reviewers
This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.
We thank the following individuals for their review of this report:
P. MICHAEL BOLGER, U.S. Food and Drug Administration (retired)
SUSAN E. CARLSON, University of Kansas Medical Center
PHILIPPE GRANDJEAN, University of Rhode Island
LORA IANNOTTI, Washington University in St. Louis
SHARON KIRKPATRICK, University of Waterloo
JIM RIVIERE, North Carolina State University
CATHERINE ROSS, Texas A&M University
MARCELA TAMAYO-ORTIZ, Columbia University
XIAOBIN WANG, Johns Hopkins Bloomberg School of Public Health
DANIELE WIKOFF, ToxStrategies
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the report nor did they see the final draft before its release. The review of this report was overseen by JACK EBELER, Health Policy Alternatives, Inc., and SUZANNE P. MURPHY, University of Hawaii at Manoa. They were responsible for making certain that an independent examination of this report was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies.
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Contents
2 METHODOLOGICAL APPROACH TO THE TASK
Supplementary Review of Systematic Reviews
3 SEAFOOD CONSUMPTION PATTERNS IN THE UNITED STATES AND CANADA
Trends in Consumption of Fish and Seafood
Survey Data on Seafood Consumption by Age and Sex Group
Factors Influencing Seafood Consumption
4 DIETARY INTAKE AND NUTRIENT COMPOSITION OF SEAFOOD
Nutrient Composition of Seafood
Dietary Patterns and Seafood Consumption
5 EXPOSURE TO CONTAMINANTS ASSOCIATED WITH CONSUMPTION OF SEAFOOD
Toxins and Toxicants of Concern in Seafood
Contaminants Resulting in Chronic Exposures
Contaminants Resulting in Acute or Episodic Exposure
Human Biomarkers of Toxicant Exposure Associated with Seafood Consumption
6 HEALTH OUTCOMES ASSOCIATED WITH SEAFOOD CONSUMPTION
Seafood Consumption and Health Outcomes in Children and Adolescents
Exposure to Toxicants in Seafood and Child Growth and Development
Common Mechanisms of Action of Contaminants Commonly Found in Seafood
Approach to Reviewing Evidence on Conducting a Risk–Benefit Analysis
Assessment of the State of the Science on Risk–Benefit Analysis
Methodologies and Frameworks Used to Conduct Risk–Benefit Analyses
Modeling Benefits and Risks of Fish Consumption
Developing a Framework for Conducting a Risk–Benefit Analysis
Scientific Principles Underpinning a Risk–Benefit Analysis
Approach to Conducting a Risk–Benefit Analysis
Steps in Evaluating When or When Not to Conduct a Risk–Benefit Analysis
Community Resilience and Access to Health Care
A COMMITTEE MEMBER BIOSKETCHES
C COMMISSIONED SYSTEMATIC REVIEWS
D SUPPLEMENTAL REVIEW OF SYSTEMATIC REVIEWS
E NHANES DATA ANALYSIS METHODOLOGY
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1 Three additional appendixes can be found at https://nap.nationalacademies.org/catalog/27623: Appendix F (Literature Searches Conducted for Systematic Reviews); Appendix G (Supplemental Literature Searches); and Appendix H (Commissioned Systematic Reviews: Final Report).
Acronyms and Abbreviations
ADHD | attention deficit hyperactivity disorder |
ALA | alpha-linolenic acid |
AMSTAR | A Measurement Tool to Assess Systematic Reviews |
ASD | autism spectrum disorder |
ATP | adenosine triphosphate |
ATSDR | Agency for Toxic Substances and Disease Registry |
BOND | biomarkers of nutrition for development |
CCHS | Canadian Community Health Survey |
CHD | coronary heart disease |
CI | confidence interval |
CSFII | Continuing Survey of Food Intakes by Individuals |
CVD | cardiovascular disease |
DALY | disability-adjusted life year |
DEXA | dual x-ray absorptiometry |
DGA | Dietary Guidelines for Americans 2020–2025 |
DHA | docosahexaenoic acid |
DMA | dimethylarsinate |
DNA | deoxyribonucleic acid |
DXA | dual x-ray absorptiometry |
EFSA | European Food Safety Authority |
EPA | eicosapentaenoic acid |
EPA | U.S. Environmental Protection Agency |
ERS | Economic Research Service |
EU | European Union |
FADS | Food Availability Data System |
FAO | Food and Agriculture Organization of the United Nations |
FDA | U.S. Food and Drug Administration |
FN | First Nations |
FPED | Food Patterns Equivalent Database |
g | gram |
GRADE | Grading of Recommendations, Assessment, Development and Evaluation |
HCL | hydrochloric acid |
HDL | high-density lipoprotein |
HEI | Healthy Eating Index |
Hg | mercury |
IF | intrinsic factor |
IOM | Institute of Medicine |
IQ | intelligence quotient |
IU | international units |
kcal | kilocalorie |
LCPUFA | long-chain, polyunsaturated fatty acid |
LDL | low-density lipoprotein |
µg | microgram |
MeHg | methylmercury |
MeSH | Medical Subject Heading |
mg | milligram |
NHANES | National Health and Nutrition Examination Survey |
NOAA | National Oceanic and Atmospheric Administration |
NSLP | National School Lunch Program |
PBDE | polybrominated diphenyl ether |
PCB | polychlorinated biphenyl |
PECOD | populations, exposures, comparators, outcomes, study design |
PFAS | per- and polyfluoroalkyl substances |
PFC | perfluorinated compounds |
PIF | potential impact fraction |
POP | persistent organic pollutant |
PUFA | polyunsaturated fatty acids |
QALY | quality-adjusted life year |
RBA | risk–benefit analysis |
RCT | randomized controlled trial |
T3 | tri-iodothyronine |
T4 | thyroglobulintetraiodothyronine or thyroxin |
TrxR | thioredoxin reductase |
TWI | tolerable weekly intake |
UFCR | usual fish consumption rate |
UK | United Kingdom |
UL | Tolerable Upper Intake Level |
USDA | U.S. Department of Agriculture |
WCBA | women of childbearing age |
WHO | World Health Organization |
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Preface
My childhood memories include the cultural and festive role of fish. Because my hometown is at the convergence of two rivers, many people fished for food and some for sport. With my grandfather, I learned of trotlines for huge catfish and the fun of catching sunfish and perch with a cane pole. A backyard fish fry was part of family reunions and parties, and our vacation to the Gulf involved shrimp and flounder for kids and crabs and oysters for adults. At those times, the safety of this freshwater and marine bounty was of no concern, nor was consumption of these foods considered to have health advantages.
At present, however, both the safety and the health advantages of fish and other seafood consumption are of high interest. The Committee on the Role of Seafood Consumption in Child Growth and Development of the National Academies of Sciences, Engineering, and Medicine was convened to understand the evidence of risks and benefits of seafood (including freshwater and marine) consumption in the United States. The committee was asked to examine seafood consumption and dietary intake by pregnant and lactating women, and by children, and its associations with growth, developmental, and health outcomes in children and adolescents. In addition, the committee evaluated the potential usefulness of the formal risk–benefit analysis methodology to inform public health recommendations issued by federal agencies, such as the U.S. Department of Agriculture, U.S. Food and Drug Administration, U.S. Environmental Protection Agency, and National Oceanic and Atmospheric Administration, and to make recommendations for seafood consumption in these two populations. It was also the committee’s charge to consider racial and ethnic subgroups, as well as subsistence and sport fishers, in order to support a diverse, inclusive, and equitable approach to the task, to the extent possible.
Understanding the safety of seafood is a complicated process requiring information about each potential toxicant for each commonly consumed species. Information is then needed on the amount of each species consumed by the various life-stage groups (birth to 18 years, pregnant or lactating women, etc.). The search for this key information revealed limited high-quality evidence that was sometimes inconsistent.
One of the surprising findings for me was how little seafood is consumed by children and pregnant women, with few women and children meeting the recommendations in the Dietary Guidelines for Americans that call for two servings of seafood per week. Pregnant and lactating women merit special attention because of the potential for seafood consumption to result in both adverse and beneficial health effects on the fetus and infant; these issues are well covered in the report. Opportunity exists to increase consumption of seafood—a source of high-quality protein, healthful fatty acids, and several micronutrients—across all life stages evaluated.
Committee members were well suited to the report’s tasks based on their scientific expertise and their experience in evaluating the quality of the evidence. After serving on this project for 20 months, the committee detailed its findings, conclusions, and recommendations. Among the recommendations are to collect additional, specific data to ensure that policy makers and other stakeholders have sufficient information for public health decision making, including promoting healthful dietary patterns while addressing safety concerns.
A technical expert panel (TEP) provided significant contributions that helped guide this report. In collaboration with the committee, TEP consultants Juleen Lam, Barbara Schneeman, Alicia Timme-Laragy, and Alice Lichtenstein worked with committee member Ian Saldanha to develop the conceptual framework to inform our approach to data gathering, review, and synthesis.1 I also want to acknowledge the scientists at the Johns Hopkins Center for a Livable Future at the Bloomberg School of Public Health, David Love and Andrew Thorne-Lyman, as well as the team at Texas A&M University, Amanda McFarland and Maureen Spill, for their work to ensure the committee had the most current and comprehensive data for its analysis and deliberations.
As chair, I express my sincere appreciation to each committee member and to each member of our National Academies staff, including Ann Yaktine, Elizabette Andrade, Kate Guyton, Alice Vorosmarti, Jennifer Stephenson, Jennifer Mouser, Thomasina Lyles, and Rebecca Morgan, for your shared commitment to this project.
Virginia A. Stallings, Chair
Committee on the Role of Seafood in Child Growth and Development
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1 Alice Lichtenstein served on the TEP until March 2023.