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

This publication is available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.

Copyright 2024 by the National Academy of Sciences. National Academies of Sciences, Engineering, and Medicine and National Academies Press and the graphical logos for each are all trademarks of the National Academy of Sciences. All rights reserved.

Printed in the United States of America.

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.

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president.

The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. John L. Anderson is president.

The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president.

The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine.

Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org.

Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process, and it represents the position of the National Academies on the statement of task.

Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies.

Rapid Expert Consultations published by the National Academies of Sciences, Engineering, and Medicine are authored by subject-matter experts on narrowly focused topics that can be supported by a body of evidence. The discussions contained in rapid expert consultations are considered those of the authors and do not contain policy recommendations. Rapid expert consultations are reviewed by the institution before release.

For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo.

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.

This page intentionally left blank.

Contents

ACRONYMS AND ABBREVIATIONS

PREFACE

SUMMARY

1 INTRODUCTION

Background for the Study

Committee’s Task and Approach

Organization of the Report

References

2 METHODOLOGICAL APPROACH TO THE TASK

Systematic Reviews

Supplementary Review of Systematic Reviews

Seafood Intake Analyses

Conceptual Framework

References

3 SEAFOOD CONSUMPTION PATTERNS IN THE UNITED STATES AND CANADA

Sources of Seafood

Trends in Consumption of Fish and Seafood

Survey Data on Seafood Consumption by Age and Sex Group

Factors Influencing Seafood Consumption

Seafood Consumption by Setting

Findings and Conclusions

Recommendations

Research Gaps

References

4 DIETARY INTAKE AND NUTRIENT COMPOSITION OF SEAFOOD

Nutrient Composition of Seafood

Dietary Patterns and Seafood Consumption

Findings and Conclusion

Research Gaps

References

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

Findings and Conclusions

Research Gaps

References

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

Findings and Conclusions

Research Gaps

References

7 RISK–BENEFIT ANALYSIS

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

A Basis for Decision Making

Community Resilience and Access to Health Care

Findings and Conclusions

Recommendations

Research Gaps

References

APPENDIXES¹

A COMMITTEE MEMBER BIOSKETCHES

B OPEN SESSION AGENDAS

C COMMISSIONED SYSTEMATIC REVIEWS

D SUPPLEMENTAL REVIEW OF SYSTEMATIC REVIEWS

E NHANES DATA ANALYSIS METHODOLOGY

___________________

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

This page intentionally left blank.

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

___________________

¹ Alice Lichtenstein served on the TEP until March 2023.