Organic foods and children

INTRODUCTION — Foods are considered organic if they are grown and processed without the use of synthetic fertilizers or pesticides [1-4]. Organic farmers attempt to protect the environment by using natural matter (eg, aged manure, humus, and compost) for fertilizer and biologic methods of pest control (eg, crop rotation and natural insect predators like lady bugs) [5-8]. Livestock and poultry used for egg, dairy, and meat production are raised on organically grown feed, without antibiotics or hormones, and provided with access to the outdoors [5,6,8-10].

The increased consumer demand for organically grown food can be attributed to [1,11-15]:

●Concern that pesticides and chemical fertilizers have adverse health effects

●Concern about environmental effects of pesticides and chemical fertilizers

●Concern about adverse developmental and health effects from ingesting meat from animals treated with antibiotics, sex steroids, and hormone supplementation

●Concern about the nutritional adequacy of foods grown by conventional agriculture

Pediatric health care providers should be prepared to help their patients and their parents/caregivers make informed decisions regarding the purchase and consumption of organic foods. Demand for food purity has increased despite governmental assurances that the American food supply is one of the safest in the world [16,17]. Organically grown foods are often promoted as and perceived by consumers to be healthier than conventionally grown foods [11,18-22]. The evidence about potential health benefits of organic foods is outlined below.

Related content can be found in the following topic reviews:

●(See "Vegetarian diets for children".)

●(See "Endocrine-disrupting chemicals".)

●(See "Dietary recommendations for toddlers and preschool and school-age children".)

●(See "Dietary history and recommended dietary intake in children".)

INDUSTRY OVERVIEW

Labeling requirements — In the United States, the National Organic Program, which is part of the United States Department of Agriculture (USDA), enforces the standards for growing and labeling organic food. Only products that have been certified as meeting the USDA guidelines for organic production may carry the USDA organic seal [23].

To use the USDA organic seal, the final product must follow strict production, handling, and labeling standards and complete the organic certification process [23,24]. The standards address a variety of factors including soil quality, animal raising practices, and pest and weed control. Organic produce must be grown on soil that had no synthetic fertilizers or pesticides applied for three years prior to harvest. Organic meat must be obtained from animals that are raised in living conditions accommodating their natural behaviors, fed organic feed, and have not received antibiotics or hormones. Synthetic fertilizers, sewage sludge, irradiation, and genetic engineering may not be used.

As of April 2008, the USDA has the following labeling requirements [23,24]:

●"100 percent organic" – Requires that all ingredients must be certified as organically produced and processed (excluding water and salt).

●"Organic" – Indicates at least 95 percent certified organically processed ingredients (excluding water and salt); the remaining 5 percent of ingredients may be nonorganically produced but must be on the USDA's National List.

●"Made with organic ingredients" – Indicates at least 70 percent certified organic ingredients (excluding water and salt); up to three individual organically produced ingredients may be listed on the side panel but with no other organic claim on the front of the package.

Market growth — Consumer demand for organic foods has grown steadily during the past three decades and in many countries [25-29]. Individuals who routinely consume organic food are more likely to be vegetarian and report food allergies compared with occasional organic food consumers [30].

●Sales – Retail sales of organic foods in the United States have grown from approximately $1 billion in 1990 to $57.5 billion in 2021 [31]. In 2020, organic food sales represented 6 percent of total retail food sales in the United States, up from 4.2 percent in 2011 [32,33]. In a 2015 study of 28,245 French adults, the average consumption of organic food was 18 to 20 percent of the diet and less than 12 percent of the respondents reported never consuming organic food in the past year [34].

●Food types – Fresh produce (fruits and vegetables) are the top-selling organic category, representing 15 percent of all fruit and vegetable sales, followed by nondairy beverages, breads and grains, packaged foods, and organic dairy products and meats [35]. Organic foods, including organic infant formulas, are available increasingly in supermarkets and chain food stores [14,16].

●Production – Producers, exporters, and retailers are struggling to meet consumer demand for a wide range of organic food products [36]. According to the 2019 USDA Organic Survey, the number of certified organic farms increased 17 percent between 2016 and 2019, from 14,217 to 16,585, respectively [37]. During the same time period, the area of farmland devoted to organic farming increased from 5 million to 5.5 million acres. Certified organic farmland is found in all 50 of the United States.

Cost — Organically grown foods typically cost 15 to 50 percent more than conventionally grown foods, but the price gap has been shrinking over time [38,39]. The reasons for the higher costs include the smaller supply (organic farmers are fewer and crop yields are smaller), and the increased cost of certification and labor intensity of growing foods without synthetic pesticides and chemicals [40].

Pesticide regulation — Use of pesticide is regulated strictly by three federal agencies: the United States Environmental Protection Agency (EPA), the US Food and Drug Administration (FDA), and the USDA [41-43].

The EPA establishes a tolerance for all pesticides that are registered and approved for use in the United States [44,45]. Tolerance is defined as the legal limit of a pesticide residue allowed in or on a raw agricultural commodity and, in appropriate cases, on processed foods [46-48]. More information about regulation of pesticides and chemicals in crops and foods can be obtained from the EPA's website.

Pesticide companies must submit scientific studies for review before the EPA establishes a tolerance. The data identify: (1) possible toxic or harmful effects of the pesticide, (2) how much of the pesticide residue is likely to remain in or on foods by the time they are marketed and prepared, and (3) all possible sources of exposure to the pesticide (eg, drinking water and residential exposure) [47].

If studies suggest that children may be harmed by exposure to a pesticide, the EPA does not approve the pesticide's use or it requires action to reduce the potential risks. Examples for which consideration for the health of infants and children affected decisions include [49,50]:

●By 2008, the EPA had cancelled most organophosphates (OP). As a result, tomatoes with detectable OP pesticide residues dropped from 37 percent in 1998 to 9 percent in 2008.

●In 2010, the EPA canceled methomyl use on grapes and strawberries.

●In 2013, the EPA canceled all domestic uses of methyl parathion and all uses of formetanate hydrochloride on apples, pears, and peaches.

●From 1995 to 2013, children's exposure to carbamates, a group of insecticides that affect the nervous system, fell by 70 percent [49].

●In 2021, the EPA banned the organophosphate chlorpyrifos for use on food crops [51]. The EPA had previously banned this pesticide in 2015 but then reversed the decision in 2017.

In 1993, the National Research Council (NRC) issued a report on pesticides in the diets of infants and children [48]. The report concluded that children may be exposed to relatively larger amounts of certain pesticide residues than are adults and that the exposure occurs at a vulnerable point in their development. It acknowledged the need for reassessment of pesticide tolerances that would apply specifically to infants and children and recommended the collection of data that would more accurately reflect the dietary patterns of children and the effects of pesticide exposure in infants and children [48,52-54].

The NRC report triggered passage of the Food Quality Protection Act (FQPA) in 1996. The FQPA required the EPA to review and reassess all existing pesticide tolerances to make them safer for infants and children by 2006 [49,55,56]. The FQPA required the EPA to apply an additional 10-fold margin of safety to its pesticide assessments to address the potential for pre- and postnatal toxicity and to compensate for gaps or inadequacies in the available database regarding potential health risks to infants and children [57-59]. The EPA is required to apply the 10-fold safety factor unless there are reliable data to support use of a different safety factor to protect infants and children [49,53,58,60].

Tolerance levels are enforced by the USDA for meat and poultry and by the FDA for all other foods. The FDA specifically analyzes for pesticide residues on all foods eaten by infants and children. The FDA monitors nutritional concerns, including pesticide exposure, through the Total Diet Study [61]. This study examines approximately 265 foods selected to typify the American diet. The Total Diet Study findings for 2015 to 2016 were consistent with previous FDA reports [42]. Residues of 155 different pesticides were found in the Total Diet Study foods. Most were found at trace levels; the residue levels in 87 percent of the samples were below 0.01 ppm.

FOOD SAFETY — Three areas of food safety to consider when comparing organic and conventionally grown foods are pesticide use, microbial infection, and natural toxins. Additional information about food safety is available from the United States Government Food Safety website and the Centers for Disease Control and Prevention Food Safety website.

Pesticides — Much of the debate about organic and conventional agriculture centers on the use of pesticides. Promoters of organic foods suggest that the pesticides used in commercial farming are detrimental to food safety and health [62]. Surveys show that individuals who purchase organic foods believe that pesticides, at any level of exposure, are hazardous to health, food safety, and the environment and that something must be done to reduce this risk [63,64].

Many people are frightened by reports of pesticides in conventionally grown foods, although the reports often lack scientific peer review. Media attention may perpetuate this misinformation. In 1989, for example, the media portrayed alar, a growth regulator used mainly on apples, as a potent cancer-causing threat to children. As a result, apples and apple products treated with alar were destroyed and alar was voluntarily withdrawn from the domestic market. However, many health authorities, including the United States Surgeon General and the American Medical Association, issued statements that alar poses no risk to the public's health when used in the approved, regulated fashion [65].

Although organic farmers avoid the use of synthetic pesticides, organic foods sometimes contain synthetic pesticide residues, probably because of cross-contamination by wind and groundwater [16,17,66,67]. The frequency and amount of pesticide residue in organic foods are usually lower than in conventionally grown foods [4,22,68-70]. In a systematic review, detectable residues were found in 7 percent of organic produce samples as compared with 38 percent of conventional produce samples [68]. However, the risk of pesticide contamination exceeding maximum-allowed limits was small for both farming methods. Of note, all plants produce toxins ("natural pesticides") that protect them from fungi, insects, and predators [16,71,72]. Plant varieties that have been developed to be naturally pest-resistant may contain increased amounts of these natural pesticides and have adverse health effects [16,73]. Similarly, the consumption of organically produced meat may not diminish carcinogenic risk from persistent organic pollutants and may even augment risk [74].

Benefits — Careful and judicious use of pesticides permits a more abundant food supply. Pesticides increase crop yields and affordability of fruits and vegetables throughout the year. They also may prolong shelf life and retard mold growth [49,75].

Adverse effects — The traces of pesticide residues in conventionally grown foods are not a problem for most people. Limited evidence suggests a possible association between exposure to pesticides in utero or through occupational exposures to the child's parents or caregivers and adverse neurodevelopment or pediatric cancer (particularly acute lymphocytic leukemia or brain tumors) [41,52].

Compared with adults, infants and young children have different levels of risk for adverse effects of pesticides. Several reasons are [49,52,53,76,77]:

●Children eat relatively more food (particularly fruits and vegetables) per unit of body weight than do adults

●Children tend to eat large quantities of single foods for days or weeks on end

●Children's behaviors, such as playing on the floor and placing hands and objects in their mouths, may increase exposures to pesticides

●A child's developing organ systems may be more susceptible to the effects of pesticides (eg, nervous system) or less able to clear the metabolites (eg, renal)

●Infants and children may have unique exposure pathways such as through the placenta and through breast milk

For rare cases of exposure to toxic levels of pesticides (eg, through accidental ingestion of agricultural pesticides), adverse effects range from mild symptoms of dizziness and nausea to serious, long-term neurologic and developmental disorders. (See "Organophosphate and carbamate poisoning".)

Exposure in utero — Effects of pesticides may depend on the developmental stage when exposure occurs [78]. There is some evidence from animal studies that in utero exposure to organophosphate (OP) pesticides at high doses may affect neurodevelopment and growth in the offspring [79,80]. The few studies that have focused specifically on pesticide exposure of children in utero indicate that OP pesticides are transferred to the developing fetus during pregnancy [6,81-84].

Large prospective studies have examined the causal relationship between exposure to dietary pesticides and adverse neurodevelopmental health outcomes in humans [12]:

●In a birth cohort in Taiwan, the children were evaluated at four time points between 2 and 12 years of age for prenatal and childhood exposure to seven phthalate esters [85]. Cognitive function was evaluated using the Bayley Scales of Infant Development (BSID-II) and the Wechsler Intelligence Scale for Children-III and IV (WISC-III and IV). An inverse association was found between intelligence quotient (IQ) scores and phthalate exposure during childhood but not for exposure during the prenatal period.

●In a French birth cohort study of 231 mothers and their six-year-old children, prenatal and child urinary dialkyl phosphate and dimethyl phosphate metabolites were not associated with the children's overall WISC-IV scores [86]. The children's highest urinary concentrations of diethyl phosphate metabolites were associated with lower scores of WISC-IV working memory but not with the verbal comprehension scores.

●In a Danish birth cohort study of 518 mothers and their 20- to 36-month-old toddlers, increased prenatal phthalate exposure was associated with lower scores on a standardized measure of language development and complexity in boys but not in girls [87].

●Another study reported that the consumption of organically produced foods during pregnancy in Norwegian women was associated with a lower prevalence of hypospadias, but not cryptorchidism, in their male infants [88].

Studies about associations between maternal pesticide exposure and fetal growth have conflicting results. In one study of an urban cohort of pregnant women and newborns in Manhattan, measurements of OP pesticides (chlorpyrifos and diazinon) were inversely associated with both birth weight and length prior to 2001 [89,90]. The adverse association between OP exposure and fetal growth disappeared within a year of the United States Environmental Protection Agency (EPA) regulatory action to phase out these pesticides. Conversely, in a birth cohort in California, maternal organochlorine exposure was not associated with birth weight, length, or length of gestation [91].

Women living in agricultural communities appear to have higher levels of exposure to pesticides. Urinary metabolites of OP pesticides were measured during pregnancy and after delivery in 600 women residing in an agricultural community in California [82]. Metabolite levels during pregnancy and postpartum were higher in this population than in a sample of women of childbearing age in the general United States population. The differences were more pronounced at the postpartum measurement, when levels were 2.5 times higher than in the reference population. These findings may have implications for estimating dose of exposure during pregnancy and lactation.

There is some evidence supporting an association between OP exposure and alterations in neonatal neurobehavior [80]. In the cohort described above, neonatal neurobehavior was assessed with the Brazelton Neonatal Behavioral Assessment Scale (BNBAS) and in utero and early postnatal OP exposure was measured by urinary OP metabolites. The study revealed a correlation between prenatal urinary metabolite levels and abnormal reflexes in the infants. However, no detrimental associations were found between postnatal urinary metabolite levels and any of the neurodevelopmental measures.

Exposure in childhood — Most evidence indicates that traces of pesticide residues in foods are not a problem for most people, regardless of whether they are conventionally or organically grown. However, data are limited regarding the toxicologic consequences of exposure to pesticide residue during infancy and early childhood [52,92]. One study found that increasing organic foods in the diet was associated with reduced biomarkers of oxidative damage [93].

Children who live in agricultural settings may be exposed to higher levels of OP pesticides than their urban counterparts [94-98]. Children of farm workers may be exposed to pesticides tracked into their homes by household members, by pesticide drift, by playing in contaminated areas, or through breast milk from their farm worker mothers [78,99]. Researchers in Washington State found that the median metabolite pesticide levels in 109 preschool children of agricultural workers were five times higher than in those in a reference population [100]. Studies are examining the effectiveness of interventions to reduce pesticide exposure to this population, including education of parents or caregivers in pesticide safety, removing contaminated shoes and clothing before entering the home, and keeping children away from pesticide-treated areas [96,101].

Methods to reduce exposure to pesticides — Organic diets appear to reduce OP exposure in children, but whether there are associated health benefits has not been established. In one study of a group of 39 preschool-aged children in Washington State, children consuming a conventional diet had urinary dimethyl OP metabolites six to nine times higher than children consuming an organic diet [102]. In another study, the short-term effects of changing to an organic diet were measured in 23 school-aged children [103]. After only 24 to 48 hours of the organic diet, urinary OP metabolites (malathion and chlorpyrifos) decreased to nondetectable levels. However, whether this reduction of urinary OP metabolites has any relevance to health outcomes has not been shown.

Most pesticides begin to break down soon after application with exposure to sunlight and rain; they continue to break down after harvest [104]. Additional pesticide reduction can be achieved through washing, peeling, cooking, or processing of foodstuffs [49,105]. Organic canned or frozen fruits and vegetables are alternatives to fresh fruits and vegetables for individuals concerned about pesticide residues. Most food preservation techniques minimize the loss of nutritive value and are safe and well standardized. One comparative analysis of fresh, frozen, and canned vegetables conducted by the University of Illinois found that canned foods are nutritionally equivalent to their fresh and frozen counterparts [106].

Hormone, sex steroid, and antibiotic treatment of livestock — Three major reasons why consumers choose organic foods are concerns about hormone supplementation and treatment with sex steroids and antibiotics used in conventional livestock farming [12].

●Hormones – Hormone injections, especially with bovine recombinant growth hormone (rBGH), are given to cows to increase milk yield by 10 to 15 percent [12]. Studies show that conventional milk does not contain significantly higher levels of bovine growth hormone (GH) compared with organic milk. In addition, 90 percent of bovine GH is destroyed by pasteurization. Bovine GH is biologically inactive in humans, so even if it were absorbed from drinking conventional milk, it would not be expected to cause adverse health effects [12].

●Sex steroids – Treatment of cattle with sex steroids accelerates the rate of growth and is an efficient way to increase meat yield. It has been postulated that ingested estrogen in food derived from sex hormone-treated animals may lead to earlier development of puberty. Limited studies have not supported this hypothesis in humans [12,107].

●Antibiotics – On conventional livestock farms, antibiotics are administered in nontherapeutic doses to enhance growth and prevent disease. Many of these antibiotics are identical or similar to antibiotic drugs given to humans [108]. One review suggests that the presence of antibiotic-resistant bacteria in nonorganic foods may be related to the routine use of antibiotics. Organic farming that prohibits the use of nontherapeutic antibiotics may contribute to a reduction in disease caused by drug-resistant organisms [12].

Limited information is available about the prevalence of these practices in conventional livestock farming in the United States or elsewhere. Use of therapeutic and prophylactic antibiotics in food animals appears to be widespread but not consistently documented [109,110]. Use of growth-promoting hormones (zeranol and trenbolone acetate) or sex steroids (estradiol, progesterone, and testosterone) is legal and common in the United States but not in the European Union. However, illegal use of these and other growth-promoting compounds may be common in the European Union [111,112].

Microbial infection — The overall risk of bacterial contamination is similar in conventional compared with organic foods, although the risk of contamination with bacteria resistant to multiple antibiotics is higher in conventional foods [68].

Microbial infection is the main cause of food-related illness. Young children are particularly vulnerable because of the immaturity of their immune systems [113-115]. Shiga toxin-producing Escherichia coli, Salmonella, Listeria monocytogenes, and Campylobacter jejuni are the major pathogens of foodborne illness [114]. Illness caused by E. coli O157:H7 has been linked to fresh-pressed apple juice and cider [4,116]. An increasing number of major foodborne disease outbreaks have been linked to consumption of fecal contamination of fresh or minimally processed produce [16,115,117-119]. (See "Causes of acute infectious diarrhea and other foodborne illnesses in resource-abundant settings".)

Foods can become contaminated by fertilization with raw manure, irrigation of crops with contaminated water, or inadvertent contact with fecal matter during handling or processing. Pasteurization, canning, and freezing help to prevent illness caused by E. coli, Salmonella, L. monocytogenes, and Campylobacter contamination [120]. The prevention of foodborne illness requires safe food-handling practices for both organic and conventional foods. These measures include (table 1):

●Thoroughly cooking meat

●Storing foods at appropriate temperatures

●Preventing cross-contamination from meats and poultry to other foods

●Keeping hands, tools, and kitchen surfaces clean

Natural toxins — Some foods, whether organically or conventionally grown, contain naturally occurring toxins: aflatoxins in peanuts and grains, solanine in green parts of potatoes, goitrogens in some raw vegetables, and other poisons in mushrooms and herbs [16]. Most of these naturally occurring toxins are harmless when eaten in small amounts as part of a healthy diet [16]. As with pesticides, "poison" is a matter of dose.

OTHER PURPORTED HEALTH BENEFITS

Nutrition — There is little evidence that organic foods have higher nutritional quality than conventionally produced foods [2,4,6,121]. Advocates of organic foods claim that organically grown foods are nutritionally superior to foods grown with conventional agriculture methods that use chemical fertilizers [1,19,122,123]. Many people believe that commercial fertilizers lack some nutrients that are present in "natural" organic fertilizers. They argue that "natural" fertilizers are better able to nourish plants and thus result in more nutritious foods [16].

However, there is little support for these claims for the following reasons:

●The nutrient content of a plant is determined by several factors, including the genetic makeup, climate and soil conditions, maturity at harvest, storage, and distribution time [124,125]. Nitrogen, potassium, and phosphorous, the main soil nutrients required by crops, must be present in sufficient amounts for plants to grow [126]. Fertilization enriches soil by providing the necessary nutrients. It does not matter whether organic or synthetic fertilizers are used as long as all of the essential nutrients are provided [126]. Synthetic fertilizers are formulated to meet this requirement. Organic fertilizers may or may not. Organic fertilizers (typically manure) must be converted to soluble mineral salts by soil bacteria before they can be utilized by plants [126]. Manure breakdown cannot be synchronized with crop growth. In addition, the nutrient benefit of manure is unpredictable because its composition varies [127].

●Nutrient-deficient soil affects crop yields to a greater extent than it affects nutritional value [125]. The nutritional content of organically and conventionally grown foods usually is similar regarding carbohydrate or vitamins and minerals [12,68,128]; however, organic vegetables may have lower nitrate and protein content than conventionally grown foods [4,129-131]. In general, organic meats are higher in total polyunsaturated fatty acids (PUFA) and omega-3 (n-3) PUFA compared with conventional meats, although these comparisons are somewhat limited because of sample heterogeneity [132].

●The nutritional composition of milk and dairy products may vary because of dietary components of feed, time of year, and whether the farms are conventional or organic. However, milk produced by both organically and conventionally reared cows has similar protein, vitamin, total lipids, and trace mineral content [12]. One study in England comparing milk obtained from conventional and organic farms found that organic milk had significantly higher levels of total PUFA (including conjugated linoleic acid and аlpha-linolenic acid), very long-chain n-3 PUFA (eicosapentaenoic acid, docosapentaenoic acid) and docosahexaenoic acid, alpha-tocopherol, and iron, but lower iodine and selenium concentrations [133,134].

Allergy — Consumption of organic foods probably has no effect on the development of atopic disease. One observational study and two systematic reviews that included this study found no overall association between consumption of organic foods during the first year of life and atopic disease [68,135,136]. However, a subgroup analysis suggested that consumption of organic dairy products is associated with a modestly lower risk for eczema as compared with consumption of conventional dairy products [135]. The authors speculate that this protective effect might be due to the antiinflammatory effects of n-3 fatty acids, which are found at higher levels in organic dairy products as compared with conventional dairy products. Because these studies are observational, these findings might be due to other elements of the diet or environment that were not included in the analysis. Conflicting evidence comes from another study that indicated that organic food consumption might be associated with increased odds of food allergy later in childhood [137].

Metabolic syndrome — Limited data suggest an inverse association between a diet based largely on organic foods and the metabolic syndrome. The most useful information comes from the NutriNet–Sante study, which is an observational study of diet and markers of metabolic health in more than 8000 French adults [138]. Higher organic food consumption was associated with a lower probability of having the metabolic syndrome, even after adjusting for body mass index (BMI). The negative association persisted after adjusting for diet quality, sociodemographic, and lifestyle variables. A similar negative association was found for consumption of organic products from plant-based foods and dairy (fruits and vegetables, starchy foods, whole-grain products, oil, eggs, and dairy products) but not for organic sources of seafood, meat, poultry, and processed meat. Higher organic food consumption was associated with lower fasting blood glucose, serum triglycerides, waist circumference, and systolic and diastolic blood pressure in the individuals who were not taking medications for these related disorders. A separate report from the same study population found a negative association between organic food consumption and obesity [139]. Similarly, an additional study found a small negative association between organic food consumption and both BMI and obesity across the lifespan [140]. This association remained significant even after controlling for several confounding variables such as socioeconomic status and quality of the diet and physical activity.

Because of their observational nature, these studies cannot establish a causal association between consumption of organic foods and improved metabolic health. Moreover, even if the association is causal, the mechanism is unclear since a diet of organic foods tends to have more favorable nutrition profile (eg, greater proportion of fruits and vegetables), in addition to lower pesticide exposure.

Cancer — Very limited evidence suggests a possible association of organic rather than conventionally grown foods and cancer prevention. One large study in adults suggests that consumption of conventionally grown foods (which were assumed to have higher pesticide residues) is associated with a slightly increased risk of certain cancers [141]. (See "Healthy diet in adults", section on 'Organic diet'.)

In addition, indirect evidence suggests that exposure to pesticides may be associated with increased risks for certain cancers during childhood. However, most of this evidence is for exposure in utero or through occupational exposures to the parents or caregivers. (See 'Adverse effects' above.)

SOCIETY GUIDELINE LINKS — Links to society and government-sponsored guidelines from selected countries and regions around the world are provided separately. (See "Society guideline links: Healthy diet in children and adolescents".)

SUMMARY AND RECOMMENDATIONS

●Definition – "Organically grown" refers to the methods used to grow and process agricultural products (eg, fruits, vegetables, dairy, meat, and poultry) and is not related to nutritional quality or food safety (see 'Labeling requirements' above). Factors to consider when deciding whether to use organic products include:

●Pesticide exposure

•Organic foods typically contain smaller amounts of synthetic pesticide residues than are present on conventionally grown foods. Thus, organically grown foods provide an alternative source of fruits and vegetables for individuals who are concerned about synthetic pesticides. Exposure to pesticide residue in either organic or conventionally grown food can also be reduced through washing, peeling, cooking, or processing of foods and trimming fats or skin from meats, poultry, and fish. (See 'Methods to reduce exposure to pesticides' above.)

•In general, the traces of pesticide residue that are found in conventionally grown food pose little threat to human health. However, fetuses, infants, and children may be more susceptible to the adverse effects of pesticides than are adults. (See 'Exposure in utero' above and 'Exposure in childhood' above.)

•Populations involved in agricultural work have higher levels of pesticide exposure, but, in most well-regulated agricultural settings, there is little definite evidence of adverse effects of such exposure levels. (See 'Exposure in utero' above and 'Exposure in childhood' above.)

•Pesticides help to maintain an abundant and varied food supply. Pesticide use is regulated by the United States Environmental Protection Agency (EPA) and enforced by the United States Department of Agriculture (USDA) and the US Food and Drug Administration (FDA). Efforts are being made to ensure that these regulations are appropriate for infants and children. (See 'Benefits' above and 'Pesticide regulation' above.)

●Hormones and antibiotics

•Limited evidence suggests that the presence of antibiotic-resistant bacteria in conventionally grown (nonorganic) foods may be related to the routine use of antibiotics in livestock production. Because organic farming prohibits nontherapeutic antibiotics, it may reduce the risk of disease attributed to organisms that are resistant to multiple antibiotics. (See 'Hormone, sex steroid, and antibiotic treatment of livestock' above.)

•It has been postulated that ingested estrogen in food derived from sex hormone-treated animals may lead to earlier development of puberty, but limited studies have not supported this hypothesis in humans. (See 'Hormone, sex steroid, and antibiotic treatment of livestock' above.)

●Microbial infection – Organic food production does not eliminate the risk of foodborne illness, and "organic" should not be interpreted as meaning "safe." To reduce risks, make sure that apple juice and cider are pasteurized to reduce the risk of foodborne illness such as Shiga toxin-producing Escherichia coli. (See 'Microbial infection' above.)

●Nutrition – There is no evidence that organic foods have higher nutritional quality than conventionally produced foods. Both organic and conventional farming supply nutritious foods when selected as part of a well-balanced diet, which should be rich in fruits and vegetables. (See 'Nutrition' above.)

●Other benefits – Organic farming is typically performed by smaller, family-owned farms and may be more environmentally friendly.

ACKNOWLEDGMENT — The UpToDate editorial staff acknowledges Kathleen J Motil, MD, PhD, who contributed to earlier versions of this topic review.