Date of download: 6/2/2016 From: Are Organic Foods Safer or Healthier Than Conventional Alternatives?: A Systematic Review Ann Intern Med. 2012;157(5):348-366.

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Date of download: 6/2/2016 From: Are Organic Foods Safer or Healthier Than Conventional Alternatives?: A Systematic Review Ann Intern Med. 2012;157(5): doi: / Summary of evidence search and selection. * Three studies reported on human diets and on the foods themselves. Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

Date of download: 6/2/2016 From: Are Organic Foods Safer or Healthier Than Conventional Alternatives?: A Systematic Review Ann Intern Med. 2012;157(5): doi: / Selected characteristics of included studies. The top panel presents the characteristics of the included human studies. Seventeen publications compared the human health effects of consuming organic vs. conventional food. Three publications report data from the same population and are counted only once in the figure. Hence, the number of studies sums to 14. The bottom panel presents the characteristics of the 223 included studies of food. IRB = institutional review board. Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

Date of download: 6/2/2016 From: Are Organic Foods Safer or Healthier Than Conventional Alternatives?: A Systematic Review Ann Intern Med. 2012;157(5): doi: / Organic standards used for studies of produce and animal products. Sixty-five produce studies and 37 studies of animal products reported the organic standard applied. EEC = European Economic Community; IFOAM = International Federation of Organic Agriculture Movements; USDA = U.S. Department of Agriculture. Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

Date of download: 6/2/2016 From: Are Organic Foods Safer or Healthier Than Conventional Alternatives?: A Systematic Review Ann Intern Med. 2012;157(5): doi: / RD of detecting any pesticide residues in organic and conventional fruits, vegetables, and grains. All studies sampled food from retail or wholesale settings except Hoogenboom and colleagues (159), which sampled directly from farms. Tasiopoulou and colleagues (263) did not specify the study design, but because the testing was part of a governmental monitoring program, we assume that samples were obtained from retail or wholesale settings, similar to the other government monitoring programs (75, 79, 231). We used a continuity correction of 0.5 (half a sample contaminated) for studies with 0 counts to allow RDs to be calculated. Removal of studies with 0 cells did not change results (see Appendix). All RDs are absolute RDs. Summary P values are adjusted P values. Funnel plots did not suggest publication bias, and results were robust to removal of 1 study at a time. RD = risk difference. Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

Date of download: 6/2/2016 From: Are Organic Foods Safer or Healthier Than Conventional Alternatives?: A Systematic Review Ann Intern Med. 2012;157(5): doi: / RD of detecting Escherichia coli in organic and conventional fruits, vegetables, and grains. All RDs are absolute RDs. Summary P value is an adjusted P value. Funnel plot did not suggest publication bias. Removal of 1 study (225) rendered results significant, suggesting higher contamination among organic produce (RD, 5.1% [95% CI, 2.92% to 7.18%]; P < 0.001; I 2 = 0%). All studies sampled foods directly from farms, except Bohaychuk and colleagues (90), which sampled produce purchased in retail settings. RD = risk difference. Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

Date of download: 6/2/2016 From: Are Organic Foods Safer or Healthier Than Conventional Alternatives?: A Systematic Review Ann Intern Med. 2012;157(5): doi: / RD for contamination of organic and conventional meat products with bacterial pathogens. Meat samples were obtained from retail stores, milk samples were raw milk obtained from farms, and all egg samples were obtained directly from farms. Risk difference is calculated as the risk for contamination in the organic group minus that in the conventional group; thus, a positive (negative) number indicates more (less) contamination in organic products. All RDs are absolute RDs. Summary effect measures reported are results of random-effect models. I 2 >25% suggests heterogeneity. Summary P values are adjusted P values. Funnel plots did not suggest publication bias, and results were robust to removal of 1 study at a time. All studies sampled products from retail or wholesale settings with 4 exceptions: Lestari and colleagues (181), Hellstrom and colleagues (152), Garmo and colleagues (130), and Schwaiger and colleagues (250, 251) sampled foods obtained directly from farms. Results for Salmonella in pork (282) are not reported in this figure because the authors reported only median prevalence of contamination. RD = risk difference. Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

Date of download: 6/2/2016 From: Are Organic Foods Safer or Healthier Than Conventional Alternatives?: A Systematic Review Ann Intern Med. 2012;157(5): doi: / RD for isolating antibiotic-resistant bacteria in selected analyses. Risk difference is calculated as the risk for contamination in the organic group minus that in the conventional group; thus, a positive (negative) number indicates more (less) contamination in the organic group. All RDs are absolute RDs. Summary P values are adjusted P values. The number of antibiotics tested in the included studies ranged from 8 to 15 (median, 9.5). All summary effect measures reported are results of random-effects models. Funnel plots did not suggest publication bias. All studies sampled food purchased in retail settings except Lestari and colleagues (181), which sampled animal products obtained directly from farms. The top panel shows the difference in risk for detecting Escherichia coli, Salmonella species, and Enterobacteriaceae resistance to at least 3 antibiotics in organic vs. conventional chicken and pork. One study (50) examined drug resistance patterns for 3 organisms (E. coli, Listeria, and Staphylococcus aureus) identified on organic and conventional products. To avoid entering the same study twice in the analyses, we included only the resistance patterns reported for E. coli. However, in sensitivity analysis, we included the results for Listeria instead of E. coli. The results did not substantially change. Two studies (52, 53) reported antibiotic resistance patterns for different bacteria (Enterobacteriaceae[53] and Enterococcus species [52]) obtained from the same population of retail packaged chicken. To avoid entering the same chickens in the synthesis twice, we included Enterobacteriaceae results in the syntheses (reported above) because it is the family to which E. coli and Salmonella belong. In sensitivity analysis, we used the Enterococcus results, which did not substantially change findings. Results were robust to removal of 1 study at a time from summary effect estimate. The bottom panel shows the difference in risk for detecting E. coli, Salmonella species, and Enterobacteriaceae resistance to ampicillin in organic vs. conventional chicken and pork. The result was not robust to removal of 1 study at a time from summary effect estimate. RD = risk difference. Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

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