Pesticide exposure has been linked to chronic health harms, yet the effects of cumulative dietary exposure to pesticide mixtures are poorly understood. A pesticide load index was created to rank produce based on pesticide contamination from national pesticide residue testing data for 44 produce types, primarily collected from 2013 to 2018. Three indices were created utilizing different indicators of pesticide contamination and toxicity. Dietary pesticide exposure scores for 1837 individuals were calculated based on produce consumption from the 2015–2016 National Health and Nutrition Examination Survey (NHANES). Covariate-adjusted weighted linear regressions were used to estimate the change in average pesticide biomarker rank relative to dietary pesticide exposure scores. Pesticide load indices were calculated based on detections of 178 unique parent pesticides, or 42 parent pesticides with matched urinary biomarkers in NHANES. Increasing dietary pesticide exposure scores were not associated with average pesticide biomarker rank (β [95 % CI] = 0.02 [-0.34, 0.38]) and were consistent across scores that utilized the different indices. Matching pesticides in food and urine, results in a slightly stronger association (β [95 % CI] = 0.09 [-0.32, 0.51]). Excluding potatoes resulted in a positive significant association (β [95 % CI] = 0.75 [0.35, 1.14]). When excluding potatoes, consumption of fruits and vegetables weighted by pesticide contamination was associated with higher levels of urinary pesticide biomarkers for organophosphate, pyrethroid, and neonicotinoid insecticides. Future research could use this methodology, with the recommendation to exclude potatoes, to assess the impact of dietary pesticide exposure on health outcomes.

Dietary pesticide exposure

Pesticide residues

Pesticide biomarkers

Pesticide load index

Biomonitoring

Cumulative risk assessment

© 2025 The Authors. Published by Elsevier GmbH.