High concentrations of essential and toxic elements in infant formula and infant foods - A matter of concern

Selenium content in milk and dairy products: Estimation of the daily intake and assessment of the potential risk to public health

In this study, selenium levels in milk (n = 19), cheese (n = 49), yogurt (n = 13) and ayran (n = 8) of different brands sold in Türkiye were first determined by inductively coupled plasma mass spectrometry. The daily selenium intake resulting from the consumption of these foods was then calculated and evaluated with non-carcinogenic health risk. Selenium levels ranged from 9 - 32 and 1- 83 μg/L for milk and ayran, respectively, and from 0 - 224 and 12- 172 μg/kg for cheese and yogurt, respectively. The total daily selenium intake of persons aged 15> (general population) was determined to be 20.4 μg/day (0.292 μg/kg bw/day). The foods contributing most to the total daily selenium intake for all individuals in the same age group were yogurt (51.4 %), ayran (25.7 %), cheese (20.2 %) and milk (2.7 %). For individuals aged 15> (general population), the Target Hazard Quotient values resulting from the consumption of each food (milk, cheese, yogurt and ayran) and the Hazard Index value calculated by consuming all foods together (0.058) were less than 1. This study was detected any health risks related to selenium intake. This study was the first to evaluate health risks of selenium intake from consumption of some milk and dairy products in adult individuals.

Mineral Profile of Infant Formulae in the Las Vegas market: Compliance with label and regulations, contribution to dietary reference intakes and method comparison

To date, there are few studies concerning determination of minerals in infant formulae intended to survey compliance of manufacturer claims and compliance with regulations. In this study, we collected infant formulae from the Las Vegas market to investigate the levels of Na, Mg, K, Mn, Fe, and Zn using inductively coupled plasma mass spectrometry (ICP-MS) following hot block-assisted digestion. Within analytical uncertainty, infant formula samples met label claims for Na, Mg, K, Fe, and Zn and were within the United States Food and Drug Administration (FDA) regulations. Estimated daily intakes (EDIs) of analyzed minerals from consumption of different types of infant formulae were: (158-316) mg d-1 for Na, (42.5-63.8) mg d-1 for Mg, (618-1025) mg d-1 for K, (0.006-0.345) mg d-1 for Mn, (4.79-16.6) mg d-1 for Fe and (4.11-8.88) mg d-1 for Zn. Except for Zn, the levels of other elements conform to currently recommended dietary reference values. In this study we also evaluated the accuracy of portable X-Ray Fluorescence (pXRF) for measuring Zn and Fe in infant formula. Bland-Altman analysis indicates that pXRF can be applied as a reliable technique for determination of Zn and Fe in infant formula.

Urinary concentrations of non-essential and essential elements during weaning in infants from the NELA cohort in Spain

Infancy is a period of continuous growth and development, where inadequate intake of essential elements and exposure to non-essential elements may have lifelong health consequences. Thus, the aim of this study is to evaluate the urine concentration of essential and non-essential elements as a proxy for internal exposure during the weaning period, from 3 to 18 months of age. The Nutrition in Early Life and Asthma (NELA) birth cohort generated the data for this study. Sociodemographic, dietary, and urine concentration of essential (Co, Cu, Mo, I, Fe, Mn, Se, Zn, and Ni) and non-essential elements (Al, V, As, Cd, Sb, Tl, and Pb) data were available for 490 participants at 3 months of age and 216 participants at 18 months of age. Paired urine samples at both time periods were available for 175 infants. At 3 months of age, exclusively breastfed infants had lower urine concentrations of Al, V, Fe, Co, Se, Sb, and Tl. Notably, the concentration of Mo had a median (IQR) of 0.60 (0.40-2.10) μg/L compared to a median (IQR) of 39.80 (25.00-56.40) μg/L observed in infants exclusively fed with formula. When we analyzed the change in urine elements concentrations between 3 and 18 months of age, we observed increased As (0.75 vs. 18.60 μg/L), Co (0.05 vs. 0.24 μg/L), Mo (1.98 vs. 50.0 μg/L), Pb (0.15 vs. 0.69 μg/L), Se (11.3 vs. 23.1 μg/L), Tl (0.02 vs. 0.11 μg/L), and V (0.05 vs. 0.11 μg/L). For Cu, lower urine concentrations were observed at 18 months of age in comparison with concentrations at 3 months (5.77 vs. 4.41 μg/L). Among the main food items identified as driving the changes in urine concentration between 3 and 18 months of age were white fish, rice and pasta, potato chips, custard, small blue fish, and legumes. Exclusively breastfed infants showed lower exposure to non-essential elements compared to those who were fed with a mixture or formula. With the introduction of solid foods, the exposure to some non-essential elements increased drastically, as in the case of As and Pb. In addition, exposure to the essential metal Mo also increased substantially with the introduction of solid food.

Dietary Intake and Exposure Assessment of Trace Elements in Infants' Diets: A Case Study in Kuwait

Different types of infant foods categorized as formulas, cereals, and purees imported from seven different countries and available on the Kuwaiti retail market were collected to determine the elemental content, including essential trace elements namely chromium (Cr), manganese (Mn), iron (Fe), copper (Cu), zinc (Zn), selenium (Se), and molybdenum (Mo); potentially toxic trace elements such as aluminum (Al), nickel (Ni), tin (Sn), antimony (Sb), and uranium (U); and toxic trace elements including arsenic (As), lead (Pb), cadmium (Cd), and mercury (Hg). The samples were analyzed using ICP-MS. An extensive literature search illustrated the uniqueness of this study since seven different essential elements, five different potentially toxic elements, and four different toxic trace elements were measured in a variety of infant foods; in addition, the different trace etlemental levels measured in the investigated infant foods were compared to the ones associated with the different infant foods types reported in the literature. The essential trace element concentrations detected in this study were implemented to calculate their total daily intake, where the calculated daily intake values were compared to their recommended dietary allowance (RDA) to assess the percentage total daily intake for the essential trace elements. Further, the calculated potentially toxic and toxic trace elements daily intake values were used to assess the potential health risks to infants incurred by consuming different infant foods by calculating the hazard quotient (HQ), while the margin of exposure (MOE) was calculated for the toxic ones only. It was concluded that infant formulas and foods should be added to the infant diet in addition to breast milk to meet specific nutritional needs. This study confirms that infants are exposed to toxic trace elements via diet, warranting careful attention to diet choices both to limit this exposure and to avert potentially hazardous adverse health effects to the infants. However, based on the calculated hazard quotients (HQs) and margin of exposures (MOEs), consuming breast milk in addition to almost all different types of infant foods is considered safe and unlikely to contribute to infants' non-cancerous health hazards.

Quantitative determination of selected elements in infant baby formulae and baby food cereals commercially available in Serbia using the ICP OES method

The aim of this paper was the quantitative determination of some macro and trace elements, especially potentially toxic elements in the samples of infant baby formulae and baby food cereals commercially available in Serbia using the inductively coupled plasma optical emission spectrometry (ICP OES) method. Among the macro elements, K is the most abundant in all infant formulae samples, followed by Ca, P, Na and Mg. On the other hand, the analysis of food cereals showed that P is presents in the highest contents, followed by K, Ca, Na, and Mg. Potentially toxic elements As, Pb, Hg, and Cd were not detected in any sample of infant formulae, while Cd was detected and quantified in cereal foods. Also, the calculated values of Estimated Tolerable Weekly Intake (ETWI) as well as the Estimated Tolerable Monthly Intake (ETMI) were lower than recommended values for a tolerable weekly intake (TWI) and provisional tolerable monthly intake (PTMI).

Elemental composition of toxic and essential elements in rice-based baby foods from the United States and other countries: A probabilistic risk analysis

Consumption of rice-based foods provides essential nutrients required for infants and toddlers' growth. However, they could contain toxic and excess essential elements that may affect human health. The study aims to determine the composition of rice-based baby foods in the USA and outside and conduct a multiple-life stages probabilistic exposure and risk assessment of toxic and essential elements in children. Elemental concentrations were measured using Inductively Coupled Plasma Mass Spectrometry (ICP-MS) in thirty-three rice-based baby foods. This includes 2 infant formulas, 11 rice baby cereals, and 20 rice snacks produced primarily in the United States, China, and other countries. A probabilistic risk assessment was conducted to assess risks of adverse health effects. Results showed that infant formula had higher median concentrations of selenium (Se), copper (Cu), zinc (Zn), sodium (Na), magnesium (Mg), calcium (Ca), and potassium (K) compared to rice baby cereal and rice snacks. On the contrary, rice snacks had the highest median concentration of Arsenic (As) (127 μg/kg) while rice baby cereals showed the highest median concentration of Cd (7 μg/kg). A higher lifetime estimated daily intake was observed for samples manufactured in the USA compared to those from China and other countries. Hazard quotient (HQ < 1) values were suggestive of minimal adverse health effects. However, lifetime carcinogenic risk analysis based on total As indicated an unacceptable cancer risk (>1E-04). These findings show a need for ongoing monitoring of rice-based foods consumed by infants and toddlers as supplementary and substitutes for breast milk or weaning food options. This can be useful in risk reduction and mitigation of early life exposure to improve health outcomes.

Essential and Toxic Elements in Infant Cereal in Brazil: Exposure Risk Assessment

Infant cereals, one of the first solid foods introduced to infants, have been reported to pose risks to human health because they contain toxic elements and an excess of essential elements. The objective of this study was to assess the cancer and non-cancer risk of exposure to essential and toxic elements in infant cereal in Brazil. In our analyses, we included data from 18 samples of infant cereals made from different raw materials and estimated the incremental lifetime cancer risks and non-cancer hazard quotients (HQs) for their consumption. Rice cereal is particularly concerning because it is immensely popular and usually contains high levels of inorganic arsenic. In addition to arsenic, we assessed aluminum, boron, barium, cadmium, chromium, copper, lead, manganese, nickel, selenium, silver, strontium, and zinc. The cancer risk was highest for rice cereal, which was also found to have an HQ > 1 for most of the tested elements. Inorganic As was the element associated with the highest cancer risk in infant cereal. All of the infant cereals included in this research contained at least one element with an HQ > 1. The essential and non-essential elements that presented HQ > 1 more frequently were zinc and cadmium, respectively. The cancer and non-cancer risks could potentially be decreased by reducing the amount of toxic and essential elements (when in excess), and public policies could have a positive influence on risk management in this complex scenario.

Probabilistic risk assessment for determining nonessential metals in commercial infant formula products in Taiwan

During the early months of life, infant formula plays a crucial role as a primary source of both food and essential nutrients for infants, serving as a replacement for or supplement to breast milk. However, nonessential metals in infant formulas are a concern because infants are highly vulnerable to chemical exposure. The aim of this study was to investigate infant exposure to nonessential metals in infant formula products in Taiwan and assess the associated health risks. In this study, concentrations of arsenic (As), barium (Ba), cadmium (Cd), manganese (Mn), lead (Pb), and vanadium (V) in 45 formula products for 0-1-year-old infants were determined by inductively coupled plasma mass spectrometry. The mean As, Ba, Cd, Mn, Pb, and V concentrations were 6.42, 280, 3.72, 1425, 20.4, and 21.9 µg/kg, respectively. According to our probabilistic simulation of the estimated daily intake of metals, the proportion of hazard quotients exceeding one was 7.69% for As and 3.29% for Mn, and that of hazard index (HI) values exceeding 1 was >17% for metals. Arsenic had the largest HI contribution (46.9%), followed by Mn (22.3%) and Pb (12.7%). The nonessential metals content in infant formula raises potential noncarcinogenic health concerns for infants in Taiwan. Therefore, regulations for nonessential metals must be imposed on related food products in Taiwan, with a particular focus on As and Mn.

Iron minerals: A frontline barrier against combined toxicity of microplastics and arsenic

The coexistence of microplastics (MPs) and arsenic (As) in terrestrial ecosystems presents challenges to controlling soil pollution and performing environmental risk assessments. In this study, the interactions among As, polystyrene MPs, and goethite in porous media were investigated and the individual and combined toxicities of MPs and As on wheat germination were evaluated. An additional experiment was conducted to assess the mitigating effect of goethite on the toxicity of the two contaminants. The results showed that the presence of MPs reduced As accumulation in wheat and decreased the acute lethal toxicity of As pollutants (the half-lethal concentration of As during wheat germination increased by 68.21%). However, MPs exhibited inhibitory effects on wheat germination and served as carriers to promote the migration of As within the plant body. The addition of goethite mitigated both individual and combined toxicities and further increased the half-lethal concentration for the combined pollution of As and MPs by 39.48%. This was primarily attributed to the adsorption and immobilization of arsenate and MPs on the medium and root surfaces. In our study, goethite reduced soluble As by 48.29% under the combined pollution scenarios and formed iron plaques on wheat roots, effectively obstructing pollutant entry. Thus, iron minerals serve as pioneering barriers to combined toxicity. Our findings contribute to the understanding of the combined toxicity of MPs and As in crops and offer potential strategies for managing combined pollution.

Urinary biomarkers of exposure to toxic and essential elements: A comparison of infants fed with human milk or formula

Background

Early-life exposure to nonessential (toxic) and essential trace elements can influence child development. Although infant formula powders and the water used to reconstitute them can contain higher concentrations of many elements compared with human milk, the influence of feeding mode on reliable biomarkers of infant exposure has rarely been demonstrated.

Methods

We evaluated associations between urinary biomarkers and feeding mode (exclusively human milk, exclusively formula, or combination-fed) for four toxic (arsenic, cadmium, nickel, and uranium) and three essential elements (cobalt, molybdenum, and selenium) using general linear models.

Results

A total of 462 participants from the rural New Hampshire Birth Cohort Study were on average 6 weeks old between July 2012 and March 2019 and had urine samples, 3-day food diaries, and relevant covariate data available. In adjusted models, urinary arsenic was 5.15 (95% confidence interval = 4.04, 6.58), molybdenum was 19.02 (14.13-25.59), and selenium was 1.51 (1.35-1.68) times higher in infants fed exclusively with formula compared with infants fed exclusively with human milk. By contrast, urinary uranium was 0.59 (0.46-0.75) and cobalt was 0.78 (0.65-0.95) times lower with formula feeding than human milk feeding.

Conclusion

Our findings suggest that infant exposure to several potentially toxic elements varies by feeding mode, as concentrations of reliable urinary biomarkers were higher with formula or human milk, depending on the element. Importantly, exposure to arsenic increased with household tap water arsenic regardless of feeding mode, suggesting that all infants could be at risk in populations with high concentrations of arsenic in drinking water.

Associations of Perinatal Metal and Metalloid Exposures with Early Child Behavioral Development Over Time in the New Hampshire Birth Cohort Study

Research on the neurodevelopmental effects of metal(loid)s has focused mainly on outcomes assessed at one time point, even though brain development progresses over time. We investigated biomarkers of perinatal exposure to metals and changes in child behavior over time. We followed 268 participants from the prospective New Hampshire Birth Cohort Study between birth and age 5 years. We measured arsenic (As), copper (Cu), manganese (Mn), lead (Pb), selenium (Se), and zinc (Zn) in toenails from 6-week-old infants. The Behavioral Symptoms Index (BSI), externalizing, and internalizing symptoms were assessed using the Behavior Assessment System for Children, 2nd edition (BASC-2) at ages 3 and 5 years. Multivariable linear regression was used to estimate associations of metals with behavior change, calculated as the difference in symptom raw scores between 3 and 5 years, in addition to the associations for symptom scores at 3 and 5 years separately. Sex-specific associations were also explored using stratified models and a sex-metal interaction term. Adjusted associations of metals and change in behavior varied by exposure and outcome. Each 1 μg/g increase in ln toenail Cu was associated with improved behavior between 3 and 5 years [BSI: β = - 3.88 (95%CI: - 7.12, - 0.64); Externalizing problems: β = - 2.20 (95%CI: - 4.07, - 0.33)]. Increasing Zn was associated with increased externalizing behavior over time (β = 3.42 (95%CI: 0.60, 6.25). Sex-stratified analyses suggested more pronounced associations among boys compared to girls. Perinatal exposure to metals may alter behavioral development between ages 3 and 5 years. Findings support the need for more research on associations between metals and neurodevelopment over longer time periods.

Manganese - a scoping review for Nordic Nutrition Recommendations 2023

Manganese is an essential trace element that is required for multiple enzymes in the human body. The general population is mainly exposed to manganese via food intake, in particular plant foods. In areas with elevated concentrations of manganese in groundwater, drinking water can also be an important source of exposure. The gastrointestinal absorption of manganese is below 10%, and it appears to be influenced by the amount of manganese in the diet and by the nutritional status of the individual, especially the iron status. In blood, most of the manganese is found in the cellular fractions. Manganese is primarily eliminated via the bile followed by excretion via faeces. To date, no specific biomarkers of manganese intake have been identified. The dietary intake of manganese in the Nordic countries has been reported to be within the range that has been reported for other European countries (2-6 mg/day). Since manganese is found in nutritionally adequate amounts in food, deficiency is not of public health concern. On the other hand, there is emerging epidemiological evidence that various suggested manganese biomarkers may be negatively associated with children's neurodevelopment. However, the limited number of prospective studies, the lack of appropriate exposure biomarkers, and validated neurodevelopmental outcomes render data uncertain and inconclusive. In 2013, the European Food Safety Authority considered the evidence to be insufficient to derive an average requirement or a population reference intake, and instead an adequate intake for adults was set at 3.0 mg/day.

Assessing heavy metal levels in pediatric enteral nutrition formulas available in the Turkish market: Implications for consumer health

In this study, we assessed the levels of lead (Pb), cadmium (Cd), mercury (Hg), and inorganic arsenic (iAs) in 27 pediatric enteral nutrition (EN) formulas from five international brands available in the Turkish market. Analysis was conducted using inductively coupled plasma mass spectrometry (ICP-MS). Non-carcinogenic and carcinogenic risk assessment was performed using hazard quotient (HQ), hazard index (HI), carcinogenic risk (CR), Toxicological contribution % of Provisional Tolerable Weekly Intake (PTWI) models. Our objective was to evaluate heavy metal exposure in EN formulas, specifically focusing on Cd, Pb, iAs, and Hg levels according to recommended amounts for different age groups based on their energy requirements. Average concentrations of iAs in polymeric (PC), oligomeric (OC), and monomeric (MC) EN formulas were as follows: PC: 2.13 ± 0.16 ( Collapse

Key Words

• Carcinogenic risk
• Enteral nutrition formula
• Hazard quotient
• Health risk assessment
• Heavy metal

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MESH Headings

• Female
• Child
• Humans
• Male
• Cadmium/analysis
• Enteral Nutrition
• Lead
• Metals, Heavy/analysis
• Mercury/analysis
• Risk Assessment

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Grants Collapse

Affiliation(s)

Gursel Isci Department of Nutrition and Dietetics, Faculty of Health Sciences, Agri Ibrahim Cecen University, 04100, Agri, Turkey.
Betul Orucoglu Department of Nutrition and Dietetics, Faculty of Health Sciences, Afyonkarahisar Health Sciences University, 03100, Afyonkarahisar, Turkey.
Merve Ekici Department of Nutrition and Dietetics, Faculty of Health Sciences, Agri Ibrahim Cecen University, 04100, Agri, Turkey; Department of Nutrition and Dietetics, Institute of Health Sciences, Acıbadem Mehmet Ali Aydınlar University, 34758, Istanbul, Turkey.

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Selenium in selected samples of infant formulas and milk commercialized in Belgium and Brazil: Total content, speciation and estimated intake

Total selenium (Se) and Se species concentrations were determined in 50 infant formulas and milk samples commercialized in Brazil and Belgium. Infant formula categories were starter, follow-up, specialized and plant-based (soy and rice), while milk samples included whole, skimmed, semi-skimmed and plant-based products. Total Se content was determined by Inductively Coupled Plasma Mass Spectrometry (ICP-MS), after microwave digestion. An enzymatic extraction method was applied to evaluate the Se species, mostly selenomethionine (SeMet), Se(IV) and Se(VI), through High Performance Liquid Chromatography coupled to ICP-MS (LC-ICP-MS). Starters and follow-up samples presented the highest total Se concentrations and values up to 30 µg/kg were observed in the reconstituted product. The lowest level (below the LOQ = 10 µg/kg) was verified in an anti-regurgitation specialized formula. The relative agreement between the measured total Se and the Se content declared on the label varied from 55 % to 317 %. Concentrations in infant formulas were not markedly different from concentrations in milk except for rice and oat milk samples that showed values below the LOQ. SeMet was the main species found in milks, while in infant formulas the species concentrations varied according to the product. The daily intake (DI) of Se via infant formula consumption was calculated and compared with the Adequate Intake (AI) value and the Dietary Reference Intake (DRI) established by the EFSA NDA Panel and ANVISA, respectively. Estimated maximum intakes of total Se obtained for reconstituted infant formula were 40.6 mg/day, corresponding to 400 % and 202 % of the DRI and AI, respectively.

Essential and Non-essential Trace Elements in Milks and Plant-Based Drinks

Although milk and plant-based drinks are widely consumed foodstuffs with high nutritional value, their consumption may also mean intake of non-essential/toxic elements becoming a risk for human health. This study was aimed at determining the concentrations of essential (Ca, Co, K, Mg, Mn, Na, Ni and P) and non-essential/toxic (Hg, Pb, U and V) elements in milks (cow and goat), plant-based drinks (soy, almond, rice and oat) and infant formulas from organic and conventional production systems. Lactose-free, fresh and ultra-high-temperature (UHT) milks were also included. Chemical analyses were performed by means of inductively coupled plasma-mass spectrometry (ICP-MS). The content of the elements hereby assessed did not depend on the production system and the presence of lactose. However, significant differences were found in the concentrations of multiple elements when comparing sterilization methods, source (animal vs. plant-based) and animal species. Non-essential elements were not detected in milks and plant-based drinks, excepting Pb, which was detected in three samples. While the consumption of goat milk is recommended, considering the global intake of essential elements and the absence of non-essential elements, further studies should be conducted to confirm the absence of non-target toxic elements at very low trace levels. On the other hand, the best plant-based drinks are those made up with almonds (intake of Ca) and soy (K and Mg). The current results should be useful to help the population to balance the benefits and risks from milks and plant-based drinks consumption, as well as to adapt their dietary habits.

Toxic Metals and Metalloids in Infant Formulas Marketed in Brazil, and Child Health Risks According to the Target Hazard Quotients and Target Cancer Risk

Children are highly vulnerable to chemical exposure. Thus, metal and metalloid in infant formulas are a concern, although studies in this regard are still relatively scarce. Thus, the presence of aluminum, arsenic, cadmium, tin, mercury, lead, and uranium was investigated in infant formulas marketed in Brazil by inductively coupled plasma mass spectrometry, and the Target Hazard Quotients (THQ) and Target Cancer Risk (TCR) were calculated in to assess the potential risk of toxicity for children who consume these products continuously. Aluminum ranging from 0.432 ± 0.049 to 1.241 ± 0.113 mg·kg-1, arsenic from 0.012 ± 0.009 to 0.034 ± 0.006 mg·kg-1, and tin from 0.007 ± 0.003 to 0.095 ± 0.024 mg·kg-1 were the major elements, while cadmium and uranium were present at the lowest concentrations. According to the THQ, arsenic contents in infant formulas showed a THQ > 1, indicating potential health risk concerns for newborns or children. Minimal carcinogenic risks were observed for the elements considered carcinogenic. Metabolic and nutritional interactions are also discussed. This study indicates the need to improve infant formula surveillance concerning contamination by potentially toxic and carcinogenic elements.

Arsenic in the water and agricultural crop production system: Bangladesh perspectives

The presence of high levels of carcinogenic metalloid arsenic (As) in the groundwater system of Bangladesh has been considered as one of the major environmental disasters in this region. Many parts of Bangladesh have extensively reported the presence of high levels of arsenic in the groundwater due to both geological and anthropogenic activities. In this paper, we reviewed the available literature and scientific information regarding arsenic pollution in Bangladesh, including arsenic chemistry and occurrences. Along with using As-rich groundwater as a drinking-water source, the agricultural activities and especially irrigation have greatly depended on the groundwater resources in this region due to high water demands for ensuring food security. A number of investigations in Bangladesh have shown that high arsenic content in both soil and groundwater may result in high levels of arsenic accumulation in different plants, including cereals and vegetables. This review provides information regarding arsenic accumulation in major rice varieties, soil-groundwater-rice arsenic interaction, and past arsenic policies and plans, as well as previously implemented arsenic mitigation options for both drinking and irrigation water systems in Bangladesh. In conclusion, this review highlights the importance and necessity for more in-depth studies as well as more effective arsenic mitigation action plans to reduce arsenic incorporation in the food chain of Bangladesh.

Dietary Exposure to Essential and Non-essential Elements During Infants' First Year of Life in the New Hampshire Birth Cohort Study

Even the low levels of non-essential elements exposure common in the US may have health consequences especially early in life. However, little is known about the infant's dynamic exposure to essential and non-essential elements. This study aims to evaluate exposure to essential and non-essential elements during infants' first year of life and to explore the association between the exposure and rice consumption. Paired urine samples from infants enrolled in the New Hampshire Birth Cohort Study (NHBCS) were collected at approximately 6 weeks (exclusively breastfed) and at 1 year of age after weaning (n = 187). A further independent subgroup of NHBCS infants with details about rice consumption at 1 year of age also was included (n = 147). Urinary concentrations of 8 essential (Co, Cr, Cu, Fe, Mn, Mo, Ni, and Se) and 9 non-essential (Al, As, Cd, Hg, Pb, Sb, Sn, V, and U) elements were determined as a measure of exposure. Several essential (Co, Fe, Mo, Ni, and Se) and non-essential (Al, As, Cd, Hg, Pb, Sb, Sn, and V) elements had higher concentrations at 1 year than at 6 weeks of age. The highest increases were for urinary As and Mo with median concentrations of 0.20 and 1.02 µg/L at 6 weeks and 2.31 and 45.36 µg/L at 1 year of age, respectively. At 1 year of age, As and Mo urine concentrations were related to rice consumption. Further efforts are necessary to minimize exposure to non-essential elements while retaining essential elements to protect and promote children's health.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12403-022-00489-x.

Health Safety Assessment of Ready-to-Eat Products Consumed by Children Aged 0.5-3 Years on the Polish Market

Toxic elements have a negative impact on health, especially among infants and young children. Even low levels of exposure can impair the normal growth and development of children. In young children, all organs and metabolic processes are insufficiently developed, making them particularly vulnerable to the effects of toxic elements. The aim of this study is to estimate the concentration of toxic elements in products consumed by infants and young children. The health risk of young children due to consumption of ready-made products potentially contaminated with As (arsenic), Cd (cadmium), Hg (mercury), and Pb (lead) was also assessed. A total of 397 samples (dinners, porridges, mousses, snacks "for the handle", baby drinks, dairy) were analyzed for the content of toxic elements. Inductively coupled plasma mass spectrometry (ICP-MS) was used to assess As, Cd, and Pb concentration. The determination of Hg was performed by atomic absorption spectrometry (AAS). In order to estimate children's exposure to toxic elements, the content of indicators was also assessed: estimated daily intake (EDI), estimated weekly intake (EWI), provisional tolerable weekly intake (PTWI), provisional tolerable monthly intake (PTMI), the benchmark dose lower confidence limit (BMDL), target hazard quotient (THQ), hazard index (HI), and cancer risk (CR). The average content of As, Cd, Hg, and Pb for all ready-made products for children is: 1.411 ± 0.248 µg/kg, 2.077 ± 0.154 µg/kg, 3.161 ± 0.159 µg/kg, and 9.265 ± 0.443 µg/kg, respectively. The highest content As was found in wafer/crisps (84.71 µg/kg); in the case of Cd, dinners with fish (20.15 µg/kg); for Hg, dinners with poultry (37.25 µg/kg); and for Pb, fruit mousse (138.99 µg/kg). The results showed that 4.53% of the samples attempted to exceed Pb, and 1.5% exceeded levels of Hg. The highest value of THQ was made in the case of drinks, for Cd and Pb in mousses for children, and Hg for dairy products. The THQ, BMDL, and PTWI ratios were not exceeded. The analyzed ready-to-eat products for children aged 0.5-3 years may contain toxic elements, but most of them appear to be harmless to health.

Provision of folic acid for reducing arsenic toxicity in arsenic-exposed children and adults

BACKGROUND

Arsenic is a common environmental toxin. Exposure to arsenic (particularly its inorganic form) through contaminated food and drinking water is an important public health burden worldwide, and is associated with increased risk of neurotoxicity, congenital anomalies, cancer, and adverse neurodevelopment in children. Arsenic is excreted following methylation reactions, which are mediated by folate. Provision of folate through folic acid supplements could facilitate arsenic methylation and excretion, thereby reducing arsenic toxicity.

OBJECTIVES

To assess the effects of provision of folic acid (through fortified foods or supplements), alone or in combination with other nutrients, in lessening the burden of arsenic-related health outcomes and reducing arsenic toxicity in arsenic-exposed populations.

SEARCH METHODS

In September 2020, we searched CENTRAL, MEDLINE, Embase, 10 other international databases, nine regional databases, and two trials registers.

SELECTION CRITERIA

Randomised controlled trials (RCTs) and quasi-RCTs comparing the provision of folic acid (at any dose or duration), alone or in combination with other nutrients or nutrient supplements, with no intervention, placebo, unfortified food, or the same nutrient or supplements without folic acid, in arsenic-exposed populations of all ages and genders.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane.

MAIN RESULTS

We included two RCTs with 822 adults exposed to arsenic-contaminated drinking water in Bangladesh. The RCTs compared 400 µg/d (FA400) or 800 µg/d (FA800) folic acid supplements, given for 12 or 24 weeks, with placebo. One RCT, a multi-armed trial, compared FA400 plus creatine (3 g/d) to creatine alone. We judged both RCTs at low risk of bias in all domains. Due to differences in co-intervention, arsenic exposure, and participants' nutritional status, we could not conduct meta-analyses, and therefore, provide a narrative description of the data. Neither RCT reported on cancer, all-cause mortality, neurocognitive function, or congenital anomalies. Folic acid supplements alone versus placebo Blood arsenic. In arsenic-exposed individuals, FA likely reduces blood arsenic concentrations compared to placebo (2 studies, 536 participants; moderate-certainty evidence). For folate-deficient and folate-replete participants who received arsenic-removal water filters as a co-intervention, FA800 reduced blood arsenic levels more than placebo (percentage change (%change) in geometric mean (GM) FA800 -17.8%, 95% confidence intervals (CI) -25.0 to -9.8; placebo GM -9.5%, 95% CI -16.5 to -1.8; 1 study, 406 participants). In one study with 130 participants with low baseline plasma folate, FA400 reduced total blood arsenic (%change FA400 mean (M) -13.62%, standard error (SE) ± 2.87; placebo M -2.49%, SE ± 3.25), and monomethylarsonic acid (MMA) concentrations (%change FA400 M -22.24%, SE ± 2.86; placebo M -1.24%, SE ± 3.59) more than placebo. Inorganic arsenic (InAs) concentrations reduced in both groups (%change FA400 M -18.54%, SE ± 3.60; placebo M -10.61%, SE ± 3.38). There was little to no change in dimethylarsinic acid (DMA) in either group. Urinary arsenic. In arsenic-exposed individuals, FA likely reduces the proportion of total urinary arsenic excreted as InAs (%InAs) and MMA (%MMA) and increases the proportion excreted as DMA (%DMA) to a greater extent than placebo (2 studies, 546 participants; moderate-certainty evidence), suggesting that FA enhances arsenic methylation. In a mixed folate-deficient and folate-replete population (1 study, 352 participants) receiving arsenic-removal water filters as a co-intervention, groups receiving FA had a greater decrease in %InAs (within-person change FA400 M -0.09%, 95% CI -0.17 to -0.01; FA800 M -0.14%, 95% CI -0.21 to -0.06; placebo M 0.05%, 95% CI 0.00 to 0.10), a greater decrease in %MMA (within-person change FA400 M -1.80%, 95% CI -2.53 to -1.07; FA800 M -2.60%, 95% CI -3.35 to -1.85; placebo M 0.15%, 95% CI -0.37 to 0.68), and a greater increase in %DMA (within-person change FA400 M 3.25%, 95% CI 1.81 to 4.68; FA800 M 4.57%, 95% CI 3.20 to 5.95; placebo M -1.17%, 95% CI -2.18 to -0.17), compared to placebo. In 194 participants with low baseline plasma folate, FA reduced %InAs (%change FA400 M -0.31%, SE ± 0.04; placebo M -0.13%, SE ± 0.04) and %MMA (%change FA400 M -2.6%, SE ± 0.37; placebo M -0.71%, SE ± 0.43), and increased %DMA (%change FA400 M 5.9%, SE ± 0.82; placebo M 2.14%, SE ± 0.71), more than placebo. Plasma homocysteine: In arsenic-exposed individuals, FA400 likely reduces homocysteine concentrations to a greater extent than placebo (2 studies, 448 participants; moderate-certainty evidence), in the mixed folate-deficient and folate-replete population receiving arsenic-removal water filters as a co-intervention (%change in GM FA400 -23.4%, 95% CI -27.1 to -19.5; placebo -1.3%, 95% CI -5.3 to 3.1; 1 study, 254 participants), and participants with low baseline plasma folate (within-person change FA400 M -3.06 µmol/L, SE ± 3.51; placebo M -0.05 µmol/L, SE ± 4.31; 1 study, 194 participants). FA supplements plus other nutrient supplements versus nutrient supplements alone In arsenic-exposed individuals who received arsenic-removal water filters as a co-intervention, FA400 plus creatine may reduce blood arsenic concentrations more than creatine alone (%change in GM FA400 + creatine -14%, 95% CI -22.2 to -5.0; creatine -7.0%, 95% CI -14.8 to 1.5; 1 study, 204 participants; low-certainty evidence); may not change urinary arsenic methylation indices (FA400 + creatine: %InAs M 13.2%, SE ± 7.0; %MMA M 10.8, SE ± 4.1; %DMA M 76, SE ± 7.8; creatine: %InAs M 14.8, SE ± 5.5; %MMA M 12.8, SE ± 4.0; %DMA M 72.4, SE ±7.6; 1 study, 190 participants; low-certainty evidence); and may reduce homocysteine concentrations to a greater extent (%change in GM FA400 + creatinine -21%, 95% CI -25.2 to -16.4; creatine -4.3%, 95% CI -9.0 to 0.7; 1 study, 204 participants; low-certainty evidence) than creatine alone.

AUTHORS' CONCLUSIONS

There is moderate-certainty evidence that FA supplements may benefit blood arsenic concentration, urinary arsenic methylation profiles, and plasma homocysteine concentration versus placebo. There is low-certainty evidence that FA supplements plus other nutrients may benefit blood arsenic and plasma homocysteine concentrations versus nutrients alone. No studies reported on cancer, all-cause mortality, neurocognitive function, or congenital anomalies. Given the limited number of RCTs, more studies conducted in diverse settings are needed to assess the effects of FA on arsenic-related health outcomes and arsenic toxicity in arsenic-exposed adults and children.

Multi-elemental risk assessment of various baby rice cereals: some cause for concern?

This study used batch and online methods to accurately determine how much arsenic (As), chromium (Cr), selenium (Se), cadmium (Cd), lead (Pb), copper (Cu), iron (Fe), and zinc (Zn) can be leached from baby rice cereals into a baby’s body. Speciation analysis of the saliva and gastric juice leachates was conducted to further assess the risk associated with the continued consumption of baby rice cereal for infants. A simple 15 min chromatographic analysis successfully separated eight species consisting of As(III), monomethylarsonic acid (MMA), dimethylarsinic acid (DMA), As(V), Se(IV), Se(VI), Cr(III), and Cr(VI). Given that 95%–100% As, 29%–100% Cr, 62%–100% Pb, 70%–100% Se, 63%–100% Cd, 36%–100% Cu, 67%–100% Fe, and 70%–100% Zn were bio-accessible and the speciation analysis results showed all bio-accessible As and Se to be in the forms of As(V) and Se(VI) and 70%–100% of Cr to be in the Cr(III) form, a variety of foods should be fed to infants rather than just baby rice cereal to ensure a well-balanced diet and less exposure to As at such a young age.

Copper and Zinc Content in Infant Milk Formulae Available on the Polish Market and Contribution to Dietary Intake

The inappropriate concentration of copper (Cu) and zinc (Zn) in formulae for infants can lead to abnormal micronutrient intake and adverse health outcomes. This study aimed to determine the concentration of Cu and Zn in different formulae and evaluate the Cu/Zn ratio. Besides, the daily intake (DI) of both micronutrients was estimated. Cu and Zn concentration in 103 formulae for infants, available in the Polish market, were assessed using atomic absorption spectrometry. The estimated DI was calculated from the average energy requirements for the 0-6 months aged infants. The microelement content of formulae was mostly in good agreement with that declared by the manufacturer (5-10% variations compared to the labeled values). The Cu/Zn ratio ranged from 1:8 to 1:25. The estimated DI of Cu was in the range of 0.14-1.11 mg/day. Six (6.7%) of the formulae did not meet the recommended range of Cu intake, especially during the first month of life and in the case of formulae for special medical purposes. The estimated DI of Zn varied from 2.27-11.25 mg/day. In most cases, the concentration of Cu and Zn in infant formulae was within the recommended range. It would be advisable to consider monitoring the DI of Cu and reconsider the Cu content in formulae for infants in proportion to its expected consumption.

Assessment of the Risk of Contamination of Food for Infants and Toddlers

Infants and toddlers are highly sensitive to contaminants in food. Chronic exposure can lead to developmental delays, disorders of the nervous, urinary and immune systems, and to cardiovascular disease. A literature review was conducted mainly in PubMed, Google Scholar and Scopus databases, and took into consideration papers published from October 2020 to March 2021. We focused on contaminant content, intake estimates, and exposure to contaminants most commonly found in foods consumed by infants and children aged 0.5-3 years. In the review, we included 83 publications with full access. Contaminants that pose a high health risk are toxic elements, acrylamide, bisphenol, and pesticide residues. Minor pollutants include: dioxins, mycotoxins, nitrates and nitrites, and polycyclic aromatic hydrocarbons. In order to reduce the negative health effects of food contamination, it seems reasonable to educate parents to limit foods that are potentially dangerous for infants and young children. An appropriate varied diet, selected cooking techniques, and proper food preparation can increase the likelihood that the foods children consume are safe for their health. It is necessary to monitor food contamination, adhere to high standards at every stage of production, and improve the quality of food for children.

Modified Baby Milk-Bioelements Composition and Toxic Elements Contamination

Breast milk has the most suitable composition for the proper development in the first year of a child’s life. However, it is often replaced with artificial milk. The aim of the study was to analyze the composition of essential elements: Na, K, Ca, P, Mg, Fe, Zn, Cu, and Mn as well as toxic elements: Ni, Pb, Sr, Li, and In in 18 formulas available in Poland. The daily supply was also estimated. The study was performed by Inductively Coupled Plasma Optical Emission Spectrometry method. The results showed the presence of all essential elements tested, but the content of P and Mn significantly differed from the concentrations declared. Such discrepancies can have significant impact on the daily dose of the bioelements taken. However, the content of elements was within the reference standards established by the EU Directive with exception of P, the amount of which exceeded the norms 5.23–18.80-times. Daily supply of P in tested milk as well as Fe and Mn provided with first and hypoallergenic formula exceeded the adequate intake. Analysis revealed the contamination with harmful elements—Pb, Sr, Li, and In were detected in almost all products. The study confirms the data concerning some discrepancies in composition and the contamination of food and may provide information on the feeding quality of children and estimation of health risk associated with exposure to toxic elements.

The impact of environmental and occupational exposures of manganese on pulmonary, hepatic, and renal functions

Manganese (Mn) is an essential trace element for humans, but long-term environmental or occupational exposures can lead to numerous health problems. Although many studies have identified an association between Mn exposures and neurological abnormalities, emerging data suggest that occupationally and environmentally relevant levels of Mn may also be linked to multiple organ dysfunction in the general population. In this regard, many experimental and clinical studies provide support for a causal link between Mn exposure and structural and functional changes that are responsible for organ dysfunction in major organs like lung, liver, and kidney. The underlying mechanisms suggested to Mn toxicity include altered activities of the components of intracellular signaling cascades, oxidative stress, apoptosis, affected cell cycle regulation, autophagy, angiogenesis, and an inflammatory response. We further discussed the sources and possible mechanisms of Mn absorption and distribution in different organs. Finally, treatment strategies available for treating Mn toxicity as well as directions for future studies were discussed.

Exposure to a mixture of metals and growth indicators in 6-11-year-old children from the 2013-16 NHANES

Lead (Pb), mercury (Hg) and fluoride (F) exposure during childhood is of concern owing to their toxicity. Also, evidence suggests that high and low exposure levels to manganese (Mn) and selenium (Se) during this vulnerable period are associated with an increased risk of adverse health effects. A reduced growth is associated with high Pb and F exposure; however, little is known about their impact on children's body size, and there is a lack of consensus on the effects of Hg, Mn, and Se exposure on children's anthropometric measures. This is particularly true for childhood metal co-exposures at levels relevant to the general population. We investigated the joint effects of exposure to a metal mixture (Pb, Mn, Hg, and Se in blood and F in plasma) on 6-11-year-old US children's anthropometry (n = 1,634). Median F, Pb, Mn, Hg, and Se concentrations were 0.3 μmol/L, 0.5 μg/dL, 10.2 μg/L, 0.3 μg/L, and 178.0 μg/L, respectively. The joint effects of the five metals were modeled using Bayesian kernel machine and linear regressions. Pb and Mn showed opposite directions of associations with all outcome measured, where Pb was inversely associated with anthropometry. For body mass index and waist circumference, the effect estimates for Pb and Mn appeared stronger at high and low concentrations of the other metals of the mixture, respectively. Our findings suggest that metal co-exposures may influence children's body mass and linear growth indicators, and that such relations may differ by the exposure levels of the components of the metal mixture.

Human Milk Concentrations of Minerals, Essential and Toxic Trace Elements and Association with Selective Medical, Social, Demographic and Environmental Factors

This study aims to quantify concentrations of minerals and trace elements in human milk (HM) and infant formula (IF) and evaluate associations with medical, social, environmental, and demographic variables. A prospective, case series study of 170 nursing mothers was made. HM samples were obtained from full-term (colostrum, intermediate and mature HM) and preterm (mature HM) mothers. Variables of interest were assessed by a questionnaire. For comparison, IF samples (n = 30) were analyzed in a cross-sectional study. Concentrations of 35 minerals, essential and toxic trace elements were quantified, 5 for the first time: thallium in HM and IF; strontium in preterm HM; and gallium, lithium and uranium in IF. In preterm and full-term HM, levels of selenium (p < 0.001) were significantly lower than recommended and were associated with low birth weight (p < 0.002). Cesium and strontium concentrations were significantly higher than recommended (p < 0.001). Associations were observed between arsenic and residence in an urban area (p = 0.013), and between lead and smoking (p = 0.024) and well-water consumption (p = 0.046). In IF, aluminum, vanadium, and uranium levels were higher than in HM (p < 0.001); uranium, quantified for the first time, was 100 times higher in all types of IF than in HM. Our results indicate that concentrations of most trace elements were within internationally accepted ranges for HM and IF. However, preterm infants are at increased risk of nutritional deficiencies and toxicity. IF manufacturers should reduce the content of toxic trace elements.

Risk Assessment of Metal(Loid)s Exposed to Infants via Consumption of Weaning Foods from Different Supermarkets in Sheffield, UK

Infant complementary foods are readily available in the UK markets and nowadays, weaning mothers prefer feeding their babies with these products due to modern lifestyles. However, there is a dearth of research with respect to the health risk assessment of trace essential and potentially toxic elements in these products. Hence, this research investigated the health risks of trace essential and potentially toxic elements exposed to infants via consumption of these complementary foods during the first 4 to 12 months of life. Levels of trace essential and potentially toxic elements were determined using inductively coupled plasma mass spectrometer, daily intakes were estimated using the Food Agricultural Organization/World Health Organization and manufacturer food consumption regime while the US Environmental Protection Agency guideline was used to estimate target hazard quotient and carcinogenic health risk indices. The levels of the elements in the foods varied and were within the safe limits recommended by food standard agencies. The results also showed that the estimated daily intakes of these elements were below the reference doses stipulated by food regulatory agencies. The target hazard quotients and the total carcinogenic risks of the elements in the infant foods were less than 1 and 1.0E-04, respectively, signifying that the target groups may not experience adverse non-carcinogenic and carcinogenic health effects because of these foods. This study will be quite helpful for weaning mothers, infant food production and processing companies and government officials in taking protective measures for reducing elemental contamination in infants' complementary foods.

How much manganese is safe for infants? A review of the scientific basis of intake guidelines and regulations relevant to the manganese content of infant formulas

BACKGROUND

Recent research has uncovered the potential for excess manganese (Mn) intakes causing significant neurotoxic effects for early brain development.

METHODS

We identified the Mn tolerable intakes (TI) published by the U.S. Institute of Medicine (IOM), World Health Organization (WHO), Agence nationale de sécurité sanitaire (ANSES), and U.S. Environmental Protection Agency (US EPA) and examined the primary studies on which regulatory TIs are based. We converted the TIs to μg of Mn/kg/day using standard assumptions specific to each agency. We estimated μg of Mn/kg/day intakes due to formulas. Using our estimates for formula intakes, weights, and kcal content, we converted regulatory maxima and minima from μg of Mn/100 kcals to estimates of μg of Mn/kg/day.

RESULTS

Except for the proposed ANSES TI for drinking water, none of the primary studies on which Mn intake guidelines and regulations are based measured health outcomes. Some infant formulas may exceed the regulatory TIs, especially if prepared with water containing considerable concentrations of Mn (e.g. 250 μg/L), even while meeting national and international regulatory standards or guidelines.

CONCLUSIONS

Infant formula regulations must be revised to reduce the potential for excess manganese intakes and the practice of manganese supplementation of infant formulas should be ceased.

Potential for Manganese-Induced Neurologic Harm to Formula-Fed Infants: A Risk Assessment of Total Oral Exposure

BACKGROUND

High oral exposure and biological vulnerabilities may put formula-fed infants at risk for manganese-induced neurotoxicity.

OBJECTIVES

We sought to characterize manganese concentrations in public drinking water and prepared infant formulas commonly purchased in the United States, integrate information from these sources into a health risk assessment specific to formula-fed infants, and examine whether households that receive water with elevated manganese concentrations avoid or treat the water, which has implications for formula preparation.

METHODS

Manganese was measured in 27 infant formulas and nearly all Minnesota community public water systems (CPWS). The risk assessment produced central tendency and upper-end exposure estimates that were compared to a neonatal animal-based health reference dose (RfD) and considered possible differences in bioavailability. A survey study assessed esthetic concerns, treatment, and use of water in a Twin Cities community with various levels of manganese in drinking water.

RESULTS

Ten percent of CPWSs were estimated to exceed the EPA health advisory level of 300   μ g / L . Manganese concentrations in formula ranged from 69.8 to 741   μ g / L , with amino acid > soy > cow ' s   milk formula concentrations. Central tendency estimates of soy and amino acid formula reconstituted with water at the CPWS 95th percentile manganese concentration exceeded the neonatal-based RfD. Upper-end estimates of manganese intake from formula alone, independent of any water contribution, equaled or exceeded the neonatal-based RfD. In the survey study, we observed increased awareness of esthetic issues and water avoidance at higher manganese concentrations, but these concentrations were not a reliable consumption deterrent, as the majority of households with inside tap drinking water results above 300   μ g / L reported drinking the water.

DISCUSSION

Excessive exposure to manganese early in life can have long-lasting neurological impacts. This assessment underscores the potential for manganese overexposure in formula-fed infants. U.S. agencies that regulate formula and drinking water must work collaboratively to assess and mitigate potential risks. https://doi.org/10.1289/EHP7901.

Content and Dietary Exposure Assessment of Toxic Elements in Infant Formulas from the Chinese Market

In this study, the content of chromium (Cr), arsenic (As), cadmium (Cd) and lead (Pb) in domestic and imported infant formulas from Beijing, China were analyzed using inductively coupled plasma mass spectrometry. The content of Cr, As, Cd and Pb was 2.51-83.80, 0.89-7.87, 0.13-3.58 and 0.36-5.57 μg/kg, respectively. Even though there were no significant differences in toxic elements content between domestic and imported infant formulas, Cd content was slightly lower in domestic samples. The estimated daily intake (EDI), target hazard quotient (THQ) and hazard index (HI) were calculated for infants between 0.5 and 5 y of age. The EDIs were lower than the oral reference doses. THQ of As, Cr, Cd and Pb was 0.027-0.103, 0.024-0.093, 0.0025-0.0090 and 0.0015-0.0046, respectively. HI values were 0.055-0.192 for boys and 0.056-0.209 for girls and were inversely associated with age with a threshold < 1. The non-carcinogenic risk value were in the safe range, indicating that exposure of As, Pb, Cr and Cd from infant formulas do not represent a health risk in China.

Determination of Aluminum, Chromium, and Barium Concentrations in Infant Formula Marketed in Lebanon

ABSTRACT

Infant formula is a major nutritional component for many infants and toddlers. However, the presence of contaminants, such as toxic metals, may pose increased health risks to infants. An investigation of the total concentrations of the metals aluminum (Al), barium (Ba), and chromium (Cr) in infant formulae marketed in Lebanon was performed. Powdered dairy and nondairy infant formula samples were collected from all commercially available brands (n = 39) in the Lebanese market on two production dates (78 samples in total) and analyzed for these three metals with inductively coupled plasma mass spectrometry. All brands contained detectable concentrations of Al and Ba, Cr was detected in 95% of brands. Mean (±standard deviation) concentrations of the metals were estimated as 1.54 ± 1.43 (Al), 0.256 ± 0.593 (Ba), and 0.168 ± 0.143 (Cr) (μg/g). The concentration ranges in the powdered formula were 0.080 to 7.93 (Al), 0.038 to 5.35 (Ba), and 0.041 to 0.348 (Cr) μg/g. A significant difference in the mean concentrations of Al, Ba, and Cr for the two production dates of a single brand was observed in 92, 59, and 83% of samples, respectively. The mean concentration of Al in the soy-based formula was significantly higher than that of aluminum in milk-based and corn-based formulas (P = 0.018). Cr concentrations in the continuation special formulations were significantly higher than those in the beginner formulations (P = 0.008). Our study provides the first publicly available information on metal contamination in infant formulas in Lebanon and reveals the need for frequent monitoring and surveillance of these products intended for infant consumption.

HIGHLIGHTS

CRM rapid response approach for the certification of arsenic species and toxic trace elements in baby cereal coarse rice flour certified reference material BARI-1

With recently legislated maximum levels of inorganic arsenic (iAs) in white and brown rice in Canada, the regulatory bodies are evaluating the need for regulation of As levels in infant food products. Rice is a major part of infants' diet, and therefore, the presence of As in this staple food causes concerns. So far, the scientific community was lacking suitable certified reference material (CRM) which could be used to assess the accuracy of developed analytical methods for As speciation in infants' food products. As a result, we have developed BARI-1, a baby cereal coarse rice flour reference material which was certified for total arsenic (0.248 ± 0.018 mg kg^-1), cadmium (0.0134 ± 0.0014 mg kg^-1), mercury (0.0026 ± 0.0003 mg kg^-1), lead (0.0064 ± 0.0016 mg kg^-1), inorganic As (0.113 ± 0.016 mg kg^-1) and dimethylarsinic acid (DMA) (0.115 ± 0.010 mg kg^-1), and reference value for monomethylarsonic acid (MMA) (0.0045 ± 0.0008 mg kg^-1) was reported. We also observed trace amounts of an unknown As compound, with chromatographic retention time close to DMA. Participating laboratories were allowed to use their in-house-validated extraction and/or digestion methods, and the detection of total metals was done by ICP-MS whereas HPLC-ICP-MS was used for As speciation. Despite the diversity in sample preparation and quantitation methods, reported values were in good agreement. For iAs measurement, the comparison between hydride generation ICP-MS and HPLC-ICP-MS found iAs overestimation with the former method, possibly due to interference from DMA. The certification was accomplished with a CRM rapid response approach in collaborative, focused effort completing the CRM development in few months instead of the typical multiyear project. This approach allowed to respond to measurement needs in a timely fashion. Graphical abstract.

Aluminum content and effect of in vitro digestion on bioaccessible fraction in cereal-based baby foods

The aim of this work was to determine the total concentration and the effect of in vitro digestion on the bioaccessible fraction of aluminum (Al) in 35 different cereal-based baby food samples and estimate the exposure to this element considering the consumption of this product. Total Al content was determined by inductively coupled plasma optical emission spectrometry after oxidative microwave digestion. An in vitro digestion method was applied and optimized to evaluate the bioaccessible fraction. The methods performance was efficient for both approached analysis and presented limits of detection and quantitation of 53 μg kg^-1 and 89 μg kg^-1, respectively. Total concentration and bioaccessibility varied according to the product composition (rice, oat, wheat, barley, corn, multicereal and fruit). Multicereals and fruit-based (plum) cereals presented the highest total Al concentrations (8.82 mg kg^-1 and 7.49 mg kg^-1, respectively), whilst lower values were observed for corn and rice flour cereals (0.92 mg kg^-1 and 1.09 mg kg^-1, respectively). The bioaccessible fraction varied from 1.5% to 10.4% in the evaluated samples. Exposure to Al was estimated and compared with the Provisional Tolerable Weekly Intake (PTWI) of 2 mg kg^-1 body weight. The results showed that the daily consumption of three portions of cereals contributes up to 10.48% of the PTWI, when considering the total Al concentration reported in this study.

Mineral compositions of infant complementary foods in relation to dietary daily intake and synergistic/antagonistic interrelationships

This study investigated the levels of selected essential elements in a brand of industrially prepared complementary foods in the UK for infants aged 4+, 7+, and 10+ months in order to ascertain their nutritional standards relative to the mineral reference daily intakes and interrelationships. Estimated daily intake of minerals was calculated from elemental contribution from the complementary foods and breast milk. The results showed remarkable significant differences (p < .05) in the concentration levels of the elements in the complementary foods. There were no significant differences (p > .05) between the estimated daily intakes compared to the standard values stipulated by the regulatory bodies. Although, the results showed that specific interrelationships were generally justified by the elemental contents, there were few differences with respect to the overall elemental profile. The results of the study support the recommendation of the use of semi-pureed meals by infants as complementary foods. However, the results of mineral interrelationships implicated imbalances and thus recommend fortification of the infants' complementary foods with iron, calcium, and zinc.

Public Health and Paediatric Risk Assessment of Aluminium, Arsenic and Mercury in Infant Formulas Marketed in Nigeria

OBJECTIVES

Infant formulas are useful alternatives to breast milk in many circumstances but may pose health risks to infants and children due to contamination by potentially toxic metals. This study aimed to determine the aluminium, arsenic and mercury concentrations and carry out an exposure health risk assessment in commonly consumed infant formulas in Nigeria.

METHODS

Different brands of both locally manufactured and imported infant formulas were purchased in March 2017 from stores in Port Harcourt, Nigeria. Analysis of metals in the samples was performed by atomic absorption spectrophotometry. The health risk was assessed by comparing estimated daily intake of aluminium, arsenic and mercury with the provisional tolerable daily intake acceptable by the Joint Food and Agricultural Organization/World Health Organization Expert Committee on Food Additives (JECFA).

RESULTS

A total of 26 infant formulas were analysed. The levels of arsenic were higher in cereal-based formulas compared to milk-based formulas, but the difference was not significant (P >0.05). The intake levels of aluminium, arsenic and mercury in infant formulas were found to be 8.02-14.2%, 437.1-771% and 23.7-41.8% of the provisional tolerable daily intake JECFA threshold values, respectively.

CONCLUSION

Commonly consumed infant formulas in Nigeria may add to the body burden of arsenic in children.

The Toxicological Analysis of Ni and Cr in Prescription Food for Special Medical Purposes and Modified Milk Products for Babies in Infancy Available in Pharmacies in Poland

Prescription food for special medical purposes (FSMPs) and modified milk products (MMPs) for babies in the infancy period available in pharmacies are increasingly frequently used for newborns and infants-especially in cases where allergies and food-borne diseases are diagnosed. However, there is a lack of scientific study around the safety assessment of the elemental impurities in these products. Importantly, the allergen Ni and the problematic metal Cr are little considered. Hence, the aim of this article was the toxicological analysis of Ni and Cr impurities in prescription FSMPs (n = 6) and MMPs (n = 6) for newborns and infants available in Polish pharmacies. For the best safety assessment, we include three approaches including (1) the levels of Ni and Cr in powdered products, (2) assessment of the daily dose depending on age and body weight of newborns and infants, and (3) the weekly intake of Ni and Cr in samples in comparison to provisional tolerable weekly intake (PTWI). Our results show that, on the basis of our data, the products from pharmacies in Poland investigated in this study do not represent a real health hazard to newborns and infants, although there may be a requirement for the monitoring of levels of Ni. Our results are pioneer and provide valuable data for other scientists and manufacturers.

Manganese levels in infant formula and young child nutritional beverages in the United States and France: Comparison to breast milk and regulations

Exposure to high levels of manganese (Mn) in children has recently been associated with adverse neurodevelopmental effects. Current infant formula regulations for Mn content were set between 1981 (United States), 2006 (European Union, France), and 2007 (Codex Alimentarius) prior to the publication of much of the growing body of research on the developmental neurotoxicity of Mn. In this study, we sought to measure the concentrations of Mn in some infant formulas and young child nutritional beverages available on the United States (US) and French markets using ion beam analysis by particle induced X-ray emission (PIXE) spectrometry and then compare the analytical results to concentrations reported in the literature for breast milk and applicable infant formula regulations and guidelines. We were particularly interested in measuring Mn concentrations in product types for which there is very little data from previous surveys, especially soy-based, rice-based, goat-milk based, chocolate-flavored, and nutritional beverages for young children that are not regulated as infant or follow-on formulas (e.g. “toddler formulas” and “toddler powders”). We purchased 44 infant formulas and young child nutritional beverage products in the US and France with varying protein sources (cow-milk, goat-milk, soy, rice) labelled for birth to 3 years. We selected these samples using maximum variation sampling to explore market extremes to facilitate comparisons to regulatory limits. Since this sampling method is non-probabilistic, other inferences cannot be made beyond this set of samples to the overall markets. We used ion beam analysis to measure the concentrations of Mn in each product. The range of measured Mn concentrations in the products is 160–2,800 μg/L, substantially higher than the 3–6 μg/L mean Mn concentration reported in human breast milk. All products satisfied national and Codex Alimentarius Commission (CAC) international standards for minimum Mn content in infant formulas; however, 7/25 of the products purchased in the US exceeded the CAC Guidance Upper Level of 100 μg Mn/kcal for infant formula.

The Hazards of a Ubiquitary Metalloid, Arsenic, Hiding in Infant Diets: Detection, Speciation, Exposure, and Risk Assessment

Different types of infant foods categorized as formulas, cereals, and purees imported from seven different countries and available on the Kuwaiti retail market were collected for arsenic analysis. The samples were analyzed both for total arsenic concentration using ICP-MS and for arsenic speciation using HPLC-ICP-MS. Speciation is essential for food analysis because of the toxicity and carcinogenicity of inorganic arsenic species. There was a strong positive linear correlation between the total and inorganic arsenic levels in the tested infant foods at the 95% confidence level. Arsenic concentrations detected in this study were implemented to calculate the total daily intake of arsenic, where the calculated daily intake values were utilized to assess the potential health risks to infants incurred by consuming different infant foods by calculating three different assessment indices namely, hazard quotient (HQ), cancer risk (CR), and margin of exposure (MOE). Both the total arsenic content and the safety of the investigated infant foods were compared to the ones associated with 406 different infant food types from seven different countries reported in the literature. This study confirms that infants are exposed to arsenic via diet since rice-based infant food products contained elevated levels of arsenic; consequently, warranting careful attention to diet choices both to limit this exposure and to avert potentially hazardous adverse health effects to the infants.

Geographical variation of arsenic distribution in paddy soil, rice and rice-based products: A meta-analytic approach and implications to human health

Arsenic is considered as ubiquitous toxic element belonging to the highest health hazard category. Wide ranges of natural as well as anthropogenic activities are subject to create global arsenic distribution in the broad sense. Rice is the major staple food consumed by world's population on the maximum scale. Growing environment of rice typically attributed by geographical origin may influence on arsenic bioavailability in rice grain. Over exploitation of arsenic contaminated, groundwater resources have recognised as major concern in agricultural perspective for rice production. On the other hand, biogeochemical weathering of arsenic bearing rocks as the geogenic origin, mining activities and application arsenical pesticides are recognised to be well known factors responsible to increase the soil arsenic level. Transfer of arsenic into rice is rightly acquainted from these possible sources of contamination in different regions around the world. Consequently, such substantial geographical variation reflects bioavailability as well as speciation of arsenic in rice. In this manuscript, we discuss the contribution of different arsenic entering pathways in soil-rice systems from regional variability. Furthermore, we attempted to apply the meta-analysis in order to predict the comparative risk assessment on distribution pattern of total and inorganic arsenic in rice commercialised from various rice producing regions of Asia, Europe and US by considering a selected number of data set an extensive range of market basket and field survey. In addition, we finally focus on health risk assessment associated by the consumption of rice and rice-based infant products as the dietary intake from the different of origin. Furthermore, we must detect and categorize the possible source of contamination, which may critically enhance the bioavailability of arsenic in rice in order to minimize the risk. These are the major aspects reviewed here.

Determination of Trace Elements in Infant Formulas Available on Polish Market

The aim of this study was to assess the levels of 13 essential and toxic elements (As, Cd, Co, Cr, Cu, Fe, Mn, Mo, Ni, Pb, Se, V, Zn) in the infant formulas, available on Polish market. Selected food samples were of animal (cow- and goat-based milks) and plant (soy-based milk, hypoallergic products, grain porridges) origin. Two analytical techniques, inductively coupled plasma mass spectrometry (ICP-MS) and neutron activation analysis (NAA), have been complementarily applied to analyze elemental content of 16 formulas dedicated for infants between 0 and 8 months. For arsenic determinations, the radiochemical mode of NAA was also used. The daily intake of some micronutrients in the age 0-8 months for non-breastfed infants was estimated and compared with present safety limits. Certified reference materials (CRMs) have been used for the validation of the methods: Non-fat Milk Powder 1549 (National Bureau of Standards-NBS), Soya Bean Flour INCT-SBF-4 (Institute of Nuclear Chemistry and Technology-INCT), Rice Flour SRM 1568b (National Institute of Standards and Technology-NIST).