Concentrations of iron, copper and zinc in human milk and powdered infant formula

Occurrence and health risk assessment of selected metals in commercially available infant formulas in Jordan

BACKGROUND

Infant formulas are the primary source of nutrition for infants and babies when breastfeeding is unavailable, as they are enriched with a variety of macro- and micronutrients to improve their nutritional value and satisfy the different needs of babies. Recently, there has been a rising concern about toxic metal levels in infant formulas, as highlighted by various studies. However, there are currently no sufficient studies focusing on toxic metal levels of infant formulas in Jordan. The current study aims to determine the levels of 25 metals, including Na, Mg, K, Ca, Cr, Fe, Mn, Co, Ni, Cu, Zn, Li, Ti, V, Ga, Sr, Ag, Ba, Bi, Th, U, Al, Cd, In, and Pb, in infant formulas (starter infant formula, follow-on formula, and growing-up formula) using inductively coupled plasma mass spectrometry (ICP-MS) and evaluate their safety and quality.

METHODS

The metal compositions of 37 infant formula samples collected from different Jordanian pharmacies were determined using inductively coupled plasma-mass spectrometry (ICP-MS) after digesting the samples with 9 mL of HNO3 (70 %) and 3 mL of H2O2 (30 %) using the microwave-assisted digestion technique. The possible health risks associated with the exposure to Cd, Pb, Al, and Ni in infant formulas were evaluated using estimated daily intake, target hazard quotient, and hazard index calculations. Also, method validation, including accuracy, precision, limit of detection, and limit of quantification, was performed.

RESULTS

The results revealed that follow-on formula (intended for 7-12-month-old babies) had the highest mean concentration of all studied metals, except for zinc, which had the highest mean concentration in starter infant formula (intended for less than 6-month-old babies). Also, 72.97 % and 89.20 % of the tested samples had Pb and Cd levels that exceeded the European permissible limit, respectively. Regarding the estimated daily intake (EDI), babies aged 7-12 months were found to be the most exposed to Cd and Pb toxicity, while babies aged less than 6 months were found to be the most exposed to Ni toxicity. Unfortunately, the overall non-carcinogenic negative adverse effects (hazard index HI) of Cd and Pb for babies aged 7-12 months exceeded the acceptable threshold of 1.

CONCLUSION

Based on the results, the consumption of infant formulas sold in Jordan may pose serious health risks to babies, with Cd and Pb levels in follow-on formulas (posing the highest risk). The source of contamination in infant formulas may be contaminated raw materials, the manufacturing process, packaging, or storage. So, strict regulations ought to be established to safeguard the health of babies.

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.

The concentration and health risk of potentially toxic elements (PTEs) in the breast milk of mothers: a systematic review and meta-analysis

AIM

Breast milk is the best source of nutrition for a newborn during the first six months of his or her life. However there is a possibility that breast milk may contain pollutants such as metals. The current meta-analytic study assessed the concentration of potentially toxic elements (PTEs), including lead (Pb), cadmium (Cd), arsenic (As), Iron (Fe), Zinc (Zn), copper (Cu), and nickel (Ni), in mothers' milk.

METHOD

The literature studies regarding the concentrations of PTEs in the breast milk of mothers were collected from international databases such as PubMed, Scopus, Web of Science, and Embase. Afterward, the Total Target Hazard Quotient (TTHQ) by Monte Carlo Simulation (MCS) model was used to assess the non-carcinogenic risk.

RESULTS AND DISCUSSION

According to 42 of the 836 retrieved articles, the PTE concentrations in mother's milk were as follows: Cu (1.84 mg/kg) > Zn (1.80 mg/kg) > Fe (1.03 mg/kg) > Ni (0.60 mg/kg) > Pb (0.10 mg/kg) > As (0.15 mg/kg) ≈ Cd (0.15 mg/kg). Based on the containment type, the highest concentrations of As (2.80 mg/kg), Cd (0.07 mg/kg), and Pb (2.68 mg/kg) were related to Western Pacific Region (WPRO), European Region (EURO), and WPRO, respectively. In addition, for trace elements, Eastern Mediterranean Region (EMRO) was the region with the highest concentrations of Cu (3.56 mg/kg), Fe (2.78 mg/kg), Ni (3.13 mg/kg), and Zn (5.58 mg/kg) were related to Lastly, the non-carcinogenic risk assessment of the PTEs in breast milk indicated different risk patterns in various countries, and the calculated TTHQ level in infants was below 1.

CONCLUSION

Overall, human breast milk was generally safe for infants to consume and poses no risks to their health.

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.

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.

The toxicological analysis of lead and cadmium in prescription food for special medical purposes and modified milk products for newborns and infants available in Polish pharmacies

There is currently a lack of risk assessments around Pb and Cd in prescription food for special medical purposes (FSMPs) and modified milk products available in from pharmacies in Poland. This article describes and evaluates a toxicological analysis of lead and cadmium in prescription FSMPs (n = 6) and modified milk products (n = 6) available in Polish pharmacies. The metals were determined using electrothermal atomisation atomic absorption spectrometry. To make the appropriate risk assessment, we considered (1) the levels of lead and cadmium in a powdered product, (2) the amount of the metals consumed in one portion (single exposure), (3) the daily dose depending on age (months) and body weight and (4) the weekly intake of Pb and Cd in samples in comparison to provisional tolerable weekly intake (PTWI). The results demonstrated that the samples analysed do not represent a health hazard to newborns and infants. This study is important because of the concerns around the complex risk assessment of prescription FSMP's and modified milk products available in Polish pharmacies related to lead and cadmium.

Overview of Nutrients in Human Milk

The WHO recommends exclusive breastfeeding for the first 6 mo of life to promote optimal infant health and development. Understanding the micro- and macronutrient concentrations of human milk and how each nutrient fluctuates with lactational stage, maternal factors, and supplementation is imperative for supporting good breastfeeding practices. Where maternal undernutrition compromises human milk quality, a thorough awareness of the effectiveness of interventions can direct efforts to achieve both maternal and infant nutrient sufficiency. This review of current knowledge covers trends in nutrient concentrations over the course of lactation and describes the influence of maternal intake, status, supplementation, and other factors on human milk concentrations of each nutrient.

Micronutrients in Human Milk: Analytical Methods

Exclusive breastfeeding is recommended by the WHO for the first 6 mo of life because human milk protects against gastrointestinal infections and supplies balanced and adequate nutrient contents to the infant. However, reliable data on micronutrient concentrations in human milk are sparse, especially because some micronutrients are affected by maternal diet. Microbiological and competitive protein-binding assays, nuclear magnetic resonance or inductively coupled plasma spectroscopy, and chromatographic analyses are among the methods that have been applied to human-milk micronutrient analysis. However, the validation or evaluation of analytical methods in terms of their suitability for the complex human-milk matrix has been commonly ignored in reports, even though the human-milk matrix differs vastly from blood, plasma, or urine matrixes. Thus, information on the validity, accuracy, and sensitivity of the methods is essential for the estimation of infant and maternal intake requirements to support and maintain adequate milk micronutrient concentrations for healthy infant growth and development. In this review, we summarize current knowledge on methods used for analyzing water- and fat-soluble vitamins as well as iron, copper, zinc, iodine, and selenium in human milk and their different forms in milk; the tools available for quality control and assurance; and guidance for preanalytical considerations. Finally, we recommend preferred methodologic approaches for analysis of specific milk micronutrients.

Use of human milk in the assessment of toxic metal exposure and essential element status in breastfeeding women and their infants in coastal Croatia

Pregnant and lactating women and infants are vulnerable population groups for adverse effects of toxic metals due to their high nutritional needs and the resultant increased gastrointestinal absorption of both, essential and toxic elements. Although breastfeeding is recommended for infants worldwide, as human milk is the best source of nutrients and other required bioactive factors, it is also a pathway of maternal excretion of toxic substances including toxic metals and thus a source of infant exposure. The aim of this research was to assess health risks in breastfeeding women in the coastal area of the Republic of Croatia and their infants (N=107) due to maternal exposure to Cd and Pb via cigarette smoking, and Hg via seafood and dental amalgam fillings, and their interaction with essential elements. Biological markers of exposure were the concentrations of main toxic metals Pb, Cd and Hg in maternal blood and three types of breast milk throughout lactation stages. Biological markers of effects were the levels of essential elements Ca, Fe, Cu, Zn and Se in maternal serum and breast milk. With regard to cigarette smoking as a source of exposure to Cd and Pb, there were effects of smoking on Cd concentration in blood and correlations between the smoking index and Cd concentrations in maternal blood (ρ=0.593; P<0.001) and mature milk (ρ=0.271; P=0.011) and Pb concentration in transitional milk (ρ=0.280; P=0.042). Regarding fish, we found correlations between weekly consumption frequency and total Hg concentrations in maternal blood (ρ=0.292; P=0.003) and mature milk (ρ=0.303; P=0.003). The number of dental amalgam fillings correlated with total Hg concentrations in colostrum (ρ=0.489; P=0.005) and transitional milk (ρ=0.309; P=0.018). As for the essential element status, only Se levels in maternal serum decreased by 10% in persons who continued smoking during pregnancy compared to non-smokers. In conclusion, the levels of main toxic metals Cd, Pb and Hg and essential elements Ca, Fe, Cu, Zn and Se in maternal blood and three types of breast milk samples in the studied area of coastal Croatia showed no risk of disrupted essential element levels with regard of toxic metal exposure in both breastfeeding women and their infants.

Essential and toxic elements in commercial baby food on the Spanish and Serbian market

About 10 heavy elements were determined in 90 samples of baby food collected from Spanish and Serbian market. The results indicated that iron, manganese and copper were most frequently detected. Tin was the predominant toxic element in both Spanish and Serbian samples, with occurrence frequencies of 12.5% and 10.0%, respectively. Element intake for Spanish and Serbian infants were estimated and compared with the recommended reference values, for the majority of elements being lower than one. However, iron and manganese intake through consumption of infant/follow-on formulas were assessed to be higher than the respective daily intakes. Particular attention should be paid to the exposure of infants who consume porridges made of vegetables and fish or chicken, because they may ingest certain elements, particularly arsenic and lead, at levels that exceed the reference toxicological values. Principal component analysis (PCA) was applied to classify and distinguish the different types of baby food.

Occurrence and infant exposure assessment of nitrates in baby foods marketed in the region of Lisbon, Portugal

Commercial baby food labelled as from organic or conventional origin, including vegetable-based baby foods, fruit purees and fruit juices (n = 80), were analysed for nitrate content by an in-house validated HPLC method. Nitrate contents ranged from 5 to 230 mg kg(-1) with a mean concentration of 102 mg kg(-1) for vegetable-based baby foods, and a median of 5 mg kg(-1) for both fruit purees and juices. One sample of vegetable-based baby food was higher than the legislated value (200 mg kg(-1)). There were no significant differences between average nitrate levels in analysed samples regarding both farming systems. The estimated nitrate intake through baby foods for a mean nitrate concentration of 47 mg kg(-1) ranged between 0.5 (15% of ADI) and 1.3 mg kg(-1) bw day(-1) (35% of ADI). The ADI level was exceeded (107-146% of ADI) only for the 95th and 99th percentiles of nitrate concentration.

Evaluation of the mineral content of infant formulas consumed in Brazil

The mineral content of 10 commercially available milk-based infant formulas widely consumed in Brazil was investigated. The levels of elements (Ca, Cu, Fe, K, Mg, Mn, Na, and Zn) were determined by inductively coupled plasma optical emission spectrometry after microwave-assisted wet digestion. The results were compared with the producers' label declarations and levels proposed by the Codex Alimentarius and the Brazilian National Health Surveillance Agency. The obtained results were in good agreement with certified reference materials, and the relative standard deviation of the measurements was always below 10%, with the exception of Cu (up to 14%). A high degree of variation between the experimental and producers' data was found for trace elements among different brands, with differences as high as 41 and 68% for Cu and Zn, respectively. The content of minerals in the starting formulas was in accordance with levels established by the Codex Alimentarius, with the exception of 1 brand that had a Zn level that was not in agreement with the Codex minimum value. Among follow-up formulas, 2 brands contained levels of Ca and K that were higher than the maximum established by Brazilian standards, and 1 brand contained less than the minimum value recommended for Zn. The guidance upper levels have not been established in the Codex Alimentarius for follow-up formulas, and the maximum value has been established for only 2 of the analyzed minerals. This lack of a standard could be a problem; as shown in the present study, if the Brazilian standard is used, several formulas could be considered out of specification. Despite the limited number of samples evaluated in this work, the levels of some elements were out of specification and special attention by the Brazilian government on the content of minerals in infant formulas is needed.

Determination of toxic elements in infant formulae by using electrothermal atomic absorption spectrometer

In present work concentrations of toxic elements (TEs), aluminum (Al), cadmium (Cd), and lead (Pb) in seventeen imported samples of infant milk-based (IMF) and infant soy-based formulae (ISF), were measured, to evaluate whether the intakes of understudy TEs accomplished within recommended permissible levels. The TEs were analyzed by electrothermal atomic absorption spectrometer, prior to microwave induced acid digestion. The validity of methodology was tested by simultaneously analyzing certified reference material and standard addition method. It was observed that ISF contains higher concentration of understudy toxic analytes as compared to IMF. The all three TEs, Al, Cd and Pb were detected in different branded infant formulae, in the range of (1070-2170), (10.5-34.4), and (28.7-119) microg/kg, respectively. The estimated intakes of TEs as microg/kg/week for infants (>1year) through milk formulae are well below the recommended tolerable levels of these elements.

Physicochemical characteristics of various milk samples available in Pakistan

We report physicochemical characteristics of various kinds of liquid milk commercially available in Pakistan in comparison with those of fresh natural milk from animals. Milk samples were collected from local markets at Peshawar, Pakistan, and analyzed for their physical features, including moisture, total solids, specific gravity, conductivity, viscosity and titratable acidity (lactic acid equivalent), and chemical components and macro-minerals, including total protein, casein, lactose, ash and minerals (Na, K and Mg). These items were compared with the physicochemical characteristics of the fresh natural milk samples from buffalo, cow and goat. The results were also compared with reported nutritional quality of milk from various countries and World Health Organization (WHO) standards. We found that all the physical features and chemical components of commercially available milk in Pakistan markets meet WHO's requirements, except for Na, K, Ca and Mg, which are below the standards.

Infusionstherapie und Ernährung von Risikogruppen

Besondere Situationen erfordern ein besonderes Vorgehen. Während bisher das »Standardvorgehen« bezüglich der Ernährung von pädiatrischen Patienten dargestellt wurde, beschäftigt sich das vorliegende Kapitel mit »Sondersituationen« der pädiatrischen Infusionstherapie und Ernährung. Behandlungssituationen, die ein besonderes Vorgehen bei der Therapie oder spezielle Aufmerksamkeit bei der Anpassung der Ernährung erfordern, entstehen in der Regel durch 4 mögliche Situationen:

spezifische Physiologie von Patientengruppen (z. B. Früh- oder Neugeborene),

Auswirkungen von therapeutischen Maßnahmen (z. B. Operationen),

Pathophysiologie von Erkrankungen (z. B. angeborene Stoffwechselerkrankungen, Erkrankungen des onkologischen, rheumatischen oder atopischen Formenkreises, Anorexia nervosa, Bulimie oder Adipositas) oder

besondere körperliche Belastungen [z. B. (Leistungs-)Sport].

Bekannte Strategien werden systematisch und prägnant dargestellt und diskutiert.

Die Beschäftigung mit der Ernährung von »Risikogruppen« übt das Erkennen und den Umgang von potenziellen Gefahrensituationen bei der Verordnung von bilanzierter Ernährung. So sollte auch derjenige von dem Kapitel profitieren, der sich mit den behandelten Patientengruppen, Situationen, Erkrankungen üblicherweise nicht beschäftigen muss.

The combination of zinc compounds and acidic pH limits aerobic growth of a Salmonella typhimurium poultry marker strain in rich and minimal media

The objective of the present study was to examine the combined effects of zinc compounds with different acidic pH levels on the aerobic growth of a S. typhimurium poultry isolate in either rich or minimal media. When overall main effects of pH levels of medium or concentrations of Zn compounds were compared, growth rates of the S. typhimurium poultry isolate were significantly (p < 0.05) decreased by stepwise increase of pH levels of medium (pH 4, 5, 6, and 7) or concentrations (0.67, 3.35, and 6.03%) of Zn compounds (Zn acetate and Zn sulfate). In general growth rates of S. typhimurium poultry isolate appeared to be more reduced by Zn acetate than by Zn sulfate and more reduced in minimal media compared to rich media.