Occurrence, sources, and pathways of chemical contaminants in infant formulas

Comprehensive analysis of contaminants in Brazilian infant formulas: Application of QuEChERS coupled with UHPLC-QqQ-MS/MS and suspect screening-unknown analysis by UHPLC-Q-Orbitrap-MS

Infant formulas (IF) can contain harmful chemical substances, such as pesticides and mycotoxins, resulting from the contamination of raw materials and inputs used in the production chain, which can cause adverse effects to infants. Therefore, the quick, easy, cheap, effective, rugged, and safe (QuEChERS) methodology prior ultra-high performance liquid chromatography coupled to triple quadrupole mass spectrometry (UHPL-QqQ-MS/MS) analysis was applied for the determination of 23 contaminants, in 30 samples of Brazilian IF. The method was validated in terms of limit of detection (0.2 to 0.4 μg/kg), limits of quantification (1 and 10 μg/kg), and recovery (64 % to 122 %); precision values, in terms of relative standard deviation (RSD), were ≤ 20 %. Fenitrothion, chlorpyrifos, and bifenthrin were the pesticides detected in the samples, but the values did not exceed the limit set by the European Union (EU), and ANVISA, and they were detected under their limits of quantification. Additionally, suspect screening and unknown analysis were conducted to tentatively identify 32 substances, including some compounds not covered in this study, such as pesticides, hormones, and veterinary drugs. Carbofuran was identified, confirmed and quantified in 10 % of the samples.

Trace elements in commercially available infant formulas in Iran: Determination and estimation of health risks

Infants are significantly more vulnerable to trace elements from their foods. The objective of the present study was to ascertain the concentrations of some trace elements namely; arsenic, cadmium, chromium, copper, nickel and lead in infant formulas sold in Iran and to estimate the potential health risks to the infants through consumption of these products. The mean concentrations of As, Cd, Cr, Cu, Ni and Pb in infant formula samples were 0.006, 0.040, 0.3980, 2.014, 0.166 and 0.285 mg/kg, respectively. The mean levels of the trace elements were in the following order: Cu > Cr > Pb > Ni > Cd > As. For arsenic, cadmium and copper, calculated EWIs (estimated weekly intakes) were within the PTWIs (provisional tolerated weekly intakes) recommended by FAO/WHO. For chromium, nickel and lead, the calculated EWIs were higher than the PTWIs in 88.8 %, 75 %, and 61.1 % of the formulas. HQs of Pb, Cu, Cd and As were above the safe limits, indicating health concerns from the consumption of some infant formulas. Based on the CR classification, CR values of some elements including Cd, Cr and Ni were above 1 × 10-4 in some brands, indicating that exposure to these elements from infant formulas may cause health risks. Therefore, regular monitoring of all the raw materials, stages of production and storage of infant formulas is essential to limit the exposure of this vulnerable age group to toxic trace elements.

Marketing and child feeding

OBJECTIVE

To carry out a narrative review on the use of marketing strategies in child nutrition, as well as potential implications for health professionals and children.

DATA SOURCE

Searches were carried out on the PubMed, SciELO, and Google platforms, using the terms "child nutrition" or "industrialized baby food" or "infant formula" or "breast milk" or "breastfeeding" and "marketing", with original articles, review articles, institutional reports, institutional position documents and websites considered relevant to the topic being analyzed.

DATA SYNTHESIS

Children's food marketing started with the industrialization of food and the resulting actions aimed at increasing sales and meeting commercial interests. Since its inception to the present, infant formulas have been the most widely used products, which has impacted breastfeeding practices. International and national institutions, that care for children's health, are searching for strategies to limit the abusive marketing of industrialized children's foods. Marketing strategies interfere with medical knowledge and actions, potentially influencing the guidance provided by pediatricians to families, and finally, compromising healthy eating practices at a critical period in life, with possible long-term effects.

CONCLUSIONS

Health professionals, especially pediatricians, must provide the best care for children and families, and need to maintain the search for quality scientific information, not influenced by conflicts of interest. Updated and critical knowledge on the part of healthcare professionals can curb marketing strategies that aim to influence their actions.

The Climate Crisis and Breastfeeding: Opportunities for Resilience

The climate crisis is an emerging global challenge that poses potential risks to breastfeeding practices and outcomes. There are multifaceted effects of climate change affecting the breastfeeding dyad across environmental, societal, and human health dimensions. Breastfeeding support in the face of climate change will require solutions at the structural level-healthcare, community, and workplace settings-and at the mother-infant dyad level. Breastfeeding can additionally be an adaptive response to crisis situations and can mitigate some of the environmental challenges associated with climate change. Despite the undeniable significance of climate change on breastfeeding (and vice versa), our perspective as experts in the field is that this topic has not been systematically addressed. Although we highlight some of the challenges, potential solutions, and co-benefits of breastfeeding in the context of climate change, there are numerous issues that could be further explored and necessitate additional preparedness planning.

Levels of organic pollutants and metals/metalloids in infant formula marketed in Brazil: Risks to early-life health

Infant formula intake is recommended to ensure comprehensive nutritional and caloric fulfillment when exclusive breastfeeding is not possible. However, similarly to breast milk, infant formulas may also contain pollutants capable of inducing endocrine-disrupting and neurotoxic effects. Thus, considering the sensitivity of their developing physiological systems and that infants have heightened susceptibility to environmental influences, this study was aimed at assessing the contents of essential elements, and inorganic and organic pollutants in infant formulas marketed in Brazil. Additionally, health risk assessments for selected contaminants were also performed. Measured contents of essential elements (Ca, Fe, Mg, Mn, Cu, Se, and Zn) were congruent with label information. Nevertheless, some toxic elements (Pb, Cd, As, Ni, and Al) were also detected. Notably, in the upper-bound scenario, Pb and Cd surpassed established threshold values when comparing the estimated daily intake (EDI) and tolerable daily intake (TDI - 3.57 and 0.36 μg/kg bw, respectively). Bisphenol P (BPP) and benzyl butyl phthalate (BBP) were frequently detected (84 % detection rate both) with elevated contents (BPP median = 4.28 ng/g and BBP median = 0.24 ng/g). Furthermore, a positive correlation (0.41) was observed between BPP and BBP, implying a potential co-occurrence within packaging materials. Methyl-paraben also correlated positively with BBP (0.57), showing a detection rate of 53 %. The cumulative PBDE contents ranged from 0.33 to 1.62 ng/g, with BDE-154 and BDE-47 the dominant congeners. When comparing EDI values with TDIs, all organic pollutants remained below the thresholds across all exposure scenarios. Moreover, non-carcinogenic risks were below the threshold (HQ > 1) when dividing the EDIs by the respective reference doses for chronic exposure. While the current findings may suggest that infant formula intake poses no immediate risk in terms of the evaluated chemicals, it remains imperative to conduct further research to safeguard the health of infants considering other chemicals, as well as their potential cumulative effects.

Micro problems with macro consequences: accumulation of persistent organic pollutants and microplastics in human breast milk and in human milk substitutes

Industrial activities provide a modern human lifestyle with advances and comforts in every field. However, such scenario has brought several negative issues. Persistent organic pollutants (POPs) and a growing plastic usage together with the degradation byproducts, namely microplastics (MPs), are current environmental problems present in every ecosystem, disturbing all forms of life. POPs and MPs are also found in human consumption products including animal and vegetal derivatives, human milk substitutes, and in human breast milk. To date, it is currently unknown what are the effects of MPs and POPs when ingested during the first and most important stage for health programming of the offspring, the first 1000 days of life. Here, we add epidemiological and clinical evidence supporting major sources of POPs and MPs in the ecosystem; and we will precisely describe the effect of POP and MP accumulation in animal- or plant-based infant formulas and human breast milk, modulating health outcomes in the newborn. This review provides a rational to incentive the POP and MP identification in human breast milk and human milk substitutes for avoiding susceptibility to negative health outcomes for the newborn.

Comparison between pollutants found in breast milk and infant formula in the last decade: A review

Since ancient times, breastfeeding has been the fundamental way of nurturing the newborn. The benefits of breast milk are widely known, as it is a source of essential nutrients and provides immunological protection, as well as developmental benefits, among others. However, when breastfeeding is not possible, infant formula is the most appropriate alternative. Its composition meets the nutritional requirements of the infant, and its quality is subject to strict control by the authorities. Nonetheless, the presence of different pollutants has been detected in both matrices. Thus, the aim of the present review is to make a comparison between the findings in both breast milk and infant formula in terms of contaminants in the last decade, in order to choose the most convenient option depending on the environmental conditions. For that, the emerging pollutants including metals, chemical compounds derived from heat treatment, pharmaceutical drugs, mycotoxins, pesticides, packaging materials, and other contaminants were described. While in breast milk the most concerning contaminants found were metals and pesticides, in infant formula pollutants such as metals, mycotoxins, and packaging materials were the most outstanding. In conclusion, the convenience of using a feeding diet based on breast milk or either infant formula depends on the maternal environmental circumstances. However, it is important to take into account the immunological benefits of the breast milk compared to the infant formula, and the possibility of using breast milk in combination with infant formula when the nutritional requirements are not fulfilled only with the intake of breast milk. Therefore, more attention should be paid in terms of analyzing these conditions in each case to be able to make a proper decision, as it will vary depending on the maternal and newborn environment.

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.

Mixture of environmental pollutants in breast milk from a Spanish cohort of nursing mothers

Breastfeeding is one of the most effective ways to ensure child health and survival, with several benefits for both the infants and their mothers. However, breast milk can contain environmental pollutants with endocrine disruption capacity, neurotoxicity and/or potential to alter microbiota. Monitoring breast milk provides information on the current chemical exposure of breastfed infants and, in addition, on the current and historical exposure of nursing mothers. In this study, the levels of a wide range of pollutants were measured in breast milk of Spanish nursing mothers. Target chemicals were dichlorodiphenyltrichloroethane (DDT), dichlorodiphenyldichloroethylene (DDE), hexachlorobenzene (HCB), oxy-chlordane, polychlorinated biphenyls (PCBs), polybrominated diphenyl ethers (PBDEs), per- and poly-fluoroalkyl substances (PFASs) (including perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA)), chlorpyrifos, bisphenol A (BPA), tetrabromobisphenol A (TBBPA), and a number of toxic and essential elements. Traces of most chemicals were found. A correlation between the levels of some persistent organic pollutants (POPs) and maternal characteristics (age and body mass index) was observed, while smoking was associated to higher concentrations of some toxic elements. Higher levels of PCBs were detected in samples from Spanish primiparous mothers compared to non-Spanish multiparous women. Breast milk from low-income mothers showed higher content of DDT and DDE than high-income mothers. Although breastfeeding is clearly beneficial for babies, the exposure to this mixture of hazardous substances, as well as their interaction and combined effects must not be disregarded.

Occurrence of per- and polyfluoroalkyl substances (PFASs) in raw milk and feed from nine Chinese provinces and human exposure risk assessment

The per- and polyfluoroalkyl substances (PFASs) are substantially produced and applied in industrial and domestic products, which have recently aroused great public concern for their potential toxicity to humans. In the present study, raw milk (n = 107) and cow feed samples (n = 70) were collected across nine Chinese provinces, in order to investigate the occurrence of PFASs in milk and feed, and the human exposure risk to milk. The concentrations of PFASs are in the range of < method detection limit -9.82 ng/g dw (average: 1.03 ng/g dw) for milk and 0.99-144 ng/g dw (7.68 ng/g dw) for feed. Perfluorobutanoic acid (34.0%) dominates in feed, while perfluorooctanesulfonic acid (67.5%) dominates in milk. No significant positive correlations of PFASs are observed between paired feed and milk (p > 0.05). However, feeds collected around fluorination production area show relatively higher PFAS levels than those from other areas, which also increase PFAS levels in milk. Risk assessment of PFASs through milk consumption is carried out according to evolving reference doses (RfDs). The hazard quotient is more than one for both adults and children when the strictest RfDs are applied. The Monte Carlo Simulation shows that children face higher PFAS exposure risk than adults.

Assessment of Aluminum via Baby Foods Consumption in Turkey: Estimated Early-Life Dietary Exposure and Target Hazard Quotient

This study focuses on infant formulas and baby biscuits, which have an important place in the nutrition of the most vulnerable individuals, namely babies. In this sense, the aluminum levels of 64 different baby foods, retrospectively consumed by 348 babies for dietary recall 24 h, were determined by ICP-MS. Then, the exposure resulting from the consumption of these foods was calculated via a deterministic model, and a risk assessment was made. Aluminum levels of infant formulas and baby biscuits that are of higher values compared to other studies were found in the range of 718-6987 and 1803-15,479 μg/kg, respectively. Aluminum exposure was calculated as 8.02, 7.28, 4.03, and 4.08 μg/kg bw/day in babies aged 0-6, 7-12, 13-24, and 25-36 months, respectively. There is no statistically significant difference between different age groups according to the total aluminum exposure levels. The toxicological contribution of aluminum exposure is quite limited (< 6.0% of PTWI). THQ values were calculated as 10-20 for babies aged 0-36 months. Therefore, THQ values indicate a potential health problem.

Multiclass and multi-residue screening of mycotoxins, pharmacologically active substances, and pesticides in infant milk formulas through ultra-high-performance liquid chromatography coupled with high-resolution mass spectrometry analysis

Infant milk formulas are designed to substitute human milk when breastfeeding is unavailable. In addition to human milk and milk-derived products, these formulas can be a vehicle of contaminants. In this work, a multiclass method based on the QuEChERS (quick, easy, cheap, effective, rugged, and safe) approach was developed for the simultaneous determination of contaminants (n = 45), including mycotoxins and veterinary drug residues, occurring in infant milk formulas. By using an ultra-high-performance liquid chromatography quadrupole-Orbitrap coupled with high-resolution mass spectrometry analysis (UHPLC-Q-Orbitrap HRMS; Thermo Fisher Scientific), further retrospective analysis of 337 contaminants, including pesticides, was achieved. The method was validated in accordance with European regulations and applied for the analysis of 54 infant milk samples. Risk assessment was also performed. Dexamethasone was detected in 16.6% of samples (range: 0.905-1.131 ng/mL), and procaine benzyl penicillin in 1 sample at a concentration of 0.295 ng/mL. Zearalenone was found in 55.5% of samples (range: 0.133-0.638 ng/mL) and α-zearalenol in 16.6% of samples (range: 1.534-10.408 ng/mL). Up to 49 pesticides, 11 veterinary drug residues, and 5 mycotoxins were tentatively identified via retrospective analysis based on the mass spectral library. These findings highlight the necessity of careful evaluation of contaminants in infant formulas, considering that they are intended for a vulnerable part of the population.

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.

Systematic Review Protocol for the Current State of Chemical Exposure in Infants via Breast Milk, Artificial Milk and Dairy Products

Many studies have shown that human breast milk is contaminated with various chemicals. In the proposed systematic review, the aim is to identify and summarize the available literature regarding chemical exposure via breastfeeding or the feeding of artificial formula. MEDLINE (PubMed) will be the primary source in this literature search. Primary studies that analyzed one or more chemicals of interest in breast milk or artificial milk and that reported information on concentrations will be eligible for this review. Conference abstracts will not be included in the review unless access to the data is easy. First, the titles and abstracts of identified articles will be screened by two or more researchers. Then, a full-text review will be conducted to extract data from the included articles and code them for classification. The results of the search and classification will be summarized narratively and bibliometrically. The aim of the review is to analyze trends in publications according to year and region from the viewpoint of target chemicals, location, range of concentrations, and health outcomes.

Occurrence of bisphenol A in the milk chain: A monitoring model for risk assessment at a dairy company

Bisphenol A (BPA) as a chemical hazard may enter the milk chain during primary production at the farm and, successively, during milk processing at a dairy company. To identify the potential pathways that play a role in the occurrence of BPA, a monitoring model for risk assessment based on the identification of the hazards at each stage of milk processing was investigated. Milk samples were analyzed using liquid chromatography with fluorescence detection. Quantifiable levels were detected in samples obtained from the raw milk storage tank, pasteurized milk from the storage tank, and packaged milk. The highest BPA contamination levels were detected in raw milk from the storage tank (mean 0.265 µg/L). Despite the fact that dietary exposure levels were below the temporary daily intake, BPA may have adverse effects, particularly for vulnerable population groups. New monitoring programs involving each stage of milk processing should therefore be applied.

Multivariate optimization of low-temperature cleanup followed by dispersive solid-phase extraction for detection of Bisphenol A and benzophenones in infant formula

A simple and effective analytical method to determine six contaminants, including five benzophenones (BP, BP-1, BP-3, BP-8, and BP-12) and bisphenol A (BPA) in infant formulas was developed in this study. For this, a sequential experimental design was used to optimize the extraction and cleanup method using low temperature partition (LTP) combined with dispersive solid phase extraction (dSPE). The effect of primary secondary amine (PSA), sodium chloride (NaCl), graphitized carbon black (GCB), octadecyl (C18), strong anion exchanger (SAX), water, acetonitrile (ACN) and, ultrasound (US) time were evaluated using a sequential design of experiments including a Plackett-Burman, a central composite rotatable design, and the Derringer and Suich's tool. The method was validated, and it showed a limit of quantification varying from 0.06 to 2 mg.kg^-1, good precision (< 20% RSD), and recovery (52-106%). The method proposed was applied to twenty-five samples of commercial infant formulas.