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Prescription Infant Formulas Are Contaminated with Aluminium

International Journal of Environmental Research and Public Health (IJERPH)

March 2019
16(5):899

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Historical and recent data demonstrate that off-the-shelf infant formulas are heavily contaminated with aluminium. The origin of this contamination remains to be elucidated though may be imported via ingredients, packaging and processing. Specialised infant formulas exist to address health issues, such as low birth weight, allergy or intolerance and medical conditions, such as renal insufficiency. The aluminium content of these prescription infant formulas is measured here for the first time. We obtained 24 prescription infant formulas through a paediatric clinic and measured their total aluminium content by transversely heated graphite furnace atomic absorption spectrometry following microwave assisted acid/peroxide digestion. The aluminium content of ready-to-drink formulas ranged from 49.9 (33.7) to 1956.3 (111.0) μg/L. The most heavily contaminated products were those designed as nutritional supplements for infants struggling to gain weight. The aluminium content of powdered formulas ranged from 0.27 (0.04) to 3.27 (0.19) μg/g. The most heavily contaminated products tended to be those addressing allergies and intolerance. Prescription infant formulas are contaminated with aluminium. Ready-made formulas available as nutritional supplements to aid infant growth contained some of the highest concentrations of aluminium in infant formulas measured in our laboratory. However, a number of prescription infant formulas contained the lowest concentrations of aluminium yet measured in our laboratory. These higher cost specialist preparations demonstrate that the contamination of infant formulas by aluminium is not inevitable. They represent what is achievable should manufacturers wish to address the threat posed to health through infant exposure to aluminium.

. Aluminium in powdered formulas designed for infants with allergies and intolerances. Mean and SD are given, n = 5.

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International Journal of

Environmental Research

and Public Health

Article

Prescription Infant Formulas Are Contaminated

with Aluminium

James Redgrove 1, Isabel Rodriguez 2, Subramanian Mahadevan-Bava 3and

Christopher Exley 2, *

1Life Sciences, Huxley Building, Keele University, Staffordshire ST5 5BG, UK; jamesredgrove11@gmail.com

2The Birchall Centre, Lennard-Jones Laboratories, Keele University, Staffordshire ST5 5BG, UK;

i.rodriguez.nunez-milara@keele.ac.uk

3Russells Hall Hospital, Dudley Group Foundation NHS Trust, Pensnett Road, Dudley DY1 2HQ,

West Midlands, UK; s.mahadevan@nhs.net

*Correspondence: c.exley@keele.ac.uk

Received: 6 February 2019; Accepted: 10 March 2019; Published: 12 March 2019





Abstract:

Historical and recent data demonstrate that off-the-shelf infant formulas are heavily

contaminated with aluminium. The origin of this contamination remains to be elucidated though

may be imported via ingredients, packaging and processing. Specialised infant formulas exist to

address health issues, such as low birth weight, allergy or intolerance and medical conditions, such

as renal insufﬁciency. The aluminium content of these prescription infant formulas is measured

here for the ﬁrst time. We obtained 24 prescription infant formulas through a paediatric clinic

and measured their total aluminium content by transversely heated graphite furnace atomic

absorption spectrometry following microwave assisted acid/peroxide digestion. The aluminium

content of ready-to-drink formulas ranged from 49.9 (33.7) to 1956.3 (111.0) µg/L. The most heavily

contaminated products were those designed as nutritional supplements for infants struggling

to gain weight. The aluminium content of powdered formulas ranged from 0.27 (0.04) to 3.27

(0.19)

g/g. The most heavily contaminated products tended to be those addressing allergies and

intolerance. Prescription infant formulas are contaminated with aluminium. Ready-made formulas

available as nutritional supplements to aid infant growth contained some of the highest concentrations

of aluminium in infant formulas measured in our laboratory. However, a number of prescription

infant formulas contained the lowest concentrations of aluminium yet measured in our laboratory.

These higher cost specialist preparations demonstrate that the contamination of infant formulas by

aluminium is not inevitable. They represent what is achievable should manufacturers wish to address

the threat posed to health through infant exposure to aluminium.

Keywords:

aluminium contamination; infant formulas; infant nutirion; aluminium toxicity; human

exposure to aluminium

1. Introduction

It is ﬁve years since we last reported the signiﬁcant contamination of infant formulas by

aluminium [

]. Recent research, though limited in its scope, suggests that off-the-shelf formulas

remain heavily contaminated [

]. There exists a wide range of specialised infant formulas that are often

only available through paediatric clinics and prescription. These are designed to address a number

of nutritional issues including low birth weight, perceived intolerances, gastrointestinal disorders,

allergies and renal insufﬁciency [

]. Many of these products are fed to vulnerable infants under the

expected guidance of a paediatrician. Some may be combined with medication [5].

Int. J. Environ. Res. Public Health 2019,16, 899; doi:10.3390/ijerph16050899 www.mdpi.com/journal/ijerph

Int. J. Environ. Res. Public Health 2019,16, 899 2 of 7

Human exposure to aluminium is a serious health concern [

]. Aluminium exposure in infants

is understandably a burgeoning issue [

]. While infant exposure to aluminium continues to be

documented, its consequences, immediate and in the future, have received only scant attention [

]

and research is required to understand the biological availability of aluminium through formula

feeding. For example, how much aluminium is absorbed across the neonate gut and its subsequent

fate, including excretion.

There is already too much aluminium in infant formulas [

] and herein we have measured its

content in a large number of prescription formulas, products which are fed to vulnerable infants in

their ﬁrst months of life. Many of these products are heavily contaminated with aluminium.

2. Materials and Methods

We obtained 24 prescription infant formulas through the Paediatric Clinic of Russells Hall

Hospital, Dudley, United Kingdom. Both ready-to-drink and powdered products were supplied

as pristine, unopened samples. They included ready-made drinks for preterm infants and those having

intrauterine growth restriction (IUGR), supplements in the form of ready-made drinks for infants

having poor weight gain, powdered formulas for allergy and intolerance and powdered formulas with

additional amino acids (see Tables 1–5for brand names).

Each unopened product (to avoid potential extraneous contamination) was mixed manually

before being opened and sampled according to needs. The total aluminium content of all formulas

was measured by transversely heated graphite furnace atomic absorption spectrometry (TH GFAAS)

following acid/peroxide microwave digestion. Analytical methods and quality assurance data are

identical to those used previously in our laboratory [

] and so are not detailed here. Data are

presented according to product specialisation (Tables 1–4) and by way of comparing ready-made and

powdered formulations (Table 5).

3. Results

3.1. Ready-Made Drinks for Preterm and IUGR Infants

The concentration of aluminium (mean and SD) ranged from 49.9 (33.7) to 249.4 (64.0)

g/L

while the amount of aluminium per serving varied from 3.5 to 45.7

g depending upon serving

volume (Table 1). The %RSD (relative standard deviation) was consistently high across all products

and probably reﬂects the inhomogeneous nature of the milks and the non-uniform distribution of

aluminium throughout the bulk volume.

Table 1.

Aluminium in ready-to-drink infant formulas designed for preterm and intrauterine growth

restriction (IUGR) infants. Mean and SD are given, n= 5.

Brand [Al] µg/L

Mean (SD)

Al µg/Serving

(Serving Size mL)

Cow & Gate

Nutriprem 1 49.9 (33.7) 3.5 (70 mL)

Cow & Gate

Nutriprem 2 139.3 (143.6) 27.9 (200 mL)

Cow & Gate

Nutriprem Hydrolysed 167.1 (10.6) 15.0 (90 mL)

Danone Nutricia

Infatrini Peptisorb 228.5 (48.3) 45.7 (200 mL)

SMA Pro

First Infant Milk 249.4 (64.0) 17.5 (70 mL)

3.2. Ready-Made Drinks as Supplements for Weight Gain

The concentration of aluminium (mean and SD) ranged from 153.5 (161.3) to 1956.3 (111.0)

g/L

while the amount of aluminium per serving varied from 25.6 to 391.3

g depending upon serving

Int. J. Environ. Res. Public Health 2019,16, 899 3 of 7

volume (Table 2). Again the %RSD (relative standard deviation) was high across all but one product

and probably demonstrates the uneven distribution of aluminium throughout the bulk volume of

a product.

Table 2.

Aluminium in ready-to-drink infant formulas designed as supplements for infants struggling

to gain weight. Mean and SD are given, n= 5.

Brand [Al] µg/L

Mean (SD)

Al µg/Serving

(Serving Size mL)

Danone Nutricia Fortini

Smoothie 709.6 (180.3) 141.9 (200 mL)

Danone Nutricia Fortini

Multi Fibre 703.4 (53.7) 140.7 (200 mL)

Danone Nutricia Fortini

Compact Multi Fibre Strawberry 568.2 (65.4) 71.0 (125 mL)

Danone Nutricia Fortini

Compact Multi Fibre Neutral 784.5 (121.7) 98.1 (125 mL)

Nutrinovo

ProSource TF Unﬂavoured 569.2 (18.1) 25.6 (45 mL)

Abbott Nutrition

PediaSure Plus Juice Strawberry 153.5 (161.3) 30.7 (200 mL)

Abbott Nutrition

PediaSure Plus Juice Apple 1956.3 (111.0) 391.3 (200 mL)

NestléHealth Sciences

Resource Fruit 180.2 (62.5) 36.0 (200 mL)

3.3. Powdered Formulas for Allergies and Intolerance

The concentration of aluminium (mean and SD) in the powders ranged from 0.35 (0.03) to 3.27

(0.19)

g/g (Table 3). The amount of aluminium per serving varied from approximately 4–71

g at

birth to 12–92

g at six months of age. Where data were available aluminium per day ranged from

26–231

g at birth to 47–367

g at six months of age. The %RSD (relative standard deviation) for

these products were not especially high which suggested a more even distribution of contaminating

aluminium in powdered products.

Table 3.

Aluminium in powdered formulas designed for infants with allergies and intolerances. Mean

and SD are given, n= 5.

Brand [Al] µg/g

Mean (SD)

Al µg/Serving *

Birth/6 Months

Al µg/Day *

Birth/6 Months

SMA Nutrition

Althera 0.46 (0.14) 6/14 53/69

Abbott Nutrition

Similac Alimentum 1.65 (0.76) 12/38 na/na

Cow & Gate

Pepti Junior 0.53 (0.40) 6/15 35/59

NestléHealth Sciences

Peptamen Junior 1.48 (0.24) 71 (no age spec) na/na

Nutramigen

Pregestimil Lipil 3.27 (0.19) 39/92 231/367

Danone

Aptamil Pepti 1 0.35 (0.03) 4/12 26/47

SMA Nutrition

Lactose Free 1.07 (0.15) 13/35 77/106

* Based upon manufacturer’s instructions.

Int. J. Environ. Res. Public Health 2019,16, 899 4 of 7

3.4. Powdered Formulas with Additional Amino Acids

The concentration of aluminium (mean and SD) in the powders ranged from 0.27 (0.04) to 2.23

(1.23)

g/g (Table 4). The amount of aluminium per serving varied from approximately 4–28

g at

birth to 8–64

g at six months of age. Where data were available aluminium per day ranged from

21–167

g at birth to 24–256

g at six months of age. The %RSD (relative standard deviation) for

these products were not especially high which suggested a more even distribution of contaminating

aluminium in powdered products.

Table 4.

Aluminium in powdered formulas supplemented with additional amino acids. Mean and SD

are given, n= 5.

Brand [Al] µg/g

Mean (SD)

Al µg/Serving *

Birth/6 Months

Al µg/Day *

Birth/6 Months

SMA Nutrition

Alfamino 0.27 (0.04) 4/8 21/24

Danone Nutricia

Neocate LCP 0.29 (0.12) 4/9 24/47

Danone Nutricia

Neocate Junior 0.61 (0.11) 19 (no age spec) na/na

Nutramigen

Puramino 2.23 (1.23) 28/64 167/256

* Based upon manufacturer’s instructions.

4. Discussion

Prescription infant formulas are contaminated with aluminium. Among the ready-made milks

those prescribed as supplements to aid slow growth rate (Table 2) were, with few exceptions,

signiﬁcantly more contaminated than those for pre-term or IUGR infants (Table 1). The Nutricia

Fortini range of products was consistently high in aluminium with concentrations between 500 and

800

g/L. One apple-ﬂavoured product from Abbott Nutrition was contaminated to a level of 2 mg/L

aluminium. For the powdered formulas, those with additional amino acids (Table 4) contained less

aluminium than those designed for allergies and intolerance (Table 3). The Nutramigen Puramino

product was an exception to this rule, while another Nutramigen product (Pregestimil Lipil) was

also the most contaminated of the allergy formulas. When the aluminium contents of all products as

ready-to-use formulas are compared it is interesting to note that powdered products are generally less

contaminated than ready-to-drink products (Table 5). This distinguishes this group of prescription

formulas from previous off-the-shelf products where the powdered forms were found to contain the

highest contents of aluminium [

]. Intriguingly some of the prescription formulas measured herein

were lower in aluminium content (e.g., 41.4 (6.1) to 67.5 (20.5)

g/L) than any other formula product

measured previously in our laboratory (Table 5). This may be indicative that the contamination of infant

formulas by aluminium is not inevitable. It may suggest that selected ingredients added to premium

products can reduce contamination by aluminium and, apparently, irrespective of the aluminium-based

packaging used in all these products. Since all manufacturers of infant formulas deny the knowing

addition of aluminium to their products, it remains a mystery as to its source. The ingredients

supplied to infant formula manufacturers are likely sources of aluminium contamination. For example,

we recently measured the aluminium content of whey protein hydrolysates (on behalf of a major

manufacturer of such products) and found they contained between 4.1 and 8.1

g/g aluminium.

This represents one ingredient of infant formulas that could be contributing signiﬁcant amounts of

aluminium to the ﬁnal product. In the products measured herein and especially the ready-to-drink

supplements (Table 2) it is clear that the inclusion of fruit or fruit ﬂavourings may be importing

aluminium into the ﬁnal product. Finally, the equipment used in processing of formulas could be a

signiﬁcant source of contamination and especially if the containers and utensils used in these operations

are aluminium-based.

Int. J. Environ. Res. Public Health 2019,16, 899 5 of 7

Table 5.

The concentration of aluminium in prescription formulas prepared as per the manufacturer’s

instructions. Powdered formulas are identiﬁed in the table as bold script. Mean and SD are given,

n= 5.

Brand [Al] µg/L

Mean (SD)

SMA Nutrition

Alfamino 41.4 (6.1)

Danone Nutricia

Neocate LCP 44.4 (18.4)

Cow & Gate

Nutriprem 1 49.9 (33.7)

Danone

Aptamil Pepti 1 52.5 (4.5)

SMA Nutrition

Althera 67.5 (20.5)

Cow & Gate

Pepti Junior 75.9 (57.3)

Danone Nutricia

Neocate Junior 130.1 (23.6)

Cow & Gate

Nutriprem 2 139.3 (143.6)

SMA Nutrition

Lactose Free 153.2 (21.5)

Abbott Nutrition

PediaSure Plus Juice Strawberry 153.5 (161.3)

Cow & Gate

Nutriprem Hydrolysed 167.1 (10.6)

NestléHealth Sciences

Resource Fruit 180.2 (62.5)

Danone Nutricia

Infatrini Peptisorb 228.5 (48.3)

Abbott Nutrition

Similac Alimentum 230.8 (106.3)

SMA Nutrition

Pro First Infant Milk 249.4 (64.0)

NestléHealth Sciences

Peptamen Junior 325.6 (52.8)

Nutramigen

Puramino 334.2 (184.3)

Nutramigen

Pregestimil Lipil 468.2 (27.2)

Danone Nutricia Fortini

Compact Multi Fibre Strawberry 568.2 (65.4)

Nutrinovo

ProSource TF Unﬂavoured 569.2 (18.1)

Danone Nutricia Fortini

Multi Fibre 703.4 (53.7)

Danone Nutricia Fortini

Smoothie 709.6 (180.3)

Danone Nutricia Fortini

Compact Multi Fibre Neutral 784.5 (121.7)

Abbott Nutrition

PediaSure Plus Juice Apple 1956.3 (111.0)

Int. J. Environ. Res. Public Health 2019,16, 899 6 of 7

5. Conclusions

Aluminium is toxic in humans [

]. There are no acceptable guidelines for human exposure

to aluminium in adults never mind in newborn infants and we have discussed many times the

inadequacies of such published recommendations [

]. In the meantime, research continues to highlight

the need to reduce exposure to aluminium in infants [

]. We do not know the form of aluminium in

infant formulas and we can only speculate upon how much of this aluminium is absorbed across the

infant gastrointestinal tract [

]. Until such much-needed research is available, precautions should be

taken to reduce infant exposure to aluminium through formula feeding. All infant formula products

reported upon herein were, as appropriate, reconstituted using ultrapure water. Formulas prepared

in the home or elsewhere may use potable, as opposed to ultrapure, water in which the content of

aluminium may additionally be high. Where possible, breast milk feeding should be prioritised, as

the aluminium content of breast milk is invariably an order of magnitude lower than in formula

feeds [

]. Where infant formulas are the only source of nutrition for many infants in their ﬁrst weeks

and months of life [

], aluminium ingested in formula feeds will be the major contributor to their body

burden of aluminium. The last thing that vulnerable infants fed specialised formulas for their speciﬁc

nutritional/medicinal need is additional aluminium in their diet. The encouraging news is that some

of these prescription infant formulas are much less contaminated than their off-the-shelf counterparts

and this highlights what can be achieved in reducing aluminium contamination of formula feeds.

While prescription formulas are invariably more expensive than off-the-shelf products, this should not

preclude future attempts to reduce their contamination and the contamination of infants by aluminium.

Author Contributions:

Conceptualization, C.E.; Data curation, J.R. and I.R.; Formal analysis, J.R. and C.E.;

Investigation, I.R., S.M.-B. and C.E.; Methodology, J.R., I.R. and C.E.; Project administration, S.M.-B.; Resources,

S.M.-B. and C.E.; Supervision, C.E.; Writing—original draft, C.E.; Writing—review & editing, J.R., I.R., S.M.-B. and

C.E.

Funding: The study did not receive any project-speciﬁc funding.

Acknowledgments: IR is in receipt of an ACORN/CMSRI PhD studentship.

Conﬂicts of Interest: The authors declare no conﬂict of interest.

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2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access

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Available via license: CC BY 4.0

Content may be subject to copyright.

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Full-text available

Nov 2024

A series of chemical elements from the chemical composition of the packs of liquid food products migrate inside them or they combine with other chemical elements existing in the food, resulting in chemical compounds that worsen the quality of the food. In the present paper, layers of food stainless steel were deposited using thermal arc spraying on an aluminum alloy substrate to stop the migration of aluminum ions inside liquid food products. The physical-chemical and mechanical properties of the protection system: stainless steel layer used in the food industry (suggestively called: food-grade stainless steel)—aluminum substrate were investigated, and then the organoleptic properties of the food liquids that came into contact with the deposit were evaluated. It was found that food-gradestainless steel deposits have low porosity (3.8%) and relatively high adhesion and hardness, which allows complete isolation of the substrate material. The investigations carried out on the properties of food liquids that come into contact with the stainless steel deposit revealed the fact that it perfectly seals the aluminum start. The food-grade stainless steel coating (80T) was much better and safer for preserving dairy products maintaining a constant acidity up to 17 degrees Thorner, wines (with an average acidity of 3.5–4 degrees), juices (with natural pigments), and oils (with a good absorbance level correlated with clarity). This aspect suggests that the created system can be successfully used to manufacture containers for the transport of liquid products.

Aluminum and Neurodegenerative Disease

Chapter

Jan 2023

Aluminum causes irreversible damage to the development of hippocampal neurons by regulating m6A RNA methylation

Article

Jul 2024
TOXICOL LETT

Autophagie, inflammation et toxicité des particules aluminiques dans un paradigme d’encéphalomyélite myalgique / syndrome de fatigue chronique

Thesis

Full-text available

Dec 2021

Jean-Daniel Masson

La vaccination est une avancée majeure de la médecine moderne ayant permis d’éradiquer certaines maladies et d’endiguer la propagation de nombreuses autres. Malgré une bonne tolérance par la population générale, certains individus présentent des difficultés d’élimination des particules aluminiques utilisées comme adjuvant vaccinaux. Ces patients présentent une lésion histopathologique musculaire caractéristique, biopersistante sur le long terme et composée de cellules immunitaires présentant des inclusions intracellulaires de cristaux aluminiques. Cette lésion, associée à un ensemble d'arthromyalgie, de fatigue chronique et de troubles cognitifs, est appelée myofasciite à macrophages (MFM).Les vaccins à base d’aluminium sont des particules pseudo-infectieuses gérées comme des agents pathogènes par des cellules présentatrices d'antigènes via endocytose et élimination ultérieure par l'intermédiaire de la machinerie xéno/autophagique. Par ailleurs, la littérature scientifique a montré que l’oxy-hydroxyde d'aluminium, l’un des principaux adjuvants, peut perturber la réponse autophagique. Cela conforte l’idée que l’intolérance aux adjuvants aluminiques pourrait être la conséquence d’une interaction de type « gènes x environnement » reposant sur une déficience de l’autophagie dans les cellules de l’immunité comme facteur de susceptibilité individuelle aux particules d’aluminium d’origine vaccinale.Les réponses autophagiques et inflammatoires des cellules immunitaires isolées en réponse aux particules aluminiques n’étant pas totalement caractérisées parmi la population globale. Le travail de thèse présenté dans ce manuscrit a donc eu pour premier objectif d’étudier ces réponses chez des individus sains avant de comparer les résultats avec ceux obtenus chez des individus atteint de MFM. Les données ont démontré que de nombreuses interactions entre les mécanismes d’endocytose, d’autophagie et d’inflammation sont mises en œuvre par les cellules de l’immunité en réponse à la présence de particules d’aluminium. Des expérimentations complémentaires seront nécessaires afin de caractériser finement les différentes intrications entre ces mécanismes. Cependant, certaines observations ont laissé entrevoir de subtiles variations de réponse au sein des cellules immunitaires des patients MFM exposées à des particules aluminiques. Ces cellules ont ainsi présenté un équilibre entre autophagie et endocytose penchant en faveur de l’endocytose et associé à une réponse inflammatoire réduite par rapport aux individus sains. Ces observations sont en accord avec la littérature scientifique actuelle et pourraient être principalement la conséquence plus que la cause de l’état de santé des patients MFM.Suite aux observations in vitro, des analyses exploratoires in vivo ont été menées afin de développer un modèle murin avec des perturbations de l’autophagie pour étudier l’importance de ce mécanisme dans la prise en charge et le devenir des particules aluminiques. Une étude longue a été réalisée pour tester l’efficacité d’un traitement pharmacologique (hydroxychloroquine) à perturber l’autophagie sans induire de toxicité. Nos résultats montrent que, bien qu’apparemment non toxique pour les animaux, le traitement utilisé n’a pas été en mesure de perturber l’autophagie sur le long terme. Par conséquent, l’étude de l’importance du mécanisme autophagique dans la translocation des particules d’aluminium a été réalisée en privilégiant un modèle de KO génétique. Les données ont confirmé les précédentes observations faites sans mettre en avant de rôle majeur de l’autophagie dans le déplacement des particules d’aluminium depuis le site d’injection initial, au regard du faible effectif d’animaux disponibles pour cette étude.En conclusion, ce travail a permis de mettre en évidence une prise en charge des particules aluminiques d’origine vaccinale d’une grande complexité, nécessitant une approche pluridisciplinaire pour être finement décrite.

Aluminum and Neurodegenerative Disease

Chapter

Jul 2021

This review assembles evidence derived from both epidemiological and laboratory studies that suggest exposure to aluminum salts may be more hazardous than generally recognized. The overview describes how available levels of environmental aluminum may be increasing, and it is submitted that this can have adverse health consequences. High levels of aluminum compounds are already recognized as being neurologically harmful, but there is growing evidence that low levels of aluminum can also have adverse consequences. The mechanism by which aluminum salts can promote the onset and development of neurodegenerative diseases is likely by way of acceleration of intrinsic undesirable events that are already taking place in the aging brain. The most deleterious of these is the gradual increase of inflammatory events with age that not associated with any exogenous provocative stimuli. The superfluous inflammation is harmful to cerebral function, and its intensity is further augmented in neurodegenerative disorders such as Alzheimer’s and Parkinson’s diseases. Aluminum at low levels, paralleling those found in some residential drinking water supplies, leads to cerebral inflammation in experimental animals. The variable incidence of Alzheimer’s disease and other age-related neurodegenerative in different populations may be in part due to by the extent of aluminum ingestion. The subtle effects of Al may also be a substantial factor in overall incidence of diseases related to neurosenescence.

Aluminum exposure and toxicity in neonates: A practical guide to halt aluminum overload in the prenatal and perinatal periods

Article

Full-text available

May 2014

During the last years, human newborns have been overexposed to biologically reactive aluminum, with possible relevant consequences on their future health and on their susceptibility to a variety of diseases. Children, newborns and particularly preterm neonates are at an increased risk of aluminum toxicity because of their relative immaturity. Based on recent original publications and classical data of the literatures, we reviewed the aluminum content in mother's food during the intrauterine life as well as in breast milk and infant formula during lactation. We also determined the possible role of aluminum in parenteral nutrition solutions, in adjuvants of vaccines and in pharmaceutical products. A special focus is placed on the relationship between aluminum overexposure and the insurgence of bone diseases. Practical points of management and prevention are suggested. Aluminum sources that infants may receive during the first 6 months of life are presented. In the context of prevention of possible adverse effects of aluminum overload in fetal tissues during development, simple suggestions to pregnant women are described. Finally, practical points of management and prevention are suggested. Pediatricians and neonatologists must be more concerned about aluminum content in all products our newborns are exposed to, starting from monitoring aluminum concentrations in milk- and soybased formulas in which, on the basis of recent studies, there is still too much aluminum.

Analysis of Micronutrients and Heavy Metals in Portuguese Infant Milk Powders by Wavelength Dispersive X-ray Fluorescence Spectrometry (WDXRF)

Article

Full-text available

Jan 2015
FOOD ANAL METHOD

Concentrations of trace mineral nutrients such as Cu, Fe and Zn have been analyzed by WDXRF in eight different infant milk powders, representing the majority of the milk powder brands commercialized in Portuguese pharmacies. Results suggest that the concentrations of some of elements analyzed are not consistent with the values labeled by manufacturers. However, all fall inside the concentration ranges defined by the Portuguese and European legislation, except for Al. The presence of aluminum was detected in all analyzed formulations in an average concentration of 8.25 mg.Kg-1 to 19.75 mg.Kg-1. This study also reveals the feasibility of WDXRF for the quantitative analysis of trace mineral nutrients in milk powder samples. Moreover, the approach described herein, using the WDXRF technique in helium mode, presents a new methodological advantage over similar published studies. This technique may represent an option for quality control of milk powders formulations, particularly at their production site.

Safety of soya-based infant formulas in children

Article

Full-text available

Feb 2014

Soya-based infant formulas (SIF) containing soya flour were introduced almost 100 years ago. Modern soya formulas are used in allergy/intolerance to cows' milk-based formulas (CMF), post-infectious diarrhoea, lactose intolerance and galactosaemia, as a vegan human milk (HM) substitute, etc. The safety of SIF is still debated. In the present study, we reviewed the safety of SIF in relation to anthropometric growth, bone health (bone mineral content), immunity, cognition, and reproductive and endocrine functions. The present review includes cross-sectional, case-control, cohort studies or clinical trials that were carried out in children fed SIF compared with those fed other types of infant formulas and that measured safety. The databases that were searched included PubMed (1909 to July 2013), Embase (1988 to May 2013), LILACS (1990 to May 2011), ARTEMISA (13th edition, December 2012), Cochrane controlled trials register, Bandolier and DARE using the Cochrane methodology. Wherever possible, a meta-analysis was carried out. We found that the anthropometric patterns of children fed SIF were similar to those of children fed CMF or HM. Despite the high levels of phytates and aluminium in SIF, Hb, serum protein, Zn and Ca concentrations and bone mineral content were found to be similar to those of children fed CMF or HM. We also found the levels of genistein and daidzein to be higher in children fed SIF; however, we did not find strong evidence of a negative effect on reproductive and endocrine functions. Immune measurements and neurocognitive parameters were similar in all the feeding groups. In conclusion, modern SIF are evidence-based safety options to feed children requiring them. The patterns of growth, bone health and metabolic, reproductive, endocrine, immune and neurological functions are similar to those observed in children fed CMF or HM.

The aluminium content of infant formulas remains too high

Article

Full-text available

Oct 2013
BMC Pediatr

Recent research published in this journal highlighted the issue of the high content of aluminium in infant formulas. The expectation was that the findings would serve as a catalyst for manufacturers to address a significant problem of these, often necessary, components of infant nutrition. It is critically important that parents and other users have confidence in the safety of infant formulas and that they have reliable information to use in choosing a product with a lower content of aluminium. Herein, we have significantly extended the scope of the previous research and the aluminium content of 30 of the most widely available and often used infant formulas has been measured. Both ready-to-drink milks and milk powders were subjected to microwave digestion in the presence of 15.8 M HNO3 and 30% w/v H2O2 and the aluminium content of the digests was measured by TH GFAAS. Both ready-to-drink milks and milk powders were contaminated with aluminium. The concentration of aluminium across all milk products ranged from ca 100 to 430 mug/L. The concentration of aluminium in two soya-based milk products was 656 and 756 mug/L. The intake of aluminium from non-soya-based infant formulas varied from ca 100 to 300 mug per day. For soya-based milks it could be as high as 700 mug per day. All 30 infant formulas were contaminated with aluminium. There was no clear evidence that subsequent to the problem of aluminium being highlighted in a previous publication in this journal that contamination had been addressed and reduced. It is the opinion of the authors that regulatory and other non-voluntary methods are now required to reduce the aluminium content of infant formulas and thereby protect infants from chronic exposure to dietary aluminium.

Human exposure to aluminium

Article

Full-text available

Aug 2013

Christopher Exley

Human activities have circumvented the efficient geochemical cycling of aluminium within the lithosphere and therewith opened a door, which was previously only ajar, onto the biotic cycle to instigate and promote the accumulation of aluminium in biota and especially humans. Neither these relatively recent activities nor the entry of aluminium into the living cycle are showing any signs of abating and it is thus now imperative that we understand as fully as possible how humans are exposed to aluminium and the future consequences of a burgeoning exposure and body burden. The aluminium age is upon us and there is now an urgent need to understand how to live safely and effectively with aluminium.

Analysis of micronutrients and heavy metals in Portuguese infant milk powders by wavelength dispersive X-ray fluorescence spectrometry (WDXRF)

Article

Jan 2014

Whats in the Bottle? A Review of Infant Formulas

Article

Sep 2016

Infant formulas are designed to be a substitute for breast milk. Since they are sole source of nutrition for growing and developing infants, they are highly regulated by the government. All ingredients in infant formulas must be considered "generally recognized as safe." Manufacturers are continually modifying their products to make them more like breast milk. Functional ingredients added to infant formula include long-chain polyunsaturated fatty acids, nucleotides, prebiotics, and probiotics. The most common breast milk substitutes are standard cow's milk-based term infant formulas, which include subcategories of organic and breast milk supplementation, and come in standard dilutions of 19 or 20 calories per ounce. In addition to standard cow's milk-based term infant formulas, there is a line of term infant formulas marketed for signs and symptoms of intolerance. These products include modifications in lactose content, partially hydrolyzed protein, added probiotics, or added rice starch. There are also specialized formulas for medical conditions such as prematurity, gastrointestinal disorders, allergy, disorders of fat metabolism, and renal insufficiency. Infants on specialty formulas should be monitored closely by medical professionals. Formulas come in ready-to-feed, liquid concentrate, and powder forms. Each offers advantages and disadvantages. Each step in the formula mixing process or each manipulation required for the feeding is another opportunity to introduce bacteria to the formula. There are guidelines for preparing formula in institutions. Standard dilution and mixing instructions are different for each formula, so individual recipes are needed. Caregivers should also be educated on proper hygiene when preparing formula at home.

The toxicity of aluminium in humans

Article

Feb 2016
Morphol Bull Assoc Anat

C. Exley

We are living in the 'aluminium age'. Human exposure to aluminium is inevitable and, perhaps, inestimable. Aluminium's free metal cation, Alaq(3+), is highly biologically reactive and biologically available aluminium is non-essential and essentially toxic. Biologically reactive aluminium is present throughout the human body and while, rarely, it can be acutely toxic, much less is understood about chronic aluminium intoxication. Herein the question is asked as to how to diagnose aluminium toxicity in an individual. While there are as yet, no unequivocal answers to this problem, there are procedures to follow to ascertain the nature of human exposure to aluminium. It is also important to recognise critical factors in exposure regimes and specifically that not all forms of aluminium are toxicologically equivalent and not all routes of exposure are equivalent in their delivery of aluminium to target sites. To ascertain if Alzheimer's disease is a symptom of chronic aluminium intoxication over decades or breast cancer is aggravated by the topical application of an aluminium salt or if autism could result from an immune cascade initiated by an aluminium adjuvant requires that each of these is considered independently and in the light of the most up to date scientific evidence. The aluminium age has taught us that there are no inevitabilities where chronic aluminium toxicity is concerned though there are clear possibilities and these require proving or discounting but not simply ignored.

Renal formulas pretreated with medications alters the nutrient profile

Article

May 2015
PEDIATR NEPHROL

Pretreating renal formulas with medications to lower the potassium and phosphorus content is common in clinical practice; however, the effect of this treatment on other nutrients is relatively unstudied. We examine whether nutrient composition is affected by pretreating renal formulas with sodium polystyrene sulfonate (SPS) suspension and sevelamer carbonate. Fixed medication doses and treatment times were utilized to determine changes in the nutrient composition of Suplena® and Similac® PM 60/40. The effect of simultaneously adding both medications (co-administration) to the formula on the nutrient composition of Suplena® was also evaluated. Pretreatment of Suplena® with SPS reduced the concentrations of calcium (11-38 %), copper (3-11 %), manganese (3-16 %), phosphorus (0-7 %), potassium (6-34 %), and zinc (5-20 %) and increased those of iron (9-34 %), sodium (89-260 %), and sulfur (19-45 %) and the pH (0.20-0.50 units). Pretreatment of Similac® PM 60/40 with SPS reduced the concentrations of calcium (8-29 %), copper (5-19 %), magnesium (3-26 %), and potassium (33-63 %) and increased those of iron (13-87 %) and sodium (86-247 %) and the pH (0.40-0.81 units). Pretreatment of both formulas with the SPS suspension led to significant increases in the aluminum concentration in both formulas (507-3957 %). No differences in potassium concentration were observed between treatment times. Unexpectedly, the levels of neither phosphorus nor potassium were effectively reduced in Suplena® pretreated with sevelamer carbonate alone or when co-administered with SPS. Pretreating formula with medications alters nutrients other than the intended target(s). Future studies should be aimed at predicting the loss of these nutrients or identifying alternative methods for managing serum potassium and phosphorus levels in formula-fed infants. The safety of pretreating formula with SPS suspension should also be examined.

Aluminium, iron and copper in human brain tissues donated to the Medical Research Council's Cognitive Function and Ageing Study

Article

Nov 2011
METALLOMICS

Aluminium, iron and copper are all implicated in the aetiology of neurodegenerative diseases including Alzheimer's disease. However, there are very few large cohort studies of the content of these metals in aged human brains. We have used microwave digestion and TH GFAAS to measure aluminium, iron and copper in the temporal, frontal, occipital and parietal lobes of 60 brains donated to the Cognitive Function and Ageing Study. Every precaution was taken to reduce contamination of samples and acid digests to a minimum. Actual contamination was estimated by preparing a large number of (170+) method blanks which were interspersed within the full set of 700+ tissue digests. Subtraction of method blank values (MBV) from tissue digest values resulted in metal contents in all tissues in the range, MBV to 33 μg g(-1) dry wt. for aluminium, 112 to 8305 μg g(-1) dry wt. for iron and MBV to 384 μg g(-1) dry wt. for copper. While the median aluminium content for all tissues was 1.02 μg g(-1) dry wt. it was informative that 41 brains out of 60 included at least one tissue with an aluminium content which could be considered as potentially pathological (> 3.50 μg g(-1) dry wt.). The median content for iron was 286.16 μg g(-1) dry wt. and overall tissue iron contents were generally high which possibly reflected increased brain iron in ageing and in neurodegenerative disease. The median content for copper was 17.41 μg g(-1) dry wt. and overall tissue copper contents were lower than expected for aged brains but they were commensurate with aged brains showing signs of neurodegenerative disease. In this study we have shown, in particular, the value of carrying out significant numbers of method blanks to identify unknown sources of contamination. When these values are subtracted from tissue digest values the absolute metal contents could be considered as conservative and yet they may still reflect aspects of ageing and neurodegenerative disease in individual brains.