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Prescription Infant Formulas Are Contaminated with Aluminium

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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.
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Int. J. Environ. Res. Public Health 2019, 16, 899; doi:10.3390/ijerph16050899 www.mdpi.com/journal/ijerph
Article
Prescription Infant Formulas Are Contaminated with
Aluminium
James Redgrove 1, Isabel Rodriguez 2, Subramanian Mahadevan-Bava 3 and Christopher Exley 2,*
1 Life Sciences, Huxley Building, Keele University, Staffordshire, ST5 5BG, UK; jamesredgrove11@gmail.com
2 The Birchall Centre, Lennard-Jones Laboratories, Keele University, Staffordshire, ST5 5BG, UK;
i.rodriguez.nunez-milara@keele.ac.uk
3 Russells 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)
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.
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 [1,2]. Recent research, though limited in its scope, suggests that off-the-shelf formulas
remain heavily contaminated [3]. 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 [4]. Many of these products are fed to vulnerable infants
under the expected guidance of a paediatrician. Some may be combined with medication [5].
Human exposure to aluminium is a serious health concern [6]. Aluminium exposure in infants
is understandably a burgeoning issue [7,8]. While infant exposure to aluminium continues to be
Int. J. Environ. Res. Public Health 2019, 16, 899 2 of 7
documented, its consequences, immediate and in the future, have received only scant attention [1,2]
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 [1,2] 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 1–5 for 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 [1,2,9] 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) μg/L while
the amount of aluminium per serving varied from 3.5 to 45.7 μg 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) μg/L
while the amount of aluminium per serving varied from 25.6 to 391.3 μg depending upon serving
volume (Table 2). Again the %RSD (relative standard deviation) was high across all but one product
Int. J. Environ. Res. Public Health 2019, 16, 899 3 of 7
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)
Nestlé Health 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) μg/g (Table 3). The amount of aluminium per serving varied from approximately 4–71 μg at
birth to 12–92 μg at six months of age. Where data were available aluminium per day ranged from
26–231 μg at birth to 47–367 μg 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
Nestlé Health 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) μg/g (Table 4). The amount of aluminium per serving varied from approximately 4–28 μg at
birth to 8–64 μg at six months of age. Where data were available aluminium per day ranged from 21–
167 μg at birth to 24–256 μg 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 μg/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 [2,3]. Intriguingly some of the prescription formulas
measured herein were lower in aluminium content (e.g., 41.4 (6.1) to 67.5 (20.5) μg/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 μg/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)
Nestlé Health 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)
Nestlé Health 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 [10]. 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 [6]. In the meantime, research continues to
highlight the need to reduce exposure to aluminium in infants [7]. 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 [6]. 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 [7]. Where infant formulas are the only source of nutrition for many
infants in their first weeks and months of life [11], 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 conflicts of interest.
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Aluminum (Al), is the third most abundant element in the earth's crust but it is “excluded from biology” as development of all biota has taken place without it and there are no known biological functions linked to it. Currently anthropogenic activities have resulted in great exposure of this non-essential metal to human beings. The intake of Al has implications on human health and increases risk of various diseases. Major sources of Al include occupational exposure, food and water. Water is of greatest concern because Al is commonly bioavailable in water. The alarming situation in Pakistan about Al concentration in drinking water calls for an immediate need to design policies and legislations to ensure below average risk of this metal's effects. Limiting human exposure to Al is the only way to reduce the risk of developing neurodegenerative disorders like Alzheimer's disease (AD). In view of the extensive literature review, we propose development of public health surveillance programs for AI at the policy level.
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The review examines the physicochemical properties, distribution in the environment, the effect on living organisms, including toxicity and ecotoxicity, ways of removing aluminum and its compounds from the human and animal organism. Analysis of scientific literature has shown that the widespread use of aluminum in nature, its use in the agricultural, food, cosmetic, aluminum, oil-producing industries, medicine, water treatment processes and other fields of activity leads to an increased intake of this element into the human body. The cumulative nature of the toxic effect of aluminum and its compounds leads to negative consequences for the respiratory, nervous, musculoskeletal systems, and mammary glands.
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Background: Aluminum exposure may originate from numerous sources, including antiperspirants. Aluminum toxicity can cause a wide range of neurological impairments. Infants are exposed to aluminum through human milk (HM), formulas, total-parenteral-nutrition and vaccines. Due to potential risk of toxicity to both infants and women, it has been advised that lactating women decrease their use of aluminum-based products and antiperspirants. Our study aimed to determine whether the use of aluminum-based antiperspirants (ABA) affects aluminum levels in HM. Methods: This cross-sectional study included healthy mothers who exclusively breastfed infants (1 week to 5 months). Questionnaires were used to collect data on demographics, antiperspirant use and aluminum exposure. Mothers were instructed to express HM during the morning at first breastfeeding session. Aluminum levels were measured by atomic absorption spectrometry with a 5 ppb limit of detection. Results: Fifteen of the 58 (26%) recruited mothers used an aluminum-free antiperspirant (AFA) and 43 (74%) used an ABA. The range of aluminum concentration in HM was 0-100.8 μg/L (mean 11.4 ± 17.4 μg/L). The median aluminum level (Q1-Q3) was 6.5 μg/L (5.2-11.9) and 5.2 μg/L (3.46-9.4) in the AFA and ABA groups, respectively (p = 0.19). The aluminum levels were not affected by maternal age, education, diet, number of children, infant age, lactation stage or self-reported aluminum exposure. Conclusion: The data from this preliminary study demonstrate that the use of an ABA by lactating mothers does not increase their HM aluminum content. Additional studies with a larger cohort are warranted to confirm these findings.
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Aluminum and mercury are environmentally ubiquitous. Individually they are both neurotoxic elements with shared neuro-pathogenic pathways: oxidative stress, altered neurotransmission, and disruption of the neuroendocrine and immune systems. In the infant, Al and Hg differ in type of exposure, absorption, distribution (brain access), and metabolism. In environmentally associated exposure (breast milk and infant formulas) their co-occurrences fluctuate randomly, but in Thimerosal-containing vaccines (TCVs) they occur combined in a proprietary ratio; in these cases, low-doses of Thimerosal-ethylmercury (EtHg) and adjuvant-Al present the most widespread binary mixture in less developed countries. Although experimental studies at low doses of the binary Hg and Al mixture are rare, when studied individually they have been shown to affect neurological outcomes negatively. In in vitro systems, comparative neurotoxicity between Al and Hg varies in relation to the measured parameters but seems less for Al than for Hg. While neurotoxicity of environmental Hg (mainly fish methyl-Hg, MeHg) is associated with neurobehavioral outcomes in children, environmental Al is not associated, except in certain clinical conditions. Therefore, the issues of their neurotoxic effects (singly or combined) are discussed. In the infant (up to six months) the organic-Hg and Al body burdens from a full TCV schedule are estimated to reach levels higher than that originating from breastfeeding or from high aluminum soy-based formulas. Despite worldwide exposure to both Al and Hg (inorganic Hg, MeHg, and Thimerosal/EtHg), our knowledge on this combined exposure is insufficient to predict their combined neurotoxic effects (and with other co-occurring neurotoxicants).
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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.
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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.
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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.
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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.
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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.
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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.
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.
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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.
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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.