Infant Formulas Are Contaminated with toxic Aluminium

Mothers’ own milk is the best source of nutrition for nearly all infants. Beyond somatic growth, breast milk as a biologic fluid has a variety of other benefits, including modulation of postnatal intestinal function, immune ontogeny, and brain development. 
Mothers’ own milk is considered to be the best source of infant nutrition. In addition to its nutritional advantage, breastfeeding is convenient and inexpensive, and also is a bonding experience for the mother and infant.
During the first six months of infant life, providing optimal nutrition is critical as the consequences of inadequate nutrition can be very severe.

Human breast milk contains carbohydrates, protein, fat, vitamins, minerals, digestive enzymes and hormones. In addition to these nutrients, it is rich in immune cells, including macrophages, stem cells, and numerous other bioactive molecules. Some of these bioactive molecules are protein-derived and lipid-derived, while others are protein-derived and indigestible, such as oligosaccharides. Human milk oligosaccharides (HMOs) possess anti-infective properties against pathogens in the infant gastrointestinal tract, such as Salmonella, Listeria, and Campylobacter, by flooding the infant gastrointestinal tract with decoys that bind the pathogens and keep them off the intestinal wall. Oligosaccharides also play a vital role in the development of a diverse and balanced microbiota, essential for appropriate innate and adaptive immune responses, and help colonize up to 90% of the infant biome. 

Human breast milk is a complex matrix with a general composition of 87% water, 3.8% fat, 1.0% protein, and 7% lactose. The fat and lactose, respectively, provide 50% and 40% of the total energy of the milk. However, the composition of human breast milk is dynamic and changes over time, adapting itself to the changing needs of the growing child. For instance, during each nursing session, the milk that is expressed first (foremilk) is thinner with a higher content of lactose, which satisfies a baby’s thirst, and following the foremilk, hindmilk, is creamier with a much higher content of fat for the baby’s needs.

Remarkably, it has been observed that a mother’s breast milk is almost always adequate in essential nutrients for her term infant’s growth and development, even when her own nutrition is inadequate.

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. 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. Prescription infant formulas are contaminated with aluminium.

Introduction:
It is five years since we last reported the significant contamination of infant formulas by aluminium. 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. Human exposure to aluminium is a serious health concern.

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.

Discussion:
Prescription infant formulas are contaminated with aluminium. Among the ready-made milks those prescribed as supplements to aid slow growth rate were, with few exceptions, significantly more contaminated than those for pre-term or IUGR infants. 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 contained less aluminium than those designed for allergies and intolerance. 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. 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 than any other formula product measured previously in our laboratory. 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 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.

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
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)

Interestingly, a study found that formula milk–induced alterations in gut microbiota shift the tryptophan metabolism from serotonin to tryptamine in the neonatal porcine colon.

Conclusion:
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. 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. 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 Artūras Bartašius

Sources:

  1. Int. J. Environ. Res. Public Health 2019, 16, 899; doi:10.3390/ijerph16050899
  2. Gao, K., Mu, C., Farzi, A., & Zhu, W. (2019). Tryptophan Metabolism: A Link Between the Gut Microbiota and Brain. Advances in Nutrition. doi:10.1093/advances/nmz127 
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4882692/

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