Early-life intake of major trace elements, bisphenol A, tetrabromobisphenol A and fatty acids: Comparing human milk and commercial infant formulas

Assessing dietary bisphenol A exposure among Koreans: comprehensive database construction and analysis using the Korea National Health and Nutrition Examination Survey

Bisphenol A (BPA) exposure primarily occurs through dietary intake. This study aimed to estimate the extent of dietary BPA exposure among Koreans. A thorough literature search was conducted to establish a BPA content database encompassing common foods consumed in Korea, including various food raw materials and processed food products. Dietary exposure levels were estimated by integrating the constructed BPA database with comprehensive nationwide 24 h-dietary recall datasets. The finding revealed that dietary BPA exposure was low for most Koreans, with a mean of 14.5 ng/kg bw/day, but was higher for preschool-age children (over 23 ng). Canned foods accounted for 9-36% of the total dietary exposure of the highest dietary exposure groups; while across all age groups, a considerable amount was derived from canned tuna, contribution of canned fruits and canned coffee (milk-containing) was high for preschool-age children and adults, respectively. Notably, for adults, a substantial proportion also stemmed from beer packaged in cans. While diet contributed over 80% of aggregate exposure for most age groups, preschool-age children experienced 60% exposure through diet due to additional exposure from indoor dust. Even at the high exposure scenario, aggregate BPA exposure levels remained lower than the current tolerable daily intake (TDI) set by the Korean agency (20 μg/kg bw/day). Nevertheless, most Koreans were exposed to BPA levels surpassing the strictest TDI (0.2 ng/kg bw/day) set by the European Food Safety Authority.

Bisphenol A and its analogues: from their occurrence in foodstuffs marketed in Europe to improved monitoring strategies-a review of published literature from 2018 to 2023

In this review article, the research works covering the analytical determination of bisphenol A (BPA) and its structural analogues published from 2018 to present (February 2024) were examined. The review offers an overview of the concentration levels of these xenoestrogens in food and beverages, and discusses concerns that these may possibly pose to the human health and scrutinises, from an analytical perspective, the main biomonitoring approaches that are applied. This comes as a natural evolution of a previous review that covered the same topic but in earlier years (up to 2017). As compared to the past, while the volume of published literature on this topic has not necessarily decreased, the research studies are now much more homogeneous in terms of their geographical origin, i.e., Southern Europe (mainly Italy and Spain). For this reason, an estimated daily intake of the European population could not be calculated at this time. In terms of the analytical approaches that were applied, 67% of the research groups exploited liquid chromatography (LC), with a detection that was prevalently (71%) afforded by mass spectrometry, with over one-fourth of the research teams using fluorescence (26%) and a minority (3%) detecting the analytes with diode array detection. One-third of the groups used gas chromatography (GC)-mass spectrometry achieving comparatively superior efficiency as compared to LC. Derivatisation was performed in 59% of the GC studies to afford more symmetrical signals and enhanced sensitivity. Although the contamination levels are well below the threshold set by governments, routinely biomonitoring is encouraged because of the possible accumulation of these contaminants in the human body and of their interplay with other xenoestrogens.

Estimated exposure to bisphenol A in breastfed and breastfed plus formula-fed infants in Turkey: a comparison study

This study aimed to estimate and compare dietary exposure to bisphenol A (BPA) in exclusively breastfed (EBF) and breastfed plus formula-fed (BF + FF) infants. A total of 70 mothers and their 0-6 month-old infants (40 in the EBF group and 30 in BF + FF group) were included in the study. After the questionnaire form was applied to the mothers, maternal breast milk, infant formula, and infant urine were collected from mother-infant dyads. Total BPA levels in breast milk, infant formula, and infant urine samples were analyzed by the high-pressure liquid chromatography (HPLC). While BPA was detected in 92.5% of the breast milk samples in the EBF group (mean ± SD = 0.59 ± 0.29 ng/mL), BPA was detected in all of the breast milk samples in the BF + FF group (mean ± SD= 0.72 ± 0.37 ng/mL) (p < 0.05). Similarly, 100% of the infant formula samples in the BF + FF group had detectable levels of BPA (mean ± SD = 7.54 ± 1.77 ng/g formula). The mean urinary BPA levels in the EBF infants (4.33 ± 1.89 µg/g creatinine) were not statistically different from the BF + FF infants (5.81 ± 0.11 µg/g creatinine) (p > 0.05). The average daily BPA intake in EBF infants (0.18 ± 0.13 µg/kg body weight (bw)/day) was found to be significantly higher than in BF + FF infants (0.12 ± 0.09 µg/kg bw/day) (p < 0.05). The estimated dietary intakes of BPA for infants in both groups were below the temporary tolerable daily intake (t-TDI) (4 µg/kg bw/day). Consequently, BPA intake of EBF and BF + FF infants were within safe daily limits during the first six months of life.

Optimizing ARA and DHA in infant formula: A systematic review of global trends, regional disparities, and considerations for precision nutrition

In the context of precision nutrition, the addition of ARA and DHA in infant formula needs to consider more factors. This study conducted a comprehensive literature review, including 112 relevant Chinese and English articles, to summarize and analyze the global levels of ARA, DHA, and the ARA/DHA ratio in breast milk. The data were correlated with local aquatic products intake and children's IQ. The results indicated that the average level of DHA in breast milk across regions is lower than that of ARA. Variations in DHA content were identified as a primary factor influencing ARA/DHA ratio fluctuations. Breast milk ARA and DHA levels decrease with prolonged lactation periods but increase over the past 22 years. Correlation analysis revealed a significant positive relationship between aquatic products intake and breast milk DHA levels (r = 0.64, p < 0.05). Breast milk DHA levels also showed a significant positive correlation with children's IQ (r = 0.67, p < 0.01). Stable breast milk ARA content did not exhibit significant correlations with aquatic products intake or children's IQ (r = 0, p > 0.05). Among 22 infant formula products available in China, only 5 had ARA levels within the range of breast milk. Most formula products had higher ARA levels than DHA, resulting in ARA/DHA ratios generally exceeding 1. The temporal and spatial variability in breast milk ARA and DHA levels may lead to diverse health outcomes in infants. Therefore, the addition of ARA and DHA in infant formula should consider this variability, including the molecular forms and positional isomerism of the added ARA and DHA. Additionally, considering the impact of different cognitive development tests and infant's gene expression on formula assessment results, there is a need to establish a more comprehensive infant health assessment system to guide the addition of ARA and DHA in formula.

Concentrations of Lead and Arsenic in Mother's Milk and Children's Blood in Peruvian Breastfeeding Dyads

BACKGROUND

Toxic trace elements could enter human milk through mothers' food consumption, drinking water, air, or incidental soil ingestion, and are of concern to the nursing infant.

RESEARCH AIM

To determine the concentration of toxic trace elements (lead and arsenic) in Peruvian mothers' milk and their association with blood concentrations in their own infants 3-20 months old.

METHOD

This exploratory, cross-sectional study, carried out in Peru, included breastfeeding mother/child dyads (N = 40). Following standardized protocols, biospecimens of human milk and child's blood were collected.

RESULTS

Lead and arsenic concentrations in milk were above the method detection limits in 73% and 100% of samples with median concentrations of 0.26 µg/L (IQR = 0.10, 0.33 µg/L) and 0.73 µg/L (IQR = 0.63, 0.91 µg/L), respectively. Concentrations of lead and arsenic in blood were 2.05 µg/dL (SD = 1.35), and 1.43 µg/dl (geometric mean: SD = 1.39), respectively. Blood lead concentrations in 12.5% (n = 5) of the samples were above the U.S. Center for Disease Control and Prevention reference value (< 3.5 µg/dl), and over half of arsenic concentrations were above the acceptable levels of < 1.3 µg/dl (Mayo Clinic Interpretative Handbook). Our results showed that for every one-month increase in age, lead blood concentrations increased by 0.1 µg/dl (p = 0.023). Additionally, every 1 µg/L increase in the mother's milk arsenic was associated with a 1.40 µg/dl increase in the child's blood arsenic concentration.

CONCLUSIONS

Implementing effective interventions to decrease the toxic exposure of reproductive-aged women is needed in Peru and worldwide.

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.

Estimated daily intake and health risk assessment of toxic elements in infant formulas

In this study, the heavy metal (Al, Mn, Co, Cu, Zn, As, Se, Cd, Sn, Pb and Hg) concentrations were determined in a total of seventy-two infant formula samples manufactured by sixteen different brands in Türkiye. During the analyses, inductively coupled plasma MS was used in evaluating the nutritional profile and the toxicological risk associated with the consumption of these products. Given the analysis results, the highest Pb content was found in milk-based 'beginner' formulas (0-6 months, three samples) packed in metal containers. The highest concentration of Mn was found in powdered infant formula (Brand 3) that is suitable for 9-12-month-olds. Mn level was found to be above the limit values in nine samples (12·5 %). Cd level exceeded the limit values in two infant formula samples of Brand 3 (0·038 µg/g) and Brand 15 (0·023 µg/g). Therefore, the mean Cd concentration found here reaches the maximum limit set by the European Union commission legislation. Cu was detected in all infant formulas. The highest concentration was determined in Brand 1 (9-12 months, seven samples) and found to be 2·637 (sd 1·928) µg/g. This value is much higher than the reference values set in the national and international standards. Based on the results achieved here, the estimated daily intake (EDI) and target hazard quotient values for all the metals in infant formulas were found lower than < 1. These findings suggest that the baby foods examined would not pose any health risk. The daily intakes exceeding the baby nutrition values recommended by the WHO would pose health risk since they would exceed the EDI levels.

Assessing heavy metal levels in pediatric enteral nutrition formulas available in the Turkish market: Implications for consumer health

In this study, we assessed the levels of lead (Pb), cadmium (Cd), mercury (Hg), and inorganic arsenic (iAs) in 27 pediatric enteral nutrition (EN) formulas from five international brands available in the Turkish market. Analysis was conducted using inductively coupled plasma mass spectrometry (ICP-MS). Non-carcinogenic and carcinogenic risk assessment was performed using hazard quotient (HQ), hazard index (HI), carcinogenic risk (CR), Toxicological contribution % of Provisional Tolerable Weekly Intake (PTWI) models. Our objective was to evaluate heavy metal exposure in EN formulas, specifically focusing on Cd, Pb, iAs, and Hg levels according to recommended amounts for different age groups based on their energy requirements. Average concentrations of iAs in polymeric (PC), oligomeric (OC), and monomeric (MC) EN formulas were as follows: PC: 2.13 ± 0.16 ( Collapse

Key Words

• Carcinogenic risk
• Enteral nutrition formula
• Hazard quotient
• Health risk assessment
• Heavy metal

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MESH Headings

• Female
• Child
• Humans
• Male
• Cadmium/analysis
• Enteral Nutrition
• Lead
• Metals, Heavy/analysis
• Mercury/analysis
• Risk Assessment

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Affiliation(s)

Gursel Isci Department of Nutrition and Dietetics, Faculty of Health Sciences, Agri Ibrahim Cecen University, 04100, Agri, Turkey.
Betul Orucoglu Department of Nutrition and Dietetics, Faculty of Health Sciences, Afyonkarahisar Health Sciences University, 03100, Afyonkarahisar, Turkey.
Merve Ekici Department of Nutrition and Dietetics, Faculty of Health Sciences, Agri Ibrahim Cecen University, 04100, Agri, Turkey; Department of Nutrition and Dietetics, Institute of Health Sciences, Acıbadem Mehmet Ali Aydınlar University, 34758, Istanbul, Turkey.

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A Review on Tetrabromobisphenol A: Human Biomonitoring, Toxicity, Detection and Treatment in the Environment

Tetrabromobisphenol A (TBBPA) is a known endocrine disruptor employed in a range of consumer products and has been predominantly found in different environments through industrial processes and in human samples. In this review, we aimed to summarize published scientific evidence on human biomonitoring, toxic effects and mode of action of TBBPA in humans. Interestingly, an overview of various pretreatment methods, emerging detection methods, and treatment methods was elucidated. Studies on exposure routes in humans, a combination of detection methods, adsorbent-based treatments and degradation of TBBPA are in the preliminary phase and have several limitations. Therefore, in-depth studies on these subjects should be considered to enhance the accurate body load of non-invasive matrix, external exposure levels, optimal design of combined detection techniques, and degrading technology of TBBPA. Overall, this review will improve the scientific comprehension of TBBPA in humans as well as the environment, and the breakthrough for treating waste products containing TBBPA.

Assessment of the Composition of Breastmilk Substitutes, Commercial Complementary Foods, and Commercial Snack Products Commonly Fed to Infant and Young Children in Lebanon: A Call to Action

(1) Background: Nutrition for optimum growth and physical development is acquired by adequate infant feeding practices. (2) Methods: One hundred seventeen different brands of infant formulas (n = 41) and baby food products (n = 76) were selected from the Lebanese market and were analyzed for their nutritional content. (3) Results: Saturated fatty acid content was detected to be the highest in follow-up formulas (79.85 g/100 g) and milky cereals (75.38 g/100 g). Among all saturated fatty acids, palmitic acid (C16:0) accounted for the greatest proportion. Moreover, glucose and sucrose were the predominant added sugars in infant formulas, while sucrose was the main added sugar in baby food products. Our data showed that the majority of the products were non-compliant to the regulations and the manufacturers' nutrition facts labels. Our results stated also that the contribution to the daily value for the saturated fatty acids, added sugars, and protein exceeded the daily recommended intake for most infant formulas and baby food products. (4) Conclusions: This requires careful evaluation from policymakers in order to improve the infant and young children feeding practices.

Legacy and novel brominated flame retardants in animal-derived foods from China Total Diet Study (CTDS): Temporal trends, evidence of substitution, and dietary exposure assessment

Based on the 6th China Total Diet Study (CTDS) conducted in 2016-2019, the occurrence of both legacy and novel brominated flame retardants (BFRs) was measured in animal-derived foods collected across China. Most BFRs could be frequently detected in food samples, indicating their ubiquity in the environment. Decabromodiphenyl ethane (DBDPE), a typical novel BFR, presented the highest contamination level, whereas legacy BFRs, including decabrominated diphenyl ether (BDE-209), tetrabromobisphenol A (TBBPA), and hexabromocyclododecane (HBCDD), still presented high detection frequencies and relatively abundant proportions in total BFRs. Compared with previous CTDSs conducted from 2007 to 2011, the levels and estimated dietary intakes (EDIs) of most BFRs showed a significant downtrend, which suggested that flame retardant consumption in China has transferred from legacy BFRs to novel BFRs (mainly DBDPE) and from BFRs to other kinds of flame retardants. Based on probabilistic estimation, the median EDIs of mainly used BFRs for the Chinese population ranged from 41.0 to 1.67 × 10³ pg/kg bw/day, and meat consumption was the primary source in dietary BFR intake. By conducting the margin of exposure (MOE) approach or comparing with the reference dose (RfD), it can be concluded that daily dietary intakes of BFRs were still unable to cause significant health risks to the general population in China.

Infant exposure to trace elements in breast milk, infant formulas and complementary foods from southern China

Excessive intake of essential trace elements or exposure to potentially toxic elements above certain thresholds may cause adverse health effects in humans. To date, there is scarce evidence concerning Chinese infant exposure to trace elements and the associated risks. In this study, we collected 61 breast milk, 54 infant formula and 90 complementary food samples from southern China to investigate the levels of cobalt (Co), chromium (Cr), copper (Cu), selenium (Se), zinc (Zn), arsenic (As), cadmium (Cd), nickel (Ni) and lead (Pb). The concentrations of these elements in the breast milk samples ranged from under the limit of detection (<LOD)-0.65, <LOD-65.5, 107-1040, 6.17-27.9, 820-10,160, <LOD-2.96, <LOD-0.52, <LOD-230, and <LOD-19.1 μg/L, respectively. In infant formula samples, the concentrations of these elements ranged from 2.77 to 7.56, 27.5-205, 188-4321, 69.7-322, 40,793-84,405, 2.47-12.2, 0.15-3.57, <LOD-505 and 2.19-26.5 μg/kg, respectively, while the concentrations detected in complementary food samples ranged from <LOD-23.7, <LOD-224, <LOD-3705, <LOD-219, 15,335-100,905, <LOD-159, <LOD-66.6, <LOD-502 and <LOD-25.6 μg/kg, respectively. The results showed that the levels of Cr, Cu and Se in 14.8-55.6 % of the infant formula and complementary food samples were lower than the reference values set by Codex Alimentarius or Chinese National Standards, while the levels of Zn in commercial food samples exceeded the corresponding reference values in 9.3-27.8 % of cases; these results suggest a potential risk via the consumption of commercial infant foods. To the best of our knowledge, this is the first study that has comprehensively assessed whether exposure to trace elements via food intake poses potential health risks to Chinese infants.

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.

Biomonitoring bisphenols, parabens, and benzophenones in breast milk from a human milk bank in Southern Spain

BACKGROUND

Human breast milk is considered the optimal source of nutrition for infants. Milk from breast milk banks offers an alternative to infant formulas for vulnerable hospitalized neonates most likely to benefit from exclusive human milk feeding. However, breast milk can also be a source of exposure to environmental contaminants, including endocrine-disrupting chemicals (EDCs).

AIM

To evaluate concentrations of phenolic EDCs, including bisphenols, parabens (PBs), and benzophenones (BPs), in samples from a human milk bank in Granada, Southern Spain and to explore sociodemographic, reproductive, and lifestyle factors related to their concentrations in the milk.

METHODS

Concentrations of three bisphenols [bisphenol A (BPA), bisphenol F (BPF), and bisphenol S (BPS)], four PBs [methyl- (MeP), ethyl- (EtP), propyl- (n-PrP), and butyl-paraben (n-BuP)], and six BPs [BP-1, BP-2, BP-3, BP-6, BP-8, and 4-hydroxy-BP] were determined in milk samples from 83 donors. Information on potential explanatory variables was gathered using the milk bank donor form and an ad hoc questionnaire. Multiple linear and logistic regression models were fitted.

RESULTS

Detectable concentrations were found of at least one of the analyzed compounds in all donor breast milk samples and at least five compounds in one-fifth of them. The most frequently detected compounds were MeP (90.5%), BP-3 (75.0%), EtP (51.2%), n-PrP (46.4%), and BPA (41.7%). Median concentrations ranged between <0.10 ng/mL (n-PrP, n-BuP, BP-1) and 0.59 ng/mL (BP-3). No sample contained detectable concentrations of BPF, BPS, or most BPs (BP-2, BP-6, BP-8, and 4- hydroxy-BP). Breast milk phenol concentrations were associated with parity, the utilization of deodorants, mouthwash, skin care products, and cosmetics, and the intake of nutritional supplements.

CONCLUSIONS

Results reveal the widespread presence of BPA, PBs, and BP-3 in donor breast milk samples, highlighting the need for preventive measures to enhance the benefits of breast milk from milk banks and from breastfeeding women in general.

Hollow fiber membrane-protected amino/hydroxyl bifunctional microporous organic network fiber for solid-phase microextraction of bisphenols A, F, S, and triclosan in breast milk and infant formula

Bisphenols and triclosan have been used in various products, and exposure to these chemicals may affect human health. The present study proposes a sensitive method for the determination of bisphenols A, F, S, and triclosan. The fiber was coated by amino/hydroxyl bifunctional microporous organic network and protected by polyvinylidene fluoride hollow fiber membrane for direct immersion solid phase microextraction. The limit of detection was 0.005 μg/L (μg/kg), and the recoveries were in the range of 76.7% to 107.5% (87.4% to 107.6%) for breast milk (infant formula), with intra-day and inter-day precisions <10.5% (7.3%) and 13.6% (8.4%), respectively. Fiber-to-fiber reproducibility of < 9.5% and a lifespan of >100 cycles were obtained. The 95th percentile estimated daily intake of total bisphenols was close to temporary tolerable daily intake for infants fed by human milk, which highlighted the needs for further attention on human exposure to BPA and its substitutes.

A Rapid Routine Methodology Based on Chemometrics to Evaluate the Toxicity of Commercial Infant Milks Due to Hazardous Elements

The toxicity and the health risk assessment associated to the presence of some hazardous elements (HEs) in dried (infant formula and powdered) milks due to manufacturing and packaging process, raw materials used, environmental conditions, etc. need to be determined. With this aim, a new methodology based on the combination of health risk quotients and non-supervised (as cluster analysis (CA) and principal component analysis (PCA)) chemometric techniques is proposed in this study. The methodology was exemplified using the concentration of 27 elements, some of them HEs, measured in 12 powdered milk samples produced for children and adults in Brazil and Colombia. The concentration values were obtained by inductively coupled plasma-mass spectrometry (ICP-MS) after acid microwave digestion. Elemental concentrations vary depending upon the type of milk (initiation, growing-up, follow-on milks and adult milks). However, hazard quotients (HQ) and carcinogenic risk (CR) values showed no risk associated to the presence of HEs on milks. The methodology designed made possible to conclude that adults’ milks are more characteristic of elements naturally present in milk. Children milks present major presence of trace and minor elements. Between infant milks, sample H, designed for babies between 12 and 36 months, was identified as of poor quality. Moreover, it was possible to deduce that while the fortification process applied to children powdered milks is a probable metal and metalloid source, together with the manufacturing, the skimming process is not a contamination source for milks.

Graphical abstract

Concentrations of bisphenols, parabens, and benzophenones in human breast milk: A systematic review and meta-analysis

BACKGROUND

Breast milk is the main source of nutrition for infants but may be responsible for their exposure to environmental chemicals, including endocrine-disrupting chemicals.

AIM

To review available evidence on the presence and concentrations of bisphenols, parabens (PBs), and benzophenones (BPs) in human milk and to explore factors related to exposure levels.

METHODS

A systematic review was carried out using Medline, Web of Science, and Scopus databases, conducting a comprehensive search of peer-reviewed original articles published during the period 2000-2020, including epidemiological and methodological studies. Inclusion criteria were met by 50 studies, which were compiled by calculating weighted detection frequencies and arithmetic mean concentrations of the chemicals. Their risk of bias was assessed using the ROBINS-I checklist.

RESULTS

Among the 50 reviewed studies, concentrations of bisphenols were assessed by 37 (74.0%), PBs by 21 (42.0%), and BPs by 10 (20.0%). Weighted detection frequencies were 63.6% for bisphenol-A (BPA), 27.9-63.4% for PBs, and 39.5% for benzophenone-3 (BP-3). Weighted mean concentrations were 1.4 ng/mL for BPA, 0.2-14.2 ng/mL for PBs, and 24.4 ng/mL for BP-3. Mean concentrations ranged among studies from 0.1 to 3.9 ng/mL for BPA, 0.1 to 1063.6 ng/mL for PBs, and 0.5 to 72.4 ng/mL for BP-3. The highest concentrations of BPA and PBs were reported in samples from Asia (versus America and Europe). Higher BPA and lower methyl-paraben concentrations were observed in samples collected after 2010. Elevated concentrations of these chemicals were associated with socio-demographic and lifestyle factors in eight studies (16.0%). Two epidemiological studies showed moderate/serious risk of bias.

CONCLUSIONS

This systematic review contributes the first overview of the widespread presence and concentrations of bisphenols, PBs, and BPs in human breast milk, revealing geographical and temporal variations. The methodological heterogeneity of published studies underscores the need for well-conducted studies to assess the magnitude of exposure to these chemicals from human milk.

The Crowded Uterine Horn Mouse Model for Examining Postnatal Metabolic Consequences of Intrauterine Growth Restriction vs. Macrosomia in Siblings

Differential placental blood flow and nutrient transport can lead to both intrauterine growth restriction (IUGR) and macrosomia. Both conditions can lead to adult obesity and other conditions clustered as metabolic syndrome. We previously showed that pregnant hemi-ovariectomized mice have a crowded uterine horn, resulting in siblings whose birth weights differ by over 100% due to differential blood flow based on uterine position. We used this crowded uterus model to compare IUGR and macrosomic male mice and also identified IUGR males with rapid (IUGR-R) and low (IUGR-L) postweaning weight gain. At week 12 IUGR-R males were heavier than IUGR-L males and did not differ from macrosomic males. Rapid growth in IUGR-R males led to glucose intolerance compared to IUGR-L males and down-regulation of adipocyte signaling pathways for fat digestion and absorption and type II diabetes. Macrosomia led to increased fat mass and altered adipocyte size distribution compared to IUGR males, and down-regulation of signaling pathways for carbohydrate and fat digestion and absorption relative to IUGR-R. Clustering analysis of gonadal fat transcriptomes indicated more similarities than differences between IUGR-R and macrosomic males compared to IUGR-L males. Our findings suggest two pathways to adult metabolic disease: macrosomia and IUGR with rapid postweaning growth rate.

Dietary Habits and Relationship with the Presence of Main and Trace Elements, Bisphenol A, Tetrabromobisphenol A, and the Lipid, Microbiological and Immunological Profiles of Breast Milk

Breastfeeding is the best way to feed an infant, although it can also be a source of abiotic contaminants such as heavy metals or bisphenol A (BPA). The early life exposure to these compounds can lead to serious toxic effects in both the short and long-term. These substances can reach breast milk through the mother’s habits, diet being one of the main routes of exposure. The aim of the present work was to analyse possible associations between the dietary habits of women and the content of major trace elements, BPA, fatty acids and lipids, and the microbiological and immunological profiles of human milk. Possible associations between major trace elements and BPA and the lipid, microbiological and immunological profiles were also analysed. The results of this study support that the microbiological composition of human milk is associated with the dietary habits of the women, and that the consumption of canned drinks is related to the presence of BPA in human milk. Furthermore, some relationships were found between the amount of major trace elements and the microbiological and immunological profile of the milk samples. Finally, the presence of BPA was associated with changes in the immunological profile of human milk.

The internal exposure of bisphenol analogues in South China adults and the associated health risks

Bisphenol A (BPA) is widely applied in industrial products and household products, leading to ubiquitous occurrences in environmental and biological samples. However, knowledge on human internal exposure to bisphenol analogues remains limited. Our study determined nine bisphenol analogues in urine samples collected from 1168 South China adults. BPA and bisphenol F (BPF) exhibited the highest detection frequencies in urine, i.e., 99.4% and 74.6%, respectively. BPA dominated over other analogues, with a median concentration of 1.74 μg/L, while BPF had a median concentration of 0.08 μg/L. Significant positive correlation was observed between urinary BPA and BPF (r = 0.201, p < 0.01), indicating similar exposure sources or pathways of these two chemicals. Urinary BPA concentrations were significantly correlated with age, marital status, drinking status and history of hyperlipidemia (p < 0.05). The median estimated daily intake (EDI) of Σ₃BPs (the sum concentrations of BPA, BPF and BPAF) was determined to be 53.6 ng/kg-bw/day for adults. The EDIs were much lower than the temporary tolerable reference dose of BPA recommended by the European Food Safety Authority, indicating the bisphenol analogues presented no obvious health risks to South China adults.

Assessment of the Risk of Contamination of Food for Infants and Toddlers

Infants and toddlers are highly sensitive to contaminants in food. Chronic exposure can lead to developmental delays, disorders of the nervous, urinary and immune systems, and to cardiovascular disease. A literature review was conducted mainly in PubMed, Google Scholar and Scopus databases, and took into consideration papers published from October 2020 to March 2021. We focused on contaminant content, intake estimates, and exposure to contaminants most commonly found in foods consumed by infants and children aged 0.5-3 years. In the review, we included 83 publications with full access. Contaminants that pose a high health risk are toxic elements, acrylamide, bisphenol, and pesticide residues. Minor pollutants include: dioxins, mycotoxins, nitrates and nitrites, and polycyclic aromatic hydrocarbons. In order to reduce the negative health effects of food contamination, it seems reasonable to educate parents to limit foods that are potentially dangerous for infants and young children. An appropriate varied diet, selected cooking techniques, and proper food preparation can increase the likelihood that the foods children consume are safe for their health. It is necessary to monitor food contamination, adhere to high standards at every stage of production, and improve the quality of food for children.

[Occupational exposures, diet and storing: Recommendations to reduce environmental pollutants in breastfeeding]

The pollution of the planet also reaches the breastfeeding ecosystem, one of the most intimate and inviolable that links us as an animal species to the rest of mammals. Nursing mothers may be concerned about whether the quality of their milk will be adequate for their baby and whether environmental pollutants through work, diet, and storing may adversely affect their child. Breast milk is a source of exposure to environmental pollutants, and at the same time it counteracts much of the effects of these exposures. An approach based on the principles of reality and precaution of environmental health to avoid, reduce or eliminate the production and use of harmful chemicals during pregnancy and lactation would improve the human and planetary health for the offspring.

Uma abordagem dos ensaios in vitro para estimar a absorção dos minerais em fórmulas infantis

Resumo A fórmula infantil é a opção de alimento mais recomendada quando a amamentação não é possível. Para o melhor entendimento do comportamento gastrointestinal e da absorção dos nutrientes presentes nas fórmulas infantis, realizam-se estudos que simulam os processos de digestão. Este trabalho teve como objetivo discutir a evolução das fórmulas infantis com foco na avaliação da absorção de Ca, Cu, Fe, K, Mg, Mn, P e Zn, identificando métodos disponíveis para a avaliação de bioacessibilidade e de biodisponibilidade, de forma a melhor entender a absorção desses nutrientes. Para isto, foi realizada uma revisão bibliográfica sobre fórmulas infantis e os métodos in vitro mais utilizados no estudo de minerais, com foco no consumo, na qualidade e nos aspectos tecnológicos. Foi constatada uma tendência mundial no aumento do consumo de fórmulas infantis e verificou-se que estudos de biodisponibilidade e bioacessibilidade de minerais, mesmo que ainda escassos, colaboram para a evolução e o desenvolvimento deste produto, visando a uma aproximação com a composição do leite materno. A pesquisa mostrou que a composição da fórmula infantil vem sendo constantemente aperfeiçoada por revisões das legislações e pela indústria, e que, para a obtenção de uma fórmula infantil com alta capacidade de absorção de nutrientes, devem ser realizados estudos de bioacessibilidade e/ou de biodisponibilidade, pois estes estudos possibilitam uma melhor compreensão da influência dos diferentes ingredientes na absorção dos nutrientes. Os estudos também mostraram que, para uma ingestão mais equilibrada, nas diferentes fases do lactente, são necessárias diferentes composições dos nutrientes nas fórmulas infantis.

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.

Essential and toxic elements in human milk concentrate with human milk lyophilizate: A preclinical study

Concentrated human milk (HM-concentrate) can be obtained from the simple and inexpensive method of donated breast milk direct lyophilization. A previous study reported that HM-concentrate contains the adequate amount of main macro- and micronutrients for use as a nutritional resource for preterm infants with very low birth weight admitted to neonatal intensive care units. However, further details need to be elucidated about HM-concentrate composition, particularly its content of essential and potentially toxic trace elements. Therefore, this study aimed to determine the concentration of essential and toxic elements in human milk considered baseline (HM-baseline) and HM-concentrate, as well as to quantify changes in concentration of these elements after the HM concentration process. The concentration of Aluminum, Arsenic, Cadmium, Chromium, Iron, Mercury, Manganese, Nickel, Lead, Selenium, Tin, and Thallium was analyzed by inductively coupled plasma-mass spectrometry (ICP-MS). Moreover, Bayesian linear mixed effect models were applied to estimate the mean difference between HM-baseline and HM-concentrate samples. After comparison (HM-concentrate versus HM-baseline), a significant increase in concentration was observed only for Manganese (0.80 μg/L; 95% CrI [0.16; 1.43]) and Selenium (6.74 μg/L; 95% CrI [4.66; 8.86]), while Lead concentration (-6.13 μg/L; 95% CrI [-8.63; -3.61]) decreased. This study provides latest and reliable information about HM composition. After milk concentration by lyophilization, there was a significant increase only in the essential elements Manganese and Selenium. The essential micronutrient content in HM-concentrate was similar or higher than that in preterm mothers' milk, which suggests it is viable for nutritional support of preterm infants. In addition, the low concentrations of potentially toxic elements in HM-concentrate indicates that it is safe for consumption by premature newborns.

Biomonitoring of co-exposure to bisphenols by consumers of canned foodstuffs

For non-occupationally exposed adults, dietary intake is the main route of exposure to bisphenols (BPs), with canned foodstuffs playing a key role. This study was aimed at biomonitoring bisphenol A (BPA) and 5 more BP analogues (BPB, BPE, BPF, BPAF and BPZ) in spot urine and blood samples of a cohort of adults, who followed a diet based on a high consumption of canned food. To the best of our knowledge, this is the first study aimed at assessing the co-exposure of BP analogues in food and biological samples after a two-day duplicate diet study. The estimated total dietary exposure was 0.37 and 0.045 µg/kg body weight/day, for the canned-diet and control groups, respectively. BPA was the compound with the highest concentration in urine in comparison with the values of the remaining BP analogues. A high detection rate of BPA was noted in urine for both groups, 96% for the canned-diet group and 90% for the control group, while in blood it could be only quantified in 6% of the samples. The identification of other analogues was hardly related to diet, so it could be the result of other potential exposure sources, such as personal care products (PCPs) or air inhalation. After 2 days, the excretion of BPA was considerably higher in the canned-diet group subjects than those in the control group (7.02 vs. 1.89 µg/day), confirming that diet and canned foodstuffs are the main route of exposure to BPA. Anyhow, the temporary tolerable daily intake (t-TDI) established by the EFSA was not exceeded, even by those consumers with a diet rich in canned food. Moreover, spot urine samples provided accurate information about exposure and excretion of BPA, being the 4 h, instead of 24 h, the optimal sampling interval, when the collection of spot urine samples is not possible.

Tetrabromobisphenol A and hexabromocyclododecane isomers in breast milk from the general population in Beijing, China: Contamination levels, temporal trends, nursing infant's daily intake, and risk assessment

Two currently used brominated flame retardants (BFRs), α, β, γ-hexabromocyclododecane (HBCDD) and tetrabromobisphenol A (TBBPA), were measured in 111 breast milk samples from 37 Beijing mothers. Each mother provided one milk sample per month for 3 months. HBCDD was detected in almost all samples, and the median level reached 5.67 ng g^-1 lipid weight (lw). α- HBCDD was the most abundant isomer (median: 4.23 ng g^-1 lw), followed by γ- and β-HBCDD. For TBBPA, a relatively lower detecting frequency (64%) and contamination level (median: 1.57 ng g^-1 lw) were obtained. A comparison to our previous study revealed that the occurrence of TBBPA and HBCDD in Beijing human milk significantly rose from 2011 to 2014, whereas another commonly used class of BFRs, polybrominated diphenyl ethers (PBDEs), showed significantly decreased during this period. However, a comparison among currently used BFRs showed that levels of some BFRs, such as HBCDD, surpassed those of PBDEs, which indicated that PBDEs were no longer the primarily used BFR in China. However, no significant temporal trends for BFR levels were observed over the 3 months of lactation. Daily intakes of TBBPA and HBCDD were calculated for nursing infants and the median TBBPA and HBCDD intakes via breastfeeding were 6.62 and 26.4 ng kg^-1 bw day^-1, respectively. These values were several times higher than those for adults via food consumption. However, risk assessment using the margin of exposure approach indicated that intakes of TBBPA and HBCDD via breastfeeding can scarcely cause significant health risks to infants.

Ion-Trap Mass Spectrometric Analysis of Bisphenol A Interactions With Titanium Dioxide Nanoparticles and Milk Proteins

Quantitative analysis of endocrine-disrupting molecules such as bisphenol A (BPA) in freshwater to determine their widespread occurrence in environmental resources has been challenged by various adsorption and desorption processes. In this work, ion trap mass spectrometry (ITMS) analysis of BPA was aimed at studying its molecular interactions with titanium dioxide (TiO2) nanoparticles and milk whey proteins. Addition of sodium formate prevented TiO2 nanoparticles from sedimentation while enhancing the electrospray ionization (ESI) efficiency to produce an abundance of [BPA + Na]+ ions at m/z 251.0. More importantly, the ESI-ITMS instrument could operate properly during a direct infusion of nanoparticles up to 500 μg/mL without clogging the intake capillary. Milk protein adsorption of BPA could decrease the [BPA + Na]+ peak intensity significantly unless the proteins were partially removed by curdling to produce whey, which allowed BPA desorption during ESI for quantitative analysis by ITMS.

Sex-specific behavioral effects following developmental exposure to tetrabromobisphenol A (TBBPA) in Wistar rats

Tetrabromobisphenol A (TBBPA) has become a ubiquitous indoor contaminant due to its widespread use as an additive flame retardant in consumer products. Reported evidence of endocrine disruption and accumulation of TBBPA in brain tissue has raised concerns regarding its potential effects on neurodevelopment and behavior. The goal of the present study was to examine the impact of developmental TBBPA exposure, across a wide range of doses, on sexually dimorphic non-reproductive behaviors in male and female Wistar rats. We first ran a pilot study using a single TBBPA dose hypothesized to produce behavioral effects. Wistar rat dams were orally exposed using cookie treats to 0 or 0.1 mg TBBPA/kg bw daily from gestational day (GD) 9 to postnatal day (PND) 21 to assess offspring (both sexes) activity and anxiety-related behaviors. Significant effects were evident in females, with exposure increasing activity levels. Thus, this dose was used as the lowest TBBPA dose in a subsequent, larger study conducted as part of a comprehensive assessment of TBBPA toxicity. Animals were exposed to 0, 0.1, 25, or 250 mg TBBPA/kg bw daily by oral gavage starting on GD 6 through PND 90 (dosed dams GD 6 - PND 21, dosed offspring PND 22 - PND 90). Significant behavioral findings were observed for male offspring, with increased anxiety-like behavior as the primary phenotype. These findings demonstrate that exposure to environmental contaminants, like TBBPA, can have sex-specific effects on behavior highlighting the vulnerability of the developing brain.

Quantification of eight bisphenol analogues in blood and urine samples of workers in a hazardous waste incinerator

Bisphenol A (BPA) has been widely used in the manufacture of polycarbonate plastic and epoxy resins. In recent years, producers have started replacing BPA by other chemical analogues, such as bisphenol -S (BPS) and -F (BPF), all of them under the label "BPA-free". However, despite bisphenol (BP) analogues have a very similar structure, their endocrine-disrupting properties could differ from those of BPA. Unfortunately, information regarding human exposure to BP analogues is very limited, not only as single substances, but also as chemical mixtures. The aim of this study was to determine the levels of 8 BP analogues (A, S, F, B, AF, Z, E, and AP) in biological samples from a controlled cohort of workers in a hazardous waste incinerator (HWI) located in Constantí (Catalonia, Spain). Firstly, a chemical method to analyze a mixture of those 8 analogues in total blood and urine was optimized, being samples quantified by means of gas chromatography coupled to mass spectrometry (GC-MS). Furthermore, a biomonitoring study was performed by collecting samples of total blood and urine of 29 people working in the HWI. Among the 8 BP analogues assessed, BPA presented the highest levels in both biological samples, with mean total (free + conjugated) BPA concentrations of 0.58 and 0.86 μg/L in blood and urine, respectively. Free vs. total BPA levels presented a mean percentage of 79% in blood and 19% in urine. Beyond BPA, traces of BPB were also found in a single sample of blood. Furthermore, none of the remaining BP analogues was detected in blood or urine. Despite BPA has been regulated, it is still very present in the environment, being human exposure to this chemical still an issue of concern for the public health.