The toxicological analysis of lead and cadmium in prescription food for special medical purposes and modified milk products for newborns and infants available in Polish pharmacies

The toxicological analysis and safety assessment of heavy metals (Hg, Pb, Cd, and As) in food for special medical purposes (FSMP) available in Polish pharmacies for oncological patients

The presence of heavy metals in food products may seem an archaic concern; however, our study reveals that the risk is significant, unexpectedly in Food for Special Medical Purposes (FSMP) for oncology patients available in Polish pharmacies. This investigation fills that gap through a detailed toxicological analysis and health risk assessment of these heavy metals in FSMP products (n = 23) using inductively coupled plasma mass spectrometry (ICP-MS). Our comprehensive risk assessment involved evaluating (1) the concentrations of As, Cd, Hg, and Pb in both liquid and powdered FSMP formulations, (2) the amount of heavy metals ingested per serving as specified by the manufacturer, and (3) the cumulative daily and weekly intake adjusted for body weight, benchmarked against the provisional tolerable weekly intake (PTWI). While most samples were below PTWI limits, Cd levels raised concerns due to potential cumulative exposure risks, particularly for oncology patients consuming these products regularly. This study underscores the hidden dangers of heavy metal contamination in FSMP, emphasizing the need for vigilant monitoring and stringent regulatory frameworks to ensure patient safety. By uncovering these latent risks through meticulous toxicological assessment, our research provides crucial insights that could safeguard vulnerable populations. This study is significant due to concerns related to the complex risk assessment of FSMP for cancer patients, considering the complexity of oncological diseases and other comorbid factors, as well as the verification of available legal and regulatory acts of FSMP at the European Community level.

The toxicological analysis of problematic and sophisticated elements (Ni, Cr, and Se) in Food for Special Medical Purposes (FSMP) using in pharmacotherapy and clinical nutrition for oncological patients available in Polish pharmacies

This study focuses on FSMPs for oncologic patients, specifically analyzing the toxicological profiles of nickel (Ni), chromium (Cr), and selenium (Se) within these products available in Polish pharmacies. The presence of these elements was quantified using inductively coupled plasma mass spectrometry (ICP-MS). Results indicated variations in the concentrations of Ni, Cr, and Se across different FSMP samples, with some products exceeding the acceptable limits set by regulatory guidelines. The study highlights the potential health risks associated with nickel exposure, including dermatitis and carcinogenesis, and the complex roles of chromium and selenium, which can be both beneficial and harmful depending on their levels. Our findings reveal significant variability in the elemental content across different FSMP products, i.e.: Ni: 0.155-25.488 μg/portion, Cr: 0.076-28.726 μg/portion and Se: 0.083-20.304 μg/portion). Notably, selenium levels in FSMPs showed considerable discrepancies compared to manufacturers' declarations, averaging only about 20% of the stated values. Regulatory assessments based on the Acceptable Daily Intake (ADI) and Permitted Daily Exposure (PDE) descriptors indicated that the estimated weekly intake of Ni, Cr, and Se from these FSMPs did not exceed the provisional tolerable weekly intake (PTWI) values. However, the highest Ni content was 30.58% of the PTWI, raising concerns about potential health risks, including dermatitis and carcinogenesis. The results for Cr underscored the necessity for careful monitoring due to its potential toxic effects. Selenium, despite its essential role, showed levels inadequate to meet the Recommended Dietary Allowance (RDA), potentially impacting its intended health benefits.

Evaluation of the Safety and Potential Benefits of Beetroot-Based Dietary Supplements According to Their Elemental Composition

The study aimed to assess the health value and safety associated with the consumption of the chosen 37 beetroot-based dietary supplements (DSs). An optimized and validated analytical procedure, using a method called microwave plasma atomic emission spectrometry (MP-AES), was developed to determine the profiles of 19 elements (Na, K, Fe, Ca, Pt, Zn, Cd, Cu, V, Co, Ni, Pb, Mo, Mg, Al, Mn, Sr, Cr, Ba) in the DSs. The products were assessed for compliance with the recommended daily doses for the chosen elements, and any deviations were identified. Results showed that powders constituted a richer source of elements than capsules and tablets. The exception was iron-enriched products, which provided the highest dose of Fe (3.75 to 25 mg/daily dose). Safety assessment was evaluated in 3 steps, including (1) the determination of levels of Al, Ba, Cd, and Pb; (2) comparison of their content with the permissible contamination limits; and (3) comparison of the weekly or monthly intake of Al and Cd with the provisional tolerable weekly (PTWI) or monthly (PTMI) intake, respectively. The content of Ba was evaluated because of the oral reference dose (RfD). Five products were significantly contaminated with Cd (4-134% of PTMI Cd), two with Al (11-12%), and three with Ba (1.085-1.331 µg/d.d.). Lead was not detected above the LOQ (0.035 mg/kg). Factor analysis was employed to differentiate between the pharmaceutical forms (capsules, tablets, and powders) and determine the origin of the powder contained in the capsules. These results highlight the importance of implementing more stringent control measures and regulatory changes in the DSs market to ensure consumer safety.

Health risk assessment of some selected heavy metals in infant food sold in Wa, Ghana

Infants remain a high-risk group as far as exposure to toxic metals is concerned. The levels of lead (Pb), cadmium (Cd), nickel (Ni), chromium (Cr), antimony (Sb), mercury (Hg), and arsenic (As) in twenty-two (22) samples of baby foods and formulas were determined using inductively coupled plasma mass spectrometry. The concentrations in (mg/kg) of As, Cd, Cr, Hg, Mn, Ni, Pb, and Sb were in the ranges 0.006-0.057, 0.043-0.064, 0.113-0.33, 0.000-0.002, 1.720-3.568, 0.065-0.183, 0.061-0.368 and 0.017-0.1 respectively. Health risk assessment indices like the Estimated Daily Intake (EDI), Target Hazard Quotient (THQ), Cancer Risk (CR) and Hazard Index (HI) were calculated. EDI values of Hg, Cr, and As were below their recommended tolerable daily intake, that of Ni and Mn were lower in 95% of samples, and Cd was also lower in 50% of the samples. THQ values for As, Cd, Cr, Hg, Mn, Ni, and Pb were 0.32-3.21, 0.75-1.10, 0.65-1.94, 0.00-0.37, 0.21-0.44, 0.08-0.12 and 0.26-1.13 respectively. The CR values were greater than 10^-6, making them unacceptable for human consumption. HI values were between 2.68 and 6.83 (greater than 1), which implied that these metals are likely to pose non-carcinogenic health risks to infants.

Human health risk assessment of potentially toxic elements in the breast milk consumed by infants in Western Iran

This study aimed to assess the human health risk of some toxic metals/metalloids [lead (Pb), mercury (Hg), cadmium (Cd), nickel (Ni), chromium (Cr), and arsenic (As)] on infants via consumption of the breast milk of women living in urban areas of Kermanshah city, west of Iran. After collecting milk samples, the carcinogenic and non-carcinogenic risk assessment as well as uncertainty analysis of toxic metal levels were carried out. The order of concentration of heavy metals/metalloids in the breast milk samples was Cr (41.07 ± 23.19) > Ni (19.25 ± 11.81) > Pb (11.5 ± 4.48) > As (1.96 ± 2.04) > Cd (.72 ± 0.42) > Hg (0.31 ± 0.26). The results revealed that the levels of Cr and Pb in the breast milk samples were exceeded the World Health Organization (WHO) tolerable daily intake. In the breast milk samples a high levels of one of the trace elements As, Cd, Cr, Pb, and Ni were observed (over 73%) and in 40% of them the levels of Cr, Pb, Cd, As, and Ni were all above WHO tolerable daily intake. Moreover, the As-related point assessment of target risk factor (THQ) was higher than the allowable limit only for 1-month-old male neonates and 2-month-old female neonates (THQ > 1). In addition, Cr-related THQ scores were higher at all age and gender groups (THQ > 1). In conclusion, our findings suggest a potential risk of some metals for infants via the consumption of mothers' breast milk.

The Toxicological Risk Assessment of Dermal Exposure of Patients Exposed to Lead and Cadmium Due to Application of Ointments with Marjoram Herb Extract (Majoranae herbae extractum)

Potential heavy metal impurities (HMI) in pharmaceuticals/pharmaceutical products/drugs based on plant raw materials (e.g., herbs) are an important problem in the pharmaceutical industry; however, there is a lack of scientific articles on the comprehensive toxicological risk assessment of HMI in ointment applied dermally. To make the appropriate toxicological risk assessment, we consider: (1) the raw results of the levels of lead and cadmium in the ointments (metal per kg of mass), (2) one-time administration of the applied ointment, (3) daily exposure of Pb and Cd in the applied ointments according to the maximum daily dose of applied pharmaceuticals, including transcutaneous penetration, (4) human health risk assessment based on the USEPA model, and 5) the margin of exposure (MoE). The raw results indicated that lead (7.05-101.78 µg/kg) and cadmium (0.32-0.81 µg/kg) were present in all samples. The levels of analyzed HMI (independently of the producer and declared composition) were similar. Pb and Cd contamination associated with daily doses met the standards of the ICH Q3D (R2) guide on elemental impurities in pharmaceuticals, including the cutaneous route of administration. Taking into account the daily amount of lead and cadmium (ointment, ug/day) the results were satisfactory, confirming the safety of marjoram herb extract ointments available in Polish pharmacies according to the ICH guideline Q3D (R2) on elemental impurities. The HQ values obtained for Pb and Cd in all samples were less than 1; therefore, exposure to these HMI would not cause a health risk based on the USEPA model strategy. Furthermore, the obtained values of MoE for Pb and Cd in ointments were above 100, so exposure to these elements would not cause a health risk based on the MoE-based strategy. The original contribution of this work is that this is the first study on the triple approach strategy to evaluate the safety of heavy metal impurities in traditional herbal medicinal products applied dermally in solid form (ointments with marjoram herb extract). The research is novel and has not been previously published; The proposed procedure includes transcutaneous penetration of heavy metal (Pb and Cd) impurities described for the first time in the literature.

Lead Exposure in Infancy and Subsequent Growth in Beninese Children

Studies suggest that elevated postnatal blood lead levels (BLLs) are negatively associated with child growth. This study aimed to investigate the associations of childhood BLLs at age one year and growth outcomes at age six years (n = 661) in a cohort of children in Allada, Benin. The growth outcomes studied are weight-for-age Z-score (WAZ), height-for-age Z-score (HAZ), BMI-for-age Z-score (BMIZ), weight-for-height Z-score (WHZ), head circumference (HC), growth velocities, underweight, stunting, and wasting. Multivariable regression models examined the associations between BLLs and growth outcomes, with adjustment for potential confounders. The geometric mean BLLs was 59.3 μg/L and 82% of children had BLLs >35 μg/L at the age of 12.8 months. After adjusting for confounding factors, no overall association was found between BLL quartiles and HAZ, WAZ, BMIZ, WHZ, growth velocities, wasting, and underweight. However, boys in the highest quartile had a 1.02 cm lower HC (95% CI: [−1.81, −0.24]) as compared to the lowest quartile. Furthermore, an increased odds of being stunted was observed in children in the highest quartile of exposure compared to the first (OR: 2.43; 95% CI: [1.11−5.33]) which remained statistically significant only among girls in sex-specific strata. Blood lead was found to be associated with an increased risk of childhood stunting and a lower head circumference in a resource-limited setting.

The Level of Cadmium Impurities in Traditional Herbal Medicinal Products with Plantago lanceolata L., folium (Ribwort Plantain Leaves) Available in Polish Pharmacies - Comprehensive Toxicological Risk Assessment Including Regulatory Point of View and ICH Q3D Elemental Impurities Guideline

Plantago lanceolata L., folium (ribwort plantain) is an active pharmaceutical ingredient in traditional herbal medicinal products (THMP) available in pharmacies as a demulcent for the symptomatic treatment of oral or pharyngeal irritations and associated dry cough. This kind of THMP is widely applied among the European population; however, recently, voices have been heard in the public about alleged cadmium impurities. The idea of our study was a comprehensive risk assessment of the Cd impurity exposure and its effect on human health. Our assessment strategy was based on regulatory aspects (raw results versus limits set by FAO/WHO for herbal medicines) and toxicological risk assessment approach based on ICH Q3D guideline for elemental impurities in final pharmaceutical products. The cadmium was determined by electrothermal atomization atomic absorption spectrometry based on our previously described methodology. Obtained results show that all analysed THMP with P. lanceolata L., folium available in the Polish pharmacies contain cadmium impurities, but at a very low level (ranged 0.73 - 20.6 μg/L). The content of Cd in a single dose (ng/single dose) is also very low and is not a threat to patients. The estimated maximum daily exposure (ng/day) of Cd based on the 'worst-case scenario' (maximum concentrations by oral administration) meets the standards of ICH Q3D guideline (all results were below oral permitted daily exposure; PDE for Cd, i.e. < 5.0 µg/day). It can be concluded that all analysed samples of THMP with P. lanceolata L., folium should not represent any health hazard to the patients due to cadmium levels. To the best of our knowledge, this is the first study about Cd impurity level in THMP with P. lanceolata L., folium (ribwort plantain leaves) available in European pharmacies.

The Content and Toxicological Risk Assessment of Trace Elemental Impurities (Pb and Cr) in Snacks from Ogun State, Southwestern Nigeria

The monitoring of food contamination by trace elemental impurities (TEIs) are major health challenges in developing countries. The present study evaluated the content and toxicological risk assessment of TEIs in commonly consumed snack/junk foods from Ogun State, Nigeria. TEIs (Pb and Cr) were determined in sixty snack food samples purchased from Ijebu Ode, Ogun State, southwestern Nigeria. The TEIs were analysed in quadruplicates using atomic absorption spectrometry with flame atomization. TEI data were subjected to simple descriptive and inferential statistics. The toxicological risk assessment of TEIs was evaluated for hazard quotient (HQ), hazard index (HI) and cancer risk (CR) using the United States Environmental Protection Agency-Integrated Risk Information System (USEPA-IRIS) model. Data showed the varying Pb levels of 8.22 ± 1.57 mg/kg in sausage to 12.25 ± 4.27 mg/kg in cocoyam chips higher than the permissible limit of the Codex Alimentarius of the Joint World Health Organization and Food and Agriculture Organization. The toxicological risk assessment revealed the HQs greater than 1.0 for Pb and Cr in most snack foods consumed by adults and children, indicating adverse health problems. The CRs of Pb (children) and Cr (adults and children) also breached the acceptable limit of 1.0 × 10^-4, signifying possible lifetime development of cancer. It is therefore necessary to periodically monitor the TEIs in snacks to protect the public health.

The Toxicological Assessment of Content and Exposure of Heavy Metals (Pb and Cd) in Traditional Herbal Medicinal Products with Marshmallow Root (Althaea officinalis L., radix) from Polish Pharmacies

The level of potentially toxic elements (PTE) in phytopharmaceuticals can be a potential threat to human health through the food chain. The traditional herbal medicinal products (THMPs) with the marshmallow root (Althaea officinalis L., radix), which we can find in European pharmacies, are widely used among the European population. However, recently, voices have been heard in the public about alleged PTE occurrence. In this article, the levels of Pb and Cd impurities were measured in samples of THMPs with marshmallow root available in Polish pharmacies (n = 10). Our proposed toxicological approach was based on two important issues. The first was PTE levels (Pb: 1.60–6.80 μg/L and Cd: 0.80–3.81 μg/L presented as raw results) in comparison with the permissible limit set by FAO/WHO for medicinal herbs (10,000 µg/kg for Pb and 300 µg/kg for Cd) and also ICH Q3D guidelines (0.5 μg/g for Pb and also Cd). The second was the estimation of exposure of investigated PTE in a single dose and daily dose for each THMP. It should be noted that the content of analyzed heavy metals in a single dose of analyzed products was very low, and hence is not a threat for patients. The obtained daily intake of heavy metals impurities in comparison with PDE values confirms the safety of all analyzed phytopharmaceuticals (all of the samples meet the standards of the ICH Q3D guideline). It can be summarized that each of the analyzed THMP with marshmallow root available in Poland are safe for the patients. Based on literature review, this article is the first study about heavy metals impurities level in final THMPs with A. officinalis L., radix (marshmallow root) available in European pharmacies.

The Toxicological Risk Assessment of Dermal Exposure of Patients Exposed to Nickel and Chromium due to Application of Ointments with Marjoram Herb Extract (Majoranae Herbae Extractum) Available in Polish Pharmacies

For elemental impurities that have been studied for transcutaneous absorption, the available data are rarely suitable for proper toxicological risk assessment - there are multiple factors that can influence this dermal absorption. Hence, in our studies, we applied generic and conservative approach - cutaneous permitted daily exposure (CPDE) described in International Conference on Harmonisation's Q3D Guideline on Elemental Impurities (ICH Q3D). The aim of this article is toxicological risk assessment (TRA) of dermal exposure of patients exposed to nickel and chromium due to application of ointments with Marjoram herb extract (Majoranae herbae extractum) available in Polish pharmacies (n = 5, because only five manufacturers produce this kind of pharmaceutical products in Poland). To make the appropriate TRA approach, we considered (1) raw results (metal per kg of ointment), (2) one-time administration of applied ointments, and (3) daily exposure versus CPDE. Due to the fact the concentrations of Ni generally present in cutaneous products as impurities are not considered sufficient to induce sensitization, the cutaneous and transcutaneous concentration limits (CTCLs) approach was applied for this element assessment. The toxicological analysis was carried out using microwave-assisted wet digestion with concentrated nitric acid and electrothermal atomization atomic absorption spectrometry. Our results show that the ointments with Marjoram herb extract from pharmacies in Poland represent a potential health hazard to patients; however, there may be a requirement for the monitoring of impurities of nickel in future. To the best of our knowledge, this paper is the first study about nickel and chromium content in ointments with Marjoram herb extract (Majoranae herbae extractum).

The Toxicological Risk Assessment of Lead and Cadmium in Valeriana officinalis L., radix (Valerian root) as Herbal Medicinal Product for the Relief of Mild Nervous Tension and Sleep Disorders Available in Polish Pharmacies

Studies related to the toxicological risk assessment (TRA) of heavy metal impurities (HMIs) in pharmaceuticals are an important issue but there is a lack of refereed literature around the safety of Valeriana officinalis L., radix (Valerian root) as herbal medicinal product (HMP) for the relief of mild nervous tension and sleep disorders according to lead and cadmium impurities. The aim of the study was to estimate the TRA of lead and cadmium in Valeriana officinalis L., radix (Valerian root) as HMP (n = 5) available in Polish pharmacies. In the case of herbal pharmaceuticals, it is particularly important to control the level of HMIs accumulated during the plant's growth. Perhaps, the exposure for a single dose is not relevant; however, justification of our studies is a fact that herbal therapies are usually long term. Therefore, even small HMI doses as present in particular plant may accumulate in patient body over a long period of time. Levels of lead and cadmium were measured by electrothermal atomization atomic absorption spectrometry. The levels of lead and cadmium as HMIs (independently of the producer and declared composition) are quite similar. Our results are satisfactory, confirming the safety of Valeriana officinalis L., radix (Valerian root) as herbal medicinal product for the relief of mild nervous tension and sleep disorders available in Polish pharmacies according to ICH guideline Q3D. To the best of our knowledge, this paper is the first study about lead and cadmium content as HMIs in HMP containing Valeriana officinalis L., radix (Valerian root).

Levels of Trace Elements in Human Breast Milk in Jordan: a Comparison with Infant Formula Milk Powder

Human breast milk and infant formula milk powder (IFMP) are the main nutritional sources for infants. In the literature, there is a lack of studies concerning levels of trace elements in human milk and IMP in Jordan. The aim of this research was the determination of levels of 24 trace elements in human breast milk from Jordanian mothers (n = 76) and IFMP from Jordanian market (n = 22). Elements were classified to essential (Mg, Fe, Zn, Cu, Mn, Ni, Cr, Mo, Co, and Se), non-essential (Al, Ag, Ba, Bi, Cs, Ga, Li, Rb, Sr, U, and V), and potentially toxic (As, Cd, and Pb). Inductively coupled plasma-mass spectrometry (ICP-MS) following a microwave digestion of samples with concentrated nitric acid and hydrogen peroxide was performed. Our results featured levels of each targeted element in human milk and IFMP (mean, standard deviation (SD), median, and range). Statistical analysis included a one-way analysis of variance (ANOVA), and Pearson's correlations. A sample toxicological analysis study for toxic elements As, Cd, and Pb was performed, and results were inspected. Levels of most elements including toxic elements are larger than in human milk samples, and comparable to in IFPMs to literature results. Mean levels of majority of the elements (17 out of 24) in human milk were significantly different than respective means in IFMP solutions. Positive correlation was observed between total toxic elements and Al, Cu, and Fe in human milk samples. Results of toxicological analysis demonstrated that most of IFMP samples do not represent a health hazard to infants regarding As, Cd, and Pb. The same applies for Cd in human milk samples. However, levels of As and Pb in 70% of human milk samples exceed the provisional tolerable weekly intake (PTWI) for As and Pb.

Advanced Methodologies for Trace Elements in Edible Oil Samples: A Review

Advanced methodologies were applied for the detection of some elements at trace levels in edible oils. Trace elements play a role in oil stability, quality of edible oils and fats. In the present study, problems were addressed related to simple, cheap, less time consuming and suitable pretreatment advanced methods for suitable sample introduction and calibrations as well as the strategies and techniques are discussed. The present review is aimed to discuss the significance of simplifying sample treatments are offered for trace elements in oils. The period covered by this review is last twenty years. However, the various applications of advanced methodologies including extraction and microextraction. The scope of spectrometric techniques used for the analysis of trace elements in edible oils was discussed by new instrumental development trends.

Mineral Constituents Profiling of Ready-To-Drink Nutritional Supplements by Inductively Coupled Plasma Optical Emission Spectrometry

Nutritional drinks (NDs) are medicinal food products intended for people with different health issues constricting nutrients provision. Eight varieties of milkshake style NDs were analyzed in this work. Prior to element analysis, they were freeze-dried, and concentrations of twenty macro- and microelements in analyzed samples were simultaneously measured by ICP-OES after their mineralization in a closed-vessel microwave-assisted digestion system. Results of this analysis indicated that these NDs must be considered as nutrient-dense foods, taking into account mineral constituents. Consumption of two bottles of such NDs per day provides very a high amount or even an excess of human daily requirements set as Recommended Dietary Allowances (RDAs). Generally, concentrations of determined elements in examined NDs were consistent with data given on the labels - most of differences did not exceed 30% (median: -5.91%, standard deviation: 14%). Discovered very strong and moderate positive correlations between concentrations of major and essential elements (Ca, Mg, P, Cu, Fe, Mn, Zn) were likely due to their incorporation into formulations of analyzed NDs. However, relationships between contents of trace elements were the result of concomitance of these elements in substrates used for examined products production or contamination of substrates.

The Toxicological Analysis of Ni and Cr in Prescription Food for Special Medical Purposes and Modified Milk Products for Babies in Infancy Available in Pharmacies in Poland

Prescription food for special medical purposes (FSMPs) and modified milk products (MMPs) for babies in the infancy period available in pharmacies are increasingly frequently used for newborns and infants-especially in cases where allergies and food-borne diseases are diagnosed. However, there is a lack of scientific study around the safety assessment of the elemental impurities in these products. Importantly, the allergen Ni and the problematic metal Cr are little considered. Hence, the aim of this article was the toxicological analysis of Ni and Cr impurities in prescription FSMPs (n = 6) and MMPs (n = 6) for newborns and infants available in Polish pharmacies. For the best safety assessment, we include three approaches including (1) the levels of Ni and Cr in powdered products, (2) assessment of the daily dose depending on age and body weight of newborns and infants, and (3) the weekly intake of Ni and Cr in samples in comparison to provisional tolerable weekly intake (PTWI). Our results show that, on the basis of our data, the products from pharmacies in Poland investigated in this study do not represent a real health hazard to newborns and infants, although there may be a requirement for the monitoring of levels of Ni. Our results are pioneer and provide valuable data for other scientists and manufacturers.

The analysis of Cu, Mn and Zn content in prescription food for special medical purposes and modified milk products for newborns and infants available in Polish pharmacies from toxicological and nutritional point of view

BACKGROUND

Prescription food for special medical purposes (FSMPs) and modified milk products (MMPs), available in pharmacies, are important for newborns and infants that are not breastfed. In the scientific literature there is a lack of comprehensive studies and corresponding safety assessment of the essential trace elements in these products.

OBJECTIVE

The aim of this article was determination of Cu, Mn and Zn levels in the most frequently available prescription FSMPs (n = 6) and MMPs (n = 6) available in Polish pharmacies.

METHODS

Flame absorption spectrometry (FAAS) following microwave induced digestion (concentrated nitric acid) was applied to determine the levels of the elements in the products.

RESULTS

Our studies are based on a triple approach (1) the "raw results" of Cu, Mn and Zn levels (products in powdered form), (2) single intake - the level of each essential trace element consumed in one portion, (3) the daily intake depending on age and weight including comparison with Adequate Intake established by European Food Safety Authority.

CONCLUSION

The results show the occurrence of differences between the manufacturer's declared composition and the finished product for consumption. The prescription FSMPs in comparison to MMPs available in Polish pharmacies contain similar levels of Cu, Mn and Zn. Our results show additionally that all of the products do not represent a health hazard to the newborns and infants. This is a pioneer study in terms of the safety assessment, and quality of prescription FSMPs and MMPs available in Polish pharmacies from toxicological and nutritional point of view.