Exposure to lead and mercury through breastfeeding during the first month of life: A CHECK cohort study

Mercury in saliva, milk, and hair of nursing mothers in southeastern Iranian mothers: levels, distribution and risk assessment

This research is on lactating mothers in the city of Chah Bahar in Iran. This descriptive-analytical and questionnaire study selected a random sample of 80 mothers to examine mercury levels in their hair, milk, and saliva. The average concentration of mercury in milk, hair and saliva of mothers was 1.23 ± 0.48 µg/l, 1.81 ± 0.55 µg/g and 1.10 ± 0.63 µg/l, respectively. There was a significant correlation between mercury levels in mothers saliva and hair. Still, only a weak correlation was found between mercury levels in milk and hair, and milk and saliva, possibly associated with the high lipid content in milk. The number of children and length of the mother's pregnancy were related to the amount of mercury in the mother's milk. The number of teeth filled with amalgam, consumption of fish and marine products, consumption of fruit, and infant's weight at birth were also associated with the amount of mercury in breast milk. Chewing gum, fish consumption, infant's birth weight, weight, and length of pregnancy were among the factors associated with the amount of mercury in mothers' saliva. The mercury concentration in milk exceeded the WHO (1.4-1.7 µg/g) normal level in 8.5% mothers, and hair mercury was found in 12.5% mothers. It should be kept in mind that any amount of mercury can be harmful.

Lactational exposure of human infants to metal(loid)s in Sub-Saharan Africa and Mediterranean Europe: A systematic review and meta-analysis

Breast milk, a fundamental component of infant nutrition, may serve as a reservoir for various metal(loid)s, which could pose significant health risks to infants of mothers exposed to toxic metals. Human exposure levels to metal(loid)s vary across regions, influenced by differences in diet, lifestyle, and environmental factors. This systematic review compares metal(loid) concentrations in breast milk from Sub-Saharan Africa (SSA) and Mediterranean Europe (Med. Europe), identifying key determinants of exposure. PubMed, Scopus, and Google Scholar were searched for articles reporting metal concentrations in human breast milk samples from SSA and Med. Europe. Weighted mean concentrations were estimated and compared between the two regions. Twenty-five studies from SSA and seventeen from Med. Europe were included in the review. Mean concentrations of cadmium (12.38 ± 1.21 µg/L vs 0.22 ± 0.51 µg/L; p < 0.0001), lead (14.96 ± 8.10 µg/L vs 1.16 ± 4.00 µg/L; p < 0.0001), and mercury (2.01 ± 1.37 µg/L vs 0.95 ± 4.32 µg/L; p = 0.008) were higher in breast milk samples from SSA than Med. Europe. Conversely, breast milk samples from SSA had lower concentrations of selenium (7.38 ± 2.67 µg/L vs 13.09 ± 16.89 µg/L; p < 0.0001) and iron (138.78 ± 106.33 µg/L vs 371.97 ± 446.74 µg/L; p < 0.0001) than those from Med. Europe. Key determinants of metal(loid)s levels in breast milk included maternal smoking, dietary patterns, and environmental exposure. There is an urgent need for effective interventions and policies to reduce metals exposure, particularly in SSA, to safeguard maternal and infant health.

Infants' and young children's dietary exposures to lead and cadmium: FDA total diet study 2018-2020

Food can be a source of lead and cadmium exposure for infants and children. Employing a semi-probabilistic approach, dietary exposures to lead and cadmium were assessed for infants 0-11 months (excluding human milk-fed infants) and children 1-6 years using U.S. total diet study data from 2018 to 2020 and food consumption data from 2015 to 2018. Estimated mean lead and cadmium exposures range from 0.7-3.6 µg/day to 0.18-0.47 µg/kg bw/day, respectively, depending on the age group and method for handling non-detected values. Dietary exposures to lead and cadmium are slightly lower and slightly higher than our estimates published in 2019. In addition to the use of more recent datasets for consumption and contamination, differences may be due to the use of refined exposure assessment methodology, particularly a new system of mapping contamination data to intake data. The processed baby food and infant formula food group is the major contributor to lead and cadmium exposure, driven by intake, among infants who do not consume human milk. The food groups contributing most to children's lead and cadmium exposure are grains/baking, dairy and fruit and grains/baking and vegetables, respectively. This work will inform FDA initiatives such as closer to zero, including research needs and regulatory priorities.

Homemade weaning foods as a source of lead and mercury exposure in Korean infants - A dietary risk assessment study

Lead (Pb) and mercury (Hg) are neurodevelopmental toxicants that pose risks to cognitive and behavioral health. Given early childhood's vulnerability to these metals, understanding their sources and pathways of exposure during infancy is crucial for public health. During the weaning process, infants may be exposed to metals through the baby food they consume. We aimed to assess metal exposure through homemade weaning foods by analyzing 288 samples consumed by 157 Korean infants aged 6-, 9-, 12-, 15-, and 24-27 months. Pb was detected in 65 % of samples, with levels reaching up to 169 ng/g. Notably, 58 % exceeded the Maximum Level (ML) of 10 ng/g, with a median concentration of 14.7 ng/g fresh weight. Total Hg was found in 88 % of samples, with a median concentration of 4.56 ng/g fresh weight. Estimated median daily intakes of Pb and Hg were 0.29 and 0.09 μg/kg/d, respectively. Considering a benchmark dose for Pb (0.5 μg/kg/d by EFSA), 94 % (the margin of exposure <10) of all age groups was estimated to have a potential health concern associated with homemade baby food consumption. For Hg, only 6 % exceeded a hazard quotients of 1 compared to a provisional tolerable weekly intake for Hg (4 μg/kg/week by WHO). This study marks the first direct assessment of daily Pb and Hg intake through homemade baby food among Korean infants. Our findings underscore the urgent need for heightened awareness regarding metal exposure through homemade baby food.

Health risk assessments of heavy metals and trace elements exposure in the breast milk of lactating mothers in the Northeastern Iran

Mother's breast milk is a natural and complete food for infants but can be a main source of exposure to toxic pollutants. These pollutants can negatively affect the health of the infant. Therefore, conducting biomonitoring surveys is essential to evaluate such health effects in toxicological research. This study aimed to estimate the probable health risks for infants exposed to essential and non-essential trace elements through breast milk ingestion. This descriptive-analytical, cross-sectional study was performed on 90 breastfeeding mothers referred to the health centers in Mashhad, Iran in January 2021. The health risk assessments (carcinogenic and non-carcinogenic risk) were estimated using chronic daily intake (CDI), hazard quotient (HQ), hazard index (HI), and lifetime carcinogenic risk (CR), which were recommended by the US Environmental Protection Agency (US EPA). The results of the HQ values of trace elements through ingestion exposure for arsenic (90%), copper (90%), zinc (40%), and iron (10%) exceeded the threshold of HQ, and arsenic (66.59%), copper (16.91%), and zinc (9.68%) and iron (4.57%) had the highest contribution to increasing the HI index. The average value of CR was 5. 08 × 10-3. Chromium and iron showed significant relationships (P<0.05) with education level and disease background in this study, and the concentration of chromium, iron, and zinc in the breast milk samples significantly changed during lactation stages (P<0.05). Overall, the risk of carcinogenicity through exposure to breast milk for infants was higher than the safety level of US EPA risk. Therefore, there could be a potential health risk of trace elements, particularly arsenic, copper, and zinc for infants in Mashhad, Iran through the consumption of mothers' breast milk. More efforts are required to control and reduce routes of receiving trace elements in breastfeeding mothers by the competent authorities.

Porphyrinuria in Autism Spectrum Disorder: A Review

Numerous studies demonstrated that the number of children with autism spectrum disorder (ASD) has increased remarkably in the past decade. A portion of ASD etiology, however, is attributed to environmental issues and genetic disorders. We highlighted a scoping review to principally evaluate the current information on mercury exposure in ASD children and to reveal knowledge gaps. Elevated porphyrins concentration in the urinary system related to mercury exposure, such as precoproporphyrin (prcP), coproporphyrin (cP), and pentacarboxyporphyrin (5cxP), was shown in comparison with controls. Moreover, high levels of urinary porphyrins have been elevated in response to heavy metal exposure. The related pattern (increased prcP, cP, and 5cxP) with Hg exposure may be used as biomarkers in the characteristics of ASD symptoms. However, this review highlighted the data gaps because the control groups were not genderand age-matched for ASD children.

Multiple exposures to heavy metals and changes in steroid hormones production in 4-year-old children

BACKGROUND

Prenatal exposure to multiple heavy metals can interfere with early neurodevelopment, lead to changes in sex hormone concentrations in children, and affect female reproductive health. To date, the influence of prenatal exposure to heavy metals on the endocrine system of children in Chinese electronic waste (e-waste) recycling areas has not been elucidated.

METHODS

Four weeks after delivery, 10 mL of human milk was collected for analysis of three heavy metals (lead (Pb), cadmium (Cd), and mercury (Hg)) via inductively coupled plasma mass spectrometry (ICP-MS). Four serum steroid hormones, including progesterone, testosterone, androstenedione (A-dione), and dehydroepiandrosterone (DHEA), were analyzed in 4-year-old children (25 boys and 17 girls). A multiple linear regression (MLR) model was implemented to investigate the association between each individual metal and serum steroid hormone. The exposure-response relationships were explored by generalized additive models (GAMs). Additionally, a Bayesian kernel machine regression (BKMR) model was used to assess the effects of multiple heavy metal exposures on each steroid hormone.

RESULTS

The MLR results show a significant positive association between a natural log unit increase in Hg and DHEA levels after adjusting for confounders (β = 65.50, 95% confidence interval (CI) = 4.37, 126.62). According to the GAM, the univariate exposure-response relationship of Hg on DHEA was almost linear. However, this association was attenuated based on the multiple metal MLR and BKMR results after accounting for multiple heavy metal exposures.

SIGNIFICANCE

Prenatal Hg exposure may affect sex hormones in children by affecting DHEA levels.

IMPACT STATEMENT

Prenatal maternal exposure to Hg may have long-term effects on the next generation. Hence, regulatory measures to reduce Hg exposure and long-term monitoring of children's health in e-waste areas are needed.

Maternal methylmercury exposure during early-life periods adversely affects mature enamel structure of offspring rats at human exposure levels: a concern for oral health

Although there are many studies on the health effects of methylmercury (MeHg) toxicity during in utero and early development, little is known about its effects on mineralized tissues present in the oral cavity, such as enamel structure. Therefore, this study evaluated the effects of MeHg exposure on the physico-chemical, ultrastructural and functional properties of mature tooth enamel. Specifically, we studied offspring of mothers exposed to MeHg during the prenatal and postnatal periods which are the developmental stages associated with tooth enamel formation. Female rats were exposed to MeHg at a dose of 40 μg/kg/day for 42 days of pregnancy and lactation. The enamel of offspring was analyzed by (1) Fourier Transform Infrared Spectroscopy and Raman to assess physicochemical composition, (2) Scanning Electron Microscopy for ultrastructural evaluation, (3) Transmitted Polarizing Light Microscopy for analysis of the enamel extracellular matrix, and (4) resistance and hardness were evaluated by microhardness. The results showed that MeHg exposure during this sensitive enamel formation period induced changes in inorganic and organic content and enamel prisms ultrastructure alterations and disturbed the organic extracellular matrix due to a decreased enamel strength. These novel findings establish for the first time that maternal exposure to MeHg pre and postnatal promoted relevant changes in mature enamel of their offspring rats.

Comparison between pollutants found in breast milk and infant formula in the last decade: A review

Since ancient times, breastfeeding has been the fundamental way of nurturing the newborn. The benefits of breast milk are widely known, as it is a source of essential nutrients and provides immunological protection, as well as developmental benefits, among others. However, when breastfeeding is not possible, infant formula is the most appropriate alternative. Its composition meets the nutritional requirements of the infant, and its quality is subject to strict control by the authorities. Nonetheless, the presence of different pollutants has been detected in both matrices. Thus, the aim of the present review is to make a comparison between the findings in both breast milk and infant formula in terms of contaminants in the last decade, in order to choose the most convenient option depending on the environmental conditions. For that, the emerging pollutants including metals, chemical compounds derived from heat treatment, pharmaceutical drugs, mycotoxins, pesticides, packaging materials, and other contaminants were described. While in breast milk the most concerning contaminants found were metals and pesticides, in infant formula pollutants such as metals, mycotoxins, and packaging materials were the most outstanding. In conclusion, the convenience of using a feeding diet based on breast milk or either infant formula depends on the maternal environmental circumstances. However, it is important to take into account the immunological benefits of the breast milk compared to the infant formula, and the possibility of using breast milk in combination with infant formula when the nutritional requirements are not fulfilled only with the intake of breast milk. Therefore, more attention should be paid in terms of analyzing these conditions in each case to be able to make a proper decision, as it will vary depending on the maternal and newborn environment.

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.

Excretion of polybrominated diphenyl ethers and AhR activation in breastmilk among firefighters

Excretion of toxicants accumulated from firefighter exposures through breastmilk represents a potential hazard. We investigated if firefighting exposures could increase the concentration of polybrominated diphenyl ethers (PBDEs) and aryl hydrocarbon receptor (AhR) activation in excreted breastmilk. Firefighters and non-firefighters collected breastmilk samples prior to any firefighting responses (baseline) and at 2, 8, 24, 48, and 72 hours after a structural fire (firefighters only). Five PBDE analytes (BDEs 15, 28, 47, 99, and 153) detected in at least 90% of samples were summed for analyses. The AhR in vitro DR CALUX® bioassay assessed the mixture of dioxin-like compounds and toxicity from breastmilk extracts. Baseline PBDEs and AhR response were compared between firefighters and non-firefighters. Separate linear mixed models assessed changes in sum of PBDEs and AhR response among firefighters over time and effect modification by interior or exterior response was assessed. Baseline PBDE concentrations and AhR responses did not differ between the 21 firefighters and 10 non-firefighters. There were no significant changes in sum of PBDEs or AhR response among firefighters over time post-fire, and no variation by interior or exterior response. Plots of sum of PBDEs and AhR response over time demonstrated individual variation but no consistent pattern. Currently, our novel study results do not support forgoing breastfeeding after a fire exposure. However, given study limitations and the potential hazard of accumulated toxicants from firefighter exposures excreted via breastfeeding, future studies should consider additional contaminants and measures of toxicity by which firefighting may impact maternal and child health.

Evaluation of some toxic metals in breast milk samples with dietary and sociodemographic characteristics: a case study of Kermanshah, Western Iran

This study aimed to investigate the concentration of some toxic metals (gold (Au), cadmium (Cd), chromium (Cr), mercury (Hg), nickel (Ni), lead (Pb), tin (Sn), and vanadium (V)) and arsenic (As) in breast milk based on demographic characteristics and the diet of mothers. In this cross-sectional study, 100 lactating mothers from Kermanshah, Western Iran, were included. The mean age of the participants was 29.5 (ranging from 16 to 43 years) with a mean BMI of 26.9 (± 3.81) kg (range: 17.0-39.1). The results of the pairwise correlation coefficient of trace elements illustrated that correlation was mostly positive and weak to moderate. A few exceptions of strong correlations were Cr-Ni (r = 0.82), Au-As (r = 0.64), Cr-V (r = 0.64), and Ni-V (r = 0.58). Moreover, results indicated that BMI (p = 0.008), cooking oil (0.042), and potato intake (p = 0.010) affected the trace element levels significantly. The concentrations of V (p = 0.044), Sn (p = 0.036), Au (p < 0.001), and As (p < 0.001) in the breast milk of women was affected by the BMI. The results of univariate linear regression analysis showed that the concentration of Pb in the milk of mothers who use cosmetics was significant (p < 0.05). Since the lifestyle of lactating women, such as cosmetics usage can impact the content of some elements in breast milk, they should be educated in this part.

Evaluating postnatal exposure to six heavy metals in a Chinese e-waste recycling area

This study is the first to assess postnatal exposure to heavy metals using breast milk in an electronic waste (e-waste) recycling area. From January to April 2021, 102 and 97 breastfeeding women were recruited from an e-waste recycling area and a control area, respectively. Four weeks after delivery, medical staff collected 20 mL of breast milk from each participant. The breast milk was tested for six heavy metals (lead, cadmium, chromium, arsenic, copper, and manganese) using inductively coupled plasma mass spectrometry (ICP-MS). The estimated daily intake (EDI) of infants during breastfeeding was calculated to assess the impact of postnatal exposure to heavy metals on infant health. The concentrations of chromium and lead in the breast milk were significantly higher in the e-waste recycling area than in the control area. Chromium concentrations in breast milk was 34.3%, exceeding the permissible limits set by the World Health Organization (WHO), in the e-waste recycling area, which is 16 times higher than that in the control areas. The EDIs of lead and chromium in the e-waste area were twice as those in the control area. This strongly indicates that the potential impact of postnatal exposure to lead and chromium on infant and child health in e-waste recycling areas cannot be ignored. Infants and children in e-waste recycling areas are at risk of long-term exposure to heavy metals. Therefore, ongoing health monitoring is necessary.

Assessment of the health risks related with metal accumulation in blue swimming crab (Portunus pelagicus) caught in East Java coastal waters, Indonesia

Blue swimming crab (BSC) Portunus pelagicus from the Bali Strait had the lowest Cu, Zn, Cr, Pb, Cd and Hg concentrations compared to those from the Java Sea and the Madura Strait. The order of metal concentrations in BSC was Cu > Zn > Cr > Pb > Cd > Hg. The levels of six metals in BSC from all stations were less than the maximum allowable limits. However, Cr levels in BSC from the Java Sea and the Madura Strait exceeded the provisional tolerable weekly intake. All of the hazardous index values reported were greater than one, indicating that consumption of this crab from these locations appears to be hazardous to human health. Furthermore, because the Cr and Cd target cancer risk values were higher than 10^-4, people who consume this crab from these locations may develop cancer after a lifespan of consumption.

Free Cortisol Mediates Associations of Maternal Urinary Heavy Metals with Neonatal Anthropometric Measures: A Cross-Sectional Study

Prenatal exposure to heavy metals is known to be associated with adverse birth outcomes and oxidative stress biomarkers. In this study, we examined whether maternal free cortisol or 8-Hydroxy-2-Deoxyguanosine (8-OHdG) could mediate associations between maternal heavy metal exposure and birth outcomes. A total of 182 healthy pregnant women were recruited. Heavy metals (including Pb, Hg, and Cd), free-cortisol, and 8-OHdG were analyzed in urine at delivery. Birth outcomes including birth weight, length, Ponderal index, and head circumference were measured. To examine associations of maternal urinary heavy metals with biomarkers and birth outcomes, generalized linear models were employed. Birth length was positively associated with Pb (β = 0.78, 95% CI: 0.09−1.46) and Hg (β = 0.84, 95% CI: 0.23−1.45) (both p < 0.05). The Ponderal index, a measure of a newborn’s leanness, was negatively associated with maternal urinary Pb (β = −0.23, 95% CI: −0.46−−0.07) and Hg (β = −0.26, 95% CI: −0.44−−0.08) (both p < 0.05). No association between maternal Cd and birth outcomes was observed. Most heavy metals showed positive associations with free cortisol and 8-OHdG. Free cortisol was identified as a mediator underlying the observed relationship between Hg and birth length or Ponderal index. This study observed adverse birth outcomes from maternal exposures to Pb and Hg. Increased free cortisol related to Hg exposure was suggested as a possible causal pathway from Hg exposure to birth outcomes such as the Ponderal index.

Health risk assessment of metals in mud crab (Scylla serrata) from the East Java Estuaries of Indonesia

Metals accumulating in mud crab from Indonesia's East Java estuaries have been assessed for potential health effects. Mud crabs from the Solo River estuary (JS) had the highest levels of all metals tested when compared to mud crabs from the Brantas River estuary (MS) and the Banyuwangi coastal area (BS). Metal accumulation in mud crabs occurred in the following order: Zn > Cu > Cr > Pb > Cd > Hg. The estimated weekly intake values for all metals from all stations were less than the provisional tolerable weekly intake requirement. Similarly, all metal target hazard quotient values from all stations were less than one, suggesting that all metals were within the allowable intake limit. The target cancer risk values for Cd and Cr, on the other hand, were somewhat higher than 10^-4, indicating that they were dangerous for human ingestion and possibly linked to a risk associated with carcinogenic agent exposure over a lifetime.

The risk estimation and assessment of heavy metal exposure by biomonitoring in the breast milk of mothers in the Cukurova Region, Turkey

Toxic heavy metals released into the environment through various industrial processes have potential adverse effects on the environment and human health. In order to reveal these adverse health effects, it is vital to carry out toxicological studies by performing biomonitoring. This study aimed to assess the level of Cr, As, Cd, Hg, and Pb in the breast milk samples of mothers in the Cukurova region, Turkey, and its association with health risk to infants. Ten-milliliter postpartum milk samples were collected from 34 breast-feeding mothers in the first 2 months of their postpartum period and living in the Cukurova region, Adana. The measurement of target heavy metals levels was performed by using inductively coupled plasma mass spectroscopy (ICP-MS). The average breast milk levels of Cr, As, Cd, Hg, and Pb were 8.25, 1.64, 0.37, 2.60, and 12.12 μg/L, respectively. Evaluation of breast milk samples for these toxic heavy metals revealed the high exposure level for Cr and As. However, the mothers who participated in the study were not occupationally exposed to these metals. This study showed that Cr, As, Cd, Hg, and Pb cross the placenta and blood-brain barrier prenatally and accumulate in breast milk postnatally.

Metal concentrations and potential health risk in clam (Meretrix lyrata Sowerby 1851) tissues from East Java Coast, Indonesia

The presence of Hg, Cu, Cr, Cd, Pb, and Zn in clam (Meretrix lyrata) from the East Java Coast (EJC), Indonesia, is reported in this study. Metal levels in clam whole tissues were Zn > Cu > Cr > Pb > Cd > Hg. Cr, Cd, and Pb levels in clam tissue surpassed the tolerated limit for eating and the provisional acceptable weekly intake (PTWI) at numerous places along the EJC. The target hazard quotients (THQs) for Cr, Cd, and Pb were greater than one in several locations, indicating that these metals could be harmful to consumers (particularly non-carcinogenic impacts). Eating clams from this area may be detrimental to human health. Furthermore, target cancer risk (TCR) values for Cr and Cd were greater than 10^-4 in several locations, implying that Cr and Cd could cause cancer in people over the course of a lifetime of exposure.

Levels of mercury in Moroccan breast milk and the affecting factors: CONTAMILK study

This study aims to evaluate the level of mercury in the breast milk of Moroccan mothers and its association with several maternal parameters and habits, and to estimate the daily intake of the newborns. Inductively coupled plasma mass spectrometry (ICP-MS) was used to determine the concentrations of mercury in 70 colostrum samples. Indeed, a structured questionnaire was administrated during milk collection to report data concerning the maternal socioeconomic and anthropometric parameters, as well as dietary habits and smoking habits in the family, etc. The median of mercury in breast milk was 3,56 μg/L (range 1.64-124 μg/L) and exceeded normal levels of 1.7 μg/l, suggested by the World health organization in 99% of milk samples. Significant associations were found between mercury levels and the occurrence of previous miscarriages, anemia before pregnancy and vitamin & mineral supplementation during pregnancy, as well the frequency of consumption of cereals and the use of lipstick. The estimated daily intake was higher than the tolerable daily intake of the World health organization and the European food safety authority in 30% of newborns. These results need to be confirmed by multicenter studies to investigate the levels of mercury in the breast milk of the Moroccan population.

Health Risk Assessments of Selected Trace Elements and Factors Associated with Their Levels in Human Breast Milk from Pretoria, South Africa

While breast milk is the recommended food for infants up to at least six months, exogenously derived compounds such as trace elements have been widely reported in human milk which may make it become toxic or a source of pollutants to the infants. Numerous short- and long-term health effects have been associated with high body-burdens of trace elements, which are amplified in infants. The current study determined the levels and possible contributing factors of six trace elements in breast milk of nursing mothers from a local hospital in Pretoria. Extraction of trace elements employed a digestion technique using perchloric and nitric acid in a ratio of 1:3, while Inductively Coupled Plasma-Membrane Spectrophotometry was used to identify and quantify their levels in breast milk. Concentrations of Cr and Mn were the highest in breast milk, with values ranging from 0.30 to 5.72 µg/L and 0.23 to 5.13 µg/L, respectively. Levels of Co, As, Pb and Cd ranged from Collapse

Key Words

• arsenic
• breast milk and passive smoking
• chromium
• manganese

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MESH Headings

• Environmental Pollutants
• Female
• Humans
• Milk, Human/chemistry
• Risk Assessment
• South Africa
• Trace Elements/analysis

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Grants Collapse

Affiliation(s)

Joshua O. Olowoyo Department of Biology, Sefako Makgatho Health Sciences University, P.O Box 139, Pretoria 0204, South Africa; (L.R.M.); (P.M.M.)
Linda R. Macheka
Phiona M. Mametja

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Lead concentrations in breast milk of Moroccan nursing mothers and associated factors of exposure: CONTAMILK STUDY

The aim of CONTAMILK study was to estimate levels of contamination of breast milk (BM) of Moroccan nursing mothers by some xenobiotics including, lead (Pb), to identify associated factors of exposure and to determine the daily intake of newborns. Lead concentrations were determined in 70 samples of colostrum by ICPMS and a structured questionnaire was filled during milk collection to report participants' data. The median lead concentration was 908 μg/L (range 1.38-515,39 μg/L) and in 79 % of samples, levels were higher than the normal range reported by the World Health Organization (WHO) in BM (2-5 μg/L). Indeed, preterm delivery, frequency of use of cosmetic powders and lipsticks were significantly associated with the level of lead in BM. The estimated daily intake was greater than the tolerable daily intake (TDI) of the European food safety authority (0.5 μg/kg/day) for 39 babies and 6 babies according to the WHO (3.6 μg/kg/day).

A review of the impact of xenobiotics from dietary sources on infant health: Early life exposures and the role of the microbiota

Xenobiotics are worldwide distributed and humans are unavoidably exposed to multiple chemical compounds during life, from preconception to adulthood. The human microbiota is mainly settled during early life and modulate host health and fitness. One of the main routes for chemical exposure is by intake of contaminated food and water. Thus, the interplay between diet-xenobiotics-microbiota during pregnancy and perinatal period may have relevant consequences for infant and adult health. Maternal exposure to metal(oid)s, persistent organic pollutants, and some food additives can modify the infant's microbiota with unknown consequences for child or adult health. Toxicants' exposure may also modulate the maternal transfer of microorganisms to the progeny during birth and breastfeeding; however, scarce information is available. The rapid increase in releasing novel chemicals to the environment, the exposure to chemical mixtures, the chronic/low dose scenario, and the delay in science-stakeholders action call for novel and groundbreaking approaches to improve a comprehensive risk assessment in sensitive population groups like pregnant women and neonates, with emphasis on microbiota as modulating factor and target-organ of xenobiotic's toxicity.

Mitochondrion: a sensitive target for Pb exposure

Pb exposure is a worldwide environmental contamination issue which has been of concern to more and more people. Exposure to environmental Pb and its compounds through food and respiratory routes causes toxic damage to the digestive, respiratory, cardiovascular and nervous systems, etc. Children and pregnant women are particularly vulnerable to Pb. Pb exposure significantly destroys children's learning ability, intelligence and perception ability. Mitochondria are involved in various life processes of eukaryotes and are one of the most sensitive organelles to various injuries. There is no doubt that Pb-induced mitochondrial damage can widely affect various physiological processes and cause great harm. In this review, we summarized the toxic effects of Pb on mitochondria which led to various pathological processes. Pb induces mitochondrial dysfunction leading to the increased level of oxidative stress. In addition, Pb leads to cell apoptosis via mitochondrial permeability transition pore (MPTP) opening. Also, Pb can stimulate the development of mitochondria-mediated inflammatory responses. Furthermore, Pb triggers the germination of autophagy via the mitochondrial pathway and induces mitochondrial dysfunction, disturbing intracellular calcium homeostasis. In a word, we discussed the effects of Pb exposure on mitochondria, hoping to provide some references for further research and better therapeutic options for Pb exposure.

Lead and mercury levels in repeatedly collected urine samples of young children: A longitudinal biomonitoring study

Early life exposures to lead (Pb) and mercury (Hg) were reported to be associated with various adverse health outcomes. However, limited data was available for urinary Pb and Hg levels in young children and the proportion of children at risk by age, as well as inter- and intra-subject variations of urinary Pb and Hg levels. Therefore, we collected total 491 urine samples from 241 children by urine collection at birth and at intervals of 3 months until 27 months of age for each child (at 10 monitoring time points), measured urinary Pb and Hg levels, and then evaluated the proportion of children at risk by age and the intra-class correlation (ICC) of the urinary Pb and Hg levels. Both the urinary Pb and Hg levels were significantly different according to the monitoring time points (p < 0.0001 for both Pb and Hg). The number of children with Hg level over the Human BioMonitoring (HBM) I (7 μg/L) and II (25 μg/L) in the first urine at birth were 3 (2.2%) and 1 (0.7%), respectively, while the urinary samples at the other time points did not show Hg level over HBM I or HBM II. However, the exceedance rate for urinary Pb based on HBM values was not calculated due to unavailable HBM values. On the other hands, the proportion of the children with Pb and Hg levels over the reference value derived on the 95th percentile of representative samples (RV₉₅) (1.7 μg/L for Canadian Pb and 0.4 μg/L for German Hg) was relatively high, ranging from 20.0% to 100.0% for Pb and from 13.6% to 100.0% for Hg. The ICC of the repeated measurements from birth to 27 months was 0 for Pb and 0.89 for Hg, while the ICC after the exclusion of the first urine at birth was 0.13 for Pb and 0.47 for Hg. Furthermore, the Pb and Hg exposures were consistent among the high-exposure group for Pb and among all population for Hg. Our data showed Korean children were exposed to relatively high levels of Pb and Hg. However, our Pb and Hg levels in children were based on only urine samples without urinary correction and without consideration of the levels in any other bio-samples such as bloods. Therefore, to explore the Pb and Hg exposures using urine samples warrant further investigation with large sample size considering urinary correction and other bio-samples in the future.

The mercury level in hair and breast milk of lactating mothers in Iran: a systematic review and meta-analysis

Exposure to mercury is one of the major global health concerns due to its stability, bioaccumulation and high toxicity. Therefore, the present study was conducted to assess the mean mercury level in hair and breast milk (BM) of Iranian lactating mothers (ILMs) through meta-analysis technique. We conducted a systematic literature search in online electronic databases included main domestic databases (SID, Magiran, Iran medex, Medlib and ISC) and international databases (Embase, Scopus and PubMed) for studies published between 2000 up 2018. Each process of research and evaluation of articles based on inclusion and exclusion criteria is done by two researchers, individually. From10 studies entered to meta-analysis process including 556 ILM, the mean hair mercury level (HML) and mean milk mercury level (MML) was estimated to be 0.15 μg/g (95 CI: 0.11-0.19, I2: 47.6%, P: 0.028) and 0.51 μg/l (95 CI: 0.28-0.74, I2: 1.9%, P: 0.421), respectively. In this meta-analysis, the mean HML and mean MML were estimated to be lower than the standard of World Health Organization (WHO). Although the mean mercury level in hair and BM of ILMs was lower than the WHO standard, but due to toxicity and serious concern of health, management and Periodic monitor are recommended in different cities of the country for evaluate the mercury levels in hair and BM of ILMs and to estimate the infant's exposure.

Systematic Review of the Literature of Factors Affecting the Exposure and the Levels of Lead in Human Breast Milk

Human milk may sometimes contain chemical contaminants, which could have adverse effects on neonates or nursing infants. Lead (Pb) is of considerable interest due to its toxicity and occurrence. Furthermore, it has been suggested that human milk is a significant potential source of lead exposure to nursing infants. A systematic literature search in PubMed, Science Direct, and Google Scholar databases was performed to identify relevant studies, published in English until 2017, that investigated and explored common factors affecting the level of lead in human milk among lactating women around the world. Forty-nine papers were rated and explored the effect of one or several factors on the level of lead in human milk from 28 countries and carried out over a wide time frame from 1983 to 2017 and through Europe, Asia, America, and Africa, reviewing more than 5,000 subjects. Place of residence, maternal age, stage of lactation, smoking habits, maternal dietary intakes, and parity were the mostly assessed factors among the studies and considered as the main factors affecting Pb levels in BM. Other factors were not studied well enough and considered minor because few surveys evaluated their impacts. However, the literature findings are very controversial.

Selenium status in lactating mothers-infants and its potential protective role against the neurotoxicity of methylmercury, lead, manganese, and DDT

A total of 206 lactating mothers and their infants (3-12 months) were included in this study to evaluate postnatal exposure to neurotoxic pollutants such as methylmercury (MeHg), lead (Pb), manganese (Mn), dichlorodiphenyltrichloroethane (DDT) and its metabolites [dichlorodiphenyldichloroethane (DDD), and dichlorodiphenyldichloroethylene (DDE)] and their association with delayed neurological development and to explore the protective role of selenium (Se) against chemical neurotoxicity. Neurodevelopmental performance was evaluated using Denver Developmental Screening Test II and Parents' Evaluation of Developmental Status (PEDS). Multivariate log-binomial regression modeling was applied for both single and multiple exposures to chemicals using a principal component analysis that generated six principal components. Both mothers and their infants had been exposed to metals and DDT metabolites, with some exceeding the accepted permissible limits. The geometric means of MeHg, Pb, Mn, DDD, DDE and DDT levels in breast milk were 1.333, 45.327, 15.576, 0.069, 0.542 and 1.08 μg/l, respectively. A single-exposure model identified a high risk of reduced PEDS performance significantly associated with DDD in breast milk [relative risk (RR) = 1.484; 95% confidence interval (95%CI) = 1.091-2.019] and marginally significantly associated with Pb in the mothers' blood (RR = 2.164; 95%CI = 0.87-5.382). We did not find a protective role of Se in neurodevelopment due to its high levels in the mothers. Models of multi-chemical exposure indicated that Mn in blood and breast milk, Se in blood and Pb in the mothers' urine were marginally significantly associated with a high risk of reduced PEDS performance (RR = 0.424; 95%CI = 0.176-1.022). The use of multi-chemical exposure approach in early life risk assessments is important because it indicates real-world exposure. Our results were not conclusive because the sample size was small, so future studies examining the implications to health of the impact of prenatal/postnatal exposure to a mixture of chemicals in the Saudi population are merited.

The impact of environmental pollution on the quality of mother's milk

Breastfeeding is a gold standard of neonate nutrition because human milk contains a lot of essential compounds crucial for proper development of a child. However, milk is also a biofluid which can contain environmental pollution, which can have effects on immune system and consequently on the various body organs. Polychlorinated biphenyls are organic pollutants which have been detected in human milk. They have lipophilic properties, so they can penetrate to fatty milk and ultimately to neonate digestive track. Another problem of interest is the presence in milk of heavy metals-arsenic, lead, cadmium, and mercury-as these compounds can lead to disorders in production of cytokines, which are important immunomodulators. The toxicants cause stimulation or suppression of this compounds. This can lead to health problems in children as allergy, disorders in the endocrine system, end even neurodevelopment delay and disorder. Consequently, correlations between pollutants and bioactive components in milk should be investigated. This article provides an overview of environmental pollutants found in human milk as well as of the consequences of cytokine disorder correlated with presence of heavy metals. Graphical abstract.

Total, organic, and inorganic mercury in human breast milk: levels and maternal factors of exposure, systematic literature review, 1976-2017

This systematic review summarizes the finding of 58 studies from 33 countries, which assessed mercury concentrations in breast milk and the factors related to the level of contamination. We performed a literature search in Pubmed, Science Direct, and Google Scholar databases for studies published between 1976 and 2017 that are monitoring and measuring mercury in human breast milk and investigating the associated factors. Then, we extracted more information about the aim of the study, the country, samples size, time of lactation, mercury concentration, and other data. Most of the studies used mature milk or colostrum for analysis and in about 60% of them, the concentrations exceed significantly the limit set by the World Health Organization (WHO) of 1.7 µg/l; In addition, many factors and parameters were related to the level of mercury contamination in breast milk. Periodic monitoring surveys are recommended in each country to evaluate the level of mercury in milk of lactating women and to estimate the level of exposure of newborns.

Metal contaminated soil leachates from an art glass factory elicit stress response, alter fatty acid metabolism and reduce lifespan in Caenorhabditis elegans

The present study evaluated the toxicity of metal contamination in soils from an art glass factory in Småland Sweden using a Caenorhabditis elegans nematode model. The aim of the study was to chemically analyze the soil samples and study the biological effects of water-soluble leachates on the nematodes using different physiological endpoints. The total metal content showed that As, Cd and Pb were at levels above the guideline values for soils in areas around the factory. Less than 10% of the total metal content in the soil was found in the water-soluble leachates, however, Al, As, Fe and Pb remained higher than the guideline values for safe drinking water. Exposure of C. elegans to the water-soluble leachates, at both post-hatching larvae stage (L1-young adult) for 48 h and at the young adult stage (L4) for 6 h, showed significant gene alteration. Although the nematodes did not exhibit acute lethality, lifespan was significantly reduced upon exposure. C. elegans also showed altered gene expression associated with stress response and fat metabolism, as well as enhanced accumulation of body fat. The study highlighted the significance of assessing environmental samples using a combination of gene expression analysis, fatty acid metabolism and lifespan for providing valuable insight into the negative impact of metals. The altered fat metabolism and reduced lifespan on exposure to soil leachates motivates further studies to explore the mechanism of the toxicity associated with the metals present in the environment.

Exposure to heavy metals released to the environment through breastfeeding: A probabilistic risk estimation

Toxic heavy metals released into the environment through various anthropogenic activities, raising concerns over their potential adverse effects on human health and the environment. Biological monitoring studies are of great value in toxicological research for estimation of such health effects. The aim of this study was to evaluate the concentrations of lead (Pb), arsenic (As), and chromium (Cr) in the breast milk of urban mothers in Hamadan city, Iran and the accompanying health risk to infants. A total of 100 lactating mothers were recruited from public health care centers in Hamadan city and breast milk samples were collected at 2, 6, 8, and 12 months postpartum. Inductively coupled plasma mass spectroscopy (ICP-MS) has been used to measure target heavy metal concentrations. The median breast milk concentrations of Pb, As, and Cr were 41.90, 0.50, and 3.95 μg/L, respectively. The highest levels of Pb were observed after two months of delivery (with the mean of 96.69 μg/L and median of 45.70 μg/L). Up to 94% of the breast milk samples exceeded the WHO limit suggested for lead contamination of breast milk (<5 μg/L). The breast milk As and Cr contents were above the limit of detection (LOD) in 19% and 76% of samples, respectively. Unacceptable non-cancer health risk levels or hazard quotient (HQ) were found for Pb and As in 61% and 10% of the samples, respectively. Nevertheless, HQ from Cr was <1.0 for 100% of breastfeeding infants. Finally, our results indicated that there may be a potential risk of toxic metals, especially lead, for infants in Hamadan via the consumption of mothers' breast milk.

Analysis of aluminum, minerals and trace elements in the milk samples from lactating mothers in Hamadan, Iran

The present cross-sectional study is aimed at analyzing the breast milk of lactating mothers in Hamadan, Iran for aluminum and several minerals and trace elements. Ten governmental health care centers were utilized to facilitate collection of breast milk samples. The breast milk samples were collected at 1, 2, 6, 7, and 12 months postpartum from one hundred healthy lactating women, who delivered full-term newborns. Detection of sodium (Na), zinc (Zn), calcium (Ca), iron (Fe), copper (Cu), magnesium (Mg) and aluminum (Al) levels was conducted with the use of Inductively Coupled Plasma Mass Spectrometry (ICP-MS). This method has shown high accuracy, precision, sensitivity, and linearity for the wide range of concentrations. The accumulated data were not normally distributed; thus, the non-parametric Mann-Whitney U test was used in the statistical analysis of the results. Mean concentrations of Fe, Zn, Cu, Ca, Mg, and Na were 0.75, 1.38, 0.35, 255, 34.58, and 155.72 μg/mL, respectively. The mean level of Al, a well-known neurotoxic metal, was determined to be an alarming 0.191 μg/mL. Moreover, 95% of participants contained very harmful concentrations of Al in their milk. This study also revealed Zn deficiency in about 50% of milk samples. Further investigation is needed to elucidate sources of exposure and factors that may influence maternal and fetal exposure to aluminum.

Multiple low-level exposures: Hg interactions with co-occurring neurotoxic substances in early life

All chemical forms of Hg can affect neurodevelopment; however, low levels of organic Hg (methylmercury-MeHg and ethylmercury-EtHg in Thimerosal-containing vaccines, hereafter 'TCV') exposures during early life (pregnancy and lactation) co-occur with other environmental neurotoxic substances. These neurotoxicants may act in parallel, synergistically, or antagonistically to Hg. Nevertheless, the risks of neurotoxicity associated with multiple neuro-toxicants depend on type, time, combinations of exposure, and environmental and/or genetic-associated factors. Neurological developmental disorders, delays in cognition and behavioral outcomes associated with multiple exposures (which include Hg) may show transient or lasting outcomes depending on constitutional and/or environmental factors that can interact to neutralize, aggravate or attenuate these effects; often these studies are challenging to interpret. During pregnancy and lactation, fish-MeHg exposure is frequently confounded with the opposing effects of neuroactive nutrients (in fish) that lead to positive, negative, or no effects on neurobehavioral tests. In infancy, exposures to acute binary mixtures (TCV- EtHg and Al-adjuvants in infant immunizations) are associated with increased risks of tics and other developmental disorders. Despite the certitude that promulgates single environmental neurotoxicants, empirical comparisons of combined exposures indicate that Hg-related outcome is uneven. Hg in combination with other neurotoxic mixtures may elevate risks of neurotoxicity, but these risks arise in circumstances that are not yet predictable. Therefore, to achieve the goals of the Minamata treaty and to safeguard the health of children, low levels of mercury exposure (in any chemical form) needs to be further reduced whether the source is environmental (air- and food-borne) or iatrogenic (pediatric TCVs).

Trace elements in seafood from the Mediterranean sea: An exposure risk assessment

Fish and shellfish belonging to five different species among pelagic, benthonic and molluscs, were collected from the Gulf of Catania in 2017 to evaluate arsenic (As), cadmium (Cd), chromium (Cr), lead (Pb), manganese (Mn), nickel (Ni), selenium (Se) vanadium (V) and zinc (Zn). Risk of developing chronic systemic effects derived from seafood consumption was evaluated with the Target Hazard Quotient (THQ) and compared with the results obtained from the same area and the species, collected in 2012. Hg, Cd and Pb concentrations were found below the limits set by European Community for human consumption in all the analysed species. The total risk is reduced from 1.1 to 0.49, and this result is strongly associated with the lower bioaccumulations levels found for Hg, Mn, Se and V. Others metals such as As, Pb, Ni and Zn bioaccumulation levels remain approximately the same, conversely, it is revealed a slight increase of Cd and Cr. Overall, the present study show a positive picture of the studied area, the Gulf of Catania, highlighting not only a decreased metal availability of the study area, but, above all, a decreased risk to develop chronic systemic effects derived from consumption of local seafood.

Plasma concentration of 14 perfluoroalkyl acids (PFAAs) among children from seven cities in Guangdong, China

The toxicity and persistence of perfluoroalkyl acids (PFAAs) in humans have drawn growing concerns, particularly for children. However, data regarding the concentrations of PFAAs in children are limited. In this study, we measured the concentrations of 14 PFAAs in plasma samples collected from 1192 children aged 0-7years from 7 cities in Guangdong Province: Guangzhou, Shenzhen, Foshan, Dongguan, Zhaoqing, Zhongshan and Zhanjiang. Perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA) were detected in >99.5% of the analysed samples. PFOS had the highest median concentration (23.6ng/mL) in the total samples, followed by PFOA (2.8ng/mL). The median concentrations of the other PFAAs were lower than 0.4ng/mL. The concentrations of perfluorohexanoic acid, perfluorononanoic acid, perfluorodecanoic acid, perfluorododecanoic acid, perfluorohexane sulfonate, PFOA and PFOS in children from Foshan were significantly higher than those found in other cities (p<0.001). Negative correlations between most of the PFAA concentrations and age (r=-0.06--0.45) were found in all children. Weak to moderate correlations (r=0.080-0.698) were observed between all PFAA concentrations. Our findings indicated a high exposure of children to PFAAs in the early life-stage. The exposure sources and pathways of PFAAs in different regions are different. Considering a lack of information on the exposure pathways and health status, more studies are needed to evaluate the exposure resources and assess the health risk of PFAA exposure in children.