Estimates of exposures to perchlorate from consumption of human milk, dairy milk, and water, and comparison to current reference dose

Influence of feeding practices in the composition and functionality of infant gut microbiota and its relationship with health

Establishing the infant's gut microbiota has long-term implications on health and immunity. Breastfeeding is recognized as the best practice of infant nutrition in comparison with formula feeding. We evaluated the effects of the primary feeding practices by analyzing the infant growth and the potential association with gut diseases. A cross-sectional and observational study was designed. This study included 55 mothers with infants, who were divided according to their feeding practices in breastfeeding (BF), formula feeding (FF), and combined breast and formula feeding (CF). Anthropometric measurements of the participants were recorded. Additionally, non-invasive fecal samples from the infants were collected to analyze the microbiota by sequencing, immunoglobulin A (IgA) concentration (ELISA), and volatile organic compounds (gas chromatography with an electronic nose). Results showed that the microbiota diversity in the BF group was the highest compared to the other two groups. The IgA levels in the BF group were twice as high as those in the FF group. Moreover, the child´s growth in the BF group showed the best infant development when the data were compared at birth to the recollection time, as noted by the correlation with a decreased concentration of toxic volatile organic compounds. Interestingly, the CF group showed a significant difference in health status when the data were compared with the FF group. We conclude that early health practices influence children's growth, which is relevant to further research about how those infants' health evolved.

Isolation and identification of chlorate-reducing Hafnia sp. from milk

Chlorate has become a concern in the food and beverage sector, related to chlorine sanitizers in industrial food production and water treatment. It is of particular concern to regulatory bodies due to the negative health effects of chlorate exposure. This study investigated the fate of chlorate in raw milk and isolated bacterial strains of interest responsible for chlorate breakdown. Unpasteurized milk was demonstrated to have a chlorate-reducing capacity, breaking down enriched chlorate to undetectable levels in 11 days. Further enrichment and isolation using conditions specific to chlorate-reducing bacteria successfully isolated three distinct strains of Hafnia paralvei. Chlorate-reducing bacteria were observed to grow in a chlorate-enriched medium with lactate as an electron donor. All isolated strains were demonstrated to reduce chlorate in liquid medium; however, the exact mechanism of chlorate degradation was not definitively identified in this study.

Perchlorate and chlorate in breast milk, infant formulas, baby supplementary food and the implications for infant exposure

Perchlorate and chlorate are ubiquitous pollutants in various types of foodstuffs, drinking water and environmental compartments. They have raised great concerns due to potential adverse effects on human thyroid functions. Dietary intake is considered as the predominant pathway for human exposure to perchlorate and chlorate. Nevertheless, data on human exposure to the chemicals above remain limited, particularly for the most vulnerable populations such as infants. In the present study, 62 breast milks, 53 infant formulas, 88 baby supplementary food and 50 tap water samples were collected in South China and the levels of perchlorate and chlorate were measured in these samples. Perchlorate and chlorate were frequently detected in more than 90% of measured samples. In these different types of samples, the median concentrations of perchlorate were 0.65 μg/L, 0.61 μg/kg, 0.56 μg/kg and 1.18 μg/L, respectively, while the median concentrations of chlorate were 1.73 μg/L, 2.48 μg/kg, 2.67 μg/kg and non-detected, respectively. Health risk assessment using hazard quotient suggested that perchlorate and chlorate exposure in the sampled baby food are not expected to increase the risk of an adverse health effect. To our knowledge, this is the first study simultaneously investigating perchlorate and chlorate exposure in Chinese infants via food intake.

The contamination and estimation of dietary intake for perchlorate and chlorate in infant formulas in China

The contents of perchlorate and chlorate were determined in a total of 278 samples of infant formulas marketed in China. The associated health risk via infant and young child formulas consumption for 0-36 month old children in China was also assessed. The contents of perchlorate and chlorate were measured by a validated method with LC-MS and the limit of detection (LOD) was 1.5 μg kg^-1 and 3.0 μg kg^-1 for perchlorate and chlorate, respectively. Perchlorate and chlorate were detected in about 85.8% (median 6.92 μg kg^-1, maximum 74.20 μg kg^-1) and 99.3% (median 52.80 μg kg^-1, maximum 2780 μg/kg) of the samples. The exposures of infant and young children to perchlorate from formulas were lower than the provisional maximum tolerable daily intake (PMTDI, 0.7 μg/kg bw/day), which was established by U.S. Environmental Protection Agency (EPA). The European Food Safety Authority (EFSA) in 2015 also proposed a tolerable daily intake (TDI) of 3 μg/kg bw/day for chlorate based on the mean and average concentrations. Only for infants 0-6 month at the 95th percentile did exposures exceed the TDI of 3 μg/day for chlorate. Therefore, the safety of infant and young child formulas is excellent. To our knowledge, this is the first report to assess the exposure of infant and young child formulas in China to perchlorate and chlorate.

Dietary exposure assessment to perchlorate in the Taiwanese population: A risk assessment based on the probabilistic approach

Perchlorate is an endocrine-disrupting chemical (EDC) that contaminate various foodstuffs. Exposure to perchlorate may cause severe health problems, mainly thyroid dysfunction. However, information on perchlorate contamination of consumer foods in Taiwan is limited. This study investigated perchlorate levels in 310 food samples belonging to 12 food groups collected from Taiwanese markets. A probabilistic risk assessment was conducted to assess the related exposure to Taiwanese people. Perchlorate was detected in 65% of the samples and high levels were identified in certain plant-origin, fruit, and processed food samples. A probabilistic approach was used to estimate daily dietary dose (Monte Carlo-estimated 95th percentile dietary exposure [MCS 95]) by using the Taiwan National Food Consumption database for 14 sex/age groups. The highest and lowest average daily doses (ADDs) were in the age groups of >65 years (MCS 95 = 3.60/3.90 [male/female] μg/kg bw/day) and 16-18 years (MCS 95 = 1.70/1.47 [M/F] μg/kg bw/day), respectively. The 95th percentile of the hazard index of exposure to perchlorate of all sex/age groups far exceeded the tolerable daily intake (0.3 μg/kg bw/day) and reference dose (0.7 μg/kg bw/day) set by the European Food Safety Authority and US EPA, respectively, but it was lower than the provisional maximum tolerable daily intake (10 μg/kg bw/day) suggested by the Joint FAO/WHO Expert Committee on Food Additives. The intake quantity and concentrations of perchlorate from vegetables, fruits, and whole grains are the critical contributors for the ADDs and integrated risk of dietary exposure to perchlorate. Long-term exposure through diets should be considered, instead of focusing on individual EDC during dietary risk assessment in specific populations. Furthermore, cumulative risks for exposure to multiple contaminants, particularly those causing thyroid adverse effects, may be higher than that from perchlorate exposure alone.

Environmental Chemicals in Breast Milk and Formula: Exposure and Risk Assessment Implications

BACKGROUND

Human health risk assessment methods have advanced in recent years to more accurately estimate risks associated with exposure during childhood. However, predicting risks related to infant exposures to environmental chemicals in breast milk and formula remains challenging.

OBJECTIVES

Our goal was to compile available information on infant exposures to environmental chemicals in breast milk and formula, describe methods to characterize infant exposure and potential for health risk in the context of a risk assessment, and identify research needed to improve risk analyses based on this type of exposure and health risk information.

METHODS

We reviewed recent literature on levels of environmental chemicals in breast milk and formula, with a focus on data from the United States. We then selected three example publications that quantified infant exposure using breast milk or formula chemical concentrations and estimated breast milk or formula intake. The potential for health risk from these dietary exposures was then characterized by comparison with available health risk benchmarks. We identified areas of this approach in need of improvement to better characterize the potential for infant health risk from this critical exposure pathway.

DISCUSSION

Measurements of chemicals in breast milk and formula are integral to the evaluation of risk from early life dietary exposures to environmental chemicals. Risk assessments may also be informed by research investigating the impact of chemical exposure on developmental processes known to be active, and subject to disruption, during infancy, and by analysis of exposure-response data specific to the infant life stage. Critical data gaps exist in all of these areas.

CONCLUSIONS

Better-designed studies are needed to characterize infant exposures to environmental chemicals in breast milk and infant formula as well as to improve risk assessments of chemicals found in both foods. https://doi.org/10.1289/EHP1953.

Infant Dietary Exposures to Environmental Chemicals and Infant/Child Health: A Critical Assessment of the Literature

BACKGROUND

The benefits of breastfeeding to the infant and mother have been well documented. It is also well known that breast milk contains environmental chemicals, and numerous epidemiological studies have explored relationships between background levels of chemicals in breast milk and health outcomes in infants and children.

OBJECTIVES

In this paper, we examine epidemiological literature to address the following question: Are infant exposures to background levels of environmental chemicals in breast milk and formula associated with adverse health effects? We critically review this literature a) to explore whether exposure-outcome associations are observed across studies, and b) to assess the literature quality.

METHODS

We reviewed literature identified from electronic literature searches. We explored whether exposure-outcome associations are observed across studies by assessing the quality (using a modified version of a previously published quality assessment tool), consistency, and strengths and weaknesses in the literature. The epidemiological literature included cohorts from several countries and examined infants/children either once or multiple times over weeks to years. Health outcomes included four broad categories: growth and maturation, morbidity, biomarkers, and neurodevelopment.

RESULTS

The available literature does not provide conclusive evidence of consistent or clinically relevant health consequences to infants exposed to environmental chemicals in breast milk at background levels.

CONCLUSIONS

It is clear that more research would better inform our understanding of the potential for health impacts from infant dietary exposures to environmental chemicals. A critical data gap is a lack of research on environmental chemicals in formula and infant/child health outcomes. https://doi.org/10.1289/EHP1954.

Occurrence and exposure evaluation of perchlorate in outdoor dust and soil in mainland China

A total of 98 paired soil and outdoor dust samples were collected across mainland China for survey of perchlorate. Perchlorate was detected in all of the soil and outdoor dust samples. High levels of perchlorate were found in soil, ranging from 0.001 to 216 mg/kg in Northern China and from 0.001 to 25.8 mg/kg in Southern China. Even higher perchlorate concentrations were detected in dust samples, with concentrations ranging from 0.132 to 5,300 mg/kg in Northern China, and from 0.270 to 3,700 mg/kg in Southern China. This is the first known report of perchlorate in dust samples. The high perchlorate levels in soil and dust may raise concern on the potential risk for organisms and human. The daily perchlorate intakes were evaluated based on our measured perchlorate concentrations via inhalation, ingestion, and dermal contact of soil and dust for both children and adults, respectively. In general, the exposure from soil does not appear to lead to perchlorate intakes exceeding the US EPA reference for both children and adults. However, children can be at risk from exposure to perchlorate via dust, and it needs considerable concern for both children and adults at the sites with high dust perchlorate concentrations. After comparison with other possible exposure pathways, such as from drinking water, we suggested that dust may be an important potential source of perchlorate exposure in China, and further study is needed, especially for indoor dust.

Perchlorate exposure and dose estimates in infants

Perchlorate is a naturally occurring inorganic anion used as a component of solid rocket fuel, explosives, and pyrotechnics. Sufficiently high perchlorate intakes can modify thyroid function by competitively inhibiting iodide uptake in adults; however, little is known about perchlorate exposure and health effects in infants. Food intake models predict that infants have higher perchlorate exposure doses than adults. For this reason, we measured perchlorate and related anions (nitrate, thiocyanate, and iodide) in 206 urine samples from 92 infants ages 1-377 days and calculated perchlorate intake dose for this sample of infants. The median estimated exposure dose for this sample of infants was 0.160 μg/kg/day. Of the 205 individual dose estimates, 9% exceeded the reference dose of 0.7 μg/kg/day; 6% of infants providing multiple samples had multiple perchlorate dose estimates above the reference dose. Estimated exposure dose differed by feeding method: breast-fed infants had a higher perchlorate exposure dose (geometric mean 0.220 μg/kg/day) than infants consuming cow milk-based formula (geometric mean 0.103 μg/kg/day, p < 0.0001) or soy-based formula (geometric mean 0.027 μg/kg/day, p < 0.0001), consistent with dose estimates based on dietary intake data. The ability of perchlorate to block adequate iodide uptake by the thyroid may have been reduced by the iodine-sufficient status of the infants studied (median urinary iodide 125 μg/L). Further research is needed to see whether these perchlorate intake doses lead to any health effects.

Perchlorate in dairy milk and milk-based powdered infant formula in South Korea

Perchlorate has been detected in dairy milk and milk-based powdered infant formula samples from many different provinces of South Korea. A total of 37 dairy milk samples from 12 different brands and 26 milk-based powdered infant formula samples from four different brands were tested for the presence of perchlorate. These brands and their products, which are analyzed in this study, cover over 95% of the dairy milk and milk-based powdered infant formula market share in South Korea, which has a population of approximately 50 million inhabitants. Perchlorate was explicitly detected by ion chromatography tandem mass spectrometry; the limit of quantification (LOQ) for dairy milk and milk-based powdered infant formula was 0.12 μg L(-1) and 1.0 μg kg(-1), respectively. The perchlorate concentration in all the samples was above the LOQ. The perchlorate detection data is given as follows: 1.99-6.41 μg L(-1) (n = 37, mean concentration = 4.59 ± 0.17 μg L(-1)) for dairy milk and 1.49-33.3 μg kg(-1) (n = 26, mean concentration = 7.83 ± 0.22 μg kg(-1)) for milk-based infant formula. This study provides increasing evidence that perchlorate commonly occurs in dairy products, presumably as the result of perchlorate intake by dairy cattle from water and feed.

Goitrogenic anions, thyroid-stimulating hormone, and thyroid hormone in infants

BACKGROUND

Environmental exposure of infants to perchlorate, thiocyanate, nitrate, might interfere with thyroid function. U.S. women with higher background perchlorate exposure have higher thyroid-stimulating hormone (TSH) and lower thyroxine (T4). There are no studies with individual measures of thyroid function and these goitrogens available in infants.

OBJECTIVE

We examined the association of urinary perchlorate, nitrate, iodide, and thiocyanate with urinary T4 and TSH in infants and whether that association differed by sex or iodide status.

METHODS

We used data and samples from the Study of Estrogen Activity and Development, which assessed hormone levels of full-term infants over the first 12 months of life. The study included 92 full-term infants between birth and 1 year of age seen up to four times. Perchlorate, thiocyanate, nitrate, and iodide were measured in 206 urine samples; TSH and T4 and were measured in urines and in 50 blood samples.

RESULTS

In separate mixed models, adjusting for creatinine, age, sex, and body mass index, infants with higher urinary perchlorate, nitrate or thiocyanate had higher urinary TSH. With all three modeled, children with higher nitrate and thiocyanate had higher TSH, but higher perchlorate was associated with TSH only in children with low iodide. Unexpectedly, exposure to the three chemicals was generally associated with higher T4.

CONCLUSIONS

The association of perchlorate exposure with increased urinary TSH in infants with low urinary iodide is consistent with previous findings. Higher thiocyanate and nitrate exposure were also associated with higher TSH in infants.

Perinatal exposure to perchlorate. thiocyanate, and nitrate in New Jersey mothers and newborns

Perchlorate is a commonly occurring environmental toxicant that may be transported across the placental barrier by the sodium-iodide symporter (NIS), possibly resulting in both increased perchlorate exposure and decreased iodide uptake by the fetus. Therefore, we measured levels of three physiologically relevant NIS-inhibitors (perchlorate, nitrate, and thiocyanate) and iodide in maternal and fetal fluids collected during cesarean-section surgeries on 150 U.S. women. Geometric means of perchlorate, thiocyanate, and nitrate levels in maternal urine (2.90, 947, and 47900 microg/L, respectively) were similar to previously published results, while urinary iodide levels (1420 microg/L) were significantly higher (p < 0.0001), likely because of prevalent prenatal vitamin use in the study population (74%). Thiocyanate levels were higher in the maternal serum, cord serum, and amniotic fluid of smokers compared to women with environmental tobacco smoke exposure and nonsmokers (p-values of 0.0006, 0.0011, and 0.0026, respectively). Perchlorate was detected in most samples: urine (100%), maternal serum (94%), cord serum (67%), and amniotic fluid (97%). Maternal urinary perchlorate levels were positively correlated with perchlorate levels in amniotic fluid (r = 0.57), indicating that maternal urine perchlorate is an effective biomarker of fetal perchlorate exposure. Maternal serum perchlorate was generally higher than cord serum perchlorate (median ratio 2.4:1 for paired samples), and maternal urine perchlorate was always higher than fetal amniotic fluid perchlorate levels (mean ratio 22:1); conversely, iodide levels were typically higher in fetal fluids compared to maternal fluids. We found no evidence of either disproportionate perchlorate accumulation or lack of iodide in the fetal compartment. In this panel of healthy infants, we found no association between cord blood levels of these anions and newborn weight length, and head circumference.

Perchlorate in the feed-dairy continuum of the southwestern United States

Perchlorate has the potential to cause thyroid dysfunction by inhibiting iodide uptake by the sodium iodide symporter. Perchlorate-contaminated waters may lead to human exposure through drinking water and food chain transfer in crops by way of irrigation water. Perchlorate has been found in dairy milk collected nationally and internationally. This study was conducted to evaluate perchlorate in the feed-dairy continuum in the southwestern United States. All feed products collected at dairies in this study had detectable levels of perchlorate as analyzed by ion chromatography-tandem mass spectrometry. The calculated total perchlorate intake across dairies ranged from 1.9 to 12.7 mg/cow per day. The variation in total perchlorate intake across dairies was largely associated with variation in forage and silage products. Alfalfa products were the single most important source of perchlorate intake variability among dairies. The estimated perchlorate intake from drinking water ranged from 0.01 mg per cow per day and was generally less than 2% of the total perchlorate intake. The perchlorate content of milk ranged from 0.9 to 10.3 microg/L and was similar to levels reported by the Food and Drug Administration's Total Diet Study. The perchlorate content of milk was significantly related to the presence of perchlorate in feed but the variation of perchlorate in milk could not be explained by feed intake alone.

Biomonitoring as a method for assessing exposure to perchlorate

Biomonitoring provides direct and quantitative information regarding human exposure to environmental toxicants, such as perchlorate (ClO(4)(-)). Because of concerns surrounding widespread exposure to ClO(4)(-), we are using biomonitoring methods to assess exposure to ClO(4)(-) and other physiologically relevant anions that can impact iodide uptake by the thyroid. These methods quantify ClO(4)(-), thiocyanate, nitrate, and iodide in human urine, milk, serum, blood spots, amniotic fluid, and infant formula using ion chromatography coupled with electrospray ionization tandem mass spectrometry. In this paper we summarize recent ClO(4)(-) biomonitoring research and provide three additional examples of the utility of biomonitoring for characterizing ClO(4)(-) exposure. Specifically, we examine variability in ClO(4)(-) excretion, compare the relative importance of different exposure sources in adults, and estimate ClO(4)(-) exposure in formula-fed infants. These applications provide examples of how biomonitoring can improve individual exposure assessment. Individual biomarker data can subsequently be compared with individual thyroid function data to better evaluate potential linkage between ClO(4)(-) exposure and health.

Evaluation of the U.S. EPA/OSWER preliminary remediation goal for perchlorate in groundwater: focus on exposure to nursing infants

BACKGROUND

Perchlorate is a common contaminant of drinking water and food. It competes with iodide for uptake into the thyroid, thus interfering with thyroid hormone production. The U.S. Environmental Protection Agency's Office of Solid Waste and Emergency Response (OSWER) set a groundwater preliminary remediation goal (PRG) of 24.5 microg/L to prevent exposure of pregnant women that would affect the fetus. This does not account for the greater exposure that is possible in nursing infants or for the relative source contribution (RSC), a factor normally used to lower the PRG due to nonwater exposures.

OBJECTIVES

Our goal was to assess whether the OSWER PRG protects infants against exposures from breast-feeding, and to evaluate the perchlorate RSC.

METHODS

We used Monte Carlo analysis to simulate nursing infant exposures associated with the OSWER PRG when combined with background perchlorate.

RESULTS

The PRG can lead to a 7-fold increase in breast milk concentration, causing 90% of nursing infants to exceed the reference dose (RfD) (average exceedance, 2.8-fold). Drinking-water perchlorate must be < 6.9 microg/L to keep the median, and < 1.3 microg/L to keep the 90th-percentile nursing infant exposure below the RfD. This is 3.6- to 19-fold below the PRG. Analysis of biomonitoring data suggests an RSC of 0.7 for pregnant women and of 0.2 for nursing infants. Recent data from the Centers for Disease Control and Prevention (CDC) suggest that the RfD itself needs to be reevaluated because of hormonal effects in the general population.

CONCLUSIONS

The OSWER PRG for perchlorate can be improved by considering infant exposures, by incorporating an RSC, and by being responsive to any changes in the RfD resulting from the new CDC data.