Aluminum contents of human milk, cow's milk, and infant formulas

Concentrations and predictors of aluminum, antimony, and lithium in breast milk: A repeated-measures study of donors

Aluminum (Al), antimony (Sb), and lithium (Li) are relatively common toxic metal(oid)s that can be transferred into breast milk and potentially to the nursing infant. This study assessed concentrations of Al, Sb, and Li in breast milk samples collected from donor mothers and explored the predictors of these concentrations. Two hundred forty-two pooled breast milk samples were collected at different times post-partum from 83 donors in Spain (2015-2018) and analyzed for Al, Sb, and Li concentrations. Mixed-effect linear regression was used to investigate the association of breast milk concentrations of these elements with the sociodemographic profile of the women, their dietary habits and utilization of personal care products (PCPs), the post-partum interval, and the nutritional characteristics of milk samples, among other factors. Al was detected in 94% of samples, with a median concentration of 57.63 μg/L. Sb and Li were detected in 72% and 79% of samples at median concentrations of 0.08 μg/L and 0.58 μg/L, respectively. Concentrations of Al, Sb, and Li were not associated with post-partum time. Al was positively associated with total lipid content of samples, weight change since before pregnancy, and coffee and butter intakes and inversely with meat intake. Li was positively associated with intake of chocolate and use of face cream and eyeliner and inversely with year of sample collection, egg, bread, and pasta intakes, and use of hand cream. Sb was positively associated with fatty fish, yoghurt, rice, and deep-fried food intakes and use of eyeliner and inversely with egg and cereal intakes and use of eyeshadow. This study shows that Al, Sb, and Li, especially Al, are widely present in donor breast milk samples. Their concentrations in the milk samples were most frequently associated with dietary habits but also with the lipid content of samples and the use of certain PCPs.

Adverse reactions after oral provocation with aluminium in children with vaccination granulomas and aluminium contact allergy

BACKGROUND

According to their parents, some children with aluminium contact allergy and vaccination granulomas may react to aluminium-containing foods by developing dermatitis, granuloma itch and subjective symptoms.

OBJECTIVES

The objective of this study is to determine whether oral intake of aluminium-containing pancakes can cause adverse events and/or systemic contact dermatitis (SCD) in children with vaccination granulomas and aluminium contact allergy.

PATIENTS/METHODS

A total of 15 children aged 3-9 years (mean age, 5 years) with vaccination granulomas and positive patch-test results to aluminium chloride hexahydrate 2%/10% pet. completed a 3-week blinded randomized controlled crossover oral aluminium/placebo provocation study with pancakes. Granuloma itch and other subjective symptoms were evaluated daily on a visual analogue scale (VAS). Dermatitis was evaluated by the primary investigator, and sleep patterns were tracked with an electronic device. Aluminium bioavailability was assessed by measuring aluminium excretion in the urine. The children served as their own controls with the placebo provocations.

RESULTS

All 15 children completed the study. The mean VAS scores were slightly higher during aluminium provocations compared with placebo for granuloma itch (mean VAS, 1.5 vs. 1.4, p = 0.6) but identical for other subjective symptoms (0.6 vs. 0.6, p = 1). There were no differences in sleep patterns and no significant correlation between urinary aluminium excretion and symptom severity. Three children developed a symmetrical rash on the face or buttocks on day 4 of the aluminium provocations, but not during placebo provocations.

CONCLUSIONS

No difference was found between oral aluminium intake and the occurrence of subjective symptoms and granuloma itch, but on a case-basis oral aluminium may be associated with the development of systemic contact dermatitis.

Evaluation of Heavy Metal Pollution in the Blood Serum of Industrial Workers, Mosul, Iraq

The study was conducted in the two main industrial areas in Mosul, northern Iraq, where the study included measuring the number of heavy metals (cadmium, aluminum, mercury, chromium) in the blood of workers in those areas. For 20 workers, in contrast, blood samples were drawn from Mosul University employees. They were considered as a control group for being far from industrial activity and for 20 employees. An atomic absorption device was used to analyze blood samples after diluting. In addition, workers were divided into groups according to (age, smoking status, and period of occupational exposure). The results revealed statistically significant differences when comparing the samples of workers to the control group, while the results did not show significant differences between groups of workers. Keywords. Pollution, Blood Serum, Industrial Area.

Neurodevelopmental Outcomes in Infants Fed with Soy Formula: A Retrospective, National Population-Based Observational Cohort Study

BACKGROUND

Soy-based infant formulas are increasingly popular, but data regarding their effects on neurodevelopmental outcomes during early childhood is scanty.

OBJECTIVE

This study investigated the effect of consuming soy-based infant formula at 9-12 mo after birth on the subsequent development of epilepsy, neurodevelopmental disorders, and developmental status.

METHODS

This nationwide retrospective administrative study used health screening examinations and linked insurance claims data of children born in Korea during 2008 and 2009. Infants who received soy formula were compared with those who received cow's milk formula using propensity score matching that considered birth history, economic status, clinical conditions, and drug prescription records. Exposure was defined as soy formula feeding determined from questionnaires completed by the parents when children were 9-12 mo old. Outcomes were epilepsy, attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and developmental status. Children were followed until 31 December, 2017.

RESULTS

A total of 153,841 eligible participants were enrolled; 11,535 (7.5%) children received soy formula, while 142,864 (92.5%) received cow's milk formula. The incidence rate of epilepsy during the follow-up period was 29.8 per 100,000 person-years (95% CI: 19.48, 41.65) in the soy formula group and 22.6 per 100,000 person-years (95% CI: 31.97, 59.07) in the cow's milk formula group, with no significant difference (aHR: 1.318; 95% CI: 0.825, 2.106). The 2 groups also had no difference based on prespecified analysis using different definitions of epilepsy. Likewise, no significant associations of soy formula with ADHD (aHR: 1.26; 95% CI: 1.00, 1.60) or ASD (aHR: 0.99; 95% CI: 0.54, 1.83), or delays of developmental stages were observed.

CONCLUSIONS

Feeding with soy formula rather than cow's milk formula had no apparent association with increased risks of epilepsy, ADHD, ASD, and developmental status, according to this cohort composed of a general pediatric population.

Aluminum environmental pollution: the silent killer

The concern about aluminum (Al) toxicity has been proven in various cases. Some cases are associated with the fact that Al is a neurotoxic substance that has been found in high levels in the brain tissues of Alzheimer's disease (AD), epilepsy, and autism patients. Other cases are related to infants, especially premature infants and ones with renal failure, who are at the risk of developing the central nervous system (CNS) and bone toxicity. This risk is a result of infants' exposure to Al from milk formulas, intravenous-feeding solutions, and possibly from aluminum-containing vaccinations. Furthermore, most antiperspirants contain  aluminum compounds that raise human exposure to toxic Al. This review paper is intended to discuss in detail the above concerns associated with aluminum, and hence urges the need for more studies exploring the effects of overexposure to Al and recommending mitigation actions.

Investigate workers' health in the western industrial region, Mosul, Iraq

The current study aims to determine the level of heavy metal contamination in the Western Industrial Region of Mosul City, northern Iraq. Heavy metals such as( Pb ،Co ،Hg ) are measured In the blood serum of 40 workers in the main industrial areas of Mosul City. It was compared with the control group of (40) people from Mosul university, Where is Far away from the industrial areas and all activities. The results indicated a highly significant increase of P<0.001 in the serum of the workers in the industrial areas compared with the control group. The study investigates the impact of heavy metals on the workers' health in the industrial areas who are in direct contact with them.

Aluminum Content of Human Milk and Antiperspirant Use

Background: Aluminum exposure may originate from numerous sources, including antiperspirants. Aluminum toxicity can cause a wide range of neurological impairments. Infants are exposed to aluminum through human milk (HM), formulas, total-parenteral-nutrition and vaccines. Due to potential risk of toxicity to both infants and women, it has been advised that lactating women decrease their use of aluminum-based products and antiperspirants. Our study aimed to determine whether the use of aluminum-based antiperspirants (ABA) affects aluminum levels in HM. Methods: This cross-sectional study included healthy mothers who exclusively breastfed infants (1 week to 5 months). Questionnaires were used to collect data on demographics, antiperspirant use and aluminum exposure. Mothers were instructed to express HM during the morning at first breastfeeding session. Aluminum levels were measured by atomic absorption spectrometry with a 5 ppb limit of detection. Results: Fifteen of the 58 (26%) recruited mothers used an aluminum-free antiperspirant (AFA) and 43 (74%) used an ABA. The range of aluminum concentration in HM was 0-100.8 μg/L (mean 11.4 ± 17.4 μg/L). The median aluminum level (Q1-Q3) was 6.5 μg/L (5.2-11.9) and 5.2 μg/L (3.46-9.4) in the AFA and ABA groups, respectively (p = 0.19). The aluminum levels were not affected by maternal age, education, diet, number of children, infant age, lactation stage or self-reported aluminum exposure. Conclusion: The data from this preliminary study demonstrate that the use of an ABA by lactating mothers does not increase their HM aluminum content. Additional studies with a larger cohort are warranted to confirm these findings.

Human Milk Concentrations of Minerals, Essential and Toxic Trace Elements and Association with Selective Medical, Social, Demographic and Environmental Factors

This study aims to quantify concentrations of minerals and trace elements in human milk (HM) and infant formula (IF) and evaluate associations with medical, social, environmental, and demographic variables. A prospective, case series study of 170 nursing mothers was made. HM samples were obtained from full-term (colostrum, intermediate and mature HM) and preterm (mature HM) mothers. Variables of interest were assessed by a questionnaire. For comparison, IF samples (n = 30) were analyzed in a cross-sectional study. Concentrations of 35 minerals, essential and toxic trace elements were quantified, 5 for the first time: thallium in HM and IF; strontium in preterm HM; and gallium, lithium and uranium in IF. In preterm and full-term HM, levels of selenium (p < 0.001) were significantly lower than recommended and were associated with low birth weight (p < 0.002). Cesium and strontium concentrations were significantly higher than recommended (p < 0.001). Associations were observed between arsenic and residence in an urban area (p = 0.013), and between lead and smoking (p = 0.024) and well-water consumption (p = 0.046). In IF, aluminum, vanadium, and uranium levels were higher than in HM (p < 0.001); uranium, quantified for the first time, was 100 times higher in all types of IF than in HM. Our results indicate that concentrations of most trace elements were within internationally accepted ranges for HM and IF. However, preterm infants are at increased risk of nutritional deficiencies and toxicity. IF manufacturers should reduce the content of toxic trace elements.

Evaluation of Cerebellar Function and Integrity of Adult Rats After Long-Term Exposure to Aluminum at Equivalent Urban Region Consumption Concentrations

High amounts of aluminum (Al) are found in soil and water. It is highly bioavailable, which makes it an important agent of environmental imbalance. Moreover, Al is considered a neurotoxic agent that is associated with several neurodegenerative diseases. Thus, this study investigated the effects of long-term Al chloride (AlCl₃) exposure on motor behavior, oxidative biochemistry, and cerebellar tissue parameters. For this, adult Wistar rats were divided into three groups: Al-D1 (8.3 mg kg^-1 day^-1), Al-D2 (5.2 mg kg^-1 day^-1), and control (distilled water); all groups were orally exposed for 60 days by intragastric gavage. After the exposure period, animals performed the open field, elevated plus maze, rotarod, and beam walking tests. Then, the blood and cerebellum were collected to evaluate Al levels and biochemical and morphological analyses, respectively. Our results demonstrate that animals exposed to Al doses presented a higher Al level in the blood. In the spontaneous locomotor activity, Al exposure groups had traveled a lower total distance when compared with the control group. There was no statistically significant difference (p > 0.05) between exposed and control groups when anxiogenic profile, forced locomotion, fine motor coordination/balance, pro-oxidative parameter, and density Purkinje cells were compared. Thus, aluminum exposure in equivalent doses to human consumption in urban regions did not promote significant changes in the cerebellum or motor parameters.

Early-life exposure to aluminum and fine motor performance in infants: a longitudinal study

BACKGROUND

Aluminum (Al) is a well-established neurotoxicant. However, little is known about its effects on the neurodevelopment of infants.

OBJECTIVES

To examine early-life exposure to Al in relation to neurodevelopment in healthy infants.

METHODS

Nail Al concentrations were measured among 747 newborn babies within 6 months of delivery in the Shanghai Birth Cohort. Neurodevelopment was assessed using Ages and stages questionnaire (third edition, ASQ-3) at ages 6 and 12 months. General linear regression models were performed to estimate the associations between Al concentrations and ASQ-3 scores.

RESULTS

After adjustment for potential confounders, early-life exposure to Al was not associated with any neurodevelopmental performance at age 6 months. However, Al level was associated with an increased risk of having a low fine motor score (quartile 4 vs. quartile 1, mean difference (MD): -1.63; 95% confidence interval (CI): -3.22, -0.05; P-trend < 0.01) at 12 months. No association was found for communication, gross motor, problem-solving, or personal-social score at 12 months.

SIGNIFICANCE

Early-life exposure to Al may be associated with poor fine motor skills in a dose-response manner among apparently healthy infants at age 12 months.

Metallomics Analysis for Assessment of Toxic Metal Burdens in Infants/Children and Their Mothers: Early Assessment and Intervention Are Essential

Accumulation of toxic metals in infants/children is of serious concern worldwide, from the viewpoint of their harmful effects on the normal growth and development. This metallomics study investigates the extent of toxic metal burdens in infants/children and the relationship to those in their mothers for 77 child/mother pair subjects. For mercury, its geometric mean concentration in infants/children was of similar level to that in their mothers, and a high-significant close correlation was observed between infants/children and their mothers (β = 0.758, r = 0.539, p < 0.0001). A significant but less intimate mother/child relationship was observed for arsenic (β = 0.301, r = 0.433), lead (β = 0.444, r = 0.471) and aluminum (β = 0.379, r = 0.451). Remarkably, the burden levels of lead, cadmium and aluminum in infants/children were approximately three times higher than those in their mothers (p < 0.0001), and the burden levels in some individuals were several tens of times higher than in the mothers. In contrast, some essential metal levels such as zinc, magnesium and calcium in infants/children were significantly lower than those in their mothers, and 29 individuals (37.7%) in the child subjects were estimated to be zinc-deficient. In addition, significant inverse correlations were observed between zinc and lead (r = −0.267, p = 0.019), and magnesium and arsenic (r = −0.514, p < 0.0001). These findings suggest that these toxic metal burdens and essential metal deficiencies in infants/children are of serious concern for their neurodevelopment, indicating that the early assessment and intervention are crucial. It is expected that larger epidemiological and intervention studies will provide a reasonable and essential pathway for intervention of neurodevelopment disorders.

Neurotoxic effects of combined exposures to aluminum and mercury in early life (infancy)

Aluminum and mercury are environmentally ubiquitous. Individually they are both neurotoxic elements with shared neuro-pathogenic pathways: oxidative stress, altered neurotransmission, and disruption of the neuroendocrine and immune systems. In the infant, Al and Hg differ in type of exposure, absorption, distribution (brain access), and metabolism. In environmentally associated exposure (breast milk and infant formulas) their co-occurrences fluctuate randomly, but in Thimerosal-containing vaccines (TCVs) they occur combined in a proprietary ratio; in these cases, low-doses of Thimerosal-ethylmercury (EtHg) and adjuvant-Al present the most widespread binary mixture in less developed countries. Although experimental studies at low doses of the binary Hg and Al mixture are rare, when studied individually they have been shown to affect neurological outcomes negatively. In invitro systems, comparative neurotoxicity between Al and Hg varies in relation to the measured parameters but seems less for Al than for Hg. While neurotoxicity of environmental Hg (mainly fish methyl-Hg, MeHg) is associated with neurobehavioral outcomes in children, environmental Al is not associated, except in certain clinical conditions. Therefore, the issues of their neurotoxic effects (singly or combined) are discussed. In the infant (up to six months) the organic-Hg and Al body burdens from a full TCV schedule are estimated to reach levels higher than that originating from breastfeeding or from high aluminum soy-based formulas. Despite worldwide exposure to both Al and Hg (inorganic Hg, MeHg, and Thimerosal/EtHg), our knowledge on this combined exposure is insufficient to predict their combined neurotoxic effects (and with other co-occurring neurotoxicants).

Public Health and Paediatric Risk Assessment of Aluminium, Arsenic and Mercury in Infant Formulas Marketed in Nigeria

OBJECTIVES

Infant formulas are useful alternatives to breast milk in many circumstances but may pose health risks to infants and children due to contamination by potentially toxic metals. This study aimed to determine the aluminium, arsenic and mercury concentrations and carry out an exposure health risk assessment in commonly consumed infant formulas in Nigeria.

METHODS

Different brands of both locally manufactured and imported infant formulas were purchased in March 2017 from stores in Port Harcourt, Nigeria. Analysis of metals in the samples was performed by atomic absorption spectrophotometry. The health risk was assessed by comparing estimated daily intake of aluminium, arsenic and mercury with the provisional tolerable daily intake acceptable by the Joint Food and Agricultural Organization/World Health Organization Expert Committee on Food Additives (JECFA).

RESULTS

A total of 26 infant formulas were analysed. The levels of arsenic were higher in cereal-based formulas compared to milk-based formulas, but the difference was not significant (P >0.05). The intake levels of aluminium, arsenic and mercury in infant formulas were found to be 8.02-14.2%, 437.1-771% and 23.7-41.8% of the provisional tolerable daily intake JECFA threshold values, respectively.

CONCLUSION

Commonly consumed infant formulas in Nigeria may add to the body burden of arsenic in children.

Aluminum Effects in Infants and Children

Aluminum has no known biological function; however, it is a contaminant present in most foods and medications. Aluminum is excreted by the renal system, and patients with renal diseases should avoid aluminum-containing medications. Studies demonstrating long-term toxicity from the aluminum content in parenteral nutrition components led the US Food and Drug Administration to implement rules for these solutions. Large-volume ingredients were required to reduce the aluminum concentration, and small-volume components were required to be labeled with the aluminum concentration. Despite these rules, the total aluminum concentration from some components continues to be above the recommended final concentration. The concerns about toxicity from the aluminum present in infant formulas and antiperspirants have not been substantiated but require more research. Aluminum is one of the most effective adjuvants used in vaccines, and a large number of studies have documented minimal adverse effects from this use. Long-term, high-concentration exposure to aluminum has been linked in meta-analyses with the development of Alzheimer disease.

Aggregated aluminium exposure: risk assessment for the general population

Aluminium is one of the most abundant elements in earth's crust and its manifold uses result in an exposure of the population from many sources. Developmental toxicity, effects on the urinary tract and neurotoxicity are known effects of aluminium and its compounds. Here, we assessed the health risks resulting from total consumer exposure towards aluminium and various aluminium compounds, including contributions from foodstuffs, food additives, food contact materials (FCM), and cosmetic products. For the estimation of aluminium contents in foodstuff, data from the German "Pilot-Total-Diet-Study" were used, which was conducted as part of the European TDS-Exposure project. These were combined with consumption data from the German National Consumption Survey II to yield aluminium exposure via food for adults. It was found that the average weekly aluminium exposure resulting from food intake amounts to approx. 50% of the tolerable weekly intake (TWI) of 1 mg/kg body weight (bw)/week, derived by the European Food Safety Authority (EFSA). For children, data from the French "Infant Total Diet Study" and the "Second French Total Diet Study" were used to estimate aluminium exposure via food. As a result, the TWI can be exhausted or slightly exceeded-particularly for infants who are not exclusively breastfed and young children relying on specially adapted diets (e.g. soy-based, lactose free, hypoallergenic). When taking into account the overall aluminium exposure from foods, cosmetic products (cosmetics), pharmaceuticals and FCM from uncoated aluminium, a significant exceedance of the EFSA-derived TWI and even the PTWI of 2 mg/kg bw/week, derived by the Joint FAO/WHO Expert Committee on Food Additives, may occur. Specifically, high exposure levels were found for adolescents aged 11-14 years. Although exposure data were collected with special regard to the German population, it is also representative for European and comparable to international consumers. From a toxicological point of view, regular exceedance of the lifetime tolerable aluminium intake (TWI/PTWI) is undesirable, since this results in an increased risk for health impairments. Consequently, recommendations on how to reduce overall aluminium exposure are given.

Some toxic metals (Al, As, Mo, Hg) from cow's milk raised in a possibly contaminated area by different sources

Milk can be considered as an indicator of the degree of environmental contamination of the place where it is produced and this is especially important when assessing its content in toxic metals. Therefore, 36 bovine milk samples from 7 farms with a semi-extensive grazing system were analysed, located in Asturias (Spain), in an area with high probability of being highly contaminated due to a mining zone, with important industrial activity and near high-density highway traffic. The samples were lyophilised to achieve total dehydration, further analysed using inductively coupled plasma mass spectrometry (ICP-MS). The metals titrated were aluminium (Al), arsenic (As), molybdenum (Mo) and mercury (Hg) in the lyophilised samples and subsequently extrapolated their values to whole milk. All samples analysed showed levels of Al and Mo above the limit of detection, with mean values of Al of 140.89 ± 157.07 in liquid milk and 1065.76 ± 1073.45 in lyophilised milk and Mo of 20.72 ± 14.61 μg/kg and 152.26 ± 96.82 μg/kg in whole and lyophilised milk. Only As was detected in four samples with mean values of 18.45 ± 6.89 and 166.45 ± 42.30 μg/kg in liquid and lyophilised milk, respectively, and no Hg was found in any of them. In no case do the values found indicate a significant hazard to the population and are in agreement with those found in other investigations. Although the various anthropogenic activities of the area (industrial, mining, traffic density) could, a priori, indicate a possibly contaminated area.

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.

How Bad Is Aluminum Exposure to Reproductive Parameters in Rats?

Aluminum (Al) is the most widely distributed metal in the environment and is extensively used in human daily life without any known biological function. It is known that exposure to high concentrations of Al impacts negatively on serum testosterone levels, testicular histomorphometry, and sperm parameters; however, no information is available about the effects of low exposure levels on reproduction. International organizations have established the Al concentration tolerated in drinking water as 3.35 × 10^-4 mg/kg. Therefore, we aimed to compare the effects of long-term exposure to low and high concentrations of Al on male reproductive functions, focusing on testis, epididymis, and sperm parameters. Adult Wistar rats were exposed to aluminum chloride (AlCl₃) at 6.7 × 10^-5, 3.35 × 10^-4, 10, and 40 mg/kg for 112 days by gavage. Al-exposed animals presented low values of testis and epididymis weight, and serum testosterone levels when compared to controls. The stereology of Leydig cells, epididymis histomorphometry, sperm motility, and structural integrity of sperm membranes changed depending on the Al concentration. In regard to epididymis histomorphometry, the initial segment and caput regions were more affected by Al exposure than distal regions. Otherwise, the histology of testis and epididymis did not alter after the Al exposure, as well as sperm morphology. In summary, we concluded that the consequences of Al exposure at low levels were as negative as high levels on reproductive parameters, suggesting adverse impact on male fertility.

Systematic review of potential health risks posed by pharmaceutical, occupational and consumer exposures to metallic and nanoscale aluminum, aluminum oxides, aluminum hydroxide and its soluble salts

Abstract Aluminum (Al) is a ubiquitous substance encountered both naturally (as the third most abundant element) and intentionally (used in water, foods, pharmaceuticals, and vaccines); it is also present in ambient and occupational airborne particulates. Existing data underscore the importance of Al physical and chemical forms in relation to its uptake, accumulation, and systemic bioavailability. The present review represents a systematic examination of the peer-reviewed literature on the adverse health effects of Al materials published since a previous critical evaluation compiled by Krewski et al. (2007) . Challenges encountered in carrying out the present review reflected the experimental use of different physical and chemical Al forms, different routes of administration, and different target organs in relation to the magnitude, frequency, and duration of exposure. Wide variations in diet can result in Al intakes that are often higher than the World Health Organization provisional tolerable weekly intake (PTWI), which is based on studies with Al citrate. Comparing daily dietary Al exposures on the basis of "total Al"assumes that gastrointestinal bioavailability for all dietary Al forms is equivalent to that for Al citrate, an approach that requires validation. Current occupational exposure limits (OELs) for identical Al substances vary as much as 15-fold. The toxicity of different Al forms depends in large measure on their physical behavior and relative solubility in water. The toxicity of soluble Al forms depends upon the delivered dose of Al(+3) to target tissues. Trivalent Al reacts with water to produce bidentate superoxide coordination spheres [Al(O2)(H2O4)(+2) and Al(H2O)6 (+3)] that after complexation with O2(•-), generate Al superoxides [Al(O2(•))](H2O5)](+2). Semireduced AlO2(•) radicals deplete mitochondrial Fe and promote generation of H2O2, O2 (•-) and OH(•). Thus, it is the Al(+3)-induced formation of oxygen radicals that accounts for the oxidative damage that leads to intrinsic apoptosis. In contrast, the toxicity of the insoluble Al oxides depends primarily on their behavior as particulates. Aluminum has been held responsible for human morbidity and mortality, but there is no consistent and convincing evidence to associate the Al found in food and drinking water at the doses and chemical forms presently consumed by people living in North America and Western Europe with increased risk for Alzheimer's disease (AD). Neither is there clear evidence to show use of Al-containing underarm antiperspirants or cosmetics increases the risk of AD or breast cancer. Metallic Al, its oxides, and common Al salts have not been shown to be either genotoxic or carcinogenic. Aluminum exposures during neonatal and pediatric parenteral nutrition (PN) can impair bone mineralization and delay neurological development. Adverse effects to vaccines with Al adjuvants have occurred; however, recent controlled trials found that the immunologic response to certain vaccines with Al adjuvants was no greater, and in some cases less than, that after identical vaccination without Al adjuvants. The scientific literature on the adverse health effects of Al is extensive. Health risk assessments for Al must take into account individual co-factors (e.g., age, renal function, diet, gastric pH). Conclusions from the current review point to the need for refinement of the PTWI, reduction of Al contamination in PN solutions, justification for routine addition of Al to vaccines, and harmonization of OELs for Al substances.

Aluminum exposure and toxicity in neonates: a practical guide to halt aluminum overload in the prenatal and perinatal periods

BACKGROUND

During the last years, human newborns have been overexposed to biologically reactive aluminum, with possible relevant consequences on their future health and on their susceptibility to a variety of diseases. Children, newborns and particularly preterm neonates are at an increased risk of aluminum toxicity because of their relative immaturity.

DATA SOURCES

Based on recent original publications and classical data of the literatures, we reviewed the aluminum content in mother's food during the intrauterine life as well as in breast milk and infant formula during lactation. We also determined the possible role of aluminum in parenteral nutrition solutions, in adjuvants of vaccines and in pharmaceutical products. A special focus is placed on the relationship between aluminum overexposure and the insurgence of bone diseases.

RESULTS

Practical points of management and prevention are suggested. Aluminum sources that infants may receive during the first 6 months of life are presented. In the context of prevention of possible adverse effects of aluminum overload in fetal tissues during development, simple suggestions to pregnant women are described. Finally, practical points of management and prevention are suggested.

CONCLUSIONS

Pediatricians and neonatologists must be more concerned about aluminum content in all products our newborns are exposed to, starting from monitoring aluminum concentrations in milk- and soy-based formulas in which, on the basis of recent studies, there is still too much aluminum.

Profiles of non-essential trace elements in ewe and goat milk and their yoghurt, Torba yoghurt and whey

The objectives of this study were to determine the profiles of non-essential trace elements in ewes' and goats' milk and manufactured products, such as yoghurt, torba yoghurt and whey, as well as changes in trace element content during Torba yoghurt-making processes. Concentrations of non-essential trace elements in ewe (Awassi) and goat (Damascus) milk and their yoghurt, torba yoghurt and whey were quantitatively determined by simultaneous inductively coupled plasma optical emission spectrometer (ICP-OES), after microwave digestion. Aluminium, antimony, arsenic, boron, beryllium, cadmium, nickel, lead, silver, titanium, thallium and vanadium were determined for both types of milk and their products. Barium was not detected in goats' milk or their products. Among all trace elements, boron was the most abundant and beryllium was least present in milk and the manufactured products. The results showed that goats' and ewes' milk and their manufactured products may be a source of 13 non-essential trace elements.

There is (still) too much aluminium in infant formulas

BACKGROUND

Infant formulas are sophisticated milk-based feeds for infants which are used as a substitute for breast milk. Historically they are known to be contaminated by aluminium and in the past this has raised health concerns for exposed infants. We have measured the aluminium content of a number of widely used infant formulas to determine if their contamination by aluminium and consequent issues of child health persists.

METHODS

Samples of ready-made milks and powders used to make milks were prepared by microwave digestion of acid/peroxide mixtures and their aluminium content determined by THGA.

RESULTS

The concentration of aluminium in ready-made milks varied from ca 176 to 700 μg/L. The latter concentration was for a milk for preterm infants. The aluminium content of powders used to make milks varied from ca 2.4 to 4.3 μg/g. The latter content was for a soya-based formula and equated to a ready-to-drink milk concentration of 629 μg/L. Using the manufacturer's own guidelines of formula consumption the average daily ingestion of aluminium from infant formulas for a child of 6 months varied from ca 200 to 600 μg of aluminium. Generally ingestion was higher from powdered as compared to ready-made formulas.

CONCLUSIONS

The aluminium content of a range of well known brands of infant formulas remains high and particularly so for a product designed for preterm infants and a soya-based product designed for infants with cow's milk intolerances and allergies. Recent research demonstrating the vulnerability of infants to early exposure to aluminium serves to highlight an urgent need to reduce the aluminium content of infant formulas to as low a level as is practically possible.

The trace metal levels in milk and dairy products consumed in middle Anatolia-Turkey

In this study, aluminium (Al), lead (Pb), cadmium (Cd), selenium (Se) and arsenic (As) contents in milk and different dairy product samples were measured. Pb, Cd, As, Al and Se contents in the milk and different dairy products ranged from 0.054 mg/kg (milk powder)-1.100 mg/kg (Kaşar cheese), 0.009 mg/kg (whey powder and yogurt)-0.051 mg/kg (Tulum cheese), 0.010 mg/kg (whey powder)-0.146 mg/kg (butter), 2.848 mg/kg (ice cream)-8.778 (drained yogurt) and n.d. (ice cream, milk and whey powder, yogurt, ayran and Lor cheese)-0.434 mg/kg (Tulum cheese), respectively. The 75% of White and Kaşar cheeses, 50% of Lor and 12.5% of Tulum cheese samples contained higher Pb according to the legal limits established by the Turkish Food Codex and European Communities regulation and 12.5% of Tulum cheese sample contained Cd. It was concluded that Pb contents of milk and dairy products from this region might be highly hazardous to human.

Determination of toxic elements in infant formulae by using electrothermal atomic absorption spectrometer

In present work concentrations of toxic elements (TEs), aluminum (Al), cadmium (Cd), and lead (Pb) in seventeen imported samples of infant milk-based (IMF) and infant soy-based formulae (ISF), were measured, to evaluate whether the intakes of understudy TEs accomplished within recommended permissible levels. The TEs were analyzed by electrothermal atomic absorption spectrometer, prior to microwave induced acid digestion. The validity of methodology was tested by simultaneously analyzing certified reference material and standard addition method. It was observed that ISF contains higher concentration of understudy toxic analytes as compared to IMF. The all three TEs, Al, Cd and Pb were detected in different branded infant formulae, in the range of (1070-2170), (10.5-34.4), and (28.7-119) microg/kg, respectively. The estimated intakes of TEs as microg/kg/week for infants (>1year) through milk formulae are well below the recommended tolerable levels of these elements.

Aluminium in human breast tissue

Aluminium is omnipresent in everyday life and increased exposure is resulting in a burgeoning body burden of this non-essential metal. Personal care products are potential contributors to the body burden of aluminium and recent evidence has linked breast cancer with aluminium-based antiperspirants. We have used graphite furnace atomic absorption spectrometry (GFAAS) to measure the aluminium content in breast biopsies obtained following mastectomies. The aluminium content of breast tissue and breast tissue fat were in the range 4-437 nmol/g dry wt. and 3-192 nmol/g oil, respectively. The aluminium content of breast tissue in the outer regions (axilla and lateral) was significantly higher (P=0.033) than the inner regions (middle and medial) of the breast. Whether differences in the regional distribution of aluminium in the breast are related to the known higher incidence of tumours in the outer upper quadrant of the breast remains to be ascertained.

Electrothermal atomic absorption spectrometry determination of aluminium in parenteral nutrition and its components

Aluminium concentration in samples of total parenteral nutrition solutions and samples of their individual components were analysed to know the exposure to this element. The median aluminium content obtained for the total parenteral nutrition solutions was 105.7 microg/L; for their individual components, 10% calcium gluconate and 1M monopotasic phosphate were the most contaminated, as well as the 1M sodium bicarbonate. The great variability found in the aluminium content of solutions suggests that contamination occurs during the manufacturing process.

Aluminum-induced suppression of testosterone through nitric oxide production in male mice

Excessive nitric oxide (NO) production in mice serum and testis due to aluminum (Al) exposure has been shown in previous studies. The aim of this study was to further investigate the role of NO on aluminum-suppressed testosterone level in male CD-1 mice. Each animal in six groups, was given intraperitoneal injections of either saline, aluminum chloride (AlCl(3)), l-N(6)-(1-iminoethyl) lysine (NO synthase inhibitor, l-NIL), or Al chloride along with l-NIL for a period of 12 days. These groups were denoted as C (control, saline), AL (35mg Al/kg/day, saline), NIL240 (total 240mg l-NIL/kg, saline), ALNIL240 (35mg Al/kg/day, total 240mg l-NIL/kg), ALNIL60 (35mg Al/kg/day, total 60mg l-NIL/kg), and NIL60 (total 60mg l-NIL/kg, saline). Results indicated that serum/testicular aluminum levels increased significantly in aluminum-treated animals compared to the controls, whereas the values observed from groups ALNIL240 than AL/ALNIL60 were markedly lower. Aluminum administration significantly increased NO production and decreased both testicular adenosine 3',5'-cyclic monophosphate (cAMP) and testosterone levels. A lower level of NO and higher concentrations of cAMP and testosterone observed in the ALNIL240 group indicated that the protective effect of NO synthase blockage was significant, although incomplete. In addition, aluminum induction significantly elevated the testicular cholesterol, but the values were lower in the ALNIL240 group than the AL or the ALNIL60 group. Finally, it was suggested that aluminum compounds exerted a significant adverse effects on the steroidogenesis and cAMP, which aided in the transport of cholesterol to the inner mitochondrial membrane. Furthermore, nitric oxide synthase blockage prevented aluminum-induced reproductive toxicity.

The biological behaviour and bioavailability of aluminium in man, with special reference to studies employing aluminium-26 as a tracer: review and study update

Until 1990 biokinetic studies of aluminium metabolism and biokinetics in man and other animals had been substantially inhibited by analytical and practical difficulties. Of these, the most important are the difficulties in differentiating between administered aluminium and endogenous aluminium-especially in body fluids and excreta and the problems associated with the contamination of samples with environmental aluminium. As a consequence of these it was not possible to detect small, residual body burdens of the metal following experimental administrations. Consequently, many believed aluminium to be quantitatively excreted within a short time of uptake in all, but renal-failure patients. Nevertheless, residual aluminium deposits in a number of different organs and tissues had been detected in normal subjects using a variety of techniques, including histochemical staining methods. In order to understand the origins and kinetics of such residual aluminium deposits new approaches were required. One approach taken was to employ the radioisotope (67)Ga as a surrogate, but this approach has been shown to be flawed-a consequence of the different biological behaviours of aluminium and gallium. A second arose from the availability, in about 1990, of both (26)Al-a rare and expensive isotope of aluminium-and accelerator mass spectrometry for the ultra-trace detection of this isotope. Using these techniques the basic features of aluminium biokinetics and bioavailability have been unravelled. It is now clear that some aluminium is retained in the body-most probably within the skeleton, and that some deposits in the brain. However, most aluminium that enters the blood is excreted in urine within a few days or weeks and the gastrointestinal tract provides an effective barrier to aluminium uptake. Aspects of the biokinetics and bioavailability of aluminium are described below.

Aluminium content of Spanish infant formula

Levels of aluminium in 82 different infant formulae from nine different manufacturers in Spain were determined by acid-microwave digestion and graphite furnace atomic absorption spectrophotometry. The influence of aluminium content in tap water in reconstituted powder formulae was examined and an estimate was made of the theoretical toxic aluminium intake in comparison with the provisional tolerable weekly intake (PTWI). Possible interactions between aluminium and certain essential trace elements added to infant formulations have been studied according to the type or main protein-based infant formula. In general, the infant formulae contained a higher aluminium content than that found in human milk, especially in the case of soya, preterm or hydrolysed casein-based formulae. Standard formulae gave lower aluminium intakes amounting to about 4% PTWI. Specialized and preterm formulae resulted in a moderate intake (11-12 and 8-10% PTWI, respectively) and soya formulae contributed the highest intake (15% PTWI). Aluminium exposure from drinking water used for powder formula reconstitution was not considered a potential risk. In accordance with the present state of knowledge about aluminium toxicity, it seems prudent to call for continued efforts to standardize routine quality control and reduce aluminium levels in infant formula as well as to keep the aluminium concentration under 300 microg l(-1) for all infant formulae, most specifically those formulae for premature and low birth neonates.

Infant feeding: a critical look at infant formulas

Commercially available infant formulas serve as the best alternative to human milk when breastfeeding is not possible. Infant formulas are designed specifically to mimic the composition of human milk or the functional aspects of human milk feeding. This review highlights the issues related to the composition of infant formulas. The most hotly debated issue currently is whether to add long-chain polyunsaturated fatty acids to infant formulas. Other controversial topics include the safety and efficacy of soy-based protein formulas, protein quantity and quality as they relate to the infant's nutritional needs and feeding tolerance, and the replacement of lactose with other carbohydrate sources for specialized infant formulas. Recent modifications in the fat blend of infant formulas have led to improved fat digestibility. However, the full spectrum of benefits associated with the addition of nucleotides awaits further study. Modifications to infant formulas are made when the preponderance of scientific evidence suggests that the compositional change will better meet the nutritional needs of the infant.