Estimating daily intakes of manganese due to breast milk, infant formulas, or young child nutritional beverages in the United States and France: Comparison to sufficiency and toxicity thresholds

Abstract

Background Although manganese (Mn) is an essential nutrient, recent research has revealed that excess Mn in early childhood may have adverse effects on neurodevelopment.Methods We estimated daily total Mn intake due to breast milk at average body weights by reviewing reported concentrations of breast milk Mn and measurements of body weight and breast milk intake at 3 weeks, 4.25 months, 7 months, and 18 months. We compared these figures to the Mn content measured in 44 infant, follow-up, and toddler formulas purchased in the United States and France. We calculated Mn content of formula products made with ultra-trace elemental analysis grade water (0 µg Mn/L) and with water containing 250 µg Mn/L, a concentration which is relatively high but less than the World Health Organization Health-based value of 400 µg Mn/L or the United States Environmental Protection Agency Health Advisory of 350 µg Mn/L.Results Estimated mean daily Mn intake from breast milk ranged from 1.2 µg Mn/kg/day (3 weeks) to 0.16 µg Mn/kg/day (18 months), with the highest intakes at the youngest age stage we considered, 3 weeks. Estimated daily Mn intake from formula products reconstituted with 0 µg Mn/L water ranged from 130 µg Mn/kg/day (3 weeks) to 4.8 µg Mn/kg/day (18 months) with the highest intakes at 3 weeks. Formula products provided 28 to 520 times greater than the mean daily intake of Mn from breast milk for the 4 age stages that we considered. Estimated daily Mn intake from formula products reconstituted with water containing 250 µg Mn/L ranged from 12 µg Mn/kg/day to 170 µg Mn/kg/day, which exceeds the United States Environmental Protection Agency Reference Dose of 140 µg Mn/kg/day for adults.Conclusions Mn deficiency is highly unlikely with exclusive breast milk or infant formula feeding, but established tolerable daily intake levels for Mn may be surpassed by some of these products when following labeled instructions.HighlightsMn deficiency is unlikely with exclusive breast milk or infant formula feeding.Breast milk Mn mean intake is 1.2 µg/kg/day (3 weeks)-0.16 µg/kg/day (18 months).Formula Mn intake range is 130 µg/kg/day (3 weeks)-4.8 µg/kg/day (18 months).Formula products reconstituted with 250 µg Mn/L water may exceed 140 µg Mn/kg/day.Formula products may surpass regulatory tolerable daily intake levels for Mn.Competing Interest StatementThe authors have declared no competing interest.1 List of abbreviationsAIAdequate IntakeANSESAgence nationale de sécurité sanitaire de l’alimentation, de l’environnement et du travail (French Agency for Food, Environmental and Occupational Health & Safety)DJAdose journalière admissible (daily admissible dose, tolerable daily intake)EFSAEuropean Food Safety AuthorityEUEuropean UnionFAOFood and Agriculture OrganizationHBVHealth-Based ValueINSPQInstitut national de santé publique du Québec (National Institute of Public Health of Québec)IOMInstitute of MedicineIQintelligence quotientJECFAJoint FAO/WHO Expert Committee on Food AdditivesLOAELLowest Observed Adverse Effect LevelMnManganeseMnSODmanganese superoxide dismutaseMRmagnetic resonanceNOAELNo Observed Adverse Effect LevelPIXEparticle induced X-ray emissionPNparental nutritionRBSRutherford backscatteringRfDReference DoseSCFScientific Committee on FoodT1RT1 relaxationTPNtotal parenteral nutritionU.S.United States Environmental Protection AgencyEPAEnvironmental Protection AgencyUSUnited StatesView Full Text