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- Title
Potential for Manganese-Induced Neurologic Harm to Formula-Fed Infants: A Risk Assessment of Total Oral Exposure.
- Authors
Scher, Deanna P.; Goeden, Helen M.; Klos, Kristine S.
- Abstract
BACKGROUND: High oral exposure and biological vulnerabilities may put formula-fed infants at risk for manganese-induced neurotoxicity. OBJECTIVES: We sought to characterize manganese concentrations in public drinking water and prepared infant formulas commonly purchased in the United States, integrate information from these sources into a health risk assessment specific to formula-fed infants, and examine whether households that receive water with elevated manganese concentrations avoid or treat the water, which has implications for formula preparation. METHODS: Manganese was measured in 27 infant formulas and nearly all Minnesota community public water systems (CPWS). The risk assessment produced central tendency and upper-end exposure estimates that were compared to a neonatal animal-based health reference dose (RfD) and considered possible differences in bioavailability. A survey study assessed esthetic concerns, treatment, and use of water in a Twin Cities community with various levels of manganese in drinking water. RESULTS: Ten percent of CPWSs were estimated to exceed the EPA health advisory level of 300 µg/L. Manganese concentrations in formula ranged from 69.8 to 741 µg/L, with amino acid >soy >cow's milk formula concentrations. Central tendency estimates of soy and amino acid formula reconstituted with water at the CPWS 95th percentile manganese concentration exceeded the neonatal-based RfD. Upper-end estimates of manganese intake from formula alone, independent of any water contribution, equaled or exceeded the neonatal-based RfD. In the survey study, we observed increased awareness of esthetic issues and water avoidance at higher manganese concentrations, but these concentrations were not a reliable consumption deterrent, as the majority of households with inside tap drinking water results above 300 µg/L reported drinking the water. DISCUSSION: Excessive exposure to manganese early in life can have long-lasting neurological impacts. This assessment underscores the potential for manganese overexposure in formula-fed infants. U.S. agencies that regulate formula and drinking water must work collaboratively to assess and mitigate potential risks.
- Subjects
MINNESOTA; UNITED States; NEUROLOGICAL disorder prevention; INFANT formulas; KRUSKAL-Wallis Test; NEUROLOGICAL disorders; CATTLE; BIOAVAILABILITY; GOVERNMENT regulation; TOXIC substance exposure; HEALTH status indicators; FAMILIES; MILK; SOYMILK; MANGANESE; WATER supply; RISK assessment; INFANT nutrition; T-test (Statistics); WATER pollution; DESCRIPTIVE statistics; GOVERNMENT agencies; CHI-squared test; AMINO acids; DATA analysis software; MOUTH; DISEASE risk factors; CHILDREN
- Publication
Environmental Health Perspectives, 2021, Vol 129, Issue 4, p047011-1
- ISSN
0091-6765
- Publication type
Article
- DOI
10.1289/EHP7901