Friday October 11 2013
Infant formula is made from treated cow’s milk
“Formula milk exposes babies to high levels of aluminium, experts warn,” The Guardian reports. A team of researchers has measured levels in the most popular brands and claims they could pose a threat to health – a claim disputed by the Food Standards Agency (FSA) – the main UK regulatory body responsible for food safety.
It is important to stress from the start that the reported study provides no evidence that any infant formula brands on the UK market are harmful.
The researchers measured the aluminium content of 30 widely available infant feeding formulas in the UK and concluded they were “too high”.
There is no reason to doubt the accuracy of their measurements. What remains unproven is their assertion that these levels pose a threat to health.
All the formulas tested had aluminium levels within current health and safety regulations and the current assessment by the FSA, is that current levels of aluminium in infant formula are safe.
This study is arguably more of an opinion piece than new research. The fact that infant feeding formulas contain traces of aluminium has been known for years. However, a compelling case that this represents a public health danger and that the current regulations are wrong has not been made.
Breastfeeding is the healthiest way to feed your baby but if you are unable or unwilling to then current evidence suggests that you have nothing to worry about with using formulas.
Where did the story come from?
The study was carried out by researchers from Keele University. It was not clear who funded the main body of the research, although it was stated that funding from the Engineering and Physical Sciences Research Council (EPSRC) paid for the equipment used to detect aluminium content.
The study was published in the peer-reviewed medical journal BMC Pediatrics, as an open access article it is free to read online or download.
The media reporting was generally accurate and repeated the author’s concerns that aluminium levels were too high in the baby feeds and that the industry needed to reduce them to the lowest practical levels.
Refreshingly, the UK media resisted the urge to report this study out of context as a ‘scare story’. All the reporting was relatively well-balanced as it included quotes that the aluminium levels were all within current guideline limits and there was no evidence they were harmful to children, as there was little evidence about the effect of aluminium on human health either way.
Usefully the Mail Online also pointed out that European recommendations on aluminium levels in drinking water are actually due to aesthetic reasons (it makes the water look a funny colour) rather than health and safety reasons.
What kind of research was this?
The research was a laboratory study analysing the aluminium content of 30 of the most widely available infant formulas in the UK.
The study was the second on this topic from the same authors. Previously they tested 15 brands, and suggested that more information should be provided about the aluminium content of the formulas so consumers, and industry purchasers, could make an informed decision on which to buy, based on their aluminium levels. The previous research concluded that in the authors’ opinion, the aluminium levels in the formulas were too high.
What did the research involve?
The researchers tested the aluminium content of 30 shelf bought infant formulas stored according to manufacturers’ instructions and only opened at the time of testing.
The aluminium content of 10 ready-to-drink infant formulas and 20 powdered infant formulas were measured using a technique called transversely heated graphite furnace atomic absorption spectrometry (TH GFAAS) following acid/peroxide microwave digestion.
All products were sampled directly from their containers following shaking to aid mixing of the products. Each product was tested five times and values averaged to improve accuracy.
What were the basic results?
The concentration of aluminium in ready-made infant formula milks ranged from 155 mircograms per litre (SMA Toddler) to 422 mircograms per litre (Aptamil Toddler Growing Up). The researchers then used the manufacturers’ recommendations for feeding along with the average concentrations of aluminium to estimate daily exposures to aluminium from each product. These ranged from 86 (Hipp Organic First) to 127 (Cow & Gate First) micrograms of aluminium per 24h period at birth, and 134 (Hipp Organic First) to 350 (Aptamil Follow-On) micrograms of aluminium per 24h period at six months of age.
In powdered milk infant formulas aluminium levels ranged from 0.69 micrograms per gram (Hipp Organic Growing Up) to 5.27 micrograms per gram (Cow & Gate Soya Infant Formula). The estimated exposure ranged from 64 (Aptamil Hungrier) to 408 (Cow & Gate Soya Infant Formula) micrograms of aluminium per 24h period at birth, and 80 (Hipp Organic Follow-On) to 725 (Cow & Gate Soya Infant Formula) at six months of age.
How did the researchers interpret the results?
The researchers concluded that “all 30 infant formulas were contaminated with aluminium. There was no clear evidence that subsequent to the problem of aluminium being highlighted in a previous publication in this journal that contamination had been addressed and reduced. It is the opinion of the authors that regulatory and other non-voluntary methods are now required to reduce the aluminium content of infant formulas and thereby protect infants from chronic exposure to dietary aluminium.”
The authors went on to discuss the possible sources of the aluminium, including packaging, which they noted was unlikely to account for the variation, and other industrial processes involved in the manufacture of the product.
They also highlighted how “the concentration of aluminium in each of the 30 infant formulas is at least twice that which is recommended in the European Union for drinking water (50μg/L) and in 14 of the milks it exceeds the maximum admissible level for drinking water of 200μg/L”.
They went on to report that “while these recommended values for aluminium in drinking water were, historically at least, not set with human health as a criterion, they are used today in general practice to ascertain whether or not potable waters are fit for human consumption”.
This study measured the aluminium content of 30 widely available infant feeding formulas in the UK.
The study invited debate about whether the current regulation on aluminium in foods is appropriate as it stands but provided no new evidence about whether the levels were harmful to health. All of the products were within current health and safety regulations and so deemed safe in the context of current regulation.
However, the authors were of the opinion that the current level of infant exposure to aluminium represents an “unnecessary potential health risk to children and may actually contribute towards ill health as adults”. The study and quotations in the papers asserted that there was limited research into the effect of aluminium and so the effects on human health are largely unknown.
One of the authors’ arguments for revisiting the regulations was that some of the assumptions used by the Food Standards Agency (FSA), may not be accurate. The FSA has concluded in the past that the current levels are safe. We were unable to review the evidence for this in the time available, so cannot offer an opinion on whether the assumptions are accurate or not.
This study appears effective at gaining publicity about whether the current regulation on the level of aluminium in infant formula is appropriate and whether industry should reduce the levels on health grounds. However, it does not contribute any extra information on whether the current levels are harmful or potentially harmful to infant health.
The most rigorous way to gather proof on the impact of infant formula on long-term health in children – a randomised control trial – would be unethical due to issues such as informed consent. The next best thing would be to track the aluminium exposure and health of children from birth to later life in a cohort study. You could then look to see if there were more health problems in those exposed to higher levels of aluminium. However, many factors influence health over time so isolating the effect of aluminium would be difficult.
The bottom line is that the study does not provide any evidence that the current regulations are wrong, or that current levels of aluminium in infant foods are in any way harmful to health.
Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter.