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Letters to the Editor

Indian Pediatrics 2002; 39:795-797

Formula Milks: Contamination, Toxicity and Physiological Imbalances

The right to grow up in the best possible health is a basic right of all children. For the last few decades, babies grown up on formula, have either not received essential ingredients or they have received them in excess. The newborn is totally dependent on a single food during the time of critical growth and development. The amount and types of nutrients can have both short and long term consequences on growth and development, adverse effect on immune responses and interference with closer parent child relationship(1). This in turn could lead to child abuse and neglect.

The literature is filled with an ever increasing number of breast milk studies, unfortunately many of which are funded by the formula milk industry(2). In order to increase the market share, the formula milk industry looks for new ingredients to add to its milk formula. In doing so, they may create physiological imbalances: either toxicity due to excess or lack due to deficiency of essential ingredients.

Bacterial contamination of formulas continues to be of concern. Recently reports from France have shown bacterial contamintion of formula milk(3).

Formula-fed infants are at risk for neonatal hypocalcemic tetany. This is due to the high phosphate load in formula and lower calcium retention in newborns. New types of formulas which contain 45% palmolein can lead to decreased absorption of calcium(4). In general, the breast-fed infant is at little risk of either a deficiency or an excess of trace elements. Formula fed infants are at a higher risk for ingestion of lead, aluminum and other heavy metals and this may affect the growing brain adversely(5). There is high level of manganese in soya formula, its absorption and retention are high during infancy(6).

Great advances in knowledge about mineral interactions and bio availability have occurred in the last decade. It is now recognized that the ability of breast milk substitutes to provide adequate levels of nutrients cannot be predicted from their compositional analysis alone and that growth by itself is not a sufficiently sensitive indicator of all possible adverse outcomes due to deficiency or excess. The mineral content of Na, K, Ca, Mg, C1 and P was determined in different batches of 5 preterm formulae. In 4 of the 5 premature formulae, variation coefficients greater than 10% were observed for at least one mineral. There were marked differences between the specifications and measurements in at least one of the formula(7).

Linolenic acid has been added very recently which babies can only partially convert to DHA (docosa hexaenoic acid), an essential omega-3 fatty acid, necessary for brain development(8). Recently it has been shown that commercial infant formulae containing long chain polyunsaturated fatty acids do not raise the plasma level of long chain polyunsaturated fatty acids to desired levels(9).

Taurine, essential for myelination of the central nervous system was absent from formulae till 1984(1). Even when essential amino acids are added to formulae milk, some amino acid levels were low in plasma(10), whereas some amino acids were found to be high in the plasma of the infant(11).

Nucleotides are present in human milk in large quantities and five nucleotides have recently been added to formula milk. Many studies suggest enchanced immunity with nucleotides in breast milk. However certain ingredients in formula may modify the action and absorption of nucleotides. Large amount of nucleotides can damage the neonatal kidney(12).

Shobha Banapurmath,

C.R. Banapurmath,

Nirmala Kesaree,

Bapuji Child Health Institute,

Davangere 577 004, India.

E-mail: sbanapuramath@hotmail.com



1. Fergusson DM, WoodWard LJ. Breast feeding and later psychosocial adjustment. Pediatr Perinat Epidemiolo 1999; 13: 144-157.

2. "Breast Milk Substitutes: Fake Foods". Editorial in Breastfeeding Briefs, GIFA, IBFAN, Box 157, 1211 Geneva 19, Switzerland. No. 17, 1993.

3. Threlfall EJ, Ward LR, Hampton MD, Ridley AM, Rowe B. Roberts D, et al. Molecular finger printing defines a strain of Salmonella enterica serotype Anatum responsible for an international outbreak associated with formula dried milk. Epidemiol Infect 1998; 121: 289-293.

4. Nelson SE, Frantz TA, Ziegler EE. Absorption of fat and calcium by infant fed a milk based formula containing palmolein. J Am Coll Nutr 1998; 17: 327-332.

5. Dabeka EW, Mckenzie AD. Lead and cadmium levels in commercial infant foods and dietary intake by infants 0-1 year old. Food Addit Contam, 1988; 5: 333-342.

6. Blood Worth BC, Hock CT, Boon TO. Aluminium content in milk powder by inductively coupled argon plasma optical emission spectrometry. Food Addit Contam 1991; 8: 749-754.

7. Remer T, wan Eyll B, Tolle HG, Manz F. Contents and batch dependent variations of mineral substances in milk formula for premature infants and possible effects on renal acid burden. Monatsschar Kinderheilkd 1990; 138: 658-663.

8. Banapurmath CR, Banapurmath S, Kesaree N. Developing brain and breastfeeding. Indian Pediatr 1996; 33: 35-38.

9. Morgan C, Davies L, Corcoran F, Stammers SJ, Coley J. Fatty acid balance studies in term infants fed formula milk containing long chain polyunsaturated fatty acid. Acta Pediatr 1998; 87: 136-142.

10. Wu TC, Hwang B. Blood nutrient indices in breast and formula fed infants: amino acids metabolic response. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi 1997; 38: 345-351.

11. Desci T, Veitl V, Szasz M, Pinter Z, Mehe SK. Plasma amino acid concentration in healthy full term infants fed hydrolysate infant formula. J Pediatr Gastroenterol Nutri 1996; 22: 62-67.

12. Quan R, Barness LA, Uauy R. Do infants need nucleotide supplemented formula for optimal nutrition? J Pediatr Gastroenterol Nutr 1990; 11: 429-434.



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