Assessing heavy metal levels in pediatric enteral nutrition formulas available in the Turkish market: Implications for consumer health

Abstract

In this study, we assessed the levels of lead (Pb), cadmium (Cd), mercury (Hg), and inorganic arsenic (iAs) in 27 pediatric enteral nutrition (EN) formulas from five international brands available in the Turkish market. Analysis was conducted using inductively coupled plasma mass spectrometry (ICP-MS). Non-carcinogenic and carcinogenic risk assessment was performed using hazard quotient (HQ), hazard index (HI), carcinogenic risk (CR), Toxicological contribution % of Provisional Tolerable Weekly Intake (PTWI) models. Our objective was to evaluate heavy metal exposure in EN formulas, specifically focusing on Cd, Pb, iAs, and Hg levels according to recommended amounts for different age groups based on their energy requirements. Average concentrations of iAs in polymeric (PC), oligomeric (OC), and monomeric (MC) EN formulas were as follows: PC: 2.13 ± 0.16 (<LOD-13.86) μg/kg, OC: 4.29 ± 0.10 (0.38-11.98) μg/kg, MC: 8.62 ± 0.19 (1.60-27.20) μg/kg. For Cd levels, average concentrations in PC, OC, and MC formulas were: PC: 0.57 ± 0.03 (<LOD-3.09) μg/kg, OC: 1.31 ± 0.07 (0.40-3.12) μg/kg, MC: 0.93 ± 0.07 (0.07-2.33) μg/kg. Similarly, average concentrations of Hg in PC, OC, and MC formulas were: PC: 0.13 ± 0.01 (<LOD-0.14) μg/kg, OC: 0.18 ± 0.01 (<LOD-0.18) μg/kg, MC: 0.20 ± 0.02 (<LOD-0.34) μg/kg. Lastly, average concentrations of Pb in PC, OC, and MC formulas were: PC: 2.32 ± 0.06 (1.52-2.96) μg/kg, OC: 0.97 ± 0.06 (0.37-2.26) μg/kg, MC: 2.58 ± 0.08 (1.95-3.28) μg/kg. The exposure levels of Cd, Pb, iAs, and Hg calculated in this study did not exceed the PTWI threshold values established by the European Food Safety Authority (EFSA). Average HQ values for each heavy metal exposure in males and females were below 1. However, P95 values for iAs exceeded 1.00 in all age groups. The HI value was greater than 1.00 in all age groups and genders. The presence of heavy metals in EN formulas may pose health risks, particularly for sensitive individuals.