This Pakistani study used inductively coupled plasma optical emission spectrometry (ICP-OES) to quantify mineral composition in 5 commercial preterm infant formulas, 10 preterm maternal milk samples, and 10 term maternal milk samples from tertiary hospitals in Lahore. The primary purpose was nutritional adequacy assessment for premature neonates relative to ESPGHAN recommendations. Toxic element measurements included aluminium and chromium; the study did not measure lead, cadmium, arsenic, or mercury.
The study found that aluminium concentrations were higher in human milk (preterm 16.2 µg/mL, term 5.9 µg/mL) than in preterm formula (1.16 µg/mL) on a reconstituted basis. Mineral composition of preterm formula met or exceeded requirements for calcium, magnesium, phosphorus, and zinc more frequently than human milk. Label discrepancies were identified for calcium, sodium, sulfur, strontium, titanium, and zinc.
Key numbers
Aluminium concentrations (ICP-OES, reconstituted basis):
| Matrix | Aluminium (µg/mL reconstituted) | Approximate ppb equivalent |
|---|---|---|
| Preterm human milk | 16.2 | ~16,200 ppb (reconstituted) |
| Term human milk | 5.9 | ~5,900 ppb (reconstituted) |
| Preterm formula (reconstituted) | 1.16 | ~1,160 ppb (reconstituted) |
Note: “µg/mL” appears in the abstract; this likely represents µg/L given the analyte and matrix context. Units require verification against the full paper tables. The preterm formula aluminium value of 1.16 µg/L (~1.16 ppb) or 1.16 µg/mL (~1,160 ppb) on a reconstituted basis is the primary toxic element finding from this paper.
The study measured 15 elements: aluminum (Al), Ba, Ca, chromium (Cr), Cu, Fe, Mg, Mn, Na, P, S, Se, Sr, Ti, Zn. Lead, cadmium, total arsenic, and mercury were not measured.
Methods (brief)
Cross-sectional analytical study. Sample collection: 25 milk samples (10 preterm, 10 term maternal milk, 5 preterm formulas) from three tertiary hospitals in Lahore, Pakistan. Microwave-assisted acid digestion (HNO3/H2O2). ICP-OES analysis (iCAP 6500, Thermo Fisher). Recoveries 89-103% using NIST 2710a CRM. Intra-day precision RSD ⇐5%, inter-day ⇐7%. Formula samples analyzed both as powder (mg/g) and reconstituted (µg/mL) per manufacturer instructions.
Evidence fitness
This source provides Pakistani preterm formula context for aluminium contamination. The finding that preterm formula has lower aluminium than human milk (reconstituted basis) is notable. The scope is limited: n=5 formulas only, preterm (not stage 1 term) formula specifically, Pakistan market, and the HMTc panel metals (lead, cadmium, arsenic, mercury) were not measured. This paper contributes aluminium context for preterm formula only and cannot support stage 1 term formula aluminium estimates.
Limitations
Very small formula sample size (n=5). Covers preterm formula specifically; stage 1 term infant formula was not in scope. Lead, cadmium, arsenic, and mercury not measured. Pakistan market only; no basis for global inference. The aluminium units in the abstract (µg/mL vs µg/L) require clarification against the paper tables to interpret correctly.
Related evidence
- Aluminum
- Infant Formula Stage 1
- Toxic Metals and Metalloids in Infant Formulas Marketed in Brazil, and Child Health Risks According to the Target Hazard Quotients and Target Cancer Risk
- Essential and Potentially Toxic Elements in Commercial Milk Formulas: Health Risk Assessment Through a Systematic Review and Meta-analysis
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