Reducing the Risk of Neurodevelopmental Harm from Excess Manganese in Infant Formula and Breast Milk Substitutes
Adopted January 2023
Exposure to excess manganese (Mn) is associated with neurodevelopmental harm in children, including impaired cognitive development, lower intelligence quotient (IQ) scores, impaired memory function, lower academic skills or achievement, impaired executive function, lower visual-spatial ability, impaired motor function, impaired olfactory function, atypical brain structure or function, and relatively high manganese exposures are suspected of increasing the risk of attention deficits, hyperactivity, or attention deficit hyperactivity disorder (ADHD), and other behavior and attention problems1.
Infant, follow-on, toddler, and pediatric formulas sold in the United States (U.S.) contain 24 to 780 times the average manganese concentration of breast milk1,2. The manganese intakes from these products for 3-week-old infants are between 28 to 110 times the average manganese intake from breast milk2. These intakes exceed the World Health Organization (WHO) tolerable daily intake (TDI) for manganese exposure3. Manganese intakes are further increased if the formula is prepared with water containing high concentrations of manganese2.
Infants have a greater sensitivity to manganese toxicity due to increased gastrointestinal absorption and decreased excretion capacity relative to adults4. Due to lack of adequate support for breastfeeding, lower-income parents tend to rely more on formula feeding5. This increased reliance likely leads to a disproportionate risk of excess manganese exposure for their infants and young children.
Policy Statement: The VtPHA will help educate parents, the pediatric community, and other stakeholders about how to avoid exposing infants to excess manganese by making careful feeding choices.
Supported Actions: The VtPHA:
References:1. Frisbie SH, Mitchell EJ, Roudeau S, Domart F, Carmona A, Ortega R. Manganese levels in infant formula and young child nutritional beverages in the United States and France: Comparison to breast milk and regulations. PLoS ONE 2019;14(11):e0223636. https://doi.org/10.1371/journal.pone.0223636 PMID: 31689314.
About the association
VtPHA is a membership organization which facilitates collaboration among people who care about public health and are interested in protecting and promoting the health of Vermont residents.
VtPHA is an Affiliate of the American Public Health Association (APHA). APHA is the national voice of public health and champions the health of all people and all communities. They are the only organization that combines a 140-plus year perspective, the ability to influence federal policy to improve the public’s health and a member community from all public health disciplines and over 40 countries. Learn more at www.apha.org.
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