Oral Health Services Research Centre, UCC

Fluoride Levels in Fluoride Levels in Powdered Infant Formula Powdered Infant Formula

Reconstituted with Reconstituted with Fluoridated WaterFluoridated Water

Oral Health Services Research Centre, UCC

ESRI Study - 1999ESRI Study - 1999

37% of Irish 37% of Irish mothers mothers breastfeedbreastfeed

Oral Health Services Research Centre, UCC

BackgroundBackground

Euro Growth Study Euro Growth Study

Conducted at 22 European Centres from 1992-1996

Lowest level of breast feeding was recorded in Ireland

Oral Health Services Research Centre, UCC

Although breast is best

Most babies in Ireland are bottle fed

Oral Health Services Research Centre, UCC

BackgroundBackgroundInfants fed with formula

reconstituted with fluoridated water ingest higher levels of fluoride than breast fed infants

How much Fluoride ion is ingested in reconstituted formula?

Oral Health Services Research Centre, UCC

Safety of tap water for Safety of tap water for reconstituting baby formulareconstituting baby formula

Oral Health Services Research Centre, UCC

Fluoride IngestionFluoride Ingestion

Intake of fluoride associated with acute toxic effects is considered to be 5 mg fluoride (F(-))/kg body weight

A newborn baby weighing 3kg would have to drink 15 litres of water fluoridated at 1ppm to ingest this level of fluoride

Data on free fluoride levels in formula reconstituted with fluoridated water was needed to estimate fluoride ingestion by infants (only free fluoride can be absorbed in the GIT)

Oral Health Services Research Centre, UCC

There is an anecdotal evidence to suggest that some mothers make batch formula for use in the following 24 hours

Fluoride forms insoluble precipitates with ionic calcium and complexes with other divalent and trivalent cations.

Free FluorideFree Fluoride

Oral Health Services Research Centre, UCC

AimsAims• To determine whether ionic (free) fluoride in infant

formula reconstituted with fluoridated water is the same as that in water

• To quantify the changes in free fluoride concentration in infant formula reconstituted with fluoridated water changes over a 24 hour period

• To investigate the association between formula calcium levels and free fluoride concentration in infant formula reconstituted with fluoridated water

Oral Health Services Research Centre, UCC

MethodsMethodsSix formula feeds were analysed:

1) Milupa Milumil2) Milupa Aptamil First3) Cow & Gate Omneo Comfort 4) SMA Gold5) Milupa Forward (6 months +) 6) SMA Progress (6 months +)

Manufacturers instructions were followed when mixing powder and water

Oral Health Services Research Centre, UCC

MethodsMethodsRepeated analysis of the ionic (free) fluoride concentrations of the reconstituted formula

– Immediately after reconstitution– At hourly intervals post -

reconstitution up to 6 hours– 24 hours post- reconstitution

Fluoride ion-specific electrode and reference electrode (Orion Models 94-09, 90-01)

Oral Health Services Research Centre, UCC

ResultsResults

In the case of the four formula recommended for use from birth the mean reductions in the amount of free fluoride relative to fluoridated water were:

•15.9% (Milupa Milumil), •5.8% (Milupa Aptamil),•9.5% (SMA Gold) •9% (Cow & Gate Omneo Comfort)

Oral Health Services Research Centre, UCC

ResultsResults

Mean reductions in free fluoride in the two formula recommended for use from 6 months onwards were:

• 14.4% (Milupa Forward)

• 37.9% (SMA Progress)

For all six formulae there was a significant drop in the level of free fluoride in the tap water once the formula was added

Oral Health Services Research Centre, UCC

0.50

0.55

0.60

0.65

0.70

0.75

0.80

0.85

0.90

-2 0 2 4 6 8 10 12 14 16 18 20 22 24Time (hrs)

Fluo

ride

Con

cent

rati

on (p

pm) MM

MA

MF

SMA G

SMA P

C&G

Free Fluoride concentration over Free Fluoride concentration over time by formulatime by formula

Oral Health Services Research Centre, UCC

ResultsResults

Free Fluoride in formula was lower than water (p < 0.0001)

There was an overall difference in Fluoride concentration among the six formulae (p < 0.0001)

Fluoride concentration varied over time (p < 0.0001)

The differences over time were similar for the six formulae (p =0.4666) 

Oral Health Services Research Centre, UCC

ResultsResults

Concentration (mg/100ml) Element Milupa

Aptamil Milupa Milumil

C&G Omneo

SMA Gold

SMA Progress

Milupa Forward

Calcium 60 76 53 46 90 87 %dec F 5.8 15.9 9 9.5 37.9 14.4

Oral Health Services Research Centre, UCC

ConclusionsConclusionsThere is a wide variation in the levels of

ionic (free) fluoride in the different powdered infant formula reconstituted with tap water

Free fluoride is associated with calcium content

Fluoridated water is safe for use in babyfood, fluoride intake is well within the safe level

Some mineral waters have a high salt content which is dangerous for babies

Oral Health Services Research Centre, UCC

EEstimate stimate of of the average daily fluoride the average daily fluoride intake of infants residing in intake of infants residing in fluoridated fluoridated areas, areas, during the first 4 months of life during the first 4 months of life

Anderson et alAnderson et al

The mean acute exposure of infants to fluoride in areas served by fluoridated water supplies was estimated to be between 0.11 and 0.14 mg/kg body weight per day

These predicted intakes were well below the intake of fluoride associated with acute toxic effects (5 mg fluoride (F(-))/kg body weight)

Dental fluorosis may be considered to be the only risk at these low doses