Estimating daily intakes of manganese due to breast milk, infant formulas, or young child nutritional beverages in the United States and France: Comparison to sufficiency and toxicity thresholds

Abstract Background Although manganese (Mn) is an essential nutrient, recent research has revealed that excess Mn in early childhood may have adverse effects on neurodevelopment. Methods We estimated daily total Mn intake due to breast milk at average body weights by reviewing reported concentrations of breast milk Mn and measurements of body weight and breast milk intake at 3 weeks, 4.25 months, 7 months, and 18 months. We compared these figures to the Mn content measured in 44 infant, follow-up, and toddler formulas purchased in the United States and France. We calculated Mn content of formula products made with ultra-trace elemental analysis grade water (0 µg Mn/L) and with water containing 250 µg Mn/L, a concentration which is relatively high but less than the World Health Organization Health-based value of 400 µg Mn/L or the United States Environmental Protection Agency Health Advisory of 350 µg Mn/L. Results Estimated mean daily Mn intake from breast milk ranged from 1.2 µg Mn/kg/day (3 weeks) to 0.16 µg Mn/kg/day (18 months), with the highest intakes at the youngest age stage we considered, 3 weeks. Estimated daily Mn intake from formula products reconstituted with 0 µg Mn/L water ranged from 130 µg Mn/kg/day (3 weeks) to 4.8 µg Mn/kg/day (18 months) with the highest intakes at 3 weeks. Formula products provided 28 to 520 times greater than the mean daily intake of Mn from breast milk for the 4 age stages that we considered. Estimated daily Mn intake from formula products reconstituted with water containing 250 µg Mn/L ranged from 12 µg Mn/kg/day to 170 µg Mn/kg/day, which exceeds the United States Environmental Protection Agency Reference Dose of 140 µg Mn/kg/day for adults. Conclusions Mn deficiency is highly unlikely with exclusive breast milk or infant formula feeding, but established tolerable daily intake levels for Mn may be surpassed by some of these products when following labeled instructions.