SynthesisThe American journal of clinical nutrition2025
Assessment of arsenic, cadmium, lead, mercury, and per- and polyfluoroalkyl substances concentrations in human milk and infant formula in the United States: a systematic review.
Synthesis in The American journal of clinical nutrition, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
4 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Bioavailability of and US Infant Exposure to Arsenic, Cadmium, Lead, Mercury, and Per- and Polyfluoroalkyls from Human Milk and Infant Formula: Results from a Series of Systematic Reviews.Advances in nutrition (Bethesda, Md.) · 2026Pooled it
- Lactation Interrupted: PFAS Impact on Capacity to Breastfeed Ignored.Current environmental health reports · 2026Review
- Effects of Legacy PFAS and Novel Alternatives on Thyroid Function in Mother‒Child Populations: A Systematic Review.Journal of toxicology · 2026Review
- Protecting infants from environmental contaminants in milk and formula: addressing assessment gaps and advancing next steps.The American journal of clinical nutrition · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
15 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundFoods, including human milk (HM) and infant formula (IF), can be sources of environmental contaminant exposure for infants, which can impact health and development.
objectivesThis systematic review describes arsenic, cadmium, lead, mercury, and per- and polyfluoroalkyl substances (PFAS) concentrations in HM and IF in the United States (PROSPERO #CRD42024528756).
methodsWe searched CAB Abstracts, CENTRAL, CINAHL, Embase, and MEDLINE for peer-reviewed articles published in English through 2 April, 2025 (no date restrictions). Studies that assessed contaminant concentrations in HM or IF from countries rated as "high" or "very high" on the Human Development Index were eligible. Screening, data extraction, and risk of bias assessments were performed by 2 independent reviewers. We narratively synthesized United States studies and assessed the certainty of evidence with Grading of Recommendations Assessment, Development, and Evaluation (GRADE). We developed heat maps for studies from all countries that may help inform evidence gaps in future systematic reviews.
resultsFrom the United States, 14 HM and 16 IF studies were included. For HM, perfluorooctanoic acid (PFOA) concentrations ranged from undetected to 36.1 pg/mL, and perfluorooctane sulfonic acid (PFOS) ranged from undetected to 106 pg/mL (GRADE: moderate); evidence was lacking for perfluorononanoic acid and perfluorohexanesulfonic acid. For IF, all PFAS were largely undetected (GRADE: moderate). For HM and IF, studies for arsenic, cadmium, lead, and mercury had small and unrepresentative samples, and most were published before 2000. We identified 317 and 108 articles for HM and IF, respectively, from other countries.
conclusionsIn published, peer-reviewed United States studies, PFOA and PFOS were detected in HM; PFAS were largely undetected in IF. There was a paucity of contemporary evidence for arsenic, cadmium, lead, and mercury in HM or IF in the United States, but we identified evidence from other countries that could help inform these knowledge gaps. Public health agencies recommend feeding infants HM given the benefits outweigh potential risks of contaminant exposure. This trial was registered at PROSPERO as CRD42024528756 (https://www.crd.york.ac.uk/PROSPERO/view/CRD42024528756).
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.