Neuroimaging identifies increased manganese deposition in infants receiving parenteral nutrition

Aschner, Judy L.; Anderson, Adam W.; Slaughter, James C.; Aschner, Michael; Steele, Steven; Beller, Amy B.; Mouvery, Amanda; Furlong, Heather M.; Maitre, Nathalie L.

doi:10.3945/ajcn.115.116285

Cited by 51 publications

(46 citation statements)

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“…Mn intake, which can be seen with shortened T1 relaxation (T1R) times using magnetic resonance (MR) relaxometry [119]. It is not known whether dietary exposure alone could cause effects such as those found with pediatric PN patients, but the nature of the neurological effects observed with Mn exposures through drinking water in school-aged children, as well as the demonstrated neurological effects of ingestion exposures in adults suggest the potential for neurological effects due to excess dietary exposures in infants, toddlers, and young children [120,121].…”

Section: The Toxicity Of Manganese By Ingestion Exposurementioning

confidence: 99%

“…It is not known whether dietary exposure alone could cause effects such as those found with pediatric PN patients, but the nature of the neurological effects observed with Mn exposures through drinking water in school-aged children, as well as the demonstrated neurological effects of ingestion exposures in adults suggest the potential for neurological effects due to excess dietary exposures in infants, toddlers, and young children [120,121]. Since biomarkers that reliably correlate with Mn exposures have not yet been identified [119,[122][123][124], regulatory toxicity thresholds for Mn by ingestion are generally based on exposures rather than biomarkers [72,79,85].…”

Section: The Toxicity Of Manganese By Ingestion Exposurementioning

confidence: 99%

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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

Mitchell¹,

Frisbie

Roudeau

et al. 2020

Preprint

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Laboratories provided no input in choosing the subject matter of this project, the hypotheses that were tested, the method of analysis, the research findings, the decision to publish, or the manner of disseminating the results. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Highlights1. Mn deficiency is unlikely with exclusive breast milk or infant formula feeding.2. Breast milk Mn mean intake is 1.2 µg/kg/day (3 weeks)-0.16 µg/kg/day (18 months).3. Formula Mn intake range is 130 µg/kg/day (3 weeks)-4.8 µg/kg/day (18 months). 4. Formula products reconstituted with 250 µg Mn/L water may exceed 140 µg Mn/kg/day. 5. Formula products may surpass regulatory tolerable daily intake levels for Mn. Abstract BackgroundAlthough manganese (Mn) is an essential nutrient, recent research has revealed that excess Mn in early childhood may have adverse effects on neurodevelopment. MethodsWe 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. ResultsEstimated 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. ConclusionsMn 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.

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Section: The Toxicity Of Manganese By Ingestion Exposurementioning

confidence: 99%

Section: The Toxicity Of Manganese By Ingestion Exposurementioning

confidence: 99%

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

Mitchell¹,

Frisbie

Roudeau

et al. 2020

Preprint

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“…Most cases of Mn toxicity are due to occupational and environmental exposures (31,62). Mn toxicity has also been reported in cases of severe liver diseases, in patients receiving total parenteral nutrition, and in rare genetic loss-offunction mutations (34,35,44,(64)(65)(66)(67). Current treatment for Mn toxicity is with chelation therapy, which increases urinary Mn excretion (44), but is nonspecific.…”

Section: Discussionmentioning

confidence: 99%

Bile acid composition regulates the manganese transporter Slc30a10 in intestine

Ahmad

Higuchi

Bertaggia

et al. 2020

Preprint

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“…Las soluciones diseñadas para adultos tienen el problema de que contienen una concentración muy elevada de manganeso comparativamente con el resto de los elementos y una menor concentración de selenio. El manganeso es potencialmente tóxico y se ha descrito, en este rango de dosis, acumulación en ganglios basales y otras zonas del cerebro (31); esta acumulación no siempre se asocia a aumento de niveles sanguíneos de manganeso (32) y puede estar aumentada en pacientes con hiperbilirrubinemia (33). Por ello se importa a través de Medicamentos Extranjeros Peditrace ® que se adecua más a los requerimientos, como se ve en la tabla IX.…”

Section: Existen Soluciones De Oligoelementos IV Específicos Para Pedunclassified

Componentes de las mezclas de nutrición parenteral para pediatría

Muñóz¹

2017

Nutr Hosp

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AMINOÁCIDOS En pacientes pediátricos, y especialmente en neonatos, está recomendado el uso de soluciones de aminoácidos (AA) específicas debido a la inmadurez de sus sistemas enzimáticos. No existen estudios sobre la adecuación de estas soluciones a niños de mayor edad, aunque tampoco sobre la idoneidad de las soluciones para adultos.El aporte proteico por vía intravenosa se administra en forma de soluciones de L-aminoácidos libres o dipéptidos y aportan aproximadamente 4 kcal por gramo. Además de los ocho AA esenciales y de la histidina, los recién nacidos pretérmino (RNPT) y a tér-mino (RNT), debido en parte a su inmadurez hepática y/o renal, requieren también cisteína, tirosina y taurina. Existen soluciones de nutrición parenteral (NP) específicas para el recién nacido y el lactante. Estas soluciones se han diseñado intentando reproducir el aminograma plasmático del cordón umbilical o el del niño alimentado con leche materna.La inclusión de taurina en las soluciones pediátricas de AA se realizó después de observarse que niños con NP a largo plazo tenían niveles plasmáticos de taurina disminuidos que se correlacionaban con electrorretinogramas anormales y que mejoraban suplementando con taurina la NP (1).Algunos AA tienen poca estabilidad en medio acuoso, como es el caso de la glutamina, que no se incluye en las soluciones de AA pediátricas disponibles en nuestro país. Actualmente existen suplementos y soluciones completas de glutamina para adultos que lo aportan en forma de dipéptido lo que incrementa su estabilidad. Sin embargo, debido a su alto coste no se añade rutinariamente a las soluciones de AA. Además, los estudios realizados hasta ahora no han encontrado una clara ventaja de la adición de glutamina a la NP en prematuros (2) o pacientes críticos (3).En algunas formulaciones, AA como la tirosina o la cisteína se aportan en su forma acetilada (N-acetil-L-tirosina, N-acetil-L-cisteína) para aumentar su solubilidad en agua o disminuir su oxidación. Sin embargo su biodisponibilidad se puede ver disminuida.No está claro cuándo los niños alcanzan los niveles de metabolización del adulto, pero parece que es bastante antes del primer año de vida. Sería recomendable que la composición de las soluciones de AA fuese distinta según los distintos rangos de edad (4). Se necesitarían más estudios para conocer cuál es la composición ideal para cada rango ya que, incluso las soluciones de AA comercializadas, no consiguen normalizar los niveles plasmáticos de todos los AA en RNPT de bajo peso (5), ni en postquirúrgicos de menos de un mes de edad (4).En la tabla I se muestran las soluciones de AA pediátricos disponibles en nuestro país.Existen en el mercado soluciones enriquecidas en AA ramificados y con menor concentración de AA aromáticos para pacientes adultos. También existen soluciones de AA esenciales cuyo uso en pacientes adultos con insuficiencia renal es controvertida. Las consideraciones sobre su utilización en niños se harán en el capítulo de modificaciones en situaciones especiales (Tabla II). HIDRATOS DE CAR...

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Neuroimaging identifies increased manganese deposition in infants receiving parenteral nutrition

Abstract: A short T1R for GA identifies infants at risk of increased brain manganese deposition associated with PN solutions commonly used to nourish critically ill infants. These trials were registered at clinicaltrials.gov as NCT00392977 and NCT00392730.

Cited by 51 publications

References 38 publications

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

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

Bile acid composition regulates the manganese transporter Slc30a10 in intestine

Componentes de las mezclas de nutrición parenteral para pediatría

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