Baby formula with inaccurate or misleading labels is being sold to parents in the UAE, dentists have found.
An investigation into fluoride levels in the products found that in some cases, up to 10 times more fluoride was in the formula than was claimed on the label. In others, fluoride was found in the products despite there being no mention of it on the label.
While proven to have widespread benefits for oral health if taken appropriately, excessive amounts of fluoride in infants can cause dental problems in later life, meaning it is important for parents to monitor how much an infant receives.
While true fluoride levels in the baby formula products tested did not exceed recommended levels on their own, some bottled water brands which may be used for dilution also includes fluoride, raising fears that parents could unwittingly give their babies too much.
In total, 24 different infant formula products on sale in the UAE were tested by researchers at Hamdan Bin Mohammed College of Dental Medicine in Dubai, which is part of Mohammed Bin Rashid University Of Medicine and Health Sciences. Of 11 samples where fluoride content was mentioned on the label, in only two cases were levels deemed to have been accurately described.
A further 13 samples had no mention of fluoride on the label, which may lead parents to assume it was not present in the product. However, fluoride was found in some quantity in all but three of them.
“When something involves babies, you expect the utmost accuracy,” said Manal Al Halabi, a clinician and academic at the dental college. “But we found this wasn’t the case.”
She said: “Flouride has been used in dentistry for ages now and it’s known to play a major role in the decline in the prevalence and severity of decay. When used in the appropriate way it is effective and safe.
“But for children the daily level of fluoride has to be known and limited. To go above it, you risk what is called fluorosis of the teeth, which in severe forms can cause browning, discolouration and weaken the structure of the teeth.”
The products, all made outside the UAE, were carefully mixed with purified water according to the manufacturers’ instructions. One brand, Primalac Premium, was advertised as having 0.03 ppm [parts per million] but in after testing it contained 0.20. Cow and Gate formula was also advertised as having 0.03 ppm but actually contained 0.3, 10 times more than stated, when a sample was analysed in the lab.
Brands including Similac Gold and Biomil Plus were among those with no mention of fluoride on the labelling, but after testing were each found to have 0.3 ppm under testing.
The product with the highest concentration of fluoride would see a child receive 0.35mg of fluoride a day from baby formula, just below the average daily recommended fluoride intake for a six-month-old baby weighing between 7.2kg and 8 kg, which is between 0.36–0.42mg, researchers said.
While none of the products contained fluoride levels that could prove harmful to children alone, Dr Al Halabi said the findings raised questions over whether other ingredients of baby formula are being accurately described on labels.
Researchers at the college are now planning to launch a similar investigation looking at sugar levels in the products.
“The first thing a child receives can be an infant formula, and sometimes fluoride or other materials might be added,” said Dr Yasser Agha, a paediatric dentist who as a student was lead researcher on the paper, and is now practicing in Abu Dhabi. “As a cumulative number, we need to know how much they are exposed to.
“Flouride has been proven for a long time to play a major role in minimising caries [decay] progression. But at the same time an excess amount can lead to unfavourable outcomes, for example discolouration of teeth or even more systemic affects to the body.
“In some products they did not even mention whether they had fluoride on not. We did the experiment and found out they did have fluoride. In some countries, the water is already fluoridated, so the cumulative amount could be above the safety margin.”
Recommendations put forward in the paper, published in the European Archives of Paediatric Dentistry journal, included tighter rules around baby formula labelling in the UAE.
A spokeswoman for Danone Middle East, which owns the Cow and Gate brand, said: “We would like to confirm that none of our formulas exceed the daily recommended level of fluoride for dental health and that our formulas follow the recommendations of European Food Safety Authorities and their Scientific Opinion on the essential composition of infant and follow-on formulae.
“We are pleased that this has been reiterated in the recently published study in the European Archives of Paediatric Dentistry. As with all our formula, we maintain strict safety and quality standards to support the healthy growth and development of babies in all respects.”