Occurrence of 3-MCPD and glycidyl esters in edible oils in the United States

Fatty acid esters of 3-monochloropropanediol (3-MCPD) and glycidol are processing contaminants found in a wide range of edible oils. While both 3 MCPD and glycidol have toxicological properties that at present has concerns for food safety, the published occurrence data are limited. Occurrence information is presented for the concentrations of 3-MCPD and glycidyl esters in 116 retail and/or industrial edible oils and fats using LC-MS/MS analysis of intact esters. The concentrations for bound 3-MCPD ranged from below the limit of quantitation (<LOQ) to 0.09 mg kg^?1 (ppm) in 22 unrefined oils and from 0.005 to 7.2 mg kg^?1 (ppm) in 94 refined oils. The concentrations for bound glycidol ranged from <LOQ to 0.03 mg kg^?1 (ppm) in unrefined oil samples and from <LOQ to 10.5 mg kg^?1 (ppm) in processed oil samples. The highest concentrations for both 3-MCPD and glycidol were seen in refined palm oil and palm olein samples. Palm olein samples also contained a higher percentage of 3-MCPD in mono-ester form than any other type of oil.     

玉米油脱臭条件对3-氯丙醇酯和缩水甘油酯影响的研究

以玉米油为原料,研究水蒸气蒸馏脱臭过程以及脱臭条件对玉米油中3-氯丙醇酯和缩水甘油酯生成的影响。结果表明:脱臭过程造成3-氯丙醇酯和缩水甘油酯含量的大幅升高,脱臭温度越高、脱臭时间越长,3-氯丙醇酯和缩水甘油酯的增加量越大,其中脱臭温度比脱臭时间对二者生成的影响更大;在脱臭温度不超过230℃时,60~120 min的脱臭时间,3-氯丙醇酯含量仅增加了0.047~2.581 mg/kg,缩水甘油酯含量仅增加了0.300~3.883 mg/kg,当脱臭温度达到250℃时,即使脱臭时间仅为60 min,3-氯丙醇酯和缩水甘油酯含量均显著升高了5.039 mg/kg和8.354mg/kg,尤其在270℃、120 min的极限脱臭条件下,3-氯丙醇酯和缩水甘油酯含量更是分别上升至13.004 mg/kg和34.864 mg/kg,达到待脱臭玉米油中其含量的4倍和15倍左右。为防范和控制玉米油脱臭过程3-氯丙醇酯和缩水甘油酯的生成,降低脱臭温度是非常必要的。     

Updated occurrence of 3-monochloropropane-1,2-diol esters (3-MCPD) and glycidyl esters in infant formulas purchased in the United States between 2017 and 2019

ABSTRACT

Fatty acid esters of 3-monochloropropane-1,2-diol (3-MCPD) and glycidol are potentially carcinogenic and/or genotoxic processing contaminants that are formed during the process of edible oil refining. Because of their toxicological properties, the presence of these compounds in refined oils and foods containing these oils, particularly infant formula, poses a potential food safety concern. For this reason, recent research efforts have focussed on the development of methods for the analysis of MCPD and glycidyl esters in infant formula in order to estimate levels of exposure. This work presents occurrence data for 3-MCPD and glycidyl esters in 222 infant formulas purchased in the United States between December 2017 and January 2019. The results of this study show a wide range of contaminant concentrations across four different manufacturers, with average bound 3-MCPD concentrations ranging from 0.035 µg g^?1 to 0.63 µg g^?1 and average bound glycidol concentrations ranging from 0.019 µg g^?1 to 0.22 µg g^?1. The data suggest that manufacturers B and C source palm oil produced with mitigation measures, leading to reduced amounts of 3-MCPD and glycidyl esters in their infant formulas. Additionally, comparison with a previously published study in our laboratory of the occurrence of 3-MCPD and glycidyl esters in infant formula purchased in the U.S. between 2013 and 2016 revealed that, since 2016, contaminant concentrations have decreased in products produced by manufacturers A, B, and C, while contaminant amounts in formulas from manufacturer D have slightly increased.     

吸附法脱除大豆油中3-氯丙醇酯及缩水甘油酯的研究

以大豆油为原料,研究了吸附剂种类、添加量对大豆油中3-氯丙醇酯的脱除效果和吸附剂种类、吸附剂添加量、吸附温度、吸附时间对大豆油中缩水甘油酯的脱除效果。结果表明:不同吸附剂对大豆油中3-氯丙醇酯的脱除效果依次为H-1号活性炭活性白土 H-2号活性炭普通活性炭凹凸棒土,所有吸附剂对3-氯丙醇酯的脱除率均较低,脱除效果相对较好的H-1号活性炭的脱除率仅达到34. 42%(添加量为油质量0. 5%),3-氯丙醇酯含量从1. 107 mg/kg下降至0. 726 mg/kg;对缩水甘油酯的脱除效果依次为H-1号活性炭 H-2号活性炭普通活性炭活性白土凹凸棒土,在添加量为2%时,前3种吸附剂对缩水甘油酯的脱除率均达到80%以上,H-1号活性炭的脱除率达到90%以上。在H-1号活性炭添加量3%、吸附时间40 min、吸附温度100℃的优化条件下,大豆油中缩水甘油酯的脱除率为95. 59%,含量从初始的2. 810 mg/kg降低至0. 124 mg/kg,可以有效脱除大豆油中的缩水甘油酯。     

油脂中3-氯丙二醇酯形成的化学反应机制

3-氯丙二醇酯是油脂及油脂食品在热加工过程中生成的副产物,目前被认为是潜在的食品安全危害因子之一.本文介绍了油脂中3-氯丙二醇酯形成的3种化学反应机制,普遍认为是氯离子的亲核进攻导致了3-氯丙二醇酯的形成.其中,第1种机制认为氯离子亲核反应的中间体环酰氧鎓离子是3-氯丙二醇酯的前体;第2种机制认为是亲核的氯离子直接攻击甘油骨架上的酯基或质子化羟基;第3种机制认为缩水甘油酯可能作为氯离子亲核反应的中间体而成为其前体.     

Washing bleached palm oil to reduce monochloropropanediols and glycidyl esters

The formation of toxic compounds, potentially carcinogenic, during food processing has been considered an important food safety issue. Among them, particular attention has been given to 3-monochloropropane-1,2-diol esters (3-MCPDE), 2-monochloropropane-1,3-diol esters (2-MCPDE) and glycidyl esters (GE), which can be formed during vegetable oil refining, especially palm oil. These substances may pose a health risk to humans due to their toxicity and carcinogenicity. The aim of this study was to investigate the effect of washing bleached palm oil (BPO) with different solvents, and evaluate the reduction of 3-MCPDE, 2-MCPDE and GE as well as assess the quality parameters of the final product. For this purpose, we used two types of washing with different solvents. A single washing was carried out in one step and a double washing in two steps using a solvent gradient. Single washing had a limited reduction in the levels of 3-MCPDE and 2-MCPDE and resulted in an increased level of GE, whereas double washing slightly reduced 3-MCPDE and 2-MCPDE and resulted in a significant reduction of GE levels. The reduction achieved in this study was up to 17.1% for 3-MCPDE, 56.4% for 2-MCPDE and 76.9% for GE levels. The reduction of 3-MCPDE and 2-MCPDE might be due to the removal of part of the ethanol-soluble chlorinated precursors from the oil which suggests that highly lipophilic forms of these substances are present in BPO. The substantial reduction on GE levels might be associated with the removal of the precursors present in the oil such as diacylglycerols. Thus, the washing treatment could be used as a supplementary strategy to reduce processing contaminants from palm oil, especially GEs.     

Application of gastrointestinal modelling to the study of the digestion and transformation of dietary glycidyl esters

Glycidyl esters (GEs) are known to be formed during vegetable oil processing. Because of their structure, it has been hypothesised that GEs, like fatty acid esters of chloropropanols (MCPD esters), may be accepted as substrates by gut lipases to release the epoxide glycidol. If confirmed such a hypothesis would be important for risk assessment since glycidol is considered as a genotoxic carcinogen. In the present study, biotransformation was investigated using static and dynamic gastrointestinal models. During the experiments, aliquots were analysed for non-digested GEs using liquid chromatography-time-of-flight-mass spectrometry (LC-ToF-MS). In the static model, a fast hydrolysis of GEs was observed as a result of lipase action. Lipase was very efficient at pH 4.8, and totally inhibited at very low pH (1.7). In the absence of lipase, GEs were found to be relatively stable. The potential impact of food matrix was studied using milk in a dynamic model simulating human physiological conditions. The fast, pH-dependent hydrolysis of GEs was further confirmed. The possible transformation of the digestion products was then investigated using gas chromatography coupled to mass spectrometry (GC-MS), mainly the epoxide ring-opening to glycerol followed by additional reactions. In any conditions applied, neither 2- nor 3-mono-chloropropanediol (2- nor 3-MCPD) were formed, indicating that a ring-opening of the epoxide group of GEs or glycidol followed by a reaction with chloride was unlikely. A small transformation of glycidol into glycerol was observed after longer incubation time correlated with a low pH. This suggested that ring-opening and reaction with water is possible in strongly acidic conditions. Overall, it is concluded that GEs are rapidly digested by gut lipases to form glycidol. Consequently, GEs should be considered as sources of glycidol exposure. In addition, risk assessment of GEs can likely rely on hazard identification and characterisation data specific for glycidol.     

Occurrence of 3-MCPD fatty acid esters in human breast milk

A series of twelve breast milk samples were analysed by gas chromatography-mass spectrometry (GC/MS) operated in selected ion monitoring mode for 3-chloropropane-1,2-diol (3-MCPD). Whilst none of the samples contained 3-MCPD above the limit of detection of 3 μg kg^?1 milk, all contained high amounts of 3-MCPD esterified with higher fatty acids. The levels of 3-MCPD released by hydrolysis of these esters (bound 3-MCPD) ranged from the limit of detection (300 μg kg^?1, expressed on a fat basis) to 2195 μg kg^?1; with a mean level of bound 3-MCPD of 1014 μg kg^?1, which corresponded to 35.5 μg kg^?1 milk. The presence of bound 3-MCPD was confirmed using orthogonal gas chromatography coupled with high-speed time-of-flight mass spectrometry analysis for four randomly selected breast milk samples. Six breast milks collected from one of the nursing mothers 14–76 days after childbirth contained bound 3-MCPD within the range of 328–2078 μg kg^?1 fat (mean 930 μg kg^?1 fat). The calculated bound 3-MCPD content of these samples was within the range of 6 and 19 μg kg^?1 milk (mean of 12 μg kg^?1 milk). The major types of 3-MCPD esters were the symmetric diesters with lauric, palmitic, and oleic acids, and asymmetric diesters with palmitic acid/oleic acid among which 3-chloro-1,2-propanediol 1,2-dioleate prevailed.     

食用油中3-氯丙醇酯的研究进展

氯丙醇酯污染是近年来国际上出现的食品安全热点问题之一,尤其是3-氯丙醇酯污染更为突出,各种食用油或油脂食品中都含有一定量的3-氯丙醇酯。总结了国内外对3-氯丙醇酯的研究现状,介绍了3-氯丙醇酯来源、毒理和安全性、可能的形成机制、检测方法、污染水平、控制措施和精炼过程中形成的影响因素等方面的内容,并提出了目前急需解决的问题。旨在推动我国油脂食品行业的健康发展。     

The comparison of several lipid extraction methods on infant formula for 3-monochloropropanediol esters and glycidyl esters analysis

This study aimed to determine the best lipid extraction method for infant formula; therefore, it can be used as a routine analysis. The samples were some commercial infant formulas in Indonesia. The research was conducted with three steps: (i) Lipid extraction of infant formula using five lipid extraction methods; (ii) 3-monochloropropanediol esters (3-MCPDE) and glycidyl esters (GE) analysis of lipid extract from three lipid extraction methods in the first step; and (iii) 3-MCPDE and GE analysis of six commercial infant formulas using the best lipid extraction method. The results showed that lipid extraction using the Dubois method gave the best results than other lipid extraction methods. The level of 3-MCPDE and GE also had no significant difference with the addition of NaCl in the Folch method, compared with the addition of Na₂SO₄. The level of 3-MCPDE and GE using the Dubois method was significantly different and higher compared with the other lipid extraction methods. 3-MCPDE and GE levels of commercial infant formula were 6.62–52.84 µg kg⁻¹ and <1.43–17.06 µg kg⁻¹, respectively. The values obtained were still within the standard according to Commission Regulation EU 2018/290 by the European Food Safety Authority (125 µg kg⁻¹ for 3-MCPDE (on progress) and 50 µg kg⁻¹ for GE).     

气相色谱-质谱联用法测定食用油中3-MCPD脂肪酸酯

本研究在德国油脂科学协会(DGF)标准检测方法的基础上进行方法优化,利用气相色谱-质谱联用(GC-MS)技术,建立了油脂中3-氯-1,2-丙二醇(3-MCPD)脂肪酸酯的分析方法。根据结果可知,该方法线性相关性良好,检出限为0.022 5 mg/kg,定量限为0.076 0 mg/kg,线性范围为0.05~5.0 mg/kg,回收率为95.36%~101.18%,相对标准偏差为1.36%~8.14%。试验中同时利用该方法对7种常见油脂中3-MCPD脂肪酸酯进行了检测。结果表明:该分析方法定性定量准确、灵敏度高、重现性好,能满足油脂中3-MCPD脂肪酸酯分析检测的要求。     

Identification of 3-MCPD esters to verify the adulteration of extra virgin olive oil

ABSTRACT

The adulteration of olive oil is an important issue around the world. This paper reports an indirect method by which to identify 3-monochloropropane-1,2-diol (3-MCPD) esters in olive oils. Following sample preparation, the samples were spiked with 1,2-bis-palmitoyl-3-chloropropanediol standard for analysis using gas chromatograph-tandem mass spectrometry. The total recovery ranged from 102.8% to 105.5%, the coefficient of variation ranged from 1.1% to 10.1%, and the limit of quantification was 0.125 mg/kg. The content of 3-MCPD esters in samples of refined olive oil (0.97–20.53 mg/kg) exceeded those of extra virgin olive oil (non-detected to 0.24 mg/kg). These results indicate that the oil refining process increased the content of 3-MCPD esters, which means that they could be used as a target compound for the differentiation of extra virgin olive oil from refined olive oil in order to prevent adulteration.     

Development of an analytical method for the simultaneous analysis of MCPD esters and glycidyl esters in oil-based foodstuffs

Substantial progress has been recently made in the development and optimisation of analytical methods for the quantification of 2-MCPD, 3-MCPD and glycidyl esters in oils and fats, and there are a few methods currently available that allow a reliable quantification of these contaminants in bulk oils and fats. On the other hand, no standard method for the analysis of foodstuffs has yet been established. The aim of this study was the development and validation of a new method for the simultaneous quantification of 2-MCPD, 3-MCPD and glycidyl esters in oil-based food products. The developed protocol includes a first step of liquid–liquid extraction and purification of the lipophilic substances of the sample, followed by the application of a previously developed procedure based on acid transesterification, for the indirect quantification of these contaminants in oils and fats. The method validation was carried out on food products (fat-based spreads, creams, margarine, mayonnaise) manufactured in-house, in order to control the manufacturing process and account for any food matrix–analyte interactions (the sample spiking was carried out on the single components used for the formulations rather than the final products). The method showed good accuracy (the recoveries ranged from 97% to 106% for bound 3-MCPD and 2-MCPD and from 88% to 115% for bound glycidol) and sensitivity (the LOD was 0.04 and 0.05 mg kg^?1 for bound MCPD and glycidol, respectively). Repeatability and reproducibility were satisfactory (RSD below 2% and 5%, respectively) for all analytes. The levels of salts and surface-active compounds in the formulation were found to have no impact on the accuracy and the other parameters of the method.     

食用植物油中3-MCPD酯GC-MS测定方法研究

建立了甲醇钠-甲醇水解,固相萃取柱净化,HFBI衍生结合气相色谱-质谱(GC-MS)方法对食用植物油中3-MCPD酯含量进行测定。该方法在0.50～2. 50 mg/L范围内线性关系良好(r~2=0.988 5),检出限为0. 025 5 mg/kg,定量限为0. 093 3 mg/kg。3-MCPD酯的平均加标回收率在94. 80%～104. 62%之间,RSD 1.47%～5.23%。本方法操作简单、灵敏度高、重复性好,能够很好地适用于食用植物油中3-MCPD酯的检测。采用该方法对新疆几种市售食用植物油中的3-MCPD酯进行测定。新疆市售的几种食用植物油中均检测出浓度不等的3-MCPD酯。其中菜籽油、亚麻籽油、番茄籽油、花生油以及葡萄籽油受3-MCPD酯污染严重,3-MCPD酯含量都高于0.4 mg/kg。而核桃油、大豆油、红花籽油中3-MCPD酯的含量都低于0.4mg/kg。     

高油酸葵花籽油煎炸过程中MCPD酯及缩水甘油酯的变化

以高油酸葵花籽油为煎炸用油对鱼排、鸡块和薯条进行煎炸实验,探究3-氯丙醇(3-MCPD)酯、2-氯丙醇(2-MCPD)酯和缩水甘油酯在煎炸过程中的变化。结果表明:原油中3-MCPD酯、2-MCPD酯及缩水甘油酯含量分别为0.26、0.05 mg/kg和0.58 mg/kg;在煎炸过程中2-MCPD酯含量与3-MCPD酯含量呈现极显著相关(p0.01);煎炸油中的MCPD酯在煎炸后有明显的生成;受煎炸材料的影响,3-MCPD酯含量在煎炸鱼排和鸡块体系煎炸12 h时达到最大值,分别为2.22 mg/kg和2.05 mg/kg,而后逐渐下降;3-MCPD酯含量在煎炸薯条体系中变化不大;缩水甘油酯含量则在所有体系中均下降,受煎炸材料的影响,缩水甘油酯分别在煎炸24 h(鱼排)、60 h(鸡块)和96 h(薯条)中基本降解完全。     

温度以及氯离子对初榨胡麻油中3-MCPD酯生成的影响

采用气相色谱-负化学离子源-质谱(GC-NCI-MS)联用技术,建立了测定食用植物油中3-氯丙醇酯(3-MCPD酯)含量的分析方法。该方法在0.01~0.10 mg/kg范围内线性关系良好(r2=0.997 4),检出限为5 μg/kg,定量限为20 μg/kg。加标回收率在80.47%~81.68%之间,相对标准偏差在5.60%~8.35%之间。对初榨胡麻油中3-MCPD酯进行检测,结果表明：低温炒籽对于初榨胡麻油中3-MCPD酯生成没有影响。将油样加热至160 ℃~200 ℃范围内,初榨胡麻油中3-MCPD酯的生成随温度的升高以而增加,但增加不明显。将油样加热至200 ℃时,初榨胡麻油中3-MCPD酯的生成随加热时间的增加而增加,但增长不显著。但将油样加热至200 ℃时,随着氯离子含量的增加,初榨胡麻油中3-MCPD酯呈显著上升趋势。     

3-MCPD: A Worldwide Problem of Food Chemistry

3-Monochloropropane-1,2-diol (3-MCPD) is a heat-induced food contaminant that has been widely investigated for decades. This paper presents an overview of current knowledge about 3-MCPD, including its formation routes, occurrence in various foodstuffs, analytical approach, toxicological aspects, and future research perspectives. So far, 3-MCPD was determined in its free and bound form in thermally treated foods, edible oils and fats, and infant foods including human breast milk. Contaminants in infant foods and human breast milk were highlighted in this paper as a serious problem as they can pose a potential hazard for infants. The analytical approach of 3-MCPD determination has been modified for over a decade. Nowadays, the method based on determining the derivative of this compound by using gas chromatography and mass spectrometry is widely used. However, there is still a big need for developing new methods that would produce repeatable results. Some of the toxicologic aspects associated with 3-MCPD still remain unknown. A number of studies on the carcinogenicity and genotoxicity of 3-MCPD were carried out on rodents; however, no clinical studies on humans have been reported so far. Moreover, both detrimental effect on kidneys and antifertility activity have been widely reported. The knowledge of 3-MCPD absorption into body fluids and tissues and its metabolic pathways is based on sometimes conflicting data derived from different studies. In conclusion, although a lot of research has been carried out on 3-MCPD, there is still a need for further research in this area.     

气相色谱-串联质谱法测定婴幼儿配方奶粉中氯丙醇酯和缩水甘油酯

目的 采用气相色谱-串联质谱(gas chromatography-tandem mass spectrometry,GC-MS/MS)技术,实现对婴幼儿配方奶粉中3-氯-1,2-丙二醇脂肪酸酯(3-monochloropropane-1,2-diol ester,3-MCPDE)、2-氯-l,3-丙二醇脂肪酸酯(2-monochloropropane-1,3-diol ester,2-MCPDE)和缩水甘油脂肪酸酯(glycidol fatty acid esters, GEs)的准确定性和定量。方法 从奶粉样品中提取的脂肪经溴代反应后,其中的缩水甘油酯转变成溴丙醇酯。溴丙醇酯和样品中的氯丙醇酯在酸性条件下发生酯交换反应,溴丙醇酯被水解为游离态形式的3-溴-1,2-丙二醇(3-MBPD)、氯丙醇酯被水解为游离态形式的氯丙醇(3-MCPD、2-MCPD);水解液经碱中和后,经硅藻土固相萃取小柱净化,洗脱液脱水后氮吹浓缩,再经七氟丁酰基咪唑(HFBI)衍生;衍生液用异辛烷定容后供GC-MS/MS分析,采用同位素内标法定量,可一次性同时测定奶粉中3-MCPDE、2-MCPDE和GEs的含量。结果 该方法在20～600 ng/mL范围内线性良好(r_²≥0.99),检出限为0.005 mg/kg脂肪,定量限为0.015 mg/kg脂肪,检出限和定量限均以相应的氯丙醇或缩水甘油计。0.1、0.5 mg/kg和1.0 mg/kg水平下的加标回收率在89.7%～105.6%之间,相对标准偏差均不大于5.56%。结论 该方法灵敏、准确可靠,适合婴幼儿配方奶粉中3-MCPDE、2-MCPDE和GEs的同时测定。     

Esters of 3-chloro-1,2-propanediol (3-MCPD) in vegetable oils: Significance in the formation of 3-MCPD

3-Mono-chloropropane-1,2-diol (3-MCPD) is a contaminant that occurs in food in its free (diol) form as well as in an esterified (with fatty acids) form. Using a simple intestinal model, it was demonstrated that 3-MCPD monoesters and 3-MCPD diesters are accepted by intestinal lipase as substrates in vitro. Under the chosen conditions, the yield of 3-MCPD from a 3-MCPD monoester was greater than 95% in approximately 1 min. Release from the diesters was slower, reaching about 45, 65 and 95% of 3-MCPD after 1, 5 and 90 min of incubation, respectively. However, in human, the hydrolysis of 3-MCPD esters is unlikely to release 100% as 3-MCPD, as triglycerides and phospholipids are hydrolysed in the intestine liberating 2-monoglycerides. Assuming a similar metabolism for 3-MCPD esters as that known for acylglycerols in humans in vivo, the de-esterification in positions 1 and 3 would thus be favoured by pancreatic lipases. Therefore, 3-MCPD, and 3-MCPD-2 monoesters would be released, respectively, from the 1-/3-monoesters, and the diesters potentially present in food. Hence, information on the exact amounts of the partial fatty acid chloroesters, i.e. 3-MCPD mono- and diesters, is important to assess the contribution of foods to the bioavailability of 3-MCPD. Therefore, a rapid method for the determination of the ratio of 3-MCPD monoesters to diesters in fats and oils was developed using gas chromatography-mass spectrometry (GC-MS) and isotopically labelled 3-MCPD esters as internal standards. The analysis of 11 different samples of fat mixes typically employed in food manufacturing demonstrated that a maximum of about 15% of the total amount of 3-MCPD bound in esters is present in the monoesterified form. The potentially slower release of 3-MCPD from 3-MCPD diesters, and the mono- to diesters ratio suggest that 3-MCPD esters may in fact contribute only marginally to the overall dietary exposure to 3-MCPD. Further work on the bioavailability, metabolism and possible toxicity of chloroesters per se is warranted.     

Public health risks and benefits associated with breast milk and infant formula consumption

The safety and quality of infant milk, whether it is breast milk (BM) or infant formula (IF), are a major concern for parents and public health authorities. BM is recommended as the gold standard at WHO level. However, nowadays IF appears as an essential alternative in Western countries, challenging producers to optimize nutritional quality and safety of IF. The aim of the present article is to give an overview on the assessment and comparison of risks and benefits associated with BM and IF consumption. To date, this intensively debated subject has been mainly investigated. It has been shown that both diets could be sources of beneficial health effects in terms of nutrition and also risks in terms of chemical safety. Moreover, microbiologists have demonstrated that IF consumption can cause illness due to product contamination or inappropriate milk preparation. The article concludes on the bottlenecks and gaps that should be investigated to further progress the quantification of the impact of early diet on infant health. Performing a multi-disciplinary risk-benefit assessment with DALY as endpoint might be a future option to help prioritize management options.