# Evaluation of Mineral Content in Preterm Human Milk and Infant Formulas in Qatar: Assessing Compliance With Dietary Recommendations and Label Accuracy

## TL;DR

This study found that preterm human milk and infant formulas in Qatar often lack essential minerals like zinc, iron, and copper, with labels sometimes overestimating their content.

## Contribution

The study provides a first-of-its-kind mineral content evaluation of preterm human milk and infant formulas in Qatar, highlighting label inaccuracies and nutrient deficiencies.

## Key findings

- Zinc and iron levels in all human milk and infant formula samples were below ASPEN recommendations.
- Copper was below recommended levels in 96% of human milk and 95% of infant formulas.
- Infant formulas significantly exceeded manganese recommendations and had higher manganese, zinc, and iron than human milk.

## Abstract

Preterm infants have higher energy and nutrient needs compared to term infants, with human milk recommended as the primary feeding choice and infant formula as the secondary option. This study aimed to evaluate the concentration of essential trace minerals (manganese, copper, iron, and zinc) in preterm human milk and infant formulas in Qatar, and assess their nutrition label accuracy and compliance with nutritional requirements. Mineral analysis was performed using Inductively Coupled Plasma Mass Spectrometry (ICP‐MS). Samples included 50 liquid human milk samples from lactating mothers of preterm infants, 42 powder infant formulas from local markets and pharmacies, and 10 water samples commonly used in Qatar. All human milk and infant formulas were below the recommended zinc and iron ranges as per the American Society for Parenteral and Enteral Nutrition (ASPEN). Additionally, 96% (48/50) of human milk and 95% (40/42) of infant formulas were below the recommended copper range. Furthermore, 34% (17/50) of human milk samples for manganese were below the recommended range, whereas 86% (36/42) of infant formulas exceeded it. Water samples showed mineral levels below detection limits, and thus had no contribution to mineral levels in reconstituted formulas. Significant differences were found between label and laboratory‐tested values for copper (p = 0.0039) and zinc (p = 0.0000), with label values higher than laboratory results. No significant differences were observed for manganese (p = 0.7564) or iron (p = 0.1966). Reconstituted formulas had significantly higher manganese, zinc, and iron laboratory levels (p < 0.001) than human milk, whereas copper showed no significant difference (p = 0.324). These findings highlight mineral imbalances in both human milk and infant formulas for preterm infants, demonstrating the need for human milk fortifiers, improved nutrient formulation, accurate labeling, and further research to ensure optimal health outcomes.

Zinc and iron concentrations were below ASPEN recommendations in all human milk and formula samples. Copper was below the recommendations in 96% of human milk and 95% of formula, whereas manganese was below recommendations in 34% of human milk and exceeded them in 86% of formula samples. Labels overestimated zinc and copper compared to lab results; no differences were found for manganese or iron. Reconstituted formulas had higher manganese, zinc, and iron than human milk, whereas copper levels were similar.