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However, there has been growing concern about heavy metal contamination, especially arsenic, in these commonly used thickeners. This is a particular concern in infants who may be more susceptible to heavy metal neurotoxicity. The study aimed to assess whether there are differences in heavy metal levels, particularly arsenic, in infants with reflux or oropharyngeal dysphagia while on different thickeners. We performed a single center study in infants (&lt;\u20091 year of age) with diagnosis of reflux or oropharyngeal dysphagia who were seen between December 2021\u20132023. Participants submitted urine samples and completed dietary questionnaires to assess their elemental exposures. The primary outcome of interest was urinary arsenic concentrations, though other elements were also measured. Of the 56 infants, 27 were on gelmix<jats:sup>\u00ae<\/jats:sup> or purees, 19 were on Enfamil AR and 10 were on infant oatmeal\/rice cereal as a thickener. The median total urinary arsenic concentration did not differ between groups (<jats:italic>p<\/jats:italic>\u2009=\u20090.086) and levels between groups were well below the Agency for Toxic Substances and Disease Registry (ATSDR)\u2019s toxicity limits. Infants with higher number of servings of alternative arsenic sources via their solid food were more likely to have higher urinary arsenic level (<jats:italic>p<\/jats:italic>\u2009=\u20090.001), suggesting a potential need for the FDA to implement stricter food supply regulations. Only molybdenum had significant difference in levels between thickeners (<jats:italic>p<\/jats:italic>\u2009=\u20090.0012). Even in high-risk patients, urinary arsenic concentrations did not differ between thickener groups.<\/jats:p>","DOI":"10.1038\/s41598-025-98768-5","type":"journal-article","created":{"date-parts":[[2025,4,23]],"date-time":"2025-04-23T07:35:03Z","timestamp":1745393703000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Heavy metal exposures in aerodigestive clinic cohort of infants with reflux or dysphagia"],"prefix":"10.1038","volume":"15","author":[{"given":"Nan","family":"Du","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maritha","family":"Du","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tracy","family":"Punshon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachel","family":"Rosen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,4,23]]},"reference":[{"issue":"7","key":"98768_CR1","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1007\/s11894-019-0697-2","volume":"21","author":"DR Duncan","year":"2019","unstructured":"Duncan, D. R., Larson, K. & Rosen, R. L. Clinical aspects of thickeners for pediatric gastroesophageal reflux and oropharyngeal dysphagia. Curr. Gastroenterol. Rep. 21(7), 30 (2019).","journal-title":"Curr. Gastroenterol. Rep."},{"key":"98768_CR2","unstructured":"Subcommitee on Economic and Consumer Policy. Baby foods are tainted with dangerous levels of arsenic, lead, cadmium and mercury. In: Committee on Oversight and Reform of US House of Representativies, Washington (2021). https:\/\/oversightdemocrats.house.gov\/sites\/evo-subsites\/democrats-oversight.house.gov\/files\/2021-02-04%20ECP%20Baby%20Food%20Staff%20Report.pdf. Accessed March 31, 2025."},{"issue":"1","key":"98768_CR3","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1007\/s12403-022-00489-x","volume":"15","author":"AJ Signes-Pastor","year":"2023","unstructured":"Signes-Pastor, A. J. et al. Dietary exposure to essential and non-essential elements during infants\u2019 first year of life in the new Hampshire birth cohort study. Expo Health 15(1), 269\u2013279 (2023).","journal-title":"Expo Health"},{"key":"98768_CR4","unstructured":"Loria, K. Are There Still Heavy Metals in Baby Food? Consumer Reports [Internet] (2023). https:\/\/www.consumerreports.org\/babies-kids\/baby-food\/are-heavy-metal-levels-in-baby-foods-getting-better-a1163977621\/. Accessed March 31, 2025."},{"key":"98768_CR5","doi-asserted-by":"publisher","first-page":"919913","DOI":"10.3389\/fnut.2022.919913","volume":"9","author":"EC Bair","year":"2022","unstructured":"Bair, E. C. A narrative review of toxic heavy metal content of infant and toddler foods and evaluation of united States policy. Front. Nutr. 9, 919913 (2022).","journal-title":"Front. Nutr."},{"key":"98768_CR6","doi-asserted-by":"crossref","unstructured":"Rodriguez-Barranco, M. et al. Association of arsenic, cadmium and manganese exposure with neurodevelopment and behavioural disorders in children: A systematic review and meta-analysis. Sci. Total Environ. 454\u2013455, 562\u2013577 (2013).","DOI":"10.1016\/j.scitotenv.2013.03.047"},{"key":"98768_CR7","unstructured":"World Health Organization. Preventing Disease Through Healthy Environments: Exposure to Arsenic: A Major Public Health Concern (World Health Organization, 2019). https:\/\/www.who.int\/publications\/i\/item\/WHO-CED-PHE-EPE-19.4.1. Accessed March 31, 2025."},{"issue":"2","key":"98768_CR8","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1111\/j.1742-7843.2007.00168.x","volume":"102","author":"M Vahter","year":"2008","unstructured":"Vahter, M. Health effects of early life exposure to arsenic. Basic. Clin. Pharmacol. Toxicol. 102(2), 204\u2013211 (2008).","journal-title":"Basic. Clin. Pharmacol. 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