New recommended fluoride dietary intakes by infants and young children in Australia and New Zealand were recently published. The updated values are available online at Nutrient Reference Values for Australia and New Zealand.
This is a regular update – the Australian National Health and Medical research council advises these recommendations be reviewed every 5 years. But the new recommendations are interesting because the upper limit for fluoride intake for infants and young children is substantially higher than the previously recommended upper limit.
Public health policy in Australia and New Zealand aims to adjust fluoride intake at the population level to be high enough to prevent dental caries but low enough not to cause moderate or severe dental fluorosis or other adverse effects. But health professionals have noted an anomaly in recent years. Dietary intake of fluoride by children may exceed the previously recommended upper levels – even when community water fluoridation levels are within the recommended targets. Despite this the occurrence of moderate or severe dental fluorosis in Australia and New Zealand was rare.
This led to health authorities acknowledging that, for example, bottle-fed infants may sometimes exceed the upper limits for dietary fluoride intake – but still recommending this was harmless. Anti-fluoride activists misrepresented this advice by claiming health authorities were recommending that fluoridated water not be used for preparing formula for bottle feeding. Their claims are incorrect and alarmist. The “warning” simply provided advice that there was no risk of harm but the if parents were concerned they should occasionally use non-fluoridated water to make up baby formula.
In part, this current report is a response to that conundrum.
Why the change?
Anti-fluoride propagandists will no doubt attack this change. They have made capital out of the situation in the past by claiming that infants and young children are getting dangerous levels of fluoride in their diet. They, of course, ignore or hide the fact that despite this, levels of moderate and severe dental fluorosis have not been a problem. They, also misrepresent the situation regarding dental fluorosis and its causes – see Dental fluorosis: badly misrepresented by FANNZ and Water fluoridation and dental fluorosis – debunking some myths.
However, the expert working group who reviewed the literature and came up with the new recommendations did have their reasons. And these were more than just the absence of moderate and severe dental fluorosis.
They also concluded the previous recommendation was not consistent. This is because it was based on the US Environmental Protection Agency’s use of mean dietary intake and not the higher percentile fluoride intake which should have been used for the upper limit.
Consequently, their recommendation for the upper limit of fluoride intake for children up to 8 years of age is 0.20 mg F/kg bw/day (kg bw = kg body weight). The previous limit was 0.1 F/kg/ bw/day. This produces the following upper limits for children of different ages.
In Australia and New Zealand, the estimated upper range of total daily fluoride intake for different age groups ranges from 0.09to 0.16 mg F/kg bw/day – considerably lower than the new recommended upper limit of 0.2 mg F/kg bw/day.
Will anti-fluoride campaigners top claiming that bottle-fed infants consume dangerous levels of fluoride if their formula is made with fluoridated water?
And the rest of us should not longer make the concession that intake levels are above the recommended upper limits – because they aren’t.
Featured image: Parents need no longer be concerned about using fluoridated water for baby formula. Photo credit: Life insurance for your heirs