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Occurrence of fluoride in breast milk: a worldwide systematic literature review and human health risk assessment by Monte Carlo simulation.Abstract
Original abstract online at
https://www.tandfonline.com/doi/full/10.1080/09603123.2026.2616406
HIGHLIGHTS
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Of 1394 breast milk samples evaluated for fluoride levels, 36.8% exceeded the EFSA guideline (100 µg/L).
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HQ value surpassed the exposure limit for one-month-old infants in 7 out of 19 cases (36.8%)
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The overall mean fluoride level in 1394 breast milk samples worldwide was 256.7 ± 256.9 µg/L, much higher than the EFSA guideline.
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The 95th percentile for the HQ factor was 1.05, higher than the acceptable level.
Fluoride is recognized for its dental health benefits; however, excessive intake during infancy may pose risks such as dental fluorosis. This review evaluated fluoride levels in breast milk (BrM), influencing factors, and potential health effects in infants. The methodology involved searching PubMed, Scopus, Web of Science, IranDoc, Science Direct, and Google Scholar for studies published from 1974 to 2025. The search strategy included Medical Subject Headings (MeSH) terms and free-text keywords – such as “fluoride,” “breast milk,” “breastfeeding,” ‘human,“and “level,” along with other relevant terms – combined with Boolean operators (AND/OR) for a comprehensive literature search. Inclusion criteria: peer-reviewed studies with original data on fluoride in BrM. Exclusion criteria: informal reports, reviews, and studies without primary data. Of the 204 records, 9 studies were included in the final analysis. Lacking raw data, values were re-simulated in Excel (2016) using mean, standard deviation, and sample size. Results showed that the mean fluoride in BrM met the European Food Safety Authority (EFSA) guideline (100 µg/L) in 12 of 19 cases (63.2%), with 36.8% outside this range. The health risk assessment showed that, for one-month-old infants, the hazard quotient (HQ) exceeded the permissible limit (HQ = 1) in 7 of 19 cases (36.8%).
Plain language summary
Of 1394 breast milk samples evaluated for fluoride levels, 36.8% exceeded the EFSA guideline (100 µg/L). HQ value surpassed the exposure limit for one-month-old infants in 7 out of 19 cases (36.8%).
The overall mean fluoride level in 1394 breast milk samples worldwide was 256.7 ± 256.9 µg/L, much higher than the EFSA guideline.
The 95th percentile for the HQ factor was 1.05, higher than the acceptable level.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Author Affiliations
• Hamed Soleimani and Masoud Moradi, Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
• Abdullah Khalid Omer, Smart Health Tower, Sulaymaniyah, Kurdistan, Iraq.
• Amir Kiani, Regenerative Medicine Research Center (RMRC), Kermanshah University of Medical Sciences, Kermanshah, Iran. And, Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
, Social Development and Health Promotion Research Center, Health Policy and Promotion Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
• GDepartment of Environmental Health Engineering, School of Public Health, Zabol University of Medical Sciences, Zabol, Iran.
Substance Abuse Prevention Research Center, Research Institute for Health, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Author contribution statement
Hamed Soliemani, Abdullah Khalid Omer, Masoud Moradi, Ali Almasi, and Tooraj Massahi: data collection, writing original draft, writing, review, and editing. Amir Kiani, Borhan Mansouri, and Gholamreza Ebrahimzadeh: visualization, validation, writing, review, and editing. Kiomars Sharafi: conceptualization, supervision, visualization, validation, writing, review, and editing.
Data availability statement
The authors confirm that the data supporting the findings of this study are available within the article.
Declaration of generative AI and AI-assisted technologies in the writing process
During the preparation of this work, the authors used Grammarly to proofread the article. After using Grammarly, the authors reviewed and edited the content as needed and took full responsibility for the publication’s content.
Ethics declarations
This article does not contain any studies involving animals or human participants performed by any of the authors. No ethical approval is required.
Additional information
Funding
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