Melamine contamination: the
short- and long-term impacts
on infants and children
Jessi Peretti
January 18, 2012
Oregon Health & Science University
Presentation Outline
During this presentation we will:
• Discuss the history of melamine, its chemical
properties, and current uses
• Review the melamine poisoning scandal from
2008
• Evaluate the research surrounding the
implications for infants and children poisoned
with melamine, as well as the mechanism
behind the illnesses associated with the
toxicity
• Discuss our role as dietitians
Think about the recent food safety issues
over the last few years in the United
States….
On a scale of 1 to 5, 1 being not at all confident and
5 being extremely confident -
How confident are you that what you purchase
at the grocery store is safe?
How confident are you that our government is
doing all they can to ensure that the products
we consume are safe?
Melamine
• Organic base
• Trimer of cyanide
• Typically formed from
the dehydration of urea
• In industry is combined
with formaldehyde to
form a heat resistant,
scratch resistant plastic
sciencebuzz.or
g
3rd1000.com
tutorvista.com
Current Uses of Melamine
•Dry erase boards
•Counter tops
•Dishes
•Fertilizers
AND . . .
marlerblog.com
As a protein supplement in dog
food and infant formula?
professorshouse.com
Why melamine?
• Melamine is composed
of 66% nitrogen
• Can be added to
products to falsely
increase the protein
content
Chinese Melamine Scandal
• September 11, 2008 Sanlu, the largest
milk producer in China, recalled 10,000
tons of infant formula tainted with
melamine
• 21 other companies found to have
contaminated milk
• Speculated that companies first
reported contamination in early July
1. Garcia Lopez FJ, Quereda C. Melamine toxicity: one more culprit in calcium
kidney lithiasis. Kidney Int 2011;80:694-6.
Sanlu Milk Powder and Upper
Limits
Sanlu’s milk powder contained:
• 2.56 g/kg of melamine
Other brands contained:
• .090 - 619 mg/kg
Upper limit set by WHO in 2007
• .2 mg/kg/day
– FDA
• .63 mg/kg/day
Press conference on testing melamine in baby milk formul, the ministry of
health of the People’s Repubilc of china, September 17, 2008.
http://www.moh.gov.cn/publicfiles/business/htmlfiles/mohbgt/s3582/20080
9/37917
Something to keep in
perspective…
This was not the first time infant formula
had been tampered with!
Exactly how big of an impact
can this have?
•
•
Use rate of infant formula is 98%
Fewer than 5% met Chinese and WHO target ranges for exclusive breastfeeding
until 6 months.
1. Qiu L, Binns CW, Zhao Y, Lee AH, Xie X. Breastfeeding practice in Zhejiang
province, PR China, in the context of melamine-contaminated formula milk. J
Health Popul Nutr 2010;28:189-98.
Chinese Melamine Scandal
• ~300,000 infants and children were ill
• ~ 52,000 infants and children were
hospitalized
• 6 children died
Symptoms of melamine
toxicity in children
•
•
•
•
Restlessness
Diarrhea
Hematuria
Hx of stone
passage*
• Renal Colic*
•
•
•
•
Acute kidney injury*
Oliguria
Anuria
Edema
NO SYMPTOMS AT ALL!
Hau AK, Kwan TH, Li PK. Melamine toxicity and the kidney. J Am Soc Nephrol
2009;20:245-50.
Shang P, Chang H, Yue ZJ, et al. Acute kidney injury caused by consumption
of melamine-contaminated infant formula in 47 children: a multiinstitutional experience in diagnosis, treatment and follow-up. Urol
Res 2011;
Variable
Conservative
Group
Intervention Group
303 (66)
156 (33)
105(65.6)
55 (34.4)
19 (4.1)
422 (91.9)
10 (6.3)
98 (61.3)
159 (34.6)
19 (4.1)
7 (1.5)
55 (34.4)
42 (26.3)
20 (12.5)
11.31  8.55
10.73  5.34
Gender
Male
Female
Medical History
Stone Passage
No presenting symptoms
Calculi location
Bilateral kidney
Bilateral ureter
Bladder
Contam inated formula
consum ption
Panfeng S, Hong C, Zhongjin Y, et al. Management of
Pediatric Urolithiasis Induced by Melaminecontaminated Powdered Formula (Report of 619
Cases). Urology 2011;78:411-6.
Kobayashi T, Okada A, Fujii Y, et al. The mechanism of renal stone
formation and renal failure induced by administration of melamine
and cyanuric acid. Urol Res 2010;38:117-25.
Human Studies
Kidney failure due to melamine toxicity
Sun et al 2009
• 25 children with urinary tract caliculi and
acute renal failure
• Ages 6-36 months
• Mean exposure of 9.5 months
Results
Results
• Renal functions impaired in all patients
• 44% of patients needed cystoscopy and
catherization
• 28% were dialysed
• 28% received fluids for 4-20 days
• At follow up at 3 months, 68% were
found to be free from stones
Conclusion
• Melamine tainted formula can cause
calculi
• Stones found in infants contain uric acid
and melamine rather than cyanuric acid
• All types of treatment were successful
Mechanism of Action
• Melamine is alkalescent
• When introduced to acid can form
cyanuric acid
www.sciencemadness.org/talk/files.php?pid=185660&aid=11296
Sun et al
• Cyanuric acid can decrease the body
fluid pH
• If pH is less than 5.5, uric acid can
accumulate leading to formation of
crystals
• Crystals block urine flow and increased
renal pressure
AKI
Sun et al
Concluded that:
• It is an obstruction of the renal tubules,
rather than a toxicity to the kidney itself,
that causes renal damage
We have clearly identified the short-term
impacts of this disaster, but what about
long-term?
Too soon to tell.
How did this happen?
• No one knows!
• Olympics
• No law indicating that you had to
reported chemicals used in dairy
products!
• Multiply government agencies at the
local and national level responsible
What was China’s response?
•
•
•
•
•
2 people received the death penalty
1 person on suspended death penalty
3 people sentenced to life in jail
3 people received 15 years in jail
7 government officials were fired or
resigned
• 13 people varied sentences.
http://www.chinadaily.com.cn/china/2009-01/23/content_7422983.htm
China’s Response
• In 2009, updated food safety laws
• Developed the National Food Safety
Commission
• Stricter penalties for intentional
tampering of food
• Laws related to pesticide use for
farmers
Impacts of the law
• Pork labeled as organic and being sold at a
higher price
– Closed 13 Walmarts for two weeks
– Fines of nearly $600,000
• China International Food Safety and Quality Conference
Impacts of the law…
• “Gutter oil”
• Pork contaminated with clenbuterol
http://www.economist.com/node/21534812
Now how confident are you?
What can we do as dietitians?
• Educate the public
• Encourage the purchase of local foods
• Help other countries incorporate
effective policy
• Acts as advocates and educators for the
importance of breastfeeding
DISCUSSION and
QUESTIONS